CDM or Payer Name,Product Type,Codes,Code Type,Description,NDC,Rate Type,Standard Charge
Aetna,HMO,0054T,CPT4/HCPCS,BONE SRGRY CMPTR FLUOR IMAGE,,Case Rate,2427.00
Aetna,HMO,0055T,CPT4/HCPCS,BONE SRGRY CMPTR CT/MRI IMAG,,Case Rate,2427.00
Aetna,HMO,0085T,CPT4/HCPCS,BREATH TEST HEART REJECT,,Fee Schedule,10876.15
Aetna,HMO,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Grouper Rate,7830.00
Aetna,HMO,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Grouper Rate,5856.00
Aetna,HMO,0191T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,5856.00
Aetna,HMO,0207T,CPT4/HCPCS,CLEAR EYELID GLAND W/HEAT,,Grouper Rate,2002.00
Aetna,HMO,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,2002.00
Aetna,HMO,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,2002.00
Aetna,HMO,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,2002.00
Aetna,HMO,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Grouper Rate,6840.00
Aetna,HMO,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Grouper Rate,2002.00
Aetna,HMO,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,2002.00
Aetna,HMO,0229T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,2002.00
Aetna,HMO,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,2002.00
Aetna,HMO,0231T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,2002.00
Aetna,HMO,0232T,CPT4/HCPCS,NJX PLATELET PLASMA,,Grouper Rate,2002.00
Aetna,HMO,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Grouper Rate,5856.00
Aetna,HMO,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Grouper Rate,5856.00
Aetna,HMO,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Grouper Rate,5856.00
Aetna,HMO,0290T,CPT4/HCPCS,LASER INC FOR PKP/LKP RECIP,,Grouper Rate,2002.00
Aetna,HMO,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Grouper Rate,3656.00
Aetna,HMO,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Grouper Rate,5856.00
Aetna,HMO,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Grouper Rate,3656.00
Aetna,HMO,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Grouper Rate,5856.00
Aetna,HMO,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Grouper Rate,5856.00
Aetna,HMO,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Grouper Rate,5856.00
Aetna,HMO,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,0347T,CPT4/HCPCS,INS BONE DEVICE FOR RSA,,Grouper Rate,3656.00
Aetna,HMO,0354T,CPT4/HCPCS,OCT BREAST SURG CAVITY I&R,,Fee Schedule,56.11
Aetna,HMO,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,2002.00
Aetna,HMO,0396T,CPT4/HCPCS,INTRAOP KINETIC BALNCE SENSR,,Grouper Rate,2002.00
Aetna,HMO,0397T,CPT4/HCPCS,ERCP W/OPTICAL ENDOMICROSCPY,,Grouper Rate,2002.00
Aetna,HMO,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Grouper Rate,2002.00
Aetna,HMO,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Grouper Rate,6840.00
Aetna,HMO,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Grouper Rate,7830.00
Aetna,HMO,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Grouper Rate,7830.00
Aetna,HMO,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Grouper Rate,6401.00
Aetna,HMO,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Grouper Rate,6401.00
Aetna,HMO,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Grouper Rate,5856.00
Aetna,HMO,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Grouper Rate,5856.00
Aetna,HMO,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Grouper Rate,7830.00
Aetna,HMO,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Grouper Rate,3656.00
Aetna,HMO,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Grouper Rate,3656.00
Aetna,HMO,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,2002.00
Aetna,HMO,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,2002.00
Aetna,HMO,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Grouper Rate,3656.00
Aetna,HMO,0424T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA COMPL,,Grouper Rate,5856.00
Aetna,HMO,0425T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA SEN LD,,Grouper Rate,3656.00
Aetna,HMO,0426T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA STM LD,,Grouper Rate,3656.00
Aetna,HMO,0427T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA PLS GN,,Grouper Rate,3656.00
Aetna,HMO,0428T,CPT4/HCPCS,RMVL NSTIM APNEA PLS GEN,,Grouper Rate,3656.00
Aetna,HMO,0429T,CPT4/HCPCS,RMVL NSTIM APNEA SEN LD,,Grouper Rate,3656.00
Aetna,HMO,0430T,CPT4/HCPCS,RMVL NSTIM APNEA STIMJ LD,,Grouper Rate,3656.00
Aetna,HMO,0431T,CPT4/HCPCS,RMVL/RPLC NSTIM APNEA PLS GN,,Grouper Rate,5856.00
Aetna,HMO,0432T,CPT4/HCPCS,REPOS NSTIM APNEA STIMJ LD,,Grouper Rate,3656.00
Aetna,HMO,0433T,CPT4/HCPCS,REPOS NSTIM APNEA SENSING LD,,Grouper Rate,3656.00
Aetna,HMO,0437T,CPT4/HCPCS,IMPLTJ SYNTH RNFCMT ABDL WAL,,Grouper Rate,2002.00
Aetna,HMO,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Grouper Rate,2002.00
Aetna,HMO,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Grouper Rate,2002.00
Aetna,HMO,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Grouper Rate,3656.00
Aetna,HMO,0444T,CPT4/HCPCS,1ST PLMT DRUG ELUT OC INS,,Grouper Rate,5856.00
Aetna,HMO,0445T,CPT4/HCPCS,SBSQT PLMT DRUG ELUT OC INS,,Grouper Rate,5856.00
Aetna,HMO,0446T,CPT4/HCPCS,INSJ IMPLTBL GLUCOSE SENSOR,,Grouper Rate,3656.00
Aetna,HMO,0447T,CPT4/HCPCS,RMVL IMPLTBL GLUCOSE SENSOR,,Grouper Rate,2002.00
Aetna,HMO,0448T,CPT4/HCPCS,REMVL INSJ IMPLTBL GLUC SENS,,Grouper Rate,3656.00
Aetna,HMO,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Grouper Rate,5856.00
Aetna,HMO,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Grouper Rate,2002.00
Aetna,HMO,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Grouper Rate,6401.00
Aetna,HMO,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Grouper Rate,6401.00
Aetna,HMO,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Grouper Rate,5856.00
Aetna,HMO,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Grouper Rate,5856.00
Aetna,HMO,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Grouper Rate,5856.00
Aetna,HMO,0466T,CPT4/HCPCS,INSJ CH WAL RESPIR ELTRD/RA,,Grouper Rate,2002.00
Aetna,HMO,0467T,CPT4/HCPCS,REVJ/RPLMNT CH RESPIR ELTRD,,Grouper Rate,2002.00
Aetna,HMO,0468T,CPT4/HCPCS,RMVL CH WAL RESPIR ELTRD/RA,,Grouper Rate,2002.00
Aetna,HMO,0474T,CPT4/HCPCS,INSJ AQUEOUS DRG DEV IO RSVR,,Grouper Rate,5856.00
Aetna,HMO,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Grouper Rate,2002.00
Aetna,HMO,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Grouper Rate,2002.00
Aetna,HMO,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Grouper Rate,2002.00
Aetna,HMO,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Grouper Rate,2002.00
Aetna,HMO,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Grouper Rate,2002.00
Aetna,HMO,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Grouper Rate,2002.00
Aetna,HMO,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Grouper Rate,2002.00
Aetna,HMO,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Grouper Rate,5856.00
Aetna,HMO,0505T,CPT4/HCPCS,EV FEMPOP ARTL REVSC,,Grouper Rate,6401.00
Aetna,HMO,0510T,CPT4/HCPCS,RMVL SINUS TARSI IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,0511T,CPT4/HCPCS,RMVL&RINSJ SINUS TARSI IMPLT,,Grouper Rate,5856.00
Aetna,HMO,0515T,CPT4/HCPCS,INSJ WCS LV COMPL SYS,,Grouper Rate,6401.00
Aetna,HMO,0516T,CPT4/HCPCS,INSJ WCS LV ELTRD ONLY,,Grouper Rate,6401.00
Aetna,HMO,0517T,CPT4/HCPCS,INSJ WCS LV PG COMPNT,,Grouper Rate,6401.00
Aetna,HMO,0518T,CPT4/HCPCS,RMVL PG COMPNT WCS,,Grouper Rate,6401.00
Aetna,HMO,0519T,CPT4/HCPCS,RMVL & RPLCMT PG COMPNT WCS,,Grouper Rate,6401.00
Aetna,HMO,0520T,CPT4/HCPCS,RMVL&RPLCMT PG WCS NEW ELTRD,,Grouper Rate,6401.00
Aetna,HMO,0524T,CPT4/HCPCS,EV CATH DIR CHEM ABLTJ W/IMG,,Grouper Rate,5856.00
Aetna,HMO,0525T,CPT4/HCPCS,INSJ/RPLCMT COMPL IIMS,,Grouper Rate,8797.00
Aetna,HMO,0526T,CPT4/HCPCS,INSJ/RPLCMT IIMS ELTRD ONLY,,Grouper Rate,6401.00
Aetna,HMO,0527T,CPT4/HCPCS,INSJ/RPLCMT IIMS IMPLT MNTR,,Grouper Rate,6401.00
Aetna,HMO,0530T,CPT4/HCPCS,REMOVAL COMPLETE IIMS,,Grouper Rate,5856.00
Aetna,HMO,0531T,CPT4/HCPCS,REMOVAL IIMS ELECTRODE ONLY,,Grouper Rate,5856.00
Aetna,HMO,0532T,CPT4/HCPCS,REMOVAL IIMS IMPLT MNTR ONLY,,Grouper Rate,5856.00
Aetna,HMO,0547T,CPT4/HCPCS,B1 MATRL QUAL TST MCRIND TIB,,Grouper Rate,2002.00
Aetna,HMO,0548T,CPT4/HCPCS,TPRNL BALO CNTNC DEV BI,,Grouper Rate,6401.00
Aetna,HMO,0549T,CPT4/HCPCS,TPRNL BALO CNTNC DEV UNI,,Grouper Rate,5856.00
Aetna,HMO,0550T,CPT4/HCPCS,TPRNL BALO CNTNC DEV RMVL EA,,Grouper Rate,3656.00
Aetna,HMO,0551T,CPT4/HCPCS,TPRNL BALO CNTNC DEV ADJMT,,Grouper Rate,2002.00
Aetna,HMO,0553T,CPT4/HCPCS,PERQ TCAT ILIAC ANAST IMPLT,,Grouper Rate,7188.00
Aetna,HMO,0563T,CPT4/HCPCS,EVAC MEIBOMIAN GLND HEAT BI,,Grouper Rate,2002.00
Aetna,HMO,0565T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS HRVG,,Grouper Rate,5856.00
Aetna,HMO,0566T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS NJX,,Grouper Rate,2002.00
Aetna,HMO,0567T,CPT4/HCPCS,PERM FLP TUBE OCCLS W/IMPLT,,Grouper Rate,5856.00
Aetna,HMO,0568T,CPT4/HCPCS,INTRO MIX SALINE&AIR F/SSG,,Grouper Rate,2002.00
Aetna,HMO,0571T,CPT4/HCPCS,INSJ/RPLCMT ICDS SS ELTRD,,Grouper Rate,7830.00
Aetna,HMO,0572T,CPT4/HCPCS,INSERTION SS DFB ELECTRODE,,Grouper Rate,5856.00
Aetna,HMO,0573T,CPT4/HCPCS,REMOVAL SS DFB ELECTRODE,,Grouper Rate,5856.00
Aetna,HMO,0574T,CPT4/HCPCS,REPOS PREV SS IMPL DFB ELTRD,,Grouper Rate,5856.00
Aetna,HMO,0580T,CPT4/HCPCS,RMVL SS IMPL DFB PG ONLY,,Grouper Rate,5856.00
Aetna,HMO,0581T,CPT4/HCPCS,ABLTJ MAL BRST TUM PERQ CRTX,,Grouper Rate,6401.00
Aetna,HMO,0582T,CPT4/HCPCS,TRURL ABLTJ MAL PRST8 TISS,,Grouper Rate,3656.00
Aetna,HMO,0583T,CPT4/HCPCS,TMPST AUTO TUBE DLVR SYS,,Grouper Rate,5856.00
Aetna,HMO,0587T,CPT4/HCPCS,PERQ IMPLTJ/RPLCMT ISDNS PTN,,Grouper Rate,2002.00
Aetna,HMO,0588T,CPT4/HCPCS,REVISION/REMOVAL ISDNS PTN,,Grouper Rate,2002.00
Aetna,HMO,10004,CPT4/HCPCS,FNA BX W/O IMG GDN EA ADDL,,Grouper Rate,2002.00
Aetna,HMO,10005,CPT4/HCPCS,FNA BX W/US GDN 1ST LES,,Grouper Rate,2002.00
Aetna,HMO,10006,CPT4/HCPCS,FNA BX W/US GDN EA ADDL,,Grouper Rate,2002.00
Aetna,HMO,10007,CPT4/HCPCS,FNA BX W/FLUOR GDN 1ST LES,,Grouper Rate,2002.00
Aetna,HMO,10008,CPT4/HCPCS,FNA BX W/FLUOR GDN EA ADDL,,Grouper Rate,2002.00
Aetna,HMO,10009,CPT4/HCPCS,FNA BX W/CT GDN 1ST LES,,Grouper Rate,2002.00
Aetna,HMO,10010,CPT4/HCPCS,FNA BX W/CT GDN EA ADDL,,Grouper Rate,2002.00
Aetna,HMO,10011,CPT4/HCPCS,FNA BX W/MR GDN 1ST LES,,Grouper Rate,2002.00
Aetna,HMO,10012,CPT4/HCPCS,FNA BX W/MR GDN EA ADDL,,Grouper Rate,2002.00
Aetna,HMO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Grouper Rate,2002.00
Aetna,HMO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Grouper Rate,3656.00
Aetna,HMO,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Grouper Rate,3656.00
Aetna,HMO,10036,CPT4/HCPCS,PERQ DEV SOFT TISS ADD IMAG,,Grouper Rate,2002.00
Aetna,HMO,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,10061,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,10080,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,2002.00
Aetna,HMO,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,2002.00
Aetna,HMO,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,2002.00
Aetna,HMO,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,3656.00
Aetna,HMO,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Grouper Rate,2002.00
Aetna,HMO,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Grouper Rate,2002.00
Aetna,HMO,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Grouper Rate,3656.00
Aetna,HMO,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Grouper Rate,2002.00
Aetna,HMO,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Grouper Rate,3656.00
Aetna,HMO,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Grouper Rate,3656.00
Aetna,HMO,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Grouper Rate,3656.00
Aetna,HMO,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Grouper Rate,3656.00
Aetna,HMO,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Grouper Rate,3656.00
Aetna,HMO,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Grouper Rate,3656.00
Aetna,HMO,11045,CPT4/HCPCS,DEB SUBQ TISSUE ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,11046,CPT4/HCPCS,DEB MUSC/FASCIA ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,11047,CPT4/HCPCS,DEB BONE ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,11055,CPT4/HCPCS,TRIM SKIN LESION,,Grouper Rate,2002.00
Aetna,HMO,11056,CPT4/HCPCS,TRIM SKIN LESIONS 2 TO 4,,Grouper Rate,2002.00
Aetna,HMO,11057,CPT4/HCPCS,TRIM SKIN LESIONS OVER 4,,Grouper Rate,2002.00
Aetna,HMO,11102,CPT4/HCPCS,TANGNTL BX SKIN SINGLE LES,,Grouper Rate,2002.00
Aetna,HMO,11103,CPT4/HCPCS,TANGNTL BX SKIN EA SEP/ADDL,,Grouper Rate,2002.00
Aetna,HMO,11104,CPT4/HCPCS,PUNCH BX SKIN SINGLE LESION,,Grouper Rate,2002.00
Aetna,HMO,11105,CPT4/HCPCS,PUNCH BX SKIN EA SEP/ADDL,,Grouper Rate,2002.00
Aetna,HMO,11106,CPT4/HCPCS,INCAL BX SKN SINGLE LES,,Grouper Rate,2002.00
Aetna,HMO,11107,CPT4/HCPCS,INCAL BX SKN EA SEP/ADDL,,Grouper Rate,2002.00
Aetna,HMO,11200,CPT4/HCPCS,REMOVAL OF SKIN TAGS 4.0 CM,,Grouper Rate,3656.00
Aetna,HMO,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Grouper Rate,3656.00
Aetna,HMO,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Grouper Rate,3656.00
Aetna,HMO,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Grouper Rate,2002.00
Aetna,HMO,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Grouper Rate,2002.00
Aetna,HMO,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Grouper Rate,3656.00
Aetna,HMO,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Grouper Rate,3656.00
Aetna,HMO,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Grouper Rate,3656.00
Aetna,HMO,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Grouper Rate,3656.00
Aetna,HMO,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Grouper Rate,2002.00
Aetna,HMO,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Grouper Rate,2002.00
Aetna,HMO,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Grouper Rate,2002.00
Aetna,HMO,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Grouper Rate,3656.00
Aetna,HMO,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,HMO,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,HMO,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,HMO,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,HMO,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,HMO,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,HMO,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Grouper Rate,2002.00
Aetna,HMO,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Grouper Rate,2002.00
Aetna,HMO,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Grouper Rate,2002.00
Aetna,HMO,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Grouper Rate,2002.00
Aetna,HMO,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Grouper Rate,3656.00
Aetna,HMO,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Grouper Rate,3656.00
Aetna,HMO,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Grouper Rate,2002.00
Aetna,HMO,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Grouper Rate,2002.00
Aetna,HMO,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Grouper Rate,2002.00
Aetna,HMO,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Grouper Rate,2002.00
Aetna,HMO,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Grouper Rate,3656.00
Aetna,HMO,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Grouper Rate,3656.00
Aetna,HMO,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Grouper Rate,3656.00
Aetna,HMO,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Grouper Rate,3656.00
Aetna,HMO,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Grouper Rate,3656.00
Aetna,HMO,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Grouper Rate,3656.00
Aetna,HMO,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Grouper Rate,3656.00
Aetna,HMO,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Grouper Rate,3656.00
Aetna,HMO,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Grouper Rate,2002.00
Aetna,HMO,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Grouper Rate,2002.00
Aetna,HMO,11730,CPT4/HCPCS,REMOVAL OF NAIL PLATE,,Grouper Rate,2002.00
Aetna,HMO,11732,CPT4/HCPCS,REMOVE NAIL PLATE ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,11740,CPT4/HCPCS,DRAIN BLOOD FROM UNDER NAIL,,Grouper Rate,2002.00
Aetna,HMO,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Grouper Rate,2002.00
Aetna,HMO,11755,CPT4/HCPCS,BIOPSY NAIL UNIT,,Grouper Rate,2002.00
Aetna,HMO,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Grouper Rate,2002.00
Aetna,HMO,11762,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED,,Grouper Rate,3656.00
Aetna,HMO,11765,CPT4/HCPCS,EXCISION OF NAIL FOLD TOE,,Grouper Rate,2002.00
Aetna,HMO,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Grouper Rate,5856.00
Aetna,HMO,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Grouper Rate,5856.00
Aetna,HMO,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Grouper Rate,5856.00
Aetna,HMO,11900,CPT4/HCPCS,INJECT SKIN LESIONS 7,,Grouper Rate,2002.00
Aetna,HMO,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Grouper Rate,2002.00
Aetna,HMO,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Grouper Rate,2002.00
Aetna,HMO,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Grouper Rate,2002.00
Aetna,HMO,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Grouper Rate,3656.00
Aetna,HMO,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Grouper Rate,5856.00
Aetna,HMO,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Grouper Rate,2002.00
Aetna,HMO,11976,CPT4/HCPCS,REMOVE CONTRACEPTIVE CAPSULE,,Grouper Rate,2002.00
Aetna,HMO,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Grouper Rate,2002.00
Aetna,HMO,11981,CPT4/HCPCS,INSERT DRUG IMPLANT DEVICE,,Grouper Rate,2002.00
Aetna,HMO,11982,CPT4/HCPCS,REMOVE DRUG IMPLANT DEVICE,,Grouper Rate,2002.00
Aetna,HMO,11983,CPT4/HCPCS,REMOVE/INSERT DRUG IMPLANT,,Grouper Rate,2002.00
Aetna,HMO,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Grouper Rate,2002.00
Aetna,HMO,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Grouper Rate,2002.00
Aetna,HMO,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Grouper Rate,3656.00
Aetna,HMO,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Grouper Rate,3656.00
Aetna,HMO,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Grouper Rate,3656.00
Aetna,HMO,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Grouper Rate,2002.00
Aetna,HMO,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Grouper Rate,2002.00
Aetna,HMO,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Grouper Rate,3656.00
Aetna,HMO,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Grouper Rate,3656.00
Aetna,HMO,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Grouper Rate,3656.00
Aetna,HMO,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,2002.00
Aetna,HMO,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,2002.00
Aetna,HMO,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Grouper Rate,2002.00
Aetna,HMO,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Grouper Rate,2002.00
Aetna,HMO,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Grouper Rate,3656.00
Aetna,HMO,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Grouper Rate,3656.00
Aetna,HMO,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Grouper Rate,3656.00
Aetna,HMO,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Grouper Rate,3656.00
Aetna,HMO,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Grouper Rate,2002.00
Aetna,HMO,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Grouper Rate,2002.00
Aetna,HMO,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Grouper Rate,3656.00
Aetna,HMO,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Grouper Rate,3656.00
Aetna,HMO,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Grouper Rate,3656.00
Aetna,HMO,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Grouper Rate,3656.00
Aetna,HMO,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Grouper Rate,2002.00
Aetna,HMO,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Grouper Rate,2002.00
Aetna,HMO,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Grouper Rate,2002.00
Aetna,HMO,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Grouper Rate,3656.00
Aetna,HMO,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Grouper Rate,3656.00
Aetna,HMO,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Grouper Rate,3656.00
Aetna,HMO,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Grouper Rate,3656.00
Aetna,HMO,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Grouper Rate,3656.00
Aetna,HMO,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Grouper Rate,5856.00
Aetna,HMO,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Grouper Rate,2002.00
Aetna,HMO,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Grouper Rate,3656.00
Aetna,HMO,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Grouper Rate,5856.00
Aetna,HMO,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Grouper Rate,2002.00
Aetna,HMO,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,3656.00
Aetna,HMO,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,5856.00
Aetna,HMO,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,2002.00
Aetna,HMO,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Grouper Rate,5856.00
Aetna,HMO,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Grouper Rate,5856.00
Aetna,HMO,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Grouper Rate,5856.00
Aetna,HMO,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Grouper Rate,3656.00
Aetna,HMO,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Grouper Rate,3656.00
Aetna,HMO,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Grouper Rate,5856.00
Aetna,HMO,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Grouper Rate,5856.00
Aetna,HMO,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Grouper Rate,5856.00
Aetna,HMO,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,3656.00
Aetna,HMO,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,5856.00
Aetna,HMO,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Grouper Rate,5856.00
Aetna,HMO,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Grouper Rate,5856.00
Aetna,HMO,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Grouper Rate,5856.00
Aetna,HMO,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Grouper Rate,2002.00
Aetna,HMO,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Grouper Rate,5856.00
Aetna,HMO,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Grouper Rate,3656.00
Aetna,HMO,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Grouper Rate,2002.00
Aetna,HMO,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Grouper Rate,3656.00
Aetna,HMO,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Grouper Rate,2002.00
Aetna,HMO,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Grouper Rate,3656.00
Aetna,HMO,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Grouper Rate,3656.00
Aetna,HMO,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Grouper Rate,3656.00
Aetna,HMO,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Grouper Rate,5856.00
Aetna,HMO,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Grouper Rate,3656.00
Aetna,HMO,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Grouper Rate,3656.00
Aetna,HMO,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Grouper Rate,2002.00
Aetna,HMO,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Grouper Rate,3656.00
Aetna,HMO,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Grouper Rate,5856.00
Aetna,HMO,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Grouper Rate,3656.00
Aetna,HMO,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Grouper Rate,3656.00
Aetna,HMO,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Grouper Rate,2002.00
Aetna,HMO,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Grouper Rate,3656.00
Aetna,HMO,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Grouper Rate,2002.00
Aetna,HMO,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Grouper Rate,2002.00
Aetna,HMO,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Grouper Rate,3656.00
Aetna,HMO,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Grouper Rate,2002.00
Aetna,HMO,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Grouper Rate,2002.00
Aetna,HMO,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Grouper Rate,5856.00
Aetna,HMO,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Grouper Rate,3656.00
Aetna,HMO,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Grouper Rate,3656.00
Aetna,HMO,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,3656.00
Aetna,HMO,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Grouper Rate,5856.00
Aetna,HMO,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,5856.00
Aetna,HMO,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Grouper Rate,3656.00
Aetna,HMO,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,3656.00
Aetna,HMO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Grouper Rate,3656.00
Aetna,HMO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Grouper Rate,3656.00
Aetna,HMO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Grouper Rate,2002.00
Aetna,HMO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Grouper Rate,3656.00
Aetna,HMO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Grouper Rate,2002.00
Aetna,HMO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Grouper Rate,3656.00
Aetna,HMO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Grouper Rate,2002.00
Aetna,HMO,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Grouper Rate,5856.00
Aetna,HMO,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Grouper Rate,5856.00
Aetna,HMO,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Grouper Rate,5856.00
Aetna,HMO,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Grouper Rate,5856.00
Aetna,HMO,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Grouper Rate,5856.00
Aetna,HMO,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Grouper Rate,5856.00
Aetna,HMO,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Grouper Rate,6401.00
Aetna,HMO,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Grouper Rate,5856.00
Aetna,HMO,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Grouper Rate,6840.00
Aetna,HMO,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Grouper Rate,5856.00
Aetna,HMO,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Grouper Rate,5856.00
Aetna,HMO,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Grouper Rate,5856.00
Aetna,HMO,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Grouper Rate,5856.00
Aetna,HMO,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Grouper Rate,5856.00
Aetna,HMO,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Grouper Rate,5856.00
Aetna,HMO,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Grouper Rate,3656.00
Aetna,HMO,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Grouper Rate,3656.00
Aetna,HMO,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Grouper Rate,5856.00
Aetna,HMO,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Grouper Rate,5856.00
Aetna,HMO,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Grouper Rate,5856.00
Aetna,HMO,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Grouper Rate,3656.00
Aetna,HMO,15769,CPT4/HCPCS,GRFG AUTOL SOFT TISS DIR EXC,,Grouper Rate,6401.00
Aetna,HMO,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Grouper Rate,5856.00
Aetna,HMO,15771,CPT4/HCPCS,GRFG AUTOL FAT LIPO 50 CC/<,,Grouper Rate,6401.00
Aetna,HMO,15772,CPT4/HCPCS,GRFG AUTOL FAT LIPO EA ADDL,,Grouper Rate,2002.00
Aetna,HMO,15773,CPT4/HCPCS,GRFG AUTOL FAT LIPO 25 CC/<,,Grouper Rate,3656.00
Aetna,HMO,15774,CPT4/HCPCS,GFRG AUTOL FAT LIPO EA ADDL,,Grouper Rate,2002.00
Aetna,HMO,15775,CPT4/HCPCS,HAIR TRNSPL 1-15 PUNCH GRFTS,,Grouper Rate,5856.00
Aetna,HMO,15776,CPT4/HCPCS,HAIR TRNSPL >15 PUNCH GRAFTS,,Grouper Rate,5856.00
Aetna,HMO,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,Grouper Rate,2002.00
Aetna,HMO,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Grouper Rate,3656.00
Aetna,HMO,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,5856.00
Aetna,HMO,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,5856.00
Aetna,HMO,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,5856.00
Aetna,HMO,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,6840.00
Aetna,HMO,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Grouper Rate,5856.00
Aetna,HMO,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Grouper Rate,5856.00
Aetna,HMO,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Grouper Rate,5856.00
Aetna,HMO,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Grouper Rate,5856.00
Aetna,HMO,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Grouper Rate,6840.00
Aetna,HMO,15830,CPT4/HCPCS,EXC SKIN ABD,,Grouper Rate,5856.00
Aetna,HMO,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Grouper Rate,5856.00
Aetna,HMO,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Grouper Rate,5856.00
Aetna,HMO,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Grouper Rate,5856.00
Aetna,HMO,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Grouper Rate,5856.00
Aetna,HMO,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Grouper Rate,5856.00
Aetna,HMO,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Grouper Rate,3656.00
Aetna,HMO,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Grouper Rate,3656.00
Aetna,HMO,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Grouper Rate,5856.00
Aetna,HMO,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Grouper Rate,6401.00
Aetna,HMO,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Grouper Rate,6401.00
Aetna,HMO,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Grouper Rate,6401.00
Aetna,HMO,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Grouper Rate,6401.00
Aetna,HMO,15847,CPT4/HCPCS,EXC SKIN ABD ADD-ON,,Grouper Rate,5856.00
Aetna,HMO,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Grouper Rate,2002.00
Aetna,HMO,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Grouper Rate,2002.00
Aetna,HMO,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Grouper Rate,2002.00
Aetna,HMO,15860,CPT4/HCPCS,TEST FOR BLOOD FLOW IN GRAFT,,Grouper Rate,2002.00
Aetna,HMO,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Grouper Rate,5856.00
Aetna,HMO,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Grouper Rate,5856.00
Aetna,HMO,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Grouper Rate,5856.00
Aetna,HMO,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Grouper Rate,5856.00
Aetna,HMO,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,5856.00
Aetna,HMO,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,6401.00
Aetna,HMO,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5856.00
Aetna,HMO,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5856.00
Aetna,HMO,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5856.00
Aetna,HMO,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,6401.00
Aetna,HMO,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,6401.00
Aetna,HMO,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,6401.00
Aetna,HMO,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5856.00
Aetna,HMO,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5856.00
Aetna,HMO,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5856.00
Aetna,HMO,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,6401.00
Aetna,HMO,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,6401.00
Aetna,HMO,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5856.00
Aetna,HMO,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,6401.00
Aetna,HMO,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5856.00
Aetna,HMO,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,6401.00
Aetna,HMO,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5856.00
Aetna,HMO,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,6401.00
Aetna,HMO,16020,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN S,,Grouper Rate,2002.00
Aetna,HMO,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Grouper Rate,3656.00
Aetna,HMO,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Grouper Rate,3656.00
Aetna,HMO,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Grouper Rate,3656.00
Aetna,HMO,17000,CPT4/HCPCS,DESTRUCT PREMALG LESION,,Grouper Rate,2002.00
Aetna,HMO,17003,CPT4/HCPCS,DESTRUCT PREMALG LES 2-14,,Grouper Rate,2002.00
Aetna,HMO,17004,CPT4/HCPCS,DESTROY PREMAL LESIONS 15/>,,Grouper Rate,2002.00
Aetna,HMO,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17110,CPT4/HCPCS,DESTRUCT B9 LESION 1-14,,Grouper Rate,2002.00
Aetna,HMO,17111,CPT4/HCPCS,DESTRUCT LESION 15 OR MORE,,Grouper Rate,2002.00
Aetna,HMO,17250,CPT4/HCPCS,CHEM CAUT OF GRANLTJ TISSUE,,Grouper Rate,2002.00
Aetna,HMO,17260,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17261,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17262,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17263,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17264,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17266,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,3656.00
Aetna,HMO,17270,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17271,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17272,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17273,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17274,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17276,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,3656.00
Aetna,HMO,17280,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17281,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17282,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17283,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17284,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,HMO,17286,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,3656.00
Aetna,HMO,17311,CPT4/HCPCS,MOHS 1 STAGE H/N/HF/G,,Grouper Rate,3656.00
Aetna,HMO,17312,CPT4/HCPCS,MOHS ADDL STAGE,,Grouper Rate,2002.00
Aetna,HMO,17313,CPT4/HCPCS,MOHS 1 STAGE T/A/L,,Grouper Rate,3656.00
Aetna,HMO,17314,CPT4/HCPCS,MOHS ADDL STAGE T/A/L,,Grouper Rate,2002.00
Aetna,HMO,17315,CPT4/HCPCS,MOHS SURG ADDL BLOCK,,Grouper Rate,2002.00
Aetna,HMO,17999,CPT4/HCPCS,SKIN TISSUE PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Grouper Rate,2002.00
Aetna,HMO,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Grouper Rate,3656.00
Aetna,HMO,19030,CPT4/HCPCS,INJECTION FOR BREAST X-RAY,,Grouper Rate,2002.00
Aetna,HMO,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Grouper Rate,3656.00
Aetna,HMO,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,Grouper Rate,2002.00
Aetna,HMO,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Grouper Rate,3656.00
Aetna,HMO,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,Grouper Rate,2002.00
Aetna,HMO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Grouper Rate,5856.00
Aetna,HMO,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,Grouper Rate,2002.00
Aetna,HMO,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Grouper Rate,2002.00
Aetna,HMO,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Grouper Rate,3656.00
Aetna,HMO,19105,CPT4/HCPCS,CRYOSURG ABLATE FA EACH,,Grouper Rate,6401.00
Aetna,HMO,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Grouper Rate,3656.00
Aetna,HMO,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Grouper Rate,5856.00
Aetna,HMO,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Grouper Rate,5856.00
Aetna,HMO,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Grouper Rate,5856.00
Aetna,HMO,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Grouper Rate,5856.00
Aetna,HMO,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,Grouper Rate,3656.00
Aetna,HMO,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,Grouper Rate,2002.00
Aetna,HMO,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,Grouper Rate,3656.00
Aetna,HMO,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,Grouper Rate,2002.00
Aetna,HMO,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,Grouper Rate,3656.00
Aetna,HMO,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,Grouper Rate,2002.00
Aetna,HMO,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,Grouper Rate,5856.00
Aetna,HMO,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,Grouper Rate,2002.00
Aetna,HMO,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Grouper Rate,2002.00
Aetna,HMO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Grouper Rate,9770.00
Aetna,HMO,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Grouper Rate,9770.00
Aetna,HMO,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Grouper Rate,7188.00
Aetna,HMO,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Grouper Rate,6401.00
Aetna,HMO,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Grouper Rate,5856.00
Aetna,HMO,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Grouper Rate,7830.00
Aetna,HMO,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Grouper Rate,6401.00
Aetna,HMO,19307,CPT4/HCPCS,MAST MOD RAD,,Grouper Rate,6840.00
Aetna,HMO,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Grouper Rate,6401.00
Aetna,HMO,19318,CPT4/HCPCS,BREAST REDUCTION,,Grouper Rate,6401.00
Aetna,HMO,19324,CPT4/HCPCS,ENLARGE BREAST,,Grouper Rate,6401.00
Aetna,HMO,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Grouper Rate,9770.00
Aetna,HMO,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Grouper Rate,2002.00
Aetna,HMO,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Grouper Rate,2002.00
Aetna,HMO,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Grouper Rate,3656.00
Aetna,HMO,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Grouper Rate,5856.00
Aetna,HMO,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,6401.00
Aetna,HMO,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Grouper Rate,6401.00
Aetna,HMO,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Grouper Rate,6840.00
Aetna,HMO,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Grouper Rate,6840.00
Aetna,HMO,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,6840.00
Aetna,HMO,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Grouper Rate,6401.00
Aetna,HMO,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Grouper Rate,6401.00
Aetna,HMO,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Grouper Rate,6840.00
Aetna,HMO,19396,CPT4/HCPCS,DESIGN CUSTOM BREAST IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,19499,CPT4/HCPCS,BREAST SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Grouper Rate,2002.00
Aetna,HMO,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Grouper Rate,3656.00
Aetna,HMO,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Grouper Rate,5856.00
Aetna,HMO,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Grouper Rate,2002.00
Aetna,HMO,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,2002.00
Aetna,HMO,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,3656.00
Aetna,HMO,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Grouper Rate,3656.00
Aetna,HMO,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Grouper Rate,5856.00
Aetna,HMO,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,5856.00
Aetna,HMO,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,5856.00
Aetna,HMO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Grouper Rate,2002.00
Aetna,HMO,20501,CPT4/HCPCS,INJECT SINUS TRACT FOR X-RAY,,Grouper Rate,2002.00
Aetna,HMO,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,3656.00
Aetna,HMO,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,5856.00
Aetna,HMO,20526,CPT4/HCPCS,THER INJECTION CARP TUNNEL,,Grouper Rate,2002.00
Aetna,HMO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Grouper Rate,2002.00
Aetna,HMO,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Grouper Rate,2002.00
Aetna,HMO,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Grouper Rate,2002.00
Aetna,HMO,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Grouper Rate,2002.00
Aetna,HMO,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Grouper Rate,2002.00
Aetna,HMO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Grouper Rate,2002.00
Aetna,HMO,20560,CPT4/HCPCS,NDL INSJ W/O NJX 1 OR 2 MUSC,,Grouper Rate,2002.00
Aetna,HMO,20561,CPT4/HCPCS,NDL INSJ W/O NJX 3+ MUSC,,Grouper Rate,2002.00
Aetna,HMO,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,2002.00
Aetna,HMO,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,2002.00
Aetna,HMO,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,2002.00
Aetna,HMO,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,2002.00
Aetna,HMO,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,2002.00
Aetna,HMO,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,2002.00
Aetna,HMO,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Grouper Rate,2002.00
Aetna,HMO,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Grouper Rate,2002.00
Aetna,HMO,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Grouper Rate,5856.00
Aetna,HMO,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Grouper Rate,3656.00
Aetna,HMO,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Grouper Rate,5856.00
Aetna,HMO,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Grouper Rate,5856.00
Aetna,HMO,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Grouper Rate,5856.00
Aetna,HMO,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Grouper Rate,2002.00
Aetna,HMO,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,2002.00
Aetna,HMO,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,3656.00
Aetna,HMO,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,5856.00
Aetna,HMO,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Grouper Rate,5856.00
Aetna,HMO,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Grouper Rate,2002.00
Aetna,HMO,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Grouper Rate,5856.00
Aetna,HMO,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Grouper Rate,5856.00
Aetna,HMO,20700,CPT4/HCPCS,MNL PREP&INSJ DP RX DLVR DEV,,Grouper Rate,2002.00
Aetna,HMO,20701,CPT4/HCPCS,RMVL DEEP RX DELIVERY DEVICE,,Grouper Rate,2002.00
Aetna,HMO,20702,CPT4/HCPCS,MNL PREP&INSJ IMED RX DEV,,Grouper Rate,2002.00
Aetna,HMO,20703,CPT4/HCPCS,RMVL IMED RX DELIVERY DEVICE,,Grouper Rate,2002.00
Aetna,HMO,20704,CPT4/HCPCS,MNL PREP&INSJ I-ARTIC RX DEV,,Grouper Rate,2002.00
Aetna,HMO,20705,CPT4/HCPCS,RMVL I-ARTIC RX DELIVERY DEV,,Grouper Rate,2002.00
Aetna,HMO,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,5856.00
Aetna,HMO,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,6401.00
Aetna,HMO,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,5856.00
Aetna,HMO,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,5856.00
Aetna,HMO,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,6401.00
Aetna,HMO,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,5856.00
Aetna,HMO,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Grouper Rate,6401.00
Aetna,HMO,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,20932,CPT4/HCPCS,OSTEOART ALGRFT W/SURF & B1,,Grouper Rate,2002.00
Aetna,HMO,20933,CPT4/HCPCS,HEMICRT INTRCLRY ALGRFT PRTL,,Grouper Rate,2002.00
Aetna,HMO,20934,CPT4/HCPCS,INTERCALARY ALGRFT COMPL,,Grouper Rate,2002.00
Aetna,HMO,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Grouper Rate,2002.00
Aetna,HMO,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Grouper Rate,2002.00
Aetna,HMO,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Grouper Rate,6401.00
Aetna,HMO,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Grouper Rate,6401.00
Aetna,HMO,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Grouper Rate,6401.00
Aetna,HMO,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Grouper Rate,6401.00
Aetna,HMO,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Grouper Rate,6401.00
Aetna,HMO,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Grouper Rate,6401.00
Aetna,HMO,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Grouper Rate,3656.00
Aetna,HMO,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,2002.00
Aetna,HMO,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,3656.00
Aetna,HMO,20985,CPT4/HCPCS,CPTR-ASST DIR MS PX,,Grouper Rate,2002.00
Aetna,HMO,20999,CPT4/HCPCS,MUSCULOSKELETAL SURGERY,,Grouper Rate,2002.00
Aetna,HMO,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Grouper Rate,3656.00
Aetna,HMO,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Grouper Rate,2002.00
Aetna,HMO,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Grouper Rate,2002.00
Aetna,HMO,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Grouper Rate,2002.00
Aetna,HMO,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Grouper Rate,2002.00
Aetna,HMO,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Grouper Rate,5856.00
Aetna,HMO,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Grouper Rate,3656.00
Aetna,HMO,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Grouper Rate,3656.00
Aetna,HMO,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Grouper Rate,3656.00
Aetna,HMO,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Grouper Rate,3656.00
Aetna,HMO,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Grouper Rate,2002.00
Aetna,HMO,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Grouper Rate,2002.00
Aetna,HMO,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Grouper Rate,5856.00
Aetna,HMO,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Grouper Rate,3656.00
Aetna,HMO,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Grouper Rate,3656.00
Aetna,HMO,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Grouper Rate,3656.00
Aetna,HMO,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Grouper Rate,3656.00
Aetna,HMO,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Grouper Rate,3656.00
Aetna,HMO,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Grouper Rate,5856.00
Aetna,HMO,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Grouper Rate,3656.00
Aetna,HMO,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Grouper Rate,5856.00
Aetna,HMO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Grouper Rate,2002.00
Aetna,HMO,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Grouper Rate,3656.00
Aetna,HMO,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Grouper Rate,2002.00
Aetna,HMO,21116,CPT4/HCPCS,INJECTION JAW JOINT X-RAY,,Grouper Rate,2002.00
Aetna,HMO,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,7830.00
Aetna,HMO,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,7830.00
Aetna,HMO,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,7830.00
Aetna,HMO,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,7830.00
Aetna,HMO,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,7830.00
Aetna,HMO,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,7188.00
Aetna,HMO,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5856.00
Aetna,HMO,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5856.00
Aetna,HMO,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Grouper Rate,6401.00
Aetna,HMO,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Grouper Rate,6401.00
Aetna,HMO,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Grouper Rate,6401.00
Aetna,HMO,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,6840.00
Aetna,HMO,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,6840.00
Aetna,HMO,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Grouper Rate,7830.00
Aetna,HMO,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Grouper Rate,6840.00
Aetna,HMO,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Grouper Rate,6840.00
Aetna,HMO,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Grouper Rate,5856.00
Aetna,HMO,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Grouper Rate,6840.00
Aetna,HMO,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Grouper Rate,6840.00
Aetna,HMO,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Grouper Rate,7830.00
Aetna,HMO,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Grouper Rate,6840.00
Aetna,HMO,21210,CPT4/HCPCS,FACE BONE GRAFT,,Grouper Rate,7830.00
Aetna,HMO,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Grouper Rate,7830.00
Aetna,HMO,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Grouper Rate,7830.00
Aetna,HMO,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Grouper Rate,7830.00
Aetna,HMO,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,6401.00
Aetna,HMO,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,6840.00
Aetna,HMO,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,6840.00
Aetna,HMO,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Grouper Rate,7830.00
Aetna,HMO,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,7830.00
Aetna,HMO,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,7830.00
Aetna,HMO,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,7830.00
Aetna,HMO,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,7830.00
Aetna,HMO,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,7830.00
Aetna,HMO,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Grouper Rate,6840.00
Aetna,HMO,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Grouper Rate,7830.00
Aetna,HMO,21280,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,6840.00
Aetna,HMO,21282,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,6840.00
Aetna,HMO,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,2002.00
Aetna,HMO,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,2002.00
Aetna,HMO,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Grouper Rate,3656.00
Aetna,HMO,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Grouper Rate,3656.00
Aetna,HMO,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Grouper Rate,3656.00
Aetna,HMO,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Grouper Rate,6401.00
Aetna,HMO,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Grouper Rate,6840.00
Aetna,HMO,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Grouper Rate,7830.00
Aetna,HMO,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Grouper Rate,6401.00
Aetna,HMO,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Grouper Rate,3656.00
Aetna,HMO,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Grouper Rate,6401.00
Aetna,HMO,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Grouper Rate,6840.00
Aetna,HMO,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Grouper Rate,6401.00
Aetna,HMO,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Grouper Rate,6840.00
Aetna,HMO,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Grouper Rate,7830.00
Aetna,HMO,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Grouper Rate,7830.00
Aetna,HMO,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Grouper Rate,6401.00
Aetna,HMO,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Grouper Rate,6840.00
Aetna,HMO,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Grouper Rate,7188.00
Aetna,HMO,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Grouper Rate,5856.00
Aetna,HMO,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Grouper Rate,6840.00
Aetna,HMO,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Grouper Rate,7188.00
Aetna,HMO,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Grouper Rate,6840.00
Aetna,HMO,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Grouper Rate,6840.00
Aetna,HMO,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Grouper Rate,6840.00
Aetna,HMO,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Grouper Rate,7830.00
Aetna,HMO,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Grouper Rate,7830.00
Aetna,HMO,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Grouper Rate,3656.00
Aetna,HMO,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Grouper Rate,5856.00
Aetna,HMO,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Grouper Rate,6401.00
Aetna,HMO,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Grouper Rate,6840.00
Aetna,HMO,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,6840.00
Aetna,HMO,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6840.00
Aetna,HMO,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6840.00
Aetna,HMO,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6840.00
Aetna,HMO,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,2002.00
Aetna,HMO,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,3656.00
Aetna,HMO,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Grouper Rate,5856.00
Aetna,HMO,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Grouper Rate,3656.00
Aetna,HMO,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Grouper Rate,3656.00
Aetna,HMO,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Grouper Rate,3656.00
Aetna,HMO,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Grouper Rate,2002.00
Aetna,HMO,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,HMO,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Grouper Rate,3656.00
Aetna,HMO,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Grouper Rate,3656.00
Aetna,HMO,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,3656.00
Aetna,HMO,21601,CPT4/HCPCS,EXC CHEST WALL TUMOR W/RIBS,,Grouper Rate,6840.00
Aetna,HMO,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,3656.00
Aetna,HMO,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Grouper Rate,3656.00
Aetna,HMO,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Grouper Rate,3656.00
Aetna,HMO,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,3656.00
Aetna,HMO,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,5856.00
Aetna,HMO,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,5856.00
Aetna,HMO,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Grouper Rate,6401.00
Aetna,HMO,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Grouper Rate,7188.00
Aetna,HMO,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Grouper Rate,7188.00
Aetna,HMO,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Grouper Rate,5856.00
Aetna,HMO,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,2002.00
Aetna,HMO,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,3656.00
Aetna,HMO,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,HMO,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Grouper Rate,3656.00
Aetna,HMO,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Grouper Rate,5856.00
Aetna,HMO,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,5856.00
Aetna,HMO,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,5856.00
Aetna,HMO,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,5856.00
Aetna,HMO,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,5856.00
Aetna,HMO,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Grouper Rate,2002.00
Aetna,HMO,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Grouper Rate,3656.00
Aetna,HMO,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Grouper Rate,3656.00
Aetna,HMO,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Grouper Rate,3656.00
Aetna,HMO,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Grouper Rate,5856.00
Aetna,HMO,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Grouper Rate,3656.00
Aetna,HMO,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Grouper Rate,9770.00
Aetna,HMO,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Grouper Rate,9770.00
Aetna,HMO,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Grouper Rate,2002.00
Aetna,HMO,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,5856.00
Aetna,HMO,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,5856.00
Aetna,HMO,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,2002.00
Aetna,HMO,22526,CPT4/HCPCS,IDET SINGLE LEVEL,,Grouper Rate,5856.00
Aetna,HMO,22527,CPT4/HCPCS,IDET 1 OR MORE LEVELS,,Grouper Rate,5856.00
Aetna,HMO,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Grouper Rate,7188.00
Aetna,HMO,22552,CPT4/HCPCS,ADDL NECK SPINE FUSION,,Grouper Rate,2002.00
Aetna,HMO,22554,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,7188.00
Aetna,HMO,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,7188.00
Aetna,HMO,22614,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,2002.00
Aetna,HMO,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,2002.00
Aetna,HMO,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,2002.00
Aetna,HMO,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,2002.00
Aetna,HMO,22853,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,2002.00
Aetna,HMO,22854,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,2002.00
Aetna,HMO,22856,CPT4/HCPCS,CERV ARTIFIC DISKECTOMY,,Grouper Rate,7188.00
Aetna,HMO,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Grouper Rate,2002.00
Aetna,HMO,22859,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,2002.00
Aetna,HMO,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,6840.00
Aetna,HMO,22868,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,2002.00
Aetna,HMO,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,3656.00
Aetna,HMO,22870,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,2002.00
Aetna,HMO,22899,CPT4/HCPCS,SPINE SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Grouper Rate,6401.00
Aetna,HMO,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,HMO,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Grouper Rate,3656.00
Aetna,HMO,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,22999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Grouper Rate,3656.00
Aetna,HMO,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Grouper Rate,3656.00
Aetna,HMO,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Grouper Rate,2002.00
Aetna,HMO,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Grouper Rate,5856.00
Aetna,HMO,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,5856.00
Aetna,HMO,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,6401.00
Aetna,HMO,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,2002.00
Aetna,HMO,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,3656.00
Aetna,HMO,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,HMO,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Grouper Rate,3656.00
Aetna,HMO,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Grouper Rate,5856.00
Aetna,HMO,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Grouper Rate,3656.00
Aetna,HMO,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Grouper Rate,7830.00
Aetna,HMO,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Grouper Rate,6401.00
Aetna,HMO,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Grouper Rate,6401.00
Aetna,HMO,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Grouper Rate,6401.00
Aetna,HMO,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Grouper Rate,6840.00
Aetna,HMO,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Grouper Rate,6840.00
Aetna,HMO,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Grouper Rate,6840.00
Aetna,HMO,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,6401.00
Aetna,HMO,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,6840.00
Aetna,HMO,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,6840.00
Aetna,HMO,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,6401.00
Aetna,HMO,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,6840.00
Aetna,HMO,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,6840.00
Aetna,HMO,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,3656.00
Aetna,HMO,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,3656.00
Aetna,HMO,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,6401.00
Aetna,HMO,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,6401.00
Aetna,HMO,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,6401.00
Aetna,HMO,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Grouper Rate,6401.00
Aetna,HMO,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Grouper Rate,6840.00
Aetna,HMO,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,2002.00
Aetna,HMO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Grouper Rate,3656.00
Aetna,HMO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,5856.00
Aetna,HMO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,6401.00
Aetna,HMO,23350,CPT4/HCPCS,INJECTION FOR SHOULDER X-RAY,,Grouper Rate,2002.00
Aetna,HMO,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Grouper Rate,6840.00
Aetna,HMO,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Grouper Rate,7830.00
Aetna,HMO,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Grouper Rate,7830.00
Aetna,HMO,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Grouper Rate,3656.00
Aetna,HMO,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Grouper Rate,3656.00
Aetna,HMO,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Grouper Rate,6840.00
Aetna,HMO,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Grouper Rate,7830.00
Aetna,HMO,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Grouper Rate,6840.00
Aetna,HMO,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Grouper Rate,7830.00
Aetna,HMO,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Grouper Rate,6401.00
Aetna,HMO,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Grouper Rate,6401.00
Aetna,HMO,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6840.00
Aetna,HMO,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,7830.00
Aetna,HMO,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6840.00
Aetna,HMO,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,7830.00
Aetna,HMO,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6840.00
Aetna,HMO,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,7830.00
Aetna,HMO,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,6840.00
Aetna,HMO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,6840.00
Aetna,HMO,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,6401.00
Aetna,HMO,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,7830.00
Aetna,HMO,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Grouper Rate,5856.00
Aetna,HMO,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Grouper Rate,5856.00
Aetna,HMO,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,6401.00
Aetna,HMO,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,6401.00
Aetna,HMO,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,2002.00
Aetna,HMO,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,2002.00
Aetna,HMO,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6840.00
Aetna,HMO,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Grouper Rate,2002.00
Aetna,HMO,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,6401.00
Aetna,HMO,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,7830.00
Aetna,HMO,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,HMO,23929,CPT4/HCPCS,SHOULDER SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Grouper Rate,2002.00
Aetna,HMO,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Grouper Rate,3656.00
Aetna,HMO,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Grouper Rate,6401.00
Aetna,HMO,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Grouper Rate,6401.00
Aetna,HMO,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,2002.00
Aetna,HMO,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,3656.00
Aetna,HMO,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,HMO,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Grouper Rate,3656.00
Aetna,HMO,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Grouper Rate,5856.00
Aetna,HMO,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Grouper Rate,2002.00
Aetna,HMO,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Grouper Rate,6401.00
Aetna,HMO,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Grouper Rate,6401.00
Aetna,HMO,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Grouper Rate,5856.00
Aetna,HMO,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,3656.00
Aetna,HMO,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Grouper Rate,5856.00
Aetna,HMO,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Grouper Rate,5856.00
Aetna,HMO,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Grouper Rate,5856.00
Aetna,HMO,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,5856.00
Aetna,HMO,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Grouper Rate,3656.00
Aetna,HMO,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Grouper Rate,6401.00
Aetna,HMO,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Grouper Rate,5856.00
Aetna,HMO,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Grouper Rate,5856.00
Aetna,HMO,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Grouper Rate,5856.00
Aetna,HMO,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Grouper Rate,3656.00
Aetna,HMO,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,3656.00
Aetna,HMO,24220,CPT4/HCPCS,INJECTION FOR ELBOW X-RAY,,Grouper Rate,2002.00
Aetna,HMO,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Grouper Rate,2002.00
Aetna,HMO,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Grouper Rate,6401.00
Aetna,HMO,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Grouper Rate,6401.00
Aetna,HMO,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Grouper Rate,5856.00
Aetna,HMO,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Grouper Rate,5856.00
Aetna,HMO,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,5856.00
Aetna,HMO,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,5856.00
Aetna,HMO,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Grouper Rate,3656.00
Aetna,HMO,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Grouper Rate,5856.00
Aetna,HMO,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Grouper Rate,5856.00
Aetna,HMO,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Grouper Rate,5856.00
Aetna,HMO,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Grouper Rate,6401.00
Aetna,HMO,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Grouper Rate,8797.00
Aetna,HMO,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Grouper Rate,3656.00
Aetna,HMO,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Grouper Rate,6401.00
Aetna,HMO,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Grouper Rate,5856.00
Aetna,HMO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Grouper Rate,5856.00
Aetna,HMO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Grouper Rate,5856.00
Aetna,HMO,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,6840.00
Aetna,HMO,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,6840.00
Aetna,HMO,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,6840.00
Aetna,HMO,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Grouper Rate,7830.00
Aetna,HMO,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,6840.00
Aetna,HMO,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,6840.00
Aetna,HMO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,6840.00
Aetna,HMO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,7830.00
Aetna,HMO,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,6401.00
Aetna,HMO,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,6401.00
Aetna,HMO,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5856.00
Aetna,HMO,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Grouper Rate,5856.00
Aetna,HMO,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Grouper Rate,6401.00
Aetna,HMO,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Grouper Rate,5856.00
Aetna,HMO,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Grouper Rate,3656.00
Aetna,HMO,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Grouper Rate,5856.00
Aetna,HMO,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6840.00
Aetna,HMO,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,6840.00
Aetna,HMO,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Grouper Rate,6401.00
Aetna,HMO,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Grouper Rate,6840.00
Aetna,HMO,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,HMO,24999,CPT4/HCPCS,UPPER ARM/ELBOW SURGERY,,Grouper Rate,2002.00
Aetna,HMO,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Grouper Rate,5856.00
Aetna,HMO,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Grouper Rate,2002.00
Aetna,HMO,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,5856.00
Aetna,HMO,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,5856.00
Aetna,HMO,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,5856.00
Aetna,HMO,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,5856.00
Aetna,HMO,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Grouper Rate,2002.00
Aetna,HMO,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Grouper Rate,3656.00
Aetna,HMO,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,6840.00
Aetna,HMO,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,2002.00
Aetna,HMO,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,3656.00
Aetna,HMO,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,HMO,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Grouper Rate,5856.00
Aetna,HMO,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Grouper Rate,5856.00
Aetna,HMO,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Grouper Rate,5856.00
Aetna,HMO,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Grouper Rate,5856.00
Aetna,HMO,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Grouper Rate,3656.00
Aetna,HMO,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,5856.00
Aetna,HMO,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,6401.00
Aetna,HMO,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Grouper Rate,5856.00
Aetna,HMO,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Grouper Rate,6401.00
Aetna,HMO,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,5856.00
Aetna,HMO,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,5856.00
Aetna,HMO,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Grouper Rate,6401.00
Aetna,HMO,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,6401.00
Aetna,HMO,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,6401.00
Aetna,HMO,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Grouper Rate,3656.00
Aetna,HMO,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,5856.00
Aetna,HMO,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Grouper Rate,5856.00
Aetna,HMO,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,5856.00
Aetna,HMO,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,5856.00
Aetna,HMO,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Grouper Rate,5856.00
Aetna,HMO,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,5856.00
Aetna,HMO,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,5856.00
Aetna,HMO,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,3656.00
Aetna,HMO,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,3656.00
Aetna,HMO,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Grouper Rate,5856.00
Aetna,HMO,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Grouper Rate,5856.00
Aetna,HMO,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Grouper Rate,6401.00
Aetna,HMO,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,6401.00
Aetna,HMO,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,6401.00
Aetna,HMO,25246,CPT4/HCPCS,INJECTION FOR WRIST X-RAY,,Grouper Rate,2002.00
Aetna,HMO,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Grouper Rate,3656.00
Aetna,HMO,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,2002.00
Aetna,HMO,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,2002.00
Aetna,HMO,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Grouper Rate,2002.00
Aetna,HMO,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,6401.00
Aetna,HMO,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,3656.00
Aetna,HMO,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5856.00
Aetna,HMO,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,6401.00
Aetna,HMO,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5856.00
Aetna,HMO,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,6401.00
Aetna,HMO,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Grouper Rate,6401.00
Aetna,HMO,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Grouper Rate,6401.00
Aetna,HMO,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Grouper Rate,5856.00
Aetna,HMO,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Grouper Rate,5856.00
Aetna,HMO,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,5856.00
Aetna,HMO,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,5856.00
Aetna,HMO,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,5856.00
Aetna,HMO,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,6401.00
Aetna,HMO,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,5856.00
Aetna,HMO,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,5856.00
Aetna,HMO,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Grouper Rate,5856.00
Aetna,HMO,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Grouper Rate,6840.00
Aetna,HMO,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Grouper Rate,5856.00
Aetna,HMO,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Grouper Rate,6840.00
Aetna,HMO,25350,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,5856.00
Aetna,HMO,25355,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,5856.00
Aetna,HMO,25360,CPT4/HCPCS,REVISION OF ULNA,,Grouper Rate,5856.00
Aetna,HMO,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,5856.00
Aetna,HMO,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Grouper Rate,5856.00
Aetna,HMO,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,6401.00
Aetna,HMO,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Grouper Rate,5856.00
Aetna,HMO,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Grouper Rate,6401.00
Aetna,HMO,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Grouper Rate,5856.00
Aetna,HMO,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Grouper Rate,6401.00
Aetna,HMO,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Grouper Rate,6840.00
Aetna,HMO,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Grouper Rate,5856.00
Aetna,HMO,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,6401.00
Aetna,HMO,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Grouper Rate,5856.00
Aetna,HMO,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,6401.00
Aetna,HMO,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,5856.00
Aetna,HMO,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,6401.00
Aetna,HMO,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Grouper Rate,5856.00
Aetna,HMO,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Grouper Rate,5856.00
Aetna,HMO,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Grouper Rate,6401.00
Aetna,HMO,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6840.00
Aetna,HMO,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6840.00
Aetna,HMO,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6840.00
Aetna,HMO,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6840.00
Aetna,HMO,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6840.00
Aetna,HMO,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Grouper Rate,7830.00
Aetna,HMO,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Grouper Rate,6840.00
Aetna,HMO,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Grouper Rate,6840.00
Aetna,HMO,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,5856.00
Aetna,HMO,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,5856.00
Aetna,HMO,25490,CPT4/HCPCS,REINFORCE RADIUS,,Grouper Rate,5856.00
Aetna,HMO,25491,CPT4/HCPCS,REINFORCE ULNA,,Grouper Rate,5856.00
Aetna,HMO,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Grouper Rate,5856.00
Aetna,HMO,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,2002.00
Aetna,HMO,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,2002.00
Aetna,HMO,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,5856.00
Aetna,HMO,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,2002.00
Aetna,HMO,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,6401.00
Aetna,HMO,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,6840.00
Aetna,HMO,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,2002.00
Aetna,HMO,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,2002.00
Aetna,HMO,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,5856.00
Aetna,HMO,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,2002.00
Aetna,HMO,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,3656.00
Aetna,HMO,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,5856.00
Aetna,HMO,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,5856.00
Aetna,HMO,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,2002.00
Aetna,HMO,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,5856.00
Aetna,HMO,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Grouper Rate,5856.00
Aetna,HMO,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Grouper Rate,6840.00
Aetna,HMO,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Grouper Rate,6840.00
Aetna,HMO,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Grouper Rate,6840.00
Aetna,HMO,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Grouper Rate,5856.00
Aetna,HMO,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Grouper Rate,6401.00
Aetna,HMO,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,6840.00
Aetna,HMO,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,6840.00
Aetna,HMO,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Grouper Rate,6401.00
Aetna,HMO,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Grouper Rate,6840.00
Aetna,HMO,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Grouper Rate,6840.00
Aetna,HMO,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,HMO,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,HMO,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,5856.00
Aetna,HMO,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,HMO,25999,CPT4/HCPCS,FOREARM OR WRIST SURGERY,,Grouper Rate,2002.00
Aetna,HMO,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Grouper Rate,3656.00
Aetna,HMO,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Grouper Rate,2002.00
Aetna,HMO,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Grouper Rate,3656.00
Aetna,HMO,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,6401.00
Aetna,HMO,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,6401.00
Aetna,HMO,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,6401.00
Aetna,HMO,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5856.00
Aetna,HMO,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Grouper Rate,3656.00
Aetna,HMO,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,3656.00
Aetna,HMO,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Grouper Rate,3656.00
Aetna,HMO,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,6401.00
Aetna,HMO,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,6401.00
Aetna,HMO,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Grouper Rate,3656.00
Aetna,HMO,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,2002.00
Aetna,HMO,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,2002.00
Aetna,HMO,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Grouper Rate,3656.00
Aetna,HMO,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Grouper Rate,3656.00
Aetna,HMO,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Grouper Rate,5856.00
Aetna,HMO,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,6401.00
Aetna,HMO,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,6401.00
Aetna,HMO,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,6401.00
Aetna,HMO,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,5856.00
Aetna,HMO,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,6401.00
Aetna,HMO,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,3656.00
Aetna,HMO,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Grouper Rate,5856.00
Aetna,HMO,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Grouper Rate,5856.00
Aetna,HMO,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Grouper Rate,5856.00
Aetna,HMO,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Grouper Rate,6401.00
Aetna,HMO,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Grouper Rate,3656.00
Aetna,HMO,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Grouper Rate,5856.00
Aetna,HMO,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Grouper Rate,7830.00
Aetna,HMO,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,5856.00
Aetna,HMO,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,5856.00
Aetna,HMO,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Grouper Rate,5856.00
Aetna,HMO,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Grouper Rate,5856.00
Aetna,HMO,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Grouper Rate,3656.00
Aetna,HMO,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Grouper Rate,3656.00
Aetna,HMO,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Grouper Rate,2002.00
Aetna,HMO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Grouper Rate,2002.00
Aetna,HMO,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,2002.00
Aetna,HMO,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,6401.00
Aetna,HMO,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,6401.00
Aetna,HMO,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,6401.00
Aetna,HMO,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,6401.00
Aetna,HMO,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,6401.00
Aetna,HMO,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,6401.00
Aetna,HMO,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5856.00
Aetna,HMO,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Grouper Rate,6401.00
Aetna,HMO,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5856.00
Aetna,HMO,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Grouper Rate,5856.00
Aetna,HMO,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5856.00
Aetna,HMO,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Grouper Rate,6401.00
Aetna,HMO,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,6401.00
Aetna,HMO,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,6401.00
Aetna,HMO,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5856.00
Aetna,HMO,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Grouper Rate,5856.00
Aetna,HMO,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Grouper Rate,5856.00
Aetna,HMO,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Grouper Rate,5856.00
Aetna,HMO,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Grouper Rate,5856.00
Aetna,HMO,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,3656.00
Aetna,HMO,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,3656.00
Aetna,HMO,26476,CPT4/HCPCS,TENDON LENGTHENING,,Grouper Rate,2002.00
Aetna,HMO,26477,CPT4/HCPCS,TENDON SHORTENING,,Grouper Rate,2002.00
Aetna,HMO,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Grouper Rate,2002.00
Aetna,HMO,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Grouper Rate,2002.00
Aetna,HMO,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Grouper Rate,5856.00
Aetna,HMO,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Grouper Rate,5856.00
Aetna,HMO,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Grouper Rate,3656.00
Aetna,HMO,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Grouper Rate,5856.00
Aetna,HMO,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,5856.00
Aetna,HMO,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Grouper Rate,5856.00
Aetna,HMO,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Grouper Rate,5856.00
Aetna,HMO,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,5856.00
Aetna,HMO,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,5856.00
Aetna,HMO,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,6401.00
Aetna,HMO,26499,CPT4/HCPCS,REVISION OF FINGER,,Grouper Rate,5856.00
Aetna,HMO,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,6401.00
Aetna,HMO,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,6401.00
Aetna,HMO,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Grouper Rate,5856.00
Aetna,HMO,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Grouper Rate,5856.00
Aetna,HMO,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Grouper Rate,2002.00
Aetna,HMO,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,5856.00
Aetna,HMO,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,5856.00
Aetna,HMO,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Grouper Rate,5856.00
Aetna,HMO,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Grouper Rate,5856.00
Aetna,HMO,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Grouper Rate,5856.00
Aetna,HMO,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Grouper Rate,7830.00
Aetna,HMO,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Grouper Rate,6840.00
Aetna,HMO,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Grouper Rate,6840.00
Aetna,HMO,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Grouper Rate,6401.00
Aetna,HMO,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,7830.00
Aetna,HMO,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,6401.00
Aetna,HMO,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,6401.00
Aetna,HMO,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Grouper Rate,6401.00
Aetna,HMO,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,6401.00
Aetna,HMO,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Grouper Rate,3656.00
Aetna,HMO,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Grouper Rate,6401.00
Aetna,HMO,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Grouper Rate,3656.00
Aetna,HMO,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Grouper Rate,3656.00
Aetna,HMO,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Grouper Rate,5856.00
Aetna,HMO,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,3656.00
Aetna,HMO,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,5856.00
Aetna,HMO,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,6401.00
Aetna,HMO,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Grouper Rate,6840.00
Aetna,HMO,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Grouper Rate,6840.00
Aetna,HMO,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Grouper Rate,5856.00
Aetna,HMO,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Grouper Rate,6840.00
Aetna,HMO,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Grouper Rate,6840.00
Aetna,HMO,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Grouper Rate,6840.00
Aetna,HMO,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Grouper Rate,5856.00
Aetna,HMO,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Grouper Rate,5856.00
Aetna,HMO,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Grouper Rate,3656.00
Aetna,HMO,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,6401.00
Aetna,HMO,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,2002.00
Aetna,HMO,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,3656.00
Aetna,HMO,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,7830.00
Aetna,HMO,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,6401.00
Aetna,HMO,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,2002.00
Aetna,HMO,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,3656.00
Aetna,HMO,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,6840.00
Aetna,HMO,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Grouper Rate,3656.00
Aetna,HMO,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,6401.00
Aetna,HMO,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,6840.00
Aetna,HMO,26841,CPT4/HCPCS,FUSION OF THUMB,,Grouper Rate,6401.00
Aetna,HMO,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,6401.00
Aetna,HMO,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Grouper Rate,5856.00
Aetna,HMO,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Grouper Rate,5856.00
Aetna,HMO,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Grouper Rate,6401.00
Aetna,HMO,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Grouper Rate,6401.00
Aetna,HMO,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Grouper Rate,5856.00
Aetna,HMO,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Grouper Rate,3656.00
Aetna,HMO,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Grouper Rate,6401.00
Aetna,HMO,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Grouper Rate,5856.00
Aetna,HMO,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Grouper Rate,5856.00
Aetna,HMO,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,3656.00
Aetna,HMO,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,6401.00
Aetna,HMO,26989,CPT4/HCPCS,HAND/FINGER SURGERY,,Grouper Rate,2002.00
Aetna,HMO,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Grouper Rate,2002.00
Aetna,HMO,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Grouper Rate,2002.00
Aetna,HMO,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3656.00
Aetna,HMO,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,5856.00
Aetna,HMO,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,5856.00
Aetna,HMO,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Grouper Rate,6401.00
Aetna,HMO,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Grouper Rate,3656.00
Aetna,HMO,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Grouper Rate,5856.00
Aetna,HMO,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Grouper Rate,5856.00
Aetna,HMO,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Grouper Rate,6401.00
Aetna,HMO,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,2002.00
Aetna,HMO,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,3656.00
Aetna,HMO,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,HMO,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Grouper Rate,5856.00
Aetna,HMO,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Grouper Rate,5856.00
Aetna,HMO,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Grouper Rate,5856.00
Aetna,HMO,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Grouper Rate,5856.00
Aetna,HMO,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Grouper Rate,3656.00
Aetna,HMO,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Grouper Rate,6840.00
Aetna,HMO,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Grouper Rate,6840.00
Aetna,HMO,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Grouper Rate,6840.00
Aetna,HMO,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Grouper Rate,6840.00
Aetna,HMO,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Grouper Rate,6840.00
Aetna,HMO,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Grouper Rate,3656.00
Aetna,HMO,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,2002.00
Aetna,HMO,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,5856.00
Aetna,HMO,27093,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,2002.00
Aetna,HMO,27095,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,2002.00
Aetna,HMO,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Grouper Rate,2002.00
Aetna,HMO,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Grouper Rate,5856.00
Aetna,HMO,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Grouper Rate,5856.00
Aetna,HMO,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Grouper Rate,6401.00
Aetna,HMO,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Grouper Rate,6401.00
Aetna,HMO,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,6401.00
Aetna,HMO,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,6401.00
Aetna,HMO,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,2002.00
Aetna,HMO,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,2002.00
Aetna,HMO,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,27267,CPT4/HCPCS,CLTX THIGH FX,,Grouper Rate,2002.00
Aetna,HMO,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,Grouper Rate,2002.00
Aetna,HMO,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Grouper Rate,3656.00
Aetna,HMO,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Grouper Rate,6840.00
Aetna,HMO,27299,CPT4/HCPCS,PELVIS/HIP JOINT SURGERY,,Grouper Rate,2002.00
Aetna,HMO,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Grouper Rate,5856.00
Aetna,HMO,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Grouper Rate,3656.00
Aetna,HMO,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,5856.00
Aetna,HMO,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,5856.00
Aetna,HMO,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Grouper Rate,6401.00
Aetna,HMO,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,2002.00
Aetna,HMO,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,2002.00
Aetna,HMO,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Grouper Rate,3656.00
Aetna,HMO,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Grouper Rate,3656.00
Aetna,HMO,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,HMO,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Grouper Rate,5856.00
Aetna,HMO,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Grouper Rate,6401.00
Aetna,HMO,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Grouper Rate,6401.00
Aetna,HMO,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Grouper Rate,6401.00
Aetna,HMO,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,6401.00
Aetna,HMO,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,6401.00
Aetna,HMO,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,6401.00
Aetna,HMO,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,6401.00
Aetna,HMO,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Grouper Rate,5856.00
Aetna,HMO,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Grouper Rate,5856.00
Aetna,HMO,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Grouper Rate,6401.00
Aetna,HMO,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Grouper Rate,6401.00
Aetna,HMO,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Grouper Rate,6401.00
Aetna,HMO,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Grouper Rate,5856.00
Aetna,HMO,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,6401.00
Aetna,HMO,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,6840.00
Aetna,HMO,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Grouper Rate,6840.00
Aetna,HMO,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Grouper Rate,6840.00
Aetna,HMO,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,27369,CPT4/HCPCS,NJX CNTRST KNE ARTHG/CT/MRI,,Grouper Rate,2002.00
Aetna,HMO,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,7830.00
Aetna,HMO,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Grouper Rate,2002.00
Aetna,HMO,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Grouper Rate,5856.00
Aetna,HMO,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Grouper Rate,5856.00
Aetna,HMO,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Grouper Rate,5856.00
Aetna,HMO,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,2002.00
Aetna,HMO,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,3656.00
Aetna,HMO,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,5856.00
Aetna,HMO,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Grouper Rate,3656.00
Aetna,HMO,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,5856.00
Aetna,HMO,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,5856.00
Aetna,HMO,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Grouper Rate,5856.00
Aetna,HMO,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Grouper Rate,5856.00
Aetna,HMO,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Grouper Rate,5856.00
Aetna,HMO,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Grouper Rate,6401.00
Aetna,HMO,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,6401.00
Aetna,HMO,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,6401.00
Aetna,HMO,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Grouper Rate,6401.00
Aetna,HMO,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Grouper Rate,5856.00
Aetna,HMO,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Grouper Rate,5856.00
Aetna,HMO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Grouper Rate,6401.00
Aetna,HMO,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Grouper Rate,5856.00
Aetna,HMO,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,5856.00
Aetna,HMO,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,7830.00
Aetna,HMO,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Grouper Rate,5856.00
Aetna,HMO,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Grouper Rate,7830.00
Aetna,HMO,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,5856.00
Aetna,HMO,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,6401.00
Aetna,HMO,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,6401.00
Aetna,HMO,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Grouper Rate,6401.00
Aetna,HMO,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Grouper Rate,6401.00
Aetna,HMO,27437,CPT4/HCPCS,REVISE KNEECAP,,Grouper Rate,6401.00
Aetna,HMO,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Grouper Rate,6840.00
Aetna,HMO,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6840.00
Aetna,HMO,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6840.00
Aetna,HMO,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6840.00
Aetna,HMO,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6840.00
Aetna,HMO,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6840.00
Aetna,HMO,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Grouper Rate,7188.00
Aetna,HMO,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6401.00
Aetna,HMO,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6840.00
Aetna,HMO,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6401.00
Aetna,HMO,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6840.00
Aetna,HMO,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,6840.00
Aetna,HMO,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,5856.00
Aetna,HMO,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,5856.00
Aetna,HMO,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,5856.00
Aetna,HMO,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,6840.00
Aetna,HMO,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,2002.00
Aetna,HMO,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,2002.00
Aetna,HMO,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Grouper Rate,2002.00
Aetna,HMO,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Grouper Rate,2002.00
Aetna,HMO,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,HMO,27599,CPT4/HCPCS,LEG SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,5856.00
Aetna,HMO,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,5856.00
Aetna,HMO,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,5856.00
Aetna,HMO,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Grouper Rate,3656.00
Aetna,HMO,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Grouper Rate,3656.00
Aetna,HMO,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,2002.00
Aetna,HMO,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,2002.00
Aetna,HMO,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Grouper Rate,3656.00
Aetna,HMO,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,3656.00
Aetna,HMO,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Grouper Rate,5856.00
Aetna,HMO,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,2002.00
Aetna,HMO,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,3656.00
Aetna,HMO,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Grouper Rate,5856.00
Aetna,HMO,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Grouper Rate,3656.00
Aetna,HMO,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Grouper Rate,5856.00
Aetna,HMO,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,6401.00
Aetna,HMO,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,6401.00
Aetna,HMO,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,6401.00
Aetna,HMO,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Grouper Rate,5856.00
Aetna,HMO,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Grouper Rate,5856.00
Aetna,HMO,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Grouper Rate,3656.00
Aetna,HMO,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Grouper Rate,3656.00
Aetna,HMO,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Grouper Rate,5856.00
Aetna,HMO,27648,CPT4/HCPCS,INJECTION FOR ANKLE X-RAY,,Grouper Rate,2002.00
Aetna,HMO,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Grouper Rate,5856.00
Aetna,HMO,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Grouper Rate,5856.00
Aetna,HMO,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Grouper Rate,5856.00
Aetna,HMO,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Grouper Rate,3656.00
Aetna,HMO,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,2002.00
Aetna,HMO,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,3656.00
Aetna,HMO,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,3656.00
Aetna,HMO,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,3656.00
Aetna,HMO,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,3656.00
Aetna,HMO,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,5856.00
Aetna,HMO,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Grouper Rate,5856.00
Aetna,HMO,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Grouper Rate,3656.00
Aetna,HMO,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Grouper Rate,5856.00
Aetna,HMO,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Grouper Rate,5856.00
Aetna,HMO,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Grouper Rate,5856.00
Aetna,HMO,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,6401.00
Aetna,HMO,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,6401.00
Aetna,HMO,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Grouper Rate,5856.00
Aetna,HMO,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,3656.00
Aetna,HMO,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Grouper Rate,3656.00
Aetna,HMO,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,3656.00
Aetna,HMO,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Grouper Rate,6840.00
Aetna,HMO,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Grouper Rate,3656.00
Aetna,HMO,27705,CPT4/HCPCS,INCISION OF TIBIA,,Grouper Rate,3656.00
Aetna,HMO,27707,CPT4/HCPCS,INCISION OF FIBULA,,Grouper Rate,3656.00
Aetna,HMO,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Grouper Rate,3656.00
Aetna,HMO,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Grouper Rate,6401.00
Aetna,HMO,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Grouper Rate,6840.00
Aetna,HMO,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,6840.00
Aetna,HMO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Grouper Rate,5856.00
Aetna,HMO,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Grouper Rate,3656.00
Aetna,HMO,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Grouper Rate,3656.00
Aetna,HMO,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Grouper Rate,3656.00
Aetna,HMO,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,3656.00
Aetna,HMO,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,3656.00
Aetna,HMO,27745,CPT4/HCPCS,REINFORCE TIBIA,,Grouper Rate,5856.00
Aetna,HMO,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Grouper Rate,2002.00
Aetna,HMO,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Grouper Rate,2002.00
Aetna,HMO,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Grouper Rate,5856.00
Aetna,HMO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Grouper Rate,2002.00
Aetna,HMO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Grouper Rate,2002.00
Aetna,HMO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Grouper Rate,5856.00
Aetna,HMO,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Grouper Rate,3656.00
Aetna,HMO,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Grouper Rate,2002.00
Aetna,HMO,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Grouper Rate,6401.00
Aetna,HMO,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Grouper Rate,6401.00
Aetna,HMO,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,HMO,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,5856.00
Aetna,HMO,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,5856.00
Aetna,HMO,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,5856.00
Aetna,HMO,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,5856.00
Aetna,HMO,27899,CPT4/HCPCS,LEG/ANKLE SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,28,DRG,Spinal procedures w MCC,,Per Diem,5769.00
Aetna,HMO,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Grouper Rate,3656.00
Aetna,HMO,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,5856.00
Aetna,HMO,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,5856.00
Aetna,HMO,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Grouper Rate,5856.00
Aetna,HMO,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Grouper Rate,5856.00
Aetna,HMO,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,3656.00
Aetna,HMO,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Grouper Rate,5856.00
Aetna,HMO,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,3656.00
Aetna,HMO,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,3656.00
Aetna,HMO,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Grouper Rate,3656.00
Aetna,HMO,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Grouper Rate,6401.00
Aetna,HMO,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Grouper Rate,2002.00
Aetna,HMO,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Grouper Rate,5856.00
Aetna,HMO,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Grouper Rate,3656.00
Aetna,HMO,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Grouper Rate,5856.00
Aetna,HMO,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Grouper Rate,5856.00
Aetna,HMO,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Grouper Rate,5856.00
Aetna,HMO,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,3656.00
Aetna,HMO,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,3656.00
Aetna,HMO,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Grouper Rate,3656.00
Aetna,HMO,28055,CPT4/HCPCS,NEURECTOMY FOOT,,Grouper Rate,6401.00
Aetna,HMO,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Grouper Rate,3656.00
Aetna,HMO,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Grouper Rate,5856.00
Aetna,HMO,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,5856.00
Aetna,HMO,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,5856.00
Aetna,HMO,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,5856.00
Aetna,HMO,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,3656.00
Aetna,HMO,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,3656.00
Aetna,HMO,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,5856.00
Aetna,HMO,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,5856.00
Aetna,HMO,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Grouper Rate,3656.00
Aetna,HMO,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,5856.00
Aetna,HMO,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,5856.00
Aetna,HMO,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3656.00
Aetna,HMO,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,5856.00
Aetna,HMO,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,5856.00
Aetna,HMO,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,3656.00
Aetna,HMO,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,5856.00
Aetna,HMO,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,5856.00
Aetna,HMO,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,5856.00
Aetna,HMO,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,5856.00
Aetna,HMO,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Grouper Rate,5856.00
Aetna,HMO,28116,CPT4/HCPCS,REVISION OF FOOT,,Grouper Rate,5856.00
Aetna,HMO,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Grouper Rate,6401.00
Aetna,HMO,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Grouper Rate,6401.00
Aetna,HMO,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Grouper Rate,7830.00
Aetna,HMO,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,5856.00
Aetna,HMO,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,3656.00
Aetna,HMO,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,5856.00
Aetna,HMO,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Grouper Rate,5856.00
Aetna,HMO,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Grouper Rate,5856.00
Aetna,HMO,28150,CPT4/HCPCS,REMOVAL OF TOE,,Grouper Rate,5856.00
Aetna,HMO,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,5856.00
Aetna,HMO,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,5856.00
Aetna,HMO,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Grouper Rate,5856.00
Aetna,HMO,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Grouper Rate,5856.00
Aetna,HMO,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Grouper Rate,5856.00
Aetna,HMO,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,3656.00
Aetna,HMO,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,3656.00
Aetna,HMO,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,6401.00
Aetna,HMO,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,HMO,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,HMO,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,HMO,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,HMO,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,3656.00
Aetna,HMO,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,2002.00
Aetna,HMO,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,2002.00
Aetna,HMO,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,2002.00
Aetna,HMO,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Grouper Rate,3656.00
Aetna,HMO,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,3656.00
Aetna,HMO,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Grouper Rate,3656.00
Aetna,HMO,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,HMO,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Grouper Rate,3656.00
Aetna,HMO,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Grouper Rate,5856.00
Aetna,HMO,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,5856.00
Aetna,HMO,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,HMO,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Grouper Rate,6401.00
Aetna,HMO,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,2002.00
Aetna,HMO,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Grouper Rate,5856.00
Aetna,HMO,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Grouper Rate,3656.00
Aetna,HMO,28280,CPT4/HCPCS,FUSION OF TOES,,Grouper Rate,3656.00
Aetna,HMO,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,5856.00
Aetna,HMO,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,6401.00
Aetna,HMO,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,5856.00
Aetna,HMO,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Grouper Rate,5856.00
Aetna,HMO,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Grouper Rate,5856.00
Aetna,HMO,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3656.00
Aetna,HMO,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3656.00
Aetna,HMO,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5856.00
Aetna,HMO,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5856.00
Aetna,HMO,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5856.00
Aetna,HMO,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,6840.00
Aetna,HMO,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Grouper Rate,3656.00
Aetna,HMO,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Grouper Rate,3656.00
Aetna,HMO,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Grouper Rate,3656.00
Aetna,HMO,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Grouper Rate,5856.00
Aetna,HMO,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,6401.00
Aetna,HMO,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,6401.00
Aetna,HMO,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,3656.00
Aetna,HMO,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Grouper Rate,6401.00
Aetna,HMO,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Grouper Rate,5856.00
Aetna,HMO,28312,CPT4/HCPCS,REVISION OF TOE,,Grouper Rate,5856.00
Aetna,HMO,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Grouper Rate,3656.00
Aetna,HMO,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Grouper Rate,6401.00
Aetna,HMO,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Grouper Rate,6401.00
Aetna,HMO,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Grouper Rate,6401.00
Aetna,HMO,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Grouper Rate,6401.00
Aetna,HMO,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Grouper Rate,6401.00
Aetna,HMO,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Grouper Rate,6401.00
Aetna,HMO,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Grouper Rate,6401.00
Aetna,HMO,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Grouper Rate,6401.00
Aetna,HMO,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,2002.00
Aetna,HMO,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,2002.00
Aetna,HMO,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,5856.00
Aetna,HMO,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,6401.00
Aetna,HMO,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,3656.00
Aetna,HMO,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,2002.00
Aetna,HMO,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,5856.00
Aetna,HMO,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,3656.00
Aetna,HMO,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,2002.00
Aetna,HMO,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Grouper Rate,5856.00
Aetna,HMO,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,HMO,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,HMO,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,HMO,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,HMO,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,HMO,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Grouper Rate,6840.00
Aetna,HMO,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,HMO,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,6401.00
Aetna,HMO,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,6401.00
Aetna,HMO,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,6401.00
Aetna,HMO,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Grouper Rate,5856.00
Aetna,HMO,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Grouper Rate,3656.00
Aetna,HMO,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Grouper Rate,3656.00
Aetna,HMO,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Grouper Rate,3656.00
Aetna,HMO,28890,CPT4/HCPCS,HI ENRGY ESWT PLANTAR FASCIA,,Grouper Rate,6401.00
Aetna,HMO,28899,CPT4/HCPCS,FOOT/TOES SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,Per Diem,5769.00
Aetna,HMO,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Grouper Rate,2002.00
Aetna,HMO,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Grouper Rate,3656.00
Aetna,HMO,29345,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Grouper Rate,2002.00
Aetna,HMO,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Grouper Rate,5856.00
Aetna,HMO,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Grouper Rate,5856.00
Aetna,HMO,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Grouper Rate,5856.00
Aetna,HMO,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Grouper Rate,5856.00
Aetna,HMO,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Grouper Rate,5856.00
Aetna,HMO,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Grouper Rate,5856.00
Aetna,HMO,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Grouper Rate,5856.00
Aetna,HMO,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Grouper Rate,5856.00
Aetna,HMO,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Grouper Rate,6840.00
Aetna,HMO,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Grouper Rate,5856.00
Aetna,HMO,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Grouper Rate,5856.00
Aetna,HMO,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Grouper Rate,6840.00
Aetna,HMO,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Grouper Rate,5856.00
Aetna,HMO,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Grouper Rate,5856.00
Aetna,HMO,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Grouper Rate,5856.00
Aetna,HMO,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,HMO,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,HMO,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,HMO,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,HMO,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Grouper Rate,6401.00
Aetna,HMO,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Grouper Rate,6401.00
Aetna,HMO,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Grouper Rate,6401.00
Aetna,HMO,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Grouper Rate,6401.00
Aetna,HMO,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,5856.00
Aetna,HMO,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,5856.00
Aetna,HMO,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Grouper Rate,5856.00
Aetna,HMO,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Grouper Rate,5856.00
Aetna,HMO,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Grouper Rate,5856.00
Aetna,HMO,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,HMO,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,HMO,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,HMO,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,HMO,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,HMO,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Grouper Rate,5856.00
Aetna,HMO,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,HMO,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Grouper Rate,5856.00
Aetna,HMO,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,5856.00
Aetna,HMO,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,5856.00
Aetna,HMO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Grouper Rate,5856.00
Aetna,HMO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Grouper Rate,5856.00
Aetna,HMO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Grouper Rate,5856.00
Aetna,HMO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Grouper Rate,5856.00
Aetna,HMO,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Grouper Rate,6401.00
Aetna,HMO,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Grouper Rate,6401.00
Aetna,HMO,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Grouper Rate,6401.00
Aetna,HMO,29999,CPT4/HCPCS,ARTHROSCOPY OF JOINT,,Grouper Rate,2002.00
Aetna,HMO,30,DRG,Spinal procedures w/o CC/MCC,,Per Diem,5769.00
Aetna,HMO,30000,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Grouper Rate,2002.00
Aetna,HMO,30020,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Grouper Rate,2002.00
Aetna,HMO,30100,CPT4/HCPCS,INTRANASAL BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,2002.00
Aetna,HMO,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,3656.00
Aetna,HMO,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,5856.00
Aetna,HMO,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,5856.00
Aetna,HMO,30120,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,2002.00
Aetna,HMO,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,2002.00
Aetna,HMO,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,3656.00
Aetna,HMO,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Grouper Rate,5856.00
Aetna,HMO,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Grouper Rate,3656.00
Aetna,HMO,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Grouper Rate,5856.00
Aetna,HMO,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Grouper Rate,6401.00
Aetna,HMO,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Grouper Rate,5856.00
Aetna,HMO,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,2002.00
Aetna,HMO,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,3656.00
Aetna,HMO,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,6401.00
Aetna,HMO,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,6840.00
Aetna,HMO,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,6840.00
Aetna,HMO,30430,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5856.00
Aetna,HMO,30435,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,6840.00
Aetna,HMO,30450,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,7830.00
Aetna,HMO,30460,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,7830.00
Aetna,HMO,30462,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,7830.00
Aetna,HMO,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Grouper Rate,7830.00
Aetna,HMO,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Grouper Rate,6401.00
Aetna,HMO,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,6840.00
Aetna,HMO,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,6840.00
Aetna,HMO,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Grouper Rate,3656.00
Aetna,HMO,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Grouper Rate,6401.00
Aetna,HMO,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Grouper Rate,6401.00
Aetna,HMO,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Grouper Rate,7830.00
Aetna,HMO,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Grouper Rate,7830.00
Aetna,HMO,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Grouper Rate,2002.00
Aetna,HMO,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Grouper Rate,2002.00
Aetna,HMO,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,2002.00
Aetna,HMO,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,2002.00
Aetna,HMO,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,2002.00
Aetna,HMO,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Grouper Rate,2002.00
Aetna,HMO,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Grouper Rate,3656.00
Aetna,HMO,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Grouper Rate,5856.00
Aetna,HMO,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Grouper Rate,6401.00
Aetna,HMO,30999,CPT4/HCPCS,NASAL SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Grouper Rate,2002.00
Aetna,HMO,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Grouper Rate,2002.00
Aetna,HMO,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,3656.00
Aetna,HMO,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,5856.00
Aetna,HMO,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Grouper Rate,6401.00
Aetna,HMO,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Grouper Rate,3656.00
Aetna,HMO,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Grouper Rate,6401.00
Aetna,HMO,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,3656.00
Aetna,HMO,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,HMO,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,HMO,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,HMO,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,HMO,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,HMO,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,HMO,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,HMO,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Grouper Rate,6840.00
Aetna,HMO,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,3656.00
Aetna,HMO,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,6840.00
Aetna,HMO,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,5856.00
Aetna,HMO,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Grouper Rate,3656.00
Aetna,HMO,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Grouper Rate,3656.00
Aetna,HMO,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Grouper Rate,3656.00
Aetna,HMO,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3656.00
Aetna,HMO,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3656.00
Aetna,HMO,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,6401.00
Aetna,HMO,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3656.00
Aetna,HMO,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Grouper Rate,5856.00
Aetna,HMO,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Grouper Rate,6840.00
Aetna,HMO,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Grouper Rate,6401.00
Aetna,HMO,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Grouper Rate,6840.00
Aetna,HMO,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,5856.00
Aetna,HMO,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Grouper Rate,6840.00
Aetna,HMO,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Grouper Rate,6840.00
Aetna,HMO,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Grouper Rate,5856.00
Aetna,HMO,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Grouper Rate,5856.00
Aetna,HMO,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5856.00
Aetna,HMO,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5856.00
Aetna,HMO,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5856.00
Aetna,HMO,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5856.00
Aetna,HMO,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Grouper Rate,5856.00
Aetna,HMO,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Grouper Rate,5856.00
Aetna,HMO,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Grouper Rate,5856.00
Aetna,HMO,31295,CPT4/HCPCS,NSL/SINS NDSC SURG MAX SINS,,Grouper Rate,5856.00
Aetna,HMO,31296,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT SINS,,Grouper Rate,5856.00
Aetna,HMO,31297,CPT4/HCPCS,NSL/SINS NDSC SURG SPHN SINS,,Grouper Rate,5856.00
Aetna,HMO,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Grouper Rate,6401.00
Aetna,HMO,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,6840.00
Aetna,HMO,31400,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,3656.00
Aetna,HMO,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Grouper Rate,3656.00
Aetna,HMO,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Grouper Rate,2002.00
Aetna,HMO,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Grouper Rate,2002.00
Aetna,HMO,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,3656.00
Aetna,HMO,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Grouper Rate,3656.00
Aetna,HMO,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,3656.00
Aetna,HMO,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Grouper Rate,3656.00
Aetna,HMO,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Grouper Rate,2002.00
Aetna,HMO,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Grouper Rate,2002.00
Aetna,HMO,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Grouper Rate,3656.00
Aetna,HMO,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Grouper Rate,3656.00
Aetna,HMO,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,3656.00
Aetna,HMO,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,3656.00
Aetna,HMO,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Grouper Rate,3656.00
Aetna,HMO,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Grouper Rate,5856.00
Aetna,HMO,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Grouper Rate,3656.00
Aetna,HMO,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Grouper Rate,5856.00
Aetna,HMO,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Grouper Rate,5856.00
Aetna,HMO,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Grouper Rate,6401.00
Aetna,HMO,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Grouper Rate,6401.00
Aetna,HMO,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Grouper Rate,6401.00
Aetna,HMO,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6840.00
Aetna,HMO,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6840.00
Aetna,HMO,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6840.00
Aetna,HMO,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6840.00
Aetna,HMO,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Grouper Rate,6840.00
Aetna,HMO,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Grouper Rate,6840.00
Aetna,HMO,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Grouper Rate,3656.00
Aetna,HMO,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Grouper Rate,3656.00
Aetna,HMO,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Grouper Rate,3656.00
Aetna,HMO,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Grouper Rate,3656.00
Aetna,HMO,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Grouper Rate,3656.00
Aetna,HMO,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,3656.00
Aetna,HMO,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Grouper Rate,3656.00
Aetna,HMO,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Grouper Rate,3656.00
Aetna,HMO,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Grouper Rate,3656.00
Aetna,HMO,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Grouper Rate,6840.00
Aetna,HMO,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Grouper Rate,6401.00
Aetna,HMO,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Grouper Rate,6401.00
Aetna,HMO,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Grouper Rate,6840.00
Aetna,HMO,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Grouper Rate,6401.00
Aetna,HMO,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Grouper Rate,6401.00
Aetna,HMO,31599,CPT4/HCPCS,LARYNX SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,3656.00
Aetna,HMO,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,2002.00
Aetna,HMO,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,2002.00
Aetna,HMO,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Grouper Rate,5856.00
Aetna,HMO,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Grouper Rate,2002.00
Aetna,HMO,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,3656.00
Aetna,HMO,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,3656.00
Aetna,HMO,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Grouper Rate,2002.00
Aetna,HMO,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Grouper Rate,3656.00
Aetna,HMO,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Grouper Rate,3656.00
Aetna,HMO,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Grouper Rate,3656.00
Aetna,HMO,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Grouper Rate,3656.00
Aetna,HMO,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Grouper Rate,5856.00
Aetna,HMO,31627,CPT4/HCPCS,NAVIGATIONAL BRONCHOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Grouper Rate,3656.00
Aetna,HMO,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Grouper Rate,3656.00
Aetna,HMO,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Grouper Rate,3656.00
Aetna,HMO,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Grouper Rate,3656.00
Aetna,HMO,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Grouper Rate,3656.00
Aetna,HMO,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Grouper Rate,3656.00
Aetna,HMO,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Grouper Rate,5856.00
Aetna,HMO,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Grouper Rate,3656.00
Aetna,HMO,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Grouper Rate,3656.00
Aetna,HMO,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Grouper Rate,3656.00
Aetna,HMO,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Grouper Rate,3656.00
Aetna,HMO,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Grouper Rate,3656.00
Aetna,HMO,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Grouper Rate,3656.00
Aetna,HMO,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Grouper Rate,3656.00
Aetna,HMO,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Grouper Rate,2002.00
Aetna,HMO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Grouper Rate,3656.00
Aetna,HMO,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Grouper Rate,3656.00
Aetna,HMO,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,Grouper Rate,2002.00
Aetna,HMO,31651,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,Grouper Rate,2002.00
Aetna,HMO,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Grouper Rate,3656.00
Aetna,HMO,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Grouper Rate,3656.00
Aetna,HMO,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Grouper Rate,2002.00
Aetna,HMO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Grouper Rate,5856.00
Aetna,HMO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Grouper Rate,5856.00
Aetna,HMO,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,2002.00
Aetna,HMO,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,2002.00
Aetna,HMO,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Grouper Rate,3656.00
Aetna,HMO,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,6840.00
Aetna,HMO,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,3656.00
Aetna,HMO,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,6401.00
Aetna,HMO,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,3656.00
Aetna,HMO,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Grouper Rate,2002.00
Aetna,HMO,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Grouper Rate,3656.00
Aetna,HMO,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Grouper Rate,3656.00
Aetna,HMO,31899,CPT4/HCPCS,AIRWAYS SURGICAL PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Grouper Rate,2002.00
Aetna,HMO,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Grouper Rate,2002.00
Aetna,HMO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Grouper Rate,3656.00
Aetna,HMO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Grouper Rate,3656.00
Aetna,HMO,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Grouper Rate,2002.00
Aetna,HMO,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Grouper Rate,2002.00
Aetna,HMO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Grouper Rate,2002.00
Aetna,HMO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Grouper Rate,2002.00
Aetna,HMO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Grouper Rate,3656.00
Aetna,HMO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Grouper Rate,3656.00
Aetna,HMO,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Grouper Rate,3656.00
Aetna,HMO,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Grouper Rate,2002.00
Aetna,HMO,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Grouper Rate,2002.00
Aetna,HMO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Grouper Rate,5856.00
Aetna,HMO,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Grouper Rate,5856.00
Aetna,HMO,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Grouper Rate,5856.00
Aetna,HMO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Grouper Rate,5856.00
Aetna,HMO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Grouper Rate,5856.00
Aetna,HMO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Grouper Rate,5856.00
Aetna,HMO,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Grouper Rate,3656.00
Aetna,HMO,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Grouper Rate,6401.00
Aetna,HMO,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Grouper Rate,6401.00
Aetna,HMO,33016,CPT4/HCPCS,PERICARDIOCENTESIS W/IMAGING,,Grouper Rate,3656.00
Aetna,HMO,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Grouper Rate,7830.00
Aetna,HMO,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Grouper Rate,7830.00
Aetna,HMO,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Grouper Rate,7830.00
Aetna,HMO,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Grouper Rate,6401.00
Aetna,HMO,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Grouper Rate,6401.00
Aetna,HMO,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Grouper Rate,5856.00
Aetna,HMO,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Grouper Rate,5856.00
Aetna,HMO,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Grouper Rate,7830.00
Aetna,HMO,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Grouper Rate,5856.00
Aetna,HMO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Grouper Rate,6401.00
Aetna,HMO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Grouper Rate,6401.00
Aetna,HMO,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Grouper Rate,6401.00
Aetna,HMO,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Grouper Rate,6401.00
Aetna,HMO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Grouper Rate,5856.00
Aetna,HMO,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Grouper Rate,3656.00
Aetna,HMO,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Grouper Rate,3656.00
Aetna,HMO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Grouper Rate,5856.00
Aetna,HMO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Grouper Rate,6401.00
Aetna,HMO,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Grouper Rate,5856.00
Aetna,HMO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Grouper Rate,5856.00
Aetna,HMO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Grouper Rate,5856.00
Aetna,HMO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Grouper Rate,5856.00
Aetna,HMO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Grouper Rate,5856.00
Aetna,HMO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Grouper Rate,5856.00
Aetna,HMO,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Grouper Rate,3656.00
Aetna,HMO,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Grouper Rate,6401.00
Aetna,HMO,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Grouper Rate,6401.00
Aetna,HMO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Grouper Rate,7830.00
Aetna,HMO,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Grouper Rate,6401.00
Aetna,HMO,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Grouper Rate,6401.00
Aetna,HMO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Grouper Rate,7830.00
Aetna,HMO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Grouper Rate,5856.00
Aetna,HMO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Grouper Rate,5856.00
Aetna,HMO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Grouper Rate,5856.00
Aetna,HMO,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Grouper Rate,5856.00
Aetna,HMO,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Grouper Rate,5856.00
Aetna,HMO,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Grouper Rate,5856.00
Aetna,HMO,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Grouper Rate,5856.00
Aetna,HMO,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,Grouper Rate,6401.00
Aetna,HMO,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,Grouper Rate,6401.00
Aetna,HMO,33285,CPT4/HCPCS,INSJ SUBQ CAR RHYTHM MNTR,,Grouper Rate,2002.00
Aetna,HMO,33286,CPT4/HCPCS,RMVL SUBQ CAR RHYTHM MNTR,,Grouper Rate,2002.00
Aetna,HMO,33289,CPT4/HCPCS,TCAT IMPL WRLS P-ART PRS SNR,,Grouper Rate,7830.00
Aetna,HMO,33968,CPT4/HCPCS,REMOVE AORTIC ASSIST DEVICE,,Grouper Rate,2002.00
Aetna,HMO,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,5856.00
Aetna,HMO,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Grouper Rate,7188.00
Aetna,HMO,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Grouper Rate,7188.00
Aetna,HMO,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Grouper Rate,7188.00
Aetna,HMO,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Grouper Rate,7188.00
Aetna,HMO,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Grouper Rate,7188.00
Aetna,HMO,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Grouper Rate,7188.00
Aetna,HMO,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Grouper Rate,8797.00
Aetna,HMO,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Grouper Rate,8797.00
Aetna,HMO,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Grouper Rate,2002.00
Aetna,HMO,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Grouper Rate,6401.00
Aetna,HMO,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Grouper Rate,2002.00
Aetna,HMO,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Grouper Rate,5856.00
Aetna,HMO,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Grouper Rate,2002.00
Aetna,HMO,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Grouper Rate,2002.00
Aetna,HMO,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Grouper Rate,2002.00
Aetna,HMO,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Grouper Rate,2002.00
Aetna,HMO,34833,CPT4/HCPCS,OPN ILAC ART EXPOS CNDT CRTJ,,Grouper Rate,8797.00
Aetna,HMO,34834,CPT4/HCPCS,OPN BRACH ART EXPOS,,Grouper Rate,8797.00
Aetna,HMO,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6401.00
Aetna,HMO,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6840.00
Aetna,HMO,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6401.00
Aetna,HMO,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6401.00
Aetna,HMO,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6401.00
Aetna,HMO,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,HMO,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,HMO,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,HMO,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,HMO,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,HMO,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,HMO,35702,CPT4/HCPCS,EXPL N/FLWD SURG UXTR ART,,Grouper Rate,3656.00
Aetna,HMO,35703,CPT4/HCPCS,EXPL N/FLWD SURG LXTR ART,,Grouper Rate,3656.00
Aetna,HMO,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,7830.00
Aetna,HMO,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,7830.00
Aetna,HMO,35883,CPT4/HCPCS,REVISE GRAFT W/NONAUTO GRAFT,,Grouper Rate,6401.00
Aetna,HMO,35884,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,6401.00
Aetna,HMO,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Grouper Rate,2002.00
Aetna,HMO,36005,CPT4/HCPCS,INJECTION EXT VENOGRAPHY,,Grouper Rate,2002.00
Aetna,HMO,36010,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,2002.00
Aetna,HMO,36011,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,2002.00
Aetna,HMO,36012,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,2002.00
Aetna,HMO,36013,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,2002.00
Aetna,HMO,36014,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,2002.00
Aetna,HMO,36015,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,2002.00
Aetna,HMO,36100,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,Grouper Rate,2002.00
Aetna,HMO,36140,CPT4/HCPCS,INTRO NDL ICATH UPR/LXTR ART,,Grouper Rate,2002.00
Aetna,HMO,36160,CPT4/HCPCS,ESTABLISH ACCESS TO AORTA,,Grouper Rate,3656.00
Aetna,HMO,36200,CPT4/HCPCS,PLACE CATHETER IN AORTA,,Grouper Rate,3656.00
Aetna,HMO,36215,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3656.00
Aetna,HMO,36216,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3656.00
Aetna,HMO,36217,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3656.00
Aetna,HMO,36218,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3656.00
Aetna,HMO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Grouper Rate,3656.00
Aetna,HMO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,3656.00
Aetna,HMO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,3656.00
Aetna,HMO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Grouper Rate,5856.00
Aetna,HMO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Grouper Rate,3656.00
Aetna,HMO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Grouper Rate,5856.00
Aetna,HMO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Grouper Rate,2002.00
Aetna,HMO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Grouper Rate,2002.00
Aetna,HMO,36245,CPT4/HCPCS,INS CATH ABD/L-EXT ART 1ST,,Grouper Rate,3656.00
Aetna,HMO,36246,CPT4/HCPCS,INS CATH ABD/L-EXT ART 2ND,,Grouper Rate,3656.00
Aetna,HMO,36247,CPT4/HCPCS,INS CATH ABD/L-EXT ART 3RD,,Grouper Rate,3656.00
Aetna,HMO,36248,CPT4/HCPCS,INS CATH ABD/L-EXT ART ADDL,,Grouper Rate,3656.00
Aetna,HMO,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,Grouper Rate,3656.00
Aetna,HMO,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,Grouper Rate,3656.00
Aetna,HMO,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,Grouper Rate,3656.00
Aetna,HMO,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,Grouper Rate,3656.00
Aetna,HMO,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Grouper Rate,5856.00
Aetna,HMO,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Grouper Rate,3656.00
Aetna,HMO,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Grouper Rate,2002.00
Aetna,HMO,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Grouper Rate,2002.00
Aetna,HMO,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Grouper Rate,2002.00
Aetna,HMO,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Grouper Rate,2002.00
Aetna,HMO,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Grouper Rate,2002.00
Aetna,HMO,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Grouper Rate,2002.00
Aetna,HMO,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Grouper Rate,2002.00
Aetna,HMO,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Grouper Rate,2002.00
Aetna,HMO,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Grouper Rate,2002.00
Aetna,HMO,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Grouper Rate,3656.00
Aetna,HMO,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Grouper Rate,3656.00
Aetna,HMO,36468,CPT4/HCPCS,NJX SCLRSNT SPIDER VEINS,,Grouper Rate,2002.00
Aetna,HMO,36470,CPT4/HCPCS,NJX SCLRSNT 1 INCMPTNT VEIN,,Grouper Rate,2002.00
Aetna,HMO,36471,CPT4/HCPCS,NJX SCLRSNT MLT INCMPTNT VN,,Grouper Rate,2002.00
Aetna,HMO,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Grouper Rate,5856.00
Aetna,HMO,36474,CPT4/HCPCS,ENDOVENOUS MCHNCHEM ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Grouper Rate,5856.00
Aetna,HMO,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Grouper Rate,5856.00
Aetna,HMO,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Grouper Rate,2002.00
Aetna,HMO,36481,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,2002.00
Aetna,HMO,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Grouper Rate,5856.00
Aetna,HMO,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Grouper Rate,2002.00
Aetna,HMO,36500,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,2002.00
Aetna,HMO,36511,CPT4/HCPCS,APHERESIS WBC,,Grouper Rate,3656.00
Aetna,HMO,36512,CPT4/HCPCS,APHERESIS RBC,,Grouper Rate,3656.00
Aetna,HMO,36513,CPT4/HCPCS,APHERESIS PLATELETS,,Grouper Rate,3656.00
Aetna,HMO,36514,CPT4/HCPCS,APHERESIS PLASMA,,Grouper Rate,3656.00
Aetna,HMO,36516,CPT4/HCPCS,APHERESIS IMMUNOADS SLCTV,,Grouper Rate,7830.00
Aetna,HMO,36522,CPT4/HCPCS,PHOTOPHERESIS,,Grouper Rate,3656.00
Aetna,HMO,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,2002.00
Aetna,HMO,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,2002.00
Aetna,HMO,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,HMO,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,HMO,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,HMO,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,HMO,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,HMO,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,HMO,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,HMO,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Grouper Rate,2002.00
Aetna,HMO,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Grouper Rate,2002.00
Aetna,HMO,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,5856.00
Aetna,HMO,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,5856.00
Aetna,HMO,36572,CPT4/HCPCS,INSJ PICC RS&I <5 YR,,Grouper Rate,2002.00
Aetna,HMO,36573,CPT4/HCPCS,INSJ PICC RS&I 5 YR+,,Grouper Rate,2002.00
Aetna,HMO,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,HMO,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,HMO,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,HMO,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Grouper Rate,2002.00
Aetna,HMO,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,HMO,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,HMO,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,HMO,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Grouper Rate,2002.00
Aetna,HMO,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Grouper Rate,5856.00
Aetna,HMO,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,2002.00
Aetna,HMO,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,2002.00
Aetna,HMO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Grouper Rate,2002.00
Aetna,HMO,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,6401.00
Aetna,HMO,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,2002.00
Aetna,HMO,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Grouper Rate,2002.00
Aetna,HMO,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Grouper Rate,3656.00
Aetna,HMO,36620,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,2002.00
Aetna,HMO,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,2002.00
Aetna,HMO,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Grouper Rate,2002.00
Aetna,HMO,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,5856.00
Aetna,HMO,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,5856.00
Aetna,HMO,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,5856.00
Aetna,HMO,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Grouper Rate,5856.00
Aetna,HMO,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Grouper Rate,5856.00
Aetna,HMO,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Grouper Rate,5856.00
Aetna,HMO,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Grouper Rate,5856.00
Aetna,HMO,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Grouper Rate,6401.00
Aetna,HMO,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Grouper Rate,6401.00
Aetna,HMO,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Grouper Rate,7830.00
Aetna,HMO,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Grouper Rate,6401.00
Aetna,HMO,36833,CPT4/HCPCS,AV FISTULA REVISION,,Grouper Rate,6401.00
Aetna,HMO,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Grouper Rate,6401.00
Aetna,HMO,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Grouper Rate,6401.00
Aetna,HMO,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Grouper Rate,3656.00
Aetna,HMO,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Grouper Rate,5856.00
Aetna,HMO,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,2002.00
Aetna,HMO,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,7830.00
Aetna,HMO,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,7830.00
Aetna,HMO,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,6840.00
Aetna,HMO,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,7830.00
Aetna,HMO,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,7830.00
Aetna,HMO,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Grouper Rate,2002.00
Aetna,HMO,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Grouper Rate,2002.00
Aetna,HMO,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Grouper Rate,2002.00
Aetna,HMO,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Grouper Rate,9770.00
Aetna,HMO,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Grouper Rate,9770.00
Aetna,HMO,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Grouper Rate,3656.00
Aetna,HMO,37186,CPT4/HCPCS,SEC ART THROMBECTOMY ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Grouper Rate,9770.00
Aetna,HMO,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Grouper Rate,9770.00
Aetna,HMO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Grouper Rate,5856.00
Aetna,HMO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Grouper Rate,5856.00
Aetna,HMO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Grouper Rate,5856.00
Aetna,HMO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Grouper Rate,5856.00
Aetna,HMO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Grouper Rate,6401.00
Aetna,HMO,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Grouper Rate,2002.00
Aetna,HMO,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Grouper Rate,2002.00
Aetna,HMO,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Grouper Rate,5856.00
Aetna,HMO,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Grouper Rate,5856.00
Aetna,HMO,37215,CPT4/HCPCS,TRANSCATH STENT CCA W/EPS,,Grouper Rate,5856.00
Aetna,HMO,37216,CPT4/HCPCS,TRANSCATH STENT CCA W/O EPS,,Grouper Rate,5856.00
Aetna,HMO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Grouper Rate,5856.00
Aetna,HMO,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Grouper Rate,5856.00
Aetna,HMO,37220,CPT4/HCPCS,ILIAC REVASC,,Grouper Rate,6401.00
Aetna,HMO,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Grouper Rate,6401.00
Aetna,HMO,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Grouper Rate,6401.00
Aetna,HMO,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Grouper Rate,6401.00
Aetna,HMO,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Grouper Rate,6401.00
Aetna,HMO,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Grouper Rate,6401.00
Aetna,HMO,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Grouper Rate,6401.00
Aetna,HMO,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Grouper Rate,6401.00
Aetna,HMO,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Grouper Rate,6401.00
Aetna,HMO,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Grouper Rate,6401.00
Aetna,HMO,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Grouper Rate,2002.00
Aetna,HMO,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Grouper Rate,2002.00
Aetna,HMO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Grouper Rate,5856.00
Aetna,HMO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,2002.00
Aetna,HMO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Grouper Rate,5856.00
Aetna,HMO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,2002.00
Aetna,HMO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Grouper Rate,5856.00
Aetna,HMO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Grouper Rate,5856.00
Aetna,HMO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Grouper Rate,5856.00
Aetna,HMO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Grouper Rate,5856.00
Aetna,HMO,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Grouper Rate,7830.00
Aetna,HMO,37247,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL ART,,Grouper Rate,2002.00
Aetna,HMO,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Grouper Rate,7830.00
Aetna,HMO,37249,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL VEIN,,Grouper Rate,2002.00
Aetna,HMO,37252,CPT4/HCPCS,INTRVASC US NONCORONARY 1ST,,Grouper Rate,2002.00
Aetna,HMO,37253,CPT4/HCPCS,INTRVASC US NONCORONARY ADDL,,Grouper Rate,2002.00
Aetna,HMO,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Grouper Rate,5856.00
Aetna,HMO,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Grouper Rate,5856.00
Aetna,HMO,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Grouper Rate,3656.00
Aetna,HMO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Grouper Rate,5856.00
Aetna,HMO,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,3656.00
Aetna,HMO,37700,CPT4/HCPCS,REVISE LEG VEIN,,Grouper Rate,3656.00
Aetna,HMO,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Grouper Rate,5856.00
Aetna,HMO,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Grouper Rate,5856.00
Aetna,HMO,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Grouper Rate,5856.00
Aetna,HMO,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Grouper Rate,5856.00
Aetna,HMO,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Grouper Rate,5856.00
Aetna,HMO,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Grouper Rate,5856.00
Aetna,HMO,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Grouper Rate,5856.00
Aetna,HMO,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Grouper Rate,5856.00
Aetna,HMO,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Grouper Rate,5856.00
Aetna,HMO,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Grouper Rate,5856.00
Aetna,HMO,37799,CPT4/HCPCS,VASCULAR SURGERY PROCEDURE,,Grouper Rate,3656.00
Aetna,HMO,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Grouper Rate,6840.00
Aetna,HMO,38129,CPT4/HCPCS,LAPAROSCOPE PROC SPLEEN,,Grouper Rate,5856.00
Aetna,HMO,38200,CPT4/HCPCS,INJECTION FOR SPLEEN X-RAY,,Grouper Rate,2002.00
Aetna,HMO,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Grouper Rate,2002.00
Aetna,HMO,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Grouper Rate,2002.00
Aetna,HMO,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Grouper Rate,2002.00
Aetna,HMO,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Grouper Rate,6840.00
Aetna,HMO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Grouper Rate,5856.00
Aetna,HMO,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Grouper Rate,6840.00
Aetna,HMO,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Grouper Rate,6840.00
Aetna,HMO,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Grouper Rate,2002.00
Aetna,HMO,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,2002.00
Aetna,HMO,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,3656.00
Aetna,HMO,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Grouper Rate,3656.00
Aetna,HMO,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3656.00
Aetna,HMO,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Grouper Rate,2002.00
Aetna,HMO,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3656.00
Aetna,HMO,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3656.00
Aetna,HMO,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3656.00
Aetna,HMO,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3656.00
Aetna,HMO,38531,CPT4/HCPCS,OPEN BX/EXC INGUINOFEM NODES,,Grouper Rate,3656.00
Aetna,HMO,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Grouper Rate,3656.00
Aetna,HMO,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,5856.00
Aetna,HMO,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,6401.00
Aetna,HMO,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Grouper Rate,7188.00
Aetna,HMO,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,9770.00
Aetna,HMO,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,9770.00
Aetna,HMO,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Grouper Rate,7188.00
Aetna,HMO,38589,CPT4/HCPCS,LAPAROSCOPE PROC LYMPHATIC,,Grouper Rate,5856.00
Aetna,HMO,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,3656.00
Aetna,HMO,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,6401.00
Aetna,HMO,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,6401.00
Aetna,HMO,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,3656.00
Aetna,HMO,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,6401.00
Aetna,HMO,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,3656.00
Aetna,HMO,38790,CPT4/HCPCS,INJECT FOR LYMPHATIC X-RAY,,Grouper Rate,2002.00
Aetna,HMO,38792,CPT4/HCPCS,RA TRACER ID OF SENTINL NODE,,Grouper Rate,2002.00
Aetna,HMO,38900,CPT4/HCPCS,IO MAP OF SENT LYMPH NODE,,Grouper Rate,2002.00
Aetna,HMO,38999,CPT4/HCPCS,BLOOD/LYMPH SYSTEM PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Grouper Rate,5856.00
Aetna,HMO,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Grouper Rate,5856.00
Aetna,HMO,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,3656.00
Aetna,HMO,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,3656.00
Aetna,HMO,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,3656.00
Aetna,HMO,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,3656.00
Aetna,HMO,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,3656.00
Aetna,HMO,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Grouper Rate,3656.00
Aetna,HMO,40650,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,5856.00
Aetna,HMO,40652,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,5856.00
Aetna,HMO,40654,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,5856.00
Aetna,HMO,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,7830.00
Aetna,HMO,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,7830.00
Aetna,HMO,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5856.00
Aetna,HMO,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,7830.00
Aetna,HMO,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5856.00
Aetna,HMO,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,3656.00
Aetna,HMO,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,3656.00
Aetna,HMO,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Grouper Rate,2002.00
Aetna,HMO,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,3656.00
Aetna,HMO,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,3656.00
Aetna,HMO,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Grouper Rate,2002.00
Aetna,HMO,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Grouper Rate,2002.00
Aetna,HMO,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,2002.00
Aetna,HMO,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,3656.00
Aetna,HMO,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5856.00
Aetna,HMO,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5856.00
Aetna,HMO,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,6840.00
Aetna,HMO,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,6840.00
Aetna,HMO,40899,CPT4/HCPCS,MOUTH SURGERY PROCEDURE,,Grouper Rate,6840.00
Aetna,HMO,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Grouper Rate,2002.00
Aetna,HMO,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Grouper Rate,2002.00
Aetna,HMO,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,2002.00
Aetna,HMO,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,3656.00
Aetna,HMO,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Grouper Rate,2002.00
Aetna,HMO,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,2002.00
Aetna,HMO,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,3656.00
Aetna,HMO,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,3656.00
Aetna,HMO,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,3656.00
Aetna,HMO,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Grouper Rate,2002.00
Aetna,HMO,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,HMO,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,6840.00
Aetna,HMO,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,3656.00
Aetna,HMO,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,3656.00
Aetna,HMO,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,3656.00
Aetna,HMO,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Grouper Rate,2002.00
Aetna,HMO,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Grouper Rate,3656.00
Aetna,HMO,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Grouper Rate,3656.00
Aetna,HMO,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Grouper Rate,2002.00
Aetna,HMO,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Grouper Rate,2002.00
Aetna,HMO,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Grouper Rate,2002.00
Aetna,HMO,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Grouper Rate,2002.00
Aetna,HMO,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Grouper Rate,2002.00
Aetna,HMO,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Grouper Rate,2002.00
Aetna,HMO,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,2002.00
Aetna,HMO,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,3656.00
Aetna,HMO,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,2002.00
Aetna,HMO,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,2002.00
Aetna,HMO,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,3656.00
Aetna,HMO,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,2002.00
Aetna,HMO,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Grouper Rate,2002.00
Aetna,HMO,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Grouper Rate,2002.00
Aetna,HMO,41870,CPT4/HCPCS,GUM GRAFT,,Grouper Rate,3656.00
Aetna,HMO,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Grouper Rate,2002.00
Aetna,HMO,41899,CPT4/HCPCS,DENTAL SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Grouper Rate,3656.00
Aetna,HMO,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Grouper Rate,2002.00
Aetna,HMO,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,3656.00
Aetna,HMO,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,3656.00
Aetna,HMO,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,3656.00
Aetna,HMO,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Grouper Rate,6401.00
Aetna,HMO,42140,CPT4/HCPCS,EXCISION OF UVULA,,Grouper Rate,3656.00
Aetna,HMO,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Grouper Rate,6840.00
Aetna,HMO,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Grouper Rate,2002.00
Aetna,HMO,42180,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,2002.00
Aetna,HMO,42182,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,3656.00
Aetna,HMO,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6840.00
Aetna,HMO,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6840.00
Aetna,HMO,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6840.00
Aetna,HMO,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,7830.00
Aetna,HMO,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6840.00
Aetna,HMO,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6840.00
Aetna,HMO,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,6840.00
Aetna,HMO,42235,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,6840.00
Aetna,HMO,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Grouper Rate,6401.00
Aetna,HMO,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Grouper Rate,2002.00
Aetna,HMO,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Grouper Rate,5856.00
Aetna,HMO,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,2002.00
Aetna,HMO,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,3656.00
Aetna,HMO,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,2002.00
Aetna,HMO,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,2002.00
Aetna,HMO,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,2002.00
Aetna,HMO,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,5856.00
Aetna,HMO,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,3656.00
Aetna,HMO,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,2002.00
Aetna,HMO,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,3656.00
Aetna,HMO,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Grouper Rate,5856.00
Aetna,HMO,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Grouper Rate,5856.00
Aetna,HMO,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5856.00
Aetna,HMO,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,7830.00
Aetna,HMO,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,7830.00
Aetna,HMO,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,7830.00
Aetna,HMO,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Grouper Rate,5856.00
Aetna,HMO,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Grouper Rate,3656.00
Aetna,HMO,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,5856.00
Aetna,HMO,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,6401.00
Aetna,HMO,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5856.00
Aetna,HMO,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,6401.00
Aetna,HMO,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,6401.00
Aetna,HMO,42550,CPT4/HCPCS,INJECTION FOR SALIVARY X-RAY,,Grouper Rate,2002.00
Aetna,HMO,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Grouper Rate,2002.00
Aetna,HMO,42650,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Grouper Rate,2002.00
Aetna,HMO,42660,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Grouper Rate,2002.00
Aetna,HMO,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Grouper Rate,7830.00
Aetna,HMO,42699,CPT4/HCPCS,SALIVARY SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,3656.00
Aetna,HMO,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Grouper Rate,2002.00
Aetna,HMO,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,2002.00
Aetna,HMO,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,3656.00
Aetna,HMO,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Grouper Rate,3656.00
Aetna,HMO,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Grouper Rate,2002.00
Aetna,HMO,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,5856.00
Aetna,HMO,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,6840.00
Aetna,HMO,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,5856.00
Aetna,HMO,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,6840.00
Aetna,HMO,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,6401.00
Aetna,HMO,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,6401.00
Aetna,HMO,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,6401.00
Aetna,HMO,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,6401.00
Aetna,HMO,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,6401.00
Aetna,HMO,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,6401.00
Aetna,HMO,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Grouper Rate,5856.00
Aetna,HMO,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Grouper Rate,5856.00
Aetna,HMO,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Grouper Rate,7830.00
Aetna,HMO,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,7830.00
Aetna,HMO,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Grouper Rate,2002.00
Aetna,HMO,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Grouper Rate,3656.00
Aetna,HMO,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Grouper Rate,3656.00
Aetna,HMO,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,2002.00
Aetna,HMO,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,3656.00
Aetna,HMO,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,2002.00
Aetna,HMO,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,5856.00
Aetna,HMO,42999,CPT4/HCPCS,THROAT SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,6840.00
Aetna,HMO,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Grouper Rate,3656.00
Aetna,HMO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Grouper Rate,2002.00
Aetna,HMO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Grouper Rate,2002.00
Aetna,HMO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Grouper Rate,2002.00
Aetna,HMO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Grouper Rate,3656.00
Aetna,HMO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Grouper Rate,3656.00
Aetna,HMO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Grouper Rate,2002.00
Aetna,HMO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Grouper Rate,2002.00
Aetna,HMO,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Grouper Rate,2002.00
Aetna,HMO,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Grouper Rate,2002.00
Aetna,HMO,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Grouper Rate,2002.00
Aetna,HMO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Grouper Rate,2002.00
Aetna,HMO,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Grouper Rate,5856.00
Aetna,HMO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Grouper Rate,3656.00
Aetna,HMO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Grouper Rate,3656.00
Aetna,HMO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Grouper Rate,3656.00
Aetna,HMO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Grouper Rate,3656.00
Aetna,HMO,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Grouper Rate,2002.00
Aetna,HMO,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Grouper Rate,2002.00
Aetna,HMO,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Grouper Rate,2002.00
Aetna,HMO,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Grouper Rate,3656.00
Aetna,HMO,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Grouper Rate,2002.00
Aetna,HMO,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Grouper Rate,3656.00
Aetna,HMO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Grouper Rate,3656.00
Aetna,HMO,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Grouper Rate,3656.00
Aetna,HMO,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Grouper Rate,3656.00
Aetna,HMO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Grouper Rate,3656.00
Aetna,HMO,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Grouper Rate,2002.00
Aetna,HMO,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Grouper Rate,3656.00
Aetna,HMO,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Grouper Rate,3656.00
Aetna,HMO,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,3656.00
Aetna,HMO,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Grouper Rate,3656.00
Aetna,HMO,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Grouper Rate,3656.00
Aetna,HMO,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Grouper Rate,3656.00
Aetna,HMO,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,3656.00
Aetna,HMO,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Grouper Rate,3656.00
Aetna,HMO,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Grouper Rate,3656.00
Aetna,HMO,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Grouper Rate,3656.00
Aetna,HMO,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Grouper Rate,3656.00
Aetna,HMO,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Grouper Rate,3656.00
Aetna,HMO,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Grouper Rate,3656.00
Aetna,HMO,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Grouper Rate,3656.00
Aetna,HMO,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Grouper Rate,3656.00
Aetna,HMO,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Grouper Rate,3656.00
Aetna,HMO,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Grouper Rate,3656.00
Aetna,HMO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Grouper Rate,5856.00
Aetna,HMO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Grouper Rate,5856.00
Aetna,HMO,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Grouper Rate,3656.00
Aetna,HMO,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Grouper Rate,5856.00
Aetna,HMO,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Grouper Rate,5856.00
Aetna,HMO,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Grouper Rate,3656.00
Aetna,HMO,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,3656.00
Aetna,HMO,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,3656.00
Aetna,HMO,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Grouper Rate,3656.00
Aetna,HMO,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Grouper Rate,3656.00
Aetna,HMO,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Grouper Rate,3656.00
Aetna,HMO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Grouper Rate,5856.00
Aetna,HMO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Grouper Rate,5856.00
Aetna,HMO,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Grouper Rate,5856.00
Aetna,HMO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Grouper Rate,5856.00
Aetna,HMO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Grouper Rate,5856.00
Aetna,HMO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Grouper Rate,5856.00
Aetna,HMO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Grouper Rate,5856.00
Aetna,HMO,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Grouper Rate,6840.00
Aetna,HMO,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Grouper Rate,6840.00
Aetna,HMO,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Grouper Rate,6840.00
Aetna,HMO,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Grouper Rate,6840.00
Aetna,HMO,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Grouper Rate,6401.00
Aetna,HMO,43289,CPT4/HCPCS,LAPAROSCOPE PROC ESOPH,,Grouper Rate,5856.00
Aetna,HMO,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,3656.00
Aetna,HMO,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Grouper Rate,2002.00
Aetna,HMO,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,2002.00
Aetna,HMO,43499,CPT4/HCPCS,ESOPHAGUS SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Grouper Rate,5856.00
Aetna,HMO,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Grouper Rate,5856.00
Aetna,HMO,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,6840.00
Aetna,HMO,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,6840.00
Aetna,HMO,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Grouper Rate,7188.00
Aetna,HMO,43659,CPT4/HCPCS,LAPAROSCOPE PROC STOM,,Grouper Rate,5856.00
Aetna,HMO,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Grouper Rate,3656.00
Aetna,HMO,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Grouper Rate,2002.00
Aetna,HMO,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Grouper Rate,2002.00
Aetna,HMO,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Grouper Rate,2002.00
Aetna,HMO,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Grouper Rate,2002.00
Aetna,HMO,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Grouper Rate,2002.00
Aetna,HMO,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Grouper Rate,2002.00
Aetna,HMO,43762,CPT4/HCPCS,RPLC GTUBE NO REVJ TRC,,Grouper Rate,2002.00
Aetna,HMO,43763,CPT4/HCPCS,RPLC GTUBE REVJ GSTRST TRC,,Grouper Rate,2002.00
Aetna,HMO,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Grouper Rate,5856.00
Aetna,HMO,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Grouper Rate,5856.00
Aetna,HMO,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Grouper Rate,5856.00
Aetna,HMO,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Grouper Rate,5856.00
Aetna,HMO,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Grouper Rate,5856.00
Aetna,HMO,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Grouper Rate,2002.00
Aetna,HMO,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Grouper Rate,2002.00
Aetna,HMO,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Grouper Rate,2002.00
Aetna,HMO,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Grouper Rate,3656.00
Aetna,HMO,43999,CPT4/HCPCS,STOMACH SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Grouper Rate,7830.00
Aetna,HMO,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Grouper Rate,7188.00
Aetna,HMO,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Grouper Rate,7188.00
Aetna,HMO,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Grouper Rate,7188.00
Aetna,HMO,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Grouper Rate,7188.00
Aetna,HMO,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Grouper Rate,7830.00
Aetna,HMO,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Grouper Rate,2002.00
Aetna,HMO,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Grouper Rate,5856.00
Aetna,HMO,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Grouper Rate,6840.00
Aetna,HMO,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Grouper Rate,5856.00
Aetna,HMO,44188,CPT4/HCPCS,LAP COLOSTOMY,,Grouper Rate,5856.00
Aetna,HMO,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Grouper Rate,6840.00
Aetna,HMO,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Grouper Rate,5856.00
Aetna,HMO,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Grouper Rate,5856.00
Aetna,HMO,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,2002.00
Aetna,HMO,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5856.00
Aetna,HMO,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,6401.00
Aetna,HMO,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,6401.00
Aetna,HMO,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,3656.00
Aetna,HMO,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Grouper Rate,6840.00
Aetna,HMO,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,3656.00
Aetna,HMO,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Grouper Rate,6840.00
Aetna,HMO,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,2002.00
Aetna,HMO,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,2002.00
Aetna,HMO,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Grouper Rate,2002.00
Aetna,HMO,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Grouper Rate,2002.00
Aetna,HMO,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Grouper Rate,2002.00
Aetna,HMO,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Grouper Rate,2002.00
Aetna,HMO,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Grouper Rate,2002.00
Aetna,HMO,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Grouper Rate,2002.00
Aetna,HMO,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Grouper Rate,2002.00
Aetna,HMO,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Grouper Rate,2002.00
Aetna,HMO,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,2002.00
Aetna,HMO,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,2002.00
Aetna,HMO,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Grouper Rate,2002.00
Aetna,HMO,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Grouper Rate,2002.00
Aetna,HMO,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Grouper Rate,2002.00
Aetna,HMO,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Grouper Rate,2002.00
Aetna,HMO,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,2002.00
Aetna,HMO,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Grouper Rate,2002.00
Aetna,HMO,44799,CPT4/HCPCS,UNLISTED PX SMALL INTESTINE,,Grouper Rate,2002.00
Aetna,HMO,44950,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,6401.00
Aetna,HMO,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Grouper Rate,5856.00
Aetna,HMO,44979,CPT4/HCPCS,LAPAROSCOPE PROC APP,,Grouper Rate,5856.00
Aetna,HMO,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,3656.00
Aetna,HMO,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,3656.00
Aetna,HMO,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Grouper Rate,2002.00
Aetna,HMO,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Grouper Rate,3656.00
Aetna,HMO,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Grouper Rate,3656.00
Aetna,HMO,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Grouper Rate,3656.00
Aetna,HMO,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Grouper Rate,2002.00
Aetna,HMO,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Grouper Rate,3656.00
Aetna,HMO,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Grouper Rate,3656.00
Aetna,HMO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,Per Diem,5769.00
Aetna,HMO,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Grouper Rate,2002.00
Aetna,HMO,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Grouper Rate,2002.00
Aetna,HMO,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Grouper Rate,2002.00
Aetna,HMO,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Grouper Rate,2002.00
Aetna,HMO,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,2002.00
Aetna,HMO,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,2002.00
Aetna,HMO,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,2002.00
Aetna,HMO,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Grouper Rate,2002.00
Aetna,HMO,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Grouper Rate,2002.00
Aetna,HMO,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Grouper Rate,2002.00
Aetna,HMO,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Grouper Rate,2002.00
Aetna,HMO,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Grouper Rate,2002.00
Aetna,HMO,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Grouper Rate,2002.00
Aetna,HMO,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Grouper Rate,2002.00
Aetna,HMO,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Grouper Rate,2002.00
Aetna,HMO,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Grouper Rate,2002.00
Aetna,HMO,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Grouper Rate,2002.00
Aetna,HMO,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Grouper Rate,2002.00
Aetna,HMO,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Grouper Rate,2002.00
Aetna,HMO,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Grouper Rate,2002.00
Aetna,HMO,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Grouper Rate,2002.00
Aetna,HMO,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Grouper Rate,2002.00
Aetna,HMO,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Grouper Rate,2002.00
Aetna,HMO,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Grouper Rate,2002.00
Aetna,HMO,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Grouper Rate,3656.00
Aetna,HMO,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Grouper Rate,3656.00
Aetna,HMO,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Grouper Rate,3656.00
Aetna,HMO,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Grouper Rate,3656.00
Aetna,HMO,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,3656.00
Aetna,HMO,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,3656.00
Aetna,HMO,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Grouper Rate,3656.00
Aetna,HMO,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Grouper Rate,3656.00
Aetna,HMO,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,3656.00
Aetna,HMO,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,3656.00
Aetna,HMO,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Grouper Rate,3656.00
Aetna,HMO,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Grouper Rate,3656.00
Aetna,HMO,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,3656.00
Aetna,HMO,45395,CPT4/HCPCS,LAP REMOVAL OF RECTUM,,Grouper Rate,5856.00
Aetna,HMO,45397,CPT4/HCPCS,LAP REMOVE RECTUM W/POUCH,,Grouper Rate,5856.00
Aetna,HMO,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Grouper Rate,3656.00
Aetna,HMO,45399,CPT4/HCPCS,UNLISTED PROCEDURE COLON,,Grouper Rate,2002.00
Aetna,HMO,454,DRG,Combined anterior/posterior spinal fusion w CC,,Per Diem,5769.00
Aetna,HMO,45400,CPT4/HCPCS,LAPAROSCOPIC PROC,,Grouper Rate,5856.00
Aetna,HMO,45402,CPT4/HCPCS,LAP PROCTOPEXY W/SIG RESECT,,Grouper Rate,5856.00
Aetna,HMO,45499,CPT4/HCPCS,LAPAROSCOPE PROC RECTUM,,Grouper Rate,5856.00
Aetna,HMO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,Per Diem,5769.00
Aetna,HMO,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,3656.00
Aetna,HMO,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,3656.00
Aetna,HMO,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Grouper Rate,2002.00
Aetna,HMO,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,3656.00
Aetna,HMO,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Grouper Rate,3656.00
Aetna,HMO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,Per Diem,5769.00
Aetna,HMO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,Per Diem,5769.00
Aetna,HMO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,Per Diem,5769.00
Aetna,HMO,459,DRG,Spinal fusion except cervical w MCC,,Per Diem,5769.00
Aetna,HMO,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Grouper Rate,2002.00
Aetna,HMO,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Grouper Rate,2002.00
Aetna,HMO,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Grouper Rate,2002.00
Aetna,HMO,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Grouper Rate,2002.00
Aetna,HMO,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Grouper Rate,3656.00
Aetna,HMO,460,DRG,Spinal fusion except cervical w/o MCC,,Per Diem,5769.00
Aetna,HMO,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Grouper Rate,5856.00
Aetna,HMO,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Grouper Rate,2002.00
Aetna,HMO,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,5856.00
Aetna,HMO,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,3656.00
Aetna,HMO,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,3656.00
Aetna,HMO,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Grouper Rate,2002.00
Aetna,HMO,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Grouper Rate,5856.00
Aetna,HMO,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Grouper Rate,2002.00
Aetna,HMO,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Grouper Rate,3656.00
Aetna,HMO,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Grouper Rate,2002.00
Aetna,HMO,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Grouper Rate,2002.00
Aetna,HMO,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Grouper Rate,2002.00
Aetna,HMO,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Grouper Rate,5856.00
Aetna,HMO,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Grouper Rate,5856.00
Aetna,HMO,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Grouper Rate,5856.00
Aetna,HMO,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Grouper Rate,5856.00
Aetna,HMO,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Grouper Rate,5856.00
Aetna,HMO,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Grouper Rate,6401.00
Aetna,HMO,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Grouper Rate,6401.00
Aetna,HMO,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Grouper Rate,5856.00
Aetna,HMO,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Grouper Rate,5856.00
Aetna,HMO,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Grouper Rate,6401.00
Aetna,HMO,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Grouper Rate,2002.00
Aetna,HMO,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Grouper Rate,6401.00
Aetna,HMO,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Grouper Rate,2002.00
Aetna,HMO,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Grouper Rate,2002.00
Aetna,HMO,46600,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY SPX,,Grouper Rate,2002.00
Aetna,HMO,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Grouper Rate,2002.00
Aetna,HMO,46606,CPT4/HCPCS,ANOSCOPY AND BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Grouper Rate,2002.00
Aetna,HMO,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Grouper Rate,2002.00
Aetna,HMO,46611,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Grouper Rate,2002.00
Aetna,HMO,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Grouper Rate,2002.00
Aetna,HMO,46615,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,3656.00
Aetna,HMO,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,5856.00
Aetna,HMO,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Grouper Rate,2002.00
Aetna,HMO,46710,CPT4/HCPCS,REPR PER/VAG POUCH SNGL PROC,,Grouper Rate,5856.00
Aetna,HMO,46712,CPT4/HCPCS,REPR PER/VAG POUCH DBL PROC,,Grouper Rate,5856.00
Aetna,HMO,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,5856.00
Aetna,HMO,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Grouper Rate,5856.00
Aetna,HMO,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Grouper Rate,3656.00
Aetna,HMO,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3656.00
Aetna,HMO,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,5856.00
Aetna,HMO,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,2002.00
Aetna,HMO,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,3656.00
Aetna,HMO,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Grouper Rate,3656.00
Aetna,HMO,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Grouper Rate,2002.00
Aetna,HMO,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Grouper Rate,2002.00
Aetna,HMO,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,2002.00
Aetna,HMO,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Grouper Rate,2002.00
Aetna,HMO,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,2002.00
Aetna,HMO,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,2002.00
Aetna,HMO,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Grouper Rate,3656.00
Aetna,HMO,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Grouper Rate,3656.00
Aetna,HMO,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Grouper Rate,7830.00
Aetna,HMO,46948,CPT4/HCPCS,INT HRHC TRANAL DARTLZJ 2+,,Grouper Rate,3656.00
Aetna,HMO,46999,CPT4/HCPCS,ANUS SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Grouper Rate,2002.00
Aetna,HMO,47001,CPT4/HCPCS,NEEDLE BIOPSY LIVER ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,471,DRG,Cervical spinal fusion w MCC,,Per Diem,5769.00
Aetna,HMO,472,DRG,Cervical spinal fusion w CC,,Per Diem,5769.00
Aetna,HMO,473,DRG,Cervical spinal fusion w/o CC/MCC,,Per Diem,5769.00
Aetna,HMO,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Grouper Rate,6401.00
Aetna,HMO,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Grouper Rate,6401.00
Aetna,HMO,47379,CPT4/HCPCS,LAPAROSCOPE PROCEDURE LIVER,,Grouper Rate,6840.00
Aetna,HMO,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Grouper Rate,6840.00
Aetna,HMO,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Grouper Rate,6840.00
Aetna,HMO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Grouper Rate,6401.00
Aetna,HMO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Grouper Rate,9770.00
Aetna,HMO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,2002.00
Aetna,HMO,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,3656.00
Aetna,HMO,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,3656.00
Aetna,HMO,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,3656.00
Aetna,HMO,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Grouper Rate,3656.00
Aetna,HMO,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Grouper Rate,3656.00
Aetna,HMO,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Grouper Rate,2002.00
Aetna,HMO,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,5856.00
Aetna,HMO,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,5856.00
Aetna,HMO,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,5856.00
Aetna,HMO,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Grouper Rate,3656.00
Aetna,HMO,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Grouper Rate,2002.00
Aetna,HMO,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Grouper Rate,2002.00
Aetna,HMO,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Grouper Rate,2002.00
Aetna,HMO,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Grouper Rate,3656.00
Aetna,HMO,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,5856.00
Aetna,HMO,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,5856.00
Aetna,HMO,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,5856.00
Aetna,HMO,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,5856.00
Aetna,HMO,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Grouper Rate,6840.00
Aetna,HMO,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Grouper Rate,6840.00
Aetna,HMO,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Grouper Rate,7830.00
Aetna,HMO,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Grouper Rate,7830.00
Aetna,HMO,47579,CPT4/HCPCS,LAPAROSCOPE PROC BILIARY,,Grouper Rate,5856.00
Aetna,HMO,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6401.00
Aetna,HMO,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6840.00
Aetna,HMO,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,7188.00
Aetna,HMO,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,7188.00
Aetna,HMO,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,7830.00
Aetna,HMO,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Grouper Rate,2002.00
Aetna,HMO,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,6401.00
Aetna,HMO,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Grouper Rate,6401.00
Aetna,HMO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Grouper Rate,3656.00
Aetna,HMO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Grouper Rate,3656.00
Aetna,HMO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Grouper Rate,3656.00
Aetna,HMO,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Grouper Rate,2002.00
Aetna,HMO,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Grouper Rate,3656.00
Aetna,HMO,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Grouper Rate,6401.00
Aetna,HMO,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Grouper Rate,5856.00
Aetna,HMO,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Grouper Rate,6401.00
Aetna,HMO,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Grouper Rate,6401.00
Aetna,HMO,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Grouper Rate,5856.00
Aetna,HMO,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Grouper Rate,6401.00
Aetna,HMO,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Grouper Rate,6401.00
Aetna,HMO,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,49327,CPT4/HCPCS,LAP INS DEVICE FOR RT,,Grouper Rate,2002.00
Aetna,HMO,49329,CPT4/HCPCS,LAPARO PROC ABDM/PER/OMENT,,Grouper Rate,2002.00
Aetna,HMO,49400,CPT4/HCPCS,AIR INJECTION INTO ABDOMEN,,Grouper Rate,2002.00
Aetna,HMO,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Grouper Rate,3656.00
Aetna,HMO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Grouper Rate,3656.00
Aetna,HMO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Grouper Rate,3656.00
Aetna,HMO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Grouper Rate,5856.00
Aetna,HMO,49411,CPT4/HCPCS,INS MARK ABD/PEL FOR RT PERQ,,Grouper Rate,2002.00
Aetna,HMO,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Grouper Rate,3656.00
Aetna,HMO,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Grouper Rate,3656.00
Aetna,HMO,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Grouper Rate,3656.00
Aetna,HMO,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Grouper Rate,2002.00
Aetna,HMO,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Grouper Rate,2002.00
Aetna,HMO,49424,CPT4/HCPCS,ASSESS CYST CONTRAST INJECT,,Grouper Rate,2002.00
Aetna,HMO,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Grouper Rate,3656.00
Aetna,HMO,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Grouper Rate,3656.00
Aetna,HMO,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,Grouper Rate,2002.00
Aetna,HMO,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Grouper Rate,3656.00
Aetna,HMO,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Grouper Rate,2002.00
Aetna,HMO,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Grouper Rate,2002.00
Aetna,HMO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Grouper Rate,3656.00
Aetna,HMO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Grouper Rate,3656.00
Aetna,HMO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Grouper Rate,3656.00
Aetna,HMO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Grouper Rate,2002.00
Aetna,HMO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Grouper Rate,2002.00
Aetna,HMO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Grouper Rate,2002.00
Aetna,HMO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Grouper Rate,2002.00
Aetna,HMO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Grouper Rate,2002.00
Aetna,HMO,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Grouper Rate,2002.00
Aetna,HMO,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Grouper Rate,6401.00
Aetna,HMO,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Grouper Rate,6840.00
Aetna,HMO,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Grouper Rate,6401.00
Aetna,HMO,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Grouper Rate,6401.00
Aetna,HMO,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Grouper Rate,6401.00
Aetna,HMO,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Grouper Rate,6401.00
Aetna,HMO,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Grouper Rate,6401.00
Aetna,HMO,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Grouper Rate,6401.00
Aetna,HMO,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Grouper Rate,6401.00
Aetna,HMO,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Grouper Rate,6401.00
Aetna,HMO,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Grouper Rate,6401.00
Aetna,HMO,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Grouper Rate,3656.00
Aetna,HMO,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Grouper Rate,6840.00
Aetna,HMO,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Grouper Rate,6401.00
Aetna,HMO,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Grouper Rate,6840.00
Aetna,HMO,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Grouper Rate,6401.00
Aetna,HMO,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Grouper Rate,6401.00
Aetna,HMO,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Grouper Rate,6401.00
Aetna,HMO,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Grouper Rate,6401.00
Aetna,HMO,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Grouper Rate,6840.00
Aetna,HMO,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Grouper Rate,7830.00
Aetna,HMO,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Grouper Rate,6401.00
Aetna,HMO,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Grouper Rate,6401.00
Aetna,HMO,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Grouper Rate,6401.00
Aetna,HMO,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Grouper Rate,6401.00
Aetna,HMO,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Grouper Rate,6401.00
Aetna,HMO,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Grouper Rate,6401.00
Aetna,HMO,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Grouper Rate,5856.00
Aetna,HMO,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,6401.00
Aetna,HMO,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,6401.00
Aetna,HMO,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Grouper Rate,6401.00
Aetna,HMO,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Grouper Rate,7830.00
Aetna,HMO,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Grouper Rate,6401.00
Aetna,HMO,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Grouper Rate,6401.00
Aetna,HMO,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Grouper Rate,6401.00
Aetna,HMO,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Grouper Rate,6401.00
Aetna,HMO,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Grouper Rate,6401.00
Aetna,HMO,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Grouper Rate,6401.00
Aetna,HMO,49659,CPT4/HCPCS,LAPARO PROC HERNIA REPAIR,,Grouper Rate,6840.00
Aetna,HMO,49999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Grouper Rate,3656.00
Aetna,HMO,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Grouper Rate,5856.00
Aetna,HMO,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,6401.00
Aetna,HMO,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,6840.00
Aetna,HMO,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Grouper Rate,2002.00
Aetna,HMO,50250,CPT4/HCPCS,CRYOABLATE RENAL MASS OPEN,,Grouper Rate,7830.00
Aetna,HMO,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Grouper Rate,2002.00
Aetna,HMO,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Grouper Rate,2002.00
Aetna,HMO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Grouper Rate,2002.00
Aetna,HMO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Grouper Rate,2002.00
Aetna,HMO,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Grouper Rate,2002.00
Aetna,HMO,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Grouper Rate,2002.00
Aetna,HMO,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Grouper Rate,2002.00
Aetna,HMO,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Grouper Rate,2002.00
Aetna,HMO,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Grouper Rate,2002.00
Aetna,HMO,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,2002.00
Aetna,HMO,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,2002.00
Aetna,HMO,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Grouper Rate,3656.00
Aetna,HMO,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Grouper Rate,3656.00
Aetna,HMO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Grouper Rate,2002.00
Aetna,HMO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Grouper Rate,2002.00
Aetna,HMO,50436,CPT4/HCPCS,DILAT XST TRC NDURLGC PX,,Grouper Rate,2002.00
Aetna,HMO,50437,CPT4/HCPCS,DILAT XST TRC NEW ACCESS RCS,,Grouper Rate,3656.00
Aetna,HMO,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Grouper Rate,2002.00
Aetna,HMO,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Grouper Rate,6840.00
Aetna,HMO,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Grouper Rate,7830.00
Aetna,HMO,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Grouper Rate,7830.00
Aetna,HMO,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Grouper Rate,6840.00
Aetna,HMO,50546,CPT4/HCPCS,LAPAROSCOPIC NEPHRECTOMY,,Grouper Rate,6840.00
Aetna,HMO,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Grouper Rate,6840.00
Aetna,HMO,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Grouper Rate,6840.00
Aetna,HMO,50549,CPT4/HCPCS,LAPAROSCOPE PROC RENAL,,Grouper Rate,5856.00
Aetna,HMO,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,HMO,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,HMO,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Grouper Rate,3656.00
Aetna,HMO,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,HMO,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,HMO,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Case Rate,8792.00
Aetna,HMO,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Grouper Rate,6401.00
Aetna,HMO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Grouper Rate,9770.00
Aetna,HMO,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Grouper Rate,6840.00
Aetna,HMO,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Grouper Rate,6840.00
Aetna,HMO,50606,CPT4/HCPCS,ENDOLUMINAL BX URTR RNL PLVS,,Grouper Rate,2002.00
Aetna,HMO,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,6840.00
Aetna,HMO,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,6840.00
Aetna,HMO,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,6840.00
Aetna,HMO,50650,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,7188.00
Aetna,HMO,50660,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,7188.00
Aetna,HMO,50684,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,2002.00
Aetna,HMO,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Grouper Rate,2002.00
Aetna,HMO,50690,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,2002.00
Aetna,HMO,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,5856.00
Aetna,HMO,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,5856.00
Aetna,HMO,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,5856.00
Aetna,HMO,50705,CPT4/HCPCS,URETERAL EMBOLIZATION/OCCL,,Grouper Rate,2002.00
Aetna,HMO,50706,CPT4/HCPCS,BALLOON DILATE URTRL STRIX,,Grouper Rate,2002.00
Aetna,HMO,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Grouper Rate,7188.00
Aetna,HMO,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,7188.00
Aetna,HMO,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,7188.00
Aetna,HMO,50949,CPT4/HCPCS,LAPAROSCOPE PROC URETER,,Grouper Rate,6840.00
Aetna,HMO,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,2002.00
Aetna,HMO,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,2002.00
Aetna,HMO,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,HMO,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,HMO,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Grouper Rate,2002.00
Aetna,HMO,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,2002.00
Aetna,HMO,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,HMO,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,HMO,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,6401.00
Aetna,HMO,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,6401.00
Aetna,HMO,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Grouper Rate,6401.00
Aetna,HMO,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Grouper Rate,6401.00
Aetna,HMO,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Grouper Rate,6401.00
Aetna,HMO,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Grouper Rate,6401.00
Aetna,HMO,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,Grouper Rate,2002.00
Aetna,HMO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Grouper Rate,2002.00
Aetna,HMO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Grouper Rate,2002.00
Aetna,HMO,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Grouper Rate,6401.00
Aetna,HMO,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,6401.00
Aetna,HMO,51700,CPT4/HCPCS,IRRIGATION OF BLADDER,,Grouper Rate,2002.00
Aetna,HMO,51701,CPT4/HCPCS,INSERT BLADDER CATHETER,,Grouper Rate,2002.00
Aetna,HMO,51702,CPT4/HCPCS,INSERT TEMP BLADDER CATH,,Grouper Rate,2002.00
Aetna,HMO,51703,CPT4/HCPCS,INSERT BLADDER CATH COMPLEX,,Grouper Rate,2002.00
Aetna,HMO,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,2002.00
Aetna,HMO,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,2002.00
Aetna,HMO,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Fee Schedule,732.14
Aetna,HMO,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Grouper Rate,2002.00
Aetna,HMO,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Grouper Rate,2002.00
Aetna,HMO,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Grouper Rate,2002.00
Aetna,HMO,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Grouper Rate,2002.00
Aetna,HMO,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Grouper Rate,2002.00
Aetna,HMO,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,2002.00
Aetna,HMO,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Grouper Rate,2002.00
Aetna,HMO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,Per Diem,5769.00
Aetna,HMO,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Grouper Rate,7830.00
Aetna,HMO,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Grouper Rate,7830.00
Aetna,HMO,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,7830.00
Aetna,HMO,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,7830.00
Aetna,HMO,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Grouper Rate,6840.00
Aetna,HMO,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,3656.00
Aetna,HMO,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,6401.00
Aetna,HMO,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Grouper Rate,2002.00
Aetna,HMO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,Per Diem,5769.00
Aetna,HMO,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Grouper Rate,6401.00
Aetna,HMO,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Grouper Rate,5856.00
Aetna,HMO,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Grouper Rate,6840.00
Aetna,HMO,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Grouper Rate,6840.00
Aetna,HMO,51999,CPT4/HCPCS,LAPAROSCOPE PROC BLA,,Grouper Rate,5856.00
Aetna,HMO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,Per Diem,5769.00
Aetna,HMO,52000,CPT4/HCPCS,CYSTOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Grouper Rate,3656.00
Aetna,HMO,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Grouper Rate,3656.00
Aetna,HMO,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Grouper Rate,3656.00
Aetna,HMO,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Grouper Rate,3656.00
Aetna,HMO,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Grouper Rate,3656.00
Aetna,HMO,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,5856.00
Aetna,HMO,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,5856.00
Aetna,HMO,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Grouper Rate,6401.00
Aetna,HMO,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,3656.00
Aetna,HMO,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,3656.00
Aetna,HMO,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,5856.00
Aetna,HMO,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Grouper Rate,5856.00
Aetna,HMO,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Grouper Rate,3656.00
Aetna,HMO,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,5856.00
Aetna,HMO,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,2002.00
Aetna,HMO,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,3656.00
Aetna,HMO,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,6840.00
Aetna,HMO,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Grouper Rate,6401.00
Aetna,HMO,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Grouper Rate,3656.00
Aetna,HMO,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Grouper Rate,5856.00
Aetna,HMO,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Grouper Rate,5856.00
Aetna,HMO,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Grouper Rate,5856.00
Aetna,HMO,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Grouper Rate,5856.00
Aetna,HMO,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Grouper Rate,5856.00
Aetna,HMO,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Grouper Rate,5856.00
Aetna,HMO,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Grouper Rate,5856.00
Aetna,HMO,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Grouper Rate,5856.00
Aetna,HMO,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Grouper Rate,6401.00
Aetna,HMO,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Case Rate,8792.00
Aetna,HMO,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Grouper Rate,6401.00
Aetna,HMO,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Grouper Rate,6401.00
Aetna,HMO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Grouper Rate,6401.00
Aetna,HMO,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Grouper Rate,5856.00
Aetna,HMO,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Grouper Rate,5856.00
Aetna,HMO,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Grouper Rate,2002.00
Aetna,HMO,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Grouper Rate,5856.00
Aetna,HMO,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Grouper Rate,5856.00
Aetna,HMO,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Grouper Rate,6401.00
Aetna,HMO,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Grouper Rate,3656.00
Aetna,HMO,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Grouper Rate,3656.00
Aetna,HMO,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,6840.00
Aetna,HMO,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,6840.00
Aetna,HMO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Grouper Rate,6840.00
Aetna,HMO,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,3656.00
Aetna,HMO,53000,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,2002.00
Aetna,HMO,53010,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,2002.00
Aetna,HMO,53020,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,2002.00
Aetna,HMO,53025,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,2002.00
Aetna,HMO,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,3656.00
Aetna,HMO,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,5856.00
Aetna,HMO,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Grouper Rate,2002.00
Aetna,HMO,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,6840.00
Aetna,HMO,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,6840.00
Aetna,HMO,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,3656.00
Aetna,HMO,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,3656.00
Aetna,HMO,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,5856.00
Aetna,HMO,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Grouper Rate,3656.00
Aetna,HMO,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,3656.00
Aetna,HMO,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,3656.00
Aetna,HMO,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,3656.00
Aetna,HMO,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,3656.00
Aetna,HMO,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,3656.00
Aetna,HMO,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Grouper Rate,5856.00
Aetna,HMO,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Grouper Rate,3656.00
Aetna,HMO,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,3656.00
Aetna,HMO,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Grouper Rate,5856.00
Aetna,HMO,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Grouper Rate,3656.00
Aetna,HMO,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,3656.00
Aetna,HMO,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Grouper Rate,3656.00
Aetna,HMO,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Grouper Rate,3656.00
Aetna,HMO,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Grouper Rate,2002.00
Aetna,HMO,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Grouper Rate,3656.00
Aetna,HMO,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Grouper Rate,2002.00
Aetna,HMO,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Grouper Rate,2002.00
Aetna,HMO,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Grouper Rate,2002.00
Aetna,HMO,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Grouper Rate,2002.00
Aetna,HMO,53450,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,2002.00
Aetna,HMO,53460,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,2002.00
Aetna,HMO,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Grouper Rate,6840.00
Aetna,HMO,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,3656.00
Aetna,HMO,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,3656.00
Aetna,HMO,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,3656.00
Aetna,HMO,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,3656.00
Aetna,HMO,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,3656.00
Aetna,HMO,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,2002.00
Aetna,HMO,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,2002.00
Aetna,HMO,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,3656.00
Aetna,HMO,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,2002.00
Aetna,HMO,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,2002.00
Aetna,HMO,53660,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,2002.00
Aetna,HMO,53665,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,2002.00
Aetna,HMO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Grouper Rate,9770.00
Aetna,HMO,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Grouper Rate,3656.00
Aetna,HMO,53854,CPT4/HCPCS,TRURL DSTRJ PRST8 TISS RF WV,,Grouper Rate,3656.00
Aetna,HMO,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Grouper Rate,2002.00
Aetna,HMO,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Grouper Rate,3656.00
Aetna,HMO,53899,CPT4/HCPCS,UROLOGY SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,3656.00
Aetna,HMO,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,3656.00
Aetna,HMO,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Grouper Rate,6401.00
Aetna,HMO,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Grouper Rate,2002.00
Aetna,HMO,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Grouper Rate,2002.00
Aetna,HMO,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,2002.00
Aetna,HMO,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,2002.00
Aetna,HMO,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,2002.00
Aetna,HMO,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,3656.00
Aetna,HMO,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,3656.00
Aetna,HMO,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,3656.00
Aetna,HMO,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,2002.00
Aetna,HMO,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Grouper Rate,3656.00
Aetna,HMO,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Grouper Rate,3656.00
Aetna,HMO,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Grouper Rate,2002.00
Aetna,HMO,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Grouper Rate,3656.00
Aetna,HMO,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Grouper Rate,3656.00
Aetna,HMO,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Grouper Rate,3656.00
Aetna,HMO,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Grouper Rate,3656.00
Aetna,HMO,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Grouper Rate,3656.00
Aetna,HMO,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,6401.00
Aetna,HMO,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,2002.00
Aetna,HMO,54230,CPT4/HCPCS,PREPARE PENIS STUDY,,Grouper Rate,2002.00
Aetna,HMO,54240,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,2002.00
Aetna,HMO,54250,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,2002.00
Aetna,HMO,54300,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5856.00
Aetna,HMO,54304,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5856.00
Aetna,HMO,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,HMO,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,HMO,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,HMO,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,HMO,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,HMO,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,HMO,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,HMO,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5856.00
Aetna,HMO,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,6840.00
Aetna,HMO,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,7830.00
Aetna,HMO,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5856.00
Aetna,HMO,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5856.00
Aetna,HMO,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5856.00
Aetna,HMO,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Grouper Rate,5856.00
Aetna,HMO,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Grouper Rate,5856.00
Aetna,HMO,54380,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5856.00
Aetna,HMO,54385,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5856.00
Aetna,HMO,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Grouper Rate,5856.00
Aetna,HMO,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Grouper Rate,5856.00
Aetna,HMO,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Grouper Rate,5856.00
Aetna,HMO,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Grouper Rate,5856.00
Aetna,HMO,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Grouper Rate,5856.00
Aetna,HMO,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Grouper Rate,5856.00
Aetna,HMO,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Grouper Rate,6840.00
Aetna,HMO,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Grouper Rate,5856.00
Aetna,HMO,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Grouper Rate,5856.00
Aetna,HMO,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Grouper Rate,6401.00
Aetna,HMO,54420,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,6401.00
Aetna,HMO,54435,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,6401.00
Aetna,HMO,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Grouper Rate,3656.00
Aetna,HMO,54440,CPT4/HCPCS,REPAIR OF PENIS,,Grouper Rate,6401.00
Aetna,HMO,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Grouper Rate,2002.00
Aetna,HMO,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,2002.00
Aetna,HMO,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,2002.00
Aetna,HMO,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Grouper Rate,3656.00
Aetna,HMO,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,5856.00
Aetna,HMO,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Grouper Rate,5856.00
Aetna,HMO,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,6401.00
Aetna,HMO,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,6401.00
Aetna,HMO,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,6401.00
Aetna,HMO,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Grouper Rate,6401.00
Aetna,HMO,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Grouper Rate,5856.00
Aetna,HMO,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Grouper Rate,6401.00
Aetna,HMO,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Grouper Rate,6401.00
Aetna,HMO,54660,CPT4/HCPCS,REVISION OF TESTIS,,Grouper Rate,3656.00
Aetna,HMO,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Grouper Rate,5856.00
Aetna,HMO,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Grouper Rate,5856.00
Aetna,HMO,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Grouper Rate,7188.00
Aetna,HMO,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Grouper Rate,7188.00
Aetna,HMO,54699,CPT4/HCPCS,LAPAROSCOPE PROC TESTIS,,Grouper Rate,5856.00
Aetna,HMO,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Grouper Rate,3656.00
Aetna,HMO,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Grouper Rate,2002.00
Aetna,HMO,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,5856.00
Aetna,HMO,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,6401.00
Aetna,HMO,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,5856.00
Aetna,HMO,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,6401.00
Aetna,HMO,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Grouper Rate,2002.00
Aetna,HMO,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,6401.00
Aetna,HMO,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,6401.00
Aetna,HMO,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,5856.00
Aetna,HMO,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Grouper Rate,6840.00
Aetna,HMO,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Grouper Rate,6401.00
Aetna,HMO,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Grouper Rate,3656.00
Aetna,HMO,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Grouper Rate,3656.00
Aetna,HMO,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Grouper Rate,2002.00
Aetna,HMO,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,2002.00
Aetna,HMO,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,3656.00
Aetna,HMO,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Grouper Rate,3656.00
Aetna,HMO,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Grouper Rate,3656.00
Aetna,HMO,55300,CPT4/HCPCS,PREPARE SPERM DUCT X-RAY,,Grouper Rate,3656.00
Aetna,HMO,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Grouper Rate,2002.00
Aetna,HMO,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,5856.00
Aetna,HMO,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Grouper Rate,6401.00
Aetna,HMO,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,6401.00
Aetna,HMO,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,6401.00
Aetna,HMO,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Grouper Rate,6840.00
Aetna,HMO,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Grouper Rate,7188.00
Aetna,HMO,55559,CPT4/HCPCS,LAPARO PROC SPERMATIC CORD,,Grouper Rate,5856.00
Aetna,HMO,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,2002.00
Aetna,HMO,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,2002.00
Aetna,HMO,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Grouper Rate,2002.00
Aetna,HMO,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Grouper Rate,2002.00
Aetna,HMO,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,3656.00
Aetna,HMO,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,3656.00
Aetna,HMO,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Grouper Rate,3656.00
Aetna,HMO,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,3656.00
Aetna,HMO,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,7830.00
Aetna,HMO,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Grouper Rate,2002.00
Aetna,HMO,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Grouper Rate,6840.00
Aetna,HMO,55870,CPT4/HCPCS,ELECTROEJACULATION,,Grouper Rate,2002.00
Aetna,HMO,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Grouper Rate,7188.00
Aetna,HMO,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Grouper Rate,2002.00
Aetna,HMO,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Grouper Rate,5856.00
Aetna,HMO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Grouper Rate,2002.00
Aetna,HMO,55899,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Grouper Rate,3656.00
Aetna,HMO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Grouper Rate,2002.00
Aetna,HMO,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Grouper Rate,3656.00
Aetna,HMO,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Grouper Rate,3656.00
Aetna,HMO,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Grouper Rate,2002.00
Aetna,HMO,56442,CPT4/HCPCS,HYMENOTOMY,,Grouper Rate,2002.00
Aetna,HMO,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Grouper Rate,2002.00
Aetna,HMO,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Grouper Rate,5856.00
Aetna,HMO,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,2002.00
Aetna,HMO,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,2002.00
Aetna,HMO,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Grouper Rate,6840.00
Aetna,HMO,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Grouper Rate,7830.00
Aetna,HMO,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Grouper Rate,2002.00
Aetna,HMO,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Grouper Rate,5856.00
Aetna,HMO,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,5856.00
Aetna,HMO,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Grouper Rate,6840.00
Aetna,HMO,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Grouper Rate,2002.00
Aetna,HMO,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Grouper Rate,2002.00
Aetna,HMO,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Grouper Rate,2002.00
Aetna,HMO,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,3656.00
Aetna,HMO,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Grouper Rate,3656.00
Aetna,HMO,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Grouper Rate,3656.00
Aetna,HMO,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Grouper Rate,2002.00
Aetna,HMO,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Grouper Rate,2002.00
Aetna,HMO,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Grouper Rate,2002.00
Aetna,HMO,57100,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,2002.00
Aetna,HMO,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,3656.00
Aetna,HMO,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Grouper Rate,5856.00
Aetna,HMO,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Grouper Rate,3656.00
Aetna,HMO,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Grouper Rate,2002.00
Aetna,HMO,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Grouper Rate,5856.00
Aetna,HMO,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Grouper Rate,5856.00
Aetna,HMO,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Grouper Rate,5856.00
Aetna,HMO,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Grouper Rate,6840.00
Aetna,HMO,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,3656.00
Aetna,HMO,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,3656.00
Aetna,HMO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Grouper Rate,3656.00
Aetna,HMO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Grouper Rate,3656.00
Aetna,HMO,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,2002.00
Aetna,HMO,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Grouper Rate,3656.00
Aetna,HMO,57220,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,5856.00
Aetna,HMO,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Grouper Rate,5856.00
Aetna,HMO,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Grouper Rate,6840.00
Aetna,HMO,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Grouper Rate,6840.00
Aetna,HMO,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Grouper Rate,6840.00
Aetna,HMO,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Grouper Rate,7830.00
Aetna,HMO,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Grouper Rate,7830.00
Aetna,HMO,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Grouper Rate,5856.00
Aetna,HMO,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Grouper Rate,6840.00
Aetna,HMO,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Grouper Rate,6840.00
Aetna,HMO,57283,CPT4/HCPCS,COLPOPEXY INTRAPERITONEAL,,Grouper Rate,6840.00
Aetna,HMO,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Grouper Rate,6840.00
Aetna,HMO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Grouper Rate,6401.00
Aetna,HMO,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Grouper Rate,6840.00
Aetna,HMO,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Grouper Rate,6840.00
Aetna,HMO,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Grouper Rate,6840.00
Aetna,HMO,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Grouper Rate,6840.00
Aetna,HMO,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Grouper Rate,6401.00
Aetna,HMO,57295,CPT4/HCPCS,REVISE VAG GRAFT VIA VAGINA,,Grouper Rate,5856.00
Aetna,HMO,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,5856.00
Aetna,HMO,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,6840.00
Aetna,HMO,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,5856.00
Aetna,HMO,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,6401.00
Aetna,HMO,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,5856.00
Aetna,HMO,57335,CPT4/HCPCS,REPAIR VAGINA,,Grouper Rate,5856.00
Aetna,HMO,57400,CPT4/HCPCS,DILATION OF VAGINA,,Grouper Rate,3656.00
Aetna,HMO,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Grouper Rate,3656.00
Aetna,HMO,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Grouper Rate,3656.00
Aetna,HMO,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Grouper Rate,2002.00
Aetna,HMO,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Grouper Rate,2002.00
Aetna,HMO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Grouper Rate,6840.00
Aetna,HMO,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Grouper Rate,6840.00
Aetna,HMO,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Grouper Rate,6840.00
Aetna,HMO,57452,CPT4/HCPCS,EXAM OF CERVIX W/SCOPE,,Grouper Rate,3656.00
Aetna,HMO,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Grouper Rate,3656.00
Aetna,HMO,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Grouper Rate,2002.00
Aetna,HMO,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Grouper Rate,2002.00
Aetna,HMO,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Grouper Rate,3656.00
Aetna,HMO,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Grouper Rate,5856.00
Aetna,HMO,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Grouper Rate,2002.00
Aetna,HMO,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Grouper Rate,2002.00
Aetna,HMO,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Grouper Rate,3656.00
Aetna,HMO,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Grouper Rate,2002.00
Aetna,HMO,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Grouper Rate,3656.00
Aetna,HMO,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,3656.00
Aetna,HMO,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,3656.00
Aetna,HMO,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Grouper Rate,5856.00
Aetna,HMO,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,5856.00
Aetna,HMO,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Grouper Rate,6840.00
Aetna,HMO,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Grouper Rate,5856.00
Aetna,HMO,57700,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,2002.00
Aetna,HMO,57720,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,5856.00
Aetna,HMO,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Grouper Rate,2002.00
Aetna,HMO,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Grouper Rate,2002.00
Aetna,HMO,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Grouper Rate,3656.00
Aetna,HMO,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Grouper Rate,7830.00
Aetna,HMO,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Grouper Rate,6840.00
Aetna,HMO,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,7830.00
Aetna,HMO,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,7830.00
Aetna,HMO,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Grouper Rate,7830.00
Aetna,HMO,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,7830.00
Aetna,HMO,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,7830.00
Aetna,HMO,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Grouper Rate,6840.00
Aetna,HMO,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Grouper Rate,6840.00
Aetna,HMO,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Grouper Rate,6840.00
Aetna,HMO,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Grouper Rate,6840.00
Aetna,HMO,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Grouper Rate,6840.00
Aetna,HMO,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Grouper Rate,6840.00
Aetna,HMO,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Grouper Rate,6840.00
Aetna,HMO,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Grouper Rate,6840.00
Aetna,HMO,58300,CPT4/HCPCS,INSERT INTRAUTERINE DEVICE,,Grouper Rate,2002.00
Aetna,HMO,58301,CPT4/HCPCS,REMOVE INTRAUTERINE DEVICE,,Grouper Rate,2002.00
Aetna,HMO,58340,CPT4/HCPCS,CATHETER FOR HYSTEROGRAPHY,,Grouper Rate,2002.00
Aetna,HMO,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,2002.00
Aetna,HMO,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Grouper Rate,3656.00
Aetna,HMO,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,5856.00
Aetna,HMO,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Grouper Rate,7830.00
Aetna,HMO,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Grouper Rate,6840.00
Aetna,HMO,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,6840.00
Aetna,HMO,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Grouper Rate,6840.00
Aetna,HMO,58540,CPT4/HCPCS,REVISION OF UTERUS,,Grouper Rate,7830.00
Aetna,HMO,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Grouper Rate,6840.00
Aetna,HMO,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Grouper Rate,6840.00
Aetna,HMO,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Grouper Rate,6840.00
Aetna,HMO,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Grouper Rate,6840.00
Aetna,HMO,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Grouper Rate,7188.00
Aetna,HMO,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Grouper Rate,7830.00
Aetna,HMO,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Grouper Rate,7188.00
Aetna,HMO,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Grouper Rate,7830.00
Aetna,HMO,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Grouper Rate,7830.00
Aetna,HMO,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Grouper Rate,7830.00
Aetna,HMO,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Grouper Rate,2002.00
Aetna,HMO,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Grouper Rate,5856.00
Aetna,HMO,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Grouper Rate,3656.00
Aetna,HMO,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Grouper Rate,5856.00
Aetna,HMO,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Grouper Rate,5856.00
Aetna,HMO,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Grouper Rate,5856.00
Aetna,HMO,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Grouper Rate,6840.00
Aetna,HMO,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Grouper Rate,5856.00
Aetna,HMO,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Grouper Rate,7188.00
Aetna,HMO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Grouper Rate,7188.00
Aetna,HMO,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Grouper Rate,7188.00
Aetna,HMO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Grouper Rate,7188.00
Aetna,HMO,58578,CPT4/HCPCS,LAPARO PROC UTERUS,,Grouper Rate,5856.00
Aetna,HMO,58579,CPT4/HCPCS,HYSTEROSCOPE PROCEDURE,,Grouper Rate,5856.00
Aetna,HMO,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3656.00
Aetna,HMO,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3656.00
Aetna,HMO,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Grouper Rate,5856.00
Aetna,HMO,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Grouper Rate,6840.00
Aetna,HMO,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Grouper Rate,6840.00
Aetna,HMO,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Grouper Rate,6840.00
Aetna,HMO,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Grouper Rate,5856.00
Aetna,HMO,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Grouper Rate,5856.00
Aetna,HMO,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Grouper Rate,6840.00
Aetna,HMO,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Grouper Rate,6840.00
Aetna,HMO,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Grouper Rate,6840.00
Aetna,HMO,58679,CPT4/HCPCS,LAPARO PROC OVIDUCT-OVARY,,Grouper Rate,5856.00
Aetna,HMO,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Grouper Rate,6840.00
Aetna,HMO,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Grouper Rate,6840.00
Aetna,HMO,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Grouper Rate,6840.00
Aetna,HMO,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Grouper Rate,6840.00
Aetna,HMO,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Grouper Rate,6840.00
Aetna,HMO,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Grouper Rate,6840.00
Aetna,HMO,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Grouper Rate,6840.00
Aetna,HMO,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,5856.00
Aetna,HMO,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,5856.00
Aetna,HMO,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Grouper Rate,5856.00
Aetna,HMO,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Grouper Rate,5856.00
Aetna,HMO,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Grouper Rate,5856.00
Aetna,HMO,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Grouper Rate,5856.00
Aetna,HMO,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Grouper Rate,5856.00
Aetna,HMO,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Grouper Rate,6840.00
Aetna,HMO,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,6840.00
Aetna,HMO,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,7830.00
Aetna,HMO,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Grouper Rate,2002.00
Aetna,HMO,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,2002.00
Aetna,HMO,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,2002.00
Aetna,HMO,58999,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Grouper Rate,2002.00
Aetna,HMO,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Grouper Rate,2002.00
Aetna,HMO,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Grouper Rate,2002.00
Aetna,HMO,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Grouper Rate,2002.00
Aetna,HMO,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Grouper Rate,2002.00
Aetna,HMO,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Grouper Rate,2002.00
Aetna,HMO,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5856.00
Aetna,HMO,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6401.00
Aetna,HMO,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6401.00
Aetna,HMO,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6401.00
Aetna,HMO,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Grouper Rate,5856.00
Aetna,HMO,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Grouper Rate,2002.00
Aetna,HMO,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Grouper Rate,3656.00
Aetna,HMO,59320,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,2002.00
Aetna,HMO,59325,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,6401.00
Aetna,HMO,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Grouper Rate,2002.00
Aetna,HMO,59410,CPT4/HCPCS,OBSTETRICAL CARE,,Grouper Rate,2002.00
Aetna,HMO,59430,CPT4/HCPCS,CARE AFTER DELIVERY,,Grouper Rate,2002.00
Aetna,HMO,59515,CPT4/HCPCS,CESAREAN DELIVERY,,Grouper Rate,6840.00
Aetna,HMO,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Grouper Rate,5856.00
Aetna,HMO,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,6840.00
Aetna,HMO,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Grouper Rate,6840.00
Aetna,HMO,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,6840.00
Aetna,HMO,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Grouper Rate,3656.00
Aetna,HMO,59840,CPT4/HCPCS,ABORTION,,Grouper Rate,6840.00
Aetna,HMO,59841,CPT4/HCPCS,ABORTION,,Grouper Rate,6840.00
Aetna,HMO,59850,CPT4/HCPCS,ABORTION,,Grouper Rate,3656.00
Aetna,HMO,59851,CPT4/HCPCS,ABORTION,,Grouper Rate,3656.00
Aetna,HMO,59852,CPT4/HCPCS,ABORTION,,Grouper Rate,3656.00
Aetna,HMO,59856,CPT4/HCPCS,ABORTION,,Grouper Rate,3656.00
Aetna,HMO,59857,CPT4/HCPCS,ABORTION,,Grouper Rate,3656.00
Aetna,HMO,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Grouper Rate,6840.00
Aetna,HMO,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Grouper Rate,6840.00
Aetna,HMO,59897,CPT4/HCPCS,FETAL INVAS PX W/US,,Grouper Rate,2002.00
Aetna,HMO,59898,CPT4/HCPCS,LAPARO PROC OB CARE/DELIVER,,Grouper Rate,5856.00
Aetna,HMO,59899,CPT4/HCPCS,MATERNITY CARE PROCEDURE,,Grouper Rate,3656.00
Aetna,HMO,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Grouper Rate,2002.00
Aetna,HMO,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Grouper Rate,2002.00
Aetna,HMO,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Grouper Rate,3656.00
Aetna,HMO,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,6401.00
Aetna,HMO,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,6401.00
Aetna,HMO,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,3656.00
Aetna,HMO,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,5856.00
Aetna,HMO,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,7830.00
Aetna,HMO,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,7830.00
Aetna,HMO,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Grouper Rate,7830.00
Aetna,HMO,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Grouper Rate,6840.00
Aetna,HMO,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,6401.00
Aetna,HMO,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,6401.00
Aetna,HMO,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,6401.00
Aetna,HMO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Grouper Rate,2002.00
Aetna,HMO,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,7830.00
Aetna,HMO,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Grouper Rate,7830.00
Aetna,HMO,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Grouper Rate,5856.00
Aetna,HMO,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,6401.00
Aetna,HMO,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,7830.00
Aetna,HMO,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Grouper Rate,6401.00
Aetna,HMO,60659,CPT4/HCPCS,LAPARO PROC ENDOCRINE,,Grouper Rate,5856.00
Aetna,HMO,60699,CPT4/HCPCS,ENDOCRINE SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,2002.00
Aetna,HMO,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,2002.00
Aetna,HMO,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Grouper Rate,2002.00
Aetna,HMO,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,2002.00
Aetna,HMO,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Grouper Rate,2002.00
Aetna,HMO,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,2002.00
Aetna,HMO,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Grouper Rate,5856.00
Aetna,HMO,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Grouper Rate,2002.00
Aetna,HMO,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Grouper Rate,8797.00
Aetna,HMO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Grouper Rate,7188.00
Aetna,HMO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Grouper Rate,7188.00
Aetna,HMO,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,Grouper Rate,7188.00
Aetna,HMO,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,Grouper Rate,2002.00
Aetna,HMO,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,Grouper Rate,2002.00
Aetna,HMO,61783,CPT4/HCPCS,SCAN PROC SPINAL,,Grouper Rate,2002.00
Aetna,HMO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Grouper Rate,5856.00
Aetna,HMO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Grouper Rate,5856.00
Aetna,HMO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Grouper Rate,3656.00
Aetna,HMO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Grouper Rate,5856.00
Aetna,HMO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,3656.00
Aetna,HMO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,2002.00
Aetna,HMO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,2002.00
Aetna,HMO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Grouper Rate,3656.00
Aetna,HMO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Grouper Rate,3656.00
Aetna,HMO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Grouper Rate,2002.00
Aetna,HMO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Grouper Rate,2002.00
Aetna,HMO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Grouper Rate,2002.00
Aetna,HMO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Grouper Rate,2002.00
Aetna,HMO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Grouper Rate,2002.00
Aetna,HMO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Grouper Rate,2002.00
Aetna,HMO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Grouper Rate,2002.00
Aetna,HMO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Grouper Rate,2002.00
Aetna,HMO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,2002.00
Aetna,HMO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,2002.00
Aetna,HMO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Grouper Rate,2002.00
Aetna,HMO,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,Grouper Rate,2002.00
Aetna,HMO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Grouper Rate,6840.00
Aetna,HMO,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,Grouper Rate,2002.00
Aetna,HMO,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,Grouper Rate,2002.00
Aetna,HMO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Grouper Rate,3656.00
Aetna,HMO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Grouper Rate,5856.00
Aetna,HMO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,2002.00
Aetna,HMO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,2002.00
Aetna,HMO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,2002.00
Aetna,HMO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,3656.00
Aetna,HMO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,2002.00
Aetna,HMO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,2002.00
Aetna,HMO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,2002.00
Aetna,HMO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,2002.00
Aetna,HMO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,2002.00
Aetna,HMO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,2002.00
Aetna,HMO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,2002.00
Aetna,HMO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,2002.00
Aetna,HMO,62328,CPT4/HCPCS,DX LMBR SPI PNXR W/FLUOR/CT,,Grouper Rate,2002.00
Aetna,HMO,62329,CPT4/HCPCS,THER SPI PNXR CSF FLUOR/CT,,Grouper Rate,2002.00
Aetna,HMO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,3656.00
Aetna,HMO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,3656.00
Aetna,HMO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Grouper Rate,3656.00
Aetna,HMO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Grouper Rate,3656.00
Aetna,HMO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,3656.00
Aetna,HMO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,3656.00
Aetna,HMO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Grouper Rate,3656.00
Aetna,HMO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Grouper Rate,3656.00
Aetna,HMO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Grouper Rate,3656.00
Aetna,HMO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Grouper Rate,3656.00
Aetna,HMO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Grouper Rate,6840.00
Aetna,HMO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Grouper Rate,7188.00
Aetna,HMO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Grouper Rate,7188.00
Aetna,HMO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Grouper Rate,6840.00
Aetna,HMO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Grouper Rate,6840.00
Aetna,HMO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Grouper Rate,6840.00
Aetna,HMO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Grouper Rate,7188.00
Aetna,HMO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Grouper Rate,7188.00
Aetna,HMO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Grouper Rate,6401.00
Aetna,HMO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,5856.00
Aetna,HMO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Grouper Rate,6840.00
Aetna,HMO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Grouper Rate,6840.00
Aetna,HMO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Grouper Rate,6840.00
Aetna,HMO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Grouper Rate,6840.00
Aetna,HMO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Grouper Rate,2002.00
Aetna,HMO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Grouper Rate,2002.00
Aetna,HMO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Grouper Rate,6840.00
Aetna,HMO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Grouper Rate,6840.00
Aetna,HMO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Grouper Rate,6840.00
Aetna,HMO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Grouper Rate,6840.00
Aetna,HMO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,6840.00
Aetna,HMO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Grouper Rate,7188.00
Aetna,HMO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,6840.00
Aetna,HMO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,6401.00
Aetna,HMO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Grouper Rate,6840.00
Aetna,HMO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Grouper Rate,3656.00
Aetna,HMO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Grouper Rate,2002.00
Aetna,HMO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,3656.00
Aetna,HMO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,7188.00
Aetna,HMO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Grouper Rate,2002.00
Aetna,HMO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Grouper Rate,2002.00
Aetna,HMO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Grouper Rate,2002.00
Aetna,HMO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Grouper Rate,2002.00
Aetna,HMO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Grouper Rate,3656.00
Aetna,HMO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,2002.00
Aetna,HMO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,3656.00
Aetna,HMO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Grouper Rate,5856.00
Aetna,HMO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Grouper Rate,3656.00
Aetna,HMO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Grouper Rate,2002.00
Aetna,HMO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Grouper Rate,2002.00
Aetna,HMO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Grouper Rate,2002.00
Aetna,HMO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Grouper Rate,2002.00
Aetna,HMO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Grouper Rate,2002.00
Aetna,HMO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Grouper Rate,2002.00
Aetna,HMO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Grouper Rate,2002.00
Aetna,HMO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Grouper Rate,2002.00
Aetna,HMO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Grouper Rate,2002.00
Aetna,HMO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Grouper Rate,2002.00
Aetna,HMO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Grouper Rate,2002.00
Aetna,HMO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Grouper Rate,2002.00
Aetna,HMO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Grouper Rate,2002.00
Aetna,HMO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Grouper Rate,2002.00
Aetna,HMO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Grouper Rate,2002.00
Aetna,HMO,64451,CPT4/HCPCS,NJX AA&/STRD NRV NRVTG SI JT,,Grouper Rate,2002.00
Aetna,HMO,64454,CPT4/HCPCS,NJX AA&/STRD GNCLR NRV BRNCH,,Grouper Rate,2002.00
Aetna,HMO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Grouper Rate,2002.00
Aetna,HMO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Grouper Rate,2002.00
Aetna,HMO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Grouper Rate,2002.00
Aetna,HMO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Grouper Rate,2002.00
Aetna,HMO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Grouper Rate,2002.00
Aetna,HMO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Grouper Rate,2002.00
Aetna,HMO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Grouper Rate,2002.00
Aetna,HMO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Grouper Rate,2002.00
Aetna,HMO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Grouper Rate,3656.00
Aetna,HMO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Grouper Rate,3656.00
Aetna,HMO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Grouper Rate,3656.00
Aetna,HMO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Grouper Rate,3656.00
Aetna,HMO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Grouper Rate,2002.00
Aetna,HMO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Grouper Rate,2002.00
Aetna,HMO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Grouper Rate,2002.00
Aetna,HMO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Grouper Rate,2002.00
Aetna,HMO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Grouper Rate,2002.00
Aetna,HMO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Grouper Rate,2002.00
Aetna,HMO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Grouper Rate,2002.00
Aetna,HMO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Grouper Rate,2002.00
Aetna,HMO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Grouper Rate,3656.00
Aetna,HMO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Grouper Rate,2002.00
Aetna,HMO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Grouper Rate,2002.00
Aetna,HMO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,2002.00
Aetna,HMO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,2002.00
Aetna,HMO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,5856.00
Aetna,HMO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Grouper Rate,2002.00
Aetna,HMO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Grouper Rate,3656.00
Aetna,HMO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Grouper Rate,3656.00
Aetna,HMO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Grouper Rate,2002.00
Aetna,HMO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,2002.00
Aetna,HMO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,2002.00
Aetna,HMO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,5856.00
Aetna,HMO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,2002.00
Aetna,HMO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Grouper Rate,3656.00
Aetna,HMO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Grouper Rate,2002.00
Aetna,HMO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,2002.00
Aetna,HMO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,2002.00
Aetna,HMO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,2002.00
Aetna,HMO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Grouper Rate,2002.00
Aetna,HMO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Grouper Rate,2002.00
Aetna,HMO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Grouper Rate,2002.00
Aetna,HMO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Grouper Rate,2002.00
Aetna,HMO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Grouper Rate,2002.00
Aetna,HMO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,2002.00
Aetna,HMO,64624,CPT4/HCPCS,DSTRJ NULYT AGT GNCLR NRV,,Grouper Rate,2002.00
Aetna,HMO,64625,CPT4/HCPCS,RF ABLTJ NRV NRVTG SI JT,,Grouper Rate,6401.00
Aetna,HMO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,3656.00
Aetna,HMO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Grouper Rate,2002.00
Aetna,HMO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Grouper Rate,2002.00
Aetna,HMO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,Grouper Rate,2002.00
Aetna,HMO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Grouper Rate,2002.00
Aetna,HMO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,Grouper Rate,2002.00
Aetna,HMO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,2002.00
Aetna,HMO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Grouper Rate,2002.00
Aetna,HMO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,Grouper Rate,2002.00
Aetna,HMO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Grouper Rate,2002.00
Aetna,HMO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,Grouper Rate,2002.00
Aetna,HMO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Grouper Rate,2002.00
Aetna,HMO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Grouper Rate,2002.00
Aetna,HMO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,2002.00
Aetna,HMO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,2002.00
Aetna,HMO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,3656.00
Aetna,HMO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,3656.00
Aetna,HMO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Grouper Rate,2002.00
Aetna,HMO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Grouper Rate,2002.00
Aetna,HMO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Grouper Rate,3656.00
Aetna,HMO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Grouper Rate,3656.00
Aetna,HMO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Grouper Rate,3656.00
Aetna,HMO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Grouper Rate,3656.00
Aetna,HMO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Grouper Rate,5856.00
Aetna,HMO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Grouper Rate,3656.00
Aetna,HMO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Grouper Rate,3656.00
Aetna,HMO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Grouper Rate,3656.00
Aetna,HMO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Grouper Rate,2002.00
Aetna,HMO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Grouper Rate,2002.00
Aetna,HMO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Grouper Rate,2002.00
Aetna,HMO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Grouper Rate,3656.00
Aetna,HMO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Grouper Rate,3656.00
Aetna,HMO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Grouper Rate,3656.00
Aetna,HMO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Grouper Rate,3656.00
Aetna,HMO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Grouper Rate,3656.00
Aetna,HMO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Grouper Rate,3656.00
Aetna,HMO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Grouper Rate,3656.00
Aetna,HMO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Grouper Rate,3656.00
Aetna,HMO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Grouper Rate,3656.00
Aetna,HMO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Grouper Rate,3656.00
Aetna,HMO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,3656.00
Aetna,HMO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Grouper Rate,5856.00
Aetna,HMO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Grouper Rate,3656.00
Aetna,HMO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Grouper Rate,5856.00
Aetna,HMO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Grouper Rate,3656.00
Aetna,HMO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Grouper Rate,5856.00
Aetna,HMO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Grouper Rate,5856.00
Aetna,HMO,64787,CPT4/HCPCS,IMPLANT NERVE END,,Grouper Rate,3656.00
Aetna,HMO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,5856.00
Aetna,HMO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,5856.00
Aetna,HMO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,5856.00
Aetna,HMO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Grouper Rate,3656.00
Aetna,HMO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Grouper Rate,3656.00
Aetna,HMO,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,6401.00
Aetna,HMO,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,3656.00
Aetna,HMO,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,Grouper Rate,3656.00
Aetna,HMO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Grouper Rate,6401.00
Aetna,HMO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,3656.00
Aetna,HMO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,5856.00
Aetna,HMO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,5856.00
Aetna,HMO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Grouper Rate,3656.00
Aetna,HMO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Grouper Rate,3656.00
Aetna,HMO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Grouper Rate,3656.00
Aetna,HMO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Grouper Rate,3656.00
Aetna,HMO,64859,CPT4/HCPCS,NERVE SURGERY,,Grouper Rate,2002.00
Aetna,HMO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Grouper Rate,5856.00
Aetna,HMO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Grouper Rate,5856.00
Aetna,HMO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,5856.00
Aetna,HMO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,6401.00
Aetna,HMO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Grouper Rate,3656.00
Aetna,HMO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Grouper Rate,5856.00
Aetna,HMO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Grouper Rate,5856.00
Aetna,HMO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Grouper Rate,3656.00
Aetna,HMO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Grouper Rate,3656.00
Aetna,HMO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,3656.00
Aetna,HMO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,3656.00
Aetna,HMO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Grouper Rate,3656.00
Aetna,HMO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,3656.00
Aetna,HMO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,5856.00
Aetna,HMO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,5856.00
Aetna,HMO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Grouper Rate,5856.00
Aetna,HMO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,5856.00
Aetna,HMO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,3656.00
Aetna,HMO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,3656.00
Aetna,HMO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,3656.00
Aetna,HMO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,2002.00
Aetna,HMO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Grouper Rate,3656.00
Aetna,HMO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Grouper Rate,3656.00
Aetna,HMO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Grouper Rate,3656.00
Aetna,HMO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Grouper Rate,2002.00
Aetna,HMO,64999,CPT4/HCPCS,NERVOUS SYSTEM SURGERY,,Grouper Rate,2002.00
Aetna,HMO,65091,CPT4/HCPCS,REVISE EYE,,Grouper Rate,5856.00
Aetna,HMO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,65101,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,5856.00
Aetna,HMO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Grouper Rate,6401.00
Aetna,HMO,65110,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,6840.00
Aetna,HMO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,7830.00
Aetna,HMO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,7830.00
Aetna,HMO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,3656.00
Aetna,HMO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,3656.00
Aetna,HMO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Grouper Rate,2002.00
Aetna,HMO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,3656.00
Aetna,HMO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,5856.00
Aetna,HMO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,6401.00
Aetna,HMO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3656.00
Aetna,HMO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3656.00
Aetna,HMO,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3656.00
Aetna,HMO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,6401.00
Aetna,HMO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,6401.00
Aetna,HMO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,6401.00
Aetna,HMO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3656.00
Aetna,HMO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Grouper Rate,5856.00
Aetna,HMO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,2002.00
Aetna,HMO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Grouper Rate,3656.00
Aetna,HMO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,3656.00
Aetna,HMO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,6840.00
Aetna,HMO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,2002.00
Aetna,HMO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,2002.00
Aetna,HMO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Grouper Rate,2002.00
Aetna,HMO,65600,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,2002.00
Aetna,HMO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,7830.00
Aetna,HMO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,7830.00
Aetna,HMO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,7830.00
Aetna,HMO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,7830.00
Aetna,HMO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Grouper Rate,7830.00
Aetna,HMO,65760,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,7830.00
Aetna,HMO,65765,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,7830.00
Aetna,HMO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Grouper Rate,7830.00
Aetna,HMO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Grouper Rate,7830.00
Aetna,HMO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Grouper Rate,7830.00
Aetna,HMO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,6401.00
Aetna,HMO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,6401.00
Aetna,HMO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Grouper Rate,2002.00
Aetna,HMO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Grouper Rate,2002.00
Aetna,HMO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,6840.00
Aetna,HMO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,6840.00
Aetna,HMO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,6840.00
Aetna,HMO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Grouper Rate,6401.00
Aetna,HMO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,2002.00
Aetna,HMO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,5856.00
Aetna,HMO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,3656.00
Aetna,HMO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Grouper Rate,2002.00
Aetna,HMO,65850,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,6401.00
Aetna,HMO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Grouper Rate,3656.00
Aetna,HMO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,6401.00
Aetna,HMO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,2002.00
Aetna,HMO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,6401.00
Aetna,HMO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,6401.00
Aetna,HMO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,6401.00
Aetna,HMO,65900,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,6840.00
Aetna,HMO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Grouper Rate,7830.00
Aetna,HMO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Grouper Rate,6840.00
Aetna,HMO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,2002.00
Aetna,HMO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,2002.00
Aetna,HMO,66130,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,7830.00
Aetna,HMO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,6401.00
Aetna,HMO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,6401.00
Aetna,HMO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,3656.00
Aetna,HMO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,6401.00
Aetna,HMO,66172,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,6401.00
Aetna,HMO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Grouper Rate,6840.00
Aetna,HMO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Grouper Rate,6840.00
Aetna,HMO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Grouper Rate,6401.00
Aetna,HMO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Grouper Rate,6840.00
Aetna,HMO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Grouper Rate,5856.00
Aetna,HMO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Grouper Rate,5856.00
Aetna,HMO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Grouper Rate,3656.00
Aetna,HMO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Grouper Rate,6401.00
Aetna,HMO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Grouper Rate,3656.00
Aetna,HMO,66500,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,2002.00
Aetna,HMO,66505,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,2002.00
Aetna,HMO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Grouper Rate,5856.00
Aetna,HMO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,5856.00
Aetna,HMO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,5856.00
Aetna,HMO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,5856.00
Aetna,HMO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,5856.00
Aetna,HMO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,5856.00
Aetna,HMO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,3656.00
Aetna,HMO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,3656.00
Aetna,HMO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Grouper Rate,3656.00
Aetna,HMO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Grouper Rate,3656.00
Aetna,HMO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,3656.00
Aetna,HMO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,3656.00
Aetna,HMO,66761,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,2002.00
Aetna,HMO,66762,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,2002.00
Aetna,HMO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Grouper Rate,2002.00
Aetna,HMO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Grouper Rate,2002.00
Aetna,HMO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Grouper Rate,3656.00
Aetna,HMO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Grouper Rate,6401.00
Aetna,HMO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Grouper Rate,6401.00
Aetna,HMO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,6401.00
Aetna,HMO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,7830.00
Aetna,HMO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,6401.00
Aetna,HMO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,6401.00
Aetna,HMO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,6840.00
Aetna,HMO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,6840.00
Aetna,HMO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Grouper Rate,8797.00
Aetna,HMO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Grouper Rate,8797.00
Aetna,HMO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Grouper Rate,8797.00
Aetna,HMO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Grouper Rate,7188.00
Aetna,HMO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Grouper Rate,7188.00
Aetna,HMO,66987,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX W/ECP,,Grouper Rate,6840.00
Aetna,HMO,66988,CPT4/HCPCS,XCAPSL CTRC RMVL W/ECP,,Grouper Rate,6840.00
Aetna,HMO,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,66999,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,6401.00
Aetna,HMO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,6401.00
Aetna,HMO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Grouper Rate,2002.00
Aetna,HMO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Grouper Rate,2002.00
Aetna,HMO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Grouper Rate,6401.00
Aetna,HMO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Grouper Rate,2002.00
Aetna,HMO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Grouper Rate,2002.00
Aetna,HMO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Grouper Rate,3656.00
Aetna,HMO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Grouper Rate,6401.00
Aetna,HMO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,7830.00
Aetna,HMO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,7830.00
Aetna,HMO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Grouper Rate,6840.00
Aetna,HMO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Grouper Rate,6840.00
Aetna,HMO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Grouper Rate,7830.00
Aetna,HMO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Grouper Rate,6401.00
Aetna,HMO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Grouper Rate,6840.00
Aetna,HMO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,6840.00
Aetna,HMO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,7830.00
Aetna,HMO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Grouper Rate,6840.00
Aetna,HMO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Grouper Rate,3656.00
Aetna,HMO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,3656.00
Aetna,HMO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,3656.00
Aetna,HMO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,3656.00
Aetna,HMO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,2002.00
Aetna,HMO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,6840.00
Aetna,HMO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,6840.00
Aetna,HMO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,6840.00
Aetna,HMO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Grouper Rate,2002.00
Aetna,HMO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Grouper Rate,2002.00
Aetna,HMO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Grouper Rate,2002.00
Aetna,HMO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Grouper Rate,2002.00
Aetna,HMO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Grouper Rate,3656.00
Aetna,HMO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Grouper Rate,5856.00
Aetna,HMO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Grouper Rate,5856.00
Aetna,HMO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,5856.00
Aetna,HMO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,6401.00
Aetna,HMO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,6401.00
Aetna,HMO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,6401.00
Aetna,HMO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Grouper Rate,6401.00
Aetna,HMO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Grouper Rate,6401.00
Aetna,HMO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Grouper Rate,6401.00
Aetna,HMO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Grouper Rate,6401.00
Aetna,HMO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Grouper Rate,6401.00
Aetna,HMO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Grouper Rate,6401.00
Aetna,HMO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Grouper Rate,6401.00
Aetna,HMO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Grouper Rate,7830.00
Aetna,HMO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Grouper Rate,2002.00
Aetna,HMO,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,Grouper Rate,2002.00
Aetna,HMO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,5856.00
Aetna,HMO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,6401.00
Aetna,HMO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,6840.00
Aetna,HMO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,6840.00
Aetna,HMO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,6840.00
Aetna,HMO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Grouper Rate,2002.00
Aetna,HMO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,6840.00
Aetna,HMO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,6840.00
Aetna,HMO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,6840.00
Aetna,HMO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,6840.00
Aetna,HMO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,6840.00
Aetna,HMO,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,2002.00
Aetna,HMO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,2002.00
Aetna,HMO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Grouper Rate,6401.00
Aetna,HMO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Grouper Rate,3656.00
Aetna,HMO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Grouper Rate,6401.00
Aetna,HMO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Grouper Rate,2002.00
Aetna,HMO,67710,CPT4/HCPCS,INCISION OF EYELID,,Grouper Rate,2002.00
Aetna,HMO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Grouper Rate,2002.00
Aetna,HMO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,2002.00
Aetna,HMO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,2002.00
Aetna,HMO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,2002.00
Aetna,HMO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Grouper Rate,3656.00
Aetna,HMO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Grouper Rate,2002.00
Aetna,HMO,67830,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,3656.00
Aetna,HMO,67835,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,3656.00
Aetna,HMO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,3656.00
Aetna,HMO,67850,CPT4/HCPCS,TREAT EYELID LESION,,Grouper Rate,2002.00
Aetna,HMO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Grouper Rate,2002.00
Aetna,HMO,67880,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5856.00
Aetna,HMO,67882,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5856.00
Aetna,HMO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Grouper Rate,6401.00
Aetna,HMO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6840.00
Aetna,HMO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6840.00
Aetna,HMO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,HMO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,HMO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6840.00
Aetna,HMO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,HMO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,6401.00
Aetna,HMO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,5856.00
Aetna,HMO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Grouper Rate,5856.00
Aetna,HMO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5856.00
Aetna,HMO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5856.00
Aetna,HMO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,HMO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,HMO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5856.00
Aetna,HMO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5856.00
Aetna,HMO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,HMO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,HMO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,3656.00
Aetna,HMO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,3656.00
Aetna,HMO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Grouper Rate,2002.00
Aetna,HMO,67950,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3656.00
Aetna,HMO,67961,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5856.00
Aetna,HMO,67966,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5856.00
Aetna,HMO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,5856.00
Aetna,HMO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,5856.00
Aetna,HMO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,5856.00
Aetna,HMO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,5856.00
Aetna,HMO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Grouper Rate,3656.00
Aetna,HMO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Grouper Rate,2002.00
Aetna,HMO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,3656.00
Aetna,HMO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,3656.00
Aetna,HMO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,3656.00
Aetna,HMO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,2002.00
Aetna,HMO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,6401.00
Aetna,HMO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,6401.00
Aetna,HMO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,6401.00
Aetna,HMO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,6401.00
Aetna,HMO,68330,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,6401.00
Aetna,HMO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,6401.00
Aetna,HMO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Grouper Rate,6401.00
Aetna,HMO,68360,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,3656.00
Aetna,HMO,68362,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,3656.00
Aetna,HMO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Grouper Rate,3656.00
Aetna,HMO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Grouper Rate,2002.00
Aetna,HMO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Grouper Rate,2002.00
Aetna,HMO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Grouper Rate,2002.00
Aetna,HMO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Grouper Rate,5856.00
Aetna,HMO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Grouper Rate,5856.00
Aetna,HMO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Grouper Rate,2002.00
Aetna,HMO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Grouper Rate,5856.00
Aetna,HMO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Grouper Rate,2002.00
Aetna,HMO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Grouper Rate,2002.00
Aetna,HMO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,5856.00
Aetna,HMO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,5856.00
Aetna,HMO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Grouper Rate,3656.00
Aetna,HMO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Grouper Rate,2002.00
Aetna,HMO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Grouper Rate,6401.00
Aetna,HMO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,6401.00
Aetna,HMO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,6401.00
Aetna,HMO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,2002.00
Aetna,HMO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,2002.00
Aetna,HMO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Grouper Rate,6401.00
Aetna,HMO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,2002.00
Aetna,HMO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,3656.00
Aetna,HMO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,3656.00
Aetna,HMO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Grouper Rate,3656.00
Aetna,HMO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Grouper Rate,2002.00
Aetna,HMO,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,Grouper Rate,2002.00
Aetna,HMO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,2002.00
Aetna,HMO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,2002.00
Aetna,HMO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Grouper Rate,2002.00
Aetna,HMO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Grouper Rate,2002.00
Aetna,HMO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Grouper Rate,3656.00
Aetna,HMO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,3656.00
Aetna,HMO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,3656.00
Aetna,HMO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Grouper Rate,5856.00
Aetna,HMO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Grouper Rate,2002.00
Aetna,HMO,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Grouper Rate,2002.00
Aetna,HMO,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Grouper Rate,2002.00
Aetna,HMO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,3656.00
Aetna,HMO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Grouper Rate,5856.00
Aetna,HMO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,5856.00
Aetna,HMO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,7830.00
Aetna,HMO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,5856.00
Aetna,HMO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,5856.00
Aetna,HMO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Grouper Rate,2002.00
Aetna,HMO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,5856.00
Aetna,HMO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,5856.00
Aetna,HMO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Grouper Rate,5856.00
Aetna,HMO,69450,CPT4/HCPCS,EARDRUM REVISION,,Grouper Rate,2002.00
Aetna,HMO,69501,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,7830.00
Aetna,HMO,69502,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,7830.00
Aetna,HMO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Grouper Rate,7830.00
Aetna,HMO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,7830.00
Aetna,HMO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,7830.00
Aetna,HMO,69540,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,3656.00
Aetna,HMO,69550,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,6840.00
Aetna,HMO,69552,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,7830.00
Aetna,HMO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,7830.00
Aetna,HMO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,7830.00
Aetna,HMO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,7830.00
Aetna,HMO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,7830.00
Aetna,HMO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,7830.00
Aetna,HMO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,5856.00
Aetna,HMO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,3656.00
Aetna,HMO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,6840.00
Aetna,HMO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6840.00
Aetna,HMO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6840.00
Aetna,HMO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,7830.00
Aetna,HMO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,7830.00
Aetna,HMO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,7830.00
Aetna,HMO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,HMO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,HMO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,HMO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,HMO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,HMO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,HMO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Grouper Rate,7830.00
Aetna,HMO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,6840.00
Aetna,HMO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,6840.00
Aetna,HMO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,6840.00
Aetna,HMO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,6401.00
Aetna,HMO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,6401.00
Aetna,HMO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Grouper Rate,5856.00
Aetna,HMO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Grouper Rate,5856.00
Aetna,HMO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Grouper Rate,5856.00
Aetna,HMO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Grouper Rate,5856.00
Aetna,HMO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Grouper Rate,2002.00
Aetna,HMO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Grouper Rate,9770.00
Aetna,HMO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Grouper Rate,9770.00
Aetna,HMO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Grouper Rate,9770.00
Aetna,HMO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Grouper Rate,9770.00
Aetna,HMO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,6840.00
Aetna,HMO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,6840.00
Aetna,HMO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,6840.00
Aetna,HMO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,6840.00
Aetna,HMO,69799,CPT4/HCPCS,MIDDLE EAR SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,69801,CPT4/HCPCS,INCISE INNER EAR,,Grouper Rate,6840.00
Aetna,HMO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,7830.00
Aetna,HMO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,7830.00
Aetna,HMO,69905,CPT4/HCPCS,REMOVE INNER EAR,,Grouper Rate,7830.00
Aetna,HMO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Grouper Rate,7830.00
Aetna,HMO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,7830.00
Aetna,HMO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Grouper Rate,7830.00
Aetna,HMO,69949,CPT4/HCPCS,INNER EAR SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,HMO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,6401.00
Aetna,HMO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Grouper Rate,6401.00
Aetna,HMO,69979,CPT4/HCPCS,TEMPORAL BONE SURGERY,,Grouper Rate,2002.00
Aetna,HMO,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,Grouper Rate,2002.00
Aetna,HMO,70010,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Fee Schedule,770.70
Aetna,HMO,70015,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Fee Schedule,768.26
Aetna,HMO,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,Fee Schedule,176.40
Aetna,HMO,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,Fee Schedule,208.90
Aetna,HMO,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,Fee Schedule,238.56
Aetna,HMO,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Fee Schedule,226.71
Aetna,HMO,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Fee Schedule,345.07
Aetna,HMO,70134,CPT4/HCPCS,X-RAY EXAM OF MIDDLE EAR,,Fee Schedule,259.22
Aetna,HMO,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Fee Schedule,179.34
Aetna,HMO,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Fee Schedule,262.16
Aetna,HMO,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,Fee Schedule,214.87
Aetna,HMO,70170,CPT4/HCPCS,X-RAY EXAM OF TEAR DUCT,,Fee Schedule,2002.47
Aetna,HMO,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Fee Schedule,220.75
Aetna,HMO,70200,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Fee Schedule,265.18
Aetna,HMO,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Fee Schedule,194.12
Aetna,HMO,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Fee Schedule,232.59
Aetna,HMO,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,Fee Schedule,176.40
Aetna,HMO,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Fee Schedule,217.81
Aetna,HMO,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Fee Schedule,268.12
Aetna,HMO,70300,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Fee Schedule,75.76
Aetna,HMO,70310,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Fee Schedule,250.32
Aetna,HMO,70320,CPT4/HCPCS,FULL MOUTH X-RAY OF TEETH,,Fee Schedule,265.18
Aetna,HMO,70328,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Fee Schedule,191.18
Aetna,HMO,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,Fee Schedule,315.50
Aetna,HMO,70332,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Fee Schedule,498.96
Aetna,HMO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,Case Rate,2427.00
Aetna,HMO,70350,CPT4/HCPCS,X-RAY HEAD FOR ORTHODONTIA,,Fee Schedule,102.39
Aetna,HMO,70355,CPT4/HCPCS,PANORAMIC X-RAY OF JAWS,,Fee Schedule,96.43
Aetna,HMO,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,Fee Schedule,167.49
Aetna,HMO,70370,CPT4/HCPCS,THROAT X-RAY & FLUOROSCOPY,,Fee Schedule,572.96
Aetna,HMO,70371,CPT4/HCPCS,SPEECH EVALUATION COMPLEX,,Fee Schedule,466.45
Aetna,HMO,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,Fee Schedule,265.18
Aetna,HMO,70390,CPT4/HCPCS,X-RAY EXAM OF SALIVARY DUCT,,Fee Schedule,720.97
Aetna,HMO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,Case Rate,2427.00
Aetna,HMO,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,Fee Schedule,2427.00
Aetna,HMO,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,Fee Schedule,2427.00
Aetna,HMO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,Case Rate,2427.00
Aetna,HMO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,Fee Schedule,2427.00
Aetna,HMO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,Fee Schedule,2427.00
Aetna,HMO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,Case Rate,2427.00
Aetna,HMO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,Fee Schedule,2427.00
Aetna,HMO,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,Fee Schedule,2427.00
Aetna,HMO,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,Case Rate,2427.00
Aetna,HMO,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,Fee Schedule,2108.98
Aetna,HMO,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,Fee Schedule,2641.71
Aetna,HMO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,Case Rate,2427.00
Aetna,HMO,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,Case Rate,2427.00
Aetna,HMO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,Case Rate,2427.00
Aetna,HMO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,Case Rate,2427.00
Aetna,HMO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,Case Rate,2427.00
Aetna,HMO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,Case Rate,2427.00
Aetna,HMO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,Case Rate,2427.00
Aetna,HMO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,Case Rate,2427.00
Aetna,HMO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,Case Rate,2427.00
Aetna,HMO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,Case Rate,2427.00
Aetna,HMO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,Case Rate,2427.00
Aetna,HMO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,Case Rate,2427.00
Aetna,HMO,70554,CPT4/HCPCS,FMRI BRAIN BY TECH,,Case Rate,2427.00
Aetna,HMO,70555,CPT4/HCPCS,FMRI BRAIN BY PHYS/PSYCH,,Case Rate,2427.00
Aetna,HMO,70557,CPT4/HCPCS,MRI BRAIN W/O DYE,,Case Rate,2427.00
Aetna,HMO,70558,CPT4/HCPCS,MRI BRAIN W/DYE,,Case Rate,2427.00
Aetna,HMO,70559,CPT4/HCPCS,MRI BRAIN W/O & W/DYE,,Case Rate,2427.00
Aetna,HMO,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,Fee Schedule,89.54
Aetna,HMO,71046,CPT4/HCPCS,X-RAY EXAM CHEST 2 VIEWS,,Fee Schedule,165.14
Aetna,HMO,71047,CPT4/HCPCS,X-RAY EXAM CHEST 3 VIEWS,,Fee Schedule,210.50
Aetna,HMO,71048,CPT4/HCPCS,X-RAY EXAM CHEST 4+ VIEWS,,Fee Schedule,216.55
Aetna,HMO,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,Fee Schedule,188.24
Aetna,HMO,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,Fee Schedule,229.65
Aetna,HMO,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,Fee Schedule,241.50
Aetna,HMO,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,Fee Schedule,324.32
Aetna,HMO,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,Fee Schedule,194.12
Aetna,HMO,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,Fee Schedule,232.59
Aetna,HMO,71250,CPT4/HCPCS,CT THORAX DX C-,,Case Rate,2427.00
Aetna,HMO,71260,CPT4/HCPCS,CT THORAX DX C+,,Fee Schedule,2427.00
Aetna,HMO,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,Fee Schedule,2427.00
Aetna,HMO,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,Fee Schedule,2946.55
Aetna,HMO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,Case Rate,2427.00
Aetna,HMO,71551,CPT4/HCPCS,MRI CHEST W/DYE,,Case Rate,2427.00
Aetna,HMO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,Case Rate,2427.00
Aetna,HMO,71555,CPT4/HCPCS,MRI ANGIO CHEST W OR W/O DYE,,Case Rate,2427.00
Aetna,HMO,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,Fee Schedule,140.86
Aetna,HMO,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,Fee Schedule,238.56
Aetna,HMO,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,Fee Schedule,324.32
Aetna,HMO,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,Fee Schedule,427.89
Aetna,HMO,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,Fee Schedule,200.00
Aetna,HMO,72072,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 3VWS,,Fee Schedule,235.53
Aetna,HMO,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,Fee Schedule,294.75
Aetna,HMO,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,Fee Schedule,217.81
Aetna,HMO,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,Fee Schedule,210.08
Aetna,HMO,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,Fee Schedule,382.20
Aetna,HMO,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,Fee Schedule,414.87
Aetna,HMO,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,Fee Schedule,500.97
Aetna,HMO,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,Fee Schedule,253.34
Aetna,HMO,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,Fee Schedule,348.01
Aetna,HMO,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,Fee Schedule,487.11
Aetna,HMO,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,Fee Schedule,348.01
Aetna,HMO,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,Case Rate,2427.00
Aetna,HMO,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,Fee Schedule,2427.00
Aetna,HMO,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,Fee Schedule,2427.00
Aetna,HMO,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,Case Rate,2427.00
Aetna,HMO,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,Fee Schedule,2427.00
Aetna,HMO,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,Fee Schedule,2427.00
Aetna,HMO,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,Case Rate,2427.00
Aetna,HMO,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,Fee Schedule,2180.05
Aetna,HMO,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,Fee Schedule,2427.00
Aetna,HMO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,Case Rate,2427.00
Aetna,HMO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,Case Rate,2427.00
Aetna,HMO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,Case Rate,2427.00
Aetna,HMO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,Case Rate,2427.00
Aetna,HMO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,Case Rate,2427.00
Aetna,HMO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,Case Rate,2427.00
Aetna,HMO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,Case Rate,2427.00
Aetna,HMO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,Case Rate,2427.00
Aetna,HMO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,Case Rate,2427.00
Aetna,HMO,72159,CPT4/HCPCS,MR ANGIO SPINE W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Fee Schedule,155.65
Aetna,HMO,72190,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Fee Schedule,268.12
Aetna,HMO,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,Case Rate,2427.00
Aetna,HMO,72193,CPT4/HCPCS,CT PELVIS W/DYE,,Fee Schedule,2427.00
Aetna,HMO,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,Fee Schedule,2427.00
Aetna,HMO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,Case Rate,2427.00
Aetna,HMO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,Case Rate,2427.00
Aetna,HMO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,Case Rate,2427.00
Aetna,HMO,72198,CPT4/HCPCS,MR ANGIO PELVIS W/O & W/DYE,,Case Rate,2427.00
Aetna,HMO,72200,CPT4/HCPCS,X-RAY EXAM SI JOINTS,,Fee Schedule,185.22
Aetna,HMO,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,Fee Schedule,220.75
Aetna,HMO,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,Fee Schedule,182.28
Aetna,HMO,72240,CPT4/HCPCS,MYELOGRAPHY NECK SPINE,,Fee Schedule,868.89
Aetna,HMO,72255,CPT4/HCPCS,MYELOGRAPHY THORACIC SPINE,,Fee Schedule,797.91
Aetna,HMO,72265,CPT4/HCPCS,MYELOGRAPHY L-S SPINE,,Fee Schedule,845.20
Aetna,HMO,72270,CPT4/HCPCS,MYELOGPHY 2/> SPINE REGIONS,,Fee Schedule,1300.99
Aetna,HMO,72275,CPT4/HCPCS,EPIDUROGRAPHY,,Fee Schedule,644.02
Aetna,HMO,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,Fee Schedule,780.10
Aetna,HMO,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,Fee Schedule,768.26
Aetna,HMO,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,Fee Schedule,179.34
Aetna,HMO,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,Fee Schedule,185.22
Aetna,HMO,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Fee Schedule,140.86
Aetna,HMO,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Fee Schedule,182.28
Aetna,HMO,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,Fee Schedule,703.16
Aetna,HMO,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,Fee Schedule,238.56
Aetna,HMO,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,Fee Schedule,179.34
Aetna,HMO,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Fee Schedule,179.34
Aetna,HMO,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Fee Schedule,223.69
Aetna,HMO,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,Fee Schedule,614.37
Aetna,HMO,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,Fee Schedule,173.37
Aetna,HMO,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,Fee Schedule,197.06
Aetna,HMO,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Fee Schedule,191.18
Aetna,HMO,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Fee Schedule,241.50
Aetna,HMO,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,Fee Schedule,709.12
Aetna,HMO,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,Fee Schedule,170.43
Aetna,HMO,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,Fee Schedule,205.96
Aetna,HMO,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,Fee Schedule,214.87
Aetna,HMO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,Case Rate,2427.00
Aetna,HMO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,Fee Schedule,2427.00
Aetna,HMO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,Fee Schedule,2427.00
Aetna,HMO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,Case Rate,2427.00
Aetna,HMO,73219,CPT4/HCPCS,MRI UPPER EXTREMITY W/DYE,,Case Rate,2427.00
Aetna,HMO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,Case Rate,2427.00
Aetna,HMO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,Case Rate,2427.00
Aetna,HMO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,73225,CPT4/HCPCS,MR ANGIO UPR EXTR W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,Fee Schedule,165.56
Aetna,HMO,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,Fee Schedule,248.64
Aetna,HMO,73503,CPT4/HCPCS,X-RAY EXAM HIP UNI 4/> VIEWS,,Fee Schedule,308.02
Aetna,HMO,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,Fee Schedule,230.83
Aetna,HMO,73522,CPT4/HCPCS,X-RAY EXAM HIPS BI 3-4 VIEWS,,Fee Schedule,278.37
Aetna,HMO,73523,CPT4/HCPCS,X-RAY EXAM HIPS BI 5/> VIEWS,,Fee Schedule,334.74
Aetna,HMO,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,Fee Schedule,632.18
Aetna,HMO,73551,CPT4/HCPCS,X-RAY EXAM OF FEMUR 1,,Fee Schedule,159.60
Aetna,HMO,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,Fee Schedule,189.33
Aetna,HMO,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,Fee Schedule,185.22
Aetna,HMO,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,Fee Schedule,232.59
Aetna,HMO,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,Fee Schedule,265.18
Aetna,HMO,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,Fee Schedule,211.84
Aetna,HMO,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,Fee Schedule,898.54
Aetna,HMO,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,Fee Schedule,167.49
Aetna,HMO,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,Fee Schedule,200.00
Aetna,HMO,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Fee Schedule,176.40
Aetna,HMO,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Fee Schedule,208.90
Aetna,HMO,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,Fee Schedule,664.69
Aetna,HMO,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Fee Schedule,170.43
Aetna,HMO,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Fee Schedule,203.02
Aetna,HMO,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,Fee Schedule,173.37
Aetna,HMO,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,Fee Schedule,200.00
Aetna,HMO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,Case Rate,2427.00
Aetna,HMO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,Fee Schedule,2427.00
Aetna,HMO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,Fee Schedule,2427.00
Aetna,HMO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,Case Rate,2427.00
Aetna,HMO,73719,CPT4/HCPCS,MRI LOWER EXTREMITY W/DYE,,Case Rate,2427.00
Aetna,HMO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,Case Rate,2427.00
Aetna,HMO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,Case Rate,2427.00
Aetna,HMO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,73725,CPT4/HCPCS,MR ANG LWR EXT W OR W/O DYE,,Case Rate,2427.00
Aetna,HMO,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,Fee Schedule,153.04
Aetna,HMO,74019,CPT4/HCPCS,X-RAY EXAM ABDOMEN 2 VIEWS,,Fee Schedule,183.28
Aetna,HMO,74021,CPT4/HCPCS,X-RAY EXAM ABDOMEN 3+ VIEWS,,Fee Schedule,213.52
Aetna,HMO,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,Fee Schedule,285.85
Aetna,HMO,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,Case Rate,2427.00
Aetna,HMO,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,Fee Schedule,2427.00
Aetna,HMO,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,Fee Schedule,2427.00
Aetna,HMO,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,Case Rate,2427.00
Aetna,HMO,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,Case Rate,2427.00
Aetna,HMO,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,Case Rate,2427.00
Aetna,HMO,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,Case Rate,2427.00
Aetna,HMO,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,Case Rate,2427.00
Aetna,HMO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,Case Rate,2427.00
Aetna,HMO,74182,CPT4/HCPCS,MRI ABDOMEN W/DYE,,Case Rate,2427.00
Aetna,HMO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,Case Rate,2427.00
Aetna,HMO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,Case Rate,2427.00
Aetna,HMO,74190,CPT4/HCPCS,X-RAY EXAM OF PERITONEUM,,Fee Schedule,2002.47
Aetna,HMO,74210,CPT4/HCPCS,X-RAY XM PHRNX&/CRV ESOPH C+,,Fee Schedule,531.55
Aetna,HMO,74220,CPT4/HCPCS,X-RAY XM ESOPHAGUS 1CNTRST,,Fee Schedule,587.74
Aetna,HMO,74230,CPT4/HCPCS,X-RAY XM SWLNG FUNCJ C+,,Fee Schedule,570.02
Aetna,HMO,74235,CPT4/HCPCS,REMOVE ESOPHAGUS OBSTRUCTION,,Fee Schedule,1034.79
Aetna,HMO,74240,CPT4/HCPCS,X-RAY XM UPR GI TRC 1CNTRST,,Fee Schedule,676.53
Aetna,HMO,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,Fee Schedule,753.48
Aetna,HMO,74250,CPT4/HCPCS,X-RAY XM SM INT 1CNTRST STD,,Fee Schedule,726.85
Aetna,HMO,74251,CPT4/HCPCS,X-RAY XM SM INT 2CNTRST STD,,Fee Schedule,1234.12
Aetna,HMO,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,Case Rate,2427.00
Aetna,HMO,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,Case Rate,2427.00
Aetna,HMO,74263,CPT4/HCPCS,CT COLONOGRAPHY SCREENING,,Case Rate,2427.00
Aetna,HMO,74270,CPT4/HCPCS,X-RAY XM COLON 1CNTRST STD,,Fee Schedule,756.42
Aetna,HMO,74280,CPT4/HCPCS,X-RAY XM COLON 2CNTRST STD,,Fee Schedule,1235.89
Aetna,HMO,74283,CPT4/HCPCS,THER NMA RDCTJ INTUS/OBSTRCJ,,Fee Schedule,753.48
Aetna,HMO,74290,CPT4/HCPCS,CONTRAST X-RAY GALLBLADDER,,Fee Schedule,460.48
Aetna,HMO,74300,CPT4/HCPCS,X-RAY BILE DUCTS/PANCREAS,,Fee Schedule,289.88
Aetna,HMO,74301,CPT4/HCPCS,X-RAYS AT SURGERY ADD-ON,,Fee Schedule,176.90
Aetna,HMO,74328,CPT4/HCPCS,X-RAY BILE DUCT ENDOSCOPY,,Fee Schedule,716.52
Aetna,HMO,74329,CPT4/HCPCS,X-RAY FOR PANCREAS ENDOSCOPY,,Fee Schedule,570.94
Aetna,HMO,74330,CPT4/HCPCS,X-RAY BILE/PANC ENDOSCOPY,,Fee Schedule,1067.38
Aetna,HMO,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,Fee Schedule,704.67
Aetna,HMO,74355,CPT4/HCPCS,X-RAY GUIDE INTESTINAL TUBE,,Fee Schedule,909.97
Aetna,HMO,74360,CPT4/HCPCS,X-RAY GUIDE GI DILATION,,Fee Schedule,788.08
Aetna,HMO,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,Fee Schedule,716.52
Aetna,HMO,74400,CPT4/HCPCS,UROGRAPHY IV +-KUB TOMOG,,Fee Schedule,765.32
Aetna,HMO,74410,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BOLUS,,Fee Schedule,791.95
Aetna,HMO,74415,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BLS W/NF,,Fee Schedule,978.43
Aetna,HMO,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,Fee Schedule,1531.90
Aetna,HMO,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,Fee Schedule,1531.90
Aetna,HMO,74430,CPT4/HCPCS,CONTRAST X-RAY BLADDER,,Fee Schedule,395.38
Aetna,HMO,74440,CPT4/HCPCS,X-RAY MALE GENITAL TRACT,,Fee Schedule,587.74
Aetna,HMO,74445,CPT4/HCPCS,X-RAY EXAM OF PENIS,,Fee Schedule,1531.90
Aetna,HMO,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Fee Schedule,1531.90
Aetna,HMO,74455,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Fee Schedule,641.00
Aetna,HMO,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,Fee Schedule,2002.47
Aetna,HMO,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,Fee Schedule,729.79
Aetna,HMO,74710,CPT4/HCPCS,X-RAY MEASUREMENT OF PELVIS,,Fee Schedule,200.00
Aetna,HMO,74712,CPT4/HCPCS,MRI FETAL SNGL/1ST GESTATION,,Case Rate,2427.00
Aetna,HMO,74713,CPT4/HCPCS,MRI FETAL EA ADDL GESTATION,,Case Rate,2427.00
Aetna,HMO,74740,CPT4/HCPCS,X-RAY FEMALE GENITAL TRACT,,Fee Schedule,528.52
Aetna,HMO,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,Fee Schedule,490.47
Aetna,HMO,74775,CPT4/HCPCS,X-RAY EXAM OF PERINEUM,,Fee Schedule,1531.90
Aetna,HMO,75557,CPT4/HCPCS,CARDIAC MRI FOR MORPH,,Fee Schedule,2427.00
Aetna,HMO,75559,CPT4/HCPCS,CARDIAC MRI W/STRESS IMG,,Fee Schedule,2427.00
Aetna,HMO,75561,CPT4/HCPCS,CARDIAC MRI FOR MORPH W/DYE,,Fee Schedule,2427.00
Aetna,HMO,75563,CPT4/HCPCS,CARD MRI W/STRESS IMG & DYE,,Fee Schedule,2427.00
Aetna,HMO,75565,CPT4/HCPCS,CARD MRI VELOC FLOW MAPPING,,Fee Schedule,2427.00
Aetna,HMO,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,Case Rate,2427.00
Aetna,HMO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,Case Rate,2427.00
Aetna,HMO,75573,CPT4/HCPCS,CT HRT W/3D IMAGE CONGEN,,Case Rate,2427.00
Aetna,HMO,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,Case Rate,2427.00
Aetna,HMO,75600,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Fee Schedule,2138.55
Aetna,HMO,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Fee Schedule,1372.05
Aetna,HMO,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,Fee Schedule,1374.99
Aetna,HMO,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,Fee Schedule,1407.58
Aetna,HMO,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,Case Rate,2427.00
Aetna,HMO,75705,CPT4/HCPCS,ARTERY X-RAYS SPINE,,Fee Schedule,1540.72
Aetna,HMO,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,Fee Schedule,1546.69
Aetna,HMO,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,Fee Schedule,1778.02
Aetna,HMO,75726,CPT4/HCPCS,ARTERY X-RAYS ABDOMEN,,Fee Schedule,1523.00
Aetna,HMO,75731,CPT4/HCPCS,ARTERY X-RAYS ADRENAL GLAND,,Fee Schedule,1546.69
Aetna,HMO,75733,CPT4/HCPCS,ARTERY X-RAYS ADRENALS,,Fee Schedule,1772.14
Aetna,HMO,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,Fee Schedule,1520.06
Aetna,HMO,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Fee Schedule,1339.46
Aetna,HMO,75743,CPT4/HCPCS,ARTERY X-RAYS LUNGS,,Fee Schedule,1413.46
Aetna,HMO,75746,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Fee Schedule,1457.90
Aetna,HMO,75756,CPT4/HCPCS,ARTERY X-RAYS CHEST,,Fee Schedule,1549.63
Aetna,HMO,75774,CPT4/HCPCS,ARTERY X-RAY EACH VESSEL,,Fee Schedule,1230.01
Aetna,HMO,75801,CPT4/HCPCS,LYMPH VESSEL X-RAY ARM/LEG,,Fee Schedule,3544.38
Aetna,HMO,75803,CPT4/HCPCS,LYMPH VESSEL X-RAY ARMS/LEGS,,Fee Schedule,3544.38
Aetna,HMO,75805,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Fee Schedule,3544.38
Aetna,HMO,75807,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Fee Schedule,3544.38
Aetna,HMO,75809,CPT4/HCPCS,NONVASCULAR SHUNT X-RAY,,Fee Schedule,646.96
Aetna,HMO,75810,CPT4/HCPCS,VEIN X-RAY SPLEEN/LIVER,,Fee Schedule,17652.93
Aetna,HMO,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,Fee Schedule,789.01
Aetna,HMO,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,Fee Schedule,883.68
Aetna,HMO,75825,CPT4/HCPCS,VEIN X-RAY TRUNK,,Fee Schedule,1306.95
Aetna,HMO,75827,CPT4/HCPCS,VEIN X-RAY CHEST,,Fee Schedule,1333.58
Aetna,HMO,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,Fee Schedule,1336.52
Aetna,HMO,75833,CPT4/HCPCS,VEIN X-RAY KIDNEYS,,Fee Schedule,1478.56
Aetna,HMO,75840,CPT4/HCPCS,VEIN X-RAY ADRENAL GLAND,,Fee Schedule,1309.89
Aetna,HMO,75842,CPT4/HCPCS,VEIN X-RAY ADRENAL GLANDS,,Fee Schedule,1469.74
Aetna,HMO,75860,CPT4/HCPCS,VEIN X-RAY NECK,,Fee Schedule,1351.30
Aetna,HMO,75870,CPT4/HCPCS,VEIN X-RAY SKULL,,Fee Schedule,1339.46
Aetna,HMO,75872,CPT4/HCPCS,VEIN X-RAY SKULL EPIDURAL,,Fee Schedule,1946.19
Aetna,HMO,75880,CPT4/HCPCS,VEIN X-RAY EYE SOCKET,,Fee Schedule,1185.57
Aetna,HMO,75885,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Fee Schedule,1336.52
Aetna,HMO,75887,CPT4/HCPCS,VEIN X-RAY LIVER W/O HEMODYN,,Fee Schedule,1357.27
Aetna,HMO,75889,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Fee Schedule,1336.52
Aetna,HMO,75891,CPT4/HCPCS,VEIN X-RAY LIVER,,Fee Schedule,1339.46
Aetna,HMO,75893,CPT4/HCPCS,VENOUS SAMPLING BY CATHETER,,Fee Schedule,1327.62
Aetna,HMO,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,Fee Schedule,7743.28
Aetna,HMO,75898,CPT4/HCPCS,FOLLOW-UP ANGIOGRAPHY,,Fee Schedule,658.81
Aetna,HMO,75901,CPT4/HCPCS,REMOVE CVA DEVICE OBSTRUCT,,Fee Schedule,1247.73
Aetna,HMO,75902,CPT4/HCPCS,REMOVE CVA LUMEN OBSTRUCT,,Fee Schedule,501.90
Aetna,HMO,75956,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,Fee Schedule,2768.30
Aetna,HMO,75957,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,Fee Schedule,2369.47
Aetna,HMO,75958,CPT4/HCPCS,XRAY PLACE PROX EXT THOR AO,,Fee Schedule,1572.06
Aetna,HMO,75959,CPT4/HCPCS,XRAY PLACE DIST EXT THOR AO,,Fee Schedule,1379.78
Aetna,HMO,75970,CPT4/HCPCS,VASCULAR BIOPSY,,Fee Schedule,3664.83
Aetna,HMO,75984,CPT4/HCPCS,XRAY CONTROL CATHETER CHANGE,,Fee Schedule,691.32
Aetna,HMO,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,Fee Schedule,673.59
Aetna,HMO,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,Fee Schedule,602.53
Aetna,HMO,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,Fee Schedule,161.53
Aetna,HMO,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,Fee Schedule,309.54
Aetna,HMO,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,Fee Schedule,96.43
Aetna,HMO,76100,CPT4/HCPCS,X-RAY EXAM OF BODY SECTION,,Fee Schedule,658.81
Aetna,HMO,76101,CPT4/HCPCS,COMPLEX BODY SECTION X-RAY,,Fee Schedule,1250.67
Aetna,HMO,76102,CPT4/HCPCS,COMPLEX BODY SECTION X-RAYS,,Fee Schedule,1774.58
Aetna,HMO,76120,CPT4/HCPCS,CINE/VIDEO X-RAYS,,Fee Schedule,504.92
Aetna,HMO,76125,CPT4/HCPCS,CINE/VIDEO X-RAYS ADD-ON,,Fee Schedule,278.12
Aetna,HMO,76140,CPT4/HCPCS,X-RAY CONSULTATION,,Fee Schedule,304.08
Aetna,HMO,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Fee Schedule,537.43
Aetna,HMO,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Fee Schedule,472.33
Aetna,HMO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,Case Rate,2427.00
Aetna,HMO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,Fee Schedule,2814.00
Aetna,HMO,76391,CPT4/HCPCS,MR ELASTOGRAPHY,,Fee Schedule,1537.28
Aetna,HMO,76496,CPT4/HCPCS,FLUOROSCOPIC PROCEDURE,,Fee Schedule,726.85
Aetna,HMO,76497,CPT4/HCPCS,CT PROCEDURE,,Fee Schedule,987.33
Aetna,HMO,76498,CPT4/HCPCS,MRI PROCEDURE,,Case Rate,2427.00
Aetna,HMO,76499,CPT4/HCPCS,RADIOGRAPHIC PROCEDURE,,Fee Schedule,392.44
Aetna,HMO,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,Fee Schedule,543.39
Aetna,HMO,76510,CPT4/HCPCS,OPH US DX B-SCAN&QUAN A-SCAN,,Fee Schedule,646.96
Aetna,HMO,76511,CPT4/HCPCS,OPH US DX QUAN A-SCAN ONLY,,Fee Schedule,422.01
Aetna,HMO,76512,CPT4/HCPCS,OPH US DX B-SCAN,,Fee Schedule,350.95
Aetna,HMO,76513,CPT4/HCPCS,OPH US DX ANT SGM US UNI/BI,,Fee Schedule,469.39
Aetna,HMO,76514,CPT4/HCPCS,ECHO EXAM OF EYE THICKNESS,,Fee Schedule,37.29
Aetna,HMO,76516,CPT4/HCPCS,ECHO EXAM OF EYE,,Fee Schedule,371.70
Aetna,HMO,76519,CPT4/HCPCS,ECHO EXAM OF EYE,,Fee Schedule,416.13
Aetna,HMO,76529,CPT4/HCPCS,ECHO EXAM OF EYE,,Fee Schedule,362.79
Aetna,HMO,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,Fee Schedule,791.95
Aetna,HMO,76604,CPT4/HCPCS,US EXAM CHEST,,Fee Schedule,531.55
Aetna,HMO,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,Fee Schedule,595.14
Aetna,HMO,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,Fee Schedule,455.78
Aetna,HMO,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,Fee Schedule,836.38
Aetna,HMO,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,Fee Schedule,679.47
Aetna,HMO,76706,CPT4/HCPCS,US ABDL AORTA SCREEN AAA,,Fee Schedule,559.18
Aetna,HMO,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,Fee Schedule,836.38
Aetna,HMO,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,Fee Schedule,720.97
Aetna,HMO,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,Fee Schedule,996.15
Aetna,HMO,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,Fee Schedule,685.44
Aetna,HMO,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,Fee Schedule,712.06
Aetna,HMO,76802,CPT4/HCPCS,OB US < 14 WKS ADDL FETUS,,Fee Schedule,253.34
Aetna,HMO,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,Fee Schedule,836.38
Aetna,HMO,76810,CPT4/HCPCS,OB US >= 14 WKS ADDL FETUS,,Fee Schedule,433.86
Aetna,HMO,76811,CPT4/HCPCS,OB US DETAILED SNGL FETUS,,Fee Schedule,871.92
Aetna,HMO,76812,CPT4/HCPCS,OB US DETAILED ADDL FETUS,,Fee Schedule,543.39
Aetna,HMO,76813,CPT4/HCPCS,OB US NUCHAL MEAS 1 GEST,,Fee Schedule,602.53
Aetna,HMO,76814,CPT4/HCPCS,OB US NUCHAL MEAS ADD-ON,,Fee Schedule,282.91
Aetna,HMO,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,Fee Schedule,522.64
Aetna,HMO,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,Fee Schedule,540.37
Aetna,HMO,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,Fee Schedule,540.37
Aetna,HMO,76818,CPT4/HCPCS,FETAL BIOPHYS PROFILE W/NST,,Fee Schedule,617.31
Aetna,HMO,76819,CPT4/HCPCS,FETAL BIOPHYS PROFIL W/O NST,,Fee Schedule,469.39
Aetna,HMO,76820,CPT4/HCPCS,UMBILICAL ARTERY ECHO,,Fee Schedule,194.12
Aetna,HMO,76821,CPT4/HCPCS,MIDDLE CEREBRAL ARTERY ECHO,,Fee Schedule,540.37
Aetna,HMO,76825,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Fee Schedule,1185.57
Aetna,HMO,76826,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Fee Schedule,738.69
Aetna,HMO,76827,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Fee Schedule,333.22
Aetna,HMO,76828,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Fee Schedule,185.22
Aetna,HMO,76830,CPT4/HCPCS,TRANSVAGINAL US NON-OB,,Fee Schedule,794.89
Aetna,HMO,76831,CPT4/HCPCS,ECHO EXAM UTERUS,,Fee Schedule,786.07
Aetna,HMO,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,Fee Schedule,791.95
Aetna,HMO,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,Fee Schedule,540.37
Aetna,HMO,76870,CPT4/HCPCS,US EXAM SCROTUM,,Fee Schedule,803.79
Aetna,HMO,76872,CPT4/HCPCS,US TRANSRECTAL,,Fee Schedule,836.38
Aetna,HMO,76873,CPT4/HCPCS,ECHOGRAP TRANS R PROS STUDY,,Fee Schedule,836.38
Aetna,HMO,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,Fee Schedule,750.54
Aetna,HMO,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,Fee Schedule,87.61
Aetna,HMO,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,Fee Schedule,543.39
Aetna,HMO,76886,CPT4/HCPCS,US EXAM INFANT HIPS STATIC,,Fee Schedule,540.37
Aetna,HMO,76932,CPT4/HCPCS,ECHO GUIDE FOR HEART BIOPSY,,Fee Schedule,512.98
Aetna,HMO,76936,CPT4/HCPCS,ECHO GUIDE FOR ARTERY REPAIR,,Fee Schedule,928.11
Aetna,HMO,76937,CPT4/HCPCS,US GUIDE VASCULAR ACCESS,,Fee Schedule,170.43
Aetna,HMO,76940,CPT4/HCPCS,US GUIDE TISSUE ABLATION,,Fee Schedule,553.22
Aetna,HMO,76941,CPT4/HCPCS,ECHO GUIDE FOR TRANSFUSION,,Fee Schedule,501.14
Aetna,HMO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,Fee Schedule,1431.27
Aetna,HMO,76945,CPT4/HCPCS,ECHO GUIDE VILLUS SAMPLING,,Fee Schedule,515.92
Aetna,HMO,76946,CPT4/HCPCS,ECHO GUIDE FOR AMNIOCENTESIS,,Fee Schedule,167.49
Aetna,HMO,76948,CPT4/HCPCS,ECHO GUIDE OVA ASPIRATION,,Fee Schedule,167.49
Aetna,HMO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,Fee Schedule,436.80
Aetna,HMO,76970,CPT4/HCPCS,ULTRASOUND EXAM FOLLOW-UP,,Fee Schedule,540.37
Aetna,HMO,76975,CPT4/HCPCS,GI ENDOSCOPIC ULTRASOUND,,Fee Schedule,1330.64
Aetna,HMO,76977,CPT4/HCPCS,US BONE DENSITY MEASURE,,Fee Schedule,66.86
Aetna,HMO,76978,CPT4/HCPCS,US TRGT DYN MBUBB 1ST LES,,Fee Schedule,2082.44
Aetna,HMO,76979,CPT4/HCPCS,US TRGT DYN MBUBB EA ADDL,,Fee Schedule,1520.40
Aetna,HMO,76981,CPT4/HCPCS,USE PARENCHYMA,,Fee Schedule,662.00
Aetna,HMO,76982,CPT4/HCPCS,USE 1ST TARGET LESION,,Fee Schedule,565.15
Aetna,HMO,76983,CPT4/HCPCS,USE EA ADDL TARGET LESION,,Fee Schedule,287.70
Aetna,HMO,76998,CPT4/HCPCS,US GUIDE INTRAOP,,Fee Schedule,487.11
Aetna,HMO,77001,CPT4/HCPCS,FLUOROGUIDE FOR VEIN DEVICE,,Fee Schedule,830.42
Aetna,HMO,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,Fee Schedule,419.07
Aetna,HMO,77003,CPT4/HCPCS,FLUOROGUIDE FOR SPINE INJECT,,Fee Schedule,285.85
Aetna,HMO,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,Case Rate,2427.00
Aetna,HMO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,Case Rate,2427.00
Aetna,HMO,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,Case Rate,2427.00
Aetna,HMO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Case Rate,2427.00
Aetna,HMO,77021,CPT4/HCPCS,MRI GUIDANCE NDL PLMT RS&I,,Case Rate,2427.00
Aetna,HMO,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,Case Rate,2427.00
Aetna,HMO,77046,CPT4/HCPCS,MRI BREAST C- UNILATERAL,,Case Rate,2427.00
Aetna,HMO,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,Case Rate,2427.00
Aetna,HMO,77048,CPT4/HCPCS,MRI BREAST C-+ W/CAD UNI,,Case Rate,2427.00
Aetna,HMO,77049,CPT4/HCPCS,MRI BREAST C-+ W/CAD BI,,Case Rate,2427.00
Aetna,HMO,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,Fee Schedule,436.80
Aetna,HMO,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,Fee Schedule,602.53
Aetna,HMO,77061,CPT4/HCPCS,BREAST TOMOSYNTHESIS UNI,,Fee Schedule,992.29
Aetna,HMO,77062,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Fee Schedule,778.84
Aetna,HMO,77063,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Fee Schedule,212.77
Aetna,HMO,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,Fee Schedule,792.87
Aetna,HMO,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,Fee Schedule,1014.55
Aetna,HMO,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,Fee Schedule,837.81
Aetna,HMO,77071,CPT4/HCPCS,X-RAY STRESS VIEW,,Fee Schedule,381.94
Aetna,HMO,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,Fee Schedule,123.06
Aetna,HMO,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,Fee Schedule,211.84
Aetna,HMO,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,Fee Schedule,413.11
Aetna,HMO,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,Fee Schedule,658.81
Aetna,HMO,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,Fee Schedule,578.84
Aetna,HMO,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,Fee Schedule,223.69
Aetna,HMO,77078,CPT4/HCPCS,CT BONE DENSITY AXIAL,,Case Rate,2427.00
Aetna,HMO,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,Fee Schedule,739.03
Aetna,HMO,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,Fee Schedule,164.55
Aetna,HMO,77084,CPT4/HCPCS,MAGNETIC IMAGE BONE MARROW,,Case Rate,2427.00
Aetna,HMO,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,Fee Schedule,340.20
Aetna,HMO,77086,CPT4/HCPCS,FRACTURE ASSESSMENT VIA DXA,,Fee Schedule,221.67
Aetna,HMO,77261,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,557.25
Aetna,HMO,77262,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,835.63
Aetna,HMO,77263,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,1239.50
Aetna,HMO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges,1264.20
Aetna,HMO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges,2611.80
Aetna,HMO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges,3362.40
Aetna,HMO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,% of Charges,1962.60
Aetna,HMO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,% of Charges,14806.20
Aetna,HMO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,% of Charges,937.20
Aetna,HMO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,% of Charges,15882.60
Aetna,HMO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,% of Charges,1291.80
Aetna,HMO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,% of Charges,6620.40
Aetna,HMO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,% of Charges,2582.40
Aetna,HMO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,% of Charges,3343.80
Aetna,HMO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,% of Charges,4469.40
Aetna,HMO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,% of Charges,2623.80
Aetna,HMO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,% of Charges,448.80
Aetna,HMO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges,936.00
Aetna,HMO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges,1336.80
Aetna,HMO,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges,2360.40
Aetna,HMO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges,1471.20
Aetna,HMO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,% of Charges,11747.40
Aetna,HMO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges,1718.40
Aetna,HMO,77371,CPT4/HCPCS,SRS MULTISOURCE,,% of Charges,11915.73
Aetna,HMO,77372,CPT4/HCPCS,SRS LINEAR BASED,,% of Charges,25283.40
Aetna,HMO,77373,CPT4/HCPCS,SBRT DELIVERY,,% of Charges,10859.40
Aetna,HMO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,% of Charges,10314.00
Aetna,HMO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,% of Charges,12034.20
Aetna,HMO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,% of Charges,193.80
Aetna,HMO,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges,220.75
Aetna,HMO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges,1037.40
Aetna,HMO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges,1412.40
Aetna,HMO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges,1557.00
Aetna,HMO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,% of Charges,324.60
Aetna,HMO,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,% of Charges,2203.74
Aetna,HMO,77424,CPT4/HCPCS,IO RAD TX DELIVERY BY X-RAY,,% of Charges,2476.06
Aetna,HMO,77425,CPT4/HCPCS,IO RAD TX DELIVER BY ELCTRNS,,% of Charges,1747.28
Aetna,HMO,77427,CPT4/HCPCS,RADIATION TX MANAGEMENT X5,,% of Charges,1390.95
Aetna,HMO,77431,CPT4/HCPCS,RADIATION THERAPY MANAGEMENT,,% of Charges,764.82
Aetna,HMO,77432,CPT4/HCPCS,STEREOTACTIC RADIATION TRMT,,% of Charges,3134.12
Aetna,HMO,77435,CPT4/HCPCS,SBRT MANAGEMENT,,% of Charges,5203.12
Aetna,HMO,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,% of Charges,2227.76
Aetna,HMO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,% of Charges,5173.20
Aetna,HMO,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,% of Charges,9231.76
Aetna,HMO,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,% of Charges,10557.62
Aetna,HMO,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,% of Charges,15981.50
Aetna,HMO,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,% of Charges,15603.75
Aetna,HMO,77600,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,% of Charges,2867.17
Aetna,HMO,77605,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,% of Charges,7137.90
Aetna,HMO,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,% of Charges,6717.64
Aetna,HMO,77615,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,% of Charges,7553.36
Aetna,HMO,77620,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,% of Charges,3528.92
Aetna,HMO,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,% of Charges,813.60
Aetna,HMO,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,% of Charges,1528.21
Aetna,HMO,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,% of Charges,1787.52
Aetna,HMO,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,% of Charges,2311.84
Aetna,HMO,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,% of Charges,1425.64
Aetna,HMO,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,% of Charges,2344.44
Aetna,HMO,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,% of Charges,9497.40
Aetna,HMO,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,% of Charges,9497.40
Aetna,HMO,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,% of Charges,9497.40
Aetna,HMO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,% of Charges,2135.40
Aetna,HMO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,% of Charges,169.80
Aetna,HMO,77790,CPT4/HCPCS,RADIATION HANDLING,,% of Charges,183.00
Aetna,HMO,78012,CPT4/HCPCS,THYROID UPTAKE MEASUREMENT,,Fee Schedule,607.15
Aetna,HMO,78013,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Fee Schedule,1233.79
Aetna,HMO,78014,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Fee Schedule,1798.86
Aetna,HMO,78015,CPT4/HCPCS,THYROID MET IMAGING,,Fee Schedule,1585.66
Aetna,HMO,78016,CPT4/HCPCS,THYROID MET IMAGING/STUDIES,,Fee Schedule,2322.60
Aetna,HMO,78018,CPT4/HCPCS,THYROID MET IMAGING BODY,,Fee Schedule,2408.44
Aetna,HMO,78020,CPT4/HCPCS,THYROID MET UPTAKE,,Fee Schedule,498.96
Aetna,HMO,78070,CPT4/HCPCS,PARATHYROID PLANAR IMAGING,,Fee Schedule,1088.47
Aetna,HMO,78071,CPT4/HCPCS,PARATHYRD PLANAR W/WO SUBTRJ,,Fee Schedule,2510.84
Aetna,HMO,78072,CPT4/HCPCS,PARATHYRD PLANAR W/SPECT&CT,,Fee Schedule,2370.73
Aetna,HMO,78075,CPT4/HCPCS,ADRENAL CORTEX & MEDULLA IMG,,Fee Schedule,3392.84
Aetna,HMO,78102,CPT4/HCPCS,BONE MARROW IMAGING LTD,,Fee Schedule,1212.79
Aetna,HMO,78103,CPT4/HCPCS,BONE MARROW IMAGING MULT,,Fee Schedule,1591.63
Aetna,HMO,78104,CPT4/HCPCS,BONE MARROW IMAGING BODY,,Fee Schedule,1828.34
Aetna,HMO,78110,CPT4/HCPCS,PLASMA VOLUME SINGLE,,Fee Schedule,635.62
Aetna,HMO,78111,CPT4/HCPCS,PLASMA VOLUME MULTIPLE,,Fee Schedule,668.22
Aetna,HMO,78120,CPT4/HCPCS,RED CELL MASS SINGLE,,Fee Schedule,662.25
Aetna,HMO,78121,CPT4/HCPCS,RED CELL MASS MULTIPLE,,Fee Schedule,739.20
Aetna,HMO,78122,CPT4/HCPCS,BLOOD VOLUME,,Fee Schedule,789.51
Aetna,HMO,78130,CPT4/HCPCS,RED CELL SURVIVAL STUDY,,Fee Schedule,1078.39
Aetna,HMO,78135,CPT4/HCPCS,RED CELL SURVIVAL KINETICS,,Fee Schedule,2707.40
Aetna,HMO,78140,CPT4/HCPCS,RED CELL SEQUESTRATION,,Fee Schedule,943.48
Aetna,HMO,78185,CPT4/HCPCS,SPLEEN IMAGING,,Fee Schedule,1576.84
Aetna,HMO,78191,CPT4/HCPCS,PLATELET SURVIVAL,,Fee Schedule,1273.69
Aetna,HMO,78195,CPT4/HCPCS,LYMPH SYSTEM IMAGING,,Fee Schedule,2236.83
Aetna,HMO,78201,CPT4/HCPCS,LIVER IMAGING,,Fee Schedule,1425.90
Aetna,HMO,78202,CPT4/HCPCS,LIVER IMAGING WITH FLOW,,Fee Schedule,1553.16
Aetna,HMO,78215,CPT4/HCPCS,LIVER AND SPLEEN IMAGING,,Fee Schedule,1458.40
Aetna,HMO,78216,CPT4/HCPCS,LIVER & SPLEEN IMAGE/FLOW,,Fee Schedule,893.17
Aetna,HMO,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Fee Schedule,2413.82
Aetna,HMO,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Fee Schedule,3352.10
Aetna,HMO,78230,CPT4/HCPCS,SALIVARY GLAND IMAGING,,Fee Schedule,1248.32
Aetna,HMO,78231,CPT4/HCPCS,SERIAL SALIVARY IMAGING,,Fee Schedule,899.05
Aetna,HMO,78232,CPT4/HCPCS,SALIVARY GLAND FUNCTION EXAM,,Fee Schedule,827.98
Aetna,HMO,78258,CPT4/HCPCS,ESOPHAGEAL MOTILITY STUDY,,Fee Schedule,1665.63
Aetna,HMO,78261,CPT4/HCPCS,GASTRIC MUCOSA IMAGING,,Fee Schedule,1872.78
Aetna,HMO,78262,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX EXAM,,Fee Schedule,1846.15
Aetna,HMO,78264,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Fee Schedule,2079.92
Aetna,HMO,78265,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Fee Schedule,2748.14
Aetna,HMO,78266,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Fee Schedule,3641.48
Aetna,HMO,78267,CPT4/HCPCS,BREATH TST ATTAIN/ANAL C-14,,Fee Schedule,97.69
Aetna,HMO,78268,CPT4/HCPCS,BREATH TEST ANALYSIS C-14,,Fee Schedule,825.72
Aetna,HMO,78278,CPT4/HCPCS,ACUTE GI BLOOD LOSS IMAGING,,Fee Schedule,2081.18
Aetna,HMO,78282,CPT4/HCPCS,GI PROTEIN LOSS EXAM,,Fee Schedule,2082.36
Aetna,HMO,78290,CPT4/HCPCS,MECKELS DIVERT EXAM,,Fee Schedule,2082.86
Aetna,HMO,78291,CPT4/HCPCS,LEVEEN/SHUNT PATENCY EXAM,,Fee Schedule,1819.52
Aetna,HMO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,3937.00
Aetna,HMO,78300,CPT4/HCPCS,BONE IMAGING LIMITED AREA,,Fee Schedule,1263.10
Aetna,HMO,78305,CPT4/HCPCS,BONE IMAGING MULTIPLE AREAS,,Fee Schedule,1668.57
Aetna,HMO,78306,CPT4/HCPCS,BONE IMAGING WHOLE BODY,,Fee Schedule,1834.30
Aetna,HMO,78315,CPT4/HCPCS,BONE IMAGING 3 PHASE,,Fee Schedule,2128.47
Aetna,HMO,78350,CPT4/HCPCS,BONE MINERAL SINGLE PHOTON,,Fee Schedule,191.18
Aetna,HMO,78351,CPT4/HCPCS,BONE MINERAL DUAL PHOTON,,Fee Schedule,81.31
Aetna,HMO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,3937.00
Aetna,HMO,78414,CPT4/HCPCS,NON-IMAGING HEART FUNCTION,,Fee Schedule,446.12
Aetna,HMO,78428,CPT4/HCPCS,CARDIAC SHUNT IMAGING,,Fee Schedule,1342.99
Aetna,HMO,78445,CPT4/HCPCS,VASCULAR FLOW IMAGING,,Fee Schedule,1283.77
Aetna,HMO,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,Fee Schedule,2393.66
Aetna,HMO,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,Fee Schedule,3478.60
Aetna,HMO,78453,CPT4/HCPCS,HT MUSCLE IMAGE PLANAR SING,,Fee Schedule,2130.24
Aetna,HMO,78454,CPT4/HCPCS,HT MUSC IMAGE PLANAR MULT,,Fee Schedule,3123.45
Aetna,HMO,78456,CPT4/HCPCS,ACUTE VENOUS THROMBUS IMAGE,,Fee Schedule,1743.75
Aetna,HMO,78457,CPT4/HCPCS,VENOUS THROMBOSIS IMAGING,,Fee Schedule,1366.68
Aetna,HMO,78458,CPT4/HCPCS,VEN THROMBOSIS IMAGES BILAT,,Fee Schedule,1334.08
Aetna,HMO,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,Fee Schedule,12600.00
Aetna,HMO,78466,CPT4/HCPCS,HEART INFARCT IMAGE,,Fee Schedule,1266.04
Aetna,HMO,78468,CPT4/HCPCS,HEART INFARCT IMAGE (EF),,Fee Schedule,1547.19
Aetna,HMO,78469,CPT4/HCPCS,HEART INFARCT IMAGE (3D),,Fee Schedule,1828.34
Aetna,HMO,78472,CPT4/HCPCS,GATED HEART PLANAR SINGLE,,Fee Schedule,1763.24
Aetna,HMO,78473,CPT4/HCPCS,GATED HEART MULTIPLE,,Fee Schedule,2248.68
Aetna,HMO,78481,CPT4/HCPCS,HEART FIRST PASS SINGLE,,Fee Schedule,1389.78
Aetna,HMO,78483,CPT4/HCPCS,HEART FIRST PASS MULTIPLE,,Fee Schedule,1872.78
Aetna,HMO,78491,CPT4/HCPCS,MYOCRD IMG PET 1STD RST/STRS,,Fee Schedule,12600.00
Aetna,HMO,78492,CPT4/HCPCS,MYOCRD IMG PET MLT RST&STRS,,Fee Schedule,12600.00
Aetna,HMO,78494,CPT4/HCPCS,HEART IMAGE SPECT,,Fee Schedule,1807.68
Aetna,HMO,78496,CPT4/HCPCS,HEART FIRST PASS ADD-ON,,Fee Schedule,484.17
Aetna,HMO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,3937.00
Aetna,HMO,78579,CPT4/HCPCS,LUNG VENTILATION IMAGING,,Fee Schedule,1245.55
Aetna,HMO,78580,CPT4/HCPCS,LUNG PERFUSION IMAGING,,Fee Schedule,1532.41
Aetna,HMO,78582,CPT4/HCPCS,LUNG VENTILAT&PERFUS IMAGING,,Fee Schedule,2237.08
Aetna,HMO,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Fee Schedule,1335.26
Aetna,HMO,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Fee Schedule,2164.17
Aetna,HMO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,3937.00
Aetna,HMO,78600,CPT4/HCPCS,BRAIN IMAGE < 4 VIEWS,,Fee Schedule,1372.56
Aetna,HMO,78601,CPT4/HCPCS,BRAIN IMAGE W/FLOW < 4 VIEWS,,Fee Schedule,1635.98
Aetna,HMO,78605,CPT4/HCPCS,BRAIN IMAGE 4+ VIEWS,,Fee Schedule,1482.09
Aetna,HMO,78606,CPT4/HCPCS,BRAIN IMAGE W/FLOW 4 + VIEWS,,Fee Schedule,2547.55
Aetna,HMO,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,Fee Schedule,12600.00
Aetna,HMO,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,Fee Schedule,12600.00
Aetna,HMO,78610,CPT4/HCPCS,BRAIN FLOW IMAGING ONLY,,Fee Schedule,1411.03
Aetna,HMO,78630,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Fee Schedule,2633.40
Aetna,HMO,78635,CPT4/HCPCS,CSF VENTRICULOGRAPHY,,Fee Schedule,2529.82
Aetna,HMO,78645,CPT4/HCPCS,CSF SHUNT EVALUATION,,Fee Schedule,2091.76
Aetna,HMO,78650,CPT4/HCPCS,CSF LEAKAGE IMAGING,,Fee Schedule,2603.83
Aetna,HMO,78660,CPT4/HCPCS,NUCLEAR EXAM OF TEAR FLOW,,Fee Schedule,1304.52
Aetna,HMO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,3937.00
Aetna,HMO,78700,CPT4/HCPCS,KIDNEY IMAGING MORPHOL,,Fee Schedule,1334.08
Aetna,HMO,78701,CPT4/HCPCS,KIDNEY IMAGING WITH FLOW,,Fee Schedule,1638.92
Aetna,HMO,78707,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/O DRUG,,Fee Schedule,1659.67
Aetna,HMO,78708,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/DRUG,,Fee Schedule,1052.94
Aetna,HMO,78709,CPT4/HCPCS,K FLOW/FUNCT IMAGE MULTIPLE,,Fee Schedule,2586.02
Aetna,HMO,78725,CPT4/HCPCS,KIDNEY FUNCTION STUDY,,Fee Schedule,730.38
Aetna,HMO,78730,CPT4/HCPCS,URINARY BLADDER RETENTION,,Fee Schedule,578.84
Aetna,HMO,78740,CPT4/HCPCS,URETERAL REFLUX STUDY,,Fee Schedule,1674.45
Aetna,HMO,78761,CPT4/HCPCS,TESTICULAR IMAGING W/FLOW,,Fee Schedule,1538.37
Aetna,HMO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,3937.00
Aetna,HMO,78800,CPT4/HCPCS,RP LOCLZJ TUM 1 AREA 1 D IMG,,Fee Schedule,1342.99
Aetna,HMO,78801,CPT4/HCPCS,RP LOCLZJ TUM 2+AREA 1+D IMG,,Fee Schedule,1857.99
Aetna,HMO,78802,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 1 D IMG,,Fee Schedule,2476.57
Aetna,HMO,78803,CPT4/HCPCS,RP LOCLZJ TUM SPECT 1 AREA,,Fee Schedule,2594.92
Aetna,HMO,78804,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 2+D IMG,,Fee Schedule,4596.14
Aetna,HMO,78808,CPT4/HCPCS,IV INJ RA DRUG DX STUDY,,Fee Schedule,364.30
Aetna,HMO,78811,CPT4/HCPCS,PET IMAGE LTD AREA,,Fee Schedule,12600.00
Aetna,HMO,78812,CPT4/HCPCS,PET IMAGE SKULL-THIGH,,Fee Schedule,12600.00
Aetna,HMO,78813,CPT4/HCPCS,PET IMAGE FULL BODY,,Fee Schedule,12600.00
Aetna,HMO,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,Fee Schedule,12600.00
Aetna,HMO,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,Fee Schedule,12600.00
Aetna,HMO,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,Fee Schedule,12600.00
Aetna,HMO,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Fee Schedule,475.27
Aetna,HMO,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,Fee Schedule,516.68
Aetna,HMO,79200,CPT4/HCPCS,NUCLEAR RX INTRACAV ADMIN,,Fee Schedule,587.74
Aetna,HMO,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Fee Schedule,463.84
Aetna,HMO,79403,CPT4/HCPCS,HEMATOPOIETIC NUCLEAR TX,,Fee Schedule,798.42
Aetna,HMO,79440,CPT4/HCPCS,NUCLEAR RX INTRA-ARTICULAR,,Fee Schedule,493.08
Aetna,HMO,79445,CPT4/HCPCS,NUCLEAR RX INTRA-ARTERIAL,,Fee Schedule,843.10
Aetna,HMO,80047,CPT4/HCPCS,METABOLIC PANEL IONIZED CA,,Fee Schedule,85.00
Aetna,HMO,80048,CPT4/HCPCS,METABOLIC PANEL TOTAL CA,,Fee Schedule,85.00
Aetna,HMO,80050,CPT4/HCPCS,GENERAL HEALTH PANEL,,Fee Schedule,352.21
Aetna,HMO,80051,CPT4/HCPCS,ELECTROLYTE PANEL,,Fee Schedule,70.47
Aetna,HMO,80053,CPT4/HCPCS,COMPREHEN METABOLIC PANEL,,Fee Schedule,106.17
Aetna,HMO,80055,CPT4/HCPCS,OBSTETRIC PANEL,,Fee Schedule,515.00
Aetna,HMO,80061,CPT4/HCPCS,LIPID PANEL,,Fee Schedule,134.56
Aetna,HMO,80069,CPT4/HCPCS,RENAL FUNCTION PANEL,,Fee Schedule,87.27
Aetna,HMO,80074,CPT4/HCPCS,ACUTE HEPATITIS PANEL,,Fee Schedule,478.46
Aetna,HMO,80076,CPT4/HCPCS,HEPATIC FUNCTION PANEL,,Fee Schedule,82.06
Aetna,HMO,80081,CPT4/HCPCS,OBSTETRIC PANEL,,Fee Schedule,728.02
Aetna,HMO,80150,CPT4/HCPCS,ASSAY OF AMIKACIN,,Fee Schedule,151.45
Aetna,HMO,80155,CPT4/HCPCS,DRUG ASSAY CAFFEINE,,Fee Schedule,137.84
Aetna,HMO,80156,CPT4/HCPCS,ASSAY CARBAMAZEPINE TOTAL,,Fee Schedule,146.32
Aetna,HMO,80157,CPT4/HCPCS,ASSAY CARBAMAZEPINE FREE,,Fee Schedule,133.22
Aetna,HMO,80158,CPT4/HCPCS,DRUG ASSAY CYCLOSPORINE,,Fee Schedule,181.35
Aetna,HMO,80159,CPT4/HCPCS,DRUG ASSAY CLOZAPINE,,Fee Schedule,180.18
Aetna,HMO,80162,CPT4/HCPCS,ASSAY OF DIGOXIN TOTAL,,Fee Schedule,133.47
Aetna,HMO,80163,CPT4/HCPCS,ASSAY OF DIGOXIN FREE,,Fee Schedule,129.02
Aetna,HMO,80164,CPT4/HCPCS,ASSAY DIPROPYLACETIC ACD TOT,,Fee Schedule,136.08
Aetna,HMO,80165,CPT4/HCPCS,DIPROPYLACETIC ACID FREE,,Fee Schedule,131.62
Aetna,HMO,80168,CPT4/HCPCS,ASSAY OF ETHOSUXIMIDE,,Fee Schedule,164.22
Aetna,HMO,80169,CPT4/HCPCS,DRUG ASSAY EVEROLIMUS,,Fee Schedule,133.72
Aetna,HMO,80170,CPT4/HCPCS,ASSAY OF GENTAMICIN,,Fee Schedule,164.72
Aetna,HMO,80171,CPT4/HCPCS,DRUG SCREEN QUANT GABAPENTIN,,Fee Schedule,129.19
Aetna,HMO,80173,CPT4/HCPCS,ASSAY OF HALOPERIDOL,,Fee Schedule,146.32
Aetna,HMO,80175,CPT4/HCPCS,DRUG SCREEN QUAN LAMOTRIGINE,,Fee Schedule,129.19
Aetna,HMO,80176,CPT4/HCPCS,ASSAY OF LIDOCAINE,,Fee Schedule,147.58
Aetna,HMO,80177,CPT4/HCPCS,DRUG SCRN QUAN LEVETIRACETAM,,Fee Schedule,129.19
Aetna,HMO,80178,CPT4/HCPCS,ASSAY OF LITHIUM,,Fee Schedule,66.44
Aetna,HMO,80180,CPT4/HCPCS,DRUG SCRN QUAN MYCOPHENOLATE,,Fee Schedule,175.89
Aetna,HMO,80183,CPT4/HCPCS,DRUG SCRN QUANT OXCARBAZEPIN,,Fee Schedule,129.19
Aetna,HMO,80184,CPT4/HCPCS,ASSAY OF PHENOBARBITAL,,Fee Schedule,109.28
Aetna,HMO,80185,CPT4/HCPCS,ASSAY OF PHENYTOIN TOTAL,,Fee Schedule,133.22
Aetna,HMO,80186,CPT4/HCPCS,ASSAY OF PHENYTOIN FREE,,Fee Schedule,138.26
Aetna,HMO,80188,CPT4/HCPCS,ASSAY OF PRIMIDONE,,Fee Schedule,146.24
Aetna,HMO,80190,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,Fee Schedule,168.25
Aetna,HMO,80192,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,Fee Schedule,168.25
Aetna,HMO,80194,CPT4/HCPCS,ASSAY OF QUINIDINE,,Fee Schedule,146.66
Aetna,HMO,80195,CPT4/HCPCS,ASSAY OF SIROLIMUS,,Fee Schedule,137.92
Aetna,HMO,80197,CPT4/HCPCS,ASSAY OF TACROLIMUS,,Fee Schedule,137.92
Aetna,HMO,80198,CPT4/HCPCS,ASSAY OF THEOPHYLLINE,,Fee Schedule,142.12
Aetna,HMO,80199,CPT4/HCPCS,DRUG SCREEN QUANT TIAGABINE,,Fee Schedule,175.89
Aetna,HMO,80200,CPT4/HCPCS,ASSAY OF TOBRAMYCIN,,Fee Schedule,161.95
Aetna,HMO,80201,CPT4/HCPCS,ASSAY OF TOPIRAMATE,,Fee Schedule,119.78
Aetna,HMO,80202,CPT4/HCPCS,ASSAY OF VANCOMYCIN,,Fee Schedule,136.08
Aetna,HMO,80203,CPT4/HCPCS,DRUG SCREEN QUANT ZONISAMIDE,,Fee Schedule,129.19
Aetna,HMO,80299,CPT4/HCPCS,QUANTITATIVE ASSAY DRUG,,Fee Schedule,133.05
Aetna,HMO,80305,CPT4/HCPCS,DRUG TEST PRSMV DIR OPT OBS,,Fee Schedule,106.84
Aetna,HMO,80306,CPT4/HCPCS,DRUG TEST PRSMV INSTRMNT,,Fee Schedule,142.46
Aetna,HMO,80307,CPT4/HCPCS,DRUG TEST PRSMV CHEM ANLYZR,,Fee Schedule,569.85
Aetna,HMO,80320,CPT4/HCPCS,DRUG SCREEN QUANTALCOHOLS,,Fee Schedule,0.08
Aetna,HMO,80321,CPT4/HCPCS,ALCOHOLS BIOMARKERS 1OR 2,,Fee Schedule,0.08
Aetna,HMO,80322,CPT4/HCPCS,ALCOHOLS BIOMARKERS 3/MORE,,Fee Schedule,0.08
Aetna,HMO,80323,CPT4/HCPCS,ALKALOIDS NOS,,Fee Schedule,0.08
Aetna,HMO,80324,CPT4/HCPCS,DRUG SCREEN AMPHETAMINES 1/2,,Fee Schedule,0.08
Aetna,HMO,80325,CPT4/HCPCS,AMPHETAMINES 3OR 4,,Fee Schedule,0.08
Aetna,HMO,80326,CPT4/HCPCS,AMPHETAMINES 5 OR MORE,,Fee Schedule,0.08
Aetna,HMO,80327,CPT4/HCPCS,ANABOLIC STEROID 1 OR 2,,Fee Schedule,0.08
Aetna,HMO,80328,CPT4/HCPCS,ANABOLIC STEROID 3 OR MORE,,Fee Schedule,0.08
Aetna,HMO,80329,CPT4/HCPCS,ANALGESICS NON-OPIOID 1 OR 2,,Fee Schedule,0.08
Aetna,HMO,80330,CPT4/HCPCS,ANALGESICS NON-OPIOID 3-5,,Fee Schedule,0.08
Aetna,HMO,80331,CPT4/HCPCS,ANALGESICS NON-OPIOID 6/MORE,,Fee Schedule,0.08
Aetna,HMO,80332,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 1 OR 2,,Fee Schedule,0.08
Aetna,HMO,80333,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 3-5,,Fee Schedule,0.08
Aetna,HMO,80334,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 6/MORE,,Fee Schedule,0.08
Aetna,HMO,80335,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 1/2,,Fee Schedule,0.08
Aetna,HMO,80336,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 3-5,,Fee Schedule,0.08
Aetna,HMO,80337,CPT4/HCPCS,TRICYCLIC & CYCLICALS 6/MORE,,Fee Schedule,0.08
Aetna,HMO,80338,CPT4/HCPCS,ANTIDEPRESSANT NOT SPECIFIED,,Fee Schedule,0.08
Aetna,HMO,80339,CPT4/HCPCS,ANTIEPILEPTICS NOS 1-3,,Fee Schedule,0.08
Aetna,HMO,80340,CPT4/HCPCS,ANTIEPILEPTICS NOS 4-6,,Fee Schedule,0.08
Aetna,HMO,80341,CPT4/HCPCS,ANTIEPILEPTICS NOS 7/MORE,,Fee Schedule,0.08
Aetna,HMO,80342,CPT4/HCPCS,ANTIPSYCHOTICS NOS 1-3,,Fee Schedule,0.08
Aetna,HMO,80343,CPT4/HCPCS,ANTIPSYCHOTICS NOS 4-6,,Fee Schedule,0.08
Aetna,HMO,80344,CPT4/HCPCS,ANTIPSYCHOTICS NOS 7/MORE,,Fee Schedule,0.08
Aetna,HMO,80345,CPT4/HCPCS,DRUG SCREENING BARBITURATES,,Fee Schedule,0.08
Aetna,HMO,80346,CPT4/HCPCS,BENZODIAZEPINES1-12,,Fee Schedule,0.08
Aetna,HMO,80347,CPT4/HCPCS,BENZODIAZEPINES 13 OR MORE,,Fee Schedule,0.08
Aetna,HMO,80348,CPT4/HCPCS,DRUG SCREENING BUPRENORPHINE,,Fee Schedule,0.08
Aetna,HMO,80349,CPT4/HCPCS,CANNABINOIDS NATURAL,,Fee Schedule,0.08
Aetna,HMO,80350,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 1-3,,Fee Schedule,0.08
Aetna,HMO,80351,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 4-6,,Fee Schedule,0.08
Aetna,HMO,80352,CPT4/HCPCS,CANNABINOID SYNTHETIC 7/MORE,,Fee Schedule,0.08
Aetna,HMO,80353,CPT4/HCPCS,DRUG SCREENING COCAINE,,Fee Schedule,0.08
Aetna,HMO,80354,CPT4/HCPCS,DRUG SCREENING FENTANYL,,Fee Schedule,0.08
Aetna,HMO,80355,CPT4/HCPCS,GABAPENTIN NON-BLOOD,,Fee Schedule,0.08
Aetna,HMO,80356,CPT4/HCPCS,HEROIN METABOLITE,,Fee Schedule,0.08
Aetna,HMO,80357,CPT4/HCPCS,KETAMINE AND NORKETAMINE,,Fee Schedule,0.08
Aetna,HMO,80358,CPT4/HCPCS,DRUG SCREENING METHADONE,,Fee Schedule,0.08
Aetna,HMO,80359,CPT4/HCPCS,METHYLENEDIOXYAMPHETAMINES,,Fee Schedule,0.08
Aetna,HMO,80360,CPT4/HCPCS,METHYLPHENIDATE,,Fee Schedule,0.08
Aetna,HMO,80361,CPT4/HCPCS,OPIATES 1 OR MORE,,Fee Schedule,0.08
Aetna,HMO,80362,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 1/2,,Fee Schedule,0.08
Aetna,HMO,80363,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 3/4,,Fee Schedule,0.08
Aetna,HMO,80364,CPT4/HCPCS,OPIOID &OPIATE ANALOG 5/MORE,,Fee Schedule,0.08
Aetna,HMO,80365,CPT4/HCPCS,DRUG SCREENING OXYCODONE,,Fee Schedule,0.08
Aetna,HMO,80366,CPT4/HCPCS,DRUG SCREENING PREGABALIN,,Fee Schedule,0.08
Aetna,HMO,80367,CPT4/HCPCS,DRUG SCREENING PROPOXYPHENE,,Fee Schedule,0.08
Aetna,HMO,80368,CPT4/HCPCS,SEDATIVE HYPNOTICS,,Fee Schedule,0.08
Aetna,HMO,80369,CPT4/HCPCS,SKELETAL MUSCLE RELAXANT 1/2,,Fee Schedule,0.08
Aetna,HMO,80370,CPT4/HCPCS,SKEL MUSC RELAXANT 3 OR MORE,,Fee Schedule,0.08
Aetna,HMO,80371,CPT4/HCPCS,STIMULANTS SYNTHETIC,,Fee Schedule,0.08
Aetna,HMO,80372,CPT4/HCPCS,DRUG SCREENING TAPENTADOL,,Fee Schedule,0.08
Aetna,HMO,80373,CPT4/HCPCS,DRUG SCREENING TRAMADOL,,Fee Schedule,0.08
Aetna,HMO,80374,CPT4/HCPCS,STEREOISOMER ANALYSIS,,Fee Schedule,0.08
Aetna,HMO,80375,CPT4/HCPCS,DRUG/SUBSTANCE NOS 1-3,,Fee Schedule,0.08
Aetna,HMO,80376,CPT4/HCPCS,DRUG/SUBSTANCE NOS 4-6,,Fee Schedule,0.08
Aetna,HMO,80377,CPT4/HCPCS,DRUG/SUBSTANCE NOS 7/MORE,,Fee Schedule,0.08
Aetna,HMO,80400,CPT4/HCPCS,ACTH STIMULATION PANEL,,Fee Schedule,327.76
Aetna,HMO,80402,CPT4/HCPCS,ACTH STIMULATION PANEL,,Fee Schedule,873.68
Aetna,HMO,80406,CPT4/HCPCS,ACTH STIMULATION PANEL,,Fee Schedule,786.40
Aetna,HMO,80408,CPT4/HCPCS,ALDOSTERONE SUPPRESSION EVAL,,Fee Schedule,1260.92
Aetna,HMO,80410,CPT4/HCPCS,CALCITONIN STIMUL PANEL,,Fee Schedule,807.32
Aetna,HMO,80412,CPT4/HCPCS,CRH STIMULATION PANEL,,Fee Schedule,3311.53
Aetna,HMO,80414,CPT4/HCPCS,TESTOSTERONE RESPONSE PANEL,,Fee Schedule,518.78
Aetna,HMO,80415,CPT4/HCPCS,TOT ESTRADIOL RESPONSE PANEL,,Fee Schedule,561.45
Aetna,HMO,80416,CPT4/HCPCS,RENIN STIMULATION PANEL,,Fee Schedule,1325.94
Aetna,HMO,80417,CPT4/HCPCS,RENIN STIMULATION PANEL,,Fee Schedule,442.00
Aetna,HMO,80418,CPT4/HCPCS,PITUITARY EVALUATION PANEL,,Fee Schedule,5823.13
Aetna,HMO,80420,CPT4/HCPCS,DEXAMETHASONE PANEL,,Fee Schedule,723.82
Aetna,HMO,80422,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,Fee Schedule,462.92
Aetna,HMO,80424,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,Fee Schedule,507.36
Aetna,HMO,80426,CPT4/HCPCS,GONADOTROPIN HORMONE PANEL,,Fee Schedule,1491.08
Aetna,HMO,80428,CPT4/HCPCS,GROWTH HORMONE PANEL,,Fee Schedule,670.32
Aetna,HMO,80430,CPT4/HCPCS,GROWTH HORMONE PANEL,,Fee Schedule,788.50
Aetna,HMO,80432,CPT4/HCPCS,INSULIN SUPPRESSION PANEL,,Fee Schedule,1357.27
Aetna,HMO,80434,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,Fee Schedule,1016.40
Aetna,HMO,80435,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,Fee Schedule,1034.96
Aetna,HMO,80436,CPT4/HCPCS,METYRAPONE PANEL,,Fee Schedule,916.10
Aetna,HMO,80438,CPT4/HCPCS,TRH STIMULATION PANEL,,Fee Schedule,506.35
Aetna,HMO,80439,CPT4/HCPCS,TRH STIMULATION PANEL,,Fee Schedule,675.19
Aetna,HMO,80500,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,Fee Schedule,139.94
Aetna,HMO,80502,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,Fee Schedule,474.76
Aetna,HMO,81000,CPT4/HCPCS,URINALYSIS NONAUTO W/SCOPE,,Fee Schedule,31.75
Aetna,HMO,81001,CPT4/HCPCS,URINALYSIS AUTO W/SCOPE,,Fee Schedule,31.75
Aetna,HMO,81002,CPT4/HCPCS,URINALYSIS NONAUTO W/O SCOPE,,Fee Schedule,25.70
Aetna,HMO,81003,CPT4/HCPCS,URINALYSIS AUTO W/O SCOPE,,Fee Schedule,22.59
Aetna,HMO,81005,CPT4/HCPCS,URINALYSIS,,Fee Schedule,21.75
Aetna,HMO,81007,CPT4/HCPCS,URINE SCREEN FOR BACTERIA,,Fee Schedule,25.78
Aetna,HMO,81015,CPT4/HCPCS,MICROSCOPIC EXAM OF URINE,,Fee Schedule,30.57
Aetna,HMO,81020,CPT4/HCPCS,URINALYSIS GLASS TEST,,Fee Schedule,37.04
Aetna,HMO,81025,CPT4/HCPCS,URINE PREGNANCY TEST,,Fee Schedule,23.60
Aetna,HMO,81050,CPT4/HCPCS,URINALYSIS VOLUME MEASURE,,Fee Schedule,30.15
Aetna,HMO,81105,CPT4/HCPCS,HPA-1 GENOTYPING,,Fee Schedule,1077.38
Aetna,HMO,81106,CPT4/HCPCS,HPA-2 GENOTYPING,,Fee Schedule,1077.38
Aetna,HMO,81107,CPT4/HCPCS,HPA-3 GENOTYPING,,Fee Schedule,1077.38
Aetna,HMO,81108,CPT4/HCPCS,HPA-4 GENOTYPING,,Fee Schedule,1077.38
Aetna,HMO,81109,CPT4/HCPCS,HPA-5 GENOTYPING,,Fee Schedule,1077.38
Aetna,HMO,81110,CPT4/HCPCS,HPA-6 GENOTYPING,,Fee Schedule,1077.38
Aetna,HMO,81111,CPT4/HCPCS,HPA-9 GENOTYPING,,Fee Schedule,1077.38
Aetna,HMO,81112,CPT4/HCPCS,HPA-15 GENOTYPING,,Fee Schedule,1077.38
Aetna,HMO,81120,CPT4/HCPCS,IDH1 COMMON VARIANTS,,Fee Schedule,1379.78
Aetna,HMO,81121,CPT4/HCPCS,IDH2 COMMON VARIANTS,,Fee Schedule,2111.92
Aetna,HMO,81161,CPT4/HCPCS,DMD DUP/DELET ANALYSIS,,Fee Schedule,4851.00
Aetna,HMO,81162,CPT4/HCPCS,BRCA1&2 GEN FULL SEQ DUP/DEL,,Fee Schedule,17749.03
Aetna,HMO,81163,CPT4/HCPCS,BRCA1&2 GENE FULL SEQ ALYS,,Fee Schedule,3341.52
Aetna,HMO,81164,CPT4/HCPCS,BRCA1&2 GEN FUL DUP/DEL ALYS,,Fee Schedule,4171.44
Aetna,HMO,81165,CPT4/HCPCS,BRCA1 GENE FULL SEQ ALYS,,Fee Schedule,2019.78
Aetna,HMO,81166,CPT4/HCPCS,BRCA1 GENE FULL DUP/DEL ALYS,,Fee Schedule,2151.66
Aetna,HMO,81167,CPT4/HCPCS,BRCA2 GENE FULL DUP/DEL ALYS,,Fee Schedule,2019.78
Aetna,HMO,81170,CPT4/HCPCS,ABL1 GENE,,Fee Schedule,2352.67
Aetna,HMO,81171,CPT4/HCPCS,AFF2 GENE DETC ABNOR ALLELES,,Fee Schedule,978.18
Aetna,HMO,81172,CPT4/HCPCS,AFF2 GENE CHARAC ALLELES,,Fee Schedule,1962.32
Aetna,HMO,81173,CPT4/HCPCS,AR GENE FULL GENE SEQUENCE,,Fee Schedule,2151.66
Aetna,HMO,81174,CPT4/HCPCS,AR GENE KNOWN FAMIL VARIANT,,Fee Schedule,1322.32
Aetna,HMO,81175,CPT4/HCPCS,ASXL1 FULL GENE SEQUENCE,,Fee Schedule,5048.14
Aetna,HMO,81176,CPT4/HCPCS,ASXL1 GENE TARGET SEQ ALYS,,Fee Schedule,2132.25
Aetna,HMO,81177,CPT4/HCPCS,ATN1 GENE DETC ABNOR ALLELES,,Fee Schedule,978.18
Aetna,HMO,81178,CPT4/HCPCS,ATXN1 GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,HMO,81179,CPT4/HCPCS,ATXN2 GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,HMO,81180,CPT4/HCPCS,ATXN3 GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,HMO,81181,CPT4/HCPCS,ATXN7 GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,HMO,81182,CPT4/HCPCS,ATXN8OS GEN DETC ABNOR ALLEL,,Fee Schedule,978.18
Aetna,HMO,81183,CPT4/HCPCS,ATXN10 GENE DETC ABNOR ALLEL,,Fee Schedule,978.18
Aetna,HMO,81184,CPT4/HCPCS,CACNA1A GEN DETC ABNOR ALLEL,,Fee Schedule,978.18
Aetna,HMO,81185,CPT4/HCPCS,CACNA1A GENE FULL GENE SEQ,,Fee Schedule,6042.37
Aetna,HMO,81186,CPT4/HCPCS,CACNA1A GEN KNOWN FAMIL VRNT,,Fee Schedule,1322.32
Aetna,HMO,81187,CPT4/HCPCS,CNBP GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,HMO,81188,CPT4/HCPCS,CSTB GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,HMO,81189,CPT4/HCPCS,CSTB GENE FULL GENE SEQUENCE,,Fee Schedule,1962.32
Aetna,HMO,81190,CPT4/HCPCS,CSTB GENE KNOWN FAMIL VRNT,,Fee Schedule,1322.32
Aetna,HMO,81200,CPT4/HCPCS,ASPA GENE,,Fee Schedule,758.60
Aetna,HMO,81201,CPT4/HCPCS,APC GENE FULL SEQUENCE,,Fee Schedule,4817.90
Aetna,HMO,81202,CPT4/HCPCS,APC GENE KNOWN FAM VARIANTS,,Fee Schedule,355.15
Aetna,HMO,81203,CPT4/HCPCS,APC GENE DUP/DELET VARIANTS,,Fee Schedule,2158.21
Aetna,HMO,81204,CPT4/HCPCS,AR GENE CHARAC ALLELES,,Fee Schedule,978.18
Aetna,HMO,81205,CPT4/HCPCS,BCKDHB GENE,,Fee Schedule,694.17
Aetna,HMO,81206,CPT4/HCPCS,BCR/ABL1 GENE MAJOR BP,,Fee Schedule,490.47
Aetna,HMO,81207,CPT4/HCPCS,BCR/ABL1 GENE MINOR BP,,Fee Schedule,436.38
Aetna,HMO,81208,CPT4/HCPCS,BCR/ABL1 GENE OTHER BP,,Fee Schedule,436.38
Aetna,HMO,81209,CPT4/HCPCS,BLM GENE,,Fee Schedule,335.07
Aetna,HMO,81210,CPT4/HCPCS,BRAF GENE,,Fee Schedule,378.00
Aetna,HMO,81212,CPT4/HCPCS,BRCA1&2 185&5385&6174 VRNT,,Fee Schedule,757.00
Aetna,HMO,81215,CPT4/HCPCS,BRCA1 GENE KNOWN FAMIL VRNT,,Fee Schedule,399.42
Aetna,HMO,81216,CPT4/HCPCS,BRCA2 GENE FULL SEQ ALYS,,Fee Schedule,5283.09
Aetna,HMO,81217,CPT4/HCPCS,BRCA2 GENE KNOWN FAMIL VRNT,,Fee Schedule,399.42
Aetna,HMO,81218,CPT4/HCPCS,CEBPA GENE FULL SEQUENCE,,Fee Schedule,2352.67
Aetna,HMO,81219,CPT4/HCPCS,CALR GENE COM VARIANTS,,Fee Schedule,1182.97
Aetna,HMO,81220,CPT4/HCPCS,CFTR GENE COM VARIANTS,,Fee Schedule,4114.99
Aetna,HMO,81221,CPT4/HCPCS,CFTR GENE KNOWN FAM VARIANTS,,Fee Schedule,419.83
Aetna,HMO,81222,CPT4/HCPCS,CFTR GENE DUP/DELET VARIANTS,,Fee Schedule,2835.84
Aetna,HMO,81223,CPT4/HCPCS,CFTR GENE FULL SEQUENCE,,Fee Schedule,5566.76
Aetna,HMO,81224,CPT4/HCPCS,CFTR GENE INTRON POLY T,,Fee Schedule,294.67
Aetna,HMO,81225,CPT4/HCPCS,CYP2C19 GENE COM VARIANTS,,Fee Schedule,673.93
Aetna,HMO,81226,CPT4/HCPCS,CYP2D6 GENE COM VARIANTS,,Fee Schedule,1033.03
Aetna,HMO,81227,CPT4/HCPCS,CYP2C9 GENE COM VARIANTS,,Fee Schedule,778.93
Aetna,HMO,81228,CPT4/HCPCS,CYTOGEN MICRARRAY COPY NMBR,,Fee Schedule,1542.24
Aetna,HMO,81229,CPT4/HCPCS,CYTOGEN M ARRAY COPY NO&SNP,,Fee Schedule,1542.24
Aetna,HMO,81230,CPT4/HCPCS,CYP3A4 GENE COMMON VARIANTS,,Fee Schedule,1248.15
Aetna,HMO,81231,CPT4/HCPCS,CYP3A5 GENE COMMON VARIANTS,,Fee Schedule,1248.15
Aetna,HMO,81232,CPT4/HCPCS,DPYD GENE COMMON VARIANTS,,Fee Schedule,1248.15
Aetna,HMO,81233,CPT4/HCPCS,BTK GENE COMMON VARIANTS,,Fee Schedule,1252.35
Aetna,HMO,81234,CPT4/HCPCS,DMPK GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,HMO,81235,CPT4/HCPCS,EGFR GENE COM VARIANTS,,Fee Schedule,1493.10
Aetna,HMO,81236,CPT4/HCPCS,EZH2 GENE FULL GENE SEQUENCE,,Fee Schedule,2019.78
Aetna,HMO,81237,CPT4/HCPCS,EZH2 GENE COMMON VARIANTS,,Fee Schedule,1252.35
Aetna,HMO,81238,CPT4/HCPCS,F9 FULL GENE SEQUENCE,,Fee Schedule,4284.00
Aetna,HMO,81239,CPT4/HCPCS,DMPK GENE CHARAC ALLELES,,Fee Schedule,1962.32
Aetna,HMO,81240,CPT4/HCPCS,F2 GENE,,Fee Schedule,254.94
Aetna,HMO,81241,CPT4/HCPCS,F5 GENE,,Fee Schedule,228.39
Aetna,HMO,81242,CPT4/HCPCS,FANCC GENE,,Fee Schedule,419.83
Aetna,HMO,81243,CPT4/HCPCS,FMR1 GENE DETECTION,,Fee Schedule,443.94
Aetna,HMO,81244,CPT4/HCPCS,FMR1 GENE CHARAC ALLELES,,Fee Schedule,141.70
Aetna,HMO,81245,CPT4/HCPCS,FLT3 GENE,,Fee Schedule,399.58
Aetna,HMO,81246,CPT4/HCPCS,FLT3 GENE ANALYSIS,,Fee Schedule,905.94
Aetna,HMO,81247,CPT4/HCPCS,G6PD GENE ALYS CMN VARIANT,,Fee Schedule,1248.15
Aetna,HMO,81248,CPT4/HCPCS,G6PD KNOWN FAMILIAL VARIANT,,Fee Schedule,2679.26
Aetna,HMO,81249,CPT4/HCPCS,G6PD FULL GENE SEQUENCE,,Fee Schedule,4284.00
Aetna,HMO,81250,CPT4/HCPCS,G6PC GENE,,Fee Schedule,524.83
Aetna,HMO,81251,CPT4/HCPCS,GBA GENE,,Fee Schedule,1012.78
Aetna,HMO,81252,CPT4/HCPCS,GJB2 GENE FULL SEQUENCE,,Fee Schedule,800.85
Aetna,HMO,81253,CPT4/HCPCS,GJB2 GENE KNOWN FAM VARIANTS,,Fee Schedule,308.28
Aetna,HMO,81254,CPT4/HCPCS,GJB6 GENE COM VARIANTS,,Fee Schedule,145.48
Aetna,HMO,81255,CPT4/HCPCS,HEXA GENE,,Fee Schedule,1097.54
Aetna,HMO,81256,CPT4/HCPCS,HFE GENE,,Fee Schedule,335.07
Aetna,HMO,81257,CPT4/HCPCS,HBA1/HBA2 GENE,,Fee Schedule,653.68
Aetna,HMO,81258,CPT4/HCPCS,HBA1/HBA2 GENE FAM VRNT,,Fee Schedule,2679.26
Aetna,HMO,81259,CPT4/HCPCS,HBA1/HBA2 FULL GENE SEQUENCE,,Fee Schedule,4284.00
Aetna,HMO,81260,CPT4/HCPCS,IKBKAP GENE,,Fee Schedule,521.80
Aetna,HMO,81261,CPT4/HCPCS,IGH GENE REARRANGE AMP METH,,Fee Schedule,525.33
Aetna,HMO,81262,CPT4/HCPCS,IGH GENE REARRANG DIR PROBE,,Fee Schedule,255.10
Aetna,HMO,81263,CPT4/HCPCS,IGH VARI REGIONAL MUTATION,,Fee Schedule,428.40
Aetna,HMO,81264,CPT4/HCPCS,IGK REARRANGEABN CLONAL POP,,Fee Schedule,872.76
Aetna,HMO,81265,CPT4/HCPCS,STR MARKERS SPECIMEN ANAL,,Fee Schedule,2268.00
Aetna,HMO,81266,CPT4/HCPCS,STR MARKERS SPEC ANAL ADDL,,Fee Schedule,522.81
Aetna,HMO,81267,CPT4/HCPCS,CHIMERISM ANAL NO CELL SELEC,,Fee Schedule,3957.24
Aetna,HMO,81268,CPT4/HCPCS,CHIMERISM ANAL W/CELL SELECT,,Fee Schedule,1524.18
Aetna,HMO,81269,CPT4/HCPCS,HBA1/HBA2 GENE DUP/DEL VRNTS,,Fee Schedule,1445.13
Aetna,HMO,81270,CPT4/HCPCS,JAK2 GENE,,Fee Schedule,290.05
Aetna,HMO,81271,CPT4/HCPCS,HTT GENE DETC ABNOR ALLELES,,Fee Schedule,978.18
Aetna,HMO,81272,CPT4/HCPCS,KIT GENE TARGETED SEQ ANALYS,,Fee Schedule,2352.67
Aetna,HMO,81273,CPT4/HCPCS,KIT GENE ANALYS D816 VARIANT,,Fee Schedule,891.57
Aetna,HMO,81274,CPT4/HCPCS,HTT GENE CHARAC ALLELES,,Fee Schedule,1962.32
Aetna,HMO,81275,CPT4/HCPCS,KRAS GENE VARIANTS EXON 2,,Fee Schedule,758.60
Aetna,HMO,81276,CPT4/HCPCS,KRAS GENE ADDL VARIANTS,,Fee Schedule,1407.92
Aetna,HMO,81283,CPT4/HCPCS,IFNL3 GENE,,Fee Schedule,538.60
Aetna,HMO,81284,CPT4/HCPCS,FXN GENE DETC ABNOR ALLELES,,Fee Schedule,978.18
Aetna,HMO,81285,CPT4/HCPCS,FXN GENE CHARAC ALLELES,,Fee Schedule,1962.32
Aetna,HMO,81286,CPT4/HCPCS,FXN GENE FULL GENE SEQUENCE,,Fee Schedule,1962.32
Aetna,HMO,81287,CPT4/HCPCS,MGMT GENE PRMTR MTHYLTN ALYS,,Fee Schedule,2940.00
Aetna,HMO,81288,CPT4/HCPCS,MLH1 GENE,,Fee Schedule,2714.20
Aetna,HMO,81289,CPT4/HCPCS,FXN GENE KNOWN FAMIL VARIANT,,Fee Schedule,1322.32
Aetna,HMO,81290,CPT4/HCPCS,MCOLN1 GENE,,Fee Schedule,419.83
Aetna,HMO,81291,CPT4/HCPCS,MTHFR GENE,,Fee Schedule,390.60
Aetna,HMO,81292,CPT4/HCPCS,MLH1 GENE FULL SEQ,,Fee Schedule,3276.00
Aetna,HMO,81293,CPT4/HCPCS,MLH1 GENE KNOWN VARIANTS,,Fee Schedule,335.07
Aetna,HMO,81294,CPT4/HCPCS,MLH1 GENE DUP/DELETE VARIANT,,Fee Schedule,1951.90
Aetna,HMO,81295,CPT4/HCPCS,MSH2 GENE FULL SEQ,,Fee Schedule,3024.00
Aetna,HMO,81296,CPT4/HCPCS,MSH2 GENE KNOWN VARIANTS,,Fee Schedule,335.07
Aetna,HMO,81297,CPT4/HCPCS,MSH2 GENE DUP/DELETE VARIANT,,Fee Schedule,1730.98
Aetna,HMO,81298,CPT4/HCPCS,MSH6 GENE FULL SEQ,,Fee Schedule,4284.00
Aetna,HMO,81299,CPT4/HCPCS,MSH6 GENE KNOWN VARIANTS,,Fee Schedule,335.07
Aetna,HMO,81300,CPT4/HCPCS,MSH6 GENE DUP/DELETE VARIANT,,Fee Schedule,756.00
Aetna,HMO,81301,CPT4/HCPCS,MICROSATELLITE INSTABILITY,,Fee Schedule,1144.75
Aetna,HMO,81302,CPT4/HCPCS,MECP2 GENE FULL SEQ,,Fee Schedule,1625.98
Aetna,HMO,81303,CPT4/HCPCS,MECP2 GENE KNOWN VARIANT,,Fee Schedule,604.80
Aetna,HMO,81304,CPT4/HCPCS,MECP2 GENE DUP/DELET VARIANT,,Fee Schedule,1056.97
Aetna,HMO,81305,CPT4/HCPCS,MYD88 GENE P.LEU265PRO VRNT,,Fee Schedule,1252.35
Aetna,HMO,81306,CPT4/HCPCS,NUDT15 GENE COMMON VARIANTS,,Fee Schedule,2080.34
Aetna,HMO,81310,CPT4/HCPCS,NPM1 GENE,,Fee Schedule,209.91
Aetna,HMO,81311,CPT4/HCPCS,NRAS GENE VARIANTS EXON 2&3,,Fee Schedule,2111.92
Aetna,HMO,81312,CPT4/HCPCS,PABPN1 GENE DETC ABNOR ALLEL,,Fee Schedule,978.18
Aetna,HMO,81313,CPT4/HCPCS,PCA3/KLK3 ANTIGEN,,Fee Schedule,1680.00
Aetna,HMO,81314,CPT4/HCPCS,PDGFRA GENE,,Fee Schedule,2352.67
Aetna,HMO,81315,CPT4/HCPCS,PML/RARALPHA COM BREAKPOINTS,,Fee Schedule,570.52
Aetna,HMO,81316,CPT4/HCPCS,PML/RARALPHA 1 BREAKPOINT,,Fee Schedule,1848.08
Aetna,HMO,81317,CPT4/HCPCS,PMS2 GENE FULL SEQ ANALYSIS,,Fee Schedule,3369.24
Aetna,HMO,81318,CPT4/HCPCS,PMS2 KNOWN FAMILIAL VARIANTS,,Fee Schedule,428.40
Aetna,HMO,81319,CPT4/HCPCS,PMS2 GENE DUP/DELET VARIANTS,,Fee Schedule,874.44
Aetna,HMO,81320,CPT4/HCPCS,PLCG2 GENE COMMON VARIANTS,,Fee Schedule,2080.34
Aetna,HMO,81321,CPT4/HCPCS,PTEN GENE FULL SEQUENCE,,Fee Schedule,2287.82
Aetna,HMO,81322,CPT4/HCPCS,PTEN GENE KNOWN FAM VARIANT,,Fee Schedule,222.43
Aetna,HMO,81323,CPT4/HCPCS,PTEN GENE DUP/DELET VARIANT,,Fee Schedule,333.64
Aetna,HMO,81324,CPT4/HCPCS,PMP22 GENE DUP/DELET,,Fee Schedule,4284.00
Aetna,HMO,81325,CPT4/HCPCS,PMP22 GENE FULL SEQUENCE,,Fee Schedule,1123.58
Aetna,HMO,81326,CPT4/HCPCS,PMP22 GENE KNOWN FAM VARIANT,,Fee Schedule,699.72
Aetna,HMO,81327,CPT4/HCPCS,SEPT9 GEN PRMTR MTHYLTN ALYS,,Fee Schedule,597.40
Aetna,HMO,81328,CPT4/HCPCS,SLCO1B1 GENE COM VARIANTS,,Fee Schedule,1248.15
Aetna,HMO,81329,CPT4/HCPCS,SMN1 GENE DOS/DELETION ALYS,,Fee Schedule,978.18
Aetna,HMO,81330,CPT4/HCPCS,SMPD1 GENE COMMON VARIANTS,,Fee Schedule,673.93
Aetna,HMO,81331,CPT4/HCPCS,SNRPN/UBE3A GENE,,Fee Schedule,294.67
Aetna,HMO,81332,CPT4/HCPCS,SERPINA1 GENE,,Fee Schedule,335.07
Aetna,HMO,81333,CPT4/HCPCS,TGFBI GENE COMMON VARIANTS,,Fee Schedule,978.18
Aetna,HMO,81334,CPT4/HCPCS,RUNX1 GENE TARGETED SEQ ALYS,,Fee Schedule,2352.67
Aetna,HMO,81335,CPT4/HCPCS,TPMT GENE COM VARIANTS,,Fee Schedule,1248.15
Aetna,HMO,81336,CPT4/HCPCS,SMN1 GENE FULL GENE SEQUENCE,,Fee Schedule,2151.66
Aetna,HMO,81337,CPT4/HCPCS,SMN1 GEN NOWN FAMIL SEQ VRNT,,Fee Schedule,1322.32
Aetna,HMO,81340,CPT4/HCPCS,TRB@ GENE REARRANGE AMPLIFY,,Fee Schedule,970.20
Aetna,HMO,81341,CPT4/HCPCS,TRB@ GENE REARRANGE DIRPROBE,,Fee Schedule,289.80
Aetna,HMO,81342,CPT4/HCPCS,TRG GENE REARRANGEMENT ANAL,,Fee Schedule,811.44
Aetna,HMO,81343,CPT4/HCPCS,PPP2R2B GEN DETC ABNOR ALLEL,,Fee Schedule,978.18
Aetna,HMO,81344,CPT4/HCPCS,TBP GENE DETC ABNOR ALLELES,,Fee Schedule,978.18
Aetna,HMO,81345,CPT4/HCPCS,TERT GENE TARGETED SEQ ALYS,,Fee Schedule,1322.32
Aetna,HMO,81346,CPT4/HCPCS,TYMS GENE COM VARIANTS,,Fee Schedule,1248.15
Aetna,HMO,81350,CPT4/HCPCS,UGT1A1 GENE COMMON VARIANTS,,Fee Schedule,417.98
Aetna,HMO,81355,CPT4/HCPCS,VKORC1 GENE,,Fee Schedule,250.40
Aetna,HMO,81361,CPT4/HCPCS,HBB GENE COM VARIANTS,,Fee Schedule,1248.15
Aetna,HMO,81362,CPT4/HCPCS,HBB GENE KNOWN FAM VARIANT,,Fee Schedule,2679.26
Aetna,HMO,81363,CPT4/HCPCS,HBB GENE DUP/DEL VARIANTS,,Fee Schedule,1445.13
Aetna,HMO,81364,CPT4/HCPCS,HBB FULL GENE SEQUENCE,,Fee Schedule,2317.47
Aetna,HMO,81370,CPT4/HCPCS,HLA I & II TYPING LR,,Fee Schedule,2350.23
Aetna,HMO,81371,CPT4/HCPCS,HLA I & II TYPE VERIFY LR,,Fee Schedule,1406.74
Aetna,HMO,81372,CPT4/HCPCS,HLA I TYPING COMPLETE LR,,Fee Schedule,2411.80
Aetna,HMO,81373,CPT4/HCPCS,HLA I TYPING 1 LOCUS LR,,Fee Schedule,817.40
Aetna,HMO,81374,CPT4/HCPCS,HLA I TYPING 1 ANTIGEN LR,,Fee Schedule,817.40
Aetna,HMO,81375,CPT4/HCPCS,HLA II TYPING AG EQUIV LR,,Fee Schedule,902.16
Aetna,HMO,81376,CPT4/HCPCS,HLA II TYPING 1 LOCUS LR,,Fee Schedule,477.45
Aetna,HMO,81377,CPT4/HCPCS,HLA II TYPE 1 AG EQUIV LR,,Fee Schedule,388.41
Aetna,HMO,81378,CPT4/HCPCS,HLA I & II TYPING HR,,Fee Schedule,2019.61
Aetna,HMO,81379,CPT4/HCPCS,HLA I TYPING COMPLETE HR,,Fee Schedule,1960.05
Aetna,HMO,81380,CPT4/HCPCS,HLA I TYPING 1 LOCUS HR,,Fee Schedule,718.11
Aetna,HMO,81381,CPT4/HCPCS,HLA I TYPING 1 ALLELE HR,,Fee Schedule,817.23
Aetna,HMO,81382,CPT4/HCPCS,HLA II TYPING 1 LOC HR,,Fee Schedule,483.58
Aetna,HMO,81383,CPT4/HCPCS,HLA II TYPING 1 ALLELE HR,,Fee Schedule,349.86
Aetna,HMO,81400,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 1,,Fee Schedule,345.32
Aetna,HMO,81401,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 2,,Fee Schedule,327.60
Aetna,HMO,81402,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 3,,Fee Schedule,504.00
Aetna,HMO,81403,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 4,,Fee Schedule,504.00
Aetna,HMO,81404,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 5,,Fee Schedule,882.00
Aetna,HMO,81405,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 6,,Fee Schedule,882.00
Aetna,HMO,81406,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 7,,Fee Schedule,502.32
Aetna,HMO,81407,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 8,,Fee Schedule,6048.00
Aetna,HMO,81408,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 9,,Fee Schedule,6048.00
Aetna,HMO,81410,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,Fee Schedule,3598.56
Aetna,HMO,81411,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,Fee Schedule,6115.20
Aetna,HMO,81412,CPT4/HCPCS,ASHKENAZI JEWISH ASSOC DIS,,Fee Schedule,4268.96
Aetna,HMO,81413,CPT4/HCPCS,CAR ION CHNNLPATH INC 10 GNS,,Fee Schedule,5728.63
Aetna,HMO,81414,CPT4/HCPCS,CAR ION CHNNLPATH INC 2 GNS,,Fee Schedule,5728.63
Aetna,HMO,81415,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,Fee Schedule,8400.00
Aetna,HMO,81416,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,Fee Schedule,8400.00
Aetna,HMO,81417,CPT4/HCPCS,EXOME RE-EVALUATION,,Fee Schedule,2284.80
Aetna,HMO,81420,CPT4/HCPCS,FETAL CHRMOML ANEUPLOIDY,,Fee Schedule,4200.00
Aetna,HMO,81422,CPT4/HCPCS,FETAL CHRMOML MICRODELTJ,,Fee Schedule,5728.63
Aetna,HMO,81425,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,Fee Schedule,0.08
Aetna,HMO,81426,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,Fee Schedule,0.08
Aetna,HMO,81427,CPT4/HCPCS,GENOME RE-EVALUATION,,Fee Schedule,0.08
Aetna,HMO,81430,CPT4/HCPCS,HEARING LOSS SEQUENCE ANALYS,,Fee Schedule,11602.50
Aetna,HMO,81431,CPT4/HCPCS,HEARING LOSS DUP/DEL ANALYS,,Fee Schedule,4852.09
Aetna,HMO,81432,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,Fee Schedule,6650.78
Aetna,HMO,81433,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,Fee Schedule,4299.03
Aetna,HMO,81434,CPT4/HCPCS,HEREDITARY RETINAL DISORDERS,,Fee Schedule,4299.03
Aetna,HMO,81435,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,Fee Schedule,4200.00
Aetna,HMO,81436,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,Fee Schedule,2940.00
Aetna,HMO,81437,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,Fee Schedule,4299.03
Aetna,HMO,81438,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,Fee Schedule,4299.03
Aetna,HMO,81439,CPT4/HCPCS,HRDTRY CARDMYPY GENE PANEL,,Fee Schedule,5728.63
Aetna,HMO,81440,CPT4/HCPCS,MITOCHONDRIAL GENE,,Fee Schedule,8400.00
Aetna,HMO,81442,CPT4/HCPCS,NOONAN SPECTRUM DISORDERS,,Fee Schedule,4350.27
Aetna,HMO,81443,CPT4/HCPCS,GENETIC TSTG SEVERE INH COND,,Fee Schedule,17482.75
Aetna,HMO,81445,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Fee Schedule,6040.18
Aetna,HMO,81448,CPT4/HCPCS,HRDTRY PERPH NEURPHY PANEL,,Fee Schedule,5155.83
Aetna,HMO,81450,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Fee Schedule,6040.18
Aetna,HMO,81455,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Fee Schedule,6040.18
Aetna,HMO,81460,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,Fee Schedule,13272.00
Aetna,HMO,81465,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,Fee Schedule,9660.00
Aetna,HMO,81470,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,Fee Schedule,6040.18
Aetna,HMO,81471,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,Fee Schedule,0.08
Aetna,HMO,81479,CPT4/HCPCS,UNLISTED MOLECULAR PATHOLOGY,,Fee Schedule,378.00
Aetna,HMO,81490,CPT4/HCPCS,AUTOIMMUNE RHEUMATOID ARTHR,,Fee Schedule,4216.96
Aetna,HMO,81493,CPT4/HCPCS,COR ARTERY DISEASE MRNA,,Fee Schedule,7442.40
Aetna,HMO,81500,CPT4/HCPCS,ONCO (OVAR) TWO PROTEINS,,Fee Schedule,1860.01
Aetna,HMO,81503,CPT4/HCPCS,ONCO (OVAR) FIVE PROTEINS,,Fee Schedule,2587.20
Aetna,HMO,81504,CPT4/HCPCS,ONCOLOGY TISSUE OF ORIGIN,,Fee Schedule,3712.80
Aetna,HMO,81506,CPT4/HCPCS,ENDO ASSAY SEVEN ANAL,,Fee Schedule,211.68
Aetna,HMO,81507,CPT4/HCPCS,FETAL ANEUPLOIDY TRISOM RISK,,Fee Schedule,4851.00
Aetna,HMO,81508,CPT4/HCPCS,FTL CGEN ABNOR TWO PROTEINS,,Fee Schedule,735.00
Aetna,HMO,81509,CPT4/HCPCS,FTL CGEN ABNOR 3 PROTEINS,,Fee Schedule,487.20
Aetna,HMO,81510,CPT4/HCPCS,FTL CGEN ABNOR THREE ANAL,,Fee Schedule,793.80
Aetna,HMO,81511,CPT4/HCPCS,FTL CGEN ABNOR FOUR ANAL,,Fee Schedule,1029.00
Aetna,HMO,81512,CPT4/HCPCS,FTL CGEN ABNOR FIVE ANAL,,Fee Schedule,2058.00
Aetna,HMO,81518,CPT4/HCPCS,ONC BRST MRNA 11 GENES,,Fee Schedule,27653.22
Aetna,HMO,81519,CPT4/HCPCS,ONCOLOGY BREAST MRNA,,Fee Schedule,23940.00
Aetna,HMO,81520,CPT4/HCPCS,ONC BREAST MRNA 58 GENES,,Fee Schedule,22127.02
Aetna,HMO,81521,CPT4/HCPCS,ONC BREAST MRNA 70 GENES,,Fee Schedule,27653.22
Aetna,HMO,81525,CPT4/HCPCS,ONCOLOGY COLON MRNA,,Fee Schedule,2692.95
Aetna,HMO,81528,CPT4/HCPCS,ONCOLOGY COLORECTAL SCR,,Fee Schedule,3633.33
Aetna,HMO,81535,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,Fee Schedule,4137.33
Aetna,HMO,81536,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,Fee Schedule,1267.81
Aetna,HMO,81538,CPT4/HCPCS,ONCOLOGY LUNG,,Fee Schedule,15185.18
Aetna,HMO,81539,CPT4/HCPCS,ONCOLOGY PROSTATE PROB SCORE,,Fee Schedule,4299.03
Aetna,HMO,81540,CPT4/HCPCS,ONCOLOGY TUM UNKNOWN ORIGIN,,Fee Schedule,20850.98
Aetna,HMO,81541,CPT4/HCPCS,ONC PROSTATE MRNA 46 GENES,,Fee Schedule,27653.22
Aetna,HMO,81545,CPT4/HCPCS,ONCOLOGY THYROID,,Fee Schedule,23007.93
Aetna,HMO,81551,CPT4/HCPCS,ONC PROSTATE 3 GENES,,Fee Schedule,11094.72
Aetna,HMO,81595,CPT4/HCPCS,CARDIOLOGY HRT TRNSPL MRNA,,Fee Schedule,20282.97
Aetna,HMO,81596,CPT4/HCPCS,NFCT DS CHRNC HCV 6 ASSAYS,,Fee Schedule,515.42
Aetna,HMO,82009,CPT4/HCPCS,TEST FOR ACETONE/KETONES,,Fee Schedule,45.44
Aetna,HMO,82010,CPT4/HCPCS,ACETONE ASSAY,,Fee Schedule,82.15
Aetna,HMO,82013,CPT4/HCPCS,ACETYLCHOLINESTERASE ASSAY,,Fee Schedule,112.22
Aetna,HMO,82016,CPT4/HCPCS,ACYLCARNITINES QUAL,,Fee Schedule,139.27
Aetna,HMO,82017,CPT4/HCPCS,ACYLCARNITINES QUANT,,Fee Schedule,169.51
Aetna,HMO,82024,CPT4/HCPCS,ASSAY OF ACTH,,Fee Schedule,388.08
Aetna,HMO,82030,CPT4/HCPCS,ASSAY OF ADP & AMP,,Fee Schedule,259.22
Aetna,HMO,82040,CPT4/HCPCS,ASSAY OF SERUM ALBUMIN,,Fee Schedule,49.72
Aetna,HMO,82042,CPT4/HCPCS,OTHER SOURCE ALBUMIN QUAN EA,,Fee Schedule,32.92
Aetna,HMO,82043,CPT4/HCPCS,UR ALBUMIN QUANTITATIVE,,Fee Schedule,58.12
Aetna,HMO,82044,CPT4/HCPCS,UR ALBUMIN SEMIQUANTITATIVE,,Fee Schedule,45.94
Aetna,HMO,82045,CPT4/HCPCS,ALBUMIN ISCHEMIA MODIFIED,,Fee Schedule,341.04
Aetna,HMO,82075,CPT4/HCPCS,ASSAY OF BREATH ETHANOL,,Fee Schedule,0.08
Aetna,HMO,82085,CPT4/HCPCS,ASSAY OF ALDOLASE,,Fee Schedule,97.52
Aetna,HMO,82088,CPT4/HCPCS,ASSAY OF ALDOSTERONE,,Fee Schedule,409.50
Aetna,HMO,82103,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN TOTAL,,Fee Schedule,134.98
Aetna,HMO,82104,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN PHENO,,Fee Schedule,145.32
Aetna,HMO,82105,CPT4/HCPCS,ALPHA-FETOPROTEIN SERUM,,Fee Schedule,168.58
Aetna,HMO,82106,CPT4/HCPCS,ALPHA-FETOPROTEIN AMNIOTIC,,Fee Schedule,168.58
Aetna,HMO,82107,CPT4/HCPCS,ALPHA-FETOPROTEIN L3,,Fee Schedule,647.13
Aetna,HMO,82108,CPT4/HCPCS,ASSAY OF ALUMINUM,,Fee Schedule,255.94
Aetna,HMO,82120,CPT4/HCPCS,AMINES VAGINAL FLUID QUAL,,Fee Schedule,37.80
Aetna,HMO,82127,CPT4/HCPCS,AMINO ACID SINGLE QUAL,,Fee Schedule,139.27
Aetna,HMO,82128,CPT4/HCPCS,AMINO ACIDS MULT QUAL,,Fee Schedule,139.27
Aetna,HMO,82131,CPT4/HCPCS,AMINO ACIDS SINGLE QUANT,,Fee Schedule,169.51
Aetna,HMO,82135,CPT4/HCPCS,ASSAY AMINOLEVULINIC ACID,,Fee Schedule,165.39
Aetna,HMO,82136,CPT4/HCPCS,AMINO ACIDS QUANT 2-5,,Fee Schedule,169.51
Aetna,HMO,82139,CPT4/HCPCS,AMINO ACIDS QUAN 6 OR MORE,,Fee Schedule,169.51
Aetna,HMO,82140,CPT4/HCPCS,ASSAY OF AMMONIA,,Fee Schedule,146.41
Aetna,HMO,82143,CPT4/HCPCS,AMNIOTIC FLUID SCAN,,Fee Schedule,69.04
Aetna,HMO,82150,CPT4/HCPCS,ASSAY OF AMYLASE,,Fee Schedule,65.10
Aetna,HMO,82154,CPT4/HCPCS,ANDROSTANEDIOL GLUCURONIDE,,Fee Schedule,289.63
Aetna,HMO,82157,CPT4/HCPCS,ASSAY OF ANDROSTENEDIONE,,Fee Schedule,294.16
Aetna,HMO,82160,CPT4/HCPCS,ASSAY OF ANDROSTERONE,,Fee Schedule,251.24
Aetna,HMO,82163,CPT4/HCPCS,ASSAY OF ANGIOTENSIN II,,Fee Schedule,206.22
Aetna,HMO,82164,CPT4/HCPCS,ANGIOTENSIN I ENZYME TEST,,Fee Schedule,146.66
Aetna,HMO,82172,CPT4/HCPCS,ASSAY OF APOLIPOPROTEIN,,Fee Schedule,141.62
Aetna,HMO,82175,CPT4/HCPCS,ASSAY OF ARSENIC,,Fee Schedule,190.68
Aetna,HMO,82180,CPT4/HCPCS,ASSAY OF ASCORBIC ACID,,Fee Schedule,99.28
Aetna,HMO,82190,CPT4/HCPCS,ATOMIC ABSORPTION,,Fee Schedule,149.77
Aetna,HMO,82232,CPT4/HCPCS,ASSAY OF BETA-2 PROTEIN,,Fee Schedule,162.54
Aetna,HMO,82239,CPT4/HCPCS,BILE ACIDS TOTAL,,Fee Schedule,172.11
Aetna,HMO,82240,CPT4/HCPCS,BILE ACIDS CHOLYLGLYCINE,,Fee Schedule,267.03
Aetna,HMO,82247,CPT4/HCPCS,BILIRUBIN TOTAL,,Fee Schedule,50.40
Aetna,HMO,82248,CPT4/HCPCS,BILIRUBIN DIRECT,,Fee Schedule,50.40
Aetna,HMO,82252,CPT4/HCPCS,FECAL BILIRUBIN TEST,,Fee Schedule,45.69
Aetna,HMO,82261,CPT4/HCPCS,ASSAY OF BIOTINIDASE,,Fee Schedule,169.51
Aetna,HMO,82270,CPT4/HCPCS,OCCULT BLOOD FECES,,Fee Schedule,32.67
Aetna,HMO,82271,CPT4/HCPCS,OCCULT BLOOD OTHER SOURCES,,Fee Schedule,32.67
Aetna,HMO,82272,CPT4/HCPCS,OCCULT BLD FECES 1-3 TESTS,,Fee Schedule,32.67
Aetna,HMO,82274,CPT4/HCPCS,ASSAY TEST FOR BLOOD FECAL,,Fee Schedule,159.76
Aetna,HMO,82286,CPT4/HCPCS,ASSAY OF BRADYKININ,,Fee Schedule,69.21
Aetna,HMO,82300,CPT4/HCPCS,ASSAY OF CADMIUM,,Fee Schedule,232.51
Aetna,HMO,82306,CPT4/HCPCS,VITAMIN D 25 HYDROXY,,Fee Schedule,297.44
Aetna,HMO,82308,CPT4/HCPCS,ASSAY OF CALCITONIN,,Fee Schedule,269.13
Aetna,HMO,82310,CPT4/HCPCS,ASSAY OF CALCIUM,,Fee Schedule,51.82
Aetna,HMO,82330,CPT4/HCPCS,ASSAY OF CALCIUM,,Fee Schedule,137.34
Aetna,HMO,82331,CPT4/HCPCS,CALCIUM INFUSION TEST,,Fee Schedule,51.99
Aetna,HMO,82340,CPT4/HCPCS,ASSAY OF CALCIUM IN URINE,,Fee Schedule,60.64
Aetna,HMO,82355,CPT4/HCPCS,CALCULUS ANALYSIS QUAL,,Fee Schedule,116.34
Aetna,HMO,82360,CPT4/HCPCS,CALCULUS ASSAY QUANT,,Fee Schedule,129.36
Aetna,HMO,82365,CPT4/HCPCS,CALCULUS SPECTROSCOPY,,Fee Schedule,129.52
Aetna,HMO,82370,CPT4/HCPCS,X-RAY ASSAY CALCULUS,,Fee Schedule,125.91
Aetna,HMO,82373,CPT4/HCPCS,ASSAY C-D TRANSFER MEASURE,,Fee Schedule,181.44
Aetna,HMO,82374,CPT4/HCPCS,ASSAY BLOOD CARBON DIOXIDE,,Fee Schedule,49.14
Aetna,HMO,82375,CPT4/HCPCS,ASSAY CARBOXYHB QUANT,,Fee Schedule,123.90
Aetna,HMO,82376,CPT4/HCPCS,ASSAY CARBOXYHB QUAL,,Fee Schedule,60.22
Aetna,HMO,82378,CPT4/HCPCS,CARCINOEMBRYONIC ANTIGEN,,Fee Schedule,190.68
Aetna,HMO,82379,CPT4/HCPCS,ASSAY OF CARNITINE,,Fee Schedule,169.51
Aetna,HMO,82380,CPT4/HCPCS,ASSAY OF CAROTENE,,Fee Schedule,92.65
Aetna,HMO,82382,CPT4/HCPCS,ASSAY URINE CATECHOLAMINES,,Fee Schedule,172.78
Aetna,HMO,82383,CPT4/HCPCS,ASSAY BLOOD CATECHOLAMINES,,Fee Schedule,251.74
Aetna,HMO,82384,CPT4/HCPCS,ASSAY THREE CATECHOLAMINES,,Fee Schedule,253.68
Aetna,HMO,82387,CPT4/HCPCS,ASSAY OF CATHEPSIN-D,,Fee Schedule,209.07
Aetna,HMO,82390,CPT4/HCPCS,ASSAY OF CERULOPLASMIN,,Fee Schedule,107.94
Aetna,HMO,82397,CPT4/HCPCS,CHEMILUMINESCENT ASSAY,,Fee Schedule,141.96
Aetna,HMO,82415,CPT4/HCPCS,ASSAY OF CHLORAMPHENICOL,,Fee Schedule,127.34
Aetna,HMO,82435,CPT4/HCPCS,ASSAY OF BLOOD CHLORIDE,,Fee Schedule,46.20
Aetna,HMO,82436,CPT4/HCPCS,ASSAY OF URINE CHLORIDE,,Fee Schedule,50.48
Aetna,HMO,82438,CPT4/HCPCS,ASSAY OTHER FLUID CHLORIDES,,Fee Schedule,49.14
Aetna,HMO,82441,CPT4/HCPCS,TEST FOR CHLOROHYDROCARBONS,,Fee Schedule,60.31
Aetna,HMO,82465,CPT4/HCPCS,ASSAY BLD/SERUM CHOLESTEROL,,Fee Schedule,43.76
Aetna,HMO,82480,CPT4/HCPCS,ASSAY SERUM CHOLINESTERASE,,Fee Schedule,79.21
Aetna,HMO,82482,CPT4/HCPCS,ASSAY RBC CHOLINESTERASE,,Fee Schedule,77.19
Aetna,HMO,82485,CPT4/HCPCS,ASSAY CHONDROITIN SULFATE,,Fee Schedule,207.48
Aetna,HMO,82495,CPT4/HCPCS,ASSAY OF CHROMIUM,,Fee Schedule,203.78
Aetna,HMO,82507,CPT4/HCPCS,ASSAY OF CITRATE,,Fee Schedule,279.38
Aetna,HMO,82523,CPT4/HCPCS,COLLAGEN CROSSLINKS,,Fee Schedule,186.39
Aetna,HMO,82525,CPT4/HCPCS,ASSAY OF COPPER,,Fee Schedule,124.65
Aetna,HMO,82528,CPT4/HCPCS,ASSAY OF CORTICOSTERONE,,Fee Schedule,226.21
Aetna,HMO,82530,CPT4/HCPCS,CORTISOL FREE,,Fee Schedule,167.91
Aetna,HMO,82533,CPT4/HCPCS,TOTAL CORTISOL,,Fee Schedule,163.88
Aetna,HMO,82540,CPT4/HCPCS,ASSAY OF CREATINE,,Fee Schedule,46.53
Aetna,HMO,82542,CPT4/HCPCS,COL CHROMOTOGRAPHY QUAL/QUAN,,Fee Schedule,181.44
Aetna,HMO,82550,CPT4/HCPCS,ASSAY OF CK (CPK),,Fee Schedule,65.43
Aetna,HMO,82552,CPT4/HCPCS,ASSAY OF CPK IN BLOOD,,Fee Schedule,134.65
Aetna,HMO,82553,CPT4/HCPCS,CREATINE MB FRACTION,,Fee Schedule,116.00
Aetna,HMO,82554,CPT4/HCPCS,CREATINE ISOFORMS,,Fee Schedule,119.28
Aetna,HMO,82565,CPT4/HCPCS,ASSAY OF CREATININE,,Fee Schedule,51.57
Aetna,HMO,82570,CPT4/HCPCS,ASSAY OF URINE CREATININE,,Fee Schedule,51.99
Aetna,HMO,82575,CPT4/HCPCS,CREATININE CLEARANCE TEST,,Fee Schedule,95.00
Aetna,HMO,82585,CPT4/HCPCS,ASSAY OF CRYOFIBRINOGEN,,Fee Schedule,86.18
Aetna,HMO,82595,CPT4/HCPCS,ASSAY OF CRYOGLOBULIN,,Fee Schedule,57.62
Aetna,HMO,82600,CPT4/HCPCS,ASSAY OF CYANIDE,,Fee Schedule,194.96
Aetna,HMO,82607,CPT4/HCPCS,VITAMIN B-12,,Fee Schedule,151.45
Aetna,HMO,82608,CPT4/HCPCS,B-12 BINDING CAPACITY,,Fee Schedule,143.89
Aetna,HMO,82610,CPT4/HCPCS,CYSTATIN C,,Fee Schedule,136.58
Aetna,HMO,82615,CPT4/HCPCS,TEST FOR URINE CYSTINES,,Fee Schedule,81.98
Aetna,HMO,82626,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,Fee Schedule,253.93
Aetna,HMO,82627,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,Fee Schedule,223.44
Aetna,HMO,82633,CPT4/HCPCS,DESOXYCORTICOSTERONE,,Fee Schedule,311.22
Aetna,HMO,82634,CPT4/HCPCS,DEOXYCORTISOL,,Fee Schedule,294.16
Aetna,HMO,82638,CPT4/HCPCS,ASSAY OF DIBUCAINE NUMBER,,Fee Schedule,123.06
Aetna,HMO,82652,CPT4/HCPCS,VIT D 1 25-DIHYDROXY,,Fee Schedule,386.82
Aetna,HMO,82656,CPT4/HCPCS,PANCREATIC ELASTASE FECAL,,Fee Schedule,93.32
Aetna,HMO,82657,CPT4/HCPCS,ENZYME CELL ACTIVITY,,Fee Schedule,181.44
Aetna,HMO,82658,CPT4/HCPCS,ENZYME CELL ACTIVITY RA,,Fee Schedule,181.44
Aetna,HMO,82664,CPT4/HCPCS,ELECTROPHORETIC TEST,,Fee Schedule,345.24
Aetna,HMO,82668,CPT4/HCPCS,ASSAY OF ERYTHROPOIETIN,,Fee Schedule,188.91
Aetna,HMO,82670,CPT4/HCPCS,ASSAY OF TOTAL ESTRADIOL,,Fee Schedule,280.72
Aetna,HMO,82671,CPT4/HCPCS,ASSAY OF ESTROGENS,,Fee Schedule,324.49
Aetna,HMO,82672,CPT4/HCPCS,ASSAY OF ESTROGEN,,Fee Schedule,217.98
Aetna,HMO,82677,CPT4/HCPCS,ASSAY OF ESTRIOL,,Fee Schedule,243.01
Aetna,HMO,82679,CPT4/HCPCS,ASSAY OF ESTRONE,,Fee Schedule,250.74
Aetna,HMO,82693,CPT4/HCPCS,ASSAY OF ETHYLENE GLYCOL,,Fee Schedule,149.68
Aetna,HMO,82696,CPT4/HCPCS,ASSAY OF ETIOCHOLANOLONE,,Fee Schedule,236.96
Aetna,HMO,82705,CPT4/HCPCS,FATS/LIPIDS FECES QUAL,,Fee Schedule,51.15
Aetna,HMO,82710,CPT4/HCPCS,FATS/LIPIDS FECES QUANT,,Fee Schedule,168.75
Aetna,HMO,82715,CPT4/HCPCS,ASSAY OF FECAL FAT,,Fee Schedule,172.95
Aetna,HMO,82725,CPT4/HCPCS,ASSAY OF BLOOD FATTY ACIDS,,Fee Schedule,133.81
Aetna,HMO,82726,CPT4/HCPCS,LONG CHAIN FATTY ACIDS,,Fee Schedule,181.44
Aetna,HMO,82728,CPT4/HCPCS,ASSAY OF FERRITIN,,Fee Schedule,136.83
Aetna,HMO,82731,CPT4/HCPCS,ASSAY OF FETAL FIBRONECTIN,,Fee Schedule,647.13
Aetna,HMO,82735,CPT4/HCPCS,ASSAY OF FLUORIDE,,Fee Schedule,186.31
Aetna,HMO,82746,CPT4/HCPCS,ASSAY OF FOLIC ACID SERUM,,Fee Schedule,147.75
Aetna,HMO,82747,CPT4/HCPCS,ASSAY OF FOLIC ACID RBC,,Fee Schedule,174.04
Aetna,HMO,82757,CPT4/HCPCS,ASSAY OF SEMEN FRUCTOSE,,Fee Schedule,174.30
Aetna,HMO,82759,CPT4/HCPCS,ASSAY OF RBC GALACTOKINASE,,Fee Schedule,215.88
Aetna,HMO,82760,CPT4/HCPCS,ASSAY OF GALACTOSE,,Fee Schedule,112.47
Aetna,HMO,82775,CPT4/HCPCS,ASSAY GALACTOSE TRANSFERASE,,Fee Schedule,211.59
Aetna,HMO,82776,CPT4/HCPCS,GALACTOSE TRANSFERASE TEST,,Fee Schedule,84.25
Aetna,HMO,82777,CPT4/HCPCS,GALECTIN-3,,Fee Schedule,127.09
Aetna,HMO,82784,CPT4/HCPCS,ASSAY IGA/IGD/IGG/IGM EACH,,Fee Schedule,65.85
Aetna,HMO,82785,CPT4/HCPCS,ASSAY OF IGE,,Fee Schedule,165.48
Aetna,HMO,82787,CPT4/HCPCS,IGG 1 2 3 OR 4 EACH,,Fee Schedule,80.64
Aetna,HMO,82800,CPT4/HCPCS,BLOOD PH,,Fee Schedule,82.15
Aetna,HMO,82803,CPT4/HCPCS,BLOOD GASES ANY COMBINATION,,Fee Schedule,194.37
Aetna,HMO,82805,CPT4/HCPCS,BLOOD GASES W/O2 SATURATION,,Fee Schedule,285.18
Aetna,HMO,82810,CPT4/HCPCS,BLOOD GASES O2 SAT ONLY,,Fee Schedule,87.69
Aetna,HMO,82820,CPT4/HCPCS,HEMOGLOBIN-OXYGEN AFFINITY,,Fee Schedule,100.46
Aetna,HMO,82930,CPT4/HCPCS,GASTRIC ANALY W/PH EA SPEC,,Fee Schedule,52.50
Aetna,HMO,82938,CPT4/HCPCS,GASTRIN TEST,,Fee Schedule,177.82
Aetna,HMO,82941,CPT4/HCPCS,ASSAY OF GASTRIN,,Fee Schedule,177.24
Aetna,HMO,82943,CPT4/HCPCS,ASSAY OF GLUCAGON,,Fee Schedule,143.55
Aetna,HMO,82945,CPT4/HCPCS,GLUCOSE OTHER FLUID,,Fee Schedule,39.39
Aetna,HMO,82946,CPT4/HCPCS,GLUCAGON TOLERANCE TEST,,Fee Schedule,151.45
Aetna,HMO,82947,CPT4/HCPCS,ASSAY GLUCOSE BLOOD QUANT,,Fee Schedule,39.39
Aetna,HMO,82948,CPT4/HCPCS,REAGENT STRIP/BLOOD GLUCOSE,,Fee Schedule,31.75
Aetna,HMO,82950,CPT4/HCPCS,GLUCOSE TEST,,Fee Schedule,47.71
Aetna,HMO,82951,CPT4/HCPCS,GLUCOSE TOLERANCE TEST (GTT),,Fee Schedule,129.36
Aetna,HMO,82952,CPT4/HCPCS,GTT-ADDED SAMPLES,,Fee Schedule,39.31
Aetna,HMO,82955,CPT4/HCPCS,ASSAY OF G6PD ENZYME,,Fee Schedule,97.44
Aetna,HMO,82960,CPT4/HCPCS,TEST FOR G6PD ENZYME,,Fee Schedule,60.81
Aetna,HMO,82962,CPT4/HCPCS,GLUCOSE BLOOD TEST,,Fee Schedule,23.52
Aetna,HMO,82963,CPT4/HCPCS,ASSAY OF GLUCOSIDASE,,Fee Schedule,215.88
Aetna,HMO,82965,CPT4/HCPCS,ASSAY OF GDH ENZYME,,Fee Schedule,77.70
Aetna,HMO,82977,CPT4/HCPCS,ASSAY OF GGT,,Fee Schedule,72.32
Aetna,HMO,82978,CPT4/HCPCS,ASSAY OF GLUTATHIONE,,Fee Schedule,143.22
Aetna,HMO,82979,CPT4/HCPCS,ASSAY RBC GLUTATHIONE,,Fee Schedule,69.21
Aetna,HMO,82985,CPT4/HCPCS,ASSAY OF GLYCATED PROTEIN,,Fee Schedule,151.45
Aetna,HMO,83001,CPT4/HCPCS,ASSAY OF GONADOTROPIN (FSH),,Fee Schedule,186.73
Aetna,HMO,83002,CPT4/HCPCS,ASSAY OF GONADOTROPIN (LH),,Fee Schedule,186.06
Aetna,HMO,83003,CPT4/HCPCS,ASSAY GROWTH HORMONE (HGH),,Fee Schedule,167.58
Aetna,HMO,83006,CPT4/HCPCS,GROWTH STIMULATION GENE 2,,Fee Schedule,213.69
Aetna,HMO,83009,CPT4/HCPCS,H PYLORI (C-13) BLOOD,,Fee Schedule,676.78
Aetna,HMO,83010,CPT4/HCPCS,ASSAY OF HAPTOGLOBIN QUANT,,Fee Schedule,126.42
Aetna,HMO,83012,CPT4/HCPCS,ASSAY OF HAPTOGLOBINS,,Fee Schedule,172.78
Aetna,HMO,83013,CPT4/HCPCS,H PYLORI (C-13) BREATH,,Fee Schedule,676.78
Aetna,HMO,83014,CPT4/HCPCS,H PYLORI DRUG ADMIN,,Fee Schedule,78.96
Aetna,HMO,83015,CPT4/HCPCS,HEAVY METAL QUAL ANY ANAL,,Fee Schedule,131.62
Aetna,HMO,83018,CPT4/HCPCS,HEAVY METAL QUANT EACH NES,,Fee Schedule,220.66
Aetna,HMO,83020,CPT4/HCPCS,HEMOGLOBIN ELECTROPHORESIS,,Fee Schedule,129.36
Aetna,HMO,83021,CPT4/HCPCS,HEMOGLOBIN CHROMOTOGRAPHY,,Fee Schedule,181.44
Aetna,HMO,83026,CPT4/HCPCS,HEMOGLOBIN COPPER SULFATE,,Fee Schedule,23.68
Aetna,HMO,83030,CPT4/HCPCS,FETAL HEMOGLOBIN CHEMICAL,,Fee Schedule,83.07
Aetna,HMO,83033,CPT4/HCPCS,FETAL HEMOGLOBIN ASSAY QUAL,,Fee Schedule,59.89
Aetna,HMO,83036,CPT4/HCPCS,GLYCOSYLATED HEMOGLOBIN TEST,,Fee Schedule,97.52
Aetna,HMO,83037,CPT4/HCPCS,GLYCOSYLATED HB HOME DEVICE,,Fee Schedule,97.52
Aetna,HMO,83045,CPT4/HCPCS,BLOOD METHEMOGLOBIN TEST,,Fee Schedule,49.72
Aetna,HMO,83050,CPT4/HCPCS,BLOOD METHEMOGLOBIN ASSAY,,Fee Schedule,73.58
Aetna,HMO,83051,CPT4/HCPCS,ASSAY OF PLASMA HEMOGLOBIN,,Fee Schedule,73.50
Aetna,HMO,83060,CPT4/HCPCS,BLOOD SULFHEMOGLOBIN ASSAY,,Fee Schedule,83.07
Aetna,HMO,83065,CPT4/HCPCS,ASSAY OF HEMOGLOBIN HEAT,,Fee Schedule,69.21
Aetna,HMO,83068,CPT4/HCPCS,HEMOGLOBIN STABILITY SCREEN,,Fee Schedule,85.00
Aetna,HMO,83069,CPT4/HCPCS,ASSAY OF URINE HEMOGLOBIN,,Fee Schedule,39.73
Aetna,HMO,83070,CPT4/HCPCS,ASSAY OF HEMOSIDERIN QUAL,,Fee Schedule,47.71
Aetna,HMO,83080,CPT4/HCPCS,ASSAY OF B HEXOSAMINIDASE,,Fee Schedule,169.51
Aetna,HMO,83088,CPT4/HCPCS,ASSAY OF HISTAMINE,,Fee Schedule,296.77
Aetna,HMO,83090,CPT4/HCPCS,ASSAY OF HOMOCYSTINE,,Fee Schedule,169.51
Aetna,HMO,83150,CPT4/HCPCS,ASSAY OF HOMOVANILLIC ACID,,Fee Schedule,194.37
Aetna,HMO,83491,CPT4/HCPCS,ASSAY OF CORTICOSTEROIDS 17,,Fee Schedule,175.98
Aetna,HMO,83497,CPT4/HCPCS,ASSAY OF 5-HIAA,,Fee Schedule,129.52
Aetna,HMO,83498,CPT4/HCPCS,ASSAY OF PROGESTERONE 17-D,,Fee Schedule,273.00
Aetna,HMO,83500,CPT4/HCPCS,ASSAY FREE HYDROXYPROLINE,,Fee Schedule,227.55
Aetna,HMO,83505,CPT4/HCPCS,ASSAY TOTAL HYDROXYPROLINE,,Fee Schedule,244.27
Aetna,HMO,83516,CPT4/HCPCS,IMMUNOASSAY NONANTIBODY,,Fee Schedule,93.32
Aetna,HMO,83518,CPT4/HCPCS,IMMUNOASSAY DIPSTICK,,Fee Schedule,34.27
Aetna,HMO,83519,CPT4/HCPCS,RIA NONANTIBODY,,Fee Schedule,135.74
Aetna,HMO,83520,CPT4/HCPCS,IMMUNOASSAY QUANT NOS NONAB,,Fee Schedule,130.11
Aetna,HMO,83525,CPT4/HCPCS,ASSAY OF INSULIN,,Fee Schedule,114.91
Aetna,HMO,83527,CPT4/HCPCS,ASSAY OF INSULIN,,Fee Schedule,130.20
Aetna,HMO,83528,CPT4/HCPCS,ASSAY OF INTRINSIC FACTOR,,Fee Schedule,159.76
Aetna,HMO,83540,CPT4/HCPCS,ASSAY OF IRON,,Fee Schedule,65.10
Aetna,HMO,83550,CPT4/HCPCS,IRON BINDING TEST,,Fee Schedule,70.30
Aetna,HMO,83570,CPT4/HCPCS,ASSAY OF IDH ENZYME,,Fee Schedule,88.87
Aetna,HMO,83582,CPT4/HCPCS,ASSAY OF KETOGENIC STEROIDS,,Fee Schedule,142.38
Aetna,HMO,83586,CPT4/HCPCS,ASSAY 17- KETOSTEROIDS,,Fee Schedule,128.68
Aetna,HMO,83593,CPT4/HCPCS,FRACTIONATION KETOSTEROIDS,,Fee Schedule,264.26
Aetna,HMO,83605,CPT4/HCPCS,ASSAY OF LACTIC ACID,,Fee Schedule,107.35
Aetna,HMO,83615,CPT4/HCPCS,LACTATE (LD) (LDH) ENZYME,,Fee Schedule,60.73
Aetna,HMO,83625,CPT4/HCPCS,ASSAY OF LDH ENZYMES,,Fee Schedule,128.60
Aetna,HMO,83630,CPT4/HCPCS,LACTOFERRIN FECAL (QUAL),,Fee Schedule,197.23
Aetna,HMO,83631,CPT4/HCPCS,LACTOFERRIN FECAL (QUANT),,Fee Schedule,197.23
Aetna,HMO,83632,CPT4/HCPCS,PLACENTAL LACTOGEN,,Fee Schedule,203.11
Aetna,HMO,83633,CPT4/HCPCS,TEST URINE FOR LACTOSE,,Fee Schedule,55.27
Aetna,HMO,83655,CPT4/HCPCS,ASSAY OF LEAD,,Fee Schedule,121.63
Aetna,HMO,83661,CPT4/HCPCS,L/S RATIO FETAL LUNG,,Fee Schedule,220.92
Aetna,HMO,83662,CPT4/HCPCS,FOAM STABILITY FETAL LUNG,,Fee Schedule,190.17
Aetna,HMO,83663,CPT4/HCPCS,FLUORO POLARIZE FETAL LUNG,,Fee Schedule,190.17
Aetna,HMO,83664,CPT4/HCPCS,LAMELLAR BDY FETAL LUNG,,Fee Schedule,190.17
Aetna,HMO,83670,CPT4/HCPCS,ASSAY OF LAP ENZYME,,Fee Schedule,92.14
Aetna,HMO,83690,CPT4/HCPCS,ASSAY OF LIPASE,,Fee Schedule,69.21
Aetna,HMO,83695,CPT4/HCPCS,ASSAY OF LIPOPROTEIN(A),,Fee Schedule,130.11
Aetna,HMO,83698,CPT4/HCPCS,ASSAY LIPOPROTEIN PLA2,,Fee Schedule,341.04
Aetna,HMO,83700,CPT4/HCPCS,LIPOPRO BLD ELECTROPHORETIC,,Fee Schedule,113.06
Aetna,HMO,83701,CPT4/HCPCS,LIPOPROTEIN BLD HR FRACTION,,Fee Schedule,249.39
Aetna,HMO,83704,CPT4/HCPCS,LIPOPROTEIN BLD QUAN PART,,Fee Schedule,317.01
Aetna,HMO,83718,CPT4/HCPCS,ASSAY OF LIPOPROTEIN,,Fee Schedule,82.23
Aetna,HMO,83719,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,Fee Schedule,116.92
Aetna,HMO,83721,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,Fee Schedule,95.84
Aetna,HMO,83722,CPT4/HCPCS,LIPOPRTN DIR MEAS SD LDL CHL,,Fee Schedule,250.32
Aetna,HMO,83727,CPT4/HCPCS,ASSAY OF LRH HORMONE,,Fee Schedule,172.78
Aetna,HMO,83735,CPT4/HCPCS,ASSAY OF MAGNESIUM,,Fee Schedule,67.36
Aetna,HMO,83775,CPT4/HCPCS,ASSAY MALATE DEHYDROGENASE,,Fee Schedule,74.00
Aetna,HMO,83785,CPT4/HCPCS,ASSAY OF MANGANESE,,Fee Schedule,247.12
Aetna,HMO,83789,CPT4/HCPCS,MASS SPECTROMETRY QUAL/QUAN,,Fee Schedule,181.44
Aetna,HMO,83825,CPT4/HCPCS,ASSAY OF MERCURY,,Fee Schedule,163.38
Aetna,HMO,83835,CPT4/HCPCS,ASSAY OF METANEPHRINES,,Fee Schedule,170.18
Aetna,HMO,83857,CPT4/HCPCS,ASSAY OF METHEMALBUMIN,,Fee Schedule,107.94
Aetna,HMO,83861,CPT4/HCPCS,MICROFLUID ANALY TEARS,,Fee Schedule,168.33
Aetna,HMO,83864,CPT4/HCPCS,MUCOPOLYSACCHARIDES,,Fee Schedule,200.08
Aetna,HMO,83872,CPT4/HCPCS,ASSAY SYNOVIAL FLUID MUCIN,,Fee Schedule,57.62
Aetna,HMO,83873,CPT4/HCPCS,ASSAY OF CSF PROTEIN,,Fee Schedule,172.87
Aetna,HMO,83874,CPT4/HCPCS,ASSAY OF MYOGLOBIN,,Fee Schedule,129.69
Aetna,HMO,83876,CPT4/HCPCS,ASSAY MYELOPEROXIDASE,,Fee Schedule,341.04
Aetna,HMO,83880,CPT4/HCPCS,ASSAY OF NATRIURETIC PEPTIDE,,Fee Schedule,341.04
Aetna,HMO,83883,CPT4/HCPCS,ASSAY NEPHELOMETRY NOT SPEC,,Fee Schedule,136.58
Aetna,HMO,83885,CPT4/HCPCS,ASSAY OF NICKEL,,Fee Schedule,246.20
Aetna,HMO,83915,CPT4/HCPCS,ASSAY OF NUCLEOTIDASE,,Fee Schedule,112.14
Aetna,HMO,83916,CPT4/HCPCS,OLIGOCLONAL BANDS,,Fee Schedule,202.10
Aetna,HMO,83918,CPT4/HCPCS,ORGANIC ACIDS TOTAL QUANT,,Fee Schedule,165.39
Aetna,HMO,83919,CPT4/HCPCS,ORGANIC ACIDS QUAL EACH,,Fee Schedule,165.39
Aetna,HMO,83921,CPT4/HCPCS,ORGANIC ACID SINGLE QUANT,,Fee Schedule,165.39
Aetna,HMO,83930,CPT4/HCPCS,ASSAY OF BLOOD OSMOLALITY,,Fee Schedule,66.44
Aetna,HMO,83935,CPT4/HCPCS,ASSAY OF URINE OSMOLALITY,,Fee Schedule,68.46
Aetna,HMO,83937,CPT4/HCPCS,ASSAY OF OSTEOCALCIN,,Fee Schedule,286.10
Aetna,HMO,83945,CPT4/HCPCS,ASSAY OF OXALATE,,Fee Schedule,129.36
Aetna,HMO,83950,CPT4/HCPCS,ONCOPROTEIN HER-2/NEU,,Fee Schedule,647.13
Aetna,HMO,83951,CPT4/HCPCS,ONCOPROTEIN DCP,,Fee Schedule,647.13
Aetna,HMO,83970,CPT4/HCPCS,ASSAY OF PARATHORMONE,,Fee Schedule,414.70
Aetna,HMO,83986,CPT4/HCPCS,ASSAY PH BODY FLUID NOS,,Fee Schedule,35.95
Aetna,HMO,83987,CPT4/HCPCS,EXHALED BREATH CONDENSATE,,Fee Schedule,159.60
Aetna,HMO,83992,CPT4/HCPCS,ASSAY FOR PHENCYCLIDINE,,Fee Schedule,0.08
Aetna,HMO,83993,CPT4/HCPCS,ASSAY FOR CALPROTECTIN FECAL,,Fee Schedule,197.23
Aetna,HMO,84030,CPT4/HCPCS,ASSAY OF BLOOD PKU,,Fee Schedule,55.27
Aetna,HMO,84035,CPT4/HCPCS,ASSAY OF PHENYLKETONES,,Fee Schedule,36.79
Aetna,HMO,84060,CPT4/HCPCS,ASSAY ACID PHOSPHATASE,,Fee Schedule,74.17
Aetna,HMO,84066,CPT4/HCPCS,ASSAY PROSTATE PHOSPHATASE,,Fee Schedule,97.02
Aetna,HMO,84075,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,Fee Schedule,51.99
Aetna,HMO,84078,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,Fee Schedule,65.85
Aetna,HMO,84080,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASES,,Fee Schedule,148.68
Aetna,HMO,84081,CPT4/HCPCS,ASSAY PHOSPHATIDYLGLYCEROL,,Fee Schedule,165.98
Aetna,HMO,84085,CPT4/HCPCS,ASSAY OF RBC PG6D ENZYME,,Fee Schedule,67.78
Aetna,HMO,84087,CPT4/HCPCS,ASSAY PHOSPHOHEXOSE ENZYMES,,Fee Schedule,103.74
Aetna,HMO,84100,CPT4/HCPCS,ASSAY OF PHOSPHORUS,,Fee Schedule,47.62
Aetna,HMO,84105,CPT4/HCPCS,ASSAY OF URINE PHOSPHORUS,,Fee Schedule,51.99
Aetna,HMO,84106,CPT4/HCPCS,TEST FOR PORPHOBILINOGEN,,Fee Schedule,43.00
Aetna,HMO,84110,CPT4/HCPCS,ASSAY OF PORPHOBILINOGEN,,Fee Schedule,84.84
Aetna,HMO,84112,CPT4/HCPCS,EVAL AMNIOTIC FLUID PROTEIN,,Fee Schedule,647.13
Aetna,HMO,84119,CPT4/HCPCS,TEST URINE FOR PORPHYRINS,,Fee Schedule,86.52
Aetna,HMO,84120,CPT4/HCPCS,ASSAY OF URINE PORPHYRINS,,Fee Schedule,147.84
Aetna,HMO,84126,CPT4/HCPCS,ASSAY OF FECES PORPHYRINS,,Fee Schedule,255.94
Aetna,HMO,84132,CPT4/HCPCS,ASSAY OF SERUM POTASSIUM,,Fee Schedule,46.20
Aetna,HMO,84133,CPT4/HCPCS,ASSAY OF URINE POTASSIUM,,Fee Schedule,43.17
Aetna,HMO,84134,CPT4/HCPCS,ASSAY OF PREALBUMIN,,Fee Schedule,146.49
Aetna,HMO,84135,CPT4/HCPCS,ASSAY OF PREGNANEDIOL,,Fee Schedule,192.19
Aetna,HMO,84138,CPT4/HCPCS,ASSAY OF PREGNANETRIOL,,Fee Schedule,190.26
Aetna,HMO,84140,CPT4/HCPCS,ASSAY OF PREGNENOLONE,,Fee Schedule,207.81
Aetna,HMO,84143,CPT4/HCPCS,ASSAY OF 17-HYDROXYPREGNENO,,Fee Schedule,229.32
Aetna,HMO,84144,CPT4/HCPCS,ASSAY OF PROGESTERONE,,Fee Schedule,209.66
Aetna,HMO,84145,CPT4/HCPCS,PROCALCITONIN (PCT),,Fee Schedule,269.13
Aetna,HMO,84146,CPT4/HCPCS,ASSAY OF PROLACTIN,,Fee Schedule,194.71
Aetna,HMO,84150,CPT4/HCPCS,ASSAY OF PROSTAGLANDIN,,Fee Schedule,250.74
Aetna,HMO,84152,CPT4/HCPCS,ASSAY OF PSA COMPLEXED,,Fee Schedule,184.88
Aetna,HMO,84153,CPT4/HCPCS,ASSAY OF PSA TOTAL,,Fee Schedule,184.88
Aetna,HMO,84154,CPT4/HCPCS,ASSAY OF PSA FREE,,Fee Schedule,184.88
Aetna,HMO,84155,CPT4/HCPCS,ASSAY OF PROTEIN SERUM,,Fee Schedule,36.87
Aetna,HMO,84156,CPT4/HCPCS,ASSAY OF PROTEIN URINE,,Fee Schedule,36.87
Aetna,HMO,84157,CPT4/HCPCS,ASSAY OF PROTEIN OTHER,,Fee Schedule,36.87
Aetna,HMO,84160,CPT4/HCPCS,ASSAY OF PROTEIN ANY SOURCE,,Fee Schedule,51.99
Aetna,HMO,84163,CPT4/HCPCS,PAPPA SERUM,,Fee Schedule,151.28
Aetna,HMO,84165,CPT4/HCPCS,PROTEIN E-PHORESIS SERUM,,Fee Schedule,107.94
Aetna,HMO,84166,CPT4/HCPCS,PROTEIN E-PHORESIS/URINE/CSF,,Fee Schedule,179.17
Aetna,HMO,84181,CPT4/HCPCS,WESTERN BLOT TEST,,Fee Schedule,171.10
Aetna,HMO,84182,CPT4/HCPCS,PROTEIN WESTERN BLOT TEST,,Fee Schedule,180.85
Aetna,HMO,84202,CPT4/HCPCS,ASSAY RBC PROTOPORPHYRIN,,Fee Schedule,144.14
Aetna,HMO,84203,CPT4/HCPCS,TEST RBC PROTOPORPHYRIN,,Fee Schedule,86.43
Aetna,HMO,84206,CPT4/HCPCS,ASSAY OF PROINSULIN,,Fee Schedule,179.00
Aetna,HMO,84207,CPT4/HCPCS,ASSAY OF VITAMIN B-6,,Fee Schedule,282.32
Aetna,HMO,84210,CPT4/HCPCS,ASSAY OF PYRUVATE,,Fee Schedule,109.03
Aetna,HMO,84220,CPT4/HCPCS,ASSAY OF PYRUVATE KINASE,,Fee Schedule,94.83
Aetna,HMO,84228,CPT4/HCPCS,ASSAY OF QUININE,,Fee Schedule,116.92
Aetna,HMO,84233,CPT4/HCPCS,ASSAY OF ESTROGEN,,Fee Schedule,647.13
Aetna,HMO,84234,CPT4/HCPCS,ASSAY OF PROGESTERONE,,Fee Schedule,651.84
Aetna,HMO,84235,CPT4/HCPCS,ASSAY OF ENDOCRINE HORMONE,,Fee Schedule,525.84
Aetna,HMO,84238,CPT4/HCPCS,ASSAY NONENDOCRINE RECEPTOR,,Fee Schedule,367.41
Aetna,HMO,84244,CPT4/HCPCS,ASSAY OF RENIN,,Fee Schedule,221.00
Aetna,HMO,84252,CPT4/HCPCS,ASSAY OF VITAMIN B-2,,Fee Schedule,203.36
Aetna,HMO,84255,CPT4/HCPCS,ASSAY OF SELENIUM,,Fee Schedule,256.53
Aetna,HMO,84260,CPT4/HCPCS,ASSAY OF SEROTONIN,,Fee Schedule,311.22
Aetna,HMO,84270,CPT4/HCPCS,ASSAY OF SEX HORMONE GLOBUL,,Fee Schedule,218.31
Aetna,HMO,84275,CPT4/HCPCS,ASSAY OF SIALIC ACID,,Fee Schedule,134.98
Aetna,HMO,84285,CPT4/HCPCS,ASSAY OF SILICA,,Fee Schedule,236.62
Aetna,HMO,84295,CPT4/HCPCS,ASSAY OF SERUM SODIUM,,Fee Schedule,48.30
Aetna,HMO,84300,CPT4/HCPCS,ASSAY OF URINE SODIUM,,Fee Schedule,48.88
Aetna,HMO,84302,CPT4/HCPCS,ASSAY OF SWEAT SODIUM,,Fee Schedule,48.88
Aetna,HMO,84305,CPT4/HCPCS,ASSAY OF SOMATOMEDIN,,Fee Schedule,213.61
Aetna,HMO,84307,CPT4/HCPCS,ASSAY OF SOMATOSTATIN,,Fee Schedule,183.70
Aetna,HMO,84311,CPT4/HCPCS,SPECTROPHOTOMETRY,,Fee Schedule,70.22
Aetna,HMO,84315,CPT4/HCPCS,BODY FLUID SPECIFIC GRAVITY,,Fee Schedule,25.20
Aetna,HMO,84375,CPT4/HCPCS,CHROMATOGRAM ASSAY SUGARS,,Fee Schedule,196.98
Aetna,HMO,84376,CPT4/HCPCS,SUGARS SINGLE QUAL,,Fee Schedule,55.27
Aetna,HMO,84377,CPT4/HCPCS,SUGARS MULTIPLE QUAL,,Fee Schedule,55.27
Aetna,HMO,84378,CPT4/HCPCS,SUGARS SINGLE QUANT,,Fee Schedule,115.83
Aetna,HMO,84379,CPT4/HCPCS,SUGARS MULTIPLE QUANT,,Fee Schedule,115.83
Aetna,HMO,84392,CPT4/HCPCS,ASSAY OF URINE SULFATE,,Fee Schedule,47.71
Aetna,HMO,84402,CPT4/HCPCS,ASSAY OF FREE TESTOSTERONE,,Fee Schedule,255.86
Aetna,HMO,84403,CPT4/HCPCS,ASSAY OF TOTAL TESTOSTERONE,,Fee Schedule,259.39
Aetna,HMO,84410,CPT4/HCPCS,TESTOSTERONE BIOAVAILABLE,,Fee Schedule,518.02
Aetna,HMO,84425,CPT4/HCPCS,ASSAY OF VITAMIN B-1,,Fee Schedule,213.36
Aetna,HMO,84430,CPT4/HCPCS,ASSAY OF THIOCYANATE,,Fee Schedule,116.92
Aetna,HMO,84431,CPT4/HCPCS,THROMBOXANE URINE,,Fee Schedule,168.75
Aetna,HMO,84432,CPT4/HCPCS,ASSAY OF THYROGLOBULIN,,Fee Schedule,161.44
Aetna,HMO,84436,CPT4/HCPCS,ASSAY OF TOTAL THYROXINE,,Fee Schedule,69.04
Aetna,HMO,84437,CPT4/HCPCS,ASSAY OF NEONATAL THYROXINE,,Fee Schedule,65.01
Aetna,HMO,84439,CPT4/HCPCS,ASSAY OF FREE THYROXINE,,Fee Schedule,90.63
Aetna,HMO,84442,CPT4/HCPCS,ASSAY OF THYROID ACTIVITY,,Fee Schedule,148.68
Aetna,HMO,84443,CPT4/HCPCS,ASSAY THYROID STIM HORMONE,,Fee Schedule,168.75
Aetna,HMO,84445,CPT4/HCPCS,ASSAY OF TSI GLOBULIN,,Fee Schedule,510.97
Aetna,HMO,84446,CPT4/HCPCS,ASSAY OF VITAMIN E,,Fee Schedule,142.46
Aetna,HMO,84449,CPT4/HCPCS,ASSAY OF TRANSCORTIN,,Fee Schedule,168.75
Aetna,HMO,84450,CPT4/HCPCS,TRANSFERASE (AST) (SGOT),,Fee Schedule,51.99
Aetna,HMO,84460,CPT4/HCPCS,ALANINE AMINO (ALT) (SGPT),,Fee Schedule,53.08
Aetna,HMO,84466,CPT4/HCPCS,ASSAY OF TRANSFERRIN,,Fee Schedule,128.26
Aetna,HMO,84478,CPT4/HCPCS,ASSAY OF TRIGLYCERIDES,,Fee Schedule,57.87
Aetna,HMO,84479,CPT4/HCPCS,ASSAY OF THYROID (T3 OR T4),,Fee Schedule,65.01
Aetna,HMO,84480,CPT4/HCPCS,ASSAY TRIIODOTHYRONINE (T3),,Fee Schedule,142.46
Aetna,HMO,84481,CPT4/HCPCS,FREE ASSAY (FT-3),,Fee Schedule,170.18
Aetna,HMO,84482,CPT4/HCPCS,T3 REVERSE,,Fee Schedule,158.34
Aetna,HMO,84484,CPT4/HCPCS,ASSAY OF TROPONIN QUANT,,Fee Schedule,98.86
Aetna,HMO,84485,CPT4/HCPCS,ASSAY DUODENAL FLUID TRYPSIN,,Fee Schedule,75.43
Aetna,HMO,84488,CPT4/HCPCS,TEST FECES FOR TRYPSIN,,Fee Schedule,73.33
Aetna,HMO,84490,CPT4/HCPCS,ASSAY OF FECES FOR TRYPSIN,,Fee Schedule,76.44
Aetna,HMO,84510,CPT4/HCPCS,ASSAY OF TYROSINE,,Fee Schedule,104.49
Aetna,HMO,84512,CPT4/HCPCS,ASSAY OF TROPONIN QUAL,,Fee Schedule,77.36
Aetna,HMO,84520,CPT4/HCPCS,ASSAY OF UREA NITROGEN,,Fee Schedule,39.73
Aetna,HMO,84525,CPT4/HCPCS,UREA NITROGEN SEMI-QUANT,,Fee Schedule,37.80
Aetna,HMO,84540,CPT4/HCPCS,ASSAY OF URINE/UREA-N,,Fee Schedule,47.71
Aetna,HMO,84545,CPT4/HCPCS,UREA-N CLEARANCE TEST,,Fee Schedule,66.36
Aetna,HMO,84550,CPT4/HCPCS,ASSAY OF BLOOD/URIC ACID,,Fee Schedule,45.44
Aetna,HMO,84560,CPT4/HCPCS,ASSAY OF URINE/URIC ACID,,Fee Schedule,47.71
Aetna,HMO,84577,CPT4/HCPCS,ASSAY OF FECES/UROBILINOGEN,,Fee Schedule,125.41
Aetna,HMO,84578,CPT4/HCPCS,TEST URINE UROBILINOGEN,,Fee Schedule,32.59
Aetna,HMO,84580,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,Fee Schedule,71.23
Aetna,HMO,84583,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,Fee Schedule,50.48
Aetna,HMO,84585,CPT4/HCPCS,ASSAY OF URINE VMA,,Fee Schedule,155.82
Aetna,HMO,84586,CPT4/HCPCS,ASSAY OF VIP,,Fee Schedule,354.98
Aetna,HMO,84588,CPT4/HCPCS,ASSAY OF VASOPRESSIN,,Fee Schedule,341.04
Aetna,HMO,84590,CPT4/HCPCS,ASSAY OF VITAMIN A,,Fee Schedule,116.50
Aetna,HMO,84591,CPT4/HCPCS,ASSAY OF NOS VITAMIN,,Fee Schedule,116.50
Aetna,HMO,84597,CPT4/HCPCS,ASSAY OF VITAMIN K,,Fee Schedule,137.76
Aetna,HMO,84600,CPT4/HCPCS,ASSAY OF VOLATILES,,Fee Schedule,161.53
Aetna,HMO,84620,CPT4/HCPCS,XYLOSE TOLERANCE TEST,,Fee Schedule,119.02
Aetna,HMO,84630,CPT4/HCPCS,ASSAY OF ZINC,,Fee Schedule,114.40
Aetna,HMO,84681,CPT4/HCPCS,ASSAY OF C-PEPTIDE,,Fee Schedule,209.07
Aetna,HMO,84702,CPT4/HCPCS,CHORIONIC GONADOTROPIN TEST,,Fee Schedule,151.28
Aetna,HMO,84703,CPT4/HCPCS,CHORIONIC GONADOTROPIN ASSAY,,Fee Schedule,75.43
Aetna,HMO,84704,CPT4/HCPCS,HCG FREE BETACHAIN TEST,,Fee Schedule,151.28
Aetna,HMO,84830,CPT4/HCPCS,OVULATION TESTS,,Fee Schedule,78.28
Aetna,HMO,85002,CPT4/HCPCS,BLEEDING TIME TEST,,Fee Schedule,45.19
Aetna,HMO,85004,CPT4/HCPCS,AUTOMATED DIFF WBC COUNT,,Fee Schedule,65.01
Aetna,HMO,85007,CPT4/HCPCS,BL SMEAR W/DIFF WBC COUNT,,Fee Schedule,34.52
Aetna,HMO,85008,CPT4/HCPCS,BL SMEAR W/O DIFF WBC COUNT,,Fee Schedule,34.52
Aetna,HMO,85009,CPT4/HCPCS,MANUAL DIFF WBC COUNT B-COAT,,Fee Schedule,37.38
Aetna,HMO,85013,CPT4/HCPCS,SPUN MICROHEMATOCRIT,,Fee Schedule,23.77
Aetna,HMO,85014,CPT4/HCPCS,HEMATOCRIT,,Fee Schedule,23.77
Aetna,HMO,85018,CPT4/HCPCS,HEMOGLOBIN,,Fee Schedule,23.77
Aetna,HMO,85025,CPT4/HCPCS,COMPLETE CBC W/AUTO DIFF WBC,,Fee Schedule,78.12
Aetna,HMO,85027,CPT4/HCPCS,COMPLETE CBC AUTOMATED,,Fee Schedule,65.01
Aetna,HMO,85032,CPT4/HCPCS,MANUAL CELL COUNT EACH,,Fee Schedule,43.17
Aetna,HMO,85041,CPT4/HCPCS,AUTOMATED RBC COUNT,,Fee Schedule,30.24
Aetna,HMO,85044,CPT4/HCPCS,MANUAL RETICULOCYTE COUNT,,Fee Schedule,43.17
Aetna,HMO,85045,CPT4/HCPCS,AUTOMATED RETICULOCYTE COUNT,,Fee Schedule,40.23
Aetna,HMO,85046,CPT4/HCPCS,RETICYTE/HGB CONCENTRATE,,Fee Schedule,56.02
Aetna,HMO,85048,CPT4/HCPCS,AUTOMATED LEUKOCYTE COUNT,,Fee Schedule,25.45
Aetna,HMO,85049,CPT4/HCPCS,AUTOMATED PLATELET COUNT,,Fee Schedule,44.94
Aetna,HMO,85055,CPT4/HCPCS,RETICULATED PLATELET ASSAY,,Fee Schedule,268.96
Aetna,HMO,85060,CPT4/HCPCS,BLOOD SMEAR INTERPRETATION,,Fee Schedule,177.91
Aetna,HMO,85097,CPT4/HCPCS,BONE MARROW INTERPRETATION,,Fee Schedule,361.11
Aetna,HMO,85130,CPT4/HCPCS,CHROMOGENIC SUBSTRATE ASSAY,,Fee Schedule,119.53
Aetna,HMO,85170,CPT4/HCPCS,BLOOD CLOT RETRACTION,,Fee Schedule,36.37
Aetna,HMO,85175,CPT4/HCPCS,BLOOD CLOT LYSIS TIME,,Fee Schedule,45.69
Aetna,HMO,85210,CPT4/HCPCS,CLOT FACTOR II PROTHROM SPEC,,Fee Schedule,130.45
Aetna,HMO,85220,CPT4/HCPCS,BLOOC CLOT FACTOR V TEST,,Fee Schedule,177.32
Aetna,HMO,85230,CPT4/HCPCS,CLOT FACTOR VII PROCONVERTIN,,Fee Schedule,179.92
Aetna,HMO,85240,CPT4/HCPCS,CLOT FACTOR VIII AHG 1 STAGE,,Fee Schedule,179.92
Aetna,HMO,85244,CPT4/HCPCS,CLOT FACTOR VIII RELTD ANTGN,,Fee Schedule,205.12
Aetna,HMO,85245,CPT4/HCPCS,CLOT FACTOR VIII VW RISTOCTN,,Fee Schedule,230.58
Aetna,HMO,85246,CPT4/HCPCS,CLOT FACTOR VIII VW ANTIGEN,,Fee Schedule,230.58
Aetna,HMO,85247,CPT4/HCPCS,CLOT FACTOR VIII MULTIMETRIC,,Fee Schedule,230.58
Aetna,HMO,85250,CPT4/HCPCS,CLOT FACTOR IX PTC/CHRSTMAS,,Fee Schedule,191.35
Aetna,HMO,85260,CPT4/HCPCS,CLOT FACTOR X STUART-POWER,,Fee Schedule,179.92
Aetna,HMO,85270,CPT4/HCPCS,CLOT FACTOR XI PTA,,Fee Schedule,179.92
Aetna,HMO,85280,CPT4/HCPCS,CLOT FACTOR XII HAGEMAN,,Fee Schedule,194.37
Aetna,HMO,85290,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN STAB,,Fee Schedule,164.22
Aetna,HMO,85291,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN SCRN,,Fee Schedule,89.29
Aetna,HMO,85292,CPT4/HCPCS,CLOT FACTOR FLETCHER FACT,,Fee Schedule,190.26
Aetna,HMO,85293,CPT4/HCPCS,CLOT FACTOR WGHT KININOGEN,,Fee Schedule,190.26
Aetna,HMO,85300,CPT4/HCPCS,ANTITHROMBIN III ACTIVITY,,Fee Schedule,119.11
Aetna,HMO,85301,CPT4/HCPCS,ANTITHROMBIN III ANTIGEN,,Fee Schedule,108.61
Aetna,HMO,85302,CPT4/HCPCS,CLOT INHIBIT PROT C ANTIGEN,,Fee Schedule,120.79
Aetna,HMO,85303,CPT4/HCPCS,CLOT INHIBIT PROT C ACTIVITY,,Fee Schedule,138.93
Aetna,HMO,85305,CPT4/HCPCS,CLOT INHIBIT PROT S TOTAL,,Fee Schedule,116.50
Aetna,HMO,85306,CPT4/HCPCS,CLOT INHIBIT PROT S FREE,,Fee Schedule,153.97
Aetna,HMO,85307,CPT4/HCPCS,ASSAY ACTIVATED PROTEIN C,,Fee Schedule,153.97
Aetna,HMO,85335,CPT4/HCPCS,FACTOR INHIBITOR TEST,,Fee Schedule,129.36
Aetna,HMO,85337,CPT4/HCPCS,THROMBOMODULIN,,Fee Schedule,104.74
Aetna,HMO,85345,CPT4/HCPCS,COAGULATION TIME LEE & WHITE,,Fee Schedule,43.17
Aetna,HMO,85347,CPT4/HCPCS,COAGULATION TIME ACTIVATED,,Fee Schedule,42.75
Aetna,HMO,85348,CPT4/HCPCS,COAGULATION TIME OTR METHOD,,Fee Schedule,37.38
Aetna,HMO,85360,CPT4/HCPCS,EUGLOBULIN LYSIS,,Fee Schedule,84.50
Aetna,HMO,85362,CPT4/HCPCS,FIBRIN DEGRADATION PRODUCTS,,Fee Schedule,65.85
Aetna,HMO,85366,CPT4/HCPCS,FIBRINOGEN TEST,,Fee Schedule,82.15
Aetna,HMO,85370,CPT4/HCPCS,FIBRINOGEN TEST,,Fee Schedule,114.07
Aetna,HMO,85378,CPT4/HCPCS,FIBRIN DEGRADE SEMIQUANT,,Fee Schedule,71.65
Aetna,HMO,85379,CPT4/HCPCS,FIBRIN DEGRADATION QUANT,,Fee Schedule,102.22
Aetna,HMO,85380,CPT4/HCPCS,FIBRIN DEGRADJ D-DIMER,,Fee Schedule,102.22
Aetna,HMO,85384,CPT4/HCPCS,FIBRINOGEN ACTIVITY,,Fee Schedule,85.34
Aetna,HMO,85385,CPT4/HCPCS,FIBRINOGEN ANTIGEN,,Fee Schedule,85.34
Aetna,HMO,85390,CPT4/HCPCS,FIBRINOLYSINS SCREEN I&R,,Fee Schedule,51.91
Aetna,HMO,85396,CPT4/HCPCS,CLOTTING ASSAY WHOLE BLOOD,,Fee Schedule,145.90
Aetna,HMO,85397,CPT4/HCPCS,CLOTTING FUNCT ACTIVITY,,Fee Schedule,230.58
Aetna,HMO,85400,CPT4/HCPCS,FIBRINOLYTIC PLASMIN,,Fee Schedule,88.87
Aetna,HMO,85410,CPT4/HCPCS,FIBRINOLYTIC ANTIPLASMIN,,Fee Schedule,77.53
Aetna,HMO,85415,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Fee Schedule,172.78
Aetna,HMO,85420,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Fee Schedule,65.68
Aetna,HMO,85421,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Fee Schedule,102.31
Aetna,HMO,85441,CPT4/HCPCS,HEINZ BODIES DIRECT,,Fee Schedule,42.25
Aetna,HMO,85445,CPT4/HCPCS,HEINZ BODIES INDUCED,,Fee Schedule,68.46
Aetna,HMO,85460,CPT4/HCPCS,HEMOGLOBIN FETAL,,Fee Schedule,77.78
Aetna,HMO,85461,CPT4/HCPCS,HEMOGLOBIN FETAL,,Fee Schedule,66.69
Aetna,HMO,85475,CPT4/HCPCS,HEMOLYSIN ACID,,Fee Schedule,89.12
Aetna,HMO,85520,CPT4/HCPCS,HEPARIN ASSAY,,Fee Schedule,131.62
Aetna,HMO,85525,CPT4/HCPCS,HEPARIN NEUTRALIZATION,,Fee Schedule,93.32
Aetna,HMO,85530,CPT4/HCPCS,HEPARIN-PROTAMINE TOLERANCE,,Fee Schedule,142.46
Aetna,HMO,85536,CPT4/HCPCS,IRON STAIN PERIPHERAL BLOOD,,Fee Schedule,65.01
Aetna,HMO,85540,CPT4/HCPCS,WBC ALKALINE PHOSPHATASE,,Fee Schedule,86.43
Aetna,HMO,85547,CPT4/HCPCS,RBC MECHANICAL FRAGILITY,,Fee Schedule,86.43
Aetna,HMO,85549,CPT4/HCPCS,MURAMIDASE,,Fee Schedule,188.49
Aetna,HMO,85555,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,Fee Schedule,67.20
Aetna,HMO,85557,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,Fee Schedule,134.23
Aetna,HMO,85576,CPT4/HCPCS,BLOOD PLATELET AGGREGATION,,Fee Schedule,215.88
Aetna,HMO,85597,CPT4/HCPCS,PHOSPHOLIPID PLTLT NEUTRALIZ,,Fee Schedule,180.68
Aetna,HMO,85598,CPT4/HCPCS,HEXAGNAL PHOSPH PLTLT NEUTRL,,Fee Schedule,180.68
Aetna,HMO,85610,CPT4/HCPCS,PROTHROMBIN TIME,,Fee Schedule,39.48
Aetna,HMO,85611,CPT4/HCPCS,PROTHROMBIN TEST,,Fee Schedule,39.56
Aetna,HMO,85612,CPT4/HCPCS,VIPER VENOM PROTHROMBIN TIME,,Fee Schedule,96.18
Aetna,HMO,85613,CPT4/HCPCS,RUSSELL VIPER VENOM DILUTED,,Fee Schedule,96.18
Aetna,HMO,85635,CPT4/HCPCS,REPTILASE TEST,,Fee Schedule,98.95
Aetna,HMO,85651,CPT4/HCPCS,RBC SED RATE NONAUTOMATED,,Fee Schedule,35.70
Aetna,HMO,85652,CPT4/HCPCS,RBC SED RATE AUTOMATED,,Fee Schedule,27.13
Aetna,HMO,85660,CPT4/HCPCS,RBC SICKLE CELL TEST,,Fee Schedule,55.44
Aetna,HMO,85670,CPT4/HCPCS,THROMBIN TIME PLASMA,,Fee Schedule,58.04
Aetna,HMO,85675,CPT4/HCPCS,THROMBIN TIME TITER,,Fee Schedule,68.79
Aetna,HMO,85705,CPT4/HCPCS,THROMBOPLASTIN INHIBITION,,Fee Schedule,96.76
Aetna,HMO,85730,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,Fee Schedule,60.31
Aetna,HMO,85732,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,Fee Schedule,65.01
Aetna,HMO,85810,CPT4/HCPCS,BLOOD VISCOSITY EXAMINATION,,Fee Schedule,117.34
Aetna,HMO,86000,CPT4/HCPCS,AGGLUTININS FEBRILE ANTIGEN,,Fee Schedule,57.62
Aetna,HMO,86001,CPT4/HCPCS,ALLERGEN SPECIFIC IGG,,Fee Schedule,52.41
Aetna,HMO,86003,CPT4/HCPCS,ALLG SPEC IGE CRUDE XTRC EA,,Fee Schedule,52.41
Aetna,HMO,86005,CPT4/HCPCS,ALLG SPEC IGE MULTIALLG SCR,,Fee Schedule,53.76
Aetna,HMO,86008,CPT4/HCPCS,ALLG SPEC IGE RECOMB EA,,Fee Schedule,158.08
Aetna,HMO,86021,CPT4/HCPCS,WBC ANTIBODY IDENTIFICATION,,Fee Schedule,137.34
Aetna,HMO,86022,CPT4/HCPCS,PLATELET ANTIBODIES,,Fee Schedule,184.54
Aetna,HMO,86023,CPT4/HCPCS,IMMUNOGLOBULIN ASSAY,,Fee Schedule,125.16
Aetna,HMO,86038,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES,,Fee Schedule,121.46
Aetna,HMO,86039,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES (ANA),,Fee Schedule,112.14
Aetna,HMO,86060,CPT4/HCPCS,ANTISTREPTOLYSIN O TITER,,Fee Schedule,73.33
Aetna,HMO,86063,CPT4/HCPCS,ANTISTREPTOLYSIN O SCREEN,,Fee Schedule,58.04
Aetna,HMO,86077,CPT4/HCPCS,PHYS BLOOD BANK SERV XMATCH,,Fee Schedule,370.02
Aetna,HMO,86078,CPT4/HCPCS,PHYS BLOOD BANK SERV REACTJ,,Fee Schedule,372.96
Aetna,HMO,86079,CPT4/HCPCS,PHYS BLOOD BANK SERV AUTHRJ,,Fee Schedule,372.96
Aetna,HMO,86140,CPT4/HCPCS,C-REACTIVE PROTEIN,,Fee Schedule,51.99
Aetna,HMO,86141,CPT4/HCPCS,C-REACTIVE PROTEIN HS,,Fee Schedule,130.11
Aetna,HMO,86146,CPT4/HCPCS,BETA-2 GLYCOPROTEIN ANTIBODY,,Fee Schedule,255.61
Aetna,HMO,86147,CPT4/HCPCS,CARDIOLIPIN ANTIBODY EA IG,,Fee Schedule,255.61
Aetna,HMO,86148,CPT4/HCPCS,ANTI-PHOSPHOLIPID ANTIBODY,,Fee Schedule,161.44
Aetna,HMO,86152,CPT4/HCPCS,CELL ENUMERATION & ID,,Fee Schedule,5829.26
Aetna,HMO,86153,CPT4/HCPCS,CELL ENUMERATION PHYS INTERP,,Fee Schedule,1260.00
Aetna,HMO,86155,CPT4/HCPCS,CHEMOTAXIS ASSAY,,Fee Schedule,160.60
Aetna,HMO,86156,CPT4/HCPCS,COLD AGGLUTININ SCREEN,,Fee Schedule,67.36
Aetna,HMO,86157,CPT4/HCPCS,COLD AGGLUTININ TITER,,Fee Schedule,81.06
Aetna,HMO,86160,CPT4/HCPCS,COMPLEMENT ANTIGEN,,Fee Schedule,120.62
Aetna,HMO,86161,CPT4/HCPCS,COMPLEMENT/FUNCTION ACTIVITY,,Fee Schedule,120.62
Aetna,HMO,86162,CPT4/HCPCS,COMPLEMENT TOTAL (CH50),,Fee Schedule,204.12
Aetna,HMO,86171,CPT4/HCPCS,COMPLEMENT FIXATION EACH,,Fee Schedule,100.71
Aetna,HMO,86200,CPT4/HCPCS,CCP ANTIBODY,,Fee Schedule,130.11
Aetna,HMO,86215,CPT4/HCPCS,DEOXYRIBONUCLEASE ANTIBODY,,Fee Schedule,133.14
Aetna,HMO,86225,CPT4/HCPCS,DNA ANTIBODY NATIVE,,Fee Schedule,138.01
Aetna,HMO,86226,CPT4/HCPCS,DNA ANTIBODY SINGLE STRAND,,Fee Schedule,121.63
Aetna,HMO,86235,CPT4/HCPCS,NUCLEAR ANTIGEN ANTIBODY,,Fee Schedule,164.47
Aetna,HMO,86255,CPT4/HCPCS,FLUORESCENT ANTIBODY SCREEN,,Fee Schedule,121.12
Aetna,HMO,86256,CPT4/HCPCS,FLUORESCENT ANTIBODY TITER,,Fee Schedule,121.12
Aetna,HMO,86277,CPT4/HCPCS,GROWTH HORMONE ANTIBODY,,Fee Schedule,158.17
Aetna,HMO,86280,CPT4/HCPCS,HEMAGGLUTINATION INHIBITION,,Fee Schedule,82.23
Aetna,HMO,86294,CPT4/HCPCS,IMMUNOASSAY TUMOR QUAL,,Fee Schedule,197.14
Aetna,HMO,86300,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 15-3,,Fee Schedule,209.16
Aetna,HMO,86301,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 19-9,,Fee Schedule,209.16
Aetna,HMO,86304,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 125,,Fee Schedule,209.16
Aetna,HMO,86305,CPT4/HCPCS,HUMAN EPIDIDYMIS PROTEIN 4,,Fee Schedule,209.16
Aetna,HMO,86308,CPT4/HCPCS,HETEROPHILE ANTIBODY SCREEN,,Fee Schedule,51.99
Aetna,HMO,86309,CPT4/HCPCS,HETEROPHILE ANTIBODY TITER,,Fee Schedule,65.01
Aetna,HMO,86310,CPT4/HCPCS,HETEROPHILE ANTIBODY ABSRBJ,,Fee Schedule,74.00
Aetna,HMO,86316,CPT4/HCPCS,IMMUNOASSAY TUMOR OTHER,,Fee Schedule,209.16
Aetna,HMO,86317,CPT4/HCPCS,IMMUNOASSAY INFECTIOUS AGENT,,Fee Schedule,150.69
Aetna,HMO,86318,CPT4/HCPCS,IA INFECTIOUS AGENT ANTIBODY,,Fee Schedule,130.11
Aetna,HMO,86320,CPT4/HCPCS,SERUM IMMUNOELECTROPHORESIS,,Fee Schedule,225.20
Aetna,HMO,86325,CPT4/HCPCS,OTHER IMMUNOELECTROPHORESIS,,Fee Schedule,224.61
Aetna,HMO,86327,CPT4/HCPCS,IMMUNOELECTROPHORESIS ASSAY,,Fee Schedule,227.97
Aetna,HMO,86329,CPT4/HCPCS,IMMUNODIFFUSION NES,,Fee Schedule,141.12
Aetna,HMO,86331,CPT4/HCPCS,IMMUNODIFFUSION OUCHTERLONY,,Fee Schedule,120.37
Aetna,HMO,86332,CPT4/HCPCS,IMMUNE COMPLEX ASSAY,,Fee Schedule,244.94
Aetna,HMO,86334,CPT4/HCPCS,IMMUNOFIX E-PHORESIS SERUM,,Fee Schedule,224.44
Aetna,HMO,86335,CPT4/HCPCS,IMMUNFIX E-PHORSIS/URINE/CSF,,Fee Schedule,294.92
Aetna,HMO,86336,CPT4/HCPCS,INHIBIN A,,Fee Schedule,156.57
Aetna,HMO,86337,CPT4/HCPCS,INSULIN ANTIBODIES,,Fee Schedule,215.12
Aetna,HMO,86340,CPT4/HCPCS,INTRINSIC FACTOR ANTIBODY,,Fee Schedule,151.45
Aetna,HMO,86341,CPT4/HCPCS,ISLET CELL ANTIBODY,,Fee Schedule,166.90
Aetna,HMO,86343,CPT4/HCPCS,LEUKOCYTE HISTAMINE RELEASE,,Fee Schedule,125.24
Aetna,HMO,86344,CPT4/HCPCS,LEUKOCYTE PHAGOCYTOSIS,,Fee Schedule,80.22
Aetna,HMO,86352,CPT4/HCPCS,CELL FUNCTION ASSAY W/STIM,,Fee Schedule,1365.08
Aetna,HMO,86353,CPT4/HCPCS,LYMPHOCYTE TRANSFORMATION,,Fee Schedule,492.57
Aetna,HMO,86355,CPT4/HCPCS,B CELLS TOTAL COUNT,,Fee Schedule,379.00
Aetna,HMO,86356,CPT4/HCPCS,MONONUCLEAR CELL ANTIGEN,,Fee Schedule,268.96
Aetna,HMO,86357,CPT4/HCPCS,NK CELLS TOTAL COUNT,,Fee Schedule,379.00
Aetna,HMO,86359,CPT4/HCPCS,T CELLS TOTAL COUNT,,Fee Schedule,379.00
Aetna,HMO,86360,CPT4/HCPCS,T CELL ABSOLUTE COUNT/RATIO,,Fee Schedule,472.08
Aetna,HMO,86361,CPT4/HCPCS,T CELL ABSOLUTE COUNT,,Fee Schedule,268.96
Aetna,HMO,86367,CPT4/HCPCS,STEM CELLS TOTAL COUNT,,Fee Schedule,379.00
Aetna,HMO,86376,CPT4/HCPCS,MICROSOMAL ANTIBODY EACH,,Fee Schedule,146.24
Aetna,HMO,86382,CPT4/HCPCS,NEUTRALIZATION TEST VIRAL,,Fee Schedule,169.93
Aetna,HMO,86384,CPT4/HCPCS,NITROBLUE TETRAZOLIUM DYE,,Fee Schedule,114.40
Aetna,HMO,86386,CPT4/HCPCS,NUCLEAR MATRIX PROTEIN 22,,Fee Schedule,161.44
Aetna,HMO,86403,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY SCRN,,Fee Schedule,102.39
Aetna,HMO,86406,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY TITR,,Fee Schedule,106.84
Aetna,HMO,86430,CPT4/HCPCS,RHEUMATOID FACTOR TEST QUAL,,Fee Schedule,56.95
Aetna,HMO,86431,CPT4/HCPCS,RHEUMATOID FACTOR QUANT,,Fee Schedule,56.95
Aetna,HMO,86480,CPT4/HCPCS,TB TEST CELL IMMUN MEASURE,,Fee Schedule,622.77
Aetna,HMO,86481,CPT4/HCPCS,TB AG RESPONSE T-CELL SUSP,,Fee Schedule,622.77
Aetna,HMO,86485,CPT4/HCPCS,SKIN TEST CANDIDA,,Fee Schedule,115.41
Aetna,HMO,86486,CPT4/HCPCS,SKIN TEST NOS ANTIGEN,,Fee Schedule,43.17
Aetna,HMO,86490,CPT4/HCPCS,COCCIDIOIDOMYCOSIS SKIN TEST,,Fee Schedule,57.96
Aetna,HMO,86510,CPT4/HCPCS,HISTOPLASMOSIS SKIN TEST,,Fee Schedule,55.02
Aetna,HMO,86580,CPT4/HCPCS,TB INTRADERMAL TEST,,Fee Schedule,63.92
Aetna,HMO,86590,CPT4/HCPCS,STREPTOKINASE ANTIBODY,,Fee Schedule,110.88
Aetna,HMO,86592,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUAL,,Fee Schedule,42.92
Aetna,HMO,86593,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUANT,,Fee Schedule,44.18
Aetna,HMO,86602,CPT4/HCPCS,ANTINOMYCES ANTIBODY,,Fee Schedule,102.22
Aetna,HMO,86603,CPT4/HCPCS,ADENOVIRUS ANTIBODY,,Fee Schedule,129.27
Aetna,HMO,86606,CPT4/HCPCS,ASPERGILLUS ANTIBODY,,Fee Schedule,151.28
Aetna,HMO,86609,CPT4/HCPCS,BACTERIUM ANTIBODY,,Fee Schedule,129.44
Aetna,HMO,86611,CPT4/HCPCS,BARTONELLA ANTIBODY,,Fee Schedule,102.22
Aetna,HMO,86612,CPT4/HCPCS,BLASTOMYCES ANTIBODY,,Fee Schedule,129.69
Aetna,HMO,86615,CPT4/HCPCS,BORDETELLA ANTIBODY,,Fee Schedule,132.55
Aetna,HMO,86617,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Fee Schedule,155.65
Aetna,HMO,86618,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Fee Schedule,171.10
Aetna,HMO,86619,CPT4/HCPCS,BORRELIA ANTIBODY,,Fee Schedule,134.48
Aetna,HMO,86622,CPT4/HCPCS,BRUCELLA ANTIBODY,,Fee Schedule,89.71
Aetna,HMO,86625,CPT4/HCPCS,CAMPYLOBACTER ANTIBODY,,Fee Schedule,131.79
Aetna,HMO,86628,CPT4/HCPCS,CANDIDA ANTIBODY,,Fee Schedule,120.70
Aetna,HMO,86631,CPT4/HCPCS,CHLAMYDIA ANTIBODY,,Fee Schedule,118.77
Aetna,HMO,86632,CPT4/HCPCS,CHLAMYDIA IGM ANTIBODY,,Fee Schedule,127.51
Aetna,HMO,86635,CPT4/HCPCS,COCCIDIOIDES ANTIBODY,,Fee Schedule,115.33
Aetna,HMO,86638,CPT4/HCPCS,Q FEVER ANTIBODY,,Fee Schedule,121.80
Aetna,HMO,86641,CPT4/HCPCS,CRYPTOCOCCUS ANTIBODY,,Fee Schedule,144.81
Aetna,HMO,86644,CPT4/HCPCS,CMV ANTIBODY,,Fee Schedule,144.56
Aetna,HMO,86645,CPT4/HCPCS,CMV ANTIBODY IGM,,Fee Schedule,169.26
Aetna,HMO,86648,CPT4/HCPCS,DIPHTHERIA ANTIBODY,,Fee Schedule,152.88
Aetna,HMO,86651,CPT4/HCPCS,ENCEPHALITIS CALIFORN ANTBDY,,Fee Schedule,132.55
Aetna,HMO,86652,CPT4/HCPCS,ENCEPHALTIS EAST EQNE ANBDY,,Fee Schedule,132.55
Aetna,HMO,86653,CPT4/HCPCS,ENCEPHALTIS ST LOUIS ANTBODY,,Fee Schedule,132.55
Aetna,HMO,86654,CPT4/HCPCS,ENCEPHALTIS WEST EQNE ANTBDY,,Fee Schedule,132.55
Aetna,HMO,86658,CPT4/HCPCS,ENTEROVIRUS ANTIBODY,,Fee Schedule,130.95
Aetna,HMO,86663,CPT4/HCPCS,EPSTEIN-BARR ANTIBODY,,Fee Schedule,131.79
Aetna,HMO,86664,CPT4/HCPCS,EPSTEIN-BARR NUCLEAR ANTIGEN,,Fee Schedule,153.72
Aetna,HMO,86665,CPT4/HCPCS,EPSTEIN-BARR CAPSID VCA,,Fee Schedule,182.28
Aetna,HMO,86666,CPT4/HCPCS,EHRLICHIA ANTIBODY,,Fee Schedule,102.22
Aetna,HMO,86668,CPT4/HCPCS,FRANCISELLA TULARENSIS,,Fee Schedule,104.49
Aetna,HMO,86671,CPT4/HCPCS,FUNGUS NES ANTIBODY,,Fee Schedule,123.14
Aetna,HMO,86674,CPT4/HCPCS,GIARDIA LAMBLIA ANTIBODY,,Fee Schedule,147.92
Aetna,HMO,86677,CPT4/HCPCS,HELICOBACTER PYLORI ANTIBODY,,Fee Schedule,145.82
Aetna,HMO,86682,CPT4/HCPCS,HELMINTH ANTIBODY,,Fee Schedule,130.70
Aetna,HMO,86684,CPT4/HCPCS,HEMOPHILUS INFLUENZA ANTIBDY,,Fee Schedule,159.26
Aetna,HMO,86687,CPT4/HCPCS,HTLV-I ANTIBODY,,Fee Schedule,84.33
Aetna,HMO,86688,CPT4/HCPCS,HTLV-II ANTIBODY,,Fee Schedule,140.70
Aetna,HMO,86689,CPT4/HCPCS,HTLV/HIV CONFIRMJ ANTIBODY,,Fee Schedule,194.46
Aetna,HMO,86692,CPT4/HCPCS,HEPATITIS DELTA AGENT ANTBDY,,Fee Schedule,172.45
Aetna,HMO,86694,CPT4/HCPCS,HERPES SIMPLEX NES ANTBDY,,Fee Schedule,144.56
Aetna,HMO,86695,CPT4/HCPCS,HERPES SIMPLEX TYPE 1 TEST,,Fee Schedule,132.55
Aetna,HMO,86696,CPT4/HCPCS,HERPES SIMPLEX TYPE 2 TEST,,Fee Schedule,194.46
Aetna,HMO,86698,CPT4/HCPCS,HISTOPLASMA ANTIBODY,,Fee Schedule,125.58
Aetna,HMO,86701,CPT4/HCPCS,HIV-1ANTIBODY,,Fee Schedule,89.29
Aetna,HMO,86702,CPT4/HCPCS,HIV-2 ANTIBODY,,Fee Schedule,135.91
Aetna,HMO,86703,CPT4/HCPCS,HIV-1/HIV-2 1 RESULT ANTBDY,,Fee Schedule,137.84
Aetna,HMO,86704,CPT4/HCPCS,HEP B CORE ANTIBODY TOTAL,,Fee Schedule,121.12
Aetna,HMO,86705,CPT4/HCPCS,HEP B CORE ANTIBODY IGM,,Fee Schedule,118.27
Aetna,HMO,86706,CPT4/HCPCS,HEP B SURFACE ANTIBODY,,Fee Schedule,107.94
Aetna,HMO,86707,CPT4/HCPCS,HEPATITIS BE ANTIBODY,,Fee Schedule,116.25
Aetna,HMO,86708,CPT4/HCPCS,HEPATITIS A ANTIBODY,,Fee Schedule,124.48
Aetna,HMO,86709,CPT4/HCPCS,HEPATITIS A IGM ANTIBODY,,Fee Schedule,113.06
Aetna,HMO,86710,CPT4/HCPCS,INFLUENZA VIRUS ANTIBODY,,Fee Schedule,136.24
Aetna,HMO,86711,CPT4/HCPCS,JOHN CUNNINGHAM ANTIBODY,,Fee Schedule,141.28
Aetna,HMO,86713,CPT4/HCPCS,LEGIONELLA ANTIBODY,,Fee Schedule,153.72
Aetna,HMO,86717,CPT4/HCPCS,LEISHMANIA ANTIBODY,,Fee Schedule,123.06
Aetna,HMO,86720,CPT4/HCPCS,LEPTOSPIRA ANTIBODY,,Fee Schedule,132.55
Aetna,HMO,86723,CPT4/HCPCS,LISTERIA MONOCYTOGENES,,Fee Schedule,132.55
Aetna,HMO,86727,CPT4/HCPCS,LYMPH CHORIOMENINGITIS AB,,Fee Schedule,129.27
Aetna,HMO,86732,CPT4/HCPCS,MUCORMYCOSIS ANTIBODY,,Fee Schedule,132.55
Aetna,HMO,86735,CPT4/HCPCS,MUMPS ANTIBODY,,Fee Schedule,131.12
Aetna,HMO,86738,CPT4/HCPCS,MYCOPLASMA ANTIBODY,,Fee Schedule,133.05
Aetna,HMO,86741,CPT4/HCPCS,NEISSERIA MENINGITIDIS,,Fee Schedule,132.55
Aetna,HMO,86744,CPT4/HCPCS,NOCARDIA ANTIBODY,,Fee Schedule,132.55
Aetna,HMO,86747,CPT4/HCPCS,PARVOVIRUS ANTIBODY,,Fee Schedule,151.11
Aetna,HMO,86750,CPT4/HCPCS,MALARIA ANTIBODY,,Fee Schedule,132.55
Aetna,HMO,86753,CPT4/HCPCS,PROTOZOA ANTIBODY NOS,,Fee Schedule,124.48
Aetna,HMO,86756,CPT4/HCPCS,RESPIRATORY VIRUS ANTIBODY,,Fee Schedule,129.52
Aetna,HMO,86757,CPT4/HCPCS,RICKETTSIA ANTIBODY,,Fee Schedule,194.46
Aetna,HMO,86759,CPT4/HCPCS,ROTAVIRUS ANTIBODY,,Fee Schedule,132.55
Aetna,HMO,86762,CPT4/HCPCS,RUBELLA ANTIBODY,,Fee Schedule,144.56
Aetna,HMO,86765,CPT4/HCPCS,RUBEOLA ANTIBODY,,Fee Schedule,129.44
Aetna,HMO,86768,CPT4/HCPCS,SALMONELLA ANTIBODY,,Fee Schedule,132.55
Aetna,HMO,86771,CPT4/HCPCS,SHIGELLA ANTIBODY,,Fee Schedule,132.55
Aetna,HMO,86774,CPT4/HCPCS,TETANUS ANTIBODY,,Fee Schedule,148.68
Aetna,HMO,86777,CPT4/HCPCS,TOXOPLASMA ANTIBODY,,Fee Schedule,144.56
Aetna,HMO,86778,CPT4/HCPCS,TOXOPLASMA ANTIBODY IGM,,Fee Schedule,144.73
Aetna,HMO,86780,CPT4/HCPCS,TREPONEMA PALLIDUM,,Fee Schedule,133.05
Aetna,HMO,86784,CPT4/HCPCS,TRICHINELLA ANTIBODY,,Fee Schedule,126.25
Aetna,HMO,86787,CPT4/HCPCS,VARICELLA-ZOSTER ANTIBODY,,Fee Schedule,129.44
Aetna,HMO,86788,CPT4/HCPCS,WEST NILE VIRUS AB IGM,,Fee Schedule,169.26
Aetna,HMO,86789,CPT4/HCPCS,WEST NILE VIRUS ANTIBODY,,Fee Schedule,144.56
Aetna,HMO,86790,CPT4/HCPCS,VIRUS ANTIBODY NOS,,Fee Schedule,129.44
Aetna,HMO,86793,CPT4/HCPCS,YERSINIA ANTIBODY,,Fee Schedule,132.55
Aetna,HMO,86794,CPT4/HCPCS,ZIKA VIRUS IGM ANTIBODY,,Fee Schedule,148.51
Aetna,HMO,86800,CPT4/HCPCS,THYROGLOBULIN ANTIBODY,,Fee Schedule,159.76
Aetna,HMO,86803,CPT4/HCPCS,HEPATITIS C AB TEST,,Fee Schedule,143.38
Aetna,HMO,86804,CPT4/HCPCS,HEP C AB TEST CONFIRM,,Fee Schedule,155.65
Aetna,HMO,86805,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,Fee Schedule,434.95
Aetna,HMO,86806,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,Fee Schedule,217.47
Aetna,HMO,86807,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,Fee Schedule,397.65
Aetna,HMO,86808,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,Fee Schedule,217.47
Aetna,HMO,86812,CPT4/HCPCS,HLA TYPING A B OR C,,Fee Schedule,259.30
Aetna,HMO,86813,CPT4/HCPCS,HLA TYPING A B OR C,,Fee Schedule,411.34
Aetna,HMO,86816,CPT4/HCPCS,HLA TYPING DR/DQ,,Fee Schedule,279.97
Aetna,HMO,86817,CPT4/HCPCS,HLA TYPING DR/DQ,,Fee Schedule,646.96
Aetna,HMO,86821,CPT4/HCPCS,LYMPHOCYTE CULTURE MIXED,,Fee Schedule,567.25
Aetna,HMO,86825,CPT4/HCPCS,HLA X-MATH NON-CYTOTOXIC,,Fee Schedule,807.07
Aetna,HMO,86826,CPT4/HCPCS,HLA X-MATCH NONCYTOTOXC ADDL,,Fee Schedule,268.96
Aetna,HMO,86828,CPT4/HCPCS,HLA CLASS I&II ANTIBODY QUAL,,Fee Schedule,388.41
Aetna,HMO,86829,CPT4/HCPCS,HLA CLASS I/II ANTIBODY QUAL,,Fee Schedule,291.31
Aetna,HMO,86830,CPT4/HCPCS,HLA CLASS I PHENOTYPE QUAL,,Fee Schedule,637.72
Aetna,HMO,86831,CPT4/HCPCS,HLA CLASS II PHENOTYPE QUAL,,Fee Schedule,546.67
Aetna,HMO,86832,CPT4/HCPCS,HLA CLASS I HIGH DEFIN QUAL,,Fee Schedule,1002.20
Aetna,HMO,86833,CPT4/HCPCS,HLA CLASS II HIGH DEFIN QUAL,,Fee Schedule,911.06
Aetna,HMO,86834,CPT4/HCPCS,HLA CLASS I SEMIQUANT PANEL,,Fee Schedule,2824.33
Aetna,HMO,86835,CPT4/HCPCS,HLA CLASS II SEMIQUANT PANEL,,Fee Schedule,2550.99
Aetna,HMO,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,Fee Schedule,142.04
Aetna,HMO,86860,CPT4/HCPCS,RBC ANTIBODY ELUTION,,Fee Schedule,183.45
Aetna,HMO,86870,CPT4/HCPCS,RBC ANTIBODY IDENTIFICATION,,Fee Schedule,251.58
Aetna,HMO,86880,CPT4/HCPCS,COOMBS TEST DIRECT,,Fee Schedule,54.01
Aetna,HMO,86885,CPT4/HCPCS,COOMBS TEST INDIRECT QUAL,,Fee Schedule,57.54
Aetna,HMO,86886,CPT4/HCPCS,COOMBS TEST INDIRECT TITER,,Fee Schedule,51.99
Aetna,HMO,86890,CPT4/HCPCS,AUTOLOGOUS BLOOD PROCESS,,Fee Schedule,580.10
Aetna,HMO,86891,CPT4/HCPCS,AUTOLOGOUS BLOOD OP SALVAGE,,Fee Schedule,816.81
Aetna,HMO,86900,CPT4/HCPCS,BLOOD TYPING SEROLOGIC ABO,,Fee Schedule,29.98
Aetna,HMO,86901,CPT4/HCPCS,BLOOD TYPING SEROLOGIC RH(D),,Fee Schedule,29.98
Aetna,HMO,86902,CPT4/HCPCS,BLOOD TYPE ANTIGEN DONOR EA,,Fee Schedule,38.38
Aetna,HMO,86904,CPT4/HCPCS,BLOOD TYPING PATIENT SERUM,,Fee Schedule,95.50
Aetna,HMO,86905,CPT4/HCPCS,BLOOD TYPING RBC ANTIGENS,,Fee Schedule,38.38
Aetna,HMO,86906,CPT4/HCPCS,BLD TYPING SEROLOGIC RH PHNT,,Fee Schedule,77.86
Aetna,HMO,86910,CPT4/HCPCS,BLOOD TYPING PATERNITY TEST,,Fee Schedule,150.94
Aetna,HMO,86911,CPT4/HCPCS,BLOOD TYPING ANTIGEN SYSTEM,,Fee Schedule,130.20
Aetna,HMO,86920,CPT4/HCPCS,COMPATIBILITY TEST SPIN,,Fee Schedule,204.20
Aetna,HMO,86921,CPT4/HCPCS,COMPATIBILITY TEST INCUBATE,,Fee Schedule,183.45
Aetna,HMO,86922,CPT4/HCPCS,COMPATIBILITY TEST ANTIGLOB,,Fee Schedule,218.98
Aetna,HMO,86923,CPT4/HCPCS,COMPATIBILITY TEST ELECTRIC,,Fee Schedule,162.79
Aetna,HMO,86927,CPT4/HCPCS,PLASMA FRESH FROZEN,,Fee Schedule,115.41
Aetna,HMO,86930,CPT4/HCPCS,FROZEN BLOOD PREP,,Fee Schedule,680.73
Aetna,HMO,86931,CPT4/HCPCS,FROZEN BLOOD THAW,,Fee Schedule,511.98
Aetna,HMO,86932,CPT4/HCPCS,FROZEN BLOOD FREEZE/THAW,,Fee Schedule,580.10
Aetna,HMO,86940,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS AUTO,,Fee Schedule,82.40
Aetna,HMO,86941,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS,,Fee Schedule,121.63
Aetna,HMO,86945,CPT4/HCPCS,BLOOD PRODUCT/IRRADIATION,,Fee Schedule,171.69
Aetna,HMO,86950,CPT4/HCPCS,LEUKACYTE TRANSFUSION,,Fee Schedule,443.94
Aetna,HMO,86960,CPT4/HCPCS,VOL REDUCTION OF BLOOD/PROD,,Fee Schedule,189.42
Aetna,HMO,86965,CPT4/HCPCS,POOLING BLOOD PLATELETS,,Fee Schedule,189.42
Aetna,HMO,86970,CPT4/HCPCS,RBC PRETX INCUBATJ W/CHEMICL,,Fee Schedule,171.69
Aetna,HMO,86971,CPT4/HCPCS,RBC PRETX INCUBATJ W/ENZYMES,,Fee Schedule,136.16
Aetna,HMO,86972,CPT4/HCPCS,RBC PRETX INCUBATJ W/DENSITY,,Fee Schedule,239.73
Aetna,HMO,86975,CPT4/HCPCS,RBC SERUM PRETX INCUBJ DRUGS,,Fee Schedule,183.45
Aetna,HMO,86976,CPT4/HCPCS,RBC SERUM PRETX ID DILUTION,,Fee Schedule,204.20
Aetna,HMO,86977,CPT4/HCPCS,RBC SERUM PRETX INCUBJ/INHIB,,Fee Schedule,204.20
Aetna,HMO,86978,CPT4/HCPCS,RBC PRETREATMENT SERUM,,Fee Schedule,204.20
Aetna,HMO,86985,CPT4/HCPCS,SPLIT BLOOD OR PRODUCTS,,Fee Schedule,150.94
Aetna,HMO,87003,CPT4/HCPCS,SMALL ANIMAL INOCULATION,,Fee Schedule,169.17
Aetna,HMO,87015,CPT4/HCPCS,SPECIMEN INFECT AGNT CONCNTJ,,Fee Schedule,67.11
Aetna,HMO,87040,CPT4/HCPCS,BLOOD CULTURE FOR BACTERIA,,Fee Schedule,103.74
Aetna,HMO,87045,CPT4/HCPCS,FECES CULTURE AEROBIC BACT,,Fee Schedule,94.83
Aetna,HMO,87046,CPT4/HCPCS,STOOL CULTR AEROBIC BACT EA,,Fee Schedule,94.83
Aetna,HMO,87070,CPT4/HCPCS,CULTURE OTHR SPECIMN AEROBIC,,Fee Schedule,86.52
Aetna,HMO,87071,CPT4/HCPCS,CULTURE AEROBIC QUANT OTHER,,Fee Schedule,94.83
Aetna,HMO,87073,CPT4/HCPCS,CULTURE BACTERIA ANAEROBIC,,Fee Schedule,94.83
Aetna,HMO,87075,CPT4/HCPCS,CULTR BACTERIA EXCEPT BLOOD,,Fee Schedule,95.00
Aetna,HMO,87076,CPT4/HCPCS,CULTURE ANAEROBE IDENT EACH,,Fee Schedule,81.14
Aetna,HMO,87077,CPT4/HCPCS,CULTURE AEROBIC IDENTIFY,,Fee Schedule,81.14
Aetna,HMO,87081,CPT4/HCPCS,CULTURE SCREEN ONLY,,Fee Schedule,66.61
Aetna,HMO,87084,CPT4/HCPCS,CULTURE OF SPECIMEN BY KIT,,Fee Schedule,86.52
Aetna,HMO,87086,CPT4/HCPCS,URINE CULTURE/COLONY COUNT,,Fee Schedule,81.14
Aetna,HMO,87088,CPT4/HCPCS,URINE BACTERIA CULTURE,,Fee Schedule,65.85
Aetna,HMO,87101,CPT4/HCPCS,SKIN FUNGI CULTURE,,Fee Schedule,77.53
Aetna,HMO,87102,CPT4/HCPCS,FUNGUS ISOLATION CULTURE,,Fee Schedule,84.50
Aetna,HMO,87103,CPT4/HCPCS,BLOOD FUNGUS CULTURE,,Fee Schedule,90.63
Aetna,HMO,87106,CPT4/HCPCS,FUNGI IDENTIFICATION YEAST,,Fee Schedule,103.74
Aetna,HMO,87107,CPT4/HCPCS,FUNGI IDENTIFICATION MOLD,,Fee Schedule,103.74
Aetna,HMO,87109,CPT4/HCPCS,MYCOPLASMA,,Fee Schedule,154.56
Aetna,HMO,87110,CPT4/HCPCS,CHLAMYDIA CULTURE,,Fee Schedule,196.81
Aetna,HMO,87116,CPT4/HCPCS,MYCOBACTERIA CULTURE,,Fee Schedule,98.78
Aetna,HMO,87118,CPT4/HCPCS,MYCOBACTERIC IDENTIFICATION,,Fee Schedule,109.95
Aetna,HMO,87140,CPT4/HCPCS,CULTURE TYPE IMMUNOFLUORESC,,Fee Schedule,55.94
Aetna,HMO,87143,CPT4/HCPCS,CULTURE TYPING GLC/HPLC,,Fee Schedule,125.91
Aetna,HMO,87147,CPT4/HCPCS,CULTURE TYPE IMMUNOLOGIC,,Fee Schedule,49.30
Aetna,HMO,87149,CPT4/HCPCS,DNA/RNA DIRECT PROBE,,Fee Schedule,201.51
Aetna,HMO,87150,CPT4/HCPCS,DNA/RNA AMPLIFIED PROBE,,Fee Schedule,352.63
Aetna,HMO,87152,CPT4/HCPCS,CULTURE TYPE PULSE FIELD GEL,,Fee Schedule,52.58
Aetna,HMO,87153,CPT4/HCPCS,DNA/RNA SEQUENCING,,Fee Schedule,1159.03
Aetna,HMO,87158,CPT4/HCPCS,CULTURE TYPING ADDED METHOD,,Fee Schedule,52.58
Aetna,HMO,87164,CPT4/HCPCS,DARK FIELD EXAMINATION,,Fee Schedule,107.94
Aetna,HMO,87166,CPT4/HCPCS,DARK FIELD EXAMINATION,,Fee Schedule,113.56
Aetna,HMO,87168,CPT4/HCPCS,MACROSCOPIC EXAM ARTHROPOD,,Fee Schedule,42.92
Aetna,HMO,87169,CPT4/HCPCS,MACROSCOPIC EXAM PARASITE,,Fee Schedule,42.92
Aetna,HMO,87172,CPT4/HCPCS,PINWORM EXAM,,Fee Schedule,42.92
Aetna,HMO,87176,CPT4/HCPCS,TISSUE HOMOGENIZATION CULTR,,Fee Schedule,59.13
Aetna,HMO,87177,CPT4/HCPCS,OVA AND PARASITES SMEARS,,Fee Schedule,89.37
Aetna,HMO,87181,CPT4/HCPCS,MICROBE SUSCEPTIBLE DIFFUSE,,Fee Schedule,16.38
Aetna,HMO,87184,CPT4/HCPCS,MICROBE SUSCEPTIBLE DISK,,Fee Schedule,69.30
Aetna,HMO,87185,CPT4/HCPCS,MICROBE SUSCEPTIBLE ENZYME,,Fee Schedule,16.38
Aetna,HMO,87186,CPT4/HCPCS,MICROBE SUSCEPTIBLE MIC,,Fee Schedule,86.85
Aetna,HMO,87187,CPT4/HCPCS,MICROBE SUSCEPTIBLE MLC,,Fee Schedule,104.16
Aetna,HMO,87188,CPT4/HCPCS,MICROBE SUSCEPT MACROBROTH,,Fee Schedule,66.69
Aetna,HMO,87190,CPT4/HCPCS,MICROBE SUSCEPT MYCOBACTERI,,Fee Schedule,49.30
Aetna,HMO,87197,CPT4/HCPCS,BACTERICIDAL LEVEL SERUM,,Fee Schedule,150.94
Aetna,HMO,87205,CPT4/HCPCS,SMEAR GRAM STAIN,,Fee Schedule,42.92
Aetna,HMO,87206,CPT4/HCPCS,SMEAR FLUORESCENT/ACID STAI,,Fee Schedule,54.01
Aetna,HMO,87207,CPT4/HCPCS,SMEAR SPECIAL STAIN,,Fee Schedule,60.22
Aetna,HMO,87209,CPT4/HCPCS,SMEAR COMPLEX STAIN,,Fee Schedule,180.60
Aetna,HMO,87210,CPT4/HCPCS,SMEAR WET MOUNT SALINE/INK,,Fee Schedule,42.92
Aetna,HMO,87220,CPT4/HCPCS,TISSUE EXAM FOR FUNGI,,Fee Schedule,42.92
Aetna,HMO,87230,CPT4/HCPCS,ASSAY TOXIN OR ANTITOXIN,,Fee Schedule,198.40
Aetna,HMO,87250,CPT4/HCPCS,VIRUS INOCULATE EGGS/ANIMAL,,Fee Schedule,196.47
Aetna,HMO,87252,CPT4/HCPCS,VIRUS INOCULATION TISSUE,,Fee Schedule,261.91
Aetna,HMO,87253,CPT4/HCPCS,VIRUS INOCULATE TISSUE ADDL,,Fee Schedule,202.94
Aetna,HMO,87254,CPT4/HCPCS,VIRUS INOCULATION SHELL VIA,,Fee Schedule,196.47
Aetna,HMO,87255,CPT4/HCPCS,GENET VIRUS ISOLATE HSV,,Fee Schedule,340.28
Aetna,HMO,87260,CPT4/HCPCS,ADENOVIRUS AG IF,,Fee Schedule,93.32
Aetna,HMO,87265,CPT4/HCPCS,PERTUSSIS AG IF,,Fee Schedule,93.32
Aetna,HMO,87267,CPT4/HCPCS,ENTEROVIRUS ANTIBODY DFA,,Fee Schedule,93.32
Aetna,HMO,87269,CPT4/HCPCS,GIARDIA AG IF,,Fee Schedule,93.32
Aetna,HMO,87270,CPT4/HCPCS,CHLAMYDIA TRACHOMATIS AG IF,,Fee Schedule,93.32
Aetna,HMO,87271,CPT4/HCPCS,CYTOMEGALOVIRUS DFA,,Fee Schedule,93.32
Aetna,HMO,87272,CPT4/HCPCS,CRYPTOSPORIDIUM AG IF,,Fee Schedule,93.32
Aetna,HMO,87273,CPT4/HCPCS,HERPES SIMPLEX 2 AG IF,,Fee Schedule,93.32
Aetna,HMO,87274,CPT4/HCPCS,HERPES SIMPLEX 1 AG IF,,Fee Schedule,93.32
Aetna,HMO,87275,CPT4/HCPCS,INFLUENZA B AG IF,,Fee Schedule,93.32
Aetna,HMO,87276,CPT4/HCPCS,INFLUENZA A AG IF,,Fee Schedule,93.32
Aetna,HMO,87278,CPT4/HCPCS,LEGION PNEUMOPHILIA AG IF,,Fee Schedule,93.32
Aetna,HMO,87279,CPT4/HCPCS,PARAINFLUENZA AG IF,,Fee Schedule,93.32
Aetna,HMO,87280,CPT4/HCPCS,RESPIRATORY SYNCYTIAL AG IF,,Fee Schedule,93.32
Aetna,HMO,87281,CPT4/HCPCS,PNEUMOCYSTIS CARINII AG IF,,Fee Schedule,93.32
Aetna,HMO,87283,CPT4/HCPCS,RUBEOLA AG IF,,Fee Schedule,93.32
Aetna,HMO,87285,CPT4/HCPCS,TREPONEMA PALLIDUM AG IF,,Fee Schedule,93.32
Aetna,HMO,87290,CPT4/HCPCS,VARICELLA ZOSTER AG IF,,Fee Schedule,93.32
Aetna,HMO,87299,CPT4/HCPCS,ANTIBODY DETECTION NOS IF,,Fee Schedule,93.32
Aetna,HMO,87300,CPT4/HCPCS,AG DETECTION POLYVAL IF,,Fee Schedule,93.32
Aetna,HMO,87301,CPT4/HCPCS,ADENOVIRUS AG IA,,Fee Schedule,93.32
Aetna,HMO,87305,CPT4/HCPCS,ASPERGILLUS AG IA,,Fee Schedule,93.32
Aetna,HMO,87320,CPT4/HCPCS,CHYLMD TRACH AG IA,,Fee Schedule,93.32
Aetna,HMO,87324,CPT4/HCPCS,CLOSTRIDIUM AG IA,,Fee Schedule,93.32
Aetna,HMO,87327,CPT4/HCPCS,CRYPTOCOCCUS NEOFORM AG IA,,Fee Schedule,93.32
Aetna,HMO,87328,CPT4/HCPCS,CRYPTOSPORIDIUM AG IA,,Fee Schedule,93.32
Aetna,HMO,87329,CPT4/HCPCS,GIARDIA AG IA,,Fee Schedule,93.32
Aetna,HMO,87332,CPT4/HCPCS,CYTOMEGALOVIRUS AG IA,,Fee Schedule,93.32
Aetna,HMO,87335,CPT4/HCPCS,E COLI 0157 AG IA,,Fee Schedule,93.32
Aetna,HMO,87336,CPT4/HCPCS,ENTAMOEB HIST DISPR AG IA,,Fee Schedule,93.32
Aetna,HMO,87337,CPT4/HCPCS,ENTAMOEB HIST GROUP AG IA,,Fee Schedule,93.32
Aetna,HMO,87338,CPT4/HCPCS,HPYLORI STOOL IA,,Fee Schedule,144.48
Aetna,HMO,87339,CPT4/HCPCS,H PYLORI AG IA,,Fee Schedule,93.32
Aetna,HMO,87340,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,Fee Schedule,103.74
Aetna,HMO,87341,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,Fee Schedule,103.74
Aetna,HMO,87350,CPT4/HCPCS,HEPATITIS BE AG IA,,Fee Schedule,115.83
Aetna,HMO,87380,CPT4/HCPCS,HEPATITIS DELTA AG IA,,Fee Schedule,164.97
Aetna,HMO,87385,CPT4/HCPCS,HISTOPLASMA CAPSUL AG IA,,Fee Schedule,93.32
Aetna,HMO,87389,CPT4/HCPCS,HIV-1 AG W/HIV-1 & HIV-2 AB,,Fee Schedule,243.60
Aetna,HMO,87390,CPT4/HCPCS,HIV-1 AG IA,,Fee Schedule,177.32
Aetna,HMO,87391,CPT4/HCPCS,HIV-2 AG IA,,Fee Schedule,177.32
Aetna,HMO,87400,CPT4/HCPCS,INFLUENZA A/B AG IA,,Fee Schedule,93.32
Aetna,HMO,87420,CPT4/HCPCS,RESP SYNCYTIAL AG IA,,Fee Schedule,93.32
Aetna,HMO,87425,CPT4/HCPCS,ROTAVIRUS AG IA,,Fee Schedule,93.32
Aetna,HMO,87427,CPT4/HCPCS,SHIGA-LIKE TOXIN AG IA,,Fee Schedule,93.32
Aetna,HMO,87430,CPT4/HCPCS,STREP A AG IA,,Fee Schedule,93.32
Aetna,HMO,87449,CPT4/HCPCS,AG DETECT NOS IA MULT,,Fee Schedule,93.32
Aetna,HMO,87450,CPT4/HCPCS,AG DETECT NOS IA SINGLE,,Fee Schedule,34.27
Aetna,HMO,87451,CPT4/HCPCS,AG DETECT POLYVAL IA MULT,,Fee Schedule,34.27
Aetna,HMO,87471,CPT4/HCPCS,BARTONELLA DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87472,CPT4/HCPCS,BARTONELLA DNA QUANT,,Fee Schedule,430.41
Aetna,HMO,87475,CPT4/HCPCS,LYME DIS DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87476,CPT4/HCPCS,LYME DIS DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87480,CPT4/HCPCS,CANDIDA DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87481,CPT4/HCPCS,CANDIDA DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87482,CPT4/HCPCS,CANDIDA DNA QUANT,,Fee Schedule,419.49
Aetna,HMO,87483,CPT4/HCPCS,CNS DNA AMP PROBE TYPE 12-25,,Fee Schedule,4082.06
Aetna,HMO,87485,CPT4/HCPCS,CHYLMD PNEUM DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87486,CPT4/HCPCS,CHYLMD PNEUM DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87487,CPT4/HCPCS,CHYLMD PNEUM DNA QUANT,,Fee Schedule,430.41
Aetna,HMO,87490,CPT4/HCPCS,CHYLMD TRACH DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87491,CPT4/HCPCS,CHYLMD TRACH DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87492,CPT4/HCPCS,CHYLMD TRACH DNA QUANT,,Fee Schedule,351.28
Aetna,HMO,87493,CPT4/HCPCS,C DIFF AMPLIFIED PROBE,,Fee Schedule,352.63
Aetna,HMO,87495,CPT4/HCPCS,CYTOMEG DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87496,CPT4/HCPCS,CYTOMEG DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87497,CPT4/HCPCS,CYTOMEG DNA QUANT,,Fee Schedule,430.41
Aetna,HMO,87498,CPT4/HCPCS,ENTEROVIRUS PROBE&REVRS TRNS,,Fee Schedule,352.63
Aetna,HMO,87500,CPT4/HCPCS,VANOMYCIN DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87501,CPT4/HCPCS,INFLUENZA DNA AMP PROB 1+,,Fee Schedule,515.67
Aetna,HMO,87502,CPT4/HCPCS,INFLUENZA DNA AMP PROBE,,Fee Schedule,855.03
Aetna,HMO,87503,CPT4/HCPCS,INFLUENZA DNA AMP PROB ADDL,,Fee Schedule,208.65
Aetna,HMO,87505,CPT4/HCPCS,NFCT AGENT DETECTION GI,,Fee Schedule,1246.47
Aetna,HMO,87506,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 6-11,,Fee Schedule,2073.79
Aetna,HMO,87507,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 12-25,,Fee Schedule,4049.64
Aetna,HMO,87510,CPT4/HCPCS,GARDNER VAG DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87511,CPT4/HCPCS,GARDNER VAG DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87512,CPT4/HCPCS,GARDNER VAG DNA QUANT,,Fee Schedule,419.49
Aetna,HMO,87516,CPT4/HCPCS,HEPATITIS B DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87517,CPT4/HCPCS,HEPATITIS B DNA QUANT,,Fee Schedule,430.41
Aetna,HMO,87520,CPT4/HCPCS,HEPATITIS C RNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87521,CPT4/HCPCS,HEPATITIS C PROBE&RVRS TRNSC,,Fee Schedule,352.63
Aetna,HMO,87522,CPT4/HCPCS,HEPATITIS C REVRS TRNSCRPJ,,Fee Schedule,430.41
Aetna,HMO,87525,CPT4/HCPCS,HEPATITIS G DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87526,CPT4/HCPCS,HEPATITIS G DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87527,CPT4/HCPCS,HEPATITIS G DNA QUANT,,Fee Schedule,419.49
Aetna,HMO,87528,CPT4/HCPCS,HSV DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87529,CPT4/HCPCS,HSV DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87530,CPT4/HCPCS,HSV DNA QUANT,,Fee Schedule,430.41
Aetna,HMO,87531,CPT4/HCPCS,HHV-6 DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87532,CPT4/HCPCS,HHV-6 DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87533,CPT4/HCPCS,HHV-6 DNA QUANT,,Fee Schedule,419.49
Aetna,HMO,87534,CPT4/HCPCS,HIV-1 DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87535,CPT4/HCPCS,HIV-1 PROBE&REVERSE TRNSCRPJ,,Fee Schedule,352.63
Aetna,HMO,87536,CPT4/HCPCS,HIV-1 QUANT&REVRSE TRNSCRPJ,,Fee Schedule,855.03
Aetna,HMO,87537,CPT4/HCPCS,HIV-2 DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87538,CPT4/HCPCS,HIV-2 PROBE&REVRSE TRNSCRIPJ,,Fee Schedule,352.63
Aetna,HMO,87539,CPT4/HCPCS,HIV-2 QUANT&REVRSE TRNSCRIPJ,,Fee Schedule,430.41
Aetna,HMO,87540,CPT4/HCPCS,LEGION PNEUMO DNA DIR PROB,,Fee Schedule,201.51
Aetna,HMO,87541,CPT4/HCPCS,LEGION PNEUMO DNA AMP PROB,,Fee Schedule,352.63
Aetna,HMO,87542,CPT4/HCPCS,LEGION PNEUMO DNA QUANT,,Fee Schedule,419.49
Aetna,HMO,87550,CPT4/HCPCS,MYCOBACTERIA DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87551,CPT4/HCPCS,MYCOBACTERIA DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87552,CPT4/HCPCS,MYCOBACTERIA DNA QUANT,,Fee Schedule,430.41
Aetna,HMO,87555,CPT4/HCPCS,M.TUBERCULO DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87556,CPT4/HCPCS,M.TUBERCULO DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87557,CPT4/HCPCS,M.TUBERCULO DNA QUANT,,Fee Schedule,430.41
Aetna,HMO,87560,CPT4/HCPCS,M.AVIUM-INTRA DNA DIR PROB,,Fee Schedule,201.51
Aetna,HMO,87561,CPT4/HCPCS,M.AVIUM-INTRA DNA AMP PROB,,Fee Schedule,352.63
Aetna,HMO,87562,CPT4/HCPCS,M.AVIUM-INTRA DNA QUANT,,Fee Schedule,430.41
Aetna,HMO,87580,CPT4/HCPCS,M.PNEUMON DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87581,CPT4/HCPCS,M.PNEUMON DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87582,CPT4/HCPCS,M.PNEUMON DNA QUANT,,Fee Schedule,419.49
Aetna,HMO,87590,CPT4/HCPCS,N.GONORRHOEAE DNA DIR PROB,,Fee Schedule,201.51
Aetna,HMO,87591,CPT4/HCPCS,N.GONORRHOEAE DNA AMP PROB,,Fee Schedule,352.63
Aetna,HMO,87592,CPT4/HCPCS,N.GONORRHOEAE DNA QUANT,,Fee Schedule,430.41
Aetna,HMO,87623,CPT4/HCPCS,HPV LOW-RISK TYPES,,Fee Schedule,341.04
Aetna,HMO,87624,CPT4/HCPCS,HPV HIGH-RISK TYPES,,Fee Schedule,341.04
Aetna,HMO,87625,CPT4/HCPCS,HPV TYPES 16 & 18 ONLY,,Fee Schedule,341.04
Aetna,HMO,87631,CPT4/HCPCS,RESP VIRUS 3-5 TARGETS,,Fee Schedule,1259.07
Aetna,HMO,87632,CPT4/HCPCS,RESP VIRUS 6-11 TARGETS,,Fee Schedule,2094.62
Aetna,HMO,87633,CPT4/HCPCS,RESP VIRUS 12-25 TARGETS,,Fee Schedule,4090.54
Aetna,HMO,87634,CPT4/HCPCS,RSV DNA/RNA AMP PROBE,,Fee Schedule,618.74
Aetna,HMO,87640,CPT4/HCPCS,STAPH A DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87641,CPT4/HCPCS,MR-STAPH DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87650,CPT4/HCPCS,STREP A DNA DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87651,CPT4/HCPCS,STREP A DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87652,CPT4/HCPCS,STREP A DNA QUANT,,Fee Schedule,419.49
Aetna,HMO,87653,CPT4/HCPCS,STREP B DNA AMP PROBE,,Fee Schedule,352.63
Aetna,HMO,87660,CPT4/HCPCS,TRICHOMONAS VAGIN DIR PROBE,,Fee Schedule,201.51
Aetna,HMO,87661,CPT4/HCPCS,TRICHOMONAS VAGINALIS AMPLIF,,Fee Schedule,341.79
Aetna,HMO,87662,CPT4/HCPCS,ZIKA VIRUS DNA/RNA AMP PROBE,,Fee Schedule,452.34
Aetna,HMO,87797,CPT4/HCPCS,DETECT AGENT NOS DNA DIR,,Fee Schedule,201.51
Aetna,HMO,87798,CPT4/HCPCS,DETECT AGENT NOS DNA AMP,,Fee Schedule,352.63
Aetna,HMO,87799,CPT4/HCPCS,DETECT AGENT NOS DNA QUANT,,Fee Schedule,430.41
Aetna,HMO,87800,CPT4/HCPCS,DETECT AGNT MULT DNA DIREC,,Fee Schedule,402.94
Aetna,HMO,87801,CPT4/HCPCS,DETECT AGNT MULT DNA AMPLI,,Fee Schedule,705.26
Aetna,HMO,87802,CPT4/HCPCS,STREP B ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,HMO,87803,CPT4/HCPCS,CLOSTRIDIUM TOXIN A W/OPTIC,,Fee Schedule,93.32
Aetna,HMO,87804,CPT4/HCPCS,INFLUENZA ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,HMO,87806,CPT4/HCPCS,HIV ANTIGEN W/HIV ANTIBODIES,,Fee Schedule,233.94
Aetna,HMO,87807,CPT4/HCPCS,RSV ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,HMO,87808,CPT4/HCPCS,TRICHOMONAS ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,HMO,87809,CPT4/HCPCS,ADENOVIRUS ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,HMO,87810,CPT4/HCPCS,CHYLMD TRACH ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,HMO,87850,CPT4/HCPCS,N. GONORRHOEAE ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,HMO,87880,CPT4/HCPCS,STREP A ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,HMO,87899,CPT4/HCPCS,AGENT NOS ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,HMO,87900,CPT4/HCPCS,PHENOTYPE INFECT AGENT DRUG,,Fee Schedule,1309.64
Aetna,HMO,87901,CPT4/HCPCS,GENOTYPE DNA HIV REVERSE T,,Fee Schedule,2586.69
Aetna,HMO,87902,CPT4/HCPCS,GENOTYPE DNA/RNA HEP C,,Fee Schedule,2586.69
Aetna,HMO,87903,CPT4/HCPCS,PHENOTYPE DNA HIV W/CULTURE,,Fee Schedule,4909.71
Aetna,HMO,87904,CPT4/HCPCS,PHENOTYPE DNA HIV W/CLT ADD,,Fee Schedule,261.91
Aetna,HMO,87905,CPT4/HCPCS,SIALIDASE ENZYME ASSAY,,Fee Schedule,122.80
Aetna,HMO,87906,CPT4/HCPCS,GENOTYPE DNA/RNA HIV,,Fee Schedule,1293.34
Aetna,HMO,87910,CPT4/HCPCS,GENOTYPE CYTOMEGALOVIRUS,,Fee Schedule,2526.72
Aetna,HMO,87912,CPT4/HCPCS,GENOTYPE DNA HEPATITIS B,,Fee Schedule,2526.72
Aetna,HMO,88000,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,1692.93
Aetna,HMO,88005,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,1977.02
Aetna,HMO,88007,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,2071.69
Aetna,HMO,88012,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,1692.93
Aetna,HMO,88014,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,1553.83
Aetna,HMO,88016,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,2163.50
Aetna,HMO,88020,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Fee Schedule,2918.16
Aetna,HMO,88025,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Fee Schedule,2823.49
Aetna,HMO,88027,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Fee Schedule,3012.91
Aetna,HMO,88028,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Fee Schedule,1692.93
Aetna,HMO,88029,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Fee Schedule,1692.93
Aetna,HMO,88036,CPT4/HCPCS,LIMITED AUTOPSY,,Fee Schedule,846.46
Aetna,HMO,88037,CPT4/HCPCS,LIMITED AUTOPSY,,Fee Schedule,751.71
Aetna,HMO,88040,CPT4/HCPCS,FORENSIC AUTOPSY (NECROPSY),,Fee Schedule,4705.76
Aetna,HMO,88045,CPT4/HCPCS,CORONERS AUTOPSY (NECROPSY),,Fee Schedule,470.56
Aetna,HMO,88104,CPT4/HCPCS,CYTOPATH FL NONGYN SMEARS,,Fee Schedule,327.34
Aetna,HMO,88106,CPT4/HCPCS,CYTOPATH FL NONGYN FILTER,,Fee Schedule,457.54
Aetna,HMO,88108,CPT4/HCPCS,CYTOPATH CONCENTRATE TECH,,Fee Schedule,419.07
Aetna,HMO,88112,CPT4/HCPCS,CYTOPATH CELL ENHANCE TECH,,Fee Schedule,401.26
Aetna,HMO,88120,CPT4/HCPCS,CYTP URNE 3-5 PROBES EA SPEC,,Fee Schedule,3515.40
Aetna,HMO,88121,CPT4/HCPCS,CYTP URINE 3-5 PROBES CMPTR,,Fee Schedule,2949.49
Aetna,HMO,88125,CPT4/HCPCS,FORENSIC CYTOPATHOLOGY,,Fee Schedule,75.76
Aetna,HMO,88130,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,Fee Schedule,151.20
Aetna,HMO,88140,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,Fee Schedule,80.30
Aetna,HMO,88141,CPT4/HCPCS,CYTOPATH C/V INTERPRET,,Fee Schedule,229.48
Aetna,HMO,88142,CPT4/HCPCS,CYTOPATH C/V THIN LAYER,,Fee Schedule,203.53
Aetna,HMO,88143,CPT4/HCPCS,CYTOPATH C/V THIN LAYER REDO,,Fee Schedule,152.71
Aetna,HMO,88147,CPT4/HCPCS,CYTOPATH C/V AUTOMATED,,Fee Schedule,114.40
Aetna,HMO,88148,CPT4/HCPCS,CYTOPATH C/V AUTO RESCREEN,,Fee Schedule,152.71
Aetna,HMO,88150,CPT4/HCPCS,CYTOPATH C/V MANUAL,,Fee Schedule,106.17
Aetna,HMO,88152,CPT4/HCPCS,CYTOPATH C/V AUTO REDO,,Fee Schedule,106.17
Aetna,HMO,88153,CPT4/HCPCS,CYTOPATH C/V REDO,,Fee Schedule,106.17
Aetna,HMO,88155,CPT4/HCPCS,CYTOPATH C/V INDEX ADD-ON,,Fee Schedule,60.22
Aetna,HMO,88160,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Fee Schedule,259.22
Aetna,HMO,88161,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Fee Schedule,265.18
Aetna,HMO,88162,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Fee Schedule,356.91
Aetna,HMO,88164,CPT4/HCPCS,CYTOPATH TBS C/V MANUAL,,Fee Schedule,106.17
Aetna,HMO,88165,CPT4/HCPCS,CYTOPATH TBS C/V REDO,,Fee Schedule,106.17
Aetna,HMO,88166,CPT4/HCPCS,CYTOPATH TBS C/V AUTO REDO,,Fee Schedule,106.17
Aetna,HMO,88167,CPT4/HCPCS,CYTOPATH TBS C/V SELECT,,Fee Schedule,106.17
Aetna,HMO,88172,CPT4/HCPCS,CYTP DX EVAL FNA 1ST EA SITE,,Fee Schedule,179.34
Aetna,HMO,88173,CPT4/HCPCS,CYTOPATH EVAL FNA REPORT,,Fee Schedule,602.53
Aetna,HMO,88174,CPT4/HCPCS,CYTOPATH C/V AUTO IN FLUID,,Fee Schedule,214.62
Aetna,HMO,88175,CPT4/HCPCS,CYTOPATH C/V AUTO FLUID REDO,,Fee Schedule,266.19
Aetna,HMO,88177,CPT4/HCPCS,CYTP FNA EVAL EA ADDL,,Fee Schedule,55.02
Aetna,HMO,88182,CPT4/HCPCS,CELL MARKER STUDY,,Fee Schedule,600.09
Aetna,HMO,88184,CPT4/HCPCS,FLOWCYTOMETRY/ TC 1 MARKER,,Fee Schedule,729.79
Aetna,HMO,88185,CPT4/HCPCS,FLOWCYTOMETRY/TC ADD-ON,,Fee Schedule,436.80
Aetna,HMO,88187,CPT4/HCPCS,FLOWCYTOMETRY/READ 2-8,,Fee Schedule,519.62
Aetna,HMO,88188,CPT4/HCPCS,FLOWCYTOMETRY/READ 9-15,,Fee Schedule,644.70
Aetna,HMO,88189,CPT4/HCPCS,FLOWCYTOMETRY/READ 16 & >,,Fee Schedule,787.33
Aetna,HMO,88230,CPT4/HCPCS,TISSUE CULTURE LYMPHOCYTE,,Fee Schedule,1170.54
Aetna,HMO,88233,CPT4/HCPCS,TISSUE CULTURE SKIN/BIOPSY,,Fee Schedule,1413.97
Aetna,HMO,88235,CPT4/HCPCS,TISSUE CULTURE PLACENTA,,Fee Schedule,1479.57
Aetna,HMO,88237,CPT4/HCPCS,TISSUE CULTURE BONE MARROW,,Fee Schedule,1269.07
Aetna,HMO,88239,CPT4/HCPCS,TISSUE CULTURE TUMOR,,Fee Schedule,1482.26
Aetna,HMO,88240,CPT4/HCPCS,CELL CRYOPRESERVE/STORAGE,,Fee Schedule,101.55
Aetna,HMO,88241,CPT4/HCPCS,FROZEN CELL PREPARATION,,Fee Schedule,101.55
Aetna,HMO,88245,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,Fee Schedule,1304.85
Aetna,HMO,88248,CPT4/HCPCS,CHROMOSOME ANALYSIS 50-100,,Fee Schedule,1740.06
Aetna,HMO,88249,CPT4/HCPCS,CHROMOSOME ANALYSIS 100,,Fee Schedule,1740.06
Aetna,HMO,88261,CPT4/HCPCS,CHROMOSOME ANALYSIS 5,,Fee Schedule,1775.76
Aetna,HMO,88262,CPT4/HCPCS,CHROMOSOME ANALYSIS 15-20,,Fee Schedule,1252.35
Aetna,HMO,88263,CPT4/HCPCS,CHROMOSOME ANALYSIS 45,,Fee Schedule,1043.86
Aetna,HMO,88264,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,Fee Schedule,1252.35
Aetna,HMO,88267,CPT4/HCPCS,CHROMOSOME ANALYS PLACENTA,,Fee Schedule,1806.25
Aetna,HMO,88269,CPT4/HCPCS,CHROMOSOME ANALYS AMNIOTIC,,Fee Schedule,1671.09
Aetna,HMO,88271,CPT4/HCPCS,CYTOGENETICS DNA PROBE,,Fee Schedule,215.20
Aetna,HMO,88272,CPT4/HCPCS,CYTOGENETICS 3-5,,Fee Schedule,268.96
Aetna,HMO,88273,CPT4/HCPCS,CYTOGENETICS 10-30,,Fee Schedule,322.81
Aetna,HMO,88274,CPT4/HCPCS,CYTOGENETICS 25-99,,Fee Schedule,349.77
Aetna,HMO,88275,CPT4/HCPCS,CYTOGENETICS 100-300,,Fee Schedule,403.45
Aetna,HMO,88280,CPT4/HCPCS,CHROMOSOME KARYOTYPE STUDY,,Fee Schedule,252.16
Aetna,HMO,88283,CPT4/HCPCS,CHROMOSOME BANDING STUDY,,Fee Schedule,86.85
Aetna,HMO,88285,CPT4/HCPCS,CHROMOSOME COUNT ADDITIONAL,,Fee Schedule,190.93
Aetna,HMO,88289,CPT4/HCPCS,CHROMOSOME STUDY ADDITIONAL,,Fee Schedule,130.53
Aetna,HMO,88291,CPT4/HCPCS,CYTO/MOLECULAR REPORT,,Fee Schedule,228.06
Aetna,HMO,88300,CPT4/HCPCS,SURGICAL PATH GROSS,,Fee Schedule,194.12
Aetna,HMO,88302,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Fee Schedule,407.23
Aetna,HMO,88304,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Fee Schedule,448.64
Aetna,HMO,88305,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Fee Schedule,605.47
Aetna,HMO,88307,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Fee Schedule,1277.38
Aetna,HMO,88309,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Fee Schedule,1772.14
Aetna,HMO,88311,CPT4/HCPCS,DECALCIFY TISSUE,,Fee Schedule,57.96
Aetna,HMO,88312,CPT4/HCPCS,SPECIAL STAINS GROUP 1,,Fee Schedule,700.22
Aetna,HMO,88313,CPT4/HCPCS,SPECIAL STAINS GROUP 2,,Fee Schedule,575.90
Aetna,HMO,88314,CPT4/HCPCS,HISTOCHEMICAL STAINS ADD-ON,,Fee Schedule,587.74
Aetna,HMO,88319,CPT4/HCPCS,ENZYME HISTOCHEMISTRY,,Fee Schedule,1043.53
Aetna,HMO,88321,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Fee Schedule,623.70
Aetna,HMO,88323,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Fee Schedule,510.80
Aetna,HMO,88325,CPT4/HCPCS,COMPREHENSIVE REVIEW OF DATA,,Fee Schedule,988.51
Aetna,HMO,88329,CPT4/HCPCS,PATH CONSULT INTROP,,Fee Schedule,264.68
Aetna,HMO,88331,CPT4/HCPCS,PATH CONSULT INTRAOP 1 BLOC,,Fee Schedule,277.03
Aetna,HMO,88332,CPT4/HCPCS,PATH CONSULT INTRAOP ADDL,,Fee Schedule,96.43
Aetna,HMO,88333,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 1,,Fee Schedule,303.66
Aetna,HMO,88334,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 2,,Fee Schedule,191.18
Aetna,HMO,88341,CPT4/HCPCS,IMMUNOHISTO ANTB ADDL SLIDE,,Fee Schedule,378.75
Aetna,HMO,88342,CPT4/HCPCS,IMMUNOHISTO ANTB 1ST STAIN,,Fee Schedule,546.33
Aetna,HMO,88344,CPT4/HCPCS,IMMUNOHISTO ANTIBODY SLIDE,,Fee Schedule,636.55
Aetna,HMO,88346,CPT4/HCPCS,IMMUNOFLUOR ANTB 1ST STAIN,,Fee Schedule,528.52
Aetna,HMO,88348,CPT4/HCPCS,ELECTRON MICROSCOPY,,Fee Schedule,5285.11
Aetna,HMO,88350,CPT4/HCPCS,IMMUNOFLUOR ANTB ADDL STAIN,,Fee Schedule,362.12
Aetna,HMO,88355,CPT4/HCPCS,ANALYSIS SKELETAL MUSCLE,,Fee Schedule,1132.32
Aetna,HMO,88356,CPT4/HCPCS,ANALYSIS NERVE,,Fee Schedule,1318.12
Aetna,HMO,88358,CPT4/HCPCS,ANALYSIS TUMOR,,Fee Schedule,282.91
Aetna,HMO,88360,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/MANUAL,,Fee Schedule,617.31
Aetna,HMO,88361,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/COMPUT,,Fee Schedule,833.36
Aetna,HMO,88362,CPT4/HCPCS,NERVE TEASING PREPARATIONS,,Fee Schedule,1522.33
Aetna,HMO,88363,CPT4/HCPCS,XM ARCHIVE TISSUE MOLEC ANAL,,Fee Schedule,128.10
Aetna,HMO,88364,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Fee Schedule,580.27
Aetna,HMO,88365,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Fee Schedule,942.90
Aetna,HMO,88366,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Fee Schedule,716.60
Aetna,HMO,88367,CPT4/HCPCS,INSITU HYBRIDIZATION AUTO,,Fee Schedule,1700.58
Aetna,HMO,88368,CPT4/HCPCS,INSITU HYBRIDIZATION MANUAL,,Fee Schedule,1372.05
Aetna,HMO,88369,CPT4/HCPCS,M/PHMTRC ALYSISHQUANT/SEMIQ,,Fee Schedule,402.44
Aetna,HMO,88371,CPT4/HCPCS,PROTEIN WESTERN BLOT TISSUE,,Fee Schedule,223.27
Aetna,HMO,88372,CPT4/HCPCS,PROTEIN ANALYSIS W/PROBE,,Fee Schedule,228.56
Aetna,HMO,88373,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Fee Schedule,325.41
Aetna,HMO,88374,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Fee Schedule,1321.23
Aetna,HMO,88375,CPT4/HCPCS,OPTICAL ENDOMICROSCPY INTERP,,Fee Schedule,338.68
Aetna,HMO,88377,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Fee Schedule,1229.34
Aetna,HMO,88380,CPT4/HCPCS,MICRODISSECTION LASER,,Fee Schedule,892.58
Aetna,HMO,88381,CPT4/HCPCS,MICRODISSECTION MANUAL,,Fee Schedule,1138.28
Aetna,HMO,88387,CPT4/HCPCS,TISS EXAM MOLECULAR STUDY,,Fee Schedule,75.76
Aetna,HMO,88388,CPT4/HCPCS,TISS EX MOLECUL STUDY ADD-ON,,Fee Schedule,37.29
Aetna,HMO,88720,CPT4/HCPCS,BILIRUBIN TOTAL TRANSCUT,,Fee Schedule,50.40
Aetna,HMO,88738,CPT4/HCPCS,HGB QUANT TRANSCUTANEOUS,,Fee Schedule,50.40
Aetna,HMO,88740,CPT4/HCPCS,TRANSCUTANEOUS CARBOXYHB,,Fee Schedule,50.40
Aetna,HMO,88741,CPT4/HCPCS,TRANSCUTANEOUS METHB,,Fee Schedule,50.40
Aetna,HMO,89049,CPT4/HCPCS,CHCT FOR MAL HYPERTHERMIA,,Fee Schedule,503.58
Aetna,HMO,89050,CPT4/HCPCS,BODY FLUID CELL COUNT,,Fee Schedule,47.46
Aetna,HMO,89051,CPT4/HCPCS,BODY FLUID CELL COUNT,,Fee Schedule,55.35
Aetna,HMO,89055,CPT4/HCPCS,LEUKOCYTE ASSESSMENT FECAL,,Fee Schedule,42.92
Aetna,HMO,89060,CPT4/HCPCS,EXAM SYNOVIAL FLUID CRYSTALS,,Fee Schedule,71.82
Aetna,HMO,89125,CPT4/HCPCS,SPECIMEN FAT STAIN,,Fee Schedule,43.42
Aetna,HMO,89160,CPT4/HCPCS,EXAM FECES FOR MEAT FIBERS,,Fee Schedule,37.04
Aetna,HMO,89190,CPT4/HCPCS,NASAL SMEAR FOR EOSINOPHILS,,Fee Schedule,47.71
Aetna,HMO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Fee Schedule,137.92
Aetna,HMO,89230,CPT4/HCPCS,COLLECT SWEAT FOR TEST,,Fee Schedule,25.45
Aetna,HMO,89250,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Fee Schedule,8544.39
Aetna,HMO,89251,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Fee Schedule,8887.70
Aetna,HMO,89253,CPT4/HCPCS,EMBRYO HATCHING,,Fee Schedule,3047.68
Aetna,HMO,89254,CPT4/HCPCS,OOCYTE IDENTIFICATION,,Fee Schedule,2430.96
Aetna,HMO,89255,CPT4/HCPCS,PREPARE EMBRYO FOR TRANSFER,,Fee Schedule,1713.51
Aetna,HMO,89257,CPT4/HCPCS,SPERM IDENTIFICATION,,Fee Schedule,2675.40
Aetna,HMO,89258,CPT4/HCPCS,CRYOPRESERVATION EMBRYO(S),,Fee Schedule,2610.72
Aetna,HMO,89259,CPT4/HCPCS,CRYOPRESERVATION SPERM,,Fee Schedule,942.48
Aetna,HMO,89260,CPT4/HCPCS,SPERM ISOLATION SIMPLE,,Fee Schedule,1064.44
Aetna,HMO,89261,CPT4/HCPCS,SPERM ISOLATION COMPLEX,,Fee Schedule,684.76
Aetna,HMO,89264,CPT4/HCPCS,IDENTIFY SPERM TISSUE,,Fee Schedule,2790.22
Aetna,HMO,89268,CPT4/HCPCS,INSEMINATION OF OOCYTES,,Fee Schedule,2826.09
Aetna,HMO,89272,CPT4/HCPCS,EXTENDED CULTURE OF OOCYTES,,Fee Schedule,3785.62
Aetna,HMO,89280,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,Fee Schedule,5329.96
Aetna,HMO,89281,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,Fee Schedule,6823.23
Aetna,HMO,89290,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,Fee Schedule,8793.62
Aetna,HMO,89291,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,Fee Schedule,7560.00
Aetna,HMO,89300,CPT4/HCPCS,SEMEN ANALYSIS W/HUHNER,,Fee Schedule,89.62
Aetna,HMO,89310,CPT4/HCPCS,SEMEN ANALYSIS W/COUNT,,Fee Schedule,86.43
Aetna,HMO,89320,CPT4/HCPCS,SEMEN ANAL VOL/COUNT/MOT,,Fee Schedule,121.12
Aetna,HMO,89321,CPT4/HCPCS,SEMEN ANAL SPERM DETECTION,,Fee Schedule,121.12
Aetna,HMO,89322,CPT4/HCPCS,SEMEN ANAL STRICT CRITERIA,,Fee Schedule,155.82
Aetna,HMO,89325,CPT4/HCPCS,SPERM ANTIBODY TEST,,Fee Schedule,107.26
Aetna,HMO,89329,CPT4/HCPCS,SPERM EVALUATION TEST,,Fee Schedule,210.67
Aetna,HMO,89330,CPT4/HCPCS,EVALUATION CERVICAL MUCUS,,Fee Schedule,99.45
Aetna,HMO,89331,CPT4/HCPCS,RETROGRADE EJACULATION ANAL,,Fee Schedule,196.81
Aetna,HMO,89335,CPT4/HCPCS,CRYOPRESERVE TESTICULAR TISS,,Fee Schedule,1362.73
Aetna,HMO,89337,CPT4/HCPCS,CRYOPRESERVATION OOCYTE(S),,Fee Schedule,3465.00
Aetna,HMO,89342,CPT4/HCPCS,STORAGE/YEAR EMBRYO(S),,Fee Schedule,699.72
Aetna,HMO,89343,CPT4/HCPCS,STORAGE/YEAR SPERM/SEMEN,,Fee Schedule,352.80
Aetna,HMO,89344,CPT4/HCPCS,STORAGE/YEAR REPROD TISSUE,,Fee Schedule,872.50
Aetna,HMO,89346,CPT4/HCPCS,STORAGE/YEAR OOCYTE(S),,Fee Schedule,1814.40
Aetna,HMO,89352,CPT4/HCPCS,THAWING CRYOPRESRVED EMBRYO,,Fee Schedule,168.00
Aetna,HMO,89353,CPT4/HCPCS,THAWING CRYOPRESRVED SPERM,,Fee Schedule,62.24
Aetna,HMO,89354,CPT4/HCPCS,THAW CRYOPRSVRD REPROD TISS,,Fee Schedule,62.24
Aetna,HMO,89356,CPT4/HCPCS,THAWING CRYOPRESRVED OOCYTE,,Fee Schedule,55.44
Aetna,HMO,91010,CPT4/HCPCS,ESOPHAGUS MOTILITY STUDY,,Grouper Rate,2002.00
Aetna,HMO,91020,CPT4/HCPCS,GASTRIC MOTILITY STUDIES,,Grouper Rate,2002.00
Aetna,HMO,91022,CPT4/HCPCS,DUODENAL MOTILITY STUDY,,Grouper Rate,2002.00
Aetna,HMO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Fee Schedule,635.37
Aetna,HMO,92508,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Fee Schedule,212.94
Aetna,HMO,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,Grouper Rate,2002.00
Aetna,HMO,92521,CPT4/HCPCS,EVALUATION OF SPEECH FLUENCY,,Fee Schedule,868.05
Aetna,HMO,92522,CPT4/HCPCS,EVALUATE SPEECH PRODUCTION,,Fee Schedule,702.74
Aetna,HMO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,Fee Schedule,1462.35
Aetna,HMO,92524,CPT4/HCPCS,BEHAVRAL QUALIT ANALYS VOICE,,Fee Schedule,764.98
Aetna,HMO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Case Rate,8792.00
Aetna,HMO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Case Rate,8792.00
Aetna,HMO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Case Rate,8792.00
Aetna,HMO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Case Rate,8792.00
Aetna,HMO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Case Rate,8792.00
Aetna,HMO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Case Rate,8792.00
Aetna,HMO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Case Rate,8792.00
Aetna,HMO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Case Rate,8792.00
Aetna,HMO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Case Rate,8792.00
Aetna,HMO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Case Rate,8792.00
Aetna,HMO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Case Rate,8792.00
Aetna,HMO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Case Rate,8792.00
Aetna,HMO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Case Rate,8792.00
Aetna,HMO,93000,CPT4/HCPCS,ELECTROCARDIOGRAM COMPLETE,,Fee Schedule,165.56
Aetna,HMO,93005,CPT4/HCPCS,ELECTROCARDIOGRAM TRACING,,Fee Schedule,95.67
Aetna,HMO,93010,CPT4/HCPCS,ELECTROCARDIOGRAM REPORT,,Fee Schedule,69.88
Aetna,HMO,93015,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Fee Schedule,786.57
Aetna,HMO,93016,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Fee Schedule,184.54
Aetna,HMO,93017,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Fee Schedule,480.39
Aetna,HMO,93018,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Fee Schedule,121.63
Aetna,HMO,93024,CPT4/HCPCS,CARDIAC DRUG STRESS TEST,,Fee Schedule,504.67
Aetna,HMO,93025,CPT4/HCPCS,MICROVOLT T-WAVE ASSESS,,Fee Schedule,1371.04
Aetna,HMO,93040,CPT4/HCPCS,RHYTHM ECG WITH REPORT,,Fee Schedule,108.94
Aetna,HMO,93041,CPT4/HCPCS,RHYTHM ECG TRACING,,Fee Schedule,50.23
Aetna,HMO,93042,CPT4/HCPCS,RHYTHM ECG REPORT,,Fee Schedule,58.63
Aetna,HMO,93050,CPT4/HCPCS,ART PRESSURE WAVEFORM ANALYS,,Fee Schedule,75.26
Aetna,HMO,93224,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Fee Schedule,905.94
Aetna,HMO,93225,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Fee Schedule,277.45
Aetna,HMO,93226,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Fee Schedule,410.76
Aetna,HMO,93227,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Fee Schedule,217.72
Aetna,HMO,93228,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,Fee Schedule,203.11
Aetna,HMO,93229,CPT4/HCPCS,REMOTE 30 DAY ECG TECH SUPP,,Fee Schedule,6072.44
Aetna,HMO,93260,CPT4/HCPCS,PRGRMG DEV EVAL IMPLTBL SYS,,Fee Schedule,190.42
Aetna,HMO,93261,CPT4/HCPCS,INTERROGATE SUBQ DEFIB,,Fee Schedule,190.42
Aetna,HMO,93264,CPT4/HCPCS,REM MNTR WRLS P-ART PRS SNR,,Fee Schedule,285.68
Aetna,HMO,93268,CPT4/HCPCS,ECG RECORD/REVIEW,,Fee Schedule,2208.52
Aetna,HMO,93270,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,Fee Schedule,135.07
Aetna,HMO,93271,CPT4/HCPCS,ECG/MONITORING AND ANALYSIS,,Fee Schedule,1867.82
Aetna,HMO,93272,CPT4/HCPCS,ECG/REVIEW INTERPRET ONLY,,Fee Schedule,205.63
Aetna,HMO,93278,CPT4/HCPCS,ECG/SIGNAL-AVERAGED,,Fee Schedule,198.66
Aetna,HMO,93279,CPT4/HCPCS,PRGRMG DEV EVAL PM/LDLS PM,,Fee Schedule,162.37
Aetna,HMO,93280,CPT4/HCPCS,PM DEVICE PROGR EVAL DUAL,,Fee Schedule,189.58
Aetna,HMO,93281,CPT4/HCPCS,PM DEVICE PROGR EVAL MULTI,,Fee Schedule,219.91
Aetna,HMO,93282,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,Fee Schedule,195.63
Aetna,HMO,93283,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,Fee Schedule,225.96
Aetna,HMO,93284,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,Fee Schedule,256.28
Aetna,HMO,93285,CPT4/HCPCS,PRGRMG DEV EVAL SCRMS IP,,Fee Schedule,150.19
Aetna,HMO,93286,CPT4/HCPCS,PERI-PX EVAL PM/LDLS PM IP,,Fee Schedule,104.74
Aetna,HMO,93287,CPT4/HCPCS,PERI-PX DEVICE EVAL & PRGR,,Fee Schedule,113.90
Aetna,HMO,93288,CPT4/HCPCS,INTERROG EVL PM/LDLS PM IP,,Fee Schedule,153.21
Aetna,HMO,93289,CPT4/HCPCS,INTERROG DEVICE EVAL HEART,,Fee Schedule,189.58
Aetna,HMO,93290,CPT4/HCPCS,INTERROG DEV EVAL ICPMS IP,,Fee Schedule,86.60
Aetna,HMO,93291,CPT4/HCPCS,INTERROG DEV EVAL SCRMS IP,,Fee Schedule,138.09
Aetna,HMO,93292,CPT4/HCPCS,WCD DEVICE INTERROGATE,,Fee Schedule,104.74
Aetna,HMO,93293,CPT4/HCPCS,PM PHONE R-STRIP DEVICE EVAL,,Fee Schedule,356.24
Aetna,HMO,93294,CPT4/HCPCS,REM INTERROG EVL PM/LDLS PM,,Fee Schedule,274.84
Aetna,HMO,93295,CPT4/HCPCS,DEV INTERROG REMOTE 1/2/MLT,,Fee Schedule,541.04
Aetna,HMO,93296,CPT4/HCPCS,REM INTERROG EVL PM/IDS,,Fee Schedule,289.54
Aetna,HMO,93297,CPT4/HCPCS,REM INTERROG DEV EVAL ICPMS,,Fee Schedule,203.11
Aetna,HMO,93298,CPT4/HCPCS,REM INTERROG DEV EVAL SCRMS,,Fee Schedule,221.34
Aetna,HMO,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,Fee Schedule,1283.18
Aetna,HMO,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,Fee Schedule,856.04
Aetna,HMO,93306,CPT4/HCPCS,TTE W/DOPPLER COMPLETE,,Fee Schedule,1471.00
Aetna,HMO,93307,CPT4/HCPCS,TTE W/O DOPPLER COMPLETE,,Fee Schedule,895.44
Aetna,HMO,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,Fee Schedule,695.52
Aetna,HMO,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,1901.67
Aetna,HMO,93313,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,318.19
Aetna,HMO,93314,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,1980.46
Aetna,HMO,93315,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,5012.19
Aetna,HMO,93316,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,348.51
Aetna,HMO,93317,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,827.82
Aetna,HMO,93318,CPT4/HCPCS,ECHO TRANSESOPHAGEAL INTRAOP,,Fee Schedule,5012.19
Aetna,HMO,93320,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Fee Schedule,383.46
Aetna,HMO,93321,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Fee Schedule,189.58
Aetna,HMO,93325,CPT4/HCPCS,DOPPLER COLOR FLOW ADD-ON,,Fee Schedule,283.50
Aetna,HMO,93350,CPT4/HCPCS,STRESS TTE ONLY,,Fee Schedule,1195.32
Aetna,HMO,93351,CPT4/HCPCS,STRESS TTE COMPLETE,,Fee Schedule,1386.75
Aetna,HMO,93352,CPT4/HCPCS,ADMIN ECG CONTRAST AGENT,,Fee Schedule,314.32
Aetna,HMO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Grouper Rate,2002.00
Aetna,HMO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Grouper Rate,7830.00
Aetna,HMO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Grouper Rate,7830.00
Aetna,HMO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Grouper Rate,7830.00
Aetna,HMO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Grouper Rate,7830.00
Aetna,HMO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Grouper Rate,7830.00
Aetna,HMO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Grouper Rate,7830.00
Aetna,HMO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Grouper Rate,7830.00
Aetna,HMO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Grouper Rate,7830.00
Aetna,HMO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,7830.00
Aetna,HMO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,7830.00
Aetna,HMO,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Grouper Rate,2002.00
Aetna,HMO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Grouper Rate,2002.00
Aetna,HMO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Grouper Rate,2002.00
Aetna,HMO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Grouper Rate,7830.00
Aetna,HMO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,7830.00
Aetna,HMO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,7830.00
Aetna,HMO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,7830.00
Aetna,HMO,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Grouper Rate,8797.00
Aetna,HMO,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Grouper Rate,8797.00
Aetna,HMO,93582,CPT4/HCPCS,PERQ TRANSCATH CLOSURE PDA,,Grouper Rate,8797.00
Aetna,HMO,93583,CPT4/HCPCS,PERQ TRANSCATH SEPTAL REDUXN,,Grouper Rate,8797.00
Aetna,HMO,93590,CPT4/HCPCS,PERQ TRANSCATH CLS MITRAL,,Grouper Rate,8797.00
Aetna,HMO,93591,CPT4/HCPCS,PERQ TRANSCATH CLS AORTIC,,Grouper Rate,8797.00
Aetna,HMO,93592,CPT4/HCPCS,PERQ TRANSCATH CLOSURE EACH,,Grouper Rate,2002.00
Aetna,HMO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Grouper Rate,7830.00
Aetna,HMO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Grouper Rate,7830.00
Aetna,HMO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Grouper Rate,7830.00
Aetna,HMO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,HMO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,HMO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,HMO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,HMO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Grouper Rate,7830.00
Aetna,HMO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,HMO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,HMO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,7830.00
Aetna,HMO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Grouper Rate,7830.00
Aetna,HMO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Grouper Rate,7830.00
Aetna,HMO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Grouper Rate,2002.00
Aetna,HMO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Grouper Rate,7830.00
Aetna,HMO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Grouper Rate,2002.00
Aetna,HMO,93880,CPT4/HCPCS,EXTRACRANIAL BILAT STUDY,,Fee Schedule,1364.91
Aetna,HMO,93882,CPT4/HCPCS,EXTRACRANIAL UNI/LTD STUDY,,Fee Schedule,1361.89
Aetna,HMO,93886,CPT4/HCPCS,INTRACRANIAL COMPLETE STUDY,,Fee Schedule,1364.91
Aetna,HMO,93888,CPT4/HCPCS,INTRACRANIAL LIMITED STUDY,,Fee Schedule,554.31
Aetna,HMO,93890,CPT4/HCPCS,TCD VASOREACTIVITY STUDY,,Fee Schedule,857.30
Aetna,HMO,93892,CPT4/HCPCS,TCD EMBOLI DETECT W/O INJ,,Fee Schedule,857.30
Aetna,HMO,93893,CPT4/HCPCS,TCD EMBOLI DETECT W/INJ,,Fee Schedule,857.30
Aetna,HMO,93895,CPT4/HCPCS,CAROTID INTIMA ATHEROMA EVAL,,Fee Schedule,627.14
Aetna,HMO,93922,CPT4/HCPCS,UPR/L XTREMITY ART 2 LEVELS,,Fee Schedule,874.18
Aetna,HMO,93923,CPT4/HCPCS,UPR/LXTR ART STDY 3+ LVLS,,Fee Schedule,1319.55
Aetna,HMO,93924,CPT4/HCPCS,LWR XTR VASC STDY BILAT,,Fee Schedule,1676.97
Aetna,HMO,93925,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Fee Schedule,1363.74
Aetna,HMO,93926,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Fee Schedule,859.06
Aetna,HMO,93930,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Fee Schedule,1364.91
Aetna,HMO,93931,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Fee Schedule,859.06
Aetna,HMO,93970,CPT4/HCPCS,EXTREMITY STUDY,,Fee Schedule,1364.91
Aetna,HMO,93971,CPT4/HCPCS,EXTREMITY STUDY,,Fee Schedule,859.06
Aetna,HMO,93975,CPT4/HCPCS,VASCULAR STUDY,,Fee Schedule,1363.74
Aetna,HMO,93976,CPT4/HCPCS,VASCULAR STUDY,,Fee Schedule,1361.89
Aetna,HMO,93978,CPT4/HCPCS,VASCULAR STUDY,,Fee Schedule,1364.91
Aetna,HMO,93979,CPT4/HCPCS,VASCULAR STUDY,,Fee Schedule,859.06
Aetna,HMO,93980,CPT4/HCPCS,PENILE VASCULAR STUDY,,Fee Schedule,1007.49
Aetna,HMO,93981,CPT4/HCPCS,PENILE VASCULAR STUDY,,Fee Schedule,877.21
Aetna,HMO,93990,CPT4/HCPCS,DOPPLER FLOW TESTING,,Fee Schedule,857.30
Aetna,HMO,93998,CPT4/HCPCS,NONINVAS VASC DX STUDY PROC,,Fee Schedule,817.57
Aetna,HMO,95782,CPT4/HCPCS,POLYSOM <6 YRS 4/> PARAMTRS,,Fee Schedule,7714.30
Aetna,HMO,95783,CPT4/HCPCS,POLYSOM <6 YRS CPAP/BILVL,,Fee Schedule,8205.28
Aetna,HMO,95800,CPT4/HCPCS,SLP STDY UNATTENDED,,Fee Schedule,1313.42
Aetna,HMO,95801,CPT4/HCPCS,SLP STDY UNATND W/ANAL,,Fee Schedule,404.71
Aetna,HMO,95805,CPT4/HCPCS,MULTIPLE SLEEP LATENCY TEST,,Fee Schedule,3103.04
Aetna,HMO,95806,CPT4/HCPCS,SLEEP STUDY UNATT&RESP EFFT,,Fee Schedule,1059.57
Aetna,HMO,95807,CPT4/HCPCS,SLEEP STUDY ATTENDED,,Fee Schedule,3613.68
Aetna,HMO,95808,CPT4/HCPCS,POLYSOM ANY AGE 1-3> PARAM,,Fee Schedule,4976.83
Aetna,HMO,95810,CPT4/HCPCS,POLYSOM 6/> YRS 4/> PARAM,,Fee Schedule,5057.38
Aetna,HMO,95811,CPT4/HCPCS,POLYSOM 6/>YRS CPAP 4/> PARM,,Fee Schedule,5495.36
Aetna,HMO,96377,CPT4/HCPCS,APPLICATON ON-BODY INJECTOR,,Grouper Rate,2002.00
Aetna,HMO,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,Fee Schedule,692.16
Aetna,HMO,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,Fee Schedule,330.03
Aetna,HMO,96405,CPT4/HCPCS,CHEMO INTRALESIONAL UP TO 7,,Fee Schedule,264.85
Aetna,HMO,96406,CPT4/HCPCS,CHEMO INTRALESIONAL OVER 7,,Fee Schedule,382.03
Aetna,HMO,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,Fee Schedule,1079.65
Aetna,HMO,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,Fee Schedule,601.35
Aetna,HMO,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,Fee Schedule,1405.15
Aetna,HMO,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,Fee Schedule,293.66
Aetna,HMO,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,Fee Schedule,1551.48
Aetna,HMO,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,Fee Schedule,690.22
Aetna,HMO,96420,CPT4/HCPCS,CHEMO IA PUSH TECNIQUE,,Fee Schedule,1042.69
Aetna,HMO,96422,CPT4/HCPCS,CHEMO IA INFUSION UP TO 1 HR,,Fee Schedule,1687.64
Aetna,HMO,96423,CPT4/HCPCS,CHEMO IA INFUSE EACH ADDL HR,,Fee Schedule,763.56
Aetna,HMO,96425,CPT4/HCPCS,CHEMOTHERAPY INFUSION METHOD,,Fee Schedule,1727.96
Aetna,HMO,96440,CPT4/HCPCS,CHEMOTHERAPY INTRACAVITARY,,Fee Schedule,1252.94
Aetna,HMO,96446,CPT4/HCPCS,CHEMOTX ADMN PRTL CAVITY,,Fee Schedule,180.76
Aetna,HMO,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,Fee Schedule,743.65
Aetna,HMO,96521,CPT4/HCPCS,REFILL/MAINT PORTABLE PUMP,,Fee Schedule,1279.57
Aetna,HMO,96522,CPT4/HCPCS,REFILL/MAINT PUMP/RESVR SYST,,Fee Schedule,1064.61
Aetna,HMO,96523,CPT4/HCPCS,IRRIG DRUG DELIVERY DEVICE,,Fee Schedule,244.77
Aetna,HMO,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,Fee Schedule,384.46
Aetna,HMO,96574,CPT4/HCPCS,DBRDMT PRMLG LES W/PDT,,Grouper Rate,2002.00
Aetna,HMO,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,Grouper Rate,2002.00
Aetna,HMO,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,Grouper Rate,2002.00
Aetna,HMO,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,Grouper Rate,2002.00
Aetna,HMO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Fee Schedule,33.26
Aetna,HMO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Fee Schedule,92.56
Aetna,HMO,97014,CPT4/HCPCS,ELECTRIC STIMULATION THERAPY,,Fee Schedule,90.38
Aetna,HMO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Fee Schedule,108.44
Aetna,HMO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Fee Schedule,60.39
Aetna,HMO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Fee Schedule,129.19
Aetna,HMO,97024,CPT4/HCPCS,DIATHERMY EG MICROWAVE,,Fee Schedule,37.80
Aetna,HMO,97026,CPT4/HCPCS,INFRARED THERAPY,,Fee Schedule,33.26
Aetna,HMO,97028,CPT4/HCPCS,ULTRAVIOLET THERAPY,,Fee Schedule,41.66
Aetna,HMO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Fee Schedule,108.36
Aetna,HMO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Fee Schedule,178.16
Aetna,HMO,97034,CPT4/HCPCS,CONTRAST BATH THERAPY,,Fee Schedule,100.63
Aetna,HMO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Fee Schedule,71.23
Aetna,HMO,97036,CPT4/HCPCS,HYDROTHERAPY,,Fee Schedule,184.29
Aetna,HMO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Fee Schedule,180.85
Aetna,HMO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Fee Schedule,189.92
Aetna,HMO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Fee Schedule,242.34
Aetna,HMO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Fee Schedule,159.93
Aetna,HMO,97124,CPT4/HCPCS,MASSAGE THERAPY,,Fee Schedule,148.00
Aetna,HMO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Fee Schedule,170.18
Aetna,HMO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Fee Schedule,116.76
Aetna,HMO,97151,CPT4/HCPCS,BHV ID ASSMT BY PHYS/QHP,,Fee Schedule,206.64
Aetna,HMO,97152,CPT4/HCPCS,BHV ID SUPRT ASSMT BY 1 TECH,,Fee Schedule,153.21
Aetna,HMO,97153,CPT4/HCPCS,ADAPTIVE BEHAVIOR TX BY TECH,,Fee Schedule,153.21
Aetna,HMO,97154,CPT4/HCPCS,GRP ADAPT BHV TX BY TECH,,Fee Schedule,153.21
Aetna,HMO,97155,CPT4/HCPCS,ADAPT BEHAVIOR TX PHYS/QHP,,Fee Schedule,206.64
Aetna,HMO,97156,CPT4/HCPCS,FAM ADAPT BHV TX GDN PHY/QHP,,Fee Schedule,206.64
Aetna,HMO,97157,CPT4/HCPCS,MULT FAM ADAPT BHV TX GDN,,Fee Schedule,206.64
Aetna,HMO,97158,CPT4/HCPCS,GRP ADAPT BHV TX BY PHY/QHP,,Fee Schedule,206.64
Aetna,HMO,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,Fee Schedule,490.98
Aetna,HMO,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,Fee Schedule,490.98
Aetna,HMO,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,Fee Schedule,490.98
Aetna,HMO,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,Fee Schedule,332.05
Aetna,HMO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,Fee Schedule,564.22
Aetna,HMO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,Fee Schedule,564.22
Aetna,HMO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,Fee Schedule,564.22
Aetna,HMO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,Fee Schedule,376.32
Aetna,HMO,97169,CPT4/HCPCS,ATHLETIC TRN EVAL LOW CMPLX,,Fee Schedule,336.75
Aetna,HMO,97170,CPT4/HCPCS,ATHLETIC TRN EVAL MOD CMPLX,,Fee Schedule,336.75
Aetna,HMO,97171,CPT4/HCPCS,ATHLETIC TRN EVAL HIGH CMPLX,,Fee Schedule,336.75
Aetna,HMO,97172,CPT4/HCPCS,ATHLETIC TRN RE-EVAL PLAN CR,,Fee Schedule,168.25
Aetna,HMO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Fee Schedule,199.33
Aetna,HMO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Fee Schedule,167.66
Aetna,HMO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Fee Schedule,198.99
Aetna,HMO,97537,CPT4/HCPCS,COMMUNITY/WORK REINTEGRATION,,Fee Schedule,171.78
Aetna,HMO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Fee Schedule,174.04
Aetna,HMO,97545,CPT4/HCPCS,WORK HARDENING,,Fee Schedule,784.56
Aetna,HMO,97546,CPT4/HCPCS,WORK HARDENING ADD-ON,,Fee Schedule,312.98
Aetna,HMO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Grouper Rate,2002.00
Aetna,HMO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Grouper Rate,2002.00
Aetna,HMO,A4642,CPT4/HCPCS,In111 satumomab,,Fee Schedule,11678.10
Aetna,HMO,A9500,CPT4/HCPCS,Tc99m sestamibi,,Fee Schedule,893.08
Aetna,HMO,A9501,CPT4/HCPCS,Technetium TC-99m teboroxime,,Fee Schedule,1003.12
Aetna,HMO,A9502,CPT4/HCPCS,Tc99m tetrofosmin,,Fee Schedule,815.38
Aetna,HMO,A9503,CPT4/HCPCS,Tc99m medronate,,Fee Schedule,108.78
Aetna,HMO,A9504,CPT4/HCPCS,Tc99m apcitide,,Fee Schedule,3486.00
Aetna,HMO,A9505,CPT4/HCPCS,TL201 thallium,,Fee Schedule,1275.12
Aetna,HMO,A9507,CPT4/HCPCS,In111 capromab,,Fee Schedule,36778.72
Aetna,HMO,A9508,CPT4/HCPCS,I131 iodobenguate, dx,,Fee Schedule,6183.91
Aetna,HMO,A9509,CPT4/HCPCS,Iodine I-123 sod iodide mil,,Fee Schedule,15130.66
Aetna,HMO,A9510,CPT4/HCPCS,Tc99m disofenin,,Fee Schedule,585.64
Aetna,HMO,A9512,CPT4/HCPCS,Tc99m pertechnetate,,Fee Schedule,58.80
Aetna,HMO,A9516,CPT4/HCPCS,Iodine I-123 sod iodide mic,,Fee Schedule,1513.09
Aetna,HMO,A9520,CPT4/HCPCS,Tc99 tilmanocept diag 0.5mci,,Fee Schedule,3930.52
Aetna,HMO,A9521,CPT4/HCPCS,Tc99m exametazime,,Fee Schedule,12181.17
Aetna,HMO,A9524,CPT4/HCPCS,I131 serum albumin, dx,,Fee Schedule,662.34
Aetna,HMO,A9526,CPT4/HCPCS,Nitrogen N-13 ammonia,,Fee Schedule,5019.84
Aetna,HMO,A9528,CPT4/HCPCS,Iodine I-131 iodide cap, dx,,Fee Schedule,454.86
Aetna,HMO,A9529,CPT4/HCPCS,I131 iodide sol, dx,,Fee Schedule,7.56
Aetna,HMO,A9531,CPT4/HCPCS,I131 max 100uCi,,Fee Schedule,40.99
Aetna,HMO,A9532,CPT4/HCPCS,I125 serum albumin, dx,,Fee Schedule,183.03
Aetna,HMO,A9536,CPT4/HCPCS,Tc99m depreotide,,Fee Schedule,9760.80
Aetna,HMO,A9537,CPT4/HCPCS,Tc99m mebrofenin,,Fee Schedule,462.84
Aetna,HMO,A9538,CPT4/HCPCS,Tc99m pyrophosphate,,Fee Schedule,418.32
Aetna,HMO,A9539,CPT4/HCPCS,Tc99m pentetate,,Fee Schedule,262.16
Aetna,HMO,A9540,CPT4/HCPCS,Tc99m MAA,,Fee Schedule,250.99
Aetna,HMO,A9541,CPT4/HCPCS,Tc99m sulfur colloid,,Fee Schedule,447.38
Aetna,HMO,A9542,CPT4/HCPCS,In111 ibritumomab, dx,,Fee Schedule,29282.40
Aetna,HMO,A9546,CPT4/HCPCS,Co57/58,,Fee Schedule,205.80
Aetna,HMO,A9547,CPT4/HCPCS,In111 oxyquinoline,,Fee Schedule,14960.14
Aetna,HMO,A9548,CPT4/HCPCS,In111 pentetate,,Fee Schedule,3456.93
Aetna,HMO,A9550,CPT4/HCPCS,Tc99m gluceptate,,Fee Schedule,161.36
Aetna,HMO,A9551,CPT4/HCPCS,Tc99m succimer,,Fee Schedule,5014.96
Aetna,HMO,A9552,CPT4/HCPCS,F18 fdg,,Fee Schedule,4056.19
Aetna,HMO,A9553,CPT4/HCPCS,Cr51 chromate,,Fee Schedule,4718.61
Aetna,HMO,A9554,CPT4/HCPCS,I125 iothalamate, dx,,Fee Schedule,292.82
Aetna,HMO,A9555,CPT4/HCPCS,Rb82 rubidium,,Fee Schedule,2987.12
Aetna,HMO,A9556,CPT4/HCPCS,Ga67 gallium,,Fee Schedule,1005.39
Aetna,HMO,A9557,CPT4/HCPCS,Tc99m bicisate,,Fee Schedule,3113.04
Aetna,HMO,A9558,CPT4/HCPCS,Xe133 xenon 10mci,,Fee Schedule,1754.50
Aetna,HMO,A9559,CPT4/HCPCS,Co57 cyano,,Fee Schedule,612.94
Aetna,HMO,A9560,CPT4/HCPCS,Tc99m labeled rbc,,Fee Schedule,781.45
Aetna,HMO,A9561,CPT4/HCPCS,Tc99m oxidronate,,Fee Schedule,368.08
Aetna,HMO,A9562,CPT4/HCPCS,Tc99m mertiatide,,Fee Schedule,6482.11
Aetna,HMO,A9566,CPT4/HCPCS,Tc99m fanolesomab,,Fee Schedule,1736.44
Aetna,HMO,A9567,CPT4/HCPCS,Technetium TC-99m aerosol,,Fee Schedule,28.56
Aetna,HMO,A9568,CPT4/HCPCS,Technetium tc99m arcitumomab,,Fee Schedule,9063.60
Aetna,HMO,A9569,CPT4/HCPCS,Technetium TC-99m auto WBC,,Fee Schedule,12181.17
Aetna,HMO,A9570,CPT4/HCPCS,Indium In-111 auto WBC,,Fee Schedule,29920.38
Aetna,HMO,A9571,CPT4/HCPCS,Indium IN-111 auto platelet,,Fee Schedule,29920.38
Aetna,HMO,A9572,CPT4/HCPCS,Indium In-111 pentetreotide,,Fee Schedule,47487.72
Aetna,HMO,A9575,CPT4/HCPCS,Inj gadoterate meglumi 0.1ml,,Fee Schedule,1.51
Aetna,HMO,A9576,CPT4/HCPCS,Inj prohance multipack,,Fee Schedule,11.92
Aetna,HMO,A9577,CPT4/HCPCS,Inj multihance,,Fee Schedule,16.38
Aetna,HMO,A9578,CPT4/HCPCS,Inj multihance multipack,,Fee Schedule,16.21
Aetna,HMO,A9579,CPT4/HCPCS,Gad-base MR contrast NOS,1ml,,Fee Schedule,13.10
Aetna,HMO,A9580,CPT4/HCPCS,Sodium fluoride F-18,,Fee Schedule,1318.80
Aetna,HMO,A9581,CPT4/HCPCS,Gadoxetate disodium inj,,Fee Schedule,125.07
Aetna,HMO,A9583,CPT4/HCPCS,Gadofosveset trisodium inj,,Fee Schedule,146.49
Aetna,HMO,A9584,CPT4/HCPCS,Iodine I-123 ioflupane,,Fee Schedule,20648.29
Aetna,HMO,A9585,CPT4/HCPCS,Gadobutrol injection,,Fee Schedule,3.10
Aetna,HMO,A9586,CPT4/HCPCS,Florbetapir F18,,Fee Schedule,23906.14
Aetna,HMO,A9599,CPT4/HCPCS,Radioph dx b amyloid pet nos,,Fee Schedule,23007.60
Aetna,HMO,C5271,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,3656.00
Aetna,HMO,C5272,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,2002.00
Aetna,HMO,C5273,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,3656.00
Aetna,HMO,C5274,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,2002.00
Aetna,HMO,C5275,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,3656.00
Aetna,HMO,C5276,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,2002.00
Aetna,HMO,C5277,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,3656.00
Aetna,HMO,C5278,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,2002.00
Aetna,HMO,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Case Rate,8792.00
Aetna,HMO,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Case Rate,8792.00
Aetna,HMO,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Case Rate,8792.00
Aetna,HMO,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Case Rate,8792.00
Aetna,HMO,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Case Rate,8792.00
Aetna,HMO,C9738,CPT4/HCPCS,Blue light cysto imag agent,,Grouper Rate,2002.00
Aetna,HMO,C9739,CPT4/HCPCS,Cystoscopy prostatic imp 1-3,,Grouper Rate,6401.00
Aetna,HMO,C9740,CPT4/HCPCS,Cysto impl 4 or more,,Grouper Rate,6840.00
Aetna,HMO,C9745,CPT4/HCPCS,Nasal endo eustachian tube,,Grouper Rate,3656.00
Aetna,HMO,C9747,CPT4/HCPCS,Ablation, hifu, prostate,,Grouper Rate,3656.00
Aetna,HMO,C9749,CPT4/HCPCS,Repair nasal stenosis w/imp,,Grouper Rate,6401.00
Aetna,HMO,C9751,CPT4/HCPCS,Microwave bronch, 3d, ebus,,Grouper Rate,7830.00
Aetna,HMO,C9752,CPT4/HCPCS,Intraosseous des lumb/sacrum,,Grouper Rate,6840.00
Aetna,HMO,C9753,CPT4/HCPCS,Intraosseous destruct add'l,,Grouper Rate,2002.00
Aetna,HMO,C9754,CPT4/HCPCS,Perc av fistula, direct,,Grouper Rate,7830.00
Aetna,HMO,C9755,CPT4/HCPCS,Rf magnetic-guide av fistula,,Grouper Rate,7830.00
Aetna,HMO,C9756,CPT4/HCPCS,Fluorescence lymph map w/icg,,Grouper Rate,2002.00
Aetna,HMO,C9757,CPT4/HCPCS,Spine/lumbar disk surgery,,Grouper Rate,6840.00
Aetna,HMO,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Grouper Rate,2002.00
Aetna,HMO,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Grouper Rate,3656.00
Aetna,HMO,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Grouper Rate,3656.00
Aetna,HMO,G0186,CPT4/HCPCS,Dstry eye lesn,fdr vssl tech,,Grouper Rate,2002.00
Aetna,HMO,G0259,CPT4/HCPCS,Inject for sacroiliac joint,,Grouper Rate,2002.00
Aetna,HMO,G0260,CPT4/HCPCS,Inj for sacroiliac jt anesth,,Grouper Rate,2002.00
Aetna,HMO,G0398,CPT4/HCPCS,Home sleep test/type 2 Porta,,Fee Schedule,1310.40
Aetna,HMO,G0399,CPT4/HCPCS,Home sleep test/type 3 Porta,,Fee Schedule,982.80
Aetna,HMO,G0400,CPT4/HCPCS,Home sleep test/type 4 Porta,,Fee Schedule,819.00
Aetna,HMO,G0413,CPT4/HCPCS,Pelvic ring fracture uni/bil,,Grouper Rate,6840.00
Aetna,HMO,G0448,CPT4/HCPCS,Place perm pacing cardiovert,,Grouper Rate,5856.00
Aetna,HMO,G0455,CPT4/HCPCS,Fecal microbiota prep instil,,Grouper Rate,2002.00
Aetna,HMO,G0516,CPT4/HCPCS,Insert drug del implant, >=4,,Grouper Rate,2002.00
Aetna,HMO,G0517,CPT4/HCPCS,Remove drug implant,,Grouper Rate,2002.00
Aetna,HMO,G0518,CPT4/HCPCS,Remove w insert drug implant,,Grouper Rate,2002.00
Aetna,HMO,J0129,CPT4/HCPCS,Abatacept injection,,Fee Schedule,465.36
Aetna,HMO,J0594,CPT4/HCPCS,Busulfan injection,,Fee Schedule,41.49
Aetna,HMO,J0881,CPT4/HCPCS,Darbepoetin alfa, non-esrd,,Fee Schedule,32.42
Aetna,HMO,J0885,CPT4/HCPCS,Epoetin alfa, non-esrd,,Fee Schedule,89.62
Aetna,HMO,J0894,CPT4/HCPCS,Decitabine injection,,Fee Schedule,36.54
Aetna,HMO,J1190,CPT4/HCPCS,Dexrazoxane HCl injection,,Fee Schedule,1675.80
Aetna,HMO,J1447,CPT4/HCPCS,Inj tbo filgrastim 1 microg,,Fee Schedule,4.53
Aetna,HMO,J2430,CPT4/HCPCS,Pamidronate disodium /30 MG,,Fee Schedule,93.82
Aetna,HMO,J8521,CPT4/HCPCS,Capecitabine, oral, 500 mg,,Fee Schedule,23.18
Aetna,HMO,J8530,CPT4/HCPCS,Cyclophosphamide oral 25 MG,,Fee Schedule,22.51
Aetna,HMO,J8540,CPT4/HCPCS,Oral dexamethasone,,Fee Schedule,0.16
Aetna,HMO,J8560,CPT4/HCPCS,Etoposide oral 50 MG,,Fee Schedule,638.56
Aetna,HMO,J8565,CPT4/HCPCS,Gefitinib oral,,Fee Schedule,2172.15
Aetna,HMO,J8600,CPT4/HCPCS,Melphalan oral 2 MG,,Fee Schedule,76.60
Aetna,HMO,J8610,CPT4/HCPCS,Methotrexate oral 2.5 mg,,Fee Schedule,1.93
Aetna,HMO,J8700,CPT4/HCPCS,Temozolomide,,Fee Schedule,7.72
Aetna,HMO,J9000,CPT4/HCPCS,Doxorubicin hcl injection,,Fee Schedule,24.36
Aetna,HMO,J9015,CPT4/HCPCS,Aldesleukin injection,,Fee Schedule,39184.90
Aetna,HMO,J9017,CPT4/HCPCS,Arsenic trioxide injection,,Fee Schedule,373.88
Aetna,HMO,J9019,CPT4/HCPCS,Erwinaze injection,,Fee Schedule,3519.34
Aetna,HMO,J9020,CPT4/HCPCS,Asparaginase, NOS,,Fee Schedule,509.54
Aetna,HMO,J9025,CPT4/HCPCS,Azacitidine injection,,Fee Schedule,8.65
Aetna,HMO,J9027,CPT4/HCPCS,Clofarabine injection,,Fee Schedule,459.98
Aetna,HMO,J9031,CPT4/HCPCS,Bcg live intravesical vac,,Fee Schedule,1314.09
Aetna,HMO,J9032,CPT4/HCPCS,Injection, belinostat, 10mg,,Fee Schedule,346.41
Aetna,HMO,J9035,CPT4/HCPCS,Bevacizumab injection,,Fee Schedule,684.18
Aetna,HMO,J9039,CPT4/HCPCS,Injection, blinatumomab,,Fee Schedule,961.63
Aetna,HMO,J9040,CPT4/HCPCS,Bleomycin sulfate injection,,Fee Schedule,192.27
Aetna,HMO,J9041,CPT4/HCPCS,Inj., velcade 0.1 mg,,Fee Schedule,380.52
Aetna,HMO,J9042,CPT4/HCPCS,Brentuximab vedotin inj,,Fee Schedule,1436.98
Aetna,HMO,J9045,CPT4/HCPCS,Carboplatin injection,,Fee Schedule,22.84
Aetna,HMO,J9047,CPT4/HCPCS,Injection, carfilzomib, 1 mg,,Fee Schedule,318.52
Aetna,HMO,J9050,CPT4/HCPCS,Carmustine injection,,Fee Schedule,22216.40
Aetna,HMO,J9055,CPT4/HCPCS,Cetuximab injection,,Fee Schedule,536.25
Aetna,HMO,J9060,CPT4/HCPCS,Cisplatin 10 MG injection,,Fee Schedule,16.38
Aetna,HMO,J9065,CPT4/HCPCS,Inj cladribine per 1 MG,,Fee Schedule,171.19
Aetna,HMO,J9070,CPT4/HCPCS,Cyclophosphamide 100 MG inj,,Fee Schedule,281.98
Aetna,HMO,J9100,CPT4/HCPCS,Cytarabine hcl 100 MG inj,,Fee Schedule,6.80
Aetna,HMO,J9120,CPT4/HCPCS,Dactinomycin injection,,Fee Schedule,9387.16
Aetna,HMO,J9130,CPT4/HCPCS,Dacarbazine 100 mg inj,,Fee Schedule,34.52
Aetna,HMO,J9150,CPT4/HCPCS,Daunorubicin injection,,Fee Schedule,410.59
Aetna,HMO,J9151,CPT4/HCPCS,Daunorubicin citrate inj,,Fee Schedule,1924.27
Aetna,HMO,J9160,CPT4/HCPCS,Denileukin diftitox inj,,Fee Schedule,12993.03
Aetna,HMO,J9165,CPT4/HCPCS,Diethylstilbestrol injection,,Fee Schedule,105.75
Aetna,HMO,J9175,CPT4/HCPCS,Elliotts b solution per ml,,Fee Schedule,75.26
Aetna,HMO,J9178,CPT4/HCPCS,Inj, epirubicin hcl, 2 mg,,Fee Schedule,9.49
Aetna,HMO,J9181,CPT4/HCPCS,Etoposide injection,,Fee Schedule,5.29
Aetna,HMO,J9185,CPT4/HCPCS,Fludarabine phosphate inj,,Fee Schedule,406.30
Aetna,HMO,J9190,CPT4/HCPCS,Fluorouracil injection,,Fee Schedule,12.85
Aetna,HMO,J9200,CPT4/HCPCS,Floxuridine injection,,Fee Schedule,724.33
Aetna,HMO,J9201,CPT4/HCPCS,In gemcitabine hcl nos 200mg,,Fee Schedule,35.28
Aetna,HMO,J9202,CPT4/HCPCS,Goserelin acetate implant,,Fee Schedule,4275.76
Aetna,HMO,J9206,CPT4/HCPCS,Irinotecan injection,,Fee Schedule,21.00
Aetna,HMO,J9208,CPT4/HCPCS,Ifosfamide injection,,Fee Schedule,226.46
Aetna,HMO,J9209,CPT4/HCPCS,Mesna injection,,Fee Schedule,18.81
Aetna,HMO,J9211,CPT4/HCPCS,Idarubicin hcl injection,,Fee Schedule,308.02
Aetna,HMO,J9212,CPT4/HCPCS,Interferon alfacon-1 inj,,Fee Schedule,80.80
Aetna,HMO,J9213,CPT4/HCPCS,Interferon alfa-2a inj,,Fee Schedule,355.15
Aetna,HMO,J9214,CPT4/HCPCS,Interferon alfa-2b inj,,Fee Schedule,290.22
Aetna,HMO,J9215,CPT4/HCPCS,Interferon alfa-n3 inj,,Fee Schedule,252.00
Aetna,HMO,J9216,CPT4/HCPCS,Interferon gamma 1-b inj,,Fee Schedule,57399.38
Aetna,HMO,J9217,CPT4/HCPCS,Leuprolide acetate suspnsion,,Fee Schedule,1951.90
Aetna,HMO,J9218,CPT4/HCPCS,Leuprolide acetate injeciton,,Fee Schedule,85.93
Aetna,HMO,J9219,CPT4/HCPCS,Leuprolide acetate implant,,Fee Schedule,33603.78
Aetna,HMO,J9225,CPT4/HCPCS,Vantas implant,,Fee Schedule,34952.31
Aetna,HMO,J9230,CPT4/HCPCS,Mechlorethamine hcl inj,,Fee Schedule,2591.14
Aetna,HMO,J9245,CPT4/HCPCS,Inj melpha hydroch nos 50 mg,,Fee Schedule,5373.64
Aetna,HMO,J9250,CPT4/HCPCS,Methotrexate sodium inj,,Fee Schedule,2.10
Aetna,HMO,J9260,CPT4/HCPCS,Methotrexate sodium inj,,Fee Schedule,21.08
Aetna,HMO,J9261,CPT4/HCPCS,Nelarabine injection,,Fee Schedule,1295.61
Aetna,HMO,J9262,CPT4/HCPCS,Inj, omacetaxine mep, 0.01mg,,Fee Schedule,24.69
Aetna,HMO,J9263,CPT4/HCPCS,Oxaliplatin,,Fee Schedule,1.26
Aetna,HMO,J9264,CPT4/HCPCS,Paclitaxel protein bound,,Fee Schedule,106.51
Aetna,HMO,J9266,CPT4/HCPCS,Pegaspargase injection,,Fee Schedule,149077.65
Aetna,HMO,J9267,CPT4/HCPCS,Paclitaxel injection,,Fee Schedule,1.17
Aetna,HMO,J9268,CPT4/HCPCS,Pentostatin injection,,Fee Schedule,17895.78
Aetna,HMO,J9270,CPT4/HCPCS,Plicamycin (mithramycin) inj,,Fee Schedule,688.38
Aetna,HMO,J9271,CPT4/HCPCS,Inj pembrolizumab,,Fee Schedule,426.46
Aetna,HMO,J9280,CPT4/HCPCS,Mitomycin injection,,Fee Schedule,677.79
Aetna,HMO,J9293,CPT4/HCPCS,Mitoxantrone hydrochl / 5 MG,,Fee Schedule,235.87
Aetna,HMO,J9299,CPT4/HCPCS,Injection, nivolumab,,Fee Schedule,238.89
Aetna,HMO,J9301,CPT4/HCPCS,Obinutuzumab inj,,Fee Schedule,538.86
Aetna,HMO,J9305,CPT4/HCPCS,Inj. pemetrexed nos 10mg,,Fee Schedule,600.60
Aetna,HMO,J9306,CPT4/HCPCS,Injection, pertuzumab, 1 mg,,Fee Schedule,107.01
Aetna,HMO,J9308,CPT4/HCPCS,Injection, ramucirumab,,Fee Schedule,506.26
Aetna,HMO,J9310,CPT4/HCPCS,Rituximab injection,,Fee Schedule,7860.38
Aetna,HMO,J9320,CPT4/HCPCS,Streptozocin injection,,Fee Schedule,2991.91
Aetna,HMO,J9340,CPT4/HCPCS,Thiotepa injection,,Fee Schedule,3495.49
Aetna,HMO,J9351,CPT4/HCPCS,Topotecan injection,,Fee Schedule,8.31
Aetna,HMO,J9354,CPT4/HCPCS,Inj, ado-trastuzumab emt 1mg,,Fee Schedule,272.41
Aetna,HMO,J9355,CPT4/HCPCS,Inj trastuzumab excl biosimi,,Fee Schedule,898.04
Aetna,HMO,J9357,CPT4/HCPCS,Valrubicin injection,,Fee Schedule,12101.20
Aetna,HMO,J9360,CPT4/HCPCS,Vinblastine sulfate inj,,Fee Schedule,32.92
Aetna,HMO,J9370,CPT4/HCPCS,Vincristine sulfate 1 MG inj,,Fee Schedule,41.41
Aetna,HMO,J9371,CPT4/HCPCS,Inj, vincristine sul lip 1mg,,Fee Schedule,26095.35
Aetna,HMO,J9390,CPT4/HCPCS,Vinorelbine tartrate inj,,Fee Schedule,101.47
Aetna,HMO,J9395,CPT4/HCPCS,Injection, Fulvestrant,,Fee Schedule,720.80
Aetna,HMO,J9400,CPT4/HCPCS,Inj, ziv-aflibercept, 1mg,,Fee Schedule,71.23
Aetna,HMO,J9600,CPT4/HCPCS,Porfimer sodium injection,,Fee Schedule,176029.05
Aetna,HMO,P9612,CPT4/HCPCS,Catheterize for urine spec,,Grouper Rate,2002.00
Aetna,HMO,P9615,CPT4/HCPCS,Urine specimen collect mult,,Grouper Rate,2002.00
Aetna,HMO,Q0083,CPT4/HCPCS,Chemo by other than infusion,,Fee Schedule,692.16
Aetna,HMO,Q0084,CPT4/HCPCS,Chemotherapy by infusion,,Fee Schedule,298.78
Aetna,HMO,Q0085,CPT4/HCPCS,Chemo by both infusion and o,,Fee Schedule,1405.15
Aetna,HMO,Q2017,CPT4/HCPCS,Teniposide, 50 mg,,Fee Schedule,20882.14
Aetna,HMO,Q2050,CPT4/HCPCS,Doxorubicin inj 10mg,,Fee Schedule,2507.14
Aetna,HMO,Q9951,CPT4/HCPCS,LOCM >= 400 mg/ml iodine,1ml,,Fee Schedule,10.08
Aetna,HMO,Q9953,CPT4/HCPCS,Inj Fe-based MR contrast,1ml,,Fee Schedule,122.22
Aetna,HMO,Q9954,CPT4/HCPCS,Oral MR contrast, 100 ml,,Fee Schedule,87.61
Aetna,HMO,Q9958,CPT4/HCPCS,HOCM <=149 mg/ml iodine, 1ml,,Fee Schedule,0.67
Aetna,HMO,Q9959,CPT4/HCPCS,HOCM 150-199mg/ml iodine,1ml,,Fee Schedule,0.75
Aetna,HMO,Q9960,CPT4/HCPCS,HOCM 200-249mg/ml iodine,1ml,,Fee Schedule,1.42
Aetna,HMO,Q9961,CPT4/HCPCS,HOCM 250-299mg/ml iodine,1ml,,Fee Schedule,2.10
Aetna,HMO,Q9962,CPT4/HCPCS,HOCM 300-349mg/ml iodine,1ml,,Fee Schedule,2.18
Aetna,HMO,Q9963,CPT4/HCPCS,HOCM 350-399mg/ml iodine,1ml,,Fee Schedule,1.68
Aetna,HMO,Q9964,CPT4/HCPCS,HOCM>= 400mg/ml iodine, 1ml,,Fee Schedule,2.68
Aetna,HMO,Q9965,CPT4/HCPCS,LOCM 100-199mg/ml iodine,1ml,,Fee Schedule,7.47
Aetna,HMO,Q9966,CPT4/HCPCS,LOCM 200-299mg/ml iodine,1ml,,Fee Schedule,2.77
Aetna,HMO,Q9967,CPT4/HCPCS,LOCM 300-399mg/ml iodine,1ml,,Fee Schedule,1.00
Aetna,HMO,Q9969,CPT4/HCPCS,Non-HEU TC-99M add-on/dose,,Fee Schedule,8.40
Aetna,HMO,Q9982,CPT4/HCPCS,flutemetamol f18 diagnostic,,Fee Schedule,27609.12
Aetna,HMO,Q9983,CPT4/HCPCS,Florbetaben f18 diagnostic,,Fee Schedule,23425.92
Aetna,HMO,S0088,CPT4/HCPCS,Imatinib 100 mg,,Fee Schedule,36.70
Aetna,HMO,S0108,CPT4/HCPCS,Mercaptopurine 50 mg,,Fee Schedule,25.20
Aetna,HMO,S0117,CPT4/HCPCS,Tretinoin topical 5 g,,Fee Schedule,73.58
Aetna,HMO,S0145,CPT4/HCPCS,Peg interferon alfa-2A/180,,Fee Schedule,8546.24
Aetna,HMO,S0148,CPT4/HCPCS,Peg interferon alfa-2b/10,,Fee Schedule,1258.57
Aetna,HMO,S0156,CPT4/HCPCS,Exemestane, 25 mg,,Fee Schedule,72.49
Aetna,HMO,S0170,CPT4/HCPCS,Anastrozole 1 mg,,Fee Schedule,4.03
Aetna,HMO,S0172,CPT4/HCPCS,Chlorambucil 2 mg,,Fee Schedule,203.53
Aetna,HMO,S0175,CPT4/HCPCS,Flutamide 125 mg,,Fee Schedule,13.02
Aetna,HMO,S0176,CPT4/HCPCS,Hydroxyurea 500 mg,,Fee Schedule,7.14
Aetna,HMO,S0178,CPT4/HCPCS,Lomustine 10 mg,,Fee Schedule,761.04
Aetna,HMO,S0179,CPT4/HCPCS,Megestrol 20 mg,,Fee Schedule,3.10
Aetna,HMO,S0182,CPT4/HCPCS,Procarbazine, oral,,Fee Schedule,827.40
Aetna,HMO,S0183,CPT4/HCPCS,Prochlorperazine 5 mg,,Fee Schedule,3.02
Aetna,HMO,S0187,CPT4/HCPCS,Tamoxifen 10 mg,,Fee Schedule,3.19
Aetna,HMO,S2083,CPT4/HCPCS,Adjustment gastric band,,Grouper Rate,2002.00
Aetna,HMO,S2095,CPT4/HCPCS,Transcath emboliz microspher,,Grouper Rate,5856.00
Aetna,HMO,S2225,CPT4/HCPCS,Myringotomy laser-assist,,Grouper Rate,5856.00
Aetna,HMO,,,NICU/Newborn - Level I,,Per Diem,1112.00
Aetna,HMO,,,Medical Surgical,,Per Diem,3937.00
Aetna,HMO,,,ICU,,Per Diem,5809.00
Aetna,HMO,,,NICU/Newborn - Level II,,Per Diem,5809.00
Aetna,HMO,,,NICU/Newborn - Level III,,Per Diem,5809.00
Aetna,HMO,,,NICU/Newborn - Level IV,,Per Diem,5809.00
Aetna,HMO,,,Telemetry,,Per Diem,5809.00
Aetna,PPO,0054T,CPT4/HCPCS,BONE SRGRY CMPTR FLUOR IMAGE,,Case Rate,2427.00
Aetna,PPO,0055T,CPT4/HCPCS,BONE SRGRY CMPTR CT/MRI IMAG,,Case Rate,2427.00
Aetna,PPO,0085T,CPT4/HCPCS,BREATH TEST HEART REJECT,,Fee Schedule,10876.15
Aetna,PPO,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Grouper Rate,7830.00
Aetna,PPO,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Grouper Rate,5856.00
Aetna,PPO,0191T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,5856.00
Aetna,PPO,0207T,CPT4/HCPCS,CLEAR EYELID GLAND W/HEAT,,Grouper Rate,2002.00
Aetna,PPO,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,2002.00
Aetna,PPO,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,2002.00
Aetna,PPO,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,2002.00
Aetna,PPO,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Grouper Rate,6840.00
Aetna,PPO,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Grouper Rate,2002.00
Aetna,PPO,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,2002.00
Aetna,PPO,0229T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,2002.00
Aetna,PPO,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,2002.00
Aetna,PPO,0231T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,2002.00
Aetna,PPO,0232T,CPT4/HCPCS,NJX PLATELET PLASMA,,Grouper Rate,2002.00
Aetna,PPO,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Grouper Rate,5856.00
Aetna,PPO,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Grouper Rate,5856.00
Aetna,PPO,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Grouper Rate,5856.00
Aetna,PPO,0290T,CPT4/HCPCS,LASER INC FOR PKP/LKP RECIP,,Grouper Rate,2002.00
Aetna,PPO,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Grouper Rate,3656.00
Aetna,PPO,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Grouper Rate,5856.00
Aetna,PPO,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Grouper Rate,3656.00
Aetna,PPO,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Grouper Rate,5856.00
Aetna,PPO,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Grouper Rate,5856.00
Aetna,PPO,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Grouper Rate,5856.00
Aetna,PPO,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,0347T,CPT4/HCPCS,INS BONE DEVICE FOR RSA,,Grouper Rate,3656.00
Aetna,PPO,0354T,CPT4/HCPCS,OCT BREAST SURG CAVITY I&R,,Fee Schedule,56.11
Aetna,PPO,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,2002.00
Aetna,PPO,0396T,CPT4/HCPCS,INTRAOP KINETIC BALNCE SENSR,,Grouper Rate,2002.00
Aetna,PPO,0397T,CPT4/HCPCS,ERCP W/OPTICAL ENDOMICROSCPY,,Grouper Rate,2002.00
Aetna,PPO,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Grouper Rate,2002.00
Aetna,PPO,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Grouper Rate,6840.00
Aetna,PPO,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Grouper Rate,7830.00
Aetna,PPO,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Grouper Rate,7830.00
Aetna,PPO,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Grouper Rate,6401.00
Aetna,PPO,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Grouper Rate,6401.00
Aetna,PPO,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Grouper Rate,5856.00
Aetna,PPO,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Grouper Rate,5856.00
Aetna,PPO,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Grouper Rate,7830.00
Aetna,PPO,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Grouper Rate,3656.00
Aetna,PPO,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Grouper Rate,3656.00
Aetna,PPO,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,2002.00
Aetna,PPO,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,2002.00
Aetna,PPO,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Grouper Rate,3656.00
Aetna,PPO,0424T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA COMPL,,Grouper Rate,5856.00
Aetna,PPO,0425T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA SEN LD,,Grouper Rate,3656.00
Aetna,PPO,0426T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA STM LD,,Grouper Rate,3656.00
Aetna,PPO,0427T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA PLS GN,,Grouper Rate,3656.00
Aetna,PPO,0428T,CPT4/HCPCS,RMVL NSTIM APNEA PLS GEN,,Grouper Rate,3656.00
Aetna,PPO,0429T,CPT4/HCPCS,RMVL NSTIM APNEA SEN LD,,Grouper Rate,3656.00
Aetna,PPO,0430T,CPT4/HCPCS,RMVL NSTIM APNEA STIMJ LD,,Grouper Rate,3656.00
Aetna,PPO,0431T,CPT4/HCPCS,RMVL/RPLC NSTIM APNEA PLS GN,,Grouper Rate,5856.00
Aetna,PPO,0432T,CPT4/HCPCS,REPOS NSTIM APNEA STIMJ LD,,Grouper Rate,3656.00
Aetna,PPO,0433T,CPT4/HCPCS,REPOS NSTIM APNEA SENSING LD,,Grouper Rate,3656.00
Aetna,PPO,0437T,CPT4/HCPCS,IMPLTJ SYNTH RNFCMT ABDL WAL,,Grouper Rate,2002.00
Aetna,PPO,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Grouper Rate,2002.00
Aetna,PPO,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Grouper Rate,2002.00
Aetna,PPO,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Grouper Rate,3656.00
Aetna,PPO,0444T,CPT4/HCPCS,1ST PLMT DRUG ELUT OC INS,,Grouper Rate,5856.00
Aetna,PPO,0445T,CPT4/HCPCS,SBSQT PLMT DRUG ELUT OC INS,,Grouper Rate,5856.00
Aetna,PPO,0446T,CPT4/HCPCS,INSJ IMPLTBL GLUCOSE SENSOR,,Grouper Rate,3656.00
Aetna,PPO,0447T,CPT4/HCPCS,RMVL IMPLTBL GLUCOSE SENSOR,,Grouper Rate,2002.00
Aetna,PPO,0448T,CPT4/HCPCS,REMVL INSJ IMPLTBL GLUC SENS,,Grouper Rate,3656.00
Aetna,PPO,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Grouper Rate,5856.00
Aetna,PPO,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Grouper Rate,2002.00
Aetna,PPO,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Grouper Rate,6401.00
Aetna,PPO,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Grouper Rate,6401.00
Aetna,PPO,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Grouper Rate,5856.00
Aetna,PPO,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Grouper Rate,5856.00
Aetna,PPO,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Grouper Rate,5856.00
Aetna,PPO,0466T,CPT4/HCPCS,INSJ CH WAL RESPIR ELTRD/RA,,Grouper Rate,2002.00
Aetna,PPO,0467T,CPT4/HCPCS,REVJ/RPLMNT CH RESPIR ELTRD,,Grouper Rate,2002.00
Aetna,PPO,0468T,CPT4/HCPCS,RMVL CH WAL RESPIR ELTRD/RA,,Grouper Rate,2002.00
Aetna,PPO,0474T,CPT4/HCPCS,INSJ AQUEOUS DRG DEV IO RSVR,,Grouper Rate,5856.00
Aetna,PPO,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Grouper Rate,2002.00
Aetna,PPO,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Grouper Rate,2002.00
Aetna,PPO,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Grouper Rate,2002.00
Aetna,PPO,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Grouper Rate,2002.00
Aetna,PPO,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Grouper Rate,2002.00
Aetna,PPO,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Grouper Rate,2002.00
Aetna,PPO,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Grouper Rate,2002.00
Aetna,PPO,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Grouper Rate,5856.00
Aetna,PPO,0505T,CPT4/HCPCS,EV FEMPOP ARTL REVSC,,Grouper Rate,6401.00
Aetna,PPO,0510T,CPT4/HCPCS,RMVL SINUS TARSI IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,0511T,CPT4/HCPCS,RMVL&RINSJ SINUS TARSI IMPLT,,Grouper Rate,5856.00
Aetna,PPO,0515T,CPT4/HCPCS,INSJ WCS LV COMPL SYS,,Grouper Rate,6401.00
Aetna,PPO,0516T,CPT4/HCPCS,INSJ WCS LV ELTRD ONLY,,Grouper Rate,6401.00
Aetna,PPO,0517T,CPT4/HCPCS,INSJ WCS LV PG COMPNT,,Grouper Rate,6401.00
Aetna,PPO,0518T,CPT4/HCPCS,RMVL PG COMPNT WCS,,Grouper Rate,6401.00
Aetna,PPO,0519T,CPT4/HCPCS,RMVL & RPLCMT PG COMPNT WCS,,Grouper Rate,6401.00
Aetna,PPO,0520T,CPT4/HCPCS,RMVL&RPLCMT PG WCS NEW ELTRD,,Grouper Rate,6401.00
Aetna,PPO,0524T,CPT4/HCPCS,EV CATH DIR CHEM ABLTJ W/IMG,,Grouper Rate,5856.00
Aetna,PPO,0525T,CPT4/HCPCS,INSJ/RPLCMT COMPL IIMS,,Grouper Rate,8797.00
Aetna,PPO,0526T,CPT4/HCPCS,INSJ/RPLCMT IIMS ELTRD ONLY,,Grouper Rate,6401.00
Aetna,PPO,0527T,CPT4/HCPCS,INSJ/RPLCMT IIMS IMPLT MNTR,,Grouper Rate,6401.00
Aetna,PPO,0530T,CPT4/HCPCS,REMOVAL COMPLETE IIMS,,Grouper Rate,5856.00
Aetna,PPO,0531T,CPT4/HCPCS,REMOVAL IIMS ELECTRODE ONLY,,Grouper Rate,5856.00
Aetna,PPO,0532T,CPT4/HCPCS,REMOVAL IIMS IMPLT MNTR ONLY,,Grouper Rate,5856.00
Aetna,PPO,0547T,CPT4/HCPCS,B1 MATRL QUAL TST MCRIND TIB,,Grouper Rate,2002.00
Aetna,PPO,0548T,CPT4/HCPCS,TPRNL BALO CNTNC DEV BI,,Grouper Rate,6401.00
Aetna,PPO,0549T,CPT4/HCPCS,TPRNL BALO CNTNC DEV UNI,,Grouper Rate,5856.00
Aetna,PPO,0550T,CPT4/HCPCS,TPRNL BALO CNTNC DEV RMVL EA,,Grouper Rate,3656.00
Aetna,PPO,0551T,CPT4/HCPCS,TPRNL BALO CNTNC DEV ADJMT,,Grouper Rate,2002.00
Aetna,PPO,0553T,CPT4/HCPCS,PERQ TCAT ILIAC ANAST IMPLT,,Grouper Rate,7188.00
Aetna,PPO,0563T,CPT4/HCPCS,EVAC MEIBOMIAN GLND HEAT BI,,Grouper Rate,2002.00
Aetna,PPO,0565T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS HRVG,,Grouper Rate,5856.00
Aetna,PPO,0566T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS NJX,,Grouper Rate,2002.00
Aetna,PPO,0567T,CPT4/HCPCS,PERM FLP TUBE OCCLS W/IMPLT,,Grouper Rate,5856.00
Aetna,PPO,0568T,CPT4/HCPCS,INTRO MIX SALINE&AIR F/SSG,,Grouper Rate,2002.00
Aetna,PPO,0571T,CPT4/HCPCS,INSJ/RPLCMT ICDS SS ELTRD,,Grouper Rate,7830.00
Aetna,PPO,0572T,CPT4/HCPCS,INSERTION SS DFB ELECTRODE,,Grouper Rate,5856.00
Aetna,PPO,0573T,CPT4/HCPCS,REMOVAL SS DFB ELECTRODE,,Grouper Rate,5856.00
Aetna,PPO,0574T,CPT4/HCPCS,REPOS PREV SS IMPL DFB ELTRD,,Grouper Rate,5856.00
Aetna,PPO,0580T,CPT4/HCPCS,RMVL SS IMPL DFB PG ONLY,,Grouper Rate,5856.00
Aetna,PPO,0581T,CPT4/HCPCS,ABLTJ MAL BRST TUM PERQ CRTX,,Grouper Rate,6401.00
Aetna,PPO,0582T,CPT4/HCPCS,TRURL ABLTJ MAL PRST8 TISS,,Grouper Rate,3656.00
Aetna,PPO,0583T,CPT4/HCPCS,TMPST AUTO TUBE DLVR SYS,,Grouper Rate,5856.00
Aetna,PPO,0587T,CPT4/HCPCS,PERQ IMPLTJ/RPLCMT ISDNS PTN,,Grouper Rate,2002.00
Aetna,PPO,0588T,CPT4/HCPCS,REVISION/REMOVAL ISDNS PTN,,Grouper Rate,2002.00
Aetna,PPO,10004,CPT4/HCPCS,FNA BX W/O IMG GDN EA ADDL,,Grouper Rate,2002.00
Aetna,PPO,10005,CPT4/HCPCS,FNA BX W/US GDN 1ST LES,,Grouper Rate,2002.00
Aetna,PPO,10006,CPT4/HCPCS,FNA BX W/US GDN EA ADDL,,Grouper Rate,2002.00
Aetna,PPO,10007,CPT4/HCPCS,FNA BX W/FLUOR GDN 1ST LES,,Grouper Rate,2002.00
Aetna,PPO,10008,CPT4/HCPCS,FNA BX W/FLUOR GDN EA ADDL,,Grouper Rate,2002.00
Aetna,PPO,10009,CPT4/HCPCS,FNA BX W/CT GDN 1ST LES,,Grouper Rate,2002.00
Aetna,PPO,10010,CPT4/HCPCS,FNA BX W/CT GDN EA ADDL,,Grouper Rate,2002.00
Aetna,PPO,10011,CPT4/HCPCS,FNA BX W/MR GDN 1ST LES,,Grouper Rate,2002.00
Aetna,PPO,10012,CPT4/HCPCS,FNA BX W/MR GDN EA ADDL,,Grouper Rate,2002.00
Aetna,PPO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Grouper Rate,2002.00
Aetna,PPO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Grouper Rate,3656.00
Aetna,PPO,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Grouper Rate,3656.00
Aetna,PPO,10036,CPT4/HCPCS,PERQ DEV SOFT TISS ADD IMAG,,Grouper Rate,2002.00
Aetna,PPO,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,10061,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,10080,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,2002.00
Aetna,PPO,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,2002.00
Aetna,PPO,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,2002.00
Aetna,PPO,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,3656.00
Aetna,PPO,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Grouper Rate,2002.00
Aetna,PPO,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Grouper Rate,2002.00
Aetna,PPO,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Grouper Rate,3656.00
Aetna,PPO,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Grouper Rate,2002.00
Aetna,PPO,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Grouper Rate,3656.00
Aetna,PPO,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Grouper Rate,3656.00
Aetna,PPO,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Grouper Rate,3656.00
Aetna,PPO,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Grouper Rate,3656.00
Aetna,PPO,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Grouper Rate,3656.00
Aetna,PPO,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Grouper Rate,3656.00
Aetna,PPO,11045,CPT4/HCPCS,DEB SUBQ TISSUE ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,11046,CPT4/HCPCS,DEB MUSC/FASCIA ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,11047,CPT4/HCPCS,DEB BONE ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,11055,CPT4/HCPCS,TRIM SKIN LESION,,Grouper Rate,2002.00
Aetna,PPO,11056,CPT4/HCPCS,TRIM SKIN LESIONS 2 TO 4,,Grouper Rate,2002.00
Aetna,PPO,11057,CPT4/HCPCS,TRIM SKIN LESIONS OVER 4,,Grouper Rate,2002.00
Aetna,PPO,11102,CPT4/HCPCS,TANGNTL BX SKIN SINGLE LES,,Grouper Rate,2002.00
Aetna,PPO,11103,CPT4/HCPCS,TANGNTL BX SKIN EA SEP/ADDL,,Grouper Rate,2002.00
Aetna,PPO,11104,CPT4/HCPCS,PUNCH BX SKIN SINGLE LESION,,Grouper Rate,2002.00
Aetna,PPO,11105,CPT4/HCPCS,PUNCH BX SKIN EA SEP/ADDL,,Grouper Rate,2002.00
Aetna,PPO,11106,CPT4/HCPCS,INCAL BX SKN SINGLE LES,,Grouper Rate,2002.00
Aetna,PPO,11107,CPT4/HCPCS,INCAL BX SKN EA SEP/ADDL,,Grouper Rate,2002.00
Aetna,PPO,11200,CPT4/HCPCS,REMOVAL OF SKIN TAGS 4.0 CM,,Grouper Rate,3656.00
Aetna,PPO,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Grouper Rate,3656.00
Aetna,PPO,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Grouper Rate,3656.00
Aetna,PPO,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Grouper Rate,2002.00
Aetna,PPO,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Grouper Rate,2002.00
Aetna,PPO,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Grouper Rate,3656.00
Aetna,PPO,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Grouper Rate,3656.00
Aetna,PPO,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Grouper Rate,3656.00
Aetna,PPO,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Grouper Rate,3656.00
Aetna,PPO,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Grouper Rate,2002.00
Aetna,PPO,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Grouper Rate,2002.00
Aetna,PPO,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Grouper Rate,2002.00
Aetna,PPO,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Grouper Rate,3656.00
Aetna,PPO,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,PPO,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,PPO,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,PPO,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,PPO,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,PPO,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3656.00
Aetna,PPO,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Grouper Rate,2002.00
Aetna,PPO,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Grouper Rate,2002.00
Aetna,PPO,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Grouper Rate,2002.00
Aetna,PPO,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Grouper Rate,2002.00
Aetna,PPO,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Grouper Rate,3656.00
Aetna,PPO,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Grouper Rate,3656.00
Aetna,PPO,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Grouper Rate,2002.00
Aetna,PPO,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Grouper Rate,2002.00
Aetna,PPO,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Grouper Rate,2002.00
Aetna,PPO,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Grouper Rate,2002.00
Aetna,PPO,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Grouper Rate,3656.00
Aetna,PPO,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Grouper Rate,3656.00
Aetna,PPO,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Grouper Rate,3656.00
Aetna,PPO,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Grouper Rate,3656.00
Aetna,PPO,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Grouper Rate,3656.00
Aetna,PPO,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Grouper Rate,3656.00
Aetna,PPO,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Grouper Rate,3656.00
Aetna,PPO,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Grouper Rate,3656.00
Aetna,PPO,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Grouper Rate,2002.00
Aetna,PPO,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Grouper Rate,2002.00
Aetna,PPO,11730,CPT4/HCPCS,REMOVAL OF NAIL PLATE,,Grouper Rate,2002.00
Aetna,PPO,11732,CPT4/HCPCS,REMOVE NAIL PLATE ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,11740,CPT4/HCPCS,DRAIN BLOOD FROM UNDER NAIL,,Grouper Rate,2002.00
Aetna,PPO,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Grouper Rate,2002.00
Aetna,PPO,11755,CPT4/HCPCS,BIOPSY NAIL UNIT,,Grouper Rate,2002.00
Aetna,PPO,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Grouper Rate,2002.00
Aetna,PPO,11762,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED,,Grouper Rate,3656.00
Aetna,PPO,11765,CPT4/HCPCS,EXCISION OF NAIL FOLD TOE,,Grouper Rate,2002.00
Aetna,PPO,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Grouper Rate,5856.00
Aetna,PPO,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Grouper Rate,5856.00
Aetna,PPO,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Grouper Rate,5856.00
Aetna,PPO,11900,CPT4/HCPCS,INJECT SKIN LESIONS 7,,Grouper Rate,2002.00
Aetna,PPO,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Grouper Rate,2002.00
Aetna,PPO,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Grouper Rate,2002.00
Aetna,PPO,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Grouper Rate,2002.00
Aetna,PPO,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Grouper Rate,3656.00
Aetna,PPO,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Grouper Rate,5856.00
Aetna,PPO,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Grouper Rate,2002.00
Aetna,PPO,11976,CPT4/HCPCS,REMOVE CONTRACEPTIVE CAPSULE,,Grouper Rate,2002.00
Aetna,PPO,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Grouper Rate,2002.00
Aetna,PPO,11981,CPT4/HCPCS,INSERT DRUG IMPLANT DEVICE,,Grouper Rate,2002.00
Aetna,PPO,11982,CPT4/HCPCS,REMOVE DRUG IMPLANT DEVICE,,Grouper Rate,2002.00
Aetna,PPO,11983,CPT4/HCPCS,REMOVE/INSERT DRUG IMPLANT,,Grouper Rate,2002.00
Aetna,PPO,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Grouper Rate,2002.00
Aetna,PPO,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Grouper Rate,2002.00
Aetna,PPO,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Grouper Rate,3656.00
Aetna,PPO,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Grouper Rate,3656.00
Aetna,PPO,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Grouper Rate,3656.00
Aetna,PPO,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Grouper Rate,2002.00
Aetna,PPO,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Grouper Rate,2002.00
Aetna,PPO,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Grouper Rate,3656.00
Aetna,PPO,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Grouper Rate,3656.00
Aetna,PPO,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Grouper Rate,3656.00
Aetna,PPO,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,2002.00
Aetna,PPO,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,2002.00
Aetna,PPO,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Grouper Rate,2002.00
Aetna,PPO,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Grouper Rate,2002.00
Aetna,PPO,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Grouper Rate,3656.00
Aetna,PPO,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Grouper Rate,3656.00
Aetna,PPO,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Grouper Rate,3656.00
Aetna,PPO,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Grouper Rate,3656.00
Aetna,PPO,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Grouper Rate,2002.00
Aetna,PPO,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Grouper Rate,2002.00
Aetna,PPO,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Grouper Rate,3656.00
Aetna,PPO,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Grouper Rate,3656.00
Aetna,PPO,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Grouper Rate,3656.00
Aetna,PPO,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Grouper Rate,3656.00
Aetna,PPO,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Grouper Rate,2002.00
Aetna,PPO,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Grouper Rate,2002.00
Aetna,PPO,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Grouper Rate,2002.00
Aetna,PPO,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Grouper Rate,3656.00
Aetna,PPO,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Grouper Rate,3656.00
Aetna,PPO,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Grouper Rate,3656.00
Aetna,PPO,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Grouper Rate,3656.00
Aetna,PPO,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Grouper Rate,3656.00
Aetna,PPO,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Grouper Rate,5856.00
Aetna,PPO,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Grouper Rate,2002.00
Aetna,PPO,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Grouper Rate,3656.00
Aetna,PPO,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Grouper Rate,5856.00
Aetna,PPO,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Grouper Rate,2002.00
Aetna,PPO,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,3656.00
Aetna,PPO,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,5856.00
Aetna,PPO,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,2002.00
Aetna,PPO,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Grouper Rate,5856.00
Aetna,PPO,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Grouper Rate,5856.00
Aetna,PPO,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Grouper Rate,5856.00
Aetna,PPO,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Grouper Rate,3656.00
Aetna,PPO,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Grouper Rate,3656.00
Aetna,PPO,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Grouper Rate,5856.00
Aetna,PPO,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Grouper Rate,5856.00
Aetna,PPO,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Grouper Rate,5856.00
Aetna,PPO,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,3656.00
Aetna,PPO,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,5856.00
Aetna,PPO,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Grouper Rate,5856.00
Aetna,PPO,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Grouper Rate,5856.00
Aetna,PPO,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Grouper Rate,5856.00
Aetna,PPO,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Grouper Rate,2002.00
Aetna,PPO,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Grouper Rate,5856.00
Aetna,PPO,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Grouper Rate,3656.00
Aetna,PPO,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Grouper Rate,2002.00
Aetna,PPO,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Grouper Rate,3656.00
Aetna,PPO,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Grouper Rate,2002.00
Aetna,PPO,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Grouper Rate,3656.00
Aetna,PPO,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Grouper Rate,3656.00
Aetna,PPO,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Grouper Rate,3656.00
Aetna,PPO,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Grouper Rate,5856.00
Aetna,PPO,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Grouper Rate,3656.00
Aetna,PPO,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Grouper Rate,3656.00
Aetna,PPO,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Grouper Rate,2002.00
Aetna,PPO,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Grouper Rate,3656.00
Aetna,PPO,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Grouper Rate,5856.00
Aetna,PPO,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Grouper Rate,3656.00
Aetna,PPO,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Grouper Rate,3656.00
Aetna,PPO,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Grouper Rate,2002.00
Aetna,PPO,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Grouper Rate,3656.00
Aetna,PPO,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Grouper Rate,2002.00
Aetna,PPO,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Grouper Rate,2002.00
Aetna,PPO,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Grouper Rate,3656.00
Aetna,PPO,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Grouper Rate,2002.00
Aetna,PPO,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Grouper Rate,2002.00
Aetna,PPO,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Grouper Rate,5856.00
Aetna,PPO,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Grouper Rate,3656.00
Aetna,PPO,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Grouper Rate,3656.00
Aetna,PPO,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,3656.00
Aetna,PPO,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Grouper Rate,5856.00
Aetna,PPO,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,5856.00
Aetna,PPO,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Grouper Rate,3656.00
Aetna,PPO,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,3656.00
Aetna,PPO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Grouper Rate,3656.00
Aetna,PPO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Grouper Rate,3656.00
Aetna,PPO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Grouper Rate,2002.00
Aetna,PPO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Grouper Rate,3656.00
Aetna,PPO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Grouper Rate,2002.00
Aetna,PPO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Grouper Rate,3656.00
Aetna,PPO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Grouper Rate,2002.00
Aetna,PPO,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Grouper Rate,5856.00
Aetna,PPO,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Grouper Rate,5856.00
Aetna,PPO,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Grouper Rate,5856.00
Aetna,PPO,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Grouper Rate,5856.00
Aetna,PPO,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Grouper Rate,5856.00
Aetna,PPO,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Grouper Rate,5856.00
Aetna,PPO,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Grouper Rate,6401.00
Aetna,PPO,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Grouper Rate,5856.00
Aetna,PPO,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Grouper Rate,6840.00
Aetna,PPO,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Grouper Rate,5856.00
Aetna,PPO,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Grouper Rate,5856.00
Aetna,PPO,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Grouper Rate,5856.00
Aetna,PPO,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Grouper Rate,5856.00
Aetna,PPO,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Grouper Rate,5856.00
Aetna,PPO,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Grouper Rate,5856.00
Aetna,PPO,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Grouper Rate,3656.00
Aetna,PPO,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Grouper Rate,3656.00
Aetna,PPO,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Grouper Rate,5856.00
Aetna,PPO,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Grouper Rate,5856.00
Aetna,PPO,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Grouper Rate,5856.00
Aetna,PPO,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Grouper Rate,3656.00
Aetna,PPO,15769,CPT4/HCPCS,GRFG AUTOL SOFT TISS DIR EXC,,Grouper Rate,6401.00
Aetna,PPO,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Grouper Rate,5856.00
Aetna,PPO,15771,CPT4/HCPCS,GRFG AUTOL FAT LIPO 50 CC/<,,Grouper Rate,6401.00
Aetna,PPO,15772,CPT4/HCPCS,GRFG AUTOL FAT LIPO EA ADDL,,Grouper Rate,2002.00
Aetna,PPO,15773,CPT4/HCPCS,GRFG AUTOL FAT LIPO 25 CC/<,,Grouper Rate,3656.00
Aetna,PPO,15774,CPT4/HCPCS,GFRG AUTOL FAT LIPO EA ADDL,,Grouper Rate,2002.00
Aetna,PPO,15775,CPT4/HCPCS,HAIR TRNSPL 1-15 PUNCH GRFTS,,Grouper Rate,5856.00
Aetna,PPO,15776,CPT4/HCPCS,HAIR TRNSPL >15 PUNCH GRAFTS,,Grouper Rate,5856.00
Aetna,PPO,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,Grouper Rate,2002.00
Aetna,PPO,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Grouper Rate,3656.00
Aetna,PPO,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,5856.00
Aetna,PPO,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,5856.00
Aetna,PPO,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,5856.00
Aetna,PPO,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,6840.00
Aetna,PPO,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Grouper Rate,5856.00
Aetna,PPO,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Grouper Rate,5856.00
Aetna,PPO,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Grouper Rate,5856.00
Aetna,PPO,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Grouper Rate,5856.00
Aetna,PPO,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Grouper Rate,6840.00
Aetna,PPO,15830,CPT4/HCPCS,EXC SKIN ABD,,Grouper Rate,5856.00
Aetna,PPO,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Grouper Rate,5856.00
Aetna,PPO,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Grouper Rate,5856.00
Aetna,PPO,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Grouper Rate,5856.00
Aetna,PPO,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Grouper Rate,5856.00
Aetna,PPO,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Grouper Rate,5856.00
Aetna,PPO,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Grouper Rate,3656.00
Aetna,PPO,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Grouper Rate,3656.00
Aetna,PPO,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Grouper Rate,5856.00
Aetna,PPO,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Grouper Rate,6401.00
Aetna,PPO,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Grouper Rate,6401.00
Aetna,PPO,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Grouper Rate,6401.00
Aetna,PPO,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Grouper Rate,6401.00
Aetna,PPO,15847,CPT4/HCPCS,EXC SKIN ABD ADD-ON,,Grouper Rate,5856.00
Aetna,PPO,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Grouper Rate,2002.00
Aetna,PPO,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Grouper Rate,2002.00
Aetna,PPO,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Grouper Rate,2002.00
Aetna,PPO,15860,CPT4/HCPCS,TEST FOR BLOOD FLOW IN GRAFT,,Grouper Rate,2002.00
Aetna,PPO,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Grouper Rate,5856.00
Aetna,PPO,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Grouper Rate,5856.00
Aetna,PPO,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Grouper Rate,5856.00
Aetna,PPO,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Grouper Rate,5856.00
Aetna,PPO,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,5856.00
Aetna,PPO,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,6401.00
Aetna,PPO,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5856.00
Aetna,PPO,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5856.00
Aetna,PPO,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5856.00
Aetna,PPO,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,6401.00
Aetna,PPO,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,6401.00
Aetna,PPO,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,6401.00
Aetna,PPO,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5856.00
Aetna,PPO,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5856.00
Aetna,PPO,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5856.00
Aetna,PPO,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,6401.00
Aetna,PPO,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,6401.00
Aetna,PPO,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5856.00
Aetna,PPO,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,6401.00
Aetna,PPO,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5856.00
Aetna,PPO,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,6401.00
Aetna,PPO,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5856.00
Aetna,PPO,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,6401.00
Aetna,PPO,16020,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN S,,Grouper Rate,2002.00
Aetna,PPO,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Grouper Rate,3656.00
Aetna,PPO,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Grouper Rate,3656.00
Aetna,PPO,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Grouper Rate,3656.00
Aetna,PPO,17000,CPT4/HCPCS,DESTRUCT PREMALG LESION,,Grouper Rate,2002.00
Aetna,PPO,17003,CPT4/HCPCS,DESTRUCT PREMALG LES 2-14,,Grouper Rate,2002.00
Aetna,PPO,17004,CPT4/HCPCS,DESTROY PREMAL LESIONS 15/>,,Grouper Rate,2002.00
Aetna,PPO,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17110,CPT4/HCPCS,DESTRUCT B9 LESION 1-14,,Grouper Rate,2002.00
Aetna,PPO,17111,CPT4/HCPCS,DESTRUCT LESION 15 OR MORE,,Grouper Rate,2002.00
Aetna,PPO,17250,CPT4/HCPCS,CHEM CAUT OF GRANLTJ TISSUE,,Grouper Rate,2002.00
Aetna,PPO,17260,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17261,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17262,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17263,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17264,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17266,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,3656.00
Aetna,PPO,17270,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17271,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17272,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17273,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17274,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17276,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,3656.00
Aetna,PPO,17280,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17281,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17282,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17283,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17284,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,2002.00
Aetna,PPO,17286,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,3656.00
Aetna,PPO,17311,CPT4/HCPCS,MOHS 1 STAGE H/N/HF/G,,Grouper Rate,3656.00
Aetna,PPO,17312,CPT4/HCPCS,MOHS ADDL STAGE,,Grouper Rate,2002.00
Aetna,PPO,17313,CPT4/HCPCS,MOHS 1 STAGE T/A/L,,Grouper Rate,3656.00
Aetna,PPO,17314,CPT4/HCPCS,MOHS ADDL STAGE T/A/L,,Grouper Rate,2002.00
Aetna,PPO,17315,CPT4/HCPCS,MOHS SURG ADDL BLOCK,,Grouper Rate,2002.00
Aetna,PPO,17999,CPT4/HCPCS,SKIN TISSUE PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Grouper Rate,2002.00
Aetna,PPO,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Grouper Rate,3656.00
Aetna,PPO,19030,CPT4/HCPCS,INJECTION FOR BREAST X-RAY,,Grouper Rate,2002.00
Aetna,PPO,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Grouper Rate,3656.00
Aetna,PPO,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,Grouper Rate,2002.00
Aetna,PPO,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Grouper Rate,3656.00
Aetna,PPO,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,Grouper Rate,2002.00
Aetna,PPO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Grouper Rate,5856.00
Aetna,PPO,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,Grouper Rate,2002.00
Aetna,PPO,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Grouper Rate,2002.00
Aetna,PPO,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Grouper Rate,3656.00
Aetna,PPO,19105,CPT4/HCPCS,CRYOSURG ABLATE FA EACH,,Grouper Rate,6401.00
Aetna,PPO,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Grouper Rate,3656.00
Aetna,PPO,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Grouper Rate,5856.00
Aetna,PPO,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Grouper Rate,5856.00
Aetna,PPO,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Grouper Rate,5856.00
Aetna,PPO,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Grouper Rate,5856.00
Aetna,PPO,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,Grouper Rate,3656.00
Aetna,PPO,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,Grouper Rate,2002.00
Aetna,PPO,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,Grouper Rate,3656.00
Aetna,PPO,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,Grouper Rate,2002.00
Aetna,PPO,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,Grouper Rate,3656.00
Aetna,PPO,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,Grouper Rate,2002.00
Aetna,PPO,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,Grouper Rate,5856.00
Aetna,PPO,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,Grouper Rate,2002.00
Aetna,PPO,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Grouper Rate,2002.00
Aetna,PPO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Grouper Rate,9770.00
Aetna,PPO,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Grouper Rate,9770.00
Aetna,PPO,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Grouper Rate,7188.00
Aetna,PPO,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Grouper Rate,6401.00
Aetna,PPO,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Grouper Rate,5856.00
Aetna,PPO,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Grouper Rate,7830.00
Aetna,PPO,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Grouper Rate,6401.00
Aetna,PPO,19307,CPT4/HCPCS,MAST MOD RAD,,Grouper Rate,6840.00
Aetna,PPO,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Grouper Rate,6401.00
Aetna,PPO,19318,CPT4/HCPCS,BREAST REDUCTION,,Grouper Rate,6401.00
Aetna,PPO,19324,CPT4/HCPCS,ENLARGE BREAST,,Grouper Rate,6401.00
Aetna,PPO,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Grouper Rate,9770.00
Aetna,PPO,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Grouper Rate,2002.00
Aetna,PPO,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Grouper Rate,2002.00
Aetna,PPO,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Grouper Rate,3656.00
Aetna,PPO,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Grouper Rate,5856.00
Aetna,PPO,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,6401.00
Aetna,PPO,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Grouper Rate,6401.00
Aetna,PPO,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Grouper Rate,6840.00
Aetna,PPO,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Grouper Rate,6840.00
Aetna,PPO,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,6840.00
Aetna,PPO,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Grouper Rate,6401.00
Aetna,PPO,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Grouper Rate,6401.00
Aetna,PPO,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Grouper Rate,6840.00
Aetna,PPO,19396,CPT4/HCPCS,DESIGN CUSTOM BREAST IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,19499,CPT4/HCPCS,BREAST SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Grouper Rate,2002.00
Aetna,PPO,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Grouper Rate,3656.00
Aetna,PPO,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Grouper Rate,5856.00
Aetna,PPO,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Grouper Rate,2002.00
Aetna,PPO,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,2002.00
Aetna,PPO,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,3656.00
Aetna,PPO,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Grouper Rate,3656.00
Aetna,PPO,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Grouper Rate,5856.00
Aetna,PPO,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,5856.00
Aetna,PPO,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,5856.00
Aetna,PPO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Grouper Rate,2002.00
Aetna,PPO,20501,CPT4/HCPCS,INJECT SINUS TRACT FOR X-RAY,,Grouper Rate,2002.00
Aetna,PPO,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,3656.00
Aetna,PPO,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,5856.00
Aetna,PPO,20526,CPT4/HCPCS,THER INJECTION CARP TUNNEL,,Grouper Rate,2002.00
Aetna,PPO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Grouper Rate,2002.00
Aetna,PPO,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Grouper Rate,2002.00
Aetna,PPO,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Grouper Rate,2002.00
Aetna,PPO,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Grouper Rate,2002.00
Aetna,PPO,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Grouper Rate,2002.00
Aetna,PPO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Grouper Rate,2002.00
Aetna,PPO,20560,CPT4/HCPCS,NDL INSJ W/O NJX 1 OR 2 MUSC,,Grouper Rate,2002.00
Aetna,PPO,20561,CPT4/HCPCS,NDL INSJ W/O NJX 3+ MUSC,,Grouper Rate,2002.00
Aetna,PPO,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,2002.00
Aetna,PPO,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,2002.00
Aetna,PPO,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,2002.00
Aetna,PPO,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,2002.00
Aetna,PPO,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,2002.00
Aetna,PPO,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,2002.00
Aetna,PPO,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Grouper Rate,2002.00
Aetna,PPO,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Grouper Rate,2002.00
Aetna,PPO,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Grouper Rate,5856.00
Aetna,PPO,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Grouper Rate,3656.00
Aetna,PPO,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Grouper Rate,5856.00
Aetna,PPO,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Grouper Rate,5856.00
Aetna,PPO,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Grouper Rate,5856.00
Aetna,PPO,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Grouper Rate,2002.00
Aetna,PPO,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,2002.00
Aetna,PPO,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,3656.00
Aetna,PPO,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,5856.00
Aetna,PPO,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Grouper Rate,5856.00
Aetna,PPO,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Grouper Rate,2002.00
Aetna,PPO,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Grouper Rate,5856.00
Aetna,PPO,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Grouper Rate,5856.00
Aetna,PPO,20700,CPT4/HCPCS,MNL PREP&INSJ DP RX DLVR DEV,,Grouper Rate,2002.00
Aetna,PPO,20701,CPT4/HCPCS,RMVL DEEP RX DELIVERY DEVICE,,Grouper Rate,2002.00
Aetna,PPO,20702,CPT4/HCPCS,MNL PREP&INSJ IMED RX DEV,,Grouper Rate,2002.00
Aetna,PPO,20703,CPT4/HCPCS,RMVL IMED RX DELIVERY DEVICE,,Grouper Rate,2002.00
Aetna,PPO,20704,CPT4/HCPCS,MNL PREP&INSJ I-ARTIC RX DEV,,Grouper Rate,2002.00
Aetna,PPO,20705,CPT4/HCPCS,RMVL I-ARTIC RX DELIVERY DEV,,Grouper Rate,2002.00
Aetna,PPO,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,5856.00
Aetna,PPO,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,6401.00
Aetna,PPO,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,5856.00
Aetna,PPO,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,5856.00
Aetna,PPO,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,6401.00
Aetna,PPO,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,5856.00
Aetna,PPO,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Grouper Rate,6401.00
Aetna,PPO,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,20932,CPT4/HCPCS,OSTEOART ALGRFT W/SURF & B1,,Grouper Rate,2002.00
Aetna,PPO,20933,CPT4/HCPCS,HEMICRT INTRCLRY ALGRFT PRTL,,Grouper Rate,2002.00
Aetna,PPO,20934,CPT4/HCPCS,INTERCALARY ALGRFT COMPL,,Grouper Rate,2002.00
Aetna,PPO,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Grouper Rate,2002.00
Aetna,PPO,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Grouper Rate,2002.00
Aetna,PPO,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Grouper Rate,6401.00
Aetna,PPO,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Grouper Rate,6401.00
Aetna,PPO,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Grouper Rate,6401.00
Aetna,PPO,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Grouper Rate,6401.00
Aetna,PPO,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Grouper Rate,6401.00
Aetna,PPO,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Grouper Rate,6401.00
Aetna,PPO,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Grouper Rate,3656.00
Aetna,PPO,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,2002.00
Aetna,PPO,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,3656.00
Aetna,PPO,20985,CPT4/HCPCS,CPTR-ASST DIR MS PX,,Grouper Rate,2002.00
Aetna,PPO,20999,CPT4/HCPCS,MUSCULOSKELETAL SURGERY,,Grouper Rate,2002.00
Aetna,PPO,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Grouper Rate,3656.00
Aetna,PPO,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Grouper Rate,2002.00
Aetna,PPO,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Grouper Rate,2002.00
Aetna,PPO,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Grouper Rate,2002.00
Aetna,PPO,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Grouper Rate,2002.00
Aetna,PPO,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Grouper Rate,5856.00
Aetna,PPO,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Grouper Rate,3656.00
Aetna,PPO,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Grouper Rate,3656.00
Aetna,PPO,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Grouper Rate,3656.00
Aetna,PPO,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Grouper Rate,3656.00
Aetna,PPO,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Grouper Rate,2002.00
Aetna,PPO,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Grouper Rate,2002.00
Aetna,PPO,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Grouper Rate,5856.00
Aetna,PPO,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Grouper Rate,3656.00
Aetna,PPO,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Grouper Rate,3656.00
Aetna,PPO,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Grouper Rate,3656.00
Aetna,PPO,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Grouper Rate,3656.00
Aetna,PPO,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Grouper Rate,3656.00
Aetna,PPO,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Grouper Rate,5856.00
Aetna,PPO,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Grouper Rate,3656.00
Aetna,PPO,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Grouper Rate,5856.00
Aetna,PPO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Grouper Rate,2002.00
Aetna,PPO,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Grouper Rate,3656.00
Aetna,PPO,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Grouper Rate,2002.00
Aetna,PPO,21116,CPT4/HCPCS,INJECTION JAW JOINT X-RAY,,Grouper Rate,2002.00
Aetna,PPO,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,7830.00
Aetna,PPO,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,7830.00
Aetna,PPO,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,7830.00
Aetna,PPO,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,7830.00
Aetna,PPO,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,7830.00
Aetna,PPO,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,7188.00
Aetna,PPO,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5856.00
Aetna,PPO,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5856.00
Aetna,PPO,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Grouper Rate,6401.00
Aetna,PPO,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Grouper Rate,6401.00
Aetna,PPO,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Grouper Rate,6401.00
Aetna,PPO,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,6840.00
Aetna,PPO,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,6840.00
Aetna,PPO,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Grouper Rate,7830.00
Aetna,PPO,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Grouper Rate,6840.00
Aetna,PPO,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Grouper Rate,6840.00
Aetna,PPO,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Grouper Rate,5856.00
Aetna,PPO,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Grouper Rate,6840.00
Aetna,PPO,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Grouper Rate,6840.00
Aetna,PPO,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Grouper Rate,7830.00
Aetna,PPO,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Grouper Rate,6840.00
Aetna,PPO,21210,CPT4/HCPCS,FACE BONE GRAFT,,Grouper Rate,7830.00
Aetna,PPO,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Grouper Rate,7830.00
Aetna,PPO,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Grouper Rate,7830.00
Aetna,PPO,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Grouper Rate,7830.00
Aetna,PPO,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,6401.00
Aetna,PPO,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,6840.00
Aetna,PPO,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,6840.00
Aetna,PPO,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Grouper Rate,7830.00
Aetna,PPO,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,7830.00
Aetna,PPO,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,7830.00
Aetna,PPO,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,7830.00
Aetna,PPO,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,7830.00
Aetna,PPO,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,7830.00
Aetna,PPO,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Grouper Rate,6840.00
Aetna,PPO,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Grouper Rate,7830.00
Aetna,PPO,21280,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,6840.00
Aetna,PPO,21282,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,6840.00
Aetna,PPO,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,2002.00
Aetna,PPO,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,2002.00
Aetna,PPO,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Grouper Rate,3656.00
Aetna,PPO,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Grouper Rate,3656.00
Aetna,PPO,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Grouper Rate,3656.00
Aetna,PPO,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Grouper Rate,6401.00
Aetna,PPO,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Grouper Rate,6840.00
Aetna,PPO,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Grouper Rate,7830.00
Aetna,PPO,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Grouper Rate,6401.00
Aetna,PPO,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Grouper Rate,3656.00
Aetna,PPO,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Grouper Rate,6401.00
Aetna,PPO,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Grouper Rate,6840.00
Aetna,PPO,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Grouper Rate,6401.00
Aetna,PPO,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Grouper Rate,6840.00
Aetna,PPO,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Grouper Rate,7830.00
Aetna,PPO,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Grouper Rate,7830.00
Aetna,PPO,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Grouper Rate,6401.00
Aetna,PPO,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Grouper Rate,6840.00
Aetna,PPO,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Grouper Rate,7188.00
Aetna,PPO,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Grouper Rate,5856.00
Aetna,PPO,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Grouper Rate,6840.00
Aetna,PPO,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Grouper Rate,7188.00
Aetna,PPO,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Grouper Rate,6840.00
Aetna,PPO,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Grouper Rate,6840.00
Aetna,PPO,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Grouper Rate,6840.00
Aetna,PPO,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Grouper Rate,7830.00
Aetna,PPO,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Grouper Rate,7830.00
Aetna,PPO,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Grouper Rate,3656.00
Aetna,PPO,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Grouper Rate,5856.00
Aetna,PPO,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Grouper Rate,6401.00
Aetna,PPO,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Grouper Rate,6840.00
Aetna,PPO,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,6840.00
Aetna,PPO,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6840.00
Aetna,PPO,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6840.00
Aetna,PPO,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6840.00
Aetna,PPO,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,2002.00
Aetna,PPO,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,3656.00
Aetna,PPO,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Grouper Rate,5856.00
Aetna,PPO,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Grouper Rate,3656.00
Aetna,PPO,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Grouper Rate,3656.00
Aetna,PPO,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Grouper Rate,3656.00
Aetna,PPO,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Grouper Rate,2002.00
Aetna,PPO,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,PPO,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Grouper Rate,3656.00
Aetna,PPO,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Grouper Rate,3656.00
Aetna,PPO,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,3656.00
Aetna,PPO,21601,CPT4/HCPCS,EXC CHEST WALL TUMOR W/RIBS,,Grouper Rate,6840.00
Aetna,PPO,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,3656.00
Aetna,PPO,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Grouper Rate,3656.00
Aetna,PPO,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Grouper Rate,3656.00
Aetna,PPO,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,3656.00
Aetna,PPO,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,5856.00
Aetna,PPO,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,5856.00
Aetna,PPO,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Grouper Rate,6401.00
Aetna,PPO,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Grouper Rate,7188.00
Aetna,PPO,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Grouper Rate,7188.00
Aetna,PPO,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Grouper Rate,5856.00
Aetna,PPO,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,2002.00
Aetna,PPO,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,3656.00
Aetna,PPO,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,PPO,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Grouper Rate,3656.00
Aetna,PPO,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Grouper Rate,5856.00
Aetna,PPO,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,5856.00
Aetna,PPO,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,5856.00
Aetna,PPO,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,5856.00
Aetna,PPO,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,5856.00
Aetna,PPO,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Grouper Rate,2002.00
Aetna,PPO,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Grouper Rate,3656.00
Aetna,PPO,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Grouper Rate,3656.00
Aetna,PPO,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Grouper Rate,3656.00
Aetna,PPO,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Grouper Rate,5856.00
Aetna,PPO,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Grouper Rate,3656.00
Aetna,PPO,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Grouper Rate,9770.00
Aetna,PPO,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Grouper Rate,9770.00
Aetna,PPO,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Grouper Rate,2002.00
Aetna,PPO,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,5856.00
Aetna,PPO,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,5856.00
Aetna,PPO,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,2002.00
Aetna,PPO,22526,CPT4/HCPCS,IDET SINGLE LEVEL,,Grouper Rate,5856.00
Aetna,PPO,22527,CPT4/HCPCS,IDET 1 OR MORE LEVELS,,Grouper Rate,5856.00
Aetna,PPO,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Grouper Rate,7188.00
Aetna,PPO,22552,CPT4/HCPCS,ADDL NECK SPINE FUSION,,Grouper Rate,2002.00
Aetna,PPO,22554,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,7188.00
Aetna,PPO,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,7188.00
Aetna,PPO,22614,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,2002.00
Aetna,PPO,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,2002.00
Aetna,PPO,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,2002.00
Aetna,PPO,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,2002.00
Aetna,PPO,22853,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,2002.00
Aetna,PPO,22854,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,2002.00
Aetna,PPO,22856,CPT4/HCPCS,CERV ARTIFIC DISKECTOMY,,Grouper Rate,7188.00
Aetna,PPO,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Grouper Rate,2002.00
Aetna,PPO,22859,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,2002.00
Aetna,PPO,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,6840.00
Aetna,PPO,22868,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,2002.00
Aetna,PPO,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,3656.00
Aetna,PPO,22870,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,2002.00
Aetna,PPO,22899,CPT4/HCPCS,SPINE SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Grouper Rate,6401.00
Aetna,PPO,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,PPO,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Grouper Rate,3656.00
Aetna,PPO,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,22999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Grouper Rate,3656.00
Aetna,PPO,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Grouper Rate,3656.00
Aetna,PPO,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Grouper Rate,2002.00
Aetna,PPO,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Grouper Rate,5856.00
Aetna,PPO,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,5856.00
Aetna,PPO,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,6401.00
Aetna,PPO,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,2002.00
Aetna,PPO,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,3656.00
Aetna,PPO,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,PPO,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Grouper Rate,3656.00
Aetna,PPO,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Grouper Rate,5856.00
Aetna,PPO,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Grouper Rate,3656.00
Aetna,PPO,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Grouper Rate,7830.00
Aetna,PPO,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Grouper Rate,6401.00
Aetna,PPO,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Grouper Rate,6401.00
Aetna,PPO,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Grouper Rate,6401.00
Aetna,PPO,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Grouper Rate,6840.00
Aetna,PPO,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Grouper Rate,6840.00
Aetna,PPO,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Grouper Rate,6840.00
Aetna,PPO,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,6401.00
Aetna,PPO,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,6840.00
Aetna,PPO,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,6840.00
Aetna,PPO,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,6401.00
Aetna,PPO,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,6840.00
Aetna,PPO,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,6840.00
Aetna,PPO,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,3656.00
Aetna,PPO,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,3656.00
Aetna,PPO,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,6401.00
Aetna,PPO,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,6401.00
Aetna,PPO,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,6401.00
Aetna,PPO,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Grouper Rate,6401.00
Aetna,PPO,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Grouper Rate,6840.00
Aetna,PPO,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,2002.00
Aetna,PPO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Grouper Rate,3656.00
Aetna,PPO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,5856.00
Aetna,PPO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,6401.00
Aetna,PPO,23350,CPT4/HCPCS,INJECTION FOR SHOULDER X-RAY,,Grouper Rate,2002.00
Aetna,PPO,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Grouper Rate,6840.00
Aetna,PPO,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Grouper Rate,7830.00
Aetna,PPO,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Grouper Rate,7830.00
Aetna,PPO,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Grouper Rate,3656.00
Aetna,PPO,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Grouper Rate,3656.00
Aetna,PPO,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Grouper Rate,6840.00
Aetna,PPO,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Grouper Rate,7830.00
Aetna,PPO,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Grouper Rate,6840.00
Aetna,PPO,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Grouper Rate,7830.00
Aetna,PPO,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Grouper Rate,6401.00
Aetna,PPO,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Grouper Rate,6401.00
Aetna,PPO,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6840.00
Aetna,PPO,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,7830.00
Aetna,PPO,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6840.00
Aetna,PPO,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,7830.00
Aetna,PPO,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6840.00
Aetna,PPO,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,7830.00
Aetna,PPO,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,6840.00
Aetna,PPO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,6840.00
Aetna,PPO,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,6401.00
Aetna,PPO,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,7830.00
Aetna,PPO,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Grouper Rate,5856.00
Aetna,PPO,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Grouper Rate,5856.00
Aetna,PPO,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,6401.00
Aetna,PPO,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,6401.00
Aetna,PPO,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,2002.00
Aetna,PPO,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,2002.00
Aetna,PPO,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6840.00
Aetna,PPO,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Grouper Rate,2002.00
Aetna,PPO,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,6401.00
Aetna,PPO,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,7830.00
Aetna,PPO,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,PPO,23929,CPT4/HCPCS,SHOULDER SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Grouper Rate,2002.00
Aetna,PPO,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Grouper Rate,3656.00
Aetna,PPO,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Grouper Rate,6401.00
Aetna,PPO,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Grouper Rate,6401.00
Aetna,PPO,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,2002.00
Aetna,PPO,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,3656.00
Aetna,PPO,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,PPO,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Grouper Rate,3656.00
Aetna,PPO,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Grouper Rate,5856.00
Aetna,PPO,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Grouper Rate,2002.00
Aetna,PPO,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Grouper Rate,6401.00
Aetna,PPO,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Grouper Rate,6401.00
Aetna,PPO,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Grouper Rate,5856.00
Aetna,PPO,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,3656.00
Aetna,PPO,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Grouper Rate,5856.00
Aetna,PPO,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Grouper Rate,5856.00
Aetna,PPO,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Grouper Rate,5856.00
Aetna,PPO,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,5856.00
Aetna,PPO,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Grouper Rate,3656.00
Aetna,PPO,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Grouper Rate,6401.00
Aetna,PPO,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Grouper Rate,5856.00
Aetna,PPO,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Grouper Rate,5856.00
Aetna,PPO,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Grouper Rate,5856.00
Aetna,PPO,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Grouper Rate,3656.00
Aetna,PPO,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,3656.00
Aetna,PPO,24220,CPT4/HCPCS,INJECTION FOR ELBOW X-RAY,,Grouper Rate,2002.00
Aetna,PPO,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Grouper Rate,2002.00
Aetna,PPO,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Grouper Rate,6401.00
Aetna,PPO,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Grouper Rate,6401.00
Aetna,PPO,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Grouper Rate,5856.00
Aetna,PPO,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Grouper Rate,5856.00
Aetna,PPO,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,5856.00
Aetna,PPO,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,5856.00
Aetna,PPO,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Grouper Rate,3656.00
Aetna,PPO,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Grouper Rate,5856.00
Aetna,PPO,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Grouper Rate,5856.00
Aetna,PPO,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Grouper Rate,5856.00
Aetna,PPO,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Grouper Rate,6401.00
Aetna,PPO,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Grouper Rate,8797.00
Aetna,PPO,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Grouper Rate,3656.00
Aetna,PPO,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Grouper Rate,6401.00
Aetna,PPO,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Grouper Rate,5856.00
Aetna,PPO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Grouper Rate,5856.00
Aetna,PPO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Grouper Rate,5856.00
Aetna,PPO,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,6840.00
Aetna,PPO,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,6840.00
Aetna,PPO,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,6840.00
Aetna,PPO,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Grouper Rate,7830.00
Aetna,PPO,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,6840.00
Aetna,PPO,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,6840.00
Aetna,PPO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,6840.00
Aetna,PPO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,7830.00
Aetna,PPO,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,6401.00
Aetna,PPO,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,6401.00
Aetna,PPO,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5856.00
Aetna,PPO,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Grouper Rate,5856.00
Aetna,PPO,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Grouper Rate,6401.00
Aetna,PPO,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Grouper Rate,5856.00
Aetna,PPO,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Grouper Rate,3656.00
Aetna,PPO,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Grouper Rate,5856.00
Aetna,PPO,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6840.00
Aetna,PPO,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,6840.00
Aetna,PPO,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Grouper Rate,6401.00
Aetna,PPO,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Grouper Rate,6840.00
Aetna,PPO,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,PPO,24999,CPT4/HCPCS,UPPER ARM/ELBOW SURGERY,,Grouper Rate,2002.00
Aetna,PPO,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Grouper Rate,5856.00
Aetna,PPO,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Grouper Rate,2002.00
Aetna,PPO,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,5856.00
Aetna,PPO,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,5856.00
Aetna,PPO,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,5856.00
Aetna,PPO,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,5856.00
Aetna,PPO,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Grouper Rate,2002.00
Aetna,PPO,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Grouper Rate,3656.00
Aetna,PPO,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,6840.00
Aetna,PPO,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,2002.00
Aetna,PPO,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,3656.00
Aetna,PPO,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,PPO,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Grouper Rate,5856.00
Aetna,PPO,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Grouper Rate,5856.00
Aetna,PPO,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Grouper Rate,5856.00
Aetna,PPO,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Grouper Rate,5856.00
Aetna,PPO,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Grouper Rate,3656.00
Aetna,PPO,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,5856.00
Aetna,PPO,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,6401.00
Aetna,PPO,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Grouper Rate,5856.00
Aetna,PPO,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Grouper Rate,6401.00
Aetna,PPO,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,5856.00
Aetna,PPO,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,5856.00
Aetna,PPO,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Grouper Rate,6401.00
Aetna,PPO,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,6401.00
Aetna,PPO,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,6401.00
Aetna,PPO,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Grouper Rate,3656.00
Aetna,PPO,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,5856.00
Aetna,PPO,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Grouper Rate,5856.00
Aetna,PPO,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,5856.00
Aetna,PPO,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,5856.00
Aetna,PPO,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Grouper Rate,5856.00
Aetna,PPO,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,5856.00
Aetna,PPO,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,5856.00
Aetna,PPO,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,3656.00
Aetna,PPO,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,3656.00
Aetna,PPO,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Grouper Rate,5856.00
Aetna,PPO,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Grouper Rate,5856.00
Aetna,PPO,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Grouper Rate,6401.00
Aetna,PPO,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,6401.00
Aetna,PPO,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,6401.00
Aetna,PPO,25246,CPT4/HCPCS,INJECTION FOR WRIST X-RAY,,Grouper Rate,2002.00
Aetna,PPO,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Grouper Rate,3656.00
Aetna,PPO,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,2002.00
Aetna,PPO,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,2002.00
Aetna,PPO,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Grouper Rate,2002.00
Aetna,PPO,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,6401.00
Aetna,PPO,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,3656.00
Aetna,PPO,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5856.00
Aetna,PPO,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,6401.00
Aetna,PPO,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5856.00
Aetna,PPO,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,6401.00
Aetna,PPO,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Grouper Rate,6401.00
Aetna,PPO,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Grouper Rate,6401.00
Aetna,PPO,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Grouper Rate,5856.00
Aetna,PPO,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Grouper Rate,5856.00
Aetna,PPO,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,5856.00
Aetna,PPO,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,5856.00
Aetna,PPO,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,5856.00
Aetna,PPO,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,6401.00
Aetna,PPO,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,5856.00
Aetna,PPO,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,5856.00
Aetna,PPO,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Grouper Rate,5856.00
Aetna,PPO,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Grouper Rate,6840.00
Aetna,PPO,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Grouper Rate,5856.00
Aetna,PPO,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Grouper Rate,6840.00
Aetna,PPO,25350,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,5856.00
Aetna,PPO,25355,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,5856.00
Aetna,PPO,25360,CPT4/HCPCS,REVISION OF ULNA,,Grouper Rate,5856.00
Aetna,PPO,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,5856.00
Aetna,PPO,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Grouper Rate,5856.00
Aetna,PPO,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,6401.00
Aetna,PPO,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Grouper Rate,5856.00
Aetna,PPO,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Grouper Rate,6401.00
Aetna,PPO,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Grouper Rate,5856.00
Aetna,PPO,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Grouper Rate,6401.00
Aetna,PPO,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Grouper Rate,6840.00
Aetna,PPO,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Grouper Rate,5856.00
Aetna,PPO,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,6401.00
Aetna,PPO,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Grouper Rate,5856.00
Aetna,PPO,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,6401.00
Aetna,PPO,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,5856.00
Aetna,PPO,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,6401.00
Aetna,PPO,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Grouper Rate,5856.00
Aetna,PPO,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Grouper Rate,5856.00
Aetna,PPO,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Grouper Rate,6401.00
Aetna,PPO,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6840.00
Aetna,PPO,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6840.00
Aetna,PPO,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6840.00
Aetna,PPO,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6840.00
Aetna,PPO,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6840.00
Aetna,PPO,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Grouper Rate,7830.00
Aetna,PPO,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Grouper Rate,6840.00
Aetna,PPO,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Grouper Rate,6840.00
Aetna,PPO,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,5856.00
Aetna,PPO,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,5856.00
Aetna,PPO,25490,CPT4/HCPCS,REINFORCE RADIUS,,Grouper Rate,5856.00
Aetna,PPO,25491,CPT4/HCPCS,REINFORCE ULNA,,Grouper Rate,5856.00
Aetna,PPO,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Grouper Rate,5856.00
Aetna,PPO,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,2002.00
Aetna,PPO,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,2002.00
Aetna,PPO,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,5856.00
Aetna,PPO,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,2002.00
Aetna,PPO,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,6401.00
Aetna,PPO,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,6840.00
Aetna,PPO,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,2002.00
Aetna,PPO,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,2002.00
Aetna,PPO,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,5856.00
Aetna,PPO,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,2002.00
Aetna,PPO,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,3656.00
Aetna,PPO,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,5856.00
Aetna,PPO,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,5856.00
Aetna,PPO,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,2002.00
Aetna,PPO,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,5856.00
Aetna,PPO,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Grouper Rate,5856.00
Aetna,PPO,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Grouper Rate,6840.00
Aetna,PPO,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Grouper Rate,6840.00
Aetna,PPO,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Grouper Rate,6840.00
Aetna,PPO,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Grouper Rate,5856.00
Aetna,PPO,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Grouper Rate,6401.00
Aetna,PPO,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,6840.00
Aetna,PPO,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,6840.00
Aetna,PPO,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Grouper Rate,6401.00
Aetna,PPO,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Grouper Rate,6840.00
Aetna,PPO,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Grouper Rate,6840.00
Aetna,PPO,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,PPO,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,PPO,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,5856.00
Aetna,PPO,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,PPO,25999,CPT4/HCPCS,FOREARM OR WRIST SURGERY,,Grouper Rate,2002.00
Aetna,PPO,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Grouper Rate,3656.00
Aetna,PPO,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Grouper Rate,2002.00
Aetna,PPO,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Grouper Rate,3656.00
Aetna,PPO,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,6401.00
Aetna,PPO,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,6401.00
Aetna,PPO,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,6401.00
Aetna,PPO,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5856.00
Aetna,PPO,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Grouper Rate,3656.00
Aetna,PPO,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,3656.00
Aetna,PPO,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Grouper Rate,3656.00
Aetna,PPO,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,6401.00
Aetna,PPO,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,6401.00
Aetna,PPO,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Grouper Rate,3656.00
Aetna,PPO,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,2002.00
Aetna,PPO,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,2002.00
Aetna,PPO,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Grouper Rate,3656.00
Aetna,PPO,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Grouper Rate,3656.00
Aetna,PPO,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Grouper Rate,5856.00
Aetna,PPO,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,6401.00
Aetna,PPO,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,6401.00
Aetna,PPO,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,6401.00
Aetna,PPO,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,5856.00
Aetna,PPO,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,6401.00
Aetna,PPO,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,3656.00
Aetna,PPO,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Grouper Rate,5856.00
Aetna,PPO,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Grouper Rate,5856.00
Aetna,PPO,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Grouper Rate,5856.00
Aetna,PPO,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Grouper Rate,6401.00
Aetna,PPO,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Grouper Rate,3656.00
Aetna,PPO,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Grouper Rate,5856.00
Aetna,PPO,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Grouper Rate,7830.00
Aetna,PPO,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,5856.00
Aetna,PPO,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,5856.00
Aetna,PPO,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Grouper Rate,5856.00
Aetna,PPO,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Grouper Rate,5856.00
Aetna,PPO,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Grouper Rate,3656.00
Aetna,PPO,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Grouper Rate,3656.00
Aetna,PPO,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Grouper Rate,2002.00
Aetna,PPO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Grouper Rate,2002.00
Aetna,PPO,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,2002.00
Aetna,PPO,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,6401.00
Aetna,PPO,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,6401.00
Aetna,PPO,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,6401.00
Aetna,PPO,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,6401.00
Aetna,PPO,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,6401.00
Aetna,PPO,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,6401.00
Aetna,PPO,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5856.00
Aetna,PPO,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Grouper Rate,6401.00
Aetna,PPO,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5856.00
Aetna,PPO,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Grouper Rate,5856.00
Aetna,PPO,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5856.00
Aetna,PPO,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Grouper Rate,6401.00
Aetna,PPO,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,6401.00
Aetna,PPO,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,6401.00
Aetna,PPO,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5856.00
Aetna,PPO,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Grouper Rate,5856.00
Aetna,PPO,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Grouper Rate,5856.00
Aetna,PPO,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Grouper Rate,5856.00
Aetna,PPO,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Grouper Rate,5856.00
Aetna,PPO,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,3656.00
Aetna,PPO,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,3656.00
Aetna,PPO,26476,CPT4/HCPCS,TENDON LENGTHENING,,Grouper Rate,2002.00
Aetna,PPO,26477,CPT4/HCPCS,TENDON SHORTENING,,Grouper Rate,2002.00
Aetna,PPO,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Grouper Rate,2002.00
Aetna,PPO,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Grouper Rate,2002.00
Aetna,PPO,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Grouper Rate,5856.00
Aetna,PPO,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Grouper Rate,5856.00
Aetna,PPO,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Grouper Rate,3656.00
Aetna,PPO,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Grouper Rate,5856.00
Aetna,PPO,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,5856.00
Aetna,PPO,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Grouper Rate,5856.00
Aetna,PPO,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Grouper Rate,5856.00
Aetna,PPO,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,5856.00
Aetna,PPO,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,5856.00
Aetna,PPO,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,6401.00
Aetna,PPO,26499,CPT4/HCPCS,REVISION OF FINGER,,Grouper Rate,5856.00
Aetna,PPO,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,6401.00
Aetna,PPO,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,6401.00
Aetna,PPO,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Grouper Rate,5856.00
Aetna,PPO,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Grouper Rate,5856.00
Aetna,PPO,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Grouper Rate,2002.00
Aetna,PPO,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,5856.00
Aetna,PPO,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,5856.00
Aetna,PPO,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Grouper Rate,5856.00
Aetna,PPO,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Grouper Rate,5856.00
Aetna,PPO,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Grouper Rate,5856.00
Aetna,PPO,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Grouper Rate,7830.00
Aetna,PPO,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Grouper Rate,6840.00
Aetna,PPO,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Grouper Rate,6840.00
Aetna,PPO,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Grouper Rate,6401.00
Aetna,PPO,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,7830.00
Aetna,PPO,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,6401.00
Aetna,PPO,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,6401.00
Aetna,PPO,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Grouper Rate,6401.00
Aetna,PPO,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,6401.00
Aetna,PPO,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Grouper Rate,3656.00
Aetna,PPO,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Grouper Rate,6401.00
Aetna,PPO,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Grouper Rate,3656.00
Aetna,PPO,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Grouper Rate,3656.00
Aetna,PPO,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Grouper Rate,5856.00
Aetna,PPO,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,3656.00
Aetna,PPO,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,5856.00
Aetna,PPO,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,6401.00
Aetna,PPO,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Grouper Rate,6840.00
Aetna,PPO,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Grouper Rate,6840.00
Aetna,PPO,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Grouper Rate,5856.00
Aetna,PPO,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Grouper Rate,6840.00
Aetna,PPO,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Grouper Rate,6840.00
Aetna,PPO,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Grouper Rate,6840.00
Aetna,PPO,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Grouper Rate,5856.00
Aetna,PPO,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Grouper Rate,5856.00
Aetna,PPO,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Grouper Rate,3656.00
Aetna,PPO,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,6401.00
Aetna,PPO,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,2002.00
Aetna,PPO,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,3656.00
Aetna,PPO,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,7830.00
Aetna,PPO,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,6401.00
Aetna,PPO,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,2002.00
Aetna,PPO,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,3656.00
Aetna,PPO,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,6840.00
Aetna,PPO,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Grouper Rate,3656.00
Aetna,PPO,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,6401.00
Aetna,PPO,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,6840.00
Aetna,PPO,26841,CPT4/HCPCS,FUSION OF THUMB,,Grouper Rate,6401.00
Aetna,PPO,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,6401.00
Aetna,PPO,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Grouper Rate,5856.00
Aetna,PPO,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Grouper Rate,5856.00
Aetna,PPO,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Grouper Rate,6401.00
Aetna,PPO,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Grouper Rate,6401.00
Aetna,PPO,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Grouper Rate,5856.00
Aetna,PPO,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Grouper Rate,3656.00
Aetna,PPO,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Grouper Rate,6401.00
Aetna,PPO,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Grouper Rate,5856.00
Aetna,PPO,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Grouper Rate,5856.00
Aetna,PPO,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,3656.00
Aetna,PPO,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,6401.00
Aetna,PPO,26989,CPT4/HCPCS,HAND/FINGER SURGERY,,Grouper Rate,2002.00
Aetna,PPO,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Grouper Rate,2002.00
Aetna,PPO,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Grouper Rate,2002.00
Aetna,PPO,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3656.00
Aetna,PPO,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,5856.00
Aetna,PPO,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,5856.00
Aetna,PPO,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Grouper Rate,6401.00
Aetna,PPO,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Grouper Rate,3656.00
Aetna,PPO,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Grouper Rate,5856.00
Aetna,PPO,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Grouper Rate,5856.00
Aetna,PPO,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Grouper Rate,6401.00
Aetna,PPO,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,2002.00
Aetna,PPO,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,3656.00
Aetna,PPO,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,PPO,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Grouper Rate,5856.00
Aetna,PPO,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Grouper Rate,5856.00
Aetna,PPO,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Grouper Rate,5856.00
Aetna,PPO,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Grouper Rate,5856.00
Aetna,PPO,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Grouper Rate,3656.00
Aetna,PPO,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Grouper Rate,6840.00
Aetna,PPO,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Grouper Rate,6840.00
Aetna,PPO,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Grouper Rate,6840.00
Aetna,PPO,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Grouper Rate,6840.00
Aetna,PPO,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Grouper Rate,6840.00
Aetna,PPO,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Grouper Rate,3656.00
Aetna,PPO,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,2002.00
Aetna,PPO,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,5856.00
Aetna,PPO,27093,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,2002.00
Aetna,PPO,27095,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,2002.00
Aetna,PPO,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Grouper Rate,2002.00
Aetna,PPO,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Grouper Rate,5856.00
Aetna,PPO,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Grouper Rate,5856.00
Aetna,PPO,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Grouper Rate,6401.00
Aetna,PPO,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Grouper Rate,6401.00
Aetna,PPO,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,6401.00
Aetna,PPO,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,6401.00
Aetna,PPO,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,2002.00
Aetna,PPO,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,2002.00
Aetna,PPO,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,27267,CPT4/HCPCS,CLTX THIGH FX,,Grouper Rate,2002.00
Aetna,PPO,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,Grouper Rate,2002.00
Aetna,PPO,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Grouper Rate,3656.00
Aetna,PPO,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Grouper Rate,6840.00
Aetna,PPO,27299,CPT4/HCPCS,PELVIS/HIP JOINT SURGERY,,Grouper Rate,2002.00
Aetna,PPO,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Grouper Rate,5856.00
Aetna,PPO,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Grouper Rate,3656.00
Aetna,PPO,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,5856.00
Aetna,PPO,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,5856.00
Aetna,PPO,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Grouper Rate,6401.00
Aetna,PPO,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,2002.00
Aetna,PPO,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,2002.00
Aetna,PPO,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Grouper Rate,3656.00
Aetna,PPO,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Grouper Rate,3656.00
Aetna,PPO,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Grouper Rate,3656.00
Aetna,PPO,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Grouper Rate,5856.00
Aetna,PPO,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Grouper Rate,6401.00
Aetna,PPO,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Grouper Rate,6401.00
Aetna,PPO,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Grouper Rate,6401.00
Aetna,PPO,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,6401.00
Aetna,PPO,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,6401.00
Aetna,PPO,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,6401.00
Aetna,PPO,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,6401.00
Aetna,PPO,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Grouper Rate,5856.00
Aetna,PPO,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Grouper Rate,5856.00
Aetna,PPO,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Grouper Rate,6401.00
Aetna,PPO,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Grouper Rate,6401.00
Aetna,PPO,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Grouper Rate,6401.00
Aetna,PPO,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Grouper Rate,5856.00
Aetna,PPO,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,6401.00
Aetna,PPO,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,6840.00
Aetna,PPO,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Grouper Rate,6840.00
Aetna,PPO,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Grouper Rate,6840.00
Aetna,PPO,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,27369,CPT4/HCPCS,NJX CNTRST KNE ARTHG/CT/MRI,,Grouper Rate,2002.00
Aetna,PPO,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,7830.00
Aetna,PPO,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Grouper Rate,2002.00
Aetna,PPO,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Grouper Rate,5856.00
Aetna,PPO,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Grouper Rate,5856.00
Aetna,PPO,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Grouper Rate,5856.00
Aetna,PPO,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,2002.00
Aetna,PPO,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,3656.00
Aetna,PPO,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,5856.00
Aetna,PPO,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Grouper Rate,3656.00
Aetna,PPO,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,5856.00
Aetna,PPO,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,5856.00
Aetna,PPO,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Grouper Rate,5856.00
Aetna,PPO,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Grouper Rate,5856.00
Aetna,PPO,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Grouper Rate,5856.00
Aetna,PPO,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Grouper Rate,6401.00
Aetna,PPO,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,6401.00
Aetna,PPO,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,6401.00
Aetna,PPO,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Grouper Rate,6401.00
Aetna,PPO,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Grouper Rate,5856.00
Aetna,PPO,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Grouper Rate,5856.00
Aetna,PPO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Grouper Rate,6401.00
Aetna,PPO,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Grouper Rate,5856.00
Aetna,PPO,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,5856.00
Aetna,PPO,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,7830.00
Aetna,PPO,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Grouper Rate,5856.00
Aetna,PPO,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Grouper Rate,7830.00
Aetna,PPO,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,5856.00
Aetna,PPO,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,6401.00
Aetna,PPO,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,6401.00
Aetna,PPO,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Grouper Rate,6401.00
Aetna,PPO,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Grouper Rate,6401.00
Aetna,PPO,27437,CPT4/HCPCS,REVISE KNEECAP,,Grouper Rate,6401.00
Aetna,PPO,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Grouper Rate,6840.00
Aetna,PPO,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6840.00
Aetna,PPO,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6840.00
Aetna,PPO,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6840.00
Aetna,PPO,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6840.00
Aetna,PPO,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6840.00
Aetna,PPO,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Grouper Rate,7188.00
Aetna,PPO,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6401.00
Aetna,PPO,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6840.00
Aetna,PPO,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6401.00
Aetna,PPO,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6840.00
Aetna,PPO,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,6840.00
Aetna,PPO,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,5856.00
Aetna,PPO,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,5856.00
Aetna,PPO,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,5856.00
Aetna,PPO,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,6840.00
Aetna,PPO,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,2002.00
Aetna,PPO,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,2002.00
Aetna,PPO,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Grouper Rate,2002.00
Aetna,PPO,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Grouper Rate,2002.00
Aetna,PPO,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,PPO,27599,CPT4/HCPCS,LEG SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,5856.00
Aetna,PPO,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,5856.00
Aetna,PPO,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,5856.00
Aetna,PPO,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Grouper Rate,3656.00
Aetna,PPO,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Grouper Rate,3656.00
Aetna,PPO,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,2002.00
Aetna,PPO,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,2002.00
Aetna,PPO,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Grouper Rate,3656.00
Aetna,PPO,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,3656.00
Aetna,PPO,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Grouper Rate,5856.00
Aetna,PPO,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,2002.00
Aetna,PPO,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,3656.00
Aetna,PPO,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Grouper Rate,5856.00
Aetna,PPO,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Grouper Rate,3656.00
Aetna,PPO,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Grouper Rate,5856.00
Aetna,PPO,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,6401.00
Aetna,PPO,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,6401.00
Aetna,PPO,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,6401.00
Aetna,PPO,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Grouper Rate,5856.00
Aetna,PPO,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Grouper Rate,5856.00
Aetna,PPO,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Grouper Rate,3656.00
Aetna,PPO,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Grouper Rate,3656.00
Aetna,PPO,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Grouper Rate,5856.00
Aetna,PPO,27648,CPT4/HCPCS,INJECTION FOR ANKLE X-RAY,,Grouper Rate,2002.00
Aetna,PPO,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Grouper Rate,5856.00
Aetna,PPO,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Grouper Rate,5856.00
Aetna,PPO,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Grouper Rate,5856.00
Aetna,PPO,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Grouper Rate,3656.00
Aetna,PPO,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,2002.00
Aetna,PPO,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,3656.00
Aetna,PPO,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,3656.00
Aetna,PPO,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,3656.00
Aetna,PPO,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,3656.00
Aetna,PPO,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,5856.00
Aetna,PPO,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Grouper Rate,5856.00
Aetna,PPO,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Grouper Rate,3656.00
Aetna,PPO,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Grouper Rate,5856.00
Aetna,PPO,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Grouper Rate,5856.00
Aetna,PPO,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Grouper Rate,5856.00
Aetna,PPO,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,6401.00
Aetna,PPO,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,6401.00
Aetna,PPO,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Grouper Rate,5856.00
Aetna,PPO,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,3656.00
Aetna,PPO,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Grouper Rate,3656.00
Aetna,PPO,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,3656.00
Aetna,PPO,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Grouper Rate,6840.00
Aetna,PPO,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Grouper Rate,3656.00
Aetna,PPO,27705,CPT4/HCPCS,INCISION OF TIBIA,,Grouper Rate,3656.00
Aetna,PPO,27707,CPT4/HCPCS,INCISION OF FIBULA,,Grouper Rate,3656.00
Aetna,PPO,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Grouper Rate,3656.00
Aetna,PPO,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Grouper Rate,6401.00
Aetna,PPO,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Grouper Rate,6840.00
Aetna,PPO,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,6840.00
Aetna,PPO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Grouper Rate,5856.00
Aetna,PPO,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Grouper Rate,3656.00
Aetna,PPO,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Grouper Rate,3656.00
Aetna,PPO,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Grouper Rate,3656.00
Aetna,PPO,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,3656.00
Aetna,PPO,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,3656.00
Aetna,PPO,27745,CPT4/HCPCS,REINFORCE TIBIA,,Grouper Rate,5856.00
Aetna,PPO,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Grouper Rate,2002.00
Aetna,PPO,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Grouper Rate,2002.00
Aetna,PPO,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Grouper Rate,5856.00
Aetna,PPO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Grouper Rate,2002.00
Aetna,PPO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Grouper Rate,2002.00
Aetna,PPO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Grouper Rate,5856.00
Aetna,PPO,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Grouper Rate,3656.00
Aetna,PPO,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Grouper Rate,2002.00
Aetna,PPO,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Grouper Rate,6401.00
Aetna,PPO,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Grouper Rate,6401.00
Aetna,PPO,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5856.00
Aetna,PPO,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,5856.00
Aetna,PPO,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,5856.00
Aetna,PPO,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,5856.00
Aetna,PPO,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,5856.00
Aetna,PPO,27899,CPT4/HCPCS,LEG/ANKLE SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,28,DRG,Spinal procedures w MCC,,Per Diem,5769.00
Aetna,PPO,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Grouper Rate,3656.00
Aetna,PPO,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,5856.00
Aetna,PPO,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,5856.00
Aetna,PPO,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Grouper Rate,5856.00
Aetna,PPO,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Grouper Rate,5856.00
Aetna,PPO,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,3656.00
Aetna,PPO,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Grouper Rate,5856.00
Aetna,PPO,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,3656.00
Aetna,PPO,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,3656.00
Aetna,PPO,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Grouper Rate,3656.00
Aetna,PPO,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Grouper Rate,6401.00
Aetna,PPO,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Grouper Rate,2002.00
Aetna,PPO,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Grouper Rate,5856.00
Aetna,PPO,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Grouper Rate,3656.00
Aetna,PPO,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Grouper Rate,5856.00
Aetna,PPO,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Grouper Rate,5856.00
Aetna,PPO,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Grouper Rate,5856.00
Aetna,PPO,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,3656.00
Aetna,PPO,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,3656.00
Aetna,PPO,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Grouper Rate,3656.00
Aetna,PPO,28055,CPT4/HCPCS,NEURECTOMY FOOT,,Grouper Rate,6401.00
Aetna,PPO,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Grouper Rate,3656.00
Aetna,PPO,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Grouper Rate,5856.00
Aetna,PPO,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,5856.00
Aetna,PPO,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,5856.00
Aetna,PPO,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,5856.00
Aetna,PPO,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,3656.00
Aetna,PPO,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,3656.00
Aetna,PPO,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,5856.00
Aetna,PPO,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,5856.00
Aetna,PPO,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Grouper Rate,3656.00
Aetna,PPO,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,5856.00
Aetna,PPO,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,5856.00
Aetna,PPO,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3656.00
Aetna,PPO,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,5856.00
Aetna,PPO,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,5856.00
Aetna,PPO,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,3656.00
Aetna,PPO,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,5856.00
Aetna,PPO,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,5856.00
Aetna,PPO,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,5856.00
Aetna,PPO,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,5856.00
Aetna,PPO,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Grouper Rate,5856.00
Aetna,PPO,28116,CPT4/HCPCS,REVISION OF FOOT,,Grouper Rate,5856.00
Aetna,PPO,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Grouper Rate,6401.00
Aetna,PPO,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Grouper Rate,6401.00
Aetna,PPO,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Grouper Rate,7830.00
Aetna,PPO,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,5856.00
Aetna,PPO,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,3656.00
Aetna,PPO,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,5856.00
Aetna,PPO,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Grouper Rate,5856.00
Aetna,PPO,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Grouper Rate,5856.00
Aetna,PPO,28150,CPT4/HCPCS,REMOVAL OF TOE,,Grouper Rate,5856.00
Aetna,PPO,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,5856.00
Aetna,PPO,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,5856.00
Aetna,PPO,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Grouper Rate,5856.00
Aetna,PPO,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Grouper Rate,5856.00
Aetna,PPO,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Grouper Rate,5856.00
Aetna,PPO,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,3656.00
Aetna,PPO,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,3656.00
Aetna,PPO,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,6401.00
Aetna,PPO,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,PPO,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,PPO,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,PPO,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,PPO,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,3656.00
Aetna,PPO,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,2002.00
Aetna,PPO,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,2002.00
Aetna,PPO,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,2002.00
Aetna,PPO,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Grouper Rate,3656.00
Aetna,PPO,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,3656.00
Aetna,PPO,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Grouper Rate,3656.00
Aetna,PPO,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,PPO,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Grouper Rate,3656.00
Aetna,PPO,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Grouper Rate,5856.00
Aetna,PPO,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,5856.00
Aetna,PPO,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,5856.00
Aetna,PPO,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Grouper Rate,6401.00
Aetna,PPO,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,2002.00
Aetna,PPO,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Grouper Rate,5856.00
Aetna,PPO,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Grouper Rate,3656.00
Aetna,PPO,28280,CPT4/HCPCS,FUSION OF TOES,,Grouper Rate,3656.00
Aetna,PPO,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,5856.00
Aetna,PPO,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,6401.00
Aetna,PPO,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,5856.00
Aetna,PPO,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Grouper Rate,5856.00
Aetna,PPO,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Grouper Rate,5856.00
Aetna,PPO,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3656.00
Aetna,PPO,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3656.00
Aetna,PPO,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5856.00
Aetna,PPO,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5856.00
Aetna,PPO,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5856.00
Aetna,PPO,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,6840.00
Aetna,PPO,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Grouper Rate,3656.00
Aetna,PPO,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Grouper Rate,3656.00
Aetna,PPO,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Grouper Rate,3656.00
Aetna,PPO,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Grouper Rate,5856.00
Aetna,PPO,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,6401.00
Aetna,PPO,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,6401.00
Aetna,PPO,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,3656.00
Aetna,PPO,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Grouper Rate,6401.00
Aetna,PPO,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Grouper Rate,5856.00
Aetna,PPO,28312,CPT4/HCPCS,REVISION OF TOE,,Grouper Rate,5856.00
Aetna,PPO,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Grouper Rate,3656.00
Aetna,PPO,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Grouper Rate,6401.00
Aetna,PPO,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Grouper Rate,6401.00
Aetna,PPO,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Grouper Rate,6401.00
Aetna,PPO,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Grouper Rate,6401.00
Aetna,PPO,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Grouper Rate,6401.00
Aetna,PPO,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Grouper Rate,6401.00
Aetna,PPO,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Grouper Rate,6401.00
Aetna,PPO,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Grouper Rate,6401.00
Aetna,PPO,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,2002.00
Aetna,PPO,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,2002.00
Aetna,PPO,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,5856.00
Aetna,PPO,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,6401.00
Aetna,PPO,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,3656.00
Aetna,PPO,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,2002.00
Aetna,PPO,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,5856.00
Aetna,PPO,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,3656.00
Aetna,PPO,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,2002.00
Aetna,PPO,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Grouper Rate,5856.00
Aetna,PPO,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,PPO,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,PPO,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,PPO,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,PPO,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,PPO,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Grouper Rate,6840.00
Aetna,PPO,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6401.00
Aetna,PPO,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,6401.00
Aetna,PPO,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,6401.00
Aetna,PPO,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,6401.00
Aetna,PPO,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Grouper Rate,5856.00
Aetna,PPO,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Grouper Rate,3656.00
Aetna,PPO,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Grouper Rate,3656.00
Aetna,PPO,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Grouper Rate,3656.00
Aetna,PPO,28890,CPT4/HCPCS,HI ENRGY ESWT PLANTAR FASCIA,,Grouper Rate,6401.00
Aetna,PPO,28899,CPT4/HCPCS,FOOT/TOES SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,Per Diem,5769.00
Aetna,PPO,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Grouper Rate,2002.00
Aetna,PPO,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Grouper Rate,3656.00
Aetna,PPO,29345,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Grouper Rate,2002.00
Aetna,PPO,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Grouper Rate,5856.00
Aetna,PPO,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Grouper Rate,5856.00
Aetna,PPO,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Grouper Rate,5856.00
Aetna,PPO,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Grouper Rate,5856.00
Aetna,PPO,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Grouper Rate,5856.00
Aetna,PPO,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Grouper Rate,5856.00
Aetna,PPO,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Grouper Rate,5856.00
Aetna,PPO,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Grouper Rate,5856.00
Aetna,PPO,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Grouper Rate,6840.00
Aetna,PPO,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Grouper Rate,5856.00
Aetna,PPO,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Grouper Rate,5856.00
Aetna,PPO,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Grouper Rate,6840.00
Aetna,PPO,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Grouper Rate,5856.00
Aetna,PPO,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Grouper Rate,5856.00
Aetna,PPO,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Grouper Rate,5856.00
Aetna,PPO,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,PPO,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,PPO,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,PPO,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,PPO,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Grouper Rate,6401.00
Aetna,PPO,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Grouper Rate,6401.00
Aetna,PPO,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Grouper Rate,6401.00
Aetna,PPO,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Grouper Rate,6401.00
Aetna,PPO,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,5856.00
Aetna,PPO,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,5856.00
Aetna,PPO,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Grouper Rate,5856.00
Aetna,PPO,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Grouper Rate,5856.00
Aetna,PPO,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Grouper Rate,5856.00
Aetna,PPO,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,PPO,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,PPO,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,PPO,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,PPO,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6401.00
Aetna,PPO,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Grouper Rate,5856.00
Aetna,PPO,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5856.00
Aetna,PPO,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Grouper Rate,5856.00
Aetna,PPO,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,5856.00
Aetna,PPO,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,5856.00
Aetna,PPO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Grouper Rate,5856.00
Aetna,PPO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Grouper Rate,5856.00
Aetna,PPO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Grouper Rate,5856.00
Aetna,PPO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Grouper Rate,5856.00
Aetna,PPO,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Grouper Rate,6401.00
Aetna,PPO,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Grouper Rate,6401.00
Aetna,PPO,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Grouper Rate,6401.00
Aetna,PPO,29999,CPT4/HCPCS,ARTHROSCOPY OF JOINT,,Grouper Rate,2002.00
Aetna,PPO,30,DRG,Spinal procedures w/o CC/MCC,,Per Diem,5769.00
Aetna,PPO,30000,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Grouper Rate,2002.00
Aetna,PPO,30020,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Grouper Rate,2002.00
Aetna,PPO,30100,CPT4/HCPCS,INTRANASAL BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,2002.00
Aetna,PPO,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,3656.00
Aetna,PPO,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,5856.00
Aetna,PPO,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,5856.00
Aetna,PPO,30120,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,2002.00
Aetna,PPO,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,2002.00
Aetna,PPO,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,3656.00
Aetna,PPO,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Grouper Rate,5856.00
Aetna,PPO,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Grouper Rate,3656.00
Aetna,PPO,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Grouper Rate,5856.00
Aetna,PPO,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Grouper Rate,6401.00
Aetna,PPO,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Grouper Rate,5856.00
Aetna,PPO,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,2002.00
Aetna,PPO,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,3656.00
Aetna,PPO,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,6401.00
Aetna,PPO,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,6840.00
Aetna,PPO,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,6840.00
Aetna,PPO,30430,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5856.00
Aetna,PPO,30435,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,6840.00
Aetna,PPO,30450,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,7830.00
Aetna,PPO,30460,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,7830.00
Aetna,PPO,30462,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,7830.00
Aetna,PPO,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Grouper Rate,7830.00
Aetna,PPO,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Grouper Rate,6401.00
Aetna,PPO,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,6840.00
Aetna,PPO,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,6840.00
Aetna,PPO,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Grouper Rate,3656.00
Aetna,PPO,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Grouper Rate,6401.00
Aetna,PPO,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Grouper Rate,6401.00
Aetna,PPO,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Grouper Rate,7830.00
Aetna,PPO,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Grouper Rate,7830.00
Aetna,PPO,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Grouper Rate,2002.00
Aetna,PPO,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Grouper Rate,2002.00
Aetna,PPO,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,2002.00
Aetna,PPO,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,2002.00
Aetna,PPO,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,2002.00
Aetna,PPO,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Grouper Rate,2002.00
Aetna,PPO,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Grouper Rate,3656.00
Aetna,PPO,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Grouper Rate,5856.00
Aetna,PPO,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Grouper Rate,6401.00
Aetna,PPO,30999,CPT4/HCPCS,NASAL SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Grouper Rate,2002.00
Aetna,PPO,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Grouper Rate,2002.00
Aetna,PPO,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,3656.00
Aetna,PPO,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,5856.00
Aetna,PPO,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Grouper Rate,6401.00
Aetna,PPO,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Grouper Rate,3656.00
Aetna,PPO,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Grouper Rate,6401.00
Aetna,PPO,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,3656.00
Aetna,PPO,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,PPO,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,PPO,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,PPO,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,PPO,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,PPO,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,PPO,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6401.00
Aetna,PPO,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Grouper Rate,6840.00
Aetna,PPO,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,3656.00
Aetna,PPO,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,6840.00
Aetna,PPO,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,5856.00
Aetna,PPO,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Grouper Rate,3656.00
Aetna,PPO,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Grouper Rate,3656.00
Aetna,PPO,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Grouper Rate,3656.00
Aetna,PPO,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3656.00
Aetna,PPO,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3656.00
Aetna,PPO,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,6401.00
Aetna,PPO,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3656.00
Aetna,PPO,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Grouper Rate,5856.00
Aetna,PPO,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Grouper Rate,6840.00
Aetna,PPO,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Grouper Rate,6401.00
Aetna,PPO,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Grouper Rate,6840.00
Aetna,PPO,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,5856.00
Aetna,PPO,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Grouper Rate,6840.00
Aetna,PPO,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Grouper Rate,6840.00
Aetna,PPO,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Grouper Rate,5856.00
Aetna,PPO,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Grouper Rate,5856.00
Aetna,PPO,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5856.00
Aetna,PPO,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5856.00
Aetna,PPO,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5856.00
Aetna,PPO,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5856.00
Aetna,PPO,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Grouper Rate,5856.00
Aetna,PPO,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Grouper Rate,5856.00
Aetna,PPO,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Grouper Rate,5856.00
Aetna,PPO,31295,CPT4/HCPCS,NSL/SINS NDSC SURG MAX SINS,,Grouper Rate,5856.00
Aetna,PPO,31296,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT SINS,,Grouper Rate,5856.00
Aetna,PPO,31297,CPT4/HCPCS,NSL/SINS NDSC SURG SPHN SINS,,Grouper Rate,5856.00
Aetna,PPO,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Grouper Rate,6401.00
Aetna,PPO,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,6840.00
Aetna,PPO,31400,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,3656.00
Aetna,PPO,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Grouper Rate,3656.00
Aetna,PPO,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Grouper Rate,2002.00
Aetna,PPO,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Grouper Rate,2002.00
Aetna,PPO,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,3656.00
Aetna,PPO,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Grouper Rate,3656.00
Aetna,PPO,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,3656.00
Aetna,PPO,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Grouper Rate,3656.00
Aetna,PPO,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Grouper Rate,2002.00
Aetna,PPO,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Grouper Rate,2002.00
Aetna,PPO,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Grouper Rate,3656.00
Aetna,PPO,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Grouper Rate,3656.00
Aetna,PPO,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,3656.00
Aetna,PPO,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,3656.00
Aetna,PPO,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Grouper Rate,3656.00
Aetna,PPO,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Grouper Rate,5856.00
Aetna,PPO,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Grouper Rate,3656.00
Aetna,PPO,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Grouper Rate,5856.00
Aetna,PPO,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Grouper Rate,5856.00
Aetna,PPO,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Grouper Rate,6401.00
Aetna,PPO,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Grouper Rate,6401.00
Aetna,PPO,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Grouper Rate,6401.00
Aetna,PPO,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6840.00
Aetna,PPO,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6840.00
Aetna,PPO,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6840.00
Aetna,PPO,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6840.00
Aetna,PPO,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Grouper Rate,6840.00
Aetna,PPO,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Grouper Rate,6840.00
Aetna,PPO,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Grouper Rate,3656.00
Aetna,PPO,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Grouper Rate,3656.00
Aetna,PPO,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Grouper Rate,3656.00
Aetna,PPO,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Grouper Rate,3656.00
Aetna,PPO,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Grouper Rate,3656.00
Aetna,PPO,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,3656.00
Aetna,PPO,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Grouper Rate,3656.00
Aetna,PPO,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Grouper Rate,3656.00
Aetna,PPO,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Grouper Rate,3656.00
Aetna,PPO,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Grouper Rate,6840.00
Aetna,PPO,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Grouper Rate,6401.00
Aetna,PPO,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Grouper Rate,6401.00
Aetna,PPO,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Grouper Rate,6840.00
Aetna,PPO,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Grouper Rate,6401.00
Aetna,PPO,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Grouper Rate,6401.00
Aetna,PPO,31599,CPT4/HCPCS,LARYNX SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,3656.00
Aetna,PPO,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,2002.00
Aetna,PPO,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,2002.00
Aetna,PPO,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Grouper Rate,5856.00
Aetna,PPO,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Grouper Rate,2002.00
Aetna,PPO,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,3656.00
Aetna,PPO,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,3656.00
Aetna,PPO,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Grouper Rate,2002.00
Aetna,PPO,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Grouper Rate,3656.00
Aetna,PPO,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Grouper Rate,3656.00
Aetna,PPO,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Grouper Rate,3656.00
Aetna,PPO,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Grouper Rate,3656.00
Aetna,PPO,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Grouper Rate,5856.00
Aetna,PPO,31627,CPT4/HCPCS,NAVIGATIONAL BRONCHOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Grouper Rate,3656.00
Aetna,PPO,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Grouper Rate,3656.00
Aetna,PPO,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Grouper Rate,3656.00
Aetna,PPO,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Grouper Rate,3656.00
Aetna,PPO,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Grouper Rate,3656.00
Aetna,PPO,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Grouper Rate,3656.00
Aetna,PPO,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Grouper Rate,5856.00
Aetna,PPO,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Grouper Rate,3656.00
Aetna,PPO,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Grouper Rate,3656.00
Aetna,PPO,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Grouper Rate,3656.00
Aetna,PPO,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Grouper Rate,3656.00
Aetna,PPO,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Grouper Rate,3656.00
Aetna,PPO,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Grouper Rate,3656.00
Aetna,PPO,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Grouper Rate,3656.00
Aetna,PPO,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Grouper Rate,2002.00
Aetna,PPO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Grouper Rate,3656.00
Aetna,PPO,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Grouper Rate,3656.00
Aetna,PPO,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,Grouper Rate,2002.00
Aetna,PPO,31651,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,Grouper Rate,2002.00
Aetna,PPO,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Grouper Rate,3656.00
Aetna,PPO,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Grouper Rate,3656.00
Aetna,PPO,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Grouper Rate,2002.00
Aetna,PPO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Grouper Rate,5856.00
Aetna,PPO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Grouper Rate,5856.00
Aetna,PPO,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,2002.00
Aetna,PPO,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,2002.00
Aetna,PPO,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Grouper Rate,3656.00
Aetna,PPO,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,6840.00
Aetna,PPO,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,3656.00
Aetna,PPO,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,6401.00
Aetna,PPO,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,3656.00
Aetna,PPO,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Grouper Rate,2002.00
Aetna,PPO,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Grouper Rate,3656.00
Aetna,PPO,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Grouper Rate,3656.00
Aetna,PPO,31899,CPT4/HCPCS,AIRWAYS SURGICAL PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Grouper Rate,2002.00
Aetna,PPO,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Grouper Rate,2002.00
Aetna,PPO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Grouper Rate,3656.00
Aetna,PPO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Grouper Rate,3656.00
Aetna,PPO,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Grouper Rate,2002.00
Aetna,PPO,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Grouper Rate,2002.00
Aetna,PPO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Grouper Rate,2002.00
Aetna,PPO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Grouper Rate,2002.00
Aetna,PPO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Grouper Rate,3656.00
Aetna,PPO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Grouper Rate,3656.00
Aetna,PPO,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Grouper Rate,3656.00
Aetna,PPO,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Grouper Rate,2002.00
Aetna,PPO,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Grouper Rate,2002.00
Aetna,PPO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Grouper Rate,5856.00
Aetna,PPO,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Grouper Rate,5856.00
Aetna,PPO,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Grouper Rate,5856.00
Aetna,PPO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Grouper Rate,5856.00
Aetna,PPO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Grouper Rate,5856.00
Aetna,PPO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Grouper Rate,5856.00
Aetna,PPO,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Grouper Rate,3656.00
Aetna,PPO,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Grouper Rate,6401.00
Aetna,PPO,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Grouper Rate,6401.00
Aetna,PPO,33016,CPT4/HCPCS,PERICARDIOCENTESIS W/IMAGING,,Grouper Rate,3656.00
Aetna,PPO,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Grouper Rate,7830.00
Aetna,PPO,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Grouper Rate,7830.00
Aetna,PPO,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Grouper Rate,7830.00
Aetna,PPO,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Grouper Rate,6401.00
Aetna,PPO,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Grouper Rate,6401.00
Aetna,PPO,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Grouper Rate,5856.00
Aetna,PPO,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Grouper Rate,5856.00
Aetna,PPO,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Grouper Rate,7830.00
Aetna,PPO,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Grouper Rate,5856.00
Aetna,PPO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Grouper Rate,6401.00
Aetna,PPO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Grouper Rate,6401.00
Aetna,PPO,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Grouper Rate,6401.00
Aetna,PPO,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Grouper Rate,6401.00
Aetna,PPO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Grouper Rate,5856.00
Aetna,PPO,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Grouper Rate,3656.00
Aetna,PPO,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Grouper Rate,3656.00
Aetna,PPO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Grouper Rate,5856.00
Aetna,PPO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Grouper Rate,6401.00
Aetna,PPO,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Grouper Rate,5856.00
Aetna,PPO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Grouper Rate,5856.00
Aetna,PPO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Grouper Rate,5856.00
Aetna,PPO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Grouper Rate,5856.00
Aetna,PPO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Grouper Rate,5856.00
Aetna,PPO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Grouper Rate,5856.00
Aetna,PPO,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Grouper Rate,3656.00
Aetna,PPO,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Grouper Rate,6401.00
Aetna,PPO,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Grouper Rate,6401.00
Aetna,PPO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Grouper Rate,7830.00
Aetna,PPO,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Grouper Rate,6401.00
Aetna,PPO,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Grouper Rate,6401.00
Aetna,PPO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Grouper Rate,7830.00
Aetna,PPO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Grouper Rate,5856.00
Aetna,PPO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Grouper Rate,5856.00
Aetna,PPO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Grouper Rate,5856.00
Aetna,PPO,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Grouper Rate,5856.00
Aetna,PPO,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Grouper Rate,5856.00
Aetna,PPO,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Grouper Rate,5856.00
Aetna,PPO,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Grouper Rate,5856.00
Aetna,PPO,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,Grouper Rate,6401.00
Aetna,PPO,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,Grouper Rate,6401.00
Aetna,PPO,33285,CPT4/HCPCS,INSJ SUBQ CAR RHYTHM MNTR,,Grouper Rate,2002.00
Aetna,PPO,33286,CPT4/HCPCS,RMVL SUBQ CAR RHYTHM MNTR,,Grouper Rate,2002.00
Aetna,PPO,33289,CPT4/HCPCS,TCAT IMPL WRLS P-ART PRS SNR,,Grouper Rate,7830.00
Aetna,PPO,33968,CPT4/HCPCS,REMOVE AORTIC ASSIST DEVICE,,Grouper Rate,2002.00
Aetna,PPO,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,5856.00
Aetna,PPO,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Grouper Rate,7188.00
Aetna,PPO,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Grouper Rate,7188.00
Aetna,PPO,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Grouper Rate,7188.00
Aetna,PPO,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Grouper Rate,7188.00
Aetna,PPO,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Grouper Rate,7188.00
Aetna,PPO,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Grouper Rate,7188.00
Aetna,PPO,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Grouper Rate,8797.00
Aetna,PPO,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Grouper Rate,8797.00
Aetna,PPO,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Grouper Rate,2002.00
Aetna,PPO,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Grouper Rate,6401.00
Aetna,PPO,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Grouper Rate,2002.00
Aetna,PPO,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Grouper Rate,5856.00
Aetna,PPO,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Grouper Rate,2002.00
Aetna,PPO,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Grouper Rate,2002.00
Aetna,PPO,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Grouper Rate,2002.00
Aetna,PPO,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Grouper Rate,2002.00
Aetna,PPO,34833,CPT4/HCPCS,OPN ILAC ART EXPOS CNDT CRTJ,,Grouper Rate,8797.00
Aetna,PPO,34834,CPT4/HCPCS,OPN BRACH ART EXPOS,,Grouper Rate,8797.00
Aetna,PPO,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6401.00
Aetna,PPO,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6840.00
Aetna,PPO,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6401.00
Aetna,PPO,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6401.00
Aetna,PPO,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6401.00
Aetna,PPO,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,PPO,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,PPO,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,PPO,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,PPO,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,PPO,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7188.00
Aetna,PPO,35702,CPT4/HCPCS,EXPL N/FLWD SURG UXTR ART,,Grouper Rate,3656.00
Aetna,PPO,35703,CPT4/HCPCS,EXPL N/FLWD SURG LXTR ART,,Grouper Rate,3656.00
Aetna,PPO,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,7830.00
Aetna,PPO,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,7830.00
Aetna,PPO,35883,CPT4/HCPCS,REVISE GRAFT W/NONAUTO GRAFT,,Grouper Rate,6401.00
Aetna,PPO,35884,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,6401.00
Aetna,PPO,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Grouper Rate,2002.00
Aetna,PPO,36005,CPT4/HCPCS,INJECTION EXT VENOGRAPHY,,Grouper Rate,2002.00
Aetna,PPO,36010,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,2002.00
Aetna,PPO,36011,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,2002.00
Aetna,PPO,36012,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,2002.00
Aetna,PPO,36013,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,2002.00
Aetna,PPO,36014,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,2002.00
Aetna,PPO,36015,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,2002.00
Aetna,PPO,36100,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,Grouper Rate,2002.00
Aetna,PPO,36140,CPT4/HCPCS,INTRO NDL ICATH UPR/LXTR ART,,Grouper Rate,2002.00
Aetna,PPO,36160,CPT4/HCPCS,ESTABLISH ACCESS TO AORTA,,Grouper Rate,3656.00
Aetna,PPO,36200,CPT4/HCPCS,PLACE CATHETER IN AORTA,,Grouper Rate,3656.00
Aetna,PPO,36215,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3656.00
Aetna,PPO,36216,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3656.00
Aetna,PPO,36217,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3656.00
Aetna,PPO,36218,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3656.00
Aetna,PPO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Grouper Rate,3656.00
Aetna,PPO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,3656.00
Aetna,PPO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,3656.00
Aetna,PPO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Grouper Rate,5856.00
Aetna,PPO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Grouper Rate,3656.00
Aetna,PPO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Grouper Rate,5856.00
Aetna,PPO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Grouper Rate,2002.00
Aetna,PPO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Grouper Rate,2002.00
Aetna,PPO,36245,CPT4/HCPCS,INS CATH ABD/L-EXT ART 1ST,,Grouper Rate,3656.00
Aetna,PPO,36246,CPT4/HCPCS,INS CATH ABD/L-EXT ART 2ND,,Grouper Rate,3656.00
Aetna,PPO,36247,CPT4/HCPCS,INS CATH ABD/L-EXT ART 3RD,,Grouper Rate,3656.00
Aetna,PPO,36248,CPT4/HCPCS,INS CATH ABD/L-EXT ART ADDL,,Grouper Rate,3656.00
Aetna,PPO,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,Grouper Rate,3656.00
Aetna,PPO,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,Grouper Rate,3656.00
Aetna,PPO,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,Grouper Rate,3656.00
Aetna,PPO,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,Grouper Rate,3656.00
Aetna,PPO,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Grouper Rate,5856.00
Aetna,PPO,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Grouper Rate,3656.00
Aetna,PPO,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Grouper Rate,2002.00
Aetna,PPO,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Grouper Rate,2002.00
Aetna,PPO,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Grouper Rate,2002.00
Aetna,PPO,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Grouper Rate,2002.00
Aetna,PPO,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Grouper Rate,2002.00
Aetna,PPO,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Grouper Rate,2002.00
Aetna,PPO,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Grouper Rate,2002.00
Aetna,PPO,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Grouper Rate,2002.00
Aetna,PPO,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Grouper Rate,2002.00
Aetna,PPO,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Grouper Rate,3656.00
Aetna,PPO,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Grouper Rate,3656.00
Aetna,PPO,36468,CPT4/HCPCS,NJX SCLRSNT SPIDER VEINS,,Grouper Rate,2002.00
Aetna,PPO,36470,CPT4/HCPCS,NJX SCLRSNT 1 INCMPTNT VEIN,,Grouper Rate,2002.00
Aetna,PPO,36471,CPT4/HCPCS,NJX SCLRSNT MLT INCMPTNT VN,,Grouper Rate,2002.00
Aetna,PPO,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Grouper Rate,5856.00
Aetna,PPO,36474,CPT4/HCPCS,ENDOVENOUS MCHNCHEM ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Grouper Rate,5856.00
Aetna,PPO,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Grouper Rate,5856.00
Aetna,PPO,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Grouper Rate,2002.00
Aetna,PPO,36481,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,2002.00
Aetna,PPO,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Grouper Rate,5856.00
Aetna,PPO,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Grouper Rate,2002.00
Aetna,PPO,36500,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,2002.00
Aetna,PPO,36511,CPT4/HCPCS,APHERESIS WBC,,Grouper Rate,3656.00
Aetna,PPO,36512,CPT4/HCPCS,APHERESIS RBC,,Grouper Rate,3656.00
Aetna,PPO,36513,CPT4/HCPCS,APHERESIS PLATELETS,,Grouper Rate,3656.00
Aetna,PPO,36514,CPT4/HCPCS,APHERESIS PLASMA,,Grouper Rate,3656.00
Aetna,PPO,36516,CPT4/HCPCS,APHERESIS IMMUNOADS SLCTV,,Grouper Rate,7830.00
Aetna,PPO,36522,CPT4/HCPCS,PHOTOPHERESIS,,Grouper Rate,3656.00
Aetna,PPO,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,2002.00
Aetna,PPO,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,2002.00
Aetna,PPO,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,PPO,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,PPO,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,PPO,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,PPO,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,PPO,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,PPO,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,PPO,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Grouper Rate,2002.00
Aetna,PPO,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Grouper Rate,2002.00
Aetna,PPO,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,5856.00
Aetna,PPO,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,5856.00
Aetna,PPO,36572,CPT4/HCPCS,INSJ PICC RS&I <5 YR,,Grouper Rate,2002.00
Aetna,PPO,36573,CPT4/HCPCS,INSJ PICC RS&I 5 YR+,,Grouper Rate,2002.00
Aetna,PPO,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,PPO,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,PPO,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,PPO,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Grouper Rate,2002.00
Aetna,PPO,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,3656.00
Aetna,PPO,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,PPO,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,5856.00
Aetna,PPO,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Grouper Rate,2002.00
Aetna,PPO,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Grouper Rate,5856.00
Aetna,PPO,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,2002.00
Aetna,PPO,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,2002.00
Aetna,PPO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Grouper Rate,2002.00
Aetna,PPO,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,6401.00
Aetna,PPO,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,2002.00
Aetna,PPO,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Grouper Rate,2002.00
Aetna,PPO,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Grouper Rate,3656.00
Aetna,PPO,36620,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,2002.00
Aetna,PPO,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,2002.00
Aetna,PPO,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Grouper Rate,2002.00
Aetna,PPO,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,5856.00
Aetna,PPO,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,5856.00
Aetna,PPO,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,5856.00
Aetna,PPO,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Grouper Rate,5856.00
Aetna,PPO,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Grouper Rate,5856.00
Aetna,PPO,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Grouper Rate,5856.00
Aetna,PPO,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Grouper Rate,5856.00
Aetna,PPO,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Grouper Rate,6401.00
Aetna,PPO,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Grouper Rate,6401.00
Aetna,PPO,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Grouper Rate,7830.00
Aetna,PPO,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Grouper Rate,6401.00
Aetna,PPO,36833,CPT4/HCPCS,AV FISTULA REVISION,,Grouper Rate,6401.00
Aetna,PPO,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Grouper Rate,6401.00
Aetna,PPO,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Grouper Rate,6401.00
Aetna,PPO,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Grouper Rate,3656.00
Aetna,PPO,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Grouper Rate,5856.00
Aetna,PPO,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,2002.00
Aetna,PPO,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,7830.00
Aetna,PPO,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,7830.00
Aetna,PPO,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,6840.00
Aetna,PPO,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,7830.00
Aetna,PPO,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,7830.00
Aetna,PPO,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Grouper Rate,2002.00
Aetna,PPO,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Grouper Rate,2002.00
Aetna,PPO,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Grouper Rate,2002.00
Aetna,PPO,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Grouper Rate,9770.00
Aetna,PPO,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Grouper Rate,9770.00
Aetna,PPO,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Grouper Rate,3656.00
Aetna,PPO,37186,CPT4/HCPCS,SEC ART THROMBECTOMY ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Grouper Rate,9770.00
Aetna,PPO,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Grouper Rate,9770.00
Aetna,PPO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Grouper Rate,5856.00
Aetna,PPO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Grouper Rate,5856.00
Aetna,PPO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Grouper Rate,5856.00
Aetna,PPO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Grouper Rate,5856.00
Aetna,PPO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Grouper Rate,6401.00
Aetna,PPO,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Grouper Rate,2002.00
Aetna,PPO,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Grouper Rate,2002.00
Aetna,PPO,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Grouper Rate,5856.00
Aetna,PPO,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Grouper Rate,5856.00
Aetna,PPO,37215,CPT4/HCPCS,TRANSCATH STENT CCA W/EPS,,Grouper Rate,5856.00
Aetna,PPO,37216,CPT4/HCPCS,TRANSCATH STENT CCA W/O EPS,,Grouper Rate,5856.00
Aetna,PPO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Grouper Rate,5856.00
Aetna,PPO,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Grouper Rate,5856.00
Aetna,PPO,37220,CPT4/HCPCS,ILIAC REVASC,,Grouper Rate,6401.00
Aetna,PPO,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Grouper Rate,6401.00
Aetna,PPO,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Grouper Rate,6401.00
Aetna,PPO,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Grouper Rate,6401.00
Aetna,PPO,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Grouper Rate,6401.00
Aetna,PPO,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Grouper Rate,6401.00
Aetna,PPO,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Grouper Rate,6401.00
Aetna,PPO,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Grouper Rate,6401.00
Aetna,PPO,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Grouper Rate,6401.00
Aetna,PPO,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Grouper Rate,6401.00
Aetna,PPO,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Grouper Rate,2002.00
Aetna,PPO,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Grouper Rate,2002.00
Aetna,PPO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Grouper Rate,5856.00
Aetna,PPO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,2002.00
Aetna,PPO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Grouper Rate,5856.00
Aetna,PPO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,2002.00
Aetna,PPO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Grouper Rate,5856.00
Aetna,PPO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Grouper Rate,5856.00
Aetna,PPO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Grouper Rate,5856.00
Aetna,PPO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Grouper Rate,5856.00
Aetna,PPO,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Grouper Rate,7830.00
Aetna,PPO,37247,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL ART,,Grouper Rate,2002.00
Aetna,PPO,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Grouper Rate,7830.00
Aetna,PPO,37249,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL VEIN,,Grouper Rate,2002.00
Aetna,PPO,37252,CPT4/HCPCS,INTRVASC US NONCORONARY 1ST,,Grouper Rate,2002.00
Aetna,PPO,37253,CPT4/HCPCS,INTRVASC US NONCORONARY ADDL,,Grouper Rate,2002.00
Aetna,PPO,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Grouper Rate,5856.00
Aetna,PPO,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Grouper Rate,5856.00
Aetna,PPO,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Grouper Rate,3656.00
Aetna,PPO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Grouper Rate,5856.00
Aetna,PPO,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,3656.00
Aetna,PPO,37700,CPT4/HCPCS,REVISE LEG VEIN,,Grouper Rate,3656.00
Aetna,PPO,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Grouper Rate,5856.00
Aetna,PPO,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Grouper Rate,5856.00
Aetna,PPO,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Grouper Rate,5856.00
Aetna,PPO,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Grouper Rate,5856.00
Aetna,PPO,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Grouper Rate,5856.00
Aetna,PPO,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Grouper Rate,5856.00
Aetna,PPO,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Grouper Rate,5856.00
Aetna,PPO,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Grouper Rate,5856.00
Aetna,PPO,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Grouper Rate,5856.00
Aetna,PPO,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Grouper Rate,5856.00
Aetna,PPO,37799,CPT4/HCPCS,VASCULAR SURGERY PROCEDURE,,Grouper Rate,3656.00
Aetna,PPO,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Grouper Rate,6840.00
Aetna,PPO,38129,CPT4/HCPCS,LAPAROSCOPE PROC SPLEEN,,Grouper Rate,5856.00
Aetna,PPO,38200,CPT4/HCPCS,INJECTION FOR SPLEEN X-RAY,,Grouper Rate,2002.00
Aetna,PPO,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Grouper Rate,2002.00
Aetna,PPO,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Grouper Rate,2002.00
Aetna,PPO,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Grouper Rate,2002.00
Aetna,PPO,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Grouper Rate,6840.00
Aetna,PPO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Grouper Rate,5856.00
Aetna,PPO,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Grouper Rate,6840.00
Aetna,PPO,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Grouper Rate,6840.00
Aetna,PPO,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Grouper Rate,2002.00
Aetna,PPO,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,2002.00
Aetna,PPO,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,3656.00
Aetna,PPO,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Grouper Rate,3656.00
Aetna,PPO,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3656.00
Aetna,PPO,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Grouper Rate,2002.00
Aetna,PPO,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3656.00
Aetna,PPO,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3656.00
Aetna,PPO,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3656.00
Aetna,PPO,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3656.00
Aetna,PPO,38531,CPT4/HCPCS,OPEN BX/EXC INGUINOFEM NODES,,Grouper Rate,3656.00
Aetna,PPO,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Grouper Rate,3656.00
Aetna,PPO,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,5856.00
Aetna,PPO,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,6401.00
Aetna,PPO,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Grouper Rate,7188.00
Aetna,PPO,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,9770.00
Aetna,PPO,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,9770.00
Aetna,PPO,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Grouper Rate,7188.00
Aetna,PPO,38589,CPT4/HCPCS,LAPAROSCOPE PROC LYMPHATIC,,Grouper Rate,5856.00
Aetna,PPO,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,3656.00
Aetna,PPO,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,6401.00
Aetna,PPO,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,6401.00
Aetna,PPO,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,3656.00
Aetna,PPO,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,6401.00
Aetna,PPO,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,3656.00
Aetna,PPO,38790,CPT4/HCPCS,INJECT FOR LYMPHATIC X-RAY,,Grouper Rate,2002.00
Aetna,PPO,38792,CPT4/HCPCS,RA TRACER ID OF SENTINL NODE,,Grouper Rate,2002.00
Aetna,PPO,38900,CPT4/HCPCS,IO MAP OF SENT LYMPH NODE,,Grouper Rate,2002.00
Aetna,PPO,38999,CPT4/HCPCS,BLOOD/LYMPH SYSTEM PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Grouper Rate,5856.00
Aetna,PPO,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Grouper Rate,5856.00
Aetna,PPO,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,3656.00
Aetna,PPO,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,3656.00
Aetna,PPO,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,3656.00
Aetna,PPO,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,3656.00
Aetna,PPO,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,3656.00
Aetna,PPO,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Grouper Rate,3656.00
Aetna,PPO,40650,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,5856.00
Aetna,PPO,40652,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,5856.00
Aetna,PPO,40654,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,5856.00
Aetna,PPO,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,7830.00
Aetna,PPO,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,7830.00
Aetna,PPO,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5856.00
Aetna,PPO,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,7830.00
Aetna,PPO,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5856.00
Aetna,PPO,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,3656.00
Aetna,PPO,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,3656.00
Aetna,PPO,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Grouper Rate,2002.00
Aetna,PPO,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,3656.00
Aetna,PPO,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,3656.00
Aetna,PPO,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Grouper Rate,2002.00
Aetna,PPO,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Grouper Rate,2002.00
Aetna,PPO,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,2002.00
Aetna,PPO,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,3656.00
Aetna,PPO,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5856.00
Aetna,PPO,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5856.00
Aetna,PPO,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,6840.00
Aetna,PPO,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,6840.00
Aetna,PPO,40899,CPT4/HCPCS,MOUTH SURGERY PROCEDURE,,Grouper Rate,6840.00
Aetna,PPO,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Grouper Rate,2002.00
Aetna,PPO,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Grouper Rate,2002.00
Aetna,PPO,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,2002.00
Aetna,PPO,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,3656.00
Aetna,PPO,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Grouper Rate,2002.00
Aetna,PPO,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,2002.00
Aetna,PPO,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,3656.00
Aetna,PPO,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,3656.00
Aetna,PPO,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,3656.00
Aetna,PPO,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Grouper Rate,2002.00
Aetna,PPO,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,2002.00
Aetna,PPO,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,6840.00
Aetna,PPO,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,3656.00
Aetna,PPO,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,3656.00
Aetna,PPO,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,3656.00
Aetna,PPO,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Grouper Rate,2002.00
Aetna,PPO,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Grouper Rate,3656.00
Aetna,PPO,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Grouper Rate,3656.00
Aetna,PPO,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Grouper Rate,2002.00
Aetna,PPO,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Grouper Rate,2002.00
Aetna,PPO,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Grouper Rate,2002.00
Aetna,PPO,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Grouper Rate,2002.00
Aetna,PPO,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Grouper Rate,2002.00
Aetna,PPO,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Grouper Rate,2002.00
Aetna,PPO,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,2002.00
Aetna,PPO,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,3656.00
Aetna,PPO,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,2002.00
Aetna,PPO,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,2002.00
Aetna,PPO,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,3656.00
Aetna,PPO,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,2002.00
Aetna,PPO,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Grouper Rate,2002.00
Aetna,PPO,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Grouper Rate,2002.00
Aetna,PPO,41870,CPT4/HCPCS,GUM GRAFT,,Grouper Rate,3656.00
Aetna,PPO,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Grouper Rate,2002.00
Aetna,PPO,41899,CPT4/HCPCS,DENTAL SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Grouper Rate,3656.00
Aetna,PPO,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Grouper Rate,2002.00
Aetna,PPO,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,3656.00
Aetna,PPO,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,3656.00
Aetna,PPO,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,3656.00
Aetna,PPO,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Grouper Rate,6401.00
Aetna,PPO,42140,CPT4/HCPCS,EXCISION OF UVULA,,Grouper Rate,3656.00
Aetna,PPO,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Grouper Rate,6840.00
Aetna,PPO,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Grouper Rate,2002.00
Aetna,PPO,42180,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,2002.00
Aetna,PPO,42182,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,3656.00
Aetna,PPO,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6840.00
Aetna,PPO,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6840.00
Aetna,PPO,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6840.00
Aetna,PPO,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,7830.00
Aetna,PPO,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6840.00
Aetna,PPO,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6840.00
Aetna,PPO,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,6840.00
Aetna,PPO,42235,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,6840.00
Aetna,PPO,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Grouper Rate,6401.00
Aetna,PPO,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Grouper Rate,2002.00
Aetna,PPO,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Grouper Rate,5856.00
Aetna,PPO,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,2002.00
Aetna,PPO,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,3656.00
Aetna,PPO,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,2002.00
Aetna,PPO,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,2002.00
Aetna,PPO,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,2002.00
Aetna,PPO,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,5856.00
Aetna,PPO,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,3656.00
Aetna,PPO,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,2002.00
Aetna,PPO,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,3656.00
Aetna,PPO,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Grouper Rate,5856.00
Aetna,PPO,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Grouper Rate,5856.00
Aetna,PPO,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5856.00
Aetna,PPO,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,7830.00
Aetna,PPO,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,7830.00
Aetna,PPO,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,7830.00
Aetna,PPO,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Grouper Rate,5856.00
Aetna,PPO,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Grouper Rate,3656.00
Aetna,PPO,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,5856.00
Aetna,PPO,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,6401.00
Aetna,PPO,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5856.00
Aetna,PPO,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,6401.00
Aetna,PPO,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,6401.00
Aetna,PPO,42550,CPT4/HCPCS,INJECTION FOR SALIVARY X-RAY,,Grouper Rate,2002.00
Aetna,PPO,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Grouper Rate,2002.00
Aetna,PPO,42650,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Grouper Rate,2002.00
Aetna,PPO,42660,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Grouper Rate,2002.00
Aetna,PPO,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Grouper Rate,7830.00
Aetna,PPO,42699,CPT4/HCPCS,SALIVARY SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,3656.00
Aetna,PPO,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Grouper Rate,2002.00
Aetna,PPO,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,2002.00
Aetna,PPO,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,3656.00
Aetna,PPO,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Grouper Rate,3656.00
Aetna,PPO,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Grouper Rate,2002.00
Aetna,PPO,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,5856.00
Aetna,PPO,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,6840.00
Aetna,PPO,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,5856.00
Aetna,PPO,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,6840.00
Aetna,PPO,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,6401.00
Aetna,PPO,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,6401.00
Aetna,PPO,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,6401.00
Aetna,PPO,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,6401.00
Aetna,PPO,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,6401.00
Aetna,PPO,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,6401.00
Aetna,PPO,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Grouper Rate,5856.00
Aetna,PPO,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Grouper Rate,5856.00
Aetna,PPO,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Grouper Rate,7830.00
Aetna,PPO,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,7830.00
Aetna,PPO,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Grouper Rate,2002.00
Aetna,PPO,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Grouper Rate,3656.00
Aetna,PPO,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Grouper Rate,3656.00
Aetna,PPO,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,2002.00
Aetna,PPO,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,3656.00
Aetna,PPO,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,2002.00
Aetna,PPO,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,5856.00
Aetna,PPO,42999,CPT4/HCPCS,THROAT SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,6840.00
Aetna,PPO,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Grouper Rate,3656.00
Aetna,PPO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Grouper Rate,2002.00
Aetna,PPO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Grouper Rate,2002.00
Aetna,PPO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Grouper Rate,2002.00
Aetna,PPO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Grouper Rate,3656.00
Aetna,PPO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Grouper Rate,3656.00
Aetna,PPO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Grouper Rate,2002.00
Aetna,PPO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Grouper Rate,2002.00
Aetna,PPO,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Grouper Rate,2002.00
Aetna,PPO,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Grouper Rate,2002.00
Aetna,PPO,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Grouper Rate,2002.00
Aetna,PPO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Grouper Rate,2002.00
Aetna,PPO,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Grouper Rate,5856.00
Aetna,PPO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Grouper Rate,3656.00
Aetna,PPO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Grouper Rate,3656.00
Aetna,PPO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Grouper Rate,3656.00
Aetna,PPO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Grouper Rate,3656.00
Aetna,PPO,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Grouper Rate,2002.00
Aetna,PPO,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Grouper Rate,2002.00
Aetna,PPO,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Grouper Rate,2002.00
Aetna,PPO,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Grouper Rate,3656.00
Aetna,PPO,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Grouper Rate,2002.00
Aetna,PPO,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Grouper Rate,3656.00
Aetna,PPO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Grouper Rate,3656.00
Aetna,PPO,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Grouper Rate,3656.00
Aetna,PPO,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Grouper Rate,3656.00
Aetna,PPO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Grouper Rate,3656.00
Aetna,PPO,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Grouper Rate,2002.00
Aetna,PPO,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Grouper Rate,3656.00
Aetna,PPO,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Grouper Rate,3656.00
Aetna,PPO,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,3656.00
Aetna,PPO,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Grouper Rate,3656.00
Aetna,PPO,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Grouper Rate,3656.00
Aetna,PPO,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Grouper Rate,3656.00
Aetna,PPO,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,3656.00
Aetna,PPO,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Grouper Rate,3656.00
Aetna,PPO,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Grouper Rate,3656.00
Aetna,PPO,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Grouper Rate,3656.00
Aetna,PPO,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Grouper Rate,3656.00
Aetna,PPO,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Grouper Rate,3656.00
Aetna,PPO,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Grouper Rate,3656.00
Aetna,PPO,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Grouper Rate,3656.00
Aetna,PPO,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Grouper Rate,3656.00
Aetna,PPO,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Grouper Rate,3656.00
Aetna,PPO,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Grouper Rate,3656.00
Aetna,PPO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Grouper Rate,5856.00
Aetna,PPO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Grouper Rate,5856.00
Aetna,PPO,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Grouper Rate,3656.00
Aetna,PPO,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Grouper Rate,5856.00
Aetna,PPO,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Grouper Rate,5856.00
Aetna,PPO,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Grouper Rate,3656.00
Aetna,PPO,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,3656.00
Aetna,PPO,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,3656.00
Aetna,PPO,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Grouper Rate,3656.00
Aetna,PPO,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Grouper Rate,3656.00
Aetna,PPO,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Grouper Rate,3656.00
Aetna,PPO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Grouper Rate,5856.00
Aetna,PPO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Grouper Rate,5856.00
Aetna,PPO,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Grouper Rate,5856.00
Aetna,PPO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Grouper Rate,5856.00
Aetna,PPO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Grouper Rate,5856.00
Aetna,PPO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Grouper Rate,5856.00
Aetna,PPO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Grouper Rate,5856.00
Aetna,PPO,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Grouper Rate,6840.00
Aetna,PPO,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Grouper Rate,6840.00
Aetna,PPO,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Grouper Rate,6840.00
Aetna,PPO,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Grouper Rate,6840.00
Aetna,PPO,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Grouper Rate,6401.00
Aetna,PPO,43289,CPT4/HCPCS,LAPAROSCOPE PROC ESOPH,,Grouper Rate,5856.00
Aetna,PPO,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,3656.00
Aetna,PPO,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Grouper Rate,2002.00
Aetna,PPO,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,2002.00
Aetna,PPO,43499,CPT4/HCPCS,ESOPHAGUS SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Grouper Rate,5856.00
Aetna,PPO,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Grouper Rate,5856.00
Aetna,PPO,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,6840.00
Aetna,PPO,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,6840.00
Aetna,PPO,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Grouper Rate,7188.00
Aetna,PPO,43659,CPT4/HCPCS,LAPAROSCOPE PROC STOM,,Grouper Rate,5856.00
Aetna,PPO,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Grouper Rate,3656.00
Aetna,PPO,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Grouper Rate,2002.00
Aetna,PPO,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Grouper Rate,2002.00
Aetna,PPO,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Grouper Rate,2002.00
Aetna,PPO,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Grouper Rate,2002.00
Aetna,PPO,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Grouper Rate,2002.00
Aetna,PPO,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Grouper Rate,2002.00
Aetna,PPO,43762,CPT4/HCPCS,RPLC GTUBE NO REVJ TRC,,Grouper Rate,2002.00
Aetna,PPO,43763,CPT4/HCPCS,RPLC GTUBE REVJ GSTRST TRC,,Grouper Rate,2002.00
Aetna,PPO,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Grouper Rate,5856.00
Aetna,PPO,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Grouper Rate,5856.00
Aetna,PPO,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Grouper Rate,5856.00
Aetna,PPO,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Grouper Rate,5856.00
Aetna,PPO,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Grouper Rate,5856.00
Aetna,PPO,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Grouper Rate,2002.00
Aetna,PPO,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Grouper Rate,2002.00
Aetna,PPO,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Grouper Rate,2002.00
Aetna,PPO,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Grouper Rate,3656.00
Aetna,PPO,43999,CPT4/HCPCS,STOMACH SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Grouper Rate,7830.00
Aetna,PPO,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Grouper Rate,7188.00
Aetna,PPO,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Grouper Rate,7188.00
Aetna,PPO,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Grouper Rate,7188.00
Aetna,PPO,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Grouper Rate,7188.00
Aetna,PPO,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Grouper Rate,7830.00
Aetna,PPO,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Grouper Rate,2002.00
Aetna,PPO,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Grouper Rate,5856.00
Aetna,PPO,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Grouper Rate,6840.00
Aetna,PPO,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Grouper Rate,5856.00
Aetna,PPO,44188,CPT4/HCPCS,LAP COLOSTOMY,,Grouper Rate,5856.00
Aetna,PPO,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Grouper Rate,6840.00
Aetna,PPO,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Grouper Rate,5856.00
Aetna,PPO,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Grouper Rate,5856.00
Aetna,PPO,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,2002.00
Aetna,PPO,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5856.00
Aetna,PPO,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,6401.00
Aetna,PPO,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,6401.00
Aetna,PPO,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,3656.00
Aetna,PPO,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Grouper Rate,6840.00
Aetna,PPO,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,3656.00
Aetna,PPO,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Grouper Rate,6840.00
Aetna,PPO,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,2002.00
Aetna,PPO,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,2002.00
Aetna,PPO,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Grouper Rate,2002.00
Aetna,PPO,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Grouper Rate,2002.00
Aetna,PPO,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Grouper Rate,2002.00
Aetna,PPO,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Grouper Rate,2002.00
Aetna,PPO,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Grouper Rate,2002.00
Aetna,PPO,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Grouper Rate,2002.00
Aetna,PPO,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Grouper Rate,2002.00
Aetna,PPO,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Grouper Rate,2002.00
Aetna,PPO,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,2002.00
Aetna,PPO,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,2002.00
Aetna,PPO,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Grouper Rate,2002.00
Aetna,PPO,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Grouper Rate,2002.00
Aetna,PPO,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Grouper Rate,2002.00
Aetna,PPO,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Grouper Rate,2002.00
Aetna,PPO,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,2002.00
Aetna,PPO,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Grouper Rate,2002.00
Aetna,PPO,44799,CPT4/HCPCS,UNLISTED PX SMALL INTESTINE,,Grouper Rate,2002.00
Aetna,PPO,44950,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,6401.00
Aetna,PPO,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Grouper Rate,5856.00
Aetna,PPO,44979,CPT4/HCPCS,LAPAROSCOPE PROC APP,,Grouper Rate,5856.00
Aetna,PPO,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,3656.00
Aetna,PPO,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,3656.00
Aetna,PPO,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Grouper Rate,2002.00
Aetna,PPO,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Grouper Rate,3656.00
Aetna,PPO,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Grouper Rate,3656.00
Aetna,PPO,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Grouper Rate,3656.00
Aetna,PPO,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Grouper Rate,2002.00
Aetna,PPO,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Grouper Rate,3656.00
Aetna,PPO,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Grouper Rate,3656.00
Aetna,PPO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,Per Diem,5769.00
Aetna,PPO,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Grouper Rate,2002.00
Aetna,PPO,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Grouper Rate,2002.00
Aetna,PPO,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Grouper Rate,2002.00
Aetna,PPO,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Grouper Rate,2002.00
Aetna,PPO,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,2002.00
Aetna,PPO,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,2002.00
Aetna,PPO,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,2002.00
Aetna,PPO,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Grouper Rate,2002.00
Aetna,PPO,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Grouper Rate,2002.00
Aetna,PPO,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Grouper Rate,2002.00
Aetna,PPO,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Grouper Rate,2002.00
Aetna,PPO,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Grouper Rate,2002.00
Aetna,PPO,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Grouper Rate,2002.00
Aetna,PPO,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Grouper Rate,2002.00
Aetna,PPO,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Grouper Rate,2002.00
Aetna,PPO,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Grouper Rate,2002.00
Aetna,PPO,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Grouper Rate,2002.00
Aetna,PPO,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Grouper Rate,2002.00
Aetna,PPO,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Grouper Rate,2002.00
Aetna,PPO,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Grouper Rate,2002.00
Aetna,PPO,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Grouper Rate,2002.00
Aetna,PPO,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Grouper Rate,2002.00
Aetna,PPO,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Grouper Rate,2002.00
Aetna,PPO,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Grouper Rate,2002.00
Aetna,PPO,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Grouper Rate,3656.00
Aetna,PPO,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Grouper Rate,3656.00
Aetna,PPO,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Grouper Rate,3656.00
Aetna,PPO,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Grouper Rate,3656.00
Aetna,PPO,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,3656.00
Aetna,PPO,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,3656.00
Aetna,PPO,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Grouper Rate,3656.00
Aetna,PPO,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Grouper Rate,3656.00
Aetna,PPO,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,3656.00
Aetna,PPO,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,3656.00
Aetna,PPO,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Grouper Rate,3656.00
Aetna,PPO,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Grouper Rate,3656.00
Aetna,PPO,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,3656.00
Aetna,PPO,45395,CPT4/HCPCS,LAP REMOVAL OF RECTUM,,Grouper Rate,5856.00
Aetna,PPO,45397,CPT4/HCPCS,LAP REMOVE RECTUM W/POUCH,,Grouper Rate,5856.00
Aetna,PPO,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Grouper Rate,3656.00
Aetna,PPO,45399,CPT4/HCPCS,UNLISTED PROCEDURE COLON,,Grouper Rate,2002.00
Aetna,PPO,454,DRG,Combined anterior/posterior spinal fusion w CC,,Per Diem,5769.00
Aetna,PPO,45400,CPT4/HCPCS,LAPAROSCOPIC PROC,,Grouper Rate,5856.00
Aetna,PPO,45402,CPT4/HCPCS,LAP PROCTOPEXY W/SIG RESECT,,Grouper Rate,5856.00
Aetna,PPO,45499,CPT4/HCPCS,LAPAROSCOPE PROC RECTUM,,Grouper Rate,5856.00
Aetna,PPO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,Per Diem,5769.00
Aetna,PPO,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,3656.00
Aetna,PPO,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,3656.00
Aetna,PPO,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Grouper Rate,2002.00
Aetna,PPO,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,3656.00
Aetna,PPO,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Grouper Rate,3656.00
Aetna,PPO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,Per Diem,5769.00
Aetna,PPO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,Per Diem,5769.00
Aetna,PPO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,Per Diem,5769.00
Aetna,PPO,459,DRG,Spinal fusion except cervical w MCC,,Per Diem,5769.00
Aetna,PPO,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Grouper Rate,2002.00
Aetna,PPO,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Grouper Rate,2002.00
Aetna,PPO,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Grouper Rate,2002.00
Aetna,PPO,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Grouper Rate,2002.00
Aetna,PPO,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Grouper Rate,3656.00
Aetna,PPO,460,DRG,Spinal fusion except cervical w/o MCC,,Per Diem,5769.00
Aetna,PPO,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Grouper Rate,5856.00
Aetna,PPO,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Grouper Rate,2002.00
Aetna,PPO,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,5856.00
Aetna,PPO,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,3656.00
Aetna,PPO,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,3656.00
Aetna,PPO,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Grouper Rate,2002.00
Aetna,PPO,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Grouper Rate,5856.00
Aetna,PPO,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Grouper Rate,2002.00
Aetna,PPO,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Grouper Rate,3656.00
Aetna,PPO,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Grouper Rate,2002.00
Aetna,PPO,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Grouper Rate,2002.00
Aetna,PPO,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Grouper Rate,2002.00
Aetna,PPO,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Grouper Rate,5856.00
Aetna,PPO,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Grouper Rate,5856.00
Aetna,PPO,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Grouper Rate,5856.00
Aetna,PPO,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Grouper Rate,5856.00
Aetna,PPO,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Grouper Rate,5856.00
Aetna,PPO,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Grouper Rate,6401.00
Aetna,PPO,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Grouper Rate,6401.00
Aetna,PPO,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Grouper Rate,5856.00
Aetna,PPO,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Grouper Rate,5856.00
Aetna,PPO,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Grouper Rate,6401.00
Aetna,PPO,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Grouper Rate,2002.00
Aetna,PPO,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Grouper Rate,6401.00
Aetna,PPO,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Grouper Rate,2002.00
Aetna,PPO,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Grouper Rate,2002.00
Aetna,PPO,46600,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY SPX,,Grouper Rate,2002.00
Aetna,PPO,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Grouper Rate,2002.00
Aetna,PPO,46606,CPT4/HCPCS,ANOSCOPY AND BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Grouper Rate,2002.00
Aetna,PPO,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Grouper Rate,2002.00
Aetna,PPO,46611,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Grouper Rate,2002.00
Aetna,PPO,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Grouper Rate,2002.00
Aetna,PPO,46615,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,3656.00
Aetna,PPO,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,5856.00
Aetna,PPO,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Grouper Rate,2002.00
Aetna,PPO,46710,CPT4/HCPCS,REPR PER/VAG POUCH SNGL PROC,,Grouper Rate,5856.00
Aetna,PPO,46712,CPT4/HCPCS,REPR PER/VAG POUCH DBL PROC,,Grouper Rate,5856.00
Aetna,PPO,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,5856.00
Aetna,PPO,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Grouper Rate,5856.00
Aetna,PPO,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Grouper Rate,3656.00
Aetna,PPO,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3656.00
Aetna,PPO,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,5856.00
Aetna,PPO,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,2002.00
Aetna,PPO,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,3656.00
Aetna,PPO,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Grouper Rate,3656.00
Aetna,PPO,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Grouper Rate,2002.00
Aetna,PPO,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Grouper Rate,2002.00
Aetna,PPO,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,2002.00
Aetna,PPO,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Grouper Rate,2002.00
Aetna,PPO,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,2002.00
Aetna,PPO,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,2002.00
Aetna,PPO,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Grouper Rate,3656.00
Aetna,PPO,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Grouper Rate,3656.00
Aetna,PPO,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Grouper Rate,7830.00
Aetna,PPO,46948,CPT4/HCPCS,INT HRHC TRANAL DARTLZJ 2+,,Grouper Rate,3656.00
Aetna,PPO,46999,CPT4/HCPCS,ANUS SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Grouper Rate,2002.00
Aetna,PPO,47001,CPT4/HCPCS,NEEDLE BIOPSY LIVER ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,471,DRG,Cervical spinal fusion w MCC,,Per Diem,5769.00
Aetna,PPO,472,DRG,Cervical spinal fusion w CC,,Per Diem,5769.00
Aetna,PPO,473,DRG,Cervical spinal fusion w/o CC/MCC,,Per Diem,5769.00
Aetna,PPO,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Grouper Rate,6401.00
Aetna,PPO,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Grouper Rate,6401.00
Aetna,PPO,47379,CPT4/HCPCS,LAPAROSCOPE PROCEDURE LIVER,,Grouper Rate,6840.00
Aetna,PPO,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Grouper Rate,6840.00
Aetna,PPO,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Grouper Rate,6840.00
Aetna,PPO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Grouper Rate,6401.00
Aetna,PPO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Grouper Rate,9770.00
Aetna,PPO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,2002.00
Aetna,PPO,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,3656.00
Aetna,PPO,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,3656.00
Aetna,PPO,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,3656.00
Aetna,PPO,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Grouper Rate,3656.00
Aetna,PPO,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Grouper Rate,3656.00
Aetna,PPO,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Grouper Rate,2002.00
Aetna,PPO,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,5856.00
Aetna,PPO,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,5856.00
Aetna,PPO,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,5856.00
Aetna,PPO,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Grouper Rate,3656.00
Aetna,PPO,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Grouper Rate,2002.00
Aetna,PPO,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Grouper Rate,2002.00
Aetna,PPO,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Grouper Rate,2002.00
Aetna,PPO,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Grouper Rate,3656.00
Aetna,PPO,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,5856.00
Aetna,PPO,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,5856.00
Aetna,PPO,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,5856.00
Aetna,PPO,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,5856.00
Aetna,PPO,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Grouper Rate,6840.00
Aetna,PPO,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Grouper Rate,6840.00
Aetna,PPO,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Grouper Rate,7830.00
Aetna,PPO,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Grouper Rate,7830.00
Aetna,PPO,47579,CPT4/HCPCS,LAPAROSCOPE PROC BILIARY,,Grouper Rate,5856.00
Aetna,PPO,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6401.00
Aetna,PPO,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6840.00
Aetna,PPO,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,7188.00
Aetna,PPO,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,7188.00
Aetna,PPO,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,7830.00
Aetna,PPO,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Grouper Rate,2002.00
Aetna,PPO,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,6401.00
Aetna,PPO,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Grouper Rate,6401.00
Aetna,PPO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Grouper Rate,3656.00
Aetna,PPO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Grouper Rate,3656.00
Aetna,PPO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Grouper Rate,3656.00
Aetna,PPO,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Grouper Rate,2002.00
Aetna,PPO,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Grouper Rate,3656.00
Aetna,PPO,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Grouper Rate,6401.00
Aetna,PPO,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Grouper Rate,5856.00
Aetna,PPO,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Grouper Rate,6401.00
Aetna,PPO,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Grouper Rate,6401.00
Aetna,PPO,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Grouper Rate,5856.00
Aetna,PPO,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Grouper Rate,6401.00
Aetna,PPO,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Grouper Rate,6401.00
Aetna,PPO,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,49327,CPT4/HCPCS,LAP INS DEVICE FOR RT,,Grouper Rate,2002.00
Aetna,PPO,49329,CPT4/HCPCS,LAPARO PROC ABDM/PER/OMENT,,Grouper Rate,2002.00
Aetna,PPO,49400,CPT4/HCPCS,AIR INJECTION INTO ABDOMEN,,Grouper Rate,2002.00
Aetna,PPO,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Grouper Rate,3656.00
Aetna,PPO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Grouper Rate,3656.00
Aetna,PPO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Grouper Rate,3656.00
Aetna,PPO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Grouper Rate,5856.00
Aetna,PPO,49411,CPT4/HCPCS,INS MARK ABD/PEL FOR RT PERQ,,Grouper Rate,2002.00
Aetna,PPO,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Grouper Rate,3656.00
Aetna,PPO,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Grouper Rate,3656.00
Aetna,PPO,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Grouper Rate,3656.00
Aetna,PPO,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Grouper Rate,2002.00
Aetna,PPO,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Grouper Rate,2002.00
Aetna,PPO,49424,CPT4/HCPCS,ASSESS CYST CONTRAST INJECT,,Grouper Rate,2002.00
Aetna,PPO,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Grouper Rate,3656.00
Aetna,PPO,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Grouper Rate,3656.00
Aetna,PPO,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,Grouper Rate,2002.00
Aetna,PPO,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Grouper Rate,3656.00
Aetna,PPO,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Grouper Rate,2002.00
Aetna,PPO,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Grouper Rate,2002.00
Aetna,PPO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Grouper Rate,3656.00
Aetna,PPO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Grouper Rate,3656.00
Aetna,PPO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Grouper Rate,3656.00
Aetna,PPO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Grouper Rate,2002.00
Aetna,PPO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Grouper Rate,2002.00
Aetna,PPO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Grouper Rate,2002.00
Aetna,PPO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Grouper Rate,2002.00
Aetna,PPO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Grouper Rate,2002.00
Aetna,PPO,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Grouper Rate,2002.00
Aetna,PPO,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Grouper Rate,6401.00
Aetna,PPO,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Grouper Rate,6840.00
Aetna,PPO,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Grouper Rate,6401.00
Aetna,PPO,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Grouper Rate,6401.00
Aetna,PPO,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Grouper Rate,6401.00
Aetna,PPO,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Grouper Rate,6401.00
Aetna,PPO,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Grouper Rate,6401.00
Aetna,PPO,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Grouper Rate,6401.00
Aetna,PPO,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Grouper Rate,6401.00
Aetna,PPO,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Grouper Rate,6401.00
Aetna,PPO,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Grouper Rate,6401.00
Aetna,PPO,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Grouper Rate,3656.00
Aetna,PPO,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Grouper Rate,6840.00
Aetna,PPO,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Grouper Rate,6401.00
Aetna,PPO,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Grouper Rate,6840.00
Aetna,PPO,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Grouper Rate,6401.00
Aetna,PPO,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Grouper Rate,6401.00
Aetna,PPO,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Grouper Rate,6401.00
Aetna,PPO,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Grouper Rate,6401.00
Aetna,PPO,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Grouper Rate,6840.00
Aetna,PPO,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Grouper Rate,7830.00
Aetna,PPO,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Grouper Rate,6401.00
Aetna,PPO,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Grouper Rate,6401.00
Aetna,PPO,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Grouper Rate,6401.00
Aetna,PPO,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Grouper Rate,6401.00
Aetna,PPO,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Grouper Rate,6401.00
Aetna,PPO,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Grouper Rate,6401.00
Aetna,PPO,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Grouper Rate,5856.00
Aetna,PPO,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,6401.00
Aetna,PPO,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,6401.00
Aetna,PPO,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Grouper Rate,6401.00
Aetna,PPO,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Grouper Rate,7830.00
Aetna,PPO,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Grouper Rate,6401.00
Aetna,PPO,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Grouper Rate,6401.00
Aetna,PPO,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Grouper Rate,6401.00
Aetna,PPO,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Grouper Rate,6401.00
Aetna,PPO,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Grouper Rate,6401.00
Aetna,PPO,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Grouper Rate,6401.00
Aetna,PPO,49659,CPT4/HCPCS,LAPARO PROC HERNIA REPAIR,,Grouper Rate,6840.00
Aetna,PPO,49999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Grouper Rate,3656.00
Aetna,PPO,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Grouper Rate,5856.00
Aetna,PPO,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,6401.00
Aetna,PPO,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,6840.00
Aetna,PPO,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Grouper Rate,2002.00
Aetna,PPO,50250,CPT4/HCPCS,CRYOABLATE RENAL MASS OPEN,,Grouper Rate,7830.00
Aetna,PPO,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Grouper Rate,2002.00
Aetna,PPO,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Grouper Rate,2002.00
Aetna,PPO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Grouper Rate,2002.00
Aetna,PPO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Grouper Rate,2002.00
Aetna,PPO,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Grouper Rate,2002.00
Aetna,PPO,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Grouper Rate,2002.00
Aetna,PPO,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Grouper Rate,2002.00
Aetna,PPO,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Grouper Rate,2002.00
Aetna,PPO,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Grouper Rate,2002.00
Aetna,PPO,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,2002.00
Aetna,PPO,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,2002.00
Aetna,PPO,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Grouper Rate,3656.00
Aetna,PPO,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Grouper Rate,3656.00
Aetna,PPO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Grouper Rate,2002.00
Aetna,PPO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Grouper Rate,2002.00
Aetna,PPO,50436,CPT4/HCPCS,DILAT XST TRC NDURLGC PX,,Grouper Rate,2002.00
Aetna,PPO,50437,CPT4/HCPCS,DILAT XST TRC NEW ACCESS RCS,,Grouper Rate,3656.00
Aetna,PPO,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Grouper Rate,2002.00
Aetna,PPO,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Grouper Rate,6840.00
Aetna,PPO,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Grouper Rate,7830.00
Aetna,PPO,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Grouper Rate,7830.00
Aetna,PPO,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Grouper Rate,6840.00
Aetna,PPO,50546,CPT4/HCPCS,LAPAROSCOPIC NEPHRECTOMY,,Grouper Rate,6840.00
Aetna,PPO,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Grouper Rate,6840.00
Aetna,PPO,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Grouper Rate,6840.00
Aetna,PPO,50549,CPT4/HCPCS,LAPAROSCOPE PROC RENAL,,Grouper Rate,5856.00
Aetna,PPO,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,PPO,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,PPO,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Grouper Rate,3656.00
Aetna,PPO,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,PPO,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,PPO,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Case Rate,8792.00
Aetna,PPO,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Grouper Rate,6401.00
Aetna,PPO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Grouper Rate,9770.00
Aetna,PPO,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Grouper Rate,6840.00
Aetna,PPO,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Grouper Rate,6840.00
Aetna,PPO,50606,CPT4/HCPCS,ENDOLUMINAL BX URTR RNL PLVS,,Grouper Rate,2002.00
Aetna,PPO,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,6840.00
Aetna,PPO,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,6840.00
Aetna,PPO,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,6840.00
Aetna,PPO,50650,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,7188.00
Aetna,PPO,50660,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,7188.00
Aetna,PPO,50684,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,2002.00
Aetna,PPO,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Grouper Rate,2002.00
Aetna,PPO,50690,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,2002.00
Aetna,PPO,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,5856.00
Aetna,PPO,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,5856.00
Aetna,PPO,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,5856.00
Aetna,PPO,50705,CPT4/HCPCS,URETERAL EMBOLIZATION/OCCL,,Grouper Rate,2002.00
Aetna,PPO,50706,CPT4/HCPCS,BALLOON DILATE URTRL STRIX,,Grouper Rate,2002.00
Aetna,PPO,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Grouper Rate,7188.00
Aetna,PPO,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,7188.00
Aetna,PPO,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,7188.00
Aetna,PPO,50949,CPT4/HCPCS,LAPAROSCOPE PROC URETER,,Grouper Rate,6840.00
Aetna,PPO,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,2002.00
Aetna,PPO,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,2002.00
Aetna,PPO,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,PPO,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,PPO,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Grouper Rate,2002.00
Aetna,PPO,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,2002.00
Aetna,PPO,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,PPO,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,2002.00
Aetna,PPO,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,6401.00
Aetna,PPO,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,6401.00
Aetna,PPO,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Grouper Rate,6401.00
Aetna,PPO,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Grouper Rate,6401.00
Aetna,PPO,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Grouper Rate,6401.00
Aetna,PPO,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Grouper Rate,6401.00
Aetna,PPO,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,Grouper Rate,2002.00
Aetna,PPO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Grouper Rate,2002.00
Aetna,PPO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Grouper Rate,2002.00
Aetna,PPO,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Grouper Rate,6401.00
Aetna,PPO,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,6401.00
Aetna,PPO,51700,CPT4/HCPCS,IRRIGATION OF BLADDER,,Grouper Rate,2002.00
Aetna,PPO,51701,CPT4/HCPCS,INSERT BLADDER CATHETER,,Grouper Rate,2002.00
Aetna,PPO,51702,CPT4/HCPCS,INSERT TEMP BLADDER CATH,,Grouper Rate,2002.00
Aetna,PPO,51703,CPT4/HCPCS,INSERT BLADDER CATH COMPLEX,,Grouper Rate,2002.00
Aetna,PPO,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,2002.00
Aetna,PPO,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,2002.00
Aetna,PPO,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Fee Schedule,732.14
Aetna,PPO,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Grouper Rate,2002.00
Aetna,PPO,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Grouper Rate,2002.00
Aetna,PPO,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Grouper Rate,2002.00
Aetna,PPO,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Grouper Rate,2002.00
Aetna,PPO,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Grouper Rate,2002.00
Aetna,PPO,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,2002.00
Aetna,PPO,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Grouper Rate,2002.00
Aetna,PPO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,Per Diem,5769.00
Aetna,PPO,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Grouper Rate,7830.00
Aetna,PPO,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Grouper Rate,7830.00
Aetna,PPO,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,7830.00
Aetna,PPO,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,7830.00
Aetna,PPO,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Grouper Rate,6840.00
Aetna,PPO,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,3656.00
Aetna,PPO,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,6401.00
Aetna,PPO,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Grouper Rate,2002.00
Aetna,PPO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,Per Diem,5769.00
Aetna,PPO,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Grouper Rate,6401.00
Aetna,PPO,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Grouper Rate,5856.00
Aetna,PPO,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Grouper Rate,6840.00
Aetna,PPO,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Grouper Rate,6840.00
Aetna,PPO,51999,CPT4/HCPCS,LAPAROSCOPE PROC BLA,,Grouper Rate,5856.00
Aetna,PPO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,Per Diem,5769.00
Aetna,PPO,52000,CPT4/HCPCS,CYSTOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Grouper Rate,3656.00
Aetna,PPO,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Grouper Rate,3656.00
Aetna,PPO,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Grouper Rate,3656.00
Aetna,PPO,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Grouper Rate,3656.00
Aetna,PPO,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Grouper Rate,3656.00
Aetna,PPO,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,5856.00
Aetna,PPO,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,5856.00
Aetna,PPO,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Grouper Rate,6401.00
Aetna,PPO,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,3656.00
Aetna,PPO,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,3656.00
Aetna,PPO,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,5856.00
Aetna,PPO,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Grouper Rate,5856.00
Aetna,PPO,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Grouper Rate,3656.00
Aetna,PPO,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,5856.00
Aetna,PPO,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,2002.00
Aetna,PPO,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,3656.00
Aetna,PPO,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,6840.00
Aetna,PPO,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Grouper Rate,6401.00
Aetna,PPO,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Grouper Rate,3656.00
Aetna,PPO,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Grouper Rate,5856.00
Aetna,PPO,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Grouper Rate,5856.00
Aetna,PPO,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Grouper Rate,5856.00
Aetna,PPO,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Grouper Rate,5856.00
Aetna,PPO,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Grouper Rate,5856.00
Aetna,PPO,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Grouper Rate,5856.00
Aetna,PPO,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Grouper Rate,5856.00
Aetna,PPO,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Grouper Rate,5856.00
Aetna,PPO,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Grouper Rate,6401.00
Aetna,PPO,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Case Rate,8792.00
Aetna,PPO,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Grouper Rate,6401.00
Aetna,PPO,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Grouper Rate,6401.00
Aetna,PPO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Grouper Rate,6401.00
Aetna,PPO,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Grouper Rate,5856.00
Aetna,PPO,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Grouper Rate,5856.00
Aetna,PPO,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Grouper Rate,2002.00
Aetna,PPO,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Grouper Rate,5856.00
Aetna,PPO,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Grouper Rate,5856.00
Aetna,PPO,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Grouper Rate,6401.00
Aetna,PPO,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Grouper Rate,3656.00
Aetna,PPO,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Grouper Rate,3656.00
Aetna,PPO,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,6840.00
Aetna,PPO,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,6840.00
Aetna,PPO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Grouper Rate,6840.00
Aetna,PPO,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,3656.00
Aetna,PPO,53000,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,2002.00
Aetna,PPO,53010,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,2002.00
Aetna,PPO,53020,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,2002.00
Aetna,PPO,53025,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,2002.00
Aetna,PPO,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,3656.00
Aetna,PPO,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,5856.00
Aetna,PPO,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Grouper Rate,2002.00
Aetna,PPO,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,6840.00
Aetna,PPO,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,6840.00
Aetna,PPO,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,3656.00
Aetna,PPO,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,3656.00
Aetna,PPO,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,5856.00
Aetna,PPO,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Grouper Rate,3656.00
Aetna,PPO,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,3656.00
Aetna,PPO,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,3656.00
Aetna,PPO,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,3656.00
Aetna,PPO,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,3656.00
Aetna,PPO,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,3656.00
Aetna,PPO,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Grouper Rate,5856.00
Aetna,PPO,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Grouper Rate,3656.00
Aetna,PPO,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,3656.00
Aetna,PPO,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Grouper Rate,5856.00
Aetna,PPO,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Grouper Rate,3656.00
Aetna,PPO,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,3656.00
Aetna,PPO,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Grouper Rate,3656.00
Aetna,PPO,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Grouper Rate,3656.00
Aetna,PPO,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Grouper Rate,2002.00
Aetna,PPO,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Grouper Rate,3656.00
Aetna,PPO,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Grouper Rate,2002.00
Aetna,PPO,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Grouper Rate,2002.00
Aetna,PPO,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Grouper Rate,2002.00
Aetna,PPO,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Grouper Rate,2002.00
Aetna,PPO,53450,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,2002.00
Aetna,PPO,53460,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,2002.00
Aetna,PPO,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Grouper Rate,6840.00
Aetna,PPO,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,3656.00
Aetna,PPO,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,3656.00
Aetna,PPO,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,3656.00
Aetna,PPO,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,3656.00
Aetna,PPO,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,3656.00
Aetna,PPO,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,2002.00
Aetna,PPO,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,2002.00
Aetna,PPO,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,3656.00
Aetna,PPO,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,2002.00
Aetna,PPO,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,2002.00
Aetna,PPO,53660,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,2002.00
Aetna,PPO,53665,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,2002.00
Aetna,PPO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Grouper Rate,9770.00
Aetna,PPO,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Grouper Rate,3656.00
Aetna,PPO,53854,CPT4/HCPCS,TRURL DSTRJ PRST8 TISS RF WV,,Grouper Rate,3656.00
Aetna,PPO,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Grouper Rate,2002.00
Aetna,PPO,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Grouper Rate,3656.00
Aetna,PPO,53899,CPT4/HCPCS,UROLOGY SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,3656.00
Aetna,PPO,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,3656.00
Aetna,PPO,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Grouper Rate,6401.00
Aetna,PPO,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Grouper Rate,2002.00
Aetna,PPO,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Grouper Rate,2002.00
Aetna,PPO,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,2002.00
Aetna,PPO,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,2002.00
Aetna,PPO,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,2002.00
Aetna,PPO,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,3656.00
Aetna,PPO,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,3656.00
Aetna,PPO,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,3656.00
Aetna,PPO,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,2002.00
Aetna,PPO,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Grouper Rate,3656.00
Aetna,PPO,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Grouper Rate,3656.00
Aetna,PPO,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Grouper Rate,2002.00
Aetna,PPO,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Grouper Rate,3656.00
Aetna,PPO,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Grouper Rate,3656.00
Aetna,PPO,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Grouper Rate,3656.00
Aetna,PPO,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Grouper Rate,3656.00
Aetna,PPO,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Grouper Rate,3656.00
Aetna,PPO,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,6401.00
Aetna,PPO,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,2002.00
Aetna,PPO,54230,CPT4/HCPCS,PREPARE PENIS STUDY,,Grouper Rate,2002.00
Aetna,PPO,54240,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,2002.00
Aetna,PPO,54250,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,2002.00
Aetna,PPO,54300,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5856.00
Aetna,PPO,54304,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5856.00
Aetna,PPO,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,PPO,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,PPO,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,PPO,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,PPO,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,PPO,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,PPO,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5856.00
Aetna,PPO,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5856.00
Aetna,PPO,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,6840.00
Aetna,PPO,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,7830.00
Aetna,PPO,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5856.00
Aetna,PPO,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5856.00
Aetna,PPO,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5856.00
Aetna,PPO,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Grouper Rate,5856.00
Aetna,PPO,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Grouper Rate,5856.00
Aetna,PPO,54380,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5856.00
Aetna,PPO,54385,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5856.00
Aetna,PPO,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Grouper Rate,5856.00
Aetna,PPO,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Grouper Rate,5856.00
Aetna,PPO,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Grouper Rate,5856.00
Aetna,PPO,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Grouper Rate,5856.00
Aetna,PPO,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Grouper Rate,5856.00
Aetna,PPO,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Grouper Rate,5856.00
Aetna,PPO,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Grouper Rate,6840.00
Aetna,PPO,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Grouper Rate,5856.00
Aetna,PPO,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Grouper Rate,5856.00
Aetna,PPO,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Grouper Rate,6401.00
Aetna,PPO,54420,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,6401.00
Aetna,PPO,54435,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,6401.00
Aetna,PPO,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Grouper Rate,3656.00
Aetna,PPO,54440,CPT4/HCPCS,REPAIR OF PENIS,,Grouper Rate,6401.00
Aetna,PPO,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Grouper Rate,2002.00
Aetna,PPO,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,2002.00
Aetna,PPO,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,2002.00
Aetna,PPO,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Grouper Rate,3656.00
Aetna,PPO,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,5856.00
Aetna,PPO,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Grouper Rate,5856.00
Aetna,PPO,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,6401.00
Aetna,PPO,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,6401.00
Aetna,PPO,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,6401.00
Aetna,PPO,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Grouper Rate,6401.00
Aetna,PPO,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Grouper Rate,5856.00
Aetna,PPO,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Grouper Rate,6401.00
Aetna,PPO,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Grouper Rate,6401.00
Aetna,PPO,54660,CPT4/HCPCS,REVISION OF TESTIS,,Grouper Rate,3656.00
Aetna,PPO,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Grouper Rate,5856.00
Aetna,PPO,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Grouper Rate,5856.00
Aetna,PPO,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Grouper Rate,7188.00
Aetna,PPO,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Grouper Rate,7188.00
Aetna,PPO,54699,CPT4/HCPCS,LAPAROSCOPE PROC TESTIS,,Grouper Rate,5856.00
Aetna,PPO,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Grouper Rate,3656.00
Aetna,PPO,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Grouper Rate,2002.00
Aetna,PPO,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,5856.00
Aetna,PPO,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,6401.00
Aetna,PPO,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,5856.00
Aetna,PPO,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,6401.00
Aetna,PPO,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Grouper Rate,2002.00
Aetna,PPO,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,6401.00
Aetna,PPO,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,6401.00
Aetna,PPO,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,5856.00
Aetna,PPO,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Grouper Rate,6840.00
Aetna,PPO,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Grouper Rate,6401.00
Aetna,PPO,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Grouper Rate,3656.00
Aetna,PPO,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Grouper Rate,3656.00
Aetna,PPO,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Grouper Rate,2002.00
Aetna,PPO,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,2002.00
Aetna,PPO,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,3656.00
Aetna,PPO,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Grouper Rate,3656.00
Aetna,PPO,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Grouper Rate,3656.00
Aetna,PPO,55300,CPT4/HCPCS,PREPARE SPERM DUCT X-RAY,,Grouper Rate,3656.00
Aetna,PPO,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Grouper Rate,2002.00
Aetna,PPO,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,5856.00
Aetna,PPO,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Grouper Rate,6401.00
Aetna,PPO,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,6401.00
Aetna,PPO,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,6401.00
Aetna,PPO,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Grouper Rate,6840.00
Aetna,PPO,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Grouper Rate,7188.00
Aetna,PPO,55559,CPT4/HCPCS,LAPARO PROC SPERMATIC CORD,,Grouper Rate,5856.00
Aetna,PPO,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,2002.00
Aetna,PPO,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,2002.00
Aetna,PPO,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Grouper Rate,2002.00
Aetna,PPO,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Grouper Rate,2002.00
Aetna,PPO,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,3656.00
Aetna,PPO,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,3656.00
Aetna,PPO,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Grouper Rate,3656.00
Aetna,PPO,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,3656.00
Aetna,PPO,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,7830.00
Aetna,PPO,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Grouper Rate,2002.00
Aetna,PPO,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Grouper Rate,6840.00
Aetna,PPO,55870,CPT4/HCPCS,ELECTROEJACULATION,,Grouper Rate,2002.00
Aetna,PPO,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Grouper Rate,7188.00
Aetna,PPO,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Grouper Rate,2002.00
Aetna,PPO,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Grouper Rate,5856.00
Aetna,PPO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Grouper Rate,2002.00
Aetna,PPO,55899,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Grouper Rate,3656.00
Aetna,PPO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Grouper Rate,2002.00
Aetna,PPO,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Grouper Rate,3656.00
Aetna,PPO,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Grouper Rate,3656.00
Aetna,PPO,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Grouper Rate,2002.00
Aetna,PPO,56442,CPT4/HCPCS,HYMENOTOMY,,Grouper Rate,2002.00
Aetna,PPO,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Grouper Rate,2002.00
Aetna,PPO,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Grouper Rate,5856.00
Aetna,PPO,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,2002.00
Aetna,PPO,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,2002.00
Aetna,PPO,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Grouper Rate,6840.00
Aetna,PPO,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Grouper Rate,7830.00
Aetna,PPO,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Grouper Rate,2002.00
Aetna,PPO,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Grouper Rate,5856.00
Aetna,PPO,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,5856.00
Aetna,PPO,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Grouper Rate,6840.00
Aetna,PPO,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Grouper Rate,2002.00
Aetna,PPO,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Grouper Rate,2002.00
Aetna,PPO,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Grouper Rate,2002.00
Aetna,PPO,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,3656.00
Aetna,PPO,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Grouper Rate,3656.00
Aetna,PPO,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Grouper Rate,3656.00
Aetna,PPO,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Grouper Rate,2002.00
Aetna,PPO,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Grouper Rate,2002.00
Aetna,PPO,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Grouper Rate,2002.00
Aetna,PPO,57100,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,2002.00
Aetna,PPO,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,3656.00
Aetna,PPO,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Grouper Rate,5856.00
Aetna,PPO,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Grouper Rate,3656.00
Aetna,PPO,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Grouper Rate,2002.00
Aetna,PPO,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Grouper Rate,5856.00
Aetna,PPO,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Grouper Rate,5856.00
Aetna,PPO,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Grouper Rate,5856.00
Aetna,PPO,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Grouper Rate,6840.00
Aetna,PPO,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,3656.00
Aetna,PPO,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,3656.00
Aetna,PPO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Grouper Rate,3656.00
Aetna,PPO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Grouper Rate,3656.00
Aetna,PPO,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,2002.00
Aetna,PPO,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Grouper Rate,3656.00
Aetna,PPO,57220,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,5856.00
Aetna,PPO,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Grouper Rate,5856.00
Aetna,PPO,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Grouper Rate,6840.00
Aetna,PPO,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Grouper Rate,6840.00
Aetna,PPO,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Grouper Rate,6840.00
Aetna,PPO,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Grouper Rate,7830.00
Aetna,PPO,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Grouper Rate,7830.00
Aetna,PPO,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Grouper Rate,5856.00
Aetna,PPO,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Grouper Rate,6840.00
Aetna,PPO,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Grouper Rate,6840.00
Aetna,PPO,57283,CPT4/HCPCS,COLPOPEXY INTRAPERITONEAL,,Grouper Rate,6840.00
Aetna,PPO,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Grouper Rate,6840.00
Aetna,PPO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Grouper Rate,6401.00
Aetna,PPO,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Grouper Rate,6840.00
Aetna,PPO,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Grouper Rate,6840.00
Aetna,PPO,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Grouper Rate,6840.00
Aetna,PPO,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Grouper Rate,6840.00
Aetna,PPO,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Grouper Rate,6401.00
Aetna,PPO,57295,CPT4/HCPCS,REVISE VAG GRAFT VIA VAGINA,,Grouper Rate,5856.00
Aetna,PPO,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,5856.00
Aetna,PPO,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,6840.00
Aetna,PPO,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,5856.00
Aetna,PPO,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,6401.00
Aetna,PPO,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,5856.00
Aetna,PPO,57335,CPT4/HCPCS,REPAIR VAGINA,,Grouper Rate,5856.00
Aetna,PPO,57400,CPT4/HCPCS,DILATION OF VAGINA,,Grouper Rate,3656.00
Aetna,PPO,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Grouper Rate,3656.00
Aetna,PPO,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Grouper Rate,3656.00
Aetna,PPO,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Grouper Rate,2002.00
Aetna,PPO,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Grouper Rate,2002.00
Aetna,PPO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Grouper Rate,6840.00
Aetna,PPO,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Grouper Rate,6840.00
Aetna,PPO,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Grouper Rate,6840.00
Aetna,PPO,57452,CPT4/HCPCS,EXAM OF CERVIX W/SCOPE,,Grouper Rate,3656.00
Aetna,PPO,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Grouper Rate,3656.00
Aetna,PPO,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Grouper Rate,2002.00
Aetna,PPO,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Grouper Rate,2002.00
Aetna,PPO,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Grouper Rate,3656.00
Aetna,PPO,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Grouper Rate,5856.00
Aetna,PPO,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Grouper Rate,2002.00
Aetna,PPO,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Grouper Rate,2002.00
Aetna,PPO,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Grouper Rate,3656.00
Aetna,PPO,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Grouper Rate,2002.00
Aetna,PPO,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Grouper Rate,3656.00
Aetna,PPO,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,3656.00
Aetna,PPO,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,3656.00
Aetna,PPO,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Grouper Rate,5856.00
Aetna,PPO,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,5856.00
Aetna,PPO,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Grouper Rate,6840.00
Aetna,PPO,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Grouper Rate,5856.00
Aetna,PPO,57700,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,2002.00
Aetna,PPO,57720,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,5856.00
Aetna,PPO,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Grouper Rate,2002.00
Aetna,PPO,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Grouper Rate,2002.00
Aetna,PPO,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Grouper Rate,3656.00
Aetna,PPO,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Grouper Rate,7830.00
Aetna,PPO,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Grouper Rate,6840.00
Aetna,PPO,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,7830.00
Aetna,PPO,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,7830.00
Aetna,PPO,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Grouper Rate,7830.00
Aetna,PPO,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,7830.00
Aetna,PPO,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,7830.00
Aetna,PPO,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Grouper Rate,6840.00
Aetna,PPO,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Grouper Rate,6840.00
Aetna,PPO,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Grouper Rate,6840.00
Aetna,PPO,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Grouper Rate,6840.00
Aetna,PPO,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Grouper Rate,6840.00
Aetna,PPO,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Grouper Rate,6840.00
Aetna,PPO,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Grouper Rate,6840.00
Aetna,PPO,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Grouper Rate,6840.00
Aetna,PPO,58300,CPT4/HCPCS,INSERT INTRAUTERINE DEVICE,,Grouper Rate,2002.00
Aetna,PPO,58301,CPT4/HCPCS,REMOVE INTRAUTERINE DEVICE,,Grouper Rate,2002.00
Aetna,PPO,58340,CPT4/HCPCS,CATHETER FOR HYSTEROGRAPHY,,Grouper Rate,2002.00
Aetna,PPO,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,2002.00
Aetna,PPO,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Grouper Rate,3656.00
Aetna,PPO,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,5856.00
Aetna,PPO,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Grouper Rate,7830.00
Aetna,PPO,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Grouper Rate,6840.00
Aetna,PPO,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,6840.00
Aetna,PPO,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Grouper Rate,6840.00
Aetna,PPO,58540,CPT4/HCPCS,REVISION OF UTERUS,,Grouper Rate,7830.00
Aetna,PPO,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Grouper Rate,6840.00
Aetna,PPO,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Grouper Rate,6840.00
Aetna,PPO,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Grouper Rate,6840.00
Aetna,PPO,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Grouper Rate,6840.00
Aetna,PPO,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Grouper Rate,7188.00
Aetna,PPO,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Grouper Rate,7830.00
Aetna,PPO,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Grouper Rate,7188.00
Aetna,PPO,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Grouper Rate,7830.00
Aetna,PPO,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Grouper Rate,7830.00
Aetna,PPO,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Grouper Rate,7830.00
Aetna,PPO,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Grouper Rate,2002.00
Aetna,PPO,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Grouper Rate,5856.00
Aetna,PPO,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Grouper Rate,3656.00
Aetna,PPO,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Grouper Rate,5856.00
Aetna,PPO,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Grouper Rate,5856.00
Aetna,PPO,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Grouper Rate,5856.00
Aetna,PPO,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Grouper Rate,6840.00
Aetna,PPO,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Grouper Rate,5856.00
Aetna,PPO,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Grouper Rate,7188.00
Aetna,PPO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Grouper Rate,7188.00
Aetna,PPO,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Grouper Rate,7188.00
Aetna,PPO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Grouper Rate,7188.00
Aetna,PPO,58578,CPT4/HCPCS,LAPARO PROC UTERUS,,Grouper Rate,5856.00
Aetna,PPO,58579,CPT4/HCPCS,HYSTEROSCOPE PROCEDURE,,Grouper Rate,5856.00
Aetna,PPO,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3656.00
Aetna,PPO,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3656.00
Aetna,PPO,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Grouper Rate,5856.00
Aetna,PPO,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Grouper Rate,6840.00
Aetna,PPO,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Grouper Rate,6840.00
Aetna,PPO,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Grouper Rate,6840.00
Aetna,PPO,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Grouper Rate,5856.00
Aetna,PPO,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Grouper Rate,5856.00
Aetna,PPO,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Grouper Rate,6840.00
Aetna,PPO,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Grouper Rate,6840.00
Aetna,PPO,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Grouper Rate,6840.00
Aetna,PPO,58679,CPT4/HCPCS,LAPARO PROC OVIDUCT-OVARY,,Grouper Rate,5856.00
Aetna,PPO,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Grouper Rate,6840.00
Aetna,PPO,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Grouper Rate,6840.00
Aetna,PPO,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Grouper Rate,6840.00
Aetna,PPO,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Grouper Rate,6840.00
Aetna,PPO,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Grouper Rate,6840.00
Aetna,PPO,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Grouper Rate,6840.00
Aetna,PPO,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Grouper Rate,6840.00
Aetna,PPO,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,5856.00
Aetna,PPO,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,5856.00
Aetna,PPO,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Grouper Rate,5856.00
Aetna,PPO,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Grouper Rate,5856.00
Aetna,PPO,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Grouper Rate,5856.00
Aetna,PPO,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Grouper Rate,5856.00
Aetna,PPO,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Grouper Rate,5856.00
Aetna,PPO,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Grouper Rate,6840.00
Aetna,PPO,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,6840.00
Aetna,PPO,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,7830.00
Aetna,PPO,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Grouper Rate,2002.00
Aetna,PPO,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,2002.00
Aetna,PPO,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,2002.00
Aetna,PPO,58999,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Grouper Rate,2002.00
Aetna,PPO,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Grouper Rate,2002.00
Aetna,PPO,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Grouper Rate,2002.00
Aetna,PPO,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Grouper Rate,2002.00
Aetna,PPO,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Grouper Rate,2002.00
Aetna,PPO,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Grouper Rate,2002.00
Aetna,PPO,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5856.00
Aetna,PPO,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6401.00
Aetna,PPO,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6401.00
Aetna,PPO,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6401.00
Aetna,PPO,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Grouper Rate,5856.00
Aetna,PPO,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Grouper Rate,2002.00
Aetna,PPO,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Grouper Rate,3656.00
Aetna,PPO,59320,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,2002.00
Aetna,PPO,59325,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,6401.00
Aetna,PPO,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Grouper Rate,2002.00
Aetna,PPO,59410,CPT4/HCPCS,OBSTETRICAL CARE,,Grouper Rate,2002.00
Aetna,PPO,59430,CPT4/HCPCS,CARE AFTER DELIVERY,,Grouper Rate,2002.00
Aetna,PPO,59515,CPT4/HCPCS,CESAREAN DELIVERY,,Grouper Rate,6840.00
Aetna,PPO,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Grouper Rate,5856.00
Aetna,PPO,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,6840.00
Aetna,PPO,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Grouper Rate,6840.00
Aetna,PPO,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,6840.00
Aetna,PPO,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Grouper Rate,3656.00
Aetna,PPO,59840,CPT4/HCPCS,ABORTION,,Grouper Rate,6840.00
Aetna,PPO,59841,CPT4/HCPCS,ABORTION,,Grouper Rate,6840.00
Aetna,PPO,59850,CPT4/HCPCS,ABORTION,,Grouper Rate,3656.00
Aetna,PPO,59851,CPT4/HCPCS,ABORTION,,Grouper Rate,3656.00
Aetna,PPO,59852,CPT4/HCPCS,ABORTION,,Grouper Rate,3656.00
Aetna,PPO,59856,CPT4/HCPCS,ABORTION,,Grouper Rate,3656.00
Aetna,PPO,59857,CPT4/HCPCS,ABORTION,,Grouper Rate,3656.00
Aetna,PPO,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Grouper Rate,6840.00
Aetna,PPO,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Grouper Rate,6840.00
Aetna,PPO,59897,CPT4/HCPCS,FETAL INVAS PX W/US,,Grouper Rate,2002.00
Aetna,PPO,59898,CPT4/HCPCS,LAPARO PROC OB CARE/DELIVER,,Grouper Rate,5856.00
Aetna,PPO,59899,CPT4/HCPCS,MATERNITY CARE PROCEDURE,,Grouper Rate,3656.00
Aetna,PPO,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Grouper Rate,2002.00
Aetna,PPO,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Grouper Rate,2002.00
Aetna,PPO,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Grouper Rate,3656.00
Aetna,PPO,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,6401.00
Aetna,PPO,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,6401.00
Aetna,PPO,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,3656.00
Aetna,PPO,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,5856.00
Aetna,PPO,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,7830.00
Aetna,PPO,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,7830.00
Aetna,PPO,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Grouper Rate,7830.00
Aetna,PPO,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Grouper Rate,6840.00
Aetna,PPO,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,6401.00
Aetna,PPO,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,6401.00
Aetna,PPO,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,6401.00
Aetna,PPO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Grouper Rate,2002.00
Aetna,PPO,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,7830.00
Aetna,PPO,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Grouper Rate,7830.00
Aetna,PPO,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Grouper Rate,5856.00
Aetna,PPO,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,6401.00
Aetna,PPO,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,7830.00
Aetna,PPO,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Grouper Rate,6401.00
Aetna,PPO,60659,CPT4/HCPCS,LAPARO PROC ENDOCRINE,,Grouper Rate,5856.00
Aetna,PPO,60699,CPT4/HCPCS,ENDOCRINE SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,2002.00
Aetna,PPO,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,2002.00
Aetna,PPO,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Grouper Rate,2002.00
Aetna,PPO,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,2002.00
Aetna,PPO,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Grouper Rate,2002.00
Aetna,PPO,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,2002.00
Aetna,PPO,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Grouper Rate,5856.00
Aetna,PPO,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Grouper Rate,2002.00
Aetna,PPO,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Grouper Rate,8797.00
Aetna,PPO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Grouper Rate,7188.00
Aetna,PPO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Grouper Rate,7188.00
Aetna,PPO,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,Grouper Rate,7188.00
Aetna,PPO,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,Grouper Rate,2002.00
Aetna,PPO,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,Grouper Rate,2002.00
Aetna,PPO,61783,CPT4/HCPCS,SCAN PROC SPINAL,,Grouper Rate,2002.00
Aetna,PPO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Grouper Rate,5856.00
Aetna,PPO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Grouper Rate,5856.00
Aetna,PPO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Grouper Rate,3656.00
Aetna,PPO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Grouper Rate,5856.00
Aetna,PPO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,3656.00
Aetna,PPO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,2002.00
Aetna,PPO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,2002.00
Aetna,PPO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Grouper Rate,3656.00
Aetna,PPO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Grouper Rate,3656.00
Aetna,PPO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Grouper Rate,2002.00
Aetna,PPO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Grouper Rate,2002.00
Aetna,PPO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Grouper Rate,2002.00
Aetna,PPO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Grouper Rate,2002.00
Aetna,PPO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Grouper Rate,2002.00
Aetna,PPO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Grouper Rate,2002.00
Aetna,PPO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Grouper Rate,2002.00
Aetna,PPO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Grouper Rate,2002.00
Aetna,PPO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,2002.00
Aetna,PPO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,2002.00
Aetna,PPO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Grouper Rate,2002.00
Aetna,PPO,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,Grouper Rate,2002.00
Aetna,PPO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Grouper Rate,6840.00
Aetna,PPO,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,Grouper Rate,2002.00
Aetna,PPO,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,Grouper Rate,2002.00
Aetna,PPO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Grouper Rate,3656.00
Aetna,PPO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Grouper Rate,5856.00
Aetna,PPO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,2002.00
Aetna,PPO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,2002.00
Aetna,PPO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,2002.00
Aetna,PPO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,3656.00
Aetna,PPO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,2002.00
Aetna,PPO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,2002.00
Aetna,PPO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,2002.00
Aetna,PPO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,2002.00
Aetna,PPO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,2002.00
Aetna,PPO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,2002.00
Aetna,PPO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,2002.00
Aetna,PPO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,2002.00
Aetna,PPO,62328,CPT4/HCPCS,DX LMBR SPI PNXR W/FLUOR/CT,,Grouper Rate,2002.00
Aetna,PPO,62329,CPT4/HCPCS,THER SPI PNXR CSF FLUOR/CT,,Grouper Rate,2002.00
Aetna,PPO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,3656.00
Aetna,PPO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,3656.00
Aetna,PPO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Grouper Rate,3656.00
Aetna,PPO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Grouper Rate,3656.00
Aetna,PPO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,3656.00
Aetna,PPO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,3656.00
Aetna,PPO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Grouper Rate,3656.00
Aetna,PPO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Grouper Rate,3656.00
Aetna,PPO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Grouper Rate,3656.00
Aetna,PPO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Grouper Rate,3656.00
Aetna,PPO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Grouper Rate,6840.00
Aetna,PPO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Grouper Rate,7188.00
Aetna,PPO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Grouper Rate,7188.00
Aetna,PPO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Grouper Rate,6840.00
Aetna,PPO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Grouper Rate,6840.00
Aetna,PPO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Grouper Rate,6840.00
Aetna,PPO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Grouper Rate,7188.00
Aetna,PPO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Grouper Rate,7188.00
Aetna,PPO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Grouper Rate,6401.00
Aetna,PPO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,5856.00
Aetna,PPO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Grouper Rate,6840.00
Aetna,PPO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Grouper Rate,6840.00
Aetna,PPO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Grouper Rate,6840.00
Aetna,PPO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Grouper Rate,6840.00
Aetna,PPO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Grouper Rate,2002.00
Aetna,PPO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Grouper Rate,2002.00
Aetna,PPO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Grouper Rate,6840.00
Aetna,PPO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Grouper Rate,6840.00
Aetna,PPO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Grouper Rate,6840.00
Aetna,PPO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Grouper Rate,6840.00
Aetna,PPO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,6840.00
Aetna,PPO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Grouper Rate,7188.00
Aetna,PPO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,6840.00
Aetna,PPO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,6401.00
Aetna,PPO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Grouper Rate,6840.00
Aetna,PPO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Grouper Rate,3656.00
Aetna,PPO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Grouper Rate,2002.00
Aetna,PPO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,3656.00
Aetna,PPO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,7188.00
Aetna,PPO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Grouper Rate,2002.00
Aetna,PPO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Grouper Rate,2002.00
Aetna,PPO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Grouper Rate,2002.00
Aetna,PPO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Grouper Rate,2002.00
Aetna,PPO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Grouper Rate,3656.00
Aetna,PPO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,2002.00
Aetna,PPO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,3656.00
Aetna,PPO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Grouper Rate,5856.00
Aetna,PPO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Grouper Rate,3656.00
Aetna,PPO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Grouper Rate,2002.00
Aetna,PPO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Grouper Rate,2002.00
Aetna,PPO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Grouper Rate,2002.00
Aetna,PPO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Grouper Rate,2002.00
Aetna,PPO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Grouper Rate,2002.00
Aetna,PPO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Grouper Rate,2002.00
Aetna,PPO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Grouper Rate,2002.00
Aetna,PPO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Grouper Rate,2002.00
Aetna,PPO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Grouper Rate,2002.00
Aetna,PPO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Grouper Rate,2002.00
Aetna,PPO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Grouper Rate,2002.00
Aetna,PPO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Grouper Rate,2002.00
Aetna,PPO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Grouper Rate,2002.00
Aetna,PPO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Grouper Rate,2002.00
Aetna,PPO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Grouper Rate,2002.00
Aetna,PPO,64451,CPT4/HCPCS,NJX AA&/STRD NRV NRVTG SI JT,,Grouper Rate,2002.00
Aetna,PPO,64454,CPT4/HCPCS,NJX AA&/STRD GNCLR NRV BRNCH,,Grouper Rate,2002.00
Aetna,PPO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Grouper Rate,2002.00
Aetna,PPO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Grouper Rate,2002.00
Aetna,PPO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Grouper Rate,2002.00
Aetna,PPO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Grouper Rate,2002.00
Aetna,PPO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Grouper Rate,2002.00
Aetna,PPO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Grouper Rate,2002.00
Aetna,PPO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Grouper Rate,2002.00
Aetna,PPO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Grouper Rate,2002.00
Aetna,PPO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Grouper Rate,3656.00
Aetna,PPO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Grouper Rate,3656.00
Aetna,PPO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Grouper Rate,3656.00
Aetna,PPO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Grouper Rate,3656.00
Aetna,PPO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Grouper Rate,2002.00
Aetna,PPO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Grouper Rate,2002.00
Aetna,PPO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Grouper Rate,2002.00
Aetna,PPO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Grouper Rate,2002.00
Aetna,PPO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Grouper Rate,2002.00
Aetna,PPO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Grouper Rate,2002.00
Aetna,PPO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Grouper Rate,2002.00
Aetna,PPO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Grouper Rate,2002.00
Aetna,PPO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Grouper Rate,3656.00
Aetna,PPO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Grouper Rate,2002.00
Aetna,PPO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Grouper Rate,2002.00
Aetna,PPO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,2002.00
Aetna,PPO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,2002.00
Aetna,PPO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,5856.00
Aetna,PPO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Grouper Rate,2002.00
Aetna,PPO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Grouper Rate,3656.00
Aetna,PPO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Grouper Rate,3656.00
Aetna,PPO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Grouper Rate,2002.00
Aetna,PPO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,2002.00
Aetna,PPO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,2002.00
Aetna,PPO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,5856.00
Aetna,PPO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,2002.00
Aetna,PPO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Grouper Rate,3656.00
Aetna,PPO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Grouper Rate,2002.00
Aetna,PPO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,2002.00
Aetna,PPO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,2002.00
Aetna,PPO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,2002.00
Aetna,PPO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Grouper Rate,2002.00
Aetna,PPO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Grouper Rate,2002.00
Aetna,PPO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Grouper Rate,2002.00
Aetna,PPO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Grouper Rate,2002.00
Aetna,PPO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Grouper Rate,2002.00
Aetna,PPO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,2002.00
Aetna,PPO,64624,CPT4/HCPCS,DSTRJ NULYT AGT GNCLR NRV,,Grouper Rate,2002.00
Aetna,PPO,64625,CPT4/HCPCS,RF ABLTJ NRV NRVTG SI JT,,Grouper Rate,6401.00
Aetna,PPO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,3656.00
Aetna,PPO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Grouper Rate,2002.00
Aetna,PPO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Grouper Rate,2002.00
Aetna,PPO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,Grouper Rate,2002.00
Aetna,PPO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Grouper Rate,2002.00
Aetna,PPO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,Grouper Rate,2002.00
Aetna,PPO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,2002.00
Aetna,PPO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Grouper Rate,2002.00
Aetna,PPO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,Grouper Rate,2002.00
Aetna,PPO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Grouper Rate,2002.00
Aetna,PPO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,Grouper Rate,2002.00
Aetna,PPO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Grouper Rate,2002.00
Aetna,PPO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Grouper Rate,2002.00
Aetna,PPO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,2002.00
Aetna,PPO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,2002.00
Aetna,PPO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,3656.00
Aetna,PPO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,3656.00
Aetna,PPO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Grouper Rate,2002.00
Aetna,PPO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Grouper Rate,2002.00
Aetna,PPO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Grouper Rate,3656.00
Aetna,PPO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Grouper Rate,3656.00
Aetna,PPO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Grouper Rate,3656.00
Aetna,PPO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Grouper Rate,3656.00
Aetna,PPO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Grouper Rate,5856.00
Aetna,PPO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Grouper Rate,3656.00
Aetna,PPO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Grouper Rate,3656.00
Aetna,PPO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Grouper Rate,3656.00
Aetna,PPO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Grouper Rate,2002.00
Aetna,PPO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Grouper Rate,2002.00
Aetna,PPO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Grouper Rate,2002.00
Aetna,PPO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Grouper Rate,3656.00
Aetna,PPO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Grouper Rate,3656.00
Aetna,PPO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Grouper Rate,3656.00
Aetna,PPO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Grouper Rate,3656.00
Aetna,PPO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Grouper Rate,3656.00
Aetna,PPO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Grouper Rate,3656.00
Aetna,PPO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Grouper Rate,3656.00
Aetna,PPO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Grouper Rate,3656.00
Aetna,PPO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Grouper Rate,3656.00
Aetna,PPO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Grouper Rate,3656.00
Aetna,PPO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,3656.00
Aetna,PPO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Grouper Rate,5856.00
Aetna,PPO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Grouper Rate,3656.00
Aetna,PPO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Grouper Rate,5856.00
Aetna,PPO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Grouper Rate,3656.00
Aetna,PPO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Grouper Rate,5856.00
Aetna,PPO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Grouper Rate,5856.00
Aetna,PPO,64787,CPT4/HCPCS,IMPLANT NERVE END,,Grouper Rate,3656.00
Aetna,PPO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,5856.00
Aetna,PPO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,5856.00
Aetna,PPO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,5856.00
Aetna,PPO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Grouper Rate,3656.00
Aetna,PPO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Grouper Rate,3656.00
Aetna,PPO,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,6401.00
Aetna,PPO,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,3656.00
Aetna,PPO,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,Grouper Rate,3656.00
Aetna,PPO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Grouper Rate,6401.00
Aetna,PPO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,3656.00
Aetna,PPO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,5856.00
Aetna,PPO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,5856.00
Aetna,PPO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Grouper Rate,3656.00
Aetna,PPO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Grouper Rate,3656.00
Aetna,PPO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Grouper Rate,3656.00
Aetna,PPO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Grouper Rate,3656.00
Aetna,PPO,64859,CPT4/HCPCS,NERVE SURGERY,,Grouper Rate,2002.00
Aetna,PPO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Grouper Rate,5856.00
Aetna,PPO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Grouper Rate,5856.00
Aetna,PPO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,5856.00
Aetna,PPO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,6401.00
Aetna,PPO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Grouper Rate,3656.00
Aetna,PPO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Grouper Rate,5856.00
Aetna,PPO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Grouper Rate,5856.00
Aetna,PPO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Grouper Rate,3656.00
Aetna,PPO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Grouper Rate,3656.00
Aetna,PPO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,3656.00
Aetna,PPO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,3656.00
Aetna,PPO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Grouper Rate,3656.00
Aetna,PPO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,3656.00
Aetna,PPO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,5856.00
Aetna,PPO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,5856.00
Aetna,PPO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Grouper Rate,5856.00
Aetna,PPO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,5856.00
Aetna,PPO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,3656.00
Aetna,PPO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,3656.00
Aetna,PPO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,3656.00
Aetna,PPO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,2002.00
Aetna,PPO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Grouper Rate,3656.00
Aetna,PPO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Grouper Rate,3656.00
Aetna,PPO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Grouper Rate,3656.00
Aetna,PPO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Grouper Rate,2002.00
Aetna,PPO,64999,CPT4/HCPCS,NERVOUS SYSTEM SURGERY,,Grouper Rate,2002.00
Aetna,PPO,65091,CPT4/HCPCS,REVISE EYE,,Grouper Rate,5856.00
Aetna,PPO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,65101,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,5856.00
Aetna,PPO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Grouper Rate,6401.00
Aetna,PPO,65110,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,6840.00
Aetna,PPO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,7830.00
Aetna,PPO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,7830.00
Aetna,PPO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,3656.00
Aetna,PPO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,3656.00
Aetna,PPO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Grouper Rate,2002.00
Aetna,PPO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,3656.00
Aetna,PPO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,5856.00
Aetna,PPO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,6401.00
Aetna,PPO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3656.00
Aetna,PPO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3656.00
Aetna,PPO,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3656.00
Aetna,PPO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,6401.00
Aetna,PPO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,6401.00
Aetna,PPO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,6401.00
Aetna,PPO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3656.00
Aetna,PPO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Grouper Rate,5856.00
Aetna,PPO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,2002.00
Aetna,PPO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Grouper Rate,3656.00
Aetna,PPO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,3656.00
Aetna,PPO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,6840.00
Aetna,PPO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,2002.00
Aetna,PPO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,2002.00
Aetna,PPO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Grouper Rate,2002.00
Aetna,PPO,65600,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,2002.00
Aetna,PPO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,7830.00
Aetna,PPO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,7830.00
Aetna,PPO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,7830.00
Aetna,PPO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,7830.00
Aetna,PPO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Grouper Rate,7830.00
Aetna,PPO,65760,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,7830.00
Aetna,PPO,65765,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,7830.00
Aetna,PPO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Grouper Rate,7830.00
Aetna,PPO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Grouper Rate,7830.00
Aetna,PPO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Grouper Rate,7830.00
Aetna,PPO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,6401.00
Aetna,PPO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,6401.00
Aetna,PPO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Grouper Rate,2002.00
Aetna,PPO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Grouper Rate,2002.00
Aetna,PPO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,6840.00
Aetna,PPO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,6840.00
Aetna,PPO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,6840.00
Aetna,PPO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Grouper Rate,6401.00
Aetna,PPO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,2002.00
Aetna,PPO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,5856.00
Aetna,PPO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,3656.00
Aetna,PPO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Grouper Rate,2002.00
Aetna,PPO,65850,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,6401.00
Aetna,PPO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Grouper Rate,3656.00
Aetna,PPO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,6401.00
Aetna,PPO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,2002.00
Aetna,PPO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,6401.00
Aetna,PPO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,6401.00
Aetna,PPO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,6401.00
Aetna,PPO,65900,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,6840.00
Aetna,PPO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Grouper Rate,7830.00
Aetna,PPO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Grouper Rate,6840.00
Aetna,PPO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,2002.00
Aetna,PPO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,2002.00
Aetna,PPO,66130,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,7830.00
Aetna,PPO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,6401.00
Aetna,PPO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,6401.00
Aetna,PPO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,3656.00
Aetna,PPO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,6401.00
Aetna,PPO,66172,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,6401.00
Aetna,PPO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Grouper Rate,6840.00
Aetna,PPO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Grouper Rate,6840.00
Aetna,PPO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Grouper Rate,6401.00
Aetna,PPO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Grouper Rate,6840.00
Aetna,PPO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Grouper Rate,5856.00
Aetna,PPO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Grouper Rate,5856.00
Aetna,PPO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Grouper Rate,3656.00
Aetna,PPO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Grouper Rate,6401.00
Aetna,PPO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Grouper Rate,3656.00
Aetna,PPO,66500,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,2002.00
Aetna,PPO,66505,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,2002.00
Aetna,PPO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Grouper Rate,5856.00
Aetna,PPO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,5856.00
Aetna,PPO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,5856.00
Aetna,PPO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,5856.00
Aetna,PPO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,5856.00
Aetna,PPO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,5856.00
Aetna,PPO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,3656.00
Aetna,PPO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,3656.00
Aetna,PPO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Grouper Rate,3656.00
Aetna,PPO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Grouper Rate,3656.00
Aetna,PPO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,3656.00
Aetna,PPO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,3656.00
Aetna,PPO,66761,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,2002.00
Aetna,PPO,66762,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,2002.00
Aetna,PPO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Grouper Rate,2002.00
Aetna,PPO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Grouper Rate,2002.00
Aetna,PPO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Grouper Rate,3656.00
Aetna,PPO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Grouper Rate,6401.00
Aetna,PPO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Grouper Rate,6401.00
Aetna,PPO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,6401.00
Aetna,PPO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,7830.00
Aetna,PPO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,6401.00
Aetna,PPO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,6401.00
Aetna,PPO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,6840.00
Aetna,PPO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,6840.00
Aetna,PPO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Grouper Rate,8797.00
Aetna,PPO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Grouper Rate,8797.00
Aetna,PPO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Grouper Rate,8797.00
Aetna,PPO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Grouper Rate,7188.00
Aetna,PPO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Grouper Rate,7188.00
Aetna,PPO,66987,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX W/ECP,,Grouper Rate,6840.00
Aetna,PPO,66988,CPT4/HCPCS,XCAPSL CTRC RMVL W/ECP,,Grouper Rate,6840.00
Aetna,PPO,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,66999,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,6401.00
Aetna,PPO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,6401.00
Aetna,PPO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Grouper Rate,2002.00
Aetna,PPO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Grouper Rate,2002.00
Aetna,PPO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Grouper Rate,6401.00
Aetna,PPO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Grouper Rate,2002.00
Aetna,PPO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Grouper Rate,2002.00
Aetna,PPO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Grouper Rate,3656.00
Aetna,PPO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Grouper Rate,6401.00
Aetna,PPO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,7830.00
Aetna,PPO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,7830.00
Aetna,PPO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Grouper Rate,6840.00
Aetna,PPO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Grouper Rate,6840.00
Aetna,PPO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Grouper Rate,7830.00
Aetna,PPO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Grouper Rate,6401.00
Aetna,PPO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Grouper Rate,6840.00
Aetna,PPO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,6840.00
Aetna,PPO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,7830.00
Aetna,PPO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Grouper Rate,6840.00
Aetna,PPO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Grouper Rate,3656.00
Aetna,PPO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,3656.00
Aetna,PPO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,3656.00
Aetna,PPO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,3656.00
Aetna,PPO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,2002.00
Aetna,PPO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,6840.00
Aetna,PPO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,6840.00
Aetna,PPO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,6840.00
Aetna,PPO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Grouper Rate,2002.00
Aetna,PPO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Grouper Rate,2002.00
Aetna,PPO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Grouper Rate,2002.00
Aetna,PPO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Grouper Rate,2002.00
Aetna,PPO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Grouper Rate,3656.00
Aetna,PPO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Grouper Rate,5856.00
Aetna,PPO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Grouper Rate,5856.00
Aetna,PPO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,5856.00
Aetna,PPO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,6401.00
Aetna,PPO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,6401.00
Aetna,PPO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,6401.00
Aetna,PPO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Grouper Rate,6401.00
Aetna,PPO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Grouper Rate,6401.00
Aetna,PPO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Grouper Rate,6401.00
Aetna,PPO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Grouper Rate,6401.00
Aetna,PPO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Grouper Rate,6401.00
Aetna,PPO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Grouper Rate,6401.00
Aetna,PPO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Grouper Rate,6401.00
Aetna,PPO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Grouper Rate,7830.00
Aetna,PPO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Grouper Rate,2002.00
Aetna,PPO,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,Grouper Rate,2002.00
Aetna,PPO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,5856.00
Aetna,PPO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,6401.00
Aetna,PPO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,6840.00
Aetna,PPO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,6840.00
Aetna,PPO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,6840.00
Aetna,PPO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Grouper Rate,2002.00
Aetna,PPO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,6840.00
Aetna,PPO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,6840.00
Aetna,PPO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,6840.00
Aetna,PPO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,6840.00
Aetna,PPO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,6840.00
Aetna,PPO,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,2002.00
Aetna,PPO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,2002.00
Aetna,PPO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Grouper Rate,6401.00
Aetna,PPO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Grouper Rate,3656.00
Aetna,PPO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Grouper Rate,6401.00
Aetna,PPO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Grouper Rate,2002.00
Aetna,PPO,67710,CPT4/HCPCS,INCISION OF EYELID,,Grouper Rate,2002.00
Aetna,PPO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Grouper Rate,2002.00
Aetna,PPO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,2002.00
Aetna,PPO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,2002.00
Aetna,PPO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,2002.00
Aetna,PPO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Grouper Rate,3656.00
Aetna,PPO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Grouper Rate,2002.00
Aetna,PPO,67830,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,3656.00
Aetna,PPO,67835,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,3656.00
Aetna,PPO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,3656.00
Aetna,PPO,67850,CPT4/HCPCS,TREAT EYELID LESION,,Grouper Rate,2002.00
Aetna,PPO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Grouper Rate,2002.00
Aetna,PPO,67880,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5856.00
Aetna,PPO,67882,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5856.00
Aetna,PPO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Grouper Rate,6401.00
Aetna,PPO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6840.00
Aetna,PPO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6840.00
Aetna,PPO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,PPO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,PPO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6840.00
Aetna,PPO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,PPO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,6401.00
Aetna,PPO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,5856.00
Aetna,PPO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Grouper Rate,5856.00
Aetna,PPO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5856.00
Aetna,PPO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5856.00
Aetna,PPO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,PPO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,PPO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5856.00
Aetna,PPO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5856.00
Aetna,PPO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,PPO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,6401.00
Aetna,PPO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,3656.00
Aetna,PPO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,3656.00
Aetna,PPO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Grouper Rate,2002.00
Aetna,PPO,67950,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3656.00
Aetna,PPO,67961,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5856.00
Aetna,PPO,67966,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5856.00
Aetna,PPO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,5856.00
Aetna,PPO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,5856.00
Aetna,PPO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,5856.00
Aetna,PPO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,5856.00
Aetna,PPO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Grouper Rate,3656.00
Aetna,PPO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Grouper Rate,2002.00
Aetna,PPO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,3656.00
Aetna,PPO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,3656.00
Aetna,PPO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,3656.00
Aetna,PPO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,2002.00
Aetna,PPO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,6401.00
Aetna,PPO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,6401.00
Aetna,PPO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,6401.00
Aetna,PPO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,6401.00
Aetna,PPO,68330,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,6401.00
Aetna,PPO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,6401.00
Aetna,PPO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Grouper Rate,6401.00
Aetna,PPO,68360,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,3656.00
Aetna,PPO,68362,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,3656.00
Aetna,PPO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Grouper Rate,3656.00
Aetna,PPO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Grouper Rate,2002.00
Aetna,PPO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Grouper Rate,2002.00
Aetna,PPO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Grouper Rate,2002.00
Aetna,PPO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Grouper Rate,5856.00
Aetna,PPO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Grouper Rate,5856.00
Aetna,PPO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Grouper Rate,2002.00
Aetna,PPO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Grouper Rate,5856.00
Aetna,PPO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Grouper Rate,2002.00
Aetna,PPO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Grouper Rate,2002.00
Aetna,PPO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,5856.00
Aetna,PPO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,5856.00
Aetna,PPO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Grouper Rate,3656.00
Aetna,PPO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Grouper Rate,2002.00
Aetna,PPO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Grouper Rate,6401.00
Aetna,PPO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,6401.00
Aetna,PPO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,6401.00
Aetna,PPO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,2002.00
Aetna,PPO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,2002.00
Aetna,PPO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Grouper Rate,6401.00
Aetna,PPO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,2002.00
Aetna,PPO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,3656.00
Aetna,PPO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,3656.00
Aetna,PPO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Grouper Rate,3656.00
Aetna,PPO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Grouper Rate,2002.00
Aetna,PPO,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,Grouper Rate,2002.00
Aetna,PPO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,2002.00
Aetna,PPO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,2002.00
Aetna,PPO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Grouper Rate,2002.00
Aetna,PPO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Grouper Rate,2002.00
Aetna,PPO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Grouper Rate,3656.00
Aetna,PPO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,3656.00
Aetna,PPO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,3656.00
Aetna,PPO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Grouper Rate,5856.00
Aetna,PPO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Grouper Rate,2002.00
Aetna,PPO,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Grouper Rate,2002.00
Aetna,PPO,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Grouper Rate,2002.00
Aetna,PPO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,3656.00
Aetna,PPO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Grouper Rate,5856.00
Aetna,PPO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,5856.00
Aetna,PPO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,7830.00
Aetna,PPO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,5856.00
Aetna,PPO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,5856.00
Aetna,PPO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Grouper Rate,2002.00
Aetna,PPO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,5856.00
Aetna,PPO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,5856.00
Aetna,PPO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Grouper Rate,5856.00
Aetna,PPO,69450,CPT4/HCPCS,EARDRUM REVISION,,Grouper Rate,2002.00
Aetna,PPO,69501,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,7830.00
Aetna,PPO,69502,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,7830.00
Aetna,PPO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Grouper Rate,7830.00
Aetna,PPO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,7830.00
Aetna,PPO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,7830.00
Aetna,PPO,69540,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,3656.00
Aetna,PPO,69550,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,6840.00
Aetna,PPO,69552,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,7830.00
Aetna,PPO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,7830.00
Aetna,PPO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,7830.00
Aetna,PPO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,7830.00
Aetna,PPO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,7830.00
Aetna,PPO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,7830.00
Aetna,PPO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,5856.00
Aetna,PPO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,3656.00
Aetna,PPO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,6840.00
Aetna,PPO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6840.00
Aetna,PPO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6840.00
Aetna,PPO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,7830.00
Aetna,PPO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,7830.00
Aetna,PPO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,7830.00
Aetna,PPO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,PPO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,PPO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,PPO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,PPO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,PPO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,7830.00
Aetna,PPO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Grouper Rate,7830.00
Aetna,PPO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,6840.00
Aetna,PPO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,6840.00
Aetna,PPO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,6840.00
Aetna,PPO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,6401.00
Aetna,PPO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,6401.00
Aetna,PPO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Grouper Rate,5856.00
Aetna,PPO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Grouper Rate,5856.00
Aetna,PPO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Grouper Rate,5856.00
Aetna,PPO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Grouper Rate,5856.00
Aetna,PPO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Grouper Rate,2002.00
Aetna,PPO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Grouper Rate,9770.00
Aetna,PPO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Grouper Rate,9770.00
Aetna,PPO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Grouper Rate,9770.00
Aetna,PPO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Grouper Rate,9770.00
Aetna,PPO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,6840.00
Aetna,PPO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,6840.00
Aetna,PPO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,6840.00
Aetna,PPO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,6840.00
Aetna,PPO,69799,CPT4/HCPCS,MIDDLE EAR SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,69801,CPT4/HCPCS,INCISE INNER EAR,,Grouper Rate,6840.00
Aetna,PPO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,7830.00
Aetna,PPO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,7830.00
Aetna,PPO,69905,CPT4/HCPCS,REMOVE INNER EAR,,Grouper Rate,7830.00
Aetna,PPO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Grouper Rate,7830.00
Aetna,PPO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,7830.00
Aetna,PPO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Grouper Rate,7830.00
Aetna,PPO,69949,CPT4/HCPCS,INNER EAR SURGERY PROCEDURE,,Grouper Rate,2002.00
Aetna,PPO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,6401.00
Aetna,PPO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Grouper Rate,6401.00
Aetna,PPO,69979,CPT4/HCPCS,TEMPORAL BONE SURGERY,,Grouper Rate,2002.00
Aetna,PPO,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,Grouper Rate,2002.00
Aetna,PPO,70010,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Fee Schedule,770.70
Aetna,PPO,70015,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Fee Schedule,768.26
Aetna,PPO,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,Fee Schedule,176.40
Aetna,PPO,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,Fee Schedule,208.90
Aetna,PPO,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,Fee Schedule,238.56
Aetna,PPO,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Fee Schedule,226.71
Aetna,PPO,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Fee Schedule,345.07
Aetna,PPO,70134,CPT4/HCPCS,X-RAY EXAM OF MIDDLE EAR,,Fee Schedule,259.22
Aetna,PPO,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Fee Schedule,179.34
Aetna,PPO,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Fee Schedule,262.16
Aetna,PPO,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,Fee Schedule,214.87
Aetna,PPO,70170,CPT4/HCPCS,X-RAY EXAM OF TEAR DUCT,,Fee Schedule,2002.47
Aetna,PPO,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Fee Schedule,220.75
Aetna,PPO,70200,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Fee Schedule,265.18
Aetna,PPO,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Fee Schedule,194.12
Aetna,PPO,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Fee Schedule,232.59
Aetna,PPO,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,Fee Schedule,176.40
Aetna,PPO,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Fee Schedule,217.81
Aetna,PPO,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Fee Schedule,268.12
Aetna,PPO,70300,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Fee Schedule,75.76
Aetna,PPO,70310,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Fee Schedule,250.32
Aetna,PPO,70320,CPT4/HCPCS,FULL MOUTH X-RAY OF TEETH,,Fee Schedule,265.18
Aetna,PPO,70328,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Fee Schedule,191.18
Aetna,PPO,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,Fee Schedule,315.50
Aetna,PPO,70332,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Fee Schedule,498.96
Aetna,PPO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,Case Rate,2427.00
Aetna,PPO,70350,CPT4/HCPCS,X-RAY HEAD FOR ORTHODONTIA,,Fee Schedule,102.39
Aetna,PPO,70355,CPT4/HCPCS,PANORAMIC X-RAY OF JAWS,,Fee Schedule,96.43
Aetna,PPO,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,Fee Schedule,167.49
Aetna,PPO,70370,CPT4/HCPCS,THROAT X-RAY & FLUOROSCOPY,,Fee Schedule,572.96
Aetna,PPO,70371,CPT4/HCPCS,SPEECH EVALUATION COMPLEX,,Fee Schedule,466.45
Aetna,PPO,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,Fee Schedule,265.18
Aetna,PPO,70390,CPT4/HCPCS,X-RAY EXAM OF SALIVARY DUCT,,Fee Schedule,720.97
Aetna,PPO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,Case Rate,2427.00
Aetna,PPO,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,Fee Schedule,2427.00
Aetna,PPO,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,Fee Schedule,2427.00
Aetna,PPO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,Case Rate,2427.00
Aetna,PPO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,Fee Schedule,2427.00
Aetna,PPO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,Fee Schedule,2427.00
Aetna,PPO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,Case Rate,2427.00
Aetna,PPO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,Fee Schedule,2427.00
Aetna,PPO,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,Fee Schedule,2427.00
Aetna,PPO,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,Case Rate,2427.00
Aetna,PPO,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,Fee Schedule,2108.98
Aetna,PPO,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,Fee Schedule,2641.71
Aetna,PPO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,Case Rate,2427.00
Aetna,PPO,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,Case Rate,2427.00
Aetna,PPO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,Case Rate,2427.00
Aetna,PPO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,Case Rate,2427.00
Aetna,PPO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,Case Rate,2427.00
Aetna,PPO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,Case Rate,2427.00
Aetna,PPO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,Case Rate,2427.00
Aetna,PPO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,Case Rate,2427.00
Aetna,PPO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,Case Rate,2427.00
Aetna,PPO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,Case Rate,2427.00
Aetna,PPO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,Case Rate,2427.00
Aetna,PPO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,Case Rate,2427.00
Aetna,PPO,70554,CPT4/HCPCS,FMRI BRAIN BY TECH,,Case Rate,2427.00
Aetna,PPO,70555,CPT4/HCPCS,FMRI BRAIN BY PHYS/PSYCH,,Case Rate,2427.00
Aetna,PPO,70557,CPT4/HCPCS,MRI BRAIN W/O DYE,,Case Rate,2427.00
Aetna,PPO,70558,CPT4/HCPCS,MRI BRAIN W/DYE,,Case Rate,2427.00
Aetna,PPO,70559,CPT4/HCPCS,MRI BRAIN W/O & W/DYE,,Case Rate,2427.00
Aetna,PPO,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,Fee Schedule,89.54
Aetna,PPO,71046,CPT4/HCPCS,X-RAY EXAM CHEST 2 VIEWS,,Fee Schedule,165.14
Aetna,PPO,71047,CPT4/HCPCS,X-RAY EXAM CHEST 3 VIEWS,,Fee Schedule,210.50
Aetna,PPO,71048,CPT4/HCPCS,X-RAY EXAM CHEST 4+ VIEWS,,Fee Schedule,216.55
Aetna,PPO,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,Fee Schedule,188.24
Aetna,PPO,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,Fee Schedule,229.65
Aetna,PPO,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,Fee Schedule,241.50
Aetna,PPO,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,Fee Schedule,324.32
Aetna,PPO,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,Fee Schedule,194.12
Aetna,PPO,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,Fee Schedule,232.59
Aetna,PPO,71250,CPT4/HCPCS,CT THORAX DX C-,,Case Rate,2427.00
Aetna,PPO,71260,CPT4/HCPCS,CT THORAX DX C+,,Fee Schedule,2427.00
Aetna,PPO,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,Fee Schedule,2427.00
Aetna,PPO,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,Fee Schedule,2946.55
Aetna,PPO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,Case Rate,2427.00
Aetna,PPO,71551,CPT4/HCPCS,MRI CHEST W/DYE,,Case Rate,2427.00
Aetna,PPO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,Case Rate,2427.00
Aetna,PPO,71555,CPT4/HCPCS,MRI ANGIO CHEST W OR W/O DYE,,Case Rate,2427.00
Aetna,PPO,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,Fee Schedule,140.86
Aetna,PPO,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,Fee Schedule,238.56
Aetna,PPO,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,Fee Schedule,324.32
Aetna,PPO,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,Fee Schedule,427.89
Aetna,PPO,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,Fee Schedule,200.00
Aetna,PPO,72072,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 3VWS,,Fee Schedule,235.53
Aetna,PPO,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,Fee Schedule,294.75
Aetna,PPO,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,Fee Schedule,217.81
Aetna,PPO,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,Fee Schedule,210.08
Aetna,PPO,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,Fee Schedule,382.20
Aetna,PPO,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,Fee Schedule,414.87
Aetna,PPO,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,Fee Schedule,500.97
Aetna,PPO,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,Fee Schedule,253.34
Aetna,PPO,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,Fee Schedule,348.01
Aetna,PPO,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,Fee Schedule,487.11
Aetna,PPO,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,Fee Schedule,348.01
Aetna,PPO,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,Case Rate,2427.00
Aetna,PPO,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,Fee Schedule,2427.00
Aetna,PPO,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,Fee Schedule,2427.00
Aetna,PPO,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,Case Rate,2427.00
Aetna,PPO,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,Fee Schedule,2427.00
Aetna,PPO,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,Fee Schedule,2427.00
Aetna,PPO,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,Case Rate,2427.00
Aetna,PPO,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,Fee Schedule,2180.05
Aetna,PPO,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,Fee Schedule,2427.00
Aetna,PPO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,Case Rate,2427.00
Aetna,PPO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,Case Rate,2427.00
Aetna,PPO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,Case Rate,2427.00
Aetna,PPO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,Case Rate,2427.00
Aetna,PPO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,Case Rate,2427.00
Aetna,PPO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,Case Rate,2427.00
Aetna,PPO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,Case Rate,2427.00
Aetna,PPO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,Case Rate,2427.00
Aetna,PPO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,Case Rate,2427.00
Aetna,PPO,72159,CPT4/HCPCS,MR ANGIO SPINE W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Fee Schedule,155.65
Aetna,PPO,72190,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Fee Schedule,268.12
Aetna,PPO,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,Case Rate,2427.00
Aetna,PPO,72193,CPT4/HCPCS,CT PELVIS W/DYE,,Fee Schedule,2427.00
Aetna,PPO,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,Fee Schedule,2427.00
Aetna,PPO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,Case Rate,2427.00
Aetna,PPO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,Case Rate,2427.00
Aetna,PPO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,Case Rate,2427.00
Aetna,PPO,72198,CPT4/HCPCS,MR ANGIO PELVIS W/O & W/DYE,,Case Rate,2427.00
Aetna,PPO,72200,CPT4/HCPCS,X-RAY EXAM SI JOINTS,,Fee Schedule,185.22
Aetna,PPO,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,Fee Schedule,220.75
Aetna,PPO,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,Fee Schedule,182.28
Aetna,PPO,72240,CPT4/HCPCS,MYELOGRAPHY NECK SPINE,,Fee Schedule,868.89
Aetna,PPO,72255,CPT4/HCPCS,MYELOGRAPHY THORACIC SPINE,,Fee Schedule,797.91
Aetna,PPO,72265,CPT4/HCPCS,MYELOGRAPHY L-S SPINE,,Fee Schedule,845.20
Aetna,PPO,72270,CPT4/HCPCS,MYELOGPHY 2/> SPINE REGIONS,,Fee Schedule,1300.99
Aetna,PPO,72275,CPT4/HCPCS,EPIDUROGRAPHY,,Fee Schedule,644.02
Aetna,PPO,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,Fee Schedule,780.10
Aetna,PPO,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,Fee Schedule,768.26
Aetna,PPO,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,Fee Schedule,179.34
Aetna,PPO,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,Fee Schedule,185.22
Aetna,PPO,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Fee Schedule,140.86
Aetna,PPO,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Fee Schedule,182.28
Aetna,PPO,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,Fee Schedule,703.16
Aetna,PPO,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,Fee Schedule,238.56
Aetna,PPO,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,Fee Schedule,179.34
Aetna,PPO,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Fee Schedule,179.34
Aetna,PPO,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Fee Schedule,223.69
Aetna,PPO,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,Fee Schedule,614.37
Aetna,PPO,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,Fee Schedule,173.37
Aetna,PPO,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,Fee Schedule,197.06
Aetna,PPO,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Fee Schedule,191.18
Aetna,PPO,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Fee Schedule,241.50
Aetna,PPO,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,Fee Schedule,709.12
Aetna,PPO,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,Fee Schedule,170.43
Aetna,PPO,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,Fee Schedule,205.96
Aetna,PPO,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,Fee Schedule,214.87
Aetna,PPO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,Case Rate,2427.00
Aetna,PPO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,Fee Schedule,2427.00
Aetna,PPO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,Fee Schedule,2427.00
Aetna,PPO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,Case Rate,2427.00
Aetna,PPO,73219,CPT4/HCPCS,MRI UPPER EXTREMITY W/DYE,,Case Rate,2427.00
Aetna,PPO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,Case Rate,2427.00
Aetna,PPO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,Case Rate,2427.00
Aetna,PPO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,73225,CPT4/HCPCS,MR ANGIO UPR EXTR W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,Fee Schedule,165.56
Aetna,PPO,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,Fee Schedule,248.64
Aetna,PPO,73503,CPT4/HCPCS,X-RAY EXAM HIP UNI 4/> VIEWS,,Fee Schedule,308.02
Aetna,PPO,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,Fee Schedule,230.83
Aetna,PPO,73522,CPT4/HCPCS,X-RAY EXAM HIPS BI 3-4 VIEWS,,Fee Schedule,278.37
Aetna,PPO,73523,CPT4/HCPCS,X-RAY EXAM HIPS BI 5/> VIEWS,,Fee Schedule,334.74
Aetna,PPO,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,Fee Schedule,632.18
Aetna,PPO,73551,CPT4/HCPCS,X-RAY EXAM OF FEMUR 1,,Fee Schedule,159.60
Aetna,PPO,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,Fee Schedule,189.33
Aetna,PPO,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,Fee Schedule,185.22
Aetna,PPO,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,Fee Schedule,232.59
Aetna,PPO,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,Fee Schedule,265.18
Aetna,PPO,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,Fee Schedule,211.84
Aetna,PPO,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,Fee Schedule,898.54
Aetna,PPO,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,Fee Schedule,167.49
Aetna,PPO,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,Fee Schedule,200.00
Aetna,PPO,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Fee Schedule,176.40
Aetna,PPO,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Fee Schedule,208.90
Aetna,PPO,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,Fee Schedule,664.69
Aetna,PPO,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Fee Schedule,170.43
Aetna,PPO,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Fee Schedule,203.02
Aetna,PPO,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,Fee Schedule,173.37
Aetna,PPO,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,Fee Schedule,200.00
Aetna,PPO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,Case Rate,2427.00
Aetna,PPO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,Fee Schedule,2427.00
Aetna,PPO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,Fee Schedule,2427.00
Aetna,PPO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,Case Rate,2427.00
Aetna,PPO,73719,CPT4/HCPCS,MRI LOWER EXTREMITY W/DYE,,Case Rate,2427.00
Aetna,PPO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,Case Rate,2427.00
Aetna,PPO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,Case Rate,2427.00
Aetna,PPO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,73725,CPT4/HCPCS,MR ANG LWR EXT W OR W/O DYE,,Case Rate,2427.00
Aetna,PPO,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,Fee Schedule,153.04
Aetna,PPO,74019,CPT4/HCPCS,X-RAY EXAM ABDOMEN 2 VIEWS,,Fee Schedule,183.28
Aetna,PPO,74021,CPT4/HCPCS,X-RAY EXAM ABDOMEN 3+ VIEWS,,Fee Schedule,213.52
Aetna,PPO,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,Fee Schedule,285.85
Aetna,PPO,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,Case Rate,2427.00
Aetna,PPO,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,Fee Schedule,2427.00
Aetna,PPO,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,Fee Schedule,2427.00
Aetna,PPO,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,Case Rate,2427.00
Aetna,PPO,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,Case Rate,2427.00
Aetna,PPO,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,Case Rate,2427.00
Aetna,PPO,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,Case Rate,2427.00
Aetna,PPO,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,Case Rate,2427.00
Aetna,PPO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,Case Rate,2427.00
Aetna,PPO,74182,CPT4/HCPCS,MRI ABDOMEN W/DYE,,Case Rate,2427.00
Aetna,PPO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,Case Rate,2427.00
Aetna,PPO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,Case Rate,2427.00
Aetna,PPO,74190,CPT4/HCPCS,X-RAY EXAM OF PERITONEUM,,Fee Schedule,2002.47
Aetna,PPO,74210,CPT4/HCPCS,X-RAY XM PHRNX&/CRV ESOPH C+,,Fee Schedule,531.55
Aetna,PPO,74220,CPT4/HCPCS,X-RAY XM ESOPHAGUS 1CNTRST,,Fee Schedule,587.74
Aetna,PPO,74230,CPT4/HCPCS,X-RAY XM SWLNG FUNCJ C+,,Fee Schedule,570.02
Aetna,PPO,74235,CPT4/HCPCS,REMOVE ESOPHAGUS OBSTRUCTION,,Fee Schedule,1034.79
Aetna,PPO,74240,CPT4/HCPCS,X-RAY XM UPR GI TRC 1CNTRST,,Fee Schedule,676.53
Aetna,PPO,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,Fee Schedule,753.48
Aetna,PPO,74250,CPT4/HCPCS,X-RAY XM SM INT 1CNTRST STD,,Fee Schedule,726.85
Aetna,PPO,74251,CPT4/HCPCS,X-RAY XM SM INT 2CNTRST STD,,Fee Schedule,1234.12
Aetna,PPO,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,Case Rate,2427.00
Aetna,PPO,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,Case Rate,2427.00
Aetna,PPO,74263,CPT4/HCPCS,CT COLONOGRAPHY SCREENING,,Case Rate,2427.00
Aetna,PPO,74270,CPT4/HCPCS,X-RAY XM COLON 1CNTRST STD,,Fee Schedule,756.42
Aetna,PPO,74280,CPT4/HCPCS,X-RAY XM COLON 2CNTRST STD,,Fee Schedule,1235.89
Aetna,PPO,74283,CPT4/HCPCS,THER NMA RDCTJ INTUS/OBSTRCJ,,Fee Schedule,753.48
Aetna,PPO,74290,CPT4/HCPCS,CONTRAST X-RAY GALLBLADDER,,Fee Schedule,460.48
Aetna,PPO,74300,CPT4/HCPCS,X-RAY BILE DUCTS/PANCREAS,,Fee Schedule,289.88
Aetna,PPO,74301,CPT4/HCPCS,X-RAYS AT SURGERY ADD-ON,,Fee Schedule,176.90
Aetna,PPO,74328,CPT4/HCPCS,X-RAY BILE DUCT ENDOSCOPY,,Fee Schedule,716.52
Aetna,PPO,74329,CPT4/HCPCS,X-RAY FOR PANCREAS ENDOSCOPY,,Fee Schedule,570.94
Aetna,PPO,74330,CPT4/HCPCS,X-RAY BILE/PANC ENDOSCOPY,,Fee Schedule,1067.38
Aetna,PPO,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,Fee Schedule,704.67
Aetna,PPO,74355,CPT4/HCPCS,X-RAY GUIDE INTESTINAL TUBE,,Fee Schedule,909.97
Aetna,PPO,74360,CPT4/HCPCS,X-RAY GUIDE GI DILATION,,Fee Schedule,788.08
Aetna,PPO,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,Fee Schedule,716.52
Aetna,PPO,74400,CPT4/HCPCS,UROGRAPHY IV +-KUB TOMOG,,Fee Schedule,765.32
Aetna,PPO,74410,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BOLUS,,Fee Schedule,791.95
Aetna,PPO,74415,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BLS W/NF,,Fee Schedule,978.43
Aetna,PPO,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,Fee Schedule,1531.90
Aetna,PPO,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,Fee Schedule,1531.90
Aetna,PPO,74430,CPT4/HCPCS,CONTRAST X-RAY BLADDER,,Fee Schedule,395.38
Aetna,PPO,74440,CPT4/HCPCS,X-RAY MALE GENITAL TRACT,,Fee Schedule,587.74
Aetna,PPO,74445,CPT4/HCPCS,X-RAY EXAM OF PENIS,,Fee Schedule,1531.90
Aetna,PPO,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Fee Schedule,1531.90
Aetna,PPO,74455,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Fee Schedule,641.00
Aetna,PPO,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,Fee Schedule,2002.47
Aetna,PPO,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,Fee Schedule,729.79
Aetna,PPO,74710,CPT4/HCPCS,X-RAY MEASUREMENT OF PELVIS,,Fee Schedule,200.00
Aetna,PPO,74712,CPT4/HCPCS,MRI FETAL SNGL/1ST GESTATION,,Case Rate,2427.00
Aetna,PPO,74713,CPT4/HCPCS,MRI FETAL EA ADDL GESTATION,,Case Rate,2427.00
Aetna,PPO,74740,CPT4/HCPCS,X-RAY FEMALE GENITAL TRACT,,Fee Schedule,528.52
Aetna,PPO,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,Fee Schedule,490.47
Aetna,PPO,74775,CPT4/HCPCS,X-RAY EXAM OF PERINEUM,,Fee Schedule,1531.90
Aetna,PPO,75557,CPT4/HCPCS,CARDIAC MRI FOR MORPH,,Fee Schedule,2427.00
Aetna,PPO,75559,CPT4/HCPCS,CARDIAC MRI W/STRESS IMG,,Fee Schedule,2427.00
Aetna,PPO,75561,CPT4/HCPCS,CARDIAC MRI FOR MORPH W/DYE,,Fee Schedule,2427.00
Aetna,PPO,75563,CPT4/HCPCS,CARD MRI W/STRESS IMG & DYE,,Fee Schedule,2427.00
Aetna,PPO,75565,CPT4/HCPCS,CARD MRI VELOC FLOW MAPPING,,Fee Schedule,2427.00
Aetna,PPO,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,Case Rate,2427.00
Aetna,PPO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,Case Rate,2427.00
Aetna,PPO,75573,CPT4/HCPCS,CT HRT W/3D IMAGE CONGEN,,Case Rate,2427.00
Aetna,PPO,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,Case Rate,2427.00
Aetna,PPO,75600,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Fee Schedule,2138.55
Aetna,PPO,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Fee Schedule,1372.05
Aetna,PPO,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,Fee Schedule,1374.99
Aetna,PPO,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,Fee Schedule,1407.58
Aetna,PPO,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,Case Rate,2427.00
Aetna,PPO,75705,CPT4/HCPCS,ARTERY X-RAYS SPINE,,Fee Schedule,1540.72
Aetna,PPO,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,Fee Schedule,1546.69
Aetna,PPO,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,Fee Schedule,1778.02
Aetna,PPO,75726,CPT4/HCPCS,ARTERY X-RAYS ABDOMEN,,Fee Schedule,1523.00
Aetna,PPO,75731,CPT4/HCPCS,ARTERY X-RAYS ADRENAL GLAND,,Fee Schedule,1546.69
Aetna,PPO,75733,CPT4/HCPCS,ARTERY X-RAYS ADRENALS,,Fee Schedule,1772.14
Aetna,PPO,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,Fee Schedule,1520.06
Aetna,PPO,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Fee Schedule,1339.46
Aetna,PPO,75743,CPT4/HCPCS,ARTERY X-RAYS LUNGS,,Fee Schedule,1413.46
Aetna,PPO,75746,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Fee Schedule,1457.90
Aetna,PPO,75756,CPT4/HCPCS,ARTERY X-RAYS CHEST,,Fee Schedule,1549.63
Aetna,PPO,75774,CPT4/HCPCS,ARTERY X-RAY EACH VESSEL,,Fee Schedule,1230.01
Aetna,PPO,75801,CPT4/HCPCS,LYMPH VESSEL X-RAY ARM/LEG,,Fee Schedule,3544.38
Aetna,PPO,75803,CPT4/HCPCS,LYMPH VESSEL X-RAY ARMS/LEGS,,Fee Schedule,3544.38
Aetna,PPO,75805,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Fee Schedule,3544.38
Aetna,PPO,75807,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Fee Schedule,3544.38
Aetna,PPO,75809,CPT4/HCPCS,NONVASCULAR SHUNT X-RAY,,Fee Schedule,646.96
Aetna,PPO,75810,CPT4/HCPCS,VEIN X-RAY SPLEEN/LIVER,,Fee Schedule,17652.93
Aetna,PPO,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,Fee Schedule,789.01
Aetna,PPO,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,Fee Schedule,883.68
Aetna,PPO,75825,CPT4/HCPCS,VEIN X-RAY TRUNK,,Fee Schedule,1306.95
Aetna,PPO,75827,CPT4/HCPCS,VEIN X-RAY CHEST,,Fee Schedule,1333.58
Aetna,PPO,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,Fee Schedule,1336.52
Aetna,PPO,75833,CPT4/HCPCS,VEIN X-RAY KIDNEYS,,Fee Schedule,1478.56
Aetna,PPO,75840,CPT4/HCPCS,VEIN X-RAY ADRENAL GLAND,,Fee Schedule,1309.89
Aetna,PPO,75842,CPT4/HCPCS,VEIN X-RAY ADRENAL GLANDS,,Fee Schedule,1469.74
Aetna,PPO,75860,CPT4/HCPCS,VEIN X-RAY NECK,,Fee Schedule,1351.30
Aetna,PPO,75870,CPT4/HCPCS,VEIN X-RAY SKULL,,Fee Schedule,1339.46
Aetna,PPO,75872,CPT4/HCPCS,VEIN X-RAY SKULL EPIDURAL,,Fee Schedule,1946.19
Aetna,PPO,75880,CPT4/HCPCS,VEIN X-RAY EYE SOCKET,,Fee Schedule,1185.57
Aetna,PPO,75885,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Fee Schedule,1336.52
Aetna,PPO,75887,CPT4/HCPCS,VEIN X-RAY LIVER W/O HEMODYN,,Fee Schedule,1357.27
Aetna,PPO,75889,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Fee Schedule,1336.52
Aetna,PPO,75891,CPT4/HCPCS,VEIN X-RAY LIVER,,Fee Schedule,1339.46
Aetna,PPO,75893,CPT4/HCPCS,VENOUS SAMPLING BY CATHETER,,Fee Schedule,1327.62
Aetna,PPO,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,Fee Schedule,7743.28
Aetna,PPO,75898,CPT4/HCPCS,FOLLOW-UP ANGIOGRAPHY,,Fee Schedule,658.81
Aetna,PPO,75901,CPT4/HCPCS,REMOVE CVA DEVICE OBSTRUCT,,Fee Schedule,1247.73
Aetna,PPO,75902,CPT4/HCPCS,REMOVE CVA LUMEN OBSTRUCT,,Fee Schedule,501.90
Aetna,PPO,75956,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,Fee Schedule,2768.30
Aetna,PPO,75957,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,Fee Schedule,2369.47
Aetna,PPO,75958,CPT4/HCPCS,XRAY PLACE PROX EXT THOR AO,,Fee Schedule,1572.06
Aetna,PPO,75959,CPT4/HCPCS,XRAY PLACE DIST EXT THOR AO,,Fee Schedule,1379.78
Aetna,PPO,75970,CPT4/HCPCS,VASCULAR BIOPSY,,Fee Schedule,3664.83
Aetna,PPO,75984,CPT4/HCPCS,XRAY CONTROL CATHETER CHANGE,,Fee Schedule,691.32
Aetna,PPO,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,Fee Schedule,673.59
Aetna,PPO,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,Fee Schedule,602.53
Aetna,PPO,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,Fee Schedule,161.53
Aetna,PPO,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,Fee Schedule,309.54
Aetna,PPO,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,Fee Schedule,96.43
Aetna,PPO,76100,CPT4/HCPCS,X-RAY EXAM OF BODY SECTION,,Fee Schedule,658.81
Aetna,PPO,76101,CPT4/HCPCS,COMPLEX BODY SECTION X-RAY,,Fee Schedule,1250.67
Aetna,PPO,76102,CPT4/HCPCS,COMPLEX BODY SECTION X-RAYS,,Fee Schedule,1774.58
Aetna,PPO,76120,CPT4/HCPCS,CINE/VIDEO X-RAYS,,Fee Schedule,504.92
Aetna,PPO,76125,CPT4/HCPCS,CINE/VIDEO X-RAYS ADD-ON,,Fee Schedule,278.12
Aetna,PPO,76140,CPT4/HCPCS,X-RAY CONSULTATION,,Fee Schedule,304.08
Aetna,PPO,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Fee Schedule,537.43
Aetna,PPO,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Fee Schedule,472.33
Aetna,PPO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,Case Rate,2427.00
Aetna,PPO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,Fee Schedule,2814.00
Aetna,PPO,76391,CPT4/HCPCS,MR ELASTOGRAPHY,,Fee Schedule,1537.28
Aetna,PPO,76496,CPT4/HCPCS,FLUOROSCOPIC PROCEDURE,,Fee Schedule,726.85
Aetna,PPO,76497,CPT4/HCPCS,CT PROCEDURE,,Fee Schedule,987.33
Aetna,PPO,76498,CPT4/HCPCS,MRI PROCEDURE,,Case Rate,2427.00
Aetna,PPO,76499,CPT4/HCPCS,RADIOGRAPHIC PROCEDURE,,Fee Schedule,392.44
Aetna,PPO,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,Fee Schedule,543.39
Aetna,PPO,76510,CPT4/HCPCS,OPH US DX B-SCAN&QUAN A-SCAN,,Fee Schedule,646.96
Aetna,PPO,76511,CPT4/HCPCS,OPH US DX QUAN A-SCAN ONLY,,Fee Schedule,422.01
Aetna,PPO,76512,CPT4/HCPCS,OPH US DX B-SCAN,,Fee Schedule,350.95
Aetna,PPO,76513,CPT4/HCPCS,OPH US DX ANT SGM US UNI/BI,,Fee Schedule,469.39
Aetna,PPO,76514,CPT4/HCPCS,ECHO EXAM OF EYE THICKNESS,,Fee Schedule,37.29
Aetna,PPO,76516,CPT4/HCPCS,ECHO EXAM OF EYE,,Fee Schedule,371.70
Aetna,PPO,76519,CPT4/HCPCS,ECHO EXAM OF EYE,,Fee Schedule,416.13
Aetna,PPO,76529,CPT4/HCPCS,ECHO EXAM OF EYE,,Fee Schedule,362.79
Aetna,PPO,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,Fee Schedule,791.95
Aetna,PPO,76604,CPT4/HCPCS,US EXAM CHEST,,Fee Schedule,531.55
Aetna,PPO,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,Fee Schedule,595.14
Aetna,PPO,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,Fee Schedule,455.78
Aetna,PPO,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,Fee Schedule,836.38
Aetna,PPO,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,Fee Schedule,679.47
Aetna,PPO,76706,CPT4/HCPCS,US ABDL AORTA SCREEN AAA,,Fee Schedule,559.18
Aetna,PPO,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,Fee Schedule,836.38
Aetna,PPO,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,Fee Schedule,720.97
Aetna,PPO,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,Fee Schedule,996.15
Aetna,PPO,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,Fee Schedule,685.44
Aetna,PPO,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,Fee Schedule,712.06
Aetna,PPO,76802,CPT4/HCPCS,OB US < 14 WKS ADDL FETUS,,Fee Schedule,253.34
Aetna,PPO,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,Fee Schedule,836.38
Aetna,PPO,76810,CPT4/HCPCS,OB US >= 14 WKS ADDL FETUS,,Fee Schedule,433.86
Aetna,PPO,76811,CPT4/HCPCS,OB US DETAILED SNGL FETUS,,Fee Schedule,871.92
Aetna,PPO,76812,CPT4/HCPCS,OB US DETAILED ADDL FETUS,,Fee Schedule,543.39
Aetna,PPO,76813,CPT4/HCPCS,OB US NUCHAL MEAS 1 GEST,,Fee Schedule,602.53
Aetna,PPO,76814,CPT4/HCPCS,OB US NUCHAL MEAS ADD-ON,,Fee Schedule,282.91
Aetna,PPO,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,Fee Schedule,522.64
Aetna,PPO,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,Fee Schedule,540.37
Aetna,PPO,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,Fee Schedule,540.37
Aetna,PPO,76818,CPT4/HCPCS,FETAL BIOPHYS PROFILE W/NST,,Fee Schedule,617.31
Aetna,PPO,76819,CPT4/HCPCS,FETAL BIOPHYS PROFIL W/O NST,,Fee Schedule,469.39
Aetna,PPO,76820,CPT4/HCPCS,UMBILICAL ARTERY ECHO,,Fee Schedule,194.12
Aetna,PPO,76821,CPT4/HCPCS,MIDDLE CEREBRAL ARTERY ECHO,,Fee Schedule,540.37
Aetna,PPO,76825,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Fee Schedule,1185.57
Aetna,PPO,76826,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Fee Schedule,738.69
Aetna,PPO,76827,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Fee Schedule,333.22
Aetna,PPO,76828,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Fee Schedule,185.22
Aetna,PPO,76830,CPT4/HCPCS,TRANSVAGINAL US NON-OB,,Fee Schedule,794.89
Aetna,PPO,76831,CPT4/HCPCS,ECHO EXAM UTERUS,,Fee Schedule,786.07
Aetna,PPO,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,Fee Schedule,791.95
Aetna,PPO,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,Fee Schedule,540.37
Aetna,PPO,76870,CPT4/HCPCS,US EXAM SCROTUM,,Fee Schedule,803.79
Aetna,PPO,76872,CPT4/HCPCS,US TRANSRECTAL,,Fee Schedule,836.38
Aetna,PPO,76873,CPT4/HCPCS,ECHOGRAP TRANS R PROS STUDY,,Fee Schedule,836.38
Aetna,PPO,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,Fee Schedule,750.54
Aetna,PPO,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,Fee Schedule,87.61
Aetna,PPO,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,Fee Schedule,543.39
Aetna,PPO,76886,CPT4/HCPCS,US EXAM INFANT HIPS STATIC,,Fee Schedule,540.37
Aetna,PPO,76932,CPT4/HCPCS,ECHO GUIDE FOR HEART BIOPSY,,Fee Schedule,512.98
Aetna,PPO,76936,CPT4/HCPCS,ECHO GUIDE FOR ARTERY REPAIR,,Fee Schedule,928.11
Aetna,PPO,76937,CPT4/HCPCS,US GUIDE VASCULAR ACCESS,,Fee Schedule,170.43
Aetna,PPO,76940,CPT4/HCPCS,US GUIDE TISSUE ABLATION,,Fee Schedule,553.22
Aetna,PPO,76941,CPT4/HCPCS,ECHO GUIDE FOR TRANSFUSION,,Fee Schedule,501.14
Aetna,PPO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,Fee Schedule,1431.27
Aetna,PPO,76945,CPT4/HCPCS,ECHO GUIDE VILLUS SAMPLING,,Fee Schedule,515.92
Aetna,PPO,76946,CPT4/HCPCS,ECHO GUIDE FOR AMNIOCENTESIS,,Fee Schedule,167.49
Aetna,PPO,76948,CPT4/HCPCS,ECHO GUIDE OVA ASPIRATION,,Fee Schedule,167.49
Aetna,PPO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,Fee Schedule,436.80
Aetna,PPO,76970,CPT4/HCPCS,ULTRASOUND EXAM FOLLOW-UP,,Fee Schedule,540.37
Aetna,PPO,76975,CPT4/HCPCS,GI ENDOSCOPIC ULTRASOUND,,Fee Schedule,1330.64
Aetna,PPO,76977,CPT4/HCPCS,US BONE DENSITY MEASURE,,Fee Schedule,66.86
Aetna,PPO,76978,CPT4/HCPCS,US TRGT DYN MBUBB 1ST LES,,Fee Schedule,2082.44
Aetna,PPO,76979,CPT4/HCPCS,US TRGT DYN MBUBB EA ADDL,,Fee Schedule,1520.40
Aetna,PPO,76981,CPT4/HCPCS,USE PARENCHYMA,,Fee Schedule,662.00
Aetna,PPO,76982,CPT4/HCPCS,USE 1ST TARGET LESION,,Fee Schedule,565.15
Aetna,PPO,76983,CPT4/HCPCS,USE EA ADDL TARGET LESION,,Fee Schedule,287.70
Aetna,PPO,76998,CPT4/HCPCS,US GUIDE INTRAOP,,Fee Schedule,487.11
Aetna,PPO,77001,CPT4/HCPCS,FLUOROGUIDE FOR VEIN DEVICE,,Fee Schedule,830.42
Aetna,PPO,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,Fee Schedule,419.07
Aetna,PPO,77003,CPT4/HCPCS,FLUOROGUIDE FOR SPINE INJECT,,Fee Schedule,285.85
Aetna,PPO,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,Case Rate,2427.00
Aetna,PPO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,Case Rate,2427.00
Aetna,PPO,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,Case Rate,2427.00
Aetna,PPO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Case Rate,2427.00
Aetna,PPO,77021,CPT4/HCPCS,MRI GUIDANCE NDL PLMT RS&I,,Case Rate,2427.00
Aetna,PPO,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,Case Rate,2427.00
Aetna,PPO,77046,CPT4/HCPCS,MRI BREAST C- UNILATERAL,,Case Rate,2427.00
Aetna,PPO,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,Case Rate,2427.00
Aetna,PPO,77048,CPT4/HCPCS,MRI BREAST C-+ W/CAD UNI,,Case Rate,2427.00
Aetna,PPO,77049,CPT4/HCPCS,MRI BREAST C-+ W/CAD BI,,Case Rate,2427.00
Aetna,PPO,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,Fee Schedule,436.80
Aetna,PPO,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,Fee Schedule,602.53
Aetna,PPO,77061,CPT4/HCPCS,BREAST TOMOSYNTHESIS UNI,,Fee Schedule,992.29
Aetna,PPO,77062,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Fee Schedule,778.84
Aetna,PPO,77063,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Fee Schedule,212.77
Aetna,PPO,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,Fee Schedule,792.87
Aetna,PPO,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,Fee Schedule,1014.55
Aetna,PPO,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,Fee Schedule,837.81
Aetna,PPO,77071,CPT4/HCPCS,X-RAY STRESS VIEW,,Fee Schedule,381.94
Aetna,PPO,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,Fee Schedule,123.06
Aetna,PPO,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,Fee Schedule,211.84
Aetna,PPO,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,Fee Schedule,413.11
Aetna,PPO,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,Fee Schedule,658.81
Aetna,PPO,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,Fee Schedule,578.84
Aetna,PPO,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,Fee Schedule,223.69
Aetna,PPO,77078,CPT4/HCPCS,CT BONE DENSITY AXIAL,,Case Rate,2427.00
Aetna,PPO,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,Fee Schedule,739.03
Aetna,PPO,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,Fee Schedule,164.55
Aetna,PPO,77084,CPT4/HCPCS,MAGNETIC IMAGE BONE MARROW,,Case Rate,2427.00
Aetna,PPO,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,Fee Schedule,340.20
Aetna,PPO,77086,CPT4/HCPCS,FRACTURE ASSESSMENT VIA DXA,,Fee Schedule,221.67
Aetna,PPO,77261,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,557.25
Aetna,PPO,77262,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,835.63
Aetna,PPO,77263,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,1239.50
Aetna,PPO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges,1264.20
Aetna,PPO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges,2611.80
Aetna,PPO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges,3362.40
Aetna,PPO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,% of Charges,1962.60
Aetna,PPO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,% of Charges,14806.20
Aetna,PPO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,% of Charges,937.20
Aetna,PPO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,% of Charges,15882.60
Aetna,PPO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,% of Charges,1291.80
Aetna,PPO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,% of Charges,6620.40
Aetna,PPO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,% of Charges,2582.40
Aetna,PPO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,% of Charges,3343.80
Aetna,PPO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,% of Charges,4469.40
Aetna,PPO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,% of Charges,2623.80
Aetna,PPO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,% of Charges,448.80
Aetna,PPO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges,936.00
Aetna,PPO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges,1336.80
Aetna,PPO,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges,2360.40
Aetna,PPO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges,1471.20
Aetna,PPO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,% of Charges,11747.40
Aetna,PPO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges,1718.40
Aetna,PPO,77371,CPT4/HCPCS,SRS MULTISOURCE,,% of Charges,11915.73
Aetna,PPO,77372,CPT4/HCPCS,SRS LINEAR BASED,,% of Charges,25283.40
Aetna,PPO,77373,CPT4/HCPCS,SBRT DELIVERY,,% of Charges,10859.40
Aetna,PPO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,% of Charges,10314.00
Aetna,PPO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,% of Charges,12034.20
Aetna,PPO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,% of Charges,193.80
Aetna,PPO,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges,220.75
Aetna,PPO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges,1037.40
Aetna,PPO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges,1412.40
Aetna,PPO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges,1557.00
Aetna,PPO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,% of Charges,324.60
Aetna,PPO,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,% of Charges,2203.74
Aetna,PPO,77424,CPT4/HCPCS,IO RAD TX DELIVERY BY X-RAY,,% of Charges,2476.06
Aetna,PPO,77425,CPT4/HCPCS,IO RAD TX DELIVER BY ELCTRNS,,% of Charges,1747.28
Aetna,PPO,77427,CPT4/HCPCS,RADIATION TX MANAGEMENT X5,,% of Charges,1390.95
Aetna,PPO,77431,CPT4/HCPCS,RADIATION THERAPY MANAGEMENT,,% of Charges,764.82
Aetna,PPO,77432,CPT4/HCPCS,STEREOTACTIC RADIATION TRMT,,% of Charges,3134.12
Aetna,PPO,77435,CPT4/HCPCS,SBRT MANAGEMENT,,% of Charges,5203.12
Aetna,PPO,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,% of Charges,2227.76
Aetna,PPO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,% of Charges,5173.20
Aetna,PPO,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,% of Charges,9231.76
Aetna,PPO,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,% of Charges,10557.62
Aetna,PPO,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,% of Charges,15981.50
Aetna,PPO,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,% of Charges,15603.75
Aetna,PPO,77600,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,% of Charges,2867.17
Aetna,PPO,77605,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,% of Charges,7137.90
Aetna,PPO,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,% of Charges,6717.64
Aetna,PPO,77615,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,% of Charges,7553.36
Aetna,PPO,77620,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,% of Charges,3528.92
Aetna,PPO,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,% of Charges,813.60
Aetna,PPO,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,% of Charges,1528.21
Aetna,PPO,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,% of Charges,1787.52
Aetna,PPO,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,% of Charges,2311.84
Aetna,PPO,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,% of Charges,1425.64
Aetna,PPO,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,% of Charges,2344.44
Aetna,PPO,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,% of Charges,9497.40
Aetna,PPO,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,% of Charges,9497.40
Aetna,PPO,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,% of Charges,9497.40
Aetna,PPO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,% of Charges,2135.40
Aetna,PPO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,% of Charges,169.80
Aetna,PPO,77790,CPT4/HCPCS,RADIATION HANDLING,,% of Charges,183.00
Aetna,PPO,78012,CPT4/HCPCS,THYROID UPTAKE MEASUREMENT,,Fee Schedule,607.15
Aetna,PPO,78013,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Fee Schedule,1233.79
Aetna,PPO,78014,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Fee Schedule,1798.86
Aetna,PPO,78015,CPT4/HCPCS,THYROID MET IMAGING,,Fee Schedule,1585.66
Aetna,PPO,78016,CPT4/HCPCS,THYROID MET IMAGING/STUDIES,,Fee Schedule,2322.60
Aetna,PPO,78018,CPT4/HCPCS,THYROID MET IMAGING BODY,,Fee Schedule,2408.44
Aetna,PPO,78020,CPT4/HCPCS,THYROID MET UPTAKE,,Fee Schedule,498.96
Aetna,PPO,78070,CPT4/HCPCS,PARATHYROID PLANAR IMAGING,,Fee Schedule,1088.47
Aetna,PPO,78071,CPT4/HCPCS,PARATHYRD PLANAR W/WO SUBTRJ,,Fee Schedule,2510.84
Aetna,PPO,78072,CPT4/HCPCS,PARATHYRD PLANAR W/SPECT&CT,,Fee Schedule,2370.73
Aetna,PPO,78075,CPT4/HCPCS,ADRENAL CORTEX & MEDULLA IMG,,Fee Schedule,3392.84
Aetna,PPO,78102,CPT4/HCPCS,BONE MARROW IMAGING LTD,,Fee Schedule,1212.79
Aetna,PPO,78103,CPT4/HCPCS,BONE MARROW IMAGING MULT,,Fee Schedule,1591.63
Aetna,PPO,78104,CPT4/HCPCS,BONE MARROW IMAGING BODY,,Fee Schedule,1828.34
Aetna,PPO,78110,CPT4/HCPCS,PLASMA VOLUME SINGLE,,Fee Schedule,635.62
Aetna,PPO,78111,CPT4/HCPCS,PLASMA VOLUME MULTIPLE,,Fee Schedule,668.22
Aetna,PPO,78120,CPT4/HCPCS,RED CELL MASS SINGLE,,Fee Schedule,662.25
Aetna,PPO,78121,CPT4/HCPCS,RED CELL MASS MULTIPLE,,Fee Schedule,739.20
Aetna,PPO,78122,CPT4/HCPCS,BLOOD VOLUME,,Fee Schedule,789.51
Aetna,PPO,78130,CPT4/HCPCS,RED CELL SURVIVAL STUDY,,Fee Schedule,1078.39
Aetna,PPO,78135,CPT4/HCPCS,RED CELL SURVIVAL KINETICS,,Fee Schedule,2707.40
Aetna,PPO,78140,CPT4/HCPCS,RED CELL SEQUESTRATION,,Fee Schedule,943.48
Aetna,PPO,78185,CPT4/HCPCS,SPLEEN IMAGING,,Fee Schedule,1576.84
Aetna,PPO,78191,CPT4/HCPCS,PLATELET SURVIVAL,,Fee Schedule,1273.69
Aetna,PPO,78195,CPT4/HCPCS,LYMPH SYSTEM IMAGING,,Fee Schedule,2236.83
Aetna,PPO,78201,CPT4/HCPCS,LIVER IMAGING,,Fee Schedule,1425.90
Aetna,PPO,78202,CPT4/HCPCS,LIVER IMAGING WITH FLOW,,Fee Schedule,1553.16
Aetna,PPO,78215,CPT4/HCPCS,LIVER AND SPLEEN IMAGING,,Fee Schedule,1458.40
Aetna,PPO,78216,CPT4/HCPCS,LIVER & SPLEEN IMAGE/FLOW,,Fee Schedule,893.17
Aetna,PPO,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Fee Schedule,2413.82
Aetna,PPO,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Fee Schedule,3352.10
Aetna,PPO,78230,CPT4/HCPCS,SALIVARY GLAND IMAGING,,Fee Schedule,1248.32
Aetna,PPO,78231,CPT4/HCPCS,SERIAL SALIVARY IMAGING,,Fee Schedule,899.05
Aetna,PPO,78232,CPT4/HCPCS,SALIVARY GLAND FUNCTION EXAM,,Fee Schedule,827.98
Aetna,PPO,78258,CPT4/HCPCS,ESOPHAGEAL MOTILITY STUDY,,Fee Schedule,1665.63
Aetna,PPO,78261,CPT4/HCPCS,GASTRIC MUCOSA IMAGING,,Fee Schedule,1872.78
Aetna,PPO,78262,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX EXAM,,Fee Schedule,1846.15
Aetna,PPO,78264,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Fee Schedule,2079.92
Aetna,PPO,78265,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Fee Schedule,2748.14
Aetna,PPO,78266,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Fee Schedule,3641.48
Aetna,PPO,78267,CPT4/HCPCS,BREATH TST ATTAIN/ANAL C-14,,Fee Schedule,97.69
Aetna,PPO,78268,CPT4/HCPCS,BREATH TEST ANALYSIS C-14,,Fee Schedule,825.72
Aetna,PPO,78278,CPT4/HCPCS,ACUTE GI BLOOD LOSS IMAGING,,Fee Schedule,2081.18
Aetna,PPO,78282,CPT4/HCPCS,GI PROTEIN LOSS EXAM,,Fee Schedule,2082.36
Aetna,PPO,78290,CPT4/HCPCS,MECKELS DIVERT EXAM,,Fee Schedule,2082.86
Aetna,PPO,78291,CPT4/HCPCS,LEVEEN/SHUNT PATENCY EXAM,,Fee Schedule,1819.52
Aetna,PPO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Per Diem,3937.00
Aetna,PPO,78300,CPT4/HCPCS,BONE IMAGING LIMITED AREA,,Fee Schedule,1263.10
Aetna,PPO,78305,CPT4/HCPCS,BONE IMAGING MULTIPLE AREAS,,Fee Schedule,1668.57
Aetna,PPO,78306,CPT4/HCPCS,BONE IMAGING WHOLE BODY,,Fee Schedule,1834.30
Aetna,PPO,78315,CPT4/HCPCS,BONE IMAGING 3 PHASE,,Fee Schedule,2128.47
Aetna,PPO,78350,CPT4/HCPCS,BONE MINERAL SINGLE PHOTON,,Fee Schedule,191.18
Aetna,PPO,78351,CPT4/HCPCS,BONE MINERAL DUAL PHOTON,,Fee Schedule,81.31
Aetna,PPO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Per Diem,3937.00
Aetna,PPO,78414,CPT4/HCPCS,NON-IMAGING HEART FUNCTION,,Fee Schedule,446.12
Aetna,PPO,78428,CPT4/HCPCS,CARDIAC SHUNT IMAGING,,Fee Schedule,1342.99
Aetna,PPO,78445,CPT4/HCPCS,VASCULAR FLOW IMAGING,,Fee Schedule,1283.77
Aetna,PPO,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,Fee Schedule,2393.66
Aetna,PPO,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,Fee Schedule,3478.60
Aetna,PPO,78453,CPT4/HCPCS,HT MUSCLE IMAGE PLANAR SING,,Fee Schedule,2130.24
Aetna,PPO,78454,CPT4/HCPCS,HT MUSC IMAGE PLANAR MULT,,Fee Schedule,3123.45
Aetna,PPO,78456,CPT4/HCPCS,ACUTE VENOUS THROMBUS IMAGE,,Fee Schedule,1743.75
Aetna,PPO,78457,CPT4/HCPCS,VENOUS THROMBOSIS IMAGING,,Fee Schedule,1366.68
Aetna,PPO,78458,CPT4/HCPCS,VEN THROMBOSIS IMAGES BILAT,,Fee Schedule,1334.08
Aetna,PPO,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,Fee Schedule,12600.00
Aetna,PPO,78466,CPT4/HCPCS,HEART INFARCT IMAGE,,Fee Schedule,1266.04
Aetna,PPO,78468,CPT4/HCPCS,HEART INFARCT IMAGE (EF),,Fee Schedule,1547.19
Aetna,PPO,78469,CPT4/HCPCS,HEART INFARCT IMAGE (3D),,Fee Schedule,1828.34
Aetna,PPO,78472,CPT4/HCPCS,GATED HEART PLANAR SINGLE,,Fee Schedule,1763.24
Aetna,PPO,78473,CPT4/HCPCS,GATED HEART MULTIPLE,,Fee Schedule,2248.68
Aetna,PPO,78481,CPT4/HCPCS,HEART FIRST PASS SINGLE,,Fee Schedule,1389.78
Aetna,PPO,78483,CPT4/HCPCS,HEART FIRST PASS MULTIPLE,,Fee Schedule,1872.78
Aetna,PPO,78491,CPT4/HCPCS,MYOCRD IMG PET 1STD RST/STRS,,Fee Schedule,12600.00
Aetna,PPO,78492,CPT4/HCPCS,MYOCRD IMG PET MLT RST&STRS,,Fee Schedule,12600.00
Aetna,PPO,78494,CPT4/HCPCS,HEART IMAGE SPECT,,Fee Schedule,1807.68
Aetna,PPO,78496,CPT4/HCPCS,HEART FIRST PASS ADD-ON,,Fee Schedule,484.17
Aetna,PPO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Per Diem,3937.00
Aetna,PPO,78579,CPT4/HCPCS,LUNG VENTILATION IMAGING,,Fee Schedule,1245.55
Aetna,PPO,78580,CPT4/HCPCS,LUNG PERFUSION IMAGING,,Fee Schedule,1532.41
Aetna,PPO,78582,CPT4/HCPCS,LUNG VENTILAT&PERFUS IMAGING,,Fee Schedule,2237.08
Aetna,PPO,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Fee Schedule,1335.26
Aetna,PPO,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Fee Schedule,2164.17
Aetna,PPO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Per Diem,3937.00
Aetna,PPO,78600,CPT4/HCPCS,BRAIN IMAGE < 4 VIEWS,,Fee Schedule,1372.56
Aetna,PPO,78601,CPT4/HCPCS,BRAIN IMAGE W/FLOW < 4 VIEWS,,Fee Schedule,1635.98
Aetna,PPO,78605,CPT4/HCPCS,BRAIN IMAGE 4+ VIEWS,,Fee Schedule,1482.09
Aetna,PPO,78606,CPT4/HCPCS,BRAIN IMAGE W/FLOW 4 + VIEWS,,Fee Schedule,2547.55
Aetna,PPO,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,Fee Schedule,12600.00
Aetna,PPO,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,Fee Schedule,12600.00
Aetna,PPO,78610,CPT4/HCPCS,BRAIN FLOW IMAGING ONLY,,Fee Schedule,1411.03
Aetna,PPO,78630,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Fee Schedule,2633.40
Aetna,PPO,78635,CPT4/HCPCS,CSF VENTRICULOGRAPHY,,Fee Schedule,2529.82
Aetna,PPO,78645,CPT4/HCPCS,CSF SHUNT EVALUATION,,Fee Schedule,2091.76
Aetna,PPO,78650,CPT4/HCPCS,CSF LEAKAGE IMAGING,,Fee Schedule,2603.83
Aetna,PPO,78660,CPT4/HCPCS,NUCLEAR EXAM OF TEAR FLOW,,Fee Schedule,1304.52
Aetna,PPO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Per Diem,3937.00
Aetna,PPO,78700,CPT4/HCPCS,KIDNEY IMAGING MORPHOL,,Fee Schedule,1334.08
Aetna,PPO,78701,CPT4/HCPCS,KIDNEY IMAGING WITH FLOW,,Fee Schedule,1638.92
Aetna,PPO,78707,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/O DRUG,,Fee Schedule,1659.67
Aetna,PPO,78708,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/DRUG,,Fee Schedule,1052.94
Aetna,PPO,78709,CPT4/HCPCS,K FLOW/FUNCT IMAGE MULTIPLE,,Fee Schedule,2586.02
Aetna,PPO,78725,CPT4/HCPCS,KIDNEY FUNCTION STUDY,,Fee Schedule,730.38
Aetna,PPO,78730,CPT4/HCPCS,URINARY BLADDER RETENTION,,Fee Schedule,578.84
Aetna,PPO,78740,CPT4/HCPCS,URETERAL REFLUX STUDY,,Fee Schedule,1674.45
Aetna,PPO,78761,CPT4/HCPCS,TESTICULAR IMAGING W/FLOW,,Fee Schedule,1538.37
Aetna,PPO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Per Diem,3937.00
Aetna,PPO,78800,CPT4/HCPCS,RP LOCLZJ TUM 1 AREA 1 D IMG,,Fee Schedule,1342.99
Aetna,PPO,78801,CPT4/HCPCS,RP LOCLZJ TUM 2+AREA 1+D IMG,,Fee Schedule,1857.99
Aetna,PPO,78802,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 1 D IMG,,Fee Schedule,2476.57
Aetna,PPO,78803,CPT4/HCPCS,RP LOCLZJ TUM SPECT 1 AREA,,Fee Schedule,2594.92
Aetna,PPO,78804,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 2+D IMG,,Fee Schedule,4596.14
Aetna,PPO,78808,CPT4/HCPCS,IV INJ RA DRUG DX STUDY,,Fee Schedule,364.30
Aetna,PPO,78811,CPT4/HCPCS,PET IMAGE LTD AREA,,Fee Schedule,12600.00
Aetna,PPO,78812,CPT4/HCPCS,PET IMAGE SKULL-THIGH,,Fee Schedule,12600.00
Aetna,PPO,78813,CPT4/HCPCS,PET IMAGE FULL BODY,,Fee Schedule,12600.00
Aetna,PPO,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,Fee Schedule,12600.00
Aetna,PPO,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,Fee Schedule,12600.00
Aetna,PPO,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,Fee Schedule,12600.00
Aetna,PPO,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Fee Schedule,475.27
Aetna,PPO,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,Fee Schedule,516.68
Aetna,PPO,79200,CPT4/HCPCS,NUCLEAR RX INTRACAV ADMIN,,Fee Schedule,587.74
Aetna,PPO,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Fee Schedule,463.84
Aetna,PPO,79403,CPT4/HCPCS,HEMATOPOIETIC NUCLEAR TX,,Fee Schedule,798.42
Aetna,PPO,79440,CPT4/HCPCS,NUCLEAR RX INTRA-ARTICULAR,,Fee Schedule,493.08
Aetna,PPO,79445,CPT4/HCPCS,NUCLEAR RX INTRA-ARTERIAL,,Fee Schedule,843.10
Aetna,PPO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,3937.00
Aetna,PPO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,3937.00
Aetna,PPO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,3937.00
Aetna,PPO,80047,CPT4/HCPCS,METABOLIC PANEL IONIZED CA,,Fee Schedule,85.00
Aetna,PPO,80048,CPT4/HCPCS,METABOLIC PANEL TOTAL CA,,Fee Schedule,85.00
Aetna,PPO,80050,CPT4/HCPCS,GENERAL HEALTH PANEL,,Fee Schedule,352.21
Aetna,PPO,80051,CPT4/HCPCS,ELECTROLYTE PANEL,,Fee Schedule,70.47
Aetna,PPO,80053,CPT4/HCPCS,COMPREHEN METABOLIC PANEL,,Fee Schedule,106.17
Aetna,PPO,80055,CPT4/HCPCS,OBSTETRIC PANEL,,Fee Schedule,515.00
Aetna,PPO,80061,CPT4/HCPCS,LIPID PANEL,,Fee Schedule,134.56
Aetna,PPO,80069,CPT4/HCPCS,RENAL FUNCTION PANEL,,Fee Schedule,87.27
Aetna,PPO,80074,CPT4/HCPCS,ACUTE HEPATITIS PANEL,,Fee Schedule,478.46
Aetna,PPO,80076,CPT4/HCPCS,HEPATIC FUNCTION PANEL,,Fee Schedule,82.06
Aetna,PPO,80081,CPT4/HCPCS,OBSTETRIC PANEL,,Fee Schedule,728.02
Aetna,PPO,80150,CPT4/HCPCS,ASSAY OF AMIKACIN,,Fee Schedule,151.45
Aetna,PPO,80155,CPT4/HCPCS,DRUG ASSAY CAFFEINE,,Fee Schedule,137.84
Aetna,PPO,80156,CPT4/HCPCS,ASSAY CARBAMAZEPINE TOTAL,,Fee Schedule,146.32
Aetna,PPO,80157,CPT4/HCPCS,ASSAY CARBAMAZEPINE FREE,,Fee Schedule,133.22
Aetna,PPO,80158,CPT4/HCPCS,DRUG ASSAY CYCLOSPORINE,,Fee Schedule,181.35
Aetna,PPO,80159,CPT4/HCPCS,DRUG ASSAY CLOZAPINE,,Fee Schedule,180.18
Aetna,PPO,80162,CPT4/HCPCS,ASSAY OF DIGOXIN TOTAL,,Fee Schedule,133.47
Aetna,PPO,80163,CPT4/HCPCS,ASSAY OF DIGOXIN FREE,,Fee Schedule,129.02
Aetna,PPO,80164,CPT4/HCPCS,ASSAY DIPROPYLACETIC ACD TOT,,Fee Schedule,136.08
Aetna,PPO,80165,CPT4/HCPCS,DIPROPYLACETIC ACID FREE,,Fee Schedule,131.62
Aetna,PPO,80168,CPT4/HCPCS,ASSAY OF ETHOSUXIMIDE,,Fee Schedule,164.22
Aetna,PPO,80169,CPT4/HCPCS,DRUG ASSAY EVEROLIMUS,,Fee Schedule,133.72
Aetna,PPO,80170,CPT4/HCPCS,ASSAY OF GENTAMICIN,,Fee Schedule,164.72
Aetna,PPO,80171,CPT4/HCPCS,DRUG SCREEN QUANT GABAPENTIN,,Fee Schedule,129.19
Aetna,PPO,80173,CPT4/HCPCS,ASSAY OF HALOPERIDOL,,Fee Schedule,146.32
Aetna,PPO,80175,CPT4/HCPCS,DRUG SCREEN QUAN LAMOTRIGINE,,Fee Schedule,129.19
Aetna,PPO,80176,CPT4/HCPCS,ASSAY OF LIDOCAINE,,Fee Schedule,147.58
Aetna,PPO,80177,CPT4/HCPCS,DRUG SCRN QUAN LEVETIRACETAM,,Fee Schedule,129.19
Aetna,PPO,80178,CPT4/HCPCS,ASSAY OF LITHIUM,,Fee Schedule,66.44
Aetna,PPO,80180,CPT4/HCPCS,DRUG SCRN QUAN MYCOPHENOLATE,,Fee Schedule,175.89
Aetna,PPO,80183,CPT4/HCPCS,DRUG SCRN QUANT OXCARBAZEPIN,,Fee Schedule,129.19
Aetna,PPO,80184,CPT4/HCPCS,ASSAY OF PHENOBARBITAL,,Fee Schedule,109.28
Aetna,PPO,80185,CPT4/HCPCS,ASSAY OF PHENYTOIN TOTAL,,Fee Schedule,133.22
Aetna,PPO,80186,CPT4/HCPCS,ASSAY OF PHENYTOIN FREE,,Fee Schedule,138.26
Aetna,PPO,80188,CPT4/HCPCS,ASSAY OF PRIMIDONE,,Fee Schedule,146.24
Aetna,PPO,80190,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,Fee Schedule,168.25
Aetna,PPO,80192,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,Fee Schedule,168.25
Aetna,PPO,80194,CPT4/HCPCS,ASSAY OF QUINIDINE,,Fee Schedule,146.66
Aetna,PPO,80195,CPT4/HCPCS,ASSAY OF SIROLIMUS,,Fee Schedule,137.92
Aetna,PPO,80197,CPT4/HCPCS,ASSAY OF TACROLIMUS,,Fee Schedule,137.92
Aetna,PPO,80198,CPT4/HCPCS,ASSAY OF THEOPHYLLINE,,Fee Schedule,142.12
Aetna,PPO,80199,CPT4/HCPCS,DRUG SCREEN QUANT TIAGABINE,,Fee Schedule,175.89
Aetna,PPO,80200,CPT4/HCPCS,ASSAY OF TOBRAMYCIN,,Fee Schedule,161.95
Aetna,PPO,80201,CPT4/HCPCS,ASSAY OF TOPIRAMATE,,Fee Schedule,119.78
Aetna,PPO,80202,CPT4/HCPCS,ASSAY OF VANCOMYCIN,,Fee Schedule,136.08
Aetna,PPO,80203,CPT4/HCPCS,DRUG SCREEN QUANT ZONISAMIDE,,Fee Schedule,129.19
Aetna,PPO,80299,CPT4/HCPCS,QUANTITATIVE ASSAY DRUG,,Fee Schedule,133.05
Aetna,PPO,80305,CPT4/HCPCS,DRUG TEST PRSMV DIR OPT OBS,,Fee Schedule,106.84
Aetna,PPO,80306,CPT4/HCPCS,DRUG TEST PRSMV INSTRMNT,,Fee Schedule,142.46
Aetna,PPO,80307,CPT4/HCPCS,DRUG TEST PRSMV CHEM ANLYZR,,Fee Schedule,569.85
Aetna,PPO,80320,CPT4/HCPCS,DRUG SCREEN QUANTALCOHOLS,,Fee Schedule,0.08
Aetna,PPO,80321,CPT4/HCPCS,ALCOHOLS BIOMARKERS 1OR 2,,Fee Schedule,0.08
Aetna,PPO,80322,CPT4/HCPCS,ALCOHOLS BIOMARKERS 3/MORE,,Fee Schedule,0.08
Aetna,PPO,80323,CPT4/HCPCS,ALKALOIDS NOS,,Fee Schedule,0.08
Aetna,PPO,80324,CPT4/HCPCS,DRUG SCREEN AMPHETAMINES 1/2,,Fee Schedule,0.08
Aetna,PPO,80325,CPT4/HCPCS,AMPHETAMINES 3OR 4,,Fee Schedule,0.08
Aetna,PPO,80326,CPT4/HCPCS,AMPHETAMINES 5 OR MORE,,Fee Schedule,0.08
Aetna,PPO,80327,CPT4/HCPCS,ANABOLIC STEROID 1 OR 2,,Fee Schedule,0.08
Aetna,PPO,80328,CPT4/HCPCS,ANABOLIC STEROID 3 OR MORE,,Fee Schedule,0.08
Aetna,PPO,80329,CPT4/HCPCS,ANALGESICS NON-OPIOID 1 OR 2,,Fee Schedule,0.08
Aetna,PPO,80330,CPT4/HCPCS,ANALGESICS NON-OPIOID 3-5,,Fee Schedule,0.08
Aetna,PPO,80331,CPT4/HCPCS,ANALGESICS NON-OPIOID 6/MORE,,Fee Schedule,0.08
Aetna,PPO,80332,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 1 OR 2,,Fee Schedule,0.08
Aetna,PPO,80333,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 3-5,,Fee Schedule,0.08
Aetna,PPO,80334,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 6/MORE,,Fee Schedule,0.08
Aetna,PPO,80335,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 1/2,,Fee Schedule,0.08
Aetna,PPO,80336,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 3-5,,Fee Schedule,0.08
Aetna,PPO,80337,CPT4/HCPCS,TRICYCLIC & CYCLICALS 6/MORE,,Fee Schedule,0.08
Aetna,PPO,80338,CPT4/HCPCS,ANTIDEPRESSANT NOT SPECIFIED,,Fee Schedule,0.08
Aetna,PPO,80339,CPT4/HCPCS,ANTIEPILEPTICS NOS 1-3,,Fee Schedule,0.08
Aetna,PPO,80340,CPT4/HCPCS,ANTIEPILEPTICS NOS 4-6,,Fee Schedule,0.08
Aetna,PPO,80341,CPT4/HCPCS,ANTIEPILEPTICS NOS 7/MORE,,Fee Schedule,0.08
Aetna,PPO,80342,CPT4/HCPCS,ANTIPSYCHOTICS NOS 1-3,,Fee Schedule,0.08
Aetna,PPO,80343,CPT4/HCPCS,ANTIPSYCHOTICS NOS 4-6,,Fee Schedule,0.08
Aetna,PPO,80344,CPT4/HCPCS,ANTIPSYCHOTICS NOS 7/MORE,,Fee Schedule,0.08
Aetna,PPO,80345,CPT4/HCPCS,DRUG SCREENING BARBITURATES,,Fee Schedule,0.08
Aetna,PPO,80346,CPT4/HCPCS,BENZODIAZEPINES1-12,,Fee Schedule,0.08
Aetna,PPO,80347,CPT4/HCPCS,BENZODIAZEPINES 13 OR MORE,,Fee Schedule,0.08
Aetna,PPO,80348,CPT4/HCPCS,DRUG SCREENING BUPRENORPHINE,,Fee Schedule,0.08
Aetna,PPO,80349,CPT4/HCPCS,CANNABINOIDS NATURAL,,Fee Schedule,0.08
Aetna,PPO,80350,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 1-3,,Fee Schedule,0.08
Aetna,PPO,80351,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 4-6,,Fee Schedule,0.08
Aetna,PPO,80352,CPT4/HCPCS,CANNABINOID SYNTHETIC 7/MORE,,Fee Schedule,0.08
Aetna,PPO,80353,CPT4/HCPCS,DRUG SCREENING COCAINE,,Fee Schedule,0.08
Aetna,PPO,80354,CPT4/HCPCS,DRUG SCREENING FENTANYL,,Fee Schedule,0.08
Aetna,PPO,80355,CPT4/HCPCS,GABAPENTIN NON-BLOOD,,Fee Schedule,0.08
Aetna,PPO,80356,CPT4/HCPCS,HEROIN METABOLITE,,Fee Schedule,0.08
Aetna,PPO,80357,CPT4/HCPCS,KETAMINE AND NORKETAMINE,,Fee Schedule,0.08
Aetna,PPO,80358,CPT4/HCPCS,DRUG SCREENING METHADONE,,Fee Schedule,0.08
Aetna,PPO,80359,CPT4/HCPCS,METHYLENEDIOXYAMPHETAMINES,,Fee Schedule,0.08
Aetna,PPO,80360,CPT4/HCPCS,METHYLPHENIDATE,,Fee Schedule,0.08
Aetna,PPO,80361,CPT4/HCPCS,OPIATES 1 OR MORE,,Fee Schedule,0.08
Aetna,PPO,80362,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 1/2,,Fee Schedule,0.08
Aetna,PPO,80363,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 3/4,,Fee Schedule,0.08
Aetna,PPO,80364,CPT4/HCPCS,OPIOID &OPIATE ANALOG 5/MORE,,Fee Schedule,0.08
Aetna,PPO,80365,CPT4/HCPCS,DRUG SCREENING OXYCODONE,,Fee Schedule,0.08
Aetna,PPO,80366,CPT4/HCPCS,DRUG SCREENING PREGABALIN,,Fee Schedule,0.08
Aetna,PPO,80367,CPT4/HCPCS,DRUG SCREENING PROPOXYPHENE,,Fee Schedule,0.08
Aetna,PPO,80368,CPT4/HCPCS,SEDATIVE HYPNOTICS,,Fee Schedule,0.08
Aetna,PPO,80369,CPT4/HCPCS,SKELETAL MUSCLE RELAXANT 1/2,,Fee Schedule,0.08
Aetna,PPO,80370,CPT4/HCPCS,SKEL MUSC RELAXANT 3 OR MORE,,Fee Schedule,0.08
Aetna,PPO,80371,CPT4/HCPCS,STIMULANTS SYNTHETIC,,Fee Schedule,0.08
Aetna,PPO,80372,CPT4/HCPCS,DRUG SCREENING TAPENTADOL,,Fee Schedule,0.08
Aetna,PPO,80373,CPT4/HCPCS,DRUG SCREENING TRAMADOL,,Fee Schedule,0.08
Aetna,PPO,80374,CPT4/HCPCS,STEREOISOMER ANALYSIS,,Fee Schedule,0.08
Aetna,PPO,80375,CPT4/HCPCS,DRUG/SUBSTANCE NOS 1-3,,Fee Schedule,0.08
Aetna,PPO,80376,CPT4/HCPCS,DRUG/SUBSTANCE NOS 4-6,,Fee Schedule,0.08
Aetna,PPO,80377,CPT4/HCPCS,DRUG/SUBSTANCE NOS 7/MORE,,Fee Schedule,0.08
Aetna,PPO,80400,CPT4/HCPCS,ACTH STIMULATION PANEL,,Fee Schedule,327.76
Aetna,PPO,80402,CPT4/HCPCS,ACTH STIMULATION PANEL,,Fee Schedule,873.68
Aetna,PPO,80406,CPT4/HCPCS,ACTH STIMULATION PANEL,,Fee Schedule,786.40
Aetna,PPO,80408,CPT4/HCPCS,ALDOSTERONE SUPPRESSION EVAL,,Fee Schedule,1260.92
Aetna,PPO,80410,CPT4/HCPCS,CALCITONIN STIMUL PANEL,,Fee Schedule,807.32
Aetna,PPO,80412,CPT4/HCPCS,CRH STIMULATION PANEL,,Fee Schedule,3311.53
Aetna,PPO,80414,CPT4/HCPCS,TESTOSTERONE RESPONSE PANEL,,Fee Schedule,518.78
Aetna,PPO,80415,CPT4/HCPCS,TOT ESTRADIOL RESPONSE PANEL,,Fee Schedule,561.45
Aetna,PPO,80416,CPT4/HCPCS,RENIN STIMULATION PANEL,,Fee Schedule,1325.94
Aetna,PPO,80417,CPT4/HCPCS,RENIN STIMULATION PANEL,,Fee Schedule,442.00
Aetna,PPO,80418,CPT4/HCPCS,PITUITARY EVALUATION PANEL,,Fee Schedule,5823.13
Aetna,PPO,80420,CPT4/HCPCS,DEXAMETHASONE PANEL,,Fee Schedule,723.82
Aetna,PPO,80422,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,Fee Schedule,462.92
Aetna,PPO,80424,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,Fee Schedule,507.36
Aetna,PPO,80426,CPT4/HCPCS,GONADOTROPIN HORMONE PANEL,,Fee Schedule,1491.08
Aetna,PPO,80428,CPT4/HCPCS,GROWTH HORMONE PANEL,,Fee Schedule,670.32
Aetna,PPO,80430,CPT4/HCPCS,GROWTH HORMONE PANEL,,Fee Schedule,788.50
Aetna,PPO,80432,CPT4/HCPCS,INSULIN SUPPRESSION PANEL,,Fee Schedule,1357.27
Aetna,PPO,80434,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,Fee Schedule,1016.40
Aetna,PPO,80435,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,Fee Schedule,1034.96
Aetna,PPO,80436,CPT4/HCPCS,METYRAPONE PANEL,,Fee Schedule,916.10
Aetna,PPO,80438,CPT4/HCPCS,TRH STIMULATION PANEL,,Fee Schedule,506.35
Aetna,PPO,80439,CPT4/HCPCS,TRH STIMULATION PANEL,,Fee Schedule,675.19
Aetna,PPO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,3937.00
Aetna,PPO,80500,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,Fee Schedule,139.94
Aetna,PPO,80502,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,Fee Schedule,474.76
Aetna,PPO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,3937.00
Aetna,PPO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,3937.00
Aetna,PPO,81000,CPT4/HCPCS,URINALYSIS NONAUTO W/SCOPE,,Fee Schedule,31.75
Aetna,PPO,81001,CPT4/HCPCS,URINALYSIS AUTO W/SCOPE,,Fee Schedule,31.75
Aetna,PPO,81002,CPT4/HCPCS,URINALYSIS NONAUTO W/O SCOPE,,Fee Schedule,25.70
Aetna,PPO,81003,CPT4/HCPCS,URINALYSIS AUTO W/O SCOPE,,Fee Schedule,22.59
Aetna,PPO,81005,CPT4/HCPCS,URINALYSIS,,Fee Schedule,21.75
Aetna,PPO,81007,CPT4/HCPCS,URINE SCREEN FOR BACTERIA,,Fee Schedule,25.78
Aetna,PPO,81015,CPT4/HCPCS,MICROSCOPIC EXAM OF URINE,,Fee Schedule,30.57
Aetna,PPO,81020,CPT4/HCPCS,URINALYSIS GLASS TEST,,Fee Schedule,37.04
Aetna,PPO,81025,CPT4/HCPCS,URINE PREGNANCY TEST,,Fee Schedule,23.60
Aetna,PPO,81050,CPT4/HCPCS,URINALYSIS VOLUME MEASURE,,Fee Schedule,30.15
Aetna,PPO,81105,CPT4/HCPCS,HPA-1 GENOTYPING,,Fee Schedule,1077.38
Aetna,PPO,81106,CPT4/HCPCS,HPA-2 GENOTYPING,,Fee Schedule,1077.38
Aetna,PPO,81107,CPT4/HCPCS,HPA-3 GENOTYPING,,Fee Schedule,1077.38
Aetna,PPO,81108,CPT4/HCPCS,HPA-4 GENOTYPING,,Fee Schedule,1077.38
Aetna,PPO,81109,CPT4/HCPCS,HPA-5 GENOTYPING,,Fee Schedule,1077.38
Aetna,PPO,81110,CPT4/HCPCS,HPA-6 GENOTYPING,,Fee Schedule,1077.38
Aetna,PPO,81111,CPT4/HCPCS,HPA-9 GENOTYPING,,Fee Schedule,1077.38
Aetna,PPO,81112,CPT4/HCPCS,HPA-15 GENOTYPING,,Fee Schedule,1077.38
Aetna,PPO,81120,CPT4/HCPCS,IDH1 COMMON VARIANTS,,Fee Schedule,1379.78
Aetna,PPO,81121,CPT4/HCPCS,IDH2 COMMON VARIANTS,,Fee Schedule,2111.92
Aetna,PPO,81161,CPT4/HCPCS,DMD DUP/DELET ANALYSIS,,Fee Schedule,4851.00
Aetna,PPO,81162,CPT4/HCPCS,BRCA1&2 GEN FULL SEQ DUP/DEL,,Fee Schedule,17749.03
Aetna,PPO,81163,CPT4/HCPCS,BRCA1&2 GENE FULL SEQ ALYS,,Fee Schedule,3341.52
Aetna,PPO,81164,CPT4/HCPCS,BRCA1&2 GEN FUL DUP/DEL ALYS,,Fee Schedule,4171.44
Aetna,PPO,81165,CPT4/HCPCS,BRCA1 GENE FULL SEQ ALYS,,Fee Schedule,2019.78
Aetna,PPO,81166,CPT4/HCPCS,BRCA1 GENE FULL DUP/DEL ALYS,,Fee Schedule,2151.66
Aetna,PPO,81167,CPT4/HCPCS,BRCA2 GENE FULL DUP/DEL ALYS,,Fee Schedule,2019.78
Aetna,PPO,81170,CPT4/HCPCS,ABL1 GENE,,Fee Schedule,2352.67
Aetna,PPO,81171,CPT4/HCPCS,AFF2 GENE DETC ABNOR ALLELES,,Fee Schedule,978.18
Aetna,PPO,81172,CPT4/HCPCS,AFF2 GENE CHARAC ALLELES,,Fee Schedule,1962.32
Aetna,PPO,81173,CPT4/HCPCS,AR GENE FULL GENE SEQUENCE,,Fee Schedule,2151.66
Aetna,PPO,81174,CPT4/HCPCS,AR GENE KNOWN FAMIL VARIANT,,Fee Schedule,1322.32
Aetna,PPO,81175,CPT4/HCPCS,ASXL1 FULL GENE SEQUENCE,,Fee Schedule,5048.14
Aetna,PPO,81176,CPT4/HCPCS,ASXL1 GENE TARGET SEQ ALYS,,Fee Schedule,2132.25
Aetna,PPO,81177,CPT4/HCPCS,ATN1 GENE DETC ABNOR ALLELES,,Fee Schedule,978.18
Aetna,PPO,81178,CPT4/HCPCS,ATXN1 GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,PPO,81179,CPT4/HCPCS,ATXN2 GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,PPO,81180,CPT4/HCPCS,ATXN3 GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,PPO,81181,CPT4/HCPCS,ATXN7 GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,PPO,81182,CPT4/HCPCS,ATXN8OS GEN DETC ABNOR ALLEL,,Fee Schedule,978.18
Aetna,PPO,81183,CPT4/HCPCS,ATXN10 GENE DETC ABNOR ALLEL,,Fee Schedule,978.18
Aetna,PPO,81184,CPT4/HCPCS,CACNA1A GEN DETC ABNOR ALLEL,,Fee Schedule,978.18
Aetna,PPO,81185,CPT4/HCPCS,CACNA1A GENE FULL GENE SEQ,,Fee Schedule,6042.37
Aetna,PPO,81186,CPT4/HCPCS,CACNA1A GEN KNOWN FAMIL VRNT,,Fee Schedule,1322.32
Aetna,PPO,81187,CPT4/HCPCS,CNBP GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,PPO,81188,CPT4/HCPCS,CSTB GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,PPO,81189,CPT4/HCPCS,CSTB GENE FULL GENE SEQUENCE,,Fee Schedule,1962.32
Aetna,PPO,81190,CPT4/HCPCS,CSTB GENE KNOWN FAMIL VRNT,,Fee Schedule,1322.32
Aetna,PPO,81200,CPT4/HCPCS,ASPA GENE,,Fee Schedule,758.60
Aetna,PPO,81201,CPT4/HCPCS,APC GENE FULL SEQUENCE,,Fee Schedule,4817.90
Aetna,PPO,81202,CPT4/HCPCS,APC GENE KNOWN FAM VARIANTS,,Fee Schedule,355.15
Aetna,PPO,81203,CPT4/HCPCS,APC GENE DUP/DELET VARIANTS,,Fee Schedule,2158.21
Aetna,PPO,81204,CPT4/HCPCS,AR GENE CHARAC ALLELES,,Fee Schedule,978.18
Aetna,PPO,81205,CPT4/HCPCS,BCKDHB GENE,,Fee Schedule,694.17
Aetna,PPO,81206,CPT4/HCPCS,BCR/ABL1 GENE MAJOR BP,,Fee Schedule,490.47
Aetna,PPO,81207,CPT4/HCPCS,BCR/ABL1 GENE MINOR BP,,Fee Schedule,436.38
Aetna,PPO,81208,CPT4/HCPCS,BCR/ABL1 GENE OTHER BP,,Fee Schedule,436.38
Aetna,PPO,81209,CPT4/HCPCS,BLM GENE,,Fee Schedule,335.07
Aetna,PPO,81210,CPT4/HCPCS,BRAF GENE,,Fee Schedule,378.00
Aetna,PPO,81212,CPT4/HCPCS,BRCA1&2 185&5385&6174 VRNT,,Fee Schedule,757.00
Aetna,PPO,81215,CPT4/HCPCS,BRCA1 GENE KNOWN FAMIL VRNT,,Fee Schedule,399.42
Aetna,PPO,81216,CPT4/HCPCS,BRCA2 GENE FULL SEQ ALYS,,Fee Schedule,5283.09
Aetna,PPO,81217,CPT4/HCPCS,BRCA2 GENE KNOWN FAMIL VRNT,,Fee Schedule,399.42
Aetna,PPO,81218,CPT4/HCPCS,CEBPA GENE FULL SEQUENCE,,Fee Schedule,2352.67
Aetna,PPO,81219,CPT4/HCPCS,CALR GENE COM VARIANTS,,Fee Schedule,1182.97
Aetna,PPO,81220,CPT4/HCPCS,CFTR GENE COM VARIANTS,,Fee Schedule,4114.99
Aetna,PPO,81221,CPT4/HCPCS,CFTR GENE KNOWN FAM VARIANTS,,Fee Schedule,419.83
Aetna,PPO,81222,CPT4/HCPCS,CFTR GENE DUP/DELET VARIANTS,,Fee Schedule,2835.84
Aetna,PPO,81223,CPT4/HCPCS,CFTR GENE FULL SEQUENCE,,Fee Schedule,5566.76
Aetna,PPO,81224,CPT4/HCPCS,CFTR GENE INTRON POLY T,,Fee Schedule,294.67
Aetna,PPO,81225,CPT4/HCPCS,CYP2C19 GENE COM VARIANTS,,Fee Schedule,673.93
Aetna,PPO,81226,CPT4/HCPCS,CYP2D6 GENE COM VARIANTS,,Fee Schedule,1033.03
Aetna,PPO,81227,CPT4/HCPCS,CYP2C9 GENE COM VARIANTS,,Fee Schedule,778.93
Aetna,PPO,81228,CPT4/HCPCS,CYTOGEN MICRARRAY COPY NMBR,,Fee Schedule,1542.24
Aetna,PPO,81229,CPT4/HCPCS,CYTOGEN M ARRAY COPY NO&SNP,,Fee Schedule,1542.24
Aetna,PPO,81230,CPT4/HCPCS,CYP3A4 GENE COMMON VARIANTS,,Fee Schedule,1248.15
Aetna,PPO,81231,CPT4/HCPCS,CYP3A5 GENE COMMON VARIANTS,,Fee Schedule,1248.15
Aetna,PPO,81232,CPT4/HCPCS,DPYD GENE COMMON VARIANTS,,Fee Schedule,1248.15
Aetna,PPO,81233,CPT4/HCPCS,BTK GENE COMMON VARIANTS,,Fee Schedule,1252.35
Aetna,PPO,81234,CPT4/HCPCS,DMPK GENE DETC ABNOR ALLELE,,Fee Schedule,978.18
Aetna,PPO,81235,CPT4/HCPCS,EGFR GENE COM VARIANTS,,Fee Schedule,1493.10
Aetna,PPO,81236,CPT4/HCPCS,EZH2 GENE FULL GENE SEQUENCE,,Fee Schedule,2019.78
Aetna,PPO,81237,CPT4/HCPCS,EZH2 GENE COMMON VARIANTS,,Fee Schedule,1252.35
Aetna,PPO,81238,CPT4/HCPCS,F9 FULL GENE SEQUENCE,,Fee Schedule,4284.00
Aetna,PPO,81239,CPT4/HCPCS,DMPK GENE CHARAC ALLELES,,Fee Schedule,1962.32
Aetna,PPO,81240,CPT4/HCPCS,F2 GENE,,Fee Schedule,254.94
Aetna,PPO,81241,CPT4/HCPCS,F5 GENE,,Fee Schedule,228.39
Aetna,PPO,81242,CPT4/HCPCS,FANCC GENE,,Fee Schedule,419.83
Aetna,PPO,81243,CPT4/HCPCS,FMR1 GENE DETECTION,,Fee Schedule,443.94
Aetna,PPO,81244,CPT4/HCPCS,FMR1 GENE CHARAC ALLELES,,Fee Schedule,141.70
Aetna,PPO,81245,CPT4/HCPCS,FLT3 GENE,,Fee Schedule,399.58
Aetna,PPO,81246,CPT4/HCPCS,FLT3 GENE ANALYSIS,,Fee Schedule,905.94
Aetna,PPO,81247,CPT4/HCPCS,G6PD GENE ALYS CMN VARIANT,,Fee Schedule,1248.15
Aetna,PPO,81248,CPT4/HCPCS,G6PD KNOWN FAMILIAL VARIANT,,Fee Schedule,2679.26
Aetna,PPO,81249,CPT4/HCPCS,G6PD FULL GENE SEQUENCE,,Fee Schedule,4284.00
Aetna,PPO,81250,CPT4/HCPCS,G6PC GENE,,Fee Schedule,524.83
Aetna,PPO,81251,CPT4/HCPCS,GBA GENE,,Fee Schedule,1012.78
Aetna,PPO,81252,CPT4/HCPCS,GJB2 GENE FULL SEQUENCE,,Fee Schedule,800.85
Aetna,PPO,81253,CPT4/HCPCS,GJB2 GENE KNOWN FAM VARIANTS,,Fee Schedule,308.28
Aetna,PPO,81254,CPT4/HCPCS,GJB6 GENE COM VARIANTS,,Fee Schedule,145.48
Aetna,PPO,81255,CPT4/HCPCS,HEXA GENE,,Fee Schedule,1097.54
Aetna,PPO,81256,CPT4/HCPCS,HFE GENE,,Fee Schedule,335.07
Aetna,PPO,81257,CPT4/HCPCS,HBA1/HBA2 GENE,,Fee Schedule,653.68
Aetna,PPO,81258,CPT4/HCPCS,HBA1/HBA2 GENE FAM VRNT,,Fee Schedule,2679.26
Aetna,PPO,81259,CPT4/HCPCS,HBA1/HBA2 FULL GENE SEQUENCE,,Fee Schedule,4284.00
Aetna,PPO,81260,CPT4/HCPCS,IKBKAP GENE,,Fee Schedule,521.80
Aetna,PPO,81261,CPT4/HCPCS,IGH GENE REARRANGE AMP METH,,Fee Schedule,525.33
Aetna,PPO,81262,CPT4/HCPCS,IGH GENE REARRANG DIR PROBE,,Fee Schedule,255.10
Aetna,PPO,81263,CPT4/HCPCS,IGH VARI REGIONAL MUTATION,,Fee Schedule,428.40
Aetna,PPO,81264,CPT4/HCPCS,IGK REARRANGEABN CLONAL POP,,Fee Schedule,872.76
Aetna,PPO,81265,CPT4/HCPCS,STR MARKERS SPECIMEN ANAL,,Fee Schedule,2268.00
Aetna,PPO,81266,CPT4/HCPCS,STR MARKERS SPEC ANAL ADDL,,Fee Schedule,522.81
Aetna,PPO,81267,CPT4/HCPCS,CHIMERISM ANAL NO CELL SELEC,,Fee Schedule,3957.24
Aetna,PPO,81268,CPT4/HCPCS,CHIMERISM ANAL W/CELL SELECT,,Fee Schedule,1524.18
Aetna,PPO,81269,CPT4/HCPCS,HBA1/HBA2 GENE DUP/DEL VRNTS,,Fee Schedule,1445.13
Aetna,PPO,81270,CPT4/HCPCS,JAK2 GENE,,Fee Schedule,290.05
Aetna,PPO,81271,CPT4/HCPCS,HTT GENE DETC ABNOR ALLELES,,Fee Schedule,978.18
Aetna,PPO,81272,CPT4/HCPCS,KIT GENE TARGETED SEQ ANALYS,,Fee Schedule,2352.67
Aetna,PPO,81273,CPT4/HCPCS,KIT GENE ANALYS D816 VARIANT,,Fee Schedule,891.57
Aetna,PPO,81274,CPT4/HCPCS,HTT GENE CHARAC ALLELES,,Fee Schedule,1962.32
Aetna,PPO,81275,CPT4/HCPCS,KRAS GENE VARIANTS EXON 2,,Fee Schedule,758.60
Aetna,PPO,81276,CPT4/HCPCS,KRAS GENE ADDL VARIANTS,,Fee Schedule,1407.92
Aetna,PPO,81283,CPT4/HCPCS,IFNL3 GENE,,Fee Schedule,538.60
Aetna,PPO,81284,CPT4/HCPCS,FXN GENE DETC ABNOR ALLELES,,Fee Schedule,978.18
Aetna,PPO,81285,CPT4/HCPCS,FXN GENE CHARAC ALLELES,,Fee Schedule,1962.32
Aetna,PPO,81286,CPT4/HCPCS,FXN GENE FULL GENE SEQUENCE,,Fee Schedule,1962.32
Aetna,PPO,81287,CPT4/HCPCS,MGMT GENE PRMTR MTHYLTN ALYS,,Fee Schedule,2940.00
Aetna,PPO,81288,CPT4/HCPCS,MLH1 GENE,,Fee Schedule,2714.20
Aetna,PPO,81289,CPT4/HCPCS,FXN GENE KNOWN FAMIL VARIANT,,Fee Schedule,1322.32
Aetna,PPO,81290,CPT4/HCPCS,MCOLN1 GENE,,Fee Schedule,419.83
Aetna,PPO,81291,CPT4/HCPCS,MTHFR GENE,,Fee Schedule,390.60
Aetna,PPO,81292,CPT4/HCPCS,MLH1 GENE FULL SEQ,,Fee Schedule,3276.00
Aetna,PPO,81293,CPT4/HCPCS,MLH1 GENE KNOWN VARIANTS,,Fee Schedule,335.07
Aetna,PPO,81294,CPT4/HCPCS,MLH1 GENE DUP/DELETE VARIANT,,Fee Schedule,1951.90
Aetna,PPO,81295,CPT4/HCPCS,MSH2 GENE FULL SEQ,,Fee Schedule,3024.00
Aetna,PPO,81296,CPT4/HCPCS,MSH2 GENE KNOWN VARIANTS,,Fee Schedule,335.07
Aetna,PPO,81297,CPT4/HCPCS,MSH2 GENE DUP/DELETE VARIANT,,Fee Schedule,1730.98
Aetna,PPO,81298,CPT4/HCPCS,MSH6 GENE FULL SEQ,,Fee Schedule,4284.00
Aetna,PPO,81299,CPT4/HCPCS,MSH6 GENE KNOWN VARIANTS,,Fee Schedule,335.07
Aetna,PPO,81300,CPT4/HCPCS,MSH6 GENE DUP/DELETE VARIANT,,Fee Schedule,756.00
Aetna,PPO,81301,CPT4/HCPCS,MICROSATELLITE INSTABILITY,,Fee Schedule,1144.75
Aetna,PPO,81302,CPT4/HCPCS,MECP2 GENE FULL SEQ,,Fee Schedule,1625.98
Aetna,PPO,81303,CPT4/HCPCS,MECP2 GENE KNOWN VARIANT,,Fee Schedule,604.80
Aetna,PPO,81304,CPT4/HCPCS,MECP2 GENE DUP/DELET VARIANT,,Fee Schedule,1056.97
Aetna,PPO,81305,CPT4/HCPCS,MYD88 GENE P.LEU265PRO VRNT,,Fee Schedule,1252.35
Aetna,PPO,81306,CPT4/HCPCS,NUDT15 GENE COMMON VARIANTS,,Fee Schedule,2080.34
Aetna,PPO,81310,CPT4/HCPCS,NPM1 GENE,,Fee Schedule,209.91
Aetna,PPO,81311,CPT4/HCPCS,NRAS GENE VARIANTS EXON 2&3,,Fee Schedule,2111.92
Aetna,PPO,81312,CPT4/HCPCS,PABPN1 GENE DETC ABNOR ALLEL,,Fee Schedule,978.18
Aetna,PPO,81313,CPT4/HCPCS,PCA3/KLK3 ANTIGEN,,Fee Schedule,1680.00
Aetna,PPO,81314,CPT4/HCPCS,PDGFRA GENE,,Fee Schedule,2352.67
Aetna,PPO,81315,CPT4/HCPCS,PML/RARALPHA COM BREAKPOINTS,,Fee Schedule,570.52
Aetna,PPO,81316,CPT4/HCPCS,PML/RARALPHA 1 BREAKPOINT,,Fee Schedule,1848.08
Aetna,PPO,81317,CPT4/HCPCS,PMS2 GENE FULL SEQ ANALYSIS,,Fee Schedule,3369.24
Aetna,PPO,81318,CPT4/HCPCS,PMS2 KNOWN FAMILIAL VARIANTS,,Fee Schedule,428.40
Aetna,PPO,81319,CPT4/HCPCS,PMS2 GENE DUP/DELET VARIANTS,,Fee Schedule,874.44
Aetna,PPO,81320,CPT4/HCPCS,PLCG2 GENE COMMON VARIANTS,,Fee Schedule,2080.34
Aetna,PPO,81321,CPT4/HCPCS,PTEN GENE FULL SEQUENCE,,Fee Schedule,2287.82
Aetna,PPO,81322,CPT4/HCPCS,PTEN GENE KNOWN FAM VARIANT,,Fee Schedule,222.43
Aetna,PPO,81323,CPT4/HCPCS,PTEN GENE DUP/DELET VARIANT,,Fee Schedule,333.64
Aetna,PPO,81324,CPT4/HCPCS,PMP22 GENE DUP/DELET,,Fee Schedule,4284.00
Aetna,PPO,81325,CPT4/HCPCS,PMP22 GENE FULL SEQUENCE,,Fee Schedule,1123.58
Aetna,PPO,81326,CPT4/HCPCS,PMP22 GENE KNOWN FAM VARIANT,,Fee Schedule,699.72
Aetna,PPO,81327,CPT4/HCPCS,SEPT9 GEN PRMTR MTHYLTN ALYS,,Fee Schedule,597.40
Aetna,PPO,81328,CPT4/HCPCS,SLCO1B1 GENE COM VARIANTS,,Fee Schedule,1248.15
Aetna,PPO,81329,CPT4/HCPCS,SMN1 GENE DOS/DELETION ALYS,,Fee Schedule,978.18
Aetna,PPO,81330,CPT4/HCPCS,SMPD1 GENE COMMON VARIANTS,,Fee Schedule,673.93
Aetna,PPO,81331,CPT4/HCPCS,SNRPN/UBE3A GENE,,Fee Schedule,294.67
Aetna,PPO,81332,CPT4/HCPCS,SERPINA1 GENE,,Fee Schedule,335.07
Aetna,PPO,81333,CPT4/HCPCS,TGFBI GENE COMMON VARIANTS,,Fee Schedule,978.18
Aetna,PPO,81334,CPT4/HCPCS,RUNX1 GENE TARGETED SEQ ALYS,,Fee Schedule,2352.67
Aetna,PPO,81335,CPT4/HCPCS,TPMT GENE COM VARIANTS,,Fee Schedule,1248.15
Aetna,PPO,81336,CPT4/HCPCS,SMN1 GENE FULL GENE SEQUENCE,,Fee Schedule,2151.66
Aetna,PPO,81337,CPT4/HCPCS,SMN1 GEN NOWN FAMIL SEQ VRNT,,Fee Schedule,1322.32
Aetna,PPO,81340,CPT4/HCPCS,TRB@ GENE REARRANGE AMPLIFY,,Fee Schedule,970.20
Aetna,PPO,81341,CPT4/HCPCS,TRB@ GENE REARRANGE DIRPROBE,,Fee Schedule,289.80
Aetna,PPO,81342,CPT4/HCPCS,TRG GENE REARRANGEMENT ANAL,,Fee Schedule,811.44
Aetna,PPO,81343,CPT4/HCPCS,PPP2R2B GEN DETC ABNOR ALLEL,,Fee Schedule,978.18
Aetna,PPO,81344,CPT4/HCPCS,TBP GENE DETC ABNOR ALLELES,,Fee Schedule,978.18
Aetna,PPO,81345,CPT4/HCPCS,TERT GENE TARGETED SEQ ALYS,,Fee Schedule,1322.32
Aetna,PPO,81346,CPT4/HCPCS,TYMS GENE COM VARIANTS,,Fee Schedule,1248.15
Aetna,PPO,81350,CPT4/HCPCS,UGT1A1 GENE COMMON VARIANTS,,Fee Schedule,417.98
Aetna,PPO,81355,CPT4/HCPCS,VKORC1 GENE,,Fee Schedule,250.40
Aetna,PPO,81361,CPT4/HCPCS,HBB GENE COM VARIANTS,,Fee Schedule,1248.15
Aetna,PPO,81362,CPT4/HCPCS,HBB GENE KNOWN FAM VARIANT,,Fee Schedule,2679.26
Aetna,PPO,81363,CPT4/HCPCS,HBB GENE DUP/DEL VARIANTS,,Fee Schedule,1445.13
Aetna,PPO,81364,CPT4/HCPCS,HBB FULL GENE SEQUENCE,,Fee Schedule,2317.47
Aetna,PPO,81370,CPT4/HCPCS,HLA I & II TYPING LR,,Fee Schedule,2350.23
Aetna,PPO,81371,CPT4/HCPCS,HLA I & II TYPE VERIFY LR,,Fee Schedule,1406.74
Aetna,PPO,81372,CPT4/HCPCS,HLA I TYPING COMPLETE LR,,Fee Schedule,2411.80
Aetna,PPO,81373,CPT4/HCPCS,HLA I TYPING 1 LOCUS LR,,Fee Schedule,817.40
Aetna,PPO,81374,CPT4/HCPCS,HLA I TYPING 1 ANTIGEN LR,,Fee Schedule,817.40
Aetna,PPO,81375,CPT4/HCPCS,HLA II TYPING AG EQUIV LR,,Fee Schedule,902.16
Aetna,PPO,81376,CPT4/HCPCS,HLA II TYPING 1 LOCUS LR,,Fee Schedule,477.45
Aetna,PPO,81377,CPT4/HCPCS,HLA II TYPE 1 AG EQUIV LR,,Fee Schedule,388.41
Aetna,PPO,81378,CPT4/HCPCS,HLA I & II TYPING HR,,Fee Schedule,2019.61
Aetna,PPO,81379,CPT4/HCPCS,HLA I TYPING COMPLETE HR,,Fee Schedule,1960.05
Aetna,PPO,81380,CPT4/HCPCS,HLA I TYPING 1 LOCUS HR,,Fee Schedule,718.11
Aetna,PPO,81381,CPT4/HCPCS,HLA I TYPING 1 ALLELE HR,,Fee Schedule,817.23
Aetna,PPO,81382,CPT4/HCPCS,HLA II TYPING 1 LOC HR,,Fee Schedule,483.58
Aetna,PPO,81383,CPT4/HCPCS,HLA II TYPING 1 ALLELE HR,,Fee Schedule,349.86
Aetna,PPO,81400,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 1,,Fee Schedule,345.32
Aetna,PPO,81401,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 2,,Fee Schedule,327.60
Aetna,PPO,81402,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 3,,Fee Schedule,504.00
Aetna,PPO,81403,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 4,,Fee Schedule,504.00
Aetna,PPO,81404,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 5,,Fee Schedule,882.00
Aetna,PPO,81405,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 6,,Fee Schedule,882.00
Aetna,PPO,81406,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 7,,Fee Schedule,502.32
Aetna,PPO,81407,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 8,,Fee Schedule,6048.00
Aetna,PPO,81408,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 9,,Fee Schedule,6048.00
Aetna,PPO,81410,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,Fee Schedule,3598.56
Aetna,PPO,81411,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,Fee Schedule,6115.20
Aetna,PPO,81412,CPT4/HCPCS,ASHKENAZI JEWISH ASSOC DIS,,Fee Schedule,4268.96
Aetna,PPO,81413,CPT4/HCPCS,CAR ION CHNNLPATH INC 10 GNS,,Fee Schedule,5728.63
Aetna,PPO,81414,CPT4/HCPCS,CAR ION CHNNLPATH INC 2 GNS,,Fee Schedule,5728.63
Aetna,PPO,81415,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,Fee Schedule,8400.00
Aetna,PPO,81416,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,Fee Schedule,8400.00
Aetna,PPO,81417,CPT4/HCPCS,EXOME RE-EVALUATION,,Fee Schedule,2284.80
Aetna,PPO,81420,CPT4/HCPCS,FETAL CHRMOML ANEUPLOIDY,,Fee Schedule,4200.00
Aetna,PPO,81422,CPT4/HCPCS,FETAL CHRMOML MICRODELTJ,,Fee Schedule,5728.63
Aetna,PPO,81425,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,Fee Schedule,0.08
Aetna,PPO,81426,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,Fee Schedule,0.08
Aetna,PPO,81427,CPT4/HCPCS,GENOME RE-EVALUATION,,Fee Schedule,0.08
Aetna,PPO,81430,CPT4/HCPCS,HEARING LOSS SEQUENCE ANALYS,,Fee Schedule,11602.50
Aetna,PPO,81431,CPT4/HCPCS,HEARING LOSS DUP/DEL ANALYS,,Fee Schedule,4852.09
Aetna,PPO,81432,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,Fee Schedule,6650.78
Aetna,PPO,81433,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,Fee Schedule,4299.03
Aetna,PPO,81434,CPT4/HCPCS,HEREDITARY RETINAL DISORDERS,,Fee Schedule,4299.03
Aetna,PPO,81435,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,Fee Schedule,4200.00
Aetna,PPO,81436,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,Fee Schedule,2940.00
Aetna,PPO,81437,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,Fee Schedule,4299.03
Aetna,PPO,81438,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,Fee Schedule,4299.03
Aetna,PPO,81439,CPT4/HCPCS,HRDTRY CARDMYPY GENE PANEL,,Fee Schedule,5728.63
Aetna,PPO,81440,CPT4/HCPCS,MITOCHONDRIAL GENE,,Fee Schedule,8400.00
Aetna,PPO,81442,CPT4/HCPCS,NOONAN SPECTRUM DISORDERS,,Fee Schedule,4350.27
Aetna,PPO,81443,CPT4/HCPCS,GENETIC TSTG SEVERE INH COND,,Fee Schedule,17482.75
Aetna,PPO,81445,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Fee Schedule,6040.18
Aetna,PPO,81448,CPT4/HCPCS,HRDTRY PERPH NEURPHY PANEL,,Fee Schedule,5155.83
Aetna,PPO,81450,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Fee Schedule,6040.18
Aetna,PPO,81455,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Fee Schedule,6040.18
Aetna,PPO,81460,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,Fee Schedule,13272.00
Aetna,PPO,81465,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,Fee Schedule,9660.00
Aetna,PPO,81470,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,Fee Schedule,6040.18
Aetna,PPO,81471,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,Fee Schedule,0.08
Aetna,PPO,81479,CPT4/HCPCS,UNLISTED MOLECULAR PATHOLOGY,,Fee Schedule,378.00
Aetna,PPO,81490,CPT4/HCPCS,AUTOIMMUNE RHEUMATOID ARTHR,,Fee Schedule,4216.96
Aetna,PPO,81493,CPT4/HCPCS,COR ARTERY DISEASE MRNA,,Fee Schedule,7442.40
Aetna,PPO,81500,CPT4/HCPCS,ONCO (OVAR) TWO PROTEINS,,Fee Schedule,1860.01
Aetna,PPO,81503,CPT4/HCPCS,ONCO (OVAR) FIVE PROTEINS,,Fee Schedule,2587.20
Aetna,PPO,81504,CPT4/HCPCS,ONCOLOGY TISSUE OF ORIGIN,,Fee Schedule,3712.80
Aetna,PPO,81506,CPT4/HCPCS,ENDO ASSAY SEVEN ANAL,,Fee Schedule,211.68
Aetna,PPO,81507,CPT4/HCPCS,FETAL ANEUPLOIDY TRISOM RISK,,Fee Schedule,4851.00
Aetna,PPO,81508,CPT4/HCPCS,FTL CGEN ABNOR TWO PROTEINS,,Fee Schedule,735.00
Aetna,PPO,81509,CPT4/HCPCS,FTL CGEN ABNOR 3 PROTEINS,,Fee Schedule,487.20
Aetna,PPO,81510,CPT4/HCPCS,FTL CGEN ABNOR THREE ANAL,,Fee Schedule,793.80
Aetna,PPO,81511,CPT4/HCPCS,FTL CGEN ABNOR FOUR ANAL,,Fee Schedule,1029.00
Aetna,PPO,81512,CPT4/HCPCS,FTL CGEN ABNOR FIVE ANAL,,Fee Schedule,2058.00
Aetna,PPO,81518,CPT4/HCPCS,ONC BRST MRNA 11 GENES,,Fee Schedule,27653.22
Aetna,PPO,81519,CPT4/HCPCS,ONCOLOGY BREAST MRNA,,Fee Schedule,23940.00
Aetna,PPO,81520,CPT4/HCPCS,ONC BREAST MRNA 58 GENES,,Fee Schedule,22127.02
Aetna,PPO,81521,CPT4/HCPCS,ONC BREAST MRNA 70 GENES,,Fee Schedule,27653.22
Aetna,PPO,81525,CPT4/HCPCS,ONCOLOGY COLON MRNA,,Fee Schedule,2692.95
Aetna,PPO,81528,CPT4/HCPCS,ONCOLOGY COLORECTAL SCR,,Fee Schedule,3633.33
Aetna,PPO,81535,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,Fee Schedule,4137.33
Aetna,PPO,81536,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,Fee Schedule,1267.81
Aetna,PPO,81538,CPT4/HCPCS,ONCOLOGY LUNG,,Fee Schedule,15185.18
Aetna,PPO,81539,CPT4/HCPCS,ONCOLOGY PROSTATE PROB SCORE,,Fee Schedule,4299.03
Aetna,PPO,81540,CPT4/HCPCS,ONCOLOGY TUM UNKNOWN ORIGIN,,Fee Schedule,20850.98
Aetna,PPO,81541,CPT4/HCPCS,ONC PROSTATE MRNA 46 GENES,,Fee Schedule,27653.22
Aetna,PPO,81545,CPT4/HCPCS,ONCOLOGY THYROID,,Fee Schedule,23007.93
Aetna,PPO,81551,CPT4/HCPCS,ONC PROSTATE 3 GENES,,Fee Schedule,11094.72
Aetna,PPO,81595,CPT4/HCPCS,CARDIOLOGY HRT TRNSPL MRNA,,Fee Schedule,20282.97
Aetna,PPO,81596,CPT4/HCPCS,NFCT DS CHRNC HCV 6 ASSAYS,,Fee Schedule,515.42
Aetna,PPO,82009,CPT4/HCPCS,TEST FOR ACETONE/KETONES,,Fee Schedule,45.44
Aetna,PPO,82010,CPT4/HCPCS,ACETONE ASSAY,,Fee Schedule,82.15
Aetna,PPO,82013,CPT4/HCPCS,ACETYLCHOLINESTERASE ASSAY,,Fee Schedule,112.22
Aetna,PPO,82016,CPT4/HCPCS,ACYLCARNITINES QUAL,,Fee Schedule,139.27
Aetna,PPO,82017,CPT4/HCPCS,ACYLCARNITINES QUANT,,Fee Schedule,169.51
Aetna,PPO,82024,CPT4/HCPCS,ASSAY OF ACTH,,Fee Schedule,388.08
Aetna,PPO,82030,CPT4/HCPCS,ASSAY OF ADP & AMP,,Fee Schedule,259.22
Aetna,PPO,82040,CPT4/HCPCS,ASSAY OF SERUM ALBUMIN,,Fee Schedule,49.72
Aetna,PPO,82042,CPT4/HCPCS,OTHER SOURCE ALBUMIN QUAN EA,,Fee Schedule,32.92
Aetna,PPO,82043,CPT4/HCPCS,UR ALBUMIN QUANTITATIVE,,Fee Schedule,58.12
Aetna,PPO,82044,CPT4/HCPCS,UR ALBUMIN SEMIQUANTITATIVE,,Fee Schedule,45.94
Aetna,PPO,82045,CPT4/HCPCS,ALBUMIN ISCHEMIA MODIFIED,,Fee Schedule,341.04
Aetna,PPO,82075,CPT4/HCPCS,ASSAY OF BREATH ETHANOL,,Fee Schedule,0.08
Aetna,PPO,82085,CPT4/HCPCS,ASSAY OF ALDOLASE,,Fee Schedule,97.52
Aetna,PPO,82088,CPT4/HCPCS,ASSAY OF ALDOSTERONE,,Fee Schedule,409.50
Aetna,PPO,82103,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN TOTAL,,Fee Schedule,134.98
Aetna,PPO,82104,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN PHENO,,Fee Schedule,145.32
Aetna,PPO,82105,CPT4/HCPCS,ALPHA-FETOPROTEIN SERUM,,Fee Schedule,168.58
Aetna,PPO,82106,CPT4/HCPCS,ALPHA-FETOPROTEIN AMNIOTIC,,Fee Schedule,168.58
Aetna,PPO,82107,CPT4/HCPCS,ALPHA-FETOPROTEIN L3,,Fee Schedule,647.13
Aetna,PPO,82108,CPT4/HCPCS,ASSAY OF ALUMINUM,,Fee Schedule,255.94
Aetna,PPO,82120,CPT4/HCPCS,AMINES VAGINAL FLUID QUAL,,Fee Schedule,37.80
Aetna,PPO,82127,CPT4/HCPCS,AMINO ACID SINGLE QUAL,,Fee Schedule,139.27
Aetna,PPO,82128,CPT4/HCPCS,AMINO ACIDS MULT QUAL,,Fee Schedule,139.27
Aetna,PPO,82131,CPT4/HCPCS,AMINO ACIDS SINGLE QUANT,,Fee Schedule,169.51
Aetna,PPO,82135,CPT4/HCPCS,ASSAY AMINOLEVULINIC ACID,,Fee Schedule,165.39
Aetna,PPO,82136,CPT4/HCPCS,AMINO ACIDS QUANT 2-5,,Fee Schedule,169.51
Aetna,PPO,82139,CPT4/HCPCS,AMINO ACIDS QUAN 6 OR MORE,,Fee Schedule,169.51
Aetna,PPO,82140,CPT4/HCPCS,ASSAY OF AMMONIA,,Fee Schedule,146.41
Aetna,PPO,82143,CPT4/HCPCS,AMNIOTIC FLUID SCAN,,Fee Schedule,69.04
Aetna,PPO,82150,CPT4/HCPCS,ASSAY OF AMYLASE,,Fee Schedule,65.10
Aetna,PPO,82154,CPT4/HCPCS,ANDROSTANEDIOL GLUCURONIDE,,Fee Schedule,289.63
Aetna,PPO,82157,CPT4/HCPCS,ASSAY OF ANDROSTENEDIONE,,Fee Schedule,294.16
Aetna,PPO,82160,CPT4/HCPCS,ASSAY OF ANDROSTERONE,,Fee Schedule,251.24
Aetna,PPO,82163,CPT4/HCPCS,ASSAY OF ANGIOTENSIN II,,Fee Schedule,206.22
Aetna,PPO,82164,CPT4/HCPCS,ANGIOTENSIN I ENZYME TEST,,Fee Schedule,146.66
Aetna,PPO,82172,CPT4/HCPCS,ASSAY OF APOLIPOPROTEIN,,Fee Schedule,141.62
Aetna,PPO,82175,CPT4/HCPCS,ASSAY OF ARSENIC,,Fee Schedule,190.68
Aetna,PPO,82180,CPT4/HCPCS,ASSAY OF ASCORBIC ACID,,Fee Schedule,99.28
Aetna,PPO,82190,CPT4/HCPCS,ATOMIC ABSORPTION,,Fee Schedule,149.77
Aetna,PPO,82232,CPT4/HCPCS,ASSAY OF BETA-2 PROTEIN,,Fee Schedule,162.54
Aetna,PPO,82239,CPT4/HCPCS,BILE ACIDS TOTAL,,Fee Schedule,172.11
Aetna,PPO,82240,CPT4/HCPCS,BILE ACIDS CHOLYLGLYCINE,,Fee Schedule,267.03
Aetna,PPO,82247,CPT4/HCPCS,BILIRUBIN TOTAL,,Fee Schedule,50.40
Aetna,PPO,82248,CPT4/HCPCS,BILIRUBIN DIRECT,,Fee Schedule,50.40
Aetna,PPO,82252,CPT4/HCPCS,FECAL BILIRUBIN TEST,,Fee Schedule,45.69
Aetna,PPO,82261,CPT4/HCPCS,ASSAY OF BIOTINIDASE,,Fee Schedule,169.51
Aetna,PPO,82270,CPT4/HCPCS,OCCULT BLOOD FECES,,Fee Schedule,32.67
Aetna,PPO,82271,CPT4/HCPCS,OCCULT BLOOD OTHER SOURCES,,Fee Schedule,32.67
Aetna,PPO,82272,CPT4/HCPCS,OCCULT BLD FECES 1-3 TESTS,,Fee Schedule,32.67
Aetna,PPO,82274,CPT4/HCPCS,ASSAY TEST FOR BLOOD FECAL,,Fee Schedule,159.76
Aetna,PPO,82286,CPT4/HCPCS,ASSAY OF BRADYKININ,,Fee Schedule,69.21
Aetna,PPO,82300,CPT4/HCPCS,ASSAY OF CADMIUM,,Fee Schedule,232.51
Aetna,PPO,82306,CPT4/HCPCS,VITAMIN D 25 HYDROXY,,Fee Schedule,297.44
Aetna,PPO,82308,CPT4/HCPCS,ASSAY OF CALCITONIN,,Fee Schedule,269.13
Aetna,PPO,82310,CPT4/HCPCS,ASSAY OF CALCIUM,,Fee Schedule,51.82
Aetna,PPO,82330,CPT4/HCPCS,ASSAY OF CALCIUM,,Fee Schedule,137.34
Aetna,PPO,82331,CPT4/HCPCS,CALCIUM INFUSION TEST,,Fee Schedule,51.99
Aetna,PPO,82340,CPT4/HCPCS,ASSAY OF CALCIUM IN URINE,,Fee Schedule,60.64
Aetna,PPO,82355,CPT4/HCPCS,CALCULUS ANALYSIS QUAL,,Fee Schedule,116.34
Aetna,PPO,82360,CPT4/HCPCS,CALCULUS ASSAY QUANT,,Fee Schedule,129.36
Aetna,PPO,82365,CPT4/HCPCS,CALCULUS SPECTROSCOPY,,Fee Schedule,129.52
Aetna,PPO,82370,CPT4/HCPCS,X-RAY ASSAY CALCULUS,,Fee Schedule,125.91
Aetna,PPO,82373,CPT4/HCPCS,ASSAY C-D TRANSFER MEASURE,,Fee Schedule,181.44
Aetna,PPO,82374,CPT4/HCPCS,ASSAY BLOOD CARBON DIOXIDE,,Fee Schedule,49.14
Aetna,PPO,82375,CPT4/HCPCS,ASSAY CARBOXYHB QUANT,,Fee Schedule,123.90
Aetna,PPO,82376,CPT4/HCPCS,ASSAY CARBOXYHB QUAL,,Fee Schedule,60.22
Aetna,PPO,82378,CPT4/HCPCS,CARCINOEMBRYONIC ANTIGEN,,Fee Schedule,190.68
Aetna,PPO,82379,CPT4/HCPCS,ASSAY OF CARNITINE,,Fee Schedule,169.51
Aetna,PPO,82380,CPT4/HCPCS,ASSAY OF CAROTENE,,Fee Schedule,92.65
Aetna,PPO,82382,CPT4/HCPCS,ASSAY URINE CATECHOLAMINES,,Fee Schedule,172.78
Aetna,PPO,82383,CPT4/HCPCS,ASSAY BLOOD CATECHOLAMINES,,Fee Schedule,251.74
Aetna,PPO,82384,CPT4/HCPCS,ASSAY THREE CATECHOLAMINES,,Fee Schedule,253.68
Aetna,PPO,82387,CPT4/HCPCS,ASSAY OF CATHEPSIN-D,,Fee Schedule,209.07
Aetna,PPO,82390,CPT4/HCPCS,ASSAY OF CERULOPLASMIN,,Fee Schedule,107.94
Aetna,PPO,82397,CPT4/HCPCS,CHEMILUMINESCENT ASSAY,,Fee Schedule,141.96
Aetna,PPO,82415,CPT4/HCPCS,ASSAY OF CHLORAMPHENICOL,,Fee Schedule,127.34
Aetna,PPO,82435,CPT4/HCPCS,ASSAY OF BLOOD CHLORIDE,,Fee Schedule,46.20
Aetna,PPO,82436,CPT4/HCPCS,ASSAY OF URINE CHLORIDE,,Fee Schedule,50.48
Aetna,PPO,82438,CPT4/HCPCS,ASSAY OTHER FLUID CHLORIDES,,Fee Schedule,49.14
Aetna,PPO,82441,CPT4/HCPCS,TEST FOR CHLOROHYDROCARBONS,,Fee Schedule,60.31
Aetna,PPO,82465,CPT4/HCPCS,ASSAY BLD/SERUM CHOLESTEROL,,Fee Schedule,43.76
Aetna,PPO,82480,CPT4/HCPCS,ASSAY SERUM CHOLINESTERASE,,Fee Schedule,79.21
Aetna,PPO,82482,CPT4/HCPCS,ASSAY RBC CHOLINESTERASE,,Fee Schedule,77.19
Aetna,PPO,82485,CPT4/HCPCS,ASSAY CHONDROITIN SULFATE,,Fee Schedule,207.48
Aetna,PPO,82495,CPT4/HCPCS,ASSAY OF CHROMIUM,,Fee Schedule,203.78
Aetna,PPO,82507,CPT4/HCPCS,ASSAY OF CITRATE,,Fee Schedule,279.38
Aetna,PPO,82523,CPT4/HCPCS,COLLAGEN CROSSLINKS,,Fee Schedule,186.39
Aetna,PPO,82525,CPT4/HCPCS,ASSAY OF COPPER,,Fee Schedule,124.65
Aetna,PPO,82528,CPT4/HCPCS,ASSAY OF CORTICOSTERONE,,Fee Schedule,226.21
Aetna,PPO,82530,CPT4/HCPCS,CORTISOL FREE,,Fee Schedule,167.91
Aetna,PPO,82533,CPT4/HCPCS,TOTAL CORTISOL,,Fee Schedule,163.88
Aetna,PPO,82540,CPT4/HCPCS,ASSAY OF CREATINE,,Fee Schedule,46.53
Aetna,PPO,82542,CPT4/HCPCS,COL CHROMOTOGRAPHY QUAL/QUAN,,Fee Schedule,181.44
Aetna,PPO,82550,CPT4/HCPCS,ASSAY OF CK (CPK),,Fee Schedule,65.43
Aetna,PPO,82552,CPT4/HCPCS,ASSAY OF CPK IN BLOOD,,Fee Schedule,134.65
Aetna,PPO,82553,CPT4/HCPCS,CREATINE MB FRACTION,,Fee Schedule,116.00
Aetna,PPO,82554,CPT4/HCPCS,CREATINE ISOFORMS,,Fee Schedule,119.28
Aetna,PPO,82565,CPT4/HCPCS,ASSAY OF CREATININE,,Fee Schedule,51.57
Aetna,PPO,82570,CPT4/HCPCS,ASSAY OF URINE CREATININE,,Fee Schedule,51.99
Aetna,PPO,82575,CPT4/HCPCS,CREATININE CLEARANCE TEST,,Fee Schedule,95.00
Aetna,PPO,82585,CPT4/HCPCS,ASSAY OF CRYOFIBRINOGEN,,Fee Schedule,86.18
Aetna,PPO,82595,CPT4/HCPCS,ASSAY OF CRYOGLOBULIN,,Fee Schedule,57.62
Aetna,PPO,82600,CPT4/HCPCS,ASSAY OF CYANIDE,,Fee Schedule,194.96
Aetna,PPO,82607,CPT4/HCPCS,VITAMIN B-12,,Fee Schedule,151.45
Aetna,PPO,82608,CPT4/HCPCS,B-12 BINDING CAPACITY,,Fee Schedule,143.89
Aetna,PPO,82610,CPT4/HCPCS,CYSTATIN C,,Fee Schedule,136.58
Aetna,PPO,82615,CPT4/HCPCS,TEST FOR URINE CYSTINES,,Fee Schedule,81.98
Aetna,PPO,82626,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,Fee Schedule,253.93
Aetna,PPO,82627,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,Fee Schedule,223.44
Aetna,PPO,82633,CPT4/HCPCS,DESOXYCORTICOSTERONE,,Fee Schedule,311.22
Aetna,PPO,82634,CPT4/HCPCS,DEOXYCORTISOL,,Fee Schedule,294.16
Aetna,PPO,82638,CPT4/HCPCS,ASSAY OF DIBUCAINE NUMBER,,Fee Schedule,123.06
Aetna,PPO,82652,CPT4/HCPCS,VIT D 1 25-DIHYDROXY,,Fee Schedule,386.82
Aetna,PPO,82656,CPT4/HCPCS,PANCREATIC ELASTASE FECAL,,Fee Schedule,93.32
Aetna,PPO,82657,CPT4/HCPCS,ENZYME CELL ACTIVITY,,Fee Schedule,181.44
Aetna,PPO,82658,CPT4/HCPCS,ENZYME CELL ACTIVITY RA,,Fee Schedule,181.44
Aetna,PPO,82664,CPT4/HCPCS,ELECTROPHORETIC TEST,,Fee Schedule,345.24
Aetna,PPO,82668,CPT4/HCPCS,ASSAY OF ERYTHROPOIETIN,,Fee Schedule,188.91
Aetna,PPO,82670,CPT4/HCPCS,ASSAY OF TOTAL ESTRADIOL,,Fee Schedule,280.72
Aetna,PPO,82671,CPT4/HCPCS,ASSAY OF ESTROGENS,,Fee Schedule,324.49
Aetna,PPO,82672,CPT4/HCPCS,ASSAY OF ESTROGEN,,Fee Schedule,217.98
Aetna,PPO,82677,CPT4/HCPCS,ASSAY OF ESTRIOL,,Fee Schedule,243.01
Aetna,PPO,82679,CPT4/HCPCS,ASSAY OF ESTRONE,,Fee Schedule,250.74
Aetna,PPO,82693,CPT4/HCPCS,ASSAY OF ETHYLENE GLYCOL,,Fee Schedule,149.68
Aetna,PPO,82696,CPT4/HCPCS,ASSAY OF ETIOCHOLANOLONE,,Fee Schedule,236.96
Aetna,PPO,82705,CPT4/HCPCS,FATS/LIPIDS FECES QUAL,,Fee Schedule,51.15
Aetna,PPO,82710,CPT4/HCPCS,FATS/LIPIDS FECES QUANT,,Fee Schedule,168.75
Aetna,PPO,82715,CPT4/HCPCS,ASSAY OF FECAL FAT,,Fee Schedule,172.95
Aetna,PPO,82725,CPT4/HCPCS,ASSAY OF BLOOD FATTY ACIDS,,Fee Schedule,133.81
Aetna,PPO,82726,CPT4/HCPCS,LONG CHAIN FATTY ACIDS,,Fee Schedule,181.44
Aetna,PPO,82728,CPT4/HCPCS,ASSAY OF FERRITIN,,Fee Schedule,136.83
Aetna,PPO,82731,CPT4/HCPCS,ASSAY OF FETAL FIBRONECTIN,,Fee Schedule,647.13
Aetna,PPO,82735,CPT4/HCPCS,ASSAY OF FLUORIDE,,Fee Schedule,186.31
Aetna,PPO,82746,CPT4/HCPCS,ASSAY OF FOLIC ACID SERUM,,Fee Schedule,147.75
Aetna,PPO,82747,CPT4/HCPCS,ASSAY OF FOLIC ACID RBC,,Fee Schedule,174.04
Aetna,PPO,82757,CPT4/HCPCS,ASSAY OF SEMEN FRUCTOSE,,Fee Schedule,174.30
Aetna,PPO,82759,CPT4/HCPCS,ASSAY OF RBC GALACTOKINASE,,Fee Schedule,215.88
Aetna,PPO,82760,CPT4/HCPCS,ASSAY OF GALACTOSE,,Fee Schedule,112.47
Aetna,PPO,82775,CPT4/HCPCS,ASSAY GALACTOSE TRANSFERASE,,Fee Schedule,211.59
Aetna,PPO,82776,CPT4/HCPCS,GALACTOSE TRANSFERASE TEST,,Fee Schedule,84.25
Aetna,PPO,82777,CPT4/HCPCS,GALECTIN-3,,Fee Schedule,127.09
Aetna,PPO,82784,CPT4/HCPCS,ASSAY IGA/IGD/IGG/IGM EACH,,Fee Schedule,65.85
Aetna,PPO,82785,CPT4/HCPCS,ASSAY OF IGE,,Fee Schedule,165.48
Aetna,PPO,82787,CPT4/HCPCS,IGG 1 2 3 OR 4 EACH,,Fee Schedule,80.64
Aetna,PPO,82800,CPT4/HCPCS,BLOOD PH,,Fee Schedule,82.15
Aetna,PPO,82803,CPT4/HCPCS,BLOOD GASES ANY COMBINATION,,Fee Schedule,194.37
Aetna,PPO,82805,CPT4/HCPCS,BLOOD GASES W/O2 SATURATION,,Fee Schedule,285.18
Aetna,PPO,82810,CPT4/HCPCS,BLOOD GASES O2 SAT ONLY,,Fee Schedule,87.69
Aetna,PPO,82820,CPT4/HCPCS,HEMOGLOBIN-OXYGEN AFFINITY,,Fee Schedule,100.46
Aetna,PPO,82930,CPT4/HCPCS,GASTRIC ANALY W/PH EA SPEC,,Fee Schedule,52.50
Aetna,PPO,82938,CPT4/HCPCS,GASTRIN TEST,,Fee Schedule,177.82
Aetna,PPO,82941,CPT4/HCPCS,ASSAY OF GASTRIN,,Fee Schedule,177.24
Aetna,PPO,82943,CPT4/HCPCS,ASSAY OF GLUCAGON,,Fee Schedule,143.55
Aetna,PPO,82945,CPT4/HCPCS,GLUCOSE OTHER FLUID,,Fee Schedule,39.39
Aetna,PPO,82946,CPT4/HCPCS,GLUCAGON TOLERANCE TEST,,Fee Schedule,151.45
Aetna,PPO,82947,CPT4/HCPCS,ASSAY GLUCOSE BLOOD QUANT,,Fee Schedule,39.39
Aetna,PPO,82948,CPT4/HCPCS,REAGENT STRIP/BLOOD GLUCOSE,,Fee Schedule,31.75
Aetna,PPO,82950,CPT4/HCPCS,GLUCOSE TEST,,Fee Schedule,47.71
Aetna,PPO,82951,CPT4/HCPCS,GLUCOSE TOLERANCE TEST (GTT),,Fee Schedule,129.36
Aetna,PPO,82952,CPT4/HCPCS,GTT-ADDED SAMPLES,,Fee Schedule,39.31
Aetna,PPO,82955,CPT4/HCPCS,ASSAY OF G6PD ENZYME,,Fee Schedule,97.44
Aetna,PPO,82960,CPT4/HCPCS,TEST FOR G6PD ENZYME,,Fee Schedule,60.81
Aetna,PPO,82962,CPT4/HCPCS,GLUCOSE BLOOD TEST,,Fee Schedule,23.52
Aetna,PPO,82963,CPT4/HCPCS,ASSAY OF GLUCOSIDASE,,Fee Schedule,215.88
Aetna,PPO,82965,CPT4/HCPCS,ASSAY OF GDH ENZYME,,Fee Schedule,77.70
Aetna,PPO,82977,CPT4/HCPCS,ASSAY OF GGT,,Fee Schedule,72.32
Aetna,PPO,82978,CPT4/HCPCS,ASSAY OF GLUTATHIONE,,Fee Schedule,143.22
Aetna,PPO,82979,CPT4/HCPCS,ASSAY RBC GLUTATHIONE,,Fee Schedule,69.21
Aetna,PPO,82985,CPT4/HCPCS,ASSAY OF GLYCATED PROTEIN,,Fee Schedule,151.45
Aetna,PPO,83001,CPT4/HCPCS,ASSAY OF GONADOTROPIN (FSH),,Fee Schedule,186.73
Aetna,PPO,83002,CPT4/HCPCS,ASSAY OF GONADOTROPIN (LH),,Fee Schedule,186.06
Aetna,PPO,83003,CPT4/HCPCS,ASSAY GROWTH HORMONE (HGH),,Fee Schedule,167.58
Aetna,PPO,83006,CPT4/HCPCS,GROWTH STIMULATION GENE 2,,Fee Schedule,213.69
Aetna,PPO,83009,CPT4/HCPCS,H PYLORI (C-13) BLOOD,,Fee Schedule,676.78
Aetna,PPO,83010,CPT4/HCPCS,ASSAY OF HAPTOGLOBIN QUANT,,Fee Schedule,126.42
Aetna,PPO,83012,CPT4/HCPCS,ASSAY OF HAPTOGLOBINS,,Fee Schedule,172.78
Aetna,PPO,83013,CPT4/HCPCS,H PYLORI (C-13) BREATH,,Fee Schedule,676.78
Aetna,PPO,83014,CPT4/HCPCS,H PYLORI DRUG ADMIN,,Fee Schedule,78.96
Aetna,PPO,83015,CPT4/HCPCS,HEAVY METAL QUAL ANY ANAL,,Fee Schedule,131.62
Aetna,PPO,83018,CPT4/HCPCS,HEAVY METAL QUANT EACH NES,,Fee Schedule,220.66
Aetna,PPO,83020,CPT4/HCPCS,HEMOGLOBIN ELECTROPHORESIS,,Fee Schedule,129.36
Aetna,PPO,83021,CPT4/HCPCS,HEMOGLOBIN CHROMOTOGRAPHY,,Fee Schedule,181.44
Aetna,PPO,83026,CPT4/HCPCS,HEMOGLOBIN COPPER SULFATE,,Fee Schedule,23.68
Aetna,PPO,83030,CPT4/HCPCS,FETAL HEMOGLOBIN CHEMICAL,,Fee Schedule,83.07
Aetna,PPO,83033,CPT4/HCPCS,FETAL HEMOGLOBIN ASSAY QUAL,,Fee Schedule,59.89
Aetna,PPO,83036,CPT4/HCPCS,GLYCOSYLATED HEMOGLOBIN TEST,,Fee Schedule,97.52
Aetna,PPO,83037,CPT4/HCPCS,GLYCOSYLATED HB HOME DEVICE,,Fee Schedule,97.52
Aetna,PPO,83045,CPT4/HCPCS,BLOOD METHEMOGLOBIN TEST,,Fee Schedule,49.72
Aetna,PPO,83050,CPT4/HCPCS,BLOOD METHEMOGLOBIN ASSAY,,Fee Schedule,73.58
Aetna,PPO,83051,CPT4/HCPCS,ASSAY OF PLASMA HEMOGLOBIN,,Fee Schedule,73.50
Aetna,PPO,83060,CPT4/HCPCS,BLOOD SULFHEMOGLOBIN ASSAY,,Fee Schedule,83.07
Aetna,PPO,83065,CPT4/HCPCS,ASSAY OF HEMOGLOBIN HEAT,,Fee Schedule,69.21
Aetna,PPO,83068,CPT4/HCPCS,HEMOGLOBIN STABILITY SCREEN,,Fee Schedule,85.00
Aetna,PPO,83069,CPT4/HCPCS,ASSAY OF URINE HEMOGLOBIN,,Fee Schedule,39.73
Aetna,PPO,83070,CPT4/HCPCS,ASSAY OF HEMOSIDERIN QUAL,,Fee Schedule,47.71
Aetna,PPO,83080,CPT4/HCPCS,ASSAY OF B HEXOSAMINIDASE,,Fee Schedule,169.51
Aetna,PPO,83088,CPT4/HCPCS,ASSAY OF HISTAMINE,,Fee Schedule,296.77
Aetna,PPO,83090,CPT4/HCPCS,ASSAY OF HOMOCYSTINE,,Fee Schedule,169.51
Aetna,PPO,83150,CPT4/HCPCS,ASSAY OF HOMOVANILLIC ACID,,Fee Schedule,194.37
Aetna,PPO,83491,CPT4/HCPCS,ASSAY OF CORTICOSTEROIDS 17,,Fee Schedule,175.98
Aetna,PPO,83497,CPT4/HCPCS,ASSAY OF 5-HIAA,,Fee Schedule,129.52
Aetna,PPO,83498,CPT4/HCPCS,ASSAY OF PROGESTERONE 17-D,,Fee Schedule,273.00
Aetna,PPO,83500,CPT4/HCPCS,ASSAY FREE HYDROXYPROLINE,,Fee Schedule,227.55
Aetna,PPO,83505,CPT4/HCPCS,ASSAY TOTAL HYDROXYPROLINE,,Fee Schedule,244.27
Aetna,PPO,83516,CPT4/HCPCS,IMMUNOASSAY NONANTIBODY,,Fee Schedule,93.32
Aetna,PPO,83518,CPT4/HCPCS,IMMUNOASSAY DIPSTICK,,Fee Schedule,34.27
Aetna,PPO,83519,CPT4/HCPCS,RIA NONANTIBODY,,Fee Schedule,135.74
Aetna,PPO,83520,CPT4/HCPCS,IMMUNOASSAY QUANT NOS NONAB,,Fee Schedule,130.11
Aetna,PPO,83525,CPT4/HCPCS,ASSAY OF INSULIN,,Fee Schedule,114.91
Aetna,PPO,83527,CPT4/HCPCS,ASSAY OF INSULIN,,Fee Schedule,130.20
Aetna,PPO,83528,CPT4/HCPCS,ASSAY OF INTRINSIC FACTOR,,Fee Schedule,159.76
Aetna,PPO,83540,CPT4/HCPCS,ASSAY OF IRON,,Fee Schedule,65.10
Aetna,PPO,83550,CPT4/HCPCS,IRON BINDING TEST,,Fee Schedule,70.30
Aetna,PPO,83570,CPT4/HCPCS,ASSAY OF IDH ENZYME,,Fee Schedule,88.87
Aetna,PPO,83582,CPT4/HCPCS,ASSAY OF KETOGENIC STEROIDS,,Fee Schedule,142.38
Aetna,PPO,83586,CPT4/HCPCS,ASSAY 17- KETOSTEROIDS,,Fee Schedule,128.68
Aetna,PPO,83593,CPT4/HCPCS,FRACTIONATION KETOSTEROIDS,,Fee Schedule,264.26
Aetna,PPO,83605,CPT4/HCPCS,ASSAY OF LACTIC ACID,,Fee Schedule,107.35
Aetna,PPO,83615,CPT4/HCPCS,LACTATE (LD) (LDH) ENZYME,,Fee Schedule,60.73
Aetna,PPO,83625,CPT4/HCPCS,ASSAY OF LDH ENZYMES,,Fee Schedule,128.60
Aetna,PPO,83630,CPT4/HCPCS,LACTOFERRIN FECAL (QUAL),,Fee Schedule,197.23
Aetna,PPO,83631,CPT4/HCPCS,LACTOFERRIN FECAL (QUANT),,Fee Schedule,197.23
Aetna,PPO,83632,CPT4/HCPCS,PLACENTAL LACTOGEN,,Fee Schedule,203.11
Aetna,PPO,83633,CPT4/HCPCS,TEST URINE FOR LACTOSE,,Fee Schedule,55.27
Aetna,PPO,83655,CPT4/HCPCS,ASSAY OF LEAD,,Fee Schedule,121.63
Aetna,PPO,83661,CPT4/HCPCS,L/S RATIO FETAL LUNG,,Fee Schedule,220.92
Aetna,PPO,83662,CPT4/HCPCS,FOAM STABILITY FETAL LUNG,,Fee Schedule,190.17
Aetna,PPO,83663,CPT4/HCPCS,FLUORO POLARIZE FETAL LUNG,,Fee Schedule,190.17
Aetna,PPO,83664,CPT4/HCPCS,LAMELLAR BDY FETAL LUNG,,Fee Schedule,190.17
Aetna,PPO,83670,CPT4/HCPCS,ASSAY OF LAP ENZYME,,Fee Schedule,92.14
Aetna,PPO,83690,CPT4/HCPCS,ASSAY OF LIPASE,,Fee Schedule,69.21
Aetna,PPO,83695,CPT4/HCPCS,ASSAY OF LIPOPROTEIN(A),,Fee Schedule,130.11
Aetna,PPO,83698,CPT4/HCPCS,ASSAY LIPOPROTEIN PLA2,,Fee Schedule,341.04
Aetna,PPO,83700,CPT4/HCPCS,LIPOPRO BLD ELECTROPHORETIC,,Fee Schedule,113.06
Aetna,PPO,83701,CPT4/HCPCS,LIPOPROTEIN BLD HR FRACTION,,Fee Schedule,249.39
Aetna,PPO,83704,CPT4/HCPCS,LIPOPROTEIN BLD QUAN PART,,Fee Schedule,317.01
Aetna,PPO,83718,CPT4/HCPCS,ASSAY OF LIPOPROTEIN,,Fee Schedule,82.23
Aetna,PPO,83719,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,Fee Schedule,116.92
Aetna,PPO,83721,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,Fee Schedule,95.84
Aetna,PPO,83722,CPT4/HCPCS,LIPOPRTN DIR MEAS SD LDL CHL,,Fee Schedule,250.32
Aetna,PPO,83727,CPT4/HCPCS,ASSAY OF LRH HORMONE,,Fee Schedule,172.78
Aetna,PPO,83735,CPT4/HCPCS,ASSAY OF MAGNESIUM,,Fee Schedule,67.36
Aetna,PPO,83775,CPT4/HCPCS,ASSAY MALATE DEHYDROGENASE,,Fee Schedule,74.00
Aetna,PPO,83785,CPT4/HCPCS,ASSAY OF MANGANESE,,Fee Schedule,247.12
Aetna,PPO,83789,CPT4/HCPCS,MASS SPECTROMETRY QUAL/QUAN,,Fee Schedule,181.44
Aetna,PPO,83825,CPT4/HCPCS,ASSAY OF MERCURY,,Fee Schedule,163.38
Aetna,PPO,83835,CPT4/HCPCS,ASSAY OF METANEPHRINES,,Fee Schedule,170.18
Aetna,PPO,83857,CPT4/HCPCS,ASSAY OF METHEMALBUMIN,,Fee Schedule,107.94
Aetna,PPO,83861,CPT4/HCPCS,MICROFLUID ANALY TEARS,,Fee Schedule,168.33
Aetna,PPO,83864,CPT4/HCPCS,MUCOPOLYSACCHARIDES,,Fee Schedule,200.08
Aetna,PPO,83872,CPT4/HCPCS,ASSAY SYNOVIAL FLUID MUCIN,,Fee Schedule,57.62
Aetna,PPO,83873,CPT4/HCPCS,ASSAY OF CSF PROTEIN,,Fee Schedule,172.87
Aetna,PPO,83874,CPT4/HCPCS,ASSAY OF MYOGLOBIN,,Fee Schedule,129.69
Aetna,PPO,83876,CPT4/HCPCS,ASSAY MYELOPEROXIDASE,,Fee Schedule,341.04
Aetna,PPO,83880,CPT4/HCPCS,ASSAY OF NATRIURETIC PEPTIDE,,Fee Schedule,341.04
Aetna,PPO,83883,CPT4/HCPCS,ASSAY NEPHELOMETRY NOT SPEC,,Fee Schedule,136.58
Aetna,PPO,83885,CPT4/HCPCS,ASSAY OF NICKEL,,Fee Schedule,246.20
Aetna,PPO,83915,CPT4/HCPCS,ASSAY OF NUCLEOTIDASE,,Fee Schedule,112.14
Aetna,PPO,83916,CPT4/HCPCS,OLIGOCLONAL BANDS,,Fee Schedule,202.10
Aetna,PPO,83918,CPT4/HCPCS,ORGANIC ACIDS TOTAL QUANT,,Fee Schedule,165.39
Aetna,PPO,83919,CPT4/HCPCS,ORGANIC ACIDS QUAL EACH,,Fee Schedule,165.39
Aetna,PPO,83921,CPT4/HCPCS,ORGANIC ACID SINGLE QUANT,,Fee Schedule,165.39
Aetna,PPO,83930,CPT4/HCPCS,ASSAY OF BLOOD OSMOLALITY,,Fee Schedule,66.44
Aetna,PPO,83935,CPT4/HCPCS,ASSAY OF URINE OSMOLALITY,,Fee Schedule,68.46
Aetna,PPO,83937,CPT4/HCPCS,ASSAY OF OSTEOCALCIN,,Fee Schedule,286.10
Aetna,PPO,83945,CPT4/HCPCS,ASSAY OF OXALATE,,Fee Schedule,129.36
Aetna,PPO,83950,CPT4/HCPCS,ONCOPROTEIN HER-2/NEU,,Fee Schedule,647.13
Aetna,PPO,83951,CPT4/HCPCS,ONCOPROTEIN DCP,,Fee Schedule,647.13
Aetna,PPO,83970,CPT4/HCPCS,ASSAY OF PARATHORMONE,,Fee Schedule,414.70
Aetna,PPO,83986,CPT4/HCPCS,ASSAY PH BODY FLUID NOS,,Fee Schedule,35.95
Aetna,PPO,83987,CPT4/HCPCS,EXHALED BREATH CONDENSATE,,Fee Schedule,159.60
Aetna,PPO,83992,CPT4/HCPCS,ASSAY FOR PHENCYCLIDINE,,Fee Schedule,0.08
Aetna,PPO,83993,CPT4/HCPCS,ASSAY FOR CALPROTECTIN FECAL,,Fee Schedule,197.23
Aetna,PPO,84030,CPT4/HCPCS,ASSAY OF BLOOD PKU,,Fee Schedule,55.27
Aetna,PPO,84035,CPT4/HCPCS,ASSAY OF PHENYLKETONES,,Fee Schedule,36.79
Aetna,PPO,84060,CPT4/HCPCS,ASSAY ACID PHOSPHATASE,,Fee Schedule,74.17
Aetna,PPO,84066,CPT4/HCPCS,ASSAY PROSTATE PHOSPHATASE,,Fee Schedule,97.02
Aetna,PPO,84075,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,Fee Schedule,51.99
Aetna,PPO,84078,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,Fee Schedule,65.85
Aetna,PPO,84080,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASES,,Fee Schedule,148.68
Aetna,PPO,84081,CPT4/HCPCS,ASSAY PHOSPHATIDYLGLYCEROL,,Fee Schedule,165.98
Aetna,PPO,84085,CPT4/HCPCS,ASSAY OF RBC PG6D ENZYME,,Fee Schedule,67.78
Aetna,PPO,84087,CPT4/HCPCS,ASSAY PHOSPHOHEXOSE ENZYMES,,Fee Schedule,103.74
Aetna,PPO,84100,CPT4/HCPCS,ASSAY OF PHOSPHORUS,,Fee Schedule,47.62
Aetna,PPO,84105,CPT4/HCPCS,ASSAY OF URINE PHOSPHORUS,,Fee Schedule,51.99
Aetna,PPO,84106,CPT4/HCPCS,TEST FOR PORPHOBILINOGEN,,Fee Schedule,43.00
Aetna,PPO,84110,CPT4/HCPCS,ASSAY OF PORPHOBILINOGEN,,Fee Schedule,84.84
Aetna,PPO,84112,CPT4/HCPCS,EVAL AMNIOTIC FLUID PROTEIN,,Fee Schedule,647.13
Aetna,PPO,84119,CPT4/HCPCS,TEST URINE FOR PORPHYRINS,,Fee Schedule,86.52
Aetna,PPO,84120,CPT4/HCPCS,ASSAY OF URINE PORPHYRINS,,Fee Schedule,147.84
Aetna,PPO,84126,CPT4/HCPCS,ASSAY OF FECES PORPHYRINS,,Fee Schedule,255.94
Aetna,PPO,84132,CPT4/HCPCS,ASSAY OF SERUM POTASSIUM,,Fee Schedule,46.20
Aetna,PPO,84133,CPT4/HCPCS,ASSAY OF URINE POTASSIUM,,Fee Schedule,43.17
Aetna,PPO,84134,CPT4/HCPCS,ASSAY OF PREALBUMIN,,Fee Schedule,146.49
Aetna,PPO,84135,CPT4/HCPCS,ASSAY OF PREGNANEDIOL,,Fee Schedule,192.19
Aetna,PPO,84138,CPT4/HCPCS,ASSAY OF PREGNANETRIOL,,Fee Schedule,190.26
Aetna,PPO,84140,CPT4/HCPCS,ASSAY OF PREGNENOLONE,,Fee Schedule,207.81
Aetna,PPO,84143,CPT4/HCPCS,ASSAY OF 17-HYDROXYPREGNENO,,Fee Schedule,229.32
Aetna,PPO,84144,CPT4/HCPCS,ASSAY OF PROGESTERONE,,Fee Schedule,209.66
Aetna,PPO,84145,CPT4/HCPCS,PROCALCITONIN (PCT),,Fee Schedule,269.13
Aetna,PPO,84146,CPT4/HCPCS,ASSAY OF PROLACTIN,,Fee Schedule,194.71
Aetna,PPO,84150,CPT4/HCPCS,ASSAY OF PROSTAGLANDIN,,Fee Schedule,250.74
Aetna,PPO,84152,CPT4/HCPCS,ASSAY OF PSA COMPLEXED,,Fee Schedule,184.88
Aetna,PPO,84153,CPT4/HCPCS,ASSAY OF PSA TOTAL,,Fee Schedule,184.88
Aetna,PPO,84154,CPT4/HCPCS,ASSAY OF PSA FREE,,Fee Schedule,184.88
Aetna,PPO,84155,CPT4/HCPCS,ASSAY OF PROTEIN SERUM,,Fee Schedule,36.87
Aetna,PPO,84156,CPT4/HCPCS,ASSAY OF PROTEIN URINE,,Fee Schedule,36.87
Aetna,PPO,84157,CPT4/HCPCS,ASSAY OF PROTEIN OTHER,,Fee Schedule,36.87
Aetna,PPO,84160,CPT4/HCPCS,ASSAY OF PROTEIN ANY SOURCE,,Fee Schedule,51.99
Aetna,PPO,84163,CPT4/HCPCS,PAPPA SERUM,,Fee Schedule,151.28
Aetna,PPO,84165,CPT4/HCPCS,PROTEIN E-PHORESIS SERUM,,Fee Schedule,107.94
Aetna,PPO,84166,CPT4/HCPCS,PROTEIN E-PHORESIS/URINE/CSF,,Fee Schedule,179.17
Aetna,PPO,84181,CPT4/HCPCS,WESTERN BLOT TEST,,Fee Schedule,171.10
Aetna,PPO,84182,CPT4/HCPCS,PROTEIN WESTERN BLOT TEST,,Fee Schedule,180.85
Aetna,PPO,84202,CPT4/HCPCS,ASSAY RBC PROTOPORPHYRIN,,Fee Schedule,144.14
Aetna,PPO,84203,CPT4/HCPCS,TEST RBC PROTOPORPHYRIN,,Fee Schedule,86.43
Aetna,PPO,84206,CPT4/HCPCS,ASSAY OF PROINSULIN,,Fee Schedule,179.00
Aetna,PPO,84207,CPT4/HCPCS,ASSAY OF VITAMIN B-6,,Fee Schedule,282.32
Aetna,PPO,84210,CPT4/HCPCS,ASSAY OF PYRUVATE,,Fee Schedule,109.03
Aetna,PPO,84220,CPT4/HCPCS,ASSAY OF PYRUVATE KINASE,,Fee Schedule,94.83
Aetna,PPO,84228,CPT4/HCPCS,ASSAY OF QUININE,,Fee Schedule,116.92
Aetna,PPO,84233,CPT4/HCPCS,ASSAY OF ESTROGEN,,Fee Schedule,647.13
Aetna,PPO,84234,CPT4/HCPCS,ASSAY OF PROGESTERONE,,Fee Schedule,651.84
Aetna,PPO,84235,CPT4/HCPCS,ASSAY OF ENDOCRINE HORMONE,,Fee Schedule,525.84
Aetna,PPO,84238,CPT4/HCPCS,ASSAY NONENDOCRINE RECEPTOR,,Fee Schedule,367.41
Aetna,PPO,84244,CPT4/HCPCS,ASSAY OF RENIN,,Fee Schedule,221.00
Aetna,PPO,84252,CPT4/HCPCS,ASSAY OF VITAMIN B-2,,Fee Schedule,203.36
Aetna,PPO,84255,CPT4/HCPCS,ASSAY OF SELENIUM,,Fee Schedule,256.53
Aetna,PPO,84260,CPT4/HCPCS,ASSAY OF SEROTONIN,,Fee Schedule,311.22
Aetna,PPO,84270,CPT4/HCPCS,ASSAY OF SEX HORMONE GLOBUL,,Fee Schedule,218.31
Aetna,PPO,84275,CPT4/HCPCS,ASSAY OF SIALIC ACID,,Fee Schedule,134.98
Aetna,PPO,84285,CPT4/HCPCS,ASSAY OF SILICA,,Fee Schedule,236.62
Aetna,PPO,84295,CPT4/HCPCS,ASSAY OF SERUM SODIUM,,Fee Schedule,48.30
Aetna,PPO,84300,CPT4/HCPCS,ASSAY OF URINE SODIUM,,Fee Schedule,48.88
Aetna,PPO,84302,CPT4/HCPCS,ASSAY OF SWEAT SODIUM,,Fee Schedule,48.88
Aetna,PPO,84305,CPT4/HCPCS,ASSAY OF SOMATOMEDIN,,Fee Schedule,213.61
Aetna,PPO,84307,CPT4/HCPCS,ASSAY OF SOMATOSTATIN,,Fee Schedule,183.70
Aetna,PPO,84311,CPT4/HCPCS,SPECTROPHOTOMETRY,,Fee Schedule,70.22
Aetna,PPO,84315,CPT4/HCPCS,BODY FLUID SPECIFIC GRAVITY,,Fee Schedule,25.20
Aetna,PPO,84375,CPT4/HCPCS,CHROMATOGRAM ASSAY SUGARS,,Fee Schedule,196.98
Aetna,PPO,84376,CPT4/HCPCS,SUGARS SINGLE QUAL,,Fee Schedule,55.27
Aetna,PPO,84377,CPT4/HCPCS,SUGARS MULTIPLE QUAL,,Fee Schedule,55.27
Aetna,PPO,84378,CPT4/HCPCS,SUGARS SINGLE QUANT,,Fee Schedule,115.83
Aetna,PPO,84379,CPT4/HCPCS,SUGARS MULTIPLE QUANT,,Fee Schedule,115.83
Aetna,PPO,84392,CPT4/HCPCS,ASSAY OF URINE SULFATE,,Fee Schedule,47.71
Aetna,PPO,84402,CPT4/HCPCS,ASSAY OF FREE TESTOSTERONE,,Fee Schedule,255.86
Aetna,PPO,84403,CPT4/HCPCS,ASSAY OF TOTAL TESTOSTERONE,,Fee Schedule,259.39
Aetna,PPO,84410,CPT4/HCPCS,TESTOSTERONE BIOAVAILABLE,,Fee Schedule,518.02
Aetna,PPO,84425,CPT4/HCPCS,ASSAY OF VITAMIN B-1,,Fee Schedule,213.36
Aetna,PPO,84430,CPT4/HCPCS,ASSAY OF THIOCYANATE,,Fee Schedule,116.92
Aetna,PPO,84431,CPT4/HCPCS,THROMBOXANE URINE,,Fee Schedule,168.75
Aetna,PPO,84432,CPT4/HCPCS,ASSAY OF THYROGLOBULIN,,Fee Schedule,161.44
Aetna,PPO,84436,CPT4/HCPCS,ASSAY OF TOTAL THYROXINE,,Fee Schedule,69.04
Aetna,PPO,84437,CPT4/HCPCS,ASSAY OF NEONATAL THYROXINE,,Fee Schedule,65.01
Aetna,PPO,84439,CPT4/HCPCS,ASSAY OF FREE THYROXINE,,Fee Schedule,90.63
Aetna,PPO,84442,CPT4/HCPCS,ASSAY OF THYROID ACTIVITY,,Fee Schedule,148.68
Aetna,PPO,84443,CPT4/HCPCS,ASSAY THYROID STIM HORMONE,,Fee Schedule,168.75
Aetna,PPO,84445,CPT4/HCPCS,ASSAY OF TSI GLOBULIN,,Fee Schedule,510.97
Aetna,PPO,84446,CPT4/HCPCS,ASSAY OF VITAMIN E,,Fee Schedule,142.46
Aetna,PPO,84449,CPT4/HCPCS,ASSAY OF TRANSCORTIN,,Fee Schedule,168.75
Aetna,PPO,84450,CPT4/HCPCS,TRANSFERASE (AST) (SGOT),,Fee Schedule,51.99
Aetna,PPO,84460,CPT4/HCPCS,ALANINE AMINO (ALT) (SGPT),,Fee Schedule,53.08
Aetna,PPO,84466,CPT4/HCPCS,ASSAY OF TRANSFERRIN,,Fee Schedule,128.26
Aetna,PPO,84478,CPT4/HCPCS,ASSAY OF TRIGLYCERIDES,,Fee Schedule,57.87
Aetna,PPO,84479,CPT4/HCPCS,ASSAY OF THYROID (T3 OR T4),,Fee Schedule,65.01
Aetna,PPO,84480,CPT4/HCPCS,ASSAY TRIIODOTHYRONINE (T3),,Fee Schedule,142.46
Aetna,PPO,84481,CPT4/HCPCS,FREE ASSAY (FT-3),,Fee Schedule,170.18
Aetna,PPO,84482,CPT4/HCPCS,T3 REVERSE,,Fee Schedule,158.34
Aetna,PPO,84484,CPT4/HCPCS,ASSAY OF TROPONIN QUANT,,Fee Schedule,98.86
Aetna,PPO,84485,CPT4/HCPCS,ASSAY DUODENAL FLUID TRYPSIN,,Fee Schedule,75.43
Aetna,PPO,84488,CPT4/HCPCS,TEST FECES FOR TRYPSIN,,Fee Schedule,73.33
Aetna,PPO,84490,CPT4/HCPCS,ASSAY OF FECES FOR TRYPSIN,,Fee Schedule,76.44
Aetna,PPO,84510,CPT4/HCPCS,ASSAY OF TYROSINE,,Fee Schedule,104.49
Aetna,PPO,84512,CPT4/HCPCS,ASSAY OF TROPONIN QUAL,,Fee Schedule,77.36
Aetna,PPO,84520,CPT4/HCPCS,ASSAY OF UREA NITROGEN,,Fee Schedule,39.73
Aetna,PPO,84525,CPT4/HCPCS,UREA NITROGEN SEMI-QUANT,,Fee Schedule,37.80
Aetna,PPO,84540,CPT4/HCPCS,ASSAY OF URINE/UREA-N,,Fee Schedule,47.71
Aetna,PPO,84545,CPT4/HCPCS,UREA-N CLEARANCE TEST,,Fee Schedule,66.36
Aetna,PPO,84550,CPT4/HCPCS,ASSAY OF BLOOD/URIC ACID,,Fee Schedule,45.44
Aetna,PPO,84560,CPT4/HCPCS,ASSAY OF URINE/URIC ACID,,Fee Schedule,47.71
Aetna,PPO,84577,CPT4/HCPCS,ASSAY OF FECES/UROBILINOGEN,,Fee Schedule,125.41
Aetna,PPO,84578,CPT4/HCPCS,TEST URINE UROBILINOGEN,,Fee Schedule,32.59
Aetna,PPO,84580,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,Fee Schedule,71.23
Aetna,PPO,84583,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,Fee Schedule,50.48
Aetna,PPO,84585,CPT4/HCPCS,ASSAY OF URINE VMA,,Fee Schedule,155.82
Aetna,PPO,84586,CPT4/HCPCS,ASSAY OF VIP,,Fee Schedule,354.98
Aetna,PPO,84588,CPT4/HCPCS,ASSAY OF VASOPRESSIN,,Fee Schedule,341.04
Aetna,PPO,84590,CPT4/HCPCS,ASSAY OF VITAMIN A,,Fee Schedule,116.50
Aetna,PPO,84591,CPT4/HCPCS,ASSAY OF NOS VITAMIN,,Fee Schedule,116.50
Aetna,PPO,84597,CPT4/HCPCS,ASSAY OF VITAMIN K,,Fee Schedule,137.76
Aetna,PPO,84600,CPT4/HCPCS,ASSAY OF VOLATILES,,Fee Schedule,161.53
Aetna,PPO,84620,CPT4/HCPCS,XYLOSE TOLERANCE TEST,,Fee Schedule,119.02
Aetna,PPO,84630,CPT4/HCPCS,ASSAY OF ZINC,,Fee Schedule,114.40
Aetna,PPO,84681,CPT4/HCPCS,ASSAY OF C-PEPTIDE,,Fee Schedule,209.07
Aetna,PPO,84702,CPT4/HCPCS,CHORIONIC GONADOTROPIN TEST,,Fee Schedule,151.28
Aetna,PPO,84703,CPT4/HCPCS,CHORIONIC GONADOTROPIN ASSAY,,Fee Schedule,75.43
Aetna,PPO,84704,CPT4/HCPCS,HCG FREE BETACHAIN TEST,,Fee Schedule,151.28
Aetna,PPO,84830,CPT4/HCPCS,OVULATION TESTS,,Fee Schedule,78.28
Aetna,PPO,85002,CPT4/HCPCS,BLEEDING TIME TEST,,Fee Schedule,45.19
Aetna,PPO,85004,CPT4/HCPCS,AUTOMATED DIFF WBC COUNT,,Fee Schedule,65.01
Aetna,PPO,85007,CPT4/HCPCS,BL SMEAR W/DIFF WBC COUNT,,Fee Schedule,34.52
Aetna,PPO,85008,CPT4/HCPCS,BL SMEAR W/O DIFF WBC COUNT,,Fee Schedule,34.52
Aetna,PPO,85009,CPT4/HCPCS,MANUAL DIFF WBC COUNT B-COAT,,Fee Schedule,37.38
Aetna,PPO,85013,CPT4/HCPCS,SPUN MICROHEMATOCRIT,,Fee Schedule,23.77
Aetna,PPO,85014,CPT4/HCPCS,HEMATOCRIT,,Fee Schedule,23.77
Aetna,PPO,85018,CPT4/HCPCS,HEMOGLOBIN,,Fee Schedule,23.77
Aetna,PPO,85025,CPT4/HCPCS,COMPLETE CBC W/AUTO DIFF WBC,,Fee Schedule,78.12
Aetna,PPO,85027,CPT4/HCPCS,COMPLETE CBC AUTOMATED,,Fee Schedule,65.01
Aetna,PPO,85032,CPT4/HCPCS,MANUAL CELL COUNT EACH,,Fee Schedule,43.17
Aetna,PPO,85041,CPT4/HCPCS,AUTOMATED RBC COUNT,,Fee Schedule,30.24
Aetna,PPO,85044,CPT4/HCPCS,MANUAL RETICULOCYTE COUNT,,Fee Schedule,43.17
Aetna,PPO,85045,CPT4/HCPCS,AUTOMATED RETICULOCYTE COUNT,,Fee Schedule,40.23
Aetna,PPO,85046,CPT4/HCPCS,RETICYTE/HGB CONCENTRATE,,Fee Schedule,56.02
Aetna,PPO,85048,CPT4/HCPCS,AUTOMATED LEUKOCYTE COUNT,,Fee Schedule,25.45
Aetna,PPO,85049,CPT4/HCPCS,AUTOMATED PLATELET COUNT,,Fee Schedule,44.94
Aetna,PPO,85055,CPT4/HCPCS,RETICULATED PLATELET ASSAY,,Fee Schedule,268.96
Aetna,PPO,85060,CPT4/HCPCS,BLOOD SMEAR INTERPRETATION,,Fee Schedule,177.91
Aetna,PPO,85097,CPT4/HCPCS,BONE MARROW INTERPRETATION,,Fee Schedule,361.11
Aetna,PPO,85130,CPT4/HCPCS,CHROMOGENIC SUBSTRATE ASSAY,,Fee Schedule,119.53
Aetna,PPO,85170,CPT4/HCPCS,BLOOD CLOT RETRACTION,,Fee Schedule,36.37
Aetna,PPO,85175,CPT4/HCPCS,BLOOD CLOT LYSIS TIME,,Fee Schedule,45.69
Aetna,PPO,85210,CPT4/HCPCS,CLOT FACTOR II PROTHROM SPEC,,Fee Schedule,130.45
Aetna,PPO,85220,CPT4/HCPCS,BLOOC CLOT FACTOR V TEST,,Fee Schedule,177.32
Aetna,PPO,85230,CPT4/HCPCS,CLOT FACTOR VII PROCONVERTIN,,Fee Schedule,179.92
Aetna,PPO,85240,CPT4/HCPCS,CLOT FACTOR VIII AHG 1 STAGE,,Fee Schedule,179.92
Aetna,PPO,85244,CPT4/HCPCS,CLOT FACTOR VIII RELTD ANTGN,,Fee Schedule,205.12
Aetna,PPO,85245,CPT4/HCPCS,CLOT FACTOR VIII VW RISTOCTN,,Fee Schedule,230.58
Aetna,PPO,85246,CPT4/HCPCS,CLOT FACTOR VIII VW ANTIGEN,,Fee Schedule,230.58
Aetna,PPO,85247,CPT4/HCPCS,CLOT FACTOR VIII MULTIMETRIC,,Fee Schedule,230.58
Aetna,PPO,85250,CPT4/HCPCS,CLOT FACTOR IX PTC/CHRSTMAS,,Fee Schedule,191.35
Aetna,PPO,85260,CPT4/HCPCS,CLOT FACTOR X STUART-POWER,,Fee Schedule,179.92
Aetna,PPO,85270,CPT4/HCPCS,CLOT FACTOR XI PTA,,Fee Schedule,179.92
Aetna,PPO,85280,CPT4/HCPCS,CLOT FACTOR XII HAGEMAN,,Fee Schedule,194.37
Aetna,PPO,85290,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN STAB,,Fee Schedule,164.22
Aetna,PPO,85291,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN SCRN,,Fee Schedule,89.29
Aetna,PPO,85292,CPT4/HCPCS,CLOT FACTOR FLETCHER FACT,,Fee Schedule,190.26
Aetna,PPO,85293,CPT4/HCPCS,CLOT FACTOR WGHT KININOGEN,,Fee Schedule,190.26
Aetna,PPO,85300,CPT4/HCPCS,ANTITHROMBIN III ACTIVITY,,Fee Schedule,119.11
Aetna,PPO,85301,CPT4/HCPCS,ANTITHROMBIN III ANTIGEN,,Fee Schedule,108.61
Aetna,PPO,85302,CPT4/HCPCS,CLOT INHIBIT PROT C ANTIGEN,,Fee Schedule,120.79
Aetna,PPO,85303,CPT4/HCPCS,CLOT INHIBIT PROT C ACTIVITY,,Fee Schedule,138.93
Aetna,PPO,85305,CPT4/HCPCS,CLOT INHIBIT PROT S TOTAL,,Fee Schedule,116.50
Aetna,PPO,85306,CPT4/HCPCS,CLOT INHIBIT PROT S FREE,,Fee Schedule,153.97
Aetna,PPO,85307,CPT4/HCPCS,ASSAY ACTIVATED PROTEIN C,,Fee Schedule,153.97
Aetna,PPO,85335,CPT4/HCPCS,FACTOR INHIBITOR TEST,,Fee Schedule,129.36
Aetna,PPO,85337,CPT4/HCPCS,THROMBOMODULIN,,Fee Schedule,104.74
Aetna,PPO,85345,CPT4/HCPCS,COAGULATION TIME LEE & WHITE,,Fee Schedule,43.17
Aetna,PPO,85347,CPT4/HCPCS,COAGULATION TIME ACTIVATED,,Fee Schedule,42.75
Aetna,PPO,85348,CPT4/HCPCS,COAGULATION TIME OTR METHOD,,Fee Schedule,37.38
Aetna,PPO,85360,CPT4/HCPCS,EUGLOBULIN LYSIS,,Fee Schedule,84.50
Aetna,PPO,85362,CPT4/HCPCS,FIBRIN DEGRADATION PRODUCTS,,Fee Schedule,65.85
Aetna,PPO,85366,CPT4/HCPCS,FIBRINOGEN TEST,,Fee Schedule,82.15
Aetna,PPO,85370,CPT4/HCPCS,FIBRINOGEN TEST,,Fee Schedule,114.07
Aetna,PPO,85378,CPT4/HCPCS,FIBRIN DEGRADE SEMIQUANT,,Fee Schedule,71.65
Aetna,PPO,85379,CPT4/HCPCS,FIBRIN DEGRADATION QUANT,,Fee Schedule,102.22
Aetna,PPO,85380,CPT4/HCPCS,FIBRIN DEGRADJ D-DIMER,,Fee Schedule,102.22
Aetna,PPO,85384,CPT4/HCPCS,FIBRINOGEN ACTIVITY,,Fee Schedule,85.34
Aetna,PPO,85385,CPT4/HCPCS,FIBRINOGEN ANTIGEN,,Fee Schedule,85.34
Aetna,PPO,85390,CPT4/HCPCS,FIBRINOLYSINS SCREEN I&R,,Fee Schedule,51.91
Aetna,PPO,85396,CPT4/HCPCS,CLOTTING ASSAY WHOLE BLOOD,,Fee Schedule,145.90
Aetna,PPO,85397,CPT4/HCPCS,CLOTTING FUNCT ACTIVITY,,Fee Schedule,230.58
Aetna,PPO,85400,CPT4/HCPCS,FIBRINOLYTIC PLASMIN,,Fee Schedule,88.87
Aetna,PPO,85410,CPT4/HCPCS,FIBRINOLYTIC ANTIPLASMIN,,Fee Schedule,77.53
Aetna,PPO,85415,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Fee Schedule,172.78
Aetna,PPO,85420,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Fee Schedule,65.68
Aetna,PPO,85421,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Fee Schedule,102.31
Aetna,PPO,85441,CPT4/HCPCS,HEINZ BODIES DIRECT,,Fee Schedule,42.25
Aetna,PPO,85445,CPT4/HCPCS,HEINZ BODIES INDUCED,,Fee Schedule,68.46
Aetna,PPO,85460,CPT4/HCPCS,HEMOGLOBIN FETAL,,Fee Schedule,77.78
Aetna,PPO,85461,CPT4/HCPCS,HEMOGLOBIN FETAL,,Fee Schedule,66.69
Aetna,PPO,85475,CPT4/HCPCS,HEMOLYSIN ACID,,Fee Schedule,89.12
Aetna,PPO,85520,CPT4/HCPCS,HEPARIN ASSAY,,Fee Schedule,131.62
Aetna,PPO,85525,CPT4/HCPCS,HEPARIN NEUTRALIZATION,,Fee Schedule,93.32
Aetna,PPO,85530,CPT4/HCPCS,HEPARIN-PROTAMINE TOLERANCE,,Fee Schedule,142.46
Aetna,PPO,85536,CPT4/HCPCS,IRON STAIN PERIPHERAL BLOOD,,Fee Schedule,65.01
Aetna,PPO,85540,CPT4/HCPCS,WBC ALKALINE PHOSPHATASE,,Fee Schedule,86.43
Aetna,PPO,85547,CPT4/HCPCS,RBC MECHANICAL FRAGILITY,,Fee Schedule,86.43
Aetna,PPO,85549,CPT4/HCPCS,MURAMIDASE,,Fee Schedule,188.49
Aetna,PPO,85555,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,Fee Schedule,67.20
Aetna,PPO,85557,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,Fee Schedule,134.23
Aetna,PPO,85576,CPT4/HCPCS,BLOOD PLATELET AGGREGATION,,Fee Schedule,215.88
Aetna,PPO,85597,CPT4/HCPCS,PHOSPHOLIPID PLTLT NEUTRALIZ,,Fee Schedule,180.68
Aetna,PPO,85598,CPT4/HCPCS,HEXAGNAL PHOSPH PLTLT NEUTRL,,Fee Schedule,180.68
Aetna,PPO,85610,CPT4/HCPCS,PROTHROMBIN TIME,,Fee Schedule,39.48
Aetna,PPO,85611,CPT4/HCPCS,PROTHROMBIN TEST,,Fee Schedule,39.56
Aetna,PPO,85612,CPT4/HCPCS,VIPER VENOM PROTHROMBIN TIME,,Fee Schedule,96.18
Aetna,PPO,85613,CPT4/HCPCS,RUSSELL VIPER VENOM DILUTED,,Fee Schedule,96.18
Aetna,PPO,85635,CPT4/HCPCS,REPTILASE TEST,,Fee Schedule,98.95
Aetna,PPO,85651,CPT4/HCPCS,RBC SED RATE NONAUTOMATED,,Fee Schedule,35.70
Aetna,PPO,85652,CPT4/HCPCS,RBC SED RATE AUTOMATED,,Fee Schedule,27.13
Aetna,PPO,85660,CPT4/HCPCS,RBC SICKLE CELL TEST,,Fee Schedule,55.44
Aetna,PPO,85670,CPT4/HCPCS,THROMBIN TIME PLASMA,,Fee Schedule,58.04
Aetna,PPO,85675,CPT4/HCPCS,THROMBIN TIME TITER,,Fee Schedule,68.79
Aetna,PPO,85705,CPT4/HCPCS,THROMBOPLASTIN INHIBITION,,Fee Schedule,96.76
Aetna,PPO,85730,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,Fee Schedule,60.31
Aetna,PPO,85732,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,Fee Schedule,65.01
Aetna,PPO,85810,CPT4/HCPCS,BLOOD VISCOSITY EXAMINATION,,Fee Schedule,117.34
Aetna,PPO,86000,CPT4/HCPCS,AGGLUTININS FEBRILE ANTIGEN,,Fee Schedule,57.62
Aetna,PPO,86001,CPT4/HCPCS,ALLERGEN SPECIFIC IGG,,Fee Schedule,52.41
Aetna,PPO,86003,CPT4/HCPCS,ALLG SPEC IGE CRUDE XTRC EA,,Fee Schedule,52.41
Aetna,PPO,86005,CPT4/HCPCS,ALLG SPEC IGE MULTIALLG SCR,,Fee Schedule,53.76
Aetna,PPO,86008,CPT4/HCPCS,ALLG SPEC IGE RECOMB EA,,Fee Schedule,158.08
Aetna,PPO,86021,CPT4/HCPCS,WBC ANTIBODY IDENTIFICATION,,Fee Schedule,137.34
Aetna,PPO,86022,CPT4/HCPCS,PLATELET ANTIBODIES,,Fee Schedule,184.54
Aetna,PPO,86023,CPT4/HCPCS,IMMUNOGLOBULIN ASSAY,,Fee Schedule,125.16
Aetna,PPO,86038,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES,,Fee Schedule,121.46
Aetna,PPO,86039,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES (ANA),,Fee Schedule,112.14
Aetna,PPO,86060,CPT4/HCPCS,ANTISTREPTOLYSIN O TITER,,Fee Schedule,73.33
Aetna,PPO,86063,CPT4/HCPCS,ANTISTREPTOLYSIN O SCREEN,,Fee Schedule,58.04
Aetna,PPO,86077,CPT4/HCPCS,PHYS BLOOD BANK SERV XMATCH,,Fee Schedule,370.02
Aetna,PPO,86078,CPT4/HCPCS,PHYS BLOOD BANK SERV REACTJ,,Fee Schedule,372.96
Aetna,PPO,86079,CPT4/HCPCS,PHYS BLOOD BANK SERV AUTHRJ,,Fee Schedule,372.96
Aetna,PPO,86140,CPT4/HCPCS,C-REACTIVE PROTEIN,,Fee Schedule,51.99
Aetna,PPO,86141,CPT4/HCPCS,C-REACTIVE PROTEIN HS,,Fee Schedule,130.11
Aetna,PPO,86146,CPT4/HCPCS,BETA-2 GLYCOPROTEIN ANTIBODY,,Fee Schedule,255.61
Aetna,PPO,86147,CPT4/HCPCS,CARDIOLIPIN ANTIBODY EA IG,,Fee Schedule,255.61
Aetna,PPO,86148,CPT4/HCPCS,ANTI-PHOSPHOLIPID ANTIBODY,,Fee Schedule,161.44
Aetna,PPO,86152,CPT4/HCPCS,CELL ENUMERATION & ID,,Fee Schedule,5829.26
Aetna,PPO,86153,CPT4/HCPCS,CELL ENUMERATION PHYS INTERP,,Fee Schedule,1260.00
Aetna,PPO,86155,CPT4/HCPCS,CHEMOTAXIS ASSAY,,Fee Schedule,160.60
Aetna,PPO,86156,CPT4/HCPCS,COLD AGGLUTININ SCREEN,,Fee Schedule,67.36
Aetna,PPO,86157,CPT4/HCPCS,COLD AGGLUTININ TITER,,Fee Schedule,81.06
Aetna,PPO,86160,CPT4/HCPCS,COMPLEMENT ANTIGEN,,Fee Schedule,120.62
Aetna,PPO,86161,CPT4/HCPCS,COMPLEMENT/FUNCTION ACTIVITY,,Fee Schedule,120.62
Aetna,PPO,86162,CPT4/HCPCS,COMPLEMENT TOTAL (CH50),,Fee Schedule,204.12
Aetna,PPO,86171,CPT4/HCPCS,COMPLEMENT FIXATION EACH,,Fee Schedule,100.71
Aetna,PPO,86200,CPT4/HCPCS,CCP ANTIBODY,,Fee Schedule,130.11
Aetna,PPO,86215,CPT4/HCPCS,DEOXYRIBONUCLEASE ANTIBODY,,Fee Schedule,133.14
Aetna,PPO,86225,CPT4/HCPCS,DNA ANTIBODY NATIVE,,Fee Schedule,138.01
Aetna,PPO,86226,CPT4/HCPCS,DNA ANTIBODY SINGLE STRAND,,Fee Schedule,121.63
Aetna,PPO,86235,CPT4/HCPCS,NUCLEAR ANTIGEN ANTIBODY,,Fee Schedule,164.47
Aetna,PPO,86255,CPT4/HCPCS,FLUORESCENT ANTIBODY SCREEN,,Fee Schedule,121.12
Aetna,PPO,86256,CPT4/HCPCS,FLUORESCENT ANTIBODY TITER,,Fee Schedule,121.12
Aetna,PPO,86277,CPT4/HCPCS,GROWTH HORMONE ANTIBODY,,Fee Schedule,158.17
Aetna,PPO,86280,CPT4/HCPCS,HEMAGGLUTINATION INHIBITION,,Fee Schedule,82.23
Aetna,PPO,86294,CPT4/HCPCS,IMMUNOASSAY TUMOR QUAL,,Fee Schedule,197.14
Aetna,PPO,86300,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 15-3,,Fee Schedule,209.16
Aetna,PPO,86301,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 19-9,,Fee Schedule,209.16
Aetna,PPO,86304,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 125,,Fee Schedule,209.16
Aetna,PPO,86305,CPT4/HCPCS,HUMAN EPIDIDYMIS PROTEIN 4,,Fee Schedule,209.16
Aetna,PPO,86308,CPT4/HCPCS,HETEROPHILE ANTIBODY SCREEN,,Fee Schedule,51.99
Aetna,PPO,86309,CPT4/HCPCS,HETEROPHILE ANTIBODY TITER,,Fee Schedule,65.01
Aetna,PPO,86310,CPT4/HCPCS,HETEROPHILE ANTIBODY ABSRBJ,,Fee Schedule,74.00
Aetna,PPO,86316,CPT4/HCPCS,IMMUNOASSAY TUMOR OTHER,,Fee Schedule,209.16
Aetna,PPO,86317,CPT4/HCPCS,IMMUNOASSAY INFECTIOUS AGENT,,Fee Schedule,150.69
Aetna,PPO,86318,CPT4/HCPCS,IA INFECTIOUS AGENT ANTIBODY,,Fee Schedule,130.11
Aetna,PPO,86320,CPT4/HCPCS,SERUM IMMUNOELECTROPHORESIS,,Fee Schedule,225.20
Aetna,PPO,86325,CPT4/HCPCS,OTHER IMMUNOELECTROPHORESIS,,Fee Schedule,224.61
Aetna,PPO,86327,CPT4/HCPCS,IMMUNOELECTROPHORESIS ASSAY,,Fee Schedule,227.97
Aetna,PPO,86329,CPT4/HCPCS,IMMUNODIFFUSION NES,,Fee Schedule,141.12
Aetna,PPO,86331,CPT4/HCPCS,IMMUNODIFFUSION OUCHTERLONY,,Fee Schedule,120.37
Aetna,PPO,86332,CPT4/HCPCS,IMMUNE COMPLEX ASSAY,,Fee Schedule,244.94
Aetna,PPO,86334,CPT4/HCPCS,IMMUNOFIX E-PHORESIS SERUM,,Fee Schedule,224.44
Aetna,PPO,86335,CPT4/HCPCS,IMMUNFIX E-PHORSIS/URINE/CSF,,Fee Schedule,294.92
Aetna,PPO,86336,CPT4/HCPCS,INHIBIN A,,Fee Schedule,156.57
Aetna,PPO,86337,CPT4/HCPCS,INSULIN ANTIBODIES,,Fee Schedule,215.12
Aetna,PPO,86340,CPT4/HCPCS,INTRINSIC FACTOR ANTIBODY,,Fee Schedule,151.45
Aetna,PPO,86341,CPT4/HCPCS,ISLET CELL ANTIBODY,,Fee Schedule,166.90
Aetna,PPO,86343,CPT4/HCPCS,LEUKOCYTE HISTAMINE RELEASE,,Fee Schedule,125.24
Aetna,PPO,86344,CPT4/HCPCS,LEUKOCYTE PHAGOCYTOSIS,,Fee Schedule,80.22
Aetna,PPO,86352,CPT4/HCPCS,CELL FUNCTION ASSAY W/STIM,,Fee Schedule,1365.08
Aetna,PPO,86353,CPT4/HCPCS,LYMPHOCYTE TRANSFORMATION,,Fee Schedule,492.57
Aetna,PPO,86355,CPT4/HCPCS,B CELLS TOTAL COUNT,,Fee Schedule,379.00
Aetna,PPO,86356,CPT4/HCPCS,MONONUCLEAR CELL ANTIGEN,,Fee Schedule,268.96
Aetna,PPO,86357,CPT4/HCPCS,NK CELLS TOTAL COUNT,,Fee Schedule,379.00
Aetna,PPO,86359,CPT4/HCPCS,T CELLS TOTAL COUNT,,Fee Schedule,379.00
Aetna,PPO,86360,CPT4/HCPCS,T CELL ABSOLUTE COUNT/RATIO,,Fee Schedule,472.08
Aetna,PPO,86361,CPT4/HCPCS,T CELL ABSOLUTE COUNT,,Fee Schedule,268.96
Aetna,PPO,86367,CPT4/HCPCS,STEM CELLS TOTAL COUNT,,Fee Schedule,379.00
Aetna,PPO,86376,CPT4/HCPCS,MICROSOMAL ANTIBODY EACH,,Fee Schedule,146.24
Aetna,PPO,86382,CPT4/HCPCS,NEUTRALIZATION TEST VIRAL,,Fee Schedule,169.93
Aetna,PPO,86384,CPT4/HCPCS,NITROBLUE TETRAZOLIUM DYE,,Fee Schedule,114.40
Aetna,PPO,86386,CPT4/HCPCS,NUCLEAR MATRIX PROTEIN 22,,Fee Schedule,161.44
Aetna,PPO,86403,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY SCRN,,Fee Schedule,102.39
Aetna,PPO,86406,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY TITR,,Fee Schedule,106.84
Aetna,PPO,86430,CPT4/HCPCS,RHEUMATOID FACTOR TEST QUAL,,Fee Schedule,56.95
Aetna,PPO,86431,CPT4/HCPCS,RHEUMATOID FACTOR QUANT,,Fee Schedule,56.95
Aetna,PPO,86480,CPT4/HCPCS,TB TEST CELL IMMUN MEASURE,,Fee Schedule,622.77
Aetna,PPO,86481,CPT4/HCPCS,TB AG RESPONSE T-CELL SUSP,,Fee Schedule,622.77
Aetna,PPO,86485,CPT4/HCPCS,SKIN TEST CANDIDA,,Fee Schedule,115.41
Aetna,PPO,86486,CPT4/HCPCS,SKIN TEST NOS ANTIGEN,,Fee Schedule,43.17
Aetna,PPO,86490,CPT4/HCPCS,COCCIDIOIDOMYCOSIS SKIN TEST,,Fee Schedule,57.96
Aetna,PPO,86510,CPT4/HCPCS,HISTOPLASMOSIS SKIN TEST,,Fee Schedule,55.02
Aetna,PPO,86580,CPT4/HCPCS,TB INTRADERMAL TEST,,Fee Schedule,63.92
Aetna,PPO,86590,CPT4/HCPCS,STREPTOKINASE ANTIBODY,,Fee Schedule,110.88
Aetna,PPO,86592,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUAL,,Fee Schedule,42.92
Aetna,PPO,86593,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUANT,,Fee Schedule,44.18
Aetna,PPO,86602,CPT4/HCPCS,ANTINOMYCES ANTIBODY,,Fee Schedule,102.22
Aetna,PPO,86603,CPT4/HCPCS,ADENOVIRUS ANTIBODY,,Fee Schedule,129.27
Aetna,PPO,86606,CPT4/HCPCS,ASPERGILLUS ANTIBODY,,Fee Schedule,151.28
Aetna,PPO,86609,CPT4/HCPCS,BACTERIUM ANTIBODY,,Fee Schedule,129.44
Aetna,PPO,86611,CPT4/HCPCS,BARTONELLA ANTIBODY,,Fee Schedule,102.22
Aetna,PPO,86612,CPT4/HCPCS,BLASTOMYCES ANTIBODY,,Fee Schedule,129.69
Aetna,PPO,86615,CPT4/HCPCS,BORDETELLA ANTIBODY,,Fee Schedule,132.55
Aetna,PPO,86617,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Fee Schedule,155.65
Aetna,PPO,86618,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Fee Schedule,171.10
Aetna,PPO,86619,CPT4/HCPCS,BORRELIA ANTIBODY,,Fee Schedule,134.48
Aetna,PPO,86622,CPT4/HCPCS,BRUCELLA ANTIBODY,,Fee Schedule,89.71
Aetna,PPO,86625,CPT4/HCPCS,CAMPYLOBACTER ANTIBODY,,Fee Schedule,131.79
Aetna,PPO,86628,CPT4/HCPCS,CANDIDA ANTIBODY,,Fee Schedule,120.70
Aetna,PPO,86631,CPT4/HCPCS,CHLAMYDIA ANTIBODY,,Fee Schedule,118.77
Aetna,PPO,86632,CPT4/HCPCS,CHLAMYDIA IGM ANTIBODY,,Fee Schedule,127.51
Aetna,PPO,86635,CPT4/HCPCS,COCCIDIOIDES ANTIBODY,,Fee Schedule,115.33
Aetna,PPO,86638,CPT4/HCPCS,Q FEVER ANTIBODY,,Fee Schedule,121.80
Aetna,PPO,86641,CPT4/HCPCS,CRYPTOCOCCUS ANTIBODY,,Fee Schedule,144.81
Aetna,PPO,86644,CPT4/HCPCS,CMV ANTIBODY,,Fee Schedule,144.56
Aetna,PPO,86645,CPT4/HCPCS,CMV ANTIBODY IGM,,Fee Schedule,169.26
Aetna,PPO,86648,CPT4/HCPCS,DIPHTHERIA ANTIBODY,,Fee Schedule,152.88
Aetna,PPO,86651,CPT4/HCPCS,ENCEPHALITIS CALIFORN ANTBDY,,Fee Schedule,132.55
Aetna,PPO,86652,CPT4/HCPCS,ENCEPHALTIS EAST EQNE ANBDY,,Fee Schedule,132.55
Aetna,PPO,86653,CPT4/HCPCS,ENCEPHALTIS ST LOUIS ANTBODY,,Fee Schedule,132.55
Aetna,PPO,86654,CPT4/HCPCS,ENCEPHALTIS WEST EQNE ANTBDY,,Fee Schedule,132.55
Aetna,PPO,86658,CPT4/HCPCS,ENTEROVIRUS ANTIBODY,,Fee Schedule,130.95
Aetna,PPO,86663,CPT4/HCPCS,EPSTEIN-BARR ANTIBODY,,Fee Schedule,131.79
Aetna,PPO,86664,CPT4/HCPCS,EPSTEIN-BARR NUCLEAR ANTIGEN,,Fee Schedule,153.72
Aetna,PPO,86665,CPT4/HCPCS,EPSTEIN-BARR CAPSID VCA,,Fee Schedule,182.28
Aetna,PPO,86666,CPT4/HCPCS,EHRLICHIA ANTIBODY,,Fee Schedule,102.22
Aetna,PPO,86668,CPT4/HCPCS,FRANCISELLA TULARENSIS,,Fee Schedule,104.49
Aetna,PPO,86671,CPT4/HCPCS,FUNGUS NES ANTIBODY,,Fee Schedule,123.14
Aetna,PPO,86674,CPT4/HCPCS,GIARDIA LAMBLIA ANTIBODY,,Fee Schedule,147.92
Aetna,PPO,86677,CPT4/HCPCS,HELICOBACTER PYLORI ANTIBODY,,Fee Schedule,145.82
Aetna,PPO,86682,CPT4/HCPCS,HELMINTH ANTIBODY,,Fee Schedule,130.70
Aetna,PPO,86684,CPT4/HCPCS,HEMOPHILUS INFLUENZA ANTIBDY,,Fee Schedule,159.26
Aetna,PPO,86687,CPT4/HCPCS,HTLV-I ANTIBODY,,Fee Schedule,84.33
Aetna,PPO,86688,CPT4/HCPCS,HTLV-II ANTIBODY,,Fee Schedule,140.70
Aetna,PPO,86689,CPT4/HCPCS,HTLV/HIV CONFIRMJ ANTIBODY,,Fee Schedule,194.46
Aetna,PPO,86692,CPT4/HCPCS,HEPATITIS DELTA AGENT ANTBDY,,Fee Schedule,172.45
Aetna,PPO,86694,CPT4/HCPCS,HERPES SIMPLEX NES ANTBDY,,Fee Schedule,144.56
Aetna,PPO,86695,CPT4/HCPCS,HERPES SIMPLEX TYPE 1 TEST,,Fee Schedule,132.55
Aetna,PPO,86696,CPT4/HCPCS,HERPES SIMPLEX TYPE 2 TEST,,Fee Schedule,194.46
Aetna,PPO,86698,CPT4/HCPCS,HISTOPLASMA ANTIBODY,,Fee Schedule,125.58
Aetna,PPO,86701,CPT4/HCPCS,HIV-1ANTIBODY,,Fee Schedule,89.29
Aetna,PPO,86702,CPT4/HCPCS,HIV-2 ANTIBODY,,Fee Schedule,135.91
Aetna,PPO,86703,CPT4/HCPCS,HIV-1/HIV-2 1 RESULT ANTBDY,,Fee Schedule,137.84
Aetna,PPO,86704,CPT4/HCPCS,HEP B CORE ANTIBODY TOTAL,,Fee Schedule,121.12
Aetna,PPO,86705,CPT4/HCPCS,HEP B CORE ANTIBODY IGM,,Fee Schedule,118.27
Aetna,PPO,86706,CPT4/HCPCS,HEP B SURFACE ANTIBODY,,Fee Schedule,107.94
Aetna,PPO,86707,CPT4/HCPCS,HEPATITIS BE ANTIBODY,,Fee Schedule,116.25
Aetna,PPO,86708,CPT4/HCPCS,HEPATITIS A ANTIBODY,,Fee Schedule,124.48
Aetna,PPO,86709,CPT4/HCPCS,HEPATITIS A IGM ANTIBODY,,Fee Schedule,113.06
Aetna,PPO,86710,CPT4/HCPCS,INFLUENZA VIRUS ANTIBODY,,Fee Schedule,136.24
Aetna,PPO,86711,CPT4/HCPCS,JOHN CUNNINGHAM ANTIBODY,,Fee Schedule,141.28
Aetna,PPO,86713,CPT4/HCPCS,LEGIONELLA ANTIBODY,,Fee Schedule,153.72
Aetna,PPO,86717,CPT4/HCPCS,LEISHMANIA ANTIBODY,,Fee Schedule,123.06
Aetna,PPO,86720,CPT4/HCPCS,LEPTOSPIRA ANTIBODY,,Fee Schedule,132.55
Aetna,PPO,86723,CPT4/HCPCS,LISTERIA MONOCYTOGENES,,Fee Schedule,132.55
Aetna,PPO,86727,CPT4/HCPCS,LYMPH CHORIOMENINGITIS AB,,Fee Schedule,129.27
Aetna,PPO,86732,CPT4/HCPCS,MUCORMYCOSIS ANTIBODY,,Fee Schedule,132.55
Aetna,PPO,86735,CPT4/HCPCS,MUMPS ANTIBODY,,Fee Schedule,131.12
Aetna,PPO,86738,CPT4/HCPCS,MYCOPLASMA ANTIBODY,,Fee Schedule,133.05
Aetna,PPO,86741,CPT4/HCPCS,NEISSERIA MENINGITIDIS,,Fee Schedule,132.55
Aetna,PPO,86744,CPT4/HCPCS,NOCARDIA ANTIBODY,,Fee Schedule,132.55
Aetna,PPO,86747,CPT4/HCPCS,PARVOVIRUS ANTIBODY,,Fee Schedule,151.11
Aetna,PPO,86750,CPT4/HCPCS,MALARIA ANTIBODY,,Fee Schedule,132.55
Aetna,PPO,86753,CPT4/HCPCS,PROTOZOA ANTIBODY NOS,,Fee Schedule,124.48
Aetna,PPO,86756,CPT4/HCPCS,RESPIRATORY VIRUS ANTIBODY,,Fee Schedule,129.52
Aetna,PPO,86757,CPT4/HCPCS,RICKETTSIA ANTIBODY,,Fee Schedule,194.46
Aetna,PPO,86759,CPT4/HCPCS,ROTAVIRUS ANTIBODY,,Fee Schedule,132.55
Aetna,PPO,86762,CPT4/HCPCS,RUBELLA ANTIBODY,,Fee Schedule,144.56
Aetna,PPO,86765,CPT4/HCPCS,RUBEOLA ANTIBODY,,Fee Schedule,129.44
Aetna,PPO,86768,CPT4/HCPCS,SALMONELLA ANTIBODY,,Fee Schedule,132.55
Aetna,PPO,86771,CPT4/HCPCS,SHIGELLA ANTIBODY,,Fee Schedule,132.55
Aetna,PPO,86774,CPT4/HCPCS,TETANUS ANTIBODY,,Fee Schedule,148.68
Aetna,PPO,86777,CPT4/HCPCS,TOXOPLASMA ANTIBODY,,Fee Schedule,144.56
Aetna,PPO,86778,CPT4/HCPCS,TOXOPLASMA ANTIBODY IGM,,Fee Schedule,144.73
Aetna,PPO,86780,CPT4/HCPCS,TREPONEMA PALLIDUM,,Fee Schedule,133.05
Aetna,PPO,86784,CPT4/HCPCS,TRICHINELLA ANTIBODY,,Fee Schedule,126.25
Aetna,PPO,86787,CPT4/HCPCS,VARICELLA-ZOSTER ANTIBODY,,Fee Schedule,129.44
Aetna,PPO,86788,CPT4/HCPCS,WEST NILE VIRUS AB IGM,,Fee Schedule,169.26
Aetna,PPO,86789,CPT4/HCPCS,WEST NILE VIRUS ANTIBODY,,Fee Schedule,144.56
Aetna,PPO,86790,CPT4/HCPCS,VIRUS ANTIBODY NOS,,Fee Schedule,129.44
Aetna,PPO,86793,CPT4/HCPCS,YERSINIA ANTIBODY,,Fee Schedule,132.55
Aetna,PPO,86794,CPT4/HCPCS,ZIKA VIRUS IGM ANTIBODY,,Fee Schedule,148.51
Aetna,PPO,86800,CPT4/HCPCS,THYROGLOBULIN ANTIBODY,,Fee Schedule,159.76
Aetna,PPO,86803,CPT4/HCPCS,HEPATITIS C AB TEST,,Fee Schedule,143.38
Aetna,PPO,86804,CPT4/HCPCS,HEP C AB TEST CONFIRM,,Fee Schedule,155.65
Aetna,PPO,86805,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,Fee Schedule,434.95
Aetna,PPO,86806,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,Fee Schedule,217.47
Aetna,PPO,86807,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,Fee Schedule,397.65
Aetna,PPO,86808,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,Fee Schedule,217.47
Aetna,PPO,86812,CPT4/HCPCS,HLA TYPING A B OR C,,Fee Schedule,259.30
Aetna,PPO,86813,CPT4/HCPCS,HLA TYPING A B OR C,,Fee Schedule,411.34
Aetna,PPO,86816,CPT4/HCPCS,HLA TYPING DR/DQ,,Fee Schedule,279.97
Aetna,PPO,86817,CPT4/HCPCS,HLA TYPING DR/DQ,,Fee Schedule,646.96
Aetna,PPO,86821,CPT4/HCPCS,LYMPHOCYTE CULTURE MIXED,,Fee Schedule,567.25
Aetna,PPO,86825,CPT4/HCPCS,HLA X-MATH NON-CYTOTOXIC,,Fee Schedule,807.07
Aetna,PPO,86826,CPT4/HCPCS,HLA X-MATCH NONCYTOTOXC ADDL,,Fee Schedule,268.96
Aetna,PPO,86828,CPT4/HCPCS,HLA CLASS I&II ANTIBODY QUAL,,Fee Schedule,388.41
Aetna,PPO,86829,CPT4/HCPCS,HLA CLASS I/II ANTIBODY QUAL,,Fee Schedule,291.31
Aetna,PPO,86830,CPT4/HCPCS,HLA CLASS I PHENOTYPE QUAL,,Fee Schedule,637.72
Aetna,PPO,86831,CPT4/HCPCS,HLA CLASS II PHENOTYPE QUAL,,Fee Schedule,546.67
Aetna,PPO,86832,CPT4/HCPCS,HLA CLASS I HIGH DEFIN QUAL,,Fee Schedule,1002.20
Aetna,PPO,86833,CPT4/HCPCS,HLA CLASS II HIGH DEFIN QUAL,,Fee Schedule,911.06
Aetna,PPO,86834,CPT4/HCPCS,HLA CLASS I SEMIQUANT PANEL,,Fee Schedule,2824.33
Aetna,PPO,86835,CPT4/HCPCS,HLA CLASS II SEMIQUANT PANEL,,Fee Schedule,2550.99
Aetna,PPO,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,Fee Schedule,142.04
Aetna,PPO,86860,CPT4/HCPCS,RBC ANTIBODY ELUTION,,Fee Schedule,183.45
Aetna,PPO,86870,CPT4/HCPCS,RBC ANTIBODY IDENTIFICATION,,Fee Schedule,251.58
Aetna,PPO,86880,CPT4/HCPCS,COOMBS TEST DIRECT,,Fee Schedule,54.01
Aetna,PPO,86885,CPT4/HCPCS,COOMBS TEST INDIRECT QUAL,,Fee Schedule,57.54
Aetna,PPO,86886,CPT4/HCPCS,COOMBS TEST INDIRECT TITER,,Fee Schedule,51.99
Aetna,PPO,86890,CPT4/HCPCS,AUTOLOGOUS BLOOD PROCESS,,Fee Schedule,580.10
Aetna,PPO,86891,CPT4/HCPCS,AUTOLOGOUS BLOOD OP SALVAGE,,Fee Schedule,816.81
Aetna,PPO,86900,CPT4/HCPCS,BLOOD TYPING SEROLOGIC ABO,,Fee Schedule,29.98
Aetna,PPO,86901,CPT4/HCPCS,BLOOD TYPING SEROLOGIC RH(D),,Fee Schedule,29.98
Aetna,PPO,86902,CPT4/HCPCS,BLOOD TYPE ANTIGEN DONOR EA,,Fee Schedule,38.38
Aetna,PPO,86904,CPT4/HCPCS,BLOOD TYPING PATIENT SERUM,,Fee Schedule,95.50
Aetna,PPO,86905,CPT4/HCPCS,BLOOD TYPING RBC ANTIGENS,,Fee Schedule,38.38
Aetna,PPO,86906,CPT4/HCPCS,BLD TYPING SEROLOGIC RH PHNT,,Fee Schedule,77.86
Aetna,PPO,86910,CPT4/HCPCS,BLOOD TYPING PATERNITY TEST,,Fee Schedule,150.94
Aetna,PPO,86911,CPT4/HCPCS,BLOOD TYPING ANTIGEN SYSTEM,,Fee Schedule,130.20
Aetna,PPO,86920,CPT4/HCPCS,COMPATIBILITY TEST SPIN,,Fee Schedule,204.20
Aetna,PPO,86921,CPT4/HCPCS,COMPATIBILITY TEST INCUBATE,,Fee Schedule,183.45
Aetna,PPO,86922,CPT4/HCPCS,COMPATIBILITY TEST ANTIGLOB,,Fee Schedule,218.98
Aetna,PPO,86923,CPT4/HCPCS,COMPATIBILITY TEST ELECTRIC,,Fee Schedule,162.79
Aetna,PPO,86927,CPT4/HCPCS,PLASMA FRESH FROZEN,,Fee Schedule,115.41
Aetna,PPO,86930,CPT4/HCPCS,FROZEN BLOOD PREP,,Fee Schedule,680.73
Aetna,PPO,86931,CPT4/HCPCS,FROZEN BLOOD THAW,,Fee Schedule,511.98
Aetna,PPO,86932,CPT4/HCPCS,FROZEN BLOOD FREEZE/THAW,,Fee Schedule,580.10
Aetna,PPO,86940,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS AUTO,,Fee Schedule,82.40
Aetna,PPO,86941,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS,,Fee Schedule,121.63
Aetna,PPO,86945,CPT4/HCPCS,BLOOD PRODUCT/IRRADIATION,,Fee Schedule,171.69
Aetna,PPO,86950,CPT4/HCPCS,LEUKACYTE TRANSFUSION,,Fee Schedule,443.94
Aetna,PPO,86960,CPT4/HCPCS,VOL REDUCTION OF BLOOD/PROD,,Fee Schedule,189.42
Aetna,PPO,86965,CPT4/HCPCS,POOLING BLOOD PLATELETS,,Fee Schedule,189.42
Aetna,PPO,86970,CPT4/HCPCS,RBC PRETX INCUBATJ W/CHEMICL,,Fee Schedule,171.69
Aetna,PPO,86971,CPT4/HCPCS,RBC PRETX INCUBATJ W/ENZYMES,,Fee Schedule,136.16
Aetna,PPO,86972,CPT4/HCPCS,RBC PRETX INCUBATJ W/DENSITY,,Fee Schedule,239.73
Aetna,PPO,86975,CPT4/HCPCS,RBC SERUM PRETX INCUBJ DRUGS,,Fee Schedule,183.45
Aetna,PPO,86976,CPT4/HCPCS,RBC SERUM PRETX ID DILUTION,,Fee Schedule,204.20
Aetna,PPO,86977,CPT4/HCPCS,RBC SERUM PRETX INCUBJ/INHIB,,Fee Schedule,204.20
Aetna,PPO,86978,CPT4/HCPCS,RBC PRETREATMENT SERUM,,Fee Schedule,204.20
Aetna,PPO,86985,CPT4/HCPCS,SPLIT BLOOD OR PRODUCTS,,Fee Schedule,150.94
Aetna,PPO,87003,CPT4/HCPCS,SMALL ANIMAL INOCULATION,,Fee Schedule,169.17
Aetna,PPO,87015,CPT4/HCPCS,SPECIMEN INFECT AGNT CONCNTJ,,Fee Schedule,67.11
Aetna,PPO,87040,CPT4/HCPCS,BLOOD CULTURE FOR BACTERIA,,Fee Schedule,103.74
Aetna,PPO,87045,CPT4/HCPCS,FECES CULTURE AEROBIC BACT,,Fee Schedule,94.83
Aetna,PPO,87046,CPT4/HCPCS,STOOL CULTR AEROBIC BACT EA,,Fee Schedule,94.83
Aetna,PPO,87070,CPT4/HCPCS,CULTURE OTHR SPECIMN AEROBIC,,Fee Schedule,86.52
Aetna,PPO,87071,CPT4/HCPCS,CULTURE AEROBIC QUANT OTHER,,Fee Schedule,94.83
Aetna,PPO,87073,CPT4/HCPCS,CULTURE BACTERIA ANAEROBIC,,Fee Schedule,94.83
Aetna,PPO,87075,CPT4/HCPCS,CULTR BACTERIA EXCEPT BLOOD,,Fee Schedule,95.00
Aetna,PPO,87076,CPT4/HCPCS,CULTURE ANAEROBE IDENT EACH,,Fee Schedule,81.14
Aetna,PPO,87077,CPT4/HCPCS,CULTURE AEROBIC IDENTIFY,,Fee Schedule,81.14
Aetna,PPO,87081,CPT4/HCPCS,CULTURE SCREEN ONLY,,Fee Schedule,66.61
Aetna,PPO,87084,CPT4/HCPCS,CULTURE OF SPECIMEN BY KIT,,Fee Schedule,86.52
Aetna,PPO,87086,CPT4/HCPCS,URINE CULTURE/COLONY COUNT,,Fee Schedule,81.14
Aetna,PPO,87088,CPT4/HCPCS,URINE BACTERIA CULTURE,,Fee Schedule,65.85
Aetna,PPO,87101,CPT4/HCPCS,SKIN FUNGI CULTURE,,Fee Schedule,77.53
Aetna,PPO,87102,CPT4/HCPCS,FUNGUS ISOLATION CULTURE,,Fee Schedule,84.50
Aetna,PPO,87103,CPT4/HCPCS,BLOOD FUNGUS CULTURE,,Fee Schedule,90.63
Aetna,PPO,87106,CPT4/HCPCS,FUNGI IDENTIFICATION YEAST,,Fee Schedule,103.74
Aetna,PPO,87107,CPT4/HCPCS,FUNGI IDENTIFICATION MOLD,,Fee Schedule,103.74
Aetna,PPO,87109,CPT4/HCPCS,MYCOPLASMA,,Fee Schedule,154.56
Aetna,PPO,87110,CPT4/HCPCS,CHLAMYDIA CULTURE,,Fee Schedule,196.81
Aetna,PPO,87116,CPT4/HCPCS,MYCOBACTERIA CULTURE,,Fee Schedule,98.78
Aetna,PPO,87118,CPT4/HCPCS,MYCOBACTERIC IDENTIFICATION,,Fee Schedule,109.95
Aetna,PPO,87140,CPT4/HCPCS,CULTURE TYPE IMMUNOFLUORESC,,Fee Schedule,55.94
Aetna,PPO,87143,CPT4/HCPCS,CULTURE TYPING GLC/HPLC,,Fee Schedule,125.91
Aetna,PPO,87147,CPT4/HCPCS,CULTURE TYPE IMMUNOLOGIC,,Fee Schedule,49.30
Aetna,PPO,87149,CPT4/HCPCS,DNA/RNA DIRECT PROBE,,Fee Schedule,201.51
Aetna,PPO,87150,CPT4/HCPCS,DNA/RNA AMPLIFIED PROBE,,Fee Schedule,352.63
Aetna,PPO,87152,CPT4/HCPCS,CULTURE TYPE PULSE FIELD GEL,,Fee Schedule,52.58
Aetna,PPO,87153,CPT4/HCPCS,DNA/RNA SEQUENCING,,Fee Schedule,1159.03
Aetna,PPO,87158,CPT4/HCPCS,CULTURE TYPING ADDED METHOD,,Fee Schedule,52.58
Aetna,PPO,87164,CPT4/HCPCS,DARK FIELD EXAMINATION,,Fee Schedule,107.94
Aetna,PPO,87166,CPT4/HCPCS,DARK FIELD EXAMINATION,,Fee Schedule,113.56
Aetna,PPO,87168,CPT4/HCPCS,MACROSCOPIC EXAM ARTHROPOD,,Fee Schedule,42.92
Aetna,PPO,87169,CPT4/HCPCS,MACROSCOPIC EXAM PARASITE,,Fee Schedule,42.92
Aetna,PPO,87172,CPT4/HCPCS,PINWORM EXAM,,Fee Schedule,42.92
Aetna,PPO,87176,CPT4/HCPCS,TISSUE HOMOGENIZATION CULTR,,Fee Schedule,59.13
Aetna,PPO,87177,CPT4/HCPCS,OVA AND PARASITES SMEARS,,Fee Schedule,89.37
Aetna,PPO,87181,CPT4/HCPCS,MICROBE SUSCEPTIBLE DIFFUSE,,Fee Schedule,16.38
Aetna,PPO,87184,CPT4/HCPCS,MICROBE SUSCEPTIBLE DISK,,Fee Schedule,69.30
Aetna,PPO,87185,CPT4/HCPCS,MICROBE SUSCEPTIBLE ENZYME,,Fee Schedule,16.38
Aetna,PPO,87186,CPT4/HCPCS,MICROBE SUSCEPTIBLE MIC,,Fee Schedule,86.85
Aetna,PPO,87187,CPT4/HCPCS,MICROBE SUSCEPTIBLE MLC,,Fee Schedule,104.16
Aetna,PPO,87188,CPT4/HCPCS,MICROBE SUSCEPT MACROBROTH,,Fee Schedule,66.69
Aetna,PPO,87190,CPT4/HCPCS,MICROBE SUSCEPT MYCOBACTERI,,Fee Schedule,49.30
Aetna,PPO,87197,CPT4/HCPCS,BACTERICIDAL LEVEL SERUM,,Fee Schedule,150.94
Aetna,PPO,87205,CPT4/HCPCS,SMEAR GRAM STAIN,,Fee Schedule,42.92
Aetna,PPO,87206,CPT4/HCPCS,SMEAR FLUORESCENT/ACID STAI,,Fee Schedule,54.01
Aetna,PPO,87207,CPT4/HCPCS,SMEAR SPECIAL STAIN,,Fee Schedule,60.22
Aetna,PPO,87209,CPT4/HCPCS,SMEAR COMPLEX STAIN,,Fee Schedule,180.60
Aetna,PPO,87210,CPT4/HCPCS,SMEAR WET MOUNT SALINE/INK,,Fee Schedule,42.92
Aetna,PPO,87220,CPT4/HCPCS,TISSUE EXAM FOR FUNGI,,Fee Schedule,42.92
Aetna,PPO,87230,CPT4/HCPCS,ASSAY TOXIN OR ANTITOXIN,,Fee Schedule,198.40
Aetna,PPO,87250,CPT4/HCPCS,VIRUS INOCULATE EGGS/ANIMAL,,Fee Schedule,196.47
Aetna,PPO,87252,CPT4/HCPCS,VIRUS INOCULATION TISSUE,,Fee Schedule,261.91
Aetna,PPO,87253,CPT4/HCPCS,VIRUS INOCULATE TISSUE ADDL,,Fee Schedule,202.94
Aetna,PPO,87254,CPT4/HCPCS,VIRUS INOCULATION SHELL VIA,,Fee Schedule,196.47
Aetna,PPO,87255,CPT4/HCPCS,GENET VIRUS ISOLATE HSV,,Fee Schedule,340.28
Aetna,PPO,87260,CPT4/HCPCS,ADENOVIRUS AG IF,,Fee Schedule,93.32
Aetna,PPO,87265,CPT4/HCPCS,PERTUSSIS AG IF,,Fee Schedule,93.32
Aetna,PPO,87267,CPT4/HCPCS,ENTEROVIRUS ANTIBODY DFA,,Fee Schedule,93.32
Aetna,PPO,87269,CPT4/HCPCS,GIARDIA AG IF,,Fee Schedule,93.32
Aetna,PPO,87270,CPT4/HCPCS,CHLAMYDIA TRACHOMATIS AG IF,,Fee Schedule,93.32
Aetna,PPO,87271,CPT4/HCPCS,CYTOMEGALOVIRUS DFA,,Fee Schedule,93.32
Aetna,PPO,87272,CPT4/HCPCS,CRYPTOSPORIDIUM AG IF,,Fee Schedule,93.32
Aetna,PPO,87273,CPT4/HCPCS,HERPES SIMPLEX 2 AG IF,,Fee Schedule,93.32
Aetna,PPO,87274,CPT4/HCPCS,HERPES SIMPLEX 1 AG IF,,Fee Schedule,93.32
Aetna,PPO,87275,CPT4/HCPCS,INFLUENZA B AG IF,,Fee Schedule,93.32
Aetna,PPO,87276,CPT4/HCPCS,INFLUENZA A AG IF,,Fee Schedule,93.32
Aetna,PPO,87278,CPT4/HCPCS,LEGION PNEUMOPHILIA AG IF,,Fee Schedule,93.32
Aetna,PPO,87279,CPT4/HCPCS,PARAINFLUENZA AG IF,,Fee Schedule,93.32
Aetna,PPO,87280,CPT4/HCPCS,RESPIRATORY SYNCYTIAL AG IF,,Fee Schedule,93.32
Aetna,PPO,87281,CPT4/HCPCS,PNEUMOCYSTIS CARINII AG IF,,Fee Schedule,93.32
Aetna,PPO,87283,CPT4/HCPCS,RUBEOLA AG IF,,Fee Schedule,93.32
Aetna,PPO,87285,CPT4/HCPCS,TREPONEMA PALLIDUM AG IF,,Fee Schedule,93.32
Aetna,PPO,87290,CPT4/HCPCS,VARICELLA ZOSTER AG IF,,Fee Schedule,93.32
Aetna,PPO,87299,CPT4/HCPCS,ANTIBODY DETECTION NOS IF,,Fee Schedule,93.32
Aetna,PPO,87300,CPT4/HCPCS,AG DETECTION POLYVAL IF,,Fee Schedule,93.32
Aetna,PPO,87301,CPT4/HCPCS,ADENOVIRUS AG IA,,Fee Schedule,93.32
Aetna,PPO,87305,CPT4/HCPCS,ASPERGILLUS AG IA,,Fee Schedule,93.32
Aetna,PPO,87320,CPT4/HCPCS,CHYLMD TRACH AG IA,,Fee Schedule,93.32
Aetna,PPO,87324,CPT4/HCPCS,CLOSTRIDIUM AG IA,,Fee Schedule,93.32
Aetna,PPO,87327,CPT4/HCPCS,CRYPTOCOCCUS NEOFORM AG IA,,Fee Schedule,93.32
Aetna,PPO,87328,CPT4/HCPCS,CRYPTOSPORIDIUM AG IA,,Fee Schedule,93.32
Aetna,PPO,87329,CPT4/HCPCS,GIARDIA AG IA,,Fee Schedule,93.32
Aetna,PPO,87332,CPT4/HCPCS,CYTOMEGALOVIRUS AG IA,,Fee Schedule,93.32
Aetna,PPO,87335,CPT4/HCPCS,E COLI 0157 AG IA,,Fee Schedule,93.32
Aetna,PPO,87336,CPT4/HCPCS,ENTAMOEB HIST DISPR AG IA,,Fee Schedule,93.32
Aetna,PPO,87337,CPT4/HCPCS,ENTAMOEB HIST GROUP AG IA,,Fee Schedule,93.32
Aetna,PPO,87338,CPT4/HCPCS,HPYLORI STOOL IA,,Fee Schedule,144.48
Aetna,PPO,87339,CPT4/HCPCS,H PYLORI AG IA,,Fee Schedule,93.32
Aetna,PPO,87340,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,Fee Schedule,103.74
Aetna,PPO,87341,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,Fee Schedule,103.74
Aetna,PPO,87350,CPT4/HCPCS,HEPATITIS BE AG IA,,Fee Schedule,115.83
Aetna,PPO,87380,CPT4/HCPCS,HEPATITIS DELTA AG IA,,Fee Schedule,164.97
Aetna,PPO,87385,CPT4/HCPCS,HISTOPLASMA CAPSUL AG IA,,Fee Schedule,93.32
Aetna,PPO,87389,CPT4/HCPCS,HIV-1 AG W/HIV-1 & HIV-2 AB,,Fee Schedule,243.60
Aetna,PPO,87390,CPT4/HCPCS,HIV-1 AG IA,,Fee Schedule,177.32
Aetna,PPO,87391,CPT4/HCPCS,HIV-2 AG IA,,Fee Schedule,177.32
Aetna,PPO,87400,CPT4/HCPCS,INFLUENZA A/B AG IA,,Fee Schedule,93.32
Aetna,PPO,87420,CPT4/HCPCS,RESP SYNCYTIAL AG IA,,Fee Schedule,93.32
Aetna,PPO,87425,CPT4/HCPCS,ROTAVIRUS AG IA,,Fee Schedule,93.32
Aetna,PPO,87427,CPT4/HCPCS,SHIGA-LIKE TOXIN AG IA,,Fee Schedule,93.32
Aetna,PPO,87430,CPT4/HCPCS,STREP A AG IA,,Fee Schedule,93.32
Aetna,PPO,87449,CPT4/HCPCS,AG DETECT NOS IA MULT,,Fee Schedule,93.32
Aetna,PPO,87450,CPT4/HCPCS,AG DETECT NOS IA SINGLE,,Fee Schedule,34.27
Aetna,PPO,87451,CPT4/HCPCS,AG DETECT POLYVAL IA MULT,,Fee Schedule,34.27
Aetna,PPO,87471,CPT4/HCPCS,BARTONELLA DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87472,CPT4/HCPCS,BARTONELLA DNA QUANT,,Fee Schedule,430.41
Aetna,PPO,87475,CPT4/HCPCS,LYME DIS DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87476,CPT4/HCPCS,LYME DIS DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87480,CPT4/HCPCS,CANDIDA DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87481,CPT4/HCPCS,CANDIDA DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87482,CPT4/HCPCS,CANDIDA DNA QUANT,,Fee Schedule,419.49
Aetna,PPO,87483,CPT4/HCPCS,CNS DNA AMP PROBE TYPE 12-25,,Fee Schedule,4082.06
Aetna,PPO,87485,CPT4/HCPCS,CHYLMD PNEUM DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87486,CPT4/HCPCS,CHYLMD PNEUM DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87487,CPT4/HCPCS,CHYLMD PNEUM DNA QUANT,,Fee Schedule,430.41
Aetna,PPO,87490,CPT4/HCPCS,CHYLMD TRACH DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87491,CPT4/HCPCS,CHYLMD TRACH DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87492,CPT4/HCPCS,CHYLMD TRACH DNA QUANT,,Fee Schedule,351.28
Aetna,PPO,87493,CPT4/HCPCS,C DIFF AMPLIFIED PROBE,,Fee Schedule,352.63
Aetna,PPO,87495,CPT4/HCPCS,CYTOMEG DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87496,CPT4/HCPCS,CYTOMEG DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87497,CPT4/HCPCS,CYTOMEG DNA QUANT,,Fee Schedule,430.41
Aetna,PPO,87498,CPT4/HCPCS,ENTEROVIRUS PROBE&REVRS TRNS,,Fee Schedule,352.63
Aetna,PPO,87500,CPT4/HCPCS,VANOMYCIN DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87501,CPT4/HCPCS,INFLUENZA DNA AMP PROB 1+,,Fee Schedule,515.67
Aetna,PPO,87502,CPT4/HCPCS,INFLUENZA DNA AMP PROBE,,Fee Schedule,855.03
Aetna,PPO,87503,CPT4/HCPCS,INFLUENZA DNA AMP PROB ADDL,,Fee Schedule,208.65
Aetna,PPO,87505,CPT4/HCPCS,NFCT AGENT DETECTION GI,,Fee Schedule,1246.47
Aetna,PPO,87506,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 6-11,,Fee Schedule,2073.79
Aetna,PPO,87507,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 12-25,,Fee Schedule,4049.64
Aetna,PPO,87510,CPT4/HCPCS,GARDNER VAG DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87511,CPT4/HCPCS,GARDNER VAG DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87512,CPT4/HCPCS,GARDNER VAG DNA QUANT,,Fee Schedule,419.49
Aetna,PPO,87516,CPT4/HCPCS,HEPATITIS B DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87517,CPT4/HCPCS,HEPATITIS B DNA QUANT,,Fee Schedule,430.41
Aetna,PPO,87520,CPT4/HCPCS,HEPATITIS C RNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87521,CPT4/HCPCS,HEPATITIS C PROBE&RVRS TRNSC,,Fee Schedule,352.63
Aetna,PPO,87522,CPT4/HCPCS,HEPATITIS C REVRS TRNSCRPJ,,Fee Schedule,430.41
Aetna,PPO,87525,CPT4/HCPCS,HEPATITIS G DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87526,CPT4/HCPCS,HEPATITIS G DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87527,CPT4/HCPCS,HEPATITIS G DNA QUANT,,Fee Schedule,419.49
Aetna,PPO,87528,CPT4/HCPCS,HSV DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87529,CPT4/HCPCS,HSV DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87530,CPT4/HCPCS,HSV DNA QUANT,,Fee Schedule,430.41
Aetna,PPO,87531,CPT4/HCPCS,HHV-6 DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87532,CPT4/HCPCS,HHV-6 DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87533,CPT4/HCPCS,HHV-6 DNA QUANT,,Fee Schedule,419.49
Aetna,PPO,87534,CPT4/HCPCS,HIV-1 DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87535,CPT4/HCPCS,HIV-1 PROBE&REVERSE TRNSCRPJ,,Fee Schedule,352.63
Aetna,PPO,87536,CPT4/HCPCS,HIV-1 QUANT&REVRSE TRNSCRPJ,,Fee Schedule,855.03
Aetna,PPO,87537,CPT4/HCPCS,HIV-2 DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87538,CPT4/HCPCS,HIV-2 PROBE&REVRSE TRNSCRIPJ,,Fee Schedule,352.63
Aetna,PPO,87539,CPT4/HCPCS,HIV-2 QUANT&REVRSE TRNSCRIPJ,,Fee Schedule,430.41
Aetna,PPO,87540,CPT4/HCPCS,LEGION PNEUMO DNA DIR PROB,,Fee Schedule,201.51
Aetna,PPO,87541,CPT4/HCPCS,LEGION PNEUMO DNA AMP PROB,,Fee Schedule,352.63
Aetna,PPO,87542,CPT4/HCPCS,LEGION PNEUMO DNA QUANT,,Fee Schedule,419.49
Aetna,PPO,87550,CPT4/HCPCS,MYCOBACTERIA DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87551,CPT4/HCPCS,MYCOBACTERIA DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87552,CPT4/HCPCS,MYCOBACTERIA DNA QUANT,,Fee Schedule,430.41
Aetna,PPO,87555,CPT4/HCPCS,M.TUBERCULO DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87556,CPT4/HCPCS,M.TUBERCULO DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87557,CPT4/HCPCS,M.TUBERCULO DNA QUANT,,Fee Schedule,430.41
Aetna,PPO,87560,CPT4/HCPCS,M.AVIUM-INTRA DNA DIR PROB,,Fee Schedule,201.51
Aetna,PPO,87561,CPT4/HCPCS,M.AVIUM-INTRA DNA AMP PROB,,Fee Schedule,352.63
Aetna,PPO,87562,CPT4/HCPCS,M.AVIUM-INTRA DNA QUANT,,Fee Schedule,430.41
Aetna,PPO,87580,CPT4/HCPCS,M.PNEUMON DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87581,CPT4/HCPCS,M.PNEUMON DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87582,CPT4/HCPCS,M.PNEUMON DNA QUANT,,Fee Schedule,419.49
Aetna,PPO,87590,CPT4/HCPCS,N.GONORRHOEAE DNA DIR PROB,,Fee Schedule,201.51
Aetna,PPO,87591,CPT4/HCPCS,N.GONORRHOEAE DNA AMP PROB,,Fee Schedule,352.63
Aetna,PPO,87592,CPT4/HCPCS,N.GONORRHOEAE DNA QUANT,,Fee Schedule,430.41
Aetna,PPO,87623,CPT4/HCPCS,HPV LOW-RISK TYPES,,Fee Schedule,341.04
Aetna,PPO,87624,CPT4/HCPCS,HPV HIGH-RISK TYPES,,Fee Schedule,341.04
Aetna,PPO,87625,CPT4/HCPCS,HPV TYPES 16 & 18 ONLY,,Fee Schedule,341.04
Aetna,PPO,87631,CPT4/HCPCS,RESP VIRUS 3-5 TARGETS,,Fee Schedule,1259.07
Aetna,PPO,87632,CPT4/HCPCS,RESP VIRUS 6-11 TARGETS,,Fee Schedule,2094.62
Aetna,PPO,87633,CPT4/HCPCS,RESP VIRUS 12-25 TARGETS,,Fee Schedule,4090.54
Aetna,PPO,87634,CPT4/HCPCS,RSV DNA/RNA AMP PROBE,,Fee Schedule,618.74
Aetna,PPO,87640,CPT4/HCPCS,STAPH A DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87641,CPT4/HCPCS,MR-STAPH DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87650,CPT4/HCPCS,STREP A DNA DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87651,CPT4/HCPCS,STREP A DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87652,CPT4/HCPCS,STREP A DNA QUANT,,Fee Schedule,419.49
Aetna,PPO,87653,CPT4/HCPCS,STREP B DNA AMP PROBE,,Fee Schedule,352.63
Aetna,PPO,87660,CPT4/HCPCS,TRICHOMONAS VAGIN DIR PROBE,,Fee Schedule,201.51
Aetna,PPO,87661,CPT4/HCPCS,TRICHOMONAS VAGINALIS AMPLIF,,Fee Schedule,341.79
Aetna,PPO,87662,CPT4/HCPCS,ZIKA VIRUS DNA/RNA AMP PROBE,,Fee Schedule,452.34
Aetna,PPO,87797,CPT4/HCPCS,DETECT AGENT NOS DNA DIR,,Fee Schedule,201.51
Aetna,PPO,87798,CPT4/HCPCS,DETECT AGENT NOS DNA AMP,,Fee Schedule,352.63
Aetna,PPO,87799,CPT4/HCPCS,DETECT AGENT NOS DNA QUANT,,Fee Schedule,430.41
Aetna,PPO,87800,CPT4/HCPCS,DETECT AGNT MULT DNA DIREC,,Fee Schedule,402.94
Aetna,PPO,87801,CPT4/HCPCS,DETECT AGNT MULT DNA AMPLI,,Fee Schedule,705.26
Aetna,PPO,87802,CPT4/HCPCS,STREP B ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,PPO,87803,CPT4/HCPCS,CLOSTRIDIUM TOXIN A W/OPTIC,,Fee Schedule,93.32
Aetna,PPO,87804,CPT4/HCPCS,INFLUENZA ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,PPO,87806,CPT4/HCPCS,HIV ANTIGEN W/HIV ANTIBODIES,,Fee Schedule,233.94
Aetna,PPO,87807,CPT4/HCPCS,RSV ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,PPO,87808,CPT4/HCPCS,TRICHOMONAS ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,PPO,87809,CPT4/HCPCS,ADENOVIRUS ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,PPO,87810,CPT4/HCPCS,CHYLMD TRACH ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,PPO,87850,CPT4/HCPCS,N. GONORRHOEAE ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,PPO,87880,CPT4/HCPCS,STREP A ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,PPO,87899,CPT4/HCPCS,AGENT NOS ASSAY W/OPTIC,,Fee Schedule,93.32
Aetna,PPO,87900,CPT4/HCPCS,PHENOTYPE INFECT AGENT DRUG,,Fee Schedule,1309.64
Aetna,PPO,87901,CPT4/HCPCS,GENOTYPE DNA HIV REVERSE T,,Fee Schedule,2586.69
Aetna,PPO,87902,CPT4/HCPCS,GENOTYPE DNA/RNA HEP C,,Fee Schedule,2586.69
Aetna,PPO,87903,CPT4/HCPCS,PHENOTYPE DNA HIV W/CULTURE,,Fee Schedule,4909.71
Aetna,PPO,87904,CPT4/HCPCS,PHENOTYPE DNA HIV W/CLT ADD,,Fee Schedule,261.91
Aetna,PPO,87905,CPT4/HCPCS,SIALIDASE ENZYME ASSAY,,Fee Schedule,122.80
Aetna,PPO,87906,CPT4/HCPCS,GENOTYPE DNA/RNA HIV,,Fee Schedule,1293.34
Aetna,PPO,87910,CPT4/HCPCS,GENOTYPE CYTOMEGALOVIRUS,,Fee Schedule,2526.72
Aetna,PPO,87912,CPT4/HCPCS,GENOTYPE DNA HEPATITIS B,,Fee Schedule,2526.72
Aetna,PPO,88000,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,1692.93
Aetna,PPO,88005,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,1977.02
Aetna,PPO,88007,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,2071.69
Aetna,PPO,88012,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,1692.93
Aetna,PPO,88014,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,1553.83
Aetna,PPO,88016,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Fee Schedule,2163.50
Aetna,PPO,88020,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Fee Schedule,2918.16
Aetna,PPO,88025,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Fee Schedule,2823.49
Aetna,PPO,88027,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Fee Schedule,3012.91
Aetna,PPO,88028,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Fee Schedule,1692.93
Aetna,PPO,88029,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Fee Schedule,1692.93
Aetna,PPO,88036,CPT4/HCPCS,LIMITED AUTOPSY,,Fee Schedule,846.46
Aetna,PPO,88037,CPT4/HCPCS,LIMITED AUTOPSY,,Fee Schedule,751.71
Aetna,PPO,88040,CPT4/HCPCS,FORENSIC AUTOPSY (NECROPSY),,Fee Schedule,4705.76
Aetna,PPO,88045,CPT4/HCPCS,CORONERS AUTOPSY (NECROPSY),,Fee Schedule,470.56
Aetna,PPO,88104,CPT4/HCPCS,CYTOPATH FL NONGYN SMEARS,,Fee Schedule,327.34
Aetna,PPO,88106,CPT4/HCPCS,CYTOPATH FL NONGYN FILTER,,Fee Schedule,457.54
Aetna,PPO,88108,CPT4/HCPCS,CYTOPATH CONCENTRATE TECH,,Fee Schedule,419.07
Aetna,PPO,88112,CPT4/HCPCS,CYTOPATH CELL ENHANCE TECH,,Fee Schedule,401.26
Aetna,PPO,88120,CPT4/HCPCS,CYTP URNE 3-5 PROBES EA SPEC,,Fee Schedule,3515.40
Aetna,PPO,88121,CPT4/HCPCS,CYTP URINE 3-5 PROBES CMPTR,,Fee Schedule,2949.49
Aetna,PPO,88125,CPT4/HCPCS,FORENSIC CYTOPATHOLOGY,,Fee Schedule,75.76
Aetna,PPO,88130,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,Fee Schedule,151.20
Aetna,PPO,88140,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,Fee Schedule,80.30
Aetna,PPO,88141,CPT4/HCPCS,CYTOPATH C/V INTERPRET,,Fee Schedule,229.48
Aetna,PPO,88142,CPT4/HCPCS,CYTOPATH C/V THIN LAYER,,Fee Schedule,203.53
Aetna,PPO,88143,CPT4/HCPCS,CYTOPATH C/V THIN LAYER REDO,,Fee Schedule,152.71
Aetna,PPO,88147,CPT4/HCPCS,CYTOPATH C/V AUTOMATED,,Fee Schedule,114.40
Aetna,PPO,88148,CPT4/HCPCS,CYTOPATH C/V AUTO RESCREEN,,Fee Schedule,152.71
Aetna,PPO,88150,CPT4/HCPCS,CYTOPATH C/V MANUAL,,Fee Schedule,106.17
Aetna,PPO,88152,CPT4/HCPCS,CYTOPATH C/V AUTO REDO,,Fee Schedule,106.17
Aetna,PPO,88153,CPT4/HCPCS,CYTOPATH C/V REDO,,Fee Schedule,106.17
Aetna,PPO,88155,CPT4/HCPCS,CYTOPATH C/V INDEX ADD-ON,,Fee Schedule,60.22
Aetna,PPO,88160,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Fee Schedule,259.22
Aetna,PPO,88161,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Fee Schedule,265.18
Aetna,PPO,88162,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Fee Schedule,356.91
Aetna,PPO,88164,CPT4/HCPCS,CYTOPATH TBS C/V MANUAL,,Fee Schedule,106.17
Aetna,PPO,88165,CPT4/HCPCS,CYTOPATH TBS C/V REDO,,Fee Schedule,106.17
Aetna,PPO,88166,CPT4/HCPCS,CYTOPATH TBS C/V AUTO REDO,,Fee Schedule,106.17
Aetna,PPO,88167,CPT4/HCPCS,CYTOPATH TBS C/V SELECT,,Fee Schedule,106.17
Aetna,PPO,88172,CPT4/HCPCS,CYTP DX EVAL FNA 1ST EA SITE,,Fee Schedule,179.34
Aetna,PPO,88173,CPT4/HCPCS,CYTOPATH EVAL FNA REPORT,,Fee Schedule,602.53
Aetna,PPO,88174,CPT4/HCPCS,CYTOPATH C/V AUTO IN FLUID,,Fee Schedule,214.62
Aetna,PPO,88175,CPT4/HCPCS,CYTOPATH C/V AUTO FLUID REDO,,Fee Schedule,266.19
Aetna,PPO,88177,CPT4/HCPCS,CYTP FNA EVAL EA ADDL,,Fee Schedule,55.02
Aetna,PPO,88182,CPT4/HCPCS,CELL MARKER STUDY,,Fee Schedule,600.09
Aetna,PPO,88184,CPT4/HCPCS,FLOWCYTOMETRY/ TC 1 MARKER,,Fee Schedule,729.79
Aetna,PPO,88185,CPT4/HCPCS,FLOWCYTOMETRY/TC ADD-ON,,Fee Schedule,436.80
Aetna,PPO,88187,CPT4/HCPCS,FLOWCYTOMETRY/READ 2-8,,Fee Schedule,519.62
Aetna,PPO,88188,CPT4/HCPCS,FLOWCYTOMETRY/READ 9-15,,Fee Schedule,644.70
Aetna,PPO,88189,CPT4/HCPCS,FLOWCYTOMETRY/READ 16 & >,,Fee Schedule,787.33
Aetna,PPO,88230,CPT4/HCPCS,TISSUE CULTURE LYMPHOCYTE,,Fee Schedule,1170.54
Aetna,PPO,88233,CPT4/HCPCS,TISSUE CULTURE SKIN/BIOPSY,,Fee Schedule,1413.97
Aetna,PPO,88235,CPT4/HCPCS,TISSUE CULTURE PLACENTA,,Fee Schedule,1479.57
Aetna,PPO,88237,CPT4/HCPCS,TISSUE CULTURE BONE MARROW,,Fee Schedule,1269.07
Aetna,PPO,88239,CPT4/HCPCS,TISSUE CULTURE TUMOR,,Fee Schedule,1482.26
Aetna,PPO,88240,CPT4/HCPCS,CELL CRYOPRESERVE/STORAGE,,Fee Schedule,101.55
Aetna,PPO,88241,CPT4/HCPCS,FROZEN CELL PREPARATION,,Fee Schedule,101.55
Aetna,PPO,88245,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,Fee Schedule,1304.85
Aetna,PPO,88248,CPT4/HCPCS,CHROMOSOME ANALYSIS 50-100,,Fee Schedule,1740.06
Aetna,PPO,88249,CPT4/HCPCS,CHROMOSOME ANALYSIS 100,,Fee Schedule,1740.06
Aetna,PPO,88261,CPT4/HCPCS,CHROMOSOME ANALYSIS 5,,Fee Schedule,1775.76
Aetna,PPO,88262,CPT4/HCPCS,CHROMOSOME ANALYSIS 15-20,,Fee Schedule,1252.35
Aetna,PPO,88263,CPT4/HCPCS,CHROMOSOME ANALYSIS 45,,Fee Schedule,1043.86
Aetna,PPO,88264,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,Fee Schedule,1252.35
Aetna,PPO,88267,CPT4/HCPCS,CHROMOSOME ANALYS PLACENTA,,Fee Schedule,1806.25
Aetna,PPO,88269,CPT4/HCPCS,CHROMOSOME ANALYS AMNIOTIC,,Fee Schedule,1671.09
Aetna,PPO,88271,CPT4/HCPCS,CYTOGENETICS DNA PROBE,,Fee Schedule,215.20
Aetna,PPO,88272,CPT4/HCPCS,CYTOGENETICS 3-5,,Fee Schedule,268.96
Aetna,PPO,88273,CPT4/HCPCS,CYTOGENETICS 10-30,,Fee Schedule,322.81
Aetna,PPO,88274,CPT4/HCPCS,CYTOGENETICS 25-99,,Fee Schedule,349.77
Aetna,PPO,88275,CPT4/HCPCS,CYTOGENETICS 100-300,,Fee Schedule,403.45
Aetna,PPO,88280,CPT4/HCPCS,CHROMOSOME KARYOTYPE STUDY,,Fee Schedule,252.16
Aetna,PPO,88283,CPT4/HCPCS,CHROMOSOME BANDING STUDY,,Fee Schedule,86.85
Aetna,PPO,88285,CPT4/HCPCS,CHROMOSOME COUNT ADDITIONAL,,Fee Schedule,190.93
Aetna,PPO,88289,CPT4/HCPCS,CHROMOSOME STUDY ADDITIONAL,,Fee Schedule,130.53
Aetna,PPO,88291,CPT4/HCPCS,CYTO/MOLECULAR REPORT,,Fee Schedule,228.06
Aetna,PPO,88300,CPT4/HCPCS,SURGICAL PATH GROSS,,Fee Schedule,194.12
Aetna,PPO,88302,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Fee Schedule,407.23
Aetna,PPO,88304,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Fee Schedule,448.64
Aetna,PPO,88305,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Fee Schedule,605.47
Aetna,PPO,88307,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Fee Schedule,1277.38
Aetna,PPO,88309,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Fee Schedule,1772.14
Aetna,PPO,88311,CPT4/HCPCS,DECALCIFY TISSUE,,Fee Schedule,57.96
Aetna,PPO,88312,CPT4/HCPCS,SPECIAL STAINS GROUP 1,,Fee Schedule,700.22
Aetna,PPO,88313,CPT4/HCPCS,SPECIAL STAINS GROUP 2,,Fee Schedule,575.90
Aetna,PPO,88314,CPT4/HCPCS,HISTOCHEMICAL STAINS ADD-ON,,Fee Schedule,587.74
Aetna,PPO,88319,CPT4/HCPCS,ENZYME HISTOCHEMISTRY,,Fee Schedule,1043.53
Aetna,PPO,88321,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Fee Schedule,623.70
Aetna,PPO,88323,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Fee Schedule,510.80
Aetna,PPO,88325,CPT4/HCPCS,COMPREHENSIVE REVIEW OF DATA,,Fee Schedule,988.51
Aetna,PPO,88329,CPT4/HCPCS,PATH CONSULT INTROP,,Fee Schedule,264.68
Aetna,PPO,88331,CPT4/HCPCS,PATH CONSULT INTRAOP 1 BLOC,,Fee Schedule,277.03
Aetna,PPO,88332,CPT4/HCPCS,PATH CONSULT INTRAOP ADDL,,Fee Schedule,96.43
Aetna,PPO,88333,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 1,,Fee Schedule,303.66
Aetna,PPO,88334,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 2,,Fee Schedule,191.18
Aetna,PPO,88341,CPT4/HCPCS,IMMUNOHISTO ANTB ADDL SLIDE,,Fee Schedule,378.75
Aetna,PPO,88342,CPT4/HCPCS,IMMUNOHISTO ANTB 1ST STAIN,,Fee Schedule,546.33
Aetna,PPO,88344,CPT4/HCPCS,IMMUNOHISTO ANTIBODY SLIDE,,Fee Schedule,636.55
Aetna,PPO,88346,CPT4/HCPCS,IMMUNOFLUOR ANTB 1ST STAIN,,Fee Schedule,528.52
Aetna,PPO,88348,CPT4/HCPCS,ELECTRON MICROSCOPY,,Fee Schedule,5285.11
Aetna,PPO,88350,CPT4/HCPCS,IMMUNOFLUOR ANTB ADDL STAIN,,Fee Schedule,362.12
Aetna,PPO,88355,CPT4/HCPCS,ANALYSIS SKELETAL MUSCLE,,Fee Schedule,1132.32
Aetna,PPO,88356,CPT4/HCPCS,ANALYSIS NERVE,,Fee Schedule,1318.12
Aetna,PPO,88358,CPT4/HCPCS,ANALYSIS TUMOR,,Fee Schedule,282.91
Aetna,PPO,88360,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/MANUAL,,Fee Schedule,617.31
Aetna,PPO,88361,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/COMPUT,,Fee Schedule,833.36
Aetna,PPO,88362,CPT4/HCPCS,NERVE TEASING PREPARATIONS,,Fee Schedule,1522.33
Aetna,PPO,88363,CPT4/HCPCS,XM ARCHIVE TISSUE MOLEC ANAL,,Fee Schedule,128.10
Aetna,PPO,88364,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Fee Schedule,580.27
Aetna,PPO,88365,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Fee Schedule,942.90
Aetna,PPO,88366,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Fee Schedule,716.60
Aetna,PPO,88367,CPT4/HCPCS,INSITU HYBRIDIZATION AUTO,,Fee Schedule,1700.58
Aetna,PPO,88368,CPT4/HCPCS,INSITU HYBRIDIZATION MANUAL,,Fee Schedule,1372.05
Aetna,PPO,88369,CPT4/HCPCS,M/PHMTRC ALYSISHQUANT/SEMIQ,,Fee Schedule,402.44
Aetna,PPO,88371,CPT4/HCPCS,PROTEIN WESTERN BLOT TISSUE,,Fee Schedule,223.27
Aetna,PPO,88372,CPT4/HCPCS,PROTEIN ANALYSIS W/PROBE,,Fee Schedule,228.56
Aetna,PPO,88373,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Fee Schedule,325.41
Aetna,PPO,88374,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Fee Schedule,1321.23
Aetna,PPO,88375,CPT4/HCPCS,OPTICAL ENDOMICROSCPY INTERP,,Fee Schedule,338.68
Aetna,PPO,88377,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Fee Schedule,1229.34
Aetna,PPO,88380,CPT4/HCPCS,MICRODISSECTION LASER,,Fee Schedule,892.58
Aetna,PPO,88381,CPT4/HCPCS,MICRODISSECTION MANUAL,,Fee Schedule,1138.28
Aetna,PPO,88387,CPT4/HCPCS,TISS EXAM MOLECULAR STUDY,,Fee Schedule,75.76
Aetna,PPO,88388,CPT4/HCPCS,TISS EX MOLECUL STUDY ADD-ON,,Fee Schedule,37.29
Aetna,PPO,88720,CPT4/HCPCS,BILIRUBIN TOTAL TRANSCUT,,Fee Schedule,50.40
Aetna,PPO,88738,CPT4/HCPCS,HGB QUANT TRANSCUTANEOUS,,Fee Schedule,50.40
Aetna,PPO,88740,CPT4/HCPCS,TRANSCUTANEOUS CARBOXYHB,,Fee Schedule,50.40
Aetna,PPO,88741,CPT4/HCPCS,TRANSCUTANEOUS METHB,,Fee Schedule,50.40
Aetna,PPO,89049,CPT4/HCPCS,CHCT FOR MAL HYPERTHERMIA,,Fee Schedule,503.58
Aetna,PPO,89050,CPT4/HCPCS,BODY FLUID CELL COUNT,,Fee Schedule,47.46
Aetna,PPO,89051,CPT4/HCPCS,BODY FLUID CELL COUNT,,Fee Schedule,55.35
Aetna,PPO,89055,CPT4/HCPCS,LEUKOCYTE ASSESSMENT FECAL,,Fee Schedule,42.92
Aetna,PPO,89060,CPT4/HCPCS,EXAM SYNOVIAL FLUID CRYSTALS,,Fee Schedule,71.82
Aetna,PPO,89125,CPT4/HCPCS,SPECIMEN FAT STAIN,,Fee Schedule,43.42
Aetna,PPO,89160,CPT4/HCPCS,EXAM FECES FOR MEAT FIBERS,,Fee Schedule,37.04
Aetna,PPO,89190,CPT4/HCPCS,NASAL SMEAR FOR EOSINOPHILS,,Fee Schedule,47.71
Aetna,PPO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Fee Schedule,137.92
Aetna,PPO,89230,CPT4/HCPCS,COLLECT SWEAT FOR TEST,,Fee Schedule,25.45
Aetna,PPO,89250,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Fee Schedule,8544.39
Aetna,PPO,89251,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Fee Schedule,8887.70
Aetna,PPO,89253,CPT4/HCPCS,EMBRYO HATCHING,,Fee Schedule,3047.68
Aetna,PPO,89254,CPT4/HCPCS,OOCYTE IDENTIFICATION,,Fee Schedule,2430.96
Aetna,PPO,89255,CPT4/HCPCS,PREPARE EMBRYO FOR TRANSFER,,Fee Schedule,1713.51
Aetna,PPO,89257,CPT4/HCPCS,SPERM IDENTIFICATION,,Fee Schedule,2675.40
Aetna,PPO,89258,CPT4/HCPCS,CRYOPRESERVATION EMBRYO(S),,Fee Schedule,2610.72
Aetna,PPO,89259,CPT4/HCPCS,CRYOPRESERVATION SPERM,,Fee Schedule,942.48
Aetna,PPO,89260,CPT4/HCPCS,SPERM ISOLATION SIMPLE,,Fee Schedule,1064.44
Aetna,PPO,89261,CPT4/HCPCS,SPERM ISOLATION COMPLEX,,Fee Schedule,684.76
Aetna,PPO,89264,CPT4/HCPCS,IDENTIFY SPERM TISSUE,,Fee Schedule,2790.22
Aetna,PPO,89268,CPT4/HCPCS,INSEMINATION OF OOCYTES,,Fee Schedule,2826.09
Aetna,PPO,89272,CPT4/HCPCS,EXTENDED CULTURE OF OOCYTES,,Fee Schedule,3785.62
Aetna,PPO,89280,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,Fee Schedule,5329.96
Aetna,PPO,89281,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,Fee Schedule,6823.23
Aetna,PPO,89290,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,Fee Schedule,8793.62
Aetna,PPO,89291,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,Fee Schedule,7560.00
Aetna,PPO,89300,CPT4/HCPCS,SEMEN ANALYSIS W/HUHNER,,Fee Schedule,89.62
Aetna,PPO,89310,CPT4/HCPCS,SEMEN ANALYSIS W/COUNT,,Fee Schedule,86.43
Aetna,PPO,89320,CPT4/HCPCS,SEMEN ANAL VOL/COUNT/MOT,,Fee Schedule,121.12
Aetna,PPO,89321,CPT4/HCPCS,SEMEN ANAL SPERM DETECTION,,Fee Schedule,121.12
Aetna,PPO,89322,CPT4/HCPCS,SEMEN ANAL STRICT CRITERIA,,Fee Schedule,155.82
Aetna,PPO,89325,CPT4/HCPCS,SPERM ANTIBODY TEST,,Fee Schedule,107.26
Aetna,PPO,89329,CPT4/HCPCS,SPERM EVALUATION TEST,,Fee Schedule,210.67
Aetna,PPO,89330,CPT4/HCPCS,EVALUATION CERVICAL MUCUS,,Fee Schedule,99.45
Aetna,PPO,89331,CPT4/HCPCS,RETROGRADE EJACULATION ANAL,,Fee Schedule,196.81
Aetna,PPO,89335,CPT4/HCPCS,CRYOPRESERVE TESTICULAR TISS,,Fee Schedule,1362.73
Aetna,PPO,89337,CPT4/HCPCS,CRYOPRESERVATION OOCYTE(S),,Fee Schedule,3465.00
Aetna,PPO,89342,CPT4/HCPCS,STORAGE/YEAR EMBRYO(S),,Fee Schedule,699.72
Aetna,PPO,89343,CPT4/HCPCS,STORAGE/YEAR SPERM/SEMEN,,Fee Schedule,352.80
Aetna,PPO,89344,CPT4/HCPCS,STORAGE/YEAR REPROD TISSUE,,Fee Schedule,872.50
Aetna,PPO,89346,CPT4/HCPCS,STORAGE/YEAR OOCYTE(S),,Fee Schedule,1814.40
Aetna,PPO,89352,CPT4/HCPCS,THAWING CRYOPRESRVED EMBRYO,,Fee Schedule,168.00
Aetna,PPO,89353,CPT4/HCPCS,THAWING CRYOPRESRVED SPERM,,Fee Schedule,62.24
Aetna,PPO,89354,CPT4/HCPCS,THAW CRYOPRSVRD REPROD TISS,,Fee Schedule,62.24
Aetna,PPO,89356,CPT4/HCPCS,THAWING CRYOPRESRVED OOCYTE,,Fee Schedule,55.44
Aetna,PPO,91010,CPT4/HCPCS,ESOPHAGUS MOTILITY STUDY,,Grouper Rate,2002.00
Aetna,PPO,91020,CPT4/HCPCS,GASTRIC MOTILITY STUDIES,,Grouper Rate,2002.00
Aetna,PPO,91022,CPT4/HCPCS,DUODENAL MOTILITY STUDY,,Grouper Rate,2002.00
Aetna,PPO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Fee Schedule,635.37
Aetna,PPO,92508,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Fee Schedule,212.94
Aetna,PPO,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,Grouper Rate,2002.00
Aetna,PPO,92521,CPT4/HCPCS,EVALUATION OF SPEECH FLUENCY,,Fee Schedule,868.05
Aetna,PPO,92522,CPT4/HCPCS,EVALUATE SPEECH PRODUCTION,,Fee Schedule,702.74
Aetna,PPO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,Fee Schedule,1462.35
Aetna,PPO,92524,CPT4/HCPCS,BEHAVRAL QUALIT ANALYS VOICE,,Fee Schedule,764.98
Aetna,PPO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Case Rate,8792.00
Aetna,PPO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Case Rate,8792.00
Aetna,PPO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Case Rate,8792.00
Aetna,PPO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Case Rate,8792.00
Aetna,PPO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Case Rate,8792.00
Aetna,PPO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Case Rate,8792.00
Aetna,PPO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Case Rate,8792.00
Aetna,PPO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Case Rate,8792.00
Aetna,PPO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Case Rate,8792.00
Aetna,PPO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Case Rate,8792.00
Aetna,PPO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Case Rate,8792.00
Aetna,PPO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Case Rate,8792.00
Aetna,PPO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Case Rate,8792.00
Aetna,PPO,93000,CPT4/HCPCS,ELECTROCARDIOGRAM COMPLETE,,Fee Schedule,165.56
Aetna,PPO,93005,CPT4/HCPCS,ELECTROCARDIOGRAM TRACING,,Fee Schedule,95.67
Aetna,PPO,93010,CPT4/HCPCS,ELECTROCARDIOGRAM REPORT,,Fee Schedule,69.88
Aetna,PPO,93015,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Fee Schedule,786.57
Aetna,PPO,93016,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Fee Schedule,184.54
Aetna,PPO,93017,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Fee Schedule,480.39
Aetna,PPO,93018,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Fee Schedule,121.63
Aetna,PPO,93024,CPT4/HCPCS,CARDIAC DRUG STRESS TEST,,Fee Schedule,504.67
Aetna,PPO,93025,CPT4/HCPCS,MICROVOLT T-WAVE ASSESS,,Fee Schedule,1371.04
Aetna,PPO,93040,CPT4/HCPCS,RHYTHM ECG WITH REPORT,,Fee Schedule,108.94
Aetna,PPO,93041,CPT4/HCPCS,RHYTHM ECG TRACING,,Fee Schedule,50.23
Aetna,PPO,93042,CPT4/HCPCS,RHYTHM ECG REPORT,,Fee Schedule,58.63
Aetna,PPO,93050,CPT4/HCPCS,ART PRESSURE WAVEFORM ANALYS,,Fee Schedule,75.26
Aetna,PPO,93224,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Fee Schedule,905.94
Aetna,PPO,93225,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Fee Schedule,277.45
Aetna,PPO,93226,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Fee Schedule,410.76
Aetna,PPO,93227,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Fee Schedule,217.72
Aetna,PPO,93228,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,Fee Schedule,203.11
Aetna,PPO,93229,CPT4/HCPCS,REMOTE 30 DAY ECG TECH SUPP,,Fee Schedule,6072.44
Aetna,PPO,93260,CPT4/HCPCS,PRGRMG DEV EVAL IMPLTBL SYS,,Fee Schedule,190.42
Aetna,PPO,93261,CPT4/HCPCS,INTERROGATE SUBQ DEFIB,,Fee Schedule,190.42
Aetna,PPO,93264,CPT4/HCPCS,REM MNTR WRLS P-ART PRS SNR,,Fee Schedule,285.68
Aetna,PPO,93268,CPT4/HCPCS,ECG RECORD/REVIEW,,Fee Schedule,2208.52
Aetna,PPO,93270,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,Fee Schedule,135.07
Aetna,PPO,93271,CPT4/HCPCS,ECG/MONITORING AND ANALYSIS,,Fee Schedule,1867.82
Aetna,PPO,93272,CPT4/HCPCS,ECG/REVIEW INTERPRET ONLY,,Fee Schedule,205.63
Aetna,PPO,93278,CPT4/HCPCS,ECG/SIGNAL-AVERAGED,,Fee Schedule,198.66
Aetna,PPO,93279,CPT4/HCPCS,PRGRMG DEV EVAL PM/LDLS PM,,Fee Schedule,162.37
Aetna,PPO,93280,CPT4/HCPCS,PM DEVICE PROGR EVAL DUAL,,Fee Schedule,189.58
Aetna,PPO,93281,CPT4/HCPCS,PM DEVICE PROGR EVAL MULTI,,Fee Schedule,219.91
Aetna,PPO,93282,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,Fee Schedule,195.63
Aetna,PPO,93283,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,Fee Schedule,225.96
Aetna,PPO,93284,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,Fee Schedule,256.28
Aetna,PPO,93285,CPT4/HCPCS,PRGRMG DEV EVAL SCRMS IP,,Fee Schedule,150.19
Aetna,PPO,93286,CPT4/HCPCS,PERI-PX EVAL PM/LDLS PM IP,,Fee Schedule,104.74
Aetna,PPO,93287,CPT4/HCPCS,PERI-PX DEVICE EVAL & PRGR,,Fee Schedule,113.90
Aetna,PPO,93288,CPT4/HCPCS,INTERROG EVL PM/LDLS PM IP,,Fee Schedule,153.21
Aetna,PPO,93289,CPT4/HCPCS,INTERROG DEVICE EVAL HEART,,Fee Schedule,189.58
Aetna,PPO,93290,CPT4/HCPCS,INTERROG DEV EVAL ICPMS IP,,Fee Schedule,86.60
Aetna,PPO,93291,CPT4/HCPCS,INTERROG DEV EVAL SCRMS IP,,Fee Schedule,138.09
Aetna,PPO,93292,CPT4/HCPCS,WCD DEVICE INTERROGATE,,Fee Schedule,104.74
Aetna,PPO,93293,CPT4/HCPCS,PM PHONE R-STRIP DEVICE EVAL,,Fee Schedule,356.24
Aetna,PPO,93294,CPT4/HCPCS,REM INTERROG EVL PM/LDLS PM,,Fee Schedule,274.84
Aetna,PPO,93295,CPT4/HCPCS,DEV INTERROG REMOTE 1/2/MLT,,Fee Schedule,541.04
Aetna,PPO,93296,CPT4/HCPCS,REM INTERROG EVL PM/IDS,,Fee Schedule,289.54
Aetna,PPO,93297,CPT4/HCPCS,REM INTERROG DEV EVAL ICPMS,,Fee Schedule,203.11
Aetna,PPO,93298,CPT4/HCPCS,REM INTERROG DEV EVAL SCRMS,,Fee Schedule,221.34
Aetna,PPO,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,Fee Schedule,1283.18
Aetna,PPO,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,Fee Schedule,856.04
Aetna,PPO,93306,CPT4/HCPCS,TTE W/DOPPLER COMPLETE,,Fee Schedule,1471.00
Aetna,PPO,93307,CPT4/HCPCS,TTE W/O DOPPLER COMPLETE,,Fee Schedule,895.44
Aetna,PPO,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,Fee Schedule,695.52
Aetna,PPO,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,1901.67
Aetna,PPO,93313,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,318.19
Aetna,PPO,93314,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,1980.46
Aetna,PPO,93315,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,5012.19
Aetna,PPO,93316,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,348.51
Aetna,PPO,93317,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Fee Schedule,827.82
Aetna,PPO,93318,CPT4/HCPCS,ECHO TRANSESOPHAGEAL INTRAOP,,Fee Schedule,5012.19
Aetna,PPO,93320,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Fee Schedule,383.46
Aetna,PPO,93321,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Fee Schedule,189.58
Aetna,PPO,93325,CPT4/HCPCS,DOPPLER COLOR FLOW ADD-ON,,Fee Schedule,283.50
Aetna,PPO,93350,CPT4/HCPCS,STRESS TTE ONLY,,Fee Schedule,1195.32
Aetna,PPO,93351,CPT4/HCPCS,STRESS TTE COMPLETE,,Fee Schedule,1386.75
Aetna,PPO,93352,CPT4/HCPCS,ADMIN ECG CONTRAST AGENT,,Fee Schedule,314.32
Aetna,PPO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Grouper Rate,2002.00
Aetna,PPO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Grouper Rate,7830.00
Aetna,PPO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Grouper Rate,7830.00
Aetna,PPO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Grouper Rate,7830.00
Aetna,PPO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Grouper Rate,7830.00
Aetna,PPO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Grouper Rate,7830.00
Aetna,PPO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Grouper Rate,7830.00
Aetna,PPO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Grouper Rate,7830.00
Aetna,PPO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Grouper Rate,7830.00
Aetna,PPO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,7830.00
Aetna,PPO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,7830.00
Aetna,PPO,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Grouper Rate,2002.00
Aetna,PPO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Grouper Rate,2002.00
Aetna,PPO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Grouper Rate,2002.00
Aetna,PPO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Grouper Rate,7830.00
Aetna,PPO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,7830.00
Aetna,PPO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,7830.00
Aetna,PPO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,7830.00
Aetna,PPO,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Grouper Rate,8797.00
Aetna,PPO,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Grouper Rate,8797.00
Aetna,PPO,93582,CPT4/HCPCS,PERQ TRANSCATH CLOSURE PDA,,Grouper Rate,8797.00
Aetna,PPO,93583,CPT4/HCPCS,PERQ TRANSCATH SEPTAL REDUXN,,Grouper Rate,8797.00
Aetna,PPO,93590,CPT4/HCPCS,PERQ TRANSCATH CLS MITRAL,,Grouper Rate,8797.00
Aetna,PPO,93591,CPT4/HCPCS,PERQ TRANSCATH CLS AORTIC,,Grouper Rate,8797.00
Aetna,PPO,93592,CPT4/HCPCS,PERQ TRANSCATH CLOSURE EACH,,Grouper Rate,2002.00
Aetna,PPO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Grouper Rate,7830.00
Aetna,PPO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Grouper Rate,7830.00
Aetna,PPO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Grouper Rate,7830.00
Aetna,PPO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,PPO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,PPO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,PPO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,PPO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Grouper Rate,7830.00
Aetna,PPO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,PPO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,7830.00
Aetna,PPO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,7830.00
Aetna,PPO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Grouper Rate,7830.00
Aetna,PPO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Grouper Rate,7830.00
Aetna,PPO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Grouper Rate,2002.00
Aetna,PPO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Grouper Rate,7830.00
Aetna,PPO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Grouper Rate,2002.00
Aetna,PPO,93880,CPT4/HCPCS,EXTRACRANIAL BILAT STUDY,,Fee Schedule,1364.91
Aetna,PPO,93882,CPT4/HCPCS,EXTRACRANIAL UNI/LTD STUDY,,Fee Schedule,1361.89
Aetna,PPO,93886,CPT4/HCPCS,INTRACRANIAL COMPLETE STUDY,,Fee Schedule,1364.91
Aetna,PPO,93888,CPT4/HCPCS,INTRACRANIAL LIMITED STUDY,,Fee Schedule,554.31
Aetna,PPO,93890,CPT4/HCPCS,TCD VASOREACTIVITY STUDY,,Fee Schedule,857.30
Aetna,PPO,93892,CPT4/HCPCS,TCD EMBOLI DETECT W/O INJ,,Fee Schedule,857.30
Aetna,PPO,93893,CPT4/HCPCS,TCD EMBOLI DETECT W/INJ,,Fee Schedule,857.30
Aetna,PPO,93895,CPT4/HCPCS,CAROTID INTIMA ATHEROMA EVAL,,Fee Schedule,627.14
Aetna,PPO,93922,CPT4/HCPCS,UPR/L XTREMITY ART 2 LEVELS,,Fee Schedule,874.18
Aetna,PPO,93923,CPT4/HCPCS,UPR/LXTR ART STDY 3+ LVLS,,Fee Schedule,1319.55
Aetna,PPO,93924,CPT4/HCPCS,LWR XTR VASC STDY BILAT,,Fee Schedule,1676.97
Aetna,PPO,93925,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Fee Schedule,1363.74
Aetna,PPO,93926,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Fee Schedule,859.06
Aetna,PPO,93930,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Fee Schedule,1364.91
Aetna,PPO,93931,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Fee Schedule,859.06
Aetna,PPO,93970,CPT4/HCPCS,EXTREMITY STUDY,,Fee Schedule,1364.91
Aetna,PPO,93971,CPT4/HCPCS,EXTREMITY STUDY,,Fee Schedule,859.06
Aetna,PPO,93975,CPT4/HCPCS,VASCULAR STUDY,,Fee Schedule,1363.74
Aetna,PPO,93976,CPT4/HCPCS,VASCULAR STUDY,,Fee Schedule,1361.89
Aetna,PPO,93978,CPT4/HCPCS,VASCULAR STUDY,,Fee Schedule,1364.91
Aetna,PPO,93979,CPT4/HCPCS,VASCULAR STUDY,,Fee Schedule,859.06
Aetna,PPO,93980,CPT4/HCPCS,PENILE VASCULAR STUDY,,Fee Schedule,1007.49
Aetna,PPO,93981,CPT4/HCPCS,PENILE VASCULAR STUDY,,Fee Schedule,877.21
Aetna,PPO,93990,CPT4/HCPCS,DOPPLER FLOW TESTING,,Fee Schedule,857.30
Aetna,PPO,93998,CPT4/HCPCS,NONINVAS VASC DX STUDY PROC,,Fee Schedule,817.57
Aetna,PPO,95782,CPT4/HCPCS,POLYSOM <6 YRS 4/> PARAMTRS,,Fee Schedule,7714.30
Aetna,PPO,95783,CPT4/HCPCS,POLYSOM <6 YRS CPAP/BILVL,,Fee Schedule,8205.28
Aetna,PPO,95800,CPT4/HCPCS,SLP STDY UNATTENDED,,Fee Schedule,1313.42
Aetna,PPO,95801,CPT4/HCPCS,SLP STDY UNATND W/ANAL,,Fee Schedule,404.71
Aetna,PPO,95805,CPT4/HCPCS,MULTIPLE SLEEP LATENCY TEST,,Fee Schedule,3103.04
Aetna,PPO,95806,CPT4/HCPCS,SLEEP STUDY UNATT&RESP EFFT,,Fee Schedule,1059.57
Aetna,PPO,95807,CPT4/HCPCS,SLEEP STUDY ATTENDED,,Fee Schedule,3613.68
Aetna,PPO,95808,CPT4/HCPCS,POLYSOM ANY AGE 1-3> PARAM,,Fee Schedule,4976.83
Aetna,PPO,95810,CPT4/HCPCS,POLYSOM 6/> YRS 4/> PARAM,,Fee Schedule,5057.38
Aetna,PPO,95811,CPT4/HCPCS,POLYSOM 6/>YRS CPAP 4/> PARM,,Fee Schedule,5495.36
Aetna,PPO,96377,CPT4/HCPCS,APPLICATON ON-BODY INJECTOR,,Grouper Rate,2002.00
Aetna,PPO,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,Fee Schedule,692.16
Aetna,PPO,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,Fee Schedule,330.03
Aetna,PPO,96405,CPT4/HCPCS,CHEMO INTRALESIONAL UP TO 7,,Fee Schedule,264.85
Aetna,PPO,96406,CPT4/HCPCS,CHEMO INTRALESIONAL OVER 7,,Fee Schedule,382.03
Aetna,PPO,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,Fee Schedule,1079.65
Aetna,PPO,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,Fee Schedule,601.35
Aetna,PPO,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,Fee Schedule,1405.15
Aetna,PPO,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,Fee Schedule,293.66
Aetna,PPO,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,Fee Schedule,1551.48
Aetna,PPO,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,Fee Schedule,690.22
Aetna,PPO,96420,CPT4/HCPCS,CHEMO IA PUSH TECNIQUE,,Fee Schedule,1042.69
Aetna,PPO,96422,CPT4/HCPCS,CHEMO IA INFUSION UP TO 1 HR,,Fee Schedule,1687.64
Aetna,PPO,96423,CPT4/HCPCS,CHEMO IA INFUSE EACH ADDL HR,,Fee Schedule,763.56
Aetna,PPO,96425,CPT4/HCPCS,CHEMOTHERAPY INFUSION METHOD,,Fee Schedule,1727.96
Aetna,PPO,96440,CPT4/HCPCS,CHEMOTHERAPY INTRACAVITARY,,Fee Schedule,1252.94
Aetna,PPO,96446,CPT4/HCPCS,CHEMOTX ADMN PRTL CAVITY,,Fee Schedule,180.76
Aetna,PPO,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,Fee Schedule,743.65
Aetna,PPO,96521,CPT4/HCPCS,REFILL/MAINT PORTABLE PUMP,,Fee Schedule,1279.57
Aetna,PPO,96522,CPT4/HCPCS,REFILL/MAINT PUMP/RESVR SYST,,Fee Schedule,1064.61
Aetna,PPO,96523,CPT4/HCPCS,IRRIG DRUG DELIVERY DEVICE,,Fee Schedule,244.77
Aetna,PPO,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,Fee Schedule,384.46
Aetna,PPO,96574,CPT4/HCPCS,DBRDMT PRMLG LES W/PDT,,Grouper Rate,2002.00
Aetna,PPO,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,Grouper Rate,2002.00
Aetna,PPO,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,Grouper Rate,2002.00
Aetna,PPO,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,Grouper Rate,2002.00
Aetna,PPO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Fee Schedule,33.26
Aetna,PPO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Fee Schedule,92.56
Aetna,PPO,97014,CPT4/HCPCS,ELECTRIC STIMULATION THERAPY,,Fee Schedule,90.38
Aetna,PPO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Fee Schedule,108.44
Aetna,PPO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Fee Schedule,60.39
Aetna,PPO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Fee Schedule,129.19
Aetna,PPO,97024,CPT4/HCPCS,DIATHERMY EG MICROWAVE,,Fee Schedule,37.80
Aetna,PPO,97026,CPT4/HCPCS,INFRARED THERAPY,,Fee Schedule,33.26
Aetna,PPO,97028,CPT4/HCPCS,ULTRAVIOLET THERAPY,,Fee Schedule,41.66
Aetna,PPO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Fee Schedule,108.36
Aetna,PPO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Fee Schedule,178.16
Aetna,PPO,97034,CPT4/HCPCS,CONTRAST BATH THERAPY,,Fee Schedule,100.63
Aetna,PPO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Fee Schedule,71.23
Aetna,PPO,97036,CPT4/HCPCS,HYDROTHERAPY,,Fee Schedule,184.29
Aetna,PPO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Fee Schedule,180.85
Aetna,PPO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Fee Schedule,189.92
Aetna,PPO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Fee Schedule,242.34
Aetna,PPO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Fee Schedule,159.93
Aetna,PPO,97124,CPT4/HCPCS,MASSAGE THERAPY,,Fee Schedule,148.00
Aetna,PPO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Fee Schedule,170.18
Aetna,PPO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Fee Schedule,116.76
Aetna,PPO,97151,CPT4/HCPCS,BHV ID ASSMT BY PHYS/QHP,,Fee Schedule,206.64
Aetna,PPO,97152,CPT4/HCPCS,BHV ID SUPRT ASSMT BY 1 TECH,,Fee Schedule,153.21
Aetna,PPO,97153,CPT4/HCPCS,ADAPTIVE BEHAVIOR TX BY TECH,,Fee Schedule,153.21
Aetna,PPO,97154,CPT4/HCPCS,GRP ADAPT BHV TX BY TECH,,Fee Schedule,153.21
Aetna,PPO,97155,CPT4/HCPCS,ADAPT BEHAVIOR TX PHYS/QHP,,Fee Schedule,206.64
Aetna,PPO,97156,CPT4/HCPCS,FAM ADAPT BHV TX GDN PHY/QHP,,Fee Schedule,206.64
Aetna,PPO,97157,CPT4/HCPCS,MULT FAM ADAPT BHV TX GDN,,Fee Schedule,206.64
Aetna,PPO,97158,CPT4/HCPCS,GRP ADAPT BHV TX BY PHY/QHP,,Fee Schedule,206.64
Aetna,PPO,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,Fee Schedule,490.98
Aetna,PPO,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,Fee Schedule,490.98
Aetna,PPO,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,Fee Schedule,490.98
Aetna,PPO,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,Fee Schedule,332.05
Aetna,PPO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,Fee Schedule,564.22
Aetna,PPO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,Fee Schedule,564.22
Aetna,PPO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,Fee Schedule,564.22
Aetna,PPO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,Fee Schedule,376.32
Aetna,PPO,97169,CPT4/HCPCS,ATHLETIC TRN EVAL LOW CMPLX,,Fee Schedule,336.75
Aetna,PPO,97170,CPT4/HCPCS,ATHLETIC TRN EVAL MOD CMPLX,,Fee Schedule,336.75
Aetna,PPO,97171,CPT4/HCPCS,ATHLETIC TRN EVAL HIGH CMPLX,,Fee Schedule,336.75
Aetna,PPO,97172,CPT4/HCPCS,ATHLETIC TRN RE-EVAL PLAN CR,,Fee Schedule,168.25
Aetna,PPO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Fee Schedule,199.33
Aetna,PPO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Fee Schedule,167.66
Aetna,PPO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Fee Schedule,198.99
Aetna,PPO,97537,CPT4/HCPCS,COMMUNITY/WORK REINTEGRATION,,Fee Schedule,171.78
Aetna,PPO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Fee Schedule,174.04
Aetna,PPO,97545,CPT4/HCPCS,WORK HARDENING,,Fee Schedule,784.56
Aetna,PPO,97546,CPT4/HCPCS,WORK HARDENING ADD-ON,,Fee Schedule,312.98
Aetna,PPO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Grouper Rate,2002.00
Aetna,PPO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Grouper Rate,2002.00
Aetna,PPO,A4642,CPT4/HCPCS,In111 satumomab,,Fee Schedule,11678.10
Aetna,PPO,A9500,CPT4/HCPCS,Tc99m sestamibi,,Fee Schedule,893.08
Aetna,PPO,A9501,CPT4/HCPCS,Technetium TC-99m teboroxime,,Fee Schedule,1003.12
Aetna,PPO,A9502,CPT4/HCPCS,Tc99m tetrofosmin,,Fee Schedule,815.38
Aetna,PPO,A9503,CPT4/HCPCS,Tc99m medronate,,Fee Schedule,108.78
Aetna,PPO,A9504,CPT4/HCPCS,Tc99m apcitide,,Fee Schedule,3486.00
Aetna,PPO,A9505,CPT4/HCPCS,TL201 thallium,,Fee Schedule,1275.12
Aetna,PPO,A9507,CPT4/HCPCS,In111 capromab,,Fee Schedule,36778.72
Aetna,PPO,A9508,CPT4/HCPCS,I131 iodobenguate, dx,,Fee Schedule,6183.91
Aetna,PPO,A9509,CPT4/HCPCS,Iodine I-123 sod iodide mil,,Fee Schedule,15130.66
Aetna,PPO,A9510,CPT4/HCPCS,Tc99m disofenin,,Fee Schedule,585.64
Aetna,PPO,A9512,CPT4/HCPCS,Tc99m pertechnetate,,Fee Schedule,58.80
Aetna,PPO,A9516,CPT4/HCPCS,Iodine I-123 sod iodide mic,,Fee Schedule,1513.09
Aetna,PPO,A9520,CPT4/HCPCS,Tc99 tilmanocept diag 0.5mci,,Fee Schedule,3930.52
Aetna,PPO,A9521,CPT4/HCPCS,Tc99m exametazime,,Fee Schedule,12181.17
Aetna,PPO,A9524,CPT4/HCPCS,I131 serum albumin, dx,,Fee Schedule,662.34
Aetna,PPO,A9526,CPT4/HCPCS,Nitrogen N-13 ammonia,,Fee Schedule,5019.84
Aetna,PPO,A9528,CPT4/HCPCS,Iodine I-131 iodide cap, dx,,Fee Schedule,454.86
Aetna,PPO,A9529,CPT4/HCPCS,I131 iodide sol, dx,,Fee Schedule,7.56
Aetna,PPO,A9531,CPT4/HCPCS,I131 max 100uCi,,Fee Schedule,40.99
Aetna,PPO,A9532,CPT4/HCPCS,I125 serum albumin, dx,,Fee Schedule,183.03
Aetna,PPO,A9536,CPT4/HCPCS,Tc99m depreotide,,Fee Schedule,9760.80
Aetna,PPO,A9537,CPT4/HCPCS,Tc99m mebrofenin,,Fee Schedule,462.84
Aetna,PPO,A9538,CPT4/HCPCS,Tc99m pyrophosphate,,Fee Schedule,418.32
Aetna,PPO,A9539,CPT4/HCPCS,Tc99m pentetate,,Fee Schedule,262.16
Aetna,PPO,A9540,CPT4/HCPCS,Tc99m MAA,,Fee Schedule,250.99
Aetna,PPO,A9541,CPT4/HCPCS,Tc99m sulfur colloid,,Fee Schedule,447.38
Aetna,PPO,A9542,CPT4/HCPCS,In111 ibritumomab, dx,,Fee Schedule,29282.40
Aetna,PPO,A9546,CPT4/HCPCS,Co57/58,,Fee Schedule,205.80
Aetna,PPO,A9547,CPT4/HCPCS,In111 oxyquinoline,,Fee Schedule,14960.14
Aetna,PPO,A9548,CPT4/HCPCS,In111 pentetate,,Fee Schedule,3456.93
Aetna,PPO,A9550,CPT4/HCPCS,Tc99m gluceptate,,Fee Schedule,161.36
Aetna,PPO,A9551,CPT4/HCPCS,Tc99m succimer,,Fee Schedule,5014.96
Aetna,PPO,A9552,CPT4/HCPCS,F18 fdg,,Fee Schedule,4056.19
Aetna,PPO,A9553,CPT4/HCPCS,Cr51 chromate,,Fee Schedule,4718.61
Aetna,PPO,A9554,CPT4/HCPCS,I125 iothalamate, dx,,Fee Schedule,292.82
Aetna,PPO,A9555,CPT4/HCPCS,Rb82 rubidium,,Fee Schedule,2987.12
Aetna,PPO,A9556,CPT4/HCPCS,Ga67 gallium,,Fee Schedule,1005.39
Aetna,PPO,A9557,CPT4/HCPCS,Tc99m bicisate,,Fee Schedule,3113.04
Aetna,PPO,A9558,CPT4/HCPCS,Xe133 xenon 10mci,,Fee Schedule,1754.50
Aetna,PPO,A9559,CPT4/HCPCS,Co57 cyano,,Fee Schedule,612.94
Aetna,PPO,A9560,CPT4/HCPCS,Tc99m labeled rbc,,Fee Schedule,781.45
Aetna,PPO,A9561,CPT4/HCPCS,Tc99m oxidronate,,Fee Schedule,368.08
Aetna,PPO,A9562,CPT4/HCPCS,Tc99m mertiatide,,Fee Schedule,6482.11
Aetna,PPO,A9566,CPT4/HCPCS,Tc99m fanolesomab,,Fee Schedule,1736.44
Aetna,PPO,A9567,CPT4/HCPCS,Technetium TC-99m aerosol,,Fee Schedule,28.56
Aetna,PPO,A9568,CPT4/HCPCS,Technetium tc99m arcitumomab,,Fee Schedule,9063.60
Aetna,PPO,A9569,CPT4/HCPCS,Technetium TC-99m auto WBC,,Fee Schedule,12181.17
Aetna,PPO,A9570,CPT4/HCPCS,Indium In-111 auto WBC,,Fee Schedule,29920.38
Aetna,PPO,A9571,CPT4/HCPCS,Indium IN-111 auto platelet,,Fee Schedule,29920.38
Aetna,PPO,A9572,CPT4/HCPCS,Indium In-111 pentetreotide,,Fee Schedule,47487.72
Aetna,PPO,A9575,CPT4/HCPCS,Inj gadoterate meglumi 0.1ml,,Fee Schedule,1.51
Aetna,PPO,A9576,CPT4/HCPCS,Inj prohance multipack,,Fee Schedule,11.92
Aetna,PPO,A9577,CPT4/HCPCS,Inj multihance,,Fee Schedule,16.38
Aetna,PPO,A9578,CPT4/HCPCS,Inj multihance multipack,,Fee Schedule,16.21
Aetna,PPO,A9579,CPT4/HCPCS,Gad-base MR contrast NOS,1ml,,Fee Schedule,13.10
Aetna,PPO,A9580,CPT4/HCPCS,Sodium fluoride F-18,,Fee Schedule,1318.80
Aetna,PPO,A9581,CPT4/HCPCS,Gadoxetate disodium inj,,Fee Schedule,125.07
Aetna,PPO,A9583,CPT4/HCPCS,Gadofosveset trisodium inj,,Fee Schedule,146.49
Aetna,PPO,A9584,CPT4/HCPCS,Iodine I-123 ioflupane,,Fee Schedule,20648.29
Aetna,PPO,A9585,CPT4/HCPCS,Gadobutrol injection,,Fee Schedule,3.10
Aetna,PPO,A9586,CPT4/HCPCS,Florbetapir F18,,Fee Schedule,23906.14
Aetna,PPO,A9599,CPT4/HCPCS,Radioph dx b amyloid pet nos,,Fee Schedule,23007.60
Aetna,PPO,C5271,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,3656.00
Aetna,PPO,C5272,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,2002.00
Aetna,PPO,C5273,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,3656.00
Aetna,PPO,C5274,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,2002.00
Aetna,PPO,C5275,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,3656.00
Aetna,PPO,C5276,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,2002.00
Aetna,PPO,C5277,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,3656.00
Aetna,PPO,C5278,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,2002.00
Aetna,PPO,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Case Rate,8792.00
Aetna,PPO,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Case Rate,8792.00
Aetna,PPO,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Case Rate,8792.00
Aetna,PPO,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Case Rate,8792.00
Aetna,PPO,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Case Rate,8792.00
Aetna,PPO,C9738,CPT4/HCPCS,Blue light cysto imag agent,,Grouper Rate,2002.00
Aetna,PPO,C9739,CPT4/HCPCS,Cystoscopy prostatic imp 1-3,,Grouper Rate,6401.00
Aetna,PPO,C9740,CPT4/HCPCS,Cysto impl 4 or more,,Grouper Rate,6840.00
Aetna,PPO,C9745,CPT4/HCPCS,Nasal endo eustachian tube,,Grouper Rate,3656.00
Aetna,PPO,C9747,CPT4/HCPCS,Ablation, hifu, prostate,,Grouper Rate,3656.00
Aetna,PPO,C9749,CPT4/HCPCS,Repair nasal stenosis w/imp,,Grouper Rate,6401.00
Aetna,PPO,C9751,CPT4/HCPCS,Microwave bronch, 3d, ebus,,Grouper Rate,7830.00
Aetna,PPO,C9752,CPT4/HCPCS,Intraosseous des lumb/sacrum,,Grouper Rate,6840.00
Aetna,PPO,C9753,CPT4/HCPCS,Intraosseous destruct add'l,,Grouper Rate,2002.00
Aetna,PPO,C9754,CPT4/HCPCS,Perc av fistula, direct,,Grouper Rate,7830.00
Aetna,PPO,C9755,CPT4/HCPCS,Rf magnetic-guide av fistula,,Grouper Rate,7830.00
Aetna,PPO,C9756,CPT4/HCPCS,Fluorescence lymph map w/icg,,Grouper Rate,2002.00
Aetna,PPO,C9757,CPT4/HCPCS,Spine/lumbar disk surgery,,Grouper Rate,6840.00
Aetna,PPO,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Grouper Rate,2002.00
Aetna,PPO,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Grouper Rate,3656.00
Aetna,PPO,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Grouper Rate,3656.00
Aetna,PPO,G0186,CPT4/HCPCS,Dstry eye lesn,fdr vssl tech,,Grouper Rate,2002.00
Aetna,PPO,G0259,CPT4/HCPCS,Inject for sacroiliac joint,,Grouper Rate,2002.00
Aetna,PPO,G0260,CPT4/HCPCS,Inj for sacroiliac jt anesth,,Grouper Rate,2002.00
Aetna,PPO,G0398,CPT4/HCPCS,Home sleep test/type 2 Porta,,Fee Schedule,1310.40
Aetna,PPO,G0399,CPT4/HCPCS,Home sleep test/type 3 Porta,,Fee Schedule,982.80
Aetna,PPO,G0400,CPT4/HCPCS,Home sleep test/type 4 Porta,,Fee Schedule,819.00
Aetna,PPO,G0413,CPT4/HCPCS,Pelvic ring fracture uni/bil,,Grouper Rate,6840.00
Aetna,PPO,G0448,CPT4/HCPCS,Place perm pacing cardiovert,,Grouper Rate,5856.00
Aetna,PPO,G0455,CPT4/HCPCS,Fecal microbiota prep instil,,Grouper Rate,2002.00
Aetna,PPO,G0516,CPT4/HCPCS,Insert drug del implant, >=4,,Grouper Rate,2002.00
Aetna,PPO,G0517,CPT4/HCPCS,Remove drug implant,,Grouper Rate,2002.00
Aetna,PPO,G0518,CPT4/HCPCS,Remove w insert drug implant,,Grouper Rate,2002.00
Aetna,PPO,J0129,CPT4/HCPCS,Abatacept injection,,Fee Schedule,465.36
Aetna,PPO,J0594,CPT4/HCPCS,Busulfan injection,,Fee Schedule,41.49
Aetna,PPO,J0881,CPT4/HCPCS,Darbepoetin alfa, non-esrd,,Fee Schedule,32.42
Aetna,PPO,J0885,CPT4/HCPCS,Epoetin alfa, non-esrd,,Fee Schedule,89.62
Aetna,PPO,J0894,CPT4/HCPCS,Decitabine injection,,Fee Schedule,36.54
Aetna,PPO,J1190,CPT4/HCPCS,Dexrazoxane HCl injection,,Fee Schedule,1675.80
Aetna,PPO,J1447,CPT4/HCPCS,Inj tbo filgrastim 1 microg,,Fee Schedule,4.53
Aetna,PPO,J2430,CPT4/HCPCS,Pamidronate disodium /30 MG,,Fee Schedule,93.82
Aetna,PPO,J8521,CPT4/HCPCS,Capecitabine, oral, 500 mg,,Fee Schedule,23.18
Aetna,PPO,J8530,CPT4/HCPCS,Cyclophosphamide oral 25 MG,,Fee Schedule,22.51
Aetna,PPO,J8540,CPT4/HCPCS,Oral dexamethasone,,Fee Schedule,0.16
Aetna,PPO,J8560,CPT4/HCPCS,Etoposide oral 50 MG,,Fee Schedule,638.56
Aetna,PPO,J8565,CPT4/HCPCS,Gefitinib oral,,Fee Schedule,2172.15
Aetna,PPO,J8600,CPT4/HCPCS,Melphalan oral 2 MG,,Fee Schedule,76.60
Aetna,PPO,J8610,CPT4/HCPCS,Methotrexate oral 2.5 mg,,Fee Schedule,1.93
Aetna,PPO,J8700,CPT4/HCPCS,Temozolomide,,Fee Schedule,7.72
Aetna,PPO,J9000,CPT4/HCPCS,Doxorubicin hcl injection,,Fee Schedule,24.36
Aetna,PPO,J9015,CPT4/HCPCS,Aldesleukin injection,,Fee Schedule,39184.90
Aetna,PPO,J9017,CPT4/HCPCS,Arsenic trioxide injection,,Fee Schedule,373.88
Aetna,PPO,J9019,CPT4/HCPCS,Erwinaze injection,,Fee Schedule,3519.34
Aetna,PPO,J9020,CPT4/HCPCS,Asparaginase, NOS,,Fee Schedule,509.54
Aetna,PPO,J9025,CPT4/HCPCS,Azacitidine injection,,Fee Schedule,8.65
Aetna,PPO,J9027,CPT4/HCPCS,Clofarabine injection,,Fee Schedule,459.98
Aetna,PPO,J9031,CPT4/HCPCS,Bcg live intravesical vac,,Fee Schedule,1314.09
Aetna,PPO,J9032,CPT4/HCPCS,Injection, belinostat, 10mg,,Fee Schedule,346.41
Aetna,PPO,J9035,CPT4/HCPCS,Bevacizumab injection,,Fee Schedule,684.18
Aetna,PPO,J9039,CPT4/HCPCS,Injection, blinatumomab,,Fee Schedule,961.63
Aetna,PPO,J9040,CPT4/HCPCS,Bleomycin sulfate injection,,Fee Schedule,192.27
Aetna,PPO,J9041,CPT4/HCPCS,Inj., velcade 0.1 mg,,Fee Schedule,380.52
Aetna,PPO,J9042,CPT4/HCPCS,Brentuximab vedotin inj,,Fee Schedule,1436.98
Aetna,PPO,J9045,CPT4/HCPCS,Carboplatin injection,,Fee Schedule,22.84
Aetna,PPO,J9047,CPT4/HCPCS,Injection, carfilzomib, 1 mg,,Fee Schedule,318.52
Aetna,PPO,J9050,CPT4/HCPCS,Carmustine injection,,Fee Schedule,22216.40
Aetna,PPO,J9055,CPT4/HCPCS,Cetuximab injection,,Fee Schedule,536.25
Aetna,PPO,J9060,CPT4/HCPCS,Cisplatin 10 MG injection,,Fee Schedule,16.38
Aetna,PPO,J9065,CPT4/HCPCS,Inj cladribine per 1 MG,,Fee Schedule,171.19
Aetna,PPO,J9070,CPT4/HCPCS,Cyclophosphamide 100 MG inj,,Fee Schedule,281.98
Aetna,PPO,J9100,CPT4/HCPCS,Cytarabine hcl 100 MG inj,,Fee Schedule,6.80
Aetna,PPO,J9120,CPT4/HCPCS,Dactinomycin injection,,Fee Schedule,9387.16
Aetna,PPO,J9130,CPT4/HCPCS,Dacarbazine 100 mg inj,,Fee Schedule,34.52
Aetna,PPO,J9150,CPT4/HCPCS,Daunorubicin injection,,Fee Schedule,410.59
Aetna,PPO,J9151,CPT4/HCPCS,Daunorubicin citrate inj,,Fee Schedule,1924.27
Aetna,PPO,J9160,CPT4/HCPCS,Denileukin diftitox inj,,Fee Schedule,12993.03
Aetna,PPO,J9165,CPT4/HCPCS,Diethylstilbestrol injection,,Fee Schedule,105.75
Aetna,PPO,J9175,CPT4/HCPCS,Elliotts b solution per ml,,Fee Schedule,75.26
Aetna,PPO,J9178,CPT4/HCPCS,Inj, epirubicin hcl, 2 mg,,Fee Schedule,9.49
Aetna,PPO,J9181,CPT4/HCPCS,Etoposide injection,,Fee Schedule,5.29
Aetna,PPO,J9185,CPT4/HCPCS,Fludarabine phosphate inj,,Fee Schedule,406.30
Aetna,PPO,J9190,CPT4/HCPCS,Fluorouracil injection,,Fee Schedule,12.85
Aetna,PPO,J9200,CPT4/HCPCS,Floxuridine injection,,Fee Schedule,724.33
Aetna,PPO,J9201,CPT4/HCPCS,In gemcitabine hcl nos 200mg,,Fee Schedule,35.28
Aetna,PPO,J9202,CPT4/HCPCS,Goserelin acetate implant,,Fee Schedule,4275.76
Aetna,PPO,J9206,CPT4/HCPCS,Irinotecan injection,,Fee Schedule,21.00
Aetna,PPO,J9208,CPT4/HCPCS,Ifosfamide injection,,Fee Schedule,226.46
Aetna,PPO,J9209,CPT4/HCPCS,Mesna injection,,Fee Schedule,18.81
Aetna,PPO,J9211,CPT4/HCPCS,Idarubicin hcl injection,,Fee Schedule,308.02
Aetna,PPO,J9212,CPT4/HCPCS,Interferon alfacon-1 inj,,Fee Schedule,80.80
Aetna,PPO,J9213,CPT4/HCPCS,Interferon alfa-2a inj,,Fee Schedule,355.15
Aetna,PPO,J9214,CPT4/HCPCS,Interferon alfa-2b inj,,Fee Schedule,290.22
Aetna,PPO,J9215,CPT4/HCPCS,Interferon alfa-n3 inj,,Fee Schedule,252.00
Aetna,PPO,J9216,CPT4/HCPCS,Interferon gamma 1-b inj,,Fee Schedule,57399.38
Aetna,PPO,J9217,CPT4/HCPCS,Leuprolide acetate suspnsion,,Fee Schedule,1951.90
Aetna,PPO,J9218,CPT4/HCPCS,Leuprolide acetate injeciton,,Fee Schedule,85.93
Aetna,PPO,J9219,CPT4/HCPCS,Leuprolide acetate implant,,Fee Schedule,33603.78
Aetna,PPO,J9225,CPT4/HCPCS,Vantas implant,,Fee Schedule,34952.31
Aetna,PPO,J9230,CPT4/HCPCS,Mechlorethamine hcl inj,,Fee Schedule,2591.14
Aetna,PPO,J9245,CPT4/HCPCS,Inj melpha hydroch nos 50 mg,,Fee Schedule,5373.64
Aetna,PPO,J9250,CPT4/HCPCS,Methotrexate sodium inj,,Fee Schedule,2.10
Aetna,PPO,J9260,CPT4/HCPCS,Methotrexate sodium inj,,Fee Schedule,21.08
Aetna,PPO,J9261,CPT4/HCPCS,Nelarabine injection,,Fee Schedule,1295.61
Aetna,PPO,J9262,CPT4/HCPCS,Inj, omacetaxine mep, 0.01mg,,Fee Schedule,24.69
Aetna,PPO,J9263,CPT4/HCPCS,Oxaliplatin,,Fee Schedule,1.26
Aetna,PPO,J9264,CPT4/HCPCS,Paclitaxel protein bound,,Fee Schedule,106.51
Aetna,PPO,J9266,CPT4/HCPCS,Pegaspargase injection,,Fee Schedule,149077.65
Aetna,PPO,J9267,CPT4/HCPCS,Paclitaxel injection,,Fee Schedule,1.17
Aetna,PPO,J9268,CPT4/HCPCS,Pentostatin injection,,Fee Schedule,17895.78
Aetna,PPO,J9270,CPT4/HCPCS,Plicamycin (mithramycin) inj,,Fee Schedule,688.38
Aetna,PPO,J9271,CPT4/HCPCS,Inj pembrolizumab,,Fee Schedule,426.46
Aetna,PPO,J9280,CPT4/HCPCS,Mitomycin injection,,Fee Schedule,677.79
Aetna,PPO,J9293,CPT4/HCPCS,Mitoxantrone hydrochl / 5 MG,,Fee Schedule,235.87
Aetna,PPO,J9299,CPT4/HCPCS,Injection, nivolumab,,Fee Schedule,238.89
Aetna,PPO,J9301,CPT4/HCPCS,Obinutuzumab inj,,Fee Schedule,538.86
Aetna,PPO,J9305,CPT4/HCPCS,Inj. pemetrexed nos 10mg,,Fee Schedule,600.60
Aetna,PPO,J9306,CPT4/HCPCS,Injection, pertuzumab, 1 mg,,Fee Schedule,107.01
Aetna,PPO,J9308,CPT4/HCPCS,Injection, ramucirumab,,Fee Schedule,506.26
Aetna,PPO,J9310,CPT4/HCPCS,Rituximab injection,,Fee Schedule,7860.38
Aetna,PPO,J9320,CPT4/HCPCS,Streptozocin injection,,Fee Schedule,2991.91
Aetna,PPO,J9340,CPT4/HCPCS,Thiotepa injection,,Fee Schedule,3495.49
Aetna,PPO,J9351,CPT4/HCPCS,Topotecan injection,,Fee Schedule,8.31
Aetna,PPO,J9354,CPT4/HCPCS,Inj, ado-trastuzumab emt 1mg,,Fee Schedule,272.41
Aetna,PPO,J9355,CPT4/HCPCS,Inj trastuzumab excl biosimi,,Fee Schedule,898.04
Aetna,PPO,J9357,CPT4/HCPCS,Valrubicin injection,,Fee Schedule,12101.20
Aetna,PPO,J9360,CPT4/HCPCS,Vinblastine sulfate inj,,Fee Schedule,32.92
Aetna,PPO,J9370,CPT4/HCPCS,Vincristine sulfate 1 MG inj,,Fee Schedule,41.41
Aetna,PPO,J9371,CPT4/HCPCS,Inj, vincristine sul lip 1mg,,Fee Schedule,26095.35
Aetna,PPO,J9390,CPT4/HCPCS,Vinorelbine tartrate inj,,Fee Schedule,101.47
Aetna,PPO,J9395,CPT4/HCPCS,Injection, Fulvestrant,,Fee Schedule,720.80
Aetna,PPO,J9400,CPT4/HCPCS,Inj, ziv-aflibercept, 1mg,,Fee Schedule,71.23
Aetna,PPO,J9600,CPT4/HCPCS,Porfimer sodium injection,,Fee Schedule,176029.05
Aetna,PPO,P9612,CPT4/HCPCS,Catheterize for urine spec,,Grouper Rate,2002.00
Aetna,PPO,P9615,CPT4/HCPCS,Urine specimen collect mult,,Grouper Rate,2002.00
Aetna,PPO,Q0083,CPT4/HCPCS,Chemo by other than infusion,,Fee Schedule,692.16
Aetna,PPO,Q0084,CPT4/HCPCS,Chemotherapy by infusion,,Fee Schedule,298.78
Aetna,PPO,Q0085,CPT4/HCPCS,Chemo by both infusion and o,,Fee Schedule,1405.15
Aetna,PPO,Q2017,CPT4/HCPCS,Teniposide, 50 mg,,Fee Schedule,20882.14
Aetna,PPO,Q2050,CPT4/HCPCS,Doxorubicin inj 10mg,,Fee Schedule,2507.14
Aetna,PPO,Q9951,CPT4/HCPCS,LOCM >= 400 mg/ml iodine,1ml,,Fee Schedule,10.08
Aetna,PPO,Q9953,CPT4/HCPCS,Inj Fe-based MR contrast,1ml,,Fee Schedule,122.22
Aetna,PPO,Q9954,CPT4/HCPCS,Oral MR contrast, 100 ml,,Fee Schedule,87.61
Aetna,PPO,Q9958,CPT4/HCPCS,HOCM <=149 mg/ml iodine, 1ml,,Fee Schedule,0.67
Aetna,PPO,Q9959,CPT4/HCPCS,HOCM 150-199mg/ml iodine,1ml,,Fee Schedule,0.75
Aetna,PPO,Q9960,CPT4/HCPCS,HOCM 200-249mg/ml iodine,1ml,,Fee Schedule,1.42
Aetna,PPO,Q9961,CPT4/HCPCS,HOCM 250-299mg/ml iodine,1ml,,Fee Schedule,2.10
Aetna,PPO,Q9962,CPT4/HCPCS,HOCM 300-349mg/ml iodine,1ml,,Fee Schedule,2.18
Aetna,PPO,Q9963,CPT4/HCPCS,HOCM 350-399mg/ml iodine,1ml,,Fee Schedule,1.68
Aetna,PPO,Q9964,CPT4/HCPCS,HOCM>= 400mg/ml iodine, 1ml,,Fee Schedule,2.68
Aetna,PPO,Q9965,CPT4/HCPCS,LOCM 100-199mg/ml iodine,1ml,,Fee Schedule,7.47
Aetna,PPO,Q9966,CPT4/HCPCS,LOCM 200-299mg/ml iodine,1ml,,Fee Schedule,2.77
Aetna,PPO,Q9967,CPT4/HCPCS,LOCM 300-399mg/ml iodine,1ml,,Fee Schedule,1.00
Aetna,PPO,Q9969,CPT4/HCPCS,Non-HEU TC-99M add-on/dose,,Fee Schedule,8.40
Aetna,PPO,Q9982,CPT4/HCPCS,flutemetamol f18 diagnostic,,Fee Schedule,27609.12
Aetna,PPO,Q9983,CPT4/HCPCS,Florbetaben f18 diagnostic,,Fee Schedule,23425.92
Aetna,PPO,S0088,CPT4/HCPCS,Imatinib 100 mg,,Fee Schedule,36.70
Aetna,PPO,S0108,CPT4/HCPCS,Mercaptopurine 50 mg,,Fee Schedule,25.20
Aetna,PPO,S0117,CPT4/HCPCS,Tretinoin topical 5 g,,Fee Schedule,73.58
Aetna,PPO,S0145,CPT4/HCPCS,Peg interferon alfa-2A/180,,Fee Schedule,8546.24
Aetna,PPO,S0148,CPT4/HCPCS,Peg interferon alfa-2b/10,,Fee Schedule,1258.57
Aetna,PPO,S0156,CPT4/HCPCS,Exemestane, 25 mg,,Fee Schedule,72.49
Aetna,PPO,S0170,CPT4/HCPCS,Anastrozole 1 mg,,Fee Schedule,4.03
Aetna,PPO,S0172,CPT4/HCPCS,Chlorambucil 2 mg,,Fee Schedule,203.53
Aetna,PPO,S0175,CPT4/HCPCS,Flutamide 125 mg,,Fee Schedule,13.02
Aetna,PPO,S0176,CPT4/HCPCS,Hydroxyurea 500 mg,,Fee Schedule,7.14
Aetna,PPO,S0178,CPT4/HCPCS,Lomustine 10 mg,,Fee Schedule,761.04
Aetna,PPO,S0179,CPT4/HCPCS,Megestrol 20 mg,,Fee Schedule,3.10
Aetna,PPO,S0182,CPT4/HCPCS,Procarbazine, oral,,Fee Schedule,827.40
Aetna,PPO,S0183,CPT4/HCPCS,Prochlorperazine 5 mg,,Fee Schedule,3.02
Aetna,PPO,S0187,CPT4/HCPCS,Tamoxifen 10 mg,,Fee Schedule,3.19
Aetna,PPO,S2083,CPT4/HCPCS,Adjustment gastric band,,Grouper Rate,2002.00
Aetna,PPO,S2095,CPT4/HCPCS,Transcath emboliz microspher,,Grouper Rate,5856.00
Aetna,PPO,S2225,CPT4/HCPCS,Myringotomy laser-assist,,Grouper Rate,5856.00
Aetna,PPO,,,NICU/Newborn - Level I,,Per Diem,1112.00
Aetna,PPO,,,Medical Surgical,,Per Diem,3937.00
Aetna,PPO,,,ICU,,Per Diem,5809.00
Aetna,PPO,,,NICU/Newborn - Level II,,Per Diem,5809.00
Aetna,PPO,,,NICU/Newborn - Level III,,Per Diem,5809.00
Aetna,PPO,,,NICU/Newborn - Level IV,,Per Diem,5809.00
Aetna,PPO,,,Telemetry,,Per Diem,5809.00
Blue Cross,EPO,0048T,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,Grouper Rate,8012.00
Blue Cross,EPO,0050T,CPT4/HCPCS,REMOVAL CIRCULATION ASSIST,,Grouper Rate,5281.00
Blue Cross,EPO,0051T,CPT4/HCPCS,IMPLANT TOTAL HEART SYSTEM,,Grouper Rate,8841.00
Blue Cross,EPO,0052T,CPT4/HCPCS,REPLACE THRC UNIT HRT SYST,,Grouper Rate,8841.00
Blue Cross,EPO,0053T,CPT4/HCPCS,REPLACE IMPLANTABLE HRT SYST,,Grouper Rate,8841.00
Blue Cross,EPO,0054T,CPT4/HCPCS,BONE SRGRY CMPTR FLUOR IMAGE,,Grouper Rate,1678.00
Blue Cross,EPO,0055T,CPT4/HCPCS,BONE SRGRY CMPTR CT/MRI IMAG,,Grouper Rate,1678.88
Blue Cross,EPO,0071T,CPT4/HCPCS,US LEIOMYOMATA ABLATE <200,,Grouper Rate,1678.00
Blue Cross,EPO,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,Grouper Rate,1678.00
Blue Cross,EPO,0075T,CPT4/HCPCS,PERQ STENT/CHEST VERT ART,,Grouper Rate,6588.00
Blue Cross,EPO,0076T,CPT4/HCPCS,S&I STENT/CHEST VERT ART,,Grouper Rate,6588.00
Blue Cross,EPO,0078T,CPT4/HCPCS,ENDOVASC AORT REPR W/DEVICE,,Grouper Rate,8841.00
Blue Cross,EPO,0079T,CPT4/HCPCS,ENDOVASC VISC EXTNSN REPR,,Grouper Rate,5029.00
Blue Cross,EPO,0080T,CPT4/HCPCS,ENDOVASC AORT REPR RAD S&I,,Grouper Rate,8841.00
Blue Cross,EPO,0081T,CPT4/HCPCS,ENDOVASC VISC EXTNSN S&I,,Grouper Rate,5029.00
Blue Cross,EPO,0092T,CPT4/HCPCS,ARTIFIC DISC ADDL CERVICAL,,Grouper Rate,5783.00
Blue Cross,EPO,0095T,CPT4/HCPCS,RMVL ARTIFIC DISC ADDL CRVCL,,Grouper Rate,3544.00
Blue Cross,EPO,0098T,CPT4/HCPCS,REV ARTIFIC DISC ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,0099T,CPT4/HCPCS,IMPLANT CORNEAL RING,,Grouper Rate,1678.88
Blue Cross,EPO,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Grouper Rate,8012.00
Blue Cross,EPO,0101T,CPT4/HCPCS,EXTRACORP SHOCKWV TX HI ENRG,,Grouper Rate,1678.88
Blue Cross,EPO,0102T,CPT4/HCPCS,EXTRACORP SHOCKWV TX ANESTH,,Grouper Rate,3544.00
Blue Cross,EPO,0123T,CPT4/HCPCS,SCLERAL FISTULIZATION,,Grouper Rate,5783.00
Blue Cross,EPO,0124T,CPT4/HCPCS,CONJUNCTIVAL DRUG PLACEMENT,,Grouper Rate,5029.00
Blue Cross,EPO,0126T,CPT4/HCPCS,CHD RISK IMT STUDY,,Grouper Rate,1678.00
Blue Cross,EPO,0169T,CPT4/HCPCS,PLACE STEREO CATH BRAIN,,Grouper Rate,3544.00
Blue Cross,EPO,0171T,CPT4/HCPCS,LUMBAR SPINE PROCES DISTRACT,,Grouper Rate,5281.00
Blue Cross,EPO,0172T,CPT4/HCPCS,LUMBAR SPINE PROCESS ADDL,,Grouper Rate,5281.00
Blue Cross,EPO,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Grouper Rate,1678.00
Blue Cross,EPO,0205T,CPT4/HCPCS,INIRS EACH VESSEL ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,EPO,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,EPO,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,EPO,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,EPO,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,EPO,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,EPO,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,Grouper Rate,1678.88
Blue Cross,EPO,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,Grouper Rate,1678.88
Blue Cross,EPO,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Grouper Rate,1678.88
Blue Cross,EPO,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,0226T,CPT4/HCPCS,ANOSCOPY HRA W/SPEC COLLECT,,Grouper Rate,1678.00
Blue Cross,EPO,0227T,CPT4/HCPCS,ANOSCOPY HRA W/BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,EPO,0229T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,EPO,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,EPO,0231T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,EPO,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Grouper Rate,5029.00
Blue Cross,EPO,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,Grouper Rate,5029.00
Blue Cross,EPO,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Grouper Rate,5029.00
Blue Cross,EPO,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Grouper Rate,5029.00
Blue Cross,EPO,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,Grouper Rate,5029.00
Blue Cross,EPO,0245T,CPT4/HCPCS,OPEN TX RIB FX 1-2 RIBS,,Grouper Rate,1678.88
Blue Cross,EPO,0246T,CPT4/HCPCS,OPN TX RIB FX 3-4 RIBS,,Grouper Rate,3544.00
Blue Cross,EPO,0247T,CPT4/HCPCS,OPN TX RIB FX 5-6 RIBS,,Grouper Rate,3544.00
Blue Cross,EPO,0248T,CPT4/HCPCS,OPEN TX RIB FX 7/> RIBS,,Grouper Rate,3544.00
Blue Cross,EPO,0249T,CPT4/HCPCS,LIGATION HEMORRHOID W/US,,Grouper Rate,1678.88
Blue Cross,EPO,0250T,CPT4/HCPCS,INSERT BRONCHIAL VALVE,,Grouper Rate,1678.00
Blue Cross,EPO,0251T,CPT4/HCPCS,REMOV BRONCHIAL VALVE,,Grouper Rate,1678.88
Blue Cross,EPO,0252T,CPT4/HCPCS,REMOV BRONCH VALVE ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,0254T,CPT4/HCPCS,EVASC RPR ILIAC ART BIFUR,,Grouper Rate,5281.00
Blue Cross,EPO,0256T,CPT4/HCPCS,EVASC AORTIC HRT VALVE,,Grouper Rate,6588.00
Blue Cross,EPO,0262T,CPT4/HCPCS,IMPLTJ PULM VLV EVASC APPR,,Grouper Rate,8012.00
Blue Cross,EPO,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,Grouper Rate,3544.00
Blue Cross,EPO,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,Grouper Rate,3544.00
Blue Cross,EPO,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,Grouper Rate,1678.88
Blue Cross,EPO,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,Grouper Rate,3544.00
Blue Cross,EPO,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,Grouper Rate,3544.00
Blue Cross,EPO,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,Grouper Rate,3544.00
Blue Cross,EPO,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,Grouper Rate,3544.00
Blue Cross,EPO,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,Grouper Rate,3544.00
Blue Cross,EPO,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,Grouper Rate,3544.00
Blue Cross,EPO,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,Grouper Rate,1678.88
Blue Cross,EPO,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,Grouper Rate,1678.88
Blue Cross,EPO,0276T,CPT4/HCPCS,BRONCH THERMOPLASTY 1 LOBE,,Grouper Rate,1678.88
Blue Cross,EPO,0277T,CPT4/HCPCS,BRONCH THERMOPLASTY LOBES,,Grouper Rate,1678.88
Blue Cross,EPO,0281T,CPT4/HCPCS,LAA CLOSURE W/IMPLANT,,Grouper Rate,5783.00
Blue Cross,EPO,0282T,CPT4/HCPCS,PERIPH FIELD STIMUL TRIAL,,Grouper Rate,1678.88
Blue Cross,EPO,0283T,CPT4/HCPCS,PERIPH FIELD STIMUL PERM,,Grouper Rate,1678.88
Blue Cross,EPO,0284T,CPT4/HCPCS,PERIPH FIELD STIMUL REVISE,,Grouper Rate,1678.88
Blue Cross,EPO,0288T,CPT4/HCPCS,ANOSCOPY W/RF DELIVERY,,Grouper Rate,1678.00
Blue Cross,EPO,0289T,CPT4/HCPCS,LASER INC FOR PKP/LKP DONOR,,Grouper Rate,6588.00
Blue Cross,EPO,0290T,CPT4/HCPCS,LASER INC FOR PKP/LKP RECIP,,Grouper Rate,6588.00
Blue Cross,EPO,0293T,CPT4/HCPCS,INS LT ATRL PRESS MONITOR,,Grouper Rate,6588.00
Blue Cross,EPO,0294T,CPT4/HCPCS,INS LT ATRL MONT PRES LEAD,,Grouper Rate,5281.00
Blue Cross,EPO,0299T,CPT4/HCPCS,ESW WOUND HEALING INIT WOUND,,Grouper Rate,1678.88
Blue Cross,EPO,0300T,CPT4/HCPCS,ESW WOUND HEALING ADDL WOUND,,Grouper Rate,1678.88
Blue Cross,EPO,0301T,CPT4/HCPCS,MW THERAPY FOR BREAST TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,0302T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS COMPL,,Grouper Rate,3544.00
Blue Cross,EPO,0303T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS ELTRD,,Grouper Rate,3544.00
Blue Cross,EPO,0304T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,0307T,CPT4/HCPCS,RMVL ICAR ISCHM MNTRNG DVCE,,Grouper Rate,3544.00
Blue Cross,EPO,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Grouper Rate,5029.00
Blue Cross,EPO,0309T,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L4/L5,,Grouper Rate,5783.00
Blue Cross,EPO,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Grouper Rate,5281.00
Blue Cross,EPO,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Grouper Rate,5281.00
Blue Cross,EPO,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Grouper Rate,5281.00
Blue Cross,EPO,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Grouper Rate,5281.00
Blue Cross,EPO,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Grouper Rate,5281.00
Blue Cross,EPO,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,Grouper Rate,5281.00
Blue Cross,EPO,0318T,CPT4/HCPCS,REPLACE AORTIC VALVE TTHORAC,,Grouper Rate,6588.00
Blue Cross,EPO,0319T,CPT4/HCPCS,INSERT SUBQ DEFIB W/ELTRD,,Grouper Rate,5029.00
Blue Cross,EPO,0320T,CPT4/HCPCS,INSERT SUBQ DEFIB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,EPO,0321T,CPT4/HCPCS,INSERT SUBQ DEFIB PLS GEN,,Grouper Rate,6588.00
Blue Cross,EPO,0322T,CPT4/HCPCS,RMVL SUBQ DEFIB PLS GEN,,Grouper Rate,5029.00
Blue Cross,EPO,0323T,CPT4/HCPCS,RMVL & REPLC SUBQ PLS GEN,,Grouper Rate,1678.88
Blue Cross,EPO,0324T,CPT4/HCPCS,RMVL SUBQ DEFIB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,EPO,0325T,CPT4/HCPCS,REPOS SUBQ DEFIB ELTRD &/GEN,,Grouper Rate,1678.88
Blue Cross,EPO,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Grouper Rate,5281.00
Blue Cross,EPO,0336T,CPT4/HCPCS,LAP ABLAT UTERINE FIBROIDS,,Grouper Rate,5029.00
Blue Cross,EPO,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,Grouper Rate,3544.00
Blue Cross,EPO,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,Grouper Rate,3544.00
Blue Cross,EPO,0340T,CPT4/HCPCS,ABLATE PULM TUMORS EXTNSN,,Grouper Rate,5783.00
Blue Cross,EPO,0343T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,8841.00
Blue Cross,EPO,0344T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,8841.00
Blue Cross,EPO,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,8841.00
Blue Cross,EPO,0375T,CPT4/HCPCS,TOTAL DISC ARTHRP ANT APPR,,Grouper Rate,5783.00
Blue Cross,EPO,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,5029.00
Blue Cross,EPO,0377T,CPT4/HCPCS,ANOSCPY INJ AGENT FOR INCONT,,Grouper Rate,1678.00
Blue Cross,EPO,0387T,CPT4/HCPCS,LEADLESS PM INS/RPL VENTR,,Grouper Rate,3544.00
Blue Cross,EPO,0388T,CPT4/HCPCS,LEADLESS PM REMOVE VENTR,,Grouper Rate,1678.88
Blue Cross,EPO,0392T,CPT4/HCPCS,LAP ES SPH AUGMENT DEV PLACE,,Grouper Rate,5029.00
Blue Cross,EPO,0393T,CPT4/HCPCS,ES SPH AUGMNT DEVICE REMOVAL,,Grouper Rate,1678.88
Blue Cross,EPO,0396T,CPT4/HCPCS,INTRAOP KINETIC BALNCE SENSR,,Grouper Rate,1678.00
Blue Cross,EPO,0397T,CPT4/HCPCS,ERCP W/OPTICAL ENDOMICROSCPY,,Grouper Rate,1678.88
Blue Cross,EPO,0398T,CPT4/HCPCS,MRGFUS STRTCTC LES ABLTJ,,Grouper Rate,1678.00
Blue Cross,EPO,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Grouper Rate,1678.00
Blue Cross,EPO,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Grouper Rate,1678.00
Blue Cross,EPO,0406T,CPT4/HCPCS,SIN NDSC PLMT DRG ELUT MPLNT,,Grouper Rate,3544.00
Blue Cross,EPO,0407T,CPT4/HCPCS,SIN NDSC PLMT DRG ELUT MPLNT,,Grouper Rate,3544.00
Blue Cross,EPO,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Grouper Rate,3544.00
Blue Cross,EPO,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Grouper Rate,1678.88
Blue Cross,EPO,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Grouper Rate,3544.00
Blue Cross,EPO,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Grouper Rate,3544.00
Blue Cross,EPO,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Grouper Rate,1678.88
Blue Cross,EPO,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Grouper Rate,1678.88
Blue Cross,EPO,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Grouper Rate,1678.88
Blue Cross,EPO,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Grouper Rate,1678.88
Blue Cross,EPO,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Grouper Rate,3544.00
Blue Cross,EPO,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,3544.00
Blue Cross,EPO,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,3544.00
Blue Cross,EPO,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Grouper Rate,3544.00
Blue Cross,EPO,0424T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA COMPL,,Grouper Rate,1678.88
Blue Cross,EPO,0425T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA SEN LD,,Grouper Rate,1678.00
Blue Cross,EPO,0426T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA STM LD,,Grouper Rate,1678.00
Blue Cross,EPO,0427T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA PLS GN,,Grouper Rate,1678.88
Blue Cross,EPO,0428T,CPT4/HCPCS,RMVL NSTIM APNEA PLS GEN,,Grouper Rate,1678.00
Blue Cross,EPO,0429T,CPT4/HCPCS,RMVL NSTIM APNEA SEN LD,,Grouper Rate,1678.00
Blue Cross,EPO,0430T,CPT4/HCPCS,RMVL NSTIM APNEA STIMJ LD,,Grouper Rate,1678.00
Blue Cross,EPO,0431T,CPT4/HCPCS,RMVL/RPLC NSTIM APNEA PLS GN,,Grouper Rate,1678.88
Blue Cross,EPO,0432T,CPT4/HCPCS,REPOS NSTIM APNEA STIMJ LD,,Grouper Rate,1678.00
Blue Cross,EPO,0433T,CPT4/HCPCS,REPOS NSTIM APNEA SENSING LD,,Grouper Rate,1678.00
Blue Cross,EPO,0437T,CPT4/HCPCS,IMPLTJ SYNTH RNFCMT ABDL WAL,,Grouper Rate,1678.00
Blue Cross,EPO,0438T,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Grouper Rate,1678.00
Blue Cross,EPO,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Grouper Rate,1678.00
Blue Cross,EPO,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Grouper Rate,1678.00
Blue Cross,EPO,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Grouper Rate,1678.00
Blue Cross,EPO,0444T,CPT4/HCPCS,1ST PLMT DRUG ELUT OC INS,,Grouper Rate,1678.00
Blue Cross,EPO,0445T,CPT4/HCPCS,SBSQT PLMT DRUG ELUT OC INS,,Grouper Rate,1678.00
Blue Cross,EPO,0446T,CPT4/HCPCS,INSJ IMPLTBL GLUCOSE SENSOR,,Grouper Rate,3544.00
Blue Cross,EPO,0447T,CPT4/HCPCS,RMVL IMPLTBL GLUCOSE SENSOR,,Grouper Rate,1678.00
Blue Cross,EPO,0448T,CPT4/HCPCS,REMVL INSJ IMPLTBL GLUC SENS,,Grouper Rate,3544.00
Blue Cross,EPO,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Grouper Rate,1678.88
Blue Cross,EPO,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Grouper Rate,1678.88
Blue Cross,EPO,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,Grouper Rate,5029.00
Blue Cross,EPO,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,Grouper Rate,5029.00
Blue Cross,EPO,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Grouper Rate,5029.00
Blue Cross,EPO,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Grouper Rate,5029.00
Blue Cross,EPO,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,Grouper Rate,3544.00
Blue Cross,EPO,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,Grouper Rate,3544.00
Blue Cross,EPO,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Grouper Rate,3544.00
Blue Cross,EPO,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Grouper Rate,3544.00
Blue Cross,EPO,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,Grouper Rate,3544.00
Blue Cross,EPO,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Grouper Rate,1678.88
Blue Cross,EPO,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,Grouper Rate,5029.00
Blue Cross,EPO,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,Grouper Rate,1678.88
Blue Cross,EPO,0466T,CPT4/HCPCS,INSJ CH WAL RESPIR ELTRD/RA,,Grouper Rate,1678.00
Blue Cross,EPO,0467T,CPT4/HCPCS,REVJ/RPLMNT CH RESPIR ELTRD,,Grouper Rate,1678.88
Blue Cross,EPO,0468T,CPT4/HCPCS,RMVL CH WAL RESPIR ELTRD/RA,,Grouper Rate,1678.88
Blue Cross,EPO,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Grouper Rate,1678.00
Blue Cross,EPO,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Grouper Rate,1678.00
Blue Cross,EPO,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Grouper Rate,1678.88
Blue Cross,EPO,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,Grouper Rate,8012.00
Blue Cross,EPO,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,Grouper Rate,8012.00
Blue Cross,EPO,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Grouper Rate,3544.00
Blue Cross,EPO,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Grouper Rate,3544.00
Blue Cross,EPO,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Grouper Rate,1678.00
Blue Cross,EPO,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Grouper Rate,1678.00
Blue Cross,EPO,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,Grouper Rate,3544.00
Blue Cross,EPO,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Grouper Rate,1678.88
Blue Cross,EPO,0505T,CPT4/HCPCS,EV FEMPOP ARTL REVSC,,Grouper Rate,5281.00
Blue Cross,EPO,0510T,CPT4/HCPCS,RMVL SINUS TARSI IMPLANT,,Grouper Rate,3544.00
Blue Cross,EPO,0511T,CPT4/HCPCS,RMVL&RINSJ SINUS TARSI IMPLT,,Grouper Rate,5281.00
Blue Cross,EPO,0512T,CPT4/HCPCS,ESW INTEG WND HLG 1ST WND,,Grouper Rate,1678.88
Blue Cross,EPO,0513T,CPT4/HCPCS,ESW INTEG WND HLG EA ADDL,,Grouper Rate,1678.88
Blue Cross,EPO,0514T,CPT4/HCPCS,INTRAOP VIS AXIS ID PT FIXJ,,Grouper Rate,1678.00
Blue Cross,EPO,0515T,CPT4/HCPCS,INSJ WCS LV COMPL SYS,,Grouper Rate,5281.00
Blue Cross,EPO,0516T,CPT4/HCPCS,INSJ WCS LV ELTRD ONLY,,Grouper Rate,5281.00
Blue Cross,EPO,0517T,CPT4/HCPCS,INSJ WCS LV PG COMPNT,,Grouper Rate,5281.00
Blue Cross,EPO,0518T,CPT4/HCPCS,RMVL PG COMPNT WCS,,Grouper Rate,1678.88
Blue Cross,EPO,0519T,CPT4/HCPCS,RMVL & RPLCMT PG COMPNT WCS,,Grouper Rate,5281.00
Blue Cross,EPO,0520T,CPT4/HCPCS,RMVL&RPLCMT PG WCS NEW ELTRD,,Grouper Rate,5281.00
Blue Cross,EPO,0524T,CPT4/HCPCS,EV CATH DIR CHEM ABLTJ W/IMG,,Grouper Rate,3544.00
Blue Cross,EPO,0525T,CPT4/HCPCS,INSJ/RPLCMT COMPL IIMS,,Grouper Rate,3544.00
Blue Cross,EPO,0526T,CPT4/HCPCS,INSJ/RPLCMT IIMS ELTRD ONLY,,Grouper Rate,3544.00
Blue Cross,EPO,0527T,CPT4/HCPCS,INSJ/RPLCMT IIMS IMPLT MNTR,,Grouper Rate,3544.00
Blue Cross,EPO,0530T,CPT4/HCPCS,REMOVAL COMPLETE IIMS,,Grouper Rate,3544.00
Blue Cross,EPO,0531T,CPT4/HCPCS,REMOVAL IIMS ELECTRODE ONLY,,Grouper Rate,3544.00
Blue Cross,EPO,0532T,CPT4/HCPCS,REMOVAL IIMS IMPLT MNTR ONLY,,Grouper Rate,3544.00
Blue Cross,EPO,0537T,CPT4/HCPCS,BLD DRV T LYMPHCYT CAR-T CLL,,Grouper Rate,1678.00
Blue Cross,EPO,0538T,CPT4/HCPCS,BLD DRV T LYMPHCYT PREP TRNS,,Grouper Rate,1678.00
Blue Cross,EPO,0539T,CPT4/HCPCS,RECEIPT&PREP CAR-T CLL ADMN,,Grouper Rate,1678.00
Blue Cross,EPO,0540T,CPT4/HCPCS,CAR-T CLL ADMN AUTOLOGOUS,,Grouper Rate,1678.88
Blue Cross,EPO,0565T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS HRVG,,Grouper Rate,3544.00
Blue Cross,EPO,0566T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS NJX,,Grouper Rate,3544.00
Blue Cross,EPO,0567T,CPT4/HCPCS,PERM FLP TUBE OCCLS W/IMPLT,,Grouper Rate,3544.00
Blue Cross,EPO,0568T,CPT4/HCPCS,INTRO MIX SALINE&AIR F/SSG,,Grouper Rate,1678.00
Blue Cross,EPO,0569T,CPT4/HCPCS,TTVR PERQ APPR 1ST PROSTH,,Grouper Rate,8012.00
Blue Cross,EPO,0570T,CPT4/HCPCS,TTVR PERQ EA ADDL PROSTH,,Grouper Rate,8012.00
Blue Cross,EPO,0571T,CPT4/HCPCS,INSJ/RPLCMT ICDS SS ELTRD,,Grouper Rate,5281.00
Blue Cross,EPO,0572T,CPT4/HCPCS,INSERTION SS DFB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,EPO,0573T,CPT4/HCPCS,REMOVAL SS DFB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,EPO,0574T,CPT4/HCPCS,REPOS PREV SS IMPL DFB ELTRD,,Grouper Rate,1678.88
Blue Cross,EPO,0580T,CPT4/HCPCS,RMVL SS IMPL DFB PG ONLY,,Grouper Rate,5029.00
Blue Cross,EPO,0581T,CPT4/HCPCS,ABLTJ MAL BRST TUM PERQ CRTX,,Grouper Rate,3544.00
Blue Cross,EPO,0582T,CPT4/HCPCS,TRURL ABLTJ MAL PRST8 TISS,,Grouper Rate,5029.00
Blue Cross,EPO,0583T,CPT4/HCPCS,TMPST AUTO TUBE DLVR SYS,,Grouper Rate,1678.00
Blue Cross,EPO,0584T,CPT4/HCPCS,PERQ ISLET CELL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,EPO,0585T,CPT4/HCPCS,LAPS ISLET CELL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,EPO,0586T,CPT4/HCPCS,OPEN ISLET CELL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,EPO,0587T,CPT4/HCPCS,PERQ IMPLTJ/RPLCMT ISDNS PTN,,Grouper Rate,3544.00
Blue Cross,EPO,0588T,CPT4/HCPCS,REVISION/REMOVAL ISDNS PTN,,Grouper Rate,1678.88
Blue Cross,EPO,0DQP0ZZ,ICD10-PCS,Repair Rectum, Open Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0DQP8ZZ,ICD10-PCS,Repair Rectum, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,EPO,0DQR0ZZ,ICD10-PCS,Repair Anal Sphincter, Open Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0DQR4ZZ,ICD10-PCS,Repair Anal Sphincter, Percutaneous Endoscopic Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0Q820ZZ,ICD10-PCS,Division of Right Pelvic Bone, Open Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0Q834ZZ,ICD10-PCS,Division of Left Pelvic Bone, Perc Endo Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0TQB0ZZ,ICD10-PCS,Repair Bladder, Open Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0TQB8ZZ,ICD10-PCS,Repair Bladder, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,EPO,0TQD7ZZ,ICD10-PCS,Repair Urethra, Via Natural or Artificial Opening,,Fee Schedule,4303.00
Blue Cross,EPO,0TQD8ZZ,ICD10-PCS,Repair Urethra, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,EPO,0TQDXZZ,ICD10-PCS,Repair Urethra, External Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0UQ98ZZ,ICD10-PCS,Repair Uterus, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,EPO,0UQC0ZZ,ICD10-PCS,Repair Cervix, Open Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0UQC8ZZ,ICD10-PCS,Repair Cervix, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,EPO,0UQG8ZZ,ICD10-PCS,Repair Vagina, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,EPO,0UQGXZZ,ICD10-PCS,Repair Vagina, External Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0UQMXZZ,ICD10-PCS,Repair Vulva, External Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0W8NXZZ,ICD10-PCS,Division of Female Perineum, External Approach,,Fee Schedule,4303.00
Blue Cross,EPO,0WQNXZZ,ICD10-PCS,Repair Female Perineum, External Approach,,Fee Schedule,4303.00
Blue Cross,EPO,1,DRG,Heart transplant or implant of heart assist system w MCC,,Case Rate,479084.40
Blue Cross,EPO,10,DRG,Pancreas transplant,,Case Rate,59836.75
Blue Cross,EPO,100,DRG,Seizures w MCC,,Case Rate,30989.34
Blue Cross,EPO,10004,CPT4/HCPCS,FNA BX W/O IMG GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,10005,CPT4/HCPCS,FNA BX W/US GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,EPO,10006,CPT4/HCPCS,FNA BX W/US GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,10007,CPT4/HCPCS,FNA BX W/FLUOR GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,EPO,10008,CPT4/HCPCS,FNA BX W/FLUOR GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,10009,CPT4/HCPCS,FNA BX W/CT GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,EPO,10010,CPT4/HCPCS,FNA BX W/CT GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,10011,CPT4/HCPCS,FNA BX W/MR GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,EPO,10012,CPT4/HCPCS,FNA BX W/MR GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,EPO,10022,CPT4/HCPCS,FNA W/IMAGE,,Grouper Rate,1678.00
Blue Cross,EPO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Grouper Rate,1678.00
Blue Cross,EPO,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Grouper Rate,1678.00
Blue Cross,EPO,10036,CPT4/HCPCS,PERQ DEV SOFT TISS ADD IMAG,,Grouper Rate,1678.00
Blue Cross,EPO,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,1678.88
Blue Cross,EPO,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,1678.88
Blue Cross,EPO,101,DRG,Seizures w/o MCC,,Case Rate,14670.98
Blue Cross,EPO,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Grouper Rate,1678.00
Blue Cross,EPO,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Grouper Rate,1678.00
Blue Cross,EPO,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Grouper Rate,1678.88
Blue Cross,EPO,102,DRG,Headaches w MCC,,Case Rate,19049.11
Blue Cross,EPO,103,DRG,Headaches w/o MCC,,Case Rate,13698.42
Blue Cross,EPO,10900ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Open Approach,,Fee Schedule,4303.00
Blue Cross,EPO,10903ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Perc Approach,,Fee Schedule,4303.00
Blue Cross,EPO,10904ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Perc Endo Approach,,Fee Schedule,4303.00
Blue Cross,EPO,10907ZA,ICD10-PCS,Drainage of Fetal Cerebrospinal Fluid from POC, Via Opening,,Fee Schedule,4303.00
Blue Cross,EPO,10907ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Via Opening,,Fee Schedule,4303.00
Blue Cross,EPO,10908ZA,ICD10-PCS,Drainage of Fetal Cerebrospinal Fluid from POC, Endo,,Fee Schedule,4303.00
Blue Cross,EPO,10908ZC,ICD10-PCS,Drainage of Amniotic Fluid, Therapeutic from POC, Endo,,Fee Schedule,4303.00
Blue Cross,EPO,10D00Z0,ICD10-PCS,Extraction of Products of Conception, High, Open Approach,,Fee Schedule,4303.00
Blue Cross,EPO,10D00Z2,ICD10-PCS,Extraction of POC, Extraperitoneal, Open Approach,,Fee Schedule,4303.00
Blue Cross,EPO,10D07Z3,ICD10-PCS,Extraction of POC, Low Forceps, Via Opening,,Fee Schedule,4303.00
Blue Cross,EPO,10D07Z8,ICD10-PCS,Extraction of Products of Conception, Other, Via Opening,,Fee Schedule,4303.00
Blue Cross,EPO,10E0XZZ,ICD10-PCS,Delivery of Products of Conception, External Approach,,Fee Schedule,4303.00
Blue Cross,EPO,10S0XZZ,ICD10-PCS,Reposition Products of Conception, External Approach,,Fee Schedule,4303.00
Blue Cross,EPO,11,DRG,Tracheostomy for face,mouth & neck diagnoses w MCC,,Case Rate,82971.25
Blue Cross,EPO,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Grouper Rate,1678.00
Blue Cross,EPO,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,Grouper Rate,1678.00
Blue Cross,EPO,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,Grouper Rate,1678.00
Blue Cross,EPO,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,Grouper Rate,1678.88
Blue Cross,EPO,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,Grouper Rate,1678.00
Blue Cross,EPO,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Grouper Rate,1678.00
Blue Cross,EPO,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Grouper Rate,1678.88
Blue Cross,EPO,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Grouper Rate,1678.88
Blue Cross,EPO,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,EPO,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,EPO,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,EPO,11045,CPT4/HCPCS,DEB SUBQ TISSUE ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,11046,CPT4/HCPCS,DEB MUSC/FASCIA ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,11047,CPT4/HCPCS,DEB BONE ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,11102,CPT4/HCPCS,TANGNTL BX SKIN SINGLE LES,,Grouper Rate,1678.00
Blue Cross,EPO,11103,CPT4/HCPCS,TANGNTL BX SKIN EA SEP/ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,11104,CPT4/HCPCS,PUNCH BX SKIN SINGLE LESION,,Grouper Rate,1678.00
Blue Cross,EPO,11105,CPT4/HCPCS,PUNCH BX SKIN EA SEP/ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,11106,CPT4/HCPCS,INCAL BX SKN SINGLE LES,,Grouper Rate,1678.00
Blue Cross,EPO,11107,CPT4/HCPCS,INCAL BX SKN EA SEP/ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,113,DRG,Orbital procedures w CC/MCC,,Case Rate,36252.37
Blue Cross,EPO,11303,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Grouper Rate,1678.00
Blue Cross,EPO,114,DRG,Orbital procedures w/o CC/MCC,,Case Rate,23908.57
Blue Cross,EPO,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,Grouper Rate,1678.88
Blue Cross,EPO,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,Grouper Rate,1678.88
Blue Cross,EPO,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Grouper Rate,1678.88
Blue Cross,EPO,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Grouper Rate,1678.88
Blue Cross,EPO,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Grouper Rate,1678.88
Blue Cross,EPO,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Grouper Rate,1678.88
Blue Cross,EPO,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Grouper Rate,1678.88
Blue Cross,EPO,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Grouper Rate,1678.88
Blue Cross,EPO,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,EPO,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,EPO,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,EPO,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,EPO,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,EPO,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,EPO,115,DRG,Extraocular procedures except orbit,,Case Rate,24037.58
Blue Cross,EPO,116,DRG,Intraocular procedures w CC/MCC,,Case Rate,31048.88
Blue Cross,EPO,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Grouper Rate,1678.88
Blue Cross,EPO,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Grouper Rate,1678.00
Blue Cross,EPO,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Grouper Rate,1678.88
Blue Cross,EPO,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Grouper Rate,1678.88
Blue Cross,EPO,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Grouper Rate,1678.88
Blue Cross,EPO,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Grouper Rate,1678.88
Blue Cross,EPO,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Grouper Rate,1678.88
Blue Cross,EPO,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Grouper Rate,1678.88
Blue Cross,EPO,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Grouper Rate,1678.88
Blue Cross,EPO,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Grouper Rate,1678.88
Blue Cross,EPO,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Grouper Rate,1678.88
Blue Cross,EPO,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Grouper Rate,1678.88
Blue Cross,EPO,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,117,DRG,Intraocular procedures w/o CC/MCC,,Case Rate,17183.40
Blue Cross,EPO,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Grouper Rate,1678.00
Blue Cross,EPO,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Grouper Rate,1678.00
Blue Cross,EPO,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Grouper Rate,1678.00
Blue Cross,EPO,11752,CPT4/HCPCS,REMOVE NAIL BED/TIP,,Grouper Rate,1678.00
Blue Cross,EPO,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Grouper Rate,1678.00
Blue Cross,EPO,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Grouper Rate,3544.00
Blue Cross,EPO,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Grouper Rate,3544.00
Blue Cross,EPO,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Grouper Rate,3544.00
Blue Cross,EPO,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Grouper Rate,1678.00
Blue Cross,EPO,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Grouper Rate,1678.00
Blue Cross,EPO,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Grouper Rate,1678.00
Blue Cross,EPO,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Grouper Rate,1678.88
Blue Cross,EPO,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Grouper Rate,5029.00
Blue Cross,EPO,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Grouper Rate,1678.00
Blue Cross,EPO,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Grouper Rate,1678.00
Blue Cross,EPO,12,DRG,Tracheostomy for face,mouth & neck diagnoses w CC,,Case Rate,63379.62
Blue Cross,EPO,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Grouper Rate,1678.88
Blue Cross,EPO,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,Grouper Rate,1678.88
Blue Cross,EPO,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Grouper Rate,1678.88
Blue Cross,EPO,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Grouper Rate,1678.88
Blue Cross,EPO,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Grouper Rate,1678.88
Blue Cross,EPO,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Grouper Rate,1678.88
Blue Cross,EPO,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,Grouper Rate,1678.88
Blue Cross,EPO,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,Grouper Rate,1678.88
Blue Cross,EPO,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Grouper Rate,1678.88
Blue Cross,EPO,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Grouper Rate,1678.88
Blue Cross,EPO,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Grouper Rate,1678.88
Blue Cross,EPO,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Grouper Rate,1678.88
Blue Cross,EPO,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Grouper Rate,1678.88
Blue Cross,EPO,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,1678.00
Blue Cross,EPO,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,1678.00
Blue Cross,EPO,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Grouper Rate,1678.88
Blue Cross,EPO,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Grouper Rate,1678.88
Blue Cross,EPO,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Grouper Rate,1678.88
Blue Cross,EPO,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Grouper Rate,1678.88
Blue Cross,EPO,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Grouper Rate,1678.88
Blue Cross,EPO,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Grouper Rate,1678.88
Blue Cross,EPO,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Grouper Rate,1678.00
Blue Cross,EPO,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Grouper Rate,1678.00
Blue Cross,EPO,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Grouper Rate,1678.88
Blue Cross,EPO,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Grouper Rate,1678.88
Blue Cross,EPO,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Grouper Rate,1678.88
Blue Cross,EPO,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Grouper Rate,1678.88
Blue Cross,EPO,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Grouper Rate,1678.00
Blue Cross,EPO,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Grouper Rate,1678.00
Blue Cross,EPO,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Grouper Rate,1678.88
Blue Cross,EPO,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Grouper Rate,1678.88
Blue Cross,EPO,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Grouper Rate,1678.88
Blue Cross,EPO,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Grouper Rate,1678.88
Blue Cross,EPO,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Grouper Rate,1678.88
Blue Cross,EPO,121,DRG,Acute major eye infections w CC/MCC,,Case Rate,19661.09
Blue Cross,EPO,122,DRG,Acute major eye infections w/o CC/MCC,,Case Rate,10648.45
Blue Cross,EPO,123,DRG,Neurological eye disorders,,Case Rate,12658.06
Blue Cross,EPO,124,DRG,Other disorders of the eye w MCC,,Case Rate,23136.15
Blue Cross,EPO,125,DRG,Other disorders of the eye w/o MCC,,Case Rate,13817.51
Blue Cross,EPO,13,DRG,Tracheostomy for face,mouth & neck diagnoses w/o CC/MCC,,Case Rate,44997.07
Blue Cross,EPO,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Grouper Rate,1678.88
Blue Cross,EPO,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Grouper Rate,1678.88
Blue Cross,EPO,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Grouper Rate,1678.00
Blue Cross,EPO,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Grouper Rate,1678.88
Blue Cross,EPO,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Grouper Rate,1678.00
Blue Cross,EPO,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1678.88
Blue Cross,EPO,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,3544.00
Blue Cross,EPO,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1678.00
Blue Cross,EPO,13150,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.0 CM/<,,Grouper Rate,3544.00
Blue Cross,EPO,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Grouper Rate,1678.00
Blue Cross,EPO,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Grouper Rate,1678.88
Blue Cross,EPO,135,DRG,Sinus & mastoid procedures w CC/MCC,,Case Rate,35405.52
Blue Cross,EPO,136,DRG,Sinus & mastoid procedures w/o CC/MCC,,Case Rate,20765.97
Blue Cross,EPO,137,DRG,Mouth procedures w CC/MCC,,Case Rate,24290.64
Blue Cross,EPO,138,DRG,Mouth procedures w/o CC/MCC,,Case Rate,13944.87
Blue Cross,EPO,139,DRG,Salivary gland procedures,,Case Rate,20291.27
Blue Cross,EPO,14,DRG,Allogeneic bone marrow transplant,,Case Rate,211361.35
Blue Cross,EPO,140,DRG,MAJOR HEAD AND NECK PROCEDURES WITH MCC,,Case Rate,65839.12
Blue Cross,EPO,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,EPO,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Grouper Rate,3544.00
Blue Cross,EPO,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Grouper Rate,3544.00
Blue Cross,EPO,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Grouper Rate,3544.00
Blue Cross,EPO,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,1678.88
Blue Cross,EPO,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,3544.00
Blue Cross,EPO,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Grouper Rate,3544.00
Blue Cross,EPO,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Grouper Rate,3544.00
Blue Cross,EPO,141,DRG,MAJOR HEAD AND NECK PROCEDURES WITH CC,,Case Rate,36512.05
Blue Cross,EPO,142,DRG,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,,Case Rate,26609.55
Blue Cross,EPO,143,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC,,Case Rate,49021.25
Blue Cross,EPO,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Grouper Rate,5029.00
Blue Cross,EPO,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Grouper Rate,1678.88
Blue Cross,EPO,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Grouper Rate,3544.00
Blue Cross,EPO,144,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC,,Case Rate,28953.27
Blue Cross,EPO,145,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,,Case Rate,20071.29
Blue Cross,EPO,146,DRG,Ear, nose, mouth & throat malignancy w MCC,,Case Rate,33627.47
Blue Cross,EPO,147,DRG,Ear, nose, mouth & throat malignancy w CC,,Case Rate,21520.19
Blue Cross,EPO,148,DRG,Ear, nose, mouth & throat malignancy w/o CC/MCC,,Case Rate,13005.40
Blue Cross,EPO,149,DRG,Dysequilibrium,,Case Rate,12165.17
Blue Cross,EPO,150,DRG,Epistaxis w MCC,,Case Rate,21910.53
Blue Cross,EPO,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Grouper Rate,1678.00
Blue Cross,EPO,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Grouper Rate,1678.00
Blue Cross,EPO,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Grouper Rate,1678.88
Blue Cross,EPO,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Grouper Rate,1678.00
Blue Cross,EPO,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Grouper Rate,1678.00
Blue Cross,EPO,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Grouper Rate,1678.00
Blue Cross,EPO,151,DRG,Epistaxis w/o MCC,,Case Rate,12189.98
Blue Cross,EPO,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,EPO,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,EPO,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Grouper Rate,1678.88
Blue Cross,EPO,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Grouper Rate,1678.88
Blue Cross,EPO,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Grouper Rate,1678.00
Blue Cross,EPO,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,EPO,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Grouper Rate,1678.88
Blue Cross,EPO,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Grouper Rate,1678.00
Blue Cross,EPO,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Grouper Rate,1678.00
Blue Cross,EPO,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Grouper Rate,1678.00
Blue Cross,EPO,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Grouper Rate,1678.88
Blue Cross,EPO,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Grouper Rate,1678.00
Blue Cross,EPO,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Grouper Rate,1678.88
Blue Cross,EPO,152,DRG,Otitis media & URI w MCC,,Case Rate,17811.92
Blue Cross,EPO,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Grouper Rate,3544.00
Blue Cross,EPO,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,EPO,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Grouper Rate,3544.00
Blue Cross,EPO,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Grouper Rate,1678.88
Blue Cross,EPO,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Grouper Rate,1678.00
Blue Cross,EPO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Grouper Rate,1678.00
Blue Cross,EPO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Grouper Rate,1678.00
Blue Cross,EPO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Grouper Rate,1678.00
Blue Cross,EPO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Grouper Rate,1678.00
Blue Cross,EPO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Grouper Rate,1678.00
Blue Cross,EPO,153,DRG,Otitis media & URI w/o MCC,,Case Rate,11753.32
Blue Cross,EPO,154,DRG,Nasal trauma & deformity w MCC,,Case Rate,25512.95
Blue Cross,EPO,155,DRG,Nasal trauma & deformity w CC,,Case Rate,14998.47
Blue Cross,EPO,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Grouper Rate,3544.00
Blue Cross,EPO,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Grouper Rate,3544.00
Blue Cross,EPO,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Grouper Rate,3544.00
Blue Cross,EPO,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Grouper Rate,3544.00
Blue Cross,EPO,156,DRG,Nasal trauma & deformity w/o CC/MCC,,Case Rate,10876.70
Blue Cross,EPO,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Grouper Rate,3544.00
Blue Cross,EPO,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Grouper Rate,3544.00
Blue Cross,EPO,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Grouper Rate,3544.00
Blue Cross,EPO,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Grouper Rate,3544.00
Blue Cross,EPO,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Grouper Rate,5281.00
Blue Cross,EPO,157,DRG,Dental & Oral Diseases w MCC,,Case Rate,26007.49
Blue Cross,EPO,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Grouper Rate,1678.88
Blue Cross,EPO,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Grouper Rate,1678.88
Blue Cross,EPO,15732,CPT4/HCPCS,MUSCLE-SKIN GRAFT HEAD/NECK,,Grouper Rate,3544.00
Blue Cross,EPO,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Grouper Rate,3544.00
Blue Cross,EPO,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Grouper Rate,3544.00
Blue Cross,EPO,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Grouper Rate,3544.00
Blue Cross,EPO,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Grouper Rate,3544.00
Blue Cross,EPO,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Grouper Rate,1678.88
Blue Cross,EPO,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Grouper Rate,1678.88
Blue Cross,EPO,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Grouper Rate,5281.00
Blue Cross,EPO,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Grouper Rate,5281.00
Blue Cross,EPO,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Grouper Rate,5281.00
Blue Cross,EPO,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Grouper Rate,1678.88
Blue Cross,EPO,15769,CPT4/HCPCS,GRFG AUTOL SOFT TISS DIR EXC,,Grouper Rate,5029.00
Blue Cross,EPO,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,15771,CPT4/HCPCS,GRFG AUTOL FAT LIPO 50 CC/<,,Grouper Rate,3544.00
Blue Cross,EPO,15772,CPT4/HCPCS,GRFG AUTOL FAT LIPO EA ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,15773,CPT4/HCPCS,GRFG AUTOL FAT LIPO 25 CC/<,,Grouper Rate,3544.00
Blue Cross,EPO,15774,CPT4/HCPCS,GFRG AUTOL FAT LIPO EA ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,Grouper Rate,1678.00
Blue Cross,EPO,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,Grouper Rate,1678.00
Blue Cross,EPO,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,Grouper Rate,1678.00
Blue Cross,EPO,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,Grouper Rate,1678.00
Blue Cross,EPO,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,Grouper Rate,1678.00
Blue Cross,EPO,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,158,DRG,Dental & Oral Diseases w CC,,Case Rate,14705.71
Blue Cross,EPO,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Grouper Rate,1678.88
Blue Cross,EPO,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,1678.88
Blue Cross,EPO,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,1678.88
Blue Cross,EPO,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,1678.88
Blue Cross,EPO,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,1678.88
Blue Cross,EPO,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Grouper Rate,3544.00
Blue Cross,EPO,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Grouper Rate,1678.88
Blue Cross,EPO,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Grouper Rate,1678.88
Blue Cross,EPO,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Grouper Rate,3544.00
Blue Cross,EPO,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Grouper Rate,3544.00
Blue Cross,EPO,15830,CPT4/HCPCS,EXC SKIN ABD,,Grouper Rate,3544.00
Blue Cross,EPO,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Grouper Rate,1678.88
Blue Cross,EPO,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Grouper Rate,3544.00
Blue Cross,EPO,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Grouper Rate,3544.00
Blue Cross,EPO,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Grouper Rate,3544.00
Blue Cross,EPO,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Grouper Rate,1678.88
Blue Cross,EPO,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Grouper Rate,1678.88
Blue Cross,EPO,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Grouper Rate,1678.88
Blue Cross,EPO,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Grouper Rate,1678.88
Blue Cross,EPO,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Grouper Rate,5029.00
Blue Cross,EPO,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Grouper Rate,1678.00
Blue Cross,EPO,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Grouper Rate,1678.00
Blue Cross,EPO,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Grouper Rate,1678.00
Blue Cross,EPO,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Grouper Rate,1678.88
Blue Cross,EPO,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Grouper Rate,3544.00
Blue Cross,EPO,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Grouper Rate,1678.88
Blue Cross,EPO,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Grouper Rate,1678.88
Blue Cross,EPO,159,DRG,Dental & Oral Diseases w/o CC/MCC,,Case Rate,10846.93
Blue Cross,EPO,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,3544.00
Blue Cross,EPO,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,5029.00
Blue Cross,EPO,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,1678.88
Blue Cross,EPO,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,EPO,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,EPO,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,EPO,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,EPO,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,EPO,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,1678.88
Blue Cross,EPO,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,EPO,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,EPO,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,EPO,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,EPO,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,EPO,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,EPO,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,EPO,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,EPO,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,EPO,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,EPO,16,DRG,Autologous bone marrow transplant w CC/MCC,,Case Rate,111251.34
Blue Cross,EPO,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Grouper Rate,1678.00
Blue Cross,EPO,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Grouper Rate,1678.00
Blue Cross,EPO,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Grouper Rate,1678.88
Blue Cross,EPO,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,Grouper Rate,1678.00
Blue Cross,EPO,163,DRG,Major chest procedures w MCC,,Case Rate,82031.78
Blue Cross,EPO,164,DRG,Major chest procedures w CC,,Case Rate,43596.13
Blue Cross,EPO,165,DRG,Major chest procedures w/o CC/MCC,,Case Rate,31568.24
Blue Cross,EPO,166,DRG,Other resp system O.R. procedures w MCC,,Case Rate,62681.63
Blue Cross,EPO,167,DRG,Other resp system O.R. procedures w CC,,Case Rate,30780.94
Blue Cross,EPO,168,DRG,Other resp system O.R. procedures w/o CC/MCC,,Case Rate,22649.87
Blue Cross,EPO,17,DRG,Autologous bone marrow transplant w/o CC/MCC,,Case Rate,79891.50
Blue Cross,EPO,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1678.00
Blue Cross,EPO,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1678.00
Blue Cross,EPO,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1678.00
Blue Cross,EPO,175,DRG,Pulmonary embolism w MCC,,Case Rate,25541.06
Blue Cross,EPO,176,DRG,Pulmonary embolism w/o MCC,,Case Rate,14666.01
Blue Cross,EPO,177,DRG,Respiratory infections & inflammations w MCC,,Case Rate,30521.26
Blue Cross,EPO,178,DRG,Respiratory infections & inflammations w CC,,Case Rate,19945.58
Blue Cross,EPO,179,DRG,Respiratory infections & inflammations w/o CC/MCC,,Case Rate,14407.99
Blue Cross,EPO,18,DRG,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY,,Case Rate,617421.66
Blue Cross,EPO,180,DRG,Respiratory neoplasms w MCC,,Case Rate,28743.21
Blue Cross,EPO,181,DRG,Respiratory neoplasms w CC,,Case Rate,18539.68
Blue Cross,EPO,182,DRG,Respiratory neoplasms w/o CC/MCC,,Case Rate,13025.25
Blue Cross,EPO,183,DRG,Major chest trauma w MCC,,Case Rate,25729.62
Blue Cross,EPO,184,DRG,Major chest trauma w CC,,Case Rate,17191.67
Blue Cross,EPO,185,DRG,Major chest trauma w/o CC/MCC,,Case Rate,12795.34
Blue Cross,EPO,186,DRG,Pleural effusion w MCC,,Case Rate,25524.52
Blue Cross,EPO,187,DRG,Pleural effusion w CC,,Case Rate,17072.58
Blue Cross,EPO,188,DRG,Pleural effusion w/o CC/MCC,,Case Rate,12042.77
Blue Cross,EPO,189,DRG,Pulmonary edema & respiratory failure,,Case Rate,20258.19
Blue Cross,EPO,19,DRG,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,,Case Rate,110187.82
Blue Cross,EPO,190,DRG,Chronic obstructive pulmonary disease w MCC,,Case Rate,18589.30
Blue Cross,EPO,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Grouper Rate,1678.00
Blue Cross,EPO,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Grouper Rate,1678.88
Blue Cross,EPO,19030,CPT4/HCPCS,INJECTION FOR BREAST X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Grouper Rate,1678.88
Blue Cross,EPO,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,Grouper Rate,1678.88
Blue Cross,EPO,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Grouper Rate,1678.88
Blue Cross,EPO,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,Grouper Rate,1678.88
Blue Cross,EPO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Grouper Rate,1678.88
Blue Cross,EPO,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,Grouper Rate,1678.88
Blue Cross,EPO,191,DRG,Chronic obstructive pulmonary disease w CC,,Case Rate,14606.47
Blue Cross,EPO,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Grouper Rate,1678.00
Blue Cross,EPO,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Grouper Rate,1678.88
Blue Cross,EPO,19102,CPT4/HCPCS,BX BREAST PERCUT W/IMAGE,,Grouper Rate,1678.88
Blue Cross,EPO,19103,CPT4/HCPCS,BX BREAST PERCUT W/DEVICE,,Grouper Rate,1678.00
Blue Cross,EPO,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Grouper Rate,1678.88
Blue Cross,EPO,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Grouper Rate,3544.00
Blue Cross,EPO,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Grouper Rate,3544.00
Blue Cross,EPO,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Grouper Rate,3544.00
Blue Cross,EPO,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Grouper Rate,1678.88
Blue Cross,EPO,192,DRG,Chronic obstructive pulmonary disease w/o CC/MCC,,Case Rate,11493.64
Blue Cross,EPO,19260,CPT4/HCPCS,REMOVAL OF CHEST WALL LESION,,Grouper Rate,5281.00
Blue Cross,EPO,19271,CPT4/HCPCS,REVISION OF CHEST WALL,,Grouper Rate,5281.00
Blue Cross,EPO,19272,CPT4/HCPCS,EXTENSIVE CHEST WALL SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,Grouper Rate,1678.00
Blue Cross,EPO,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,Grouper Rate,1678.00
Blue Cross,EPO,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,Grouper Rate,1678.00
Blue Cross,EPO,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,Grouper Rate,1678.00
Blue Cross,EPO,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,Grouper Rate,1678.00
Blue Cross,EPO,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,Grouper Rate,1678.00
Blue Cross,EPO,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,Grouper Rate,1678.88
Blue Cross,EPO,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,Grouper Rate,1678.88
Blue Cross,EPO,19290,CPT4/HCPCS,PLACE NEEDLE WIRE BREAST,,Grouper Rate,1678.00
Blue Cross,EPO,19291,CPT4/HCPCS,PLACE NEEDLE WIRE BREAST,,Grouper Rate,1678.00
Blue Cross,EPO,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Grouper Rate,1678.00
Blue Cross,EPO,19295,CPT4/HCPCS,PLACE BREAST CLIP PERCUT,,Grouper Rate,1678.00
Blue Cross,EPO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Grouper Rate,1678.00
Blue Cross,EPO,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Grouper Rate,1678.00
Blue Cross,EPO,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Grouper Rate,1678.88
Blue Cross,EPO,193,DRG,Simple pneumonia & pleurisy w MCC,,Case Rate,21678.97
Blue Cross,EPO,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Grouper Rate,5029.00
Blue Cross,EPO,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Grouper Rate,3544.00
Blue Cross,EPO,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Grouper Rate,5029.00
Blue Cross,EPO,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Grouper Rate,5029.00
Blue Cross,EPO,19304,CPT4/HCPCS,MAST SUBQ,,Grouper Rate,5029.00
Blue Cross,EPO,19305,CPT4/HCPCS,MAST RADICAL,,Grouper Rate,5281.00
Blue Cross,EPO,19306,CPT4/HCPCS,MAST RAD URBAN TYPE,,Grouper Rate,5281.00
Blue Cross,EPO,19307,CPT4/HCPCS,MAST MOD RAD,,Grouper Rate,5281.00
Blue Cross,EPO,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Grouper Rate,5029.00
Blue Cross,EPO,19318,CPT4/HCPCS,BREAST REDUCTION,,Grouper Rate,5281.00
Blue Cross,EPO,19324,CPT4/HCPCS,ENLARGE BREAST,,Grouper Rate,5029.00
Blue Cross,EPO,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Grouper Rate,5029.00
Blue Cross,EPO,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Grouper Rate,1678.00
Blue Cross,EPO,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Grouper Rate,1678.00
Blue Cross,EPO,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Grouper Rate,1678.88
Blue Cross,EPO,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Grouper Rate,5029.00
Blue Cross,EPO,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,5029.00
Blue Cross,EPO,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Grouper Rate,1678.88
Blue Cross,EPO,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Grouper Rate,5029.00
Blue Cross,EPO,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,Grouper Rate,5281.00
Blue Cross,EPO,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Grouper Rate,5281.00
Blue Cross,EPO,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,5281.00
Blue Cross,EPO,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,Grouper Rate,5281.00
Blue Cross,EPO,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,Grouper Rate,5281.00
Blue Cross,EPO,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,Grouper Rate,5281.00
Blue Cross,EPO,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Grouper Rate,1678.88
Blue Cross,EPO,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Grouper Rate,5029.00
Blue Cross,EPO,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Grouper Rate,5281.00
Blue Cross,EPO,194,DRG,Simple pneumonia & pleurisy w CC,,Case Rate,14274.02
Blue Cross,EPO,195,DRG,Simple pneumonia & pleurisy w/o CC/MCC,,Case Rate,10999.10
Blue Cross,EPO,196,DRG,Interstitial lung disease w MCC,,Case Rate,28715.09
Blue Cross,EPO,197,DRG,Interstitial lung disease w CC,,Case Rate,16632.62
Blue Cross,EPO,198,DRG,Interstitial lung disease w/o CC/MCC,,Case Rate,12277.64
Blue Cross,EPO,199,DRG,Pneumothorax w MCC,,Case Rate,29566.90
Blue Cross,EPO,2,DRG,Heart transplant or implant of heart assist system w/o MCC,,Case Rate,263498.74
Blue Cross,EPO,20,DRG,Intracranial vascular procedures w PDX hemorrhage w MCC,,Case Rate,170694.45
Blue Cross,EPO,200,DRG,Pneumothorax w CC,,Case Rate,17780.50
Blue Cross,EPO,20005,CPT4/HCPCS,I&D ABSCESS SUBFASCIAL,,Grouper Rate,1678.88
Blue Cross,EPO,201,DRG,Pneumothorax w/o CC/MCC,,Case Rate,11735.13
Blue Cross,EPO,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,Grouper Rate,1678.88
Blue Cross,EPO,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,Grouper Rate,5029.00
Blue Cross,EPO,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,Grouper Rate,3544.00
Blue Cross,EPO,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Grouper Rate,1678.88
Blue Cross,EPO,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,Grouper Rate,5029.00
Blue Cross,EPO,202,DRG,Bronchitis & asthma w CC/MCC,,Case Rate,15971.02
Blue Cross,EPO,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Grouper Rate,1678.88
Blue Cross,EPO,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Grouper Rate,3544.00
Blue Cross,EPO,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Grouper Rate,1678.00
Blue Cross,EPO,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,1678.00
Blue Cross,EPO,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,1678.88
Blue Cross,EPO,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Grouper Rate,1678.88
Blue Cross,EPO,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Grouper Rate,3544.00
Blue Cross,EPO,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,3544.00
Blue Cross,EPO,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,3544.00
Blue Cross,EPO,203,DRG,Bronchitis & asthma w/o CC/MCC,,Case Rate,11668.97
Blue Cross,EPO,204,DRG,Respiratory signs & symptoms,,Case Rate,13107.95
Blue Cross,EPO,205,DRG,Other respiratory system diagnoses w MCC,,Case Rate,27825.24
Blue Cross,EPO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Grouper Rate,1678.00
Blue Cross,EPO,20501,CPT4/HCPCS,INJECT SINUS TRACT FOR X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,EPO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Grouper Rate,1678.00
Blue Cross,EPO,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Grouper Rate,1678.00
Blue Cross,EPO,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Grouper Rate,1678.00
Blue Cross,EPO,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Grouper Rate,1678.00
Blue Cross,EPO,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Grouper Rate,1678.00
Blue Cross,EPO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Grouper Rate,3544.00
Blue Cross,EPO,206,DRG,Other respiratory system diagnoses w/o MCC,,Case Rate,14624.66
Blue Cross,EPO,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1678.00
Blue Cross,EPO,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1678.00
Blue Cross,EPO,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1678.88
Blue Cross,EPO,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1678.88
Blue Cross,EPO,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,3544.00
Blue Cross,EPO,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,3544.00
Blue Cross,EPO,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Grouper Rate,1678.88
Blue Cross,EPO,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Grouper Rate,1678.00
Blue Cross,EPO,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Grouper Rate,3544.00
Blue Cross,EPO,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Grouper Rate,1678.88
Blue Cross,EPO,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Grouper Rate,3544.00
Blue Cross,EPO,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Grouper Rate,3544.00
Blue Cross,EPO,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Grouper Rate,3544.00
Blue Cross,EPO,20664,CPT4/HCPCS,APPLICATION OF HALO,,Grouper Rate,1678.88
Blue Cross,EPO,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Grouper Rate,1678.00
Blue Cross,EPO,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,1678.88
Blue Cross,EPO,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,3544.00
Blue Cross,EPO,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,1678.88
Blue Cross,EPO,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Grouper Rate,1678.00
Blue Cross,EPO,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Grouper Rate,1678.00
Blue Cross,EPO,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Grouper Rate,5029.00
Blue Cross,EPO,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Grouper Rate,5029.00
Blue Cross,EPO,207,DRG,Respiratory system diagnosis w ventilator support 96+ hours,,Case Rate,94714.65
Blue Cross,EPO,208,DRG,Respiratory system diagnosis w ventilator support <96 hours,,Case Rate,42049.64
Blue Cross,EPO,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,Grouper Rate,8012.00
Blue Cross,EPO,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,Grouper Rate,8012.00
Blue Cross,EPO,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,Grouper Rate,8012.00
Blue Cross,EPO,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Grouper Rate,5783.00
Blue Cross,EPO,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Grouper Rate,5783.00
Blue Cross,EPO,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Grouper Rate,6588.00
Blue Cross,EPO,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Grouper Rate,5029.00
Blue Cross,EPO,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,Grouper Rate,8012.00
Blue Cross,EPO,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,20926,CPT4/HCPCS,REMOVAL OF TISSUE FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,20932,CPT4/HCPCS,OSTEOART ALGRFT W/SURF & B1,,Grouper Rate,8841.00
Blue Cross,EPO,20933,CPT4/HCPCS,HEMICRT INTRCLRY ALGRFT PRTL,,Grouper Rate,8841.00
Blue Cross,EPO,20934,CPT4/HCPCS,INTERCALARY ALGRFT COMPL,,Grouper Rate,8841.00
Blue Cross,EPO,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Grouper Rate,1678.00
Blue Cross,EPO,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Grouper Rate,1678.00
Blue Cross,EPO,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,EPO,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,EPO,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,EPO,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,EPO,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,EPO,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Grouper Rate,5029.00
Blue Cross,EPO,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Grouper Rate,5029.00
Blue Cross,EPO,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Grouper Rate,5029.00
Blue Cross,EPO,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Grouper Rate,1678.00
Blue Cross,EPO,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,1678.88
Blue Cross,EPO,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,1678.88
Blue Cross,EPO,21,DRG,Intracranial vascular procedures w PDX hemorrhage w CC,,Case Rate,124572.66
Blue Cross,EPO,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Grouper Rate,1678.88
Blue Cross,EPO,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Grouper Rate,1678.00
Blue Cross,EPO,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Grouper Rate,1678.00
Blue Cross,EPO,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Grouper Rate,3544.00
Blue Cross,EPO,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Grouper Rate,1678.88
Blue Cross,EPO,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Grouper Rate,1678.88
Blue Cross,EPO,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Grouper Rate,1678.88
Blue Cross,EPO,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Grouper Rate,1678.88
Blue Cross,EPO,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Grouper Rate,1678.88
Blue Cross,EPO,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Grouper Rate,3544.00
Blue Cross,EPO,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Grouper Rate,3544.00
Blue Cross,EPO,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Grouper Rate,5029.00
Blue Cross,EPO,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Grouper Rate,5281.00
Blue Cross,EPO,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Grouper Rate,1678.88
Blue Cross,EPO,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Grouper Rate,3544.00
Blue Cross,EPO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Grouper Rate,1678.00
Blue Cross,EPO,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,EPO,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Grouper Rate,1678.88
Blue Cross,EPO,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Grouper Rate,1678.88
Blue Cross,EPO,21116,CPT4/HCPCS,INJECTION JAW JOINT X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,1678.88
Blue Cross,EPO,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,1678.88
Blue Cross,EPO,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,1678.88
Blue Cross,EPO,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,5029.00
Blue Cross,EPO,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,1678.88
Blue Cross,EPO,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,5029.00
Blue Cross,EPO,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,3544.00
Blue Cross,EPO,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5029.00
Blue Cross,EPO,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5281.00
Blue Cross,EPO,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Grouper Rate,5783.00
Blue Cross,EPO,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Grouper Rate,5783.00
Blue Cross,EPO,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,Grouper Rate,6588.00
Blue Cross,EPO,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,Grouper Rate,5783.00
Blue Cross,EPO,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Grouper Rate,5783.00
Blue Cross,EPO,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,Grouper Rate,5783.00
Blue Cross,EPO,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,Grouper Rate,6588.00
Blue Cross,EPO,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,Grouper Rate,6588.00
Blue Cross,EPO,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,Grouper Rate,6588.00
Blue Cross,EPO,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,Grouper Rate,6588.00
Blue Cross,EPO,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,Grouper Rate,5281.00
Blue Cross,EPO,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,Grouper Rate,5281.00
Blue Cross,EPO,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,5783.00
Blue Cross,EPO,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,3544.00
Blue Cross,EPO,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Grouper Rate,3544.00
Blue Cross,EPO,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Grouper Rate,3544.00
Blue Cross,EPO,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,5029.00
Blue Cross,EPO,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,5029.00
Blue Cross,EPO,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,5029.00
Blue Cross,EPO,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,Grouper Rate,5281.00
Blue Cross,EPO,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Grouper Rate,5281.00
Blue Cross,EPO,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,Grouper Rate,5281.00
Blue Cross,EPO,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Grouper Rate,5281.00
Blue Cross,EPO,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Grouper Rate,5281.00
Blue Cross,EPO,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Grouper Rate,5281.00
Blue Cross,EPO,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Grouper Rate,5783.00
Blue Cross,EPO,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Grouper Rate,5281.00
Blue Cross,EPO,21210,CPT4/HCPCS,FACE BONE GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Grouper Rate,6588.00
Blue Cross,EPO,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Grouper Rate,5783.00
Blue Cross,EPO,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Grouper Rate,6588.00
Blue Cross,EPO,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,EPO,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,EPO,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Grouper Rate,5281.00
Blue Cross,EPO,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,EPO,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,EPO,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Grouper Rate,5281.00
Blue Cross,EPO,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,Grouper Rate,5783.00
Blue Cross,EPO,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,EPO,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,EPO,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,EPO,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,6588.00
Blue Cross,EPO,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,EPO,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Grouper Rate,5281.00
Blue Cross,EPO,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Grouper Rate,6588.00
Blue Cross,EPO,21280,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5029.00
Blue Cross,EPO,21282,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5029.00
Blue Cross,EPO,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,5029.00
Blue Cross,EPO,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,5029.00
Blue Cross,EPO,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Grouper Rate,1678.88
Blue Cross,EPO,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Grouper Rate,1678.88
Blue Cross,EPO,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Grouper Rate,1678.88
Blue Cross,EPO,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Grouper Rate,5029.00
Blue Cross,EPO,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Grouper Rate,5281.00
Blue Cross,EPO,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Grouper Rate,6588.00
Blue Cross,EPO,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Grouper Rate,5281.00
Blue Cross,EPO,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Grouper Rate,1678.88
Blue Cross,EPO,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Grouper Rate,5029.00
Blue Cross,EPO,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Grouper Rate,5281.00
Blue Cross,EPO,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Grouper Rate,5029.00
Blue Cross,EPO,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Grouper Rate,5029.00
Blue Cross,EPO,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Grouper Rate,5029.00
Blue Cross,EPO,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Grouper Rate,3544.00
Blue Cross,EPO,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Grouper Rate,5281.00
Blue Cross,EPO,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Grouper Rate,5281.00
Blue Cross,EPO,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Grouper Rate,5029.00
Blue Cross,EPO,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Grouper Rate,5281.00
Blue Cross,EPO,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Grouper Rate,5029.00
Blue Cross,EPO,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Grouper Rate,5281.00
Blue Cross,EPO,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Grouper Rate,5281.00
Blue Cross,EPO,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Grouper Rate,5281.00
Blue Cross,EPO,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Grouper Rate,6588.00
Blue Cross,EPO,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Grouper Rate,6588.00
Blue Cross,EPO,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Grouper Rate,1678.00
Blue Cross,EPO,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Grouper Rate,1678.88
Blue Cross,EPO,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Grouper Rate,5029.00
Blue Cross,EPO,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Grouper Rate,5281.00
Blue Cross,EPO,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,Grouper Rate,5281.00
Blue Cross,EPO,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,1678.00
Blue Cross,EPO,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,1678.88
Blue Cross,EPO,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Grouper Rate,3544.00
Blue Cross,EPO,21495,CPT4/HCPCS,TREAT HYOID BONE FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Grouper Rate,1678.88
Blue Cross,EPO,215,DRG,Other heart assist system implant,,Case Rate,184551.66
Blue Cross,EPO,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Grouper Rate,1678.88
Blue Cross,EPO,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Grouper Rate,1678.88
Blue Cross,EPO,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Grouper Rate,1678.00
Blue Cross,EPO,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,EPO,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Grouper Rate,5029.00
Blue Cross,EPO,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,172513.85
Blue Cross,EPO,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,1678.88
Blue Cross,EPO,21601,CPT4/HCPCS,EXC CHEST WALL TUMOR W/RIBS,,Grouper Rate,5281.00
Blue Cross,EPO,21602,CPT4/HCPCS,EXC CH WAL TUM W/O LYMPHADEC,,Grouper Rate,5281.00
Blue Cross,EPO,21603,CPT4/HCPCS,EXC CH WAL TUM W/LYMPHADEC,,Grouper Rate,6588.00
Blue Cross,EPO,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,1678.88
Blue Cross,EPO,21615,CPT4/HCPCS,REMOVAL OF RIB,,Grouper Rate,5281.00
Blue Cross,EPO,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,Grouper Rate,5783.00
Blue Cross,EPO,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Grouper Rate,1678.88
Blue Cross,EPO,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,Grouper Rate,1678.88
Blue Cross,EPO,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Grouper Rate,5281.00
Blue Cross,EPO,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,107390.91
Blue Cross,EPO,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,1678.88
Blue Cross,EPO,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,Grouper Rate,5783.00
Blue Cross,EPO,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,3544.00
Blue Cross,EPO,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,3544.00
Blue Cross,EPO,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Grouper Rate,5281.00
Blue Cross,EPO,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Grouper Rate,5783.00
Blue Cross,EPO,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Grouper Rate,6588.00
Blue Cross,EPO,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,Grouper Rate,5029.00
Blue Cross,EPO,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,85068.52
Blue Cross,EPO,21800,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,21805,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,21810,CPT4/HCPCS,TREATMENT OF RIB FRACTURE(S),,Grouper Rate,1678.88
Blue Cross,EPO,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Grouper Rate,3544.00
Blue Cross,EPO,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,133231.35
Blue Cross,EPO,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,1678.00
Blue Cross,EPO,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,1678.88
Blue Cross,EPO,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Grouper Rate,3544.00
Blue Cross,EPO,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Grouper Rate,1678.88
Blue Cross,EPO,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,22,DRG,Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC,,Case Rate,80377.78
Blue Cross,EPO,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,89314.34
Blue Cross,EPO,22010,CPT4/HCPCS,I&D P-SPINE C/T/CERV-THOR,,Grouper Rate,1678.88
Blue Cross,EPO,22015,CPT4/HCPCS,I&D ABSCESS P-SPINE L/S/LS,,Grouper Rate,1678.88
Blue Cross,EPO,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,75295.04
Blue Cross,EPO,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,3544.00
Blue Cross,EPO,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,3544.00
Blue Cross,EPO,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,3544.00
Blue Cross,EPO,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,1678.88
Blue Cross,EPO,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,3544.00
Blue Cross,EPO,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,3544.00
Blue Cross,EPO,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,3544.00
Blue Cross,EPO,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,3544.00
Blue Cross,EPO,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,139284.99
Blue Cross,EPO,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,Grouper Rate,3544.00
Blue Cross,EPO,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,Grouper Rate,3544.00
Blue Cross,EPO,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,Grouper Rate,3544.00
Blue Cross,EPO,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,Grouper Rate,3544.00
Blue Cross,EPO,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,Grouper Rate,6588.00
Blue Cross,EPO,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,Grouper Rate,5029.00
Blue Cross,EPO,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,Grouper Rate,5029.00
Blue Cross,EPO,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,Grouper Rate,1678.88
Blue Cross,EPO,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,102748.13
Blue Cross,EPO,22305,CPT4/HCPCS,CLOSED TX SPINE PROCESS FX,,Grouper Rate,1678.00
Blue Cross,EPO,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Grouper Rate,1678.00
Blue Cross,EPO,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Grouper Rate,1678.88
Blue Cross,EPO,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Grouper Rate,5783.00
Blue Cross,EPO,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Grouper Rate,1678.88
Blue Cross,EPO,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,121770.78
Blue Cross,EPO,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,93067.27
Blue Cross,EPO,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Grouper Rate,1678.88
Blue Cross,EPO,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Grouper Rate,1678.00
Blue Cross,EPO,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Grouper Rate,1678.00
Blue Cross,EPO,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Grouper Rate,1678.00
Blue Cross,EPO,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1678.88
Blue Cross,EPO,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1678.88
Blue Cross,EPO,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1678.00
Blue Cross,EPO,22520,CPT4/HCPCS,PERCUT VERTEBROPLASTY THOR,,Grouper Rate,1678.00
Blue Cross,EPO,22521,CPT4/HCPCS,PERCUT VERTEBROPLASTY LUMB,,Grouper Rate,1678.00
Blue Cross,EPO,22522,CPT4/HCPCS,PERCUT VERTEBROPLASTY ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,22523,CPT4/HCPCS,PERCUT KYPHOPLASTY THOR,,Grouper Rate,1678.88
Blue Cross,EPO,22524,CPT4/HCPCS,PERCUT KYPHOPLASTY LUMBAR,,Grouper Rate,1678.88
Blue Cross,EPO,22525,CPT4/HCPCS,PERCUT KYPHOPLASTY ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,22548,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,8841.00
Blue Cross,EPO,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Grouper Rate,8841.00
Blue Cross,EPO,22552,CPT4/HCPCS,ADDL NECK SPINE FUSION,,Grouper Rate,5029.00
Blue Cross,EPO,22554,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,8841.00
Blue Cross,EPO,22556,CPT4/HCPCS,THORAX SPINE FUSION,,Grouper Rate,8841.00
Blue Cross,EPO,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,Grouper Rate,5029.00
Blue Cross,EPO,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,Grouper Rate,8841.00
Blue Cross,EPO,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,Grouper Rate,8012.00
Blue Cross,EPO,22595,CPT4/HCPCS,NECK SPINAL FUSION,,Grouper Rate,8012.00
Blue Cross,EPO,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,109359.17
Blue Cross,EPO,22600,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,8012.00
Blue Cross,EPO,22610,CPT4/HCPCS,THORAX SPINE FUSION,,Grouper Rate,5783.00
Blue Cross,EPO,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,5783.00
Blue Cross,EPO,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,6588.00
Blue Cross,EPO,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,3544.00
Blue Cross,EPO,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,Grouper Rate,6588.00
Blue Cross,EPO,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,6588.00
Blue Cross,EPO,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,86866.42
Blue Cross,EPO,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,102801.06
Blue Cross,EPO,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,Grouper Rate,8012.00
Blue Cross,EPO,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,Grouper Rate,8012.00
Blue Cross,EPO,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,Grouper Rate,8841.00
Blue Cross,EPO,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,Grouper Rate,6588.00
Blue Cross,EPO,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,Grouper Rate,8012.00
Blue Cross,EPO,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,Grouper Rate,8841.00
Blue Cross,EPO,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,Grouper Rate,6588.00
Blue Cross,EPO,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,Grouper Rate,8012.00
Blue Cross,EPO,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,Grouper Rate,5281.00
Blue Cross,EPO,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,EPO,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5281.00
Blue Cross,EPO,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5783.00
Blue Cross,EPO,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,6588.00
Blue Cross,EPO,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,EPO,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,EPO,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,EPO,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,Grouper Rate,1678.88
Blue Cross,EPO,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,22853,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,22854,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,5281.00
Blue Cross,EPO,22856,CPT4/HCPCS,CERV ARTIFIC DISKECTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,22859,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,22861,CPT4/HCPCS,REVISE CERV ARTIFIC DISC,,Grouper Rate,5783.00
Blue Cross,EPO,22864,CPT4/HCPCS,REMOVE CERV ARTIF DISC,,Grouper Rate,5029.00
Blue Cross,EPO,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,5281.00
Blue Cross,EPO,22868,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,5281.00
Blue Cross,EPO,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,5029.00
Blue Cross,EPO,22870,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,5029.00
Blue Cross,EPO,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,65961.52
Blue Cross,EPO,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Grouper Rate,5029.00
Blue Cross,EPO,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Grouper Rate,1678.00
Blue Cross,EPO,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Grouper Rate,1678.88
Blue Cross,EPO,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,23,DRG,Cranio w major dev impl/acute complex CNS PDX w MCC or chemo implant,,Case Rate,93654.44
Blue Cross,EPO,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Grouper Rate,1678.88
Blue Cross,EPO,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Grouper Rate,1678.88
Blue Cross,EPO,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Grouper Rate,1678.00
Blue Cross,EPO,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Grouper Rate,1678.00
Blue Cross,EPO,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,1678.00
Blue Cross,EPO,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,1678.88
Blue Cross,EPO,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,EPO,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Grouper Rate,1678.88
Blue Cross,EPO,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,140427.90
Blue Cross,EPO,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Grouper Rate,1678.88
Blue Cross,EPO,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Grouper Rate,5029.00
Blue Cross,EPO,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Grouper Rate,5029.00
Blue Cross,EPO,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Grouper Rate,5281.00
Blue Cross,EPO,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Grouper Rate,5281.00
Blue Cross,EPO,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5029.00
Blue Cross,EPO,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5281.00
Blue Cross,EPO,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5281.00
Blue Cross,EPO,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5029.00
Blue Cross,EPO,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5281.00
Blue Cross,EPO,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5281.00
Blue Cross,EPO,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,1678.88
Blue Cross,EPO,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,5029.00
Blue Cross,EPO,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,5029.00
Blue Cross,EPO,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,5029.00
Blue Cross,EPO,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Grouper Rate,5029.00
Blue Cross,EPO,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Grouper Rate,5281.00
Blue Cross,EPO,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,97557.88
Blue Cross,EPO,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,Grouper Rate,5029.00
Blue Cross,EPO,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,Grouper Rate,5029.00
Blue Cross,EPO,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,Grouper Rate,5281.00
Blue Cross,EPO,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,128891.25
Blue Cross,EPO,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,23331,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,23332,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,5029.00
Blue Cross,EPO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Grouper Rate,1678.00
Blue Cross,EPO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,5029.00
Blue Cross,EPO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,5029.00
Blue Cross,EPO,23350,CPT4/HCPCS,INJECTION FOR SHOULDER X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Grouper Rate,5281.00
Blue Cross,EPO,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Grouper Rate,6588.00
Blue Cross,EPO,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,87949.79
Blue Cross,EPO,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Grouper Rate,6588.00
Blue Cross,EPO,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Grouper Rate,1678.88
Blue Cross,EPO,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Grouper Rate,1678.88
Blue Cross,EPO,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Grouper Rate,5783.00
Blue Cross,EPO,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Grouper Rate,6588.00
Blue Cross,EPO,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Grouper Rate,5783.00
Blue Cross,EPO,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Grouper Rate,6588.00
Blue Cross,EPO,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5281.00
Blue Cross,EPO,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6588.00
Blue Cross,EPO,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5281.00
Blue Cross,EPO,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6588.00
Blue Cross,EPO,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5281.00
Blue Cross,EPO,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6588.00
Blue Cross,EPO,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,EPO,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,EPO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,EPO,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,EPO,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,5029.00
Blue Cross,EPO,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,5281.00
Blue Cross,EPO,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Grouper Rate,3544.00
Blue Cross,EPO,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Grouper Rate,3544.00
Blue Cross,EPO,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,99739.50
Blue Cross,EPO,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,5029.00
Blue Cross,EPO,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,5029.00
Blue Cross,EPO,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,1678.00
Blue Cross,EPO,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,1678.00
Blue Cross,EPO,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,67496.43
Blue Cross,EPO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Grouper Rate,1678.00
Blue Cross,EPO,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,6588.00
Blue Cross,EPO,239,DRG,Amputation for circ sys disorders exc upper limb & toe w MCC,,Case Rate,79535.89
Blue Cross,EPO,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,Grouper Rate,5281.00
Blue Cross,EPO,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Grouper Rate,1678.00
Blue Cross,EPO,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Grouper Rate,1678.88
Blue Cross,EPO,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,24,DRG,Cranio w major dev impl/acute complex CNS PDX w/o MCC,,Case Rate,65043.55
Blue Cross,EPO,240,DRG,Amputation for circ sys disorders exc upper limb & toe w CC,,Case Rate,46146.60
Blue Cross,EPO,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,1678.00
Blue Cross,EPO,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,1678.88
Blue Cross,EPO,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,EPO,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,241,DRG,Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC,,Case Rate,26321.75
Blue Cross,EPO,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Grouper Rate,1678.00
Blue Cross,EPO,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Grouper Rate,5029.00
Blue Cross,EPO,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Grouper Rate,3544.00
Blue Cross,EPO,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,3544.00
Blue Cross,EPO,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Grouper Rate,3544.00
Blue Cross,EPO,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Grouper Rate,3544.00
Blue Cross,EPO,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Grouper Rate,3544.00
Blue Cross,EPO,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,3544.00
Blue Cross,EPO,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Grouper Rate,3544.00
Blue Cross,EPO,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Grouper Rate,3544.00
Blue Cross,EPO,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Grouper Rate,1678.88
Blue Cross,EPO,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Grouper Rate,3544.00
Blue Cross,EPO,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,61570.15
Blue Cross,EPO,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,EPO,24220,CPT4/HCPCS,INJECTION FOR ELBOW X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,41889.20
Blue Cross,EPO,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Grouper Rate,1678.00
Blue Cross,EPO,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Grouper Rate,5029.00
Blue Cross,EPO,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Grouper Rate,5029.00
Blue Cross,EPO,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,3544.00
Blue Cross,EPO,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,3544.00
Blue Cross,EPO,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Grouper Rate,1678.88
Blue Cross,EPO,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Grouper Rate,1678.88
Blue Cross,EPO,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Grouper Rate,1678.88
Blue Cross,EPO,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Grouper Rate,3544.00
Blue Cross,EPO,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Grouper Rate,1678.88
Blue Cross,EPO,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Grouper Rate,3544.00
Blue Cross,EPO,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Grouper Rate,3544.00
Blue Cross,EPO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Grouper Rate,3544.00
Blue Cross,EPO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Grouper Rate,3544.00
Blue Cross,EPO,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Grouper Rate,6588.00
Blue Cross,EPO,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,5281.00
Blue Cross,EPO,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,5281.00
Blue Cross,EPO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,6588.00
Blue Cross,EPO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,6588.00
Blue Cross,EPO,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,34166.67
Blue Cross,EPO,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5029.00
Blue Cross,EPO,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5029.00
Blue Cross,EPO,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,3544.00
Blue Cross,EPO,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Grouper Rate,3544.00
Blue Cross,EPO,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Grouper Rate,1678.88
Blue Cross,EPO,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Grouper Rate,3544.00
Blue Cross,EPO,245,DRG,AICD lead & generator procedures,,Case Rate,89547.56
Blue Cross,EPO,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,51699.07
Blue Cross,EPO,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,32884.82
Blue Cross,EPO,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,52496.30
Blue Cross,EPO,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,31083.62
Blue Cross,EPO,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Grouper Rate,5029.00
Blue Cross,EPO,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Grouper Rate,5029.00
Blue Cross,EPO,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1678.88
Blue Cross,EPO,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,Grouper Rate,5029.00
Blue Cross,EPO,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,Grouper Rate,3544.00
Blue Cross,EPO,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,Grouper Rate,5029.00
Blue Cross,EPO,25,DRG,Craniotomy & endovascular intracranial procedures w MCC,,Case Rate,74292.71
Blue Cross,EPO,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,41727.11
Blue Cross,EPO,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Grouper Rate,3544.00
Blue Cross,EPO,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Grouper Rate,1678.00
Blue Cross,EPO,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,3544.00
Blue Cross,EPO,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,3544.00
Blue Cross,EPO,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,1678.88
Blue Cross,EPO,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,1678.88
Blue Cross,EPO,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Grouper Rate,1678.00
Blue Cross,EPO,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Grouper Rate,1678.88
Blue Cross,EPO,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,EPO,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,1678.88
Blue Cross,EPO,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Grouper Rate,1678.00
Blue Cross,EPO,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,EPO,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Grouper Rate,3544.00
Blue Cross,EPO,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Grouper Rate,3544.00
Blue Cross,EPO,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Grouper Rate,3544.00
Blue Cross,EPO,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Grouper Rate,3544.00
Blue Cross,EPO,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,27453.09
Blue Cross,EPO,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Grouper Rate,1678.88
Blue Cross,EPO,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,5029.00
Blue Cross,EPO,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Grouper Rate,3544.00
Blue Cross,EPO,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Grouper Rate,1678.00
Blue Cross,EPO,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,3544.00
Blue Cross,EPO,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,3544.00
Blue Cross,EPO,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Grouper Rate,3544.00
Blue Cross,EPO,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,5029.00
Blue Cross,EPO,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,5029.00
Blue Cross,EPO,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,EPO,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,3544.00
Blue Cross,EPO,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Grouper Rate,3544.00
Blue Cross,EPO,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,3544.00
Blue Cross,EPO,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,3544.00
Blue Cross,EPO,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Grouper Rate,3544.00
Blue Cross,EPO,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,3544.00
Blue Cross,EPO,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,3544.00
Blue Cross,EPO,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,1678.88
Blue Cross,EPO,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,1678.88
Blue Cross,EPO,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,252,DRG,Other vascular procedures w MCC,,Case Rate,54924.37
Blue Cross,EPO,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Grouper Rate,3544.00
Blue Cross,EPO,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Grouper Rate,5029.00
Blue Cross,EPO,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,5029.00
Blue Cross,EPO,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,5029.00
Blue Cross,EPO,25246,CPT4/HCPCS,INJECTION FOR WRIST X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,EPO,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,1678.00
Blue Cross,EPO,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,1678.00
Blue Cross,EPO,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Grouper Rate,1678.00
Blue Cross,EPO,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5029.00
Blue Cross,EPO,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,1678.88
Blue Cross,EPO,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,3544.00
Blue Cross,EPO,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5029.00
Blue Cross,EPO,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,3544.00
Blue Cross,EPO,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5029.00
Blue Cross,EPO,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Grouper Rate,3544.00
Blue Cross,EPO,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,253,DRG,Other vascular procedures w CC,,Case Rate,43892.19
Blue Cross,EPO,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,3544.00
Blue Cross,EPO,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,3544.00
Blue Cross,EPO,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,3544.00
Blue Cross,EPO,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,3544.00
Blue Cross,EPO,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Grouper Rate,3544.00
Blue Cross,EPO,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Grouper Rate,3544.00
Blue Cross,EPO,25350,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,3544.00
Blue Cross,EPO,25355,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,3544.00
Blue Cross,EPO,25360,CPT4/HCPCS,REVISION OF ULNA,,Grouper Rate,3544.00
Blue Cross,EPO,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,EPO,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,EPO,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,EPO,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,EPO,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Grouper Rate,5029.00
Blue Cross,EPO,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,EPO,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Grouper Rate,5281.00
Blue Cross,EPO,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Grouper Rate,3544.00
Blue Cross,EPO,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,29929.13
Blue Cross,EPO,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,EPO,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,5029.00
Blue Cross,EPO,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,EPO,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,5281.00
Blue Cross,EPO,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,EPO,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,EPO,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Grouper Rate,3544.00
Blue Cross,EPO,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Grouper Rate,5029.00
Blue Cross,EPO,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Grouper Rate,5029.00
Blue Cross,EPO,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Grouper Rate,6588.00
Blue Cross,EPO,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Grouper Rate,5281.00
Blue Cross,EPO,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Grouper Rate,5281.00
Blue Cross,EPO,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,25490,CPT4/HCPCS,REINFORCE RADIUS,,Grouper Rate,3544.00
Blue Cross,EPO,25491,CPT4/HCPCS,REINFORCE ULNA,,Grouper Rate,3544.00
Blue Cross,EPO,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Grouper Rate,5029.00
Blue Cross,EPO,255,DRG,Upper limb & toe amputation for circ system disorders w MCC,,Case Rate,42061.22
Blue Cross,EPO,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1678.00
Blue Cross,EPO,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1678.00
Blue Cross,EPO,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,3544.00
Blue Cross,EPO,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1678.00
Blue Cross,EPO,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,5029.00
Blue Cross,EPO,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,5029.00
Blue Cross,EPO,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,1678.00
Blue Cross,EPO,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,1678.00
Blue Cross,EPO,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,3544.00
Blue Cross,EPO,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,1678.88
Blue Cross,EPO,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,1678.88
Blue Cross,EPO,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,EPO,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,3544.00
Blue Cross,EPO,256,DRG,Upper limb & toe amputation for circ system disorders w CC,,Case Rate,27176.87
Blue Cross,EPO,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,1678.88
Blue Cross,EPO,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,1678.88
Blue Cross,EPO,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Grouper Rate,1678.88
Blue Cross,EPO,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Grouper Rate,3544.00
Blue Cross,EPO,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Grouper Rate,3544.00
Blue Cross,EPO,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Grouper Rate,3544.00
Blue Cross,EPO,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Grouper Rate,5029.00
Blue Cross,EPO,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,257,DRG,Upper limb & toe amputation for circ system disorders w/o CC/MCC,,Case Rate,19202.94
Blue Cross,EPO,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,52949.50
Blue Cross,EPO,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Grouper Rate,5029.00
Blue Cross,EPO,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Grouper Rate,3544.00
Blue Cross,EPO,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,35068.10
Blue Cross,EPO,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,6588.00
Blue Cross,EPO,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,6588.00
Blue Cross,EPO,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,5029.00
Blue Cross,EPO,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,5281.00
Blue Cross,EPO,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,3544.00
Blue Cross,EPO,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,25927,CPT4/HCPCS,AMPUTATION OF HAND,,Grouper Rate,3544.00
Blue Cross,EPO,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1678.88
Blue Cross,EPO,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,26,DRG,Craniotomy & endovascular intracranial procedures w CC,,Case Rate,50579.32
Blue Cross,EPO,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,59282.66
Blue Cross,EPO,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Grouper Rate,1678.00
Blue Cross,EPO,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Grouper Rate,1678.00
Blue Cross,EPO,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Grouper Rate,1678.88
Blue Cross,EPO,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,5029.00
Blue Cross,EPO,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,5029.00
Blue Cross,EPO,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,EPO,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,1678.88
Blue Cross,EPO,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Grouper Rate,1678.88
Blue Cross,EPO,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,32936.10
Blue Cross,EPO,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Grouper Rate,1678.88
Blue Cross,EPO,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,1678.00
Blue Cross,EPO,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,1678.00
Blue Cross,EPO,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Grouper Rate,1678.88
Blue Cross,EPO,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Grouper Rate,3544.00
Blue Cross,EPO,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,3544.00
Blue Cross,EPO,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,5029.00
Blue Cross,EPO,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,1678.88
Blue Cross,EPO,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Grouper Rate,3544.00
Blue Cross,EPO,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Grouper Rate,3544.00
Blue Cross,EPO,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Grouper Rate,3544.00
Blue Cross,EPO,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Grouper Rate,1678.88
Blue Cross,EPO,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,28251.97
Blue Cross,EPO,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Grouper Rate,1678.88
Blue Cross,EPO,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Grouper Rate,3544.00
Blue Cross,EPO,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Grouper Rate,1678.88
Blue Cross,EPO,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,1678.88
Blue Cross,EPO,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,1678.88
Blue Cross,EPO,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,263,DRG,Vein ligation & stripping,,Case Rate,38129.66
Blue Cross,EPO,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Grouper Rate,1678.88
Blue Cross,EPO,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Grouper Rate,1678.00
Blue Cross,EPO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Grouper Rate,1678.00
Blue Cross,EPO,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,1678.88
Blue Cross,EPO,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,264,DRG,Other circulatory system O.R. procedures,,Case Rate,53718.61
Blue Cross,EPO,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Grouper Rate,5281.00
Blue Cross,EPO,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Grouper Rate,3544.00
Blue Cross,EPO,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,1678.88
Blue Cross,EPO,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,1678.88
Blue Cross,EPO,26476,CPT4/HCPCS,TENDON LENGTHENING,,Grouper Rate,1678.00
Blue Cross,EPO,26477,CPT4/HCPCS,TENDON SHORTENING,,Grouper Rate,1678.00
Blue Cross,EPO,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Grouper Rate,1678.88
Blue Cross,EPO,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Grouper Rate,3544.00
Blue Cross,EPO,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,3544.00
Blue Cross,EPO,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,5029.00
Blue Cross,EPO,26499,CPT4/HCPCS,REVISION OF FINGER,,Grouper Rate,3544.00
Blue Cross,EPO,265,DRG,AICD lead procedures,,Case Rate,55619.05
Blue Cross,EPO,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,5029.00
Blue Cross,EPO,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,5029.00
Blue Cross,EPO,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Grouper Rate,3544.00
Blue Cross,EPO,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Grouper Rate,1678.88
Blue Cross,EPO,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,3544.00
Blue Cross,EPO,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,5029.00
Blue Cross,EPO,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Grouper Rate,5029.00
Blue Cross,EPO,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Grouper Rate,3544.00
Blue Cross,EPO,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Grouper Rate,5281.00
Blue Cross,EPO,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Grouper Rate,5281.00
Blue Cross,EPO,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Grouper Rate,5281.00
Blue Cross,EPO,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Grouper Rate,5281.00
Blue Cross,EPO,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Grouper Rate,3544.00
Blue Cross,EPO,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,Grouper Rate,5029.00
Blue Cross,EPO,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,1678.88
Blue Cross,EPO,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,3544.00
Blue Cross,EPO,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,5029.00
Blue Cross,EPO,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Grouper Rate,5281.00
Blue Cross,EPO,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Grouper Rate,5281.00
Blue Cross,EPO,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Grouper Rate,3544.00
Blue Cross,EPO,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Grouper Rate,5281.00
Blue Cross,EPO,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Grouper Rate,5281.00
Blue Cross,EPO,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Grouper Rate,5281.00
Blue Cross,EPO,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Grouper Rate,3544.00
Blue Cross,EPO,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Grouper Rate,3544.00
Blue Cross,EPO,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Grouper Rate,1678.88
Blue Cross,EPO,266,DRG,Endovascular Cardiac Valve Replacement w MCC,,Case Rate,117387.68
Blue Cross,EPO,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,267,DRG,Endovascular Cardiac Valve Replacement w/o MCC,,Case Rate,92638.88
Blue Cross,EPO,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,5029.00
Blue Cross,EPO,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,EPO,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,EPO,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,EPO,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,EPO,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,EPO,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,EPO,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,EPO,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,EPO,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,EPO,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Grouper Rate,1678.88
Blue Cross,EPO,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,EPO,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,268,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w MCC,,Case Rate,115029.08
Blue Cross,EPO,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,26841,CPT4/HCPCS,FUSION OF THUMB,,Grouper Rate,5029.00
Blue Cross,EPO,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Grouper Rate,5029.00
Blue Cross,EPO,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,269,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w/o MCC,,Case Rate,71363.48
Blue Cross,EPO,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Grouper Rate,3544.00
Blue Cross,EPO,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,1678.88
Blue Cross,EPO,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,5029.00
Blue Cross,EPO,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Grouper Rate,1678.00
Blue Cross,EPO,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Grouper Rate,1678.00
Blue Cross,EPO,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,27,DRG,Craniotomy & endovascular intracranial procedures w/o CC/MCC,,Case Rate,41545.17
Blue Cross,EPO,270,DRG,Other Major Cardiovascular Procedures w MCC,,Case Rate,85703.66
Blue Cross,EPO,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,1678.88
Blue Cross,EPO,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Grouper Rate,3544.00
Blue Cross,EPO,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,Grouper Rate,1678.00
Blue Cross,EPO,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Grouper Rate,1678.00
Blue Cross,EPO,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,Grouper Rate,5029.00
Blue Cross,EPO,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,EPO,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,1678.88
Blue Cross,EPO,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,EPO,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,Grouper Rate,3544.00
Blue Cross,EPO,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Grouper Rate,1678.00
Blue Cross,EPO,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Grouper Rate,5029.00
Blue Cross,EPO,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Grouper Rate,5029.00
Blue Cross,EPO,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Grouper Rate,5281.00
Blue Cross,EPO,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Grouper Rate,5783.00
Blue Cross,EPO,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Grouper Rate,6588.00
Blue Cross,EPO,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,Grouper Rate,1678.88
Blue Cross,EPO,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,Grouper Rate,3544.00
Blue Cross,EPO,27075,CPT4/HCPCS,RESECT HIP TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,Grouper Rate,5783.00
Blue Cross,EPO,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,Grouper Rate,5029.00
Blue Cross,EPO,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,Grouper Rate,3544.00
Blue Cross,EPO,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Grouper Rate,1678.88
Blue Cross,EPO,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,3544.00
Blue Cross,EPO,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,EPO,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,EPO,27093,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,27095,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Grouper Rate,1678.00
Blue Cross,EPO,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Grouper Rate,3544.00
Blue Cross,EPO,271,DRG,Other Major Cardiovascular Procedures w CC,,Case Rate,58958.48
Blue Cross,EPO,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Grouper Rate,5029.00
Blue Cross,EPO,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Grouper Rate,5029.00
Blue Cross,EPO,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,5029.00
Blue Cross,EPO,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,5029.00
Blue Cross,EPO,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Grouper Rate,5783.00
Blue Cross,EPO,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Grouper Rate,5281.00
Blue Cross,EPO,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,Grouper Rate,5783.00
Blue Cross,EPO,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Grouper Rate,5783.00
Blue Cross,EPO,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Grouper Rate,5783.00
Blue Cross,EPO,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,5783.00
Blue Cross,EPO,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,5281.00
Blue Cross,EPO,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,5281.00
Blue Cross,EPO,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,Grouper Rate,5029.00
Blue Cross,EPO,27146,CPT4/HCPCS,INCISION OF HIP BONE,,Grouper Rate,5281.00
Blue Cross,EPO,27147,CPT4/HCPCS,REVISION OF HIP BONE,,Grouper Rate,5783.00
Blue Cross,EPO,27151,CPT4/HCPCS,INCISION OF HIP BONES,,Grouper Rate,5783.00
Blue Cross,EPO,27156,CPT4/HCPCS,REVISION OF HIP BONES,,Grouper Rate,6588.00
Blue Cross,EPO,27158,CPT4/HCPCS,REVISION OF PELVIS,,Grouper Rate,5281.00
Blue Cross,EPO,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,Grouper Rate,5281.00
Blue Cross,EPO,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,Grouper Rate,1678.00
Blue Cross,EPO,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,Grouper Rate,5281.00
Blue Cross,EPO,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,1678.88
Blue Cross,EPO,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5281.00
Blue Cross,EPO,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5783.00
Blue Cross,EPO,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5029.00
Blue Cross,EPO,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,Grouper Rate,6588.00
Blue Cross,EPO,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5783.00
Blue Cross,EPO,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,Grouper Rate,5281.00
Blue Cross,EPO,27187,CPT4/HCPCS,REINFORCE HIP BONES,,Grouper Rate,5783.00
Blue Cross,EPO,27193,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27194,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,1678.00
Blue Cross,EPO,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,1678.88
Blue Cross,EPO,272,DRG,Other Major Cardiovascular Procedures w/o CC/MCC,,Case Rate,44472.75
Blue Cross,EPO,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,Grouper Rate,5029.00
Blue Cross,EPO,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Grouper Rate,5281.00
Blue Cross,EPO,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Grouper Rate,5281.00
Blue Cross,EPO,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5029.00
Blue Cross,EPO,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5029.00
Blue Cross,EPO,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5029.00
Blue Cross,EPO,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27269,CPT4/HCPCS,OPTX THIGH FX,,Grouper Rate,5281.00
Blue Cross,EPO,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Grouper Rate,1678.00
Blue Cross,EPO,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,Grouper Rate,6588.00
Blue Cross,EPO,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Grouper Rate,5281.00
Blue Cross,EPO,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Grouper Rate,5029.00
Blue Cross,EPO,273,DRG,Percutaneous Intracardiac Procedures w MCC,,Case Rate,63467.28
Blue Cross,EPO,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Grouper Rate,1678.88
Blue Cross,EPO,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,5029.00
Blue Cross,EPO,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,EPO,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,EPO,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Grouper Rate,1678.00
Blue Cross,EPO,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Grouper Rate,1678.00
Blue Cross,EPO,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,EPO,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Grouper Rate,3544.00
Blue Cross,EPO,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,EPO,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,5029.00
Blue Cross,EPO,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,5029.00
Blue Cross,EPO,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,EPO,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,EPO,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Grouper Rate,1678.00
Blue Cross,EPO,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Grouper Rate,3544.00
Blue Cross,EPO,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Grouper Rate,5029.00
Blue Cross,EPO,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Grouper Rate,5029.00
Blue Cross,EPO,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Grouper Rate,5029.00
Blue Cross,EPO,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Grouper Rate,3544.00
Blue Cross,EPO,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Grouper Rate,1678.88
Blue Cross,EPO,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Grouper Rate,5029.00
Blue Cross,EPO,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,Grouper Rate,5783.00
Blue Cross,EPO,27369,CPT4/HCPCS,NJX CNTRST KNE ARTHG/CT/MRI,,Grouper Rate,1678.00
Blue Cross,EPO,27370,CPT4/HCPCS,INJECTION FOR KNEE X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,3544.00
Blue Cross,EPO,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Grouper Rate,3544.00
Blue Cross,EPO,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Grouper Rate,3544.00
Blue Cross,EPO,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,1678.88
Blue Cross,EPO,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,3544.00
Blue Cross,EPO,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Grouper Rate,1678.88
Blue Cross,EPO,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,3544.00
Blue Cross,EPO,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,3544.00
Blue Cross,EPO,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Grouper Rate,5029.00
Blue Cross,EPO,274,DRG,Percutaneous Intracardiac Procedures w/o MCC,,Case Rate,54340.51
Blue Cross,EPO,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Grouper Rate,3544.00
Blue Cross,EPO,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Grouper Rate,5029.00
Blue Cross,EPO,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,5029.00
Blue Cross,EPO,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,5029.00
Blue Cross,EPO,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Grouper Rate,5029.00
Blue Cross,EPO,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Grouper Rate,6588.00
Blue Cross,EPO,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Grouper Rate,8012.00
Blue Cross,EPO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Grouper Rate,8012.00
Blue Cross,EPO,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Grouper Rate,3544.00
Blue Cross,EPO,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,5029.00
Blue Cross,EPO,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,5783.00
Blue Cross,EPO,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Grouper Rate,3544.00
Blue Cross,EPO,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Grouper Rate,5281.00
Blue Cross,EPO,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,3544.00
Blue Cross,EPO,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,8012.00
Blue Cross,EPO,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,5029.00
Blue Cross,EPO,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Grouper Rate,5029.00
Blue Cross,EPO,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,27437,CPT4/HCPCS,REVISE KNEECAP,,Grouper Rate,5029.00
Blue Cross,EPO,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Grouper Rate,5281.00
Blue Cross,EPO,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,8841.00
Blue Cross,EPO,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Grouper Rate,8841.00
Blue Cross,EPO,27448,CPT4/HCPCS,INCISION OF THIGH,,Grouper Rate,5281.00
Blue Cross,EPO,27450,CPT4/HCPCS,INCISION OF THIGH,,Grouper Rate,6588.00
Blue Cross,EPO,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,Grouper Rate,5281.00
Blue Cross,EPO,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,Grouper Rate,5281.00
Blue Cross,EPO,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,Grouper Rate,5783.00
Blue Cross,EPO,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,Grouper Rate,5281.00
Blue Cross,EPO,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,Grouper Rate,5281.00
Blue Cross,EPO,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,Grouper Rate,5281.00
Blue Cross,EPO,27470,CPT4/HCPCS,REPAIR OF THIGH,,Grouper Rate,5029.00
Blue Cross,EPO,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,Grouper Rate,5281.00
Blue Cross,EPO,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,1678.88
Blue Cross,EPO,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,1678.88
Blue Cross,EPO,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6588.00
Blue Cross,EPO,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,5783.00
Blue Cross,EPO,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,Grouper Rate,5029.00
Blue Cross,EPO,27495,CPT4/HCPCS,REINFORCE THIGH,,Grouper Rate,5029.00
Blue Cross,EPO,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,1678.88
Blue Cross,EPO,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,1678.88
Blue Cross,EPO,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,3544.00
Blue Cross,EPO,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,3544.00
Blue Cross,EPO,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5783.00
Blue Cross,EPO,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5783.00
Blue Cross,EPO,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,EPO,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1678.00
Blue Cross,EPO,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1678.00
Blue Cross,EPO,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,5281.00
Blue Cross,EPO,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Grouper Rate,1678.00
Blue Cross,EPO,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Grouper Rate,1678.00
Blue Cross,EPO,27580,CPT4/HCPCS,FUSION OF KNEE,,Grouper Rate,5281.00
Blue Cross,EPO,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,3544.00
Blue Cross,EPO,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,5281.00
Blue Cross,EPO,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,5029.00
Blue Cross,EPO,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,Grouper Rate,5029.00
Blue Cross,EPO,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,1678.88
Blue Cross,EPO,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,1678.88
Blue Cross,EPO,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,3544.00
Blue Cross,EPO,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Grouper Rate,1678.00
Blue Cross,EPO,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Grouper Rate,1678.00
Blue Cross,EPO,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,1678.88
Blue Cross,EPO,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,1678.00
Blue Cross,EPO,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,1678.88
Blue Cross,EPO,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Grouper Rate,1678.88
Blue Cross,EPO,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Grouper Rate,3544.00
Blue Cross,EPO,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,EPO,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,EPO,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Grouper Rate,3544.00
Blue Cross,EPO,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5029.00
Blue Cross,EPO,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5029.00
Blue Cross,EPO,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Grouper Rate,1678.88
Blue Cross,EPO,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Grouper Rate,1678.88
Blue Cross,EPO,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,Grouper Rate,5029.00
Blue Cross,EPO,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,Grouper Rate,1678.88
Blue Cross,EPO,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Grouper Rate,1678.88
Blue Cross,EPO,27648,CPT4/HCPCS,INJECTION FOR ANKLE X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Grouper Rate,1678.88
Blue Cross,EPO,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.00
Blue Cross,EPO,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.88
Blue Cross,EPO,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.88
Blue Cross,EPO,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.88
Blue Cross,EPO,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,1678.88
Blue Cross,EPO,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,3544.00
Blue Cross,EPO,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Grouper Rate,1678.88
Blue Cross,EPO,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Grouper Rate,1678.88
Blue Cross,EPO,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Grouper Rate,1678.88
Blue Cross,EPO,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,5029.00
Blue Cross,EPO,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,1678.88
Blue Cross,EPO,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Grouper Rate,1678.88
Blue Cross,EPO,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,1678.88
Blue Cross,EPO,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,Grouper Rate,5281.00
Blue Cross,EPO,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Grouper Rate,1678.88
Blue Cross,EPO,27705,CPT4/HCPCS,INCISION OF TIBIA,,Grouper Rate,1678.88
Blue Cross,EPO,27707,CPT4/HCPCS,INCISION OF FIBULA,,Grouper Rate,1678.88
Blue Cross,EPO,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Grouper Rate,3544.00
Blue Cross,EPO,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,Grouper Rate,5029.00
Blue Cross,EPO,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Grouper Rate,5029.00
Blue Cross,EPO,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Grouper Rate,5029.00
Blue Cross,EPO,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,5281.00
Blue Cross,EPO,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,5281.00
Blue Cross,EPO,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,Grouper Rate,3544.00
Blue Cross,EPO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Grouper Rate,5281.00
Blue Cross,EPO,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,Grouper Rate,3544.00
Blue Cross,EPO,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Grouper Rate,1678.88
Blue Cross,EPO,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Grouper Rate,1678.88
Blue Cross,EPO,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Grouper Rate,1678.88
Blue Cross,EPO,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,1678.88
Blue Cross,EPO,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,1678.88
Blue Cross,EPO,27745,CPT4/HCPCS,REINFORCE TIBIA,,Grouper Rate,3544.00
Blue Cross,EPO,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Grouper Rate,1678.00
Blue Cross,EPO,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Grouper Rate,1678.00
Blue Cross,EPO,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Grouper Rate,3544.00
Blue Cross,EPO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Grouper Rate,1678.00
Blue Cross,EPO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Grouper Rate,1678.00
Blue Cross,EPO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Grouper Rate,3544.00
Blue Cross,EPO,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,5029.00
Blue Cross,EPO,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Grouper Rate,1678.88
Blue Cross,EPO,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Grouper Rate,1678.00
Blue Cross,EPO,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Grouper Rate,5029.00
Blue Cross,EPO,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,5783.00
Blue Cross,EPO,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,5281.00
Blue Cross,EPO,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,5281.00
Blue Cross,EPO,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,6588.00
Blue Cross,EPO,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,6588.00
Blue Cross,EPO,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,1678.88
Blue Cross,EPO,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,1678.88
Blue Cross,EPO,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,3544.00
Blue Cross,EPO,28,DRG,Spinal procedures w MCC,,Case Rate,96262.80
Blue Cross,EPO,280,DRG,Acute myocardial infarction, discharged alive w MCC,,Case Rate,26897.34
Blue Cross,EPO,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Grouper Rate,1678.00
Blue Cross,EPO,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,1678.88
Blue Cross,EPO,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,3544.00
Blue Cross,EPO,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Grouper Rate,1678.88
Blue Cross,EPO,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Grouper Rate,1678.00
Blue Cross,EPO,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,1678.88
Blue Cross,EPO,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,1678.00
Blue Cross,EPO,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Grouper Rate,1678.00
Blue Cross,EPO,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Grouper Rate,5029.00
Blue Cross,EPO,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Grouper Rate,1678.00
Blue Cross,EPO,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Grouper Rate,1678.88
Blue Cross,EPO,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Grouper Rate,1678.88
Blue Cross,EPO,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Grouper Rate,3544.00
Blue Cross,EPO,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Grouper Rate,3544.00
Blue Cross,EPO,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Grouper Rate,3544.00
Blue Cross,EPO,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,1678.88
Blue Cross,EPO,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,1678.00
Blue Cross,EPO,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Grouper Rate,1678.88
Blue Cross,EPO,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Grouper Rate,1678.88
Blue Cross,EPO,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Grouper Rate,3544.00
Blue Cross,EPO,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,3544.00
Blue Cross,EPO,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,3544.00
Blue Cross,EPO,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3544.00
Blue Cross,EPO,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,EPO,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,EPO,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3544.00
Blue Cross,EPO,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,3544.00
Blue Cross,EPO,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,15416.93
Blue Cross,EPO,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Grouper Rate,1678.88
Blue Cross,EPO,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,EPO,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,EPO,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,1678.88
Blue Cross,EPO,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,EPO,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,EPO,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,1678.88
Blue Cross,EPO,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,EPO,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,EPO,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,EPO,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,EPO,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Grouper Rate,3544.00
Blue Cross,EPO,28116,CPT4/HCPCS,REVISION OF FOOT,,Grouper Rate,3544.00
Blue Cross,EPO,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Grouper Rate,3544.00
Blue Cross,EPO,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Grouper Rate,3544.00
Blue Cross,EPO,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Grouper Rate,3544.00
Blue Cross,EPO,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,3544.00
Blue Cross,EPO,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.00
Blue Cross,EPO,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.00
Blue Cross,EPO,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Grouper Rate,3544.00
Blue Cross,EPO,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,EPO,28150,CPT4/HCPCS,REMOVAL OF TOE,,Grouper Rate,1678.88
Blue Cross,EPO,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.88
Blue Cross,EPO,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.88
Blue Cross,EPO,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,EPO,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,EPO,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,11999.77
Blue Cross,EPO,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,1678.00
Blue Cross,EPO,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,1678.00
Blue Cross,EPO,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Grouper Rate,1678.00
Blue Cross,EPO,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Grouper Rate,1678.00
Blue Cross,EPO,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Grouper Rate,1678.88
Blue Cross,EPO,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Grouper Rate,3544.00
Blue Cross,EPO,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,EPO,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Grouper Rate,5029.00
Blue Cross,EPO,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,1678.00
Blue Cross,EPO,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Grouper Rate,1678.00
Blue Cross,EPO,28280,CPT4/HCPCS,FUSION OF TOES,,Grouper Rate,1678.88
Blue Cross,EPO,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,3544.00
Blue Cross,EPO,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,3544.00
Blue Cross,EPO,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,1678.88
Blue Cross,EPO,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Grouper Rate,3544.00
Blue Cross,EPO,28290,CPT4/HCPCS,CORRECTION OF BUNION,,Grouper Rate,1678.88
Blue Cross,EPO,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Grouper Rate,3544.00
Blue Cross,EPO,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,1678.88
Blue Cross,EPO,28293,CPT4/HCPCS,CORRECTION OF BUNION,,Grouper Rate,3544.00
Blue Cross,EPO,28294,CPT4/HCPCS,CORRECTION OF BUNION,,Grouper Rate,3544.00
Blue Cross,EPO,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,1678.88
Blue Cross,EPO,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,EPO,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,EPO,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,EPO,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,EPO,283,DRG,Acute myocardial infarction, expired w MCC,,Case Rate,30840.48
Blue Cross,EPO,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Grouper Rate,1678.88
Blue Cross,EPO,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Grouper Rate,1678.88
Blue Cross,EPO,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Grouper Rate,1678.88
Blue Cross,EPO,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Grouper Rate,3544.00
Blue Cross,EPO,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,5029.00
Blue Cross,EPO,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,5281.00
Blue Cross,EPO,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,EPO,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Grouper Rate,5029.00
Blue Cross,EPO,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Grouper Rate,3544.00
Blue Cross,EPO,28312,CPT4/HCPCS,REVISION OF TOE,,Grouper Rate,3544.00
Blue Cross,EPO,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Grouper Rate,1678.88
Blue Cross,EPO,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Grouper Rate,1678.88
Blue Cross,EPO,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,EPO,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Grouper Rate,5029.00
Blue Cross,EPO,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Grouper Rate,3544.00
Blue Cross,EPO,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Grouper Rate,3544.00
Blue Cross,EPO,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Grouper Rate,3544.00
Blue Cross,EPO,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Grouper Rate,3544.00
Blue Cross,EPO,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,Grouper Rate,5029.00
Blue Cross,EPO,284,DRG,Acute myocardial infarction, expired w CC,,Case Rate,12143.66
Blue Cross,EPO,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Grouper Rate,3544.00
Blue Cross,EPO,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,EPO,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,EPO,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,3544.00
Blue Cross,EPO,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,285,DRG,Acute myocardial infarction, expired w/o CC/MCC,,Case Rate,8210.45
Blue Cross,EPO,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Grouper Rate,3544.00
Blue Cross,EPO,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,EPO,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,36621.21
Blue Cross,EPO,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,EPO,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,EPO,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,EPO,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,19021.00
Blue Cross,EPO,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,EPO,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,EPO,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,EPO,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,EPO,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,EPO,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Grouper Rate,5281.00
Blue Cross,EPO,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,EPO,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,3544.00
Blue Cross,EPO,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,5029.00
Blue Cross,EPO,288,DRG,Acute & subacute endocarditis w MCC,,Case Rate,44343.74
Blue Cross,EPO,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,Grouper Rate,3544.00
Blue Cross,EPO,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Grouper Rate,3544.00
Blue Cross,EPO,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Grouper Rate,1678.88
Blue Cross,EPO,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Grouper Rate,1678.88
Blue Cross,EPO,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Grouper Rate,1678.88
Blue Cross,EPO,28890,CPT4/HCPCS,HI ENRGY ESWT PLANTAR FASCIA,,Grouper Rate,3544.00
Blue Cross,EPO,289,DRG,Acute & subacute endocarditis w CC,,Case Rate,27168.60
Blue Cross,EPO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,Case Rate,54499.30
Blue Cross,EPO,290,DRG,Acute & subacute endocarditis w/o CC/MCC,,Case Rate,16930.34
Blue Cross,EPO,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,EPO,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,EPO,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,EPO,29020,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,EPO,29025,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,3544.00
Blue Cross,EPO,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,EPO,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,EPO,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,EPO,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,EPO,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,Grouper Rate,1678.00
Blue Cross,EPO,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Grouper Rate,1678.00
Blue Cross,EPO,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Grouper Rate,1678.00
Blue Cross,EPO,29086,CPT4/HCPCS,APPLY FINGER CAST,,Grouper Rate,1678.00
Blue Cross,EPO,291,DRG,Heart failure & shock w MCC,,Case Rate,22178.48
Blue Cross,EPO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Per Date of Service,193.00
Blue Cross,EPO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Per Date of Service,193.00
Blue Cross,EPO,292,DRG,Heart failure & shock w CC,,Case Rate,14804.95
Blue Cross,EPO,29200,CPT4/HCPCS,STRAPPING OF CHEST,,Grouper Rate,1678.00
Blue Cross,EPO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Per Date of Service,193.00
Blue Cross,EPO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Per Date of Service,193.00
Blue Cross,EPO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Per Date of Service,193.00
Blue Cross,EPO,293,DRG,Heart failure & shock w/o CC/MCC,,Case Rate,10794.00
Blue Cross,EPO,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Grouper Rate,1678.00
Blue Cross,EPO,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Grouper Rate,1678.00
Blue Cross,EPO,294,DRG,Deep vein thrombophlebitis w CC/MCC,,Case Rate,21205.93
Blue Cross,EPO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,Per Date of Service,193.00
Blue Cross,EPO,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,Grouper Rate,1678.00
Blue Cross,EPO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,Grouper Rate,1678.00
Blue Cross,EPO,295,DRG,Deep vein thrombophlebitis w/o CC/MCC,,Case Rate,16230.70
Blue Cross,EPO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Per Date of Service,193.00
Blue Cross,EPO,29520,CPT4/HCPCS,STRAPPING OF HIP,,Per Date of Service,193.00
Blue Cross,EPO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,Per Date of Service,193.00
Blue Cross,EPO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,Grouper Rate,1678.00
Blue Cross,EPO,29550,CPT4/HCPCS,STRAPPING OF TOES,,Per Date of Service,193.00
Blue Cross,EPO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Grouper Rate,1678.00
Blue Cross,EPO,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,Grouper Rate,1678.00
Blue Cross,EPO,29582,CPT4/HCPCS,APPLY MULTLAY COMPRS UPR LEG,,Grouper Rate,1678.00
Blue Cross,EPO,29583,CPT4/HCPCS,APPLY MULTLAY COMPRS UPR ARM,,Grouper Rate,1678.00
Blue Cross,EPO,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,Grouper Rate,1678.00
Blue Cross,EPO,296,DRG,Cardiac arrest, unexplained w MCC,,Case Rate,26377.99
Blue Cross,EPO,297,DRG,Cardiac arrest, unexplained w CC,,Case Rate,11654.08
Blue Cross,EPO,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1678.00
Blue Cross,EPO,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1678.00
Blue Cross,EPO,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,Grouper Rate,1678.00
Blue Cross,EPO,29730,CPT4/HCPCS,WINDOWING OF CAST,,Grouper Rate,1678.00
Blue Cross,EPO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,Per Date of Service,193.00
Blue Cross,EPO,298,DRG,Cardiac arrest, unexplained w/o CC/MCC,,Case Rate,8074.82
Blue Cross,EPO,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Grouper Rate,5029.00
Blue Cross,EPO,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Grouper Rate,5281.00
Blue Cross,EPO,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Grouper Rate,6588.00
Blue Cross,EPO,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Grouper Rate,3544.00
Blue Cross,EPO,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Grouper Rate,3544.00
Blue Cross,EPO,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Grouper Rate,3544.00
Blue Cross,EPO,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Grouper Rate,5029.00
Blue Cross,EPO,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Grouper Rate,5281.00
Blue Cross,EPO,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Grouper Rate,5029.00
Blue Cross,EPO,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Grouper Rate,3544.00
Blue Cross,EPO,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Grouper Rate,5281.00
Blue Cross,EPO,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Grouper Rate,6588.00
Blue Cross,EPO,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Grouper Rate,5281.00
Blue Cross,EPO,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Grouper Rate,3544.00
Blue Cross,EPO,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Grouper Rate,3544.00
Blue Cross,EPO,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Grouper Rate,1678.88
Blue Cross,EPO,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Grouper Rate,5029.00
Blue Cross,EPO,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Grouper Rate,3544.00
Blue Cross,EPO,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Grouper Rate,5783.00
Blue Cross,EPO,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,8841.00
Blue Cross,EPO,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,8841.00
Blue Cross,EPO,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Grouper Rate,6588.00
Blue Cross,EPO,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Grouper Rate,3544.00
Blue Cross,EPO,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Grouper Rate,3544.00
Blue Cross,EPO,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,8012.00
Blue Cross,EPO,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,8012.00
Blue Cross,EPO,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Grouper Rate,3544.00
Blue Cross,EPO,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,8012.00
Blue Cross,EPO,299,DRG,Peripheral vascular disorders w MCC,,Case Rate,25329.35
Blue Cross,EPO,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Grouper Rate,1678.88
Blue Cross,EPO,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,EPO,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,EPO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Grouper Rate,3544.00
Blue Cross,EPO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Grouper Rate,3544.00
Blue Cross,EPO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Grouper Rate,3544.00
Blue Cross,EPO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Grouper Rate,3544.00
Blue Cross,EPO,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Grouper Rate,6588.00
Blue Cross,EPO,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Grouper Rate,6588.00
Blue Cross,EPO,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Grouper Rate,6588.00
Blue Cross,EPO,3,DRG,ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R.,,Case Rate,314114.44
Blue Cross,EPO,30,DRG,Spinal procedures w/o CC/MCC,,Case Rate,38986.43
Blue Cross,EPO,300,DRG,Peripheral vascular disorders w CC,,Case Rate,17237.98
Blue Cross,EPO,301,DRG,Peripheral vascular disorders w/o CC/MCC,,Case Rate,12280.95
Blue Cross,EPO,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,1678.00
Blue Cross,EPO,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,1678.88
Blue Cross,EPO,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,1678.88
Blue Cross,EPO,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,3544.00
Blue Cross,EPO,30120,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,1678.00
Blue Cross,EPO,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,1678.00
Blue Cross,EPO,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Grouper Rate,1678.00
Blue Cross,EPO,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Grouper Rate,1678.88
Blue Cross,EPO,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Grouper Rate,3544.00
Blue Cross,EPO,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Grouper Rate,5029.00
Blue Cross,EPO,302,DRG,Atherosclerosis w MCC,,Case Rate,18086.49
Blue Cross,EPO,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Grouper Rate,1678.00
Blue Cross,EPO,303,DRG,Atherosclerosis w/o MCC,,Case Rate,11187.65
Blue Cross,EPO,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,EPO,304,DRG,Hypertension w MCC,,Case Rate,18121.22
Blue Cross,EPO,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5029.00
Blue Cross,EPO,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5281.00
Blue Cross,EPO,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5281.00
Blue Cross,EPO,30430,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,3544.00
Blue Cross,EPO,30435,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,EPO,30450,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,EPO,30460,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,EPO,30462,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,EPO,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Grouper Rate,3544.00
Blue Cross,EPO,305,DRG,Hypertension w/o MCC,,Case Rate,12214.79
Blue Cross,EPO,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Grouper Rate,6588.00
Blue Cross,EPO,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,5281.00
Blue Cross,EPO,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,1678.00
Blue Cross,EPO,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Grouper Rate,1678.00
Blue Cross,EPO,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Grouper Rate,5029.00
Blue Cross,EPO,306,DRG,Cardiac congenital & valvular disorders w MCC,,Case Rate,24871.19
Blue Cross,EPO,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Grouper Rate,5029.00
Blue Cross,EPO,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Grouper Rate,6588.00
Blue Cross,EPO,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Grouper Rate,6588.00
Blue Cross,EPO,307,DRG,Cardiac congenital & valvular disorders w/o MCC,,Case Rate,14363.33
Blue Cross,EPO,308,DRG,Cardiac arrhythmia & conduction disorders w MCC,,Case Rate,19836.42
Blue Cross,EPO,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Grouper Rate,1678.00
Blue Cross,EPO,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Grouper Rate,1678.00
Blue Cross,EPO,309,DRG,Cardiac arrhythmia & conduction disorders w CC,,Case Rate,12395.07
Blue Cross,EPO,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,EPO,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,EPO,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,EPO,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,EPO,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Grouper Rate,1678.88
Blue Cross,EPO,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Grouper Rate,1678.00
Blue Cross,EPO,31,DRG,Ventricular shunt procedures w MCC,,Case Rate,72215.29
Blue Cross,EPO,310,DRG,Cardiac arrhythmia & conduction disorders w/o CC/MCC,,Case Rate,9235.93
Blue Cross,EPO,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Grouper Rate,1678.00
Blue Cross,EPO,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Grouper Rate,1678.00
Blue Cross,EPO,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,1678.88
Blue Cross,EPO,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,3544.00
Blue Cross,EPO,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Grouper Rate,5029.00
Blue Cross,EPO,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,Grouper Rate,5029.00
Blue Cross,EPO,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Grouper Rate,1678.88
Blue Cross,EPO,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,1678.88
Blue Cross,EPO,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,EPO,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,EPO,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,EPO,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,EPO,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,EPO,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,3544.00
Blue Cross,EPO,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,3544.00
Blue Cross,EPO,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Grouper Rate,5281.00
Blue Cross,EPO,311,DRG,Angina pectoris,,Case Rate,11528.38
Blue Cross,EPO,312,DRG,Syncope & collapse,,Case Rate,13847.28
Blue Cross,EPO,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,1678.88
Blue Cross,EPO,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,5281.00
Blue Cross,EPO,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,3544.00
Blue Cross,EPO,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Grouper Rate,5029.00
Blue Cross,EPO,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Grouper Rate,3544.00
Blue Cross,EPO,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Grouper Rate,1678.00
Blue Cross,EPO,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Grouper Rate,1678.00
Blue Cross,EPO,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Grouper Rate,1678.00
Blue Cross,EPO,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.00
Blue Cross,EPO,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.00
Blue Cross,EPO,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,EPO,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,EPO,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Grouper Rate,1678.00
Blue Cross,EPO,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Grouper Rate,3544.00
Blue Cross,EPO,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Grouper Rate,3544.00
Blue Cross,EPO,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Grouper Rate,3544.00
Blue Cross,EPO,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,1678.88
Blue Cross,EPO,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Grouper Rate,3544.00
Blue Cross,EPO,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Grouper Rate,3544.00
Blue Cross,EPO,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Grouper Rate,3544.00
Blue Cross,EPO,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Grouper Rate,3544.00
Blue Cross,EPO,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,EPO,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3544.00
Blue Cross,EPO,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5029.00
Blue Cross,EPO,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5029.00
Blue Cross,EPO,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Grouper Rate,3544.00
Blue Cross,EPO,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Grouper Rate,3544.00
Blue Cross,EPO,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Grouper Rate,5029.00
Blue Cross,EPO,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Grouper Rate,1678.88
Blue Cross,EPO,313,DRG,Chest pain,,Case Rate,11922.03
Blue Cross,EPO,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,5281.00
Blue Cross,EPO,31320,CPT4/HCPCS,DIAGNOSTIC INCISION LARYNX,,Grouper Rate,1678.88
Blue Cross,EPO,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,Grouper Rate,6588.00
Blue Cross,EPO,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,Grouper Rate,6588.00
Blue Cross,EPO,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5783.00
Blue Cross,EPO,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,6588.00
Blue Cross,EPO,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5281.00
Blue Cross,EPO,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5281.00
Blue Cross,EPO,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5281.00
Blue Cross,EPO,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,8841.00
Blue Cross,EPO,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,Grouper Rate,6588.00
Blue Cross,EPO,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,Grouper Rate,6588.00
Blue Cross,EPO,314,DRG,Other circulatory system diagnoses w MCC,,Case Rate,34459.43
Blue Cross,EPO,31400,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,3544.00
Blue Cross,EPO,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Grouper Rate,3544.00
Blue Cross,EPO,315,DRG,Other circulatory system diagnoses w CC,,Case Rate,16129.80
Blue Cross,EPO,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Grouper Rate,1678.00
Blue Cross,EPO,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Grouper Rate,1678.00
Blue Cross,EPO,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Grouper Rate,1678.00
Blue Cross,EPO,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,1678.00
Blue Cross,EPO,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Grouper Rate,1678.00
Blue Cross,EPO,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Grouper Rate,1678.00
Blue Cross,EPO,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Grouper Rate,1678.00
Blue Cross,EPO,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Grouper Rate,1678.00
Blue Cross,EPO,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Grouper Rate,1678.88
Blue Cross,EPO,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,1678.88
Blue Cross,EPO,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,1678.88
Blue Cross,EPO,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Grouper Rate,1678.88
Blue Cross,EPO,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Grouper Rate,1678.88
Blue Cross,EPO,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Grouper Rate,1678.88
Blue Cross,EPO,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Grouper Rate,1678.88
Blue Cross,EPO,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Grouper Rate,3544.00
Blue Cross,EPO,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Grouper Rate,3544.00
Blue Cross,EPO,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Grouper Rate,5029.00
Blue Cross,EPO,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,EPO,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,EPO,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,EPO,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,EPO,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Grouper Rate,5281.00
Blue Cross,EPO,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Grouper Rate,5281.00
Blue Cross,EPO,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Grouper Rate,1678.88
Blue Cross,EPO,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Grouper Rate,1678.88
Blue Cross,EPO,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Grouper Rate,1678.00
Blue Cross,EPO,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Grouper Rate,1678.00
Blue Cross,EPO,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Grouper Rate,1678.00
Blue Cross,EPO,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Grouper Rate,1678.00
Blue Cross,EPO,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Grouper Rate,1678.88
Blue Cross,EPO,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Grouper Rate,1678.00
Blue Cross,EPO,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Grouper Rate,5281.00
Blue Cross,EPO,31582,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,5281.00
Blue Cross,EPO,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Grouper Rate,5029.00
Blue Cross,EPO,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Grouper Rate,5029.00
Blue Cross,EPO,31588,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,5281.00
Blue Cross,EPO,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Grouper Rate,5281.00
Blue Cross,EPO,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Grouper Rate,5029.00
Blue Cross,EPO,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Grouper Rate,5029.00
Blue Cross,EPO,31595,CPT4/HCPCS,LARYNX NERVE SURGERY,,Grouper Rate,1678.88
Blue Cross,EPO,316,DRG,Other circulatory system diagnoses w/o CC/MCC,,Case Rate,12396.73
Blue Cross,EPO,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,EPO,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,EPO,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,3544.00
Blue Cross,EPO,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,EPO,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,EPO,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Grouper Rate,3544.00
Blue Cross,EPO,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Grouper Rate,1678.00
Blue Cross,EPO,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,1678.88
Blue Cross,EPO,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,1678.88
Blue Cross,EPO,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Grouper Rate,1678.00
Blue Cross,EPO,31620,CPT4/HCPCS,ENDOBRONCHIAL US ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Grouper Rate,1678.88
Blue Cross,EPO,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Grouper Rate,1678.88
Blue Cross,EPO,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Grouper Rate,1678.88
Blue Cross,EPO,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Grouper Rate,1678.88
Blue Cross,EPO,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Grouper Rate,1678.88
Blue Cross,EPO,31627,CPT4/HCPCS,NAVIGATIONAL BRONCHOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Grouper Rate,1678.88
Blue Cross,EPO,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Grouper Rate,1678.88
Blue Cross,EPO,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Grouper Rate,1678.88
Blue Cross,EPO,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Grouper Rate,1678.88
Blue Cross,EPO,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Grouper Rate,1678.88
Blue Cross,EPO,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Grouper Rate,1678.88
Blue Cross,EPO,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Grouper Rate,1678.88
Blue Cross,EPO,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Grouper Rate,1678.88
Blue Cross,EPO,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Grouper Rate,1678.88
Blue Cross,EPO,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Grouper Rate,1678.88
Blue Cross,EPO,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Grouper Rate,1678.00
Blue Cross,EPO,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Grouper Rate,1678.00
Blue Cross,EPO,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Grouper Rate,1678.00
Blue Cross,EPO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Grouper Rate,1678.88
Blue Cross,EPO,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Grouper Rate,1678.88
Blue Cross,EPO,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,31651,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,Grouper Rate,1678.00
Blue Cross,EPO,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Grouper Rate,1678.00
Blue Cross,EPO,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Grouper Rate,1678.00
Blue Cross,EPO,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Grouper Rate,1678.00
Blue Cross,EPO,31656,CPT4/HCPCS,BRONCHOSCOPY INJ FOR X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Grouper Rate,1678.88
Blue Cross,EPO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Grouper Rate,1678.88
Blue Cross,EPO,31715,CPT4/HCPCS,INJECTION FOR BRONCHUS X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,1678.00
Blue Cross,EPO,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,1678.00
Blue Cross,EPO,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,5281.00
Blue Cross,EPO,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,EPO,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,6588.00
Blue Cross,EPO,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,Grouper Rate,6588.00
Blue Cross,EPO,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,Grouper Rate,6588.00
Blue Cross,EPO,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,Grouper Rate,6588.00
Blue Cross,EPO,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Grouper Rate,6588.00
Blue Cross,EPO,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Grouper Rate,6588.00
Blue Cross,EPO,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,5029.00
Blue Cross,EPO,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,5029.00
Blue Cross,EPO,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,1678.88
Blue Cross,EPO,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,5783.00
Blue Cross,EPO,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Grouper Rate,1678.00
Blue Cross,EPO,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Grouper Rate,1678.88
Blue Cross,EPO,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Grouper Rate,1678.88
Blue Cross,EPO,319,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W MCC,,Case Rate,71383.33
Blue Cross,EPO,32,DRG,Ventricular shunt procedures w CC,,Case Rate,36589.78
Blue Cross,EPO,320,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W/O MCC,,Case Rate,40418.79
Blue Cross,EPO,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,Grouper Rate,5029.00
Blue Cross,EPO,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,Grouper Rate,5029.00
Blue Cross,EPO,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,Grouper Rate,8012.00
Blue Cross,EPO,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,Grouper Rate,8012.00
Blue Cross,EPO,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,Grouper Rate,8012.00
Blue Cross,EPO,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,8012.00
Blue Cross,EPO,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,Grouper Rate,6588.00
Blue Cross,EPO,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,Grouper Rate,6588.00
Blue Cross,EPO,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,Grouper Rate,6588.00
Blue Cross,EPO,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Grouper Rate,6588.00
Blue Cross,EPO,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,Grouper Rate,6588.00
Blue Cross,EPO,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Grouper Rate,6588.00
Blue Cross,EPO,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,Grouper Rate,6588.00
Blue Cross,EPO,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,Grouper Rate,5281.00
Blue Cross,EPO,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,Grouper Rate,6588.00
Blue Cross,EPO,32201,CPT4/HCPCS,DRAIN PERCUT LUNG LESION,,Grouper Rate,1678.00
Blue Cross,EPO,32215,CPT4/HCPCS,TREAT CHEST LINING,,Grouper Rate,3544.00
Blue Cross,EPO,32220,CPT4/HCPCS,RELEASE OF LUNG,,Grouper Rate,8012.00
Blue Cross,EPO,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,Grouper Rate,6588.00
Blue Cross,EPO,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,Grouper Rate,6588.00
Blue Cross,EPO,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,Grouper Rate,6588.00
Blue Cross,EPO,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Grouper Rate,1678.00
Blue Cross,EPO,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Grouper Rate,1678.00
Blue Cross,EPO,32420,CPT4/HCPCS,PUNCTURE/CLEAR LUNG,,Grouper Rate,1678.00
Blue Cross,EPO,32421,CPT4/HCPCS,THORACENTESIS FOR ASPIRATION,,Grouper Rate,1678.00
Blue Cross,EPO,32422,CPT4/HCPCS,THORACENTESIS W/TUBE INSERT,,Grouper Rate,1678.00
Blue Cross,EPO,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,Grouper Rate,8012.00
Blue Cross,EPO,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,Grouper Rate,8841.00
Blue Cross,EPO,32482,CPT4/HCPCS,BILOBECTOMY,,Grouper Rate,8841.00
Blue Cross,EPO,32484,CPT4/HCPCS,SEGMENTECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,Grouper Rate,8841.00
Blue Cross,EPO,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,Grouper Rate,3544.00
Blue Cross,EPO,32503,CPT4/HCPCS,RESECT APICAL LUNG TUMOR,,Grouper Rate,6588.00
Blue Cross,EPO,32504,CPT4/HCPCS,RESECT APICAL LUNG TUM/CHEST,,Grouper Rate,6588.00
Blue Cross,EPO,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,Grouper Rate,6588.00
Blue Cross,EPO,32506,CPT4/HCPCS,WEDGE RESECT OF LUNG ADD-ON,,Grouper Rate,6588.00
Blue Cross,EPO,32507,CPT4/HCPCS,WEDGE RESECT OF LUNG DIAG,,Grouper Rate,6588.00
Blue Cross,EPO,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,Grouper Rate,6588.00
Blue Cross,EPO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Grouper Rate,1678.00
Blue Cross,EPO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Grouper Rate,1678.88
Blue Cross,EPO,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Grouper Rate,1678.00
Blue Cross,EPO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Grouper Rate,1678.00
Blue Cross,EPO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Grouper Rate,1678.00
Blue Cross,EPO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Grouper Rate,1678.00
Blue Cross,EPO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Grouper Rate,1678.00
Blue Cross,EPO,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Grouper Rate,1678.00
Blue Cross,EPO,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Grouper Rate,1678.00
Blue Cross,EPO,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Grouper Rate,1678.00
Blue Cross,EPO,326,DRG,Stomach, esophageal & duodenal proc w MCC,,Case Rate,88947.15
Blue Cross,EPO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Grouper Rate,3544.00
Blue Cross,EPO,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Grouper Rate,3544.00
Blue Cross,EPO,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Grouper Rate,3544.00
Blue Cross,EPO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Grouper Rate,3544.00
Blue Cross,EPO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Grouper Rate,3544.00
Blue Cross,EPO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Grouper Rate,3544.00
Blue Cross,EPO,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,Grouper Rate,3544.00
Blue Cross,EPO,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,Grouper Rate,5029.00
Blue Cross,EPO,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,Grouper Rate,8012.00
Blue Cross,EPO,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,Grouper Rate,3544.00
Blue Cross,EPO,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,Grouper Rate,3544.00
Blue Cross,EPO,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,Grouper Rate,5029.00
Blue Cross,EPO,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,Grouper Rate,5783.00
Blue Cross,EPO,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,Grouper Rate,6588.00
Blue Cross,EPO,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,Grouper Rate,8012.00
Blue Cross,EPO,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,Grouper Rate,5783.00
Blue Cross,EPO,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Grouper Rate,5783.00
Blue Cross,EPO,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,Grouper Rate,5783.00
Blue Cross,EPO,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,Grouper Rate,3544.00
Blue Cross,EPO,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,Grouper Rate,3544.00
Blue Cross,EPO,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,Grouper Rate,3544.00
Blue Cross,EPO,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,Grouper Rate,3544.00
Blue Cross,EPO,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,Grouper Rate,3544.00
Blue Cross,EPO,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,Grouper Rate,3544.00
Blue Cross,EPO,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,Grouper Rate,3544.00
Blue Cross,EPO,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,Grouper Rate,3544.00
Blue Cross,EPO,327,DRG,Stomach, esophageal & duodenal proc w CC,,Case Rate,43162.78
Blue Cross,EPO,32701,CPT4/HCPCS,THORAX STEREO RAD TARGETW/TX,,Grouper Rate,1678.00
Blue Cross,EPO,328,DRG,Stomach, esophageal & duodenal proc w/o CC/MCC,,Case Rate,27547.37
Blue Cross,EPO,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,Grouper Rate,8012.00
Blue Cross,EPO,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,Grouper Rate,6588.00
Blue Cross,EPO,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,Grouper Rate,6588.00
Blue Cross,EPO,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,Grouper Rate,5783.00
Blue Cross,EPO,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,Grouper Rate,8841.00
Blue Cross,EPO,32855,CPT4/HCPCS,PREPARE DONOR LUNG SINGLE,,Grouper Rate,3544.00
Blue Cross,EPO,32856,CPT4/HCPCS,PREPARE DONOR LUNG DOUBLE,,Grouper Rate,3544.00
Blue Cross,EPO,329,DRG,Major small & large bowel procedures w MCC,,Case Rate,80223.96
Blue Cross,EPO,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,Grouper Rate,5783.00
Blue Cross,EPO,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Grouper Rate,5783.00
Blue Cross,EPO,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Grouper Rate,5783.00
Blue Cross,EPO,32940,CPT4/HCPCS,REVISION OF LUNG,,Grouper Rate,5029.00
Blue Cross,EPO,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,Grouper Rate,1678.88
Blue Cross,EPO,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Grouper Rate,5783.00
Blue Cross,EPO,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,Grouper Rate,1678.00
Blue Cross,EPO,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Grouper Rate,5783.00
Blue Cross,EPO,33,DRG,Ventricular shunt procedures w/o CC/MCC,,Case Rate,28460.37
Blue Cross,EPO,330,DRG,Major small & large bowel procedures w CC,,Case Rate,41995.06
Blue Cross,EPO,33010,CPT4/HCPCS,DRAINAGE OF HEART SAC,,Grouper Rate,1678.00
Blue Cross,EPO,33011,CPT4/HCPCS,REPEAT DRAINAGE OF HEART SAC,,Grouper Rate,1678.00
Blue Cross,EPO,33015,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,3544.00
Blue Cross,EPO,33016,CPT4/HCPCS,PERICARDIOCENTESIS W/IMAGING,,Grouper Rate,1678.88
Blue Cross,EPO,33017,CPT4/HCPCS,PRCRD DRG 6YR+ W/O CGEN CAR,,Grouper Rate,3544.00
Blue Cross,EPO,33018,CPT4/HCPCS,PRCRD DRG 0-5YR OR W/ANOMLY,,Grouper Rate,3544.00
Blue Cross,EPO,33019,CPT4/HCPCS,PERQ PRCRD DRG INSJ CATH CT,,Grouper Rate,3544.00
Blue Cross,EPO,33020,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,5029.00
Blue Cross,EPO,33025,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,6588.00
Blue Cross,EPO,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Grouper Rate,5783.00
Blue Cross,EPO,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Grouper Rate,6588.00
Blue Cross,EPO,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,Grouper Rate,5783.00
Blue Cross,EPO,331,DRG,Major small & large bowel procedures w/o CC/MCC,,Case Rate,28285.05
Blue Cross,EPO,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,6588.00
Blue Cross,EPO,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,6588.00
Blue Cross,EPO,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,Grouper Rate,5783.00
Blue Cross,EPO,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,Grouper Rate,3544.00
Blue Cross,EPO,332,DRG,Rectal resection w MCC,,Case Rate,68801.43
Blue Cross,EPO,33202,CPT4/HCPCS,INSERT EPICARD ELTRD OPEN,,Grouper Rate,5029.00
Blue Cross,EPO,33203,CPT4/HCPCS,INSERT EPICARD ELTRD ENDO,,Grouper Rate,1678.88
Blue Cross,EPO,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Grouper Rate,3544.00
Blue Cross,EPO,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Grouper Rate,3544.00
Blue Cross,EPO,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Grouper Rate,5281.00
Blue Cross,EPO,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Grouper Rate,3544.00
Blue Cross,EPO,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Grouper Rate,3544.00
Blue Cross,EPO,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Grouper Rate,6588.00
Blue Cross,EPO,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Grouper Rate,6588.00
Blue Cross,EPO,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Grouper Rate,3544.00
Blue Cross,EPO,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Grouper Rate,1678.88
Blue Cross,EPO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Grouper Rate,1678.88
Blue Cross,EPO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Grouper Rate,1678.88
Blue Cross,EPO,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Grouper Rate,1678.88
Blue Cross,EPO,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Grouper Rate,1678.88
Blue Cross,EPO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Grouper Rate,1678.88
Blue Cross,EPO,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Grouper Rate,3544.00
Blue Cross,EPO,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Grouper Rate,3544.00
Blue Cross,EPO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Grouper Rate,5281.00
Blue Cross,EPO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Grouper Rate,5029.00
Blue Cross,EPO,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Grouper Rate,5029.00
Blue Cross,EPO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Grouper Rate,1678.88
Blue Cross,EPO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Grouper Rate,1678.88
Blue Cross,EPO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Grouper Rate,1678.88
Blue Cross,EPO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Grouper Rate,1678.88
Blue Cross,EPO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Grouper Rate,1678.88
Blue Cross,EPO,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Grouper Rate,1678.88
Blue Cross,EPO,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Grouper Rate,1678.88
Blue Cross,EPO,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Grouper Rate,1678.88
Blue Cross,EPO,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Grouper Rate,6588.00
Blue Cross,EPO,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Grouper Rate,5029.00
Blue Cross,EPO,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Grouper Rate,5029.00
Blue Cross,EPO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Grouper Rate,5281.00
Blue Cross,EPO,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,5281.00
Blue Cross,EPO,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,5281.00
Blue Cross,EPO,33254,CPT4/HCPCS,ABLATE ATRIA LMTD,,Grouper Rate,5029.00
Blue Cross,EPO,33255,CPT4/HCPCS,ABLATE ATRIA W/O BYPASS EXT,,Grouper Rate,5281.00
Blue Cross,EPO,33256,CPT4/HCPCS,ABLATE ATRIA W/BYPASS EXTEN,,Grouper Rate,5783.00
Blue Cross,EPO,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,Grouper Rate,5029.00
Blue Cross,EPO,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,Grouper Rate,5029.00
Blue Cross,EPO,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,Grouper Rate,5281.00
Blue Cross,EPO,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,5281.00
Blue Cross,EPO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Grouper Rate,1678.88
Blue Cross,EPO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Grouper Rate,1678.88
Blue Cross,EPO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Grouper Rate,1678.88
Blue Cross,EPO,33265,CPT4/HCPCS,ABLATE ATRIA LMTD ENDO,,Grouper Rate,5029.00
Blue Cross,EPO,33266,CPT4/HCPCS,ABLATE ATRIA X10SV ENDO,,Grouper Rate,5029.00
Blue Cross,EPO,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Grouper Rate,5029.00
Blue Cross,EPO,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Grouper Rate,5029.00
Blue Cross,EPO,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Grouper Rate,5029.00
Blue Cross,EPO,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Grouper Rate,1678.88
Blue Cross,EPO,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,Grouper Rate,3544.00
Blue Cross,EPO,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,Grouper Rate,1678.88
Blue Cross,EPO,33282,CPT4/HCPCS,IMPLANT PAT-ACTIVE HT RECORD,,Grouper Rate,3544.00
Blue Cross,EPO,33284,CPT4/HCPCS,REMOVE PAT-ACTIVE HT RECORD,,Grouper Rate,1678.00
Blue Cross,EPO,33285,CPT4/HCPCS,INSJ SUBQ CAR RHYTHM MNTR,,Grouper Rate,3544.00
Blue Cross,EPO,33286,CPT4/HCPCS,RMVL SUBQ CAR RHYTHM MNTR,,Grouper Rate,1678.88
Blue Cross,EPO,33289,CPT4/HCPCS,TCAT IMPL WRLS P-ART PRS SNR,,Grouper Rate,8841.00
Blue Cross,EPO,333,DRG,Rectal resection w CC,,Case Rate,35412.14
Blue Cross,EPO,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,Grouper Rate,5783.00
Blue Cross,EPO,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,Grouper Rate,6588.00
Blue Cross,EPO,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Grouper Rate,5783.00
Blue Cross,EPO,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,Grouper Rate,5783.00
Blue Cross,EPO,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Grouper Rate,6588.00
Blue Cross,EPO,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,6588.00
Blue Cross,EPO,33332,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,6588.00
Blue Cross,EPO,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,8012.00
Blue Cross,EPO,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,Grouper Rate,5783.00
Blue Cross,EPO,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,Grouper Rate,6588.00
Blue Cross,EPO,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,EPO,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,EPO,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,EPO,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,EPO,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,Grouper Rate,6588.00
Blue Cross,EPO,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,5029.00
Blue Cross,EPO,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,5029.00
Blue Cross,EPO,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,5029.00
Blue Cross,EPO,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,334,DRG,Rectal resection w/o CC/MCC,,Case Rate,26616.16
Blue Cross,EPO,33400,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,Grouper Rate,5281.00
Blue Cross,EPO,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,6588.00
Blue Cross,EPO,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,8841.00
Blue Cross,EPO,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,Grouper Rate,8841.00
Blue Cross,EPO,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,Grouper Rate,8841.00
Blue Cross,EPO,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,5783.00
Blue Cross,EPO,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,8012.00
Blue Cross,EPO,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33440,CPT4/HCPCS,RPLCMT A-VALVE TLCJ AUTOL PV,,Grouper Rate,8841.00
Blue Cross,EPO,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,6588.00
Blue Cross,EPO,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,Grouper Rate,5281.00
Blue Cross,EPO,33472,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,6588.00
Blue Cross,EPO,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,8841.00
Blue Cross,EPO,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8012.00
Blue Cross,EPO,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,Grouper Rate,8012.00
Blue Cross,EPO,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8841.00
Blue Cross,EPO,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,Grouper Rate,8841.00
Blue Cross,EPO,335,DRG,Peritoneal adhesiolysis w MCC,,Case Rate,64347.21
Blue Cross,EPO,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Grouper Rate,8841.00
Blue Cross,EPO,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Grouper Rate,6588.00
Blue Cross,EPO,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,Grouper Rate,5783.00
Blue Cross,EPO,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Grouper Rate,6588.00
Blue Cross,EPO,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,33507,CPT4/HCPCS,REPAIR ART INTRAMURAL,,Grouper Rate,6588.00
Blue Cross,EPO,33508,CPT4/HCPCS,ENDOSCOPIC VEIN HARVEST,,Grouper Rate,3544.00
Blue Cross,EPO,33542,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,5783.00
Blue Cross,EPO,33545,CPT4/HCPCS,REPAIR OF HEART DAMAGE,,Grouper Rate,5783.00
Blue Cross,EPO,33548,CPT4/HCPCS,RESTORE/REMODEL VENTRICLE,,Grouper Rate,5783.00
Blue Cross,EPO,33572,CPT4/HCPCS,OPEN CORONARY ENDARTERECTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,336,DRG,Peritoneal adhesiolysis w CC,,Case Rate,37759.16
Blue Cross,EPO,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,Grouper Rate,6588.00
Blue Cross,EPO,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,Grouper Rate,6588.00
Blue Cross,EPO,33641,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33645,CPT4/HCPCS,REVISION OF HEART VEINS,,Grouper Rate,5783.00
Blue Cross,EPO,33647,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECTS,,Grouper Rate,8841.00
Blue Cross,EPO,33660,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,EPO,33665,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,EPO,33670,CPT4/HCPCS,REPAIR OF HEART CHAMBERS,,Grouper Rate,8841.00
Blue Cross,EPO,33675,CPT4/HCPCS,CLOSE MULT VSD,,Grouper Rate,8841.00
Blue Cross,EPO,33676,CPT4/HCPCS,CLOSE MULT VSD W/RESECTION,,Grouper Rate,8841.00
Blue Cross,EPO,33677,CPT4/HCPCS,CL MULT VSD W/REM PUL BAND,,Grouper Rate,8841.00
Blue Cross,EPO,33681,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33684,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33688,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33690,CPT4/HCPCS,REINFORCE PULMONARY ARTERY,,Grouper Rate,6588.00
Blue Cross,EPO,33692,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,EPO,33694,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,EPO,337,DRG,Peritoneal adhesiolysis w/o CC/MCC,,Case Rate,27003.20
Blue Cross,EPO,33702,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,EPO,33710,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,EPO,33720,CPT4/HCPCS,REPAIR OF HEART DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33724,CPT4/HCPCS,REPAIR VENOUS ANOMALY,,Grouper Rate,8012.00
Blue Cross,EPO,33726,CPT4/HCPCS,REPAIR PUL VENOUS STENOSIS,,Grouper Rate,8841.00
Blue Cross,EPO,33730,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT(S),,Grouper Rate,8841.00
Blue Cross,EPO,33735,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,6588.00
Blue Cross,EPO,33737,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8012.00
Blue Cross,EPO,33750,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,EPO,33755,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,EPO,33762,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,EPO,33764,CPT4/HCPCS,MAJOR VESSEL SHUNT & GRAFT,,Grouper Rate,8012.00
Blue Cross,EPO,33766,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,EPO,33774,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33775,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33776,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33777,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33778,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33779,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33780,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33781,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33786,CPT4/HCPCS,REPAIR ARTERIAL TRUNK,,Grouper Rate,8841.00
Blue Cross,EPO,33788,CPT4/HCPCS,REVISION OF PULMONARY ARTERY,,Grouper Rate,8012.00
Blue Cross,EPO,338,DRG,Appendectomy w complicated principal diag w MCC,,Case Rate,46292.15
Blue Cross,EPO,33800,CPT4/HCPCS,AORTIC SUSPENSION,,Grouper Rate,8012.00
Blue Cross,EPO,33802,CPT4/HCPCS,REPAIR VESSEL DEFECT,,Grouper Rate,6588.00
Blue Cross,EPO,33803,CPT4/HCPCS,REPAIR VESSEL DEFECT,,Grouper Rate,8012.00
Blue Cross,EPO,33813,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,8012.00
Blue Cross,EPO,33814,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33820,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,6588.00
Blue Cross,EPO,33822,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,6588.00
Blue Cross,EPO,33824,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,8012.00
Blue Cross,EPO,33840,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,8841.00
Blue Cross,EPO,33845,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,8841.00
Blue Cross,EPO,33851,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,8841.00
Blue Cross,EPO,33852,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,8841.00
Blue Cross,EPO,33858,CPT4/HCPCS,AS-AORT GRF F/AORTIC DSJ,,Grouper Rate,8841.00
Blue Cross,EPO,33859,CPT4/HCPCS,AS-AORT GRF F/DS OTH/THN DSJ,,Grouper Rate,8841.00
Blue Cross,EPO,33860,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,33864,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,33866,CPT4/HCPCS,AORTIC HEMIARCH GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,33870,CPT4/HCPCS,TRANSVERSE AORTIC ARCH GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,33871,CPT4/HCPCS,TRANSVRS A-ARCH GRF HYPTHRM,,Grouper Rate,8841.00
Blue Cross,EPO,33875,CPT4/HCPCS,THORACIC AORTIC GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,33877,CPT4/HCPCS,THORACOABDOMINAL GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,33880,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,Grouper Rate,8012.00
Blue Cross,EPO,33881,CPT4/HCPCS,ENDOVASC TAA REPR W/O SUBCL,,Grouper Rate,8012.00
Blue Cross,EPO,33883,CPT4/HCPCS,INSERT ENDOVASC PROSTH TAA,,Grouper Rate,3544.00
Blue Cross,EPO,33884,CPT4/HCPCS,ENDOVASC PROSTH TAA ADD-ON,,Grouper Rate,3544.00
Blue Cross,EPO,33886,CPT4/HCPCS,ENDOVASC PROSTH DELAYED,,Grouper Rate,5029.00
Blue Cross,EPO,339,DRG,Appendectomy w complicated principal diag w CC,,Case Rate,28035.30
Blue Cross,EPO,33910,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,Grouper Rate,8841.00
Blue Cross,EPO,33915,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,Grouper Rate,8012.00
Blue Cross,EPO,33916,CPT4/HCPCS,SURGERY OF GREAT VESSEL,,Grouper Rate,8841.00
Blue Cross,EPO,33924,CPT4/HCPCS,REMOVE PULMONARY SHUNT,,Grouper Rate,5281.00
Blue Cross,EPO,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,Grouper Rate,8841.00
Blue Cross,EPO,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,Grouper Rate,8841.00
Blue Cross,EPO,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,Grouper Rate,8841.00
Blue Cross,EPO,33933,CPT4/HCPCS,PREPARE DONOR HEART/LUNG,,Grouper Rate,3544.00
Blue Cross,EPO,33944,CPT4/HCPCS,PREPARE DONOR HEART,,Grouper Rate,3544.00
Blue Cross,EPO,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,Grouper Rate,5281.00
Blue Cross,EPO,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,Grouper Rate,5281.00
Blue Cross,EPO,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,Grouper Rate,3544.00
Blue Cross,EPO,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,EPO,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,EPO,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,EPO,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,EPO,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Grouper Rate,3544.00
Blue Cross,EPO,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Grouper Rate,3544.00
Blue Cross,EPO,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,EPO,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,EPO,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,EPO,33960,CPT4/HCPCS,EXTERNAL CIRCULATION ASSIST,,Grouper Rate,5281.00
Blue Cross,EPO,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,EPO,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,EPO,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,EPO,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Grouper Rate,5281.00
Blue Cross,EPO,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Grouper Rate,5281.00
Blue Cross,EPO,33967,CPT4/HCPCS,INSERT I-AORT PERCUT DEVICE,,Grouper Rate,5029.00
Blue Cross,EPO,33968,CPT4/HCPCS,REMOVE AORTIC ASSIST DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Grouper Rate,5281.00
Blue Cross,EPO,33970,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,Grouper Rate,5029.00
Blue Cross,EPO,33971,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,Grouper Rate,5281.00
Blue Cross,EPO,33976,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,Grouper Rate,8012.00
Blue Cross,EPO,33979,CPT4/HCPCS,INSERT INTRACORPOREAL DEVICE,,Grouper Rate,8012.00
Blue Cross,EPO,33980,CPT4/HCPCS,REMOVE INTRACORPOREAL DEVICE,,Grouper Rate,5281.00
Blue Cross,EPO,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Grouper Rate,5281.00
Blue Cross,EPO,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Grouper Rate,5281.00
Blue Cross,EPO,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Grouper Rate,5281.00
Blue Cross,EPO,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,Grouper Rate,5029.00
Blue Cross,EPO,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,Grouper Rate,5029.00
Blue Cross,EPO,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,Grouper Rate,5029.00
Blue Cross,EPO,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,Grouper Rate,8012.00
Blue Cross,EPO,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,Grouper Rate,8012.00
Blue Cross,EPO,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,Grouper Rate,5281.00
Blue Cross,EPO,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,Grouper Rate,8012.00
Blue Cross,EPO,34,DRG,Carotid artery stent procedure w MCC,,Case Rate,65739.88
Blue Cross,EPO,340,DRG,Appendectomy w complicated principal diag w/o CC/MCC,,Case Rate,20317.73
Blue Cross,EPO,34001,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,3544.00
Blue Cross,EPO,34051,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,6588.00
Blue Cross,EPO,341,DRG,Appendectomy w/o complicated principal diag w MCC,,Case Rate,38309.94
Blue Cross,EPO,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,3544.00
Blue Cross,EPO,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,Grouper Rate,3544.00
Blue Cross,EPO,34151,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,5281.00
Blue Cross,EPO,342,DRG,Appendectomy w/o complicated principal diag w CC,,Case Rate,23703.47
Blue Cross,EPO,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,5281.00
Blue Cross,EPO,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,Grouper Rate,5029.00
Blue Cross,EPO,343,DRG,Appendectomy w/o complicated principal diag w/o CC/MCC,,Case Rate,18349.47
Blue Cross,EPO,344,DRG,Minor small & large bowel procedures w MCC,,Case Rate,46326.88
Blue Cross,EPO,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,5029.00
Blue Cross,EPO,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,EPO,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,EPO,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,EPO,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,EPO,345,DRG,Minor small & large bowel procedures w CC,,Case Rate,26095.15
Blue Cross,EPO,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,Grouper Rate,5029.00
Blue Cross,EPO,34502,CPT4/HCPCS,RECONSTRUCT VENA CAVA,,Grouper Rate,6588.00
Blue Cross,EPO,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,Grouper Rate,5029.00
Blue Cross,EPO,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,34530,CPT4/HCPCS,LEG VEIN FUSION,,Grouper Rate,3544.00
Blue Cross,EPO,346,DRG,Minor small & large bowel procedures w/o CC/MCC,,Case Rate,21088.50
Blue Cross,EPO,347,DRG,Anal & stomal procedures w MCC,,Case Rate,40714.86
Blue Cross,EPO,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Grouper Rate,5783.00
Blue Cross,EPO,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Grouper Rate,5783.00
Blue Cross,EPO,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Grouper Rate,5783.00
Blue Cross,EPO,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Grouper Rate,5783.00
Blue Cross,EPO,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Grouper Rate,5783.00
Blue Cross,EPO,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Grouper Rate,5783.00
Blue Cross,EPO,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Grouper Rate,5783.00
Blue Cross,EPO,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Grouper Rate,5783.00
Blue Cross,EPO,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Grouper Rate,3544.00
Blue Cross,EPO,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Grouper Rate,3544.00
Blue Cross,EPO,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Grouper Rate,1678.88
Blue Cross,EPO,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Grouper Rate,5029.00
Blue Cross,EPO,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Grouper Rate,5029.00
Blue Cross,EPO,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Grouper Rate,5029.00
Blue Cross,EPO,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Grouper Rate,5029.00
Blue Cross,EPO,34717,CPT4/HCPCS,EVASC RPR A-ILIAC NDGFT,,Grouper Rate,5783.00
Blue Cross,EPO,34718,CPT4/HCPCS,EVASC RPR N/A A-ILIAC NDGFT,,Grouper Rate,5281.00
Blue Cross,EPO,348,DRG,Anal & stomal procedures w CC,,Case Rate,22203.29
Blue Cross,EPO,34800,CPT4/HCPCS,ENDOVAS AAA REPR W/SM TUBE,,Grouper Rate,5783.00
Blue Cross,EPO,34802,CPT4/HCPCS,ENDOVAS AAA REPR W/2-P PART,,Grouper Rate,5783.00
Blue Cross,EPO,34803,CPT4/HCPCS,ENDOVAS AAA REPR W/3-P PART,,Grouper Rate,5783.00
Blue Cross,EPO,34804,CPT4/HCPCS,ENDOVAS AAA REPR W/1-P PART,,Grouper Rate,5783.00
Blue Cross,EPO,34805,CPT4/HCPCS,ENDOVAS AAA REPR W/LONG TUBE,,Grouper Rate,5783.00
Blue Cross,EPO,34806,CPT4/HCPCS,ANEURYSM PRESS SENSOR ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,34808,CPT4/HCPCS,ENDOVAS ILIAC A DEVICE ADDON,,Grouper Rate,3544.00
Blue Cross,EPO,34812,CPT4/HCPCS,OPN FEM ART EXPOS,,Grouper Rate,5029.00
Blue Cross,EPO,34813,CPT4/HCPCS,FEMORAL ENDOVAS GRAFT ADD-ON,,Grouper Rate,5029.00
Blue Cross,EPO,34820,CPT4/HCPCS,OPN ILIAC ART EXPOS,,Grouper Rate,5029.00
Blue Cross,EPO,34825,CPT4/HCPCS,ENDOVASC EXTEND PROSTH INIT,,Grouper Rate,3544.00
Blue Cross,EPO,34826,CPT4/HCPCS,ENDOVASC EXTEN PROSTH ADDL,,Grouper Rate,1678.88
Blue Cross,EPO,34830,CPT4/HCPCS,OPEN AORTIC TUBE PROSTH REPR,,Grouper Rate,8012.00
Blue Cross,EPO,34831,CPT4/HCPCS,OPEN AORTOILIAC PROSTH REPR,,Grouper Rate,8012.00
Blue Cross,EPO,34832,CPT4/HCPCS,OPEN AORTOFEMOR PROSTH REPR,,Grouper Rate,8012.00
Blue Cross,EPO,34833,CPT4/HCPCS,OPN ILAC ART EXPOS CNDT CRTJ,,Grouper Rate,5029.00
Blue Cross,EPO,34834,CPT4/HCPCS,OPN BRACH ART EXPOS,,Grouper Rate,5029.00
Blue Cross,EPO,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,Grouper Rate,8841.00
Blue Cross,EPO,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,Grouper Rate,8841.00
Blue Cross,EPO,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,Grouper Rate,8841.00
Blue Cross,EPO,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,Grouper Rate,8841.00
Blue Cross,EPO,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,Grouper Rate,8841.00
Blue Cross,EPO,349,DRG,Anal & stomal procedures w/o CC/MCC,,Case Rate,16197.62
Blue Cross,EPO,34900,CPT4/HCPCS,ENDOVASC ILIAC REPR W/GRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,35,DRG,Carotid artery stent procedure w CC,,Case Rate,38655.63
Blue Cross,EPO,350,DRG,Inguinal & femoral hernia procedures w MCC,,Case Rate,40562.69
Blue Cross,EPO,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,EPO,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,Grouper Rate,5783.00
Blue Cross,EPO,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,EPO,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,Grouper Rate,5281.00
Blue Cross,EPO,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,6588.00
Blue Cross,EPO,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,Grouper Rate,6588.00
Blue Cross,EPO,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,Grouper Rate,5029.00
Blue Cross,EPO,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,8012.00
Blue Cross,EPO,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,8012.00
Blue Cross,EPO,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,8012.00
Blue Cross,EPO,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,8012.00
Blue Cross,EPO,351,DRG,Inguinal & femoral hernia procedures w CC,,Case Rate,24651.21
Blue Cross,EPO,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,8012.00
Blue Cross,EPO,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,8012.00
Blue Cross,EPO,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5783.00
Blue Cross,EPO,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,Grouper Rate,5783.00
Blue Cross,EPO,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5783.00
Blue Cross,EPO,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,Grouper Rate,6588.00
Blue Cross,EPO,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5783.00
Blue Cross,EPO,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,Grouper Rate,5783.00
Blue Cross,EPO,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,EPO,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,Grouper Rate,5281.00
Blue Cross,EPO,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,EPO,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,Grouper Rate,5281.00
Blue Cross,EPO,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5783.00
Blue Cross,EPO,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,352,DRG,Inguinal & femoral hernia procedures w/o CC/MCC,,Case Rate,18243.62
Blue Cross,EPO,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,EPO,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,EPO,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,EPO,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8841.00
Blue Cross,EPO,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8012.00
Blue Cross,EPO,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5783.00
Blue Cross,EPO,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,EPO,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8841.00
Blue Cross,EPO,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6588.00
Blue Cross,EPO,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6588.00
Blue Cross,EPO,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8841.00
Blue Cross,EPO,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6588.00
Blue Cross,EPO,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5783.00
Blue Cross,EPO,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,353,DRG,Hernia procedures except inguinal & femoral w MCC,,Case Rate,49757.28
Blue Cross,EPO,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,EPO,35302,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,EPO,35303,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,EPO,35304,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,EPO,35305,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,EPO,35306,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1678.88
Blue Cross,EPO,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,6588.00
Blue Cross,EPO,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,EPO,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,EPO,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,EPO,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,EPO,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,EPO,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,EPO,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,EPO,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,EPO,354,DRG,Hernia procedures except inguinal & femoral w CC,,Case Rate,29490.82
Blue Cross,EPO,35400,CPT4/HCPCS,ANGIOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,35450,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,3544.00
Blue Cross,EPO,35452,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,EPO,35458,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,3544.00
Blue Cross,EPO,35460,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,Grouper Rate,3544.00
Blue Cross,EPO,35471,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,EPO,35472,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,EPO,35475,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,EPO,35476,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,EPO,355,DRG,Hernia procedures except inguinal & femoral w/o CC/MCC,,Case Rate,22481.16
Blue Cross,EPO,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,Grouper Rate,1678.00
Blue Cross,EPO,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,Grouper Rate,5281.00
Blue Cross,EPO,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,Grouper Rate,5029.00
Blue Cross,EPO,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,Grouper Rate,5029.00
Blue Cross,EPO,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,Grouper Rate,5281.00
Blue Cross,EPO,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,Grouper Rate,5281.00
Blue Cross,EPO,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,Grouper Rate,5029.00
Blue Cross,EPO,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,Grouper Rate,5029.00
Blue Cross,EPO,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,Grouper Rate,5281.00
Blue Cross,EPO,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,Grouper Rate,5281.00
Blue Cross,EPO,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,Grouper Rate,5281.00
Blue Cross,EPO,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,Grouper Rate,5783.00
Blue Cross,EPO,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,Grouper Rate,5281.00
Blue Cross,EPO,35535,CPT4/HCPCS,ART BYP GRFT HEPATORENAL,,Grouper Rate,5783.00
Blue Cross,EPO,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,Grouper Rate,5783.00
Blue Cross,EPO,35537,CPT4/HCPCS,ART BYP GRFT AORTOILIAC,,Grouper Rate,5783.00
Blue Cross,EPO,35538,CPT4/HCPCS,ART BYP GRFT AORTOBI-ILIAC,,Grouper Rate,5783.00
Blue Cross,EPO,35539,CPT4/HCPCS,ART BYP GRFT AORTOFEMORAL,,Grouper Rate,5783.00
Blue Cross,EPO,35540,CPT4/HCPCS,ART BYP GRFT AORTBIFEMORAL,,Grouper Rate,5783.00
Blue Cross,EPO,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,Grouper Rate,5281.00
Blue Cross,EPO,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,Grouper Rate,5281.00
Blue Cross,EPO,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,Grouper Rate,5783.00
Blue Cross,EPO,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,Grouper Rate,5281.00
Blue Cross,EPO,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,Grouper Rate,5029.00
Blue Cross,EPO,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Grouper Rate,5029.00
Blue Cross,EPO,35570,CPT4/HCPCS,ART BYP TIBIAL-TIB/PERONEAL,,Grouper Rate,5029.00
Blue Cross,EPO,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Grouper Rate,5029.00
Blue Cross,EPO,35572,CPT4/HCPCS,HARVEST FEMOROPOPLITEAL VEIN,,Grouper Rate,1678.00
Blue Cross,EPO,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,Grouper Rate,5029.00
Blue Cross,EPO,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,Grouper Rate,5029.00
Blue Cross,EPO,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,Grouper Rate,5029.00
Blue Cross,EPO,356,DRG,Other digestive system O.R. procedures w MCC,,Case Rate,70979.75
Blue Cross,EPO,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,Grouper Rate,5281.00
Blue Cross,EPO,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,Grouper Rate,5029.00
Blue Cross,EPO,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,Grouper Rate,5281.00
Blue Cross,EPO,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,Grouper Rate,5029.00
Blue Cross,EPO,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,Grouper Rate,5281.00
Blue Cross,EPO,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,Grouper Rate,5281.00
Blue Cross,EPO,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,Grouper Rate,5281.00
Blue Cross,EPO,35632,CPT4/HCPCS,ART BYP ILIO-CELIAC,,Grouper Rate,5281.00
Blue Cross,EPO,35633,CPT4/HCPCS,ART BYP ILIO-MESENTERIC,,Grouper Rate,5281.00
Blue Cross,EPO,35634,CPT4/HCPCS,ART BYP ILIORENAL,,Grouper Rate,5281.00
Blue Cross,EPO,35636,CPT4/HCPCS,ART BYP SPENORENAL,,Grouper Rate,5281.00
Blue Cross,EPO,35637,CPT4/HCPCS,ART BYP AORTOILIAC,,Grouper Rate,5783.00
Blue Cross,EPO,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,Grouper Rate,5029.00
Blue Cross,EPO,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,Grouper Rate,5029.00
Blue Cross,EPO,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,Grouper Rate,5783.00
Blue Cross,EPO,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,Grouper Rate,5783.00
Blue Cross,EPO,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,Grouper Rate,5281.00
Blue Cross,EPO,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,Grouper Rate,5281.00
Blue Cross,EPO,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,Grouper Rate,5029.00
Blue Cross,EPO,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,Grouper Rate,5029.00
Blue Cross,EPO,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,Grouper Rate,5029.00
Blue Cross,EPO,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,Grouper Rate,5029.00
Blue Cross,EPO,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Grouper Rate,5029.00
Blue Cross,EPO,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Grouper Rate,5029.00
Blue Cross,EPO,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,Grouper Rate,5281.00
Blue Cross,EPO,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,Grouper Rate,1678.00
Blue Cross,EPO,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,Grouper Rate,1678.88
Blue Cross,EPO,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,Grouper Rate,1678.88
Blue Cross,EPO,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,Grouper Rate,1678.88
Blue Cross,EPO,357,DRG,Other digestive system O.R. procedures w CC,,Case Rate,37276.19
Blue Cross,EPO,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,Grouper Rate,1678.00
Blue Cross,EPO,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,Grouper Rate,3544.00
Blue Cross,EPO,35702,CPT4/HCPCS,EXPL N/FLWD SURG UXTR ART,,Grouper Rate,3544.00
Blue Cross,EPO,35703,CPT4/HCPCS,EXPL N/FLWD SURG LXTR ART,,Grouper Rate,3544.00
Blue Cross,EPO,35721,CPT4/HCPCS,EXPLORATION FEMORAL ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,35741,CPT4/HCPCS,EXPLORATION POPLITEAL ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,35761,CPT4/HCPCS,EXPLORATION OF ARTERY/VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,358,DRG,Other digestive system O.R. procedures w/o CC/MCC,,Case Rate,22147.06
Blue Cross,EPO,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,Grouper Rate,1678.88
Blue Cross,EPO,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,Grouper Rate,5281.00
Blue Cross,EPO,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,Grouper Rate,5029.00
Blue Cross,EPO,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,Grouper Rate,1678.88
Blue Cross,EPO,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,Grouper Rate,5783.00
Blue Cross,EPO,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,5029.00
Blue Cross,EPO,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,5029.00
Blue Cross,EPO,35883,CPT4/HCPCS,REVISE GRAFT W/NONAUTO GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,35884,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,5029.00
Blue Cross,EPO,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,Grouper Rate,1678.88
Blue Cross,EPO,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,Grouper Rate,1678.88
Blue Cross,EPO,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,Grouper Rate,5029.00
Blue Cross,EPO,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,Grouper Rate,6588.00
Blue Cross,EPO,36,DRG,Carotid artery stent procedure w/o CC/MCC,,Case Rate,30618.84
Blue Cross,EPO,36000,CPT4/HCPCS,PLACE NEEDLE IN VEIN,,Grouper Rate,1678.00
Blue Cross,EPO,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Grouper Rate,1678.00
Blue Cross,EPO,36005,CPT4/HCPCS,INJECTION EXT VENOGRAPHY,,Grouper Rate,1678.88
Blue Cross,EPO,36010,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1678.00
Blue Cross,EPO,36011,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1678.00
Blue Cross,EPO,36012,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1678.00
Blue Cross,EPO,36013,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,36014,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,36015,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,36100,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,36120,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,36140,CPT4/HCPCS,INTRO NDL ICATH UPR/LXTR ART,,Grouper Rate,1678.00
Blue Cross,EPO,36147,CPT4/HCPCS,ACCESS AV DIAL GRFT FOR EVAL,,Grouper Rate,1678.00
Blue Cross,EPO,36148,CPT4/HCPCS,ACCESS AV DIAL GRFT FOR PROC,,Grouper Rate,1678.00
Blue Cross,EPO,36160,CPT4/HCPCS,ESTABLISH ACCESS TO AORTA,,Grouper Rate,1678.00
Blue Cross,EPO,36200,CPT4/HCPCS,PLACE CATHETER IN AORTA,,Grouper Rate,3544.00
Blue Cross,EPO,36215,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,36216,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,36217,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,36218,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Grouper Rate,3544.00
Blue Cross,EPO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,3544.00
Blue Cross,EPO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,3544.00
Blue Cross,EPO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Grouper Rate,3544.00
Blue Cross,EPO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Grouper Rate,3544.00
Blue Cross,EPO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Grouper Rate,3544.00
Blue Cross,EPO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Grouper Rate,3544.00
Blue Cross,EPO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Grouper Rate,3544.00
Blue Cross,EPO,36245,CPT4/HCPCS,INS CATH ABD/L-EXT ART 1ST,,Grouper Rate,3544.00
Blue Cross,EPO,36246,CPT4/HCPCS,INS CATH ABD/L-EXT ART 2ND,,Grouper Rate,3544.00
Blue Cross,EPO,36247,CPT4/HCPCS,INS CATH ABD/L-EXT ART 3RD,,Grouper Rate,3544.00
Blue Cross,EPO,36248,CPT4/HCPCS,INS CATH ABD/L-EXT ART ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,Grouper Rate,3544.00
Blue Cross,EPO,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,Grouper Rate,3544.00
Blue Cross,EPO,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,Grouper Rate,3544.00
Blue Cross,EPO,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,Grouper Rate,3544.00
Blue Cross,EPO,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Grouper Rate,1678.00
Blue Cross,EPO,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Grouper Rate,1678.00
Blue Cross,EPO,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Grouper Rate,1678.00
Blue Cross,EPO,36416,CPT4/HCPCS,CAPILLARY BLOOD DRAW,,Grouper Rate,1678.00
Blue Cross,EPO,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Grouper Rate,1678.00
Blue Cross,EPO,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Grouper Rate,1678.00
Blue Cross,EPO,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Grouper Rate,1678.00
Blue Cross,EPO,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Grouper Rate,1678.00
Blue Cross,EPO,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Grouper Rate,1678.00
Blue Cross,EPO,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Grouper Rate,3544.00
Blue Cross,EPO,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Grouper Rate,1678.00
Blue Cross,EPO,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Grouper Rate,1678.88
Blue Cross,EPO,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Grouper Rate,1678.00
Blue Cross,EPO,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Grouper Rate,1678.00
Blue Cross,EPO,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,36474,CPT4/HCPCS,ENDOVENOUS MCHNCHEM ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Grouper Rate,1678.00
Blue Cross,EPO,36481,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1678.00
Blue Cross,EPO,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Grouper Rate,3544.00
Blue Cross,EPO,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Grouper Rate,1678.88
Blue Cross,EPO,36500,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1678.00
Blue Cross,EPO,36510,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1678.00
Blue Cross,EPO,36514,CPT4/HCPCS,APHERESIS PLASMA,,Grouper Rate,1678.00
Blue Cross,EPO,36522,CPT4/HCPCS,PHOTOPHERESIS,,Grouper Rate,1678.00
Blue Cross,EPO,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,1678.00
Blue Cross,EPO,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,1678.00
Blue Cross,EPO,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,3544.00
Blue Cross,EPO,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,3544.00
Blue Cross,EPO,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Grouper Rate,1678.88
Blue Cross,EPO,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Grouper Rate,1678.88
Blue Cross,EPO,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,3544.00
Blue Cross,EPO,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,3544.00
Blue Cross,EPO,36572,CPT4/HCPCS,INSJ PICC RS&I <5 YR,,Grouper Rate,1678.88
Blue Cross,EPO,36573,CPT4/HCPCS,INSJ PICC RS&I 5 YR+,,Grouper Rate,1678.88
Blue Cross,EPO,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,EPO,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Grouper Rate,1678.00
Blue Cross,EPO,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,EPO,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,EPO,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,EPO,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Grouper Rate,1678.00
Blue Cross,EPO,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,EPO,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Grouper Rate,1678.00
Blue Cross,EPO,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,EPO,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Grouper Rate,1678.00
Blue Cross,EPO,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Grouper Rate,1678.00
Blue Cross,EPO,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,Grouper Rate,1678.00
Blue Cross,EPO,36620,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,36625,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Grouper Rate,1678.00
Blue Cross,EPO,368,DRG,Major esophageal disorders w MCC,,Case Rate,32125.64
Blue Cross,EPO,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,3544.00
Blue Cross,EPO,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,3544.00
Blue Cross,EPO,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,3544.00
Blue Cross,EPO,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Grouper Rate,3544.00
Blue Cross,EPO,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Grouper Rate,5029.00
Blue Cross,EPO,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Grouper Rate,5029.00
Blue Cross,EPO,36822,CPT4/HCPCS,INSERTION OF CANNULA(S),,Grouper Rate,3544.00
Blue Cross,EPO,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,Grouper Rate,5281.00
Blue Cross,EPO,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Grouper Rate,5029.00
Blue Cross,EPO,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Grouper Rate,5029.00
Blue Cross,EPO,36833,CPT4/HCPCS,AV FISTULA REVISION,,Grouper Rate,5029.00
Blue Cross,EPO,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Grouper Rate,5029.00
Blue Cross,EPO,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Grouper Rate,3544.00
Blue Cross,EPO,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Grouper Rate,1678.88
Blue Cross,EPO,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Grouper Rate,3544.00
Blue Cross,EPO,36870,CPT4/HCPCS,PERCUT THROMBECT AV FISTULA,,Grouper Rate,1678.88
Blue Cross,EPO,369,DRG,Major esophageal disorders w CC,,Case Rate,17810.27
Blue Cross,EPO,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,1678.00
Blue Cross,EPO,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,5029.00
Blue Cross,EPO,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,5029.00
Blue Cross,EPO,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,1678.88
Blue Cross,EPO,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,5029.00
Blue Cross,EPO,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,3544.00
Blue Cross,EPO,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Grouper Rate,5029.00
Blue Cross,EPO,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Grouper Rate,1678.88
Blue Cross,EPO,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Grouper Rate,1678.88
Blue Cross,EPO,37,DRG,Extracranial procedures w MCC,,Case Rate,54163.53
Blue Cross,EPO,370,DRG,Major esophageal disorders w/o CC/MCC,,Case Rate,12365.30
Blue Cross,EPO,371,DRG,Major gastrointestinal disorders & peritoneal infections w MCC,,Case Rate,28586.08
Blue Cross,EPO,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,EPO,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,EPO,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,EPO,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,EPO,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,Grouper Rate,5783.00
Blue Cross,EPO,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,Grouper Rate,5029.00
Blue Cross,EPO,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Grouper Rate,5783.00
Blue Cross,EPO,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Grouper Rate,3544.00
Blue Cross,EPO,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Grouper Rate,1678.88
Blue Cross,EPO,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Grouper Rate,1678.88
Blue Cross,EPO,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Grouper Rate,1678.88
Blue Cross,EPO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Grouper Rate,5029.00
Blue Cross,EPO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Grouper Rate,5029.00
Blue Cross,EPO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Grouper Rate,5029.00
Blue Cross,EPO,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,Grouper Rate,1678.88
Blue Cross,EPO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Grouper Rate,3544.00
Blue Cross,EPO,372,DRG,Major gastrointestinal disorders & peritoneal infections w CC,,Case Rate,16996.50
Blue Cross,EPO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Grouper Rate,1678.88
Blue Cross,EPO,37201,CPT4/HCPCS,TRANSCATHETER THERAPY INFUSE,,Grouper Rate,1678.88
Blue Cross,EPO,37202,CPT4/HCPCS,TRANSCATHETER THERAPY INFUSE,,Grouper Rate,1678.88
Blue Cross,EPO,37203,CPT4/HCPCS,TRANSCATHETER RETRIEVAL,,Grouper Rate,3544.00
Blue Cross,EPO,37204,CPT4/HCPCS,TRANSCATHETER OCCLUSION,,Grouper Rate,5029.00
Blue Cross,EPO,37205,CPT4/HCPCS,TRANSCATH IV STENT PERCUT,,Grouper Rate,5029.00
Blue Cross,EPO,37206,CPT4/HCPCS,TRANSCATH IV STENT/PERC ADDL,,Grouper Rate,1678.88
Blue Cross,EPO,37207,CPT4/HCPCS,TRANSCATH IV STENT OPEN,,Grouper Rate,5029.00
Blue Cross,EPO,37208,CPT4/HCPCS,TRANSCATH IV STENT/OPEN ADDL,,Grouper Rate,1678.88
Blue Cross,EPO,37209,CPT4/HCPCS,CHANGE IV CATH AT THROMB TX,,Grouper Rate,1678.00
Blue Cross,EPO,37210,CPT4/HCPCS,EMBOLIZATION UTERINE FIBROID,,Grouper Rate,5029.00
Blue Cross,EPO,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Grouper Rate,1678.88
Blue Cross,EPO,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Grouper Rate,1678.88
Blue Cross,EPO,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Grouper Rate,1678.88
Blue Cross,EPO,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Grouper Rate,1678.88
Blue Cross,EPO,37215,CPT4/HCPCS,TRANSCATH STENT CCA W/EPS,,Grouper Rate,5281.00
Blue Cross,EPO,37216,CPT4/HCPCS,TRANSCATH STENT CCA W/O EPS,,Grouper Rate,5029.00
Blue Cross,EPO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Grouper Rate,5029.00
Blue Cross,EPO,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Grouper Rate,5029.00
Blue Cross,EPO,37220,CPT4/HCPCS,ILIAC REVASC,,Grouper Rate,5029.00
Blue Cross,EPO,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Grouper Rate,5029.00
Blue Cross,EPO,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Grouper Rate,3544.00
Blue Cross,EPO,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Grouper Rate,5029.00
Blue Cross,EPO,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Grouper Rate,5029.00
Blue Cross,EPO,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Grouper Rate,5281.00
Blue Cross,EPO,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Grouper Rate,5029.00
Blue Cross,EPO,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Grouper Rate,5281.00
Blue Cross,EPO,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Grouper Rate,5281.00
Blue Cross,EPO,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Grouper Rate,5281.00
Blue Cross,EPO,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Grouper Rate,1678.88
Blue Cross,EPO,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Grouper Rate,1678.88
Blue Cross,EPO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Grouper Rate,5029.00
Blue Cross,EPO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,1678.88
Blue Cross,EPO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Grouper Rate,5029.00
Blue Cross,EPO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,1678.88
Blue Cross,EPO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Grouper Rate,5281.00
Blue Cross,EPO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Grouper Rate,5281.00
Blue Cross,EPO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Grouper Rate,5281.00
Blue Cross,EPO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Grouper Rate,5281.00
Blue Cross,EPO,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Grouper Rate,5029.00
Blue Cross,EPO,37247,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL ART,,Grouper Rate,5029.00
Blue Cross,EPO,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Grouper Rate,5029.00
Blue Cross,EPO,37249,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL VEIN,,Grouper Rate,5029.00
Blue Cross,EPO,37252,CPT4/HCPCS,INTRVASC US NONCORONARY 1ST,,Grouper Rate,1678.00
Blue Cross,EPO,37253,CPT4/HCPCS,INTRVASC US NONCORONARY ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,373,DRG,Major gastrointestinal disorders & peritoneal infections w/o CC/MCC,,Case Rate,12297.49
Blue Cross,EPO,374,DRG,Digestive malignancy w MCC,,Case Rate,34203.06
Blue Cross,EPO,375,DRG,Digestive malignancy w CC,,Case Rate,19929.04
Blue Cross,EPO,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Grouper Rate,1678.88
Blue Cross,EPO,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,Grouper Rate,1678.88
Blue Cross,EPO,376,DRG,Digestive malignancy w/o CC/MCC,,Case Rate,14806.60
Blue Cross,EPO,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,5029.00
Blue Cross,EPO,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Grouper Rate,3544.00
Blue Cross,EPO,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Grouper Rate,1678.88
Blue Cross,EPO,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,Grouper Rate,5029.00
Blue Cross,EPO,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,Grouper Rate,5029.00
Blue Cross,EPO,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Grouper Rate,6588.00
Blue Cross,EPO,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,5029.00
Blue Cross,EPO,377,DRG,G.I. hemorrhage w MCC,,Case Rate,29753.80
Blue Cross,EPO,37700,CPT4/HCPCS,REVISE LEG VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Grouper Rate,3544.00
Blue Cross,EPO,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Grouper Rate,3544.00
Blue Cross,EPO,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Grouper Rate,3544.00
Blue Cross,EPO,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Grouper Rate,3544.00
Blue Cross,EPO,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Grouper Rate,3544.00
Blue Cross,EPO,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,Grouper Rate,5029.00
Blue Cross,EPO,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Grouper Rate,3544.00
Blue Cross,EPO,378,DRG,G.I. hemorrhage w CC,,Case Rate,16427.52
Blue Cross,EPO,379,DRG,G.I. hemorrhage w/o CC/MCC,,Case Rate,10537.63
Blue Cross,EPO,38,DRG,Extracranial procedures w CC,,Case Rate,27411.74
Blue Cross,EPO,380,DRG,Complicated peptic ulcer w MCC,,Case Rate,31146.47
Blue Cross,EPO,381,DRG,Complicated peptic ulcer w CC,,Case Rate,17527.43
Blue Cross,EPO,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Grouper Rate,5783.00
Blue Cross,EPO,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,Grouper Rate,5783.00
Blue Cross,EPO,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Grouper Rate,3544.00
Blue Cross,EPO,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,Grouper Rate,5783.00
Blue Cross,EPO,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,382,DRG,Complicated peptic ulcer w/o CC/MCC,,Case Rate,12707.68
Blue Cross,EPO,38200,CPT4/HCPCS,INJECTION FOR SPLEEN X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,38204,CPT4/HCPCS,BL DONOR SEARCH MANAGEMENT,,Grouper Rate,1678.00
Blue Cross,EPO,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,Grouper Rate,1678.00
Blue Cross,EPO,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,Grouper Rate,1678.00
Blue Cross,EPO,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,Grouper Rate,1678.00
Blue Cross,EPO,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,Grouper Rate,1678.00
Blue Cross,EPO,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,Grouper Rate,1678.00
Blue Cross,EPO,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,Grouper Rate,1678.00
Blue Cross,EPO,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,Grouper Rate,1678.00
Blue Cross,EPO,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,Grouper Rate,1678.00
Blue Cross,EPO,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,Grouper Rate,1678.00
Blue Cross,EPO,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,Grouper Rate,1678.00
Blue Cross,EPO,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,Grouper Rate,1678.00
Blue Cross,EPO,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Grouper Rate,1678.00
Blue Cross,EPO,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Grouper Rate,1678.00
Blue Cross,EPO,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Grouper Rate,1678.00
Blue Cross,EPO,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Grouper Rate,1678.88
Blue Cross,EPO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Grouper Rate,1678.88
Blue Cross,EPO,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Grouper Rate,6588.00
Blue Cross,EPO,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Grouper Rate,6588.00
Blue Cross,EPO,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,Grouper Rate,1678.00
Blue Cross,EPO,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Grouper Rate,6588.00
Blue Cross,EPO,383,DRG,Uncomplicated peptic ulcer w MCC,,Case Rate,21682.28
Blue Cross,EPO,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,1678.00
Blue Cross,EPO,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Grouper Rate,1678.88
Blue Cross,EPO,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,5783.00
Blue Cross,EPO,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,6588.00
Blue Cross,EPO,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,5783.00
Blue Cross,EPO,384,DRG,Uncomplicated peptic ulcer w/o MCC,,Case Rate,14760.29
Blue Cross,EPO,385,DRG,Inflammatory bowel disease w MCC,,Case Rate,26779.91
Blue Cross,EPO,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,EPO,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Grouper Rate,1678.00
Blue Cross,EPO,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,EPO,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,EPO,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,EPO,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,EPO,38531,CPT4/HCPCS,OPEN BX/EXC INGUINOFEM NODES,,Grouper Rate,1678.88
Blue Cross,EPO,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Grouper Rate,1678.88
Blue Cross,EPO,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,3544.00
Blue Cross,EPO,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,5029.00
Blue Cross,EPO,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,Grouper Rate,5281.00
Blue Cross,EPO,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,Grouper Rate,5281.00
Blue Cross,EPO,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Grouper Rate,3544.00
Blue Cross,EPO,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Grouper Rate,5281.00
Blue Cross,EPO,386,DRG,Inflammatory bowel disease w CC,,Case Rate,16432.49
Blue Cross,EPO,387,DRG,Inflammatory bowel disease w/o CC/MCC,,Case Rate,11801.29
Blue Cross,EPO,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,1678.88
Blue Cross,EPO,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,5281.00
Blue Cross,EPO,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,8012.00
Blue Cross,EPO,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,EPO,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,5029.00
Blue Cross,EPO,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,Grouper Rate,6588.00
Blue Cross,EPO,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,Grouper Rate,6588.00
Blue Cross,EPO,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,EPO,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,EPO,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,Grouper Rate,5783.00
Blue Cross,EPO,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,Grouper Rate,5783.00
Blue Cross,EPO,38790,CPT4/HCPCS,INJECT FOR LYMPHATIC X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,38792,CPT4/HCPCS,RA TRACER ID OF SENTINL NODE,,Grouper Rate,1678.00
Blue Cross,EPO,38794,CPT4/HCPCS,ACCESS THORACIC LYMPH DUCT,,Grouper Rate,1678.88
Blue Cross,EPO,388,DRG,G.I. obstruction w MCC,,Case Rate,25005.17
Blue Cross,EPO,389,DRG,G.I. obstruction w CC,,Case Rate,13592.57
Blue Cross,EPO,38900,CPT4/HCPCS,IO MAP OF SENT LYMPH NODE,,Grouper Rate,1678.00
Blue Cross,EPO,39,DRG,Extracranial procedures w/o CC/MCC,,Case Rate,18839.06
Blue Cross,EPO,390,DRG,G.I. obstruction w/o CC/MCC,,Case Rate,9636.20
Blue Cross,EPO,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,5029.00
Blue Cross,EPO,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,5029.00
Blue Cross,EPO,391,DRG,Esophagitis, gastroent & misc digest disorders w MCC,,Case Rate,20582.37
Blue Cross,EPO,392,DRG,Esophagitis, gastroent & misc digest disorders w/o MCC,,Case Rate,12643.17
Blue Cross,EPO,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,Grouper Rate,5029.00
Blue Cross,EPO,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,Grouper Rate,5029.00
Blue Cross,EPO,393,DRG,Other digestive system diagnoses w MCC,,Case Rate,27350.54
Blue Cross,EPO,394,DRG,Other digestive system diagnoses w CC,,Case Rate,15524.44
Blue Cross,EPO,39400,CPT4/HCPCS,MEDIASTINOSCOPY INCL BIOPSY,,Grouper Rate,3544.00
Blue Cross,EPO,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Grouper Rate,3544.00
Blue Cross,EPO,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Grouper Rate,3544.00
Blue Cross,EPO,395,DRG,Other digestive system diagnoses w/o CC/MCC,,Case Rate,10746.03
Blue Cross,EPO,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,Grouper Rate,5783.00
Blue Cross,EPO,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,6588.00
Blue Cross,EPO,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,5783.00
Blue Cross,EPO,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,5783.00
Blue Cross,EPO,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,Grouper Rate,5783.00
Blue Cross,EPO,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,Grouper Rate,5281.00
Blue Cross,EPO,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,Grouper Rate,6588.00
Blue Cross,EPO,4,DRG,Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R.,,Case Rate,196197.48
Blue Cross,EPO,40,DRG,Periph/cranial nerve & other nerv syst proc w MCC,,Case Rate,65462.01
Blue Cross,EPO,40490,CPT4/HCPCS,BIOPSY OF LIP,,Grouper Rate,1678.00
Blue Cross,EPO,405,DRG,Pancreas, liver & shunt procedures w MCC,,Case Rate,94782.47
Blue Cross,EPO,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1678.88
Blue Cross,EPO,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1678.88
Blue Cross,EPO,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1678.88
Blue Cross,EPO,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,1678.88
Blue Cross,EPO,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,1678.88
Blue Cross,EPO,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Grouper Rate,1678.88
Blue Cross,EPO,406,DRG,Pancreas, liver & shunt procedures w CC,,Case Rate,47585.58
Blue Cross,EPO,40650,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,3544.00
Blue Cross,EPO,40652,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,3544.00
Blue Cross,EPO,40654,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,3544.00
Blue Cross,EPO,407,DRG,Pancreas, liver & shunt procedures w/o CC/MCC,,Case Rate,34998.64
Blue Cross,EPO,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,3544.00
Blue Cross,EPO,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5029.00
Blue Cross,EPO,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5029.00
Blue Cross,EPO,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5029.00
Blue Cross,EPO,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,3544.00
Blue Cross,EPO,408,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC,,Case Rate,62016.73
Blue Cross,EPO,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.88
Blue Cross,EPO,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,1678.00
Blue Cross,EPO,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,1678.88
Blue Cross,EPO,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Grouper Rate,1678.00
Blue Cross,EPO,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,1678.88
Blue Cross,EPO,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1678.88
Blue Cross,EPO,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Grouper Rate,1678.00
Blue Cross,EPO,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Grouper Rate,1678.00
Blue Cross,EPO,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,1678.00
Blue Cross,EPO,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,1678.00
Blue Cross,EPO,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,1678.88
Blue Cross,EPO,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,1678.88
Blue Cross,EPO,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,1678.88
Blue Cross,EPO,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5281.00
Blue Cross,EPO,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5281.00
Blue Cross,EPO,409,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w CC,,Case Rate,34970.52
Blue Cross,EPO,41,DRG,Periph/cranial nerve & other nerv syst proc w CC or periph neurostim,,Case Rate,38882.23
Blue Cross,EPO,410,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC,,Case Rate,25896.67
Blue Cross,EPO,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Grouper Rate,1678.00
Blue Cross,EPO,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Grouper Rate,1678.00
Blue Cross,EPO,411,DRG,Cholecystectomy w c.d.e. w MCC,,Case Rate,62064.69
Blue Cross,EPO,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,1678.00
Blue Cross,EPO,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,1678.00
Blue Cross,EPO,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Grouper Rate,1678.00
Blue Cross,EPO,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Grouper Rate,1678.00
Blue Cross,EPO,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,5029.00
Blue Cross,EPO,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,5281.00
Blue Cross,EPO,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,Grouper Rate,5783.00
Blue Cross,EPO,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,412,DRG,Cholecystectomy w c.d.e. w CC,,Case Rate,37640.07
Blue Cross,EPO,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1678.88
Blue Cross,EPO,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1678.88
Blue Cross,EPO,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1678.88
Blue Cross,EPO,413,DRG,Cholecystectomy w c.d.e. w/o CC/MCC,,Case Rate,28637.35
Blue Cross,EPO,414,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w MCC,,Case Rate,59965.77
Blue Cross,EPO,415,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w CC,,Case Rate,33607.62
Blue Cross,EPO,41500,CPT4/HCPCS,FIXATION OF TONGUE,,Grouper Rate,1678.00
Blue Cross,EPO,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Grouper Rate,1678.00
Blue Cross,EPO,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Grouper Rate,1678.00
Blue Cross,EPO,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Grouper Rate,1678.00
Blue Cross,EPO,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Grouper Rate,1678.88
Blue Cross,EPO,416,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC,,Case Rate,23523.18
Blue Cross,EPO,417,DRG,Laparoscopic cholecystectomy w/o c.d.e. w MCC,,Case Rate,40084.69
Blue Cross,EPO,418,DRG,Laparoscopic cholecystectomy w/o c.d.e. w CC,,Case Rate,27921.17
Blue Cross,EPO,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Grouper Rate,1678.00
Blue Cross,EPO,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Grouper Rate,1678.00
Blue Cross,EPO,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Grouper Rate,1678.00
Blue Cross,EPO,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Grouper Rate,1678.00
Blue Cross,EPO,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,EPO,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,EPO,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,EPO,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,EPO,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,EPO,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Grouper Rate,1678.88
Blue Cross,EPO,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Grouper Rate,1678.00
Blue Cross,EPO,41870,CPT4/HCPCS,GUM GRAFT,,Grouper Rate,1678.88
Blue Cross,EPO,41872,CPT4/HCPCS,REPAIR GUM,,Grouper Rate,1678.88
Blue Cross,EPO,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Grouper Rate,1678.88
Blue Cross,EPO,419,DRG,Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC,,Case Rate,21753.40
Blue Cross,EPO,42,DRG,Periph/cranial nerve & other nerv syst proc w/o CC/MCC,,Case Rate,31176.24
Blue Cross,EPO,420,DRG,Hepatobiliary diagnostic procedures w MCC,,Case Rate,58123.21
Blue Cross,EPO,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Grouper Rate,1678.88
Blue Cross,EPO,421,DRG,Hepatobiliary diagnostic procedures w CC,,Case Rate,31573.20
Blue Cross,EPO,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Grouper Rate,1678.00
Blue Cross,EPO,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1678.00
Blue Cross,EPO,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1678.88
Blue Cross,EPO,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1678.88
Blue Cross,EPO,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Grouper Rate,5029.00
Blue Cross,EPO,42140,CPT4/HCPCS,EXCISION OF UVULA,,Grouper Rate,1678.88
Blue Cross,EPO,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Grouper Rate,5029.00
Blue Cross,EPO,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Grouper Rate,1678.00
Blue Cross,EPO,42180,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,1678.00
Blue Cross,EPO,42182,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,1678.88
Blue Cross,EPO,422,DRG,Hepatobiliary diagnostic procedures w/o CC/MCC,,Case Rate,24006.15
Blue Cross,EPO,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,EPO,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,EPO,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,EPO,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5783.00
Blue Cross,EPO,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,EPO,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,EPO,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,3544.00
Blue Cross,EPO,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,3544.00
Blue Cross,EPO,42235,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,5029.00
Blue Cross,EPO,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Grouper Rate,5029.00
Blue Cross,EPO,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Grouper Rate,1678.00
Blue Cross,EPO,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Grouper Rate,3544.00
Blue Cross,EPO,423,DRG,Other hepatobiliary or pancreas O.R. procedures w MCC,,Case Rate,69120.66
Blue Cross,EPO,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,EPO,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.88
Blue Cross,EPO,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,EPO,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,EPO,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,1678.00
Blue Cross,EPO,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,3544.00
Blue Cross,EPO,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,1678.88
Blue Cross,EPO,424,DRG,Other hepatobiliary or pancreas O.R. procedures w CC,,Case Rate,37737.66
Blue Cross,EPO,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,EPO,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,EPO,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Grouper Rate,3544.00
Blue Cross,EPO,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Grouper Rate,3544.00
Blue Cross,EPO,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,3544.00
Blue Cross,EPO,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5029.00
Blue Cross,EPO,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,6588.00
Blue Cross,EPO,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,6588.00
Blue Cross,EPO,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5783.00
Blue Cross,EPO,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Grouper Rate,3544.00
Blue Cross,EPO,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Grouper Rate,1678.88
Blue Cross,EPO,425,DRG,Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC,,Case Rate,25526.18
Blue Cross,EPO,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,3544.00
Blue Cross,EPO,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,5029.00
Blue Cross,EPO,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,3544.00
Blue Cross,EPO,42508,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5029.00
Blue Cross,EPO,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5029.00
Blue Cross,EPO,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5029.00
Blue Cross,EPO,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Grouper Rate,1678.00
Blue Cross,EPO,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Grouper Rate,1678.00
Blue Cross,EPO,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,1678.88
Blue Cross,EPO,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Grouper Rate,1678.00
Blue Cross,EPO,42802,CPT4/HCPCS,BIOPSY OF THROAT,,Grouper Rate,1678.00
Blue Cross,EPO,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,1678.00
Blue Cross,EPO,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,1678.00
Blue Cross,EPO,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Grouper Rate,1678.88
Blue Cross,EPO,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,3544.00
Blue Cross,EPO,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,5281.00
Blue Cross,EPO,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,5029.00
Blue Cross,EPO,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,5029.00
Blue Cross,EPO,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,5029.00
Blue Cross,EPO,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,5029.00
Blue Cross,EPO,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,EPO,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,EPO,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,EPO,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,EPO,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,5029.00
Blue Cross,EPO,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,5281.00
Blue Cross,EPO,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,5281.00
Blue Cross,EPO,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Grouper Rate,3544.00
Blue Cross,EPO,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Grouper Rate,3544.00
Blue Cross,EPO,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Grouper Rate,3544.00
Blue Cross,EPO,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,5029.00
Blue Cross,EPO,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,5281.00
Blue Cross,EPO,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Grouper Rate,1678.00
Blue Cross,EPO,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Grouper Rate,1678.88
Blue Cross,EPO,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,Grouper Rate,5281.00
Blue Cross,EPO,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Grouper Rate,1678.88
Blue Cross,EPO,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,EPO,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,EPO,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1678.88
Blue Cross,EPO,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,EPO,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,EPO,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1678.88
Blue Cross,EPO,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Grouper Rate,5029.00
Blue Cross,EPO,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Grouper Rate,5783.00
Blue Cross,EPO,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Grouper Rate,6588.00
Blue Cross,EPO,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,Grouper Rate,6588.00
Blue Cross,EPO,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,5783.00
Blue Cross,EPO,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,5281.00
Blue Cross,EPO,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,6588.00
Blue Cross,EPO,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Grouper Rate,1678.00
Blue Cross,EPO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Grouper Rate,1678.00
Blue Cross,EPO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Grouper Rate,1678.00
Blue Cross,EPO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Grouper Rate,1678.00
Blue Cross,EPO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Grouper Rate,1678.00
Blue Cross,EPO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Grouper Rate,1678.00
Blue Cross,EPO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Grouper Rate,1678.00
Blue Cross,EPO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,432,DRG,Cirrhosis & alcoholic hepatitis w MCC,,Case Rate,31129.93
Blue Cross,EPO,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Grouper Rate,1678.00
Blue Cross,EPO,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Grouper Rate,1678.88
Blue Cross,EPO,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Grouper Rate,1678.00
Blue Cross,EPO,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Grouper Rate,1678.88
Blue Cross,EPO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Grouper Rate,3544.00
Blue Cross,EPO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Grouper Rate,1678.00
Blue Cross,EPO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Grouper Rate,1678.00
Blue Cross,EPO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Grouper Rate,1678.00
Blue Cross,EPO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Grouper Rate,1678.00
Blue Cross,EPO,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Grouper Rate,1678.00
Blue Cross,EPO,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Grouper Rate,1678.88
Blue Cross,EPO,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Grouper Rate,1678.00
Blue Cross,EPO,43219,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Grouper Rate,1678.00
Blue Cross,EPO,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Grouper Rate,1678.00
Blue Cross,EPO,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Grouper Rate,1678.88
Blue Cross,EPO,43228,CPT4/HCPCS,ESOPH ENDOSCOPY ABLATION,,Grouper Rate,1678.88
Blue Cross,EPO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Grouper Rate,1678.00
Blue Cross,EPO,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Grouper Rate,1678.00
Blue Cross,EPO,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Grouper Rate,1678.00
Blue Cross,EPO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Grouper Rate,1678.00
Blue Cross,EPO,43234,CPT4/HCPCS,UPPER GI ENDOSCOPY EXAM,,Grouper Rate,1678.00
Blue Cross,EPO,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Grouper Rate,1678.88
Blue Cross,EPO,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Grouper Rate,1678.88
Blue Cross,EPO,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Grouper Rate,1678.88
Blue Cross,EPO,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,1678.88
Blue Cross,EPO,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Grouper Rate,1678.88
Blue Cross,EPO,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Grouper Rate,1678.00
Blue Cross,EPO,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Grouper Rate,1678.88
Blue Cross,EPO,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,1678.00
Blue Cross,EPO,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Grouper Rate,1678.88
Blue Cross,EPO,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Grouper Rate,1678.88
Blue Cross,EPO,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Grouper Rate,1678.88
Blue Cross,EPO,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Grouper Rate,1678.88
Blue Cross,EPO,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,EPO,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Grouper Rate,1678.88
Blue Cross,EPO,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Grouper Rate,1678.88
Blue Cross,EPO,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Grouper Rate,1678.88
Blue Cross,EPO,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Grouper Rate,1678.88
Blue Cross,EPO,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Grouper Rate,1678.00
Blue Cross,EPO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Grouper Rate,1678.88
Blue Cross,EPO,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Grouper Rate,1678.88
Blue Cross,EPO,43256,CPT4/HCPCS,UPPR GI ENDOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,EPO,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Grouper Rate,1678.88
Blue Cross,EPO,43258,CPT4/HCPCS,OPERATIVE UPPER GI ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Grouper Rate,1678.88
Blue Cross,EPO,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Grouper Rate,1678.88
Blue Cross,EPO,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,EPO,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,EPO,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Grouper Rate,1678.88
Blue Cross,EPO,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Grouper Rate,1678.88
Blue Cross,EPO,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Grouper Rate,1678.88
Blue Cross,EPO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Grouper Rate,1678.00
Blue Cross,EPO,43267,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,EPO,43268,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,EPO,43269,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,EPO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Grouper Rate,1678.88
Blue Cross,EPO,43271,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,EPO,43272,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,EPO,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Grouper Rate,1678.88
Blue Cross,EPO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Grouper Rate,1678.88
Blue Cross,EPO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Grouper Rate,1678.88
Blue Cross,EPO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Grouper Rate,1678.88
Blue Cross,EPO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Grouper Rate,1678.88
Blue Cross,EPO,43279,CPT4/HCPCS,LAP MYOTOMY HELLER,,Grouper Rate,5783.00
Blue Cross,EPO,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Grouper Rate,6588.00
Blue Cross,EPO,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Grouper Rate,6588.00
Blue Cross,EPO,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Grouper Rate,6588.00
Blue Cross,EPO,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,Grouper Rate,6588.00
Blue Cross,EPO,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Grouper Rate,5029.00
Blue Cross,EPO,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Grouper Rate,1678.88
Blue Cross,EPO,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,Grouper Rate,6588.00
Blue Cross,EPO,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,Grouper Rate,6588.00
Blue Cross,EPO,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,Grouper Rate,6588.00
Blue Cross,EPO,433,DRG,Cirrhosis & alcoholic hepatitis w CC,,Case Rate,17011.39
Blue Cross,EPO,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Grouper Rate,5281.00
Blue Cross,EPO,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Grouper Rate,5783.00
Blue Cross,EPO,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Grouper Rate,6588.00
Blue Cross,EPO,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,Grouper Rate,6588.00
Blue Cross,EPO,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,Grouper Rate,6588.00
Blue Cross,EPO,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,Grouper Rate,6588.00
Blue Cross,EPO,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,Grouper Rate,5783.00
Blue Cross,EPO,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,Grouper Rate,5783.00
Blue Cross,EPO,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,Grouper Rate,6588.00
Blue Cross,EPO,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,Grouper Rate,5783.00
Blue Cross,EPO,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,Grouper Rate,6588.00
Blue Cross,EPO,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Grouper Rate,6588.00
Blue Cross,EPO,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Grouper Rate,6588.00
Blue Cross,EPO,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Grouper Rate,6588.00
Blue Cross,EPO,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Grouper Rate,6588.00
Blue Cross,EPO,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Grouper Rate,8012.00
Blue Cross,EPO,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Grouper Rate,8012.00
Blue Cross,EPO,43338,CPT4/HCPCS,ESOPH LENGTHENING,,Grouper Rate,5783.00
Blue Cross,EPO,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Grouper Rate,5783.00
Blue Cross,EPO,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Grouper Rate,6588.00
Blue Cross,EPO,43350,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,5783.00
Blue Cross,EPO,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,EPO,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,5029.00
Blue Cross,EPO,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Grouper Rate,5783.00
Blue Cross,EPO,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Grouper Rate,5783.00
Blue Cross,EPO,434,DRG,Cirrhosis & alcoholic hepatitis w/o CC/MCC,,Case Rate,10248.18
Blue Cross,EPO,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,Grouper Rate,3544.00
Blue Cross,EPO,43401,CPT4/HCPCS,ESOPHAGUS SURGERY FOR VEINS,,Grouper Rate,5783.00
Blue Cross,EPO,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,Grouper Rate,5783.00
Blue Cross,EPO,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Grouper Rate,5281.00
Blue Cross,EPO,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Grouper Rate,6588.00
Blue Cross,EPO,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,5281.00
Blue Cross,EPO,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,6588.00
Blue Cross,EPO,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Grouper Rate,1678.00
Blue Cross,EPO,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1678.00
Blue Cross,EPO,43456,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1678.88
Blue Cross,EPO,43458,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1678.88
Blue Cross,EPO,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,Grouper Rate,1678.88
Blue Cross,EPO,435,DRG,Malignancy of hepatobiliary system or pancreas w MCC,,Case Rate,28991.31
Blue Cross,EPO,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Grouper Rate,5281.00
Blue Cross,EPO,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Grouper Rate,5783.00
Blue Cross,EPO,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Grouper Rate,5783.00
Blue Cross,EPO,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Grouper Rate,1678.00
Blue Cross,EPO,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,Grouper Rate,5281.00
Blue Cross,EPO,436,DRG,Malignancy of hepatobiliary system or pancreas w CC,,Case Rate,18528.10
Blue Cross,EPO,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,Grouper Rate,5029.00
Blue Cross,EPO,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Grouper Rate,1678.88
Blue Cross,EPO,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Grouper Rate,1678.88
Blue Cross,EPO,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,6588.00
Blue Cross,EPO,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,6588.00
Blue Cross,EPO,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,5783.00
Blue Cross,EPO,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,EPO,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,EPO,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,EPO,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,EPO,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,3544.00
Blue Cross,EPO,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Grouper Rate,5783.00
Blue Cross,EPO,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Grouper Rate,5783.00
Blue Cross,EPO,43645,CPT4/HCPCS,LAP GASTR BYPASS INCL SMLL I,,Grouper Rate,5783.00
Blue Cross,EPO,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Grouper Rate,3544.00
Blue Cross,EPO,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Grouper Rate,1678.88
Blue Cross,EPO,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,5281.00
Blue Cross,EPO,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,5281.00
Blue Cross,EPO,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,437,DRG,Malignancy of hepatobiliary system or pancreas w/o CC/MCC,,Case Rate,14795.03
Blue Cross,EPO,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Grouper Rate,1678.00
Blue Cross,EPO,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Grouper Rate,1678.00
Blue Cross,EPO,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Grouper Rate,1678.00
Blue Cross,EPO,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Grouper Rate,1678.00
Blue Cross,EPO,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Grouper Rate,1678.00
Blue Cross,EPO,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Grouper Rate,1678.00
Blue Cross,EPO,43760,CPT4/HCPCS,CHANGE GASTROSTOMY TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,43762,CPT4/HCPCS,RPLC GTUBE NO REVJ TRC,,Grouper Rate,1678.00
Blue Cross,EPO,43763,CPT4/HCPCS,RPLC GTUBE REVJ GSTRST TRC,,Grouper Rate,1678.00
Blue Cross,EPO,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Grouper Rate,5783.00
Blue Cross,EPO,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Grouper Rate,5029.00
Blue Cross,EPO,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Grouper Rate,5029.00
Blue Cross,EPO,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Grouper Rate,5281.00
Blue Cross,EPO,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Grouper Rate,5029.00
Blue Cross,EPO,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,438,DRG,Disorders of pancreas except malignancy w MCC,,Case Rate,26402.80
Blue Cross,EPO,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,Grouper Rate,5783.00
Blue Cross,EPO,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,3544.00
Blue Cross,EPO,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,1678.88
Blue Cross,EPO,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,5281.00
Blue Cross,EPO,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,Grouper Rate,5783.00
Blue Cross,EPO,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,Grouper Rate,5783.00
Blue Cross,EPO,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,Grouper Rate,5783.00
Blue Cross,EPO,43845,CPT4/HCPCS,GASTROPLASTY DUODENAL SWITCH,,Grouper Rate,6588.00
Blue Cross,EPO,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,Grouper Rate,5783.00
Blue Cross,EPO,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,Grouper Rate,5783.00
Blue Cross,EPO,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,Grouper Rate,5783.00
Blue Cross,EPO,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,EPO,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,EPO,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,EPO,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,EPO,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Grouper Rate,1678.00
Blue Cross,EPO,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,Grouper Rate,5783.00
Blue Cross,EPO,43881,CPT4/HCPCS,IMPL/REDO ELECTRD ANTRUM,,Grouper Rate,5281.00
Blue Cross,EPO,43882,CPT4/HCPCS,REVISE/REMOVE ELECTRD ANTRUM,,Grouper Rate,5281.00
Blue Cross,EPO,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Grouper Rate,3544.00
Blue Cross,EPO,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Grouper Rate,3544.00
Blue Cross,EPO,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Grouper Rate,5029.00
Blue Cross,EPO,439,DRG,Disorders of pancreas except malignancy w CC,,Case Rate,13966.37
Blue Cross,EPO,440,DRG,Disorders of pancreas except malignancy w/o CC/MCC,,Case Rate,10021.58
Blue Cross,EPO,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Grouper Rate,5029.00
Blue Cross,EPO,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,Grouper Rate,3544.00
Blue Cross,EPO,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Grouper Rate,5281.00
Blue Cross,EPO,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,Grouper Rate,5281.00
Blue Cross,EPO,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Grouper Rate,5281.00
Blue Cross,EPO,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Grouper Rate,5281.00
Blue Cross,EPO,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Grouper Rate,5281.00
Blue Cross,EPO,441,DRG,Disorders of liver except malig,cirr,alc hepa w MCC,,Case Rate,31156.39
Blue Cross,EPO,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Grouper Rate,1678.00
Blue Cross,EPO,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,Grouper Rate,5281.00
Blue Cross,EPO,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,Grouper Rate,5281.00
Blue Cross,EPO,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,5783.00
Blue Cross,EPO,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,1678.88
Blue Cross,EPO,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,5783.00
Blue Cross,EPO,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,Grouper Rate,5783.00
Blue Cross,EPO,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,Grouper Rate,5783.00
Blue Cross,EPO,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,Grouper Rate,5783.00
Blue Cross,EPO,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,Grouper Rate,5281.00
Blue Cross,EPO,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,Grouper Rate,3544.00
Blue Cross,EPO,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,Grouper Rate,5783.00
Blue Cross,EPO,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,Grouper Rate,5783.00
Blue Cross,EPO,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,Grouper Rate,5281.00
Blue Cross,EPO,44137,CPT4/HCPCS,REMOVE INTESTINAL ALLOGRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,Grouper Rate,1678.88
Blue Cross,EPO,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,EPO,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,EPO,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,EPO,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,EPO,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,EPO,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,EPO,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,EPO,44150,CPT4/HCPCS,REMOVAL OF COLON,,Grouper Rate,6588.00
Blue Cross,EPO,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,44157,CPT4/HCPCS,COLECTOMY W/ILEOANAL ANAST,,Grouper Rate,6588.00
Blue Cross,EPO,44158,CPT4/HCPCS,COLECTOMY W/NEO-RECTUM POUCH,,Grouper Rate,6588.00
Blue Cross,EPO,44160,CPT4/HCPCS,REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,EPO,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Grouper Rate,5281.00
Blue Cross,EPO,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Grouper Rate,5281.00
Blue Cross,EPO,44188,CPT4/HCPCS,LAP COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,442,DRG,Disorders of liver except malig,cirr,alc hepa w CC,,Case Rate,15408.66
Blue Cross,EPO,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,Grouper Rate,1678.88
Blue Cross,EPO,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,Grouper Rate,5783.00
Blue Cross,EPO,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,443,DRG,Disorders of liver except malig,cirr,alc hepa w/o CC/MCC,,Case Rate,10962.71
Blue Cross,EPO,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,Grouper Rate,5281.00
Blue Cross,EPO,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,1678.00
Blue Cross,EPO,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,Grouper Rate,5783.00
Blue Cross,EPO,44320,CPT4/HCPCS,COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,Grouper Rate,5783.00
Blue Cross,EPO,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,3544.00
Blue Cross,EPO,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,1678.88
Blue Cross,EPO,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Grouper Rate,1678.88
Blue Cross,EPO,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,1678.88
Blue Cross,EPO,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Grouper Rate,1678.88
Blue Cross,EPO,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,1678.00
Blue Cross,EPO,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,1678.00
Blue Cross,EPO,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,44383,CPT4/HCPCS,ILEOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,EPO,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Grouper Rate,1678.00
Blue Cross,EPO,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Grouper Rate,1678.00
Blue Cross,EPO,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Grouper Rate,1678.00
Blue Cross,EPO,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Grouper Rate,1678.00
Blue Cross,EPO,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Grouper Rate,1678.00
Blue Cross,EPO,44393,CPT4/HCPCS,COLONOSCOPY LESION REMOVAL,,Grouper Rate,1678.00
Blue Cross,EPO,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Grouper Rate,1678.00
Blue Cross,EPO,44397,CPT4/HCPCS,COLONOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,EPO,444,DRG,Disorders of the biliary tract w MCC,,Case Rate,27601.95
Blue Cross,EPO,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Grouper Rate,1678.00
Blue Cross,EPO,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,1678.00
Blue Cross,EPO,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,1678.00
Blue Cross,EPO,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Grouper Rate,1678.00
Blue Cross,EPO,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Grouper Rate,1678.00
Blue Cross,EPO,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Grouper Rate,1678.00
Blue Cross,EPO,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Grouper Rate,1678.00
Blue Cross,EPO,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,1678.00
Blue Cross,EPO,445,DRG,Disorders of the biliary tract w CC,,Case Rate,17810.27
Blue Cross,EPO,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,446,DRG,Disorders of the biliary tract w/o CC/MCC,,Case Rate,13499.94
Blue Cross,EPO,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Grouper Rate,5281.00
Blue Cross,EPO,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Grouper Rate,5281.00
Blue Cross,EPO,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,Grouper Rate,5783.00
Blue Cross,EPO,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,Grouper Rate,5783.00
Blue Cross,EPO,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,Grouper Rate,5783.00
Blue Cross,EPO,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,5281.00
Blue Cross,EPO,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,5783.00
Blue Cross,EPO,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,5783.00
Blue Cross,EPO,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,Grouper Rate,5281.00
Blue Cross,EPO,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,Grouper Rate,5281.00
Blue Cross,EPO,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Grouper Rate,5281.00
Blue Cross,EPO,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Grouper Rate,5783.00
Blue Cross,EPO,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,Grouper Rate,5281.00
Blue Cross,EPO,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,Grouper Rate,3544.00
Blue Cross,EPO,44701,CPT4/HCPCS,INTRAOP COLON LAVAGE ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Grouper Rate,3544.00
Blue Cross,EPO,44715,CPT4/HCPCS,PREPARE DONOR INTESTINE,,Grouper Rate,3544.00
Blue Cross,EPO,44720,CPT4/HCPCS,PREP DONOR INTESTINE/VENOUS,,Grouper Rate,1678.00
Blue Cross,EPO,44721,CPT4/HCPCS,PREP DONOR INTESTINE/ARTERY,,Grouper Rate,1678.00
Blue Cross,EPO,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,Grouper Rate,5281.00
Blue Cross,EPO,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,Grouper Rate,5281.00
Blue Cross,EPO,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,Grouper Rate,5281.00
Blue Cross,EPO,44901,CPT4/HCPCS,DRAIN APP ABSCESS PERCUT,,Grouper Rate,1678.88
Blue Cross,EPO,44950,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,44960,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Grouper Rate,3544.00
Blue Cross,EPO,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,EPO,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Grouper Rate,1678.00
Blue Cross,EPO,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Grouper Rate,1678.88
Blue Cross,EPO,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,EPO,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,1678.88
Blue Cross,EPO,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,EPO,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,EPO,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,5783.00
Blue Cross,EPO,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,Grouper Rate,6588.00
Blue Cross,EPO,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,EPO,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,Grouper Rate,6588.00
Blue Cross,EPO,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,45126,CPT4/HCPCS,PELVIC EXENTERATION,,Grouper Rate,6588.00
Blue Cross,EPO,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Grouper Rate,5029.00
Blue Cross,EPO,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Grouper Rate,5783.00
Blue Cross,EPO,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,Grouper Rate,5783.00
Blue Cross,EPO,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Grouper Rate,1678.00
Blue Cross,EPO,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Grouper Rate,1678.88
Blue Cross,EPO,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Grouper Rate,5029.00
Blue Cross,EPO,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Grouper Rate,5281.00
Blue Cross,EPO,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Grouper Rate,1678.88
Blue Cross,EPO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,Case Rate,152062.14
Blue Cross,EPO,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Grouper Rate,1678.00
Blue Cross,EPO,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Grouper Rate,1678.00
Blue Cross,EPO,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Grouper Rate,1678.00
Blue Cross,EPO,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Grouper Rate,1678.00
Blue Cross,EPO,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1678.00
Blue Cross,EPO,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1678.00
Blue Cross,EPO,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1678.00
Blue Cross,EPO,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Grouper Rate,1678.00
Blue Cross,EPO,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Grouper Rate,1678.00
Blue Cross,EPO,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Grouper Rate,1678.00
Blue Cross,EPO,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,EPO,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Grouper Rate,1678.00
Blue Cross,EPO,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Grouper Rate,1678.00
Blue Cross,EPO,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Grouper Rate,1678.00
Blue Cross,EPO,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Grouper Rate,1678.00
Blue Cross,EPO,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Grouper Rate,1678.00
Blue Cross,EPO,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Grouper Rate,1678.00
Blue Cross,EPO,45339,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATE TUMR,,Grouper Rate,1678.00
Blue Cross,EPO,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Grouper Rate,1678.00
Blue Cross,EPO,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Grouper Rate,1678.00
Blue Cross,EPO,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Grouper Rate,1678.00
Blue Cross,EPO,45345,CPT4/HCPCS,SIGMOIDOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,EPO,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Grouper Rate,1678.00
Blue Cross,EPO,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Grouper Rate,1678.00
Blue Cross,EPO,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Grouper Rate,1678.00
Blue Cross,EPO,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Grouper Rate,1678.00
Blue Cross,EPO,45355,CPT4/HCPCS,SURGICAL COLONOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Grouper Rate,1678.00
Blue Cross,EPO,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Grouper Rate,1678.00
Blue Cross,EPO,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Grouper Rate,1678.00
Blue Cross,EPO,45383,CPT4/HCPCS,LESION REMOVAL COLONOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,1678.00
Blue Cross,EPO,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,1678.00
Blue Cross,EPO,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Grouper Rate,1678.88
Blue Cross,EPO,45387,CPT4/HCPCS,COLONOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,EPO,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Grouper Rate,1678.00
Blue Cross,EPO,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,1678.00
Blue Cross,EPO,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,1678.00
Blue Cross,EPO,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Grouper Rate,1678.88
Blue Cross,EPO,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Grouper Rate,1678.00
Blue Cross,EPO,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,1678.88
Blue Cross,EPO,45395,CPT4/HCPCS,LAP REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,EPO,45397,CPT4/HCPCS,LAP REMOVE RECTUM W/POUCH,,Grouper Rate,5783.00
Blue Cross,EPO,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Grouper Rate,1678.00
Blue Cross,EPO,454,DRG,Combined anterior/posterior spinal fusion w CC,,Case Rate,100862.57
Blue Cross,EPO,45400,CPT4/HCPCS,LAPAROSCOPIC PROC,,Grouper Rate,5281.00
Blue Cross,EPO,45402,CPT4/HCPCS,LAP PROCTOPEXY W/SIG RESECT,,Grouper Rate,5783.00
Blue Cross,EPO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,Case Rate,79243.14
Blue Cross,EPO,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,1678.88
Blue Cross,EPO,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,1678.88
Blue Cross,EPO,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Grouper Rate,1678.00
Blue Cross,EPO,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,5281.00
Blue Cross,EPO,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,1678.88
Blue Cross,EPO,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,Grouper Rate,5783.00
Blue Cross,EPO,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Grouper Rate,1678.88
Blue Cross,EPO,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Grouper Rate,1678.88
Blue Cross,EPO,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Grouper Rate,5281.00
Blue Cross,EPO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,Case Rate,142212.57
Blue Cross,EPO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,Case Rate,107543.08
Blue Cross,EPO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,Case Rate,82987.79
Blue Cross,EPO,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,Grouper Rate,5281.00
Blue Cross,EPO,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,Grouper Rate,5281.00
Blue Cross,EPO,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,459,DRG,Spinal fusion except cervical w MCC,,Case Rate,111343.97
Blue Cross,EPO,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Grouper Rate,1678.00
Blue Cross,EPO,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Grouper Rate,1678.00
Blue Cross,EPO,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Grouper Rate,1678.00
Blue Cross,EPO,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Grouper Rate,1678.00
Blue Cross,EPO,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Grouper Rate,1678.00
Blue Cross,EPO,460,DRG,Spinal fusion except cervical w/o MCC,,Case Rate,65046.85
Blue Cross,EPO,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Grouper Rate,1678.00
Blue Cross,EPO,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Grouper Rate,1678.00
Blue Cross,EPO,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,EPO,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,EPO,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,EPO,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Grouper Rate,1678.00
Blue Cross,EPO,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,EPO,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Grouper Rate,1678.00
Blue Cross,EPO,461,DRG,Bilateral or multiple major joint procs of lower extremity w MCC,,Case Rate,100500.34
Blue Cross,EPO,462,DRG,Bilateral or multiple major joint procs of lower extremity w/o MCC,,Case Rate,52005.06
Blue Cross,EPO,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Grouper Rate,1678.88
Blue Cross,EPO,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Grouper Rate,1678.00
Blue Cross,EPO,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Grouper Rate,1678.00
Blue Cross,EPO,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Grouper Rate,1678.00
Blue Cross,EPO,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Grouper Rate,3544.00
Blue Cross,EPO,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Grouper Rate,3544.00
Blue Cross,EPO,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Grouper Rate,3544.00
Blue Cross,EPO,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Grouper Rate,3544.00
Blue Cross,EPO,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Grouper Rate,3544.00
Blue Cross,EPO,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Grouper Rate,5029.00
Blue Cross,EPO,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Grouper Rate,5029.00
Blue Cross,EPO,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Grouper Rate,3544.00
Blue Cross,EPO,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Grouper Rate,3544.00
Blue Cross,EPO,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Grouper Rate,5029.00
Blue Cross,EPO,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Grouper Rate,1678.00
Blue Cross,EPO,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Grouper Rate,3544.00
Blue Cross,EPO,463,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC,,Case Rate,88743.71
Blue Cross,EPO,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Grouper Rate,1678.00
Blue Cross,EPO,464,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC,,Case Rate,49198.23
Blue Cross,EPO,465,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC,,Case Rate,30493.14
Blue Cross,EPO,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Grouper Rate,1678.00
Blue Cross,EPO,466,DRG,Revision of hip or knee replacement w MCC,,Case Rate,88406.30
Blue Cross,EPO,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Grouper Rate,1678.00
Blue Cross,EPO,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Grouper Rate,1678.00
Blue Cross,EPO,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Grouper Rate,1678.00
Blue Cross,EPO,46611,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Grouper Rate,1678.00
Blue Cross,EPO,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Grouper Rate,1678.00
Blue Cross,EPO,46615,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,467,DRG,Revision of hip or knee replacement w CC,,Case Rate,59150.34
Blue Cross,EPO,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,3544.00
Blue Cross,EPO,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,3544.00
Blue Cross,EPO,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Grouper Rate,1678.00
Blue Cross,EPO,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,Grouper Rate,1678.00
Blue Cross,EPO,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,Grouper Rate,3544.00
Blue Cross,EPO,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,Grouper Rate,3544.00
Blue Cross,EPO,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,3544.00
Blue Cross,EPO,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,5281.00
Blue Cross,EPO,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,5281.00
Blue Cross,EPO,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,Grouper Rate,5783.00
Blue Cross,EPO,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1678.88
Blue Cross,EPO,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1678.88
Blue Cross,EPO,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,5783.00
Blue Cross,EPO,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,EPO,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,EPO,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Grouper Rate,3544.00
Blue Cross,EPO,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Grouper Rate,1678.00
Blue Cross,EPO,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,1678.88
Blue Cross,EPO,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,EPO,46762,CPT4/HCPCS,IMPLANT ARTIFICIAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,EPO,468,DRG,Revision of hip or knee replacement w/o CC/MCC,,Case Rate,46378.16
Blue Cross,EPO,469,DRG,Major joint replacement or reattachment of lower extremity w MCC,,Case Rate,51015.97
Blue Cross,EPO,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Grouper Rate,1678.00
Blue Cross,EPO,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Grouper Rate,1678.00
Blue Cross,EPO,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,1678.00
Blue Cross,EPO,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,1678.00
Blue Cross,EPO,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Grouper Rate,1678.00
Blue Cross,EPO,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Grouper Rate,1678.00
Blue Cross,EPO,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Grouper Rate,3544.00
Blue Cross,EPO,46948,CPT4/HCPCS,INT HRHC TRANAL DARTLZJ 2+,,Grouper Rate,1678.88
Blue Cross,EPO,470,DRG,Major joint replacement or reattachment of lower extremity w/o MCC,,Case Rate,31424.34
Blue Cross,EPO,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Grouper Rate,1678.00
Blue Cross,EPO,47001,CPT4/HCPCS,NEEDLE BIOPSY LIVER ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,Grouper Rate,5783.00
Blue Cross,EPO,47011,CPT4/HCPCS,PERCUT DRAIN LIVER LESION,,Grouper Rate,1678.00
Blue Cross,EPO,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,Grouper Rate,5281.00
Blue Cross,EPO,471,DRG,Cervical spinal fusion w MCC,,Case Rate,82977.87
Blue Cross,EPO,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,Grouper Rate,5029.00
Blue Cross,EPO,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,5783.00
Blue Cross,EPO,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,Grouper Rate,6588.00
Blue Cross,EPO,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,5783.00
Blue Cross,EPO,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,6588.00
Blue Cross,EPO,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,EPO,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,Grouper Rate,8841.00
Blue Cross,EPO,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,EPO,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,EPO,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,EPO,47143,CPT4/HCPCS,PREP DONOR LIVER WHOLE,,Grouper Rate,3544.00
Blue Cross,EPO,47144,CPT4/HCPCS,PREP DONOR LIVER 3-SEGMENT,,Grouper Rate,3544.00
Blue Cross,EPO,47145,CPT4/HCPCS,PREP DONOR LIVER LOBE SPLIT,,Grouper Rate,3544.00
Blue Cross,EPO,47146,CPT4/HCPCS,PREP DONOR LIVER/VENOUS,,Grouper Rate,1678.00
Blue Cross,EPO,47147,CPT4/HCPCS,PREP DONOR LIVER/ARTERIAL,,Grouper Rate,1678.00
Blue Cross,EPO,472,DRG,Cervical spinal fusion w CC,,Case Rate,50499.92
Blue Cross,EPO,473,DRG,Cervical spinal fusion w/o CC/MCC,,Case Rate,42014.90
Blue Cross,EPO,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,Grouper Rate,5281.00
Blue Cross,EPO,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5281.00
Blue Cross,EPO,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5783.00
Blue Cross,EPO,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5783.00
Blue Cross,EPO,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5029.00
Blue Cross,EPO,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Grouper Rate,5029.00
Blue Cross,EPO,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Grouper Rate,5029.00
Blue Cross,EPO,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Grouper Rate,5029.00
Blue Cross,EPO,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Grouper Rate,5029.00
Blue Cross,EPO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Grouper Rate,5783.00
Blue Cross,EPO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Grouper Rate,5783.00
Blue Cross,EPO,474,DRG,Amputation for musculoskeletal sys & conn tissue dis w MCC,,Case Rate,67364.11
Blue Cross,EPO,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,Grouper Rate,5281.00
Blue Cross,EPO,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,Grouper Rate,5281.00
Blue Cross,EPO,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,Grouper Rate,5783.00
Blue Cross,EPO,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,Grouper Rate,5029.00
Blue Cross,EPO,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,Grouper Rate,3544.00
Blue Cross,EPO,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,Grouper Rate,1678.00
Blue Cross,EPO,475,DRG,Amputation for musculoskeletal sys & conn tissue dis w CC,,Case Rate,36282.14
Blue Cross,EPO,47500,CPT4/HCPCS,INJECTION FOR LIVER X-RAYS,,Grouper Rate,1678.00
Blue Cross,EPO,47505,CPT4/HCPCS,INJECTION FOR LIVER X-RAYS,,Grouper Rate,1678.00
Blue Cross,EPO,47510,CPT4/HCPCS,INSERT CATHETER BILE DUCT,,Grouper Rate,1678.88
Blue Cross,EPO,47511,CPT4/HCPCS,INSERT BILE DUCT DRAIN,,Grouper Rate,1678.88
Blue Cross,EPO,47525,CPT4/HCPCS,CHANGE BILE DUCT CATHETER,,Grouper Rate,1678.00
Blue Cross,EPO,47530,CPT4/HCPCS,REVISE/REINSERT BILE TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,1678.00
Blue Cross,EPO,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,1678.00
Blue Cross,EPO,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,1678.88
Blue Cross,EPO,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,1678.88
Blue Cross,EPO,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Grouper Rate,1678.00
Blue Cross,EPO,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Grouper Rate,1678.00
Blue Cross,EPO,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Grouper Rate,1678.00
Blue Cross,EPO,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,1678.00
Blue Cross,EPO,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,1678.00
Blue Cross,EPO,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,1678.00
Blue Cross,EPO,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Grouper Rate,1678.00
Blue Cross,EPO,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Grouper Rate,1678.00
Blue Cross,EPO,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Grouper Rate,1678.00
Blue Cross,EPO,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Grouper Rate,3544.00
Blue Cross,EPO,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Grouper Rate,1678.88
Blue Cross,EPO,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,EPO,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,EPO,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,EPO,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,EPO,47560,CPT4/HCPCS,LAPAROSCOPY W/CHOLANGIO,,Grouper Rate,3544.00
Blue Cross,EPO,47561,CPT4/HCPCS,LAPARO W/CHOLANGIO/BIOPSY,,Grouper Rate,3544.00
Blue Cross,EPO,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Grouper Rate,8841.00
Blue Cross,EPO,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Grouper Rate,8841.00
Blue Cross,EPO,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Grouper Rate,8841.00
Blue Cross,EPO,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Grouper Rate,8841.00
Blue Cross,EPO,476,DRG,Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC,,Case Rate,19183.09
Blue Cross,EPO,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,EPO,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,EPO,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,8012.00
Blue Cross,EPO,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,EPO,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,EPO,47630,CPT4/HCPCS,REMOVE BILE DUCT STONE,,Grouper Rate,3544.00
Blue Cross,EPO,477,DRG,Biopsies of musculoskeletal system & connective tissue w MCC,,Case Rate,55523.12
Blue Cross,EPO,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,Grouper Rate,5281.00
Blue Cross,EPO,47701,CPT4/HCPCS,BILE DUCT REVISION,,Grouper Rate,5783.00
Blue Cross,EPO,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Grouper Rate,5783.00
Blue Cross,EPO,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Grouper Rate,5783.00
Blue Cross,EPO,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,Grouper Rate,5783.00
Blue Cross,EPO,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,Grouper Rate,5783.00
Blue Cross,EPO,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,478,DRG,Biopsies of musculoskeletal system & connective tissue w CC,,Case Rate,38983.12
Blue Cross,EPO,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,Grouper Rate,5783.00
Blue Cross,EPO,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,Grouper Rate,5029.00
Blue Cross,EPO,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,Grouper Rate,5281.00
Blue Cross,EPO,479,DRG,Biopsies of musculoskeletal system & connective tissue w/o CC/MCC,,Case Rate,29925.82
Blue Cross,EPO,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,Grouper Rate,5281.00
Blue Cross,EPO,480,DRG,Hip & femur procedures except major joint w MCC,,Case Rate,50025.23
Blue Cross,EPO,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,Grouper Rate,5281.00
Blue Cross,EPO,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,Grouper Rate,5783.00
Blue Cross,EPO,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,Grouper Rate,5281.00
Blue Cross,EPO,481,DRG,Hip & femur procedures except major joint w CC,,Case Rate,34659.57
Blue Cross,EPO,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,Grouper Rate,5783.00
Blue Cross,EPO,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Grouper Rate,1678.00
Blue Cross,EPO,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,Grouper Rate,5783.00
Blue Cross,EPO,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,5783.00
Blue Cross,EPO,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,5783.00
Blue Cross,EPO,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,Grouper Rate,5783.00
Blue Cross,EPO,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,6588.00
Blue Cross,EPO,48153,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,Grouper Rate,6588.00
Blue Cross,EPO,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,EPO,482,DRG,Hip & femur procedures except major joint w/o CC/MCC,,Case Rate,27238.07
Blue Cross,EPO,483,DRG,Major joint & limb reattachment proc of upper extremity w CC/MCC,,Case Rate,39469.40
Blue Cross,EPO,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,485,DRG,Knee procedures w pdx of infection w MCC,,Case Rate,56361.70
Blue Cross,EPO,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,Grouper Rate,5281.00
Blue Cross,EPO,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Grouper Rate,5281.00
Blue Cross,EPO,48511,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Grouper Rate,1678.88
Blue Cross,EPO,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,48545,CPT4/HCPCS,PANCREATORRHAPHY,,Grouper Rate,5281.00
Blue Cross,EPO,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,Grouper Rate,5783.00
Blue Cross,EPO,48548,CPT4/HCPCS,FUSE PANCREAS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,48550,CPT4/HCPCS,DONOR PANCREATECTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,48551,CPT4/HCPCS,PREP DONOR PANCREAS,,Grouper Rate,3544.00
Blue Cross,EPO,48552,CPT4/HCPCS,PREP DONOR PANCREAS/VENOUS,,Grouper Rate,1678.00
Blue Cross,EPO,48556,CPT4/HCPCS,REMOVAL ALLOGRAFT PANCREAS,,Grouper Rate,5783.00
Blue Cross,EPO,486,DRG,Knee procedures w pdx of infection w CC,,Case Rate,35534.53
Blue Cross,EPO,487,DRG,Knee procedures w pdx of infection w/o CC/MCC,,Case Rate,27130.56
Blue Cross,EPO,488,DRG,Knee procedures w/o pdx of infection w CC/MCC,,Case Rate,32659.88
Blue Cross,EPO,489,DRG,Knee procedures w/o pdx of infection w/o CC/MCC,,Case Rate,21472.22
Blue Cross,EPO,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,5029.00
Blue Cross,EPO,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,Grouper Rate,5029.00
Blue Cross,EPO,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Grouper Rate,8012.00
Blue Cross,EPO,49013,CPT4/HCPCS,PRPERTL PEL PACK HEMRRG TRMA,,Grouper Rate,1678.88
Blue Cross,EPO,49014,CPT4/HCPCS,REEXPLORATION PELVIC WOUND,,Grouper Rate,1678.88
Blue Cross,EPO,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,Grouper Rate,8012.00
Blue Cross,EPO,49021,CPT4/HCPCS,DRAIN ABDOMINAL ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,Grouper Rate,8012.00
Blue Cross,EPO,49041,CPT4/HCPCS,DRAIN PERCUT ABDOM ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,Grouper Rate,8012.00
Blue Cross,EPO,49061,CPT4/HCPCS,DRAIN PERCUT RETROPER ABSC,,Grouper Rate,1678.00
Blue Cross,EPO,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,Grouper Rate,5029.00
Blue Cross,EPO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Grouper Rate,1678.88
Blue Cross,EPO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Grouper Rate,1678.88
Blue Cross,EPO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Grouper Rate,1678.88
Blue Cross,EPO,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Grouper Rate,1678.00
Blue Cross,EPO,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Grouper Rate,1678.00
Blue Cross,EPO,492,DRG,Lower extrem & humer proc except hip,foot,femur w MCC,,Case Rate,57364.02
Blue Cross,EPO,49203,CPT4/HCPCS,EXC ABD TUM 5 CM OR LESS,,Grouper Rate,5029.00
Blue Cross,EPO,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,Grouper Rate,5029.00
Blue Cross,EPO,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,Grouper Rate,5783.00
Blue Cross,EPO,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Grouper Rate,3544.00
Blue Cross,EPO,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,Grouper Rate,5029.00
Blue Cross,EPO,493,DRG,Lower extrem & humer proc except hip,foot,femur w CC,,Case Rate,38458.80
Blue Cross,EPO,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Grouper Rate,1678.88
Blue Cross,EPO,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Grouper Rate,3544.00
Blue Cross,EPO,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Grouper Rate,6588.00
Blue Cross,EPO,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Grouper Rate,5281.00
Blue Cross,EPO,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Grouper Rate,1678.00
Blue Cross,EPO,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Grouper Rate,1678.00
Blue Cross,EPO,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,49327,CPT4/HCPCS,LAP INS DEVICE FOR RT,,Grouper Rate,3544.00
Blue Cross,EPO,494,DRG,Lower extrem & humer proc except hip,foot,femur w/o CC/MCC,,Case Rate,30630.42
Blue Cross,EPO,49400,CPT4/HCPCS,AIR INJECTION INTO ABDOMEN,,Grouper Rate,1678.00
Blue Cross,EPO,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Grouper Rate,1678.00
Blue Cross,EPO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Grouper Rate,1678.00
Blue Cross,EPO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Grouper Rate,1678.88
Blue Cross,EPO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Grouper Rate,1678.88
Blue Cross,EPO,49412,CPT4/HCPCS,INS DEVICE FOR RT GUIDE OPEN,,Grouper Rate,5029.00
Blue Cross,EPO,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Grouper Rate,1678.88
Blue Cross,EPO,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Grouper Rate,1678.88
Blue Cross,EPO,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Grouper Rate,1678.00
Blue Cross,EPO,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Grouper Rate,1678.88
Blue Cross,EPO,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Grouper Rate,1678.00
Blue Cross,EPO,49424,CPT4/HCPCS,ASSESS CYST CONTRAST INJECT,,Grouper Rate,1678.00
Blue Cross,EPO,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Grouper Rate,1678.88
Blue Cross,EPO,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Grouper Rate,1678.88
Blue Cross,EPO,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,Grouper Rate,1678.00
Blue Cross,EPO,49428,CPT4/HCPCS,LIGATION OF SHUNT,,Grouper Rate,1678.88
Blue Cross,EPO,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Grouper Rate,1678.88
Blue Cross,EPO,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Grouper Rate,1678.00
Blue Cross,EPO,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Grouper Rate,1678.00
Blue Cross,EPO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Grouper Rate,1678.88
Blue Cross,EPO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Grouper Rate,1678.88
Blue Cross,EPO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Grouper Rate,1678.88
Blue Cross,EPO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Grouper Rate,1678.88
Blue Cross,EPO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Grouper Rate,1678.88
Blue Cross,EPO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Grouper Rate,1678.88
Blue Cross,EPO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Grouper Rate,1678.88
Blue Cross,EPO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Grouper Rate,1678.00
Blue Cross,EPO,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Grouper Rate,5029.00
Blue Cross,EPO,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Grouper Rate,5029.00
Blue Cross,EPO,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Grouper Rate,5029.00
Blue Cross,EPO,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Grouper Rate,5029.00
Blue Cross,EPO,495,DRG,Local excision & removal int fix devices exc hip & femur w MCC,,Case Rate,60109.66
Blue Cross,EPO,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Grouper Rate,5029.00
Blue Cross,EPO,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Grouper Rate,5029.00
Blue Cross,EPO,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Grouper Rate,5029.00
Blue Cross,EPO,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Grouper Rate,5029.00
Blue Cross,EPO,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Grouper Rate,5029.00
Blue Cross,EPO,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Grouper Rate,5029.00
Blue Cross,EPO,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Grouper Rate,5029.00
Blue Cross,EPO,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Grouper Rate,1678.88
Blue Cross,EPO,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Grouper Rate,5281.00
Blue Cross,EPO,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Grouper Rate,5029.00
Blue Cross,EPO,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Grouper Rate,5281.00
Blue Cross,EPO,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Grouper Rate,5029.00
Blue Cross,EPO,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Grouper Rate,5029.00
Blue Cross,EPO,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Grouper Rate,5029.00
Blue Cross,EPO,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Grouper Rate,5029.00
Blue Cross,EPO,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Grouper Rate,5029.00
Blue Cross,EPO,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Grouper Rate,5029.00
Blue Cross,EPO,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Grouper Rate,5029.00
Blue Cross,EPO,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Grouper Rate,3544.00
Blue Cross,EPO,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Grouper Rate,5029.00
Blue Cross,EPO,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Grouper Rate,5029.00
Blue Cross,EPO,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Grouper Rate,5029.00
Blue Cross,EPO,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Grouper Rate,5029.00
Blue Cross,EPO,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Grouper Rate,3544.00
Blue Cross,EPO,496,DRG,Local excision & removal int fix devices exc hip & femur w CC,,Case Rate,32841.82
Blue Cross,EPO,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,3544.00
Blue Cross,EPO,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5281.00
Blue Cross,EPO,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5281.00
Blue Cross,EPO,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5281.00
Blue Cross,EPO,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Grouper Rate,5029.00
Blue Cross,EPO,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Grouper Rate,5029.00
Blue Cross,EPO,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Grouper Rate,5029.00
Blue Cross,EPO,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Grouper Rate,5029.00
Blue Cross,EPO,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Grouper Rate,5029.00
Blue Cross,EPO,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Grouper Rate,5029.00
Blue Cross,EPO,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Grouper Rate,5029.00
Blue Cross,EPO,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Grouper Rate,5029.00
Blue Cross,EPO,497,DRG,Local excision & removal int fix devices exc hip & femur w/o CC/MCC,,Case Rate,24126.89
Blue Cross,EPO,498,DRG,Local excision & removal int fix devices of hip & femur w CC/MCC,,Case Rate,42744.32
Blue Cross,EPO,499,DRG,Local excision & removal int fix devices of hip & femur w/o CC/MCC,,Case Rate,19826.49
Blue Cross,EPO,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,Grouper Rate,3544.00
Blue Cross,EPO,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,Grouper Rate,1678.88
Blue Cross,EPO,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,Grouper Rate,1678.88
Blue Cross,EPO,5,DRG,Liver transplant w MCC or intestinal transplant,,Case Rate,169093.38
Blue Cross,EPO,500,DRG,Soft tissue procedures w MCC,,Case Rate,52165.50
Blue Cross,EPO,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,5783.00
Blue Cross,EPO,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Grouper Rate,1678.88
Blue Cross,EPO,50021,CPT4/HCPCS,RENAL ABSCESS PERCUT DRAIN,,Grouper Rate,1678.00
Blue Cross,EPO,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Grouper Rate,3544.00
Blue Cross,EPO,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1678.88
Blue Cross,EPO,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,1678.88
Blue Cross,EPO,50065,CPT4/HCPCS,INCISION OF KIDNEY,,Grouper Rate,1678.88
Blue Cross,EPO,50070,CPT4/HCPCS,INCISION OF KIDNEY,,Grouper Rate,1678.88
Blue Cross,EPO,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,5783.00
Blue Cross,EPO,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,3544.00
Blue Cross,EPO,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,3544.00
Blue Cross,EPO,501,DRG,Soft tissue procedures w CC,,Case Rate,28862.30
Blue Cross,EPO,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,Grouper Rate,5783.00
Blue Cross,EPO,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,5783.00
Blue Cross,EPO,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,Grouper Rate,3544.00
Blue Cross,EPO,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,5029.00
Blue Cross,EPO,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,5029.00
Blue Cross,EPO,502,DRG,Soft tissue procedures w/o CC/MCC,,Case Rate,22011.43
Blue Cross,EPO,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Grouper Rate,1678.00
Blue Cross,EPO,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,Grouper Rate,5029.00
Blue Cross,EPO,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,Grouper Rate,5783.00
Blue Cross,EPO,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,Grouper Rate,5783.00
Blue Cross,EPO,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Grouper Rate,5783.00
Blue Cross,EPO,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Grouper Rate,5783.00
Blue Cross,EPO,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,Grouper Rate,5281.00
Blue Cross,EPO,50250,CPT4/HCPCS,CRYOABLATE RENAL MASS OPEN,,Grouper Rate,5029.00
Blue Cross,EPO,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Grouper Rate,5783.00
Blue Cross,EPO,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Grouper Rate,5281.00
Blue Cross,EPO,503,DRG,Foot procedures w MCC,,Case Rate,43478.69
Blue Cross,EPO,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,Grouper Rate,3544.00
Blue Cross,EPO,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,Grouper Rate,5281.00
Blue Cross,EPO,50323,CPT4/HCPCS,PREP CADAVER RENAL ALLOGRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,50325,CPT4/HCPCS,PREP DONOR RENAL GRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,50327,CPT4/HCPCS,PREP RENAL GRAFT/VENOUS,,Grouper Rate,1678.00
Blue Cross,EPO,50328,CPT4/HCPCS,PREP RENAL GRAFT/ARTERIAL,,Grouper Rate,1678.00
Blue Cross,EPO,50329,CPT4/HCPCS,PREP RENAL GRAFT/URETERAL,,Grouper Rate,1678.00
Blue Cross,EPO,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,Grouper Rate,5281.00
Blue Cross,EPO,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Grouper Rate,6588.00
Blue Cross,EPO,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Grouper Rate,6588.00
Blue Cross,EPO,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,Grouper Rate,5281.00
Blue Cross,EPO,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,Grouper Rate,6588.00
Blue Cross,EPO,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Grouper Rate,1678.88
Blue Cross,EPO,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Grouper Rate,1678.88
Blue Cross,EPO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Grouper Rate,1678.88
Blue Cross,EPO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Grouper Rate,1678.88
Blue Cross,EPO,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Grouper Rate,1678.88
Blue Cross,EPO,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Grouper Rate,1678.00
Blue Cross,EPO,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Grouper Rate,1678.00
Blue Cross,EPO,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Grouper Rate,1678.00
Blue Cross,EPO,50392,CPT4/HCPCS,INSERT KIDNEY DRAIN,,Grouper Rate,1678.00
Blue Cross,EPO,50393,CPT4/HCPCS,INSERT URETERAL TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,50394,CPT4/HCPCS,INJECTION FOR KIDNEY X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,50395,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Grouper Rate,1678.00
Blue Cross,EPO,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Grouper Rate,1678.00
Blue Cross,EPO,50398,CPT4/HCPCS,CHANGE KIDNEY TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,504,DRG,Foot procedures w CC,,Case Rate,29340.30
Blue Cross,EPO,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Grouper Rate,5783.00
Blue Cross,EPO,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Grouper Rate,5281.00
Blue Cross,EPO,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,1678.00
Blue Cross,EPO,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,1678.00
Blue Cross,EPO,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Grouper Rate,1678.00
Blue Cross,EPO,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Grouper Rate,1678.00
Blue Cross,EPO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Grouper Rate,1678.00
Blue Cross,EPO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Grouper Rate,1678.00
Blue Cross,EPO,50436,CPT4/HCPCS,DILAT XST TRC NDURLGC PX,,Grouper Rate,1678.00
Blue Cross,EPO,50437,CPT4/HCPCS,DILAT XST TRC NEW ACCESS RCS,,Grouper Rate,1678.00
Blue Cross,EPO,505,DRG,Foot procedures w/o CC/MCC,,Case Rate,29340.30
Blue Cross,EPO,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,Grouper Rate,5281.00
Blue Cross,EPO,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Grouper Rate,1678.00
Blue Cross,EPO,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Grouper Rate,5783.00
Blue Cross,EPO,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Grouper Rate,6588.00
Blue Cross,EPO,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,Grouper Rate,5783.00
Blue Cross,EPO,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Grouper Rate,5029.00
Blue Cross,EPO,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Grouper Rate,5281.00
Blue Cross,EPO,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Grouper Rate,5281.00
Blue Cross,EPO,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Grouper Rate,5029.00
Blue Cross,EPO,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Grouper Rate,5281.00
Blue Cross,EPO,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,EPO,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,EPO,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Grouper Rate,5281.00
Blue Cross,EPO,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,EPO,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,EPO,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Grouper Rate,8841.00
Blue Cross,EPO,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Grouper Rate,5783.00
Blue Cross,EPO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Grouper Rate,5281.00
Blue Cross,EPO,506,DRG,Major thumb or joint procedures,,Case Rate,24408.07
Blue Cross,EPO,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Grouper Rate,5783.00
Blue Cross,EPO,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Grouper Rate,5029.00
Blue Cross,EPO,50606,CPT4/HCPCS,ENDOLUMINAL BX URTR RNL PLVS,,Grouper Rate,1678.00
Blue Cross,EPO,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,EPO,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,EPO,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,EPO,50650,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,5783.00
Blue Cross,EPO,50660,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,6588.00
Blue Cross,EPO,50684,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,Grouper Rate,1678.00
Blue Cross,EPO,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Grouper Rate,1678.00
Blue Cross,EPO,50690,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,1678.00
Blue Cross,EPO,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,1678.00
Blue Cross,EPO,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,1678.00
Blue Cross,EPO,507,DRG,Major shoulder or elbow joint procedures w CC/MCC,,Case Rate,33448.84
Blue Cross,EPO,50700,CPT4/HCPCS,REVISION OF URETER,,Grouper Rate,5281.00
Blue Cross,EPO,50705,CPT4/HCPCS,URETERAL EMBOLIZATION/OCCL,,Grouper Rate,1678.88
Blue Cross,EPO,50706,CPT4/HCPCS,BALLOON DILATE URTRL STRIX,,Grouper Rate,1678.88
Blue Cross,EPO,50715,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,5281.00
Blue Cross,EPO,50722,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,5281.00
Blue Cross,EPO,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,Grouper Rate,5783.00
Blue Cross,EPO,50727,CPT4/HCPCS,REVISE URETER,,Grouper Rate,1678.88
Blue Cross,EPO,50728,CPT4/HCPCS,REVISE URETER,,Grouper Rate,3544.00
Blue Cross,EPO,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Grouper Rate,5029.00
Blue Cross,EPO,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Grouper Rate,5029.00
Blue Cross,EPO,50760,CPT4/HCPCS,FUSION OF URETERS,,Grouper Rate,5281.00
Blue Cross,EPO,50770,CPT4/HCPCS,SPLICING OF URETERS,,Grouper Rate,5281.00
Blue Cross,EPO,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,5783.00
Blue Cross,EPO,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,5281.00
Blue Cross,EPO,508,DRG,Major shoulder or elbow joint procedures w/o CC/MCC,,Case Rate,23387.56
Blue Cross,EPO,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,Grouper Rate,5281.00
Blue Cross,EPO,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,Grouper Rate,6588.00
Blue Cross,EPO,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Grouper Rate,8012.00
Blue Cross,EPO,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Grouper Rate,8012.00
Blue Cross,EPO,50830,CPT4/HCPCS,REVISE URINE FLOW,,Grouper Rate,6588.00
Blue Cross,EPO,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,Grouper Rate,6588.00
Blue Cross,EPO,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,Grouper Rate,5029.00
Blue Cross,EPO,509,DRG,Arthroscopy,,Case Rate,27684.65
Blue Cross,EPO,50900,CPT4/HCPCS,REPAIR OF URETER,,Grouper Rate,5783.00
Blue Cross,EPO,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,Grouper Rate,5783.00
Blue Cross,EPO,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,Grouper Rate,5783.00
Blue Cross,EPO,50940,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,5783.00
Blue Cross,EPO,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,5281.00
Blue Cross,EPO,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,5281.00
Blue Cross,EPO,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,1678.00
Blue Cross,EPO,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,1678.00
Blue Cross,EPO,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,EPO,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,EPO,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Grouper Rate,1678.00
Blue Cross,EPO,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,EPO,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,EPO,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,EPO,510,DRG,Shoulder,elbow or forearm proc,exc major joint proc w MCC,,Case Rate,45165.77
Blue Cross,EPO,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,5029.00
Blue Cross,EPO,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,5029.00
Blue Cross,EPO,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Grouper Rate,5029.00
Blue Cross,EPO,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Grouper Rate,5029.00
Blue Cross,EPO,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Grouper Rate,5029.00
Blue Cross,EPO,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,EPO,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Grouper Rate,5029.00
Blue Cross,EPO,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Grouper Rate,3544.00
Blue Cross,EPO,511,DRG,Shoulder,elbow or forearm proc,exc major joint proc w CC,,Case Rate,32558.99
Blue Cross,EPO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Grouper Rate,1678.00
Blue Cross,EPO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Grouper Rate,1678.00
Blue Cross,EPO,512,DRG,Shoulder,elbow or forearm proc,exc major joint proc w/o CC/MCC,,Case Rate,25739.54
Blue Cross,EPO,513,DRG,Hand or wrist proc, except major thumb or joint proc w CC/MCC,,Case Rate,25785.86
Blue Cross,EPO,514,DRG,Hand or wrist proc, except major thumb or joint proc w/o CC/MCC,,Case Rate,16444.06
Blue Cross,EPO,515,DRG,Other musculoskelet sys & conn tiss O.R. proc w MCC,,Case Rate,51885.98
Blue Cross,EPO,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Grouper Rate,5029.00
Blue Cross,EPO,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5029.00
Blue Cross,EPO,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5029.00
Blue Cross,EPO,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5029.00
Blue Cross,EPO,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,Grouper Rate,5029.00
Blue Cross,EPO,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Grouper Rate,1678.88
Blue Cross,EPO,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Grouper Rate,1678.88
Blue Cross,EPO,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,Grouper Rate,6588.00
Blue Cross,EPO,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,Grouper Rate,6588.00
Blue Cross,EPO,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Grouper Rate,6588.00
Blue Cross,EPO,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,6588.00
Blue Cross,EPO,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Grouper Rate,6588.00
Blue Cross,EPO,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,8012.00
Blue Cross,EPO,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,8012.00
Blue Cross,EPO,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,Grouper Rate,8012.00
Blue Cross,EPO,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,Grouper Rate,8841.00
Blue Cross,EPO,516,DRG,Other musculoskelet sys & conn tiss O.R. proc w CC,,Case Rate,32436.59
Blue Cross,EPO,51600,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,Grouper Rate,1678.88
Blue Cross,EPO,51605,CPT4/HCPCS,PREPARATION FOR BLADDER XRAY,,Grouper Rate,1678.00
Blue Cross,EPO,51610,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,Grouper Rate,1678.88
Blue Cross,EPO,517,DRG,Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC,,Case Rate,23101.41
Blue Cross,EPO,51703,CPT4/HCPCS,INSERT BLADDER CATH COMPLEX,,Grouper Rate,1678.00
Blue Cross,EPO,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Grouper Rate,1678.88
Blue Cross,EPO,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Grouper Rate,1678.00
Blue Cross,EPO,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Grouper Rate,1678.00
Blue Cross,EPO,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Grouper Rate,1678.00
Blue Cross,EPO,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Grouper Rate,1678.00
Blue Cross,EPO,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Grouper Rate,1678.00
Blue Cross,EPO,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Grouper Rate,1678.88
Blue Cross,EPO,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,Grouper Rate,1678.00
Blue Cross,EPO,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,Grouper Rate,1678.00
Blue Cross,EPO,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,1678.00
Blue Cross,EPO,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,1678.00
Blue Cross,EPO,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,Grouper Rate,1678.00
Blue Cross,EPO,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Grouper Rate,1678.00
Blue Cross,EPO,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,Grouper Rate,1678.00
Blue Cross,EPO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,Case Rate,59284.32
Blue Cross,EPO,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Grouper Rate,5281.00
Blue Cross,EPO,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Grouper Rate,6588.00
Blue Cross,EPO,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,5281.00
Blue Cross,EPO,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,5281.00
Blue Cross,EPO,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Grouper Rate,5281.00
Blue Cross,EPO,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,5029.00
Blue Cross,EPO,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,5029.00
Blue Cross,EPO,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Grouper Rate,1678.00
Blue Cross,EPO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,Case Rate,32380.35
Blue Cross,EPO,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Grouper Rate,5029.00
Blue Cross,EPO,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Grouper Rate,3544.00
Blue Cross,EPO,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,Grouper Rate,5783.00
Blue Cross,EPO,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,Grouper Rate,5281.00
Blue Cross,EPO,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,EPO,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,Grouper Rate,5029.00
Blue Cross,EPO,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Grouper Rate,5281.00
Blue Cross,EPO,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Grouper Rate,5281.00
Blue Cross,EPO,52,DRG,Spinal disorders & injuries w CC/MCC,,Case Rate,30517.95
Blue Cross,EPO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,Case Rate,23443.79
Blue Cross,EPO,52000,CPT4/HCPCS,CYSTOSCOPY,,Grouper Rate,1678.88
Blue Cross,EPO,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Grouper Rate,1678.00
Blue Cross,EPO,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Grouper Rate,1678.88
Blue Cross,EPO,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Grouper Rate,1678.88
Blue Cross,EPO,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Grouper Rate,1678.88
Blue Cross,EPO,521,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,,Case Rate,50668.63
Blue Cross,EPO,522,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,,Case Rate,36207.71
Blue Cross,EPO,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Grouper Rate,1678.88
Blue Cross,EPO,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3544.00
Blue Cross,EPO,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Grouper Rate,5029.00
Blue Cross,EPO,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3544.00
Blue Cross,EPO,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,1678.88
Blue Cross,EPO,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,1678.88
Blue Cross,EPO,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Grouper Rate,1678.88
Blue Cross,EPO,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Grouper Rate,1678.88
Blue Cross,EPO,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,1678.88
Blue Cross,EPO,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,1678.88
Blue Cross,EPO,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Grouper Rate,5029.00
Blue Cross,EPO,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Grouper Rate,1678.88
Blue Cross,EPO,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,EPO,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Grouper Rate,3544.00
Blue Cross,EPO,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Grouper Rate,1678.88
Blue Cross,EPO,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Grouper Rate,1678.88
Blue Cross,EPO,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Grouper Rate,1678.88
Blue Cross,EPO,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Grouper Rate,3544.00
Blue Cross,EPO,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Grouper Rate,3544.00
Blue Cross,EPO,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Grouper Rate,3544.00
Blue Cross,EPO,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Grouper Rate,3544.00
Blue Cross,EPO,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Grouper Rate,1678.88
Blue Cross,EPO,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Grouper Rate,1678.88
Blue Cross,EPO,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Grouper Rate,3544.00
Blue Cross,EPO,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Grouper Rate,5029.00
Blue Cross,EPO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Grouper Rate,1678.88
Blue Cross,EPO,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Grouper Rate,1678.88
Blue Cross,EPO,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Grouper Rate,1678.88
Blue Cross,EPO,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Grouper Rate,1678.88
Blue Cross,EPO,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Grouper Rate,1678.88
Blue Cross,EPO,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Grouper Rate,3544.00
Blue Cross,EPO,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Grouper Rate,3544.00
Blue Cross,EPO,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Grouper Rate,3544.00
Blue Cross,EPO,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Grouper Rate,1678.88
Blue Cross,EPO,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Grouper Rate,1678.88
Blue Cross,EPO,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,EPO,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,EPO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Grouper Rate,1678.88
Blue Cross,EPO,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,1678.88
Blue Cross,EPO,53,DRG,Spinal disorders & injuries w/o CC/MCC,,Case Rate,18791.09
Blue Cross,EPO,53000,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,EPO,53010,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,EPO,53020,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,EPO,53025,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,EPO,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,1678.88
Blue Cross,EPO,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,1678.00
Blue Cross,EPO,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,1678.88
Blue Cross,EPO,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Grouper Rate,1678.00
Blue Cross,EPO,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,5281.00
Blue Cross,EPO,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,5281.00
Blue Cross,EPO,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,1678.88
Blue Cross,EPO,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,1678.88
Blue Cross,EPO,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,3544.00
Blue Cross,EPO,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Grouper Rate,1678.88
Blue Cross,EPO,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,1678.88
Blue Cross,EPO,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,1678.88
Blue Cross,EPO,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,1678.00
Blue Cross,EPO,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,1678.00
Blue Cross,EPO,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,1678.00
Blue Cross,EPO,533,DRG,Fractures of femur w MCC,,Case Rate,23364.40
Blue Cross,EPO,534,DRG,Fractures of femur w/o MCC,,Case Rate,13043.44
Blue Cross,EPO,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Grouper Rate,3544.00
Blue Cross,EPO,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Grouper Rate,1678.88
Blue Cross,EPO,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,1678.88
Blue Cross,EPO,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,EPO,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Grouper Rate,3544.00
Blue Cross,EPO,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Grouper Rate,1678.88
Blue Cross,EPO,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,1678.88
Blue Cross,EPO,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Grouper Rate,3544.00
Blue Cross,EPO,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Grouper Rate,1678.88
Blue Cross,EPO,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Grouper Rate,1678.00
Blue Cross,EPO,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Grouper Rate,3544.00
Blue Cross,EPO,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Grouper Rate,5281.00
Blue Cross,EPO,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Grouper Rate,3544.00
Blue Cross,EPO,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Grouper Rate,1678.00
Blue Cross,EPO,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,Grouper Rate,5783.00
Blue Cross,EPO,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Grouper Rate,1678.00
Blue Cross,EPO,53450,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,EPO,53460,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,EPO,535,DRG,Fractures of hip & pelvis w MCC,,Case Rate,20407.05
Blue Cross,EPO,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Grouper Rate,3544.00
Blue Cross,EPO,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,EPO,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,EPO,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,EPO,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,EPO,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,1678.88
Blue Cross,EPO,536,DRG,Fractures of hip & pelvis w/o MCC,,Case Rate,12762.26
Blue Cross,EPO,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,EPO,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,EPO,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,EPO,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,EPO,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,EPO,53665,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,EPO,537,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC,,Case Rate,15435.12
Blue Cross,EPO,538,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC,,Case Rate,11931.95
Blue Cross,EPO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Grouper Rate,3544.00
Blue Cross,EPO,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Grouper Rate,3544.00
Blue Cross,EPO,53854,CPT4/HCPCS,TRURL DSTRJ PRST8 TISS RF WV,,Grouper Rate,3544.00
Blue Cross,EPO,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Grouper Rate,1678.00
Blue Cross,EPO,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Grouper Rate,3544.00
Blue Cross,EPO,539,DRG,Osteomyelitis w MCC,,Case Rate,32107.44
Blue Cross,EPO,54,DRG,Nervous system neoplasms w MCC,,Case Rate,22590.33
Blue Cross,EPO,540,DRG,Osteomyelitis w CC,,Case Rate,21424.26
Blue Cross,EPO,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,1678.00
Blue Cross,EPO,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,1678.00
Blue Cross,EPO,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Grouper Rate,1678.88
Blue Cross,EPO,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,541,DRG,Osteomyelitis w/o CC/MCC,,Case Rate,13903.52
Blue Cross,EPO,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,1678.00
Blue Cross,EPO,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,1678.00
Blue Cross,EPO,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.88
Blue Cross,EPO,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,5281.00
Blue Cross,EPO,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,5783.00
Blue Cross,EPO,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.00
Blue Cross,EPO,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Grouper Rate,1678.88
Blue Cross,EPO,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Grouper Rate,1678.88
Blue Cross,EPO,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,Grouper Rate,5281.00
Blue Cross,EPO,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,Grouper Rate,5783.00
Blue Cross,EPO,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Grouper Rate,1678.00
Blue Cross,EPO,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Grouper Rate,1678.00
Blue Cross,EPO,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Grouper Rate,1678.00
Blue Cross,EPO,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Grouper Rate,1678.00
Blue Cross,EPO,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Grouper Rate,1678.00
Blue Cross,EPO,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Grouper Rate,1678.00
Blue Cross,EPO,542,DRG,Pathological fractures & musculoskelet & conn tiss malig w MCC,,Case Rate,29859.66
Blue Cross,EPO,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.88
Blue Cross,EPO,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.00
Blue Cross,EPO,54240,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,1678.00
Blue Cross,EPO,543,DRG,Pathological fractures & musculoskelet & conn tiss malig w CC,,Case Rate,17256.18
Blue Cross,EPO,54300,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,3544.00
Blue Cross,EPO,54304,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,3544.00
Blue Cross,EPO,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,EPO,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,EPO,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,EPO,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5281.00
Blue Cross,EPO,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,1678.88
Blue Cross,EPO,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,3544.00
Blue Cross,EPO,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,3544.00
Blue Cross,EPO,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5029.00
Blue Cross,EPO,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5029.00
Blue Cross,EPO,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5029.00
Blue Cross,EPO,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Grouper Rate,5029.00
Blue Cross,EPO,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,54380,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5029.00
Blue Cross,EPO,54385,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5029.00
Blue Cross,EPO,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,Grouper Rate,5029.00
Blue Cross,EPO,544,DRG,Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC,,Case Rate,12838.34
Blue Cross,EPO,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,EPO,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,EPO,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Grouper Rate,3544.00
Blue Cross,EPO,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Grouper Rate,5281.00
Blue Cross,EPO,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Grouper Rate,5281.00
Blue Cross,EPO,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Grouper Rate,5783.00
Blue Cross,EPO,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Grouper Rate,5281.00
Blue Cross,EPO,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Grouper Rate,5029.00
Blue Cross,EPO,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Grouper Rate,5281.00
Blue Cross,EPO,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Grouper Rate,5281.00
Blue Cross,EPO,54420,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5029.00
Blue Cross,EPO,54430,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,1678.88
Blue Cross,EPO,54435,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5029.00
Blue Cross,EPO,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Grouper Rate,3544.00
Blue Cross,EPO,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,Grouper Rate,5281.00
Blue Cross,EPO,54440,CPT4/HCPCS,REPAIR OF PENIS,,Grouper Rate,5029.00
Blue Cross,EPO,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Grouper Rate,1678.00
Blue Cross,EPO,545,DRG,Connective tissue disorders w MCC,,Case Rate,41341.73
Blue Cross,EPO,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,1678.00
Blue Cross,EPO,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,1678.00
Blue Cross,EPO,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Grouper Rate,1678.00
Blue Cross,EPO,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,3544.00
Blue Cross,EPO,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Grouper Rate,1678.88
Blue Cross,EPO,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,5029.00
Blue Cross,EPO,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,3544.00
Blue Cross,EPO,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,5029.00
Blue Cross,EPO,546,DRG,Connective tissue disorders w CC,,Case Rate,19957.16
Blue Cross,EPO,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Grouper Rate,5029.00
Blue Cross,EPO,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Grouper Rate,3544.00
Blue Cross,EPO,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Grouper Rate,3544.00
Blue Cross,EPO,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Grouper Rate,5029.00
Blue Cross,EPO,54660,CPT4/HCPCS,REVISION OF TESTIS,,Grouper Rate,1678.88
Blue Cross,EPO,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Grouper Rate,3544.00
Blue Cross,EPO,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Grouper Rate,3544.00
Blue Cross,EPO,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Grouper Rate,3544.00
Blue Cross,EPO,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Grouper Rate,5281.00
Blue Cross,EPO,547,DRG,Connective tissue disorders w/o CC/MCC,,Case Rate,13777.82
Blue Cross,EPO,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Grouper Rate,1678.88
Blue Cross,EPO,548,DRG,Septic arthritis w MCC,,Case Rate,33569.58
Blue Cross,EPO,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Grouper Rate,1678.00
Blue Cross,EPO,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,3544.00
Blue Cross,EPO,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,5029.00
Blue Cross,EPO,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,5029.00
Blue Cross,EPO,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,5029.00
Blue Cross,EPO,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Grouper Rate,1678.00
Blue Cross,EPO,549,DRG,Septic arthritis w CC,,Case Rate,20623.72
Blue Cross,EPO,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,5029.00
Blue Cross,EPO,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,5029.00
Blue Cross,EPO,55,DRG,Nervous system neoplasms w/o MCC,,Case Rate,17257.83
Blue Cross,EPO,550,DRG,Septic arthritis w/o CC/MCC,,Case Rate,14599.85
Blue Cross,EPO,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,5029.00
Blue Cross,EPO,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Grouper Rate,5029.00
Blue Cross,EPO,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Grouper Rate,5029.00
Blue Cross,EPO,551,DRG,Medical back problems w MCC,,Case Rate,26846.07
Blue Cross,EPO,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Grouper Rate,1678.88
Blue Cross,EPO,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Grouper Rate,1678.88
Blue Cross,EPO,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Grouper Rate,1678.00
Blue Cross,EPO,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,1678.00
Blue Cross,EPO,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,1678.88
Blue Cross,EPO,552,DRG,Medical back problems w/o MCC,,Case Rate,15580.68
Blue Cross,EPO,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Grouper Rate,1678.88
Blue Cross,EPO,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Grouper Rate,1678.88
Blue Cross,EPO,553,DRG,Bone diseases & arthropathies w MCC,,Case Rate,20977.68
Blue Cross,EPO,55300,CPT4/HCPCS,PREPARE SPERM DUCT X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,554,DRG,Bone diseases & arthropathies w/o MCC,,Case Rate,13073.21
Blue Cross,EPO,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Grouper Rate,1678.00
Blue Cross,EPO,55450,CPT4/HCPCS,LIGATION OF SPERM DUCT,,Grouper Rate,1678.00
Blue Cross,EPO,555,DRG,Signs & symptoms of musculoskeletal system & conn tissue w MCC,,Case Rate,22540.71
Blue Cross,EPO,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,3544.00
Blue Cross,EPO,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Grouper Rate,5029.00
Blue Cross,EPO,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,5029.00
Blue Cross,EPO,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,5029.00
Blue Cross,EPO,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Grouper Rate,5029.00
Blue Cross,EPO,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Grouper Rate,3544.00
Blue Cross,EPO,556,DRG,Signs & symptoms of musculoskeletal system & conn tissue w/o MCC,,Case Rate,13336.20
Blue Cross,EPO,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,1678.00
Blue Cross,EPO,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,1678.00
Blue Cross,EPO,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Grouper Rate,1678.00
Blue Cross,EPO,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Grouper Rate,1678.00
Blue Cross,EPO,557,DRG,Tendonitis, myositis & bursitis w MCC,,Case Rate,23055.10
Blue Cross,EPO,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,EPO,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,EPO,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Grouper Rate,1678.88
Blue Cross,EPO,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,558,DRG,Tendonitis, myositis & bursitis w/o MCC,,Case Rate,14196.28
Blue Cross,EPO,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,5281.00
Blue Cross,EPO,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,5783.00
Blue Cross,EPO,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,5783.00
Blue Cross,EPO,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Grouper Rate,3544.00
Blue Cross,EPO,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,55870,CPT4/HCPCS,ELECTROEJACULATION,,Grouper Rate,1678.00
Blue Cross,EPO,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Grouper Rate,6588.00
Blue Cross,EPO,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Grouper Rate,1678.00
Blue Cross,EPO,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Grouper Rate,8841.00
Blue Cross,EPO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Grouper Rate,1678.88
Blue Cross,EPO,559,DRG,Aftercare, musculoskeletal system & connective tissue w MCC,,Case Rate,30895.06
Blue Cross,EPO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Grouper Rate,1678.00
Blue Cross,EPO,55970,CPT4/HCPCS,SEX TRANSFORMATION M TO F,,Grouper Rate,5783.00
Blue Cross,EPO,55980,CPT4/HCPCS,SEX TRANSFORMATION F TO M,,Grouper Rate,5783.00
Blue Cross,EPO,56,DRG,Degenerative nervous system disorders w MCC,,Case Rate,36177.94
Blue Cross,EPO,560,DRG,Aftercare, musculoskeletal system & connective tissue w CC,,Case Rate,17803.65
Blue Cross,EPO,561,DRG,Aftercare, musculoskeletal system & connective tissue w/o CC/MCC,,Case Rate,13084.79
Blue Cross,EPO,562,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC,,Case Rate,23288.32
Blue Cross,EPO,563,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC,,Case Rate,14403.03
Blue Cross,EPO,564,DRG,Other musculoskeletal sys & connective tissue diagnoses w MCC,,Case Rate,25038.25
Blue Cross,EPO,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Grouper Rate,1678.00
Blue Cross,EPO,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Grouper Rate,1678.88
Blue Cross,EPO,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Grouper Rate,1678.00
Blue Cross,EPO,56442,CPT4/HCPCS,HYMENOTOMY,,Grouper Rate,1678.00
Blue Cross,EPO,565,DRG,Other musculoskeletal sys & connective tissue diagnoses w CC,,Case Rate,16644.20
Blue Cross,EPO,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Grouper Rate,1678.00
Blue Cross,EPO,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Grouper Rate,1678.88
Blue Cross,EPO,566,DRG,Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC,,Case Rate,12429.81
Blue Cross,EPO,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,1678.00
Blue Cross,EPO,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,1678.00
Blue Cross,EPO,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Grouper Rate,5281.00
Blue Cross,EPO,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Grouper Rate,6588.00
Blue Cross,EPO,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Grouper Rate,1678.00
Blue Cross,EPO,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Grouper Rate,3544.00
Blue Cross,EPO,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,3544.00
Blue Cross,EPO,56805,CPT4/HCPCS,REPAIR CLITORIS,,Grouper Rate,1678.88
Blue Cross,EPO,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Grouper Rate,5281.00
Blue Cross,EPO,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Grouper Rate,1678.00
Blue Cross,EPO,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Grouper Rate,1678.00
Blue Cross,EPO,57,DRG,Degenerative nervous system disorders w/o MCC,,Case Rate,20909.86
Blue Cross,EPO,570,DRG,Skin debridement w MCC,,Case Rate,46912.40
Blue Cross,EPO,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Grouper Rate,1678.00
Blue Cross,EPO,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,1678.88
Blue Cross,EPO,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Grouper Rate,1678.88
Blue Cross,EPO,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Grouper Rate,1678.00
Blue Cross,EPO,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Grouper Rate,1678.00
Blue Cross,EPO,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Grouper Rate,1678.00
Blue Cross,EPO,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Grouper Rate,1678.00
Blue Cross,EPO,571,DRG,Skin debridement w CC,,Case Rate,27006.51
Blue Cross,EPO,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,1678.88
Blue Cross,EPO,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Grouper Rate,5281.00
Blue Cross,EPO,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Grouper Rate,5281.00
Blue Cross,EPO,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Grouper Rate,5783.00
Blue Cross,EPO,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Grouper Rate,5281.00
Blue Cross,EPO,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Grouper Rate,5281.00
Blue Cross,EPO,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Grouper Rate,5783.00
Blue Cross,EPO,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Grouper Rate,5783.00
Blue Cross,EPO,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,1678.88
Blue Cross,EPO,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,1678.88
Blue Cross,EPO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Grouper Rate,1678.00
Blue Cross,EPO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Grouper Rate,1678.00
Blue Cross,EPO,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,Grouper Rate,1678.00
Blue Cross,EPO,572,DRG,Skin debridement w/o CC/MCC,,Case Rate,18237.00
Blue Cross,EPO,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,1678.00
Blue Cross,EPO,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Grouper Rate,1678.88
Blue Cross,EPO,57220,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,3544.00
Blue Cross,EPO,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Grouper Rate,3544.00
Blue Cross,EPO,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Grouper Rate,5281.00
Blue Cross,EPO,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Grouper Rate,5281.00
Blue Cross,EPO,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Grouper Rate,5281.00
Blue Cross,EPO,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Grouper Rate,6588.00
Blue Cross,EPO,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Grouper Rate,1678.88
Blue Cross,EPO,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Grouper Rate,3544.00
Blue Cross,EPO,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,Grouper Rate,5029.00
Blue Cross,EPO,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Grouper Rate,5029.00
Blue Cross,EPO,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Grouper Rate,5281.00
Blue Cross,EPO,57283,CPT4/HCPCS,COLPOPEXY INTRAPERITONEAL,,Grouper Rate,5281.00
Blue Cross,EPO,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Grouper Rate,5029.00
Blue Cross,EPO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Grouper Rate,5029.00
Blue Cross,EPO,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Grouper Rate,1678.00
Blue Cross,EPO,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Grouper Rate,1678.88
Blue Cross,EPO,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Grouper Rate,5281.00
Blue Cross,EPO,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Grouper Rate,5783.00
Blue Cross,EPO,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Grouper Rate,5783.00
Blue Cross,EPO,57296,CPT4/HCPCS,REVISE VAG GRAFT OPEN ABD,,Grouper Rate,1678.00
Blue Cross,EPO,573,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w MCC,,Case Rate,91586.94
Blue Cross,EPO,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,3544.00
Blue Cross,EPO,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,5281.00
Blue Cross,EPO,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,Grouper Rate,5783.00
Blue Cross,EPO,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,Grouper Rate,5281.00
Blue Cross,EPO,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,3544.00
Blue Cross,EPO,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,5029.00
Blue Cross,EPO,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,3544.00
Blue Cross,EPO,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,5783.00
Blue Cross,EPO,57335,CPT4/HCPCS,REPAIR VAGINA,,Grouper Rate,5029.00
Blue Cross,EPO,574,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w CC,,Case Rate,53726.88
Blue Cross,EPO,57400,CPT4/HCPCS,DILATION OF VAGINA,,Grouper Rate,1678.00
Blue Cross,EPO,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Grouper Rate,1678.00
Blue Cross,EPO,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Grouper Rate,1678.00
Blue Cross,EPO,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Grouper Rate,1678.00
Blue Cross,EPO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Grouper Rate,5029.00
Blue Cross,EPO,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Grouper Rate,5281.00
Blue Cross,EPO,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Grouper Rate,3544.00
Blue Cross,EPO,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Grouper Rate,1678.88
Blue Cross,EPO,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Grouper Rate,1678.00
Blue Cross,EPO,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Grouper Rate,1678.00
Blue Cross,EPO,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Grouper Rate,1678.00
Blue Cross,EPO,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Grouper Rate,1678.88
Blue Cross,EPO,575,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/MCC,,Case Rate,29135.21
Blue Cross,EPO,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Grouper Rate,1678.00
Blue Cross,EPO,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Grouper Rate,1678.00
Blue Cross,EPO,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Grouper Rate,1678.00
Blue Cross,EPO,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Grouper Rate,1678.00
Blue Cross,EPO,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Grouper Rate,1678.88
Blue Cross,EPO,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,1678.88
Blue Cross,EPO,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,1678.88
Blue Cross,EPO,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Grouper Rate,3544.00
Blue Cross,EPO,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,Grouper Rate,5783.00
Blue Cross,EPO,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,5783.00
Blue Cross,EPO,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,Grouper Rate,5783.00
Blue Cross,EPO,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,3544.00
Blue Cross,EPO,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,Grouper Rate,5029.00
Blue Cross,EPO,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Grouper Rate,5281.00
Blue Cross,EPO,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Grouper Rate,1678.00
Blue Cross,EPO,576,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC,,Case Rate,83541.88
Blue Cross,EPO,577,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w CC,,Case Rate,42239.85
Blue Cross,EPO,57700,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,1678.00
Blue Cross,EPO,57720,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3544.00
Blue Cross,EPO,578,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC,,Case Rate,26971.77
Blue Cross,EPO,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Grouper Rate,1678.00
Blue Cross,EPO,579,DRG,Other skin, subcut tiss & breast proc w MCC,,Case Rate,48425.81
Blue Cross,EPO,58,DRG,Multiple sclerosis & cerebellar ataxia w MCC,,Case Rate,28725.01
Blue Cross,EPO,580,DRG,Other skin, subcut tiss & breast proc w CC,,Case Rate,26468.96
Blue Cross,EPO,581,DRG,Other skin, subcut tiss & breast proc w/o CC/MCC,,Case Rate,20709.73
Blue Cross,EPO,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Grouper Rate,1678.00
Blue Cross,EPO,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Grouper Rate,1678.88
Blue Cross,EPO,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Grouper Rate,5281.00
Blue Cross,EPO,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Grouper Rate,5029.00
Blue Cross,EPO,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,Grouper Rate,6588.00
Blue Cross,EPO,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Grouper Rate,5029.00
Blue Cross,EPO,582,DRG,Mastectomy for malignancy w CC/MCC,,Case Rate,27056.13
Blue Cross,EPO,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,8841.00
Blue Cross,EPO,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,Grouper Rate,8841.00
Blue Cross,EPO,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Grouper Rate,8012.00
Blue Cross,EPO,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Grouper Rate,8012.00
Blue Cross,EPO,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,Grouper Rate,8012.00
Blue Cross,EPO,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Grouper Rate,8012.00
Blue Cross,EPO,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Grouper Rate,8012.00
Blue Cross,EPO,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Grouper Rate,8012.00
Blue Cross,EPO,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Grouper Rate,8012.00
Blue Cross,EPO,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Grouper Rate,8012.00
Blue Cross,EPO,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Grouper Rate,8012.00
Blue Cross,EPO,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,Grouper Rate,8012.00
Blue Cross,EPO,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Grouper Rate,8012.00
Blue Cross,EPO,583,DRG,Mastectomy for malignancy w/o CC/MCC,,Case Rate,25436.86
Blue Cross,EPO,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Grouper Rate,1678.00
Blue Cross,EPO,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Grouper Rate,1678.00
Blue Cross,EPO,58340,CPT4/HCPCS,CATHETER FOR HYSTEROGRAPHY,,Grouper Rate,1678.00
Blue Cross,EPO,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Grouper Rate,1678.00
Blue Cross,EPO,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Grouper Rate,5029.00
Blue Cross,EPO,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Grouper Rate,5029.00
Blue Cross,EPO,584,DRG,Breast biopsy, local excision & other breast procedures w CC/MCC,,Case Rate,30173.92
Blue Cross,EPO,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,3544.00
Blue Cross,EPO,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,3544.00
Blue Cross,EPO,585,DRG,Breast biopsy, local excision & other breast procedures w/o CC/MCC,,Case Rate,28723.36
Blue Cross,EPO,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Grouper Rate,3544.00
Blue Cross,EPO,58540,CPT4/HCPCS,REVISION OF UTERUS,,Grouper Rate,3544.00
Blue Cross,EPO,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Grouper Rate,5029.00
Blue Cross,EPO,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Grouper Rate,5281.00
Blue Cross,EPO,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Grouper Rate,5029.00
Blue Cross,EPO,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Grouper Rate,5281.00
Blue Cross,EPO,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Grouper Rate,5783.00
Blue Cross,EPO,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,EPO,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Grouper Rate,8012.00
Blue Cross,EPO,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Grouper Rate,8012.00
Blue Cross,EPO,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Grouper Rate,8012.00
Blue Cross,EPO,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Grouper Rate,1678.00
Blue Cross,EPO,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Grouper Rate,1678.88
Blue Cross,EPO,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Grouper Rate,3544.00
Blue Cross,EPO,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Grouper Rate,3544.00
Blue Cross,EPO,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Grouper Rate,3544.00
Blue Cross,EPO,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Grouper Rate,1678.88
Blue Cross,EPO,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Grouper Rate,5029.00
Blue Cross,EPO,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Grouper Rate,3544.00
Blue Cross,EPO,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Grouper Rate,8012.00
Blue Cross,EPO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Grouper Rate,8012.00
Blue Cross,EPO,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Grouper Rate,8012.00
Blue Cross,EPO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Grouper Rate,8012.00
Blue Cross,EPO,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,Grouper Rate,8012.00
Blue Cross,EPO,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3544.00
Blue Cross,EPO,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3544.00
Blue Cross,EPO,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Grouper Rate,3544.00
Blue Cross,EPO,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Grouper Rate,3544.00
Blue Cross,EPO,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Grouper Rate,6588.00
Blue Cross,EPO,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Grouper Rate,5783.00
Blue Cross,EPO,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Grouper Rate,5281.00
Blue Cross,EPO,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Grouper Rate,3544.00
Blue Cross,EPO,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Grouper Rate,3544.00
Blue Cross,EPO,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Grouper Rate,5281.00
Blue Cross,EPO,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Grouper Rate,5281.00
Blue Cross,EPO,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Grouper Rate,5029.00
Blue Cross,EPO,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Grouper Rate,5029.00
Blue Cross,EPO,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Grouper Rate,5281.00
Blue Cross,EPO,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Grouper Rate,5029.00
Blue Cross,EPO,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Grouper Rate,5783.00
Blue Cross,EPO,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Grouper Rate,5029.00
Blue Cross,EPO,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Grouper Rate,5029.00
Blue Cross,EPO,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Grouper Rate,5029.00
Blue Cross,EPO,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,3544.00
Blue Cross,EPO,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,5029.00
Blue Cross,EPO,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Grouper Rate,3544.00
Blue Cross,EPO,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Grouper Rate,5281.00
Blue Cross,EPO,58823,CPT4/HCPCS,DRAIN PELVIC ABSCESS PERCUT,,Grouper Rate,1678.00
Blue Cross,EPO,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Grouper Rate,5029.00
Blue Cross,EPO,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Grouper Rate,3544.00
Blue Cross,EPO,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Grouper Rate,5029.00
Blue Cross,EPO,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Grouper Rate,5281.00
Blue Cross,EPO,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,5281.00
Blue Cross,EPO,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,5783.00
Blue Cross,EPO,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,5783.00
Blue Cross,EPO,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,5783.00
Blue Cross,EPO,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,6588.00
Blue Cross,EPO,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,Grouper Rate,8012.00
Blue Cross,EPO,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,Grouper Rate,8012.00
Blue Cross,EPO,58956,CPT4/HCPCS,BSO OMENTECTOMY W/TAH,,Grouper Rate,5281.00
Blue Cross,EPO,58957,CPT4/HCPCS,RESECT RECURRENT GYN MAL,,Grouper Rate,5783.00
Blue Cross,EPO,58958,CPT4/HCPCS,RESECT RECUR GYN MAL W/LYM,,Grouper Rate,6588.00
Blue Cross,EPO,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,5783.00
Blue Cross,EPO,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Grouper Rate,1678.00
Blue Cross,EPO,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,1678.00
Blue Cross,EPO,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,1678.00
Blue Cross,EPO,59,DRG,Multiple sclerosis & cerebellar ataxia w CC,,Case Rate,18632.31
Blue Cross,EPO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Grouper Rate,1678.00
Blue Cross,EPO,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Grouper Rate,1678.00
Blue Cross,EPO,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,Grouper Rate,1678.00
Blue Cross,EPO,59015,CPT4/HCPCS,CHORION BIOPSY,,Grouper Rate,1678.88
Blue Cross,EPO,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Grouper Rate,3544.00
Blue Cross,EPO,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Grouper Rate,3544.00
Blue Cross,EPO,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Grouper Rate,1678.88
Blue Cross,EPO,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Grouper Rate,1678.88
Blue Cross,EPO,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,Grouper Rate,5029.00
Blue Cross,EPO,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1678.88
Blue Cross,EPO,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,EPO,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,EPO,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,8012.00
Blue Cross,EPO,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6588.00
Blue Cross,EPO,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,3544.00
Blue Cross,EPO,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,EPO,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,EPO,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Grouper Rate,1678.88
Blue Cross,EPO,592,DRG,Skin ulcers w MCC,,Case Rate,27898.01
Blue Cross,EPO,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Grouper Rate,1678.00
Blue Cross,EPO,593,DRG,Skin ulcers w CC,,Case Rate,18802.67
Blue Cross,EPO,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Grouper Rate,3544.00
Blue Cross,EPO,59320,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3544.00
Blue Cross,EPO,59325,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3544.00
Blue Cross,EPO,59350,CPT4/HCPCS,REPAIR OF UTERUS,,Grouper Rate,5281.00
Blue Cross,EPO,594,DRG,Skin ulcers w/o CC/MCC,,Case Rate,13541.29
Blue Cross,EPO,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Grouper Rate,5783.00
Blue Cross,EPO,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,Grouper Rate,1678.00
Blue Cross,EPO,59414,CPT4/HCPCS,DELIVER PLACENTA,,Grouper Rate,1678.88
Blue Cross,EPO,595,DRG,Major skin disorders w MCC,,Case Rate,33280.13
Blue Cross,EPO,59514,CPT4/HCPCS,CESAREAN DELIVERY ONLY,,Grouper Rate,5783.00
Blue Cross,EPO,59515,CPT4/HCPCS,CESAREAN DELIVERY,,Grouper Rate,5783.00
Blue Cross,EPO,59525,CPT4/HCPCS,REMOVE UTERUS AFTER CESAREAN,,Grouper Rate,5029.00
Blue Cross,EPO,596,DRG,Major skin disorders w/o MCC,,Case Rate,16361.36
Blue Cross,EPO,59610,CPT4/HCPCS,VBAC DELIVERY,,Grouper Rate,5281.00
Blue Cross,EPO,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Grouper Rate,5281.00
Blue Cross,EPO,59614,CPT4/HCPCS,VBAC CARE AFTER DELIVERY,,Grouper Rate,5281.00
Blue Cross,EPO,59618,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY,,Grouper Rate,5783.00
Blue Cross,EPO,59620,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY ONLY,,Grouper Rate,5783.00
Blue Cross,EPO,59622,CPT4/HCPCS,ATTEMPTED VBAC AFTER CARE,,Grouper Rate,5783.00
Blue Cross,EPO,597,DRG,Malignant breast disorders w MCC,,Case Rate,27071.01
Blue Cross,EPO,598,DRG,Malignant breast disorders w CC,,Case Rate,18379.24
Blue Cross,EPO,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,3544.00
Blue Cross,EPO,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Grouper Rate,3544.00
Blue Cross,EPO,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,3544.00
Blue Cross,EPO,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Grouper Rate,3544.00
Blue Cross,EPO,59840,CPT4/HCPCS,ABORTION,,Grouper Rate,3544.00
Blue Cross,EPO,59841,CPT4/HCPCS,ABORTION,,Grouper Rate,3544.00
Blue Cross,EPO,59850,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.00
Blue Cross,EPO,59851,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.00
Blue Cross,EPO,59852,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.00
Blue Cross,EPO,59855,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.88
Blue Cross,EPO,59856,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.88
Blue Cross,EPO,59857,CPT4/HCPCS,ABORTION,,Grouper Rate,5029.00
Blue Cross,EPO,59866,CPT4/HCPCS,ABORTION (MPR),,Grouper Rate,1678.00
Blue Cross,EPO,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Grouper Rate,3544.00
Blue Cross,EPO,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Grouper Rate,1678.00
Blue Cross,EPO,599,DRG,Malignant breast disorders w/o CC/MCC,,Case Rate,11101.64
Blue Cross,EPO,6,DRG,Liver transplant w/o MCC,,Case Rate,77600.71
Blue Cross,EPO,60,DRG,Multiple sclerosis & cerebellar ataxia w/o CC/MCC,,Case Rate,15144.02
Blue Cross,EPO,600,DRG,Non-malignant breast disorders w CC/MCC,,Case Rate,16468.87
Blue Cross,EPO,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Grouper Rate,1678.00
Blue Cross,EPO,601,DRG,Non-malignant breast disorders w/o CC/MCC,,Case Rate,11372.90
Blue Cross,EPO,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Grouper Rate,1678.00
Blue Cross,EPO,602,DRG,Cellulitis w MCC,,Case Rate,23761.36
Blue Cross,EPO,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Grouper Rate,1678.88
Blue Cross,EPO,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,1678.88
Blue Cross,EPO,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,1678.88
Blue Cross,EPO,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,1678.88
Blue Cross,EPO,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,3544.00
Blue Cross,EPO,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,5783.00
Blue Cross,EPO,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,5029.00
Blue Cross,EPO,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Grouper Rate,5783.00
Blue Cross,EPO,60270,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,8012.00
Blue Cross,EPO,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,8012.00
Blue Cross,EPO,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,5029.00
Blue Cross,EPO,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,5029.00
Blue Cross,EPO,603,DRG,Cellulitis w/o MCC,,Case Rate,13972.99
Blue Cross,EPO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Grouper Rate,1678.00
Blue Cross,EPO,604,DRG,Trauma to the skin, subcut tiss & breast w MCC,,Case Rate,24666.10
Blue Cross,EPO,605,DRG,Trauma to the skin, subcut tiss & breast w/o MCC,,Case Rate,15038.16
Blue Cross,EPO,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,8012.00
Blue Cross,EPO,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Grouper Rate,8012.00
Blue Cross,EPO,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,8012.00
Blue Cross,EPO,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Grouper Rate,1678.88
Blue Cross,EPO,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,5281.00
Blue Cross,EPO,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,5783.00
Blue Cross,EPO,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,5783.00
Blue Cross,EPO,606,DRG,Minor skin disorders w MCC,,Case Rate,24991.94
Blue Cross,EPO,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Grouper Rate,5281.00
Blue Cross,EPO,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Grouper Rate,5281.00
Blue Cross,EPO,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,607,DRG,Minor skin disorders w/o MCC,,Case Rate,13655.42
Blue Cross,EPO,61,DRG,Acute ischemic stroke w use of thrombolytic agent w MCC,,Case Rate,47770.82
Blue Cross,EPO,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,1678.00
Blue Cross,EPO,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,1678.00
Blue Cross,EPO,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Grouper Rate,1678.00
Blue Cross,EPO,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,1678.00
Blue Cross,EPO,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Grouper Rate,1678.00
Blue Cross,EPO,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,1678.00
Blue Cross,EPO,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Grouper Rate,1678.00
Blue Cross,EPO,61105,CPT4/HCPCS,TWIST DRILL HOLE,,Grouper Rate,1678.88
Blue Cross,EPO,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,Grouper Rate,3544.00
Blue Cross,EPO,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,Grouper Rate,5783.00
Blue Cross,EPO,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,Grouper Rate,5783.00
Blue Cross,EPO,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,Grouper Rate,5783.00
Blue Cross,EPO,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,5281.00
Blue Cross,EPO,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,5281.00
Blue Cross,EPO,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,Grouper Rate,5281.00
Blue Cross,EPO,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,5281.00
Blue Cross,EPO,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,Grouper Rate,5281.00
Blue Cross,EPO,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Grouper Rate,3544.00
Blue Cross,EPO,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Grouper Rate,5281.00
Blue Cross,EPO,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Grouper Rate,5281.00
Blue Cross,EPO,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Grouper Rate,6588.00
Blue Cross,EPO,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,6588.00
Blue Cross,EPO,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,6588.00
Blue Cross,EPO,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Grouper Rate,1678.00
Blue Cross,EPO,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,6588.00
Blue Cross,EPO,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,Grouper Rate,5783.00
Blue Cross,EPO,61332,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,1678.88
Blue Cross,EPO,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,Grouper Rate,5029.00
Blue Cross,EPO,61334,CPT4/HCPCS,EXPLORE ORBIT/REMOVE OBJECT,,Grouper Rate,5029.00
Blue Cross,EPO,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,Grouper Rate,6588.00
Blue Cross,EPO,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,Grouper Rate,6588.00
Blue Cross,EPO,614,DRG,Adrenal & pituitary procedures w CC/MCC,,Case Rate,39477.67
Blue Cross,EPO,61440,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Grouper Rate,6588.00
Blue Cross,EPO,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,61490,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,615,DRG,Adrenal & pituitary procedures w/o CC/MCC,,Case Rate,26035.61
Blue Cross,EPO,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Grouper Rate,8012.00
Blue Cross,EPO,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,Grouper Rate,5783.00
Blue Cross,EPO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,EPO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Grouper Rate,6588.00
Blue Cross,EPO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Grouper Rate,6588.00
Blue Cross,EPO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,EPO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,Grouper Rate,5029.00
Blue Cross,EPO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Grouper Rate,6588.00
Blue Cross,EPO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,EPO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,EPO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,8012.00
Blue Cross,EPO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,5783.00
Blue Cross,EPO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,EPO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,Grouper Rate,5783.00
Blue Cross,EPO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,EPO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,EPO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,8012.00
Blue Cross,EPO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,8012.00
Blue Cross,EPO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,EPO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,EPO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,Grouper Rate,8012.00
Blue Cross,EPO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,Grouper Rate,8012.00
Blue Cross,EPO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Grouper Rate,6588.00
Blue Cross,EPO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Grouper Rate,5783.00
Blue Cross,EPO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Grouper Rate,6588.00
Blue Cross,EPO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,Grouper Rate,5783.00
Blue Cross,EPO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,Grouper Rate,5783.00
Blue Cross,EPO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Grouper Rate,6588.00
Blue Cross,EPO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Grouper Rate,6588.00
Blue Cross,EPO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Grouper Rate,5281.00
Blue Cross,EPO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Grouper Rate,5783.00
Blue Cross,EPO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,EPO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,EPO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,Grouper Rate,6588.00
Blue Cross,EPO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Grouper Rate,6588.00
Blue Cross,EPO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Grouper Rate,8012.00
Blue Cross,EPO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Grouper Rate,8012.00
Blue Cross,EPO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,6588.00
Blue Cross,EPO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,6588.00
Blue Cross,EPO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,8012.00
Blue Cross,EPO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,6588.00
Blue Cross,EPO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,EPO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,EPO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,EPO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,EPO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,EPO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,EPO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,EPO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,EPO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,EPO,616,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w MCC,,Case Rate,65974.75
Blue Cross,EPO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,6588.00
Blue Cross,EPO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,8012.00
Blue Cross,EPO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,6588.00
Blue Cross,EPO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,8012.00
Blue Cross,EPO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,8012.00
Blue Cross,EPO,61609,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,6588.00
Blue Cross,EPO,61610,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,8012.00
Blue Cross,EPO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,6588.00
Blue Cross,EPO,61612,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,8012.00
Blue Cross,EPO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,Grouper Rate,8012.00
Blue Cross,EPO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Grouper Rate,8841.00
Blue Cross,EPO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Grouper Rate,8841.00
Blue Cross,EPO,61618,CPT4/HCPCS,REPAIR DURA,,Grouper Rate,6588.00
Blue Cross,EPO,61619,CPT4/HCPCS,REPAIR DURA,,Grouper Rate,5783.00
Blue Cross,EPO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Grouper Rate,5029.00
Blue Cross,EPO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,Grouper Rate,5029.00
Blue Cross,EPO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Grouper Rate,5029.00
Blue Cross,EPO,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,Grouper Rate,5029.00
Blue Cross,EPO,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,Grouper Rate,5029.00
Blue Cross,EPO,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,Grouper Rate,5029.00
Blue Cross,EPO,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,Grouper Rate,1678.88
Blue Cross,EPO,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,Grouper Rate,1678.88
Blue Cross,EPO,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,Grouper Rate,3544.00
Blue Cross,EPO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,Grouper Rate,1678.88
Blue Cross,EPO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,Grouper Rate,1678.88
Blue Cross,EPO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,EPO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,EPO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,EPO,617,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w CC,,Case Rate,33644.01
Blue Cross,EPO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,Grouper Rate,6588.00
Blue Cross,EPO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,EPO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,Grouper Rate,6588.00
Blue Cross,EPO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,8012.00
Blue Cross,EPO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,6588.00
Blue Cross,EPO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,5281.00
Blue Cross,EPO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,Grouper Rate,5281.00
Blue Cross,EPO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,Grouper Rate,5281.00
Blue Cross,EPO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,5783.00
Blue Cross,EPO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,Grouper Rate,5783.00
Blue Cross,EPO,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,Grouper Rate,1678.00
Blue Cross,EPO,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,Grouper Rate,1678.00
Blue Cross,EPO,61783,CPT4/HCPCS,SCAN PROC SPINAL,,Grouper Rate,1678.00
Blue Cross,EPO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Grouper Rate,3544.00
Blue Cross,EPO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Grouper Rate,3544.00
Blue Cross,EPO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,Grouper Rate,8841.00
Blue Cross,EPO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,Grouper Rate,5029.00
Blue Cross,EPO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,Grouper Rate,8841.00
Blue Cross,EPO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,Grouper Rate,5029.00
Blue Cross,EPO,618,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w/o CC/MCC,,Case Rate,21551.62
Blue Cross,EPO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,5783.00
Blue Cross,EPO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,5783.00
Blue Cross,EPO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Grouper Rate,6588.00
Blue Cross,EPO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Grouper Rate,6588.00
Blue Cross,EPO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,6588.00
Blue Cross,EPO,61875,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,6588.00
Blue Cross,EPO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,5281.00
Blue Cross,EPO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Grouper Rate,1678.88
Blue Cross,EPO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Grouper Rate,5029.00
Blue Cross,EPO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,1678.00
Blue Cross,EPO,619,DRG,O.R. procedures for obesity w MCC,,Case Rate,50630.59
Blue Cross,EPO,62,DRG,Acute ischemic stroke w use of thrombolytic agent w CC,,Case Rate,32868.28
Blue Cross,EPO,620,DRG,O.R. procedures for obesity w CC,,Case Rate,29128.59
Blue Cross,EPO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,Grouper Rate,5783.00
Blue Cross,EPO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,Grouper Rate,5783.00
Blue Cross,EPO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,Grouper Rate,5783.00
Blue Cross,EPO,621,DRG,O.R. procedures for obesity w/o CC/MCC,,Case Rate,26404.45
Blue Cross,EPO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,Grouper Rate,5783.00
Blue Cross,EPO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,EPO,62116,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,EPO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,6588.00
Blue Cross,EPO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,Grouper Rate,6588.00
Blue Cross,EPO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,Grouper Rate,8012.00
Blue Cross,EPO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,EPO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,EPO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,Grouper Rate,5783.00
Blue Cross,EPO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,Grouper Rate,6588.00
Blue Cross,EPO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,Grouper Rate,6588.00
Blue Cross,EPO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Grouper Rate,6588.00
Blue Cross,EPO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Grouper Rate,6588.00
Blue Cross,EPO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,Grouper Rate,1678.00
Blue Cross,EPO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,Grouper Rate,3544.00
Blue Cross,EPO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,Grouper Rate,5029.00
Blue Cross,EPO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,Grouper Rate,5029.00
Blue Cross,EPO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,Grouper Rate,6588.00
Blue Cross,EPO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,Grouper Rate,6588.00
Blue Cross,EPO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,5281.00
Blue Cross,EPO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,5281.00
Blue Cross,EPO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,1678.00
Blue Cross,EPO,622,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC,,Case Rate,59755.71
Blue Cross,EPO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,5783.00
Blue Cross,EPO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,Grouper Rate,5783.00
Blue Cross,EPO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,6588.00
Blue Cross,EPO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,6588.00
Blue Cross,EPO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,1678.00
Blue Cross,EPO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Grouper Rate,1678.88
Blue Cross,EPO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,Grouper Rate,1678.00
Blue Cross,EPO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Grouper Rate,1678.88
Blue Cross,EPO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,Grouper Rate,5783.00
Blue Cross,EPO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Grouper Rate,1678.88
Blue Cross,EPO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Grouper Rate,1678.88
Blue Cross,EPO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Grouper Rate,1678.00
Blue Cross,EPO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Grouper Rate,1678.00
Blue Cross,EPO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Grouper Rate,1678.00
Blue Cross,EPO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Grouper Rate,1678.00
Blue Cross,EPO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Grouper Rate,1678.00
Blue Cross,EPO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Grouper Rate,1678.00
Blue Cross,EPO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,1678.00
Blue Cross,EPO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,1678.00
Blue Cross,EPO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Grouper Rate,1678.00
Blue Cross,EPO,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,Grouper Rate,1678.88
Blue Cross,EPO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Grouper Rate,3544.00
Blue Cross,EPO,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,Grouper Rate,1678.88
Blue Cross,EPO,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,Grouper Rate,1678.88
Blue Cross,EPO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Grouper Rate,3544.00
Blue Cross,EPO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Grouper Rate,3544.00
Blue Cross,EPO,623,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w CC,,Case Rate,30977.76
Blue Cross,EPO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,EPO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,EPO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,EPO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,EPO,62310,CPT4/HCPCS,INJECT SPINE CERV/THORACIC,,Grouper Rate,1678.00
Blue Cross,EPO,62311,CPT4/HCPCS,INJECT SPINE LUMBAR/SACRAL,,Grouper Rate,1678.00
Blue Cross,EPO,62318,CPT4/HCPCS,INJECT SPINE W/CATH CRV/THRC,,Grouper Rate,1678.00
Blue Cross,EPO,62319,CPT4/HCPCS,INJECT SPINE W/CATH LMB/SCRL,,Grouper Rate,1678.00
Blue Cross,EPO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,EPO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,EPO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,EPO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,EPO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,EPO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,EPO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,EPO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,EPO,62328,CPT4/HCPCS,DX LMBR SPI PNXR W/FLUOR/CT,,Grouper Rate,1678.00
Blue Cross,EPO,62329,CPT4/HCPCS,THER SPI PNXR CSF FLUOR/CT,,Grouper Rate,1678.00
Blue Cross,EPO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,1678.88
Blue Cross,EPO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,1678.88
Blue Cross,EPO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Grouper Rate,1678.88
Blue Cross,EPO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Grouper Rate,1678.88
Blue Cross,EPO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,1678.88
Blue Cross,EPO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,1678.88
Blue Cross,EPO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Grouper Rate,1678.88
Blue Cross,EPO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Grouper Rate,1678.88
Blue Cross,EPO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Grouper Rate,1678.88
Blue Cross,EPO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,Grouper Rate,1678.88
Blue Cross,EPO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Grouper Rate,1678.88
Blue Cross,EPO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Grouper Rate,1678.88
Blue Cross,EPO,624,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC,,Case Rate,18099.72
Blue Cross,EPO,625,DRG,Thyroid, parathyroid & thyroglossal procedures w MCC,,Case Rate,46993.44
Blue Cross,EPO,626,DRG,Thyroid, parathyroid & thyroglossal procedures w CC,,Case Rate,27329.04
Blue Cross,EPO,627,DRG,Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC,,Case Rate,19546.97
Blue Cross,EPO,628,DRG,Other endocrine, nutrit & metab O.R. proc w MCC,,Case Rate,61166.57
Blue Cross,EPO,629,DRG,Other endocrine, nutrit & metab O.R. proc w CC,,Case Rate,38816.07
Blue Cross,EPO,63,DRG,Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC,,Case Rate,28281.74
Blue Cross,EPO,630,DRG,Other endocrine, nutrit & metab O.R. proc w/o CC/MCC,,Case Rate,23270.12
Blue Cross,EPO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Grouper Rate,5783.00
Blue Cross,EPO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Grouper Rate,5783.00
Blue Cross,EPO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Grouper Rate,3544.00
Blue Cross,EPO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Grouper Rate,5783.00
Blue Cross,EPO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Grouper Rate,6588.00
Blue Cross,EPO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Grouper Rate,6588.00
Blue Cross,EPO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Grouper Rate,6588.00
Blue Cross,EPO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Grouper Rate,6588.00
Blue Cross,EPO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Grouper Rate,5029.00
Blue Cross,EPO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Grouper Rate,5281.00
Blue Cross,EPO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Grouper Rate,6588.00
Blue Cross,EPO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Grouper Rate,1678.88
Blue Cross,EPO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Grouper Rate,5029.00
Blue Cross,EPO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Grouper Rate,5029.00
Blue Cross,EPO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Grouper Rate,5281.00
Blue Cross,EPO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,Grouper Rate,5281.00
Blue Cross,EPO,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,Grouper Rate,6588.00
Blue Cross,EPO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,5029.00
Blue Cross,EPO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Grouper Rate,5029.00
Blue Cross,EPO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,5029.00
Blue Cross,EPO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,6588.00
Blue Cross,EPO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,6588.00
Blue Cross,EPO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,5281.00
Blue Cross,EPO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,1678.88
Blue Cross,EPO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Grouper Rate,5281.00
Blue Cross,EPO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,Grouper Rate,5783.00
Blue Cross,EPO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,EPO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Grouper Rate,5783.00
Blue Cross,EPO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,EPO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,5783.00
Blue Cross,EPO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Grouper Rate,5783.00
Blue Cross,EPO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,EPO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Grouper Rate,6588.00
Blue Cross,EPO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Grouper Rate,5783.00
Blue Cross,EPO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,Grouper Rate,5281.00
Blue Cross,EPO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Grouper Rate,5783.00
Blue Cross,EPO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Grouper Rate,5783.00
Blue Cross,EPO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Grouper Rate,5783.00
Blue Cross,EPO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Grouper Rate,6588.00
Blue Cross,EPO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,Grouper Rate,5783.00
Blue Cross,EPO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,Grouper Rate,5783.00
Blue Cross,EPO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,Grouper Rate,5783.00
Blue Cross,EPO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,Grouper Rate,5783.00
Blue Cross,EPO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,Grouper Rate,5783.00
Blue Cross,EPO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,Grouper Rate,5783.00
Blue Cross,EPO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,Grouper Rate,5783.00
Blue Cross,EPO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,Grouper Rate,5783.00
Blue Cross,EPO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,Grouper Rate,5783.00
Blue Cross,EPO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,Grouper Rate,5783.00
Blue Cross,EPO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,Grouper Rate,5783.00
Blue Cross,EPO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,Grouper Rate,5783.00
Blue Cross,EPO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,Grouper Rate,5783.00
Blue Cross,EPO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Grouper Rate,5281.00
Blue Cross,EPO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Grouper Rate,5281.00
Blue Cross,EPO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Grouper Rate,5281.00
Blue Cross,EPO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Grouper Rate,5281.00
Blue Cross,EPO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,Grouper Rate,5783.00
Blue Cross,EPO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Grouper Rate,5783.00
Blue Cross,EPO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Grouper Rate,5281.00
Blue Cross,EPO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Grouper Rate,5281.00
Blue Cross,EPO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,Grouper Rate,5281.00
Blue Cross,EPO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,Grouper Rate,5281.00
Blue Cross,EPO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,Grouper Rate,5281.00
Blue Cross,EPO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,Grouper Rate,5281.00
Blue Cross,EPO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,Grouper Rate,5281.00
Blue Cross,EPO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,Grouper Rate,5281.00
Blue Cross,EPO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,Grouper Rate,5281.00
Blue Cross,EPO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,Grouper Rate,5281.00
Blue Cross,EPO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,Grouper Rate,5281.00
Blue Cross,EPO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,Grouper Rate,5281.00
Blue Cross,EPO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,Grouper Rate,5281.00
Blue Cross,EPO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,Grouper Rate,5783.00
Blue Cross,EPO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,Grouper Rate,5281.00
Blue Cross,EPO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,Grouper Rate,5783.00
Blue Cross,EPO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,Grouper Rate,5783.00
Blue Cross,EPO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,Grouper Rate,5783.00
Blue Cross,EPO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,Grouper Rate,5783.00
Blue Cross,EPO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,Grouper Rate,5783.00
Blue Cross,EPO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,Grouper Rate,5783.00
Blue Cross,EPO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,Grouper Rate,5783.00
Blue Cross,EPO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,EPO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Grouper Rate,1678.88
Blue Cross,EPO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Grouper Rate,1678.00
Blue Cross,EPO,63615,CPT4/HCPCS,REMOVE LESION OF SPINAL CORD,,Grouper Rate,5281.00
Blue Cross,EPO,63620,CPT4/HCPCS,SRS SPINAL LESION,,Grouper Rate,8841.00
Blue Cross,EPO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,Grouper Rate,5029.00
Blue Cross,EPO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,EPO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,EPO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Grouper Rate,1678.00
Blue Cross,EPO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Grouper Rate,1678.88
Blue Cross,EPO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Grouper Rate,1678.88
Blue Cross,EPO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Grouper Rate,5281.00
Blue Cross,EPO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Grouper Rate,1678.88
Blue Cross,EPO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,1678.00
Blue Cross,EPO,637,DRG,Diabetes w MCC,,Case Rate,22737.53
Blue Cross,EPO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,EPO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,EPO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,EPO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,EPO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Grouper Rate,5281.00
Blue Cross,EPO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Grouper Rate,5281.00
Blue Cross,EPO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,Grouper Rate,5281.00
Blue Cross,EPO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,5783.00
Blue Cross,EPO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,5281.00
Blue Cross,EPO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Grouper Rate,3544.00
Blue Cross,EPO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Grouper Rate,1678.88
Blue Cross,EPO,638,DRG,Diabetes w CC,,Case Rate,14545.27
Blue Cross,EPO,639,DRG,Diabetes w/o CC/MCC,,Case Rate,10077.82
Blue Cross,EPO,64,DRG,Intracranial hemorrhage or cerebral infarction w MCC,,Case Rate,31641.02
Blue Cross,EPO,640,DRG,Nutritional & misc metabolic disorders w MCC,,Case Rate,20307.81
Blue Cross,EPO,641,DRG,Nutritional & misc metabolic disorders w/o MCC,,Case Rate,12454.62
Blue Cross,EPO,642,DRG,Inborn errors of metabolism,,Case Rate,21295.25
Blue Cross,EPO,643,DRG,Endocrine disorders w MCC,,Case Rate,27510.98
Blue Cross,EPO,644,DRG,Endocrine disorders w CC,,Case Rate,16842.68
Blue Cross,EPO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Grouper Rate,1678.00
Blue Cross,EPO,64402,CPT4/HCPCS,N BLOCK INJ FACIAL,,Grouper Rate,1678.00
Blue Cross,EPO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Grouper Rate,1678.00
Blue Cross,EPO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Grouper Rate,1678.00
Blue Cross,EPO,64410,CPT4/HCPCS,N BLOCK INJ PHRENIC,,Grouper Rate,1678.00
Blue Cross,EPO,64412,CPT4/HCPCS,N BLOCK INJ SPINAL ACCESSOR,,Grouper Rate,1678.00
Blue Cross,EPO,64413,CPT4/HCPCS,N BLOCK INJ CERVICAL PLEXUS,,Grouper Rate,1678.00
Blue Cross,EPO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Grouper Rate,1678.00
Blue Cross,EPO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Grouper Rate,1678.00
Blue Cross,EPO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Grouper Rate,1678.00
Blue Cross,EPO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Grouper Rate,1678.00
Blue Cross,EPO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Grouper Rate,1678.00
Blue Cross,EPO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Grouper Rate,1678.00
Blue Cross,EPO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Grouper Rate,1678.00
Blue Cross,EPO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Grouper Rate,1678.00
Blue Cross,EPO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,Grouper Rate,1678.00
Blue Cross,EPO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,Grouper Rate,1678.00
Blue Cross,EPO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Grouper Rate,1678.00
Blue Cross,EPO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Grouper Rate,1678.00
Blue Cross,EPO,64451,CPT4/HCPCS,NJX AA&/STRD NRV NRVTG SI JT,,Grouper Rate,1678.00
Blue Cross,EPO,64454,CPT4/HCPCS,NJX AA&/STRD GNCLR NRV BRNCH,,Grouper Rate,1678.00
Blue Cross,EPO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Grouper Rate,1678.00
Blue Cross,EPO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Grouper Rate,1678.00
Blue Cross,EPO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Grouper Rate,1678.00
Blue Cross,EPO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Grouper Rate,1678.00
Blue Cross,EPO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Grouper Rate,1678.00
Blue Cross,EPO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Grouper Rate,1678.00
Blue Cross,EPO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Grouper Rate,1678.00
Blue Cross,EPO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Grouper Rate,1678.00
Blue Cross,EPO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Grouper Rate,1678.00
Blue Cross,EPO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Grouper Rate,1678.00
Blue Cross,EPO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Grouper Rate,1678.00
Blue Cross,EPO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Grouper Rate,1678.00
Blue Cross,EPO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Grouper Rate,1678.00
Blue Cross,EPO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Grouper Rate,1678.00
Blue Cross,EPO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Grouper Rate,1678.00
Blue Cross,EPO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Grouper Rate,1678.00
Blue Cross,EPO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Grouper Rate,1678.00
Blue Cross,EPO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Grouper Rate,1678.00
Blue Cross,EPO,645,DRG,Endocrine disorders w/o CC/MCC,,Case Rate,12699.41
Blue Cross,EPO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Grouper Rate,1678.00
Blue Cross,EPO,64508,CPT4/HCPCS,N BLOCK CAROTID SINUS S/P,,Grouper Rate,1678.00
Blue Cross,EPO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Grouper Rate,1678.00
Blue Cross,EPO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Grouper Rate,1678.00
Blue Cross,EPO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Grouper Rate,1678.00
Blue Cross,EPO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Grouper Rate,1678.00
Blue Cross,EPO,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,Grouper Rate,1678.00
Blue Cross,EPO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,EPO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,EPO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,EPO,64565,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,EPO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Grouper Rate,1678.88
Blue Cross,EPO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Grouper Rate,3544.00
Blue Cross,EPO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Grouper Rate,3544.00
Blue Cross,EPO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Grouper Rate,3544.00
Blue Cross,EPO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,EPO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,EPO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,EPO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,1678.00
Blue Cross,EPO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Grouper Rate,1678.88
Blue Cross,EPO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Grouper Rate,1678.00
Blue Cross,EPO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Grouper Rate,1678.88
Blue Cross,EPO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Grouper Rate,1678.00
Blue Cross,EPO,64613,CPT4/HCPCS,DESTROY NERVE NECK MUSCLE,,Grouper Rate,1678.00
Blue Cross,EPO,64614,CPT4/HCPCS,DESTROY NERVE EXTREM MUSC,,Grouper Rate,1678.00
Blue Cross,EPO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Grouper Rate,1678.00
Blue Cross,EPO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Grouper Rate,1678.00
Blue Cross,EPO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Grouper Rate,1678.00
Blue Cross,EPO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64624,CPT4/HCPCS,DSTRJ NULYT AGT GNCLR NRV,,Grouper Rate,1678.00
Blue Cross,EPO,64625,CPT4/HCPCS,RF ABLTJ NRV NRVTG SI JT,,Grouper Rate,1678.88
Blue Cross,EPO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Grouper Rate,1678.00
Blue Cross,EPO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Grouper Rate,1678.00
Blue Cross,EPO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Grouper Rate,1678.00
Blue Cross,EPO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,Grouper Rate,1678.00
Blue Cross,EPO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Grouper Rate,1678.00
Blue Cross,EPO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,Grouper Rate,1678.00
Blue Cross,EPO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Grouper Rate,1678.00
Blue Cross,EPO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,Grouper Rate,1678.00
Blue Cross,EPO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Grouper Rate,1678.00
Blue Cross,EPO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Grouper Rate,1678.00
Blue Cross,EPO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,1678.00
Blue Cross,EPO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,1678.00
Blue Cross,EPO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Grouper Rate,1678.88
Blue Cross,EPO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Grouper Rate,1678.88
Blue Cross,EPO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Grouper Rate,3544.00
Blue Cross,EPO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Grouper Rate,1678.88
Blue Cross,EPO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Grouper Rate,1678.88
Blue Cross,EPO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Grouper Rate,1678.88
Blue Cross,EPO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Grouper Rate,1678.00
Blue Cross,EPO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Grouper Rate,1678.00
Blue Cross,EPO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Grouper Rate,1678.88
Blue Cross,EPO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64752,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Grouper Rate,5783.00
Blue Cross,EPO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,Grouper Rate,5281.00
Blue Cross,EPO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Grouper Rate,5783.00
Blue Cross,EPO,64761,CPT4/HCPCS,INCISION OF PELVIS NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Grouper Rate,3544.00
Blue Cross,EPO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Grouper Rate,5281.00
Blue Cross,EPO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,64787,CPT4/HCPCS,IMPLANT NERVE END,,Grouper Rate,1678.00
Blue Cross,EPO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Grouper Rate,1678.88
Blue Cross,EPO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,1678.88
Blue Cross,EPO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,5281.00
Blue Cross,EPO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,Grouper Rate,1678.88
Blue Cross,EPO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Grouper Rate,3544.00
Blue Cross,EPO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,3544.00
Blue Cross,EPO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,3544.00
Blue Cross,EPO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Grouper Rate,1678.88
Blue Cross,EPO,64859,CPT4/HCPCS,NERVE SURGERY,,Grouper Rate,1678.00
Blue Cross,EPO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Grouper Rate,3544.00
Blue Cross,EPO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Grouper Rate,3544.00
Blue Cross,EPO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,3544.00
Blue Cross,EPO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,5029.00
Blue Cross,EPO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,5029.00
Blue Cross,EPO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,5029.00
Blue Cross,EPO,64870,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,5029.00
Blue Cross,EPO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Grouper Rate,1678.00
Blue Cross,EPO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Grouper Rate,3544.00
Blue Cross,EPO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Grouper Rate,3544.00
Blue Cross,EPO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Grouper Rate,5783.00
Blue Cross,EPO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Grouper Rate,5783.00
Blue Cross,EPO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,1678.88
Blue Cross,EPO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,3544.00
Blue Cross,EPO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,3544.00
Blue Cross,EPO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Grouper Rate,3544.00
Blue Cross,EPO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,3544.00
Blue Cross,EPO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,1678.88
Blue Cross,EPO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,1678.00
Blue Cross,EPO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Grouper Rate,1678.00
Blue Cross,EPO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Grouper Rate,3544.00
Blue Cross,EPO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Grouper Rate,1678.88
Blue Cross,EPO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Grouper Rate,1678.88
Blue Cross,EPO,65,DRG,Intracranial hemorrhage or cerebral infarction w CC,,Case Rate,16841.02
Blue Cross,EPO,650,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,,Case Rate,74646.67
Blue Cross,EPO,65091,CPT4/HCPCS,REVISE EYE,,Grouper Rate,3544.00
Blue Cross,EPO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Grouper Rate,3544.00
Blue Cross,EPO,651,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,,Case Rate,61092.14
Blue Cross,EPO,65101,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,3544.00
Blue Cross,EPO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Grouper Rate,3544.00
Blue Cross,EPO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Grouper Rate,5029.00
Blue Cross,EPO,65110,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,5281.00
Blue Cross,EPO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,6588.00
Blue Cross,EPO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,6588.00
Blue Cross,EPO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,1678.00
Blue Cross,EPO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,3544.00
Blue Cross,EPO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,1678.88
Blue Cross,EPO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Grouper Rate,3544.00
Blue Cross,EPO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,1678.88
Blue Cross,EPO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Grouper Rate,3544.00
Blue Cross,EPO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Grouper Rate,1678.00
Blue Cross,EPO,652,DRG,Kidney transplant,,Case Rate,52628.62
Blue Cross,EPO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,EPO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,EPO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,EPO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,EPO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.88
Blue Cross,EPO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,3544.00
Blue Cross,EPO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,5029.00
Blue Cross,EPO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1678.88
Blue Cross,EPO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1678.88
Blue Cross,EPO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,5029.00
Blue Cross,EPO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,5029.00
Blue Cross,EPO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,5029.00
Blue Cross,EPO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1678.00
Blue Cross,EPO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Grouper Rate,3544.00
Blue Cross,EPO,653,DRG,Major bladder procedures w MCC,,Case Rate,90129.76
Blue Cross,EPO,654,DRG,Major bladder procedures w CC,,Case Rate,47969.30
Blue Cross,EPO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,1678.00
Blue Cross,EPO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Grouper Rate,1678.88
Blue Cross,EPO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,5281.00
Blue Cross,EPO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,1678.00
Blue Cross,EPO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,1678.00
Blue Cross,EPO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Grouper Rate,1678.00
Blue Cross,EPO,655,DRG,Major bladder procedures w/o CC/MCC,,Case Rate,34404.85
Blue Cross,EPO,656,DRG,Kidney & ureter procedures for neoplasm w MCC,,Case Rate,54279.31
Blue Cross,EPO,65600,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,1678.00
Blue Cross,EPO,657,DRG,Kidney & ureter procedures for neoplasm w CC,,Case Rate,31990.01
Blue Cross,EPO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,EPO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,EPO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,EPO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,EPO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Grouper Rate,6588.00
Blue Cross,EPO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,Grouper Rate,1678.00
Blue Cross,EPO,65760,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,1678.88
Blue Cross,EPO,65765,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,5029.00
Blue Cross,EPO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,EPO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Grouper Rate,6588.00
Blue Cross,EPO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Grouper Rate,1678.00
Blue Cross,EPO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,1678.00
Blue Cross,EPO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,1678.00
Blue Cross,EPO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Grouper Rate,1678.00
Blue Cross,EPO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Grouper Rate,1678.00
Blue Cross,EPO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,EPO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,EPO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,EPO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Grouper Rate,1678.88
Blue Cross,EPO,658,DRG,Kidney & ureter procedures for neoplasm w/o CC/MCC,,Case Rate,26118.31
Blue Cross,EPO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1678.00
Blue Cross,EPO,65805,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1678.00
Blue Cross,EPO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,3544.00
Blue Cross,EPO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1678.88
Blue Cross,EPO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Grouper Rate,1678.88
Blue Cross,EPO,65850,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,5029.00
Blue Cross,EPO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Grouper Rate,1678.00
Blue Cross,EPO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,1678.88
Blue Cross,EPO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,1678.00
Blue Cross,EPO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,3544.00
Blue Cross,EPO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,5029.00
Blue Cross,EPO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,5029.00
Blue Cross,EPO,659,DRG,Kidney & ureter procedures for non-neoplasm w MCC,,Case Rate,44075.79
Blue Cross,EPO,65900,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,5281.00
Blue Cross,EPO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Grouper Rate,6588.00
Blue Cross,EPO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Grouper Rate,1678.88
Blue Cross,EPO,66,DRG,Intracranial hemorrhage or cerebral infarction w/o CC/MCC,,Case Rate,11758.28
Blue Cross,EPO,660,DRG,Kidney & ureter procedures for non-neoplasm w CC,,Case Rate,23873.83
Blue Cross,EPO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,1678.00
Blue Cross,EPO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,1678.00
Blue Cross,EPO,661,DRG,Kidney & ureter procedures for non-neoplasm w/o CC/MCC,,Case Rate,17605.17
Blue Cross,EPO,66130,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,6588.00
Blue Cross,EPO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,66165,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,66172,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,5029.00
Blue Cross,EPO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Grouper Rate,1678.00
Blue Cross,EPO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Grouper Rate,1678.00
Blue Cross,EPO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Grouper Rate,5029.00
Blue Cross,EPO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Grouper Rate,5029.00
Blue Cross,EPO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Grouper Rate,5029.00
Blue Cross,EPO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Grouper Rate,5029.00
Blue Cross,EPO,662,DRG,Minor bladder procedures w MCC,,Case Rate,48458.89
Blue Cross,EPO,66220,CPT4/HCPCS,REPAIR EYE LESION,,Grouper Rate,3544.00
Blue Cross,EPO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Grouper Rate,5029.00
Blue Cross,EPO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Grouper Rate,1678.88
Blue Cross,EPO,663,DRG,Minor bladder procedures w CC,,Case Rate,26379.64
Blue Cross,EPO,664,DRG,Minor bladder procedures w/o CC/MCC,,Case Rate,19586.66
Blue Cross,EPO,665,DRG,Prostatectomy w MCC,,Case Rate,50227.01
Blue Cross,EPO,66500,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,EPO,66505,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,EPO,666,DRG,Prostatectomy w CC,,Case Rate,28685.32
Blue Cross,EPO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Grouper Rate,3544.00
Blue Cross,EPO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,EPO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,EPO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,EPO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,EPO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,3544.00
Blue Cross,EPO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,EPO,667,DRG,Prostatectomy w/o CC/MCC,,Case Rate,16455.64
Blue Cross,EPO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,EPO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Grouper Rate,1678.88
Blue Cross,EPO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Grouper Rate,1678.00
Blue Cross,EPO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,EPO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,EPO,66761,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,EPO,66762,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,EPO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Grouper Rate,1678.88
Blue Cross,EPO,668,DRG,Transurethral procedures w MCC,,Case Rate,45569.35
Blue Cross,EPO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Grouper Rate,3544.00
Blue Cross,EPO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Grouper Rate,1678.88
Blue Cross,EPO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Grouper Rate,5029.00
Blue Cross,EPO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Grouper Rate,5029.00
Blue Cross,EPO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,5029.00
Blue Cross,EPO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,5783.00
Blue Cross,EPO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,5029.00
Blue Cross,EPO,669,DRG,Transurethral procedures w CC,,Case Rate,25337.62
Blue Cross,EPO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,5029.00
Blue Cross,EPO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,5281.00
Blue Cross,EPO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,5281.00
Blue Cross,EPO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Grouper Rate,6588.00
Blue Cross,EPO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Grouper Rate,8012.00
Blue Cross,EPO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Grouper Rate,6588.00
Blue Cross,EPO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Grouper Rate,5783.00
Blue Cross,EPO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Grouper Rate,5783.00
Blue Cross,EPO,66987,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX W/ECP,,Grouper Rate,8012.00
Blue Cross,EPO,66988,CPT4/HCPCS,XCAPSL CTRC RMVL W/ECP,,Grouper Rate,8012.00
Blue Cross,EPO,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,67,DRG,Nonspecific cva & precerebral occlusion w/o infarct w MCC,,Case Rate,23562.88
Blue Cross,EPO,670,DRG,Transurethral procedures w/o CC/MCC,,Case Rate,16151.31
Blue Cross,EPO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,5029.00
Blue Cross,EPO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,5029.00
Blue Cross,EPO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Grouper Rate,1678.00
Blue Cross,EPO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Grouper Rate,1678.00
Blue Cross,EPO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Grouper Rate,5029.00
Blue Cross,EPO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Grouper Rate,1678.00
Blue Cross,EPO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Grouper Rate,1678.00
Blue Cross,EPO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Grouper Rate,1678.88
Blue Cross,EPO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Grouper Rate,3544.00
Blue Cross,EPO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,5029.00
Blue Cross,EPO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,5029.00
Blue Cross,EPO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Grouper Rate,3544.00
Blue Cross,EPO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Grouper Rate,5029.00
Blue Cross,EPO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Grouper Rate,5281.00
Blue Cross,EPO,671,DRG,Urethral procedures w CC/MCC,,Case Rate,29386.61
Blue Cross,EPO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Grouper Rate,5029.00
Blue Cross,EPO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Grouper Rate,5029.00
Blue Cross,EPO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,5281.00
Blue Cross,EPO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,5783.00
Blue Cross,EPO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,1678.88
Blue Cross,EPO,67112,CPT4/HCPCS,REREPAIR DETACHED RETINA,,Grouper Rate,6588.00
Blue Cross,EPO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Grouper Rate,6588.00
Blue Cross,EPO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Grouper Rate,1678.88
Blue Cross,EPO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,1678.88
Blue Cross,EPO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,1678.88
Blue Cross,EPO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,1678.88
Blue Cross,EPO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,1678.00
Blue Cross,EPO,672,DRG,Urethral procedures w/o CC/MCC,,Case Rate,19035.88
Blue Cross,EPO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,1678.00
Blue Cross,EPO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,1678.00
Blue Cross,EPO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,5281.00
Blue Cross,EPO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Grouper Rate,1678.00
Blue Cross,EPO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Grouper Rate,1678.88
Blue Cross,EPO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Grouper Rate,1678.00
Blue Cross,EPO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Grouper Rate,1678.00
Blue Cross,EPO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Grouper Rate,3544.00
Blue Cross,EPO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Grouper Rate,3544.00
Blue Cross,EPO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Grouper Rate,3544.00
Blue Cross,EPO,673,DRG,Other kidney & urinary tract procedures w MCC,,Case Rate,57279.67
Blue Cross,EPO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,3544.00
Blue Cross,EPO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,5029.00
Blue Cross,EPO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,5029.00
Blue Cross,EPO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,5029.00
Blue Cross,EPO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Grouper Rate,5029.00
Blue Cross,EPO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Grouper Rate,5029.00
Blue Cross,EPO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Grouper Rate,5029.00
Blue Cross,EPO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Grouper Rate,5029.00
Blue Cross,EPO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Grouper Rate,5029.00
Blue Cross,EPO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Grouper Rate,1678.00
Blue Cross,EPO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Grouper Rate,5029.00
Blue Cross,EPO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Grouper Rate,3544.00
Blue Cross,EPO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Grouper Rate,1678.00
Blue Cross,EPO,674,DRG,Other kidney & urinary tract procedures w CC,,Case Rate,39371.81
Blue Cross,EPO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,3544.00
Blue Cross,EPO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,5029.00
Blue Cross,EPO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,EPO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,EPO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,5029.00
Blue Cross,EPO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Grouper Rate,1678.00
Blue Cross,EPO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,EPO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,EPO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,EPO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,5783.00
Blue Cross,EPO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,EPO,675,DRG,Other kidney & urinary tract procedures w/o CC/MCC,,Case Rate,28978.08
Blue Cross,EPO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,1678.00
Blue Cross,EPO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Grouper Rate,5029.00
Blue Cross,EPO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Grouper Rate,1678.88
Blue Cross,EPO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Grouper Rate,5281.00
Blue Cross,EPO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Grouper Rate,1678.00
Blue Cross,EPO,67710,CPT4/HCPCS,INCISION OF EYELID,,Grouper Rate,1678.00
Blue Cross,EPO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Grouper Rate,1678.00
Blue Cross,EPO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,1678.00
Blue Cross,EPO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,1678.00
Blue Cross,EPO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,1678.00
Blue Cross,EPO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Grouper Rate,1678.88
Blue Cross,EPO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Grouper Rate,1678.00
Blue Cross,EPO,67820,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.00
Blue Cross,EPO,67825,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.00
Blue Cross,EPO,67830,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.88
Blue Cross,EPO,67835,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.88
Blue Cross,EPO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,1678.00
Blue Cross,EPO,67850,CPT4/HCPCS,TREAT EYELID LESION,,Grouper Rate,1678.00
Blue Cross,EPO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Grouper Rate,1678.00
Blue Cross,EPO,67880,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,EPO,67882,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,EPO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Grouper Rate,1678.00
Blue Cross,EPO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5281.00
Blue Cross,EPO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5281.00
Blue Cross,EPO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,EPO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,EPO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5281.00
Blue Cross,EPO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,EPO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,EPO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,3544.00
Blue Cross,EPO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Grouper Rate,5029.00
Blue Cross,EPO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3544.00
Blue Cross,EPO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,1678.00
Blue Cross,EPO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,EPO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,EPO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3544.00
Blue Cross,EPO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,1678.00
Blue Cross,EPO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,EPO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,EPO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,1678.00
Blue Cross,EPO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,1678.88
Blue Cross,EPO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,EPO,67950,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,1678.88
Blue Cross,EPO,67961,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,EPO,67966,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,EPO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,EPO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,EPO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,EPO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,EPO,68,DRG,Nonspecific cva & precerebral occlusion w/o infarct w/o MCC,,Case Rate,14697.44
Blue Cross,EPO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Grouper Rate,1678.00
Blue Cross,EPO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,Grouper Rate,1678.00
Blue Cross,EPO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Grouper Rate,1678.00
Blue Cross,EPO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.00
Blue Cross,EPO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.00
Blue Cross,EPO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.88
Blue Cross,EPO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.00
Blue Cross,EPO,682,DRG,Renal failure w MCC,,Case Rate,24317.10
Blue Cross,EPO,683,DRG,Renal failure w CC,,Case Rate,14523.77
Blue Cross,EPO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,EPO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,EPO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,EPO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,EPO,68330,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,5029.00
Blue Cross,EPO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,EPO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Grouper Rate,5029.00
Blue Cross,EPO,68360,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,1678.88
Blue Cross,EPO,68362,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,1678.88
Blue Cross,EPO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Grouper Rate,1678.88
Blue Cross,EPO,684,DRG,Renal failure w/o CC/MCC,,Case Rate,10048.05
Blue Cross,EPO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Grouper Rate,1678.00
Blue Cross,EPO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Grouper Rate,1678.00
Blue Cross,EPO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,EPO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Grouper Rate,3544.00
Blue Cross,EPO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Grouper Rate,3544.00
Blue Cross,EPO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Grouper Rate,1678.00
Blue Cross,EPO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Grouper Rate,3544.00
Blue Cross,EPO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Grouper Rate,1678.00
Blue Cross,EPO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Grouper Rate,1678.00
Blue Cross,EPO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,3544.00
Blue Cross,EPO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,3544.00
Blue Cross,EPO,686,DRG,Kidney & urinary tract neoplasms w MCC,,Case Rate,30982.72
Blue Cross,EPO,687,DRG,Kidney & urinary tract neoplasms w CC,,Case Rate,17330.61
Blue Cross,EPO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Grouper Rate,1678.88
Blue Cross,EPO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,EPO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Grouper Rate,5029.00
Blue Cross,EPO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,3544.00
Blue Cross,EPO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,5029.00
Blue Cross,EPO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,EPO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,EPO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Grouper Rate,1678.00
Blue Cross,EPO,688,DRG,Kidney & urinary tract neoplasms w/o CC/MCC,,Case Rate,11334.86
Blue Cross,EPO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,EPO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1678.00
Blue Cross,EPO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1678.00
Blue Cross,EPO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1678.88
Blue Cross,EPO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Grouper Rate,1678.00
Blue Cross,EPO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Grouper Rate,1678.00
Blue Cross,EPO,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,Grouper Rate,1678.00
Blue Cross,EPO,689,DRG,Kidney & urinary tract infections w MCC,,Case Rate,18380.90
Blue Cross,EPO,69,DRG,Transient ischemia,,Case Rate,13002.09
Blue Cross,EPO,690,DRG,Kidney & urinary tract infections w/o MCC,,Case Rate,13102.98
Blue Cross,EPO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,1678.00
Blue Cross,EPO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,1678.00
Blue Cross,EPO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Grouper Rate,1678.00
Blue Cross,EPO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,Grouper Rate,1678.00
Blue Cross,EPO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,Grouper Rate,1678.00
Blue Cross,EPO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Grouper Rate,1678.00
Blue Cross,EPO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Grouper Rate,1678.88
Blue Cross,EPO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,1678.88
Blue Cross,EPO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,1678.88
Blue Cross,EPO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Grouper Rate,3544.00
Blue Cross,EPO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,Grouper Rate,5029.00
Blue Cross,EPO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Grouper Rate,1678.00
Blue Cross,EPO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,1678.88
Blue Cross,EPO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,3544.00
Blue Cross,EPO,693,DRG,Urinary stones w/o esw lithotripsy w MCC,,Case Rate,20985.95
Blue Cross,EPO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Grouper Rate,1678.88
Blue Cross,EPO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,3544.00
Blue Cross,EPO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,5029.00
Blue Cross,EPO,694,DRG,Urinary stones w/o esw lithotripsy w/o MCC,,Case Rate,12062.62
Blue Cross,EPO,69405,CPT4/HCPCS,CATHETERIZE MIDDLE EAR CANAL,,Grouper Rate,1678.00
Blue Cross,EPO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,1678.00
Blue Cross,EPO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,1678.00
Blue Cross,EPO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Grouper Rate,1678.00
Blue Cross,EPO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,1678.00
Blue Cross,EPO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,1678.88
Blue Cross,EPO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Grouper Rate,3544.00
Blue Cross,EPO,69450,CPT4/HCPCS,EARDRUM REVISION,,Grouper Rate,1678.00
Blue Cross,EPO,695,DRG,Kidney & urinary tract signs & symptoms w MCC,,Case Rate,18794.40
Blue Cross,EPO,69501,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,69502,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,6588.00
Blue Cross,EPO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Grouper Rate,6588.00
Blue Cross,EPO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,6588.00
Blue Cross,EPO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,Grouper Rate,5281.00
Blue Cross,EPO,69540,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,1678.00
Blue Cross,EPO,69550,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,5281.00
Blue Cross,EPO,69552,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,6588.00
Blue Cross,EPO,69554,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,1678.88
Blue Cross,EPO,696,DRG,Kidney & urinary tract signs & symptoms w/o MCC,,Case Rate,11407.63
Blue Cross,EPO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,EPO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,EPO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,EPO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,EPO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,EPO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,1678.88
Blue Cross,EPO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,1678.88
Blue Cross,EPO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,5281.00
Blue Cross,EPO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,5281.00
Blue Cross,EPO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,5281.00
Blue Cross,EPO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,6588.00
Blue Cross,EPO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6588.00
Blue Cross,EPO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6588.00
Blue Cross,EPO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,EPO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,EPO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,EPO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,EPO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,EPO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,EPO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Grouper Rate,5783.00
Blue Cross,EPO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5281.00
Blue Cross,EPO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5281.00
Blue Cross,EPO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5029.00
Blue Cross,EPO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,5029.00
Blue Cross,EPO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,5029.00
Blue Cross,EPO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Grouper Rate,3544.00
Blue Cross,EPO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Grouper Rate,3544.00
Blue Cross,EPO,697,DRG,Urethral stricture,,Case Rate,16490.38
Blue Cross,EPO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Grouper Rate,3544.00
Blue Cross,EPO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Grouper Rate,3544.00
Blue Cross,EPO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Grouper Rate,1678.00
Blue Cross,EPO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Grouper Rate,5783.00
Blue Cross,EPO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Grouper Rate,5783.00
Blue Cross,EPO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Grouper Rate,5281.00
Blue Cross,EPO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Grouper Rate,5281.00
Blue Cross,EPO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,EPO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,EPO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,EPO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,EPO,698,DRG,Other kidney & urinary tract diagnoses w MCC,,Case Rate,26574.81
Blue Cross,EPO,69801,CPT4/HCPCS,INCISE INNER EAR,,Grouper Rate,5281.00
Blue Cross,EPO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,6588.00
Blue Cross,EPO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,6588.00
Blue Cross,EPO,69820,CPT4/HCPCS,ESTABLISH INNER EAR WINDOW,,Grouper Rate,5281.00
Blue Cross,EPO,69840,CPT4/HCPCS,REVISE INNER EAR WINDOW,,Grouper Rate,5281.00
Blue Cross,EPO,699,DRG,Other kidney & urinary tract diagnoses w CC,,Case Rate,16956.80
Blue Cross,EPO,69905,CPT4/HCPCS,REMOVE INNER EAR,,Grouper Rate,6588.00
Blue Cross,EPO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,EPO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,6588.00
Blue Cross,EPO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Grouper Rate,6588.00
Blue Cross,EPO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,6588.00
Blue Cross,EPO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5783.00
Blue Cross,EPO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,Grouper Rate,6588.00
Blue Cross,EPO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Grouper Rate,6588.00
Blue Cross,EPO,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,7,DRG,Lung transplant,,Case Rate,191438.92
Blue Cross,EPO,70,DRG,Nonspecific cerebrovascular disorders w MCC,,Case Rate,27727.65
Blue Cross,EPO,700,DRG,Other kidney & urinary tract diagnoses w/o CC/MCC,,Case Rate,12318.99
Blue Cross,EPO,707,DRG,Major male pelvic procedures w CC/MCC,,Case Rate,31766.72
Blue Cross,EPO,708,DRG,Major male pelvic procedures w/o CC/MCC,,Case Rate,24667.75
Blue Cross,EPO,709,DRG,Penis procedures w CC/MCC,,Case Rate,38238.82
Blue Cross,EPO,71,DRG,Nonspecific cerebrovascular disorders w CC,,Case Rate,16718.63
Blue Cross,EPO,710,DRG,Penis procedures w/o CC/MCC,,Case Rate,26462.34
Blue Cross,EPO,711,DRG,Testes procedures w CC/MCC,,Case Rate,35235.16
Blue Cross,EPO,712,DRG,Testes procedures w/o CC/MCC,,Case Rate,17491.05
Blue Cross,EPO,713,DRG,Transurethral prostatectomy w CC/MCC,,Case Rate,24671.06
Blue Cross,EPO,714,DRG,Transurethral prostatectomy w/o CC/MCC,,Case Rate,15357.39
Blue Cross,EPO,715,DRG,Other male reproductive system O.R. proc for malignancy w CC/MCC,,Case Rate,33392.60
Blue Cross,EPO,716,DRG,Other male reproductive system O.R. proc for malignancy w/o CC/MCC,,Case Rate,21113.31
Blue Cross,EPO,717,DRG,Other male reproductive system O.R. proc exc malignancy w CC/MCC,,Case Rate,29747.19
Blue Cross,EPO,718,DRG,Other male reproductive system O.R. proc exc malignancy w/o CC/MCC,,Case Rate,20446.74
Blue Cross,EPO,72,DRG,Nonspecific cerebrovascular disorders w/o CC/MCC,,Case Rate,12755.64
Blue Cross,EPO,722,DRG,Malignancy, male reproductive system w MCC,,Case Rate,28266.86
Blue Cross,EPO,723,DRG,Malignancy, male reproductive system w CC,,Case Rate,18013.71
Blue Cross,EPO,724,DRG,Malignancy, male reproductive system w/o CC/MCC,,Case Rate,10741.07
Blue Cross,EPO,725,DRG,Benign prostatic hypertrophy w MCC,,Case Rate,21202.62
Blue Cross,EPO,726,DRG,Benign prostatic hypertrophy w/o MCC,,Case Rate,12294.18
Blue Cross,EPO,727,DRG,Inflammation of the male reproductive system w MCC,,Case Rate,23455.37
Blue Cross,EPO,728,DRG,Inflammation of the male reproductive system w/o MCC,,Case Rate,13289.89
Blue Cross,EPO,729,DRG,Other male reproductive system diagnoses w CC/MCC,,Case Rate,16619.39
Blue Cross,EPO,73,DRG,Cranial & peripheral nerve disorders w MCC,,Case Rate,23973.07
Blue Cross,EPO,730,DRG,Other male reproductive system diagnoses w/o CC/MCC,,Case Rate,9356.67
Blue Cross,EPO,734,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC,,Case Rate,36765.11
Blue Cross,EPO,735,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC,,Case Rate,23379.29
Blue Cross,EPO,736,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w MCC,,Case Rate,70430.62
Blue Cross,EPO,737,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w CC,,Case Rate,34042.62
Blue Cross,EPO,738,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC,,Case Rate,24422.96
Blue Cross,EPO,739,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w MCC,,Case Rate,63210.91
Blue Cross,EPO,74,DRG,Cranial & peripheral nerve disorders w/o MCC,,Case Rate,16844.33
Blue Cross,EPO,740,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w CC,,Case Rate,29772.00
Blue Cross,EPO,741,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC,,Case Rate,21162.93
Blue Cross,EPO,742,DRG,Uterine & adnexa proc for non-malignancy w CC/MCC,,Case Rate,28399.18
Blue Cross,EPO,743,DRG,Uterine & adnexa proc for non-malignancy w/o CC/MCC,,Case Rate,18728.24
Blue Cross,EPO,744,DRG,D&C, conization, laparascopy & tubal interruption w CC/MCC,,Case Rate,29672.76
Blue Cross,EPO,745,DRG,D&C, conization, laparascopy & tubal interruption w/o CC/MCC,,Case Rate,19360.07
Blue Cross,EPO,746,DRG,Vagina, cervix & vulva procedures w CC/MCC,,Case Rate,26619.47
Blue Cross,EPO,747,DRG,Vagina, cervix & vulva procedures w/o CC/MCC,,Case Rate,15514.52
Blue Cross,EPO,748,DRG,Female reproductive system reconstructive procedures,,Case Rate,22300.88
Blue Cross,EPO,749,DRG,Other female reproductive system O.R. procedures w CC/MCC,,Case Rate,44780.39
Blue Cross,EPO,75,DRG,Viral meningitis w CC/MCC,,Case Rate,26894.04
Blue Cross,EPO,750,DRG,Other female reproductive system O.R. procedures w/o CC/MCC,,Case Rate,24245.98
Blue Cross,EPO,754,DRG,Malignancy, female reproductive system w MCC,,Case Rate,30119.34
Blue Cross,EPO,755,DRG,Malignancy, female reproductive system w CC,,Case Rate,18650.50
Blue Cross,EPO,756,DRG,Malignancy, female reproductive system w/o CC/MCC,,Case Rate,15152.29
Blue Cross,EPO,757,DRG,Infections, female reproductive system w MCC,,Case Rate,25175.53
Blue Cross,EPO,758,DRG,Infections, female reproductive system w CC,,Case Rate,15994.18
Blue Cross,EPO,759,DRG,Infections, female reproductive system w/o CC/MCC,,Case Rate,11300.12
Blue Cross,EPO,76,DRG,Viral meningitis w/o CC/MCC,,Case Rate,16224.08
Blue Cross,EPO,760,DRG,Menstrual & other female reproductive system disorders w CC/MCC,,Case Rate,15259.80
Blue Cross,EPO,761,DRG,Menstrual & other female reproductive system disorders w/o CC/MCC,,Case Rate,9758.60
Blue Cross,EPO,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,Case Rate,19365.03
Blue Cross,EPO,769,DRG,Postpartum & post abortion diagnoses w O.R. procedure,,Case Rate,26801.41
Blue Cross,EPO,77,DRG,Hypertensive encephalopathy w MCC,,Case Rate,25337.62
Blue Cross,EPO,770,DRG,Abortion w D&C, aspiration curettage or hysterotomy,,Case Rate,14689.17
Blue Cross,EPO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Fee Schedule,566.75
Blue Cross,EPO,77261,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,417.19
Blue Cross,EPO,77262,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,634.12
Blue Cross,EPO,77263,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,942.23
Blue Cross,EPO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Fee Schedule,632.25
Blue Cross,EPO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Fee Schedule,1015.51
Blue Cross,EPO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Fee Schedule,1181.79
Blue Cross,EPO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,Fee Schedule,2069.34
Blue Cross,EPO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,Fee Schedule,5099.08
Blue Cross,EPO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,Fee Schedule,281.89
Blue Cross,EPO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,Fee Schedule,5564.17
Blue Cross,EPO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,Fee Schedule,546.43
Blue Cross,EPO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,Fee Schedule,1000.91
Blue Cross,EPO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,Fee Schedule,850.86
Blue Cross,EPO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,Fee Schedule,1109.35
Blue Cross,EPO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,Fee Schedule,1505.69
Blue Cross,EPO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,Fee Schedule,961.27
Blue Cross,EPO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,Fee Schedule,107.85
Blue Cross,EPO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Fee Schedule,280.71
Blue Cross,EPO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Fee Schedule,399.29
Blue Cross,EPO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Fee Schedule,549.48
Blue Cross,EPO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,Fee Schedule,1915.70
Blue Cross,EPO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Fee Schedule,661.52
Blue Cross,EPO,77371,CPT4/HCPCS,SRS MULTISOURCE,,Fee Schedule,6096.45
Blue Cross,EPO,77372,CPT4/HCPCS,SRS LINEAR BASED,,Fee Schedule,4626.31
Blue Cross,EPO,77373,CPT4/HCPCS,SBRT DELIVERY,,Fee Schedule,8630.99
Blue Cross,EPO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,Fee Schedule,2983.40
Blue Cross,EPO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,Fee Schedule,3580.79
Blue Cross,EPO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,Fee Schedule,358.27
Blue Cross,EPO,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,327.19
Blue Cross,EPO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,327.78
Blue Cross,EPO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,423.14
Blue Cross,EPO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,438.04
Blue Cross,EPO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,Fee Schedule,120.98
Blue Cross,EPO,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,Fee Schedule,477.14
Blue Cross,EPO,77425,CPT4/HCPCS,IO RAD TX DELIVER BY ELCTRNS,,Fee Schedule,737.20
Blue Cross,EPO,77427,CPT4/HCPCS,RADIATION TX MANAGEMENT X5,,Fee Schedule,986.55
Blue Cross,EPO,77431,CPT4/HCPCS,RADIATION THERAPY MANAGEMENT,,Fee Schedule,440.99
Blue Cross,EPO,77432,CPT4/HCPCS,STEREOTACTIC RADIATION TRMT,,Fee Schedule,2166.91
Blue Cross,EPO,77435,CPT4/HCPCS,SBRT MANAGEMENT,,Fee Schedule,3149.53
Blue Cross,EPO,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,Fee Schedule,1608.38
Blue Cross,EPO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,Fee Schedule,2028.72
Blue Cross,EPO,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,Fee Schedule,762.83
Blue Cross,EPO,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,Fee Schedule,703.66
Blue Cross,EPO,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,Fee Schedule,953.55
Blue Cross,EPO,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,Fee Schedule,990.87
Blue Cross,EPO,776,DRG,Postpartum & post abortion diagnoses w/o O.R. procedure,,Case Rate,12715.95
Blue Cross,EPO,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Fee Schedule,638.84
Blue Cross,EPO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Fee Schedule,1101.33
Blue Cross,EPO,77785,CPT4/HCPCS,HDR BRACHYTX 1 CHANNEL,,Grouper Rate,1678.88
Blue Cross,EPO,77786,CPT4/HCPCS,HDR BRACHYTX 2-12 CHANNEL,,Grouper Rate,1678.88
Blue Cross,EPO,77787,CPT4/HCPCS,HDR BRACHYTX OVER 12 CHAN,,Grouper Rate,3544.00
Blue Cross,EPO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Fee Schedule,81.09
Blue Cross,EPO,77790,CPT4/HCPCS,RADIATION HANDLING,,Fee Schedule,107.85
Blue Cross,EPO,779,DRG,Abortion w/o D&C,,Case Rate,17208.21
Blue Cross,EPO,78,DRG,Hypertensive encephalopathy w CC,,Case Rate,15696.46
Blue Cross,EPO,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Fee Schedule,1823.79
Blue Cross,EPO,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Fee Schedule,1823.79
Blue Cross,EPO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,30974.45
Blue Cross,EPO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,18109.64
Blue Cross,EPO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,15139.06
Blue Cross,EPO,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Fee Schedule,1008.82
Blue Cross,EPO,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Fee Schedule,1634.94
Blue Cross,EPO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,26316.79
Blue Cross,EPO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,17577.05
Blue Cross,EPO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,14672.63
Blue Cross,EPO,789,DRG,Neonates, died or transferred to another acute care facility,,Case Rate,28423.99
Blue Cross,EPO,79,DRG,Hypertensive encephalopathy w/o CC/MCC,,Case Rate,12021.27
Blue Cross,EPO,790,DRG,Extreme immaturity or respiratory distress syndrome, neonate,,Case Rate,93733.83
Blue Cross,EPO,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Fee Schedule,535.17
Blue Cross,EPO,791,DRG,Prematurity w major problems,,Case Rate,64016.41
Blue Cross,EPO,792,DRG,Prematurity w/o major problems,,Case Rate,38625.86
Blue Cross,EPO,793,DRG,Full term neonate w major problems,,Case Rate,65758.07
Blue Cross,EPO,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Fee Schedule,2085.87
Blue Cross,EPO,794,DRG,Neonate w other significant problems,,Case Rate,23275.08
Blue Cross,EPO,795,DRG,Normal newborn,,Case Rate,3150.87
Blue Cross,EPO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,17663.06
Blue Cross,EPO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,15215.14
Blue Cross,EPO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,13683.54
Blue Cross,EPO,799,DRG,Splenectomy w MCC,,Case Rate,85080.10
Blue Cross,EPO,8,DRG,Simultaneous pancreas/kidney transplant,,Case Rate,89759.27
Blue Cross,EPO,80,DRG,Nontraumatic stupor & coma w MCC,,Case Rate,34601.68
Blue Cross,EPO,800,DRG,Splenectomy w CC,,Case Rate,48816.15
Blue Cross,EPO,801,DRG,Splenectomy w/o CC/MCC,,Case Rate,27845.09
Blue Cross,EPO,802,DRG,Other O.R. proc of the blood & blood forming organs w MCC,,Case Rate,61341.89
Blue Cross,EPO,803,DRG,Other O.R. proc of the blood & blood forming organs w CC,,Case Rate,31174.59
Blue Cross,EPO,804,DRG,Other O.R. proc of the blood & blood forming organs w/o CC/MCC,,Case Rate,22563.86
Blue Cross,EPO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,16983.27
Blue Cross,EPO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,12138.70
Blue Cross,EPO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,10603.79
Blue Cross,EPO,808,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w MCC,,Case Rate,36022.46
Blue Cross,EPO,809,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w CC,,Case Rate,20206.91
Blue Cross,EPO,81,DRG,Nontraumatic stupor & coma w/o MCC,,Case Rate,12768.88
Blue Cross,EPO,810,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC,,Case Rate,15889.97
Blue Cross,EPO,811,DRG,Red blood cell disorders w MCC,,Case Rate,22785.50
Blue Cross,EPO,812,DRG,Red blood cell disorders w/o MCC,,Case Rate,14550.23
Blue Cross,EPO,813,DRG,Coagulation disorders,,Case Rate,25549.33
Blue Cross,EPO,814,DRG,Reticuloendothelial & immunity disorders w MCC,,Case Rate,31273.83
Blue Cross,EPO,815,DRG,Reticuloendothelial & immunity disorders w CC,,Case Rate,16415.95
Blue Cross,EPO,816,DRG,Reticuloendothelial & immunity disorders w/o CC/MCC,,Case Rate,10931.28
Blue Cross,EPO,817,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC,,Case Rate,38071.77
Blue Cross,EPO,818,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC,,Case Rate,21774.91
Blue Cross,EPO,819,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC,,Case Rate,16505.26
Blue Cross,EPO,82,DRG,Traumatic stupor & coma, coma >1 hr w MCC,,Case Rate,37348.97
Blue Cross,EPO,820,DRG,Lymphoma & leukemia w major O.R. procedure w MCC,,Case Rate,94067.94
Blue Cross,EPO,821,DRG,Lymphoma & leukemia w major O.R. procedure w CC,,Case Rate,35645.35
Blue Cross,EPO,822,DRG,Lymphoma & leukemia w major O.R. procedure w/o CC/MCC,,Case Rate,20701.46
Blue Cross,EPO,823,DRG,Lymphoma & non-acute leukemia w other O.R. proc w MCC,,Case Rate,74382.03
Blue Cross,EPO,824,DRG,Lymphoma & non-acute leukemia w other O.R. proc w CC,,Case Rate,39079.05
Blue Cross,EPO,825,DRG,Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC,,Case Rate,23167.57
Blue Cross,EPO,826,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC,,Case Rate,83308.67
Blue Cross,EPO,827,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC,,Case Rate,41310.30
Blue Cross,EPO,828,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o CC/MCC,,Case Rate,27749.15
Blue Cross,EPO,829,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC,,Case Rate,53022.27
Blue Cross,EPO,83,DRG,Traumatic stupor & coma, coma >1 hr w CC,,Case Rate,22191.71
Blue Cross,EPO,830,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w/o CC/MCC,,Case Rate,24421.31
Blue Cross,EPO,831,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC,,Case Rate,18542.99
Blue Cross,EPO,832,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC,,Case Rate,12897.89
Blue Cross,EPO,833,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC,,Case Rate,8865.44
Blue Cross,EPO,834,DRG,Acute leukemia w/o major O.R. procedure w MCC,,Case Rate,100068.65
Blue Cross,EPO,835,DRG,Acute leukemia w/o major O.R. procedure w CC,,Case Rate,34960.59
Blue Cross,EPO,836,DRG,Acute leukemia w/o major O.R. procedure w/o CC/MCC,,Case Rate,19345.18
Blue Cross,EPO,837,DRG,Chemo w acute leukemia as sdx or w high dose chemo agent w MCC,,Case Rate,94264.76
Blue Cross,EPO,838,DRG,Chemo w acute leukemia as sdx w CC or high dose chemo agent,,Case Rate,37360.55
Blue Cross,EPO,839,DRG,Chemo w acute leukemia as sdx w/o CC/MCC,,Case Rate,24583.40
Blue Cross,EPO,84,DRG,Traumatic stupor & coma, coma >1 hr w/o CC/MCC,,Case Rate,14955.46
Blue Cross,EPO,840,DRG,Lymphoma & non-acute leukemia w MCC,,Case Rate,53187.67
Blue Cross,EPO,841,DRG,Lymphoma & non-acute leukemia w CC,,Case Rate,26808.03
Blue Cross,EPO,842,DRG,Lymphoma & non-acute leukemia w/o CC/MCC,,Case Rate,18116.26
Blue Cross,EPO,843,DRG,Other myeloprolif dis or poorly diff neopl diag w MCC,,Case Rate,31473.96
Blue Cross,EPO,844,DRG,Other myeloprolif dis or poorly diff neopl diag w CC,,Case Rate,19525.47
Blue Cross,EPO,845,DRG,Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC,,Case Rate,14015.99
Blue Cross,EPO,846,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w MCC,,Case Rate,44160.14
Blue Cross,EPO,847,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w CC,,Case Rate,22084.20
Blue Cross,EPO,848,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC,,Case Rate,17019.66
Blue Cross,EPO,849,DRG,Radiotherapy,,Case Rate,41143.25
Blue Cross,EPO,85,DRG,Traumatic stupor & coma, coma <1 hr w MCC,,Case Rate,38147.85
Blue Cross,EPO,853,DRG,Infectious & parasitic diseases w O.R. procedure w MCC,,Case Rate,81783.68
Blue Cross,EPO,854,DRG,Infectious & parasitic diseases w O.R. procedure w CC,,Case Rate,34641.37
Blue Cross,EPO,855,DRG,Infectious & parasitic diseases w O.R. procedure w/o CC/MCC,,Case Rate,24727.30
Blue Cross,EPO,856,DRG,Postoperative or post-traumatic infections w O.R. proc w MCC,,Case Rate,75185.87
Blue Cross,EPO,857,DRG,Postoperative or post-traumatic infections w O.R. proc w CC,,Case Rate,33653.93
Blue Cross,EPO,858,DRG,Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC,,Case Rate,22302.53
Blue Cross,EPO,86,DRG,Traumatic stupor & coma, coma <1 hr w CC,,Case Rate,21053.76
Blue Cross,EPO,862,DRG,Postoperative & post-traumatic infections w MCC,,Case Rate,31075.35
Blue Cross,EPO,863,DRG,Postoperative & post-traumatic infections w/o MCC,,Case Rate,16166.19
Blue Cross,EPO,864,DRG,Fever of unknown origin,,Case Rate,14472.50
Blue Cross,EPO,865,DRG,Viral illness w MCC,,Case Rate,24461.00
Blue Cross,EPO,866,DRG,Viral illness w/o MCC,,Case Rate,13847.28
Blue Cross,EPO,867,DRG,Other infectious & parasitic diseases diagnoses w MCC,,Case Rate,36875.93
Blue Cross,EPO,868,DRG,Other infectious & parasitic diseases diagnoses w CC,,Case Rate,17505.93
Blue Cross,EPO,869,DRG,Other infectious & parasitic diseases diagnoses w/o CC/MCC,,Case Rate,12008.04
Blue Cross,EPO,87,DRG,Traumatic stupor & coma, coma <1 hr w/o CC/MCC,,Case Rate,14267.40
Blue Cross,EPO,870,DRG,Septicemia w MV 96+ hours,,Case Rate,106266.19
Blue Cross,EPO,871,DRG,Septicemia w/o MV 96+ hours w MCC,,Case Rate,30900.02
Blue Cross,EPO,872,DRG,Septicemia w/o MV 96+ hours w/o MCC,,Case Rate,16897.26
Blue Cross,EPO,876,DRG,O.R. procedure w principal diagnoses of mental illness,,Case Rate,53941.90
Blue Cross,EPO,88,DRG,Concussion w MCC,,Case Rate,24136.82
Blue Cross,EPO,880,DRG,Acute adjustment reaction & psychosocial dysfunction,,Case Rate,14283.94
Blue Cross,EPO,881,DRG,Depressive neuroses,,Case Rate,13255.15
Blue Cross,EPO,882,DRG,Neuroses except depressive,,Case Rate,13612.42
Blue Cross,EPO,883,DRG,Disorders of personality & impulse control,,Case Rate,26105.08
Blue Cross,EPO,884,DRG,Organic disturbances & mental retardation,,Case Rate,23880.45
Blue Cross,EPO,885,DRG,Psychoses,,Case Rate,20461.63
Blue Cross,EPO,886,DRG,Behavioral & developmental disorders,,Case Rate,20203.61
Blue Cross,EPO,887,DRG,Other mental disorder diagnoses,,Case Rate,17841.69
Blue Cross,EPO,89,DRG,Concussion w CC,,Case Rate,17552.24
Blue Cross,EPO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Per Date of Service,193.00
Blue Cross,EPO,894,DRG,Alcohol/drug abuse or dependence, left ama,,Case Rate,9055.65
Blue Cross,EPO,895,DRG,Alcohol/drug abuse or dependence w rehabilitation therapy,,Case Rate,26331.68
Blue Cross,EPO,896,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC,,Case Rate,29391.58
Blue Cross,EPO,897,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC,,Case Rate,13653.77
Blue Cross,EPO,90,DRG,Concussion w/o CC/MCC,,Case Rate,14138.39
Blue Cross,EPO,901,DRG,Wound debridements for injuries w MCC,,Case Rate,70496.78
Blue Cross,EPO,902,DRG,Wound debridements for injuries w CC,,Case Rate,32458.09
Blue Cross,EPO,903,DRG,Wound debridements for injuries w/o CC/MCC,,Case Rate,18762.97
Blue Cross,EPO,904,DRG,Skin grafts for injuries w CC/MCC,,Case Rate,61551.95
Blue Cross,EPO,905,DRG,Skin grafts for injuries w/o CC/MCC,,Case Rate,27157.02
Blue Cross,EPO,906,DRG,Hand procedures for injuries,,Case Rate,29669.45
Blue Cross,EPO,907,DRG,Other O.R. procedures for injuries w MCC,,Case Rate,65450.43
Blue Cross,EPO,908,DRG,Other O.R. procedures for injuries w CC,,Case Rate,33748.21
Blue Cross,EPO,909,DRG,Other O.R. procedures for injuries w/o CC/MCC,,Case Rate,22740.84
Blue Cross,EPO,90901,CPT4/HCPCS,BIOFEEDBACK TRAIN ANY METH,,Per Date of Service,193.00
Blue Cross,EPO,90911,CPT4/HCPCS,BIOFEEDBACK PERI/URO/RECTAL,,Per Date of Service,193.00
Blue Cross,EPO,90912,CPT4/HCPCS,BFB TRAINING 1ST 15 MIN,,Per Date of Service,193.00
Blue Cross,EPO,90913,CPT4/HCPCS,BFB TRAINING EA ADDL 15 MIN,,Per Date of Service,193.00
Blue Cross,EPO,91,DRG,Other disorders of nervous system w MCC,,Case Rate,27272.80
Blue Cross,EPO,913,DRG,Traumatic injury w MCC,,Case Rate,27066.05
Blue Cross,EPO,914,DRG,Traumatic injury w/o MCC,,Case Rate,14697.44
Blue Cross,EPO,915,DRG,Allergic reactions w MCC,,Case Rate,28078.30
Blue Cross,EPO,916,DRG,Allergic reactions w/o MCC,,Case Rate,10871.74
Blue Cross,EPO,917,DRG,Poisoning & toxic effects of drugs w MCC,,Case Rate,24437.85
Blue Cross,EPO,918,DRG,Poisoning & toxic effects of drugs w/o MCC,,Case Rate,13084.79
Blue Cross,EPO,919,DRG,Complications of treatment w MCC,,Case Rate,30340.97
Blue Cross,EPO,92,DRG,Other disorders of nervous system w CC,,Case Rate,16310.09
Blue Cross,EPO,920,DRG,Complications of treatment w CC,,Case Rate,16991.54
Blue Cross,EPO,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,Grouper Rate,1678.00
Blue Cross,EPO,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,Grouper Rate,1678.00
Blue Cross,EPO,921,DRG,Complications of treatment w/o CC/MCC,,Case Rate,11435.75
Blue Cross,EPO,922,DRG,Other injury, poisoning & toxic effect diag w MCC,,Case Rate,26258.90
Blue Cross,EPO,92225,CPT4/HCPCS,SPECIAL EYE EXAM INITIAL,,Grouper Rate,1678.00
Blue Cross,EPO,92226,CPT4/HCPCS,SPECIAL EYE EXAM SUBSEQUENT,,Grouper Rate,1678.00
Blue Cross,EPO,92235,CPT4/HCPCS,FLUORESCEIN ANGRPH UNI/BI,,Grouper Rate,1678.00
Blue Cross,EPO,92240,CPT4/HCPCS,ICG ANGIOGRAPHY UNI/BI,,Grouper Rate,1678.00
Blue Cross,EPO,92250,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Grouper Rate,1678.00
Blue Cross,EPO,92260,CPT4/HCPCS,OPHTHALMOSCOPY/DYNAMOMETRY,,Grouper Rate,1678.00
Blue Cross,EPO,923,DRG,Other injury, poisoning & toxic effect diag w/o MCC,,Case Rate,15388.81
Blue Cross,EPO,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,Grouper Rate,1678.00
Blue Cross,EPO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Per Date of Service,193.00
Blue Cross,EPO,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,Grouper Rate,1678.00
Blue Cross,EPO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,Per Date of Service,193.00
Blue Cross,EPO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,Per Date of Service,193.00
Blue Cross,EPO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,Per Date of Service,193.00
Blue Cross,EPO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,Per Date of Service,193.00
Blue Cross,EPO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,Per Date of Service,193.00
Blue Cross,EPO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,Per Date of Service,193.00
Blue Cross,EPO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,Per Date of Service,193.00
Blue Cross,EPO,927,DRG,Extensive burns or full thickness burns w MV 96+ hrs w skin graft,,Case Rate,347851.08
Blue Cross,EPO,928,DRG,Full thickness burn w skin graft or inhal inj w CC/MCC,,Case Rate,107825.91
Blue Cross,EPO,929,DRG,Full thickness burn w skin graft or inhal inj w/o CC/MCC,,Case Rate,49767.20
Blue Cross,EPO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Grouper Rate,8841.00
Blue Cross,EPO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Grouper Rate,3544.00
Blue Cross,EPO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Grouper Rate,8841.00
Blue Cross,EPO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Grouper Rate,8841.00
Blue Cross,EPO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Grouper Rate,8841.00
Blue Cross,EPO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Grouper Rate,3544.00
Blue Cross,EPO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Grouper Rate,8841.00
Blue Cross,EPO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Grouper Rate,8841.00
Blue Cross,EPO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Grouper Rate,8841.00
Blue Cross,EPO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Grouper Rate,3544.00
Blue Cross,EPO,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,Grouper Rate,1678.00
Blue Cross,EPO,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,Grouper Rate,1678.00
Blue Cross,EPO,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Grouper Rate,1678.00
Blue Cross,EPO,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,Grouper Rate,1678.00
Blue Cross,EPO,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,Grouper Rate,1678.00
Blue Cross,EPO,92973,CPT4/HCPCS,PRQ CORONARY MECH THROMBECT,,Grouper Rate,5281.00
Blue Cross,EPO,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Grouper Rate,1678.00
Blue Cross,EPO,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Grouper Rate,3544.00
Blue Cross,EPO,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,Grouper Rate,1678.00
Blue Cross,EPO,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,Grouper Rate,1678.00
Blue Cross,EPO,92980,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Grouper Rate,8012.00
Blue Cross,EPO,92981,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Grouper Rate,8012.00
Blue Cross,EPO,92982,CPT4/HCPCS,CORONARY ARTERY DILATION,,Grouper Rate,8841.00
Blue Cross,EPO,92984,CPT4/HCPCS,CORONARY ARTERY DILATION,,Grouper Rate,3544.00
Blue Cross,EPO,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,Grouper Rate,5783.00
Blue Cross,EPO,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,5783.00
Blue Cross,EPO,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8841.00
Blue Cross,EPO,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8841.00
Blue Cross,EPO,92995,CPT4/HCPCS,CORONARY ATHERECTOMY,,Grouper Rate,8841.00
Blue Cross,EPO,92996,CPT4/HCPCS,CORONARY ATHERECTOMY ADD-ON,,Grouper Rate,3544.00
Blue Cross,EPO,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Grouper Rate,5029.00
Blue Cross,EPO,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Grouper Rate,1678.88
Blue Cross,EPO,93,DRG,Other disorders of nervous system w/o CC/MCC,,Case Rate,12922.70
Blue Cross,EPO,933,DRG,Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft,,Case Rate,37340.70
Blue Cross,EPO,934,DRG,Full thickness burn w/o skin grft or inhal inj,,Case Rate,32042.94
Blue Cross,EPO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Grouper Rate,3544.00
Blue Cross,EPO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Grouper Rate,8012.00
Blue Cross,EPO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Grouper Rate,8012.00
Blue Cross,EPO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Grouper Rate,8841.00
Blue Cross,EPO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Grouper Rate,8841.00
Blue Cross,EPO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Grouper Rate,8841.00
Blue Cross,EPO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Grouper Rate,8841.00
Blue Cross,EPO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Grouper Rate,8841.00
Blue Cross,EPO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Grouper Rate,8841.00
Blue Cross,EPO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,8841.00
Blue Cross,EPO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,8841.00
Blue Cross,EPO,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Grouper Rate,8841.00
Blue Cross,EPO,935,DRG,Non-extensive burns,,Case Rate,31976.78
Blue Cross,EPO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Grouper Rate,3544.00
Blue Cross,EPO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Grouper Rate,3544.00
Blue Cross,EPO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Grouper Rate,5783.00
Blue Cross,EPO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,8841.00
Blue Cross,EPO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,8841.00
Blue Cross,EPO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,8841.00
Blue Cross,EPO,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,Grouper Rate,1678.88
Blue Cross,EPO,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,Grouper Rate,1678.88
Blue Cross,EPO,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,Grouper Rate,1678.88
Blue Cross,EPO,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,Grouper Rate,1678.88
Blue Cross,EPO,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,Grouper Rate,1678.88
Blue Cross,EPO,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,Grouper Rate,1678.88
Blue Cross,EPO,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Grouper Rate,5783.00
Blue Cross,EPO,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Grouper Rate,5783.00
Blue Cross,EPO,93582,CPT4/HCPCS,PERQ TRANSCATH CLOSURE PDA,,Grouper Rate,5783.00
Blue Cross,EPO,93583,CPT4/HCPCS,PERQ TRANSCATH SEPTAL REDUXN,,Grouper Rate,5783.00
Blue Cross,EPO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Grouper Rate,1678.88
Blue Cross,EPO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Grouper Rate,1678.88
Blue Cross,EPO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Grouper Rate,1678.88
Blue Cross,EPO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Grouper Rate,5281.00
Blue Cross,EPO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Grouper Rate,1678.00
Blue Cross,EPO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Grouper Rate,1678.00
Blue Cross,EPO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Grouper Rate,1678.88
Blue Cross,EPO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Grouper Rate,1678.00
Blue Cross,EPO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Grouper Rate,1678.00
Blue Cross,EPO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Grouper Rate,1678.00
Blue Cross,EPO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,EPO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,EPO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,EPO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,EPO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Grouper Rate,3544.00
Blue Cross,EPO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Grouper Rate,5281.00
Blue Cross,EPO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Grouper Rate,1678.00
Blue Cross,EPO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Grouper Rate,6588.00
Blue Cross,EPO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,EPO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,1678.88
Blue Cross,EPO,93644,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,1678.88
Blue Cross,EPO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,8841.00
Blue Cross,EPO,93651,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,8841.00
Blue Cross,EPO,93652,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,8841.00
Blue Cross,EPO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Grouper Rate,8841.00
Blue Cross,EPO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Grouper Rate,8841.00
Blue Cross,EPO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Grouper Rate,8841.00
Blue Cross,EPO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Grouper Rate,8841.00
Blue Cross,EPO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Grouper Rate,8841.00
Blue Cross,EPO,93724,CPT4/HCPCS,ANALYZE PACEMAKER SYSTEM,,Grouper Rate,5281.00
Blue Cross,EPO,939,DRG,O.R. proc w diagnoses of other contact w health services w MCC,,Case Rate,56007.74
Blue Cross,EPO,94,DRG,Bacterial & tuberculous infections of nervous system w MCC,,Case Rate,60091.47
Blue Cross,EPO,940,DRG,O.R. proc w diagnoses of other contact w health services w CC,,Case Rate,36679.10
Blue Cross,EPO,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,Per Date of Service,193.00
Blue Cross,EPO,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,Per Date of Service,193.00
Blue Cross,EPO,941,DRG,O.R. proc w diagnoses of other contact w health services w/o CC/MCC,,Case Rate,31834.53
Blue Cross,EPO,945,DRG,Rehabilitation w CC/MCC,,Case Rate,24556.93
Blue Cross,EPO,946,DRG,Rehabilitation w/o CC/MCC,,Case Rate,18643.88
Blue Cross,EPO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,Per Date of Service,193.00
Blue Cross,EPO,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,Per Date of Service,193.00
Blue Cross,EPO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,Per Date of Service,193.00
Blue Cross,EPO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,Per Date of Service,193.00
Blue Cross,EPO,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,Per Date of Service,193.00
Blue Cross,EPO,947,DRG,Signs & symptoms w MCC,,Case Rate,19684.25
Blue Cross,EPO,948,DRG,Signs & symptoms w/o MCC,,Case Rate,12993.82
Blue Cross,EPO,949,DRG,Aftercare w CC/MCC,,Case Rate,18311.43
Blue Cross,EPO,95,DRG,Bacterial & tuberculous infections of nervous system w CC,,Case Rate,41482.32
Blue Cross,EPO,950,DRG,Aftercare w/o CC/MCC,,Case Rate,12221.40
Blue Cross,EPO,951,DRG,Other factors influencing health status,,Case Rate,9232.62
Blue Cross,EPO,955,DRG,Craniotomy for multiple significant trauma,,Case Rate,104003.52
Blue Cross,EPO,956,DRG,Limb reattachment, hip & femur proc for multiple significant trauma,,Case Rate,63659.15
Blue Cross,EPO,957,DRG,Other O.R. procedures for multiple significant trauma w MCC,,Case Rate,122740.03
Blue Cross,EPO,958,DRG,Other O.R. procedures for multiple significant trauma w CC,,Case Rate,69557.31
Blue Cross,EPO,95830,CPT4/HCPCS,INSERT ELECTRODES FOR EEG,,Grouper Rate,1678.88
Blue Cross,EPO,959,DRG,Other O.R. procedures for multiple significant trauma w/o CC/MCC,,Case Rate,45223.66
Blue Cross,EPO,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Grouper Rate,1678.00
Blue Cross,EPO,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Grouper Rate,1678.00
Blue Cross,EPO,95992,CPT4/HCPCS,CANALITH REPOSITIONING PROC,,Per Date of Service,193.00
Blue Cross,EPO,96,DRG,Bacterial & tuberculous infections of nervous system w/o CC/MCC,,Case Rate,38563.01
Blue Cross,EPO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,Per Date of Service,193.00
Blue Cross,EPO,963,DRG,Other multiple significant trauma w MCC,,Case Rate,45058.26
Blue Cross,EPO,96365,CPT4/HCPCS,THER/PROPH/DIAG IV INF INIT,,Per Date of Service,193.00
Blue Cross,EPO,96376,CPT4/HCPCS,TX/PRO/DX INJ SAME DRUG ADON,,Per Date of Service,193.00
Blue Cross,EPO,964,DRG,Other multiple significant trauma w CC,,Case Rate,24618.13
Blue Cross,EPO,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,Per Date of Service,193.00
Blue Cross,EPO,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,Per Date of Service,193.00
Blue Cross,EPO,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,Per Date of Service,193.00
Blue Cross,EPO,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,Per Date of Service,193.00
Blue Cross,EPO,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,Per Date of Service,193.00
Blue Cross,EPO,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,Per Date of Service,193.00
Blue Cross,EPO,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,Per Date of Service,193.00
Blue Cross,EPO,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,Per Date of Service,193.00
Blue Cross,EPO,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,Per Date of Service,193.00
Blue Cross,EPO,965,DRG,Other multiple significant trauma w/o CC/MCC,,Case Rate,15099.36
Blue Cross,EPO,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,Per Date of Service,193.00
Blue Cross,EPO,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,Grouper Rate,1678.00
Blue Cross,EPO,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,Grouper Rate,1678.00
Blue Cross,EPO,969,DRG,HIV w extensive O.R. procedure w MCC,,Case Rate,95723.59
Blue Cross,EPO,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,Grouper Rate,1678.00
Blue Cross,EPO,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,Grouper Rate,1678.00
Blue Cross,EPO,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,Grouper Rate,1678.00
Blue Cross,EPO,97,DRG,Non-bacterial infect of nervous sys exc viral meningitis w MCC,,Case Rate,62068.00
Blue Cross,EPO,970,DRG,HIV w extensive O.R. procedure w/o MCC,,Case Rate,48711.95
Blue Cross,EPO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Per Date of Service,193.00
Blue Cross,EPO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Per Date of Service,193.00
Blue Cross,EPO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Per Date of Service,193.00
Blue Cross,EPO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Per Date of Service,193.00
Blue Cross,EPO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Per Date of Service,193.00
Blue Cross,EPO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Per Date of Service,193.00
Blue Cross,EPO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Per Date of Service,193.00
Blue Cross,EPO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Per Date of Service,193.00
Blue Cross,EPO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Per Date of Service,193.00
Blue Cross,EPO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Per Date of Service,193.00
Blue Cross,EPO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Per Date of Service,193.00
Blue Cross,EPO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Per Date of Service,193.00
Blue Cross,EPO,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,Per Date of Service,193.00
Blue Cross,EPO,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,Per Date of Service,193.00
Blue Cross,EPO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Per Date of Service,193.00
Blue Cross,EPO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Per Date of Service,193.00
Blue Cross,EPO,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,Per Date of Service,193.00
Blue Cross,EPO,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,Per Date of Service,193.00
Blue Cross,EPO,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,Per Date of Service,193.00
Blue Cross,EPO,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,Per Date of Service,193.00
Blue Cross,EPO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,Per Date of Service,193.00
Blue Cross,EPO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,Per Date of Service,193.00
Blue Cross,EPO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,Per Date of Service,193.00
Blue Cross,EPO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,Per Date of Service,193.00
Blue Cross,EPO,974,DRG,HIV w major related condition w MCC,,Case Rate,44421.47
Blue Cross,EPO,975,DRG,HIV w major related condition w CC,,Case Rate,21156.31
Blue Cross,EPO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Per Date of Service,193.00
Blue Cross,EPO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Per Date of Service,193.00
Blue Cross,EPO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Per Date of Service,193.00
Blue Cross,EPO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Per Date of Service,193.00
Blue Cross,EPO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Per Date of Service,193.00
Blue Cross,EPO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Per Date of Service,193.00
Blue Cross,EPO,976,DRG,HIV w major related condition w/o CC/MCC,,Case Rate,15698.11
Blue Cross,EPO,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,Per Date of Service,193.00
Blue Cross,EPO,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,Per Date of Service,193.00
Blue Cross,EPO,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,Per Date of Service,193.00
Blue Cross,EPO,977,DRG,HIV w or w/o other related condition,,Case Rate,21846.03
Blue Cross,EPO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,Per Date of Service,193.00
Blue Cross,EPO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,Per Date of Service,193.00
Blue Cross,EPO,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,Per Date of Service,193.00
Blue Cross,EPO,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,Per Date of Service,193.00
Blue Cross,EPO,98,DRG,Non-bacterial infect of nervous sys exc viral meningitis w CC,,Case Rate,34914.28
Blue Cross,EPO,981,DRG,Extensive O.R. procedure unrelated to principal diagnosis w MCC,,Case Rate,76213.01
Blue Cross,EPO,982,DRG,Extensive O.R. procedure unrelated to principal diagnosis w CC,,Case Rate,42034.75
Blue Cross,EPO,983,DRG,Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC,,Case Rate,27370.39
Blue Cross,EPO,987,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w MCC,,Case Rate,53955.13
Blue Cross,EPO,988,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w CC,,Case Rate,27798.77
Blue Cross,EPO,989,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC,,Case Rate,18456.98
Blue Cross,EPO,99,DRG,Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC,,Case Rate,23111.34
Blue Cross,EPO,99170,CPT4/HCPCS,ANOGENITAL EXAM CHILD W IMAG,,Grouper Rate,1678.00
Blue Cross,EPO,99195,CPT4/HCPCS,PHLEBOTOMY,,Grouper Rate,1678.00
Blue Cross,EPO,C2596,CPT4/HCPCS,Probe, robotic, water-jet,,Grouper Rate,5029.00
Blue Cross,EPO,C8957,CPT4/HCPCS,Prolonged IV inf, req pump,,Per Date of Service,193.00
Blue Cross,EPO,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Grouper Rate,8012.00
Blue Cross,EPO,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Grouper Rate,8012.00
Blue Cross,EPO,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Grouper Rate,8012.00
Blue Cross,EPO,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,Grouper Rate,8012.00
Blue Cross,EPO,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,Grouper Rate,8012.00
Blue Cross,EPO,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,Grouper Rate,8012.00
Blue Cross,EPO,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Grouper Rate,8012.00
Blue Cross,EPO,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Grouper Rate,8012.00
Blue Cross,EPO,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,Grouper Rate,8012.00
Blue Cross,EPO,C9729,CPT4/HCPCS,Percut lumbar lami,,Grouper Rate,3544.00
Blue Cross,EPO,C9732,CPT4/HCPCS,Insert ocular telescope pros,,Grouper Rate,3544.00
Blue Cross,EPO,C9734,CPT4/HCPCS,U/S trtmt, not leiomyomata,,Grouper Rate,1678.00
Blue Cross,EPO,C9738,CPT4/HCPCS,Blue light cysto imag agent,,Grouper Rate,1678.00
Blue Cross,EPO,C9742,CPT4/HCPCS,Laryngoscopy with injection,,Grouper Rate,1678.00
Blue Cross,EPO,C9743,CPT4/HCPCS,Bulking/spacer material impl,,Grouper Rate,1678.00
Blue Cross,EPO,C9748,CPT4/HCPCS,Prostatic rf water vapor tx,,Grouper Rate,3544.00
Blue Cross,EPO,C9749,CPT4/HCPCS,Repair nasal stenosis w/imp,,Grouper Rate,3544.00
Blue Cross,EPO,C9750,CPT4/HCPCS,Ins/rem-replace compl iims,,Grouper Rate,3544.00
Blue Cross,EPO,C9757,CPT4/HCPCS,Spine/lumbar disk surgery,,Grouper Rate,5281.00
Blue Cross,EPO,C9758,CPT4/HCPCS,Blind interatrial shunt ide,,Grouper Rate,8841.00
Blue Cross,EPO,C9800,CPT4/HCPCS,Dermal filler inj px/suppl,,Grouper Rate,1678.00
Blue Cross,EPO,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Grouper Rate,1678.00
Blue Cross,EPO,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Grouper Rate,1678.88
Blue Cross,EPO,G0120,CPT4/HCPCS,Colon ca scrn; barium enema,,Grouper Rate,1678.88
Blue Cross,EPO,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Grouper Rate,1678.88
Blue Cross,EPO,G0186,CPT4/HCPCS,Dstry eye lesn,fdr vssl tech,,Grouper Rate,1678.88
Blue Cross,EPO,G0237,CPT4/HCPCS,Therapeutic procd strg endur,,Per Date of Service,193.00
Blue Cross,EPO,G0238,CPT4/HCPCS,Oth resp proc, indiv,,Per Date of Service,193.00
Blue Cross,EPO,G0239,CPT4/HCPCS,Oth resp proc, group,,Per Date of Service,193.00
Blue Cross,EPO,G0251,CPT4/HCPCS,Linear acc based stero radio,,Grouper Rate,8841.00
Blue Cross,EPO,G0256,CPT4/HCPCS,Prostate brachy w palladium,,Grouper Rate,8012.00
Blue Cross,EPO,G0259,CPT4/HCPCS,Inject for sacroiliac joint,,Grouper Rate,1678.00
Blue Cross,EPO,G0260,CPT4/HCPCS,Inj for sacroiliac jt anesth,,Grouper Rate,1678.00
Blue Cross,EPO,G0269,CPT4/HCPCS,Occlusive device in vein art,,Grouper Rate,1678.00
Blue Cross,EPO,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,Grouper Rate,3544.00
Blue Cross,EPO,G0277,CPT4/HCPCS,Hbot, full body chamber, 30m,,Grouper Rate,3544.00
Blue Cross,EPO,G0283,CPT4/HCPCS,Elec stim other than wound,,Per Date of Service,193.00
Blue Cross,EPO,G0289,CPT4/HCPCS,Arthro, loose body + chondro,,Grouper Rate,5029.00
Blue Cross,EPO,G0290,CPT4/HCPCS,Drug-eluting stents, single,,Grouper Rate,8012.00
Blue Cross,EPO,G0291,CPT4/HCPCS,Drug-eluting stents,each add,,Grouper Rate,8012.00
Blue Cross,EPO,G0293,CPT4/HCPCS,Non-cov surg proc,clin trial,,Grouper Rate,1678.00
Blue Cross,EPO,G0339,CPT4/HCPCS,Robot lin-radsurg com, first,,Grouper Rate,8841.00
Blue Cross,EPO,G0340,CPT4/HCPCS,Robt lin-radsurg fractx 2-5,,Grouper Rate,8841.00
Blue Cross,EPO,G0341,CPT4/HCPCS,Percutaneous islet celltrans,,Grouper Rate,1678.00
Blue Cross,EPO,G0412,CPT4/HCPCS,Open tx iliac spine uni/bil,,Grouper Rate,5029.00
Blue Cross,EPO,G0413,CPT4/HCPCS,Pelvic ring fracture uni/bil,,Grouper Rate,3544.00
Blue Cross,EPO,G0414,CPT4/HCPCS,Pelvic ring fx treat int fix,,Grouper Rate,5281.00
Blue Cross,EPO,G0415,CPT4/HCPCS,Open tx post pelvic fxcture,,Grouper Rate,5281.00
Blue Cross,EPO,G0429,CPT4/HCPCS,Dermal filler injection(s),,Grouper Rate,1678.00
Blue Cross,EPO,G0448,CPT4/HCPCS,Place perm pacing cardiovert,,Grouper Rate,3544.00
Blue Cross,EPO,G0455,CPT4/HCPCS,Fecal microbiota prep instil,,Grouper Rate,3544.00
Blue Cross,EPO,G0515,CPT4/HCPCS,Cognitive skills development,,Per Date of Service,193.00
Blue Cross,EPO,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,Per Date of Service,193.00
Blue Cross,EPO,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,Per Date of Service,193.00
Blue Cross,EPO,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,Per Date of Service,193.00
Blue Cross,EPO,G6001,CPT4/HCPCS,Echo guidance radiotherapy,,Fee Schedule,159.34
Blue Cross,EPO,G6002,CPT4/HCPCS,Stereoscopic x-ray guidance,,Fee Schedule,588.34
Blue Cross,EPO,G6003,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1195.46
Blue Cross,EPO,G6004,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,925.46
Blue Cross,EPO,G6005,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1033.91
Blue Cross,EPO,G6006,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1028.74
Blue Cross,EPO,G6007,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1902.52
Blue Cross,EPO,G6008,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1280.30
Blue Cross,EPO,G6009,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1417.85
Blue Cross,EPO,G6010,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1417.85
Blue Cross,EPO,G6011,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,2034.57
Blue Cross,EPO,G6012,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1685.30
Blue Cross,EPO,G6013,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1897.02
Blue Cross,EPO,G6014,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1897.02
Blue Cross,EPO,G6015,CPT4/HCPCS,Radiation tx delivery imrt,,Fee Schedule,2957.43
Blue Cross,EPO,G6016,CPT4/HCPCS,Delivery comp imrt,,Fee Schedule,2953.40
Blue Cross,EPO,G6018,CPT4/HCPCS,Ileoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,EPO,G6019,CPT4/HCPCS,Colonoscopy lesion removal,,Grouper Rate,1678.00
Blue Cross,EPO,G6020,CPT4/HCPCS,Colonoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,EPO,G6022,CPT4/HCPCS,Sigmoidoscopy w/ablate tumr,,Grouper Rate,1678.00
Blue Cross,EPO,G6023,CPT4/HCPCS,Sigmoidoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,EPO,G6024,CPT4/HCPCS,Lesion removal colonoscopy,,Grouper Rate,1678.00
Blue Cross,EPO,G6025,CPT4/HCPCS,Colonoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,EPO,G6027,CPT4/HCPCS,Anoscopy hra w/spec collect,,Grouper Rate,1678.00
Blue Cross,EPO,G6028,CPT4/HCPCS,Anoscopy hra w/biopsy,,Grouper Rate,1678.00
Blue Cross,EPO,G8627,CPT4/HCPCS,Surg proc w/in 30 days,,Grouper Rate,5029.00
Blue Cross,EPO,G8628,CPT4/HCPCS,No surg proc w/in 30 days,,Grouper Rate,5783.00
Blue Cross,EPO,G8978,CPT4/HCPCS,Mobility current status,,Per Date of Service,193.00
Blue Cross,EPO,G8979,CPT4/HCPCS,Mobility goal status,,Per Date of Service,193.00
Blue Cross,EPO,G8980,CPT4/HCPCS,Mobility d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G8981,CPT4/HCPCS,Body pos current status,,Per Date of Service,193.00
Blue Cross,EPO,G8982,CPT4/HCPCS,Body pos goal status,,Per Date of Service,193.00
Blue Cross,EPO,G8983,CPT4/HCPCS,Body pos d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G8984,CPT4/HCPCS,Carry current status,,Per Date of Service,193.00
Blue Cross,EPO,G8985,CPT4/HCPCS,Carry goal status,,Per Date of Service,193.00
Blue Cross,EPO,G8986,CPT4/HCPCS,Carry d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G8987,CPT4/HCPCS,Self care current status,,Per Date of Service,193.00
Blue Cross,EPO,G8988,CPT4/HCPCS,Self care goal status,,Per Date of Service,193.00
Blue Cross,EPO,G8989,CPT4/HCPCS,Self care d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G8990,CPT4/HCPCS,Other pt/ot current status,,Per Date of Service,193.00
Blue Cross,EPO,G8991,CPT4/HCPCS,Other pt/ot goal status,,Per Date of Service,193.00
Blue Cross,EPO,G8992,CPT4/HCPCS,Other pt/ot d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G8993,CPT4/HCPCS,Sub pt/ot current status,,Per Date of Service,193.00
Blue Cross,EPO,G8994,CPT4/HCPCS,Sub pt/ot goal status,,Per Date of Service,193.00
Blue Cross,EPO,G8995,CPT4/HCPCS,Sub pt/ot d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G8996,CPT4/HCPCS,Swallow current status,,Per Date of Service,193.00
Blue Cross,EPO,G8997,CPT4/HCPCS,Swallow goal status,,Per Date of Service,193.00
Blue Cross,EPO,G8998,CPT4/HCPCS,Swallow d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G8999,CPT4/HCPCS,Motor speech current status,,Per Date of Service,193.00
Blue Cross,EPO,G9158,CPT4/HCPCS,Motor speech d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G9159,CPT4/HCPCS,Lang comp current status,,Per Date of Service,193.00
Blue Cross,EPO,G9160,CPT4/HCPCS,Lang comp goal status,,Per Date of Service,193.00
Blue Cross,EPO,G9161,CPT4/HCPCS,Lang comp d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G9162,CPT4/HCPCS,Lang express current status,,Per Date of Service,193.00
Blue Cross,EPO,G9163,CPT4/HCPCS,Lang express goal status,,Per Date of Service,193.00
Blue Cross,EPO,G9164,CPT4/HCPCS,Lang express d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G9165,CPT4/HCPCS,Atten current status,,Per Date of Service,193.00
Blue Cross,EPO,G9166,CPT4/HCPCS,Atten goal status,,Per Date of Service,193.00
Blue Cross,EPO,G9167,CPT4/HCPCS,Atten d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G9168,CPT4/HCPCS,Memory current status,,Per Date of Service,193.00
Blue Cross,EPO,G9169,CPT4/HCPCS,Memory goal status,,Per Date of Service,193.00
Blue Cross,EPO,G9170,CPT4/HCPCS,Memory d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G9171,CPT4/HCPCS,Voice current status,,Per Date of Service,193.00
Blue Cross,EPO,G9172,CPT4/HCPCS,Voice goal status,,Per Date of Service,193.00
Blue Cross,EPO,G9173,CPT4/HCPCS,Voice d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G9174,CPT4/HCPCS,Speech lang current status,,Per Date of Service,193.00
Blue Cross,EPO,G9175,CPT4/HCPCS,Speech lang goal status,,Per Date of Service,193.00
Blue Cross,EPO,G9176,CPT4/HCPCS,Speech lang d/c status,,Per Date of Service,193.00
Blue Cross,EPO,G9186,CPT4/HCPCS,Motor speech goal status,,Per Date of Service,193.00
Blue Cross,EPO,P9010,CPT4/HCPCS,Whole blood for transfusion,,Case Rate,3628.00
Blue Cross,EPO,P9022,CPT4/HCPCS,Washed red blood cells unit,,Case Rate,3628.00
Blue Cross,EPO,P9031,CPT4/HCPCS,Platelets leukocytes reduced,,Case Rate,3628.00
Blue Cross,EPO,P9033,CPT4/HCPCS,Platelets leukoreduced irrad,,Case Rate,3628.00
Blue Cross,EPO,P9039,CPT4/HCPCS,RBC deglycerolized,,Case Rate,3628.00
Blue Cross,EPO,P9054,CPT4/HCPCS,Blood, l/r, froz/degly/wash,,Case Rate,3628.00
Blue Cross,EPO,P9057,CPT4/HCPCS,RBC, frz/deg/wsh, l/r, irrad,,Case Rate,3628.00
Blue Cross,EPO,S2054,CPT4/HCPCS,Transplantation of multivisc,,Grouper Rate,6588.00
Blue Cross,EPO,S2083,CPT4/HCPCS,Adjustment gastric band,,Grouper Rate,1678.00
Blue Cross,EPO,S2115,CPT4/HCPCS,Periacetabular osteotomy,,Grouper Rate,5783.00
Blue Cross,EPO,S2118,CPT4/HCPCS,Total hip resurfacing,,Grouper Rate,5783.00
Blue Cross,EPO,S2152,CPT4/HCPCS,Solid organ transpl pkg,,Grouper Rate,6588.00
Blue Cross,EPO,S2350,CPT4/HCPCS,Diskectomy, anterior, with d,,Grouper Rate,5281.00
Blue Cross,EPO,S2351,CPT4/HCPCS,Diskectomy, anterior, with d,,Grouper Rate,1678.88
Blue Cross,EPO,S2400,CPT4/HCPCS,Fetal surg congen hernia,,Grouper Rate,8012.00
Blue Cross,EPO,S2401,CPT4/HCPCS,Fetal surg urin trac obstr,,Grouper Rate,8012.00
Blue Cross,EPO,S2402,CPT4/HCPCS,Fetal surg cong cyst malf,,Grouper Rate,8012.00
Blue Cross,EPO,S2403,CPT4/HCPCS,Fetal surg pulmon sequest,,Grouper Rate,8012.00
Blue Cross,EPO,S2404,CPT4/HCPCS,Fetal surg myelomeningo,,Grouper Rate,8012.00
Blue Cross,EPO,S2405,CPT4/HCPCS,Fetal surg sacrococ teratoma,,Grouper Rate,8012.00
Blue Cross,EPO,S2409,CPT4/HCPCS,Fetal surg noc,,Grouper Rate,8012.00
Blue Cross,EPO,,,Boarder Baby,,Per Case,1245.00
Blue Cross,EPO,,,NICU/Newborn - Level I,,Per Diem,3973.00
Blue Cross,EPO,,,NICU/Newborn - Level II,,Per Diem,7200.00
Blue Cross,EPO,,,NICU/Newborn - Level III,,Per Diem,7200.00
Blue Cross,EPO,,,NICU/Newborn - Level IV,,Per Diem,7200.00
Blue Cross,HMO,0048T,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,Grouper Rate,8012.00
Blue Cross,HMO,0050T,CPT4/HCPCS,REMOVAL CIRCULATION ASSIST,,Grouper Rate,5281.00
Blue Cross,HMO,0051T,CPT4/HCPCS,IMPLANT TOTAL HEART SYSTEM,,Grouper Rate,8841.00
Blue Cross,HMO,0052T,CPT4/HCPCS,REPLACE THRC UNIT HRT SYST,,Grouper Rate,8841.00
Blue Cross,HMO,0053T,CPT4/HCPCS,REPLACE IMPLANTABLE HRT SYST,,Grouper Rate,8841.00
Blue Cross,HMO,0054T,CPT4/HCPCS,BONE SRGRY CMPTR FLUOR IMAGE,,Grouper Rate,1678.00
Blue Cross,HMO,0055T,CPT4/HCPCS,BONE SRGRY CMPTR CT/MRI IMAG,,Grouper Rate,1678.88
Blue Cross,HMO,0071T,CPT4/HCPCS,US LEIOMYOMATA ABLATE <200,,Grouper Rate,1678.00
Blue Cross,HMO,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,Grouper Rate,1678.00
Blue Cross,HMO,0075T,CPT4/HCPCS,PERQ STENT/CHEST VERT ART,,Grouper Rate,6588.00
Blue Cross,HMO,0076T,CPT4/HCPCS,S&I STENT/CHEST VERT ART,,Grouper Rate,6588.00
Blue Cross,HMO,0078T,CPT4/HCPCS,ENDOVASC AORT REPR W/DEVICE,,Grouper Rate,8841.00
Blue Cross,HMO,0079T,CPT4/HCPCS,ENDOVASC VISC EXTNSN REPR,,Grouper Rate,5029.00
Blue Cross,HMO,0080T,CPT4/HCPCS,ENDOVASC AORT REPR RAD S&I,,Grouper Rate,8841.00
Blue Cross,HMO,0081T,CPT4/HCPCS,ENDOVASC VISC EXTNSN S&I,,Grouper Rate,5029.00
Blue Cross,HMO,0092T,CPT4/HCPCS,ARTIFIC DISC ADDL CERVICAL,,Grouper Rate,5783.00
Blue Cross,HMO,0095T,CPT4/HCPCS,RMVL ARTIFIC DISC ADDL CRVCL,,Grouper Rate,3544.00
Blue Cross,HMO,0098T,CPT4/HCPCS,REV ARTIFIC DISC ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,0099T,CPT4/HCPCS,IMPLANT CORNEAL RING,,Grouper Rate,1678.88
Blue Cross,HMO,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Grouper Rate,8012.00
Blue Cross,HMO,0101T,CPT4/HCPCS,EXTRACORP SHOCKWV TX HI ENRG,,Grouper Rate,1678.88
Blue Cross,HMO,0102T,CPT4/HCPCS,EXTRACORP SHOCKWV TX ANESTH,,Grouper Rate,3544.00
Blue Cross,HMO,0123T,CPT4/HCPCS,SCLERAL FISTULIZATION,,Grouper Rate,5783.00
Blue Cross,HMO,0124T,CPT4/HCPCS,CONJUNCTIVAL DRUG PLACEMENT,,Grouper Rate,5029.00
Blue Cross,HMO,0126T,CPT4/HCPCS,CHD RISK IMT STUDY,,Grouper Rate,1678.00
Blue Cross,HMO,0169T,CPT4/HCPCS,PLACE STEREO CATH BRAIN,,Grouper Rate,3544.00
Blue Cross,HMO,0171T,CPT4/HCPCS,LUMBAR SPINE PROCES DISTRACT,,Grouper Rate,5281.00
Blue Cross,HMO,0172T,CPT4/HCPCS,LUMBAR SPINE PROCESS ADDL,,Grouper Rate,5281.00
Blue Cross,HMO,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Grouper Rate,1678.00
Blue Cross,HMO,0205T,CPT4/HCPCS,INIRS EACH VESSEL ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,HMO,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,HMO,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,HMO,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,HMO,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,HMO,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,HMO,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,Grouper Rate,1678.88
Blue Cross,HMO,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,Grouper Rate,1678.88
Blue Cross,HMO,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Grouper Rate,1678.88
Blue Cross,HMO,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,0226T,CPT4/HCPCS,ANOSCOPY HRA W/SPEC COLLECT,,Grouper Rate,1678.00
Blue Cross,HMO,0227T,CPT4/HCPCS,ANOSCOPY HRA W/BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,HMO,0229T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,HMO,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,HMO,0231T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,HMO,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Grouper Rate,5029.00
Blue Cross,HMO,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,Grouper Rate,5029.00
Blue Cross,HMO,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Grouper Rate,5029.00
Blue Cross,HMO,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Grouper Rate,5029.00
Blue Cross,HMO,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,Grouper Rate,5029.00
Blue Cross,HMO,0245T,CPT4/HCPCS,OPEN TX RIB FX 1-2 RIBS,,Grouper Rate,1678.88
Blue Cross,HMO,0246T,CPT4/HCPCS,OPN TX RIB FX 3-4 RIBS,,Grouper Rate,3544.00
Blue Cross,HMO,0247T,CPT4/HCPCS,OPN TX RIB FX 5-6 RIBS,,Grouper Rate,3544.00
Blue Cross,HMO,0248T,CPT4/HCPCS,OPEN TX RIB FX 7/> RIBS,,Grouper Rate,3544.00
Blue Cross,HMO,0249T,CPT4/HCPCS,LIGATION HEMORRHOID W/US,,Grouper Rate,1678.88
Blue Cross,HMO,0250T,CPT4/HCPCS,INSERT BRONCHIAL VALVE,,Grouper Rate,1678.00
Blue Cross,HMO,0251T,CPT4/HCPCS,REMOV BRONCHIAL VALVE,,Grouper Rate,1678.88
Blue Cross,HMO,0252T,CPT4/HCPCS,REMOV BRONCH VALVE ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,0254T,CPT4/HCPCS,EVASC RPR ILIAC ART BIFUR,,Grouper Rate,5281.00
Blue Cross,HMO,0256T,CPT4/HCPCS,EVASC AORTIC HRT VALVE,,Grouper Rate,6588.00
Blue Cross,HMO,0262T,CPT4/HCPCS,IMPLTJ PULM VLV EVASC APPR,,Grouper Rate,8012.00
Blue Cross,HMO,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,Grouper Rate,3544.00
Blue Cross,HMO,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,Grouper Rate,3544.00
Blue Cross,HMO,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,Grouper Rate,1678.88
Blue Cross,HMO,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,Grouper Rate,3544.00
Blue Cross,HMO,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,Grouper Rate,3544.00
Blue Cross,HMO,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,Grouper Rate,3544.00
Blue Cross,HMO,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,Grouper Rate,3544.00
Blue Cross,HMO,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,Grouper Rate,3544.00
Blue Cross,HMO,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,Grouper Rate,3544.00
Blue Cross,HMO,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,Grouper Rate,1678.88
Blue Cross,HMO,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,Grouper Rate,1678.88
Blue Cross,HMO,0276T,CPT4/HCPCS,BRONCH THERMOPLASTY 1 LOBE,,Grouper Rate,1678.88
Blue Cross,HMO,0277T,CPT4/HCPCS,BRONCH THERMOPLASTY LOBES,,Grouper Rate,1678.88
Blue Cross,HMO,0281T,CPT4/HCPCS,LAA CLOSURE W/IMPLANT,,Grouper Rate,5783.00
Blue Cross,HMO,0282T,CPT4/HCPCS,PERIPH FIELD STIMUL TRIAL,,Grouper Rate,1678.88
Blue Cross,HMO,0283T,CPT4/HCPCS,PERIPH FIELD STIMUL PERM,,Grouper Rate,1678.88
Blue Cross,HMO,0284T,CPT4/HCPCS,PERIPH FIELD STIMUL REVISE,,Grouper Rate,1678.88
Blue Cross,HMO,0288T,CPT4/HCPCS,ANOSCOPY W/RF DELIVERY,,Grouper Rate,1678.00
Blue Cross,HMO,0289T,CPT4/HCPCS,LASER INC FOR PKP/LKP DONOR,,Grouper Rate,6588.00
Blue Cross,HMO,0290T,CPT4/HCPCS,LASER INC FOR PKP/LKP RECIP,,Grouper Rate,6588.00
Blue Cross,HMO,0293T,CPT4/HCPCS,INS LT ATRL PRESS MONITOR,,Grouper Rate,6588.00
Blue Cross,HMO,0294T,CPT4/HCPCS,INS LT ATRL MONT PRES LEAD,,Grouper Rate,5281.00
Blue Cross,HMO,0299T,CPT4/HCPCS,ESW WOUND HEALING INIT WOUND,,Grouper Rate,1678.88
Blue Cross,HMO,0300T,CPT4/HCPCS,ESW WOUND HEALING ADDL WOUND,,Grouper Rate,1678.88
Blue Cross,HMO,0301T,CPT4/HCPCS,MW THERAPY FOR BREAST TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,0302T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS COMPL,,Grouper Rate,3544.00
Blue Cross,HMO,0303T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS ELTRD,,Grouper Rate,3544.00
Blue Cross,HMO,0304T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,0307T,CPT4/HCPCS,RMVL ICAR ISCHM MNTRNG DVCE,,Grouper Rate,3544.00
Blue Cross,HMO,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Grouper Rate,5029.00
Blue Cross,HMO,0309T,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L4/L5,,Grouper Rate,5783.00
Blue Cross,HMO,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Grouper Rate,5281.00
Blue Cross,HMO,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Grouper Rate,5281.00
Blue Cross,HMO,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Grouper Rate,5281.00
Blue Cross,HMO,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Grouper Rate,5281.00
Blue Cross,HMO,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Grouper Rate,5281.00
Blue Cross,HMO,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,Grouper Rate,5281.00
Blue Cross,HMO,0318T,CPT4/HCPCS,REPLACE AORTIC VALVE TTHORAC,,Grouper Rate,6588.00
Blue Cross,HMO,0319T,CPT4/HCPCS,INSERT SUBQ DEFIB W/ELTRD,,Grouper Rate,5029.00
Blue Cross,HMO,0320T,CPT4/HCPCS,INSERT SUBQ DEFIB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,HMO,0321T,CPT4/HCPCS,INSERT SUBQ DEFIB PLS GEN,,Grouper Rate,6588.00
Blue Cross,HMO,0322T,CPT4/HCPCS,RMVL SUBQ DEFIB PLS GEN,,Grouper Rate,5029.00
Blue Cross,HMO,0323T,CPT4/HCPCS,RMVL & REPLC SUBQ PLS GEN,,Grouper Rate,1678.88
Blue Cross,HMO,0324T,CPT4/HCPCS,RMVL SUBQ DEFIB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,HMO,0325T,CPT4/HCPCS,REPOS SUBQ DEFIB ELTRD &/GEN,,Grouper Rate,1678.88
Blue Cross,HMO,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Grouper Rate,5281.00
Blue Cross,HMO,0336T,CPT4/HCPCS,LAP ABLAT UTERINE FIBROIDS,,Grouper Rate,5029.00
Blue Cross,HMO,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,Grouper Rate,3544.00
Blue Cross,HMO,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,Grouper Rate,3544.00
Blue Cross,HMO,0340T,CPT4/HCPCS,ABLATE PULM TUMORS EXTNSN,,Grouper Rate,5783.00
Blue Cross,HMO,0343T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,8841.00
Blue Cross,HMO,0344T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,8841.00
Blue Cross,HMO,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,8841.00
Blue Cross,HMO,0375T,CPT4/HCPCS,TOTAL DISC ARTHRP ANT APPR,,Grouper Rate,5783.00
Blue Cross,HMO,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,5029.00
Blue Cross,HMO,0377T,CPT4/HCPCS,ANOSCPY INJ AGENT FOR INCONT,,Grouper Rate,1678.00
Blue Cross,HMO,0387T,CPT4/HCPCS,LEADLESS PM INS/RPL VENTR,,Grouper Rate,3544.00
Blue Cross,HMO,0388T,CPT4/HCPCS,LEADLESS PM REMOVE VENTR,,Grouper Rate,1678.88
Blue Cross,HMO,0392T,CPT4/HCPCS,LAP ES SPH AUGMENT DEV PLACE,,Grouper Rate,5029.00
Blue Cross,HMO,0393T,CPT4/HCPCS,ES SPH AUGMNT DEVICE REMOVAL,,Grouper Rate,1678.88
Blue Cross,HMO,0396T,CPT4/HCPCS,INTRAOP KINETIC BALNCE SENSR,,Grouper Rate,1678.00
Blue Cross,HMO,0397T,CPT4/HCPCS,ERCP W/OPTICAL ENDOMICROSCPY,,Grouper Rate,1678.88
Blue Cross,HMO,0398T,CPT4/HCPCS,MRGFUS STRTCTC LES ABLTJ,,Grouper Rate,1678.00
Blue Cross,HMO,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Grouper Rate,1678.00
Blue Cross,HMO,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Grouper Rate,1678.00
Blue Cross,HMO,0406T,CPT4/HCPCS,SIN NDSC PLMT DRG ELUT MPLNT,,Grouper Rate,3544.00
Blue Cross,HMO,0407T,CPT4/HCPCS,SIN NDSC PLMT DRG ELUT MPLNT,,Grouper Rate,3544.00
Blue Cross,HMO,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Grouper Rate,3544.00
Blue Cross,HMO,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Grouper Rate,1678.88
Blue Cross,HMO,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Grouper Rate,3544.00
Blue Cross,HMO,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Grouper Rate,3544.00
Blue Cross,HMO,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Grouper Rate,1678.88
Blue Cross,HMO,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Grouper Rate,1678.88
Blue Cross,HMO,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Grouper Rate,1678.88
Blue Cross,HMO,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Grouper Rate,1678.88
Blue Cross,HMO,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Grouper Rate,3544.00
Blue Cross,HMO,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,3544.00
Blue Cross,HMO,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,3544.00
Blue Cross,HMO,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Grouper Rate,3544.00
Blue Cross,HMO,0424T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA COMPL,,Grouper Rate,1678.88
Blue Cross,HMO,0425T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA SEN LD,,Grouper Rate,1678.00
Blue Cross,HMO,0426T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA STM LD,,Grouper Rate,1678.00
Blue Cross,HMO,0427T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA PLS GN,,Grouper Rate,1678.88
Blue Cross,HMO,0428T,CPT4/HCPCS,RMVL NSTIM APNEA PLS GEN,,Grouper Rate,1678.00
Blue Cross,HMO,0429T,CPT4/HCPCS,RMVL NSTIM APNEA SEN LD,,Grouper Rate,1678.00
Blue Cross,HMO,0430T,CPT4/HCPCS,RMVL NSTIM APNEA STIMJ LD,,Grouper Rate,1678.00
Blue Cross,HMO,0431T,CPT4/HCPCS,RMVL/RPLC NSTIM APNEA PLS GN,,Grouper Rate,1678.88
Blue Cross,HMO,0432T,CPT4/HCPCS,REPOS NSTIM APNEA STIMJ LD,,Grouper Rate,1678.00
Blue Cross,HMO,0433T,CPT4/HCPCS,REPOS NSTIM APNEA SENSING LD,,Grouper Rate,1678.00
Blue Cross,HMO,0437T,CPT4/HCPCS,IMPLTJ SYNTH RNFCMT ABDL WAL,,Grouper Rate,1678.00
Blue Cross,HMO,0438T,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Grouper Rate,1678.00
Blue Cross,HMO,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Grouper Rate,1678.00
Blue Cross,HMO,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Grouper Rate,1678.00
Blue Cross,HMO,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Grouper Rate,1678.00
Blue Cross,HMO,0444T,CPT4/HCPCS,1ST PLMT DRUG ELUT OC INS,,Grouper Rate,1678.00
Blue Cross,HMO,0445T,CPT4/HCPCS,SBSQT PLMT DRUG ELUT OC INS,,Grouper Rate,1678.00
Blue Cross,HMO,0446T,CPT4/HCPCS,INSJ IMPLTBL GLUCOSE SENSOR,,Grouper Rate,3544.00
Blue Cross,HMO,0447T,CPT4/HCPCS,RMVL IMPLTBL GLUCOSE SENSOR,,Grouper Rate,1678.00
Blue Cross,HMO,0448T,CPT4/HCPCS,REMVL INSJ IMPLTBL GLUC SENS,,Grouper Rate,3544.00
Blue Cross,HMO,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Grouper Rate,1678.88
Blue Cross,HMO,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Grouper Rate,1678.88
Blue Cross,HMO,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,Grouper Rate,5029.00
Blue Cross,HMO,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,Grouper Rate,5029.00
Blue Cross,HMO,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Grouper Rate,5029.00
Blue Cross,HMO,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Grouper Rate,5029.00
Blue Cross,HMO,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,Grouper Rate,3544.00
Blue Cross,HMO,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,Grouper Rate,3544.00
Blue Cross,HMO,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Grouper Rate,3544.00
Blue Cross,HMO,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Grouper Rate,3544.00
Blue Cross,HMO,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,Grouper Rate,3544.00
Blue Cross,HMO,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Grouper Rate,1678.88
Blue Cross,HMO,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,Grouper Rate,5029.00
Blue Cross,HMO,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,Grouper Rate,1678.88
Blue Cross,HMO,0466T,CPT4/HCPCS,INSJ CH WAL RESPIR ELTRD/RA,,Grouper Rate,1678.00
Blue Cross,HMO,0467T,CPT4/HCPCS,REVJ/RPLMNT CH RESPIR ELTRD,,Grouper Rate,1678.88
Blue Cross,HMO,0468T,CPT4/HCPCS,RMVL CH WAL RESPIR ELTRD/RA,,Grouper Rate,1678.88
Blue Cross,HMO,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Grouper Rate,1678.00
Blue Cross,HMO,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Grouper Rate,1678.00
Blue Cross,HMO,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Grouper Rate,1678.88
Blue Cross,HMO,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,Grouper Rate,8012.00
Blue Cross,HMO,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,Grouper Rate,8012.00
Blue Cross,HMO,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Grouper Rate,3544.00
Blue Cross,HMO,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Grouper Rate,3544.00
Blue Cross,HMO,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Grouper Rate,1678.00
Blue Cross,HMO,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Grouper Rate,1678.00
Blue Cross,HMO,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,Grouper Rate,3544.00
Blue Cross,HMO,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Grouper Rate,1678.88
Blue Cross,HMO,0505T,CPT4/HCPCS,EV FEMPOP ARTL REVSC,,Grouper Rate,5281.00
Blue Cross,HMO,0510T,CPT4/HCPCS,RMVL SINUS TARSI IMPLANT,,Grouper Rate,3544.00
Blue Cross,HMO,0511T,CPT4/HCPCS,RMVL&RINSJ SINUS TARSI IMPLT,,Grouper Rate,5281.00
Blue Cross,HMO,0512T,CPT4/HCPCS,ESW INTEG WND HLG 1ST WND,,Grouper Rate,1678.88
Blue Cross,HMO,0513T,CPT4/HCPCS,ESW INTEG WND HLG EA ADDL,,Grouper Rate,1678.88
Blue Cross,HMO,0514T,CPT4/HCPCS,INTRAOP VIS AXIS ID PT FIXJ,,Grouper Rate,1678.00
Blue Cross,HMO,0515T,CPT4/HCPCS,INSJ WCS LV COMPL SYS,,Grouper Rate,5281.00
Blue Cross,HMO,0516T,CPT4/HCPCS,INSJ WCS LV ELTRD ONLY,,Grouper Rate,5281.00
Blue Cross,HMO,0517T,CPT4/HCPCS,INSJ WCS LV PG COMPNT,,Grouper Rate,5281.00
Blue Cross,HMO,0518T,CPT4/HCPCS,RMVL PG COMPNT WCS,,Grouper Rate,1678.88
Blue Cross,HMO,0519T,CPT4/HCPCS,RMVL & RPLCMT PG COMPNT WCS,,Grouper Rate,5281.00
Blue Cross,HMO,0520T,CPT4/HCPCS,RMVL&RPLCMT PG WCS NEW ELTRD,,Grouper Rate,5281.00
Blue Cross,HMO,0524T,CPT4/HCPCS,EV CATH DIR CHEM ABLTJ W/IMG,,Grouper Rate,3544.00
Blue Cross,HMO,0525T,CPT4/HCPCS,INSJ/RPLCMT COMPL IIMS,,Grouper Rate,3544.00
Blue Cross,HMO,0526T,CPT4/HCPCS,INSJ/RPLCMT IIMS ELTRD ONLY,,Grouper Rate,3544.00
Blue Cross,HMO,0527T,CPT4/HCPCS,INSJ/RPLCMT IIMS IMPLT MNTR,,Grouper Rate,3544.00
Blue Cross,HMO,0530T,CPT4/HCPCS,REMOVAL COMPLETE IIMS,,Grouper Rate,3544.00
Blue Cross,HMO,0531T,CPT4/HCPCS,REMOVAL IIMS ELECTRODE ONLY,,Grouper Rate,3544.00
Blue Cross,HMO,0532T,CPT4/HCPCS,REMOVAL IIMS IMPLT MNTR ONLY,,Grouper Rate,3544.00
Blue Cross,HMO,0537T,CPT4/HCPCS,BLD DRV T LYMPHCYT CAR-T CLL,,Grouper Rate,1678.00
Blue Cross,HMO,0538T,CPT4/HCPCS,BLD DRV T LYMPHCYT PREP TRNS,,Grouper Rate,1678.00
Blue Cross,HMO,0539T,CPT4/HCPCS,RECEIPT&PREP CAR-T CLL ADMN,,Grouper Rate,1678.00
Blue Cross,HMO,0540T,CPT4/HCPCS,CAR-T CLL ADMN AUTOLOGOUS,,Grouper Rate,1678.88
Blue Cross,HMO,0565T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS HRVG,,Grouper Rate,3544.00
Blue Cross,HMO,0566T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS NJX,,Grouper Rate,3544.00
Blue Cross,HMO,0567T,CPT4/HCPCS,PERM FLP TUBE OCCLS W/IMPLT,,Grouper Rate,3544.00
Blue Cross,HMO,0568T,CPT4/HCPCS,INTRO MIX SALINE&AIR F/SSG,,Grouper Rate,1678.00
Blue Cross,HMO,0569T,CPT4/HCPCS,TTVR PERQ APPR 1ST PROSTH,,Grouper Rate,8012.00
Blue Cross,HMO,0570T,CPT4/HCPCS,TTVR PERQ EA ADDL PROSTH,,Grouper Rate,8012.00
Blue Cross,HMO,0571T,CPT4/HCPCS,INSJ/RPLCMT ICDS SS ELTRD,,Grouper Rate,5281.00
Blue Cross,HMO,0572T,CPT4/HCPCS,INSERTION SS DFB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,HMO,0573T,CPT4/HCPCS,REMOVAL SS DFB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,HMO,0574T,CPT4/HCPCS,REPOS PREV SS IMPL DFB ELTRD,,Grouper Rate,1678.88
Blue Cross,HMO,0580T,CPT4/HCPCS,RMVL SS IMPL DFB PG ONLY,,Grouper Rate,5029.00
Blue Cross,HMO,0581T,CPT4/HCPCS,ABLTJ MAL BRST TUM PERQ CRTX,,Grouper Rate,3544.00
Blue Cross,HMO,0582T,CPT4/HCPCS,TRURL ABLTJ MAL PRST8 TISS,,Grouper Rate,5029.00
Blue Cross,HMO,0583T,CPT4/HCPCS,TMPST AUTO TUBE DLVR SYS,,Grouper Rate,1678.00
Blue Cross,HMO,0584T,CPT4/HCPCS,PERQ ISLET CELL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,HMO,0585T,CPT4/HCPCS,LAPS ISLET CELL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,HMO,0586T,CPT4/HCPCS,OPEN ISLET CELL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,HMO,0587T,CPT4/HCPCS,PERQ IMPLTJ/RPLCMT ISDNS PTN,,Grouper Rate,3544.00
Blue Cross,HMO,0588T,CPT4/HCPCS,REVISION/REMOVAL ISDNS PTN,,Grouper Rate,1678.88
Blue Cross,HMO,0DQP0ZZ,ICD10-PCS,Repair Rectum, Open Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0DQP8ZZ,ICD10-PCS,Repair Rectum, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,HMO,0DQR0ZZ,ICD10-PCS,Repair Anal Sphincter, Open Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0DQR4ZZ,ICD10-PCS,Repair Anal Sphincter, Percutaneous Endoscopic Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0Q820ZZ,ICD10-PCS,Division of Right Pelvic Bone, Open Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0Q834ZZ,ICD10-PCS,Division of Left Pelvic Bone, Perc Endo Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0TQB0ZZ,ICD10-PCS,Repair Bladder, Open Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0TQB8ZZ,ICD10-PCS,Repair Bladder, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,HMO,0TQD7ZZ,ICD10-PCS,Repair Urethra, Via Natural or Artificial Opening,,Fee Schedule,4303.00
Blue Cross,HMO,0TQD8ZZ,ICD10-PCS,Repair Urethra, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,HMO,0TQDXZZ,ICD10-PCS,Repair Urethra, External Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0UQ98ZZ,ICD10-PCS,Repair Uterus, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,HMO,0UQC0ZZ,ICD10-PCS,Repair Cervix, Open Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0UQC8ZZ,ICD10-PCS,Repair Cervix, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,HMO,0UQG8ZZ,ICD10-PCS,Repair Vagina, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,HMO,0UQGXZZ,ICD10-PCS,Repair Vagina, External Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0UQMXZZ,ICD10-PCS,Repair Vulva, External Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0W8NXZZ,ICD10-PCS,Division of Female Perineum, External Approach,,Fee Schedule,4303.00
Blue Cross,HMO,0WQNXZZ,ICD10-PCS,Repair Female Perineum, External Approach,,Fee Schedule,4303.00
Blue Cross,HMO,1,DRG,Heart transplant or implant of heart assist system w MCC,,Case Rate,479084.40
Blue Cross,HMO,10,DRG,Pancreas transplant,,Case Rate,59836.75
Blue Cross,HMO,100,DRG,Seizures w MCC,,Case Rate,30989.34
Blue Cross,HMO,10004,CPT4/HCPCS,FNA BX W/O IMG GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,10005,CPT4/HCPCS,FNA BX W/US GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,HMO,10006,CPT4/HCPCS,FNA BX W/US GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,10007,CPT4/HCPCS,FNA BX W/FLUOR GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,HMO,10008,CPT4/HCPCS,FNA BX W/FLUOR GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,10009,CPT4/HCPCS,FNA BX W/CT GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,HMO,10010,CPT4/HCPCS,FNA BX W/CT GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,10011,CPT4/HCPCS,FNA BX W/MR GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,HMO,10012,CPT4/HCPCS,FNA BX W/MR GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,HMO,10022,CPT4/HCPCS,FNA W/IMAGE,,Grouper Rate,1678.00
Blue Cross,HMO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Grouper Rate,1678.00
Blue Cross,HMO,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Grouper Rate,1678.00
Blue Cross,HMO,10036,CPT4/HCPCS,PERQ DEV SOFT TISS ADD IMAG,,Grouper Rate,1678.00
Blue Cross,HMO,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,1678.88
Blue Cross,HMO,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,1678.88
Blue Cross,HMO,101,DRG,Seizures w/o MCC,,Case Rate,14670.98
Blue Cross,HMO,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Grouper Rate,1678.00
Blue Cross,HMO,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Grouper Rate,1678.00
Blue Cross,HMO,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Grouper Rate,1678.88
Blue Cross,HMO,102,DRG,Headaches w MCC,,Case Rate,19049.11
Blue Cross,HMO,103,DRG,Headaches w/o MCC,,Case Rate,13698.42
Blue Cross,HMO,10900ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Open Approach,,Fee Schedule,4303.00
Blue Cross,HMO,10903ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Perc Approach,,Fee Schedule,4303.00
Blue Cross,HMO,10904ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Perc Endo Approach,,Fee Schedule,4303.00
Blue Cross,HMO,10907ZA,ICD10-PCS,Drainage of Fetal Cerebrospinal Fluid from POC, Via Opening,,Fee Schedule,4303.00
Blue Cross,HMO,10907ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Via Opening,,Fee Schedule,4303.00
Blue Cross,HMO,10908ZA,ICD10-PCS,Drainage of Fetal Cerebrospinal Fluid from POC, Endo,,Fee Schedule,4303.00
Blue Cross,HMO,10908ZC,ICD10-PCS,Drainage of Amniotic Fluid, Therapeutic from POC, Endo,,Fee Schedule,4303.00
Blue Cross,HMO,10D00Z0,ICD10-PCS,Extraction of Products of Conception, High, Open Approach,,Fee Schedule,4303.00
Blue Cross,HMO,10D00Z2,ICD10-PCS,Extraction of POC, Extraperitoneal, Open Approach,,Fee Schedule,4303.00
Blue Cross,HMO,10D07Z3,ICD10-PCS,Extraction of POC, Low Forceps, Via Opening,,Fee Schedule,4303.00
Blue Cross,HMO,10D07Z8,ICD10-PCS,Extraction of Products of Conception, Other, Via Opening,,Fee Schedule,4303.00
Blue Cross,HMO,10E0XZZ,ICD10-PCS,Delivery of Products of Conception, External Approach,,Fee Schedule,4303.00
Blue Cross,HMO,10S0XZZ,ICD10-PCS,Reposition Products of Conception, External Approach,,Fee Schedule,4303.00
Blue Cross,HMO,11,DRG,Tracheostomy for face,mouth & neck diagnoses w MCC,,Case Rate,82971.25
Blue Cross,HMO,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Grouper Rate,1678.00
Blue Cross,HMO,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,Grouper Rate,1678.00
Blue Cross,HMO,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,Grouper Rate,1678.00
Blue Cross,HMO,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,Grouper Rate,1678.88
Blue Cross,HMO,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,Grouper Rate,1678.00
Blue Cross,HMO,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Grouper Rate,1678.00
Blue Cross,HMO,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Grouper Rate,1678.88
Blue Cross,HMO,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Grouper Rate,1678.88
Blue Cross,HMO,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,HMO,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,HMO,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,HMO,11045,CPT4/HCPCS,DEB SUBQ TISSUE ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,11046,CPT4/HCPCS,DEB MUSC/FASCIA ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,11047,CPT4/HCPCS,DEB BONE ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,11102,CPT4/HCPCS,TANGNTL BX SKIN SINGLE LES,,Grouper Rate,1678.00
Blue Cross,HMO,11103,CPT4/HCPCS,TANGNTL BX SKIN EA SEP/ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,11104,CPT4/HCPCS,PUNCH BX SKIN SINGLE LESION,,Grouper Rate,1678.00
Blue Cross,HMO,11105,CPT4/HCPCS,PUNCH BX SKIN EA SEP/ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,11106,CPT4/HCPCS,INCAL BX SKN SINGLE LES,,Grouper Rate,1678.00
Blue Cross,HMO,11107,CPT4/HCPCS,INCAL BX SKN EA SEP/ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,113,DRG,Orbital procedures w CC/MCC,,Case Rate,36252.37
Blue Cross,HMO,11303,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Grouper Rate,1678.00
Blue Cross,HMO,114,DRG,Orbital procedures w/o CC/MCC,,Case Rate,23908.57
Blue Cross,HMO,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,Grouper Rate,1678.88
Blue Cross,HMO,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,Grouper Rate,1678.88
Blue Cross,HMO,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Grouper Rate,1678.88
Blue Cross,HMO,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Grouper Rate,1678.88
Blue Cross,HMO,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Grouper Rate,1678.88
Blue Cross,HMO,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Grouper Rate,1678.88
Blue Cross,HMO,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Grouper Rate,1678.88
Blue Cross,HMO,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Grouper Rate,1678.88
Blue Cross,HMO,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,HMO,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,HMO,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,HMO,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,HMO,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,HMO,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,HMO,115,DRG,Extraocular procedures except orbit,,Case Rate,24037.58
Blue Cross,HMO,116,DRG,Intraocular procedures w CC/MCC,,Case Rate,31048.88
Blue Cross,HMO,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Grouper Rate,1678.88
Blue Cross,HMO,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Grouper Rate,1678.00
Blue Cross,HMO,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Grouper Rate,1678.88
Blue Cross,HMO,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Grouper Rate,1678.88
Blue Cross,HMO,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Grouper Rate,1678.88
Blue Cross,HMO,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Grouper Rate,1678.88
Blue Cross,HMO,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Grouper Rate,1678.88
Blue Cross,HMO,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Grouper Rate,1678.88
Blue Cross,HMO,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Grouper Rate,1678.88
Blue Cross,HMO,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Grouper Rate,1678.88
Blue Cross,HMO,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Grouper Rate,1678.88
Blue Cross,HMO,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Grouper Rate,1678.88
Blue Cross,HMO,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,117,DRG,Intraocular procedures w/o CC/MCC,,Case Rate,17183.40
Blue Cross,HMO,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Grouper Rate,1678.00
Blue Cross,HMO,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Grouper Rate,1678.00
Blue Cross,HMO,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Grouper Rate,1678.00
Blue Cross,HMO,11752,CPT4/HCPCS,REMOVE NAIL BED/TIP,,Grouper Rate,1678.00
Blue Cross,HMO,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Grouper Rate,1678.00
Blue Cross,HMO,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Grouper Rate,3544.00
Blue Cross,HMO,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Grouper Rate,3544.00
Blue Cross,HMO,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Grouper Rate,3544.00
Blue Cross,HMO,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Grouper Rate,1678.00
Blue Cross,HMO,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Grouper Rate,1678.00
Blue Cross,HMO,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Grouper Rate,1678.00
Blue Cross,HMO,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Grouper Rate,1678.88
Blue Cross,HMO,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Grouper Rate,5029.00
Blue Cross,HMO,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Grouper Rate,1678.00
Blue Cross,HMO,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Grouper Rate,1678.00
Blue Cross,HMO,12,DRG,Tracheostomy for face,mouth & neck diagnoses w CC,,Case Rate,63379.62
Blue Cross,HMO,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Grouper Rate,1678.88
Blue Cross,HMO,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,Grouper Rate,1678.88
Blue Cross,HMO,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Grouper Rate,1678.88
Blue Cross,HMO,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Grouper Rate,1678.88
Blue Cross,HMO,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Grouper Rate,1678.88
Blue Cross,HMO,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Grouper Rate,1678.88
Blue Cross,HMO,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,Grouper Rate,1678.88
Blue Cross,HMO,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,Grouper Rate,1678.88
Blue Cross,HMO,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Grouper Rate,1678.88
Blue Cross,HMO,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Grouper Rate,1678.88
Blue Cross,HMO,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Grouper Rate,1678.88
Blue Cross,HMO,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Grouper Rate,1678.88
Blue Cross,HMO,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Grouper Rate,1678.88
Blue Cross,HMO,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,1678.00
Blue Cross,HMO,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,1678.00
Blue Cross,HMO,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Grouper Rate,1678.88
Blue Cross,HMO,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Grouper Rate,1678.88
Blue Cross,HMO,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Grouper Rate,1678.88
Blue Cross,HMO,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Grouper Rate,1678.88
Blue Cross,HMO,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Grouper Rate,1678.88
Blue Cross,HMO,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Grouper Rate,1678.88
Blue Cross,HMO,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Grouper Rate,1678.00
Blue Cross,HMO,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Grouper Rate,1678.00
Blue Cross,HMO,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Grouper Rate,1678.88
Blue Cross,HMO,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Grouper Rate,1678.88
Blue Cross,HMO,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Grouper Rate,1678.88
Blue Cross,HMO,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Grouper Rate,1678.88
Blue Cross,HMO,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Grouper Rate,1678.00
Blue Cross,HMO,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Grouper Rate,1678.00
Blue Cross,HMO,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Grouper Rate,1678.88
Blue Cross,HMO,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Grouper Rate,1678.88
Blue Cross,HMO,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Grouper Rate,1678.88
Blue Cross,HMO,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Grouper Rate,1678.88
Blue Cross,HMO,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Grouper Rate,1678.88
Blue Cross,HMO,121,DRG,Acute major eye infections w CC/MCC,,Case Rate,19661.09
Blue Cross,HMO,122,DRG,Acute major eye infections w/o CC/MCC,,Case Rate,10648.45
Blue Cross,HMO,123,DRG,Neurological eye disorders,,Case Rate,12658.06
Blue Cross,HMO,124,DRG,Other disorders of the eye w MCC,,Case Rate,23136.15
Blue Cross,HMO,125,DRG,Other disorders of the eye w/o MCC,,Case Rate,13817.51
Blue Cross,HMO,13,DRG,Tracheostomy for face,mouth & neck diagnoses w/o CC/MCC,,Case Rate,44997.07
Blue Cross,HMO,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Grouper Rate,1678.88
Blue Cross,HMO,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Grouper Rate,1678.88
Blue Cross,HMO,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Grouper Rate,1678.00
Blue Cross,HMO,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Grouper Rate,1678.88
Blue Cross,HMO,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Grouper Rate,1678.00
Blue Cross,HMO,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1678.88
Blue Cross,HMO,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,3544.00
Blue Cross,HMO,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1678.00
Blue Cross,HMO,13150,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.0 CM/<,,Grouper Rate,3544.00
Blue Cross,HMO,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Grouper Rate,1678.00
Blue Cross,HMO,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Grouper Rate,1678.88
Blue Cross,HMO,135,DRG,Sinus & mastoid procedures w CC/MCC,,Case Rate,35405.52
Blue Cross,HMO,136,DRG,Sinus & mastoid procedures w/o CC/MCC,,Case Rate,20765.97
Blue Cross,HMO,137,DRG,Mouth procedures w CC/MCC,,Case Rate,24290.64
Blue Cross,HMO,138,DRG,Mouth procedures w/o CC/MCC,,Case Rate,13944.87
Blue Cross,HMO,139,DRG,Salivary gland procedures,,Case Rate,20291.27
Blue Cross,HMO,14,DRG,Allogeneic bone marrow transplant,,Case Rate,211361.35
Blue Cross,HMO,140,DRG,MAJOR HEAD AND NECK PROCEDURES WITH MCC,,Case Rate,65839.12
Blue Cross,HMO,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,HMO,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Grouper Rate,3544.00
Blue Cross,HMO,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Grouper Rate,3544.00
Blue Cross,HMO,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Grouper Rate,3544.00
Blue Cross,HMO,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,1678.88
Blue Cross,HMO,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,3544.00
Blue Cross,HMO,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Grouper Rate,3544.00
Blue Cross,HMO,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Grouper Rate,3544.00
Blue Cross,HMO,141,DRG,MAJOR HEAD AND NECK PROCEDURES WITH CC,,Case Rate,36512.05
Blue Cross,HMO,142,DRG,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,,Case Rate,26609.55
Blue Cross,HMO,143,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC,,Case Rate,49021.25
Blue Cross,HMO,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Grouper Rate,5029.00
Blue Cross,HMO,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Grouper Rate,1678.88
Blue Cross,HMO,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Grouper Rate,3544.00
Blue Cross,HMO,144,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC,,Case Rate,28953.27
Blue Cross,HMO,145,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,,Case Rate,20071.29
Blue Cross,HMO,146,DRG,Ear, nose, mouth & throat malignancy w MCC,,Case Rate,33627.47
Blue Cross,HMO,147,DRG,Ear, nose, mouth & throat malignancy w CC,,Case Rate,21520.19
Blue Cross,HMO,148,DRG,Ear, nose, mouth & throat malignancy w/o CC/MCC,,Case Rate,13005.40
Blue Cross,HMO,149,DRG,Dysequilibrium,,Case Rate,12165.17
Blue Cross,HMO,150,DRG,Epistaxis w MCC,,Case Rate,21910.53
Blue Cross,HMO,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Grouper Rate,1678.00
Blue Cross,HMO,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Grouper Rate,1678.00
Blue Cross,HMO,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Grouper Rate,1678.88
Blue Cross,HMO,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Grouper Rate,1678.00
Blue Cross,HMO,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Grouper Rate,1678.00
Blue Cross,HMO,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Grouper Rate,1678.00
Blue Cross,HMO,151,DRG,Epistaxis w/o MCC,,Case Rate,12189.98
Blue Cross,HMO,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,HMO,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,HMO,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Grouper Rate,1678.88
Blue Cross,HMO,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Grouper Rate,1678.88
Blue Cross,HMO,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Grouper Rate,1678.00
Blue Cross,HMO,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,HMO,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Grouper Rate,1678.88
Blue Cross,HMO,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Grouper Rate,1678.00
Blue Cross,HMO,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Grouper Rate,1678.00
Blue Cross,HMO,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Grouper Rate,1678.00
Blue Cross,HMO,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Grouper Rate,1678.88
Blue Cross,HMO,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Grouper Rate,1678.00
Blue Cross,HMO,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Grouper Rate,1678.88
Blue Cross,HMO,152,DRG,Otitis media & URI w MCC,,Case Rate,17811.92
Blue Cross,HMO,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Grouper Rate,3544.00
Blue Cross,HMO,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,HMO,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Grouper Rate,3544.00
Blue Cross,HMO,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Grouper Rate,1678.88
Blue Cross,HMO,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Grouper Rate,1678.00
Blue Cross,HMO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Grouper Rate,1678.00
Blue Cross,HMO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Grouper Rate,1678.00
Blue Cross,HMO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Grouper Rate,1678.00
Blue Cross,HMO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Grouper Rate,1678.00
Blue Cross,HMO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Grouper Rate,1678.00
Blue Cross,HMO,153,DRG,Otitis media & URI w/o MCC,,Case Rate,11753.32
Blue Cross,HMO,154,DRG,Nasal trauma & deformity w MCC,,Case Rate,25512.95
Blue Cross,HMO,155,DRG,Nasal trauma & deformity w CC,,Case Rate,14998.47
Blue Cross,HMO,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Grouper Rate,3544.00
Blue Cross,HMO,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Grouper Rate,3544.00
Blue Cross,HMO,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Grouper Rate,3544.00
Blue Cross,HMO,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Grouper Rate,3544.00
Blue Cross,HMO,156,DRG,Nasal trauma & deformity w/o CC/MCC,,Case Rate,10876.70
Blue Cross,HMO,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Grouper Rate,3544.00
Blue Cross,HMO,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Grouper Rate,3544.00
Blue Cross,HMO,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Grouper Rate,3544.00
Blue Cross,HMO,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Grouper Rate,3544.00
Blue Cross,HMO,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Grouper Rate,5281.00
Blue Cross,HMO,157,DRG,Dental & Oral Diseases w MCC,,Case Rate,26007.49
Blue Cross,HMO,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Grouper Rate,1678.88
Blue Cross,HMO,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Grouper Rate,1678.88
Blue Cross,HMO,15732,CPT4/HCPCS,MUSCLE-SKIN GRAFT HEAD/NECK,,Grouper Rate,3544.00
Blue Cross,HMO,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Grouper Rate,3544.00
Blue Cross,HMO,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Grouper Rate,3544.00
Blue Cross,HMO,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Grouper Rate,3544.00
Blue Cross,HMO,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Grouper Rate,3544.00
Blue Cross,HMO,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Grouper Rate,1678.88
Blue Cross,HMO,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Grouper Rate,1678.88
Blue Cross,HMO,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Grouper Rate,5281.00
Blue Cross,HMO,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Grouper Rate,5281.00
Blue Cross,HMO,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Grouper Rate,5281.00
Blue Cross,HMO,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Grouper Rate,1678.88
Blue Cross,HMO,15769,CPT4/HCPCS,GRFG AUTOL SOFT TISS DIR EXC,,Grouper Rate,5029.00
Blue Cross,HMO,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,15771,CPT4/HCPCS,GRFG AUTOL FAT LIPO 50 CC/<,,Grouper Rate,3544.00
Blue Cross,HMO,15772,CPT4/HCPCS,GRFG AUTOL FAT LIPO EA ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,15773,CPT4/HCPCS,GRFG AUTOL FAT LIPO 25 CC/<,,Grouper Rate,3544.00
Blue Cross,HMO,15774,CPT4/HCPCS,GFRG AUTOL FAT LIPO EA ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,Grouper Rate,1678.00
Blue Cross,HMO,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,Grouper Rate,1678.00
Blue Cross,HMO,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,Grouper Rate,1678.00
Blue Cross,HMO,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,Grouper Rate,1678.00
Blue Cross,HMO,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,Grouper Rate,1678.00
Blue Cross,HMO,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,158,DRG,Dental & Oral Diseases w CC,,Case Rate,14705.71
Blue Cross,HMO,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Grouper Rate,1678.88
Blue Cross,HMO,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,1678.88
Blue Cross,HMO,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,1678.88
Blue Cross,HMO,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,1678.88
Blue Cross,HMO,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,1678.88
Blue Cross,HMO,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Grouper Rate,3544.00
Blue Cross,HMO,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Grouper Rate,1678.88
Blue Cross,HMO,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Grouper Rate,1678.88
Blue Cross,HMO,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Grouper Rate,3544.00
Blue Cross,HMO,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Grouper Rate,3544.00
Blue Cross,HMO,15830,CPT4/HCPCS,EXC SKIN ABD,,Grouper Rate,3544.00
Blue Cross,HMO,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Grouper Rate,1678.88
Blue Cross,HMO,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Grouper Rate,3544.00
Blue Cross,HMO,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Grouper Rate,3544.00
Blue Cross,HMO,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Grouper Rate,3544.00
Blue Cross,HMO,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Grouper Rate,1678.88
Blue Cross,HMO,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Grouper Rate,1678.88
Blue Cross,HMO,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Grouper Rate,1678.88
Blue Cross,HMO,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Grouper Rate,1678.88
Blue Cross,HMO,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Grouper Rate,5029.00
Blue Cross,HMO,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Grouper Rate,1678.00
Blue Cross,HMO,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Grouper Rate,1678.00
Blue Cross,HMO,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Grouper Rate,1678.00
Blue Cross,HMO,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Grouper Rate,1678.88
Blue Cross,HMO,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Grouper Rate,3544.00
Blue Cross,HMO,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Grouper Rate,1678.88
Blue Cross,HMO,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Grouper Rate,1678.88
Blue Cross,HMO,159,DRG,Dental & Oral Diseases w/o CC/MCC,,Case Rate,10846.93
Blue Cross,HMO,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,3544.00
Blue Cross,HMO,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,5029.00
Blue Cross,HMO,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,1678.88
Blue Cross,HMO,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,HMO,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,HMO,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,HMO,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,HMO,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,HMO,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,1678.88
Blue Cross,HMO,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,HMO,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,HMO,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,HMO,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,HMO,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,HMO,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,HMO,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,HMO,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,HMO,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,HMO,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,HMO,16,DRG,Autologous bone marrow transplant w CC/MCC,,Case Rate,111251.34
Blue Cross,HMO,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Grouper Rate,1678.00
Blue Cross,HMO,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Grouper Rate,1678.00
Blue Cross,HMO,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Grouper Rate,1678.88
Blue Cross,HMO,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,Grouper Rate,1678.00
Blue Cross,HMO,163,DRG,Major chest procedures w MCC,,Case Rate,82031.78
Blue Cross,HMO,164,DRG,Major chest procedures w CC,,Case Rate,43596.13
Blue Cross,HMO,165,DRG,Major chest procedures w/o CC/MCC,,Case Rate,31568.24
Blue Cross,HMO,166,DRG,Other resp system O.R. procedures w MCC,,Case Rate,62681.63
Blue Cross,HMO,167,DRG,Other resp system O.R. procedures w CC,,Case Rate,30780.94
Blue Cross,HMO,168,DRG,Other resp system O.R. procedures w/o CC/MCC,,Case Rate,22649.87
Blue Cross,HMO,17,DRG,Autologous bone marrow transplant w/o CC/MCC,,Case Rate,79891.50
Blue Cross,HMO,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1678.00
Blue Cross,HMO,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1678.00
Blue Cross,HMO,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1678.00
Blue Cross,HMO,175,DRG,Pulmonary embolism w MCC,,Case Rate,25541.06
Blue Cross,HMO,176,DRG,Pulmonary embolism w/o MCC,,Case Rate,14666.01
Blue Cross,HMO,177,DRG,Respiratory infections & inflammations w MCC,,Case Rate,30521.26
Blue Cross,HMO,178,DRG,Respiratory infections & inflammations w CC,,Case Rate,19945.58
Blue Cross,HMO,179,DRG,Respiratory infections & inflammations w/o CC/MCC,,Case Rate,14407.99
Blue Cross,HMO,18,DRG,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY,,Case Rate,617421.66
Blue Cross,HMO,180,DRG,Respiratory neoplasms w MCC,,Case Rate,28743.21
Blue Cross,HMO,181,DRG,Respiratory neoplasms w CC,,Case Rate,18539.68
Blue Cross,HMO,182,DRG,Respiratory neoplasms w/o CC/MCC,,Case Rate,13025.25
Blue Cross,HMO,183,DRG,Major chest trauma w MCC,,Case Rate,25729.62
Blue Cross,HMO,184,DRG,Major chest trauma w CC,,Case Rate,17191.67
Blue Cross,HMO,185,DRG,Major chest trauma w/o CC/MCC,,Case Rate,12795.34
Blue Cross,HMO,186,DRG,Pleural effusion w MCC,,Case Rate,25524.52
Blue Cross,HMO,187,DRG,Pleural effusion w CC,,Case Rate,17072.58
Blue Cross,HMO,188,DRG,Pleural effusion w/o CC/MCC,,Case Rate,12042.77
Blue Cross,HMO,189,DRG,Pulmonary edema & respiratory failure,,Case Rate,20258.19
Blue Cross,HMO,19,DRG,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,,Case Rate,110187.82
Blue Cross,HMO,190,DRG,Chronic obstructive pulmonary disease w MCC,,Case Rate,18589.30
Blue Cross,HMO,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Grouper Rate,1678.00
Blue Cross,HMO,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Grouper Rate,1678.88
Blue Cross,HMO,19030,CPT4/HCPCS,INJECTION FOR BREAST X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Grouper Rate,1678.88
Blue Cross,HMO,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,Grouper Rate,1678.88
Blue Cross,HMO,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Grouper Rate,1678.88
Blue Cross,HMO,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,Grouper Rate,1678.88
Blue Cross,HMO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Grouper Rate,1678.88
Blue Cross,HMO,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,Grouper Rate,1678.88
Blue Cross,HMO,191,DRG,Chronic obstructive pulmonary disease w CC,,Case Rate,14606.47
Blue Cross,HMO,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Grouper Rate,1678.00
Blue Cross,HMO,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Grouper Rate,1678.88
Blue Cross,HMO,19102,CPT4/HCPCS,BX BREAST PERCUT W/IMAGE,,Grouper Rate,1678.88
Blue Cross,HMO,19103,CPT4/HCPCS,BX BREAST PERCUT W/DEVICE,,Grouper Rate,1678.00
Blue Cross,HMO,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Grouper Rate,1678.88
Blue Cross,HMO,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Grouper Rate,3544.00
Blue Cross,HMO,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Grouper Rate,3544.00
Blue Cross,HMO,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Grouper Rate,3544.00
Blue Cross,HMO,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Grouper Rate,1678.88
Blue Cross,HMO,192,DRG,Chronic obstructive pulmonary disease w/o CC/MCC,,Case Rate,11493.64
Blue Cross,HMO,19260,CPT4/HCPCS,REMOVAL OF CHEST WALL LESION,,Grouper Rate,5281.00
Blue Cross,HMO,19271,CPT4/HCPCS,REVISION OF CHEST WALL,,Grouper Rate,5281.00
Blue Cross,HMO,19272,CPT4/HCPCS,EXTENSIVE CHEST WALL SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,Grouper Rate,1678.00
Blue Cross,HMO,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,Grouper Rate,1678.00
Blue Cross,HMO,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,Grouper Rate,1678.00
Blue Cross,HMO,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,Grouper Rate,1678.00
Blue Cross,HMO,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,Grouper Rate,1678.00
Blue Cross,HMO,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,Grouper Rate,1678.00
Blue Cross,HMO,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,Grouper Rate,1678.88
Blue Cross,HMO,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,Grouper Rate,1678.88
Blue Cross,HMO,19290,CPT4/HCPCS,PLACE NEEDLE WIRE BREAST,,Grouper Rate,1678.00
Blue Cross,HMO,19291,CPT4/HCPCS,PLACE NEEDLE WIRE BREAST,,Grouper Rate,1678.00
Blue Cross,HMO,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Grouper Rate,1678.00
Blue Cross,HMO,19295,CPT4/HCPCS,PLACE BREAST CLIP PERCUT,,Grouper Rate,1678.00
Blue Cross,HMO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Grouper Rate,1678.00
Blue Cross,HMO,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Grouper Rate,1678.00
Blue Cross,HMO,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Grouper Rate,1678.88
Blue Cross,HMO,193,DRG,Simple pneumonia & pleurisy w MCC,,Case Rate,21678.97
Blue Cross,HMO,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Grouper Rate,5029.00
Blue Cross,HMO,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Grouper Rate,3544.00
Blue Cross,HMO,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Grouper Rate,5029.00
Blue Cross,HMO,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Grouper Rate,5029.00
Blue Cross,HMO,19304,CPT4/HCPCS,MAST SUBQ,,Grouper Rate,5029.00
Blue Cross,HMO,19305,CPT4/HCPCS,MAST RADICAL,,Grouper Rate,5281.00
Blue Cross,HMO,19306,CPT4/HCPCS,MAST RAD URBAN TYPE,,Grouper Rate,5281.00
Blue Cross,HMO,19307,CPT4/HCPCS,MAST MOD RAD,,Grouper Rate,5281.00
Blue Cross,HMO,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Grouper Rate,5029.00
Blue Cross,HMO,19318,CPT4/HCPCS,BREAST REDUCTION,,Grouper Rate,5281.00
Blue Cross,HMO,19324,CPT4/HCPCS,ENLARGE BREAST,,Grouper Rate,5029.00
Blue Cross,HMO,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Grouper Rate,5029.00
Blue Cross,HMO,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Grouper Rate,1678.00
Blue Cross,HMO,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Grouper Rate,1678.00
Blue Cross,HMO,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Grouper Rate,1678.88
Blue Cross,HMO,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Grouper Rate,5029.00
Blue Cross,HMO,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,5029.00
Blue Cross,HMO,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Grouper Rate,1678.88
Blue Cross,HMO,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Grouper Rate,5029.00
Blue Cross,HMO,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,Grouper Rate,5281.00
Blue Cross,HMO,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Grouper Rate,5281.00
Blue Cross,HMO,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,5281.00
Blue Cross,HMO,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,Grouper Rate,5281.00
Blue Cross,HMO,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,Grouper Rate,5281.00
Blue Cross,HMO,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,Grouper Rate,5281.00
Blue Cross,HMO,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Grouper Rate,1678.88
Blue Cross,HMO,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Grouper Rate,5029.00
Blue Cross,HMO,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Grouper Rate,5281.00
Blue Cross,HMO,194,DRG,Simple pneumonia & pleurisy w CC,,Case Rate,14274.02
Blue Cross,HMO,195,DRG,Simple pneumonia & pleurisy w/o CC/MCC,,Case Rate,10999.10
Blue Cross,HMO,196,DRG,Interstitial lung disease w MCC,,Case Rate,28715.09
Blue Cross,HMO,197,DRG,Interstitial lung disease w CC,,Case Rate,16632.62
Blue Cross,HMO,198,DRG,Interstitial lung disease w/o CC/MCC,,Case Rate,12277.64
Blue Cross,HMO,199,DRG,Pneumothorax w MCC,,Case Rate,29566.90
Blue Cross,HMO,2,DRG,Heart transplant or implant of heart assist system w/o MCC,,Case Rate,263498.74
Blue Cross,HMO,20,DRG,Intracranial vascular procedures w PDX hemorrhage w MCC,,Case Rate,170694.45
Blue Cross,HMO,200,DRG,Pneumothorax w CC,,Case Rate,17780.50
Blue Cross,HMO,20005,CPT4/HCPCS,I&D ABSCESS SUBFASCIAL,,Grouper Rate,1678.88
Blue Cross,HMO,201,DRG,Pneumothorax w/o CC/MCC,,Case Rate,11735.13
Blue Cross,HMO,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,Grouper Rate,1678.88
Blue Cross,HMO,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,Grouper Rate,5029.00
Blue Cross,HMO,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,Grouper Rate,3544.00
Blue Cross,HMO,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Grouper Rate,1678.88
Blue Cross,HMO,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,Grouper Rate,5029.00
Blue Cross,HMO,202,DRG,Bronchitis & asthma w CC/MCC,,Case Rate,15971.02
Blue Cross,HMO,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Grouper Rate,1678.88
Blue Cross,HMO,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Grouper Rate,3544.00
Blue Cross,HMO,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Grouper Rate,1678.00
Blue Cross,HMO,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,1678.00
Blue Cross,HMO,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,1678.88
Blue Cross,HMO,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Grouper Rate,1678.88
Blue Cross,HMO,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Grouper Rate,3544.00
Blue Cross,HMO,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,3544.00
Blue Cross,HMO,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,3544.00
Blue Cross,HMO,203,DRG,Bronchitis & asthma w/o CC/MCC,,Case Rate,11668.97
Blue Cross,HMO,204,DRG,Respiratory signs & symptoms,,Case Rate,13107.95
Blue Cross,HMO,205,DRG,Other respiratory system diagnoses w MCC,,Case Rate,27825.24
Blue Cross,HMO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Grouper Rate,1678.00
Blue Cross,HMO,20501,CPT4/HCPCS,INJECT SINUS TRACT FOR X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,HMO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Grouper Rate,1678.00
Blue Cross,HMO,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Grouper Rate,1678.00
Blue Cross,HMO,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Grouper Rate,1678.00
Blue Cross,HMO,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Grouper Rate,1678.00
Blue Cross,HMO,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Grouper Rate,1678.00
Blue Cross,HMO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Grouper Rate,3544.00
Blue Cross,HMO,206,DRG,Other respiratory system diagnoses w/o MCC,,Case Rate,14624.66
Blue Cross,HMO,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1678.00
Blue Cross,HMO,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1678.00
Blue Cross,HMO,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1678.88
Blue Cross,HMO,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1678.88
Blue Cross,HMO,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,3544.00
Blue Cross,HMO,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,3544.00
Blue Cross,HMO,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Grouper Rate,1678.88
Blue Cross,HMO,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Grouper Rate,1678.00
Blue Cross,HMO,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Grouper Rate,3544.00
Blue Cross,HMO,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Grouper Rate,1678.88
Blue Cross,HMO,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Grouper Rate,3544.00
Blue Cross,HMO,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Grouper Rate,3544.00
Blue Cross,HMO,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Grouper Rate,3544.00
Blue Cross,HMO,20664,CPT4/HCPCS,APPLICATION OF HALO,,Grouper Rate,1678.88
Blue Cross,HMO,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Grouper Rate,1678.00
Blue Cross,HMO,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,1678.88
Blue Cross,HMO,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,3544.00
Blue Cross,HMO,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,1678.88
Blue Cross,HMO,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Grouper Rate,1678.00
Blue Cross,HMO,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Grouper Rate,1678.00
Blue Cross,HMO,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Grouper Rate,5029.00
Blue Cross,HMO,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Grouper Rate,5029.00
Blue Cross,HMO,207,DRG,Respiratory system diagnosis w ventilator support 96+ hours,,Case Rate,94714.65
Blue Cross,HMO,208,DRG,Respiratory system diagnosis w ventilator support <96 hours,,Case Rate,42049.64
Blue Cross,HMO,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,Grouper Rate,8012.00
Blue Cross,HMO,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,Grouper Rate,8012.00
Blue Cross,HMO,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,Grouper Rate,8012.00
Blue Cross,HMO,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Grouper Rate,5783.00
Blue Cross,HMO,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Grouper Rate,5783.00
Blue Cross,HMO,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Grouper Rate,6588.00
Blue Cross,HMO,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Grouper Rate,5029.00
Blue Cross,HMO,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,Grouper Rate,8012.00
Blue Cross,HMO,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,20926,CPT4/HCPCS,REMOVAL OF TISSUE FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,20932,CPT4/HCPCS,OSTEOART ALGRFT W/SURF & B1,,Grouper Rate,8841.00
Blue Cross,HMO,20933,CPT4/HCPCS,HEMICRT INTRCLRY ALGRFT PRTL,,Grouper Rate,8841.00
Blue Cross,HMO,20934,CPT4/HCPCS,INTERCALARY ALGRFT COMPL,,Grouper Rate,8841.00
Blue Cross,HMO,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Grouper Rate,1678.00
Blue Cross,HMO,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Grouper Rate,1678.00
Blue Cross,HMO,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,HMO,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,HMO,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,HMO,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,HMO,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,HMO,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Grouper Rate,5029.00
Blue Cross,HMO,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Grouper Rate,5029.00
Blue Cross,HMO,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Grouper Rate,5029.00
Blue Cross,HMO,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Grouper Rate,1678.00
Blue Cross,HMO,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,1678.88
Blue Cross,HMO,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,1678.88
Blue Cross,HMO,21,DRG,Intracranial vascular procedures w PDX hemorrhage w CC,,Case Rate,124572.66
Blue Cross,HMO,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Grouper Rate,1678.88
Blue Cross,HMO,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Grouper Rate,1678.00
Blue Cross,HMO,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Grouper Rate,1678.00
Blue Cross,HMO,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Grouper Rate,3544.00
Blue Cross,HMO,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Grouper Rate,1678.88
Blue Cross,HMO,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Grouper Rate,1678.88
Blue Cross,HMO,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Grouper Rate,1678.88
Blue Cross,HMO,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Grouper Rate,1678.88
Blue Cross,HMO,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Grouper Rate,1678.88
Blue Cross,HMO,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Grouper Rate,3544.00
Blue Cross,HMO,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Grouper Rate,3544.00
Blue Cross,HMO,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Grouper Rate,5029.00
Blue Cross,HMO,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Grouper Rate,5281.00
Blue Cross,HMO,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Grouper Rate,1678.88
Blue Cross,HMO,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Grouper Rate,3544.00
Blue Cross,HMO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Grouper Rate,1678.00
Blue Cross,HMO,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,HMO,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Grouper Rate,1678.88
Blue Cross,HMO,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Grouper Rate,1678.88
Blue Cross,HMO,21116,CPT4/HCPCS,INJECTION JAW JOINT X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,1678.88
Blue Cross,HMO,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,1678.88
Blue Cross,HMO,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,1678.88
Blue Cross,HMO,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,5029.00
Blue Cross,HMO,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,1678.88
Blue Cross,HMO,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,5029.00
Blue Cross,HMO,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,3544.00
Blue Cross,HMO,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5029.00
Blue Cross,HMO,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5281.00
Blue Cross,HMO,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Grouper Rate,5783.00
Blue Cross,HMO,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Grouper Rate,5783.00
Blue Cross,HMO,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,Grouper Rate,6588.00
Blue Cross,HMO,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,Grouper Rate,5783.00
Blue Cross,HMO,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Grouper Rate,5783.00
Blue Cross,HMO,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,Grouper Rate,5783.00
Blue Cross,HMO,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,Grouper Rate,6588.00
Blue Cross,HMO,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,Grouper Rate,6588.00
Blue Cross,HMO,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,Grouper Rate,6588.00
Blue Cross,HMO,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,Grouper Rate,6588.00
Blue Cross,HMO,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,Grouper Rate,5281.00
Blue Cross,HMO,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,Grouper Rate,5281.00
Blue Cross,HMO,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,5783.00
Blue Cross,HMO,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,3544.00
Blue Cross,HMO,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Grouper Rate,3544.00
Blue Cross,HMO,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Grouper Rate,3544.00
Blue Cross,HMO,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,5029.00
Blue Cross,HMO,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,5029.00
Blue Cross,HMO,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,5029.00
Blue Cross,HMO,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,Grouper Rate,5281.00
Blue Cross,HMO,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Grouper Rate,5281.00
Blue Cross,HMO,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,Grouper Rate,5281.00
Blue Cross,HMO,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Grouper Rate,5281.00
Blue Cross,HMO,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Grouper Rate,5281.00
Blue Cross,HMO,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Grouper Rate,5281.00
Blue Cross,HMO,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Grouper Rate,5783.00
Blue Cross,HMO,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Grouper Rate,5281.00
Blue Cross,HMO,21210,CPT4/HCPCS,FACE BONE GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Grouper Rate,6588.00
Blue Cross,HMO,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Grouper Rate,5783.00
Blue Cross,HMO,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Grouper Rate,6588.00
Blue Cross,HMO,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,HMO,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,HMO,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Grouper Rate,5281.00
Blue Cross,HMO,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,HMO,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,HMO,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Grouper Rate,5281.00
Blue Cross,HMO,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,Grouper Rate,5783.00
Blue Cross,HMO,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,HMO,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,HMO,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,HMO,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,6588.00
Blue Cross,HMO,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,HMO,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Grouper Rate,5281.00
Blue Cross,HMO,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Grouper Rate,6588.00
Blue Cross,HMO,21280,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5029.00
Blue Cross,HMO,21282,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5029.00
Blue Cross,HMO,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,5029.00
Blue Cross,HMO,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,5029.00
Blue Cross,HMO,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Grouper Rate,1678.88
Blue Cross,HMO,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Grouper Rate,1678.88
Blue Cross,HMO,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Grouper Rate,1678.88
Blue Cross,HMO,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Grouper Rate,5029.00
Blue Cross,HMO,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Grouper Rate,5281.00
Blue Cross,HMO,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Grouper Rate,6588.00
Blue Cross,HMO,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Grouper Rate,5281.00
Blue Cross,HMO,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Grouper Rate,1678.88
Blue Cross,HMO,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Grouper Rate,5029.00
Blue Cross,HMO,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Grouper Rate,5281.00
Blue Cross,HMO,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Grouper Rate,5029.00
Blue Cross,HMO,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Grouper Rate,5029.00
Blue Cross,HMO,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Grouper Rate,5029.00
Blue Cross,HMO,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Grouper Rate,3544.00
Blue Cross,HMO,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Grouper Rate,5281.00
Blue Cross,HMO,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Grouper Rate,5281.00
Blue Cross,HMO,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Grouper Rate,5029.00
Blue Cross,HMO,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Grouper Rate,5281.00
Blue Cross,HMO,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Grouper Rate,5029.00
Blue Cross,HMO,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Grouper Rate,5281.00
Blue Cross,HMO,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Grouper Rate,5281.00
Blue Cross,HMO,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Grouper Rate,5281.00
Blue Cross,HMO,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Grouper Rate,6588.00
Blue Cross,HMO,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Grouper Rate,6588.00
Blue Cross,HMO,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Grouper Rate,1678.00
Blue Cross,HMO,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Grouper Rate,1678.88
Blue Cross,HMO,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Grouper Rate,5029.00
Blue Cross,HMO,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Grouper Rate,5281.00
Blue Cross,HMO,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,Grouper Rate,5281.00
Blue Cross,HMO,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,1678.00
Blue Cross,HMO,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,1678.88
Blue Cross,HMO,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Grouper Rate,3544.00
Blue Cross,HMO,21495,CPT4/HCPCS,TREAT HYOID BONE FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Grouper Rate,1678.88
Blue Cross,HMO,215,DRG,Other heart assist system implant,,Case Rate,184551.66
Blue Cross,HMO,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Grouper Rate,1678.88
Blue Cross,HMO,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Grouper Rate,1678.88
Blue Cross,HMO,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Grouper Rate,1678.00
Blue Cross,HMO,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,HMO,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Grouper Rate,5029.00
Blue Cross,HMO,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,172513.85
Blue Cross,HMO,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,1678.88
Blue Cross,HMO,21601,CPT4/HCPCS,EXC CHEST WALL TUMOR W/RIBS,,Grouper Rate,5281.00
Blue Cross,HMO,21602,CPT4/HCPCS,EXC CH WAL TUM W/O LYMPHADEC,,Grouper Rate,5281.00
Blue Cross,HMO,21603,CPT4/HCPCS,EXC CH WAL TUM W/LYMPHADEC,,Grouper Rate,6588.00
Blue Cross,HMO,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,1678.88
Blue Cross,HMO,21615,CPT4/HCPCS,REMOVAL OF RIB,,Grouper Rate,5281.00
Blue Cross,HMO,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,Grouper Rate,5783.00
Blue Cross,HMO,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Grouper Rate,1678.88
Blue Cross,HMO,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,Grouper Rate,1678.88
Blue Cross,HMO,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Grouper Rate,5281.00
Blue Cross,HMO,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,107390.91
Blue Cross,HMO,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,1678.88
Blue Cross,HMO,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,Grouper Rate,5783.00
Blue Cross,HMO,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,3544.00
Blue Cross,HMO,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,3544.00
Blue Cross,HMO,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Grouper Rate,5281.00
Blue Cross,HMO,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Grouper Rate,5783.00
Blue Cross,HMO,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Grouper Rate,6588.00
Blue Cross,HMO,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,Grouper Rate,5029.00
Blue Cross,HMO,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,85068.52
Blue Cross,HMO,21800,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,21805,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,21810,CPT4/HCPCS,TREATMENT OF RIB FRACTURE(S),,Grouper Rate,1678.88
Blue Cross,HMO,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Grouper Rate,3544.00
Blue Cross,HMO,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,133231.35
Blue Cross,HMO,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,1678.00
Blue Cross,HMO,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,1678.88
Blue Cross,HMO,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Grouper Rate,3544.00
Blue Cross,HMO,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Grouper Rate,1678.88
Blue Cross,HMO,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,22,DRG,Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC,,Case Rate,80377.78
Blue Cross,HMO,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,89314.34
Blue Cross,HMO,22010,CPT4/HCPCS,I&D P-SPINE C/T/CERV-THOR,,Grouper Rate,1678.88
Blue Cross,HMO,22015,CPT4/HCPCS,I&D ABSCESS P-SPINE L/S/LS,,Grouper Rate,1678.88
Blue Cross,HMO,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,75295.04
Blue Cross,HMO,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,3544.00
Blue Cross,HMO,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,3544.00
Blue Cross,HMO,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,3544.00
Blue Cross,HMO,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,1678.88
Blue Cross,HMO,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,3544.00
Blue Cross,HMO,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,3544.00
Blue Cross,HMO,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,3544.00
Blue Cross,HMO,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,3544.00
Blue Cross,HMO,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,139284.99
Blue Cross,HMO,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,Grouper Rate,3544.00
Blue Cross,HMO,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,Grouper Rate,3544.00
Blue Cross,HMO,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,Grouper Rate,3544.00
Blue Cross,HMO,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,Grouper Rate,3544.00
Blue Cross,HMO,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,Grouper Rate,6588.00
Blue Cross,HMO,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,Grouper Rate,5029.00
Blue Cross,HMO,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,Grouper Rate,5029.00
Blue Cross,HMO,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,Grouper Rate,1678.88
Blue Cross,HMO,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,102748.13
Blue Cross,HMO,22305,CPT4/HCPCS,CLOSED TX SPINE PROCESS FX,,Grouper Rate,1678.00
Blue Cross,HMO,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Grouper Rate,1678.00
Blue Cross,HMO,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Grouper Rate,1678.88
Blue Cross,HMO,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Grouper Rate,5783.00
Blue Cross,HMO,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Grouper Rate,1678.88
Blue Cross,HMO,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,121770.78
Blue Cross,HMO,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,93067.27
Blue Cross,HMO,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Grouper Rate,1678.88
Blue Cross,HMO,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Grouper Rate,1678.00
Blue Cross,HMO,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Grouper Rate,1678.00
Blue Cross,HMO,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Grouper Rate,1678.00
Blue Cross,HMO,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1678.88
Blue Cross,HMO,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1678.88
Blue Cross,HMO,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1678.00
Blue Cross,HMO,22520,CPT4/HCPCS,PERCUT VERTEBROPLASTY THOR,,Grouper Rate,1678.00
Blue Cross,HMO,22521,CPT4/HCPCS,PERCUT VERTEBROPLASTY LUMB,,Grouper Rate,1678.00
Blue Cross,HMO,22522,CPT4/HCPCS,PERCUT VERTEBROPLASTY ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,22523,CPT4/HCPCS,PERCUT KYPHOPLASTY THOR,,Grouper Rate,1678.88
Blue Cross,HMO,22524,CPT4/HCPCS,PERCUT KYPHOPLASTY LUMBAR,,Grouper Rate,1678.88
Blue Cross,HMO,22525,CPT4/HCPCS,PERCUT KYPHOPLASTY ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,22548,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,8841.00
Blue Cross,HMO,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Grouper Rate,8841.00
Blue Cross,HMO,22552,CPT4/HCPCS,ADDL NECK SPINE FUSION,,Grouper Rate,5029.00
Blue Cross,HMO,22554,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,8841.00
Blue Cross,HMO,22556,CPT4/HCPCS,THORAX SPINE FUSION,,Grouper Rate,8841.00
Blue Cross,HMO,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,Grouper Rate,5029.00
Blue Cross,HMO,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,Grouper Rate,8841.00
Blue Cross,HMO,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,Grouper Rate,8012.00
Blue Cross,HMO,22595,CPT4/HCPCS,NECK SPINAL FUSION,,Grouper Rate,8012.00
Blue Cross,HMO,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,109359.17
Blue Cross,HMO,22600,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,8012.00
Blue Cross,HMO,22610,CPT4/HCPCS,THORAX SPINE FUSION,,Grouper Rate,5783.00
Blue Cross,HMO,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,5783.00
Blue Cross,HMO,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,6588.00
Blue Cross,HMO,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,3544.00
Blue Cross,HMO,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,Grouper Rate,6588.00
Blue Cross,HMO,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,6588.00
Blue Cross,HMO,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,86866.42
Blue Cross,HMO,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,102801.06
Blue Cross,HMO,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,Grouper Rate,8012.00
Blue Cross,HMO,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,Grouper Rate,8012.00
Blue Cross,HMO,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,Grouper Rate,8841.00
Blue Cross,HMO,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,Grouper Rate,6588.00
Blue Cross,HMO,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,Grouper Rate,8012.00
Blue Cross,HMO,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,Grouper Rate,8841.00
Blue Cross,HMO,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,Grouper Rate,6588.00
Blue Cross,HMO,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,Grouper Rate,8012.00
Blue Cross,HMO,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,Grouper Rate,5281.00
Blue Cross,HMO,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,HMO,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5281.00
Blue Cross,HMO,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5783.00
Blue Cross,HMO,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,6588.00
Blue Cross,HMO,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,HMO,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,HMO,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,HMO,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,Grouper Rate,1678.88
Blue Cross,HMO,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,22853,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,22854,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,5281.00
Blue Cross,HMO,22856,CPT4/HCPCS,CERV ARTIFIC DISKECTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,22859,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,22861,CPT4/HCPCS,REVISE CERV ARTIFIC DISC,,Grouper Rate,5783.00
Blue Cross,HMO,22864,CPT4/HCPCS,REMOVE CERV ARTIF DISC,,Grouper Rate,5029.00
Blue Cross,HMO,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,5281.00
Blue Cross,HMO,22868,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,5281.00
Blue Cross,HMO,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,5029.00
Blue Cross,HMO,22870,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,5029.00
Blue Cross,HMO,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,65961.52
Blue Cross,HMO,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Grouper Rate,5029.00
Blue Cross,HMO,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Grouper Rate,1678.00
Blue Cross,HMO,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Grouper Rate,1678.88
Blue Cross,HMO,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,23,DRG,Cranio w major dev impl/acute complex CNS PDX w MCC or chemo implant,,Case Rate,93654.44
Blue Cross,HMO,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Grouper Rate,1678.88
Blue Cross,HMO,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Grouper Rate,1678.88
Blue Cross,HMO,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Grouper Rate,1678.00
Blue Cross,HMO,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Grouper Rate,1678.00
Blue Cross,HMO,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,1678.00
Blue Cross,HMO,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,1678.88
Blue Cross,HMO,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,HMO,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Grouper Rate,1678.88
Blue Cross,HMO,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,140427.90
Blue Cross,HMO,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Grouper Rate,1678.88
Blue Cross,HMO,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Grouper Rate,5029.00
Blue Cross,HMO,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Grouper Rate,5029.00
Blue Cross,HMO,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Grouper Rate,5281.00
Blue Cross,HMO,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Grouper Rate,5281.00
Blue Cross,HMO,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5029.00
Blue Cross,HMO,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5281.00
Blue Cross,HMO,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5281.00
Blue Cross,HMO,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5029.00
Blue Cross,HMO,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5281.00
Blue Cross,HMO,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5281.00
Blue Cross,HMO,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,1678.88
Blue Cross,HMO,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,5029.00
Blue Cross,HMO,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,5029.00
Blue Cross,HMO,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,5029.00
Blue Cross,HMO,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Grouper Rate,5029.00
Blue Cross,HMO,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Grouper Rate,5281.00
Blue Cross,HMO,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,97557.88
Blue Cross,HMO,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,Grouper Rate,5029.00
Blue Cross,HMO,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,Grouper Rate,5029.00
Blue Cross,HMO,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,Grouper Rate,5281.00
Blue Cross,HMO,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,128891.25
Blue Cross,HMO,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,23331,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,23332,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,5029.00
Blue Cross,HMO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Grouper Rate,1678.00
Blue Cross,HMO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,5029.00
Blue Cross,HMO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,5029.00
Blue Cross,HMO,23350,CPT4/HCPCS,INJECTION FOR SHOULDER X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Grouper Rate,5281.00
Blue Cross,HMO,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Grouper Rate,6588.00
Blue Cross,HMO,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,87949.79
Blue Cross,HMO,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Grouper Rate,6588.00
Blue Cross,HMO,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Grouper Rate,1678.88
Blue Cross,HMO,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Grouper Rate,1678.88
Blue Cross,HMO,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Grouper Rate,5783.00
Blue Cross,HMO,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Grouper Rate,6588.00
Blue Cross,HMO,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Grouper Rate,5783.00
Blue Cross,HMO,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Grouper Rate,6588.00
Blue Cross,HMO,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5281.00
Blue Cross,HMO,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6588.00
Blue Cross,HMO,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5281.00
Blue Cross,HMO,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6588.00
Blue Cross,HMO,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5281.00
Blue Cross,HMO,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6588.00
Blue Cross,HMO,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,HMO,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,HMO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,HMO,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,HMO,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,5029.00
Blue Cross,HMO,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,5281.00
Blue Cross,HMO,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Grouper Rate,3544.00
Blue Cross,HMO,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Grouper Rate,3544.00
Blue Cross,HMO,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,99739.50
Blue Cross,HMO,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,5029.00
Blue Cross,HMO,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,5029.00
Blue Cross,HMO,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,1678.00
Blue Cross,HMO,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,1678.00
Blue Cross,HMO,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,67496.43
Blue Cross,HMO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Grouper Rate,1678.00
Blue Cross,HMO,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,6588.00
Blue Cross,HMO,239,DRG,Amputation for circ sys disorders exc upper limb & toe w MCC,,Case Rate,79535.89
Blue Cross,HMO,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,Grouper Rate,5281.00
Blue Cross,HMO,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Grouper Rate,1678.00
Blue Cross,HMO,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Grouper Rate,1678.88
Blue Cross,HMO,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,24,DRG,Cranio w major dev impl/acute complex CNS PDX w/o MCC,,Case Rate,65043.55
Blue Cross,HMO,240,DRG,Amputation for circ sys disorders exc upper limb & toe w CC,,Case Rate,46146.60
Blue Cross,HMO,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,1678.00
Blue Cross,HMO,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,1678.88
Blue Cross,HMO,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,HMO,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,241,DRG,Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC,,Case Rate,26321.75
Blue Cross,HMO,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Grouper Rate,1678.00
Blue Cross,HMO,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Grouper Rate,5029.00
Blue Cross,HMO,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Grouper Rate,3544.00
Blue Cross,HMO,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,3544.00
Blue Cross,HMO,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Grouper Rate,3544.00
Blue Cross,HMO,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Grouper Rate,3544.00
Blue Cross,HMO,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Grouper Rate,3544.00
Blue Cross,HMO,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,3544.00
Blue Cross,HMO,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Grouper Rate,3544.00
Blue Cross,HMO,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Grouper Rate,3544.00
Blue Cross,HMO,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Grouper Rate,1678.88
Blue Cross,HMO,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Grouper Rate,3544.00
Blue Cross,HMO,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,61570.15
Blue Cross,HMO,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,HMO,24220,CPT4/HCPCS,INJECTION FOR ELBOW X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,41889.20
Blue Cross,HMO,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Grouper Rate,1678.00
Blue Cross,HMO,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Grouper Rate,5029.00
Blue Cross,HMO,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Grouper Rate,5029.00
Blue Cross,HMO,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,3544.00
Blue Cross,HMO,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,3544.00
Blue Cross,HMO,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Grouper Rate,1678.88
Blue Cross,HMO,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Grouper Rate,1678.88
Blue Cross,HMO,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Grouper Rate,1678.88
Blue Cross,HMO,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Grouper Rate,3544.00
Blue Cross,HMO,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Grouper Rate,1678.88
Blue Cross,HMO,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Grouper Rate,3544.00
Blue Cross,HMO,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Grouper Rate,3544.00
Blue Cross,HMO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Grouper Rate,3544.00
Blue Cross,HMO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Grouper Rate,3544.00
Blue Cross,HMO,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Grouper Rate,6588.00
Blue Cross,HMO,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,5281.00
Blue Cross,HMO,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,5281.00
Blue Cross,HMO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,6588.00
Blue Cross,HMO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,6588.00
Blue Cross,HMO,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,34166.67
Blue Cross,HMO,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5029.00
Blue Cross,HMO,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5029.00
Blue Cross,HMO,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,3544.00
Blue Cross,HMO,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Grouper Rate,3544.00
Blue Cross,HMO,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Grouper Rate,1678.88
Blue Cross,HMO,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Grouper Rate,3544.00
Blue Cross,HMO,245,DRG,AICD lead & generator procedures,,Case Rate,89547.56
Blue Cross,HMO,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,51699.07
Blue Cross,HMO,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,32884.82
Blue Cross,HMO,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,52496.30
Blue Cross,HMO,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,31083.62
Blue Cross,HMO,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Grouper Rate,5029.00
Blue Cross,HMO,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Grouper Rate,5029.00
Blue Cross,HMO,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1678.88
Blue Cross,HMO,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,Grouper Rate,5029.00
Blue Cross,HMO,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,Grouper Rate,3544.00
Blue Cross,HMO,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,Grouper Rate,5029.00
Blue Cross,HMO,25,DRG,Craniotomy & endovascular intracranial procedures w MCC,,Case Rate,74292.71
Blue Cross,HMO,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,41727.11
Blue Cross,HMO,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Grouper Rate,3544.00
Blue Cross,HMO,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Grouper Rate,1678.00
Blue Cross,HMO,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,3544.00
Blue Cross,HMO,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,3544.00
Blue Cross,HMO,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,1678.88
Blue Cross,HMO,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,1678.88
Blue Cross,HMO,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Grouper Rate,1678.00
Blue Cross,HMO,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Grouper Rate,1678.88
Blue Cross,HMO,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,HMO,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,1678.88
Blue Cross,HMO,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Grouper Rate,1678.00
Blue Cross,HMO,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,HMO,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Grouper Rate,3544.00
Blue Cross,HMO,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Grouper Rate,3544.00
Blue Cross,HMO,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Grouper Rate,3544.00
Blue Cross,HMO,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Grouper Rate,3544.00
Blue Cross,HMO,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,27453.09
Blue Cross,HMO,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Grouper Rate,1678.88
Blue Cross,HMO,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,5029.00
Blue Cross,HMO,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Grouper Rate,3544.00
Blue Cross,HMO,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Grouper Rate,1678.00
Blue Cross,HMO,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,3544.00
Blue Cross,HMO,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,3544.00
Blue Cross,HMO,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Grouper Rate,3544.00
Blue Cross,HMO,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,5029.00
Blue Cross,HMO,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,5029.00
Blue Cross,HMO,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,HMO,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,3544.00
Blue Cross,HMO,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Grouper Rate,3544.00
Blue Cross,HMO,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,3544.00
Blue Cross,HMO,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,3544.00
Blue Cross,HMO,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Grouper Rate,3544.00
Blue Cross,HMO,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,3544.00
Blue Cross,HMO,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,3544.00
Blue Cross,HMO,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,1678.88
Blue Cross,HMO,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,1678.88
Blue Cross,HMO,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,252,DRG,Other vascular procedures w MCC,,Case Rate,54924.37
Blue Cross,HMO,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Grouper Rate,3544.00
Blue Cross,HMO,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Grouper Rate,5029.00
Blue Cross,HMO,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,5029.00
Blue Cross,HMO,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,5029.00
Blue Cross,HMO,25246,CPT4/HCPCS,INJECTION FOR WRIST X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,HMO,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,1678.00
Blue Cross,HMO,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,1678.00
Blue Cross,HMO,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Grouper Rate,1678.00
Blue Cross,HMO,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5029.00
Blue Cross,HMO,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,1678.88
Blue Cross,HMO,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,3544.00
Blue Cross,HMO,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5029.00
Blue Cross,HMO,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,3544.00
Blue Cross,HMO,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5029.00
Blue Cross,HMO,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Grouper Rate,3544.00
Blue Cross,HMO,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,253,DRG,Other vascular procedures w CC,,Case Rate,43892.19
Blue Cross,HMO,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,3544.00
Blue Cross,HMO,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,3544.00
Blue Cross,HMO,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,3544.00
Blue Cross,HMO,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,3544.00
Blue Cross,HMO,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Grouper Rate,3544.00
Blue Cross,HMO,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Grouper Rate,3544.00
Blue Cross,HMO,25350,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,3544.00
Blue Cross,HMO,25355,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,3544.00
Blue Cross,HMO,25360,CPT4/HCPCS,REVISION OF ULNA,,Grouper Rate,3544.00
Blue Cross,HMO,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,HMO,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,HMO,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,HMO,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,HMO,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Grouper Rate,5029.00
Blue Cross,HMO,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,HMO,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Grouper Rate,5281.00
Blue Cross,HMO,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Grouper Rate,3544.00
Blue Cross,HMO,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,29929.13
Blue Cross,HMO,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,HMO,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,5029.00
Blue Cross,HMO,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,HMO,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,5281.00
Blue Cross,HMO,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,HMO,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,HMO,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Grouper Rate,3544.00
Blue Cross,HMO,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Grouper Rate,5029.00
Blue Cross,HMO,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Grouper Rate,5029.00
Blue Cross,HMO,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Grouper Rate,6588.00
Blue Cross,HMO,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Grouper Rate,5281.00
Blue Cross,HMO,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Grouper Rate,5281.00
Blue Cross,HMO,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,25490,CPT4/HCPCS,REINFORCE RADIUS,,Grouper Rate,3544.00
Blue Cross,HMO,25491,CPT4/HCPCS,REINFORCE ULNA,,Grouper Rate,3544.00
Blue Cross,HMO,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Grouper Rate,5029.00
Blue Cross,HMO,255,DRG,Upper limb & toe amputation for circ system disorders w MCC,,Case Rate,42061.22
Blue Cross,HMO,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1678.00
Blue Cross,HMO,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1678.00
Blue Cross,HMO,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,3544.00
Blue Cross,HMO,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1678.00
Blue Cross,HMO,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,5029.00
Blue Cross,HMO,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,5029.00
Blue Cross,HMO,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,1678.00
Blue Cross,HMO,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,1678.00
Blue Cross,HMO,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,3544.00
Blue Cross,HMO,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,1678.88
Blue Cross,HMO,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,1678.88
Blue Cross,HMO,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,HMO,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,3544.00
Blue Cross,HMO,256,DRG,Upper limb & toe amputation for circ system disorders w CC,,Case Rate,27176.87
Blue Cross,HMO,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,1678.88
Blue Cross,HMO,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,1678.88
Blue Cross,HMO,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Grouper Rate,1678.88
Blue Cross,HMO,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Grouper Rate,3544.00
Blue Cross,HMO,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Grouper Rate,3544.00
Blue Cross,HMO,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Grouper Rate,3544.00
Blue Cross,HMO,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Grouper Rate,5029.00
Blue Cross,HMO,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,257,DRG,Upper limb & toe amputation for circ system disorders w/o CC/MCC,,Case Rate,19202.94
Blue Cross,HMO,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,52949.50
Blue Cross,HMO,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Grouper Rate,5029.00
Blue Cross,HMO,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Grouper Rate,3544.00
Blue Cross,HMO,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,35068.10
Blue Cross,HMO,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,6588.00
Blue Cross,HMO,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,6588.00
Blue Cross,HMO,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,5029.00
Blue Cross,HMO,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,5281.00
Blue Cross,HMO,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,3544.00
Blue Cross,HMO,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,25927,CPT4/HCPCS,AMPUTATION OF HAND,,Grouper Rate,3544.00
Blue Cross,HMO,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1678.88
Blue Cross,HMO,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,26,DRG,Craniotomy & endovascular intracranial procedures w CC,,Case Rate,50579.32
Blue Cross,HMO,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,59282.66
Blue Cross,HMO,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Grouper Rate,1678.00
Blue Cross,HMO,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Grouper Rate,1678.00
Blue Cross,HMO,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Grouper Rate,1678.88
Blue Cross,HMO,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,5029.00
Blue Cross,HMO,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,5029.00
Blue Cross,HMO,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,HMO,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,1678.88
Blue Cross,HMO,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Grouper Rate,1678.88
Blue Cross,HMO,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,32936.10
Blue Cross,HMO,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Grouper Rate,1678.88
Blue Cross,HMO,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,1678.00
Blue Cross,HMO,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,1678.00
Blue Cross,HMO,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Grouper Rate,1678.88
Blue Cross,HMO,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Grouper Rate,3544.00
Blue Cross,HMO,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,3544.00
Blue Cross,HMO,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,5029.00
Blue Cross,HMO,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,1678.88
Blue Cross,HMO,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Grouper Rate,3544.00
Blue Cross,HMO,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Grouper Rate,3544.00
Blue Cross,HMO,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Grouper Rate,3544.00
Blue Cross,HMO,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Grouper Rate,1678.88
Blue Cross,HMO,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,28251.97
Blue Cross,HMO,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Grouper Rate,1678.88
Blue Cross,HMO,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Grouper Rate,3544.00
Blue Cross,HMO,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Grouper Rate,1678.88
Blue Cross,HMO,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,1678.88
Blue Cross,HMO,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,1678.88
Blue Cross,HMO,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,263,DRG,Vein ligation & stripping,,Case Rate,38129.66
Blue Cross,HMO,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Grouper Rate,1678.88
Blue Cross,HMO,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Grouper Rate,1678.00
Blue Cross,HMO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Grouper Rate,1678.00
Blue Cross,HMO,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,1678.88
Blue Cross,HMO,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,264,DRG,Other circulatory system O.R. procedures,,Case Rate,53718.61
Blue Cross,HMO,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Grouper Rate,5281.00
Blue Cross,HMO,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Grouper Rate,3544.00
Blue Cross,HMO,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,1678.88
Blue Cross,HMO,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,1678.88
Blue Cross,HMO,26476,CPT4/HCPCS,TENDON LENGTHENING,,Grouper Rate,1678.00
Blue Cross,HMO,26477,CPT4/HCPCS,TENDON SHORTENING,,Grouper Rate,1678.00
Blue Cross,HMO,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Grouper Rate,1678.88
Blue Cross,HMO,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Grouper Rate,3544.00
Blue Cross,HMO,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,3544.00
Blue Cross,HMO,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,5029.00
Blue Cross,HMO,26499,CPT4/HCPCS,REVISION OF FINGER,,Grouper Rate,3544.00
Blue Cross,HMO,265,DRG,AICD lead procedures,,Case Rate,55619.05
Blue Cross,HMO,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,5029.00
Blue Cross,HMO,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,5029.00
Blue Cross,HMO,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Grouper Rate,3544.00
Blue Cross,HMO,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Grouper Rate,1678.88
Blue Cross,HMO,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,3544.00
Blue Cross,HMO,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,5029.00
Blue Cross,HMO,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Grouper Rate,5029.00
Blue Cross,HMO,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Grouper Rate,3544.00
Blue Cross,HMO,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Grouper Rate,5281.00
Blue Cross,HMO,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Grouper Rate,5281.00
Blue Cross,HMO,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Grouper Rate,5281.00
Blue Cross,HMO,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Grouper Rate,5281.00
Blue Cross,HMO,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Grouper Rate,3544.00
Blue Cross,HMO,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,Grouper Rate,5029.00
Blue Cross,HMO,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,1678.88
Blue Cross,HMO,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,3544.00
Blue Cross,HMO,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,5029.00
Blue Cross,HMO,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Grouper Rate,5281.00
Blue Cross,HMO,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Grouper Rate,5281.00
Blue Cross,HMO,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Grouper Rate,3544.00
Blue Cross,HMO,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Grouper Rate,5281.00
Blue Cross,HMO,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Grouper Rate,5281.00
Blue Cross,HMO,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Grouper Rate,5281.00
Blue Cross,HMO,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Grouper Rate,3544.00
Blue Cross,HMO,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Grouper Rate,3544.00
Blue Cross,HMO,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Grouper Rate,1678.88
Blue Cross,HMO,266,DRG,Endovascular Cardiac Valve Replacement w MCC,,Case Rate,117387.68
Blue Cross,HMO,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,267,DRG,Endovascular Cardiac Valve Replacement w/o MCC,,Case Rate,92638.88
Blue Cross,HMO,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,5029.00
Blue Cross,HMO,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,HMO,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,HMO,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,HMO,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,HMO,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,HMO,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,HMO,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,HMO,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,HMO,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,HMO,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Grouper Rate,1678.88
Blue Cross,HMO,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,HMO,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,268,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w MCC,,Case Rate,115029.08
Blue Cross,HMO,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,26841,CPT4/HCPCS,FUSION OF THUMB,,Grouper Rate,5029.00
Blue Cross,HMO,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Grouper Rate,5029.00
Blue Cross,HMO,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,269,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w/o MCC,,Case Rate,71363.48
Blue Cross,HMO,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Grouper Rate,3544.00
Blue Cross,HMO,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,1678.88
Blue Cross,HMO,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,5029.00
Blue Cross,HMO,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Grouper Rate,1678.00
Blue Cross,HMO,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Grouper Rate,1678.00
Blue Cross,HMO,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,27,DRG,Craniotomy & endovascular intracranial procedures w/o CC/MCC,,Case Rate,41545.17
Blue Cross,HMO,270,DRG,Other Major Cardiovascular Procedures w MCC,,Case Rate,85703.66
Blue Cross,HMO,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,1678.88
Blue Cross,HMO,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Grouper Rate,3544.00
Blue Cross,HMO,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,Grouper Rate,1678.00
Blue Cross,HMO,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Grouper Rate,1678.00
Blue Cross,HMO,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,Grouper Rate,5029.00
Blue Cross,HMO,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,HMO,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,1678.88
Blue Cross,HMO,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,HMO,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,Grouper Rate,3544.00
Blue Cross,HMO,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Grouper Rate,1678.00
Blue Cross,HMO,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Grouper Rate,5029.00
Blue Cross,HMO,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Grouper Rate,5029.00
Blue Cross,HMO,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Grouper Rate,5281.00
Blue Cross,HMO,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Grouper Rate,5783.00
Blue Cross,HMO,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Grouper Rate,6588.00
Blue Cross,HMO,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,Grouper Rate,1678.88
Blue Cross,HMO,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,Grouper Rate,3544.00
Blue Cross,HMO,27075,CPT4/HCPCS,RESECT HIP TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,Grouper Rate,5783.00
Blue Cross,HMO,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,Grouper Rate,5029.00
Blue Cross,HMO,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,Grouper Rate,3544.00
Blue Cross,HMO,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Grouper Rate,1678.88
Blue Cross,HMO,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,3544.00
Blue Cross,HMO,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,HMO,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,HMO,27093,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,27095,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Grouper Rate,1678.00
Blue Cross,HMO,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Grouper Rate,3544.00
Blue Cross,HMO,271,DRG,Other Major Cardiovascular Procedures w CC,,Case Rate,58958.48
Blue Cross,HMO,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Grouper Rate,5029.00
Blue Cross,HMO,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Grouper Rate,5029.00
Blue Cross,HMO,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,5029.00
Blue Cross,HMO,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,5029.00
Blue Cross,HMO,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Grouper Rate,5783.00
Blue Cross,HMO,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Grouper Rate,5281.00
Blue Cross,HMO,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,Grouper Rate,5783.00
Blue Cross,HMO,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Grouper Rate,5783.00
Blue Cross,HMO,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Grouper Rate,5783.00
Blue Cross,HMO,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,5783.00
Blue Cross,HMO,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,5281.00
Blue Cross,HMO,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,5281.00
Blue Cross,HMO,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,Grouper Rate,5029.00
Blue Cross,HMO,27146,CPT4/HCPCS,INCISION OF HIP BONE,,Grouper Rate,5281.00
Blue Cross,HMO,27147,CPT4/HCPCS,REVISION OF HIP BONE,,Grouper Rate,5783.00
Blue Cross,HMO,27151,CPT4/HCPCS,INCISION OF HIP BONES,,Grouper Rate,5783.00
Blue Cross,HMO,27156,CPT4/HCPCS,REVISION OF HIP BONES,,Grouper Rate,6588.00
Blue Cross,HMO,27158,CPT4/HCPCS,REVISION OF PELVIS,,Grouper Rate,5281.00
Blue Cross,HMO,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,Grouper Rate,5281.00
Blue Cross,HMO,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,Grouper Rate,1678.00
Blue Cross,HMO,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,Grouper Rate,5281.00
Blue Cross,HMO,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,1678.88
Blue Cross,HMO,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5281.00
Blue Cross,HMO,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5783.00
Blue Cross,HMO,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5029.00
Blue Cross,HMO,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,Grouper Rate,6588.00
Blue Cross,HMO,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5783.00
Blue Cross,HMO,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,Grouper Rate,5281.00
Blue Cross,HMO,27187,CPT4/HCPCS,REINFORCE HIP BONES,,Grouper Rate,5783.00
Blue Cross,HMO,27193,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27194,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,1678.00
Blue Cross,HMO,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,1678.88
Blue Cross,HMO,272,DRG,Other Major Cardiovascular Procedures w/o CC/MCC,,Case Rate,44472.75
Blue Cross,HMO,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,Grouper Rate,5029.00
Blue Cross,HMO,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Grouper Rate,5281.00
Blue Cross,HMO,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Grouper Rate,5281.00
Blue Cross,HMO,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5029.00
Blue Cross,HMO,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5029.00
Blue Cross,HMO,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5029.00
Blue Cross,HMO,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27269,CPT4/HCPCS,OPTX THIGH FX,,Grouper Rate,5281.00
Blue Cross,HMO,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Grouper Rate,1678.00
Blue Cross,HMO,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,Grouper Rate,6588.00
Blue Cross,HMO,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Grouper Rate,5281.00
Blue Cross,HMO,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Grouper Rate,5029.00
Blue Cross,HMO,273,DRG,Percutaneous Intracardiac Procedures w MCC,,Case Rate,63467.28
Blue Cross,HMO,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Grouper Rate,1678.88
Blue Cross,HMO,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,5029.00
Blue Cross,HMO,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,HMO,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,HMO,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Grouper Rate,1678.00
Blue Cross,HMO,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Grouper Rate,1678.00
Blue Cross,HMO,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,HMO,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Grouper Rate,3544.00
Blue Cross,HMO,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,HMO,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,5029.00
Blue Cross,HMO,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,5029.00
Blue Cross,HMO,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,HMO,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,HMO,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Grouper Rate,1678.00
Blue Cross,HMO,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Grouper Rate,3544.00
Blue Cross,HMO,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Grouper Rate,5029.00
Blue Cross,HMO,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Grouper Rate,5029.00
Blue Cross,HMO,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Grouper Rate,5029.00
Blue Cross,HMO,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Grouper Rate,3544.00
Blue Cross,HMO,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Grouper Rate,1678.88
Blue Cross,HMO,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Grouper Rate,5029.00
Blue Cross,HMO,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,Grouper Rate,5783.00
Blue Cross,HMO,27369,CPT4/HCPCS,NJX CNTRST KNE ARTHG/CT/MRI,,Grouper Rate,1678.00
Blue Cross,HMO,27370,CPT4/HCPCS,INJECTION FOR KNEE X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,3544.00
Blue Cross,HMO,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Grouper Rate,3544.00
Blue Cross,HMO,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Grouper Rate,3544.00
Blue Cross,HMO,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,1678.88
Blue Cross,HMO,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,3544.00
Blue Cross,HMO,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Grouper Rate,1678.88
Blue Cross,HMO,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,3544.00
Blue Cross,HMO,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,3544.00
Blue Cross,HMO,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Grouper Rate,5029.00
Blue Cross,HMO,274,DRG,Percutaneous Intracardiac Procedures w/o MCC,,Case Rate,54340.51
Blue Cross,HMO,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Grouper Rate,3544.00
Blue Cross,HMO,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Grouper Rate,5029.00
Blue Cross,HMO,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,5029.00
Blue Cross,HMO,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,5029.00
Blue Cross,HMO,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Grouper Rate,5029.00
Blue Cross,HMO,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Grouper Rate,6588.00
Blue Cross,HMO,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Grouper Rate,8012.00
Blue Cross,HMO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Grouper Rate,8012.00
Blue Cross,HMO,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Grouper Rate,3544.00
Blue Cross,HMO,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,5029.00
Blue Cross,HMO,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,5783.00
Blue Cross,HMO,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Grouper Rate,3544.00
Blue Cross,HMO,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Grouper Rate,5281.00
Blue Cross,HMO,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,3544.00
Blue Cross,HMO,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,8012.00
Blue Cross,HMO,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,5029.00
Blue Cross,HMO,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Grouper Rate,5029.00
Blue Cross,HMO,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,27437,CPT4/HCPCS,REVISE KNEECAP,,Grouper Rate,5029.00
Blue Cross,HMO,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Grouper Rate,5281.00
Blue Cross,HMO,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,8841.00
Blue Cross,HMO,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Grouper Rate,8841.00
Blue Cross,HMO,27448,CPT4/HCPCS,INCISION OF THIGH,,Grouper Rate,5281.00
Blue Cross,HMO,27450,CPT4/HCPCS,INCISION OF THIGH,,Grouper Rate,6588.00
Blue Cross,HMO,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,Grouper Rate,5281.00
Blue Cross,HMO,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,Grouper Rate,5281.00
Blue Cross,HMO,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,Grouper Rate,5783.00
Blue Cross,HMO,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,Grouper Rate,5281.00
Blue Cross,HMO,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,Grouper Rate,5281.00
Blue Cross,HMO,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,Grouper Rate,5281.00
Blue Cross,HMO,27470,CPT4/HCPCS,REPAIR OF THIGH,,Grouper Rate,5029.00
Blue Cross,HMO,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,Grouper Rate,5281.00
Blue Cross,HMO,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,1678.88
Blue Cross,HMO,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,1678.88
Blue Cross,HMO,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6588.00
Blue Cross,HMO,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,5783.00
Blue Cross,HMO,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,Grouper Rate,5029.00
Blue Cross,HMO,27495,CPT4/HCPCS,REINFORCE THIGH,,Grouper Rate,5029.00
Blue Cross,HMO,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,1678.88
Blue Cross,HMO,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,1678.88
Blue Cross,HMO,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,3544.00
Blue Cross,HMO,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,3544.00
Blue Cross,HMO,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5783.00
Blue Cross,HMO,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5783.00
Blue Cross,HMO,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,HMO,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1678.00
Blue Cross,HMO,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1678.00
Blue Cross,HMO,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,5281.00
Blue Cross,HMO,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Grouper Rate,1678.00
Blue Cross,HMO,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Grouper Rate,1678.00
Blue Cross,HMO,27580,CPT4/HCPCS,FUSION OF KNEE,,Grouper Rate,5281.00
Blue Cross,HMO,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,3544.00
Blue Cross,HMO,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,5281.00
Blue Cross,HMO,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,5029.00
Blue Cross,HMO,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,Grouper Rate,5029.00
Blue Cross,HMO,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,1678.88
Blue Cross,HMO,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,1678.88
Blue Cross,HMO,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,3544.00
Blue Cross,HMO,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Grouper Rate,1678.00
Blue Cross,HMO,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Grouper Rate,1678.00
Blue Cross,HMO,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,1678.88
Blue Cross,HMO,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,1678.00
Blue Cross,HMO,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,1678.88
Blue Cross,HMO,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Grouper Rate,1678.88
Blue Cross,HMO,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Grouper Rate,3544.00
Blue Cross,HMO,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,HMO,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,HMO,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Grouper Rate,3544.00
Blue Cross,HMO,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5029.00
Blue Cross,HMO,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5029.00
Blue Cross,HMO,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Grouper Rate,1678.88
Blue Cross,HMO,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Grouper Rate,1678.88
Blue Cross,HMO,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,Grouper Rate,5029.00
Blue Cross,HMO,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,Grouper Rate,1678.88
Blue Cross,HMO,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Grouper Rate,1678.88
Blue Cross,HMO,27648,CPT4/HCPCS,INJECTION FOR ANKLE X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Grouper Rate,1678.88
Blue Cross,HMO,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.00
Blue Cross,HMO,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.88
Blue Cross,HMO,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.88
Blue Cross,HMO,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.88
Blue Cross,HMO,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,1678.88
Blue Cross,HMO,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,3544.00
Blue Cross,HMO,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Grouper Rate,1678.88
Blue Cross,HMO,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Grouper Rate,1678.88
Blue Cross,HMO,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Grouper Rate,1678.88
Blue Cross,HMO,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,5029.00
Blue Cross,HMO,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,1678.88
Blue Cross,HMO,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Grouper Rate,1678.88
Blue Cross,HMO,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,1678.88
Blue Cross,HMO,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,Grouper Rate,5281.00
Blue Cross,HMO,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Grouper Rate,1678.88
Blue Cross,HMO,27705,CPT4/HCPCS,INCISION OF TIBIA,,Grouper Rate,1678.88
Blue Cross,HMO,27707,CPT4/HCPCS,INCISION OF FIBULA,,Grouper Rate,1678.88
Blue Cross,HMO,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Grouper Rate,3544.00
Blue Cross,HMO,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,Grouper Rate,5029.00
Blue Cross,HMO,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Grouper Rate,5029.00
Blue Cross,HMO,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Grouper Rate,5029.00
Blue Cross,HMO,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,5281.00
Blue Cross,HMO,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,5281.00
Blue Cross,HMO,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,Grouper Rate,3544.00
Blue Cross,HMO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Grouper Rate,5281.00
Blue Cross,HMO,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,Grouper Rate,3544.00
Blue Cross,HMO,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Grouper Rate,1678.88
Blue Cross,HMO,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Grouper Rate,1678.88
Blue Cross,HMO,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Grouper Rate,1678.88
Blue Cross,HMO,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,1678.88
Blue Cross,HMO,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,1678.88
Blue Cross,HMO,27745,CPT4/HCPCS,REINFORCE TIBIA,,Grouper Rate,3544.00
Blue Cross,HMO,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Grouper Rate,1678.00
Blue Cross,HMO,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Grouper Rate,1678.00
Blue Cross,HMO,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Grouper Rate,3544.00
Blue Cross,HMO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Grouper Rate,1678.00
Blue Cross,HMO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Grouper Rate,1678.00
Blue Cross,HMO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Grouper Rate,3544.00
Blue Cross,HMO,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,5029.00
Blue Cross,HMO,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Grouper Rate,1678.88
Blue Cross,HMO,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Grouper Rate,1678.00
Blue Cross,HMO,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Grouper Rate,5029.00
Blue Cross,HMO,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,5783.00
Blue Cross,HMO,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,5281.00
Blue Cross,HMO,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,5281.00
Blue Cross,HMO,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,6588.00
Blue Cross,HMO,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,6588.00
Blue Cross,HMO,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,1678.88
Blue Cross,HMO,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,1678.88
Blue Cross,HMO,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,3544.00
Blue Cross,HMO,28,DRG,Spinal procedures w MCC,,Case Rate,96262.80
Blue Cross,HMO,280,DRG,Acute myocardial infarction, discharged alive w MCC,,Case Rate,26897.34
Blue Cross,HMO,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Grouper Rate,1678.00
Blue Cross,HMO,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,1678.88
Blue Cross,HMO,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,3544.00
Blue Cross,HMO,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Grouper Rate,1678.88
Blue Cross,HMO,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Grouper Rate,1678.00
Blue Cross,HMO,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,1678.88
Blue Cross,HMO,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,1678.00
Blue Cross,HMO,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Grouper Rate,1678.00
Blue Cross,HMO,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Grouper Rate,5029.00
Blue Cross,HMO,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Grouper Rate,1678.00
Blue Cross,HMO,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Grouper Rate,1678.88
Blue Cross,HMO,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Grouper Rate,1678.88
Blue Cross,HMO,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Grouper Rate,3544.00
Blue Cross,HMO,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Grouper Rate,3544.00
Blue Cross,HMO,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Grouper Rate,3544.00
Blue Cross,HMO,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,1678.88
Blue Cross,HMO,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,1678.00
Blue Cross,HMO,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Grouper Rate,1678.88
Blue Cross,HMO,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Grouper Rate,1678.88
Blue Cross,HMO,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Grouper Rate,3544.00
Blue Cross,HMO,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,3544.00
Blue Cross,HMO,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,3544.00
Blue Cross,HMO,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3544.00
Blue Cross,HMO,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,HMO,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,HMO,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3544.00
Blue Cross,HMO,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,3544.00
Blue Cross,HMO,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,15416.93
Blue Cross,HMO,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Grouper Rate,1678.88
Blue Cross,HMO,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,HMO,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,HMO,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,1678.88
Blue Cross,HMO,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,HMO,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,HMO,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,1678.88
Blue Cross,HMO,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,HMO,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,HMO,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,HMO,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,HMO,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Grouper Rate,3544.00
Blue Cross,HMO,28116,CPT4/HCPCS,REVISION OF FOOT,,Grouper Rate,3544.00
Blue Cross,HMO,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Grouper Rate,3544.00
Blue Cross,HMO,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Grouper Rate,3544.00
Blue Cross,HMO,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Grouper Rate,3544.00
Blue Cross,HMO,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,3544.00
Blue Cross,HMO,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.00
Blue Cross,HMO,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.00
Blue Cross,HMO,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Grouper Rate,3544.00
Blue Cross,HMO,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,HMO,28150,CPT4/HCPCS,REMOVAL OF TOE,,Grouper Rate,1678.88
Blue Cross,HMO,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.88
Blue Cross,HMO,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.88
Blue Cross,HMO,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,HMO,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,HMO,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,11999.77
Blue Cross,HMO,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,1678.00
Blue Cross,HMO,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,1678.00
Blue Cross,HMO,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Grouper Rate,1678.00
Blue Cross,HMO,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Grouper Rate,1678.00
Blue Cross,HMO,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Grouper Rate,1678.88
Blue Cross,HMO,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Grouper Rate,3544.00
Blue Cross,HMO,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,HMO,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Grouper Rate,5029.00
Blue Cross,HMO,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,1678.00
Blue Cross,HMO,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Grouper Rate,1678.00
Blue Cross,HMO,28280,CPT4/HCPCS,FUSION OF TOES,,Grouper Rate,1678.88
Blue Cross,HMO,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,3544.00
Blue Cross,HMO,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,3544.00
Blue Cross,HMO,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,1678.88
Blue Cross,HMO,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Grouper Rate,3544.00
Blue Cross,HMO,28290,CPT4/HCPCS,CORRECTION OF BUNION,,Grouper Rate,1678.88
Blue Cross,HMO,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Grouper Rate,3544.00
Blue Cross,HMO,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,1678.88
Blue Cross,HMO,28293,CPT4/HCPCS,CORRECTION OF BUNION,,Grouper Rate,3544.00
Blue Cross,HMO,28294,CPT4/HCPCS,CORRECTION OF BUNION,,Grouper Rate,3544.00
Blue Cross,HMO,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,1678.88
Blue Cross,HMO,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,HMO,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,HMO,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,HMO,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,HMO,283,DRG,Acute myocardial infarction, expired w MCC,,Case Rate,30840.48
Blue Cross,HMO,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Grouper Rate,1678.88
Blue Cross,HMO,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Grouper Rate,1678.88
Blue Cross,HMO,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Grouper Rate,1678.88
Blue Cross,HMO,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Grouper Rate,3544.00
Blue Cross,HMO,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,5029.00
Blue Cross,HMO,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,5281.00
Blue Cross,HMO,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,HMO,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Grouper Rate,5029.00
Blue Cross,HMO,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Grouper Rate,3544.00
Blue Cross,HMO,28312,CPT4/HCPCS,REVISION OF TOE,,Grouper Rate,3544.00
Blue Cross,HMO,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Grouper Rate,1678.88
Blue Cross,HMO,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Grouper Rate,1678.88
Blue Cross,HMO,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,HMO,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Grouper Rate,5029.00
Blue Cross,HMO,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Grouper Rate,3544.00
Blue Cross,HMO,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Grouper Rate,3544.00
Blue Cross,HMO,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Grouper Rate,3544.00
Blue Cross,HMO,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Grouper Rate,3544.00
Blue Cross,HMO,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,Grouper Rate,5029.00
Blue Cross,HMO,284,DRG,Acute myocardial infarction, expired w CC,,Case Rate,12143.66
Blue Cross,HMO,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Grouper Rate,3544.00
Blue Cross,HMO,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,HMO,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,HMO,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,3544.00
Blue Cross,HMO,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,285,DRG,Acute myocardial infarction, expired w/o CC/MCC,,Case Rate,8210.45
Blue Cross,HMO,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Grouper Rate,3544.00
Blue Cross,HMO,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,HMO,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,36621.21
Blue Cross,HMO,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,HMO,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,HMO,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,HMO,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,19021.00
Blue Cross,HMO,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,HMO,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,HMO,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,HMO,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,HMO,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,HMO,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Grouper Rate,5281.00
Blue Cross,HMO,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,HMO,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,3544.00
Blue Cross,HMO,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,5029.00
Blue Cross,HMO,288,DRG,Acute & subacute endocarditis w MCC,,Case Rate,44343.74
Blue Cross,HMO,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,Grouper Rate,3544.00
Blue Cross,HMO,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Grouper Rate,3544.00
Blue Cross,HMO,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Grouper Rate,1678.88
Blue Cross,HMO,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Grouper Rate,1678.88
Blue Cross,HMO,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Grouper Rate,1678.88
Blue Cross,HMO,28890,CPT4/HCPCS,HI ENRGY ESWT PLANTAR FASCIA,,Grouper Rate,3544.00
Blue Cross,HMO,289,DRG,Acute & subacute endocarditis w CC,,Case Rate,27168.60
Blue Cross,HMO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,Case Rate,54499.30
Blue Cross,HMO,290,DRG,Acute & subacute endocarditis w/o CC/MCC,,Case Rate,16930.34
Blue Cross,HMO,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,HMO,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,HMO,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,HMO,29020,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,HMO,29025,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,3544.00
Blue Cross,HMO,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,HMO,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,HMO,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,HMO,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,HMO,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,Grouper Rate,1678.00
Blue Cross,HMO,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Grouper Rate,1678.00
Blue Cross,HMO,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Grouper Rate,1678.00
Blue Cross,HMO,29086,CPT4/HCPCS,APPLY FINGER CAST,,Grouper Rate,1678.00
Blue Cross,HMO,291,DRG,Heart failure & shock w MCC,,Case Rate,22178.48
Blue Cross,HMO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Per Date of Service,193.00
Blue Cross,HMO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Per Date of Service,193.00
Blue Cross,HMO,292,DRG,Heart failure & shock w CC,,Case Rate,14804.95
Blue Cross,HMO,29200,CPT4/HCPCS,STRAPPING OF CHEST,,Grouper Rate,1678.00
Blue Cross,HMO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Per Date of Service,193.00
Blue Cross,HMO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Per Date of Service,193.00
Blue Cross,HMO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Per Date of Service,193.00
Blue Cross,HMO,293,DRG,Heart failure & shock w/o CC/MCC,,Case Rate,10794.00
Blue Cross,HMO,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Grouper Rate,1678.00
Blue Cross,HMO,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Grouper Rate,1678.00
Blue Cross,HMO,294,DRG,Deep vein thrombophlebitis w CC/MCC,,Case Rate,21205.93
Blue Cross,HMO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,Per Date of Service,193.00
Blue Cross,HMO,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,Grouper Rate,1678.00
Blue Cross,HMO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,Grouper Rate,1678.00
Blue Cross,HMO,295,DRG,Deep vein thrombophlebitis w/o CC/MCC,,Case Rate,16230.70
Blue Cross,HMO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Per Date of Service,193.00
Blue Cross,HMO,29520,CPT4/HCPCS,STRAPPING OF HIP,,Per Date of Service,193.00
Blue Cross,HMO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,Per Date of Service,193.00
Blue Cross,HMO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,Grouper Rate,1678.00
Blue Cross,HMO,29550,CPT4/HCPCS,STRAPPING OF TOES,,Per Date of Service,193.00
Blue Cross,HMO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Grouper Rate,1678.00
Blue Cross,HMO,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,Grouper Rate,1678.00
Blue Cross,HMO,29582,CPT4/HCPCS,APPLY MULTLAY COMPRS UPR LEG,,Grouper Rate,1678.00
Blue Cross,HMO,29583,CPT4/HCPCS,APPLY MULTLAY COMPRS UPR ARM,,Grouper Rate,1678.00
Blue Cross,HMO,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,Grouper Rate,1678.00
Blue Cross,HMO,296,DRG,Cardiac arrest, unexplained w MCC,,Case Rate,26377.99
Blue Cross,HMO,297,DRG,Cardiac arrest, unexplained w CC,,Case Rate,11654.08
Blue Cross,HMO,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1678.00
Blue Cross,HMO,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1678.00
Blue Cross,HMO,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,Grouper Rate,1678.00
Blue Cross,HMO,29730,CPT4/HCPCS,WINDOWING OF CAST,,Grouper Rate,1678.00
Blue Cross,HMO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,Per Date of Service,193.00
Blue Cross,HMO,298,DRG,Cardiac arrest, unexplained w/o CC/MCC,,Case Rate,8074.82
Blue Cross,HMO,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Grouper Rate,5029.00
Blue Cross,HMO,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Grouper Rate,5281.00
Blue Cross,HMO,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Grouper Rate,6588.00
Blue Cross,HMO,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Grouper Rate,3544.00
Blue Cross,HMO,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Grouper Rate,3544.00
Blue Cross,HMO,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Grouper Rate,3544.00
Blue Cross,HMO,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Grouper Rate,5029.00
Blue Cross,HMO,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Grouper Rate,5281.00
Blue Cross,HMO,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Grouper Rate,5029.00
Blue Cross,HMO,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Grouper Rate,3544.00
Blue Cross,HMO,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Grouper Rate,5281.00
Blue Cross,HMO,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Grouper Rate,6588.00
Blue Cross,HMO,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Grouper Rate,5281.00
Blue Cross,HMO,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Grouper Rate,3544.00
Blue Cross,HMO,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Grouper Rate,3544.00
Blue Cross,HMO,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Grouper Rate,1678.88
Blue Cross,HMO,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Grouper Rate,5029.00
Blue Cross,HMO,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Grouper Rate,3544.00
Blue Cross,HMO,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Grouper Rate,5783.00
Blue Cross,HMO,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,8841.00
Blue Cross,HMO,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,8841.00
Blue Cross,HMO,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Grouper Rate,6588.00
Blue Cross,HMO,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Grouper Rate,3544.00
Blue Cross,HMO,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Grouper Rate,3544.00
Blue Cross,HMO,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,8012.00
Blue Cross,HMO,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,8012.00
Blue Cross,HMO,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Grouper Rate,3544.00
Blue Cross,HMO,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,8012.00
Blue Cross,HMO,299,DRG,Peripheral vascular disorders w MCC,,Case Rate,25329.35
Blue Cross,HMO,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Grouper Rate,1678.88
Blue Cross,HMO,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,HMO,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,HMO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Grouper Rate,3544.00
Blue Cross,HMO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Grouper Rate,3544.00
Blue Cross,HMO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Grouper Rate,3544.00
Blue Cross,HMO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Grouper Rate,3544.00
Blue Cross,HMO,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Grouper Rate,6588.00
Blue Cross,HMO,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Grouper Rate,6588.00
Blue Cross,HMO,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Grouper Rate,6588.00
Blue Cross,HMO,3,DRG,ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R.,,Case Rate,314114.44
Blue Cross,HMO,30,DRG,Spinal procedures w/o CC/MCC,,Case Rate,38986.43
Blue Cross,HMO,300,DRG,Peripheral vascular disorders w CC,,Case Rate,17237.98
Blue Cross,HMO,301,DRG,Peripheral vascular disorders w/o CC/MCC,,Case Rate,12280.95
Blue Cross,HMO,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,1678.00
Blue Cross,HMO,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,1678.88
Blue Cross,HMO,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,1678.88
Blue Cross,HMO,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,3544.00
Blue Cross,HMO,30120,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,1678.00
Blue Cross,HMO,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,1678.00
Blue Cross,HMO,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Grouper Rate,1678.00
Blue Cross,HMO,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Grouper Rate,1678.88
Blue Cross,HMO,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Grouper Rate,3544.00
Blue Cross,HMO,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Grouper Rate,5029.00
Blue Cross,HMO,302,DRG,Atherosclerosis w MCC,,Case Rate,18086.49
Blue Cross,HMO,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Grouper Rate,1678.00
Blue Cross,HMO,303,DRG,Atherosclerosis w/o MCC,,Case Rate,11187.65
Blue Cross,HMO,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,HMO,304,DRG,Hypertension w MCC,,Case Rate,18121.22
Blue Cross,HMO,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5029.00
Blue Cross,HMO,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5281.00
Blue Cross,HMO,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5281.00
Blue Cross,HMO,30430,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,3544.00
Blue Cross,HMO,30435,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,HMO,30450,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,HMO,30460,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,HMO,30462,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,HMO,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Grouper Rate,3544.00
Blue Cross,HMO,305,DRG,Hypertension w/o MCC,,Case Rate,12214.79
Blue Cross,HMO,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Grouper Rate,6588.00
Blue Cross,HMO,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,5281.00
Blue Cross,HMO,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,1678.00
Blue Cross,HMO,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Grouper Rate,1678.00
Blue Cross,HMO,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Grouper Rate,5029.00
Blue Cross,HMO,306,DRG,Cardiac congenital & valvular disorders w MCC,,Case Rate,24871.19
Blue Cross,HMO,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Grouper Rate,5029.00
Blue Cross,HMO,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Grouper Rate,6588.00
Blue Cross,HMO,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Grouper Rate,6588.00
Blue Cross,HMO,307,DRG,Cardiac congenital & valvular disorders w/o MCC,,Case Rate,14363.33
Blue Cross,HMO,308,DRG,Cardiac arrhythmia & conduction disorders w MCC,,Case Rate,19836.42
Blue Cross,HMO,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Grouper Rate,1678.00
Blue Cross,HMO,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Grouper Rate,1678.00
Blue Cross,HMO,309,DRG,Cardiac arrhythmia & conduction disorders w CC,,Case Rate,12395.07
Blue Cross,HMO,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,HMO,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,HMO,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,HMO,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,HMO,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Grouper Rate,1678.88
Blue Cross,HMO,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Grouper Rate,1678.00
Blue Cross,HMO,31,DRG,Ventricular shunt procedures w MCC,,Case Rate,72215.29
Blue Cross,HMO,310,DRG,Cardiac arrhythmia & conduction disorders w/o CC/MCC,,Case Rate,9235.93
Blue Cross,HMO,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Grouper Rate,1678.00
Blue Cross,HMO,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Grouper Rate,1678.00
Blue Cross,HMO,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,1678.88
Blue Cross,HMO,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,3544.00
Blue Cross,HMO,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Grouper Rate,5029.00
Blue Cross,HMO,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,Grouper Rate,5029.00
Blue Cross,HMO,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Grouper Rate,1678.88
Blue Cross,HMO,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,1678.88
Blue Cross,HMO,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,HMO,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,HMO,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,HMO,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,HMO,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,HMO,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,3544.00
Blue Cross,HMO,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,3544.00
Blue Cross,HMO,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Grouper Rate,5281.00
Blue Cross,HMO,311,DRG,Angina pectoris,,Case Rate,11528.38
Blue Cross,HMO,312,DRG,Syncope & collapse,,Case Rate,13847.28
Blue Cross,HMO,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,1678.88
Blue Cross,HMO,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,5281.00
Blue Cross,HMO,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,3544.00
Blue Cross,HMO,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Grouper Rate,5029.00
Blue Cross,HMO,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Grouper Rate,3544.00
Blue Cross,HMO,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Grouper Rate,1678.00
Blue Cross,HMO,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Grouper Rate,1678.00
Blue Cross,HMO,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Grouper Rate,1678.00
Blue Cross,HMO,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.00
Blue Cross,HMO,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.00
Blue Cross,HMO,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,HMO,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,HMO,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Grouper Rate,1678.00
Blue Cross,HMO,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Grouper Rate,3544.00
Blue Cross,HMO,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Grouper Rate,3544.00
Blue Cross,HMO,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Grouper Rate,3544.00
Blue Cross,HMO,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,1678.88
Blue Cross,HMO,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Grouper Rate,3544.00
Blue Cross,HMO,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Grouper Rate,3544.00
Blue Cross,HMO,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Grouper Rate,3544.00
Blue Cross,HMO,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Grouper Rate,3544.00
Blue Cross,HMO,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,HMO,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3544.00
Blue Cross,HMO,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5029.00
Blue Cross,HMO,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5029.00
Blue Cross,HMO,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Grouper Rate,3544.00
Blue Cross,HMO,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Grouper Rate,3544.00
Blue Cross,HMO,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Grouper Rate,5029.00
Blue Cross,HMO,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Grouper Rate,1678.88
Blue Cross,HMO,313,DRG,Chest pain,,Case Rate,11922.03
Blue Cross,HMO,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,5281.00
Blue Cross,HMO,31320,CPT4/HCPCS,DIAGNOSTIC INCISION LARYNX,,Grouper Rate,1678.88
Blue Cross,HMO,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,Grouper Rate,6588.00
Blue Cross,HMO,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,Grouper Rate,6588.00
Blue Cross,HMO,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5783.00
Blue Cross,HMO,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,6588.00
Blue Cross,HMO,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5281.00
Blue Cross,HMO,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5281.00
Blue Cross,HMO,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5281.00
Blue Cross,HMO,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,8841.00
Blue Cross,HMO,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,Grouper Rate,6588.00
Blue Cross,HMO,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,Grouper Rate,6588.00
Blue Cross,HMO,314,DRG,Other circulatory system diagnoses w MCC,,Case Rate,34459.43
Blue Cross,HMO,31400,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,3544.00
Blue Cross,HMO,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Grouper Rate,3544.00
Blue Cross,HMO,315,DRG,Other circulatory system diagnoses w CC,,Case Rate,16129.80
Blue Cross,HMO,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Grouper Rate,1678.00
Blue Cross,HMO,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Grouper Rate,1678.00
Blue Cross,HMO,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Grouper Rate,1678.00
Blue Cross,HMO,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,1678.00
Blue Cross,HMO,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Grouper Rate,1678.00
Blue Cross,HMO,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Grouper Rate,1678.00
Blue Cross,HMO,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Grouper Rate,1678.00
Blue Cross,HMO,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Grouper Rate,1678.00
Blue Cross,HMO,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Grouper Rate,1678.88
Blue Cross,HMO,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,1678.88
Blue Cross,HMO,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,1678.88
Blue Cross,HMO,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Grouper Rate,1678.88
Blue Cross,HMO,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Grouper Rate,1678.88
Blue Cross,HMO,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Grouper Rate,1678.88
Blue Cross,HMO,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Grouper Rate,1678.88
Blue Cross,HMO,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Grouper Rate,3544.00
Blue Cross,HMO,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Grouper Rate,3544.00
Blue Cross,HMO,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Grouper Rate,5029.00
Blue Cross,HMO,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,HMO,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,HMO,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,HMO,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,HMO,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Grouper Rate,5281.00
Blue Cross,HMO,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Grouper Rate,5281.00
Blue Cross,HMO,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Grouper Rate,1678.88
Blue Cross,HMO,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Grouper Rate,1678.88
Blue Cross,HMO,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Grouper Rate,1678.00
Blue Cross,HMO,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Grouper Rate,1678.00
Blue Cross,HMO,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Grouper Rate,1678.00
Blue Cross,HMO,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Grouper Rate,1678.00
Blue Cross,HMO,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Grouper Rate,1678.88
Blue Cross,HMO,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Grouper Rate,1678.00
Blue Cross,HMO,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Grouper Rate,5281.00
Blue Cross,HMO,31582,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,5281.00
Blue Cross,HMO,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Grouper Rate,5029.00
Blue Cross,HMO,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Grouper Rate,5029.00
Blue Cross,HMO,31588,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,5281.00
Blue Cross,HMO,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Grouper Rate,5281.00
Blue Cross,HMO,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Grouper Rate,5029.00
Blue Cross,HMO,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Grouper Rate,5029.00
Blue Cross,HMO,31595,CPT4/HCPCS,LARYNX NERVE SURGERY,,Grouper Rate,1678.88
Blue Cross,HMO,316,DRG,Other circulatory system diagnoses w/o CC/MCC,,Case Rate,12396.73
Blue Cross,HMO,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,HMO,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,HMO,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,3544.00
Blue Cross,HMO,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,HMO,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,HMO,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Grouper Rate,3544.00
Blue Cross,HMO,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Grouper Rate,1678.00
Blue Cross,HMO,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,1678.88
Blue Cross,HMO,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,1678.88
Blue Cross,HMO,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Grouper Rate,1678.00
Blue Cross,HMO,31620,CPT4/HCPCS,ENDOBRONCHIAL US ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Grouper Rate,1678.88
Blue Cross,HMO,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Grouper Rate,1678.88
Blue Cross,HMO,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Grouper Rate,1678.88
Blue Cross,HMO,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Grouper Rate,1678.88
Blue Cross,HMO,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Grouper Rate,1678.88
Blue Cross,HMO,31627,CPT4/HCPCS,NAVIGATIONAL BRONCHOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Grouper Rate,1678.88
Blue Cross,HMO,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Grouper Rate,1678.88
Blue Cross,HMO,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Grouper Rate,1678.88
Blue Cross,HMO,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Grouper Rate,1678.88
Blue Cross,HMO,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Grouper Rate,1678.88
Blue Cross,HMO,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Grouper Rate,1678.88
Blue Cross,HMO,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Grouper Rate,1678.88
Blue Cross,HMO,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Grouper Rate,1678.88
Blue Cross,HMO,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Grouper Rate,1678.88
Blue Cross,HMO,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Grouper Rate,1678.88
Blue Cross,HMO,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Grouper Rate,1678.00
Blue Cross,HMO,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Grouper Rate,1678.00
Blue Cross,HMO,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Grouper Rate,1678.00
Blue Cross,HMO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Grouper Rate,1678.88
Blue Cross,HMO,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Grouper Rate,1678.88
Blue Cross,HMO,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,31651,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,Grouper Rate,1678.00
Blue Cross,HMO,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Grouper Rate,1678.00
Blue Cross,HMO,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Grouper Rate,1678.00
Blue Cross,HMO,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Grouper Rate,1678.00
Blue Cross,HMO,31656,CPT4/HCPCS,BRONCHOSCOPY INJ FOR X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Grouper Rate,1678.88
Blue Cross,HMO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Grouper Rate,1678.88
Blue Cross,HMO,31715,CPT4/HCPCS,INJECTION FOR BRONCHUS X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,1678.00
Blue Cross,HMO,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,1678.00
Blue Cross,HMO,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,5281.00
Blue Cross,HMO,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,HMO,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,6588.00
Blue Cross,HMO,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,Grouper Rate,6588.00
Blue Cross,HMO,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,Grouper Rate,6588.00
Blue Cross,HMO,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,Grouper Rate,6588.00
Blue Cross,HMO,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Grouper Rate,6588.00
Blue Cross,HMO,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Grouper Rate,6588.00
Blue Cross,HMO,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,5029.00
Blue Cross,HMO,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,5029.00
Blue Cross,HMO,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,1678.88
Blue Cross,HMO,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,5783.00
Blue Cross,HMO,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Grouper Rate,1678.00
Blue Cross,HMO,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Grouper Rate,1678.88
Blue Cross,HMO,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Grouper Rate,1678.88
Blue Cross,HMO,319,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W MCC,,Case Rate,71383.33
Blue Cross,HMO,32,DRG,Ventricular shunt procedures w CC,,Case Rate,36589.78
Blue Cross,HMO,320,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W/O MCC,,Case Rate,40418.79
Blue Cross,HMO,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,Grouper Rate,5029.00
Blue Cross,HMO,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,Grouper Rate,5029.00
Blue Cross,HMO,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,Grouper Rate,8012.00
Blue Cross,HMO,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,Grouper Rate,8012.00
Blue Cross,HMO,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,Grouper Rate,8012.00
Blue Cross,HMO,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,8012.00
Blue Cross,HMO,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,Grouper Rate,6588.00
Blue Cross,HMO,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,Grouper Rate,6588.00
Blue Cross,HMO,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,Grouper Rate,6588.00
Blue Cross,HMO,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Grouper Rate,6588.00
Blue Cross,HMO,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,Grouper Rate,6588.00
Blue Cross,HMO,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Grouper Rate,6588.00
Blue Cross,HMO,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,Grouper Rate,6588.00
Blue Cross,HMO,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,Grouper Rate,5281.00
Blue Cross,HMO,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,Grouper Rate,6588.00
Blue Cross,HMO,32201,CPT4/HCPCS,DRAIN PERCUT LUNG LESION,,Grouper Rate,1678.00
Blue Cross,HMO,32215,CPT4/HCPCS,TREAT CHEST LINING,,Grouper Rate,3544.00
Blue Cross,HMO,32220,CPT4/HCPCS,RELEASE OF LUNG,,Grouper Rate,8012.00
Blue Cross,HMO,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,Grouper Rate,6588.00
Blue Cross,HMO,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,Grouper Rate,6588.00
Blue Cross,HMO,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,Grouper Rate,6588.00
Blue Cross,HMO,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Grouper Rate,1678.00
Blue Cross,HMO,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Grouper Rate,1678.00
Blue Cross,HMO,32420,CPT4/HCPCS,PUNCTURE/CLEAR LUNG,,Grouper Rate,1678.00
Blue Cross,HMO,32421,CPT4/HCPCS,THORACENTESIS FOR ASPIRATION,,Grouper Rate,1678.00
Blue Cross,HMO,32422,CPT4/HCPCS,THORACENTESIS W/TUBE INSERT,,Grouper Rate,1678.00
Blue Cross,HMO,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,Grouper Rate,8012.00
Blue Cross,HMO,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,Grouper Rate,8841.00
Blue Cross,HMO,32482,CPT4/HCPCS,BILOBECTOMY,,Grouper Rate,8841.00
Blue Cross,HMO,32484,CPT4/HCPCS,SEGMENTECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,Grouper Rate,8841.00
Blue Cross,HMO,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,Grouper Rate,3544.00
Blue Cross,HMO,32503,CPT4/HCPCS,RESECT APICAL LUNG TUMOR,,Grouper Rate,6588.00
Blue Cross,HMO,32504,CPT4/HCPCS,RESECT APICAL LUNG TUM/CHEST,,Grouper Rate,6588.00
Blue Cross,HMO,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,Grouper Rate,6588.00
Blue Cross,HMO,32506,CPT4/HCPCS,WEDGE RESECT OF LUNG ADD-ON,,Grouper Rate,6588.00
Blue Cross,HMO,32507,CPT4/HCPCS,WEDGE RESECT OF LUNG DIAG,,Grouper Rate,6588.00
Blue Cross,HMO,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,Grouper Rate,6588.00
Blue Cross,HMO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Grouper Rate,1678.00
Blue Cross,HMO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Grouper Rate,1678.88
Blue Cross,HMO,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Grouper Rate,1678.00
Blue Cross,HMO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Grouper Rate,1678.00
Blue Cross,HMO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Grouper Rate,1678.00
Blue Cross,HMO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Grouper Rate,1678.00
Blue Cross,HMO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Grouper Rate,1678.00
Blue Cross,HMO,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Grouper Rate,1678.00
Blue Cross,HMO,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Grouper Rate,1678.00
Blue Cross,HMO,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Grouper Rate,1678.00
Blue Cross,HMO,326,DRG,Stomach, esophageal & duodenal proc w MCC,,Case Rate,88947.15
Blue Cross,HMO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Grouper Rate,3544.00
Blue Cross,HMO,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Grouper Rate,3544.00
Blue Cross,HMO,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Grouper Rate,3544.00
Blue Cross,HMO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Grouper Rate,3544.00
Blue Cross,HMO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Grouper Rate,3544.00
Blue Cross,HMO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Grouper Rate,3544.00
Blue Cross,HMO,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,Grouper Rate,3544.00
Blue Cross,HMO,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,Grouper Rate,5029.00
Blue Cross,HMO,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,Grouper Rate,8012.00
Blue Cross,HMO,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,Grouper Rate,3544.00
Blue Cross,HMO,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,Grouper Rate,3544.00
Blue Cross,HMO,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,Grouper Rate,5029.00
Blue Cross,HMO,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,Grouper Rate,5783.00
Blue Cross,HMO,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,Grouper Rate,6588.00
Blue Cross,HMO,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,Grouper Rate,8012.00
Blue Cross,HMO,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,Grouper Rate,5783.00
Blue Cross,HMO,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Grouper Rate,5783.00
Blue Cross,HMO,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,Grouper Rate,5783.00
Blue Cross,HMO,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,Grouper Rate,3544.00
Blue Cross,HMO,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,Grouper Rate,3544.00
Blue Cross,HMO,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,Grouper Rate,3544.00
Blue Cross,HMO,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,Grouper Rate,3544.00
Blue Cross,HMO,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,Grouper Rate,3544.00
Blue Cross,HMO,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,Grouper Rate,3544.00
Blue Cross,HMO,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,Grouper Rate,3544.00
Blue Cross,HMO,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,Grouper Rate,3544.00
Blue Cross,HMO,327,DRG,Stomach, esophageal & duodenal proc w CC,,Case Rate,43162.78
Blue Cross,HMO,32701,CPT4/HCPCS,THORAX STEREO RAD TARGETW/TX,,Grouper Rate,1678.00
Blue Cross,HMO,328,DRG,Stomach, esophageal & duodenal proc w/o CC/MCC,,Case Rate,27547.37
Blue Cross,HMO,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,Grouper Rate,8012.00
Blue Cross,HMO,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,Grouper Rate,6588.00
Blue Cross,HMO,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,Grouper Rate,6588.00
Blue Cross,HMO,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,Grouper Rate,5783.00
Blue Cross,HMO,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,Grouper Rate,8841.00
Blue Cross,HMO,32855,CPT4/HCPCS,PREPARE DONOR LUNG SINGLE,,Grouper Rate,3544.00
Blue Cross,HMO,32856,CPT4/HCPCS,PREPARE DONOR LUNG DOUBLE,,Grouper Rate,3544.00
Blue Cross,HMO,329,DRG,Major small & large bowel procedures w MCC,,Case Rate,80223.96
Blue Cross,HMO,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,Grouper Rate,5783.00
Blue Cross,HMO,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Grouper Rate,5783.00
Blue Cross,HMO,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Grouper Rate,5783.00
Blue Cross,HMO,32940,CPT4/HCPCS,REVISION OF LUNG,,Grouper Rate,5029.00
Blue Cross,HMO,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,Grouper Rate,1678.88
Blue Cross,HMO,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Grouper Rate,5783.00
Blue Cross,HMO,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,Grouper Rate,1678.00
Blue Cross,HMO,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Grouper Rate,5783.00
Blue Cross,HMO,33,DRG,Ventricular shunt procedures w/o CC/MCC,,Case Rate,28460.37
Blue Cross,HMO,330,DRG,Major small & large bowel procedures w CC,,Case Rate,41995.06
Blue Cross,HMO,33010,CPT4/HCPCS,DRAINAGE OF HEART SAC,,Grouper Rate,1678.00
Blue Cross,HMO,33011,CPT4/HCPCS,REPEAT DRAINAGE OF HEART SAC,,Grouper Rate,1678.00
Blue Cross,HMO,33015,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,3544.00
Blue Cross,HMO,33016,CPT4/HCPCS,PERICARDIOCENTESIS W/IMAGING,,Grouper Rate,1678.88
Blue Cross,HMO,33017,CPT4/HCPCS,PRCRD DRG 6YR+ W/O CGEN CAR,,Grouper Rate,3544.00
Blue Cross,HMO,33018,CPT4/HCPCS,PRCRD DRG 0-5YR OR W/ANOMLY,,Grouper Rate,3544.00
Blue Cross,HMO,33019,CPT4/HCPCS,PERQ PRCRD DRG INSJ CATH CT,,Grouper Rate,3544.00
Blue Cross,HMO,33020,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,5029.00
Blue Cross,HMO,33025,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,6588.00
Blue Cross,HMO,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Grouper Rate,5783.00
Blue Cross,HMO,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Grouper Rate,6588.00
Blue Cross,HMO,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,Grouper Rate,5783.00
Blue Cross,HMO,331,DRG,Major small & large bowel procedures w/o CC/MCC,,Case Rate,28285.05
Blue Cross,HMO,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,6588.00
Blue Cross,HMO,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,6588.00
Blue Cross,HMO,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,Grouper Rate,5783.00
Blue Cross,HMO,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,Grouper Rate,3544.00
Blue Cross,HMO,332,DRG,Rectal resection w MCC,,Case Rate,68801.43
Blue Cross,HMO,33202,CPT4/HCPCS,INSERT EPICARD ELTRD OPEN,,Grouper Rate,5029.00
Blue Cross,HMO,33203,CPT4/HCPCS,INSERT EPICARD ELTRD ENDO,,Grouper Rate,1678.88
Blue Cross,HMO,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Grouper Rate,3544.00
Blue Cross,HMO,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Grouper Rate,3544.00
Blue Cross,HMO,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Grouper Rate,5281.00
Blue Cross,HMO,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Grouper Rate,3544.00
Blue Cross,HMO,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Grouper Rate,3544.00
Blue Cross,HMO,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Grouper Rate,6588.00
Blue Cross,HMO,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Grouper Rate,6588.00
Blue Cross,HMO,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Grouper Rate,3544.00
Blue Cross,HMO,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Grouper Rate,1678.88
Blue Cross,HMO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Grouper Rate,1678.88
Blue Cross,HMO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Grouper Rate,1678.88
Blue Cross,HMO,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Grouper Rate,1678.88
Blue Cross,HMO,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Grouper Rate,1678.88
Blue Cross,HMO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Grouper Rate,1678.88
Blue Cross,HMO,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Grouper Rate,3544.00
Blue Cross,HMO,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Grouper Rate,3544.00
Blue Cross,HMO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Grouper Rate,5281.00
Blue Cross,HMO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Grouper Rate,5029.00
Blue Cross,HMO,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Grouper Rate,5029.00
Blue Cross,HMO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Grouper Rate,1678.88
Blue Cross,HMO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Grouper Rate,1678.88
Blue Cross,HMO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Grouper Rate,1678.88
Blue Cross,HMO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Grouper Rate,1678.88
Blue Cross,HMO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Grouper Rate,1678.88
Blue Cross,HMO,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Grouper Rate,1678.88
Blue Cross,HMO,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Grouper Rate,1678.88
Blue Cross,HMO,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Grouper Rate,1678.88
Blue Cross,HMO,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Grouper Rate,6588.00
Blue Cross,HMO,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Grouper Rate,5029.00
Blue Cross,HMO,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Grouper Rate,5029.00
Blue Cross,HMO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Grouper Rate,5281.00
Blue Cross,HMO,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,5281.00
Blue Cross,HMO,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,5281.00
Blue Cross,HMO,33254,CPT4/HCPCS,ABLATE ATRIA LMTD,,Grouper Rate,5029.00
Blue Cross,HMO,33255,CPT4/HCPCS,ABLATE ATRIA W/O BYPASS EXT,,Grouper Rate,5281.00
Blue Cross,HMO,33256,CPT4/HCPCS,ABLATE ATRIA W/BYPASS EXTEN,,Grouper Rate,5783.00
Blue Cross,HMO,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,Grouper Rate,5029.00
Blue Cross,HMO,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,Grouper Rate,5029.00
Blue Cross,HMO,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,Grouper Rate,5281.00
Blue Cross,HMO,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,5281.00
Blue Cross,HMO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Grouper Rate,1678.88
Blue Cross,HMO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Grouper Rate,1678.88
Blue Cross,HMO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Grouper Rate,1678.88
Blue Cross,HMO,33265,CPT4/HCPCS,ABLATE ATRIA LMTD ENDO,,Grouper Rate,5029.00
Blue Cross,HMO,33266,CPT4/HCPCS,ABLATE ATRIA X10SV ENDO,,Grouper Rate,5029.00
Blue Cross,HMO,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Grouper Rate,5029.00
Blue Cross,HMO,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Grouper Rate,5029.00
Blue Cross,HMO,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Grouper Rate,5029.00
Blue Cross,HMO,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Grouper Rate,1678.88
Blue Cross,HMO,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,Grouper Rate,3544.00
Blue Cross,HMO,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,Grouper Rate,1678.88
Blue Cross,HMO,33282,CPT4/HCPCS,IMPLANT PAT-ACTIVE HT RECORD,,Grouper Rate,3544.00
Blue Cross,HMO,33284,CPT4/HCPCS,REMOVE PAT-ACTIVE HT RECORD,,Grouper Rate,1678.00
Blue Cross,HMO,33285,CPT4/HCPCS,INSJ SUBQ CAR RHYTHM MNTR,,Grouper Rate,3544.00
Blue Cross,HMO,33286,CPT4/HCPCS,RMVL SUBQ CAR RHYTHM MNTR,,Grouper Rate,1678.88
Blue Cross,HMO,33289,CPT4/HCPCS,TCAT IMPL WRLS P-ART PRS SNR,,Grouper Rate,8841.00
Blue Cross,HMO,333,DRG,Rectal resection w CC,,Case Rate,35412.14
Blue Cross,HMO,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,Grouper Rate,5783.00
Blue Cross,HMO,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,Grouper Rate,6588.00
Blue Cross,HMO,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Grouper Rate,5783.00
Blue Cross,HMO,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,Grouper Rate,5783.00
Blue Cross,HMO,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Grouper Rate,6588.00
Blue Cross,HMO,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,6588.00
Blue Cross,HMO,33332,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,6588.00
Blue Cross,HMO,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,8012.00
Blue Cross,HMO,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,Grouper Rate,5783.00
Blue Cross,HMO,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,Grouper Rate,6588.00
Blue Cross,HMO,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,HMO,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,HMO,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,HMO,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,HMO,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,Grouper Rate,6588.00
Blue Cross,HMO,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,5029.00
Blue Cross,HMO,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,5029.00
Blue Cross,HMO,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,5029.00
Blue Cross,HMO,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,334,DRG,Rectal resection w/o CC/MCC,,Case Rate,26616.16
Blue Cross,HMO,33400,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,Grouper Rate,5281.00
Blue Cross,HMO,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,6588.00
Blue Cross,HMO,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,8841.00
Blue Cross,HMO,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,Grouper Rate,8841.00
Blue Cross,HMO,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,Grouper Rate,8841.00
Blue Cross,HMO,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,5783.00
Blue Cross,HMO,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,8012.00
Blue Cross,HMO,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33440,CPT4/HCPCS,RPLCMT A-VALVE TLCJ AUTOL PV,,Grouper Rate,8841.00
Blue Cross,HMO,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,6588.00
Blue Cross,HMO,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,Grouper Rate,5281.00
Blue Cross,HMO,33472,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,6588.00
Blue Cross,HMO,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,8841.00
Blue Cross,HMO,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8012.00
Blue Cross,HMO,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,Grouper Rate,8012.00
Blue Cross,HMO,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8841.00
Blue Cross,HMO,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,Grouper Rate,8841.00
Blue Cross,HMO,335,DRG,Peritoneal adhesiolysis w MCC,,Case Rate,64347.21
Blue Cross,HMO,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Grouper Rate,8841.00
Blue Cross,HMO,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Grouper Rate,6588.00
Blue Cross,HMO,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,Grouper Rate,5783.00
Blue Cross,HMO,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Grouper Rate,6588.00
Blue Cross,HMO,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,33507,CPT4/HCPCS,REPAIR ART INTRAMURAL,,Grouper Rate,6588.00
Blue Cross,HMO,33508,CPT4/HCPCS,ENDOSCOPIC VEIN HARVEST,,Grouper Rate,3544.00
Blue Cross,HMO,33542,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,5783.00
Blue Cross,HMO,33545,CPT4/HCPCS,REPAIR OF HEART DAMAGE,,Grouper Rate,5783.00
Blue Cross,HMO,33548,CPT4/HCPCS,RESTORE/REMODEL VENTRICLE,,Grouper Rate,5783.00
Blue Cross,HMO,33572,CPT4/HCPCS,OPEN CORONARY ENDARTERECTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,336,DRG,Peritoneal adhesiolysis w CC,,Case Rate,37759.16
Blue Cross,HMO,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,Grouper Rate,6588.00
Blue Cross,HMO,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,Grouper Rate,6588.00
Blue Cross,HMO,33641,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33645,CPT4/HCPCS,REVISION OF HEART VEINS,,Grouper Rate,5783.00
Blue Cross,HMO,33647,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECTS,,Grouper Rate,8841.00
Blue Cross,HMO,33660,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,HMO,33665,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,HMO,33670,CPT4/HCPCS,REPAIR OF HEART CHAMBERS,,Grouper Rate,8841.00
Blue Cross,HMO,33675,CPT4/HCPCS,CLOSE MULT VSD,,Grouper Rate,8841.00
Blue Cross,HMO,33676,CPT4/HCPCS,CLOSE MULT VSD W/RESECTION,,Grouper Rate,8841.00
Blue Cross,HMO,33677,CPT4/HCPCS,CL MULT VSD W/REM PUL BAND,,Grouper Rate,8841.00
Blue Cross,HMO,33681,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33684,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33688,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33690,CPT4/HCPCS,REINFORCE PULMONARY ARTERY,,Grouper Rate,6588.00
Blue Cross,HMO,33692,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,HMO,33694,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,HMO,337,DRG,Peritoneal adhesiolysis w/o CC/MCC,,Case Rate,27003.20
Blue Cross,HMO,33702,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,HMO,33710,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,HMO,33720,CPT4/HCPCS,REPAIR OF HEART DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33724,CPT4/HCPCS,REPAIR VENOUS ANOMALY,,Grouper Rate,8012.00
Blue Cross,HMO,33726,CPT4/HCPCS,REPAIR PUL VENOUS STENOSIS,,Grouper Rate,8841.00
Blue Cross,HMO,33730,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT(S),,Grouper Rate,8841.00
Blue Cross,HMO,33735,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,6588.00
Blue Cross,HMO,33737,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8012.00
Blue Cross,HMO,33750,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,HMO,33755,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,HMO,33762,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,HMO,33764,CPT4/HCPCS,MAJOR VESSEL SHUNT & GRAFT,,Grouper Rate,8012.00
Blue Cross,HMO,33766,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,HMO,33774,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33775,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33776,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33777,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33778,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33779,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33780,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33781,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33786,CPT4/HCPCS,REPAIR ARTERIAL TRUNK,,Grouper Rate,8841.00
Blue Cross,HMO,33788,CPT4/HCPCS,REVISION OF PULMONARY ARTERY,,Grouper Rate,8012.00
Blue Cross,HMO,338,DRG,Appendectomy w complicated principal diag w MCC,,Case Rate,46292.15
Blue Cross,HMO,33800,CPT4/HCPCS,AORTIC SUSPENSION,,Grouper Rate,8012.00
Blue Cross,HMO,33802,CPT4/HCPCS,REPAIR VESSEL DEFECT,,Grouper Rate,6588.00
Blue Cross,HMO,33803,CPT4/HCPCS,REPAIR VESSEL DEFECT,,Grouper Rate,8012.00
Blue Cross,HMO,33813,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,8012.00
Blue Cross,HMO,33814,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33820,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,6588.00
Blue Cross,HMO,33822,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,6588.00
Blue Cross,HMO,33824,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,8012.00
Blue Cross,HMO,33840,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,8841.00
Blue Cross,HMO,33845,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,8841.00
Blue Cross,HMO,33851,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,8841.00
Blue Cross,HMO,33852,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,8841.00
Blue Cross,HMO,33858,CPT4/HCPCS,AS-AORT GRF F/AORTIC DSJ,,Grouper Rate,8841.00
Blue Cross,HMO,33859,CPT4/HCPCS,AS-AORT GRF F/DS OTH/THN DSJ,,Grouper Rate,8841.00
Blue Cross,HMO,33860,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,33864,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,33866,CPT4/HCPCS,AORTIC HEMIARCH GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,33870,CPT4/HCPCS,TRANSVERSE AORTIC ARCH GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,33871,CPT4/HCPCS,TRANSVRS A-ARCH GRF HYPTHRM,,Grouper Rate,8841.00
Blue Cross,HMO,33875,CPT4/HCPCS,THORACIC AORTIC GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,33877,CPT4/HCPCS,THORACOABDOMINAL GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,33880,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,Grouper Rate,8012.00
Blue Cross,HMO,33881,CPT4/HCPCS,ENDOVASC TAA REPR W/O SUBCL,,Grouper Rate,8012.00
Blue Cross,HMO,33883,CPT4/HCPCS,INSERT ENDOVASC PROSTH TAA,,Grouper Rate,3544.00
Blue Cross,HMO,33884,CPT4/HCPCS,ENDOVASC PROSTH TAA ADD-ON,,Grouper Rate,3544.00
Blue Cross,HMO,33886,CPT4/HCPCS,ENDOVASC PROSTH DELAYED,,Grouper Rate,5029.00
Blue Cross,HMO,339,DRG,Appendectomy w complicated principal diag w CC,,Case Rate,28035.30
Blue Cross,HMO,33910,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,Grouper Rate,8841.00
Blue Cross,HMO,33915,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,Grouper Rate,8012.00
Blue Cross,HMO,33916,CPT4/HCPCS,SURGERY OF GREAT VESSEL,,Grouper Rate,8841.00
Blue Cross,HMO,33924,CPT4/HCPCS,REMOVE PULMONARY SHUNT,,Grouper Rate,5281.00
Blue Cross,HMO,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,Grouper Rate,8841.00
Blue Cross,HMO,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,Grouper Rate,8841.00
Blue Cross,HMO,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,Grouper Rate,8841.00
Blue Cross,HMO,33933,CPT4/HCPCS,PREPARE DONOR HEART/LUNG,,Grouper Rate,3544.00
Blue Cross,HMO,33944,CPT4/HCPCS,PREPARE DONOR HEART,,Grouper Rate,3544.00
Blue Cross,HMO,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,Grouper Rate,5281.00
Blue Cross,HMO,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,Grouper Rate,5281.00
Blue Cross,HMO,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,Grouper Rate,3544.00
Blue Cross,HMO,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,HMO,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,HMO,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,HMO,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,HMO,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Grouper Rate,3544.00
Blue Cross,HMO,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Grouper Rate,3544.00
Blue Cross,HMO,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,HMO,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,HMO,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,HMO,33960,CPT4/HCPCS,EXTERNAL CIRCULATION ASSIST,,Grouper Rate,5281.00
Blue Cross,HMO,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,HMO,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,HMO,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,HMO,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Grouper Rate,5281.00
Blue Cross,HMO,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Grouper Rate,5281.00
Blue Cross,HMO,33967,CPT4/HCPCS,INSERT I-AORT PERCUT DEVICE,,Grouper Rate,5029.00
Blue Cross,HMO,33968,CPT4/HCPCS,REMOVE AORTIC ASSIST DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Grouper Rate,5281.00
Blue Cross,HMO,33970,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,Grouper Rate,5029.00
Blue Cross,HMO,33971,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,Grouper Rate,5281.00
Blue Cross,HMO,33976,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,Grouper Rate,8012.00
Blue Cross,HMO,33979,CPT4/HCPCS,INSERT INTRACORPOREAL DEVICE,,Grouper Rate,8012.00
Blue Cross,HMO,33980,CPT4/HCPCS,REMOVE INTRACORPOREAL DEVICE,,Grouper Rate,5281.00
Blue Cross,HMO,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Grouper Rate,5281.00
Blue Cross,HMO,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Grouper Rate,5281.00
Blue Cross,HMO,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Grouper Rate,5281.00
Blue Cross,HMO,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,Grouper Rate,5029.00
Blue Cross,HMO,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,Grouper Rate,5029.00
Blue Cross,HMO,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,Grouper Rate,5029.00
Blue Cross,HMO,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,Grouper Rate,8012.00
Blue Cross,HMO,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,Grouper Rate,8012.00
Blue Cross,HMO,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,Grouper Rate,5281.00
Blue Cross,HMO,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,Grouper Rate,8012.00
Blue Cross,HMO,34,DRG,Carotid artery stent procedure w MCC,,Case Rate,65739.88
Blue Cross,HMO,340,DRG,Appendectomy w complicated principal diag w/o CC/MCC,,Case Rate,20317.73
Blue Cross,HMO,34001,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,3544.00
Blue Cross,HMO,34051,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,6588.00
Blue Cross,HMO,341,DRG,Appendectomy w/o complicated principal diag w MCC,,Case Rate,38309.94
Blue Cross,HMO,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,3544.00
Blue Cross,HMO,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,Grouper Rate,3544.00
Blue Cross,HMO,34151,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,5281.00
Blue Cross,HMO,342,DRG,Appendectomy w/o complicated principal diag w CC,,Case Rate,23703.47
Blue Cross,HMO,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,5281.00
Blue Cross,HMO,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,Grouper Rate,5029.00
Blue Cross,HMO,343,DRG,Appendectomy w/o complicated principal diag w/o CC/MCC,,Case Rate,18349.47
Blue Cross,HMO,344,DRG,Minor small & large bowel procedures w MCC,,Case Rate,46326.88
Blue Cross,HMO,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,5029.00
Blue Cross,HMO,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,HMO,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,HMO,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,HMO,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,HMO,345,DRG,Minor small & large bowel procedures w CC,,Case Rate,26095.15
Blue Cross,HMO,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,Grouper Rate,5029.00
Blue Cross,HMO,34502,CPT4/HCPCS,RECONSTRUCT VENA CAVA,,Grouper Rate,6588.00
Blue Cross,HMO,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,Grouper Rate,5029.00
Blue Cross,HMO,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,34530,CPT4/HCPCS,LEG VEIN FUSION,,Grouper Rate,3544.00
Blue Cross,HMO,346,DRG,Minor small & large bowel procedures w/o CC/MCC,,Case Rate,21088.50
Blue Cross,HMO,347,DRG,Anal & stomal procedures w MCC,,Case Rate,40714.86
Blue Cross,HMO,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Grouper Rate,5783.00
Blue Cross,HMO,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Grouper Rate,5783.00
Blue Cross,HMO,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Grouper Rate,5783.00
Blue Cross,HMO,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Grouper Rate,5783.00
Blue Cross,HMO,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Grouper Rate,5783.00
Blue Cross,HMO,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Grouper Rate,5783.00
Blue Cross,HMO,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Grouper Rate,5783.00
Blue Cross,HMO,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Grouper Rate,5783.00
Blue Cross,HMO,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Grouper Rate,3544.00
Blue Cross,HMO,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Grouper Rate,3544.00
Blue Cross,HMO,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Grouper Rate,1678.88
Blue Cross,HMO,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Grouper Rate,5029.00
Blue Cross,HMO,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Grouper Rate,5029.00
Blue Cross,HMO,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Grouper Rate,5029.00
Blue Cross,HMO,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Grouper Rate,5029.00
Blue Cross,HMO,34717,CPT4/HCPCS,EVASC RPR A-ILIAC NDGFT,,Grouper Rate,5783.00
Blue Cross,HMO,34718,CPT4/HCPCS,EVASC RPR N/A A-ILIAC NDGFT,,Grouper Rate,5281.00
Blue Cross,HMO,348,DRG,Anal & stomal procedures w CC,,Case Rate,22203.29
Blue Cross,HMO,34800,CPT4/HCPCS,ENDOVAS AAA REPR W/SM TUBE,,Grouper Rate,5783.00
Blue Cross,HMO,34802,CPT4/HCPCS,ENDOVAS AAA REPR W/2-P PART,,Grouper Rate,5783.00
Blue Cross,HMO,34803,CPT4/HCPCS,ENDOVAS AAA REPR W/3-P PART,,Grouper Rate,5783.00
Blue Cross,HMO,34804,CPT4/HCPCS,ENDOVAS AAA REPR W/1-P PART,,Grouper Rate,5783.00
Blue Cross,HMO,34805,CPT4/HCPCS,ENDOVAS AAA REPR W/LONG TUBE,,Grouper Rate,5783.00
Blue Cross,HMO,34806,CPT4/HCPCS,ANEURYSM PRESS SENSOR ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,34808,CPT4/HCPCS,ENDOVAS ILIAC A DEVICE ADDON,,Grouper Rate,3544.00
Blue Cross,HMO,34812,CPT4/HCPCS,OPN FEM ART EXPOS,,Grouper Rate,5029.00
Blue Cross,HMO,34813,CPT4/HCPCS,FEMORAL ENDOVAS GRAFT ADD-ON,,Grouper Rate,5029.00
Blue Cross,HMO,34820,CPT4/HCPCS,OPN ILIAC ART EXPOS,,Grouper Rate,5029.00
Blue Cross,HMO,34825,CPT4/HCPCS,ENDOVASC EXTEND PROSTH INIT,,Grouper Rate,3544.00
Blue Cross,HMO,34826,CPT4/HCPCS,ENDOVASC EXTEN PROSTH ADDL,,Grouper Rate,1678.88
Blue Cross,HMO,34830,CPT4/HCPCS,OPEN AORTIC TUBE PROSTH REPR,,Grouper Rate,8012.00
Blue Cross,HMO,34831,CPT4/HCPCS,OPEN AORTOILIAC PROSTH REPR,,Grouper Rate,8012.00
Blue Cross,HMO,34832,CPT4/HCPCS,OPEN AORTOFEMOR PROSTH REPR,,Grouper Rate,8012.00
Blue Cross,HMO,34833,CPT4/HCPCS,OPN ILAC ART EXPOS CNDT CRTJ,,Grouper Rate,5029.00
Blue Cross,HMO,34834,CPT4/HCPCS,OPN BRACH ART EXPOS,,Grouper Rate,5029.00
Blue Cross,HMO,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,Grouper Rate,8841.00
Blue Cross,HMO,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,Grouper Rate,8841.00
Blue Cross,HMO,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,Grouper Rate,8841.00
Blue Cross,HMO,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,Grouper Rate,8841.00
Blue Cross,HMO,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,Grouper Rate,8841.00
Blue Cross,HMO,349,DRG,Anal & stomal procedures w/o CC/MCC,,Case Rate,16197.62
Blue Cross,HMO,34900,CPT4/HCPCS,ENDOVASC ILIAC REPR W/GRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,35,DRG,Carotid artery stent procedure w CC,,Case Rate,38655.63
Blue Cross,HMO,350,DRG,Inguinal & femoral hernia procedures w MCC,,Case Rate,40562.69
Blue Cross,HMO,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,HMO,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,Grouper Rate,5783.00
Blue Cross,HMO,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,HMO,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,Grouper Rate,5281.00
Blue Cross,HMO,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,6588.00
Blue Cross,HMO,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,Grouper Rate,6588.00
Blue Cross,HMO,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,Grouper Rate,5029.00
Blue Cross,HMO,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,8012.00
Blue Cross,HMO,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,8012.00
Blue Cross,HMO,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,8012.00
Blue Cross,HMO,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,8012.00
Blue Cross,HMO,351,DRG,Inguinal & femoral hernia procedures w CC,,Case Rate,24651.21
Blue Cross,HMO,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,8012.00
Blue Cross,HMO,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,8012.00
Blue Cross,HMO,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5783.00
Blue Cross,HMO,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,Grouper Rate,5783.00
Blue Cross,HMO,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5783.00
Blue Cross,HMO,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,Grouper Rate,6588.00
Blue Cross,HMO,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5783.00
Blue Cross,HMO,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,Grouper Rate,5783.00
Blue Cross,HMO,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,HMO,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,Grouper Rate,5281.00
Blue Cross,HMO,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,HMO,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,Grouper Rate,5281.00
Blue Cross,HMO,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5783.00
Blue Cross,HMO,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,352,DRG,Inguinal & femoral hernia procedures w/o CC/MCC,,Case Rate,18243.62
Blue Cross,HMO,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,HMO,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,HMO,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,HMO,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8841.00
Blue Cross,HMO,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8012.00
Blue Cross,HMO,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5783.00
Blue Cross,HMO,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,HMO,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8841.00
Blue Cross,HMO,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6588.00
Blue Cross,HMO,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6588.00
Blue Cross,HMO,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8841.00
Blue Cross,HMO,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6588.00
Blue Cross,HMO,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5783.00
Blue Cross,HMO,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,353,DRG,Hernia procedures except inguinal & femoral w MCC,,Case Rate,49757.28
Blue Cross,HMO,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,HMO,35302,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,HMO,35303,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,HMO,35304,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,HMO,35305,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,HMO,35306,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1678.88
Blue Cross,HMO,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,6588.00
Blue Cross,HMO,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,HMO,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,HMO,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,HMO,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,HMO,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,HMO,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,HMO,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,HMO,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,HMO,354,DRG,Hernia procedures except inguinal & femoral w CC,,Case Rate,29490.82
Blue Cross,HMO,35400,CPT4/HCPCS,ANGIOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,35450,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,3544.00
Blue Cross,HMO,35452,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,HMO,35458,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,3544.00
Blue Cross,HMO,35460,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,Grouper Rate,3544.00
Blue Cross,HMO,35471,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,HMO,35472,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,HMO,35475,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,HMO,35476,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,HMO,355,DRG,Hernia procedures except inguinal & femoral w/o CC/MCC,,Case Rate,22481.16
Blue Cross,HMO,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,Grouper Rate,1678.00
Blue Cross,HMO,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,Grouper Rate,5281.00
Blue Cross,HMO,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,Grouper Rate,5029.00
Blue Cross,HMO,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,Grouper Rate,5029.00
Blue Cross,HMO,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,Grouper Rate,5281.00
Blue Cross,HMO,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,Grouper Rate,5281.00
Blue Cross,HMO,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,Grouper Rate,5029.00
Blue Cross,HMO,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,Grouper Rate,5029.00
Blue Cross,HMO,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,Grouper Rate,5281.00
Blue Cross,HMO,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,Grouper Rate,5281.00
Blue Cross,HMO,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,Grouper Rate,5281.00
Blue Cross,HMO,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,Grouper Rate,5783.00
Blue Cross,HMO,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,Grouper Rate,5281.00
Blue Cross,HMO,35535,CPT4/HCPCS,ART BYP GRFT HEPATORENAL,,Grouper Rate,5783.00
Blue Cross,HMO,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,Grouper Rate,5783.00
Blue Cross,HMO,35537,CPT4/HCPCS,ART BYP GRFT AORTOILIAC,,Grouper Rate,5783.00
Blue Cross,HMO,35538,CPT4/HCPCS,ART BYP GRFT AORTOBI-ILIAC,,Grouper Rate,5783.00
Blue Cross,HMO,35539,CPT4/HCPCS,ART BYP GRFT AORTOFEMORAL,,Grouper Rate,5783.00
Blue Cross,HMO,35540,CPT4/HCPCS,ART BYP GRFT AORTBIFEMORAL,,Grouper Rate,5783.00
Blue Cross,HMO,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,Grouper Rate,5281.00
Blue Cross,HMO,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,Grouper Rate,5281.00
Blue Cross,HMO,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,Grouper Rate,5783.00
Blue Cross,HMO,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,Grouper Rate,5281.00
Blue Cross,HMO,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,Grouper Rate,5029.00
Blue Cross,HMO,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Grouper Rate,5029.00
Blue Cross,HMO,35570,CPT4/HCPCS,ART BYP TIBIAL-TIB/PERONEAL,,Grouper Rate,5029.00
Blue Cross,HMO,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Grouper Rate,5029.00
Blue Cross,HMO,35572,CPT4/HCPCS,HARVEST FEMOROPOPLITEAL VEIN,,Grouper Rate,1678.00
Blue Cross,HMO,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,Grouper Rate,5029.00
Blue Cross,HMO,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,Grouper Rate,5029.00
Blue Cross,HMO,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,Grouper Rate,5029.00
Blue Cross,HMO,356,DRG,Other digestive system O.R. procedures w MCC,,Case Rate,70979.75
Blue Cross,HMO,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,Grouper Rate,5281.00
Blue Cross,HMO,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,Grouper Rate,5029.00
Blue Cross,HMO,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,Grouper Rate,5281.00
Blue Cross,HMO,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,Grouper Rate,5029.00
Blue Cross,HMO,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,Grouper Rate,5281.00
Blue Cross,HMO,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,Grouper Rate,5281.00
Blue Cross,HMO,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,Grouper Rate,5281.00
Blue Cross,HMO,35632,CPT4/HCPCS,ART BYP ILIO-CELIAC,,Grouper Rate,5281.00
Blue Cross,HMO,35633,CPT4/HCPCS,ART BYP ILIO-MESENTERIC,,Grouper Rate,5281.00
Blue Cross,HMO,35634,CPT4/HCPCS,ART BYP ILIORENAL,,Grouper Rate,5281.00
Blue Cross,HMO,35636,CPT4/HCPCS,ART BYP SPENORENAL,,Grouper Rate,5281.00
Blue Cross,HMO,35637,CPT4/HCPCS,ART BYP AORTOILIAC,,Grouper Rate,5783.00
Blue Cross,HMO,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,Grouper Rate,5029.00
Blue Cross,HMO,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,Grouper Rate,5029.00
Blue Cross,HMO,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,Grouper Rate,5783.00
Blue Cross,HMO,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,Grouper Rate,5783.00
Blue Cross,HMO,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,Grouper Rate,5281.00
Blue Cross,HMO,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,Grouper Rate,5281.00
Blue Cross,HMO,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,Grouper Rate,5029.00
Blue Cross,HMO,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,Grouper Rate,5029.00
Blue Cross,HMO,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,Grouper Rate,5029.00
Blue Cross,HMO,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,Grouper Rate,5029.00
Blue Cross,HMO,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Grouper Rate,5029.00
Blue Cross,HMO,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Grouper Rate,5029.00
Blue Cross,HMO,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,Grouper Rate,5281.00
Blue Cross,HMO,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,Grouper Rate,1678.00
Blue Cross,HMO,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,Grouper Rate,1678.88
Blue Cross,HMO,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,Grouper Rate,1678.88
Blue Cross,HMO,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,Grouper Rate,1678.88
Blue Cross,HMO,357,DRG,Other digestive system O.R. procedures w CC,,Case Rate,37276.19
Blue Cross,HMO,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,Grouper Rate,1678.00
Blue Cross,HMO,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,Grouper Rate,3544.00
Blue Cross,HMO,35702,CPT4/HCPCS,EXPL N/FLWD SURG UXTR ART,,Grouper Rate,3544.00
Blue Cross,HMO,35703,CPT4/HCPCS,EXPL N/FLWD SURG LXTR ART,,Grouper Rate,3544.00
Blue Cross,HMO,35721,CPT4/HCPCS,EXPLORATION FEMORAL ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,35741,CPT4/HCPCS,EXPLORATION POPLITEAL ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,35761,CPT4/HCPCS,EXPLORATION OF ARTERY/VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,358,DRG,Other digestive system O.R. procedures w/o CC/MCC,,Case Rate,22147.06
Blue Cross,HMO,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,Grouper Rate,1678.88
Blue Cross,HMO,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,Grouper Rate,5281.00
Blue Cross,HMO,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,Grouper Rate,5029.00
Blue Cross,HMO,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,Grouper Rate,1678.88
Blue Cross,HMO,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,Grouper Rate,5783.00
Blue Cross,HMO,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,5029.00
Blue Cross,HMO,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,5029.00
Blue Cross,HMO,35883,CPT4/HCPCS,REVISE GRAFT W/NONAUTO GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,35884,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,5029.00
Blue Cross,HMO,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,Grouper Rate,1678.88
Blue Cross,HMO,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,Grouper Rate,1678.88
Blue Cross,HMO,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,Grouper Rate,5029.00
Blue Cross,HMO,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,Grouper Rate,6588.00
Blue Cross,HMO,36,DRG,Carotid artery stent procedure w/o CC/MCC,,Case Rate,30618.84
Blue Cross,HMO,36000,CPT4/HCPCS,PLACE NEEDLE IN VEIN,,Grouper Rate,1678.00
Blue Cross,HMO,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Grouper Rate,1678.00
Blue Cross,HMO,36005,CPT4/HCPCS,INJECTION EXT VENOGRAPHY,,Grouper Rate,1678.88
Blue Cross,HMO,36010,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1678.00
Blue Cross,HMO,36011,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1678.00
Blue Cross,HMO,36012,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1678.00
Blue Cross,HMO,36013,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,36014,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,36015,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,36100,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,36120,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,36140,CPT4/HCPCS,INTRO NDL ICATH UPR/LXTR ART,,Grouper Rate,1678.00
Blue Cross,HMO,36147,CPT4/HCPCS,ACCESS AV DIAL GRFT FOR EVAL,,Grouper Rate,1678.00
Blue Cross,HMO,36148,CPT4/HCPCS,ACCESS AV DIAL GRFT FOR PROC,,Grouper Rate,1678.00
Blue Cross,HMO,36160,CPT4/HCPCS,ESTABLISH ACCESS TO AORTA,,Grouper Rate,1678.00
Blue Cross,HMO,36200,CPT4/HCPCS,PLACE CATHETER IN AORTA,,Grouper Rate,3544.00
Blue Cross,HMO,36215,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,36216,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,36217,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,36218,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Grouper Rate,3544.00
Blue Cross,HMO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,3544.00
Blue Cross,HMO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,3544.00
Blue Cross,HMO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Grouper Rate,3544.00
Blue Cross,HMO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Grouper Rate,3544.00
Blue Cross,HMO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Grouper Rate,3544.00
Blue Cross,HMO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Grouper Rate,3544.00
Blue Cross,HMO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Grouper Rate,3544.00
Blue Cross,HMO,36245,CPT4/HCPCS,INS CATH ABD/L-EXT ART 1ST,,Grouper Rate,3544.00
Blue Cross,HMO,36246,CPT4/HCPCS,INS CATH ABD/L-EXT ART 2ND,,Grouper Rate,3544.00
Blue Cross,HMO,36247,CPT4/HCPCS,INS CATH ABD/L-EXT ART 3RD,,Grouper Rate,3544.00
Blue Cross,HMO,36248,CPT4/HCPCS,INS CATH ABD/L-EXT ART ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,Grouper Rate,3544.00
Blue Cross,HMO,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,Grouper Rate,3544.00
Blue Cross,HMO,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,Grouper Rate,3544.00
Blue Cross,HMO,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,Grouper Rate,3544.00
Blue Cross,HMO,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Grouper Rate,1678.00
Blue Cross,HMO,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Grouper Rate,1678.00
Blue Cross,HMO,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Grouper Rate,1678.00
Blue Cross,HMO,36416,CPT4/HCPCS,CAPILLARY BLOOD DRAW,,Grouper Rate,1678.00
Blue Cross,HMO,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Grouper Rate,1678.00
Blue Cross,HMO,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Grouper Rate,1678.00
Blue Cross,HMO,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Grouper Rate,1678.00
Blue Cross,HMO,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Grouper Rate,1678.00
Blue Cross,HMO,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Grouper Rate,1678.00
Blue Cross,HMO,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Grouper Rate,3544.00
Blue Cross,HMO,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Grouper Rate,1678.00
Blue Cross,HMO,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Grouper Rate,1678.88
Blue Cross,HMO,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Grouper Rate,1678.00
Blue Cross,HMO,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Grouper Rate,1678.00
Blue Cross,HMO,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,36474,CPT4/HCPCS,ENDOVENOUS MCHNCHEM ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Grouper Rate,1678.00
Blue Cross,HMO,36481,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1678.00
Blue Cross,HMO,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Grouper Rate,3544.00
Blue Cross,HMO,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Grouper Rate,1678.88
Blue Cross,HMO,36500,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1678.00
Blue Cross,HMO,36510,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1678.00
Blue Cross,HMO,36514,CPT4/HCPCS,APHERESIS PLASMA,,Grouper Rate,1678.00
Blue Cross,HMO,36522,CPT4/HCPCS,PHOTOPHERESIS,,Grouper Rate,1678.00
Blue Cross,HMO,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,1678.00
Blue Cross,HMO,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,1678.00
Blue Cross,HMO,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,3544.00
Blue Cross,HMO,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,3544.00
Blue Cross,HMO,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Grouper Rate,1678.88
Blue Cross,HMO,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Grouper Rate,1678.88
Blue Cross,HMO,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,3544.00
Blue Cross,HMO,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,3544.00
Blue Cross,HMO,36572,CPT4/HCPCS,INSJ PICC RS&I <5 YR,,Grouper Rate,1678.88
Blue Cross,HMO,36573,CPT4/HCPCS,INSJ PICC RS&I 5 YR+,,Grouper Rate,1678.88
Blue Cross,HMO,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,HMO,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Grouper Rate,1678.00
Blue Cross,HMO,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,HMO,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,HMO,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,HMO,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Grouper Rate,1678.00
Blue Cross,HMO,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,HMO,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Grouper Rate,1678.00
Blue Cross,HMO,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,HMO,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Grouper Rate,1678.00
Blue Cross,HMO,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Grouper Rate,1678.00
Blue Cross,HMO,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,Grouper Rate,1678.00
Blue Cross,HMO,36620,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,36625,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Grouper Rate,1678.00
Blue Cross,HMO,368,DRG,Major esophageal disorders w MCC,,Case Rate,32125.64
Blue Cross,HMO,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,3544.00
Blue Cross,HMO,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,3544.00
Blue Cross,HMO,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,3544.00
Blue Cross,HMO,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Grouper Rate,3544.00
Blue Cross,HMO,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Grouper Rate,5029.00
Blue Cross,HMO,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Grouper Rate,5029.00
Blue Cross,HMO,36822,CPT4/HCPCS,INSERTION OF CANNULA(S),,Grouper Rate,3544.00
Blue Cross,HMO,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,Grouper Rate,5281.00
Blue Cross,HMO,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Grouper Rate,5029.00
Blue Cross,HMO,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Grouper Rate,5029.00
Blue Cross,HMO,36833,CPT4/HCPCS,AV FISTULA REVISION,,Grouper Rate,5029.00
Blue Cross,HMO,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Grouper Rate,5029.00
Blue Cross,HMO,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Grouper Rate,3544.00
Blue Cross,HMO,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Grouper Rate,1678.88
Blue Cross,HMO,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Grouper Rate,3544.00
Blue Cross,HMO,36870,CPT4/HCPCS,PERCUT THROMBECT AV FISTULA,,Grouper Rate,1678.88
Blue Cross,HMO,369,DRG,Major esophageal disorders w CC,,Case Rate,17810.27
Blue Cross,HMO,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,1678.00
Blue Cross,HMO,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,5029.00
Blue Cross,HMO,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,5029.00
Blue Cross,HMO,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,1678.88
Blue Cross,HMO,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,5029.00
Blue Cross,HMO,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,3544.00
Blue Cross,HMO,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Grouper Rate,5029.00
Blue Cross,HMO,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Grouper Rate,1678.88
Blue Cross,HMO,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Grouper Rate,1678.88
Blue Cross,HMO,37,DRG,Extracranial procedures w MCC,,Case Rate,54163.53
Blue Cross,HMO,370,DRG,Major esophageal disorders w/o CC/MCC,,Case Rate,12365.30
Blue Cross,HMO,371,DRG,Major gastrointestinal disorders & peritoneal infections w MCC,,Case Rate,28586.08
Blue Cross,HMO,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,HMO,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,HMO,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,HMO,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,HMO,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,Grouper Rate,5783.00
Blue Cross,HMO,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,Grouper Rate,5029.00
Blue Cross,HMO,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Grouper Rate,5783.00
Blue Cross,HMO,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Grouper Rate,3544.00
Blue Cross,HMO,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Grouper Rate,1678.88
Blue Cross,HMO,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Grouper Rate,1678.88
Blue Cross,HMO,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Grouper Rate,1678.88
Blue Cross,HMO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Grouper Rate,5029.00
Blue Cross,HMO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Grouper Rate,5029.00
Blue Cross,HMO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Grouper Rate,5029.00
Blue Cross,HMO,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,Grouper Rate,1678.88
Blue Cross,HMO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Grouper Rate,3544.00
Blue Cross,HMO,372,DRG,Major gastrointestinal disorders & peritoneal infections w CC,,Case Rate,16996.50
Blue Cross,HMO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Grouper Rate,1678.88
Blue Cross,HMO,37201,CPT4/HCPCS,TRANSCATHETER THERAPY INFUSE,,Grouper Rate,1678.88
Blue Cross,HMO,37202,CPT4/HCPCS,TRANSCATHETER THERAPY INFUSE,,Grouper Rate,1678.88
Blue Cross,HMO,37203,CPT4/HCPCS,TRANSCATHETER RETRIEVAL,,Grouper Rate,3544.00
Blue Cross,HMO,37204,CPT4/HCPCS,TRANSCATHETER OCCLUSION,,Grouper Rate,5029.00
Blue Cross,HMO,37205,CPT4/HCPCS,TRANSCATH IV STENT PERCUT,,Grouper Rate,5029.00
Blue Cross,HMO,37206,CPT4/HCPCS,TRANSCATH IV STENT/PERC ADDL,,Grouper Rate,1678.88
Blue Cross,HMO,37207,CPT4/HCPCS,TRANSCATH IV STENT OPEN,,Grouper Rate,5029.00
Blue Cross,HMO,37208,CPT4/HCPCS,TRANSCATH IV STENT/OPEN ADDL,,Grouper Rate,1678.88
Blue Cross,HMO,37209,CPT4/HCPCS,CHANGE IV CATH AT THROMB TX,,Grouper Rate,1678.00
Blue Cross,HMO,37210,CPT4/HCPCS,EMBOLIZATION UTERINE FIBROID,,Grouper Rate,5029.00
Blue Cross,HMO,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Grouper Rate,1678.88
Blue Cross,HMO,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Grouper Rate,1678.88
Blue Cross,HMO,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Grouper Rate,1678.88
Blue Cross,HMO,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Grouper Rate,1678.88
Blue Cross,HMO,37215,CPT4/HCPCS,TRANSCATH STENT CCA W/EPS,,Grouper Rate,5281.00
Blue Cross,HMO,37216,CPT4/HCPCS,TRANSCATH STENT CCA W/O EPS,,Grouper Rate,5029.00
Blue Cross,HMO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Grouper Rate,5029.00
Blue Cross,HMO,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Grouper Rate,5029.00
Blue Cross,HMO,37220,CPT4/HCPCS,ILIAC REVASC,,Grouper Rate,5029.00
Blue Cross,HMO,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Grouper Rate,5029.00
Blue Cross,HMO,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Grouper Rate,3544.00
Blue Cross,HMO,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Grouper Rate,5029.00
Blue Cross,HMO,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Grouper Rate,5029.00
Blue Cross,HMO,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Grouper Rate,5281.00
Blue Cross,HMO,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Grouper Rate,5029.00
Blue Cross,HMO,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Grouper Rate,5281.00
Blue Cross,HMO,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Grouper Rate,5281.00
Blue Cross,HMO,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Grouper Rate,5281.00
Blue Cross,HMO,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Grouper Rate,1678.88
Blue Cross,HMO,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Grouper Rate,1678.88
Blue Cross,HMO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Grouper Rate,5029.00
Blue Cross,HMO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,1678.88
Blue Cross,HMO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Grouper Rate,5029.00
Blue Cross,HMO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,1678.88
Blue Cross,HMO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Grouper Rate,5281.00
Blue Cross,HMO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Grouper Rate,5281.00
Blue Cross,HMO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Grouper Rate,5281.00
Blue Cross,HMO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Grouper Rate,5281.00
Blue Cross,HMO,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Grouper Rate,5029.00
Blue Cross,HMO,37247,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL ART,,Grouper Rate,5029.00
Blue Cross,HMO,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Grouper Rate,5029.00
Blue Cross,HMO,37249,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL VEIN,,Grouper Rate,5029.00
Blue Cross,HMO,37252,CPT4/HCPCS,INTRVASC US NONCORONARY 1ST,,Grouper Rate,1678.00
Blue Cross,HMO,37253,CPT4/HCPCS,INTRVASC US NONCORONARY ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,373,DRG,Major gastrointestinal disorders & peritoneal infections w/o CC/MCC,,Case Rate,12297.49
Blue Cross,HMO,374,DRG,Digestive malignancy w MCC,,Case Rate,34203.06
Blue Cross,HMO,375,DRG,Digestive malignancy w CC,,Case Rate,19929.04
Blue Cross,HMO,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Grouper Rate,1678.88
Blue Cross,HMO,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,Grouper Rate,1678.88
Blue Cross,HMO,376,DRG,Digestive malignancy w/o CC/MCC,,Case Rate,14806.60
Blue Cross,HMO,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,5029.00
Blue Cross,HMO,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Grouper Rate,3544.00
Blue Cross,HMO,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Grouper Rate,1678.88
Blue Cross,HMO,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,Grouper Rate,5029.00
Blue Cross,HMO,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,Grouper Rate,5029.00
Blue Cross,HMO,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Grouper Rate,6588.00
Blue Cross,HMO,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,5029.00
Blue Cross,HMO,377,DRG,G.I. hemorrhage w MCC,,Case Rate,29753.80
Blue Cross,HMO,37700,CPT4/HCPCS,REVISE LEG VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Grouper Rate,3544.00
Blue Cross,HMO,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Grouper Rate,3544.00
Blue Cross,HMO,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Grouper Rate,3544.00
Blue Cross,HMO,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Grouper Rate,3544.00
Blue Cross,HMO,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Grouper Rate,3544.00
Blue Cross,HMO,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,Grouper Rate,5029.00
Blue Cross,HMO,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Grouper Rate,3544.00
Blue Cross,HMO,378,DRG,G.I. hemorrhage w CC,,Case Rate,16427.52
Blue Cross,HMO,379,DRG,G.I. hemorrhage w/o CC/MCC,,Case Rate,10537.63
Blue Cross,HMO,38,DRG,Extracranial procedures w CC,,Case Rate,27411.74
Blue Cross,HMO,380,DRG,Complicated peptic ulcer w MCC,,Case Rate,31146.47
Blue Cross,HMO,381,DRG,Complicated peptic ulcer w CC,,Case Rate,17527.43
Blue Cross,HMO,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Grouper Rate,5783.00
Blue Cross,HMO,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,Grouper Rate,5783.00
Blue Cross,HMO,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Grouper Rate,3544.00
Blue Cross,HMO,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,Grouper Rate,5783.00
Blue Cross,HMO,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,382,DRG,Complicated peptic ulcer w/o CC/MCC,,Case Rate,12707.68
Blue Cross,HMO,38200,CPT4/HCPCS,INJECTION FOR SPLEEN X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,38204,CPT4/HCPCS,BL DONOR SEARCH MANAGEMENT,,Grouper Rate,1678.00
Blue Cross,HMO,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,Grouper Rate,1678.00
Blue Cross,HMO,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,Grouper Rate,1678.00
Blue Cross,HMO,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,Grouper Rate,1678.00
Blue Cross,HMO,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,Grouper Rate,1678.00
Blue Cross,HMO,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,Grouper Rate,1678.00
Blue Cross,HMO,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,Grouper Rate,1678.00
Blue Cross,HMO,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,Grouper Rate,1678.00
Blue Cross,HMO,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,Grouper Rate,1678.00
Blue Cross,HMO,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,Grouper Rate,1678.00
Blue Cross,HMO,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,Grouper Rate,1678.00
Blue Cross,HMO,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,Grouper Rate,1678.00
Blue Cross,HMO,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Grouper Rate,1678.00
Blue Cross,HMO,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Grouper Rate,1678.00
Blue Cross,HMO,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Grouper Rate,1678.00
Blue Cross,HMO,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Grouper Rate,1678.88
Blue Cross,HMO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Grouper Rate,1678.88
Blue Cross,HMO,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Grouper Rate,6588.00
Blue Cross,HMO,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Grouper Rate,6588.00
Blue Cross,HMO,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,Grouper Rate,1678.00
Blue Cross,HMO,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Grouper Rate,6588.00
Blue Cross,HMO,383,DRG,Uncomplicated peptic ulcer w MCC,,Case Rate,21682.28
Blue Cross,HMO,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,1678.00
Blue Cross,HMO,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Grouper Rate,1678.88
Blue Cross,HMO,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,5783.00
Blue Cross,HMO,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,6588.00
Blue Cross,HMO,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,5783.00
Blue Cross,HMO,384,DRG,Uncomplicated peptic ulcer w/o MCC,,Case Rate,14760.29
Blue Cross,HMO,385,DRG,Inflammatory bowel disease w MCC,,Case Rate,26779.91
Blue Cross,HMO,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,HMO,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Grouper Rate,1678.00
Blue Cross,HMO,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,HMO,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,HMO,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,HMO,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,HMO,38531,CPT4/HCPCS,OPEN BX/EXC INGUINOFEM NODES,,Grouper Rate,1678.88
Blue Cross,HMO,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Grouper Rate,1678.88
Blue Cross,HMO,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,3544.00
Blue Cross,HMO,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,5029.00
Blue Cross,HMO,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,Grouper Rate,5281.00
Blue Cross,HMO,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,Grouper Rate,5281.00
Blue Cross,HMO,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Grouper Rate,3544.00
Blue Cross,HMO,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Grouper Rate,5281.00
Blue Cross,HMO,386,DRG,Inflammatory bowel disease w CC,,Case Rate,16432.49
Blue Cross,HMO,387,DRG,Inflammatory bowel disease w/o CC/MCC,,Case Rate,11801.29
Blue Cross,HMO,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,1678.88
Blue Cross,HMO,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,5281.00
Blue Cross,HMO,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,8012.00
Blue Cross,HMO,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,HMO,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,5029.00
Blue Cross,HMO,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,Grouper Rate,6588.00
Blue Cross,HMO,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,Grouper Rate,6588.00
Blue Cross,HMO,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,HMO,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,HMO,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,Grouper Rate,5783.00
Blue Cross,HMO,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,Grouper Rate,5783.00
Blue Cross,HMO,38790,CPT4/HCPCS,INJECT FOR LYMPHATIC X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,38792,CPT4/HCPCS,RA TRACER ID OF SENTINL NODE,,Grouper Rate,1678.00
Blue Cross,HMO,38794,CPT4/HCPCS,ACCESS THORACIC LYMPH DUCT,,Grouper Rate,1678.88
Blue Cross,HMO,388,DRG,G.I. obstruction w MCC,,Case Rate,25005.17
Blue Cross,HMO,389,DRG,G.I. obstruction w CC,,Case Rate,13592.57
Blue Cross,HMO,38900,CPT4/HCPCS,IO MAP OF SENT LYMPH NODE,,Grouper Rate,1678.00
Blue Cross,HMO,39,DRG,Extracranial procedures w/o CC/MCC,,Case Rate,18839.06
Blue Cross,HMO,390,DRG,G.I. obstruction w/o CC/MCC,,Case Rate,9636.20
Blue Cross,HMO,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,5029.00
Blue Cross,HMO,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,5029.00
Blue Cross,HMO,391,DRG,Esophagitis, gastroent & misc digest disorders w MCC,,Case Rate,20582.37
Blue Cross,HMO,392,DRG,Esophagitis, gastroent & misc digest disorders w/o MCC,,Case Rate,12643.17
Blue Cross,HMO,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,Grouper Rate,5029.00
Blue Cross,HMO,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,Grouper Rate,5029.00
Blue Cross,HMO,393,DRG,Other digestive system diagnoses w MCC,,Case Rate,27350.54
Blue Cross,HMO,394,DRG,Other digestive system diagnoses w CC,,Case Rate,15524.44
Blue Cross,HMO,39400,CPT4/HCPCS,MEDIASTINOSCOPY INCL BIOPSY,,Grouper Rate,3544.00
Blue Cross,HMO,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Grouper Rate,3544.00
Blue Cross,HMO,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Grouper Rate,3544.00
Blue Cross,HMO,395,DRG,Other digestive system diagnoses w/o CC/MCC,,Case Rate,10746.03
Blue Cross,HMO,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,Grouper Rate,5783.00
Blue Cross,HMO,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,6588.00
Blue Cross,HMO,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,5783.00
Blue Cross,HMO,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,5783.00
Blue Cross,HMO,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,Grouper Rate,5783.00
Blue Cross,HMO,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,Grouper Rate,5281.00
Blue Cross,HMO,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,Grouper Rate,6588.00
Blue Cross,HMO,4,DRG,Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R.,,Case Rate,196197.48
Blue Cross,HMO,40,DRG,Periph/cranial nerve & other nerv syst proc w MCC,,Case Rate,65462.01
Blue Cross,HMO,40490,CPT4/HCPCS,BIOPSY OF LIP,,Grouper Rate,1678.00
Blue Cross,HMO,405,DRG,Pancreas, liver & shunt procedures w MCC,,Case Rate,94782.47
Blue Cross,HMO,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1678.88
Blue Cross,HMO,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1678.88
Blue Cross,HMO,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1678.88
Blue Cross,HMO,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,1678.88
Blue Cross,HMO,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,1678.88
Blue Cross,HMO,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Grouper Rate,1678.88
Blue Cross,HMO,406,DRG,Pancreas, liver & shunt procedures w CC,,Case Rate,47585.58
Blue Cross,HMO,40650,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,3544.00
Blue Cross,HMO,40652,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,3544.00
Blue Cross,HMO,40654,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,3544.00
Blue Cross,HMO,407,DRG,Pancreas, liver & shunt procedures w/o CC/MCC,,Case Rate,34998.64
Blue Cross,HMO,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,3544.00
Blue Cross,HMO,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5029.00
Blue Cross,HMO,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5029.00
Blue Cross,HMO,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5029.00
Blue Cross,HMO,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,3544.00
Blue Cross,HMO,408,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC,,Case Rate,62016.73
Blue Cross,HMO,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.88
Blue Cross,HMO,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,1678.00
Blue Cross,HMO,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,1678.88
Blue Cross,HMO,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Grouper Rate,1678.00
Blue Cross,HMO,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,1678.88
Blue Cross,HMO,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1678.88
Blue Cross,HMO,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Grouper Rate,1678.00
Blue Cross,HMO,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Grouper Rate,1678.00
Blue Cross,HMO,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,1678.00
Blue Cross,HMO,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,1678.00
Blue Cross,HMO,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,1678.88
Blue Cross,HMO,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,1678.88
Blue Cross,HMO,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,1678.88
Blue Cross,HMO,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5281.00
Blue Cross,HMO,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5281.00
Blue Cross,HMO,409,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w CC,,Case Rate,34970.52
Blue Cross,HMO,41,DRG,Periph/cranial nerve & other nerv syst proc w CC or periph neurostim,,Case Rate,38882.23
Blue Cross,HMO,410,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC,,Case Rate,25896.67
Blue Cross,HMO,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Grouper Rate,1678.00
Blue Cross,HMO,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Grouper Rate,1678.00
Blue Cross,HMO,411,DRG,Cholecystectomy w c.d.e. w MCC,,Case Rate,62064.69
Blue Cross,HMO,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,1678.00
Blue Cross,HMO,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,1678.00
Blue Cross,HMO,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Grouper Rate,1678.00
Blue Cross,HMO,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Grouper Rate,1678.00
Blue Cross,HMO,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,5029.00
Blue Cross,HMO,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,5281.00
Blue Cross,HMO,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,Grouper Rate,5783.00
Blue Cross,HMO,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,412,DRG,Cholecystectomy w c.d.e. w CC,,Case Rate,37640.07
Blue Cross,HMO,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1678.88
Blue Cross,HMO,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1678.88
Blue Cross,HMO,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1678.88
Blue Cross,HMO,413,DRG,Cholecystectomy w c.d.e. w/o CC/MCC,,Case Rate,28637.35
Blue Cross,HMO,414,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w MCC,,Case Rate,59965.77
Blue Cross,HMO,415,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w CC,,Case Rate,33607.62
Blue Cross,HMO,41500,CPT4/HCPCS,FIXATION OF TONGUE,,Grouper Rate,1678.00
Blue Cross,HMO,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Grouper Rate,1678.00
Blue Cross,HMO,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Grouper Rate,1678.00
Blue Cross,HMO,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Grouper Rate,1678.00
Blue Cross,HMO,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Grouper Rate,1678.88
Blue Cross,HMO,416,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC,,Case Rate,23523.18
Blue Cross,HMO,417,DRG,Laparoscopic cholecystectomy w/o c.d.e. w MCC,,Case Rate,40084.69
Blue Cross,HMO,418,DRG,Laparoscopic cholecystectomy w/o c.d.e. w CC,,Case Rate,27921.17
Blue Cross,HMO,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Grouper Rate,1678.00
Blue Cross,HMO,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Grouper Rate,1678.00
Blue Cross,HMO,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Grouper Rate,1678.00
Blue Cross,HMO,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Grouper Rate,1678.00
Blue Cross,HMO,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,HMO,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,HMO,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,HMO,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,HMO,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,HMO,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Grouper Rate,1678.88
Blue Cross,HMO,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Grouper Rate,1678.00
Blue Cross,HMO,41870,CPT4/HCPCS,GUM GRAFT,,Grouper Rate,1678.88
Blue Cross,HMO,41872,CPT4/HCPCS,REPAIR GUM,,Grouper Rate,1678.88
Blue Cross,HMO,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Grouper Rate,1678.88
Blue Cross,HMO,419,DRG,Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC,,Case Rate,21753.40
Blue Cross,HMO,42,DRG,Periph/cranial nerve & other nerv syst proc w/o CC/MCC,,Case Rate,31176.24
Blue Cross,HMO,420,DRG,Hepatobiliary diagnostic procedures w MCC,,Case Rate,58123.21
Blue Cross,HMO,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Grouper Rate,1678.88
Blue Cross,HMO,421,DRG,Hepatobiliary diagnostic procedures w CC,,Case Rate,31573.20
Blue Cross,HMO,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Grouper Rate,1678.00
Blue Cross,HMO,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1678.00
Blue Cross,HMO,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1678.88
Blue Cross,HMO,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1678.88
Blue Cross,HMO,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Grouper Rate,5029.00
Blue Cross,HMO,42140,CPT4/HCPCS,EXCISION OF UVULA,,Grouper Rate,1678.88
Blue Cross,HMO,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Grouper Rate,5029.00
Blue Cross,HMO,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Grouper Rate,1678.00
Blue Cross,HMO,42180,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,1678.00
Blue Cross,HMO,42182,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,1678.88
Blue Cross,HMO,422,DRG,Hepatobiliary diagnostic procedures w/o CC/MCC,,Case Rate,24006.15
Blue Cross,HMO,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,HMO,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,HMO,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,HMO,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5783.00
Blue Cross,HMO,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,HMO,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,HMO,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,3544.00
Blue Cross,HMO,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,3544.00
Blue Cross,HMO,42235,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,5029.00
Blue Cross,HMO,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Grouper Rate,5029.00
Blue Cross,HMO,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Grouper Rate,1678.00
Blue Cross,HMO,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Grouper Rate,3544.00
Blue Cross,HMO,423,DRG,Other hepatobiliary or pancreas O.R. procedures w MCC,,Case Rate,69120.66
Blue Cross,HMO,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,HMO,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.88
Blue Cross,HMO,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,HMO,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,HMO,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,1678.00
Blue Cross,HMO,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,3544.00
Blue Cross,HMO,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,1678.88
Blue Cross,HMO,424,DRG,Other hepatobiliary or pancreas O.R. procedures w CC,,Case Rate,37737.66
Blue Cross,HMO,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,HMO,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,HMO,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Grouper Rate,3544.00
Blue Cross,HMO,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Grouper Rate,3544.00
Blue Cross,HMO,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,3544.00
Blue Cross,HMO,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5029.00
Blue Cross,HMO,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,6588.00
Blue Cross,HMO,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,6588.00
Blue Cross,HMO,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5783.00
Blue Cross,HMO,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Grouper Rate,3544.00
Blue Cross,HMO,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Grouper Rate,1678.88
Blue Cross,HMO,425,DRG,Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC,,Case Rate,25526.18
Blue Cross,HMO,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,3544.00
Blue Cross,HMO,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,5029.00
Blue Cross,HMO,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,3544.00
Blue Cross,HMO,42508,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5029.00
Blue Cross,HMO,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5029.00
Blue Cross,HMO,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5029.00
Blue Cross,HMO,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Grouper Rate,1678.00
Blue Cross,HMO,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Grouper Rate,1678.00
Blue Cross,HMO,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,1678.88
Blue Cross,HMO,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Grouper Rate,1678.00
Blue Cross,HMO,42802,CPT4/HCPCS,BIOPSY OF THROAT,,Grouper Rate,1678.00
Blue Cross,HMO,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,1678.00
Blue Cross,HMO,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,1678.00
Blue Cross,HMO,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Grouper Rate,1678.88
Blue Cross,HMO,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,3544.00
Blue Cross,HMO,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,5281.00
Blue Cross,HMO,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,5029.00
Blue Cross,HMO,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,5029.00
Blue Cross,HMO,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,5029.00
Blue Cross,HMO,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,5029.00
Blue Cross,HMO,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,HMO,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,HMO,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,HMO,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,HMO,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,5029.00
Blue Cross,HMO,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,5281.00
Blue Cross,HMO,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,5281.00
Blue Cross,HMO,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Grouper Rate,3544.00
Blue Cross,HMO,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Grouper Rate,3544.00
Blue Cross,HMO,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Grouper Rate,3544.00
Blue Cross,HMO,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,5029.00
Blue Cross,HMO,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,5281.00
Blue Cross,HMO,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Grouper Rate,1678.00
Blue Cross,HMO,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Grouper Rate,1678.88
Blue Cross,HMO,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,Grouper Rate,5281.00
Blue Cross,HMO,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Grouper Rate,1678.88
Blue Cross,HMO,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,HMO,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,HMO,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1678.88
Blue Cross,HMO,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,HMO,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,HMO,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1678.88
Blue Cross,HMO,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Grouper Rate,5029.00
Blue Cross,HMO,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Grouper Rate,5783.00
Blue Cross,HMO,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Grouper Rate,6588.00
Blue Cross,HMO,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,Grouper Rate,6588.00
Blue Cross,HMO,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,5783.00
Blue Cross,HMO,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,5281.00
Blue Cross,HMO,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,6588.00
Blue Cross,HMO,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Grouper Rate,1678.00
Blue Cross,HMO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Grouper Rate,1678.00
Blue Cross,HMO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Grouper Rate,1678.00
Blue Cross,HMO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Grouper Rate,1678.00
Blue Cross,HMO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Grouper Rate,1678.00
Blue Cross,HMO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Grouper Rate,1678.00
Blue Cross,HMO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Grouper Rate,1678.00
Blue Cross,HMO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,432,DRG,Cirrhosis & alcoholic hepatitis w MCC,,Case Rate,31129.93
Blue Cross,HMO,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Grouper Rate,1678.00
Blue Cross,HMO,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Grouper Rate,1678.88
Blue Cross,HMO,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Grouper Rate,1678.00
Blue Cross,HMO,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Grouper Rate,1678.88
Blue Cross,HMO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Grouper Rate,3544.00
Blue Cross,HMO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Grouper Rate,1678.00
Blue Cross,HMO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Grouper Rate,1678.00
Blue Cross,HMO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Grouper Rate,1678.00
Blue Cross,HMO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Grouper Rate,1678.00
Blue Cross,HMO,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Grouper Rate,1678.00
Blue Cross,HMO,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Grouper Rate,1678.88
Blue Cross,HMO,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Grouper Rate,1678.00
Blue Cross,HMO,43219,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Grouper Rate,1678.00
Blue Cross,HMO,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Grouper Rate,1678.00
Blue Cross,HMO,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Grouper Rate,1678.88
Blue Cross,HMO,43228,CPT4/HCPCS,ESOPH ENDOSCOPY ABLATION,,Grouper Rate,1678.88
Blue Cross,HMO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Grouper Rate,1678.00
Blue Cross,HMO,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Grouper Rate,1678.00
Blue Cross,HMO,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Grouper Rate,1678.00
Blue Cross,HMO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Grouper Rate,1678.00
Blue Cross,HMO,43234,CPT4/HCPCS,UPPER GI ENDOSCOPY EXAM,,Grouper Rate,1678.00
Blue Cross,HMO,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Grouper Rate,1678.88
Blue Cross,HMO,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Grouper Rate,1678.88
Blue Cross,HMO,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Grouper Rate,1678.88
Blue Cross,HMO,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,1678.88
Blue Cross,HMO,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Grouper Rate,1678.88
Blue Cross,HMO,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Grouper Rate,1678.00
Blue Cross,HMO,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Grouper Rate,1678.88
Blue Cross,HMO,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,1678.00
Blue Cross,HMO,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Grouper Rate,1678.88
Blue Cross,HMO,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Grouper Rate,1678.88
Blue Cross,HMO,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Grouper Rate,1678.88
Blue Cross,HMO,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Grouper Rate,1678.88
Blue Cross,HMO,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,HMO,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Grouper Rate,1678.88
Blue Cross,HMO,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Grouper Rate,1678.88
Blue Cross,HMO,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Grouper Rate,1678.88
Blue Cross,HMO,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Grouper Rate,1678.88
Blue Cross,HMO,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Grouper Rate,1678.00
Blue Cross,HMO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Grouper Rate,1678.88
Blue Cross,HMO,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Grouper Rate,1678.88
Blue Cross,HMO,43256,CPT4/HCPCS,UPPR GI ENDOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,HMO,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Grouper Rate,1678.88
Blue Cross,HMO,43258,CPT4/HCPCS,OPERATIVE UPPER GI ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Grouper Rate,1678.88
Blue Cross,HMO,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Grouper Rate,1678.88
Blue Cross,HMO,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,HMO,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,HMO,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Grouper Rate,1678.88
Blue Cross,HMO,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Grouper Rate,1678.88
Blue Cross,HMO,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Grouper Rate,1678.88
Blue Cross,HMO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Grouper Rate,1678.00
Blue Cross,HMO,43267,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,HMO,43268,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,HMO,43269,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,HMO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Grouper Rate,1678.88
Blue Cross,HMO,43271,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,HMO,43272,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,HMO,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Grouper Rate,1678.88
Blue Cross,HMO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Grouper Rate,1678.88
Blue Cross,HMO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Grouper Rate,1678.88
Blue Cross,HMO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Grouper Rate,1678.88
Blue Cross,HMO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Grouper Rate,1678.88
Blue Cross,HMO,43279,CPT4/HCPCS,LAP MYOTOMY HELLER,,Grouper Rate,5783.00
Blue Cross,HMO,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Grouper Rate,6588.00
Blue Cross,HMO,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Grouper Rate,6588.00
Blue Cross,HMO,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Grouper Rate,6588.00
Blue Cross,HMO,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,Grouper Rate,6588.00
Blue Cross,HMO,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Grouper Rate,5029.00
Blue Cross,HMO,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Grouper Rate,1678.88
Blue Cross,HMO,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,Grouper Rate,6588.00
Blue Cross,HMO,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,Grouper Rate,6588.00
Blue Cross,HMO,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,Grouper Rate,6588.00
Blue Cross,HMO,433,DRG,Cirrhosis & alcoholic hepatitis w CC,,Case Rate,17011.39
Blue Cross,HMO,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Grouper Rate,5281.00
Blue Cross,HMO,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Grouper Rate,5783.00
Blue Cross,HMO,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Grouper Rate,6588.00
Blue Cross,HMO,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,Grouper Rate,6588.00
Blue Cross,HMO,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,Grouper Rate,6588.00
Blue Cross,HMO,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,Grouper Rate,6588.00
Blue Cross,HMO,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,Grouper Rate,5783.00
Blue Cross,HMO,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,Grouper Rate,5783.00
Blue Cross,HMO,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,Grouper Rate,6588.00
Blue Cross,HMO,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,Grouper Rate,5783.00
Blue Cross,HMO,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,Grouper Rate,6588.00
Blue Cross,HMO,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Grouper Rate,6588.00
Blue Cross,HMO,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Grouper Rate,6588.00
Blue Cross,HMO,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Grouper Rate,6588.00
Blue Cross,HMO,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Grouper Rate,6588.00
Blue Cross,HMO,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Grouper Rate,8012.00
Blue Cross,HMO,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Grouper Rate,8012.00
Blue Cross,HMO,43338,CPT4/HCPCS,ESOPH LENGTHENING,,Grouper Rate,5783.00
Blue Cross,HMO,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Grouper Rate,5783.00
Blue Cross,HMO,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Grouper Rate,6588.00
Blue Cross,HMO,43350,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,5783.00
Blue Cross,HMO,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,HMO,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,5029.00
Blue Cross,HMO,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Grouper Rate,5783.00
Blue Cross,HMO,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Grouper Rate,5783.00
Blue Cross,HMO,434,DRG,Cirrhosis & alcoholic hepatitis w/o CC/MCC,,Case Rate,10248.18
Blue Cross,HMO,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,Grouper Rate,3544.00
Blue Cross,HMO,43401,CPT4/HCPCS,ESOPHAGUS SURGERY FOR VEINS,,Grouper Rate,5783.00
Blue Cross,HMO,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,Grouper Rate,5783.00
Blue Cross,HMO,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Grouper Rate,5281.00
Blue Cross,HMO,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Grouper Rate,6588.00
Blue Cross,HMO,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,5281.00
Blue Cross,HMO,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,6588.00
Blue Cross,HMO,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Grouper Rate,1678.00
Blue Cross,HMO,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1678.00
Blue Cross,HMO,43456,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1678.88
Blue Cross,HMO,43458,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1678.88
Blue Cross,HMO,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,Grouper Rate,1678.88
Blue Cross,HMO,435,DRG,Malignancy of hepatobiliary system or pancreas w MCC,,Case Rate,28991.31
Blue Cross,HMO,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Grouper Rate,5281.00
Blue Cross,HMO,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Grouper Rate,5783.00
Blue Cross,HMO,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Grouper Rate,5783.00
Blue Cross,HMO,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Grouper Rate,1678.00
Blue Cross,HMO,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,Grouper Rate,5281.00
Blue Cross,HMO,436,DRG,Malignancy of hepatobiliary system or pancreas w CC,,Case Rate,18528.10
Blue Cross,HMO,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,Grouper Rate,5029.00
Blue Cross,HMO,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Grouper Rate,1678.88
Blue Cross,HMO,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Grouper Rate,1678.88
Blue Cross,HMO,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,6588.00
Blue Cross,HMO,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,6588.00
Blue Cross,HMO,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,5783.00
Blue Cross,HMO,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,HMO,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,HMO,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,HMO,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,HMO,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,3544.00
Blue Cross,HMO,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Grouper Rate,5783.00
Blue Cross,HMO,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Grouper Rate,5783.00
Blue Cross,HMO,43645,CPT4/HCPCS,LAP GASTR BYPASS INCL SMLL I,,Grouper Rate,5783.00
Blue Cross,HMO,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Grouper Rate,3544.00
Blue Cross,HMO,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Grouper Rate,1678.88
Blue Cross,HMO,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,5281.00
Blue Cross,HMO,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,5281.00
Blue Cross,HMO,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,437,DRG,Malignancy of hepatobiliary system or pancreas w/o CC/MCC,,Case Rate,14795.03
Blue Cross,HMO,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Grouper Rate,1678.00
Blue Cross,HMO,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Grouper Rate,1678.00
Blue Cross,HMO,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Grouper Rate,1678.00
Blue Cross,HMO,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Grouper Rate,1678.00
Blue Cross,HMO,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Grouper Rate,1678.00
Blue Cross,HMO,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Grouper Rate,1678.00
Blue Cross,HMO,43760,CPT4/HCPCS,CHANGE GASTROSTOMY TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,43762,CPT4/HCPCS,RPLC GTUBE NO REVJ TRC,,Grouper Rate,1678.00
Blue Cross,HMO,43763,CPT4/HCPCS,RPLC GTUBE REVJ GSTRST TRC,,Grouper Rate,1678.00
Blue Cross,HMO,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Grouper Rate,5783.00
Blue Cross,HMO,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Grouper Rate,5029.00
Blue Cross,HMO,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Grouper Rate,5029.00
Blue Cross,HMO,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Grouper Rate,5281.00
Blue Cross,HMO,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Grouper Rate,5029.00
Blue Cross,HMO,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,438,DRG,Disorders of pancreas except malignancy w MCC,,Case Rate,26402.80
Blue Cross,HMO,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,Grouper Rate,5783.00
Blue Cross,HMO,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,3544.00
Blue Cross,HMO,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,1678.88
Blue Cross,HMO,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,5281.00
Blue Cross,HMO,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,Grouper Rate,5783.00
Blue Cross,HMO,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,Grouper Rate,5783.00
Blue Cross,HMO,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,Grouper Rate,5783.00
Blue Cross,HMO,43845,CPT4/HCPCS,GASTROPLASTY DUODENAL SWITCH,,Grouper Rate,6588.00
Blue Cross,HMO,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,Grouper Rate,5783.00
Blue Cross,HMO,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,Grouper Rate,5783.00
Blue Cross,HMO,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,Grouper Rate,5783.00
Blue Cross,HMO,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,HMO,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,HMO,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,HMO,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,HMO,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Grouper Rate,1678.00
Blue Cross,HMO,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,Grouper Rate,5783.00
Blue Cross,HMO,43881,CPT4/HCPCS,IMPL/REDO ELECTRD ANTRUM,,Grouper Rate,5281.00
Blue Cross,HMO,43882,CPT4/HCPCS,REVISE/REMOVE ELECTRD ANTRUM,,Grouper Rate,5281.00
Blue Cross,HMO,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Grouper Rate,3544.00
Blue Cross,HMO,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Grouper Rate,3544.00
Blue Cross,HMO,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Grouper Rate,5029.00
Blue Cross,HMO,439,DRG,Disorders of pancreas except malignancy w CC,,Case Rate,13966.37
Blue Cross,HMO,440,DRG,Disorders of pancreas except malignancy w/o CC/MCC,,Case Rate,10021.58
Blue Cross,HMO,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Grouper Rate,5029.00
Blue Cross,HMO,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,Grouper Rate,3544.00
Blue Cross,HMO,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Grouper Rate,5281.00
Blue Cross,HMO,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,Grouper Rate,5281.00
Blue Cross,HMO,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Grouper Rate,5281.00
Blue Cross,HMO,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Grouper Rate,5281.00
Blue Cross,HMO,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Grouper Rate,5281.00
Blue Cross,HMO,441,DRG,Disorders of liver except malig,cirr,alc hepa w MCC,,Case Rate,31156.39
Blue Cross,HMO,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Grouper Rate,1678.00
Blue Cross,HMO,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,Grouper Rate,5281.00
Blue Cross,HMO,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,Grouper Rate,5281.00
Blue Cross,HMO,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,5783.00
Blue Cross,HMO,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,1678.88
Blue Cross,HMO,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,5783.00
Blue Cross,HMO,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,Grouper Rate,5783.00
Blue Cross,HMO,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,Grouper Rate,5783.00
Blue Cross,HMO,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,Grouper Rate,5783.00
Blue Cross,HMO,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,Grouper Rate,5281.00
Blue Cross,HMO,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,Grouper Rate,3544.00
Blue Cross,HMO,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,Grouper Rate,5783.00
Blue Cross,HMO,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,Grouper Rate,5783.00
Blue Cross,HMO,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,Grouper Rate,5281.00
Blue Cross,HMO,44137,CPT4/HCPCS,REMOVE INTESTINAL ALLOGRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,Grouper Rate,1678.88
Blue Cross,HMO,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,HMO,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,HMO,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,HMO,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,HMO,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,HMO,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,HMO,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,HMO,44150,CPT4/HCPCS,REMOVAL OF COLON,,Grouper Rate,6588.00
Blue Cross,HMO,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,44157,CPT4/HCPCS,COLECTOMY W/ILEOANAL ANAST,,Grouper Rate,6588.00
Blue Cross,HMO,44158,CPT4/HCPCS,COLECTOMY W/NEO-RECTUM POUCH,,Grouper Rate,6588.00
Blue Cross,HMO,44160,CPT4/HCPCS,REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,HMO,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Grouper Rate,5281.00
Blue Cross,HMO,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Grouper Rate,5281.00
Blue Cross,HMO,44188,CPT4/HCPCS,LAP COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,442,DRG,Disorders of liver except malig,cirr,alc hepa w CC,,Case Rate,15408.66
Blue Cross,HMO,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,Grouper Rate,1678.88
Blue Cross,HMO,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,Grouper Rate,5783.00
Blue Cross,HMO,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,443,DRG,Disorders of liver except malig,cirr,alc hepa w/o CC/MCC,,Case Rate,10962.71
Blue Cross,HMO,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,Grouper Rate,5281.00
Blue Cross,HMO,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,1678.00
Blue Cross,HMO,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,Grouper Rate,5783.00
Blue Cross,HMO,44320,CPT4/HCPCS,COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,Grouper Rate,5783.00
Blue Cross,HMO,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,3544.00
Blue Cross,HMO,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,1678.88
Blue Cross,HMO,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Grouper Rate,1678.88
Blue Cross,HMO,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,1678.88
Blue Cross,HMO,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Grouper Rate,1678.88
Blue Cross,HMO,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,1678.00
Blue Cross,HMO,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,1678.00
Blue Cross,HMO,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,44383,CPT4/HCPCS,ILEOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,HMO,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Grouper Rate,1678.00
Blue Cross,HMO,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Grouper Rate,1678.00
Blue Cross,HMO,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Grouper Rate,1678.00
Blue Cross,HMO,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Grouper Rate,1678.00
Blue Cross,HMO,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Grouper Rate,1678.00
Blue Cross,HMO,44393,CPT4/HCPCS,COLONOSCOPY LESION REMOVAL,,Grouper Rate,1678.00
Blue Cross,HMO,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Grouper Rate,1678.00
Blue Cross,HMO,44397,CPT4/HCPCS,COLONOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,HMO,444,DRG,Disorders of the biliary tract w MCC,,Case Rate,27601.95
Blue Cross,HMO,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Grouper Rate,1678.00
Blue Cross,HMO,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,1678.00
Blue Cross,HMO,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,1678.00
Blue Cross,HMO,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Grouper Rate,1678.00
Blue Cross,HMO,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Grouper Rate,1678.00
Blue Cross,HMO,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Grouper Rate,1678.00
Blue Cross,HMO,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Grouper Rate,1678.00
Blue Cross,HMO,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,1678.00
Blue Cross,HMO,445,DRG,Disorders of the biliary tract w CC,,Case Rate,17810.27
Blue Cross,HMO,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,446,DRG,Disorders of the biliary tract w/o CC/MCC,,Case Rate,13499.94
Blue Cross,HMO,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Grouper Rate,5281.00
Blue Cross,HMO,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Grouper Rate,5281.00
Blue Cross,HMO,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,Grouper Rate,5783.00
Blue Cross,HMO,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,Grouper Rate,5783.00
Blue Cross,HMO,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,Grouper Rate,5783.00
Blue Cross,HMO,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,5281.00
Blue Cross,HMO,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,5783.00
Blue Cross,HMO,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,5783.00
Blue Cross,HMO,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,Grouper Rate,5281.00
Blue Cross,HMO,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,Grouper Rate,5281.00
Blue Cross,HMO,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Grouper Rate,5281.00
Blue Cross,HMO,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Grouper Rate,5783.00
Blue Cross,HMO,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,Grouper Rate,5281.00
Blue Cross,HMO,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,Grouper Rate,3544.00
Blue Cross,HMO,44701,CPT4/HCPCS,INTRAOP COLON LAVAGE ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Grouper Rate,3544.00
Blue Cross,HMO,44715,CPT4/HCPCS,PREPARE DONOR INTESTINE,,Grouper Rate,3544.00
Blue Cross,HMO,44720,CPT4/HCPCS,PREP DONOR INTESTINE/VENOUS,,Grouper Rate,1678.00
Blue Cross,HMO,44721,CPT4/HCPCS,PREP DONOR INTESTINE/ARTERY,,Grouper Rate,1678.00
Blue Cross,HMO,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,Grouper Rate,5281.00
Blue Cross,HMO,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,Grouper Rate,5281.00
Blue Cross,HMO,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,Grouper Rate,5281.00
Blue Cross,HMO,44901,CPT4/HCPCS,DRAIN APP ABSCESS PERCUT,,Grouper Rate,1678.88
Blue Cross,HMO,44950,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,44960,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Grouper Rate,3544.00
Blue Cross,HMO,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,HMO,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Grouper Rate,1678.00
Blue Cross,HMO,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Grouper Rate,1678.88
Blue Cross,HMO,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,HMO,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,1678.88
Blue Cross,HMO,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,HMO,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,HMO,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,5783.00
Blue Cross,HMO,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,Grouper Rate,6588.00
Blue Cross,HMO,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,HMO,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,Grouper Rate,6588.00
Blue Cross,HMO,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,45126,CPT4/HCPCS,PELVIC EXENTERATION,,Grouper Rate,6588.00
Blue Cross,HMO,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Grouper Rate,5029.00
Blue Cross,HMO,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Grouper Rate,5783.00
Blue Cross,HMO,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,Grouper Rate,5783.00
Blue Cross,HMO,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Grouper Rate,1678.00
Blue Cross,HMO,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Grouper Rate,1678.88
Blue Cross,HMO,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Grouper Rate,5029.00
Blue Cross,HMO,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Grouper Rate,5281.00
Blue Cross,HMO,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Grouper Rate,1678.88
Blue Cross,HMO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,Case Rate,152062.14
Blue Cross,HMO,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Grouper Rate,1678.00
Blue Cross,HMO,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Grouper Rate,1678.00
Blue Cross,HMO,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Grouper Rate,1678.00
Blue Cross,HMO,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Grouper Rate,1678.00
Blue Cross,HMO,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1678.00
Blue Cross,HMO,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1678.00
Blue Cross,HMO,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1678.00
Blue Cross,HMO,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Grouper Rate,1678.00
Blue Cross,HMO,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Grouper Rate,1678.00
Blue Cross,HMO,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Grouper Rate,1678.00
Blue Cross,HMO,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,HMO,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Grouper Rate,1678.00
Blue Cross,HMO,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Grouper Rate,1678.00
Blue Cross,HMO,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Grouper Rate,1678.00
Blue Cross,HMO,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Grouper Rate,1678.00
Blue Cross,HMO,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Grouper Rate,1678.00
Blue Cross,HMO,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Grouper Rate,1678.00
Blue Cross,HMO,45339,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATE TUMR,,Grouper Rate,1678.00
Blue Cross,HMO,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Grouper Rate,1678.00
Blue Cross,HMO,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Grouper Rate,1678.00
Blue Cross,HMO,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Grouper Rate,1678.00
Blue Cross,HMO,45345,CPT4/HCPCS,SIGMOIDOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,HMO,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Grouper Rate,1678.00
Blue Cross,HMO,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Grouper Rate,1678.00
Blue Cross,HMO,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Grouper Rate,1678.00
Blue Cross,HMO,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Grouper Rate,1678.00
Blue Cross,HMO,45355,CPT4/HCPCS,SURGICAL COLONOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Grouper Rate,1678.00
Blue Cross,HMO,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Grouper Rate,1678.00
Blue Cross,HMO,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Grouper Rate,1678.00
Blue Cross,HMO,45383,CPT4/HCPCS,LESION REMOVAL COLONOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,1678.00
Blue Cross,HMO,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,1678.00
Blue Cross,HMO,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Grouper Rate,1678.88
Blue Cross,HMO,45387,CPT4/HCPCS,COLONOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,HMO,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Grouper Rate,1678.00
Blue Cross,HMO,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,1678.00
Blue Cross,HMO,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,1678.00
Blue Cross,HMO,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Grouper Rate,1678.88
Blue Cross,HMO,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Grouper Rate,1678.00
Blue Cross,HMO,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,1678.88
Blue Cross,HMO,45395,CPT4/HCPCS,LAP REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,HMO,45397,CPT4/HCPCS,LAP REMOVE RECTUM W/POUCH,,Grouper Rate,5783.00
Blue Cross,HMO,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Grouper Rate,1678.00
Blue Cross,HMO,454,DRG,Combined anterior/posterior spinal fusion w CC,,Case Rate,100862.57
Blue Cross,HMO,45400,CPT4/HCPCS,LAPAROSCOPIC PROC,,Grouper Rate,5281.00
Blue Cross,HMO,45402,CPT4/HCPCS,LAP PROCTOPEXY W/SIG RESECT,,Grouper Rate,5783.00
Blue Cross,HMO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,Case Rate,79243.14
Blue Cross,HMO,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,1678.88
Blue Cross,HMO,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,1678.88
Blue Cross,HMO,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Grouper Rate,1678.00
Blue Cross,HMO,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,5281.00
Blue Cross,HMO,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,1678.88
Blue Cross,HMO,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,Grouper Rate,5783.00
Blue Cross,HMO,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Grouper Rate,1678.88
Blue Cross,HMO,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Grouper Rate,1678.88
Blue Cross,HMO,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Grouper Rate,5281.00
Blue Cross,HMO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,Case Rate,142212.57
Blue Cross,HMO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,Case Rate,107543.08
Blue Cross,HMO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,Case Rate,82987.79
Blue Cross,HMO,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,Grouper Rate,5281.00
Blue Cross,HMO,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,Grouper Rate,5281.00
Blue Cross,HMO,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,459,DRG,Spinal fusion except cervical w MCC,,Case Rate,111343.97
Blue Cross,HMO,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Grouper Rate,1678.00
Blue Cross,HMO,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Grouper Rate,1678.00
Blue Cross,HMO,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Grouper Rate,1678.00
Blue Cross,HMO,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Grouper Rate,1678.00
Blue Cross,HMO,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Grouper Rate,1678.00
Blue Cross,HMO,460,DRG,Spinal fusion except cervical w/o MCC,,Case Rate,65046.85
Blue Cross,HMO,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Grouper Rate,1678.00
Blue Cross,HMO,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Grouper Rate,1678.00
Blue Cross,HMO,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,HMO,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,HMO,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,HMO,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Grouper Rate,1678.00
Blue Cross,HMO,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,HMO,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Grouper Rate,1678.00
Blue Cross,HMO,461,DRG,Bilateral or multiple major joint procs of lower extremity w MCC,,Case Rate,100500.34
Blue Cross,HMO,462,DRG,Bilateral or multiple major joint procs of lower extremity w/o MCC,,Case Rate,52005.06
Blue Cross,HMO,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Grouper Rate,1678.88
Blue Cross,HMO,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Grouper Rate,1678.00
Blue Cross,HMO,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Grouper Rate,1678.00
Blue Cross,HMO,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Grouper Rate,1678.00
Blue Cross,HMO,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Grouper Rate,3544.00
Blue Cross,HMO,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Grouper Rate,3544.00
Blue Cross,HMO,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Grouper Rate,3544.00
Blue Cross,HMO,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Grouper Rate,3544.00
Blue Cross,HMO,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Grouper Rate,3544.00
Blue Cross,HMO,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Grouper Rate,5029.00
Blue Cross,HMO,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Grouper Rate,5029.00
Blue Cross,HMO,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Grouper Rate,3544.00
Blue Cross,HMO,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Grouper Rate,3544.00
Blue Cross,HMO,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Grouper Rate,5029.00
Blue Cross,HMO,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Grouper Rate,1678.00
Blue Cross,HMO,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Grouper Rate,3544.00
Blue Cross,HMO,463,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC,,Case Rate,88743.71
Blue Cross,HMO,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Grouper Rate,1678.00
Blue Cross,HMO,464,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC,,Case Rate,49198.23
Blue Cross,HMO,465,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC,,Case Rate,30493.14
Blue Cross,HMO,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Grouper Rate,1678.00
Blue Cross,HMO,466,DRG,Revision of hip or knee replacement w MCC,,Case Rate,88406.30
Blue Cross,HMO,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Grouper Rate,1678.00
Blue Cross,HMO,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Grouper Rate,1678.00
Blue Cross,HMO,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Grouper Rate,1678.00
Blue Cross,HMO,46611,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Grouper Rate,1678.00
Blue Cross,HMO,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Grouper Rate,1678.00
Blue Cross,HMO,46615,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,467,DRG,Revision of hip or knee replacement w CC,,Case Rate,59150.34
Blue Cross,HMO,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,3544.00
Blue Cross,HMO,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,3544.00
Blue Cross,HMO,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Grouper Rate,1678.00
Blue Cross,HMO,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,Grouper Rate,1678.00
Blue Cross,HMO,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,Grouper Rate,3544.00
Blue Cross,HMO,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,Grouper Rate,3544.00
Blue Cross,HMO,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,3544.00
Blue Cross,HMO,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,5281.00
Blue Cross,HMO,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,5281.00
Blue Cross,HMO,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,Grouper Rate,5783.00
Blue Cross,HMO,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1678.88
Blue Cross,HMO,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1678.88
Blue Cross,HMO,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,5783.00
Blue Cross,HMO,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,HMO,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,HMO,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Grouper Rate,3544.00
Blue Cross,HMO,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Grouper Rate,1678.00
Blue Cross,HMO,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,1678.88
Blue Cross,HMO,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,HMO,46762,CPT4/HCPCS,IMPLANT ARTIFICIAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,HMO,468,DRG,Revision of hip or knee replacement w/o CC/MCC,,Case Rate,46378.16
Blue Cross,HMO,469,DRG,Major joint replacement or reattachment of lower extremity w MCC,,Case Rate,51015.97
Blue Cross,HMO,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Grouper Rate,1678.00
Blue Cross,HMO,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Grouper Rate,1678.00
Blue Cross,HMO,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,1678.00
Blue Cross,HMO,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,1678.00
Blue Cross,HMO,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Grouper Rate,1678.00
Blue Cross,HMO,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Grouper Rate,1678.00
Blue Cross,HMO,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Grouper Rate,3544.00
Blue Cross,HMO,46948,CPT4/HCPCS,INT HRHC TRANAL DARTLZJ 2+,,Grouper Rate,1678.88
Blue Cross,HMO,470,DRG,Major joint replacement or reattachment of lower extremity w/o MCC,,Case Rate,31424.34
Blue Cross,HMO,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Grouper Rate,1678.00
Blue Cross,HMO,47001,CPT4/HCPCS,NEEDLE BIOPSY LIVER ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,Grouper Rate,5783.00
Blue Cross,HMO,47011,CPT4/HCPCS,PERCUT DRAIN LIVER LESION,,Grouper Rate,1678.00
Blue Cross,HMO,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,Grouper Rate,5281.00
Blue Cross,HMO,471,DRG,Cervical spinal fusion w MCC,,Case Rate,82977.87
Blue Cross,HMO,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,Grouper Rate,5029.00
Blue Cross,HMO,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,5783.00
Blue Cross,HMO,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,Grouper Rate,6588.00
Blue Cross,HMO,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,5783.00
Blue Cross,HMO,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,6588.00
Blue Cross,HMO,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,HMO,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,Grouper Rate,8841.00
Blue Cross,HMO,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,HMO,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,HMO,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,HMO,47143,CPT4/HCPCS,PREP DONOR LIVER WHOLE,,Grouper Rate,3544.00
Blue Cross,HMO,47144,CPT4/HCPCS,PREP DONOR LIVER 3-SEGMENT,,Grouper Rate,3544.00
Blue Cross,HMO,47145,CPT4/HCPCS,PREP DONOR LIVER LOBE SPLIT,,Grouper Rate,3544.00
Blue Cross,HMO,47146,CPT4/HCPCS,PREP DONOR LIVER/VENOUS,,Grouper Rate,1678.00
Blue Cross,HMO,47147,CPT4/HCPCS,PREP DONOR LIVER/ARTERIAL,,Grouper Rate,1678.00
Blue Cross,HMO,472,DRG,Cervical spinal fusion w CC,,Case Rate,50499.92
Blue Cross,HMO,473,DRG,Cervical spinal fusion w/o CC/MCC,,Case Rate,42014.90
Blue Cross,HMO,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,Grouper Rate,5281.00
Blue Cross,HMO,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5281.00
Blue Cross,HMO,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5783.00
Blue Cross,HMO,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5783.00
Blue Cross,HMO,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5029.00
Blue Cross,HMO,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Grouper Rate,5029.00
Blue Cross,HMO,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Grouper Rate,5029.00
Blue Cross,HMO,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Grouper Rate,5029.00
Blue Cross,HMO,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Grouper Rate,5029.00
Blue Cross,HMO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Grouper Rate,5783.00
Blue Cross,HMO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Grouper Rate,5783.00
Blue Cross,HMO,474,DRG,Amputation for musculoskeletal sys & conn tissue dis w MCC,,Case Rate,67364.11
Blue Cross,HMO,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,Grouper Rate,5281.00
Blue Cross,HMO,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,Grouper Rate,5281.00
Blue Cross,HMO,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,Grouper Rate,5783.00
Blue Cross,HMO,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,Grouper Rate,5029.00
Blue Cross,HMO,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,Grouper Rate,3544.00
Blue Cross,HMO,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,Grouper Rate,1678.00
Blue Cross,HMO,475,DRG,Amputation for musculoskeletal sys & conn tissue dis w CC,,Case Rate,36282.14
Blue Cross,HMO,47500,CPT4/HCPCS,INJECTION FOR LIVER X-RAYS,,Grouper Rate,1678.00
Blue Cross,HMO,47505,CPT4/HCPCS,INJECTION FOR LIVER X-RAYS,,Grouper Rate,1678.00
Blue Cross,HMO,47510,CPT4/HCPCS,INSERT CATHETER BILE DUCT,,Grouper Rate,1678.88
Blue Cross,HMO,47511,CPT4/HCPCS,INSERT BILE DUCT DRAIN,,Grouper Rate,1678.88
Blue Cross,HMO,47525,CPT4/HCPCS,CHANGE BILE DUCT CATHETER,,Grouper Rate,1678.00
Blue Cross,HMO,47530,CPT4/HCPCS,REVISE/REINSERT BILE TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,1678.00
Blue Cross,HMO,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,1678.00
Blue Cross,HMO,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,1678.88
Blue Cross,HMO,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,1678.88
Blue Cross,HMO,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Grouper Rate,1678.00
Blue Cross,HMO,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Grouper Rate,1678.00
Blue Cross,HMO,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Grouper Rate,1678.00
Blue Cross,HMO,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,1678.00
Blue Cross,HMO,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,1678.00
Blue Cross,HMO,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,1678.00
Blue Cross,HMO,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Grouper Rate,1678.00
Blue Cross,HMO,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Grouper Rate,1678.00
Blue Cross,HMO,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Grouper Rate,1678.00
Blue Cross,HMO,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Grouper Rate,3544.00
Blue Cross,HMO,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Grouper Rate,1678.88
Blue Cross,HMO,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,HMO,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,HMO,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,HMO,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,HMO,47560,CPT4/HCPCS,LAPAROSCOPY W/CHOLANGIO,,Grouper Rate,3544.00
Blue Cross,HMO,47561,CPT4/HCPCS,LAPARO W/CHOLANGIO/BIOPSY,,Grouper Rate,3544.00
Blue Cross,HMO,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Grouper Rate,8841.00
Blue Cross,HMO,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Grouper Rate,8841.00
Blue Cross,HMO,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Grouper Rate,8841.00
Blue Cross,HMO,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Grouper Rate,8841.00
Blue Cross,HMO,476,DRG,Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC,,Case Rate,19183.09
Blue Cross,HMO,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,HMO,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,HMO,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,8012.00
Blue Cross,HMO,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,HMO,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,HMO,47630,CPT4/HCPCS,REMOVE BILE DUCT STONE,,Grouper Rate,3544.00
Blue Cross,HMO,477,DRG,Biopsies of musculoskeletal system & connective tissue w MCC,,Case Rate,55523.12
Blue Cross,HMO,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,Grouper Rate,5281.00
Blue Cross,HMO,47701,CPT4/HCPCS,BILE DUCT REVISION,,Grouper Rate,5783.00
Blue Cross,HMO,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Grouper Rate,5783.00
Blue Cross,HMO,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Grouper Rate,5783.00
Blue Cross,HMO,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,Grouper Rate,5783.00
Blue Cross,HMO,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,Grouper Rate,5783.00
Blue Cross,HMO,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,478,DRG,Biopsies of musculoskeletal system & connective tissue w CC,,Case Rate,38983.12
Blue Cross,HMO,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,Grouper Rate,5783.00
Blue Cross,HMO,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,Grouper Rate,5029.00
Blue Cross,HMO,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,Grouper Rate,5281.00
Blue Cross,HMO,479,DRG,Biopsies of musculoskeletal system & connective tissue w/o CC/MCC,,Case Rate,29925.82
Blue Cross,HMO,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,Grouper Rate,5281.00
Blue Cross,HMO,480,DRG,Hip & femur procedures except major joint w MCC,,Case Rate,50025.23
Blue Cross,HMO,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,Grouper Rate,5281.00
Blue Cross,HMO,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,Grouper Rate,5783.00
Blue Cross,HMO,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,Grouper Rate,5281.00
Blue Cross,HMO,481,DRG,Hip & femur procedures except major joint w CC,,Case Rate,34659.57
Blue Cross,HMO,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,Grouper Rate,5783.00
Blue Cross,HMO,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Grouper Rate,1678.00
Blue Cross,HMO,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,Grouper Rate,5783.00
Blue Cross,HMO,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,5783.00
Blue Cross,HMO,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,5783.00
Blue Cross,HMO,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,Grouper Rate,5783.00
Blue Cross,HMO,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,6588.00
Blue Cross,HMO,48153,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,Grouper Rate,6588.00
Blue Cross,HMO,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,HMO,482,DRG,Hip & femur procedures except major joint w/o CC/MCC,,Case Rate,27238.07
Blue Cross,HMO,483,DRG,Major joint & limb reattachment proc of upper extremity w CC/MCC,,Case Rate,39469.40
Blue Cross,HMO,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,485,DRG,Knee procedures w pdx of infection w MCC,,Case Rate,56361.70
Blue Cross,HMO,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,Grouper Rate,5281.00
Blue Cross,HMO,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Grouper Rate,5281.00
Blue Cross,HMO,48511,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Grouper Rate,1678.88
Blue Cross,HMO,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,48545,CPT4/HCPCS,PANCREATORRHAPHY,,Grouper Rate,5281.00
Blue Cross,HMO,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,Grouper Rate,5783.00
Blue Cross,HMO,48548,CPT4/HCPCS,FUSE PANCREAS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,48550,CPT4/HCPCS,DONOR PANCREATECTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,48551,CPT4/HCPCS,PREP DONOR PANCREAS,,Grouper Rate,3544.00
Blue Cross,HMO,48552,CPT4/HCPCS,PREP DONOR PANCREAS/VENOUS,,Grouper Rate,1678.00
Blue Cross,HMO,48556,CPT4/HCPCS,REMOVAL ALLOGRAFT PANCREAS,,Grouper Rate,5783.00
Blue Cross,HMO,486,DRG,Knee procedures w pdx of infection w CC,,Case Rate,35534.53
Blue Cross,HMO,487,DRG,Knee procedures w pdx of infection w/o CC/MCC,,Case Rate,27130.56
Blue Cross,HMO,488,DRG,Knee procedures w/o pdx of infection w CC/MCC,,Case Rate,32659.88
Blue Cross,HMO,489,DRG,Knee procedures w/o pdx of infection w/o CC/MCC,,Case Rate,21472.22
Blue Cross,HMO,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,5029.00
Blue Cross,HMO,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,Grouper Rate,5029.00
Blue Cross,HMO,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Grouper Rate,8012.00
Blue Cross,HMO,49013,CPT4/HCPCS,PRPERTL PEL PACK HEMRRG TRMA,,Grouper Rate,1678.88
Blue Cross,HMO,49014,CPT4/HCPCS,REEXPLORATION PELVIC WOUND,,Grouper Rate,1678.88
Blue Cross,HMO,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,Grouper Rate,8012.00
Blue Cross,HMO,49021,CPT4/HCPCS,DRAIN ABDOMINAL ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,Grouper Rate,8012.00
Blue Cross,HMO,49041,CPT4/HCPCS,DRAIN PERCUT ABDOM ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,Grouper Rate,8012.00
Blue Cross,HMO,49061,CPT4/HCPCS,DRAIN PERCUT RETROPER ABSC,,Grouper Rate,1678.00
Blue Cross,HMO,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,Grouper Rate,5029.00
Blue Cross,HMO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Grouper Rate,1678.88
Blue Cross,HMO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Grouper Rate,1678.88
Blue Cross,HMO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Grouper Rate,1678.88
Blue Cross,HMO,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Grouper Rate,1678.00
Blue Cross,HMO,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Grouper Rate,1678.00
Blue Cross,HMO,492,DRG,Lower extrem & humer proc except hip,foot,femur w MCC,,Case Rate,57364.02
Blue Cross,HMO,49203,CPT4/HCPCS,EXC ABD TUM 5 CM OR LESS,,Grouper Rate,5029.00
Blue Cross,HMO,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,Grouper Rate,5029.00
Blue Cross,HMO,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,Grouper Rate,5783.00
Blue Cross,HMO,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Grouper Rate,3544.00
Blue Cross,HMO,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,Grouper Rate,5029.00
Blue Cross,HMO,493,DRG,Lower extrem & humer proc except hip,foot,femur w CC,,Case Rate,38458.80
Blue Cross,HMO,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Grouper Rate,1678.88
Blue Cross,HMO,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Grouper Rate,3544.00
Blue Cross,HMO,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Grouper Rate,6588.00
Blue Cross,HMO,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Grouper Rate,5281.00
Blue Cross,HMO,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Grouper Rate,1678.00
Blue Cross,HMO,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Grouper Rate,1678.00
Blue Cross,HMO,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,49327,CPT4/HCPCS,LAP INS DEVICE FOR RT,,Grouper Rate,3544.00
Blue Cross,HMO,494,DRG,Lower extrem & humer proc except hip,foot,femur w/o CC/MCC,,Case Rate,30630.42
Blue Cross,HMO,49400,CPT4/HCPCS,AIR INJECTION INTO ABDOMEN,,Grouper Rate,1678.00
Blue Cross,HMO,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Grouper Rate,1678.00
Blue Cross,HMO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Grouper Rate,1678.00
Blue Cross,HMO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Grouper Rate,1678.88
Blue Cross,HMO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Grouper Rate,1678.88
Blue Cross,HMO,49412,CPT4/HCPCS,INS DEVICE FOR RT GUIDE OPEN,,Grouper Rate,5029.00
Blue Cross,HMO,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Grouper Rate,1678.88
Blue Cross,HMO,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Grouper Rate,1678.88
Blue Cross,HMO,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Grouper Rate,1678.00
Blue Cross,HMO,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Grouper Rate,1678.88
Blue Cross,HMO,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Grouper Rate,1678.00
Blue Cross,HMO,49424,CPT4/HCPCS,ASSESS CYST CONTRAST INJECT,,Grouper Rate,1678.00
Blue Cross,HMO,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Grouper Rate,1678.88
Blue Cross,HMO,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Grouper Rate,1678.88
Blue Cross,HMO,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,Grouper Rate,1678.00
Blue Cross,HMO,49428,CPT4/HCPCS,LIGATION OF SHUNT,,Grouper Rate,1678.88
Blue Cross,HMO,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Grouper Rate,1678.88
Blue Cross,HMO,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Grouper Rate,1678.00
Blue Cross,HMO,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Grouper Rate,1678.00
Blue Cross,HMO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Grouper Rate,1678.88
Blue Cross,HMO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Grouper Rate,1678.88
Blue Cross,HMO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Grouper Rate,1678.88
Blue Cross,HMO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Grouper Rate,1678.88
Blue Cross,HMO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Grouper Rate,1678.88
Blue Cross,HMO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Grouper Rate,1678.88
Blue Cross,HMO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Grouper Rate,1678.88
Blue Cross,HMO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Grouper Rate,1678.00
Blue Cross,HMO,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Grouper Rate,5029.00
Blue Cross,HMO,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Grouper Rate,5029.00
Blue Cross,HMO,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Grouper Rate,5029.00
Blue Cross,HMO,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Grouper Rate,5029.00
Blue Cross,HMO,495,DRG,Local excision & removal int fix devices exc hip & femur w MCC,,Case Rate,60109.66
Blue Cross,HMO,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Grouper Rate,5029.00
Blue Cross,HMO,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Grouper Rate,5029.00
Blue Cross,HMO,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Grouper Rate,5029.00
Blue Cross,HMO,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Grouper Rate,5029.00
Blue Cross,HMO,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Grouper Rate,5029.00
Blue Cross,HMO,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Grouper Rate,5029.00
Blue Cross,HMO,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Grouper Rate,5029.00
Blue Cross,HMO,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Grouper Rate,1678.88
Blue Cross,HMO,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Grouper Rate,5281.00
Blue Cross,HMO,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Grouper Rate,5029.00
Blue Cross,HMO,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Grouper Rate,5281.00
Blue Cross,HMO,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Grouper Rate,5029.00
Blue Cross,HMO,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Grouper Rate,5029.00
Blue Cross,HMO,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Grouper Rate,5029.00
Blue Cross,HMO,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Grouper Rate,5029.00
Blue Cross,HMO,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Grouper Rate,5029.00
Blue Cross,HMO,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Grouper Rate,5029.00
Blue Cross,HMO,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Grouper Rate,5029.00
Blue Cross,HMO,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Grouper Rate,3544.00
Blue Cross,HMO,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Grouper Rate,5029.00
Blue Cross,HMO,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Grouper Rate,5029.00
Blue Cross,HMO,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Grouper Rate,5029.00
Blue Cross,HMO,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Grouper Rate,5029.00
Blue Cross,HMO,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Grouper Rate,3544.00
Blue Cross,HMO,496,DRG,Local excision & removal int fix devices exc hip & femur w CC,,Case Rate,32841.82
Blue Cross,HMO,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,3544.00
Blue Cross,HMO,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5281.00
Blue Cross,HMO,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5281.00
Blue Cross,HMO,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5281.00
Blue Cross,HMO,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Grouper Rate,5029.00
Blue Cross,HMO,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Grouper Rate,5029.00
Blue Cross,HMO,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Grouper Rate,5029.00
Blue Cross,HMO,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Grouper Rate,5029.00
Blue Cross,HMO,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Grouper Rate,5029.00
Blue Cross,HMO,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Grouper Rate,5029.00
Blue Cross,HMO,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Grouper Rate,5029.00
Blue Cross,HMO,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Grouper Rate,5029.00
Blue Cross,HMO,497,DRG,Local excision & removal int fix devices exc hip & femur w/o CC/MCC,,Case Rate,24126.89
Blue Cross,HMO,498,DRG,Local excision & removal int fix devices of hip & femur w CC/MCC,,Case Rate,42744.32
Blue Cross,HMO,499,DRG,Local excision & removal int fix devices of hip & femur w/o CC/MCC,,Case Rate,19826.49
Blue Cross,HMO,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,Grouper Rate,3544.00
Blue Cross,HMO,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,Grouper Rate,1678.88
Blue Cross,HMO,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,Grouper Rate,1678.88
Blue Cross,HMO,5,DRG,Liver transplant w MCC or intestinal transplant,,Case Rate,169093.38
Blue Cross,HMO,500,DRG,Soft tissue procedures w MCC,,Case Rate,52165.50
Blue Cross,HMO,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,5783.00
Blue Cross,HMO,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Grouper Rate,1678.88
Blue Cross,HMO,50021,CPT4/HCPCS,RENAL ABSCESS PERCUT DRAIN,,Grouper Rate,1678.00
Blue Cross,HMO,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Grouper Rate,3544.00
Blue Cross,HMO,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1678.88
Blue Cross,HMO,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,1678.88
Blue Cross,HMO,50065,CPT4/HCPCS,INCISION OF KIDNEY,,Grouper Rate,1678.88
Blue Cross,HMO,50070,CPT4/HCPCS,INCISION OF KIDNEY,,Grouper Rate,1678.88
Blue Cross,HMO,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,5783.00
Blue Cross,HMO,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,3544.00
Blue Cross,HMO,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,3544.00
Blue Cross,HMO,501,DRG,Soft tissue procedures w CC,,Case Rate,28862.30
Blue Cross,HMO,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,Grouper Rate,5783.00
Blue Cross,HMO,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,5783.00
Blue Cross,HMO,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,Grouper Rate,3544.00
Blue Cross,HMO,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,5029.00
Blue Cross,HMO,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,5029.00
Blue Cross,HMO,502,DRG,Soft tissue procedures w/o CC/MCC,,Case Rate,22011.43
Blue Cross,HMO,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Grouper Rate,1678.00
Blue Cross,HMO,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,Grouper Rate,5029.00
Blue Cross,HMO,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,Grouper Rate,5783.00
Blue Cross,HMO,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,Grouper Rate,5783.00
Blue Cross,HMO,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Grouper Rate,5783.00
Blue Cross,HMO,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Grouper Rate,5783.00
Blue Cross,HMO,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,Grouper Rate,5281.00
Blue Cross,HMO,50250,CPT4/HCPCS,CRYOABLATE RENAL MASS OPEN,,Grouper Rate,5029.00
Blue Cross,HMO,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Grouper Rate,5783.00
Blue Cross,HMO,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Grouper Rate,5281.00
Blue Cross,HMO,503,DRG,Foot procedures w MCC,,Case Rate,43478.69
Blue Cross,HMO,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,Grouper Rate,3544.00
Blue Cross,HMO,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,Grouper Rate,5281.00
Blue Cross,HMO,50323,CPT4/HCPCS,PREP CADAVER RENAL ALLOGRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,50325,CPT4/HCPCS,PREP DONOR RENAL GRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,50327,CPT4/HCPCS,PREP RENAL GRAFT/VENOUS,,Grouper Rate,1678.00
Blue Cross,HMO,50328,CPT4/HCPCS,PREP RENAL GRAFT/ARTERIAL,,Grouper Rate,1678.00
Blue Cross,HMO,50329,CPT4/HCPCS,PREP RENAL GRAFT/URETERAL,,Grouper Rate,1678.00
Blue Cross,HMO,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,Grouper Rate,5281.00
Blue Cross,HMO,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Grouper Rate,6588.00
Blue Cross,HMO,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Grouper Rate,6588.00
Blue Cross,HMO,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,Grouper Rate,5281.00
Blue Cross,HMO,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,Grouper Rate,6588.00
Blue Cross,HMO,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Grouper Rate,1678.88
Blue Cross,HMO,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Grouper Rate,1678.88
Blue Cross,HMO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Grouper Rate,1678.88
Blue Cross,HMO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Grouper Rate,1678.88
Blue Cross,HMO,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Grouper Rate,1678.88
Blue Cross,HMO,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Grouper Rate,1678.00
Blue Cross,HMO,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Grouper Rate,1678.00
Blue Cross,HMO,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Grouper Rate,1678.00
Blue Cross,HMO,50392,CPT4/HCPCS,INSERT KIDNEY DRAIN,,Grouper Rate,1678.00
Blue Cross,HMO,50393,CPT4/HCPCS,INSERT URETERAL TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,50394,CPT4/HCPCS,INJECTION FOR KIDNEY X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,50395,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Grouper Rate,1678.00
Blue Cross,HMO,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Grouper Rate,1678.00
Blue Cross,HMO,50398,CPT4/HCPCS,CHANGE KIDNEY TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,504,DRG,Foot procedures w CC,,Case Rate,29340.30
Blue Cross,HMO,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Grouper Rate,5783.00
Blue Cross,HMO,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Grouper Rate,5281.00
Blue Cross,HMO,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,1678.00
Blue Cross,HMO,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,1678.00
Blue Cross,HMO,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Grouper Rate,1678.00
Blue Cross,HMO,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Grouper Rate,1678.00
Blue Cross,HMO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Grouper Rate,1678.00
Blue Cross,HMO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Grouper Rate,1678.00
Blue Cross,HMO,50436,CPT4/HCPCS,DILAT XST TRC NDURLGC PX,,Grouper Rate,1678.00
Blue Cross,HMO,50437,CPT4/HCPCS,DILAT XST TRC NEW ACCESS RCS,,Grouper Rate,1678.00
Blue Cross,HMO,505,DRG,Foot procedures w/o CC/MCC,,Case Rate,29340.30
Blue Cross,HMO,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,Grouper Rate,5281.00
Blue Cross,HMO,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Grouper Rate,1678.00
Blue Cross,HMO,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Grouper Rate,5783.00
Blue Cross,HMO,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Grouper Rate,6588.00
Blue Cross,HMO,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,Grouper Rate,5783.00
Blue Cross,HMO,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Grouper Rate,5029.00
Blue Cross,HMO,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Grouper Rate,5281.00
Blue Cross,HMO,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Grouper Rate,5281.00
Blue Cross,HMO,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Grouper Rate,5029.00
Blue Cross,HMO,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Grouper Rate,5281.00
Blue Cross,HMO,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,HMO,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,HMO,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Grouper Rate,5281.00
Blue Cross,HMO,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,HMO,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,HMO,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Grouper Rate,8841.00
Blue Cross,HMO,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Grouper Rate,5783.00
Blue Cross,HMO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Grouper Rate,5281.00
Blue Cross,HMO,506,DRG,Major thumb or joint procedures,,Case Rate,24408.07
Blue Cross,HMO,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Grouper Rate,5783.00
Blue Cross,HMO,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Grouper Rate,5029.00
Blue Cross,HMO,50606,CPT4/HCPCS,ENDOLUMINAL BX URTR RNL PLVS,,Grouper Rate,1678.00
Blue Cross,HMO,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,HMO,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,HMO,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,HMO,50650,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,5783.00
Blue Cross,HMO,50660,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,6588.00
Blue Cross,HMO,50684,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,Grouper Rate,1678.00
Blue Cross,HMO,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Grouper Rate,1678.00
Blue Cross,HMO,50690,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,1678.00
Blue Cross,HMO,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,1678.00
Blue Cross,HMO,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,1678.00
Blue Cross,HMO,507,DRG,Major shoulder or elbow joint procedures w CC/MCC,,Case Rate,33448.84
Blue Cross,HMO,50700,CPT4/HCPCS,REVISION OF URETER,,Grouper Rate,5281.00
Blue Cross,HMO,50705,CPT4/HCPCS,URETERAL EMBOLIZATION/OCCL,,Grouper Rate,1678.88
Blue Cross,HMO,50706,CPT4/HCPCS,BALLOON DILATE URTRL STRIX,,Grouper Rate,1678.88
Blue Cross,HMO,50715,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,5281.00
Blue Cross,HMO,50722,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,5281.00
Blue Cross,HMO,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,Grouper Rate,5783.00
Blue Cross,HMO,50727,CPT4/HCPCS,REVISE URETER,,Grouper Rate,1678.88
Blue Cross,HMO,50728,CPT4/HCPCS,REVISE URETER,,Grouper Rate,3544.00
Blue Cross,HMO,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Grouper Rate,5029.00
Blue Cross,HMO,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Grouper Rate,5029.00
Blue Cross,HMO,50760,CPT4/HCPCS,FUSION OF URETERS,,Grouper Rate,5281.00
Blue Cross,HMO,50770,CPT4/HCPCS,SPLICING OF URETERS,,Grouper Rate,5281.00
Blue Cross,HMO,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,5783.00
Blue Cross,HMO,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,5281.00
Blue Cross,HMO,508,DRG,Major shoulder or elbow joint procedures w/o CC/MCC,,Case Rate,23387.56
Blue Cross,HMO,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,Grouper Rate,5281.00
Blue Cross,HMO,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,Grouper Rate,6588.00
Blue Cross,HMO,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Grouper Rate,8012.00
Blue Cross,HMO,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Grouper Rate,8012.00
Blue Cross,HMO,50830,CPT4/HCPCS,REVISE URINE FLOW,,Grouper Rate,6588.00
Blue Cross,HMO,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,Grouper Rate,6588.00
Blue Cross,HMO,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,Grouper Rate,5029.00
Blue Cross,HMO,509,DRG,Arthroscopy,,Case Rate,27684.65
Blue Cross,HMO,50900,CPT4/HCPCS,REPAIR OF URETER,,Grouper Rate,5783.00
Blue Cross,HMO,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,Grouper Rate,5783.00
Blue Cross,HMO,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,Grouper Rate,5783.00
Blue Cross,HMO,50940,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,5783.00
Blue Cross,HMO,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,5281.00
Blue Cross,HMO,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,5281.00
Blue Cross,HMO,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,1678.00
Blue Cross,HMO,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,1678.00
Blue Cross,HMO,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,HMO,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,HMO,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Grouper Rate,1678.00
Blue Cross,HMO,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,HMO,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,HMO,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,HMO,510,DRG,Shoulder,elbow or forearm proc,exc major joint proc w MCC,,Case Rate,45165.77
Blue Cross,HMO,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,5029.00
Blue Cross,HMO,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,5029.00
Blue Cross,HMO,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Grouper Rate,5029.00
Blue Cross,HMO,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Grouper Rate,5029.00
Blue Cross,HMO,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Grouper Rate,5029.00
Blue Cross,HMO,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,HMO,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Grouper Rate,5029.00
Blue Cross,HMO,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Grouper Rate,3544.00
Blue Cross,HMO,511,DRG,Shoulder,elbow or forearm proc,exc major joint proc w CC,,Case Rate,32558.99
Blue Cross,HMO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Grouper Rate,1678.00
Blue Cross,HMO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Grouper Rate,1678.00
Blue Cross,HMO,512,DRG,Shoulder,elbow or forearm proc,exc major joint proc w/o CC/MCC,,Case Rate,25739.54
Blue Cross,HMO,513,DRG,Hand or wrist proc, except major thumb or joint proc w CC/MCC,,Case Rate,25785.86
Blue Cross,HMO,514,DRG,Hand or wrist proc, except major thumb or joint proc w/o CC/MCC,,Case Rate,16444.06
Blue Cross,HMO,515,DRG,Other musculoskelet sys & conn tiss O.R. proc w MCC,,Case Rate,51885.98
Blue Cross,HMO,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Grouper Rate,5029.00
Blue Cross,HMO,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5029.00
Blue Cross,HMO,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5029.00
Blue Cross,HMO,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5029.00
Blue Cross,HMO,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,Grouper Rate,5029.00
Blue Cross,HMO,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Grouper Rate,1678.88
Blue Cross,HMO,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Grouper Rate,1678.88
Blue Cross,HMO,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,Grouper Rate,6588.00
Blue Cross,HMO,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,Grouper Rate,6588.00
Blue Cross,HMO,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Grouper Rate,6588.00
Blue Cross,HMO,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,6588.00
Blue Cross,HMO,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Grouper Rate,6588.00
Blue Cross,HMO,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,8012.00
Blue Cross,HMO,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,8012.00
Blue Cross,HMO,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,Grouper Rate,8012.00
Blue Cross,HMO,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,Grouper Rate,8841.00
Blue Cross,HMO,516,DRG,Other musculoskelet sys & conn tiss O.R. proc w CC,,Case Rate,32436.59
Blue Cross,HMO,51600,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,Grouper Rate,1678.88
Blue Cross,HMO,51605,CPT4/HCPCS,PREPARATION FOR BLADDER XRAY,,Grouper Rate,1678.00
Blue Cross,HMO,51610,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,Grouper Rate,1678.88
Blue Cross,HMO,517,DRG,Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC,,Case Rate,23101.41
Blue Cross,HMO,51703,CPT4/HCPCS,INSERT BLADDER CATH COMPLEX,,Grouper Rate,1678.00
Blue Cross,HMO,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Grouper Rate,1678.88
Blue Cross,HMO,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Grouper Rate,1678.00
Blue Cross,HMO,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Grouper Rate,1678.00
Blue Cross,HMO,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Grouper Rate,1678.00
Blue Cross,HMO,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Grouper Rate,1678.00
Blue Cross,HMO,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Grouper Rate,1678.00
Blue Cross,HMO,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Grouper Rate,1678.88
Blue Cross,HMO,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,Grouper Rate,1678.00
Blue Cross,HMO,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,Grouper Rate,1678.00
Blue Cross,HMO,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,1678.00
Blue Cross,HMO,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,1678.00
Blue Cross,HMO,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,Grouper Rate,1678.00
Blue Cross,HMO,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Grouper Rate,1678.00
Blue Cross,HMO,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,Grouper Rate,1678.00
Blue Cross,HMO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,Case Rate,59284.32
Blue Cross,HMO,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Grouper Rate,5281.00
Blue Cross,HMO,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Grouper Rate,6588.00
Blue Cross,HMO,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,5281.00
Blue Cross,HMO,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,5281.00
Blue Cross,HMO,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Grouper Rate,5281.00
Blue Cross,HMO,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,5029.00
Blue Cross,HMO,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,5029.00
Blue Cross,HMO,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Grouper Rate,1678.00
Blue Cross,HMO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,Case Rate,32380.35
Blue Cross,HMO,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Grouper Rate,5029.00
Blue Cross,HMO,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Grouper Rate,3544.00
Blue Cross,HMO,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,Grouper Rate,5783.00
Blue Cross,HMO,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,Grouper Rate,5281.00
Blue Cross,HMO,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,HMO,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,Grouper Rate,5029.00
Blue Cross,HMO,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Grouper Rate,5281.00
Blue Cross,HMO,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Grouper Rate,5281.00
Blue Cross,HMO,52,DRG,Spinal disorders & injuries w CC/MCC,,Case Rate,30517.95
Blue Cross,HMO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,Case Rate,23443.79
Blue Cross,HMO,52000,CPT4/HCPCS,CYSTOSCOPY,,Grouper Rate,1678.88
Blue Cross,HMO,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Grouper Rate,1678.00
Blue Cross,HMO,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Grouper Rate,1678.88
Blue Cross,HMO,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Grouper Rate,1678.88
Blue Cross,HMO,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Grouper Rate,1678.88
Blue Cross,HMO,521,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,,Case Rate,50668.63
Blue Cross,HMO,522,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,,Case Rate,36207.71
Blue Cross,HMO,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Grouper Rate,1678.88
Blue Cross,HMO,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3544.00
Blue Cross,HMO,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Grouper Rate,5029.00
Blue Cross,HMO,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3544.00
Blue Cross,HMO,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,1678.88
Blue Cross,HMO,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,1678.88
Blue Cross,HMO,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Grouper Rate,1678.88
Blue Cross,HMO,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Grouper Rate,1678.88
Blue Cross,HMO,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,1678.88
Blue Cross,HMO,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,1678.88
Blue Cross,HMO,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Grouper Rate,5029.00
Blue Cross,HMO,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Grouper Rate,1678.88
Blue Cross,HMO,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,HMO,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Grouper Rate,3544.00
Blue Cross,HMO,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Grouper Rate,1678.88
Blue Cross,HMO,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Grouper Rate,1678.88
Blue Cross,HMO,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Grouper Rate,1678.88
Blue Cross,HMO,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Grouper Rate,3544.00
Blue Cross,HMO,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Grouper Rate,3544.00
Blue Cross,HMO,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Grouper Rate,3544.00
Blue Cross,HMO,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Grouper Rate,3544.00
Blue Cross,HMO,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Grouper Rate,1678.88
Blue Cross,HMO,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Grouper Rate,1678.88
Blue Cross,HMO,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Grouper Rate,3544.00
Blue Cross,HMO,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Grouper Rate,5029.00
Blue Cross,HMO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Grouper Rate,1678.88
Blue Cross,HMO,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Grouper Rate,1678.88
Blue Cross,HMO,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Grouper Rate,1678.88
Blue Cross,HMO,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Grouper Rate,1678.88
Blue Cross,HMO,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Grouper Rate,1678.88
Blue Cross,HMO,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Grouper Rate,3544.00
Blue Cross,HMO,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Grouper Rate,3544.00
Blue Cross,HMO,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Grouper Rate,3544.00
Blue Cross,HMO,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Grouper Rate,1678.88
Blue Cross,HMO,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Grouper Rate,1678.88
Blue Cross,HMO,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,HMO,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,HMO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Grouper Rate,1678.88
Blue Cross,HMO,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,1678.88
Blue Cross,HMO,53,DRG,Spinal disorders & injuries w/o CC/MCC,,Case Rate,18791.09
Blue Cross,HMO,53000,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,HMO,53010,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,HMO,53020,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,HMO,53025,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,HMO,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,1678.88
Blue Cross,HMO,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,1678.00
Blue Cross,HMO,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,1678.88
Blue Cross,HMO,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Grouper Rate,1678.00
Blue Cross,HMO,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,5281.00
Blue Cross,HMO,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,5281.00
Blue Cross,HMO,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,1678.88
Blue Cross,HMO,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,1678.88
Blue Cross,HMO,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,3544.00
Blue Cross,HMO,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Grouper Rate,1678.88
Blue Cross,HMO,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,1678.88
Blue Cross,HMO,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,1678.88
Blue Cross,HMO,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,1678.00
Blue Cross,HMO,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,1678.00
Blue Cross,HMO,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,1678.00
Blue Cross,HMO,533,DRG,Fractures of femur w MCC,,Case Rate,23364.40
Blue Cross,HMO,534,DRG,Fractures of femur w/o MCC,,Case Rate,13043.44
Blue Cross,HMO,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Grouper Rate,3544.00
Blue Cross,HMO,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Grouper Rate,1678.88
Blue Cross,HMO,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,1678.88
Blue Cross,HMO,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,HMO,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Grouper Rate,3544.00
Blue Cross,HMO,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Grouper Rate,1678.88
Blue Cross,HMO,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,1678.88
Blue Cross,HMO,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Grouper Rate,3544.00
Blue Cross,HMO,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Grouper Rate,1678.88
Blue Cross,HMO,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Grouper Rate,1678.00
Blue Cross,HMO,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Grouper Rate,3544.00
Blue Cross,HMO,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Grouper Rate,5281.00
Blue Cross,HMO,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Grouper Rate,3544.00
Blue Cross,HMO,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Grouper Rate,1678.00
Blue Cross,HMO,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,Grouper Rate,5783.00
Blue Cross,HMO,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Grouper Rate,1678.00
Blue Cross,HMO,53450,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,HMO,53460,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,HMO,535,DRG,Fractures of hip & pelvis w MCC,,Case Rate,20407.05
Blue Cross,HMO,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Grouper Rate,3544.00
Blue Cross,HMO,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,HMO,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,HMO,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,HMO,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,HMO,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,1678.88
Blue Cross,HMO,536,DRG,Fractures of hip & pelvis w/o MCC,,Case Rate,12762.26
Blue Cross,HMO,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,HMO,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,HMO,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,HMO,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,HMO,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,HMO,53665,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,HMO,537,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC,,Case Rate,15435.12
Blue Cross,HMO,538,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC,,Case Rate,11931.95
Blue Cross,HMO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Grouper Rate,3544.00
Blue Cross,HMO,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Grouper Rate,3544.00
Blue Cross,HMO,53854,CPT4/HCPCS,TRURL DSTRJ PRST8 TISS RF WV,,Grouper Rate,3544.00
Blue Cross,HMO,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Grouper Rate,1678.00
Blue Cross,HMO,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Grouper Rate,3544.00
Blue Cross,HMO,539,DRG,Osteomyelitis w MCC,,Case Rate,32107.44
Blue Cross,HMO,54,DRG,Nervous system neoplasms w MCC,,Case Rate,22590.33
Blue Cross,HMO,540,DRG,Osteomyelitis w CC,,Case Rate,21424.26
Blue Cross,HMO,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,1678.00
Blue Cross,HMO,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,1678.00
Blue Cross,HMO,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Grouper Rate,1678.88
Blue Cross,HMO,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,541,DRG,Osteomyelitis w/o CC/MCC,,Case Rate,13903.52
Blue Cross,HMO,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,1678.00
Blue Cross,HMO,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,1678.00
Blue Cross,HMO,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.88
Blue Cross,HMO,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,5281.00
Blue Cross,HMO,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,5783.00
Blue Cross,HMO,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.00
Blue Cross,HMO,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Grouper Rate,1678.88
Blue Cross,HMO,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Grouper Rate,1678.88
Blue Cross,HMO,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,Grouper Rate,5281.00
Blue Cross,HMO,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,Grouper Rate,5783.00
Blue Cross,HMO,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Grouper Rate,1678.00
Blue Cross,HMO,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Grouper Rate,1678.00
Blue Cross,HMO,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Grouper Rate,1678.00
Blue Cross,HMO,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Grouper Rate,1678.00
Blue Cross,HMO,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Grouper Rate,1678.00
Blue Cross,HMO,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Grouper Rate,1678.00
Blue Cross,HMO,542,DRG,Pathological fractures & musculoskelet & conn tiss malig w MCC,,Case Rate,29859.66
Blue Cross,HMO,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.88
Blue Cross,HMO,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.00
Blue Cross,HMO,54240,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,1678.00
Blue Cross,HMO,543,DRG,Pathological fractures & musculoskelet & conn tiss malig w CC,,Case Rate,17256.18
Blue Cross,HMO,54300,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,3544.00
Blue Cross,HMO,54304,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,3544.00
Blue Cross,HMO,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,HMO,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,HMO,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,HMO,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5281.00
Blue Cross,HMO,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,1678.88
Blue Cross,HMO,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,3544.00
Blue Cross,HMO,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,3544.00
Blue Cross,HMO,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5029.00
Blue Cross,HMO,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5029.00
Blue Cross,HMO,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5029.00
Blue Cross,HMO,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Grouper Rate,5029.00
Blue Cross,HMO,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,54380,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5029.00
Blue Cross,HMO,54385,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5029.00
Blue Cross,HMO,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,Grouper Rate,5029.00
Blue Cross,HMO,544,DRG,Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC,,Case Rate,12838.34
Blue Cross,HMO,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,HMO,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,HMO,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Grouper Rate,3544.00
Blue Cross,HMO,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Grouper Rate,5281.00
Blue Cross,HMO,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Grouper Rate,5281.00
Blue Cross,HMO,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Grouper Rate,5783.00
Blue Cross,HMO,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Grouper Rate,5281.00
Blue Cross,HMO,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Grouper Rate,5029.00
Blue Cross,HMO,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Grouper Rate,5281.00
Blue Cross,HMO,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Grouper Rate,5281.00
Blue Cross,HMO,54420,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5029.00
Blue Cross,HMO,54430,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,1678.88
Blue Cross,HMO,54435,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5029.00
Blue Cross,HMO,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Grouper Rate,3544.00
Blue Cross,HMO,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,Grouper Rate,5281.00
Blue Cross,HMO,54440,CPT4/HCPCS,REPAIR OF PENIS,,Grouper Rate,5029.00
Blue Cross,HMO,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Grouper Rate,1678.00
Blue Cross,HMO,545,DRG,Connective tissue disorders w MCC,,Case Rate,41341.73
Blue Cross,HMO,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,1678.00
Blue Cross,HMO,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,1678.00
Blue Cross,HMO,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Grouper Rate,1678.00
Blue Cross,HMO,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,3544.00
Blue Cross,HMO,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Grouper Rate,1678.88
Blue Cross,HMO,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,5029.00
Blue Cross,HMO,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,3544.00
Blue Cross,HMO,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,5029.00
Blue Cross,HMO,546,DRG,Connective tissue disorders w CC,,Case Rate,19957.16
Blue Cross,HMO,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Grouper Rate,5029.00
Blue Cross,HMO,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Grouper Rate,3544.00
Blue Cross,HMO,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Grouper Rate,3544.00
Blue Cross,HMO,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Grouper Rate,5029.00
Blue Cross,HMO,54660,CPT4/HCPCS,REVISION OF TESTIS,,Grouper Rate,1678.88
Blue Cross,HMO,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Grouper Rate,3544.00
Blue Cross,HMO,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Grouper Rate,3544.00
Blue Cross,HMO,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Grouper Rate,3544.00
Blue Cross,HMO,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Grouper Rate,5281.00
Blue Cross,HMO,547,DRG,Connective tissue disorders w/o CC/MCC,,Case Rate,13777.82
Blue Cross,HMO,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Grouper Rate,1678.88
Blue Cross,HMO,548,DRG,Septic arthritis w MCC,,Case Rate,33569.58
Blue Cross,HMO,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Grouper Rate,1678.00
Blue Cross,HMO,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,3544.00
Blue Cross,HMO,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,5029.00
Blue Cross,HMO,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,5029.00
Blue Cross,HMO,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,5029.00
Blue Cross,HMO,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Grouper Rate,1678.00
Blue Cross,HMO,549,DRG,Septic arthritis w CC,,Case Rate,20623.72
Blue Cross,HMO,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,5029.00
Blue Cross,HMO,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,5029.00
Blue Cross,HMO,55,DRG,Nervous system neoplasms w/o MCC,,Case Rate,17257.83
Blue Cross,HMO,550,DRG,Septic arthritis w/o CC/MCC,,Case Rate,14599.85
Blue Cross,HMO,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,5029.00
Blue Cross,HMO,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Grouper Rate,5029.00
Blue Cross,HMO,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Grouper Rate,5029.00
Blue Cross,HMO,551,DRG,Medical back problems w MCC,,Case Rate,26846.07
Blue Cross,HMO,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Grouper Rate,1678.88
Blue Cross,HMO,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Grouper Rate,1678.88
Blue Cross,HMO,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Grouper Rate,1678.00
Blue Cross,HMO,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,1678.00
Blue Cross,HMO,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,1678.88
Blue Cross,HMO,552,DRG,Medical back problems w/o MCC,,Case Rate,15580.68
Blue Cross,HMO,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Grouper Rate,1678.88
Blue Cross,HMO,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Grouper Rate,1678.88
Blue Cross,HMO,553,DRG,Bone diseases & arthropathies w MCC,,Case Rate,20977.68
Blue Cross,HMO,55300,CPT4/HCPCS,PREPARE SPERM DUCT X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,554,DRG,Bone diseases & arthropathies w/o MCC,,Case Rate,13073.21
Blue Cross,HMO,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Grouper Rate,1678.00
Blue Cross,HMO,55450,CPT4/HCPCS,LIGATION OF SPERM DUCT,,Grouper Rate,1678.00
Blue Cross,HMO,555,DRG,Signs & symptoms of musculoskeletal system & conn tissue w MCC,,Case Rate,22540.71
Blue Cross,HMO,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,3544.00
Blue Cross,HMO,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Grouper Rate,5029.00
Blue Cross,HMO,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,5029.00
Blue Cross,HMO,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,5029.00
Blue Cross,HMO,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Grouper Rate,5029.00
Blue Cross,HMO,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Grouper Rate,3544.00
Blue Cross,HMO,556,DRG,Signs & symptoms of musculoskeletal system & conn tissue w/o MCC,,Case Rate,13336.20
Blue Cross,HMO,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,1678.00
Blue Cross,HMO,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,1678.00
Blue Cross,HMO,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Grouper Rate,1678.00
Blue Cross,HMO,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Grouper Rate,1678.00
Blue Cross,HMO,557,DRG,Tendonitis, myositis & bursitis w MCC,,Case Rate,23055.10
Blue Cross,HMO,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,HMO,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,HMO,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Grouper Rate,1678.88
Blue Cross,HMO,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,558,DRG,Tendonitis, myositis & bursitis w/o MCC,,Case Rate,14196.28
Blue Cross,HMO,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,5281.00
Blue Cross,HMO,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,5783.00
Blue Cross,HMO,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,5783.00
Blue Cross,HMO,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Grouper Rate,3544.00
Blue Cross,HMO,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,55870,CPT4/HCPCS,ELECTROEJACULATION,,Grouper Rate,1678.00
Blue Cross,HMO,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Grouper Rate,6588.00
Blue Cross,HMO,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Grouper Rate,1678.00
Blue Cross,HMO,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Grouper Rate,8841.00
Blue Cross,HMO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Grouper Rate,1678.88
Blue Cross,HMO,559,DRG,Aftercare, musculoskeletal system & connective tissue w MCC,,Case Rate,30895.06
Blue Cross,HMO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Grouper Rate,1678.00
Blue Cross,HMO,55970,CPT4/HCPCS,SEX TRANSFORMATION M TO F,,Grouper Rate,5783.00
Blue Cross,HMO,55980,CPT4/HCPCS,SEX TRANSFORMATION F TO M,,Grouper Rate,5783.00
Blue Cross,HMO,56,DRG,Degenerative nervous system disorders w MCC,,Case Rate,36177.94
Blue Cross,HMO,560,DRG,Aftercare, musculoskeletal system & connective tissue w CC,,Case Rate,17803.65
Blue Cross,HMO,561,DRG,Aftercare, musculoskeletal system & connective tissue w/o CC/MCC,,Case Rate,13084.79
Blue Cross,HMO,562,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC,,Case Rate,23288.32
Blue Cross,HMO,563,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC,,Case Rate,14403.03
Blue Cross,HMO,564,DRG,Other musculoskeletal sys & connective tissue diagnoses w MCC,,Case Rate,25038.25
Blue Cross,HMO,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Grouper Rate,1678.00
Blue Cross,HMO,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Grouper Rate,1678.88
Blue Cross,HMO,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Grouper Rate,1678.00
Blue Cross,HMO,56442,CPT4/HCPCS,HYMENOTOMY,,Grouper Rate,1678.00
Blue Cross,HMO,565,DRG,Other musculoskeletal sys & connective tissue diagnoses w CC,,Case Rate,16644.20
Blue Cross,HMO,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Grouper Rate,1678.00
Blue Cross,HMO,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Grouper Rate,1678.88
Blue Cross,HMO,566,DRG,Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC,,Case Rate,12429.81
Blue Cross,HMO,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,1678.00
Blue Cross,HMO,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,1678.00
Blue Cross,HMO,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Grouper Rate,5281.00
Blue Cross,HMO,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Grouper Rate,6588.00
Blue Cross,HMO,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Grouper Rate,1678.00
Blue Cross,HMO,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Grouper Rate,3544.00
Blue Cross,HMO,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,3544.00
Blue Cross,HMO,56805,CPT4/HCPCS,REPAIR CLITORIS,,Grouper Rate,1678.88
Blue Cross,HMO,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Grouper Rate,5281.00
Blue Cross,HMO,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Grouper Rate,1678.00
Blue Cross,HMO,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Grouper Rate,1678.00
Blue Cross,HMO,57,DRG,Degenerative nervous system disorders w/o MCC,,Case Rate,20909.86
Blue Cross,HMO,570,DRG,Skin debridement w MCC,,Case Rate,46912.40
Blue Cross,HMO,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Grouper Rate,1678.00
Blue Cross,HMO,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,1678.88
Blue Cross,HMO,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Grouper Rate,1678.88
Blue Cross,HMO,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Grouper Rate,1678.00
Blue Cross,HMO,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Grouper Rate,1678.00
Blue Cross,HMO,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Grouper Rate,1678.00
Blue Cross,HMO,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Grouper Rate,1678.00
Blue Cross,HMO,571,DRG,Skin debridement w CC,,Case Rate,27006.51
Blue Cross,HMO,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,1678.88
Blue Cross,HMO,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Grouper Rate,5281.00
Blue Cross,HMO,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Grouper Rate,5281.00
Blue Cross,HMO,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Grouper Rate,5783.00
Blue Cross,HMO,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Grouper Rate,5281.00
Blue Cross,HMO,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Grouper Rate,5281.00
Blue Cross,HMO,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Grouper Rate,5783.00
Blue Cross,HMO,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Grouper Rate,5783.00
Blue Cross,HMO,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,1678.88
Blue Cross,HMO,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,1678.88
Blue Cross,HMO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Grouper Rate,1678.00
Blue Cross,HMO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Grouper Rate,1678.00
Blue Cross,HMO,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,Grouper Rate,1678.00
Blue Cross,HMO,572,DRG,Skin debridement w/o CC/MCC,,Case Rate,18237.00
Blue Cross,HMO,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,1678.00
Blue Cross,HMO,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Grouper Rate,1678.88
Blue Cross,HMO,57220,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,3544.00
Blue Cross,HMO,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Grouper Rate,3544.00
Blue Cross,HMO,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Grouper Rate,5281.00
Blue Cross,HMO,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Grouper Rate,5281.00
Blue Cross,HMO,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Grouper Rate,5281.00
Blue Cross,HMO,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Grouper Rate,6588.00
Blue Cross,HMO,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Grouper Rate,1678.88
Blue Cross,HMO,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Grouper Rate,3544.00
Blue Cross,HMO,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,Grouper Rate,5029.00
Blue Cross,HMO,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Grouper Rate,5029.00
Blue Cross,HMO,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Grouper Rate,5281.00
Blue Cross,HMO,57283,CPT4/HCPCS,COLPOPEXY INTRAPERITONEAL,,Grouper Rate,5281.00
Blue Cross,HMO,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Grouper Rate,5029.00
Blue Cross,HMO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Grouper Rate,5029.00
Blue Cross,HMO,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Grouper Rate,1678.00
Blue Cross,HMO,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Grouper Rate,1678.88
Blue Cross,HMO,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Grouper Rate,5281.00
Blue Cross,HMO,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Grouper Rate,5783.00
Blue Cross,HMO,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Grouper Rate,5783.00
Blue Cross,HMO,57296,CPT4/HCPCS,REVISE VAG GRAFT OPEN ABD,,Grouper Rate,1678.00
Blue Cross,HMO,573,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w MCC,,Case Rate,91586.94
Blue Cross,HMO,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,3544.00
Blue Cross,HMO,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,5281.00
Blue Cross,HMO,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,Grouper Rate,5783.00
Blue Cross,HMO,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,Grouper Rate,5281.00
Blue Cross,HMO,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,3544.00
Blue Cross,HMO,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,5029.00
Blue Cross,HMO,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,3544.00
Blue Cross,HMO,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,5783.00
Blue Cross,HMO,57335,CPT4/HCPCS,REPAIR VAGINA,,Grouper Rate,5029.00
Blue Cross,HMO,574,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w CC,,Case Rate,53726.88
Blue Cross,HMO,57400,CPT4/HCPCS,DILATION OF VAGINA,,Grouper Rate,1678.00
Blue Cross,HMO,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Grouper Rate,1678.00
Blue Cross,HMO,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Grouper Rate,1678.00
Blue Cross,HMO,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Grouper Rate,1678.00
Blue Cross,HMO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Grouper Rate,5029.00
Blue Cross,HMO,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Grouper Rate,5281.00
Blue Cross,HMO,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Grouper Rate,3544.00
Blue Cross,HMO,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Grouper Rate,1678.88
Blue Cross,HMO,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Grouper Rate,1678.00
Blue Cross,HMO,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Grouper Rate,1678.00
Blue Cross,HMO,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Grouper Rate,1678.00
Blue Cross,HMO,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Grouper Rate,1678.88
Blue Cross,HMO,575,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/MCC,,Case Rate,29135.21
Blue Cross,HMO,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Grouper Rate,1678.00
Blue Cross,HMO,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Grouper Rate,1678.00
Blue Cross,HMO,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Grouper Rate,1678.00
Blue Cross,HMO,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Grouper Rate,1678.00
Blue Cross,HMO,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Grouper Rate,1678.88
Blue Cross,HMO,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,1678.88
Blue Cross,HMO,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,1678.88
Blue Cross,HMO,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Grouper Rate,3544.00
Blue Cross,HMO,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,Grouper Rate,5783.00
Blue Cross,HMO,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,5783.00
Blue Cross,HMO,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,Grouper Rate,5783.00
Blue Cross,HMO,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,3544.00
Blue Cross,HMO,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,Grouper Rate,5029.00
Blue Cross,HMO,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Grouper Rate,5281.00
Blue Cross,HMO,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Grouper Rate,1678.00
Blue Cross,HMO,576,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC,,Case Rate,83541.88
Blue Cross,HMO,577,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w CC,,Case Rate,42239.85
Blue Cross,HMO,57700,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,1678.00
Blue Cross,HMO,57720,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3544.00
Blue Cross,HMO,578,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC,,Case Rate,26971.77
Blue Cross,HMO,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Grouper Rate,1678.00
Blue Cross,HMO,579,DRG,Other skin, subcut tiss & breast proc w MCC,,Case Rate,48425.81
Blue Cross,HMO,58,DRG,Multiple sclerosis & cerebellar ataxia w MCC,,Case Rate,28725.01
Blue Cross,HMO,580,DRG,Other skin, subcut tiss & breast proc w CC,,Case Rate,26468.96
Blue Cross,HMO,581,DRG,Other skin, subcut tiss & breast proc w/o CC/MCC,,Case Rate,20709.73
Blue Cross,HMO,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Grouper Rate,1678.00
Blue Cross,HMO,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Grouper Rate,1678.88
Blue Cross,HMO,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Grouper Rate,5281.00
Blue Cross,HMO,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Grouper Rate,5029.00
Blue Cross,HMO,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,Grouper Rate,6588.00
Blue Cross,HMO,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Grouper Rate,5029.00
Blue Cross,HMO,582,DRG,Mastectomy for malignancy w CC/MCC,,Case Rate,27056.13
Blue Cross,HMO,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,8841.00
Blue Cross,HMO,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,Grouper Rate,8841.00
Blue Cross,HMO,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Grouper Rate,8012.00
Blue Cross,HMO,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Grouper Rate,8012.00
Blue Cross,HMO,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,Grouper Rate,8012.00
Blue Cross,HMO,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Grouper Rate,8012.00
Blue Cross,HMO,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Grouper Rate,8012.00
Blue Cross,HMO,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Grouper Rate,8012.00
Blue Cross,HMO,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Grouper Rate,8012.00
Blue Cross,HMO,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Grouper Rate,8012.00
Blue Cross,HMO,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Grouper Rate,8012.00
Blue Cross,HMO,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,Grouper Rate,8012.00
Blue Cross,HMO,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Grouper Rate,8012.00
Blue Cross,HMO,583,DRG,Mastectomy for malignancy w/o CC/MCC,,Case Rate,25436.86
Blue Cross,HMO,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Grouper Rate,1678.00
Blue Cross,HMO,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Grouper Rate,1678.00
Blue Cross,HMO,58340,CPT4/HCPCS,CATHETER FOR HYSTEROGRAPHY,,Grouper Rate,1678.00
Blue Cross,HMO,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Grouper Rate,1678.00
Blue Cross,HMO,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Grouper Rate,5029.00
Blue Cross,HMO,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Grouper Rate,5029.00
Blue Cross,HMO,584,DRG,Breast biopsy, local excision & other breast procedures w CC/MCC,,Case Rate,30173.92
Blue Cross,HMO,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,3544.00
Blue Cross,HMO,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,3544.00
Blue Cross,HMO,585,DRG,Breast biopsy, local excision & other breast procedures w/o CC/MCC,,Case Rate,28723.36
Blue Cross,HMO,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Grouper Rate,3544.00
Blue Cross,HMO,58540,CPT4/HCPCS,REVISION OF UTERUS,,Grouper Rate,3544.00
Blue Cross,HMO,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Grouper Rate,5029.00
Blue Cross,HMO,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Grouper Rate,5281.00
Blue Cross,HMO,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Grouper Rate,5029.00
Blue Cross,HMO,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Grouper Rate,5281.00
Blue Cross,HMO,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Grouper Rate,5783.00
Blue Cross,HMO,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,HMO,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Grouper Rate,8012.00
Blue Cross,HMO,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Grouper Rate,8012.00
Blue Cross,HMO,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Grouper Rate,8012.00
Blue Cross,HMO,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Grouper Rate,1678.00
Blue Cross,HMO,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Grouper Rate,1678.88
Blue Cross,HMO,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Grouper Rate,3544.00
Blue Cross,HMO,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Grouper Rate,3544.00
Blue Cross,HMO,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Grouper Rate,3544.00
Blue Cross,HMO,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Grouper Rate,1678.88
Blue Cross,HMO,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Grouper Rate,5029.00
Blue Cross,HMO,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Grouper Rate,3544.00
Blue Cross,HMO,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Grouper Rate,8012.00
Blue Cross,HMO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Grouper Rate,8012.00
Blue Cross,HMO,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Grouper Rate,8012.00
Blue Cross,HMO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Grouper Rate,8012.00
Blue Cross,HMO,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,Grouper Rate,8012.00
Blue Cross,HMO,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3544.00
Blue Cross,HMO,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3544.00
Blue Cross,HMO,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Grouper Rate,3544.00
Blue Cross,HMO,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Grouper Rate,3544.00
Blue Cross,HMO,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Grouper Rate,6588.00
Blue Cross,HMO,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Grouper Rate,5783.00
Blue Cross,HMO,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Grouper Rate,5281.00
Blue Cross,HMO,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Grouper Rate,3544.00
Blue Cross,HMO,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Grouper Rate,3544.00
Blue Cross,HMO,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Grouper Rate,5281.00
Blue Cross,HMO,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Grouper Rate,5281.00
Blue Cross,HMO,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Grouper Rate,5029.00
Blue Cross,HMO,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Grouper Rate,5029.00
Blue Cross,HMO,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Grouper Rate,5281.00
Blue Cross,HMO,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Grouper Rate,5029.00
Blue Cross,HMO,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Grouper Rate,5783.00
Blue Cross,HMO,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Grouper Rate,5029.00
Blue Cross,HMO,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Grouper Rate,5029.00
Blue Cross,HMO,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Grouper Rate,5029.00
Blue Cross,HMO,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,3544.00
Blue Cross,HMO,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,5029.00
Blue Cross,HMO,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Grouper Rate,3544.00
Blue Cross,HMO,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Grouper Rate,5281.00
Blue Cross,HMO,58823,CPT4/HCPCS,DRAIN PELVIC ABSCESS PERCUT,,Grouper Rate,1678.00
Blue Cross,HMO,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Grouper Rate,5029.00
Blue Cross,HMO,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Grouper Rate,3544.00
Blue Cross,HMO,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Grouper Rate,5029.00
Blue Cross,HMO,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Grouper Rate,5281.00
Blue Cross,HMO,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,5281.00
Blue Cross,HMO,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,5783.00
Blue Cross,HMO,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,5783.00
Blue Cross,HMO,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,5783.00
Blue Cross,HMO,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,6588.00
Blue Cross,HMO,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,Grouper Rate,8012.00
Blue Cross,HMO,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,Grouper Rate,8012.00
Blue Cross,HMO,58956,CPT4/HCPCS,BSO OMENTECTOMY W/TAH,,Grouper Rate,5281.00
Blue Cross,HMO,58957,CPT4/HCPCS,RESECT RECURRENT GYN MAL,,Grouper Rate,5783.00
Blue Cross,HMO,58958,CPT4/HCPCS,RESECT RECUR GYN MAL W/LYM,,Grouper Rate,6588.00
Blue Cross,HMO,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,5783.00
Blue Cross,HMO,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Grouper Rate,1678.00
Blue Cross,HMO,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,1678.00
Blue Cross,HMO,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,1678.00
Blue Cross,HMO,59,DRG,Multiple sclerosis & cerebellar ataxia w CC,,Case Rate,18632.31
Blue Cross,HMO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Grouper Rate,1678.00
Blue Cross,HMO,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Grouper Rate,1678.00
Blue Cross,HMO,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,Grouper Rate,1678.00
Blue Cross,HMO,59015,CPT4/HCPCS,CHORION BIOPSY,,Grouper Rate,1678.88
Blue Cross,HMO,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Grouper Rate,3544.00
Blue Cross,HMO,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Grouper Rate,3544.00
Blue Cross,HMO,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Grouper Rate,1678.88
Blue Cross,HMO,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Grouper Rate,1678.88
Blue Cross,HMO,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,Grouper Rate,5029.00
Blue Cross,HMO,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1678.88
Blue Cross,HMO,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,HMO,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,HMO,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,8012.00
Blue Cross,HMO,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6588.00
Blue Cross,HMO,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,3544.00
Blue Cross,HMO,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,HMO,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,HMO,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Grouper Rate,1678.88
Blue Cross,HMO,592,DRG,Skin ulcers w MCC,,Case Rate,27898.01
Blue Cross,HMO,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Grouper Rate,1678.00
Blue Cross,HMO,593,DRG,Skin ulcers w CC,,Case Rate,18802.67
Blue Cross,HMO,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Grouper Rate,3544.00
Blue Cross,HMO,59320,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3544.00
Blue Cross,HMO,59325,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3544.00
Blue Cross,HMO,59350,CPT4/HCPCS,REPAIR OF UTERUS,,Grouper Rate,5281.00
Blue Cross,HMO,594,DRG,Skin ulcers w/o CC/MCC,,Case Rate,13541.29
Blue Cross,HMO,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Grouper Rate,5783.00
Blue Cross,HMO,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,Grouper Rate,1678.00
Blue Cross,HMO,59414,CPT4/HCPCS,DELIVER PLACENTA,,Grouper Rate,1678.88
Blue Cross,HMO,595,DRG,Major skin disorders w MCC,,Case Rate,33280.13
Blue Cross,HMO,59514,CPT4/HCPCS,CESAREAN DELIVERY ONLY,,Grouper Rate,5783.00
Blue Cross,HMO,59515,CPT4/HCPCS,CESAREAN DELIVERY,,Grouper Rate,5783.00
Blue Cross,HMO,59525,CPT4/HCPCS,REMOVE UTERUS AFTER CESAREAN,,Grouper Rate,5029.00
Blue Cross,HMO,596,DRG,Major skin disorders w/o MCC,,Case Rate,16361.36
Blue Cross,HMO,59610,CPT4/HCPCS,VBAC DELIVERY,,Grouper Rate,5281.00
Blue Cross,HMO,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Grouper Rate,5281.00
Blue Cross,HMO,59614,CPT4/HCPCS,VBAC CARE AFTER DELIVERY,,Grouper Rate,5281.00
Blue Cross,HMO,59618,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY,,Grouper Rate,5783.00
Blue Cross,HMO,59620,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY ONLY,,Grouper Rate,5783.00
Blue Cross,HMO,59622,CPT4/HCPCS,ATTEMPTED VBAC AFTER CARE,,Grouper Rate,5783.00
Blue Cross,HMO,597,DRG,Malignant breast disorders w MCC,,Case Rate,27071.01
Blue Cross,HMO,598,DRG,Malignant breast disorders w CC,,Case Rate,18379.24
Blue Cross,HMO,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,3544.00
Blue Cross,HMO,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Grouper Rate,3544.00
Blue Cross,HMO,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,3544.00
Blue Cross,HMO,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Grouper Rate,3544.00
Blue Cross,HMO,59840,CPT4/HCPCS,ABORTION,,Grouper Rate,3544.00
Blue Cross,HMO,59841,CPT4/HCPCS,ABORTION,,Grouper Rate,3544.00
Blue Cross,HMO,59850,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.00
Blue Cross,HMO,59851,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.00
Blue Cross,HMO,59852,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.00
Blue Cross,HMO,59855,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.88
Blue Cross,HMO,59856,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.88
Blue Cross,HMO,59857,CPT4/HCPCS,ABORTION,,Grouper Rate,5029.00
Blue Cross,HMO,59866,CPT4/HCPCS,ABORTION (MPR),,Grouper Rate,1678.00
Blue Cross,HMO,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Grouper Rate,3544.00
Blue Cross,HMO,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Grouper Rate,1678.00
Blue Cross,HMO,599,DRG,Malignant breast disorders w/o CC/MCC,,Case Rate,11101.64
Blue Cross,HMO,6,DRG,Liver transplant w/o MCC,,Case Rate,77600.71
Blue Cross,HMO,60,DRG,Multiple sclerosis & cerebellar ataxia w/o CC/MCC,,Case Rate,15144.02
Blue Cross,HMO,600,DRG,Non-malignant breast disorders w CC/MCC,,Case Rate,16468.87
Blue Cross,HMO,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Grouper Rate,1678.00
Blue Cross,HMO,601,DRG,Non-malignant breast disorders w/o CC/MCC,,Case Rate,11372.90
Blue Cross,HMO,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Grouper Rate,1678.00
Blue Cross,HMO,602,DRG,Cellulitis w MCC,,Case Rate,23761.36
Blue Cross,HMO,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Grouper Rate,1678.88
Blue Cross,HMO,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,1678.88
Blue Cross,HMO,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,1678.88
Blue Cross,HMO,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,1678.88
Blue Cross,HMO,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,3544.00
Blue Cross,HMO,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,5783.00
Blue Cross,HMO,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,5029.00
Blue Cross,HMO,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Grouper Rate,5783.00
Blue Cross,HMO,60270,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,8012.00
Blue Cross,HMO,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,8012.00
Blue Cross,HMO,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,5029.00
Blue Cross,HMO,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,5029.00
Blue Cross,HMO,603,DRG,Cellulitis w/o MCC,,Case Rate,13972.99
Blue Cross,HMO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Grouper Rate,1678.00
Blue Cross,HMO,604,DRG,Trauma to the skin, subcut tiss & breast w MCC,,Case Rate,24666.10
Blue Cross,HMO,605,DRG,Trauma to the skin, subcut tiss & breast w/o MCC,,Case Rate,15038.16
Blue Cross,HMO,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,8012.00
Blue Cross,HMO,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Grouper Rate,8012.00
Blue Cross,HMO,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,8012.00
Blue Cross,HMO,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Grouper Rate,1678.88
Blue Cross,HMO,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,5281.00
Blue Cross,HMO,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,5783.00
Blue Cross,HMO,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,5783.00
Blue Cross,HMO,606,DRG,Minor skin disorders w MCC,,Case Rate,24991.94
Blue Cross,HMO,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Grouper Rate,5281.00
Blue Cross,HMO,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Grouper Rate,5281.00
Blue Cross,HMO,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,607,DRG,Minor skin disorders w/o MCC,,Case Rate,13655.42
Blue Cross,HMO,61,DRG,Acute ischemic stroke w use of thrombolytic agent w MCC,,Case Rate,47770.82
Blue Cross,HMO,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,1678.00
Blue Cross,HMO,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,1678.00
Blue Cross,HMO,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Grouper Rate,1678.00
Blue Cross,HMO,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,1678.00
Blue Cross,HMO,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Grouper Rate,1678.00
Blue Cross,HMO,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,1678.00
Blue Cross,HMO,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Grouper Rate,1678.00
Blue Cross,HMO,61105,CPT4/HCPCS,TWIST DRILL HOLE,,Grouper Rate,1678.88
Blue Cross,HMO,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,Grouper Rate,3544.00
Blue Cross,HMO,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,Grouper Rate,5783.00
Blue Cross,HMO,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,Grouper Rate,5783.00
Blue Cross,HMO,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,Grouper Rate,5783.00
Blue Cross,HMO,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,5281.00
Blue Cross,HMO,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,5281.00
Blue Cross,HMO,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,Grouper Rate,5281.00
Blue Cross,HMO,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,5281.00
Blue Cross,HMO,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,Grouper Rate,5281.00
Blue Cross,HMO,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Grouper Rate,3544.00
Blue Cross,HMO,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Grouper Rate,5281.00
Blue Cross,HMO,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Grouper Rate,5281.00
Blue Cross,HMO,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Grouper Rate,6588.00
Blue Cross,HMO,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,6588.00
Blue Cross,HMO,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,6588.00
Blue Cross,HMO,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Grouper Rate,1678.00
Blue Cross,HMO,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,6588.00
Blue Cross,HMO,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,Grouper Rate,5783.00
Blue Cross,HMO,61332,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,1678.88
Blue Cross,HMO,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,Grouper Rate,5029.00
Blue Cross,HMO,61334,CPT4/HCPCS,EXPLORE ORBIT/REMOVE OBJECT,,Grouper Rate,5029.00
Blue Cross,HMO,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,Grouper Rate,6588.00
Blue Cross,HMO,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,Grouper Rate,6588.00
Blue Cross,HMO,614,DRG,Adrenal & pituitary procedures w CC/MCC,,Case Rate,39477.67
Blue Cross,HMO,61440,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Grouper Rate,6588.00
Blue Cross,HMO,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,61490,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,615,DRG,Adrenal & pituitary procedures w/o CC/MCC,,Case Rate,26035.61
Blue Cross,HMO,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Grouper Rate,8012.00
Blue Cross,HMO,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,Grouper Rate,5783.00
Blue Cross,HMO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,HMO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Grouper Rate,6588.00
Blue Cross,HMO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Grouper Rate,6588.00
Blue Cross,HMO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,HMO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,Grouper Rate,5029.00
Blue Cross,HMO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Grouper Rate,6588.00
Blue Cross,HMO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,HMO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,HMO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,8012.00
Blue Cross,HMO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,5783.00
Blue Cross,HMO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,HMO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,Grouper Rate,5783.00
Blue Cross,HMO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,HMO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,HMO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,8012.00
Blue Cross,HMO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,8012.00
Blue Cross,HMO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,HMO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,HMO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,Grouper Rate,8012.00
Blue Cross,HMO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,Grouper Rate,8012.00
Blue Cross,HMO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Grouper Rate,6588.00
Blue Cross,HMO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Grouper Rate,5783.00
Blue Cross,HMO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Grouper Rate,6588.00
Blue Cross,HMO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,Grouper Rate,5783.00
Blue Cross,HMO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,Grouper Rate,5783.00
Blue Cross,HMO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Grouper Rate,6588.00
Blue Cross,HMO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Grouper Rate,6588.00
Blue Cross,HMO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Grouper Rate,5281.00
Blue Cross,HMO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Grouper Rate,5783.00
Blue Cross,HMO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,HMO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,HMO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,Grouper Rate,6588.00
Blue Cross,HMO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Grouper Rate,6588.00
Blue Cross,HMO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Grouper Rate,8012.00
Blue Cross,HMO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Grouper Rate,8012.00
Blue Cross,HMO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,6588.00
Blue Cross,HMO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,6588.00
Blue Cross,HMO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,8012.00
Blue Cross,HMO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,6588.00
Blue Cross,HMO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,HMO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,HMO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,HMO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,HMO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,HMO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,HMO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,HMO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,HMO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,HMO,616,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w MCC,,Case Rate,65974.75
Blue Cross,HMO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,6588.00
Blue Cross,HMO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,8012.00
Blue Cross,HMO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,6588.00
Blue Cross,HMO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,8012.00
Blue Cross,HMO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,8012.00
Blue Cross,HMO,61609,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,6588.00
Blue Cross,HMO,61610,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,8012.00
Blue Cross,HMO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,6588.00
Blue Cross,HMO,61612,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,8012.00
Blue Cross,HMO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,Grouper Rate,8012.00
Blue Cross,HMO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Grouper Rate,8841.00
Blue Cross,HMO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Grouper Rate,8841.00
Blue Cross,HMO,61618,CPT4/HCPCS,REPAIR DURA,,Grouper Rate,6588.00
Blue Cross,HMO,61619,CPT4/HCPCS,REPAIR DURA,,Grouper Rate,5783.00
Blue Cross,HMO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Grouper Rate,5029.00
Blue Cross,HMO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,Grouper Rate,5029.00
Blue Cross,HMO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Grouper Rate,5029.00
Blue Cross,HMO,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,Grouper Rate,5029.00
Blue Cross,HMO,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,Grouper Rate,5029.00
Blue Cross,HMO,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,Grouper Rate,5029.00
Blue Cross,HMO,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,Grouper Rate,1678.88
Blue Cross,HMO,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,Grouper Rate,1678.88
Blue Cross,HMO,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,Grouper Rate,3544.00
Blue Cross,HMO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,Grouper Rate,1678.88
Blue Cross,HMO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,Grouper Rate,1678.88
Blue Cross,HMO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,HMO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,HMO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,HMO,617,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w CC,,Case Rate,33644.01
Blue Cross,HMO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,Grouper Rate,6588.00
Blue Cross,HMO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,HMO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,Grouper Rate,6588.00
Blue Cross,HMO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,8012.00
Blue Cross,HMO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,6588.00
Blue Cross,HMO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,5281.00
Blue Cross,HMO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,Grouper Rate,5281.00
Blue Cross,HMO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,Grouper Rate,5281.00
Blue Cross,HMO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,5783.00
Blue Cross,HMO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,Grouper Rate,5783.00
Blue Cross,HMO,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,Grouper Rate,1678.00
Blue Cross,HMO,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,Grouper Rate,1678.00
Blue Cross,HMO,61783,CPT4/HCPCS,SCAN PROC SPINAL,,Grouper Rate,1678.00
Blue Cross,HMO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Grouper Rate,3544.00
Blue Cross,HMO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Grouper Rate,3544.00
Blue Cross,HMO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,Grouper Rate,8841.00
Blue Cross,HMO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,Grouper Rate,5029.00
Blue Cross,HMO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,Grouper Rate,8841.00
Blue Cross,HMO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,Grouper Rate,5029.00
Blue Cross,HMO,618,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w/o CC/MCC,,Case Rate,21551.62
Blue Cross,HMO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,5783.00
Blue Cross,HMO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,5783.00
Blue Cross,HMO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Grouper Rate,6588.00
Blue Cross,HMO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Grouper Rate,6588.00
Blue Cross,HMO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,6588.00
Blue Cross,HMO,61875,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,6588.00
Blue Cross,HMO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,5281.00
Blue Cross,HMO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Grouper Rate,1678.88
Blue Cross,HMO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Grouper Rate,5029.00
Blue Cross,HMO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,1678.00
Blue Cross,HMO,619,DRG,O.R. procedures for obesity w MCC,,Case Rate,50630.59
Blue Cross,HMO,62,DRG,Acute ischemic stroke w use of thrombolytic agent w CC,,Case Rate,32868.28
Blue Cross,HMO,620,DRG,O.R. procedures for obesity w CC,,Case Rate,29128.59
Blue Cross,HMO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,Grouper Rate,5783.00
Blue Cross,HMO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,Grouper Rate,5783.00
Blue Cross,HMO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,Grouper Rate,5783.00
Blue Cross,HMO,621,DRG,O.R. procedures for obesity w/o CC/MCC,,Case Rate,26404.45
Blue Cross,HMO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,Grouper Rate,5783.00
Blue Cross,HMO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,HMO,62116,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,HMO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,6588.00
Blue Cross,HMO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,Grouper Rate,6588.00
Blue Cross,HMO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,Grouper Rate,8012.00
Blue Cross,HMO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,HMO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,HMO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,Grouper Rate,5783.00
Blue Cross,HMO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,Grouper Rate,6588.00
Blue Cross,HMO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,Grouper Rate,6588.00
Blue Cross,HMO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Grouper Rate,6588.00
Blue Cross,HMO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Grouper Rate,6588.00
Blue Cross,HMO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,Grouper Rate,1678.00
Blue Cross,HMO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,Grouper Rate,3544.00
Blue Cross,HMO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,Grouper Rate,5029.00
Blue Cross,HMO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,Grouper Rate,5029.00
Blue Cross,HMO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,Grouper Rate,6588.00
Blue Cross,HMO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,Grouper Rate,6588.00
Blue Cross,HMO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,5281.00
Blue Cross,HMO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,5281.00
Blue Cross,HMO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,1678.00
Blue Cross,HMO,622,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC,,Case Rate,59755.71
Blue Cross,HMO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,5783.00
Blue Cross,HMO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,Grouper Rate,5783.00
Blue Cross,HMO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,6588.00
Blue Cross,HMO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,6588.00
Blue Cross,HMO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,1678.00
Blue Cross,HMO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Grouper Rate,1678.88
Blue Cross,HMO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,Grouper Rate,1678.00
Blue Cross,HMO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Grouper Rate,1678.88
Blue Cross,HMO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,Grouper Rate,5783.00
Blue Cross,HMO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Grouper Rate,1678.88
Blue Cross,HMO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Grouper Rate,1678.88
Blue Cross,HMO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Grouper Rate,1678.00
Blue Cross,HMO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Grouper Rate,1678.00
Blue Cross,HMO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Grouper Rate,1678.00
Blue Cross,HMO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Grouper Rate,1678.00
Blue Cross,HMO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Grouper Rate,1678.00
Blue Cross,HMO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Grouper Rate,1678.00
Blue Cross,HMO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,1678.00
Blue Cross,HMO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,1678.00
Blue Cross,HMO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Grouper Rate,1678.00
Blue Cross,HMO,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,Grouper Rate,1678.88
Blue Cross,HMO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Grouper Rate,3544.00
Blue Cross,HMO,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,Grouper Rate,1678.88
Blue Cross,HMO,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,Grouper Rate,1678.88
Blue Cross,HMO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Grouper Rate,3544.00
Blue Cross,HMO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Grouper Rate,3544.00
Blue Cross,HMO,623,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w CC,,Case Rate,30977.76
Blue Cross,HMO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,HMO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,HMO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,HMO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,HMO,62310,CPT4/HCPCS,INJECT SPINE CERV/THORACIC,,Grouper Rate,1678.00
Blue Cross,HMO,62311,CPT4/HCPCS,INJECT SPINE LUMBAR/SACRAL,,Grouper Rate,1678.00
Blue Cross,HMO,62318,CPT4/HCPCS,INJECT SPINE W/CATH CRV/THRC,,Grouper Rate,1678.00
Blue Cross,HMO,62319,CPT4/HCPCS,INJECT SPINE W/CATH LMB/SCRL,,Grouper Rate,1678.00
Blue Cross,HMO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,HMO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,HMO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,HMO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,HMO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,HMO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,HMO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,HMO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,HMO,62328,CPT4/HCPCS,DX LMBR SPI PNXR W/FLUOR/CT,,Grouper Rate,1678.00
Blue Cross,HMO,62329,CPT4/HCPCS,THER SPI PNXR CSF FLUOR/CT,,Grouper Rate,1678.00
Blue Cross,HMO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,1678.88
Blue Cross,HMO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,1678.88
Blue Cross,HMO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Grouper Rate,1678.88
Blue Cross,HMO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Grouper Rate,1678.88
Blue Cross,HMO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,1678.88
Blue Cross,HMO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,1678.88
Blue Cross,HMO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Grouper Rate,1678.88
Blue Cross,HMO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Grouper Rate,1678.88
Blue Cross,HMO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Grouper Rate,1678.88
Blue Cross,HMO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,Grouper Rate,1678.88
Blue Cross,HMO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Grouper Rate,1678.88
Blue Cross,HMO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Grouper Rate,1678.88
Blue Cross,HMO,624,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC,,Case Rate,18099.72
Blue Cross,HMO,625,DRG,Thyroid, parathyroid & thyroglossal procedures w MCC,,Case Rate,46993.44
Blue Cross,HMO,626,DRG,Thyroid, parathyroid & thyroglossal procedures w CC,,Case Rate,27329.04
Blue Cross,HMO,627,DRG,Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC,,Case Rate,19546.97
Blue Cross,HMO,628,DRG,Other endocrine, nutrit & metab O.R. proc w MCC,,Case Rate,61166.57
Blue Cross,HMO,629,DRG,Other endocrine, nutrit & metab O.R. proc w CC,,Case Rate,38816.07
Blue Cross,HMO,63,DRG,Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC,,Case Rate,28281.74
Blue Cross,HMO,630,DRG,Other endocrine, nutrit & metab O.R. proc w/o CC/MCC,,Case Rate,23270.12
Blue Cross,HMO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Grouper Rate,5783.00
Blue Cross,HMO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Grouper Rate,5783.00
Blue Cross,HMO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Grouper Rate,3544.00
Blue Cross,HMO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Grouper Rate,5783.00
Blue Cross,HMO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Grouper Rate,6588.00
Blue Cross,HMO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Grouper Rate,6588.00
Blue Cross,HMO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Grouper Rate,6588.00
Blue Cross,HMO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Grouper Rate,6588.00
Blue Cross,HMO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Grouper Rate,5029.00
Blue Cross,HMO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Grouper Rate,5281.00
Blue Cross,HMO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Grouper Rate,6588.00
Blue Cross,HMO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Grouper Rate,1678.88
Blue Cross,HMO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Grouper Rate,5029.00
Blue Cross,HMO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Grouper Rate,5029.00
Blue Cross,HMO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Grouper Rate,5281.00
Blue Cross,HMO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,Grouper Rate,5281.00
Blue Cross,HMO,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,Grouper Rate,6588.00
Blue Cross,HMO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,5029.00
Blue Cross,HMO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Grouper Rate,5029.00
Blue Cross,HMO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,5029.00
Blue Cross,HMO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,6588.00
Blue Cross,HMO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,6588.00
Blue Cross,HMO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,5281.00
Blue Cross,HMO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,1678.88
Blue Cross,HMO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Grouper Rate,5281.00
Blue Cross,HMO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,Grouper Rate,5783.00
Blue Cross,HMO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,HMO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Grouper Rate,5783.00
Blue Cross,HMO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,HMO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,5783.00
Blue Cross,HMO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Grouper Rate,5783.00
Blue Cross,HMO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,HMO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Grouper Rate,6588.00
Blue Cross,HMO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Grouper Rate,5783.00
Blue Cross,HMO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,Grouper Rate,5281.00
Blue Cross,HMO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Grouper Rate,5783.00
Blue Cross,HMO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Grouper Rate,5783.00
Blue Cross,HMO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Grouper Rate,5783.00
Blue Cross,HMO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Grouper Rate,6588.00
Blue Cross,HMO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,Grouper Rate,5783.00
Blue Cross,HMO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,Grouper Rate,5783.00
Blue Cross,HMO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,Grouper Rate,5783.00
Blue Cross,HMO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,Grouper Rate,5783.00
Blue Cross,HMO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,Grouper Rate,5783.00
Blue Cross,HMO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,Grouper Rate,5783.00
Blue Cross,HMO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,Grouper Rate,5783.00
Blue Cross,HMO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,Grouper Rate,5783.00
Blue Cross,HMO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,Grouper Rate,5783.00
Blue Cross,HMO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,Grouper Rate,5783.00
Blue Cross,HMO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,Grouper Rate,5783.00
Blue Cross,HMO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,Grouper Rate,5783.00
Blue Cross,HMO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,Grouper Rate,5783.00
Blue Cross,HMO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Grouper Rate,5281.00
Blue Cross,HMO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Grouper Rate,5281.00
Blue Cross,HMO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Grouper Rate,5281.00
Blue Cross,HMO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Grouper Rate,5281.00
Blue Cross,HMO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,Grouper Rate,5783.00
Blue Cross,HMO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Grouper Rate,5783.00
Blue Cross,HMO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Grouper Rate,5281.00
Blue Cross,HMO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Grouper Rate,5281.00
Blue Cross,HMO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,Grouper Rate,5281.00
Blue Cross,HMO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,Grouper Rate,5281.00
Blue Cross,HMO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,Grouper Rate,5281.00
Blue Cross,HMO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,Grouper Rate,5281.00
Blue Cross,HMO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,Grouper Rate,5281.00
Blue Cross,HMO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,Grouper Rate,5281.00
Blue Cross,HMO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,Grouper Rate,5281.00
Blue Cross,HMO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,Grouper Rate,5281.00
Blue Cross,HMO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,Grouper Rate,5281.00
Blue Cross,HMO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,Grouper Rate,5281.00
Blue Cross,HMO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,Grouper Rate,5281.00
Blue Cross,HMO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,Grouper Rate,5783.00
Blue Cross,HMO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,Grouper Rate,5281.00
Blue Cross,HMO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,Grouper Rate,5783.00
Blue Cross,HMO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,Grouper Rate,5783.00
Blue Cross,HMO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,Grouper Rate,5783.00
Blue Cross,HMO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,Grouper Rate,5783.00
Blue Cross,HMO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,Grouper Rate,5783.00
Blue Cross,HMO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,Grouper Rate,5783.00
Blue Cross,HMO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,Grouper Rate,5783.00
Blue Cross,HMO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,HMO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Grouper Rate,1678.88
Blue Cross,HMO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Grouper Rate,1678.00
Blue Cross,HMO,63615,CPT4/HCPCS,REMOVE LESION OF SPINAL CORD,,Grouper Rate,5281.00
Blue Cross,HMO,63620,CPT4/HCPCS,SRS SPINAL LESION,,Grouper Rate,8841.00
Blue Cross,HMO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,Grouper Rate,5029.00
Blue Cross,HMO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,HMO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,HMO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Grouper Rate,1678.00
Blue Cross,HMO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Grouper Rate,1678.88
Blue Cross,HMO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Grouper Rate,1678.88
Blue Cross,HMO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Grouper Rate,5281.00
Blue Cross,HMO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Grouper Rate,1678.88
Blue Cross,HMO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,1678.00
Blue Cross,HMO,637,DRG,Diabetes w MCC,,Case Rate,22737.53
Blue Cross,HMO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,HMO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,HMO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,HMO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,HMO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Grouper Rate,5281.00
Blue Cross,HMO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Grouper Rate,5281.00
Blue Cross,HMO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,Grouper Rate,5281.00
Blue Cross,HMO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,5783.00
Blue Cross,HMO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,5281.00
Blue Cross,HMO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Grouper Rate,3544.00
Blue Cross,HMO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Grouper Rate,1678.88
Blue Cross,HMO,638,DRG,Diabetes w CC,,Case Rate,14545.27
Blue Cross,HMO,639,DRG,Diabetes w/o CC/MCC,,Case Rate,10077.82
Blue Cross,HMO,64,DRG,Intracranial hemorrhage or cerebral infarction w MCC,,Case Rate,31641.02
Blue Cross,HMO,640,DRG,Nutritional & misc metabolic disorders w MCC,,Case Rate,20307.81
Blue Cross,HMO,641,DRG,Nutritional & misc metabolic disorders w/o MCC,,Case Rate,12454.62
Blue Cross,HMO,642,DRG,Inborn errors of metabolism,,Case Rate,21295.25
Blue Cross,HMO,643,DRG,Endocrine disorders w MCC,,Case Rate,27510.98
Blue Cross,HMO,644,DRG,Endocrine disorders w CC,,Case Rate,16842.68
Blue Cross,HMO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Grouper Rate,1678.00
Blue Cross,HMO,64402,CPT4/HCPCS,N BLOCK INJ FACIAL,,Grouper Rate,1678.00
Blue Cross,HMO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Grouper Rate,1678.00
Blue Cross,HMO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Grouper Rate,1678.00
Blue Cross,HMO,64410,CPT4/HCPCS,N BLOCK INJ PHRENIC,,Grouper Rate,1678.00
Blue Cross,HMO,64412,CPT4/HCPCS,N BLOCK INJ SPINAL ACCESSOR,,Grouper Rate,1678.00
Blue Cross,HMO,64413,CPT4/HCPCS,N BLOCK INJ CERVICAL PLEXUS,,Grouper Rate,1678.00
Blue Cross,HMO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Grouper Rate,1678.00
Blue Cross,HMO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Grouper Rate,1678.00
Blue Cross,HMO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Grouper Rate,1678.00
Blue Cross,HMO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Grouper Rate,1678.00
Blue Cross,HMO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Grouper Rate,1678.00
Blue Cross,HMO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Grouper Rate,1678.00
Blue Cross,HMO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Grouper Rate,1678.00
Blue Cross,HMO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Grouper Rate,1678.00
Blue Cross,HMO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,Grouper Rate,1678.00
Blue Cross,HMO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,Grouper Rate,1678.00
Blue Cross,HMO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Grouper Rate,1678.00
Blue Cross,HMO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Grouper Rate,1678.00
Blue Cross,HMO,64451,CPT4/HCPCS,NJX AA&/STRD NRV NRVTG SI JT,,Grouper Rate,1678.00
Blue Cross,HMO,64454,CPT4/HCPCS,NJX AA&/STRD GNCLR NRV BRNCH,,Grouper Rate,1678.00
Blue Cross,HMO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Grouper Rate,1678.00
Blue Cross,HMO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Grouper Rate,1678.00
Blue Cross,HMO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Grouper Rate,1678.00
Blue Cross,HMO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Grouper Rate,1678.00
Blue Cross,HMO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Grouper Rate,1678.00
Blue Cross,HMO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Grouper Rate,1678.00
Blue Cross,HMO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Grouper Rate,1678.00
Blue Cross,HMO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Grouper Rate,1678.00
Blue Cross,HMO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Grouper Rate,1678.00
Blue Cross,HMO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Grouper Rate,1678.00
Blue Cross,HMO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Grouper Rate,1678.00
Blue Cross,HMO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Grouper Rate,1678.00
Blue Cross,HMO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Grouper Rate,1678.00
Blue Cross,HMO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Grouper Rate,1678.00
Blue Cross,HMO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Grouper Rate,1678.00
Blue Cross,HMO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Grouper Rate,1678.00
Blue Cross,HMO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Grouper Rate,1678.00
Blue Cross,HMO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Grouper Rate,1678.00
Blue Cross,HMO,645,DRG,Endocrine disorders w/o CC/MCC,,Case Rate,12699.41
Blue Cross,HMO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Grouper Rate,1678.00
Blue Cross,HMO,64508,CPT4/HCPCS,N BLOCK CAROTID SINUS S/P,,Grouper Rate,1678.00
Blue Cross,HMO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Grouper Rate,1678.00
Blue Cross,HMO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Grouper Rate,1678.00
Blue Cross,HMO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Grouper Rate,1678.00
Blue Cross,HMO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Grouper Rate,1678.00
Blue Cross,HMO,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,Grouper Rate,1678.00
Blue Cross,HMO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,HMO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,HMO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,HMO,64565,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,HMO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Grouper Rate,1678.88
Blue Cross,HMO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Grouper Rate,3544.00
Blue Cross,HMO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Grouper Rate,3544.00
Blue Cross,HMO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Grouper Rate,3544.00
Blue Cross,HMO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,HMO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,HMO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,HMO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,1678.00
Blue Cross,HMO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Grouper Rate,1678.88
Blue Cross,HMO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Grouper Rate,1678.00
Blue Cross,HMO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Grouper Rate,1678.88
Blue Cross,HMO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Grouper Rate,1678.00
Blue Cross,HMO,64613,CPT4/HCPCS,DESTROY NERVE NECK MUSCLE,,Grouper Rate,1678.00
Blue Cross,HMO,64614,CPT4/HCPCS,DESTROY NERVE EXTREM MUSC,,Grouper Rate,1678.00
Blue Cross,HMO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Grouper Rate,1678.00
Blue Cross,HMO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Grouper Rate,1678.00
Blue Cross,HMO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Grouper Rate,1678.00
Blue Cross,HMO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64624,CPT4/HCPCS,DSTRJ NULYT AGT GNCLR NRV,,Grouper Rate,1678.00
Blue Cross,HMO,64625,CPT4/HCPCS,RF ABLTJ NRV NRVTG SI JT,,Grouper Rate,1678.88
Blue Cross,HMO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Grouper Rate,1678.00
Blue Cross,HMO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Grouper Rate,1678.00
Blue Cross,HMO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Grouper Rate,1678.00
Blue Cross,HMO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,Grouper Rate,1678.00
Blue Cross,HMO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Grouper Rate,1678.00
Blue Cross,HMO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,Grouper Rate,1678.00
Blue Cross,HMO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Grouper Rate,1678.00
Blue Cross,HMO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,Grouper Rate,1678.00
Blue Cross,HMO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Grouper Rate,1678.00
Blue Cross,HMO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Grouper Rate,1678.00
Blue Cross,HMO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,1678.00
Blue Cross,HMO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,1678.00
Blue Cross,HMO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Grouper Rate,1678.88
Blue Cross,HMO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Grouper Rate,1678.88
Blue Cross,HMO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Grouper Rate,3544.00
Blue Cross,HMO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Grouper Rate,1678.88
Blue Cross,HMO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Grouper Rate,1678.88
Blue Cross,HMO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Grouper Rate,1678.88
Blue Cross,HMO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Grouper Rate,1678.00
Blue Cross,HMO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Grouper Rate,1678.00
Blue Cross,HMO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Grouper Rate,1678.88
Blue Cross,HMO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64752,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Grouper Rate,5783.00
Blue Cross,HMO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,Grouper Rate,5281.00
Blue Cross,HMO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Grouper Rate,5783.00
Blue Cross,HMO,64761,CPT4/HCPCS,INCISION OF PELVIS NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Grouper Rate,3544.00
Blue Cross,HMO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Grouper Rate,5281.00
Blue Cross,HMO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,64787,CPT4/HCPCS,IMPLANT NERVE END,,Grouper Rate,1678.00
Blue Cross,HMO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Grouper Rate,1678.88
Blue Cross,HMO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,1678.88
Blue Cross,HMO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,5281.00
Blue Cross,HMO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,Grouper Rate,1678.88
Blue Cross,HMO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Grouper Rate,3544.00
Blue Cross,HMO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,3544.00
Blue Cross,HMO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,3544.00
Blue Cross,HMO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Grouper Rate,1678.88
Blue Cross,HMO,64859,CPT4/HCPCS,NERVE SURGERY,,Grouper Rate,1678.00
Blue Cross,HMO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Grouper Rate,3544.00
Blue Cross,HMO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Grouper Rate,3544.00
Blue Cross,HMO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,3544.00
Blue Cross,HMO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,5029.00
Blue Cross,HMO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,5029.00
Blue Cross,HMO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,5029.00
Blue Cross,HMO,64870,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,5029.00
Blue Cross,HMO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Grouper Rate,1678.00
Blue Cross,HMO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Grouper Rate,3544.00
Blue Cross,HMO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Grouper Rate,3544.00
Blue Cross,HMO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Grouper Rate,5783.00
Blue Cross,HMO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Grouper Rate,5783.00
Blue Cross,HMO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,1678.88
Blue Cross,HMO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,3544.00
Blue Cross,HMO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,3544.00
Blue Cross,HMO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Grouper Rate,3544.00
Blue Cross,HMO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,3544.00
Blue Cross,HMO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,1678.88
Blue Cross,HMO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,1678.00
Blue Cross,HMO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Grouper Rate,1678.00
Blue Cross,HMO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Grouper Rate,3544.00
Blue Cross,HMO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Grouper Rate,1678.88
Blue Cross,HMO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Grouper Rate,1678.88
Blue Cross,HMO,65,DRG,Intracranial hemorrhage or cerebral infarction w CC,,Case Rate,16841.02
Blue Cross,HMO,650,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,,Case Rate,74646.67
Blue Cross,HMO,65091,CPT4/HCPCS,REVISE EYE,,Grouper Rate,3544.00
Blue Cross,HMO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Grouper Rate,3544.00
Blue Cross,HMO,651,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,,Case Rate,61092.14
Blue Cross,HMO,65101,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,3544.00
Blue Cross,HMO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Grouper Rate,3544.00
Blue Cross,HMO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Grouper Rate,5029.00
Blue Cross,HMO,65110,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,5281.00
Blue Cross,HMO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,6588.00
Blue Cross,HMO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,6588.00
Blue Cross,HMO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,1678.00
Blue Cross,HMO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,3544.00
Blue Cross,HMO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,1678.88
Blue Cross,HMO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Grouper Rate,3544.00
Blue Cross,HMO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,1678.88
Blue Cross,HMO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Grouper Rate,3544.00
Blue Cross,HMO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Grouper Rate,1678.00
Blue Cross,HMO,652,DRG,Kidney transplant,,Case Rate,52628.62
Blue Cross,HMO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,HMO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,HMO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,HMO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,HMO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.88
Blue Cross,HMO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,3544.00
Blue Cross,HMO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,5029.00
Blue Cross,HMO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1678.88
Blue Cross,HMO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1678.88
Blue Cross,HMO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,5029.00
Blue Cross,HMO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,5029.00
Blue Cross,HMO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,5029.00
Blue Cross,HMO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1678.00
Blue Cross,HMO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Grouper Rate,3544.00
Blue Cross,HMO,653,DRG,Major bladder procedures w MCC,,Case Rate,90129.76
Blue Cross,HMO,654,DRG,Major bladder procedures w CC,,Case Rate,47969.30
Blue Cross,HMO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,1678.00
Blue Cross,HMO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Grouper Rate,1678.88
Blue Cross,HMO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,5281.00
Blue Cross,HMO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,1678.00
Blue Cross,HMO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,1678.00
Blue Cross,HMO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Grouper Rate,1678.00
Blue Cross,HMO,655,DRG,Major bladder procedures w/o CC/MCC,,Case Rate,34404.85
Blue Cross,HMO,656,DRG,Kidney & ureter procedures for neoplasm w MCC,,Case Rate,54279.31
Blue Cross,HMO,65600,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,1678.00
Blue Cross,HMO,657,DRG,Kidney & ureter procedures for neoplasm w CC,,Case Rate,31990.01
Blue Cross,HMO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,HMO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,HMO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,HMO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,HMO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Grouper Rate,6588.00
Blue Cross,HMO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,Grouper Rate,1678.00
Blue Cross,HMO,65760,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,1678.88
Blue Cross,HMO,65765,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,5029.00
Blue Cross,HMO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,HMO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Grouper Rate,6588.00
Blue Cross,HMO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Grouper Rate,1678.00
Blue Cross,HMO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,1678.00
Blue Cross,HMO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,1678.00
Blue Cross,HMO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Grouper Rate,1678.00
Blue Cross,HMO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Grouper Rate,1678.00
Blue Cross,HMO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,HMO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,HMO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,HMO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Grouper Rate,1678.88
Blue Cross,HMO,658,DRG,Kidney & ureter procedures for neoplasm w/o CC/MCC,,Case Rate,26118.31
Blue Cross,HMO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1678.00
Blue Cross,HMO,65805,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1678.00
Blue Cross,HMO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,3544.00
Blue Cross,HMO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1678.88
Blue Cross,HMO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Grouper Rate,1678.88
Blue Cross,HMO,65850,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,5029.00
Blue Cross,HMO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Grouper Rate,1678.00
Blue Cross,HMO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,1678.88
Blue Cross,HMO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,1678.00
Blue Cross,HMO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,3544.00
Blue Cross,HMO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,5029.00
Blue Cross,HMO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,5029.00
Blue Cross,HMO,659,DRG,Kidney & ureter procedures for non-neoplasm w MCC,,Case Rate,44075.79
Blue Cross,HMO,65900,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,5281.00
Blue Cross,HMO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Grouper Rate,6588.00
Blue Cross,HMO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Grouper Rate,1678.88
Blue Cross,HMO,66,DRG,Intracranial hemorrhage or cerebral infarction w/o CC/MCC,,Case Rate,11758.28
Blue Cross,HMO,660,DRG,Kidney & ureter procedures for non-neoplasm w CC,,Case Rate,23873.83
Blue Cross,HMO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,1678.00
Blue Cross,HMO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,1678.00
Blue Cross,HMO,661,DRG,Kidney & ureter procedures for non-neoplasm w/o CC/MCC,,Case Rate,17605.17
Blue Cross,HMO,66130,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,6588.00
Blue Cross,HMO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,66165,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,66172,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,5029.00
Blue Cross,HMO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Grouper Rate,1678.00
Blue Cross,HMO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Grouper Rate,1678.00
Blue Cross,HMO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Grouper Rate,5029.00
Blue Cross,HMO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Grouper Rate,5029.00
Blue Cross,HMO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Grouper Rate,5029.00
Blue Cross,HMO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Grouper Rate,5029.00
Blue Cross,HMO,662,DRG,Minor bladder procedures w MCC,,Case Rate,48458.89
Blue Cross,HMO,66220,CPT4/HCPCS,REPAIR EYE LESION,,Grouper Rate,3544.00
Blue Cross,HMO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Grouper Rate,5029.00
Blue Cross,HMO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Grouper Rate,1678.88
Blue Cross,HMO,663,DRG,Minor bladder procedures w CC,,Case Rate,26379.64
Blue Cross,HMO,664,DRG,Minor bladder procedures w/o CC/MCC,,Case Rate,19586.66
Blue Cross,HMO,665,DRG,Prostatectomy w MCC,,Case Rate,50227.01
Blue Cross,HMO,66500,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,HMO,66505,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,HMO,666,DRG,Prostatectomy w CC,,Case Rate,28685.32
Blue Cross,HMO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Grouper Rate,3544.00
Blue Cross,HMO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,HMO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,HMO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,HMO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,HMO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,3544.00
Blue Cross,HMO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,HMO,667,DRG,Prostatectomy w/o CC/MCC,,Case Rate,16455.64
Blue Cross,HMO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,HMO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Grouper Rate,1678.88
Blue Cross,HMO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Grouper Rate,1678.00
Blue Cross,HMO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,HMO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,HMO,66761,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,HMO,66762,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,HMO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Grouper Rate,1678.88
Blue Cross,HMO,668,DRG,Transurethral procedures w MCC,,Case Rate,45569.35
Blue Cross,HMO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Grouper Rate,3544.00
Blue Cross,HMO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Grouper Rate,1678.88
Blue Cross,HMO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Grouper Rate,5029.00
Blue Cross,HMO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Grouper Rate,5029.00
Blue Cross,HMO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,5029.00
Blue Cross,HMO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,5783.00
Blue Cross,HMO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,5029.00
Blue Cross,HMO,669,DRG,Transurethral procedures w CC,,Case Rate,25337.62
Blue Cross,HMO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,5029.00
Blue Cross,HMO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,5281.00
Blue Cross,HMO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,5281.00
Blue Cross,HMO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Grouper Rate,6588.00
Blue Cross,HMO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Grouper Rate,8012.00
Blue Cross,HMO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Grouper Rate,6588.00
Blue Cross,HMO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Grouper Rate,5783.00
Blue Cross,HMO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Grouper Rate,5783.00
Blue Cross,HMO,66987,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX W/ECP,,Grouper Rate,8012.00
Blue Cross,HMO,66988,CPT4/HCPCS,XCAPSL CTRC RMVL W/ECP,,Grouper Rate,8012.00
Blue Cross,HMO,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,67,DRG,Nonspecific cva & precerebral occlusion w/o infarct w MCC,,Case Rate,23562.88
Blue Cross,HMO,670,DRG,Transurethral procedures w/o CC/MCC,,Case Rate,16151.31
Blue Cross,HMO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,5029.00
Blue Cross,HMO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,5029.00
Blue Cross,HMO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Grouper Rate,1678.00
Blue Cross,HMO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Grouper Rate,1678.00
Blue Cross,HMO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Grouper Rate,5029.00
Blue Cross,HMO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Grouper Rate,1678.00
Blue Cross,HMO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Grouper Rate,1678.00
Blue Cross,HMO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Grouper Rate,1678.88
Blue Cross,HMO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Grouper Rate,3544.00
Blue Cross,HMO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,5029.00
Blue Cross,HMO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,5029.00
Blue Cross,HMO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Grouper Rate,3544.00
Blue Cross,HMO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Grouper Rate,5029.00
Blue Cross,HMO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Grouper Rate,5281.00
Blue Cross,HMO,671,DRG,Urethral procedures w CC/MCC,,Case Rate,29386.61
Blue Cross,HMO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Grouper Rate,5029.00
Blue Cross,HMO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Grouper Rate,5029.00
Blue Cross,HMO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,5281.00
Blue Cross,HMO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,5783.00
Blue Cross,HMO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,1678.88
Blue Cross,HMO,67112,CPT4/HCPCS,REREPAIR DETACHED RETINA,,Grouper Rate,6588.00
Blue Cross,HMO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Grouper Rate,6588.00
Blue Cross,HMO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Grouper Rate,1678.88
Blue Cross,HMO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,1678.88
Blue Cross,HMO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,1678.88
Blue Cross,HMO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,1678.88
Blue Cross,HMO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,1678.00
Blue Cross,HMO,672,DRG,Urethral procedures w/o CC/MCC,,Case Rate,19035.88
Blue Cross,HMO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,1678.00
Blue Cross,HMO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,1678.00
Blue Cross,HMO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,5281.00
Blue Cross,HMO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Grouper Rate,1678.00
Blue Cross,HMO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Grouper Rate,1678.88
Blue Cross,HMO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Grouper Rate,1678.00
Blue Cross,HMO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Grouper Rate,1678.00
Blue Cross,HMO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Grouper Rate,3544.00
Blue Cross,HMO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Grouper Rate,3544.00
Blue Cross,HMO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Grouper Rate,3544.00
Blue Cross,HMO,673,DRG,Other kidney & urinary tract procedures w MCC,,Case Rate,57279.67
Blue Cross,HMO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,3544.00
Blue Cross,HMO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,5029.00
Blue Cross,HMO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,5029.00
Blue Cross,HMO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,5029.00
Blue Cross,HMO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Grouper Rate,5029.00
Blue Cross,HMO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Grouper Rate,5029.00
Blue Cross,HMO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Grouper Rate,5029.00
Blue Cross,HMO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Grouper Rate,5029.00
Blue Cross,HMO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Grouper Rate,5029.00
Blue Cross,HMO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Grouper Rate,1678.00
Blue Cross,HMO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Grouper Rate,5029.00
Blue Cross,HMO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Grouper Rate,3544.00
Blue Cross,HMO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Grouper Rate,1678.00
Blue Cross,HMO,674,DRG,Other kidney & urinary tract procedures w CC,,Case Rate,39371.81
Blue Cross,HMO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,3544.00
Blue Cross,HMO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,5029.00
Blue Cross,HMO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,HMO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,HMO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,5029.00
Blue Cross,HMO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Grouper Rate,1678.00
Blue Cross,HMO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,HMO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,HMO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,HMO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,5783.00
Blue Cross,HMO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,HMO,675,DRG,Other kidney & urinary tract procedures w/o CC/MCC,,Case Rate,28978.08
Blue Cross,HMO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,1678.00
Blue Cross,HMO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Grouper Rate,5029.00
Blue Cross,HMO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Grouper Rate,1678.88
Blue Cross,HMO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Grouper Rate,5281.00
Blue Cross,HMO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Grouper Rate,1678.00
Blue Cross,HMO,67710,CPT4/HCPCS,INCISION OF EYELID,,Grouper Rate,1678.00
Blue Cross,HMO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Grouper Rate,1678.00
Blue Cross,HMO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,1678.00
Blue Cross,HMO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,1678.00
Blue Cross,HMO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,1678.00
Blue Cross,HMO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Grouper Rate,1678.88
Blue Cross,HMO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Grouper Rate,1678.00
Blue Cross,HMO,67820,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.00
Blue Cross,HMO,67825,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.00
Blue Cross,HMO,67830,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.88
Blue Cross,HMO,67835,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.88
Blue Cross,HMO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,1678.00
Blue Cross,HMO,67850,CPT4/HCPCS,TREAT EYELID LESION,,Grouper Rate,1678.00
Blue Cross,HMO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Grouper Rate,1678.00
Blue Cross,HMO,67880,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,HMO,67882,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,HMO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Grouper Rate,1678.00
Blue Cross,HMO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5281.00
Blue Cross,HMO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5281.00
Blue Cross,HMO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,HMO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,HMO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5281.00
Blue Cross,HMO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,HMO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,HMO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,3544.00
Blue Cross,HMO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Grouper Rate,5029.00
Blue Cross,HMO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3544.00
Blue Cross,HMO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,1678.00
Blue Cross,HMO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,HMO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,HMO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3544.00
Blue Cross,HMO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,1678.00
Blue Cross,HMO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,HMO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,HMO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,1678.00
Blue Cross,HMO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,1678.88
Blue Cross,HMO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,HMO,67950,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,1678.88
Blue Cross,HMO,67961,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,HMO,67966,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,HMO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,HMO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,HMO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,HMO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,HMO,68,DRG,Nonspecific cva & precerebral occlusion w/o infarct w/o MCC,,Case Rate,14697.44
Blue Cross,HMO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Grouper Rate,1678.00
Blue Cross,HMO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,Grouper Rate,1678.00
Blue Cross,HMO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Grouper Rate,1678.00
Blue Cross,HMO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.00
Blue Cross,HMO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.00
Blue Cross,HMO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.88
Blue Cross,HMO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.00
Blue Cross,HMO,682,DRG,Renal failure w MCC,,Case Rate,24317.10
Blue Cross,HMO,683,DRG,Renal failure w CC,,Case Rate,14523.77
Blue Cross,HMO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,HMO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,HMO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,HMO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,HMO,68330,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,5029.00
Blue Cross,HMO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,HMO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Grouper Rate,5029.00
Blue Cross,HMO,68360,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,1678.88
Blue Cross,HMO,68362,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,1678.88
Blue Cross,HMO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Grouper Rate,1678.88
Blue Cross,HMO,684,DRG,Renal failure w/o CC/MCC,,Case Rate,10048.05
Blue Cross,HMO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Grouper Rate,1678.00
Blue Cross,HMO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Grouper Rate,1678.00
Blue Cross,HMO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,HMO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Grouper Rate,3544.00
Blue Cross,HMO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Grouper Rate,3544.00
Blue Cross,HMO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Grouper Rate,1678.00
Blue Cross,HMO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Grouper Rate,3544.00
Blue Cross,HMO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Grouper Rate,1678.00
Blue Cross,HMO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Grouper Rate,1678.00
Blue Cross,HMO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,3544.00
Blue Cross,HMO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,3544.00
Blue Cross,HMO,686,DRG,Kidney & urinary tract neoplasms w MCC,,Case Rate,30982.72
Blue Cross,HMO,687,DRG,Kidney & urinary tract neoplasms w CC,,Case Rate,17330.61
Blue Cross,HMO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Grouper Rate,1678.88
Blue Cross,HMO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,HMO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Grouper Rate,5029.00
Blue Cross,HMO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,3544.00
Blue Cross,HMO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,5029.00
Blue Cross,HMO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,HMO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,HMO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Grouper Rate,1678.00
Blue Cross,HMO,688,DRG,Kidney & urinary tract neoplasms w/o CC/MCC,,Case Rate,11334.86
Blue Cross,HMO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,HMO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1678.00
Blue Cross,HMO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1678.00
Blue Cross,HMO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1678.88
Blue Cross,HMO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Grouper Rate,1678.00
Blue Cross,HMO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Grouper Rate,1678.00
Blue Cross,HMO,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,Grouper Rate,1678.00
Blue Cross,HMO,689,DRG,Kidney & urinary tract infections w MCC,,Case Rate,18380.90
Blue Cross,HMO,69,DRG,Transient ischemia,,Case Rate,13002.09
Blue Cross,HMO,690,DRG,Kidney & urinary tract infections w/o MCC,,Case Rate,13102.98
Blue Cross,HMO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,1678.00
Blue Cross,HMO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,1678.00
Blue Cross,HMO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Grouper Rate,1678.00
Blue Cross,HMO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,Grouper Rate,1678.00
Blue Cross,HMO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,Grouper Rate,1678.00
Blue Cross,HMO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Grouper Rate,1678.00
Blue Cross,HMO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Grouper Rate,1678.88
Blue Cross,HMO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,1678.88
Blue Cross,HMO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,1678.88
Blue Cross,HMO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Grouper Rate,3544.00
Blue Cross,HMO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,Grouper Rate,5029.00
Blue Cross,HMO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Grouper Rate,1678.00
Blue Cross,HMO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,1678.88
Blue Cross,HMO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,3544.00
Blue Cross,HMO,693,DRG,Urinary stones w/o esw lithotripsy w MCC,,Case Rate,20985.95
Blue Cross,HMO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Grouper Rate,1678.88
Blue Cross,HMO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,3544.00
Blue Cross,HMO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,5029.00
Blue Cross,HMO,694,DRG,Urinary stones w/o esw lithotripsy w/o MCC,,Case Rate,12062.62
Blue Cross,HMO,69405,CPT4/HCPCS,CATHETERIZE MIDDLE EAR CANAL,,Grouper Rate,1678.00
Blue Cross,HMO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,1678.00
Blue Cross,HMO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,1678.00
Blue Cross,HMO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Grouper Rate,1678.00
Blue Cross,HMO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,1678.00
Blue Cross,HMO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,1678.88
Blue Cross,HMO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Grouper Rate,3544.00
Blue Cross,HMO,69450,CPT4/HCPCS,EARDRUM REVISION,,Grouper Rate,1678.00
Blue Cross,HMO,695,DRG,Kidney & urinary tract signs & symptoms w MCC,,Case Rate,18794.40
Blue Cross,HMO,69501,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,69502,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,6588.00
Blue Cross,HMO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Grouper Rate,6588.00
Blue Cross,HMO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,6588.00
Blue Cross,HMO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,Grouper Rate,5281.00
Blue Cross,HMO,69540,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,1678.00
Blue Cross,HMO,69550,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,5281.00
Blue Cross,HMO,69552,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,6588.00
Blue Cross,HMO,69554,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,1678.88
Blue Cross,HMO,696,DRG,Kidney & urinary tract signs & symptoms w/o MCC,,Case Rate,11407.63
Blue Cross,HMO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,HMO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,HMO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,HMO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,HMO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,HMO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,1678.88
Blue Cross,HMO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,1678.88
Blue Cross,HMO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,5281.00
Blue Cross,HMO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,5281.00
Blue Cross,HMO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,5281.00
Blue Cross,HMO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,6588.00
Blue Cross,HMO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6588.00
Blue Cross,HMO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6588.00
Blue Cross,HMO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,HMO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,HMO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,HMO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,HMO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,HMO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,HMO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Grouper Rate,5783.00
Blue Cross,HMO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5281.00
Blue Cross,HMO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5281.00
Blue Cross,HMO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5029.00
Blue Cross,HMO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,5029.00
Blue Cross,HMO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,5029.00
Blue Cross,HMO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Grouper Rate,3544.00
Blue Cross,HMO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Grouper Rate,3544.00
Blue Cross,HMO,697,DRG,Urethral stricture,,Case Rate,16490.38
Blue Cross,HMO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Grouper Rate,3544.00
Blue Cross,HMO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Grouper Rate,3544.00
Blue Cross,HMO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Grouper Rate,1678.00
Blue Cross,HMO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Grouper Rate,5783.00
Blue Cross,HMO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Grouper Rate,5783.00
Blue Cross,HMO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Grouper Rate,5281.00
Blue Cross,HMO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Grouper Rate,5281.00
Blue Cross,HMO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,HMO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,HMO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,HMO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,HMO,698,DRG,Other kidney & urinary tract diagnoses w MCC,,Case Rate,26574.81
Blue Cross,HMO,69801,CPT4/HCPCS,INCISE INNER EAR,,Grouper Rate,5281.00
Blue Cross,HMO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,6588.00
Blue Cross,HMO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,6588.00
Blue Cross,HMO,69820,CPT4/HCPCS,ESTABLISH INNER EAR WINDOW,,Grouper Rate,5281.00
Blue Cross,HMO,69840,CPT4/HCPCS,REVISE INNER EAR WINDOW,,Grouper Rate,5281.00
Blue Cross,HMO,699,DRG,Other kidney & urinary tract diagnoses w CC,,Case Rate,16956.80
Blue Cross,HMO,69905,CPT4/HCPCS,REMOVE INNER EAR,,Grouper Rate,6588.00
Blue Cross,HMO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,HMO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,6588.00
Blue Cross,HMO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Grouper Rate,6588.00
Blue Cross,HMO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,6588.00
Blue Cross,HMO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5783.00
Blue Cross,HMO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,Grouper Rate,6588.00
Blue Cross,HMO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Grouper Rate,6588.00
Blue Cross,HMO,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,7,DRG,Lung transplant,,Case Rate,191438.92
Blue Cross,HMO,70,DRG,Nonspecific cerebrovascular disorders w MCC,,Case Rate,27727.65
Blue Cross,HMO,700,DRG,Other kidney & urinary tract diagnoses w/o CC/MCC,,Case Rate,12318.99
Blue Cross,HMO,707,DRG,Major male pelvic procedures w CC/MCC,,Case Rate,31766.72
Blue Cross,HMO,708,DRG,Major male pelvic procedures w/o CC/MCC,,Case Rate,24667.75
Blue Cross,HMO,709,DRG,Penis procedures w CC/MCC,,Case Rate,38238.82
Blue Cross,HMO,71,DRG,Nonspecific cerebrovascular disorders w CC,,Case Rate,16718.63
Blue Cross,HMO,710,DRG,Penis procedures w/o CC/MCC,,Case Rate,26462.34
Blue Cross,HMO,711,DRG,Testes procedures w CC/MCC,,Case Rate,35235.16
Blue Cross,HMO,712,DRG,Testes procedures w/o CC/MCC,,Case Rate,17491.05
Blue Cross,HMO,713,DRG,Transurethral prostatectomy w CC/MCC,,Case Rate,24671.06
Blue Cross,HMO,714,DRG,Transurethral prostatectomy w/o CC/MCC,,Case Rate,15357.39
Blue Cross,HMO,715,DRG,Other male reproductive system O.R. proc for malignancy w CC/MCC,,Case Rate,33392.60
Blue Cross,HMO,716,DRG,Other male reproductive system O.R. proc for malignancy w/o CC/MCC,,Case Rate,21113.31
Blue Cross,HMO,717,DRG,Other male reproductive system O.R. proc exc malignancy w CC/MCC,,Case Rate,29747.19
Blue Cross,HMO,718,DRG,Other male reproductive system O.R. proc exc malignancy w/o CC/MCC,,Case Rate,20446.74
Blue Cross,HMO,72,DRG,Nonspecific cerebrovascular disorders w/o CC/MCC,,Case Rate,12755.64
Blue Cross,HMO,722,DRG,Malignancy, male reproductive system w MCC,,Case Rate,28266.86
Blue Cross,HMO,723,DRG,Malignancy, male reproductive system w CC,,Case Rate,18013.71
Blue Cross,HMO,724,DRG,Malignancy, male reproductive system w/o CC/MCC,,Case Rate,10741.07
Blue Cross,HMO,725,DRG,Benign prostatic hypertrophy w MCC,,Case Rate,21202.62
Blue Cross,HMO,726,DRG,Benign prostatic hypertrophy w/o MCC,,Case Rate,12294.18
Blue Cross,HMO,727,DRG,Inflammation of the male reproductive system w MCC,,Case Rate,23455.37
Blue Cross,HMO,728,DRG,Inflammation of the male reproductive system w/o MCC,,Case Rate,13289.89
Blue Cross,HMO,729,DRG,Other male reproductive system diagnoses w CC/MCC,,Case Rate,16619.39
Blue Cross,HMO,73,DRG,Cranial & peripheral nerve disorders w MCC,,Case Rate,23973.07
Blue Cross,HMO,730,DRG,Other male reproductive system diagnoses w/o CC/MCC,,Case Rate,9356.67
Blue Cross,HMO,734,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC,,Case Rate,36765.11
Blue Cross,HMO,735,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC,,Case Rate,23379.29
Blue Cross,HMO,736,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w MCC,,Case Rate,70430.62
Blue Cross,HMO,737,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w CC,,Case Rate,34042.62
Blue Cross,HMO,738,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC,,Case Rate,24422.96
Blue Cross,HMO,739,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w MCC,,Case Rate,63210.91
Blue Cross,HMO,74,DRG,Cranial & peripheral nerve disorders w/o MCC,,Case Rate,16844.33
Blue Cross,HMO,740,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w CC,,Case Rate,29772.00
Blue Cross,HMO,741,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC,,Case Rate,21162.93
Blue Cross,HMO,742,DRG,Uterine & adnexa proc for non-malignancy w CC/MCC,,Case Rate,28399.18
Blue Cross,HMO,743,DRG,Uterine & adnexa proc for non-malignancy w/o CC/MCC,,Case Rate,18728.24
Blue Cross,HMO,744,DRG,D&C, conization, laparascopy & tubal interruption w CC/MCC,,Case Rate,29672.76
Blue Cross,HMO,745,DRG,D&C, conization, laparascopy & tubal interruption w/o CC/MCC,,Case Rate,19360.07
Blue Cross,HMO,746,DRG,Vagina, cervix & vulva procedures w CC/MCC,,Case Rate,26619.47
Blue Cross,HMO,747,DRG,Vagina, cervix & vulva procedures w/o CC/MCC,,Case Rate,15514.52
Blue Cross,HMO,748,DRG,Female reproductive system reconstructive procedures,,Case Rate,22300.88
Blue Cross,HMO,749,DRG,Other female reproductive system O.R. procedures w CC/MCC,,Case Rate,44780.39
Blue Cross,HMO,75,DRG,Viral meningitis w CC/MCC,,Case Rate,26894.04
Blue Cross,HMO,750,DRG,Other female reproductive system O.R. procedures w/o CC/MCC,,Case Rate,24245.98
Blue Cross,HMO,754,DRG,Malignancy, female reproductive system w MCC,,Case Rate,30119.34
Blue Cross,HMO,755,DRG,Malignancy, female reproductive system w CC,,Case Rate,18650.50
Blue Cross,HMO,756,DRG,Malignancy, female reproductive system w/o CC/MCC,,Case Rate,15152.29
Blue Cross,HMO,757,DRG,Infections, female reproductive system w MCC,,Case Rate,25175.53
Blue Cross,HMO,758,DRG,Infections, female reproductive system w CC,,Case Rate,15994.18
Blue Cross,HMO,759,DRG,Infections, female reproductive system w/o CC/MCC,,Case Rate,11300.12
Blue Cross,HMO,76,DRG,Viral meningitis w/o CC/MCC,,Case Rate,16224.08
Blue Cross,HMO,760,DRG,Menstrual & other female reproductive system disorders w CC/MCC,,Case Rate,15259.80
Blue Cross,HMO,761,DRG,Menstrual & other female reproductive system disorders w/o CC/MCC,,Case Rate,9758.60
Blue Cross,HMO,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,Case Rate,19365.03
Blue Cross,HMO,769,DRG,Postpartum & post abortion diagnoses w O.R. procedure,,Case Rate,26801.41
Blue Cross,HMO,77,DRG,Hypertensive encephalopathy w MCC,,Case Rate,25337.62
Blue Cross,HMO,770,DRG,Abortion w D&C, aspiration curettage or hysterotomy,,Case Rate,14689.17
Blue Cross,HMO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Fee Schedule,566.75
Blue Cross,HMO,77261,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,417.19
Blue Cross,HMO,77262,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,634.12
Blue Cross,HMO,77263,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,942.23
Blue Cross,HMO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Fee Schedule,632.25
Blue Cross,HMO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Fee Schedule,1015.51
Blue Cross,HMO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Fee Schedule,1181.79
Blue Cross,HMO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,Fee Schedule,2069.34
Blue Cross,HMO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,Fee Schedule,5099.08
Blue Cross,HMO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,Fee Schedule,281.89
Blue Cross,HMO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,Fee Schedule,5564.17
Blue Cross,HMO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,Fee Schedule,546.43
Blue Cross,HMO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,Fee Schedule,1000.91
Blue Cross,HMO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,Fee Schedule,850.86
Blue Cross,HMO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,Fee Schedule,1109.35
Blue Cross,HMO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,Fee Schedule,1505.69
Blue Cross,HMO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,Fee Schedule,961.27
Blue Cross,HMO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,Fee Schedule,107.85
Blue Cross,HMO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Fee Schedule,280.71
Blue Cross,HMO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Fee Schedule,399.29
Blue Cross,HMO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Fee Schedule,549.48
Blue Cross,HMO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,Fee Schedule,1915.70
Blue Cross,HMO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Fee Schedule,661.52
Blue Cross,HMO,77371,CPT4/HCPCS,SRS MULTISOURCE,,Fee Schedule,6096.45
Blue Cross,HMO,77372,CPT4/HCPCS,SRS LINEAR BASED,,Fee Schedule,4626.31
Blue Cross,HMO,77373,CPT4/HCPCS,SBRT DELIVERY,,Fee Schedule,8630.99
Blue Cross,HMO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,Fee Schedule,2983.40
Blue Cross,HMO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,Fee Schedule,3580.79
Blue Cross,HMO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,Fee Schedule,358.27
Blue Cross,HMO,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,327.19
Blue Cross,HMO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,327.78
Blue Cross,HMO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,423.14
Blue Cross,HMO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,438.04
Blue Cross,HMO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,Fee Schedule,120.98
Blue Cross,HMO,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,Fee Schedule,477.14
Blue Cross,HMO,77425,CPT4/HCPCS,IO RAD TX DELIVER BY ELCTRNS,,Fee Schedule,737.20
Blue Cross,HMO,77427,CPT4/HCPCS,RADIATION TX MANAGEMENT X5,,Fee Schedule,986.55
Blue Cross,HMO,77431,CPT4/HCPCS,RADIATION THERAPY MANAGEMENT,,Fee Schedule,440.99
Blue Cross,HMO,77432,CPT4/HCPCS,STEREOTACTIC RADIATION TRMT,,Fee Schedule,2166.91
Blue Cross,HMO,77435,CPT4/HCPCS,SBRT MANAGEMENT,,Fee Schedule,3149.53
Blue Cross,HMO,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,Fee Schedule,1608.38
Blue Cross,HMO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,Fee Schedule,2028.72
Blue Cross,HMO,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,Fee Schedule,762.83
Blue Cross,HMO,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,Fee Schedule,703.66
Blue Cross,HMO,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,Fee Schedule,953.55
Blue Cross,HMO,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,Fee Schedule,990.87
Blue Cross,HMO,776,DRG,Postpartum & post abortion diagnoses w/o O.R. procedure,,Case Rate,12715.95
Blue Cross,HMO,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Fee Schedule,638.84
Blue Cross,HMO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Fee Schedule,1101.33
Blue Cross,HMO,77785,CPT4/HCPCS,HDR BRACHYTX 1 CHANNEL,,Grouper Rate,1678.88
Blue Cross,HMO,77786,CPT4/HCPCS,HDR BRACHYTX 2-12 CHANNEL,,Grouper Rate,1678.88
Blue Cross,HMO,77787,CPT4/HCPCS,HDR BRACHYTX OVER 12 CHAN,,Grouper Rate,3544.00
Blue Cross,HMO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Fee Schedule,81.09
Blue Cross,HMO,77790,CPT4/HCPCS,RADIATION HANDLING,,Fee Schedule,107.85
Blue Cross,HMO,779,DRG,Abortion w/o D&C,,Case Rate,17208.21
Blue Cross,HMO,78,DRG,Hypertensive encephalopathy w CC,,Case Rate,15696.46
Blue Cross,HMO,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Fee Schedule,1823.79
Blue Cross,HMO,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Fee Schedule,1823.79
Blue Cross,HMO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,30974.45
Blue Cross,HMO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,18109.64
Blue Cross,HMO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,15139.06
Blue Cross,HMO,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Fee Schedule,1008.82
Blue Cross,HMO,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Fee Schedule,1634.94
Blue Cross,HMO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,26316.79
Blue Cross,HMO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,17577.05
Blue Cross,HMO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,14672.63
Blue Cross,HMO,789,DRG,Neonates, died or transferred to another acute care facility,,Case Rate,28423.99
Blue Cross,HMO,79,DRG,Hypertensive encephalopathy w/o CC/MCC,,Case Rate,12021.27
Blue Cross,HMO,790,DRG,Extreme immaturity or respiratory distress syndrome, neonate,,Case Rate,93733.83
Blue Cross,HMO,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Fee Schedule,535.17
Blue Cross,HMO,791,DRG,Prematurity w major problems,,Case Rate,64016.41
Blue Cross,HMO,792,DRG,Prematurity w/o major problems,,Case Rate,38625.86
Blue Cross,HMO,793,DRG,Full term neonate w major problems,,Case Rate,65758.07
Blue Cross,HMO,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Fee Schedule,2085.87
Blue Cross,HMO,794,DRG,Neonate w other significant problems,,Case Rate,23275.08
Blue Cross,HMO,795,DRG,Normal newborn,,Case Rate,3150.87
Blue Cross,HMO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,17663.06
Blue Cross,HMO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,15215.14
Blue Cross,HMO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,13683.54
Blue Cross,HMO,799,DRG,Splenectomy w MCC,,Case Rate,85080.10
Blue Cross,HMO,8,DRG,Simultaneous pancreas/kidney transplant,,Case Rate,89759.27
Blue Cross,HMO,80,DRG,Nontraumatic stupor & coma w MCC,,Case Rate,34601.68
Blue Cross,HMO,800,DRG,Splenectomy w CC,,Case Rate,48816.15
Blue Cross,HMO,801,DRG,Splenectomy w/o CC/MCC,,Case Rate,27845.09
Blue Cross,HMO,802,DRG,Other O.R. proc of the blood & blood forming organs w MCC,,Case Rate,61341.89
Blue Cross,HMO,803,DRG,Other O.R. proc of the blood & blood forming organs w CC,,Case Rate,31174.59
Blue Cross,HMO,804,DRG,Other O.R. proc of the blood & blood forming organs w/o CC/MCC,,Case Rate,22563.86
Blue Cross,HMO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,16983.27
Blue Cross,HMO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,12138.70
Blue Cross,HMO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,10603.79
Blue Cross,HMO,808,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w MCC,,Case Rate,36022.46
Blue Cross,HMO,809,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w CC,,Case Rate,20206.91
Blue Cross,HMO,81,DRG,Nontraumatic stupor & coma w/o MCC,,Case Rate,12768.88
Blue Cross,HMO,810,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC,,Case Rate,15889.97
Blue Cross,HMO,811,DRG,Red blood cell disorders w MCC,,Case Rate,22785.50
Blue Cross,HMO,812,DRG,Red blood cell disorders w/o MCC,,Case Rate,14550.23
Blue Cross,HMO,813,DRG,Coagulation disorders,,Case Rate,25549.33
Blue Cross,HMO,814,DRG,Reticuloendothelial & immunity disorders w MCC,,Case Rate,31273.83
Blue Cross,HMO,815,DRG,Reticuloendothelial & immunity disorders w CC,,Case Rate,16415.95
Blue Cross,HMO,816,DRG,Reticuloendothelial & immunity disorders w/o CC/MCC,,Case Rate,10931.28
Blue Cross,HMO,817,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC,,Case Rate,38071.77
Blue Cross,HMO,818,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC,,Case Rate,21774.91
Blue Cross,HMO,819,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC,,Case Rate,16505.26
Blue Cross,HMO,82,DRG,Traumatic stupor & coma, coma >1 hr w MCC,,Case Rate,37348.97
Blue Cross,HMO,820,DRG,Lymphoma & leukemia w major O.R. procedure w MCC,,Case Rate,94067.94
Blue Cross,HMO,821,DRG,Lymphoma & leukemia w major O.R. procedure w CC,,Case Rate,35645.35
Blue Cross,HMO,822,DRG,Lymphoma & leukemia w major O.R. procedure w/o CC/MCC,,Case Rate,20701.46
Blue Cross,HMO,823,DRG,Lymphoma & non-acute leukemia w other O.R. proc w MCC,,Case Rate,74382.03
Blue Cross,HMO,824,DRG,Lymphoma & non-acute leukemia w other O.R. proc w CC,,Case Rate,39079.05
Blue Cross,HMO,825,DRG,Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC,,Case Rate,23167.57
Blue Cross,HMO,826,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC,,Case Rate,83308.67
Blue Cross,HMO,827,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC,,Case Rate,41310.30
Blue Cross,HMO,828,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o CC/MCC,,Case Rate,27749.15
Blue Cross,HMO,829,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC,,Case Rate,53022.27
Blue Cross,HMO,83,DRG,Traumatic stupor & coma, coma >1 hr w CC,,Case Rate,22191.71
Blue Cross,HMO,830,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w/o CC/MCC,,Case Rate,24421.31
Blue Cross,HMO,831,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC,,Case Rate,18542.99
Blue Cross,HMO,832,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC,,Case Rate,12897.89
Blue Cross,HMO,833,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC,,Case Rate,8865.44
Blue Cross,HMO,834,DRG,Acute leukemia w/o major O.R. procedure w MCC,,Case Rate,100068.65
Blue Cross,HMO,835,DRG,Acute leukemia w/o major O.R. procedure w CC,,Case Rate,34960.59
Blue Cross,HMO,836,DRG,Acute leukemia w/o major O.R. procedure w/o CC/MCC,,Case Rate,19345.18
Blue Cross,HMO,837,DRG,Chemo w acute leukemia as sdx or w high dose chemo agent w MCC,,Case Rate,94264.76
Blue Cross,HMO,838,DRG,Chemo w acute leukemia as sdx w CC or high dose chemo agent,,Case Rate,37360.55
Blue Cross,HMO,839,DRG,Chemo w acute leukemia as sdx w/o CC/MCC,,Case Rate,24583.40
Blue Cross,HMO,84,DRG,Traumatic stupor & coma, coma >1 hr w/o CC/MCC,,Case Rate,14955.46
Blue Cross,HMO,840,DRG,Lymphoma & non-acute leukemia w MCC,,Case Rate,53187.67
Blue Cross,HMO,841,DRG,Lymphoma & non-acute leukemia w CC,,Case Rate,26808.03
Blue Cross,HMO,842,DRG,Lymphoma & non-acute leukemia w/o CC/MCC,,Case Rate,18116.26
Blue Cross,HMO,843,DRG,Other myeloprolif dis or poorly diff neopl diag w MCC,,Case Rate,31473.96
Blue Cross,HMO,844,DRG,Other myeloprolif dis or poorly diff neopl diag w CC,,Case Rate,19525.47
Blue Cross,HMO,845,DRG,Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC,,Case Rate,14015.99
Blue Cross,HMO,846,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w MCC,,Case Rate,44160.14
Blue Cross,HMO,847,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w CC,,Case Rate,22084.20
Blue Cross,HMO,848,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC,,Case Rate,17019.66
Blue Cross,HMO,849,DRG,Radiotherapy,,Case Rate,41143.25
Blue Cross,HMO,85,DRG,Traumatic stupor & coma, coma <1 hr w MCC,,Case Rate,38147.85
Blue Cross,HMO,853,DRG,Infectious & parasitic diseases w O.R. procedure w MCC,,Case Rate,81783.68
Blue Cross,HMO,854,DRG,Infectious & parasitic diseases w O.R. procedure w CC,,Case Rate,34641.37
Blue Cross,HMO,855,DRG,Infectious & parasitic diseases w O.R. procedure w/o CC/MCC,,Case Rate,24727.30
Blue Cross,HMO,856,DRG,Postoperative or post-traumatic infections w O.R. proc w MCC,,Case Rate,75185.87
Blue Cross,HMO,857,DRG,Postoperative or post-traumatic infections w O.R. proc w CC,,Case Rate,33653.93
Blue Cross,HMO,858,DRG,Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC,,Case Rate,22302.53
Blue Cross,HMO,86,DRG,Traumatic stupor & coma, coma <1 hr w CC,,Case Rate,21053.76
Blue Cross,HMO,862,DRG,Postoperative & post-traumatic infections w MCC,,Case Rate,31075.35
Blue Cross,HMO,863,DRG,Postoperative & post-traumatic infections w/o MCC,,Case Rate,16166.19
Blue Cross,HMO,864,DRG,Fever of unknown origin,,Case Rate,14472.50
Blue Cross,HMO,865,DRG,Viral illness w MCC,,Case Rate,24461.00
Blue Cross,HMO,866,DRG,Viral illness w/o MCC,,Case Rate,13847.28
Blue Cross,HMO,867,DRG,Other infectious & parasitic diseases diagnoses w MCC,,Case Rate,36875.93
Blue Cross,HMO,868,DRG,Other infectious & parasitic diseases diagnoses w CC,,Case Rate,17505.93
Blue Cross,HMO,869,DRG,Other infectious & parasitic diseases diagnoses w/o CC/MCC,,Case Rate,12008.04
Blue Cross,HMO,87,DRG,Traumatic stupor & coma, coma <1 hr w/o CC/MCC,,Case Rate,14267.40
Blue Cross,HMO,870,DRG,Septicemia w MV 96+ hours,,Case Rate,106266.19
Blue Cross,HMO,871,DRG,Septicemia w/o MV 96+ hours w MCC,,Case Rate,30900.02
Blue Cross,HMO,872,DRG,Septicemia w/o MV 96+ hours w/o MCC,,Case Rate,16897.26
Blue Cross,HMO,876,DRG,O.R. procedure w principal diagnoses of mental illness,,Case Rate,53941.90
Blue Cross,HMO,88,DRG,Concussion w MCC,,Case Rate,24136.82
Blue Cross,HMO,880,DRG,Acute adjustment reaction & psychosocial dysfunction,,Case Rate,14283.94
Blue Cross,HMO,881,DRG,Depressive neuroses,,Case Rate,13255.15
Blue Cross,HMO,882,DRG,Neuroses except depressive,,Case Rate,13612.42
Blue Cross,HMO,883,DRG,Disorders of personality & impulse control,,Case Rate,26105.08
Blue Cross,HMO,884,DRG,Organic disturbances & mental retardation,,Case Rate,23880.45
Blue Cross,HMO,885,DRG,Psychoses,,Case Rate,20461.63
Blue Cross,HMO,886,DRG,Behavioral & developmental disorders,,Case Rate,20203.61
Blue Cross,HMO,887,DRG,Other mental disorder diagnoses,,Case Rate,17841.69
Blue Cross,HMO,89,DRG,Concussion w CC,,Case Rate,17552.24
Blue Cross,HMO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Per Date of Service,193.00
Blue Cross,HMO,894,DRG,Alcohol/drug abuse or dependence, left ama,,Case Rate,9055.65
Blue Cross,HMO,895,DRG,Alcohol/drug abuse or dependence w rehabilitation therapy,,Case Rate,26331.68
Blue Cross,HMO,896,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC,,Case Rate,29391.58
Blue Cross,HMO,897,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC,,Case Rate,13653.77
Blue Cross,HMO,90,DRG,Concussion w/o CC/MCC,,Case Rate,14138.39
Blue Cross,HMO,901,DRG,Wound debridements for injuries w MCC,,Case Rate,70496.78
Blue Cross,HMO,902,DRG,Wound debridements for injuries w CC,,Case Rate,32458.09
Blue Cross,HMO,903,DRG,Wound debridements for injuries w/o CC/MCC,,Case Rate,18762.97
Blue Cross,HMO,904,DRG,Skin grafts for injuries w CC/MCC,,Case Rate,61551.95
Blue Cross,HMO,905,DRG,Skin grafts for injuries w/o CC/MCC,,Case Rate,27157.02
Blue Cross,HMO,906,DRG,Hand procedures for injuries,,Case Rate,29669.45
Blue Cross,HMO,907,DRG,Other O.R. procedures for injuries w MCC,,Case Rate,65450.43
Blue Cross,HMO,908,DRG,Other O.R. procedures for injuries w CC,,Case Rate,33748.21
Blue Cross,HMO,909,DRG,Other O.R. procedures for injuries w/o CC/MCC,,Case Rate,22740.84
Blue Cross,HMO,90901,CPT4/HCPCS,BIOFEEDBACK TRAIN ANY METH,,Per Date of Service,193.00
Blue Cross,HMO,90911,CPT4/HCPCS,BIOFEEDBACK PERI/URO/RECTAL,,Per Date of Service,193.00
Blue Cross,HMO,90912,CPT4/HCPCS,BFB TRAINING 1ST 15 MIN,,Per Date of Service,193.00
Blue Cross,HMO,90913,CPT4/HCPCS,BFB TRAINING EA ADDL 15 MIN,,Per Date of Service,193.00
Blue Cross,HMO,91,DRG,Other disorders of nervous system w MCC,,Case Rate,27272.80
Blue Cross,HMO,913,DRG,Traumatic injury w MCC,,Case Rate,27066.05
Blue Cross,HMO,914,DRG,Traumatic injury w/o MCC,,Case Rate,14697.44
Blue Cross,HMO,915,DRG,Allergic reactions w MCC,,Case Rate,28078.30
Blue Cross,HMO,916,DRG,Allergic reactions w/o MCC,,Case Rate,10871.74
Blue Cross,HMO,917,DRG,Poisoning & toxic effects of drugs w MCC,,Case Rate,24437.85
Blue Cross,HMO,918,DRG,Poisoning & toxic effects of drugs w/o MCC,,Case Rate,13084.79
Blue Cross,HMO,919,DRG,Complications of treatment w MCC,,Case Rate,30340.97
Blue Cross,HMO,92,DRG,Other disorders of nervous system w CC,,Case Rate,16310.09
Blue Cross,HMO,920,DRG,Complications of treatment w CC,,Case Rate,16991.54
Blue Cross,HMO,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,Grouper Rate,1678.00
Blue Cross,HMO,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,Grouper Rate,1678.00
Blue Cross,HMO,921,DRG,Complications of treatment w/o CC/MCC,,Case Rate,11435.75
Blue Cross,HMO,922,DRG,Other injury, poisoning & toxic effect diag w MCC,,Case Rate,26258.90
Blue Cross,HMO,92225,CPT4/HCPCS,SPECIAL EYE EXAM INITIAL,,Grouper Rate,1678.00
Blue Cross,HMO,92226,CPT4/HCPCS,SPECIAL EYE EXAM SUBSEQUENT,,Grouper Rate,1678.00
Blue Cross,HMO,92235,CPT4/HCPCS,FLUORESCEIN ANGRPH UNI/BI,,Grouper Rate,1678.00
Blue Cross,HMO,92240,CPT4/HCPCS,ICG ANGIOGRAPHY UNI/BI,,Grouper Rate,1678.00
Blue Cross,HMO,92250,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Grouper Rate,1678.00
Blue Cross,HMO,92260,CPT4/HCPCS,OPHTHALMOSCOPY/DYNAMOMETRY,,Grouper Rate,1678.00
Blue Cross,HMO,923,DRG,Other injury, poisoning & toxic effect diag w/o MCC,,Case Rate,15388.81
Blue Cross,HMO,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,Grouper Rate,1678.00
Blue Cross,HMO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Per Date of Service,193.00
Blue Cross,HMO,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,Grouper Rate,1678.00
Blue Cross,HMO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,Per Date of Service,193.00
Blue Cross,HMO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,Per Date of Service,193.00
Blue Cross,HMO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,Per Date of Service,193.00
Blue Cross,HMO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,Per Date of Service,193.00
Blue Cross,HMO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,Per Date of Service,193.00
Blue Cross,HMO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,Per Date of Service,193.00
Blue Cross,HMO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,Per Date of Service,193.00
Blue Cross,HMO,927,DRG,Extensive burns or full thickness burns w MV 96+ hrs w skin graft,,Case Rate,347851.08
Blue Cross,HMO,928,DRG,Full thickness burn w skin graft or inhal inj w CC/MCC,,Case Rate,107825.91
Blue Cross,HMO,929,DRG,Full thickness burn w skin graft or inhal inj w/o CC/MCC,,Case Rate,49767.20
Blue Cross,HMO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Grouper Rate,8841.00
Blue Cross,HMO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Grouper Rate,3544.00
Blue Cross,HMO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Grouper Rate,8841.00
Blue Cross,HMO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Grouper Rate,8841.00
Blue Cross,HMO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Grouper Rate,8841.00
Blue Cross,HMO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Grouper Rate,3544.00
Blue Cross,HMO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Grouper Rate,8841.00
Blue Cross,HMO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Grouper Rate,8841.00
Blue Cross,HMO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Grouper Rate,8841.00
Blue Cross,HMO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Grouper Rate,3544.00
Blue Cross,HMO,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,Grouper Rate,1678.00
Blue Cross,HMO,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,Grouper Rate,1678.00
Blue Cross,HMO,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Grouper Rate,1678.00
Blue Cross,HMO,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,Grouper Rate,1678.00
Blue Cross,HMO,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,Grouper Rate,1678.00
Blue Cross,HMO,92973,CPT4/HCPCS,PRQ CORONARY MECH THROMBECT,,Grouper Rate,5281.00
Blue Cross,HMO,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Grouper Rate,1678.00
Blue Cross,HMO,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Grouper Rate,3544.00
Blue Cross,HMO,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,Grouper Rate,1678.00
Blue Cross,HMO,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,Grouper Rate,1678.00
Blue Cross,HMO,92980,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Grouper Rate,8012.00
Blue Cross,HMO,92981,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Grouper Rate,8012.00
Blue Cross,HMO,92982,CPT4/HCPCS,CORONARY ARTERY DILATION,,Grouper Rate,8841.00
Blue Cross,HMO,92984,CPT4/HCPCS,CORONARY ARTERY DILATION,,Grouper Rate,3544.00
Blue Cross,HMO,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,Grouper Rate,5783.00
Blue Cross,HMO,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,5783.00
Blue Cross,HMO,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8841.00
Blue Cross,HMO,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8841.00
Blue Cross,HMO,92995,CPT4/HCPCS,CORONARY ATHERECTOMY,,Grouper Rate,8841.00
Blue Cross,HMO,92996,CPT4/HCPCS,CORONARY ATHERECTOMY ADD-ON,,Grouper Rate,3544.00
Blue Cross,HMO,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Grouper Rate,5029.00
Blue Cross,HMO,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Grouper Rate,1678.88
Blue Cross,HMO,93,DRG,Other disorders of nervous system w/o CC/MCC,,Case Rate,12922.70
Blue Cross,HMO,933,DRG,Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft,,Case Rate,37340.70
Blue Cross,HMO,934,DRG,Full thickness burn w/o skin grft or inhal inj,,Case Rate,32042.94
Blue Cross,HMO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Grouper Rate,3544.00
Blue Cross,HMO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Grouper Rate,8012.00
Blue Cross,HMO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Grouper Rate,8012.00
Blue Cross,HMO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Grouper Rate,8841.00
Blue Cross,HMO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Grouper Rate,8841.00
Blue Cross,HMO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Grouper Rate,8841.00
Blue Cross,HMO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Grouper Rate,8841.00
Blue Cross,HMO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Grouper Rate,8841.00
Blue Cross,HMO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Grouper Rate,8841.00
Blue Cross,HMO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,8841.00
Blue Cross,HMO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,8841.00
Blue Cross,HMO,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Grouper Rate,8841.00
Blue Cross,HMO,935,DRG,Non-extensive burns,,Case Rate,31976.78
Blue Cross,HMO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Grouper Rate,3544.00
Blue Cross,HMO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Grouper Rate,3544.00
Blue Cross,HMO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Grouper Rate,5783.00
Blue Cross,HMO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,8841.00
Blue Cross,HMO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,8841.00
Blue Cross,HMO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,8841.00
Blue Cross,HMO,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,Grouper Rate,1678.88
Blue Cross,HMO,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,Grouper Rate,1678.88
Blue Cross,HMO,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,Grouper Rate,1678.88
Blue Cross,HMO,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,Grouper Rate,1678.88
Blue Cross,HMO,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,Grouper Rate,1678.88
Blue Cross,HMO,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,Grouper Rate,1678.88
Blue Cross,HMO,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Grouper Rate,5783.00
Blue Cross,HMO,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Grouper Rate,5783.00
Blue Cross,HMO,93582,CPT4/HCPCS,PERQ TRANSCATH CLOSURE PDA,,Grouper Rate,5783.00
Blue Cross,HMO,93583,CPT4/HCPCS,PERQ TRANSCATH SEPTAL REDUXN,,Grouper Rate,5783.00
Blue Cross,HMO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Grouper Rate,1678.88
Blue Cross,HMO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Grouper Rate,1678.88
Blue Cross,HMO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Grouper Rate,1678.88
Blue Cross,HMO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Grouper Rate,5281.00
Blue Cross,HMO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Grouper Rate,1678.00
Blue Cross,HMO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Grouper Rate,1678.00
Blue Cross,HMO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Grouper Rate,1678.88
Blue Cross,HMO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Grouper Rate,1678.00
Blue Cross,HMO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Grouper Rate,1678.00
Blue Cross,HMO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Grouper Rate,1678.00
Blue Cross,HMO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,HMO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,HMO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,HMO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,HMO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Grouper Rate,3544.00
Blue Cross,HMO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Grouper Rate,5281.00
Blue Cross,HMO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Grouper Rate,1678.00
Blue Cross,HMO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Grouper Rate,6588.00
Blue Cross,HMO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,HMO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,1678.88
Blue Cross,HMO,93644,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,1678.88
Blue Cross,HMO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,8841.00
Blue Cross,HMO,93651,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,8841.00
Blue Cross,HMO,93652,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,8841.00
Blue Cross,HMO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Grouper Rate,8841.00
Blue Cross,HMO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Grouper Rate,8841.00
Blue Cross,HMO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Grouper Rate,8841.00
Blue Cross,HMO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Grouper Rate,8841.00
Blue Cross,HMO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Grouper Rate,8841.00
Blue Cross,HMO,93724,CPT4/HCPCS,ANALYZE PACEMAKER SYSTEM,,Grouper Rate,5281.00
Blue Cross,HMO,939,DRG,O.R. proc w diagnoses of other contact w health services w MCC,,Case Rate,56007.74
Blue Cross,HMO,94,DRG,Bacterial & tuberculous infections of nervous system w MCC,,Case Rate,60091.47
Blue Cross,HMO,940,DRG,O.R. proc w diagnoses of other contact w health services w CC,,Case Rate,36679.10
Blue Cross,HMO,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,Per Date of Service,193.00
Blue Cross,HMO,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,Per Date of Service,193.00
Blue Cross,HMO,941,DRG,O.R. proc w diagnoses of other contact w health services w/o CC/MCC,,Case Rate,31834.53
Blue Cross,HMO,945,DRG,Rehabilitation w CC/MCC,,Case Rate,24556.93
Blue Cross,HMO,946,DRG,Rehabilitation w/o CC/MCC,,Case Rate,18643.88
Blue Cross,HMO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,Per Date of Service,193.00
Blue Cross,HMO,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,Per Date of Service,193.00
Blue Cross,HMO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,Per Date of Service,193.00
Blue Cross,HMO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,Per Date of Service,193.00
Blue Cross,HMO,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,Per Date of Service,193.00
Blue Cross,HMO,947,DRG,Signs & symptoms w MCC,,Case Rate,19684.25
Blue Cross,HMO,948,DRG,Signs & symptoms w/o MCC,,Case Rate,12993.82
Blue Cross,HMO,949,DRG,Aftercare w CC/MCC,,Case Rate,18311.43
Blue Cross,HMO,95,DRG,Bacterial & tuberculous infections of nervous system w CC,,Case Rate,41482.32
Blue Cross,HMO,950,DRG,Aftercare w/o CC/MCC,,Case Rate,12221.40
Blue Cross,HMO,951,DRG,Other factors influencing health status,,Case Rate,9232.62
Blue Cross,HMO,955,DRG,Craniotomy for multiple significant trauma,,Case Rate,104003.52
Blue Cross,HMO,956,DRG,Limb reattachment, hip & femur proc for multiple significant trauma,,Case Rate,63659.15
Blue Cross,HMO,957,DRG,Other O.R. procedures for multiple significant trauma w MCC,,Case Rate,122740.03
Blue Cross,HMO,958,DRG,Other O.R. procedures for multiple significant trauma w CC,,Case Rate,69557.31
Blue Cross,HMO,95830,CPT4/HCPCS,INSERT ELECTRODES FOR EEG,,Grouper Rate,1678.88
Blue Cross,HMO,959,DRG,Other O.R. procedures for multiple significant trauma w/o CC/MCC,,Case Rate,45223.66
Blue Cross,HMO,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Grouper Rate,1678.00
Blue Cross,HMO,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Grouper Rate,1678.00
Blue Cross,HMO,95992,CPT4/HCPCS,CANALITH REPOSITIONING PROC,,Per Date of Service,193.00
Blue Cross,HMO,96,DRG,Bacterial & tuberculous infections of nervous system w/o CC/MCC,,Case Rate,38563.01
Blue Cross,HMO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,Per Date of Service,193.00
Blue Cross,HMO,963,DRG,Other multiple significant trauma w MCC,,Case Rate,45058.26
Blue Cross,HMO,96365,CPT4/HCPCS,THER/PROPH/DIAG IV INF INIT,,Per Date of Service,193.00
Blue Cross,HMO,96376,CPT4/HCPCS,TX/PRO/DX INJ SAME DRUG ADON,,Per Date of Service,193.00
Blue Cross,HMO,964,DRG,Other multiple significant trauma w CC,,Case Rate,24618.13
Blue Cross,HMO,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,Per Date of Service,193.00
Blue Cross,HMO,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,Per Date of Service,193.00
Blue Cross,HMO,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,Per Date of Service,193.00
Blue Cross,HMO,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,Per Date of Service,193.00
Blue Cross,HMO,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,Per Date of Service,193.00
Blue Cross,HMO,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,Per Date of Service,193.00
Blue Cross,HMO,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,Per Date of Service,193.00
Blue Cross,HMO,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,Per Date of Service,193.00
Blue Cross,HMO,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,Per Date of Service,193.00
Blue Cross,HMO,965,DRG,Other multiple significant trauma w/o CC/MCC,,Case Rate,15099.36
Blue Cross,HMO,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,Per Date of Service,193.00
Blue Cross,HMO,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,Grouper Rate,1678.00
Blue Cross,HMO,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,Grouper Rate,1678.00
Blue Cross,HMO,969,DRG,HIV w extensive O.R. procedure w MCC,,Case Rate,95723.59
Blue Cross,HMO,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,Grouper Rate,1678.00
Blue Cross,HMO,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,Grouper Rate,1678.00
Blue Cross,HMO,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,Grouper Rate,1678.00
Blue Cross,HMO,97,DRG,Non-bacterial infect of nervous sys exc viral meningitis w MCC,,Case Rate,62068.00
Blue Cross,HMO,970,DRG,HIV w extensive O.R. procedure w/o MCC,,Case Rate,48711.95
Blue Cross,HMO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Per Date of Service,193.00
Blue Cross,HMO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Per Date of Service,193.00
Blue Cross,HMO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Per Date of Service,193.00
Blue Cross,HMO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Per Date of Service,193.00
Blue Cross,HMO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Per Date of Service,193.00
Blue Cross,HMO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Per Date of Service,193.00
Blue Cross,HMO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Per Date of Service,193.00
Blue Cross,HMO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Per Date of Service,193.00
Blue Cross,HMO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Per Date of Service,193.00
Blue Cross,HMO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Per Date of Service,193.00
Blue Cross,HMO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Per Date of Service,193.00
Blue Cross,HMO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Per Date of Service,193.00
Blue Cross,HMO,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,Per Date of Service,193.00
Blue Cross,HMO,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,Per Date of Service,193.00
Blue Cross,HMO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Per Date of Service,193.00
Blue Cross,HMO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Per Date of Service,193.00
Blue Cross,HMO,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,Per Date of Service,193.00
Blue Cross,HMO,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,Per Date of Service,193.00
Blue Cross,HMO,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,Per Date of Service,193.00
Blue Cross,HMO,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,Per Date of Service,193.00
Blue Cross,HMO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,Per Date of Service,193.00
Blue Cross,HMO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,Per Date of Service,193.00
Blue Cross,HMO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,Per Date of Service,193.00
Blue Cross,HMO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,Per Date of Service,193.00
Blue Cross,HMO,974,DRG,HIV w major related condition w MCC,,Case Rate,44421.47
Blue Cross,HMO,975,DRG,HIV w major related condition w CC,,Case Rate,21156.31
Blue Cross,HMO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Per Date of Service,193.00
Blue Cross,HMO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Per Date of Service,193.00
Blue Cross,HMO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Per Date of Service,193.00
Blue Cross,HMO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Per Date of Service,193.00
Blue Cross,HMO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Per Date of Service,193.00
Blue Cross,HMO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Per Date of Service,193.00
Blue Cross,HMO,976,DRG,HIV w major related condition w/o CC/MCC,,Case Rate,15698.11
Blue Cross,HMO,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,Per Date of Service,193.00
Blue Cross,HMO,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,Per Date of Service,193.00
Blue Cross,HMO,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,Per Date of Service,193.00
Blue Cross,HMO,977,DRG,HIV w or w/o other related condition,,Case Rate,21846.03
Blue Cross,HMO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,Per Date of Service,193.00
Blue Cross,HMO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,Per Date of Service,193.00
Blue Cross,HMO,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,Per Date of Service,193.00
Blue Cross,HMO,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,Per Date of Service,193.00
Blue Cross,HMO,98,DRG,Non-bacterial infect of nervous sys exc viral meningitis w CC,,Case Rate,34914.28
Blue Cross,HMO,981,DRG,Extensive O.R. procedure unrelated to principal diagnosis w MCC,,Case Rate,76213.01
Blue Cross,HMO,982,DRG,Extensive O.R. procedure unrelated to principal diagnosis w CC,,Case Rate,42034.75
Blue Cross,HMO,983,DRG,Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC,,Case Rate,27370.39
Blue Cross,HMO,987,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w MCC,,Case Rate,53955.13
Blue Cross,HMO,988,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w CC,,Case Rate,27798.77
Blue Cross,HMO,989,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC,,Case Rate,18456.98
Blue Cross,HMO,99,DRG,Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC,,Case Rate,23111.34
Blue Cross,HMO,99170,CPT4/HCPCS,ANOGENITAL EXAM CHILD W IMAG,,Grouper Rate,1678.00
Blue Cross,HMO,99195,CPT4/HCPCS,PHLEBOTOMY,,Grouper Rate,1678.00
Blue Cross,HMO,C2596,CPT4/HCPCS,Probe, robotic, water-jet,,Grouper Rate,5029.00
Blue Cross,HMO,C8957,CPT4/HCPCS,Prolonged IV inf, req pump,,Per Date of Service,193.00
Blue Cross,HMO,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Grouper Rate,8012.00
Blue Cross,HMO,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Grouper Rate,8012.00
Blue Cross,HMO,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Grouper Rate,8012.00
Blue Cross,HMO,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,Grouper Rate,8012.00
Blue Cross,HMO,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,Grouper Rate,8012.00
Blue Cross,HMO,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,Grouper Rate,8012.00
Blue Cross,HMO,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Grouper Rate,8012.00
Blue Cross,HMO,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Grouper Rate,8012.00
Blue Cross,HMO,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,Grouper Rate,8012.00
Blue Cross,HMO,C9729,CPT4/HCPCS,Percut lumbar lami,,Grouper Rate,3544.00
Blue Cross,HMO,C9732,CPT4/HCPCS,Insert ocular telescope pros,,Grouper Rate,3544.00
Blue Cross,HMO,C9734,CPT4/HCPCS,U/S trtmt, not leiomyomata,,Grouper Rate,1678.00
Blue Cross,HMO,C9738,CPT4/HCPCS,Blue light cysto imag agent,,Grouper Rate,1678.00
Blue Cross,HMO,C9742,CPT4/HCPCS,Laryngoscopy with injection,,Grouper Rate,1678.00
Blue Cross,HMO,C9743,CPT4/HCPCS,Bulking/spacer material impl,,Grouper Rate,1678.00
Blue Cross,HMO,C9748,CPT4/HCPCS,Prostatic rf water vapor tx,,Grouper Rate,3544.00
Blue Cross,HMO,C9749,CPT4/HCPCS,Repair nasal stenosis w/imp,,Grouper Rate,3544.00
Blue Cross,HMO,C9750,CPT4/HCPCS,Ins/rem-replace compl iims,,Grouper Rate,3544.00
Blue Cross,HMO,C9757,CPT4/HCPCS,Spine/lumbar disk surgery,,Grouper Rate,5281.00
Blue Cross,HMO,C9758,CPT4/HCPCS,Blind interatrial shunt ide,,Grouper Rate,8841.00
Blue Cross,HMO,C9800,CPT4/HCPCS,Dermal filler inj px/suppl,,Grouper Rate,1678.00
Blue Cross,HMO,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Grouper Rate,1678.00
Blue Cross,HMO,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Grouper Rate,1678.88
Blue Cross,HMO,G0120,CPT4/HCPCS,Colon ca scrn; barium enema,,Grouper Rate,1678.88
Blue Cross,HMO,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Grouper Rate,1678.88
Blue Cross,HMO,G0186,CPT4/HCPCS,Dstry eye lesn,fdr vssl tech,,Grouper Rate,1678.88
Blue Cross,HMO,G0237,CPT4/HCPCS,Therapeutic procd strg endur,,Per Date of Service,193.00
Blue Cross,HMO,G0238,CPT4/HCPCS,Oth resp proc, indiv,,Per Date of Service,193.00
Blue Cross,HMO,G0239,CPT4/HCPCS,Oth resp proc, group,,Per Date of Service,193.00
Blue Cross,HMO,G0251,CPT4/HCPCS,Linear acc based stero radio,,Grouper Rate,8841.00
Blue Cross,HMO,G0256,CPT4/HCPCS,Prostate brachy w palladium,,Grouper Rate,8012.00
Blue Cross,HMO,G0259,CPT4/HCPCS,Inject for sacroiliac joint,,Grouper Rate,1678.00
Blue Cross,HMO,G0260,CPT4/HCPCS,Inj for sacroiliac jt anesth,,Grouper Rate,1678.00
Blue Cross,HMO,G0269,CPT4/HCPCS,Occlusive device in vein art,,Grouper Rate,1678.00
Blue Cross,HMO,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,Grouper Rate,3544.00
Blue Cross,HMO,G0277,CPT4/HCPCS,Hbot, full body chamber, 30m,,Grouper Rate,3544.00
Blue Cross,HMO,G0283,CPT4/HCPCS,Elec stim other than wound,,Per Date of Service,193.00
Blue Cross,HMO,G0289,CPT4/HCPCS,Arthro, loose body + chondro,,Grouper Rate,5029.00
Blue Cross,HMO,G0290,CPT4/HCPCS,Drug-eluting stents, single,,Grouper Rate,8012.00
Blue Cross,HMO,G0291,CPT4/HCPCS,Drug-eluting stents,each add,,Grouper Rate,8012.00
Blue Cross,HMO,G0293,CPT4/HCPCS,Non-cov surg proc,clin trial,,Grouper Rate,1678.00
Blue Cross,HMO,G0339,CPT4/HCPCS,Robot lin-radsurg com, first,,Grouper Rate,8841.00
Blue Cross,HMO,G0340,CPT4/HCPCS,Robt lin-radsurg fractx 2-5,,Grouper Rate,8841.00
Blue Cross,HMO,G0341,CPT4/HCPCS,Percutaneous islet celltrans,,Grouper Rate,1678.00
Blue Cross,HMO,G0412,CPT4/HCPCS,Open tx iliac spine uni/bil,,Grouper Rate,5029.00
Blue Cross,HMO,G0413,CPT4/HCPCS,Pelvic ring fracture uni/bil,,Grouper Rate,3544.00
Blue Cross,HMO,G0414,CPT4/HCPCS,Pelvic ring fx treat int fix,,Grouper Rate,5281.00
Blue Cross,HMO,G0415,CPT4/HCPCS,Open tx post pelvic fxcture,,Grouper Rate,5281.00
Blue Cross,HMO,G0429,CPT4/HCPCS,Dermal filler injection(s),,Grouper Rate,1678.00
Blue Cross,HMO,G0448,CPT4/HCPCS,Place perm pacing cardiovert,,Grouper Rate,3544.00
Blue Cross,HMO,G0455,CPT4/HCPCS,Fecal microbiota prep instil,,Grouper Rate,3544.00
Blue Cross,HMO,G0515,CPT4/HCPCS,Cognitive skills development,,Per Date of Service,193.00
Blue Cross,HMO,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,Per Date of Service,193.00
Blue Cross,HMO,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,Per Date of Service,193.00
Blue Cross,HMO,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,Per Date of Service,193.00
Blue Cross,HMO,G6001,CPT4/HCPCS,Echo guidance radiotherapy,,Fee Schedule,159.34
Blue Cross,HMO,G6002,CPT4/HCPCS,Stereoscopic x-ray guidance,,Fee Schedule,588.34
Blue Cross,HMO,G6003,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1195.46
Blue Cross,HMO,G6004,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,925.46
Blue Cross,HMO,G6005,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1033.91
Blue Cross,HMO,G6006,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1028.74
Blue Cross,HMO,G6007,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1902.52
Blue Cross,HMO,G6008,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1280.30
Blue Cross,HMO,G6009,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1417.85
Blue Cross,HMO,G6010,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1417.85
Blue Cross,HMO,G6011,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,2034.57
Blue Cross,HMO,G6012,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1685.30
Blue Cross,HMO,G6013,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1897.02
Blue Cross,HMO,G6014,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1897.02
Blue Cross,HMO,G6015,CPT4/HCPCS,Radiation tx delivery imrt,,Fee Schedule,2957.43
Blue Cross,HMO,G6016,CPT4/HCPCS,Delivery comp imrt,,Fee Schedule,2953.40
Blue Cross,HMO,G6018,CPT4/HCPCS,Ileoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,HMO,G6019,CPT4/HCPCS,Colonoscopy lesion removal,,Grouper Rate,1678.00
Blue Cross,HMO,G6020,CPT4/HCPCS,Colonoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,HMO,G6022,CPT4/HCPCS,Sigmoidoscopy w/ablate tumr,,Grouper Rate,1678.00
Blue Cross,HMO,G6023,CPT4/HCPCS,Sigmoidoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,HMO,G6024,CPT4/HCPCS,Lesion removal colonoscopy,,Grouper Rate,1678.00
Blue Cross,HMO,G6025,CPT4/HCPCS,Colonoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,HMO,G6027,CPT4/HCPCS,Anoscopy hra w/spec collect,,Grouper Rate,1678.00
Blue Cross,HMO,G6028,CPT4/HCPCS,Anoscopy hra w/biopsy,,Grouper Rate,1678.00
Blue Cross,HMO,G8627,CPT4/HCPCS,Surg proc w/in 30 days,,Grouper Rate,5029.00
Blue Cross,HMO,G8628,CPT4/HCPCS,No surg proc w/in 30 days,,Grouper Rate,5783.00
Blue Cross,HMO,G8978,CPT4/HCPCS,Mobility current status,,Per Date of Service,193.00
Blue Cross,HMO,G8979,CPT4/HCPCS,Mobility goal status,,Per Date of Service,193.00
Blue Cross,HMO,G8980,CPT4/HCPCS,Mobility d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G8981,CPT4/HCPCS,Body pos current status,,Per Date of Service,193.00
Blue Cross,HMO,G8982,CPT4/HCPCS,Body pos goal status,,Per Date of Service,193.00
Blue Cross,HMO,G8983,CPT4/HCPCS,Body pos d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G8984,CPT4/HCPCS,Carry current status,,Per Date of Service,193.00
Blue Cross,HMO,G8985,CPT4/HCPCS,Carry goal status,,Per Date of Service,193.00
Blue Cross,HMO,G8986,CPT4/HCPCS,Carry d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G8987,CPT4/HCPCS,Self care current status,,Per Date of Service,193.00
Blue Cross,HMO,G8988,CPT4/HCPCS,Self care goal status,,Per Date of Service,193.00
Blue Cross,HMO,G8989,CPT4/HCPCS,Self care d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G8990,CPT4/HCPCS,Other pt/ot current status,,Per Date of Service,193.00
Blue Cross,HMO,G8991,CPT4/HCPCS,Other pt/ot goal status,,Per Date of Service,193.00
Blue Cross,HMO,G8992,CPT4/HCPCS,Other pt/ot d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G8993,CPT4/HCPCS,Sub pt/ot current status,,Per Date of Service,193.00
Blue Cross,HMO,G8994,CPT4/HCPCS,Sub pt/ot goal status,,Per Date of Service,193.00
Blue Cross,HMO,G8995,CPT4/HCPCS,Sub pt/ot d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G8996,CPT4/HCPCS,Swallow current status,,Per Date of Service,193.00
Blue Cross,HMO,G8997,CPT4/HCPCS,Swallow goal status,,Per Date of Service,193.00
Blue Cross,HMO,G8998,CPT4/HCPCS,Swallow d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G8999,CPT4/HCPCS,Motor speech current status,,Per Date of Service,193.00
Blue Cross,HMO,G9158,CPT4/HCPCS,Motor speech d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G9159,CPT4/HCPCS,Lang comp current status,,Per Date of Service,193.00
Blue Cross,HMO,G9160,CPT4/HCPCS,Lang comp goal status,,Per Date of Service,193.00
Blue Cross,HMO,G9161,CPT4/HCPCS,Lang comp d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G9162,CPT4/HCPCS,Lang express current status,,Per Date of Service,193.00
Blue Cross,HMO,G9163,CPT4/HCPCS,Lang express goal status,,Per Date of Service,193.00
Blue Cross,HMO,G9164,CPT4/HCPCS,Lang express d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G9165,CPT4/HCPCS,Atten current status,,Per Date of Service,193.00
Blue Cross,HMO,G9166,CPT4/HCPCS,Atten goal status,,Per Date of Service,193.00
Blue Cross,HMO,G9167,CPT4/HCPCS,Atten d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G9168,CPT4/HCPCS,Memory current status,,Per Date of Service,193.00
Blue Cross,HMO,G9169,CPT4/HCPCS,Memory goal status,,Per Date of Service,193.00
Blue Cross,HMO,G9170,CPT4/HCPCS,Memory d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G9171,CPT4/HCPCS,Voice current status,,Per Date of Service,193.00
Blue Cross,HMO,G9172,CPT4/HCPCS,Voice goal status,,Per Date of Service,193.00
Blue Cross,HMO,G9173,CPT4/HCPCS,Voice d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G9174,CPT4/HCPCS,Speech lang current status,,Per Date of Service,193.00
Blue Cross,HMO,G9175,CPT4/HCPCS,Speech lang goal status,,Per Date of Service,193.00
Blue Cross,HMO,G9176,CPT4/HCPCS,Speech lang d/c status,,Per Date of Service,193.00
Blue Cross,HMO,G9186,CPT4/HCPCS,Motor speech goal status,,Per Date of Service,193.00
Blue Cross,HMO,P9010,CPT4/HCPCS,Whole blood for transfusion,,Case Rate,3628.00
Blue Cross,HMO,P9022,CPT4/HCPCS,Washed red blood cells unit,,Case Rate,3628.00
Blue Cross,HMO,P9031,CPT4/HCPCS,Platelets leukocytes reduced,,Case Rate,3628.00
Blue Cross,HMO,P9033,CPT4/HCPCS,Platelets leukoreduced irrad,,Case Rate,3628.00
Blue Cross,HMO,P9039,CPT4/HCPCS,RBC deglycerolized,,Case Rate,3628.00
Blue Cross,HMO,P9054,CPT4/HCPCS,Blood, l/r, froz/degly/wash,,Case Rate,3628.00
Blue Cross,HMO,P9057,CPT4/HCPCS,RBC, frz/deg/wsh, l/r, irrad,,Case Rate,3628.00
Blue Cross,HMO,S2054,CPT4/HCPCS,Transplantation of multivisc,,Grouper Rate,6588.00
Blue Cross,HMO,S2083,CPT4/HCPCS,Adjustment gastric band,,Grouper Rate,1678.00
Blue Cross,HMO,S2115,CPT4/HCPCS,Periacetabular osteotomy,,Grouper Rate,5783.00
Blue Cross,HMO,S2118,CPT4/HCPCS,Total hip resurfacing,,Grouper Rate,5783.00
Blue Cross,HMO,S2152,CPT4/HCPCS,Solid organ transpl pkg,,Grouper Rate,6588.00
Blue Cross,HMO,S2350,CPT4/HCPCS,Diskectomy, anterior, with d,,Grouper Rate,5281.00
Blue Cross,HMO,S2351,CPT4/HCPCS,Diskectomy, anterior, with d,,Grouper Rate,1678.88
Blue Cross,HMO,S2400,CPT4/HCPCS,Fetal surg congen hernia,,Grouper Rate,8012.00
Blue Cross,HMO,S2401,CPT4/HCPCS,Fetal surg urin trac obstr,,Grouper Rate,8012.00
Blue Cross,HMO,S2402,CPT4/HCPCS,Fetal surg cong cyst malf,,Grouper Rate,8012.00
Blue Cross,HMO,S2403,CPT4/HCPCS,Fetal surg pulmon sequest,,Grouper Rate,8012.00
Blue Cross,HMO,S2404,CPT4/HCPCS,Fetal surg myelomeningo,,Grouper Rate,8012.00
Blue Cross,HMO,S2405,CPT4/HCPCS,Fetal surg sacrococ teratoma,,Grouper Rate,8012.00
Blue Cross,HMO,S2409,CPT4/HCPCS,Fetal surg noc,,Grouper Rate,8012.00
Blue Cross,HMO,,,Boarder Baby,,Per Case,1245.00
Blue Cross,HMO,,,NICU/Newborn - Level I,,Per Diem,3973.00
Blue Cross,HMO,,,NICU/Newborn - Level II,,Per Diem,7200.00
Blue Cross,HMO,,,NICU/Newborn - Level III,,Per Diem,7200.00
Blue Cross,HMO,,,NICU/Newborn - Level IV,,Per Diem,7200.00
Blue Cross,PPO,0048T,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,Grouper Rate,8012.00
Blue Cross,PPO,0050T,CPT4/HCPCS,REMOVAL CIRCULATION ASSIST,,Grouper Rate,5281.00
Blue Cross,PPO,0051T,CPT4/HCPCS,IMPLANT TOTAL HEART SYSTEM,,Grouper Rate,8841.00
Blue Cross,PPO,0052T,CPT4/HCPCS,REPLACE THRC UNIT HRT SYST,,Grouper Rate,8841.00
Blue Cross,PPO,0053T,CPT4/HCPCS,REPLACE IMPLANTABLE HRT SYST,,Grouper Rate,8841.00
Blue Cross,PPO,0054T,CPT4/HCPCS,BONE SRGRY CMPTR FLUOR IMAGE,,Grouper Rate,1678.00
Blue Cross,PPO,0055T,CPT4/HCPCS,BONE SRGRY CMPTR CT/MRI IMAG,,Grouper Rate,1678.88
Blue Cross,PPO,0071T,CPT4/HCPCS,US LEIOMYOMATA ABLATE <200,,Grouper Rate,1678.00
Blue Cross,PPO,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,Grouper Rate,1678.00
Blue Cross,PPO,0075T,CPT4/HCPCS,PERQ STENT/CHEST VERT ART,,Grouper Rate,6588.00
Blue Cross,PPO,0076T,CPT4/HCPCS,S&I STENT/CHEST VERT ART,,Grouper Rate,6588.00
Blue Cross,PPO,0078T,CPT4/HCPCS,ENDOVASC AORT REPR W/DEVICE,,Grouper Rate,8841.00
Blue Cross,PPO,0079T,CPT4/HCPCS,ENDOVASC VISC EXTNSN REPR,,Grouper Rate,5029.00
Blue Cross,PPO,0080T,CPT4/HCPCS,ENDOVASC AORT REPR RAD S&I,,Grouper Rate,8841.00
Blue Cross,PPO,0081T,CPT4/HCPCS,ENDOVASC VISC EXTNSN S&I,,Grouper Rate,5029.00
Blue Cross,PPO,0092T,CPT4/HCPCS,ARTIFIC DISC ADDL CERVICAL,,Grouper Rate,5783.00
Blue Cross,PPO,0095T,CPT4/HCPCS,RMVL ARTIFIC DISC ADDL CRVCL,,Grouper Rate,3544.00
Blue Cross,PPO,0098T,CPT4/HCPCS,REV ARTIFIC DISC ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,0099T,CPT4/HCPCS,IMPLANT CORNEAL RING,,Grouper Rate,1678.88
Blue Cross,PPO,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Grouper Rate,8012.00
Blue Cross,PPO,0101T,CPT4/HCPCS,EXTRACORP SHOCKWV TX HI ENRG,,Grouper Rate,1678.88
Blue Cross,PPO,0102T,CPT4/HCPCS,EXTRACORP SHOCKWV TX ANESTH,,Grouper Rate,3544.00
Blue Cross,PPO,0123T,CPT4/HCPCS,SCLERAL FISTULIZATION,,Grouper Rate,5783.00
Blue Cross,PPO,0124T,CPT4/HCPCS,CONJUNCTIVAL DRUG PLACEMENT,,Grouper Rate,5029.00
Blue Cross,PPO,0126T,CPT4/HCPCS,CHD RISK IMT STUDY,,Grouper Rate,1678.00
Blue Cross,PPO,0169T,CPT4/HCPCS,PLACE STEREO CATH BRAIN,,Grouper Rate,3544.00
Blue Cross,PPO,0171T,CPT4/HCPCS,LUMBAR SPINE PROCES DISTRACT,,Grouper Rate,5281.00
Blue Cross,PPO,0172T,CPT4/HCPCS,LUMBAR SPINE PROCESS ADDL,,Grouper Rate,5281.00
Blue Cross,PPO,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Grouper Rate,1678.00
Blue Cross,PPO,0205T,CPT4/HCPCS,INIRS EACH VESSEL ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,PPO,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,PPO,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,PPO,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,PPO,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,PPO,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,PPO,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,Grouper Rate,1678.88
Blue Cross,PPO,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,Grouper Rate,1678.88
Blue Cross,PPO,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Grouper Rate,1678.88
Blue Cross,PPO,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,0226T,CPT4/HCPCS,ANOSCOPY HRA W/SPEC COLLECT,,Grouper Rate,1678.00
Blue Cross,PPO,0227T,CPT4/HCPCS,ANOSCOPY HRA W/BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,PPO,0229T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,1678.00
Blue Cross,PPO,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,PPO,0231T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,1678.00
Blue Cross,PPO,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Grouper Rate,5029.00
Blue Cross,PPO,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,Grouper Rate,5029.00
Blue Cross,PPO,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Grouper Rate,5029.00
Blue Cross,PPO,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Grouper Rate,5029.00
Blue Cross,PPO,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,Grouper Rate,5029.00
Blue Cross,PPO,0245T,CPT4/HCPCS,OPEN TX RIB FX 1-2 RIBS,,Grouper Rate,1678.88
Blue Cross,PPO,0246T,CPT4/HCPCS,OPN TX RIB FX 3-4 RIBS,,Grouper Rate,3544.00
Blue Cross,PPO,0247T,CPT4/HCPCS,OPN TX RIB FX 5-6 RIBS,,Grouper Rate,3544.00
Blue Cross,PPO,0248T,CPT4/HCPCS,OPEN TX RIB FX 7/> RIBS,,Grouper Rate,3544.00
Blue Cross,PPO,0249T,CPT4/HCPCS,LIGATION HEMORRHOID W/US,,Grouper Rate,1678.88
Blue Cross,PPO,0250T,CPT4/HCPCS,INSERT BRONCHIAL VALVE,,Grouper Rate,1678.00
Blue Cross,PPO,0251T,CPT4/HCPCS,REMOV BRONCHIAL VALVE,,Grouper Rate,1678.88
Blue Cross,PPO,0252T,CPT4/HCPCS,REMOV BRONCH VALVE ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,0254T,CPT4/HCPCS,EVASC RPR ILIAC ART BIFUR,,Grouper Rate,5281.00
Blue Cross,PPO,0256T,CPT4/HCPCS,EVASC AORTIC HRT VALVE,,Grouper Rate,6588.00
Blue Cross,PPO,0262T,CPT4/HCPCS,IMPLTJ PULM VLV EVASC APPR,,Grouper Rate,8012.00
Blue Cross,PPO,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,Grouper Rate,3544.00
Blue Cross,PPO,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,Grouper Rate,3544.00
Blue Cross,PPO,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,Grouper Rate,1678.88
Blue Cross,PPO,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,Grouper Rate,3544.00
Blue Cross,PPO,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,Grouper Rate,3544.00
Blue Cross,PPO,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,Grouper Rate,3544.00
Blue Cross,PPO,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,Grouper Rate,3544.00
Blue Cross,PPO,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,Grouper Rate,3544.00
Blue Cross,PPO,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,Grouper Rate,3544.00
Blue Cross,PPO,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,Grouper Rate,1678.88
Blue Cross,PPO,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,Grouper Rate,1678.88
Blue Cross,PPO,0276T,CPT4/HCPCS,BRONCH THERMOPLASTY 1 LOBE,,Grouper Rate,1678.88
Blue Cross,PPO,0277T,CPT4/HCPCS,BRONCH THERMOPLASTY LOBES,,Grouper Rate,1678.88
Blue Cross,PPO,0281T,CPT4/HCPCS,LAA CLOSURE W/IMPLANT,,Grouper Rate,5783.00
Blue Cross,PPO,0282T,CPT4/HCPCS,PERIPH FIELD STIMUL TRIAL,,Grouper Rate,1678.88
Blue Cross,PPO,0283T,CPT4/HCPCS,PERIPH FIELD STIMUL PERM,,Grouper Rate,1678.88
Blue Cross,PPO,0284T,CPT4/HCPCS,PERIPH FIELD STIMUL REVISE,,Grouper Rate,1678.88
Blue Cross,PPO,0288T,CPT4/HCPCS,ANOSCOPY W/RF DELIVERY,,Grouper Rate,1678.00
Blue Cross,PPO,0289T,CPT4/HCPCS,LASER INC FOR PKP/LKP DONOR,,Grouper Rate,6588.00
Blue Cross,PPO,0290T,CPT4/HCPCS,LASER INC FOR PKP/LKP RECIP,,Grouper Rate,6588.00
Blue Cross,PPO,0293T,CPT4/HCPCS,INS LT ATRL PRESS MONITOR,,Grouper Rate,6588.00
Blue Cross,PPO,0294T,CPT4/HCPCS,INS LT ATRL MONT PRES LEAD,,Grouper Rate,5281.00
Blue Cross,PPO,0299T,CPT4/HCPCS,ESW WOUND HEALING INIT WOUND,,Grouper Rate,1678.88
Blue Cross,PPO,0300T,CPT4/HCPCS,ESW WOUND HEALING ADDL WOUND,,Grouper Rate,1678.88
Blue Cross,PPO,0301T,CPT4/HCPCS,MW THERAPY FOR BREAST TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,0302T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS COMPL,,Grouper Rate,3544.00
Blue Cross,PPO,0303T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS ELTRD,,Grouper Rate,3544.00
Blue Cross,PPO,0304T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,0307T,CPT4/HCPCS,RMVL ICAR ISCHM MNTRNG DVCE,,Grouper Rate,3544.00
Blue Cross,PPO,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Grouper Rate,5029.00
Blue Cross,PPO,0309T,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L4/L5,,Grouper Rate,5783.00
Blue Cross,PPO,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Grouper Rate,5281.00
Blue Cross,PPO,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Grouper Rate,5281.00
Blue Cross,PPO,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Grouper Rate,5281.00
Blue Cross,PPO,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Grouper Rate,5281.00
Blue Cross,PPO,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Grouper Rate,5281.00
Blue Cross,PPO,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,Grouper Rate,5281.00
Blue Cross,PPO,0318T,CPT4/HCPCS,REPLACE AORTIC VALVE TTHORAC,,Grouper Rate,6588.00
Blue Cross,PPO,0319T,CPT4/HCPCS,INSERT SUBQ DEFIB W/ELTRD,,Grouper Rate,5029.00
Blue Cross,PPO,0320T,CPT4/HCPCS,INSERT SUBQ DEFIB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,PPO,0321T,CPT4/HCPCS,INSERT SUBQ DEFIB PLS GEN,,Grouper Rate,6588.00
Blue Cross,PPO,0322T,CPT4/HCPCS,RMVL SUBQ DEFIB PLS GEN,,Grouper Rate,5029.00
Blue Cross,PPO,0323T,CPT4/HCPCS,RMVL & REPLC SUBQ PLS GEN,,Grouper Rate,1678.88
Blue Cross,PPO,0324T,CPT4/HCPCS,RMVL SUBQ DEFIB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,PPO,0325T,CPT4/HCPCS,REPOS SUBQ DEFIB ELTRD &/GEN,,Grouper Rate,1678.88
Blue Cross,PPO,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Grouper Rate,5281.00
Blue Cross,PPO,0336T,CPT4/HCPCS,LAP ABLAT UTERINE FIBROIDS,,Grouper Rate,5029.00
Blue Cross,PPO,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,Grouper Rate,3544.00
Blue Cross,PPO,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,Grouper Rate,3544.00
Blue Cross,PPO,0340T,CPT4/HCPCS,ABLATE PULM TUMORS EXTNSN,,Grouper Rate,5783.00
Blue Cross,PPO,0343T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,8841.00
Blue Cross,PPO,0344T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,8841.00
Blue Cross,PPO,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,8841.00
Blue Cross,PPO,0375T,CPT4/HCPCS,TOTAL DISC ARTHRP ANT APPR,,Grouper Rate,5783.00
Blue Cross,PPO,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,5029.00
Blue Cross,PPO,0377T,CPT4/HCPCS,ANOSCPY INJ AGENT FOR INCONT,,Grouper Rate,1678.00
Blue Cross,PPO,0387T,CPT4/HCPCS,LEADLESS PM INS/RPL VENTR,,Grouper Rate,3544.00
Blue Cross,PPO,0388T,CPT4/HCPCS,LEADLESS PM REMOVE VENTR,,Grouper Rate,1678.88
Blue Cross,PPO,0392T,CPT4/HCPCS,LAP ES SPH AUGMENT DEV PLACE,,Grouper Rate,5029.00
Blue Cross,PPO,0393T,CPT4/HCPCS,ES SPH AUGMNT DEVICE REMOVAL,,Grouper Rate,1678.88
Blue Cross,PPO,0396T,CPT4/HCPCS,INTRAOP KINETIC BALNCE SENSR,,Grouper Rate,1678.00
Blue Cross,PPO,0397T,CPT4/HCPCS,ERCP W/OPTICAL ENDOMICROSCPY,,Grouper Rate,1678.88
Blue Cross,PPO,0398T,CPT4/HCPCS,MRGFUS STRTCTC LES ABLTJ,,Grouper Rate,1678.00
Blue Cross,PPO,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Grouper Rate,1678.00
Blue Cross,PPO,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Grouper Rate,1678.00
Blue Cross,PPO,0406T,CPT4/HCPCS,SIN NDSC PLMT DRG ELUT MPLNT,,Grouper Rate,3544.00
Blue Cross,PPO,0407T,CPT4/HCPCS,SIN NDSC PLMT DRG ELUT MPLNT,,Grouper Rate,3544.00
Blue Cross,PPO,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Grouper Rate,3544.00
Blue Cross,PPO,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Grouper Rate,1678.88
Blue Cross,PPO,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Grouper Rate,3544.00
Blue Cross,PPO,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Grouper Rate,3544.00
Blue Cross,PPO,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Grouper Rate,1678.88
Blue Cross,PPO,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Grouper Rate,1678.88
Blue Cross,PPO,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Grouper Rate,1678.88
Blue Cross,PPO,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Grouper Rate,1678.88
Blue Cross,PPO,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Grouper Rate,3544.00
Blue Cross,PPO,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,3544.00
Blue Cross,PPO,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,3544.00
Blue Cross,PPO,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Grouper Rate,3544.00
Blue Cross,PPO,0424T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA COMPL,,Grouper Rate,1678.88
Blue Cross,PPO,0425T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA SEN LD,,Grouper Rate,1678.00
Blue Cross,PPO,0426T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA STM LD,,Grouper Rate,1678.00
Blue Cross,PPO,0427T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA PLS GN,,Grouper Rate,1678.88
Blue Cross,PPO,0428T,CPT4/HCPCS,RMVL NSTIM APNEA PLS GEN,,Grouper Rate,1678.00
Blue Cross,PPO,0429T,CPT4/HCPCS,RMVL NSTIM APNEA SEN LD,,Grouper Rate,1678.00
Blue Cross,PPO,0430T,CPT4/HCPCS,RMVL NSTIM APNEA STIMJ LD,,Grouper Rate,1678.00
Blue Cross,PPO,0431T,CPT4/HCPCS,RMVL/RPLC NSTIM APNEA PLS GN,,Grouper Rate,1678.88
Blue Cross,PPO,0432T,CPT4/HCPCS,REPOS NSTIM APNEA STIMJ LD,,Grouper Rate,1678.00
Blue Cross,PPO,0433T,CPT4/HCPCS,REPOS NSTIM APNEA SENSING LD,,Grouper Rate,1678.00
Blue Cross,PPO,0437T,CPT4/HCPCS,IMPLTJ SYNTH RNFCMT ABDL WAL,,Grouper Rate,1678.00
Blue Cross,PPO,0438T,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Grouper Rate,1678.00
Blue Cross,PPO,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Grouper Rate,1678.00
Blue Cross,PPO,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Grouper Rate,1678.00
Blue Cross,PPO,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Grouper Rate,1678.00
Blue Cross,PPO,0444T,CPT4/HCPCS,1ST PLMT DRUG ELUT OC INS,,Grouper Rate,1678.00
Blue Cross,PPO,0445T,CPT4/HCPCS,SBSQT PLMT DRUG ELUT OC INS,,Grouper Rate,1678.00
Blue Cross,PPO,0446T,CPT4/HCPCS,INSJ IMPLTBL GLUCOSE SENSOR,,Grouper Rate,3544.00
Blue Cross,PPO,0447T,CPT4/HCPCS,RMVL IMPLTBL GLUCOSE SENSOR,,Grouper Rate,1678.00
Blue Cross,PPO,0448T,CPT4/HCPCS,REMVL INSJ IMPLTBL GLUC SENS,,Grouper Rate,3544.00
Blue Cross,PPO,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Grouper Rate,1678.88
Blue Cross,PPO,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Grouper Rate,1678.88
Blue Cross,PPO,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,Grouper Rate,5029.00
Blue Cross,PPO,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,Grouper Rate,5029.00
Blue Cross,PPO,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Grouper Rate,5029.00
Blue Cross,PPO,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Grouper Rate,5029.00
Blue Cross,PPO,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,Grouper Rate,3544.00
Blue Cross,PPO,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,Grouper Rate,3544.00
Blue Cross,PPO,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Grouper Rate,3544.00
Blue Cross,PPO,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Grouper Rate,3544.00
Blue Cross,PPO,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,Grouper Rate,3544.00
Blue Cross,PPO,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Grouper Rate,1678.88
Blue Cross,PPO,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,Grouper Rate,5029.00
Blue Cross,PPO,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,Grouper Rate,1678.88
Blue Cross,PPO,0466T,CPT4/HCPCS,INSJ CH WAL RESPIR ELTRD/RA,,Grouper Rate,1678.00
Blue Cross,PPO,0467T,CPT4/HCPCS,REVJ/RPLMNT CH RESPIR ELTRD,,Grouper Rate,1678.88
Blue Cross,PPO,0468T,CPT4/HCPCS,RMVL CH WAL RESPIR ELTRD/RA,,Grouper Rate,1678.88
Blue Cross,PPO,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Grouper Rate,1678.00
Blue Cross,PPO,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Grouper Rate,1678.00
Blue Cross,PPO,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Grouper Rate,1678.88
Blue Cross,PPO,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,Grouper Rate,8012.00
Blue Cross,PPO,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,Grouper Rate,8012.00
Blue Cross,PPO,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Grouper Rate,3544.00
Blue Cross,PPO,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Grouper Rate,3544.00
Blue Cross,PPO,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Grouper Rate,1678.00
Blue Cross,PPO,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Grouper Rate,1678.00
Blue Cross,PPO,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,Grouper Rate,3544.00
Blue Cross,PPO,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Grouper Rate,1678.88
Blue Cross,PPO,0505T,CPT4/HCPCS,EV FEMPOP ARTL REVSC,,Grouper Rate,5281.00
Blue Cross,PPO,0510T,CPT4/HCPCS,RMVL SINUS TARSI IMPLANT,,Grouper Rate,3544.00
Blue Cross,PPO,0511T,CPT4/HCPCS,RMVL&RINSJ SINUS TARSI IMPLT,,Grouper Rate,5281.00
Blue Cross,PPO,0512T,CPT4/HCPCS,ESW INTEG WND HLG 1ST WND,,Grouper Rate,1678.88
Blue Cross,PPO,0513T,CPT4/HCPCS,ESW INTEG WND HLG EA ADDL,,Grouper Rate,1678.88
Blue Cross,PPO,0514T,CPT4/HCPCS,INTRAOP VIS AXIS ID PT FIXJ,,Grouper Rate,1678.00
Blue Cross,PPO,0515T,CPT4/HCPCS,INSJ WCS LV COMPL SYS,,Grouper Rate,5281.00
Blue Cross,PPO,0516T,CPT4/HCPCS,INSJ WCS LV ELTRD ONLY,,Grouper Rate,5281.00
Blue Cross,PPO,0517T,CPT4/HCPCS,INSJ WCS LV PG COMPNT,,Grouper Rate,5281.00
Blue Cross,PPO,0518T,CPT4/HCPCS,RMVL PG COMPNT WCS,,Grouper Rate,1678.88
Blue Cross,PPO,0519T,CPT4/HCPCS,RMVL & RPLCMT PG COMPNT WCS,,Grouper Rate,5281.00
Blue Cross,PPO,0520T,CPT4/HCPCS,RMVL&RPLCMT PG WCS NEW ELTRD,,Grouper Rate,5281.00
Blue Cross,PPO,0524T,CPT4/HCPCS,EV CATH DIR CHEM ABLTJ W/IMG,,Grouper Rate,3544.00
Blue Cross,PPO,0525T,CPT4/HCPCS,INSJ/RPLCMT COMPL IIMS,,Grouper Rate,3544.00
Blue Cross,PPO,0526T,CPT4/HCPCS,INSJ/RPLCMT IIMS ELTRD ONLY,,Grouper Rate,3544.00
Blue Cross,PPO,0527T,CPT4/HCPCS,INSJ/RPLCMT IIMS IMPLT MNTR,,Grouper Rate,3544.00
Blue Cross,PPO,0530T,CPT4/HCPCS,REMOVAL COMPLETE IIMS,,Grouper Rate,3544.00
Blue Cross,PPO,0531T,CPT4/HCPCS,REMOVAL IIMS ELECTRODE ONLY,,Grouper Rate,3544.00
Blue Cross,PPO,0532T,CPT4/HCPCS,REMOVAL IIMS IMPLT MNTR ONLY,,Grouper Rate,3544.00
Blue Cross,PPO,0537T,CPT4/HCPCS,BLD DRV T LYMPHCYT CAR-T CLL,,Grouper Rate,1678.00
Blue Cross,PPO,0538T,CPT4/HCPCS,BLD DRV T LYMPHCYT PREP TRNS,,Grouper Rate,1678.00
Blue Cross,PPO,0539T,CPT4/HCPCS,RECEIPT&PREP CAR-T CLL ADMN,,Grouper Rate,1678.00
Blue Cross,PPO,0540T,CPT4/HCPCS,CAR-T CLL ADMN AUTOLOGOUS,,Grouper Rate,1678.88
Blue Cross,PPO,0565T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS HRVG,,Grouper Rate,3544.00
Blue Cross,PPO,0566T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS NJX,,Grouper Rate,3544.00
Blue Cross,PPO,0567T,CPT4/HCPCS,PERM FLP TUBE OCCLS W/IMPLT,,Grouper Rate,3544.00
Blue Cross,PPO,0568T,CPT4/HCPCS,INTRO MIX SALINE&AIR F/SSG,,Grouper Rate,1678.00
Blue Cross,PPO,0569T,CPT4/HCPCS,TTVR PERQ APPR 1ST PROSTH,,Grouper Rate,8012.00
Blue Cross,PPO,0570T,CPT4/HCPCS,TTVR PERQ EA ADDL PROSTH,,Grouper Rate,8012.00
Blue Cross,PPO,0571T,CPT4/HCPCS,INSJ/RPLCMT ICDS SS ELTRD,,Grouper Rate,5281.00
Blue Cross,PPO,0572T,CPT4/HCPCS,INSERTION SS DFB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,PPO,0573T,CPT4/HCPCS,REMOVAL SS DFB ELECTRODE,,Grouper Rate,5029.00
Blue Cross,PPO,0574T,CPT4/HCPCS,REPOS PREV SS IMPL DFB ELTRD,,Grouper Rate,1678.88
Blue Cross,PPO,0580T,CPT4/HCPCS,RMVL SS IMPL DFB PG ONLY,,Grouper Rate,5029.00
Blue Cross,PPO,0581T,CPT4/HCPCS,ABLTJ MAL BRST TUM PERQ CRTX,,Grouper Rate,3544.00
Blue Cross,PPO,0582T,CPT4/HCPCS,TRURL ABLTJ MAL PRST8 TISS,,Grouper Rate,5029.00
Blue Cross,PPO,0583T,CPT4/HCPCS,TMPST AUTO TUBE DLVR SYS,,Grouper Rate,1678.00
Blue Cross,PPO,0584T,CPT4/HCPCS,PERQ ISLET CELL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,PPO,0585T,CPT4/HCPCS,LAPS ISLET CELL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,PPO,0586T,CPT4/HCPCS,OPEN ISLET CELL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,PPO,0587T,CPT4/HCPCS,PERQ IMPLTJ/RPLCMT ISDNS PTN,,Grouper Rate,3544.00
Blue Cross,PPO,0588T,CPT4/HCPCS,REVISION/REMOVAL ISDNS PTN,,Grouper Rate,1678.88
Blue Cross,PPO,0DQP0ZZ,ICD10-PCS,Repair Rectum, Open Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0DQP8ZZ,ICD10-PCS,Repair Rectum, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,PPO,0DQR0ZZ,ICD10-PCS,Repair Anal Sphincter, Open Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0DQR4ZZ,ICD10-PCS,Repair Anal Sphincter, Percutaneous Endoscopic Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0Q820ZZ,ICD10-PCS,Division of Right Pelvic Bone, Open Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0Q834ZZ,ICD10-PCS,Division of Left Pelvic Bone, Perc Endo Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0TQB0ZZ,ICD10-PCS,Repair Bladder, Open Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0TQB8ZZ,ICD10-PCS,Repair Bladder, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,PPO,0TQD7ZZ,ICD10-PCS,Repair Urethra, Via Natural or Artificial Opening,,Fee Schedule,4303.00
Blue Cross,PPO,0TQD8ZZ,ICD10-PCS,Repair Urethra, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,PPO,0TQDXZZ,ICD10-PCS,Repair Urethra, External Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0UQ98ZZ,ICD10-PCS,Repair Uterus, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,PPO,0UQC0ZZ,ICD10-PCS,Repair Cervix, Open Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0UQC8ZZ,ICD10-PCS,Repair Cervix, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,PPO,0UQG8ZZ,ICD10-PCS,Repair Vagina, Via Natural or Artificial Opening Endoscopic,,Fee Schedule,4303.00
Blue Cross,PPO,0UQGXZZ,ICD10-PCS,Repair Vagina, External Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0UQMXZZ,ICD10-PCS,Repair Vulva, External Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0W8NXZZ,ICD10-PCS,Division of Female Perineum, External Approach,,Fee Schedule,4303.00
Blue Cross,PPO,0WQNXZZ,ICD10-PCS,Repair Female Perineum, External Approach,,Fee Schedule,4303.00
Blue Cross,PPO,1,DRG,Heart transplant or implant of heart assist system w MCC,,Case Rate,479084.40
Blue Cross,PPO,10,DRG,Pancreas transplant,,Case Rate,59836.75
Blue Cross,PPO,100,DRG,Seizures w MCC,,Case Rate,30989.34
Blue Cross,PPO,10004,CPT4/HCPCS,FNA BX W/O IMG GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,10005,CPT4/HCPCS,FNA BX W/US GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,PPO,10006,CPT4/HCPCS,FNA BX W/US GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,10007,CPT4/HCPCS,FNA BX W/FLUOR GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,PPO,10008,CPT4/HCPCS,FNA BX W/FLUOR GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,10009,CPT4/HCPCS,FNA BX W/CT GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,PPO,10010,CPT4/HCPCS,FNA BX W/CT GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,10011,CPT4/HCPCS,FNA BX W/MR GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,PPO,10012,CPT4/HCPCS,FNA BX W/MR GDN EA ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Grouper Rate,1678.00
Blue Cross,PPO,10022,CPT4/HCPCS,FNA W/IMAGE,,Grouper Rate,1678.00
Blue Cross,PPO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Grouper Rate,1678.00
Blue Cross,PPO,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Grouper Rate,1678.00
Blue Cross,PPO,10036,CPT4/HCPCS,PERQ DEV SOFT TISS ADD IMAG,,Grouper Rate,1678.00
Blue Cross,PPO,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,1678.88
Blue Cross,PPO,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,1678.88
Blue Cross,PPO,101,DRG,Seizures w/o MCC,,Case Rate,14670.98
Blue Cross,PPO,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Grouper Rate,1678.00
Blue Cross,PPO,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Grouper Rate,1678.00
Blue Cross,PPO,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Grouper Rate,1678.88
Blue Cross,PPO,102,DRG,Headaches w MCC,,Case Rate,19049.11
Blue Cross,PPO,103,DRG,Headaches w/o MCC,,Case Rate,13698.42
Blue Cross,PPO,10900ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Open Approach,,Fee Schedule,4303.00
Blue Cross,PPO,10903ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Perc Approach,,Fee Schedule,4303.00
Blue Cross,PPO,10904ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Perc Endo Approach,,Fee Schedule,4303.00
Blue Cross,PPO,10907ZA,ICD10-PCS,Drainage of Fetal Cerebrospinal Fluid from POC, Via Opening,,Fee Schedule,4303.00
Blue Cross,PPO,10907ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Via Opening,,Fee Schedule,4303.00
Blue Cross,PPO,10908ZA,ICD10-PCS,Drainage of Fetal Cerebrospinal Fluid from POC, Endo,,Fee Schedule,4303.00
Blue Cross,PPO,10908ZC,ICD10-PCS,Drainage of Amniotic Fluid, Therapeutic from POC, Endo,,Fee Schedule,4303.00
Blue Cross,PPO,10D00Z0,ICD10-PCS,Extraction of Products of Conception, High, Open Approach,,Fee Schedule,4303.00
Blue Cross,PPO,10D00Z2,ICD10-PCS,Extraction of POC, Extraperitoneal, Open Approach,,Fee Schedule,4303.00
Blue Cross,PPO,10D07Z3,ICD10-PCS,Extraction of POC, Low Forceps, Via Opening,,Fee Schedule,4303.00
Blue Cross,PPO,10D07Z8,ICD10-PCS,Extraction of Products of Conception, Other, Via Opening,,Fee Schedule,4303.00
Blue Cross,PPO,10E0XZZ,ICD10-PCS,Delivery of Products of Conception, External Approach,,Fee Schedule,4303.00
Blue Cross,PPO,10S0XZZ,ICD10-PCS,Reposition Products of Conception, External Approach,,Fee Schedule,4303.00
Blue Cross,PPO,11,DRG,Tracheostomy for face,mouth & neck diagnoses w MCC,,Case Rate,82971.25
Blue Cross,PPO,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Grouper Rate,1678.00
Blue Cross,PPO,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,Grouper Rate,1678.00
Blue Cross,PPO,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,Grouper Rate,1678.00
Blue Cross,PPO,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,Grouper Rate,1678.88
Blue Cross,PPO,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,Grouper Rate,1678.00
Blue Cross,PPO,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Grouper Rate,1678.00
Blue Cross,PPO,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Grouper Rate,1678.88
Blue Cross,PPO,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Grouper Rate,1678.88
Blue Cross,PPO,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,PPO,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,PPO,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,PPO,11045,CPT4/HCPCS,DEB SUBQ TISSUE ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,11046,CPT4/HCPCS,DEB MUSC/FASCIA ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,11047,CPT4/HCPCS,DEB BONE ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,11102,CPT4/HCPCS,TANGNTL BX SKIN SINGLE LES,,Grouper Rate,1678.00
Blue Cross,PPO,11103,CPT4/HCPCS,TANGNTL BX SKIN EA SEP/ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,11104,CPT4/HCPCS,PUNCH BX SKIN SINGLE LESION,,Grouper Rate,1678.00
Blue Cross,PPO,11105,CPT4/HCPCS,PUNCH BX SKIN EA SEP/ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,11106,CPT4/HCPCS,INCAL BX SKN SINGLE LES,,Grouper Rate,1678.00
Blue Cross,PPO,11107,CPT4/HCPCS,INCAL BX SKN EA SEP/ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,113,DRG,Orbital procedures w CC/MCC,,Case Rate,36252.37
Blue Cross,PPO,11303,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Grouper Rate,1678.00
Blue Cross,PPO,114,DRG,Orbital procedures w/o CC/MCC,,Case Rate,23908.57
Blue Cross,PPO,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,Grouper Rate,1678.88
Blue Cross,PPO,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,Grouper Rate,1678.88
Blue Cross,PPO,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Grouper Rate,1678.88
Blue Cross,PPO,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Grouper Rate,1678.88
Blue Cross,PPO,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Grouper Rate,1678.88
Blue Cross,PPO,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Grouper Rate,1678.88
Blue Cross,PPO,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Grouper Rate,1678.88
Blue Cross,PPO,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Grouper Rate,1678.88
Blue Cross,PPO,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,PPO,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,PPO,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,PPO,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,PPO,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,PPO,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,1678.88
Blue Cross,PPO,115,DRG,Extraocular procedures except orbit,,Case Rate,24037.58
Blue Cross,PPO,116,DRG,Intraocular procedures w CC/MCC,,Case Rate,31048.88
Blue Cross,PPO,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Grouper Rate,1678.88
Blue Cross,PPO,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Grouper Rate,1678.00
Blue Cross,PPO,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Grouper Rate,1678.88
Blue Cross,PPO,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Grouper Rate,1678.88
Blue Cross,PPO,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Grouper Rate,1678.88
Blue Cross,PPO,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Grouper Rate,1678.88
Blue Cross,PPO,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Grouper Rate,1678.88
Blue Cross,PPO,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Grouper Rate,1678.88
Blue Cross,PPO,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Grouper Rate,1678.88
Blue Cross,PPO,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Grouper Rate,1678.88
Blue Cross,PPO,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Grouper Rate,1678.88
Blue Cross,PPO,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Grouper Rate,1678.88
Blue Cross,PPO,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,117,DRG,Intraocular procedures w/o CC/MCC,,Case Rate,17183.40
Blue Cross,PPO,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Grouper Rate,1678.00
Blue Cross,PPO,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Grouper Rate,1678.00
Blue Cross,PPO,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Grouper Rate,1678.00
Blue Cross,PPO,11752,CPT4/HCPCS,REMOVE NAIL BED/TIP,,Grouper Rate,1678.00
Blue Cross,PPO,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Grouper Rate,1678.00
Blue Cross,PPO,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Grouper Rate,3544.00
Blue Cross,PPO,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Grouper Rate,3544.00
Blue Cross,PPO,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Grouper Rate,3544.00
Blue Cross,PPO,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Grouper Rate,1678.00
Blue Cross,PPO,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Grouper Rate,1678.00
Blue Cross,PPO,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Grouper Rate,1678.00
Blue Cross,PPO,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Grouper Rate,1678.88
Blue Cross,PPO,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Grouper Rate,5029.00
Blue Cross,PPO,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Grouper Rate,1678.00
Blue Cross,PPO,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Grouper Rate,1678.00
Blue Cross,PPO,12,DRG,Tracheostomy for face,mouth & neck diagnoses w CC,,Case Rate,63379.62
Blue Cross,PPO,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Grouper Rate,1678.88
Blue Cross,PPO,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,Grouper Rate,1678.88
Blue Cross,PPO,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Grouper Rate,1678.88
Blue Cross,PPO,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Grouper Rate,1678.88
Blue Cross,PPO,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Grouper Rate,1678.88
Blue Cross,PPO,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Grouper Rate,1678.88
Blue Cross,PPO,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,Grouper Rate,1678.88
Blue Cross,PPO,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,Grouper Rate,1678.88
Blue Cross,PPO,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Grouper Rate,1678.88
Blue Cross,PPO,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Grouper Rate,1678.88
Blue Cross,PPO,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Grouper Rate,1678.88
Blue Cross,PPO,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Grouper Rate,1678.88
Blue Cross,PPO,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Grouper Rate,1678.88
Blue Cross,PPO,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,1678.00
Blue Cross,PPO,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,1678.00
Blue Cross,PPO,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Grouper Rate,1678.88
Blue Cross,PPO,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Grouper Rate,1678.88
Blue Cross,PPO,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Grouper Rate,1678.88
Blue Cross,PPO,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Grouper Rate,1678.88
Blue Cross,PPO,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Grouper Rate,1678.88
Blue Cross,PPO,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Grouper Rate,1678.88
Blue Cross,PPO,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Grouper Rate,1678.00
Blue Cross,PPO,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Grouper Rate,1678.00
Blue Cross,PPO,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Grouper Rate,1678.88
Blue Cross,PPO,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Grouper Rate,1678.88
Blue Cross,PPO,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Grouper Rate,1678.88
Blue Cross,PPO,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Grouper Rate,1678.88
Blue Cross,PPO,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Grouper Rate,1678.00
Blue Cross,PPO,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Grouper Rate,1678.00
Blue Cross,PPO,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Grouper Rate,1678.88
Blue Cross,PPO,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Grouper Rate,1678.88
Blue Cross,PPO,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Grouper Rate,1678.88
Blue Cross,PPO,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Grouper Rate,1678.88
Blue Cross,PPO,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Grouper Rate,1678.88
Blue Cross,PPO,121,DRG,Acute major eye infections w CC/MCC,,Case Rate,19661.09
Blue Cross,PPO,122,DRG,Acute major eye infections w/o CC/MCC,,Case Rate,10648.45
Blue Cross,PPO,123,DRG,Neurological eye disorders,,Case Rate,12658.06
Blue Cross,PPO,124,DRG,Other disorders of the eye w MCC,,Case Rate,23136.15
Blue Cross,PPO,125,DRG,Other disorders of the eye w/o MCC,,Case Rate,13817.51
Blue Cross,PPO,13,DRG,Tracheostomy for face,mouth & neck diagnoses w/o CC/MCC,,Case Rate,44997.07
Blue Cross,PPO,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Grouper Rate,1678.88
Blue Cross,PPO,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Grouper Rate,1678.88
Blue Cross,PPO,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Grouper Rate,1678.00
Blue Cross,PPO,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Grouper Rate,1678.88
Blue Cross,PPO,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Grouper Rate,1678.00
Blue Cross,PPO,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1678.88
Blue Cross,PPO,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,3544.00
Blue Cross,PPO,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1678.00
Blue Cross,PPO,13150,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.0 CM/<,,Grouper Rate,3544.00
Blue Cross,PPO,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Grouper Rate,1678.00
Blue Cross,PPO,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Grouper Rate,1678.88
Blue Cross,PPO,135,DRG,Sinus & mastoid procedures w CC/MCC,,Case Rate,35405.52
Blue Cross,PPO,136,DRG,Sinus & mastoid procedures w/o CC/MCC,,Case Rate,20765.97
Blue Cross,PPO,137,DRG,Mouth procedures w CC/MCC,,Case Rate,24290.64
Blue Cross,PPO,138,DRG,Mouth procedures w/o CC/MCC,,Case Rate,13944.87
Blue Cross,PPO,139,DRG,Salivary gland procedures,,Case Rate,20291.27
Blue Cross,PPO,14,DRG,Allogeneic bone marrow transplant,,Case Rate,211361.35
Blue Cross,PPO,140,DRG,MAJOR HEAD AND NECK PROCEDURES WITH MCC,,Case Rate,65839.12
Blue Cross,PPO,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Grouper Rate,1678.88
Blue Cross,PPO,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Grouper Rate,3544.00
Blue Cross,PPO,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Grouper Rate,3544.00
Blue Cross,PPO,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Grouper Rate,3544.00
Blue Cross,PPO,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,1678.88
Blue Cross,PPO,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,3544.00
Blue Cross,PPO,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Grouper Rate,3544.00
Blue Cross,PPO,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Grouper Rate,3544.00
Blue Cross,PPO,141,DRG,MAJOR HEAD AND NECK PROCEDURES WITH CC,,Case Rate,36512.05
Blue Cross,PPO,142,DRG,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,,Case Rate,26609.55
Blue Cross,PPO,143,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC,,Case Rate,49021.25
Blue Cross,PPO,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Grouper Rate,5029.00
Blue Cross,PPO,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Grouper Rate,1678.88
Blue Cross,PPO,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Grouper Rate,3544.00
Blue Cross,PPO,144,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC,,Case Rate,28953.27
Blue Cross,PPO,145,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,,Case Rate,20071.29
Blue Cross,PPO,146,DRG,Ear, nose, mouth & throat malignancy w MCC,,Case Rate,33627.47
Blue Cross,PPO,147,DRG,Ear, nose, mouth & throat malignancy w CC,,Case Rate,21520.19
Blue Cross,PPO,148,DRG,Ear, nose, mouth & throat malignancy w/o CC/MCC,,Case Rate,13005.40
Blue Cross,PPO,149,DRG,Dysequilibrium,,Case Rate,12165.17
Blue Cross,PPO,150,DRG,Epistaxis w MCC,,Case Rate,21910.53
Blue Cross,PPO,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Grouper Rate,1678.00
Blue Cross,PPO,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Grouper Rate,1678.00
Blue Cross,PPO,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Grouper Rate,1678.88
Blue Cross,PPO,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Grouper Rate,1678.00
Blue Cross,PPO,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Grouper Rate,1678.00
Blue Cross,PPO,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Grouper Rate,1678.00
Blue Cross,PPO,151,DRG,Epistaxis w/o MCC,,Case Rate,12189.98
Blue Cross,PPO,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,PPO,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,PPO,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Grouper Rate,1678.88
Blue Cross,PPO,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Grouper Rate,1678.88
Blue Cross,PPO,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Grouper Rate,1678.00
Blue Cross,PPO,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,PPO,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Grouper Rate,1678.88
Blue Cross,PPO,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Grouper Rate,1678.00
Blue Cross,PPO,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Grouper Rate,1678.00
Blue Cross,PPO,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Grouper Rate,1678.00
Blue Cross,PPO,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Grouper Rate,1678.88
Blue Cross,PPO,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Grouper Rate,1678.00
Blue Cross,PPO,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Grouper Rate,1678.88
Blue Cross,PPO,152,DRG,Otitis media & URI w MCC,,Case Rate,17811.92
Blue Cross,PPO,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Grouper Rate,3544.00
Blue Cross,PPO,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Grouper Rate,1678.88
Blue Cross,PPO,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Grouper Rate,3544.00
Blue Cross,PPO,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Grouper Rate,1678.88
Blue Cross,PPO,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Grouper Rate,1678.00
Blue Cross,PPO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Grouper Rate,1678.00
Blue Cross,PPO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Grouper Rate,1678.00
Blue Cross,PPO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Grouper Rate,1678.00
Blue Cross,PPO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Grouper Rate,1678.00
Blue Cross,PPO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Grouper Rate,1678.00
Blue Cross,PPO,153,DRG,Otitis media & URI w/o MCC,,Case Rate,11753.32
Blue Cross,PPO,154,DRG,Nasal trauma & deformity w MCC,,Case Rate,25512.95
Blue Cross,PPO,155,DRG,Nasal trauma & deformity w CC,,Case Rate,14998.47
Blue Cross,PPO,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Grouper Rate,3544.00
Blue Cross,PPO,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Grouper Rate,3544.00
Blue Cross,PPO,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Grouper Rate,3544.00
Blue Cross,PPO,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Grouper Rate,3544.00
Blue Cross,PPO,156,DRG,Nasal trauma & deformity w/o CC/MCC,,Case Rate,10876.70
Blue Cross,PPO,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Grouper Rate,3544.00
Blue Cross,PPO,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Grouper Rate,3544.00
Blue Cross,PPO,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Grouper Rate,3544.00
Blue Cross,PPO,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Grouper Rate,3544.00
Blue Cross,PPO,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Grouper Rate,5281.00
Blue Cross,PPO,157,DRG,Dental & Oral Diseases w MCC,,Case Rate,26007.49
Blue Cross,PPO,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Grouper Rate,1678.88
Blue Cross,PPO,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Grouper Rate,1678.88
Blue Cross,PPO,15732,CPT4/HCPCS,MUSCLE-SKIN GRAFT HEAD/NECK,,Grouper Rate,3544.00
Blue Cross,PPO,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Grouper Rate,3544.00
Blue Cross,PPO,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Grouper Rate,3544.00
Blue Cross,PPO,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Grouper Rate,3544.00
Blue Cross,PPO,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Grouper Rate,3544.00
Blue Cross,PPO,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Grouper Rate,1678.88
Blue Cross,PPO,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Grouper Rate,1678.88
Blue Cross,PPO,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Grouper Rate,5281.00
Blue Cross,PPO,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Grouper Rate,5281.00
Blue Cross,PPO,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Grouper Rate,5281.00
Blue Cross,PPO,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Grouper Rate,1678.88
Blue Cross,PPO,15769,CPT4/HCPCS,GRFG AUTOL SOFT TISS DIR EXC,,Grouper Rate,5029.00
Blue Cross,PPO,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,15771,CPT4/HCPCS,GRFG AUTOL FAT LIPO 50 CC/<,,Grouper Rate,3544.00
Blue Cross,PPO,15772,CPT4/HCPCS,GRFG AUTOL FAT LIPO EA ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,15773,CPT4/HCPCS,GRFG AUTOL FAT LIPO 25 CC/<,,Grouper Rate,3544.00
Blue Cross,PPO,15774,CPT4/HCPCS,GFRG AUTOL FAT LIPO EA ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,Grouper Rate,1678.00
Blue Cross,PPO,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,Grouper Rate,1678.00
Blue Cross,PPO,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,Grouper Rate,1678.00
Blue Cross,PPO,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,Grouper Rate,1678.00
Blue Cross,PPO,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,Grouper Rate,1678.00
Blue Cross,PPO,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,158,DRG,Dental & Oral Diseases w CC,,Case Rate,14705.71
Blue Cross,PPO,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Grouper Rate,1678.88
Blue Cross,PPO,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,1678.88
Blue Cross,PPO,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,1678.88
Blue Cross,PPO,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,1678.88
Blue Cross,PPO,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,1678.88
Blue Cross,PPO,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Grouper Rate,3544.00
Blue Cross,PPO,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Grouper Rate,1678.88
Blue Cross,PPO,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Grouper Rate,1678.88
Blue Cross,PPO,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Grouper Rate,3544.00
Blue Cross,PPO,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Grouper Rate,3544.00
Blue Cross,PPO,15830,CPT4/HCPCS,EXC SKIN ABD,,Grouper Rate,3544.00
Blue Cross,PPO,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Grouper Rate,1678.88
Blue Cross,PPO,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Grouper Rate,3544.00
Blue Cross,PPO,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Grouper Rate,3544.00
Blue Cross,PPO,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Grouper Rate,3544.00
Blue Cross,PPO,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Grouper Rate,1678.88
Blue Cross,PPO,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Grouper Rate,1678.88
Blue Cross,PPO,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Grouper Rate,1678.88
Blue Cross,PPO,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Grouper Rate,1678.88
Blue Cross,PPO,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Grouper Rate,5029.00
Blue Cross,PPO,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Grouper Rate,1678.00
Blue Cross,PPO,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Grouper Rate,1678.00
Blue Cross,PPO,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Grouper Rate,1678.00
Blue Cross,PPO,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Grouper Rate,1678.88
Blue Cross,PPO,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Grouper Rate,3544.00
Blue Cross,PPO,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Grouper Rate,1678.88
Blue Cross,PPO,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Grouper Rate,1678.88
Blue Cross,PPO,159,DRG,Dental & Oral Diseases w/o CC/MCC,,Case Rate,10846.93
Blue Cross,PPO,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,3544.00
Blue Cross,PPO,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,5029.00
Blue Cross,PPO,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,1678.88
Blue Cross,PPO,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,PPO,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,PPO,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,PPO,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,PPO,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,PPO,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,1678.88
Blue Cross,PPO,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,PPO,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,PPO,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,PPO,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,PPO,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,PPO,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,PPO,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,PPO,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,PPO,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3544.00
Blue Cross,PPO,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5029.00
Blue Cross,PPO,16,DRG,Autologous bone marrow transplant w CC/MCC,,Case Rate,111251.34
Blue Cross,PPO,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Grouper Rate,1678.00
Blue Cross,PPO,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Grouper Rate,1678.00
Blue Cross,PPO,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Grouper Rate,1678.88
Blue Cross,PPO,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,Grouper Rate,1678.00
Blue Cross,PPO,163,DRG,Major chest procedures w MCC,,Case Rate,82031.78
Blue Cross,PPO,164,DRG,Major chest procedures w CC,,Case Rate,43596.13
Blue Cross,PPO,165,DRG,Major chest procedures w/o CC/MCC,,Case Rate,31568.24
Blue Cross,PPO,166,DRG,Other resp system O.R. procedures w MCC,,Case Rate,62681.63
Blue Cross,PPO,167,DRG,Other resp system O.R. procedures w CC,,Case Rate,30780.94
Blue Cross,PPO,168,DRG,Other resp system O.R. procedures w/o CC/MCC,,Case Rate,22649.87
Blue Cross,PPO,17,DRG,Autologous bone marrow transplant w/o CC/MCC,,Case Rate,79891.50
Blue Cross,PPO,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1678.00
Blue Cross,PPO,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1678.00
Blue Cross,PPO,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1678.00
Blue Cross,PPO,175,DRG,Pulmonary embolism w MCC,,Case Rate,25541.06
Blue Cross,PPO,176,DRG,Pulmonary embolism w/o MCC,,Case Rate,14666.01
Blue Cross,PPO,177,DRG,Respiratory infections & inflammations w MCC,,Case Rate,30521.26
Blue Cross,PPO,178,DRG,Respiratory infections & inflammations w CC,,Case Rate,19945.58
Blue Cross,PPO,179,DRG,Respiratory infections & inflammations w/o CC/MCC,,Case Rate,14407.99
Blue Cross,PPO,18,DRG,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY,,Case Rate,617421.66
Blue Cross,PPO,180,DRG,Respiratory neoplasms w MCC,,Case Rate,28743.21
Blue Cross,PPO,181,DRG,Respiratory neoplasms w CC,,Case Rate,18539.68
Blue Cross,PPO,182,DRG,Respiratory neoplasms w/o CC/MCC,,Case Rate,13025.25
Blue Cross,PPO,183,DRG,Major chest trauma w MCC,,Case Rate,25729.62
Blue Cross,PPO,184,DRG,Major chest trauma w CC,,Case Rate,17191.67
Blue Cross,PPO,185,DRG,Major chest trauma w/o CC/MCC,,Case Rate,12795.34
Blue Cross,PPO,186,DRG,Pleural effusion w MCC,,Case Rate,25524.52
Blue Cross,PPO,187,DRG,Pleural effusion w CC,,Case Rate,17072.58
Blue Cross,PPO,188,DRG,Pleural effusion w/o CC/MCC,,Case Rate,12042.77
Blue Cross,PPO,189,DRG,Pulmonary edema & respiratory failure,,Case Rate,20258.19
Blue Cross,PPO,19,DRG,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,,Case Rate,110187.82
Blue Cross,PPO,190,DRG,Chronic obstructive pulmonary disease w MCC,,Case Rate,18589.30
Blue Cross,PPO,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Grouper Rate,1678.00
Blue Cross,PPO,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Grouper Rate,1678.88
Blue Cross,PPO,19030,CPT4/HCPCS,INJECTION FOR BREAST X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Grouper Rate,1678.88
Blue Cross,PPO,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,Grouper Rate,1678.88
Blue Cross,PPO,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Grouper Rate,1678.88
Blue Cross,PPO,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,Grouper Rate,1678.88
Blue Cross,PPO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Grouper Rate,1678.88
Blue Cross,PPO,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,Grouper Rate,1678.88
Blue Cross,PPO,191,DRG,Chronic obstructive pulmonary disease w CC,,Case Rate,14606.47
Blue Cross,PPO,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Grouper Rate,1678.00
Blue Cross,PPO,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Grouper Rate,1678.88
Blue Cross,PPO,19102,CPT4/HCPCS,BX BREAST PERCUT W/IMAGE,,Grouper Rate,1678.88
Blue Cross,PPO,19103,CPT4/HCPCS,BX BREAST PERCUT W/DEVICE,,Grouper Rate,1678.00
Blue Cross,PPO,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Grouper Rate,1678.88
Blue Cross,PPO,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Grouper Rate,3544.00
Blue Cross,PPO,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Grouper Rate,3544.00
Blue Cross,PPO,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Grouper Rate,3544.00
Blue Cross,PPO,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Grouper Rate,1678.88
Blue Cross,PPO,192,DRG,Chronic obstructive pulmonary disease w/o CC/MCC,,Case Rate,11493.64
Blue Cross,PPO,19260,CPT4/HCPCS,REMOVAL OF CHEST WALL LESION,,Grouper Rate,5281.00
Blue Cross,PPO,19271,CPT4/HCPCS,REVISION OF CHEST WALL,,Grouper Rate,5281.00
Blue Cross,PPO,19272,CPT4/HCPCS,EXTENSIVE CHEST WALL SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,Grouper Rate,1678.00
Blue Cross,PPO,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,Grouper Rate,1678.00
Blue Cross,PPO,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,Grouper Rate,1678.00
Blue Cross,PPO,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,Grouper Rate,1678.00
Blue Cross,PPO,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,Grouper Rate,1678.00
Blue Cross,PPO,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,Grouper Rate,1678.00
Blue Cross,PPO,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,Grouper Rate,1678.88
Blue Cross,PPO,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,Grouper Rate,1678.88
Blue Cross,PPO,19290,CPT4/HCPCS,PLACE NEEDLE WIRE BREAST,,Grouper Rate,1678.00
Blue Cross,PPO,19291,CPT4/HCPCS,PLACE NEEDLE WIRE BREAST,,Grouper Rate,1678.00
Blue Cross,PPO,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Grouper Rate,1678.00
Blue Cross,PPO,19295,CPT4/HCPCS,PLACE BREAST CLIP PERCUT,,Grouper Rate,1678.00
Blue Cross,PPO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Grouper Rate,1678.00
Blue Cross,PPO,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Grouper Rate,1678.00
Blue Cross,PPO,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Grouper Rate,1678.88
Blue Cross,PPO,193,DRG,Simple pneumonia & pleurisy w MCC,,Case Rate,21678.97
Blue Cross,PPO,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Grouper Rate,5029.00
Blue Cross,PPO,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Grouper Rate,3544.00
Blue Cross,PPO,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Grouper Rate,5029.00
Blue Cross,PPO,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Grouper Rate,5029.00
Blue Cross,PPO,19304,CPT4/HCPCS,MAST SUBQ,,Grouper Rate,5029.00
Blue Cross,PPO,19305,CPT4/HCPCS,MAST RADICAL,,Grouper Rate,5281.00
Blue Cross,PPO,19306,CPT4/HCPCS,MAST RAD URBAN TYPE,,Grouper Rate,5281.00
Blue Cross,PPO,19307,CPT4/HCPCS,MAST MOD RAD,,Grouper Rate,5281.00
Blue Cross,PPO,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Grouper Rate,5029.00
Blue Cross,PPO,19318,CPT4/HCPCS,BREAST REDUCTION,,Grouper Rate,5281.00
Blue Cross,PPO,19324,CPT4/HCPCS,ENLARGE BREAST,,Grouper Rate,5029.00
Blue Cross,PPO,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Grouper Rate,5029.00
Blue Cross,PPO,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Grouper Rate,1678.00
Blue Cross,PPO,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Grouper Rate,1678.00
Blue Cross,PPO,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Grouper Rate,1678.88
Blue Cross,PPO,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Grouper Rate,5029.00
Blue Cross,PPO,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,5029.00
Blue Cross,PPO,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Grouper Rate,1678.88
Blue Cross,PPO,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Grouper Rate,5029.00
Blue Cross,PPO,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,Grouper Rate,5281.00
Blue Cross,PPO,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Grouper Rate,5281.00
Blue Cross,PPO,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,5281.00
Blue Cross,PPO,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,Grouper Rate,5281.00
Blue Cross,PPO,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,Grouper Rate,5281.00
Blue Cross,PPO,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,Grouper Rate,5281.00
Blue Cross,PPO,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Grouper Rate,1678.88
Blue Cross,PPO,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Grouper Rate,5029.00
Blue Cross,PPO,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Grouper Rate,5281.00
Blue Cross,PPO,194,DRG,Simple pneumonia & pleurisy w CC,,Case Rate,14274.02
Blue Cross,PPO,195,DRG,Simple pneumonia & pleurisy w/o CC/MCC,,Case Rate,10999.10
Blue Cross,PPO,196,DRG,Interstitial lung disease w MCC,,Case Rate,28715.09
Blue Cross,PPO,197,DRG,Interstitial lung disease w CC,,Case Rate,16632.62
Blue Cross,PPO,198,DRG,Interstitial lung disease w/o CC/MCC,,Case Rate,12277.64
Blue Cross,PPO,199,DRG,Pneumothorax w MCC,,Case Rate,29566.90
Blue Cross,PPO,2,DRG,Heart transplant or implant of heart assist system w/o MCC,,Case Rate,263498.74
Blue Cross,PPO,20,DRG,Intracranial vascular procedures w PDX hemorrhage w MCC,,Case Rate,170694.45
Blue Cross,PPO,200,DRG,Pneumothorax w CC,,Case Rate,17780.50
Blue Cross,PPO,20005,CPT4/HCPCS,I&D ABSCESS SUBFASCIAL,,Grouper Rate,1678.88
Blue Cross,PPO,201,DRG,Pneumothorax w/o CC/MCC,,Case Rate,11735.13
Blue Cross,PPO,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,Grouper Rate,1678.88
Blue Cross,PPO,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,Grouper Rate,5029.00
Blue Cross,PPO,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,Grouper Rate,3544.00
Blue Cross,PPO,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Grouper Rate,1678.88
Blue Cross,PPO,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,Grouper Rate,5029.00
Blue Cross,PPO,202,DRG,Bronchitis & asthma w CC/MCC,,Case Rate,15971.02
Blue Cross,PPO,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Grouper Rate,1678.88
Blue Cross,PPO,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Grouper Rate,3544.00
Blue Cross,PPO,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Grouper Rate,1678.00
Blue Cross,PPO,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,1678.00
Blue Cross,PPO,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,1678.88
Blue Cross,PPO,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Grouper Rate,1678.88
Blue Cross,PPO,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Grouper Rate,3544.00
Blue Cross,PPO,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,3544.00
Blue Cross,PPO,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,3544.00
Blue Cross,PPO,203,DRG,Bronchitis & asthma w/o CC/MCC,,Case Rate,11668.97
Blue Cross,PPO,204,DRG,Respiratory signs & symptoms,,Case Rate,13107.95
Blue Cross,PPO,205,DRG,Other respiratory system diagnoses w MCC,,Case Rate,27825.24
Blue Cross,PPO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Grouper Rate,1678.00
Blue Cross,PPO,20501,CPT4/HCPCS,INJECT SINUS TRACT FOR X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,PPO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Grouper Rate,1678.00
Blue Cross,PPO,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Grouper Rate,1678.00
Blue Cross,PPO,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Grouper Rate,1678.00
Blue Cross,PPO,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Grouper Rate,1678.00
Blue Cross,PPO,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Grouper Rate,1678.00
Blue Cross,PPO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Grouper Rate,3544.00
Blue Cross,PPO,206,DRG,Other respiratory system diagnoses w/o MCC,,Case Rate,14624.66
Blue Cross,PPO,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1678.00
Blue Cross,PPO,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1678.00
Blue Cross,PPO,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1678.88
Blue Cross,PPO,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1678.88
Blue Cross,PPO,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,3544.00
Blue Cross,PPO,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,3544.00
Blue Cross,PPO,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Grouper Rate,1678.88
Blue Cross,PPO,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Grouper Rate,1678.00
Blue Cross,PPO,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Grouper Rate,3544.00
Blue Cross,PPO,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Grouper Rate,1678.88
Blue Cross,PPO,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Grouper Rate,3544.00
Blue Cross,PPO,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Grouper Rate,3544.00
Blue Cross,PPO,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Grouper Rate,3544.00
Blue Cross,PPO,20664,CPT4/HCPCS,APPLICATION OF HALO,,Grouper Rate,1678.88
Blue Cross,PPO,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Grouper Rate,1678.00
Blue Cross,PPO,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,1678.88
Blue Cross,PPO,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,3544.00
Blue Cross,PPO,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,1678.88
Blue Cross,PPO,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Grouper Rate,1678.00
Blue Cross,PPO,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Grouper Rate,1678.00
Blue Cross,PPO,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Grouper Rate,5029.00
Blue Cross,PPO,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Grouper Rate,5029.00
Blue Cross,PPO,207,DRG,Respiratory system diagnosis w ventilator support 96+ hours,,Case Rate,94714.65
Blue Cross,PPO,208,DRG,Respiratory system diagnosis w ventilator support <96 hours,,Case Rate,42049.64
Blue Cross,PPO,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,Grouper Rate,8012.00
Blue Cross,PPO,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,Grouper Rate,8012.00
Blue Cross,PPO,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,Grouper Rate,8012.00
Blue Cross,PPO,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Grouper Rate,5783.00
Blue Cross,PPO,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Grouper Rate,5783.00
Blue Cross,PPO,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Grouper Rate,6588.00
Blue Cross,PPO,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Grouper Rate,5029.00
Blue Cross,PPO,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,Grouper Rate,8012.00
Blue Cross,PPO,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,20926,CPT4/HCPCS,REMOVAL OF TISSUE FOR GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,20932,CPT4/HCPCS,OSTEOART ALGRFT W/SURF & B1,,Grouper Rate,8841.00
Blue Cross,PPO,20933,CPT4/HCPCS,HEMICRT INTRCLRY ALGRFT PRTL,,Grouper Rate,8841.00
Blue Cross,PPO,20934,CPT4/HCPCS,INTERCALARY ALGRFT COMPL,,Grouper Rate,8841.00
Blue Cross,PPO,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Grouper Rate,1678.00
Blue Cross,PPO,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Grouper Rate,1678.00
Blue Cross,PPO,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,PPO,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,PPO,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,PPO,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,PPO,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Grouper Rate,5029.00
Blue Cross,PPO,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Grouper Rate,5029.00
Blue Cross,PPO,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Grouper Rate,5029.00
Blue Cross,PPO,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Grouper Rate,5029.00
Blue Cross,PPO,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Grouper Rate,1678.00
Blue Cross,PPO,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,1678.88
Blue Cross,PPO,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,1678.88
Blue Cross,PPO,21,DRG,Intracranial vascular procedures w PDX hemorrhage w CC,,Case Rate,124572.66
Blue Cross,PPO,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Grouper Rate,1678.88
Blue Cross,PPO,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Grouper Rate,1678.00
Blue Cross,PPO,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Grouper Rate,1678.00
Blue Cross,PPO,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Grouper Rate,3544.00
Blue Cross,PPO,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Grouper Rate,1678.88
Blue Cross,PPO,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Grouper Rate,1678.88
Blue Cross,PPO,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Grouper Rate,1678.88
Blue Cross,PPO,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Grouper Rate,1678.88
Blue Cross,PPO,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Grouper Rate,1678.88
Blue Cross,PPO,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Grouper Rate,3544.00
Blue Cross,PPO,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Grouper Rate,3544.00
Blue Cross,PPO,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Grouper Rate,5029.00
Blue Cross,PPO,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Grouper Rate,5281.00
Blue Cross,PPO,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Grouper Rate,1678.88
Blue Cross,PPO,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Grouper Rate,3544.00
Blue Cross,PPO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Grouper Rate,1678.00
Blue Cross,PPO,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1678.88
Blue Cross,PPO,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Grouper Rate,1678.88
Blue Cross,PPO,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Grouper Rate,1678.88
Blue Cross,PPO,21116,CPT4/HCPCS,INJECTION JAW JOINT X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,1678.88
Blue Cross,PPO,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,1678.88
Blue Cross,PPO,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,1678.88
Blue Cross,PPO,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,5029.00
Blue Cross,PPO,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,1678.88
Blue Cross,PPO,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,5029.00
Blue Cross,PPO,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,3544.00
Blue Cross,PPO,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5029.00
Blue Cross,PPO,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5281.00
Blue Cross,PPO,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Grouper Rate,5783.00
Blue Cross,PPO,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Grouper Rate,5783.00
Blue Cross,PPO,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,Grouper Rate,6588.00
Blue Cross,PPO,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,Grouper Rate,5783.00
Blue Cross,PPO,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Grouper Rate,5783.00
Blue Cross,PPO,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,Grouper Rate,5783.00
Blue Cross,PPO,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,Grouper Rate,6588.00
Blue Cross,PPO,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,Grouper Rate,6588.00
Blue Cross,PPO,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,Grouper Rate,6588.00
Blue Cross,PPO,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,Grouper Rate,6588.00
Blue Cross,PPO,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,Grouper Rate,5281.00
Blue Cross,PPO,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,Grouper Rate,5281.00
Blue Cross,PPO,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,5783.00
Blue Cross,PPO,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,3544.00
Blue Cross,PPO,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Grouper Rate,3544.00
Blue Cross,PPO,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Grouper Rate,3544.00
Blue Cross,PPO,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,5029.00
Blue Cross,PPO,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,5029.00
Blue Cross,PPO,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,5029.00
Blue Cross,PPO,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,Grouper Rate,5281.00
Blue Cross,PPO,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Grouper Rate,5281.00
Blue Cross,PPO,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,Grouper Rate,5281.00
Blue Cross,PPO,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Grouper Rate,5281.00
Blue Cross,PPO,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Grouper Rate,5281.00
Blue Cross,PPO,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Grouper Rate,5281.00
Blue Cross,PPO,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Grouper Rate,5783.00
Blue Cross,PPO,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Grouper Rate,5281.00
Blue Cross,PPO,21210,CPT4/HCPCS,FACE BONE GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Grouper Rate,6588.00
Blue Cross,PPO,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Grouper Rate,5783.00
Blue Cross,PPO,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Grouper Rate,6588.00
Blue Cross,PPO,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,PPO,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,PPO,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Grouper Rate,5281.00
Blue Cross,PPO,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,PPO,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6588.00
Blue Cross,PPO,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Grouper Rate,5281.00
Blue Cross,PPO,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,Grouper Rate,5783.00
Blue Cross,PPO,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,PPO,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,PPO,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,PPO,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,6588.00
Blue Cross,PPO,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5783.00
Blue Cross,PPO,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Grouper Rate,5281.00
Blue Cross,PPO,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Grouper Rate,6588.00
Blue Cross,PPO,21280,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5029.00
Blue Cross,PPO,21282,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5029.00
Blue Cross,PPO,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,5029.00
Blue Cross,PPO,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,5029.00
Blue Cross,PPO,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Grouper Rate,1678.88
Blue Cross,PPO,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Grouper Rate,1678.88
Blue Cross,PPO,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Grouper Rate,1678.88
Blue Cross,PPO,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Grouper Rate,5029.00
Blue Cross,PPO,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Grouper Rate,5281.00
Blue Cross,PPO,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Grouper Rate,6588.00
Blue Cross,PPO,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Grouper Rate,5281.00
Blue Cross,PPO,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Grouper Rate,1678.88
Blue Cross,PPO,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Grouper Rate,5029.00
Blue Cross,PPO,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Grouper Rate,5281.00
Blue Cross,PPO,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Grouper Rate,5029.00
Blue Cross,PPO,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Grouper Rate,5029.00
Blue Cross,PPO,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Grouper Rate,5029.00
Blue Cross,PPO,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Grouper Rate,3544.00
Blue Cross,PPO,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Grouper Rate,5281.00
Blue Cross,PPO,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Grouper Rate,5281.00
Blue Cross,PPO,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Grouper Rate,5029.00
Blue Cross,PPO,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Grouper Rate,5281.00
Blue Cross,PPO,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Grouper Rate,5029.00
Blue Cross,PPO,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Grouper Rate,5281.00
Blue Cross,PPO,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Grouper Rate,5281.00
Blue Cross,PPO,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Grouper Rate,5281.00
Blue Cross,PPO,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Grouper Rate,6588.00
Blue Cross,PPO,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Grouper Rate,6588.00
Blue Cross,PPO,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Grouper Rate,1678.00
Blue Cross,PPO,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Grouper Rate,1678.88
Blue Cross,PPO,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Grouper Rate,5029.00
Blue Cross,PPO,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Grouper Rate,5281.00
Blue Cross,PPO,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,Grouper Rate,5281.00
Blue Cross,PPO,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,1678.00
Blue Cross,PPO,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,1678.88
Blue Cross,PPO,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Grouper Rate,3544.00
Blue Cross,PPO,21495,CPT4/HCPCS,TREAT HYOID BONE FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Grouper Rate,1678.88
Blue Cross,PPO,215,DRG,Other heart assist system implant,,Case Rate,184551.66
Blue Cross,PPO,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Grouper Rate,1678.88
Blue Cross,PPO,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Grouper Rate,1678.88
Blue Cross,PPO,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Grouper Rate,1678.00
Blue Cross,PPO,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,PPO,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Grouper Rate,5029.00
Blue Cross,PPO,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,172513.85
Blue Cross,PPO,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,1678.88
Blue Cross,PPO,21601,CPT4/HCPCS,EXC CHEST WALL TUMOR W/RIBS,,Grouper Rate,5281.00
Blue Cross,PPO,21602,CPT4/HCPCS,EXC CH WAL TUM W/O LYMPHADEC,,Grouper Rate,5281.00
Blue Cross,PPO,21603,CPT4/HCPCS,EXC CH WAL TUM W/LYMPHADEC,,Grouper Rate,6588.00
Blue Cross,PPO,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,1678.88
Blue Cross,PPO,21615,CPT4/HCPCS,REMOVAL OF RIB,,Grouper Rate,5281.00
Blue Cross,PPO,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,Grouper Rate,5783.00
Blue Cross,PPO,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Grouper Rate,1678.88
Blue Cross,PPO,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,Grouper Rate,1678.88
Blue Cross,PPO,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Grouper Rate,5281.00
Blue Cross,PPO,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,107390.91
Blue Cross,PPO,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,1678.88
Blue Cross,PPO,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,Grouper Rate,5783.00
Blue Cross,PPO,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,3544.00
Blue Cross,PPO,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,3544.00
Blue Cross,PPO,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Grouper Rate,5281.00
Blue Cross,PPO,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Grouper Rate,5783.00
Blue Cross,PPO,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Grouper Rate,6588.00
Blue Cross,PPO,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,Grouper Rate,5029.00
Blue Cross,PPO,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,85068.52
Blue Cross,PPO,21800,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,21805,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,21810,CPT4/HCPCS,TREATMENT OF RIB FRACTURE(S),,Grouper Rate,1678.88
Blue Cross,PPO,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Grouper Rate,3544.00
Blue Cross,PPO,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,133231.35
Blue Cross,PPO,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,1678.00
Blue Cross,PPO,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,1678.88
Blue Cross,PPO,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Grouper Rate,3544.00
Blue Cross,PPO,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Grouper Rate,1678.88
Blue Cross,PPO,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,22,DRG,Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC,,Case Rate,80377.78
Blue Cross,PPO,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,89314.34
Blue Cross,PPO,22010,CPT4/HCPCS,I&D P-SPINE C/T/CERV-THOR,,Grouper Rate,1678.88
Blue Cross,PPO,22015,CPT4/HCPCS,I&D ABSCESS P-SPINE L/S/LS,,Grouper Rate,1678.88
Blue Cross,PPO,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,75295.04
Blue Cross,PPO,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,3544.00
Blue Cross,PPO,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,3544.00
Blue Cross,PPO,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,3544.00
Blue Cross,PPO,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,1678.88
Blue Cross,PPO,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,3544.00
Blue Cross,PPO,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,3544.00
Blue Cross,PPO,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,3544.00
Blue Cross,PPO,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,3544.00
Blue Cross,PPO,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,139284.99
Blue Cross,PPO,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,Grouper Rate,3544.00
Blue Cross,PPO,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,Grouper Rate,3544.00
Blue Cross,PPO,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,Grouper Rate,3544.00
Blue Cross,PPO,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,Grouper Rate,3544.00
Blue Cross,PPO,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,Grouper Rate,6588.00
Blue Cross,PPO,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,Grouper Rate,5029.00
Blue Cross,PPO,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,Grouper Rate,5029.00
Blue Cross,PPO,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,Grouper Rate,1678.88
Blue Cross,PPO,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,102748.13
Blue Cross,PPO,22305,CPT4/HCPCS,CLOSED TX SPINE PROCESS FX,,Grouper Rate,1678.00
Blue Cross,PPO,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Grouper Rate,1678.00
Blue Cross,PPO,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Grouper Rate,1678.88
Blue Cross,PPO,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Grouper Rate,5783.00
Blue Cross,PPO,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Grouper Rate,1678.88
Blue Cross,PPO,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,121770.78
Blue Cross,PPO,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,93067.27
Blue Cross,PPO,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Grouper Rate,1678.88
Blue Cross,PPO,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Grouper Rate,1678.00
Blue Cross,PPO,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Grouper Rate,1678.00
Blue Cross,PPO,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Grouper Rate,1678.00
Blue Cross,PPO,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1678.88
Blue Cross,PPO,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1678.88
Blue Cross,PPO,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1678.00
Blue Cross,PPO,22520,CPT4/HCPCS,PERCUT VERTEBROPLASTY THOR,,Grouper Rate,1678.00
Blue Cross,PPO,22521,CPT4/HCPCS,PERCUT VERTEBROPLASTY LUMB,,Grouper Rate,1678.00
Blue Cross,PPO,22522,CPT4/HCPCS,PERCUT VERTEBROPLASTY ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,22523,CPT4/HCPCS,PERCUT KYPHOPLASTY THOR,,Grouper Rate,1678.88
Blue Cross,PPO,22524,CPT4/HCPCS,PERCUT KYPHOPLASTY LUMBAR,,Grouper Rate,1678.88
Blue Cross,PPO,22525,CPT4/HCPCS,PERCUT KYPHOPLASTY ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,22548,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,8841.00
Blue Cross,PPO,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Grouper Rate,8841.00
Blue Cross,PPO,22552,CPT4/HCPCS,ADDL NECK SPINE FUSION,,Grouper Rate,5029.00
Blue Cross,PPO,22554,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,8841.00
Blue Cross,PPO,22556,CPT4/HCPCS,THORAX SPINE FUSION,,Grouper Rate,8841.00
Blue Cross,PPO,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,Grouper Rate,5029.00
Blue Cross,PPO,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,Grouper Rate,8841.00
Blue Cross,PPO,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,Grouper Rate,8012.00
Blue Cross,PPO,22595,CPT4/HCPCS,NECK SPINAL FUSION,,Grouper Rate,8012.00
Blue Cross,PPO,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,109359.17
Blue Cross,PPO,22600,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,8012.00
Blue Cross,PPO,22610,CPT4/HCPCS,THORAX SPINE FUSION,,Grouper Rate,5783.00
Blue Cross,PPO,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,5783.00
Blue Cross,PPO,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,6588.00
Blue Cross,PPO,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,3544.00
Blue Cross,PPO,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,Grouper Rate,6588.00
Blue Cross,PPO,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,6588.00
Blue Cross,PPO,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,86866.42
Blue Cross,PPO,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,102801.06
Blue Cross,PPO,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,Grouper Rate,8012.00
Blue Cross,PPO,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,Grouper Rate,8012.00
Blue Cross,PPO,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,Grouper Rate,8841.00
Blue Cross,PPO,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,Grouper Rate,6588.00
Blue Cross,PPO,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,Grouper Rate,8012.00
Blue Cross,PPO,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,Grouper Rate,8841.00
Blue Cross,PPO,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,Grouper Rate,6588.00
Blue Cross,PPO,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,Grouper Rate,8012.00
Blue Cross,PPO,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,Grouper Rate,5281.00
Blue Cross,PPO,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,PPO,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5281.00
Blue Cross,PPO,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5783.00
Blue Cross,PPO,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,6588.00
Blue Cross,PPO,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,PPO,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,PPO,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,5029.00
Blue Cross,PPO,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,Grouper Rate,1678.88
Blue Cross,PPO,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,22853,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,22854,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,5281.00
Blue Cross,PPO,22856,CPT4/HCPCS,CERV ARTIFIC DISKECTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,22859,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,22861,CPT4/HCPCS,REVISE CERV ARTIFIC DISC,,Grouper Rate,5783.00
Blue Cross,PPO,22864,CPT4/HCPCS,REMOVE CERV ARTIF DISC,,Grouper Rate,5029.00
Blue Cross,PPO,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,5281.00
Blue Cross,PPO,22868,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,5281.00
Blue Cross,PPO,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,5029.00
Blue Cross,PPO,22870,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,5029.00
Blue Cross,PPO,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,65961.52
Blue Cross,PPO,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Grouper Rate,5029.00
Blue Cross,PPO,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Grouper Rate,1678.00
Blue Cross,PPO,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Grouper Rate,1678.88
Blue Cross,PPO,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,23,DRG,Cranio w major dev impl/acute complex CNS PDX w MCC or chemo implant,,Case Rate,93654.44
Blue Cross,PPO,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Grouper Rate,1678.88
Blue Cross,PPO,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Grouper Rate,1678.88
Blue Cross,PPO,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Grouper Rate,1678.00
Blue Cross,PPO,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Grouper Rate,1678.00
Blue Cross,PPO,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,1678.00
Blue Cross,PPO,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,1678.88
Blue Cross,PPO,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,PPO,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Grouper Rate,1678.88
Blue Cross,PPO,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,140427.90
Blue Cross,PPO,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Grouper Rate,1678.88
Blue Cross,PPO,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Grouper Rate,5029.00
Blue Cross,PPO,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Grouper Rate,5029.00
Blue Cross,PPO,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Grouper Rate,5281.00
Blue Cross,PPO,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Grouper Rate,5281.00
Blue Cross,PPO,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5029.00
Blue Cross,PPO,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5281.00
Blue Cross,PPO,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5281.00
Blue Cross,PPO,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5029.00
Blue Cross,PPO,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5281.00
Blue Cross,PPO,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5281.00
Blue Cross,PPO,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,1678.88
Blue Cross,PPO,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,5029.00
Blue Cross,PPO,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,5029.00
Blue Cross,PPO,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,5029.00
Blue Cross,PPO,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Grouper Rate,5029.00
Blue Cross,PPO,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Grouper Rate,5281.00
Blue Cross,PPO,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,97557.88
Blue Cross,PPO,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,Grouper Rate,5029.00
Blue Cross,PPO,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,Grouper Rate,5029.00
Blue Cross,PPO,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,Grouper Rate,5281.00
Blue Cross,PPO,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,128891.25
Blue Cross,PPO,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,23331,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,23332,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,5029.00
Blue Cross,PPO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Grouper Rate,1678.00
Blue Cross,PPO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,5029.00
Blue Cross,PPO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,5029.00
Blue Cross,PPO,23350,CPT4/HCPCS,INJECTION FOR SHOULDER X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Grouper Rate,5281.00
Blue Cross,PPO,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Grouper Rate,6588.00
Blue Cross,PPO,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,87949.79
Blue Cross,PPO,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Grouper Rate,6588.00
Blue Cross,PPO,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Grouper Rate,1678.88
Blue Cross,PPO,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Grouper Rate,1678.88
Blue Cross,PPO,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Grouper Rate,5783.00
Blue Cross,PPO,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Grouper Rate,6588.00
Blue Cross,PPO,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Grouper Rate,5783.00
Blue Cross,PPO,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Grouper Rate,6588.00
Blue Cross,PPO,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5281.00
Blue Cross,PPO,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6588.00
Blue Cross,PPO,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5281.00
Blue Cross,PPO,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6588.00
Blue Cross,PPO,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5281.00
Blue Cross,PPO,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6588.00
Blue Cross,PPO,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,PPO,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,PPO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,PPO,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,8012.00
Blue Cross,PPO,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,5029.00
Blue Cross,PPO,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,5281.00
Blue Cross,PPO,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Grouper Rate,3544.00
Blue Cross,PPO,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Grouper Rate,3544.00
Blue Cross,PPO,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,99739.50
Blue Cross,PPO,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,5029.00
Blue Cross,PPO,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,5029.00
Blue Cross,PPO,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,1678.00
Blue Cross,PPO,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,1678.00
Blue Cross,PPO,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,67496.43
Blue Cross,PPO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Grouper Rate,1678.00
Blue Cross,PPO,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,6588.00
Blue Cross,PPO,239,DRG,Amputation for circ sys disorders exc upper limb & toe w MCC,,Case Rate,79535.89
Blue Cross,PPO,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,Grouper Rate,5281.00
Blue Cross,PPO,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Grouper Rate,1678.00
Blue Cross,PPO,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Grouper Rate,1678.88
Blue Cross,PPO,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,24,DRG,Cranio w major dev impl/acute complex CNS PDX w/o MCC,,Case Rate,65043.55
Blue Cross,PPO,240,DRG,Amputation for circ sys disorders exc upper limb & toe w CC,,Case Rate,46146.60
Blue Cross,PPO,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,1678.00
Blue Cross,PPO,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,1678.88
Blue Cross,PPO,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,PPO,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,241,DRG,Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC,,Case Rate,26321.75
Blue Cross,PPO,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Grouper Rate,1678.00
Blue Cross,PPO,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Grouper Rate,5029.00
Blue Cross,PPO,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Grouper Rate,3544.00
Blue Cross,PPO,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,3544.00
Blue Cross,PPO,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Grouper Rate,3544.00
Blue Cross,PPO,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Grouper Rate,3544.00
Blue Cross,PPO,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Grouper Rate,3544.00
Blue Cross,PPO,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,3544.00
Blue Cross,PPO,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Grouper Rate,3544.00
Blue Cross,PPO,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Grouper Rate,3544.00
Blue Cross,PPO,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Grouper Rate,1678.88
Blue Cross,PPO,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Grouper Rate,3544.00
Blue Cross,PPO,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,61570.15
Blue Cross,PPO,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,PPO,24220,CPT4/HCPCS,INJECTION FOR ELBOW X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,41889.20
Blue Cross,PPO,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Grouper Rate,1678.00
Blue Cross,PPO,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Grouper Rate,5029.00
Blue Cross,PPO,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Grouper Rate,5029.00
Blue Cross,PPO,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,3544.00
Blue Cross,PPO,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,3544.00
Blue Cross,PPO,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Grouper Rate,1678.88
Blue Cross,PPO,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Grouper Rate,1678.88
Blue Cross,PPO,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Grouper Rate,1678.88
Blue Cross,PPO,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Grouper Rate,3544.00
Blue Cross,PPO,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Grouper Rate,1678.88
Blue Cross,PPO,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Grouper Rate,3544.00
Blue Cross,PPO,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Grouper Rate,3544.00
Blue Cross,PPO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Grouper Rate,3544.00
Blue Cross,PPO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Grouper Rate,3544.00
Blue Cross,PPO,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Grouper Rate,6588.00
Blue Cross,PPO,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,5281.00
Blue Cross,PPO,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,5281.00
Blue Cross,PPO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,6588.00
Blue Cross,PPO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,6588.00
Blue Cross,PPO,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,34166.67
Blue Cross,PPO,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5029.00
Blue Cross,PPO,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5029.00
Blue Cross,PPO,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,3544.00
Blue Cross,PPO,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Grouper Rate,3544.00
Blue Cross,PPO,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Grouper Rate,1678.88
Blue Cross,PPO,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Grouper Rate,3544.00
Blue Cross,PPO,245,DRG,AICD lead & generator procedures,,Case Rate,89547.56
Blue Cross,PPO,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,51699.07
Blue Cross,PPO,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,32884.82
Blue Cross,PPO,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,52496.30
Blue Cross,PPO,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,31083.62
Blue Cross,PPO,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Grouper Rate,5029.00
Blue Cross,PPO,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Grouper Rate,5029.00
Blue Cross,PPO,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1678.88
Blue Cross,PPO,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,Grouper Rate,5029.00
Blue Cross,PPO,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,Grouper Rate,3544.00
Blue Cross,PPO,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,Grouper Rate,5029.00
Blue Cross,PPO,25,DRG,Craniotomy & endovascular intracranial procedures w MCC,,Case Rate,74292.71
Blue Cross,PPO,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,41727.11
Blue Cross,PPO,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Grouper Rate,3544.00
Blue Cross,PPO,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Grouper Rate,1678.00
Blue Cross,PPO,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,3544.00
Blue Cross,PPO,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,3544.00
Blue Cross,PPO,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,1678.88
Blue Cross,PPO,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,1678.88
Blue Cross,PPO,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Grouper Rate,1678.00
Blue Cross,PPO,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Grouper Rate,1678.88
Blue Cross,PPO,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,PPO,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,1678.88
Blue Cross,PPO,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Grouper Rate,1678.00
Blue Cross,PPO,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,PPO,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Grouper Rate,3544.00
Blue Cross,PPO,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Grouper Rate,3544.00
Blue Cross,PPO,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Grouper Rate,3544.00
Blue Cross,PPO,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Grouper Rate,3544.00
Blue Cross,PPO,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,27453.09
Blue Cross,PPO,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Grouper Rate,1678.88
Blue Cross,PPO,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,5029.00
Blue Cross,PPO,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Grouper Rate,3544.00
Blue Cross,PPO,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Grouper Rate,1678.00
Blue Cross,PPO,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,3544.00
Blue Cross,PPO,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,3544.00
Blue Cross,PPO,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Grouper Rate,3544.00
Blue Cross,PPO,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,5029.00
Blue Cross,PPO,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,5029.00
Blue Cross,PPO,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,PPO,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,3544.00
Blue Cross,PPO,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Grouper Rate,3544.00
Blue Cross,PPO,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,3544.00
Blue Cross,PPO,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,3544.00
Blue Cross,PPO,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Grouper Rate,3544.00
Blue Cross,PPO,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,3544.00
Blue Cross,PPO,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,3544.00
Blue Cross,PPO,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,1678.88
Blue Cross,PPO,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,1678.88
Blue Cross,PPO,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,252,DRG,Other vascular procedures w MCC,,Case Rate,54924.37
Blue Cross,PPO,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Grouper Rate,3544.00
Blue Cross,PPO,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Grouper Rate,5029.00
Blue Cross,PPO,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,5029.00
Blue Cross,PPO,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,5029.00
Blue Cross,PPO,25246,CPT4/HCPCS,INJECTION FOR WRIST X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,PPO,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,1678.00
Blue Cross,PPO,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,1678.00
Blue Cross,PPO,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Grouper Rate,1678.00
Blue Cross,PPO,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5029.00
Blue Cross,PPO,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,1678.88
Blue Cross,PPO,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,3544.00
Blue Cross,PPO,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5029.00
Blue Cross,PPO,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,3544.00
Blue Cross,PPO,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5029.00
Blue Cross,PPO,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Grouper Rate,3544.00
Blue Cross,PPO,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,253,DRG,Other vascular procedures w CC,,Case Rate,43892.19
Blue Cross,PPO,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,3544.00
Blue Cross,PPO,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,3544.00
Blue Cross,PPO,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,3544.00
Blue Cross,PPO,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,3544.00
Blue Cross,PPO,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Grouper Rate,3544.00
Blue Cross,PPO,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Grouper Rate,3544.00
Blue Cross,PPO,25350,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,3544.00
Blue Cross,PPO,25355,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,3544.00
Blue Cross,PPO,25360,CPT4/HCPCS,REVISION OF ULNA,,Grouper Rate,3544.00
Blue Cross,PPO,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,PPO,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,PPO,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,PPO,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,PPO,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Grouper Rate,5029.00
Blue Cross,PPO,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,PPO,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Grouper Rate,5281.00
Blue Cross,PPO,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Grouper Rate,3544.00
Blue Cross,PPO,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,29929.13
Blue Cross,PPO,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,PPO,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,5029.00
Blue Cross,PPO,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,PPO,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,5281.00
Blue Cross,PPO,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,3544.00
Blue Cross,PPO,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,PPO,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Grouper Rate,3544.00
Blue Cross,PPO,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Grouper Rate,5029.00
Blue Cross,PPO,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Grouper Rate,5029.00
Blue Cross,PPO,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Grouper Rate,6588.00
Blue Cross,PPO,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Grouper Rate,5281.00
Blue Cross,PPO,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Grouper Rate,5281.00
Blue Cross,PPO,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,25490,CPT4/HCPCS,REINFORCE RADIUS,,Grouper Rate,3544.00
Blue Cross,PPO,25491,CPT4/HCPCS,REINFORCE ULNA,,Grouper Rate,3544.00
Blue Cross,PPO,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Grouper Rate,5029.00
Blue Cross,PPO,255,DRG,Upper limb & toe amputation for circ system disorders w MCC,,Case Rate,42061.22
Blue Cross,PPO,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1678.00
Blue Cross,PPO,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1678.00
Blue Cross,PPO,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,3544.00
Blue Cross,PPO,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1678.00
Blue Cross,PPO,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,5029.00
Blue Cross,PPO,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,5029.00
Blue Cross,PPO,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,1678.00
Blue Cross,PPO,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,1678.00
Blue Cross,PPO,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,3544.00
Blue Cross,PPO,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,1678.88
Blue Cross,PPO,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,1678.88
Blue Cross,PPO,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,5029.00
Blue Cross,PPO,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,3544.00
Blue Cross,PPO,256,DRG,Upper limb & toe amputation for circ system disorders w CC,,Case Rate,27176.87
Blue Cross,PPO,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,1678.88
Blue Cross,PPO,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,1678.88
Blue Cross,PPO,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Grouper Rate,1678.88
Blue Cross,PPO,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Grouper Rate,3544.00
Blue Cross,PPO,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Grouper Rate,3544.00
Blue Cross,PPO,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Grouper Rate,3544.00
Blue Cross,PPO,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Grouper Rate,5029.00
Blue Cross,PPO,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,257,DRG,Upper limb & toe amputation for circ system disorders w/o CC/MCC,,Case Rate,19202.94
Blue Cross,PPO,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,52949.50
Blue Cross,PPO,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Grouper Rate,5029.00
Blue Cross,PPO,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Grouper Rate,3544.00
Blue Cross,PPO,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,35068.10
Blue Cross,PPO,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,6588.00
Blue Cross,PPO,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,6588.00
Blue Cross,PPO,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,5029.00
Blue Cross,PPO,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,5281.00
Blue Cross,PPO,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,3544.00
Blue Cross,PPO,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,25927,CPT4/HCPCS,AMPUTATION OF HAND,,Grouper Rate,3544.00
Blue Cross,PPO,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1678.88
Blue Cross,PPO,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,26,DRG,Craniotomy & endovascular intracranial procedures w CC,,Case Rate,50579.32
Blue Cross,PPO,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,59282.66
Blue Cross,PPO,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Grouper Rate,1678.00
Blue Cross,PPO,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Grouper Rate,1678.00
Blue Cross,PPO,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Grouper Rate,1678.88
Blue Cross,PPO,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,5029.00
Blue Cross,PPO,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,5029.00
Blue Cross,PPO,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,PPO,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,1678.88
Blue Cross,PPO,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Grouper Rate,1678.88
Blue Cross,PPO,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,32936.10
Blue Cross,PPO,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Grouper Rate,1678.88
Blue Cross,PPO,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,1678.00
Blue Cross,PPO,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,1678.00
Blue Cross,PPO,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Grouper Rate,1678.88
Blue Cross,PPO,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Grouper Rate,3544.00
Blue Cross,PPO,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,3544.00
Blue Cross,PPO,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,5029.00
Blue Cross,PPO,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,1678.88
Blue Cross,PPO,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Grouper Rate,3544.00
Blue Cross,PPO,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Grouper Rate,3544.00
Blue Cross,PPO,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Grouper Rate,3544.00
Blue Cross,PPO,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Grouper Rate,1678.88
Blue Cross,PPO,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,28251.97
Blue Cross,PPO,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Grouper Rate,1678.88
Blue Cross,PPO,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Grouper Rate,3544.00
Blue Cross,PPO,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Grouper Rate,1678.88
Blue Cross,PPO,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,1678.88
Blue Cross,PPO,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,1678.88
Blue Cross,PPO,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,263,DRG,Vein ligation & stripping,,Case Rate,38129.66
Blue Cross,PPO,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Grouper Rate,1678.88
Blue Cross,PPO,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Grouper Rate,1678.00
Blue Cross,PPO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Grouper Rate,1678.00
Blue Cross,PPO,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,1678.88
Blue Cross,PPO,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,264,DRG,Other circulatory system O.R. procedures,,Case Rate,53718.61
Blue Cross,PPO,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Grouper Rate,5281.00
Blue Cross,PPO,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Grouper Rate,3544.00
Blue Cross,PPO,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,1678.88
Blue Cross,PPO,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,1678.88
Blue Cross,PPO,26476,CPT4/HCPCS,TENDON LENGTHENING,,Grouper Rate,1678.00
Blue Cross,PPO,26477,CPT4/HCPCS,TENDON SHORTENING,,Grouper Rate,1678.00
Blue Cross,PPO,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Grouper Rate,1678.88
Blue Cross,PPO,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Grouper Rate,3544.00
Blue Cross,PPO,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,3544.00
Blue Cross,PPO,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,5029.00
Blue Cross,PPO,26499,CPT4/HCPCS,REVISION OF FINGER,,Grouper Rate,3544.00
Blue Cross,PPO,265,DRG,AICD lead procedures,,Case Rate,55619.05
Blue Cross,PPO,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,5029.00
Blue Cross,PPO,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,5029.00
Blue Cross,PPO,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Grouper Rate,3544.00
Blue Cross,PPO,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Grouper Rate,1678.88
Blue Cross,PPO,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,3544.00
Blue Cross,PPO,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,5029.00
Blue Cross,PPO,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Grouper Rate,5029.00
Blue Cross,PPO,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Grouper Rate,3544.00
Blue Cross,PPO,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Grouper Rate,5281.00
Blue Cross,PPO,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Grouper Rate,5281.00
Blue Cross,PPO,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Grouper Rate,5281.00
Blue Cross,PPO,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Grouper Rate,5281.00
Blue Cross,PPO,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Grouper Rate,3544.00
Blue Cross,PPO,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,Grouper Rate,5029.00
Blue Cross,PPO,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,1678.88
Blue Cross,PPO,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,3544.00
Blue Cross,PPO,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,5029.00
Blue Cross,PPO,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Grouper Rate,5281.00
Blue Cross,PPO,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Grouper Rate,5281.00
Blue Cross,PPO,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Grouper Rate,3544.00
Blue Cross,PPO,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Grouper Rate,5281.00
Blue Cross,PPO,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Grouper Rate,5281.00
Blue Cross,PPO,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Grouper Rate,5281.00
Blue Cross,PPO,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Grouper Rate,3544.00
Blue Cross,PPO,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Grouper Rate,3544.00
Blue Cross,PPO,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Grouper Rate,1678.88
Blue Cross,PPO,266,DRG,Endovascular Cardiac Valve Replacement w MCC,,Case Rate,117387.68
Blue Cross,PPO,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,267,DRG,Endovascular Cardiac Valve Replacement w/o MCC,,Case Rate,92638.88
Blue Cross,PPO,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,5029.00
Blue Cross,PPO,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,PPO,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,PPO,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,PPO,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,PPO,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,PPO,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,PPO,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,PPO,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,PPO,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,PPO,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Grouper Rate,1678.88
Blue Cross,PPO,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,5029.00
Blue Cross,PPO,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,268,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w MCC,,Case Rate,115029.08
Blue Cross,PPO,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,26841,CPT4/HCPCS,FUSION OF THUMB,,Grouper Rate,5029.00
Blue Cross,PPO,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Grouper Rate,5029.00
Blue Cross,PPO,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,269,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w/o MCC,,Case Rate,71363.48
Blue Cross,PPO,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Grouper Rate,3544.00
Blue Cross,PPO,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,1678.88
Blue Cross,PPO,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,5029.00
Blue Cross,PPO,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Grouper Rate,1678.00
Blue Cross,PPO,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Grouper Rate,1678.00
Blue Cross,PPO,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,27,DRG,Craniotomy & endovascular intracranial procedures w/o CC/MCC,,Case Rate,41545.17
Blue Cross,PPO,270,DRG,Other Major Cardiovascular Procedures w MCC,,Case Rate,85703.66
Blue Cross,PPO,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,1678.88
Blue Cross,PPO,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Grouper Rate,3544.00
Blue Cross,PPO,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,Grouper Rate,1678.00
Blue Cross,PPO,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Grouper Rate,1678.00
Blue Cross,PPO,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,Grouper Rate,5029.00
Blue Cross,PPO,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,PPO,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,1678.88
Blue Cross,PPO,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,PPO,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,Grouper Rate,3544.00
Blue Cross,PPO,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Grouper Rate,1678.00
Blue Cross,PPO,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Grouper Rate,5029.00
Blue Cross,PPO,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Grouper Rate,5029.00
Blue Cross,PPO,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Grouper Rate,5281.00
Blue Cross,PPO,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Grouper Rate,5783.00
Blue Cross,PPO,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Grouper Rate,6588.00
Blue Cross,PPO,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,Grouper Rate,1678.88
Blue Cross,PPO,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,Grouper Rate,3544.00
Blue Cross,PPO,27075,CPT4/HCPCS,RESECT HIP TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,Grouper Rate,5783.00
Blue Cross,PPO,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,Grouper Rate,5029.00
Blue Cross,PPO,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,Grouper Rate,3544.00
Blue Cross,PPO,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Grouper Rate,1678.88
Blue Cross,PPO,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,3544.00
Blue Cross,PPO,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,PPO,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,PPO,27093,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,27095,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Grouper Rate,1678.00
Blue Cross,PPO,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Grouper Rate,3544.00
Blue Cross,PPO,271,DRG,Other Major Cardiovascular Procedures w CC,,Case Rate,58958.48
Blue Cross,PPO,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Grouper Rate,5029.00
Blue Cross,PPO,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Grouper Rate,5029.00
Blue Cross,PPO,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,5029.00
Blue Cross,PPO,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,5029.00
Blue Cross,PPO,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Grouper Rate,5783.00
Blue Cross,PPO,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Grouper Rate,5281.00
Blue Cross,PPO,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,Grouper Rate,5783.00
Blue Cross,PPO,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Grouper Rate,5783.00
Blue Cross,PPO,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Grouper Rate,5783.00
Blue Cross,PPO,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,5783.00
Blue Cross,PPO,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,5281.00
Blue Cross,PPO,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,5281.00
Blue Cross,PPO,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,Grouper Rate,5029.00
Blue Cross,PPO,27146,CPT4/HCPCS,INCISION OF HIP BONE,,Grouper Rate,5281.00
Blue Cross,PPO,27147,CPT4/HCPCS,REVISION OF HIP BONE,,Grouper Rate,5783.00
Blue Cross,PPO,27151,CPT4/HCPCS,INCISION OF HIP BONES,,Grouper Rate,5783.00
Blue Cross,PPO,27156,CPT4/HCPCS,REVISION OF HIP BONES,,Grouper Rate,6588.00
Blue Cross,PPO,27158,CPT4/HCPCS,REVISION OF PELVIS,,Grouper Rate,5281.00
Blue Cross,PPO,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,Grouper Rate,5281.00
Blue Cross,PPO,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,Grouper Rate,1678.00
Blue Cross,PPO,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,Grouper Rate,5281.00
Blue Cross,PPO,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,1678.88
Blue Cross,PPO,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5281.00
Blue Cross,PPO,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5783.00
Blue Cross,PPO,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5029.00
Blue Cross,PPO,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,Grouper Rate,6588.00
Blue Cross,PPO,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,5783.00
Blue Cross,PPO,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,Grouper Rate,5281.00
Blue Cross,PPO,27187,CPT4/HCPCS,REINFORCE HIP BONES,,Grouper Rate,5783.00
Blue Cross,PPO,27193,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27194,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,1678.00
Blue Cross,PPO,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,1678.88
Blue Cross,PPO,272,DRG,Other Major Cardiovascular Procedures w/o CC/MCC,,Case Rate,44472.75
Blue Cross,PPO,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,Grouper Rate,5029.00
Blue Cross,PPO,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Grouper Rate,5281.00
Blue Cross,PPO,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Grouper Rate,5281.00
Blue Cross,PPO,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5029.00
Blue Cross,PPO,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5029.00
Blue Cross,PPO,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,5029.00
Blue Cross,PPO,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27269,CPT4/HCPCS,OPTX THIGH FX,,Grouper Rate,5281.00
Blue Cross,PPO,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Grouper Rate,1678.00
Blue Cross,PPO,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,Grouper Rate,6588.00
Blue Cross,PPO,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Grouper Rate,5281.00
Blue Cross,PPO,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Grouper Rate,5029.00
Blue Cross,PPO,273,DRG,Percutaneous Intracardiac Procedures w MCC,,Case Rate,63467.28
Blue Cross,PPO,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Grouper Rate,1678.88
Blue Cross,PPO,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,5029.00
Blue Cross,PPO,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,PPO,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,1678.00
Blue Cross,PPO,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Grouper Rate,1678.00
Blue Cross,PPO,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Grouper Rate,1678.00
Blue Cross,PPO,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Grouper Rate,1678.88
Blue Cross,PPO,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Grouper Rate,3544.00
Blue Cross,PPO,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,PPO,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,5029.00
Blue Cross,PPO,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,5029.00
Blue Cross,PPO,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,PPO,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,PPO,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Grouper Rate,1678.00
Blue Cross,PPO,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Grouper Rate,3544.00
Blue Cross,PPO,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Grouper Rate,5029.00
Blue Cross,PPO,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Grouper Rate,5029.00
Blue Cross,PPO,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Grouper Rate,5029.00
Blue Cross,PPO,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Grouper Rate,3544.00
Blue Cross,PPO,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Grouper Rate,1678.88
Blue Cross,PPO,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Grouper Rate,5029.00
Blue Cross,PPO,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,Grouper Rate,5783.00
Blue Cross,PPO,27369,CPT4/HCPCS,NJX CNTRST KNE ARTHG/CT/MRI,,Grouper Rate,1678.00
Blue Cross,PPO,27370,CPT4/HCPCS,INJECTION FOR KNEE X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,3544.00
Blue Cross,PPO,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Grouper Rate,3544.00
Blue Cross,PPO,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Grouper Rate,3544.00
Blue Cross,PPO,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,1678.88
Blue Cross,PPO,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,3544.00
Blue Cross,PPO,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Grouper Rate,1678.88
Blue Cross,PPO,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,3544.00
Blue Cross,PPO,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,3544.00
Blue Cross,PPO,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Grouper Rate,5029.00
Blue Cross,PPO,274,DRG,Percutaneous Intracardiac Procedures w/o MCC,,Case Rate,54340.51
Blue Cross,PPO,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Grouper Rate,3544.00
Blue Cross,PPO,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Grouper Rate,5029.00
Blue Cross,PPO,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,5029.00
Blue Cross,PPO,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,5029.00
Blue Cross,PPO,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Grouper Rate,5029.00
Blue Cross,PPO,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Grouper Rate,6588.00
Blue Cross,PPO,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Grouper Rate,8012.00
Blue Cross,PPO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Grouper Rate,8012.00
Blue Cross,PPO,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Grouper Rate,3544.00
Blue Cross,PPO,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,5029.00
Blue Cross,PPO,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,5783.00
Blue Cross,PPO,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Grouper Rate,3544.00
Blue Cross,PPO,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Grouper Rate,5281.00
Blue Cross,PPO,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,3544.00
Blue Cross,PPO,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,8012.00
Blue Cross,PPO,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,5029.00
Blue Cross,PPO,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Grouper Rate,5029.00
Blue Cross,PPO,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,27437,CPT4/HCPCS,REVISE KNEECAP,,Grouper Rate,5029.00
Blue Cross,PPO,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Grouper Rate,5281.00
Blue Cross,PPO,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,8841.00
Blue Cross,PPO,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Grouper Rate,8841.00
Blue Cross,PPO,27448,CPT4/HCPCS,INCISION OF THIGH,,Grouper Rate,5281.00
Blue Cross,PPO,27450,CPT4/HCPCS,INCISION OF THIGH,,Grouper Rate,6588.00
Blue Cross,PPO,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,Grouper Rate,5281.00
Blue Cross,PPO,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,Grouper Rate,5281.00
Blue Cross,PPO,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,Grouper Rate,5783.00
Blue Cross,PPO,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,Grouper Rate,5281.00
Blue Cross,PPO,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,Grouper Rate,5281.00
Blue Cross,PPO,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,Grouper Rate,5281.00
Blue Cross,PPO,27470,CPT4/HCPCS,REPAIR OF THIGH,,Grouper Rate,5029.00
Blue Cross,PPO,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,Grouper Rate,5281.00
Blue Cross,PPO,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,1678.88
Blue Cross,PPO,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,1678.88
Blue Cross,PPO,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,6588.00
Blue Cross,PPO,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,5783.00
Blue Cross,PPO,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,Grouper Rate,5029.00
Blue Cross,PPO,27495,CPT4/HCPCS,REINFORCE THIGH,,Grouper Rate,5029.00
Blue Cross,PPO,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,1678.88
Blue Cross,PPO,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,1678.88
Blue Cross,PPO,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,3544.00
Blue Cross,PPO,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,3544.00
Blue Cross,PPO,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5783.00
Blue Cross,PPO,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5783.00
Blue Cross,PPO,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5281.00
Blue Cross,PPO,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1678.00
Blue Cross,PPO,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1678.00
Blue Cross,PPO,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,5281.00
Blue Cross,PPO,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Grouper Rate,1678.00
Blue Cross,PPO,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Grouper Rate,1678.00
Blue Cross,PPO,27580,CPT4/HCPCS,FUSION OF KNEE,,Grouper Rate,5281.00
Blue Cross,PPO,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,3544.00
Blue Cross,PPO,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,5281.00
Blue Cross,PPO,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,5029.00
Blue Cross,PPO,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,Grouper Rate,5029.00
Blue Cross,PPO,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,1678.88
Blue Cross,PPO,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,1678.88
Blue Cross,PPO,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,3544.00
Blue Cross,PPO,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Grouper Rate,1678.00
Blue Cross,PPO,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Grouper Rate,1678.00
Blue Cross,PPO,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,1678.88
Blue Cross,PPO,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,1678.00
Blue Cross,PPO,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,1678.88
Blue Cross,PPO,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Grouper Rate,1678.88
Blue Cross,PPO,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Grouper Rate,3544.00
Blue Cross,PPO,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,PPO,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,5029.00
Blue Cross,PPO,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Grouper Rate,3544.00
Blue Cross,PPO,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5029.00
Blue Cross,PPO,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5029.00
Blue Cross,PPO,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Grouper Rate,1678.88
Blue Cross,PPO,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Grouper Rate,1678.88
Blue Cross,PPO,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,Grouper Rate,5029.00
Blue Cross,PPO,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,Grouper Rate,1678.88
Blue Cross,PPO,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Grouper Rate,1678.88
Blue Cross,PPO,27648,CPT4/HCPCS,INJECTION FOR ANKLE X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Grouper Rate,1678.88
Blue Cross,PPO,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.00
Blue Cross,PPO,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.88
Blue Cross,PPO,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.88
Blue Cross,PPO,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,1678.88
Blue Cross,PPO,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,1678.88
Blue Cross,PPO,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,3544.00
Blue Cross,PPO,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Grouper Rate,1678.88
Blue Cross,PPO,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Grouper Rate,1678.88
Blue Cross,PPO,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Grouper Rate,1678.88
Blue Cross,PPO,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,5029.00
Blue Cross,PPO,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,1678.88
Blue Cross,PPO,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Grouper Rate,1678.88
Blue Cross,PPO,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,1678.88
Blue Cross,PPO,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,Grouper Rate,5281.00
Blue Cross,PPO,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Grouper Rate,1678.88
Blue Cross,PPO,27705,CPT4/HCPCS,INCISION OF TIBIA,,Grouper Rate,1678.88
Blue Cross,PPO,27707,CPT4/HCPCS,INCISION OF FIBULA,,Grouper Rate,1678.88
Blue Cross,PPO,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Grouper Rate,3544.00
Blue Cross,PPO,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,Grouper Rate,5029.00
Blue Cross,PPO,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Grouper Rate,5029.00
Blue Cross,PPO,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Grouper Rate,5029.00
Blue Cross,PPO,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,5281.00
Blue Cross,PPO,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,5281.00
Blue Cross,PPO,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,Grouper Rate,3544.00
Blue Cross,PPO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Grouper Rate,5281.00
Blue Cross,PPO,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,Grouper Rate,3544.00
Blue Cross,PPO,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Grouper Rate,1678.88
Blue Cross,PPO,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Grouper Rate,1678.88
Blue Cross,PPO,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Grouper Rate,1678.88
Blue Cross,PPO,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,1678.88
Blue Cross,PPO,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,1678.88
Blue Cross,PPO,27745,CPT4/HCPCS,REINFORCE TIBIA,,Grouper Rate,3544.00
Blue Cross,PPO,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Grouper Rate,1678.00
Blue Cross,PPO,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Grouper Rate,1678.00
Blue Cross,PPO,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Grouper Rate,3544.00
Blue Cross,PPO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Grouper Rate,1678.00
Blue Cross,PPO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Grouper Rate,1678.00
Blue Cross,PPO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Grouper Rate,3544.00
Blue Cross,PPO,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,5029.00
Blue Cross,PPO,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Grouper Rate,1678.88
Blue Cross,PPO,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Grouper Rate,1678.00
Blue Cross,PPO,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Grouper Rate,5029.00
Blue Cross,PPO,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,5783.00
Blue Cross,PPO,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,5281.00
Blue Cross,PPO,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,5281.00
Blue Cross,PPO,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,6588.00
Blue Cross,PPO,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,6588.00
Blue Cross,PPO,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,1678.88
Blue Cross,PPO,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,1678.88
Blue Cross,PPO,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,3544.00
Blue Cross,PPO,28,DRG,Spinal procedures w MCC,,Case Rate,96262.80
Blue Cross,PPO,280,DRG,Acute myocardial infarction, discharged alive w MCC,,Case Rate,26897.34
Blue Cross,PPO,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Grouper Rate,1678.00
Blue Cross,PPO,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,1678.88
Blue Cross,PPO,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,3544.00
Blue Cross,PPO,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Grouper Rate,1678.88
Blue Cross,PPO,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Grouper Rate,1678.00
Blue Cross,PPO,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,1678.88
Blue Cross,PPO,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,1678.00
Blue Cross,PPO,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Grouper Rate,1678.00
Blue Cross,PPO,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Grouper Rate,5029.00
Blue Cross,PPO,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Grouper Rate,1678.00
Blue Cross,PPO,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Grouper Rate,1678.88
Blue Cross,PPO,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Grouper Rate,1678.88
Blue Cross,PPO,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Grouper Rate,3544.00
Blue Cross,PPO,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Grouper Rate,3544.00
Blue Cross,PPO,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Grouper Rate,3544.00
Blue Cross,PPO,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,1678.88
Blue Cross,PPO,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,1678.00
Blue Cross,PPO,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Grouper Rate,1678.88
Blue Cross,PPO,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Grouper Rate,1678.88
Blue Cross,PPO,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Grouper Rate,3544.00
Blue Cross,PPO,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,3544.00
Blue Cross,PPO,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,3544.00
Blue Cross,PPO,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3544.00
Blue Cross,PPO,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,PPO,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,1678.88
Blue Cross,PPO,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3544.00
Blue Cross,PPO,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,3544.00
Blue Cross,PPO,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,15416.93
Blue Cross,PPO,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Grouper Rate,1678.88
Blue Cross,PPO,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,PPO,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,PPO,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,1678.88
Blue Cross,PPO,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,PPO,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,3544.00
Blue Cross,PPO,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,1678.88
Blue Cross,PPO,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,PPO,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,PPO,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,PPO,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,PPO,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Grouper Rate,3544.00
Blue Cross,PPO,28116,CPT4/HCPCS,REVISION OF FOOT,,Grouper Rate,3544.00
Blue Cross,PPO,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Grouper Rate,3544.00
Blue Cross,PPO,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Grouper Rate,3544.00
Blue Cross,PPO,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Grouper Rate,3544.00
Blue Cross,PPO,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,3544.00
Blue Cross,PPO,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.00
Blue Cross,PPO,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.00
Blue Cross,PPO,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Grouper Rate,3544.00
Blue Cross,PPO,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,PPO,28150,CPT4/HCPCS,REMOVAL OF TOE,,Grouper Rate,1678.88
Blue Cross,PPO,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.88
Blue Cross,PPO,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,1678.88
Blue Cross,PPO,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,PPO,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,PPO,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,11999.77
Blue Cross,PPO,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,1678.00
Blue Cross,PPO,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,1678.00
Blue Cross,PPO,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Grouper Rate,1678.00
Blue Cross,PPO,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Grouper Rate,1678.00
Blue Cross,PPO,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Grouper Rate,1678.88
Blue Cross,PPO,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Grouper Rate,3544.00
Blue Cross,PPO,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,3544.00
Blue Cross,PPO,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Grouper Rate,5029.00
Blue Cross,PPO,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,1678.00
Blue Cross,PPO,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Grouper Rate,1678.00
Blue Cross,PPO,28280,CPT4/HCPCS,FUSION OF TOES,,Grouper Rate,1678.88
Blue Cross,PPO,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,3544.00
Blue Cross,PPO,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,3544.00
Blue Cross,PPO,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,1678.88
Blue Cross,PPO,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Grouper Rate,3544.00
Blue Cross,PPO,28290,CPT4/HCPCS,CORRECTION OF BUNION,,Grouper Rate,1678.88
Blue Cross,PPO,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Grouper Rate,3544.00
Blue Cross,PPO,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,1678.88
Blue Cross,PPO,28293,CPT4/HCPCS,CORRECTION OF BUNION,,Grouper Rate,3544.00
Blue Cross,PPO,28294,CPT4/HCPCS,CORRECTION OF BUNION,,Grouper Rate,3544.00
Blue Cross,PPO,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,1678.88
Blue Cross,PPO,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,PPO,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,PPO,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,PPO,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,3544.00
Blue Cross,PPO,283,DRG,Acute myocardial infarction, expired w MCC,,Case Rate,30840.48
Blue Cross,PPO,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Grouper Rate,1678.88
Blue Cross,PPO,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Grouper Rate,1678.88
Blue Cross,PPO,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Grouper Rate,1678.88
Blue Cross,PPO,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Grouper Rate,3544.00
Blue Cross,PPO,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,5029.00
Blue Cross,PPO,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,5281.00
Blue Cross,PPO,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,3544.00
Blue Cross,PPO,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Grouper Rate,5029.00
Blue Cross,PPO,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Grouper Rate,3544.00
Blue Cross,PPO,28312,CPT4/HCPCS,REVISION OF TOE,,Grouper Rate,3544.00
Blue Cross,PPO,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Grouper Rate,1678.88
Blue Cross,PPO,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Grouper Rate,1678.88
Blue Cross,PPO,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,PPO,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Grouper Rate,5029.00
Blue Cross,PPO,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Grouper Rate,3544.00
Blue Cross,PPO,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Grouper Rate,3544.00
Blue Cross,PPO,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Grouper Rate,3544.00
Blue Cross,PPO,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Grouper Rate,3544.00
Blue Cross,PPO,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,Grouper Rate,5029.00
Blue Cross,PPO,284,DRG,Acute myocardial infarction, expired w CC,,Case Rate,12143.66
Blue Cross,PPO,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Grouper Rate,3544.00
Blue Cross,PPO,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,PPO,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,1678.00
Blue Cross,PPO,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,3544.00
Blue Cross,PPO,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,285,DRG,Acute myocardial infarction, expired w/o CC/MCC,,Case Rate,8210.45
Blue Cross,PPO,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Grouper Rate,3544.00
Blue Cross,PPO,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,1678.00
Blue Cross,PPO,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,36621.21
Blue Cross,PPO,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.00
Blue Cross,PPO,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1678.88
Blue Cross,PPO,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Grouper Rate,3544.00
Blue Cross,PPO,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,19021.00
Blue Cross,PPO,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,PPO,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,PPO,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,PPO,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,PPO,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,PPO,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Grouper Rate,5281.00
Blue Cross,PPO,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,5029.00
Blue Cross,PPO,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,3544.00
Blue Cross,PPO,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,5029.00
Blue Cross,PPO,288,DRG,Acute & subacute endocarditis w MCC,,Case Rate,44343.74
Blue Cross,PPO,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,Grouper Rate,3544.00
Blue Cross,PPO,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Grouper Rate,3544.00
Blue Cross,PPO,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Grouper Rate,1678.88
Blue Cross,PPO,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Grouper Rate,1678.88
Blue Cross,PPO,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Grouper Rate,1678.88
Blue Cross,PPO,28890,CPT4/HCPCS,HI ENRGY ESWT PLANTAR FASCIA,,Grouper Rate,3544.00
Blue Cross,PPO,289,DRG,Acute & subacute endocarditis w CC,,Case Rate,27168.60
Blue Cross,PPO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,Case Rate,54499.30
Blue Cross,PPO,290,DRG,Acute & subacute endocarditis w/o CC/MCC,,Case Rate,16930.34
Blue Cross,PPO,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,PPO,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,PPO,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,PPO,29020,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,PPO,29025,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,3544.00
Blue Cross,PPO,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,PPO,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,PPO,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,PPO,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1678.88
Blue Cross,PPO,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,Grouper Rate,1678.00
Blue Cross,PPO,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Grouper Rate,1678.00
Blue Cross,PPO,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Grouper Rate,1678.00
Blue Cross,PPO,29086,CPT4/HCPCS,APPLY FINGER CAST,,Grouper Rate,1678.00
Blue Cross,PPO,291,DRG,Heart failure & shock w MCC,,Case Rate,22178.48
Blue Cross,PPO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Per Date of Service,193.00
Blue Cross,PPO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Per Date of Service,193.00
Blue Cross,PPO,292,DRG,Heart failure & shock w CC,,Case Rate,14804.95
Blue Cross,PPO,29200,CPT4/HCPCS,STRAPPING OF CHEST,,Grouper Rate,1678.00
Blue Cross,PPO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Per Date of Service,193.00
Blue Cross,PPO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Per Date of Service,193.00
Blue Cross,PPO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Per Date of Service,193.00
Blue Cross,PPO,293,DRG,Heart failure & shock w/o CC/MCC,,Case Rate,10794.00
Blue Cross,PPO,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Grouper Rate,1678.00
Blue Cross,PPO,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Grouper Rate,1678.00
Blue Cross,PPO,294,DRG,Deep vein thrombophlebitis w CC/MCC,,Case Rate,21205.93
Blue Cross,PPO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,Per Date of Service,193.00
Blue Cross,PPO,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,Grouper Rate,1678.00
Blue Cross,PPO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,Grouper Rate,1678.00
Blue Cross,PPO,295,DRG,Deep vein thrombophlebitis w/o CC/MCC,,Case Rate,16230.70
Blue Cross,PPO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Per Date of Service,193.00
Blue Cross,PPO,29520,CPT4/HCPCS,STRAPPING OF HIP,,Per Date of Service,193.00
Blue Cross,PPO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,Per Date of Service,193.00
Blue Cross,PPO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,Grouper Rate,1678.00
Blue Cross,PPO,29550,CPT4/HCPCS,STRAPPING OF TOES,,Per Date of Service,193.00
Blue Cross,PPO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Grouper Rate,1678.00
Blue Cross,PPO,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,Grouper Rate,1678.00
Blue Cross,PPO,29582,CPT4/HCPCS,APPLY MULTLAY COMPRS UPR LEG,,Grouper Rate,1678.00
Blue Cross,PPO,29583,CPT4/HCPCS,APPLY MULTLAY COMPRS UPR ARM,,Grouper Rate,1678.00
Blue Cross,PPO,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,Grouper Rate,1678.00
Blue Cross,PPO,296,DRG,Cardiac arrest, unexplained w MCC,,Case Rate,26377.99
Blue Cross,PPO,297,DRG,Cardiac arrest, unexplained w CC,,Case Rate,11654.08
Blue Cross,PPO,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1678.00
Blue Cross,PPO,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1678.00
Blue Cross,PPO,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,Grouper Rate,1678.00
Blue Cross,PPO,29730,CPT4/HCPCS,WINDOWING OF CAST,,Grouper Rate,1678.00
Blue Cross,PPO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,Per Date of Service,193.00
Blue Cross,PPO,298,DRG,Cardiac arrest, unexplained w/o CC/MCC,,Case Rate,8074.82
Blue Cross,PPO,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Grouper Rate,5029.00
Blue Cross,PPO,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Grouper Rate,5281.00
Blue Cross,PPO,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Grouper Rate,6588.00
Blue Cross,PPO,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Grouper Rate,3544.00
Blue Cross,PPO,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Grouper Rate,3544.00
Blue Cross,PPO,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Grouper Rate,3544.00
Blue Cross,PPO,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Grouper Rate,5029.00
Blue Cross,PPO,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Grouper Rate,5281.00
Blue Cross,PPO,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Grouper Rate,5029.00
Blue Cross,PPO,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Grouper Rate,3544.00
Blue Cross,PPO,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Grouper Rate,5281.00
Blue Cross,PPO,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Grouper Rate,6588.00
Blue Cross,PPO,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Grouper Rate,5281.00
Blue Cross,PPO,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Grouper Rate,3544.00
Blue Cross,PPO,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Grouper Rate,3544.00
Blue Cross,PPO,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Grouper Rate,1678.88
Blue Cross,PPO,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Grouper Rate,5029.00
Blue Cross,PPO,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Grouper Rate,3544.00
Blue Cross,PPO,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Grouper Rate,5783.00
Blue Cross,PPO,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,8841.00
Blue Cross,PPO,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,8841.00
Blue Cross,PPO,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Grouper Rate,6588.00
Blue Cross,PPO,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Grouper Rate,3544.00
Blue Cross,PPO,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Grouper Rate,3544.00
Blue Cross,PPO,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,8012.00
Blue Cross,PPO,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,8012.00
Blue Cross,PPO,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Grouper Rate,3544.00
Blue Cross,PPO,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,8012.00
Blue Cross,PPO,299,DRG,Peripheral vascular disorders w MCC,,Case Rate,25329.35
Blue Cross,PPO,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Grouper Rate,1678.88
Blue Cross,PPO,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,PPO,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,PPO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Grouper Rate,3544.00
Blue Cross,PPO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Grouper Rate,3544.00
Blue Cross,PPO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Grouper Rate,3544.00
Blue Cross,PPO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Grouper Rate,3544.00
Blue Cross,PPO,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Grouper Rate,6588.00
Blue Cross,PPO,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Grouper Rate,6588.00
Blue Cross,PPO,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Grouper Rate,6588.00
Blue Cross,PPO,3,DRG,ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R.,,Case Rate,314114.44
Blue Cross,PPO,30,DRG,Spinal procedures w/o CC/MCC,,Case Rate,38986.43
Blue Cross,PPO,300,DRG,Peripheral vascular disorders w CC,,Case Rate,17237.98
Blue Cross,PPO,301,DRG,Peripheral vascular disorders w/o CC/MCC,,Case Rate,12280.95
Blue Cross,PPO,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,1678.00
Blue Cross,PPO,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,1678.88
Blue Cross,PPO,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,1678.88
Blue Cross,PPO,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,3544.00
Blue Cross,PPO,30120,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,1678.00
Blue Cross,PPO,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,1678.00
Blue Cross,PPO,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Grouper Rate,1678.00
Blue Cross,PPO,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Grouper Rate,1678.88
Blue Cross,PPO,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Grouper Rate,3544.00
Blue Cross,PPO,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Grouper Rate,5029.00
Blue Cross,PPO,302,DRG,Atherosclerosis w MCC,,Case Rate,18086.49
Blue Cross,PPO,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Grouper Rate,1678.00
Blue Cross,PPO,303,DRG,Atherosclerosis w/o MCC,,Case Rate,11187.65
Blue Cross,PPO,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,PPO,304,DRG,Hypertension w MCC,,Case Rate,18121.22
Blue Cross,PPO,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5029.00
Blue Cross,PPO,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5281.00
Blue Cross,PPO,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5281.00
Blue Cross,PPO,30430,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,3544.00
Blue Cross,PPO,30435,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,PPO,30450,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,PPO,30460,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,PPO,30462,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5281.00
Blue Cross,PPO,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Grouper Rate,3544.00
Blue Cross,PPO,305,DRG,Hypertension w/o MCC,,Case Rate,12214.79
Blue Cross,PPO,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Grouper Rate,6588.00
Blue Cross,PPO,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,5281.00
Blue Cross,PPO,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,1678.00
Blue Cross,PPO,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Grouper Rate,1678.00
Blue Cross,PPO,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Grouper Rate,5029.00
Blue Cross,PPO,306,DRG,Cardiac congenital & valvular disorders w MCC,,Case Rate,24871.19
Blue Cross,PPO,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Grouper Rate,5029.00
Blue Cross,PPO,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Grouper Rate,6588.00
Blue Cross,PPO,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Grouper Rate,6588.00
Blue Cross,PPO,307,DRG,Cardiac congenital & valvular disorders w/o MCC,,Case Rate,14363.33
Blue Cross,PPO,308,DRG,Cardiac arrhythmia & conduction disorders w MCC,,Case Rate,19836.42
Blue Cross,PPO,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Grouper Rate,1678.00
Blue Cross,PPO,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Grouper Rate,1678.00
Blue Cross,PPO,309,DRG,Cardiac arrhythmia & conduction disorders w CC,,Case Rate,12395.07
Blue Cross,PPO,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,PPO,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,PPO,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,PPO,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Grouper Rate,1678.00
Blue Cross,PPO,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Grouper Rate,1678.88
Blue Cross,PPO,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Grouper Rate,1678.00
Blue Cross,PPO,31,DRG,Ventricular shunt procedures w MCC,,Case Rate,72215.29
Blue Cross,PPO,310,DRG,Cardiac arrhythmia & conduction disorders w/o CC/MCC,,Case Rate,9235.93
Blue Cross,PPO,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Grouper Rate,1678.00
Blue Cross,PPO,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Grouper Rate,1678.00
Blue Cross,PPO,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,1678.88
Blue Cross,PPO,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,3544.00
Blue Cross,PPO,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Grouper Rate,5029.00
Blue Cross,PPO,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,Grouper Rate,5029.00
Blue Cross,PPO,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Grouper Rate,1678.88
Blue Cross,PPO,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,1678.88
Blue Cross,PPO,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,PPO,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,PPO,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,PPO,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,PPO,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5029.00
Blue Cross,PPO,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,3544.00
Blue Cross,PPO,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,3544.00
Blue Cross,PPO,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Grouper Rate,5281.00
Blue Cross,PPO,311,DRG,Angina pectoris,,Case Rate,11528.38
Blue Cross,PPO,312,DRG,Syncope & collapse,,Case Rate,13847.28
Blue Cross,PPO,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,1678.88
Blue Cross,PPO,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,5281.00
Blue Cross,PPO,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,3544.00
Blue Cross,PPO,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Grouper Rate,5029.00
Blue Cross,PPO,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Grouper Rate,3544.00
Blue Cross,PPO,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Grouper Rate,1678.00
Blue Cross,PPO,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Grouper Rate,1678.00
Blue Cross,PPO,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Grouper Rate,1678.00
Blue Cross,PPO,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.00
Blue Cross,PPO,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.00
Blue Cross,PPO,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,PPO,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,PPO,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Grouper Rate,1678.00
Blue Cross,PPO,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Grouper Rate,3544.00
Blue Cross,PPO,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Grouper Rate,3544.00
Blue Cross,PPO,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Grouper Rate,3544.00
Blue Cross,PPO,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,1678.88
Blue Cross,PPO,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Grouper Rate,3544.00
Blue Cross,PPO,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Grouper Rate,3544.00
Blue Cross,PPO,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Grouper Rate,3544.00
Blue Cross,PPO,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Grouper Rate,3544.00
Blue Cross,PPO,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1678.88
Blue Cross,PPO,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3544.00
Blue Cross,PPO,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5029.00
Blue Cross,PPO,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5029.00
Blue Cross,PPO,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Grouper Rate,3544.00
Blue Cross,PPO,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Grouper Rate,3544.00
Blue Cross,PPO,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Grouper Rate,5029.00
Blue Cross,PPO,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Grouper Rate,1678.88
Blue Cross,PPO,313,DRG,Chest pain,,Case Rate,11922.03
Blue Cross,PPO,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,5281.00
Blue Cross,PPO,31320,CPT4/HCPCS,DIAGNOSTIC INCISION LARYNX,,Grouper Rate,1678.88
Blue Cross,PPO,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,Grouper Rate,6588.00
Blue Cross,PPO,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,Grouper Rate,6588.00
Blue Cross,PPO,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5783.00
Blue Cross,PPO,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,6588.00
Blue Cross,PPO,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5281.00
Blue Cross,PPO,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5281.00
Blue Cross,PPO,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,5281.00
Blue Cross,PPO,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,8841.00
Blue Cross,PPO,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,Grouper Rate,6588.00
Blue Cross,PPO,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,Grouper Rate,6588.00
Blue Cross,PPO,314,DRG,Other circulatory system diagnoses w MCC,,Case Rate,34459.43
Blue Cross,PPO,31400,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,3544.00
Blue Cross,PPO,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Grouper Rate,3544.00
Blue Cross,PPO,315,DRG,Other circulatory system diagnoses w CC,,Case Rate,16129.80
Blue Cross,PPO,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Grouper Rate,1678.00
Blue Cross,PPO,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Grouper Rate,1678.00
Blue Cross,PPO,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Grouper Rate,1678.00
Blue Cross,PPO,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,1678.00
Blue Cross,PPO,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Grouper Rate,1678.00
Blue Cross,PPO,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Grouper Rate,1678.00
Blue Cross,PPO,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Grouper Rate,1678.00
Blue Cross,PPO,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Grouper Rate,1678.00
Blue Cross,PPO,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Grouper Rate,1678.88
Blue Cross,PPO,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,1678.88
Blue Cross,PPO,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,1678.88
Blue Cross,PPO,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Grouper Rate,1678.88
Blue Cross,PPO,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Grouper Rate,1678.88
Blue Cross,PPO,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Grouper Rate,1678.88
Blue Cross,PPO,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Grouper Rate,1678.88
Blue Cross,PPO,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Grouper Rate,3544.00
Blue Cross,PPO,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Grouper Rate,3544.00
Blue Cross,PPO,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Grouper Rate,5029.00
Blue Cross,PPO,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,PPO,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,PPO,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,PPO,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5281.00
Blue Cross,PPO,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Grouper Rate,5281.00
Blue Cross,PPO,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Grouper Rate,5281.00
Blue Cross,PPO,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Grouper Rate,1678.88
Blue Cross,PPO,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Grouper Rate,1678.88
Blue Cross,PPO,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Grouper Rate,1678.00
Blue Cross,PPO,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Grouper Rate,1678.00
Blue Cross,PPO,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Grouper Rate,1678.00
Blue Cross,PPO,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Grouper Rate,1678.00
Blue Cross,PPO,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Grouper Rate,1678.88
Blue Cross,PPO,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Grouper Rate,1678.00
Blue Cross,PPO,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Grouper Rate,5281.00
Blue Cross,PPO,31582,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,5281.00
Blue Cross,PPO,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Grouper Rate,5029.00
Blue Cross,PPO,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Grouper Rate,5029.00
Blue Cross,PPO,31588,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,5281.00
Blue Cross,PPO,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Grouper Rate,5281.00
Blue Cross,PPO,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Grouper Rate,5029.00
Blue Cross,PPO,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Grouper Rate,5029.00
Blue Cross,PPO,31595,CPT4/HCPCS,LARYNX NERVE SURGERY,,Grouper Rate,1678.88
Blue Cross,PPO,316,DRG,Other circulatory system diagnoses w/o CC/MCC,,Case Rate,12396.73
Blue Cross,PPO,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,PPO,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,PPO,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,3544.00
Blue Cross,PPO,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,PPO,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,PPO,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Grouper Rate,3544.00
Blue Cross,PPO,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Grouper Rate,1678.00
Blue Cross,PPO,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,1678.88
Blue Cross,PPO,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,1678.88
Blue Cross,PPO,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Grouper Rate,1678.00
Blue Cross,PPO,31620,CPT4/HCPCS,ENDOBRONCHIAL US ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Grouper Rate,1678.88
Blue Cross,PPO,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Grouper Rate,1678.88
Blue Cross,PPO,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Grouper Rate,1678.88
Blue Cross,PPO,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Grouper Rate,1678.88
Blue Cross,PPO,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Grouper Rate,1678.88
Blue Cross,PPO,31627,CPT4/HCPCS,NAVIGATIONAL BRONCHOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Grouper Rate,1678.88
Blue Cross,PPO,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Grouper Rate,1678.88
Blue Cross,PPO,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Grouper Rate,1678.88
Blue Cross,PPO,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Grouper Rate,1678.88
Blue Cross,PPO,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Grouper Rate,1678.88
Blue Cross,PPO,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Grouper Rate,1678.88
Blue Cross,PPO,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Grouper Rate,1678.88
Blue Cross,PPO,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Grouper Rate,1678.88
Blue Cross,PPO,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Grouper Rate,1678.88
Blue Cross,PPO,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Grouper Rate,1678.88
Blue Cross,PPO,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Grouper Rate,1678.00
Blue Cross,PPO,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Grouper Rate,1678.00
Blue Cross,PPO,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Grouper Rate,1678.00
Blue Cross,PPO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Grouper Rate,1678.88
Blue Cross,PPO,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Grouper Rate,1678.88
Blue Cross,PPO,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,31651,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,Grouper Rate,1678.00
Blue Cross,PPO,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Grouper Rate,1678.00
Blue Cross,PPO,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Grouper Rate,1678.00
Blue Cross,PPO,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Grouper Rate,1678.00
Blue Cross,PPO,31656,CPT4/HCPCS,BRONCHOSCOPY INJ FOR X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Grouper Rate,1678.88
Blue Cross,PPO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Grouper Rate,1678.88
Blue Cross,PPO,31715,CPT4/HCPCS,INJECTION FOR BRONCHUS X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,1678.00
Blue Cross,PPO,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,1678.00
Blue Cross,PPO,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,5281.00
Blue Cross,PPO,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,1678.88
Blue Cross,PPO,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,6588.00
Blue Cross,PPO,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,Grouper Rate,6588.00
Blue Cross,PPO,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,Grouper Rate,6588.00
Blue Cross,PPO,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,Grouper Rate,6588.00
Blue Cross,PPO,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Grouper Rate,6588.00
Blue Cross,PPO,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Grouper Rate,6588.00
Blue Cross,PPO,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,5029.00
Blue Cross,PPO,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,5029.00
Blue Cross,PPO,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,1678.88
Blue Cross,PPO,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,5783.00
Blue Cross,PPO,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Grouper Rate,1678.00
Blue Cross,PPO,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Grouper Rate,1678.88
Blue Cross,PPO,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Grouper Rate,1678.88
Blue Cross,PPO,319,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W MCC,,Case Rate,71383.33
Blue Cross,PPO,32,DRG,Ventricular shunt procedures w CC,,Case Rate,36589.78
Blue Cross,PPO,320,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W/O MCC,,Case Rate,40418.79
Blue Cross,PPO,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,Grouper Rate,5029.00
Blue Cross,PPO,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,Grouper Rate,5029.00
Blue Cross,PPO,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,Grouper Rate,8012.00
Blue Cross,PPO,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,Grouper Rate,8012.00
Blue Cross,PPO,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,Grouper Rate,8012.00
Blue Cross,PPO,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,8012.00
Blue Cross,PPO,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,Grouper Rate,6588.00
Blue Cross,PPO,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,Grouper Rate,6588.00
Blue Cross,PPO,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,Grouper Rate,6588.00
Blue Cross,PPO,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Grouper Rate,6588.00
Blue Cross,PPO,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,Grouper Rate,6588.00
Blue Cross,PPO,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Grouper Rate,6588.00
Blue Cross,PPO,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,Grouper Rate,6588.00
Blue Cross,PPO,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,Grouper Rate,5281.00
Blue Cross,PPO,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,Grouper Rate,6588.00
Blue Cross,PPO,32201,CPT4/HCPCS,DRAIN PERCUT LUNG LESION,,Grouper Rate,1678.00
Blue Cross,PPO,32215,CPT4/HCPCS,TREAT CHEST LINING,,Grouper Rate,3544.00
Blue Cross,PPO,32220,CPT4/HCPCS,RELEASE OF LUNG,,Grouper Rate,8012.00
Blue Cross,PPO,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,Grouper Rate,6588.00
Blue Cross,PPO,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,Grouper Rate,6588.00
Blue Cross,PPO,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,Grouper Rate,6588.00
Blue Cross,PPO,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Grouper Rate,1678.00
Blue Cross,PPO,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Grouper Rate,1678.00
Blue Cross,PPO,32420,CPT4/HCPCS,PUNCTURE/CLEAR LUNG,,Grouper Rate,1678.00
Blue Cross,PPO,32421,CPT4/HCPCS,THORACENTESIS FOR ASPIRATION,,Grouper Rate,1678.00
Blue Cross,PPO,32422,CPT4/HCPCS,THORACENTESIS W/TUBE INSERT,,Grouper Rate,1678.00
Blue Cross,PPO,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,Grouper Rate,8012.00
Blue Cross,PPO,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,Grouper Rate,8841.00
Blue Cross,PPO,32482,CPT4/HCPCS,BILOBECTOMY,,Grouper Rate,8841.00
Blue Cross,PPO,32484,CPT4/HCPCS,SEGMENTECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,Grouper Rate,8841.00
Blue Cross,PPO,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,Grouper Rate,3544.00
Blue Cross,PPO,32503,CPT4/HCPCS,RESECT APICAL LUNG TUMOR,,Grouper Rate,6588.00
Blue Cross,PPO,32504,CPT4/HCPCS,RESECT APICAL LUNG TUM/CHEST,,Grouper Rate,6588.00
Blue Cross,PPO,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,Grouper Rate,6588.00
Blue Cross,PPO,32506,CPT4/HCPCS,WEDGE RESECT OF LUNG ADD-ON,,Grouper Rate,6588.00
Blue Cross,PPO,32507,CPT4/HCPCS,WEDGE RESECT OF LUNG DIAG,,Grouper Rate,6588.00
Blue Cross,PPO,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,Grouper Rate,6588.00
Blue Cross,PPO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Grouper Rate,1678.00
Blue Cross,PPO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Grouper Rate,1678.88
Blue Cross,PPO,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Grouper Rate,1678.00
Blue Cross,PPO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Grouper Rate,1678.00
Blue Cross,PPO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Grouper Rate,1678.00
Blue Cross,PPO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Grouper Rate,1678.00
Blue Cross,PPO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Grouper Rate,1678.00
Blue Cross,PPO,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Grouper Rate,1678.00
Blue Cross,PPO,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Grouper Rate,1678.00
Blue Cross,PPO,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Grouper Rate,1678.00
Blue Cross,PPO,326,DRG,Stomach, esophageal & duodenal proc w MCC,,Case Rate,88947.15
Blue Cross,PPO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Grouper Rate,3544.00
Blue Cross,PPO,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Grouper Rate,3544.00
Blue Cross,PPO,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Grouper Rate,3544.00
Blue Cross,PPO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Grouper Rate,3544.00
Blue Cross,PPO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Grouper Rate,3544.00
Blue Cross,PPO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Grouper Rate,3544.00
Blue Cross,PPO,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,Grouper Rate,3544.00
Blue Cross,PPO,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,Grouper Rate,5029.00
Blue Cross,PPO,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,Grouper Rate,8012.00
Blue Cross,PPO,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,Grouper Rate,3544.00
Blue Cross,PPO,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,Grouper Rate,3544.00
Blue Cross,PPO,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,Grouper Rate,5029.00
Blue Cross,PPO,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,Grouper Rate,5783.00
Blue Cross,PPO,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,Grouper Rate,6588.00
Blue Cross,PPO,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,Grouper Rate,8012.00
Blue Cross,PPO,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,Grouper Rate,5783.00
Blue Cross,PPO,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Grouper Rate,5783.00
Blue Cross,PPO,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,Grouper Rate,5783.00
Blue Cross,PPO,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,Grouper Rate,3544.00
Blue Cross,PPO,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,Grouper Rate,3544.00
Blue Cross,PPO,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,Grouper Rate,3544.00
Blue Cross,PPO,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,Grouper Rate,3544.00
Blue Cross,PPO,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,Grouper Rate,3544.00
Blue Cross,PPO,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,Grouper Rate,3544.00
Blue Cross,PPO,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,Grouper Rate,3544.00
Blue Cross,PPO,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,Grouper Rate,3544.00
Blue Cross,PPO,327,DRG,Stomach, esophageal & duodenal proc w CC,,Case Rate,43162.78
Blue Cross,PPO,32701,CPT4/HCPCS,THORAX STEREO RAD TARGETW/TX,,Grouper Rate,1678.00
Blue Cross,PPO,328,DRG,Stomach, esophageal & duodenal proc w/o CC/MCC,,Case Rate,27547.37
Blue Cross,PPO,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,Grouper Rate,8012.00
Blue Cross,PPO,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,Grouper Rate,6588.00
Blue Cross,PPO,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,Grouper Rate,6588.00
Blue Cross,PPO,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,Grouper Rate,5783.00
Blue Cross,PPO,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,Grouper Rate,8841.00
Blue Cross,PPO,32855,CPT4/HCPCS,PREPARE DONOR LUNG SINGLE,,Grouper Rate,3544.00
Blue Cross,PPO,32856,CPT4/HCPCS,PREPARE DONOR LUNG DOUBLE,,Grouper Rate,3544.00
Blue Cross,PPO,329,DRG,Major small & large bowel procedures w MCC,,Case Rate,80223.96
Blue Cross,PPO,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,Grouper Rate,5783.00
Blue Cross,PPO,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Grouper Rate,5783.00
Blue Cross,PPO,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Grouper Rate,5783.00
Blue Cross,PPO,32940,CPT4/HCPCS,REVISION OF LUNG,,Grouper Rate,5029.00
Blue Cross,PPO,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,Grouper Rate,1678.88
Blue Cross,PPO,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Grouper Rate,5783.00
Blue Cross,PPO,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,Grouper Rate,1678.00
Blue Cross,PPO,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Grouper Rate,5783.00
Blue Cross,PPO,33,DRG,Ventricular shunt procedures w/o CC/MCC,,Case Rate,28460.37
Blue Cross,PPO,330,DRG,Major small & large bowel procedures w CC,,Case Rate,41995.06
Blue Cross,PPO,33010,CPT4/HCPCS,DRAINAGE OF HEART SAC,,Grouper Rate,1678.00
Blue Cross,PPO,33011,CPT4/HCPCS,REPEAT DRAINAGE OF HEART SAC,,Grouper Rate,1678.00
Blue Cross,PPO,33015,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,3544.00
Blue Cross,PPO,33016,CPT4/HCPCS,PERICARDIOCENTESIS W/IMAGING,,Grouper Rate,1678.88
Blue Cross,PPO,33017,CPT4/HCPCS,PRCRD DRG 6YR+ W/O CGEN CAR,,Grouper Rate,3544.00
Blue Cross,PPO,33018,CPT4/HCPCS,PRCRD DRG 0-5YR OR W/ANOMLY,,Grouper Rate,3544.00
Blue Cross,PPO,33019,CPT4/HCPCS,PERQ PRCRD DRG INSJ CATH CT,,Grouper Rate,3544.00
Blue Cross,PPO,33020,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,5029.00
Blue Cross,PPO,33025,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,6588.00
Blue Cross,PPO,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Grouper Rate,5783.00
Blue Cross,PPO,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Grouper Rate,6588.00
Blue Cross,PPO,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,Grouper Rate,5783.00
Blue Cross,PPO,331,DRG,Major small & large bowel procedures w/o CC/MCC,,Case Rate,28285.05
Blue Cross,PPO,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,6588.00
Blue Cross,PPO,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,6588.00
Blue Cross,PPO,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,Grouper Rate,5783.00
Blue Cross,PPO,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,Grouper Rate,3544.00
Blue Cross,PPO,332,DRG,Rectal resection w MCC,,Case Rate,68801.43
Blue Cross,PPO,33202,CPT4/HCPCS,INSERT EPICARD ELTRD OPEN,,Grouper Rate,5029.00
Blue Cross,PPO,33203,CPT4/HCPCS,INSERT EPICARD ELTRD ENDO,,Grouper Rate,1678.88
Blue Cross,PPO,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Grouper Rate,3544.00
Blue Cross,PPO,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Grouper Rate,3544.00
Blue Cross,PPO,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Grouper Rate,5281.00
Blue Cross,PPO,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Grouper Rate,3544.00
Blue Cross,PPO,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Grouper Rate,3544.00
Blue Cross,PPO,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Grouper Rate,6588.00
Blue Cross,PPO,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Grouper Rate,6588.00
Blue Cross,PPO,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Grouper Rate,3544.00
Blue Cross,PPO,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Grouper Rate,1678.88
Blue Cross,PPO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Grouper Rate,1678.88
Blue Cross,PPO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Grouper Rate,1678.88
Blue Cross,PPO,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Grouper Rate,1678.88
Blue Cross,PPO,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Grouper Rate,1678.88
Blue Cross,PPO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Grouper Rate,1678.88
Blue Cross,PPO,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Grouper Rate,3544.00
Blue Cross,PPO,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Grouper Rate,3544.00
Blue Cross,PPO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Grouper Rate,5281.00
Blue Cross,PPO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Grouper Rate,5029.00
Blue Cross,PPO,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Grouper Rate,5029.00
Blue Cross,PPO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Grouper Rate,1678.88
Blue Cross,PPO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Grouper Rate,1678.88
Blue Cross,PPO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Grouper Rate,1678.88
Blue Cross,PPO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Grouper Rate,1678.88
Blue Cross,PPO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Grouper Rate,1678.88
Blue Cross,PPO,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Grouper Rate,1678.88
Blue Cross,PPO,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Grouper Rate,1678.88
Blue Cross,PPO,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Grouper Rate,1678.88
Blue Cross,PPO,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Grouper Rate,6588.00
Blue Cross,PPO,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Grouper Rate,5029.00
Blue Cross,PPO,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Grouper Rate,5029.00
Blue Cross,PPO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Grouper Rate,5281.00
Blue Cross,PPO,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,5281.00
Blue Cross,PPO,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,5281.00
Blue Cross,PPO,33254,CPT4/HCPCS,ABLATE ATRIA LMTD,,Grouper Rate,5029.00
Blue Cross,PPO,33255,CPT4/HCPCS,ABLATE ATRIA W/O BYPASS EXT,,Grouper Rate,5281.00
Blue Cross,PPO,33256,CPT4/HCPCS,ABLATE ATRIA W/BYPASS EXTEN,,Grouper Rate,5783.00
Blue Cross,PPO,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,Grouper Rate,5029.00
Blue Cross,PPO,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,Grouper Rate,5029.00
Blue Cross,PPO,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,Grouper Rate,5281.00
Blue Cross,PPO,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,5281.00
Blue Cross,PPO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Grouper Rate,1678.88
Blue Cross,PPO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Grouper Rate,1678.88
Blue Cross,PPO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Grouper Rate,1678.88
Blue Cross,PPO,33265,CPT4/HCPCS,ABLATE ATRIA LMTD ENDO,,Grouper Rate,5029.00
Blue Cross,PPO,33266,CPT4/HCPCS,ABLATE ATRIA X10SV ENDO,,Grouper Rate,5029.00
Blue Cross,PPO,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Grouper Rate,5029.00
Blue Cross,PPO,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Grouper Rate,5029.00
Blue Cross,PPO,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Grouper Rate,5029.00
Blue Cross,PPO,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Grouper Rate,1678.88
Blue Cross,PPO,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,Grouper Rate,3544.00
Blue Cross,PPO,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,Grouper Rate,1678.88
Blue Cross,PPO,33282,CPT4/HCPCS,IMPLANT PAT-ACTIVE HT RECORD,,Grouper Rate,3544.00
Blue Cross,PPO,33284,CPT4/HCPCS,REMOVE PAT-ACTIVE HT RECORD,,Grouper Rate,1678.00
Blue Cross,PPO,33285,CPT4/HCPCS,INSJ SUBQ CAR RHYTHM MNTR,,Grouper Rate,3544.00
Blue Cross,PPO,33286,CPT4/HCPCS,RMVL SUBQ CAR RHYTHM MNTR,,Grouper Rate,1678.88
Blue Cross,PPO,33289,CPT4/HCPCS,TCAT IMPL WRLS P-ART PRS SNR,,Grouper Rate,8841.00
Blue Cross,PPO,333,DRG,Rectal resection w CC,,Case Rate,35412.14
Blue Cross,PPO,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,Grouper Rate,5783.00
Blue Cross,PPO,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,Grouper Rate,6588.00
Blue Cross,PPO,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Grouper Rate,5783.00
Blue Cross,PPO,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,Grouper Rate,5783.00
Blue Cross,PPO,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Grouper Rate,6588.00
Blue Cross,PPO,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,6588.00
Blue Cross,PPO,33332,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,6588.00
Blue Cross,PPO,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,8012.00
Blue Cross,PPO,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,Grouper Rate,5783.00
Blue Cross,PPO,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,Grouper Rate,6588.00
Blue Cross,PPO,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,PPO,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,PPO,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,PPO,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,8841.00
Blue Cross,PPO,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,Grouper Rate,6588.00
Blue Cross,PPO,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,5029.00
Blue Cross,PPO,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,5029.00
Blue Cross,PPO,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,5029.00
Blue Cross,PPO,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,334,DRG,Rectal resection w/o CC/MCC,,Case Rate,26616.16
Blue Cross,PPO,33400,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,Grouper Rate,5281.00
Blue Cross,PPO,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,6588.00
Blue Cross,PPO,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,8841.00
Blue Cross,PPO,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,Grouper Rate,8841.00
Blue Cross,PPO,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,Grouper Rate,8841.00
Blue Cross,PPO,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,5783.00
Blue Cross,PPO,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,8012.00
Blue Cross,PPO,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33440,CPT4/HCPCS,RPLCMT A-VALVE TLCJ AUTOL PV,,Grouper Rate,8841.00
Blue Cross,PPO,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,6588.00
Blue Cross,PPO,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,Grouper Rate,5281.00
Blue Cross,PPO,33472,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,6588.00
Blue Cross,PPO,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,8841.00
Blue Cross,PPO,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8012.00
Blue Cross,PPO,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,Grouper Rate,8012.00
Blue Cross,PPO,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8841.00
Blue Cross,PPO,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,Grouper Rate,8841.00
Blue Cross,PPO,335,DRG,Peritoneal adhesiolysis w MCC,,Case Rate,64347.21
Blue Cross,PPO,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Grouper Rate,8841.00
Blue Cross,PPO,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Grouper Rate,6588.00
Blue Cross,PPO,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,Grouper Rate,5783.00
Blue Cross,PPO,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Grouper Rate,6588.00
Blue Cross,PPO,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,33507,CPT4/HCPCS,REPAIR ART INTRAMURAL,,Grouper Rate,6588.00
Blue Cross,PPO,33508,CPT4/HCPCS,ENDOSCOPIC VEIN HARVEST,,Grouper Rate,3544.00
Blue Cross,PPO,33542,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,5783.00
Blue Cross,PPO,33545,CPT4/HCPCS,REPAIR OF HEART DAMAGE,,Grouper Rate,5783.00
Blue Cross,PPO,33548,CPT4/HCPCS,RESTORE/REMODEL VENTRICLE,,Grouper Rate,5783.00
Blue Cross,PPO,33572,CPT4/HCPCS,OPEN CORONARY ENDARTERECTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,336,DRG,Peritoneal adhesiolysis w CC,,Case Rate,37759.16
Blue Cross,PPO,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,Grouper Rate,6588.00
Blue Cross,PPO,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,Grouper Rate,6588.00
Blue Cross,PPO,33641,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33645,CPT4/HCPCS,REVISION OF HEART VEINS,,Grouper Rate,5783.00
Blue Cross,PPO,33647,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECTS,,Grouper Rate,8841.00
Blue Cross,PPO,33660,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,PPO,33665,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,PPO,33670,CPT4/HCPCS,REPAIR OF HEART CHAMBERS,,Grouper Rate,8841.00
Blue Cross,PPO,33675,CPT4/HCPCS,CLOSE MULT VSD,,Grouper Rate,8841.00
Blue Cross,PPO,33676,CPT4/HCPCS,CLOSE MULT VSD W/RESECTION,,Grouper Rate,8841.00
Blue Cross,PPO,33677,CPT4/HCPCS,CL MULT VSD W/REM PUL BAND,,Grouper Rate,8841.00
Blue Cross,PPO,33681,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33684,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33688,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33690,CPT4/HCPCS,REINFORCE PULMONARY ARTERY,,Grouper Rate,6588.00
Blue Cross,PPO,33692,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,PPO,33694,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,PPO,337,DRG,Peritoneal adhesiolysis w/o CC/MCC,,Case Rate,27003.20
Blue Cross,PPO,33702,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,PPO,33710,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,8841.00
Blue Cross,PPO,33720,CPT4/HCPCS,REPAIR OF HEART DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33724,CPT4/HCPCS,REPAIR VENOUS ANOMALY,,Grouper Rate,8012.00
Blue Cross,PPO,33726,CPT4/HCPCS,REPAIR PUL VENOUS STENOSIS,,Grouper Rate,8841.00
Blue Cross,PPO,33730,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT(S),,Grouper Rate,8841.00
Blue Cross,PPO,33735,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,6588.00
Blue Cross,PPO,33737,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8012.00
Blue Cross,PPO,33750,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,PPO,33755,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,PPO,33762,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,PPO,33764,CPT4/HCPCS,MAJOR VESSEL SHUNT & GRAFT,,Grouper Rate,8012.00
Blue Cross,PPO,33766,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,8012.00
Blue Cross,PPO,33774,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33775,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33776,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33777,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33778,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33779,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33780,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33781,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33786,CPT4/HCPCS,REPAIR ARTERIAL TRUNK,,Grouper Rate,8841.00
Blue Cross,PPO,33788,CPT4/HCPCS,REVISION OF PULMONARY ARTERY,,Grouper Rate,8012.00
Blue Cross,PPO,338,DRG,Appendectomy w complicated principal diag w MCC,,Case Rate,46292.15
Blue Cross,PPO,33800,CPT4/HCPCS,AORTIC SUSPENSION,,Grouper Rate,8012.00
Blue Cross,PPO,33802,CPT4/HCPCS,REPAIR VESSEL DEFECT,,Grouper Rate,6588.00
Blue Cross,PPO,33803,CPT4/HCPCS,REPAIR VESSEL DEFECT,,Grouper Rate,8012.00
Blue Cross,PPO,33813,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,8012.00
Blue Cross,PPO,33814,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33820,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,6588.00
Blue Cross,PPO,33822,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,6588.00
Blue Cross,PPO,33824,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,8012.00
Blue Cross,PPO,33840,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,8841.00
Blue Cross,PPO,33845,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,8841.00
Blue Cross,PPO,33851,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,8841.00
Blue Cross,PPO,33852,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,8841.00
Blue Cross,PPO,33858,CPT4/HCPCS,AS-AORT GRF F/AORTIC DSJ,,Grouper Rate,8841.00
Blue Cross,PPO,33859,CPT4/HCPCS,AS-AORT GRF F/DS OTH/THN DSJ,,Grouper Rate,8841.00
Blue Cross,PPO,33860,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,33864,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,33866,CPT4/HCPCS,AORTIC HEMIARCH GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,33870,CPT4/HCPCS,TRANSVERSE AORTIC ARCH GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,33871,CPT4/HCPCS,TRANSVRS A-ARCH GRF HYPTHRM,,Grouper Rate,8841.00
Blue Cross,PPO,33875,CPT4/HCPCS,THORACIC AORTIC GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,33877,CPT4/HCPCS,THORACOABDOMINAL GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,33880,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,Grouper Rate,8012.00
Blue Cross,PPO,33881,CPT4/HCPCS,ENDOVASC TAA REPR W/O SUBCL,,Grouper Rate,8012.00
Blue Cross,PPO,33883,CPT4/HCPCS,INSERT ENDOVASC PROSTH TAA,,Grouper Rate,3544.00
Blue Cross,PPO,33884,CPT4/HCPCS,ENDOVASC PROSTH TAA ADD-ON,,Grouper Rate,3544.00
Blue Cross,PPO,33886,CPT4/HCPCS,ENDOVASC PROSTH DELAYED,,Grouper Rate,5029.00
Blue Cross,PPO,339,DRG,Appendectomy w complicated principal diag w CC,,Case Rate,28035.30
Blue Cross,PPO,33910,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,Grouper Rate,8841.00
Blue Cross,PPO,33915,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,Grouper Rate,8012.00
Blue Cross,PPO,33916,CPT4/HCPCS,SURGERY OF GREAT VESSEL,,Grouper Rate,8841.00
Blue Cross,PPO,33924,CPT4/HCPCS,REMOVE PULMONARY SHUNT,,Grouper Rate,5281.00
Blue Cross,PPO,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,Grouper Rate,8841.00
Blue Cross,PPO,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,Grouper Rate,8841.00
Blue Cross,PPO,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,Grouper Rate,8841.00
Blue Cross,PPO,33933,CPT4/HCPCS,PREPARE DONOR HEART/LUNG,,Grouper Rate,3544.00
Blue Cross,PPO,33944,CPT4/HCPCS,PREPARE DONOR HEART,,Grouper Rate,3544.00
Blue Cross,PPO,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,Grouper Rate,5281.00
Blue Cross,PPO,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,Grouper Rate,5281.00
Blue Cross,PPO,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,Grouper Rate,3544.00
Blue Cross,PPO,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,PPO,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,PPO,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,PPO,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,3544.00
Blue Cross,PPO,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Grouper Rate,3544.00
Blue Cross,PPO,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Grouper Rate,3544.00
Blue Cross,PPO,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,PPO,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,PPO,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,PPO,33960,CPT4/HCPCS,EXTERNAL CIRCULATION ASSIST,,Grouper Rate,5281.00
Blue Cross,PPO,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,PPO,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,PPO,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,8012.00
Blue Cross,PPO,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Grouper Rate,5281.00
Blue Cross,PPO,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Grouper Rate,5281.00
Blue Cross,PPO,33967,CPT4/HCPCS,INSERT I-AORT PERCUT DEVICE,,Grouper Rate,5029.00
Blue Cross,PPO,33968,CPT4/HCPCS,REMOVE AORTIC ASSIST DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Grouper Rate,5281.00
Blue Cross,PPO,33970,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,Grouper Rate,5029.00
Blue Cross,PPO,33971,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,Grouper Rate,5281.00
Blue Cross,PPO,33976,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,Grouper Rate,8012.00
Blue Cross,PPO,33979,CPT4/HCPCS,INSERT INTRACORPOREAL DEVICE,,Grouper Rate,8012.00
Blue Cross,PPO,33980,CPT4/HCPCS,REMOVE INTRACORPOREAL DEVICE,,Grouper Rate,5281.00
Blue Cross,PPO,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Grouper Rate,5281.00
Blue Cross,PPO,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Grouper Rate,5281.00
Blue Cross,PPO,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Grouper Rate,5281.00
Blue Cross,PPO,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,Grouper Rate,5029.00
Blue Cross,PPO,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,Grouper Rate,5029.00
Blue Cross,PPO,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,Grouper Rate,5029.00
Blue Cross,PPO,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,Grouper Rate,8012.00
Blue Cross,PPO,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,Grouper Rate,8012.00
Blue Cross,PPO,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,Grouper Rate,5281.00
Blue Cross,PPO,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,Grouper Rate,8012.00
Blue Cross,PPO,34,DRG,Carotid artery stent procedure w MCC,,Case Rate,65739.88
Blue Cross,PPO,340,DRG,Appendectomy w complicated principal diag w/o CC/MCC,,Case Rate,20317.73
Blue Cross,PPO,34001,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,3544.00
Blue Cross,PPO,34051,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,6588.00
Blue Cross,PPO,341,DRG,Appendectomy w/o complicated principal diag w MCC,,Case Rate,38309.94
Blue Cross,PPO,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,3544.00
Blue Cross,PPO,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,Grouper Rate,3544.00
Blue Cross,PPO,34151,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,5281.00
Blue Cross,PPO,342,DRG,Appendectomy w/o complicated principal diag w CC,,Case Rate,23703.47
Blue Cross,PPO,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,5281.00
Blue Cross,PPO,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,Grouper Rate,5029.00
Blue Cross,PPO,343,DRG,Appendectomy w/o complicated principal diag w/o CC/MCC,,Case Rate,18349.47
Blue Cross,PPO,344,DRG,Minor small & large bowel procedures w MCC,,Case Rate,46326.88
Blue Cross,PPO,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,5029.00
Blue Cross,PPO,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,PPO,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,PPO,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,PPO,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,3544.00
Blue Cross,PPO,345,DRG,Minor small & large bowel procedures w CC,,Case Rate,26095.15
Blue Cross,PPO,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,Grouper Rate,5029.00
Blue Cross,PPO,34502,CPT4/HCPCS,RECONSTRUCT VENA CAVA,,Grouper Rate,6588.00
Blue Cross,PPO,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,Grouper Rate,5029.00
Blue Cross,PPO,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,34530,CPT4/HCPCS,LEG VEIN FUSION,,Grouper Rate,3544.00
Blue Cross,PPO,346,DRG,Minor small & large bowel procedures w/o CC/MCC,,Case Rate,21088.50
Blue Cross,PPO,347,DRG,Anal & stomal procedures w MCC,,Case Rate,40714.86
Blue Cross,PPO,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Grouper Rate,5783.00
Blue Cross,PPO,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Grouper Rate,5783.00
Blue Cross,PPO,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Grouper Rate,5783.00
Blue Cross,PPO,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Grouper Rate,5783.00
Blue Cross,PPO,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Grouper Rate,5783.00
Blue Cross,PPO,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Grouper Rate,5783.00
Blue Cross,PPO,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Grouper Rate,5783.00
Blue Cross,PPO,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Grouper Rate,5783.00
Blue Cross,PPO,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Grouper Rate,3544.00
Blue Cross,PPO,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Grouper Rate,3544.00
Blue Cross,PPO,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Grouper Rate,1678.88
Blue Cross,PPO,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Grouper Rate,5029.00
Blue Cross,PPO,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Grouper Rate,5029.00
Blue Cross,PPO,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Grouper Rate,5029.00
Blue Cross,PPO,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Grouper Rate,5029.00
Blue Cross,PPO,34717,CPT4/HCPCS,EVASC RPR A-ILIAC NDGFT,,Grouper Rate,5783.00
Blue Cross,PPO,34718,CPT4/HCPCS,EVASC RPR N/A A-ILIAC NDGFT,,Grouper Rate,5281.00
Blue Cross,PPO,348,DRG,Anal & stomal procedures w CC,,Case Rate,22203.29
Blue Cross,PPO,34800,CPT4/HCPCS,ENDOVAS AAA REPR W/SM TUBE,,Grouper Rate,5783.00
Blue Cross,PPO,34802,CPT4/HCPCS,ENDOVAS AAA REPR W/2-P PART,,Grouper Rate,5783.00
Blue Cross,PPO,34803,CPT4/HCPCS,ENDOVAS AAA REPR W/3-P PART,,Grouper Rate,5783.00
Blue Cross,PPO,34804,CPT4/HCPCS,ENDOVAS AAA REPR W/1-P PART,,Grouper Rate,5783.00
Blue Cross,PPO,34805,CPT4/HCPCS,ENDOVAS AAA REPR W/LONG TUBE,,Grouper Rate,5783.00
Blue Cross,PPO,34806,CPT4/HCPCS,ANEURYSM PRESS SENSOR ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,34808,CPT4/HCPCS,ENDOVAS ILIAC A DEVICE ADDON,,Grouper Rate,3544.00
Blue Cross,PPO,34812,CPT4/HCPCS,OPN FEM ART EXPOS,,Grouper Rate,5029.00
Blue Cross,PPO,34813,CPT4/HCPCS,FEMORAL ENDOVAS GRAFT ADD-ON,,Grouper Rate,5029.00
Blue Cross,PPO,34820,CPT4/HCPCS,OPN ILIAC ART EXPOS,,Grouper Rate,5029.00
Blue Cross,PPO,34825,CPT4/HCPCS,ENDOVASC EXTEND PROSTH INIT,,Grouper Rate,3544.00
Blue Cross,PPO,34826,CPT4/HCPCS,ENDOVASC EXTEN PROSTH ADDL,,Grouper Rate,1678.88
Blue Cross,PPO,34830,CPT4/HCPCS,OPEN AORTIC TUBE PROSTH REPR,,Grouper Rate,8012.00
Blue Cross,PPO,34831,CPT4/HCPCS,OPEN AORTOILIAC PROSTH REPR,,Grouper Rate,8012.00
Blue Cross,PPO,34832,CPT4/HCPCS,OPEN AORTOFEMOR PROSTH REPR,,Grouper Rate,8012.00
Blue Cross,PPO,34833,CPT4/HCPCS,OPN ILAC ART EXPOS CNDT CRTJ,,Grouper Rate,5029.00
Blue Cross,PPO,34834,CPT4/HCPCS,OPN BRACH ART EXPOS,,Grouper Rate,5029.00
Blue Cross,PPO,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,Grouper Rate,8841.00
Blue Cross,PPO,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,Grouper Rate,8841.00
Blue Cross,PPO,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,Grouper Rate,8841.00
Blue Cross,PPO,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,Grouper Rate,8841.00
Blue Cross,PPO,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,Grouper Rate,8841.00
Blue Cross,PPO,349,DRG,Anal & stomal procedures w/o CC/MCC,,Case Rate,16197.62
Blue Cross,PPO,34900,CPT4/HCPCS,ENDOVASC ILIAC REPR W/GRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,35,DRG,Carotid artery stent procedure w CC,,Case Rate,38655.63
Blue Cross,PPO,350,DRG,Inguinal & femoral hernia procedures w MCC,,Case Rate,40562.69
Blue Cross,PPO,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,PPO,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,Grouper Rate,5783.00
Blue Cross,PPO,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,PPO,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,Grouper Rate,5281.00
Blue Cross,PPO,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,6588.00
Blue Cross,PPO,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,Grouper Rate,6588.00
Blue Cross,PPO,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,Grouper Rate,5029.00
Blue Cross,PPO,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,8012.00
Blue Cross,PPO,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,8012.00
Blue Cross,PPO,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,8012.00
Blue Cross,PPO,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,8012.00
Blue Cross,PPO,351,DRG,Inguinal & femoral hernia procedures w CC,,Case Rate,24651.21
Blue Cross,PPO,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,8012.00
Blue Cross,PPO,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,8012.00
Blue Cross,PPO,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5783.00
Blue Cross,PPO,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,Grouper Rate,5783.00
Blue Cross,PPO,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5783.00
Blue Cross,PPO,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,Grouper Rate,6588.00
Blue Cross,PPO,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5783.00
Blue Cross,PPO,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,Grouper Rate,5783.00
Blue Cross,PPO,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,PPO,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,Grouper Rate,5281.00
Blue Cross,PPO,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,5281.00
Blue Cross,PPO,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,Grouper Rate,5281.00
Blue Cross,PPO,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5783.00
Blue Cross,PPO,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,352,DRG,Inguinal & femoral hernia procedures w/o CC/MCC,,Case Rate,18243.62
Blue Cross,PPO,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,PPO,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,PPO,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,PPO,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8841.00
Blue Cross,PPO,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8012.00
Blue Cross,PPO,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5783.00
Blue Cross,PPO,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,3544.00
Blue Cross,PPO,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8841.00
Blue Cross,PPO,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6588.00
Blue Cross,PPO,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6588.00
Blue Cross,PPO,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,8841.00
Blue Cross,PPO,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6588.00
Blue Cross,PPO,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5783.00
Blue Cross,PPO,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,353,DRG,Hernia procedures except inguinal & femoral w MCC,,Case Rate,49757.28
Blue Cross,PPO,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,PPO,35302,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,PPO,35303,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,PPO,35304,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,PPO,35305,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,PPO,35306,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1678.88
Blue Cross,PPO,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,6588.00
Blue Cross,PPO,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,PPO,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,PPO,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,PPO,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5281.00
Blue Cross,PPO,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,PPO,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,PPO,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5783.00
Blue Cross,PPO,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,5029.00
Blue Cross,PPO,354,DRG,Hernia procedures except inguinal & femoral w CC,,Case Rate,29490.82
Blue Cross,PPO,35400,CPT4/HCPCS,ANGIOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,35450,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,3544.00
Blue Cross,PPO,35452,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,PPO,35458,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,3544.00
Blue Cross,PPO,35460,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,Grouper Rate,3544.00
Blue Cross,PPO,35471,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,PPO,35472,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,PPO,35475,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,PPO,35476,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,Grouper Rate,5029.00
Blue Cross,PPO,355,DRG,Hernia procedures except inguinal & femoral w/o CC/MCC,,Case Rate,22481.16
Blue Cross,PPO,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,Grouper Rate,1678.00
Blue Cross,PPO,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,Grouper Rate,5281.00
Blue Cross,PPO,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,Grouper Rate,5029.00
Blue Cross,PPO,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,Grouper Rate,5029.00
Blue Cross,PPO,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,Grouper Rate,5281.00
Blue Cross,PPO,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,Grouper Rate,5281.00
Blue Cross,PPO,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,Grouper Rate,5029.00
Blue Cross,PPO,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,Grouper Rate,5029.00
Blue Cross,PPO,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,Grouper Rate,5281.00
Blue Cross,PPO,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,Grouper Rate,5281.00
Blue Cross,PPO,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,Grouper Rate,5281.00
Blue Cross,PPO,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,Grouper Rate,5783.00
Blue Cross,PPO,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,Grouper Rate,5281.00
Blue Cross,PPO,35535,CPT4/HCPCS,ART BYP GRFT HEPATORENAL,,Grouper Rate,5783.00
Blue Cross,PPO,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,Grouper Rate,5783.00
Blue Cross,PPO,35537,CPT4/HCPCS,ART BYP GRFT AORTOILIAC,,Grouper Rate,5783.00
Blue Cross,PPO,35538,CPT4/HCPCS,ART BYP GRFT AORTOBI-ILIAC,,Grouper Rate,5783.00
Blue Cross,PPO,35539,CPT4/HCPCS,ART BYP GRFT AORTOFEMORAL,,Grouper Rate,5783.00
Blue Cross,PPO,35540,CPT4/HCPCS,ART BYP GRFT AORTBIFEMORAL,,Grouper Rate,5783.00
Blue Cross,PPO,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,Grouper Rate,5281.00
Blue Cross,PPO,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,Grouper Rate,5281.00
Blue Cross,PPO,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,Grouper Rate,5783.00
Blue Cross,PPO,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,Grouper Rate,5281.00
Blue Cross,PPO,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,Grouper Rate,5029.00
Blue Cross,PPO,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Grouper Rate,5029.00
Blue Cross,PPO,35570,CPT4/HCPCS,ART BYP TIBIAL-TIB/PERONEAL,,Grouper Rate,5029.00
Blue Cross,PPO,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Grouper Rate,5029.00
Blue Cross,PPO,35572,CPT4/HCPCS,HARVEST FEMOROPOPLITEAL VEIN,,Grouper Rate,1678.00
Blue Cross,PPO,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,Grouper Rate,5029.00
Blue Cross,PPO,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,Grouper Rate,5029.00
Blue Cross,PPO,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,Grouper Rate,5029.00
Blue Cross,PPO,356,DRG,Other digestive system O.R. procedures w MCC,,Case Rate,70979.75
Blue Cross,PPO,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,Grouper Rate,5281.00
Blue Cross,PPO,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,Grouper Rate,5029.00
Blue Cross,PPO,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,Grouper Rate,5281.00
Blue Cross,PPO,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,Grouper Rate,5029.00
Blue Cross,PPO,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,Grouper Rate,5281.00
Blue Cross,PPO,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,Grouper Rate,5281.00
Blue Cross,PPO,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,Grouper Rate,5281.00
Blue Cross,PPO,35632,CPT4/HCPCS,ART BYP ILIO-CELIAC,,Grouper Rate,5281.00
Blue Cross,PPO,35633,CPT4/HCPCS,ART BYP ILIO-MESENTERIC,,Grouper Rate,5281.00
Blue Cross,PPO,35634,CPT4/HCPCS,ART BYP ILIORENAL,,Grouper Rate,5281.00
Blue Cross,PPO,35636,CPT4/HCPCS,ART BYP SPENORENAL,,Grouper Rate,5281.00
Blue Cross,PPO,35637,CPT4/HCPCS,ART BYP AORTOILIAC,,Grouper Rate,5783.00
Blue Cross,PPO,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,Grouper Rate,5029.00
Blue Cross,PPO,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,Grouper Rate,5029.00
Blue Cross,PPO,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,Grouper Rate,5783.00
Blue Cross,PPO,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,Grouper Rate,5783.00
Blue Cross,PPO,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,Grouper Rate,5281.00
Blue Cross,PPO,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,Grouper Rate,5281.00
Blue Cross,PPO,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,Grouper Rate,5029.00
Blue Cross,PPO,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,Grouper Rate,5029.00
Blue Cross,PPO,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,Grouper Rate,5029.00
Blue Cross,PPO,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,Grouper Rate,5029.00
Blue Cross,PPO,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Grouper Rate,5029.00
Blue Cross,PPO,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Grouper Rate,5029.00
Blue Cross,PPO,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,Grouper Rate,5281.00
Blue Cross,PPO,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,Grouper Rate,1678.00
Blue Cross,PPO,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,Grouper Rate,1678.88
Blue Cross,PPO,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,Grouper Rate,1678.88
Blue Cross,PPO,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,Grouper Rate,1678.88
Blue Cross,PPO,357,DRG,Other digestive system O.R. procedures w CC,,Case Rate,37276.19
Blue Cross,PPO,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,Grouper Rate,1678.00
Blue Cross,PPO,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,Grouper Rate,3544.00
Blue Cross,PPO,35702,CPT4/HCPCS,EXPL N/FLWD SURG UXTR ART,,Grouper Rate,3544.00
Blue Cross,PPO,35703,CPT4/HCPCS,EXPL N/FLWD SURG LXTR ART,,Grouper Rate,3544.00
Blue Cross,PPO,35721,CPT4/HCPCS,EXPLORATION FEMORAL ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,35741,CPT4/HCPCS,EXPLORATION POPLITEAL ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,35761,CPT4/HCPCS,EXPLORATION OF ARTERY/VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,358,DRG,Other digestive system O.R. procedures w/o CC/MCC,,Case Rate,22147.06
Blue Cross,PPO,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,Grouper Rate,1678.88
Blue Cross,PPO,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,Grouper Rate,5281.00
Blue Cross,PPO,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,Grouper Rate,5029.00
Blue Cross,PPO,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,Grouper Rate,1678.88
Blue Cross,PPO,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,Grouper Rate,5783.00
Blue Cross,PPO,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,5029.00
Blue Cross,PPO,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,5029.00
Blue Cross,PPO,35883,CPT4/HCPCS,REVISE GRAFT W/NONAUTO GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,35884,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,5029.00
Blue Cross,PPO,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,Grouper Rate,1678.88
Blue Cross,PPO,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,Grouper Rate,1678.88
Blue Cross,PPO,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,Grouper Rate,5029.00
Blue Cross,PPO,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,Grouper Rate,6588.00
Blue Cross,PPO,36,DRG,Carotid artery stent procedure w/o CC/MCC,,Case Rate,30618.84
Blue Cross,PPO,36000,CPT4/HCPCS,PLACE NEEDLE IN VEIN,,Grouper Rate,1678.00
Blue Cross,PPO,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Grouper Rate,1678.00
Blue Cross,PPO,36005,CPT4/HCPCS,INJECTION EXT VENOGRAPHY,,Grouper Rate,1678.88
Blue Cross,PPO,36010,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1678.00
Blue Cross,PPO,36011,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1678.00
Blue Cross,PPO,36012,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1678.00
Blue Cross,PPO,36013,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,36014,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,36015,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,36100,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,36120,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,36140,CPT4/HCPCS,INTRO NDL ICATH UPR/LXTR ART,,Grouper Rate,1678.00
Blue Cross,PPO,36147,CPT4/HCPCS,ACCESS AV DIAL GRFT FOR EVAL,,Grouper Rate,1678.00
Blue Cross,PPO,36148,CPT4/HCPCS,ACCESS AV DIAL GRFT FOR PROC,,Grouper Rate,1678.00
Blue Cross,PPO,36160,CPT4/HCPCS,ESTABLISH ACCESS TO AORTA,,Grouper Rate,1678.00
Blue Cross,PPO,36200,CPT4/HCPCS,PLACE CATHETER IN AORTA,,Grouper Rate,3544.00
Blue Cross,PPO,36215,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,36216,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,36217,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,36218,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Grouper Rate,3544.00
Blue Cross,PPO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,3544.00
Blue Cross,PPO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,3544.00
Blue Cross,PPO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Grouper Rate,3544.00
Blue Cross,PPO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Grouper Rate,3544.00
Blue Cross,PPO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Grouper Rate,3544.00
Blue Cross,PPO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Grouper Rate,3544.00
Blue Cross,PPO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Grouper Rate,3544.00
Blue Cross,PPO,36245,CPT4/HCPCS,INS CATH ABD/L-EXT ART 1ST,,Grouper Rate,3544.00
Blue Cross,PPO,36246,CPT4/HCPCS,INS CATH ABD/L-EXT ART 2ND,,Grouper Rate,3544.00
Blue Cross,PPO,36247,CPT4/HCPCS,INS CATH ABD/L-EXT ART 3RD,,Grouper Rate,3544.00
Blue Cross,PPO,36248,CPT4/HCPCS,INS CATH ABD/L-EXT ART ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,Grouper Rate,3544.00
Blue Cross,PPO,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,Grouper Rate,3544.00
Blue Cross,PPO,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,Grouper Rate,3544.00
Blue Cross,PPO,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,Grouper Rate,3544.00
Blue Cross,PPO,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Grouper Rate,1678.00
Blue Cross,PPO,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Grouper Rate,1678.00
Blue Cross,PPO,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Grouper Rate,1678.00
Blue Cross,PPO,36416,CPT4/HCPCS,CAPILLARY BLOOD DRAW,,Grouper Rate,1678.00
Blue Cross,PPO,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Grouper Rate,1678.00
Blue Cross,PPO,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Grouper Rate,1678.00
Blue Cross,PPO,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Grouper Rate,1678.00
Blue Cross,PPO,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Grouper Rate,1678.00
Blue Cross,PPO,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Grouper Rate,1678.00
Blue Cross,PPO,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Grouper Rate,3544.00
Blue Cross,PPO,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Grouper Rate,1678.00
Blue Cross,PPO,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Grouper Rate,1678.88
Blue Cross,PPO,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Grouper Rate,1678.00
Blue Cross,PPO,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Grouper Rate,1678.00
Blue Cross,PPO,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,36474,CPT4/HCPCS,ENDOVENOUS MCHNCHEM ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Grouper Rate,1678.00
Blue Cross,PPO,36481,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1678.00
Blue Cross,PPO,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Grouper Rate,3544.00
Blue Cross,PPO,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Grouper Rate,1678.88
Blue Cross,PPO,36500,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1678.00
Blue Cross,PPO,36510,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1678.00
Blue Cross,PPO,36514,CPT4/HCPCS,APHERESIS PLASMA,,Grouper Rate,1678.00
Blue Cross,PPO,36522,CPT4/HCPCS,PHOTOPHERESIS,,Grouper Rate,1678.00
Blue Cross,PPO,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,1678.00
Blue Cross,PPO,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,1678.00
Blue Cross,PPO,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,3544.00
Blue Cross,PPO,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,3544.00
Blue Cross,PPO,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Grouper Rate,1678.88
Blue Cross,PPO,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Grouper Rate,1678.88
Blue Cross,PPO,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,3544.00
Blue Cross,PPO,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,3544.00
Blue Cross,PPO,36572,CPT4/HCPCS,INSJ PICC RS&I <5 YR,,Grouper Rate,1678.88
Blue Cross,PPO,36573,CPT4/HCPCS,INSJ PICC RS&I 5 YR+,,Grouper Rate,1678.88
Blue Cross,PPO,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,PPO,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Grouper Rate,1678.00
Blue Cross,PPO,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,PPO,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,PPO,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,PPO,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Grouper Rate,1678.00
Blue Cross,PPO,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,1678.00
Blue Cross,PPO,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Grouper Rate,1678.00
Blue Cross,PPO,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,1678.88
Blue Cross,PPO,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Grouper Rate,1678.00
Blue Cross,PPO,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Grouper Rate,1678.00
Blue Cross,PPO,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,Grouper Rate,1678.00
Blue Cross,PPO,36620,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,36625,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Grouper Rate,1678.00
Blue Cross,PPO,368,DRG,Major esophageal disorders w MCC,,Case Rate,32125.64
Blue Cross,PPO,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,3544.00
Blue Cross,PPO,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,3544.00
Blue Cross,PPO,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,3544.00
Blue Cross,PPO,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Grouper Rate,3544.00
Blue Cross,PPO,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Grouper Rate,5029.00
Blue Cross,PPO,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Grouper Rate,5029.00
Blue Cross,PPO,36822,CPT4/HCPCS,INSERTION OF CANNULA(S),,Grouper Rate,3544.00
Blue Cross,PPO,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,Grouper Rate,5281.00
Blue Cross,PPO,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Grouper Rate,5029.00
Blue Cross,PPO,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Grouper Rate,5029.00
Blue Cross,PPO,36833,CPT4/HCPCS,AV FISTULA REVISION,,Grouper Rate,5029.00
Blue Cross,PPO,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Grouper Rate,5029.00
Blue Cross,PPO,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Grouper Rate,3544.00
Blue Cross,PPO,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Grouper Rate,1678.88
Blue Cross,PPO,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Grouper Rate,3544.00
Blue Cross,PPO,36870,CPT4/HCPCS,PERCUT THROMBECT AV FISTULA,,Grouper Rate,1678.88
Blue Cross,PPO,369,DRG,Major esophageal disorders w CC,,Case Rate,17810.27
Blue Cross,PPO,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,1678.00
Blue Cross,PPO,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,5029.00
Blue Cross,PPO,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,5029.00
Blue Cross,PPO,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,1678.88
Blue Cross,PPO,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,5029.00
Blue Cross,PPO,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,3544.00
Blue Cross,PPO,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Grouper Rate,5029.00
Blue Cross,PPO,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Grouper Rate,1678.88
Blue Cross,PPO,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Grouper Rate,1678.88
Blue Cross,PPO,37,DRG,Extracranial procedures w MCC,,Case Rate,54163.53
Blue Cross,PPO,370,DRG,Major esophageal disorders w/o CC/MCC,,Case Rate,12365.30
Blue Cross,PPO,371,DRG,Major gastrointestinal disorders & peritoneal infections w MCC,,Case Rate,28586.08
Blue Cross,PPO,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,PPO,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,PPO,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,PPO,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,5783.00
Blue Cross,PPO,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,Grouper Rate,5783.00
Blue Cross,PPO,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,Grouper Rate,5029.00
Blue Cross,PPO,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Grouper Rate,5783.00
Blue Cross,PPO,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Grouper Rate,3544.00
Blue Cross,PPO,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Grouper Rate,1678.88
Blue Cross,PPO,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Grouper Rate,1678.88
Blue Cross,PPO,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Grouper Rate,1678.88
Blue Cross,PPO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Grouper Rate,5029.00
Blue Cross,PPO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Grouper Rate,5029.00
Blue Cross,PPO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Grouper Rate,5029.00
Blue Cross,PPO,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,Grouper Rate,1678.88
Blue Cross,PPO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Grouper Rate,3544.00
Blue Cross,PPO,372,DRG,Major gastrointestinal disorders & peritoneal infections w CC,,Case Rate,16996.50
Blue Cross,PPO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Grouper Rate,1678.88
Blue Cross,PPO,37201,CPT4/HCPCS,TRANSCATHETER THERAPY INFUSE,,Grouper Rate,1678.88
Blue Cross,PPO,37202,CPT4/HCPCS,TRANSCATHETER THERAPY INFUSE,,Grouper Rate,1678.88
Blue Cross,PPO,37203,CPT4/HCPCS,TRANSCATHETER RETRIEVAL,,Grouper Rate,3544.00
Blue Cross,PPO,37204,CPT4/HCPCS,TRANSCATHETER OCCLUSION,,Grouper Rate,5029.00
Blue Cross,PPO,37205,CPT4/HCPCS,TRANSCATH IV STENT PERCUT,,Grouper Rate,5029.00
Blue Cross,PPO,37206,CPT4/HCPCS,TRANSCATH IV STENT/PERC ADDL,,Grouper Rate,1678.88
Blue Cross,PPO,37207,CPT4/HCPCS,TRANSCATH IV STENT OPEN,,Grouper Rate,5029.00
Blue Cross,PPO,37208,CPT4/HCPCS,TRANSCATH IV STENT/OPEN ADDL,,Grouper Rate,1678.88
Blue Cross,PPO,37209,CPT4/HCPCS,CHANGE IV CATH AT THROMB TX,,Grouper Rate,1678.00
Blue Cross,PPO,37210,CPT4/HCPCS,EMBOLIZATION UTERINE FIBROID,,Grouper Rate,5029.00
Blue Cross,PPO,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Grouper Rate,1678.88
Blue Cross,PPO,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Grouper Rate,1678.88
Blue Cross,PPO,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Grouper Rate,1678.88
Blue Cross,PPO,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Grouper Rate,1678.88
Blue Cross,PPO,37215,CPT4/HCPCS,TRANSCATH STENT CCA W/EPS,,Grouper Rate,5281.00
Blue Cross,PPO,37216,CPT4/HCPCS,TRANSCATH STENT CCA W/O EPS,,Grouper Rate,5029.00
Blue Cross,PPO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Grouper Rate,5029.00
Blue Cross,PPO,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Grouper Rate,5029.00
Blue Cross,PPO,37220,CPT4/HCPCS,ILIAC REVASC,,Grouper Rate,5029.00
Blue Cross,PPO,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Grouper Rate,5029.00
Blue Cross,PPO,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Grouper Rate,3544.00
Blue Cross,PPO,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Grouper Rate,5029.00
Blue Cross,PPO,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Grouper Rate,5029.00
Blue Cross,PPO,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Grouper Rate,5281.00
Blue Cross,PPO,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Grouper Rate,5029.00
Blue Cross,PPO,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Grouper Rate,5281.00
Blue Cross,PPO,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Grouper Rate,5281.00
Blue Cross,PPO,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Grouper Rate,5281.00
Blue Cross,PPO,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Grouper Rate,1678.88
Blue Cross,PPO,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Grouper Rate,1678.88
Blue Cross,PPO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Grouper Rate,5029.00
Blue Cross,PPO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,1678.88
Blue Cross,PPO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Grouper Rate,5029.00
Blue Cross,PPO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,1678.88
Blue Cross,PPO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Grouper Rate,5281.00
Blue Cross,PPO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Grouper Rate,5281.00
Blue Cross,PPO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Grouper Rate,5281.00
Blue Cross,PPO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Grouper Rate,5281.00
Blue Cross,PPO,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Grouper Rate,5029.00
Blue Cross,PPO,37247,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL ART,,Grouper Rate,5029.00
Blue Cross,PPO,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Grouper Rate,5029.00
Blue Cross,PPO,37249,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL VEIN,,Grouper Rate,5029.00
Blue Cross,PPO,37252,CPT4/HCPCS,INTRVASC US NONCORONARY 1ST,,Grouper Rate,1678.00
Blue Cross,PPO,37253,CPT4/HCPCS,INTRVASC US NONCORONARY ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,373,DRG,Major gastrointestinal disorders & peritoneal infections w/o CC/MCC,,Case Rate,12297.49
Blue Cross,PPO,374,DRG,Digestive malignancy w MCC,,Case Rate,34203.06
Blue Cross,PPO,375,DRG,Digestive malignancy w CC,,Case Rate,19929.04
Blue Cross,PPO,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Grouper Rate,1678.88
Blue Cross,PPO,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,Grouper Rate,1678.88
Blue Cross,PPO,376,DRG,Digestive malignancy w/o CC/MCC,,Case Rate,14806.60
Blue Cross,PPO,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,5029.00
Blue Cross,PPO,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Grouper Rate,3544.00
Blue Cross,PPO,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Grouper Rate,1678.88
Blue Cross,PPO,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,Grouper Rate,5029.00
Blue Cross,PPO,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,Grouper Rate,5029.00
Blue Cross,PPO,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Grouper Rate,6588.00
Blue Cross,PPO,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,5029.00
Blue Cross,PPO,377,DRG,G.I. hemorrhage w MCC,,Case Rate,29753.80
Blue Cross,PPO,37700,CPT4/HCPCS,REVISE LEG VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Grouper Rate,3544.00
Blue Cross,PPO,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Grouper Rate,3544.00
Blue Cross,PPO,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Grouper Rate,3544.00
Blue Cross,PPO,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Grouper Rate,3544.00
Blue Cross,PPO,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Grouper Rate,3544.00
Blue Cross,PPO,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,Grouper Rate,5029.00
Blue Cross,PPO,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Grouper Rate,3544.00
Blue Cross,PPO,378,DRG,G.I. hemorrhage w CC,,Case Rate,16427.52
Blue Cross,PPO,379,DRG,G.I. hemorrhage w/o CC/MCC,,Case Rate,10537.63
Blue Cross,PPO,38,DRG,Extracranial procedures w CC,,Case Rate,27411.74
Blue Cross,PPO,380,DRG,Complicated peptic ulcer w MCC,,Case Rate,31146.47
Blue Cross,PPO,381,DRG,Complicated peptic ulcer w CC,,Case Rate,17527.43
Blue Cross,PPO,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Grouper Rate,5783.00
Blue Cross,PPO,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,Grouper Rate,5783.00
Blue Cross,PPO,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Grouper Rate,3544.00
Blue Cross,PPO,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,Grouper Rate,5783.00
Blue Cross,PPO,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,382,DRG,Complicated peptic ulcer w/o CC/MCC,,Case Rate,12707.68
Blue Cross,PPO,38200,CPT4/HCPCS,INJECTION FOR SPLEEN X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,38204,CPT4/HCPCS,BL DONOR SEARCH MANAGEMENT,,Grouper Rate,1678.00
Blue Cross,PPO,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,Grouper Rate,1678.00
Blue Cross,PPO,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,Grouper Rate,1678.00
Blue Cross,PPO,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,Grouper Rate,1678.00
Blue Cross,PPO,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,Grouper Rate,1678.00
Blue Cross,PPO,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,Grouper Rate,1678.00
Blue Cross,PPO,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,Grouper Rate,1678.00
Blue Cross,PPO,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,Grouper Rate,1678.00
Blue Cross,PPO,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,Grouper Rate,1678.00
Blue Cross,PPO,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,Grouper Rate,1678.00
Blue Cross,PPO,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,Grouper Rate,1678.00
Blue Cross,PPO,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,Grouper Rate,1678.00
Blue Cross,PPO,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Grouper Rate,1678.00
Blue Cross,PPO,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Grouper Rate,1678.00
Blue Cross,PPO,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Grouper Rate,1678.00
Blue Cross,PPO,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Grouper Rate,1678.88
Blue Cross,PPO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Grouper Rate,1678.88
Blue Cross,PPO,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Grouper Rate,6588.00
Blue Cross,PPO,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Grouper Rate,6588.00
Blue Cross,PPO,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,Grouper Rate,1678.00
Blue Cross,PPO,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Grouper Rate,6588.00
Blue Cross,PPO,383,DRG,Uncomplicated peptic ulcer w MCC,,Case Rate,21682.28
Blue Cross,PPO,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,1678.00
Blue Cross,PPO,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Grouper Rate,1678.88
Blue Cross,PPO,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,5783.00
Blue Cross,PPO,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,6588.00
Blue Cross,PPO,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,5783.00
Blue Cross,PPO,384,DRG,Uncomplicated peptic ulcer w/o MCC,,Case Rate,14760.29
Blue Cross,PPO,385,DRG,Inflammatory bowel disease w MCC,,Case Rate,26779.91
Blue Cross,PPO,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,PPO,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Grouper Rate,1678.00
Blue Cross,PPO,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,PPO,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,PPO,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,PPO,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,PPO,38531,CPT4/HCPCS,OPEN BX/EXC INGUINOFEM NODES,,Grouper Rate,1678.88
Blue Cross,PPO,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Grouper Rate,1678.88
Blue Cross,PPO,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,3544.00
Blue Cross,PPO,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,5029.00
Blue Cross,PPO,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,Grouper Rate,5281.00
Blue Cross,PPO,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,Grouper Rate,5281.00
Blue Cross,PPO,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Grouper Rate,3544.00
Blue Cross,PPO,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Grouper Rate,5281.00
Blue Cross,PPO,386,DRG,Inflammatory bowel disease w CC,,Case Rate,16432.49
Blue Cross,PPO,387,DRG,Inflammatory bowel disease w/o CC/MCC,,Case Rate,11801.29
Blue Cross,PPO,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,1678.88
Blue Cross,PPO,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,5281.00
Blue Cross,PPO,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,8012.00
Blue Cross,PPO,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,PPO,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,5029.00
Blue Cross,PPO,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,Grouper Rate,6588.00
Blue Cross,PPO,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,Grouper Rate,6588.00
Blue Cross,PPO,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,PPO,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,1678.88
Blue Cross,PPO,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,Grouper Rate,5783.00
Blue Cross,PPO,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,Grouper Rate,5783.00
Blue Cross,PPO,38790,CPT4/HCPCS,INJECT FOR LYMPHATIC X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,38792,CPT4/HCPCS,RA TRACER ID OF SENTINL NODE,,Grouper Rate,1678.00
Blue Cross,PPO,38794,CPT4/HCPCS,ACCESS THORACIC LYMPH DUCT,,Grouper Rate,1678.88
Blue Cross,PPO,388,DRG,G.I. obstruction w MCC,,Case Rate,25005.17
Blue Cross,PPO,389,DRG,G.I. obstruction w CC,,Case Rate,13592.57
Blue Cross,PPO,38900,CPT4/HCPCS,IO MAP OF SENT LYMPH NODE,,Grouper Rate,1678.00
Blue Cross,PPO,39,DRG,Extracranial procedures w/o CC/MCC,,Case Rate,18839.06
Blue Cross,PPO,390,DRG,G.I. obstruction w/o CC/MCC,,Case Rate,9636.20
Blue Cross,PPO,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,5029.00
Blue Cross,PPO,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,5029.00
Blue Cross,PPO,391,DRG,Esophagitis, gastroent & misc digest disorders w MCC,,Case Rate,20582.37
Blue Cross,PPO,392,DRG,Esophagitis, gastroent & misc digest disorders w/o MCC,,Case Rate,12643.17
Blue Cross,PPO,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,Grouper Rate,5029.00
Blue Cross,PPO,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,Grouper Rate,5029.00
Blue Cross,PPO,393,DRG,Other digestive system diagnoses w MCC,,Case Rate,27350.54
Blue Cross,PPO,394,DRG,Other digestive system diagnoses w CC,,Case Rate,15524.44
Blue Cross,PPO,39400,CPT4/HCPCS,MEDIASTINOSCOPY INCL BIOPSY,,Grouper Rate,3544.00
Blue Cross,PPO,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Grouper Rate,3544.00
Blue Cross,PPO,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Grouper Rate,3544.00
Blue Cross,PPO,395,DRG,Other digestive system diagnoses w/o CC/MCC,,Case Rate,10746.03
Blue Cross,PPO,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,Grouper Rate,5783.00
Blue Cross,PPO,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,6588.00
Blue Cross,PPO,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,5783.00
Blue Cross,PPO,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,5783.00
Blue Cross,PPO,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,Grouper Rate,5783.00
Blue Cross,PPO,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,Grouper Rate,5281.00
Blue Cross,PPO,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,Grouper Rate,6588.00
Blue Cross,PPO,4,DRG,Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R.,,Case Rate,196197.48
Blue Cross,PPO,40,DRG,Periph/cranial nerve & other nerv syst proc w MCC,,Case Rate,65462.01
Blue Cross,PPO,40490,CPT4/HCPCS,BIOPSY OF LIP,,Grouper Rate,1678.00
Blue Cross,PPO,405,DRG,Pancreas, liver & shunt procedures w MCC,,Case Rate,94782.47
Blue Cross,PPO,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1678.88
Blue Cross,PPO,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1678.88
Blue Cross,PPO,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1678.88
Blue Cross,PPO,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,1678.88
Blue Cross,PPO,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,1678.88
Blue Cross,PPO,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Grouper Rate,1678.88
Blue Cross,PPO,406,DRG,Pancreas, liver & shunt procedures w CC,,Case Rate,47585.58
Blue Cross,PPO,40650,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,3544.00
Blue Cross,PPO,40652,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,3544.00
Blue Cross,PPO,40654,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,3544.00
Blue Cross,PPO,407,DRG,Pancreas, liver & shunt procedures w/o CC/MCC,,Case Rate,34998.64
Blue Cross,PPO,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,3544.00
Blue Cross,PPO,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5029.00
Blue Cross,PPO,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5029.00
Blue Cross,PPO,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5029.00
Blue Cross,PPO,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,3544.00
Blue Cross,PPO,408,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC,,Case Rate,62016.73
Blue Cross,PPO,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.88
Blue Cross,PPO,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,1678.00
Blue Cross,PPO,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,1678.88
Blue Cross,PPO,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Grouper Rate,1678.00
Blue Cross,PPO,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,1678.88
Blue Cross,PPO,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1678.88
Blue Cross,PPO,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Grouper Rate,1678.00
Blue Cross,PPO,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Grouper Rate,1678.00
Blue Cross,PPO,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,1678.00
Blue Cross,PPO,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,1678.00
Blue Cross,PPO,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,1678.88
Blue Cross,PPO,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,1678.88
Blue Cross,PPO,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,1678.88
Blue Cross,PPO,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5281.00
Blue Cross,PPO,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5281.00
Blue Cross,PPO,409,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w CC,,Case Rate,34970.52
Blue Cross,PPO,41,DRG,Periph/cranial nerve & other nerv syst proc w CC or periph neurostim,,Case Rate,38882.23
Blue Cross,PPO,410,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC,,Case Rate,25896.67
Blue Cross,PPO,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Grouper Rate,1678.00
Blue Cross,PPO,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Grouper Rate,1678.00
Blue Cross,PPO,411,DRG,Cholecystectomy w c.d.e. w MCC,,Case Rate,62064.69
Blue Cross,PPO,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,1678.00
Blue Cross,PPO,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,1678.00
Blue Cross,PPO,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Grouper Rate,1678.00
Blue Cross,PPO,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Grouper Rate,1678.00
Blue Cross,PPO,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,5029.00
Blue Cross,PPO,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,5281.00
Blue Cross,PPO,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,Grouper Rate,5783.00
Blue Cross,PPO,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,412,DRG,Cholecystectomy w c.d.e. w CC,,Case Rate,37640.07
Blue Cross,PPO,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1678.88
Blue Cross,PPO,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1678.88
Blue Cross,PPO,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1678.88
Blue Cross,PPO,413,DRG,Cholecystectomy w c.d.e. w/o CC/MCC,,Case Rate,28637.35
Blue Cross,PPO,414,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w MCC,,Case Rate,59965.77
Blue Cross,PPO,415,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w CC,,Case Rate,33607.62
Blue Cross,PPO,41500,CPT4/HCPCS,FIXATION OF TONGUE,,Grouper Rate,1678.00
Blue Cross,PPO,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Grouper Rate,1678.00
Blue Cross,PPO,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Grouper Rate,1678.00
Blue Cross,PPO,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Grouper Rate,1678.00
Blue Cross,PPO,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Grouper Rate,1678.88
Blue Cross,PPO,416,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC,,Case Rate,23523.18
Blue Cross,PPO,417,DRG,Laparoscopic cholecystectomy w/o c.d.e. w MCC,,Case Rate,40084.69
Blue Cross,PPO,418,DRG,Laparoscopic cholecystectomy w/o c.d.e. w CC,,Case Rate,27921.17
Blue Cross,PPO,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Grouper Rate,1678.00
Blue Cross,PPO,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Grouper Rate,1678.00
Blue Cross,PPO,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Grouper Rate,1678.00
Blue Cross,PPO,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Grouper Rate,1678.00
Blue Cross,PPO,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,PPO,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,PPO,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,PPO,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,PPO,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1678.88
Blue Cross,PPO,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Grouper Rate,1678.88
Blue Cross,PPO,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Grouper Rate,1678.00
Blue Cross,PPO,41870,CPT4/HCPCS,GUM GRAFT,,Grouper Rate,1678.88
Blue Cross,PPO,41872,CPT4/HCPCS,REPAIR GUM,,Grouper Rate,1678.88
Blue Cross,PPO,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Grouper Rate,1678.88
Blue Cross,PPO,419,DRG,Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC,,Case Rate,21753.40
Blue Cross,PPO,42,DRG,Periph/cranial nerve & other nerv syst proc w/o CC/MCC,,Case Rate,31176.24
Blue Cross,PPO,420,DRG,Hepatobiliary diagnostic procedures w MCC,,Case Rate,58123.21
Blue Cross,PPO,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Grouper Rate,1678.88
Blue Cross,PPO,421,DRG,Hepatobiliary diagnostic procedures w CC,,Case Rate,31573.20
Blue Cross,PPO,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Grouper Rate,1678.00
Blue Cross,PPO,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1678.00
Blue Cross,PPO,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1678.88
Blue Cross,PPO,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1678.88
Blue Cross,PPO,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Grouper Rate,5029.00
Blue Cross,PPO,42140,CPT4/HCPCS,EXCISION OF UVULA,,Grouper Rate,1678.88
Blue Cross,PPO,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Grouper Rate,5029.00
Blue Cross,PPO,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Grouper Rate,1678.00
Blue Cross,PPO,42180,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,1678.00
Blue Cross,PPO,42182,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,1678.88
Blue Cross,PPO,422,DRG,Hepatobiliary diagnostic procedures w/o CC/MCC,,Case Rate,24006.15
Blue Cross,PPO,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,PPO,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,PPO,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,PPO,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5783.00
Blue Cross,PPO,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,PPO,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5281.00
Blue Cross,PPO,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,3544.00
Blue Cross,PPO,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,3544.00
Blue Cross,PPO,42235,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,5029.00
Blue Cross,PPO,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Grouper Rate,5029.00
Blue Cross,PPO,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Grouper Rate,1678.00
Blue Cross,PPO,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Grouper Rate,3544.00
Blue Cross,PPO,423,DRG,Other hepatobiliary or pancreas O.R. procedures w MCC,,Case Rate,69120.66
Blue Cross,PPO,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,PPO,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.88
Blue Cross,PPO,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,PPO,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,PPO,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,1678.00
Blue Cross,PPO,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,3544.00
Blue Cross,PPO,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,1678.88
Blue Cross,PPO,424,DRG,Other hepatobiliary or pancreas O.R. procedures w CC,,Case Rate,37737.66
Blue Cross,PPO,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,PPO,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,1678.00
Blue Cross,PPO,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Grouper Rate,3544.00
Blue Cross,PPO,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Grouper Rate,3544.00
Blue Cross,PPO,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,3544.00
Blue Cross,PPO,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5029.00
Blue Cross,PPO,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,6588.00
Blue Cross,PPO,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,6588.00
Blue Cross,PPO,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5783.00
Blue Cross,PPO,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Grouper Rate,3544.00
Blue Cross,PPO,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Grouper Rate,1678.88
Blue Cross,PPO,425,DRG,Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC,,Case Rate,25526.18
Blue Cross,PPO,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,3544.00
Blue Cross,PPO,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,5029.00
Blue Cross,PPO,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,3544.00
Blue Cross,PPO,42508,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5029.00
Blue Cross,PPO,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5029.00
Blue Cross,PPO,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5029.00
Blue Cross,PPO,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Grouper Rate,1678.00
Blue Cross,PPO,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Grouper Rate,1678.00
Blue Cross,PPO,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,1678.88
Blue Cross,PPO,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Grouper Rate,1678.00
Blue Cross,PPO,42802,CPT4/HCPCS,BIOPSY OF THROAT,,Grouper Rate,1678.00
Blue Cross,PPO,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,1678.00
Blue Cross,PPO,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,1678.00
Blue Cross,PPO,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Grouper Rate,1678.88
Blue Cross,PPO,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,3544.00
Blue Cross,PPO,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,5281.00
Blue Cross,PPO,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,5029.00
Blue Cross,PPO,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,5029.00
Blue Cross,PPO,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,5029.00
Blue Cross,PPO,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,5029.00
Blue Cross,PPO,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,PPO,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,PPO,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,PPO,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3544.00
Blue Cross,PPO,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,5029.00
Blue Cross,PPO,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,5281.00
Blue Cross,PPO,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,5281.00
Blue Cross,PPO,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Grouper Rate,3544.00
Blue Cross,PPO,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Grouper Rate,3544.00
Blue Cross,PPO,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Grouper Rate,3544.00
Blue Cross,PPO,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,5029.00
Blue Cross,PPO,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,5281.00
Blue Cross,PPO,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Grouper Rate,1678.00
Blue Cross,PPO,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Grouper Rate,1678.88
Blue Cross,PPO,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,Grouper Rate,5281.00
Blue Cross,PPO,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Grouper Rate,1678.88
Blue Cross,PPO,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,PPO,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,PPO,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1678.88
Blue Cross,PPO,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,PPO,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1678.00
Blue Cross,PPO,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1678.88
Blue Cross,PPO,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Grouper Rate,5029.00
Blue Cross,PPO,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Grouper Rate,5783.00
Blue Cross,PPO,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Grouper Rate,6588.00
Blue Cross,PPO,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,Grouper Rate,6588.00
Blue Cross,PPO,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,5783.00
Blue Cross,PPO,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,5281.00
Blue Cross,PPO,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,6588.00
Blue Cross,PPO,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Grouper Rate,1678.00
Blue Cross,PPO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Grouper Rate,1678.00
Blue Cross,PPO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Grouper Rate,1678.00
Blue Cross,PPO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Grouper Rate,1678.00
Blue Cross,PPO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Grouper Rate,1678.00
Blue Cross,PPO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Grouper Rate,1678.00
Blue Cross,PPO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Grouper Rate,1678.00
Blue Cross,PPO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,432,DRG,Cirrhosis & alcoholic hepatitis w MCC,,Case Rate,31129.93
Blue Cross,PPO,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Grouper Rate,1678.00
Blue Cross,PPO,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Grouper Rate,1678.88
Blue Cross,PPO,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Grouper Rate,1678.00
Blue Cross,PPO,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Grouper Rate,1678.88
Blue Cross,PPO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Grouper Rate,3544.00
Blue Cross,PPO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Grouper Rate,1678.00
Blue Cross,PPO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Grouper Rate,1678.00
Blue Cross,PPO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Grouper Rate,1678.00
Blue Cross,PPO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Grouper Rate,1678.00
Blue Cross,PPO,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Grouper Rate,1678.00
Blue Cross,PPO,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Grouper Rate,1678.88
Blue Cross,PPO,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Grouper Rate,1678.00
Blue Cross,PPO,43219,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Grouper Rate,1678.00
Blue Cross,PPO,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Grouper Rate,1678.00
Blue Cross,PPO,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Grouper Rate,1678.88
Blue Cross,PPO,43228,CPT4/HCPCS,ESOPH ENDOSCOPY ABLATION,,Grouper Rate,1678.88
Blue Cross,PPO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Grouper Rate,1678.00
Blue Cross,PPO,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Grouper Rate,1678.00
Blue Cross,PPO,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Grouper Rate,1678.00
Blue Cross,PPO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Grouper Rate,1678.00
Blue Cross,PPO,43234,CPT4/HCPCS,UPPER GI ENDOSCOPY EXAM,,Grouper Rate,1678.00
Blue Cross,PPO,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Grouper Rate,1678.88
Blue Cross,PPO,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Grouper Rate,1678.88
Blue Cross,PPO,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Grouper Rate,1678.88
Blue Cross,PPO,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,1678.88
Blue Cross,PPO,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Grouper Rate,1678.88
Blue Cross,PPO,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Grouper Rate,1678.00
Blue Cross,PPO,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Grouper Rate,1678.88
Blue Cross,PPO,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,1678.00
Blue Cross,PPO,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Grouper Rate,1678.88
Blue Cross,PPO,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Grouper Rate,1678.88
Blue Cross,PPO,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Grouper Rate,1678.88
Blue Cross,PPO,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Grouper Rate,1678.88
Blue Cross,PPO,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Grouper Rate,1678.88
Blue Cross,PPO,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Grouper Rate,1678.88
Blue Cross,PPO,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Grouper Rate,1678.88
Blue Cross,PPO,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Grouper Rate,1678.88
Blue Cross,PPO,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Grouper Rate,1678.88
Blue Cross,PPO,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Grouper Rate,1678.00
Blue Cross,PPO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Grouper Rate,1678.88
Blue Cross,PPO,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Grouper Rate,1678.88
Blue Cross,PPO,43256,CPT4/HCPCS,UPPR GI ENDOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,PPO,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Grouper Rate,1678.88
Blue Cross,PPO,43258,CPT4/HCPCS,OPERATIVE UPPER GI ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Grouper Rate,1678.88
Blue Cross,PPO,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Grouper Rate,1678.88
Blue Cross,PPO,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,PPO,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,PPO,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Grouper Rate,1678.88
Blue Cross,PPO,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Grouper Rate,1678.88
Blue Cross,PPO,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Grouper Rate,1678.88
Blue Cross,PPO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Grouper Rate,1678.00
Blue Cross,PPO,43267,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,PPO,43268,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,PPO,43269,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,PPO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Grouper Rate,1678.88
Blue Cross,PPO,43271,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,PPO,43272,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,1678.88
Blue Cross,PPO,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Grouper Rate,1678.88
Blue Cross,PPO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Grouper Rate,1678.88
Blue Cross,PPO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Grouper Rate,1678.88
Blue Cross,PPO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Grouper Rate,1678.88
Blue Cross,PPO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Grouper Rate,1678.88
Blue Cross,PPO,43279,CPT4/HCPCS,LAP MYOTOMY HELLER,,Grouper Rate,5783.00
Blue Cross,PPO,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Grouper Rate,6588.00
Blue Cross,PPO,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Grouper Rate,6588.00
Blue Cross,PPO,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Grouper Rate,6588.00
Blue Cross,PPO,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,Grouper Rate,6588.00
Blue Cross,PPO,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Grouper Rate,5029.00
Blue Cross,PPO,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Grouper Rate,1678.88
Blue Cross,PPO,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,Grouper Rate,6588.00
Blue Cross,PPO,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,Grouper Rate,6588.00
Blue Cross,PPO,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,Grouper Rate,6588.00
Blue Cross,PPO,433,DRG,Cirrhosis & alcoholic hepatitis w CC,,Case Rate,17011.39
Blue Cross,PPO,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Grouper Rate,5281.00
Blue Cross,PPO,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Grouper Rate,5783.00
Blue Cross,PPO,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Grouper Rate,6588.00
Blue Cross,PPO,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,Grouper Rate,6588.00
Blue Cross,PPO,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,Grouper Rate,6588.00
Blue Cross,PPO,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,Grouper Rate,6588.00
Blue Cross,PPO,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,Grouper Rate,5783.00
Blue Cross,PPO,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,Grouper Rate,5783.00
Blue Cross,PPO,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,Grouper Rate,6588.00
Blue Cross,PPO,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,Grouper Rate,5783.00
Blue Cross,PPO,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,Grouper Rate,6588.00
Blue Cross,PPO,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Grouper Rate,6588.00
Blue Cross,PPO,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Grouper Rate,6588.00
Blue Cross,PPO,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Grouper Rate,6588.00
Blue Cross,PPO,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Grouper Rate,6588.00
Blue Cross,PPO,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Grouper Rate,8012.00
Blue Cross,PPO,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Grouper Rate,8012.00
Blue Cross,PPO,43338,CPT4/HCPCS,ESOPH LENGTHENING,,Grouper Rate,5783.00
Blue Cross,PPO,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Grouper Rate,5783.00
Blue Cross,PPO,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Grouper Rate,6588.00
Blue Cross,PPO,43350,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,5783.00
Blue Cross,PPO,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,6588.00
Blue Cross,PPO,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,5029.00
Blue Cross,PPO,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Grouper Rate,5783.00
Blue Cross,PPO,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Grouper Rate,5783.00
Blue Cross,PPO,434,DRG,Cirrhosis & alcoholic hepatitis w/o CC/MCC,,Case Rate,10248.18
Blue Cross,PPO,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,Grouper Rate,3544.00
Blue Cross,PPO,43401,CPT4/HCPCS,ESOPHAGUS SURGERY FOR VEINS,,Grouper Rate,5783.00
Blue Cross,PPO,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,Grouper Rate,5783.00
Blue Cross,PPO,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Grouper Rate,5281.00
Blue Cross,PPO,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Grouper Rate,6588.00
Blue Cross,PPO,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,5281.00
Blue Cross,PPO,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,6588.00
Blue Cross,PPO,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Grouper Rate,1678.00
Blue Cross,PPO,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1678.00
Blue Cross,PPO,43456,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1678.88
Blue Cross,PPO,43458,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1678.88
Blue Cross,PPO,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,Grouper Rate,1678.88
Blue Cross,PPO,435,DRG,Malignancy of hepatobiliary system or pancreas w MCC,,Case Rate,28991.31
Blue Cross,PPO,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Grouper Rate,5281.00
Blue Cross,PPO,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Grouper Rate,5783.00
Blue Cross,PPO,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Grouper Rate,5783.00
Blue Cross,PPO,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Grouper Rate,1678.00
Blue Cross,PPO,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,Grouper Rate,5281.00
Blue Cross,PPO,436,DRG,Malignancy of hepatobiliary system or pancreas w CC,,Case Rate,18528.10
Blue Cross,PPO,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,Grouper Rate,5029.00
Blue Cross,PPO,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Grouper Rate,1678.88
Blue Cross,PPO,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Grouper Rate,1678.88
Blue Cross,PPO,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,6588.00
Blue Cross,PPO,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,6588.00
Blue Cross,PPO,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,5783.00
Blue Cross,PPO,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,PPO,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,PPO,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,PPO,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,5783.00
Blue Cross,PPO,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,3544.00
Blue Cross,PPO,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Grouper Rate,5783.00
Blue Cross,PPO,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Grouper Rate,5783.00
Blue Cross,PPO,43645,CPT4/HCPCS,LAP GASTR BYPASS INCL SMLL I,,Grouper Rate,5783.00
Blue Cross,PPO,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Grouper Rate,3544.00
Blue Cross,PPO,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Grouper Rate,1678.88
Blue Cross,PPO,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,5281.00
Blue Cross,PPO,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,5281.00
Blue Cross,PPO,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,437,DRG,Malignancy of hepatobiliary system or pancreas w/o CC/MCC,,Case Rate,14795.03
Blue Cross,PPO,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Grouper Rate,1678.00
Blue Cross,PPO,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Grouper Rate,1678.00
Blue Cross,PPO,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Grouper Rate,1678.00
Blue Cross,PPO,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Grouper Rate,1678.00
Blue Cross,PPO,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Grouper Rate,1678.00
Blue Cross,PPO,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Grouper Rate,1678.00
Blue Cross,PPO,43760,CPT4/HCPCS,CHANGE GASTROSTOMY TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,43762,CPT4/HCPCS,RPLC GTUBE NO REVJ TRC,,Grouper Rate,1678.00
Blue Cross,PPO,43763,CPT4/HCPCS,RPLC GTUBE REVJ GSTRST TRC,,Grouper Rate,1678.00
Blue Cross,PPO,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Grouper Rate,5783.00
Blue Cross,PPO,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Grouper Rate,5029.00
Blue Cross,PPO,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Grouper Rate,5029.00
Blue Cross,PPO,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Grouper Rate,5281.00
Blue Cross,PPO,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Grouper Rate,5029.00
Blue Cross,PPO,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,438,DRG,Disorders of pancreas except malignancy w MCC,,Case Rate,26402.80
Blue Cross,PPO,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,Grouper Rate,5783.00
Blue Cross,PPO,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,3544.00
Blue Cross,PPO,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,1678.88
Blue Cross,PPO,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,5281.00
Blue Cross,PPO,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,Grouper Rate,5783.00
Blue Cross,PPO,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,Grouper Rate,5783.00
Blue Cross,PPO,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,Grouper Rate,5783.00
Blue Cross,PPO,43845,CPT4/HCPCS,GASTROPLASTY DUODENAL SWITCH,,Grouper Rate,6588.00
Blue Cross,PPO,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,Grouper Rate,5783.00
Blue Cross,PPO,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,Grouper Rate,5783.00
Blue Cross,PPO,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,Grouper Rate,5783.00
Blue Cross,PPO,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,PPO,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,PPO,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,PPO,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,5783.00
Blue Cross,PPO,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Grouper Rate,1678.00
Blue Cross,PPO,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,Grouper Rate,5783.00
Blue Cross,PPO,43881,CPT4/HCPCS,IMPL/REDO ELECTRD ANTRUM,,Grouper Rate,5281.00
Blue Cross,PPO,43882,CPT4/HCPCS,REVISE/REMOVE ELECTRD ANTRUM,,Grouper Rate,5281.00
Blue Cross,PPO,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Grouper Rate,3544.00
Blue Cross,PPO,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Grouper Rate,3544.00
Blue Cross,PPO,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Grouper Rate,5029.00
Blue Cross,PPO,439,DRG,Disorders of pancreas except malignancy w CC,,Case Rate,13966.37
Blue Cross,PPO,440,DRG,Disorders of pancreas except malignancy w/o CC/MCC,,Case Rate,10021.58
Blue Cross,PPO,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Grouper Rate,5029.00
Blue Cross,PPO,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,Grouper Rate,3544.00
Blue Cross,PPO,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Grouper Rate,5281.00
Blue Cross,PPO,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,Grouper Rate,5281.00
Blue Cross,PPO,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Grouper Rate,5281.00
Blue Cross,PPO,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Grouper Rate,5281.00
Blue Cross,PPO,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Grouper Rate,5281.00
Blue Cross,PPO,441,DRG,Disorders of liver except malig,cirr,alc hepa w MCC,,Case Rate,31156.39
Blue Cross,PPO,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Grouper Rate,1678.00
Blue Cross,PPO,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,Grouper Rate,5281.00
Blue Cross,PPO,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,Grouper Rate,5281.00
Blue Cross,PPO,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,5783.00
Blue Cross,PPO,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,1678.88
Blue Cross,PPO,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,5783.00
Blue Cross,PPO,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,Grouper Rate,5783.00
Blue Cross,PPO,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,Grouper Rate,5783.00
Blue Cross,PPO,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,Grouper Rate,5783.00
Blue Cross,PPO,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,Grouper Rate,5281.00
Blue Cross,PPO,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,Grouper Rate,3544.00
Blue Cross,PPO,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,Grouper Rate,5783.00
Blue Cross,PPO,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,Grouper Rate,5783.00
Blue Cross,PPO,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,Grouper Rate,5281.00
Blue Cross,PPO,44137,CPT4/HCPCS,REMOVE INTESTINAL ALLOGRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,Grouper Rate,1678.88
Blue Cross,PPO,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,PPO,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,PPO,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,PPO,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,PPO,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,PPO,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,PPO,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,PPO,44150,CPT4/HCPCS,REMOVAL OF COLON,,Grouper Rate,6588.00
Blue Cross,PPO,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,44157,CPT4/HCPCS,COLECTOMY W/ILEOANAL ANAST,,Grouper Rate,6588.00
Blue Cross,PPO,44158,CPT4/HCPCS,COLECTOMY W/NEO-RECTUM POUCH,,Grouper Rate,6588.00
Blue Cross,PPO,44160,CPT4/HCPCS,REMOVAL OF COLON,,Grouper Rate,5783.00
Blue Cross,PPO,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Grouper Rate,5281.00
Blue Cross,PPO,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Grouper Rate,5281.00
Blue Cross,PPO,44188,CPT4/HCPCS,LAP COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,442,DRG,Disorders of liver except malig,cirr,alc hepa w CC,,Case Rate,15408.66
Blue Cross,PPO,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,Grouper Rate,1678.88
Blue Cross,PPO,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,Grouper Rate,5783.00
Blue Cross,PPO,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,443,DRG,Disorders of liver except malig,cirr,alc hepa w/o CC/MCC,,Case Rate,10962.71
Blue Cross,PPO,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,Grouper Rate,5281.00
Blue Cross,PPO,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,1678.00
Blue Cross,PPO,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,Grouper Rate,5783.00
Blue Cross,PPO,44320,CPT4/HCPCS,COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,Grouper Rate,5783.00
Blue Cross,PPO,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,3544.00
Blue Cross,PPO,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,1678.88
Blue Cross,PPO,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Grouper Rate,1678.88
Blue Cross,PPO,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,1678.88
Blue Cross,PPO,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Grouper Rate,1678.88
Blue Cross,PPO,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,1678.00
Blue Cross,PPO,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,1678.00
Blue Cross,PPO,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,44383,CPT4/HCPCS,ILEOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,PPO,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Grouper Rate,1678.00
Blue Cross,PPO,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Grouper Rate,1678.00
Blue Cross,PPO,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Grouper Rate,1678.00
Blue Cross,PPO,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Grouper Rate,1678.00
Blue Cross,PPO,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Grouper Rate,1678.00
Blue Cross,PPO,44393,CPT4/HCPCS,COLONOSCOPY LESION REMOVAL,,Grouper Rate,1678.00
Blue Cross,PPO,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Grouper Rate,1678.00
Blue Cross,PPO,44397,CPT4/HCPCS,COLONOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,PPO,444,DRG,Disorders of the biliary tract w MCC,,Case Rate,27601.95
Blue Cross,PPO,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Grouper Rate,1678.00
Blue Cross,PPO,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,1678.00
Blue Cross,PPO,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,1678.00
Blue Cross,PPO,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Grouper Rate,1678.00
Blue Cross,PPO,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Grouper Rate,1678.00
Blue Cross,PPO,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Grouper Rate,1678.00
Blue Cross,PPO,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Grouper Rate,1678.00
Blue Cross,PPO,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,1678.00
Blue Cross,PPO,445,DRG,Disorders of the biliary tract w CC,,Case Rate,17810.27
Blue Cross,PPO,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,446,DRG,Disorders of the biliary tract w/o CC/MCC,,Case Rate,13499.94
Blue Cross,PPO,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Grouper Rate,5281.00
Blue Cross,PPO,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Grouper Rate,5281.00
Blue Cross,PPO,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,Grouper Rate,5783.00
Blue Cross,PPO,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,Grouper Rate,5783.00
Blue Cross,PPO,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,Grouper Rate,5783.00
Blue Cross,PPO,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,5281.00
Blue Cross,PPO,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,5783.00
Blue Cross,PPO,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,5783.00
Blue Cross,PPO,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,Grouper Rate,5281.00
Blue Cross,PPO,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,Grouper Rate,5281.00
Blue Cross,PPO,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Grouper Rate,5281.00
Blue Cross,PPO,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Grouper Rate,5783.00
Blue Cross,PPO,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,Grouper Rate,5281.00
Blue Cross,PPO,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,Grouper Rate,3544.00
Blue Cross,PPO,44701,CPT4/HCPCS,INTRAOP COLON LAVAGE ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Grouper Rate,3544.00
Blue Cross,PPO,44715,CPT4/HCPCS,PREPARE DONOR INTESTINE,,Grouper Rate,3544.00
Blue Cross,PPO,44720,CPT4/HCPCS,PREP DONOR INTESTINE/VENOUS,,Grouper Rate,1678.00
Blue Cross,PPO,44721,CPT4/HCPCS,PREP DONOR INTESTINE/ARTERY,,Grouper Rate,1678.00
Blue Cross,PPO,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,Grouper Rate,5281.00
Blue Cross,PPO,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,Grouper Rate,5281.00
Blue Cross,PPO,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,Grouper Rate,5281.00
Blue Cross,PPO,44901,CPT4/HCPCS,DRAIN APP ABSCESS PERCUT,,Grouper Rate,1678.88
Blue Cross,PPO,44950,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,44960,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Grouper Rate,3544.00
Blue Cross,PPO,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,PPO,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Grouper Rate,1678.00
Blue Cross,PPO,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Grouper Rate,1678.88
Blue Cross,PPO,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,PPO,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,1678.88
Blue Cross,PPO,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,PPO,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,PPO,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,5783.00
Blue Cross,PPO,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,Grouper Rate,6588.00
Blue Cross,PPO,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,PPO,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,Grouper Rate,6588.00
Blue Cross,PPO,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,45126,CPT4/HCPCS,PELVIC EXENTERATION,,Grouper Rate,6588.00
Blue Cross,PPO,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Grouper Rate,5029.00
Blue Cross,PPO,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Grouper Rate,5783.00
Blue Cross,PPO,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,Grouper Rate,5783.00
Blue Cross,PPO,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Grouper Rate,1678.00
Blue Cross,PPO,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Grouper Rate,1678.88
Blue Cross,PPO,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Grouper Rate,5029.00
Blue Cross,PPO,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Grouper Rate,5281.00
Blue Cross,PPO,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Grouper Rate,1678.88
Blue Cross,PPO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,Case Rate,152062.14
Blue Cross,PPO,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Grouper Rate,1678.00
Blue Cross,PPO,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Grouper Rate,1678.00
Blue Cross,PPO,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Grouper Rate,1678.00
Blue Cross,PPO,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Grouper Rate,1678.00
Blue Cross,PPO,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1678.00
Blue Cross,PPO,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1678.00
Blue Cross,PPO,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1678.00
Blue Cross,PPO,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Grouper Rate,1678.00
Blue Cross,PPO,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Grouper Rate,1678.00
Blue Cross,PPO,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Grouper Rate,1678.00
Blue Cross,PPO,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,PPO,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Grouper Rate,1678.00
Blue Cross,PPO,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Grouper Rate,1678.00
Blue Cross,PPO,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Grouper Rate,1678.00
Blue Cross,PPO,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Grouper Rate,1678.00
Blue Cross,PPO,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Grouper Rate,1678.00
Blue Cross,PPO,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Grouper Rate,1678.00
Blue Cross,PPO,45339,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATE TUMR,,Grouper Rate,1678.00
Blue Cross,PPO,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Grouper Rate,1678.00
Blue Cross,PPO,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Grouper Rate,1678.00
Blue Cross,PPO,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Grouper Rate,1678.00
Blue Cross,PPO,45345,CPT4/HCPCS,SIGMOIDOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,PPO,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Grouper Rate,1678.00
Blue Cross,PPO,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Grouper Rate,1678.00
Blue Cross,PPO,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Grouper Rate,1678.00
Blue Cross,PPO,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Grouper Rate,1678.00
Blue Cross,PPO,45355,CPT4/HCPCS,SURGICAL COLONOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Grouper Rate,1678.00
Blue Cross,PPO,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Grouper Rate,1678.00
Blue Cross,PPO,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Grouper Rate,1678.00
Blue Cross,PPO,45383,CPT4/HCPCS,LESION REMOVAL COLONOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,1678.00
Blue Cross,PPO,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,1678.00
Blue Cross,PPO,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Grouper Rate,1678.88
Blue Cross,PPO,45387,CPT4/HCPCS,COLONOSCOPY W/STENT,,Grouper Rate,1678.00
Blue Cross,PPO,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Grouper Rate,1678.00
Blue Cross,PPO,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,1678.00
Blue Cross,PPO,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,1678.00
Blue Cross,PPO,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Grouper Rate,1678.88
Blue Cross,PPO,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Grouper Rate,1678.00
Blue Cross,PPO,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,1678.88
Blue Cross,PPO,45395,CPT4/HCPCS,LAP REMOVAL OF RECTUM,,Grouper Rate,6588.00
Blue Cross,PPO,45397,CPT4/HCPCS,LAP REMOVE RECTUM W/POUCH,,Grouper Rate,5783.00
Blue Cross,PPO,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Grouper Rate,1678.00
Blue Cross,PPO,454,DRG,Combined anterior/posterior spinal fusion w CC,,Case Rate,100862.57
Blue Cross,PPO,45400,CPT4/HCPCS,LAPAROSCOPIC PROC,,Grouper Rate,5281.00
Blue Cross,PPO,45402,CPT4/HCPCS,LAP PROCTOPEXY W/SIG RESECT,,Grouper Rate,5783.00
Blue Cross,PPO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,Case Rate,79243.14
Blue Cross,PPO,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,1678.88
Blue Cross,PPO,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,1678.88
Blue Cross,PPO,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Grouper Rate,1678.00
Blue Cross,PPO,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,5281.00
Blue Cross,PPO,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,1678.88
Blue Cross,PPO,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,Grouper Rate,5783.00
Blue Cross,PPO,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Grouper Rate,1678.88
Blue Cross,PPO,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Grouper Rate,1678.88
Blue Cross,PPO,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Grouper Rate,5281.00
Blue Cross,PPO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,Case Rate,142212.57
Blue Cross,PPO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,Case Rate,107543.08
Blue Cross,PPO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,Case Rate,82987.79
Blue Cross,PPO,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,Grouper Rate,5281.00
Blue Cross,PPO,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,Grouper Rate,5281.00
Blue Cross,PPO,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,459,DRG,Spinal fusion except cervical w MCC,,Case Rate,111343.97
Blue Cross,PPO,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Grouper Rate,1678.00
Blue Cross,PPO,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Grouper Rate,1678.00
Blue Cross,PPO,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Grouper Rate,1678.00
Blue Cross,PPO,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Grouper Rate,1678.00
Blue Cross,PPO,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Grouper Rate,1678.00
Blue Cross,PPO,460,DRG,Spinal fusion except cervical w/o MCC,,Case Rate,65046.85
Blue Cross,PPO,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Grouper Rate,1678.00
Blue Cross,PPO,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Grouper Rate,1678.00
Blue Cross,PPO,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,PPO,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,PPO,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1678.88
Blue Cross,PPO,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Grouper Rate,1678.00
Blue Cross,PPO,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,PPO,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Grouper Rate,1678.00
Blue Cross,PPO,461,DRG,Bilateral or multiple major joint procs of lower extremity w MCC,,Case Rate,100500.34
Blue Cross,PPO,462,DRG,Bilateral or multiple major joint procs of lower extremity w/o MCC,,Case Rate,52005.06
Blue Cross,PPO,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Grouper Rate,1678.88
Blue Cross,PPO,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Grouper Rate,1678.00
Blue Cross,PPO,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Grouper Rate,1678.00
Blue Cross,PPO,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Grouper Rate,1678.00
Blue Cross,PPO,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Grouper Rate,3544.00
Blue Cross,PPO,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Grouper Rate,3544.00
Blue Cross,PPO,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Grouper Rate,3544.00
Blue Cross,PPO,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Grouper Rate,3544.00
Blue Cross,PPO,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Grouper Rate,3544.00
Blue Cross,PPO,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Grouper Rate,5029.00
Blue Cross,PPO,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Grouper Rate,5029.00
Blue Cross,PPO,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Grouper Rate,3544.00
Blue Cross,PPO,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Grouper Rate,3544.00
Blue Cross,PPO,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Grouper Rate,5029.00
Blue Cross,PPO,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Grouper Rate,1678.00
Blue Cross,PPO,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Grouper Rate,3544.00
Blue Cross,PPO,463,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC,,Case Rate,88743.71
Blue Cross,PPO,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Grouper Rate,1678.00
Blue Cross,PPO,464,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC,,Case Rate,49198.23
Blue Cross,PPO,465,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC,,Case Rate,30493.14
Blue Cross,PPO,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Grouper Rate,1678.00
Blue Cross,PPO,466,DRG,Revision of hip or knee replacement w MCC,,Case Rate,88406.30
Blue Cross,PPO,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Grouper Rate,1678.00
Blue Cross,PPO,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Grouper Rate,1678.00
Blue Cross,PPO,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Grouper Rate,1678.00
Blue Cross,PPO,46611,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Grouper Rate,1678.00
Blue Cross,PPO,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Grouper Rate,1678.00
Blue Cross,PPO,46615,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,467,DRG,Revision of hip or knee replacement w CC,,Case Rate,59150.34
Blue Cross,PPO,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,3544.00
Blue Cross,PPO,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,3544.00
Blue Cross,PPO,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Grouper Rate,1678.00
Blue Cross,PPO,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,Grouper Rate,1678.00
Blue Cross,PPO,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,Grouper Rate,3544.00
Blue Cross,PPO,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,Grouper Rate,3544.00
Blue Cross,PPO,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,3544.00
Blue Cross,PPO,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,5281.00
Blue Cross,PPO,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,5281.00
Blue Cross,PPO,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,Grouper Rate,5783.00
Blue Cross,PPO,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1678.88
Blue Cross,PPO,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1678.88
Blue Cross,PPO,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,5783.00
Blue Cross,PPO,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,PPO,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,PPO,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Grouper Rate,3544.00
Blue Cross,PPO,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Grouper Rate,1678.00
Blue Cross,PPO,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,1678.88
Blue Cross,PPO,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,PPO,46762,CPT4/HCPCS,IMPLANT ARTIFICIAL SPHINCTER,,Grouper Rate,3544.00
Blue Cross,PPO,468,DRG,Revision of hip or knee replacement w/o CC/MCC,,Case Rate,46378.16
Blue Cross,PPO,469,DRG,Major joint replacement or reattachment of lower extremity w MCC,,Case Rate,51015.97
Blue Cross,PPO,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Grouper Rate,1678.00
Blue Cross,PPO,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Grouper Rate,1678.00
Blue Cross,PPO,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,1678.00
Blue Cross,PPO,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,1678.00
Blue Cross,PPO,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Grouper Rate,1678.00
Blue Cross,PPO,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Grouper Rate,1678.00
Blue Cross,PPO,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Grouper Rate,3544.00
Blue Cross,PPO,46948,CPT4/HCPCS,INT HRHC TRANAL DARTLZJ 2+,,Grouper Rate,1678.88
Blue Cross,PPO,470,DRG,Major joint replacement or reattachment of lower extremity w/o MCC,,Case Rate,31424.34
Blue Cross,PPO,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Grouper Rate,1678.00
Blue Cross,PPO,47001,CPT4/HCPCS,NEEDLE BIOPSY LIVER ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,Grouper Rate,5783.00
Blue Cross,PPO,47011,CPT4/HCPCS,PERCUT DRAIN LIVER LESION,,Grouper Rate,1678.00
Blue Cross,PPO,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,Grouper Rate,5281.00
Blue Cross,PPO,471,DRG,Cervical spinal fusion w MCC,,Case Rate,82977.87
Blue Cross,PPO,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,Grouper Rate,5029.00
Blue Cross,PPO,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,5783.00
Blue Cross,PPO,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,Grouper Rate,6588.00
Blue Cross,PPO,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,5783.00
Blue Cross,PPO,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,6588.00
Blue Cross,PPO,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,PPO,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,Grouper Rate,8841.00
Blue Cross,PPO,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,PPO,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,PPO,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,5783.00
Blue Cross,PPO,47143,CPT4/HCPCS,PREP DONOR LIVER WHOLE,,Grouper Rate,3544.00
Blue Cross,PPO,47144,CPT4/HCPCS,PREP DONOR LIVER 3-SEGMENT,,Grouper Rate,3544.00
Blue Cross,PPO,47145,CPT4/HCPCS,PREP DONOR LIVER LOBE SPLIT,,Grouper Rate,3544.00
Blue Cross,PPO,47146,CPT4/HCPCS,PREP DONOR LIVER/VENOUS,,Grouper Rate,1678.00
Blue Cross,PPO,47147,CPT4/HCPCS,PREP DONOR LIVER/ARTERIAL,,Grouper Rate,1678.00
Blue Cross,PPO,472,DRG,Cervical spinal fusion w CC,,Case Rate,50499.92
Blue Cross,PPO,473,DRG,Cervical spinal fusion w/o CC/MCC,,Case Rate,42014.90
Blue Cross,PPO,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,Grouper Rate,5281.00
Blue Cross,PPO,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5281.00
Blue Cross,PPO,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5783.00
Blue Cross,PPO,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5783.00
Blue Cross,PPO,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,5029.00
Blue Cross,PPO,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Grouper Rate,5029.00
Blue Cross,PPO,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Grouper Rate,5029.00
Blue Cross,PPO,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Grouper Rate,5029.00
Blue Cross,PPO,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Grouper Rate,5029.00
Blue Cross,PPO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Grouper Rate,5783.00
Blue Cross,PPO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Grouper Rate,5783.00
Blue Cross,PPO,474,DRG,Amputation for musculoskeletal sys & conn tissue dis w MCC,,Case Rate,67364.11
Blue Cross,PPO,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,Grouper Rate,5281.00
Blue Cross,PPO,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,Grouper Rate,5281.00
Blue Cross,PPO,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,Grouper Rate,5783.00
Blue Cross,PPO,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,Grouper Rate,5029.00
Blue Cross,PPO,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,Grouper Rate,3544.00
Blue Cross,PPO,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,Grouper Rate,1678.00
Blue Cross,PPO,475,DRG,Amputation for musculoskeletal sys & conn tissue dis w CC,,Case Rate,36282.14
Blue Cross,PPO,47500,CPT4/HCPCS,INJECTION FOR LIVER X-RAYS,,Grouper Rate,1678.00
Blue Cross,PPO,47505,CPT4/HCPCS,INJECTION FOR LIVER X-RAYS,,Grouper Rate,1678.00
Blue Cross,PPO,47510,CPT4/HCPCS,INSERT CATHETER BILE DUCT,,Grouper Rate,1678.88
Blue Cross,PPO,47511,CPT4/HCPCS,INSERT BILE DUCT DRAIN,,Grouper Rate,1678.88
Blue Cross,PPO,47525,CPT4/HCPCS,CHANGE BILE DUCT CATHETER,,Grouper Rate,1678.00
Blue Cross,PPO,47530,CPT4/HCPCS,REVISE/REINSERT BILE TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,1678.00
Blue Cross,PPO,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,1678.00
Blue Cross,PPO,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,1678.88
Blue Cross,PPO,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,1678.88
Blue Cross,PPO,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Grouper Rate,1678.00
Blue Cross,PPO,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Grouper Rate,1678.00
Blue Cross,PPO,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Grouper Rate,1678.00
Blue Cross,PPO,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,1678.00
Blue Cross,PPO,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,1678.00
Blue Cross,PPO,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,1678.00
Blue Cross,PPO,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Grouper Rate,1678.00
Blue Cross,PPO,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Grouper Rate,1678.00
Blue Cross,PPO,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Grouper Rate,1678.00
Blue Cross,PPO,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Grouper Rate,3544.00
Blue Cross,PPO,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Grouper Rate,1678.88
Blue Cross,PPO,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,PPO,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,PPO,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,PPO,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,3544.00
Blue Cross,PPO,47560,CPT4/HCPCS,LAPAROSCOPY W/CHOLANGIO,,Grouper Rate,3544.00
Blue Cross,PPO,47561,CPT4/HCPCS,LAPARO W/CHOLANGIO/BIOPSY,,Grouper Rate,3544.00
Blue Cross,PPO,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Grouper Rate,8841.00
Blue Cross,PPO,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Grouper Rate,8841.00
Blue Cross,PPO,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Grouper Rate,8841.00
Blue Cross,PPO,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Grouper Rate,8841.00
Blue Cross,PPO,476,DRG,Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC,,Case Rate,19183.09
Blue Cross,PPO,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,PPO,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,PPO,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,8012.00
Blue Cross,PPO,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,PPO,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,6588.00
Blue Cross,PPO,47630,CPT4/HCPCS,REMOVE BILE DUCT STONE,,Grouper Rate,3544.00
Blue Cross,PPO,477,DRG,Biopsies of musculoskeletal system & connective tissue w MCC,,Case Rate,55523.12
Blue Cross,PPO,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,Grouper Rate,5281.00
Blue Cross,PPO,47701,CPT4/HCPCS,BILE DUCT REVISION,,Grouper Rate,5783.00
Blue Cross,PPO,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Grouper Rate,5783.00
Blue Cross,PPO,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Grouper Rate,5783.00
Blue Cross,PPO,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,Grouper Rate,5783.00
Blue Cross,PPO,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,Grouper Rate,5783.00
Blue Cross,PPO,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,478,DRG,Biopsies of musculoskeletal system & connective tissue w CC,,Case Rate,38983.12
Blue Cross,PPO,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,Grouper Rate,5783.00
Blue Cross,PPO,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,Grouper Rate,5029.00
Blue Cross,PPO,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,Grouper Rate,5281.00
Blue Cross,PPO,479,DRG,Biopsies of musculoskeletal system & connective tissue w/o CC/MCC,,Case Rate,29925.82
Blue Cross,PPO,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,Grouper Rate,5281.00
Blue Cross,PPO,480,DRG,Hip & femur procedures except major joint w MCC,,Case Rate,50025.23
Blue Cross,PPO,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,Grouper Rate,5281.00
Blue Cross,PPO,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,Grouper Rate,5783.00
Blue Cross,PPO,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,Grouper Rate,5281.00
Blue Cross,PPO,481,DRG,Hip & femur procedures except major joint w CC,,Case Rate,34659.57
Blue Cross,PPO,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,Grouper Rate,5783.00
Blue Cross,PPO,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Grouper Rate,1678.00
Blue Cross,PPO,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,Grouper Rate,5783.00
Blue Cross,PPO,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,5783.00
Blue Cross,PPO,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,5783.00
Blue Cross,PPO,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,Grouper Rate,5783.00
Blue Cross,PPO,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,6588.00
Blue Cross,PPO,48153,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,Grouper Rate,6588.00
Blue Cross,PPO,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,PPO,482,DRG,Hip & femur procedures except major joint w/o CC/MCC,,Case Rate,27238.07
Blue Cross,PPO,483,DRG,Major joint & limb reattachment proc of upper extremity w CC/MCC,,Case Rate,39469.40
Blue Cross,PPO,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,485,DRG,Knee procedures w pdx of infection w MCC,,Case Rate,56361.70
Blue Cross,PPO,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,Grouper Rate,5281.00
Blue Cross,PPO,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Grouper Rate,5281.00
Blue Cross,PPO,48511,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Grouper Rate,1678.88
Blue Cross,PPO,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,48545,CPT4/HCPCS,PANCREATORRHAPHY,,Grouper Rate,5281.00
Blue Cross,PPO,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,Grouper Rate,5783.00
Blue Cross,PPO,48548,CPT4/HCPCS,FUSE PANCREAS AND BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,48550,CPT4/HCPCS,DONOR PANCREATECTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,48551,CPT4/HCPCS,PREP DONOR PANCREAS,,Grouper Rate,3544.00
Blue Cross,PPO,48552,CPT4/HCPCS,PREP DONOR PANCREAS/VENOUS,,Grouper Rate,1678.00
Blue Cross,PPO,48556,CPT4/HCPCS,REMOVAL ALLOGRAFT PANCREAS,,Grouper Rate,5783.00
Blue Cross,PPO,486,DRG,Knee procedures w pdx of infection w CC,,Case Rate,35534.53
Blue Cross,PPO,487,DRG,Knee procedures w pdx of infection w/o CC/MCC,,Case Rate,27130.56
Blue Cross,PPO,488,DRG,Knee procedures w/o pdx of infection w CC/MCC,,Case Rate,32659.88
Blue Cross,PPO,489,DRG,Knee procedures w/o pdx of infection w/o CC/MCC,,Case Rate,21472.22
Blue Cross,PPO,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,5029.00
Blue Cross,PPO,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,Grouper Rate,5029.00
Blue Cross,PPO,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Grouper Rate,8012.00
Blue Cross,PPO,49013,CPT4/HCPCS,PRPERTL PEL PACK HEMRRG TRMA,,Grouper Rate,1678.88
Blue Cross,PPO,49014,CPT4/HCPCS,REEXPLORATION PELVIC WOUND,,Grouper Rate,1678.88
Blue Cross,PPO,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,Grouper Rate,8012.00
Blue Cross,PPO,49021,CPT4/HCPCS,DRAIN ABDOMINAL ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,Grouper Rate,8012.00
Blue Cross,PPO,49041,CPT4/HCPCS,DRAIN PERCUT ABDOM ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,Grouper Rate,8012.00
Blue Cross,PPO,49061,CPT4/HCPCS,DRAIN PERCUT RETROPER ABSC,,Grouper Rate,1678.00
Blue Cross,PPO,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,Grouper Rate,5029.00
Blue Cross,PPO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Grouper Rate,1678.88
Blue Cross,PPO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Grouper Rate,1678.88
Blue Cross,PPO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Grouper Rate,1678.88
Blue Cross,PPO,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Grouper Rate,1678.00
Blue Cross,PPO,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Grouper Rate,1678.00
Blue Cross,PPO,492,DRG,Lower extrem & humer proc except hip,foot,femur w MCC,,Case Rate,57364.02
Blue Cross,PPO,49203,CPT4/HCPCS,EXC ABD TUM 5 CM OR LESS,,Grouper Rate,5029.00
Blue Cross,PPO,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,Grouper Rate,5029.00
Blue Cross,PPO,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,Grouper Rate,5783.00
Blue Cross,PPO,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Grouper Rate,3544.00
Blue Cross,PPO,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,Grouper Rate,5029.00
Blue Cross,PPO,493,DRG,Lower extrem & humer proc except hip,foot,femur w CC,,Case Rate,38458.80
Blue Cross,PPO,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Grouper Rate,1678.88
Blue Cross,PPO,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Grouper Rate,3544.00
Blue Cross,PPO,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Grouper Rate,6588.00
Blue Cross,PPO,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Grouper Rate,5281.00
Blue Cross,PPO,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Grouper Rate,1678.00
Blue Cross,PPO,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Grouper Rate,1678.00
Blue Cross,PPO,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,49327,CPT4/HCPCS,LAP INS DEVICE FOR RT,,Grouper Rate,3544.00
Blue Cross,PPO,494,DRG,Lower extrem & humer proc except hip,foot,femur w/o CC/MCC,,Case Rate,30630.42
Blue Cross,PPO,49400,CPT4/HCPCS,AIR INJECTION INTO ABDOMEN,,Grouper Rate,1678.00
Blue Cross,PPO,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Grouper Rate,1678.00
Blue Cross,PPO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Grouper Rate,1678.00
Blue Cross,PPO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Grouper Rate,1678.88
Blue Cross,PPO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Grouper Rate,1678.88
Blue Cross,PPO,49412,CPT4/HCPCS,INS DEVICE FOR RT GUIDE OPEN,,Grouper Rate,5029.00
Blue Cross,PPO,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Grouper Rate,1678.88
Blue Cross,PPO,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Grouper Rate,1678.88
Blue Cross,PPO,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Grouper Rate,1678.00
Blue Cross,PPO,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Grouper Rate,1678.88
Blue Cross,PPO,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Grouper Rate,1678.00
Blue Cross,PPO,49424,CPT4/HCPCS,ASSESS CYST CONTRAST INJECT,,Grouper Rate,1678.00
Blue Cross,PPO,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Grouper Rate,1678.88
Blue Cross,PPO,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Grouper Rate,1678.88
Blue Cross,PPO,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,Grouper Rate,1678.00
Blue Cross,PPO,49428,CPT4/HCPCS,LIGATION OF SHUNT,,Grouper Rate,1678.88
Blue Cross,PPO,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Grouper Rate,1678.88
Blue Cross,PPO,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Grouper Rate,1678.00
Blue Cross,PPO,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Grouper Rate,1678.00
Blue Cross,PPO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Grouper Rate,1678.88
Blue Cross,PPO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Grouper Rate,1678.88
Blue Cross,PPO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Grouper Rate,1678.88
Blue Cross,PPO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Grouper Rate,1678.88
Blue Cross,PPO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Grouper Rate,1678.88
Blue Cross,PPO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Grouper Rate,1678.88
Blue Cross,PPO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Grouper Rate,1678.88
Blue Cross,PPO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Grouper Rate,1678.00
Blue Cross,PPO,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Grouper Rate,5029.00
Blue Cross,PPO,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Grouper Rate,5029.00
Blue Cross,PPO,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Grouper Rate,5029.00
Blue Cross,PPO,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Grouper Rate,5029.00
Blue Cross,PPO,495,DRG,Local excision & removal int fix devices exc hip & femur w MCC,,Case Rate,60109.66
Blue Cross,PPO,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Grouper Rate,5029.00
Blue Cross,PPO,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Grouper Rate,5029.00
Blue Cross,PPO,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Grouper Rate,5029.00
Blue Cross,PPO,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Grouper Rate,5029.00
Blue Cross,PPO,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Grouper Rate,5029.00
Blue Cross,PPO,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Grouper Rate,5029.00
Blue Cross,PPO,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Grouper Rate,5029.00
Blue Cross,PPO,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Grouper Rate,1678.88
Blue Cross,PPO,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Grouper Rate,5281.00
Blue Cross,PPO,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Grouper Rate,5029.00
Blue Cross,PPO,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Grouper Rate,5281.00
Blue Cross,PPO,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Grouper Rate,5029.00
Blue Cross,PPO,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Grouper Rate,5029.00
Blue Cross,PPO,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Grouper Rate,5029.00
Blue Cross,PPO,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Grouper Rate,5029.00
Blue Cross,PPO,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Grouper Rate,5029.00
Blue Cross,PPO,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Grouper Rate,5029.00
Blue Cross,PPO,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Grouper Rate,5029.00
Blue Cross,PPO,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Grouper Rate,3544.00
Blue Cross,PPO,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Grouper Rate,5029.00
Blue Cross,PPO,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Grouper Rate,5029.00
Blue Cross,PPO,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Grouper Rate,5029.00
Blue Cross,PPO,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Grouper Rate,5029.00
Blue Cross,PPO,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Grouper Rate,3544.00
Blue Cross,PPO,496,DRG,Local excision & removal int fix devices exc hip & femur w CC,,Case Rate,32841.82
Blue Cross,PPO,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,3544.00
Blue Cross,PPO,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5281.00
Blue Cross,PPO,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5281.00
Blue Cross,PPO,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5281.00
Blue Cross,PPO,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Grouper Rate,5029.00
Blue Cross,PPO,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Grouper Rate,5029.00
Blue Cross,PPO,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Grouper Rate,5029.00
Blue Cross,PPO,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Grouper Rate,5029.00
Blue Cross,PPO,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Grouper Rate,5029.00
Blue Cross,PPO,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Grouper Rate,5029.00
Blue Cross,PPO,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Grouper Rate,5029.00
Blue Cross,PPO,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Grouper Rate,5029.00
Blue Cross,PPO,497,DRG,Local excision & removal int fix devices exc hip & femur w/o CC/MCC,,Case Rate,24126.89
Blue Cross,PPO,498,DRG,Local excision & removal int fix devices of hip & femur w CC/MCC,,Case Rate,42744.32
Blue Cross,PPO,499,DRG,Local excision & removal int fix devices of hip & femur w/o CC/MCC,,Case Rate,19826.49
Blue Cross,PPO,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,Grouper Rate,3544.00
Blue Cross,PPO,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,Grouper Rate,1678.88
Blue Cross,PPO,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,Grouper Rate,1678.88
Blue Cross,PPO,5,DRG,Liver transplant w MCC or intestinal transplant,,Case Rate,169093.38
Blue Cross,PPO,500,DRG,Soft tissue procedures w MCC,,Case Rate,52165.50
Blue Cross,PPO,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,5783.00
Blue Cross,PPO,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Grouper Rate,1678.88
Blue Cross,PPO,50021,CPT4/HCPCS,RENAL ABSCESS PERCUT DRAIN,,Grouper Rate,1678.00
Blue Cross,PPO,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Grouper Rate,3544.00
Blue Cross,PPO,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1678.88
Blue Cross,PPO,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,1678.88
Blue Cross,PPO,50065,CPT4/HCPCS,INCISION OF KIDNEY,,Grouper Rate,1678.88
Blue Cross,PPO,50070,CPT4/HCPCS,INCISION OF KIDNEY,,Grouper Rate,1678.88
Blue Cross,PPO,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,5783.00
Blue Cross,PPO,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,3544.00
Blue Cross,PPO,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,3544.00
Blue Cross,PPO,501,DRG,Soft tissue procedures w CC,,Case Rate,28862.30
Blue Cross,PPO,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,Grouper Rate,5783.00
Blue Cross,PPO,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,5783.00
Blue Cross,PPO,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,Grouper Rate,3544.00
Blue Cross,PPO,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,5029.00
Blue Cross,PPO,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,5029.00
Blue Cross,PPO,502,DRG,Soft tissue procedures w/o CC/MCC,,Case Rate,22011.43
Blue Cross,PPO,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Grouper Rate,1678.00
Blue Cross,PPO,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,Grouper Rate,5029.00
Blue Cross,PPO,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,Grouper Rate,5783.00
Blue Cross,PPO,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,Grouper Rate,5783.00
Blue Cross,PPO,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Grouper Rate,5783.00
Blue Cross,PPO,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Grouper Rate,5783.00
Blue Cross,PPO,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,Grouper Rate,5281.00
Blue Cross,PPO,50250,CPT4/HCPCS,CRYOABLATE RENAL MASS OPEN,,Grouper Rate,5029.00
Blue Cross,PPO,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Grouper Rate,5783.00
Blue Cross,PPO,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Grouper Rate,5281.00
Blue Cross,PPO,503,DRG,Foot procedures w MCC,,Case Rate,43478.69
Blue Cross,PPO,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,Grouper Rate,3544.00
Blue Cross,PPO,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,Grouper Rate,5281.00
Blue Cross,PPO,50323,CPT4/HCPCS,PREP CADAVER RENAL ALLOGRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,50325,CPT4/HCPCS,PREP DONOR RENAL GRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,50327,CPT4/HCPCS,PREP RENAL GRAFT/VENOUS,,Grouper Rate,1678.00
Blue Cross,PPO,50328,CPT4/HCPCS,PREP RENAL GRAFT/ARTERIAL,,Grouper Rate,1678.00
Blue Cross,PPO,50329,CPT4/HCPCS,PREP RENAL GRAFT/URETERAL,,Grouper Rate,1678.00
Blue Cross,PPO,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,Grouper Rate,5281.00
Blue Cross,PPO,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Grouper Rate,6588.00
Blue Cross,PPO,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Grouper Rate,6588.00
Blue Cross,PPO,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,Grouper Rate,5281.00
Blue Cross,PPO,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,Grouper Rate,6588.00
Blue Cross,PPO,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Grouper Rate,1678.88
Blue Cross,PPO,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Grouper Rate,1678.88
Blue Cross,PPO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Grouper Rate,1678.88
Blue Cross,PPO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Grouper Rate,1678.88
Blue Cross,PPO,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Grouper Rate,1678.88
Blue Cross,PPO,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Grouper Rate,1678.00
Blue Cross,PPO,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Grouper Rate,1678.00
Blue Cross,PPO,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Grouper Rate,1678.00
Blue Cross,PPO,50392,CPT4/HCPCS,INSERT KIDNEY DRAIN,,Grouper Rate,1678.00
Blue Cross,PPO,50393,CPT4/HCPCS,INSERT URETERAL TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,50394,CPT4/HCPCS,INJECTION FOR KIDNEY X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,50395,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Grouper Rate,1678.00
Blue Cross,PPO,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Grouper Rate,1678.00
Blue Cross,PPO,50398,CPT4/HCPCS,CHANGE KIDNEY TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,504,DRG,Foot procedures w CC,,Case Rate,29340.30
Blue Cross,PPO,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Grouper Rate,5783.00
Blue Cross,PPO,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Grouper Rate,5281.00
Blue Cross,PPO,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,1678.00
Blue Cross,PPO,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,1678.00
Blue Cross,PPO,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Grouper Rate,1678.00
Blue Cross,PPO,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Grouper Rate,1678.00
Blue Cross,PPO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Grouper Rate,1678.00
Blue Cross,PPO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Grouper Rate,1678.00
Blue Cross,PPO,50436,CPT4/HCPCS,DILAT XST TRC NDURLGC PX,,Grouper Rate,1678.00
Blue Cross,PPO,50437,CPT4/HCPCS,DILAT XST TRC NEW ACCESS RCS,,Grouper Rate,1678.00
Blue Cross,PPO,505,DRG,Foot procedures w/o CC/MCC,,Case Rate,29340.30
Blue Cross,PPO,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,Grouper Rate,5281.00
Blue Cross,PPO,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Grouper Rate,1678.00
Blue Cross,PPO,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Grouper Rate,5783.00
Blue Cross,PPO,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Grouper Rate,6588.00
Blue Cross,PPO,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,Grouper Rate,5783.00
Blue Cross,PPO,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Grouper Rate,5029.00
Blue Cross,PPO,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Grouper Rate,5281.00
Blue Cross,PPO,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Grouper Rate,5281.00
Blue Cross,PPO,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Grouper Rate,5029.00
Blue Cross,PPO,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Grouper Rate,5281.00
Blue Cross,PPO,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,PPO,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,PPO,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Grouper Rate,5281.00
Blue Cross,PPO,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,PPO,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,PPO,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Grouper Rate,8841.00
Blue Cross,PPO,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Grouper Rate,5783.00
Blue Cross,PPO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Grouper Rate,5281.00
Blue Cross,PPO,506,DRG,Major thumb or joint procedures,,Case Rate,24408.07
Blue Cross,PPO,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Grouper Rate,5783.00
Blue Cross,PPO,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Grouper Rate,5029.00
Blue Cross,PPO,50606,CPT4/HCPCS,ENDOLUMINAL BX URTR RNL PLVS,,Grouper Rate,1678.00
Blue Cross,PPO,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,PPO,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,PPO,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,PPO,50650,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,5783.00
Blue Cross,PPO,50660,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,6588.00
Blue Cross,PPO,50684,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,Grouper Rate,1678.00
Blue Cross,PPO,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Grouper Rate,1678.00
Blue Cross,PPO,50690,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,1678.00
Blue Cross,PPO,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,1678.00
Blue Cross,PPO,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,1678.00
Blue Cross,PPO,507,DRG,Major shoulder or elbow joint procedures w CC/MCC,,Case Rate,33448.84
Blue Cross,PPO,50700,CPT4/HCPCS,REVISION OF URETER,,Grouper Rate,5281.00
Blue Cross,PPO,50705,CPT4/HCPCS,URETERAL EMBOLIZATION/OCCL,,Grouper Rate,1678.88
Blue Cross,PPO,50706,CPT4/HCPCS,BALLOON DILATE URTRL STRIX,,Grouper Rate,1678.88
Blue Cross,PPO,50715,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,5281.00
Blue Cross,PPO,50722,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,5281.00
Blue Cross,PPO,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,Grouper Rate,5783.00
Blue Cross,PPO,50727,CPT4/HCPCS,REVISE URETER,,Grouper Rate,1678.88
Blue Cross,PPO,50728,CPT4/HCPCS,REVISE URETER,,Grouper Rate,3544.00
Blue Cross,PPO,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Grouper Rate,5029.00
Blue Cross,PPO,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Grouper Rate,5029.00
Blue Cross,PPO,50760,CPT4/HCPCS,FUSION OF URETERS,,Grouper Rate,5281.00
Blue Cross,PPO,50770,CPT4/HCPCS,SPLICING OF URETERS,,Grouper Rate,5281.00
Blue Cross,PPO,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,5783.00
Blue Cross,PPO,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,5281.00
Blue Cross,PPO,508,DRG,Major shoulder or elbow joint procedures w/o CC/MCC,,Case Rate,23387.56
Blue Cross,PPO,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,Grouper Rate,5281.00
Blue Cross,PPO,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,Grouper Rate,6588.00
Blue Cross,PPO,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Grouper Rate,8012.00
Blue Cross,PPO,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Grouper Rate,8012.00
Blue Cross,PPO,50830,CPT4/HCPCS,REVISE URINE FLOW,,Grouper Rate,6588.00
Blue Cross,PPO,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,Grouper Rate,6588.00
Blue Cross,PPO,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,Grouper Rate,5029.00
Blue Cross,PPO,509,DRG,Arthroscopy,,Case Rate,27684.65
Blue Cross,PPO,50900,CPT4/HCPCS,REPAIR OF URETER,,Grouper Rate,5783.00
Blue Cross,PPO,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,Grouper Rate,5783.00
Blue Cross,PPO,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,Grouper Rate,5783.00
Blue Cross,PPO,50940,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,5783.00
Blue Cross,PPO,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,5281.00
Blue Cross,PPO,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,5281.00
Blue Cross,PPO,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,1678.00
Blue Cross,PPO,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,1678.00
Blue Cross,PPO,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,PPO,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,PPO,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Grouper Rate,1678.00
Blue Cross,PPO,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,1678.00
Blue Cross,PPO,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,PPO,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1678.00
Blue Cross,PPO,510,DRG,Shoulder,elbow or forearm proc,exc major joint proc w MCC,,Case Rate,45165.77
Blue Cross,PPO,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,5029.00
Blue Cross,PPO,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,5029.00
Blue Cross,PPO,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Grouper Rate,5029.00
Blue Cross,PPO,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Grouper Rate,5029.00
Blue Cross,PPO,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Grouper Rate,5029.00
Blue Cross,PPO,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5029.00
Blue Cross,PPO,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Grouper Rate,5029.00
Blue Cross,PPO,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Grouper Rate,3544.00
Blue Cross,PPO,511,DRG,Shoulder,elbow or forearm proc,exc major joint proc w CC,,Case Rate,32558.99
Blue Cross,PPO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Grouper Rate,1678.00
Blue Cross,PPO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Grouper Rate,1678.00
Blue Cross,PPO,512,DRG,Shoulder,elbow or forearm proc,exc major joint proc w/o CC/MCC,,Case Rate,25739.54
Blue Cross,PPO,513,DRG,Hand or wrist proc, except major thumb or joint proc w CC/MCC,,Case Rate,25785.86
Blue Cross,PPO,514,DRG,Hand or wrist proc, except major thumb or joint proc w/o CC/MCC,,Case Rate,16444.06
Blue Cross,PPO,515,DRG,Other musculoskelet sys & conn tiss O.R. proc w MCC,,Case Rate,51885.98
Blue Cross,PPO,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Grouper Rate,5029.00
Blue Cross,PPO,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5029.00
Blue Cross,PPO,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5029.00
Blue Cross,PPO,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5029.00
Blue Cross,PPO,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,Grouper Rate,5029.00
Blue Cross,PPO,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Grouper Rate,1678.88
Blue Cross,PPO,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Grouper Rate,1678.88
Blue Cross,PPO,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,Grouper Rate,6588.00
Blue Cross,PPO,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,Grouper Rate,6588.00
Blue Cross,PPO,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Grouper Rate,6588.00
Blue Cross,PPO,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,6588.00
Blue Cross,PPO,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Grouper Rate,6588.00
Blue Cross,PPO,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,8012.00
Blue Cross,PPO,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,8012.00
Blue Cross,PPO,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,Grouper Rate,8012.00
Blue Cross,PPO,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,Grouper Rate,8841.00
Blue Cross,PPO,516,DRG,Other musculoskelet sys & conn tiss O.R. proc w CC,,Case Rate,32436.59
Blue Cross,PPO,51600,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,Grouper Rate,1678.88
Blue Cross,PPO,51605,CPT4/HCPCS,PREPARATION FOR BLADDER XRAY,,Grouper Rate,1678.00
Blue Cross,PPO,51610,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,Grouper Rate,1678.88
Blue Cross,PPO,517,DRG,Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC,,Case Rate,23101.41
Blue Cross,PPO,51703,CPT4/HCPCS,INSERT BLADDER CATH COMPLEX,,Grouper Rate,1678.00
Blue Cross,PPO,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Grouper Rate,1678.88
Blue Cross,PPO,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Grouper Rate,1678.00
Blue Cross,PPO,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Grouper Rate,1678.00
Blue Cross,PPO,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Grouper Rate,1678.00
Blue Cross,PPO,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Grouper Rate,1678.00
Blue Cross,PPO,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Grouper Rate,1678.00
Blue Cross,PPO,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Grouper Rate,1678.88
Blue Cross,PPO,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,Grouper Rate,1678.00
Blue Cross,PPO,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,Grouper Rate,1678.00
Blue Cross,PPO,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,1678.00
Blue Cross,PPO,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,1678.00
Blue Cross,PPO,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,Grouper Rate,1678.00
Blue Cross,PPO,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Grouper Rate,1678.00
Blue Cross,PPO,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,Grouper Rate,1678.00
Blue Cross,PPO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,Case Rate,59284.32
Blue Cross,PPO,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Grouper Rate,5281.00
Blue Cross,PPO,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Grouper Rate,6588.00
Blue Cross,PPO,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,5281.00
Blue Cross,PPO,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,5281.00
Blue Cross,PPO,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Grouper Rate,5281.00
Blue Cross,PPO,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,5029.00
Blue Cross,PPO,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,5029.00
Blue Cross,PPO,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Grouper Rate,1678.00
Blue Cross,PPO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,Case Rate,32380.35
Blue Cross,PPO,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Grouper Rate,5029.00
Blue Cross,PPO,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Grouper Rate,3544.00
Blue Cross,PPO,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,Grouper Rate,5783.00
Blue Cross,PPO,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,Grouper Rate,5281.00
Blue Cross,PPO,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,Grouper Rate,5783.00
Blue Cross,PPO,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,Grouper Rate,5029.00
Blue Cross,PPO,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Grouper Rate,5281.00
Blue Cross,PPO,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Grouper Rate,5281.00
Blue Cross,PPO,52,DRG,Spinal disorders & injuries w CC/MCC,,Case Rate,30517.95
Blue Cross,PPO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,Case Rate,23443.79
Blue Cross,PPO,52000,CPT4/HCPCS,CYSTOSCOPY,,Grouper Rate,1678.88
Blue Cross,PPO,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Grouper Rate,1678.00
Blue Cross,PPO,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Grouper Rate,1678.88
Blue Cross,PPO,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Grouper Rate,1678.88
Blue Cross,PPO,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Grouper Rate,1678.88
Blue Cross,PPO,521,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,,Case Rate,50668.63
Blue Cross,PPO,522,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,,Case Rate,36207.71
Blue Cross,PPO,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Grouper Rate,1678.88
Blue Cross,PPO,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3544.00
Blue Cross,PPO,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Grouper Rate,5029.00
Blue Cross,PPO,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3544.00
Blue Cross,PPO,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,1678.88
Blue Cross,PPO,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,1678.88
Blue Cross,PPO,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Grouper Rate,1678.88
Blue Cross,PPO,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Grouper Rate,1678.88
Blue Cross,PPO,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,1678.88
Blue Cross,PPO,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,1678.88
Blue Cross,PPO,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Grouper Rate,5029.00
Blue Cross,PPO,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Grouper Rate,1678.88
Blue Cross,PPO,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1678.88
Blue Cross,PPO,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Grouper Rate,3544.00
Blue Cross,PPO,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Grouper Rate,1678.88
Blue Cross,PPO,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Grouper Rate,1678.88
Blue Cross,PPO,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Grouper Rate,1678.88
Blue Cross,PPO,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Grouper Rate,3544.00
Blue Cross,PPO,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Grouper Rate,3544.00
Blue Cross,PPO,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Grouper Rate,3544.00
Blue Cross,PPO,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Grouper Rate,3544.00
Blue Cross,PPO,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Grouper Rate,1678.88
Blue Cross,PPO,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Grouper Rate,1678.88
Blue Cross,PPO,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Grouper Rate,3544.00
Blue Cross,PPO,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Grouper Rate,5029.00
Blue Cross,PPO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Grouper Rate,1678.88
Blue Cross,PPO,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Grouper Rate,1678.88
Blue Cross,PPO,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Grouper Rate,1678.88
Blue Cross,PPO,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Grouper Rate,1678.88
Blue Cross,PPO,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Grouper Rate,1678.88
Blue Cross,PPO,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Grouper Rate,3544.00
Blue Cross,PPO,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Grouper Rate,3544.00
Blue Cross,PPO,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Grouper Rate,3544.00
Blue Cross,PPO,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Grouper Rate,1678.88
Blue Cross,PPO,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Grouper Rate,1678.88
Blue Cross,PPO,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,PPO,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,PPO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Grouper Rate,1678.88
Blue Cross,PPO,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,1678.88
Blue Cross,PPO,53,DRG,Spinal disorders & injuries w/o CC/MCC,,Case Rate,18791.09
Blue Cross,PPO,53000,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,PPO,53010,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,PPO,53020,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,PPO,53025,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,PPO,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,1678.88
Blue Cross,PPO,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,1678.00
Blue Cross,PPO,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,1678.88
Blue Cross,PPO,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Grouper Rate,1678.00
Blue Cross,PPO,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,5281.00
Blue Cross,PPO,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,5281.00
Blue Cross,PPO,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,1678.88
Blue Cross,PPO,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,1678.88
Blue Cross,PPO,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,3544.00
Blue Cross,PPO,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Grouper Rate,1678.88
Blue Cross,PPO,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,1678.88
Blue Cross,PPO,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,1678.88
Blue Cross,PPO,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,1678.00
Blue Cross,PPO,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,1678.00
Blue Cross,PPO,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,1678.00
Blue Cross,PPO,533,DRG,Fractures of femur w MCC,,Case Rate,23364.40
Blue Cross,PPO,534,DRG,Fractures of femur w/o MCC,,Case Rate,13043.44
Blue Cross,PPO,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Grouper Rate,3544.00
Blue Cross,PPO,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Grouper Rate,1678.88
Blue Cross,PPO,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,1678.88
Blue Cross,PPO,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,PPO,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Grouper Rate,3544.00
Blue Cross,PPO,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Grouper Rate,1678.88
Blue Cross,PPO,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,1678.88
Blue Cross,PPO,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Grouper Rate,3544.00
Blue Cross,PPO,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Grouper Rate,1678.88
Blue Cross,PPO,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Grouper Rate,1678.00
Blue Cross,PPO,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Grouper Rate,3544.00
Blue Cross,PPO,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Grouper Rate,5281.00
Blue Cross,PPO,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Grouper Rate,3544.00
Blue Cross,PPO,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Grouper Rate,1678.00
Blue Cross,PPO,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,Grouper Rate,5783.00
Blue Cross,PPO,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Grouper Rate,1678.00
Blue Cross,PPO,53450,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,PPO,53460,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,PPO,535,DRG,Fractures of hip & pelvis w MCC,,Case Rate,20407.05
Blue Cross,PPO,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Grouper Rate,3544.00
Blue Cross,PPO,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,PPO,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,PPO,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,PPO,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,1678.88
Blue Cross,PPO,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,1678.88
Blue Cross,PPO,536,DRG,Fractures of hip & pelvis w/o MCC,,Case Rate,12762.26
Blue Cross,PPO,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,PPO,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,PPO,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,PPO,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,PPO,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1678.00
Blue Cross,PPO,53665,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,1678.00
Blue Cross,PPO,537,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC,,Case Rate,15435.12
Blue Cross,PPO,538,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC,,Case Rate,11931.95
Blue Cross,PPO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Grouper Rate,3544.00
Blue Cross,PPO,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Grouper Rate,3544.00
Blue Cross,PPO,53854,CPT4/HCPCS,TRURL DSTRJ PRST8 TISS RF WV,,Grouper Rate,3544.00
Blue Cross,PPO,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Grouper Rate,1678.00
Blue Cross,PPO,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Grouper Rate,3544.00
Blue Cross,PPO,539,DRG,Osteomyelitis w MCC,,Case Rate,32107.44
Blue Cross,PPO,54,DRG,Nervous system neoplasms w MCC,,Case Rate,22590.33
Blue Cross,PPO,540,DRG,Osteomyelitis w CC,,Case Rate,21424.26
Blue Cross,PPO,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,1678.00
Blue Cross,PPO,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,1678.00
Blue Cross,PPO,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Grouper Rate,1678.88
Blue Cross,PPO,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,541,DRG,Osteomyelitis w/o CC/MCC,,Case Rate,13903.52
Blue Cross,PPO,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,1678.00
Blue Cross,PPO,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,1678.00
Blue Cross,PPO,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.88
Blue Cross,PPO,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,5281.00
Blue Cross,PPO,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,5783.00
Blue Cross,PPO,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.00
Blue Cross,PPO,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Grouper Rate,1678.88
Blue Cross,PPO,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Grouper Rate,1678.88
Blue Cross,PPO,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,Grouper Rate,5281.00
Blue Cross,PPO,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,Grouper Rate,5783.00
Blue Cross,PPO,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Grouper Rate,1678.00
Blue Cross,PPO,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Grouper Rate,1678.00
Blue Cross,PPO,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Grouper Rate,1678.00
Blue Cross,PPO,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Grouper Rate,1678.00
Blue Cross,PPO,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Grouper Rate,1678.00
Blue Cross,PPO,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Grouper Rate,1678.00
Blue Cross,PPO,542,DRG,Pathological fractures & musculoskelet & conn tiss malig w MCC,,Case Rate,29859.66
Blue Cross,PPO,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.88
Blue Cross,PPO,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1678.00
Blue Cross,PPO,54240,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,1678.00
Blue Cross,PPO,543,DRG,Pathological fractures & musculoskelet & conn tiss malig w CC,,Case Rate,17256.18
Blue Cross,PPO,54300,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,3544.00
Blue Cross,PPO,54304,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,3544.00
Blue Cross,PPO,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,PPO,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,PPO,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5029.00
Blue Cross,PPO,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5281.00
Blue Cross,PPO,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,1678.88
Blue Cross,PPO,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,3544.00
Blue Cross,PPO,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,3544.00
Blue Cross,PPO,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5029.00
Blue Cross,PPO,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5029.00
Blue Cross,PPO,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5029.00
Blue Cross,PPO,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Grouper Rate,5029.00
Blue Cross,PPO,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,54380,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5029.00
Blue Cross,PPO,54385,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5029.00
Blue Cross,PPO,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,Grouper Rate,5029.00
Blue Cross,PPO,544,DRG,Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC,,Case Rate,12838.34
Blue Cross,PPO,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,PPO,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Grouper Rate,5281.00
Blue Cross,PPO,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Grouper Rate,3544.00
Blue Cross,PPO,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Grouper Rate,5281.00
Blue Cross,PPO,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Grouper Rate,5281.00
Blue Cross,PPO,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Grouper Rate,5783.00
Blue Cross,PPO,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Grouper Rate,5281.00
Blue Cross,PPO,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Grouper Rate,5029.00
Blue Cross,PPO,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Grouper Rate,5281.00
Blue Cross,PPO,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Grouper Rate,5281.00
Blue Cross,PPO,54420,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5029.00
Blue Cross,PPO,54430,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,1678.88
Blue Cross,PPO,54435,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5029.00
Blue Cross,PPO,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Grouper Rate,3544.00
Blue Cross,PPO,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,Grouper Rate,5281.00
Blue Cross,PPO,54440,CPT4/HCPCS,REPAIR OF PENIS,,Grouper Rate,5029.00
Blue Cross,PPO,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Grouper Rate,1678.00
Blue Cross,PPO,545,DRG,Connective tissue disorders w MCC,,Case Rate,41341.73
Blue Cross,PPO,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,1678.00
Blue Cross,PPO,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,1678.00
Blue Cross,PPO,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Grouper Rate,1678.00
Blue Cross,PPO,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,3544.00
Blue Cross,PPO,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Grouper Rate,1678.88
Blue Cross,PPO,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,5029.00
Blue Cross,PPO,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,3544.00
Blue Cross,PPO,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,5029.00
Blue Cross,PPO,546,DRG,Connective tissue disorders w CC,,Case Rate,19957.16
Blue Cross,PPO,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Grouper Rate,5029.00
Blue Cross,PPO,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Grouper Rate,3544.00
Blue Cross,PPO,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Grouper Rate,3544.00
Blue Cross,PPO,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Grouper Rate,5029.00
Blue Cross,PPO,54660,CPT4/HCPCS,REVISION OF TESTIS,,Grouper Rate,1678.88
Blue Cross,PPO,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Grouper Rate,3544.00
Blue Cross,PPO,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Grouper Rate,3544.00
Blue Cross,PPO,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Grouper Rate,3544.00
Blue Cross,PPO,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Grouper Rate,5281.00
Blue Cross,PPO,547,DRG,Connective tissue disorders w/o CC/MCC,,Case Rate,13777.82
Blue Cross,PPO,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Grouper Rate,1678.88
Blue Cross,PPO,548,DRG,Septic arthritis w MCC,,Case Rate,33569.58
Blue Cross,PPO,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Grouper Rate,1678.00
Blue Cross,PPO,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,3544.00
Blue Cross,PPO,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,5029.00
Blue Cross,PPO,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,5029.00
Blue Cross,PPO,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,5029.00
Blue Cross,PPO,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Grouper Rate,1678.00
Blue Cross,PPO,549,DRG,Septic arthritis w CC,,Case Rate,20623.72
Blue Cross,PPO,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,5029.00
Blue Cross,PPO,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,5029.00
Blue Cross,PPO,55,DRG,Nervous system neoplasms w/o MCC,,Case Rate,17257.83
Blue Cross,PPO,550,DRG,Septic arthritis w/o CC/MCC,,Case Rate,14599.85
Blue Cross,PPO,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,5029.00
Blue Cross,PPO,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Grouper Rate,5029.00
Blue Cross,PPO,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Grouper Rate,5029.00
Blue Cross,PPO,551,DRG,Medical back problems w MCC,,Case Rate,26846.07
Blue Cross,PPO,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Grouper Rate,1678.88
Blue Cross,PPO,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Grouper Rate,1678.88
Blue Cross,PPO,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Grouper Rate,1678.00
Blue Cross,PPO,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,1678.00
Blue Cross,PPO,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,1678.88
Blue Cross,PPO,552,DRG,Medical back problems w/o MCC,,Case Rate,15580.68
Blue Cross,PPO,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Grouper Rate,1678.88
Blue Cross,PPO,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Grouper Rate,1678.88
Blue Cross,PPO,553,DRG,Bone diseases & arthropathies w MCC,,Case Rate,20977.68
Blue Cross,PPO,55300,CPT4/HCPCS,PREPARE SPERM DUCT X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,554,DRG,Bone diseases & arthropathies w/o MCC,,Case Rate,13073.21
Blue Cross,PPO,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Grouper Rate,1678.00
Blue Cross,PPO,55450,CPT4/HCPCS,LIGATION OF SPERM DUCT,,Grouper Rate,1678.00
Blue Cross,PPO,555,DRG,Signs & symptoms of musculoskeletal system & conn tissue w MCC,,Case Rate,22540.71
Blue Cross,PPO,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,3544.00
Blue Cross,PPO,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Grouper Rate,5029.00
Blue Cross,PPO,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,5029.00
Blue Cross,PPO,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,5029.00
Blue Cross,PPO,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Grouper Rate,5029.00
Blue Cross,PPO,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Grouper Rate,3544.00
Blue Cross,PPO,556,DRG,Signs & symptoms of musculoskeletal system & conn tissue w/o MCC,,Case Rate,13336.20
Blue Cross,PPO,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,1678.00
Blue Cross,PPO,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,1678.00
Blue Cross,PPO,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Grouper Rate,1678.00
Blue Cross,PPO,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Grouper Rate,1678.00
Blue Cross,PPO,557,DRG,Tendonitis, myositis & bursitis w MCC,,Case Rate,23055.10
Blue Cross,PPO,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,PPO,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,1678.88
Blue Cross,PPO,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Grouper Rate,1678.88
Blue Cross,PPO,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,558,DRG,Tendonitis, myositis & bursitis w/o MCC,,Case Rate,14196.28
Blue Cross,PPO,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,5281.00
Blue Cross,PPO,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,5783.00
Blue Cross,PPO,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,5783.00
Blue Cross,PPO,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Grouper Rate,3544.00
Blue Cross,PPO,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,55870,CPT4/HCPCS,ELECTROEJACULATION,,Grouper Rate,1678.00
Blue Cross,PPO,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Grouper Rate,6588.00
Blue Cross,PPO,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Grouper Rate,1678.00
Blue Cross,PPO,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Grouper Rate,8841.00
Blue Cross,PPO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Grouper Rate,1678.88
Blue Cross,PPO,559,DRG,Aftercare, musculoskeletal system & connective tissue w MCC,,Case Rate,30895.06
Blue Cross,PPO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Grouper Rate,1678.00
Blue Cross,PPO,55970,CPT4/HCPCS,SEX TRANSFORMATION M TO F,,Grouper Rate,5783.00
Blue Cross,PPO,55980,CPT4/HCPCS,SEX TRANSFORMATION F TO M,,Grouper Rate,5783.00
Blue Cross,PPO,56,DRG,Degenerative nervous system disorders w MCC,,Case Rate,36177.94
Blue Cross,PPO,560,DRG,Aftercare, musculoskeletal system & connective tissue w CC,,Case Rate,17803.65
Blue Cross,PPO,561,DRG,Aftercare, musculoskeletal system & connective tissue w/o CC/MCC,,Case Rate,13084.79
Blue Cross,PPO,562,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC,,Case Rate,23288.32
Blue Cross,PPO,563,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC,,Case Rate,14403.03
Blue Cross,PPO,564,DRG,Other musculoskeletal sys & connective tissue diagnoses w MCC,,Case Rate,25038.25
Blue Cross,PPO,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Grouper Rate,1678.00
Blue Cross,PPO,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Grouper Rate,1678.88
Blue Cross,PPO,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Grouper Rate,1678.00
Blue Cross,PPO,56442,CPT4/HCPCS,HYMENOTOMY,,Grouper Rate,1678.00
Blue Cross,PPO,565,DRG,Other musculoskeletal sys & connective tissue diagnoses w CC,,Case Rate,16644.20
Blue Cross,PPO,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Grouper Rate,1678.00
Blue Cross,PPO,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Grouper Rate,1678.88
Blue Cross,PPO,566,DRG,Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC,,Case Rate,12429.81
Blue Cross,PPO,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,1678.00
Blue Cross,PPO,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,1678.00
Blue Cross,PPO,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Grouper Rate,5281.00
Blue Cross,PPO,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Grouper Rate,6588.00
Blue Cross,PPO,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Grouper Rate,1678.00
Blue Cross,PPO,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Grouper Rate,3544.00
Blue Cross,PPO,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,3544.00
Blue Cross,PPO,56805,CPT4/HCPCS,REPAIR CLITORIS,,Grouper Rate,1678.88
Blue Cross,PPO,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Grouper Rate,5281.00
Blue Cross,PPO,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Grouper Rate,1678.00
Blue Cross,PPO,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Grouper Rate,1678.00
Blue Cross,PPO,57,DRG,Degenerative nervous system disorders w/o MCC,,Case Rate,20909.86
Blue Cross,PPO,570,DRG,Skin debridement w MCC,,Case Rate,46912.40
Blue Cross,PPO,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Grouper Rate,1678.00
Blue Cross,PPO,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,1678.88
Blue Cross,PPO,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Grouper Rate,1678.88
Blue Cross,PPO,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Grouper Rate,1678.00
Blue Cross,PPO,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Grouper Rate,1678.00
Blue Cross,PPO,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Grouper Rate,1678.00
Blue Cross,PPO,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Grouper Rate,1678.00
Blue Cross,PPO,571,DRG,Skin debridement w CC,,Case Rate,27006.51
Blue Cross,PPO,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,1678.88
Blue Cross,PPO,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Grouper Rate,5281.00
Blue Cross,PPO,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Grouper Rate,5281.00
Blue Cross,PPO,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Grouper Rate,5783.00
Blue Cross,PPO,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Grouper Rate,5281.00
Blue Cross,PPO,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Grouper Rate,5281.00
Blue Cross,PPO,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Grouper Rate,5783.00
Blue Cross,PPO,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Grouper Rate,5783.00
Blue Cross,PPO,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,1678.88
Blue Cross,PPO,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,1678.88
Blue Cross,PPO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Grouper Rate,1678.00
Blue Cross,PPO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Grouper Rate,1678.00
Blue Cross,PPO,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,Grouper Rate,1678.00
Blue Cross,PPO,572,DRG,Skin debridement w/o CC/MCC,,Case Rate,18237.00
Blue Cross,PPO,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,1678.00
Blue Cross,PPO,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Grouper Rate,1678.88
Blue Cross,PPO,57220,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,3544.00
Blue Cross,PPO,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Grouper Rate,3544.00
Blue Cross,PPO,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Grouper Rate,5281.00
Blue Cross,PPO,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Grouper Rate,5281.00
Blue Cross,PPO,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Grouper Rate,5281.00
Blue Cross,PPO,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Grouper Rate,6588.00
Blue Cross,PPO,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Grouper Rate,1678.88
Blue Cross,PPO,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Grouper Rate,3544.00
Blue Cross,PPO,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,Grouper Rate,5029.00
Blue Cross,PPO,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Grouper Rate,5029.00
Blue Cross,PPO,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Grouper Rate,5281.00
Blue Cross,PPO,57283,CPT4/HCPCS,COLPOPEXY INTRAPERITONEAL,,Grouper Rate,5281.00
Blue Cross,PPO,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Grouper Rate,5029.00
Blue Cross,PPO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Grouper Rate,5029.00
Blue Cross,PPO,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Grouper Rate,1678.00
Blue Cross,PPO,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Grouper Rate,1678.88
Blue Cross,PPO,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Grouper Rate,5281.00
Blue Cross,PPO,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Grouper Rate,5783.00
Blue Cross,PPO,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Grouper Rate,5783.00
Blue Cross,PPO,57296,CPT4/HCPCS,REVISE VAG GRAFT OPEN ABD,,Grouper Rate,1678.00
Blue Cross,PPO,573,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w MCC,,Case Rate,91586.94
Blue Cross,PPO,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,3544.00
Blue Cross,PPO,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,5281.00
Blue Cross,PPO,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,Grouper Rate,5783.00
Blue Cross,PPO,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,Grouper Rate,5281.00
Blue Cross,PPO,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,3544.00
Blue Cross,PPO,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,5029.00
Blue Cross,PPO,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,3544.00
Blue Cross,PPO,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,5783.00
Blue Cross,PPO,57335,CPT4/HCPCS,REPAIR VAGINA,,Grouper Rate,5029.00
Blue Cross,PPO,574,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w CC,,Case Rate,53726.88
Blue Cross,PPO,57400,CPT4/HCPCS,DILATION OF VAGINA,,Grouper Rate,1678.00
Blue Cross,PPO,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Grouper Rate,1678.00
Blue Cross,PPO,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Grouper Rate,1678.00
Blue Cross,PPO,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Grouper Rate,1678.00
Blue Cross,PPO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Grouper Rate,5029.00
Blue Cross,PPO,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Grouper Rate,5281.00
Blue Cross,PPO,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Grouper Rate,3544.00
Blue Cross,PPO,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Grouper Rate,1678.88
Blue Cross,PPO,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Grouper Rate,1678.00
Blue Cross,PPO,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Grouper Rate,1678.00
Blue Cross,PPO,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Grouper Rate,1678.00
Blue Cross,PPO,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Grouper Rate,1678.88
Blue Cross,PPO,575,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/MCC,,Case Rate,29135.21
Blue Cross,PPO,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Grouper Rate,1678.00
Blue Cross,PPO,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Grouper Rate,1678.00
Blue Cross,PPO,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Grouper Rate,1678.00
Blue Cross,PPO,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Grouper Rate,1678.00
Blue Cross,PPO,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Grouper Rate,1678.88
Blue Cross,PPO,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,1678.88
Blue Cross,PPO,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,1678.88
Blue Cross,PPO,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Grouper Rate,3544.00
Blue Cross,PPO,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,Grouper Rate,5783.00
Blue Cross,PPO,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,5783.00
Blue Cross,PPO,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,Grouper Rate,5783.00
Blue Cross,PPO,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,3544.00
Blue Cross,PPO,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,Grouper Rate,5029.00
Blue Cross,PPO,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Grouper Rate,5281.00
Blue Cross,PPO,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Grouper Rate,1678.00
Blue Cross,PPO,576,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC,,Case Rate,83541.88
Blue Cross,PPO,577,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w CC,,Case Rate,42239.85
Blue Cross,PPO,57700,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,1678.00
Blue Cross,PPO,57720,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3544.00
Blue Cross,PPO,578,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC,,Case Rate,26971.77
Blue Cross,PPO,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Grouper Rate,1678.00
Blue Cross,PPO,579,DRG,Other skin, subcut tiss & breast proc w MCC,,Case Rate,48425.81
Blue Cross,PPO,58,DRG,Multiple sclerosis & cerebellar ataxia w MCC,,Case Rate,28725.01
Blue Cross,PPO,580,DRG,Other skin, subcut tiss & breast proc w CC,,Case Rate,26468.96
Blue Cross,PPO,581,DRG,Other skin, subcut tiss & breast proc w/o CC/MCC,,Case Rate,20709.73
Blue Cross,PPO,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Grouper Rate,1678.00
Blue Cross,PPO,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Grouper Rate,1678.88
Blue Cross,PPO,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Grouper Rate,5281.00
Blue Cross,PPO,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Grouper Rate,5029.00
Blue Cross,PPO,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,Grouper Rate,6588.00
Blue Cross,PPO,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Grouper Rate,5029.00
Blue Cross,PPO,582,DRG,Mastectomy for malignancy w CC/MCC,,Case Rate,27056.13
Blue Cross,PPO,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,8841.00
Blue Cross,PPO,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,Grouper Rate,8841.00
Blue Cross,PPO,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Grouper Rate,8012.00
Blue Cross,PPO,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Grouper Rate,8012.00
Blue Cross,PPO,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,Grouper Rate,8012.00
Blue Cross,PPO,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Grouper Rate,8012.00
Blue Cross,PPO,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Grouper Rate,8012.00
Blue Cross,PPO,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Grouper Rate,8012.00
Blue Cross,PPO,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Grouper Rate,8012.00
Blue Cross,PPO,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Grouper Rate,8012.00
Blue Cross,PPO,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Grouper Rate,8012.00
Blue Cross,PPO,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,Grouper Rate,8012.00
Blue Cross,PPO,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Grouper Rate,8012.00
Blue Cross,PPO,583,DRG,Mastectomy for malignancy w/o CC/MCC,,Case Rate,25436.86
Blue Cross,PPO,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Grouper Rate,1678.00
Blue Cross,PPO,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Grouper Rate,1678.00
Blue Cross,PPO,58340,CPT4/HCPCS,CATHETER FOR HYSTEROGRAPHY,,Grouper Rate,1678.00
Blue Cross,PPO,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Grouper Rate,1678.00
Blue Cross,PPO,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Grouper Rate,5029.00
Blue Cross,PPO,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Grouper Rate,5029.00
Blue Cross,PPO,584,DRG,Breast biopsy, local excision & other breast procedures w CC/MCC,,Case Rate,30173.92
Blue Cross,PPO,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,3544.00
Blue Cross,PPO,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,3544.00
Blue Cross,PPO,585,DRG,Breast biopsy, local excision & other breast procedures w/o CC/MCC,,Case Rate,28723.36
Blue Cross,PPO,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Grouper Rate,3544.00
Blue Cross,PPO,58540,CPT4/HCPCS,REVISION OF UTERUS,,Grouper Rate,3544.00
Blue Cross,PPO,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Grouper Rate,5029.00
Blue Cross,PPO,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Grouper Rate,5281.00
Blue Cross,PPO,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Grouper Rate,5029.00
Blue Cross,PPO,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Grouper Rate,5281.00
Blue Cross,PPO,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Grouper Rate,5783.00
Blue Cross,PPO,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Grouper Rate,8012.00
Blue Cross,PPO,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Grouper Rate,8012.00
Blue Cross,PPO,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Grouper Rate,8012.00
Blue Cross,PPO,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Grouper Rate,8012.00
Blue Cross,PPO,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Grouper Rate,1678.00
Blue Cross,PPO,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Grouper Rate,1678.88
Blue Cross,PPO,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Grouper Rate,3544.00
Blue Cross,PPO,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Grouper Rate,3544.00
Blue Cross,PPO,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Grouper Rate,3544.00
Blue Cross,PPO,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Grouper Rate,1678.88
Blue Cross,PPO,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Grouper Rate,5029.00
Blue Cross,PPO,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Grouper Rate,3544.00
Blue Cross,PPO,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Grouper Rate,8012.00
Blue Cross,PPO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Grouper Rate,8012.00
Blue Cross,PPO,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Grouper Rate,8012.00
Blue Cross,PPO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Grouper Rate,8012.00
Blue Cross,PPO,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,Grouper Rate,8012.00
Blue Cross,PPO,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3544.00
Blue Cross,PPO,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3544.00
Blue Cross,PPO,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Grouper Rate,3544.00
Blue Cross,PPO,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Grouper Rate,3544.00
Blue Cross,PPO,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Grouper Rate,6588.00
Blue Cross,PPO,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Grouper Rate,5783.00
Blue Cross,PPO,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Grouper Rate,5281.00
Blue Cross,PPO,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Grouper Rate,3544.00
Blue Cross,PPO,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Grouper Rate,3544.00
Blue Cross,PPO,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Grouper Rate,5281.00
Blue Cross,PPO,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Grouper Rate,5281.00
Blue Cross,PPO,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Grouper Rate,5029.00
Blue Cross,PPO,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Grouper Rate,5029.00
Blue Cross,PPO,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Grouper Rate,5281.00
Blue Cross,PPO,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Grouper Rate,5029.00
Blue Cross,PPO,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Grouper Rate,5783.00
Blue Cross,PPO,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Grouper Rate,5029.00
Blue Cross,PPO,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Grouper Rate,5029.00
Blue Cross,PPO,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Grouper Rate,5029.00
Blue Cross,PPO,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,3544.00
Blue Cross,PPO,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,5029.00
Blue Cross,PPO,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Grouper Rate,3544.00
Blue Cross,PPO,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Grouper Rate,5281.00
Blue Cross,PPO,58823,CPT4/HCPCS,DRAIN PELVIC ABSCESS PERCUT,,Grouper Rate,1678.00
Blue Cross,PPO,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Grouper Rate,5029.00
Blue Cross,PPO,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Grouper Rate,3544.00
Blue Cross,PPO,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Grouper Rate,5029.00
Blue Cross,PPO,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Grouper Rate,5281.00
Blue Cross,PPO,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,5281.00
Blue Cross,PPO,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,5783.00
Blue Cross,PPO,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,5783.00
Blue Cross,PPO,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,5783.00
Blue Cross,PPO,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,6588.00
Blue Cross,PPO,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,Grouper Rate,8012.00
Blue Cross,PPO,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,Grouper Rate,8012.00
Blue Cross,PPO,58956,CPT4/HCPCS,BSO OMENTECTOMY W/TAH,,Grouper Rate,5281.00
Blue Cross,PPO,58957,CPT4/HCPCS,RESECT RECURRENT GYN MAL,,Grouper Rate,5783.00
Blue Cross,PPO,58958,CPT4/HCPCS,RESECT RECUR GYN MAL W/LYM,,Grouper Rate,6588.00
Blue Cross,PPO,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,5783.00
Blue Cross,PPO,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Grouper Rate,1678.00
Blue Cross,PPO,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,1678.00
Blue Cross,PPO,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,1678.00
Blue Cross,PPO,59,DRG,Multiple sclerosis & cerebellar ataxia w CC,,Case Rate,18632.31
Blue Cross,PPO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Grouper Rate,1678.00
Blue Cross,PPO,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Grouper Rate,1678.00
Blue Cross,PPO,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,Grouper Rate,1678.00
Blue Cross,PPO,59015,CPT4/HCPCS,CHORION BIOPSY,,Grouper Rate,1678.88
Blue Cross,PPO,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Grouper Rate,3544.00
Blue Cross,PPO,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Grouper Rate,3544.00
Blue Cross,PPO,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Grouper Rate,1678.88
Blue Cross,PPO,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Grouper Rate,1678.88
Blue Cross,PPO,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,Grouper Rate,5029.00
Blue Cross,PPO,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1678.88
Blue Cross,PPO,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,PPO,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,PPO,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,8012.00
Blue Cross,PPO,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6588.00
Blue Cross,PPO,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,3544.00
Blue Cross,PPO,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,PPO,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5281.00
Blue Cross,PPO,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Grouper Rate,1678.88
Blue Cross,PPO,592,DRG,Skin ulcers w MCC,,Case Rate,27898.01
Blue Cross,PPO,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Grouper Rate,1678.00
Blue Cross,PPO,593,DRG,Skin ulcers w CC,,Case Rate,18802.67
Blue Cross,PPO,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Grouper Rate,3544.00
Blue Cross,PPO,59320,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3544.00
Blue Cross,PPO,59325,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3544.00
Blue Cross,PPO,59350,CPT4/HCPCS,REPAIR OF UTERUS,,Grouper Rate,5281.00
Blue Cross,PPO,594,DRG,Skin ulcers w/o CC/MCC,,Case Rate,13541.29
Blue Cross,PPO,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Grouper Rate,5783.00
Blue Cross,PPO,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,Grouper Rate,1678.00
Blue Cross,PPO,59414,CPT4/HCPCS,DELIVER PLACENTA,,Grouper Rate,1678.88
Blue Cross,PPO,595,DRG,Major skin disorders w MCC,,Case Rate,33280.13
Blue Cross,PPO,59514,CPT4/HCPCS,CESAREAN DELIVERY ONLY,,Grouper Rate,5783.00
Blue Cross,PPO,59515,CPT4/HCPCS,CESAREAN DELIVERY,,Grouper Rate,5783.00
Blue Cross,PPO,59525,CPT4/HCPCS,REMOVE UTERUS AFTER CESAREAN,,Grouper Rate,5029.00
Blue Cross,PPO,596,DRG,Major skin disorders w/o MCC,,Case Rate,16361.36
Blue Cross,PPO,59610,CPT4/HCPCS,VBAC DELIVERY,,Grouper Rate,5281.00
Blue Cross,PPO,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Grouper Rate,5281.00
Blue Cross,PPO,59614,CPT4/HCPCS,VBAC CARE AFTER DELIVERY,,Grouper Rate,5281.00
Blue Cross,PPO,59618,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY,,Grouper Rate,5783.00
Blue Cross,PPO,59620,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY ONLY,,Grouper Rate,5783.00
Blue Cross,PPO,59622,CPT4/HCPCS,ATTEMPTED VBAC AFTER CARE,,Grouper Rate,5783.00
Blue Cross,PPO,597,DRG,Malignant breast disorders w MCC,,Case Rate,27071.01
Blue Cross,PPO,598,DRG,Malignant breast disorders w CC,,Case Rate,18379.24
Blue Cross,PPO,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,3544.00
Blue Cross,PPO,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Grouper Rate,3544.00
Blue Cross,PPO,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,3544.00
Blue Cross,PPO,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Grouper Rate,3544.00
Blue Cross,PPO,59840,CPT4/HCPCS,ABORTION,,Grouper Rate,3544.00
Blue Cross,PPO,59841,CPT4/HCPCS,ABORTION,,Grouper Rate,3544.00
Blue Cross,PPO,59850,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.00
Blue Cross,PPO,59851,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.00
Blue Cross,PPO,59852,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.00
Blue Cross,PPO,59855,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.88
Blue Cross,PPO,59856,CPT4/HCPCS,ABORTION,,Grouper Rate,1678.88
Blue Cross,PPO,59857,CPT4/HCPCS,ABORTION,,Grouper Rate,5029.00
Blue Cross,PPO,59866,CPT4/HCPCS,ABORTION (MPR),,Grouper Rate,1678.00
Blue Cross,PPO,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Grouper Rate,3544.00
Blue Cross,PPO,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Grouper Rate,1678.00
Blue Cross,PPO,599,DRG,Malignant breast disorders w/o CC/MCC,,Case Rate,11101.64
Blue Cross,PPO,6,DRG,Liver transplant w/o MCC,,Case Rate,77600.71
Blue Cross,PPO,60,DRG,Multiple sclerosis & cerebellar ataxia w/o CC/MCC,,Case Rate,15144.02
Blue Cross,PPO,600,DRG,Non-malignant breast disorders w CC/MCC,,Case Rate,16468.87
Blue Cross,PPO,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Grouper Rate,1678.00
Blue Cross,PPO,601,DRG,Non-malignant breast disorders w/o CC/MCC,,Case Rate,11372.90
Blue Cross,PPO,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Grouper Rate,1678.00
Blue Cross,PPO,602,DRG,Cellulitis w MCC,,Case Rate,23761.36
Blue Cross,PPO,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Grouper Rate,1678.88
Blue Cross,PPO,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,1678.88
Blue Cross,PPO,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,1678.88
Blue Cross,PPO,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,1678.88
Blue Cross,PPO,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,3544.00
Blue Cross,PPO,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,5783.00
Blue Cross,PPO,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,5029.00
Blue Cross,PPO,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Grouper Rate,5783.00
Blue Cross,PPO,60270,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,8012.00
Blue Cross,PPO,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,8012.00
Blue Cross,PPO,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,5029.00
Blue Cross,PPO,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,5029.00
Blue Cross,PPO,603,DRG,Cellulitis w/o MCC,,Case Rate,13972.99
Blue Cross,PPO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Grouper Rate,1678.00
Blue Cross,PPO,604,DRG,Trauma to the skin, subcut tiss & breast w MCC,,Case Rate,24666.10
Blue Cross,PPO,605,DRG,Trauma to the skin, subcut tiss & breast w/o MCC,,Case Rate,15038.16
Blue Cross,PPO,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,8012.00
Blue Cross,PPO,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Grouper Rate,8012.00
Blue Cross,PPO,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,8012.00
Blue Cross,PPO,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Grouper Rate,1678.88
Blue Cross,PPO,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,5281.00
Blue Cross,PPO,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,5783.00
Blue Cross,PPO,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,5783.00
Blue Cross,PPO,606,DRG,Minor skin disorders w MCC,,Case Rate,24991.94
Blue Cross,PPO,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Grouper Rate,5281.00
Blue Cross,PPO,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Grouper Rate,5281.00
Blue Cross,PPO,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,607,DRG,Minor skin disorders w/o MCC,,Case Rate,13655.42
Blue Cross,PPO,61,DRG,Acute ischemic stroke w use of thrombolytic agent w MCC,,Case Rate,47770.82
Blue Cross,PPO,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,1678.00
Blue Cross,PPO,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,1678.00
Blue Cross,PPO,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Grouper Rate,1678.00
Blue Cross,PPO,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,1678.00
Blue Cross,PPO,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Grouper Rate,1678.00
Blue Cross,PPO,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,1678.00
Blue Cross,PPO,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Grouper Rate,1678.00
Blue Cross,PPO,61105,CPT4/HCPCS,TWIST DRILL HOLE,,Grouper Rate,1678.88
Blue Cross,PPO,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,Grouper Rate,3544.00
Blue Cross,PPO,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,Grouper Rate,5783.00
Blue Cross,PPO,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,Grouper Rate,5783.00
Blue Cross,PPO,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,Grouper Rate,5783.00
Blue Cross,PPO,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,5281.00
Blue Cross,PPO,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,5281.00
Blue Cross,PPO,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,Grouper Rate,5281.00
Blue Cross,PPO,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,5281.00
Blue Cross,PPO,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,Grouper Rate,5281.00
Blue Cross,PPO,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Grouper Rate,3544.00
Blue Cross,PPO,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Grouper Rate,5281.00
Blue Cross,PPO,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Grouper Rate,5281.00
Blue Cross,PPO,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Grouper Rate,6588.00
Blue Cross,PPO,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,6588.00
Blue Cross,PPO,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,6588.00
Blue Cross,PPO,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Grouper Rate,1678.00
Blue Cross,PPO,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,6588.00
Blue Cross,PPO,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,Grouper Rate,5783.00
Blue Cross,PPO,61332,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,1678.88
Blue Cross,PPO,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,Grouper Rate,5029.00
Blue Cross,PPO,61334,CPT4/HCPCS,EXPLORE ORBIT/REMOVE OBJECT,,Grouper Rate,5029.00
Blue Cross,PPO,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,Grouper Rate,6588.00
Blue Cross,PPO,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,Grouper Rate,6588.00
Blue Cross,PPO,614,DRG,Adrenal & pituitary procedures w CC/MCC,,Case Rate,39477.67
Blue Cross,PPO,61440,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Grouper Rate,6588.00
Blue Cross,PPO,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,61490,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,615,DRG,Adrenal & pituitary procedures w/o CC/MCC,,Case Rate,26035.61
Blue Cross,PPO,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Grouper Rate,8012.00
Blue Cross,PPO,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,Grouper Rate,5783.00
Blue Cross,PPO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,PPO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Grouper Rate,6588.00
Blue Cross,PPO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Grouper Rate,6588.00
Blue Cross,PPO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,PPO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,Grouper Rate,5029.00
Blue Cross,PPO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Grouper Rate,6588.00
Blue Cross,PPO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,PPO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,PPO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,8012.00
Blue Cross,PPO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,5783.00
Blue Cross,PPO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,PPO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,Grouper Rate,5783.00
Blue Cross,PPO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,6588.00
Blue Cross,PPO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,PPO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,8012.00
Blue Cross,PPO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,8012.00
Blue Cross,PPO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,PPO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,PPO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,Grouper Rate,8012.00
Blue Cross,PPO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,Grouper Rate,8012.00
Blue Cross,PPO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Grouper Rate,6588.00
Blue Cross,PPO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Grouper Rate,5783.00
Blue Cross,PPO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Grouper Rate,6588.00
Blue Cross,PPO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,Grouper Rate,5783.00
Blue Cross,PPO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,Grouper Rate,5783.00
Blue Cross,PPO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Grouper Rate,6588.00
Blue Cross,PPO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Grouper Rate,6588.00
Blue Cross,PPO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Grouper Rate,5281.00
Blue Cross,PPO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Grouper Rate,5783.00
Blue Cross,PPO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,PPO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Grouper Rate,6588.00
Blue Cross,PPO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,Grouper Rate,6588.00
Blue Cross,PPO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Grouper Rate,6588.00
Blue Cross,PPO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Grouper Rate,8012.00
Blue Cross,PPO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Grouper Rate,8012.00
Blue Cross,PPO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,6588.00
Blue Cross,PPO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,6588.00
Blue Cross,PPO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,8012.00
Blue Cross,PPO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,6588.00
Blue Cross,PPO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,PPO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,PPO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,PPO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,PPO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,PPO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,PPO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,Grouper Rate,6588.00
Blue Cross,PPO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,PPO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,Grouper Rate,8012.00
Blue Cross,PPO,616,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w MCC,,Case Rate,65974.75
Blue Cross,PPO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,6588.00
Blue Cross,PPO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,8012.00
Blue Cross,PPO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,6588.00
Blue Cross,PPO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,8012.00
Blue Cross,PPO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,8012.00
Blue Cross,PPO,61609,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,6588.00
Blue Cross,PPO,61610,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,8012.00
Blue Cross,PPO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,6588.00
Blue Cross,PPO,61612,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,8012.00
Blue Cross,PPO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,Grouper Rate,8012.00
Blue Cross,PPO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Grouper Rate,8841.00
Blue Cross,PPO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Grouper Rate,8841.00
Blue Cross,PPO,61618,CPT4/HCPCS,REPAIR DURA,,Grouper Rate,6588.00
Blue Cross,PPO,61619,CPT4/HCPCS,REPAIR DURA,,Grouper Rate,5783.00
Blue Cross,PPO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Grouper Rate,5029.00
Blue Cross,PPO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,Grouper Rate,5029.00
Blue Cross,PPO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Grouper Rate,5029.00
Blue Cross,PPO,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,Grouper Rate,5029.00
Blue Cross,PPO,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,Grouper Rate,5029.00
Blue Cross,PPO,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,Grouper Rate,5029.00
Blue Cross,PPO,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,Grouper Rate,1678.88
Blue Cross,PPO,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,Grouper Rate,1678.88
Blue Cross,PPO,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,Grouper Rate,3544.00
Blue Cross,PPO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,Grouper Rate,1678.88
Blue Cross,PPO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,Grouper Rate,1678.88
Blue Cross,PPO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,PPO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,PPO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,PPO,617,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w CC,,Case Rate,33644.01
Blue Cross,PPO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,Grouper Rate,6588.00
Blue Cross,PPO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,Grouper Rate,8012.00
Blue Cross,PPO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,Grouper Rate,6588.00
Blue Cross,PPO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,8012.00
Blue Cross,PPO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,6588.00
Blue Cross,PPO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,5281.00
Blue Cross,PPO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,Grouper Rate,5281.00
Blue Cross,PPO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,Grouper Rate,5281.00
Blue Cross,PPO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,5783.00
Blue Cross,PPO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,Grouper Rate,5783.00
Blue Cross,PPO,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,Grouper Rate,1678.00
Blue Cross,PPO,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,Grouper Rate,1678.00
Blue Cross,PPO,61783,CPT4/HCPCS,SCAN PROC SPINAL,,Grouper Rate,1678.00
Blue Cross,PPO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Grouper Rate,3544.00
Blue Cross,PPO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Grouper Rate,3544.00
Blue Cross,PPO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,Grouper Rate,8841.00
Blue Cross,PPO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,Grouper Rate,5029.00
Blue Cross,PPO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,Grouper Rate,8841.00
Blue Cross,PPO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,Grouper Rate,5029.00
Blue Cross,PPO,618,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w/o CC/MCC,,Case Rate,21551.62
Blue Cross,PPO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,5783.00
Blue Cross,PPO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,5783.00
Blue Cross,PPO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Grouper Rate,6588.00
Blue Cross,PPO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Grouper Rate,6588.00
Blue Cross,PPO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,6588.00
Blue Cross,PPO,61875,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,6588.00
Blue Cross,PPO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,5281.00
Blue Cross,PPO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Grouper Rate,1678.88
Blue Cross,PPO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Grouper Rate,5029.00
Blue Cross,PPO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,1678.00
Blue Cross,PPO,619,DRG,O.R. procedures for obesity w MCC,,Case Rate,50630.59
Blue Cross,PPO,62,DRG,Acute ischemic stroke w use of thrombolytic agent w CC,,Case Rate,32868.28
Blue Cross,PPO,620,DRG,O.R. procedures for obesity w CC,,Case Rate,29128.59
Blue Cross,PPO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,Grouper Rate,5783.00
Blue Cross,PPO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,Grouper Rate,5783.00
Blue Cross,PPO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,Grouper Rate,5783.00
Blue Cross,PPO,621,DRG,O.R. procedures for obesity w/o CC/MCC,,Case Rate,26404.45
Blue Cross,PPO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,Grouper Rate,5783.00
Blue Cross,PPO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,PPO,62116,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,PPO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,6588.00
Blue Cross,PPO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,Grouper Rate,6588.00
Blue Cross,PPO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,Grouper Rate,8012.00
Blue Cross,PPO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,PPO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Grouper Rate,5783.00
Blue Cross,PPO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,Grouper Rate,5783.00
Blue Cross,PPO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,Grouper Rate,6588.00
Blue Cross,PPO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,Grouper Rate,6588.00
Blue Cross,PPO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Grouper Rate,6588.00
Blue Cross,PPO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Grouper Rate,6588.00
Blue Cross,PPO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,Grouper Rate,1678.00
Blue Cross,PPO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,Grouper Rate,3544.00
Blue Cross,PPO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,Grouper Rate,5029.00
Blue Cross,PPO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,Grouper Rate,5029.00
Blue Cross,PPO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,Grouper Rate,6588.00
Blue Cross,PPO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,Grouper Rate,6588.00
Blue Cross,PPO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,5281.00
Blue Cross,PPO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,5281.00
Blue Cross,PPO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,1678.00
Blue Cross,PPO,622,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC,,Case Rate,59755.71
Blue Cross,PPO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,5783.00
Blue Cross,PPO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,Grouper Rate,5783.00
Blue Cross,PPO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,6588.00
Blue Cross,PPO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,6588.00
Blue Cross,PPO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,1678.00
Blue Cross,PPO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Grouper Rate,1678.88
Blue Cross,PPO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,Grouper Rate,1678.00
Blue Cross,PPO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Grouper Rate,1678.88
Blue Cross,PPO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,Grouper Rate,5783.00
Blue Cross,PPO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Grouper Rate,1678.88
Blue Cross,PPO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Grouper Rate,1678.88
Blue Cross,PPO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Grouper Rate,1678.00
Blue Cross,PPO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Grouper Rate,1678.00
Blue Cross,PPO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Grouper Rate,1678.00
Blue Cross,PPO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Grouper Rate,1678.00
Blue Cross,PPO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Grouper Rate,1678.00
Blue Cross,PPO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Grouper Rate,1678.00
Blue Cross,PPO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,1678.00
Blue Cross,PPO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,1678.00
Blue Cross,PPO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Grouper Rate,1678.00
Blue Cross,PPO,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,Grouper Rate,1678.88
Blue Cross,PPO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Grouper Rate,3544.00
Blue Cross,PPO,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,Grouper Rate,1678.88
Blue Cross,PPO,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,Grouper Rate,1678.88
Blue Cross,PPO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Grouper Rate,3544.00
Blue Cross,PPO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Grouper Rate,3544.00
Blue Cross,PPO,623,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w CC,,Case Rate,30977.76
Blue Cross,PPO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,PPO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,PPO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,PPO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1678.88
Blue Cross,PPO,62310,CPT4/HCPCS,INJECT SPINE CERV/THORACIC,,Grouper Rate,1678.00
Blue Cross,PPO,62311,CPT4/HCPCS,INJECT SPINE LUMBAR/SACRAL,,Grouper Rate,1678.00
Blue Cross,PPO,62318,CPT4/HCPCS,INJECT SPINE W/CATH CRV/THRC,,Grouper Rate,1678.00
Blue Cross,PPO,62319,CPT4/HCPCS,INJECT SPINE W/CATH LMB/SCRL,,Grouper Rate,1678.00
Blue Cross,PPO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,PPO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,PPO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,PPO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,PPO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,PPO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1678.00
Blue Cross,PPO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,PPO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1678.00
Blue Cross,PPO,62328,CPT4/HCPCS,DX LMBR SPI PNXR W/FLUOR/CT,,Grouper Rate,1678.00
Blue Cross,PPO,62329,CPT4/HCPCS,THER SPI PNXR CSF FLUOR/CT,,Grouper Rate,1678.00
Blue Cross,PPO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,1678.88
Blue Cross,PPO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,1678.88
Blue Cross,PPO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Grouper Rate,1678.88
Blue Cross,PPO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Grouper Rate,1678.88
Blue Cross,PPO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,1678.88
Blue Cross,PPO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,1678.88
Blue Cross,PPO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Grouper Rate,1678.88
Blue Cross,PPO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Grouper Rate,1678.88
Blue Cross,PPO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Grouper Rate,1678.88
Blue Cross,PPO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,Grouper Rate,1678.88
Blue Cross,PPO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Grouper Rate,1678.88
Blue Cross,PPO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Grouper Rate,1678.88
Blue Cross,PPO,624,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC,,Case Rate,18099.72
Blue Cross,PPO,625,DRG,Thyroid, parathyroid & thyroglossal procedures w MCC,,Case Rate,46993.44
Blue Cross,PPO,626,DRG,Thyroid, parathyroid & thyroglossal procedures w CC,,Case Rate,27329.04
Blue Cross,PPO,627,DRG,Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC,,Case Rate,19546.97
Blue Cross,PPO,628,DRG,Other endocrine, nutrit & metab O.R. proc w MCC,,Case Rate,61166.57
Blue Cross,PPO,629,DRG,Other endocrine, nutrit & metab O.R. proc w CC,,Case Rate,38816.07
Blue Cross,PPO,63,DRG,Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC,,Case Rate,28281.74
Blue Cross,PPO,630,DRG,Other endocrine, nutrit & metab O.R. proc w/o CC/MCC,,Case Rate,23270.12
Blue Cross,PPO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Grouper Rate,5783.00
Blue Cross,PPO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Grouper Rate,5783.00
Blue Cross,PPO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Grouper Rate,3544.00
Blue Cross,PPO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Grouper Rate,5783.00
Blue Cross,PPO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Grouper Rate,6588.00
Blue Cross,PPO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Grouper Rate,6588.00
Blue Cross,PPO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Grouper Rate,6588.00
Blue Cross,PPO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Grouper Rate,6588.00
Blue Cross,PPO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Grouper Rate,5029.00
Blue Cross,PPO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Grouper Rate,5281.00
Blue Cross,PPO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Grouper Rate,6588.00
Blue Cross,PPO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Grouper Rate,1678.88
Blue Cross,PPO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Grouper Rate,5029.00
Blue Cross,PPO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Grouper Rate,5029.00
Blue Cross,PPO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Grouper Rate,5281.00
Blue Cross,PPO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,Grouper Rate,5281.00
Blue Cross,PPO,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,Grouper Rate,6588.00
Blue Cross,PPO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,5029.00
Blue Cross,PPO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Grouper Rate,5029.00
Blue Cross,PPO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,5029.00
Blue Cross,PPO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,6588.00
Blue Cross,PPO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,6588.00
Blue Cross,PPO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,5281.00
Blue Cross,PPO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,1678.88
Blue Cross,PPO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Grouper Rate,5281.00
Blue Cross,PPO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,Grouper Rate,5783.00
Blue Cross,PPO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,PPO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Grouper Rate,5783.00
Blue Cross,PPO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,PPO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,5783.00
Blue Cross,PPO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Grouper Rate,5783.00
Blue Cross,PPO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,PPO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Grouper Rate,6588.00
Blue Cross,PPO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Grouper Rate,5783.00
Blue Cross,PPO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,Grouper Rate,5281.00
Blue Cross,PPO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Grouper Rate,5783.00
Blue Cross,PPO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Grouper Rate,5783.00
Blue Cross,PPO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Grouper Rate,5783.00
Blue Cross,PPO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Grouper Rate,6588.00
Blue Cross,PPO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,Grouper Rate,5783.00
Blue Cross,PPO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,Grouper Rate,5783.00
Blue Cross,PPO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,Grouper Rate,5783.00
Blue Cross,PPO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,Grouper Rate,5783.00
Blue Cross,PPO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,Grouper Rate,5783.00
Blue Cross,PPO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,Grouper Rate,5783.00
Blue Cross,PPO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,Grouper Rate,5783.00
Blue Cross,PPO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,Grouper Rate,5783.00
Blue Cross,PPO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,Grouper Rate,5783.00
Blue Cross,PPO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,Grouper Rate,5783.00
Blue Cross,PPO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,Grouper Rate,5783.00
Blue Cross,PPO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,Grouper Rate,5783.00
Blue Cross,PPO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,Grouper Rate,5783.00
Blue Cross,PPO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Grouper Rate,5281.00
Blue Cross,PPO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Grouper Rate,5281.00
Blue Cross,PPO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Grouper Rate,5281.00
Blue Cross,PPO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Grouper Rate,5281.00
Blue Cross,PPO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,Grouper Rate,5783.00
Blue Cross,PPO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Grouper Rate,5783.00
Blue Cross,PPO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Grouper Rate,5281.00
Blue Cross,PPO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Grouper Rate,5281.00
Blue Cross,PPO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,Grouper Rate,5281.00
Blue Cross,PPO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,Grouper Rate,5281.00
Blue Cross,PPO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,Grouper Rate,5281.00
Blue Cross,PPO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,Grouper Rate,5281.00
Blue Cross,PPO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,Grouper Rate,5281.00
Blue Cross,PPO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,Grouper Rate,5281.00
Blue Cross,PPO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,Grouper Rate,5281.00
Blue Cross,PPO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,Grouper Rate,5281.00
Blue Cross,PPO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,Grouper Rate,5281.00
Blue Cross,PPO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,Grouper Rate,5281.00
Blue Cross,PPO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,Grouper Rate,5281.00
Blue Cross,PPO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,Grouper Rate,5783.00
Blue Cross,PPO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,Grouper Rate,5281.00
Blue Cross,PPO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,Grouper Rate,5783.00
Blue Cross,PPO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,Grouper Rate,5783.00
Blue Cross,PPO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,Grouper Rate,5783.00
Blue Cross,PPO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,Grouper Rate,5783.00
Blue Cross,PPO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,Grouper Rate,5783.00
Blue Cross,PPO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,Grouper Rate,5783.00
Blue Cross,PPO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,Grouper Rate,5783.00
Blue Cross,PPO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,3544.00
Blue Cross,PPO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Grouper Rate,1678.88
Blue Cross,PPO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Grouper Rate,1678.00
Blue Cross,PPO,63615,CPT4/HCPCS,REMOVE LESION OF SPINAL CORD,,Grouper Rate,5281.00
Blue Cross,PPO,63620,CPT4/HCPCS,SRS SPINAL LESION,,Grouper Rate,8841.00
Blue Cross,PPO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,Grouper Rate,5029.00
Blue Cross,PPO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,PPO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,PPO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Grouper Rate,1678.00
Blue Cross,PPO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Grouper Rate,1678.88
Blue Cross,PPO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Grouper Rate,1678.88
Blue Cross,PPO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Grouper Rate,5281.00
Blue Cross,PPO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Grouper Rate,1678.88
Blue Cross,PPO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,1678.00
Blue Cross,PPO,637,DRG,Diabetes w MCC,,Case Rate,22737.53
Blue Cross,PPO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,PPO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,PPO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,PPO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,5281.00
Blue Cross,PPO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Grouper Rate,5281.00
Blue Cross,PPO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Grouper Rate,5281.00
Blue Cross,PPO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,Grouper Rate,5281.00
Blue Cross,PPO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,5783.00
Blue Cross,PPO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,5281.00
Blue Cross,PPO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Grouper Rate,3544.00
Blue Cross,PPO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Grouper Rate,1678.88
Blue Cross,PPO,638,DRG,Diabetes w CC,,Case Rate,14545.27
Blue Cross,PPO,639,DRG,Diabetes w/o CC/MCC,,Case Rate,10077.82
Blue Cross,PPO,64,DRG,Intracranial hemorrhage or cerebral infarction w MCC,,Case Rate,31641.02
Blue Cross,PPO,640,DRG,Nutritional & misc metabolic disorders w MCC,,Case Rate,20307.81
Blue Cross,PPO,641,DRG,Nutritional & misc metabolic disorders w/o MCC,,Case Rate,12454.62
Blue Cross,PPO,642,DRG,Inborn errors of metabolism,,Case Rate,21295.25
Blue Cross,PPO,643,DRG,Endocrine disorders w MCC,,Case Rate,27510.98
Blue Cross,PPO,644,DRG,Endocrine disorders w CC,,Case Rate,16842.68
Blue Cross,PPO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Grouper Rate,1678.00
Blue Cross,PPO,64402,CPT4/HCPCS,N BLOCK INJ FACIAL,,Grouper Rate,1678.00
Blue Cross,PPO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Grouper Rate,1678.00
Blue Cross,PPO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Grouper Rate,1678.00
Blue Cross,PPO,64410,CPT4/HCPCS,N BLOCK INJ PHRENIC,,Grouper Rate,1678.00
Blue Cross,PPO,64412,CPT4/HCPCS,N BLOCK INJ SPINAL ACCESSOR,,Grouper Rate,1678.00
Blue Cross,PPO,64413,CPT4/HCPCS,N BLOCK INJ CERVICAL PLEXUS,,Grouper Rate,1678.00
Blue Cross,PPO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Grouper Rate,1678.00
Blue Cross,PPO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Grouper Rate,1678.00
Blue Cross,PPO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Grouper Rate,1678.00
Blue Cross,PPO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Grouper Rate,1678.00
Blue Cross,PPO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Grouper Rate,1678.00
Blue Cross,PPO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Grouper Rate,1678.00
Blue Cross,PPO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Grouper Rate,1678.00
Blue Cross,PPO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Grouper Rate,1678.00
Blue Cross,PPO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,Grouper Rate,1678.00
Blue Cross,PPO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,Grouper Rate,1678.00
Blue Cross,PPO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Grouper Rate,1678.00
Blue Cross,PPO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Grouper Rate,1678.00
Blue Cross,PPO,64451,CPT4/HCPCS,NJX AA&/STRD NRV NRVTG SI JT,,Grouper Rate,1678.00
Blue Cross,PPO,64454,CPT4/HCPCS,NJX AA&/STRD GNCLR NRV BRNCH,,Grouper Rate,1678.00
Blue Cross,PPO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Grouper Rate,1678.00
Blue Cross,PPO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Grouper Rate,1678.00
Blue Cross,PPO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Grouper Rate,1678.00
Blue Cross,PPO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Grouper Rate,1678.00
Blue Cross,PPO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Grouper Rate,1678.00
Blue Cross,PPO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Grouper Rate,1678.00
Blue Cross,PPO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Grouper Rate,1678.00
Blue Cross,PPO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Grouper Rate,1678.00
Blue Cross,PPO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Grouper Rate,1678.00
Blue Cross,PPO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Grouper Rate,1678.00
Blue Cross,PPO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Grouper Rate,1678.00
Blue Cross,PPO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Grouper Rate,1678.00
Blue Cross,PPO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Grouper Rate,1678.00
Blue Cross,PPO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Grouper Rate,1678.00
Blue Cross,PPO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Grouper Rate,1678.00
Blue Cross,PPO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Grouper Rate,1678.00
Blue Cross,PPO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Grouper Rate,1678.00
Blue Cross,PPO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Grouper Rate,1678.00
Blue Cross,PPO,645,DRG,Endocrine disorders w/o CC/MCC,,Case Rate,12699.41
Blue Cross,PPO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Grouper Rate,1678.00
Blue Cross,PPO,64508,CPT4/HCPCS,N BLOCK CAROTID SINUS S/P,,Grouper Rate,1678.00
Blue Cross,PPO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Grouper Rate,1678.00
Blue Cross,PPO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Grouper Rate,1678.00
Blue Cross,PPO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Grouper Rate,1678.00
Blue Cross,PPO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Grouper Rate,1678.00
Blue Cross,PPO,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,Grouper Rate,1678.00
Blue Cross,PPO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,PPO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,PPO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,PPO,64565,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,PPO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Grouper Rate,1678.88
Blue Cross,PPO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Grouper Rate,3544.00
Blue Cross,PPO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Grouper Rate,3544.00
Blue Cross,PPO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Grouper Rate,3544.00
Blue Cross,PPO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,PPO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.00
Blue Cross,PPO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1678.88
Blue Cross,PPO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,1678.00
Blue Cross,PPO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Grouper Rate,1678.88
Blue Cross,PPO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Grouper Rate,1678.00
Blue Cross,PPO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Grouper Rate,1678.88
Blue Cross,PPO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Grouper Rate,1678.00
Blue Cross,PPO,64613,CPT4/HCPCS,DESTROY NERVE NECK MUSCLE,,Grouper Rate,1678.00
Blue Cross,PPO,64614,CPT4/HCPCS,DESTROY NERVE EXTREM MUSC,,Grouper Rate,1678.00
Blue Cross,PPO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Grouper Rate,1678.00
Blue Cross,PPO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Grouper Rate,1678.00
Blue Cross,PPO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Grouper Rate,1678.00
Blue Cross,PPO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64624,CPT4/HCPCS,DSTRJ NULYT AGT GNCLR NRV,,Grouper Rate,1678.00
Blue Cross,PPO,64625,CPT4/HCPCS,RF ABLTJ NRV NRVTG SI JT,,Grouper Rate,1678.88
Blue Cross,PPO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Grouper Rate,1678.00
Blue Cross,PPO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Grouper Rate,1678.00
Blue Cross,PPO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Grouper Rate,1678.00
Blue Cross,PPO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,Grouper Rate,1678.00
Blue Cross,PPO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Grouper Rate,1678.00
Blue Cross,PPO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,Grouper Rate,1678.00
Blue Cross,PPO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Grouper Rate,1678.00
Blue Cross,PPO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,Grouper Rate,1678.00
Blue Cross,PPO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Grouper Rate,1678.00
Blue Cross,PPO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Grouper Rate,1678.00
Blue Cross,PPO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,1678.00
Blue Cross,PPO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,1678.00
Blue Cross,PPO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Grouper Rate,1678.88
Blue Cross,PPO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Grouper Rate,1678.88
Blue Cross,PPO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Grouper Rate,3544.00
Blue Cross,PPO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Grouper Rate,1678.88
Blue Cross,PPO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Grouper Rate,1678.88
Blue Cross,PPO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Grouper Rate,1678.88
Blue Cross,PPO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Grouper Rate,1678.00
Blue Cross,PPO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Grouper Rate,1678.00
Blue Cross,PPO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Grouper Rate,1678.88
Blue Cross,PPO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64752,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Grouper Rate,5783.00
Blue Cross,PPO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,Grouper Rate,5281.00
Blue Cross,PPO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Grouper Rate,5783.00
Blue Cross,PPO,64761,CPT4/HCPCS,INCISION OF PELVIS NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Grouper Rate,3544.00
Blue Cross,PPO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Grouper Rate,5281.00
Blue Cross,PPO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,64787,CPT4/HCPCS,IMPLANT NERVE END,,Grouper Rate,1678.00
Blue Cross,PPO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Grouper Rate,1678.88
Blue Cross,PPO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,1678.88
Blue Cross,PPO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,5281.00
Blue Cross,PPO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,Grouper Rate,1678.88
Blue Cross,PPO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Grouper Rate,3544.00
Blue Cross,PPO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,3544.00
Blue Cross,PPO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,3544.00
Blue Cross,PPO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Grouper Rate,1678.88
Blue Cross,PPO,64859,CPT4/HCPCS,NERVE SURGERY,,Grouper Rate,1678.00
Blue Cross,PPO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Grouper Rate,3544.00
Blue Cross,PPO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Grouper Rate,3544.00
Blue Cross,PPO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,3544.00
Blue Cross,PPO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,5029.00
Blue Cross,PPO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,5029.00
Blue Cross,PPO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,5029.00
Blue Cross,PPO,64870,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,5029.00
Blue Cross,PPO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Grouper Rate,1678.00
Blue Cross,PPO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Grouper Rate,3544.00
Blue Cross,PPO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Grouper Rate,3544.00
Blue Cross,PPO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Grouper Rate,5783.00
Blue Cross,PPO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Grouper Rate,5783.00
Blue Cross,PPO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,1678.88
Blue Cross,PPO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,3544.00
Blue Cross,PPO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,3544.00
Blue Cross,PPO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Grouper Rate,3544.00
Blue Cross,PPO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,3544.00
Blue Cross,PPO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,1678.88
Blue Cross,PPO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,1678.00
Blue Cross,PPO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Grouper Rate,1678.00
Blue Cross,PPO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Grouper Rate,3544.00
Blue Cross,PPO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Grouper Rate,1678.88
Blue Cross,PPO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Grouper Rate,1678.88
Blue Cross,PPO,65,DRG,Intracranial hemorrhage or cerebral infarction w CC,,Case Rate,16841.02
Blue Cross,PPO,650,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,,Case Rate,74646.67
Blue Cross,PPO,65091,CPT4/HCPCS,REVISE EYE,,Grouper Rate,3544.00
Blue Cross,PPO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Grouper Rate,3544.00
Blue Cross,PPO,651,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,,Case Rate,61092.14
Blue Cross,PPO,65101,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,3544.00
Blue Cross,PPO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Grouper Rate,3544.00
Blue Cross,PPO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Grouper Rate,5029.00
Blue Cross,PPO,65110,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,5281.00
Blue Cross,PPO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,6588.00
Blue Cross,PPO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,6588.00
Blue Cross,PPO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,1678.00
Blue Cross,PPO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,3544.00
Blue Cross,PPO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,1678.88
Blue Cross,PPO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Grouper Rate,3544.00
Blue Cross,PPO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,1678.88
Blue Cross,PPO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Grouper Rate,3544.00
Blue Cross,PPO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Grouper Rate,1678.00
Blue Cross,PPO,652,DRG,Kidney transplant,,Case Rate,52628.62
Blue Cross,PPO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,PPO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,PPO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,PPO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.00
Blue Cross,PPO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1678.88
Blue Cross,PPO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,3544.00
Blue Cross,PPO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,5029.00
Blue Cross,PPO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1678.88
Blue Cross,PPO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1678.88
Blue Cross,PPO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,5029.00
Blue Cross,PPO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,5029.00
Blue Cross,PPO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,5029.00
Blue Cross,PPO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1678.00
Blue Cross,PPO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Grouper Rate,3544.00
Blue Cross,PPO,653,DRG,Major bladder procedures w MCC,,Case Rate,90129.76
Blue Cross,PPO,654,DRG,Major bladder procedures w CC,,Case Rate,47969.30
Blue Cross,PPO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,1678.00
Blue Cross,PPO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Grouper Rate,1678.88
Blue Cross,PPO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,5281.00
Blue Cross,PPO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,1678.00
Blue Cross,PPO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,1678.00
Blue Cross,PPO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Grouper Rate,1678.00
Blue Cross,PPO,655,DRG,Major bladder procedures w/o CC/MCC,,Case Rate,34404.85
Blue Cross,PPO,656,DRG,Kidney & ureter procedures for neoplasm w MCC,,Case Rate,54279.31
Blue Cross,PPO,65600,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,1678.00
Blue Cross,PPO,657,DRG,Kidney & ureter procedures for neoplasm w CC,,Case Rate,31990.01
Blue Cross,PPO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,PPO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,PPO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,PPO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6588.00
Blue Cross,PPO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Grouper Rate,6588.00
Blue Cross,PPO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,Grouper Rate,1678.00
Blue Cross,PPO,65760,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,1678.88
Blue Cross,PPO,65765,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,5029.00
Blue Cross,PPO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,PPO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Grouper Rate,6588.00
Blue Cross,PPO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Grouper Rate,1678.00
Blue Cross,PPO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,1678.00
Blue Cross,PPO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,1678.00
Blue Cross,PPO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Grouper Rate,1678.00
Blue Cross,PPO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Grouper Rate,1678.00
Blue Cross,PPO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,PPO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,PPO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5029.00
Blue Cross,PPO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Grouper Rate,1678.88
Blue Cross,PPO,658,DRG,Kidney & ureter procedures for neoplasm w/o CC/MCC,,Case Rate,26118.31
Blue Cross,PPO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1678.00
Blue Cross,PPO,65805,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1678.00
Blue Cross,PPO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,3544.00
Blue Cross,PPO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1678.88
Blue Cross,PPO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Grouper Rate,1678.88
Blue Cross,PPO,65850,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,5029.00
Blue Cross,PPO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Grouper Rate,1678.00
Blue Cross,PPO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,1678.88
Blue Cross,PPO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,1678.00
Blue Cross,PPO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,3544.00
Blue Cross,PPO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,5029.00
Blue Cross,PPO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,5029.00
Blue Cross,PPO,659,DRG,Kidney & ureter procedures for non-neoplasm w MCC,,Case Rate,44075.79
Blue Cross,PPO,65900,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,5281.00
Blue Cross,PPO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Grouper Rate,6588.00
Blue Cross,PPO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Grouper Rate,1678.88
Blue Cross,PPO,66,DRG,Intracranial hemorrhage or cerebral infarction w/o CC/MCC,,Case Rate,11758.28
Blue Cross,PPO,660,DRG,Kidney & ureter procedures for non-neoplasm w CC,,Case Rate,23873.83
Blue Cross,PPO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,1678.00
Blue Cross,PPO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,1678.00
Blue Cross,PPO,661,DRG,Kidney & ureter procedures for non-neoplasm w/o CC/MCC,,Case Rate,17605.17
Blue Cross,PPO,66130,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,6588.00
Blue Cross,PPO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,66165,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,66172,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,5029.00
Blue Cross,PPO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Grouper Rate,1678.00
Blue Cross,PPO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Grouper Rate,1678.00
Blue Cross,PPO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Grouper Rate,5029.00
Blue Cross,PPO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Grouper Rate,5029.00
Blue Cross,PPO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Grouper Rate,5029.00
Blue Cross,PPO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Grouper Rate,5029.00
Blue Cross,PPO,662,DRG,Minor bladder procedures w MCC,,Case Rate,48458.89
Blue Cross,PPO,66220,CPT4/HCPCS,REPAIR EYE LESION,,Grouper Rate,3544.00
Blue Cross,PPO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Grouper Rate,5029.00
Blue Cross,PPO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Grouper Rate,1678.88
Blue Cross,PPO,663,DRG,Minor bladder procedures w CC,,Case Rate,26379.64
Blue Cross,PPO,664,DRG,Minor bladder procedures w/o CC/MCC,,Case Rate,19586.66
Blue Cross,PPO,665,DRG,Prostatectomy w MCC,,Case Rate,50227.01
Blue Cross,PPO,66500,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,PPO,66505,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,PPO,666,DRG,Prostatectomy w CC,,Case Rate,28685.32
Blue Cross,PPO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Grouper Rate,3544.00
Blue Cross,PPO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,PPO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,PPO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,PPO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3544.00
Blue Cross,PPO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,3544.00
Blue Cross,PPO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,PPO,667,DRG,Prostatectomy w/o CC/MCC,,Case Rate,16455.64
Blue Cross,PPO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,PPO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Grouper Rate,1678.88
Blue Cross,PPO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Grouper Rate,1678.00
Blue Cross,PPO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,PPO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1678.88
Blue Cross,PPO,66761,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,PPO,66762,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,1678.00
Blue Cross,PPO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Grouper Rate,1678.88
Blue Cross,PPO,668,DRG,Transurethral procedures w MCC,,Case Rate,45569.35
Blue Cross,PPO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Grouper Rate,3544.00
Blue Cross,PPO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Grouper Rate,1678.88
Blue Cross,PPO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Grouper Rate,5029.00
Blue Cross,PPO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Grouper Rate,5029.00
Blue Cross,PPO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,5029.00
Blue Cross,PPO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,5783.00
Blue Cross,PPO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,5029.00
Blue Cross,PPO,669,DRG,Transurethral procedures w CC,,Case Rate,25337.62
Blue Cross,PPO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,5029.00
Blue Cross,PPO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,5281.00
Blue Cross,PPO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,5281.00
Blue Cross,PPO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Grouper Rate,6588.00
Blue Cross,PPO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Grouper Rate,8012.00
Blue Cross,PPO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Grouper Rate,6588.00
Blue Cross,PPO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Grouper Rate,5783.00
Blue Cross,PPO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Grouper Rate,5783.00
Blue Cross,PPO,66987,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX W/ECP,,Grouper Rate,8012.00
Blue Cross,PPO,66988,CPT4/HCPCS,XCAPSL CTRC RMVL W/ECP,,Grouper Rate,8012.00
Blue Cross,PPO,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,67,DRG,Nonspecific cva & precerebral occlusion w/o infarct w MCC,,Case Rate,23562.88
Blue Cross,PPO,670,DRG,Transurethral procedures w/o CC/MCC,,Case Rate,16151.31
Blue Cross,PPO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,5029.00
Blue Cross,PPO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,5029.00
Blue Cross,PPO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Grouper Rate,1678.00
Blue Cross,PPO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Grouper Rate,1678.00
Blue Cross,PPO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Grouper Rate,5029.00
Blue Cross,PPO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Grouper Rate,1678.00
Blue Cross,PPO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Grouper Rate,1678.00
Blue Cross,PPO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Grouper Rate,1678.88
Blue Cross,PPO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Grouper Rate,3544.00
Blue Cross,PPO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,5029.00
Blue Cross,PPO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,5029.00
Blue Cross,PPO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Grouper Rate,3544.00
Blue Cross,PPO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Grouper Rate,5029.00
Blue Cross,PPO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Grouper Rate,5281.00
Blue Cross,PPO,671,DRG,Urethral procedures w CC/MCC,,Case Rate,29386.61
Blue Cross,PPO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Grouper Rate,5029.00
Blue Cross,PPO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Grouper Rate,5029.00
Blue Cross,PPO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,5281.00
Blue Cross,PPO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,5783.00
Blue Cross,PPO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,1678.88
Blue Cross,PPO,67112,CPT4/HCPCS,REREPAIR DETACHED RETINA,,Grouper Rate,6588.00
Blue Cross,PPO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Grouper Rate,6588.00
Blue Cross,PPO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Grouper Rate,1678.88
Blue Cross,PPO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,1678.88
Blue Cross,PPO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,1678.88
Blue Cross,PPO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,1678.88
Blue Cross,PPO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,1678.00
Blue Cross,PPO,672,DRG,Urethral procedures w/o CC/MCC,,Case Rate,19035.88
Blue Cross,PPO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,1678.00
Blue Cross,PPO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,1678.00
Blue Cross,PPO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,5281.00
Blue Cross,PPO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Grouper Rate,1678.00
Blue Cross,PPO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Grouper Rate,1678.88
Blue Cross,PPO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Grouper Rate,1678.00
Blue Cross,PPO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Grouper Rate,1678.00
Blue Cross,PPO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Grouper Rate,3544.00
Blue Cross,PPO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Grouper Rate,3544.00
Blue Cross,PPO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Grouper Rate,3544.00
Blue Cross,PPO,673,DRG,Other kidney & urinary tract procedures w MCC,,Case Rate,57279.67
Blue Cross,PPO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,3544.00
Blue Cross,PPO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,5029.00
Blue Cross,PPO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,5029.00
Blue Cross,PPO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,5029.00
Blue Cross,PPO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Grouper Rate,5029.00
Blue Cross,PPO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Grouper Rate,5029.00
Blue Cross,PPO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Grouper Rate,5029.00
Blue Cross,PPO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Grouper Rate,5029.00
Blue Cross,PPO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Grouper Rate,5029.00
Blue Cross,PPO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Grouper Rate,1678.00
Blue Cross,PPO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Grouper Rate,5029.00
Blue Cross,PPO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Grouper Rate,3544.00
Blue Cross,PPO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Grouper Rate,1678.00
Blue Cross,PPO,674,DRG,Other kidney & urinary tract procedures w CC,,Case Rate,39371.81
Blue Cross,PPO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,3544.00
Blue Cross,PPO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,5029.00
Blue Cross,PPO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,PPO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,PPO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,5029.00
Blue Cross,PPO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Grouper Rate,1678.00
Blue Cross,PPO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,PPO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,PPO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,PPO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,5783.00
Blue Cross,PPO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,5281.00
Blue Cross,PPO,675,DRG,Other kidney & urinary tract procedures w/o CC/MCC,,Case Rate,28978.08
Blue Cross,PPO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,1678.00
Blue Cross,PPO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Grouper Rate,5029.00
Blue Cross,PPO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Grouper Rate,1678.88
Blue Cross,PPO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Grouper Rate,5281.00
Blue Cross,PPO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Grouper Rate,1678.00
Blue Cross,PPO,67710,CPT4/HCPCS,INCISION OF EYELID,,Grouper Rate,1678.00
Blue Cross,PPO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Grouper Rate,1678.00
Blue Cross,PPO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,1678.00
Blue Cross,PPO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,1678.00
Blue Cross,PPO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,1678.00
Blue Cross,PPO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Grouper Rate,1678.88
Blue Cross,PPO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Grouper Rate,1678.00
Blue Cross,PPO,67820,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.00
Blue Cross,PPO,67825,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.00
Blue Cross,PPO,67830,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.88
Blue Cross,PPO,67835,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1678.88
Blue Cross,PPO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,1678.00
Blue Cross,PPO,67850,CPT4/HCPCS,TREAT EYELID LESION,,Grouper Rate,1678.00
Blue Cross,PPO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Grouper Rate,1678.00
Blue Cross,PPO,67880,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,PPO,67882,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,PPO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Grouper Rate,1678.00
Blue Cross,PPO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5281.00
Blue Cross,PPO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5281.00
Blue Cross,PPO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,PPO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,PPO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5281.00
Blue Cross,PPO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,PPO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,PPO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,3544.00
Blue Cross,PPO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Grouper Rate,5029.00
Blue Cross,PPO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3544.00
Blue Cross,PPO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,1678.00
Blue Cross,PPO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,PPO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,PPO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3544.00
Blue Cross,PPO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,1678.00
Blue Cross,PPO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,PPO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5029.00
Blue Cross,PPO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,1678.00
Blue Cross,PPO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,1678.88
Blue Cross,PPO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Grouper Rate,1678.00
Blue Cross,PPO,67950,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,1678.88
Blue Cross,PPO,67961,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,PPO,67966,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3544.00
Blue Cross,PPO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,PPO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,PPO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,PPO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3544.00
Blue Cross,PPO,68,DRG,Nonspecific cva & precerebral occlusion w/o infarct w/o MCC,,Case Rate,14697.44
Blue Cross,PPO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Grouper Rate,1678.00
Blue Cross,PPO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,Grouper Rate,1678.00
Blue Cross,PPO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Grouper Rate,1678.00
Blue Cross,PPO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.00
Blue Cross,PPO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.00
Blue Cross,PPO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.88
Blue Cross,PPO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,1678.00
Blue Cross,PPO,682,DRG,Renal failure w MCC,,Case Rate,24317.10
Blue Cross,PPO,683,DRG,Renal failure w CC,,Case Rate,14523.77
Blue Cross,PPO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,PPO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,PPO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,PPO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,PPO,68330,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,5029.00
Blue Cross,PPO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5029.00
Blue Cross,PPO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Grouper Rate,5029.00
Blue Cross,PPO,68360,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,1678.88
Blue Cross,PPO,68362,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,1678.88
Blue Cross,PPO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Grouper Rate,1678.88
Blue Cross,PPO,684,DRG,Renal failure w/o CC/MCC,,Case Rate,10048.05
Blue Cross,PPO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Grouper Rate,1678.00
Blue Cross,PPO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Grouper Rate,1678.00
Blue Cross,PPO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,PPO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Grouper Rate,3544.00
Blue Cross,PPO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Grouper Rate,3544.00
Blue Cross,PPO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Grouper Rate,1678.00
Blue Cross,PPO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Grouper Rate,3544.00
Blue Cross,PPO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Grouper Rate,1678.00
Blue Cross,PPO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Grouper Rate,1678.00
Blue Cross,PPO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,3544.00
Blue Cross,PPO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,3544.00
Blue Cross,PPO,686,DRG,Kidney & urinary tract neoplasms w MCC,,Case Rate,30982.72
Blue Cross,PPO,687,DRG,Kidney & urinary tract neoplasms w CC,,Case Rate,17330.61
Blue Cross,PPO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Grouper Rate,1678.88
Blue Cross,PPO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,PPO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Grouper Rate,5029.00
Blue Cross,PPO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,3544.00
Blue Cross,PPO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,5029.00
Blue Cross,PPO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,PPO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,PPO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Grouper Rate,1678.00
Blue Cross,PPO,688,DRG,Kidney & urinary tract neoplasms w/o CC/MCC,,Case Rate,11334.86
Blue Cross,PPO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,Grouper Rate,1678.00
Blue Cross,PPO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1678.00
Blue Cross,PPO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1678.00
Blue Cross,PPO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1678.88
Blue Cross,PPO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Grouper Rate,1678.00
Blue Cross,PPO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Grouper Rate,1678.00
Blue Cross,PPO,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,Grouper Rate,1678.00
Blue Cross,PPO,689,DRG,Kidney & urinary tract infections w MCC,,Case Rate,18380.90
Blue Cross,PPO,69,DRG,Transient ischemia,,Case Rate,13002.09
Blue Cross,PPO,690,DRG,Kidney & urinary tract infections w/o MCC,,Case Rate,13102.98
Blue Cross,PPO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,1678.00
Blue Cross,PPO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,1678.00
Blue Cross,PPO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Grouper Rate,1678.00
Blue Cross,PPO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,Grouper Rate,1678.00
Blue Cross,PPO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,Grouper Rate,1678.00
Blue Cross,PPO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Grouper Rate,1678.00
Blue Cross,PPO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Grouper Rate,1678.88
Blue Cross,PPO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,1678.88
Blue Cross,PPO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,1678.88
Blue Cross,PPO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Grouper Rate,3544.00
Blue Cross,PPO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,Grouper Rate,5029.00
Blue Cross,PPO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Grouper Rate,1678.00
Blue Cross,PPO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,1678.88
Blue Cross,PPO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,3544.00
Blue Cross,PPO,693,DRG,Urinary stones w/o esw lithotripsy w MCC,,Case Rate,20985.95
Blue Cross,PPO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Grouper Rate,1678.88
Blue Cross,PPO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,3544.00
Blue Cross,PPO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,5029.00
Blue Cross,PPO,694,DRG,Urinary stones w/o esw lithotripsy w/o MCC,,Case Rate,12062.62
Blue Cross,PPO,69405,CPT4/HCPCS,CATHETERIZE MIDDLE EAR CANAL,,Grouper Rate,1678.00
Blue Cross,PPO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,1678.00
Blue Cross,PPO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,1678.00
Blue Cross,PPO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Grouper Rate,1678.00
Blue Cross,PPO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,1678.00
Blue Cross,PPO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,1678.88
Blue Cross,PPO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Grouper Rate,3544.00
Blue Cross,PPO,69450,CPT4/HCPCS,EARDRUM REVISION,,Grouper Rate,1678.00
Blue Cross,PPO,695,DRG,Kidney & urinary tract signs & symptoms w MCC,,Case Rate,18794.40
Blue Cross,PPO,69501,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,69502,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,6588.00
Blue Cross,PPO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Grouper Rate,6588.00
Blue Cross,PPO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,6588.00
Blue Cross,PPO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,Grouper Rate,5281.00
Blue Cross,PPO,69540,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,1678.00
Blue Cross,PPO,69550,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,5281.00
Blue Cross,PPO,69552,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,6588.00
Blue Cross,PPO,69554,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,1678.88
Blue Cross,PPO,696,DRG,Kidney & urinary tract signs & symptoms w/o MCC,,Case Rate,11407.63
Blue Cross,PPO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,PPO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,PPO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,PPO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,PPO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6588.00
Blue Cross,PPO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,1678.88
Blue Cross,PPO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,1678.88
Blue Cross,PPO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,5281.00
Blue Cross,PPO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,5281.00
Blue Cross,PPO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,5281.00
Blue Cross,PPO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,6588.00
Blue Cross,PPO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6588.00
Blue Cross,PPO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6588.00
Blue Cross,PPO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,PPO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,PPO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,PPO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,PPO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,PPO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,PPO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Grouper Rate,5783.00
Blue Cross,PPO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5281.00
Blue Cross,PPO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5281.00
Blue Cross,PPO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5029.00
Blue Cross,PPO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,5029.00
Blue Cross,PPO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,5029.00
Blue Cross,PPO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Grouper Rate,3544.00
Blue Cross,PPO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Grouper Rate,3544.00
Blue Cross,PPO,697,DRG,Urethral stricture,,Case Rate,16490.38
Blue Cross,PPO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Grouper Rate,3544.00
Blue Cross,PPO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Grouper Rate,3544.00
Blue Cross,PPO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Grouper Rate,1678.00
Blue Cross,PPO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Grouper Rate,5783.00
Blue Cross,PPO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Grouper Rate,5783.00
Blue Cross,PPO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Grouper Rate,5281.00
Blue Cross,PPO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Grouper Rate,5281.00
Blue Cross,PPO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,PPO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,PPO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,PPO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,5281.00
Blue Cross,PPO,698,DRG,Other kidney & urinary tract diagnoses w MCC,,Case Rate,26574.81
Blue Cross,PPO,69801,CPT4/HCPCS,INCISE INNER EAR,,Grouper Rate,5281.00
Blue Cross,PPO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,6588.00
Blue Cross,PPO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,6588.00
Blue Cross,PPO,69820,CPT4/HCPCS,ESTABLISH INNER EAR WINDOW,,Grouper Rate,5281.00
Blue Cross,PPO,69840,CPT4/HCPCS,REVISE INNER EAR WINDOW,,Grouper Rate,5281.00
Blue Cross,PPO,699,DRG,Other kidney & urinary tract diagnoses w CC,,Case Rate,16956.80
Blue Cross,PPO,69905,CPT4/HCPCS,REMOVE INNER EAR,,Grouper Rate,6588.00
Blue Cross,PPO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Grouper Rate,6588.00
Blue Cross,PPO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,6588.00
Blue Cross,PPO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Grouper Rate,6588.00
Blue Cross,PPO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,6588.00
Blue Cross,PPO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5783.00
Blue Cross,PPO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,Grouper Rate,6588.00
Blue Cross,PPO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Grouper Rate,6588.00
Blue Cross,PPO,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,7,DRG,Lung transplant,,Case Rate,191438.92
Blue Cross,PPO,70,DRG,Nonspecific cerebrovascular disorders w MCC,,Case Rate,27727.65
Blue Cross,PPO,700,DRG,Other kidney & urinary tract diagnoses w/o CC/MCC,,Case Rate,12318.99
Blue Cross,PPO,707,DRG,Major male pelvic procedures w CC/MCC,,Case Rate,31766.72
Blue Cross,PPO,708,DRG,Major male pelvic procedures w/o CC/MCC,,Case Rate,24667.75
Blue Cross,PPO,709,DRG,Penis procedures w CC/MCC,,Case Rate,38238.82
Blue Cross,PPO,71,DRG,Nonspecific cerebrovascular disorders w CC,,Case Rate,16718.63
Blue Cross,PPO,710,DRG,Penis procedures w/o CC/MCC,,Case Rate,26462.34
Blue Cross,PPO,711,DRG,Testes procedures w CC/MCC,,Case Rate,35235.16
Blue Cross,PPO,712,DRG,Testes procedures w/o CC/MCC,,Case Rate,17491.05
Blue Cross,PPO,713,DRG,Transurethral prostatectomy w CC/MCC,,Case Rate,24671.06
Blue Cross,PPO,714,DRG,Transurethral prostatectomy w/o CC/MCC,,Case Rate,15357.39
Blue Cross,PPO,715,DRG,Other male reproductive system O.R. proc for malignancy w CC/MCC,,Case Rate,33392.60
Blue Cross,PPO,716,DRG,Other male reproductive system O.R. proc for malignancy w/o CC/MCC,,Case Rate,21113.31
Blue Cross,PPO,717,DRG,Other male reproductive system O.R. proc exc malignancy w CC/MCC,,Case Rate,29747.19
Blue Cross,PPO,718,DRG,Other male reproductive system O.R. proc exc malignancy w/o CC/MCC,,Case Rate,20446.74
Blue Cross,PPO,72,DRG,Nonspecific cerebrovascular disorders w/o CC/MCC,,Case Rate,12755.64
Blue Cross,PPO,722,DRG,Malignancy, male reproductive system w MCC,,Case Rate,28266.86
Blue Cross,PPO,723,DRG,Malignancy, male reproductive system w CC,,Case Rate,18013.71
Blue Cross,PPO,724,DRG,Malignancy, male reproductive system w/o CC/MCC,,Case Rate,10741.07
Blue Cross,PPO,725,DRG,Benign prostatic hypertrophy w MCC,,Case Rate,21202.62
Blue Cross,PPO,726,DRG,Benign prostatic hypertrophy w/o MCC,,Case Rate,12294.18
Blue Cross,PPO,727,DRG,Inflammation of the male reproductive system w MCC,,Case Rate,23455.37
Blue Cross,PPO,728,DRG,Inflammation of the male reproductive system w/o MCC,,Case Rate,13289.89
Blue Cross,PPO,729,DRG,Other male reproductive system diagnoses w CC/MCC,,Case Rate,16619.39
Blue Cross,PPO,73,DRG,Cranial & peripheral nerve disorders w MCC,,Case Rate,23973.07
Blue Cross,PPO,730,DRG,Other male reproductive system diagnoses w/o CC/MCC,,Case Rate,9356.67
Blue Cross,PPO,734,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC,,Case Rate,36765.11
Blue Cross,PPO,735,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC,,Case Rate,23379.29
Blue Cross,PPO,736,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w MCC,,Case Rate,70430.62
Blue Cross,PPO,737,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w CC,,Case Rate,34042.62
Blue Cross,PPO,738,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC,,Case Rate,24422.96
Blue Cross,PPO,739,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w MCC,,Case Rate,63210.91
Blue Cross,PPO,74,DRG,Cranial & peripheral nerve disorders w/o MCC,,Case Rate,16844.33
Blue Cross,PPO,740,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w CC,,Case Rate,29772.00
Blue Cross,PPO,741,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC,,Case Rate,21162.93
Blue Cross,PPO,742,DRG,Uterine & adnexa proc for non-malignancy w CC/MCC,,Case Rate,28399.18
Blue Cross,PPO,743,DRG,Uterine & adnexa proc for non-malignancy w/o CC/MCC,,Case Rate,18728.24
Blue Cross,PPO,744,DRG,D&C, conization, laparascopy & tubal interruption w CC/MCC,,Case Rate,29672.76
Blue Cross,PPO,745,DRG,D&C, conization, laparascopy & tubal interruption w/o CC/MCC,,Case Rate,19360.07
Blue Cross,PPO,746,DRG,Vagina, cervix & vulva procedures w CC/MCC,,Case Rate,26619.47
Blue Cross,PPO,747,DRG,Vagina, cervix & vulva procedures w/o CC/MCC,,Case Rate,15514.52
Blue Cross,PPO,748,DRG,Female reproductive system reconstructive procedures,,Case Rate,22300.88
Blue Cross,PPO,749,DRG,Other female reproductive system O.R. procedures w CC/MCC,,Case Rate,44780.39
Blue Cross,PPO,75,DRG,Viral meningitis w CC/MCC,,Case Rate,26894.04
Blue Cross,PPO,750,DRG,Other female reproductive system O.R. procedures w/o CC/MCC,,Case Rate,24245.98
Blue Cross,PPO,754,DRG,Malignancy, female reproductive system w MCC,,Case Rate,30119.34
Blue Cross,PPO,755,DRG,Malignancy, female reproductive system w CC,,Case Rate,18650.50
Blue Cross,PPO,756,DRG,Malignancy, female reproductive system w/o CC/MCC,,Case Rate,15152.29
Blue Cross,PPO,757,DRG,Infections, female reproductive system w MCC,,Case Rate,25175.53
Blue Cross,PPO,758,DRG,Infections, female reproductive system w CC,,Case Rate,15994.18
Blue Cross,PPO,759,DRG,Infections, female reproductive system w/o CC/MCC,,Case Rate,11300.12
Blue Cross,PPO,76,DRG,Viral meningitis w/o CC/MCC,,Case Rate,16224.08
Blue Cross,PPO,760,DRG,Menstrual & other female reproductive system disorders w CC/MCC,,Case Rate,15259.80
Blue Cross,PPO,761,DRG,Menstrual & other female reproductive system disorders w/o CC/MCC,,Case Rate,9758.60
Blue Cross,PPO,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,Case Rate,19365.03
Blue Cross,PPO,769,DRG,Postpartum & post abortion diagnoses w O.R. procedure,,Case Rate,26801.41
Blue Cross,PPO,77,DRG,Hypertensive encephalopathy w MCC,,Case Rate,25337.62
Blue Cross,PPO,770,DRG,Abortion w D&C, aspiration curettage or hysterotomy,,Case Rate,14689.17
Blue Cross,PPO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Fee Schedule,566.75
Blue Cross,PPO,77261,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,417.19
Blue Cross,PPO,77262,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,634.12
Blue Cross,PPO,77263,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Fee Schedule,942.23
Blue Cross,PPO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Fee Schedule,632.25
Blue Cross,PPO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Fee Schedule,1015.51
Blue Cross,PPO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Fee Schedule,1181.79
Blue Cross,PPO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,Fee Schedule,2069.34
Blue Cross,PPO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,Fee Schedule,5099.08
Blue Cross,PPO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,Fee Schedule,281.89
Blue Cross,PPO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,Fee Schedule,5564.17
Blue Cross,PPO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,Fee Schedule,546.43
Blue Cross,PPO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,Fee Schedule,1000.91
Blue Cross,PPO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,Fee Schedule,850.86
Blue Cross,PPO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,Fee Schedule,1109.35
Blue Cross,PPO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,Fee Schedule,1505.69
Blue Cross,PPO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,Fee Schedule,961.27
Blue Cross,PPO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,Fee Schedule,107.85
Blue Cross,PPO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Fee Schedule,280.71
Blue Cross,PPO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Fee Schedule,399.29
Blue Cross,PPO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Fee Schedule,549.48
Blue Cross,PPO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,Fee Schedule,1915.70
Blue Cross,PPO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Fee Schedule,661.52
Blue Cross,PPO,77371,CPT4/HCPCS,SRS MULTISOURCE,,Fee Schedule,6096.45
Blue Cross,PPO,77372,CPT4/HCPCS,SRS LINEAR BASED,,Fee Schedule,4626.31
Blue Cross,PPO,77373,CPT4/HCPCS,SBRT DELIVERY,,Fee Schedule,8630.99
Blue Cross,PPO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,Fee Schedule,2983.40
Blue Cross,PPO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,Fee Schedule,3580.79
Blue Cross,PPO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,Fee Schedule,358.27
Blue Cross,PPO,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,327.19
Blue Cross,PPO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,327.78
Blue Cross,PPO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,423.14
Blue Cross,PPO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Fee Schedule,438.04
Blue Cross,PPO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,Fee Schedule,120.98
Blue Cross,PPO,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,Fee Schedule,477.14
Blue Cross,PPO,77425,CPT4/HCPCS,IO RAD TX DELIVER BY ELCTRNS,,Fee Schedule,737.20
Blue Cross,PPO,77427,CPT4/HCPCS,RADIATION TX MANAGEMENT X5,,Fee Schedule,986.55
Blue Cross,PPO,77431,CPT4/HCPCS,RADIATION THERAPY MANAGEMENT,,Fee Schedule,440.99
Blue Cross,PPO,77432,CPT4/HCPCS,STEREOTACTIC RADIATION TRMT,,Fee Schedule,2166.91
Blue Cross,PPO,77435,CPT4/HCPCS,SBRT MANAGEMENT,,Fee Schedule,3149.53
Blue Cross,PPO,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,Fee Schedule,1608.38
Blue Cross,PPO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,Fee Schedule,2028.72
Blue Cross,PPO,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,Fee Schedule,762.83
Blue Cross,PPO,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,Fee Schedule,703.66
Blue Cross,PPO,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,Fee Schedule,953.55
Blue Cross,PPO,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,Fee Schedule,990.87
Blue Cross,PPO,776,DRG,Postpartum & post abortion diagnoses w/o O.R. procedure,,Case Rate,12715.95
Blue Cross,PPO,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Fee Schedule,638.84
Blue Cross,PPO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Fee Schedule,1101.33
Blue Cross,PPO,77785,CPT4/HCPCS,HDR BRACHYTX 1 CHANNEL,,Grouper Rate,1678.88
Blue Cross,PPO,77786,CPT4/HCPCS,HDR BRACHYTX 2-12 CHANNEL,,Grouper Rate,1678.88
Blue Cross,PPO,77787,CPT4/HCPCS,HDR BRACHYTX OVER 12 CHAN,,Grouper Rate,3544.00
Blue Cross,PPO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Fee Schedule,81.09
Blue Cross,PPO,77790,CPT4/HCPCS,RADIATION HANDLING,,Fee Schedule,107.85
Blue Cross,PPO,779,DRG,Abortion w/o D&C,,Case Rate,17208.21
Blue Cross,PPO,78,DRG,Hypertensive encephalopathy w CC,,Case Rate,15696.46
Blue Cross,PPO,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Fee Schedule,1823.79
Blue Cross,PPO,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Fee Schedule,1823.79
Blue Cross,PPO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,30974.45
Blue Cross,PPO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,18109.64
Blue Cross,PPO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,15139.06
Blue Cross,PPO,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Fee Schedule,1008.82
Blue Cross,PPO,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Fee Schedule,1634.94
Blue Cross,PPO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,26316.79
Blue Cross,PPO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,17577.05
Blue Cross,PPO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,14672.63
Blue Cross,PPO,789,DRG,Neonates, died or transferred to another acute care facility,,Case Rate,28423.99
Blue Cross,PPO,79,DRG,Hypertensive encephalopathy w/o CC/MCC,,Case Rate,12021.27
Blue Cross,PPO,790,DRG,Extreme immaturity or respiratory distress syndrome, neonate,,Case Rate,93733.83
Blue Cross,PPO,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Fee Schedule,535.17
Blue Cross,PPO,791,DRG,Prematurity w major problems,,Case Rate,64016.41
Blue Cross,PPO,792,DRG,Prematurity w/o major problems,,Case Rate,38625.86
Blue Cross,PPO,793,DRG,Full term neonate w major problems,,Case Rate,65758.07
Blue Cross,PPO,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Fee Schedule,2085.87
Blue Cross,PPO,794,DRG,Neonate w other significant problems,,Case Rate,23275.08
Blue Cross,PPO,795,DRG,Normal newborn,,Case Rate,3150.87
Blue Cross,PPO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,17663.06
Blue Cross,PPO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,15215.14
Blue Cross,PPO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,13683.54
Blue Cross,PPO,799,DRG,Splenectomy w MCC,,Case Rate,85080.10
Blue Cross,PPO,8,DRG,Simultaneous pancreas/kidney transplant,,Case Rate,89759.27
Blue Cross,PPO,80,DRG,Nontraumatic stupor & coma w MCC,,Case Rate,34601.68
Blue Cross,PPO,800,DRG,Splenectomy w CC,,Case Rate,48816.15
Blue Cross,PPO,801,DRG,Splenectomy w/o CC/MCC,,Case Rate,27845.09
Blue Cross,PPO,802,DRG,Other O.R. proc of the blood & blood forming organs w MCC,,Case Rate,61341.89
Blue Cross,PPO,803,DRG,Other O.R. proc of the blood & blood forming organs w CC,,Case Rate,31174.59
Blue Cross,PPO,804,DRG,Other O.R. proc of the blood & blood forming organs w/o CC/MCC,,Case Rate,22563.86
Blue Cross,PPO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,16983.27
Blue Cross,PPO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,12138.70
Blue Cross,PPO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,10603.79
Blue Cross,PPO,808,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w MCC,,Case Rate,36022.46
Blue Cross,PPO,809,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w CC,,Case Rate,20206.91
Blue Cross,PPO,81,DRG,Nontraumatic stupor & coma w/o MCC,,Case Rate,12768.88
Blue Cross,PPO,810,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC,,Case Rate,15889.97
Blue Cross,PPO,811,DRG,Red blood cell disorders w MCC,,Case Rate,22785.50
Blue Cross,PPO,812,DRG,Red blood cell disorders w/o MCC,,Case Rate,14550.23
Blue Cross,PPO,813,DRG,Coagulation disorders,,Case Rate,25549.33
Blue Cross,PPO,814,DRG,Reticuloendothelial & immunity disorders w MCC,,Case Rate,31273.83
Blue Cross,PPO,815,DRG,Reticuloendothelial & immunity disorders w CC,,Case Rate,16415.95
Blue Cross,PPO,816,DRG,Reticuloendothelial & immunity disorders w/o CC/MCC,,Case Rate,10931.28
Blue Cross,PPO,817,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC,,Case Rate,38071.77
Blue Cross,PPO,818,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC,,Case Rate,21774.91
Blue Cross,PPO,819,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC,,Case Rate,16505.26
Blue Cross,PPO,82,DRG,Traumatic stupor & coma, coma >1 hr w MCC,,Case Rate,37348.97
Blue Cross,PPO,820,DRG,Lymphoma & leukemia w major O.R. procedure w MCC,,Case Rate,94067.94
Blue Cross,PPO,821,DRG,Lymphoma & leukemia w major O.R. procedure w CC,,Case Rate,35645.35
Blue Cross,PPO,822,DRG,Lymphoma & leukemia w major O.R. procedure w/o CC/MCC,,Case Rate,20701.46
Blue Cross,PPO,823,DRG,Lymphoma & non-acute leukemia w other O.R. proc w MCC,,Case Rate,74382.03
Blue Cross,PPO,824,DRG,Lymphoma & non-acute leukemia w other O.R. proc w CC,,Case Rate,39079.05
Blue Cross,PPO,825,DRG,Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC,,Case Rate,23167.57
Blue Cross,PPO,826,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC,,Case Rate,83308.67
Blue Cross,PPO,827,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC,,Case Rate,41310.30
Blue Cross,PPO,828,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o CC/MCC,,Case Rate,27749.15
Blue Cross,PPO,829,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC,,Case Rate,53022.27
Blue Cross,PPO,83,DRG,Traumatic stupor & coma, coma >1 hr w CC,,Case Rate,22191.71
Blue Cross,PPO,830,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w/o CC/MCC,,Case Rate,24421.31
Blue Cross,PPO,831,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC,,Case Rate,18542.99
Blue Cross,PPO,832,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC,,Case Rate,12897.89
Blue Cross,PPO,833,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC,,Case Rate,8865.44
Blue Cross,PPO,834,DRG,Acute leukemia w/o major O.R. procedure w MCC,,Case Rate,100068.65
Blue Cross,PPO,835,DRG,Acute leukemia w/o major O.R. procedure w CC,,Case Rate,34960.59
Blue Cross,PPO,836,DRG,Acute leukemia w/o major O.R. procedure w/o CC/MCC,,Case Rate,19345.18
Blue Cross,PPO,837,DRG,Chemo w acute leukemia as sdx or w high dose chemo agent w MCC,,Case Rate,94264.76
Blue Cross,PPO,838,DRG,Chemo w acute leukemia as sdx w CC or high dose chemo agent,,Case Rate,37360.55
Blue Cross,PPO,839,DRG,Chemo w acute leukemia as sdx w/o CC/MCC,,Case Rate,24583.40
Blue Cross,PPO,84,DRG,Traumatic stupor & coma, coma >1 hr w/o CC/MCC,,Case Rate,14955.46
Blue Cross,PPO,840,DRG,Lymphoma & non-acute leukemia w MCC,,Case Rate,53187.67
Blue Cross,PPO,841,DRG,Lymphoma & non-acute leukemia w CC,,Case Rate,26808.03
Blue Cross,PPO,842,DRG,Lymphoma & non-acute leukemia w/o CC/MCC,,Case Rate,18116.26
Blue Cross,PPO,843,DRG,Other myeloprolif dis or poorly diff neopl diag w MCC,,Case Rate,31473.96
Blue Cross,PPO,844,DRG,Other myeloprolif dis or poorly diff neopl diag w CC,,Case Rate,19525.47
Blue Cross,PPO,845,DRG,Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC,,Case Rate,14015.99
Blue Cross,PPO,846,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w MCC,,Case Rate,44160.14
Blue Cross,PPO,847,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w CC,,Case Rate,22084.20
Blue Cross,PPO,848,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC,,Case Rate,17019.66
Blue Cross,PPO,849,DRG,Radiotherapy,,Case Rate,41143.25
Blue Cross,PPO,85,DRG,Traumatic stupor & coma, coma <1 hr w MCC,,Case Rate,38147.85
Blue Cross,PPO,853,DRG,Infectious & parasitic diseases w O.R. procedure w MCC,,Case Rate,81783.68
Blue Cross,PPO,854,DRG,Infectious & parasitic diseases w O.R. procedure w CC,,Case Rate,34641.37
Blue Cross,PPO,855,DRG,Infectious & parasitic diseases w O.R. procedure w/o CC/MCC,,Case Rate,24727.30
Blue Cross,PPO,856,DRG,Postoperative or post-traumatic infections w O.R. proc w MCC,,Case Rate,75185.87
Blue Cross,PPO,857,DRG,Postoperative or post-traumatic infections w O.R. proc w CC,,Case Rate,33653.93
Blue Cross,PPO,858,DRG,Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC,,Case Rate,22302.53
Blue Cross,PPO,86,DRG,Traumatic stupor & coma, coma <1 hr w CC,,Case Rate,21053.76
Blue Cross,PPO,862,DRG,Postoperative & post-traumatic infections w MCC,,Case Rate,31075.35
Blue Cross,PPO,863,DRG,Postoperative & post-traumatic infections w/o MCC,,Case Rate,16166.19
Blue Cross,PPO,864,DRG,Fever of unknown origin,,Case Rate,14472.50
Blue Cross,PPO,865,DRG,Viral illness w MCC,,Case Rate,24461.00
Blue Cross,PPO,866,DRG,Viral illness w/o MCC,,Case Rate,13847.28
Blue Cross,PPO,867,DRG,Other infectious & parasitic diseases diagnoses w MCC,,Case Rate,36875.93
Blue Cross,PPO,868,DRG,Other infectious & parasitic diseases diagnoses w CC,,Case Rate,17505.93
Blue Cross,PPO,869,DRG,Other infectious & parasitic diseases diagnoses w/o CC/MCC,,Case Rate,12008.04
Blue Cross,PPO,87,DRG,Traumatic stupor & coma, coma <1 hr w/o CC/MCC,,Case Rate,14267.40
Blue Cross,PPO,870,DRG,Septicemia w MV 96+ hours,,Case Rate,106266.19
Blue Cross,PPO,871,DRG,Septicemia w/o MV 96+ hours w MCC,,Case Rate,30900.02
Blue Cross,PPO,872,DRG,Septicemia w/o MV 96+ hours w/o MCC,,Case Rate,16897.26
Blue Cross,PPO,876,DRG,O.R. procedure w principal diagnoses of mental illness,,Case Rate,53941.90
Blue Cross,PPO,88,DRG,Concussion w MCC,,Case Rate,24136.82
Blue Cross,PPO,880,DRG,Acute adjustment reaction & psychosocial dysfunction,,Case Rate,14283.94
Blue Cross,PPO,881,DRG,Depressive neuroses,,Case Rate,13255.15
Blue Cross,PPO,882,DRG,Neuroses except depressive,,Case Rate,13612.42
Blue Cross,PPO,883,DRG,Disorders of personality & impulse control,,Case Rate,26105.08
Blue Cross,PPO,884,DRG,Organic disturbances & mental retardation,,Case Rate,23880.45
Blue Cross,PPO,885,DRG,Psychoses,,Case Rate,20461.63
Blue Cross,PPO,886,DRG,Behavioral & developmental disorders,,Case Rate,20203.61
Blue Cross,PPO,887,DRG,Other mental disorder diagnoses,,Case Rate,17841.69
Blue Cross,PPO,89,DRG,Concussion w CC,,Case Rate,17552.24
Blue Cross,PPO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Per Date of Service,193.00
Blue Cross,PPO,894,DRG,Alcohol/drug abuse or dependence, left ama,,Case Rate,9055.65
Blue Cross,PPO,895,DRG,Alcohol/drug abuse or dependence w rehabilitation therapy,,Case Rate,26331.68
Blue Cross,PPO,896,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC,,Case Rate,29391.58
Blue Cross,PPO,897,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC,,Case Rate,13653.77
Blue Cross,PPO,90,DRG,Concussion w/o CC/MCC,,Case Rate,14138.39
Blue Cross,PPO,901,DRG,Wound debridements for injuries w MCC,,Case Rate,70496.78
Blue Cross,PPO,902,DRG,Wound debridements for injuries w CC,,Case Rate,32458.09
Blue Cross,PPO,903,DRG,Wound debridements for injuries w/o CC/MCC,,Case Rate,18762.97
Blue Cross,PPO,904,DRG,Skin grafts for injuries w CC/MCC,,Case Rate,61551.95
Blue Cross,PPO,905,DRG,Skin grafts for injuries w/o CC/MCC,,Case Rate,27157.02
Blue Cross,PPO,906,DRG,Hand procedures for injuries,,Case Rate,29669.45
Blue Cross,PPO,907,DRG,Other O.R. procedures for injuries w MCC,,Case Rate,65450.43
Blue Cross,PPO,908,DRG,Other O.R. procedures for injuries w CC,,Case Rate,33748.21
Blue Cross,PPO,909,DRG,Other O.R. procedures for injuries w/o CC/MCC,,Case Rate,22740.84
Blue Cross,PPO,90901,CPT4/HCPCS,BIOFEEDBACK TRAIN ANY METH,,Per Date of Service,193.00
Blue Cross,PPO,90911,CPT4/HCPCS,BIOFEEDBACK PERI/URO/RECTAL,,Per Date of Service,193.00
Blue Cross,PPO,90912,CPT4/HCPCS,BFB TRAINING 1ST 15 MIN,,Per Date of Service,193.00
Blue Cross,PPO,90913,CPT4/HCPCS,BFB TRAINING EA ADDL 15 MIN,,Per Date of Service,193.00
Blue Cross,PPO,91,DRG,Other disorders of nervous system w MCC,,Case Rate,27272.80
Blue Cross,PPO,913,DRG,Traumatic injury w MCC,,Case Rate,27066.05
Blue Cross,PPO,914,DRG,Traumatic injury w/o MCC,,Case Rate,14697.44
Blue Cross,PPO,915,DRG,Allergic reactions w MCC,,Case Rate,28078.30
Blue Cross,PPO,916,DRG,Allergic reactions w/o MCC,,Case Rate,10871.74
Blue Cross,PPO,917,DRG,Poisoning & toxic effects of drugs w MCC,,Case Rate,24437.85
Blue Cross,PPO,918,DRG,Poisoning & toxic effects of drugs w/o MCC,,Case Rate,13084.79
Blue Cross,PPO,919,DRG,Complications of treatment w MCC,,Case Rate,30340.97
Blue Cross,PPO,92,DRG,Other disorders of nervous system w CC,,Case Rate,16310.09
Blue Cross,PPO,920,DRG,Complications of treatment w CC,,Case Rate,16991.54
Blue Cross,PPO,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,Grouper Rate,1678.00
Blue Cross,PPO,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,Grouper Rate,1678.00
Blue Cross,PPO,921,DRG,Complications of treatment w/o CC/MCC,,Case Rate,11435.75
Blue Cross,PPO,922,DRG,Other injury, poisoning & toxic effect diag w MCC,,Case Rate,26258.90
Blue Cross,PPO,92225,CPT4/HCPCS,SPECIAL EYE EXAM INITIAL,,Grouper Rate,1678.00
Blue Cross,PPO,92226,CPT4/HCPCS,SPECIAL EYE EXAM SUBSEQUENT,,Grouper Rate,1678.00
Blue Cross,PPO,92235,CPT4/HCPCS,FLUORESCEIN ANGRPH UNI/BI,,Grouper Rate,1678.00
Blue Cross,PPO,92240,CPT4/HCPCS,ICG ANGIOGRAPHY UNI/BI,,Grouper Rate,1678.00
Blue Cross,PPO,92250,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Grouper Rate,1678.00
Blue Cross,PPO,92260,CPT4/HCPCS,OPHTHALMOSCOPY/DYNAMOMETRY,,Grouper Rate,1678.00
Blue Cross,PPO,923,DRG,Other injury, poisoning & toxic effect diag w/o MCC,,Case Rate,15388.81
Blue Cross,PPO,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,Grouper Rate,1678.00
Blue Cross,PPO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Per Date of Service,193.00
Blue Cross,PPO,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,Grouper Rate,1678.00
Blue Cross,PPO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,Per Date of Service,193.00
Blue Cross,PPO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,Per Date of Service,193.00
Blue Cross,PPO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,Per Date of Service,193.00
Blue Cross,PPO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,Per Date of Service,193.00
Blue Cross,PPO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,Per Date of Service,193.00
Blue Cross,PPO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,Per Date of Service,193.00
Blue Cross,PPO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,Per Date of Service,193.00
Blue Cross,PPO,927,DRG,Extensive burns or full thickness burns w MV 96+ hrs w skin graft,,Case Rate,347851.08
Blue Cross,PPO,928,DRG,Full thickness burn w skin graft or inhal inj w CC/MCC,,Case Rate,107825.91
Blue Cross,PPO,929,DRG,Full thickness burn w skin graft or inhal inj w/o CC/MCC,,Case Rate,49767.20
Blue Cross,PPO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Grouper Rate,8841.00
Blue Cross,PPO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Grouper Rate,3544.00
Blue Cross,PPO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Grouper Rate,8841.00
Blue Cross,PPO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Grouper Rate,8841.00
Blue Cross,PPO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Grouper Rate,8841.00
Blue Cross,PPO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Grouper Rate,3544.00
Blue Cross,PPO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Grouper Rate,8841.00
Blue Cross,PPO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Grouper Rate,8841.00
Blue Cross,PPO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Grouper Rate,8841.00
Blue Cross,PPO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Grouper Rate,3544.00
Blue Cross,PPO,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,Grouper Rate,1678.00
Blue Cross,PPO,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,Grouper Rate,1678.00
Blue Cross,PPO,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Grouper Rate,1678.00
Blue Cross,PPO,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,Grouper Rate,1678.00
Blue Cross,PPO,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,Grouper Rate,1678.00
Blue Cross,PPO,92973,CPT4/HCPCS,PRQ CORONARY MECH THROMBECT,,Grouper Rate,5281.00
Blue Cross,PPO,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Grouper Rate,1678.00
Blue Cross,PPO,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Grouper Rate,3544.00
Blue Cross,PPO,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,Grouper Rate,1678.00
Blue Cross,PPO,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,Grouper Rate,1678.00
Blue Cross,PPO,92980,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Grouper Rate,8012.00
Blue Cross,PPO,92981,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Grouper Rate,8012.00
Blue Cross,PPO,92982,CPT4/HCPCS,CORONARY ARTERY DILATION,,Grouper Rate,8841.00
Blue Cross,PPO,92984,CPT4/HCPCS,CORONARY ARTERY DILATION,,Grouper Rate,3544.00
Blue Cross,PPO,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,Grouper Rate,5783.00
Blue Cross,PPO,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,5783.00
Blue Cross,PPO,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8841.00
Blue Cross,PPO,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,8841.00
Blue Cross,PPO,92995,CPT4/HCPCS,CORONARY ATHERECTOMY,,Grouper Rate,8841.00
Blue Cross,PPO,92996,CPT4/HCPCS,CORONARY ATHERECTOMY ADD-ON,,Grouper Rate,3544.00
Blue Cross,PPO,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Grouper Rate,5029.00
Blue Cross,PPO,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Grouper Rate,1678.88
Blue Cross,PPO,93,DRG,Other disorders of nervous system w/o CC/MCC,,Case Rate,12922.70
Blue Cross,PPO,933,DRG,Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft,,Case Rate,37340.70
Blue Cross,PPO,934,DRG,Full thickness burn w/o skin grft or inhal inj,,Case Rate,32042.94
Blue Cross,PPO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Grouper Rate,3544.00
Blue Cross,PPO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Grouper Rate,8012.00
Blue Cross,PPO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Grouper Rate,8012.00
Blue Cross,PPO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Grouper Rate,8841.00
Blue Cross,PPO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Grouper Rate,8841.00
Blue Cross,PPO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Grouper Rate,8841.00
Blue Cross,PPO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Grouper Rate,8841.00
Blue Cross,PPO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Grouper Rate,8841.00
Blue Cross,PPO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Grouper Rate,8841.00
Blue Cross,PPO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,8841.00
Blue Cross,PPO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,8841.00
Blue Cross,PPO,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Grouper Rate,8841.00
Blue Cross,PPO,935,DRG,Non-extensive burns,,Case Rate,31976.78
Blue Cross,PPO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Grouper Rate,3544.00
Blue Cross,PPO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Grouper Rate,3544.00
Blue Cross,PPO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Grouper Rate,5783.00
Blue Cross,PPO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,8841.00
Blue Cross,PPO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,8841.00
Blue Cross,PPO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,8841.00
Blue Cross,PPO,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,Grouper Rate,1678.88
Blue Cross,PPO,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,Grouper Rate,1678.88
Blue Cross,PPO,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,Grouper Rate,1678.88
Blue Cross,PPO,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,Grouper Rate,1678.88
Blue Cross,PPO,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,Grouper Rate,1678.88
Blue Cross,PPO,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,Grouper Rate,1678.88
Blue Cross,PPO,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Grouper Rate,5783.00
Blue Cross,PPO,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Grouper Rate,5783.00
Blue Cross,PPO,93582,CPT4/HCPCS,PERQ TRANSCATH CLOSURE PDA,,Grouper Rate,5783.00
Blue Cross,PPO,93583,CPT4/HCPCS,PERQ TRANSCATH SEPTAL REDUXN,,Grouper Rate,5783.00
Blue Cross,PPO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Grouper Rate,1678.88
Blue Cross,PPO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Grouper Rate,1678.88
Blue Cross,PPO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Grouper Rate,1678.88
Blue Cross,PPO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Grouper Rate,5281.00
Blue Cross,PPO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Grouper Rate,1678.00
Blue Cross,PPO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Grouper Rate,1678.00
Blue Cross,PPO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Grouper Rate,1678.88
Blue Cross,PPO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Grouper Rate,1678.00
Blue Cross,PPO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Grouper Rate,1678.00
Blue Cross,PPO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Grouper Rate,1678.00
Blue Cross,PPO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,PPO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,PPO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,PPO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,PPO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Grouper Rate,3544.00
Blue Cross,PPO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Grouper Rate,5281.00
Blue Cross,PPO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Grouper Rate,1678.00
Blue Cross,PPO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Grouper Rate,6588.00
Blue Cross,PPO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,5281.00
Blue Cross,PPO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,1678.88
Blue Cross,PPO,93644,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Grouper Rate,1678.88
Blue Cross,PPO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,8841.00
Blue Cross,PPO,93651,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,8841.00
Blue Cross,PPO,93652,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,8841.00
Blue Cross,PPO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Grouper Rate,8841.00
Blue Cross,PPO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Grouper Rate,8841.00
Blue Cross,PPO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Grouper Rate,8841.00
Blue Cross,PPO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Grouper Rate,8841.00
Blue Cross,PPO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Grouper Rate,8841.00
Blue Cross,PPO,93724,CPT4/HCPCS,ANALYZE PACEMAKER SYSTEM,,Grouper Rate,5281.00
Blue Cross,PPO,939,DRG,O.R. proc w diagnoses of other contact w health services w MCC,,Case Rate,56007.74
Blue Cross,PPO,94,DRG,Bacterial & tuberculous infections of nervous system w MCC,,Case Rate,60091.47
Blue Cross,PPO,940,DRG,O.R. proc w diagnoses of other contact w health services w CC,,Case Rate,36679.10
Blue Cross,PPO,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,Per Date of Service,193.00
Blue Cross,PPO,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,Per Date of Service,193.00
Blue Cross,PPO,941,DRG,O.R. proc w diagnoses of other contact w health services w/o CC/MCC,,Case Rate,31834.53
Blue Cross,PPO,945,DRG,Rehabilitation w CC/MCC,,Case Rate,24556.93
Blue Cross,PPO,946,DRG,Rehabilitation w/o CC/MCC,,Case Rate,18643.88
Blue Cross,PPO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,Per Date of Service,193.00
Blue Cross,PPO,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,Per Date of Service,193.00
Blue Cross,PPO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,Per Date of Service,193.00
Blue Cross,PPO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,Per Date of Service,193.00
Blue Cross,PPO,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,Per Date of Service,193.00
Blue Cross,PPO,947,DRG,Signs & symptoms w MCC,,Case Rate,19684.25
Blue Cross,PPO,948,DRG,Signs & symptoms w/o MCC,,Case Rate,12993.82
Blue Cross,PPO,949,DRG,Aftercare w CC/MCC,,Case Rate,18311.43
Blue Cross,PPO,95,DRG,Bacterial & tuberculous infections of nervous system w CC,,Case Rate,41482.32
Blue Cross,PPO,950,DRG,Aftercare w/o CC/MCC,,Case Rate,12221.40
Blue Cross,PPO,951,DRG,Other factors influencing health status,,Case Rate,9232.62
Blue Cross,PPO,955,DRG,Craniotomy for multiple significant trauma,,Case Rate,104003.52
Blue Cross,PPO,956,DRG,Limb reattachment, hip & femur proc for multiple significant trauma,,Case Rate,63659.15
Blue Cross,PPO,957,DRG,Other O.R. procedures for multiple significant trauma w MCC,,Case Rate,122740.03
Blue Cross,PPO,958,DRG,Other O.R. procedures for multiple significant trauma w CC,,Case Rate,69557.31
Blue Cross,PPO,95830,CPT4/HCPCS,INSERT ELECTRODES FOR EEG,,Grouper Rate,1678.88
Blue Cross,PPO,959,DRG,Other O.R. procedures for multiple significant trauma w/o CC/MCC,,Case Rate,45223.66
Blue Cross,PPO,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Grouper Rate,1678.00
Blue Cross,PPO,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Grouper Rate,1678.00
Blue Cross,PPO,95992,CPT4/HCPCS,CANALITH REPOSITIONING PROC,,Per Date of Service,193.00
Blue Cross,PPO,96,DRG,Bacterial & tuberculous infections of nervous system w/o CC/MCC,,Case Rate,38563.01
Blue Cross,PPO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,Per Date of Service,193.00
Blue Cross,PPO,963,DRG,Other multiple significant trauma w MCC,,Case Rate,45058.26
Blue Cross,PPO,96365,CPT4/HCPCS,THER/PROPH/DIAG IV INF INIT,,Per Date of Service,193.00
Blue Cross,PPO,96376,CPT4/HCPCS,TX/PRO/DX INJ SAME DRUG ADON,,Per Date of Service,193.00
Blue Cross,PPO,964,DRG,Other multiple significant trauma w CC,,Case Rate,24618.13
Blue Cross,PPO,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,Per Date of Service,193.00
Blue Cross,PPO,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,Per Date of Service,193.00
Blue Cross,PPO,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,Per Date of Service,193.00
Blue Cross,PPO,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,Per Date of Service,193.00
Blue Cross,PPO,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,Per Date of Service,193.00
Blue Cross,PPO,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,Per Date of Service,193.00
Blue Cross,PPO,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,Per Date of Service,193.00
Blue Cross,PPO,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,Per Date of Service,193.00
Blue Cross,PPO,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,Per Date of Service,193.00
Blue Cross,PPO,965,DRG,Other multiple significant trauma w/o CC/MCC,,Case Rate,15099.36
Blue Cross,PPO,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,Per Date of Service,193.00
Blue Cross,PPO,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,Grouper Rate,1678.00
Blue Cross,PPO,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,Grouper Rate,1678.00
Blue Cross,PPO,969,DRG,HIV w extensive O.R. procedure w MCC,,Case Rate,95723.59
Blue Cross,PPO,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,Grouper Rate,1678.00
Blue Cross,PPO,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,Grouper Rate,1678.00
Blue Cross,PPO,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,Grouper Rate,1678.00
Blue Cross,PPO,97,DRG,Non-bacterial infect of nervous sys exc viral meningitis w MCC,,Case Rate,62068.00
Blue Cross,PPO,970,DRG,HIV w extensive O.R. procedure w/o MCC,,Case Rate,48711.95
Blue Cross,PPO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Per Date of Service,193.00
Blue Cross,PPO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Per Date of Service,193.00
Blue Cross,PPO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Per Date of Service,193.00
Blue Cross,PPO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Per Date of Service,193.00
Blue Cross,PPO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Per Date of Service,193.00
Blue Cross,PPO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Per Date of Service,193.00
Blue Cross,PPO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Per Date of Service,193.00
Blue Cross,PPO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Per Date of Service,193.00
Blue Cross,PPO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Per Date of Service,193.00
Blue Cross,PPO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Per Date of Service,193.00
Blue Cross,PPO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Per Date of Service,193.00
Blue Cross,PPO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Per Date of Service,193.00
Blue Cross,PPO,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,Per Date of Service,193.00
Blue Cross,PPO,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,Per Date of Service,193.00
Blue Cross,PPO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Per Date of Service,193.00
Blue Cross,PPO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Per Date of Service,193.00
Blue Cross,PPO,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,Per Date of Service,193.00
Blue Cross,PPO,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,Per Date of Service,193.00
Blue Cross,PPO,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,Per Date of Service,193.00
Blue Cross,PPO,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,Per Date of Service,193.00
Blue Cross,PPO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,Per Date of Service,193.00
Blue Cross,PPO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,Per Date of Service,193.00
Blue Cross,PPO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,Per Date of Service,193.00
Blue Cross,PPO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,Per Date of Service,193.00
Blue Cross,PPO,974,DRG,HIV w major related condition w MCC,,Case Rate,44421.47
Blue Cross,PPO,975,DRG,HIV w major related condition w CC,,Case Rate,21156.31
Blue Cross,PPO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Per Date of Service,193.00
Blue Cross,PPO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Per Date of Service,193.00
Blue Cross,PPO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Per Date of Service,193.00
Blue Cross,PPO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Per Date of Service,193.00
Blue Cross,PPO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Per Date of Service,193.00
Blue Cross,PPO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Per Date of Service,193.00
Blue Cross,PPO,976,DRG,HIV w major related condition w/o CC/MCC,,Case Rate,15698.11
Blue Cross,PPO,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,Per Date of Service,193.00
Blue Cross,PPO,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,Per Date of Service,193.00
Blue Cross,PPO,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,Per Date of Service,193.00
Blue Cross,PPO,977,DRG,HIV w or w/o other related condition,,Case Rate,21846.03
Blue Cross,PPO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,Per Date of Service,193.00
Blue Cross,PPO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,Per Date of Service,193.00
Blue Cross,PPO,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,Per Date of Service,193.00
Blue Cross,PPO,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,Per Date of Service,193.00
Blue Cross,PPO,98,DRG,Non-bacterial infect of nervous sys exc viral meningitis w CC,,Case Rate,34914.28
Blue Cross,PPO,981,DRG,Extensive O.R. procedure unrelated to principal diagnosis w MCC,,Case Rate,76213.01
Blue Cross,PPO,982,DRG,Extensive O.R. procedure unrelated to principal diagnosis w CC,,Case Rate,42034.75
Blue Cross,PPO,983,DRG,Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC,,Case Rate,27370.39
Blue Cross,PPO,987,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w MCC,,Case Rate,53955.13
Blue Cross,PPO,988,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w CC,,Case Rate,27798.77
Blue Cross,PPO,989,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC,,Case Rate,18456.98
Blue Cross,PPO,99,DRG,Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC,,Case Rate,23111.34
Blue Cross,PPO,99170,CPT4/HCPCS,ANOGENITAL EXAM CHILD W IMAG,,Grouper Rate,1678.00
Blue Cross,PPO,99195,CPT4/HCPCS,PHLEBOTOMY,,Grouper Rate,1678.00
Blue Cross,PPO,C2596,CPT4/HCPCS,Probe, robotic, water-jet,,Grouper Rate,5029.00
Blue Cross,PPO,C8957,CPT4/HCPCS,Prolonged IV inf, req pump,,Per Date of Service,193.00
Blue Cross,PPO,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Grouper Rate,8012.00
Blue Cross,PPO,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Grouper Rate,8012.00
Blue Cross,PPO,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Grouper Rate,8012.00
Blue Cross,PPO,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,Grouper Rate,8012.00
Blue Cross,PPO,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,Grouper Rate,8012.00
Blue Cross,PPO,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,Grouper Rate,8012.00
Blue Cross,PPO,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Grouper Rate,8012.00
Blue Cross,PPO,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Grouper Rate,8012.00
Blue Cross,PPO,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,Grouper Rate,8012.00
Blue Cross,PPO,C9729,CPT4/HCPCS,Percut lumbar lami,,Grouper Rate,3544.00
Blue Cross,PPO,C9732,CPT4/HCPCS,Insert ocular telescope pros,,Grouper Rate,3544.00
Blue Cross,PPO,C9734,CPT4/HCPCS,U/S trtmt, not leiomyomata,,Grouper Rate,1678.00
Blue Cross,PPO,C9738,CPT4/HCPCS,Blue light cysto imag agent,,Grouper Rate,1678.00
Blue Cross,PPO,C9742,CPT4/HCPCS,Laryngoscopy with injection,,Grouper Rate,1678.00
Blue Cross,PPO,C9743,CPT4/HCPCS,Bulking/spacer material impl,,Grouper Rate,1678.00
Blue Cross,PPO,C9748,CPT4/HCPCS,Prostatic rf water vapor tx,,Grouper Rate,3544.00
Blue Cross,PPO,C9749,CPT4/HCPCS,Repair nasal stenosis w/imp,,Grouper Rate,3544.00
Blue Cross,PPO,C9750,CPT4/HCPCS,Ins/rem-replace compl iims,,Grouper Rate,3544.00
Blue Cross,PPO,C9757,CPT4/HCPCS,Spine/lumbar disk surgery,,Grouper Rate,5281.00
Blue Cross,PPO,C9758,CPT4/HCPCS,Blind interatrial shunt ide,,Grouper Rate,8841.00
Blue Cross,PPO,C9800,CPT4/HCPCS,Dermal filler inj px/suppl,,Grouper Rate,1678.00
Blue Cross,PPO,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Grouper Rate,1678.00
Blue Cross,PPO,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Grouper Rate,1678.88
Blue Cross,PPO,G0120,CPT4/HCPCS,Colon ca scrn; barium enema,,Grouper Rate,1678.88
Blue Cross,PPO,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Grouper Rate,1678.88
Blue Cross,PPO,G0186,CPT4/HCPCS,Dstry eye lesn,fdr vssl tech,,Grouper Rate,1678.88
Blue Cross,PPO,G0237,CPT4/HCPCS,Therapeutic procd strg endur,,Per Date of Service,193.00
Blue Cross,PPO,G0238,CPT4/HCPCS,Oth resp proc, indiv,,Per Date of Service,193.00
Blue Cross,PPO,G0239,CPT4/HCPCS,Oth resp proc, group,,Per Date of Service,193.00
Blue Cross,PPO,G0251,CPT4/HCPCS,Linear acc based stero radio,,Grouper Rate,8841.00
Blue Cross,PPO,G0256,CPT4/HCPCS,Prostate brachy w palladium,,Grouper Rate,8012.00
Blue Cross,PPO,G0259,CPT4/HCPCS,Inject for sacroiliac joint,,Grouper Rate,1678.00
Blue Cross,PPO,G0260,CPT4/HCPCS,Inj for sacroiliac jt anesth,,Grouper Rate,1678.00
Blue Cross,PPO,G0269,CPT4/HCPCS,Occlusive device in vein art,,Grouper Rate,1678.00
Blue Cross,PPO,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,Grouper Rate,3544.00
Blue Cross,PPO,G0277,CPT4/HCPCS,Hbot, full body chamber, 30m,,Grouper Rate,3544.00
Blue Cross,PPO,G0283,CPT4/HCPCS,Elec stim other than wound,,Per Date of Service,193.00
Blue Cross,PPO,G0289,CPT4/HCPCS,Arthro, loose body + chondro,,Grouper Rate,5029.00
Blue Cross,PPO,G0290,CPT4/HCPCS,Drug-eluting stents, single,,Grouper Rate,8012.00
Blue Cross,PPO,G0291,CPT4/HCPCS,Drug-eluting stents,each add,,Grouper Rate,8012.00
Blue Cross,PPO,G0293,CPT4/HCPCS,Non-cov surg proc,clin trial,,Grouper Rate,1678.00
Blue Cross,PPO,G0339,CPT4/HCPCS,Robot lin-radsurg com, first,,Grouper Rate,8841.00
Blue Cross,PPO,G0340,CPT4/HCPCS,Robt lin-radsurg fractx 2-5,,Grouper Rate,8841.00
Blue Cross,PPO,G0341,CPT4/HCPCS,Percutaneous islet celltrans,,Grouper Rate,1678.00
Blue Cross,PPO,G0412,CPT4/HCPCS,Open tx iliac spine uni/bil,,Grouper Rate,5029.00
Blue Cross,PPO,G0413,CPT4/HCPCS,Pelvic ring fracture uni/bil,,Grouper Rate,3544.00
Blue Cross,PPO,G0414,CPT4/HCPCS,Pelvic ring fx treat int fix,,Grouper Rate,5281.00
Blue Cross,PPO,G0415,CPT4/HCPCS,Open tx post pelvic fxcture,,Grouper Rate,5281.00
Blue Cross,PPO,G0429,CPT4/HCPCS,Dermal filler injection(s),,Grouper Rate,1678.00
Blue Cross,PPO,G0448,CPT4/HCPCS,Place perm pacing cardiovert,,Grouper Rate,3544.00
Blue Cross,PPO,G0455,CPT4/HCPCS,Fecal microbiota prep instil,,Grouper Rate,3544.00
Blue Cross,PPO,G0515,CPT4/HCPCS,Cognitive skills development,,Per Date of Service,193.00
Blue Cross,PPO,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,Per Date of Service,193.00
Blue Cross,PPO,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,Per Date of Service,193.00
Blue Cross,PPO,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,Per Date of Service,193.00
Blue Cross,PPO,G6001,CPT4/HCPCS,Echo guidance radiotherapy,,Fee Schedule,159.34
Blue Cross,PPO,G6002,CPT4/HCPCS,Stereoscopic x-ray guidance,,Fee Schedule,588.34
Blue Cross,PPO,G6003,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1195.46
Blue Cross,PPO,G6004,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,925.46
Blue Cross,PPO,G6005,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1033.91
Blue Cross,PPO,G6006,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1028.74
Blue Cross,PPO,G6007,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1902.52
Blue Cross,PPO,G6008,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1280.30
Blue Cross,PPO,G6009,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1417.85
Blue Cross,PPO,G6010,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1417.85
Blue Cross,PPO,G6011,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,2034.57
Blue Cross,PPO,G6012,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1685.30
Blue Cross,PPO,G6013,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1897.02
Blue Cross,PPO,G6014,CPT4/HCPCS,Radiation treatment delivery,,Fee Schedule,1897.02
Blue Cross,PPO,G6015,CPT4/HCPCS,Radiation tx delivery imrt,,Fee Schedule,2957.43
Blue Cross,PPO,G6016,CPT4/HCPCS,Delivery comp imrt,,Fee Schedule,2953.40
Blue Cross,PPO,G6018,CPT4/HCPCS,Ileoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,PPO,G6019,CPT4/HCPCS,Colonoscopy lesion removal,,Grouper Rate,1678.00
Blue Cross,PPO,G6020,CPT4/HCPCS,Colonoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,PPO,G6022,CPT4/HCPCS,Sigmoidoscopy w/ablate tumr,,Grouper Rate,1678.00
Blue Cross,PPO,G6023,CPT4/HCPCS,Sigmoidoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,PPO,G6024,CPT4/HCPCS,Lesion removal colonoscopy,,Grouper Rate,1678.00
Blue Cross,PPO,G6025,CPT4/HCPCS,Colonoscopy w/stent,,Grouper Rate,1678.00
Blue Cross,PPO,G6027,CPT4/HCPCS,Anoscopy hra w/spec collect,,Grouper Rate,1678.00
Blue Cross,PPO,G6028,CPT4/HCPCS,Anoscopy hra w/biopsy,,Grouper Rate,1678.00
Blue Cross,PPO,G8627,CPT4/HCPCS,Surg proc w/in 30 days,,Grouper Rate,5029.00
Blue Cross,PPO,G8628,CPT4/HCPCS,No surg proc w/in 30 days,,Grouper Rate,5783.00
Blue Cross,PPO,G8978,CPT4/HCPCS,Mobility current status,,Per Date of Service,193.00
Blue Cross,PPO,G8979,CPT4/HCPCS,Mobility goal status,,Per Date of Service,193.00
Blue Cross,PPO,G8980,CPT4/HCPCS,Mobility d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G8981,CPT4/HCPCS,Body pos current status,,Per Date of Service,193.00
Blue Cross,PPO,G8982,CPT4/HCPCS,Body pos goal status,,Per Date of Service,193.00
Blue Cross,PPO,G8983,CPT4/HCPCS,Body pos d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G8984,CPT4/HCPCS,Carry current status,,Per Date of Service,193.00
Blue Cross,PPO,G8985,CPT4/HCPCS,Carry goal status,,Per Date of Service,193.00
Blue Cross,PPO,G8986,CPT4/HCPCS,Carry d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G8987,CPT4/HCPCS,Self care current status,,Per Date of Service,193.00
Blue Cross,PPO,G8988,CPT4/HCPCS,Self care goal status,,Per Date of Service,193.00
Blue Cross,PPO,G8989,CPT4/HCPCS,Self care d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G8990,CPT4/HCPCS,Other pt/ot current status,,Per Date of Service,193.00
Blue Cross,PPO,G8991,CPT4/HCPCS,Other pt/ot goal status,,Per Date of Service,193.00
Blue Cross,PPO,G8992,CPT4/HCPCS,Other pt/ot d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G8993,CPT4/HCPCS,Sub pt/ot current status,,Per Date of Service,193.00
Blue Cross,PPO,G8994,CPT4/HCPCS,Sub pt/ot goal status,,Per Date of Service,193.00
Blue Cross,PPO,G8995,CPT4/HCPCS,Sub pt/ot d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G8996,CPT4/HCPCS,Swallow current status,,Per Date of Service,193.00
Blue Cross,PPO,G8997,CPT4/HCPCS,Swallow goal status,,Per Date of Service,193.00
Blue Cross,PPO,G8998,CPT4/HCPCS,Swallow d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G8999,CPT4/HCPCS,Motor speech current status,,Per Date of Service,193.00
Blue Cross,PPO,G9158,CPT4/HCPCS,Motor speech d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G9159,CPT4/HCPCS,Lang comp current status,,Per Date of Service,193.00
Blue Cross,PPO,G9160,CPT4/HCPCS,Lang comp goal status,,Per Date of Service,193.00
Blue Cross,PPO,G9161,CPT4/HCPCS,Lang comp d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G9162,CPT4/HCPCS,Lang express current status,,Per Date of Service,193.00
Blue Cross,PPO,G9163,CPT4/HCPCS,Lang express goal status,,Per Date of Service,193.00
Blue Cross,PPO,G9164,CPT4/HCPCS,Lang express d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G9165,CPT4/HCPCS,Atten current status,,Per Date of Service,193.00
Blue Cross,PPO,G9166,CPT4/HCPCS,Atten goal status,,Per Date of Service,193.00
Blue Cross,PPO,G9167,CPT4/HCPCS,Atten d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G9168,CPT4/HCPCS,Memory current status,,Per Date of Service,193.00
Blue Cross,PPO,G9169,CPT4/HCPCS,Memory goal status,,Per Date of Service,193.00
Blue Cross,PPO,G9170,CPT4/HCPCS,Memory d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G9171,CPT4/HCPCS,Voice current status,,Per Date of Service,193.00
Blue Cross,PPO,G9172,CPT4/HCPCS,Voice goal status,,Per Date of Service,193.00
Blue Cross,PPO,G9173,CPT4/HCPCS,Voice d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G9174,CPT4/HCPCS,Speech lang current status,,Per Date of Service,193.00
Blue Cross,PPO,G9175,CPT4/HCPCS,Speech lang goal status,,Per Date of Service,193.00
Blue Cross,PPO,G9176,CPT4/HCPCS,Speech lang d/c status,,Per Date of Service,193.00
Blue Cross,PPO,G9186,CPT4/HCPCS,Motor speech goal status,,Per Date of Service,193.00
Blue Cross,PPO,P9010,CPT4/HCPCS,Whole blood for transfusion,,Case Rate,3628.00
Blue Cross,PPO,P9022,CPT4/HCPCS,Washed red blood cells unit,,Case Rate,3628.00
Blue Cross,PPO,P9031,CPT4/HCPCS,Platelets leukocytes reduced,,Case Rate,3628.00
Blue Cross,PPO,P9033,CPT4/HCPCS,Platelets leukoreduced irrad,,Case Rate,3628.00
Blue Cross,PPO,P9039,CPT4/HCPCS,RBC deglycerolized,,Case Rate,3628.00
Blue Cross,PPO,P9054,CPT4/HCPCS,Blood, l/r, froz/degly/wash,,Case Rate,3628.00
Blue Cross,PPO,P9057,CPT4/HCPCS,RBC, frz/deg/wsh, l/r, irrad,,Case Rate,3628.00
Blue Cross,PPO,S2054,CPT4/HCPCS,Transplantation of multivisc,,Grouper Rate,6588.00
Blue Cross,PPO,S2083,CPT4/HCPCS,Adjustment gastric band,,Grouper Rate,1678.00
Blue Cross,PPO,S2115,CPT4/HCPCS,Periacetabular osteotomy,,Grouper Rate,5783.00
Blue Cross,PPO,S2118,CPT4/HCPCS,Total hip resurfacing,,Grouper Rate,5783.00
Blue Cross,PPO,S2152,CPT4/HCPCS,Solid organ transpl pkg,,Grouper Rate,6588.00
Blue Cross,PPO,S2350,CPT4/HCPCS,Diskectomy, anterior, with d,,Grouper Rate,5281.00
Blue Cross,PPO,S2351,CPT4/HCPCS,Diskectomy, anterior, with d,,Grouper Rate,1678.88
Blue Cross,PPO,S2400,CPT4/HCPCS,Fetal surg congen hernia,,Grouper Rate,8012.00
Blue Cross,PPO,S2401,CPT4/HCPCS,Fetal surg urin trac obstr,,Grouper Rate,8012.00
Blue Cross,PPO,S2402,CPT4/HCPCS,Fetal surg cong cyst malf,,Grouper Rate,8012.00
Blue Cross,PPO,S2403,CPT4/HCPCS,Fetal surg pulmon sequest,,Grouper Rate,8012.00
Blue Cross,PPO,S2404,CPT4/HCPCS,Fetal surg myelomeningo,,Grouper Rate,8012.00
Blue Cross,PPO,S2405,CPT4/HCPCS,Fetal surg sacrococ teratoma,,Grouper Rate,8012.00
Blue Cross,PPO,S2409,CPT4/HCPCS,Fetal surg noc,,Grouper Rate,8012.00
Blue Cross,PPO,,,Boarder Baby,,Per Case,1245.00
Blue Cross,PPO,,,NICU/Newborn - Level I,,Per Diem,3973.00
Blue Cross,PPO,,,NICU/Newborn - Level II,,Per Diem,7200.00
Blue Cross,PPO,,,NICU/Newborn - Level III,,Per Diem,7200.00
Blue Cross,PPO,,,NICU/Newborn - Level IV,,Per Diem,7200.00
Blue Shield,EPO,001U074,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U076,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U077,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U079,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U0J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U0J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U0J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U0J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U0K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U0K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U0K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U0K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,001U374,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U376,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U377,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U379,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U3J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U3J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U3J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U3J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U3K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U3K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U3K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,001U3K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0033T,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,Fee Schedule,3198.57
Blue Shield,EPO,005T0ZZ,ICD10-PCS,Destruction of Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005T3ZZ,ICD10-PCS,Destruction of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005T4ZZ,ICD10-PCS,Destruction of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005W0ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005W3ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005W4ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005X0ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005X3ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005X4ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005Y0ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005Y3ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,005Y4ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,Fee Schedule,3198.57
Blue Shield,EPO,008W0ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,008W3ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,008W4ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,008X0ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,008X3ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,008X4ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,008Y0ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,008Y3ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,008Y4ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009T00Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009T0ZX,ICD10-PCS,Drainage of Spinal Meninges, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,EPO,009T0ZZ,ICD10-PCS,DRAINAGE OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,009T30Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009T3ZX,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,009T3ZZ,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009T40Z,ICD10-PCS,Drain of Spinal Meninges with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009T4ZX,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,009T4ZZ,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009U00Z,ICD10-PCS,Drainage of Spinal Canal with Drainage Device, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009U0ZX,ICD10-PCS,Drainage of Spinal Canal, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,EPO,009U0ZZ,ICD10-PCS,DRAINAGE OF SPINAL CANAL OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,009W00Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009W0ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,EPO,009W0ZZ,ICD10-PCS,DRAINAGE OF CERVICAL SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,009W30Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009W3ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,009W3ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009W40Z,ICD10-PCS,Drain of Cerv Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009W4ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,009W4ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009X00Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009X0ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,EPO,009X0ZZ,ICD10-PCS,DRAINAGE OF THORACIC SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,009X30Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009X3ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,009X3ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009X40Z,ICD10-PCS,Drain of Thor Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009X4ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,009X4ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009Y00Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009Y0ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,EPO,009Y0ZZ,ICD10-PCS,DRAINAGE OF LUMBAR SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,009Y30Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009Y3ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,009Y3ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009Y40Z,ICD10-PCS,Drain of Lum Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,009Y4ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,009Y4ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00BT0ZX,ICD10-PCS,Excision of Spinal Meninges, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,EPO,00BT0ZZ,ICD10-PCS,EXCISION OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,00BT3ZX,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,00BT3ZZ,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00BT4ZX,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,00BT4ZZ,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00BW0ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,EPO,00BW0ZZ,ICD10-PCS,EXCISION OF CERVICAL SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,00BW3ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,00BW3ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00BW4ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,00BW4ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00BX0ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,EPO,00BX0ZZ,ICD10-PCS,EXCISION OF THORACIC SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,00BX3ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,00BX3ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00BX4ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,00BX4ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00BY0ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,EPO,00BY0ZZ,ICD10-PCS,EXCISION OF LUMBAR SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,00BY3ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,00BY3ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00BY4ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,EPO,00BY4ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00C30ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00C33ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00C34ZZ,ICD10-PCS,Extirpate of Matter from Cran Epidur Spc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00CT0ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00CT3ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00CT4ZZ,ICD10-PCS,Extirpate of Matter from Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00CW0ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00CW3ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00CW4ZZ,ICD10-PCS,Extirpate matter from Cerv Spinal Cord, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,00CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00CX4ZZ,ICD10-PCS,Extirpate matter from Thor Spinal Cord, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,00CY0ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00CY3ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00CY4ZZ,ICD10-PCS,Extirpate of Matter from Lum Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00DT0ZZ,ICD10-PCS,EXTRACTION OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,00DT3ZZ,ICD10-PCS,Extraction of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00DT4ZZ,ICD10-PCS,Extraction of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00FU0ZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,00FU3ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00FU4ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00FUXZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL EXTERNAL APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,00HU02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HU0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HU32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HU3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HU42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HU4MZ,ICD10-PCS,Insert of Neuro Lead into Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HV02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HV0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HV32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HV3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HV42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00HV4MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00JU0ZZ,ICD10-PCS,INSPECTION OF SPINAL CANAL OPEN,,Fee Schedule,8271.00
Blue Shield,EPO,00JU3ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00JU4ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00JV0ZZ,ICD10-PCS,INSPECTION OF SPINAL CORD OPEN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,00JV3ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00JV4ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NT0ZZ,ICD10-PCS,Release Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NT3ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NT4ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NW0ZZ,ICD10-PCS,Release Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NW3ZZ,ICD10-PCS,Release Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NW4ZZ,ICD10-PCS,Release Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NX0ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NX3ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NX4ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NY0ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NY3ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00NY4ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU00Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU02Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU03Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU30Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU32Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU33Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU40Z,ICD10-PCS,Removal of Drain Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU43Z,ICD10-PCS,Remove of Infusion Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PU4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV00Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV02Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV03Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV07Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV0KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV30Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV32Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV33Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV37Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV3KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV40Z,ICD10-PCS,Removal of Drain Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV43Z,ICD10-PCS,Removal of Infusion Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV47Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV4KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00PV4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QT0ZZ,ICD10-PCS,Repair Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QT3ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QT4ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QW0ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QW3ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QW4ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QX0ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QX3ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QX4ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QY0ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QY3ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00QY4ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00SW0ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00SW3ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00SW4ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00SX0ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00SX3ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00SX4ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00SY0ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00SY3ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00SY4ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00UT07Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00UT0JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00UT0KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00UT37Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00UT3JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00UT3KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00UT47Z,ICD10-PCS,Supplement Spinal Meninges w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,00UT4JZ,ICD10-PCS,Supplement Spinal Meninges w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,00UT4KZ,ICD10-PCS,Supplement Spinal Meninges w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,00WU00Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU03Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU30Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU33Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU40Z,ICD10-PCS,Revision of Drain Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WU4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV00Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV03Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV07Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV0KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV30Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV33Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV37Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV3KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV40Z,ICD10-PCS,Revision of Drain Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV47Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV4KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,00WV4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Fee Schedule,12850.71
Blue Shield,EPO,01510ZZ,ICD10-PCS,Destruction of Cervical Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,01514ZZ,ICD10-PCS,Destruction of Cervical Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,01580ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,01584ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,015B0ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,015B4ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,015R0ZZ,ICD10-PCS,DESTRUCTION OF SACRAL NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,015R4ZZ,ICD10-PCS,Destruction of Sacral Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0163T,CPT4/HCPCS,LUMB ARTIF DISKECTOMY ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,0164T,CPT4/HCPCS,REMOVE LUMB ARTIF DISC ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,0165T,CPT4/HCPCS,REVISE LUMB ARTIF DISC ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,01810ZZ,ICD10-PCS,DIVISION OF CERVICAL NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,01813ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,01814ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Fee Schedule,4891.93
Blue Shield,EPO,01880ZZ,ICD10-PCS,DIVISION OF THORACIC NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,01883ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,01884ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,018B0ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE OPEN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,018B3ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE PERCUTANEOUS APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,018B4ZZ,ICD10-PCS,Division of Lumbar Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,018R0ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE OPEN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,018R3ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE PERQ APPR,,Fee Schedule,8271.00
Blue Shield,EPO,018R4ZZ,ICD10-PCS,Division of Sacral Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0190T,CPT4/HCPCS,PLACE INTRAOC RADIATION SRC,,Fee Schedule,3198.57
Blue Shield,EPO,0191T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Fee Schedule,12850.71
Blue Shield,EPO,0200T,CPT4/HCPCS,PERQ SACRAL AUGMT UNILAT INJ,,Fee Schedule,3198.57
Blue Shield,EPO,0201T,CPT4/HCPCS,PERQ SACRAL AUGMT BILAT INJ,,Fee Schedule,3198.57
Blue Shield,EPO,0207T,CPT4/HCPCS,CLEAR EYELID GLAND W/HEAT,,Fee Schedule,987.79
Blue Shield,EPO,0210083,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0210088,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0210089,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021008C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021008F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021008W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0210093,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0210098,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0210099,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021009C,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021009F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021009W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02100A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02100AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100AW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02100J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02100JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100JW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02100K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02100KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02100KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100KW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02100ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0210483,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0210488,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0210489,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021048C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021048F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021048W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0210493,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0210498,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0210499,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021049C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021049F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021049W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104AW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104JW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104KW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02104Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02104Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02104Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02104ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02104ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0211083,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0211088,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0211089,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021108C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021108F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021108W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0211093,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0211098,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0211099,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021109C,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021109F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021109W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02110A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02110AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110AW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02110J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02110JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110JW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02110K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02110KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02110KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110KW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02110ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0211483,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0211488,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0211489,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021148C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021148F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021148W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0211493,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0211498,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0211499,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021149C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021149F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021149W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114AW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114JW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114KW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02114Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02114Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02114Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02114ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02114ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0212083,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0212088,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0212089,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021208C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021208F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021208W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0212093,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0212098,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0212099,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021209C,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021209F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021209W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02120A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02120AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120AW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02120J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02120JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120JW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02120K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02120KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02120KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120KW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02120ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0212483,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0212488,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0212489,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021248C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021248F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021248W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0212493,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0212498,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0212499,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021249C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021249F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021249W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124AW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124JW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124KW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02124Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02124Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02124Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02124ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02124ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0213083,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0213088,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0213089,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021308C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021308F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021308W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0213093,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0213098,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0213099,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021309C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021309F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021309W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02130KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02130ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0213483,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0213488,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0213489,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021348C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021348F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021348W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0213493,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0213498,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0213499,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021349C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021349F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021349W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02134Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02134Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02134Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02134ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02134ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,EPO,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,EPO,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,EPO,021608P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021608Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021608R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021609P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021609Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021609R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160AR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160JR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160KR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160ZQ,ICD10-PCS,Bypass Right Atrium to Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02160ZR,ICD10-PCS,Bypass Right Atrium to Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021648P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021648Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021648R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021649P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021649Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021649R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02164AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02164AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02164AR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02164JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02164JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02164JR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02164KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02164KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02164KR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02164Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02164ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02164ZQ,ICD10-PCS,Bypass Right Atrium to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02164ZR,ICD10-PCS,Bypass Right Atrium to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,EPO,021708P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021708Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021708R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021709P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021709Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021709R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170AR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170JR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170KR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170ZQ,ICD10-PCS,Bypass Left Atrium to Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02170ZR,ICD10-PCS,Bypass Left Atrium to Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021748P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021748Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021748R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021749P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021749Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021749R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02174AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02174AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02174AR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02174JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02174JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02174JR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02174KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02174KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02174KR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02174ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02174ZQ,ICD10-PCS,Bypass Left Atrium to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02174ZR,ICD10-PCS,Bypass Left Atrium to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,EPO,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,EPO,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,Fee Schedule,987.79
Blue Shield,EPO,021K08P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K08Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K08R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K09P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K09Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K09R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K0AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K0AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K0AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K0JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K0JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K0JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K0KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K0KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K0KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021K0Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K0Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K0ZC,ICD10-PCS,Bypass Right Ventricle to Thoracic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K0ZF,ICD10-PCS,Bypass Right Ventricle to Abdominal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K0ZP,ICD10-PCS,Bypass Right Ventricle to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K0ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K0ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K0ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K48P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K48Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K48R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K49P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K49Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K49R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K4AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K4AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K4AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K4JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K4JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K4JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K4KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K4KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K4KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021K4Z5,ICD10-PCS,Bypass Right Ventricle to Cor Circ, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K4Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K4Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K4ZC,ICD10-PCS,Bypass Right Ventricle to Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K4ZF,ICD10-PCS,Bypass Right Ventricle to Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K4ZP,ICD10-PCS,Bypass Right Ventricle to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K4ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K4ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021K4ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L08P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L08Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L08R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L09P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L09Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L09R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L0AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L0AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L0AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L0JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L0JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L0JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L0KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L0KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L0KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021L0Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L0Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L0ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L0ZF,ICD10-PCS,Bypass Left Ventricle to Abdominal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L0ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L0ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L0ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L0ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L48P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L48Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L48R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L49P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L49Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L49R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L4AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L4AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L4AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L4JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L4JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L4JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L4KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L4KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L4KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021L4Z5,ICD10-PCS,Bypass Left Ventricle to Cor Circ, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L4Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L4Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L4ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L4ZF,ICD10-PCS,Bypass Left Ventricle to Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L4ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L4ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L4ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021L4ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021V08P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V08Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V08R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V09P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V09Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V09R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V0AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V0AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V0AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V0JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V0JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V0JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V0KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V0KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V0KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021V0ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021V0ZQ,ICD10-PCS,Bypass Superior Vena Cava to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021V0ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021V48P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V48Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V48R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V49P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V49Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V49R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V4AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V4AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V4AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V4JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V4JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V4JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V4KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V4KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V4KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021V4ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021V4ZQ,ICD10-PCS,BYPASS SUPERIOR VENA CAVA TO RT PULM ART PC ENDO,,Fee Schedule,8271.00
Blue Shield,EPO,021V4ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021W08B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W08D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W08P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W08Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W08R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W09B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W09D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W09P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W09Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W09R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021W0ZB,ICD10-PCS,Bypass Thoracic Aorta, Descending to Subclav, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021W0ZD,ICD10-PCS,Bypass Thoracic Aorta, Descending to Carotid, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021W0ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021W0ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021W0ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021W48B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W48D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W48P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W48Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W48R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W49B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W49D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W49P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W49Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W49R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021W4ZB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021W4ZD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021W4ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021W4ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021W4ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021X08B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X08D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X08P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X08Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X08R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X09B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X09D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X09P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X09Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X09R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,021X0ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021X0ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021X0ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021X0ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021X0ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021X48B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X48D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X48P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X48Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X48R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X49B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X49D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X49P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X49Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X49R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,021X4ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021X4ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021X4ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021X4ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,021X4ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,Fee Schedule,987.79
Blue Shield,EPO,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Fee Schedule,987.79
Blue Shield,EPO,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Fee Schedule,987.79
Blue Shield,EPO,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,EPO,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,EPO,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Fee Schedule,9548.66
Blue Shield,EPO,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,Fee Schedule,9548.66
Blue Shield,EPO,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Fee Schedule,9548.66
Blue Shield,EPO,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Fee Schedule,9548.66
Blue Shield,EPO,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,Fee Schedule,9548.66
Blue Shield,EPO,0249T,CPT4/HCPCS,LIGATION HEMORRHOID W/US,,Fee Schedule,4280.44
Blue Shield,EPO,024F07J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024F08J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024F0JJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024F0KJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024G072,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024G082,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024G0J2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024G0K2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024J072,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024J082,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024J0J2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,024J0K2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,02540ZZ,ICD10-PCS,Destruction of Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02543ZZ,ICD10-PCS,Destruction of Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02544ZZ,ICD10-PCS,Destruction of Coronary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0254T,CPT4/HCPCS,EVASC RPR ILIAC ART BIFUR,,Fee Schedule,3198.57
Blue Shield,EPO,02550ZZ,ICD10-PCS,Destruction of Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02553ZZ,ICD10-PCS,Destruction of Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02560ZZ,ICD10-PCS,Destruction of Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02563ZZ,ICD10-PCS,Destruction of Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02570ZZ,ICD10-PCS,Destruction of Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02573ZZ,ICD10-PCS,Destruction of Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02580ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02583ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02590ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02593ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025D0ZZ,ICD10-PCS,Destruction of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025D3ZZ,ICD10-PCS,Destruction of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025D4ZZ,ICD10-PCS,Destruction of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025F0ZZ,ICD10-PCS,Destruction of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025F3ZZ,ICD10-PCS,Destruction of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025G0ZZ,ICD10-PCS,Destruction of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025G3ZZ,ICD10-PCS,Destruction of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025H0ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025H3ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025J0ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025J3ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025K0ZZ,ICD10-PCS,Destruction of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025K3ZZ,ICD10-PCS,Destruction of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025L0ZZ,ICD10-PCS,Destruction of Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025L3ZZ,ICD10-PCS,Destruction of Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025M0ZZ,ICD10-PCS,Destruction of Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025M3ZZ,ICD10-PCS,Destruction of Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025P0ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025P3ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025P4ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025Q0ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025Q3ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025Q4ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025R0ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025R3ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025R4ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025S0ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025S3ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025S4ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025T0ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025T3ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025T4ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025V0ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025V3ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025V4ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025W0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025W3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025W4ZZ,ICD10-PCS,Destruction of Thor Aorta Desc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025X0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025X3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,025X4ZZ,ICD10-PCS,Destruction of Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,Fee Schedule,7902.34
Blue Shield,EPO,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,Fee Schedule,6049.05
Blue Shield,EPO,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,Fee Schedule,6049.05
Blue Shield,EPO,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,Fee Schedule,9304.07
Blue Shield,EPO,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,Fee Schedule,9304.07
Blue Shield,EPO,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,Fee Schedule,4891.93
Blue Shield,EPO,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,Fee Schedule,9304.07
Blue Shield,EPO,0270046,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027004Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270056,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027005Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270066,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027006Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270076,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027007Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02700D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02700DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02700E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02700EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02700F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02700FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02700G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02700GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02700T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02700TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02700Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02700ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270346,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027034Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270356,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027035Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270366,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027036Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270376,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027037Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02703D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02703DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02703E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02703EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02703F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02703FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02703G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02703GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02703T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02703TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02703Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02703ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270446,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027044Z,ICD10-PCS,Dilate of 1 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270456,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027045Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270466,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027046Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270476,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027047Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02704D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02704DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02704E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02704EZ,ICD10-PCS,Dilate of 1 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02704F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02704FZ,ICD10-PCS,Dilate of 1 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02704G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02704GZ,ICD10-PCS,Dilate of 1 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02704T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02704TZ,ICD10-PCS,Dilate 1 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02704Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02704ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,Fee Schedule,9304.07
Blue Shield,EPO,0271046,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027104Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271056,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027105Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271066,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027106Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271076,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027107Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02710D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02710DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02710E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02710EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02710F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02710FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02710G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02710GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02710T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02710TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02710Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02710ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271346,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027134Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271356,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027135Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271366,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027136Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271376,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027137Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02713D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02713DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02713E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02713EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02713F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02713FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02713G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02713GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02713T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02713TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02713Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02713ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271446,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027144Z,ICD10-PCS,Dilate of 2 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271456,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027145Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271466,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027146Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271476,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027147Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02714D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02714DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02714E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02714EZ,ICD10-PCS,Dilate of 2 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02714F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02714FZ,ICD10-PCS,Dilate of 2 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02714G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02714GZ,ICD10-PCS,Dilate of 2 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02714T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02714TZ,ICD10-PCS,Dilate 2 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02714Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02714ZZ,ICD10-PCS,Dilation of 2 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,Fee Schedule,9304.07
Blue Shield,EPO,0272046,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027204Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272056,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027205Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272066,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027206Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272076,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027207Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02720D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02720DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02720E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02720EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02720F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02720FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02720G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02720GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02720T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02720TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02720Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02720ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272346,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027234Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272356,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027235Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272366,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027236Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272376,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027237Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02723D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02723DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02723E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02723EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02723F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02723FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02723G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02723GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02723T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02723TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02723Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02723ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272446,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027244Z,ICD10-PCS,Dilate of 3 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272456,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027245Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272466,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027246Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272476,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027247Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02724D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02724DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02724E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02724EZ,ICD10-PCS,Dilate of 3 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02724F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02724FZ,ICD10-PCS,Dilate of 3 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02724G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02724GZ,ICD10-PCS,Dilate of 3 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02724T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02724TZ,ICD10-PCS,Dilate 3 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02724Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02724ZZ,ICD10-PCS,Dilation of 3 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0272T,CPT4/HCPCS,INTERROGATE CRTD SNS DEV,,Fee Schedule,987.79
Blue Shield,EPO,0273046,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027304Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273056,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027305Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273066,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027306Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273076,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027307Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02730D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02730DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02730E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02730EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02730F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02730FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02730G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02730GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02730T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02730TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02730Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02730ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273346,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027334Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273356,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027335Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273366,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027336Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273376,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027337Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02733D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02733DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02733E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02733EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02733F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02733FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02733G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02733GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02733T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02733TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02733Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02733ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273446,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027344Z,ICD10-PCS,Dilate 4+ Cor Art w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0273456,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027345Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273466,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027346Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273476,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027347Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02734D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02734DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02734E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02734EZ,ICD10-PCS,Dilate of 4+ Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02734F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02734FZ,ICD10-PCS,Dilate of 4+ Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02734G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02734GZ,ICD10-PCS,Dilate 4+ Cor Art w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02734T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02734TZ,ICD10-PCS,Dilate 4+ Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02734Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02734ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0273T,CPT4/HCPCS,INTERROGATE CRTD SNS W/PGRMG,,Fee Schedule,987.79
Blue Shield,EPO,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,Fee Schedule,9548.66
Blue Shield,EPO,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,Fee Schedule,9548.66
Blue Shield,EPO,0278T,CPT4/HCPCS,TEMPR,,Fee Schedule,987.79
Blue Shield,EPO,027F04Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027F0DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027F0ZZ,ICD10-PCS,Dilation of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027F34Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027F3DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027F3ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027F44Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027F4DZ,ICD10-PCS,Dilate of Aortic Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027F4ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027G04Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027G0DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027G0ZZ,ICD10-PCS,Dilation of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027G34Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027G3DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027G3ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027G44Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027G4DZ,ICD10-PCS,Dilate of Mitral Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027G4ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027H04Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027H0DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027H0ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027H34Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027H3DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027H3ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027H44Z,ICD10-PCS,Dilate Pulm Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027H4DZ,ICD10-PCS,Dilation of Pulm Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027H4ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027J04Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027J0DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027J0ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027J34Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027J3DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027J3ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027J44Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027J4DZ,ICD10-PCS,Dilate Tricusp Valve w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027J4ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027K04Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027K0DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027K0ZZ,ICD10-PCS,Dilation of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027K34Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027K3DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027K3ZZ,ICD10-PCS,Dilation of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027K44Z,ICD10-PCS,Dilate R Ventricle w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027K4DZ,ICD10-PCS,Dilate of R Ventricle with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027K4ZZ,ICD10-PCS,Dilation of Right Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027R04T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,EPO,027R0DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027R0ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027R34T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,027R3DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027R3ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,027R44T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027R4DT,ICD10-PCS,Dilate Ductus Arterio w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,027R4ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02890ZZ,ICD10-PCS,Division of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02893ZZ,ICD10-PCS,Division of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02894ZZ,ICD10-PCS,Division of Chordae Tendineae, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,028D0ZZ,ICD10-PCS,Division of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,028D3ZZ,ICD10-PCS,Division of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,028D4ZZ,ICD10-PCS,Division of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0295T,CPT4/HCPCS,EXT ECG COMPLETE,,Fee Schedule,987.79
Blue Shield,EPO,0296T,CPT4/HCPCS,EXT ECG RECORDING,,Fee Schedule,987.79
Blue Shield,EPO,0297T,CPT4/HCPCS,EXT ECG SCAN W/REPORT,,Fee Schedule,987.79
Blue Shield,EPO,0298T,CPT4/HCPCS,EXT ECG REVIEW AND INTERP,,Fee Schedule,987.79
Blue Shield,EPO,02B40ZZ,ICD10-PCS,Excision of Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B43ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B44ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B50ZZ,ICD10-PCS,Excision of Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B53ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B54ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B60ZZ,ICD10-PCS,Excision of Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B63ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B64ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B70ZZ,ICD10-PCS,Excision of Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B73ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B74ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B80ZZ,ICD10-PCS,Excision of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B83ZZ,ICD10-PCS,Excision of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B90ZZ,ICD10-PCS,Excision of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02B93ZZ,ICD10-PCS,Excision of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BD0ZZ,ICD10-PCS,Excision of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BD3ZZ,ICD10-PCS,Excision of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BD4ZZ,ICD10-PCS,Excision of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BF0ZZ,ICD10-PCS,Excision of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BF3ZZ,ICD10-PCS,Excision of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BG0ZZ,ICD10-PCS,Excision of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BG3ZZ,ICD10-PCS,Excision of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BH0ZZ,ICD10-PCS,Excision of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BH3ZZ,ICD10-PCS,Excision of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BJ0ZZ,ICD10-PCS,Excision of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BJ3ZZ,ICD10-PCS,Excision of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BK0ZZ,ICD10-PCS,Excision of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BK3ZZ,ICD10-PCS,Excision of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BK4ZZ,ICD10-PCS,Excision of Right Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BL0ZZ,ICD10-PCS,Excision of Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BL3ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BL4ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BM0ZZ,ICD10-PCS,Excision of Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BM3ZZ,ICD10-PCS,Excision of Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BP0ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BP3ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BP4ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BQ0ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BQ3ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BQ4ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BR0ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BR3ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BR4ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BS0ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BS3ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BS4ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BT0ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BT3ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BT4ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BV0ZZ,ICD10-PCS,Excision of Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BV3ZZ,ICD10-PCS,Excision of Superior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BV4ZZ,ICD10-PCS,Excision of Superior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BW0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BW3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BW4ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BX0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BX3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02BX4ZZ,ICD10-PCS,Excision of Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C00Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C00ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C03Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C03ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C04Z6,ICD10-PCS,Extirpate matter from 1 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02C04ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C10Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C10ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C13Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C13ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C14Z6,ICD10-PCS,Extirpate matter from 2 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02C14ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C20Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C20ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C23Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C23ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C24Z6,ICD10-PCS,Extirpate matter from 3 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02C24ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C30Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C30ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C33Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C33ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C34Z6,ICD10-PCS,Extirpate matter from 4+ Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02C34ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C40ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C43ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02C44ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02CD0ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02CD3ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02CD4ZZ,ICD10-PCS,Extirpate matter from Papillary Muscle, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02CW0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02CW3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02CW4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Desc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02CX4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02FN0ZZ,ICD10-PCS,Fragmentation in Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02FN3ZZ,ICD10-PCS,Fragmentation in Pericardium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02FN4ZZ,ICD10-PCS,Fragmentation in Pericardium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H402Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H403Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H40DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H40KZ,ICD10-PCS,Insertion of Defibrillator Lead into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H40NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H432Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H433Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H43DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H43NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H442Z,ICD10-PCS,Insertion of Monitor Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H443Z,ICD10-PCS,Insertion of Infusion Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H44DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H44KZ,ICD10-PCS,Insertion of Defib Lead into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H44NZ,ICD10-PCS,Insert of Intracard Pacer into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H60KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H63KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H64KZ,ICD10-PCS,Insertion of Defib Lead into R Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H70KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H73KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02H74KZ,ICD10-PCS,Insertion of Defib Lead into L Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HA0RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HA3RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HA4RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HK0KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HK3KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HK4KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HL0KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HL3DZ,ICD10-PCS,Insertion of Intralum Dev into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HL3KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HL3NZ,ICD10-PCS,Insertion of Intracard Pacer into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HL4KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HN0KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HN3KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HN4KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HP0DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HP3DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HP4DZ,ICD10-PCS,Insert of Intralum Dev into Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HQ0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HQ3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HQ4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HR0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HR3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HR4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HS02Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HS0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HS32Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HS3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HS42Z,ICD10-PCS,Insert of Monitor Dev into R Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HS4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HT02Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HT0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HT32Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HT3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HT42Z,ICD10-PCS,Insert of Monitor Dev into L Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HT4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HW02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HW0DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HW32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HW3DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HW42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Desc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02HW4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Desc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02HX02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HX0DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HX32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HX3DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02HX42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Asc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02HX4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Asc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02K80ZZ,ICD10-PCS,Map Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02K83ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02K84ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02LH0CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02LH0DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02LH0ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02LH3CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02LH3DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02LH3ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02LH4CZ,ICD10-PCS,Occlusion Pulm Valve w Extralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02LH4DZ,ICD10-PCS,Occlusion Pulm Valve w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02LH4ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02N40ZZ,ICD10-PCS,Release Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02N43ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02N44ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02N80ZZ,ICD10-PCS,Release Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02N83ZZ,ICD10-PCS,Release Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02N84ZZ,ICD10-PCS,Release Conduction Mechanism, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02N90ZZ,ICD10-PCS,Release Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02N93ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02N94ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02ND0ZZ,ICD10-PCS,Release Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02ND3ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02ND4ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02NF0ZZ,ICD10-PCS,Release Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02NG0ZZ,ICD10-PCS,Release Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02NH0ZZ,ICD10-PCS,Release Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02NJ0ZZ,ICD10-PCS,Release Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02NK0ZZ,ICD10-PCS,Release Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02NK3ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02NK4ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02NL0ZZ,ICD10-PCS,Release Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02NL3ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02NL4ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY02Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY03Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY07Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY08Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY0CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY0DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY0JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY0KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY32Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY33Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY37Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY38Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY3CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY3DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY3JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY3KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY42Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY43Z,ICD10-PCS,Remove of Infusion Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY47Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY48Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY4CZ,ICD10-PCS,Remove of Extralum Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY4DZ,ICD10-PCS,Remove of Intralum Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY4JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02PY4KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q00ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q03ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q04ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q10ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q13ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q14ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q20ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q23ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q24ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q30ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q33ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q34ZZ,ICD10-PCS,Repair 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q40ZZ,ICD10-PCS,Repair Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q43ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q44ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q50ZZ,ICD10-PCS,Repair Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q53ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q54ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q60ZZ,ICD10-PCS,Repair Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q63ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q64ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q70ZZ,ICD10-PCS,Repair Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q73ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q74ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q80ZZ,ICD10-PCS,Repair Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q83ZZ,ICD10-PCS,Repair Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q84ZZ,ICD10-PCS,Repair Conduction Mechanism, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q90ZZ,ICD10-PCS,Repair Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q93ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02Q94ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QA0ZZ,ICD10-PCS,Repair Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QA3ZZ,ICD10-PCS,Repair Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QA4ZZ,ICD10-PCS,Repair Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QB0ZZ,ICD10-PCS,Repair Right Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QB3ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QB4ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QC0ZZ,ICD10-PCS,Repair Left Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QC3ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QC4ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QD0ZZ,ICD10-PCS,Repair Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QD3ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QD4ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QF0ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QF0ZZ,ICD10-PCS,Repair Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QF3ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QF3ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QF4ZJ,ICD10-PCS,Repair Aort Valve created from Trunc Vlv, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QF4ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QG0ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QG0ZZ,ICD10-PCS,Repair Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QG3ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QG3ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QG4ZE,ICD10-PCS,Repair Mitral Valve fr L AV Vlv, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02QG4ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QH0ZZ,ICD10-PCS,Repair Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QH3ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QH4ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QJ0ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QJ0ZZ,ICD10-PCS,Repair Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QJ3ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QJ3ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QJ4ZG,ICD10-PCS,Repair Tricusp Valve fr R AV Vlv, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02QJ4ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QK0ZZ,ICD10-PCS,Repair Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QK3ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QK4ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QL0ZZ,ICD10-PCS,Repair Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QL3ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QL4ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QM0ZZ,ICD10-PCS,Repair Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QM3ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QM4ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QN0ZZ,ICD10-PCS,Repair Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QN3ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02QN4ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R507Z,ICD10-PCS,Replacement of Atrial Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R508Z,ICD10-PCS,Replacement of Atrial Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R50JZ,ICD10-PCS,Replacement of Atrial Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R50KZ,ICD10-PCS,Replacement of Atrial Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R547Z,ICD10-PCS,Replace of Atrial Sept with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R548Z,ICD10-PCS,Replace of Atrial Sept with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R54JZ,ICD10-PCS,Replace of Atrial Sept with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R54KZ,ICD10-PCS,Replace of Atrial Sept with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R607Z,ICD10-PCS,Replacement of Right Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R608Z,ICD10-PCS,Replacement of Right Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R60JZ,ICD10-PCS,Replacement of Right Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R60KZ,ICD10-PCS,Replacement of Right Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R647Z,ICD10-PCS,Replacement of R Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R648Z,ICD10-PCS,Replacement of R Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R64JZ,ICD10-PCS,Replacement of R Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R64KZ,ICD10-PCS,Replacement of R Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R707Z,ICD10-PCS,Replacement of Left Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R708Z,ICD10-PCS,Replacement of Left Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R70JZ,ICD10-PCS,Replacement of Left Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R70KZ,ICD10-PCS,Replacement of Left Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R747Z,ICD10-PCS,Replacement of L Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R748Z,ICD10-PCS,Replacement of L Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R74JZ,ICD10-PCS,Replacement of L Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R74KZ,ICD10-PCS,Replacement of L Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R907Z,ICD10-PCS,Replace of Chordae Tendineae with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R908Z,ICD10-PCS,Replace of Chordae Tendineae with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R90JZ,ICD10-PCS,Replace of Chordae Tendineae with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R90KZ,ICD10-PCS,Replace of Chordae Tendineae with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02R947Z,ICD10-PCS,Replace Chordae Tendineae w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02R948Z,ICD10-PCS,Replace Chordae Tendineae w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02R94JZ,ICD10-PCS,Replace Chordae Tendineae w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02R94KZ,ICD10-PCS,Replace Chordae Tendineae w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RD07Z,ICD10-PCS,Replace of Papillary Muscle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RD08Z,ICD10-PCS,Replace of Papillary Muscle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RD0JZ,ICD10-PCS,Replace of Papillary Muscle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RD0KZ,ICD10-PCS,Replace of Papillary Muscle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RD47Z,ICD10-PCS,Replace Papillary Muscle w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RD48Z,ICD10-PCS,Replace Papillary Muscle w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RD4JZ,ICD10-PCS,Replace Papillary Muscle w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RD4KZ,ICD10-PCS,Replace Papillary Muscle w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RF07Z,ICD10-PCS,Replacement of Aortic Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RF08Z,ICD10-PCS,Replacement of Aortic Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RF0JZ,ICD10-PCS,Replacement of Aortic Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RF0KZ,ICD10-PCS,Replacement of Aortic Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RF47Z,ICD10-PCS,Replace of Aortic Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RF48Z,ICD10-PCS,Replace of Aortic Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RF4JZ,ICD10-PCS,Replace of Aortic Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RF4KZ,ICD10-PCS,Replace of Aortic Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG07Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG08Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG0JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG0KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG37Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG38Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG3JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG3KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG47Z,ICD10-PCS,Replace of Mitral Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG48Z,ICD10-PCS,Replace of Mitral Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG4JZ,ICD10-PCS,Replace of Mitral Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RG4KZ,ICD10-PCS,Replace of Mitral Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RH07Z,ICD10-PCS,Replacement of Pulmonary Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RH08Z,ICD10-PCS,Replacement of Pulm Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RH0JZ,ICD10-PCS,Replacement of Pulmonary Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RH0KZ,ICD10-PCS,Replacement of Pulm Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RH47Z,ICD10-PCS,Replacement of Pulm Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RH48Z,ICD10-PCS,Replace of Pulm Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RH4JZ,ICD10-PCS,Replacement of Pulm Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RH4KZ,ICD10-PCS,Replace of Pulm Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RJ07Z,ICD10-PCS,Replacement of Tricuspid Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RJ08Z,ICD10-PCS,Replacement of Tricusp Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RJ0JZ,ICD10-PCS,Replacement of Tricuspid Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RJ0KZ,ICD10-PCS,Replacement of Tricusp Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RJ47Z,ICD10-PCS,Replace of Tricusp Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RJ48Z,ICD10-PCS,Replace of Tricusp Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RJ4JZ,ICD10-PCS,Replace of Tricusp Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RJ4KZ,ICD10-PCS,Replace of Tricusp Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RK07Z,ICD10-PCS,Replacement of Right Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RK08Z,ICD10-PCS,Replacement of R Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RK0JZ,ICD10-PCS,Replacement of Right Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RK0KZ,ICD10-PCS,Replacement of R Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RK47Z,ICD10-PCS,Replace of R Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RK48Z,ICD10-PCS,Replace of R Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RK4JZ,ICD10-PCS,Replace of R Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RK4KZ,ICD10-PCS,Replace of R Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RL07Z,ICD10-PCS,Replacement of Left Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RL08Z,ICD10-PCS,Replacement of Left Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RL0JZ,ICD10-PCS,Replacement of Left Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RL0KZ,ICD10-PCS,Replacement of Left Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RL47Z,ICD10-PCS,Replace of L Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RL48Z,ICD10-PCS,Replace of L Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RL4JZ,ICD10-PCS,Replace of L Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RL4KZ,ICD10-PCS,Replace of L Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RM07Z,ICD10-PCS,Replace of Ventricular Sept with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RM08Z,ICD10-PCS,Replace of Ventricular Sept with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RM0JZ,ICD10-PCS,Replace of Ventricular Sept with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RM0KZ,ICD10-PCS,Replace of Ventricular Sept with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RM47Z,ICD10-PCS,Replace Ventricular Sept w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RM48Z,ICD10-PCS,Replace Ventricular Sept w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RM4KZ,ICD10-PCS,Replace Ventricular Sept w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RN07Z,ICD10-PCS,Replacement of Pericardium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RN08Z,ICD10-PCS,Replacement of Pericardium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RN0JZ,ICD10-PCS,Replacement of Pericardium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RN0KZ,ICD10-PCS,Replacement of Pericardium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RN47Z,ICD10-PCS,Replace of Pericardium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RN48Z,ICD10-PCS,Replace of Pericardium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RN4JZ,ICD10-PCS,Replace of Pericardium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RN4KZ,ICD10-PCS,Replace of Pericardium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RP07Z,ICD10-PCS,Replacement of Pulmonary Trunk with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RP08Z,ICD10-PCS,Replacement of Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RP0JZ,ICD10-PCS,Replacement of Pulmonary Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RP0KZ,ICD10-PCS,Replacement of Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RP47Z,ICD10-PCS,Replacement of Pulm Trunk with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RP48Z,ICD10-PCS,Replace of Pulm Trunk with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RP4JZ,ICD10-PCS,Replacement of Pulm Trunk with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RP4KZ,ICD10-PCS,Replace of Pulm Trunk with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RQ07Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RQ08Z,ICD10-PCS,Replacement of R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RQ0JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RQ0KZ,ICD10-PCS,Replacement of R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RQ47Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RQ48Z,ICD10-PCS,Replace of R Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RQ4JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RQ4KZ,ICD10-PCS,Replace of R Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RR07Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RR08Z,ICD10-PCS,Replacement of L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RR0JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RR0KZ,ICD10-PCS,Replacement of L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RR47Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RR48Z,ICD10-PCS,Replace of L Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RR4JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RR4KZ,ICD10-PCS,Replace of L Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RS07Z,ICD10-PCS,Replacement of R Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RS08Z,ICD10-PCS,Replacement of R Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RS0JZ,ICD10-PCS,Replacement of R Pulm Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RS0KZ,ICD10-PCS,Replacement of R Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RS47Z,ICD10-PCS,Replace of R Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RS48Z,ICD10-PCS,Replace of R Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RS4JZ,ICD10-PCS,Replace of R Pulm Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RS4KZ,ICD10-PCS,Replace of R Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RT07Z,ICD10-PCS,Replacement of L Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RT08Z,ICD10-PCS,Replacement of L Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RT0JZ,ICD10-PCS,Replacement of L Pulm Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RT0KZ,ICD10-PCS,Replacement of L Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RT47Z,ICD10-PCS,Replace of L Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RT48Z,ICD10-PCS,Replace of L Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RT4JZ,ICD10-PCS,Replace of L Pulm Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RT4KZ,ICD10-PCS,Replace of L Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RV07Z,ICD10-PCS,Replacement of Sup Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RV08Z,ICD10-PCS,Replacement of Sup Vena Cava with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RV0JZ,ICD10-PCS,Replacement of Sup Vena Cava with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RV0KZ,ICD10-PCS,Replacement of Sup Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RV47Z,ICD10-PCS,Replace of Sup Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RV48Z,ICD10-PCS,Replace of Sup Vena Cava with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RV4JZ,ICD10-PCS,Replace of Sup Vena Cava with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RV4KZ,ICD10-PCS,Replace of Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RW07Z,ICD10-PCS,Replacement of Thor Aorta Desc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RW08Z,ICD10-PCS,Replace of Thor Aorta Desc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RW0JZ,ICD10-PCS,Replacement of Thor Aorta Desc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RW0KZ,ICD10-PCS,Replace of Thor Aorta Desc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RW47Z,ICD10-PCS,Replace Thor Aorta Desc w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RW48Z,ICD10-PCS,Replace Thor Aorta Desc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RW4JZ,ICD10-PCS,Replace Thor Aorta Desc w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RW4KZ,ICD10-PCS,Replace Thor Aorta Desc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RX07Z,ICD10-PCS,Replacement of Thor Aorta Asc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RX08Z,ICD10-PCS,Replacement of Thor Aorta Asc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RX0JZ,ICD10-PCS,Replacement of Thor Aorta Asc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RX0KZ,ICD10-PCS,Replacement of Thor Aorta Asc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RX47Z,ICD10-PCS,Replace of Thor Aorta Asc with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RX48Z,ICD10-PCS,Replace Thor Aorta Asc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02RX4JZ,ICD10-PCS,Replace of Thor Aorta Asc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02RX4KZ,ICD10-PCS,Replace Thor Aorta Asc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02S00ZZ,ICD10-PCS,Reposition Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02S10ZZ,ICD10-PCS,Reposition Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02SP0ZZ,ICD10-PCS,Reposition Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02SQ0ZZ,ICD10-PCS,Reposition Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02SR0ZZ,ICD10-PCS,Reposition Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02SS0ZZ,ICD10-PCS,Reposition Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02ST0ZZ,ICD10-PCS,Reposition Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02SV0ZZ,ICD10-PCS,Reposition Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02SW0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02SX0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02T80ZZ,ICD10-PCS,Resection of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02T83ZZ,ICD10-PCS,Resection of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02T90ZZ,ICD10-PCS,Resection of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02T93ZZ,ICD10-PCS,Resection of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02T94ZZ,ICD10-PCS,Resection of Chordae Tendineae, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02TD0ZZ,ICD10-PCS,Resection of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02TD3ZZ,ICD10-PCS,Resection of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02TD4ZZ,ICD10-PCS,Resection of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U507Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U508Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U50JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U50KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U537Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U538Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U53JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U53KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U547Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U548Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U54JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U54KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U607Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U608Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U60JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U60KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U637Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U638Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U63JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U63KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U647Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U648Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U64JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U64KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U707Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U708Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U70JZ,ICD10-PCS,Supplement Left Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U70KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U737Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U738Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U73KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U747Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U748Z,ICD10-PCS,Supplement Left Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U74KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U907Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U908Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U90JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U90KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U937Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U938Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U93JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U93KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02U947Z,ICD10-PCS,Supplement Chordae Tendineae w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02U948Z,ICD10-PCS,Supplement Chordae Tendineae w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02U94JZ,ICD10-PCS,Supplement Chordae Tendineae w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02U94KZ,ICD10-PCS,Supplement Chordae Tendineae w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UA07Z,ICD10-PCS,Supplement Heart with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA08Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA0JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA0KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA37Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA38Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA3JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA3KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA47Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA48Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA4JZ,ICD10-PCS,Supplement Heart with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UA4KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UD07Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UD08Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UD0JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UD0KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UD37Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UD38Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UD3JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UD3KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UD47Z,ICD10-PCS,Supplement Papillary Muscle w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UD48Z,ICD10-PCS,Supplement Papillary Muscle w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UD4JZ,ICD10-PCS,Supplement Papillary Muscle w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UD4KZ,ICD10-PCS,Supplement Papillary Muscle w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UF07J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UF07Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF08J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UF08Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF0JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UF0JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF0KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UF0KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF37J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UF37Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF38J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UF38Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF3JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UF3JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF3KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UF3KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF47J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UF47Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF48J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UF48Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF4JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UF4JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UF4KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UF4KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG07E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UG07Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG08E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UG08Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG0JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UG0JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG0KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UG0KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG37E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UG37Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG38E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UG38Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG3JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UG3JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG3KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UG3KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG47E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UG47Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG48E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UG48Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG4JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UG4JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UG4KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UG4KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH07Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH08Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH0JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH0KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH37Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH38Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH3JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH3KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH47Z,ICD10-PCS,Supplement Pulm Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH48Z,ICD10-PCS,Supplement Pulm Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH4JZ,ICD10-PCS,Supplement Pulm Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UH4KZ,ICD10-PCS,Supplement Pulm Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ07G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ07Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ08G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ08Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ0JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ0JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ0KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ0KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ37G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ37Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ38G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ38Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ3JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ3JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ3KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ3KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ47G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ47Z,ICD10-PCS,Supplement Tricusp Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ48G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ48Z,ICD10-PCS,Supplement Tricusp Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ4JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ4JZ,ICD10-PCS,Supplement Tricusp Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ4KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UJ4KZ,ICD10-PCS,Supplement Tricusp Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK07Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK08Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK0JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK0KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK37Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK38Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK3JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK3KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK47Z,ICD10-PCS,Supplement R Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK48Z,ICD10-PCS,Supplement R Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK4JZ,ICD10-PCS,Supplement R Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UK4KZ,ICD10-PCS,Supplement R Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL07Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL08Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL0JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL0KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL37Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL38Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL3JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL3KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL47Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL48Z,ICD10-PCS,Supplement L Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL4JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UL4KZ,ICD10-PCS,Supplement L Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UM07Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UM08Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UM0JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UM0KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UM37Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UM38Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UM3JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UM3KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UM47Z,ICD10-PCS,Supplement Ventricular Sept w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UM48Z,ICD10-PCS,Supplement Ventricular Sept w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UM4JZ,ICD10-PCS,Supplement Ventricular Sept w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UM4KZ,ICD10-PCS,Supplement Ventricular Sept w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UN07Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN08Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN0JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN0KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN37Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN38Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN3JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN3KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN47Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN48Z,ICD10-PCS,Supplement Pericardium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN4JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UN4KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UP07Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UP08Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UP0KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UP37Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UP38Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UP3KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UP47Z,ICD10-PCS,Supplement Pulm Trunk with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UP48Z,ICD10-PCS,Supplement Pulm Trunk with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UP4KZ,ICD10-PCS,Supplement Pulm Trunk with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UQ07Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UQ08Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UQ0KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UQ37Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UQ38Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UQ3KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UQ47Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UQ48Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UQ4KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UR07Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UR08Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UR0KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UR37Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UR38Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UR3KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UR47Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UR48Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UR4KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02US07Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02US08Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02US0KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02US37Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02US38Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02US3KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02US47Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02US48Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02US4KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UT07Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UT08Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UT0KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UT37Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UT38Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UT3KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UT47Z,ICD10-PCS,Supplement L Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UT48Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UT4KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UV07Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UV08Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UV0KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UV37Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UV38Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UV3KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UV47Z,ICD10-PCS,Supplement Sup Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UV48Z,ICD10-PCS,Supplement Sup Vena Cava with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UV4KZ,ICD10-PCS,Supplement Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UW07Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UW08Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UW0KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UW37Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UW38Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UW3JZ,ICD10-PCS,Supplement Thor Aorta Desc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UW3KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UW47Z,ICD10-PCS,Supplement Thor Aorta Desc w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UW48Z,ICD10-PCS,Supplement Thor Aorta Desc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UW4JZ,ICD10-PCS,Supplement Thor Aorta Desc w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UW4KZ,ICD10-PCS,Supplement Thor Aorta Desc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UX07Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UX08Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UX0KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UX37Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UX38Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UX3JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UX3KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UX47Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UX48Z,ICD10-PCS,Supplement Thor Aorta Asc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02UX4JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02UX4KZ,ICD10-PCS,Supplement Thor Aorta Asc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02VA0CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02VA0ZZ,ICD10-PCS,Restriction of Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02VA3CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02VA3ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02VA4CZ,ICD10-PCS,Restriction of Heart with Extralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02VA4ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02VW0DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02VW0EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02VW0FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02VW3DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02VW3EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02VW3FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02VW4DZ,ICD10-PCS,Restrict Thor Aorta Desc w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02VW4EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02VW4FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02VX0DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02VX0EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02VX0FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Open,,Fee Schedule,8271.00
Blue Shield,EPO,02VX3DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02VX3EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02VX3FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,02VX4DZ,ICD10-PCS,Restrict Thor Aorta Asc w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02VX4EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02VX4FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,02W50JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02W54JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WF07Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WF08Z,ICD10-PCS,Revision of Zooplastic Tissue in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WF0JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WF0KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WF47Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WF48Z,ICD10-PCS,Revision of Zooplastic in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WF4JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WF4KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WG07Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WG08Z,ICD10-PCS,Revision of Zooplastic Tissue in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WG0JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WG0KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WG47Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WG48Z,ICD10-PCS,Revision of Zooplastic in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WG4JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WG4KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WH07Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WH08Z,ICD10-PCS,Revision of Zooplastic Tissue in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WH0JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WH0KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WH47Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WH48Z,ICD10-PCS,Revision of Zooplastic in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WH4JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WH4KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WJ07Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WJ08Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WJ0JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WJ0KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WJ47Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WJ48Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WJ4JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WJ4KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WM0JZ,ICD10-PCS,Revision of Synth Sub in Ventricular Sept, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WM4JZ,ICD10-PCS,Revise of Synth Sub in Ventricular Sept, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY02Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY03Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY07Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY08Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY0CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY0DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY0JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY0KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY32Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY33Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY37Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY38Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY3CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY3DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY3JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY3KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY42Z,ICD10-PCS,Revision of Monitor Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY43Z,ICD10-PCS,Revision of Infusion Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY47Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY48Z,ICD10-PCS,Revision of Zooplastic in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY4CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY4DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY4JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,02WY4KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Fee Schedule,7902.34
Blue Shield,EPO,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Fee Schedule,6876.92
Blue Shield,EPO,031309M,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,031309N,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03130AM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03130AN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03130JM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03130JN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03130KM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03130KN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03130ZM,ICD10-PCS,Bypass Right Subclavian Artery to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03130ZN,ICD10-PCS,Bypass Right Subclavian Artery to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Fee Schedule,6876.92
Blue Shield,EPO,031409M,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,031409N,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03140AM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03140AN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03140JM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03140JN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03140KM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03140KN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,03140ZM,ICD10-PCS,Bypass Left Subclavian Artery to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03140ZN,ICD10-PCS,Bypass Left Subclavian Artery to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Fee Schedule,6876.92
Blue Shield,EPO,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Fee Schedule,3198.57
Blue Shield,EPO,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Fee Schedule,3198.57
Blue Shield,EPO,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,Fee Schedule,3198.57
Blue Shield,EPO,0331T,CPT4/HCPCS,HEART SYMP IMAGE PLNR,,Fee Schedule,987.79
Blue Shield,EPO,0332T,CPT4/HCPCS,HEART SYMP IMAGE PLNR SPECT,,Fee Schedule,987.79
Blue Shield,EPO,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Fee Schedule,6876.92
Blue Shield,EPO,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,Fee Schedule,3198.57
Blue Shield,EPO,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,Fee Schedule,3198.57
Blue Shield,EPO,0342T,CPT4/HCPCS,THXP APHERESIS W/HDL DELIP,,Fee Schedule,6049.05
Blue Shield,EPO,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Fee Schedule,987.79
Blue Shield,EPO,03500ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03503ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03504ZZ,ICD10-PCS,Destruction of R Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03510ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03513ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03514ZZ,ICD10-PCS,Destruction of L Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03520ZZ,ICD10-PCS,Destruction of Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03523ZZ,ICD10-PCS,Destruction of Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03524ZZ,ICD10-PCS,Destruction of Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03530ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03533ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03534ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03540ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03543ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03544ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0375T,CPT4/HCPCS,TOTAL DISC ARTHRP ANT APPR,,Fee Schedule,987.79
Blue Shield,EPO,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Fee Schedule,3198.57
Blue Shield,EPO,0377T,CPT4/HCPCS,ANOSCPY INJ AGENT FOR INCONT,,Fee Schedule,6049.05
Blue Shield,EPO,0378T,CPT4/HCPCS,VISUAL FIELD ASSMNT REV/RPRT,,Fee Schedule,6049.05
Blue Shield,EPO,0379T,CPT4/HCPCS,VIS FIELD ASSMNT TECH SUPPT,,Fee Schedule,6049.05
Blue Shield,EPO,0380T,CPT4/HCPCS,COMP ANIMAT RET IMAG SERIES,,Fee Schedule,6049.05
Blue Shield,EPO,0387T,CPT4/HCPCS,LEADLESS PM INS/RPL VENTR,,Fee Schedule,6876.92
Blue Shield,EPO,0388T,CPT4/HCPCS,LEADLESS PM REMOVE VENTR,,Fee Schedule,6876.92
Blue Shield,EPO,0394T,CPT4/HCPCS,HDR ELCTRNC SKN SURF BRCHYTX,,Fee Schedule,12850.71
Blue Shield,EPO,0395T,CPT4/HCPCS,HDR ELCTR NTRST/NTRCV BRCHTX,,Fee Schedule,12850.71
Blue Shield,EPO,03B00ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B03ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B04ZZ,ICD10-PCS,Excision of R Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B10ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B13ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B14ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B20ZZ,ICD10-PCS,Excision of Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B23ZZ,ICD10-PCS,Excision of Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B24ZZ,ICD10-PCS,Excision of Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B30ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B33ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B34ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B40ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B43ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03B44ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R007Z,ICD10-PCS,Replacement of R Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R00JZ,ICD10-PCS,Replacement of R Int Mamm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R00KZ,ICD10-PCS,Replacement of R Int Mamm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R047Z,ICD10-PCS,Replace of R Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R04JZ,ICD10-PCS,Replace of R Int Mamm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R04KZ,ICD10-PCS,Replace R Int Mamm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,03R107Z,ICD10-PCS,Replacement of L Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R10JZ,ICD10-PCS,Replacement of L Int Mamm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R10KZ,ICD10-PCS,Replacement of L Int Mamm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R147Z,ICD10-PCS,Replace of L Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R14JZ,ICD10-PCS,Replace of L Int Mamm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R14KZ,ICD10-PCS,Replace L Int Mamm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,03R207Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R20JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R20KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R247Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R24JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R24KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R307Z,ICD10-PCS,Replacement of R Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R30JZ,ICD10-PCS,Replacement of R Subclav Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R30KZ,ICD10-PCS,Replacement of R Subclav Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R347Z,ICD10-PCS,Replace of R Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R34JZ,ICD10-PCS,Replace of R Subclav Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R34KZ,ICD10-PCS,Replace of R Subclav Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R407Z,ICD10-PCS,Replacement of L Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R40JZ,ICD10-PCS,Replacement of L Subclav Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R40KZ,ICD10-PCS,Replacement of L Subclav Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R447Z,ICD10-PCS,Replace of L Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R44JZ,ICD10-PCS,Replace of L Subclav Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03R44KZ,ICD10-PCS,Replace of L Subclav Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S00ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S03ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S04ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S10ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S13ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S14ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S20ZZ,ICD10-PCS,Reposition Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S23ZZ,ICD10-PCS,Reposition Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S24ZZ,ICD10-PCS,Reposition Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S30ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S33ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S34ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S40ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S43ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S44ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S50ZZ,ICD10-PCS,Reposition Right Axillary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S53ZZ,ICD10-PCS,Reposition Right Axillary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S54ZZ,ICD10-PCS,Reposition Right Axillary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S60ZZ,ICD10-PCS,Reposition Left Axillary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S63ZZ,ICD10-PCS,Reposition Left Axillary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S64ZZ,ICD10-PCS,Reposition Left Axillary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S70ZZ,ICD10-PCS,Reposition Right Brachial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S73ZZ,ICD10-PCS,Reposition Right Brachial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S74ZZ,ICD10-PCS,Reposition Right Brachial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S80ZZ,ICD10-PCS,Reposition Left Brachial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S83ZZ,ICD10-PCS,Reposition Left Brachial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S84ZZ,ICD10-PCS,Reposition Left Brachial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S90ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S93ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03S94ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SA0ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SA3ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SA4ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SB0ZZ,ICD10-PCS,Reposition Right Radial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SB3ZZ,ICD10-PCS,Reposition Right Radial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SB4ZZ,ICD10-PCS,Reposition Right Radial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SC0ZZ,ICD10-PCS,Reposition Left Radial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SC3ZZ,ICD10-PCS,Reposition Left Radial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SC4ZZ,ICD10-PCS,Reposition Left Radial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SD0ZZ,ICD10-PCS,Reposition Right Hand Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SD3ZZ,ICD10-PCS,Reposition Right Hand Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SD4ZZ,ICD10-PCS,Reposition Right Hand Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SF0ZZ,ICD10-PCS,Reposition Left Hand Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SF3ZZ,ICD10-PCS,Reposition Left Hand Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SF4ZZ,ICD10-PCS,Reposition Left Hand Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SG0ZZ,ICD10-PCS,Reposition Intracranial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SG3ZZ,ICD10-PCS,Reposition Intracranial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SG4ZZ,ICD10-PCS,Reposition Intracranial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SH0ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SH3ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SH4ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SJ0ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SJ3ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SJ4ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SK0ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SK3ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SK4ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SL0ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SL3ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SL4ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SM0ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SM3ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SM4ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SN0ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SN3ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SN4ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SP0ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SP3ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SP4ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SQ0ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SQ3ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SQ4ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SR0ZZ,ICD10-PCS,Reposition Face Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SR3ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SR4ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SS0ZZ,ICD10-PCS,Reposition Right Temporal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SS3ZZ,ICD10-PCS,Reposition Right Temporal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SS4ZZ,ICD10-PCS,Reposition Right Temporal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03ST0ZZ,ICD10-PCS,Reposition Left Temporal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03ST3ZZ,ICD10-PCS,Reposition Left Temporal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03ST4ZZ,ICD10-PCS,Reposition Left Temporal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SU0ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SU3ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SU4ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SV0ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SV3ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SV4ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SY0ZZ,ICD10-PCS,Reposition Upper Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SY3ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03SY4ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U007Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U037Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U047Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U107Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U137Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U147Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U207Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U237Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U247Z,ICD10-PCS,Supplement Innom Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U307Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U337Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U347Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U407Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U437Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U447Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U507Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U537Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U547Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U607Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U637Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U647Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U707Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U737Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U747Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U807Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U837Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U847Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U907Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U937Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03U947Z,ICD10-PCS,Supplement R Ulnar Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UA07Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UA37Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UA47Z,ICD10-PCS,Supplement L Ulnar Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UB07Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UB37Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UB47Z,ICD10-PCS,Supplement R Radial Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UC07Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UC37Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UC47Z,ICD10-PCS,Supplement L Radial Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UD07Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UD37Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UD47Z,ICD10-PCS,Supplement R Hand Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UF07Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UF37Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UF47Z,ICD10-PCS,Supplement L Hand Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UG07Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UG37Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UG47Z,ICD10-PCS,Supplement Intracran Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UH07Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UH37Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UH47Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UJ07Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UJ37Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UJ47Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UK07Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UK37Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UK47Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UL07Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UL37Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UL47Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UM07Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UM37Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UM47Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UN07Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UN37Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UN47Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UP07Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UP37Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UP47Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UQ07Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UQ37Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UQ47Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UR07Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UR37Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UR47Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03US07Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03US37Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03US47Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UT07Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UT37Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UT47Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UU07Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UU37Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UU47Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UV07Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UV37Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UV47Z,ICD10-PCS,Supplement L Thyroid Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UY07Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UY37Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,03UY47Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Fee Schedule,3198.57
Blue Shield,EPO,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Fee Schedule,6876.92
Blue Shield,EPO,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Fee Schedule,3198.57
Blue Shield,EPO,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Fee Schedule,3198.57
Blue Shield,EPO,0410090,ICD10-PCS,BYPASS ABD AORTA ABD AORTA AUTO VENOUS TISS OPN,,Fee Schedule,8271.00
Blue Shield,EPO,0410091,ICD10-PCS,Bypass Abd Aorta to Celiac Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0410092,ICD10-PCS,Bypass Abd Aorta to Mesent Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0410093,ICD10-PCS,BP ABDOMINAL AORTA RT RENL ART AUTO VEN TISS OPN,,Fee Schedule,8271.00
Blue Shield,EPO,0410094,ICD10-PCS,BP ABD AORTA LT RENAL ARTERY AUTO VEN TISS OPN,,Fee Schedule,8271.00
Blue Shield,EPO,0410095,ICD10-PCS,Bypass Abd Aorta to B Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0410096,ICD10-PCS,Bypass Abd Aorta to R Com Ilia with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0410097,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,0410098,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,0410099,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,041009B,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,041009C,ICD10-PCS,BP ABD AO B INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,041009D,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,041009F,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,041009G,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,041009H,ICD10-PCS,BP ABD AO RT FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,041009J,ICD10-PCS,BP ABD AO LT FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,041009K,ICD10-PCS,BYPS ABD AO B FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,041009Q,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,041009R,ICD10-PCS,BYPS ABD AO LOW ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100A0,ICD10-PCS,BYPS ABD AO ABD AO AUTO ART TISSUE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100A1,ICD10-PCS,BP ABD AO CELIAC ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100A2,ICD10-PCS,BYPS ABD AO MES ART AUTO ART TISSUE OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100A3,ICD10-PCS,BP ABD AO RT RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100A4,ICD10-PCS,BP ABD AO LT RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100A5,ICD10-PCS,BP ABD AO B RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100A6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100A7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100A8,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100A9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100AB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100AC,ICD10-PCS,BP ABDOMINAL AO BIL INTRL ILIAC ART AUTO ART OPN,,Fee Schedule,8271.00
Blue Shield,EPO,04100AD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100AF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100AG,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100AH,ICD10-PCS,BP ABD AO RT FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100AJ,ICD10-PCS,BP ABD AO LT FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100AK,ICD10-PCS,BYPS ABD AO B FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100AQ,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100AR,ICD10-PCS,BYPS ABD AO LOW ART AUTO ART TISSUE OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100J0,ICD10-PCS,BYPASS ABD AO ABD AO SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100J1,ICD10-PCS,BYPS ABD AO CELIAC ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100J2,ICD10-PCS,BYPASS ABD AO MES ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100J3,ICD10-PCS,BYPS ABD AO RT RENL ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100J4,ICD10-PCS,BYPS ABD AO LT RENL ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100J5,ICD10-PCS,BYPS ABD AO BIL RENL ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100J6,ICD10-PCS,BP ABD AO RT COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100J7,ICD10-PCS,BP ABD AO LT COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100J8,ICD10-PCS,BP ABD AO B COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100J9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100JB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100JC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100JD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100JF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100JG,ICD10-PCS,BP ABD AO B EXT ILIAC ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100JH,ICD10-PCS,BYPS ABD AO RT FEM ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100JJ,ICD10-PCS,BYPS ABD AO LT FEM ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100JK,ICD10-PCS,BYPS ABD AO BIL FEM ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100JQ,ICD10-PCS,BP ABD AO LOW EXTREM ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100JR,ICD10-PCS,BYPASS ABD AO LOW ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100K0,ICD10-PCS,BP ABD AO ABD AO NONAUTO TISS SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100K1,ICD10-PCS,BP ABD AO CELIAC ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100K2,ICD10-PCS,BP ABD AO MES ART NONAUTO TISS SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100K3,ICD10-PCS,BP ABD AO RT RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100K4,ICD10-PCS,BP ABD AO LT RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100K5,ICD10-PCS,BP ABD AO B RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100K6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100K7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100K8,ICD10-PCS,BP ABD AO B CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100K9,ICD10-PCS,BP ABD AO RT IIA NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100KB,ICD10-PCS,BP ABD AO LT IIA NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100KC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100KD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100KF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100KG,ICD10-PCS,BP ABD AO B EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100KH,ICD10-PCS,BP ABD AO RT FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100KJ,ICD10-PCS,BP ABD AO LT FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100KK,ICD10-PCS,BP ABD AO B FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100KQ,ICD10-PCS,BP ABD AO LOW EXT ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,EPO,04100KR,ICD10-PCS,BP ABD AO LOW ART NONAUTO TISS SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100Z0,ICD10-PCS,BYPASS ABD AORTA ABDOMINAL AORTA OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100Z1,ICD10-PCS,BYPASS ABD AORTA CELIAC ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100Z2,ICD10-PCS,BYPASS ABD AORTA MESENTERIC ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100Z3,ICD10-PCS,BYPASS ABD AORTA RT RENAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100Z4,ICD10-PCS,BYPASS ABD AORTA LT RENAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100Z5,ICD10-PCS,BYPASS ABDDOMINAL AORTA BILATERAL RENAL ART OPEN,,Fee Schedule,8271.00
Blue Shield,EPO,04100Z6,ICD10-PCS,BYPASS ABD AO RT COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100Z7,ICD10-PCS,BYPASS ABD AO LT COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100Z8,ICD10-PCS,BYPASS ABD AO BIL COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100Z9,ICD10-PCS,BYPASS ABD AO RT INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100ZB,ICD10-PCS,BYPASS ABD AO LT INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100ZC,ICD10-PCS,BYPASS ABD AO BIL INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100ZD,ICD10-PCS,BYPASS ABD AORTA RT EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100ZF,ICD10-PCS,BYPASS ABD AORTA LT EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100ZG,ICD10-PCS,BYPASS ABD AO BIL EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100ZH,ICD10-PCS,BYPASS ABD AORTA RT FEMORAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100ZJ,ICD10-PCS,BYPASS ABD AORTA LT FEMORAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100ZK,ICD10-PCS,BYPASS ABD AO BIL FEMORAL ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,EPO,04100ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04100ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0410490,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0410491,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0410492,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0410493,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0410494,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0410495,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0410496,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0410497,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0410498,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0410499,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041049B,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041049C,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041049D,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041049F,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041049G,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041049H,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041049J,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041049K,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041049Q,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041049R,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104A0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104A1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104A2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104A3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104A4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104A5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104A6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104A7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104A8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104A9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104AB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104AC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104AD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104AF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104AG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104AH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104AJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104AK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104AQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104AR,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104J0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104J1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104J2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104J3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104J4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104J5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104J6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104J7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104J8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104J9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104JB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104JC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104JD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104JF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104JG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104JH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104JJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104JK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104JQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104JR,ICD10-PCS,Bypass Abd Aorta to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104K0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104K1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104K2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104K3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104K4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104K5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104K6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104K7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104K8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104K9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104KB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104KC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104KD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104KF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104KG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104KH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104KJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104KK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104KQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104KR,ICD10-PCS,Bypass Abd Aorta to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04104Z0,ICD10-PCS,Bypass Abdominal Aorta to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104Z1,ICD10-PCS,Bypass Abdominal Aorta to Celiac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104Z2,ICD10-PCS,Bypass Abdominal Aorta to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104Z3,ICD10-PCS,Bypass Abdominal Aorta to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104Z4,ICD10-PCS,Bypass Abdominal Aorta to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104Z5,ICD10-PCS,Bypass Abdominal Aorta to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104Z6,ICD10-PCS,Bypass Abdominal Aorta to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104Z7,ICD10-PCS,Bypass Abdominal Aorta to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104Z8,ICD10-PCS,Bypass Abdominal Aorta to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104Z9,ICD10-PCS,Bypass Abdominal Aorta to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104ZB,ICD10-PCS,Bypass Abdominal Aorta to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104ZC,ICD10-PCS,Bypass Abdominal Aorta to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104ZD,ICD10-PCS,Bypass Abdominal Aorta to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104ZF,ICD10-PCS,Bypass Abdominal Aorta to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104ZG,ICD10-PCS,Bypass Abdominal Aorta to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104ZH,ICD10-PCS,Bypass Abdominal Aorta to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104ZJ,ICD10-PCS,Bypass Abdominal Aorta to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104ZK,ICD10-PCS,Bypass Abdominal Aorta to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04104ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Fee Schedule,3198.57
Blue Shield,EPO,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Fee Schedule,3198.57
Blue Shield,EPO,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Fee Schedule,4891.93
Blue Shield,EPO,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Fee Schedule,4891.93
Blue Shield,EPO,0414093,ICD10-PCS,Bypass Splenic Art to R Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0414094,ICD10-PCS,Bypass Splenic Art to L Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0414095,ICD10-PCS,Bypass Splenic Art to B Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04140A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,04140A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,04140A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,04140J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,04140J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,04140J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,04140K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,04140K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,04140K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,04140Z3,ICD10-PCS,Bypass Splenic Artery to Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04140Z4,ICD10-PCS,Bypass Splenic Artery to Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04140Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0414493,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0414494,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0414495,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04144A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04144A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04144A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04144J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04144J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04144J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04144K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04144K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04144K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04144Z3,ICD10-PCS,Bypass Splenic Artery to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04144Z4,ICD10-PCS,Bypass Splenic Artery to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04144Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Fee Schedule,4891.93
Blue Shield,EPO,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Fee Schedule,4891.93
Blue Shield,EPO,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Fee Schedule,4891.93
Blue Shield,EPO,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Fee Schedule,987.79
Blue Shield,EPO,041C090,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C091,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C092,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C093,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C094,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C095,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C096,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C097,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C098,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C099,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C09B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C09C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C09D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C09F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C09G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C09H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C09J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C09K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C09Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C09R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041C0Z0,ICD10-PCS,Bypass Right Common Iliac Artery to Abd Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0Z3,ICD10-PCS,Bypass Right Common Iliac Artery to R Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0Z4,ICD10-PCS,Bypass Right Common Iliac Artery to L Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0Z5,ICD10-PCS,Bypass Right Common Iliac Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0ZH,ICD10-PCS,Bypass Right Common Iliac Artery to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0ZJ,ICD10-PCS,Bypass Right Common Iliac Artery to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0ZK,ICD10-PCS,Bypass Right Common Iliac Artery to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C0ZR,ICD10-PCS,Bypass Right Common Iliac Artery to Low Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C490,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C491,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C492,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C493,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C494,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C495,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C496,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C497,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C498,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C499,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C49B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C49C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C49D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C49F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C49G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C49H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C49J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C49K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C49Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C49R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041C4Z0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4Z3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4Z4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4Z5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4ZH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4ZJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4ZK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041C4ZR,ICD10-PCS,Bypass R Com Iliac Art to Low Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D090,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D091,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D092,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D093,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D094,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D095,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D096,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D097,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D098,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D099,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D09B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D09C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D09D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D09F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D09G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D09H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D09J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D09K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D09Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D09R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041D0Z0,ICD10-PCS,Bypass Left Common Iliac Artery to Abd Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0Z1,ICD10-PCS,Bypass Left Common Iliac Artery to Celiac Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0Z2,ICD10-PCS,Bypass Left Common Iliac Artery to Mesent Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0Z3,ICD10-PCS,Bypass Left Common Iliac Artery to R Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0Z4,ICD10-PCS,Bypass Left Common Iliac Artery to L Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0Z5,ICD10-PCS,Bypass Left Common Iliac Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0Z6,ICD10-PCS,Bypass Left Common Iliac Artery to R Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0Z7,ICD10-PCS,Bypass Left Common Iliac Artery to L Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0Z8,ICD10-PCS,Bypass Left Common Iliac Artery to B Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0Z9,ICD10-PCS,Bypass Left Common Iliac Artery to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0ZB,ICD10-PCS,Bypass Left Common Iliac Artery to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0ZC,ICD10-PCS,Bypass Left Common Iliac Artery to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0ZD,ICD10-PCS,Bypass Left Common Iliac Artery to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0ZF,ICD10-PCS,Bypass Left Common Iliac Artery to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0ZG,ICD10-PCS,Bypass Left Common Iliac Artery to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0ZH,ICD10-PCS,Bypass Left Common Iliac Artery to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0ZJ,ICD10-PCS,Bypass Left Common Iliac Artery to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0ZK,ICD10-PCS,Bypass Left Common Iliac Artery to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0ZQ,ICD10-PCS,Bypass Left Common Iliac Artery to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D0ZR,ICD10-PCS,Bypass Left Common Iliac Artery to Low Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D490,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D491,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D492,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D493,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D494,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D495,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D496,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D497,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D498,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D499,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D49B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D49C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D49D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D49F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D49G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D49H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D49J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D49K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D49Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D49R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041D4Z0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4Z1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4Z2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4Z3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4Z4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4Z5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4Z6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4Z7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4Z8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4Z9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4ZB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4ZC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4ZD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4ZF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4ZG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4ZH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4ZJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4ZK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4ZQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041D4ZR,ICD10-PCS,Bypass L Com Iliac Art to Low Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E099,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E09B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E09C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E09D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E09F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E09G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E09H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E09J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E09K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E09P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E09Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041E0Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E0ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E0ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E0ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E0ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E0ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E0ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E0ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E0ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E0ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E0ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E499,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E49B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E49C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E49D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E49F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E49G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E49H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E49J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E49K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E49P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E49Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041E4Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E4ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E4ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E4ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E4ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E4ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E4ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E4ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E4ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E4ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041E4ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F099,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F09B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F09C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F09D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F09F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F09G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F09H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F09J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F09K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F09P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F09Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041F0Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F0ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F0ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F0ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F0ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F0ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F0ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F0ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F0ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F0ZP,ICD10-PCS,Bypass Left Internal Iliac Artery to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F0ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F499,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F49B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F49C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F49D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F49F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F49G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F49H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F49J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F49K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F49P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F49Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041F4Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F4ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F4ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F4ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F4ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F4ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F4ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F4ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F4ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F4ZP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041F4ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H099,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H09B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H09C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H09D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H09F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H09G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H09H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H09J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H09K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H09P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H09Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041H0Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H0ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H0ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H0ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H0ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H0ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H0ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H0ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H0ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H0ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H0ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H499,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H49B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H49C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H49D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H49F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H49G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H49H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H49J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H49K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H49P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H49Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041H4Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H4ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H4ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H4ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H4ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H4ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H4ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H4ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H4ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H4ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041H4ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J099,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J09B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J09C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J09D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J09F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J09G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J09H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J09J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J09K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J09P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J09Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,041J0Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J0ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J0ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J0ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J0ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J0ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J0ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J0ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J0ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J0ZP,ICD10-PCS,Bypass Left External Iliac Artery to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J0ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J499,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J49B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J49C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J49D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J49F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J49G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J49H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J49J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J49K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J49P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J49Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,041J4Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J4ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J4ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J4ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J4ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J4ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J4ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J4ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J4ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J4ZP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,041J4ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Fee Schedule,987.79
Blue Shield,EPO,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Fee Schedule,987.79
Blue Shield,EPO,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Fee Schedule,4891.93
Blue Shield,EPO,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Fee Schedule,4891.93
Blue Shield,EPO,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Fee Schedule,4891.93
Blue Shield,EPO,0443T,CPT4/HCPCS,R-T SPCTRL ALYS PRST8 TISS,,Fee Schedule,4280.44
Blue Shield,EPO,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Fee Schedule,3198.57
Blue Shield,EPO,04500ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04503ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04504ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Fee Schedule,3198.57
Blue Shield,EPO,04510ZZ,ICD10-PCS,Destruction of Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04513ZZ,ICD10-PCS,Destruction of Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04514ZZ,ICD10-PCS,Destruction of Celiac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,Fee Schedule,987.79
Blue Shield,EPO,04520ZZ,ICD10-PCS,Destruction of Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04523ZZ,ICD10-PCS,Destruction of Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04524ZZ,ICD10-PCS,Destruction of Gastric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,Fee Schedule,987.79
Blue Shield,EPO,04530ZZ,ICD10-PCS,Destruction of Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04533ZZ,ICD10-PCS,Destruction of Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04534ZZ,ICD10-PCS,Destruction of Hepatic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Fee Schedule,987.79
Blue Shield,EPO,04540ZZ,ICD10-PCS,Destruction of Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04543ZZ,ICD10-PCS,Destruction of Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04544ZZ,ICD10-PCS,Destruction of Splenic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Fee Schedule,987.79
Blue Shield,EPO,04550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04554ZZ,ICD10-PCS,Destruction of Sup Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,Fee Schedule,987.79
Blue Shield,EPO,04560ZZ,ICD10-PCS,Destruction of Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04563ZZ,ICD10-PCS,Destruction of Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04564ZZ,ICD10-PCS,Destruction of Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,Fee Schedule,987.79
Blue Shield,EPO,04570ZZ,ICD10-PCS,Destruction of Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04573ZZ,ICD10-PCS,Destruction of Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04574ZZ,ICD10-PCS,Destruction of Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Fee Schedule,987.79
Blue Shield,EPO,04580ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04583ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04584ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Fee Schedule,987.79
Blue Shield,EPO,04590ZZ,ICD10-PCS,Destruction of Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04593ZZ,ICD10-PCS,Destruction of Right Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04594ZZ,ICD10-PCS,Destruction of Right Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,Fee Schedule,987.79
Blue Shield,EPO,045A0ZZ,ICD10-PCS,Destruction of Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045A3ZZ,ICD10-PCS,Destruction of Left Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045A4ZZ,ICD10-PCS,Destruction of Left Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045B0ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045B3ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045B4ZZ,ICD10-PCS,Destruction of Inf Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045E0ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045E3ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045E4ZZ,ICD10-PCS,Destruction of R Int Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045F0ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045F3ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045F4ZZ,ICD10-PCS,Destruction of L Int Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045H0ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045H3ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045H4ZZ,ICD10-PCS,Destruction of R Ext Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045J0ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045J3ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,045J4ZZ,ICD10-PCS,Destruction of L Ext Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Fee Schedule,987.79
Blue Shield,EPO,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,Fee Schedule,987.79
Blue Shield,EPO,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,Fee Schedule,3198.57
Blue Shield,EPO,0474T,CPT4/HCPCS,INSJ AQUEOUS DRG DEV IO RSVR,,Fee Schedule,3198.57
Blue Shield,EPO,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Fee Schedule,4891.93
Blue Shield,EPO,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Fee Schedule,4891.93
Blue Shield,EPO,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Fee Schedule,6049.05
Blue Shield,EPO,0482T,CPT4/HCPCS,ABSL QUAN MYOCRD BLD FLO PET,,Fee Schedule,3198.57
Blue Shield,EPO,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,Fee Schedule,3198.57
Blue Shield,EPO,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,Fee Schedule,3198.57
Blue Shield,EPO,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Fee Schedule,6049.05
Blue Shield,EPO,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Fee Schedule,6049.05
Blue Shield,EPO,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Fee Schedule,4891.93
Blue Shield,EPO,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Fee Schedule,4891.93
Blue Shield,EPO,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,Fee Schedule,3198.57
Blue Shield,EPO,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Fee Schedule,4280.44
Blue Shield,EPO,04B00ZZ,ICD10-PCS,Excision of Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B03ZZ,ICD10-PCS,Excision of Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B04ZZ,ICD10-PCS,Excision of Abdominal Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B10ZZ,ICD10-PCS,Excision of Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B13ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B14ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B20ZZ,ICD10-PCS,Excision of Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B23ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B24ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B30ZZ,ICD10-PCS,Excision of Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B33ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B34ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B40ZZ,ICD10-PCS,Excision of Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B43ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B44ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B60ZZ,ICD10-PCS,Excision of Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B63ZZ,ICD10-PCS,Excision of Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B64ZZ,ICD10-PCS,Excision of Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B70ZZ,ICD10-PCS,Excision of Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B73ZZ,ICD10-PCS,Excision of Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B74ZZ,ICD10-PCS,Excision of Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B80ZZ,ICD10-PCS,Excision of Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B83ZZ,ICD10-PCS,Excision of Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B84ZZ,ICD10-PCS,Excision of Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B90ZZ,ICD10-PCS,Excision of Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B93ZZ,ICD10-PCS,Excision of Right Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04B94ZZ,ICD10-PCS,Excision of Right Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BA0ZZ,ICD10-PCS,Excision of Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BA3ZZ,ICD10-PCS,Excision of Left Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BA4ZZ,ICD10-PCS,Excision of Left Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BB0ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BB3ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BB4ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BE0ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BE3ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BE4ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BF0ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BF3ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BF4ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BH0ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BH3ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BH4ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BJ0ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BJ3ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04BJ4ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04C00ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04C03ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04C04ZZ,ICD10-PCS,Extirpation of Matter from Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R007Z,ICD10-PCS,Replacement of Abdominal Aorta with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R00JZ,ICD10-PCS,Replacement of Abdominal Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R00KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R047Z,ICD10-PCS,Replacement of Abd Aorta with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R04JZ,ICD10-PCS,Replacement of Abd Aorta with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R04KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R107Z,ICD10-PCS,Replacement of Celiac Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R10JZ,ICD10-PCS,Replacement of Celiac Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R10KZ,ICD10-PCS,Replacement of Celiac Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R147Z,ICD10-PCS,Replacement of Celiac Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R14JZ,ICD10-PCS,Replacement of Celiac Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R14KZ,ICD10-PCS,Replace of Celiac Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R207Z,ICD10-PCS,Replacement of Gastric Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R20JZ,ICD10-PCS,Replacement of Gastric Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R20KZ,ICD10-PCS,Replacement of Gastric Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R247Z,ICD10-PCS,Replace of Gastric Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R24JZ,ICD10-PCS,Replace of Gastric Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R24KZ,ICD10-PCS,Replace of Gastric Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R307Z,ICD10-PCS,Replacement of Hepatic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R30JZ,ICD10-PCS,Replacement of Hepatic Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R30KZ,ICD10-PCS,Replacement of Hepatic Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R347Z,ICD10-PCS,Replace of Hepatic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R34JZ,ICD10-PCS,Replace of Hepatic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R34KZ,ICD10-PCS,Replace of Hepatic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R407Z,ICD10-PCS,Replacement of Splenic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R40JZ,ICD10-PCS,Replacement of Splenic Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R40KZ,ICD10-PCS,Replacement of Splenic Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R447Z,ICD10-PCS,Replace of Splenic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R44JZ,ICD10-PCS,Replace of Splenic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R44KZ,ICD10-PCS,Replace of Splenic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R507Z,ICD10-PCS,Replacement of Sup Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R50JZ,ICD10-PCS,Replacement of Sup Mesent Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R50KZ,ICD10-PCS,Replacement of Sup Mesent Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R547Z,ICD10-PCS,Replace of Sup Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R54JZ,ICD10-PCS,Replace of Sup Mesent Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R54KZ,ICD10-PCS,Replace Sup Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04R607Z,ICD10-PCS,Replacement of R Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R60JZ,ICD10-PCS,Replacement of R Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R60KZ,ICD10-PCS,Replacement of R Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R647Z,ICD10-PCS,Replace of R Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R64JZ,ICD10-PCS,Replace of R Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R64KZ,ICD10-PCS,Replace of R Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R707Z,ICD10-PCS,Replacement of L Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R70JZ,ICD10-PCS,Replacement of L Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R70KZ,ICD10-PCS,Replacement of L Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R747Z,ICD10-PCS,Replace of L Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R74JZ,ICD10-PCS,Replace of L Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R74KZ,ICD10-PCS,Replace of L Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R807Z,ICD10-PCS,Replacement of Mid Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R80JZ,ICD10-PCS,Replacement of Mid Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R80KZ,ICD10-PCS,Replacement of Mid Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R847Z,ICD10-PCS,Replace of Mid Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R84JZ,ICD10-PCS,Replace of Mid Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R84KZ,ICD10-PCS,Replace of Mid Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R907Z,ICD10-PCS,Replacement of R Renal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R90JZ,ICD10-PCS,Replacement of R Renal Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R90KZ,ICD10-PCS,Replacement of R Renal Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R947Z,ICD10-PCS,Replace of R Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R94JZ,ICD10-PCS,Replace of R Renal Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04R94KZ,ICD10-PCS,Replace of R Renal Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RA07Z,ICD10-PCS,Replacement of L Renal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RA0JZ,ICD10-PCS,Replacement of L Renal Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RA0KZ,ICD10-PCS,Replacement of L Renal Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RA47Z,ICD10-PCS,Replace of L Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RA4JZ,ICD10-PCS,Replace of L Renal Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RA4KZ,ICD10-PCS,Replace of L Renal Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RB07Z,ICD10-PCS,Replacement of Inf Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RB0JZ,ICD10-PCS,Replacement of Inf Mesent Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RB0KZ,ICD10-PCS,Replacement of Inf Mesent Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RB47Z,ICD10-PCS,Replace of Inf Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RB4JZ,ICD10-PCS,Replace of Inf Mesent Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RB4KZ,ICD10-PCS,Replace Inf Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RC07Z,ICD10-PCS,Replacement of R Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RC0JZ,ICD10-PCS,Replacement of R Com Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RC0KZ,ICD10-PCS,Replace of R Com Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RC47Z,ICD10-PCS,Replace R Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RC4JZ,ICD10-PCS,Replace R Com Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RC4KZ,ICD10-PCS,Replace R Com Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RD07Z,ICD10-PCS,Replacement of L Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RD0JZ,ICD10-PCS,Replacement of L Com Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RD0KZ,ICD10-PCS,Replace of L Com Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RD47Z,ICD10-PCS,Replace L Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RD4JZ,ICD10-PCS,Replace L Com Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RD4KZ,ICD10-PCS,Replace L Com Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RE07Z,ICD10-PCS,Replacement of R Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RE0JZ,ICD10-PCS,Replacement of R Int Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RE0KZ,ICD10-PCS,Replace of R Int Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RE47Z,ICD10-PCS,Replace R Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RE4JZ,ICD10-PCS,Replace R Int Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RE4KZ,ICD10-PCS,Replace R Int Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RF07Z,ICD10-PCS,Replacement of L Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RF0JZ,ICD10-PCS,Replacement of L Int Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RF0KZ,ICD10-PCS,Replace of L Int Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RF47Z,ICD10-PCS,Replace L Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RF4JZ,ICD10-PCS,Replace L Int Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RF4KZ,ICD10-PCS,Replace L Int Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RH07Z,ICD10-PCS,Replacement of R Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RH0JZ,ICD10-PCS,Replacement of R Ext Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RH0KZ,ICD10-PCS,Replace of R Ext Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RH47Z,ICD10-PCS,Replace R Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RH4JZ,ICD10-PCS,Replace R Ext Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RH4KZ,ICD10-PCS,Replace R Ext Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RJ07Z,ICD10-PCS,Replacement of L Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RJ0JZ,ICD10-PCS,Replacement of L Ext Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RJ0KZ,ICD10-PCS,Replace of L Ext Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04RJ47Z,ICD10-PCS,Replace L Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RJ4JZ,ICD10-PCS,Replace L Ext Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04RJ4KZ,ICD10-PCS,Replace L Ext Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04S00ZZ,ICD10-PCS,Reposition Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S03ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S04ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S10ZZ,ICD10-PCS,Reposition Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S13ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S14ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S20ZZ,ICD10-PCS,Reposition Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S23ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S24ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S30ZZ,ICD10-PCS,Reposition Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S33ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S34ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S40ZZ,ICD10-PCS,Reposition Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S43ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S44ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S60ZZ,ICD10-PCS,Reposition Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S63ZZ,ICD10-PCS,Reposition Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S64ZZ,ICD10-PCS,Reposition Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S70ZZ,ICD10-PCS,Reposition Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S73ZZ,ICD10-PCS,Reposition Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S74ZZ,ICD10-PCS,Reposition Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S80ZZ,ICD10-PCS,Reposition Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S83ZZ,ICD10-PCS,Reposition Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04S84ZZ,ICD10-PCS,Reposition Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SB0ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SB3ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SB4ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SE0ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SE3ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SE4ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SF0ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SF3ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SF4ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SH0ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SH3ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SH4ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SJ0ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SJ3ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SJ4ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SK0ZZ,ICD10-PCS,Reposition Right Femoral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SK3ZZ,ICD10-PCS,Reposition Right Femoral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SK4ZZ,ICD10-PCS,Reposition Right Femoral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SL0ZZ,ICD10-PCS,Reposition Left Femoral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SL3ZZ,ICD10-PCS,Reposition Left Femoral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SL4ZZ,ICD10-PCS,Reposition Left Femoral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SM0ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SM3ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SM4ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SN0ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SN3ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SN4ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SP0ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SP3ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SP4ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SQ0ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SQ3ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SQ4ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SR0ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SR3ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SR4ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SS0ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SS3ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SS4ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04ST0ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04ST3ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04ST4ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SU0ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SU3ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SU4ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SV0ZZ,ICD10-PCS,Reposition Right Foot Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SV3ZZ,ICD10-PCS,Reposition Right Foot Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SV4ZZ,ICD10-PCS,Reposition Right Foot Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SW0ZZ,ICD10-PCS,Reposition Left Foot Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SW3ZZ,ICD10-PCS,Reposition Left Foot Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SW4ZZ,ICD10-PCS,Reposition Left Foot Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SY0ZZ,ICD10-PCS,Reposition Lower Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SY3ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04SY4ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U007Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U037Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U047Z,ICD10-PCS,Supplement Abd Aorta with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U107Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U137Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U147Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U207Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U237Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U247Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U307Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U337Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U347Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U407Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U437Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U447Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U507Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U537Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U547Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U607Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U637Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U647Z,ICD10-PCS,Supplement R Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U707Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U737Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U747Z,ICD10-PCS,Supplement L Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U807Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U837Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U847Z,ICD10-PCS,Supplement Mid Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U907Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U937Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04U947Z,ICD10-PCS,Supplement R Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UA07Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UA37Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UA47Z,ICD10-PCS,Supplement L Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UB07Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UB37Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UB47Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UC07Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UC37Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UC47Z,ICD10-PCS,Supplement R Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04UD07Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UD37Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UD47Z,ICD10-PCS,Supplement L Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04UE07Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UE37Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UE47Z,ICD10-PCS,Supplement R Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04UF07Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UF37Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UF47Z,ICD10-PCS,Supplement L Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04UH07Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UH37Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UH47Z,ICD10-PCS,Supplement R Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04UJ07Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UJ37Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UJ47Z,ICD10-PCS,Supplement L Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,04UK07Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UK37Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UK47Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UL07Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UL37Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UL47Z,ICD10-PCS,Supplement L Femor Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UM07Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UM37Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UM47Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UN07Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UN37Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UN47Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UP07Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UP37Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UP47Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UQ07Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UQ37Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UQ47Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UR07Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UR37Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UR47Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04US07Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04US37Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04US47Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UT07Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UT37Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UT47Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UU07Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UU37Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UU47Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UV07Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UV37Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UV47Z,ICD10-PCS,Supplement R Foot Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UW07Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UW37Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UW47Z,ICD10-PCS,Supplement L Foot Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UY07Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UY37Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,04UY47Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051007Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051009Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05100AY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05100JY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05100KY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05100ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051047Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,051049Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05104AY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05104JY,ICD10-PCS,BYPASS AZYGOS VEIN UP VEIN SYNTH SUB PERC ENDO,,Fee Schedule,8271.00
Blue Shield,EPO,05104KY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05104ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051107Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,051109Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05110AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05110JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05110KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05110ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051147Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,051149Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05114AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05114JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05114KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05114ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051307Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051309Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05130AY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05130JY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05130KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05130ZY,ICD10-PCS,Bypass Right Innominate Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051347Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,051349Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05134AY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05134JY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05134KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05134ZY,ICD10-PCS,Bypass Right Innominate Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051407Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051409Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05140AY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05140JY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05140KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05140ZY,ICD10-PCS,Bypass Left Innominate Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051447Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,051449Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05144AY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05144JY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05144KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05144ZY,ICD10-PCS,Bypass Left Innominate Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051507Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,051509Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05150AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05150JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05150KY,ICD10-PCS,BYPS RT SV UP VEIN NONAUT SUB OPEN,,Fee Schedule,8271.00
Blue Shield,EPO,05150ZY,ICD10-PCS,Bypass Right Subclavian Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051547Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,051549Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05154AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05154JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05154KY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05154ZY,ICD10-PCS,Bypass Right Subclavian Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051607Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,051609Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05160AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05160JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05160KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,EPO,05160ZY,ICD10-PCS,Bypass Left Subclavian Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,051647Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,051649Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05164AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05164JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05164KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05164ZY,ICD10-PCS,Bypass Left Subclavian Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05500ZZ,ICD10-PCS,Destruction of Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05503ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05504ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05510ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05513ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05514ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05530ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05533ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05534ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05540ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05543ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05544ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05550ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05553ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05554ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05560ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05563ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05564ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B00ZZ,ICD10-PCS,Excision of Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B03ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B04ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B10ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B13ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B14ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B30ZZ,ICD10-PCS,Excision of Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B33ZZ,ICD10-PCS,Excision of Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B34ZZ,ICD10-PCS,Excision of Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B40ZZ,ICD10-PCS,Excision of Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B43ZZ,ICD10-PCS,Excision of Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B44ZZ,ICD10-PCS,Excision of Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B50ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B53ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B54ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B60ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B63ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05B64ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R007Z,ICD10-PCS,Replacement of Azygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R00JZ,ICD10-PCS,Replacement of Azygos Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R00KZ,ICD10-PCS,Replacement of Azygos Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R047Z,ICD10-PCS,Replace of Azygos Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R04JZ,ICD10-PCS,Replace of Azygos Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R04KZ,ICD10-PCS,Replace of Azygos Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R107Z,ICD10-PCS,Replacement of Hemiazygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R10JZ,ICD10-PCS,Replacement of Hemiazygos Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R10KZ,ICD10-PCS,Replace of Hemiazygos Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R147Z,ICD10-PCS,Replace Hemiazygos Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05R14JZ,ICD10-PCS,Replace Hemiazygos Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05R14KZ,ICD10-PCS,Replace Hemiazygos Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05R307Z,ICD10-PCS,Replacement of R Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R30JZ,ICD10-PCS,Replacement of R Innom Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R30KZ,ICD10-PCS,Replacement of R Innom Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R347Z,ICD10-PCS,Replace of R Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R34JZ,ICD10-PCS,Replace of R Innom Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R34KZ,ICD10-PCS,Replace of R Innom Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R407Z,ICD10-PCS,Replacement of L Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R40JZ,ICD10-PCS,Replacement of L Innom Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R40KZ,ICD10-PCS,Replacement of L Innom Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R447Z,ICD10-PCS,Replace of L Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R44JZ,ICD10-PCS,Replace of L Innom Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R44KZ,ICD10-PCS,Replace of L Innom Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R507Z,ICD10-PCS,Replacement of R Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R50JZ,ICD10-PCS,Replacement of R Subclav Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R50KZ,ICD10-PCS,Replacement of R Subclav Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R547Z,ICD10-PCS,Replace of R Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R54JZ,ICD10-PCS,Replace of R Subclav Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R54KZ,ICD10-PCS,Replace R Subclav Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05R607Z,ICD10-PCS,Replacement of L Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R60JZ,ICD10-PCS,Replacement of L Subclav Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R60KZ,ICD10-PCS,Replacement of L Subclav Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R647Z,ICD10-PCS,Replace of L Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R64JZ,ICD10-PCS,Replace of L Subclav Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05R64KZ,ICD10-PCS,Replace L Subclav Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05S00ZZ,ICD10-PCS,Reposition Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S03ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S04ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S10ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S13ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S14ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S30ZZ,ICD10-PCS,Reposition Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S33ZZ,ICD10-PCS,Reposition Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S34ZZ,ICD10-PCS,Reposition Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S40ZZ,ICD10-PCS,Reposition Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S43ZZ,ICD10-PCS,Reposition Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S44ZZ,ICD10-PCS,Reposition Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S50ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S53ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S54ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S60ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S63ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S64ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S70ZZ,ICD10-PCS,Reposition Right Axillary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S73ZZ,ICD10-PCS,REPOSITION RIGHT AXILLARY VEIN PERQ,,Fee Schedule,8271.00
Blue Shield,EPO,05S74ZZ,ICD10-PCS,Reposition Right Axillary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S80ZZ,ICD10-PCS,Reposition Left Axillary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S83ZZ,ICD10-PCS,Reposition Left Axillary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S84ZZ,ICD10-PCS,Reposition Left Axillary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S90ZZ,ICD10-PCS,Reposition Right Brachial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S93ZZ,ICD10-PCS,Reposition Right Brachial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05S94ZZ,ICD10-PCS,Reposition Right Brachial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SA0ZZ,ICD10-PCS,Reposition Left Brachial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SA3ZZ,ICD10-PCS,Reposition Left Brachial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SA4ZZ,ICD10-PCS,Reposition Left Brachial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SB0ZZ,ICD10-PCS,Reposition Right Basilic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SB3ZZ,ICD10-PCS,Reposition Right Basilic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SB4ZZ,ICD10-PCS,Reposition Right Basilic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SC0ZZ,ICD10-PCS,Reposition Left Basilic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SC3ZZ,ICD10-PCS,Reposition Left Basilic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SC4ZZ,ICD10-PCS,Reposition Left Basilic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SD0ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SD3ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SD4ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SF0ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SF3ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SF4ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SG0ZZ,ICD10-PCS,Reposition Right Hand Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SG3ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SG4ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SH0ZZ,ICD10-PCS,Reposition Left Hand Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SH3ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SH4ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SL0ZZ,ICD10-PCS,Reposition Intracranial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SL3ZZ,ICD10-PCS,Reposition Intracranial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SL4ZZ,ICD10-PCS,Reposition Intracranial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SM0ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SM3ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SM4ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SN0ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SN3ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SN4ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SP0ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SP3ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SP4ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SQ0ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SQ3ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SQ4ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SR0ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SR3ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SR4ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SS0ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SS3ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SS4ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05ST0ZZ,ICD10-PCS,Reposition Right Face Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05ST3ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05ST4ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SV0ZZ,ICD10-PCS,Reposition Left Face Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SV3ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SV4ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SY0ZZ,ICD10-PCS,Reposition Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SY3ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05SY4ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U007Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U037Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U047Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U107Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U137Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U147Z,ICD10-PCS,Supplement Hemiazygos Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05U307Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U337Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U347Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U407Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U437Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U447Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U507Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U537Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U547Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U607Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U637Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U647Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U707Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U737Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U747Z,ICD10-PCS,Supplement R Axilla Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U807Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U837Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U847Z,ICD10-PCS,Supplement L Axilla Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U907Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U937Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05U947Z,ICD10-PCS,Supplement R Brach Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UA07Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UA37Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UA47Z,ICD10-PCS,Supplement L Brach Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UB07Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UB37Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UB47Z,ICD10-PCS,Supplement R Basilic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UC07Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UC37Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UC47Z,ICD10-PCS,Supplement L Basilic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UD07Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UD37Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UD47Z,ICD10-PCS,Supplement R Cephalic Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05UF07Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UF37Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UF47Z,ICD10-PCS,Supplement L Cephalic Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05UG07Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UG37Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UG47Z,ICD10-PCS,Supplement R Hand Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UH07Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UH37Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UH47Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UL07Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UL37Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UL47Z,ICD10-PCS,Supplement Intracran Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UM07Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UM37Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UM47Z,ICD10-PCS,Supplement R Int Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05UN07Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UN37Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UN47Z,ICD10-PCS,Supplement L Int Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05UP07Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UP37Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UP47Z,ICD10-PCS,Supplement R Ext Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05UQ07Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UQ37Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UQ47Z,ICD10-PCS,Supplement L Ext Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,05UR07Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UR37Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UR47Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05US07Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05US37Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05US47Z,ICD10-PCS,Supplement L Verteb Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UT07Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UT37Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UT47Z,ICD10-PCS,Supplement R Face Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UV07Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UV37Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UV47Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UY07Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UY37Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,05UY47Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06500ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06503ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06504ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06510ZZ,ICD10-PCS,Destruction of Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06513ZZ,ICD10-PCS,Destruction of Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06514ZZ,ICD10-PCS,Destruction of Splenic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06520ZZ,ICD10-PCS,Destruction of Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06523ZZ,ICD10-PCS,Destruction of Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06524ZZ,ICD10-PCS,Destruction of Gastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06540ZZ,ICD10-PCS,Destruction of Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06543ZZ,ICD10-PCS,Destruction of Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06544ZZ,ICD10-PCS,Destruction of Hepatic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06554ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06560ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06563ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06564ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06570ZZ,ICD10-PCS,Destruction of Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06573ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06574ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06580ZZ,ICD10-PCS,Destruction of Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06583ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06584ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06590ZZ,ICD10-PCS,Destruction of Right Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06593ZZ,ICD10-PCS,Destruction of Right Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06594ZZ,ICD10-PCS,Destruction of Right Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065B0ZZ,ICD10-PCS,Destruction of Left Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065B3ZZ,ICD10-PCS,Destruction of Left Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065B4ZZ,ICD10-PCS,Destruction of Left Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065F0ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065F3ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065F4ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065G0ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065G3ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065G4ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065H0ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065H3ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065H4ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065J0ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065J3ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,065J4ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B00ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B03ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B04ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B10ZZ,ICD10-PCS,Excision of Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B13ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B14ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B20ZZ,ICD10-PCS,Excision of Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B23ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B24ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B40ZZ,ICD10-PCS,Excision of Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B43ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B44ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B60ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B63ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B64ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B70ZZ,ICD10-PCS,Excision of Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B73ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B74ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B80ZZ,ICD10-PCS,Excision of Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B83ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B84ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B90ZZ,ICD10-PCS,Excision of Right Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B93ZZ,ICD10-PCS,Excision of Right Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06B94ZZ,ICD10-PCS,Excision of Right Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BB0ZZ,ICD10-PCS,Excision of Left Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BB3ZZ,ICD10-PCS,Excision of Left Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BB4ZZ,ICD10-PCS,Excision of Left Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BF0ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BF3ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BF4ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BG0ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BG3ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BG4ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BH0ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BH3ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BH4ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BJ0ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BJ3ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06BJ4ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R007Z,ICD10-PCS,Replacement of Inf Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R00JZ,ICD10-PCS,Replacement of Inf Vena Cava with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R00KZ,ICD10-PCS,Replacement of Inf Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R047Z,ICD10-PCS,Replace of Inf Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R04JZ,ICD10-PCS,Replace of Inf Vena Cava with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R04KZ,ICD10-PCS,Replace of Inf Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R107Z,ICD10-PCS,Replacement of Splenic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R10JZ,ICD10-PCS,Replacement of Splenic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R10KZ,ICD10-PCS,Replacement of Splenic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R147Z,ICD10-PCS,Replace of Splenic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R14JZ,ICD10-PCS,Replace of Splenic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R14KZ,ICD10-PCS,Replace of Splenic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R207Z,ICD10-PCS,Replacement of Gastric Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R20JZ,ICD10-PCS,Replacement of Gastric Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R20KZ,ICD10-PCS,Replacement of Gastric Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R247Z,ICD10-PCS,Replace of Gastric Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R24JZ,ICD10-PCS,Replace of Gastric Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R24KZ,ICD10-PCS,Replace of Gastric Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R407Z,ICD10-PCS,Replacement of Hepatic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R40JZ,ICD10-PCS,Replacement of Hepatic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R40KZ,ICD10-PCS,Replacement of Hepatic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R447Z,ICD10-PCS,Replace of Hepatic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R44JZ,ICD10-PCS,Replace of Hepatic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R44KZ,ICD10-PCS,Replace of Hepatic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R507Z,ICD10-PCS,Replacement of Sup Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R50JZ,ICD10-PCS,Replacement of Sup Mesent Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R50KZ,ICD10-PCS,Replace of Sup Mesent Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R547Z,ICD10-PCS,Replace Sup Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06R54JZ,ICD10-PCS,Replace Sup Mesent Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06R54KZ,ICD10-PCS,Replace Sup Mesent Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06R607Z,ICD10-PCS,Replacement of Inf Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R60JZ,ICD10-PCS,Replacement of Inf Mesent Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R60KZ,ICD10-PCS,Replace of Inf Mesent Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R647Z,ICD10-PCS,Replace Inf Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06R64JZ,ICD10-PCS,Replace Inf Mesent Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06R64KZ,ICD10-PCS,Replace Inf Mesent Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06R707Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R70JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R70KZ,ICD10-PCS,Replacement of Colic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R747Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R74JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R74KZ,ICD10-PCS,Replace of Colic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R807Z,ICD10-PCS,Replacement of Portal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R80JZ,ICD10-PCS,Replacement of Portal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R80KZ,ICD10-PCS,Replacement of Portal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R847Z,ICD10-PCS,Replace of Portal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R84JZ,ICD10-PCS,Replace of Portal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R84KZ,ICD10-PCS,Replace of Portal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R907Z,ICD10-PCS,Replacement of R Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R90JZ,ICD10-PCS,Replacement of R Renal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R90KZ,ICD10-PCS,Replacement of R Renal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R947Z,ICD10-PCS,Replace of R Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R94JZ,ICD10-PCS,Replace of R Renal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06R94KZ,ICD10-PCS,Replace of R Renal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RB07Z,ICD10-PCS,Replacement of Left Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RB0JZ,ICD10-PCS,Replacement of Left Renal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RB0KZ,ICD10-PCS,Replacement of L Renal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RB47Z,ICD10-PCS,Replace of L Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RB4JZ,ICD10-PCS,Replace of L Renal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RB4KZ,ICD10-PCS,Replace of L Renal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RC07Z,ICD10-PCS,Replace of R Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RC0JZ,ICD10-PCS,Replace of R Com Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RC0KZ,ICD10-PCS,Replace of R Com Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RC47Z,ICD10-PCS,Replace R Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RC4JZ,ICD10-PCS,Replace R Com Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RC4KZ,ICD10-PCS,Replace R Com Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RD07Z,ICD10-PCS,Replace of L Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RD0JZ,ICD10-PCS,Replace of L Com Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RD0KZ,ICD10-PCS,Replace of L Com Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RD47Z,ICD10-PCS,Replace L Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RD4JZ,ICD10-PCS,Replace L Com Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RD4KZ,ICD10-PCS,Replace L Com Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RF07Z,ICD10-PCS,Replace of R Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RF0JZ,ICD10-PCS,Replace of R Ext Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RF0KZ,ICD10-PCS,Replace of R Ext Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RF47Z,ICD10-PCS,Replace R Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RF4JZ,ICD10-PCS,Replace R Ext Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RF4KZ,ICD10-PCS,Replace R Ext Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RG07Z,ICD10-PCS,Replace of L Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RG0JZ,ICD10-PCS,Replace of L Ext Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RG0KZ,ICD10-PCS,Replace of L Ext Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RG47Z,ICD10-PCS,Replace L Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RG4JZ,ICD10-PCS,Replace L Ext Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RG4KZ,ICD10-PCS,Replace L Ext Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RH07Z,ICD10-PCS,Replacement of R Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RH0JZ,ICD10-PCS,Replacement of R Hypogast Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RH0KZ,ICD10-PCS,Replace of R Hypogast Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RH47Z,ICD10-PCS,Replace R Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RH4JZ,ICD10-PCS,Replace R Hypogast Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RH4KZ,ICD10-PCS,Replace R Hypogast Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RJ07Z,ICD10-PCS,Replacement of L Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RJ0JZ,ICD10-PCS,Replacement of L Hypogast Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RJ0KZ,ICD10-PCS,Replace of L Hypogast Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06RJ47Z,ICD10-PCS,Replace L Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RJ4JZ,ICD10-PCS,Replace L Hypogast Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06RJ4KZ,ICD10-PCS,Replace L Hypogast Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06S00ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S03ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S04ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S10ZZ,ICD10-PCS,Reposition Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S13ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S14ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S20ZZ,ICD10-PCS,Reposition Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S23ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S24ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S30ZZ,ICD10-PCS,Reposition Esophageal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S33ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S34ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S40ZZ,ICD10-PCS,Reposition Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S43ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S44ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S60ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S63ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S64ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S70ZZ,ICD10-PCS,Reposition Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S73ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S74ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S80ZZ,ICD10-PCS,Reposition Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S83ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06S84ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SF0ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SF3ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SF4ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SG0ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SG3ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SG4ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SH0ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SH3ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SH4ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SJ0ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SJ3ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SJ4ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SM0ZZ,ICD10-PCS,Reposition Right Femoral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SM3ZZ,ICD10-PCS,Reposition Right Femoral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SM4ZZ,ICD10-PCS,Reposition Right Femoral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SN0ZZ,ICD10-PCS,Reposition Left Femoral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SN3ZZ,ICD10-PCS,Reposition Left Femoral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SN4ZZ,ICD10-PCS,Reposition Left Femoral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SP0ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SP3ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SP4ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SQ0ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SQ3ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SQ4ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SR0ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SR3ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SR4ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SS0ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SS3ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SS4ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06ST0ZZ,ICD10-PCS,Reposition Right Foot Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06ST3ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06ST4ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SV0ZZ,ICD10-PCS,Reposition Left Foot Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SV3ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SV4ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SY0ZZ,ICD10-PCS,Reposition Lower Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SY3ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06SY4ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U007Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U037Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U047Z,ICD10-PCS,Supplement Inf Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U107Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U137Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U147Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U207Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U237Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U247Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U307Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U337Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U347Z,ICD10-PCS,Supplement Esophageal Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06U407Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U437Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U447Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U507Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U537Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U547Z,ICD10-PCS,Supplement Sup Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06U607Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U637Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U647Z,ICD10-PCS,Supplement Inf Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06U707Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U737Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U747Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U807Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U837Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U847Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U907Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U937Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06U947Z,ICD10-PCS,Supplement R Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UB07Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UB37Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UB47Z,ICD10-PCS,Supplement L Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UC07Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UC37Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UC47Z,ICD10-PCS,Supplement R Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06UD07Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UD37Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UD47Z,ICD10-PCS,Supplement L Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06UF07Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UF37Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UF47Z,ICD10-PCS,Supplement R Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06UG07Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UG37Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UG47Z,ICD10-PCS,Supplement L Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06UH07Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UH37Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UH47Z,ICD10-PCS,Supplement R Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06UJ07Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UJ37Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UJ47Z,ICD10-PCS,Supplement L Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06UM07Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UM37Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UM47Z,ICD10-PCS,Supplement R Femor Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UN07Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UN37Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UN47Z,ICD10-PCS,Supplement L Femor Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UP07Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UP37Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UP47Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UQ07Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UQ37Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UQ47Z,ICD10-PCS,Supplement L Saphenous with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UR07Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UR37Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UR47Z,ICD10-PCS,Supplement R Less Saphenous w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06US07Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06US37Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06US47Z,ICD10-PCS,Supplement L Less Saphenous w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,06UT07Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UT37Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UT47Z,ICD10-PCS,Supplement R Foot Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UV07Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UV37Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UV47Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UY07Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UY37Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,06UY47Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0JH608Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0JH638Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0JH808Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0JH838Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS304Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS30ZZ,ICD10-PCS,Reposition Cervical Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS334Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS33ZZ,ICD10-PCS,Reposition Cervical Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS344Z,ICD10-PCS,Reposition Cervcal Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS34ZZ,ICD10-PCS,Reposition Cervical Vertebra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS3XZZ,ICD10-PCS,Reposition Cervical Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS404Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS40ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS434Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS43ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS444Z,ICD10-PCS,Reposition Thor Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS44ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0PS4XZZ,ICD10-PCS,Reposition Thoracic Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS004Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS00ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS034Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS03ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS044Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS04ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS0XZZ,ICD10-PCS,Reposition Lumbar Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS104Z,ICD10-PCS,Reposition Sacrum with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS10ZZ,ICD10-PCS,Reposition Sacrum, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS134Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS13ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS144Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS14ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QS1XZZ,ICD10-PCS,Reposition Sacrum, External Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QSS04Z,ICD10-PCS,Reposition Coccyx with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QSS0ZZ,ICD10-PCS,Reposition Coccyx, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QSS34Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QSS3ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QSS44Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QSS4ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0QSSXZZ,ICD10-PCS,Reposition Coccyx, External Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0R530ZZ,ICD10-PCS,Destruction of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0R550ZZ,ICD10-PCS,Destruction of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0R590ZZ,ICD10-PCS,Destruction of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0R5B0ZZ,ICD10-PCS,Destruction of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB00ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB03ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB04ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB10ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB13ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB14ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB30ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB33ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB34ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB40ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB43ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB44ZZ,ICD10-PCS,Excision of C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB50ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB53ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB54ZZ,ICD10-PCS,Excision of C-thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB60ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB63ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB64ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB90ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB93ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RB94ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RBA0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RBA3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RBA4ZZ,ICD10-PCS,Excision of T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RBB0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RBB3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RBB4ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG0070,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG0071,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG007J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG00ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG0370,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG0371,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG037J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG03ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG0470,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG0471,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG047J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG04ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG1070,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG1071,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG107J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG10ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG1370,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG1371,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG137J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG13ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG1470,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG1471,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG147J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG14ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG2070,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG2071,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG207J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG20ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG2370,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG2371,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG237J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG23ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG2470,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG2471,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG247J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG24ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG4070,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG4071,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG407J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG40ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG4370,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG4371,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG437J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG43ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG4470,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG4471,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG447J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG44ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG6070,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG6071,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG607J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG60ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG6370,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG6371,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG637J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG63ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG6470,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG6471,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG647J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG64ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG7070,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG7071,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG707J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG70ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG7370,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG7371,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG737J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG73ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG7470,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG7471,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG747J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG74ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG8070,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG8071,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG807J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG80ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG8370,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG8371,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG837J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG83ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG8470,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG8471,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG847J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RG84ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA070,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA071,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA07J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA0ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA370,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA371,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA37J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA3ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA470,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA471,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA47J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RGA4ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH00BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH03BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RH04CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Occip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH04DZ,ICD10-PCS,Insert of Facet Stabl Dev into Occip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH10BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH10CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH10DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH13BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH13CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH13DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH14BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Cerv Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RH14CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Cerv Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH14DZ,ICD10-PCS,Insert of Facet Stabl Dev into Cerv Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH40BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RH40CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH40DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH43BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RH43CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH43DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH44BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RH44CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH44DZ,ICD10-PCS,Insert of Facet Stabl Dev into C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH60BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH60CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH60DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH63BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH63CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH63DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH64BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Thor Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RH64CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RH64DZ,ICD10-PCS,Insert of Facet Stabl Dev into Thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RHA0BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0RHA0CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RHA0DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RHA3BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0RHA3CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RHA3DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RHA4BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0RHA4CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RHA4DZ,ICD10-PCS,Insert of Facet Stabl Dev into T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RR30JZ,ICD10-PCS,Replacement of Cerv Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RR50JZ,ICD10-PCS,Replacement of C-thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RR90JZ,ICD10-PCS,Replacement of Thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RRB0JZ,ICD10-PCS,Replacement of T-lum Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RT30ZZ,ICD10-PCS,Resection of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RT40ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RT50ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RT90ZZ,ICD10-PCS,Resection of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RTB0ZZ,ICD10-PCS,Resection of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU00JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU03JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU04JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU10JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU13JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU14JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU40JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU43JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU44JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU50JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU53JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU54JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU60JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU63JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RU64JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RUA0JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RUA3JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RUA4JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RW30JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RW33JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RW34JZ,ICD10-PCS,Revision of Synth Sub in Cerv Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RW50JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RW53JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RW54JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RW90JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RW93JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RW94JZ,ICD10-PCS,Revision of Synth Sub in Thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RWB0JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RWB3JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0RWB4JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0S520ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0S523ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0S524ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0S540ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0S543ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0S544ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB00ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB03ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB04ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB20ZZ,ICD10-PCS,EXCISION LUMBAR VERTEBRAL DISC OPEN,,Fee Schedule,8271.00
Blue Shield,EPO,0SB23ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB24ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB30ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,EPO,0SB33ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB34ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB40ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL DISC OPEN,,Fee Schedule,8271.00
Blue Shield,EPO,0SB43ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB44ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB50ZZ,ICD10-PCS,EXCISION SACROCOCCYGEAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,EPO,0SB53ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB54ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB60ZZ,ICD10-PCS,EXCISION OF COCCYGEAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,EPO,0SB63ZZ,ICD10-PCS,Excision of Coccygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB64ZZ,ICD10-PCS,Excision of Coccygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB70ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB73ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB74ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB80ZZ,ICD10-PCS,EXCISION LEFT SACROILIAC JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,EPO,0SB83ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SB84ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG0070,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG0071,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG007J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG00ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG0370,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG0371,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG037J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG03ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG0470,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG0471,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG047J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG04ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG1070,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG1071,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG107J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG10ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG1370,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG1371,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG137J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG13ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG1470,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG1471,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG147J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG14ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG3070,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG3071,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG307J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG30ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG3370,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG3371,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG337J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG33ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG3470,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG3471,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG347J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34Z0,ICD10-PCS,Fusion of Lumsac Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34Z1,ICD10-PCS,Fusion of Lumsac Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG34ZJ,ICD10-PCS,Fusion of Lumsac Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG504Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG507Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG50JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG50KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG50ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG534Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG537Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG53JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG53KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG53ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG544Z,ICD10-PCS,Fusion of Sacrococcygeal Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG547Z,ICD10-PCS,Fusion Sacrococcygeal Jt w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG54JZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG54KZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG54ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG604Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG607Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG60JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG60KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG60ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG634Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG637Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG63JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG63KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG63ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG644Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG647Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG64JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG64KZ,ICD10-PCS,Fusion of Coccygeal Jt with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG64ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG704Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG707Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG70JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG70KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG70ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG734Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG737Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG73JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG73KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG73ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG744Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG747Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG74JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG74KZ,ICD10-PCS,Fusion R Sacroiliac Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG74ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG804Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG807Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG80JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG80KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG80ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG834Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG837Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG83JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG83KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG83ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG844Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG847Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG84JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SG84KZ,ICD10-PCS,Fusion L Sacroiliac Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SG84ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH00BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH03BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lum Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SH04CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH04DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH30BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SH30CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH30DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH33BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,0SH33CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH33DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH34BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SH34CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Lumsac Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SH34DZ,ICD10-PCS,Insert of Facet Stabl Dev into Lumsac Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR20JZ,ICD10-PCS,Replacement of Lum Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR40JZ,ICD10-PCS,Replacement of Lumsac Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR9019,ICD10-PCS,Replacement of R Hip Jt with Metal, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR901A,ICD10-PCS,Replacement of R Hip Jt with Metal, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR901Z,ICD10-PCS,Replacement of Right Hip Joint with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR9029,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SR902A,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SR902Z,ICD10-PCS,Replacement of R Hip Jt with Metal on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR9039,ICD10-PCS,Replacement of R Hip Jt with Ceramic, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR903A,ICD10-PCS,Replace of R Hip Jt with Ceramic, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR903Z,ICD10-PCS,REPLACE RT HIP JOINT CERAMIC SYNTH SUBST OPEN,,Fee Schedule,8271.00
Blue Shield,EPO,0SR9049,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SR904A,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SR904Z,ICD10-PCS,Replacement of R Hip Jt with Ceramic on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR907Z,ICD10-PCS,Replacement of Right Hip Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR90J9,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR90JA,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR90JZ,ICD10-PCS,Replacement of Right Hip Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SR90KZ,ICD10-PCS,Replacement of R Hip Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA009,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA00A,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA00Z,ICD10-PCS,REPLACEMENT RT HIP JOINT ACETAB SURF POLYETHYLENE SYNTH SUBS,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA019,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA01A,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA01Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA039,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA03A,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA03Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA07Z,ICD10-PCS,Replace of R Hip Jt, Acetab with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA0J9,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA0JA,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA0JZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRA0KZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB019,ICD10-PCS,Replacement of L Hip Jt with Metal, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB01A,ICD10-PCS,Replacement of L Hip Jt with Metal, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB01Z,ICD10-PCS,Replacement of Left Hip Joint with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB029,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB02A,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB02Z,ICD10-PCS,Replacement of L Hip Jt with Metal on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB039,ICD10-PCS,Replacement of L Hip Jt with Ceramic, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB03A,ICD10-PCS,Replace of L Hip Jt with Ceramic, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB03Z,ICD10-PCS,Replacement of Left Hip Joint with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB049,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB04A,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB04Z,ICD10-PCS,Replacement of L Hip Jt with Ceramic on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB07Z,ICD10-PCS,Replacement of Left Hip Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB0J9,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB0JA,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB0JZ,ICD10-PCS,Replacement of Left Hip Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRB0KZ,ICD10-PCS,Replacement of Left Hip Joint with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRC07Z,ICD10-PCS,Replacement of R Knee Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRC0J9,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRC0JA,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRC0JZ,ICD10-PCS,Replacement of R Knee Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRC0KZ,ICD10-PCS,Replacement of R Knee Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRD07Z,ICD10-PCS,Replacement of Left Knee Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRD0J9,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRD0JA,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRD0JZ,ICD10-PCS,Replacement of Left Knee Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRD0KZ,ICD10-PCS,Replacement of L Knee Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE009,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE00A,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE00Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Polyeth, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE019,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE01A,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE01Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE039,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE03A,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE03Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE07Z,ICD10-PCS,Replace of L Hip Jt, Acetab with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE0J9,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE0JA,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE0JZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRE0KZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR019,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR01A,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR01Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR039,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR03A,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR03Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR07Z,ICD10-PCS,Replace of R Hip Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR0J9,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR0JA,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR0JZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRR0KZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS019,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS01A,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS01Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS039,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS03A,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS03Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS07Z,ICD10-PCS,Replace of L Hip Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS0J9,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS0JA,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS0JZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRS0KZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRT07Z,ICD10-PCS,Replace of R Knee Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRT0J9,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRT0JA,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRT0JZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRT0KZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRU07Z,ICD10-PCS,Replace of L Knee Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRU0J9,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRU0JA,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRU0JZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRU0KZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRV07Z,ICD10-PCS,Replace of R Knee Jt, Tibial with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRV0J9,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRV0JA,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRV0JZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRV0KZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRW07Z,ICD10-PCS,Replace of L Knee Jt, Tibial with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRW0J9,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRW0JA,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,EPO,0SRW0JZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SRW0KZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0ST20ZZ,ICD10-PCS,Resection of Lumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0ST40ZZ,ICD10-PCS,Resection of Lumbosacral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU00JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU03JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU04JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU30JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU33JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU34JZ,ICD10-PCS,Supplement Lumsac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU50JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU53JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU54JZ,ICD10-PCS,Supplement Sacrococcygeal Jt w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,EPO,0SU60JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU63JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU64JZ,ICD10-PCS,Supplement Coccygeal Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SU90BZ,ICD10-PCS,Supplement Right Hip Joint with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SUA0BZ,ICD10-PCS,Supplement R Hip Jt, Acetab with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SUB0BZ,ICD10-PCS,Supplement Left Hip Joint with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SUE0BZ,ICD10-PCS,Supplement L Hip Jt, Acetab with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SUR0BZ,ICD10-PCS,Supplement R Hip Jt, Femoral with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SUS0BZ,ICD10-PCS,Supplement L Hip Jt, Femoral with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SW20JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SW23JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SW24JZ,ICD10-PCS,Revision of Synth Sub in Lum Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SW40JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SW43JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SW44JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SW90JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SW93JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SW94JZ,ICD10-PCS,Revision of Synth Sub in R Hip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SWB0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SWB3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SWB4JZ,ICD10-PCS,Revision of Synth Sub in L Hip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SWC0JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SWC3JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SWC4JZ,ICD10-PCS,Revision of Synth Sub in R Knee Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SWD0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SWD3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0SWD4JZ,ICD10-PCS,Revision of Synth Sub in L Knee Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0WFD0ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0WFD3ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0WFD4ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,EPO,0WFDXZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, External Approach,,Fee Schedule,8271.00
Blue Shield,EPO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Fee Schedule,987.79
Blue Shield,EPO,10022,CPT4/HCPCS,FNA W/IMAGE,,Fee Schedule,3198.57
Blue Shield,EPO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Fee Schedule,3198.57
Blue Shield,EPO,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Fee Schedule,3198.57
Blue Shield,EPO,10040,CPT4/HCPCS,ACNE SURGERY,,Fee Schedule,987.79
Blue Shield,EPO,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Fee Schedule,987.79
Blue Shield,EPO,10061,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,10080,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Fee Schedule,987.79
Blue Shield,EPO,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Fee Schedule,3198.57
Blue Shield,EPO,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,EPO,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,EPO,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Fee Schedule,3198.57
Blue Shield,EPO,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Fee Schedule,987.79
Blue Shield,EPO,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Fee Schedule,4280.44
Blue Shield,EPO,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Fee Schedule,987.79
Blue Shield,EPO,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Fee Schedule,987.79
Blue Shield,EPO,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,Fee Schedule,3198.57
Blue Shield,EPO,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,Fee Schedule,3198.57
Blue Shield,EPO,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,Fee Schedule,3198.57
Blue Shield,EPO,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,Fee Schedule,987.79
Blue Shield,EPO,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Fee Schedule,4280.44
Blue Shield,EPO,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Fee Schedule,4280.44
Blue Shield,EPO,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Fee Schedule,4280.44
Blue Shield,EPO,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,EPO,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,EPO,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,EPO,11055,CPT4/HCPCS,TRIM SKIN LESION,,Fee Schedule,987.79
Blue Shield,EPO,11056,CPT4/HCPCS,TRIM SKIN LESIONS 2 TO 4,,Fee Schedule,987.79
Blue Shield,EPO,11057,CPT4/HCPCS,TRIM SKIN LESIONS OVER 4,,Fee Schedule,987.79
Blue Shield,EPO,11100,CPT4/HCPCS,BIOPSY SKIN LESION,,Fee Schedule,987.79
Blue Shield,EPO,11101,CPT4/HCPCS,BIOPSY SKIN ADD-ON,,Fee Schedule,987.79
Blue Shield,EPO,11200,CPT4/HCPCS,REMOVAL OF SKIN TAGS 2.0 CM,,Fee Schedule,987.79
Blue Shield,EPO,11305,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Fee Schedule,987.79
Blue Shield,EPO,11306,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Fee Schedule,987.79
Blue Shield,EPO,11307,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Fee Schedule,987.79
Blue Shield,EPO,11308,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Fee Schedule,987.79
Blue Shield,EPO,11310,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Fee Schedule,987.79
Blue Shield,EPO,11311,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Fee Schedule,987.79
Blue Shield,EPO,11312,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Fee Schedule,987.79
Blue Shield,EPO,11313,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Fee Schedule,987.79
Blue Shield,EPO,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,Fee Schedule,3198.57
Blue Shield,EPO,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,EPO,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,EPO,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,Fee Schedule,3198.57
Blue Shield,EPO,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,Fee Schedule,3198.57
Blue Shield,EPO,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,Fee Schedule,4280.44
Blue Shield,EPO,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Fee Schedule,3198.57
Blue Shield,EPO,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Fee Schedule,3198.57
Blue Shield,EPO,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Fee Schedule,3198.57
Blue Shield,EPO,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Fee Schedule,3198.57
Blue Shield,EPO,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Fee Schedule,4280.44
Blue Shield,EPO,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Fee Schedule,3198.57
Blue Shield,EPO,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,EPO,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,EPO,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Fee Schedule,3198.57
Blue Shield,EPO,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Fee Schedule,3198.57
Blue Shield,EPO,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,EPO,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,EPO,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,EPO,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,EPO,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,EPO,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,EPO,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Fee Schedule,3198.57
Blue Shield,EPO,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,EPO,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,EPO,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Fee Schedule,3198.57
Blue Shield,EPO,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Fee Schedule,3198.57
Blue Shield,EPO,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Fee Schedule,3198.57
Blue Shield,EPO,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Fee Schedule,3198.57
Blue Shield,EPO,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Fee Schedule,3198.57
Blue Shield,EPO,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Fee Schedule,4280.44
Blue Shield,EPO,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Fee Schedule,3198.57
Blue Shield,EPO,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Fee Schedule,3198.57
Blue Shield,EPO,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Fee Schedule,3198.57
Blue Shield,EPO,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Fee Schedule,3198.57
Blue Shield,EPO,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Fee Schedule,4280.44
Blue Shield,EPO,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,11719,CPT4/HCPCS,TRIM NAIL(S) ANY NUMBER,,Fee Schedule,987.79
Blue Shield,EPO,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Fee Schedule,987.79
Blue Shield,EPO,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Fee Schedule,987.79
Blue Shield,EPO,11730,CPT4/HCPCS,REMOVAL OF NAIL PLATE,,Fee Schedule,987.79
Blue Shield,EPO,11732,CPT4/HCPCS,REMOVE NAIL PLATE ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,11740,CPT4/HCPCS,DRAIN BLOOD FROM UNDER NAIL,,Fee Schedule,987.79
Blue Shield,EPO,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,EPO,11755,CPT4/HCPCS,BIOPSY NAIL UNIT,,Fee Schedule,3198.57
Blue Shield,EPO,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,EPO,11762,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,EPO,11765,CPT4/HCPCS,EXCISION OF NAIL FOLD TOE,,Fee Schedule,987.79
Blue Shield,EPO,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Fee Schedule,4891.93
Blue Shield,EPO,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Fee Schedule,4891.93
Blue Shield,EPO,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Fee Schedule,4891.93
Blue Shield,EPO,11900,CPT4/HCPCS,INJECT SKIN LESIONS 7,,Fee Schedule,987.79
Blue Shield,EPO,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Fee Schedule,3198.57
Blue Shield,EPO,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Fee Schedule,987.79
Blue Shield,EPO,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Fee Schedule,987.79
Blue Shield,EPO,11950,CPT4/HCPCS,TX CONTOUR DEFECTS 1 CC/<,,Fee Schedule,987.79
Blue Shield,EPO,11951,CPT4/HCPCS,TX CONTOUR DEFECTS 1.1-5.0CC,,Fee Schedule,987.79
Blue Shield,EPO,11952,CPT4/HCPCS,TX CONTOUR DEFECTS 5.1-10CC,,Fee Schedule,987.79
Blue Shield,EPO,11954,CPT4/HCPCS,TX CONTOUR DEFECTS >10.0 CC,,Fee Schedule,987.79
Blue Shield,EPO,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Fee Schedule,4280.44
Blue Shield,EPO,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Fee Schedule,4891.93
Blue Shield,EPO,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Fee Schedule,3198.57
Blue Shield,EPO,11976,CPT4/HCPCS,REMOVE CONTRACEPTIVE CAPSULE,,Fee Schedule,3198.57
Blue Shield,EPO,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Fee Schedule,987.79
Blue Shield,EPO,11981,CPT4/HCPCS,INSERT DRUG IMPLANT DEVICE,,Fee Schedule,987.79
Blue Shield,EPO,11982,CPT4/HCPCS,REMOVE DRUG IMPLANT DEVICE,,Fee Schedule,987.79
Blue Shield,EPO,11983,CPT4/HCPCS,REMOVE/INSERT DRUG IMPLANT,,Fee Schedule,3198.57
Blue Shield,EPO,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Fee Schedule,987.79
Blue Shield,EPO,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,Fee Schedule,987.79
Blue Shield,EPO,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Fee Schedule,987.79
Blue Shield,EPO,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Fee Schedule,4280.44
Blue Shield,EPO,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Fee Schedule,4280.44
Blue Shield,EPO,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Fee Schedule,4280.44
Blue Shield,EPO,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,Fee Schedule,987.79
Blue Shield,EPO,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,Fee Schedule,987.79
Blue Shield,EPO,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Fee Schedule,987.79
Blue Shield,EPO,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Fee Schedule,987.79
Blue Shield,EPO,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Fee Schedule,4280.44
Blue Shield,EPO,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Fee Schedule,4280.44
Blue Shield,EPO,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Fee Schedule,4280.44
Blue Shield,EPO,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Fee Schedule,3198.57
Blue Shield,EPO,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Fee Schedule,3198.57
Blue Shield,EPO,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Fee Schedule,4280.44
Blue Shield,EPO,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Fee Schedule,4280.44
Blue Shield,EPO,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Fee Schedule,4280.44
Blue Shield,EPO,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Fee Schedule,4280.44
Blue Shield,EPO,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Fee Schedule,3198.57
Blue Shield,EPO,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Fee Schedule,3198.57
Blue Shield,EPO,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Fee Schedule,4280.44
Blue Shield,EPO,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Fee Schedule,4280.44
Blue Shield,EPO,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Fee Schedule,4280.44
Blue Shield,EPO,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Fee Schedule,4280.44
Blue Shield,EPO,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Fee Schedule,3198.57
Blue Shield,EPO,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Fee Schedule,3198.57
Blue Shield,EPO,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Fee Schedule,3198.57
Blue Shield,EPO,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Fee Schedule,4280.44
Blue Shield,EPO,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Fee Schedule,4280.44
Blue Shield,EPO,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Fee Schedule,4280.44
Blue Shield,EPO,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Fee Schedule,4280.44
Blue Shield,EPO,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Fee Schedule,4280.44
Blue Shield,EPO,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Fee Schedule,3198.57
Blue Shield,EPO,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Fee Schedule,4280.44
Blue Shield,EPO,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Fee Schedule,3198.57
Blue Shield,EPO,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,4280.44
Blue Shield,EPO,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,4891.93
Blue Shield,EPO,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,3198.57
Blue Shield,EPO,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Fee Schedule,3198.57
Blue Shield,EPO,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Fee Schedule,4280.44
Blue Shield,EPO,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,EPO,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Fee Schedule,4891.93
Blue Shield,EPO,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Fee Schedule,4891.93
Blue Shield,EPO,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Fee Schedule,4891.93
Blue Shield,EPO,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Fee Schedule,4280.44
Blue Shield,EPO,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Fee Schedule,4891.93
Blue Shield,EPO,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Fee Schedule,4891.93
Blue Shield,EPO,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Fee Schedule,4891.93
Blue Shield,EPO,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Fee Schedule,4891.93
Blue Shield,EPO,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Fee Schedule,3198.57
Blue Shield,EPO,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Fee Schedule,4891.93
Blue Shield,EPO,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,EPO,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Fee Schedule,3198.57
Blue Shield,EPO,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Fee Schedule,4280.44
Blue Shield,EPO,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Fee Schedule,3198.57
Blue Shield,EPO,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,EPO,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Fee Schedule,4891.93
Blue Shield,EPO,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,EPO,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,EPO,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,EPO,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Fee Schedule,4891.93
Blue Shield,EPO,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,EPO,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,EPO,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Fee Schedule,3198.57
Blue Shield,EPO,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,EPO,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Fee Schedule,3198.57
Blue Shield,EPO,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Fee Schedule,4280.44
Blue Shield,EPO,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Fee Schedule,3198.57
Blue Shield,EPO,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Fee Schedule,3198.57
Blue Shield,EPO,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Fee Schedule,4891.93
Blue Shield,EPO,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Fee Schedule,4280.44
Blue Shield,EPO,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,EPO,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,EPO,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Fee Schedule,4891.93
Blue Shield,EPO,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4891.93
Blue Shield,EPO,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Fee Schedule,4280.44
Blue Shield,EPO,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,EPO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,EPO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Fee Schedule,987.79
Blue Shield,EPO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Fee Schedule,4280.44
Blue Shield,EPO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Fee Schedule,987.79
Blue Shield,EPO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Fee Schedule,4280.44
Blue Shield,EPO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Fee Schedule,987.79
Blue Shield,EPO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Fee Schedule,4280.44
Blue Shield,EPO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Fee Schedule,987.79
Blue Shield,EPO,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Fee Schedule,4891.93
Blue Shield,EPO,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Fee Schedule,4891.93
Blue Shield,EPO,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Fee Schedule,4891.93
Blue Shield,EPO,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Fee Schedule,4891.93
Blue Shield,EPO,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Fee Schedule,4891.93
Blue Shield,EPO,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Fee Schedule,4891.93
Blue Shield,EPO,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Fee Schedule,6049.05
Blue Shield,EPO,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Fee Schedule,4891.93
Blue Shield,EPO,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Fee Schedule,6876.92
Blue Shield,EPO,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Fee Schedule,4891.93
Blue Shield,EPO,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Fee Schedule,4891.93
Blue Shield,EPO,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Fee Schedule,4891.93
Blue Shield,EPO,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Fee Schedule,4891.93
Blue Shield,EPO,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Fee Schedule,4891.93
Blue Shield,EPO,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Fee Schedule,4891.93
Blue Shield,EPO,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Fee Schedule,4280.44
Blue Shield,EPO,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,EPO,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,EPO,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,EPO,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Fee Schedule,4891.93
Blue Shield,EPO,15775,CPT4/HCPCS,HAIR TRNSPL 1-15 PUNCH GRFTS,,Fee Schedule,4891.93
Blue Shield,EPO,15776,CPT4/HCPCS,HAIR TRNSPL >15 PUNCH GRAFTS,,Fee Schedule,4891.93
Blue Shield,EPO,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,Fee Schedule,4891.93
Blue Shield,EPO,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,Fee Schedule,3198.57
Blue Shield,EPO,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,Fee Schedule,3198.57
Blue Shield,EPO,15783,CPT4/HCPCS,DERMABRASION SUPRFL ANY SITE,,Fee Schedule,987.79
Blue Shield,EPO,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,Fee Schedule,987.79
Blue Shield,EPO,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,Fee Schedule,987.79
Blue Shield,EPO,15788,CPT4/HCPCS,CHEMICAL PEEL FACE EPIDERM,,Fee Schedule,987.79
Blue Shield,EPO,15789,CPT4/HCPCS,CHEMICAL PEEL FACE DERMAL,,Fee Schedule,987.79
Blue Shield,EPO,15792,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Fee Schedule,987.79
Blue Shield,EPO,15793,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Fee Schedule,987.79
Blue Shield,EPO,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Fee Schedule,3198.57
Blue Shield,EPO,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Fee Schedule,6876.92
Blue Shield,EPO,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Fee Schedule,4891.93
Blue Shield,EPO,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Fee Schedule,4891.93
Blue Shield,EPO,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Fee Schedule,4891.93
Blue Shield,EPO,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Fee Schedule,4891.93
Blue Shield,EPO,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Fee Schedule,6876.92
Blue Shield,EPO,15830,CPT4/HCPCS,EXC SKIN ABD,,Fee Schedule,4891.93
Blue Shield,EPO,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Fee Schedule,4891.93
Blue Shield,EPO,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Fee Schedule,4891.93
Blue Shield,EPO,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Fee Schedule,4891.93
Blue Shield,EPO,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Fee Schedule,4891.93
Blue Shield,EPO,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Fee Schedule,3198.57
Blue Shield,EPO,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Fee Schedule,3198.57
Blue Shield,EPO,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Fee Schedule,3198.57
Blue Shield,EPO,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Fee Schedule,3198.57
Blue Shield,EPO,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Fee Schedule,6049.05
Blue Shield,EPO,15847,CPT4/HCPCS,EXC SKIN ABD ADD-ON,,Fee Schedule,4891.93
Blue Shield,EPO,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Fee Schedule,3198.57
Blue Shield,EPO,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Fee Schedule,3198.57
Blue Shield,EPO,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Fee Schedule,3198.57
Blue Shield,EPO,15860,CPT4/HCPCS,TEST FOR BLOOD FLOW IN GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Fee Schedule,4891.93
Blue Shield,EPO,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Fee Schedule,4891.93
Blue Shield,EPO,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Fee Schedule,4891.93
Blue Shield,EPO,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Fee Schedule,4891.93
Blue Shield,EPO,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Fee Schedule,4891.93
Blue Shield,EPO,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Fee Schedule,6049.05
Blue Shield,EPO,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,EPO,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,EPO,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,EPO,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,EPO,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,EPO,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,EPO,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,EPO,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,EPO,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,EPO,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,EPO,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,EPO,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,EPO,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,EPO,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,EPO,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,EPO,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,EPO,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,EPO,15999,CPT4/HCPCS,REMOVAL OF PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,EPO,16000,CPT4/HCPCS,INITIAL TREATMENT OF BURN(S),,Fee Schedule,987.79
Blue Shield,EPO,16020,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN S,,Fee Schedule,987.79
Blue Shield,EPO,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Fee Schedule,4280.44
Blue Shield,EPO,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Fee Schedule,4280.44
Blue Shield,EPO,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Fee Schedule,3198.57
Blue Shield,EPO,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,Fee Schedule,3198.57
Blue Shield,EPO,17000,CPT4/HCPCS,DESTRUCT PREMALG LESION,,Fee Schedule,987.79
Blue Shield,EPO,17003,CPT4/HCPCS,DESTRUCT PREMALG LES 2-14,,Fee Schedule,987.79
Blue Shield,EPO,17004,CPT4/HCPCS,DESTROY PREMAL LESIONS 15/>,,Fee Schedule,987.79
Blue Shield,EPO,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,EPO,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,EPO,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,EPO,17110,CPT4/HCPCS,DESTRUCT B9 LESION 1-14,,Fee Schedule,987.79
Blue Shield,EPO,17111,CPT4/HCPCS,DESTRUCT LESION 15 OR MORE,,Fee Schedule,987.79
Blue Shield,EPO,17250,CPT4/HCPCS,CHEM CAUT OF GRANLTJ TISSUE,,Fee Schedule,987.79
Blue Shield,EPO,17260,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17261,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17262,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17263,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17264,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17266,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17270,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17271,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17272,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17273,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17274,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17276,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17280,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17281,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17282,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17283,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17284,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17286,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,17311,CPT4/HCPCS,MOHS 1 STAGE H/N/HF/G,,Fee Schedule,3198.57
Blue Shield,EPO,17312,CPT4/HCPCS,MOHS ADDL STAGE,,Fee Schedule,3198.57
Blue Shield,EPO,17313,CPT4/HCPCS,MOHS 1 STAGE T/A/L,,Fee Schedule,3198.57
Blue Shield,EPO,17314,CPT4/HCPCS,MOHS ADDL STAGE T/A/L,,Fee Schedule,3198.57
Blue Shield,EPO,17315,CPT4/HCPCS,MOHS SURG ADDL BLOCK,,Fee Schedule,3198.57
Blue Shield,EPO,17340,CPT4/HCPCS,CRYOTHERAPY OF SKIN,,Fee Schedule,987.79
Blue Shield,EPO,17360,CPT4/HCPCS,SKIN PEEL THERAPY,,Fee Schedule,987.79
Blue Shield,EPO,17380,CPT4/HCPCS,HAIR REMOVAL BY ELECTROLYSIS,,Fee Schedule,987.79
Blue Shield,EPO,17999,CPT4/HCPCS,SKIN TISSUE PROCEDURE,,Fee Schedule,987.79
Blue Shield,EPO,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Fee Schedule,987.79
Blue Shield,EPO,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Fee Schedule,987.79
Blue Shield,EPO,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Fee Schedule,4280.44
Blue Shield,EPO,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Fee Schedule,4280.44
Blue Shield,EPO,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Fee Schedule,4280.44
Blue Shield,EPO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Fee Schedule,4280.44
Blue Shield,EPO,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Fee Schedule,3198.57
Blue Shield,EPO,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Fee Schedule,4280.44
Blue Shield,EPO,19105,CPT4/HCPCS,CRYOSURG ABLATE FA EACH,,Fee Schedule,3198.57
Blue Shield,EPO,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Fee Schedule,4280.44
Blue Shield,EPO,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Fee Schedule,4891.93
Blue Shield,EPO,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Fee Schedule,4891.93
Blue Shield,EPO,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Fee Schedule,4891.93
Blue Shield,EPO,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Fee Schedule,4891.93
Blue Shield,EPO,19260,CPT4/HCPCS,REMOVAL OF CHEST WALL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,19271,CPT4/HCPCS,REVISION OF CHEST WALL,,Fee Schedule,4280.44
Blue Shield,EPO,19272,CPT4/HCPCS,EXTENSIVE CHEST WALL SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Fee Schedule,12850.71
Blue Shield,EPO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Fee Schedule,12850.71
Blue Shield,EPO,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Fee Schedule,12850.71
Blue Shield,EPO,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Fee Schedule,12850.71
Blue Shield,EPO,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Fee Schedule,6049.05
Blue Shield,EPO,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Fee Schedule,4891.93
Blue Shield,EPO,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Fee Schedule,9548.66
Blue Shield,EPO,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Fee Schedule,6049.05
Blue Shield,EPO,19304,CPT4/HCPCS,MAST SUBQ,,Fee Schedule,6049.05
Blue Shield,EPO,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Fee Schedule,6049.05
Blue Shield,EPO,19318,CPT4/HCPCS,BREAST REDUCTION,,Fee Schedule,6049.05
Blue Shield,EPO,19324,CPT4/HCPCS,ENLARGE BREAST,,Fee Schedule,6049.05
Blue Shield,EPO,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Fee Schedule,12850.71
Blue Shield,EPO,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Fee Schedule,3198.57
Blue Shield,EPO,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Fee Schedule,3198.57
Blue Shield,EPO,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Fee Schedule,4280.44
Blue Shield,EPO,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Fee Schedule,4891.93
Blue Shield,EPO,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,EPO,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Fee Schedule,6049.05
Blue Shield,EPO,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Fee Schedule,6876.92
Blue Shield,EPO,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,Fee Schedule,4280.44
Blue Shield,EPO,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Fee Schedule,7902.34
Blue Shield,EPO,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Fee Schedule,6876.92
Blue Shield,EPO,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,Fee Schedule,4891.93
Blue Shield,EPO,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,Fee Schedule,6049.05
Blue Shield,EPO,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,Fee Schedule,6049.05
Blue Shield,EPO,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Fee Schedule,6049.05
Blue Shield,EPO,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Fee Schedule,6049.05
Blue Shield,EPO,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Fee Schedule,6876.92
Blue Shield,EPO,19396,CPT4/HCPCS,DESIGN CUSTOM BREAST IMPLANT,,Fee Schedule,7902.34
Blue Shield,EPO,19499,CPT4/HCPCS,BREAST SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,EPO,20005,CPT4/HCPCS,I&D ABSCESS SUBFASCIAL,,Fee Schedule,4280.44
Blue Shield,EPO,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,Fee Schedule,3198.57
Blue Shield,EPO,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,Fee Schedule,4280.44
Blue Shield,EPO,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,Fee Schedule,4280.44
Blue Shield,EPO,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Fee Schedule,3198.57
Blue Shield,EPO,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,Fee Schedule,9548.66
Blue Shield,EPO,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Fee Schedule,4280.44
Blue Shield,EPO,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Fee Schedule,4891.93
Blue Shield,EPO,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Fee Schedule,3198.57
Blue Shield,EPO,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Fee Schedule,3198.57
Blue Shield,EPO,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Fee Schedule,4280.44
Blue Shield,EPO,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Fee Schedule,4280.44
Blue Shield,EPO,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Fee Schedule,4891.93
Blue Shield,EPO,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Fee Schedule,4891.93
Blue Shield,EPO,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Fee Schedule,4891.93
Blue Shield,EPO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Fee Schedule,987.79
Blue Shield,EPO,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,EPO,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,4891.93
Blue Shield,EPO,20526,CPT4/HCPCS,THER INJECTION CARP TUNNEL,,Fee Schedule,987.79
Blue Shield,EPO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Fee Schedule,987.79
Blue Shield,EPO,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Fee Schedule,987.79
Blue Shield,EPO,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Fee Schedule,987.79
Blue Shield,EPO,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Fee Schedule,987.79
Blue Shield,EPO,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Fee Schedule,987.79
Blue Shield,EPO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Fee Schedule,3198.57
Blue Shield,EPO,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,EPO,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,EPO,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,EPO,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,EPO,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,EPO,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,EPO,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Fee Schedule,987.79
Blue Shield,EPO,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Fee Schedule,987.79
Blue Shield,EPO,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Fee Schedule,4891.93
Blue Shield,EPO,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Fee Schedule,3198.57
Blue Shield,EPO,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Fee Schedule,3198.57
Blue Shield,EPO,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Fee Schedule,3198.57
Blue Shield,EPO,20664,CPT4/HCPCS,APPLICATION OF HALO,,Fee Schedule,3198.57
Blue Shield,EPO,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Fee Schedule,3198.57
Blue Shield,EPO,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Fee Schedule,4891.93
Blue Shield,EPO,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Fee Schedule,4280.44
Blue Shield,EPO,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Fee Schedule,4891.93
Blue Shield,EPO,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Fee Schedule,4891.93
Blue Shield,EPO,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Fee Schedule,4891.93
Blue Shield,EPO,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Fee Schedule,4280.44
Blue Shield,EPO,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,Fee Schedule,7902.34
Blue Shield,EPO,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,Fee Schedule,12850.71
Blue Shield,EPO,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,Fee Schedule,12850.71
Blue Shield,EPO,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Fee Schedule,12850.71
Blue Shield,EPO,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Fee Schedule,12850.71
Blue Shield,EPO,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Fee Schedule,12850.71
Blue Shield,EPO,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Fee Schedule,12850.71
Blue Shield,EPO,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,Fee Schedule,7902.34
Blue Shield,EPO,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,EPO,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,EPO,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,EPO,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,EPO,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,20926,CPT4/HCPCS,REMOVAL OF TISSUE FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Fee Schedule,3198.57
Blue Shield,EPO,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Fee Schedule,987.79
Blue Shield,EPO,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Fee Schedule,9548.66
Blue Shield,EPO,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,Fee Schedule,7902.34
Blue Shield,EPO,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,Fee Schedule,6876.92
Blue Shield,EPO,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Fee Schedule,7902.34
Blue Shield,EPO,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Fee Schedule,9548.66
Blue Shield,EPO,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Fee Schedule,9548.66
Blue Shield,EPO,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Fee Schedule,6049.05
Blue Shield,EPO,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Fee Schedule,9548.66
Blue Shield,EPO,20974,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Fee Schedule,987.79
Blue Shield,EPO,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Fee Schedule,4280.44
Blue Shield,EPO,20979,CPT4/HCPCS,US BONE STIMULATION,,Fee Schedule,987.79
Blue Shield,EPO,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Fee Schedule,9548.66
Blue Shield,EPO,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Fee Schedule,9548.66
Blue Shield,EPO,20999,CPT4/HCPCS,MUSCULOSKELETAL SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Fee Schedule,4280.44
Blue Shield,EPO,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Fee Schedule,4891.93
Blue Shield,EPO,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Fee Schedule,4891.93
Blue Shield,EPO,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Fee Schedule,4280.44
Blue Shield,EPO,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Fee Schedule,4280.44
Blue Shield,EPO,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Fee Schedule,6049.05
Blue Shield,EPO,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Fee Schedule,6049.05
Blue Shield,EPO,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Fee Schedule,6049.05
Blue Shield,EPO,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Fee Schedule,4891.93
Blue Shield,EPO,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Fee Schedule,4280.44
Blue Shield,EPO,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Fee Schedule,4280.44
Blue Shield,EPO,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Fee Schedule,9548.66
Blue Shield,EPO,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Fee Schedule,9548.66
Blue Shield,EPO,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Fee Schedule,4280.44
Blue Shield,EPO,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Fee Schedule,4891.93
Blue Shield,EPO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Fee Schedule,3198.57
Blue Shield,EPO,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,6049.05
Blue Shield,EPO,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,EPO,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,EPO,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,EPO,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,EPO,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,EPO,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,EPO,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,EPO,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,EPO,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,EPO,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,EPO,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,EPO,21089,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,EPO,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Fee Schedule,4280.44
Blue Shield,EPO,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Fee Schedule,3198.57
Blue Shield,EPO,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,6049.05
Blue Shield,EPO,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,EPO,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,EPO,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,EPO,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Fee Schedule,6049.05
Blue Shield,EPO,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Fee Schedule,12850.71
Blue Shield,EPO,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,6049.05
Blue Shield,EPO,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,9548.66
Blue Shield,EPO,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,9548.66
Blue Shield,EPO,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,Fee Schedule,4891.93
Blue Shield,EPO,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,Fee Schedule,6049.05
Blue Shield,EPO,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,Fee Schedule,6049.05
Blue Shield,EPO,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,Fee Schedule,6876.92
Blue Shield,EPO,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,Fee Schedule,6876.92
Blue Shield,EPO,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,Fee Schedule,9548.66
Blue Shield,EPO,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Fee Schedule,4891.93
Blue Shield,EPO,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Fee Schedule,6049.05
Blue Shield,EPO,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Fee Schedule,6049.05
Blue Shield,EPO,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Fee Schedule,6049.05
Blue Shield,EPO,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Fee Schedule,9548.66
Blue Shield,EPO,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6876.92
Blue Shield,EPO,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6876.92
Blue Shield,EPO,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6049.05
Blue Shield,EPO,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,Fee Schedule,4891.93
Blue Shield,EPO,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Fee Schedule,3198.57
Blue Shield,EPO,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,Fee Schedule,4280.44
Blue Shield,EPO,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Fee Schedule,9548.66
Blue Shield,EPO,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Fee Schedule,9548.66
Blue Shield,EPO,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Fee Schedule,6876.92
Blue Shield,EPO,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Fee Schedule,9548.66
Blue Shield,EPO,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Fee Schedule,6876.92
Blue Shield,EPO,21210,CPT4/HCPCS,FACE BONE GRAFT,,Fee Schedule,9548.66
Blue Shield,EPO,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Fee Schedule,9548.66
Blue Shield,EPO,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Fee Schedule,9548.66
Blue Shield,EPO,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Fee Schedule,9548.66
Blue Shield,EPO,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Fee Schedule,9548.66
Blue Shield,EPO,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,EPO,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,EPO,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Fee Schedule,6049.05
Blue Shield,EPO,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,EPO,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,EPO,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Fee Schedule,4280.44
Blue Shield,EPO,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,Fee Schedule,4280.44
Blue Shield,EPO,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,EPO,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,EPO,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,EPO,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,EPO,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,4280.44
Blue Shield,EPO,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Fee Schedule,6876.92
Blue Shield,EPO,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Fee Schedule,9548.66
Blue Shield,EPO,21280,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,6876.92
Blue Shield,EPO,21282,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,6876.92
Blue Shield,EPO,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Fee Schedule,3198.57
Blue Shield,EPO,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Fee Schedule,3198.57
Blue Shield,EPO,21299,CPT4/HCPCS,CRANIO/MAXILLOFACIAL SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Fee Schedule,4280.44
Blue Shield,EPO,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Fee Schedule,4280.44
Blue Shield,EPO,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Fee Schedule,4280.44
Blue Shield,EPO,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Fee Schedule,6049.05
Blue Shield,EPO,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Fee Schedule,6876.92
Blue Shield,EPO,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Fee Schedule,9548.66
Blue Shield,EPO,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Fee Schedule,6049.05
Blue Shield,EPO,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Fee Schedule,4280.44
Blue Shield,EPO,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Fee Schedule,6049.05
Blue Shield,EPO,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Fee Schedule,6876.92
Blue Shield,EPO,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Fee Schedule,6049.05
Blue Shield,EPO,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Fee Schedule,3198.57
Blue Shield,EPO,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Fee Schedule,4280.44
Blue Shield,EPO,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Fee Schedule,9548.66
Blue Shield,EPO,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Fee Schedule,3198.57
Blue Shield,EPO,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Fee Schedule,3198.57
Blue Shield,EPO,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Fee Schedule,3198.57
Blue Shield,EPO,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Fee Schedule,3198.57
Blue Shield,EPO,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Fee Schedule,4280.44
Blue Shield,EPO,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Fee Schedule,3198.57
Blue Shield,EPO,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Fee Schedule,3198.57
Blue Shield,EPO,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Fee Schedule,3198.57
Blue Shield,EPO,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Fee Schedule,9548.66
Blue Shield,EPO,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Fee Schedule,3198.57
Blue Shield,EPO,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Fee Schedule,4280.44
Blue Shield,EPO,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Fee Schedule,4891.93
Blue Shield,EPO,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,Fee Schedule,3198.57
Blue Shield,EPO,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6876.92
Blue Shield,EPO,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6876.92
Blue Shield,EPO,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,9548.66
Blue Shield,EPO,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Fee Schedule,3198.57
Blue Shield,EPO,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Fee Schedule,4280.44
Blue Shield,EPO,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Fee Schedule,4891.93
Blue Shield,EPO,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Fee Schedule,4280.44
Blue Shield,EPO,21499,CPT4/HCPCS,HEAD SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,EPO,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Fee Schedule,4280.44
Blue Shield,EPO,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Fee Schedule,4280.44
Blue Shield,EPO,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,3198.57
Blue Shield,EPO,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Fee Schedule,3198.57
Blue Shield,EPO,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,EPO,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,EPO,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Fee Schedule,3198.57
Blue Shield,EPO,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,EPO,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,EPO,21615,CPT4/HCPCS,REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,EPO,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,Fee Schedule,4280.44
Blue Shield,EPO,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Fee Schedule,3198.57
Blue Shield,EPO,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,Fee Schedule,4280.44
Blue Shield,EPO,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Fee Schedule,3198.57
Blue Shield,EPO,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4280.44
Blue Shield,EPO,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,Fee Schedule,4280.44
Blue Shield,EPO,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4891.93
Blue Shield,EPO,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4891.93
Blue Shield,EPO,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Fee Schedule,4280.44
Blue Shield,EPO,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Fee Schedule,9548.66
Blue Shield,EPO,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Fee Schedule,9548.66
Blue Shield,EPO,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,Fee Schedule,3198.57
Blue Shield,EPO,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Fee Schedule,4891.93
Blue Shield,EPO,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,21899,CPT4/HCPCS,NECK/CHEST SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Fee Schedule,3198.57
Blue Shield,EPO,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Fee Schedule,4280.44
Blue Shield,EPO,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,EPO,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Fee Schedule,9548.66
Blue Shield,EPO,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Fee Schedule,9548.66
Blue Shield,EPO,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Fee Schedule,9548.66
Blue Shield,EPO,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Fee Schedule,9548.66
Blue Shield,EPO,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Fee Schedule,3198.57
Blue Shield,EPO,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Fee Schedule,3198.57
Blue Shield,EPO,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Fee Schedule,3198.57
Blue Shield,EPO,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,EPO,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,Fee Schedule,4891.93
Blue Shield,EPO,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,Fee Schedule,4280.44
Blue Shield,EPO,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,Fee Schedule,4891.93
Blue Shield,EPO,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,EPO,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,Fee Schedule,4891.93
Blue Shield,EPO,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,Fee Schedule,4280.44
Blue Shield,EPO,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,Fee Schedule,4891.93
Blue Shield,EPO,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,EPO,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Fee Schedule,3198.57
Blue Shield,EPO,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Fee Schedule,4280.44
Blue Shield,EPO,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Fee Schedule,4891.93
Blue Shield,EPO,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Fee Schedule,3198.57
Blue Shield,EPO,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Fee Schedule,4280.44
Blue Shield,EPO,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Fee Schedule,6876.92
Blue Shield,EPO,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Fee Schedule,6876.92
Blue Shield,EPO,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Fee Schedule,9548.66
Blue Shield,EPO,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,6876.92
Blue Shield,EPO,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,6876.92
Blue Shield,EPO,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,9548.66
Blue Shield,EPO,22532,CPT4/HCPCS,LAT THORAX SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,EPO,22533,CPT4/HCPCS,LAT LUMBAR SPINE FUSION,,Fee Schedule,3198.57
Blue Shield,EPO,22534,CPT4/HCPCS,LAT THOR/LUMB ADDL SEG,,Fee Schedule,3198.57
Blue Shield,EPO,22548,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,EPO,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Fee Schedule,4891.93
Blue Shield,EPO,22554,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,6876.92
Blue Shield,EPO,22556,CPT4/HCPCS,THORAX SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,EPO,22558,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,EPO,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,Fee Schedule,3198.57
Blue Shield,EPO,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,Fee Schedule,7902.34
Blue Shield,EPO,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,Fee Schedule,4891.93
Blue Shield,EPO,22595,CPT4/HCPCS,NECK SPINAL FUSION,,Fee Schedule,4280.44
Blue Shield,EPO,22600,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,EPO,22610,CPT4/HCPCS,THORAX SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,EPO,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,9548.66
Blue Shield,EPO,22614,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,9548.66
Blue Shield,EPO,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,EPO,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,3198.57
Blue Shield,EPO,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,Fee Schedule,7902.34
Blue Shield,EPO,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,3198.57
Blue Shield,EPO,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,Fee Schedule,4280.44
Blue Shield,EPO,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,Fee Schedule,6876.92
Blue Shield,EPO,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,Fee Schedule,6876.92
Blue Shield,EPO,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,Fee Schedule,6049.05
Blue Shield,EPO,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,Fee Schedule,6049.05
Blue Shield,EPO,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,Fee Schedule,6876.92
Blue Shield,EPO,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,Fee Schedule,6876.92
Blue Shield,EPO,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,Fee Schedule,6876.92
Blue Shield,EPO,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,Fee Schedule,3198.57
Blue Shield,EPO,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,Fee Schedule,4280.44
Blue Shield,EPO,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Fee Schedule,987.79
Blue Shield,EPO,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Fee Schedule,3198.57
Blue Shield,EPO,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Fee Schedule,3198.57
Blue Shield,EPO,22899,CPT4/HCPCS,SPINE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Fee Schedule,6049.05
Blue Shield,EPO,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,EPO,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Fee Schedule,4891.93
Blue Shield,EPO,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,22999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Fee Schedule,4891.93
Blue Shield,EPO,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Fee Schedule,4280.44
Blue Shield,EPO,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Fee Schedule,3198.57
Blue Shield,EPO,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Fee Schedule,4891.93
Blue Shield,EPO,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Fee Schedule,3198.57
Blue Shield,EPO,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Fee Schedule,4280.44
Blue Shield,EPO,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,EPO,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,EPO,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Fee Schedule,9548.66
Blue Shield,EPO,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Fee Schedule,6049.05
Blue Shield,EPO,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Fee Schedule,6876.92
Blue Shield,EPO,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Fee Schedule,6876.92
Blue Shield,EPO,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Fee Schedule,6876.92
Blue Shield,EPO,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6049.05
Blue Shield,EPO,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6876.92
Blue Shield,EPO,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6876.92
Blue Shield,EPO,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6049.05
Blue Shield,EPO,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6876.92
Blue Shield,EPO,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6876.92
Blue Shield,EPO,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,4280.44
Blue Shield,EPO,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Fee Schedule,6049.05
Blue Shield,EPO,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Fee Schedule,6049.05
Blue Shield,EPO,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,6049.05
Blue Shield,EPO,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Fee Schedule,6049.05
Blue Shield,EPO,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Fee Schedule,6876.92
Blue Shield,EPO,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,Fee Schedule,4280.44
Blue Shield,EPO,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,Fee Schedule,4280.44
Blue Shield,EPO,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,Fee Schedule,4891.93
Blue Shield,EPO,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,EPO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Fee Schedule,4280.44
Blue Shield,EPO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Fee Schedule,9548.66
Blue Shield,EPO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Fee Schedule,987.79
Blue Shield,EPO,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Fee Schedule,6876.92
Blue Shield,EPO,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Fee Schedule,9548.66
Blue Shield,EPO,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Fee Schedule,9548.66
Blue Shield,EPO,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Fee Schedule,4280.44
Blue Shield,EPO,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Fee Schedule,4280.44
Blue Shield,EPO,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Fee Schedule,6876.92
Blue Shield,EPO,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Fee Schedule,9548.66
Blue Shield,EPO,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Fee Schedule,6876.92
Blue Shield,EPO,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Fee Schedule,9548.66
Blue Shield,EPO,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,EPO,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,EPO,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,EPO,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,EPO,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,EPO,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,EPO,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Fee Schedule,12850.71
Blue Shield,EPO,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,EPO,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,EPO,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Fee Schedule,6049.05
Blue Shield,EPO,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Fee Schedule,9548.66
Blue Shield,EPO,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Fee Schedule,4891.93
Blue Shield,EPO,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Fee Schedule,4891.93
Blue Shield,EPO,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,EPO,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,EPO,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Fee Schedule,3198.57
Blue Shield,EPO,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Fee Schedule,3198.57
Blue Shield,EPO,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6876.92
Blue Shield,EPO,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Fee Schedule,3198.57
Blue Shield,EPO,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,EPO,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,Fee Schedule,4891.93
Blue Shield,EPO,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,23929,CPT4/HCPCS,SHOULDER SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Fee Schedule,3198.57
Blue Shield,EPO,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Fee Schedule,4280.44
Blue Shield,EPO,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Fee Schedule,3198.57
Blue Shield,EPO,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Fee Schedule,4280.44
Blue Shield,EPO,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,EPO,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,EPO,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Fee Schedule,3198.57
Blue Shield,EPO,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Fee Schedule,6049.05
Blue Shield,EPO,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Fee Schedule,4891.93
Blue Shield,EPO,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,4280.44
Blue Shield,EPO,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Fee Schedule,4891.93
Blue Shield,EPO,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Fee Schedule,4891.93
Blue Shield,EPO,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Fee Schedule,4891.93
Blue Shield,EPO,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,4891.93
Blue Shield,EPO,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Fee Schedule,4280.44
Blue Shield,EPO,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Fee Schedule,3198.57
Blue Shield,EPO,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Fee Schedule,9548.66
Blue Shield,EPO,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Fee Schedule,9548.66
Blue Shield,EPO,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Fee Schedule,4280.44
Blue Shield,EPO,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Fee Schedule,4891.93
Blue Shield,EPO,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,EPO,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,EPO,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Fee Schedule,3198.57
Blue Shield,EPO,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Fee Schedule,6049.05
Blue Shield,EPO,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Fee Schedule,6049.05
Blue Shield,EPO,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Fee Schedule,4891.93
Blue Shield,EPO,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Fee Schedule,4891.93
Blue Shield,EPO,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Fee Schedule,4891.93
Blue Shield,EPO,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,EPO,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Fee Schedule,6049.05
Blue Shield,EPO,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Fee Schedule,9548.66
Blue Shield,EPO,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Fee Schedule,4280.44
Blue Shield,EPO,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Fee Schedule,9548.66
Blue Shield,EPO,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Fee Schedule,4891.93
Blue Shield,EPO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Fee Schedule,4891.93
Blue Shield,EPO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Fee Schedule,4891.93
Blue Shield,EPO,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Fee Schedule,9548.66
Blue Shield,EPO,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Fee Schedule,6876.92
Blue Shield,EPO,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Fee Schedule,6876.92
Blue Shield,EPO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Fee Schedule,7902.34
Blue Shield,EPO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Fee Schedule,9548.66
Blue Shield,EPO,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,6049.05
Blue Shield,EPO,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,6049.05
Blue Shield,EPO,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,4891.93
Blue Shield,EPO,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Fee Schedule,4891.93
Blue Shield,EPO,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,EPO,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Fee Schedule,4891.93
Blue Shield,EPO,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6876.92
Blue Shield,EPO,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,6876.92
Blue Shield,EPO,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Fee Schedule,3198.57
Blue Shield,EPO,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Fee Schedule,4280.44
Blue Shield,EPO,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,Fee Schedule,3198.57
Blue Shield,EPO,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,Fee Schedule,9548.66
Blue Shield,EPO,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,Fee Schedule,9548.66
Blue Shield,EPO,24999,CPT4/HCPCS,UPPER ARM/ELBOW SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Fee Schedule,4891.93
Blue Shield,EPO,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Fee Schedule,4891.93
Blue Shield,EPO,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Fee Schedule,4891.93
Blue Shield,EPO,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Fee Schedule,4891.93
Blue Shield,EPO,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Fee Schedule,4891.93
Blue Shield,EPO,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Fee Schedule,4891.93
Blue Shield,EPO,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Fee Schedule,3198.57
Blue Shield,EPO,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Fee Schedule,4280.44
Blue Shield,EPO,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,EPO,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Fee Schedule,4280.44
Blue Shield,EPO,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,EPO,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Fee Schedule,4891.93
Blue Shield,EPO,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Fee Schedule,4891.93
Blue Shield,EPO,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Fee Schedule,4891.93
Blue Shield,EPO,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Fee Schedule,4891.93
Blue Shield,EPO,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Fee Schedule,6049.05
Blue Shield,EPO,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Fee Schedule,4891.93
Blue Shield,EPO,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Fee Schedule,4891.93
Blue Shield,EPO,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Fee Schedule,4891.93
Blue Shield,EPO,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Fee Schedule,4891.93
Blue Shield,EPO,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Fee Schedule,6049.05
Blue Shield,EPO,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Fee Schedule,6049.05
Blue Shield,EPO,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Fee Schedule,6049.05
Blue Shield,EPO,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,EPO,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,EPO,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,EPO,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,EPO,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Fee Schedule,4891.93
Blue Shield,EPO,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Fee Schedule,4891.93
Blue Shield,EPO,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Fee Schedule,4891.93
Blue Shield,EPO,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,4280.44
Blue Shield,EPO,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,4280.44
Blue Shield,EPO,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Fee Schedule,9548.66
Blue Shield,EPO,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Fee Schedule,4891.93
Blue Shield,EPO,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Fee Schedule,6049.05
Blue Shield,EPO,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,6049.05
Blue Shield,EPO,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,6049.05
Blue Shield,EPO,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,EPO,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,EPO,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,EPO,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Fee Schedule,3198.57
Blue Shield,EPO,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,EPO,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4280.44
Blue Shield,EPO,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,EPO,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,EPO,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,EPO,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,EPO,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Fee Schedule,6049.05
Blue Shield,EPO,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Fee Schedule,4891.93
Blue Shield,EPO,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Fee Schedule,4891.93
Blue Shield,EPO,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Fee Schedule,4891.93
Blue Shield,EPO,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Fee Schedule,4891.93
Blue Shield,EPO,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Fee Schedule,4891.93
Blue Shield,EPO,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Fee Schedule,6876.92
Blue Shield,EPO,25350,CPT4/HCPCS,REVISION OF RADIUS,,Fee Schedule,4891.93
Blue Shield,EPO,25355,CPT4/HCPCS,REVISION OF RADIUS,,Fee Schedule,4891.93
Blue Shield,EPO,25360,CPT4/HCPCS,REVISION OF ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,EPO,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Fee Schedule,6049.05
Blue Shield,EPO,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,EPO,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Fee Schedule,4280.44
Blue Shield,EPO,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Fee Schedule,6049.05
Blue Shield,EPO,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,EPO,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,EPO,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Fee Schedule,6049.05
Blue Shield,EPO,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Fee Schedule,6049.05
Blue Shield,EPO,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Fee Schedule,6049.05
Blue Shield,EPO,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Fee Schedule,9548.66
Blue Shield,EPO,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Fee Schedule,6876.92
Blue Shield,EPO,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Fee Schedule,6876.92
Blue Shield,EPO,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,25490,CPT4/HCPCS,REINFORCE RADIUS,,Fee Schedule,4891.93
Blue Shield,EPO,25491,CPT4/HCPCS,REINFORCE ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,987.79
Blue Shield,EPO,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,3198.57
Blue Shield,EPO,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,4891.93
Blue Shield,EPO,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,3198.57
Blue Shield,EPO,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,6049.05
Blue Shield,EPO,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,6876.92
Blue Shield,EPO,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,987.79
Blue Shield,EPO,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,3198.57
Blue Shield,EPO,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,987.79
Blue Shield,EPO,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,4280.44
Blue Shield,EPO,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,987.79
Blue Shield,EPO,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,4891.93
Blue Shield,EPO,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Fee Schedule,4891.93
Blue Shield,EPO,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Fee Schedule,6876.92
Blue Shield,EPO,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Fee Schedule,6876.92
Blue Shield,EPO,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Fee Schedule,6876.92
Blue Shield,EPO,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Fee Schedule,7902.34
Blue Shield,EPO,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Fee Schedule,7902.34
Blue Shield,EPO,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Fee Schedule,6049.05
Blue Shield,EPO,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Fee Schedule,6876.92
Blue Shield,EPO,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Fee Schedule,6876.92
Blue Shield,EPO,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,EPO,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,EPO,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4891.93
Blue Shield,EPO,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Fee Schedule,3198.57
Blue Shield,EPO,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Fee Schedule,4891.93
Blue Shield,EPO,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,25927,CPT4/HCPCS,AMPUTATION OF HAND,,Fee Schedule,4280.44
Blue Shield,EPO,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,25999,CPT4/HCPCS,FOREARM OR WRIST SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,26010,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Fee Schedule,987.79
Blue Shield,EPO,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,EPO,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Fee Schedule,3198.57
Blue Shield,EPO,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Fee Schedule,4280.44
Blue Shield,EPO,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Fee Schedule,4280.44
Blue Shield,EPO,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Fee Schedule,4280.44
Blue Shield,EPO,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,EPO,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Fee Schedule,4280.44
Blue Shield,EPO,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Fee Schedule,4280.44
Blue Shield,EPO,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Fee Schedule,3198.57
Blue Shield,EPO,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Fee Schedule,3198.57
Blue Shield,EPO,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,EPO,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,EPO,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Fee Schedule,4891.93
Blue Shield,EPO,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Fee Schedule,4891.93
Blue Shield,EPO,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Fee Schedule,6049.05
Blue Shield,EPO,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Fee Schedule,4280.44
Blue Shield,EPO,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Fee Schedule,4891.93
Blue Shield,EPO,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Fee Schedule,4891.93
Blue Shield,EPO,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Fee Schedule,4891.93
Blue Shield,EPO,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Fee Schedule,6049.05
Blue Shield,EPO,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Fee Schedule,4280.44
Blue Shield,EPO,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Fee Schedule,4891.93
Blue Shield,EPO,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Fee Schedule,9548.66
Blue Shield,EPO,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Fee Schedule,4891.93
Blue Shield,EPO,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Fee Schedule,4891.93
Blue Shield,EPO,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Fee Schedule,4891.93
Blue Shield,EPO,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Fee Schedule,4280.44
Blue Shield,EPO,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Fee Schedule,4280.44
Blue Shield,EPO,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Fee Schedule,987.79
Blue Shield,EPO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Fee Schedule,987.79
Blue Shield,EPO,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,3198.57
Blue Shield,EPO,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Fee Schedule,4891.93
Blue Shield,EPO,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Fee Schedule,4280.44
Blue Shield,EPO,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Fee Schedule,4280.44
Blue Shield,EPO,26476,CPT4/HCPCS,TENDON LENGTHENING,,Fee Schedule,3198.57
Blue Shield,EPO,26477,CPT4/HCPCS,TENDON SHORTENING,,Fee Schedule,3198.57
Blue Shield,EPO,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Fee Schedule,3198.57
Blue Shield,EPO,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Fee Schedule,3198.57
Blue Shield,EPO,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Fee Schedule,4280.44
Blue Shield,EPO,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Fee Schedule,4891.93
Blue Shield,EPO,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Fee Schedule,4891.93
Blue Shield,EPO,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Fee Schedule,4891.93
Blue Shield,EPO,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Fee Schedule,6049.05
Blue Shield,EPO,26499,CPT4/HCPCS,REVISION OF FINGER,,Fee Schedule,4891.93
Blue Shield,EPO,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,EPO,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,EPO,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Fee Schedule,4891.93
Blue Shield,EPO,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Fee Schedule,3198.57
Blue Shield,EPO,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Fee Schedule,4891.93
Blue Shield,EPO,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Fee Schedule,4891.93
Blue Shield,EPO,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Fee Schedule,9548.66
Blue Shield,EPO,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Fee Schedule,6049.05
Blue Shield,EPO,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Fee Schedule,4280.44
Blue Shield,EPO,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Fee Schedule,9548.66
Blue Shield,EPO,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Fee Schedule,9548.66
Blue Shield,EPO,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Fee Schedule,9548.66
Blue Shield,EPO,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Fee Schedule,4891.93
Blue Shield,EPO,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,Fee Schedule,9548.66
Blue Shield,EPO,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,4280.44
Blue Shield,EPO,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,4891.93
Blue Shield,EPO,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,6049.05
Blue Shield,EPO,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Fee Schedule,6876.92
Blue Shield,EPO,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Fee Schedule,6876.92
Blue Shield,EPO,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Fee Schedule,4891.93
Blue Shield,EPO,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Fee Schedule,6876.92
Blue Shield,EPO,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Fee Schedule,6876.92
Blue Shield,EPO,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Fee Schedule,6876.92
Blue Shield,EPO,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Fee Schedule,4891.93
Blue Shield,EPO,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Fee Schedule,4891.93
Blue Shield,EPO,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Fee Schedule,4280.44
Blue Shield,EPO,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,EPO,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,EPO,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,EPO,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,9548.66
Blue Shield,EPO,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6049.05
Blue Shield,EPO,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,EPO,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,4280.44
Blue Shield,EPO,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6876.92
Blue Shield,EPO,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,EPO,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,EPO,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Fee Schedule,4280.44
Blue Shield,EPO,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6049.05
Blue Shield,EPO,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Fee Schedule,6876.92
Blue Shield,EPO,26841,CPT4/HCPCS,FUSION OF THUMB,,Fee Schedule,6049.05
Blue Shield,EPO,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Fee Schedule,6049.05
Blue Shield,EPO,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Fee Schedule,4280.44
Blue Shield,EPO,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Fee Schedule,4891.93
Blue Shield,EPO,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Fee Schedule,4280.44
Blue Shield,EPO,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Fee Schedule,6049.05
Blue Shield,EPO,26989,CPT4/HCPCS,HAND/FINGER SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Fee Schedule,3198.57
Blue Shield,EPO,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Fee Schedule,3198.57
Blue Shield,EPO,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,6049.05
Blue Shield,EPO,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4280.44
Blue Shield,EPO,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,3198.57
Blue Shield,EPO,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Fee Schedule,3198.57
Blue Shield,EPO,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,Fee Schedule,3198.57
Blue Shield,EPO,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Fee Schedule,6049.05
Blue Shield,EPO,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,Fee Schedule,4280.44
Blue Shield,EPO,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,EPO,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Fee Schedule,4280.44
Blue Shield,EPO,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,EPO,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,Fee Schedule,3198.57
Blue Shield,EPO,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Fee Schedule,6049.05
Blue Shield,EPO,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Fee Schedule,6876.92
Blue Shield,EPO,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Fee Schedule,6876.92
Blue Shield,EPO,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Fee Schedule,6876.92
Blue Shield,EPO,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Fee Schedule,6876.92
Blue Shield,EPO,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Fee Schedule,6876.92
Blue Shield,EPO,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,Fee Schedule,4891.93
Blue Shield,EPO,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,Fee Schedule,6049.05
Blue Shield,EPO,27075,CPT4/HCPCS,RESECT HIP TUMOR,,Fee Schedule,7902.34
Blue Shield,EPO,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,Fee Schedule,6049.05
Blue Shield,EPO,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,Fee Schedule,9548.66
Blue Shield,EPO,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,Fee Schedule,4891.93
Blue Shield,EPO,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Fee Schedule,4280.44
Blue Shield,EPO,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,EPO,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Fee Schedule,4891.93
Blue Shield,EPO,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,EPO,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,EPO,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Fee Schedule,3198.57
Blue Shield,EPO,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Fee Schedule,4891.93
Blue Shield,EPO,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Fee Schedule,6049.05
Blue Shield,EPO,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Fee Schedule,6049.05
Blue Shield,EPO,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Fee Schedule,6049.05
Blue Shield,EPO,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Fee Schedule,6049.05
Blue Shield,EPO,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Fee Schedule,4280.44
Blue Shield,EPO,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Fee Schedule,4280.44
Blue Shield,EPO,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,Fee Schedule,4280.44
Blue Shield,EPO,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Fee Schedule,4891.93
Blue Shield,EPO,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Fee Schedule,6049.05
Blue Shield,EPO,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,6876.92
Blue Shield,EPO,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,4891.93
Blue Shield,EPO,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,4891.93
Blue Shield,EPO,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,Fee Schedule,3198.57
Blue Shield,EPO,27146,CPT4/HCPCS,INCISION OF HIP BONE,,Fee Schedule,4891.93
Blue Shield,EPO,27147,CPT4/HCPCS,REVISION OF HIP BONE,,Fee Schedule,4891.93
Blue Shield,EPO,27151,CPT4/HCPCS,INCISION OF HIP BONES,,Fee Schedule,6049.05
Blue Shield,EPO,27156,CPT4/HCPCS,REVISION OF HIP BONES,,Fee Schedule,6049.05
Blue Shield,EPO,27158,CPT4/HCPCS,REVISION OF PELVIS,,Fee Schedule,4891.93
Blue Shield,EPO,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,Fee Schedule,4280.44
Blue Shield,EPO,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,Fee Schedule,4280.44
Blue Shield,EPO,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,Fee Schedule,4280.44
Blue Shield,EPO,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,EPO,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,EPO,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,EPO,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,EPO,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,Fee Schedule,3198.57
Blue Shield,EPO,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,EPO,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,EPO,27187,CPT4/HCPCS,REINFORCE HIP BONES,,Fee Schedule,4280.44
Blue Shield,EPO,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Fee Schedule,3198.57
Blue Shield,EPO,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Fee Schedule,4280.44
Blue Shield,EPO,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,Fee Schedule,3198.57
Blue Shield,EPO,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Fee Schedule,4891.93
Blue Shield,EPO,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Fee Schedule,6049.05
Blue Shield,EPO,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,27267,CPT4/HCPCS,CLTX THIGH FX,,Fee Schedule,4280.44
Blue Shield,EPO,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,Fee Schedule,4280.44
Blue Shield,EPO,27269,CPT4/HCPCS,OPTX THIGH FX,,Fee Schedule,6876.92
Blue Shield,EPO,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,Fee Schedule,3198.57
Blue Shield,EPO,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Fee Schedule,4891.93
Blue Shield,EPO,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Fee Schedule,4280.44
Blue Shield,EPO,27299,CPT4/HCPCS,PELVIS/HIP JOINT SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Fee Schedule,4280.44
Blue Shield,EPO,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,EPO,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,EPO,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,EPO,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Fee Schedule,4280.44
Blue Shield,EPO,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Fee Schedule,4280.44
Blue Shield,EPO,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,EPO,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Fee Schedule,4891.93
Blue Shield,EPO,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Fee Schedule,6049.05
Blue Shield,EPO,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,EPO,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,EPO,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,EPO,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,EPO,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,EPO,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Fee Schedule,4891.93
Blue Shield,EPO,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Fee Schedule,6049.05
Blue Shield,EPO,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Fee Schedule,6049.05
Blue Shield,EPO,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Fee Schedule,6049.05
Blue Shield,EPO,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Fee Schedule,4891.93
Blue Shield,EPO,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Fee Schedule,6876.92
Blue Shield,EPO,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Fee Schedule,6876.92
Blue Shield,EPO,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Fee Schedule,6876.92
Blue Shield,EPO,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,Fee Schedule,4891.93
Blue Shield,EPO,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,9548.66
Blue Shield,EPO,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Fee Schedule,3198.57
Blue Shield,EPO,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Fee Schedule,4891.93
Blue Shield,EPO,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Fee Schedule,4891.93
Blue Shield,EPO,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Fee Schedule,3198.57
Blue Shield,EPO,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4280.44
Blue Shield,EPO,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,EPO,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Fee Schedule,4280.44
Blue Shield,EPO,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,EPO,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,EPO,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,EPO,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Fee Schedule,4891.93
Blue Shield,EPO,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,EPO,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Fee Schedule,6049.05
Blue Shield,EPO,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Fee Schedule,6049.05
Blue Shield,EPO,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Fee Schedule,6049.05
Blue Shield,EPO,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Fee Schedule,12850.71
Blue Shield,EPO,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Fee Schedule,12850.71
Blue Shield,EPO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Fee Schedule,4891.93
Blue Shield,EPO,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Fee Schedule,4891.93
Blue Shield,EPO,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Fee Schedule,9548.66
Blue Shield,EPO,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Fee Schedule,4891.93
Blue Shield,EPO,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Fee Schedule,9548.66
Blue Shield,EPO,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,4891.93
Blue Shield,EPO,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,6049.05
Blue Shield,EPO,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,6049.05
Blue Shield,EPO,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Fee Schedule,6049.05
Blue Shield,EPO,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,27437,CPT4/HCPCS,REVISE KNEECAP,,Fee Schedule,6049.05
Blue Shield,EPO,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Fee Schedule,6876.92
Blue Shield,EPO,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,7902.34
Blue Shield,EPO,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,12850.71
Blue Shield,EPO,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Fee Schedule,4891.93
Blue Shield,EPO,27448,CPT4/HCPCS,INCISION OF THIGH,,Fee Schedule,3198.57
Blue Shield,EPO,27450,CPT4/HCPCS,INCISION OF THIGH,,Fee Schedule,4280.44
Blue Shield,EPO,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,Fee Schedule,4891.93
Blue Shield,EPO,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,Fee Schedule,4280.44
Blue Shield,EPO,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,Fee Schedule,3198.57
Blue Shield,EPO,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,Fee Schedule,4280.44
Blue Shield,EPO,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,Fee Schedule,4891.93
Blue Shield,EPO,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,Fee Schedule,4280.44
Blue Shield,EPO,27470,CPT4/HCPCS,REPAIR OF THIGH,,Fee Schedule,4891.93
Blue Shield,EPO,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,Fee Schedule,4891.93
Blue Shield,EPO,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,EPO,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,EPO,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,EPO,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,EPO,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,EPO,27495,CPT4/HCPCS,REINFORCE THIGH,,Fee Schedule,4891.93
Blue Shield,EPO,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,6876.92
Blue Shield,EPO,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,EPO,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,EPO,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,EPO,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,3198.57
Blue Shield,EPO,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,3198.57
Blue Shield,EPO,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,4280.44
Blue Shield,EPO,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Fee Schedule,7902.34
Blue Shield,EPO,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Fee Schedule,3198.57
Blue Shield,EPO,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Fee Schedule,3198.57
Blue Shield,EPO,27580,CPT4/HCPCS,FUSION OF KNEE,,Fee Schedule,4891.93
Blue Shield,EPO,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,EPO,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,EPO,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,EPO,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,Fee Schedule,3198.57
Blue Shield,EPO,27599,CPT4/HCPCS,LEG SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,EPO,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,EPO,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,EPO,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Fee Schedule,4280.44
Blue Shield,EPO,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Fee Schedule,4280.44
Blue Shield,EPO,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Fee Schedule,3198.57
Blue Shield,EPO,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Fee Schedule,3198.57
Blue Shield,EPO,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Fee Schedule,3198.57
Blue Shield,EPO,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Fee Schedule,4280.44
Blue Shield,EPO,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Fee Schedule,4280.44
Blue Shield,EPO,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Fee Schedule,4891.93
Blue Shield,EPO,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,EPO,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,EPO,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Fee Schedule,4891.93
Blue Shield,EPO,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Fee Schedule,4280.44
Blue Shield,EPO,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Fee Schedule,4280.44
Blue Shield,EPO,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,Fee Schedule,6049.05
Blue Shield,EPO,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,Fee Schedule,6049.05
Blue Shield,EPO,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Fee Schedule,4891.93
Blue Shield,EPO,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Fee Schedule,4280.44
Blue Shield,EPO,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,3198.57
Blue Shield,EPO,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,EPO,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,EPO,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,EPO,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Fee Schedule,4280.44
Blue Shield,EPO,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Fee Schedule,4891.93
Blue Shield,EPO,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Fee Schedule,4280.44
Blue Shield,EPO,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Fee Schedule,4891.93
Blue Shield,EPO,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Fee Schedule,6049.05
Blue Shield,EPO,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Fee Schedule,4280.44
Blue Shield,EPO,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,EPO,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Fee Schedule,4280.44
Blue Shield,EPO,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Fee Schedule,4280.44
Blue Shield,EPO,27705,CPT4/HCPCS,INCISION OF TIBIA,,Fee Schedule,4280.44
Blue Shield,EPO,27707,CPT4/HCPCS,INCISION OF FIBULA,,Fee Schedule,4280.44
Blue Shield,EPO,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Fee Schedule,4280.44
Blue Shield,EPO,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,EPO,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,EPO,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Fee Schedule,4280.44
Blue Shield,EPO,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Fee Schedule,4280.44
Blue Shield,EPO,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Fee Schedule,4891.93
Blue Shield,EPO,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,EPO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Fee Schedule,4891.93
Blue Shield,EPO,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,EPO,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Fee Schedule,4280.44
Blue Shield,EPO,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Fee Schedule,4280.44
Blue Shield,EPO,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,EPO,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,EPO,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,EPO,27745,CPT4/HCPCS,REINFORCE TIBIA,,Fee Schedule,4891.93
Blue Shield,EPO,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Fee Schedule,3198.57
Blue Shield,EPO,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Fee Schedule,3198.57
Blue Shield,EPO,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Fee Schedule,4891.93
Blue Shield,EPO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Fee Schedule,4280.44
Blue Shield,EPO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Fee Schedule,4280.44
Blue Shield,EPO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Fee Schedule,6049.05
Blue Shield,EPO,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Fee Schedule,3198.57
Blue Shield,EPO,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Fee Schedule,6049.05
Blue Shield,EPO,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,3198.57
Blue Shield,EPO,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,EPO,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,EPO,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Fee Schedule,3198.57
Blue Shield,EPO,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Fee Schedule,4891.93
Blue Shield,EPO,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,EPO,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,EPO,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,EPO,27899,CPT4/HCPCS,LEG/ANKLE SURGERY PROCEDURE,,Fee Schedule,987.79
Blue Shield,EPO,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Fee Schedule,3198.57
Blue Shield,EPO,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Fee Schedule,4891.93
Blue Shield,EPO,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Fee Schedule,4891.93
Blue Shield,EPO,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,EPO,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Fee Schedule,4891.93
Blue Shield,EPO,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Fee Schedule,4280.44
Blue Shield,EPO,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Fee Schedule,6049.05
Blue Shield,EPO,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Fee Schedule,4280.44
Blue Shield,EPO,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,EPO,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Fee Schedule,4891.93
Blue Shield,EPO,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Fee Schedule,4891.93
Blue Shield,EPO,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Fee Schedule,4891.93
Blue Shield,EPO,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Fee Schedule,4280.44
Blue Shield,EPO,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Fee Schedule,4280.44
Blue Shield,EPO,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Fee Schedule,4280.44
Blue Shield,EPO,28055,CPT4/HCPCS,NEURECTOMY FOOT,,Fee Schedule,4891.93
Blue Shield,EPO,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Fee Schedule,4280.44
Blue Shield,EPO,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,EPO,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Fee Schedule,4891.93
Blue Shield,EPO,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Fee Schedule,4891.93
Blue Shield,EPO,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4891.93
Blue Shield,EPO,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,EPO,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,EPO,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4891.93
Blue Shield,EPO,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Fee Schedule,4891.93
Blue Shield,EPO,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Fee Schedule,4280.44
Blue Shield,EPO,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,EPO,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,EPO,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4280.44
Blue Shield,EPO,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,EPO,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,EPO,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Fee Schedule,4891.93
Blue Shield,EPO,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,EPO,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,EPO,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,EPO,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,EPO,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Fee Schedule,4891.93
Blue Shield,EPO,28116,CPT4/HCPCS,REVISION OF FOOT,,Fee Schedule,4891.93
Blue Shield,EPO,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Fee Schedule,6049.05
Blue Shield,EPO,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Fee Schedule,6049.05
Blue Shield,EPO,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Fee Schedule,9548.66
Blue Shield,EPO,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Fee Schedule,4891.93
Blue Shield,EPO,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,EPO,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,EPO,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Fee Schedule,4891.93
Blue Shield,EPO,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,EPO,28150,CPT4/HCPCS,REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,EPO,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,EPO,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,EPO,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Fee Schedule,4891.93
Blue Shield,EPO,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Fee Schedule,4891.93
Blue Shield,EPO,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Fee Schedule,4891.93
Blue Shield,EPO,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,EPO,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,EPO,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,6049.05
Blue Shield,EPO,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Fee Schedule,3198.57
Blue Shield,EPO,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Fee Schedule,3198.57
Blue Shield,EPO,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Fee Schedule,3198.57
Blue Shield,EPO,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Fee Schedule,4891.93
Blue Shield,EPO,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Fee Schedule,4280.44
Blue Shield,EPO,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Fee Schedule,4280.44
Blue Shield,EPO,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,EPO,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Fee Schedule,4891.93
Blue Shield,EPO,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,EPO,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Fee Schedule,6049.05
Blue Shield,EPO,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Fee Schedule,3198.57
Blue Shield,EPO,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Fee Schedule,4891.93
Blue Shield,EPO,28280,CPT4/HCPCS,FUSION OF TOES,,Fee Schedule,4280.44
Blue Shield,EPO,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Fee Schedule,4891.93
Blue Shield,EPO,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Fee Schedule,6049.05
Blue Shield,EPO,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Fee Schedule,4891.93
Blue Shield,EPO,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Fee Schedule,4891.93
Blue Shield,EPO,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Fee Schedule,4891.93
Blue Shield,EPO,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4280.44
Blue Shield,EPO,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,EPO,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,EPO,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,EPO,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,EPO,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,6876.92
Blue Shield,EPO,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Fee Schedule,4280.44
Blue Shield,EPO,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Fee Schedule,4280.44
Blue Shield,EPO,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Fee Schedule,4280.44
Blue Shield,EPO,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Fee Schedule,4891.93
Blue Shield,EPO,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,6049.05
Blue Shield,EPO,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,6049.05
Blue Shield,EPO,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,4280.44
Blue Shield,EPO,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Fee Schedule,6049.05
Blue Shield,EPO,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Fee Schedule,4891.93
Blue Shield,EPO,28312,CPT4/HCPCS,REVISION OF TOE,,Fee Schedule,4891.93
Blue Shield,EPO,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Fee Schedule,4280.44
Blue Shield,EPO,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Fee Schedule,6049.05
Blue Shield,EPO,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,EPO,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Fee Schedule,6049.05
Blue Shield,EPO,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Fee Schedule,6049.05
Blue Shield,EPO,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Fee Schedule,6049.05
Blue Shield,EPO,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Fee Schedule,6049.05
Blue Shield,EPO,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Fee Schedule,6049.05
Blue Shield,EPO,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,Fee Schedule,6876.92
Blue Shield,EPO,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Fee Schedule,6049.05
Blue Shield,EPO,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,EPO,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,3198.57
Blue Shield,EPO,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,4891.93
Blue Shield,EPO,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,EPO,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,EPO,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,EPO,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,EPO,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,987.79
Blue Shield,EPO,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,EPO,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,EPO,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,EPO,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,EPO,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,EPO,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,EPO,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,EPO,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Fee Schedule,6876.92
Blue Shield,EPO,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,EPO,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,EPO,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,Fee Schedule,3198.57
Blue Shield,EPO,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Fee Schedule,3198.57
Blue Shield,EPO,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Fee Schedule,4280.44
Blue Shield,EPO,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Fee Schedule,4280.44
Blue Shield,EPO,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Fee Schedule,4280.44
Blue Shield,EPO,28899,CPT4/HCPCS,FOOT/TOES SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,EPO,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,EPO,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,EPO,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,EPO,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,EPO,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,EPO,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,EPO,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,Fee Schedule,987.79
Blue Shield,EPO,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Fee Schedule,987.79
Blue Shield,EPO,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Fee Schedule,987.79
Blue Shield,EPO,29065,CPT4/HCPCS,APPLICATION OF LONG ARM CAST,,Fee Schedule,987.79
Blue Shield,EPO,29075,CPT4/HCPCS,APPLICATION OF FOREARM CAST,,Fee Schedule,987.79
Blue Shield,EPO,29085,CPT4/HCPCS,APPLY HAND/WRIST CAST,,Fee Schedule,987.79
Blue Shield,EPO,29086,CPT4/HCPCS,APPLY FINGER CAST,,Fee Schedule,987.79
Blue Shield,EPO,29105,CPT4/HCPCS,APPLY LONG ARM SPLINT,,Fee Schedule,987.79
Blue Shield,EPO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Fee Schedule,987.79
Blue Shield,EPO,29126,CPT4/HCPCS,APPLY FOREARM SPLINT,,Fee Schedule,987.79
Blue Shield,EPO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Fee Schedule,987.79
Blue Shield,EPO,29131,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Fee Schedule,987.79
Blue Shield,EPO,29200,CPT4/HCPCS,STRAPPING OF CHEST,,Fee Schedule,987.79
Blue Shield,EPO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Fee Schedule,987.79
Blue Shield,EPO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Fee Schedule,987.79
Blue Shield,EPO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Fee Schedule,987.79
Blue Shield,EPO,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Fee Schedule,987.79
Blue Shield,EPO,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Fee Schedule,987.79
Blue Shield,EPO,29345,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,EPO,29355,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,EPO,29358,CPT4/HCPCS,APPLY LONG LEG CAST BRACE,,Fee Schedule,987.79
Blue Shield,EPO,29365,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,EPO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,EPO,29425,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,EPO,29435,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,EPO,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,Fee Schedule,987.79
Blue Shield,EPO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,Fee Schedule,987.79
Blue Shield,EPO,29450,CPT4/HCPCS,APPLICATION OF LEG CAST,,Fee Schedule,987.79
Blue Shield,EPO,29505,CPT4/HCPCS,APPLICATION LONG LEG SPLINT,,Fee Schedule,987.79
Blue Shield,EPO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Fee Schedule,987.79
Blue Shield,EPO,29520,CPT4/HCPCS,STRAPPING OF HIP,,Fee Schedule,987.79
Blue Shield,EPO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,Fee Schedule,987.79
Blue Shield,EPO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,Fee Schedule,987.79
Blue Shield,EPO,29550,CPT4/HCPCS,STRAPPING OF TOES,,Fee Schedule,987.79
Blue Shield,EPO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Fee Schedule,987.79
Blue Shield,EPO,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,Fee Schedule,987.79
Blue Shield,EPO,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,Fee Schedule,7902.34
Blue Shield,EPO,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,EPO,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,EPO,29710,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,EPO,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,Fee Schedule,987.79
Blue Shield,EPO,29730,CPT4/HCPCS,WINDOWING OF CAST,,Fee Schedule,987.79
Blue Shield,EPO,29740,CPT4/HCPCS,WEDGING OF CAST,,Fee Schedule,987.79
Blue Shield,EPO,29750,CPT4/HCPCS,WEDGING OF CLUBFOOT CAST,,Fee Schedule,987.79
Blue Shield,EPO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,Fee Schedule,987.79
Blue Shield,EPO,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Fee Schedule,4891.93
Blue Shield,EPO,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Fee Schedule,4891.93
Blue Shield,EPO,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Fee Schedule,4891.93
Blue Shield,EPO,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Fee Schedule,4891.93
Blue Shield,EPO,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Fee Schedule,4891.93
Blue Shield,EPO,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Fee Schedule,4891.93
Blue Shield,EPO,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Fee Schedule,4891.93
Blue Shield,EPO,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Fee Schedule,4891.93
Blue Shield,EPO,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Fee Schedule,6876.92
Blue Shield,EPO,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Fee Schedule,4891.93
Blue Shield,EPO,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Fee Schedule,4891.93
Blue Shield,EPO,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Fee Schedule,6876.92
Blue Shield,EPO,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Fee Schedule,4891.93
Blue Shield,EPO,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Fee Schedule,4891.93
Blue Shield,EPO,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Fee Schedule,4891.93
Blue Shield,EPO,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Fee Schedule,12850.71
Blue Shield,EPO,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Fee Schedule,6049.05
Blue Shield,EPO,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Fee Schedule,6049.05
Blue Shield,EPO,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Fee Schedule,12850.71
Blue Shield,EPO,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Fee Schedule,6049.05
Blue Shield,EPO,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Fee Schedule,12850.71
Blue Shield,EPO,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Fee Schedule,12850.71
Blue Shield,EPO,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Fee Schedule,12850.71
Blue Shield,EPO,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Fee Schedule,4891.93
Blue Shield,EPO,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Fee Schedule,4891.93
Blue Shield,EPO,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6876.92
Blue Shield,EPO,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Fee Schedule,12850.71
Blue Shield,EPO,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Fee Schedule,4891.93
Blue Shield,EPO,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,EPO,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,EPO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Fee Schedule,4891.93
Blue Shield,EPO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Fee Schedule,4891.93
Blue Shield,EPO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Fee Schedule,4891.93
Blue Shield,EPO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Fee Schedule,6049.05
Blue Shield,EPO,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Fee Schedule,6049.05
Blue Shield,EPO,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Fee Schedule,6049.05
Blue Shield,EPO,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Fee Schedule,6049.05
Blue Shield,EPO,29999,CPT4/HCPCS,ARTHROSCOPY OF JOINT,,Fee Schedule,6876.92
Blue Shield,EPO,30000,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,EPO,30020,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,EPO,30100,CPT4/HCPCS,INTRANASAL BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Fee Schedule,4280.44
Blue Shield,EPO,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Fee Schedule,4280.44
Blue Shield,EPO,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Fee Schedule,4891.93
Blue Shield,EPO,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Fee Schedule,4891.93
Blue Shield,EPO,30120,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,3198.57
Blue Shield,EPO,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,EPO,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Fee Schedule,4891.93
Blue Shield,EPO,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Fee Schedule,4280.44
Blue Shield,EPO,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Fee Schedule,4891.93
Blue Shield,EPO,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Fee Schedule,6049.05
Blue Shield,EPO,30200,CPT4/HCPCS,INJECTION TREATMENT OF NOSE,,Fee Schedule,4280.44
Blue Shield,EPO,30210,CPT4/HCPCS,NASAL SINUS THERAPY,,Fee Schedule,3198.57
Blue Shield,EPO,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Fee Schedule,3198.57
Blue Shield,EPO,30300,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,EPO,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,EPO,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,EPO,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6049.05
Blue Shield,EPO,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6876.92
Blue Shield,EPO,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6876.92
Blue Shield,EPO,30430,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,4891.93
Blue Shield,EPO,30435,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,6876.92
Blue Shield,EPO,30450,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,9548.66
Blue Shield,EPO,30460,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,9548.66
Blue Shield,EPO,30462,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,12850.71
Blue Shield,EPO,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Fee Schedule,12850.71
Blue Shield,EPO,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Fee Schedule,6049.05
Blue Shield,EPO,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Fee Schedule,6876.92
Blue Shield,EPO,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Fee Schedule,6876.92
Blue Shield,EPO,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Fee Schedule,4280.44
Blue Shield,EPO,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Fee Schedule,6049.05
Blue Shield,EPO,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Fee Schedule,6049.05
Blue Shield,EPO,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Fee Schedule,9548.66
Blue Shield,EPO,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Fee Schedule,9548.66
Blue Shield,EPO,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Fee Schedule,3198.57
Blue Shield,EPO,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Fee Schedule,3198.57
Blue Shield,EPO,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,987.79
Blue Shield,EPO,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,EPO,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,EPO,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,EPO,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Fee Schedule,4280.44
Blue Shield,EPO,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Fee Schedule,4891.93
Blue Shield,EPO,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Fee Schedule,6049.05
Blue Shield,EPO,30999,CPT4/HCPCS,NASAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Fee Schedule,3198.57
Blue Shield,EPO,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Fee Schedule,3198.57
Blue Shield,EPO,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4280.44
Blue Shield,EPO,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,EPO,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Fee Schedule,6049.05
Blue Shield,EPO,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,Fee Schedule,6049.05
Blue Shield,EPO,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Fee Schedule,4280.44
Blue Shield,EPO,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Fee Schedule,4280.44
Blue Shield,EPO,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,EPO,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,EPO,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,EPO,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,EPO,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,EPO,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,EPO,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,EPO,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Fee Schedule,6876.92
Blue Shield,EPO,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,4280.44
Blue Shield,EPO,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,6876.92
Blue Shield,EPO,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,4891.93
Blue Shield,EPO,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Fee Schedule,4891.93
Blue Shield,EPO,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Fee Schedule,4891.93
Blue Shield,EPO,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Fee Schedule,987.79
Blue Shield,EPO,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Fee Schedule,4280.44
Blue Shield,EPO,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Fee Schedule,3198.57
Blue Shield,EPO,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4280.44
Blue Shield,EPO,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,EPO,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,6049.05
Blue Shield,EPO,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4280.44
Blue Shield,EPO,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Fee Schedule,6876.92
Blue Shield,EPO,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Fee Schedule,6876.92
Blue Shield,EPO,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Fee Schedule,4891.93
Blue Shield,EPO,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Fee Schedule,6876.92
Blue Shield,EPO,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,EPO,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Fee Schedule,6876.92
Blue Shield,EPO,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Fee Schedule,6876.92
Blue Shield,EPO,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,EPO,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Fee Schedule,4891.93
Blue Shield,EPO,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,EPO,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,EPO,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,EPO,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,EPO,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Fee Schedule,3198.57
Blue Shield,EPO,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Fee Schedule,3198.57
Blue Shield,EPO,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Fee Schedule,4280.44
Blue Shield,EPO,31295,CPT4/HCPCS,NSL/SINS NDSC SURG MAX SINS,,Fee Schedule,3198.57
Blue Shield,EPO,31296,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT SINS,,Fee Schedule,3198.57
Blue Shield,EPO,31297,CPT4/HCPCS,NSL/SINS NDSC SURG SPHN SINS,,Fee Schedule,3198.57
Blue Shield,EPO,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Fee Schedule,3198.57
Blue Shield,EPO,31299,CPT4/HCPCS,SINUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Fee Schedule,6876.92
Blue Shield,EPO,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,EPO,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,EPO,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,EPO,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,7902.34
Blue Shield,EPO,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,EPO,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,EPO,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,EPO,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,EPO,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,Fee Schedule,7902.34
Blue Shield,EPO,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,Fee Schedule,9548.66
Blue Shield,EPO,31400,CPT4/HCPCS,REVISION OF LARYNX,,Fee Schedule,4280.44
Blue Shield,EPO,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Fee Schedule,4280.44
Blue Shield,EPO,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Fee Schedule,3198.57
Blue Shield,EPO,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Fee Schedule,987.79
Blue Shield,EPO,31505,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Fee Schedule,4280.44
Blue Shield,EPO,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Fee Schedule,4280.44
Blue Shield,EPO,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Fee Schedule,4280.44
Blue Shield,EPO,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Fee Schedule,4280.44
Blue Shield,EPO,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Fee Schedule,3198.57
Blue Shield,EPO,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Fee Schedule,3198.57
Blue Shield,EPO,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Fee Schedule,3198.57
Blue Shield,EPO,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Fee Schedule,4280.44
Blue Shield,EPO,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Fee Schedule,3198.57
Blue Shield,EPO,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Fee Schedule,4280.44
Blue Shield,EPO,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Fee Schedule,4280.44
Blue Shield,EPO,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,EPO,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Fee Schedule,4891.93
Blue Shield,EPO,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Fee Schedule,4280.44
Blue Shield,EPO,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Fee Schedule,4891.93
Blue Shield,EPO,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Fee Schedule,4891.93
Blue Shield,EPO,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Fee Schedule,6049.05
Blue Shield,EPO,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Fee Schedule,4891.93
Blue Shield,EPO,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Fee Schedule,4891.93
Blue Shield,EPO,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,EPO,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,EPO,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,EPO,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,EPO,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Fee Schedule,6876.92
Blue Shield,EPO,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Fee Schedule,6876.92
Blue Shield,EPO,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Fee Schedule,4280.44
Blue Shield,EPO,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Fee Schedule,4280.44
Blue Shield,EPO,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Fee Schedule,4280.44
Blue Shield,EPO,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Fee Schedule,4280.44
Blue Shield,EPO,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Fee Schedule,4280.44
Blue Shield,EPO,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Fee Schedule,987.79
Blue Shield,EPO,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Fee Schedule,4280.44
Blue Shield,EPO,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Fee Schedule,4280.44
Blue Shield,EPO,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Fee Schedule,4280.44
Blue Shield,EPO,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Fee Schedule,3198.57
Blue Shield,EPO,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Fee Schedule,6876.92
Blue Shield,EPO,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Fee Schedule,6049.05
Blue Shield,EPO,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Fee Schedule,4280.44
Blue Shield,EPO,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Fee Schedule,6876.92
Blue Shield,EPO,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Fee Schedule,6876.92
Blue Shield,EPO,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Fee Schedule,6876.92
Blue Shield,EPO,31595,CPT4/HCPCS,LARYNX NERVE SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,31599,CPT4/HCPCS,LARYNX SURGERY PROCEDURE,,Fee Schedule,6049.05
Blue Shield,EPO,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,EPO,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,EPO,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,3198.57
Blue Shield,EPO,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,EPO,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,EPO,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,EPO,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Fee Schedule,3198.57
Blue Shield,EPO,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Fee Schedule,4280.44
Blue Shield,EPO,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Fee Schedule,4280.44
Blue Shield,EPO,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Fee Schedule,3198.57
Blue Shield,EPO,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Fee Schedule,3198.57
Blue Shield,EPO,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Fee Schedule,4280.44
Blue Shield,EPO,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Fee Schedule,4280.44
Blue Shield,EPO,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Fee Schedule,4280.44
Blue Shield,EPO,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Fee Schedule,4891.93
Blue Shield,EPO,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Fee Schedule,4280.44
Blue Shield,EPO,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Fee Schedule,4280.44
Blue Shield,EPO,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Fee Schedule,4280.44
Blue Shield,EPO,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Fee Schedule,4280.44
Blue Shield,EPO,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Fee Schedule,4280.44
Blue Shield,EPO,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,EPO,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Fee Schedule,6049.05
Blue Shield,EPO,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Fee Schedule,6049.05
Blue Shield,EPO,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Fee Schedule,4280.44
Blue Shield,EPO,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Fee Schedule,4280.44
Blue Shield,EPO,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Fee Schedule,4280.44
Blue Shield,EPO,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Fee Schedule,3198.57
Blue Shield,EPO,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Fee Schedule,3198.57
Blue Shield,EPO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Fee Schedule,4280.44
Blue Shield,EPO,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Fee Schedule,4280.44
Blue Shield,EPO,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Fee Schedule,4280.44
Blue Shield,EPO,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Fee Schedule,4280.44
Blue Shield,EPO,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Fee Schedule,3198.57
Blue Shield,EPO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Fee Schedule,4280.44
Blue Shield,EPO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Fee Schedule,4891.93
Blue Shield,EPO,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Fee Schedule,3198.57
Blue Shield,EPO,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Fee Schedule,3198.57
Blue Shield,EPO,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,6876.92
Blue Shield,EPO,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,EPO,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,EPO,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,EPO,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,Fee Schedule,4891.93
Blue Shield,EPO,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,Fee Schedule,4280.44
Blue Shield,EPO,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Fee Schedule,4280.44
Blue Shield,EPO,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Fee Schedule,4891.93
Blue Shield,EPO,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Fee Schedule,6049.05
Blue Shield,EPO,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Fee Schedule,6049.05
Blue Shield,EPO,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Fee Schedule,3198.57
Blue Shield,EPO,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Fee Schedule,6049.05
Blue Shield,EPO,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Fee Schedule,3198.57
Blue Shield,EPO,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Fee Schedule,4280.44
Blue Shield,EPO,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Fee Schedule,4280.44
Blue Shield,EPO,31899,CPT4/HCPCS,AIRWAYS SURGICAL PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,Fee Schedule,3198.57
Blue Shield,EPO,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,Fee Schedule,3198.57
Blue Shield,EPO,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,Fee Schedule,7902.34
Blue Shield,EPO,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,Fee Schedule,7902.34
Blue Shield,EPO,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,Fee Schedule,7902.34
Blue Shield,EPO,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,EPO,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,Fee Schedule,4280.44
Blue Shield,EPO,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,EPO,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Fee Schedule,3198.57
Blue Shield,EPO,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Fee Schedule,3198.57
Blue Shield,EPO,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,EPO,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,Fee Schedule,3198.57
Blue Shield,EPO,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,Fee Schedule,3198.57
Blue Shield,EPO,32215,CPT4/HCPCS,TREAT CHEST LINING,,Fee Schedule,3198.57
Blue Shield,EPO,32220,CPT4/HCPCS,RELEASE OF LUNG,,Fee Schedule,4280.44
Blue Shield,EPO,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,Fee Schedule,3198.57
Blue Shield,EPO,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,Fee Schedule,3198.57
Blue Shield,EPO,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,Fee Schedule,4280.44
Blue Shield,EPO,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Fee Schedule,3198.57
Blue Shield,EPO,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Fee Schedule,3198.57
Blue Shield,EPO,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,Fee Schedule,4280.44
Blue Shield,EPO,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,Fee Schedule,4280.44
Blue Shield,EPO,32482,CPT4/HCPCS,BILOBECTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,32484,CPT4/HCPCS,SEGMENTECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,32488,CPT4/HCPCS,COMPLETION PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,Fee Schedule,4280.44
Blue Shield,EPO,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,Fee Schedule,7902.34
Blue Shield,EPO,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,Fee Schedule,3198.57
Blue Shield,EPO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Fee Schedule,3198.57
Blue Shield,EPO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Fee Schedule,987.79
Blue Shield,EPO,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Fee Schedule,987.79
Blue Shield,EPO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,EPO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Fee Schedule,3198.57
Blue Shield,EPO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Fee Schedule,3198.57
Blue Shield,EPO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Fee Schedule,3198.57
Blue Shield,EPO,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Fee Schedule,3198.57
Blue Shield,EPO,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Fee Schedule,3198.57
Blue Shield,EPO,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Fee Schedule,987.79
Blue Shield,EPO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Fee Schedule,7902.34
Blue Shield,EPO,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Fee Schedule,7902.34
Blue Shield,EPO,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Fee Schedule,7902.34
Blue Shield,EPO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Fee Schedule,7902.34
Blue Shield,EPO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Fee Schedule,7902.34
Blue Shield,EPO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Fee Schedule,7902.34
Blue Shield,EPO,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,Fee Schedule,3198.57
Blue Shield,EPO,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,Fee Schedule,3198.57
Blue Shield,EPO,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,Fee Schedule,3198.57
Blue Shield,EPO,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,Fee Schedule,3198.57
Blue Shield,EPO,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,Fee Schedule,3198.57
Blue Shield,EPO,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,Fee Schedule,3198.57
Blue Shield,EPO,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,Fee Schedule,3198.57
Blue Shield,EPO,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,Fee Schedule,3198.57
Blue Shield,EPO,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,Fee Schedule,3198.57
Blue Shield,EPO,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,Fee Schedule,3198.57
Blue Shield,EPO,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Fee Schedule,3198.57
Blue Shield,EPO,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,Fee Schedule,3198.57
Blue Shield,EPO,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,Fee Schedule,7902.34
Blue Shield,EPO,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,Fee Schedule,987.79
Blue Shield,EPO,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,Fee Schedule,987.79
Blue Shield,EPO,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,Fee Schedule,7902.34
Blue Shield,EPO,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,Fee Schedule,7902.34
Blue Shield,EPO,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,Fee Schedule,7902.34
Blue Shield,EPO,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,Fee Schedule,7902.34
Blue Shield,EPO,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,Fee Schedule,7902.34
Blue Shield,EPO,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,Fee Schedule,987.79
Blue Shield,EPO,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,Fee Schedule,3198.57
Blue Shield,EPO,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,Fee Schedule,3198.57
Blue Shield,EPO,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,Fee Schedule,4280.44
Blue Shield,EPO,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,Fee Schedule,4280.44
Blue Shield,EPO,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,Fee Schedule,6876.92
Blue Shield,EPO,32852,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Fee Schedule,7902.34
Blue Shield,EPO,32853,CPT4/HCPCS,LUNG TRANSPLANT DOUBLE,,Fee Schedule,7902.34
Blue Shield,EPO,32854,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Fee Schedule,9548.66
Blue Shield,EPO,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,Fee Schedule,3198.57
Blue Shield,EPO,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Fee Schedule,4280.44
Blue Shield,EPO,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Fee Schedule,4280.44
Blue Shield,EPO,32940,CPT4/HCPCS,REVISION OF LUNG,,Fee Schedule,3198.57
Blue Shield,EPO,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,Fee Schedule,3198.57
Blue Shield,EPO,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Fee Schedule,4280.44
Blue Shield,EPO,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,Fee Schedule,3198.57
Blue Shield,EPO,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Fee Schedule,4280.44
Blue Shield,EPO,32999,CPT4/HCPCS,CHEST SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,33010,CPT4/HCPCS,DRAINAGE OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,EPO,33011,CPT4/HCPCS,REPEAT DRAINAGE OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,EPO,33015,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,EPO,33020,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,EPO,33025,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,EPO,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,EPO,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,EPO,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,Fee Schedule,3198.57
Blue Shield,EPO,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,Fee Schedule,4891.93
Blue Shield,EPO,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,Fee Schedule,3198.57
Blue Shield,EPO,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,Fee Schedule,3198.57
Blue Shield,EPO,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Fee Schedule,12850.71
Blue Shield,EPO,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Fee Schedule,12850.71
Blue Shield,EPO,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Fee Schedule,12850.71
Blue Shield,EPO,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Fee Schedule,12850.71
Blue Shield,EPO,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Fee Schedule,12850.71
Blue Shield,EPO,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Fee Schedule,12850.71
Blue Shield,EPO,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Fee Schedule,12850.71
Blue Shield,EPO,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Fee Schedule,12850.71
Blue Shield,EPO,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Fee Schedule,12850.71
Blue Shield,EPO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Fee Schedule,12850.71
Blue Shield,EPO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Fee Schedule,12850.71
Blue Shield,EPO,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Fee Schedule,12850.71
Blue Shield,EPO,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Fee Schedule,12850.71
Blue Shield,EPO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Fee Schedule,3198.57
Blue Shield,EPO,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Fee Schedule,4280.44
Blue Shield,EPO,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Fee Schedule,4280.44
Blue Shield,EPO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Fee Schedule,4280.44
Blue Shield,EPO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Fee Schedule,4891.93
Blue Shield,EPO,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Fee Schedule,4891.93
Blue Shield,EPO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Fee Schedule,4280.44
Blue Shield,EPO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Fee Schedule,4280.44
Blue Shield,EPO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Fee Schedule,4280.44
Blue Shield,EPO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Fee Schedule,3198.57
Blue Shield,EPO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Fee Schedule,3198.57
Blue Shield,EPO,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Fee Schedule,4891.93
Blue Shield,EPO,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Fee Schedule,4891.93
Blue Shield,EPO,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Fee Schedule,4891.93
Blue Shield,EPO,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Fee Schedule,12850.71
Blue Shield,EPO,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Fee Schedule,4891.93
Blue Shield,EPO,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Fee Schedule,4891.93
Blue Shield,EPO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Fee Schedule,12850.71
Blue Shield,EPO,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,EPO,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,EPO,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,EPO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Fee Schedule,4280.44
Blue Shield,EPO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Fee Schedule,4280.44
Blue Shield,EPO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Fee Schedule,4280.44
Blue Shield,EPO,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Fee Schedule,4280.44
Blue Shield,EPO,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Fee Schedule,12850.71
Blue Shield,EPO,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Fee Schedule,987.79
Blue Shield,EPO,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Fee Schedule,4891.93
Blue Shield,EPO,33282,CPT4/HCPCS,IMPLANT PAT-ACTIVE HT RECORD,,Fee Schedule,12850.71
Blue Shield,EPO,33284,CPT4/HCPCS,REMOVE PAT-ACTIVE HT RECORD,,Fee Schedule,3198.57
Blue Shield,EPO,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,Fee Schedule,4280.44
Blue Shield,EPO,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Fee Schedule,3198.57
Blue Shield,EPO,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,Fee Schedule,4280.44
Blue Shield,EPO,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Fee Schedule,4280.44
Blue Shield,EPO,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Fee Schedule,4891.93
Blue Shield,EPO,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,Fee Schedule,9304.07
Blue Shield,EPO,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,Fee Schedule,7902.34
Blue Shield,EPO,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,EPO,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,EPO,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,EPO,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,EPO,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,Fee Schedule,987.79
Blue Shield,EPO,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,EPO,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,EPO,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,EPO,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,EPO,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,EPO,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,Fee Schedule,4891.93
Blue Shield,EPO,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,4891.93
Blue Shield,EPO,33406,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,6049.05
Blue Shield,EPO,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,4891.93
Blue Shield,EPO,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,EPO,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,6876.92
Blue Shield,EPO,33413,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,6876.92
Blue Shield,EPO,33414,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,EPO,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,Fee Schedule,4891.93
Blue Shield,EPO,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,Fee Schedule,4891.93
Blue Shield,EPO,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,EPO,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Fee Schedule,987.79
Blue Shield,EPO,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Fee Schedule,987.79
Blue Shield,EPO,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,3198.57
Blue Shield,EPO,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,4280.44
Blue Shield,EPO,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,4280.44
Blue Shield,EPO,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,4891.93
Blue Shield,EPO,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,6049.05
Blue Shield,EPO,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,Fee Schedule,4891.93
Blue Shield,EPO,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Fee Schedule,4280.44
Blue Shield,EPO,33463,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Fee Schedule,4280.44
Blue Shield,EPO,33464,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Fee Schedule,4891.93
Blue Shield,EPO,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,Fee Schedule,4891.93
Blue Shield,EPO,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Fee Schedule,6049.05
Blue Shield,EPO,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,EPO,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,EPO,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,EPO,33475,CPT4/HCPCS,REPLACEMENT PULMONARY VALVE,,Fee Schedule,6049.05
Blue Shield,EPO,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,4280.44
Blue Shield,EPO,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,Fee Schedule,987.79
Blue Shield,EPO,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,4280.44
Blue Shield,EPO,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,Fee Schedule,4891.93
Blue Shield,EPO,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Fee Schedule,4280.44
Blue Shield,EPO,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,Fee Schedule,4891.93
Blue Shield,EPO,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Fee Schedule,4891.93
Blue Shield,EPO,33505,CPT4/HCPCS,REPAIR ARTERY W/TUNNEL,,Fee Schedule,6049.05
Blue Shield,EPO,33506,CPT4/HCPCS,REPAIR ARTERY TRANSLOCATION,,Fee Schedule,6049.05
Blue Shield,EPO,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,Fee Schedule,3198.57
Blue Shield,EPO,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,Fee Schedule,3198.57
Blue Shield,EPO,33622,CPT4/HCPCS,REDO COMPL CARDIAC ANOMALY,,Fee Schedule,3198.57
Blue Shield,EPO,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,Fee Schedule,3198.57
Blue Shield,EPO,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,Fee Schedule,3198.57
Blue Shield,EPO,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,Fee Schedule,3198.57
Blue Shield,EPO,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,Fee Schedule,987.79
Blue Shield,EPO,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,Fee Schedule,987.79
Blue Shield,EPO,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,Fee Schedule,987.79
Blue Shield,EPO,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,Fee Schedule,987.79
Blue Shield,EPO,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,EPO,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,EPO,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,EPO,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,EPO,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,EPO,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,EPO,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Fee Schedule,987.79
Blue Shield,EPO,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,Fee Schedule,987.79
Blue Shield,EPO,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,Fee Schedule,987.79
Blue Shield,EPO,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,Fee Schedule,987.79
Blue Shield,EPO,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,Fee Schedule,9304.07
Blue Shield,EPO,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,Fee Schedule,9304.07
Blue Shield,EPO,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,Fee Schedule,9304.07
Blue Shield,EPO,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,Fee Schedule,9304.07
Blue Shield,EPO,33999,CPT4/HCPCS,CARDIAC SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,EPO,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,EPO,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,EPO,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,EPO,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,3198.57
Blue Shield,EPO,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,EPO,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,3198.57
Blue Shield,EPO,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,EPO,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,EPO,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,Fee Schedule,9548.66
Blue Shield,EPO,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,Fee Schedule,9548.66
Blue Shield,EPO,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,Fee Schedule,9548.66
Blue Shield,EPO,34530,CPT4/HCPCS,LEG VEIN FUSION,,Fee Schedule,9548.66
Blue Shield,EPO,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Fee Schedule,3198.57
Blue Shield,EPO,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Fee Schedule,3198.57
Blue Shield,EPO,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Fee Schedule,3198.57
Blue Shield,EPO,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Fee Schedule,3198.57
Blue Shield,EPO,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Fee Schedule,3198.57
Blue Shield,EPO,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Fee Schedule,3198.57
Blue Shield,EPO,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Fee Schedule,3198.57
Blue Shield,EPO,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Fee Schedule,3198.57
Blue Shield,EPO,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Fee Schedule,3198.57
Blue Shield,EPO,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Fee Schedule,3198.57
Blue Shield,EPO,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Fee Schedule,3198.57
Blue Shield,EPO,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Fee Schedule,3198.57
Blue Shield,EPO,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Fee Schedule,3198.57
Blue Shield,EPO,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Fee Schedule,3198.57
Blue Shield,EPO,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Fee Schedule,3198.57
Blue Shield,EPO,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,Fee Schedule,987.79
Blue Shield,EPO,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,Fee Schedule,987.79
Blue Shield,EPO,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,Fee Schedule,987.79
Blue Shield,EPO,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,Fee Schedule,987.79
Blue Shield,EPO,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,Fee Schedule,987.79
Blue Shield,EPO,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,Fee Schedule,987.79
Blue Shield,EPO,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,Fee Schedule,987.79
Blue Shield,EPO,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,Fee Schedule,987.79
Blue Shield,EPO,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,Fee Schedule,3198.57
Blue Shield,EPO,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,7902.34
Blue Shield,EPO,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,Fee Schedule,3198.57
Blue Shield,EPO,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,Fee Schedule,3198.57
Blue Shield,EPO,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4280.44
Blue Shield,EPO,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,4280.44
Blue Shield,EPO,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4891.93
Blue Shield,EPO,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,4280.44
Blue Shield,EPO,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4891.93
Blue Shield,EPO,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,Fee Schedule,3198.57
Blue Shield,EPO,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,Fee Schedule,4280.44
Blue Shield,EPO,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,Fee Schedule,3198.57
Blue Shield,EPO,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,Fee Schedule,3198.57
Blue Shield,EPO,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,Fee Schedule,3198.57
Blue Shield,EPO,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,EPO,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,EPO,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,EPO,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,EPO,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,EPO,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,EPO,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,EPO,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,EPO,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,7902.34
Blue Shield,EPO,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,6049.05
Blue Shield,EPO,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,4280.44
Blue Shield,EPO,35371,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35390,CPT4/HCPCS,REOPERATION CAROTID ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,35400,CPT4/HCPCS,ANGIOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,Fee Schedule,9548.66
Blue Shield,EPO,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,Fee Schedule,3198.57
Blue Shield,EPO,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,Fee Schedule,3198.57
Blue Shield,EPO,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,Fee Schedule,3198.57
Blue Shield,EPO,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,Fee Schedule,3198.57
Blue Shield,EPO,35510,CPT4/HCPCS,ART BYP GRFT CAROTID-BRCHIAL,,Fee Schedule,3198.57
Blue Shield,EPO,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,Fee Schedule,3198.57
Blue Shield,EPO,35512,CPT4/HCPCS,ART BYP GRFT SUBCLAV-BRCHIAL,,Fee Schedule,3198.57
Blue Shield,EPO,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,Fee Schedule,3198.57
Blue Shield,EPO,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,Fee Schedule,3198.57
Blue Shield,EPO,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,Fee Schedule,3198.57
Blue Shield,EPO,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,Fee Schedule,3198.57
Blue Shield,EPO,35522,CPT4/HCPCS,ART BYP GRFT AXILL-BRACHIAL,,Fee Schedule,3198.57
Blue Shield,EPO,35525,CPT4/HCPCS,ART BYP GRFT BRACHIAL-BRCHL,,Fee Schedule,3198.57
Blue Shield,EPO,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,Fee Schedule,3198.57
Blue Shield,EPO,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,Fee Schedule,4280.44
Blue Shield,EPO,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,Fee Schedule,3198.57
Blue Shield,EPO,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,Fee Schedule,4280.44
Blue Shield,EPO,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,EPO,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,Fee Schedule,3198.57
Blue Shield,EPO,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,Fee Schedule,4280.44
Blue Shield,EPO,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,Fee Schedule,3198.57
Blue Shield,EPO,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,Fee Schedule,3198.57
Blue Shield,EPO,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Fee Schedule,3198.57
Blue Shield,EPO,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Fee Schedule,3198.57
Blue Shield,EPO,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,EPO,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,Fee Schedule,4280.44
Blue Shield,EPO,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,Fee Schedule,4280.44
Blue Shield,EPO,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,Fee Schedule,3198.57
Blue Shield,EPO,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,EPO,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,EPO,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,Fee Schedule,3198.57
Blue Shield,EPO,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,Fee Schedule,3198.57
Blue Shield,EPO,35623,CPT4/HCPCS,ART BYP AXILLARY-POP-TIBIAL,,Fee Schedule,3198.57
Blue Shield,EPO,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,Fee Schedule,3198.57
Blue Shield,EPO,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,Fee Schedule,4280.44
Blue Shield,EPO,35636,CPT4/HCPCS,ART BYP SPENORENAL,,Fee Schedule,3198.57
Blue Shield,EPO,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,Fee Schedule,3198.57
Blue Shield,EPO,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,Fee Schedule,3198.57
Blue Shield,EPO,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,Fee Schedule,4280.44
Blue Shield,EPO,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,Fee Schedule,3198.57
Blue Shield,EPO,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,Fee Schedule,3198.57
Blue Shield,EPO,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,Fee Schedule,3198.57
Blue Shield,EPO,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,EPO,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,Fee Schedule,3198.57
Blue Shield,EPO,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,Fee Schedule,3198.57
Blue Shield,EPO,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,Fee Schedule,3198.57
Blue Shield,EPO,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Fee Schedule,3198.57
Blue Shield,EPO,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Fee Schedule,3198.57
Blue Shield,EPO,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,Fee Schedule,3198.57
Blue Shield,EPO,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,Fee Schedule,3198.57
Blue Shield,EPO,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,Fee Schedule,3198.57
Blue Shield,EPO,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,Fee Schedule,6049.05
Blue Shield,EPO,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,Fee Schedule,6049.05
Blue Shield,EPO,35691,CPT4/HCPCS,ART TRNSPOSJ VERTBRL CAROTID,,Fee Schedule,3198.57
Blue Shield,EPO,35693,CPT4/HCPCS,ART TRNSPOSJ SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,EPO,35694,CPT4/HCPCS,ART TRNSPOSJ SUBCLAV CAROTID,,Fee Schedule,3198.57
Blue Shield,EPO,35695,CPT4/HCPCS,ART TRNSPOSJ CAROTID SUBCLAV,,Fee Schedule,3198.57
Blue Shield,EPO,35697,CPT4/HCPCS,REIMPLANT ARTERY EACH,,Fee Schedule,3198.57
Blue Shield,EPO,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,Fee Schedule,3198.57
Blue Shield,EPO,35721,CPT4/HCPCS,EXPLORATION FEMORAL ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35741,CPT4/HCPCS,EXPLORATION POPLITEAL ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,35761,CPT4/HCPCS,EXPLORATION OF ARTERY/VEIN,,Fee Schedule,6876.92
Blue Shield,EPO,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,Fee Schedule,3198.57
Blue Shield,EPO,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,Fee Schedule,3198.57
Blue Shield,EPO,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,Fee Schedule,3198.57
Blue Shield,EPO,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,Fee Schedule,6049.05
Blue Shield,EPO,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,Fee Schedule,3198.57
Blue Shield,EPO,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Fee Schedule,12850.71
Blue Shield,EPO,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Fee Schedule,12850.71
Blue Shield,EPO,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Fee Schedule,9548.66
Blue Shield,EPO,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Fee Schedule,9548.66
Blue Shield,EPO,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,Fee Schedule,3198.57
Blue Shield,EPO,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,Fee Schedule,6876.92
Blue Shield,EPO,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,Fee Schedule,4891.93
Blue Shield,EPO,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,Fee Schedule,4280.44
Blue Shield,EPO,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Fee Schedule,3198.57
Blue Shield,EPO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Fee Schedule,3198.57
Blue Shield,EPO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Fee Schedule,3198.57
Blue Shield,EPO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Fee Schedule,3198.57
Blue Shield,EPO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Fee Schedule,3198.57
Blue Shield,EPO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Fee Schedule,3198.57
Blue Shield,EPO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Fee Schedule,3198.57
Blue Shield,EPO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Fee Schedule,3198.57
Blue Shield,EPO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Fee Schedule,3198.57
Blue Shield,EPO,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Fee Schedule,4891.93
Blue Shield,EPO,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,EPO,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Fee Schedule,3198.57
Blue Shield,EPO,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Fee Schedule,3198.57
Blue Shield,EPO,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Fee Schedule,3198.57
Blue Shield,EPO,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Fee Schedule,987.79
Blue Shield,EPO,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Fee Schedule,3198.57
Blue Shield,EPO,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Fee Schedule,3198.57
Blue Shield,EPO,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Fee Schedule,3198.57
Blue Shield,EPO,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Fee Schedule,3198.57
Blue Shield,EPO,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Fee Schedule,3198.57
Blue Shield,EPO,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Fee Schedule,3198.57
Blue Shield,EPO,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Fee Schedule,3198.57
Blue Shield,EPO,36468,CPT4/HCPCS,NJX SCLRSNT SPIDER VEINS,,Fee Schedule,3198.57
Blue Shield,EPO,36470,CPT4/HCPCS,NJX SCLRSNT 1 INCMPTNT VEIN,,Fee Schedule,3198.57
Blue Shield,EPO,36471,CPT4/HCPCS,NJX SCLRSNT MLT INCMPTNT VN,,Fee Schedule,3198.57
Blue Shield,EPO,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,EPO,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,EPO,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Fee Schedule,6876.92
Blue Shield,EPO,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,EPO,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Fee Schedule,6876.92
Blue Shield,EPO,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Fee Schedule,6876.92
Blue Shield,EPO,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Fee Schedule,6876.92
Blue Shield,EPO,36511,CPT4/HCPCS,APHERESIS WBC,,Fee Schedule,3198.57
Blue Shield,EPO,36512,CPT4/HCPCS,APHERESIS RBC,,Fee Schedule,3198.57
Blue Shield,EPO,36513,CPT4/HCPCS,APHERESIS PLATELETS,,Fee Schedule,3198.57
Blue Shield,EPO,36514,CPT4/HCPCS,APHERESIS PLASMA,,Fee Schedule,3198.57
Blue Shield,EPO,36516,CPT4/HCPCS,APHERESIS IMMUNOADS SLCTV,,Fee Schedule,9548.66
Blue Shield,EPO,36522,CPT4/HCPCS,PHOTOPHERESIS,,Fee Schedule,9548.66
Blue Shield,EPO,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,EPO,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,EPO,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,EPO,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,EPO,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,12850.71
Blue Shield,EPO,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,EPO,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,EPO,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,EPO,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,EPO,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Fee Schedule,3198.57
Blue Shield,EPO,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Fee Schedule,987.79
Blue Shield,EPO,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,EPO,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Fee Schedule,3198.57
Blue Shield,EPO,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Fee Schedule,987.79
Blue Shield,EPO,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Fee Schedule,987.79
Blue Shield,EPO,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,EPO,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,EPO,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,EPO,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Fee Schedule,9548.66
Blue Shield,EPO,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Fee Schedule,4891.93
Blue Shield,EPO,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Fee Schedule,4891.93
Blue Shield,EPO,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Fee Schedule,4891.93
Blue Shield,EPO,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,Fee Schedule,3198.57
Blue Shield,EPO,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Fee Schedule,12850.71
Blue Shield,EPO,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Fee Schedule,6049.05
Blue Shield,EPO,36833,CPT4/HCPCS,AV FISTULA REVISION,,Fee Schedule,6049.05
Blue Shield,EPO,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Fee Schedule,6049.05
Blue Shield,EPO,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Fee Schedule,9548.66
Blue Shield,EPO,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Fee Schedule,4280.44
Blue Shield,EPO,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Fee Schedule,4891.93
Blue Shield,EPO,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,EPO,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,EPO,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,EPO,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,EPO,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,EPO,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,EPO,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Fee Schedule,6049.05
Blue Shield,EPO,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Fee Schedule,6049.05
Blue Shield,EPO,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Fee Schedule,6049.05
Blue Shield,EPO,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,EPO,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,4280.44
Blue Shield,EPO,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,EPO,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,EPO,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,Fee Schedule,3198.57
Blue Shield,EPO,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,Fee Schedule,3198.57
Blue Shield,EPO,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Fee Schedule,3198.57
Blue Shield,EPO,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Fee Schedule,4891.93
Blue Shield,EPO,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Fee Schedule,4891.93
Blue Shield,EPO,37186,CPT4/HCPCS,SEC ART THROMBECTOMY ADD-ON,,Fee Schedule,4891.93
Blue Shield,EPO,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Fee Schedule,4891.93
Blue Shield,EPO,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Fee Schedule,4891.93
Blue Shield,EPO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Fee Schedule,4280.44
Blue Shield,EPO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Fee Schedule,4280.44
Blue Shield,EPO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Fee Schedule,4280.44
Blue Shield,EPO,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,Fee Schedule,3198.57
Blue Shield,EPO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,EPO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Fee Schedule,4891.93
Blue Shield,EPO,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Fee Schedule,4891.93
Blue Shield,EPO,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Fee Schedule,4891.93
Blue Shield,EPO,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Fee Schedule,4891.93
Blue Shield,EPO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Fee Schedule,987.79
Blue Shield,EPO,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Fee Schedule,987.79
Blue Shield,EPO,37220,CPT4/HCPCS,ILIAC REVASC,,Fee Schedule,6049.05
Blue Shield,EPO,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,EPO,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Fee Schedule,6049.05
Blue Shield,EPO,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Fee Schedule,6049.05
Blue Shield,EPO,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Fee Schedule,6049.05
Blue Shield,EPO,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Fee Schedule,6049.05
Blue Shield,EPO,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,EPO,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Fee Schedule,6049.05
Blue Shield,EPO,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Fee Schedule,6049.05
Blue Shield,EPO,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Fee Schedule,6049.05
Blue Shield,EPO,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,EPO,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Fee Schedule,6049.05
Blue Shield,EPO,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Fee Schedule,6049.05
Blue Shield,EPO,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Fee Schedule,6049.05
Blue Shield,EPO,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Fee Schedule,6049.05
Blue Shield,EPO,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Fee Schedule,6049.05
Blue Shield,EPO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Fee Schedule,6049.05
Blue Shield,EPO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Fee Schedule,6049.05
Blue Shield,EPO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Fee Schedule,6049.05
Blue Shield,EPO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Fee Schedule,6049.05
Blue Shield,EPO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Fee Schedule,987.79
Blue Shield,EPO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Fee Schedule,987.79
Blue Shield,EPO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Fee Schedule,987.79
Blue Shield,EPO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Fee Schedule,987.79
Blue Shield,EPO,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Fee Schedule,3198.57
Blue Shield,EPO,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Fee Schedule,3198.57
Blue Shield,EPO,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Fee Schedule,6876.92
Blue Shield,EPO,37501,CPT4/HCPCS,VASCULAR ENDOSCOPY PROCEDURE,,Fee Schedule,6876.92
Blue Shield,EPO,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,Fee Schedule,6049.05
Blue Shield,EPO,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,6049.05
Blue Shield,EPO,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,EPO,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,EPO,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Fee Schedule,4891.93
Blue Shield,EPO,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,EPO,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,EPO,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Fee Schedule,7902.34
Blue Shield,EPO,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Fee Schedule,4280.44
Blue Shield,EPO,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Fee Schedule,3198.57
Blue Shield,EPO,37700,CPT4/HCPCS,REVISE LEG VEIN,,Fee Schedule,4280.44
Blue Shield,EPO,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Fee Schedule,4891.93
Blue Shield,EPO,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Fee Schedule,4891.93
Blue Shield,EPO,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Fee Schedule,4891.93
Blue Shield,EPO,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Fee Schedule,4891.93
Blue Shield,EPO,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Fee Schedule,6876.92
Blue Shield,EPO,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Fee Schedule,7902.34
Blue Shield,EPO,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Fee Schedule,7902.34
Blue Shield,EPO,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Fee Schedule,4891.93
Blue Shield,EPO,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Fee Schedule,4891.93
Blue Shield,EPO,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,Fee Schedule,4280.44
Blue Shield,EPO,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Fee Schedule,4891.93
Blue Shield,EPO,37799,CPT4/HCPCS,VASCULAR SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Fee Schedule,3198.57
Blue Shield,EPO,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,Fee Schedule,3198.57
Blue Shield,EPO,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Fee Schedule,3198.57
Blue Shield,EPO,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,Fee Schedule,3198.57
Blue Shield,EPO,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Fee Schedule,9548.66
Blue Shield,EPO,38129,CPT4/HCPCS,LAPAROSCOPE PROC SPLEEN,,Fee Schedule,7902.34
Blue Shield,EPO,38204,CPT4/HCPCS,BL DONOR SEARCH MANAGEMENT,,Fee Schedule,3198.57
Blue Shield,EPO,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,Fee Schedule,3198.57
Blue Shield,EPO,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,Fee Schedule,3198.57
Blue Shield,EPO,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,Fee Schedule,3198.57
Blue Shield,EPO,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,Fee Schedule,3198.57
Blue Shield,EPO,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,Fee Schedule,3198.57
Blue Shield,EPO,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,Fee Schedule,3198.57
Blue Shield,EPO,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,Fee Schedule,3198.57
Blue Shield,EPO,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,Fee Schedule,3198.57
Blue Shield,EPO,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,Fee Schedule,3198.57
Blue Shield,EPO,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,Fee Schedule,3198.57
Blue Shield,EPO,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,Fee Schedule,3198.57
Blue Shield,EPO,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Fee Schedule,987.79
Blue Shield,EPO,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Fee Schedule,987.79
Blue Shield,EPO,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Fee Schedule,987.79
Blue Shield,EPO,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Fee Schedule,3198.57
Blue Shield,EPO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Fee Schedule,6049.05
Blue Shield,EPO,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Fee Schedule,3198.57
Blue Shield,EPO,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Fee Schedule,3198.57
Blue Shield,EPO,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,Fee Schedule,3198.57
Blue Shield,EPO,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Fee Schedule,3198.57
Blue Shield,EPO,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Fee Schedule,3198.57
Blue Shield,EPO,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Fee Schedule,4280.44
Blue Shield,EPO,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,EPO,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,EPO,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,EPO,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,EPO,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,EPO,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,EPO,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Fee Schedule,4280.44
Blue Shield,EPO,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Fee Schedule,4891.93
Blue Shield,EPO,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Fee Schedule,6049.05
Blue Shield,EPO,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,EPO,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,EPO,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Fee Schedule,12850.71
Blue Shield,EPO,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Fee Schedule,12850.71
Blue Shield,EPO,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Fee Schedule,12850.71
Blue Shield,EPO,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Fee Schedule,12850.71
Blue Shield,EPO,38589,CPT4/HCPCS,LAPAROSCOPE PROC LYMPHATIC,,Fee Schedule,7902.34
Blue Shield,EPO,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,EPO,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,EPO,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,EPO,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,EPO,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Fee Schedule,6049.05
Blue Shield,EPO,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,EPO,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,EPO,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,EPO,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,EPO,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,EPO,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,EPO,38999,CPT4/HCPCS,BLOOD/LYMPH SYSTEM PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,EPO,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,EPO,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,Fee Schedule,3198.57
Blue Shield,EPO,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,Fee Schedule,3198.57
Blue Shield,EPO,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Fee Schedule,7902.34
Blue Shield,EPO,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Fee Schedule,7902.34
Blue Shield,EPO,39499,CPT4/HCPCS,CHEST PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,Fee Schedule,3198.57
Blue Shield,EPO,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,12850.71
Blue Shield,EPO,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,3198.57
Blue Shield,EPO,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,3198.57
Blue Shield,EPO,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,Fee Schedule,3198.57
Blue Shield,EPO,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,Fee Schedule,3198.57
Blue Shield,EPO,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,Fee Schedule,3198.57
Blue Shield,EPO,39599,CPT4/HCPCS,DIAPHRAGM SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,40490,CPT4/HCPCS,BIOPSY OF LIP,,Fee Schedule,3198.57
Blue Shield,EPO,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,EPO,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,EPO,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,EPO,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Fee Schedule,4280.44
Blue Shield,EPO,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Fee Schedule,4280.44
Blue Shield,EPO,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Fee Schedule,4280.44
Blue Shield,EPO,40650,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,EPO,40652,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,EPO,40654,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,EPO,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,EPO,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,EPO,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,EPO,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,EPO,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,4891.93
Blue Shield,EPO,40799,CPT4/HCPCS,LIP SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,EPO,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,987.79
Blue Shield,EPO,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,EPO,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Fee Schedule,987.79
Blue Shield,EPO,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Fee Schedule,3198.57
Blue Shield,EPO,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Fee Schedule,3198.57
Blue Shield,EPO,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,EPO,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,EPO,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,EPO,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,EPO,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Fee Schedule,3198.57
Blue Shield,EPO,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,EPO,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Fee Schedule,987.79
Blue Shield,EPO,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Fee Schedule,3198.57
Blue Shield,EPO,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4280.44
Blue Shield,EPO,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4891.93
Blue Shield,EPO,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4891.93
Blue Shield,EPO,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,6876.92
Blue Shield,EPO,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,6876.92
Blue Shield,EPO,40899,CPT4/HCPCS,MOUTH SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Fee Schedule,3198.57
Blue Shield,EPO,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Fee Schedule,3198.57
Blue Shield,EPO,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Fee Schedule,3198.57
Blue Shield,EPO,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Fee Schedule,4280.44
Blue Shield,EPO,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Fee Schedule,3198.57
Blue Shield,EPO,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Fee Schedule,3198.57
Blue Shield,EPO,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Fee Schedule,6876.92
Blue Shield,EPO,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Fee Schedule,3198.57
Blue Shield,EPO,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,Fee Schedule,4891.93
Blue Shield,EPO,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,EPO,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,EPO,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,EPO,41500,CPT4/HCPCS,FIXATION OF TONGUE,,Fee Schedule,3198.57
Blue Shield,EPO,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Fee Schedule,4891.93
Blue Shield,EPO,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Fee Schedule,4280.44
Blue Shield,EPO,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Fee Schedule,4280.44
Blue Shield,EPO,41599,CPT4/HCPCS,TONGUE AND MOUTH SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Fee Schedule,3198.57
Blue Shield,EPO,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Fee Schedule,6049.05
Blue Shield,EPO,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Fee Schedule,4280.44
Blue Shield,EPO,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Fee Schedule,3198.57
Blue Shield,EPO,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Fee Schedule,3198.57
Blue Shield,EPO,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,6049.05
Blue Shield,EPO,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Fee Schedule,4280.44
Blue Shield,EPO,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,EPO,41870,CPT4/HCPCS,GUM GRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,41872,CPT4/HCPCS,REPAIR GUM,,Fee Schedule,4280.44
Blue Shield,EPO,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Fee Schedule,6049.05
Blue Shield,EPO,41899,CPT4/HCPCS,DENTAL SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,EPO,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Fee Schedule,4280.44
Blue Shield,EPO,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Fee Schedule,3198.57
Blue Shield,EPO,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,EPO,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,EPO,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,EPO,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Fee Schedule,6049.05
Blue Shield,EPO,42140,CPT4/HCPCS,EXCISION OF UVULA,,Fee Schedule,4280.44
Blue Shield,EPO,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Fee Schedule,6876.92
Blue Shield,EPO,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Fee Schedule,4280.44
Blue Shield,EPO,42180,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,3198.57
Blue Shield,EPO,42182,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,4280.44
Blue Shield,EPO,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,EPO,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,EPO,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,EPO,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,9548.66
Blue Shield,EPO,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,EPO,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,9548.66
Blue Shield,EPO,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Fee Schedule,6876.92
Blue Shield,EPO,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,Fee Schedule,9548.66
Blue Shield,EPO,42235,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,6876.92
Blue Shield,EPO,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Fee Schedule,6049.05
Blue Shield,EPO,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Fee Schedule,987.79
Blue Shield,EPO,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,EPO,42299,CPT4/HCPCS,PALATE/UVULA SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,EPO,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,4280.44
Blue Shield,EPO,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,EPO,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,EPO,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,EPO,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,EPO,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,EPO,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Fee Schedule,987.79
Blue Shield,EPO,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Fee Schedule,4280.44
Blue Shield,EPO,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Fee Schedule,4891.93
Blue Shield,EPO,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Fee Schedule,4891.93
Blue Shield,EPO,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,4891.93
Blue Shield,EPO,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,EPO,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,EPO,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,EPO,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,4891.93
Blue Shield,EPO,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Fee Schedule,4891.93
Blue Shield,EPO,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Fee Schedule,4280.44
Blue Shield,EPO,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Fee Schedule,4891.93
Blue Shield,EPO,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Fee Schedule,6049.05
Blue Shield,EPO,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,4891.93
Blue Shield,EPO,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,6049.05
Blue Shield,EPO,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,6049.05
Blue Shield,EPO,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,42650,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Fee Schedule,3198.57
Blue Shield,EPO,42660,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Fee Schedule,3198.57
Blue Shield,EPO,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Fee Schedule,6049.05
Blue Shield,EPO,42699,CPT4/HCPCS,SALIVARY SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,EPO,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Fee Schedule,4280.44
Blue Shield,EPO,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Fee Schedule,3198.57
Blue Shield,EPO,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Fee Schedule,4280.44
Blue Shield,EPO,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Fee Schedule,4280.44
Blue Shield,EPO,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,EPO,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Fee Schedule,4891.93
Blue Shield,EPO,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Fee Schedule,6876.92
Blue Shield,EPO,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Fee Schedule,4891.93
Blue Shield,EPO,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Fee Schedule,6876.92
Blue Shield,EPO,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Fee Schedule,6049.05
Blue Shield,EPO,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Fee Schedule,6049.05
Blue Shield,EPO,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,EPO,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,EPO,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,EPO,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,EPO,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,6049.05
Blue Shield,EPO,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,9548.66
Blue Shield,EPO,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,4891.93
Blue Shield,EPO,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Fee Schedule,4891.93
Blue Shield,EPO,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Fee Schedule,4891.93
Blue Shield,EPO,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Fee Schedule,9548.66
Blue Shield,EPO,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Fee Schedule,9548.66
Blue Shield,EPO,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Fee Schedule,4891.93
Blue Shield,EPO,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Fee Schedule,4280.44
Blue Shield,EPO,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,EPO,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Fee Schedule,4280.44
Blue Shield,EPO,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,EPO,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,EPO,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,4280.44
Blue Shield,EPO,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,EPO,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,EPO,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,4891.93
Blue Shield,EPO,42999,CPT4/HCPCS,THROAT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,EPO,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,EPO,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Fee Schedule,3198.57
Blue Shield,EPO,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Fee Schedule,3198.57
Blue Shield,EPO,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,EPO,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,EPO,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,Fee Schedule,6049.05
Blue Shield,EPO,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,EPO,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,EPO,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,EPO,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,EPO,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,EPO,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,EPO,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,EPO,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,EPO,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Fee Schedule,6049.05
Blue Shield,EPO,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Fee Schedule,3198.57
Blue Shield,EPO,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Fee Schedule,3198.57
Blue Shield,EPO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Fee Schedule,3198.57
Blue Shield,EPO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Fee Schedule,3198.57
Blue Shield,EPO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Fee Schedule,3198.57
Blue Shield,EPO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Fee Schedule,3198.57
Blue Shield,EPO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Fee Schedule,3198.57
Blue Shield,EPO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Fee Schedule,3198.57
Blue Shield,EPO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Fee Schedule,3198.57
Blue Shield,EPO,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Fee Schedule,3198.57
Blue Shield,EPO,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Fee Schedule,3198.57
Blue Shield,EPO,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Fee Schedule,3198.57
Blue Shield,EPO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Fee Schedule,3198.57
Blue Shield,EPO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Fee Schedule,3198.57
Blue Shield,EPO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Fee Schedule,3198.57
Blue Shield,EPO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Fee Schedule,3198.57
Blue Shield,EPO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Fee Schedule,3198.57
Blue Shield,EPO,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Fee Schedule,3198.57
Blue Shield,EPO,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Fee Schedule,3198.57
Blue Shield,EPO,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Fee Schedule,3198.57
Blue Shield,EPO,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Fee Schedule,3198.57
Blue Shield,EPO,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Fee Schedule,3198.57
Blue Shield,EPO,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Fee Schedule,4280.44
Blue Shield,EPO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Fee Schedule,3198.57
Blue Shield,EPO,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Fee Schedule,4280.44
Blue Shield,EPO,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Fee Schedule,4280.44
Blue Shield,EPO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Fee Schedule,3198.57
Blue Shield,EPO,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Fee Schedule,3198.57
Blue Shield,EPO,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Fee Schedule,4280.44
Blue Shield,EPO,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Fee Schedule,3198.57
Blue Shield,EPO,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Fee Schedule,3198.57
Blue Shield,EPO,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Fee Schedule,4280.44
Blue Shield,EPO,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Fee Schedule,4280.44
Blue Shield,EPO,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Fee Schedule,4280.44
Blue Shield,EPO,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Fee Schedule,4280.44
Blue Shield,EPO,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Fee Schedule,4280.44
Blue Shield,EPO,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Fee Schedule,4280.44
Blue Shield,EPO,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Fee Schedule,4280.44
Blue Shield,EPO,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Fee Schedule,4280.44
Blue Shield,EPO,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,EPO,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Fee Schedule,4280.44
Blue Shield,EPO,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Fee Schedule,4280.44
Blue Shield,EPO,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Fee Schedule,4280.44
Blue Shield,EPO,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Fee Schedule,4280.44
Blue Shield,EPO,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Fee Schedule,3198.57
Blue Shield,EPO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Fee Schedule,3198.57
Blue Shield,EPO,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Fee Schedule,4280.44
Blue Shield,EPO,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Fee Schedule,6049.05
Blue Shield,EPO,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Fee Schedule,4891.93
Blue Shield,EPO,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Fee Schedule,4280.44
Blue Shield,EPO,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Fee Schedule,4280.44
Blue Shield,EPO,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Fee Schedule,4280.44
Blue Shield,EPO,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Fee Schedule,4280.44
Blue Shield,EPO,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Fee Schedule,4280.44
Blue Shield,EPO,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Fee Schedule,4280.44
Blue Shield,EPO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Fee Schedule,4280.44
Blue Shield,EPO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Fee Schedule,4280.44
Blue Shield,EPO,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Fee Schedule,4280.44
Blue Shield,EPO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Fee Schedule,4280.44
Blue Shield,EPO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Fee Schedule,4280.44
Blue Shield,EPO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Fee Schedule,4280.44
Blue Shield,EPO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Fee Schedule,4280.44
Blue Shield,EPO,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Fee Schedule,12850.71
Blue Shield,EPO,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Fee Schedule,7902.34
Blue Shield,EPO,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Fee Schedule,9548.66
Blue Shield,EPO,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,Fee Schedule,3198.57
Blue Shield,EPO,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Fee Schedule,6049.05
Blue Shield,EPO,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Fee Schedule,3198.57
Blue Shield,EPO,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,Fee Schedule,3198.57
Blue Shield,EPO,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,Fee Schedule,3198.57
Blue Shield,EPO,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,Fee Schedule,3198.57
Blue Shield,EPO,43289,CPT4/HCPCS,LAPAROSCOPE PROC ESOPH,,Fee Schedule,7902.34
Blue Shield,EPO,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,EPO,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Fee Schedule,4280.44
Blue Shield,EPO,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,EPO,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Fee Schedule,4891.93
Blue Shield,EPO,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,Fee Schedule,6876.92
Blue Shield,EPO,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,Fee Schedule,6876.92
Blue Shield,EPO,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,Fee Schedule,3198.57
Blue Shield,EPO,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,Fee Schedule,3198.57
Blue Shield,EPO,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,Fee Schedule,3198.57
Blue Shield,EPO,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,Fee Schedule,3198.57
Blue Shield,EPO,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,Fee Schedule,3198.57
Blue Shield,EPO,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,Fee Schedule,3198.57
Blue Shield,EPO,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Fee Schedule,3198.57
Blue Shield,EPO,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Fee Schedule,3198.57
Blue Shield,EPO,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Fee Schedule,3198.57
Blue Shield,EPO,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Fee Schedule,3198.57
Blue Shield,EPO,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Fee Schedule,3198.57
Blue Shield,EPO,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Fee Schedule,3198.57
Blue Shield,EPO,43338,CPT4/HCPCS,ESOPH LENGTHENING,,Fee Schedule,3198.57
Blue Shield,EPO,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,EPO,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,EPO,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Fee Schedule,4891.93
Blue Shield,EPO,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Fee Schedule,4891.93
Blue Shield,EPO,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,Fee Schedule,3198.57
Blue Shield,EPO,43401,CPT4/HCPCS,ESOPHAGUS SURGERY FOR VEINS,,Fee Schedule,3198.57
Blue Shield,EPO,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,EPO,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Fee Schedule,4280.44
Blue Shield,EPO,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Fee Schedule,3198.57
Blue Shield,EPO,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,EPO,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,EPO,43496,CPT4/HCPCS,FREE JEJUNUM FLAP MICROVASC,,Fee Schedule,3198.57
Blue Shield,EPO,43499,CPT4/HCPCS,ESOPHAGUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Fee Schedule,3198.57
Blue Shield,EPO,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Fee Schedule,3198.57
Blue Shield,EPO,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Fee Schedule,3198.57
Blue Shield,EPO,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Fee Schedule,3198.57
Blue Shield,EPO,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,Fee Schedule,3198.57
Blue Shield,EPO,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,Fee Schedule,3198.57
Blue Shield,EPO,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,EPO,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,EPO,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,EPO,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,EPO,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,EPO,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,EPO,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,EPO,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,EPO,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Fee Schedule,3198.57
Blue Shield,EPO,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Fee Schedule,3198.57
Blue Shield,EPO,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Fee Schedule,4280.44
Blue Shield,EPO,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Fee Schedule,4280.44
Blue Shield,EPO,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Fee Schedule,12850.71
Blue Shield,EPO,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Fee Schedule,12850.71
Blue Shield,EPO,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Fee Schedule,12850.71
Blue Shield,EPO,43659,CPT4/HCPCS,LAPAROSCOPE PROC STOM,,Fee Schedule,7902.34
Blue Shield,EPO,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Fee Schedule,987.79
Blue Shield,EPO,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Fee Schedule,987.79
Blue Shield,EPO,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Fee Schedule,987.79
Blue Shield,EPO,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Fee Schedule,987.79
Blue Shield,EPO,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Fee Schedule,987.79
Blue Shield,EPO,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Fee Schedule,987.79
Blue Shield,EPO,43760,CPT4/HCPCS,CHANGE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Fee Schedule,987.79
Blue Shield,EPO,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,EPO,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,EPO,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,EPO,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,EPO,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Fee Schedule,6049.05
Blue Shield,EPO,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,Fee Schedule,9548.66
Blue Shield,EPO,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,Fee Schedule,3198.57
Blue Shield,EPO,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,Fee Schedule,3198.57
Blue Shield,EPO,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,Fee Schedule,3198.57
Blue Shield,EPO,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,Fee Schedule,4280.44
Blue Shield,EPO,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,Fee Schedule,4891.93
Blue Shield,EPO,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,Fee Schedule,4891.93
Blue Shield,EPO,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,EPO,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,EPO,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,EPO,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,EPO,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,EPO,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,EPO,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,EPO,43999,CPT4/HCPCS,STOMACH SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Fee Schedule,3198.57
Blue Shield,EPO,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Fee Schedule,3198.57
Blue Shield,EPO,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,Fee Schedule,3198.57
Blue Shield,EPO,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,Fee Schedule,3198.57
Blue Shield,EPO,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,Fee Schedule,4891.93
Blue Shield,EPO,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,Fee Schedule,6049.05
Blue Shield,EPO,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,EPO,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,Fee Schedule,3198.57
Blue Shield,EPO,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,Fee Schedule,3198.57
Blue Shield,EPO,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,Fee Schedule,3198.57
Blue Shield,EPO,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,Fee Schedule,3198.57
Blue Shield,EPO,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,Fee Schedule,3198.57
Blue Shield,EPO,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,EPO,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,EPO,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,4280.44
Blue Shield,EPO,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,EPO,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,EPO,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,4891.93
Blue Shield,EPO,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,EPO,44150,CPT4/HCPCS,REMOVAL OF COLON,,Fee Schedule,4280.44
Blue Shield,EPO,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,EPO,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,EPO,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,EPO,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Fee Schedule,4891.93
Blue Shield,EPO,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Fee Schedule,4891.93
Blue Shield,EPO,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Fee Schedule,4891.93
Blue Shield,EPO,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44205,CPT4/HCPCS,LAP COLECTOMY PART W/ILEUM,,Fee Schedule,3198.57
Blue Shield,EPO,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,Fee Schedule,12850.71
Blue Shield,EPO,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Fee Schedule,12850.71
Blue Shield,EPO,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Fee Schedule,12850.71
Blue Shield,EPO,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Fee Schedule,7902.34
Blue Shield,EPO,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,Fee Schedule,7902.34
Blue Shield,EPO,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Fee Schedule,7902.34
Blue Shield,EPO,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Fee Schedule,6876.92
Blue Shield,EPO,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Fee Schedule,6876.92
Blue Shield,EPO,44238,CPT4/HCPCS,LAPAROSCOPE PROC INTESTINE,,Fee Schedule,7902.34
Blue Shield,EPO,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,Fee Schedule,3198.57
Blue Shield,EPO,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,Fee Schedule,4280.44
Blue Shield,EPO,44320,CPT4/HCPCS,COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,Fee Schedule,3198.57
Blue Shield,EPO,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,4891.93
Blue Shield,EPO,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Fee Schedule,4280.44
Blue Shield,EPO,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Fee Schedule,12850.71
Blue Shield,EPO,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Fee Schedule,4280.44
Blue Shield,EPO,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Fee Schedule,12850.71
Blue Shield,EPO,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Fee Schedule,3198.57
Blue Shield,EPO,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Fee Schedule,4891.93
Blue Shield,EPO,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Fee Schedule,3198.57
Blue Shield,EPO,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Fee Schedule,3198.57
Blue Shield,EPO,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Fee Schedule,3198.57
Blue Shield,EPO,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,EPO,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Fee Schedule,3198.57
Blue Shield,EPO,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Fee Schedule,3198.57
Blue Shield,EPO,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Fee Schedule,3198.57
Blue Shield,EPO,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Fee Schedule,3198.57
Blue Shield,EPO,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,EPO,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Fee Schedule,3198.57
Blue Shield,EPO,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Fee Schedule,3198.57
Blue Shield,EPO,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Fee Schedule,3198.57
Blue Shield,EPO,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Fee Schedule,3198.57
Blue Shield,EPO,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,EPO,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,Fee Schedule,3198.57
Blue Shield,EPO,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,EPO,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Fee Schedule,3198.57
Blue Shield,EPO,44799,CPT4/HCPCS,UNLISTED PX SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,44800,CPT4/HCPCS,EXCISION OF BOWEL POUCH,,Fee Schedule,3198.57
Blue Shield,EPO,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,Fee Schedule,3198.57
Blue Shield,EPO,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,Fee Schedule,3198.57
Blue Shield,EPO,44899,CPT4/HCPCS,BOWEL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,Fee Schedule,3198.57
Blue Shield,EPO,44950,CPT4/HCPCS,APPENDECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,44960,CPT4/HCPCS,APPENDECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Fee Schedule,7902.34
Blue Shield,EPO,44979,CPT4/HCPCS,LAPAROSCOPE PROC APP,,Fee Schedule,7902.34
Blue Shield,EPO,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Fee Schedule,3198.57
Blue Shield,EPO,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Fee Schedule,4280.44
Blue Shield,EPO,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,EPO,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,EPO,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,EPO,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,EPO,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,EPO,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,Fee Schedule,4280.44
Blue Shield,EPO,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,EPO,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,Fee Schedule,4280.44
Blue Shield,EPO,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,45126,CPT4/HCPCS,PELVIC EXENTERATION,,Fee Schedule,6049.05
Blue Shield,EPO,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,EPO,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,EPO,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,Fee Schedule,4280.44
Blue Shield,EPO,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Fee Schedule,4280.44
Blue Shield,EPO,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Fee Schedule,4280.44
Blue Shield,EPO,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Fee Schedule,7902.34
Blue Shield,EPO,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Fee Schedule,7902.34
Blue Shield,EPO,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Fee Schedule,12850.71
Blue Shield,EPO,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Fee Schedule,3198.57
Blue Shield,EPO,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Fee Schedule,3198.57
Blue Shield,EPO,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Fee Schedule,3198.57
Blue Shield,EPO,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Fee Schedule,3198.57
Blue Shield,EPO,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,EPO,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,EPO,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,EPO,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Fee Schedule,3198.57
Blue Shield,EPO,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Fee Schedule,3198.57
Blue Shield,EPO,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Fee Schedule,3198.57
Blue Shield,EPO,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Fee Schedule,9548.66
Blue Shield,EPO,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Fee Schedule,3198.57
Blue Shield,EPO,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Fee Schedule,3198.57
Blue Shield,EPO,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Fee Schedule,3198.57
Blue Shield,EPO,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Fee Schedule,3198.57
Blue Shield,EPO,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Fee Schedule,3198.57
Blue Shield,EPO,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Fee Schedule,3198.57
Blue Shield,EPO,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Fee Schedule,3198.57
Blue Shield,EPO,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Fee Schedule,3198.57
Blue Shield,EPO,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Fee Schedule,3198.57
Blue Shield,EPO,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Fee Schedule,3198.57
Blue Shield,EPO,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,EPO,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Fee Schedule,3198.57
Blue Shield,EPO,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,EPO,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Fee Schedule,4280.44
Blue Shield,EPO,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Fee Schedule,4280.44
Blue Shield,EPO,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Fee Schedule,4280.44
Blue Shield,EPO,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Fee Schedule,4280.44
Blue Shield,EPO,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Fee Schedule,4280.44
Blue Shield,EPO,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Fee Schedule,4280.44
Blue Shield,EPO,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Fee Schedule,3198.57
Blue Shield,EPO,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Fee Schedule,3198.57
Blue Shield,EPO,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,EPO,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Fee Schedule,3198.57
Blue Shield,EPO,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Fee Schedule,3198.57
Blue Shield,EPO,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,EPO,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Fee Schedule,3198.57
Blue Shield,EPO,45399,CPT4/HCPCS,UNLISTED PROCEDURE COLON,,Fee Schedule,3198.57
Blue Shield,EPO,45499,CPT4/HCPCS,LAPAROSCOPE PROC RECTUM,,Fee Schedule,4891.93
Blue Shield,EPO,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Fee Schedule,4280.44
Blue Shield,EPO,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Fee Schedule,4280.44
Blue Shield,EPO,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Fee Schedule,987.79
Blue Shield,EPO,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,EPO,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,EPO,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,Fee Schedule,3198.57
Blue Shield,EPO,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Fee Schedule,4280.44
Blue Shield,EPO,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Fee Schedule,3198.57
Blue Shield,EPO,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Fee Schedule,3198.57
Blue Shield,EPO,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,EPO,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Fee Schedule,3198.57
Blue Shield,EPO,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Fee Schedule,3198.57
Blue Shield,EPO,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Fee Schedule,3198.57
Blue Shield,EPO,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Fee Schedule,4280.44
Blue Shield,EPO,45999,CPT4/HCPCS,RECTUM SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Fee Schedule,4891.93
Blue Shield,EPO,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Fee Schedule,3198.57
Blue Shield,EPO,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4891.93
Blue Shield,EPO,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Fee Schedule,3198.57
Blue Shield,EPO,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,EPO,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Fee Schedule,3198.57
Blue Shield,EPO,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Fee Schedule,4280.44
Blue Shield,EPO,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Fee Schedule,3198.57
Blue Shield,EPO,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Fee Schedule,3198.57
Blue Shield,EPO,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Fee Schedule,4280.44
Blue Shield,EPO,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Fee Schedule,4891.93
Blue Shield,EPO,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Fee Schedule,4891.93
Blue Shield,EPO,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Fee Schedule,4891.93
Blue Shield,EPO,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Fee Schedule,4891.93
Blue Shield,EPO,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Fee Schedule,4891.93
Blue Shield,EPO,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Fee Schedule,6049.05
Blue Shield,EPO,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Fee Schedule,6049.05
Blue Shield,EPO,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Fee Schedule,4891.93
Blue Shield,EPO,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Fee Schedule,4891.93
Blue Shield,EPO,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Fee Schedule,6049.05
Blue Shield,EPO,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Fee Schedule,3198.57
Blue Shield,EPO,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Fee Schedule,6049.05
Blue Shield,EPO,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Fee Schedule,3198.57
Blue Shield,EPO,46500,CPT4/HCPCS,INJECTION INTO HEMORRHOID(S),,Fee Schedule,3198.57
Blue Shield,EPO,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Fee Schedule,3198.57
Blue Shield,EPO,46600,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY SPX,,Fee Schedule,987.79
Blue Shield,EPO,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Fee Schedule,987.79
Blue Shield,EPO,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Fee Schedule,3198.57
Blue Shield,EPO,46606,CPT4/HCPCS,ANOSCOPY AND BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Fee Schedule,3198.57
Blue Shield,EPO,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Fee Schedule,3198.57
Blue Shield,EPO,46611,CPT4/HCPCS,ANOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Fee Schedule,3198.57
Blue Shield,EPO,46615,CPT4/HCPCS,ANOSCOPY,,Fee Schedule,4280.44
Blue Shield,EPO,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Fee Schedule,4891.93
Blue Shield,EPO,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Fee Schedule,3198.57
Blue Shield,EPO,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Fee Schedule,3198.57
Blue Shield,EPO,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,Fee Schedule,7902.34
Blue Shield,EPO,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,Fee Schedule,3198.57
Blue Shield,EPO,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,Fee Schedule,3198.57
Blue Shield,EPO,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,3198.57
Blue Shield,EPO,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,4891.93
Blue Shield,EPO,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,4280.44
Blue Shield,EPO,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,Fee Schedule,6049.05
Blue Shield,EPO,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,6876.92
Blue Shield,EPO,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,7902.34
Blue Shield,EPO,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,9548.66
Blue Shield,EPO,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,EPO,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,3198.57
Blue Shield,EPO,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Fee Schedule,4891.93
Blue Shield,EPO,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Fee Schedule,4280.44
Blue Shield,EPO,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4280.44
Blue Shield,EPO,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,EPO,46762,CPT4/HCPCS,IMPLANT ARTIFICIAL SPHINCTER,,Fee Schedule,9548.66
Blue Shield,EPO,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,987.79
Blue Shield,EPO,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,EPO,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Fee Schedule,987.79
Blue Shield,EPO,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Fee Schedule,3198.57
Blue Shield,EPO,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,3198.57
Blue Shield,EPO,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Fee Schedule,3198.57
Blue Shield,EPO,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Fee Schedule,4280.44
Blue Shield,EPO,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Fee Schedule,3198.57
Blue Shield,EPO,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Fee Schedule,3198.57
Blue Shield,EPO,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Fee Schedule,3198.57
Blue Shield,EPO,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Fee Schedule,6049.05
Blue Shield,EPO,46999,CPT4/HCPCS,ANUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Fee Schedule,3198.57
Blue Shield,EPO,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,Fee Schedule,3198.57
Blue Shield,EPO,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,Fee Schedule,3198.57
Blue Shield,EPO,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,Fee Schedule,3198.57
Blue Shield,EPO,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,4891.93
Blue Shield,EPO,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,EPO,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,EPO,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,EPO,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,Fee Schedule,6876.92
Blue Shield,EPO,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,Fee Schedule,12850.71
Blue Shield,EPO,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,6049.05
Blue Shield,EPO,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,6876.92
Blue Shield,EPO,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,7902.34
Blue Shield,EPO,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,Fee Schedule,3198.57
Blue Shield,EPO,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,4280.44
Blue Shield,EPO,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,6049.05
Blue Shield,EPO,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Fee Schedule,9548.66
Blue Shield,EPO,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Fee Schedule,9548.66
Blue Shield,EPO,47379,CPT4/HCPCS,LAPAROSCOPE PROCEDURE LIVER,,Fee Schedule,7902.34
Blue Shield,EPO,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Fee Schedule,3198.57
Blue Shield,EPO,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Fee Schedule,3198.57
Blue Shield,EPO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Fee Schedule,9548.66
Blue Shield,EPO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Fee Schedule,9548.66
Blue Shield,EPO,47399,CPT4/HCPCS,LIVER SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,Fee Schedule,4280.44
Blue Shield,EPO,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,Fee Schedule,3198.57
Blue Shield,EPO,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,Fee Schedule,3198.57
Blue Shield,EPO,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,Fee Schedule,3198.57
Blue Shield,EPO,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Fee Schedule,4891.93
Blue Shield,EPO,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Fee Schedule,4891.93
Blue Shield,EPO,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Fee Schedule,4891.93
Blue Shield,EPO,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Fee Schedule,4891.93
Blue Shield,EPO,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Fee Schedule,4891.93
Blue Shield,EPO,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Fee Schedule,4891.93
Blue Shield,EPO,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Fee Schedule,3198.57
Blue Shield,EPO,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,EPO,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,EPO,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,EPO,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Fee Schedule,4891.93
Blue Shield,EPO,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Fee Schedule,4891.93
Blue Shield,EPO,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Fee Schedule,4891.93
Blue Shield,EPO,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Fee Schedule,4891.93
Blue Shield,EPO,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Fee Schedule,4280.44
Blue Shield,EPO,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,EPO,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,EPO,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,EPO,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,12850.71
Blue Shield,EPO,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Fee Schedule,9548.66
Blue Shield,EPO,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Fee Schedule,9548.66
Blue Shield,EPO,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Fee Schedule,9548.66
Blue Shield,EPO,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,47579,CPT4/HCPCS,LAPAROSCOPE PROC BILIARY,,Fee Schedule,7902.34
Blue Shield,EPO,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,Fee Schedule,3198.57
Blue Shield,EPO,47701,CPT4/HCPCS,BILE DUCT REVISION,,Fee Schedule,4280.44
Blue Shield,EPO,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Fee Schedule,3198.57
Blue Shield,EPO,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Fee Schedule,4280.44
Blue Shield,EPO,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,Fee Schedule,3198.57
Blue Shield,EPO,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,Fee Schedule,3198.57
Blue Shield,EPO,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,Fee Schedule,4280.44
Blue Shield,EPO,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,4280.44
Blue Shield,EPO,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,4280.44
Blue Shield,EPO,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,Fee Schedule,3198.57
Blue Shield,EPO,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,Fee Schedule,3198.57
Blue Shield,EPO,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,Fee Schedule,3198.57
Blue Shield,EPO,47999,CPT4/HCPCS,BILE TRACT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,Fee Schedule,4280.44
Blue Shield,EPO,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,Fee Schedule,4280.44
Blue Shield,EPO,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,Fee Schedule,3198.57
Blue Shield,EPO,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,Fee Schedule,3198.57
Blue Shield,EPO,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Fee Schedule,3198.57
Blue Shield,EPO,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,Fee Schedule,3198.57
Blue Shield,EPO,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,3198.57
Blue Shield,EPO,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,3198.57
Blue Shield,EPO,48146,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,Fee Schedule,3198.57
Blue Shield,EPO,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,6049.05
Blue Shield,EPO,48152,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6049.05
Blue Shield,EPO,48153,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6876.92
Blue Shield,EPO,48154,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6049.05
Blue Shield,EPO,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,Fee Schedule,4280.44
Blue Shield,EPO,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,Fee Schedule,4280.44
Blue Shield,EPO,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,Fee Schedule,3198.57
Blue Shield,EPO,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Fee Schedule,3198.57
Blue Shield,EPO,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,48545,CPT4/HCPCS,PANCREATORRHAPHY,,Fee Schedule,3198.57
Blue Shield,EPO,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,Fee Schedule,3198.57
Blue Shield,EPO,48550,CPT4/HCPCS,DONOR PANCREATECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,48554,CPT4/HCPCS,TRANSPL ALLOGRAFT PANCREAS,,Fee Schedule,3198.57
Blue Shield,EPO,48556,CPT4/HCPCS,REMOVAL ALLOGRAFT PANCREAS,,Fee Schedule,3198.57
Blue Shield,EPO,48999,CPT4/HCPCS,PANCREAS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,EPO,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,EPO,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Fee Schedule,3198.57
Blue Shield,EPO,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,Fee Schedule,3198.57
Blue Shield,EPO,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,Fee Schedule,3198.57
Blue Shield,EPO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Fee Schedule,987.79
Blue Shield,EPO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Fee Schedule,3198.57
Blue Shield,EPO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Fee Schedule,4891.93
Blue Shield,EPO,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Fee Schedule,3198.57
Blue Shield,EPO,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Fee Schedule,3198.57
Blue Shield,EPO,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,Fee Schedule,4891.93
Blue Shield,EPO,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,Fee Schedule,3198.57
Blue Shield,EPO,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Fee Schedule,6049.05
Blue Shield,EPO,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,Fee Schedule,3198.57
Blue Shield,EPO,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Fee Schedule,4891.93
Blue Shield,EPO,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Fee Schedule,6049.05
Blue Shield,EPO,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Fee Schedule,6049.05
Blue Shield,EPO,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Fee Schedule,7902.34
Blue Shield,EPO,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Fee Schedule,4891.93
Blue Shield,EPO,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Fee Schedule,4891.93
Blue Shield,EPO,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,49329,CPT4/HCPCS,LAPARO PROC ABDM/PER/OMENT,,Fee Schedule,7902.34
Blue Shield,EPO,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Fee Schedule,4280.44
Blue Shield,EPO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Fee Schedule,3198.57
Blue Shield,EPO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Fee Schedule,3198.57
Blue Shield,EPO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Fee Schedule,3198.57
Blue Shield,EPO,49411,CPT4/HCPCS,INS MARK ABD/PEL FOR RT PERQ,,Fee Schedule,987.79
Blue Shield,EPO,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Fee Schedule,4280.44
Blue Shield,EPO,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Fee Schedule,12850.71
Blue Shield,EPO,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Fee Schedule,3198.57
Blue Shield,EPO,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Fee Schedule,3198.57
Blue Shield,EPO,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Fee Schedule,3198.57
Blue Shield,EPO,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Fee Schedule,3198.57
Blue Shield,EPO,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Fee Schedule,4280.44
Blue Shield,EPO,49428,CPT4/HCPCS,LIGATION OF SHUNT,,Fee Schedule,3198.57
Blue Shield,EPO,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Fee Schedule,4891.93
Blue Shield,EPO,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Fee Schedule,3198.57
Blue Shield,EPO,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Fee Schedule,4280.44
Blue Shield,EPO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Fee Schedule,4280.44
Blue Shield,EPO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Fee Schedule,4280.44
Blue Shield,EPO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Fee Schedule,4280.44
Blue Shield,EPO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Fee Schedule,4280.44
Blue Shield,EPO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Fee Schedule,4280.44
Blue Shield,EPO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Fee Schedule,4280.44
Blue Shield,EPO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Fee Schedule,4280.44
Blue Shield,EPO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Fee Schedule,6876.92
Blue Shield,EPO,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Fee Schedule,6876.92
Blue Shield,EPO,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Fee Schedule,6049.05
Blue Shield,EPO,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Fee Schedule,6049.05
Blue Shield,EPO,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Fee Schedule,6049.05
Blue Shield,EPO,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Fee Schedule,12850.71
Blue Shield,EPO,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Fee Schedule,6049.05
Blue Shield,EPO,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Fee Schedule,12850.71
Blue Shield,EPO,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Fee Schedule,9548.66
Blue Shield,EPO,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Fee Schedule,12850.71
Blue Shield,EPO,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Fee Schedule,6049.05
Blue Shield,EPO,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Fee Schedule,4280.44
Blue Shield,EPO,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Fee Schedule,6876.92
Blue Shield,EPO,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Fee Schedule,12850.71
Blue Shield,EPO,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Fee Schedule,6876.92
Blue Shield,EPO,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Fee Schedule,12850.71
Blue Shield,EPO,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Fee Schedule,6049.05
Blue Shield,EPO,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Fee Schedule,12850.71
Blue Shield,EPO,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Fee Schedule,6049.05
Blue Shield,EPO,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Fee Schedule,12850.71
Blue Shield,EPO,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Fee Schedule,9548.66
Blue Shield,EPO,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Fee Schedule,6049.05
Blue Shield,EPO,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Fee Schedule,12850.71
Blue Shield,EPO,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Fee Schedule,6049.05
Blue Shield,EPO,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Fee Schedule,12850.71
Blue Shield,EPO,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Fee Schedule,6049.05
Blue Shield,EPO,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Fee Schedule,12850.71
Blue Shield,EPO,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Fee Schedule,4891.93
Blue Shield,EPO,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,9548.66
Blue Shield,EPO,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Fee Schedule,6049.05
Blue Shield,EPO,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Fee Schedule,9548.66
Blue Shield,EPO,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Fee Schedule,7902.34
Blue Shield,EPO,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Fee Schedule,7902.34
Blue Shield,EPO,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Fee Schedule,7902.34
Blue Shield,EPO,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Fee Schedule,7902.34
Blue Shield,EPO,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Fee Schedule,7902.34
Blue Shield,EPO,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Fee Schedule,7902.34
Blue Shield,EPO,49659,CPT4/HCPCS,LAPARO PROC HERNIA REPAIR,,Fee Schedule,9548.66
Blue Shield,EPO,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,Fee Schedule,3198.57
Blue Shield,EPO,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,Fee Schedule,4280.44
Blue Shield,EPO,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,Fee Schedule,3198.57
Blue Shield,EPO,49906,CPT4/HCPCS,FREE OMENTAL FLAP MICROVASC,,Fee Schedule,3198.57
Blue Shield,EPO,49999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Fee Schedule,4891.93
Blue Shield,EPO,4A020N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,4A020N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,EPO,4A020N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Open,,Fee Schedule,8271.00
Blue Shield,EPO,4A023FZ,ICD10-PCS,Measurement of Cardiac Rhythm, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,EPO,4A023N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,4A023N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,EPO,4A023N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Perc,,Fee Schedule,8271.00
Blue Shield,EPO,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Fee Schedule,4280.44
Blue Shield,EPO,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,9548.66
Blue Shield,EPO,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,3198.57
Blue Shield,EPO,50065,CPT4/HCPCS,INCISION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50070,CPT4/HCPCS,INCISION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,4280.44
Blue Shield,EPO,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,9548.66
Blue Shield,EPO,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,9548.66
Blue Shield,EPO,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,Fee Schedule,3198.57
Blue Shield,EPO,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,3198.57
Blue Shield,EPO,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Fee Schedule,3198.57
Blue Shield,EPO,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,Fee Schedule,3198.57
Blue Shield,EPO,50220,CPT4/HCPCS,REMOVE KIDNEY OPEN,,Fee Schedule,3198.57
Blue Shield,EPO,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,Fee Schedule,3198.57
Blue Shield,EPO,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,Fee Schedule,3198.57
Blue Shield,EPO,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Fee Schedule,4280.44
Blue Shield,EPO,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,Fee Schedule,4280.44
Blue Shield,EPO,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,EPO,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,EPO,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,Fee Schedule,3198.57
Blue Shield,EPO,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Fee Schedule,4891.93
Blue Shield,EPO,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Fee Schedule,6049.05
Blue Shield,EPO,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,Fee Schedule,4280.44
Blue Shield,EPO,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Fee Schedule,4280.44
Blue Shield,EPO,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Fee Schedule,4280.44
Blue Shield,EPO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Fee Schedule,4280.44
Blue Shield,EPO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Fee Schedule,4280.44
Blue Shield,EPO,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Fee Schedule,4280.44
Blue Shield,EPO,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Fee Schedule,4280.44
Blue Shield,EPO,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,EPO,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Fee Schedule,987.79
Blue Shield,EPO,50395,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Fee Schedule,3198.57
Blue Shield,EPO,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Fee Schedule,3198.57
Blue Shield,EPO,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Fee Schedule,3198.57
Blue Shield,EPO,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Fee Schedule,3198.57
Blue Shield,EPO,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Fee Schedule,3198.57
Blue Shield,EPO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Fee Schedule,3198.57
Blue Shield,EPO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Fee Schedule,3198.57
Blue Shield,EPO,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Fee Schedule,4280.44
Blue Shield,EPO,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Fee Schedule,4280.44
Blue Shield,EPO,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Fee Schedule,7902.34
Blue Shield,EPO,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Fee Schedule,9548.66
Blue Shield,EPO,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Fee Schedule,9548.66
Blue Shield,EPO,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Fee Schedule,7902.34
Blue Shield,EPO,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,50546,CPT4/HCPCS,LAPAROSCOPIC NEPHRECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50549,CPT4/HCPCS,LAPAROSCOPE PROC RENAL,,Fee Schedule,7902.34
Blue Shield,EPO,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,EPO,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,EPO,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Fee Schedule,9548.66
Blue Shield,EPO,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,EPO,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,EPO,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Fee Schedule,12850.71
Blue Shield,EPO,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Fee Schedule,6876.92
Blue Shield,EPO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Fee Schedule,4891.93
Blue Shield,EPO,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Fee Schedule,3198.57
Blue Shield,EPO,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,EPO,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,EPO,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,EPO,50650,CPT4/HCPCS,REMOVAL OF URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50660,CPT4/HCPCS,REMOVAL OF URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,Fee Schedule,987.79
Blue Shield,EPO,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Fee Schedule,3198.57
Blue Shield,EPO,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,EPO,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,EPO,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,EPO,50700,CPT4/HCPCS,REVISION OF URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50715,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50722,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50727,CPT4/HCPCS,REVISE URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50728,CPT4/HCPCS,REVISE URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Fee Schedule,3198.57
Blue Shield,EPO,50760,CPT4/HCPCS,FUSION OF URETERS,,Fee Schedule,3198.57
Blue Shield,EPO,50770,CPT4/HCPCS,SPLICING OF URETERS,,Fee Schedule,3198.57
Blue Shield,EPO,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,50782,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,50783,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,Fee Schedule,3198.57
Blue Shield,EPO,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Fee Schedule,4891.93
Blue Shield,EPO,50830,CPT4/HCPCS,REVISE URINE FLOW,,Fee Schedule,4891.93
Blue Shield,EPO,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,Fee Schedule,3198.57
Blue Shield,EPO,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,Fee Schedule,3198.57
Blue Shield,EPO,50900,CPT4/HCPCS,REPAIR OF URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,50940,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Fee Schedule,9548.66
Blue Shield,EPO,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Fee Schedule,12850.71
Blue Shield,EPO,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Fee Schedule,12850.71
Blue Shield,EPO,50949,CPT4/HCPCS,LAPAROSCOPE PROC URETER,,Fee Schedule,7902.34
Blue Shield,EPO,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Fee Schedule,3198.57
Blue Shield,EPO,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,EPO,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,EPO,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Fee Schedule,3198.57
Blue Shield,EPO,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,EPO,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,EPO,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Fee Schedule,6049.05
Blue Shield,EPO,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Fee Schedule,6049.05
Blue Shield,EPO,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Fee Schedule,6049.05
Blue Shield,EPO,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Fee Schedule,6049.05
Blue Shield,EPO,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Fee Schedule,6049.05
Blue Shield,EPO,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,EPO,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Fee Schedule,6049.05
Blue Shield,EPO,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,Fee Schedule,987.79
Blue Shield,EPO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Fee Schedule,3198.57
Blue Shield,EPO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Fee Schedule,3198.57
Blue Shield,EPO,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Fee Schedule,6049.05
Blue Shield,EPO,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,6049.05
Blue Shield,EPO,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,3198.57
Blue Shield,EPO,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,3198.57
Blue Shield,EPO,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,Fee Schedule,3198.57
Blue Shield,EPO,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Fee Schedule,3198.57
Blue Shield,EPO,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,Fee Schedule,3198.57
Blue Shield,EPO,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,Fee Schedule,4280.44
Blue Shield,EPO,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Fee Schedule,4891.93
Blue Shield,EPO,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,EPO,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Fee Schedule,4891.93
Blue Shield,EPO,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,EPO,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,EPO,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,Fee Schedule,6049.05
Blue Shield,EPO,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,Fee Schedule,4891.93
Blue Shield,EPO,51700,CPT4/HCPCS,IRRIGATION OF BLADDER,,Fee Schedule,987.79
Blue Shield,EPO,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Fee Schedule,987.79
Blue Shield,EPO,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Fee Schedule,4891.93
Blue Shield,EPO,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Fee Schedule,987.79
Blue Shield,EPO,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Fee Schedule,3198.57
Blue Shield,EPO,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Fee Schedule,3198.57
Blue Shield,EPO,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Fee Schedule,3198.57
Blue Shield,EPO,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Fee Schedule,3198.57
Blue Shield,EPO,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Fee Schedule,3198.57
Blue Shield,EPO,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,Fee Schedule,987.79
Blue Shield,EPO,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,Fee Schedule,987.79
Blue Shield,EPO,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Fee Schedule,987.79
Blue Shield,EPO,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Fee Schedule,3198.57
Blue Shield,EPO,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,Fee Schedule,987.79
Blue Shield,EPO,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Fee Schedule,987.79
Blue Shield,EPO,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,Fee Schedule,987.79
Blue Shield,EPO,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Fee Schedule,3198.57
Blue Shield,EPO,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Fee Schedule,3198.57
Blue Shield,EPO,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Fee Schedule,3198.57
Blue Shield,EPO,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Fee Schedule,3198.57
Blue Shield,EPO,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,Fee Schedule,3198.57
Blue Shield,EPO,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,Fee Schedule,4891.93
Blue Shield,EPO,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,Fee Schedule,4280.44
Blue Shield,EPO,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Fee Schedule,9548.66
Blue Shield,EPO,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Fee Schedule,12850.71
Blue Shield,EPO,51999,CPT4/HCPCS,LAPAROSCOPE PROC BLA,,Fee Schedule,6049.05
Blue Shield,EPO,52000,CPT4/HCPCS,CYSTOSCOPY,,Fee Schedule,3198.57
Blue Shield,EPO,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Fee Schedule,4280.44
Blue Shield,EPO,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Fee Schedule,4280.44
Blue Shield,EPO,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Fee Schedule,4280.44
Blue Shield,EPO,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Fee Schedule,4280.44
Blue Shield,EPO,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Fee Schedule,4280.44
Blue Shield,EPO,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,EPO,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,EPO,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Fee Schedule,6049.05
Blue Shield,EPO,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,3198.57
Blue Shield,EPO,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Fee Schedule,4280.44
Blue Shield,EPO,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Fee Schedule,4280.44
Blue Shield,EPO,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,EPO,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Fee Schedule,12850.71
Blue Shield,EPO,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Fee Schedule,4280.44
Blue Shield,EPO,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Fee Schedule,3198.57
Blue Shield,EPO,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Fee Schedule,4280.44
Blue Shield,EPO,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,6876.92
Blue Shield,EPO,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Fee Schedule,6049.05
Blue Shield,EPO,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Fee Schedule,4280.44
Blue Shield,EPO,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Fee Schedule,4891.93
Blue Shield,EPO,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,EPO,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,EPO,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,EPO,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,EPO,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Fee Schedule,4891.93
Blue Shield,EPO,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Fee Schedule,4891.93
Blue Shield,EPO,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Fee Schedule,4891.93
Blue Shield,EPO,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Fee Schedule,6049.05
Blue Shield,EPO,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Fee Schedule,6049.05
Blue Shield,EPO,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Fee Schedule,6049.05
Blue Shield,EPO,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Fee Schedule,6049.05
Blue Shield,EPO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Fee Schedule,6049.05
Blue Shield,EPO,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Fee Schedule,4891.93
Blue Shield,EPO,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Fee Schedule,6049.05
Blue Shield,EPO,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Fee Schedule,987.79
Blue Shield,EPO,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Fee Schedule,987.79
Blue Shield,EPO,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Fee Schedule,4891.93
Blue Shield,EPO,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Fee Schedule,4891.93
Blue Shield,EPO,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Fee Schedule,6049.05
Blue Shield,EPO,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Fee Schedule,4280.44
Blue Shield,EPO,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Fee Schedule,4280.44
Blue Shield,EPO,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Fee Schedule,12850.71
Blue Shield,EPO,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Fee Schedule,12850.71
Blue Shield,EPO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Fee Schedule,6049.05
Blue Shield,EPO,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,53000,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,53010,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,53020,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,53025,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,EPO,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Fee Schedule,4891.93
Blue Shield,EPO,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Fee Schedule,3198.57
Blue Shield,EPO,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Fee Schedule,6876.92
Blue Shield,EPO,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Fee Schedule,6876.92
Blue Shield,EPO,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,EPO,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,EPO,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Fee Schedule,4891.93
Blue Shield,EPO,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Fee Schedule,4280.44
Blue Shield,EPO,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Fee Schedule,4280.44
Blue Shield,EPO,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,EPO,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,EPO,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Fee Schedule,4280.44
Blue Shield,EPO,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Fee Schedule,4280.44
Blue Shield,EPO,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Fee Schedule,4891.93
Blue Shield,EPO,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Fee Schedule,4280.44
Blue Shield,EPO,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,EPO,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Fee Schedule,4891.93
Blue Shield,EPO,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Fee Schedule,4280.44
Blue Shield,EPO,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,EPO,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Fee Schedule,4280.44
Blue Shield,EPO,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Fee Schedule,4280.44
Blue Shield,EPO,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Fee Schedule,3198.57
Blue Shield,EPO,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Fee Schedule,4280.44
Blue Shield,EPO,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Fee Schedule,3198.57
Blue Shield,EPO,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Fee Schedule,3198.57
Blue Shield,EPO,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Fee Schedule,3198.57
Blue Shield,EPO,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,Fee Schedule,3198.57
Blue Shield,EPO,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Fee Schedule,3198.57
Blue Shield,EPO,53450,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,53460,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Fee Schedule,7902.34
Blue Shield,EPO,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,EPO,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,EPO,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,EPO,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,EPO,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Fee Schedule,4280.44
Blue Shield,EPO,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,3198.57
Blue Shield,EPO,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,3198.57
Blue Shield,EPO,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,4280.44
Blue Shield,EPO,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,4280.44
Blue Shield,EPO,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,987.79
Blue Shield,EPO,53660,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,987.79
Blue Shield,EPO,53661,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,987.79
Blue Shield,EPO,53665,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Fee Schedule,12850.71
Blue Shield,EPO,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Fee Schedule,12850.71
Blue Shield,EPO,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Fee Schedule,3198.57
Blue Shield,EPO,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Fee Schedule,987.79
Blue Shield,EPO,53899,CPT4/HCPCS,UROLOGY SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Fee Schedule,4280.44
Blue Shield,EPO,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Fee Schedule,4280.44
Blue Shield,EPO,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Fee Schedule,6049.05
Blue Shield,EPO,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,987.79
Blue Shield,EPO,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,4280.44
Blue Shield,EPO,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,Fee Schedule,987.79
Blue Shield,EPO,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,EPO,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,EPO,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,EPO,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Fee Schedule,3198.57
Blue Shield,EPO,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Fee Schedule,3198.57
Blue Shield,EPO,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,4280.44
Blue Shield,EPO,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,3198.57
Blue Shield,EPO,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Fee Schedule,4280.44
Blue Shield,EPO,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Fee Schedule,3198.57
Blue Shield,EPO,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,Fee Schedule,3198.57
Blue Shield,EPO,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,Fee Schedule,4280.44
Blue Shield,EPO,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Fee Schedule,3198.57
Blue Shield,EPO,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Fee Schedule,4280.44
Blue Shield,EPO,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Fee Schedule,4280.44
Blue Shield,EPO,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Fee Schedule,4280.44
Blue Shield,EPO,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Fee Schedule,4280.44
Blue Shield,EPO,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Fee Schedule,4280.44
Blue Shield,EPO,54200,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,987.79
Blue Shield,EPO,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,6049.05
Blue Shield,EPO,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,3198.57
Blue Shield,EPO,54231,CPT4/HCPCS,DYNAMIC CAVERNOSOMETRY,,Fee Schedule,4280.44
Blue Shield,EPO,54235,CPT4/HCPCS,PENILE INJECTION,,Fee Schedule,987.79
Blue Shield,EPO,54240,CPT4/HCPCS,PENIS STUDY,,Fee Schedule,987.79
Blue Shield,EPO,54250,CPT4/HCPCS,PENIS STUDY,,Fee Schedule,987.79
Blue Shield,EPO,54300,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,4891.93
Blue Shield,EPO,54304,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,4891.93
Blue Shield,EPO,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,EPO,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,EPO,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,EPO,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,EPO,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,EPO,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,EPO,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,EPO,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,4891.93
Blue Shield,EPO,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,3198.57
Blue Shield,EPO,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,4280.44
Blue Shield,EPO,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Fee Schedule,4891.93
Blue Shield,EPO,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,54380,CPT4/HCPCS,REPAIR PENIS,,Fee Schedule,4891.93
Blue Shield,EPO,54385,CPT4/HCPCS,REPAIR PENIS,,Fee Schedule,4891.93
Blue Shield,EPO,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,Fee Schedule,4280.44
Blue Shield,EPO,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,EPO,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,EPO,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,EPO,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,EPO,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,EPO,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Fee Schedule,4891.93
Blue Shield,EPO,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Fee Schedule,3198.57
Blue Shield,EPO,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Fee Schedule,4891.93
Blue Shield,EPO,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Fee Schedule,4891.93
Blue Shield,EPO,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Fee Schedule,3198.57
Blue Shield,EPO,54420,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,6049.05
Blue Shield,EPO,54430,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,3198.57
Blue Shield,EPO,54435,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,6049.05
Blue Shield,EPO,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Fee Schedule,6049.05
Blue Shield,EPO,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,Fee Schedule,987.79
Blue Shield,EPO,54440,CPT4/HCPCS,REPAIR OF PENIS,,Fee Schedule,6049.05
Blue Shield,EPO,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Fee Schedule,3198.57
Blue Shield,EPO,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Fee Schedule,3198.57
Blue Shield,EPO,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Fee Schedule,3198.57
Blue Shield,EPO,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Fee Schedule,4280.44
Blue Shield,EPO,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Fee Schedule,4891.93
Blue Shield,EPO,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Fee Schedule,4891.93
Blue Shield,EPO,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Fee Schedule,6049.05
Blue Shield,EPO,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Fee Schedule,6049.05
Blue Shield,EPO,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Fee Schedule,3198.57
Blue Shield,EPO,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Fee Schedule,6049.05
Blue Shield,EPO,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Fee Schedule,4891.93
Blue Shield,EPO,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Fee Schedule,6049.05
Blue Shield,EPO,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Fee Schedule,3198.57
Blue Shield,EPO,54660,CPT4/HCPCS,REVISION OF TESTIS,,Fee Schedule,4280.44
Blue Shield,EPO,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Fee Schedule,4891.93
Blue Shield,EPO,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Fee Schedule,4891.93
Blue Shield,EPO,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Fee Schedule,12850.71
Blue Shield,EPO,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Fee Schedule,12850.71
Blue Shield,EPO,54699,CPT4/HCPCS,LAPAROSCOPE PROC TESTIS,,Fee Schedule,7902.34
Blue Shield,EPO,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Fee Schedule,4280.44
Blue Shield,EPO,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Fee Schedule,3198.57
Blue Shield,EPO,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Fee Schedule,4891.93
Blue Shield,EPO,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Fee Schedule,6049.05
Blue Shield,EPO,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Fee Schedule,4891.93
Blue Shield,EPO,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Fee Schedule,6049.05
Blue Shield,EPO,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Fee Schedule,3198.57
Blue Shield,EPO,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Fee Schedule,6049.05
Blue Shield,EPO,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Fee Schedule,6049.05
Blue Shield,EPO,55000,CPT4/HCPCS,DRAINAGE OF HYDROCELE,,Fee Schedule,987.79
Blue Shield,EPO,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Fee Schedule,4891.93
Blue Shield,EPO,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Fee Schedule,6876.92
Blue Shield,EPO,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Fee Schedule,6049.05
Blue Shield,EPO,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Fee Schedule,4280.44
Blue Shield,EPO,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Fee Schedule,4280.44
Blue Shield,EPO,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Fee Schedule,3198.57
Blue Shield,EPO,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Fee Schedule,3198.57
Blue Shield,EPO,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Fee Schedule,4280.44
Blue Shield,EPO,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Fee Schedule,4280.44
Blue Shield,EPO,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Fee Schedule,4280.44
Blue Shield,EPO,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Fee Schedule,3198.57
Blue Shield,EPO,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Fee Schedule,4891.93
Blue Shield,EPO,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Fee Schedule,6049.05
Blue Shield,EPO,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Fee Schedule,6049.05
Blue Shield,EPO,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Fee Schedule,6049.05
Blue Shield,EPO,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Fee Schedule,6876.92
Blue Shield,EPO,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Fee Schedule,12850.71
Blue Shield,EPO,55559,CPT4/HCPCS,LAPARO PROC SPERMATIC CORD,,Fee Schedule,7902.34
Blue Shield,EPO,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,EPO,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,EPO,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,EPO,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Fee Schedule,3198.57
Blue Shield,EPO,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Fee Schedule,4280.44
Blue Shield,EPO,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Fee Schedule,4280.44
Blue Shield,EPO,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Fee Schedule,4280.44
Blue Shield,EPO,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,EPO,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,EPO,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,EPO,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Fee Schedule,4280.44
Blue Shield,EPO,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,55870,CPT4/HCPCS,ELECTROEJACULATION,,Fee Schedule,3198.57
Blue Shield,EPO,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Fee Schedule,12850.71
Blue Shield,EPO,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Fee Schedule,12850.71
Blue Shield,EPO,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Fee Schedule,12850.71
Blue Shield,EPO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Fee Schedule,12850.71
Blue Shield,EPO,55899,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Fee Schedule,3198.57
Blue Shield,EPO,55970,CPT4/HCPCS,SEX TRANSFORMATION M TO F,,Fee Schedule,3198.57
Blue Shield,EPO,55980,CPT4/HCPCS,SEX TRANSFORMATION F TO M,,Fee Schedule,3198.57
Blue Shield,EPO,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,EPO,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Fee Schedule,3198.57
Blue Shield,EPO,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Fee Schedule,4280.44
Blue Shield,EPO,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Fee Schedule,3198.57
Blue Shield,EPO,56442,CPT4/HCPCS,HYMENOTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Fee Schedule,4280.44
Blue Shield,EPO,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Fee Schedule,4891.93
Blue Shield,EPO,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,EPO,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,EPO,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Fee Schedule,6876.92
Blue Shield,EPO,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Fee Schedule,9548.66
Blue Shield,EPO,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Fee Schedule,3198.57
Blue Shield,EPO,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Fee Schedule,4891.93
Blue Shield,EPO,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Fee Schedule,4891.93
Blue Shield,EPO,56805,CPT4/HCPCS,REPAIR CLITORIS,,Fee Schedule,4891.93
Blue Shield,EPO,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Fee Schedule,6876.92
Blue Shield,EPO,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Fee Schedule,987.79
Blue Shield,EPO,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Fee Schedule,987.79
Blue Shield,EPO,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Fee Schedule,3198.57
Blue Shield,EPO,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Fee Schedule,4280.44
Blue Shield,EPO,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Fee Schedule,3198.57
Blue Shield,EPO,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Fee Schedule,3198.57
Blue Shield,EPO,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Fee Schedule,4891.93
Blue Shield,EPO,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Fee Schedule,3198.57
Blue Shield,EPO,57100,CPT4/HCPCS,BIOPSY OF VAGINA,,Fee Schedule,987.79
Blue Shield,EPO,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Fee Schedule,4280.44
Blue Shield,EPO,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Fee Schedule,4891.93
Blue Shield,EPO,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Fee Schedule,6876.92
Blue Shield,EPO,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Fee Schedule,6876.92
Blue Shield,EPO,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Fee Schedule,3198.57
Blue Shield,EPO,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Fee Schedule,4280.44
Blue Shield,EPO,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Fee Schedule,4280.44
Blue Shield,EPO,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Fee Schedule,6876.92
Blue Shield,EPO,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Fee Schedule,4280.44
Blue Shield,EPO,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Fee Schedule,4280.44
Blue Shield,EPO,57150,CPT4/HCPCS,TREAT VAGINA INFECTION,,Fee Schedule,987.79
Blue Shield,EPO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Fee Schedule,4280.44
Blue Shield,EPO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Fee Schedule,987.79
Blue Shield,EPO,57160,CPT4/HCPCS,INSERT PESSARY/OTHER DEVICE,,Fee Schedule,987.79
Blue Shield,EPO,57170,CPT4/HCPCS,FITTING OF DIAPHRAGM/CAP,,Fee Schedule,987.79
Blue Shield,EPO,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,Fee Schedule,3198.57
Blue Shield,EPO,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Fee Schedule,3198.57
Blue Shield,EPO,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Fee Schedule,4280.44
Blue Shield,EPO,57220,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,EPO,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Fee Schedule,4891.93
Blue Shield,EPO,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Fee Schedule,6876.92
Blue Shield,EPO,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Fee Schedule,6876.92
Blue Shield,EPO,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Fee Schedule,6876.92
Blue Shield,EPO,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Fee Schedule,9548.66
Blue Shield,EPO,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Fee Schedule,6876.92
Blue Shield,EPO,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Fee Schedule,4891.93
Blue Shield,EPO,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,Fee Schedule,4891.93
Blue Shield,EPO,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Fee Schedule,4891.93
Blue Shield,EPO,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Fee Schedule,3198.57
Blue Shield,EPO,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Fee Schedule,6876.92
Blue Shield,EPO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Fee Schedule,4891.93
Blue Shield,EPO,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Fee Schedule,9548.66
Blue Shield,EPO,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Fee Schedule,9548.66
Blue Shield,EPO,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Fee Schedule,6876.92
Blue Shield,EPO,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Fee Schedule,6876.92
Blue Shield,EPO,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,57295,CPT4/HCPCS,REVISE VAG GRAFT VIA VAGINA,,Fee Schedule,3198.57
Blue Shield,EPO,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Fee Schedule,4891.93
Blue Shield,EPO,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Fee Schedule,4891.93
Blue Shield,EPO,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,Fee Schedule,4891.93
Blue Shield,EPO,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,Fee Schedule,3198.57
Blue Shield,EPO,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Fee Schedule,6876.92
Blue Shield,EPO,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Fee Schedule,6876.92
Blue Shield,EPO,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Fee Schedule,6876.92
Blue Shield,EPO,57335,CPT4/HCPCS,REPAIR VAGINA,,Fee Schedule,3198.57
Blue Shield,EPO,57400,CPT4/HCPCS,DILATION OF VAGINA,,Fee Schedule,4280.44
Blue Shield,EPO,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Fee Schedule,4280.44
Blue Shield,EPO,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,EPO,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Fee Schedule,987.79
Blue Shield,EPO,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Fee Schedule,987.79
Blue Shield,EPO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Fee Schedule,6049.05
Blue Shield,EPO,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Fee Schedule,7902.34
Blue Shield,EPO,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Fee Schedule,6876.92
Blue Shield,EPO,57452,CPT4/HCPCS,EXAM OF CERVIX W/SCOPE,,Fee Schedule,987.79
Blue Shield,EPO,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Fee Schedule,3198.57
Blue Shield,EPO,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Fee Schedule,987.79
Blue Shield,EPO,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Fee Schedule,3198.57
Blue Shield,EPO,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Fee Schedule,4280.44
Blue Shield,EPO,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Fee Schedule,4891.93
Blue Shield,EPO,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Fee Schedule,3198.57
Blue Shield,EPO,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Fee Schedule,987.79
Blue Shield,EPO,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,EPO,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Fee Schedule,3198.57
Blue Shield,EPO,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Fee Schedule,4280.44
Blue Shield,EPO,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,EPO,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,EPO,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Fee Schedule,4891.93
Blue Shield,EPO,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,Fee Schedule,4280.44
Blue Shield,EPO,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Fee Schedule,3198.57
Blue Shield,EPO,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,Fee Schedule,3198.57
Blue Shield,EPO,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Fee Schedule,4891.93
Blue Shield,EPO,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,Fee Schedule,6876.92
Blue Shield,EPO,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Fee Schedule,6876.92
Blue Shield,EPO,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Fee Schedule,4891.93
Blue Shield,EPO,57700,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,3198.57
Blue Shield,EPO,57720,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,4891.93
Blue Shield,EPO,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Fee Schedule,4280.44
Blue Shield,EPO,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Fee Schedule,987.79
Blue Shield,EPO,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Fee Schedule,987.79
Blue Shield,EPO,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Fee Schedule,4280.44
Blue Shield,EPO,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Fee Schedule,6876.92
Blue Shield,EPO,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Fee Schedule,6876.92
Blue Shield,EPO,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,Fee Schedule,6876.92
Blue Shield,EPO,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,Fee Schedule,6049.05
Blue Shield,EPO,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Fee Schedule,3198.57
Blue Shield,EPO,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Fee Schedule,3198.57
Blue Shield,EPO,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,Fee Schedule,3198.57
Blue Shield,EPO,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Fee Schedule,3198.57
Blue Shield,EPO,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Fee Schedule,3198.57
Blue Shield,EPO,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Fee Schedule,3198.57
Blue Shield,EPO,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Fee Schedule,3198.57
Blue Shield,EPO,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Fee Schedule,3198.57
Blue Shield,EPO,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Fee Schedule,3198.57
Blue Shield,EPO,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,Fee Schedule,3198.57
Blue Shield,EPO,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Fee Schedule,3198.57
Blue Shield,EPO,58300,CPT4/HCPCS,INSERT INTRAUTERINE DEVICE,,Fee Schedule,987.79
Blue Shield,EPO,58301,CPT4/HCPCS,REMOVE INTRAUTERINE DEVICE,,Fee Schedule,987.79
Blue Shield,EPO,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Fee Schedule,987.79
Blue Shield,EPO,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Fee Schedule,987.79
Blue Shield,EPO,58323,CPT4/HCPCS,SPERM WASHING,,Fee Schedule,987.79
Blue Shield,EPO,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Fee Schedule,4891.93
Blue Shield,EPO,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Fee Schedule,4280.44
Blue Shield,EPO,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Fee Schedule,4891.93
Blue Shield,EPO,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Fee Schedule,6049.05
Blue Shield,EPO,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Fee Schedule,9548.66
Blue Shield,EPO,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,EPO,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,EPO,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Fee Schedule,3198.57
Blue Shield,EPO,58540,CPT4/HCPCS,REVISION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,EPO,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Fee Schedule,6049.05
Blue Shield,EPO,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Fee Schedule,6049.05
Blue Shield,EPO,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Fee Schedule,6049.05
Blue Shield,EPO,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Fee Schedule,6049.05
Blue Shield,EPO,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Fee Schedule,12850.71
Blue Shield,EPO,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Fee Schedule,12850.71
Blue Shield,EPO,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Fee Schedule,12850.71
Blue Shield,EPO,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Fee Schedule,12850.71
Blue Shield,EPO,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Fee Schedule,12850.71
Blue Shield,EPO,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Fee Schedule,12850.71
Blue Shield,EPO,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Fee Schedule,3198.57
Blue Shield,EPO,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Fee Schedule,4891.93
Blue Shield,EPO,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Fee Schedule,4280.44
Blue Shield,EPO,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Fee Schedule,4891.93
Blue Shield,EPO,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Fee Schedule,4891.93
Blue Shield,EPO,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Fee Schedule,4891.93
Blue Shield,EPO,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Fee Schedule,6049.05
Blue Shield,EPO,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Fee Schedule,9548.66
Blue Shield,EPO,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Fee Schedule,6876.92
Blue Shield,EPO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Fee Schedule,6876.92
Blue Shield,EPO,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Fee Schedule,6876.92
Blue Shield,EPO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Fee Schedule,6876.92
Blue Shield,EPO,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,Fee Schedule,6876.92
Blue Shield,EPO,58578,CPT4/HCPCS,LAPARO PROC UTERUS,,Fee Schedule,7902.34
Blue Shield,EPO,58579,CPT4/HCPCS,HYSTEROSCOPE PROCEDURE,,Fee Schedule,4891.93
Blue Shield,EPO,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Fee Schedule,6876.92
Blue Shield,EPO,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Fee Schedule,4891.93
Blue Shield,EPO,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Fee Schedule,6876.92
Blue Shield,EPO,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Fee Schedule,6876.92
Blue Shield,EPO,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Fee Schedule,6876.92
Blue Shield,EPO,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Fee Schedule,4891.93
Blue Shield,EPO,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Fee Schedule,4891.93
Blue Shield,EPO,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Fee Schedule,6876.92
Blue Shield,EPO,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Fee Schedule,6876.92
Blue Shield,EPO,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Fee Schedule,6049.05
Blue Shield,EPO,58679,CPT4/HCPCS,LAPARO PROC OVIDUCT-OVARY,,Fee Schedule,7902.34
Blue Shield,EPO,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Fee Schedule,3198.57
Blue Shield,EPO,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Fee Schedule,3198.57
Blue Shield,EPO,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Fee Schedule,3198.57
Blue Shield,EPO,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Fee Schedule,3198.57
Blue Shield,EPO,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Fee Schedule,3198.57
Blue Shield,EPO,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Fee Schedule,4891.93
Blue Shield,EPO,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Fee Schedule,3198.57
Blue Shield,EPO,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Fee Schedule,4891.93
Blue Shield,EPO,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Fee Schedule,3198.57
Blue Shield,EPO,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Fee Schedule,3198.57
Blue Shield,EPO,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Fee Schedule,4891.93
Blue Shield,EPO,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Fee Schedule,6876.92
Blue Shield,EPO,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Fee Schedule,6876.92
Blue Shield,EPO,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Fee Schedule,3198.57
Blue Shield,EPO,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,Fee Schedule,3198.57
Blue Shield,EPO,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,3198.57
Blue Shield,EPO,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,3198.57
Blue Shield,EPO,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,4280.44
Blue Shield,EPO,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,Fee Schedule,4891.93
Blue Shield,EPO,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,Fee Schedule,4891.93
Blue Shield,EPO,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,EPO,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Fee Schedule,4891.93
Blue Shield,EPO,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Fee Schedule,3198.57
Blue Shield,EPO,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Fee Schedule,3198.57
Blue Shield,EPO,58999,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Fee Schedule,3198.57
Blue Shield,EPO,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Fee Schedule,3198.57
Blue Shield,EPO,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,Fee Schedule,3198.57
Blue Shield,EPO,59015,CPT4/HCPCS,CHORION BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,59020,CPT4/HCPCS,FETAL CONTRACT STRESS TEST,,Fee Schedule,987.79
Blue Shield,EPO,59025,CPT4/HCPCS,FETAL NON-STRESS TEST,,Fee Schedule,987.79
Blue Shield,EPO,59030,CPT4/HCPCS,FETAL SCALP BLOOD SAMPLE,,Fee Schedule,3198.57
Blue Shield,EPO,59050,CPT4/HCPCS,FETAL MONITOR W/REPORT,,Fee Schedule,987.79
Blue Shield,EPO,59051,CPT4/HCPCS,FETAL MONITOR/INTERPRET ONLY,,Fee Schedule,987.79
Blue Shield,EPO,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Fee Schedule,3198.57
Blue Shield,EPO,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Fee Schedule,3198.57
Blue Shield,EPO,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Fee Schedule,3198.57
Blue Shield,EPO,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Fee Schedule,3198.57
Blue Shield,EPO,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,Fee Schedule,9548.66
Blue Shield,EPO,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,EPO,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,EPO,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,EPO,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,EPO,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,EPO,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,EPO,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,EPO,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,EPO,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Fee Schedule,4891.93
Blue Shield,EPO,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Fee Schedule,987.79
Blue Shield,EPO,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Fee Schedule,4280.44
Blue Shield,EPO,59320,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,3198.57
Blue Shield,EPO,59325,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,EPO,59350,CPT4/HCPCS,REPAIR OF UTERUS,,Fee Schedule,4280.44
Blue Shield,EPO,59400,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,EPO,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,EPO,59410,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,EPO,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,Fee Schedule,987.79
Blue Shield,EPO,59414,CPT4/HCPCS,DELIVER PLACENTA,,Fee Schedule,4280.44
Blue Shield,EPO,59425,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,Fee Schedule,987.79
Blue Shield,EPO,59426,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,Fee Schedule,3198.57
Blue Shield,EPO,59430,CPT4/HCPCS,CARE AFTER DELIVERY,,Fee Schedule,987.79
Blue Shield,EPO,59510,CPT4/HCPCS,CESAREAN DELIVERY,,Fee Schedule,4891.93
Blue Shield,EPO,59514,CPT4/HCPCS,CESAREAN DELIVERY ONLY,,Fee Schedule,4891.93
Blue Shield,EPO,59515,CPT4/HCPCS,CESAREAN DELIVERY,,Fee Schedule,4891.93
Blue Shield,EPO,59525,CPT4/HCPCS,REMOVE UTERUS AFTER CESAREAN,,Fee Schedule,3198.57
Blue Shield,EPO,59610,CPT4/HCPCS,VBAC DELIVERY,,Fee Schedule,4280.44
Blue Shield,EPO,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Fee Schedule,4280.44
Blue Shield,EPO,59614,CPT4/HCPCS,VBAC CARE AFTER DELIVERY,,Fee Schedule,4280.44
Blue Shield,EPO,59618,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY,,Fee Schedule,4891.93
Blue Shield,EPO,59620,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY ONLY,,Fee Schedule,4891.93
Blue Shield,EPO,59622,CPT4/HCPCS,ATTEMPTED VBAC AFTER CARE,,Fee Schedule,4891.93
Blue Shield,EPO,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,EPO,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,EPO,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,EPO,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Fee Schedule,4280.44
Blue Shield,EPO,59840,CPT4/HCPCS,ABORTION,,Fee Schedule,6876.92
Blue Shield,EPO,59841,CPT4/HCPCS,ABORTION,,Fee Schedule,6876.92
Blue Shield,EPO,59850,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,EPO,59851,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,EPO,59852,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,EPO,59855,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,EPO,59856,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,EPO,59857,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,EPO,59866,CPT4/HCPCS,ABORTION (MPR),,Fee Schedule,3198.57
Blue Shield,EPO,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Fee Schedule,6876.92
Blue Shield,EPO,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Fee Schedule,6876.92
Blue Shield,EPO,59897,CPT4/HCPCS,FETAL INVAS PX W/US,,Fee Schedule,3198.57
Blue Shield,EPO,59898,CPT4/HCPCS,LAPARO PROC OB CARE/DELIVER,,Fee Schedule,7902.34
Blue Shield,EPO,59899,CPT4/HCPCS,MATERNITY CARE PROCEDURE,,Fee Schedule,987.79
Blue Shield,EPO,5A02110,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,EPO,5A02116,ICD10-PCS,Assist with Cardiac Output using Other Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,EPO,5A0211D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,EPO,5A02210,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,EPO,5A02216,ICD10-PCS,Assistance with Cardiac Output using Other Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,EPO,5A0221D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,EPO,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Fee Schedule,3198.57
Blue Shield,EPO,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Fee Schedule,987.79
Blue Shield,EPO,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Fee Schedule,4280.44
Blue Shield,EPO,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Fee Schedule,9548.66
Blue Shield,EPO,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Fee Schedule,9548.66
Blue Shield,EPO,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,EPO,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,EPO,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,EPO,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,EPO,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Fee Schedule,9548.66
Blue Shield,EPO,60270,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,3198.57
Blue Shield,EPO,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,3198.57
Blue Shield,EPO,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Fee Schedule,6049.05
Blue Shield,EPO,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Fee Schedule,6049.05
Blue Shield,EPO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Fee Schedule,987.79
Blue Shield,EPO,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Fee Schedule,9548.66
Blue Shield,EPO,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Fee Schedule,3198.57
Blue Shield,EPO,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Fee Schedule,3198.57
Blue Shield,EPO,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Fee Schedule,4891.93
Blue Shield,EPO,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,3198.57
Blue Shield,EPO,60521,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,3198.57
Blue Shield,EPO,60522,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,4280.44
Blue Shield,EPO,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Fee Schedule,3198.57
Blue Shield,EPO,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Fee Schedule,3198.57
Blue Shield,EPO,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Fee Schedule,4280.44
Blue Shield,EPO,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Fee Schedule,4891.93
Blue Shield,EPO,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Fee Schedule,3198.57
Blue Shield,EPO,60659,CPT4/HCPCS,LAPARO PROC ENDOCRINE,,Fee Schedule,7902.34
Blue Shield,EPO,60699,CPT4/HCPCS,ENDOCRINE SURGERY PROCEDURE,,Fee Schedule,9548.66
Blue Shield,EPO,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,EPO,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,EPO,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,EPO,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Fee Schedule,3198.57
Blue Shield,EPO,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Fee Schedule,3198.57
Blue Shield,EPO,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Fee Schedule,3198.57
Blue Shield,EPO,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,61105,CPT4/HCPCS,TWIST DRILL HOLE,,Fee Schedule,3198.57
Blue Shield,EPO,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,Fee Schedule,3198.57
Blue Shield,EPO,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,EPO,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,Fee Schedule,3198.57
Blue Shield,EPO,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,EPO,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,EPO,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,Fee Schedule,3198.57
Blue Shield,EPO,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,EPO,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,Fee Schedule,3198.57
Blue Shield,EPO,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Fee Schedule,4891.93
Blue Shield,EPO,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Fee Schedule,3198.57
Blue Shield,EPO,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Fee Schedule,3198.57
Blue Shield,EPO,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Fee Schedule,4280.44
Blue Shield,EPO,61305,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Fee Schedule,4891.93
Blue Shield,EPO,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,EPO,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,EPO,61314,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,EPO,61315,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4891.93
Blue Shield,EPO,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Fee Schedule,3198.57
Blue Shield,EPO,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,EPO,61321,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4891.93
Blue Shield,EPO,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,Fee Schedule,4280.44
Blue Shield,EPO,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,Fee Schedule,9548.66
Blue Shield,EPO,61332,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,6049.05
Blue Shield,EPO,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,EPO,61343,CPT4/HCPCS,INCISE SKULL (PRESS RELIEF),,Fee Schedule,4891.93
Blue Shield,EPO,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,Fee Schedule,4891.93
Blue Shield,EPO,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Fee Schedule,4891.93
Blue Shield,EPO,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,61480,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,Fee Schedule,3198.57
Blue Shield,EPO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4891.93
Blue Shield,EPO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Fee Schedule,6049.05
Blue Shield,EPO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Fee Schedule,4280.44
Blue Shield,EPO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,EPO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,6876.92
Blue Shield,EPO,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Fee Schedule,6876.92
Blue Shield,EPO,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,9548.66
Blue Shield,EPO,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,7902.34
Blue Shield,EPO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Fee Schedule,4891.93
Blue Shield,EPO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4891.93
Blue Shield,EPO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,9548.66
Blue Shield,EPO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,7902.34
Blue Shield,EPO,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,EPO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,EPO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,EPO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,EPO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,6049.05
Blue Shield,EPO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4280.44
Blue Shield,EPO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,EPO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,6049.05
Blue Shield,EPO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,EPO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,EPO,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,EPO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,EPO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,Fee Schedule,7902.34
Blue Shield,EPO,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Fee Schedule,6049.05
Blue Shield,EPO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Fee Schedule,4280.44
Blue Shield,EPO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Fee Schedule,3198.57
Blue Shield,EPO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Fee Schedule,3198.57
Blue Shield,EPO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,Fee Schedule,3198.57
Blue Shield,EPO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,Fee Schedule,4280.44
Blue Shield,EPO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Fee Schedule,4280.44
Blue Shield,EPO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Fee Schedule,6049.05
Blue Shield,EPO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Fee Schedule,4891.93
Blue Shield,EPO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Fee Schedule,6049.05
Blue Shield,EPO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,EPO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Fee Schedule,6049.05
Blue Shield,EPO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,Fee Schedule,4280.44
Blue Shield,EPO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Fee Schedule,4891.93
Blue Shield,EPO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Fee Schedule,7902.34
Blue Shield,EPO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6049.05
Blue Shield,EPO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6876.92
Blue Shield,EPO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,7902.34
Blue Shield,EPO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6876.92
Blue Shield,EPO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,EPO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,EPO,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,Fee Schedule,6049.05
Blue Shield,EPO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,EPO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,EPO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,EPO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,Fee Schedule,6049.05
Blue Shield,EPO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,EPO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,EPO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,Fee Schedule,6049.05
Blue Shield,EPO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,4891.93
Blue Shield,EPO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6049.05
Blue Shield,EPO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6876.92
Blue Shield,EPO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6876.92
Blue Shield,EPO,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,7902.34
Blue Shield,EPO,61610,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,4280.44
Blue Shield,EPO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,3198.57
Blue Shield,EPO,61612,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,4280.44
Blue Shield,EPO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,Fee Schedule,7902.34
Blue Shield,EPO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Fee Schedule,6049.05
Blue Shield,EPO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Fee Schedule,7902.34
Blue Shield,EPO,61618,CPT4/HCPCS,REPAIR DURA,,Fee Schedule,3198.57
Blue Shield,EPO,61619,CPT4/HCPCS,REPAIR DURA,,Fee Schedule,4280.44
Blue Shield,EPO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Fee Schedule,7902.34
Blue Shield,EPO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,Fee Schedule,3198.57
Blue Shield,EPO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Fee Schedule,9548.66
Blue Shield,EPO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,Fee Schedule,987.79
Blue Shield,EPO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,Fee Schedule,987.79
Blue Shield,EPO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,EPO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,6876.92
Blue Shield,EPO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,EPO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,EPO,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Fee Schedule,7902.34
Blue Shield,EPO,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Fee Schedule,7902.34
Blue Shield,EPO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,Fee Schedule,7902.34
Blue Shield,EPO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,Fee Schedule,7902.34
Blue Shield,EPO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,Fee Schedule,3198.57
Blue Shield,EPO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,6049.05
Blue Shield,EPO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,4891.93
Blue Shield,EPO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,4280.44
Blue Shield,EPO,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,Fee Schedule,6049.05
Blue Shield,EPO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,Fee Schedule,3198.57
Blue Shield,EPO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,Fee Schedule,3198.57
Blue Shield,EPO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,4280.44
Blue Shield,EPO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,Fee Schedule,4280.44
Blue Shield,EPO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Fee Schedule,4891.93
Blue Shield,EPO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Fee Schedule,4891.93
Blue Shield,EPO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,Case Rate,4361.03
Blue Shield,EPO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,Case Rate,935.23
Blue Shield,EPO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,Case Rate,4361.03
Blue Shield,EPO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,Case Rate,1293.58
Blue Shield,EPO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Case Rate,764.05
Blue Shield,EPO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,EPO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,4280.44
Blue Shield,EPO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Fee Schedule,3198.57
Blue Shield,EPO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Fee Schedule,4280.44
Blue Shield,EPO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Fee Schedule,3198.57
Blue Shield,EPO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,EPO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Fee Schedule,4891.93
Blue Shield,EPO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Fee Schedule,4280.44
Blue Shield,EPO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Fee Schedule,4891.93
Blue Shield,EPO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Fee Schedule,3198.57
Blue Shield,EPO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,Fee Schedule,3198.57
Blue Shield,EPO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,Fee Schedule,3198.57
Blue Shield,EPO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,Fee Schedule,4280.44
Blue Shield,EPO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,EPO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Fee Schedule,4891.93
Blue Shield,EPO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,Fee Schedule,4280.44
Blue Shield,EPO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,Fee Schedule,4280.44
Blue Shield,EPO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,EPO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,EPO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,Fee Schedule,3198.57
Blue Shield,EPO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,Fee Schedule,3198.57
Blue Shield,EPO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,Fee Schedule,3198.57
Blue Shield,EPO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,Fee Schedule,3198.57
Blue Shield,EPO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,Fee Schedule,3198.57
Blue Shield,EPO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,Fee Schedule,4280.44
Blue Shield,EPO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,Fee Schedule,3198.57
Blue Shield,EPO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,Fee Schedule,4280.44
Blue Shield,EPO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,Fee Schedule,3198.57
Blue Shield,EPO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,4280.44
Blue Shield,EPO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,EPO,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,EPO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Fee Schedule,3198.57
Blue Shield,EPO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,EPO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,Fee Schedule,3198.57
Blue Shield,EPO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,EPO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,EPO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Fee Schedule,3198.57
Blue Shield,EPO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Fee Schedule,4280.44
Blue Shield,EPO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,Fee Schedule,3198.57
Blue Shield,EPO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,EPO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,EPO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Fee Schedule,3198.57
Blue Shield,EPO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Fee Schedule,3198.57
Blue Shield,EPO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Fee Schedule,3198.57
Blue Shield,EPO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Fee Schedule,3198.57
Blue Shield,EPO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Fee Schedule,3198.57
Blue Shield,EPO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Fee Schedule,3198.57
Blue Shield,EPO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Fee Schedule,3198.57
Blue Shield,EPO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Fee Schedule,3198.57
Blue Shield,EPO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Fee Schedule,3198.57
Blue Shield,EPO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Fee Schedule,3198.57
Blue Shield,EPO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Fee Schedule,12850.71
Blue Shield,EPO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Fee Schedule,3198.57
Blue Shield,EPO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Fee Schedule,4891.93
Blue Shield,EPO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,EPO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,EPO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,EPO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,EPO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,EPO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,EPO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,EPO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,EPO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,EPO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,EPO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,EPO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,EPO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Fee Schedule,4280.44
Blue Shield,EPO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Fee Schedule,9548.66
Blue Shield,EPO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Fee Schedule,4280.44
Blue Shield,EPO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Fee Schedule,4280.44
Blue Shield,EPO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,EPO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,EPO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Fee Schedule,4280.44
Blue Shield,EPO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Fee Schedule,3198.57
Blue Shield,EPO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Fee Schedule,3198.57
Blue Shield,EPO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,Fee Schedule,987.79
Blue Shield,EPO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Fee Schedule,987.79
Blue Shield,EPO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Fee Schedule,9548.66
Blue Shield,EPO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Fee Schedule,9548.66
Blue Shield,EPO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Fee Schedule,9548.66
Blue Shield,EPO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Fee Schedule,9548.66
Blue Shield,EPO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Fee Schedule,9548.66
Blue Shield,EPO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Fee Schedule,9548.66
Blue Shield,EPO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Fee Schedule,9548.66
Blue Shield,EPO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Fee Schedule,9548.66
Blue Shield,EPO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Fee Schedule,9548.66
Blue Shield,EPO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,9548.66
Blue Shield,EPO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Fee Schedule,9548.66
Blue Shield,EPO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Fee Schedule,9548.66
Blue Shield,EPO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Fee Schedule,9548.66
Blue Shield,EPO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Fee Schedule,9548.66
Blue Shield,EPO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Fee Schedule,3198.57
Blue Shield,EPO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Fee Schedule,3198.57
Blue Shield,EPO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Fee Schedule,9548.66
Blue Shield,EPO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Fee Schedule,9548.66
Blue Shield,EPO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Fee Schedule,9548.66
Blue Shield,EPO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Fee Schedule,9548.66
Blue Shield,EPO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Fee Schedule,9548.66
Blue Shield,EPO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Fee Schedule,9548.66
Blue Shield,EPO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Fee Schedule,9548.66
Blue Shield,EPO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Fee Schedule,9548.66
Blue Shield,EPO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Fee Schedule,9548.66
Blue Shield,EPO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Fee Schedule,4891.93
Blue Shield,EPO,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Fee Schedule,3198.57
Blue Shield,EPO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,Fee Schedule,4891.93
Blue Shield,EPO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Fee Schedule,4891.93
Blue Shield,EPO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,Fee Schedule,6876.92
Blue Shield,EPO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Fee Schedule,4891.93
Blue Shield,EPO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Fee Schedule,4891.93
Blue Shield,EPO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Fee Schedule,4891.93
Blue Shield,EPO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,Fee Schedule,4280.44
Blue Shield,EPO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Fee Schedule,4280.44
Blue Shield,EPO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Fee Schedule,4891.93
Blue Shield,EPO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,EPO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,EPO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,Fee Schedule,3198.57
Blue Shield,EPO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,Fee Schedule,3198.57
Blue Shield,EPO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,Fee Schedule,4280.44
Blue Shield,EPO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,Fee Schedule,4280.44
Blue Shield,EPO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,Fee Schedule,4280.44
Blue Shield,EPO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,Fee Schedule,4280.44
Blue Shield,EPO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,Fee Schedule,4280.44
Blue Shield,EPO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,Fee Schedule,4891.93
Blue Shield,EPO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,Fee Schedule,4280.44
Blue Shield,EPO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,Fee Schedule,6876.92
Blue Shield,EPO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,Fee Schedule,6876.92
Blue Shield,EPO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,Fee Schedule,6876.92
Blue Shield,EPO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Fee Schedule,4280.44
Blue Shield,EPO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Fee Schedule,4280.44
Blue Shield,EPO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Fee Schedule,3198.57
Blue Shield,EPO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Fee Schedule,3198.57
Blue Shield,EPO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,Fee Schedule,4891.93
Blue Shield,EPO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Fee Schedule,4891.93
Blue Shield,EPO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Fee Schedule,4891.93
Blue Shield,EPO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Fee Schedule,4280.44
Blue Shield,EPO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,Fee Schedule,4280.44
Blue Shield,EPO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,Fee Schedule,4280.44
Blue Shield,EPO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,Fee Schedule,4280.44
Blue Shield,EPO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,Fee Schedule,4280.44
Blue Shield,EPO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,Fee Schedule,4891.93
Blue Shield,EPO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,Fee Schedule,4891.93
Blue Shield,EPO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,Fee Schedule,4891.93
Blue Shield,EPO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,Fee Schedule,4280.44
Blue Shield,EPO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,Fee Schedule,6049.05
Blue Shield,EPO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,Fee Schedule,6049.05
Blue Shield,EPO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,Fee Schedule,6049.05
Blue Shield,EPO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,Fee Schedule,6876.92
Blue Shield,EPO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,Fee Schedule,4280.44
Blue Shield,EPO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,Fee Schedule,4891.93
Blue Shield,EPO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,Fee Schedule,4891.93
Blue Shield,EPO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,Fee Schedule,4891.93
Blue Shield,EPO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,Fee Schedule,4891.93
Blue Shield,EPO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,Fee Schedule,6049.05
Blue Shield,EPO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,Fee Schedule,6049.05
Blue Shield,EPO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,Fee Schedule,4891.93
Blue Shield,EPO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Fee Schedule,4280.44
Blue Shield,EPO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Fee Schedule,3198.57
Blue Shield,EPO,63615,CPT4/HCPCS,REMOVE LESION OF SPINAL CORD,,Fee Schedule,4280.44
Blue Shield,EPO,63620,CPT4/HCPCS,SRS SPINAL LESION,,Case Rate,4361.03
Blue Shield,EPO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,Case Rate,1075.84
Blue Shield,EPO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,4280.44
Blue Shield,EPO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,EPO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Fee Schedule,4280.44
Blue Shield,EPO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Fee Schedule,4280.44
Blue Shield,EPO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Fee Schedule,4280.44
Blue Shield,EPO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Fee Schedule,4280.44
Blue Shield,EPO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Fee Schedule,4280.44
Blue Shield,EPO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Fee Schedule,3198.57
Blue Shield,EPO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,3198.57
Blue Shield,EPO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,3198.57
Blue Shield,EPO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,4280.44
Blue Shield,EPO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,4280.44
Blue Shield,EPO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Fee Schedule,3198.57
Blue Shield,EPO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Fee Schedule,3198.57
Blue Shield,EPO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,Fee Schedule,3198.57
Blue Shield,EPO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Fee Schedule,3198.57
Blue Shield,EPO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Fee Schedule,12850.71
Blue Shield,EPO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Fee Schedule,4891.93
Blue Shield,EPO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Fee Schedule,4280.44
Blue Shield,EPO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Fee Schedule,3198.57
Blue Shield,EPO,64402,CPT4/HCPCS,N BLOCK INJ FACIAL,,Fee Schedule,3198.57
Blue Shield,EPO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Fee Schedule,987.79
Blue Shield,EPO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Fee Schedule,3198.57
Blue Shield,EPO,64410,CPT4/HCPCS,N BLOCK INJ PHRENIC,,Fee Schedule,3198.57
Blue Shield,EPO,64413,CPT4/HCPCS,N BLOCK INJ CERVICAL PLEXUS,,Fee Schedule,3198.57
Blue Shield,EPO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Fee Schedule,3198.57
Blue Shield,EPO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Fee Schedule,3198.57
Blue Shield,EPO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Fee Schedule,3198.57
Blue Shield,EPO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Fee Schedule,3198.57
Blue Shield,EPO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Fee Schedule,3198.57
Blue Shield,EPO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Fee Schedule,3198.57
Blue Shield,EPO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Fee Schedule,3198.57
Blue Shield,EPO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Fee Schedule,3198.57
Blue Shield,EPO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Fee Schedule,987.79
Blue Shield,EPO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,Fee Schedule,3198.57
Blue Shield,EPO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,Fee Schedule,3198.57
Blue Shield,EPO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Fee Schedule,3198.57
Blue Shield,EPO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Fee Schedule,3198.57
Blue Shield,EPO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Fee Schedule,3198.57
Blue Shield,EPO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Fee Schedule,3198.57
Blue Shield,EPO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Fee Schedule,3198.57
Blue Shield,EPO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Fee Schedule,3198.57
Blue Shield,EPO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Fee Schedule,3198.57
Blue Shield,EPO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Fee Schedule,3198.57
Blue Shield,EPO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Fee Schedule,3198.57
Blue Shield,EPO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Fee Schedule,3198.57
Blue Shield,EPO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Fee Schedule,3198.57
Blue Shield,EPO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Fee Schedule,3198.57
Blue Shield,EPO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Fee Schedule,3198.57
Blue Shield,EPO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Fee Schedule,3198.57
Blue Shield,EPO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Fee Schedule,3198.57
Blue Shield,EPO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Fee Schedule,3198.57
Blue Shield,EPO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Fee Schedule,3198.57
Blue Shield,EPO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Fee Schedule,3198.57
Blue Shield,EPO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Fee Schedule,3198.57
Blue Shield,EPO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Fee Schedule,3198.57
Blue Shield,EPO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Fee Schedule,3198.57
Blue Shield,EPO,64508,CPT4/HCPCS,N BLOCK CAROTID SINUS S/P,,Fee Schedule,3198.57
Blue Shield,EPO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Fee Schedule,3198.57
Blue Shield,EPO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Fee Schedule,3198.57
Blue Shield,EPO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Fee Schedule,3198.57
Blue Shield,EPO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Fee Schedule,3198.57
Blue Shield,EPO,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,Fee Schedule,987.79
Blue Shield,EPO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,EPO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,EPO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,EPO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Fee Schedule,987.79
Blue Shield,EPO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Fee Schedule,4280.44
Blue Shield,EPO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Fee Schedule,4280.44
Blue Shield,EPO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Fee Schedule,4280.44
Blue Shield,EPO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,EPO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,EPO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,EPO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Fee Schedule,3198.57
Blue Shield,EPO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Fee Schedule,4280.44
Blue Shield,EPO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Fee Schedule,3198.57
Blue Shield,EPO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Fee Schedule,987.79
Blue Shield,EPO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Fee Schedule,3198.57
Blue Shield,EPO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Fee Schedule,3198.57
Blue Shield,EPO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Fee Schedule,987.79
Blue Shield,EPO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Fee Schedule,987.79
Blue Shield,EPO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Fee Schedule,3198.57
Blue Shield,EPO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Fee Schedule,4891.93
Blue Shield,EPO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Fee Schedule,4891.93
Blue Shield,EPO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Fee Schedule,3198.57
Blue Shield,EPO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Fee Schedule,3198.57
Blue Shield,EPO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Fee Schedule,3198.57
Blue Shield,EPO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Fee Schedule,3198.57
Blue Shield,EPO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Fee Schedule,987.79
Blue Shield,EPO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Fee Schedule,987.79
Blue Shield,EPO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Fee Schedule,4280.44
Blue Shield,EPO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Fee Schedule,4280.44
Blue Shield,EPO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Fee Schedule,4891.93
Blue Shield,EPO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Fee Schedule,4280.44
Blue Shield,EPO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Fee Schedule,4280.44
Blue Shield,EPO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Fee Schedule,3198.57
Blue Shield,EPO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Fee Schedule,3198.57
Blue Shield,EPO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Fee Schedule,4280.44
Blue Shield,EPO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,Fee Schedule,4280.44
Blue Shield,EPO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Fee Schedule,4280.44
Blue Shield,EPO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Fee Schedule,4280.44
Blue Shield,EPO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,64787,CPT4/HCPCS,IMPLANT NERVE END,,Fee Schedule,4280.44
Blue Shield,EPO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Fee Schedule,4280.44
Blue Shield,EPO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,EPO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,EPO,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,EPO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,Fee Schedule,4280.44
Blue Shield,EPO,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,6049.05
Blue Shield,EPO,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,6049.05
Blue Shield,EPO,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,Fee Schedule,6049.05
Blue Shield,EPO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Fee Schedule,6049.05
Blue Shield,EPO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4891.93
Blue Shield,EPO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4891.93
Blue Shield,EPO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64859,CPT4/HCPCS,NERVE SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Fee Schedule,4891.93
Blue Shield,EPO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Fee Schedule,4891.93
Blue Shield,EPO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Fee Schedule,4891.93
Blue Shield,EPO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Fee Schedule,6049.05
Blue Shield,EPO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Fee Schedule,3198.57
Blue Shield,EPO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Fee Schedule,4280.44
Blue Shield,EPO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Fee Schedule,4891.93
Blue Shield,EPO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Fee Schedule,4891.93
Blue Shield,EPO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Fee Schedule,4280.44
Blue Shield,EPO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Fee Schedule,4891.93
Blue Shield,EPO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Fee Schedule,4891.93
Blue Shield,EPO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Fee Schedule,4891.93
Blue Shield,EPO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Fee Schedule,4891.93
Blue Shield,EPO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,EPO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,EPO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Fee Schedule,4280.44
Blue Shield,EPO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Fee Schedule,3198.57
Blue Shield,EPO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,EPO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Fee Schedule,6049.05
Blue Shield,EPO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Fee Schedule,6049.05
Blue Shield,EPO,64999,CPT4/HCPCS,NERVOUS SYSTEM SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,65091,CPT4/HCPCS,REVISE EYE,,Fee Schedule,4891.93
Blue Shield,EPO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Fee Schedule,4891.93
Blue Shield,EPO,65101,CPT4/HCPCS,REMOVAL OF EYE,,Fee Schedule,4891.93
Blue Shield,EPO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Fee Schedule,4891.93
Blue Shield,EPO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Fee Schedule,6049.05
Blue Shield,EPO,65110,CPT4/HCPCS,REMOVAL OF EYE,,Fee Schedule,6876.92
Blue Shield,EPO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Fee Schedule,9548.66
Blue Shield,EPO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Fee Schedule,9548.66
Blue Shield,EPO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,EPO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,EPO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,EPO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,EPO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,EPO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,EPO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Fee Schedule,3198.57
Blue Shield,EPO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,EPO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,EPO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,EPO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,EPO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,4280.44
Blue Shield,EPO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,4891.93
Blue Shield,EPO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,6049.05
Blue Shield,EPO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,4280.44
Blue Shield,EPO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,4280.44
Blue Shield,EPO,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,EPO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,EPO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,EPO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,3198.57
Blue Shield,EPO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Fee Schedule,4891.93
Blue Shield,EPO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,3198.57
Blue Shield,EPO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Fee Schedule,4280.44
Blue Shield,EPO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,4280.44
Blue Shield,EPO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,6876.92
Blue Shield,EPO,65430,CPT4/HCPCS,CORNEAL SMEAR,,Fee Schedule,987.79
Blue Shield,EPO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Fee Schedule,3198.57
Blue Shield,EPO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Fee Schedule,3198.57
Blue Shield,EPO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,65600,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,4280.44
Blue Shield,EPO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Fee Schedule,7902.34
Blue Shield,EPO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,65760,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,9548.66
Blue Shield,EPO,65765,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,9548.66
Blue Shield,EPO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Fee Schedule,9548.66
Blue Shield,EPO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Fee Schedule,6049.05
Blue Shield,EPO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Fee Schedule,6049.05
Blue Shield,EPO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Fee Schedule,987.79
Blue Shield,EPO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Fee Schedule,987.79
Blue Shield,EPO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,EPO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Fee Schedule,9548.66
Blue Shield,EPO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,3198.57
Blue Shield,EPO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,4891.93
Blue Shield,EPO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,4280.44
Blue Shield,EPO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Fee Schedule,3198.57
Blue Shield,EPO,65850,CPT4/HCPCS,INCISION OF EYE,,Fee Schedule,6049.05
Blue Shield,EPO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Fee Schedule,3198.57
Blue Shield,EPO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,EPO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,EPO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,EPO,65900,CPT4/HCPCS,REMOVE EYE LESION,,Fee Schedule,6876.92
Blue Shield,EPO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Fee Schedule,9548.66
Blue Shield,EPO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Fee Schedule,6876.92
Blue Shield,EPO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Fee Schedule,3198.57
Blue Shield,EPO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Fee Schedule,3198.57
Blue Shield,EPO,66130,CPT4/HCPCS,REMOVE EYE LESION,,Fee Schedule,9548.66
Blue Shield,EPO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,66172,CPT4/HCPCS,INCISION OF EYE,,Fee Schedule,6049.05
Blue Shield,EPO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Fee Schedule,4280.44
Blue Shield,EPO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Fee Schedule,4280.44
Blue Shield,EPO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,EPO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Fee Schedule,6876.92
Blue Shield,EPO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Fee Schedule,4280.44
Blue Shield,EPO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Fee Schedule,4280.44
Blue Shield,EPO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Fee Schedule,4280.44
Blue Shield,EPO,66220,CPT4/HCPCS,REPAIR EYE LESION,,Fee Schedule,4891.93
Blue Shield,EPO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Fee Schedule,6049.05
Blue Shield,EPO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Fee Schedule,4280.44
Blue Shield,EPO,66500,CPT4/HCPCS,INCISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,EPO,66505,CPT4/HCPCS,INCISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,EPO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Fee Schedule,4891.93
Blue Shield,EPO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,EPO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,EPO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,EPO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,EPO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Fee Schedule,4891.93
Blue Shield,EPO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,EPO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,EPO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Fee Schedule,4280.44
Blue Shield,EPO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Fee Schedule,4280.44
Blue Shield,EPO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,EPO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,EPO,66761,CPT4/HCPCS,REVISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,EPO,66762,CPT4/HCPCS,REVISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,EPO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Fee Schedule,3198.57
Blue Shield,EPO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Fee Schedule,3198.57
Blue Shield,EPO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Fee Schedule,4280.44
Blue Shield,EPO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Fee Schedule,6049.05
Blue Shield,EPO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Fee Schedule,6049.05
Blue Shield,EPO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,6049.05
Blue Shield,EPO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,9548.66
Blue Shield,EPO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,6049.05
Blue Shield,EPO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6049.05
Blue Shield,EPO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6876.92
Blue Shield,EPO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6876.92
Blue Shield,EPO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Fee Schedule,9304.07
Blue Shield,EPO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Fee Schedule,9304.07
Blue Shield,EPO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Fee Schedule,9304.07
Blue Shield,EPO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Fee Schedule,7902.34
Blue Shield,EPO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Fee Schedule,7902.34
Blue Shield,EPO,66999,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Fee Schedule,6049.05
Blue Shield,EPO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Fee Schedule,6049.05
Blue Shield,EPO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Fee Schedule,3198.57
Blue Shield,EPO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Fee Schedule,3198.57
Blue Shield,EPO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Fee Schedule,6049.05
Blue Shield,EPO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Fee Schedule,3198.57
Blue Shield,EPO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Fee Schedule,3198.57
Blue Shield,EPO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Fee Schedule,4280.44
Blue Shield,EPO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Fee Schedule,6049.05
Blue Shield,EPO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Fee Schedule,9548.66
Blue Shield,EPO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Fee Schedule,9548.66
Blue Shield,EPO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Fee Schedule,4891.93
Blue Shield,EPO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Fee Schedule,4891.93
Blue Shield,EPO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Fee Schedule,4891.93
Blue Shield,EPO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Fee Schedule,3198.57
Blue Shield,EPO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Fee Schedule,3198.57
Blue Shield,EPO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,6876.92
Blue Shield,EPO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,9548.66
Blue Shield,EPO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,4891.93
Blue Shield,EPO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Fee Schedule,9548.66
Blue Shield,EPO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Fee Schedule,4280.44
Blue Shield,EPO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Fee Schedule,4280.44
Blue Shield,EPO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Fee Schedule,4280.44
Blue Shield,EPO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Fee Schedule,4280.44
Blue Shield,EPO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Fee Schedule,3198.57
Blue Shield,EPO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,3198.57
Blue Shield,EPO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,6876.92
Blue Shield,EPO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Fee Schedule,3198.57
Blue Shield,EPO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Fee Schedule,3198.57
Blue Shield,EPO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Fee Schedule,3198.57
Blue Shield,EPO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Fee Schedule,3198.57
Blue Shield,EPO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Fee Schedule,3198.57
Blue Shield,EPO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Fee Schedule,7902.34
Blue Shield,EPO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Fee Schedule,4891.93
Blue Shield,EPO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Fee Schedule,4891.93
Blue Shield,EPO,67299,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Fee Schedule,4891.93
Blue Shield,EPO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Fee Schedule,6049.05
Blue Shield,EPO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Fee Schedule,6049.05
Blue Shield,EPO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Fee Schedule,6049.05
Blue Shield,EPO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Fee Schedule,6049.05
Blue Shield,EPO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Fee Schedule,6049.05
Blue Shield,EPO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Fee Schedule,6049.05
Blue Shield,EPO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Fee Schedule,6049.05
Blue Shield,EPO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Fee Schedule,6049.05
Blue Shield,EPO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Fee Schedule,6049.05
Blue Shield,EPO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Fee Schedule,6049.05
Blue Shield,EPO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Fee Schedule,6049.05
Blue Shield,EPO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Fee Schedule,3198.57
Blue Shield,EPO,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,Fee Schedule,3198.57
Blue Shield,EPO,67399,CPT4/HCPCS,UNLISTED PX EXTRAOCULAR MUSC,,Fee Schedule,6049.05
Blue Shield,EPO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,4891.93
Blue Shield,EPO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Fee Schedule,6049.05
Blue Shield,EPO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,EPO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,EPO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Fee Schedule,7902.34
Blue Shield,EPO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Fee Schedule,3198.57
Blue Shield,EPO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,EPO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,EPO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,EPO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Fee Schedule,7902.34
Blue Shield,EPO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,EPO,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,EPO,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,EPO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,EPO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Fee Schedule,6049.05
Blue Shield,EPO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Fee Schedule,4280.44
Blue Shield,EPO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Fee Schedule,7902.34
Blue Shield,EPO,67599,CPT4/HCPCS,ORBIT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Fee Schedule,987.79
Blue Shield,EPO,67710,CPT4/HCPCS,INCISION OF EYELID,,Fee Schedule,3198.57
Blue Shield,EPO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Fee Schedule,3198.57
Blue Shield,EPO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Fee Schedule,987.79
Blue Shield,EPO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Fee Schedule,3198.57
Blue Shield,EPO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Fee Schedule,987.79
Blue Shield,EPO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Fee Schedule,4280.44
Blue Shield,EPO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Fee Schedule,987.79
Blue Shield,EPO,67820,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,3198.57
Blue Shield,EPO,67825,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,3198.57
Blue Shield,EPO,67830,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,4280.44
Blue Shield,EPO,67835,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,4280.44
Blue Shield,EPO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Fee Schedule,3198.57
Blue Shield,EPO,67850,CPT4/HCPCS,TREAT EYELID LESION,,Fee Schedule,3198.57
Blue Shield,EPO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Fee Schedule,3198.57
Blue Shield,EPO,67880,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,67882,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Fee Schedule,6049.05
Blue Shield,EPO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,EPO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,EPO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,EPO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,EPO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,EPO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,EPO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,EPO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,EPO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Fee Schedule,3198.57
Blue Shield,EPO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,EPO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,3198.57
Blue Shield,EPO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,EPO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,EPO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,EPO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4280.44
Blue Shield,EPO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,EPO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,EPO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Fee Schedule,4280.44
Blue Shield,EPO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Fee Schedule,4280.44
Blue Shield,EPO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,EPO,67950,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4280.44
Blue Shield,EPO,67961,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,67966,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,EPO,67999,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4280.44
Blue Shield,EPO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Fee Schedule,4280.44
Blue Shield,EPO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,Fee Schedule,987.79
Blue Shield,EPO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Fee Schedule,3198.57
Blue Shield,EPO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,3198.57
Blue Shield,EPO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,4280.44
Blue Shield,EPO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,4280.44
Blue Shield,EPO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,3198.57
Blue Shield,EPO,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,Fee Schedule,987.79
Blue Shield,EPO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,EPO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,EPO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,EPO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,EPO,68330,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,6049.05
Blue Shield,EPO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,EPO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Fee Schedule,6049.05
Blue Shield,EPO,68360,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,4280.44
Blue Shield,EPO,68362,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,4280.44
Blue Shield,EPO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Fee Schedule,3198.57
Blue Shield,EPO,68399,CPT4/HCPCS,EYELID LINING SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Fee Schedule,987.79
Blue Shield,EPO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Fee Schedule,4280.44
Blue Shield,EPO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Fee Schedule,4891.93
Blue Shield,EPO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Fee Schedule,4891.93
Blue Shield,EPO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Fee Schedule,3198.57
Blue Shield,EPO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Fee Schedule,4891.93
Blue Shield,EPO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Fee Schedule,3198.57
Blue Shield,EPO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Fee Schedule,4280.44
Blue Shield,EPO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Fee Schedule,4891.93
Blue Shield,EPO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Fee Schedule,4891.93
Blue Shield,EPO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Fee Schedule,4280.44
Blue Shield,EPO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Fee Schedule,6049.05
Blue Shield,EPO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Fee Schedule,6049.05
Blue Shield,EPO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Fee Schedule,6049.05
Blue Shield,EPO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Fee Schedule,987.79
Blue Shield,EPO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Fee Schedule,6049.05
Blue Shield,EPO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,3198.57
Blue Shield,EPO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,4280.44
Blue Shield,EPO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,4280.44
Blue Shield,EPO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Fee Schedule,3198.57
Blue Shield,EPO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Fee Schedule,3198.57
Blue Shield,EPO,68899,CPT4/HCPCS,TEAR DUCT SYSTEM SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Fee Schedule,987.79
Blue Shield,EPO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Fee Schedule,3198.57
Blue Shield,EPO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Fee Schedule,987.79
Blue Shield,EPO,69090,CPT4/HCPCS,PIERCE EARLOBES,,Fee Schedule,987.79
Blue Shield,EPO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,Fee Schedule,3198.57
Blue Shield,EPO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,Fee Schedule,4280.44
Blue Shield,EPO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Fee Schedule,3198.57
Blue Shield,EPO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Fee Schedule,4280.44
Blue Shield,EPO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,EPO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,EPO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,EPO,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Fee Schedule,987.79
Blue Shield,EPO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Fee Schedule,3198.57
Blue Shield,EPO,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Fee Schedule,987.79
Blue Shield,EPO,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Fee Schedule,987.79
Blue Shield,EPO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Fee Schedule,987.79
Blue Shield,EPO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Fee Schedule,4280.44
Blue Shield,EPO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Fee Schedule,4891.93
Blue Shield,EPO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Fee Schedule,4891.93
Blue Shield,EPO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Fee Schedule,9548.66
Blue Shield,EPO,69399,CPT4/HCPCS,OUTER EAR SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,EPO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Fee Schedule,3198.57
Blue Shield,EPO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Fee Schedule,4891.93
Blue Shield,EPO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Fee Schedule,3198.57
Blue Shield,EPO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Fee Schedule,3198.57
Blue Shield,EPO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Fee Schedule,4891.93
Blue Shield,EPO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Fee Schedule,4891.93
Blue Shield,EPO,69450,CPT4/HCPCS,EARDRUM REVISION,,Fee Schedule,3198.57
Blue Shield,EPO,69501,CPT4/HCPCS,MASTOIDECTOMY,,Fee Schedule,9548.66
Blue Shield,EPO,69502,CPT4/HCPCS,MASTOIDECTOMY,,Fee Schedule,9548.66
Blue Shield,EPO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Fee Schedule,9548.66
Blue Shield,EPO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Fee Schedule,9548.66
Blue Shield,EPO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Fee Schedule,9548.66
Blue Shield,EPO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,Fee Schedule,7902.34
Blue Shield,EPO,69540,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,4280.44
Blue Shield,EPO,69550,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,6876.92
Blue Shield,EPO,69552,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,9548.66
Blue Shield,EPO,69554,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,6876.92
Blue Shield,EPO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,EPO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,EPO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,EPO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,EPO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,EPO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Fee Schedule,6049.05
Blue Shield,EPO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Fee Schedule,4280.44
Blue Shield,EPO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,EPO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,EPO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,EPO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,EPO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,EPO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,EPO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,EPO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,EPO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,EPO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,EPO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,EPO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,EPO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Fee Schedule,9548.66
Blue Shield,EPO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,EPO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,EPO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,EPO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Fee Schedule,6049.05
Blue Shield,EPO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Fee Schedule,6049.05
Blue Shield,EPO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Fee Schedule,4891.93
Blue Shield,EPO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Fee Schedule,4891.93
Blue Shield,EPO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Fee Schedule,4891.93
Blue Shield,EPO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Fee Schedule,6049.05
Blue Shield,EPO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Fee Schedule,3198.57
Blue Shield,EPO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Fee Schedule,12850.71
Blue Shield,EPO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Fee Schedule,12850.71
Blue Shield,EPO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Fee Schedule,12850.71
Blue Shield,EPO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Fee Schedule,12850.71
Blue Shield,EPO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,EPO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,EPO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,EPO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,EPO,69799,CPT4/HCPCS,MIDDLE EAR SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,EPO,69801,CPT4/HCPCS,INCISE INNER EAR,,Fee Schedule,6876.92
Blue Shield,EPO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Fee Schedule,9548.66
Blue Shield,EPO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Fee Schedule,9548.66
Blue Shield,EPO,69905,CPT4/HCPCS,REMOVE INNER EAR,,Fee Schedule,9548.66
Blue Shield,EPO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,EPO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Fee Schedule,9548.66
Blue Shield,EPO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Fee Schedule,9548.66
Blue Shield,EPO,69949,CPT4/HCPCS,INNER EAR SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,EPO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,Fee Schedule,9548.66
Blue Shield,EPO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,9548.66
Blue Shield,EPO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,Fee Schedule,9548.66
Blue Shield,EPO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Fee Schedule,9548.66
Blue Shield,EPO,69979,CPT4/HCPCS,TEMPORAL BONE SURGERY,,Fee Schedule,3198.57
Blue Shield,EPO,70010,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Case Rate,2177.00
Blue Shield,EPO,70015,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Case Rate,686.66
Blue Shield,EPO,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,Case Rate,205.35
Blue Shield,EPO,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,Case Rate,258.27
Blue Shield,EPO,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,Case Rate,314.46
Blue Shield,EPO,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Case Rate,314.46
Blue Shield,EPO,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Case Rate,400.29
Blue Shield,EPO,70134,CPT4/HCPCS,X-RAY EXAM OF MIDDLE EAR,,Case Rate,376.23
Blue Shield,EPO,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Case Rate,314.46
Blue Shield,EPO,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Case Rate,400.29
Blue Shield,EPO,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,Case Rate,258.27
Blue Shield,EPO,70170,CPT4/HCPCS,X-RAY EXAM OF TEAR DUCT,,Case Rate,481.31
Blue Shield,EPO,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Case Rate,314.46
Blue Shield,EPO,70200,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Case Rate,400.29
Blue Shield,EPO,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Case Rate,314.46
Blue Shield,EPO,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Case Rate,400.29
Blue Shield,EPO,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,Case Rate,205.35
Blue Shield,EPO,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Case Rate,314.46
Blue Shield,EPO,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Case Rate,452.44
Blue Shield,EPO,70300,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Case Rate,137.98
Blue Shield,EPO,70310,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Case Rate,205.35
Blue Shield,EPO,70320,CPT4/HCPCS,FULL MOUTH X-RAY OF TEETH,,Case Rate,400.29
Blue Shield,EPO,70328,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Case Rate,243.84
Blue Shield,EPO,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,Case Rate,429.16
Blue Shield,EPO,70332,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Case Rate,1058.85
Blue Shield,EPO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,Case Rate,5646.30
Blue Shield,EPO,70350,CPT4/HCPCS,X-RAY HEAD FOR ORTHODONTIA,,Case Rate,186.10
Blue Shield,EPO,70355,CPT4/HCPCS,PANORAMIC X-RAY OF JAWS,,Case Rate,290.40
Blue Shield,EPO,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,Case Rate,205.35
Blue Shield,EPO,70370,CPT4/HCPCS,THROAT X-RAY & FLUOROSCOPY,,Case Rate,658.56
Blue Shield,EPO,70371,CPT4/HCPCS,SPEECH EVALUATION COMPLEX,,Case Rate,1058.85
Blue Shield,EPO,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,Case Rate,338.52
Blue Shield,EPO,70390,CPT4/HCPCS,X-RAY EXAM OF SALIVARY DUCT,,Case Rate,905.66
Blue Shield,EPO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,Case Rate,2381.57
Blue Shield,EPO,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,Case Rate,2849.22
Blue Shield,EPO,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,Case Rate,3565.53
Blue Shield,EPO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,Case Rate,2381.57
Blue Shield,EPO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,Case Rate,2849.22
Blue Shield,EPO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,Case Rate,3565.53
Blue Shield,EPO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,Case Rate,2381.57
Blue Shield,EPO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,Case Rate,2849.22
Blue Shield,EPO,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,Case Rate,3565.53
Blue Shield,EPO,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,Case Rate,2381.57
Blue Shield,EPO,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,Case Rate,2849.22
Blue Shield,EPO,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,Case Rate,3565.53
Blue Shield,EPO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,Case Rate,5358.37
Blue Shield,EPO,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,Case Rate,5358.37
Blue Shield,EPO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,Case Rate,5565.61
Blue Shield,EPO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,Case Rate,6680.50
Blue Shield,EPO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,Case Rate,12358.33
Blue Shield,EPO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,Case Rate,5646.30
Blue Shield,EPO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,Case Rate,5646.30
Blue Shield,EPO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,Case Rate,11059.38
Blue Shield,EPO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,Case Rate,5646.30
Blue Shield,EPO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,Case Rate,5646.30
Blue Shield,EPO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,Case Rate,11059.38
Blue Shield,EPO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,Case Rate,5646.30
Blue Shield,EPO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,Case Rate,6773.29
Blue Shield,EPO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,Case Rate,12547.94
Blue Shield,EPO,70554,CPT4/HCPCS,FMRI BRAIN BY TECH,,Case Rate,6533.00
Blue Shield,EPO,70557,CPT4/HCPCS,MRI BRAIN W/O DYE,,Case Rate,7560.21
Blue Shield,EPO,70558,CPT4/HCPCS,MRI BRAIN W/DYE,,Case Rate,8361.57
Blue Shield,EPO,70559,CPT4/HCPCS,MRI BRAIN W/O & W/DYE,,Case Rate,8400.06
Blue Shield,EPO,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,Case Rate,143.57
Blue Shield,EPO,71046,CPT4/HCPCS,X-RAY EXAM CHEST 2 VIEWS,,Case Rate,263.86
Blue Shield,EPO,71047,CPT4/HCPCS,X-RAY EXAM CHEST 3 VIEWS,,Case Rate,336.04
Blue Shield,EPO,71048,CPT4/HCPCS,X-RAY EXAM CHEST 4+ VIEWS,,Case Rate,345.66
Blue Shield,EPO,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,Case Rate,290.40
Blue Shield,EPO,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,Case Rate,338.52
Blue Shield,EPO,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,Case Rate,400.29
Blue Shield,EPO,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,Case Rate,452.44
Blue Shield,EPO,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,Case Rate,328.89
Blue Shield,EPO,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,Case Rate,357.76
Blue Shield,EPO,71250,CPT4/HCPCS,CT THORAX DX C-,,Case Rate,2978.36
Blue Shield,EPO,71260,CPT4/HCPCS,CT THORAX DX C+,,Case Rate,3565.53
Blue Shield,EPO,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,Case Rate,4458.30
Blue Shield,EPO,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,Case Rate,6133.38
Blue Shield,EPO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,Case Rate,5589.81
Blue Shield,EPO,71551,CPT4/HCPCS,MRI CHEST W/DYE,,Case Rate,6700.67
Blue Shield,EPO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,Case Rate,12293.78
Blue Shield,EPO,71555,CPT4/HCPCS,MRI ANGIO CHEST W OR W/O DYE,,Case Rate,5646.30
Blue Shield,EPO,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,Case Rate,205.35
Blue Shield,EPO,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,Case Rate,304.83
Blue Shield,EPO,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,Case Rate,452.44
Blue Shield,EPO,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,Case Rate,567.92
Blue Shield,EPO,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,Case Rate,328.89
Blue Shield,EPO,72072,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 3VWS,,Case Rate,376.23
Blue Shield,EPO,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,Case Rate,462.06
Blue Shield,EPO,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,Case Rate,338.52
Blue Shield,EPO,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,Case Rate,340.85
Blue Shield,EPO,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,Case Rate,619.92
Blue Shield,EPO,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,Case Rate,672.85
Blue Shield,EPO,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,Case Rate,807.58
Blue Shield,EPO,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,Case Rate,338.52
Blue Shield,EPO,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,Case Rate,462.06
Blue Shield,EPO,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,Case Rate,596.79
Blue Shield,EPO,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,Case Rate,452.44
Blue Shield,EPO,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,EPO,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,Case Rate,3565.53
Blue Shield,EPO,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,EPO,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,EPO,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,Case Rate,3565.53
Blue Shield,EPO,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,EPO,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,EPO,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,Case Rate,3565.53
Blue Shield,EPO,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,EPO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,Case Rate,5646.30
Blue Shield,EPO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,Case Rate,6773.29
Blue Shield,EPO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,Case Rate,6263.11
Blue Shield,EPO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,Case Rate,6773.29
Blue Shield,EPO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,Case Rate,6263.11
Blue Shield,EPO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,Case Rate,6773.29
Blue Shield,EPO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,EPO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,EPO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,EPO,72159,CPT4/HCPCS,MR ANGIO SPINE W/O&W/DYE,,Case Rate,6142.82
Blue Shield,EPO,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Case Rate,258.27
Blue Shield,EPO,72190,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Case Rate,338.52
Blue Shield,EPO,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,Case Rate,5964.97
Blue Shield,EPO,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,Case Rate,2978.36
Blue Shield,EPO,72193,CPT4/HCPCS,CT PELVIS W/DYE,,Case Rate,3450.82
Blue Shield,EPO,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,Case Rate,4272.98
Blue Shield,EPO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,Case Rate,5589.81
Blue Shield,EPO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,Case Rate,6700.67
Blue Shield,EPO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,Case Rate,12390.60
Blue Shield,EPO,72198,CPT4/HCPCS,MR ANGIO PELVIS W/O & W/DYE,,Case Rate,5646.30
Blue Shield,EPO,72200,CPT4/HCPCS,X-RAY EXAM SI JOINTS,,Case Rate,258.27
Blue Shield,EPO,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,Case Rate,314.46
Blue Shield,EPO,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,Case Rate,290.40
Blue Shield,EPO,72240,CPT4/HCPCS,MYELOGRAPHY NECK SPINE,,Case Rate,2396.00
Blue Shield,EPO,72255,CPT4/HCPCS,MYELOGRAPHY THORACIC SPINE,,Case Rate,2177.00
Blue Shield,EPO,72265,CPT4/HCPCS,MYELOGRAPHY L-S SPINE,,Case Rate,2056.71
Blue Shield,EPO,72270,CPT4/HCPCS,MYELOGPHY 2/> SPINE REGIONS,,Case Rate,3077.85
Blue Shield,EPO,72275,CPT4/HCPCS,EPIDUROGRAPHY,,Case Rate,1099.20
Blue Shield,EPO,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,Case Rate,4220.06
Blue Shield,EPO,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,Case Rate,3952.94
Blue Shield,EPO,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,Case Rate,258.27
Blue Shield,EPO,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,Case Rate,258.27
Blue Shield,EPO,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Case Rate,234.22
Blue Shield,EPO,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Case Rate,290.40
Blue Shield,EPO,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,Case Rate,1058.85
Blue Shield,EPO,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,Case Rate,338.52
Blue Shield,EPO,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,Case Rate,290.40
Blue Shield,EPO,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Case Rate,258.27
Blue Shield,EPO,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Case Rate,290.40
Blue Shield,EPO,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,Case Rate,1058.85
Blue Shield,EPO,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,Case Rate,258.27
Blue Shield,EPO,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,Case Rate,243.84
Blue Shield,EPO,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Case Rate,243.84
Blue Shield,EPO,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Case Rate,263.08
Blue Shield,EPO,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,Case Rate,800.58
Blue Shield,EPO,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,Case Rate,243.84
Blue Shield,EPO,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,Case Rate,263.08
Blue Shield,EPO,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,Case Rate,205.35
Blue Shield,EPO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,Case Rate,2492.24
Blue Shield,EPO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,Case Rate,2978.36
Blue Shield,EPO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,Case Rate,3742.00
Blue Shield,EPO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,Case Rate,5450.13
Blue Shield,EPO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,Case Rate,5565.61
Blue Shield,EPO,73219,CPT4/HCPCS,MRI UPPER EXTREMITY W/DYE,,Case Rate,6680.50
Blue Shield,EPO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,Case Rate,12358.33
Blue Shield,EPO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,Case Rate,5565.61
Blue Shield,EPO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,Case Rate,6680.50
Blue Shield,EPO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,Case Rate,12358.33
Blue Shield,EPO,73225,CPT4/HCPCS,MR ANGIO UPR EXTR W/O&W/DYE,,Case Rate,5535.63
Blue Shield,EPO,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,Case Rate,273.49
Blue Shield,EPO,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,Case Rate,403.40
Blue Shield,EPO,73503,CPT4/HCPCS,X-RAY EXAM HIP UNI 4/> VIEWS,,Case Rate,499.63
Blue Shield,EPO,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,Case Rate,379.34
Blue Shield,EPO,73522,CPT4/HCPCS,X-RAY EXAM HIPS BI 3-4 VIEWS,,Case Rate,451.52
Blue Shield,EPO,73523,CPT4/HCPCS,X-RAY EXAM HIPS BI 5/> VIEWS,,Case Rate,542.94
Blue Shield,EPO,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,Case Rate,1058.85
Blue Shield,EPO,73551,CPT4/HCPCS,X-RAY EXAM OF FEMUR 1,,Case Rate,259.05
Blue Shield,EPO,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,Case Rate,307.17
Blue Shield,EPO,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,Case Rate,258.27
Blue Shield,EPO,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,Case Rate,290.40
Blue Shield,EPO,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,Case Rate,314.46
Blue Shield,EPO,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,Case Rate,243.84
Blue Shield,EPO,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,Case Rate,1317.13
Blue Shield,EPO,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,Case Rate,258.27
Blue Shield,EPO,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,Case Rate,243.84
Blue Shield,EPO,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Case Rate,243.84
Blue Shield,EPO,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Case Rate,263.08
Blue Shield,EPO,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,Case Rate,1058.85
Blue Shield,EPO,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Case Rate,243.84
Blue Shield,EPO,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Case Rate,263.08
Blue Shield,EPO,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,Case Rate,234.22
Blue Shield,EPO,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,Case Rate,205.35
Blue Shield,EPO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,Case Rate,2492.24
Blue Shield,EPO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,Case Rate,2978.36
Blue Shield,EPO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,Case Rate,3742.00
Blue Shield,EPO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,Case Rate,5450.13
Blue Shield,EPO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,Case Rate,5565.61
Blue Shield,EPO,73719,CPT4/HCPCS,MRI LOWER EXTREMITY W/DYE,,Case Rate,6680.50
Blue Shield,EPO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,Case Rate,12358.33
Blue Shield,EPO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,Case Rate,5565.61
Blue Shield,EPO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,Case Rate,6680.50
Blue Shield,EPO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,Case Rate,12358.33
Blue Shield,EPO,73725,CPT4/HCPCS,MR ANG LWR EXT W OR W/O DYE,,Case Rate,5646.30
Blue Shield,EPO,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,Case Rate,244.62
Blue Shield,EPO,74019,CPT4/HCPCS,X-RAY EXAM ABDOMEN 2 VIEWS,,Case Rate,292.73
Blue Shield,EPO,74021,CPT4/HCPCS,X-RAY EXAM ABDOMEN 3+ VIEWS,,Case Rate,340.85
Blue Shield,EPO,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,Case Rate,376.23
Blue Shield,EPO,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,Case Rate,2849.22
Blue Shield,EPO,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,Case Rate,3450.82
Blue Shield,EPO,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,Case Rate,4272.98
Blue Shield,EPO,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,Case Rate,6451.62
Blue Shield,EPO,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,Case Rate,5964.97
Blue Shield,EPO,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,Case Rate,1866.13
Blue Shield,EPO,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,Case Rate,3559.83
Blue Shield,EPO,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,Case Rate,4704.99
Blue Shield,EPO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,Case Rate,5589.81
Blue Shield,EPO,74182,CPT4/HCPCS,MRI ABDOMEN W/DYE,,Case Rate,6700.67
Blue Shield,EPO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,Case Rate,12390.60
Blue Shield,EPO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,Case Rate,5646.30
Blue Shield,EPO,74190,CPT4/HCPCS,X-RAY EXAM OF PERITONEUM,,Case Rate,658.56
Blue Shield,EPO,74210,CPT4/HCPCS,X-RAY XM PHRNX&/CRV ESOPH C+,,Case Rate,596.79
Blue Shield,EPO,74220,CPT4/HCPCS,X-RAY XM ESOPHAGUS 1CNTRST,,Case Rate,596.79
Blue Shield,EPO,74230,CPT4/HCPCS,X-RAY XM SWLNG FUNCJ C+,,Case Rate,658.56
Blue Shield,EPO,74235,CPT4/HCPCS,REMOVE ESOPHAGUS OBSTRUCTION,,Case Rate,1317.13
Blue Shield,EPO,74240,CPT4/HCPCS,X-RAY XM UPR GI TRC 1CNTRST,,Case Rate,734.77
Blue Shield,EPO,74241,CPT4/HCPCS,X-RAY UPPER GI DELAY W/KUB,,Case Rate,749.21
Blue Shield,EPO,74245,CPT4/HCPCS,X-RAY UPPER GI&SMALL INTEST,,Case Rate,1202.43
Blue Shield,EPO,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,Case Rate,834.26
Blue Shield,EPO,74247,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,Case Rate,857.54
Blue Shield,EPO,74249,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,Case Rate,1302.69
Blue Shield,EPO,74250,CPT4/HCPCS,X-RAY XM SM INT 1CNTRST STD,,Case Rate,658.56
Blue Shield,EPO,74251,CPT4/HCPCS,X-RAY XM SM INT 2CNTRST STD,,Case Rate,658.56
Blue Shield,EPO,74260,CPT4/HCPCS,X-RAY EXAM OF SMALL BOWEL,,Case Rate,749.21
Blue Shield,EPO,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,Case Rate,6620.02
Blue Shield,EPO,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,Case Rate,7442.81
Blue Shield,EPO,74263,CPT4/HCPCS,CT COLONOGRAPHY SCREENING,,Case Rate,7866.23
Blue Shield,EPO,74270,CPT4/HCPCS,X-RAY XM COLON 1CNTRST STD,,Case Rate,867.17
Blue Shield,EPO,74280,CPT4/HCPCS,X-RAY XM COLON 2CNTRST STD,,Case Rate,1130.25
Blue Shield,EPO,74283,CPT4/HCPCS,THER NMA RDCTJ INTUS/OBSTRCJ,,Case Rate,1297.88
Blue Shield,EPO,74290,CPT4/HCPCS,CONTRAST X-RAY GALLBLADDER,,Case Rate,376.23
Blue Shield,EPO,74300,CPT4/HCPCS,X-RAY BILE DUCTS/PANCREAS,,Case Rate,443.59
Blue Shield,EPO,74301,CPT4/HCPCS,X-RAYS AT SURGERY ADD-ON,,Case Rate,257.50
Blue Shield,EPO,74328,CPT4/HCPCS,X-RAY BILE DUCT ENDOSCOPY,,Case Rate,1593.87
Blue Shield,EPO,74329,CPT4/HCPCS,X-RAY FOR PANCREAS ENDOSCOPY,,Case Rate,1593.87
Blue Shield,EPO,74330,CPT4/HCPCS,X-RAY BILE/PANC ENDOSCOPY,,Case Rate,1593.87
Blue Shield,EPO,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,Case Rate,1317.13
Blue Shield,EPO,74355,CPT4/HCPCS,X-RAY GUIDE INTESTINAL TUBE,,Case Rate,1317.13
Blue Shield,EPO,74360,CPT4/HCPCS,X-RAY GUIDE GI DILATION,,Case Rate,1593.87
Blue Shield,EPO,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,Case Rate,3077.85
Blue Shield,EPO,74400,CPT4/HCPCS,UROGRAPHY IV +-KUB TOMOG,,Case Rate,857.54
Blue Shield,EPO,74410,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BOLUS,,Case Rate,987.46
Blue Shield,EPO,74415,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BLS W/NF,,Case Rate,1068.48
Blue Shield,EPO,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,Case Rate,1317.13
Blue Shield,EPO,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,Case Rate,658.56
Blue Shield,EPO,74430,CPT4/HCPCS,CONTRAST X-RAY BLADDER,,Case Rate,534.24
Blue Shield,EPO,74440,CPT4/HCPCS,X-RAY MALE GENITAL TRACT,,Case Rate,567.92
Blue Shield,EPO,74445,CPT4/HCPCS,X-RAY EXAM OF PENIS,,Case Rate,567.92
Blue Shield,EPO,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Case Rate,734.77
Blue Shield,EPO,74455,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Case Rate,800.58
Blue Shield,EPO,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,Case Rate,629.69
Blue Shield,EPO,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,Case Rate,1593.87
Blue Shield,EPO,74710,CPT4/HCPCS,X-RAY MEASUREMENT OF PELVIS,,Case Rate,534.24
Blue Shield,EPO,74712,CPT4/HCPCS,MRI FETAL SNGL/1ST GESTATION,,Case Rate,4444.39
Blue Shield,EPO,74713,CPT4/HCPCS,MRI FETAL EA ADDL GESTATION,,Case Rate,1904.63
Blue Shield,EPO,74740,CPT4/HCPCS,X-RAY FEMALE GENITAL TRACT,,Case Rate,658.56
Blue Shield,EPO,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,Case Rate,1593.87
Blue Shield,EPO,74775,CPT4/HCPCS,X-RAY EXAM OF PERINEUM,,Case Rate,734.77
Blue Shield,EPO,75557,CPT4/HCPCS,CARDIAC MRI FOR MORPH,,Case Rate,5321.40
Blue Shield,EPO,75559,CPT4/HCPCS,CARDIAC MRI W/STRESS IMG,,Case Rate,8044.78
Blue Shield,EPO,75561,CPT4/HCPCS,CARDIAC MRI FOR MORPH W/DYE,,Case Rate,7575.87
Blue Shield,EPO,75563,CPT4/HCPCS,CARD MRI W/STRESS IMG & DYE,,Case Rate,9456.44
Blue Shield,EPO,75565,CPT4/HCPCS,CARD MRI VELOC FLOW MAPPING,,Case Rate,1052.97
Blue Shield,EPO,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,Case Rate,1231.00
Blue Shield,EPO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,Case Rate,692.10
Blue Shield,EPO,75573,CPT4/HCPCS,CT HRT W/3D IMAGE CONGEN,,Case Rate,826.82
Blue Shield,EPO,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,Case Rate,6186.98
Blue Shield,EPO,75600,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Case Rate,6344.13
Blue Shield,EPO,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Case Rate,6344.13
Blue Shield,EPO,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,Case Rate,6344.13
Blue Shield,EPO,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,Case Rate,6615.28
Blue Shield,EPO,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,Case Rate,7841.51
Blue Shield,EPO,75705,CPT4/HCPCS,ARTERY X-RAYS SPINE,,Case Rate,6344.13
Blue Shield,EPO,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,Case Rate,6344.13
Blue Shield,EPO,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,Case Rate,6344.13
Blue Shield,EPO,75726,CPT4/HCPCS,ARTERY X-RAYS ABDOMEN,,Case Rate,6344.13
Blue Shield,EPO,75731,CPT4/HCPCS,ARTERY X-RAYS ADRENAL GLAND,,Case Rate,6344.13
Blue Shield,EPO,75733,CPT4/HCPCS,ARTERY X-RAYS ADRENALS,,Case Rate,6344.13
Blue Shield,EPO,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,Case Rate,6344.13
Blue Shield,EPO,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Case Rate,6344.13
Blue Shield,EPO,75743,CPT4/HCPCS,ARTERY X-RAYS LUNGS,,Case Rate,6344.13
Blue Shield,EPO,75746,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Case Rate,6344.13
Blue Shield,EPO,75756,CPT4/HCPCS,ARTERY X-RAYS CHEST,,Case Rate,6344.13
Blue Shield,EPO,75774,CPT4/HCPCS,ARTERY X-RAY EACH VESSEL,,Case Rate,6344.13
Blue Shield,EPO,75801,CPT4/HCPCS,LYMPH VESSEL X-RAY ARM/LEG,,Case Rate,2734.52
Blue Shield,EPO,75803,CPT4/HCPCS,LYMPH VESSEL X-RAY ARMS/LEGS,,Case Rate,2734.52
Blue Shield,EPO,75805,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Case Rate,3077.85
Blue Shield,EPO,75807,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Case Rate,3077.85
Blue Shield,EPO,75809,CPT4/HCPCS,NONVASCULAR SHUNT X-RAY,,Case Rate,400.29
Blue Shield,EPO,75810,CPT4/HCPCS,VEIN X-RAY SPLEEN/LIVER,,Case Rate,6344.13
Blue Shield,EPO,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,Case Rate,481.31
Blue Shield,EPO,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,Case Rate,744.40
Blue Shield,EPO,75825,CPT4/HCPCS,VEIN X-RAY TRUNK,,Case Rate,6344.13
Blue Shield,EPO,75827,CPT4/HCPCS,VEIN X-RAY CHEST,,Case Rate,6344.13
Blue Shield,EPO,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,Case Rate,6344.13
Blue Shield,EPO,75833,CPT4/HCPCS,VEIN X-RAY KIDNEYS,,Case Rate,6344.13
Blue Shield,EPO,75840,CPT4/HCPCS,VEIN X-RAY ADRENAL GLAND,,Case Rate,6344.13
Blue Shield,EPO,75842,CPT4/HCPCS,VEIN X-RAY ADRENAL GLANDS,,Case Rate,6344.13
Blue Shield,EPO,75860,CPT4/HCPCS,VEIN X-RAY NECK,,Case Rate,6344.13
Blue Shield,EPO,75870,CPT4/HCPCS,VEIN X-RAY SKULL,,Case Rate,6344.13
Blue Shield,EPO,75872,CPT4/HCPCS,VEIN X-RAY SKULL EPIDURAL,,Case Rate,6344.13
Blue Shield,EPO,75880,CPT4/HCPCS,VEIN X-RAY EYE SOCKET,,Case Rate,481.31
Blue Shield,EPO,75885,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Case Rate,6344.13
Blue Shield,EPO,75887,CPT4/HCPCS,VEIN X-RAY LIVER W/O HEMODYN,,Case Rate,6344.13
Blue Shield,EPO,75889,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Case Rate,6344.13
Blue Shield,EPO,75891,CPT4/HCPCS,VEIN X-RAY LIVER,,Case Rate,6344.13
Blue Shield,EPO,75893,CPT4/HCPCS,VENOUS SAMPLING BY CATHETER,,Case Rate,6344.13
Blue Shield,EPO,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,Case Rate,12166.12
Blue Shield,EPO,75898,CPT4/HCPCS,FOLLOW-UP ANGIOGRAPHY,,Case Rate,534.24
Blue Shield,EPO,75901,CPT4/HCPCS,REMOVE CVA DEVICE OBSTRUCT,,Case Rate,965.17
Blue Shield,EPO,75902,CPT4/HCPCS,REMOVE CVA LUMEN OBSTRUCT,,Case Rate,965.17
Blue Shield,EPO,75970,CPT4/HCPCS,VASCULAR BIOPSY,,Case Rate,5818.74
Blue Shield,EPO,75984,CPT4/HCPCS,XRAY CONTROL CATHETER CHANGE,,Case Rate,987.46
Blue Shield,EPO,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,Case Rate,1593.87
Blue Shield,EPO,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,Case Rate,658.56
Blue Shield,EPO,76001,CPT4/HCPCS,FLUOROSCOPE EXAM EXTENSIVE,,Case Rate,1317.13
Blue Shield,EPO,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,Case Rate,258.27
Blue Shield,EPO,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,Case Rate,534.24
Blue Shield,EPO,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,Case Rate,205.35
Blue Shield,EPO,76100,CPT4/HCPCS,X-RAY EXAM OF BODY SECTION,,Case Rate,629.69
Blue Shield,EPO,76101,CPT4/HCPCS,COMPLEX BODY SECTION X-RAY,,Case Rate,720.34
Blue Shield,EPO,76102,CPT4/HCPCS,COMPLEX BODY SECTION X-RAYS,,Case Rate,881.60
Blue Shield,EPO,76120,CPT4/HCPCS,CINE/VIDEO X-RAYS,,Case Rate,534.24
Blue Shield,EPO,76125,CPT4/HCPCS,CINE/VIDEO X-RAYS ADD-ON,,Case Rate,400.29
Blue Shield,EPO,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Case Rate,1682.66
Blue Shield,EPO,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Case Rate,1775.45
Blue Shield,EPO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,Case Rate,1761.50
Blue Shield,EPO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,Case Rate,5535.63
Blue Shield,EPO,76393,CPT4/HCPCS,MR GUIDANCE FOR NEEDLE PLACE,,Case Rate,5630.16
Blue Shield,EPO,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,Case Rate,720.34
Blue Shield,EPO,76510,CPT4/HCPCS,OPH US DX B-SCAN&QUAN A-SCAN,,Case Rate,1077.18
Blue Shield,EPO,76511,CPT4/HCPCS,OPH US DX QUAN A-SCAN ONLY,,Case Rate,360.24
Blue Shield,EPO,76512,CPT4/HCPCS,OPH US DX B-SCAN,,Case Rate,386.78
Blue Shield,EPO,76513,CPT4/HCPCS,OPH US DX ANT SGM US UNI/BI,,Case Rate,425.27
Blue Shield,EPO,76514,CPT4/HCPCS,ECHO EXAM OF EYE THICKNESS,,Case Rate,32.90
Blue Shield,EPO,76516,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,259.20
Blue Shield,EPO,76519,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,297.69
Blue Shield,EPO,76529,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,282.48
Blue Shield,EPO,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,Case Rate,720.34
Blue Shield,EPO,76604,CPT4/HCPCS,US EXAM CHEST,,Case Rate,658.56
Blue Shield,EPO,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,Case Rate,961.55
Blue Shield,EPO,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,Case Rate,735.40
Blue Shield,EPO,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,Case Rate,997.08
Blue Shield,EPO,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,Case Rate,720.34
Blue Shield,EPO,76706,CPT4/HCPCS,US ABDL AORTA SCREEN AAA,,Case Rate,899.00
Blue Shield,EPO,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,Case Rate,997.08
Blue Shield,EPO,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,Case Rate,720.34
Blue Shield,EPO,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,Case Rate,1478.24
Blue Shield,EPO,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,Case Rate,720.34
Blue Shield,EPO,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,Case Rate,1058.85
Blue Shield,EPO,76802,CPT4/HCPCS,OB US < 14 WKS ADDL FETUS,,Case Rate,558.44
Blue Shield,EPO,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,Case Rate,1058.85
Blue Shield,EPO,76810,CPT4/HCPCS,OB US >= 14 WKS ADDL FETUS,,Case Rate,598.79
Blue Shield,EPO,76811,CPT4/HCPCS,OB US DETAILED SNGL FETUS,,Case Rate,1876.79
Blue Shield,EPO,76812,CPT4/HCPCS,OB US DETAILED ADDL FETUS,,Case Rate,675.44
Blue Shield,EPO,76813,CPT4/HCPCS,OB US NUCHAL MEAS 1 GEST,,Case Rate,888.89
Blue Shield,EPO,76814,CPT4/HCPCS,OB US NUCHAL MEAS ADD-ON,,Case Rate,460.66
Blue Shield,EPO,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,Case Rate,720.34
Blue Shield,EPO,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,Case Rate,563.11
Blue Shield,EPO,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,Case Rate,755.57
Blue Shield,EPO,76818,CPT4/HCPCS,FETAL BIOPHYS PROFILE W/NST,,Case Rate,819.83
Blue Shield,EPO,76819,CPT4/HCPCS,FETAL BIOPHYS PROFIL W/O NST,,Case Rate,819.83
Blue Shield,EPO,76820,CPT4/HCPCS,UMBILICAL ARTERY ECHO,,Case Rate,823.08
Blue Shield,EPO,76821,CPT4/HCPCS,MIDDLE CEREBRAL ARTERY ECHO,,Case Rate,823.08
Blue Shield,EPO,76825,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,997.08
Blue Shield,EPO,76826,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,361.80
Blue Shield,EPO,76827,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,880.82
Blue Shield,EPO,76828,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,571.18
Blue Shield,EPO,76830,CPT4/HCPCS,TRANSVAGINAL US NON-OB,,Case Rate,771.71
Blue Shield,EPO,76831,CPT4/HCPCS,ECHO EXAM UTERUS,,Case Rate,771.71
Blue Shield,EPO,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,Case Rate,771.71
Blue Shield,EPO,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,Case Rate,779.63
Blue Shield,EPO,76870,CPT4/HCPCS,US EXAM SCROTUM,,Case Rate,771.71
Blue Shield,EPO,76872,CPT4/HCPCS,US TRANSRECTAL,,Case Rate,935.31
Blue Shield,EPO,76873,CPT4/HCPCS,ECHOGRAP TRANS R PROS STUDY,,Case Rate,1074.99
Blue Shield,EPO,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,Case Rate,1221.38
Blue Shield,EPO,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,Case Rate,143.57
Blue Shield,EPO,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,Case Rate,771.71
Blue Shield,EPO,76886,CPT4/HCPCS,US EXAM INFANT HIPS STATIC,,Case Rate,720.34
Blue Shield,EPO,76930,CPT4/HCPCS,ECHO GUIDE CARDIOCENTESIS,,Case Rate,771.71
Blue Shield,EPO,76932,CPT4/HCPCS,ECHO GUIDE FOR HEART BIOPSY,,Case Rate,771.71
Blue Shield,EPO,76936,CPT4/HCPCS,ECHO GUIDE FOR ARTERY REPAIR,,Case Rate,3178.12
Blue Shield,EPO,76937,CPT4/HCPCS,US GUIDE VASCULAR ACCESS,,Case Rate,218.37
Blue Shield,EPO,76940,CPT4/HCPCS,US GUIDE TISSUE ABLATION,,Case Rate,848.36
Blue Shield,EPO,76941,CPT4/HCPCS,ECHO GUIDE FOR TRANSFUSION,,Case Rate,768.45
Blue Shield,EPO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,Case Rate,1262.50
Blue Shield,EPO,76945,CPT4/HCPCS,ECHO GUIDE VILLUS SAMPLING,,Case Rate,768.45
Blue Shield,EPO,76946,CPT4/HCPCS,ECHO GUIDE FOR AMNIOCENTESIS,,Case Rate,771.71
Blue Shield,EPO,76948,CPT4/HCPCS,ECHO GUIDE OVA ASPIRATION,,Case Rate,771.71
Blue Shield,EPO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,Case Rate,2806.70
Blue Shield,EPO,76970,CPT4/HCPCS,ULTRASOUND EXAM FOLLOW-UP,,Case Rate,534.24
Blue Shield,EPO,76975,CPT4/HCPCS,GI ENDOSCOPIC ULTRASOUND,,Case Rate,771.71
Blue Shield,EPO,76977,CPT4/HCPCS,US BONE DENSITY MEASURE,,Case Rate,419.54
Blue Shield,EPO,77001,CPT4/HCPCS,FLUOROGUIDE FOR VEIN DEVICE,,Case Rate,1228.82
Blue Shield,EPO,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,Case Rate,514.21
Blue Shield,EPO,77003,CPT4/HCPCS,FLUOROGUIDE FOR SPINE INJECT,,Case Rate,316.94
Blue Shield,EPO,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,Case Rate,9388.52
Blue Shield,EPO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,Case Rate,1040.35
Blue Shield,EPO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Case Rate,2066.19
Blue Shield,EPO,77021,CPT4/HCPCS,MRI GUIDANCE NDL PLMT RS&I,,Case Rate,4436.87
Blue Shield,EPO,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,Case Rate,292.25
Blue Shield,EPO,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,Case Rate,764.72
Blue Shield,EPO,77058,CPT4/HCPCS,MRI ONE BREAST,,Case Rate,10066.59
Blue Shield,EPO,77059,CPT4/HCPCS,MRI BOTH BREASTS,,Case Rate,10147.57
Blue Shield,EPO,77063,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Case Rate,345.66
Blue Shield,EPO,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,Case Rate,996.15
Blue Shield,EPO,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,Case Rate,1494.93
Blue Shield,EPO,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,Case Rate,1514.18
Blue Shield,EPO,77071,CPT4/HCPCS,X-RAY STRESS VIEW,,Case Rate,389.89
Blue Shield,EPO,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,Case Rate,171.66
Blue Shield,EPO,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,Case Rate,284.81
Blue Shield,EPO,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,Case Rate,606.41
Blue Shield,EPO,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,Case Rate,984.98
Blue Shield,EPO,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,Case Rate,852.58
Blue Shield,EPO,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,Case Rate,279.22
Blue Shield,EPO,77078,CPT4/HCPCS,CT BONE DENSITY AXIAL,,Case Rate,279.22
Blue Shield,EPO,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,Case Rate,419.83
Blue Shield,EPO,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,Case Rate,323.30
Blue Shield,EPO,77084,CPT4/HCPCS,MAGNETIC IMAGE BONE MARROW,,Case Rate,6651.93
Blue Shield,EPO,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,Case Rate,552.56
Blue Shield,EPO,77086,CPT4/HCPCS,FRACTURE ASSESSMENT VIA DXA,,Case Rate,360.09
Blue Shield,EPO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,1747.06
Blue Shield,EPO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,2810.73
Blue Shield,EPO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,3283.19
Blue Shield,EPO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,Case Rate,4411.49
Blue Shield,EPO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,Case Rate,14084.07
Blue Shield,EPO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,Case Rate,677.81
Blue Shield,EPO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,Case Rate,14084.07
Blue Shield,EPO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,Case Rate,985.61
Blue Shield,EPO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,Case Rate,1803.58
Blue Shield,EPO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,Case Rate,1529.32
Blue Shield,EPO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,Case Rate,1996.05
Blue Shield,EPO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,Case Rate,2708.17
Blue Shield,EPO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,Case Rate,2038.24
Blue Shield,EPO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,Case Rate,248.65
Blue Shield,EPO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,677.81
Blue Shield,EPO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,958.59
Blue Shield,EPO,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,1637.17
Blue Shield,EPO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,1503.23
Blue Shield,EPO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,Case Rate,3362.55
Blue Shield,EPO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,1756.69
Blue Shield,EPO,77371,CPT4/HCPCS,SRS MULTISOURCE,,Case Rate,14607.62
Blue Shield,EPO,77372,CPT4/HCPCS,SRS LINEAR BASED,,Case Rate,11085.51
Blue Shield,EPO,77373,CPT4/HCPCS,SBRT DELIVERY,,Case Rate,20679.89
Blue Shield,EPO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,Case Rate,8995.00
Blue Shield,EPO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,Case Rate,8995.00
Blue Shield,EPO,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,900.85
Blue Shield,EPO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,900.85
Blue Shield,EPO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,1054.04
Blue Shield,EPO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,1178.37
Blue Shield,EPO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,Case Rate,300.02
Blue Shield,EPO,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,Case Rate,1139.87
Blue Shield,EPO,77435,CPT4/HCPCS,SBRT MANAGEMENT,,Case Rate,2498.08
Blue Shield,EPO,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,Case Rate,1402.14
Blue Shield,EPO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,Case Rate,5622.24
Blue Shield,EPO,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,Case Rate,6586.41
Blue Shield,EPO,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,Case Rate,6586.41
Blue Shield,EPO,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,Case Rate,9965.84
Blue Shield,EPO,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,Case Rate,9965.84
Blue Shield,EPO,77600,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,EPO,77605,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2051.90
Blue Shield,EPO,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,EPO,77615,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2051.90
Blue Shield,EPO,77620,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,EPO,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Case Rate,673.00
Blue Shield,EPO,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Case Rate,1269.01
Blue Shield,EPO,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Case Rate,1818.46
Blue Shield,EPO,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Case Rate,2258.02
Blue Shield,EPO,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,2307.25
Blue Shield,EPO,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,3792.49
Blue Shield,EPO,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,2984.91
Blue Shield,EPO,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,5436.51
Blue Shield,EPO,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,8579.43
Blue Shield,EPO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Case Rate,2586.92
Blue Shield,EPO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Case Rate,224.59
Blue Shield,EPO,77790,CPT4/HCPCS,RADIATION HANDLING,,Case Rate,248.65
Blue Shield,EPO,78012,CPT4/HCPCS,THYROID UPTAKE MEASUREMENT,,Case Rate,1048.16
Blue Shield,EPO,78013,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Case Rate,2725.86
Blue Shield,EPO,78014,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Case Rate,3110.79
Blue Shield,EPO,78015,CPT4/HCPCS,THYROID MET IMAGING,,Case Rate,1302.69
Blue Shield,EPO,78016,CPT4/HCPCS,THYROID MET IMAGING/STUDIES,,Case Rate,1751.88
Blue Shield,EPO,78018,CPT4/HCPCS,THYROID MET IMAGING BODY,,Case Rate,2739.33
Blue Shield,EPO,78020,CPT4/HCPCS,THYROID MET UPTAKE,,Case Rate,686.80
Blue Shield,EPO,78070,CPT4/HCPCS,PARATHYROID PLANAR IMAGING,,Case Rate,924.91
Blue Shield,EPO,78071,CPT4/HCPCS,PARATHYRD PLANAR W/WO SUBTRJ,,Case Rate,4337.76
Blue Shield,EPO,78075,CPT4/HCPCS,ADRENAL CORTEX & MEDULLA IMG,,Case Rate,2739.33
Blue Shield,EPO,78102,CPT4/HCPCS,BONE MARROW IMAGING LTD,,Case Rate,1029.98
Blue Shield,EPO,78103,CPT4/HCPCS,BONE MARROW IMAGING MULT,,Case Rate,1598.68
Blue Shield,EPO,78104,CPT4/HCPCS,BONE MARROW IMAGING BODY,,Case Rate,2056.71
Blue Shield,EPO,78110,CPT4/HCPCS,PLASMA VOLUME SINGLE,,Case Rate,481.31
Blue Shield,EPO,78111,CPT4/HCPCS,PLASMA VOLUME MULTIPLE,,Case Rate,1302.69
Blue Shield,EPO,78120,CPT4/HCPCS,RED CELL MASS SINGLE,,Case Rate,881.60
Blue Shield,EPO,78121,CPT4/HCPCS,RED CELL MASS MULTIPLE,,Case Rate,1461.48
Blue Shield,EPO,78122,CPT4/HCPCS,BLOOD VOLUME,,Case Rate,2319.80
Blue Shield,EPO,78130,CPT4/HCPCS,RED CELL SURVIVAL STUDY,,Case Rate,1432.61
Blue Shield,EPO,78135,CPT4/HCPCS,RED CELL SURVIVAL KINETICS,,Case Rate,2453.74
Blue Shield,EPO,78140,CPT4/HCPCS,RED CELL SEQUESTRATION,,Case Rate,1985.31
Blue Shield,EPO,78185,CPT4/HCPCS,SPLEEN IMAGING,,Case Rate,1192.80
Blue Shield,EPO,78191,CPT4/HCPCS,PLATELET SURVIVAL,,Case Rate,3690.63
Blue Shield,EPO,78195,CPT4/HCPCS,LYMPH SYSTEM IMAGING,,Case Rate,2056.71
Blue Shield,EPO,78201,CPT4/HCPCS,LIVER IMAGING,,Case Rate,1192.80
Blue Shield,EPO,78202,CPT4/HCPCS,LIVER IMAGING WITH FLOW,,Case Rate,1447.04
Blue Shield,EPO,78205,CPT4/HCPCS,LIVER IMAGING (3D),,Case Rate,2978.36
Blue Shield,EPO,78206,CPT4/HCPCS,LIVER IMAGE (3D) WITH FLOW,,Case Rate,2897.67
Blue Shield,EPO,78215,CPT4/HCPCS,LIVER AND SPLEEN IMAGING,,Case Rate,1475.91
Blue Shield,EPO,78216,CPT4/HCPCS,LIVER & SPLEEN IMAGE/FLOW,,Case Rate,1751.88
Blue Shield,EPO,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Case Rate,4145.29
Blue Shield,EPO,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Case Rate,5756.41
Blue Shield,EPO,78230,CPT4/HCPCS,SALIVARY GLAND IMAGING,,Case Rate,1101.38
Blue Shield,EPO,78231,CPT4/HCPCS,SERIAL SALIVARY IMAGING,,Case Rate,1598.68
Blue Shield,EPO,78232,CPT4/HCPCS,SALIVARY GLAND FUNCTION EXAM,,Case Rate,1780.75
Blue Shield,EPO,78258,CPT4/HCPCS,ESOPHAGEAL MOTILITY STUDY,,Case Rate,1447.04
Blue Shield,EPO,78261,CPT4/HCPCS,GASTRIC MUCOSA IMAGING,,Case Rate,2066.33
Blue Shield,EPO,78262,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX EXAM,,Case Rate,2143.32
Blue Shield,EPO,78264,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,2080.77
Blue Shield,EPO,78265,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,4918.41
Blue Shield,EPO,78266,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,5885.55
Blue Shield,EPO,78270,CPT4/HCPCS,VIT B-12 ABSORPTION EXAM,,Case Rate,786.15
Blue Shield,EPO,78271,CPT4/HCPCS,VIT B-12 ABSRP EXAM INT FAC,,Case Rate,834.26
Blue Shield,EPO,78272,CPT4/HCPCS,VIT B-12 ABSORP COMBINED,,Case Rate,1173.56
Blue Shield,EPO,78278,CPT4/HCPCS,ACUTE GI BLOOD LOSS IMAGING,,Case Rate,2453.74
Blue Shield,EPO,78282,CPT4/HCPCS,GI PROTEIN LOSS EXAM,,Case Rate,758.83
Blue Shield,EPO,78290,CPT4/HCPCS,MECKELS DIVERT EXAM,,Case Rate,1536.91
Blue Shield,EPO,78291,CPT4/HCPCS,LEVEEN/SHUNT PATENCY EXAM,,Case Rate,1546.53
Blue Shield,EPO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Per Diem,5692.00
Blue Shield,EPO,78300,CPT4/HCPCS,BONE IMAGING LIMITED AREA,,Case Rate,1259.39
Blue Shield,EPO,78305,CPT4/HCPCS,BONE IMAGING MULTIPLE AREAS,,Case Rate,1847.33
Blue Shield,EPO,78306,CPT4/HCPCS,BONE IMAGING WHOLE BODY,,Case Rate,2152.94
Blue Shield,EPO,78315,CPT4/HCPCS,BONE IMAGING 3 PHASE,,Case Rate,2410.44
Blue Shield,EPO,78320,CPT4/HCPCS,BONE IMAGING (3D),,Case Rate,2978.36
Blue Shield,EPO,78350,CPT4/HCPCS,BONE MINERAL SINGLE PHOTON,,Case Rate,385.86
Blue Shield,EPO,78351,CPT4/HCPCS,BONE MINERAL DUAL PHOTON,,Case Rate,148.38
Blue Shield,EPO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Per Diem,5692.00
Blue Shield,EPO,78414,CPT4/HCPCS,NON-IMAGING HEART FUNCTION,,Case Rate,701.87
Blue Shield,EPO,78428,CPT4/HCPCS,CARDIAC SHUNT IMAGING,,Case Rate,1139.87
Blue Shield,EPO,78445,CPT4/HCPCS,VASCULAR FLOW IMAGING,,Case Rate,944.15
Blue Shield,EPO,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,Case Rate,2073.03
Blue Shield,EPO,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,Case Rate,4007.31
Blue Shield,EPO,78453,CPT4/HCPCS,HT MUSCLE IMAGE PLANAR SING,,Case Rate,1933.50
Blue Shield,EPO,78454,CPT4/HCPCS,HT MUSC IMAGE PLANAR MULT,,Case Rate,1625.55
Blue Shield,EPO,78456,CPT4/HCPCS,ACUTE VENOUS THROMBUS IMAGE,,Case Rate,2041.65
Blue Shield,EPO,78457,CPT4/HCPCS,VENOUS THROMBOSIS IMAGING,,Case Rate,1336.37
Blue Shield,EPO,78458,CPT4/HCPCS,VEN THROMBOSIS IMAGES BILAT,,Case Rate,2028.62
Blue Shield,EPO,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,Case Rate,2362.32
Blue Shield,EPO,78466,CPT4/HCPCS,HEART INFARCT IMAGE,,Case Rate,1317.13
Blue Shield,EPO,78468,CPT4/HCPCS,HEART INFARCT IMAGE (EF),,Case Rate,1847.33
Blue Shield,EPO,78469,CPT4/HCPCS,HEART INFARCT IMAGE (3D),,Case Rate,2634.25
Blue Shield,EPO,78472,CPT4/HCPCS,GATED HEART PLANAR SINGLE,,Case Rate,2781.86
Blue Shield,EPO,78473,CPT4/HCPCS,GATED HEART MULTIPLE,,Case Rate,4158.28
Blue Shield,EPO,78481,CPT4/HCPCS,HEART FIRST PASS SINGLE,,Case Rate,2634.25
Blue Shield,EPO,78483,CPT4/HCPCS,HEART FIRST PASS MULTIPLE,,Case Rate,3961.78
Blue Shield,EPO,78491,CPT4/HCPCS,MYOCRD IMG PET 1STD RST/STRS,,Case Rate,2396.00
Blue Shield,EPO,78492,CPT4/HCPCS,MYOCRD IMG PET MLT RST&STRS,,Case Rate,2983.17
Blue Shield,EPO,78494,CPT4/HCPCS,HEART IMAGE SPECT,,Case Rate,3537.29
Blue Shield,EPO,78496,CPT4/HCPCS,HEART FIRST PASS ADD-ON,,Case Rate,3537.29
Blue Shield,EPO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Per Diem,5692.00
Blue Shield,EPO,78579,CPT4/HCPCS,LUNG VENTILATION IMAGING,,Case Rate,2139.62
Blue Shield,EPO,78580,CPT4/HCPCS,LUNG PERFUSION IMAGING,,Case Rate,1727.82
Blue Shield,EPO,78582,CPT4/HCPCS,LUNG VENTILAT&PERFUS IMAGING,,Case Rate,3837.35
Blue Shield,EPO,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Case Rate,2293.59
Blue Shield,EPO,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Case Rate,3717.06
Blue Shield,EPO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Per Diem,5692.00
Blue Shield,EPO,78600,CPT4/HCPCS,BRAIN IMAGE < 4 VIEWS,,Case Rate,1447.04
Blue Shield,EPO,78601,CPT4/HCPCS,BRAIN IMAGE W/FLOW < 4 VIEWS,,Case Rate,1713.38
Blue Shield,EPO,78605,CPT4/HCPCS,BRAIN IMAGE 4+ VIEWS,,Case Rate,1713.38
Blue Shield,EPO,78606,CPT4/HCPCS,BRAIN IMAGE W/FLOW 4 + VIEWS,,Case Rate,1951.63
Blue Shield,EPO,78607,CPT4/HCPCS,BRAIN IMAGING (3D),,Case Rate,3307.25
Blue Shield,EPO,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,Case Rate,18766.19
Blue Shield,EPO,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,Case Rate,745.95
Blue Shield,EPO,78610,CPT4/HCPCS,BRAIN FLOW IMAGING ONLY,,Case Rate,800.58
Blue Shield,EPO,78630,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Case Rate,2538.80
Blue Shield,EPO,78635,CPT4/HCPCS,CSF VENTRICULOGRAPHY,,Case Rate,1288.26
Blue Shield,EPO,78645,CPT4/HCPCS,CSF SHUNT EVALUATION,,Case Rate,1727.82
Blue Shield,EPO,78647,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Case Rate,2978.36
Blue Shield,EPO,78650,CPT4/HCPCS,CSF LEAKAGE IMAGING,,Case Rate,2339.04
Blue Shield,EPO,78660,CPT4/HCPCS,NUCLEAR EXAM OF TEAR FLOW,,Case Rate,1068.48
Blue Shield,EPO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Per Diem,5692.00
Blue Shield,EPO,78700,CPT4/HCPCS,KIDNEY IMAGING MORPHOL,,Case Rate,1536.91
Blue Shield,EPO,78701,CPT4/HCPCS,KIDNEY IMAGING WITH FLOW,,Case Rate,1790.37
Blue Shield,EPO,78707,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/O DRUG,,Case Rate,2248.40
Blue Shield,EPO,78708,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/DRUG,,Case Rate,2248.40
Blue Shield,EPO,78709,CPT4/HCPCS,K FLOW/FUNCT IMAGE MULTIPLE,,Case Rate,2248.40
Blue Shield,EPO,78710,CPT4/HCPCS,KIDNEY IMAGING (3D),,Case Rate,2978.36
Blue Shield,EPO,78725,CPT4/HCPCS,KIDNEY FUNCTION STUDY,,Case Rate,905.66
Blue Shield,EPO,78730,CPT4/HCPCS,URINARY BLADDER RETENTION,,Case Rate,734.77
Blue Shield,EPO,78740,CPT4/HCPCS,URETERAL REFLUX STUDY,,Case Rate,1068.48
Blue Shield,EPO,78761,CPT4/HCPCS,TESTICULAR IMAGING W/FLOW,,Case Rate,1613.12
Blue Shield,EPO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Per Diem,5692.00
Blue Shield,EPO,78800,CPT4/HCPCS,RP LOCLZJ TUM 1 AREA 1 D IMG,,Case Rate,1713.38
Blue Shield,EPO,78801,CPT4/HCPCS,RP LOCLZJ TUM 2+AREA 1+D IMG,,Case Rate,2128.89
Blue Shield,EPO,78802,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 1 D IMG,,Case Rate,2791.48
Blue Shield,EPO,78803,CPT4/HCPCS,RP LOCLZJ TUM SPECT 1 AREA,,Case Rate,3307.25
Blue Shield,EPO,78804,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 2+D IMG,,Case Rate,2185.22
Blue Shield,EPO,78805,CPT4/HCPCS,ABSCESS IMAGING LTD AREA,,Case Rate,1713.38
Blue Shield,EPO,78806,CPT4/HCPCS,ABSCESS IMAGING WHOLE BODY,,Case Rate,3244.70
Blue Shield,EPO,78807,CPT4/HCPCS,NUCLEAR LOCALIZATION/ABSCESS,,Case Rate,3307.25
Blue Shield,EPO,78811,CPT4/HCPCS,PET IMAGE LTD AREA,,Case Rate,17587.83
Blue Shield,EPO,78812,CPT4/HCPCS,PET IMAGE SKULL-THIGH,,Case Rate,18766.19
Blue Shield,EPO,78813,CPT4/HCPCS,PET IMAGE FULL BODY,,Case Rate,19935.71
Blue Shield,EPO,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,Case Rate,17587.83
Blue Shield,EPO,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,Case Rate,18766.19
Blue Shield,EPO,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,Case Rate,19935.71
Blue Shield,EPO,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Case Rate,1317.13
Blue Shield,EPO,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,Case Rate,1317.13
Blue Shield,EPO,79200,CPT4/HCPCS,NUCLEAR RX INTRACAV ADMIN,,Case Rate,1317.13
Blue Shield,EPO,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Case Rate,711.49
Blue Shield,EPO,79403,CPT4/HCPCS,HEMATOPOIETIC NUCLEAR TX,,Case Rate,2120.67
Blue Shield,EPO,79440,CPT4/HCPCS,NUCLEAR RX INTRA-ARTICULAR,,Case Rate,1317.13
Blue Shield,EPO,79445,CPT4/HCPCS,NUCLEAR RX INTRA-ARTERIAL,,Case Rate,1325.20
Blue Shield,EPO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Per Diem,5692.00
Blue Shield,EPO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Per Diem,5692.00
Blue Shield,EPO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Per Diem,5692.00
Blue Shield,EPO,80050,CPT4/HCPCS,GENERAL HEALTH PANEL,,Case Rate,572.58
Blue Shield,EPO,80055,CPT4/HCPCS,OBSTETRIC PANEL,,Case Rate,654.38
Blue Shield,EPO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Per Diem,5692.00
Blue Shield,EPO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Per Diem,5692.00
Blue Shield,EPO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Per Diem,5692.00
Blue Shield,EPO,85396,CPT4/HCPCS,CLOTTING ASSAY WHOLE BLOOD,,Case Rate,93.12
Blue Shield,EPO,86077,CPT4/HCPCS,PHYS BLOOD BANK SERV XMATCH,,Case Rate,199.76
Blue Shield,EPO,86078,CPT4/HCPCS,PHYS BLOOD BANK SERV REACTJ,,Case Rate,233.44
Blue Shield,EPO,86079,CPT4/HCPCS,PHYS BLOOD BANK SERV AUTHRJ,,Case Rate,228.63
Blue Shield,EPO,86486,CPT4/HCPCS,SKIN TEST NOS ANTIGEN,,Case Rate,70.62
Blue Shield,EPO,86490,CPT4/HCPCS,COCCIDIOIDOMYCOSIS SKIN TEST,,Case Rate,147.61
Blue Shield,EPO,86510,CPT4/HCPCS,HISTOPLASMOSIS SKIN TEST,,Case Rate,162.04
Blue Shield,EPO,86580,CPT4/HCPCS,TB INTRADERMAL TEST,,Case Rate,133.17
Blue Shield,EPO,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,Case Rate,226.15
Blue Shield,EPO,86860,CPT4/HCPCS,RBC ANTIBODY ELUTION,,Case Rate,226.15
Blue Shield,EPO,86870,CPT4/HCPCS,RBC ANTIBODY IDENTIFICATION,,Case Rate,399.37
Blue Shield,EPO,86890,CPT4/HCPCS,AUTOLOGOUS BLOOD PROCESS,,Case Rate,914.21
Blue Shield,EPO,86891,CPT4/HCPCS,AUTOLOGOUS BLOOD OP SALVAGE,,Case Rate,1424.24
Blue Shield,EPO,86910,CPT4/HCPCS,BLOOD TYPING PATERNITY TEST,,Case Rate,250.20
Blue Shield,EPO,86911,CPT4/HCPCS,BLOOD TYPING ANTIGEN SYSTEM,,Case Rate,192.47
Blue Shield,EPO,86920,CPT4/HCPCS,COMPATIBILITY TEST SPIN,,Case Rate,250.20
Blue Shield,EPO,86921,CPT4/HCPCS,COMPATIBILITY TEST INCUBATE,,Case Rate,226.15
Blue Shield,EPO,86922,CPT4/HCPCS,COMPATIBILITY TEST ANTIGLOB,,Case Rate,134.73
Blue Shield,EPO,86927,CPT4/HCPCS,PLASMA FRESH FROZEN,,Case Rate,125.10
Blue Shield,EPO,86930,CPT4/HCPCS,FROZEN BLOOD PREP,,Case Rate,1140.36
Blue Shield,EPO,86931,CPT4/HCPCS,FROZEN BLOOD THAW,,Case Rate,1255.83
Blue Shield,EPO,86932,CPT4/HCPCS,FROZEN BLOOD FREEZE/THAW,,Case Rate,1366.50
Blue Shield,EPO,86945,CPT4/HCPCS,BLOOD PRODUCT/IRRADIATION,,Case Rate,341.63
Blue Shield,EPO,86950,CPT4/HCPCS,LEUKACYTE TRANSFUSION,,Case Rate,625.51
Blue Shield,EPO,86965,CPT4/HCPCS,POOLING BLOOD PLATELETS,,Case Rate,158.78
Blue Shield,EPO,86970,CPT4/HCPCS,RBC PRETX INCUBATJ W/CHEMICL,,Case Rate,182.84
Blue Shield,EPO,86971,CPT4/HCPCS,RBC PRETX INCUBATJ W/ENZYMES,,Case Rate,182.84
Blue Shield,EPO,86972,CPT4/HCPCS,RBC PRETX INCUBATJ W/DENSITY,,Case Rate,173.22
Blue Shield,EPO,86975,CPT4/HCPCS,RBC SERUM PRETX INCUBJ DRUGS,,Case Rate,115.48
Blue Shield,EPO,86976,CPT4/HCPCS,RBC SERUM PRETX ID DILUTION,,Case Rate,91.42
Blue Shield,EPO,86977,CPT4/HCPCS,RBC SERUM PRETX INCUBJ/INHIB,,Case Rate,115.48
Blue Shield,EPO,86978,CPT4/HCPCS,RBC PRETREATMENT SERUM,,Case Rate,250.20
Blue Shield,EPO,86985,CPT4/HCPCS,SPLIT BLOOD OR PRODUCTS,,Case Rate,240.58
Blue Shield,EPO,88104,CPT4/HCPCS,CYTOPATH FL NONGYN SMEARS,,Case Rate,248.65
Blue Shield,EPO,88106,CPT4/HCPCS,CYTOPATH FL NONGYN FILTER,,Case Rate,186.10
Blue Shield,EPO,88108,CPT4/HCPCS,CYTOPATH CONCENTRATE TECH,,Case Rate,277.52
Blue Shield,EPO,88112,CPT4/HCPCS,CYTOPATH CELL ENHANCE TECH,,Case Rate,715.38
Blue Shield,EPO,88120,CPT4/HCPCS,CYTP URNE 3-5 PROBES EA SPEC,,Case Rate,5718.69
Blue Shield,EPO,88121,CPT4/HCPCS,CYTP URINE 3-5 PROBES CMPTR,,Case Rate,4796.42
Blue Shield,EPO,88125,CPT4/HCPCS,FORENSIC CYTOPATHOLOGY,,Case Rate,71.40
Blue Shield,EPO,88160,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,344.88
Blue Shield,EPO,88161,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,325.64
Blue Shield,EPO,88162,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,171.66
Blue Shield,EPO,88172,CPT4/HCPCS,CYTP DX EVAL FNA 1ST EA SITE,,Case Rate,195.72
Blue Shield,EPO,88173,CPT4/HCPCS,CYTOPATH EVAL FNA REPORT,,Case Rate,561.41
Blue Shield,EPO,88177,CPT4/HCPCS,CYTP FNA EVAL EA ADDL,,Case Rate,90.64
Blue Shield,EPO,88182,CPT4/HCPCS,CELL MARKER STUDY,,Case Rate,617.59
Blue Shield,EPO,88184,CPT4/HCPCS,FLOWCYTOMETRY/ TC 1 MARKER,,Case Rate,643.20
Blue Shield,EPO,88185,CPT4/HCPCS,FLOWCYTOMETRY/TC ADD-ON,,Case Rate,316.01
Blue Shield,EPO,88187,CPT4/HCPCS,FLOWCYTOMETRY/READ 2-8,,Case Rate,220.56
Blue Shield,EPO,88188,CPT4/HCPCS,FLOWCYTOMETRY/READ 9-15,,Case Rate,278.30
Blue Shield,EPO,88189,CPT4/HCPCS,FLOWCYTOMETRY/READ 16 & >,,Case Rate,364.91
Blue Shield,EPO,88291,CPT4/HCPCS,CYTO/MOLECULAR REPORT,,Case Rate,89.87
Blue Shield,EPO,88300,CPT4/HCPCS,SURGICAL PATH GROSS,,Case Rate,119.51
Blue Shield,EPO,88302,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,311.20
Blue Shield,EPO,88304,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,378.56
Blue Shield,EPO,88305,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,689.77
Blue Shield,EPO,88307,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,967.29
Blue Shield,EPO,88309,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,1106.82
Blue Shield,EPO,88311,CPT4/HCPCS,DECALCIFY TISSUE,,Case Rate,47.34
Blue Shield,EPO,88312,CPT4/HCPCS,SPECIAL STAINS GROUP 1,,Case Rate,538.13
Blue Shield,EPO,88313,CPT4/HCPCS,SPECIAL STAINS GROUP 2,,Case Rate,475.57
Blue Shield,EPO,88314,CPT4/HCPCS,HISTOCHEMICAL STAINS ADD-ON,,Case Rate,340.07
Blue Shield,EPO,88319,CPT4/HCPCS,ENZYME HISTOCHEMISTRY,,Case Rate,806.80
Blue Shield,EPO,88323,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Case Rate,417.06
Blue Shield,EPO,88331,CPT4/HCPCS,PATH CONSULT INTRAOP 1 BLOC,,Case Rate,237.47
Blue Shield,EPO,88332,CPT4/HCPCS,PATH CONSULT INTRAOP ADDL,,Case Rate,123.55
Blue Shield,EPO,88333,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 1,,Case Rate,280.78
Blue Shield,EPO,88334,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 2,,Case Rate,171.66
Blue Shield,EPO,88341,CPT4/HCPCS,IMMUNOHISTO ANTB ADDL SLIDE,,Case Rate,610.30
Blue Shield,EPO,88342,CPT4/HCPCS,IMMUNOHISTO ANTB 1ST STAIN,,Case Rate,479.61
Blue Shield,EPO,88344,CPT4/HCPCS,IMMUNOHISTO ANTIBODY SLIDE,,Case Rate,1033.72
Blue Shield,EPO,88346,CPT4/HCPCS,IMMUNOFLUOR ANTB 1ST STAIN,,Case Rate,522.91
Blue Shield,EPO,88348,CPT4/HCPCS,ELECTRON MICROSCOPY,,Case Rate,3790.93
Blue Shield,EPO,88350,CPT4/HCPCS,IMMUNOFLUOR ANTB ADDL STAIN,,Case Rate,591.05
Blue Shield,EPO,88355,CPT4/HCPCS,ANALYSIS SKELETAL MUSCLE,,Case Rate,890.30
Blue Shield,EPO,88356,CPT4/HCPCS,ANALYSIS NERVE,,Case Rate,798.10
Blue Shield,EPO,88358,CPT4/HCPCS,ANALYSIS TUMOR,,Case Rate,100.41
Blue Shield,EPO,88360,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/MANUAL,,Case Rate,614.33
Blue Shield,EPO,88361,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/COMPUT,,Case Rate,1077.18
Blue Shield,EPO,88362,CPT4/HCPCS,NERVE TEASING PREPARATIONS,,Case Rate,1693.84
Blue Shield,EPO,88363,CPT4/HCPCS,XM ARCHIVE TISSUE MOLEC ANAL,,Case Rate,60.22
Blue Shield,EPO,88364,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,942.30
Blue Shield,EPO,88365,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,874.16
Blue Shield,EPO,88366,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,1158.82
Blue Shield,EPO,88367,CPT4/HCPCS,INSITU HYBRIDIZATION AUTO,,Case Rate,1741.96
Blue Shield,EPO,88368,CPT4/HCPCS,INSITU HYBRIDIZATION MANUAL,,Case Rate,1419.58
Blue Shield,EPO,88369,CPT4/HCPCS,M/PHMTRC ALYSISHQUANT/SEMIQ,,Case Rate,653.60
Blue Shield,EPO,88373,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,523.69
Blue Shield,EPO,88374,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,2150.02
Blue Shield,EPO,88377,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,2000.86
Blue Shield,EPO,88381,CPT4/HCPCS,MICRODISSECTION MANUAL,,Case Rate,2004.89
Blue Shield,EPO,88387,CPT4/HCPCS,TISS EXAM MOLECULAR STUDY,,Case Rate,105.08
Blue Shield,EPO,88388,CPT4/HCPCS,TISS EX MOLECUL STUDY ADD-ON,,Case Rate,52.15
Blue Shield,EPO,89049,CPT4/HCPCS,CHCT FOR MAL HYPERTHERMIA,,Case Rate,1737.15
Blue Shield,EPO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Case Rate,404.18
Blue Shield,EPO,89230,CPT4/HCPCS,COLLECT SWEAT FOR TEST,,Case Rate,769.86
Blue Shield,EPO,89250,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Case Rate,12919.22
Blue Shield,EPO,90801,CPT4/HCPCS,PSY DX INTERVIEW,,Case Rate,312.90
Blue Shield,EPO,90802,CPT4/HCPCS,INTAC PSY DX INTERVIEW,,Case Rate,345.81
Blue Shield,EPO,90804,CPT4/HCPCS,PSYTX OFFICE 20-30 MIN,,Case Rate,117.96
Blue Shield,EPO,90805,CPT4/HCPCS,PSYTX OFF 20-30 MIN W/E&M,,Case Rate,127.58
Blue Shield,EPO,90806,CPT4/HCPCS,PSYTX OFF 45-50 MIN,,Case Rate,174.92
Blue Shield,EPO,90807,CPT4/HCPCS,PSYTX OFF 45-50 MIN W/E&M,,Case Rate,193.39
Blue Shield,EPO,90808,CPT4/HCPCS,PSYTX OFFICE 75-80 MIN,,Case Rate,259.98
Blue Shield,EPO,90809,CPT4/HCPCS,PSYTX OFF 75-80 W/E&M,,Case Rate,283.26
Blue Shield,EPO,90810,CPT4/HCPCS,INTAC PSYTX OFF 20-30 MIN,,Case Rate,131.62
Blue Shield,EPO,90811,CPT4/HCPCS,INTAC PSYTX 20-30 W/E&M,,Case Rate,141.24
Blue Shield,EPO,90812,CPT4/HCPCS,INTAC PSYTX OFF 45-50 MIN,,Case Rate,184.54
Blue Shield,EPO,90813,CPT4/HCPCS,INTAC PSYTX 45-50 MIN W/E&M,,Case Rate,203.01
Blue Shield,EPO,90814,CPT4/HCPCS,INTAC PSYTX OFF 75-80 MIN,,Case Rate,274.41
Blue Shield,EPO,90815,CPT4/HCPCS,INTAC PSYTX 75-80 W/E&M,,Case Rate,288.07
Blue Shield,EPO,90816,CPT4/HCPCS,PSYTX HOSP 20-30 MIN,,Case Rate,166.08
Blue Shield,EPO,90817,CPT4/HCPCS,PSYTX HOSP 20-30 MIN W/E&M,,Case Rate,185.32
Blue Shield,EPO,90818,CPT4/HCPCS,PSYTX HOSP 45-50 MIN,,Case Rate,223.04
Blue Shield,EPO,90819,CPT4/HCPCS,PSYTX HOSP 45-50 MIN W/E&M,,Case Rate,246.32
Blue Shield,EPO,90821,CPT4/HCPCS,PSYTX HOSP 75-80 MIN,,Case Rate,312.90
Blue Shield,EPO,90822,CPT4/HCPCS,PSYTX HOSP 75-80 MIN W/E&M,,Case Rate,340.22
Blue Shield,EPO,90823,CPT4/HCPCS,INTAC PSYTX HOSP 20-30 MIN,,Case Rate,175.70
Blue Shield,EPO,90824,CPT4/HCPCS,INTAC PSYTX HSP 20-30 W/E&M,,Case Rate,198.98
Blue Shield,EPO,90826,CPT4/HCPCS,INTAC PSYTX HOSP 45-50 MIN,,Case Rate,241.51
Blue Shield,EPO,90827,CPT4/HCPCS,INTAC PSYTX HSP 45-50 W/E&M,,Case Rate,255.94
Blue Shield,EPO,90828,CPT4/HCPCS,INTAC PSYTX HOSP 75-80 MIN,,Case Rate,317.72
Blue Shield,EPO,90829,CPT4/HCPCS,INTAC PSYTX HSP 75-80 W/E&M,,Case Rate,345.81
Blue Shield,EPO,90845,CPT4/HCPCS,PSYCHOANALYSIS,,Case Rate,170.11
Blue Shield,EPO,90846,CPT4/HCPCS,FAMILY PSYTX W/O PT 50 MIN,,Case Rate,223.04
Blue Shield,EPO,90847,CPT4/HCPCS,FAMILY PSYTX W/PT 50 MIN,,Case Rate,255.94
Blue Shield,EPO,90849,CPT4/HCPCS,MULTIPLE FAMILY GROUP PSYTX,,Case Rate,104.30
Blue Shield,EPO,90853,CPT4/HCPCS,GROUP PSYCHOTHERAPY,,Case Rate,100.27
Blue Shield,EPO,90857,CPT4/HCPCS,INTAC GROUP PSYTX,,Case Rate,105.08
Blue Shield,EPO,90862,CPT4/HCPCS,MEDICATION MANAGEMENT,,Case Rate,137.98
Blue Shield,EPO,90865,CPT4/HCPCS,NARCOSYNTHESIS,,Case Rate,361.17
Blue Shield,EPO,90867,CPT4/HCPCS,TCRANIAL MAGN STIM TX PLAN,,Fee Schedule,987.79
Blue Shield,EPO,90868,CPT4/HCPCS,TCRANIAL MAGN STIM TX DELI,,Fee Schedule,987.79
Blue Shield,EPO,90869,CPT4/HCPCS,TCRAN MAGN STIM REDETEMINE,,Fee Schedule,3198.57
Blue Shield,EPO,90870,CPT4/HCPCS,ELECTROCONVULSIVE THERAPY,,Case Rate,203.79
Blue Shield,EPO,90875,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,Case Rate,150.86
Blue Shield,EPO,90876,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,Case Rate,231.88
Blue Shield,EPO,90880,CPT4/HCPCS,HYPNOTHERAPY,,Case Rate,207.83
Blue Shield,EPO,90885,CPT4/HCPCS,PSY EVALUATION OF RECORDS,,Case Rate,113.92
Blue Shield,EPO,90887,CPT4/HCPCS,CONSULTATION WITH FAMILY,,Case Rate,179.73
Blue Shield,EPO,90935,CPT4/HCPCS,HEMODIALYSIS ONE EVALUATION,,Case Rate,338.52
Blue Shield,EPO,90937,CPT4/HCPCS,HEMODIALYSIS REPEATED EVAL,,Case Rate,494.97
Blue Shield,EPO,90940,CPT4/HCPCS,HEMODIALYSIS ACCESS STUDY,,Case Rate,629.69
Blue Shield,EPO,90945,CPT4/HCPCS,DIALYSIS ONE EVALUATION,,Case Rate,348.14
Blue Shield,EPO,90947,CPT4/HCPCS,DIALYSIS REPEATED EVAL,,Case Rate,504.59
Blue Shield,EPO,90997,CPT4/HCPCS,HEMOPERFUSION,,Case Rate,341.77
Blue Shield,EPO,91010,CPT4/HCPCS,ESOPHAGUS MOTILITY STUDY,,Case Rate,1121.26
Blue Shield,EPO,91013,CPT4/HCPCS,ESOPHGL MOTIL W/STIM/PERFUS,,Case Rate,186.88
Blue Shield,EPO,91020,CPT4/HCPCS,GASTRIC MOTILITY STUDIES,,Case Rate,1203.05
Blue Shield,EPO,91022,CPT4/HCPCS,DUODENAL MOTILITY STUDY,,Case Rate,1900.74
Blue Shield,EPO,91030,CPT4/HCPCS,ACID PERFUSION OF ESOPHAGUS,,Case Rate,1004.08
Blue Shield,EPO,91034,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX TEST,,Case Rate,2381.90
Blue Shield,EPO,91035,CPT4/HCPCS,G-ESOPH REFLX TST W/ELECTROD,,Case Rate,4951.31
Blue Shield,EPO,91037,CPT4/HCPCS,ESOPH IMPED FUNCTION TEST,,Case Rate,1270.42
Blue Shield,EPO,91038,CPT4/HCPCS,ESOPH IMPED FUNCT TEST > 1HR,,Case Rate,904.73
Blue Shield,EPO,91040,CPT4/HCPCS,ESOPH BALLOON DISTENSION TST,,Case Rate,5215.95
Blue Shield,EPO,91060,CPT4/HCPCS,GASTRIC SALINE LOAD TEST,,Case Rate,85.05
Blue Shield,EPO,91065,CPT4/HCPCS,BREATH HYDROGEN/METHANE TEST,,Case Rate,917.47
Blue Shield,EPO,91110,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,Case Rate,9569.70
Blue Shield,EPO,91111,CPT4/HCPCS,ESOPHAGEAL CAPSULE ENDOSCOPY,,Case Rate,8760.42
Blue Shield,EPO,91112,CPT4/HCPCS,GI WIRELESS CAPSULE MEASURE,,Fee Schedule,4280.44
Blue Shield,EPO,91120,CPT4/HCPCS,RECTAL SENSATION TEST,,Case Rate,5135.71
Blue Shield,EPO,91122,CPT4/HCPCS,ANAL PRESSURE RECORD,,Case Rate,2659.42
Blue Shield,EPO,91132,CPT4/HCPCS,ELECTROGASTROGRAPHY,,Case Rate,190.91
Blue Shield,EPO,91133,CPT4/HCPCS,ELECTROGASTROGRAPHY W/TEST,,Case Rate,243.06
Blue Shield,EPO,91200,CPT4/HCPCS,LIVER ELASTOGRAPHY,,Case Rate,287.92
Blue Shield,EPO,92002,CPT4/HCPCS,EYE EXAM NEW PATIENT,,Case Rate,474.80
Blue Shield,EPO,92004,CPT4/HCPCS,EYE EXAM NEW PATIENT,,Case Rate,834.11
Blue Shield,EPO,92012,CPT4/HCPCS,EYE EXAM ESTABLISH PATIENT,,Case Rate,503.67
Blue Shield,EPO,92014,CPT4/HCPCS,EYE EXAM&TX ESTAB PT 1/>VST,,Case Rate,690.54
Blue Shield,EPO,92015,CPT4/HCPCS,DETERMINE REFRACTIVE STATE,,Case Rate,720.97
Blue Shield,EPO,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,Case Rate,543.08
Blue Shield,EPO,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,Case Rate,281.55
Blue Shield,EPO,92020,CPT4/HCPCS,SPECIAL EYE EVALUATION,,Case Rate,167.63
Blue Shield,EPO,92025,CPT4/HCPCS,CORNEAL TOPOGRAPHY,,Case Rate,158.01
Blue Shield,EPO,92060,CPT4/HCPCS,SPECIAL EYE EVALUATION,,Case Rate,210.93
Blue Shield,EPO,92065,CPT4/HCPCS,ORTHOPTIC/PLEOPTIC TRAINING,,Case Rate,191.69
Blue Shield,EPO,92071,CPT4/HCPCS,CONTACT LENS FITTING FOR TX,,Case Rate,175.70
Blue Shield,EPO,92072,CPT4/HCPCS,FIT CONTAC LENS FOR MANAGMNT,,Case Rate,395.63
Blue Shield,EPO,92081,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,340.85
Blue Shield,EPO,92082,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,465.95
Blue Shield,EPO,92083,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,538.13
Blue Shield,EPO,92100,CPT4/HCPCS,SERIAL TONOMETRY EXAM(S),,Case Rate,657.64
Blue Shield,EPO,92132,CPT4/HCPCS,CMPTR OPHTH DX IMG ANT SEGMT,,Fee Schedule,987.79
Blue Shield,EPO,92133,CPT4/HCPCS,CMPTR OPHTH IMG OPTIC NERVE,,Fee Schedule,987.79
Blue Shield,EPO,92134,CPT4/HCPCS,CPTR OPHTH DX IMG POST SEGMT,,Fee Schedule,987.79
Blue Shield,EPO,92136,CPT4/HCPCS,OPHTHALMIC BIOMETRY,,Case Rate,749.98
Blue Shield,EPO,92140,CPT4/HCPCS,GLAUCOMA PROVOCATIVE TESTS,,Case Rate,480.39
Blue Shield,EPO,92225,CPT4/HCPCS,SPECIAL EYE EXAM INITIAL,,Case Rate,109.89
Blue Shield,EPO,92226,CPT4/HCPCS,SPECIAL EYE EXAM SUBSEQUENT,,Case Rate,105.08
Blue Shield,EPO,92227,CPT4/HCPCS,IMG RTA DETCJ/MNTR DS STAFF,,Case Rate,162.82
Blue Shield,EPO,92228,CPT4/HCPCS,IMG RTA DETC/MNTR DS PHY/QHP,,Case Rate,177.25
Blue Shield,EPO,92230,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Case Rate,744.25
Blue Shield,EPO,92235,CPT4/HCPCS,FLUORESCEIN ANGRPH UNI/BI,,Case Rate,1255.98
Blue Shield,EPO,92240,CPT4/HCPCS,ICG ANGIOGRAPHY UNI/BI,,Case Rate,3171.01
Blue Shield,EPO,92250,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Case Rate,740.21
Blue Shield,EPO,92260,CPT4/HCPCS,OPHTHALMOSCOPY/DYNAMOMETRY,,Case Rate,129.14
Blue Shield,EPO,92265,CPT4/HCPCS,EYE MUSCLE EVALUATION,,Case Rate,777.93
Blue Shield,EPO,92270,CPT4/HCPCS,ELECTRO-OCULOGRAPHY,,Case Rate,595.09
Blue Shield,EPO,92275,CPT4/HCPCS,ELECTRORETINOGRAPHY,,Case Rate,734.62
Blue Shield,EPO,92283,CPT4/HCPCS,COLOR VISION EXAMINATION,,Case Rate,369.72
Blue Shield,EPO,92284,CPT4/HCPCS,DARK ADAPTATION EYE EXAM,,Case Rate,1072.22
Blue Shield,EPO,92285,CPT4/HCPCS,EYE PHOTOGRAPHY,,Case Rate,475.57
Blue Shield,EPO,92286,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,Case Rate,1485.24
Blue Shield,EPO,92287,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,Case Rate,1158.05
Blue Shield,EPO,92310,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,555.04
Blue Shield,EPO,92311,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,536.57
Blue Shield,EPO,92312,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,531.76
Blue Shield,EPO,92313,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,518.10
Blue Shield,EPO,92314,CPT4/HCPCS,PRESCRIPTION OF CONTACT LENS,,Case Rate,456.33
Blue Shield,EPO,92315,CPT4/HCPCS,RX CNTACT LENS APHAKIA 1 EYE,,Case Rate,413.02
Blue Shield,EPO,92316,CPT4/HCPCS,RX CNTACT LENS APHAKIA 2 EYE,,Case Rate,445.93
Blue Shield,EPO,92317,CPT4/HCPCS,RX CORNEOSCLERAL CNTACT LENS,,Case Rate,456.33
Blue Shield,EPO,92325,CPT4/HCPCS,MODIFICATION OF CONTACT LENS,,Case Rate,196.50
Blue Shield,EPO,92326,CPT4/HCPCS,REPLACEMENT OF CONTACT LENS,,Case Rate,808.50
Blue Shield,EPO,92340,CPT4/HCPCS,FIT SPECTACLES MONOFOCAL,,Case Rate,340.85
Blue Shield,EPO,92341,CPT4/HCPCS,FIT SPECTACLES BIFOCAL,,Case Rate,360.09
Blue Shield,EPO,92342,CPT4/HCPCS,FIT SPECTACLES MULTIFOCAL,,Case Rate,369.72
Blue Shield,EPO,92352,CPT4/HCPCS,FIT APHAKIA SPECTCL MONOFOCL,,Case Rate,331.23
Blue Shield,EPO,92353,CPT4/HCPCS,FIT APHAKIA SPECTCL MULTIFOC,,Case Rate,359.32
Blue Shield,EPO,92354,CPT4/HCPCS,FIT SPECTACLES SINGLE SYSTEM,,Case Rate,4317.88
Blue Shield,EPO,92355,CPT4/HCPCS,FIT SPECTACLES COMPOUND LENS,,Case Rate,2092.28
Blue Shield,EPO,92358,CPT4/HCPCS,APHAKIA PROSTH SERVICE TEMP,,Case Rate,486.90
Blue Shield,EPO,92370,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,Case Rate,272.71
Blue Shield,EPO,92371,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,Case Rate,306.39
Blue Shield,EPO,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,Case Rate,554.26
Blue Shield,EPO,92504,CPT4/HCPCS,EAR MICROSCOPY EXAMINATION,,Case Rate,244.62
Blue Shield,EPO,92506,CPT4/HCPCS,SPEECH/HEARING EVALUATION,,Case Rate,1263.13
Blue Shield,EPO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,542.16
Blue Shield,EPO,92508,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,249.43
Blue Shield,EPO,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,Case Rate,1609.56
Blue Shield,EPO,92512,CPT4/HCPCS,NASAL FUNCTION STUDIES,,Case Rate,556.59
Blue Shield,EPO,92516,CPT4/HCPCS,FACIAL NERVE FUNCTION TEST,,Case Rate,581.43
Blue Shield,EPO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,Case Rate,257.50
Blue Shield,EPO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,Case Rate,797.18
Blue Shield,EPO,92537,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,Fee Schedule,987.79
Blue Shield,EPO,92538,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,Fee Schedule,987.79
Blue Shield,EPO,92540,CPT4/HCPCS,BASIC VESTIBULAR EVALUATION,,Case Rate,220.56
Blue Shield,EPO,92541,CPT4/HCPCS,SPONTANEOUS NYSTAGMUS TEST,,Case Rate,383.38
Blue Shield,EPO,92542,CPT4/HCPCS,POSITIONAL NYSTAGMUS TEST,,Case Rate,441.12
Blue Shield,EPO,92543,CPT4/HCPCS,CALORIC VESTIBULAR TEST,,Case Rate,234.99
Blue Shield,EPO,92544,CPT4/HCPCS,OPTOKINETIC NYSTAGMUS TEST,,Case Rate,354.51
Blue Shield,EPO,92545,CPT4/HCPCS,OSCILLATING TRACKING TEST,,Case Rate,335.26
Blue Shield,EPO,92546,CPT4/HCPCS,SINUSOIDAL ROTATIONAL TEST,,Case Rate,811.61
Blue Shield,EPO,92547,CPT4/HCPCS,SUPPLEMENTAL ELECTRICAL TEST,,Case Rate,577.54
Blue Shield,EPO,92548,CPT4/HCPCS,CDP-SOT 6 COND W/I&R,,Case Rate,1462.25
Blue Shield,EPO,92550,CPT4/HCPCS,TYMPANOMETRY & REFLEX THRESH,,Case Rate,105.08
Blue Shield,EPO,92552,CPT4/HCPCS,PURE TONE AUDIOMETRY AIR,,Case Rate,227.85
Blue Shield,EPO,92553,CPT4/HCPCS,AUDIOMETRY AIR & BONE,,Case Rate,341.77
Blue Shield,EPO,92555,CPT4/HCPCS,SPEECH THRESHOLD AUDIOMETRY,,Case Rate,194.17
Blue Shield,EPO,92556,CPT4/HCPCS,SPEECH AUDIOMETRY COMPLETE,,Case Rate,298.47
Blue Shield,EPO,92557,CPT4/HCPCS,COMPREHENSIVE HEARING TEST,,Case Rate,621.00
Blue Shield,EPO,92561,CPT4/HCPCS,BEKESY AUDIOMETRY DIAGNOSIS,,Case Rate,370.64
Blue Shield,EPO,92562,CPT4/HCPCS,LOUDNESS BALANCE TEST,,Case Rate,208.60
Blue Shield,EPO,92563,CPT4/HCPCS,TONE DECAY HEARING TEST,,Case Rate,194.17
Blue Shield,EPO,92564,CPT4/HCPCS,SISI HEARING TEST,,Case Rate,246.32
Blue Shield,EPO,92565,CPT4/HCPCS,STENGER TEST PURE TONE,,Case Rate,203.79
Blue Shield,EPO,92567,CPT4/HCPCS,TYMPANOMETRY,,Case Rate,274.41
Blue Shield,EPO,92568,CPT4/HCPCS,ACOUSTIC REFL THRESHOLD TST,,Case Rate,194.17
Blue Shield,EPO,92570,CPT4/HCPCS,ACOUSTIC IMMITANCE TESTING,,Case Rate,128.36
Blue Shield,EPO,92571,CPT4/HCPCS,FILTERED SPEECH HEARING TEST,,Case Rate,198.98
Blue Shield,EPO,92572,CPT4/HCPCS,STAGGERED SPONDAIC WORD TEST,,Case Rate,47.34
Blue Shield,EPO,92575,CPT4/HCPCS,SENSORINEURAL ACUITY TEST,,Case Rate,152.42
Blue Shield,EPO,92576,CPT4/HCPCS,SYNTHETIC SENTENCE TEST,,Case Rate,231.88
Blue Shield,EPO,92577,CPT4/HCPCS,STENGER TEST SPEECH,,Case Rate,374.68
Blue Shield,EPO,92579,CPT4/HCPCS,VISUAL AUDIOMETRY (VRA),,Case Rate,375.45
Blue Shield,EPO,92582,CPT4/HCPCS,CONDITIONING PLAY AUDIOMETRY,,Case Rate,375.45
Blue Shield,EPO,92583,CPT4/HCPCS,SELECT PICTURE AUDIOMETRY,,Case Rate,460.51
Blue Shield,EPO,92584,CPT4/HCPCS,ELECTROCOCHLEOGRAPHY,,Case Rate,1282.82
Blue Shield,EPO,92585,CPT4/HCPCS,AUDITOR EVOKE POTENT COMPRE,,Case Rate,951.44
Blue Shield,EPO,92586,CPT4/HCPCS,AUDITOR EVOKE POTENT LIMIT,,Case Rate,951.44
Blue Shield,EPO,92587,CPT4/HCPCS,EVOKED AUDITORY TEST LIMITED,,Case Rate,674.70
Blue Shield,EPO,92588,CPT4/HCPCS,EVOKED AUDITORY TST COMPLETE,,Case Rate,759.76
Blue Shield,EPO,92596,CPT4/HCPCS,EAR PROTECTOR EVALUATION,,Case Rate,308.09
Blue Shield,EPO,92597,CPT4/HCPCS,ORAL SPEECH DEVICE EVAL,,Case Rate,825.27
Blue Shield,EPO,92601,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM <7,,Case Rate,1669.01
Blue Shield,EPO,92602,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT <7,,Case Rate,1163.78
Blue Shield,EPO,92603,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM 7/>,,Case Rate,1101.23
Blue Shield,EPO,92604,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT 7/>,,Case Rate,735.55
Blue Shield,EPO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,Case Rate,1569.52
Blue Shield,EPO,92608,CPT4/HCPCS,EX FOR SPEECH DEVICE RX ADDL,,Case Rate,342.55
Blue Shield,EPO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,Case Rate,786.00
Blue Shield,EPO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,Case Rate,1687.47
Blue Shield,EPO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,Case Rate,1687.47
Blue Shield,EPO,92612,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) VID,,Case Rate,1339.33
Blue Shield,EPO,92613,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) I&R,,Case Rate,212.64
Blue Shield,EPO,92614,CPT4/HCPCS,LARYNGOSCOPIC SENSORY VID,,Case Rate,1223.86
Blue Shield,EPO,92615,CPT4/HCPCS,LARYNGOSCOPIC SENSORY I&R,,Case Rate,188.58
Blue Shield,EPO,92616,CPT4/HCPCS,FEES W/LARYNGEAL SENSE TEST,,Case Rate,1660.16
Blue Shield,EPO,92617,CPT4/HCPCS,FEES W/LARYNGEAL SENSE I&R,,Case Rate,231.88
Blue Shield,EPO,92618,CPT4/HCPCS,EX FOR NONSPEECH DEV RX ADD,,Case Rate,137.21
Blue Shield,EPO,92620,CPT4/HCPCS,AUDITORY FUNCTION 60 MIN,,Case Rate,572.73
Blue Shield,EPO,92621,CPT4/HCPCS,AUDITORY FUNCTION + 15 MIN,,Case Rate,144.50
Blue Shield,EPO,92625,CPT4/HCPCS,TINNITUS ASSESSMENT,,Case Rate,563.11
Blue Shield,EPO,92626,CPT4/HCPCS,EVAL AUD FUNCJ 1ST HOUR,,Case Rate,1082.76
Blue Shield,EPO,92627,CPT4/HCPCS,EVAL AUD FUNCJ EA ADDL 15,,Case Rate,272.71
Blue Shield,EPO,92640,CPT4/HCPCS,AUD BRAINSTEM IMPLT PROGRAMG,,Case Rate,677.66
Blue Shield,EPO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Fee Schedule,6876.92
Blue Shield,EPO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Fee Schedule,6876.92
Blue Shield,EPO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Fee Schedule,6876.92
Blue Shield,EPO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Fee Schedule,6876.92
Blue Shield,EPO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Fee Schedule,6876.92
Blue Shield,EPO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Fee Schedule,6876.92
Blue Shield,EPO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Fee Schedule,6876.92
Blue Shield,EPO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Fee Schedule,6876.92
Blue Shield,EPO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Fee Schedule,6876.92
Blue Shield,EPO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Fee Schedule,6876.92
Blue Shield,EPO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Fee Schedule,6876.92
Blue Shield,EPO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Fee Schedule,6876.92
Blue Shield,EPO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Fee Schedule,6876.92
Blue Shield,EPO,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,Case Rate,2138.66
Blue Shield,EPO,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,Case Rate,41.75
Blue Shield,EPO,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Case Rate,3074.00
Blue Shield,EPO,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,Case Rate,1122.63
Blue Shield,EPO,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,Case Rate,574.58
Blue Shield,EPO,92971,CPT4/HCPCS,CARDIOASSIST EXTERNAL,,Case Rate,433.19
Blue Shield,EPO,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Case Rate,1558.60
Blue Shield,EPO,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Case Rate,4073.37
Blue Shield,EPO,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,Case Rate,2300.55
Blue Shield,EPO,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,Case Rate,1159.12
Blue Shield,EPO,92980,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Case Rate,3336.19
Blue Shield,EPO,92981,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Case Rate,901.29
Blue Shield,EPO,92982,CPT4/HCPCS,CORONARY ARTERY DILATION,,Case Rate,2491.09
Blue Shield,EPO,92984,CPT4/HCPCS,CORONARY ARTERY DILATION,,Case Rate,642.87
Blue Shield,EPO,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,Fee Schedule,12850.71
Blue Shield,EPO,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,12850.71
Blue Shield,EPO,92990,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,12850.71
Blue Shield,EPO,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,3198.57
Blue Shield,EPO,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,3198.57
Blue Shield,EPO,92995,CPT4/HCPCS,CORONARY ATHERECTOMY,,Case Rate,2730.26
Blue Shield,EPO,92996,CPT4/HCPCS,CORONARY ATHERECTOMY ADD-ON,,Case Rate,651.42
Blue Shield,EPO,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Fee Schedule,9548.66
Blue Shield,EPO,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Fee Schedule,9548.66
Blue Shield,EPO,93000,CPT4/HCPCS,ELECTROCARDIOGRAM COMPLETE,,Case Rate,257.50
Blue Shield,EPO,93005,CPT4/HCPCS,ELECTROCARDIOGRAM TRACING,,Case Rate,224.59
Blue Shield,EPO,93010,CPT4/HCPCS,ELECTROCARDIOGRAM REPORT,,Case Rate,32.90
Blue Shield,EPO,93015,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,999.56
Blue Shield,EPO,93016,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,89.87
Blue Shield,EPO,93017,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,857.54
Blue Shield,EPO,93018,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,56.96
Blue Shield,EPO,93024,CPT4/HCPCS,CARDIAC DRUG STRESS TEST,,Case Rate,571.18
Blue Shield,EPO,93025,CPT4/HCPCS,MICROVOLT T-WAVE ASSESS,,Case Rate,3840.75
Blue Shield,EPO,93040,CPT4/HCPCS,RHYTHM ECG WITH REPORT,,Case Rate,104.30
Blue Shield,EPO,93041,CPT4/HCPCS,RHYTHM ECG TRACING,,Case Rate,76.21
Blue Shield,EPO,93042,CPT4/HCPCS,RHYTHM ECG REPORT,,Case Rate,28.09
Blue Shield,EPO,93050,CPT4/HCPCS,ART PRESSURE WAVEFORM ANALYS,,Fee Schedule,987.79
Blue Shield,EPO,93224,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,1838.63
Blue Shield,EPO,93225,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,628.92
Blue Shield,EPO,93226,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,1110.23
Blue Shield,EPO,93227,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,99.49
Blue Shield,EPO,93268,CPT4/HCPCS,ECG RECORD/REVIEW,,Case Rate,3702.44
Blue Shield,EPO,93270,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,Case Rate,628.92
Blue Shield,EPO,93271,CPT4/HCPCS,ECG/MONITORING AND ANALYSIS,,Case Rate,2978.84
Blue Shield,EPO,93272,CPT4/HCPCS,ECG/REVIEW INTERPRET ONLY,,Case Rate,99.49
Blue Shield,EPO,93278,CPT4/HCPCS,ECG/SIGNAL-AVERAGED,,Case Rate,597.71
Blue Shield,EPO,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,1954.89
Blue Shield,EPO,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,990.71
Blue Shield,EPO,93307,CPT4/HCPCS,TTE W/O DOPPLER COMPLETE,,Case Rate,1954.89
Blue Shield,EPO,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,Case Rate,990.71
Blue Shield,EPO,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,1940.60
Blue Shield,EPO,93313,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,125.25
Blue Shield,EPO,93314,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,1940.60
Blue Shield,EPO,93315,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,522.28
Blue Shield,EPO,93316,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,135.65
Blue Shield,EPO,93317,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,354.65
Blue Shield,EPO,93318,CPT4/HCPCS,ECHO TRANSESOPHAGEAL INTRAOP,,Case Rate,1598.68
Blue Shield,EPO,93320,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,876.01
Blue Shield,EPO,93321,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,571.18
Blue Shield,EPO,93325,CPT4/HCPCS,DOPPLER COLOR FLOW ADD-ON,,Case Rate,1484.90
Blue Shield,EPO,93350,CPT4/HCPCS,STRESS TTE ONLY,,Case Rate,904.10
Blue Shield,EPO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Fee Schedule,9548.66
Blue Shield,EPO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Fee Schedule,9548.66
Blue Shield,EPO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Fee Schedule,9548.66
Blue Shield,EPO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Fee Schedule,9548.66
Blue Shield,EPO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Fee Schedule,9548.66
Blue Shield,EPO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Fee Schedule,9548.66
Blue Shield,EPO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Fee Schedule,9548.66
Blue Shield,EPO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,EPO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Fee Schedule,9548.66
Blue Shield,EPO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,EPO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,EPO,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Fee Schedule,987.79
Blue Shield,EPO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Fee Schedule,3198.57
Blue Shield,EPO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Fee Schedule,3198.57
Blue Shield,EPO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,EPO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,EPO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,EPO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,EPO,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Case Rate,4064.90
Blue Shield,EPO,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Case Rate,5222.42
Blue Shield,EPO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Case Rate,995.53
Blue Shield,EPO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Case Rate,567.14
Blue Shield,EPO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Case Rate,857.54
Blue Shield,EPO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Case Rate,1377.35
Blue Shield,EPO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Case Rate,694.72
Blue Shield,EPO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Case Rate,823.86
Blue Shield,EPO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Case Rate,1530.50
Blue Shield,EPO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,162.04
Blue Shield,EPO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,162.04
Blue Shield,EPO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Case Rate,2011.85
Blue Shield,EPO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3913.81
Blue Shield,EPO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,6701.11
Blue Shield,EPO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,1212.05
Blue Shield,EPO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,1999.75
Blue Shield,EPO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Case Rate,1622.74
Blue Shield,EPO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Case Rate,1009.96
Blue Shield,EPO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Case Rate,3218.90
Blue Shield,EPO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Case Rate,3633.81
Blue Shield,EPO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3633.81
Blue Shield,EPO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3633.81
Blue Shield,EPO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,2430.87
Blue Shield,EPO,93651,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,3506.45
Blue Shield,EPO,93652,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,3816.25
Blue Shield,EPO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Fee Schedule,9548.66
Blue Shield,EPO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Fee Schedule,9548.66
Blue Shield,EPO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Fee Schedule,9548.66
Blue Shield,EPO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Fee Schedule,9548.66
Blue Shield,EPO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Fee Schedule,9548.66
Blue Shield,EPO,93660,CPT4/HCPCS,TILT TABLE EVALUATION,,Case Rate,821.23
Blue Shield,EPO,93662,CPT4/HCPCS,INTRACARDIAC ECG (ICE),,Case Rate,1718.19
Blue Shield,EPO,93668,CPT4/HCPCS,PERIPHERAL VASCULAR REHAB,,Case Rate,663.38
Blue Shield,EPO,93701,CPT4/HCPCS,BIOIMPEDANCE CV ANALYSIS,,Case Rate,461.14
Blue Shield,EPO,93724,CPT4/HCPCS,ANALYZE PACEMAKER SYSTEM,,Case Rate,2011.85
Blue Shield,EPO,93740,CPT4/HCPCS,TEMPERATURE GRADIENT STUDIES,,Case Rate,81.02
Blue Shield,EPO,93750,CPT4/HCPCS,INTERROGATION VAD IN PERSON,,Case Rate,164.52
Blue Shield,EPO,93770,CPT4/HCPCS,MEASURE VENOUS PRESSURE,,Case Rate,18.47
Blue Shield,EPO,93784,CPT4/HCPCS,AMBL BP MNTR W/SOFTWARE,,Case Rate,757.91
Blue Shield,EPO,93786,CPT4/HCPCS,AMBL BP MNTR W/SW REC ONLY,,Case Rate,441.89
Blue Shield,EPO,93788,CPT4/HCPCS,AMBL BP MNTR W/SW A/R,,Case Rate,249.43
Blue Shield,EPO,93790,CPT4/HCPCS,AMBL BP MNTR W/SW I&R,,Case Rate,66.59
Blue Shield,EPO,93797,CPT4/HCPCS,CARDIAC REHAB,,Case Rate,148.38
Blue Shield,EPO,93798,CPT4/HCPCS,CARDIAC REHAB/MONITOR,,Case Rate,225.37
Blue Shield,EPO,93880,CPT4/HCPCS,EXTRACRANIAL BILAT STUDY,,Case Rate,2051.42
Blue Shield,EPO,93882,CPT4/HCPCS,EXTRACRANIAL UNI/LTD STUDY,,Case Rate,1469.69
Blue Shield,EPO,93886,CPT4/HCPCS,INTRACRANIAL COMPLETE STUDY,,Case Rate,2130.11
Blue Shield,EPO,93888,CPT4/HCPCS,INTRACRANIAL LIMITED STUDY,,Case Rate,1451.37
Blue Shield,EPO,93890,CPT4/HCPCS,TCD VASOREACTIVITY STUDY,,Case Rate,2322.57
Blue Shield,EPO,93892,CPT4/HCPCS,TCD EMBOLI DETECT W/O INJ,,Case Rate,2418.80
Blue Shield,EPO,93893,CPT4/HCPCS,TCD EMBOLI DETECT W/INJ,,Case Rate,2356.25
Blue Shield,EPO,93922,CPT4/HCPCS,UPR/L XTREMITY ART 2 LEVELS,,Case Rate,937.79
Blue Shield,EPO,93923,CPT4/HCPCS,UPR/LXTR ART STDY 3+ LVLS,,Case Rate,1460.07
Blue Shield,EPO,93924,CPT4/HCPCS,LWR XTR VASC STDY BILAT,,Case Rate,1828.23
Blue Shield,EPO,93925,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Case Rate,2388.23
Blue Shield,EPO,93926,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Case Rate,1709.50
Blue Shield,EPO,93930,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Case Rate,1924.76
Blue Shield,EPO,93931,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Case Rate,1400.78
Blue Shield,EPO,93965,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,885.64
Blue Shield,EPO,93970,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,1960.92
Blue Shield,EPO,93971,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,1412.88
Blue Shield,EPO,93975,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,2685.15
Blue Shield,EPO,93976,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1593.39
Blue Shield,EPO,93978,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1765.98
Blue Shield,EPO,93979,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1299.73
Blue Shield,EPO,93980,CPT4/HCPCS,PENILE VASCULAR STUDY,,Case Rate,2239.85
Blue Shield,EPO,93981,CPT4/HCPCS,PENILE VASCULAR STUDY,,Case Rate,2271.05
Blue Shield,EPO,93982,CPT4/HCPCS,ANEURYSM PRESSURE SENS STUDY,,Case Rate,388.96
Blue Shield,EPO,93990,CPT4/HCPCS,DOPPLER FLOW TESTING,,Case Rate,1695.06
Blue Shield,EPO,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,Case Rate,223.96
Blue Shield,EPO,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,Case Rate,182.99
Blue Shield,EPO,94004,CPT4/HCPCS,VENT MGMT NF PER DAY,,Case Rate,131.62
Blue Shield,EPO,94005,CPT4/HCPCS,HOME VENT MGMT SUPERVISION,,Case Rate,356.21
Blue Shield,EPO,94010,CPT4/HCPCS,BREATHING CAPACITY TEST,,Case Rate,306.39
Blue Shield,EPO,94011,CPT4/HCPCS,SPIROMETRY UP TO 2 YRS OLD,,Case Rate,318.49
Blue Shield,EPO,94012,CPT4/HCPCS,SPIRMTRY W/BRNCHDIL INF-2 YR,,Case Rate,484.57
Blue Shield,EPO,94013,CPT4/HCPCS,MEAS LUNG VOL THRU 2 YRS,,Case Rate,98.71
Blue Shield,EPO,94014,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,Case Rate,377.79
Blue Shield,EPO,94015,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,Case Rate,292.73
Blue Shield,EPO,94016,CPT4/HCPCS,REVIEW PATIENT SPIROMETRY,,Case Rate,89.87
Blue Shield,EPO,94060,CPT4/HCPCS,EVALUATION OF WHEEZING,,Case Rate,514.99
Blue Shield,EPO,94070,CPT4/HCPCS,EVALUATION OF WHEEZING,,Case Rate,1387.60
Blue Shield,EPO,94150,CPT4/HCPCS,VITAL CAPACITY TEST,,Case Rate,220.56
Blue Shield,EPO,94200,CPT4/HCPCS,LUNG FUNCTION TEST (MBC/MVV),,Case Rate,205.35
Blue Shield,EPO,94250,CPT4/HCPCS,EXPIRED GAS COLLECTION,,Case Rate,302.36
Blue Shield,EPO,94375,CPT4/HCPCS,RESPIRATORY FLOW VOLUME LOOP,,Case Rate,253.46
Blue Shield,EPO,94400,CPT4/HCPCS,CO2 BREATHING RESPONSE CURVE,,Case Rate,370.64
Blue Shield,EPO,94450,CPT4/HCPCS,HYPOXIA RESPONSE CURVE,,Case Rate,277.52
Blue Shield,EPO,94452,CPT4/HCPCS,HAST W/REPORT,,Case Rate,455.55
Blue Shield,EPO,94453,CPT4/HCPCS,HAST W/OXYGEN TITRATE,,Case Rate,676.88
Blue Shield,EPO,94610,CPT4/HCPCS,SURFACTANT ADMIN THRU TUBE,,Case Rate,273.30
Blue Shield,EPO,94620,CPT4/HCPCS,PULMONARY STRESS TEST/SIMPLE,,Case Rate,1108.52
Blue Shield,EPO,94621,CPT4/HCPCS,CARDIOPULM EXERCISE TESTING,,Case Rate,824.64
Blue Shield,EPO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,Case Rate,162.04
Blue Shield,EPO,94644,CPT4/HCPCS,CBT 1ST HOUR,,Case Rate,450.74
Blue Shield,EPO,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,Case Rate,171.66
Blue Shield,EPO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,Case Rate,328.89
Blue Shield,EPO,94662,CPT4/HCPCS,NEG PRESS VENTILATION CNP,,Case Rate,122.77
Blue Shield,EPO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,Case Rate,170.11
Blue Shield,EPO,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,Case Rate,280.00
Blue Shield,EPO,94668,CPT4/HCPCS,CHEST WALL MANIPULATION,,Case Rate,229.40
Blue Shield,EPO,94680,CPT4/HCPCS,EXHALED AIR ANALYSIS O2,,Case Rate,895.11
Blue Shield,EPO,94681,CPT4/HCPCS,EXHALED AIR ANALYSIS O2/CO2,,Case Rate,1275.38
Blue Shield,EPO,94690,CPT4/HCPCS,EXHALED AIR ANALYSIS,,Case Rate,954.40
Blue Shield,EPO,94726,CPT4/HCPCS,PULM FUNCT TST PLETHYSMOGRAP,,Case Rate,585.46
Blue Shield,EPO,94727,CPT4/HCPCS,PULM FUNCTION TEST BY GAS,,Case Rate,422.65
Blue Shield,EPO,94728,CPT4/HCPCS,AIRWY RESIST BY OSCILLOMETRY,,Case Rate,422.65
Blue Shield,EPO,94729,CPT4/HCPCS,CO/MEMBANE DIFFUSE CAPACITY,,Case Rate,639.17
Blue Shield,EPO,94750,CPT4/HCPCS,PULMONARY COMPLIANCE STUDY,,Case Rate,632.03
Blue Shield,EPO,94760,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,27.32
Blue Shield,EPO,94761,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,57.89
Blue Shield,EPO,94762,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,232.81
Blue Shield,EPO,94770,CPT4/HCPCS,EXHALED CARBON DIOXIDE TEST,,Case Rate,812.54
Blue Shield,EPO,94780,CPT4/HCPCS,CARS/BD TST INFT-12MO 60 MIN,,Case Rate,98.71
Blue Shield,EPO,94781,CPT4/HCPCS,CARS/BD TST INFT-12MO +30MIN,,Case Rate,32.90
Blue Shield,EPO,95004,CPT4/HCPCS,PERCUT ALLERGY SKIN TESTS,,Case Rate,52.15
Blue Shield,EPO,95010,CPT4/HCPCS,PERCUT ALLERGY TITRATE TEST,,Case Rate,158.01
Blue Shield,EPO,95012,CPT4/HCPCS,EXHALED NITRIC OXIDE MEAS,,Case Rate,234.99
Blue Shield,EPO,95015,CPT4/HCPCS,ID ALLERGY TITRATE-DRUG/BUG,,Case Rate,71.40
Blue Shield,EPO,95024,CPT4/HCPCS,ICUT ALLERGY TEST DRUG/BUG,,Case Rate,76.21
Blue Shield,EPO,95027,CPT4/HCPCS,ICUT ALLERGY TITRATE-AIRBORN,,Case Rate,76.21
Blue Shield,EPO,95028,CPT4/HCPCS,ICUT ALLERGY TEST-DELAYED,,Case Rate,119.51
Blue Shield,EPO,95044,CPT4/HCPCS,ALLERGY PATCH TESTS,,Case Rate,105.08
Blue Shield,EPO,95052,CPT4/HCPCS,PHOTO PATCH TEST,,Case Rate,129.14
Blue Shield,EPO,95056,CPT4/HCPCS,PHOTOSENSITIVITY TESTS,,Case Rate,90.64
Blue Shield,EPO,95060,CPT4/HCPCS,EYE ALLERGY TESTS,,Case Rate,176.48
Blue Shield,EPO,95065,CPT4/HCPCS,NOSE ALLERGY TEST,,Case Rate,105.08
Blue Shield,EPO,95070,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,Case Rate,1109.93
Blue Shield,EPO,95071,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,Case Rate,1417.88
Blue Shield,EPO,95075,CPT4/HCPCS,INGESTION CHALLENGE TEST,,Case Rate,406.66
Blue Shield,EPO,95115,CPT4/HCPCS,IMMUNOTHERAPY ONE INJECTION,,Case Rate,190.91
Blue Shield,EPO,95117,CPT4/HCPCS,IMMUNOTHERAPY INJECTIONS,,Case Rate,248.65
Blue Shield,EPO,95144,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,95.46
Blue Shield,EPO,95145,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,158.01
Blue Shield,EPO,95146,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,215.75
Blue Shield,EPO,95147,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,206.12
Blue Shield,EPO,95148,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,283.11
Blue Shield,EPO,95149,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,388.96
Blue Shield,EPO,95165,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,95.46
Blue Shield,EPO,95170,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,66.59
Blue Shield,EPO,95180,CPT4/HCPCS,RAPID DESENSITIZATION,,Case Rate,997.71
Blue Shield,EPO,95250,CPT4/HCPCS,CONT GLUC MNTR PHYS/QHP EQP,,Case Rate,1842.08
Blue Shield,EPO,95251,CPT4/HCPCS,CONT GLUC MNTR ANALYSIS I&R,,Case Rate,99.49
Blue Shield,EPO,95800,CPT4/HCPCS,SLP STDY UNATTENDED,,Case Rate,2087.47
Blue Shield,EPO,95801,CPT4/HCPCS,SLP STDY UNATND W/ANAL,,Case Rate,643.98
Blue Shield,EPO,95805,CPT4/HCPCS,MULTIPLE SLEEP LATENCY TEST,,Case Rate,7643.31
Blue Shield,EPO,95806,CPT4/HCPCS,SLEEP STUDY UNATT&RESP EFFT,,Case Rate,1703.28
Blue Shield,EPO,95807,CPT4/HCPCS,SLEEP STUDY ATTENDED,,Case Rate,5529.60
Blue Shield,EPO,95808,CPT4/HCPCS,POLYSOM ANY AGE 1-3> PARAM,,Case Rate,5933.77
Blue Shield,EPO,95810,CPT4/HCPCS,POLYSOM 6/> YRS 4/> PARAM,,Case Rate,7791.06
Blue Shield,EPO,95811,CPT4/HCPCS,POLYSOM 6/>YRS CPAP 4/> PARM,,Case Rate,8439.85
Blue Shield,EPO,95812,CPT4/HCPCS,EEG 41-60 MINUTES,,Case Rate,1709.20
Blue Shield,EPO,95813,CPT4/HCPCS,EEG EXTND MNTR 61-119 MIN,,Case Rate,2079.70
Blue Shield,EPO,95816,CPT4/HCPCS,EEG AWAKE AND DROWSY,,Case Rate,1329.86
Blue Shield,EPO,95819,CPT4/HCPCS,EEG AWAKE AND ASLEEP,,Case Rate,1594.50
Blue Shield,EPO,95822,CPT4/HCPCS,EEG COMA OR SLEEP ONLY,,Case Rate,1928.98
Blue Shield,EPO,95824,CPT4/HCPCS,EEG CEREBRAL DEATH ONLY,,Case Rate,802.14
Blue Shield,EPO,95827,CPT4/HCPCS,EEG ALL NIGHT RECORDING,,Case Rate,1163.16
Blue Shield,EPO,95829,CPT4/HCPCS,SURGERY ELECTROCORTICOGRAM,,Case Rate,13947.35
Blue Shield,EPO,95830,CPT4/HCPCS,INSERT ELECTRODES FOR EEG,,Case Rate,1632.21
Blue Shield,EPO,95831,CPT4/HCPCS,LIMB MUSCLE TESTING MANUAL,,Case Rate,225.37
Blue Shield,EPO,95832,CPT4/HCPCS,HAND MUSCLE TESTING MANUAL,,Case Rate,166.85
Blue Shield,EPO,95833,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,Case Rate,287.14
Blue Shield,EPO,95834,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,Case Rate,315.24
Blue Shield,EPO,95851,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,Case Rate,177.25
Blue Shield,EPO,95852,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,Case Rate,129.14
Blue Shield,EPO,95857,CPT4/HCPCS,CHOLINESTERASE CHALLENGE,,Case Rate,296.77
Blue Shield,EPO,95860,CPT4/HCPCS,MUSCLE TEST ONE LIMB,,Case Rate,503.67
Blue Shield,EPO,95861,CPT4/HCPCS,MUSCLE TEST 2 LIMBS,,Case Rate,380.27
Blue Shield,EPO,95863,CPT4/HCPCS,MUSCLE TEST 3 LIMBS,,Case Rate,476.50
Blue Shield,EPO,95864,CPT4/HCPCS,MUSCLE TEST 4 LIMBS,,Case Rate,909.69
Blue Shield,EPO,95865,CPT4/HCPCS,MUSCLE TEST LARYNX,,Case Rate,339.29
Blue Shield,EPO,95866,CPT4/HCPCS,MUSCLE TEST HEMIDIAPHRAGM,,Case Rate,406.03
Blue Shield,EPO,95867,CPT4/HCPCS,MUSCLE TEST CRAN NERV UNILAT,,Case Rate,295.21
Blue Shield,EPO,95868,CPT4/HCPCS,MUSCLE TEST CRAN NERVE BILAT,,Case Rate,356.99
Blue Shield,EPO,95869,CPT4/HCPCS,MUSCLE TEST THOR PARASPINAL,,Case Rate,113.92
Blue Shield,EPO,95870,CPT4/HCPCS,MUSCLE TEST NONPARASPINAL,,Case Rate,113.92
Blue Shield,EPO,95872,CPT4/HCPCS,MUSCLE TEST ONE FIBER,,Case Rate,308.87
Blue Shield,EPO,95873,CPT4/HCPCS,GUIDE NERV DESTR ELEC STIM,,Case Rate,104.30
Blue Shield,EPO,95874,CPT4/HCPCS,GUIDE NERV DESTR NEEDLE EMG,,Case Rate,104.30
Blue Shield,EPO,95875,CPT4/HCPCS,LIMB EXERCISE TEST,,Case Rate,505.37
Blue Shield,EPO,95885,CPT4/HCPCS,MUSC TST DONE W/NERV TST LIM,,Case Rate,538.13
Blue Shield,EPO,95886,CPT4/HCPCS,MUSC TEST DONE W/N TEST COMP,,Case Rate,566.99
Blue Shield,EPO,95887,CPT4/HCPCS,MUSC TST DONE W/N TST NONEXT,,Case Rate,576.62
Blue Shield,EPO,95900,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,Case Rate,537.35
Blue Shield,EPO,95903,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,Case Rate,465.17
Blue Shield,EPO,95904,CPT4/HCPCS,SENSE NERVE CONDUCTION TEST,,Case Rate,469.98
Blue Shield,EPO,95905,CPT4/HCPCS,MOTOR &/ SENS NRVE CNDJ TEST,,Case Rate,975.98
Blue Shield,EPO,95920,CPT4/HCPCS,INTRAOP NERVE TEST ADD-ON,,Case Rate,658.56
Blue Shield,EPO,95921,CPT4/HCPCS,AUTONOMIC NRV PARASYM INERVJ,,Case Rate,186.10
Blue Shield,EPO,95922,CPT4/HCPCS,AUTONOMIC NRV ADRENRG INERVJ,,Case Rate,186.10
Blue Shield,EPO,95923,CPT4/HCPCS,AUTONOMIC NRV SYST FUNJ TEST,,Case Rate,830.86
Blue Shield,EPO,95925,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,EPO,95926,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,EPO,95927,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,EPO,95928,CPT4/HCPCS,C MOTOR EVOKED UPPR LIMBS,,Case Rate,1152.46
Blue Shield,EPO,95929,CPT4/HCPCS,C MOTOR EVOKED LWR LIMBS,,Case Rate,1243.88
Blue Shield,EPO,95930,CPT4/HCPCS,VISUAL EP TEST CNS W/I&R,,Case Rate,619.92
Blue Shield,EPO,95933,CPT4/HCPCS,BLINK REFLEX TEST,,Case Rate,404.32
Blue Shield,EPO,95934,CPT4/HCPCS,H-REFLEX TEST,,Case Rate,113.92
Blue Shield,EPO,95936,CPT4/HCPCS,H-REFLEX TEST,,Case Rate,113.92
Blue Shield,EPO,95937,CPT4/HCPCS,NEUROMUSCULAR JUNCTION TEST,,Case Rate,171.66
Blue Shield,EPO,95938,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,3563.08
Blue Shield,EPO,95939,CPT4/HCPCS,C MOTOR EVOKED UPR&LWR LIMBS,,Case Rate,4919.19
Blue Shield,EPO,95950,CPT4/HCPCS,AMBULATORY EEG MONITORING,,Case Rate,2016.33
Blue Shield,EPO,95951,CPT4/HCPCS,EEG MONITORING/VIDEORECORD,,Case Rate,1360.88
Blue Shield,EPO,95953,CPT4/HCPCS,EEG MONITORING/COMPUTER,,Case Rate,3228.86
Blue Shield,EPO,95954,CPT4/HCPCS,EEG MONITORING/GIVING DRUGS,,Case Rate,1583.17
Blue Shield,EPO,95955,CPT4/HCPCS,EEG DURING SURGERY,,Case Rate,1016.47
Blue Shield,EPO,95956,CPT4/HCPCS,EEG MONITOR TECHNOL ATTENDED,,Case Rate,6351.61
Blue Shield,EPO,95957,CPT4/HCPCS,EEG DIGITAL ANALYSIS,,Case Rate,871.20
Blue Shield,EPO,95958,CPT4/HCPCS,EEG MONITORING/FUNCTION TEST,,Case Rate,894.48
Blue Shield,EPO,95961,CPT4/HCPCS,ELECTRODE STIMULATION BRAIN,,Case Rate,658.56
Blue Shield,EPO,95962,CPT4/HCPCS,ELECTRODE STIM BRAIN ADD-ON,,Case Rate,658.56
Blue Shield,EPO,95965,CPT4/HCPCS,MEG SPONTANEOUS,,Case Rate,22488.95
Blue Shield,EPO,95966,CPT4/HCPCS,MEG EVOKED SINGLE,,Case Rate,11263.72
Blue Shield,EPO,95967,CPT4/HCPCS,MEG EVOKED EACH ADDL,,Case Rate,9507.03
Blue Shield,EPO,95970,CPT4/HCPCS,ALYS NPGT W/O PRGRMG,,Case Rate,421.09
Blue Shield,EPO,95971,CPT4/HCPCS,ALYS SMPL SP/PN NPGT W/PRGRM,,Case Rate,355.43
Blue Shield,EPO,95972,CPT4/HCPCS,ALYS CPLX SP/PN NPGT W/PRGRM,,Case Rate,638.69
Blue Shield,EPO,95973,CPT4/HCPCS,ANALYZE NEUROSTIM COMPLEX,,Case Rate,326.56
Blue Shield,EPO,95974,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,Case Rate,882.53
Blue Shield,EPO,95975,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,Case Rate,476.65
Blue Shield,EPO,95978,CPT4/HCPCS,ANALYZE NEUROSTIM BRAIN/1H,,Case Rate,1006.07
Blue Shield,EPO,95979,CPT4/HCPCS,ANALYZ NEUROSTIM BRAIN ADDON,,Case Rate,450.89
Blue Shield,EPO,95980,CPT4/HCPCS,IO ANAL GAST N-STIM INIT,,Case Rate,148.53
Blue Shield,EPO,95981,CPT4/HCPCS,IO ANAL GAST N-STIM SUBSQ,,Case Rate,65.81
Blue Shield,EPO,95982,CPT4/HCPCS,IO GA N-STIM SUBSQ W/REPROG,,Case Rate,106.78
Blue Shield,EPO,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Case Rate,745.95
Blue Shield,EPO,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Case Rate,726.70
Blue Shield,EPO,96000,CPT4/HCPCS,MOTION ANALYSIS VIDEO/3D,,Case Rate,299.39
Blue Shield,EPO,96001,CPT4/HCPCS,MOTION TEST W/FT PRESS MEAS,,Case Rate,357.91
Blue Shield,EPO,96002,CPT4/HCPCS,DYNAMIC SURFACE EMG,,Case Rate,80.24
Blue Shield,EPO,96003,CPT4/HCPCS,DYNAMIC FINE WIRE EMG,,Case Rate,65.81
Blue Shield,EPO,96004,CPT4/HCPCS,PHYS REVIEW OF MOTION TESTS,,Case Rate,496.67
Blue Shield,EPO,96040,CPT4/HCPCS,GENETIC COUNSELING 30 MIN,,Case Rate,470.76
Blue Shield,EPO,96101,CPT4/HCPCS,PSYCHO TESTING BY PSYCH/PHYS,,Case Rate,178.96
Blue Shield,EPO,96102,CPT4/HCPCS,PSYCHO TESTING BY TECHNICIAN,,Case Rate,47.34
Blue Shield,EPO,96103,CPT4/HCPCS,PSYCHO TESTING ADMIN BY COMP,,Case Rate,51.37
Blue Shield,EPO,96105,CPT4/HCPCS,ASSESSMENT OF APHASIA,,Case Rate,924.28
Blue Shield,EPO,96110,CPT4/HCPCS,DEVELOPMENTAL SCREEN W/SCORE,,Case Rate,164.04
Blue Shield,EPO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,Case Rate,332.45
Blue Shield,EPO,96116,CPT4/HCPCS,NUBHVL XM PHYS/QHP 1ST HR,,Case Rate,279.52
Blue Shield,EPO,96118,CPT4/HCPCS,NEUROPSYCH TST BY PSYCH/PHYS,,Case Rate,231.40
Blue Shield,EPO,96119,CPT4/HCPCS,NEUROPSYCH TESTING BY TEC,,Case Rate,120.73
Blue Shield,EPO,96120,CPT4/HCPCS,NEUROPSYCH TST ADMIN W/COMP,,Case Rate,51.37
Blue Shield,EPO,96125,CPT4/HCPCS,COGNITIVE TEST BY HC PRO,,Case Rate,242.58
Blue Shield,EPO,96150,CPT4/HCPCS,ASSESS HLTH/BEHAVE INIT,,Case Rate,47.34
Blue Shield,EPO,96151,CPT4/HCPCS,ASSESS HLTH/BEHAVE SUBSEQ,,Case Rate,47.34
Blue Shield,EPO,96152,CPT4/HCPCS,INTERVENE HLTH/BEHAVE INDIV,,Case Rate,42.53
Blue Shield,EPO,96153,CPT4/HCPCS,INTERVENE HLTH/BEHAVE GROUP,,Case Rate,13.66
Blue Shield,EPO,96154,CPT4/HCPCS,INTERV HLTH/BEHAV FAM W/PT,,Case Rate,42.53
Blue Shield,EPO,96155,CPT4/HCPCS,INTERV HLTH/BEHAV FAM NO PT,,Case Rate,56.18
Blue Shield,EPO,96360,CPT4/HCPCS,HYDRATION IV INFUSION INIT,,Case Rate,648.94
Blue Shield,EPO,96361,CPT4/HCPCS,HYDRATE IV INFUSION ADD-ON,,Case Rate,165.30
Blue Shield,EPO,96365,CPT4/HCPCS,THER/PROPH/DIAG IV INF INIT,,Case Rate,788.48
Blue Shield,EPO,96366,CPT4/HCPCS,THER/PROPH/DIAG IV INF ADDON,,Case Rate,194.17
Blue Shield,EPO,96367,CPT4/HCPCS,TX/PROPH/DG ADDL SEQ IV INF,,Case Rate,343.33
Blue Shield,EPO,96368,CPT4/HCPCS,THER/DIAG CONCURRENT INF,,Case Rate,179.73
Blue Shield,EPO,96369,CPT4/HCPCS,SC THER INFUSION UP TO 1 HR,,Case Rate,1881.49
Blue Shield,EPO,96370,CPT4/HCPCS,SC THER INFUSION ADDL HR,,Case Rate,121.99
Blue Shield,EPO,96371,CPT4/HCPCS,SC THER INFUSION RESET PUMP,,Case Rate,985.61
Blue Shield,EPO,96372,CPT4/HCPCS,THER/PROPH/DIAG INJ SC/IM,,Case Rate,210.93
Blue Shield,EPO,96373,CPT4/HCPCS,THER/PROPH/DIAG INJ IA,,Case Rate,152.42
Blue Shield,EPO,96374,CPT4/HCPCS,THER/PROPH/DIAG INJ IV PUSH,,Case Rate,632.03
Blue Shield,EPO,96375,CPT4/HCPCS,TX/PRO/DX INJ NEW DRUG ADDON,,Case Rate,256.72
Blue Shield,EPO,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,Case Rate,899.00
Blue Shield,EPO,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,Case Rate,345.66
Blue Shield,EPO,96405,CPT4/HCPCS,CHEMO INTRALESIONAL UP TO 7,,Case Rate,122.77
Blue Shield,EPO,96406,CPT4/HCPCS,CHEMO INTRALESIONAL OVER 7,,Case Rate,146.83
Blue Shield,EPO,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,Case Rate,1357.03
Blue Shield,EPO,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,Case Rate,741.14
Blue Shield,EPO,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,Case Rate,1769.27
Blue Shield,EPO,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,Case Rate,341.00
Blue Shield,EPO,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,Case Rate,1985.80
Blue Shield,EPO,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,Case Rate,855.84
Blue Shield,EPO,96420,CPT4/HCPCS,CHEMO IA PUSH TECNIQUE,,Case Rate,1326.60
Blue Shield,EPO,96422,CPT4/HCPCS,CHEMO IA INFUSION UP TO 1 HR,,Case Rate,1860.69
Blue Shield,EPO,96423,CPT4/HCPCS,CHEMO IA INFUSE EACH ADDL HR,,Case Rate,927.09
Blue Shield,EPO,96425,CPT4/HCPCS,CHEMOTHERAPY INFUSION METHOD,,Case Rate,2207.13
Blue Shield,EPO,96440,CPT4/HCPCS,CHEMOTHERAPY INTRACAVITARY,,Case Rate,549.75
Blue Shield,EPO,96446,CPT4/HCPCS,CHEMOTX ADMN PRTL CAVITY,,Case Rate,119.66
Blue Shield,EPO,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,Case Rate,435.67
Blue Shield,EPO,96521,CPT4/HCPCS,REFILL/MAINT PORTABLE PUMP,,Case Rate,1530.25
Blue Shield,EPO,96522,CPT4/HCPCS,REFILL/MAINT PUMP/RESVR SYST,,Case Rate,1332.97
Blue Shield,EPO,96523,CPT4/HCPCS,IRRIG DRUG DELIVERY DEVICE,,Case Rate,311.98
Blue Shield,EPO,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,Case Rate,187.02
Blue Shield,EPO,96567,CPT4/HCPCS,PDT DSTR PRMLG LES SKN,,Case Rate,1815.69
Blue Shield,EPO,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,Case Rate,241.65
Blue Shield,EPO,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,Case Rate,108.34
Blue Shield,EPO,96900,CPT4/HCPCS,ULTRAVIOLET LIGHT THERAPY,,Case Rate,277.52
Blue Shield,EPO,96902,CPT4/HCPCS,TRICHOGRAM,,Case Rate,52.15
Blue Shield,EPO,96910,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-B,,Case Rate,978.46
Blue Shield,EPO,96912,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-A,,Case Rate,1261.57
Blue Shield,EPO,96913,CPT4/HCPCS,PHOTOCHEMOTHERAPY UV-A OR B,,Case Rate,1796.59
Blue Shield,EPO,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,Case Rate,287.14
Blue Shield,EPO,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,Case Rate,276.74
Blue Shield,EPO,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,Case Rate,526.17
Blue Shield,EPO,96931,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,987.79
Blue Shield,EPO,96932,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,6049.05
Blue Shield,EPO,96933,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,987.79
Blue Shield,EPO,97001,CPT4/HCPCS,PT EVALUATION,,Case Rate,342.55
Blue Shield,EPO,97002,CPT4/HCPCS,PT RE-EVALUATION,,Case Rate,205.35
Blue Shield,EPO,97003,CPT4/HCPCS,OT EVALUATION,,Case Rate,399.51
Blue Shield,EPO,97004,CPT4/HCPCS,OT RE-EVALUATION,,Case Rate,272.71
Blue Shield,EPO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Case Rate,37.72
Blue Shield,EPO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Case Rate,71.40
Blue Shield,EPO,97014,CPT4/HCPCS,ELECTRIC STIMULATION THERAPY,,Case Rate,90.64
Blue Shield,EPO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Case Rate,119.51
Blue Shield,EPO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Case Rate,85.83
Blue Shield,EPO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Case Rate,162.82
Blue Shield,EPO,97024,CPT4/HCPCS,DIATHERMY EG MICROWAVE,,Case Rate,42.53
Blue Shield,EPO,97026,CPT4/HCPCS,INFRARED THERAPY,,Case Rate,37.72
Blue Shield,EPO,97028,CPT4/HCPCS,ULTRAVIOLET THERAPY,,Case Rate,42.53
Blue Shield,EPO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Case Rate,100.27
Blue Shield,EPO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Case Rate,215.75
Blue Shield,EPO,97034,CPT4/HCPCS,CONTRAST BATH THERAPY,,Case Rate,100.27
Blue Shield,EPO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Case Rate,52.15
Blue Shield,EPO,97036,CPT4/HCPCS,HYDROTHERAPY,,Case Rate,215.75
Blue Shield,EPO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Case Rate,162.04
Blue Shield,EPO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Case Rate,167.63
Blue Shield,EPO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Case Rate,259.05
Blue Shield,EPO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Case Rate,138.76
Blue Shield,EPO,97124,CPT4/HCPCS,MASSAGE THERAPY,,Case Rate,133.95
Blue Shield,EPO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Case Rate,143.57
Blue Shield,EPO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Case Rate,109.89
Blue Shield,EPO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Case Rate,186.88
Blue Shield,EPO,97532,CPT4/HCPCS,COGNITIVE SKILLS DEVELOPMENT,,Case Rate,109.89
Blue Shield,EPO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Case Rate,133.95
Blue Shield,EPO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Case Rate,182.06
Blue Shield,EPO,97537,CPT4/HCPCS,COMMUNITY/WORK REINTEGRATION,,Case Rate,138.76
Blue Shield,EPO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Case Rate,143.57
Blue Shield,EPO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Fee Schedule,987.79
Blue Shield,EPO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Fee Schedule,987.79
Blue Shield,EPO,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,Case Rate,65.81
Blue Shield,EPO,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,Case Rate,74.65
Blue Shield,EPO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,Case Rate,166.85
Blue Shield,EPO,97755,CPT4/HCPCS,ASSISTIVE TECHNOLOGY ASSESS,,Case Rate,142.79
Blue Shield,EPO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,Case Rate,214.19
Blue Shield,EPO,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,Case Rate,166.85
Blue Shield,EPO,97762,CPT4/HCPCS,C/O FOR ORTHOTIC/PROSTH USE,,Case Rate,359.32
Blue Shield,EPO,97802,CPT4/HCPCS,MEDICAL NUTRITION INDIV IN,,Case Rate,230.18
Blue Shield,EPO,97803,CPT4/HCPCS,MED NUTRITION INDIV SUBSEQ,,Case Rate,230.18
Blue Shield,EPO,97804,CPT4/HCPCS,MEDICAL NUTRITION GROUP,,Case Rate,95.46
Blue Shield,EPO,99170,CPT4/HCPCS,ANOGENITAL EXAM CHILD W IMAG,,Case Rate,883.93
Blue Shield,EPO,99172,CPT4/HCPCS,OCULAR FUNCTION SCREEN,,Case Rate,262.31
Blue Shield,EPO,99175,CPT4/HCPCS,INDUCTION OF VOMITING,,Case Rate,713.97
Blue Shield,EPO,99183,CPT4/HCPCS,HYPERBARIC OXYGEN THERAPY,,Case Rate,1628.33
Blue Shield,EPO,99184,CPT4/HCPCS,HYPOTHERMIA ILL NEONATE,,Fee Schedule,987.79
Blue Shield,EPO,99190,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,7464.76
Blue Shield,EPO,99191,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,5593.37
Blue Shield,EPO,99192,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,3732.38
Blue Shield,EPO,99195,CPT4/HCPCS,PHLEBOTOMY,,Case Rate,219.78
Blue Shield,EPO,B2000ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2001ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B200YZZ,ICD10-PCS,Plain Radiography of Single Cor Art using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2010ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2011ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B201YZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2020ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2021ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B202YZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2030ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2031ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B203YZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2040ZZ,ICD10-PCS,Plain Radiography of Right Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2041ZZ,ICD10-PCS,Plain Radiography of Right Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B204YZZ,ICD10-PCS,Plain Radiography of Right Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2050ZZ,ICD10-PCS,Plain Radiography of Left Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2051ZZ,ICD10-PCS,Plain Radiography of Left Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B205YZZ,ICD10-PCS,Plain Radiography of Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2060ZZ,ICD10-PCS,Plain Radiography of R & L Heart using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2061ZZ,ICD10-PCS,Plain Radiography of R & L Heart using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B206YZZ,ICD10-PCS,Plain Radiography of Right and Left Heart using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2070ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2071ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B207YZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2080ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2081ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B208YZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B20F0ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B20F1ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B20FYZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using Other Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2100ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2101ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B210YZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using Other Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2110ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2111ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B211YZZ,ICD10-PCS,Fluoroscopy of Multiple Coronary Arteries using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2120ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2121ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B212YZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2130ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2131ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B213YZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2140ZZ,ICD10-PCS,Fluoroscopy of Right Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2141ZZ,ICD10-PCS,Fluoroscopy of Right Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B214YZZ,ICD10-PCS,Fluoroscopy of Right Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2150ZZ,ICD10-PCS,Fluoroscopy of Left Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2151ZZ,ICD10-PCS,Fluoroscopy of Left Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B215YZZ,ICD10-PCS,Fluoroscopy of Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2160ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2161ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B216YZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2170ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2171ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B217YZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2180ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B2181ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B218YZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B21F0ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B21F1ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,B21FYZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Other Contrast,,Fee Schedule,8271.00
Blue Shield,EPO,C8929,CPT4/HCPCS,Tte w or wo fol wcon,doppler,,Fee Schedule,3198.57
Blue Shield,EPO,C8930,CPT4/HCPCS,Tte w or w/o contr, cont ecg,,Fee Schedule,3198.57
Blue Shield,EPO,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Fee Schedule,6876.92
Blue Shield,EPO,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Fee Schedule,6876.92
Blue Shield,EPO,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Fee Schedule,6876.92
Blue Shield,EPO,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,Fee Schedule,6876.92
Blue Shield,EPO,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,Fee Schedule,6876.92
Blue Shield,EPO,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,Fee Schedule,6876.92
Blue Shield,EPO,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Fee Schedule,6876.92
Blue Shield,EPO,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Fee Schedule,6876.92
Blue Shield,EPO,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,Fee Schedule,6876.92
Blue Shield,EPO,C9739,CPT4/HCPCS,Cystoscopy prostatic imp 1-3,,Fee Schedule,4280.44
Blue Shield,EPO,C9740,CPT4/HCPCS,Cysto impl 4 or more,,Fee Schedule,4280.44
Blue Shield,EPO,C9742,CPT4/HCPCS,Laryngoscopy with injection,,Fee Schedule,4280.44
Blue Shield,EPO,C9748,CPT4/HCPCS,Prostatic rf water vapor tx,,Fee Schedule,12850.71
Blue Shield,EPO,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Fee Schedule,3198.57
Blue Shield,EPO,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Fee Schedule,4280.44
Blue Shield,EPO,G0106,CPT4/HCPCS,Colon CA screen;barium enema,,Case Rate,1130.25
Blue Shield,EPO,G0120,CPT4/HCPCS,Colon ca scrn; barium enema,,Case Rate,1130.25
Blue Shield,EPO,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Fee Schedule,4280.44
Blue Shield,EPO,G0122,CPT4/HCPCS,Colon ca scrn; barium enema,,Case Rate,1106.19
Blue Shield,EPO,G0130,CPT4/HCPCS,Single energy x-ray study,,Case Rate,409.91
Blue Shield,EPO,G0168,CPT4/HCPCS,Wound closure by adhesive,,Fee Schedule,3198.57
Blue Shield,EPO,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,Fee Schedule,4280.44
Blue Shield,EPO,G0277,CPT4/HCPCS,Hbot, full body chamber, 30m,,Fee Schedule,4280.44
Blue Shield,EPO,G0279,CPT4/HCPCS,Tomosynthesis, mammo,,Fee Schedule,4280.44
Blue Shield,EPO,G0288,CPT4/HCPCS,Recon, CTA for surg plan,,Case Rate,5201.81
Blue Shield,EPO,G0297,CPT4/HCPCS,Ldct for lung ca screen,,Fee Schedule,4280.44
Blue Shield,EPO,G0392,CPT4/HCPCS,AV fistula or graft arterial,,Fee Schedule,12850.71
Blue Shield,EPO,G0393,CPT4/HCPCS,AV fistula or graft venous,,Fee Schedule,12850.71
Blue Shield,EPO,Q0035,CPT4/HCPCS,Cardiokymography,,Case Rate,190.91
Blue Shield,EPO,Q0092,CPT4/HCPCS,Set up port xray equipment,,Case Rate,158.01
Blue Shield,EPO,X2A5312,ICD10-PCS,Cereb Filtr, Brach L Carotid Art, Perc, New Tech 2,,Fee Schedule,8271.00
Blue Shield,EPO,X2RF032,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Open, New Tech 2,,Fee Schedule,8271.00
Blue Shield,EPO,X2RF432,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Perc Endo, New Tech 2,,Fee Schedule,8271.00
Blue Shield,EPO,,,Clinic Visit,,Case Rate,60.00
Blue Shield,EPO,,,NICU/Newborn - Level I,,Per Diem,946.00
Blue Shield,EPO,,,CCU,,Per Diem,5692.00
Blue Shield,EPO,,,ICU,,Per Diem,5692.00
Blue Shield,EPO,,,Medical Surgical,,Per Diem,5692.00
Blue Shield,EPO,,,Pediatrics,,Per Diem,5692.00
Blue Shield,EPO,,,NICU/Newborn - Level II,,Per Diem,7077.00
Blue Shield,EPO,,,NICU/Newborn - Level III,,Per Diem,7077.00
Blue Shield,EPO,,,NICU/Newborn - Level IV,,Per Diem,7077.00
Blue Shield,HMO,001U074,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U076,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U077,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U079,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U0J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U0J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U0J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U0J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U0K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U0K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U0K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U0K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,001U374,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U376,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U377,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U379,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U3J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U3J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U3J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U3J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U3K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U3K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U3K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,001U3K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0033T,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,Fee Schedule,3198.57
Blue Shield,HMO,005T0ZZ,ICD10-PCS,Destruction of Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005T3ZZ,ICD10-PCS,Destruction of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005T4ZZ,ICD10-PCS,Destruction of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005W0ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005W3ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005W4ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005X0ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005X3ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005X4ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005Y0ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005Y3ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,005Y4ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,Fee Schedule,3198.57
Blue Shield,HMO,008W0ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,008W3ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,008W4ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,008X0ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,008X3ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,008X4ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,008Y0ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,008Y3ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,008Y4ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009T00Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009T0ZX,ICD10-PCS,Drainage of Spinal Meninges, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,HMO,009T0ZZ,ICD10-PCS,DRAINAGE OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,009T30Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009T3ZX,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,009T3ZZ,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009T40Z,ICD10-PCS,Drain of Spinal Meninges with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009T4ZX,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,009T4ZZ,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009U00Z,ICD10-PCS,Drainage of Spinal Canal with Drainage Device, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009U0ZX,ICD10-PCS,Drainage of Spinal Canal, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,HMO,009U0ZZ,ICD10-PCS,DRAINAGE OF SPINAL CANAL OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,009W00Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009W0ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,HMO,009W0ZZ,ICD10-PCS,DRAINAGE OF CERVICAL SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,009W30Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009W3ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,009W3ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009W40Z,ICD10-PCS,Drain of Cerv Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009W4ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,009W4ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009X00Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009X0ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,HMO,009X0ZZ,ICD10-PCS,DRAINAGE OF THORACIC SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,009X30Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009X3ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,009X3ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009X40Z,ICD10-PCS,Drain of Thor Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009X4ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,009X4ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009Y00Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009Y0ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,HMO,009Y0ZZ,ICD10-PCS,DRAINAGE OF LUMBAR SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,009Y30Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009Y3ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,009Y3ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009Y40Z,ICD10-PCS,Drain of Lum Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,009Y4ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,009Y4ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00BT0ZX,ICD10-PCS,Excision of Spinal Meninges, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,HMO,00BT0ZZ,ICD10-PCS,EXCISION OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,00BT3ZX,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,00BT3ZZ,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00BT4ZX,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,00BT4ZZ,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00BW0ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,HMO,00BW0ZZ,ICD10-PCS,EXCISION OF CERVICAL SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,00BW3ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,00BW3ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00BW4ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,00BW4ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00BX0ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,HMO,00BX0ZZ,ICD10-PCS,EXCISION OF THORACIC SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,00BX3ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,00BX3ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00BX4ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,00BX4ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00BY0ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,HMO,00BY0ZZ,ICD10-PCS,EXCISION OF LUMBAR SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,00BY3ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,00BY3ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00BY4ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,HMO,00BY4ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00C30ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00C33ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00C34ZZ,ICD10-PCS,Extirpate of Matter from Cran Epidur Spc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00CT0ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00CT3ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00CT4ZZ,ICD10-PCS,Extirpate of Matter from Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00CW0ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00CW3ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00CW4ZZ,ICD10-PCS,Extirpate matter from Cerv Spinal Cord, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,00CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00CX4ZZ,ICD10-PCS,Extirpate matter from Thor Spinal Cord, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,00CY0ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00CY3ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00CY4ZZ,ICD10-PCS,Extirpate of Matter from Lum Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00DT0ZZ,ICD10-PCS,EXTRACTION OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,00DT3ZZ,ICD10-PCS,Extraction of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00DT4ZZ,ICD10-PCS,Extraction of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00FU0ZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,00FU3ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00FU4ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00FUXZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL EXTERNAL APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,00HU02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HU0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HU32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HU3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HU42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HU4MZ,ICD10-PCS,Insert of Neuro Lead into Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HV02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HV0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HV32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HV3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HV42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00HV4MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00JU0ZZ,ICD10-PCS,INSPECTION OF SPINAL CANAL OPEN,,Fee Schedule,8271.00
Blue Shield,HMO,00JU3ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00JU4ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00JV0ZZ,ICD10-PCS,INSPECTION OF SPINAL CORD OPEN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,00JV3ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00JV4ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NT0ZZ,ICD10-PCS,Release Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NT3ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NT4ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NW0ZZ,ICD10-PCS,Release Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NW3ZZ,ICD10-PCS,Release Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NW4ZZ,ICD10-PCS,Release Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NX0ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NX3ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NX4ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NY0ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NY3ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00NY4ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU00Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU02Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU03Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU30Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU32Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU33Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU40Z,ICD10-PCS,Removal of Drain Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU43Z,ICD10-PCS,Remove of Infusion Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PU4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV00Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV02Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV03Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV07Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV0KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV30Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV32Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV33Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV37Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV3KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV40Z,ICD10-PCS,Removal of Drain Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV43Z,ICD10-PCS,Removal of Infusion Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV47Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV4KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00PV4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QT0ZZ,ICD10-PCS,Repair Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QT3ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QT4ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QW0ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QW3ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QW4ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QX0ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QX3ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QX4ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QY0ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QY3ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00QY4ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00SW0ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00SW3ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00SW4ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00SX0ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00SX3ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00SX4ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00SY0ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00SY3ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00SY4ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00UT07Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00UT0JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00UT0KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00UT37Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00UT3JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00UT3KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00UT47Z,ICD10-PCS,Supplement Spinal Meninges w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,00UT4JZ,ICD10-PCS,Supplement Spinal Meninges w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,00UT4KZ,ICD10-PCS,Supplement Spinal Meninges w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,00WU00Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU03Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU30Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU33Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU40Z,ICD10-PCS,Revision of Drain Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WU4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV00Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV03Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV07Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV0KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV30Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV33Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV37Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV3KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV40Z,ICD10-PCS,Revision of Drain Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV47Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV4KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,00WV4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Fee Schedule,12850.71
Blue Shield,HMO,01510ZZ,ICD10-PCS,Destruction of Cervical Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,01514ZZ,ICD10-PCS,Destruction of Cervical Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,01580ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,01584ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,015B0ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,015B4ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,015R0ZZ,ICD10-PCS,DESTRUCTION OF SACRAL NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,015R4ZZ,ICD10-PCS,Destruction of Sacral Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0163T,CPT4/HCPCS,LUMB ARTIF DISKECTOMY ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,0164T,CPT4/HCPCS,REMOVE LUMB ARTIF DISC ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,0165T,CPT4/HCPCS,REVISE LUMB ARTIF DISC ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,01810ZZ,ICD10-PCS,DIVISION OF CERVICAL NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,01813ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,01814ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Fee Schedule,4891.93
Blue Shield,HMO,01880ZZ,ICD10-PCS,DIVISION OF THORACIC NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,01883ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,01884ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,018B0ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE OPEN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,018B3ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE PERCUTANEOUS APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,018B4ZZ,ICD10-PCS,Division of Lumbar Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,018R0ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE OPEN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,018R3ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE PERQ APPR,,Fee Schedule,8271.00
Blue Shield,HMO,018R4ZZ,ICD10-PCS,Division of Sacral Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0190T,CPT4/HCPCS,PLACE INTRAOC RADIATION SRC,,Fee Schedule,3198.57
Blue Shield,HMO,0191T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Fee Schedule,12850.71
Blue Shield,HMO,0200T,CPT4/HCPCS,PERQ SACRAL AUGMT UNILAT INJ,,Fee Schedule,3198.57
Blue Shield,HMO,0201T,CPT4/HCPCS,PERQ SACRAL AUGMT BILAT INJ,,Fee Schedule,3198.57
Blue Shield,HMO,0207T,CPT4/HCPCS,CLEAR EYELID GLAND W/HEAT,,Fee Schedule,987.79
Blue Shield,HMO,0210083,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0210088,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0210089,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021008C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021008F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021008W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0210093,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0210098,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0210099,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021009C,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021009F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021009W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02100A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02100AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100AW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02100J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02100JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100JW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02100K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02100KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02100KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100KW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02100ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0210483,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0210488,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0210489,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021048C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021048F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021048W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0210493,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0210498,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0210499,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021049C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021049F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021049W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104AW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104JW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104KW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02104Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02104Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02104Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02104ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02104ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0211083,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0211088,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0211089,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021108C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021108F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021108W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0211093,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0211098,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0211099,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021109C,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021109F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021109W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02110A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02110AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110AW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02110J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02110JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110JW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02110K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02110KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02110KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110KW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02110ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0211483,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0211488,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0211489,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021148C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021148F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021148W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0211493,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0211498,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0211499,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021149C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021149F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021149W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114AW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114JW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114KW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02114Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02114Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02114Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02114ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02114ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0212083,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0212088,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0212089,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021208C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021208F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021208W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0212093,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0212098,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0212099,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021209C,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021209F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021209W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02120A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02120AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120AW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02120J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02120JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120JW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02120K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02120KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02120KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120KW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02120ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0212483,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0212488,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0212489,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021248C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021248F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021248W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0212493,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0212498,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0212499,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021249C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021249F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021249W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124AW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124JW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124KW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02124Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02124Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02124Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02124ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02124ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0213083,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0213088,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0213089,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021308C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021308F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021308W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0213093,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0213098,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0213099,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021309C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021309F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021309W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02130KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02130ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0213483,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0213488,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0213489,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021348C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021348F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021348W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0213493,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0213498,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0213499,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021349C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021349F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021349W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02134Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02134Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02134Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02134ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02134ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,HMO,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,HMO,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,HMO,021608P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021608Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021608R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021609P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021609Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021609R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160AR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160JR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160KR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160ZQ,ICD10-PCS,Bypass Right Atrium to Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02160ZR,ICD10-PCS,Bypass Right Atrium to Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021648P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021648Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021648R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021649P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021649Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021649R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02164AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02164AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02164AR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02164JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02164JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02164JR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02164KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02164KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02164KR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02164Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02164ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02164ZQ,ICD10-PCS,Bypass Right Atrium to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02164ZR,ICD10-PCS,Bypass Right Atrium to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,HMO,021708P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021708Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021708R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021709P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021709Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021709R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170AR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170JR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170KR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170ZQ,ICD10-PCS,Bypass Left Atrium to Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02170ZR,ICD10-PCS,Bypass Left Atrium to Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021748P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021748Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021748R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021749P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021749Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021749R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02174AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02174AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02174AR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02174JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02174JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02174JR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02174KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02174KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02174KR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02174ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02174ZQ,ICD10-PCS,Bypass Left Atrium to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02174ZR,ICD10-PCS,Bypass Left Atrium to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,HMO,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,HMO,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,Fee Schedule,987.79
Blue Shield,HMO,021K08P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K08Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K08R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K09P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K09Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K09R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K0AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K0AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K0AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K0JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K0JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K0JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K0KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K0KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K0KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021K0Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K0Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K0ZC,ICD10-PCS,Bypass Right Ventricle to Thoracic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K0ZF,ICD10-PCS,Bypass Right Ventricle to Abdominal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K0ZP,ICD10-PCS,Bypass Right Ventricle to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K0ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K0ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K0ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K48P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K48Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K48R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K49P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K49Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K49R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K4AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K4AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K4AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K4JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K4JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K4JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K4KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K4KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K4KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021K4Z5,ICD10-PCS,Bypass Right Ventricle to Cor Circ, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K4Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K4Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K4ZC,ICD10-PCS,Bypass Right Ventricle to Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K4ZF,ICD10-PCS,Bypass Right Ventricle to Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K4ZP,ICD10-PCS,Bypass Right Ventricle to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K4ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K4ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021K4ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L08P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L08Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L08R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L09P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L09Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L09R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L0AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L0AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L0AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L0JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L0JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L0JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L0KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L0KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L0KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021L0Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L0Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L0ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L0ZF,ICD10-PCS,Bypass Left Ventricle to Abdominal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L0ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L0ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L0ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L0ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L48P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L48Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L48R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L49P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L49Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L49R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L4AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L4AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L4AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L4JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L4JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L4JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L4KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L4KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L4KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021L4Z5,ICD10-PCS,Bypass Left Ventricle to Cor Circ, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L4Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L4Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L4ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L4ZF,ICD10-PCS,Bypass Left Ventricle to Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L4ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L4ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L4ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021L4ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021V08P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V08Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V08R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V09P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V09Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V09R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V0AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V0AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V0AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V0JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V0JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V0JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V0KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V0KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V0KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021V0ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021V0ZQ,ICD10-PCS,Bypass Superior Vena Cava to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021V0ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021V48P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V48Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V48R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V49P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V49Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V49R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V4AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V4AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V4AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V4JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V4JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V4JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V4KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V4KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V4KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021V4ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021V4ZQ,ICD10-PCS,BYPASS SUPERIOR VENA CAVA TO RT PULM ART PC ENDO,,Fee Schedule,8271.00
Blue Shield,HMO,021V4ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021W08B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W08D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W08P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W08Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W08R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W09B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W09D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W09P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W09Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W09R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021W0ZB,ICD10-PCS,Bypass Thoracic Aorta, Descending to Subclav, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021W0ZD,ICD10-PCS,Bypass Thoracic Aorta, Descending to Carotid, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021W0ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021W0ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021W0ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021W48B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W48D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W48P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W48Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W48R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W49B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W49D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W49P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W49Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W49R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021W4ZB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021W4ZD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021W4ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021W4ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021W4ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021X08B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X08D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X08P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X08Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X08R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X09B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X09D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X09P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X09Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X09R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,021X0ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021X0ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021X0ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021X0ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021X0ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021X48B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X48D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X48P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X48Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X48R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X49B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X49D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X49P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X49Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X49R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,021X4ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021X4ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021X4ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021X4ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,021X4ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,Fee Schedule,987.79
Blue Shield,HMO,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Fee Schedule,987.79
Blue Shield,HMO,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Fee Schedule,987.79
Blue Shield,HMO,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,HMO,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,HMO,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Fee Schedule,9548.66
Blue Shield,HMO,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,Fee Schedule,9548.66
Blue Shield,HMO,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Fee Schedule,9548.66
Blue Shield,HMO,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Fee Schedule,9548.66
Blue Shield,HMO,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,Fee Schedule,9548.66
Blue Shield,HMO,0249T,CPT4/HCPCS,LIGATION HEMORRHOID W/US,,Fee Schedule,4280.44
Blue Shield,HMO,024F07J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024F08J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024F0JJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024F0KJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024G072,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024G082,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024G0J2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024G0K2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024J072,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024J082,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024J0J2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,024J0K2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,02540ZZ,ICD10-PCS,Destruction of Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02543ZZ,ICD10-PCS,Destruction of Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02544ZZ,ICD10-PCS,Destruction of Coronary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0254T,CPT4/HCPCS,EVASC RPR ILIAC ART BIFUR,,Fee Schedule,3198.57
Blue Shield,HMO,02550ZZ,ICD10-PCS,Destruction of Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02553ZZ,ICD10-PCS,Destruction of Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02560ZZ,ICD10-PCS,Destruction of Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02563ZZ,ICD10-PCS,Destruction of Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02570ZZ,ICD10-PCS,Destruction of Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02573ZZ,ICD10-PCS,Destruction of Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02580ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02583ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02590ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02593ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025D0ZZ,ICD10-PCS,Destruction of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025D3ZZ,ICD10-PCS,Destruction of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025D4ZZ,ICD10-PCS,Destruction of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025F0ZZ,ICD10-PCS,Destruction of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025F3ZZ,ICD10-PCS,Destruction of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025G0ZZ,ICD10-PCS,Destruction of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025G3ZZ,ICD10-PCS,Destruction of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025H0ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025H3ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025J0ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025J3ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025K0ZZ,ICD10-PCS,Destruction of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025K3ZZ,ICD10-PCS,Destruction of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025L0ZZ,ICD10-PCS,Destruction of Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025L3ZZ,ICD10-PCS,Destruction of Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025M0ZZ,ICD10-PCS,Destruction of Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025M3ZZ,ICD10-PCS,Destruction of Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025P0ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025P3ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025P4ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025Q0ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025Q3ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025Q4ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025R0ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025R3ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025R4ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025S0ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025S3ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025S4ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025T0ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025T3ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025T4ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025V0ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025V3ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025V4ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025W0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025W3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025W4ZZ,ICD10-PCS,Destruction of Thor Aorta Desc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025X0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025X3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,025X4ZZ,ICD10-PCS,Destruction of Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,Fee Schedule,7902.34
Blue Shield,HMO,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,Fee Schedule,6049.05
Blue Shield,HMO,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,Fee Schedule,6049.05
Blue Shield,HMO,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,Fee Schedule,9304.07
Blue Shield,HMO,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,Fee Schedule,9304.07
Blue Shield,HMO,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,Fee Schedule,4891.93
Blue Shield,HMO,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,Fee Schedule,9304.07
Blue Shield,HMO,0270046,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027004Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270056,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027005Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270066,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027006Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270076,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027007Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02700D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02700DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02700E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02700EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02700F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02700FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02700G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02700GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02700T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02700TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02700Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02700ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270346,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027034Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270356,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027035Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270366,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027036Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270376,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027037Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02703D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02703DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02703E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02703EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02703F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02703FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02703G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02703GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02703T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02703TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02703Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02703ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270446,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027044Z,ICD10-PCS,Dilate of 1 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270456,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027045Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270466,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027046Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270476,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027047Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02704D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02704DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02704E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02704EZ,ICD10-PCS,Dilate of 1 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02704F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02704FZ,ICD10-PCS,Dilate of 1 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02704G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02704GZ,ICD10-PCS,Dilate of 1 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02704T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02704TZ,ICD10-PCS,Dilate 1 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02704Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02704ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,Fee Schedule,9304.07
Blue Shield,HMO,0271046,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027104Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271056,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027105Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271066,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027106Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271076,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027107Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02710D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02710DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02710E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02710EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02710F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02710FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02710G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02710GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02710T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02710TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02710Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02710ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271346,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027134Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271356,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027135Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271366,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027136Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271376,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027137Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02713D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02713DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02713E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02713EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02713F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02713FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02713G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02713GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02713T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02713TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02713Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02713ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271446,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027144Z,ICD10-PCS,Dilate of 2 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271456,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027145Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271466,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027146Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271476,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027147Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02714D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02714DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02714E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02714EZ,ICD10-PCS,Dilate of 2 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02714F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02714FZ,ICD10-PCS,Dilate of 2 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02714G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02714GZ,ICD10-PCS,Dilate of 2 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02714T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02714TZ,ICD10-PCS,Dilate 2 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02714Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02714ZZ,ICD10-PCS,Dilation of 2 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,Fee Schedule,9304.07
Blue Shield,HMO,0272046,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027204Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272056,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027205Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272066,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027206Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272076,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027207Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02720D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02720DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02720E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02720EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02720F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02720FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02720G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02720GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02720T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02720TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02720Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02720ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272346,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027234Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272356,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027235Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272366,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027236Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272376,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027237Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02723D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02723DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02723E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02723EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02723F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02723FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02723G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02723GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02723T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02723TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02723Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02723ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272446,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027244Z,ICD10-PCS,Dilate of 3 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272456,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027245Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272466,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027246Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272476,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027247Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02724D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02724DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02724E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02724EZ,ICD10-PCS,Dilate of 3 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02724F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02724FZ,ICD10-PCS,Dilate of 3 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02724G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02724GZ,ICD10-PCS,Dilate of 3 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02724T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02724TZ,ICD10-PCS,Dilate 3 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02724Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02724ZZ,ICD10-PCS,Dilation of 3 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0272T,CPT4/HCPCS,INTERROGATE CRTD SNS DEV,,Fee Schedule,987.79
Blue Shield,HMO,0273046,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027304Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273056,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027305Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273066,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027306Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273076,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027307Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02730D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02730DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02730E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02730EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02730F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02730FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02730G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02730GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02730T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02730TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02730Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02730ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273346,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027334Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273356,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027335Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273366,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027336Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273376,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027337Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02733D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02733DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02733E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02733EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02733F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02733FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02733G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02733GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02733T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02733TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02733Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02733ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273446,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027344Z,ICD10-PCS,Dilate 4+ Cor Art w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0273456,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027345Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273466,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027346Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273476,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027347Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02734D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02734DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02734E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02734EZ,ICD10-PCS,Dilate of 4+ Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02734F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02734FZ,ICD10-PCS,Dilate of 4+ Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02734G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02734GZ,ICD10-PCS,Dilate 4+ Cor Art w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02734T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02734TZ,ICD10-PCS,Dilate 4+ Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02734Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02734ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0273T,CPT4/HCPCS,INTERROGATE CRTD SNS W/PGRMG,,Fee Schedule,987.79
Blue Shield,HMO,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,Fee Schedule,9548.66
Blue Shield,HMO,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,Fee Schedule,9548.66
Blue Shield,HMO,0278T,CPT4/HCPCS,TEMPR,,Fee Schedule,987.79
Blue Shield,HMO,027F04Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027F0DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027F0ZZ,ICD10-PCS,Dilation of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027F34Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027F3DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027F3ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027F44Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027F4DZ,ICD10-PCS,Dilate of Aortic Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027F4ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027G04Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027G0DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027G0ZZ,ICD10-PCS,Dilation of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027G34Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027G3DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027G3ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027G44Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027G4DZ,ICD10-PCS,Dilate of Mitral Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027G4ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027H04Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027H0DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027H0ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027H34Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027H3DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027H3ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027H44Z,ICD10-PCS,Dilate Pulm Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027H4DZ,ICD10-PCS,Dilation of Pulm Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027H4ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027J04Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027J0DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027J0ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027J34Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027J3DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027J3ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027J44Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027J4DZ,ICD10-PCS,Dilate Tricusp Valve w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027J4ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027K04Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027K0DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027K0ZZ,ICD10-PCS,Dilation of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027K34Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027K3DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027K3ZZ,ICD10-PCS,Dilation of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027K44Z,ICD10-PCS,Dilate R Ventricle w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027K4DZ,ICD10-PCS,Dilate of R Ventricle with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027K4ZZ,ICD10-PCS,Dilation of Right Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027R04T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,HMO,027R0DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027R0ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027R34T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,027R3DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027R3ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,027R44T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027R4DT,ICD10-PCS,Dilate Ductus Arterio w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,027R4ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02890ZZ,ICD10-PCS,Division of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02893ZZ,ICD10-PCS,Division of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02894ZZ,ICD10-PCS,Division of Chordae Tendineae, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,028D0ZZ,ICD10-PCS,Division of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,028D3ZZ,ICD10-PCS,Division of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,028D4ZZ,ICD10-PCS,Division of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0295T,CPT4/HCPCS,EXT ECG COMPLETE,,Fee Schedule,987.79
Blue Shield,HMO,0296T,CPT4/HCPCS,EXT ECG RECORDING,,Fee Schedule,987.79
Blue Shield,HMO,0297T,CPT4/HCPCS,EXT ECG SCAN W/REPORT,,Fee Schedule,987.79
Blue Shield,HMO,0298T,CPT4/HCPCS,EXT ECG REVIEW AND INTERP,,Fee Schedule,987.79
Blue Shield,HMO,02B40ZZ,ICD10-PCS,Excision of Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B43ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B44ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B50ZZ,ICD10-PCS,Excision of Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B53ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B54ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B60ZZ,ICD10-PCS,Excision of Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B63ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B64ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B70ZZ,ICD10-PCS,Excision of Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B73ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B74ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B80ZZ,ICD10-PCS,Excision of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B83ZZ,ICD10-PCS,Excision of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B90ZZ,ICD10-PCS,Excision of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02B93ZZ,ICD10-PCS,Excision of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BD0ZZ,ICD10-PCS,Excision of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BD3ZZ,ICD10-PCS,Excision of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BD4ZZ,ICD10-PCS,Excision of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BF0ZZ,ICD10-PCS,Excision of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BF3ZZ,ICD10-PCS,Excision of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BG0ZZ,ICD10-PCS,Excision of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BG3ZZ,ICD10-PCS,Excision of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BH0ZZ,ICD10-PCS,Excision of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BH3ZZ,ICD10-PCS,Excision of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BJ0ZZ,ICD10-PCS,Excision of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BJ3ZZ,ICD10-PCS,Excision of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BK0ZZ,ICD10-PCS,Excision of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BK3ZZ,ICD10-PCS,Excision of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BK4ZZ,ICD10-PCS,Excision of Right Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BL0ZZ,ICD10-PCS,Excision of Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BL3ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BL4ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BM0ZZ,ICD10-PCS,Excision of Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BM3ZZ,ICD10-PCS,Excision of Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BP0ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BP3ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BP4ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BQ0ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BQ3ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BQ4ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BR0ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BR3ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BR4ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BS0ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BS3ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BS4ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BT0ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BT3ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BT4ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BV0ZZ,ICD10-PCS,Excision of Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BV3ZZ,ICD10-PCS,Excision of Superior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BV4ZZ,ICD10-PCS,Excision of Superior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BW0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BW3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BW4ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BX0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BX3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02BX4ZZ,ICD10-PCS,Excision of Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C00Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C00ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C03Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C03ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C04Z6,ICD10-PCS,Extirpate matter from 1 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02C04ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C10Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C10ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C13Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C13ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C14Z6,ICD10-PCS,Extirpate matter from 2 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02C14ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C20Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C20ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C23Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C23ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C24Z6,ICD10-PCS,Extirpate matter from 3 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02C24ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C30Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C30ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C33Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C33ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C34Z6,ICD10-PCS,Extirpate matter from 4+ Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02C34ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C40ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C43ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02C44ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02CD0ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02CD3ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02CD4ZZ,ICD10-PCS,Extirpate matter from Papillary Muscle, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02CW0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02CW3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02CW4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Desc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02CX4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02FN0ZZ,ICD10-PCS,Fragmentation in Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02FN3ZZ,ICD10-PCS,Fragmentation in Pericardium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02FN4ZZ,ICD10-PCS,Fragmentation in Pericardium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H402Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H403Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H40DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H40KZ,ICD10-PCS,Insertion of Defibrillator Lead into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H40NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H432Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H433Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H43DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H43NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H442Z,ICD10-PCS,Insertion of Monitor Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H443Z,ICD10-PCS,Insertion of Infusion Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H44DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H44KZ,ICD10-PCS,Insertion of Defib Lead into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H44NZ,ICD10-PCS,Insert of Intracard Pacer into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H60KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H63KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H64KZ,ICD10-PCS,Insertion of Defib Lead into R Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H70KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H73KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02H74KZ,ICD10-PCS,Insertion of Defib Lead into L Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HA0RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HA3RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HA4RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HK0KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HK3KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HK4KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HL0KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HL3DZ,ICD10-PCS,Insertion of Intralum Dev into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HL3KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HL3NZ,ICD10-PCS,Insertion of Intracard Pacer into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HL4KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HN0KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HN3KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HN4KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HP0DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HP3DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HP4DZ,ICD10-PCS,Insert of Intralum Dev into Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HQ0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HQ3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HQ4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HR0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HR3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HR4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HS02Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HS0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HS32Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HS3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HS42Z,ICD10-PCS,Insert of Monitor Dev into R Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HS4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HT02Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HT0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HT32Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HT3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HT42Z,ICD10-PCS,Insert of Monitor Dev into L Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HT4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HW02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HW0DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HW32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HW3DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HW42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Desc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02HW4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Desc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02HX02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HX0DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HX32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HX3DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02HX42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Asc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02HX4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Asc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02K80ZZ,ICD10-PCS,Map Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02K83ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02K84ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02LH0CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02LH0DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02LH0ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02LH3CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02LH3DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02LH3ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02LH4CZ,ICD10-PCS,Occlusion Pulm Valve w Extralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02LH4DZ,ICD10-PCS,Occlusion Pulm Valve w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02LH4ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02N40ZZ,ICD10-PCS,Release Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02N43ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02N44ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02N80ZZ,ICD10-PCS,Release Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02N83ZZ,ICD10-PCS,Release Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02N84ZZ,ICD10-PCS,Release Conduction Mechanism, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02N90ZZ,ICD10-PCS,Release Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02N93ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02N94ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02ND0ZZ,ICD10-PCS,Release Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02ND3ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02ND4ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02NF0ZZ,ICD10-PCS,Release Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02NG0ZZ,ICD10-PCS,Release Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02NH0ZZ,ICD10-PCS,Release Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02NJ0ZZ,ICD10-PCS,Release Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02NK0ZZ,ICD10-PCS,Release Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02NK3ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02NK4ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02NL0ZZ,ICD10-PCS,Release Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02NL3ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02NL4ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY02Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY03Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY07Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY08Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY0CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY0DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY0JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY0KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY32Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY33Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY37Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY38Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY3CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY3DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY3JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY3KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY42Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY43Z,ICD10-PCS,Remove of Infusion Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY47Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY48Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY4CZ,ICD10-PCS,Remove of Extralum Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY4DZ,ICD10-PCS,Remove of Intralum Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY4JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02PY4KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q00ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q03ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q04ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q10ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q13ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q14ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q20ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q23ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q24ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q30ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q33ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q34ZZ,ICD10-PCS,Repair 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q40ZZ,ICD10-PCS,Repair Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q43ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q44ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q50ZZ,ICD10-PCS,Repair Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q53ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q54ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q60ZZ,ICD10-PCS,Repair Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q63ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q64ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q70ZZ,ICD10-PCS,Repair Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q73ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q74ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q80ZZ,ICD10-PCS,Repair Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q83ZZ,ICD10-PCS,Repair Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q84ZZ,ICD10-PCS,Repair Conduction Mechanism, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q90ZZ,ICD10-PCS,Repair Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q93ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02Q94ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QA0ZZ,ICD10-PCS,Repair Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QA3ZZ,ICD10-PCS,Repair Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QA4ZZ,ICD10-PCS,Repair Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QB0ZZ,ICD10-PCS,Repair Right Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QB3ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QB4ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QC0ZZ,ICD10-PCS,Repair Left Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QC3ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QC4ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QD0ZZ,ICD10-PCS,Repair Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QD3ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QD4ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QF0ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QF0ZZ,ICD10-PCS,Repair Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QF3ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QF3ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QF4ZJ,ICD10-PCS,Repair Aort Valve created from Trunc Vlv, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QF4ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QG0ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QG0ZZ,ICD10-PCS,Repair Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QG3ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QG3ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QG4ZE,ICD10-PCS,Repair Mitral Valve fr L AV Vlv, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02QG4ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QH0ZZ,ICD10-PCS,Repair Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QH3ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QH4ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QJ0ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QJ0ZZ,ICD10-PCS,Repair Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QJ3ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QJ3ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QJ4ZG,ICD10-PCS,Repair Tricusp Valve fr R AV Vlv, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02QJ4ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QK0ZZ,ICD10-PCS,Repair Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QK3ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QK4ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QL0ZZ,ICD10-PCS,Repair Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QL3ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QL4ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QM0ZZ,ICD10-PCS,Repair Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QM3ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QM4ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QN0ZZ,ICD10-PCS,Repair Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QN3ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02QN4ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R507Z,ICD10-PCS,Replacement of Atrial Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R508Z,ICD10-PCS,Replacement of Atrial Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R50JZ,ICD10-PCS,Replacement of Atrial Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R50KZ,ICD10-PCS,Replacement of Atrial Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R547Z,ICD10-PCS,Replace of Atrial Sept with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R548Z,ICD10-PCS,Replace of Atrial Sept with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R54JZ,ICD10-PCS,Replace of Atrial Sept with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R54KZ,ICD10-PCS,Replace of Atrial Sept with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R607Z,ICD10-PCS,Replacement of Right Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R608Z,ICD10-PCS,Replacement of Right Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R60JZ,ICD10-PCS,Replacement of Right Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R60KZ,ICD10-PCS,Replacement of Right Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R647Z,ICD10-PCS,Replacement of R Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R648Z,ICD10-PCS,Replacement of R Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R64JZ,ICD10-PCS,Replacement of R Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R64KZ,ICD10-PCS,Replacement of R Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R707Z,ICD10-PCS,Replacement of Left Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R708Z,ICD10-PCS,Replacement of Left Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R70JZ,ICD10-PCS,Replacement of Left Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R70KZ,ICD10-PCS,Replacement of Left Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R747Z,ICD10-PCS,Replacement of L Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R748Z,ICD10-PCS,Replacement of L Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R74JZ,ICD10-PCS,Replacement of L Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R74KZ,ICD10-PCS,Replacement of L Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R907Z,ICD10-PCS,Replace of Chordae Tendineae with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R908Z,ICD10-PCS,Replace of Chordae Tendineae with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R90JZ,ICD10-PCS,Replace of Chordae Tendineae with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R90KZ,ICD10-PCS,Replace of Chordae Tendineae with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02R947Z,ICD10-PCS,Replace Chordae Tendineae w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02R948Z,ICD10-PCS,Replace Chordae Tendineae w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02R94JZ,ICD10-PCS,Replace Chordae Tendineae w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02R94KZ,ICD10-PCS,Replace Chordae Tendineae w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RD07Z,ICD10-PCS,Replace of Papillary Muscle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RD08Z,ICD10-PCS,Replace of Papillary Muscle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RD0JZ,ICD10-PCS,Replace of Papillary Muscle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RD0KZ,ICD10-PCS,Replace of Papillary Muscle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RD47Z,ICD10-PCS,Replace Papillary Muscle w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RD48Z,ICD10-PCS,Replace Papillary Muscle w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RD4JZ,ICD10-PCS,Replace Papillary Muscle w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RD4KZ,ICD10-PCS,Replace Papillary Muscle w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RF07Z,ICD10-PCS,Replacement of Aortic Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RF08Z,ICD10-PCS,Replacement of Aortic Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RF0JZ,ICD10-PCS,Replacement of Aortic Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RF0KZ,ICD10-PCS,Replacement of Aortic Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RF47Z,ICD10-PCS,Replace of Aortic Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RF48Z,ICD10-PCS,Replace of Aortic Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RF4JZ,ICD10-PCS,Replace of Aortic Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RF4KZ,ICD10-PCS,Replace of Aortic Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG07Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG08Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG0JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG0KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG37Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG38Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG3JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG3KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG47Z,ICD10-PCS,Replace of Mitral Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG48Z,ICD10-PCS,Replace of Mitral Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG4JZ,ICD10-PCS,Replace of Mitral Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RG4KZ,ICD10-PCS,Replace of Mitral Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RH07Z,ICD10-PCS,Replacement of Pulmonary Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RH08Z,ICD10-PCS,Replacement of Pulm Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RH0JZ,ICD10-PCS,Replacement of Pulmonary Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RH0KZ,ICD10-PCS,Replacement of Pulm Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RH47Z,ICD10-PCS,Replacement of Pulm Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RH48Z,ICD10-PCS,Replace of Pulm Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RH4JZ,ICD10-PCS,Replacement of Pulm Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RH4KZ,ICD10-PCS,Replace of Pulm Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RJ07Z,ICD10-PCS,Replacement of Tricuspid Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RJ08Z,ICD10-PCS,Replacement of Tricusp Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RJ0JZ,ICD10-PCS,Replacement of Tricuspid Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RJ0KZ,ICD10-PCS,Replacement of Tricusp Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RJ47Z,ICD10-PCS,Replace of Tricusp Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RJ48Z,ICD10-PCS,Replace of Tricusp Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RJ4JZ,ICD10-PCS,Replace of Tricusp Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RJ4KZ,ICD10-PCS,Replace of Tricusp Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RK07Z,ICD10-PCS,Replacement of Right Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RK08Z,ICD10-PCS,Replacement of R Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RK0JZ,ICD10-PCS,Replacement of Right Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RK0KZ,ICD10-PCS,Replacement of R Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RK47Z,ICD10-PCS,Replace of R Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RK48Z,ICD10-PCS,Replace of R Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RK4JZ,ICD10-PCS,Replace of R Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RK4KZ,ICD10-PCS,Replace of R Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RL07Z,ICD10-PCS,Replacement of Left Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RL08Z,ICD10-PCS,Replacement of Left Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RL0JZ,ICD10-PCS,Replacement of Left Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RL0KZ,ICD10-PCS,Replacement of Left Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RL47Z,ICD10-PCS,Replace of L Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RL48Z,ICD10-PCS,Replace of L Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RL4JZ,ICD10-PCS,Replace of L Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RL4KZ,ICD10-PCS,Replace of L Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RM07Z,ICD10-PCS,Replace of Ventricular Sept with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RM08Z,ICD10-PCS,Replace of Ventricular Sept with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RM0JZ,ICD10-PCS,Replace of Ventricular Sept with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RM0KZ,ICD10-PCS,Replace of Ventricular Sept with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RM47Z,ICD10-PCS,Replace Ventricular Sept w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RM48Z,ICD10-PCS,Replace Ventricular Sept w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RM4KZ,ICD10-PCS,Replace Ventricular Sept w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RN07Z,ICD10-PCS,Replacement of Pericardium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RN08Z,ICD10-PCS,Replacement of Pericardium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RN0JZ,ICD10-PCS,Replacement of Pericardium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RN0KZ,ICD10-PCS,Replacement of Pericardium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RN47Z,ICD10-PCS,Replace of Pericardium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RN48Z,ICD10-PCS,Replace of Pericardium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RN4JZ,ICD10-PCS,Replace of Pericardium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RN4KZ,ICD10-PCS,Replace of Pericardium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RP07Z,ICD10-PCS,Replacement of Pulmonary Trunk with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RP08Z,ICD10-PCS,Replacement of Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RP0JZ,ICD10-PCS,Replacement of Pulmonary Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RP0KZ,ICD10-PCS,Replacement of Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RP47Z,ICD10-PCS,Replacement of Pulm Trunk with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RP48Z,ICD10-PCS,Replace of Pulm Trunk with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RP4JZ,ICD10-PCS,Replacement of Pulm Trunk with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RP4KZ,ICD10-PCS,Replace of Pulm Trunk with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RQ07Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RQ08Z,ICD10-PCS,Replacement of R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RQ0JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RQ0KZ,ICD10-PCS,Replacement of R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RQ47Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RQ48Z,ICD10-PCS,Replace of R Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RQ4JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RQ4KZ,ICD10-PCS,Replace of R Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RR07Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RR08Z,ICD10-PCS,Replacement of L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RR0JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RR0KZ,ICD10-PCS,Replacement of L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RR47Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RR48Z,ICD10-PCS,Replace of L Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RR4JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RR4KZ,ICD10-PCS,Replace of L Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RS07Z,ICD10-PCS,Replacement of R Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RS08Z,ICD10-PCS,Replacement of R Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RS0JZ,ICD10-PCS,Replacement of R Pulm Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RS0KZ,ICD10-PCS,Replacement of R Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RS47Z,ICD10-PCS,Replace of R Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RS48Z,ICD10-PCS,Replace of R Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RS4JZ,ICD10-PCS,Replace of R Pulm Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RS4KZ,ICD10-PCS,Replace of R Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RT07Z,ICD10-PCS,Replacement of L Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RT08Z,ICD10-PCS,Replacement of L Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RT0JZ,ICD10-PCS,Replacement of L Pulm Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RT0KZ,ICD10-PCS,Replacement of L Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RT47Z,ICD10-PCS,Replace of L Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RT48Z,ICD10-PCS,Replace of L Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RT4JZ,ICD10-PCS,Replace of L Pulm Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RT4KZ,ICD10-PCS,Replace of L Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RV07Z,ICD10-PCS,Replacement of Sup Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RV08Z,ICD10-PCS,Replacement of Sup Vena Cava with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RV0JZ,ICD10-PCS,Replacement of Sup Vena Cava with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RV0KZ,ICD10-PCS,Replacement of Sup Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RV47Z,ICD10-PCS,Replace of Sup Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RV48Z,ICD10-PCS,Replace of Sup Vena Cava with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RV4JZ,ICD10-PCS,Replace of Sup Vena Cava with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RV4KZ,ICD10-PCS,Replace of Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RW07Z,ICD10-PCS,Replacement of Thor Aorta Desc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RW08Z,ICD10-PCS,Replace of Thor Aorta Desc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RW0JZ,ICD10-PCS,Replacement of Thor Aorta Desc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RW0KZ,ICD10-PCS,Replace of Thor Aorta Desc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RW47Z,ICD10-PCS,Replace Thor Aorta Desc w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RW48Z,ICD10-PCS,Replace Thor Aorta Desc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RW4JZ,ICD10-PCS,Replace Thor Aorta Desc w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RW4KZ,ICD10-PCS,Replace Thor Aorta Desc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RX07Z,ICD10-PCS,Replacement of Thor Aorta Asc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RX08Z,ICD10-PCS,Replacement of Thor Aorta Asc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RX0JZ,ICD10-PCS,Replacement of Thor Aorta Asc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RX0KZ,ICD10-PCS,Replacement of Thor Aorta Asc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RX47Z,ICD10-PCS,Replace of Thor Aorta Asc with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RX48Z,ICD10-PCS,Replace Thor Aorta Asc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02RX4JZ,ICD10-PCS,Replace of Thor Aorta Asc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02RX4KZ,ICD10-PCS,Replace Thor Aorta Asc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02S00ZZ,ICD10-PCS,Reposition Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02S10ZZ,ICD10-PCS,Reposition Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02SP0ZZ,ICD10-PCS,Reposition Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02SQ0ZZ,ICD10-PCS,Reposition Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02SR0ZZ,ICD10-PCS,Reposition Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02SS0ZZ,ICD10-PCS,Reposition Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02ST0ZZ,ICD10-PCS,Reposition Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02SV0ZZ,ICD10-PCS,Reposition Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02SW0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02SX0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02T80ZZ,ICD10-PCS,Resection of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02T83ZZ,ICD10-PCS,Resection of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02T90ZZ,ICD10-PCS,Resection of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02T93ZZ,ICD10-PCS,Resection of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02T94ZZ,ICD10-PCS,Resection of Chordae Tendineae, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02TD0ZZ,ICD10-PCS,Resection of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02TD3ZZ,ICD10-PCS,Resection of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02TD4ZZ,ICD10-PCS,Resection of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U507Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U508Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U50JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U50KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U537Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U538Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U53JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U53KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U547Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U548Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U54JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U54KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U607Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U608Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U60JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U60KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U637Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U638Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U63JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U63KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U647Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U648Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U64JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U64KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U707Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U708Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U70JZ,ICD10-PCS,Supplement Left Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U70KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U737Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U738Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U73KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U747Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U748Z,ICD10-PCS,Supplement Left Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U74KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U907Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U908Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U90JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U90KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U937Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U938Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U93JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U93KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02U947Z,ICD10-PCS,Supplement Chordae Tendineae w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02U948Z,ICD10-PCS,Supplement Chordae Tendineae w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02U94JZ,ICD10-PCS,Supplement Chordae Tendineae w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02U94KZ,ICD10-PCS,Supplement Chordae Tendineae w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UA07Z,ICD10-PCS,Supplement Heart with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA08Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA0JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA0KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA37Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA38Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA3JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA3KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA47Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA48Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA4JZ,ICD10-PCS,Supplement Heart with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UA4KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UD07Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UD08Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UD0JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UD0KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UD37Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UD38Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UD3JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UD3KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UD47Z,ICD10-PCS,Supplement Papillary Muscle w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UD48Z,ICD10-PCS,Supplement Papillary Muscle w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UD4JZ,ICD10-PCS,Supplement Papillary Muscle w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UD4KZ,ICD10-PCS,Supplement Papillary Muscle w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UF07J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UF07Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF08J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UF08Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF0JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UF0JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF0KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UF0KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF37J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UF37Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF38J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UF38Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF3JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UF3JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF3KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UF3KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF47J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UF47Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF48J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UF48Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF4JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UF4JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UF4KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UF4KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG07E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UG07Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG08E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UG08Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG0JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UG0JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG0KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UG0KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG37E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UG37Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG38E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UG38Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG3JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UG3JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG3KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UG3KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG47E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UG47Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG48E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UG48Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG4JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UG4JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UG4KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UG4KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH07Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH08Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH0JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH0KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH37Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH38Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH3JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH3KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH47Z,ICD10-PCS,Supplement Pulm Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH48Z,ICD10-PCS,Supplement Pulm Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH4JZ,ICD10-PCS,Supplement Pulm Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UH4KZ,ICD10-PCS,Supplement Pulm Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ07G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ07Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ08G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ08Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ0JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ0JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ0KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ0KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ37G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ37Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ38G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ38Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ3JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ3JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ3KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ3KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ47G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ47Z,ICD10-PCS,Supplement Tricusp Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ48G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ48Z,ICD10-PCS,Supplement Tricusp Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ4JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ4JZ,ICD10-PCS,Supplement Tricusp Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ4KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UJ4KZ,ICD10-PCS,Supplement Tricusp Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK07Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK08Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK0JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK0KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK37Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK38Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK3JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK3KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK47Z,ICD10-PCS,Supplement R Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK48Z,ICD10-PCS,Supplement R Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK4JZ,ICD10-PCS,Supplement R Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UK4KZ,ICD10-PCS,Supplement R Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL07Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL08Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL0JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL0KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL37Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL38Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL3JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL3KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL47Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL48Z,ICD10-PCS,Supplement L Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL4JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UL4KZ,ICD10-PCS,Supplement L Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UM07Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UM08Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UM0JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UM0KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UM37Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UM38Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UM3JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UM3KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UM47Z,ICD10-PCS,Supplement Ventricular Sept w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UM48Z,ICD10-PCS,Supplement Ventricular Sept w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UM4JZ,ICD10-PCS,Supplement Ventricular Sept w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UM4KZ,ICD10-PCS,Supplement Ventricular Sept w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UN07Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN08Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN0JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN0KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN37Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN38Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN3JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN3KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN47Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN48Z,ICD10-PCS,Supplement Pericardium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN4JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UN4KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UP07Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UP08Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UP0KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UP37Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UP38Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UP3KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UP47Z,ICD10-PCS,Supplement Pulm Trunk with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UP48Z,ICD10-PCS,Supplement Pulm Trunk with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UP4KZ,ICD10-PCS,Supplement Pulm Trunk with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UQ07Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UQ08Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UQ0KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UQ37Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UQ38Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UQ3KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UQ47Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UQ48Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UQ4KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UR07Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UR08Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UR0KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UR37Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UR38Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UR3KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UR47Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UR48Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UR4KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02US07Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02US08Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02US0KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02US37Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02US38Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02US3KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02US47Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02US48Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02US4KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UT07Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UT08Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UT0KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UT37Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UT38Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UT3KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UT47Z,ICD10-PCS,Supplement L Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UT48Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UT4KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UV07Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UV08Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UV0KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UV37Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UV38Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UV3KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UV47Z,ICD10-PCS,Supplement Sup Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UV48Z,ICD10-PCS,Supplement Sup Vena Cava with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UV4KZ,ICD10-PCS,Supplement Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UW07Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UW08Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UW0KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UW37Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UW38Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UW3JZ,ICD10-PCS,Supplement Thor Aorta Desc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UW3KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UW47Z,ICD10-PCS,Supplement Thor Aorta Desc w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UW48Z,ICD10-PCS,Supplement Thor Aorta Desc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UW4JZ,ICD10-PCS,Supplement Thor Aorta Desc w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UW4KZ,ICD10-PCS,Supplement Thor Aorta Desc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UX07Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UX08Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UX0KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UX37Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UX38Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UX3JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UX3KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UX47Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UX48Z,ICD10-PCS,Supplement Thor Aorta Asc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02UX4JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02UX4KZ,ICD10-PCS,Supplement Thor Aorta Asc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02VA0CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02VA0ZZ,ICD10-PCS,Restriction of Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02VA3CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02VA3ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02VA4CZ,ICD10-PCS,Restriction of Heart with Extralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02VA4ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02VW0DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02VW0EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02VW0FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02VW3DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02VW3EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02VW3FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02VW4DZ,ICD10-PCS,Restrict Thor Aorta Desc w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02VW4EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02VW4FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02VX0DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02VX0EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02VX0FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Open,,Fee Schedule,8271.00
Blue Shield,HMO,02VX3DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02VX3EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02VX3FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,02VX4DZ,ICD10-PCS,Restrict Thor Aorta Asc w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02VX4EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02VX4FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,02W50JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02W54JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WF07Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WF08Z,ICD10-PCS,Revision of Zooplastic Tissue in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WF0JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WF0KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WF47Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WF48Z,ICD10-PCS,Revision of Zooplastic in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WF4JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WF4KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WG07Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WG08Z,ICD10-PCS,Revision of Zooplastic Tissue in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WG0JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WG0KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WG47Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WG48Z,ICD10-PCS,Revision of Zooplastic in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WG4JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WG4KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WH07Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WH08Z,ICD10-PCS,Revision of Zooplastic Tissue in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WH0JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WH0KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WH47Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WH48Z,ICD10-PCS,Revision of Zooplastic in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WH4JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WH4KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WJ07Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WJ08Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WJ0JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WJ0KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WJ47Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WJ48Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WJ4JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WJ4KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WM0JZ,ICD10-PCS,Revision of Synth Sub in Ventricular Sept, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WM4JZ,ICD10-PCS,Revise of Synth Sub in Ventricular Sept, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY02Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY03Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY07Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY08Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY0CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY0DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY0JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY0KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY32Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY33Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY37Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY38Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY3CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY3DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY3JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY3KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY42Z,ICD10-PCS,Revision of Monitor Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY43Z,ICD10-PCS,Revision of Infusion Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY47Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY48Z,ICD10-PCS,Revision of Zooplastic in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY4CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY4DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY4JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,02WY4KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Fee Schedule,7902.34
Blue Shield,HMO,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Fee Schedule,6876.92
Blue Shield,HMO,031309M,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,031309N,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03130AM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03130AN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03130JM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03130JN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03130KM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03130KN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03130ZM,ICD10-PCS,Bypass Right Subclavian Artery to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03130ZN,ICD10-PCS,Bypass Right Subclavian Artery to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Fee Schedule,6876.92
Blue Shield,HMO,031409M,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,031409N,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03140AM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03140AN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03140JM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03140JN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03140KM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03140KN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,03140ZM,ICD10-PCS,Bypass Left Subclavian Artery to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03140ZN,ICD10-PCS,Bypass Left Subclavian Artery to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Fee Schedule,6876.92
Blue Shield,HMO,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Fee Schedule,3198.57
Blue Shield,HMO,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Fee Schedule,3198.57
Blue Shield,HMO,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,Fee Schedule,3198.57
Blue Shield,HMO,0331T,CPT4/HCPCS,HEART SYMP IMAGE PLNR,,Fee Schedule,987.79
Blue Shield,HMO,0332T,CPT4/HCPCS,HEART SYMP IMAGE PLNR SPECT,,Fee Schedule,987.79
Blue Shield,HMO,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Fee Schedule,6876.92
Blue Shield,HMO,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,Fee Schedule,3198.57
Blue Shield,HMO,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,Fee Schedule,3198.57
Blue Shield,HMO,0342T,CPT4/HCPCS,THXP APHERESIS W/HDL DELIP,,Fee Schedule,6049.05
Blue Shield,HMO,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Fee Schedule,987.79
Blue Shield,HMO,03500ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03503ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03504ZZ,ICD10-PCS,Destruction of R Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03510ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03513ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03514ZZ,ICD10-PCS,Destruction of L Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03520ZZ,ICD10-PCS,Destruction of Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03523ZZ,ICD10-PCS,Destruction of Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03524ZZ,ICD10-PCS,Destruction of Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03530ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03533ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03534ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03540ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03543ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03544ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0375T,CPT4/HCPCS,TOTAL DISC ARTHRP ANT APPR,,Fee Schedule,987.79
Blue Shield,HMO,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Fee Schedule,3198.57
Blue Shield,HMO,0377T,CPT4/HCPCS,ANOSCPY INJ AGENT FOR INCONT,,Fee Schedule,6049.05
Blue Shield,HMO,0378T,CPT4/HCPCS,VISUAL FIELD ASSMNT REV/RPRT,,Fee Schedule,6049.05
Blue Shield,HMO,0379T,CPT4/HCPCS,VIS FIELD ASSMNT TECH SUPPT,,Fee Schedule,6049.05
Blue Shield,HMO,0380T,CPT4/HCPCS,COMP ANIMAT RET IMAG SERIES,,Fee Schedule,6049.05
Blue Shield,HMO,0387T,CPT4/HCPCS,LEADLESS PM INS/RPL VENTR,,Fee Schedule,6876.92
Blue Shield,HMO,0388T,CPT4/HCPCS,LEADLESS PM REMOVE VENTR,,Fee Schedule,6876.92
Blue Shield,HMO,0394T,CPT4/HCPCS,HDR ELCTRNC SKN SURF BRCHYTX,,Fee Schedule,12850.71
Blue Shield,HMO,0395T,CPT4/HCPCS,HDR ELCTR NTRST/NTRCV BRCHTX,,Fee Schedule,12850.71
Blue Shield,HMO,03B00ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B03ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B04ZZ,ICD10-PCS,Excision of R Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B10ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B13ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B14ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B20ZZ,ICD10-PCS,Excision of Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B23ZZ,ICD10-PCS,Excision of Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B24ZZ,ICD10-PCS,Excision of Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B30ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B33ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B34ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B40ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B43ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03B44ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R007Z,ICD10-PCS,Replacement of R Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R00JZ,ICD10-PCS,Replacement of R Int Mamm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R00KZ,ICD10-PCS,Replacement of R Int Mamm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R047Z,ICD10-PCS,Replace of R Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R04JZ,ICD10-PCS,Replace of R Int Mamm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R04KZ,ICD10-PCS,Replace R Int Mamm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,03R107Z,ICD10-PCS,Replacement of L Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R10JZ,ICD10-PCS,Replacement of L Int Mamm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R10KZ,ICD10-PCS,Replacement of L Int Mamm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R147Z,ICD10-PCS,Replace of L Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R14JZ,ICD10-PCS,Replace of L Int Mamm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R14KZ,ICD10-PCS,Replace L Int Mamm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,03R207Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R20JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R20KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R247Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R24JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R24KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R307Z,ICD10-PCS,Replacement of R Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R30JZ,ICD10-PCS,Replacement of R Subclav Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R30KZ,ICD10-PCS,Replacement of R Subclav Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R347Z,ICD10-PCS,Replace of R Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R34JZ,ICD10-PCS,Replace of R Subclav Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R34KZ,ICD10-PCS,Replace of R Subclav Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R407Z,ICD10-PCS,Replacement of L Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R40JZ,ICD10-PCS,Replacement of L Subclav Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R40KZ,ICD10-PCS,Replacement of L Subclav Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R447Z,ICD10-PCS,Replace of L Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R44JZ,ICD10-PCS,Replace of L Subclav Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03R44KZ,ICD10-PCS,Replace of L Subclav Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S00ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S03ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S04ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S10ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S13ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S14ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S20ZZ,ICD10-PCS,Reposition Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S23ZZ,ICD10-PCS,Reposition Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S24ZZ,ICD10-PCS,Reposition Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S30ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S33ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S34ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S40ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S43ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S44ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S50ZZ,ICD10-PCS,Reposition Right Axillary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S53ZZ,ICD10-PCS,Reposition Right Axillary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S54ZZ,ICD10-PCS,Reposition Right Axillary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S60ZZ,ICD10-PCS,Reposition Left Axillary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S63ZZ,ICD10-PCS,Reposition Left Axillary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S64ZZ,ICD10-PCS,Reposition Left Axillary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S70ZZ,ICD10-PCS,Reposition Right Brachial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S73ZZ,ICD10-PCS,Reposition Right Brachial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S74ZZ,ICD10-PCS,Reposition Right Brachial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S80ZZ,ICD10-PCS,Reposition Left Brachial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S83ZZ,ICD10-PCS,Reposition Left Brachial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S84ZZ,ICD10-PCS,Reposition Left Brachial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S90ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S93ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03S94ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SA0ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SA3ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SA4ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SB0ZZ,ICD10-PCS,Reposition Right Radial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SB3ZZ,ICD10-PCS,Reposition Right Radial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SB4ZZ,ICD10-PCS,Reposition Right Radial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SC0ZZ,ICD10-PCS,Reposition Left Radial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SC3ZZ,ICD10-PCS,Reposition Left Radial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SC4ZZ,ICD10-PCS,Reposition Left Radial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SD0ZZ,ICD10-PCS,Reposition Right Hand Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SD3ZZ,ICD10-PCS,Reposition Right Hand Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SD4ZZ,ICD10-PCS,Reposition Right Hand Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SF0ZZ,ICD10-PCS,Reposition Left Hand Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SF3ZZ,ICD10-PCS,Reposition Left Hand Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SF4ZZ,ICD10-PCS,Reposition Left Hand Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SG0ZZ,ICD10-PCS,Reposition Intracranial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SG3ZZ,ICD10-PCS,Reposition Intracranial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SG4ZZ,ICD10-PCS,Reposition Intracranial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SH0ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SH3ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SH4ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SJ0ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SJ3ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SJ4ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SK0ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SK3ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SK4ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SL0ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SL3ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SL4ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SM0ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SM3ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SM4ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SN0ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SN3ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SN4ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SP0ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SP3ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SP4ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SQ0ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SQ3ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SQ4ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SR0ZZ,ICD10-PCS,Reposition Face Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SR3ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SR4ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SS0ZZ,ICD10-PCS,Reposition Right Temporal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SS3ZZ,ICD10-PCS,Reposition Right Temporal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SS4ZZ,ICD10-PCS,Reposition Right Temporal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03ST0ZZ,ICD10-PCS,Reposition Left Temporal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03ST3ZZ,ICD10-PCS,Reposition Left Temporal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03ST4ZZ,ICD10-PCS,Reposition Left Temporal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SU0ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SU3ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SU4ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SV0ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SV3ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SV4ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SY0ZZ,ICD10-PCS,Reposition Upper Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SY3ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03SY4ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U007Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U037Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U047Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U107Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U137Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U147Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U207Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U237Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U247Z,ICD10-PCS,Supplement Innom Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U307Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U337Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U347Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U407Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U437Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U447Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U507Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U537Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U547Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U607Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U637Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U647Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U707Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U737Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U747Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U807Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U837Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U847Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U907Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U937Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03U947Z,ICD10-PCS,Supplement R Ulnar Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UA07Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UA37Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UA47Z,ICD10-PCS,Supplement L Ulnar Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UB07Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UB37Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UB47Z,ICD10-PCS,Supplement R Radial Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UC07Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UC37Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UC47Z,ICD10-PCS,Supplement L Radial Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UD07Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UD37Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UD47Z,ICD10-PCS,Supplement R Hand Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UF07Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UF37Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UF47Z,ICD10-PCS,Supplement L Hand Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UG07Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UG37Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UG47Z,ICD10-PCS,Supplement Intracran Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UH07Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UH37Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UH47Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UJ07Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UJ37Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UJ47Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UK07Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UK37Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UK47Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UL07Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UL37Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UL47Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UM07Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UM37Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UM47Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UN07Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UN37Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UN47Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UP07Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UP37Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UP47Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UQ07Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UQ37Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UQ47Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UR07Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UR37Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UR47Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03US07Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03US37Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03US47Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UT07Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UT37Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UT47Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UU07Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UU37Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UU47Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UV07Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UV37Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UV47Z,ICD10-PCS,Supplement L Thyroid Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UY07Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UY37Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,03UY47Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Fee Schedule,3198.57
Blue Shield,HMO,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Fee Schedule,6876.92
Blue Shield,HMO,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Fee Schedule,3198.57
Blue Shield,HMO,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Fee Schedule,3198.57
Blue Shield,HMO,0410090,ICD10-PCS,BYPASS ABD AORTA ABD AORTA AUTO VENOUS TISS OPN,,Fee Schedule,8271.00
Blue Shield,HMO,0410091,ICD10-PCS,Bypass Abd Aorta to Celiac Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0410092,ICD10-PCS,Bypass Abd Aorta to Mesent Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0410093,ICD10-PCS,BP ABDOMINAL AORTA RT RENL ART AUTO VEN TISS OPN,,Fee Schedule,8271.00
Blue Shield,HMO,0410094,ICD10-PCS,BP ABD AORTA LT RENAL ARTERY AUTO VEN TISS OPN,,Fee Schedule,8271.00
Blue Shield,HMO,0410095,ICD10-PCS,Bypass Abd Aorta to B Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0410096,ICD10-PCS,Bypass Abd Aorta to R Com Ilia with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0410097,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,0410098,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,0410099,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,041009B,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,041009C,ICD10-PCS,BP ABD AO B INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,041009D,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,041009F,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,041009G,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,041009H,ICD10-PCS,BP ABD AO RT FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,041009J,ICD10-PCS,BP ABD AO LT FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,041009K,ICD10-PCS,BYPS ABD AO B FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,041009Q,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,041009R,ICD10-PCS,BYPS ABD AO LOW ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100A0,ICD10-PCS,BYPS ABD AO ABD AO AUTO ART TISSUE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100A1,ICD10-PCS,BP ABD AO CELIAC ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100A2,ICD10-PCS,BYPS ABD AO MES ART AUTO ART TISSUE OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100A3,ICD10-PCS,BP ABD AO RT RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100A4,ICD10-PCS,BP ABD AO LT RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100A5,ICD10-PCS,BP ABD AO B RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100A6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100A7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100A8,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100A9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100AB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100AC,ICD10-PCS,BP ABDOMINAL AO BIL INTRL ILIAC ART AUTO ART OPN,,Fee Schedule,8271.00
Blue Shield,HMO,04100AD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100AF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100AG,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100AH,ICD10-PCS,BP ABD AO RT FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100AJ,ICD10-PCS,BP ABD AO LT FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100AK,ICD10-PCS,BYPS ABD AO B FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100AQ,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100AR,ICD10-PCS,BYPS ABD AO LOW ART AUTO ART TISSUE OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100J0,ICD10-PCS,BYPASS ABD AO ABD AO SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100J1,ICD10-PCS,BYPS ABD AO CELIAC ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100J2,ICD10-PCS,BYPASS ABD AO MES ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100J3,ICD10-PCS,BYPS ABD AO RT RENL ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100J4,ICD10-PCS,BYPS ABD AO LT RENL ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100J5,ICD10-PCS,BYPS ABD AO BIL RENL ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100J6,ICD10-PCS,BP ABD AO RT COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100J7,ICD10-PCS,BP ABD AO LT COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100J8,ICD10-PCS,BP ABD AO B COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100J9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100JB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100JC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100JD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100JF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100JG,ICD10-PCS,BP ABD AO B EXT ILIAC ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100JH,ICD10-PCS,BYPS ABD AO RT FEM ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100JJ,ICD10-PCS,BYPS ABD AO LT FEM ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100JK,ICD10-PCS,BYPS ABD AO BIL FEM ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100JQ,ICD10-PCS,BP ABD AO LOW EXTREM ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100JR,ICD10-PCS,BYPASS ABD AO LOW ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100K0,ICD10-PCS,BP ABD AO ABD AO NONAUTO TISS SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100K1,ICD10-PCS,BP ABD AO CELIAC ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100K2,ICD10-PCS,BP ABD AO MES ART NONAUTO TISS SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100K3,ICD10-PCS,BP ABD AO RT RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100K4,ICD10-PCS,BP ABD AO LT RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100K5,ICD10-PCS,BP ABD AO B RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100K6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100K7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100K8,ICD10-PCS,BP ABD AO B CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100K9,ICD10-PCS,BP ABD AO RT IIA NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100KB,ICD10-PCS,BP ABD AO LT IIA NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100KC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100KD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100KF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100KG,ICD10-PCS,BP ABD AO B EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100KH,ICD10-PCS,BP ABD AO RT FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100KJ,ICD10-PCS,BP ABD AO LT FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100KK,ICD10-PCS,BP ABD AO B FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100KQ,ICD10-PCS,BP ABD AO LOW EXT ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,HMO,04100KR,ICD10-PCS,BP ABD AO LOW ART NONAUTO TISS SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100Z0,ICD10-PCS,BYPASS ABD AORTA ABDOMINAL AORTA OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100Z1,ICD10-PCS,BYPASS ABD AORTA CELIAC ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100Z2,ICD10-PCS,BYPASS ABD AORTA MESENTERIC ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100Z3,ICD10-PCS,BYPASS ABD AORTA RT RENAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100Z4,ICD10-PCS,BYPASS ABD AORTA LT RENAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100Z5,ICD10-PCS,BYPASS ABDDOMINAL AORTA BILATERAL RENAL ART OPEN,,Fee Schedule,8271.00
Blue Shield,HMO,04100Z6,ICD10-PCS,BYPASS ABD AO RT COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100Z7,ICD10-PCS,BYPASS ABD AO LT COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100Z8,ICD10-PCS,BYPASS ABD AO BIL COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100Z9,ICD10-PCS,BYPASS ABD AO RT INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100ZB,ICD10-PCS,BYPASS ABD AO LT INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100ZC,ICD10-PCS,BYPASS ABD AO BIL INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100ZD,ICD10-PCS,BYPASS ABD AORTA RT EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100ZF,ICD10-PCS,BYPASS ABD AORTA LT EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100ZG,ICD10-PCS,BYPASS ABD AO BIL EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100ZH,ICD10-PCS,BYPASS ABD AORTA RT FEMORAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100ZJ,ICD10-PCS,BYPASS ABD AORTA LT FEMORAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100ZK,ICD10-PCS,BYPASS ABD AO BIL FEMORAL ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,HMO,04100ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04100ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0410490,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0410491,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0410492,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0410493,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0410494,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0410495,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0410496,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0410497,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0410498,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0410499,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041049B,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041049C,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041049D,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041049F,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041049G,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041049H,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041049J,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041049K,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041049Q,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041049R,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104A0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104A1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104A2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104A3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104A4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104A5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104A6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104A7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104A8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104A9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104AB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104AC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104AD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104AF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104AG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104AH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104AJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104AK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104AQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104AR,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104J0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104J1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104J2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104J3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104J4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104J5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104J6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104J7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104J8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104J9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104JB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104JC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104JD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104JF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104JG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104JH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104JJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104JK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104JQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104JR,ICD10-PCS,Bypass Abd Aorta to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104K0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104K1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104K2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104K3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104K4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104K5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104K6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104K7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104K8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104K9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104KB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104KC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104KD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104KF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104KG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104KH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104KJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104KK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104KQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104KR,ICD10-PCS,Bypass Abd Aorta to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04104Z0,ICD10-PCS,Bypass Abdominal Aorta to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104Z1,ICD10-PCS,Bypass Abdominal Aorta to Celiac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104Z2,ICD10-PCS,Bypass Abdominal Aorta to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104Z3,ICD10-PCS,Bypass Abdominal Aorta to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104Z4,ICD10-PCS,Bypass Abdominal Aorta to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104Z5,ICD10-PCS,Bypass Abdominal Aorta to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104Z6,ICD10-PCS,Bypass Abdominal Aorta to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104Z7,ICD10-PCS,Bypass Abdominal Aorta to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104Z8,ICD10-PCS,Bypass Abdominal Aorta to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104Z9,ICD10-PCS,Bypass Abdominal Aorta to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104ZB,ICD10-PCS,Bypass Abdominal Aorta to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104ZC,ICD10-PCS,Bypass Abdominal Aorta to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104ZD,ICD10-PCS,Bypass Abdominal Aorta to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104ZF,ICD10-PCS,Bypass Abdominal Aorta to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104ZG,ICD10-PCS,Bypass Abdominal Aorta to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104ZH,ICD10-PCS,Bypass Abdominal Aorta to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104ZJ,ICD10-PCS,Bypass Abdominal Aorta to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104ZK,ICD10-PCS,Bypass Abdominal Aorta to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04104ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Fee Schedule,3198.57
Blue Shield,HMO,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Fee Schedule,3198.57
Blue Shield,HMO,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Fee Schedule,4891.93
Blue Shield,HMO,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Fee Schedule,4891.93
Blue Shield,HMO,0414093,ICD10-PCS,Bypass Splenic Art to R Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0414094,ICD10-PCS,Bypass Splenic Art to L Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0414095,ICD10-PCS,Bypass Splenic Art to B Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04140A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,04140A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,04140A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,04140J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,04140J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,04140J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,04140K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,04140K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,04140K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,04140Z3,ICD10-PCS,Bypass Splenic Artery to Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04140Z4,ICD10-PCS,Bypass Splenic Artery to Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04140Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0414493,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0414494,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0414495,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04144A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04144A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04144A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04144J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04144J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04144J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04144K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04144K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04144K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04144Z3,ICD10-PCS,Bypass Splenic Artery to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04144Z4,ICD10-PCS,Bypass Splenic Artery to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04144Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Fee Schedule,4891.93
Blue Shield,HMO,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Fee Schedule,4891.93
Blue Shield,HMO,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Fee Schedule,4891.93
Blue Shield,HMO,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Fee Schedule,987.79
Blue Shield,HMO,041C090,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C091,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C092,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C093,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C094,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C095,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C096,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C097,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C098,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C099,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C09B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C09C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C09D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C09F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C09G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C09H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C09J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C09K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C09Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C09R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041C0Z0,ICD10-PCS,Bypass Right Common Iliac Artery to Abd Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0Z3,ICD10-PCS,Bypass Right Common Iliac Artery to R Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0Z4,ICD10-PCS,Bypass Right Common Iliac Artery to L Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0Z5,ICD10-PCS,Bypass Right Common Iliac Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0ZH,ICD10-PCS,Bypass Right Common Iliac Artery to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0ZJ,ICD10-PCS,Bypass Right Common Iliac Artery to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0ZK,ICD10-PCS,Bypass Right Common Iliac Artery to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C0ZR,ICD10-PCS,Bypass Right Common Iliac Artery to Low Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C490,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C491,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C492,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C493,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C494,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C495,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C496,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C497,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C498,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C499,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C49B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C49C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C49D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C49F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C49G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C49H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C49J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C49K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C49Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C49R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041C4Z0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4Z3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4Z4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4Z5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4ZH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4ZJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4ZK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041C4ZR,ICD10-PCS,Bypass R Com Iliac Art to Low Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D090,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D091,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D092,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D093,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D094,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D095,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D096,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D097,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D098,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D099,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D09B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D09C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D09D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D09F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D09G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D09H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D09J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D09K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D09Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D09R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041D0Z0,ICD10-PCS,Bypass Left Common Iliac Artery to Abd Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0Z1,ICD10-PCS,Bypass Left Common Iliac Artery to Celiac Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0Z2,ICD10-PCS,Bypass Left Common Iliac Artery to Mesent Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0Z3,ICD10-PCS,Bypass Left Common Iliac Artery to R Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0Z4,ICD10-PCS,Bypass Left Common Iliac Artery to L Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0Z5,ICD10-PCS,Bypass Left Common Iliac Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0Z6,ICD10-PCS,Bypass Left Common Iliac Artery to R Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0Z7,ICD10-PCS,Bypass Left Common Iliac Artery to L Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0Z8,ICD10-PCS,Bypass Left Common Iliac Artery to B Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0Z9,ICD10-PCS,Bypass Left Common Iliac Artery to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0ZB,ICD10-PCS,Bypass Left Common Iliac Artery to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0ZC,ICD10-PCS,Bypass Left Common Iliac Artery to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0ZD,ICD10-PCS,Bypass Left Common Iliac Artery to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0ZF,ICD10-PCS,Bypass Left Common Iliac Artery to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0ZG,ICD10-PCS,Bypass Left Common Iliac Artery to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0ZH,ICD10-PCS,Bypass Left Common Iliac Artery to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0ZJ,ICD10-PCS,Bypass Left Common Iliac Artery to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0ZK,ICD10-PCS,Bypass Left Common Iliac Artery to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0ZQ,ICD10-PCS,Bypass Left Common Iliac Artery to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D0ZR,ICD10-PCS,Bypass Left Common Iliac Artery to Low Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D490,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D491,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D492,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D493,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D494,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D495,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D496,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D497,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D498,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D499,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D49B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D49C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D49D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D49F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D49G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D49H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D49J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D49K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D49Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D49R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041D4Z0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4Z1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4Z2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4Z3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4Z4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4Z5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4Z6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4Z7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4Z8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4Z9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4ZB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4ZC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4ZD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4ZF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4ZG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4ZH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4ZJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4ZK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4ZQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041D4ZR,ICD10-PCS,Bypass L Com Iliac Art to Low Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E099,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E09B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E09C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E09D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E09F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E09G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E09H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E09J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E09K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E09P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E09Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041E0Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E0ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E0ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E0ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E0ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E0ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E0ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E0ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E0ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E0ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E0ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E499,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E49B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E49C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E49D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E49F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E49G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E49H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E49J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E49K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E49P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E49Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041E4Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E4ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E4ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E4ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E4ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E4ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E4ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E4ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E4ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E4ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041E4ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F099,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F09B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F09C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F09D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F09F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F09G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F09H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F09J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F09K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F09P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F09Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041F0Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F0ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F0ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F0ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F0ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F0ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F0ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F0ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F0ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F0ZP,ICD10-PCS,Bypass Left Internal Iliac Artery to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F0ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F499,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F49B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F49C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F49D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F49F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F49G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F49H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F49J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F49K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F49P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F49Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041F4Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F4ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F4ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F4ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F4ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F4ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F4ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F4ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F4ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F4ZP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041F4ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H099,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H09B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H09C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H09D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H09F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H09G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H09H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H09J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H09K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H09P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H09Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041H0Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H0ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H0ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H0ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H0ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H0ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H0ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H0ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H0ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H0ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H0ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H499,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H49B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H49C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H49D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H49F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H49G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H49H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H49J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H49K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H49P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H49Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041H4Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H4ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H4ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H4ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H4ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H4ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H4ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H4ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H4ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H4ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041H4ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J099,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J09B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J09C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J09D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J09F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J09G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J09H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J09J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J09K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J09P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J09Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,041J0Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J0ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J0ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J0ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J0ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J0ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J0ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J0ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J0ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J0ZP,ICD10-PCS,Bypass Left External Iliac Artery to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J0ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J499,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J49B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J49C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J49D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J49F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J49G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J49H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J49J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J49K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J49P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J49Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,041J4Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J4ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J4ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J4ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J4ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J4ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J4ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J4ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J4ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J4ZP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,041J4ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Fee Schedule,987.79
Blue Shield,HMO,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Fee Schedule,987.79
Blue Shield,HMO,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Fee Schedule,4891.93
Blue Shield,HMO,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Fee Schedule,4891.93
Blue Shield,HMO,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Fee Schedule,4891.93
Blue Shield,HMO,0443T,CPT4/HCPCS,R-T SPCTRL ALYS PRST8 TISS,,Fee Schedule,4280.44
Blue Shield,HMO,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Fee Schedule,3198.57
Blue Shield,HMO,04500ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04503ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04504ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Fee Schedule,3198.57
Blue Shield,HMO,04510ZZ,ICD10-PCS,Destruction of Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04513ZZ,ICD10-PCS,Destruction of Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04514ZZ,ICD10-PCS,Destruction of Celiac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,Fee Schedule,987.79
Blue Shield,HMO,04520ZZ,ICD10-PCS,Destruction of Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04523ZZ,ICD10-PCS,Destruction of Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04524ZZ,ICD10-PCS,Destruction of Gastric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,Fee Schedule,987.79
Blue Shield,HMO,04530ZZ,ICD10-PCS,Destruction of Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04533ZZ,ICD10-PCS,Destruction of Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04534ZZ,ICD10-PCS,Destruction of Hepatic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Fee Schedule,987.79
Blue Shield,HMO,04540ZZ,ICD10-PCS,Destruction of Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04543ZZ,ICD10-PCS,Destruction of Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04544ZZ,ICD10-PCS,Destruction of Splenic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Fee Schedule,987.79
Blue Shield,HMO,04550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04554ZZ,ICD10-PCS,Destruction of Sup Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,Fee Schedule,987.79
Blue Shield,HMO,04560ZZ,ICD10-PCS,Destruction of Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04563ZZ,ICD10-PCS,Destruction of Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04564ZZ,ICD10-PCS,Destruction of Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,Fee Schedule,987.79
Blue Shield,HMO,04570ZZ,ICD10-PCS,Destruction of Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04573ZZ,ICD10-PCS,Destruction of Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04574ZZ,ICD10-PCS,Destruction of Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Fee Schedule,987.79
Blue Shield,HMO,04580ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04583ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04584ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Fee Schedule,987.79
Blue Shield,HMO,04590ZZ,ICD10-PCS,Destruction of Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04593ZZ,ICD10-PCS,Destruction of Right Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04594ZZ,ICD10-PCS,Destruction of Right Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,Fee Schedule,987.79
Blue Shield,HMO,045A0ZZ,ICD10-PCS,Destruction of Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045A3ZZ,ICD10-PCS,Destruction of Left Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045A4ZZ,ICD10-PCS,Destruction of Left Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045B0ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045B3ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045B4ZZ,ICD10-PCS,Destruction of Inf Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045E0ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045E3ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045E4ZZ,ICD10-PCS,Destruction of R Int Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045F0ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045F3ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045F4ZZ,ICD10-PCS,Destruction of L Int Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045H0ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045H3ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045H4ZZ,ICD10-PCS,Destruction of R Ext Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045J0ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045J3ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,045J4ZZ,ICD10-PCS,Destruction of L Ext Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Fee Schedule,987.79
Blue Shield,HMO,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,Fee Schedule,987.79
Blue Shield,HMO,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,Fee Schedule,3198.57
Blue Shield,HMO,0474T,CPT4/HCPCS,INSJ AQUEOUS DRG DEV IO RSVR,,Fee Schedule,3198.57
Blue Shield,HMO,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Fee Schedule,4891.93
Blue Shield,HMO,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Fee Schedule,4891.93
Blue Shield,HMO,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Fee Schedule,6049.05
Blue Shield,HMO,0482T,CPT4/HCPCS,ABSL QUAN MYOCRD BLD FLO PET,,Fee Schedule,3198.57
Blue Shield,HMO,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,Fee Schedule,3198.57
Blue Shield,HMO,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,Fee Schedule,3198.57
Blue Shield,HMO,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Fee Schedule,6049.05
Blue Shield,HMO,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Fee Schedule,6049.05
Blue Shield,HMO,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Fee Schedule,4891.93
Blue Shield,HMO,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Fee Schedule,4891.93
Blue Shield,HMO,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,Fee Schedule,3198.57
Blue Shield,HMO,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Fee Schedule,4280.44
Blue Shield,HMO,04B00ZZ,ICD10-PCS,Excision of Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B03ZZ,ICD10-PCS,Excision of Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B04ZZ,ICD10-PCS,Excision of Abdominal Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B10ZZ,ICD10-PCS,Excision of Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B13ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B14ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B20ZZ,ICD10-PCS,Excision of Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B23ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B24ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B30ZZ,ICD10-PCS,Excision of Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B33ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B34ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B40ZZ,ICD10-PCS,Excision of Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B43ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B44ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B60ZZ,ICD10-PCS,Excision of Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B63ZZ,ICD10-PCS,Excision of Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B64ZZ,ICD10-PCS,Excision of Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B70ZZ,ICD10-PCS,Excision of Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B73ZZ,ICD10-PCS,Excision of Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B74ZZ,ICD10-PCS,Excision of Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B80ZZ,ICD10-PCS,Excision of Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B83ZZ,ICD10-PCS,Excision of Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B84ZZ,ICD10-PCS,Excision of Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B90ZZ,ICD10-PCS,Excision of Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B93ZZ,ICD10-PCS,Excision of Right Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04B94ZZ,ICD10-PCS,Excision of Right Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BA0ZZ,ICD10-PCS,Excision of Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BA3ZZ,ICD10-PCS,Excision of Left Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BA4ZZ,ICD10-PCS,Excision of Left Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BB0ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BB3ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BB4ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BE0ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BE3ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BE4ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BF0ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BF3ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BF4ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BH0ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BH3ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BH4ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BJ0ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BJ3ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04BJ4ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04C00ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04C03ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04C04ZZ,ICD10-PCS,Extirpation of Matter from Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R007Z,ICD10-PCS,Replacement of Abdominal Aorta with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R00JZ,ICD10-PCS,Replacement of Abdominal Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R00KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R047Z,ICD10-PCS,Replacement of Abd Aorta with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R04JZ,ICD10-PCS,Replacement of Abd Aorta with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R04KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R107Z,ICD10-PCS,Replacement of Celiac Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R10JZ,ICD10-PCS,Replacement of Celiac Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R10KZ,ICD10-PCS,Replacement of Celiac Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R147Z,ICD10-PCS,Replacement of Celiac Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R14JZ,ICD10-PCS,Replacement of Celiac Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R14KZ,ICD10-PCS,Replace of Celiac Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R207Z,ICD10-PCS,Replacement of Gastric Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R20JZ,ICD10-PCS,Replacement of Gastric Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R20KZ,ICD10-PCS,Replacement of Gastric Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R247Z,ICD10-PCS,Replace of Gastric Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R24JZ,ICD10-PCS,Replace of Gastric Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R24KZ,ICD10-PCS,Replace of Gastric Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R307Z,ICD10-PCS,Replacement of Hepatic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R30JZ,ICD10-PCS,Replacement of Hepatic Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R30KZ,ICD10-PCS,Replacement of Hepatic Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R347Z,ICD10-PCS,Replace of Hepatic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R34JZ,ICD10-PCS,Replace of Hepatic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R34KZ,ICD10-PCS,Replace of Hepatic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R407Z,ICD10-PCS,Replacement of Splenic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R40JZ,ICD10-PCS,Replacement of Splenic Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R40KZ,ICD10-PCS,Replacement of Splenic Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R447Z,ICD10-PCS,Replace of Splenic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R44JZ,ICD10-PCS,Replace of Splenic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R44KZ,ICD10-PCS,Replace of Splenic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R507Z,ICD10-PCS,Replacement of Sup Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R50JZ,ICD10-PCS,Replacement of Sup Mesent Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R50KZ,ICD10-PCS,Replacement of Sup Mesent Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R547Z,ICD10-PCS,Replace of Sup Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R54JZ,ICD10-PCS,Replace of Sup Mesent Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R54KZ,ICD10-PCS,Replace Sup Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04R607Z,ICD10-PCS,Replacement of R Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R60JZ,ICD10-PCS,Replacement of R Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R60KZ,ICD10-PCS,Replacement of R Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R647Z,ICD10-PCS,Replace of R Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R64JZ,ICD10-PCS,Replace of R Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R64KZ,ICD10-PCS,Replace of R Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R707Z,ICD10-PCS,Replacement of L Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R70JZ,ICD10-PCS,Replacement of L Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R70KZ,ICD10-PCS,Replacement of L Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R747Z,ICD10-PCS,Replace of L Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R74JZ,ICD10-PCS,Replace of L Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R74KZ,ICD10-PCS,Replace of L Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R807Z,ICD10-PCS,Replacement of Mid Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R80JZ,ICD10-PCS,Replacement of Mid Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R80KZ,ICD10-PCS,Replacement of Mid Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R847Z,ICD10-PCS,Replace of Mid Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R84JZ,ICD10-PCS,Replace of Mid Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R84KZ,ICD10-PCS,Replace of Mid Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R907Z,ICD10-PCS,Replacement of R Renal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R90JZ,ICD10-PCS,Replacement of R Renal Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R90KZ,ICD10-PCS,Replacement of R Renal Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R947Z,ICD10-PCS,Replace of R Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R94JZ,ICD10-PCS,Replace of R Renal Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04R94KZ,ICD10-PCS,Replace of R Renal Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RA07Z,ICD10-PCS,Replacement of L Renal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RA0JZ,ICD10-PCS,Replacement of L Renal Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RA0KZ,ICD10-PCS,Replacement of L Renal Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RA47Z,ICD10-PCS,Replace of L Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RA4JZ,ICD10-PCS,Replace of L Renal Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RA4KZ,ICD10-PCS,Replace of L Renal Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RB07Z,ICD10-PCS,Replacement of Inf Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RB0JZ,ICD10-PCS,Replacement of Inf Mesent Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RB0KZ,ICD10-PCS,Replacement of Inf Mesent Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RB47Z,ICD10-PCS,Replace of Inf Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RB4JZ,ICD10-PCS,Replace of Inf Mesent Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RB4KZ,ICD10-PCS,Replace Inf Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RC07Z,ICD10-PCS,Replacement of R Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RC0JZ,ICD10-PCS,Replacement of R Com Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RC0KZ,ICD10-PCS,Replace of R Com Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RC47Z,ICD10-PCS,Replace R Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RC4JZ,ICD10-PCS,Replace R Com Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RC4KZ,ICD10-PCS,Replace R Com Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RD07Z,ICD10-PCS,Replacement of L Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RD0JZ,ICD10-PCS,Replacement of L Com Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RD0KZ,ICD10-PCS,Replace of L Com Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RD47Z,ICD10-PCS,Replace L Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RD4JZ,ICD10-PCS,Replace L Com Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RD4KZ,ICD10-PCS,Replace L Com Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RE07Z,ICD10-PCS,Replacement of R Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RE0JZ,ICD10-PCS,Replacement of R Int Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RE0KZ,ICD10-PCS,Replace of R Int Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RE47Z,ICD10-PCS,Replace R Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RE4JZ,ICD10-PCS,Replace R Int Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RE4KZ,ICD10-PCS,Replace R Int Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RF07Z,ICD10-PCS,Replacement of L Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RF0JZ,ICD10-PCS,Replacement of L Int Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RF0KZ,ICD10-PCS,Replace of L Int Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RF47Z,ICD10-PCS,Replace L Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RF4JZ,ICD10-PCS,Replace L Int Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RF4KZ,ICD10-PCS,Replace L Int Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RH07Z,ICD10-PCS,Replacement of R Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RH0JZ,ICD10-PCS,Replacement of R Ext Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RH0KZ,ICD10-PCS,Replace of R Ext Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RH47Z,ICD10-PCS,Replace R Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RH4JZ,ICD10-PCS,Replace R Ext Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RH4KZ,ICD10-PCS,Replace R Ext Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RJ07Z,ICD10-PCS,Replacement of L Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RJ0JZ,ICD10-PCS,Replacement of L Ext Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RJ0KZ,ICD10-PCS,Replace of L Ext Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04RJ47Z,ICD10-PCS,Replace L Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RJ4JZ,ICD10-PCS,Replace L Ext Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04RJ4KZ,ICD10-PCS,Replace L Ext Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04S00ZZ,ICD10-PCS,Reposition Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S03ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S04ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S10ZZ,ICD10-PCS,Reposition Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S13ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S14ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S20ZZ,ICD10-PCS,Reposition Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S23ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S24ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S30ZZ,ICD10-PCS,Reposition Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S33ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S34ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S40ZZ,ICD10-PCS,Reposition Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S43ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S44ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S60ZZ,ICD10-PCS,Reposition Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S63ZZ,ICD10-PCS,Reposition Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S64ZZ,ICD10-PCS,Reposition Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S70ZZ,ICD10-PCS,Reposition Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S73ZZ,ICD10-PCS,Reposition Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S74ZZ,ICD10-PCS,Reposition Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S80ZZ,ICD10-PCS,Reposition Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S83ZZ,ICD10-PCS,Reposition Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04S84ZZ,ICD10-PCS,Reposition Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SB0ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SB3ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SB4ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SE0ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SE3ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SE4ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SF0ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SF3ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SF4ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SH0ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SH3ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SH4ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SJ0ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SJ3ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SJ4ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SK0ZZ,ICD10-PCS,Reposition Right Femoral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SK3ZZ,ICD10-PCS,Reposition Right Femoral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SK4ZZ,ICD10-PCS,Reposition Right Femoral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SL0ZZ,ICD10-PCS,Reposition Left Femoral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SL3ZZ,ICD10-PCS,Reposition Left Femoral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SL4ZZ,ICD10-PCS,Reposition Left Femoral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SM0ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SM3ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SM4ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SN0ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SN3ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SN4ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SP0ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SP3ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SP4ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SQ0ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SQ3ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SQ4ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SR0ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SR3ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SR4ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SS0ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SS3ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SS4ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04ST0ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04ST3ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04ST4ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SU0ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SU3ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SU4ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SV0ZZ,ICD10-PCS,Reposition Right Foot Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SV3ZZ,ICD10-PCS,Reposition Right Foot Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SV4ZZ,ICD10-PCS,Reposition Right Foot Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SW0ZZ,ICD10-PCS,Reposition Left Foot Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SW3ZZ,ICD10-PCS,Reposition Left Foot Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SW4ZZ,ICD10-PCS,Reposition Left Foot Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SY0ZZ,ICD10-PCS,Reposition Lower Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SY3ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04SY4ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U007Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U037Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U047Z,ICD10-PCS,Supplement Abd Aorta with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U107Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U137Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U147Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U207Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U237Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U247Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U307Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U337Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U347Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U407Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U437Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U447Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U507Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U537Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U547Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U607Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U637Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U647Z,ICD10-PCS,Supplement R Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U707Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U737Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U747Z,ICD10-PCS,Supplement L Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U807Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U837Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U847Z,ICD10-PCS,Supplement Mid Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U907Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U937Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04U947Z,ICD10-PCS,Supplement R Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UA07Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UA37Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UA47Z,ICD10-PCS,Supplement L Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UB07Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UB37Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UB47Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UC07Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UC37Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UC47Z,ICD10-PCS,Supplement R Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04UD07Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UD37Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UD47Z,ICD10-PCS,Supplement L Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04UE07Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UE37Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UE47Z,ICD10-PCS,Supplement R Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04UF07Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UF37Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UF47Z,ICD10-PCS,Supplement L Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04UH07Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UH37Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UH47Z,ICD10-PCS,Supplement R Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04UJ07Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UJ37Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UJ47Z,ICD10-PCS,Supplement L Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,04UK07Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UK37Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UK47Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UL07Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UL37Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UL47Z,ICD10-PCS,Supplement L Femor Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UM07Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UM37Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UM47Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UN07Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UN37Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UN47Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UP07Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UP37Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UP47Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UQ07Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UQ37Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UQ47Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UR07Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UR37Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UR47Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04US07Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04US37Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04US47Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UT07Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UT37Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UT47Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UU07Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UU37Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UU47Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UV07Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UV37Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UV47Z,ICD10-PCS,Supplement R Foot Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UW07Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UW37Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UW47Z,ICD10-PCS,Supplement L Foot Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UY07Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UY37Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,04UY47Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051007Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051009Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05100AY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05100JY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05100KY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05100ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051047Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,051049Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05104AY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05104JY,ICD10-PCS,BYPASS AZYGOS VEIN UP VEIN SYNTH SUB PERC ENDO,,Fee Schedule,8271.00
Blue Shield,HMO,05104KY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05104ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051107Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,051109Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05110AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05110JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05110KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05110ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051147Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,051149Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05114AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05114JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05114KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05114ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051307Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051309Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05130AY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05130JY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05130KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05130ZY,ICD10-PCS,Bypass Right Innominate Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051347Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,051349Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05134AY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05134JY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05134KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05134ZY,ICD10-PCS,Bypass Right Innominate Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051407Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051409Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05140AY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05140JY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05140KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05140ZY,ICD10-PCS,Bypass Left Innominate Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051447Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,051449Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05144AY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05144JY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05144KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05144ZY,ICD10-PCS,Bypass Left Innominate Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051507Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,051509Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05150AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05150JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05150KY,ICD10-PCS,BYPS RT SV UP VEIN NONAUT SUB OPEN,,Fee Schedule,8271.00
Blue Shield,HMO,05150ZY,ICD10-PCS,Bypass Right Subclavian Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051547Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,051549Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05154AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05154JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05154KY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05154ZY,ICD10-PCS,Bypass Right Subclavian Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051607Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,051609Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05160AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05160JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05160KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,HMO,05160ZY,ICD10-PCS,Bypass Left Subclavian Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,051647Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,051649Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05164AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05164JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05164KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05164ZY,ICD10-PCS,Bypass Left Subclavian Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05500ZZ,ICD10-PCS,Destruction of Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05503ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05504ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05510ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05513ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05514ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05530ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05533ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05534ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05540ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05543ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05544ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05550ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05553ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05554ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05560ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05563ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05564ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B00ZZ,ICD10-PCS,Excision of Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B03ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B04ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B10ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B13ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B14ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B30ZZ,ICD10-PCS,Excision of Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B33ZZ,ICD10-PCS,Excision of Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B34ZZ,ICD10-PCS,Excision of Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B40ZZ,ICD10-PCS,Excision of Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B43ZZ,ICD10-PCS,Excision of Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B44ZZ,ICD10-PCS,Excision of Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B50ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B53ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B54ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B60ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B63ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05B64ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R007Z,ICD10-PCS,Replacement of Azygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R00JZ,ICD10-PCS,Replacement of Azygos Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R00KZ,ICD10-PCS,Replacement of Azygos Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R047Z,ICD10-PCS,Replace of Azygos Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R04JZ,ICD10-PCS,Replace of Azygos Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R04KZ,ICD10-PCS,Replace of Azygos Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R107Z,ICD10-PCS,Replacement of Hemiazygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R10JZ,ICD10-PCS,Replacement of Hemiazygos Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R10KZ,ICD10-PCS,Replace of Hemiazygos Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R147Z,ICD10-PCS,Replace Hemiazygos Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05R14JZ,ICD10-PCS,Replace Hemiazygos Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05R14KZ,ICD10-PCS,Replace Hemiazygos Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05R307Z,ICD10-PCS,Replacement of R Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R30JZ,ICD10-PCS,Replacement of R Innom Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R30KZ,ICD10-PCS,Replacement of R Innom Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R347Z,ICD10-PCS,Replace of R Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R34JZ,ICD10-PCS,Replace of R Innom Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R34KZ,ICD10-PCS,Replace of R Innom Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R407Z,ICD10-PCS,Replacement of L Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R40JZ,ICD10-PCS,Replacement of L Innom Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R40KZ,ICD10-PCS,Replacement of L Innom Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R447Z,ICD10-PCS,Replace of L Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R44JZ,ICD10-PCS,Replace of L Innom Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R44KZ,ICD10-PCS,Replace of L Innom Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R507Z,ICD10-PCS,Replacement of R Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R50JZ,ICD10-PCS,Replacement of R Subclav Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R50KZ,ICD10-PCS,Replacement of R Subclav Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R547Z,ICD10-PCS,Replace of R Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R54JZ,ICD10-PCS,Replace of R Subclav Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R54KZ,ICD10-PCS,Replace R Subclav Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05R607Z,ICD10-PCS,Replacement of L Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R60JZ,ICD10-PCS,Replacement of L Subclav Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R60KZ,ICD10-PCS,Replacement of L Subclav Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R647Z,ICD10-PCS,Replace of L Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R64JZ,ICD10-PCS,Replace of L Subclav Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05R64KZ,ICD10-PCS,Replace L Subclav Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05S00ZZ,ICD10-PCS,Reposition Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S03ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S04ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S10ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S13ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S14ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S30ZZ,ICD10-PCS,Reposition Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S33ZZ,ICD10-PCS,Reposition Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S34ZZ,ICD10-PCS,Reposition Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S40ZZ,ICD10-PCS,Reposition Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S43ZZ,ICD10-PCS,Reposition Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S44ZZ,ICD10-PCS,Reposition Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S50ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S53ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S54ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S60ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S63ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S64ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S70ZZ,ICD10-PCS,Reposition Right Axillary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S73ZZ,ICD10-PCS,REPOSITION RIGHT AXILLARY VEIN PERQ,,Fee Schedule,8271.00
Blue Shield,HMO,05S74ZZ,ICD10-PCS,Reposition Right Axillary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S80ZZ,ICD10-PCS,Reposition Left Axillary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S83ZZ,ICD10-PCS,Reposition Left Axillary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S84ZZ,ICD10-PCS,Reposition Left Axillary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S90ZZ,ICD10-PCS,Reposition Right Brachial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S93ZZ,ICD10-PCS,Reposition Right Brachial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05S94ZZ,ICD10-PCS,Reposition Right Brachial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SA0ZZ,ICD10-PCS,Reposition Left Brachial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SA3ZZ,ICD10-PCS,Reposition Left Brachial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SA4ZZ,ICD10-PCS,Reposition Left Brachial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SB0ZZ,ICD10-PCS,Reposition Right Basilic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SB3ZZ,ICD10-PCS,Reposition Right Basilic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SB4ZZ,ICD10-PCS,Reposition Right Basilic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SC0ZZ,ICD10-PCS,Reposition Left Basilic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SC3ZZ,ICD10-PCS,Reposition Left Basilic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SC4ZZ,ICD10-PCS,Reposition Left Basilic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SD0ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SD3ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SD4ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SF0ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SF3ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SF4ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SG0ZZ,ICD10-PCS,Reposition Right Hand Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SG3ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SG4ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SH0ZZ,ICD10-PCS,Reposition Left Hand Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SH3ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SH4ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SL0ZZ,ICD10-PCS,Reposition Intracranial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SL3ZZ,ICD10-PCS,Reposition Intracranial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SL4ZZ,ICD10-PCS,Reposition Intracranial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SM0ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SM3ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SM4ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SN0ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SN3ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SN4ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SP0ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SP3ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SP4ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SQ0ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SQ3ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SQ4ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SR0ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SR3ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SR4ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SS0ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SS3ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SS4ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05ST0ZZ,ICD10-PCS,Reposition Right Face Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05ST3ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05ST4ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SV0ZZ,ICD10-PCS,Reposition Left Face Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SV3ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SV4ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SY0ZZ,ICD10-PCS,Reposition Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SY3ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05SY4ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U007Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U037Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U047Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U107Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U137Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U147Z,ICD10-PCS,Supplement Hemiazygos Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05U307Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U337Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U347Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U407Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U437Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U447Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U507Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U537Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U547Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U607Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U637Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U647Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U707Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U737Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U747Z,ICD10-PCS,Supplement R Axilla Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U807Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U837Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U847Z,ICD10-PCS,Supplement L Axilla Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U907Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U937Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05U947Z,ICD10-PCS,Supplement R Brach Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UA07Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UA37Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UA47Z,ICD10-PCS,Supplement L Brach Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UB07Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UB37Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UB47Z,ICD10-PCS,Supplement R Basilic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UC07Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UC37Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UC47Z,ICD10-PCS,Supplement L Basilic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UD07Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UD37Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UD47Z,ICD10-PCS,Supplement R Cephalic Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05UF07Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UF37Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UF47Z,ICD10-PCS,Supplement L Cephalic Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05UG07Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UG37Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UG47Z,ICD10-PCS,Supplement R Hand Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UH07Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UH37Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UH47Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UL07Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UL37Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UL47Z,ICD10-PCS,Supplement Intracran Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UM07Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UM37Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UM47Z,ICD10-PCS,Supplement R Int Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05UN07Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UN37Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UN47Z,ICD10-PCS,Supplement L Int Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05UP07Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UP37Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UP47Z,ICD10-PCS,Supplement R Ext Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05UQ07Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UQ37Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UQ47Z,ICD10-PCS,Supplement L Ext Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,05UR07Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UR37Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UR47Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05US07Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05US37Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05US47Z,ICD10-PCS,Supplement L Verteb Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UT07Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UT37Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UT47Z,ICD10-PCS,Supplement R Face Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UV07Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UV37Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UV47Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UY07Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UY37Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,05UY47Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06500ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06503ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06504ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06510ZZ,ICD10-PCS,Destruction of Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06513ZZ,ICD10-PCS,Destruction of Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06514ZZ,ICD10-PCS,Destruction of Splenic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06520ZZ,ICD10-PCS,Destruction of Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06523ZZ,ICD10-PCS,Destruction of Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06524ZZ,ICD10-PCS,Destruction of Gastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06540ZZ,ICD10-PCS,Destruction of Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06543ZZ,ICD10-PCS,Destruction of Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06544ZZ,ICD10-PCS,Destruction of Hepatic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06554ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06560ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06563ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06564ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06570ZZ,ICD10-PCS,Destruction of Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06573ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06574ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06580ZZ,ICD10-PCS,Destruction of Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06583ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06584ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06590ZZ,ICD10-PCS,Destruction of Right Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06593ZZ,ICD10-PCS,Destruction of Right Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06594ZZ,ICD10-PCS,Destruction of Right Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065B0ZZ,ICD10-PCS,Destruction of Left Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065B3ZZ,ICD10-PCS,Destruction of Left Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065B4ZZ,ICD10-PCS,Destruction of Left Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065F0ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065F3ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065F4ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065G0ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065G3ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065G4ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065H0ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065H3ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065H4ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065J0ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065J3ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,065J4ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B00ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B03ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B04ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B10ZZ,ICD10-PCS,Excision of Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B13ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B14ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B20ZZ,ICD10-PCS,Excision of Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B23ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B24ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B40ZZ,ICD10-PCS,Excision of Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B43ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B44ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B60ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B63ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B64ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B70ZZ,ICD10-PCS,Excision of Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B73ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B74ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B80ZZ,ICD10-PCS,Excision of Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B83ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B84ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B90ZZ,ICD10-PCS,Excision of Right Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B93ZZ,ICD10-PCS,Excision of Right Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06B94ZZ,ICD10-PCS,Excision of Right Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BB0ZZ,ICD10-PCS,Excision of Left Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BB3ZZ,ICD10-PCS,Excision of Left Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BB4ZZ,ICD10-PCS,Excision of Left Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BF0ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BF3ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BF4ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BG0ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BG3ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BG4ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BH0ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BH3ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BH4ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BJ0ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BJ3ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06BJ4ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R007Z,ICD10-PCS,Replacement of Inf Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R00JZ,ICD10-PCS,Replacement of Inf Vena Cava with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R00KZ,ICD10-PCS,Replacement of Inf Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R047Z,ICD10-PCS,Replace of Inf Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R04JZ,ICD10-PCS,Replace of Inf Vena Cava with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R04KZ,ICD10-PCS,Replace of Inf Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R107Z,ICD10-PCS,Replacement of Splenic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R10JZ,ICD10-PCS,Replacement of Splenic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R10KZ,ICD10-PCS,Replacement of Splenic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R147Z,ICD10-PCS,Replace of Splenic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R14JZ,ICD10-PCS,Replace of Splenic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R14KZ,ICD10-PCS,Replace of Splenic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R207Z,ICD10-PCS,Replacement of Gastric Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R20JZ,ICD10-PCS,Replacement of Gastric Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R20KZ,ICD10-PCS,Replacement of Gastric Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R247Z,ICD10-PCS,Replace of Gastric Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R24JZ,ICD10-PCS,Replace of Gastric Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R24KZ,ICD10-PCS,Replace of Gastric Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R407Z,ICD10-PCS,Replacement of Hepatic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R40JZ,ICD10-PCS,Replacement of Hepatic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R40KZ,ICD10-PCS,Replacement of Hepatic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R447Z,ICD10-PCS,Replace of Hepatic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R44JZ,ICD10-PCS,Replace of Hepatic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R44KZ,ICD10-PCS,Replace of Hepatic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R507Z,ICD10-PCS,Replacement of Sup Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R50JZ,ICD10-PCS,Replacement of Sup Mesent Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R50KZ,ICD10-PCS,Replace of Sup Mesent Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R547Z,ICD10-PCS,Replace Sup Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06R54JZ,ICD10-PCS,Replace Sup Mesent Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06R54KZ,ICD10-PCS,Replace Sup Mesent Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06R607Z,ICD10-PCS,Replacement of Inf Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R60JZ,ICD10-PCS,Replacement of Inf Mesent Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R60KZ,ICD10-PCS,Replace of Inf Mesent Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R647Z,ICD10-PCS,Replace Inf Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06R64JZ,ICD10-PCS,Replace Inf Mesent Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06R64KZ,ICD10-PCS,Replace Inf Mesent Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06R707Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R70JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R70KZ,ICD10-PCS,Replacement of Colic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R747Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R74JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R74KZ,ICD10-PCS,Replace of Colic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R807Z,ICD10-PCS,Replacement of Portal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R80JZ,ICD10-PCS,Replacement of Portal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R80KZ,ICD10-PCS,Replacement of Portal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R847Z,ICD10-PCS,Replace of Portal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R84JZ,ICD10-PCS,Replace of Portal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R84KZ,ICD10-PCS,Replace of Portal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R907Z,ICD10-PCS,Replacement of R Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R90JZ,ICD10-PCS,Replacement of R Renal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R90KZ,ICD10-PCS,Replacement of R Renal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R947Z,ICD10-PCS,Replace of R Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R94JZ,ICD10-PCS,Replace of R Renal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06R94KZ,ICD10-PCS,Replace of R Renal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RB07Z,ICD10-PCS,Replacement of Left Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RB0JZ,ICD10-PCS,Replacement of Left Renal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RB0KZ,ICD10-PCS,Replacement of L Renal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RB47Z,ICD10-PCS,Replace of L Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RB4JZ,ICD10-PCS,Replace of L Renal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RB4KZ,ICD10-PCS,Replace of L Renal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RC07Z,ICD10-PCS,Replace of R Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RC0JZ,ICD10-PCS,Replace of R Com Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RC0KZ,ICD10-PCS,Replace of R Com Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RC47Z,ICD10-PCS,Replace R Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RC4JZ,ICD10-PCS,Replace R Com Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RC4KZ,ICD10-PCS,Replace R Com Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RD07Z,ICD10-PCS,Replace of L Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RD0JZ,ICD10-PCS,Replace of L Com Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RD0KZ,ICD10-PCS,Replace of L Com Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RD47Z,ICD10-PCS,Replace L Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RD4JZ,ICD10-PCS,Replace L Com Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RD4KZ,ICD10-PCS,Replace L Com Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RF07Z,ICD10-PCS,Replace of R Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RF0JZ,ICD10-PCS,Replace of R Ext Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RF0KZ,ICD10-PCS,Replace of R Ext Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RF47Z,ICD10-PCS,Replace R Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RF4JZ,ICD10-PCS,Replace R Ext Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RF4KZ,ICD10-PCS,Replace R Ext Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RG07Z,ICD10-PCS,Replace of L Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RG0JZ,ICD10-PCS,Replace of L Ext Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RG0KZ,ICD10-PCS,Replace of L Ext Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RG47Z,ICD10-PCS,Replace L Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RG4JZ,ICD10-PCS,Replace L Ext Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RG4KZ,ICD10-PCS,Replace L Ext Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RH07Z,ICD10-PCS,Replacement of R Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RH0JZ,ICD10-PCS,Replacement of R Hypogast Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RH0KZ,ICD10-PCS,Replace of R Hypogast Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RH47Z,ICD10-PCS,Replace R Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RH4JZ,ICD10-PCS,Replace R Hypogast Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RH4KZ,ICD10-PCS,Replace R Hypogast Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RJ07Z,ICD10-PCS,Replacement of L Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RJ0JZ,ICD10-PCS,Replacement of L Hypogast Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RJ0KZ,ICD10-PCS,Replace of L Hypogast Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06RJ47Z,ICD10-PCS,Replace L Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RJ4JZ,ICD10-PCS,Replace L Hypogast Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06RJ4KZ,ICD10-PCS,Replace L Hypogast Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06S00ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S03ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S04ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S10ZZ,ICD10-PCS,Reposition Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S13ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S14ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S20ZZ,ICD10-PCS,Reposition Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S23ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S24ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S30ZZ,ICD10-PCS,Reposition Esophageal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S33ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S34ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S40ZZ,ICD10-PCS,Reposition Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S43ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S44ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S60ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S63ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S64ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S70ZZ,ICD10-PCS,Reposition Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S73ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S74ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S80ZZ,ICD10-PCS,Reposition Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S83ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06S84ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SF0ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SF3ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SF4ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SG0ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SG3ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SG4ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SH0ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SH3ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SH4ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SJ0ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SJ3ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SJ4ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SM0ZZ,ICD10-PCS,Reposition Right Femoral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SM3ZZ,ICD10-PCS,Reposition Right Femoral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SM4ZZ,ICD10-PCS,Reposition Right Femoral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SN0ZZ,ICD10-PCS,Reposition Left Femoral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SN3ZZ,ICD10-PCS,Reposition Left Femoral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SN4ZZ,ICD10-PCS,Reposition Left Femoral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SP0ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SP3ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SP4ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SQ0ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SQ3ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SQ4ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SR0ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SR3ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SR4ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SS0ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SS3ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SS4ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06ST0ZZ,ICD10-PCS,Reposition Right Foot Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06ST3ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06ST4ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SV0ZZ,ICD10-PCS,Reposition Left Foot Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SV3ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SV4ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SY0ZZ,ICD10-PCS,Reposition Lower Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SY3ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06SY4ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U007Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U037Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U047Z,ICD10-PCS,Supplement Inf Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U107Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U137Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U147Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U207Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U237Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U247Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U307Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U337Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U347Z,ICD10-PCS,Supplement Esophageal Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06U407Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U437Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U447Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U507Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U537Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U547Z,ICD10-PCS,Supplement Sup Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06U607Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U637Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U647Z,ICD10-PCS,Supplement Inf Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06U707Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U737Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U747Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U807Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U837Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U847Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U907Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U937Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06U947Z,ICD10-PCS,Supplement R Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UB07Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UB37Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UB47Z,ICD10-PCS,Supplement L Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UC07Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UC37Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UC47Z,ICD10-PCS,Supplement R Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06UD07Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UD37Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UD47Z,ICD10-PCS,Supplement L Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06UF07Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UF37Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UF47Z,ICD10-PCS,Supplement R Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06UG07Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UG37Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UG47Z,ICD10-PCS,Supplement L Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06UH07Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UH37Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UH47Z,ICD10-PCS,Supplement R Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06UJ07Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UJ37Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UJ47Z,ICD10-PCS,Supplement L Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06UM07Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UM37Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UM47Z,ICD10-PCS,Supplement R Femor Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UN07Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UN37Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UN47Z,ICD10-PCS,Supplement L Femor Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UP07Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UP37Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UP47Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UQ07Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UQ37Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UQ47Z,ICD10-PCS,Supplement L Saphenous with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UR07Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UR37Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UR47Z,ICD10-PCS,Supplement R Less Saphenous w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06US07Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06US37Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06US47Z,ICD10-PCS,Supplement L Less Saphenous w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,06UT07Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UT37Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UT47Z,ICD10-PCS,Supplement R Foot Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UV07Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UV37Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UV47Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UY07Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UY37Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,06UY47Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0JH608Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0JH638Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0JH808Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0JH838Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS304Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS30ZZ,ICD10-PCS,Reposition Cervical Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS334Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS33ZZ,ICD10-PCS,Reposition Cervical Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS344Z,ICD10-PCS,Reposition Cervcal Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS34ZZ,ICD10-PCS,Reposition Cervical Vertebra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS3XZZ,ICD10-PCS,Reposition Cervical Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS404Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS40ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS434Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS43ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS444Z,ICD10-PCS,Reposition Thor Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS44ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0PS4XZZ,ICD10-PCS,Reposition Thoracic Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS004Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS00ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS034Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS03ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS044Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS04ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS0XZZ,ICD10-PCS,Reposition Lumbar Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS104Z,ICD10-PCS,Reposition Sacrum with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS10ZZ,ICD10-PCS,Reposition Sacrum, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS134Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS13ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS144Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS14ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QS1XZZ,ICD10-PCS,Reposition Sacrum, External Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QSS04Z,ICD10-PCS,Reposition Coccyx with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QSS0ZZ,ICD10-PCS,Reposition Coccyx, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QSS34Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QSS3ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QSS44Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QSS4ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0QSSXZZ,ICD10-PCS,Reposition Coccyx, External Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0R530ZZ,ICD10-PCS,Destruction of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0R550ZZ,ICD10-PCS,Destruction of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0R590ZZ,ICD10-PCS,Destruction of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0R5B0ZZ,ICD10-PCS,Destruction of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB00ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB03ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB04ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB10ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB13ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB14ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB30ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB33ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB34ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB40ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB43ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB44ZZ,ICD10-PCS,Excision of C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB50ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB53ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB54ZZ,ICD10-PCS,Excision of C-thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB60ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB63ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB64ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB90ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB93ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RB94ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RBA0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RBA3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RBA4ZZ,ICD10-PCS,Excision of T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RBB0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RBB3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RBB4ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG0070,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG0071,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG007J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG00ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG0370,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG0371,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG037J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG03ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG0470,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG0471,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG047J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG04ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG1070,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG1071,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG107J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG10ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG1370,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG1371,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG137J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG13ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG1470,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG1471,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG147J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG14ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG2070,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG2071,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG207J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG20ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG2370,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG2371,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG237J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG23ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG2470,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG2471,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG247J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG24ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG4070,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG4071,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG407J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG40ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG4370,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG4371,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG437J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG43ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG4470,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG4471,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG447J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG44ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG6070,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG6071,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG607J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG60ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG6370,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG6371,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG637J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG63ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG6470,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG6471,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG647J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG64ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG7070,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG7071,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG707J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG70ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG7370,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG7371,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG737J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG73ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG7470,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG7471,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG747J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG74ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG8070,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG8071,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG807J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG80ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG8370,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG8371,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG837J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG83ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG8470,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG8471,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG847J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RG84ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA070,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA071,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA07J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA0ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA370,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA371,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA37J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA3ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA470,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA471,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA47J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RGA4ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH00BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH03BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RH04CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Occip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH04DZ,ICD10-PCS,Insert of Facet Stabl Dev into Occip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH10BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH10CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH10DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH13BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH13CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH13DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH14BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Cerv Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RH14CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Cerv Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH14DZ,ICD10-PCS,Insert of Facet Stabl Dev into Cerv Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH40BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RH40CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH40DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH43BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RH43CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH43DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH44BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RH44CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH44DZ,ICD10-PCS,Insert of Facet Stabl Dev into C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH60BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH60CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH60DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH63BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH63CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH63DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH64BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Thor Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RH64CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RH64DZ,ICD10-PCS,Insert of Facet Stabl Dev into Thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RHA0BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0RHA0CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RHA0DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RHA3BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0RHA3CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RHA3DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RHA4BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0RHA4CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RHA4DZ,ICD10-PCS,Insert of Facet Stabl Dev into T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RR30JZ,ICD10-PCS,Replacement of Cerv Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RR50JZ,ICD10-PCS,Replacement of C-thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RR90JZ,ICD10-PCS,Replacement of Thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RRB0JZ,ICD10-PCS,Replacement of T-lum Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RT30ZZ,ICD10-PCS,Resection of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RT40ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RT50ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RT90ZZ,ICD10-PCS,Resection of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RTB0ZZ,ICD10-PCS,Resection of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU00JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU03JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU04JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU10JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU13JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU14JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU40JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU43JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU44JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU50JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU53JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU54JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU60JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU63JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RU64JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RUA0JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RUA3JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RUA4JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RW30JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RW33JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RW34JZ,ICD10-PCS,Revision of Synth Sub in Cerv Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RW50JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RW53JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RW54JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RW90JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RW93JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RW94JZ,ICD10-PCS,Revision of Synth Sub in Thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RWB0JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RWB3JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0RWB4JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0S520ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0S523ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0S524ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0S540ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0S543ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0S544ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB00ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB03ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB04ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB20ZZ,ICD10-PCS,EXCISION LUMBAR VERTEBRAL DISC OPEN,,Fee Schedule,8271.00
Blue Shield,HMO,0SB23ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB24ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB30ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,HMO,0SB33ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB34ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB40ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL DISC OPEN,,Fee Schedule,8271.00
Blue Shield,HMO,0SB43ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB44ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB50ZZ,ICD10-PCS,EXCISION SACROCOCCYGEAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,HMO,0SB53ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB54ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB60ZZ,ICD10-PCS,EXCISION OF COCCYGEAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,HMO,0SB63ZZ,ICD10-PCS,Excision of Coccygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB64ZZ,ICD10-PCS,Excision of Coccygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB70ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB73ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB74ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB80ZZ,ICD10-PCS,EXCISION LEFT SACROILIAC JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,HMO,0SB83ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SB84ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG0070,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG0071,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG007J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG00ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG0370,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG0371,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG037J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG03ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG0470,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG0471,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG047J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG04ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG1070,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG1071,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG107J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG10ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG1370,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG1371,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG137J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG13ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG1470,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG1471,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG147J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG14ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG3070,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG3071,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG307J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG30ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG3370,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG3371,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG337J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG33ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG3470,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG3471,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG347J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34Z0,ICD10-PCS,Fusion of Lumsac Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34Z1,ICD10-PCS,Fusion of Lumsac Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG34ZJ,ICD10-PCS,Fusion of Lumsac Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG504Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG507Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG50JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG50KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG50ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG534Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG537Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG53JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG53KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG53ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG544Z,ICD10-PCS,Fusion of Sacrococcygeal Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG547Z,ICD10-PCS,Fusion Sacrococcygeal Jt w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG54JZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG54KZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG54ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG604Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG607Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG60JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG60KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG60ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG634Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG637Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG63JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG63KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG63ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG644Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG647Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG64JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG64KZ,ICD10-PCS,Fusion of Coccygeal Jt with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG64ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG704Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG707Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG70JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG70KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG70ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG734Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG737Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG73JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG73KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG73ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG744Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG747Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG74JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG74KZ,ICD10-PCS,Fusion R Sacroiliac Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG74ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG804Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG807Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG80JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG80KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG80ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG834Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG837Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG83JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG83KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG83ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG844Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG847Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG84JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SG84KZ,ICD10-PCS,Fusion L Sacroiliac Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SG84ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH00BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH03BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lum Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SH04CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH04DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH30BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SH30CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH30DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH33BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,0SH33CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH33DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH34BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SH34CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Lumsac Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SH34DZ,ICD10-PCS,Insert of Facet Stabl Dev into Lumsac Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR20JZ,ICD10-PCS,Replacement of Lum Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR40JZ,ICD10-PCS,Replacement of Lumsac Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR9019,ICD10-PCS,Replacement of R Hip Jt with Metal, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR901A,ICD10-PCS,Replacement of R Hip Jt with Metal, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR901Z,ICD10-PCS,Replacement of Right Hip Joint with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR9029,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SR902A,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SR902Z,ICD10-PCS,Replacement of R Hip Jt with Metal on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR9039,ICD10-PCS,Replacement of R Hip Jt with Ceramic, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR903A,ICD10-PCS,Replace of R Hip Jt with Ceramic, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR903Z,ICD10-PCS,REPLACE RT HIP JOINT CERAMIC SYNTH SUBST OPEN,,Fee Schedule,8271.00
Blue Shield,HMO,0SR9049,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SR904A,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SR904Z,ICD10-PCS,Replacement of R Hip Jt with Ceramic on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR907Z,ICD10-PCS,Replacement of Right Hip Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR90J9,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR90JA,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR90JZ,ICD10-PCS,Replacement of Right Hip Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SR90KZ,ICD10-PCS,Replacement of R Hip Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA009,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA00A,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA00Z,ICD10-PCS,REPLACEMENT RT HIP JOINT ACETAB SURF POLYETHYLENE SYNTH SUBS,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA019,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA01A,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA01Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA039,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA03A,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA03Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA07Z,ICD10-PCS,Replace of R Hip Jt, Acetab with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA0J9,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA0JA,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA0JZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRA0KZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB019,ICD10-PCS,Replacement of L Hip Jt with Metal, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB01A,ICD10-PCS,Replacement of L Hip Jt with Metal, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB01Z,ICD10-PCS,Replacement of Left Hip Joint with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB029,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB02A,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB02Z,ICD10-PCS,Replacement of L Hip Jt with Metal on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB039,ICD10-PCS,Replacement of L Hip Jt with Ceramic, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB03A,ICD10-PCS,Replace of L Hip Jt with Ceramic, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB03Z,ICD10-PCS,Replacement of Left Hip Joint with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB049,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB04A,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB04Z,ICD10-PCS,Replacement of L Hip Jt with Ceramic on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB07Z,ICD10-PCS,Replacement of Left Hip Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB0J9,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB0JA,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB0JZ,ICD10-PCS,Replacement of Left Hip Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRB0KZ,ICD10-PCS,Replacement of Left Hip Joint with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRC07Z,ICD10-PCS,Replacement of R Knee Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRC0J9,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRC0JA,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRC0JZ,ICD10-PCS,Replacement of R Knee Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRC0KZ,ICD10-PCS,Replacement of R Knee Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRD07Z,ICD10-PCS,Replacement of Left Knee Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRD0J9,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRD0JA,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRD0JZ,ICD10-PCS,Replacement of Left Knee Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRD0KZ,ICD10-PCS,Replacement of L Knee Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE009,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE00A,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE00Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Polyeth, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE019,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE01A,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE01Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE039,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE03A,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE03Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE07Z,ICD10-PCS,Replace of L Hip Jt, Acetab with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE0J9,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE0JA,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE0JZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRE0KZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR019,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR01A,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR01Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR039,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR03A,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR03Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR07Z,ICD10-PCS,Replace of R Hip Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR0J9,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR0JA,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR0JZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRR0KZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS019,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS01A,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS01Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS039,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS03A,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS03Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS07Z,ICD10-PCS,Replace of L Hip Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS0J9,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS0JA,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS0JZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRS0KZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRT07Z,ICD10-PCS,Replace of R Knee Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRT0J9,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRT0JA,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRT0JZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRT0KZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRU07Z,ICD10-PCS,Replace of L Knee Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRU0J9,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRU0JA,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRU0JZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRU0KZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRV07Z,ICD10-PCS,Replace of R Knee Jt, Tibial with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRV0J9,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRV0JA,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRV0JZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRV0KZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRW07Z,ICD10-PCS,Replace of L Knee Jt, Tibial with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRW0J9,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRW0JA,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,HMO,0SRW0JZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SRW0KZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0ST20ZZ,ICD10-PCS,Resection of Lumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0ST40ZZ,ICD10-PCS,Resection of Lumbosacral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU00JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU03JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU04JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU30JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU33JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU34JZ,ICD10-PCS,Supplement Lumsac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU50JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU53JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU54JZ,ICD10-PCS,Supplement Sacrococcygeal Jt w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,HMO,0SU60JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU63JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU64JZ,ICD10-PCS,Supplement Coccygeal Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SU90BZ,ICD10-PCS,Supplement Right Hip Joint with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SUA0BZ,ICD10-PCS,Supplement R Hip Jt, Acetab with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SUB0BZ,ICD10-PCS,Supplement Left Hip Joint with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SUE0BZ,ICD10-PCS,Supplement L Hip Jt, Acetab with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SUR0BZ,ICD10-PCS,Supplement R Hip Jt, Femoral with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SUS0BZ,ICD10-PCS,Supplement L Hip Jt, Femoral with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SW20JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SW23JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SW24JZ,ICD10-PCS,Revision of Synth Sub in Lum Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SW40JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SW43JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SW44JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SW90JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SW93JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SW94JZ,ICD10-PCS,Revision of Synth Sub in R Hip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SWB0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SWB3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SWB4JZ,ICD10-PCS,Revision of Synth Sub in L Hip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SWC0JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SWC3JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SWC4JZ,ICD10-PCS,Revision of Synth Sub in R Knee Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SWD0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SWD3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0SWD4JZ,ICD10-PCS,Revision of Synth Sub in L Knee Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0WFD0ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0WFD3ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0WFD4ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,HMO,0WFDXZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, External Approach,,Fee Schedule,8271.00
Blue Shield,HMO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Fee Schedule,987.79
Blue Shield,HMO,10022,CPT4/HCPCS,FNA W/IMAGE,,Fee Schedule,3198.57
Blue Shield,HMO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Fee Schedule,3198.57
Blue Shield,HMO,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Fee Schedule,3198.57
Blue Shield,HMO,10040,CPT4/HCPCS,ACNE SURGERY,,Fee Schedule,987.79
Blue Shield,HMO,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Fee Schedule,987.79
Blue Shield,HMO,10061,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,10080,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Fee Schedule,987.79
Blue Shield,HMO,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Fee Schedule,3198.57
Blue Shield,HMO,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,HMO,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,HMO,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Fee Schedule,3198.57
Blue Shield,HMO,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Fee Schedule,987.79
Blue Shield,HMO,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Fee Schedule,4280.44
Blue Shield,HMO,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Fee Schedule,987.79
Blue Shield,HMO,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Fee Schedule,987.79
Blue Shield,HMO,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,Fee Schedule,3198.57
Blue Shield,HMO,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,Fee Schedule,3198.57
Blue Shield,HMO,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,Fee Schedule,3198.57
Blue Shield,HMO,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,Fee Schedule,987.79
Blue Shield,HMO,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Fee Schedule,4280.44
Blue Shield,HMO,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Fee Schedule,4280.44
Blue Shield,HMO,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Fee Schedule,4280.44
Blue Shield,HMO,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,HMO,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,HMO,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,HMO,11055,CPT4/HCPCS,TRIM SKIN LESION,,Fee Schedule,987.79
Blue Shield,HMO,11056,CPT4/HCPCS,TRIM SKIN LESIONS 2 TO 4,,Fee Schedule,987.79
Blue Shield,HMO,11057,CPT4/HCPCS,TRIM SKIN LESIONS OVER 4,,Fee Schedule,987.79
Blue Shield,HMO,11100,CPT4/HCPCS,BIOPSY SKIN LESION,,Fee Schedule,987.79
Blue Shield,HMO,11101,CPT4/HCPCS,BIOPSY SKIN ADD-ON,,Fee Schedule,987.79
Blue Shield,HMO,11200,CPT4/HCPCS,REMOVAL OF SKIN TAGS 2.0 CM,,Fee Schedule,987.79
Blue Shield,HMO,11305,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Fee Schedule,987.79
Blue Shield,HMO,11306,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Fee Schedule,987.79
Blue Shield,HMO,11307,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Fee Schedule,987.79
Blue Shield,HMO,11308,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Fee Schedule,987.79
Blue Shield,HMO,11310,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Fee Schedule,987.79
Blue Shield,HMO,11311,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Fee Schedule,987.79
Blue Shield,HMO,11312,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Fee Schedule,987.79
Blue Shield,HMO,11313,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Fee Schedule,987.79
Blue Shield,HMO,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,Fee Schedule,3198.57
Blue Shield,HMO,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,HMO,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,HMO,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,Fee Schedule,3198.57
Blue Shield,HMO,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,Fee Schedule,3198.57
Blue Shield,HMO,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,Fee Schedule,4280.44
Blue Shield,HMO,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Fee Schedule,3198.57
Blue Shield,HMO,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Fee Schedule,3198.57
Blue Shield,HMO,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Fee Schedule,3198.57
Blue Shield,HMO,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Fee Schedule,3198.57
Blue Shield,HMO,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Fee Schedule,4280.44
Blue Shield,HMO,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Fee Schedule,3198.57
Blue Shield,HMO,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,HMO,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,HMO,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Fee Schedule,3198.57
Blue Shield,HMO,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Fee Schedule,3198.57
Blue Shield,HMO,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,HMO,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,HMO,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,HMO,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,HMO,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,HMO,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,HMO,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Fee Schedule,3198.57
Blue Shield,HMO,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,HMO,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,HMO,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Fee Schedule,3198.57
Blue Shield,HMO,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Fee Schedule,3198.57
Blue Shield,HMO,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Fee Schedule,3198.57
Blue Shield,HMO,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Fee Schedule,3198.57
Blue Shield,HMO,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Fee Schedule,3198.57
Blue Shield,HMO,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Fee Schedule,4280.44
Blue Shield,HMO,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Fee Schedule,3198.57
Blue Shield,HMO,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Fee Schedule,3198.57
Blue Shield,HMO,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Fee Schedule,3198.57
Blue Shield,HMO,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Fee Schedule,3198.57
Blue Shield,HMO,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Fee Schedule,4280.44
Blue Shield,HMO,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,11719,CPT4/HCPCS,TRIM NAIL(S) ANY NUMBER,,Fee Schedule,987.79
Blue Shield,HMO,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Fee Schedule,987.79
Blue Shield,HMO,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Fee Schedule,987.79
Blue Shield,HMO,11730,CPT4/HCPCS,REMOVAL OF NAIL PLATE,,Fee Schedule,987.79
Blue Shield,HMO,11732,CPT4/HCPCS,REMOVE NAIL PLATE ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,11740,CPT4/HCPCS,DRAIN BLOOD FROM UNDER NAIL,,Fee Schedule,987.79
Blue Shield,HMO,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,HMO,11755,CPT4/HCPCS,BIOPSY NAIL UNIT,,Fee Schedule,3198.57
Blue Shield,HMO,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,HMO,11762,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,HMO,11765,CPT4/HCPCS,EXCISION OF NAIL FOLD TOE,,Fee Schedule,987.79
Blue Shield,HMO,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Fee Schedule,4891.93
Blue Shield,HMO,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Fee Schedule,4891.93
Blue Shield,HMO,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Fee Schedule,4891.93
Blue Shield,HMO,11900,CPT4/HCPCS,INJECT SKIN LESIONS 7,,Fee Schedule,987.79
Blue Shield,HMO,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Fee Schedule,3198.57
Blue Shield,HMO,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Fee Schedule,987.79
Blue Shield,HMO,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Fee Schedule,987.79
Blue Shield,HMO,11950,CPT4/HCPCS,TX CONTOUR DEFECTS 1 CC/<,,Fee Schedule,987.79
Blue Shield,HMO,11951,CPT4/HCPCS,TX CONTOUR DEFECTS 1.1-5.0CC,,Fee Schedule,987.79
Blue Shield,HMO,11952,CPT4/HCPCS,TX CONTOUR DEFECTS 5.1-10CC,,Fee Schedule,987.79
Blue Shield,HMO,11954,CPT4/HCPCS,TX CONTOUR DEFECTS >10.0 CC,,Fee Schedule,987.79
Blue Shield,HMO,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Fee Schedule,4280.44
Blue Shield,HMO,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Fee Schedule,4891.93
Blue Shield,HMO,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Fee Schedule,3198.57
Blue Shield,HMO,11976,CPT4/HCPCS,REMOVE CONTRACEPTIVE CAPSULE,,Fee Schedule,3198.57
Blue Shield,HMO,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Fee Schedule,987.79
Blue Shield,HMO,11981,CPT4/HCPCS,INSERT DRUG IMPLANT DEVICE,,Fee Schedule,987.79
Blue Shield,HMO,11982,CPT4/HCPCS,REMOVE DRUG IMPLANT DEVICE,,Fee Schedule,987.79
Blue Shield,HMO,11983,CPT4/HCPCS,REMOVE/INSERT DRUG IMPLANT,,Fee Schedule,3198.57
Blue Shield,HMO,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Fee Schedule,987.79
Blue Shield,HMO,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,Fee Schedule,987.79
Blue Shield,HMO,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Fee Schedule,987.79
Blue Shield,HMO,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Fee Schedule,4280.44
Blue Shield,HMO,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Fee Schedule,4280.44
Blue Shield,HMO,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Fee Schedule,4280.44
Blue Shield,HMO,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,Fee Schedule,987.79
Blue Shield,HMO,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,Fee Schedule,987.79
Blue Shield,HMO,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Fee Schedule,987.79
Blue Shield,HMO,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Fee Schedule,987.79
Blue Shield,HMO,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Fee Schedule,4280.44
Blue Shield,HMO,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Fee Schedule,4280.44
Blue Shield,HMO,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Fee Schedule,4280.44
Blue Shield,HMO,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Fee Schedule,3198.57
Blue Shield,HMO,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Fee Schedule,3198.57
Blue Shield,HMO,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Fee Schedule,4280.44
Blue Shield,HMO,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Fee Schedule,4280.44
Blue Shield,HMO,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Fee Schedule,4280.44
Blue Shield,HMO,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Fee Schedule,4280.44
Blue Shield,HMO,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Fee Schedule,3198.57
Blue Shield,HMO,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Fee Schedule,3198.57
Blue Shield,HMO,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Fee Schedule,4280.44
Blue Shield,HMO,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Fee Schedule,4280.44
Blue Shield,HMO,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Fee Schedule,4280.44
Blue Shield,HMO,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Fee Schedule,4280.44
Blue Shield,HMO,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Fee Schedule,3198.57
Blue Shield,HMO,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Fee Schedule,3198.57
Blue Shield,HMO,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Fee Schedule,3198.57
Blue Shield,HMO,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Fee Schedule,4280.44
Blue Shield,HMO,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Fee Schedule,4280.44
Blue Shield,HMO,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Fee Schedule,4280.44
Blue Shield,HMO,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Fee Schedule,4280.44
Blue Shield,HMO,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Fee Schedule,4280.44
Blue Shield,HMO,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Fee Schedule,3198.57
Blue Shield,HMO,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Fee Schedule,4280.44
Blue Shield,HMO,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Fee Schedule,3198.57
Blue Shield,HMO,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,4280.44
Blue Shield,HMO,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,4891.93
Blue Shield,HMO,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,3198.57
Blue Shield,HMO,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Fee Schedule,3198.57
Blue Shield,HMO,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Fee Schedule,4280.44
Blue Shield,HMO,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,HMO,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Fee Schedule,4891.93
Blue Shield,HMO,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Fee Schedule,4891.93
Blue Shield,HMO,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Fee Schedule,4891.93
Blue Shield,HMO,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Fee Schedule,4280.44
Blue Shield,HMO,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Fee Schedule,4891.93
Blue Shield,HMO,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Fee Schedule,4891.93
Blue Shield,HMO,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Fee Schedule,4891.93
Blue Shield,HMO,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Fee Schedule,4891.93
Blue Shield,HMO,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Fee Schedule,3198.57
Blue Shield,HMO,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Fee Schedule,4891.93
Blue Shield,HMO,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,HMO,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Fee Schedule,3198.57
Blue Shield,HMO,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Fee Schedule,4280.44
Blue Shield,HMO,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Fee Schedule,3198.57
Blue Shield,HMO,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,HMO,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Fee Schedule,4891.93
Blue Shield,HMO,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,HMO,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,HMO,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,HMO,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Fee Schedule,4891.93
Blue Shield,HMO,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,HMO,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,HMO,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Fee Schedule,3198.57
Blue Shield,HMO,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,HMO,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Fee Schedule,3198.57
Blue Shield,HMO,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Fee Schedule,4280.44
Blue Shield,HMO,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Fee Schedule,3198.57
Blue Shield,HMO,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Fee Schedule,3198.57
Blue Shield,HMO,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Fee Schedule,4891.93
Blue Shield,HMO,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Fee Schedule,4280.44
Blue Shield,HMO,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,HMO,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,HMO,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Fee Schedule,4891.93
Blue Shield,HMO,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4891.93
Blue Shield,HMO,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Fee Schedule,4280.44
Blue Shield,HMO,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,HMO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,HMO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Fee Schedule,987.79
Blue Shield,HMO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Fee Schedule,4280.44
Blue Shield,HMO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Fee Schedule,987.79
Blue Shield,HMO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Fee Schedule,4280.44
Blue Shield,HMO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Fee Schedule,987.79
Blue Shield,HMO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Fee Schedule,4280.44
Blue Shield,HMO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Fee Schedule,987.79
Blue Shield,HMO,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Fee Schedule,4891.93
Blue Shield,HMO,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Fee Schedule,4891.93
Blue Shield,HMO,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Fee Schedule,4891.93
Blue Shield,HMO,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Fee Schedule,4891.93
Blue Shield,HMO,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Fee Schedule,4891.93
Blue Shield,HMO,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Fee Schedule,4891.93
Blue Shield,HMO,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Fee Schedule,6049.05
Blue Shield,HMO,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Fee Schedule,4891.93
Blue Shield,HMO,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Fee Schedule,6876.92
Blue Shield,HMO,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Fee Schedule,4891.93
Blue Shield,HMO,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Fee Schedule,4891.93
Blue Shield,HMO,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Fee Schedule,4891.93
Blue Shield,HMO,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Fee Schedule,4891.93
Blue Shield,HMO,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Fee Schedule,4891.93
Blue Shield,HMO,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Fee Schedule,4891.93
Blue Shield,HMO,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Fee Schedule,4280.44
Blue Shield,HMO,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,HMO,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,HMO,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,HMO,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Fee Schedule,4891.93
Blue Shield,HMO,15775,CPT4/HCPCS,HAIR TRNSPL 1-15 PUNCH GRFTS,,Fee Schedule,4891.93
Blue Shield,HMO,15776,CPT4/HCPCS,HAIR TRNSPL >15 PUNCH GRAFTS,,Fee Schedule,4891.93
Blue Shield,HMO,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,Fee Schedule,4891.93
Blue Shield,HMO,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,Fee Schedule,3198.57
Blue Shield,HMO,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,Fee Schedule,3198.57
Blue Shield,HMO,15783,CPT4/HCPCS,DERMABRASION SUPRFL ANY SITE,,Fee Schedule,987.79
Blue Shield,HMO,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,Fee Schedule,987.79
Blue Shield,HMO,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,Fee Schedule,987.79
Blue Shield,HMO,15788,CPT4/HCPCS,CHEMICAL PEEL FACE EPIDERM,,Fee Schedule,987.79
Blue Shield,HMO,15789,CPT4/HCPCS,CHEMICAL PEEL FACE DERMAL,,Fee Schedule,987.79
Blue Shield,HMO,15792,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Fee Schedule,987.79
Blue Shield,HMO,15793,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Fee Schedule,987.79
Blue Shield,HMO,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Fee Schedule,3198.57
Blue Shield,HMO,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Fee Schedule,6876.92
Blue Shield,HMO,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Fee Schedule,4891.93
Blue Shield,HMO,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Fee Schedule,4891.93
Blue Shield,HMO,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Fee Schedule,4891.93
Blue Shield,HMO,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Fee Schedule,4891.93
Blue Shield,HMO,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Fee Schedule,6876.92
Blue Shield,HMO,15830,CPT4/HCPCS,EXC SKIN ABD,,Fee Schedule,4891.93
Blue Shield,HMO,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Fee Schedule,4891.93
Blue Shield,HMO,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Fee Schedule,4891.93
Blue Shield,HMO,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Fee Schedule,4891.93
Blue Shield,HMO,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Fee Schedule,4891.93
Blue Shield,HMO,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Fee Schedule,3198.57
Blue Shield,HMO,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Fee Schedule,3198.57
Blue Shield,HMO,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Fee Schedule,3198.57
Blue Shield,HMO,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Fee Schedule,3198.57
Blue Shield,HMO,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Fee Schedule,6049.05
Blue Shield,HMO,15847,CPT4/HCPCS,EXC SKIN ABD ADD-ON,,Fee Schedule,4891.93
Blue Shield,HMO,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Fee Schedule,3198.57
Blue Shield,HMO,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Fee Schedule,3198.57
Blue Shield,HMO,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Fee Schedule,3198.57
Blue Shield,HMO,15860,CPT4/HCPCS,TEST FOR BLOOD FLOW IN GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Fee Schedule,4891.93
Blue Shield,HMO,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Fee Schedule,4891.93
Blue Shield,HMO,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Fee Schedule,4891.93
Blue Shield,HMO,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Fee Schedule,4891.93
Blue Shield,HMO,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Fee Schedule,4891.93
Blue Shield,HMO,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Fee Schedule,6049.05
Blue Shield,HMO,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,HMO,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,HMO,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,HMO,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,HMO,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,HMO,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,HMO,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,HMO,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,HMO,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,HMO,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,HMO,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,HMO,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,HMO,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,HMO,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,HMO,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,HMO,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,HMO,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,HMO,15999,CPT4/HCPCS,REMOVAL OF PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,HMO,16000,CPT4/HCPCS,INITIAL TREATMENT OF BURN(S),,Fee Schedule,987.79
Blue Shield,HMO,16020,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN S,,Fee Schedule,987.79
Blue Shield,HMO,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Fee Schedule,4280.44
Blue Shield,HMO,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Fee Schedule,4280.44
Blue Shield,HMO,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Fee Schedule,3198.57
Blue Shield,HMO,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,Fee Schedule,3198.57
Blue Shield,HMO,17000,CPT4/HCPCS,DESTRUCT PREMALG LESION,,Fee Schedule,987.79
Blue Shield,HMO,17003,CPT4/HCPCS,DESTRUCT PREMALG LES 2-14,,Fee Schedule,987.79
Blue Shield,HMO,17004,CPT4/HCPCS,DESTROY PREMAL LESIONS 15/>,,Fee Schedule,987.79
Blue Shield,HMO,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,HMO,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,HMO,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,HMO,17110,CPT4/HCPCS,DESTRUCT B9 LESION 1-14,,Fee Schedule,987.79
Blue Shield,HMO,17111,CPT4/HCPCS,DESTRUCT LESION 15 OR MORE,,Fee Schedule,987.79
Blue Shield,HMO,17250,CPT4/HCPCS,CHEM CAUT OF GRANLTJ TISSUE,,Fee Schedule,987.79
Blue Shield,HMO,17260,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17261,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17262,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17263,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17264,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17266,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17270,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17271,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17272,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17273,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17274,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17276,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17280,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17281,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17282,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17283,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17284,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17286,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,17311,CPT4/HCPCS,MOHS 1 STAGE H/N/HF/G,,Fee Schedule,3198.57
Blue Shield,HMO,17312,CPT4/HCPCS,MOHS ADDL STAGE,,Fee Schedule,3198.57
Blue Shield,HMO,17313,CPT4/HCPCS,MOHS 1 STAGE T/A/L,,Fee Schedule,3198.57
Blue Shield,HMO,17314,CPT4/HCPCS,MOHS ADDL STAGE T/A/L,,Fee Schedule,3198.57
Blue Shield,HMO,17315,CPT4/HCPCS,MOHS SURG ADDL BLOCK,,Fee Schedule,3198.57
Blue Shield,HMO,17340,CPT4/HCPCS,CRYOTHERAPY OF SKIN,,Fee Schedule,987.79
Blue Shield,HMO,17360,CPT4/HCPCS,SKIN PEEL THERAPY,,Fee Schedule,987.79
Blue Shield,HMO,17380,CPT4/HCPCS,HAIR REMOVAL BY ELECTROLYSIS,,Fee Schedule,987.79
Blue Shield,HMO,17999,CPT4/HCPCS,SKIN TISSUE PROCEDURE,,Fee Schedule,987.79
Blue Shield,HMO,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Fee Schedule,987.79
Blue Shield,HMO,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Fee Schedule,987.79
Blue Shield,HMO,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Fee Schedule,4280.44
Blue Shield,HMO,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Fee Schedule,4280.44
Blue Shield,HMO,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Fee Schedule,4280.44
Blue Shield,HMO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Fee Schedule,4280.44
Blue Shield,HMO,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Fee Schedule,3198.57
Blue Shield,HMO,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Fee Schedule,4280.44
Blue Shield,HMO,19105,CPT4/HCPCS,CRYOSURG ABLATE FA EACH,,Fee Schedule,3198.57
Blue Shield,HMO,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Fee Schedule,4280.44
Blue Shield,HMO,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Fee Schedule,4891.93
Blue Shield,HMO,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Fee Schedule,4891.93
Blue Shield,HMO,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Fee Schedule,4891.93
Blue Shield,HMO,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Fee Schedule,4891.93
Blue Shield,HMO,19260,CPT4/HCPCS,REMOVAL OF CHEST WALL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,19271,CPT4/HCPCS,REVISION OF CHEST WALL,,Fee Schedule,4280.44
Blue Shield,HMO,19272,CPT4/HCPCS,EXTENSIVE CHEST WALL SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Fee Schedule,12850.71
Blue Shield,HMO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Fee Schedule,12850.71
Blue Shield,HMO,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Fee Schedule,12850.71
Blue Shield,HMO,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Fee Schedule,12850.71
Blue Shield,HMO,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Fee Schedule,6049.05
Blue Shield,HMO,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Fee Schedule,4891.93
Blue Shield,HMO,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Fee Schedule,9548.66
Blue Shield,HMO,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Fee Schedule,6049.05
Blue Shield,HMO,19304,CPT4/HCPCS,MAST SUBQ,,Fee Schedule,6049.05
Blue Shield,HMO,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Fee Schedule,6049.05
Blue Shield,HMO,19318,CPT4/HCPCS,BREAST REDUCTION,,Fee Schedule,6049.05
Blue Shield,HMO,19324,CPT4/HCPCS,ENLARGE BREAST,,Fee Schedule,6049.05
Blue Shield,HMO,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Fee Schedule,12850.71
Blue Shield,HMO,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Fee Schedule,3198.57
Blue Shield,HMO,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Fee Schedule,3198.57
Blue Shield,HMO,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Fee Schedule,4280.44
Blue Shield,HMO,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Fee Schedule,4891.93
Blue Shield,HMO,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,HMO,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Fee Schedule,6049.05
Blue Shield,HMO,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Fee Schedule,6876.92
Blue Shield,HMO,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,Fee Schedule,4280.44
Blue Shield,HMO,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Fee Schedule,7902.34
Blue Shield,HMO,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Fee Schedule,6876.92
Blue Shield,HMO,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,Fee Schedule,4891.93
Blue Shield,HMO,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,Fee Schedule,6049.05
Blue Shield,HMO,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,Fee Schedule,6049.05
Blue Shield,HMO,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Fee Schedule,6049.05
Blue Shield,HMO,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Fee Schedule,6049.05
Blue Shield,HMO,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Fee Schedule,6876.92
Blue Shield,HMO,19396,CPT4/HCPCS,DESIGN CUSTOM BREAST IMPLANT,,Fee Schedule,7902.34
Blue Shield,HMO,19499,CPT4/HCPCS,BREAST SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,HMO,20005,CPT4/HCPCS,I&D ABSCESS SUBFASCIAL,,Fee Schedule,4280.44
Blue Shield,HMO,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,Fee Schedule,3198.57
Blue Shield,HMO,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,Fee Schedule,4280.44
Blue Shield,HMO,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,Fee Schedule,4280.44
Blue Shield,HMO,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Fee Schedule,3198.57
Blue Shield,HMO,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,Fee Schedule,9548.66
Blue Shield,HMO,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Fee Schedule,4280.44
Blue Shield,HMO,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Fee Schedule,4891.93
Blue Shield,HMO,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Fee Schedule,3198.57
Blue Shield,HMO,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Fee Schedule,3198.57
Blue Shield,HMO,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Fee Schedule,4280.44
Blue Shield,HMO,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Fee Schedule,4280.44
Blue Shield,HMO,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Fee Schedule,4891.93
Blue Shield,HMO,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Fee Schedule,4891.93
Blue Shield,HMO,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Fee Schedule,4891.93
Blue Shield,HMO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Fee Schedule,987.79
Blue Shield,HMO,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,HMO,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,4891.93
Blue Shield,HMO,20526,CPT4/HCPCS,THER INJECTION CARP TUNNEL,,Fee Schedule,987.79
Blue Shield,HMO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Fee Schedule,987.79
Blue Shield,HMO,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Fee Schedule,987.79
Blue Shield,HMO,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Fee Schedule,987.79
Blue Shield,HMO,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Fee Schedule,987.79
Blue Shield,HMO,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Fee Schedule,987.79
Blue Shield,HMO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Fee Schedule,3198.57
Blue Shield,HMO,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,HMO,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,HMO,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,HMO,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,HMO,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,HMO,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,HMO,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Fee Schedule,987.79
Blue Shield,HMO,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Fee Schedule,987.79
Blue Shield,HMO,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Fee Schedule,4891.93
Blue Shield,HMO,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Fee Schedule,3198.57
Blue Shield,HMO,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Fee Schedule,3198.57
Blue Shield,HMO,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Fee Schedule,3198.57
Blue Shield,HMO,20664,CPT4/HCPCS,APPLICATION OF HALO,,Fee Schedule,3198.57
Blue Shield,HMO,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Fee Schedule,3198.57
Blue Shield,HMO,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Fee Schedule,4891.93
Blue Shield,HMO,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Fee Schedule,4280.44
Blue Shield,HMO,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Fee Schedule,4891.93
Blue Shield,HMO,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Fee Schedule,4891.93
Blue Shield,HMO,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Fee Schedule,4891.93
Blue Shield,HMO,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Fee Schedule,4280.44
Blue Shield,HMO,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,Fee Schedule,7902.34
Blue Shield,HMO,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,Fee Schedule,12850.71
Blue Shield,HMO,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,Fee Schedule,12850.71
Blue Shield,HMO,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Fee Schedule,12850.71
Blue Shield,HMO,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Fee Schedule,12850.71
Blue Shield,HMO,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Fee Schedule,12850.71
Blue Shield,HMO,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Fee Schedule,12850.71
Blue Shield,HMO,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,Fee Schedule,7902.34
Blue Shield,HMO,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,HMO,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,HMO,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,HMO,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,HMO,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,20926,CPT4/HCPCS,REMOVAL OF TISSUE FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Fee Schedule,3198.57
Blue Shield,HMO,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Fee Schedule,987.79
Blue Shield,HMO,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Fee Schedule,9548.66
Blue Shield,HMO,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,Fee Schedule,7902.34
Blue Shield,HMO,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,Fee Schedule,6876.92
Blue Shield,HMO,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Fee Schedule,7902.34
Blue Shield,HMO,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Fee Schedule,9548.66
Blue Shield,HMO,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Fee Schedule,9548.66
Blue Shield,HMO,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Fee Schedule,6049.05
Blue Shield,HMO,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Fee Schedule,9548.66
Blue Shield,HMO,20974,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Fee Schedule,987.79
Blue Shield,HMO,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Fee Schedule,4280.44
Blue Shield,HMO,20979,CPT4/HCPCS,US BONE STIMULATION,,Fee Schedule,987.79
Blue Shield,HMO,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Fee Schedule,9548.66
Blue Shield,HMO,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Fee Schedule,9548.66
Blue Shield,HMO,20999,CPT4/HCPCS,MUSCULOSKELETAL SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Fee Schedule,4280.44
Blue Shield,HMO,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Fee Schedule,4891.93
Blue Shield,HMO,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Fee Schedule,4891.93
Blue Shield,HMO,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Fee Schedule,4280.44
Blue Shield,HMO,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Fee Schedule,4280.44
Blue Shield,HMO,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Fee Schedule,6049.05
Blue Shield,HMO,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Fee Schedule,6049.05
Blue Shield,HMO,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Fee Schedule,6049.05
Blue Shield,HMO,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Fee Schedule,4891.93
Blue Shield,HMO,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Fee Schedule,4280.44
Blue Shield,HMO,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Fee Schedule,4280.44
Blue Shield,HMO,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Fee Schedule,9548.66
Blue Shield,HMO,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Fee Schedule,9548.66
Blue Shield,HMO,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Fee Schedule,4280.44
Blue Shield,HMO,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Fee Schedule,4891.93
Blue Shield,HMO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Fee Schedule,3198.57
Blue Shield,HMO,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,6049.05
Blue Shield,HMO,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,HMO,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,HMO,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,HMO,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,HMO,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,HMO,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,HMO,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,HMO,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,HMO,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,HMO,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,HMO,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,HMO,21089,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,HMO,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Fee Schedule,4280.44
Blue Shield,HMO,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Fee Schedule,3198.57
Blue Shield,HMO,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,6049.05
Blue Shield,HMO,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,HMO,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,HMO,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,HMO,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Fee Schedule,6049.05
Blue Shield,HMO,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Fee Schedule,12850.71
Blue Shield,HMO,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,6049.05
Blue Shield,HMO,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,9548.66
Blue Shield,HMO,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,9548.66
Blue Shield,HMO,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,Fee Schedule,4891.93
Blue Shield,HMO,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,Fee Schedule,6049.05
Blue Shield,HMO,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,Fee Schedule,6049.05
Blue Shield,HMO,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,Fee Schedule,6876.92
Blue Shield,HMO,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,Fee Schedule,6876.92
Blue Shield,HMO,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,Fee Schedule,9548.66
Blue Shield,HMO,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Fee Schedule,4891.93
Blue Shield,HMO,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Fee Schedule,6049.05
Blue Shield,HMO,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Fee Schedule,6049.05
Blue Shield,HMO,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Fee Schedule,6049.05
Blue Shield,HMO,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Fee Schedule,9548.66
Blue Shield,HMO,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6876.92
Blue Shield,HMO,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6876.92
Blue Shield,HMO,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6049.05
Blue Shield,HMO,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,Fee Schedule,4891.93
Blue Shield,HMO,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Fee Schedule,3198.57
Blue Shield,HMO,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,Fee Schedule,4280.44
Blue Shield,HMO,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Fee Schedule,9548.66
Blue Shield,HMO,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Fee Schedule,9548.66
Blue Shield,HMO,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Fee Schedule,6876.92
Blue Shield,HMO,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Fee Schedule,9548.66
Blue Shield,HMO,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Fee Schedule,6876.92
Blue Shield,HMO,21210,CPT4/HCPCS,FACE BONE GRAFT,,Fee Schedule,9548.66
Blue Shield,HMO,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Fee Schedule,9548.66
Blue Shield,HMO,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Fee Schedule,9548.66
Blue Shield,HMO,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Fee Schedule,9548.66
Blue Shield,HMO,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Fee Schedule,9548.66
Blue Shield,HMO,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,HMO,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,HMO,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Fee Schedule,6049.05
Blue Shield,HMO,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,HMO,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,HMO,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Fee Schedule,4280.44
Blue Shield,HMO,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,Fee Schedule,4280.44
Blue Shield,HMO,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,HMO,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,HMO,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,HMO,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,HMO,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,4280.44
Blue Shield,HMO,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Fee Schedule,6876.92
Blue Shield,HMO,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Fee Schedule,9548.66
Blue Shield,HMO,21280,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,6876.92
Blue Shield,HMO,21282,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,6876.92
Blue Shield,HMO,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Fee Schedule,3198.57
Blue Shield,HMO,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Fee Schedule,3198.57
Blue Shield,HMO,21299,CPT4/HCPCS,CRANIO/MAXILLOFACIAL SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Fee Schedule,4280.44
Blue Shield,HMO,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Fee Schedule,4280.44
Blue Shield,HMO,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Fee Schedule,4280.44
Blue Shield,HMO,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Fee Schedule,6049.05
Blue Shield,HMO,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Fee Schedule,6876.92
Blue Shield,HMO,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Fee Schedule,9548.66
Blue Shield,HMO,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Fee Schedule,6049.05
Blue Shield,HMO,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Fee Schedule,4280.44
Blue Shield,HMO,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Fee Schedule,6049.05
Blue Shield,HMO,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Fee Schedule,6876.92
Blue Shield,HMO,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Fee Schedule,6049.05
Blue Shield,HMO,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Fee Schedule,3198.57
Blue Shield,HMO,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Fee Schedule,4280.44
Blue Shield,HMO,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Fee Schedule,9548.66
Blue Shield,HMO,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Fee Schedule,3198.57
Blue Shield,HMO,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Fee Schedule,3198.57
Blue Shield,HMO,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Fee Schedule,3198.57
Blue Shield,HMO,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Fee Schedule,3198.57
Blue Shield,HMO,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Fee Schedule,4280.44
Blue Shield,HMO,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Fee Schedule,3198.57
Blue Shield,HMO,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Fee Schedule,3198.57
Blue Shield,HMO,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Fee Schedule,3198.57
Blue Shield,HMO,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Fee Schedule,9548.66
Blue Shield,HMO,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Fee Schedule,3198.57
Blue Shield,HMO,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Fee Schedule,4280.44
Blue Shield,HMO,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Fee Schedule,4891.93
Blue Shield,HMO,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,Fee Schedule,3198.57
Blue Shield,HMO,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6876.92
Blue Shield,HMO,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6876.92
Blue Shield,HMO,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,9548.66
Blue Shield,HMO,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Fee Schedule,3198.57
Blue Shield,HMO,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Fee Schedule,4280.44
Blue Shield,HMO,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Fee Schedule,4891.93
Blue Shield,HMO,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Fee Schedule,4280.44
Blue Shield,HMO,21499,CPT4/HCPCS,HEAD SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,HMO,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Fee Schedule,4280.44
Blue Shield,HMO,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Fee Schedule,4280.44
Blue Shield,HMO,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,3198.57
Blue Shield,HMO,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Fee Schedule,3198.57
Blue Shield,HMO,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,HMO,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,HMO,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Fee Schedule,3198.57
Blue Shield,HMO,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,HMO,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,HMO,21615,CPT4/HCPCS,REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,HMO,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,Fee Schedule,4280.44
Blue Shield,HMO,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Fee Schedule,3198.57
Blue Shield,HMO,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,Fee Schedule,4280.44
Blue Shield,HMO,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Fee Schedule,3198.57
Blue Shield,HMO,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4280.44
Blue Shield,HMO,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,Fee Schedule,4280.44
Blue Shield,HMO,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4891.93
Blue Shield,HMO,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4891.93
Blue Shield,HMO,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Fee Schedule,4280.44
Blue Shield,HMO,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Fee Schedule,9548.66
Blue Shield,HMO,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Fee Schedule,9548.66
Blue Shield,HMO,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,Fee Schedule,3198.57
Blue Shield,HMO,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Fee Schedule,4891.93
Blue Shield,HMO,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,21899,CPT4/HCPCS,NECK/CHEST SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Fee Schedule,3198.57
Blue Shield,HMO,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Fee Schedule,4280.44
Blue Shield,HMO,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,HMO,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Fee Schedule,9548.66
Blue Shield,HMO,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Fee Schedule,9548.66
Blue Shield,HMO,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Fee Schedule,9548.66
Blue Shield,HMO,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Fee Schedule,9548.66
Blue Shield,HMO,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Fee Schedule,3198.57
Blue Shield,HMO,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Fee Schedule,3198.57
Blue Shield,HMO,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Fee Schedule,3198.57
Blue Shield,HMO,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,HMO,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,Fee Schedule,4891.93
Blue Shield,HMO,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,Fee Schedule,4280.44
Blue Shield,HMO,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,Fee Schedule,4891.93
Blue Shield,HMO,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,HMO,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,Fee Schedule,4891.93
Blue Shield,HMO,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,Fee Schedule,4280.44
Blue Shield,HMO,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,Fee Schedule,4891.93
Blue Shield,HMO,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,HMO,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Fee Schedule,3198.57
Blue Shield,HMO,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Fee Schedule,4280.44
Blue Shield,HMO,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Fee Schedule,4891.93
Blue Shield,HMO,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Fee Schedule,3198.57
Blue Shield,HMO,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Fee Schedule,4280.44
Blue Shield,HMO,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Fee Schedule,6876.92
Blue Shield,HMO,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Fee Schedule,6876.92
Blue Shield,HMO,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Fee Schedule,9548.66
Blue Shield,HMO,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,6876.92
Blue Shield,HMO,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,6876.92
Blue Shield,HMO,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,9548.66
Blue Shield,HMO,22532,CPT4/HCPCS,LAT THORAX SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,HMO,22533,CPT4/HCPCS,LAT LUMBAR SPINE FUSION,,Fee Schedule,3198.57
Blue Shield,HMO,22534,CPT4/HCPCS,LAT THOR/LUMB ADDL SEG,,Fee Schedule,3198.57
Blue Shield,HMO,22548,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,HMO,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Fee Schedule,4891.93
Blue Shield,HMO,22554,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,6876.92
Blue Shield,HMO,22556,CPT4/HCPCS,THORAX SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,HMO,22558,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,HMO,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,Fee Schedule,3198.57
Blue Shield,HMO,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,Fee Schedule,7902.34
Blue Shield,HMO,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,Fee Schedule,4891.93
Blue Shield,HMO,22595,CPT4/HCPCS,NECK SPINAL FUSION,,Fee Schedule,4280.44
Blue Shield,HMO,22600,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,HMO,22610,CPT4/HCPCS,THORAX SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,HMO,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,9548.66
Blue Shield,HMO,22614,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,9548.66
Blue Shield,HMO,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,HMO,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,3198.57
Blue Shield,HMO,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,Fee Schedule,7902.34
Blue Shield,HMO,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,3198.57
Blue Shield,HMO,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,Fee Schedule,4280.44
Blue Shield,HMO,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,Fee Schedule,6876.92
Blue Shield,HMO,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,Fee Schedule,6876.92
Blue Shield,HMO,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,Fee Schedule,6049.05
Blue Shield,HMO,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,Fee Schedule,6049.05
Blue Shield,HMO,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,Fee Schedule,6876.92
Blue Shield,HMO,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,Fee Schedule,6876.92
Blue Shield,HMO,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,Fee Schedule,6876.92
Blue Shield,HMO,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,Fee Schedule,3198.57
Blue Shield,HMO,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,Fee Schedule,4280.44
Blue Shield,HMO,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Fee Schedule,987.79
Blue Shield,HMO,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Fee Schedule,3198.57
Blue Shield,HMO,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Fee Schedule,3198.57
Blue Shield,HMO,22899,CPT4/HCPCS,SPINE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Fee Schedule,6049.05
Blue Shield,HMO,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,HMO,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Fee Schedule,4891.93
Blue Shield,HMO,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,22999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Fee Schedule,4891.93
Blue Shield,HMO,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Fee Schedule,4280.44
Blue Shield,HMO,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Fee Schedule,3198.57
Blue Shield,HMO,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Fee Schedule,4891.93
Blue Shield,HMO,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Fee Schedule,3198.57
Blue Shield,HMO,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Fee Schedule,4280.44
Blue Shield,HMO,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,HMO,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,HMO,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Fee Schedule,9548.66
Blue Shield,HMO,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Fee Schedule,6049.05
Blue Shield,HMO,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Fee Schedule,6876.92
Blue Shield,HMO,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Fee Schedule,6876.92
Blue Shield,HMO,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Fee Schedule,6876.92
Blue Shield,HMO,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6049.05
Blue Shield,HMO,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6876.92
Blue Shield,HMO,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6876.92
Blue Shield,HMO,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6049.05
Blue Shield,HMO,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6876.92
Blue Shield,HMO,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6876.92
Blue Shield,HMO,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,4280.44
Blue Shield,HMO,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Fee Schedule,6049.05
Blue Shield,HMO,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Fee Schedule,6049.05
Blue Shield,HMO,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,6049.05
Blue Shield,HMO,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Fee Schedule,6049.05
Blue Shield,HMO,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Fee Schedule,6876.92
Blue Shield,HMO,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,Fee Schedule,4280.44
Blue Shield,HMO,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,Fee Schedule,4280.44
Blue Shield,HMO,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,Fee Schedule,4891.93
Blue Shield,HMO,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,HMO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Fee Schedule,4280.44
Blue Shield,HMO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Fee Schedule,9548.66
Blue Shield,HMO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Fee Schedule,987.79
Blue Shield,HMO,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Fee Schedule,6876.92
Blue Shield,HMO,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Fee Schedule,9548.66
Blue Shield,HMO,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Fee Schedule,9548.66
Blue Shield,HMO,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Fee Schedule,4280.44
Blue Shield,HMO,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Fee Schedule,4280.44
Blue Shield,HMO,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Fee Schedule,6876.92
Blue Shield,HMO,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Fee Schedule,9548.66
Blue Shield,HMO,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Fee Schedule,6876.92
Blue Shield,HMO,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Fee Schedule,9548.66
Blue Shield,HMO,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,HMO,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,HMO,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,HMO,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,HMO,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,HMO,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,HMO,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Fee Schedule,12850.71
Blue Shield,HMO,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,HMO,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,HMO,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Fee Schedule,6049.05
Blue Shield,HMO,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Fee Schedule,9548.66
Blue Shield,HMO,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Fee Schedule,4891.93
Blue Shield,HMO,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Fee Schedule,4891.93
Blue Shield,HMO,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,HMO,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,HMO,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Fee Schedule,3198.57
Blue Shield,HMO,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Fee Schedule,3198.57
Blue Shield,HMO,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6876.92
Blue Shield,HMO,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Fee Schedule,3198.57
Blue Shield,HMO,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,HMO,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,Fee Schedule,4891.93
Blue Shield,HMO,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,23929,CPT4/HCPCS,SHOULDER SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Fee Schedule,3198.57
Blue Shield,HMO,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Fee Schedule,4280.44
Blue Shield,HMO,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Fee Schedule,3198.57
Blue Shield,HMO,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Fee Schedule,4280.44
Blue Shield,HMO,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,HMO,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,HMO,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Fee Schedule,3198.57
Blue Shield,HMO,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Fee Schedule,6049.05
Blue Shield,HMO,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Fee Schedule,4891.93
Blue Shield,HMO,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,4280.44
Blue Shield,HMO,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Fee Schedule,4891.93
Blue Shield,HMO,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Fee Schedule,4891.93
Blue Shield,HMO,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Fee Schedule,4891.93
Blue Shield,HMO,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,4891.93
Blue Shield,HMO,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Fee Schedule,4280.44
Blue Shield,HMO,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Fee Schedule,3198.57
Blue Shield,HMO,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Fee Schedule,9548.66
Blue Shield,HMO,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Fee Schedule,9548.66
Blue Shield,HMO,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Fee Schedule,4280.44
Blue Shield,HMO,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Fee Schedule,4891.93
Blue Shield,HMO,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,HMO,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,HMO,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Fee Schedule,3198.57
Blue Shield,HMO,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Fee Schedule,6049.05
Blue Shield,HMO,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Fee Schedule,6049.05
Blue Shield,HMO,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Fee Schedule,4891.93
Blue Shield,HMO,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Fee Schedule,4891.93
Blue Shield,HMO,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Fee Schedule,4891.93
Blue Shield,HMO,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,HMO,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Fee Schedule,6049.05
Blue Shield,HMO,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Fee Schedule,9548.66
Blue Shield,HMO,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Fee Schedule,4280.44
Blue Shield,HMO,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Fee Schedule,9548.66
Blue Shield,HMO,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Fee Schedule,4891.93
Blue Shield,HMO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Fee Schedule,4891.93
Blue Shield,HMO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Fee Schedule,4891.93
Blue Shield,HMO,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Fee Schedule,9548.66
Blue Shield,HMO,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Fee Schedule,6876.92
Blue Shield,HMO,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Fee Schedule,6876.92
Blue Shield,HMO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Fee Schedule,7902.34
Blue Shield,HMO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Fee Schedule,9548.66
Blue Shield,HMO,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,6049.05
Blue Shield,HMO,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,6049.05
Blue Shield,HMO,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,4891.93
Blue Shield,HMO,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Fee Schedule,4891.93
Blue Shield,HMO,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,HMO,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Fee Schedule,4891.93
Blue Shield,HMO,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6876.92
Blue Shield,HMO,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,6876.92
Blue Shield,HMO,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Fee Schedule,3198.57
Blue Shield,HMO,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Fee Schedule,4280.44
Blue Shield,HMO,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,Fee Schedule,3198.57
Blue Shield,HMO,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,Fee Schedule,9548.66
Blue Shield,HMO,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,Fee Schedule,9548.66
Blue Shield,HMO,24999,CPT4/HCPCS,UPPER ARM/ELBOW SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Fee Schedule,4891.93
Blue Shield,HMO,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Fee Schedule,4891.93
Blue Shield,HMO,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Fee Schedule,4891.93
Blue Shield,HMO,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Fee Schedule,4891.93
Blue Shield,HMO,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Fee Schedule,4891.93
Blue Shield,HMO,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Fee Schedule,4891.93
Blue Shield,HMO,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Fee Schedule,3198.57
Blue Shield,HMO,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Fee Schedule,4280.44
Blue Shield,HMO,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,HMO,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Fee Schedule,4280.44
Blue Shield,HMO,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,HMO,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Fee Schedule,4891.93
Blue Shield,HMO,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Fee Schedule,4891.93
Blue Shield,HMO,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Fee Schedule,4891.93
Blue Shield,HMO,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Fee Schedule,4891.93
Blue Shield,HMO,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Fee Schedule,6049.05
Blue Shield,HMO,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Fee Schedule,4891.93
Blue Shield,HMO,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Fee Schedule,4891.93
Blue Shield,HMO,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Fee Schedule,4891.93
Blue Shield,HMO,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Fee Schedule,4891.93
Blue Shield,HMO,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Fee Schedule,6049.05
Blue Shield,HMO,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Fee Schedule,6049.05
Blue Shield,HMO,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Fee Schedule,6049.05
Blue Shield,HMO,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,HMO,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,HMO,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,HMO,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,HMO,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Fee Schedule,4891.93
Blue Shield,HMO,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Fee Schedule,4891.93
Blue Shield,HMO,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Fee Schedule,4891.93
Blue Shield,HMO,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,4280.44
Blue Shield,HMO,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,4280.44
Blue Shield,HMO,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Fee Schedule,9548.66
Blue Shield,HMO,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Fee Schedule,4891.93
Blue Shield,HMO,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Fee Schedule,6049.05
Blue Shield,HMO,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,6049.05
Blue Shield,HMO,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,6049.05
Blue Shield,HMO,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,HMO,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,HMO,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,HMO,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Fee Schedule,3198.57
Blue Shield,HMO,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,HMO,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4280.44
Blue Shield,HMO,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,HMO,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,HMO,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,HMO,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,HMO,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Fee Schedule,6049.05
Blue Shield,HMO,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Fee Schedule,4891.93
Blue Shield,HMO,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Fee Schedule,4891.93
Blue Shield,HMO,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Fee Schedule,4891.93
Blue Shield,HMO,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Fee Schedule,4891.93
Blue Shield,HMO,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Fee Schedule,4891.93
Blue Shield,HMO,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Fee Schedule,6876.92
Blue Shield,HMO,25350,CPT4/HCPCS,REVISION OF RADIUS,,Fee Schedule,4891.93
Blue Shield,HMO,25355,CPT4/HCPCS,REVISION OF RADIUS,,Fee Schedule,4891.93
Blue Shield,HMO,25360,CPT4/HCPCS,REVISION OF ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,HMO,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Fee Schedule,6049.05
Blue Shield,HMO,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,HMO,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Fee Schedule,4280.44
Blue Shield,HMO,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Fee Schedule,6049.05
Blue Shield,HMO,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,HMO,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,HMO,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Fee Schedule,6049.05
Blue Shield,HMO,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Fee Schedule,6049.05
Blue Shield,HMO,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Fee Schedule,6049.05
Blue Shield,HMO,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Fee Schedule,9548.66
Blue Shield,HMO,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Fee Schedule,6876.92
Blue Shield,HMO,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Fee Schedule,6876.92
Blue Shield,HMO,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,25490,CPT4/HCPCS,REINFORCE RADIUS,,Fee Schedule,4891.93
Blue Shield,HMO,25491,CPT4/HCPCS,REINFORCE ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,987.79
Blue Shield,HMO,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,3198.57
Blue Shield,HMO,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,4891.93
Blue Shield,HMO,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,3198.57
Blue Shield,HMO,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,6049.05
Blue Shield,HMO,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,6876.92
Blue Shield,HMO,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,987.79
Blue Shield,HMO,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,3198.57
Blue Shield,HMO,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,987.79
Blue Shield,HMO,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,4280.44
Blue Shield,HMO,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,987.79
Blue Shield,HMO,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,4891.93
Blue Shield,HMO,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Fee Schedule,4891.93
Blue Shield,HMO,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Fee Schedule,6876.92
Blue Shield,HMO,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Fee Schedule,6876.92
Blue Shield,HMO,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Fee Schedule,6876.92
Blue Shield,HMO,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Fee Schedule,7902.34
Blue Shield,HMO,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Fee Schedule,7902.34
Blue Shield,HMO,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Fee Schedule,6049.05
Blue Shield,HMO,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Fee Schedule,6876.92
Blue Shield,HMO,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Fee Schedule,6876.92
Blue Shield,HMO,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,HMO,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,HMO,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4891.93
Blue Shield,HMO,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Fee Schedule,3198.57
Blue Shield,HMO,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Fee Schedule,4891.93
Blue Shield,HMO,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,25927,CPT4/HCPCS,AMPUTATION OF HAND,,Fee Schedule,4280.44
Blue Shield,HMO,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,25999,CPT4/HCPCS,FOREARM OR WRIST SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,26010,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Fee Schedule,987.79
Blue Shield,HMO,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,HMO,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Fee Schedule,3198.57
Blue Shield,HMO,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Fee Schedule,4280.44
Blue Shield,HMO,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Fee Schedule,4280.44
Blue Shield,HMO,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Fee Schedule,4280.44
Blue Shield,HMO,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,HMO,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Fee Schedule,4280.44
Blue Shield,HMO,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Fee Schedule,4280.44
Blue Shield,HMO,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Fee Schedule,3198.57
Blue Shield,HMO,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Fee Schedule,3198.57
Blue Shield,HMO,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,HMO,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,HMO,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Fee Schedule,4891.93
Blue Shield,HMO,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Fee Schedule,4891.93
Blue Shield,HMO,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Fee Schedule,6049.05
Blue Shield,HMO,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Fee Schedule,4280.44
Blue Shield,HMO,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Fee Schedule,4891.93
Blue Shield,HMO,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Fee Schedule,4891.93
Blue Shield,HMO,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Fee Schedule,4891.93
Blue Shield,HMO,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Fee Schedule,6049.05
Blue Shield,HMO,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Fee Schedule,4280.44
Blue Shield,HMO,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Fee Schedule,4891.93
Blue Shield,HMO,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Fee Schedule,9548.66
Blue Shield,HMO,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Fee Schedule,4891.93
Blue Shield,HMO,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Fee Schedule,4891.93
Blue Shield,HMO,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Fee Schedule,4891.93
Blue Shield,HMO,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Fee Schedule,4280.44
Blue Shield,HMO,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Fee Schedule,4280.44
Blue Shield,HMO,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Fee Schedule,987.79
Blue Shield,HMO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Fee Schedule,987.79
Blue Shield,HMO,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,3198.57
Blue Shield,HMO,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Fee Schedule,4891.93
Blue Shield,HMO,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Fee Schedule,4280.44
Blue Shield,HMO,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Fee Schedule,4280.44
Blue Shield,HMO,26476,CPT4/HCPCS,TENDON LENGTHENING,,Fee Schedule,3198.57
Blue Shield,HMO,26477,CPT4/HCPCS,TENDON SHORTENING,,Fee Schedule,3198.57
Blue Shield,HMO,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Fee Schedule,3198.57
Blue Shield,HMO,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Fee Schedule,3198.57
Blue Shield,HMO,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Fee Schedule,4280.44
Blue Shield,HMO,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Fee Schedule,4891.93
Blue Shield,HMO,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Fee Schedule,4891.93
Blue Shield,HMO,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Fee Schedule,4891.93
Blue Shield,HMO,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Fee Schedule,6049.05
Blue Shield,HMO,26499,CPT4/HCPCS,REVISION OF FINGER,,Fee Schedule,4891.93
Blue Shield,HMO,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,HMO,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,HMO,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Fee Schedule,4891.93
Blue Shield,HMO,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Fee Schedule,3198.57
Blue Shield,HMO,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Fee Schedule,4891.93
Blue Shield,HMO,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Fee Schedule,4891.93
Blue Shield,HMO,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Fee Schedule,9548.66
Blue Shield,HMO,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Fee Schedule,6049.05
Blue Shield,HMO,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Fee Schedule,4280.44
Blue Shield,HMO,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Fee Schedule,9548.66
Blue Shield,HMO,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Fee Schedule,9548.66
Blue Shield,HMO,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Fee Schedule,9548.66
Blue Shield,HMO,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Fee Schedule,4891.93
Blue Shield,HMO,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,Fee Schedule,9548.66
Blue Shield,HMO,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,4280.44
Blue Shield,HMO,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,4891.93
Blue Shield,HMO,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,6049.05
Blue Shield,HMO,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Fee Schedule,6876.92
Blue Shield,HMO,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Fee Schedule,6876.92
Blue Shield,HMO,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Fee Schedule,4891.93
Blue Shield,HMO,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Fee Schedule,6876.92
Blue Shield,HMO,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Fee Schedule,6876.92
Blue Shield,HMO,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Fee Schedule,6876.92
Blue Shield,HMO,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Fee Schedule,4891.93
Blue Shield,HMO,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Fee Schedule,4891.93
Blue Shield,HMO,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Fee Schedule,4280.44
Blue Shield,HMO,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,HMO,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,HMO,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,HMO,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,9548.66
Blue Shield,HMO,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6049.05
Blue Shield,HMO,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,HMO,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,4280.44
Blue Shield,HMO,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6876.92
Blue Shield,HMO,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,HMO,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,HMO,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Fee Schedule,4280.44
Blue Shield,HMO,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6049.05
Blue Shield,HMO,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Fee Schedule,6876.92
Blue Shield,HMO,26841,CPT4/HCPCS,FUSION OF THUMB,,Fee Schedule,6049.05
Blue Shield,HMO,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Fee Schedule,6049.05
Blue Shield,HMO,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Fee Schedule,4280.44
Blue Shield,HMO,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Fee Schedule,4891.93
Blue Shield,HMO,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Fee Schedule,4280.44
Blue Shield,HMO,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Fee Schedule,6049.05
Blue Shield,HMO,26989,CPT4/HCPCS,HAND/FINGER SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Fee Schedule,3198.57
Blue Shield,HMO,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Fee Schedule,3198.57
Blue Shield,HMO,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,6049.05
Blue Shield,HMO,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4280.44
Blue Shield,HMO,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,3198.57
Blue Shield,HMO,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Fee Schedule,3198.57
Blue Shield,HMO,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,Fee Schedule,3198.57
Blue Shield,HMO,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Fee Schedule,6049.05
Blue Shield,HMO,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,Fee Schedule,4280.44
Blue Shield,HMO,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,HMO,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Fee Schedule,4280.44
Blue Shield,HMO,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,HMO,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,Fee Schedule,3198.57
Blue Shield,HMO,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Fee Schedule,6049.05
Blue Shield,HMO,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Fee Schedule,6876.92
Blue Shield,HMO,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Fee Schedule,6876.92
Blue Shield,HMO,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Fee Schedule,6876.92
Blue Shield,HMO,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Fee Schedule,6876.92
Blue Shield,HMO,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Fee Schedule,6876.92
Blue Shield,HMO,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,Fee Schedule,4891.93
Blue Shield,HMO,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,Fee Schedule,6049.05
Blue Shield,HMO,27075,CPT4/HCPCS,RESECT HIP TUMOR,,Fee Schedule,7902.34
Blue Shield,HMO,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,Fee Schedule,6049.05
Blue Shield,HMO,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,Fee Schedule,9548.66
Blue Shield,HMO,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,Fee Schedule,4891.93
Blue Shield,HMO,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Fee Schedule,4280.44
Blue Shield,HMO,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,HMO,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Fee Schedule,4891.93
Blue Shield,HMO,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,HMO,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,HMO,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Fee Schedule,3198.57
Blue Shield,HMO,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Fee Schedule,4891.93
Blue Shield,HMO,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Fee Schedule,6049.05
Blue Shield,HMO,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Fee Schedule,6049.05
Blue Shield,HMO,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Fee Schedule,6049.05
Blue Shield,HMO,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Fee Schedule,6049.05
Blue Shield,HMO,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Fee Schedule,4280.44
Blue Shield,HMO,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Fee Schedule,4280.44
Blue Shield,HMO,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,Fee Schedule,4280.44
Blue Shield,HMO,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Fee Schedule,4891.93
Blue Shield,HMO,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Fee Schedule,6049.05
Blue Shield,HMO,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,6876.92
Blue Shield,HMO,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,4891.93
Blue Shield,HMO,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,4891.93
Blue Shield,HMO,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,Fee Schedule,3198.57
Blue Shield,HMO,27146,CPT4/HCPCS,INCISION OF HIP BONE,,Fee Schedule,4891.93
Blue Shield,HMO,27147,CPT4/HCPCS,REVISION OF HIP BONE,,Fee Schedule,4891.93
Blue Shield,HMO,27151,CPT4/HCPCS,INCISION OF HIP BONES,,Fee Schedule,6049.05
Blue Shield,HMO,27156,CPT4/HCPCS,REVISION OF HIP BONES,,Fee Schedule,6049.05
Blue Shield,HMO,27158,CPT4/HCPCS,REVISION OF PELVIS,,Fee Schedule,4891.93
Blue Shield,HMO,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,Fee Schedule,4280.44
Blue Shield,HMO,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,Fee Schedule,4280.44
Blue Shield,HMO,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,Fee Schedule,4280.44
Blue Shield,HMO,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,HMO,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,HMO,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,HMO,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,HMO,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,Fee Schedule,3198.57
Blue Shield,HMO,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,HMO,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,HMO,27187,CPT4/HCPCS,REINFORCE HIP BONES,,Fee Schedule,4280.44
Blue Shield,HMO,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Fee Schedule,3198.57
Blue Shield,HMO,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Fee Schedule,4280.44
Blue Shield,HMO,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,Fee Schedule,3198.57
Blue Shield,HMO,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Fee Schedule,4891.93
Blue Shield,HMO,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Fee Schedule,6049.05
Blue Shield,HMO,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,27267,CPT4/HCPCS,CLTX THIGH FX,,Fee Schedule,4280.44
Blue Shield,HMO,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,Fee Schedule,4280.44
Blue Shield,HMO,27269,CPT4/HCPCS,OPTX THIGH FX,,Fee Schedule,6876.92
Blue Shield,HMO,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,Fee Schedule,3198.57
Blue Shield,HMO,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Fee Schedule,4891.93
Blue Shield,HMO,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Fee Schedule,4280.44
Blue Shield,HMO,27299,CPT4/HCPCS,PELVIS/HIP JOINT SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Fee Schedule,4280.44
Blue Shield,HMO,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,HMO,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,HMO,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,HMO,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Fee Schedule,4280.44
Blue Shield,HMO,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Fee Schedule,4280.44
Blue Shield,HMO,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,HMO,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Fee Schedule,4891.93
Blue Shield,HMO,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Fee Schedule,6049.05
Blue Shield,HMO,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,HMO,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,HMO,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,HMO,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,HMO,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,HMO,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Fee Schedule,4891.93
Blue Shield,HMO,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Fee Schedule,6049.05
Blue Shield,HMO,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Fee Schedule,6049.05
Blue Shield,HMO,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Fee Schedule,6049.05
Blue Shield,HMO,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Fee Schedule,4891.93
Blue Shield,HMO,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Fee Schedule,6876.92
Blue Shield,HMO,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Fee Schedule,6876.92
Blue Shield,HMO,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Fee Schedule,6876.92
Blue Shield,HMO,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,Fee Schedule,4891.93
Blue Shield,HMO,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,9548.66
Blue Shield,HMO,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Fee Schedule,3198.57
Blue Shield,HMO,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Fee Schedule,4891.93
Blue Shield,HMO,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Fee Schedule,4891.93
Blue Shield,HMO,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Fee Schedule,3198.57
Blue Shield,HMO,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4280.44
Blue Shield,HMO,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,HMO,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Fee Schedule,4280.44
Blue Shield,HMO,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,HMO,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,HMO,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,HMO,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Fee Schedule,4891.93
Blue Shield,HMO,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,HMO,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Fee Schedule,6049.05
Blue Shield,HMO,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Fee Schedule,6049.05
Blue Shield,HMO,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Fee Schedule,6049.05
Blue Shield,HMO,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Fee Schedule,12850.71
Blue Shield,HMO,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Fee Schedule,12850.71
Blue Shield,HMO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Fee Schedule,4891.93
Blue Shield,HMO,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Fee Schedule,4891.93
Blue Shield,HMO,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Fee Schedule,9548.66
Blue Shield,HMO,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Fee Schedule,4891.93
Blue Shield,HMO,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Fee Schedule,9548.66
Blue Shield,HMO,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,4891.93
Blue Shield,HMO,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,6049.05
Blue Shield,HMO,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,6049.05
Blue Shield,HMO,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Fee Schedule,6049.05
Blue Shield,HMO,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,27437,CPT4/HCPCS,REVISE KNEECAP,,Fee Schedule,6049.05
Blue Shield,HMO,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Fee Schedule,6876.92
Blue Shield,HMO,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,7902.34
Blue Shield,HMO,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,12850.71
Blue Shield,HMO,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Fee Schedule,4891.93
Blue Shield,HMO,27448,CPT4/HCPCS,INCISION OF THIGH,,Fee Schedule,3198.57
Blue Shield,HMO,27450,CPT4/HCPCS,INCISION OF THIGH,,Fee Schedule,4280.44
Blue Shield,HMO,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,Fee Schedule,4891.93
Blue Shield,HMO,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,Fee Schedule,4280.44
Blue Shield,HMO,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,Fee Schedule,3198.57
Blue Shield,HMO,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,Fee Schedule,4280.44
Blue Shield,HMO,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,Fee Schedule,4891.93
Blue Shield,HMO,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,Fee Schedule,4280.44
Blue Shield,HMO,27470,CPT4/HCPCS,REPAIR OF THIGH,,Fee Schedule,4891.93
Blue Shield,HMO,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,Fee Schedule,4891.93
Blue Shield,HMO,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,HMO,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,HMO,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,HMO,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,HMO,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,HMO,27495,CPT4/HCPCS,REINFORCE THIGH,,Fee Schedule,4891.93
Blue Shield,HMO,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,6876.92
Blue Shield,HMO,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,HMO,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,HMO,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,HMO,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,3198.57
Blue Shield,HMO,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,3198.57
Blue Shield,HMO,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,4280.44
Blue Shield,HMO,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Fee Schedule,7902.34
Blue Shield,HMO,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Fee Schedule,3198.57
Blue Shield,HMO,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Fee Schedule,3198.57
Blue Shield,HMO,27580,CPT4/HCPCS,FUSION OF KNEE,,Fee Schedule,4891.93
Blue Shield,HMO,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,HMO,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,HMO,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,HMO,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,Fee Schedule,3198.57
Blue Shield,HMO,27599,CPT4/HCPCS,LEG SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,HMO,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,HMO,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,HMO,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Fee Schedule,4280.44
Blue Shield,HMO,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Fee Schedule,4280.44
Blue Shield,HMO,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Fee Schedule,3198.57
Blue Shield,HMO,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Fee Schedule,3198.57
Blue Shield,HMO,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Fee Schedule,3198.57
Blue Shield,HMO,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Fee Schedule,4280.44
Blue Shield,HMO,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Fee Schedule,4280.44
Blue Shield,HMO,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Fee Schedule,4891.93
Blue Shield,HMO,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,HMO,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,HMO,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Fee Schedule,4891.93
Blue Shield,HMO,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Fee Schedule,4280.44
Blue Shield,HMO,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Fee Schedule,4280.44
Blue Shield,HMO,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,Fee Schedule,6049.05
Blue Shield,HMO,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,Fee Schedule,6049.05
Blue Shield,HMO,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Fee Schedule,4891.93
Blue Shield,HMO,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Fee Schedule,4280.44
Blue Shield,HMO,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,3198.57
Blue Shield,HMO,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,HMO,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,HMO,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,HMO,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Fee Schedule,4280.44
Blue Shield,HMO,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Fee Schedule,4891.93
Blue Shield,HMO,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Fee Schedule,4280.44
Blue Shield,HMO,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Fee Schedule,4891.93
Blue Shield,HMO,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Fee Schedule,6049.05
Blue Shield,HMO,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Fee Schedule,4280.44
Blue Shield,HMO,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,HMO,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Fee Schedule,4280.44
Blue Shield,HMO,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Fee Schedule,4280.44
Blue Shield,HMO,27705,CPT4/HCPCS,INCISION OF TIBIA,,Fee Schedule,4280.44
Blue Shield,HMO,27707,CPT4/HCPCS,INCISION OF FIBULA,,Fee Schedule,4280.44
Blue Shield,HMO,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Fee Schedule,4280.44
Blue Shield,HMO,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,HMO,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,HMO,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Fee Schedule,4280.44
Blue Shield,HMO,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Fee Schedule,4280.44
Blue Shield,HMO,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Fee Schedule,4891.93
Blue Shield,HMO,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,HMO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Fee Schedule,4891.93
Blue Shield,HMO,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,HMO,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Fee Schedule,4280.44
Blue Shield,HMO,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Fee Schedule,4280.44
Blue Shield,HMO,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,HMO,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,HMO,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,HMO,27745,CPT4/HCPCS,REINFORCE TIBIA,,Fee Schedule,4891.93
Blue Shield,HMO,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Fee Schedule,3198.57
Blue Shield,HMO,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Fee Schedule,3198.57
Blue Shield,HMO,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Fee Schedule,4891.93
Blue Shield,HMO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Fee Schedule,4280.44
Blue Shield,HMO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Fee Schedule,4280.44
Blue Shield,HMO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Fee Schedule,6049.05
Blue Shield,HMO,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Fee Schedule,3198.57
Blue Shield,HMO,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Fee Schedule,6049.05
Blue Shield,HMO,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,3198.57
Blue Shield,HMO,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,HMO,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,HMO,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Fee Schedule,3198.57
Blue Shield,HMO,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Fee Schedule,4891.93
Blue Shield,HMO,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,HMO,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,HMO,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,HMO,27899,CPT4/HCPCS,LEG/ANKLE SURGERY PROCEDURE,,Fee Schedule,987.79
Blue Shield,HMO,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Fee Schedule,3198.57
Blue Shield,HMO,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Fee Schedule,4891.93
Blue Shield,HMO,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Fee Schedule,4891.93
Blue Shield,HMO,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,HMO,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Fee Schedule,4891.93
Blue Shield,HMO,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Fee Schedule,4280.44
Blue Shield,HMO,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Fee Schedule,6049.05
Blue Shield,HMO,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Fee Schedule,4280.44
Blue Shield,HMO,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,HMO,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Fee Schedule,4891.93
Blue Shield,HMO,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Fee Schedule,4891.93
Blue Shield,HMO,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Fee Schedule,4891.93
Blue Shield,HMO,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Fee Schedule,4280.44
Blue Shield,HMO,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Fee Schedule,4280.44
Blue Shield,HMO,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Fee Schedule,4280.44
Blue Shield,HMO,28055,CPT4/HCPCS,NEURECTOMY FOOT,,Fee Schedule,4891.93
Blue Shield,HMO,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Fee Schedule,4280.44
Blue Shield,HMO,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,HMO,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Fee Schedule,4891.93
Blue Shield,HMO,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Fee Schedule,4891.93
Blue Shield,HMO,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4891.93
Blue Shield,HMO,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,HMO,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,HMO,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4891.93
Blue Shield,HMO,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Fee Schedule,4891.93
Blue Shield,HMO,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Fee Schedule,4280.44
Blue Shield,HMO,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,HMO,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,HMO,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4280.44
Blue Shield,HMO,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,HMO,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,HMO,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Fee Schedule,4891.93
Blue Shield,HMO,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,HMO,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,HMO,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,HMO,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,HMO,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Fee Schedule,4891.93
Blue Shield,HMO,28116,CPT4/HCPCS,REVISION OF FOOT,,Fee Schedule,4891.93
Blue Shield,HMO,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Fee Schedule,6049.05
Blue Shield,HMO,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Fee Schedule,6049.05
Blue Shield,HMO,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Fee Schedule,9548.66
Blue Shield,HMO,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Fee Schedule,4891.93
Blue Shield,HMO,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,HMO,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,HMO,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Fee Schedule,4891.93
Blue Shield,HMO,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,HMO,28150,CPT4/HCPCS,REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,HMO,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,HMO,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,HMO,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Fee Schedule,4891.93
Blue Shield,HMO,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Fee Schedule,4891.93
Blue Shield,HMO,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Fee Schedule,4891.93
Blue Shield,HMO,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,HMO,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,HMO,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,6049.05
Blue Shield,HMO,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Fee Schedule,3198.57
Blue Shield,HMO,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Fee Schedule,3198.57
Blue Shield,HMO,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Fee Schedule,3198.57
Blue Shield,HMO,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Fee Schedule,4891.93
Blue Shield,HMO,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Fee Schedule,4280.44
Blue Shield,HMO,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Fee Schedule,4280.44
Blue Shield,HMO,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,HMO,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Fee Schedule,4891.93
Blue Shield,HMO,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,HMO,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Fee Schedule,6049.05
Blue Shield,HMO,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Fee Schedule,3198.57
Blue Shield,HMO,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Fee Schedule,4891.93
Blue Shield,HMO,28280,CPT4/HCPCS,FUSION OF TOES,,Fee Schedule,4280.44
Blue Shield,HMO,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Fee Schedule,4891.93
Blue Shield,HMO,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Fee Schedule,6049.05
Blue Shield,HMO,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Fee Schedule,4891.93
Blue Shield,HMO,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Fee Schedule,4891.93
Blue Shield,HMO,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Fee Schedule,4891.93
Blue Shield,HMO,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4280.44
Blue Shield,HMO,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,HMO,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,HMO,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,HMO,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,HMO,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,6876.92
Blue Shield,HMO,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Fee Schedule,4280.44
Blue Shield,HMO,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Fee Schedule,4280.44
Blue Shield,HMO,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Fee Schedule,4280.44
Blue Shield,HMO,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Fee Schedule,4891.93
Blue Shield,HMO,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,6049.05
Blue Shield,HMO,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,6049.05
Blue Shield,HMO,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,4280.44
Blue Shield,HMO,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Fee Schedule,6049.05
Blue Shield,HMO,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Fee Schedule,4891.93
Blue Shield,HMO,28312,CPT4/HCPCS,REVISION OF TOE,,Fee Schedule,4891.93
Blue Shield,HMO,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Fee Schedule,4280.44
Blue Shield,HMO,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Fee Schedule,6049.05
Blue Shield,HMO,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,HMO,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Fee Schedule,6049.05
Blue Shield,HMO,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Fee Schedule,6049.05
Blue Shield,HMO,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Fee Schedule,6049.05
Blue Shield,HMO,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Fee Schedule,6049.05
Blue Shield,HMO,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Fee Schedule,6049.05
Blue Shield,HMO,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,Fee Schedule,6876.92
Blue Shield,HMO,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Fee Schedule,6049.05
Blue Shield,HMO,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,HMO,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,3198.57
Blue Shield,HMO,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,4891.93
Blue Shield,HMO,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,HMO,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,HMO,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,HMO,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,HMO,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,987.79
Blue Shield,HMO,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,HMO,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,HMO,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,HMO,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,HMO,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,HMO,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,HMO,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,HMO,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Fee Schedule,6876.92
Blue Shield,HMO,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,HMO,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,HMO,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,Fee Schedule,3198.57
Blue Shield,HMO,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Fee Schedule,3198.57
Blue Shield,HMO,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Fee Schedule,4280.44
Blue Shield,HMO,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Fee Schedule,4280.44
Blue Shield,HMO,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Fee Schedule,4280.44
Blue Shield,HMO,28899,CPT4/HCPCS,FOOT/TOES SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,HMO,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,HMO,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,HMO,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,HMO,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,HMO,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,HMO,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,HMO,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,Fee Schedule,987.79
Blue Shield,HMO,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Fee Schedule,987.79
Blue Shield,HMO,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Fee Schedule,987.79
Blue Shield,HMO,29065,CPT4/HCPCS,APPLICATION OF LONG ARM CAST,,Fee Schedule,987.79
Blue Shield,HMO,29075,CPT4/HCPCS,APPLICATION OF FOREARM CAST,,Fee Schedule,987.79
Blue Shield,HMO,29085,CPT4/HCPCS,APPLY HAND/WRIST CAST,,Fee Schedule,987.79
Blue Shield,HMO,29086,CPT4/HCPCS,APPLY FINGER CAST,,Fee Schedule,987.79
Blue Shield,HMO,29105,CPT4/HCPCS,APPLY LONG ARM SPLINT,,Fee Schedule,987.79
Blue Shield,HMO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Fee Schedule,987.79
Blue Shield,HMO,29126,CPT4/HCPCS,APPLY FOREARM SPLINT,,Fee Schedule,987.79
Blue Shield,HMO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Fee Schedule,987.79
Blue Shield,HMO,29131,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Fee Schedule,987.79
Blue Shield,HMO,29200,CPT4/HCPCS,STRAPPING OF CHEST,,Fee Schedule,987.79
Blue Shield,HMO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Fee Schedule,987.79
Blue Shield,HMO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Fee Schedule,987.79
Blue Shield,HMO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Fee Schedule,987.79
Blue Shield,HMO,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Fee Schedule,987.79
Blue Shield,HMO,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Fee Schedule,987.79
Blue Shield,HMO,29345,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,HMO,29355,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,HMO,29358,CPT4/HCPCS,APPLY LONG LEG CAST BRACE,,Fee Schedule,987.79
Blue Shield,HMO,29365,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,HMO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,HMO,29425,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,HMO,29435,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,HMO,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,Fee Schedule,987.79
Blue Shield,HMO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,Fee Schedule,987.79
Blue Shield,HMO,29450,CPT4/HCPCS,APPLICATION OF LEG CAST,,Fee Schedule,987.79
Blue Shield,HMO,29505,CPT4/HCPCS,APPLICATION LONG LEG SPLINT,,Fee Schedule,987.79
Blue Shield,HMO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Fee Schedule,987.79
Blue Shield,HMO,29520,CPT4/HCPCS,STRAPPING OF HIP,,Fee Schedule,987.79
Blue Shield,HMO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,Fee Schedule,987.79
Blue Shield,HMO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,Fee Schedule,987.79
Blue Shield,HMO,29550,CPT4/HCPCS,STRAPPING OF TOES,,Fee Schedule,987.79
Blue Shield,HMO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Fee Schedule,987.79
Blue Shield,HMO,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,Fee Schedule,987.79
Blue Shield,HMO,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,Fee Schedule,7902.34
Blue Shield,HMO,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,HMO,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,HMO,29710,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,HMO,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,Fee Schedule,987.79
Blue Shield,HMO,29730,CPT4/HCPCS,WINDOWING OF CAST,,Fee Schedule,987.79
Blue Shield,HMO,29740,CPT4/HCPCS,WEDGING OF CAST,,Fee Schedule,987.79
Blue Shield,HMO,29750,CPT4/HCPCS,WEDGING OF CLUBFOOT CAST,,Fee Schedule,987.79
Blue Shield,HMO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,Fee Schedule,987.79
Blue Shield,HMO,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Fee Schedule,4891.93
Blue Shield,HMO,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Fee Schedule,4891.93
Blue Shield,HMO,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Fee Schedule,4891.93
Blue Shield,HMO,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Fee Schedule,4891.93
Blue Shield,HMO,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Fee Schedule,4891.93
Blue Shield,HMO,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Fee Schedule,4891.93
Blue Shield,HMO,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Fee Schedule,4891.93
Blue Shield,HMO,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Fee Schedule,4891.93
Blue Shield,HMO,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Fee Schedule,6876.92
Blue Shield,HMO,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Fee Schedule,4891.93
Blue Shield,HMO,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Fee Schedule,4891.93
Blue Shield,HMO,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Fee Schedule,6876.92
Blue Shield,HMO,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Fee Schedule,4891.93
Blue Shield,HMO,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Fee Schedule,4891.93
Blue Shield,HMO,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Fee Schedule,4891.93
Blue Shield,HMO,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Fee Schedule,12850.71
Blue Shield,HMO,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Fee Schedule,6049.05
Blue Shield,HMO,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Fee Schedule,6049.05
Blue Shield,HMO,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Fee Schedule,12850.71
Blue Shield,HMO,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Fee Schedule,6049.05
Blue Shield,HMO,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Fee Schedule,12850.71
Blue Shield,HMO,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Fee Schedule,12850.71
Blue Shield,HMO,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Fee Schedule,12850.71
Blue Shield,HMO,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Fee Schedule,4891.93
Blue Shield,HMO,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Fee Schedule,4891.93
Blue Shield,HMO,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6876.92
Blue Shield,HMO,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Fee Schedule,12850.71
Blue Shield,HMO,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Fee Schedule,4891.93
Blue Shield,HMO,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,HMO,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,HMO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Fee Schedule,4891.93
Blue Shield,HMO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Fee Schedule,4891.93
Blue Shield,HMO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Fee Schedule,4891.93
Blue Shield,HMO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Fee Schedule,6049.05
Blue Shield,HMO,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Fee Schedule,6049.05
Blue Shield,HMO,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Fee Schedule,6049.05
Blue Shield,HMO,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Fee Schedule,6049.05
Blue Shield,HMO,29999,CPT4/HCPCS,ARTHROSCOPY OF JOINT,,Fee Schedule,6876.92
Blue Shield,HMO,30000,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,HMO,30020,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,HMO,30100,CPT4/HCPCS,INTRANASAL BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Fee Schedule,4280.44
Blue Shield,HMO,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Fee Schedule,4280.44
Blue Shield,HMO,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Fee Schedule,4891.93
Blue Shield,HMO,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Fee Schedule,4891.93
Blue Shield,HMO,30120,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,3198.57
Blue Shield,HMO,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,HMO,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Fee Schedule,4891.93
Blue Shield,HMO,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Fee Schedule,4280.44
Blue Shield,HMO,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Fee Schedule,4891.93
Blue Shield,HMO,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Fee Schedule,6049.05
Blue Shield,HMO,30200,CPT4/HCPCS,INJECTION TREATMENT OF NOSE,,Fee Schedule,4280.44
Blue Shield,HMO,30210,CPT4/HCPCS,NASAL SINUS THERAPY,,Fee Schedule,3198.57
Blue Shield,HMO,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Fee Schedule,3198.57
Blue Shield,HMO,30300,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,HMO,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,HMO,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,HMO,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6049.05
Blue Shield,HMO,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6876.92
Blue Shield,HMO,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6876.92
Blue Shield,HMO,30430,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,4891.93
Blue Shield,HMO,30435,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,6876.92
Blue Shield,HMO,30450,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,9548.66
Blue Shield,HMO,30460,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,9548.66
Blue Shield,HMO,30462,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,12850.71
Blue Shield,HMO,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Fee Schedule,12850.71
Blue Shield,HMO,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Fee Schedule,6049.05
Blue Shield,HMO,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Fee Schedule,6876.92
Blue Shield,HMO,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Fee Schedule,6876.92
Blue Shield,HMO,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Fee Schedule,4280.44
Blue Shield,HMO,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Fee Schedule,6049.05
Blue Shield,HMO,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Fee Schedule,6049.05
Blue Shield,HMO,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Fee Schedule,9548.66
Blue Shield,HMO,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Fee Schedule,9548.66
Blue Shield,HMO,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Fee Schedule,3198.57
Blue Shield,HMO,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Fee Schedule,3198.57
Blue Shield,HMO,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,987.79
Blue Shield,HMO,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,HMO,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,HMO,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,HMO,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Fee Schedule,4280.44
Blue Shield,HMO,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Fee Schedule,4891.93
Blue Shield,HMO,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Fee Schedule,6049.05
Blue Shield,HMO,30999,CPT4/HCPCS,NASAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Fee Schedule,3198.57
Blue Shield,HMO,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Fee Schedule,3198.57
Blue Shield,HMO,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4280.44
Blue Shield,HMO,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,HMO,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Fee Schedule,6049.05
Blue Shield,HMO,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,Fee Schedule,6049.05
Blue Shield,HMO,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Fee Schedule,4280.44
Blue Shield,HMO,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Fee Schedule,4280.44
Blue Shield,HMO,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,HMO,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,HMO,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,HMO,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,HMO,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,HMO,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,HMO,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,HMO,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Fee Schedule,6876.92
Blue Shield,HMO,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,4280.44
Blue Shield,HMO,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,6876.92
Blue Shield,HMO,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,4891.93
Blue Shield,HMO,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Fee Schedule,4891.93
Blue Shield,HMO,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Fee Schedule,4891.93
Blue Shield,HMO,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Fee Schedule,987.79
Blue Shield,HMO,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Fee Schedule,4280.44
Blue Shield,HMO,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Fee Schedule,3198.57
Blue Shield,HMO,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4280.44
Blue Shield,HMO,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,HMO,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,6049.05
Blue Shield,HMO,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4280.44
Blue Shield,HMO,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Fee Schedule,6876.92
Blue Shield,HMO,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Fee Schedule,6876.92
Blue Shield,HMO,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Fee Schedule,4891.93
Blue Shield,HMO,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Fee Schedule,6876.92
Blue Shield,HMO,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,HMO,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Fee Schedule,6876.92
Blue Shield,HMO,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Fee Schedule,6876.92
Blue Shield,HMO,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,HMO,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Fee Schedule,4891.93
Blue Shield,HMO,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,HMO,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,HMO,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,HMO,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,HMO,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Fee Schedule,3198.57
Blue Shield,HMO,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Fee Schedule,3198.57
Blue Shield,HMO,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Fee Schedule,4280.44
Blue Shield,HMO,31295,CPT4/HCPCS,NSL/SINS NDSC SURG MAX SINS,,Fee Schedule,3198.57
Blue Shield,HMO,31296,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT SINS,,Fee Schedule,3198.57
Blue Shield,HMO,31297,CPT4/HCPCS,NSL/SINS NDSC SURG SPHN SINS,,Fee Schedule,3198.57
Blue Shield,HMO,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Fee Schedule,3198.57
Blue Shield,HMO,31299,CPT4/HCPCS,SINUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Fee Schedule,6876.92
Blue Shield,HMO,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,HMO,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,HMO,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,HMO,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,7902.34
Blue Shield,HMO,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,HMO,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,HMO,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,HMO,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,HMO,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,Fee Schedule,7902.34
Blue Shield,HMO,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,Fee Schedule,9548.66
Blue Shield,HMO,31400,CPT4/HCPCS,REVISION OF LARYNX,,Fee Schedule,4280.44
Blue Shield,HMO,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Fee Schedule,4280.44
Blue Shield,HMO,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Fee Schedule,3198.57
Blue Shield,HMO,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Fee Schedule,987.79
Blue Shield,HMO,31505,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Fee Schedule,4280.44
Blue Shield,HMO,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Fee Schedule,4280.44
Blue Shield,HMO,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Fee Schedule,4280.44
Blue Shield,HMO,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Fee Schedule,4280.44
Blue Shield,HMO,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Fee Schedule,3198.57
Blue Shield,HMO,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Fee Schedule,3198.57
Blue Shield,HMO,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Fee Schedule,3198.57
Blue Shield,HMO,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Fee Schedule,4280.44
Blue Shield,HMO,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Fee Schedule,3198.57
Blue Shield,HMO,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Fee Schedule,4280.44
Blue Shield,HMO,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Fee Schedule,4280.44
Blue Shield,HMO,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,HMO,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Fee Schedule,4891.93
Blue Shield,HMO,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Fee Schedule,4280.44
Blue Shield,HMO,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Fee Schedule,4891.93
Blue Shield,HMO,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Fee Schedule,4891.93
Blue Shield,HMO,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Fee Schedule,6049.05
Blue Shield,HMO,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Fee Schedule,4891.93
Blue Shield,HMO,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Fee Schedule,4891.93
Blue Shield,HMO,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,HMO,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,HMO,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,HMO,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,HMO,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Fee Schedule,6876.92
Blue Shield,HMO,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Fee Schedule,6876.92
Blue Shield,HMO,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Fee Schedule,4280.44
Blue Shield,HMO,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Fee Schedule,4280.44
Blue Shield,HMO,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Fee Schedule,4280.44
Blue Shield,HMO,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Fee Schedule,4280.44
Blue Shield,HMO,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Fee Schedule,4280.44
Blue Shield,HMO,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Fee Schedule,987.79
Blue Shield,HMO,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Fee Schedule,4280.44
Blue Shield,HMO,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Fee Schedule,4280.44
Blue Shield,HMO,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Fee Schedule,4280.44
Blue Shield,HMO,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Fee Schedule,3198.57
Blue Shield,HMO,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Fee Schedule,6876.92
Blue Shield,HMO,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Fee Schedule,6049.05
Blue Shield,HMO,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Fee Schedule,4280.44
Blue Shield,HMO,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Fee Schedule,6876.92
Blue Shield,HMO,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Fee Schedule,6876.92
Blue Shield,HMO,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Fee Schedule,6876.92
Blue Shield,HMO,31595,CPT4/HCPCS,LARYNX NERVE SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,31599,CPT4/HCPCS,LARYNX SURGERY PROCEDURE,,Fee Schedule,6049.05
Blue Shield,HMO,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,HMO,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,HMO,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,3198.57
Blue Shield,HMO,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,HMO,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,HMO,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,HMO,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Fee Schedule,3198.57
Blue Shield,HMO,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Fee Schedule,4280.44
Blue Shield,HMO,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Fee Schedule,4280.44
Blue Shield,HMO,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Fee Schedule,3198.57
Blue Shield,HMO,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Fee Schedule,3198.57
Blue Shield,HMO,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Fee Schedule,4280.44
Blue Shield,HMO,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Fee Schedule,4280.44
Blue Shield,HMO,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Fee Schedule,4280.44
Blue Shield,HMO,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Fee Schedule,4891.93
Blue Shield,HMO,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Fee Schedule,4280.44
Blue Shield,HMO,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Fee Schedule,4280.44
Blue Shield,HMO,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Fee Schedule,4280.44
Blue Shield,HMO,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Fee Schedule,4280.44
Blue Shield,HMO,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Fee Schedule,4280.44
Blue Shield,HMO,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,HMO,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Fee Schedule,6049.05
Blue Shield,HMO,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Fee Schedule,6049.05
Blue Shield,HMO,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Fee Schedule,4280.44
Blue Shield,HMO,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Fee Schedule,4280.44
Blue Shield,HMO,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Fee Schedule,4280.44
Blue Shield,HMO,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Fee Schedule,3198.57
Blue Shield,HMO,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Fee Schedule,3198.57
Blue Shield,HMO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Fee Schedule,4280.44
Blue Shield,HMO,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Fee Schedule,4280.44
Blue Shield,HMO,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Fee Schedule,4280.44
Blue Shield,HMO,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Fee Schedule,4280.44
Blue Shield,HMO,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Fee Schedule,3198.57
Blue Shield,HMO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Fee Schedule,4280.44
Blue Shield,HMO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Fee Schedule,4891.93
Blue Shield,HMO,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Fee Schedule,3198.57
Blue Shield,HMO,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Fee Schedule,3198.57
Blue Shield,HMO,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,6876.92
Blue Shield,HMO,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,HMO,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,HMO,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,HMO,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,Fee Schedule,4891.93
Blue Shield,HMO,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,Fee Schedule,4280.44
Blue Shield,HMO,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Fee Schedule,4280.44
Blue Shield,HMO,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Fee Schedule,4891.93
Blue Shield,HMO,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Fee Schedule,6049.05
Blue Shield,HMO,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Fee Schedule,6049.05
Blue Shield,HMO,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Fee Schedule,3198.57
Blue Shield,HMO,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Fee Schedule,6049.05
Blue Shield,HMO,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Fee Schedule,3198.57
Blue Shield,HMO,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Fee Schedule,4280.44
Blue Shield,HMO,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Fee Schedule,4280.44
Blue Shield,HMO,31899,CPT4/HCPCS,AIRWAYS SURGICAL PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,Fee Schedule,3198.57
Blue Shield,HMO,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,Fee Schedule,3198.57
Blue Shield,HMO,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,Fee Schedule,7902.34
Blue Shield,HMO,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,Fee Schedule,7902.34
Blue Shield,HMO,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,Fee Schedule,7902.34
Blue Shield,HMO,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,HMO,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,Fee Schedule,4280.44
Blue Shield,HMO,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,HMO,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Fee Schedule,3198.57
Blue Shield,HMO,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Fee Schedule,3198.57
Blue Shield,HMO,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,HMO,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,Fee Schedule,3198.57
Blue Shield,HMO,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,Fee Schedule,3198.57
Blue Shield,HMO,32215,CPT4/HCPCS,TREAT CHEST LINING,,Fee Schedule,3198.57
Blue Shield,HMO,32220,CPT4/HCPCS,RELEASE OF LUNG,,Fee Schedule,4280.44
Blue Shield,HMO,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,Fee Schedule,3198.57
Blue Shield,HMO,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,Fee Schedule,3198.57
Blue Shield,HMO,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,Fee Schedule,4280.44
Blue Shield,HMO,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Fee Schedule,3198.57
Blue Shield,HMO,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Fee Schedule,3198.57
Blue Shield,HMO,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,Fee Schedule,4280.44
Blue Shield,HMO,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,Fee Schedule,4280.44
Blue Shield,HMO,32482,CPT4/HCPCS,BILOBECTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,32484,CPT4/HCPCS,SEGMENTECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,32488,CPT4/HCPCS,COMPLETION PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,Fee Schedule,4280.44
Blue Shield,HMO,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,Fee Schedule,7902.34
Blue Shield,HMO,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,Fee Schedule,3198.57
Blue Shield,HMO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Fee Schedule,3198.57
Blue Shield,HMO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Fee Schedule,987.79
Blue Shield,HMO,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Fee Schedule,987.79
Blue Shield,HMO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,HMO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Fee Schedule,3198.57
Blue Shield,HMO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Fee Schedule,3198.57
Blue Shield,HMO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Fee Schedule,3198.57
Blue Shield,HMO,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Fee Schedule,3198.57
Blue Shield,HMO,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Fee Schedule,3198.57
Blue Shield,HMO,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Fee Schedule,987.79
Blue Shield,HMO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Fee Schedule,7902.34
Blue Shield,HMO,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Fee Schedule,7902.34
Blue Shield,HMO,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Fee Schedule,7902.34
Blue Shield,HMO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Fee Schedule,7902.34
Blue Shield,HMO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Fee Schedule,7902.34
Blue Shield,HMO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Fee Schedule,7902.34
Blue Shield,HMO,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,Fee Schedule,3198.57
Blue Shield,HMO,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,Fee Schedule,3198.57
Blue Shield,HMO,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,Fee Schedule,3198.57
Blue Shield,HMO,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,Fee Schedule,3198.57
Blue Shield,HMO,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,Fee Schedule,3198.57
Blue Shield,HMO,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,Fee Schedule,3198.57
Blue Shield,HMO,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,Fee Schedule,3198.57
Blue Shield,HMO,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,Fee Schedule,3198.57
Blue Shield,HMO,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,Fee Schedule,3198.57
Blue Shield,HMO,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,Fee Schedule,3198.57
Blue Shield,HMO,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Fee Schedule,3198.57
Blue Shield,HMO,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,Fee Schedule,3198.57
Blue Shield,HMO,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,Fee Schedule,7902.34
Blue Shield,HMO,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,Fee Schedule,987.79
Blue Shield,HMO,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,Fee Schedule,987.79
Blue Shield,HMO,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,Fee Schedule,7902.34
Blue Shield,HMO,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,Fee Schedule,7902.34
Blue Shield,HMO,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,Fee Schedule,7902.34
Blue Shield,HMO,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,Fee Schedule,7902.34
Blue Shield,HMO,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,Fee Schedule,7902.34
Blue Shield,HMO,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,Fee Schedule,987.79
Blue Shield,HMO,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,Fee Schedule,3198.57
Blue Shield,HMO,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,Fee Schedule,3198.57
Blue Shield,HMO,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,Fee Schedule,4280.44
Blue Shield,HMO,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,Fee Schedule,4280.44
Blue Shield,HMO,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,Fee Schedule,6876.92
Blue Shield,HMO,32852,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Fee Schedule,7902.34
Blue Shield,HMO,32853,CPT4/HCPCS,LUNG TRANSPLANT DOUBLE,,Fee Schedule,7902.34
Blue Shield,HMO,32854,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Fee Schedule,9548.66
Blue Shield,HMO,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,Fee Schedule,3198.57
Blue Shield,HMO,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Fee Schedule,4280.44
Blue Shield,HMO,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Fee Schedule,4280.44
Blue Shield,HMO,32940,CPT4/HCPCS,REVISION OF LUNG,,Fee Schedule,3198.57
Blue Shield,HMO,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,Fee Schedule,3198.57
Blue Shield,HMO,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Fee Schedule,4280.44
Blue Shield,HMO,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,Fee Schedule,3198.57
Blue Shield,HMO,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Fee Schedule,4280.44
Blue Shield,HMO,32999,CPT4/HCPCS,CHEST SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,33010,CPT4/HCPCS,DRAINAGE OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,HMO,33011,CPT4/HCPCS,REPEAT DRAINAGE OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,HMO,33015,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,HMO,33020,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,HMO,33025,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,HMO,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,HMO,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,HMO,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,Fee Schedule,3198.57
Blue Shield,HMO,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,Fee Schedule,4891.93
Blue Shield,HMO,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,Fee Schedule,3198.57
Blue Shield,HMO,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,Fee Schedule,3198.57
Blue Shield,HMO,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Fee Schedule,12850.71
Blue Shield,HMO,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Fee Schedule,12850.71
Blue Shield,HMO,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Fee Schedule,12850.71
Blue Shield,HMO,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Fee Schedule,12850.71
Blue Shield,HMO,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Fee Schedule,12850.71
Blue Shield,HMO,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Fee Schedule,12850.71
Blue Shield,HMO,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Fee Schedule,12850.71
Blue Shield,HMO,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Fee Schedule,12850.71
Blue Shield,HMO,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Fee Schedule,12850.71
Blue Shield,HMO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Fee Schedule,12850.71
Blue Shield,HMO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Fee Schedule,12850.71
Blue Shield,HMO,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Fee Schedule,12850.71
Blue Shield,HMO,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Fee Schedule,12850.71
Blue Shield,HMO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Fee Schedule,3198.57
Blue Shield,HMO,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Fee Schedule,4280.44
Blue Shield,HMO,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Fee Schedule,4280.44
Blue Shield,HMO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Fee Schedule,4280.44
Blue Shield,HMO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Fee Schedule,4891.93
Blue Shield,HMO,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Fee Schedule,4891.93
Blue Shield,HMO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Fee Schedule,4280.44
Blue Shield,HMO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Fee Schedule,4280.44
Blue Shield,HMO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Fee Schedule,4280.44
Blue Shield,HMO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Fee Schedule,3198.57
Blue Shield,HMO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Fee Schedule,3198.57
Blue Shield,HMO,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Fee Schedule,4891.93
Blue Shield,HMO,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Fee Schedule,4891.93
Blue Shield,HMO,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Fee Schedule,4891.93
Blue Shield,HMO,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Fee Schedule,12850.71
Blue Shield,HMO,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Fee Schedule,4891.93
Blue Shield,HMO,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Fee Schedule,4891.93
Blue Shield,HMO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Fee Schedule,12850.71
Blue Shield,HMO,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,HMO,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,HMO,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,HMO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Fee Schedule,4280.44
Blue Shield,HMO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Fee Schedule,4280.44
Blue Shield,HMO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Fee Schedule,4280.44
Blue Shield,HMO,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Fee Schedule,4280.44
Blue Shield,HMO,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Fee Schedule,12850.71
Blue Shield,HMO,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Fee Schedule,987.79
Blue Shield,HMO,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Fee Schedule,4891.93
Blue Shield,HMO,33282,CPT4/HCPCS,IMPLANT PAT-ACTIVE HT RECORD,,Fee Schedule,12850.71
Blue Shield,HMO,33284,CPT4/HCPCS,REMOVE PAT-ACTIVE HT RECORD,,Fee Schedule,3198.57
Blue Shield,HMO,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,Fee Schedule,4280.44
Blue Shield,HMO,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Fee Schedule,3198.57
Blue Shield,HMO,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,Fee Schedule,4280.44
Blue Shield,HMO,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Fee Schedule,4280.44
Blue Shield,HMO,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Fee Schedule,4891.93
Blue Shield,HMO,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,Fee Schedule,9304.07
Blue Shield,HMO,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,Fee Schedule,7902.34
Blue Shield,HMO,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,HMO,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,HMO,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,HMO,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,HMO,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,Fee Schedule,987.79
Blue Shield,HMO,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,HMO,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,HMO,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,HMO,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,HMO,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,HMO,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,Fee Schedule,4891.93
Blue Shield,HMO,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,4891.93
Blue Shield,HMO,33406,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,6049.05
Blue Shield,HMO,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,4891.93
Blue Shield,HMO,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,HMO,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,6876.92
Blue Shield,HMO,33413,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,6876.92
Blue Shield,HMO,33414,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,HMO,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,Fee Schedule,4891.93
Blue Shield,HMO,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,Fee Schedule,4891.93
Blue Shield,HMO,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,HMO,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Fee Schedule,987.79
Blue Shield,HMO,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Fee Schedule,987.79
Blue Shield,HMO,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,3198.57
Blue Shield,HMO,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,4280.44
Blue Shield,HMO,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,4280.44
Blue Shield,HMO,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,4891.93
Blue Shield,HMO,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,6049.05
Blue Shield,HMO,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,Fee Schedule,4891.93
Blue Shield,HMO,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Fee Schedule,4280.44
Blue Shield,HMO,33463,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Fee Schedule,4280.44
Blue Shield,HMO,33464,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Fee Schedule,4891.93
Blue Shield,HMO,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,Fee Schedule,4891.93
Blue Shield,HMO,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Fee Schedule,6049.05
Blue Shield,HMO,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,HMO,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,HMO,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,HMO,33475,CPT4/HCPCS,REPLACEMENT PULMONARY VALVE,,Fee Schedule,6049.05
Blue Shield,HMO,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,4280.44
Blue Shield,HMO,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,Fee Schedule,987.79
Blue Shield,HMO,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,4280.44
Blue Shield,HMO,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,Fee Schedule,4891.93
Blue Shield,HMO,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Fee Schedule,4280.44
Blue Shield,HMO,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,Fee Schedule,4891.93
Blue Shield,HMO,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Fee Schedule,4891.93
Blue Shield,HMO,33505,CPT4/HCPCS,REPAIR ARTERY W/TUNNEL,,Fee Schedule,6049.05
Blue Shield,HMO,33506,CPT4/HCPCS,REPAIR ARTERY TRANSLOCATION,,Fee Schedule,6049.05
Blue Shield,HMO,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,Fee Schedule,3198.57
Blue Shield,HMO,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,Fee Schedule,3198.57
Blue Shield,HMO,33622,CPT4/HCPCS,REDO COMPL CARDIAC ANOMALY,,Fee Schedule,3198.57
Blue Shield,HMO,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,Fee Schedule,3198.57
Blue Shield,HMO,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,Fee Schedule,3198.57
Blue Shield,HMO,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,Fee Schedule,3198.57
Blue Shield,HMO,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,Fee Schedule,987.79
Blue Shield,HMO,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,Fee Schedule,987.79
Blue Shield,HMO,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,Fee Schedule,987.79
Blue Shield,HMO,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,Fee Schedule,987.79
Blue Shield,HMO,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,HMO,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,HMO,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,HMO,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,HMO,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,HMO,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,HMO,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Fee Schedule,987.79
Blue Shield,HMO,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,Fee Schedule,987.79
Blue Shield,HMO,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,Fee Schedule,987.79
Blue Shield,HMO,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,Fee Schedule,987.79
Blue Shield,HMO,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,Fee Schedule,9304.07
Blue Shield,HMO,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,Fee Schedule,9304.07
Blue Shield,HMO,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,Fee Schedule,9304.07
Blue Shield,HMO,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,Fee Schedule,9304.07
Blue Shield,HMO,33999,CPT4/HCPCS,CARDIAC SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,HMO,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,HMO,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,HMO,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,HMO,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,3198.57
Blue Shield,HMO,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,HMO,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,3198.57
Blue Shield,HMO,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,HMO,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,HMO,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,Fee Schedule,9548.66
Blue Shield,HMO,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,Fee Schedule,9548.66
Blue Shield,HMO,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,Fee Schedule,9548.66
Blue Shield,HMO,34530,CPT4/HCPCS,LEG VEIN FUSION,,Fee Schedule,9548.66
Blue Shield,HMO,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Fee Schedule,3198.57
Blue Shield,HMO,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Fee Schedule,3198.57
Blue Shield,HMO,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Fee Schedule,3198.57
Blue Shield,HMO,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Fee Schedule,3198.57
Blue Shield,HMO,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Fee Schedule,3198.57
Blue Shield,HMO,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Fee Schedule,3198.57
Blue Shield,HMO,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Fee Schedule,3198.57
Blue Shield,HMO,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Fee Schedule,3198.57
Blue Shield,HMO,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Fee Schedule,3198.57
Blue Shield,HMO,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Fee Schedule,3198.57
Blue Shield,HMO,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Fee Schedule,3198.57
Blue Shield,HMO,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Fee Schedule,3198.57
Blue Shield,HMO,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Fee Schedule,3198.57
Blue Shield,HMO,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Fee Schedule,3198.57
Blue Shield,HMO,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Fee Schedule,3198.57
Blue Shield,HMO,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,Fee Schedule,987.79
Blue Shield,HMO,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,Fee Schedule,987.79
Blue Shield,HMO,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,Fee Schedule,987.79
Blue Shield,HMO,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,Fee Schedule,987.79
Blue Shield,HMO,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,Fee Schedule,987.79
Blue Shield,HMO,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,Fee Schedule,987.79
Blue Shield,HMO,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,Fee Schedule,987.79
Blue Shield,HMO,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,Fee Schedule,987.79
Blue Shield,HMO,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,Fee Schedule,3198.57
Blue Shield,HMO,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,7902.34
Blue Shield,HMO,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,Fee Schedule,3198.57
Blue Shield,HMO,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,Fee Schedule,3198.57
Blue Shield,HMO,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4280.44
Blue Shield,HMO,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,4280.44
Blue Shield,HMO,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4891.93
Blue Shield,HMO,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,4280.44
Blue Shield,HMO,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4891.93
Blue Shield,HMO,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,Fee Schedule,3198.57
Blue Shield,HMO,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,Fee Schedule,4280.44
Blue Shield,HMO,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,Fee Schedule,3198.57
Blue Shield,HMO,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,Fee Schedule,3198.57
Blue Shield,HMO,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,Fee Schedule,3198.57
Blue Shield,HMO,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,HMO,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,HMO,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,HMO,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,HMO,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,HMO,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,HMO,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,HMO,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,HMO,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,7902.34
Blue Shield,HMO,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,6049.05
Blue Shield,HMO,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,4280.44
Blue Shield,HMO,35371,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35390,CPT4/HCPCS,REOPERATION CAROTID ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,35400,CPT4/HCPCS,ANGIOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,Fee Schedule,9548.66
Blue Shield,HMO,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,Fee Schedule,3198.57
Blue Shield,HMO,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,Fee Schedule,3198.57
Blue Shield,HMO,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,Fee Schedule,3198.57
Blue Shield,HMO,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,Fee Schedule,3198.57
Blue Shield,HMO,35510,CPT4/HCPCS,ART BYP GRFT CAROTID-BRCHIAL,,Fee Schedule,3198.57
Blue Shield,HMO,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,Fee Schedule,3198.57
Blue Shield,HMO,35512,CPT4/HCPCS,ART BYP GRFT SUBCLAV-BRCHIAL,,Fee Schedule,3198.57
Blue Shield,HMO,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,Fee Schedule,3198.57
Blue Shield,HMO,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,Fee Schedule,3198.57
Blue Shield,HMO,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,Fee Schedule,3198.57
Blue Shield,HMO,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,Fee Schedule,3198.57
Blue Shield,HMO,35522,CPT4/HCPCS,ART BYP GRFT AXILL-BRACHIAL,,Fee Schedule,3198.57
Blue Shield,HMO,35525,CPT4/HCPCS,ART BYP GRFT BRACHIAL-BRCHL,,Fee Schedule,3198.57
Blue Shield,HMO,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,Fee Schedule,3198.57
Blue Shield,HMO,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,Fee Schedule,4280.44
Blue Shield,HMO,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,Fee Schedule,3198.57
Blue Shield,HMO,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,Fee Schedule,4280.44
Blue Shield,HMO,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,HMO,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,Fee Schedule,3198.57
Blue Shield,HMO,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,Fee Schedule,4280.44
Blue Shield,HMO,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,Fee Schedule,3198.57
Blue Shield,HMO,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,Fee Schedule,3198.57
Blue Shield,HMO,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Fee Schedule,3198.57
Blue Shield,HMO,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Fee Schedule,3198.57
Blue Shield,HMO,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,HMO,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,Fee Schedule,4280.44
Blue Shield,HMO,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,Fee Schedule,4280.44
Blue Shield,HMO,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,Fee Schedule,3198.57
Blue Shield,HMO,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,HMO,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,HMO,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,Fee Schedule,3198.57
Blue Shield,HMO,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,Fee Schedule,3198.57
Blue Shield,HMO,35623,CPT4/HCPCS,ART BYP AXILLARY-POP-TIBIAL,,Fee Schedule,3198.57
Blue Shield,HMO,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,Fee Schedule,3198.57
Blue Shield,HMO,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,Fee Schedule,4280.44
Blue Shield,HMO,35636,CPT4/HCPCS,ART BYP SPENORENAL,,Fee Schedule,3198.57
Blue Shield,HMO,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,Fee Schedule,3198.57
Blue Shield,HMO,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,Fee Schedule,3198.57
Blue Shield,HMO,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,Fee Schedule,4280.44
Blue Shield,HMO,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,Fee Schedule,3198.57
Blue Shield,HMO,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,Fee Schedule,3198.57
Blue Shield,HMO,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,Fee Schedule,3198.57
Blue Shield,HMO,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,HMO,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,Fee Schedule,3198.57
Blue Shield,HMO,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,Fee Schedule,3198.57
Blue Shield,HMO,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,Fee Schedule,3198.57
Blue Shield,HMO,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Fee Schedule,3198.57
Blue Shield,HMO,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Fee Schedule,3198.57
Blue Shield,HMO,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,Fee Schedule,3198.57
Blue Shield,HMO,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,Fee Schedule,3198.57
Blue Shield,HMO,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,Fee Schedule,3198.57
Blue Shield,HMO,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,Fee Schedule,6049.05
Blue Shield,HMO,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,Fee Schedule,6049.05
Blue Shield,HMO,35691,CPT4/HCPCS,ART TRNSPOSJ VERTBRL CAROTID,,Fee Schedule,3198.57
Blue Shield,HMO,35693,CPT4/HCPCS,ART TRNSPOSJ SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,HMO,35694,CPT4/HCPCS,ART TRNSPOSJ SUBCLAV CAROTID,,Fee Schedule,3198.57
Blue Shield,HMO,35695,CPT4/HCPCS,ART TRNSPOSJ CAROTID SUBCLAV,,Fee Schedule,3198.57
Blue Shield,HMO,35697,CPT4/HCPCS,REIMPLANT ARTERY EACH,,Fee Schedule,3198.57
Blue Shield,HMO,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,Fee Schedule,3198.57
Blue Shield,HMO,35721,CPT4/HCPCS,EXPLORATION FEMORAL ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35741,CPT4/HCPCS,EXPLORATION POPLITEAL ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,35761,CPT4/HCPCS,EXPLORATION OF ARTERY/VEIN,,Fee Schedule,6876.92
Blue Shield,HMO,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,Fee Schedule,3198.57
Blue Shield,HMO,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,Fee Schedule,3198.57
Blue Shield,HMO,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,Fee Schedule,3198.57
Blue Shield,HMO,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,Fee Schedule,6049.05
Blue Shield,HMO,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,Fee Schedule,3198.57
Blue Shield,HMO,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Fee Schedule,12850.71
Blue Shield,HMO,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Fee Schedule,12850.71
Blue Shield,HMO,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Fee Schedule,9548.66
Blue Shield,HMO,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Fee Schedule,9548.66
Blue Shield,HMO,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,Fee Schedule,3198.57
Blue Shield,HMO,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,Fee Schedule,6876.92
Blue Shield,HMO,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,Fee Schedule,4891.93
Blue Shield,HMO,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,Fee Schedule,4280.44
Blue Shield,HMO,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Fee Schedule,3198.57
Blue Shield,HMO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Fee Schedule,3198.57
Blue Shield,HMO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Fee Schedule,3198.57
Blue Shield,HMO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Fee Schedule,3198.57
Blue Shield,HMO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Fee Schedule,3198.57
Blue Shield,HMO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Fee Schedule,3198.57
Blue Shield,HMO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Fee Schedule,3198.57
Blue Shield,HMO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Fee Schedule,3198.57
Blue Shield,HMO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Fee Schedule,3198.57
Blue Shield,HMO,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Fee Schedule,4891.93
Blue Shield,HMO,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,HMO,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Fee Schedule,3198.57
Blue Shield,HMO,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Fee Schedule,3198.57
Blue Shield,HMO,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Fee Schedule,3198.57
Blue Shield,HMO,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Fee Schedule,987.79
Blue Shield,HMO,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Fee Schedule,3198.57
Blue Shield,HMO,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Fee Schedule,3198.57
Blue Shield,HMO,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Fee Schedule,3198.57
Blue Shield,HMO,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Fee Schedule,3198.57
Blue Shield,HMO,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Fee Schedule,3198.57
Blue Shield,HMO,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Fee Schedule,3198.57
Blue Shield,HMO,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Fee Schedule,3198.57
Blue Shield,HMO,36468,CPT4/HCPCS,NJX SCLRSNT SPIDER VEINS,,Fee Schedule,3198.57
Blue Shield,HMO,36470,CPT4/HCPCS,NJX SCLRSNT 1 INCMPTNT VEIN,,Fee Schedule,3198.57
Blue Shield,HMO,36471,CPT4/HCPCS,NJX SCLRSNT MLT INCMPTNT VN,,Fee Schedule,3198.57
Blue Shield,HMO,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,HMO,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,HMO,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Fee Schedule,6876.92
Blue Shield,HMO,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,HMO,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Fee Schedule,6876.92
Blue Shield,HMO,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Fee Schedule,6876.92
Blue Shield,HMO,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Fee Schedule,6876.92
Blue Shield,HMO,36511,CPT4/HCPCS,APHERESIS WBC,,Fee Schedule,3198.57
Blue Shield,HMO,36512,CPT4/HCPCS,APHERESIS RBC,,Fee Schedule,3198.57
Blue Shield,HMO,36513,CPT4/HCPCS,APHERESIS PLATELETS,,Fee Schedule,3198.57
Blue Shield,HMO,36514,CPT4/HCPCS,APHERESIS PLASMA,,Fee Schedule,3198.57
Blue Shield,HMO,36516,CPT4/HCPCS,APHERESIS IMMUNOADS SLCTV,,Fee Schedule,9548.66
Blue Shield,HMO,36522,CPT4/HCPCS,PHOTOPHERESIS,,Fee Schedule,9548.66
Blue Shield,HMO,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,HMO,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,HMO,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,HMO,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,HMO,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,12850.71
Blue Shield,HMO,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,HMO,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,HMO,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,HMO,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,HMO,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Fee Schedule,3198.57
Blue Shield,HMO,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Fee Schedule,987.79
Blue Shield,HMO,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,HMO,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Fee Schedule,3198.57
Blue Shield,HMO,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Fee Schedule,987.79
Blue Shield,HMO,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Fee Schedule,987.79
Blue Shield,HMO,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,HMO,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,HMO,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,HMO,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Fee Schedule,9548.66
Blue Shield,HMO,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Fee Schedule,4891.93
Blue Shield,HMO,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Fee Schedule,4891.93
Blue Shield,HMO,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Fee Schedule,4891.93
Blue Shield,HMO,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,Fee Schedule,3198.57
Blue Shield,HMO,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Fee Schedule,12850.71
Blue Shield,HMO,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Fee Schedule,6049.05
Blue Shield,HMO,36833,CPT4/HCPCS,AV FISTULA REVISION,,Fee Schedule,6049.05
Blue Shield,HMO,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Fee Schedule,6049.05
Blue Shield,HMO,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Fee Schedule,9548.66
Blue Shield,HMO,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Fee Schedule,4280.44
Blue Shield,HMO,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Fee Schedule,4891.93
Blue Shield,HMO,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,HMO,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,HMO,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,HMO,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,HMO,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,HMO,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,HMO,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Fee Schedule,6049.05
Blue Shield,HMO,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Fee Schedule,6049.05
Blue Shield,HMO,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Fee Schedule,6049.05
Blue Shield,HMO,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,HMO,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,4280.44
Blue Shield,HMO,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,HMO,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,HMO,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,Fee Schedule,3198.57
Blue Shield,HMO,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,Fee Schedule,3198.57
Blue Shield,HMO,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Fee Schedule,3198.57
Blue Shield,HMO,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Fee Schedule,4891.93
Blue Shield,HMO,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Fee Schedule,4891.93
Blue Shield,HMO,37186,CPT4/HCPCS,SEC ART THROMBECTOMY ADD-ON,,Fee Schedule,4891.93
Blue Shield,HMO,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Fee Schedule,4891.93
Blue Shield,HMO,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Fee Schedule,4891.93
Blue Shield,HMO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Fee Schedule,4280.44
Blue Shield,HMO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Fee Schedule,4280.44
Blue Shield,HMO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Fee Schedule,4280.44
Blue Shield,HMO,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,Fee Schedule,3198.57
Blue Shield,HMO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,HMO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Fee Schedule,4891.93
Blue Shield,HMO,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Fee Schedule,4891.93
Blue Shield,HMO,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Fee Schedule,4891.93
Blue Shield,HMO,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Fee Schedule,4891.93
Blue Shield,HMO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Fee Schedule,987.79
Blue Shield,HMO,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Fee Schedule,987.79
Blue Shield,HMO,37220,CPT4/HCPCS,ILIAC REVASC,,Fee Schedule,6049.05
Blue Shield,HMO,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,HMO,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Fee Schedule,6049.05
Blue Shield,HMO,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Fee Schedule,6049.05
Blue Shield,HMO,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Fee Schedule,6049.05
Blue Shield,HMO,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Fee Schedule,6049.05
Blue Shield,HMO,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,HMO,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Fee Schedule,6049.05
Blue Shield,HMO,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Fee Schedule,6049.05
Blue Shield,HMO,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Fee Schedule,6049.05
Blue Shield,HMO,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,HMO,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Fee Schedule,6049.05
Blue Shield,HMO,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Fee Schedule,6049.05
Blue Shield,HMO,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Fee Schedule,6049.05
Blue Shield,HMO,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Fee Schedule,6049.05
Blue Shield,HMO,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Fee Schedule,6049.05
Blue Shield,HMO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Fee Schedule,6049.05
Blue Shield,HMO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Fee Schedule,6049.05
Blue Shield,HMO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Fee Schedule,6049.05
Blue Shield,HMO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Fee Schedule,6049.05
Blue Shield,HMO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Fee Schedule,987.79
Blue Shield,HMO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Fee Schedule,987.79
Blue Shield,HMO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Fee Schedule,987.79
Blue Shield,HMO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Fee Schedule,987.79
Blue Shield,HMO,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Fee Schedule,3198.57
Blue Shield,HMO,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Fee Schedule,3198.57
Blue Shield,HMO,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Fee Schedule,6876.92
Blue Shield,HMO,37501,CPT4/HCPCS,VASCULAR ENDOSCOPY PROCEDURE,,Fee Schedule,6876.92
Blue Shield,HMO,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,Fee Schedule,6049.05
Blue Shield,HMO,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,6049.05
Blue Shield,HMO,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,HMO,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,HMO,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Fee Schedule,4891.93
Blue Shield,HMO,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,HMO,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,HMO,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Fee Schedule,7902.34
Blue Shield,HMO,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Fee Schedule,4280.44
Blue Shield,HMO,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Fee Schedule,3198.57
Blue Shield,HMO,37700,CPT4/HCPCS,REVISE LEG VEIN,,Fee Schedule,4280.44
Blue Shield,HMO,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Fee Schedule,4891.93
Blue Shield,HMO,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Fee Schedule,4891.93
Blue Shield,HMO,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Fee Schedule,4891.93
Blue Shield,HMO,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Fee Schedule,4891.93
Blue Shield,HMO,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Fee Schedule,6876.92
Blue Shield,HMO,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Fee Schedule,7902.34
Blue Shield,HMO,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Fee Schedule,7902.34
Blue Shield,HMO,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Fee Schedule,4891.93
Blue Shield,HMO,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Fee Schedule,4891.93
Blue Shield,HMO,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,Fee Schedule,4280.44
Blue Shield,HMO,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Fee Schedule,4891.93
Blue Shield,HMO,37799,CPT4/HCPCS,VASCULAR SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Fee Schedule,3198.57
Blue Shield,HMO,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,Fee Schedule,3198.57
Blue Shield,HMO,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Fee Schedule,3198.57
Blue Shield,HMO,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,Fee Schedule,3198.57
Blue Shield,HMO,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Fee Schedule,9548.66
Blue Shield,HMO,38129,CPT4/HCPCS,LAPAROSCOPE PROC SPLEEN,,Fee Schedule,7902.34
Blue Shield,HMO,38204,CPT4/HCPCS,BL DONOR SEARCH MANAGEMENT,,Fee Schedule,3198.57
Blue Shield,HMO,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,Fee Schedule,3198.57
Blue Shield,HMO,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,Fee Schedule,3198.57
Blue Shield,HMO,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,Fee Schedule,3198.57
Blue Shield,HMO,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,Fee Schedule,3198.57
Blue Shield,HMO,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,Fee Schedule,3198.57
Blue Shield,HMO,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,Fee Schedule,3198.57
Blue Shield,HMO,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,Fee Schedule,3198.57
Blue Shield,HMO,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,Fee Schedule,3198.57
Blue Shield,HMO,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,Fee Schedule,3198.57
Blue Shield,HMO,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,Fee Schedule,3198.57
Blue Shield,HMO,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,Fee Schedule,3198.57
Blue Shield,HMO,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Fee Schedule,987.79
Blue Shield,HMO,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Fee Schedule,987.79
Blue Shield,HMO,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Fee Schedule,987.79
Blue Shield,HMO,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Fee Schedule,3198.57
Blue Shield,HMO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Fee Schedule,6049.05
Blue Shield,HMO,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Fee Schedule,3198.57
Blue Shield,HMO,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Fee Schedule,3198.57
Blue Shield,HMO,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,Fee Schedule,3198.57
Blue Shield,HMO,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Fee Schedule,3198.57
Blue Shield,HMO,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Fee Schedule,3198.57
Blue Shield,HMO,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Fee Schedule,4280.44
Blue Shield,HMO,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,HMO,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,HMO,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,HMO,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,HMO,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,HMO,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,HMO,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Fee Schedule,4280.44
Blue Shield,HMO,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Fee Schedule,4891.93
Blue Shield,HMO,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Fee Schedule,6049.05
Blue Shield,HMO,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,HMO,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,HMO,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Fee Schedule,12850.71
Blue Shield,HMO,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Fee Schedule,12850.71
Blue Shield,HMO,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Fee Schedule,12850.71
Blue Shield,HMO,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Fee Schedule,12850.71
Blue Shield,HMO,38589,CPT4/HCPCS,LAPAROSCOPE PROC LYMPHATIC,,Fee Schedule,7902.34
Blue Shield,HMO,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,HMO,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,HMO,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,HMO,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,HMO,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Fee Schedule,6049.05
Blue Shield,HMO,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,HMO,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,HMO,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,HMO,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,HMO,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,HMO,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,HMO,38999,CPT4/HCPCS,BLOOD/LYMPH SYSTEM PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,HMO,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,HMO,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,Fee Schedule,3198.57
Blue Shield,HMO,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,Fee Schedule,3198.57
Blue Shield,HMO,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Fee Schedule,7902.34
Blue Shield,HMO,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Fee Schedule,7902.34
Blue Shield,HMO,39499,CPT4/HCPCS,CHEST PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,Fee Schedule,3198.57
Blue Shield,HMO,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,12850.71
Blue Shield,HMO,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,3198.57
Blue Shield,HMO,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,3198.57
Blue Shield,HMO,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,Fee Schedule,3198.57
Blue Shield,HMO,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,Fee Schedule,3198.57
Blue Shield,HMO,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,Fee Schedule,3198.57
Blue Shield,HMO,39599,CPT4/HCPCS,DIAPHRAGM SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,40490,CPT4/HCPCS,BIOPSY OF LIP,,Fee Schedule,3198.57
Blue Shield,HMO,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,HMO,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,HMO,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,HMO,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Fee Schedule,4280.44
Blue Shield,HMO,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Fee Schedule,4280.44
Blue Shield,HMO,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Fee Schedule,4280.44
Blue Shield,HMO,40650,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,HMO,40652,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,HMO,40654,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,HMO,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,HMO,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,HMO,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,HMO,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,HMO,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,4891.93
Blue Shield,HMO,40799,CPT4/HCPCS,LIP SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,HMO,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,987.79
Blue Shield,HMO,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,HMO,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Fee Schedule,987.79
Blue Shield,HMO,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Fee Schedule,3198.57
Blue Shield,HMO,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Fee Schedule,3198.57
Blue Shield,HMO,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,HMO,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,HMO,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,HMO,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,HMO,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Fee Schedule,3198.57
Blue Shield,HMO,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,HMO,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Fee Schedule,987.79
Blue Shield,HMO,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Fee Schedule,3198.57
Blue Shield,HMO,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4280.44
Blue Shield,HMO,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4891.93
Blue Shield,HMO,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4891.93
Blue Shield,HMO,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,6876.92
Blue Shield,HMO,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,6876.92
Blue Shield,HMO,40899,CPT4/HCPCS,MOUTH SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Fee Schedule,3198.57
Blue Shield,HMO,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Fee Schedule,3198.57
Blue Shield,HMO,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Fee Schedule,3198.57
Blue Shield,HMO,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Fee Schedule,4280.44
Blue Shield,HMO,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Fee Schedule,3198.57
Blue Shield,HMO,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Fee Schedule,3198.57
Blue Shield,HMO,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Fee Schedule,6876.92
Blue Shield,HMO,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Fee Schedule,3198.57
Blue Shield,HMO,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,Fee Schedule,4891.93
Blue Shield,HMO,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,HMO,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,HMO,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,HMO,41500,CPT4/HCPCS,FIXATION OF TONGUE,,Fee Schedule,3198.57
Blue Shield,HMO,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Fee Schedule,4891.93
Blue Shield,HMO,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Fee Schedule,4280.44
Blue Shield,HMO,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Fee Schedule,4280.44
Blue Shield,HMO,41599,CPT4/HCPCS,TONGUE AND MOUTH SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Fee Schedule,3198.57
Blue Shield,HMO,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Fee Schedule,6049.05
Blue Shield,HMO,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Fee Schedule,4280.44
Blue Shield,HMO,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Fee Schedule,3198.57
Blue Shield,HMO,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Fee Schedule,3198.57
Blue Shield,HMO,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,6049.05
Blue Shield,HMO,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Fee Schedule,4280.44
Blue Shield,HMO,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,HMO,41870,CPT4/HCPCS,GUM GRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,41872,CPT4/HCPCS,REPAIR GUM,,Fee Schedule,4280.44
Blue Shield,HMO,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Fee Schedule,6049.05
Blue Shield,HMO,41899,CPT4/HCPCS,DENTAL SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,HMO,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Fee Schedule,4280.44
Blue Shield,HMO,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Fee Schedule,3198.57
Blue Shield,HMO,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,HMO,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,HMO,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,HMO,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Fee Schedule,6049.05
Blue Shield,HMO,42140,CPT4/HCPCS,EXCISION OF UVULA,,Fee Schedule,4280.44
Blue Shield,HMO,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Fee Schedule,6876.92
Blue Shield,HMO,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Fee Schedule,4280.44
Blue Shield,HMO,42180,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,3198.57
Blue Shield,HMO,42182,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,4280.44
Blue Shield,HMO,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,HMO,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,HMO,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,HMO,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,9548.66
Blue Shield,HMO,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,HMO,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,9548.66
Blue Shield,HMO,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Fee Schedule,6876.92
Blue Shield,HMO,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,Fee Schedule,9548.66
Blue Shield,HMO,42235,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,6876.92
Blue Shield,HMO,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Fee Schedule,6049.05
Blue Shield,HMO,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Fee Schedule,987.79
Blue Shield,HMO,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,HMO,42299,CPT4/HCPCS,PALATE/UVULA SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,HMO,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,4280.44
Blue Shield,HMO,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,HMO,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,HMO,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,HMO,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,HMO,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,HMO,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Fee Schedule,987.79
Blue Shield,HMO,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Fee Schedule,4280.44
Blue Shield,HMO,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Fee Schedule,4891.93
Blue Shield,HMO,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Fee Schedule,4891.93
Blue Shield,HMO,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,4891.93
Blue Shield,HMO,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,HMO,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,HMO,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,HMO,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,4891.93
Blue Shield,HMO,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Fee Schedule,4891.93
Blue Shield,HMO,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Fee Schedule,4280.44
Blue Shield,HMO,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Fee Schedule,4891.93
Blue Shield,HMO,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Fee Schedule,6049.05
Blue Shield,HMO,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,4891.93
Blue Shield,HMO,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,6049.05
Blue Shield,HMO,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,6049.05
Blue Shield,HMO,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,42650,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Fee Schedule,3198.57
Blue Shield,HMO,42660,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Fee Schedule,3198.57
Blue Shield,HMO,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Fee Schedule,6049.05
Blue Shield,HMO,42699,CPT4/HCPCS,SALIVARY SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,HMO,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Fee Schedule,4280.44
Blue Shield,HMO,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Fee Schedule,3198.57
Blue Shield,HMO,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Fee Schedule,4280.44
Blue Shield,HMO,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Fee Schedule,4280.44
Blue Shield,HMO,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,HMO,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Fee Schedule,4891.93
Blue Shield,HMO,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Fee Schedule,6876.92
Blue Shield,HMO,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Fee Schedule,4891.93
Blue Shield,HMO,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Fee Schedule,6876.92
Blue Shield,HMO,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Fee Schedule,6049.05
Blue Shield,HMO,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Fee Schedule,6049.05
Blue Shield,HMO,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,HMO,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,HMO,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,HMO,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,HMO,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,6049.05
Blue Shield,HMO,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,9548.66
Blue Shield,HMO,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,4891.93
Blue Shield,HMO,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Fee Schedule,4891.93
Blue Shield,HMO,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Fee Schedule,4891.93
Blue Shield,HMO,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Fee Schedule,9548.66
Blue Shield,HMO,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Fee Schedule,9548.66
Blue Shield,HMO,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Fee Schedule,4891.93
Blue Shield,HMO,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Fee Schedule,4280.44
Blue Shield,HMO,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,HMO,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Fee Schedule,4280.44
Blue Shield,HMO,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,HMO,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,HMO,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,4280.44
Blue Shield,HMO,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,HMO,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,HMO,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,4891.93
Blue Shield,HMO,42999,CPT4/HCPCS,THROAT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,HMO,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,HMO,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Fee Schedule,3198.57
Blue Shield,HMO,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Fee Schedule,3198.57
Blue Shield,HMO,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,HMO,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,HMO,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,Fee Schedule,6049.05
Blue Shield,HMO,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,HMO,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,HMO,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,HMO,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,HMO,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,HMO,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,HMO,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,HMO,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,HMO,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Fee Schedule,6049.05
Blue Shield,HMO,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Fee Schedule,3198.57
Blue Shield,HMO,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Fee Schedule,3198.57
Blue Shield,HMO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Fee Schedule,3198.57
Blue Shield,HMO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Fee Schedule,3198.57
Blue Shield,HMO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Fee Schedule,3198.57
Blue Shield,HMO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Fee Schedule,3198.57
Blue Shield,HMO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Fee Schedule,3198.57
Blue Shield,HMO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Fee Schedule,3198.57
Blue Shield,HMO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Fee Schedule,3198.57
Blue Shield,HMO,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Fee Schedule,3198.57
Blue Shield,HMO,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Fee Schedule,3198.57
Blue Shield,HMO,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Fee Schedule,3198.57
Blue Shield,HMO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Fee Schedule,3198.57
Blue Shield,HMO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Fee Schedule,3198.57
Blue Shield,HMO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Fee Schedule,3198.57
Blue Shield,HMO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Fee Schedule,3198.57
Blue Shield,HMO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Fee Schedule,3198.57
Blue Shield,HMO,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Fee Schedule,3198.57
Blue Shield,HMO,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Fee Schedule,3198.57
Blue Shield,HMO,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Fee Schedule,3198.57
Blue Shield,HMO,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Fee Schedule,3198.57
Blue Shield,HMO,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Fee Schedule,3198.57
Blue Shield,HMO,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Fee Schedule,4280.44
Blue Shield,HMO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Fee Schedule,3198.57
Blue Shield,HMO,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Fee Schedule,4280.44
Blue Shield,HMO,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Fee Schedule,4280.44
Blue Shield,HMO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Fee Schedule,3198.57
Blue Shield,HMO,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Fee Schedule,3198.57
Blue Shield,HMO,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Fee Schedule,4280.44
Blue Shield,HMO,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Fee Schedule,3198.57
Blue Shield,HMO,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Fee Schedule,3198.57
Blue Shield,HMO,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Fee Schedule,4280.44
Blue Shield,HMO,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Fee Schedule,4280.44
Blue Shield,HMO,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Fee Schedule,4280.44
Blue Shield,HMO,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Fee Schedule,4280.44
Blue Shield,HMO,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Fee Schedule,4280.44
Blue Shield,HMO,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Fee Schedule,4280.44
Blue Shield,HMO,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Fee Schedule,4280.44
Blue Shield,HMO,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Fee Schedule,4280.44
Blue Shield,HMO,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,HMO,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Fee Schedule,4280.44
Blue Shield,HMO,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Fee Schedule,4280.44
Blue Shield,HMO,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Fee Schedule,4280.44
Blue Shield,HMO,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Fee Schedule,4280.44
Blue Shield,HMO,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Fee Schedule,3198.57
Blue Shield,HMO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Fee Schedule,3198.57
Blue Shield,HMO,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Fee Schedule,4280.44
Blue Shield,HMO,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Fee Schedule,6049.05
Blue Shield,HMO,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Fee Schedule,4891.93
Blue Shield,HMO,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Fee Schedule,4280.44
Blue Shield,HMO,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Fee Schedule,4280.44
Blue Shield,HMO,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Fee Schedule,4280.44
Blue Shield,HMO,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Fee Schedule,4280.44
Blue Shield,HMO,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Fee Schedule,4280.44
Blue Shield,HMO,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Fee Schedule,4280.44
Blue Shield,HMO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Fee Schedule,4280.44
Blue Shield,HMO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Fee Schedule,4280.44
Blue Shield,HMO,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Fee Schedule,4280.44
Blue Shield,HMO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Fee Schedule,4280.44
Blue Shield,HMO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Fee Schedule,4280.44
Blue Shield,HMO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Fee Schedule,4280.44
Blue Shield,HMO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Fee Schedule,4280.44
Blue Shield,HMO,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Fee Schedule,12850.71
Blue Shield,HMO,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Fee Schedule,7902.34
Blue Shield,HMO,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Fee Schedule,9548.66
Blue Shield,HMO,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,Fee Schedule,3198.57
Blue Shield,HMO,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Fee Schedule,6049.05
Blue Shield,HMO,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Fee Schedule,3198.57
Blue Shield,HMO,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,Fee Schedule,3198.57
Blue Shield,HMO,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,Fee Schedule,3198.57
Blue Shield,HMO,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,Fee Schedule,3198.57
Blue Shield,HMO,43289,CPT4/HCPCS,LAPAROSCOPE PROC ESOPH,,Fee Schedule,7902.34
Blue Shield,HMO,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,HMO,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Fee Schedule,4280.44
Blue Shield,HMO,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,HMO,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Fee Schedule,4891.93
Blue Shield,HMO,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,Fee Schedule,6876.92
Blue Shield,HMO,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,Fee Schedule,6876.92
Blue Shield,HMO,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,Fee Schedule,3198.57
Blue Shield,HMO,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,Fee Schedule,3198.57
Blue Shield,HMO,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,Fee Schedule,3198.57
Blue Shield,HMO,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,Fee Schedule,3198.57
Blue Shield,HMO,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,Fee Schedule,3198.57
Blue Shield,HMO,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,Fee Schedule,3198.57
Blue Shield,HMO,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Fee Schedule,3198.57
Blue Shield,HMO,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Fee Schedule,3198.57
Blue Shield,HMO,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Fee Schedule,3198.57
Blue Shield,HMO,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Fee Schedule,3198.57
Blue Shield,HMO,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Fee Schedule,3198.57
Blue Shield,HMO,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Fee Schedule,3198.57
Blue Shield,HMO,43338,CPT4/HCPCS,ESOPH LENGTHENING,,Fee Schedule,3198.57
Blue Shield,HMO,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,HMO,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,HMO,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Fee Schedule,4891.93
Blue Shield,HMO,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Fee Schedule,4891.93
Blue Shield,HMO,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,Fee Schedule,3198.57
Blue Shield,HMO,43401,CPT4/HCPCS,ESOPHAGUS SURGERY FOR VEINS,,Fee Schedule,3198.57
Blue Shield,HMO,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,HMO,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Fee Schedule,4280.44
Blue Shield,HMO,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Fee Schedule,3198.57
Blue Shield,HMO,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,HMO,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,HMO,43496,CPT4/HCPCS,FREE JEJUNUM FLAP MICROVASC,,Fee Schedule,3198.57
Blue Shield,HMO,43499,CPT4/HCPCS,ESOPHAGUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Fee Schedule,3198.57
Blue Shield,HMO,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Fee Schedule,3198.57
Blue Shield,HMO,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Fee Schedule,3198.57
Blue Shield,HMO,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Fee Schedule,3198.57
Blue Shield,HMO,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,Fee Schedule,3198.57
Blue Shield,HMO,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,Fee Schedule,3198.57
Blue Shield,HMO,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,HMO,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,HMO,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,HMO,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,HMO,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,HMO,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,HMO,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,HMO,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,HMO,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Fee Schedule,3198.57
Blue Shield,HMO,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Fee Schedule,3198.57
Blue Shield,HMO,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Fee Schedule,4280.44
Blue Shield,HMO,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Fee Schedule,4280.44
Blue Shield,HMO,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Fee Schedule,12850.71
Blue Shield,HMO,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Fee Schedule,12850.71
Blue Shield,HMO,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Fee Schedule,12850.71
Blue Shield,HMO,43659,CPT4/HCPCS,LAPAROSCOPE PROC STOM,,Fee Schedule,7902.34
Blue Shield,HMO,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Fee Schedule,987.79
Blue Shield,HMO,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Fee Schedule,987.79
Blue Shield,HMO,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Fee Schedule,987.79
Blue Shield,HMO,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Fee Schedule,987.79
Blue Shield,HMO,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Fee Schedule,987.79
Blue Shield,HMO,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Fee Schedule,987.79
Blue Shield,HMO,43760,CPT4/HCPCS,CHANGE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Fee Schedule,987.79
Blue Shield,HMO,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,HMO,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,HMO,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,HMO,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,HMO,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Fee Schedule,6049.05
Blue Shield,HMO,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,Fee Schedule,9548.66
Blue Shield,HMO,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,Fee Schedule,3198.57
Blue Shield,HMO,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,Fee Schedule,3198.57
Blue Shield,HMO,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,Fee Schedule,3198.57
Blue Shield,HMO,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,Fee Schedule,4280.44
Blue Shield,HMO,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,Fee Schedule,4891.93
Blue Shield,HMO,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,Fee Schedule,4891.93
Blue Shield,HMO,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,HMO,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,HMO,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,HMO,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,HMO,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,HMO,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,HMO,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,HMO,43999,CPT4/HCPCS,STOMACH SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Fee Schedule,3198.57
Blue Shield,HMO,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Fee Schedule,3198.57
Blue Shield,HMO,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,Fee Schedule,3198.57
Blue Shield,HMO,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,Fee Schedule,3198.57
Blue Shield,HMO,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,Fee Schedule,4891.93
Blue Shield,HMO,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,Fee Schedule,6049.05
Blue Shield,HMO,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,HMO,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,Fee Schedule,3198.57
Blue Shield,HMO,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,Fee Schedule,3198.57
Blue Shield,HMO,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,Fee Schedule,3198.57
Blue Shield,HMO,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,Fee Schedule,3198.57
Blue Shield,HMO,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,Fee Schedule,3198.57
Blue Shield,HMO,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,HMO,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,HMO,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,4280.44
Blue Shield,HMO,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,HMO,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,HMO,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,4891.93
Blue Shield,HMO,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,HMO,44150,CPT4/HCPCS,REMOVAL OF COLON,,Fee Schedule,4280.44
Blue Shield,HMO,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,HMO,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,HMO,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,HMO,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Fee Schedule,4891.93
Blue Shield,HMO,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Fee Schedule,4891.93
Blue Shield,HMO,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Fee Schedule,4891.93
Blue Shield,HMO,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44205,CPT4/HCPCS,LAP COLECTOMY PART W/ILEUM,,Fee Schedule,3198.57
Blue Shield,HMO,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,Fee Schedule,12850.71
Blue Shield,HMO,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Fee Schedule,12850.71
Blue Shield,HMO,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Fee Schedule,12850.71
Blue Shield,HMO,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Fee Schedule,7902.34
Blue Shield,HMO,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,Fee Schedule,7902.34
Blue Shield,HMO,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Fee Schedule,7902.34
Blue Shield,HMO,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Fee Schedule,6876.92
Blue Shield,HMO,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Fee Schedule,6876.92
Blue Shield,HMO,44238,CPT4/HCPCS,LAPAROSCOPE PROC INTESTINE,,Fee Schedule,7902.34
Blue Shield,HMO,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,Fee Schedule,3198.57
Blue Shield,HMO,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,Fee Schedule,4280.44
Blue Shield,HMO,44320,CPT4/HCPCS,COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,Fee Schedule,3198.57
Blue Shield,HMO,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,4891.93
Blue Shield,HMO,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Fee Schedule,4280.44
Blue Shield,HMO,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Fee Schedule,12850.71
Blue Shield,HMO,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Fee Schedule,4280.44
Blue Shield,HMO,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Fee Schedule,12850.71
Blue Shield,HMO,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Fee Schedule,3198.57
Blue Shield,HMO,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Fee Schedule,4891.93
Blue Shield,HMO,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Fee Schedule,3198.57
Blue Shield,HMO,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Fee Schedule,3198.57
Blue Shield,HMO,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Fee Schedule,3198.57
Blue Shield,HMO,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,HMO,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Fee Schedule,3198.57
Blue Shield,HMO,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Fee Schedule,3198.57
Blue Shield,HMO,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Fee Schedule,3198.57
Blue Shield,HMO,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Fee Schedule,3198.57
Blue Shield,HMO,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,HMO,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Fee Schedule,3198.57
Blue Shield,HMO,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Fee Schedule,3198.57
Blue Shield,HMO,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Fee Schedule,3198.57
Blue Shield,HMO,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Fee Schedule,3198.57
Blue Shield,HMO,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,HMO,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,Fee Schedule,3198.57
Blue Shield,HMO,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,HMO,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Fee Schedule,3198.57
Blue Shield,HMO,44799,CPT4/HCPCS,UNLISTED PX SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,44800,CPT4/HCPCS,EXCISION OF BOWEL POUCH,,Fee Schedule,3198.57
Blue Shield,HMO,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,Fee Schedule,3198.57
Blue Shield,HMO,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,Fee Schedule,3198.57
Blue Shield,HMO,44899,CPT4/HCPCS,BOWEL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,Fee Schedule,3198.57
Blue Shield,HMO,44950,CPT4/HCPCS,APPENDECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,44960,CPT4/HCPCS,APPENDECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Fee Schedule,7902.34
Blue Shield,HMO,44979,CPT4/HCPCS,LAPAROSCOPE PROC APP,,Fee Schedule,7902.34
Blue Shield,HMO,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Fee Schedule,3198.57
Blue Shield,HMO,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Fee Schedule,4280.44
Blue Shield,HMO,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,HMO,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,HMO,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,HMO,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,HMO,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,HMO,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,Fee Schedule,4280.44
Blue Shield,HMO,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,HMO,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,Fee Schedule,4280.44
Blue Shield,HMO,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,45126,CPT4/HCPCS,PELVIC EXENTERATION,,Fee Schedule,6049.05
Blue Shield,HMO,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,HMO,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,HMO,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,Fee Schedule,4280.44
Blue Shield,HMO,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Fee Schedule,4280.44
Blue Shield,HMO,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Fee Schedule,4280.44
Blue Shield,HMO,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Fee Schedule,7902.34
Blue Shield,HMO,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Fee Schedule,7902.34
Blue Shield,HMO,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Fee Schedule,12850.71
Blue Shield,HMO,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Fee Schedule,3198.57
Blue Shield,HMO,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Fee Schedule,3198.57
Blue Shield,HMO,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Fee Schedule,3198.57
Blue Shield,HMO,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Fee Schedule,3198.57
Blue Shield,HMO,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,HMO,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,HMO,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,HMO,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Fee Schedule,3198.57
Blue Shield,HMO,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Fee Schedule,3198.57
Blue Shield,HMO,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Fee Schedule,3198.57
Blue Shield,HMO,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Fee Schedule,9548.66
Blue Shield,HMO,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Fee Schedule,3198.57
Blue Shield,HMO,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Fee Schedule,3198.57
Blue Shield,HMO,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Fee Schedule,3198.57
Blue Shield,HMO,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Fee Schedule,3198.57
Blue Shield,HMO,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Fee Schedule,3198.57
Blue Shield,HMO,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Fee Schedule,3198.57
Blue Shield,HMO,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Fee Schedule,3198.57
Blue Shield,HMO,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Fee Schedule,3198.57
Blue Shield,HMO,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Fee Schedule,3198.57
Blue Shield,HMO,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Fee Schedule,3198.57
Blue Shield,HMO,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,HMO,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Fee Schedule,3198.57
Blue Shield,HMO,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,HMO,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Fee Schedule,4280.44
Blue Shield,HMO,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Fee Schedule,4280.44
Blue Shield,HMO,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Fee Schedule,4280.44
Blue Shield,HMO,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Fee Schedule,4280.44
Blue Shield,HMO,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Fee Schedule,4280.44
Blue Shield,HMO,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Fee Schedule,4280.44
Blue Shield,HMO,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Fee Schedule,3198.57
Blue Shield,HMO,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Fee Schedule,3198.57
Blue Shield,HMO,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,HMO,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Fee Schedule,3198.57
Blue Shield,HMO,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Fee Schedule,3198.57
Blue Shield,HMO,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,HMO,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Fee Schedule,3198.57
Blue Shield,HMO,45399,CPT4/HCPCS,UNLISTED PROCEDURE COLON,,Fee Schedule,3198.57
Blue Shield,HMO,45499,CPT4/HCPCS,LAPAROSCOPE PROC RECTUM,,Fee Schedule,4891.93
Blue Shield,HMO,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Fee Schedule,4280.44
Blue Shield,HMO,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Fee Schedule,4280.44
Blue Shield,HMO,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Fee Schedule,987.79
Blue Shield,HMO,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,HMO,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,HMO,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,Fee Schedule,3198.57
Blue Shield,HMO,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Fee Schedule,4280.44
Blue Shield,HMO,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Fee Schedule,3198.57
Blue Shield,HMO,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Fee Schedule,3198.57
Blue Shield,HMO,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,HMO,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Fee Schedule,3198.57
Blue Shield,HMO,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Fee Schedule,3198.57
Blue Shield,HMO,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Fee Schedule,3198.57
Blue Shield,HMO,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Fee Schedule,4280.44
Blue Shield,HMO,45999,CPT4/HCPCS,RECTUM SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Fee Schedule,4891.93
Blue Shield,HMO,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Fee Schedule,3198.57
Blue Shield,HMO,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4891.93
Blue Shield,HMO,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Fee Schedule,3198.57
Blue Shield,HMO,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,HMO,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Fee Schedule,3198.57
Blue Shield,HMO,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Fee Schedule,4280.44
Blue Shield,HMO,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Fee Schedule,3198.57
Blue Shield,HMO,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Fee Schedule,3198.57
Blue Shield,HMO,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Fee Schedule,4280.44
Blue Shield,HMO,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Fee Schedule,4891.93
Blue Shield,HMO,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Fee Schedule,4891.93
Blue Shield,HMO,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Fee Schedule,4891.93
Blue Shield,HMO,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Fee Schedule,4891.93
Blue Shield,HMO,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Fee Schedule,4891.93
Blue Shield,HMO,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Fee Schedule,6049.05
Blue Shield,HMO,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Fee Schedule,6049.05
Blue Shield,HMO,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Fee Schedule,4891.93
Blue Shield,HMO,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Fee Schedule,4891.93
Blue Shield,HMO,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Fee Schedule,6049.05
Blue Shield,HMO,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Fee Schedule,3198.57
Blue Shield,HMO,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Fee Schedule,6049.05
Blue Shield,HMO,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Fee Schedule,3198.57
Blue Shield,HMO,46500,CPT4/HCPCS,INJECTION INTO HEMORRHOID(S),,Fee Schedule,3198.57
Blue Shield,HMO,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Fee Schedule,3198.57
Blue Shield,HMO,46600,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY SPX,,Fee Schedule,987.79
Blue Shield,HMO,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Fee Schedule,987.79
Blue Shield,HMO,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Fee Schedule,3198.57
Blue Shield,HMO,46606,CPT4/HCPCS,ANOSCOPY AND BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Fee Schedule,3198.57
Blue Shield,HMO,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Fee Schedule,3198.57
Blue Shield,HMO,46611,CPT4/HCPCS,ANOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Fee Schedule,3198.57
Blue Shield,HMO,46615,CPT4/HCPCS,ANOSCOPY,,Fee Schedule,4280.44
Blue Shield,HMO,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Fee Schedule,4891.93
Blue Shield,HMO,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Fee Schedule,3198.57
Blue Shield,HMO,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Fee Schedule,3198.57
Blue Shield,HMO,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,Fee Schedule,7902.34
Blue Shield,HMO,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,Fee Schedule,3198.57
Blue Shield,HMO,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,Fee Schedule,3198.57
Blue Shield,HMO,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,3198.57
Blue Shield,HMO,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,4891.93
Blue Shield,HMO,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,4280.44
Blue Shield,HMO,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,Fee Schedule,6049.05
Blue Shield,HMO,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,6876.92
Blue Shield,HMO,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,7902.34
Blue Shield,HMO,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,9548.66
Blue Shield,HMO,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,HMO,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,3198.57
Blue Shield,HMO,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Fee Schedule,4891.93
Blue Shield,HMO,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Fee Schedule,4280.44
Blue Shield,HMO,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4280.44
Blue Shield,HMO,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,HMO,46762,CPT4/HCPCS,IMPLANT ARTIFICIAL SPHINCTER,,Fee Schedule,9548.66
Blue Shield,HMO,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,987.79
Blue Shield,HMO,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,HMO,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Fee Schedule,987.79
Blue Shield,HMO,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Fee Schedule,3198.57
Blue Shield,HMO,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,3198.57
Blue Shield,HMO,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Fee Schedule,3198.57
Blue Shield,HMO,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Fee Schedule,4280.44
Blue Shield,HMO,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Fee Schedule,3198.57
Blue Shield,HMO,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Fee Schedule,3198.57
Blue Shield,HMO,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Fee Schedule,3198.57
Blue Shield,HMO,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Fee Schedule,6049.05
Blue Shield,HMO,46999,CPT4/HCPCS,ANUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Fee Schedule,3198.57
Blue Shield,HMO,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,Fee Schedule,3198.57
Blue Shield,HMO,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,Fee Schedule,3198.57
Blue Shield,HMO,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,Fee Schedule,3198.57
Blue Shield,HMO,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,4891.93
Blue Shield,HMO,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,HMO,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,HMO,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,HMO,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,Fee Schedule,6876.92
Blue Shield,HMO,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,Fee Schedule,12850.71
Blue Shield,HMO,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,6049.05
Blue Shield,HMO,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,6876.92
Blue Shield,HMO,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,7902.34
Blue Shield,HMO,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,Fee Schedule,3198.57
Blue Shield,HMO,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,4280.44
Blue Shield,HMO,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,6049.05
Blue Shield,HMO,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Fee Schedule,9548.66
Blue Shield,HMO,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Fee Schedule,9548.66
Blue Shield,HMO,47379,CPT4/HCPCS,LAPAROSCOPE PROCEDURE LIVER,,Fee Schedule,7902.34
Blue Shield,HMO,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Fee Schedule,3198.57
Blue Shield,HMO,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Fee Schedule,3198.57
Blue Shield,HMO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Fee Schedule,9548.66
Blue Shield,HMO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Fee Schedule,9548.66
Blue Shield,HMO,47399,CPT4/HCPCS,LIVER SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,Fee Schedule,4280.44
Blue Shield,HMO,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,Fee Schedule,3198.57
Blue Shield,HMO,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,Fee Schedule,3198.57
Blue Shield,HMO,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,Fee Schedule,3198.57
Blue Shield,HMO,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Fee Schedule,4891.93
Blue Shield,HMO,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Fee Schedule,4891.93
Blue Shield,HMO,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Fee Schedule,4891.93
Blue Shield,HMO,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Fee Schedule,4891.93
Blue Shield,HMO,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Fee Schedule,4891.93
Blue Shield,HMO,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Fee Schedule,4891.93
Blue Shield,HMO,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Fee Schedule,3198.57
Blue Shield,HMO,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,HMO,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,HMO,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,HMO,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Fee Schedule,4891.93
Blue Shield,HMO,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Fee Schedule,4891.93
Blue Shield,HMO,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Fee Schedule,4891.93
Blue Shield,HMO,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Fee Schedule,4891.93
Blue Shield,HMO,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Fee Schedule,4280.44
Blue Shield,HMO,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,HMO,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,HMO,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,HMO,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,12850.71
Blue Shield,HMO,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Fee Schedule,9548.66
Blue Shield,HMO,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Fee Schedule,9548.66
Blue Shield,HMO,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Fee Schedule,9548.66
Blue Shield,HMO,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,47579,CPT4/HCPCS,LAPAROSCOPE PROC BILIARY,,Fee Schedule,7902.34
Blue Shield,HMO,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,Fee Schedule,3198.57
Blue Shield,HMO,47701,CPT4/HCPCS,BILE DUCT REVISION,,Fee Schedule,4280.44
Blue Shield,HMO,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Fee Schedule,3198.57
Blue Shield,HMO,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Fee Schedule,4280.44
Blue Shield,HMO,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,Fee Schedule,3198.57
Blue Shield,HMO,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,Fee Schedule,3198.57
Blue Shield,HMO,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,Fee Schedule,4280.44
Blue Shield,HMO,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,4280.44
Blue Shield,HMO,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,4280.44
Blue Shield,HMO,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,Fee Schedule,3198.57
Blue Shield,HMO,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,Fee Schedule,3198.57
Blue Shield,HMO,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,Fee Schedule,3198.57
Blue Shield,HMO,47999,CPT4/HCPCS,BILE TRACT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,Fee Schedule,4280.44
Blue Shield,HMO,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,Fee Schedule,4280.44
Blue Shield,HMO,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,Fee Schedule,3198.57
Blue Shield,HMO,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,Fee Schedule,3198.57
Blue Shield,HMO,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Fee Schedule,3198.57
Blue Shield,HMO,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,Fee Schedule,3198.57
Blue Shield,HMO,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,3198.57
Blue Shield,HMO,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,3198.57
Blue Shield,HMO,48146,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,Fee Schedule,3198.57
Blue Shield,HMO,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,6049.05
Blue Shield,HMO,48152,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6049.05
Blue Shield,HMO,48153,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6876.92
Blue Shield,HMO,48154,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6049.05
Blue Shield,HMO,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,Fee Schedule,4280.44
Blue Shield,HMO,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,Fee Schedule,4280.44
Blue Shield,HMO,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,Fee Schedule,3198.57
Blue Shield,HMO,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Fee Schedule,3198.57
Blue Shield,HMO,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,48545,CPT4/HCPCS,PANCREATORRHAPHY,,Fee Schedule,3198.57
Blue Shield,HMO,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,Fee Schedule,3198.57
Blue Shield,HMO,48550,CPT4/HCPCS,DONOR PANCREATECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,48554,CPT4/HCPCS,TRANSPL ALLOGRAFT PANCREAS,,Fee Schedule,3198.57
Blue Shield,HMO,48556,CPT4/HCPCS,REMOVAL ALLOGRAFT PANCREAS,,Fee Schedule,3198.57
Blue Shield,HMO,48999,CPT4/HCPCS,PANCREAS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,HMO,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,HMO,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Fee Schedule,3198.57
Blue Shield,HMO,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,Fee Schedule,3198.57
Blue Shield,HMO,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,Fee Schedule,3198.57
Blue Shield,HMO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Fee Schedule,987.79
Blue Shield,HMO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Fee Schedule,3198.57
Blue Shield,HMO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Fee Schedule,4891.93
Blue Shield,HMO,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Fee Schedule,3198.57
Blue Shield,HMO,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Fee Schedule,3198.57
Blue Shield,HMO,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,Fee Schedule,4891.93
Blue Shield,HMO,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,Fee Schedule,3198.57
Blue Shield,HMO,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Fee Schedule,6049.05
Blue Shield,HMO,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,Fee Schedule,3198.57
Blue Shield,HMO,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Fee Schedule,4891.93
Blue Shield,HMO,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Fee Schedule,6049.05
Blue Shield,HMO,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Fee Schedule,6049.05
Blue Shield,HMO,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Fee Schedule,7902.34
Blue Shield,HMO,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Fee Schedule,4891.93
Blue Shield,HMO,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Fee Schedule,4891.93
Blue Shield,HMO,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,49329,CPT4/HCPCS,LAPARO PROC ABDM/PER/OMENT,,Fee Schedule,7902.34
Blue Shield,HMO,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Fee Schedule,4280.44
Blue Shield,HMO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Fee Schedule,3198.57
Blue Shield,HMO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Fee Schedule,3198.57
Blue Shield,HMO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Fee Schedule,3198.57
Blue Shield,HMO,49411,CPT4/HCPCS,INS MARK ABD/PEL FOR RT PERQ,,Fee Schedule,987.79
Blue Shield,HMO,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Fee Schedule,4280.44
Blue Shield,HMO,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Fee Schedule,12850.71
Blue Shield,HMO,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Fee Schedule,3198.57
Blue Shield,HMO,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Fee Schedule,3198.57
Blue Shield,HMO,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Fee Schedule,3198.57
Blue Shield,HMO,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Fee Schedule,3198.57
Blue Shield,HMO,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Fee Schedule,4280.44
Blue Shield,HMO,49428,CPT4/HCPCS,LIGATION OF SHUNT,,Fee Schedule,3198.57
Blue Shield,HMO,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Fee Schedule,4891.93
Blue Shield,HMO,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Fee Schedule,3198.57
Blue Shield,HMO,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Fee Schedule,4280.44
Blue Shield,HMO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Fee Schedule,4280.44
Blue Shield,HMO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Fee Schedule,4280.44
Blue Shield,HMO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Fee Schedule,4280.44
Blue Shield,HMO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Fee Schedule,4280.44
Blue Shield,HMO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Fee Schedule,4280.44
Blue Shield,HMO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Fee Schedule,4280.44
Blue Shield,HMO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Fee Schedule,4280.44
Blue Shield,HMO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Fee Schedule,6876.92
Blue Shield,HMO,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Fee Schedule,6876.92
Blue Shield,HMO,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Fee Schedule,6049.05
Blue Shield,HMO,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Fee Schedule,6049.05
Blue Shield,HMO,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Fee Schedule,6049.05
Blue Shield,HMO,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Fee Schedule,12850.71
Blue Shield,HMO,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Fee Schedule,6049.05
Blue Shield,HMO,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Fee Schedule,12850.71
Blue Shield,HMO,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Fee Schedule,9548.66
Blue Shield,HMO,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Fee Schedule,12850.71
Blue Shield,HMO,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Fee Schedule,6049.05
Blue Shield,HMO,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Fee Schedule,4280.44
Blue Shield,HMO,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Fee Schedule,6876.92
Blue Shield,HMO,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Fee Schedule,12850.71
Blue Shield,HMO,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Fee Schedule,6876.92
Blue Shield,HMO,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Fee Schedule,12850.71
Blue Shield,HMO,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Fee Schedule,6049.05
Blue Shield,HMO,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Fee Schedule,12850.71
Blue Shield,HMO,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Fee Schedule,6049.05
Blue Shield,HMO,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Fee Schedule,12850.71
Blue Shield,HMO,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Fee Schedule,9548.66
Blue Shield,HMO,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Fee Schedule,6049.05
Blue Shield,HMO,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Fee Schedule,12850.71
Blue Shield,HMO,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Fee Schedule,6049.05
Blue Shield,HMO,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Fee Schedule,12850.71
Blue Shield,HMO,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Fee Schedule,6049.05
Blue Shield,HMO,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Fee Schedule,12850.71
Blue Shield,HMO,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Fee Schedule,4891.93
Blue Shield,HMO,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,9548.66
Blue Shield,HMO,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Fee Schedule,6049.05
Blue Shield,HMO,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Fee Schedule,9548.66
Blue Shield,HMO,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Fee Schedule,7902.34
Blue Shield,HMO,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Fee Schedule,7902.34
Blue Shield,HMO,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Fee Schedule,7902.34
Blue Shield,HMO,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Fee Schedule,7902.34
Blue Shield,HMO,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Fee Schedule,7902.34
Blue Shield,HMO,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Fee Schedule,7902.34
Blue Shield,HMO,49659,CPT4/HCPCS,LAPARO PROC HERNIA REPAIR,,Fee Schedule,9548.66
Blue Shield,HMO,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,Fee Schedule,3198.57
Blue Shield,HMO,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,Fee Schedule,4280.44
Blue Shield,HMO,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,Fee Schedule,3198.57
Blue Shield,HMO,49906,CPT4/HCPCS,FREE OMENTAL FLAP MICROVASC,,Fee Schedule,3198.57
Blue Shield,HMO,49999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Fee Schedule,4891.93
Blue Shield,HMO,4A020N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,4A020N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,HMO,4A020N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Open,,Fee Schedule,8271.00
Blue Shield,HMO,4A023FZ,ICD10-PCS,Measurement of Cardiac Rhythm, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,HMO,4A023N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,4A023N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,HMO,4A023N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Perc,,Fee Schedule,8271.00
Blue Shield,HMO,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Fee Schedule,4280.44
Blue Shield,HMO,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,9548.66
Blue Shield,HMO,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,3198.57
Blue Shield,HMO,50065,CPT4/HCPCS,INCISION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50070,CPT4/HCPCS,INCISION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,4280.44
Blue Shield,HMO,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,9548.66
Blue Shield,HMO,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,9548.66
Blue Shield,HMO,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,Fee Schedule,3198.57
Blue Shield,HMO,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,3198.57
Blue Shield,HMO,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Fee Schedule,3198.57
Blue Shield,HMO,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,Fee Schedule,3198.57
Blue Shield,HMO,50220,CPT4/HCPCS,REMOVE KIDNEY OPEN,,Fee Schedule,3198.57
Blue Shield,HMO,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,Fee Schedule,3198.57
Blue Shield,HMO,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,Fee Schedule,3198.57
Blue Shield,HMO,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Fee Schedule,4280.44
Blue Shield,HMO,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,Fee Schedule,4280.44
Blue Shield,HMO,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,HMO,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,HMO,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,Fee Schedule,3198.57
Blue Shield,HMO,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Fee Schedule,4891.93
Blue Shield,HMO,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Fee Schedule,6049.05
Blue Shield,HMO,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,Fee Schedule,4280.44
Blue Shield,HMO,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Fee Schedule,4280.44
Blue Shield,HMO,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Fee Schedule,4280.44
Blue Shield,HMO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Fee Schedule,4280.44
Blue Shield,HMO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Fee Schedule,4280.44
Blue Shield,HMO,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Fee Schedule,4280.44
Blue Shield,HMO,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Fee Schedule,4280.44
Blue Shield,HMO,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,HMO,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Fee Schedule,987.79
Blue Shield,HMO,50395,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Fee Schedule,3198.57
Blue Shield,HMO,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Fee Schedule,3198.57
Blue Shield,HMO,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Fee Schedule,3198.57
Blue Shield,HMO,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Fee Schedule,3198.57
Blue Shield,HMO,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Fee Schedule,3198.57
Blue Shield,HMO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Fee Schedule,3198.57
Blue Shield,HMO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Fee Schedule,3198.57
Blue Shield,HMO,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Fee Schedule,4280.44
Blue Shield,HMO,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Fee Schedule,4280.44
Blue Shield,HMO,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Fee Schedule,7902.34
Blue Shield,HMO,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Fee Schedule,9548.66
Blue Shield,HMO,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Fee Schedule,9548.66
Blue Shield,HMO,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Fee Schedule,7902.34
Blue Shield,HMO,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,50546,CPT4/HCPCS,LAPAROSCOPIC NEPHRECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50549,CPT4/HCPCS,LAPAROSCOPE PROC RENAL,,Fee Schedule,7902.34
Blue Shield,HMO,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,HMO,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,HMO,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Fee Schedule,9548.66
Blue Shield,HMO,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,HMO,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,HMO,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Fee Schedule,12850.71
Blue Shield,HMO,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Fee Schedule,6876.92
Blue Shield,HMO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Fee Schedule,4891.93
Blue Shield,HMO,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Fee Schedule,3198.57
Blue Shield,HMO,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,HMO,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,HMO,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,HMO,50650,CPT4/HCPCS,REMOVAL OF URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50660,CPT4/HCPCS,REMOVAL OF URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,Fee Schedule,987.79
Blue Shield,HMO,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Fee Schedule,3198.57
Blue Shield,HMO,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,HMO,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,HMO,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,HMO,50700,CPT4/HCPCS,REVISION OF URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50715,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50722,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50727,CPT4/HCPCS,REVISE URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50728,CPT4/HCPCS,REVISE URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Fee Schedule,3198.57
Blue Shield,HMO,50760,CPT4/HCPCS,FUSION OF URETERS,,Fee Schedule,3198.57
Blue Shield,HMO,50770,CPT4/HCPCS,SPLICING OF URETERS,,Fee Schedule,3198.57
Blue Shield,HMO,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,50782,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,50783,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,Fee Schedule,3198.57
Blue Shield,HMO,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Fee Schedule,4891.93
Blue Shield,HMO,50830,CPT4/HCPCS,REVISE URINE FLOW,,Fee Schedule,4891.93
Blue Shield,HMO,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,Fee Schedule,3198.57
Blue Shield,HMO,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,Fee Schedule,3198.57
Blue Shield,HMO,50900,CPT4/HCPCS,REPAIR OF URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,50940,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Fee Schedule,9548.66
Blue Shield,HMO,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Fee Schedule,12850.71
Blue Shield,HMO,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Fee Schedule,12850.71
Blue Shield,HMO,50949,CPT4/HCPCS,LAPAROSCOPE PROC URETER,,Fee Schedule,7902.34
Blue Shield,HMO,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Fee Schedule,3198.57
Blue Shield,HMO,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,HMO,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,HMO,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Fee Schedule,3198.57
Blue Shield,HMO,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,HMO,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,HMO,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Fee Schedule,6049.05
Blue Shield,HMO,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Fee Schedule,6049.05
Blue Shield,HMO,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Fee Schedule,6049.05
Blue Shield,HMO,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Fee Schedule,6049.05
Blue Shield,HMO,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Fee Schedule,6049.05
Blue Shield,HMO,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,HMO,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Fee Schedule,6049.05
Blue Shield,HMO,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,Fee Schedule,987.79
Blue Shield,HMO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Fee Schedule,3198.57
Blue Shield,HMO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Fee Schedule,3198.57
Blue Shield,HMO,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Fee Schedule,6049.05
Blue Shield,HMO,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,6049.05
Blue Shield,HMO,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,3198.57
Blue Shield,HMO,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,3198.57
Blue Shield,HMO,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,Fee Schedule,3198.57
Blue Shield,HMO,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Fee Schedule,3198.57
Blue Shield,HMO,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,Fee Schedule,3198.57
Blue Shield,HMO,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,Fee Schedule,4280.44
Blue Shield,HMO,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Fee Schedule,4891.93
Blue Shield,HMO,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,HMO,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Fee Schedule,4891.93
Blue Shield,HMO,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,HMO,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,HMO,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,Fee Schedule,6049.05
Blue Shield,HMO,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,Fee Schedule,4891.93
Blue Shield,HMO,51700,CPT4/HCPCS,IRRIGATION OF BLADDER,,Fee Schedule,987.79
Blue Shield,HMO,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Fee Schedule,987.79
Blue Shield,HMO,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Fee Schedule,4891.93
Blue Shield,HMO,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Fee Schedule,987.79
Blue Shield,HMO,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Fee Schedule,3198.57
Blue Shield,HMO,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Fee Schedule,3198.57
Blue Shield,HMO,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Fee Schedule,3198.57
Blue Shield,HMO,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Fee Schedule,3198.57
Blue Shield,HMO,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Fee Schedule,3198.57
Blue Shield,HMO,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,Fee Schedule,987.79
Blue Shield,HMO,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,Fee Schedule,987.79
Blue Shield,HMO,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Fee Schedule,987.79
Blue Shield,HMO,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Fee Schedule,3198.57
Blue Shield,HMO,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,Fee Schedule,987.79
Blue Shield,HMO,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Fee Schedule,987.79
Blue Shield,HMO,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,Fee Schedule,987.79
Blue Shield,HMO,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Fee Schedule,3198.57
Blue Shield,HMO,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Fee Schedule,3198.57
Blue Shield,HMO,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Fee Schedule,3198.57
Blue Shield,HMO,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Fee Schedule,3198.57
Blue Shield,HMO,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,Fee Schedule,3198.57
Blue Shield,HMO,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,Fee Schedule,4891.93
Blue Shield,HMO,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,Fee Schedule,4280.44
Blue Shield,HMO,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Fee Schedule,9548.66
Blue Shield,HMO,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Fee Schedule,12850.71
Blue Shield,HMO,51999,CPT4/HCPCS,LAPAROSCOPE PROC BLA,,Fee Schedule,6049.05
Blue Shield,HMO,52000,CPT4/HCPCS,CYSTOSCOPY,,Fee Schedule,3198.57
Blue Shield,HMO,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Fee Schedule,4280.44
Blue Shield,HMO,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Fee Schedule,4280.44
Blue Shield,HMO,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Fee Schedule,4280.44
Blue Shield,HMO,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Fee Schedule,4280.44
Blue Shield,HMO,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Fee Schedule,4280.44
Blue Shield,HMO,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,HMO,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,HMO,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Fee Schedule,6049.05
Blue Shield,HMO,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,3198.57
Blue Shield,HMO,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Fee Schedule,4280.44
Blue Shield,HMO,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Fee Schedule,4280.44
Blue Shield,HMO,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,HMO,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Fee Schedule,12850.71
Blue Shield,HMO,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Fee Schedule,4280.44
Blue Shield,HMO,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Fee Schedule,3198.57
Blue Shield,HMO,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Fee Schedule,4280.44
Blue Shield,HMO,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,6876.92
Blue Shield,HMO,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Fee Schedule,6049.05
Blue Shield,HMO,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Fee Schedule,4280.44
Blue Shield,HMO,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Fee Schedule,4891.93
Blue Shield,HMO,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,HMO,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,HMO,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,HMO,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,HMO,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Fee Schedule,4891.93
Blue Shield,HMO,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Fee Schedule,4891.93
Blue Shield,HMO,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Fee Schedule,4891.93
Blue Shield,HMO,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Fee Schedule,6049.05
Blue Shield,HMO,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Fee Schedule,6049.05
Blue Shield,HMO,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Fee Schedule,6049.05
Blue Shield,HMO,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Fee Schedule,6049.05
Blue Shield,HMO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Fee Schedule,6049.05
Blue Shield,HMO,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Fee Schedule,4891.93
Blue Shield,HMO,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Fee Schedule,6049.05
Blue Shield,HMO,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Fee Schedule,987.79
Blue Shield,HMO,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Fee Schedule,987.79
Blue Shield,HMO,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Fee Schedule,4891.93
Blue Shield,HMO,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Fee Schedule,4891.93
Blue Shield,HMO,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Fee Schedule,6049.05
Blue Shield,HMO,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Fee Schedule,4280.44
Blue Shield,HMO,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Fee Schedule,4280.44
Blue Shield,HMO,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Fee Schedule,12850.71
Blue Shield,HMO,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Fee Schedule,12850.71
Blue Shield,HMO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Fee Schedule,6049.05
Blue Shield,HMO,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,53000,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,53010,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,53020,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,53025,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,HMO,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Fee Schedule,4891.93
Blue Shield,HMO,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Fee Schedule,3198.57
Blue Shield,HMO,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Fee Schedule,6876.92
Blue Shield,HMO,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Fee Schedule,6876.92
Blue Shield,HMO,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,HMO,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,HMO,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Fee Schedule,4891.93
Blue Shield,HMO,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Fee Schedule,4280.44
Blue Shield,HMO,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Fee Schedule,4280.44
Blue Shield,HMO,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,HMO,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,HMO,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Fee Schedule,4280.44
Blue Shield,HMO,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Fee Schedule,4280.44
Blue Shield,HMO,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Fee Schedule,4891.93
Blue Shield,HMO,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Fee Schedule,4280.44
Blue Shield,HMO,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,HMO,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Fee Schedule,4891.93
Blue Shield,HMO,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Fee Schedule,4280.44
Blue Shield,HMO,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,HMO,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Fee Schedule,4280.44
Blue Shield,HMO,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Fee Schedule,4280.44
Blue Shield,HMO,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Fee Schedule,3198.57
Blue Shield,HMO,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Fee Schedule,4280.44
Blue Shield,HMO,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Fee Schedule,3198.57
Blue Shield,HMO,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Fee Schedule,3198.57
Blue Shield,HMO,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Fee Schedule,3198.57
Blue Shield,HMO,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,Fee Schedule,3198.57
Blue Shield,HMO,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Fee Schedule,3198.57
Blue Shield,HMO,53450,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,53460,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Fee Schedule,7902.34
Blue Shield,HMO,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,HMO,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,HMO,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,HMO,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,HMO,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Fee Schedule,4280.44
Blue Shield,HMO,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,3198.57
Blue Shield,HMO,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,3198.57
Blue Shield,HMO,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,4280.44
Blue Shield,HMO,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,4280.44
Blue Shield,HMO,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,987.79
Blue Shield,HMO,53660,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,987.79
Blue Shield,HMO,53661,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,987.79
Blue Shield,HMO,53665,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Fee Schedule,12850.71
Blue Shield,HMO,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Fee Schedule,12850.71
Blue Shield,HMO,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Fee Schedule,3198.57
Blue Shield,HMO,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Fee Schedule,987.79
Blue Shield,HMO,53899,CPT4/HCPCS,UROLOGY SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Fee Schedule,4280.44
Blue Shield,HMO,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Fee Schedule,4280.44
Blue Shield,HMO,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Fee Schedule,6049.05
Blue Shield,HMO,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,987.79
Blue Shield,HMO,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,4280.44
Blue Shield,HMO,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,Fee Schedule,987.79
Blue Shield,HMO,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,HMO,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,HMO,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,HMO,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Fee Schedule,3198.57
Blue Shield,HMO,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Fee Schedule,3198.57
Blue Shield,HMO,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,4280.44
Blue Shield,HMO,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,3198.57
Blue Shield,HMO,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Fee Schedule,4280.44
Blue Shield,HMO,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Fee Schedule,3198.57
Blue Shield,HMO,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,Fee Schedule,3198.57
Blue Shield,HMO,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,Fee Schedule,4280.44
Blue Shield,HMO,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Fee Schedule,3198.57
Blue Shield,HMO,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Fee Schedule,4280.44
Blue Shield,HMO,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Fee Schedule,4280.44
Blue Shield,HMO,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Fee Schedule,4280.44
Blue Shield,HMO,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Fee Schedule,4280.44
Blue Shield,HMO,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Fee Schedule,4280.44
Blue Shield,HMO,54200,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,987.79
Blue Shield,HMO,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,6049.05
Blue Shield,HMO,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,3198.57
Blue Shield,HMO,54231,CPT4/HCPCS,DYNAMIC CAVERNOSOMETRY,,Fee Schedule,4280.44
Blue Shield,HMO,54235,CPT4/HCPCS,PENILE INJECTION,,Fee Schedule,987.79
Blue Shield,HMO,54240,CPT4/HCPCS,PENIS STUDY,,Fee Schedule,987.79
Blue Shield,HMO,54250,CPT4/HCPCS,PENIS STUDY,,Fee Schedule,987.79
Blue Shield,HMO,54300,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,4891.93
Blue Shield,HMO,54304,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,4891.93
Blue Shield,HMO,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,HMO,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,HMO,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,HMO,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,HMO,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,HMO,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,HMO,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,HMO,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,4891.93
Blue Shield,HMO,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,3198.57
Blue Shield,HMO,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,4280.44
Blue Shield,HMO,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Fee Schedule,4891.93
Blue Shield,HMO,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,54380,CPT4/HCPCS,REPAIR PENIS,,Fee Schedule,4891.93
Blue Shield,HMO,54385,CPT4/HCPCS,REPAIR PENIS,,Fee Schedule,4891.93
Blue Shield,HMO,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,Fee Schedule,4280.44
Blue Shield,HMO,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,HMO,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,HMO,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,HMO,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,HMO,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,HMO,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Fee Schedule,4891.93
Blue Shield,HMO,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Fee Schedule,3198.57
Blue Shield,HMO,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Fee Schedule,4891.93
Blue Shield,HMO,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Fee Schedule,4891.93
Blue Shield,HMO,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Fee Schedule,3198.57
Blue Shield,HMO,54420,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,6049.05
Blue Shield,HMO,54430,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,3198.57
Blue Shield,HMO,54435,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,6049.05
Blue Shield,HMO,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Fee Schedule,6049.05
Blue Shield,HMO,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,Fee Schedule,987.79
Blue Shield,HMO,54440,CPT4/HCPCS,REPAIR OF PENIS,,Fee Schedule,6049.05
Blue Shield,HMO,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Fee Schedule,3198.57
Blue Shield,HMO,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Fee Schedule,3198.57
Blue Shield,HMO,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Fee Schedule,3198.57
Blue Shield,HMO,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Fee Schedule,4280.44
Blue Shield,HMO,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Fee Schedule,4891.93
Blue Shield,HMO,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Fee Schedule,4891.93
Blue Shield,HMO,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Fee Schedule,6049.05
Blue Shield,HMO,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Fee Schedule,6049.05
Blue Shield,HMO,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Fee Schedule,3198.57
Blue Shield,HMO,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Fee Schedule,6049.05
Blue Shield,HMO,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Fee Schedule,4891.93
Blue Shield,HMO,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Fee Schedule,6049.05
Blue Shield,HMO,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Fee Schedule,3198.57
Blue Shield,HMO,54660,CPT4/HCPCS,REVISION OF TESTIS,,Fee Schedule,4280.44
Blue Shield,HMO,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Fee Schedule,4891.93
Blue Shield,HMO,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Fee Schedule,4891.93
Blue Shield,HMO,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Fee Schedule,12850.71
Blue Shield,HMO,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Fee Schedule,12850.71
Blue Shield,HMO,54699,CPT4/HCPCS,LAPAROSCOPE PROC TESTIS,,Fee Schedule,7902.34
Blue Shield,HMO,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Fee Schedule,4280.44
Blue Shield,HMO,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Fee Schedule,3198.57
Blue Shield,HMO,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Fee Schedule,4891.93
Blue Shield,HMO,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Fee Schedule,6049.05
Blue Shield,HMO,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Fee Schedule,4891.93
Blue Shield,HMO,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Fee Schedule,6049.05
Blue Shield,HMO,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Fee Schedule,3198.57
Blue Shield,HMO,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Fee Schedule,6049.05
Blue Shield,HMO,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Fee Schedule,6049.05
Blue Shield,HMO,55000,CPT4/HCPCS,DRAINAGE OF HYDROCELE,,Fee Schedule,987.79
Blue Shield,HMO,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Fee Schedule,4891.93
Blue Shield,HMO,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Fee Schedule,6876.92
Blue Shield,HMO,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Fee Schedule,6049.05
Blue Shield,HMO,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Fee Schedule,4280.44
Blue Shield,HMO,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Fee Schedule,4280.44
Blue Shield,HMO,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Fee Schedule,3198.57
Blue Shield,HMO,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Fee Schedule,3198.57
Blue Shield,HMO,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Fee Schedule,4280.44
Blue Shield,HMO,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Fee Schedule,4280.44
Blue Shield,HMO,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Fee Schedule,4280.44
Blue Shield,HMO,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Fee Schedule,3198.57
Blue Shield,HMO,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Fee Schedule,4891.93
Blue Shield,HMO,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Fee Schedule,6049.05
Blue Shield,HMO,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Fee Schedule,6049.05
Blue Shield,HMO,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Fee Schedule,6049.05
Blue Shield,HMO,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Fee Schedule,6876.92
Blue Shield,HMO,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Fee Schedule,12850.71
Blue Shield,HMO,55559,CPT4/HCPCS,LAPARO PROC SPERMATIC CORD,,Fee Schedule,7902.34
Blue Shield,HMO,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,HMO,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,HMO,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,HMO,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Fee Schedule,3198.57
Blue Shield,HMO,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Fee Schedule,4280.44
Blue Shield,HMO,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Fee Schedule,4280.44
Blue Shield,HMO,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Fee Schedule,4280.44
Blue Shield,HMO,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,HMO,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,HMO,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,HMO,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Fee Schedule,4280.44
Blue Shield,HMO,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,55870,CPT4/HCPCS,ELECTROEJACULATION,,Fee Schedule,3198.57
Blue Shield,HMO,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Fee Schedule,12850.71
Blue Shield,HMO,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Fee Schedule,12850.71
Blue Shield,HMO,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Fee Schedule,12850.71
Blue Shield,HMO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Fee Schedule,12850.71
Blue Shield,HMO,55899,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Fee Schedule,3198.57
Blue Shield,HMO,55970,CPT4/HCPCS,SEX TRANSFORMATION M TO F,,Fee Schedule,3198.57
Blue Shield,HMO,55980,CPT4/HCPCS,SEX TRANSFORMATION F TO M,,Fee Schedule,3198.57
Blue Shield,HMO,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,HMO,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Fee Schedule,3198.57
Blue Shield,HMO,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Fee Schedule,4280.44
Blue Shield,HMO,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Fee Schedule,3198.57
Blue Shield,HMO,56442,CPT4/HCPCS,HYMENOTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Fee Schedule,4280.44
Blue Shield,HMO,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Fee Schedule,4891.93
Blue Shield,HMO,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,HMO,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,HMO,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Fee Schedule,6876.92
Blue Shield,HMO,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Fee Schedule,9548.66
Blue Shield,HMO,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Fee Schedule,3198.57
Blue Shield,HMO,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Fee Schedule,4891.93
Blue Shield,HMO,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Fee Schedule,4891.93
Blue Shield,HMO,56805,CPT4/HCPCS,REPAIR CLITORIS,,Fee Schedule,4891.93
Blue Shield,HMO,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Fee Schedule,6876.92
Blue Shield,HMO,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Fee Schedule,987.79
Blue Shield,HMO,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Fee Schedule,987.79
Blue Shield,HMO,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Fee Schedule,3198.57
Blue Shield,HMO,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Fee Schedule,4280.44
Blue Shield,HMO,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Fee Schedule,3198.57
Blue Shield,HMO,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Fee Schedule,3198.57
Blue Shield,HMO,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Fee Schedule,4891.93
Blue Shield,HMO,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Fee Schedule,3198.57
Blue Shield,HMO,57100,CPT4/HCPCS,BIOPSY OF VAGINA,,Fee Schedule,987.79
Blue Shield,HMO,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Fee Schedule,4280.44
Blue Shield,HMO,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Fee Schedule,4891.93
Blue Shield,HMO,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Fee Schedule,6876.92
Blue Shield,HMO,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Fee Schedule,6876.92
Blue Shield,HMO,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Fee Schedule,3198.57
Blue Shield,HMO,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Fee Schedule,4280.44
Blue Shield,HMO,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Fee Schedule,4280.44
Blue Shield,HMO,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Fee Schedule,6876.92
Blue Shield,HMO,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Fee Schedule,4280.44
Blue Shield,HMO,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Fee Schedule,4280.44
Blue Shield,HMO,57150,CPT4/HCPCS,TREAT VAGINA INFECTION,,Fee Schedule,987.79
Blue Shield,HMO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Fee Schedule,4280.44
Blue Shield,HMO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Fee Schedule,987.79
Blue Shield,HMO,57160,CPT4/HCPCS,INSERT PESSARY/OTHER DEVICE,,Fee Schedule,987.79
Blue Shield,HMO,57170,CPT4/HCPCS,FITTING OF DIAPHRAGM/CAP,,Fee Schedule,987.79
Blue Shield,HMO,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,Fee Schedule,3198.57
Blue Shield,HMO,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Fee Schedule,3198.57
Blue Shield,HMO,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Fee Schedule,4280.44
Blue Shield,HMO,57220,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,HMO,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Fee Schedule,4891.93
Blue Shield,HMO,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Fee Schedule,6876.92
Blue Shield,HMO,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Fee Schedule,6876.92
Blue Shield,HMO,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Fee Schedule,6876.92
Blue Shield,HMO,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Fee Schedule,9548.66
Blue Shield,HMO,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Fee Schedule,6876.92
Blue Shield,HMO,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Fee Schedule,4891.93
Blue Shield,HMO,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,Fee Schedule,4891.93
Blue Shield,HMO,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Fee Schedule,4891.93
Blue Shield,HMO,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Fee Schedule,3198.57
Blue Shield,HMO,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Fee Schedule,6876.92
Blue Shield,HMO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Fee Schedule,4891.93
Blue Shield,HMO,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Fee Schedule,9548.66
Blue Shield,HMO,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Fee Schedule,9548.66
Blue Shield,HMO,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Fee Schedule,6876.92
Blue Shield,HMO,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Fee Schedule,6876.92
Blue Shield,HMO,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,57295,CPT4/HCPCS,REVISE VAG GRAFT VIA VAGINA,,Fee Schedule,3198.57
Blue Shield,HMO,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Fee Schedule,4891.93
Blue Shield,HMO,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Fee Schedule,4891.93
Blue Shield,HMO,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,Fee Schedule,4891.93
Blue Shield,HMO,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,Fee Schedule,3198.57
Blue Shield,HMO,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Fee Schedule,6876.92
Blue Shield,HMO,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Fee Schedule,6876.92
Blue Shield,HMO,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Fee Schedule,6876.92
Blue Shield,HMO,57335,CPT4/HCPCS,REPAIR VAGINA,,Fee Schedule,3198.57
Blue Shield,HMO,57400,CPT4/HCPCS,DILATION OF VAGINA,,Fee Schedule,4280.44
Blue Shield,HMO,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Fee Schedule,4280.44
Blue Shield,HMO,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,HMO,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Fee Schedule,987.79
Blue Shield,HMO,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Fee Schedule,987.79
Blue Shield,HMO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Fee Schedule,6049.05
Blue Shield,HMO,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Fee Schedule,7902.34
Blue Shield,HMO,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Fee Schedule,6876.92
Blue Shield,HMO,57452,CPT4/HCPCS,EXAM OF CERVIX W/SCOPE,,Fee Schedule,987.79
Blue Shield,HMO,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Fee Schedule,3198.57
Blue Shield,HMO,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Fee Schedule,987.79
Blue Shield,HMO,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Fee Schedule,3198.57
Blue Shield,HMO,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Fee Schedule,4280.44
Blue Shield,HMO,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Fee Schedule,4891.93
Blue Shield,HMO,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Fee Schedule,3198.57
Blue Shield,HMO,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Fee Schedule,987.79
Blue Shield,HMO,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,HMO,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Fee Schedule,3198.57
Blue Shield,HMO,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Fee Schedule,4280.44
Blue Shield,HMO,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,HMO,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,HMO,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Fee Schedule,4891.93
Blue Shield,HMO,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,Fee Schedule,4280.44
Blue Shield,HMO,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Fee Schedule,3198.57
Blue Shield,HMO,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,Fee Schedule,3198.57
Blue Shield,HMO,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Fee Schedule,4891.93
Blue Shield,HMO,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,Fee Schedule,6876.92
Blue Shield,HMO,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Fee Schedule,6876.92
Blue Shield,HMO,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Fee Schedule,4891.93
Blue Shield,HMO,57700,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,3198.57
Blue Shield,HMO,57720,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,4891.93
Blue Shield,HMO,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Fee Schedule,4280.44
Blue Shield,HMO,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Fee Schedule,987.79
Blue Shield,HMO,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Fee Schedule,987.79
Blue Shield,HMO,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Fee Schedule,4280.44
Blue Shield,HMO,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Fee Schedule,6876.92
Blue Shield,HMO,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Fee Schedule,6876.92
Blue Shield,HMO,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,Fee Schedule,6876.92
Blue Shield,HMO,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,Fee Schedule,6049.05
Blue Shield,HMO,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Fee Schedule,3198.57
Blue Shield,HMO,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Fee Schedule,3198.57
Blue Shield,HMO,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,Fee Schedule,3198.57
Blue Shield,HMO,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Fee Schedule,3198.57
Blue Shield,HMO,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Fee Schedule,3198.57
Blue Shield,HMO,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Fee Schedule,3198.57
Blue Shield,HMO,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Fee Schedule,3198.57
Blue Shield,HMO,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Fee Schedule,3198.57
Blue Shield,HMO,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Fee Schedule,3198.57
Blue Shield,HMO,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,Fee Schedule,3198.57
Blue Shield,HMO,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Fee Schedule,3198.57
Blue Shield,HMO,58300,CPT4/HCPCS,INSERT INTRAUTERINE DEVICE,,Fee Schedule,987.79
Blue Shield,HMO,58301,CPT4/HCPCS,REMOVE INTRAUTERINE DEVICE,,Fee Schedule,987.79
Blue Shield,HMO,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Fee Schedule,987.79
Blue Shield,HMO,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Fee Schedule,987.79
Blue Shield,HMO,58323,CPT4/HCPCS,SPERM WASHING,,Fee Schedule,987.79
Blue Shield,HMO,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Fee Schedule,4891.93
Blue Shield,HMO,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Fee Schedule,4280.44
Blue Shield,HMO,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Fee Schedule,4891.93
Blue Shield,HMO,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Fee Schedule,6049.05
Blue Shield,HMO,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Fee Schedule,9548.66
Blue Shield,HMO,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,HMO,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,HMO,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Fee Schedule,3198.57
Blue Shield,HMO,58540,CPT4/HCPCS,REVISION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,HMO,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Fee Schedule,6049.05
Blue Shield,HMO,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Fee Schedule,6049.05
Blue Shield,HMO,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Fee Schedule,6049.05
Blue Shield,HMO,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Fee Schedule,6049.05
Blue Shield,HMO,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Fee Schedule,12850.71
Blue Shield,HMO,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Fee Schedule,12850.71
Blue Shield,HMO,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Fee Schedule,12850.71
Blue Shield,HMO,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Fee Schedule,12850.71
Blue Shield,HMO,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Fee Schedule,12850.71
Blue Shield,HMO,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Fee Schedule,12850.71
Blue Shield,HMO,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Fee Schedule,3198.57
Blue Shield,HMO,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Fee Schedule,4891.93
Blue Shield,HMO,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Fee Schedule,4280.44
Blue Shield,HMO,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Fee Schedule,4891.93
Blue Shield,HMO,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Fee Schedule,4891.93
Blue Shield,HMO,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Fee Schedule,4891.93
Blue Shield,HMO,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Fee Schedule,6049.05
Blue Shield,HMO,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Fee Schedule,9548.66
Blue Shield,HMO,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Fee Schedule,6876.92
Blue Shield,HMO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Fee Schedule,6876.92
Blue Shield,HMO,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Fee Schedule,6876.92
Blue Shield,HMO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Fee Schedule,6876.92
Blue Shield,HMO,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,Fee Schedule,6876.92
Blue Shield,HMO,58578,CPT4/HCPCS,LAPARO PROC UTERUS,,Fee Schedule,7902.34
Blue Shield,HMO,58579,CPT4/HCPCS,HYSTEROSCOPE PROCEDURE,,Fee Schedule,4891.93
Blue Shield,HMO,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Fee Schedule,6876.92
Blue Shield,HMO,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Fee Schedule,4891.93
Blue Shield,HMO,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Fee Schedule,6876.92
Blue Shield,HMO,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Fee Schedule,6876.92
Blue Shield,HMO,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Fee Schedule,6876.92
Blue Shield,HMO,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Fee Schedule,4891.93
Blue Shield,HMO,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Fee Schedule,4891.93
Blue Shield,HMO,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Fee Schedule,6876.92
Blue Shield,HMO,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Fee Schedule,6876.92
Blue Shield,HMO,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Fee Schedule,6049.05
Blue Shield,HMO,58679,CPT4/HCPCS,LAPARO PROC OVIDUCT-OVARY,,Fee Schedule,7902.34
Blue Shield,HMO,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Fee Schedule,3198.57
Blue Shield,HMO,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Fee Schedule,3198.57
Blue Shield,HMO,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Fee Schedule,3198.57
Blue Shield,HMO,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Fee Schedule,3198.57
Blue Shield,HMO,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Fee Schedule,3198.57
Blue Shield,HMO,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Fee Schedule,4891.93
Blue Shield,HMO,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Fee Schedule,3198.57
Blue Shield,HMO,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Fee Schedule,4891.93
Blue Shield,HMO,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Fee Schedule,3198.57
Blue Shield,HMO,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Fee Schedule,3198.57
Blue Shield,HMO,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Fee Schedule,4891.93
Blue Shield,HMO,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Fee Schedule,6876.92
Blue Shield,HMO,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Fee Schedule,6876.92
Blue Shield,HMO,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Fee Schedule,3198.57
Blue Shield,HMO,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,Fee Schedule,3198.57
Blue Shield,HMO,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,3198.57
Blue Shield,HMO,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,3198.57
Blue Shield,HMO,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,4280.44
Blue Shield,HMO,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,Fee Schedule,4891.93
Blue Shield,HMO,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,Fee Schedule,4891.93
Blue Shield,HMO,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,HMO,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Fee Schedule,4891.93
Blue Shield,HMO,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Fee Schedule,3198.57
Blue Shield,HMO,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Fee Schedule,3198.57
Blue Shield,HMO,58999,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Fee Schedule,3198.57
Blue Shield,HMO,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Fee Schedule,3198.57
Blue Shield,HMO,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,Fee Schedule,3198.57
Blue Shield,HMO,59015,CPT4/HCPCS,CHORION BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,59020,CPT4/HCPCS,FETAL CONTRACT STRESS TEST,,Fee Schedule,987.79
Blue Shield,HMO,59025,CPT4/HCPCS,FETAL NON-STRESS TEST,,Fee Schedule,987.79
Blue Shield,HMO,59030,CPT4/HCPCS,FETAL SCALP BLOOD SAMPLE,,Fee Schedule,3198.57
Blue Shield,HMO,59050,CPT4/HCPCS,FETAL MONITOR W/REPORT,,Fee Schedule,987.79
Blue Shield,HMO,59051,CPT4/HCPCS,FETAL MONITOR/INTERPRET ONLY,,Fee Schedule,987.79
Blue Shield,HMO,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Fee Schedule,3198.57
Blue Shield,HMO,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Fee Schedule,3198.57
Blue Shield,HMO,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Fee Schedule,3198.57
Blue Shield,HMO,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Fee Schedule,3198.57
Blue Shield,HMO,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,Fee Schedule,9548.66
Blue Shield,HMO,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,HMO,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,HMO,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,HMO,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,HMO,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,HMO,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,HMO,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,HMO,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,HMO,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Fee Schedule,4891.93
Blue Shield,HMO,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Fee Schedule,987.79
Blue Shield,HMO,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Fee Schedule,4280.44
Blue Shield,HMO,59320,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,3198.57
Blue Shield,HMO,59325,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,HMO,59350,CPT4/HCPCS,REPAIR OF UTERUS,,Fee Schedule,4280.44
Blue Shield,HMO,59400,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,HMO,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,HMO,59410,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,HMO,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,Fee Schedule,987.79
Blue Shield,HMO,59414,CPT4/HCPCS,DELIVER PLACENTA,,Fee Schedule,4280.44
Blue Shield,HMO,59425,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,Fee Schedule,987.79
Blue Shield,HMO,59426,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,Fee Schedule,3198.57
Blue Shield,HMO,59430,CPT4/HCPCS,CARE AFTER DELIVERY,,Fee Schedule,987.79
Blue Shield,HMO,59510,CPT4/HCPCS,CESAREAN DELIVERY,,Fee Schedule,4891.93
Blue Shield,HMO,59514,CPT4/HCPCS,CESAREAN DELIVERY ONLY,,Fee Schedule,4891.93
Blue Shield,HMO,59515,CPT4/HCPCS,CESAREAN DELIVERY,,Fee Schedule,4891.93
Blue Shield,HMO,59525,CPT4/HCPCS,REMOVE UTERUS AFTER CESAREAN,,Fee Schedule,3198.57
Blue Shield,HMO,59610,CPT4/HCPCS,VBAC DELIVERY,,Fee Schedule,4280.44
Blue Shield,HMO,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Fee Schedule,4280.44
Blue Shield,HMO,59614,CPT4/HCPCS,VBAC CARE AFTER DELIVERY,,Fee Schedule,4280.44
Blue Shield,HMO,59618,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY,,Fee Schedule,4891.93
Blue Shield,HMO,59620,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY ONLY,,Fee Schedule,4891.93
Blue Shield,HMO,59622,CPT4/HCPCS,ATTEMPTED VBAC AFTER CARE,,Fee Schedule,4891.93
Blue Shield,HMO,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,HMO,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,HMO,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,HMO,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Fee Schedule,4280.44
Blue Shield,HMO,59840,CPT4/HCPCS,ABORTION,,Fee Schedule,6876.92
Blue Shield,HMO,59841,CPT4/HCPCS,ABORTION,,Fee Schedule,6876.92
Blue Shield,HMO,59850,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,HMO,59851,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,HMO,59852,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,HMO,59855,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,HMO,59856,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,HMO,59857,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,HMO,59866,CPT4/HCPCS,ABORTION (MPR),,Fee Schedule,3198.57
Blue Shield,HMO,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Fee Schedule,6876.92
Blue Shield,HMO,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Fee Schedule,6876.92
Blue Shield,HMO,59897,CPT4/HCPCS,FETAL INVAS PX W/US,,Fee Schedule,3198.57
Blue Shield,HMO,59898,CPT4/HCPCS,LAPARO PROC OB CARE/DELIVER,,Fee Schedule,7902.34
Blue Shield,HMO,59899,CPT4/HCPCS,MATERNITY CARE PROCEDURE,,Fee Schedule,987.79
Blue Shield,HMO,5A02110,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,HMO,5A02116,ICD10-PCS,Assist with Cardiac Output using Other Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,HMO,5A0211D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,HMO,5A02210,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,HMO,5A02216,ICD10-PCS,Assistance with Cardiac Output using Other Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,HMO,5A0221D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,HMO,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Fee Schedule,3198.57
Blue Shield,HMO,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Fee Schedule,987.79
Blue Shield,HMO,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Fee Schedule,4280.44
Blue Shield,HMO,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Fee Schedule,9548.66
Blue Shield,HMO,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Fee Schedule,9548.66
Blue Shield,HMO,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,HMO,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,HMO,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,HMO,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,HMO,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Fee Schedule,9548.66
Blue Shield,HMO,60270,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,3198.57
Blue Shield,HMO,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,3198.57
Blue Shield,HMO,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Fee Schedule,6049.05
Blue Shield,HMO,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Fee Schedule,6049.05
Blue Shield,HMO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Fee Schedule,987.79
Blue Shield,HMO,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Fee Schedule,9548.66
Blue Shield,HMO,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Fee Schedule,3198.57
Blue Shield,HMO,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Fee Schedule,3198.57
Blue Shield,HMO,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Fee Schedule,4891.93
Blue Shield,HMO,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,3198.57
Blue Shield,HMO,60521,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,3198.57
Blue Shield,HMO,60522,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,4280.44
Blue Shield,HMO,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Fee Schedule,3198.57
Blue Shield,HMO,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Fee Schedule,3198.57
Blue Shield,HMO,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Fee Schedule,4280.44
Blue Shield,HMO,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Fee Schedule,4891.93
Blue Shield,HMO,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Fee Schedule,3198.57
Blue Shield,HMO,60659,CPT4/HCPCS,LAPARO PROC ENDOCRINE,,Fee Schedule,7902.34
Blue Shield,HMO,60699,CPT4/HCPCS,ENDOCRINE SURGERY PROCEDURE,,Fee Schedule,9548.66
Blue Shield,HMO,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,HMO,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,HMO,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,HMO,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Fee Schedule,3198.57
Blue Shield,HMO,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Fee Schedule,3198.57
Blue Shield,HMO,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Fee Schedule,3198.57
Blue Shield,HMO,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,61105,CPT4/HCPCS,TWIST DRILL HOLE,,Fee Schedule,3198.57
Blue Shield,HMO,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,Fee Schedule,3198.57
Blue Shield,HMO,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,HMO,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,Fee Schedule,3198.57
Blue Shield,HMO,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,HMO,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,HMO,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,Fee Schedule,3198.57
Blue Shield,HMO,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,HMO,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,Fee Schedule,3198.57
Blue Shield,HMO,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Fee Schedule,4891.93
Blue Shield,HMO,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Fee Schedule,3198.57
Blue Shield,HMO,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Fee Schedule,3198.57
Blue Shield,HMO,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Fee Schedule,4280.44
Blue Shield,HMO,61305,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Fee Schedule,4891.93
Blue Shield,HMO,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,HMO,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,HMO,61314,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,HMO,61315,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4891.93
Blue Shield,HMO,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Fee Schedule,3198.57
Blue Shield,HMO,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,HMO,61321,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4891.93
Blue Shield,HMO,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,Fee Schedule,4280.44
Blue Shield,HMO,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,Fee Schedule,9548.66
Blue Shield,HMO,61332,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,6049.05
Blue Shield,HMO,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,HMO,61343,CPT4/HCPCS,INCISE SKULL (PRESS RELIEF),,Fee Schedule,4891.93
Blue Shield,HMO,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,Fee Schedule,4891.93
Blue Shield,HMO,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Fee Schedule,4891.93
Blue Shield,HMO,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,61480,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,Fee Schedule,3198.57
Blue Shield,HMO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4891.93
Blue Shield,HMO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Fee Schedule,6049.05
Blue Shield,HMO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Fee Schedule,4280.44
Blue Shield,HMO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,HMO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,6876.92
Blue Shield,HMO,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Fee Schedule,6876.92
Blue Shield,HMO,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,9548.66
Blue Shield,HMO,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,7902.34
Blue Shield,HMO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Fee Schedule,4891.93
Blue Shield,HMO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4891.93
Blue Shield,HMO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,9548.66
Blue Shield,HMO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,7902.34
Blue Shield,HMO,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,HMO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,HMO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,HMO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,HMO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,6049.05
Blue Shield,HMO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4280.44
Blue Shield,HMO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,HMO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,6049.05
Blue Shield,HMO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,HMO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,HMO,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,HMO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,HMO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,Fee Schedule,7902.34
Blue Shield,HMO,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Fee Schedule,6049.05
Blue Shield,HMO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Fee Schedule,4280.44
Blue Shield,HMO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Fee Schedule,3198.57
Blue Shield,HMO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Fee Schedule,3198.57
Blue Shield,HMO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,Fee Schedule,3198.57
Blue Shield,HMO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,Fee Schedule,4280.44
Blue Shield,HMO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Fee Schedule,4280.44
Blue Shield,HMO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Fee Schedule,6049.05
Blue Shield,HMO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Fee Schedule,4891.93
Blue Shield,HMO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Fee Schedule,6049.05
Blue Shield,HMO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,HMO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Fee Schedule,6049.05
Blue Shield,HMO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,Fee Schedule,4280.44
Blue Shield,HMO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Fee Schedule,4891.93
Blue Shield,HMO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Fee Schedule,7902.34
Blue Shield,HMO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6049.05
Blue Shield,HMO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6876.92
Blue Shield,HMO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,7902.34
Blue Shield,HMO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6876.92
Blue Shield,HMO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,HMO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,HMO,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,Fee Schedule,6049.05
Blue Shield,HMO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,HMO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,HMO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,HMO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,Fee Schedule,6049.05
Blue Shield,HMO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,HMO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,HMO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,Fee Schedule,6049.05
Blue Shield,HMO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,4891.93
Blue Shield,HMO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6049.05
Blue Shield,HMO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6876.92
Blue Shield,HMO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6876.92
Blue Shield,HMO,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,7902.34
Blue Shield,HMO,61610,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,4280.44
Blue Shield,HMO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,3198.57
Blue Shield,HMO,61612,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,4280.44
Blue Shield,HMO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,Fee Schedule,7902.34
Blue Shield,HMO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Fee Schedule,6049.05
Blue Shield,HMO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Fee Schedule,7902.34
Blue Shield,HMO,61618,CPT4/HCPCS,REPAIR DURA,,Fee Schedule,3198.57
Blue Shield,HMO,61619,CPT4/HCPCS,REPAIR DURA,,Fee Schedule,4280.44
Blue Shield,HMO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Fee Schedule,7902.34
Blue Shield,HMO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,Fee Schedule,3198.57
Blue Shield,HMO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Fee Schedule,9548.66
Blue Shield,HMO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,Fee Schedule,987.79
Blue Shield,HMO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,Fee Schedule,987.79
Blue Shield,HMO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,HMO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,6876.92
Blue Shield,HMO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,HMO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,HMO,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Fee Schedule,7902.34
Blue Shield,HMO,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Fee Schedule,7902.34
Blue Shield,HMO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,Fee Schedule,7902.34
Blue Shield,HMO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,Fee Schedule,7902.34
Blue Shield,HMO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,Fee Schedule,3198.57
Blue Shield,HMO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,6049.05
Blue Shield,HMO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,4891.93
Blue Shield,HMO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,4280.44
Blue Shield,HMO,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,Fee Schedule,6049.05
Blue Shield,HMO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,Fee Schedule,3198.57
Blue Shield,HMO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,Fee Schedule,3198.57
Blue Shield,HMO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,4280.44
Blue Shield,HMO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,Fee Schedule,4280.44
Blue Shield,HMO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Fee Schedule,4891.93
Blue Shield,HMO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Fee Schedule,4891.93
Blue Shield,HMO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,Case Rate,4361.03
Blue Shield,HMO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,Case Rate,935.23
Blue Shield,HMO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,Case Rate,4361.03
Blue Shield,HMO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,Case Rate,1293.58
Blue Shield,HMO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Case Rate,764.05
Blue Shield,HMO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,HMO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,4280.44
Blue Shield,HMO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Fee Schedule,3198.57
Blue Shield,HMO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Fee Schedule,4280.44
Blue Shield,HMO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Fee Schedule,3198.57
Blue Shield,HMO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,HMO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Fee Schedule,4891.93
Blue Shield,HMO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Fee Schedule,4280.44
Blue Shield,HMO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Fee Schedule,4891.93
Blue Shield,HMO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Fee Schedule,3198.57
Blue Shield,HMO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,Fee Schedule,3198.57
Blue Shield,HMO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,Fee Schedule,3198.57
Blue Shield,HMO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,Fee Schedule,4280.44
Blue Shield,HMO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,HMO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Fee Schedule,4891.93
Blue Shield,HMO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,Fee Schedule,4280.44
Blue Shield,HMO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,Fee Schedule,4280.44
Blue Shield,HMO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,HMO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,HMO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,Fee Schedule,3198.57
Blue Shield,HMO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,Fee Schedule,3198.57
Blue Shield,HMO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,Fee Schedule,3198.57
Blue Shield,HMO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,Fee Schedule,3198.57
Blue Shield,HMO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,Fee Schedule,3198.57
Blue Shield,HMO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,Fee Schedule,4280.44
Blue Shield,HMO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,Fee Schedule,3198.57
Blue Shield,HMO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,Fee Schedule,4280.44
Blue Shield,HMO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,Fee Schedule,3198.57
Blue Shield,HMO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,4280.44
Blue Shield,HMO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,HMO,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,HMO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Fee Schedule,3198.57
Blue Shield,HMO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,HMO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,Fee Schedule,3198.57
Blue Shield,HMO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,HMO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,HMO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Fee Schedule,3198.57
Blue Shield,HMO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Fee Schedule,4280.44
Blue Shield,HMO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,Fee Schedule,3198.57
Blue Shield,HMO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,HMO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,HMO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Fee Schedule,3198.57
Blue Shield,HMO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Fee Schedule,3198.57
Blue Shield,HMO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Fee Schedule,3198.57
Blue Shield,HMO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Fee Schedule,3198.57
Blue Shield,HMO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Fee Schedule,3198.57
Blue Shield,HMO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Fee Schedule,3198.57
Blue Shield,HMO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Fee Schedule,3198.57
Blue Shield,HMO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Fee Schedule,3198.57
Blue Shield,HMO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Fee Schedule,3198.57
Blue Shield,HMO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Fee Schedule,3198.57
Blue Shield,HMO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Fee Schedule,12850.71
Blue Shield,HMO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Fee Schedule,3198.57
Blue Shield,HMO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Fee Schedule,4891.93
Blue Shield,HMO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,HMO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,HMO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,HMO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,HMO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,HMO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,HMO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,HMO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,HMO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,HMO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,HMO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,HMO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,HMO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Fee Schedule,4280.44
Blue Shield,HMO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Fee Schedule,9548.66
Blue Shield,HMO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Fee Schedule,4280.44
Blue Shield,HMO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Fee Schedule,4280.44
Blue Shield,HMO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,HMO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,HMO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Fee Schedule,4280.44
Blue Shield,HMO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Fee Schedule,3198.57
Blue Shield,HMO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Fee Schedule,3198.57
Blue Shield,HMO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,Fee Schedule,987.79
Blue Shield,HMO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Fee Schedule,987.79
Blue Shield,HMO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Fee Schedule,9548.66
Blue Shield,HMO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Fee Schedule,9548.66
Blue Shield,HMO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Fee Schedule,9548.66
Blue Shield,HMO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Fee Schedule,9548.66
Blue Shield,HMO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Fee Schedule,9548.66
Blue Shield,HMO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Fee Schedule,9548.66
Blue Shield,HMO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Fee Schedule,9548.66
Blue Shield,HMO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Fee Schedule,9548.66
Blue Shield,HMO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Fee Schedule,9548.66
Blue Shield,HMO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,9548.66
Blue Shield,HMO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Fee Schedule,9548.66
Blue Shield,HMO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Fee Schedule,9548.66
Blue Shield,HMO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Fee Schedule,9548.66
Blue Shield,HMO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Fee Schedule,9548.66
Blue Shield,HMO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Fee Schedule,3198.57
Blue Shield,HMO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Fee Schedule,3198.57
Blue Shield,HMO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Fee Schedule,9548.66
Blue Shield,HMO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Fee Schedule,9548.66
Blue Shield,HMO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Fee Schedule,9548.66
Blue Shield,HMO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Fee Schedule,9548.66
Blue Shield,HMO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Fee Schedule,9548.66
Blue Shield,HMO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Fee Schedule,9548.66
Blue Shield,HMO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Fee Schedule,9548.66
Blue Shield,HMO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Fee Schedule,9548.66
Blue Shield,HMO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Fee Schedule,9548.66
Blue Shield,HMO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Fee Schedule,4891.93
Blue Shield,HMO,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Fee Schedule,3198.57
Blue Shield,HMO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,Fee Schedule,4891.93
Blue Shield,HMO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Fee Schedule,4891.93
Blue Shield,HMO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,Fee Schedule,6876.92
Blue Shield,HMO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Fee Schedule,4891.93
Blue Shield,HMO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Fee Schedule,4891.93
Blue Shield,HMO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Fee Schedule,4891.93
Blue Shield,HMO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,Fee Schedule,4280.44
Blue Shield,HMO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Fee Schedule,4280.44
Blue Shield,HMO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Fee Schedule,4891.93
Blue Shield,HMO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,HMO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,HMO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,Fee Schedule,3198.57
Blue Shield,HMO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,Fee Schedule,3198.57
Blue Shield,HMO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,Fee Schedule,4280.44
Blue Shield,HMO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,Fee Schedule,4280.44
Blue Shield,HMO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,Fee Schedule,4280.44
Blue Shield,HMO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,Fee Schedule,4280.44
Blue Shield,HMO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,Fee Schedule,4280.44
Blue Shield,HMO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,Fee Schedule,4891.93
Blue Shield,HMO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,Fee Schedule,4280.44
Blue Shield,HMO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,Fee Schedule,6876.92
Blue Shield,HMO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,Fee Schedule,6876.92
Blue Shield,HMO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,Fee Schedule,6876.92
Blue Shield,HMO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Fee Schedule,4280.44
Blue Shield,HMO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Fee Schedule,4280.44
Blue Shield,HMO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Fee Schedule,3198.57
Blue Shield,HMO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Fee Schedule,3198.57
Blue Shield,HMO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,Fee Schedule,4891.93
Blue Shield,HMO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Fee Schedule,4891.93
Blue Shield,HMO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Fee Schedule,4891.93
Blue Shield,HMO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Fee Schedule,4280.44
Blue Shield,HMO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,Fee Schedule,4280.44
Blue Shield,HMO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,Fee Schedule,4280.44
Blue Shield,HMO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,Fee Schedule,4280.44
Blue Shield,HMO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,Fee Schedule,4280.44
Blue Shield,HMO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,Fee Schedule,4891.93
Blue Shield,HMO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,Fee Schedule,4891.93
Blue Shield,HMO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,Fee Schedule,4891.93
Blue Shield,HMO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,Fee Schedule,4280.44
Blue Shield,HMO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,Fee Schedule,6049.05
Blue Shield,HMO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,Fee Schedule,6049.05
Blue Shield,HMO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,Fee Schedule,6049.05
Blue Shield,HMO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,Fee Schedule,6876.92
Blue Shield,HMO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,Fee Schedule,4280.44
Blue Shield,HMO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,Fee Schedule,4891.93
Blue Shield,HMO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,Fee Schedule,4891.93
Blue Shield,HMO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,Fee Schedule,4891.93
Blue Shield,HMO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,Fee Schedule,4891.93
Blue Shield,HMO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,Fee Schedule,6049.05
Blue Shield,HMO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,Fee Schedule,6049.05
Blue Shield,HMO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,Fee Schedule,4891.93
Blue Shield,HMO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Fee Schedule,4280.44
Blue Shield,HMO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Fee Schedule,3198.57
Blue Shield,HMO,63615,CPT4/HCPCS,REMOVE LESION OF SPINAL CORD,,Fee Schedule,4280.44
Blue Shield,HMO,63620,CPT4/HCPCS,SRS SPINAL LESION,,Case Rate,4361.03
Blue Shield,HMO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,Case Rate,1075.84
Blue Shield,HMO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,4280.44
Blue Shield,HMO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,HMO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Fee Schedule,4280.44
Blue Shield,HMO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Fee Schedule,4280.44
Blue Shield,HMO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Fee Schedule,4280.44
Blue Shield,HMO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Fee Schedule,4280.44
Blue Shield,HMO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Fee Schedule,4280.44
Blue Shield,HMO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Fee Schedule,3198.57
Blue Shield,HMO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,3198.57
Blue Shield,HMO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,3198.57
Blue Shield,HMO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,4280.44
Blue Shield,HMO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,4280.44
Blue Shield,HMO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Fee Schedule,3198.57
Blue Shield,HMO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Fee Schedule,3198.57
Blue Shield,HMO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,Fee Schedule,3198.57
Blue Shield,HMO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Fee Schedule,3198.57
Blue Shield,HMO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Fee Schedule,12850.71
Blue Shield,HMO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Fee Schedule,4891.93
Blue Shield,HMO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Fee Schedule,4280.44
Blue Shield,HMO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Fee Schedule,3198.57
Blue Shield,HMO,64402,CPT4/HCPCS,N BLOCK INJ FACIAL,,Fee Schedule,3198.57
Blue Shield,HMO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Fee Schedule,987.79
Blue Shield,HMO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Fee Schedule,3198.57
Blue Shield,HMO,64410,CPT4/HCPCS,N BLOCK INJ PHRENIC,,Fee Schedule,3198.57
Blue Shield,HMO,64413,CPT4/HCPCS,N BLOCK INJ CERVICAL PLEXUS,,Fee Schedule,3198.57
Blue Shield,HMO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Fee Schedule,3198.57
Blue Shield,HMO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Fee Schedule,3198.57
Blue Shield,HMO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Fee Schedule,3198.57
Blue Shield,HMO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Fee Schedule,3198.57
Blue Shield,HMO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Fee Schedule,3198.57
Blue Shield,HMO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Fee Schedule,3198.57
Blue Shield,HMO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Fee Schedule,3198.57
Blue Shield,HMO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Fee Schedule,3198.57
Blue Shield,HMO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Fee Schedule,987.79
Blue Shield,HMO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,Fee Schedule,3198.57
Blue Shield,HMO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,Fee Schedule,3198.57
Blue Shield,HMO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Fee Schedule,3198.57
Blue Shield,HMO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Fee Schedule,3198.57
Blue Shield,HMO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Fee Schedule,3198.57
Blue Shield,HMO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Fee Schedule,3198.57
Blue Shield,HMO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Fee Schedule,3198.57
Blue Shield,HMO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Fee Schedule,3198.57
Blue Shield,HMO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Fee Schedule,3198.57
Blue Shield,HMO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Fee Schedule,3198.57
Blue Shield,HMO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Fee Schedule,3198.57
Blue Shield,HMO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Fee Schedule,3198.57
Blue Shield,HMO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Fee Schedule,3198.57
Blue Shield,HMO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Fee Schedule,3198.57
Blue Shield,HMO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Fee Schedule,3198.57
Blue Shield,HMO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Fee Schedule,3198.57
Blue Shield,HMO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Fee Schedule,3198.57
Blue Shield,HMO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Fee Schedule,3198.57
Blue Shield,HMO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Fee Schedule,3198.57
Blue Shield,HMO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Fee Schedule,3198.57
Blue Shield,HMO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Fee Schedule,3198.57
Blue Shield,HMO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Fee Schedule,3198.57
Blue Shield,HMO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Fee Schedule,3198.57
Blue Shield,HMO,64508,CPT4/HCPCS,N BLOCK CAROTID SINUS S/P,,Fee Schedule,3198.57
Blue Shield,HMO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Fee Schedule,3198.57
Blue Shield,HMO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Fee Schedule,3198.57
Blue Shield,HMO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Fee Schedule,3198.57
Blue Shield,HMO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Fee Schedule,3198.57
Blue Shield,HMO,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,Fee Schedule,987.79
Blue Shield,HMO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,HMO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,HMO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,HMO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Fee Schedule,987.79
Blue Shield,HMO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Fee Schedule,4280.44
Blue Shield,HMO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Fee Schedule,4280.44
Blue Shield,HMO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Fee Schedule,4280.44
Blue Shield,HMO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,HMO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,HMO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,HMO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Fee Schedule,3198.57
Blue Shield,HMO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Fee Schedule,4280.44
Blue Shield,HMO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Fee Schedule,3198.57
Blue Shield,HMO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Fee Schedule,987.79
Blue Shield,HMO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Fee Schedule,3198.57
Blue Shield,HMO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Fee Schedule,3198.57
Blue Shield,HMO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Fee Schedule,987.79
Blue Shield,HMO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Fee Schedule,987.79
Blue Shield,HMO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Fee Schedule,3198.57
Blue Shield,HMO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Fee Schedule,4891.93
Blue Shield,HMO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Fee Schedule,4891.93
Blue Shield,HMO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Fee Schedule,3198.57
Blue Shield,HMO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Fee Schedule,3198.57
Blue Shield,HMO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Fee Schedule,3198.57
Blue Shield,HMO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Fee Schedule,3198.57
Blue Shield,HMO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Fee Schedule,987.79
Blue Shield,HMO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Fee Schedule,987.79
Blue Shield,HMO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Fee Schedule,4280.44
Blue Shield,HMO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Fee Schedule,4280.44
Blue Shield,HMO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Fee Schedule,4891.93
Blue Shield,HMO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Fee Schedule,4280.44
Blue Shield,HMO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Fee Schedule,4280.44
Blue Shield,HMO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Fee Schedule,3198.57
Blue Shield,HMO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Fee Schedule,3198.57
Blue Shield,HMO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Fee Schedule,4280.44
Blue Shield,HMO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,Fee Schedule,4280.44
Blue Shield,HMO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Fee Schedule,4280.44
Blue Shield,HMO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Fee Schedule,4280.44
Blue Shield,HMO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,64787,CPT4/HCPCS,IMPLANT NERVE END,,Fee Schedule,4280.44
Blue Shield,HMO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Fee Schedule,4280.44
Blue Shield,HMO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,HMO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,HMO,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,HMO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,Fee Schedule,4280.44
Blue Shield,HMO,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,6049.05
Blue Shield,HMO,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,6049.05
Blue Shield,HMO,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,Fee Schedule,6049.05
Blue Shield,HMO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Fee Schedule,6049.05
Blue Shield,HMO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4891.93
Blue Shield,HMO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4891.93
Blue Shield,HMO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64859,CPT4/HCPCS,NERVE SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Fee Schedule,4891.93
Blue Shield,HMO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Fee Schedule,4891.93
Blue Shield,HMO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Fee Schedule,4891.93
Blue Shield,HMO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Fee Schedule,6049.05
Blue Shield,HMO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Fee Schedule,3198.57
Blue Shield,HMO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Fee Schedule,4280.44
Blue Shield,HMO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Fee Schedule,4891.93
Blue Shield,HMO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Fee Schedule,4891.93
Blue Shield,HMO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Fee Schedule,4280.44
Blue Shield,HMO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Fee Schedule,4891.93
Blue Shield,HMO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Fee Schedule,4891.93
Blue Shield,HMO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Fee Schedule,4891.93
Blue Shield,HMO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Fee Schedule,4891.93
Blue Shield,HMO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,HMO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,HMO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Fee Schedule,4280.44
Blue Shield,HMO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Fee Schedule,3198.57
Blue Shield,HMO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,HMO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Fee Schedule,6049.05
Blue Shield,HMO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Fee Schedule,6049.05
Blue Shield,HMO,64999,CPT4/HCPCS,NERVOUS SYSTEM SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,65091,CPT4/HCPCS,REVISE EYE,,Fee Schedule,4891.93
Blue Shield,HMO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Fee Schedule,4891.93
Blue Shield,HMO,65101,CPT4/HCPCS,REMOVAL OF EYE,,Fee Schedule,4891.93
Blue Shield,HMO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Fee Schedule,4891.93
Blue Shield,HMO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Fee Schedule,6049.05
Blue Shield,HMO,65110,CPT4/HCPCS,REMOVAL OF EYE,,Fee Schedule,6876.92
Blue Shield,HMO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Fee Schedule,9548.66
Blue Shield,HMO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Fee Schedule,9548.66
Blue Shield,HMO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,HMO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,HMO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,HMO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,HMO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,HMO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,HMO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Fee Schedule,3198.57
Blue Shield,HMO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,HMO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,HMO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,HMO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,HMO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,4280.44
Blue Shield,HMO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,4891.93
Blue Shield,HMO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,6049.05
Blue Shield,HMO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,4280.44
Blue Shield,HMO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,4280.44
Blue Shield,HMO,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,HMO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,HMO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,HMO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,3198.57
Blue Shield,HMO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Fee Schedule,4891.93
Blue Shield,HMO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,3198.57
Blue Shield,HMO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Fee Schedule,4280.44
Blue Shield,HMO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,4280.44
Blue Shield,HMO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,6876.92
Blue Shield,HMO,65430,CPT4/HCPCS,CORNEAL SMEAR,,Fee Schedule,987.79
Blue Shield,HMO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Fee Schedule,3198.57
Blue Shield,HMO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Fee Schedule,3198.57
Blue Shield,HMO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,65600,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,4280.44
Blue Shield,HMO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Fee Schedule,7902.34
Blue Shield,HMO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,65760,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,9548.66
Blue Shield,HMO,65765,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,9548.66
Blue Shield,HMO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Fee Schedule,9548.66
Blue Shield,HMO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Fee Schedule,6049.05
Blue Shield,HMO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Fee Schedule,6049.05
Blue Shield,HMO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Fee Schedule,987.79
Blue Shield,HMO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Fee Schedule,987.79
Blue Shield,HMO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,HMO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Fee Schedule,9548.66
Blue Shield,HMO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,3198.57
Blue Shield,HMO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,4891.93
Blue Shield,HMO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,4280.44
Blue Shield,HMO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Fee Schedule,3198.57
Blue Shield,HMO,65850,CPT4/HCPCS,INCISION OF EYE,,Fee Schedule,6049.05
Blue Shield,HMO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Fee Schedule,3198.57
Blue Shield,HMO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,HMO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,HMO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,HMO,65900,CPT4/HCPCS,REMOVE EYE LESION,,Fee Schedule,6876.92
Blue Shield,HMO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Fee Schedule,9548.66
Blue Shield,HMO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Fee Schedule,6876.92
Blue Shield,HMO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Fee Schedule,3198.57
Blue Shield,HMO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Fee Schedule,3198.57
Blue Shield,HMO,66130,CPT4/HCPCS,REMOVE EYE LESION,,Fee Schedule,9548.66
Blue Shield,HMO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,66172,CPT4/HCPCS,INCISION OF EYE,,Fee Schedule,6049.05
Blue Shield,HMO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Fee Schedule,4280.44
Blue Shield,HMO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Fee Schedule,4280.44
Blue Shield,HMO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,HMO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Fee Schedule,6876.92
Blue Shield,HMO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Fee Schedule,4280.44
Blue Shield,HMO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Fee Schedule,4280.44
Blue Shield,HMO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Fee Schedule,4280.44
Blue Shield,HMO,66220,CPT4/HCPCS,REPAIR EYE LESION,,Fee Schedule,4891.93
Blue Shield,HMO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Fee Schedule,6049.05
Blue Shield,HMO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Fee Schedule,4280.44
Blue Shield,HMO,66500,CPT4/HCPCS,INCISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,HMO,66505,CPT4/HCPCS,INCISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,HMO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Fee Schedule,4891.93
Blue Shield,HMO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,HMO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,HMO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,HMO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,HMO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Fee Schedule,4891.93
Blue Shield,HMO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,HMO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,HMO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Fee Schedule,4280.44
Blue Shield,HMO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Fee Schedule,4280.44
Blue Shield,HMO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,HMO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,HMO,66761,CPT4/HCPCS,REVISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,HMO,66762,CPT4/HCPCS,REVISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,HMO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Fee Schedule,3198.57
Blue Shield,HMO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Fee Schedule,3198.57
Blue Shield,HMO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Fee Schedule,4280.44
Blue Shield,HMO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Fee Schedule,6049.05
Blue Shield,HMO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Fee Schedule,6049.05
Blue Shield,HMO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,6049.05
Blue Shield,HMO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,9548.66
Blue Shield,HMO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,6049.05
Blue Shield,HMO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6049.05
Blue Shield,HMO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6876.92
Blue Shield,HMO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6876.92
Blue Shield,HMO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Fee Schedule,9304.07
Blue Shield,HMO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Fee Schedule,9304.07
Blue Shield,HMO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Fee Schedule,9304.07
Blue Shield,HMO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Fee Schedule,7902.34
Blue Shield,HMO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Fee Schedule,7902.34
Blue Shield,HMO,66999,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Fee Schedule,6049.05
Blue Shield,HMO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Fee Schedule,6049.05
Blue Shield,HMO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Fee Schedule,3198.57
Blue Shield,HMO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Fee Schedule,3198.57
Blue Shield,HMO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Fee Schedule,6049.05
Blue Shield,HMO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Fee Schedule,3198.57
Blue Shield,HMO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Fee Schedule,3198.57
Blue Shield,HMO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Fee Schedule,4280.44
Blue Shield,HMO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Fee Schedule,6049.05
Blue Shield,HMO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Fee Schedule,9548.66
Blue Shield,HMO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Fee Schedule,9548.66
Blue Shield,HMO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Fee Schedule,4891.93
Blue Shield,HMO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Fee Schedule,4891.93
Blue Shield,HMO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Fee Schedule,4891.93
Blue Shield,HMO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Fee Schedule,3198.57
Blue Shield,HMO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Fee Schedule,3198.57
Blue Shield,HMO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,6876.92
Blue Shield,HMO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,9548.66
Blue Shield,HMO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,4891.93
Blue Shield,HMO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Fee Schedule,9548.66
Blue Shield,HMO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Fee Schedule,4280.44
Blue Shield,HMO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Fee Schedule,4280.44
Blue Shield,HMO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Fee Schedule,4280.44
Blue Shield,HMO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Fee Schedule,4280.44
Blue Shield,HMO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Fee Schedule,3198.57
Blue Shield,HMO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,3198.57
Blue Shield,HMO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,6876.92
Blue Shield,HMO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Fee Schedule,3198.57
Blue Shield,HMO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Fee Schedule,3198.57
Blue Shield,HMO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Fee Schedule,3198.57
Blue Shield,HMO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Fee Schedule,3198.57
Blue Shield,HMO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Fee Schedule,3198.57
Blue Shield,HMO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Fee Schedule,7902.34
Blue Shield,HMO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Fee Schedule,4891.93
Blue Shield,HMO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Fee Schedule,4891.93
Blue Shield,HMO,67299,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Fee Schedule,4891.93
Blue Shield,HMO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Fee Schedule,6049.05
Blue Shield,HMO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Fee Schedule,6049.05
Blue Shield,HMO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Fee Schedule,6049.05
Blue Shield,HMO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Fee Schedule,6049.05
Blue Shield,HMO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Fee Schedule,6049.05
Blue Shield,HMO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Fee Schedule,6049.05
Blue Shield,HMO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Fee Schedule,6049.05
Blue Shield,HMO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Fee Schedule,6049.05
Blue Shield,HMO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Fee Schedule,6049.05
Blue Shield,HMO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Fee Schedule,6049.05
Blue Shield,HMO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Fee Schedule,6049.05
Blue Shield,HMO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Fee Schedule,3198.57
Blue Shield,HMO,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,Fee Schedule,3198.57
Blue Shield,HMO,67399,CPT4/HCPCS,UNLISTED PX EXTRAOCULAR MUSC,,Fee Schedule,6049.05
Blue Shield,HMO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,4891.93
Blue Shield,HMO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Fee Schedule,6049.05
Blue Shield,HMO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,HMO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,HMO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Fee Schedule,7902.34
Blue Shield,HMO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Fee Schedule,3198.57
Blue Shield,HMO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,HMO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,HMO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,HMO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Fee Schedule,7902.34
Blue Shield,HMO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,HMO,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,HMO,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,HMO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,HMO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Fee Schedule,6049.05
Blue Shield,HMO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Fee Schedule,4280.44
Blue Shield,HMO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Fee Schedule,7902.34
Blue Shield,HMO,67599,CPT4/HCPCS,ORBIT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Fee Schedule,987.79
Blue Shield,HMO,67710,CPT4/HCPCS,INCISION OF EYELID,,Fee Schedule,3198.57
Blue Shield,HMO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Fee Schedule,3198.57
Blue Shield,HMO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Fee Schedule,987.79
Blue Shield,HMO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Fee Schedule,3198.57
Blue Shield,HMO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Fee Schedule,987.79
Blue Shield,HMO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Fee Schedule,4280.44
Blue Shield,HMO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Fee Schedule,987.79
Blue Shield,HMO,67820,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,3198.57
Blue Shield,HMO,67825,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,3198.57
Blue Shield,HMO,67830,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,4280.44
Blue Shield,HMO,67835,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,4280.44
Blue Shield,HMO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Fee Schedule,3198.57
Blue Shield,HMO,67850,CPT4/HCPCS,TREAT EYELID LESION,,Fee Schedule,3198.57
Blue Shield,HMO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Fee Schedule,3198.57
Blue Shield,HMO,67880,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,67882,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Fee Schedule,6049.05
Blue Shield,HMO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,HMO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,HMO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,HMO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,HMO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,HMO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,HMO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,HMO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,HMO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Fee Schedule,3198.57
Blue Shield,HMO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,HMO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,3198.57
Blue Shield,HMO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,HMO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,HMO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,HMO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4280.44
Blue Shield,HMO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,HMO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,HMO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Fee Schedule,4280.44
Blue Shield,HMO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Fee Schedule,4280.44
Blue Shield,HMO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,HMO,67950,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4280.44
Blue Shield,HMO,67961,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,67966,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,HMO,67999,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4280.44
Blue Shield,HMO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Fee Schedule,4280.44
Blue Shield,HMO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,Fee Schedule,987.79
Blue Shield,HMO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Fee Schedule,3198.57
Blue Shield,HMO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,3198.57
Blue Shield,HMO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,4280.44
Blue Shield,HMO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,4280.44
Blue Shield,HMO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,3198.57
Blue Shield,HMO,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,Fee Schedule,987.79
Blue Shield,HMO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,HMO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,HMO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,HMO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,HMO,68330,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,6049.05
Blue Shield,HMO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,HMO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Fee Schedule,6049.05
Blue Shield,HMO,68360,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,4280.44
Blue Shield,HMO,68362,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,4280.44
Blue Shield,HMO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Fee Schedule,3198.57
Blue Shield,HMO,68399,CPT4/HCPCS,EYELID LINING SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Fee Schedule,987.79
Blue Shield,HMO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Fee Schedule,4280.44
Blue Shield,HMO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Fee Schedule,4891.93
Blue Shield,HMO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Fee Schedule,4891.93
Blue Shield,HMO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Fee Schedule,3198.57
Blue Shield,HMO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Fee Schedule,4891.93
Blue Shield,HMO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Fee Schedule,3198.57
Blue Shield,HMO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Fee Schedule,4280.44
Blue Shield,HMO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Fee Schedule,4891.93
Blue Shield,HMO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Fee Schedule,4891.93
Blue Shield,HMO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Fee Schedule,4280.44
Blue Shield,HMO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Fee Schedule,6049.05
Blue Shield,HMO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Fee Schedule,6049.05
Blue Shield,HMO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Fee Schedule,6049.05
Blue Shield,HMO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Fee Schedule,987.79
Blue Shield,HMO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Fee Schedule,6049.05
Blue Shield,HMO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,3198.57
Blue Shield,HMO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,4280.44
Blue Shield,HMO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,4280.44
Blue Shield,HMO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Fee Schedule,3198.57
Blue Shield,HMO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Fee Schedule,3198.57
Blue Shield,HMO,68899,CPT4/HCPCS,TEAR DUCT SYSTEM SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Fee Schedule,987.79
Blue Shield,HMO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Fee Schedule,3198.57
Blue Shield,HMO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Fee Schedule,987.79
Blue Shield,HMO,69090,CPT4/HCPCS,PIERCE EARLOBES,,Fee Schedule,987.79
Blue Shield,HMO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,Fee Schedule,3198.57
Blue Shield,HMO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,Fee Schedule,4280.44
Blue Shield,HMO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Fee Schedule,3198.57
Blue Shield,HMO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Fee Schedule,4280.44
Blue Shield,HMO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,HMO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,HMO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,HMO,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Fee Schedule,987.79
Blue Shield,HMO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Fee Schedule,3198.57
Blue Shield,HMO,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Fee Schedule,987.79
Blue Shield,HMO,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Fee Schedule,987.79
Blue Shield,HMO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Fee Schedule,987.79
Blue Shield,HMO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Fee Schedule,4280.44
Blue Shield,HMO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Fee Schedule,4891.93
Blue Shield,HMO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Fee Schedule,4891.93
Blue Shield,HMO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Fee Schedule,9548.66
Blue Shield,HMO,69399,CPT4/HCPCS,OUTER EAR SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,HMO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Fee Schedule,3198.57
Blue Shield,HMO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Fee Schedule,4891.93
Blue Shield,HMO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Fee Schedule,3198.57
Blue Shield,HMO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Fee Schedule,3198.57
Blue Shield,HMO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Fee Schedule,4891.93
Blue Shield,HMO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Fee Schedule,4891.93
Blue Shield,HMO,69450,CPT4/HCPCS,EARDRUM REVISION,,Fee Schedule,3198.57
Blue Shield,HMO,69501,CPT4/HCPCS,MASTOIDECTOMY,,Fee Schedule,9548.66
Blue Shield,HMO,69502,CPT4/HCPCS,MASTOIDECTOMY,,Fee Schedule,9548.66
Blue Shield,HMO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Fee Schedule,9548.66
Blue Shield,HMO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Fee Schedule,9548.66
Blue Shield,HMO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Fee Schedule,9548.66
Blue Shield,HMO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,Fee Schedule,7902.34
Blue Shield,HMO,69540,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,4280.44
Blue Shield,HMO,69550,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,6876.92
Blue Shield,HMO,69552,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,9548.66
Blue Shield,HMO,69554,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,6876.92
Blue Shield,HMO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,HMO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,HMO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,HMO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,HMO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,HMO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Fee Schedule,6049.05
Blue Shield,HMO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Fee Schedule,4280.44
Blue Shield,HMO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,HMO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,HMO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,HMO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,HMO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,HMO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,HMO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,HMO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,HMO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,HMO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,HMO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,HMO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,HMO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Fee Schedule,9548.66
Blue Shield,HMO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,HMO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,HMO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,HMO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Fee Schedule,6049.05
Blue Shield,HMO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Fee Schedule,6049.05
Blue Shield,HMO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Fee Schedule,4891.93
Blue Shield,HMO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Fee Schedule,4891.93
Blue Shield,HMO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Fee Schedule,4891.93
Blue Shield,HMO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Fee Schedule,6049.05
Blue Shield,HMO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Fee Schedule,3198.57
Blue Shield,HMO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Fee Schedule,12850.71
Blue Shield,HMO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Fee Schedule,12850.71
Blue Shield,HMO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Fee Schedule,12850.71
Blue Shield,HMO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Fee Schedule,12850.71
Blue Shield,HMO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,HMO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,HMO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,HMO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,HMO,69799,CPT4/HCPCS,MIDDLE EAR SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,HMO,69801,CPT4/HCPCS,INCISE INNER EAR,,Fee Schedule,6876.92
Blue Shield,HMO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Fee Schedule,9548.66
Blue Shield,HMO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Fee Schedule,9548.66
Blue Shield,HMO,69905,CPT4/HCPCS,REMOVE INNER EAR,,Fee Schedule,9548.66
Blue Shield,HMO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,HMO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Fee Schedule,9548.66
Blue Shield,HMO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Fee Schedule,9548.66
Blue Shield,HMO,69949,CPT4/HCPCS,INNER EAR SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,HMO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,Fee Schedule,9548.66
Blue Shield,HMO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,9548.66
Blue Shield,HMO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,Fee Schedule,9548.66
Blue Shield,HMO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Fee Schedule,9548.66
Blue Shield,HMO,69979,CPT4/HCPCS,TEMPORAL BONE SURGERY,,Fee Schedule,3198.57
Blue Shield,HMO,70010,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Case Rate,2177.00
Blue Shield,HMO,70015,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Case Rate,686.66
Blue Shield,HMO,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,Case Rate,205.35
Blue Shield,HMO,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,Case Rate,258.27
Blue Shield,HMO,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,Case Rate,314.46
Blue Shield,HMO,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Case Rate,314.46
Blue Shield,HMO,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Case Rate,400.29
Blue Shield,HMO,70134,CPT4/HCPCS,X-RAY EXAM OF MIDDLE EAR,,Case Rate,376.23
Blue Shield,HMO,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Case Rate,314.46
Blue Shield,HMO,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Case Rate,400.29
Blue Shield,HMO,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,Case Rate,258.27
Blue Shield,HMO,70170,CPT4/HCPCS,X-RAY EXAM OF TEAR DUCT,,Case Rate,481.31
Blue Shield,HMO,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Case Rate,314.46
Blue Shield,HMO,70200,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Case Rate,400.29
Blue Shield,HMO,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Case Rate,314.46
Blue Shield,HMO,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Case Rate,400.29
Blue Shield,HMO,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,Case Rate,205.35
Blue Shield,HMO,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Case Rate,314.46
Blue Shield,HMO,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Case Rate,452.44
Blue Shield,HMO,70300,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Case Rate,137.98
Blue Shield,HMO,70310,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Case Rate,205.35
Blue Shield,HMO,70320,CPT4/HCPCS,FULL MOUTH X-RAY OF TEETH,,Case Rate,400.29
Blue Shield,HMO,70328,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Case Rate,243.84
Blue Shield,HMO,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,Case Rate,429.16
Blue Shield,HMO,70332,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Case Rate,1058.85
Blue Shield,HMO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,Case Rate,5646.30
Blue Shield,HMO,70350,CPT4/HCPCS,X-RAY HEAD FOR ORTHODONTIA,,Case Rate,186.10
Blue Shield,HMO,70355,CPT4/HCPCS,PANORAMIC X-RAY OF JAWS,,Case Rate,290.40
Blue Shield,HMO,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,Case Rate,205.35
Blue Shield,HMO,70370,CPT4/HCPCS,THROAT X-RAY & FLUOROSCOPY,,Case Rate,658.56
Blue Shield,HMO,70371,CPT4/HCPCS,SPEECH EVALUATION COMPLEX,,Case Rate,1058.85
Blue Shield,HMO,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,Case Rate,338.52
Blue Shield,HMO,70390,CPT4/HCPCS,X-RAY EXAM OF SALIVARY DUCT,,Case Rate,905.66
Blue Shield,HMO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,Case Rate,2381.57
Blue Shield,HMO,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,Case Rate,2849.22
Blue Shield,HMO,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,Case Rate,3565.53
Blue Shield,HMO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,Case Rate,2381.57
Blue Shield,HMO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,Case Rate,2849.22
Blue Shield,HMO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,Case Rate,3565.53
Blue Shield,HMO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,Case Rate,2381.57
Blue Shield,HMO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,Case Rate,2849.22
Blue Shield,HMO,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,Case Rate,3565.53
Blue Shield,HMO,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,Case Rate,2381.57
Blue Shield,HMO,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,Case Rate,2849.22
Blue Shield,HMO,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,Case Rate,3565.53
Blue Shield,HMO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,Case Rate,5358.37
Blue Shield,HMO,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,Case Rate,5358.37
Blue Shield,HMO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,Case Rate,5565.61
Blue Shield,HMO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,Case Rate,6680.50
Blue Shield,HMO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,Case Rate,12358.33
Blue Shield,HMO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,Case Rate,5646.30
Blue Shield,HMO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,Case Rate,5646.30
Blue Shield,HMO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,Case Rate,11059.38
Blue Shield,HMO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,Case Rate,5646.30
Blue Shield,HMO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,Case Rate,5646.30
Blue Shield,HMO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,Case Rate,11059.38
Blue Shield,HMO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,Case Rate,5646.30
Blue Shield,HMO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,Case Rate,6773.29
Blue Shield,HMO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,Case Rate,12547.94
Blue Shield,HMO,70554,CPT4/HCPCS,FMRI BRAIN BY TECH,,Case Rate,6533.00
Blue Shield,HMO,70557,CPT4/HCPCS,MRI BRAIN W/O DYE,,Case Rate,7560.21
Blue Shield,HMO,70558,CPT4/HCPCS,MRI BRAIN W/DYE,,Case Rate,8361.57
Blue Shield,HMO,70559,CPT4/HCPCS,MRI BRAIN W/O & W/DYE,,Case Rate,8400.06
Blue Shield,HMO,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,Case Rate,143.57
Blue Shield,HMO,71046,CPT4/HCPCS,X-RAY EXAM CHEST 2 VIEWS,,Case Rate,263.86
Blue Shield,HMO,71047,CPT4/HCPCS,X-RAY EXAM CHEST 3 VIEWS,,Case Rate,336.04
Blue Shield,HMO,71048,CPT4/HCPCS,X-RAY EXAM CHEST 4+ VIEWS,,Case Rate,345.66
Blue Shield,HMO,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,Case Rate,290.40
Blue Shield,HMO,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,Case Rate,338.52
Blue Shield,HMO,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,Case Rate,400.29
Blue Shield,HMO,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,Case Rate,452.44
Blue Shield,HMO,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,Case Rate,328.89
Blue Shield,HMO,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,Case Rate,357.76
Blue Shield,HMO,71250,CPT4/HCPCS,CT THORAX DX C-,,Case Rate,2978.36
Blue Shield,HMO,71260,CPT4/HCPCS,CT THORAX DX C+,,Case Rate,3565.53
Blue Shield,HMO,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,Case Rate,4458.30
Blue Shield,HMO,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,Case Rate,6133.38
Blue Shield,HMO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,Case Rate,5589.81
Blue Shield,HMO,71551,CPT4/HCPCS,MRI CHEST W/DYE,,Case Rate,6700.67
Blue Shield,HMO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,Case Rate,12293.78
Blue Shield,HMO,71555,CPT4/HCPCS,MRI ANGIO CHEST W OR W/O DYE,,Case Rate,5646.30
Blue Shield,HMO,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,Case Rate,205.35
Blue Shield,HMO,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,Case Rate,304.83
Blue Shield,HMO,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,Case Rate,452.44
Blue Shield,HMO,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,Case Rate,567.92
Blue Shield,HMO,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,Case Rate,328.89
Blue Shield,HMO,72072,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 3VWS,,Case Rate,376.23
Blue Shield,HMO,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,Case Rate,462.06
Blue Shield,HMO,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,Case Rate,338.52
Blue Shield,HMO,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,Case Rate,340.85
Blue Shield,HMO,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,Case Rate,619.92
Blue Shield,HMO,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,Case Rate,672.85
Blue Shield,HMO,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,Case Rate,807.58
Blue Shield,HMO,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,Case Rate,338.52
Blue Shield,HMO,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,Case Rate,462.06
Blue Shield,HMO,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,Case Rate,596.79
Blue Shield,HMO,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,Case Rate,452.44
Blue Shield,HMO,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,HMO,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,Case Rate,3565.53
Blue Shield,HMO,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,HMO,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,HMO,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,Case Rate,3565.53
Blue Shield,HMO,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,HMO,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,HMO,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,Case Rate,3565.53
Blue Shield,HMO,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,HMO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,Case Rate,5646.30
Blue Shield,HMO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,Case Rate,6773.29
Blue Shield,HMO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,Case Rate,6263.11
Blue Shield,HMO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,Case Rate,6773.29
Blue Shield,HMO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,Case Rate,6263.11
Blue Shield,HMO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,Case Rate,6773.29
Blue Shield,HMO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,HMO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,HMO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,HMO,72159,CPT4/HCPCS,MR ANGIO SPINE W/O&W/DYE,,Case Rate,6142.82
Blue Shield,HMO,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Case Rate,258.27
Blue Shield,HMO,72190,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Case Rate,338.52
Blue Shield,HMO,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,Case Rate,5964.97
Blue Shield,HMO,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,Case Rate,2978.36
Blue Shield,HMO,72193,CPT4/HCPCS,CT PELVIS W/DYE,,Case Rate,3450.82
Blue Shield,HMO,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,Case Rate,4272.98
Blue Shield,HMO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,Case Rate,5589.81
Blue Shield,HMO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,Case Rate,6700.67
Blue Shield,HMO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,Case Rate,12390.60
Blue Shield,HMO,72198,CPT4/HCPCS,MR ANGIO PELVIS W/O & W/DYE,,Case Rate,5646.30
Blue Shield,HMO,72200,CPT4/HCPCS,X-RAY EXAM SI JOINTS,,Case Rate,258.27
Blue Shield,HMO,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,Case Rate,314.46
Blue Shield,HMO,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,Case Rate,290.40
Blue Shield,HMO,72240,CPT4/HCPCS,MYELOGRAPHY NECK SPINE,,Case Rate,2396.00
Blue Shield,HMO,72255,CPT4/HCPCS,MYELOGRAPHY THORACIC SPINE,,Case Rate,2177.00
Blue Shield,HMO,72265,CPT4/HCPCS,MYELOGRAPHY L-S SPINE,,Case Rate,2056.71
Blue Shield,HMO,72270,CPT4/HCPCS,MYELOGPHY 2/> SPINE REGIONS,,Case Rate,3077.85
Blue Shield,HMO,72275,CPT4/HCPCS,EPIDUROGRAPHY,,Case Rate,1099.20
Blue Shield,HMO,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,Case Rate,4220.06
Blue Shield,HMO,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,Case Rate,3952.94
Blue Shield,HMO,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,Case Rate,258.27
Blue Shield,HMO,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,Case Rate,258.27
Blue Shield,HMO,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Case Rate,234.22
Blue Shield,HMO,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Case Rate,290.40
Blue Shield,HMO,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,Case Rate,1058.85
Blue Shield,HMO,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,Case Rate,338.52
Blue Shield,HMO,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,Case Rate,290.40
Blue Shield,HMO,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Case Rate,258.27
Blue Shield,HMO,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Case Rate,290.40
Blue Shield,HMO,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,Case Rate,1058.85
Blue Shield,HMO,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,Case Rate,258.27
Blue Shield,HMO,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,Case Rate,243.84
Blue Shield,HMO,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Case Rate,243.84
Blue Shield,HMO,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Case Rate,263.08
Blue Shield,HMO,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,Case Rate,800.58
Blue Shield,HMO,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,Case Rate,243.84
Blue Shield,HMO,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,Case Rate,263.08
Blue Shield,HMO,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,Case Rate,205.35
Blue Shield,HMO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,Case Rate,2492.24
Blue Shield,HMO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,Case Rate,2978.36
Blue Shield,HMO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,Case Rate,3742.00
Blue Shield,HMO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,Case Rate,5450.13
Blue Shield,HMO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,Case Rate,5565.61
Blue Shield,HMO,73219,CPT4/HCPCS,MRI UPPER EXTREMITY W/DYE,,Case Rate,6680.50
Blue Shield,HMO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,Case Rate,12358.33
Blue Shield,HMO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,Case Rate,5565.61
Blue Shield,HMO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,Case Rate,6680.50
Blue Shield,HMO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,Case Rate,12358.33
Blue Shield,HMO,73225,CPT4/HCPCS,MR ANGIO UPR EXTR W/O&W/DYE,,Case Rate,5535.63
Blue Shield,HMO,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,Case Rate,273.49
Blue Shield,HMO,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,Case Rate,403.40
Blue Shield,HMO,73503,CPT4/HCPCS,X-RAY EXAM HIP UNI 4/> VIEWS,,Case Rate,499.63
Blue Shield,HMO,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,Case Rate,379.34
Blue Shield,HMO,73522,CPT4/HCPCS,X-RAY EXAM HIPS BI 3-4 VIEWS,,Case Rate,451.52
Blue Shield,HMO,73523,CPT4/HCPCS,X-RAY EXAM HIPS BI 5/> VIEWS,,Case Rate,542.94
Blue Shield,HMO,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,Case Rate,1058.85
Blue Shield,HMO,73551,CPT4/HCPCS,X-RAY EXAM OF FEMUR 1,,Case Rate,259.05
Blue Shield,HMO,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,Case Rate,307.17
Blue Shield,HMO,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,Case Rate,258.27
Blue Shield,HMO,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,Case Rate,290.40
Blue Shield,HMO,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,Case Rate,314.46
Blue Shield,HMO,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,Case Rate,243.84
Blue Shield,HMO,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,Case Rate,1317.13
Blue Shield,HMO,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,Case Rate,258.27
Blue Shield,HMO,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,Case Rate,243.84
Blue Shield,HMO,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Case Rate,243.84
Blue Shield,HMO,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Case Rate,263.08
Blue Shield,HMO,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,Case Rate,1058.85
Blue Shield,HMO,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Case Rate,243.84
Blue Shield,HMO,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Case Rate,263.08
Blue Shield,HMO,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,Case Rate,234.22
Blue Shield,HMO,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,Case Rate,205.35
Blue Shield,HMO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,Case Rate,2492.24
Blue Shield,HMO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,Case Rate,2978.36
Blue Shield,HMO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,Case Rate,3742.00
Blue Shield,HMO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,Case Rate,5450.13
Blue Shield,HMO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,Case Rate,5565.61
Blue Shield,HMO,73719,CPT4/HCPCS,MRI LOWER EXTREMITY W/DYE,,Case Rate,6680.50
Blue Shield,HMO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,Case Rate,12358.33
Blue Shield,HMO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,Case Rate,5565.61
Blue Shield,HMO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,Case Rate,6680.50
Blue Shield,HMO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,Case Rate,12358.33
Blue Shield,HMO,73725,CPT4/HCPCS,MR ANG LWR EXT W OR W/O DYE,,Case Rate,5646.30
Blue Shield,HMO,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,Case Rate,244.62
Blue Shield,HMO,74019,CPT4/HCPCS,X-RAY EXAM ABDOMEN 2 VIEWS,,Case Rate,292.73
Blue Shield,HMO,74021,CPT4/HCPCS,X-RAY EXAM ABDOMEN 3+ VIEWS,,Case Rate,340.85
Blue Shield,HMO,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,Case Rate,376.23
Blue Shield,HMO,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,Case Rate,2849.22
Blue Shield,HMO,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,Case Rate,3450.82
Blue Shield,HMO,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,Case Rate,4272.98
Blue Shield,HMO,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,Case Rate,6451.62
Blue Shield,HMO,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,Case Rate,5964.97
Blue Shield,HMO,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,Case Rate,1866.13
Blue Shield,HMO,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,Case Rate,3559.83
Blue Shield,HMO,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,Case Rate,4704.99
Blue Shield,HMO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,Case Rate,5589.81
Blue Shield,HMO,74182,CPT4/HCPCS,MRI ABDOMEN W/DYE,,Case Rate,6700.67
Blue Shield,HMO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,Case Rate,12390.60
Blue Shield,HMO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,Case Rate,5646.30
Blue Shield,HMO,74190,CPT4/HCPCS,X-RAY EXAM OF PERITONEUM,,Case Rate,658.56
Blue Shield,HMO,74210,CPT4/HCPCS,X-RAY XM PHRNX&/CRV ESOPH C+,,Case Rate,596.79
Blue Shield,HMO,74220,CPT4/HCPCS,X-RAY XM ESOPHAGUS 1CNTRST,,Case Rate,596.79
Blue Shield,HMO,74230,CPT4/HCPCS,X-RAY XM SWLNG FUNCJ C+,,Case Rate,658.56
Blue Shield,HMO,74235,CPT4/HCPCS,REMOVE ESOPHAGUS OBSTRUCTION,,Case Rate,1317.13
Blue Shield,HMO,74240,CPT4/HCPCS,X-RAY XM UPR GI TRC 1CNTRST,,Case Rate,734.77
Blue Shield,HMO,74241,CPT4/HCPCS,X-RAY UPPER GI DELAY W/KUB,,Case Rate,749.21
Blue Shield,HMO,74245,CPT4/HCPCS,X-RAY UPPER GI&SMALL INTEST,,Case Rate,1202.43
Blue Shield,HMO,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,Case Rate,834.26
Blue Shield,HMO,74247,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,Case Rate,857.54
Blue Shield,HMO,74249,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,Case Rate,1302.69
Blue Shield,HMO,74250,CPT4/HCPCS,X-RAY XM SM INT 1CNTRST STD,,Case Rate,658.56
Blue Shield,HMO,74251,CPT4/HCPCS,X-RAY XM SM INT 2CNTRST STD,,Case Rate,658.56
Blue Shield,HMO,74260,CPT4/HCPCS,X-RAY EXAM OF SMALL BOWEL,,Case Rate,749.21
Blue Shield,HMO,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,Case Rate,6620.02
Blue Shield,HMO,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,Case Rate,7442.81
Blue Shield,HMO,74263,CPT4/HCPCS,CT COLONOGRAPHY SCREENING,,Case Rate,7866.23
Blue Shield,HMO,74270,CPT4/HCPCS,X-RAY XM COLON 1CNTRST STD,,Case Rate,867.17
Blue Shield,HMO,74280,CPT4/HCPCS,X-RAY XM COLON 2CNTRST STD,,Case Rate,1130.25
Blue Shield,HMO,74283,CPT4/HCPCS,THER NMA RDCTJ INTUS/OBSTRCJ,,Case Rate,1297.88
Blue Shield,HMO,74290,CPT4/HCPCS,CONTRAST X-RAY GALLBLADDER,,Case Rate,376.23
Blue Shield,HMO,74300,CPT4/HCPCS,X-RAY BILE DUCTS/PANCREAS,,Case Rate,443.59
Blue Shield,HMO,74301,CPT4/HCPCS,X-RAYS AT SURGERY ADD-ON,,Case Rate,257.50
Blue Shield,HMO,74328,CPT4/HCPCS,X-RAY BILE DUCT ENDOSCOPY,,Case Rate,1593.87
Blue Shield,HMO,74329,CPT4/HCPCS,X-RAY FOR PANCREAS ENDOSCOPY,,Case Rate,1593.87
Blue Shield,HMO,74330,CPT4/HCPCS,X-RAY BILE/PANC ENDOSCOPY,,Case Rate,1593.87
Blue Shield,HMO,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,Case Rate,1317.13
Blue Shield,HMO,74355,CPT4/HCPCS,X-RAY GUIDE INTESTINAL TUBE,,Case Rate,1317.13
Blue Shield,HMO,74360,CPT4/HCPCS,X-RAY GUIDE GI DILATION,,Case Rate,1593.87
Blue Shield,HMO,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,Case Rate,3077.85
Blue Shield,HMO,74400,CPT4/HCPCS,UROGRAPHY IV +-KUB TOMOG,,Case Rate,857.54
Blue Shield,HMO,74410,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BOLUS,,Case Rate,987.46
Blue Shield,HMO,74415,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BLS W/NF,,Case Rate,1068.48
Blue Shield,HMO,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,Case Rate,1317.13
Blue Shield,HMO,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,Case Rate,658.56
Blue Shield,HMO,74430,CPT4/HCPCS,CONTRAST X-RAY BLADDER,,Case Rate,534.24
Blue Shield,HMO,74440,CPT4/HCPCS,X-RAY MALE GENITAL TRACT,,Case Rate,567.92
Blue Shield,HMO,74445,CPT4/HCPCS,X-RAY EXAM OF PENIS,,Case Rate,567.92
Blue Shield,HMO,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Case Rate,734.77
Blue Shield,HMO,74455,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Case Rate,800.58
Blue Shield,HMO,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,Case Rate,629.69
Blue Shield,HMO,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,Case Rate,1593.87
Blue Shield,HMO,74710,CPT4/HCPCS,X-RAY MEASUREMENT OF PELVIS,,Case Rate,534.24
Blue Shield,HMO,74712,CPT4/HCPCS,MRI FETAL SNGL/1ST GESTATION,,Case Rate,4444.39
Blue Shield,HMO,74713,CPT4/HCPCS,MRI FETAL EA ADDL GESTATION,,Case Rate,1904.63
Blue Shield,HMO,74740,CPT4/HCPCS,X-RAY FEMALE GENITAL TRACT,,Case Rate,658.56
Blue Shield,HMO,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,Case Rate,1593.87
Blue Shield,HMO,74775,CPT4/HCPCS,X-RAY EXAM OF PERINEUM,,Case Rate,734.77
Blue Shield,HMO,75557,CPT4/HCPCS,CARDIAC MRI FOR MORPH,,Case Rate,5321.40
Blue Shield,HMO,75559,CPT4/HCPCS,CARDIAC MRI W/STRESS IMG,,Case Rate,8044.78
Blue Shield,HMO,75561,CPT4/HCPCS,CARDIAC MRI FOR MORPH W/DYE,,Case Rate,7575.87
Blue Shield,HMO,75563,CPT4/HCPCS,CARD MRI W/STRESS IMG & DYE,,Case Rate,9456.44
Blue Shield,HMO,75565,CPT4/HCPCS,CARD MRI VELOC FLOW MAPPING,,Case Rate,1052.97
Blue Shield,HMO,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,Case Rate,1231.00
Blue Shield,HMO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,Case Rate,692.10
Blue Shield,HMO,75573,CPT4/HCPCS,CT HRT W/3D IMAGE CONGEN,,Case Rate,826.82
Blue Shield,HMO,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,Case Rate,6186.98
Blue Shield,HMO,75600,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Case Rate,6344.13
Blue Shield,HMO,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Case Rate,6344.13
Blue Shield,HMO,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,Case Rate,6344.13
Blue Shield,HMO,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,Case Rate,6615.28
Blue Shield,HMO,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,Case Rate,7841.51
Blue Shield,HMO,75705,CPT4/HCPCS,ARTERY X-RAYS SPINE,,Case Rate,6344.13
Blue Shield,HMO,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,Case Rate,6344.13
Blue Shield,HMO,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,Case Rate,6344.13
Blue Shield,HMO,75726,CPT4/HCPCS,ARTERY X-RAYS ABDOMEN,,Case Rate,6344.13
Blue Shield,HMO,75731,CPT4/HCPCS,ARTERY X-RAYS ADRENAL GLAND,,Case Rate,6344.13
Blue Shield,HMO,75733,CPT4/HCPCS,ARTERY X-RAYS ADRENALS,,Case Rate,6344.13
Blue Shield,HMO,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,Case Rate,6344.13
Blue Shield,HMO,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Case Rate,6344.13
Blue Shield,HMO,75743,CPT4/HCPCS,ARTERY X-RAYS LUNGS,,Case Rate,6344.13
Blue Shield,HMO,75746,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Case Rate,6344.13
Blue Shield,HMO,75756,CPT4/HCPCS,ARTERY X-RAYS CHEST,,Case Rate,6344.13
Blue Shield,HMO,75774,CPT4/HCPCS,ARTERY X-RAY EACH VESSEL,,Case Rate,6344.13
Blue Shield,HMO,75801,CPT4/HCPCS,LYMPH VESSEL X-RAY ARM/LEG,,Case Rate,2734.52
Blue Shield,HMO,75803,CPT4/HCPCS,LYMPH VESSEL X-RAY ARMS/LEGS,,Case Rate,2734.52
Blue Shield,HMO,75805,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Case Rate,3077.85
Blue Shield,HMO,75807,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Case Rate,3077.85
Blue Shield,HMO,75809,CPT4/HCPCS,NONVASCULAR SHUNT X-RAY,,Case Rate,400.29
Blue Shield,HMO,75810,CPT4/HCPCS,VEIN X-RAY SPLEEN/LIVER,,Case Rate,6344.13
Blue Shield,HMO,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,Case Rate,481.31
Blue Shield,HMO,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,Case Rate,744.40
Blue Shield,HMO,75825,CPT4/HCPCS,VEIN X-RAY TRUNK,,Case Rate,6344.13
Blue Shield,HMO,75827,CPT4/HCPCS,VEIN X-RAY CHEST,,Case Rate,6344.13
Blue Shield,HMO,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,Case Rate,6344.13
Blue Shield,HMO,75833,CPT4/HCPCS,VEIN X-RAY KIDNEYS,,Case Rate,6344.13
Blue Shield,HMO,75840,CPT4/HCPCS,VEIN X-RAY ADRENAL GLAND,,Case Rate,6344.13
Blue Shield,HMO,75842,CPT4/HCPCS,VEIN X-RAY ADRENAL GLANDS,,Case Rate,6344.13
Blue Shield,HMO,75860,CPT4/HCPCS,VEIN X-RAY NECK,,Case Rate,6344.13
Blue Shield,HMO,75870,CPT4/HCPCS,VEIN X-RAY SKULL,,Case Rate,6344.13
Blue Shield,HMO,75872,CPT4/HCPCS,VEIN X-RAY SKULL EPIDURAL,,Case Rate,6344.13
Blue Shield,HMO,75880,CPT4/HCPCS,VEIN X-RAY EYE SOCKET,,Case Rate,481.31
Blue Shield,HMO,75885,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Case Rate,6344.13
Blue Shield,HMO,75887,CPT4/HCPCS,VEIN X-RAY LIVER W/O HEMODYN,,Case Rate,6344.13
Blue Shield,HMO,75889,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Case Rate,6344.13
Blue Shield,HMO,75891,CPT4/HCPCS,VEIN X-RAY LIVER,,Case Rate,6344.13
Blue Shield,HMO,75893,CPT4/HCPCS,VENOUS SAMPLING BY CATHETER,,Case Rate,6344.13
Blue Shield,HMO,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,Case Rate,12166.12
Blue Shield,HMO,75898,CPT4/HCPCS,FOLLOW-UP ANGIOGRAPHY,,Case Rate,534.24
Blue Shield,HMO,75901,CPT4/HCPCS,REMOVE CVA DEVICE OBSTRUCT,,Case Rate,965.17
Blue Shield,HMO,75902,CPT4/HCPCS,REMOVE CVA LUMEN OBSTRUCT,,Case Rate,965.17
Blue Shield,HMO,75970,CPT4/HCPCS,VASCULAR BIOPSY,,Case Rate,5818.74
Blue Shield,HMO,75984,CPT4/HCPCS,XRAY CONTROL CATHETER CHANGE,,Case Rate,987.46
Blue Shield,HMO,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,Case Rate,1593.87
Blue Shield,HMO,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,Case Rate,658.56
Blue Shield,HMO,76001,CPT4/HCPCS,FLUOROSCOPE EXAM EXTENSIVE,,Case Rate,1317.13
Blue Shield,HMO,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,Case Rate,258.27
Blue Shield,HMO,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,Case Rate,534.24
Blue Shield,HMO,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,Case Rate,205.35
Blue Shield,HMO,76100,CPT4/HCPCS,X-RAY EXAM OF BODY SECTION,,Case Rate,629.69
Blue Shield,HMO,76101,CPT4/HCPCS,COMPLEX BODY SECTION X-RAY,,Case Rate,720.34
Blue Shield,HMO,76102,CPT4/HCPCS,COMPLEX BODY SECTION X-RAYS,,Case Rate,881.60
Blue Shield,HMO,76120,CPT4/HCPCS,CINE/VIDEO X-RAYS,,Case Rate,534.24
Blue Shield,HMO,76125,CPT4/HCPCS,CINE/VIDEO X-RAYS ADD-ON,,Case Rate,400.29
Blue Shield,HMO,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Case Rate,1682.66
Blue Shield,HMO,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Case Rate,1775.45
Blue Shield,HMO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,Case Rate,1761.50
Blue Shield,HMO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,Case Rate,5535.63
Blue Shield,HMO,76393,CPT4/HCPCS,MR GUIDANCE FOR NEEDLE PLACE,,Case Rate,5630.16
Blue Shield,HMO,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,Case Rate,720.34
Blue Shield,HMO,76510,CPT4/HCPCS,OPH US DX B-SCAN&QUAN A-SCAN,,Case Rate,1077.18
Blue Shield,HMO,76511,CPT4/HCPCS,OPH US DX QUAN A-SCAN ONLY,,Case Rate,360.24
Blue Shield,HMO,76512,CPT4/HCPCS,OPH US DX B-SCAN,,Case Rate,386.78
Blue Shield,HMO,76513,CPT4/HCPCS,OPH US DX ANT SGM US UNI/BI,,Case Rate,425.27
Blue Shield,HMO,76514,CPT4/HCPCS,ECHO EXAM OF EYE THICKNESS,,Case Rate,32.90
Blue Shield,HMO,76516,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,259.20
Blue Shield,HMO,76519,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,297.69
Blue Shield,HMO,76529,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,282.48
Blue Shield,HMO,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,Case Rate,720.34
Blue Shield,HMO,76604,CPT4/HCPCS,US EXAM CHEST,,Case Rate,658.56
Blue Shield,HMO,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,Case Rate,961.55
Blue Shield,HMO,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,Case Rate,735.40
Blue Shield,HMO,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,Case Rate,997.08
Blue Shield,HMO,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,Case Rate,720.34
Blue Shield,HMO,76706,CPT4/HCPCS,US ABDL AORTA SCREEN AAA,,Case Rate,899.00
Blue Shield,HMO,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,Case Rate,997.08
Blue Shield,HMO,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,Case Rate,720.34
Blue Shield,HMO,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,Case Rate,1478.24
Blue Shield,HMO,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,Case Rate,720.34
Blue Shield,HMO,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,Case Rate,1058.85
Blue Shield,HMO,76802,CPT4/HCPCS,OB US < 14 WKS ADDL FETUS,,Case Rate,558.44
Blue Shield,HMO,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,Case Rate,1058.85
Blue Shield,HMO,76810,CPT4/HCPCS,OB US >= 14 WKS ADDL FETUS,,Case Rate,598.79
Blue Shield,HMO,76811,CPT4/HCPCS,OB US DETAILED SNGL FETUS,,Case Rate,1876.79
Blue Shield,HMO,76812,CPT4/HCPCS,OB US DETAILED ADDL FETUS,,Case Rate,675.44
Blue Shield,HMO,76813,CPT4/HCPCS,OB US NUCHAL MEAS 1 GEST,,Case Rate,888.89
Blue Shield,HMO,76814,CPT4/HCPCS,OB US NUCHAL MEAS ADD-ON,,Case Rate,460.66
Blue Shield,HMO,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,Case Rate,720.34
Blue Shield,HMO,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,Case Rate,563.11
Blue Shield,HMO,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,Case Rate,755.57
Blue Shield,HMO,76818,CPT4/HCPCS,FETAL BIOPHYS PROFILE W/NST,,Case Rate,819.83
Blue Shield,HMO,76819,CPT4/HCPCS,FETAL BIOPHYS PROFIL W/O NST,,Case Rate,819.83
Blue Shield,HMO,76820,CPT4/HCPCS,UMBILICAL ARTERY ECHO,,Case Rate,823.08
Blue Shield,HMO,76821,CPT4/HCPCS,MIDDLE CEREBRAL ARTERY ECHO,,Case Rate,823.08
Blue Shield,HMO,76825,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,997.08
Blue Shield,HMO,76826,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,361.80
Blue Shield,HMO,76827,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,880.82
Blue Shield,HMO,76828,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,571.18
Blue Shield,HMO,76830,CPT4/HCPCS,TRANSVAGINAL US NON-OB,,Case Rate,771.71
Blue Shield,HMO,76831,CPT4/HCPCS,ECHO EXAM UTERUS,,Case Rate,771.71
Blue Shield,HMO,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,Case Rate,771.71
Blue Shield,HMO,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,Case Rate,779.63
Blue Shield,HMO,76870,CPT4/HCPCS,US EXAM SCROTUM,,Case Rate,771.71
Blue Shield,HMO,76872,CPT4/HCPCS,US TRANSRECTAL,,Case Rate,935.31
Blue Shield,HMO,76873,CPT4/HCPCS,ECHOGRAP TRANS R PROS STUDY,,Case Rate,1074.99
Blue Shield,HMO,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,Case Rate,1221.38
Blue Shield,HMO,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,Case Rate,143.57
Blue Shield,HMO,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,Case Rate,771.71
Blue Shield,HMO,76886,CPT4/HCPCS,US EXAM INFANT HIPS STATIC,,Case Rate,720.34
Blue Shield,HMO,76930,CPT4/HCPCS,ECHO GUIDE CARDIOCENTESIS,,Case Rate,771.71
Blue Shield,HMO,76932,CPT4/HCPCS,ECHO GUIDE FOR HEART BIOPSY,,Case Rate,771.71
Blue Shield,HMO,76936,CPT4/HCPCS,ECHO GUIDE FOR ARTERY REPAIR,,Case Rate,3178.12
Blue Shield,HMO,76937,CPT4/HCPCS,US GUIDE VASCULAR ACCESS,,Case Rate,218.37
Blue Shield,HMO,76940,CPT4/HCPCS,US GUIDE TISSUE ABLATION,,Case Rate,848.36
Blue Shield,HMO,76941,CPT4/HCPCS,ECHO GUIDE FOR TRANSFUSION,,Case Rate,768.45
Blue Shield,HMO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,Case Rate,1262.50
Blue Shield,HMO,76945,CPT4/HCPCS,ECHO GUIDE VILLUS SAMPLING,,Case Rate,768.45
Blue Shield,HMO,76946,CPT4/HCPCS,ECHO GUIDE FOR AMNIOCENTESIS,,Case Rate,771.71
Blue Shield,HMO,76948,CPT4/HCPCS,ECHO GUIDE OVA ASPIRATION,,Case Rate,771.71
Blue Shield,HMO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,Case Rate,2806.70
Blue Shield,HMO,76970,CPT4/HCPCS,ULTRASOUND EXAM FOLLOW-UP,,Case Rate,534.24
Blue Shield,HMO,76975,CPT4/HCPCS,GI ENDOSCOPIC ULTRASOUND,,Case Rate,771.71
Blue Shield,HMO,76977,CPT4/HCPCS,US BONE DENSITY MEASURE,,Case Rate,419.54
Blue Shield,HMO,77001,CPT4/HCPCS,FLUOROGUIDE FOR VEIN DEVICE,,Case Rate,1228.82
Blue Shield,HMO,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,Case Rate,514.21
Blue Shield,HMO,77003,CPT4/HCPCS,FLUOROGUIDE FOR SPINE INJECT,,Case Rate,316.94
Blue Shield,HMO,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,Case Rate,9388.52
Blue Shield,HMO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,Case Rate,1040.35
Blue Shield,HMO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Case Rate,2066.19
Blue Shield,HMO,77021,CPT4/HCPCS,MRI GUIDANCE NDL PLMT RS&I,,Case Rate,4436.87
Blue Shield,HMO,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,Case Rate,292.25
Blue Shield,HMO,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,Case Rate,764.72
Blue Shield,HMO,77058,CPT4/HCPCS,MRI ONE BREAST,,Case Rate,10066.59
Blue Shield,HMO,77059,CPT4/HCPCS,MRI BOTH BREASTS,,Case Rate,10147.57
Blue Shield,HMO,77063,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Case Rate,345.66
Blue Shield,HMO,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,Case Rate,996.15
Blue Shield,HMO,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,Case Rate,1494.93
Blue Shield,HMO,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,Case Rate,1514.18
Blue Shield,HMO,77071,CPT4/HCPCS,X-RAY STRESS VIEW,,Case Rate,389.89
Blue Shield,HMO,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,Case Rate,171.66
Blue Shield,HMO,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,Case Rate,284.81
Blue Shield,HMO,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,Case Rate,606.41
Blue Shield,HMO,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,Case Rate,984.98
Blue Shield,HMO,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,Case Rate,852.58
Blue Shield,HMO,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,Case Rate,279.22
Blue Shield,HMO,77078,CPT4/HCPCS,CT BONE DENSITY AXIAL,,Case Rate,279.22
Blue Shield,HMO,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,Case Rate,419.83
Blue Shield,HMO,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,Case Rate,323.30
Blue Shield,HMO,77084,CPT4/HCPCS,MAGNETIC IMAGE BONE MARROW,,Case Rate,6651.93
Blue Shield,HMO,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,Case Rate,552.56
Blue Shield,HMO,77086,CPT4/HCPCS,FRACTURE ASSESSMENT VIA DXA,,Case Rate,360.09
Blue Shield,HMO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,1747.06
Blue Shield,HMO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,2810.73
Blue Shield,HMO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,3283.19
Blue Shield,HMO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,Case Rate,4411.49
Blue Shield,HMO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,Case Rate,14084.07
Blue Shield,HMO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,Case Rate,677.81
Blue Shield,HMO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,Case Rate,14084.07
Blue Shield,HMO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,Case Rate,985.61
Blue Shield,HMO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,Case Rate,1803.58
Blue Shield,HMO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,Case Rate,1529.32
Blue Shield,HMO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,Case Rate,1996.05
Blue Shield,HMO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,Case Rate,2708.17
Blue Shield,HMO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,Case Rate,2038.24
Blue Shield,HMO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,Case Rate,248.65
Blue Shield,HMO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,677.81
Blue Shield,HMO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,958.59
Blue Shield,HMO,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,1637.17
Blue Shield,HMO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,1503.23
Blue Shield,HMO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,Case Rate,3362.55
Blue Shield,HMO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,1756.69
Blue Shield,HMO,77371,CPT4/HCPCS,SRS MULTISOURCE,,Case Rate,14607.62
Blue Shield,HMO,77372,CPT4/HCPCS,SRS LINEAR BASED,,Case Rate,11085.51
Blue Shield,HMO,77373,CPT4/HCPCS,SBRT DELIVERY,,Case Rate,20679.89
Blue Shield,HMO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,Case Rate,8995.00
Blue Shield,HMO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,Case Rate,8995.00
Blue Shield,HMO,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,900.85
Blue Shield,HMO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,900.85
Blue Shield,HMO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,1054.04
Blue Shield,HMO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,1178.37
Blue Shield,HMO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,Case Rate,300.02
Blue Shield,HMO,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,Case Rate,1139.87
Blue Shield,HMO,77435,CPT4/HCPCS,SBRT MANAGEMENT,,Case Rate,2498.08
Blue Shield,HMO,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,Case Rate,1402.14
Blue Shield,HMO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,Case Rate,5622.24
Blue Shield,HMO,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,Case Rate,6586.41
Blue Shield,HMO,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,Case Rate,6586.41
Blue Shield,HMO,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,Case Rate,9965.84
Blue Shield,HMO,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,Case Rate,9965.84
Blue Shield,HMO,77600,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,HMO,77605,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2051.90
Blue Shield,HMO,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,HMO,77615,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2051.90
Blue Shield,HMO,77620,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,HMO,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Case Rate,673.00
Blue Shield,HMO,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Case Rate,1269.01
Blue Shield,HMO,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Case Rate,1818.46
Blue Shield,HMO,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Case Rate,2258.02
Blue Shield,HMO,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,2307.25
Blue Shield,HMO,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,3792.49
Blue Shield,HMO,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,2984.91
Blue Shield,HMO,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,5436.51
Blue Shield,HMO,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,8579.43
Blue Shield,HMO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Case Rate,2586.92
Blue Shield,HMO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Case Rate,224.59
Blue Shield,HMO,77790,CPT4/HCPCS,RADIATION HANDLING,,Case Rate,248.65
Blue Shield,HMO,78012,CPT4/HCPCS,THYROID UPTAKE MEASUREMENT,,Case Rate,1048.16
Blue Shield,HMO,78013,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Case Rate,2725.86
Blue Shield,HMO,78014,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Case Rate,3110.79
Blue Shield,HMO,78015,CPT4/HCPCS,THYROID MET IMAGING,,Case Rate,1302.69
Blue Shield,HMO,78016,CPT4/HCPCS,THYROID MET IMAGING/STUDIES,,Case Rate,1751.88
Blue Shield,HMO,78018,CPT4/HCPCS,THYROID MET IMAGING BODY,,Case Rate,2739.33
Blue Shield,HMO,78020,CPT4/HCPCS,THYROID MET UPTAKE,,Case Rate,686.80
Blue Shield,HMO,78070,CPT4/HCPCS,PARATHYROID PLANAR IMAGING,,Case Rate,924.91
Blue Shield,HMO,78071,CPT4/HCPCS,PARATHYRD PLANAR W/WO SUBTRJ,,Case Rate,4337.76
Blue Shield,HMO,78075,CPT4/HCPCS,ADRENAL CORTEX & MEDULLA IMG,,Case Rate,2739.33
Blue Shield,HMO,78102,CPT4/HCPCS,BONE MARROW IMAGING LTD,,Case Rate,1029.98
Blue Shield,HMO,78103,CPT4/HCPCS,BONE MARROW IMAGING MULT,,Case Rate,1598.68
Blue Shield,HMO,78104,CPT4/HCPCS,BONE MARROW IMAGING BODY,,Case Rate,2056.71
Blue Shield,HMO,78110,CPT4/HCPCS,PLASMA VOLUME SINGLE,,Case Rate,481.31
Blue Shield,HMO,78111,CPT4/HCPCS,PLASMA VOLUME MULTIPLE,,Case Rate,1302.69
Blue Shield,HMO,78120,CPT4/HCPCS,RED CELL MASS SINGLE,,Case Rate,881.60
Blue Shield,HMO,78121,CPT4/HCPCS,RED CELL MASS MULTIPLE,,Case Rate,1461.48
Blue Shield,HMO,78122,CPT4/HCPCS,BLOOD VOLUME,,Case Rate,2319.80
Blue Shield,HMO,78130,CPT4/HCPCS,RED CELL SURVIVAL STUDY,,Case Rate,1432.61
Blue Shield,HMO,78135,CPT4/HCPCS,RED CELL SURVIVAL KINETICS,,Case Rate,2453.74
Blue Shield,HMO,78140,CPT4/HCPCS,RED CELL SEQUESTRATION,,Case Rate,1985.31
Blue Shield,HMO,78185,CPT4/HCPCS,SPLEEN IMAGING,,Case Rate,1192.80
Blue Shield,HMO,78191,CPT4/HCPCS,PLATELET SURVIVAL,,Case Rate,3690.63
Blue Shield,HMO,78195,CPT4/HCPCS,LYMPH SYSTEM IMAGING,,Case Rate,2056.71
Blue Shield,HMO,78201,CPT4/HCPCS,LIVER IMAGING,,Case Rate,1192.80
Blue Shield,HMO,78202,CPT4/HCPCS,LIVER IMAGING WITH FLOW,,Case Rate,1447.04
Blue Shield,HMO,78205,CPT4/HCPCS,LIVER IMAGING (3D),,Case Rate,2978.36
Blue Shield,HMO,78206,CPT4/HCPCS,LIVER IMAGE (3D) WITH FLOW,,Case Rate,2897.67
Blue Shield,HMO,78215,CPT4/HCPCS,LIVER AND SPLEEN IMAGING,,Case Rate,1475.91
Blue Shield,HMO,78216,CPT4/HCPCS,LIVER & SPLEEN IMAGE/FLOW,,Case Rate,1751.88
Blue Shield,HMO,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Case Rate,4145.29
Blue Shield,HMO,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Case Rate,5756.41
Blue Shield,HMO,78230,CPT4/HCPCS,SALIVARY GLAND IMAGING,,Case Rate,1101.38
Blue Shield,HMO,78231,CPT4/HCPCS,SERIAL SALIVARY IMAGING,,Case Rate,1598.68
Blue Shield,HMO,78232,CPT4/HCPCS,SALIVARY GLAND FUNCTION EXAM,,Case Rate,1780.75
Blue Shield,HMO,78258,CPT4/HCPCS,ESOPHAGEAL MOTILITY STUDY,,Case Rate,1447.04
Blue Shield,HMO,78261,CPT4/HCPCS,GASTRIC MUCOSA IMAGING,,Case Rate,2066.33
Blue Shield,HMO,78262,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX EXAM,,Case Rate,2143.32
Blue Shield,HMO,78264,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,2080.77
Blue Shield,HMO,78265,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,4918.41
Blue Shield,HMO,78266,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,5885.55
Blue Shield,HMO,78270,CPT4/HCPCS,VIT B-12 ABSORPTION EXAM,,Case Rate,786.15
Blue Shield,HMO,78271,CPT4/HCPCS,VIT B-12 ABSRP EXAM INT FAC,,Case Rate,834.26
Blue Shield,HMO,78272,CPT4/HCPCS,VIT B-12 ABSORP COMBINED,,Case Rate,1173.56
Blue Shield,HMO,78278,CPT4/HCPCS,ACUTE GI BLOOD LOSS IMAGING,,Case Rate,2453.74
Blue Shield,HMO,78282,CPT4/HCPCS,GI PROTEIN LOSS EXAM,,Case Rate,758.83
Blue Shield,HMO,78290,CPT4/HCPCS,MECKELS DIVERT EXAM,,Case Rate,1536.91
Blue Shield,HMO,78291,CPT4/HCPCS,LEVEEN/SHUNT PATENCY EXAM,,Case Rate,1546.53
Blue Shield,HMO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Per Diem,4250.00
Blue Shield,HMO,78300,CPT4/HCPCS,BONE IMAGING LIMITED AREA,,Case Rate,1259.39
Blue Shield,HMO,78305,CPT4/HCPCS,BONE IMAGING MULTIPLE AREAS,,Case Rate,1847.33
Blue Shield,HMO,78306,CPT4/HCPCS,BONE IMAGING WHOLE BODY,,Case Rate,2152.94
Blue Shield,HMO,78315,CPT4/HCPCS,BONE IMAGING 3 PHASE,,Case Rate,2410.44
Blue Shield,HMO,78320,CPT4/HCPCS,BONE IMAGING (3D),,Case Rate,2978.36
Blue Shield,HMO,78350,CPT4/HCPCS,BONE MINERAL SINGLE PHOTON,,Case Rate,385.86
Blue Shield,HMO,78351,CPT4/HCPCS,BONE MINERAL DUAL PHOTON,,Case Rate,148.38
Blue Shield,HMO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Per Diem,4250.00
Blue Shield,HMO,78414,CPT4/HCPCS,NON-IMAGING HEART FUNCTION,,Case Rate,701.87
Blue Shield,HMO,78428,CPT4/HCPCS,CARDIAC SHUNT IMAGING,,Case Rate,1139.87
Blue Shield,HMO,78445,CPT4/HCPCS,VASCULAR FLOW IMAGING,,Case Rate,944.15
Blue Shield,HMO,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,Case Rate,2073.03
Blue Shield,HMO,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,Case Rate,4007.31
Blue Shield,HMO,78453,CPT4/HCPCS,HT MUSCLE IMAGE PLANAR SING,,Case Rate,1933.50
Blue Shield,HMO,78454,CPT4/HCPCS,HT MUSC IMAGE PLANAR MULT,,Case Rate,1625.55
Blue Shield,HMO,78456,CPT4/HCPCS,ACUTE VENOUS THROMBUS IMAGE,,Case Rate,2041.65
Blue Shield,HMO,78457,CPT4/HCPCS,VENOUS THROMBOSIS IMAGING,,Case Rate,1336.37
Blue Shield,HMO,78458,CPT4/HCPCS,VEN THROMBOSIS IMAGES BILAT,,Case Rate,2028.62
Blue Shield,HMO,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,Case Rate,2362.32
Blue Shield,HMO,78466,CPT4/HCPCS,HEART INFARCT IMAGE,,Case Rate,1317.13
Blue Shield,HMO,78468,CPT4/HCPCS,HEART INFARCT IMAGE (EF),,Case Rate,1847.33
Blue Shield,HMO,78469,CPT4/HCPCS,HEART INFARCT IMAGE (3D),,Case Rate,2634.25
Blue Shield,HMO,78472,CPT4/HCPCS,GATED HEART PLANAR SINGLE,,Case Rate,2781.86
Blue Shield,HMO,78473,CPT4/HCPCS,GATED HEART MULTIPLE,,Case Rate,4158.28
Blue Shield,HMO,78481,CPT4/HCPCS,HEART FIRST PASS SINGLE,,Case Rate,2634.25
Blue Shield,HMO,78483,CPT4/HCPCS,HEART FIRST PASS MULTIPLE,,Case Rate,3961.78
Blue Shield,HMO,78491,CPT4/HCPCS,MYOCRD IMG PET 1STD RST/STRS,,Case Rate,2396.00
Blue Shield,HMO,78492,CPT4/HCPCS,MYOCRD IMG PET MLT RST&STRS,,Case Rate,2983.17
Blue Shield,HMO,78494,CPT4/HCPCS,HEART IMAGE SPECT,,Case Rate,3537.29
Blue Shield,HMO,78496,CPT4/HCPCS,HEART FIRST PASS ADD-ON,,Case Rate,3537.29
Blue Shield,HMO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Per Diem,4250.00
Blue Shield,HMO,78579,CPT4/HCPCS,LUNG VENTILATION IMAGING,,Case Rate,2139.62
Blue Shield,HMO,78580,CPT4/HCPCS,LUNG PERFUSION IMAGING,,Case Rate,1727.82
Blue Shield,HMO,78582,CPT4/HCPCS,LUNG VENTILAT&PERFUS IMAGING,,Case Rate,3837.35
Blue Shield,HMO,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Case Rate,2293.59
Blue Shield,HMO,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Case Rate,3717.06
Blue Shield,HMO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Per Diem,4250.00
Blue Shield,HMO,78600,CPT4/HCPCS,BRAIN IMAGE < 4 VIEWS,,Case Rate,1447.04
Blue Shield,HMO,78601,CPT4/HCPCS,BRAIN IMAGE W/FLOW < 4 VIEWS,,Case Rate,1713.38
Blue Shield,HMO,78605,CPT4/HCPCS,BRAIN IMAGE 4+ VIEWS,,Case Rate,1713.38
Blue Shield,HMO,78606,CPT4/HCPCS,BRAIN IMAGE W/FLOW 4 + VIEWS,,Case Rate,1951.63
Blue Shield,HMO,78607,CPT4/HCPCS,BRAIN IMAGING (3D),,Case Rate,3307.25
Blue Shield,HMO,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,Case Rate,18766.19
Blue Shield,HMO,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,Case Rate,745.95
Blue Shield,HMO,78610,CPT4/HCPCS,BRAIN FLOW IMAGING ONLY,,Case Rate,800.58
Blue Shield,HMO,78630,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Case Rate,2538.80
Blue Shield,HMO,78635,CPT4/HCPCS,CSF VENTRICULOGRAPHY,,Case Rate,1288.26
Blue Shield,HMO,78645,CPT4/HCPCS,CSF SHUNT EVALUATION,,Case Rate,1727.82
Blue Shield,HMO,78647,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Case Rate,2978.36
Blue Shield,HMO,78650,CPT4/HCPCS,CSF LEAKAGE IMAGING,,Case Rate,2339.04
Blue Shield,HMO,78660,CPT4/HCPCS,NUCLEAR EXAM OF TEAR FLOW,,Case Rate,1068.48
Blue Shield,HMO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Per Diem,4250.00
Blue Shield,HMO,78700,CPT4/HCPCS,KIDNEY IMAGING MORPHOL,,Case Rate,1536.91
Blue Shield,HMO,78701,CPT4/HCPCS,KIDNEY IMAGING WITH FLOW,,Case Rate,1790.37
Blue Shield,HMO,78707,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/O DRUG,,Case Rate,2248.40
Blue Shield,HMO,78708,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/DRUG,,Case Rate,2248.40
Blue Shield,HMO,78709,CPT4/HCPCS,K FLOW/FUNCT IMAGE MULTIPLE,,Case Rate,2248.40
Blue Shield,HMO,78710,CPT4/HCPCS,KIDNEY IMAGING (3D),,Case Rate,2978.36
Blue Shield,HMO,78725,CPT4/HCPCS,KIDNEY FUNCTION STUDY,,Case Rate,905.66
Blue Shield,HMO,78730,CPT4/HCPCS,URINARY BLADDER RETENTION,,Case Rate,734.77
Blue Shield,HMO,78740,CPT4/HCPCS,URETERAL REFLUX STUDY,,Case Rate,1068.48
Blue Shield,HMO,78761,CPT4/HCPCS,TESTICULAR IMAGING W/FLOW,,Case Rate,1613.12
Blue Shield,HMO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Per Diem,4250.00
Blue Shield,HMO,78800,CPT4/HCPCS,RP LOCLZJ TUM 1 AREA 1 D IMG,,Case Rate,1713.38
Blue Shield,HMO,78801,CPT4/HCPCS,RP LOCLZJ TUM 2+AREA 1+D IMG,,Case Rate,2128.89
Blue Shield,HMO,78802,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 1 D IMG,,Case Rate,2791.48
Blue Shield,HMO,78803,CPT4/HCPCS,RP LOCLZJ TUM SPECT 1 AREA,,Case Rate,3307.25
Blue Shield,HMO,78804,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 2+D IMG,,Case Rate,2185.22
Blue Shield,HMO,78805,CPT4/HCPCS,ABSCESS IMAGING LTD AREA,,Case Rate,1713.38
Blue Shield,HMO,78806,CPT4/HCPCS,ABSCESS IMAGING WHOLE BODY,,Case Rate,3244.70
Blue Shield,HMO,78807,CPT4/HCPCS,NUCLEAR LOCALIZATION/ABSCESS,,Case Rate,3307.25
Blue Shield,HMO,78811,CPT4/HCPCS,PET IMAGE LTD AREA,,Case Rate,17587.83
Blue Shield,HMO,78812,CPT4/HCPCS,PET IMAGE SKULL-THIGH,,Case Rate,18766.19
Blue Shield,HMO,78813,CPT4/HCPCS,PET IMAGE FULL BODY,,Case Rate,19935.71
Blue Shield,HMO,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,Case Rate,17587.83
Blue Shield,HMO,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,Case Rate,18766.19
Blue Shield,HMO,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,Case Rate,19935.71
Blue Shield,HMO,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Case Rate,1317.13
Blue Shield,HMO,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,Case Rate,1317.13
Blue Shield,HMO,79200,CPT4/HCPCS,NUCLEAR RX INTRACAV ADMIN,,Case Rate,1317.13
Blue Shield,HMO,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Case Rate,711.49
Blue Shield,HMO,79403,CPT4/HCPCS,HEMATOPOIETIC NUCLEAR TX,,Case Rate,2120.67
Blue Shield,HMO,79440,CPT4/HCPCS,NUCLEAR RX INTRA-ARTICULAR,,Case Rate,1317.13
Blue Shield,HMO,79445,CPT4/HCPCS,NUCLEAR RX INTRA-ARTERIAL,,Case Rate,1325.20
Blue Shield,HMO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Per Diem,4250.00
Blue Shield,HMO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Per Diem,4250.00
Blue Shield,HMO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Per Diem,4250.00
Blue Shield,HMO,80050,CPT4/HCPCS,GENERAL HEALTH PANEL,,Case Rate,572.58
Blue Shield,HMO,80055,CPT4/HCPCS,OBSTETRIC PANEL,,Case Rate,654.38
Blue Shield,HMO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Per Diem,4250.00
Blue Shield,HMO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Per Diem,4250.00
Blue Shield,HMO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Per Diem,4250.00
Blue Shield,HMO,85396,CPT4/HCPCS,CLOTTING ASSAY WHOLE BLOOD,,Case Rate,93.12
Blue Shield,HMO,86077,CPT4/HCPCS,PHYS BLOOD BANK SERV XMATCH,,Case Rate,199.76
Blue Shield,HMO,86078,CPT4/HCPCS,PHYS BLOOD BANK SERV REACTJ,,Case Rate,233.44
Blue Shield,HMO,86079,CPT4/HCPCS,PHYS BLOOD BANK SERV AUTHRJ,,Case Rate,228.63
Blue Shield,HMO,86486,CPT4/HCPCS,SKIN TEST NOS ANTIGEN,,Case Rate,70.62
Blue Shield,HMO,86490,CPT4/HCPCS,COCCIDIOIDOMYCOSIS SKIN TEST,,Case Rate,147.61
Blue Shield,HMO,86510,CPT4/HCPCS,HISTOPLASMOSIS SKIN TEST,,Case Rate,162.04
Blue Shield,HMO,86580,CPT4/HCPCS,TB INTRADERMAL TEST,,Case Rate,133.17
Blue Shield,HMO,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,Case Rate,226.15
Blue Shield,HMO,86860,CPT4/HCPCS,RBC ANTIBODY ELUTION,,Case Rate,226.15
Blue Shield,HMO,86870,CPT4/HCPCS,RBC ANTIBODY IDENTIFICATION,,Case Rate,399.37
Blue Shield,HMO,86890,CPT4/HCPCS,AUTOLOGOUS BLOOD PROCESS,,Case Rate,914.21
Blue Shield,HMO,86891,CPT4/HCPCS,AUTOLOGOUS BLOOD OP SALVAGE,,Case Rate,1424.24
Blue Shield,HMO,86910,CPT4/HCPCS,BLOOD TYPING PATERNITY TEST,,Case Rate,250.20
Blue Shield,HMO,86911,CPT4/HCPCS,BLOOD TYPING ANTIGEN SYSTEM,,Case Rate,192.47
Blue Shield,HMO,86920,CPT4/HCPCS,COMPATIBILITY TEST SPIN,,Case Rate,250.20
Blue Shield,HMO,86921,CPT4/HCPCS,COMPATIBILITY TEST INCUBATE,,Case Rate,226.15
Blue Shield,HMO,86922,CPT4/HCPCS,COMPATIBILITY TEST ANTIGLOB,,Case Rate,134.73
Blue Shield,HMO,86927,CPT4/HCPCS,PLASMA FRESH FROZEN,,Case Rate,125.10
Blue Shield,HMO,86930,CPT4/HCPCS,FROZEN BLOOD PREP,,Case Rate,1140.36
Blue Shield,HMO,86931,CPT4/HCPCS,FROZEN BLOOD THAW,,Case Rate,1255.83
Blue Shield,HMO,86932,CPT4/HCPCS,FROZEN BLOOD FREEZE/THAW,,Case Rate,1366.50
Blue Shield,HMO,86945,CPT4/HCPCS,BLOOD PRODUCT/IRRADIATION,,Case Rate,341.63
Blue Shield,HMO,86950,CPT4/HCPCS,LEUKACYTE TRANSFUSION,,Case Rate,625.51
Blue Shield,HMO,86965,CPT4/HCPCS,POOLING BLOOD PLATELETS,,Case Rate,158.78
Blue Shield,HMO,86970,CPT4/HCPCS,RBC PRETX INCUBATJ W/CHEMICL,,Case Rate,182.84
Blue Shield,HMO,86971,CPT4/HCPCS,RBC PRETX INCUBATJ W/ENZYMES,,Case Rate,182.84
Blue Shield,HMO,86972,CPT4/HCPCS,RBC PRETX INCUBATJ W/DENSITY,,Case Rate,173.22
Blue Shield,HMO,86975,CPT4/HCPCS,RBC SERUM PRETX INCUBJ DRUGS,,Case Rate,115.48
Blue Shield,HMO,86976,CPT4/HCPCS,RBC SERUM PRETX ID DILUTION,,Case Rate,91.42
Blue Shield,HMO,86977,CPT4/HCPCS,RBC SERUM PRETX INCUBJ/INHIB,,Case Rate,115.48
Blue Shield,HMO,86978,CPT4/HCPCS,RBC PRETREATMENT SERUM,,Case Rate,250.20
Blue Shield,HMO,86985,CPT4/HCPCS,SPLIT BLOOD OR PRODUCTS,,Case Rate,240.58
Blue Shield,HMO,88104,CPT4/HCPCS,CYTOPATH FL NONGYN SMEARS,,Case Rate,248.65
Blue Shield,HMO,88106,CPT4/HCPCS,CYTOPATH FL NONGYN FILTER,,Case Rate,186.10
Blue Shield,HMO,88108,CPT4/HCPCS,CYTOPATH CONCENTRATE TECH,,Case Rate,277.52
Blue Shield,HMO,88112,CPT4/HCPCS,CYTOPATH CELL ENHANCE TECH,,Case Rate,715.38
Blue Shield,HMO,88120,CPT4/HCPCS,CYTP URNE 3-5 PROBES EA SPEC,,Case Rate,5718.69
Blue Shield,HMO,88121,CPT4/HCPCS,CYTP URINE 3-5 PROBES CMPTR,,Case Rate,4796.42
Blue Shield,HMO,88125,CPT4/HCPCS,FORENSIC CYTOPATHOLOGY,,Case Rate,71.40
Blue Shield,HMO,88160,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,344.88
Blue Shield,HMO,88161,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,325.64
Blue Shield,HMO,88162,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,171.66
Blue Shield,HMO,88172,CPT4/HCPCS,CYTP DX EVAL FNA 1ST EA SITE,,Case Rate,195.72
Blue Shield,HMO,88173,CPT4/HCPCS,CYTOPATH EVAL FNA REPORT,,Case Rate,561.41
Blue Shield,HMO,88177,CPT4/HCPCS,CYTP FNA EVAL EA ADDL,,Case Rate,90.64
Blue Shield,HMO,88182,CPT4/HCPCS,CELL MARKER STUDY,,Case Rate,617.59
Blue Shield,HMO,88184,CPT4/HCPCS,FLOWCYTOMETRY/ TC 1 MARKER,,Case Rate,643.20
Blue Shield,HMO,88185,CPT4/HCPCS,FLOWCYTOMETRY/TC ADD-ON,,Case Rate,316.01
Blue Shield,HMO,88187,CPT4/HCPCS,FLOWCYTOMETRY/READ 2-8,,Case Rate,220.56
Blue Shield,HMO,88188,CPT4/HCPCS,FLOWCYTOMETRY/READ 9-15,,Case Rate,278.30
Blue Shield,HMO,88189,CPT4/HCPCS,FLOWCYTOMETRY/READ 16 & >,,Case Rate,364.91
Blue Shield,HMO,88291,CPT4/HCPCS,CYTO/MOLECULAR REPORT,,Case Rate,89.87
Blue Shield,HMO,88300,CPT4/HCPCS,SURGICAL PATH GROSS,,Case Rate,119.51
Blue Shield,HMO,88302,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,311.20
Blue Shield,HMO,88304,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,378.56
Blue Shield,HMO,88305,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,689.77
Blue Shield,HMO,88307,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,967.29
Blue Shield,HMO,88309,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,1106.82
Blue Shield,HMO,88311,CPT4/HCPCS,DECALCIFY TISSUE,,Case Rate,47.34
Blue Shield,HMO,88312,CPT4/HCPCS,SPECIAL STAINS GROUP 1,,Case Rate,538.13
Blue Shield,HMO,88313,CPT4/HCPCS,SPECIAL STAINS GROUP 2,,Case Rate,475.57
Blue Shield,HMO,88314,CPT4/HCPCS,HISTOCHEMICAL STAINS ADD-ON,,Case Rate,340.07
Blue Shield,HMO,88319,CPT4/HCPCS,ENZYME HISTOCHEMISTRY,,Case Rate,806.80
Blue Shield,HMO,88323,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Case Rate,417.06
Blue Shield,HMO,88331,CPT4/HCPCS,PATH CONSULT INTRAOP 1 BLOC,,Case Rate,237.47
Blue Shield,HMO,88332,CPT4/HCPCS,PATH CONSULT INTRAOP ADDL,,Case Rate,123.55
Blue Shield,HMO,88333,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 1,,Case Rate,280.78
Blue Shield,HMO,88334,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 2,,Case Rate,171.66
Blue Shield,HMO,88341,CPT4/HCPCS,IMMUNOHISTO ANTB ADDL SLIDE,,Case Rate,610.30
Blue Shield,HMO,88342,CPT4/HCPCS,IMMUNOHISTO ANTB 1ST STAIN,,Case Rate,479.61
Blue Shield,HMO,88344,CPT4/HCPCS,IMMUNOHISTO ANTIBODY SLIDE,,Case Rate,1033.72
Blue Shield,HMO,88346,CPT4/HCPCS,IMMUNOFLUOR ANTB 1ST STAIN,,Case Rate,522.91
Blue Shield,HMO,88348,CPT4/HCPCS,ELECTRON MICROSCOPY,,Case Rate,3790.93
Blue Shield,HMO,88350,CPT4/HCPCS,IMMUNOFLUOR ANTB ADDL STAIN,,Case Rate,591.05
Blue Shield,HMO,88355,CPT4/HCPCS,ANALYSIS SKELETAL MUSCLE,,Case Rate,890.30
Blue Shield,HMO,88356,CPT4/HCPCS,ANALYSIS NERVE,,Case Rate,798.10
Blue Shield,HMO,88358,CPT4/HCPCS,ANALYSIS TUMOR,,Case Rate,100.41
Blue Shield,HMO,88360,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/MANUAL,,Case Rate,614.33
Blue Shield,HMO,88361,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/COMPUT,,Case Rate,1077.18
Blue Shield,HMO,88362,CPT4/HCPCS,NERVE TEASING PREPARATIONS,,Case Rate,1693.84
Blue Shield,HMO,88363,CPT4/HCPCS,XM ARCHIVE TISSUE MOLEC ANAL,,Case Rate,60.22
Blue Shield,HMO,88364,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,942.30
Blue Shield,HMO,88365,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,874.16
Blue Shield,HMO,88366,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,1158.82
Blue Shield,HMO,88367,CPT4/HCPCS,INSITU HYBRIDIZATION AUTO,,Case Rate,1741.96
Blue Shield,HMO,88368,CPT4/HCPCS,INSITU HYBRIDIZATION MANUAL,,Case Rate,1419.58
Blue Shield,HMO,88369,CPT4/HCPCS,M/PHMTRC ALYSISHQUANT/SEMIQ,,Case Rate,653.60
Blue Shield,HMO,88373,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,523.69
Blue Shield,HMO,88374,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,2150.02
Blue Shield,HMO,88377,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,2000.86
Blue Shield,HMO,88381,CPT4/HCPCS,MICRODISSECTION MANUAL,,Case Rate,2004.89
Blue Shield,HMO,88387,CPT4/HCPCS,TISS EXAM MOLECULAR STUDY,,Case Rate,105.08
Blue Shield,HMO,88388,CPT4/HCPCS,TISS EX MOLECUL STUDY ADD-ON,,Case Rate,52.15
Blue Shield,HMO,89049,CPT4/HCPCS,CHCT FOR MAL HYPERTHERMIA,,Case Rate,1737.15
Blue Shield,HMO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Case Rate,404.18
Blue Shield,HMO,89230,CPT4/HCPCS,COLLECT SWEAT FOR TEST,,Case Rate,769.86
Blue Shield,HMO,89250,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Case Rate,12919.22
Blue Shield,HMO,90801,CPT4/HCPCS,PSY DX INTERVIEW,,Case Rate,312.90
Blue Shield,HMO,90802,CPT4/HCPCS,INTAC PSY DX INTERVIEW,,Case Rate,345.81
Blue Shield,HMO,90804,CPT4/HCPCS,PSYTX OFFICE 20-30 MIN,,Case Rate,117.96
Blue Shield,HMO,90805,CPT4/HCPCS,PSYTX OFF 20-30 MIN W/E&M,,Case Rate,127.58
Blue Shield,HMO,90806,CPT4/HCPCS,PSYTX OFF 45-50 MIN,,Case Rate,174.92
Blue Shield,HMO,90807,CPT4/HCPCS,PSYTX OFF 45-50 MIN W/E&M,,Case Rate,193.39
Blue Shield,HMO,90808,CPT4/HCPCS,PSYTX OFFICE 75-80 MIN,,Case Rate,259.98
Blue Shield,HMO,90809,CPT4/HCPCS,PSYTX OFF 75-80 W/E&M,,Case Rate,283.26
Blue Shield,HMO,90810,CPT4/HCPCS,INTAC PSYTX OFF 20-30 MIN,,Case Rate,131.62
Blue Shield,HMO,90811,CPT4/HCPCS,INTAC PSYTX 20-30 W/E&M,,Case Rate,141.24
Blue Shield,HMO,90812,CPT4/HCPCS,INTAC PSYTX OFF 45-50 MIN,,Case Rate,184.54
Blue Shield,HMO,90813,CPT4/HCPCS,INTAC PSYTX 45-50 MIN W/E&M,,Case Rate,203.01
Blue Shield,HMO,90814,CPT4/HCPCS,INTAC PSYTX OFF 75-80 MIN,,Case Rate,274.41
Blue Shield,HMO,90815,CPT4/HCPCS,INTAC PSYTX 75-80 W/E&M,,Case Rate,288.07
Blue Shield,HMO,90816,CPT4/HCPCS,PSYTX HOSP 20-30 MIN,,Case Rate,166.08
Blue Shield,HMO,90817,CPT4/HCPCS,PSYTX HOSP 20-30 MIN W/E&M,,Case Rate,185.32
Blue Shield,HMO,90818,CPT4/HCPCS,PSYTX HOSP 45-50 MIN,,Case Rate,223.04
Blue Shield,HMO,90819,CPT4/HCPCS,PSYTX HOSP 45-50 MIN W/E&M,,Case Rate,246.32
Blue Shield,HMO,90821,CPT4/HCPCS,PSYTX HOSP 75-80 MIN,,Case Rate,312.90
Blue Shield,HMO,90822,CPT4/HCPCS,PSYTX HOSP 75-80 MIN W/E&M,,Case Rate,340.22
Blue Shield,HMO,90823,CPT4/HCPCS,INTAC PSYTX HOSP 20-30 MIN,,Case Rate,175.70
Blue Shield,HMO,90824,CPT4/HCPCS,INTAC PSYTX HSP 20-30 W/E&M,,Case Rate,198.98
Blue Shield,HMO,90826,CPT4/HCPCS,INTAC PSYTX HOSP 45-50 MIN,,Case Rate,241.51
Blue Shield,HMO,90827,CPT4/HCPCS,INTAC PSYTX HSP 45-50 W/E&M,,Case Rate,255.94
Blue Shield,HMO,90828,CPT4/HCPCS,INTAC PSYTX HOSP 75-80 MIN,,Case Rate,317.72
Blue Shield,HMO,90829,CPT4/HCPCS,INTAC PSYTX HSP 75-80 W/E&M,,Case Rate,345.81
Blue Shield,HMO,90845,CPT4/HCPCS,PSYCHOANALYSIS,,Case Rate,170.11
Blue Shield,HMO,90846,CPT4/HCPCS,FAMILY PSYTX W/O PT 50 MIN,,Case Rate,223.04
Blue Shield,HMO,90847,CPT4/HCPCS,FAMILY PSYTX W/PT 50 MIN,,Case Rate,255.94
Blue Shield,HMO,90849,CPT4/HCPCS,MULTIPLE FAMILY GROUP PSYTX,,Case Rate,104.30
Blue Shield,HMO,90853,CPT4/HCPCS,GROUP PSYCHOTHERAPY,,Case Rate,100.27
Blue Shield,HMO,90857,CPT4/HCPCS,INTAC GROUP PSYTX,,Case Rate,105.08
Blue Shield,HMO,90862,CPT4/HCPCS,MEDICATION MANAGEMENT,,Case Rate,137.98
Blue Shield,HMO,90865,CPT4/HCPCS,NARCOSYNTHESIS,,Case Rate,361.17
Blue Shield,HMO,90867,CPT4/HCPCS,TCRANIAL MAGN STIM TX PLAN,,Fee Schedule,987.79
Blue Shield,HMO,90868,CPT4/HCPCS,TCRANIAL MAGN STIM TX DELI,,Fee Schedule,987.79
Blue Shield,HMO,90869,CPT4/HCPCS,TCRAN MAGN STIM REDETEMINE,,Fee Schedule,3198.57
Blue Shield,HMO,90870,CPT4/HCPCS,ELECTROCONVULSIVE THERAPY,,Case Rate,203.79
Blue Shield,HMO,90875,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,Case Rate,150.86
Blue Shield,HMO,90876,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,Case Rate,231.88
Blue Shield,HMO,90880,CPT4/HCPCS,HYPNOTHERAPY,,Case Rate,207.83
Blue Shield,HMO,90885,CPT4/HCPCS,PSY EVALUATION OF RECORDS,,Case Rate,113.92
Blue Shield,HMO,90887,CPT4/HCPCS,CONSULTATION WITH FAMILY,,Case Rate,179.73
Blue Shield,HMO,90935,CPT4/HCPCS,HEMODIALYSIS ONE EVALUATION,,Case Rate,338.52
Blue Shield,HMO,90937,CPT4/HCPCS,HEMODIALYSIS REPEATED EVAL,,Case Rate,494.97
Blue Shield,HMO,90940,CPT4/HCPCS,HEMODIALYSIS ACCESS STUDY,,Case Rate,629.69
Blue Shield,HMO,90945,CPT4/HCPCS,DIALYSIS ONE EVALUATION,,Case Rate,348.14
Blue Shield,HMO,90947,CPT4/HCPCS,DIALYSIS REPEATED EVAL,,Case Rate,504.59
Blue Shield,HMO,90997,CPT4/HCPCS,HEMOPERFUSION,,Case Rate,341.77
Blue Shield,HMO,91010,CPT4/HCPCS,ESOPHAGUS MOTILITY STUDY,,Case Rate,1121.26
Blue Shield,HMO,91013,CPT4/HCPCS,ESOPHGL MOTIL W/STIM/PERFUS,,Case Rate,186.88
Blue Shield,HMO,91020,CPT4/HCPCS,GASTRIC MOTILITY STUDIES,,Case Rate,1203.05
Blue Shield,HMO,91022,CPT4/HCPCS,DUODENAL MOTILITY STUDY,,Case Rate,1900.74
Blue Shield,HMO,91030,CPT4/HCPCS,ACID PERFUSION OF ESOPHAGUS,,Case Rate,1004.08
Blue Shield,HMO,91034,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX TEST,,Case Rate,2381.90
Blue Shield,HMO,91035,CPT4/HCPCS,G-ESOPH REFLX TST W/ELECTROD,,Case Rate,4951.31
Blue Shield,HMO,91037,CPT4/HCPCS,ESOPH IMPED FUNCTION TEST,,Case Rate,1270.42
Blue Shield,HMO,91038,CPT4/HCPCS,ESOPH IMPED FUNCT TEST > 1HR,,Case Rate,904.73
Blue Shield,HMO,91040,CPT4/HCPCS,ESOPH BALLOON DISTENSION TST,,Case Rate,5215.95
Blue Shield,HMO,91060,CPT4/HCPCS,GASTRIC SALINE LOAD TEST,,Case Rate,85.05
Blue Shield,HMO,91065,CPT4/HCPCS,BREATH HYDROGEN/METHANE TEST,,Case Rate,917.47
Blue Shield,HMO,91110,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,Case Rate,9569.70
Blue Shield,HMO,91111,CPT4/HCPCS,ESOPHAGEAL CAPSULE ENDOSCOPY,,Case Rate,8760.42
Blue Shield,HMO,91112,CPT4/HCPCS,GI WIRELESS CAPSULE MEASURE,,Fee Schedule,4280.44
Blue Shield,HMO,91120,CPT4/HCPCS,RECTAL SENSATION TEST,,Case Rate,5135.71
Blue Shield,HMO,91122,CPT4/HCPCS,ANAL PRESSURE RECORD,,Case Rate,2659.42
Blue Shield,HMO,91132,CPT4/HCPCS,ELECTROGASTROGRAPHY,,Case Rate,190.91
Blue Shield,HMO,91133,CPT4/HCPCS,ELECTROGASTROGRAPHY W/TEST,,Case Rate,243.06
Blue Shield,HMO,91200,CPT4/HCPCS,LIVER ELASTOGRAPHY,,Case Rate,287.92
Blue Shield,HMO,92002,CPT4/HCPCS,EYE EXAM NEW PATIENT,,Case Rate,474.80
Blue Shield,HMO,92004,CPT4/HCPCS,EYE EXAM NEW PATIENT,,Case Rate,834.11
Blue Shield,HMO,92012,CPT4/HCPCS,EYE EXAM ESTABLISH PATIENT,,Case Rate,503.67
Blue Shield,HMO,92014,CPT4/HCPCS,EYE EXAM&TX ESTAB PT 1/>VST,,Case Rate,690.54
Blue Shield,HMO,92015,CPT4/HCPCS,DETERMINE REFRACTIVE STATE,,Case Rate,720.97
Blue Shield,HMO,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,Case Rate,543.08
Blue Shield,HMO,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,Case Rate,281.55
Blue Shield,HMO,92020,CPT4/HCPCS,SPECIAL EYE EVALUATION,,Case Rate,167.63
Blue Shield,HMO,92025,CPT4/HCPCS,CORNEAL TOPOGRAPHY,,Case Rate,158.01
Blue Shield,HMO,92060,CPT4/HCPCS,SPECIAL EYE EVALUATION,,Case Rate,210.93
Blue Shield,HMO,92065,CPT4/HCPCS,ORTHOPTIC/PLEOPTIC TRAINING,,Case Rate,191.69
Blue Shield,HMO,92071,CPT4/HCPCS,CONTACT LENS FITTING FOR TX,,Case Rate,175.70
Blue Shield,HMO,92072,CPT4/HCPCS,FIT CONTAC LENS FOR MANAGMNT,,Case Rate,395.63
Blue Shield,HMO,92081,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,340.85
Blue Shield,HMO,92082,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,465.95
Blue Shield,HMO,92083,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,538.13
Blue Shield,HMO,92100,CPT4/HCPCS,SERIAL TONOMETRY EXAM(S),,Case Rate,657.64
Blue Shield,HMO,92132,CPT4/HCPCS,CMPTR OPHTH DX IMG ANT SEGMT,,Fee Schedule,987.79
Blue Shield,HMO,92133,CPT4/HCPCS,CMPTR OPHTH IMG OPTIC NERVE,,Fee Schedule,987.79
Blue Shield,HMO,92134,CPT4/HCPCS,CPTR OPHTH DX IMG POST SEGMT,,Fee Schedule,987.79
Blue Shield,HMO,92136,CPT4/HCPCS,OPHTHALMIC BIOMETRY,,Case Rate,749.98
Blue Shield,HMO,92140,CPT4/HCPCS,GLAUCOMA PROVOCATIVE TESTS,,Case Rate,480.39
Blue Shield,HMO,92225,CPT4/HCPCS,SPECIAL EYE EXAM INITIAL,,Case Rate,109.89
Blue Shield,HMO,92226,CPT4/HCPCS,SPECIAL EYE EXAM SUBSEQUENT,,Case Rate,105.08
Blue Shield,HMO,92227,CPT4/HCPCS,IMG RTA DETCJ/MNTR DS STAFF,,Case Rate,162.82
Blue Shield,HMO,92228,CPT4/HCPCS,IMG RTA DETC/MNTR DS PHY/QHP,,Case Rate,177.25
Blue Shield,HMO,92230,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Case Rate,744.25
Blue Shield,HMO,92235,CPT4/HCPCS,FLUORESCEIN ANGRPH UNI/BI,,Case Rate,1255.98
Blue Shield,HMO,92240,CPT4/HCPCS,ICG ANGIOGRAPHY UNI/BI,,Case Rate,3171.01
Blue Shield,HMO,92250,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Case Rate,740.21
Blue Shield,HMO,92260,CPT4/HCPCS,OPHTHALMOSCOPY/DYNAMOMETRY,,Case Rate,129.14
Blue Shield,HMO,92265,CPT4/HCPCS,EYE MUSCLE EVALUATION,,Case Rate,777.93
Blue Shield,HMO,92270,CPT4/HCPCS,ELECTRO-OCULOGRAPHY,,Case Rate,595.09
Blue Shield,HMO,92275,CPT4/HCPCS,ELECTRORETINOGRAPHY,,Case Rate,734.62
Blue Shield,HMO,92283,CPT4/HCPCS,COLOR VISION EXAMINATION,,Case Rate,369.72
Blue Shield,HMO,92284,CPT4/HCPCS,DARK ADAPTATION EYE EXAM,,Case Rate,1072.22
Blue Shield,HMO,92285,CPT4/HCPCS,EYE PHOTOGRAPHY,,Case Rate,475.57
Blue Shield,HMO,92286,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,Case Rate,1485.24
Blue Shield,HMO,92287,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,Case Rate,1158.05
Blue Shield,HMO,92310,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,555.04
Blue Shield,HMO,92311,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,536.57
Blue Shield,HMO,92312,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,531.76
Blue Shield,HMO,92313,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,518.10
Blue Shield,HMO,92314,CPT4/HCPCS,PRESCRIPTION OF CONTACT LENS,,Case Rate,456.33
Blue Shield,HMO,92315,CPT4/HCPCS,RX CNTACT LENS APHAKIA 1 EYE,,Case Rate,413.02
Blue Shield,HMO,92316,CPT4/HCPCS,RX CNTACT LENS APHAKIA 2 EYE,,Case Rate,445.93
Blue Shield,HMO,92317,CPT4/HCPCS,RX CORNEOSCLERAL CNTACT LENS,,Case Rate,456.33
Blue Shield,HMO,92325,CPT4/HCPCS,MODIFICATION OF CONTACT LENS,,Case Rate,196.50
Blue Shield,HMO,92326,CPT4/HCPCS,REPLACEMENT OF CONTACT LENS,,Case Rate,808.50
Blue Shield,HMO,92340,CPT4/HCPCS,FIT SPECTACLES MONOFOCAL,,Case Rate,340.85
Blue Shield,HMO,92341,CPT4/HCPCS,FIT SPECTACLES BIFOCAL,,Case Rate,360.09
Blue Shield,HMO,92342,CPT4/HCPCS,FIT SPECTACLES MULTIFOCAL,,Case Rate,369.72
Blue Shield,HMO,92352,CPT4/HCPCS,FIT APHAKIA SPECTCL MONOFOCL,,Case Rate,331.23
Blue Shield,HMO,92353,CPT4/HCPCS,FIT APHAKIA SPECTCL MULTIFOC,,Case Rate,359.32
Blue Shield,HMO,92354,CPT4/HCPCS,FIT SPECTACLES SINGLE SYSTEM,,Case Rate,4317.88
Blue Shield,HMO,92355,CPT4/HCPCS,FIT SPECTACLES COMPOUND LENS,,Case Rate,2092.28
Blue Shield,HMO,92358,CPT4/HCPCS,APHAKIA PROSTH SERVICE TEMP,,Case Rate,486.90
Blue Shield,HMO,92370,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,Case Rate,272.71
Blue Shield,HMO,92371,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,Case Rate,306.39
Blue Shield,HMO,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,Case Rate,554.26
Blue Shield,HMO,92504,CPT4/HCPCS,EAR MICROSCOPY EXAMINATION,,Case Rate,244.62
Blue Shield,HMO,92506,CPT4/HCPCS,SPEECH/HEARING EVALUATION,,Case Rate,1263.13
Blue Shield,HMO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,542.16
Blue Shield,HMO,92508,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,249.43
Blue Shield,HMO,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,Case Rate,1609.56
Blue Shield,HMO,92512,CPT4/HCPCS,NASAL FUNCTION STUDIES,,Case Rate,556.59
Blue Shield,HMO,92516,CPT4/HCPCS,FACIAL NERVE FUNCTION TEST,,Case Rate,581.43
Blue Shield,HMO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,Case Rate,257.50
Blue Shield,HMO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,Case Rate,797.18
Blue Shield,HMO,92537,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,Fee Schedule,987.79
Blue Shield,HMO,92538,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,Fee Schedule,987.79
Blue Shield,HMO,92540,CPT4/HCPCS,BASIC VESTIBULAR EVALUATION,,Case Rate,220.56
Blue Shield,HMO,92541,CPT4/HCPCS,SPONTANEOUS NYSTAGMUS TEST,,Case Rate,383.38
Blue Shield,HMO,92542,CPT4/HCPCS,POSITIONAL NYSTAGMUS TEST,,Case Rate,441.12
Blue Shield,HMO,92543,CPT4/HCPCS,CALORIC VESTIBULAR TEST,,Case Rate,234.99
Blue Shield,HMO,92544,CPT4/HCPCS,OPTOKINETIC NYSTAGMUS TEST,,Case Rate,354.51
Blue Shield,HMO,92545,CPT4/HCPCS,OSCILLATING TRACKING TEST,,Case Rate,335.26
Blue Shield,HMO,92546,CPT4/HCPCS,SINUSOIDAL ROTATIONAL TEST,,Case Rate,811.61
Blue Shield,HMO,92547,CPT4/HCPCS,SUPPLEMENTAL ELECTRICAL TEST,,Case Rate,577.54
Blue Shield,HMO,92548,CPT4/HCPCS,CDP-SOT 6 COND W/I&R,,Case Rate,1462.25
Blue Shield,HMO,92550,CPT4/HCPCS,TYMPANOMETRY & REFLEX THRESH,,Case Rate,105.08
Blue Shield,HMO,92552,CPT4/HCPCS,PURE TONE AUDIOMETRY AIR,,Case Rate,227.85
Blue Shield,HMO,92553,CPT4/HCPCS,AUDIOMETRY AIR & BONE,,Case Rate,341.77
Blue Shield,HMO,92555,CPT4/HCPCS,SPEECH THRESHOLD AUDIOMETRY,,Case Rate,194.17
Blue Shield,HMO,92556,CPT4/HCPCS,SPEECH AUDIOMETRY COMPLETE,,Case Rate,298.47
Blue Shield,HMO,92557,CPT4/HCPCS,COMPREHENSIVE HEARING TEST,,Case Rate,621.00
Blue Shield,HMO,92561,CPT4/HCPCS,BEKESY AUDIOMETRY DIAGNOSIS,,Case Rate,370.64
Blue Shield,HMO,92562,CPT4/HCPCS,LOUDNESS BALANCE TEST,,Case Rate,208.60
Blue Shield,HMO,92563,CPT4/HCPCS,TONE DECAY HEARING TEST,,Case Rate,194.17
Blue Shield,HMO,92564,CPT4/HCPCS,SISI HEARING TEST,,Case Rate,246.32
Blue Shield,HMO,92565,CPT4/HCPCS,STENGER TEST PURE TONE,,Case Rate,203.79
Blue Shield,HMO,92567,CPT4/HCPCS,TYMPANOMETRY,,Case Rate,274.41
Blue Shield,HMO,92568,CPT4/HCPCS,ACOUSTIC REFL THRESHOLD TST,,Case Rate,194.17
Blue Shield,HMO,92570,CPT4/HCPCS,ACOUSTIC IMMITANCE TESTING,,Case Rate,128.36
Blue Shield,HMO,92571,CPT4/HCPCS,FILTERED SPEECH HEARING TEST,,Case Rate,198.98
Blue Shield,HMO,92572,CPT4/HCPCS,STAGGERED SPONDAIC WORD TEST,,Case Rate,47.34
Blue Shield,HMO,92575,CPT4/HCPCS,SENSORINEURAL ACUITY TEST,,Case Rate,152.42
Blue Shield,HMO,92576,CPT4/HCPCS,SYNTHETIC SENTENCE TEST,,Case Rate,231.88
Blue Shield,HMO,92577,CPT4/HCPCS,STENGER TEST SPEECH,,Case Rate,374.68
Blue Shield,HMO,92579,CPT4/HCPCS,VISUAL AUDIOMETRY (VRA),,Case Rate,375.45
Blue Shield,HMO,92582,CPT4/HCPCS,CONDITIONING PLAY AUDIOMETRY,,Case Rate,375.45
Blue Shield,HMO,92583,CPT4/HCPCS,SELECT PICTURE AUDIOMETRY,,Case Rate,460.51
Blue Shield,HMO,92584,CPT4/HCPCS,ELECTROCOCHLEOGRAPHY,,Case Rate,1282.82
Blue Shield,HMO,92585,CPT4/HCPCS,AUDITOR EVOKE POTENT COMPRE,,Case Rate,951.44
Blue Shield,HMO,92586,CPT4/HCPCS,AUDITOR EVOKE POTENT LIMIT,,Case Rate,951.44
Blue Shield,HMO,92587,CPT4/HCPCS,EVOKED AUDITORY TEST LIMITED,,Case Rate,674.70
Blue Shield,HMO,92588,CPT4/HCPCS,EVOKED AUDITORY TST COMPLETE,,Case Rate,759.76
Blue Shield,HMO,92596,CPT4/HCPCS,EAR PROTECTOR EVALUATION,,Case Rate,308.09
Blue Shield,HMO,92597,CPT4/HCPCS,ORAL SPEECH DEVICE EVAL,,Case Rate,825.27
Blue Shield,HMO,92601,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM <7,,Case Rate,1669.01
Blue Shield,HMO,92602,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT <7,,Case Rate,1163.78
Blue Shield,HMO,92603,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM 7/>,,Case Rate,1101.23
Blue Shield,HMO,92604,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT 7/>,,Case Rate,735.55
Blue Shield,HMO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,Case Rate,1569.52
Blue Shield,HMO,92608,CPT4/HCPCS,EX FOR SPEECH DEVICE RX ADDL,,Case Rate,342.55
Blue Shield,HMO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,Case Rate,786.00
Blue Shield,HMO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,Case Rate,1687.47
Blue Shield,HMO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,Case Rate,1687.47
Blue Shield,HMO,92612,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) VID,,Case Rate,1339.33
Blue Shield,HMO,92613,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) I&R,,Case Rate,212.64
Blue Shield,HMO,92614,CPT4/HCPCS,LARYNGOSCOPIC SENSORY VID,,Case Rate,1223.86
Blue Shield,HMO,92615,CPT4/HCPCS,LARYNGOSCOPIC SENSORY I&R,,Case Rate,188.58
Blue Shield,HMO,92616,CPT4/HCPCS,FEES W/LARYNGEAL SENSE TEST,,Case Rate,1660.16
Blue Shield,HMO,92617,CPT4/HCPCS,FEES W/LARYNGEAL SENSE I&R,,Case Rate,231.88
Blue Shield,HMO,92618,CPT4/HCPCS,EX FOR NONSPEECH DEV RX ADD,,Case Rate,137.21
Blue Shield,HMO,92620,CPT4/HCPCS,AUDITORY FUNCTION 60 MIN,,Case Rate,572.73
Blue Shield,HMO,92621,CPT4/HCPCS,AUDITORY FUNCTION + 15 MIN,,Case Rate,144.50
Blue Shield,HMO,92625,CPT4/HCPCS,TINNITUS ASSESSMENT,,Case Rate,563.11
Blue Shield,HMO,92626,CPT4/HCPCS,EVAL AUD FUNCJ 1ST HOUR,,Case Rate,1082.76
Blue Shield,HMO,92627,CPT4/HCPCS,EVAL AUD FUNCJ EA ADDL 15,,Case Rate,272.71
Blue Shield,HMO,92640,CPT4/HCPCS,AUD BRAINSTEM IMPLT PROGRAMG,,Case Rate,677.66
Blue Shield,HMO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Fee Schedule,6876.92
Blue Shield,HMO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Fee Schedule,6876.92
Blue Shield,HMO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Fee Schedule,6876.92
Blue Shield,HMO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Fee Schedule,6876.92
Blue Shield,HMO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Fee Schedule,6876.92
Blue Shield,HMO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Fee Schedule,6876.92
Blue Shield,HMO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Fee Schedule,6876.92
Blue Shield,HMO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Fee Schedule,6876.92
Blue Shield,HMO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Fee Schedule,6876.92
Blue Shield,HMO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Fee Schedule,6876.92
Blue Shield,HMO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Fee Schedule,6876.92
Blue Shield,HMO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Fee Schedule,6876.92
Blue Shield,HMO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Fee Schedule,6876.92
Blue Shield,HMO,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,Case Rate,2138.66
Blue Shield,HMO,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,Case Rate,41.75
Blue Shield,HMO,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Case Rate,3074.00
Blue Shield,HMO,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,Case Rate,1122.63
Blue Shield,HMO,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,Case Rate,574.58
Blue Shield,HMO,92971,CPT4/HCPCS,CARDIOASSIST EXTERNAL,,Case Rate,433.19
Blue Shield,HMO,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Case Rate,1558.60
Blue Shield,HMO,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Case Rate,4073.37
Blue Shield,HMO,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,Case Rate,2300.55
Blue Shield,HMO,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,Case Rate,1159.12
Blue Shield,HMO,92980,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Case Rate,3336.19
Blue Shield,HMO,92981,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Case Rate,901.29
Blue Shield,HMO,92982,CPT4/HCPCS,CORONARY ARTERY DILATION,,Case Rate,2491.09
Blue Shield,HMO,92984,CPT4/HCPCS,CORONARY ARTERY DILATION,,Case Rate,642.87
Blue Shield,HMO,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,Fee Schedule,12850.71
Blue Shield,HMO,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,12850.71
Blue Shield,HMO,92990,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,12850.71
Blue Shield,HMO,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,3198.57
Blue Shield,HMO,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,3198.57
Blue Shield,HMO,92995,CPT4/HCPCS,CORONARY ATHERECTOMY,,Case Rate,2730.26
Blue Shield,HMO,92996,CPT4/HCPCS,CORONARY ATHERECTOMY ADD-ON,,Case Rate,651.42
Blue Shield,HMO,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Fee Schedule,9548.66
Blue Shield,HMO,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Fee Schedule,9548.66
Blue Shield,HMO,93000,CPT4/HCPCS,ELECTROCARDIOGRAM COMPLETE,,Case Rate,257.50
Blue Shield,HMO,93005,CPT4/HCPCS,ELECTROCARDIOGRAM TRACING,,Case Rate,224.59
Blue Shield,HMO,93010,CPT4/HCPCS,ELECTROCARDIOGRAM REPORT,,Case Rate,32.90
Blue Shield,HMO,93015,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,999.56
Blue Shield,HMO,93016,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,89.87
Blue Shield,HMO,93017,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,857.54
Blue Shield,HMO,93018,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,56.96
Blue Shield,HMO,93024,CPT4/HCPCS,CARDIAC DRUG STRESS TEST,,Case Rate,571.18
Blue Shield,HMO,93025,CPT4/HCPCS,MICROVOLT T-WAVE ASSESS,,Case Rate,3840.75
Blue Shield,HMO,93040,CPT4/HCPCS,RHYTHM ECG WITH REPORT,,Case Rate,104.30
Blue Shield,HMO,93041,CPT4/HCPCS,RHYTHM ECG TRACING,,Case Rate,76.21
Blue Shield,HMO,93042,CPT4/HCPCS,RHYTHM ECG REPORT,,Case Rate,28.09
Blue Shield,HMO,93050,CPT4/HCPCS,ART PRESSURE WAVEFORM ANALYS,,Fee Schedule,987.79
Blue Shield,HMO,93224,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,1838.63
Blue Shield,HMO,93225,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,628.92
Blue Shield,HMO,93226,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,1110.23
Blue Shield,HMO,93227,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,99.49
Blue Shield,HMO,93268,CPT4/HCPCS,ECG RECORD/REVIEW,,Case Rate,3702.44
Blue Shield,HMO,93270,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,Case Rate,628.92
Blue Shield,HMO,93271,CPT4/HCPCS,ECG/MONITORING AND ANALYSIS,,Case Rate,2978.84
Blue Shield,HMO,93272,CPT4/HCPCS,ECG/REVIEW INTERPRET ONLY,,Case Rate,99.49
Blue Shield,HMO,93278,CPT4/HCPCS,ECG/SIGNAL-AVERAGED,,Case Rate,597.71
Blue Shield,HMO,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,1954.89
Blue Shield,HMO,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,990.71
Blue Shield,HMO,93307,CPT4/HCPCS,TTE W/O DOPPLER COMPLETE,,Case Rate,1954.89
Blue Shield,HMO,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,Case Rate,990.71
Blue Shield,HMO,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,1940.60
Blue Shield,HMO,93313,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,125.25
Blue Shield,HMO,93314,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,1940.60
Blue Shield,HMO,93315,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,522.28
Blue Shield,HMO,93316,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,135.65
Blue Shield,HMO,93317,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,354.65
Blue Shield,HMO,93318,CPT4/HCPCS,ECHO TRANSESOPHAGEAL INTRAOP,,Case Rate,1598.68
Blue Shield,HMO,93320,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,876.01
Blue Shield,HMO,93321,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,571.18
Blue Shield,HMO,93325,CPT4/HCPCS,DOPPLER COLOR FLOW ADD-ON,,Case Rate,1484.90
Blue Shield,HMO,93350,CPT4/HCPCS,STRESS TTE ONLY,,Case Rate,904.10
Blue Shield,HMO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Fee Schedule,9548.66
Blue Shield,HMO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Fee Schedule,9548.66
Blue Shield,HMO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Fee Schedule,9548.66
Blue Shield,HMO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Fee Schedule,9548.66
Blue Shield,HMO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Fee Schedule,9548.66
Blue Shield,HMO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Fee Schedule,9548.66
Blue Shield,HMO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Fee Schedule,9548.66
Blue Shield,HMO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,HMO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Fee Schedule,9548.66
Blue Shield,HMO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,HMO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,HMO,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Fee Schedule,987.79
Blue Shield,HMO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Fee Schedule,3198.57
Blue Shield,HMO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Fee Schedule,3198.57
Blue Shield,HMO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,HMO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,HMO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,HMO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,HMO,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Case Rate,4064.90
Blue Shield,HMO,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Case Rate,5222.42
Blue Shield,HMO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Case Rate,995.53
Blue Shield,HMO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Case Rate,567.14
Blue Shield,HMO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Case Rate,857.54
Blue Shield,HMO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Case Rate,1377.35
Blue Shield,HMO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Case Rate,694.72
Blue Shield,HMO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Case Rate,823.86
Blue Shield,HMO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Case Rate,1530.50
Blue Shield,HMO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,162.04
Blue Shield,HMO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,162.04
Blue Shield,HMO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Case Rate,2011.85
Blue Shield,HMO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3913.81
Blue Shield,HMO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,6701.11
Blue Shield,HMO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,1212.05
Blue Shield,HMO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,1999.75
Blue Shield,HMO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Case Rate,1622.74
Blue Shield,HMO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Case Rate,1009.96
Blue Shield,HMO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Case Rate,3218.90
Blue Shield,HMO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Case Rate,3633.81
Blue Shield,HMO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3633.81
Blue Shield,HMO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3633.81
Blue Shield,HMO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,2430.87
Blue Shield,HMO,93651,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,3506.45
Blue Shield,HMO,93652,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,3816.25
Blue Shield,HMO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Fee Schedule,9548.66
Blue Shield,HMO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Fee Schedule,9548.66
Blue Shield,HMO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Fee Schedule,9548.66
Blue Shield,HMO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Fee Schedule,9548.66
Blue Shield,HMO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Fee Schedule,9548.66
Blue Shield,HMO,93660,CPT4/HCPCS,TILT TABLE EVALUATION,,Case Rate,821.23
Blue Shield,HMO,93662,CPT4/HCPCS,INTRACARDIAC ECG (ICE),,Case Rate,1718.19
Blue Shield,HMO,93668,CPT4/HCPCS,PERIPHERAL VASCULAR REHAB,,Case Rate,663.38
Blue Shield,HMO,93701,CPT4/HCPCS,BIOIMPEDANCE CV ANALYSIS,,Case Rate,461.14
Blue Shield,HMO,93724,CPT4/HCPCS,ANALYZE PACEMAKER SYSTEM,,Case Rate,2011.85
Blue Shield,HMO,93740,CPT4/HCPCS,TEMPERATURE GRADIENT STUDIES,,Case Rate,81.02
Blue Shield,HMO,93750,CPT4/HCPCS,INTERROGATION VAD IN PERSON,,Case Rate,164.52
Blue Shield,HMO,93770,CPT4/HCPCS,MEASURE VENOUS PRESSURE,,Case Rate,18.47
Blue Shield,HMO,93784,CPT4/HCPCS,AMBL BP MNTR W/SOFTWARE,,Case Rate,757.91
Blue Shield,HMO,93786,CPT4/HCPCS,AMBL BP MNTR W/SW REC ONLY,,Case Rate,441.89
Blue Shield,HMO,93788,CPT4/HCPCS,AMBL BP MNTR W/SW A/R,,Case Rate,249.43
Blue Shield,HMO,93790,CPT4/HCPCS,AMBL BP MNTR W/SW I&R,,Case Rate,66.59
Blue Shield,HMO,93797,CPT4/HCPCS,CARDIAC REHAB,,Case Rate,148.38
Blue Shield,HMO,93798,CPT4/HCPCS,CARDIAC REHAB/MONITOR,,Case Rate,225.37
Blue Shield,HMO,93880,CPT4/HCPCS,EXTRACRANIAL BILAT STUDY,,Case Rate,2051.42
Blue Shield,HMO,93882,CPT4/HCPCS,EXTRACRANIAL UNI/LTD STUDY,,Case Rate,1469.69
Blue Shield,HMO,93886,CPT4/HCPCS,INTRACRANIAL COMPLETE STUDY,,Case Rate,2130.11
Blue Shield,HMO,93888,CPT4/HCPCS,INTRACRANIAL LIMITED STUDY,,Case Rate,1451.37
Blue Shield,HMO,93890,CPT4/HCPCS,TCD VASOREACTIVITY STUDY,,Case Rate,2322.57
Blue Shield,HMO,93892,CPT4/HCPCS,TCD EMBOLI DETECT W/O INJ,,Case Rate,2418.80
Blue Shield,HMO,93893,CPT4/HCPCS,TCD EMBOLI DETECT W/INJ,,Case Rate,2356.25
Blue Shield,HMO,93922,CPT4/HCPCS,UPR/L XTREMITY ART 2 LEVELS,,Case Rate,937.79
Blue Shield,HMO,93923,CPT4/HCPCS,UPR/LXTR ART STDY 3+ LVLS,,Case Rate,1460.07
Blue Shield,HMO,93924,CPT4/HCPCS,LWR XTR VASC STDY BILAT,,Case Rate,1828.23
Blue Shield,HMO,93925,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Case Rate,2388.23
Blue Shield,HMO,93926,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Case Rate,1709.50
Blue Shield,HMO,93930,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Case Rate,1924.76
Blue Shield,HMO,93931,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Case Rate,1400.78
Blue Shield,HMO,93965,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,885.64
Blue Shield,HMO,93970,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,1960.92
Blue Shield,HMO,93971,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,1412.88
Blue Shield,HMO,93975,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,2685.15
Blue Shield,HMO,93976,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1593.39
Blue Shield,HMO,93978,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1765.98
Blue Shield,HMO,93979,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1299.73
Blue Shield,HMO,93980,CPT4/HCPCS,PENILE VASCULAR STUDY,,Case Rate,2239.85
Blue Shield,HMO,93981,CPT4/HCPCS,PENILE VASCULAR STUDY,,Case Rate,2271.05
Blue Shield,HMO,93982,CPT4/HCPCS,ANEURYSM PRESSURE SENS STUDY,,Case Rate,388.96
Blue Shield,HMO,93990,CPT4/HCPCS,DOPPLER FLOW TESTING,,Case Rate,1695.06
Blue Shield,HMO,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,Case Rate,223.96
Blue Shield,HMO,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,Case Rate,182.99
Blue Shield,HMO,94004,CPT4/HCPCS,VENT MGMT NF PER DAY,,Case Rate,131.62
Blue Shield,HMO,94005,CPT4/HCPCS,HOME VENT MGMT SUPERVISION,,Case Rate,356.21
Blue Shield,HMO,94010,CPT4/HCPCS,BREATHING CAPACITY TEST,,Case Rate,306.39
Blue Shield,HMO,94011,CPT4/HCPCS,SPIROMETRY UP TO 2 YRS OLD,,Case Rate,318.49
Blue Shield,HMO,94012,CPT4/HCPCS,SPIRMTRY W/BRNCHDIL INF-2 YR,,Case Rate,484.57
Blue Shield,HMO,94013,CPT4/HCPCS,MEAS LUNG VOL THRU 2 YRS,,Case Rate,98.71
Blue Shield,HMO,94014,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,Case Rate,377.79
Blue Shield,HMO,94015,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,Case Rate,292.73
Blue Shield,HMO,94016,CPT4/HCPCS,REVIEW PATIENT SPIROMETRY,,Case Rate,89.87
Blue Shield,HMO,94060,CPT4/HCPCS,EVALUATION OF WHEEZING,,Case Rate,514.99
Blue Shield,HMO,94070,CPT4/HCPCS,EVALUATION OF WHEEZING,,Case Rate,1387.60
Blue Shield,HMO,94150,CPT4/HCPCS,VITAL CAPACITY TEST,,Case Rate,220.56
Blue Shield,HMO,94200,CPT4/HCPCS,LUNG FUNCTION TEST (MBC/MVV),,Case Rate,205.35
Blue Shield,HMO,94250,CPT4/HCPCS,EXPIRED GAS COLLECTION,,Case Rate,302.36
Blue Shield,HMO,94375,CPT4/HCPCS,RESPIRATORY FLOW VOLUME LOOP,,Case Rate,253.46
Blue Shield,HMO,94400,CPT4/HCPCS,CO2 BREATHING RESPONSE CURVE,,Case Rate,370.64
Blue Shield,HMO,94450,CPT4/HCPCS,HYPOXIA RESPONSE CURVE,,Case Rate,277.52
Blue Shield,HMO,94452,CPT4/HCPCS,HAST W/REPORT,,Case Rate,455.55
Blue Shield,HMO,94453,CPT4/HCPCS,HAST W/OXYGEN TITRATE,,Case Rate,676.88
Blue Shield,HMO,94610,CPT4/HCPCS,SURFACTANT ADMIN THRU TUBE,,Case Rate,273.30
Blue Shield,HMO,94620,CPT4/HCPCS,PULMONARY STRESS TEST/SIMPLE,,Case Rate,1108.52
Blue Shield,HMO,94621,CPT4/HCPCS,CARDIOPULM EXERCISE TESTING,,Case Rate,824.64
Blue Shield,HMO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,Case Rate,162.04
Blue Shield,HMO,94644,CPT4/HCPCS,CBT 1ST HOUR,,Case Rate,450.74
Blue Shield,HMO,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,Case Rate,171.66
Blue Shield,HMO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,Case Rate,328.89
Blue Shield,HMO,94662,CPT4/HCPCS,NEG PRESS VENTILATION CNP,,Case Rate,122.77
Blue Shield,HMO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,Case Rate,170.11
Blue Shield,HMO,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,Case Rate,280.00
Blue Shield,HMO,94668,CPT4/HCPCS,CHEST WALL MANIPULATION,,Case Rate,229.40
Blue Shield,HMO,94680,CPT4/HCPCS,EXHALED AIR ANALYSIS O2,,Case Rate,895.11
Blue Shield,HMO,94681,CPT4/HCPCS,EXHALED AIR ANALYSIS O2/CO2,,Case Rate,1275.38
Blue Shield,HMO,94690,CPT4/HCPCS,EXHALED AIR ANALYSIS,,Case Rate,954.40
Blue Shield,HMO,94726,CPT4/HCPCS,PULM FUNCT TST PLETHYSMOGRAP,,Case Rate,585.46
Blue Shield,HMO,94727,CPT4/HCPCS,PULM FUNCTION TEST BY GAS,,Case Rate,422.65
Blue Shield,HMO,94728,CPT4/HCPCS,AIRWY RESIST BY OSCILLOMETRY,,Case Rate,422.65
Blue Shield,HMO,94729,CPT4/HCPCS,CO/MEMBANE DIFFUSE CAPACITY,,Case Rate,639.17
Blue Shield,HMO,94750,CPT4/HCPCS,PULMONARY COMPLIANCE STUDY,,Case Rate,632.03
Blue Shield,HMO,94760,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,27.32
Blue Shield,HMO,94761,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,57.89
Blue Shield,HMO,94762,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,232.81
Blue Shield,HMO,94770,CPT4/HCPCS,EXHALED CARBON DIOXIDE TEST,,Case Rate,812.54
Blue Shield,HMO,94780,CPT4/HCPCS,CARS/BD TST INFT-12MO 60 MIN,,Case Rate,98.71
Blue Shield,HMO,94781,CPT4/HCPCS,CARS/BD TST INFT-12MO +30MIN,,Case Rate,32.90
Blue Shield,HMO,95004,CPT4/HCPCS,PERCUT ALLERGY SKIN TESTS,,Case Rate,52.15
Blue Shield,HMO,95010,CPT4/HCPCS,PERCUT ALLERGY TITRATE TEST,,Case Rate,158.01
Blue Shield,HMO,95012,CPT4/HCPCS,EXHALED NITRIC OXIDE MEAS,,Case Rate,234.99
Blue Shield,HMO,95015,CPT4/HCPCS,ID ALLERGY TITRATE-DRUG/BUG,,Case Rate,71.40
Blue Shield,HMO,95024,CPT4/HCPCS,ICUT ALLERGY TEST DRUG/BUG,,Case Rate,76.21
Blue Shield,HMO,95027,CPT4/HCPCS,ICUT ALLERGY TITRATE-AIRBORN,,Case Rate,76.21
Blue Shield,HMO,95028,CPT4/HCPCS,ICUT ALLERGY TEST-DELAYED,,Case Rate,119.51
Blue Shield,HMO,95044,CPT4/HCPCS,ALLERGY PATCH TESTS,,Case Rate,105.08
Blue Shield,HMO,95052,CPT4/HCPCS,PHOTO PATCH TEST,,Case Rate,129.14
Blue Shield,HMO,95056,CPT4/HCPCS,PHOTOSENSITIVITY TESTS,,Case Rate,90.64
Blue Shield,HMO,95060,CPT4/HCPCS,EYE ALLERGY TESTS,,Case Rate,176.48
Blue Shield,HMO,95065,CPT4/HCPCS,NOSE ALLERGY TEST,,Case Rate,105.08
Blue Shield,HMO,95070,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,Case Rate,1109.93
Blue Shield,HMO,95071,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,Case Rate,1417.88
Blue Shield,HMO,95075,CPT4/HCPCS,INGESTION CHALLENGE TEST,,Case Rate,406.66
Blue Shield,HMO,95115,CPT4/HCPCS,IMMUNOTHERAPY ONE INJECTION,,Case Rate,190.91
Blue Shield,HMO,95117,CPT4/HCPCS,IMMUNOTHERAPY INJECTIONS,,Case Rate,248.65
Blue Shield,HMO,95144,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,95.46
Blue Shield,HMO,95145,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,158.01
Blue Shield,HMO,95146,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,215.75
Blue Shield,HMO,95147,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,206.12
Blue Shield,HMO,95148,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,283.11
Blue Shield,HMO,95149,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,388.96
Blue Shield,HMO,95165,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,95.46
Blue Shield,HMO,95170,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,66.59
Blue Shield,HMO,95180,CPT4/HCPCS,RAPID DESENSITIZATION,,Case Rate,997.71
Blue Shield,HMO,95250,CPT4/HCPCS,CONT GLUC MNTR PHYS/QHP EQP,,Case Rate,1842.08
Blue Shield,HMO,95251,CPT4/HCPCS,CONT GLUC MNTR ANALYSIS I&R,,Case Rate,99.49
Blue Shield,HMO,95800,CPT4/HCPCS,SLP STDY UNATTENDED,,Case Rate,2087.47
Blue Shield,HMO,95801,CPT4/HCPCS,SLP STDY UNATND W/ANAL,,Case Rate,643.98
Blue Shield,HMO,95805,CPT4/HCPCS,MULTIPLE SLEEP LATENCY TEST,,Case Rate,7643.31
Blue Shield,HMO,95806,CPT4/HCPCS,SLEEP STUDY UNATT&RESP EFFT,,Case Rate,1703.28
Blue Shield,HMO,95807,CPT4/HCPCS,SLEEP STUDY ATTENDED,,Case Rate,5529.60
Blue Shield,HMO,95808,CPT4/HCPCS,POLYSOM ANY AGE 1-3> PARAM,,Case Rate,5933.77
Blue Shield,HMO,95810,CPT4/HCPCS,POLYSOM 6/> YRS 4/> PARAM,,Case Rate,7791.06
Blue Shield,HMO,95811,CPT4/HCPCS,POLYSOM 6/>YRS CPAP 4/> PARM,,Case Rate,8439.85
Blue Shield,HMO,95812,CPT4/HCPCS,EEG 41-60 MINUTES,,Case Rate,1709.20
Blue Shield,HMO,95813,CPT4/HCPCS,EEG EXTND MNTR 61-119 MIN,,Case Rate,2079.70
Blue Shield,HMO,95816,CPT4/HCPCS,EEG AWAKE AND DROWSY,,Case Rate,1329.86
Blue Shield,HMO,95819,CPT4/HCPCS,EEG AWAKE AND ASLEEP,,Case Rate,1594.50
Blue Shield,HMO,95822,CPT4/HCPCS,EEG COMA OR SLEEP ONLY,,Case Rate,1928.98
Blue Shield,HMO,95824,CPT4/HCPCS,EEG CEREBRAL DEATH ONLY,,Case Rate,802.14
Blue Shield,HMO,95827,CPT4/HCPCS,EEG ALL NIGHT RECORDING,,Case Rate,1163.16
Blue Shield,HMO,95829,CPT4/HCPCS,SURGERY ELECTROCORTICOGRAM,,Case Rate,13947.35
Blue Shield,HMO,95830,CPT4/HCPCS,INSERT ELECTRODES FOR EEG,,Case Rate,1632.21
Blue Shield,HMO,95831,CPT4/HCPCS,LIMB MUSCLE TESTING MANUAL,,Case Rate,225.37
Blue Shield,HMO,95832,CPT4/HCPCS,HAND MUSCLE TESTING MANUAL,,Case Rate,166.85
Blue Shield,HMO,95833,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,Case Rate,287.14
Blue Shield,HMO,95834,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,Case Rate,315.24
Blue Shield,HMO,95851,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,Case Rate,177.25
Blue Shield,HMO,95852,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,Case Rate,129.14
Blue Shield,HMO,95857,CPT4/HCPCS,CHOLINESTERASE CHALLENGE,,Case Rate,296.77
Blue Shield,HMO,95860,CPT4/HCPCS,MUSCLE TEST ONE LIMB,,Case Rate,503.67
Blue Shield,HMO,95861,CPT4/HCPCS,MUSCLE TEST 2 LIMBS,,Case Rate,380.27
Blue Shield,HMO,95863,CPT4/HCPCS,MUSCLE TEST 3 LIMBS,,Case Rate,476.50
Blue Shield,HMO,95864,CPT4/HCPCS,MUSCLE TEST 4 LIMBS,,Case Rate,909.69
Blue Shield,HMO,95865,CPT4/HCPCS,MUSCLE TEST LARYNX,,Case Rate,339.29
Blue Shield,HMO,95866,CPT4/HCPCS,MUSCLE TEST HEMIDIAPHRAGM,,Case Rate,406.03
Blue Shield,HMO,95867,CPT4/HCPCS,MUSCLE TEST CRAN NERV UNILAT,,Case Rate,295.21
Blue Shield,HMO,95868,CPT4/HCPCS,MUSCLE TEST CRAN NERVE BILAT,,Case Rate,356.99
Blue Shield,HMO,95869,CPT4/HCPCS,MUSCLE TEST THOR PARASPINAL,,Case Rate,113.92
Blue Shield,HMO,95870,CPT4/HCPCS,MUSCLE TEST NONPARASPINAL,,Case Rate,113.92
Blue Shield,HMO,95872,CPT4/HCPCS,MUSCLE TEST ONE FIBER,,Case Rate,308.87
Blue Shield,HMO,95873,CPT4/HCPCS,GUIDE NERV DESTR ELEC STIM,,Case Rate,104.30
Blue Shield,HMO,95874,CPT4/HCPCS,GUIDE NERV DESTR NEEDLE EMG,,Case Rate,104.30
Blue Shield,HMO,95875,CPT4/HCPCS,LIMB EXERCISE TEST,,Case Rate,505.37
Blue Shield,HMO,95885,CPT4/HCPCS,MUSC TST DONE W/NERV TST LIM,,Case Rate,538.13
Blue Shield,HMO,95886,CPT4/HCPCS,MUSC TEST DONE W/N TEST COMP,,Case Rate,566.99
Blue Shield,HMO,95887,CPT4/HCPCS,MUSC TST DONE W/N TST NONEXT,,Case Rate,576.62
Blue Shield,HMO,95900,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,Case Rate,537.35
Blue Shield,HMO,95903,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,Case Rate,465.17
Blue Shield,HMO,95904,CPT4/HCPCS,SENSE NERVE CONDUCTION TEST,,Case Rate,469.98
Blue Shield,HMO,95905,CPT4/HCPCS,MOTOR &/ SENS NRVE CNDJ TEST,,Case Rate,975.98
Blue Shield,HMO,95920,CPT4/HCPCS,INTRAOP NERVE TEST ADD-ON,,Case Rate,658.56
Blue Shield,HMO,95921,CPT4/HCPCS,AUTONOMIC NRV PARASYM INERVJ,,Case Rate,186.10
Blue Shield,HMO,95922,CPT4/HCPCS,AUTONOMIC NRV ADRENRG INERVJ,,Case Rate,186.10
Blue Shield,HMO,95923,CPT4/HCPCS,AUTONOMIC NRV SYST FUNJ TEST,,Case Rate,830.86
Blue Shield,HMO,95925,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,HMO,95926,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,HMO,95927,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,HMO,95928,CPT4/HCPCS,C MOTOR EVOKED UPPR LIMBS,,Case Rate,1152.46
Blue Shield,HMO,95929,CPT4/HCPCS,C MOTOR EVOKED LWR LIMBS,,Case Rate,1243.88
Blue Shield,HMO,95930,CPT4/HCPCS,VISUAL EP TEST CNS W/I&R,,Case Rate,619.92
Blue Shield,HMO,95933,CPT4/HCPCS,BLINK REFLEX TEST,,Case Rate,404.32
Blue Shield,HMO,95934,CPT4/HCPCS,H-REFLEX TEST,,Case Rate,113.92
Blue Shield,HMO,95936,CPT4/HCPCS,H-REFLEX TEST,,Case Rate,113.92
Blue Shield,HMO,95937,CPT4/HCPCS,NEUROMUSCULAR JUNCTION TEST,,Case Rate,171.66
Blue Shield,HMO,95938,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,3563.08
Blue Shield,HMO,95939,CPT4/HCPCS,C MOTOR EVOKED UPR&LWR LIMBS,,Case Rate,4919.19
Blue Shield,HMO,95950,CPT4/HCPCS,AMBULATORY EEG MONITORING,,Case Rate,2016.33
Blue Shield,HMO,95951,CPT4/HCPCS,EEG MONITORING/VIDEORECORD,,Case Rate,1360.88
Blue Shield,HMO,95953,CPT4/HCPCS,EEG MONITORING/COMPUTER,,Case Rate,3228.86
Blue Shield,HMO,95954,CPT4/HCPCS,EEG MONITORING/GIVING DRUGS,,Case Rate,1583.17
Blue Shield,HMO,95955,CPT4/HCPCS,EEG DURING SURGERY,,Case Rate,1016.47
Blue Shield,HMO,95956,CPT4/HCPCS,EEG MONITOR TECHNOL ATTENDED,,Case Rate,6351.61
Blue Shield,HMO,95957,CPT4/HCPCS,EEG DIGITAL ANALYSIS,,Case Rate,871.20
Blue Shield,HMO,95958,CPT4/HCPCS,EEG MONITORING/FUNCTION TEST,,Case Rate,894.48
Blue Shield,HMO,95961,CPT4/HCPCS,ELECTRODE STIMULATION BRAIN,,Case Rate,658.56
Blue Shield,HMO,95962,CPT4/HCPCS,ELECTRODE STIM BRAIN ADD-ON,,Case Rate,658.56
Blue Shield,HMO,95965,CPT4/HCPCS,MEG SPONTANEOUS,,Case Rate,22488.95
Blue Shield,HMO,95966,CPT4/HCPCS,MEG EVOKED SINGLE,,Case Rate,11263.72
Blue Shield,HMO,95967,CPT4/HCPCS,MEG EVOKED EACH ADDL,,Case Rate,9507.03
Blue Shield,HMO,95970,CPT4/HCPCS,ALYS NPGT W/O PRGRMG,,Case Rate,421.09
Blue Shield,HMO,95971,CPT4/HCPCS,ALYS SMPL SP/PN NPGT W/PRGRM,,Case Rate,355.43
Blue Shield,HMO,95972,CPT4/HCPCS,ALYS CPLX SP/PN NPGT W/PRGRM,,Case Rate,638.69
Blue Shield,HMO,95973,CPT4/HCPCS,ANALYZE NEUROSTIM COMPLEX,,Case Rate,326.56
Blue Shield,HMO,95974,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,Case Rate,882.53
Blue Shield,HMO,95975,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,Case Rate,476.65
Blue Shield,HMO,95978,CPT4/HCPCS,ANALYZE NEUROSTIM BRAIN/1H,,Case Rate,1006.07
Blue Shield,HMO,95979,CPT4/HCPCS,ANALYZ NEUROSTIM BRAIN ADDON,,Case Rate,450.89
Blue Shield,HMO,95980,CPT4/HCPCS,IO ANAL GAST N-STIM INIT,,Case Rate,148.53
Blue Shield,HMO,95981,CPT4/HCPCS,IO ANAL GAST N-STIM SUBSQ,,Case Rate,65.81
Blue Shield,HMO,95982,CPT4/HCPCS,IO GA N-STIM SUBSQ W/REPROG,,Case Rate,106.78
Blue Shield,HMO,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Case Rate,745.95
Blue Shield,HMO,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Case Rate,726.70
Blue Shield,HMO,96000,CPT4/HCPCS,MOTION ANALYSIS VIDEO/3D,,Case Rate,299.39
Blue Shield,HMO,96001,CPT4/HCPCS,MOTION TEST W/FT PRESS MEAS,,Case Rate,357.91
Blue Shield,HMO,96002,CPT4/HCPCS,DYNAMIC SURFACE EMG,,Case Rate,80.24
Blue Shield,HMO,96003,CPT4/HCPCS,DYNAMIC FINE WIRE EMG,,Case Rate,65.81
Blue Shield,HMO,96004,CPT4/HCPCS,PHYS REVIEW OF MOTION TESTS,,Case Rate,496.67
Blue Shield,HMO,96040,CPT4/HCPCS,GENETIC COUNSELING 30 MIN,,Case Rate,470.76
Blue Shield,HMO,96101,CPT4/HCPCS,PSYCHO TESTING BY PSYCH/PHYS,,Case Rate,178.96
Blue Shield,HMO,96102,CPT4/HCPCS,PSYCHO TESTING BY TECHNICIAN,,Case Rate,47.34
Blue Shield,HMO,96103,CPT4/HCPCS,PSYCHO TESTING ADMIN BY COMP,,Case Rate,51.37
Blue Shield,HMO,96105,CPT4/HCPCS,ASSESSMENT OF APHASIA,,Case Rate,924.28
Blue Shield,HMO,96110,CPT4/HCPCS,DEVELOPMENTAL SCREEN W/SCORE,,Case Rate,164.04
Blue Shield,HMO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,Case Rate,332.45
Blue Shield,HMO,96116,CPT4/HCPCS,NUBHVL XM PHYS/QHP 1ST HR,,Case Rate,279.52
Blue Shield,HMO,96118,CPT4/HCPCS,NEUROPSYCH TST BY PSYCH/PHYS,,Case Rate,231.40
Blue Shield,HMO,96119,CPT4/HCPCS,NEUROPSYCH TESTING BY TEC,,Case Rate,120.73
Blue Shield,HMO,96120,CPT4/HCPCS,NEUROPSYCH TST ADMIN W/COMP,,Case Rate,51.37
Blue Shield,HMO,96125,CPT4/HCPCS,COGNITIVE TEST BY HC PRO,,Case Rate,242.58
Blue Shield,HMO,96150,CPT4/HCPCS,ASSESS HLTH/BEHAVE INIT,,Case Rate,47.34
Blue Shield,HMO,96151,CPT4/HCPCS,ASSESS HLTH/BEHAVE SUBSEQ,,Case Rate,47.34
Blue Shield,HMO,96152,CPT4/HCPCS,INTERVENE HLTH/BEHAVE INDIV,,Case Rate,42.53
Blue Shield,HMO,96153,CPT4/HCPCS,INTERVENE HLTH/BEHAVE GROUP,,Case Rate,13.66
Blue Shield,HMO,96154,CPT4/HCPCS,INTERV HLTH/BEHAV FAM W/PT,,Case Rate,42.53
Blue Shield,HMO,96155,CPT4/HCPCS,INTERV HLTH/BEHAV FAM NO PT,,Case Rate,56.18
Blue Shield,HMO,96360,CPT4/HCPCS,HYDRATION IV INFUSION INIT,,Case Rate,648.94
Blue Shield,HMO,96361,CPT4/HCPCS,HYDRATE IV INFUSION ADD-ON,,Case Rate,165.30
Blue Shield,HMO,96365,CPT4/HCPCS,THER/PROPH/DIAG IV INF INIT,,Case Rate,788.48
Blue Shield,HMO,96366,CPT4/HCPCS,THER/PROPH/DIAG IV INF ADDON,,Case Rate,194.17
Blue Shield,HMO,96367,CPT4/HCPCS,TX/PROPH/DG ADDL SEQ IV INF,,Case Rate,343.33
Blue Shield,HMO,96368,CPT4/HCPCS,THER/DIAG CONCURRENT INF,,Case Rate,179.73
Blue Shield,HMO,96369,CPT4/HCPCS,SC THER INFUSION UP TO 1 HR,,Case Rate,1881.49
Blue Shield,HMO,96370,CPT4/HCPCS,SC THER INFUSION ADDL HR,,Case Rate,121.99
Blue Shield,HMO,96371,CPT4/HCPCS,SC THER INFUSION RESET PUMP,,Case Rate,985.61
Blue Shield,HMO,96372,CPT4/HCPCS,THER/PROPH/DIAG INJ SC/IM,,Case Rate,210.93
Blue Shield,HMO,96373,CPT4/HCPCS,THER/PROPH/DIAG INJ IA,,Case Rate,152.42
Blue Shield,HMO,96374,CPT4/HCPCS,THER/PROPH/DIAG INJ IV PUSH,,Case Rate,632.03
Blue Shield,HMO,96375,CPT4/HCPCS,TX/PRO/DX INJ NEW DRUG ADDON,,Case Rate,256.72
Blue Shield,HMO,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,Case Rate,899.00
Blue Shield,HMO,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,Case Rate,345.66
Blue Shield,HMO,96405,CPT4/HCPCS,CHEMO INTRALESIONAL UP TO 7,,Case Rate,122.77
Blue Shield,HMO,96406,CPT4/HCPCS,CHEMO INTRALESIONAL OVER 7,,Case Rate,146.83
Blue Shield,HMO,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,Case Rate,1357.03
Blue Shield,HMO,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,Case Rate,741.14
Blue Shield,HMO,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,Case Rate,1769.27
Blue Shield,HMO,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,Case Rate,341.00
Blue Shield,HMO,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,Case Rate,1985.80
Blue Shield,HMO,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,Case Rate,855.84
Blue Shield,HMO,96420,CPT4/HCPCS,CHEMO IA PUSH TECNIQUE,,Case Rate,1326.60
Blue Shield,HMO,96422,CPT4/HCPCS,CHEMO IA INFUSION UP TO 1 HR,,Case Rate,1860.69
Blue Shield,HMO,96423,CPT4/HCPCS,CHEMO IA INFUSE EACH ADDL HR,,Case Rate,927.09
Blue Shield,HMO,96425,CPT4/HCPCS,CHEMOTHERAPY INFUSION METHOD,,Case Rate,2207.13
Blue Shield,HMO,96440,CPT4/HCPCS,CHEMOTHERAPY INTRACAVITARY,,Case Rate,549.75
Blue Shield,HMO,96446,CPT4/HCPCS,CHEMOTX ADMN PRTL CAVITY,,Case Rate,119.66
Blue Shield,HMO,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,Case Rate,435.67
Blue Shield,HMO,96521,CPT4/HCPCS,REFILL/MAINT PORTABLE PUMP,,Case Rate,1530.25
Blue Shield,HMO,96522,CPT4/HCPCS,REFILL/MAINT PUMP/RESVR SYST,,Case Rate,1332.97
Blue Shield,HMO,96523,CPT4/HCPCS,IRRIG DRUG DELIVERY DEVICE,,Case Rate,311.98
Blue Shield,HMO,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,Case Rate,187.02
Blue Shield,HMO,96567,CPT4/HCPCS,PDT DSTR PRMLG LES SKN,,Case Rate,1815.69
Blue Shield,HMO,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,Case Rate,241.65
Blue Shield,HMO,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,Case Rate,108.34
Blue Shield,HMO,96900,CPT4/HCPCS,ULTRAVIOLET LIGHT THERAPY,,Case Rate,277.52
Blue Shield,HMO,96902,CPT4/HCPCS,TRICHOGRAM,,Case Rate,52.15
Blue Shield,HMO,96910,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-B,,Case Rate,978.46
Blue Shield,HMO,96912,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-A,,Case Rate,1261.57
Blue Shield,HMO,96913,CPT4/HCPCS,PHOTOCHEMOTHERAPY UV-A OR B,,Case Rate,1796.59
Blue Shield,HMO,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,Case Rate,287.14
Blue Shield,HMO,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,Case Rate,276.74
Blue Shield,HMO,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,Case Rate,526.17
Blue Shield,HMO,96931,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,987.79
Blue Shield,HMO,96932,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,6049.05
Blue Shield,HMO,96933,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,987.79
Blue Shield,HMO,97001,CPT4/HCPCS,PT EVALUATION,,Case Rate,342.55
Blue Shield,HMO,97002,CPT4/HCPCS,PT RE-EVALUATION,,Case Rate,205.35
Blue Shield,HMO,97003,CPT4/HCPCS,OT EVALUATION,,Case Rate,399.51
Blue Shield,HMO,97004,CPT4/HCPCS,OT RE-EVALUATION,,Case Rate,272.71
Blue Shield,HMO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Case Rate,37.72
Blue Shield,HMO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Case Rate,71.40
Blue Shield,HMO,97014,CPT4/HCPCS,ELECTRIC STIMULATION THERAPY,,Case Rate,90.64
Blue Shield,HMO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Case Rate,119.51
Blue Shield,HMO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Case Rate,85.83
Blue Shield,HMO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Case Rate,162.82
Blue Shield,HMO,97024,CPT4/HCPCS,DIATHERMY EG MICROWAVE,,Case Rate,42.53
Blue Shield,HMO,97026,CPT4/HCPCS,INFRARED THERAPY,,Case Rate,37.72
Blue Shield,HMO,97028,CPT4/HCPCS,ULTRAVIOLET THERAPY,,Case Rate,42.53
Blue Shield,HMO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Case Rate,100.27
Blue Shield,HMO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Case Rate,215.75
Blue Shield,HMO,97034,CPT4/HCPCS,CONTRAST BATH THERAPY,,Case Rate,100.27
Blue Shield,HMO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Case Rate,52.15
Blue Shield,HMO,97036,CPT4/HCPCS,HYDROTHERAPY,,Case Rate,215.75
Blue Shield,HMO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Case Rate,162.04
Blue Shield,HMO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Case Rate,167.63
Blue Shield,HMO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Case Rate,259.05
Blue Shield,HMO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Case Rate,138.76
Blue Shield,HMO,97124,CPT4/HCPCS,MASSAGE THERAPY,,Case Rate,133.95
Blue Shield,HMO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Case Rate,143.57
Blue Shield,HMO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Case Rate,109.89
Blue Shield,HMO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Case Rate,186.88
Blue Shield,HMO,97532,CPT4/HCPCS,COGNITIVE SKILLS DEVELOPMENT,,Case Rate,109.89
Blue Shield,HMO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Case Rate,133.95
Blue Shield,HMO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Case Rate,182.06
Blue Shield,HMO,97537,CPT4/HCPCS,COMMUNITY/WORK REINTEGRATION,,Case Rate,138.76
Blue Shield,HMO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Case Rate,143.57
Blue Shield,HMO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Fee Schedule,987.79
Blue Shield,HMO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Fee Schedule,987.79
Blue Shield,HMO,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,Case Rate,65.81
Blue Shield,HMO,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,Case Rate,74.65
Blue Shield,HMO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,Case Rate,166.85
Blue Shield,HMO,97755,CPT4/HCPCS,ASSISTIVE TECHNOLOGY ASSESS,,Case Rate,142.79
Blue Shield,HMO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,Case Rate,214.19
Blue Shield,HMO,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,Case Rate,166.85
Blue Shield,HMO,97762,CPT4/HCPCS,C/O FOR ORTHOTIC/PROSTH USE,,Case Rate,359.32
Blue Shield,HMO,97802,CPT4/HCPCS,MEDICAL NUTRITION INDIV IN,,Case Rate,230.18
Blue Shield,HMO,97803,CPT4/HCPCS,MED NUTRITION INDIV SUBSEQ,,Case Rate,230.18
Blue Shield,HMO,97804,CPT4/HCPCS,MEDICAL NUTRITION GROUP,,Case Rate,95.46
Blue Shield,HMO,99170,CPT4/HCPCS,ANOGENITAL EXAM CHILD W IMAG,,Case Rate,883.93
Blue Shield,HMO,99172,CPT4/HCPCS,OCULAR FUNCTION SCREEN,,Case Rate,262.31
Blue Shield,HMO,99175,CPT4/HCPCS,INDUCTION OF VOMITING,,Case Rate,713.97
Blue Shield,HMO,99183,CPT4/HCPCS,HYPERBARIC OXYGEN THERAPY,,Case Rate,1628.33
Blue Shield,HMO,99184,CPT4/HCPCS,HYPOTHERMIA ILL NEONATE,,Fee Schedule,987.79
Blue Shield,HMO,99190,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,7464.76
Blue Shield,HMO,99191,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,5593.37
Blue Shield,HMO,99192,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,3732.38
Blue Shield,HMO,99195,CPT4/HCPCS,PHLEBOTOMY,,Case Rate,219.78
Blue Shield,HMO,B2000ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2001ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B200YZZ,ICD10-PCS,Plain Radiography of Single Cor Art using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2010ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2011ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B201YZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2020ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2021ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B202YZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2030ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2031ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B203YZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2040ZZ,ICD10-PCS,Plain Radiography of Right Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2041ZZ,ICD10-PCS,Plain Radiography of Right Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B204YZZ,ICD10-PCS,Plain Radiography of Right Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2050ZZ,ICD10-PCS,Plain Radiography of Left Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2051ZZ,ICD10-PCS,Plain Radiography of Left Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B205YZZ,ICD10-PCS,Plain Radiography of Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2060ZZ,ICD10-PCS,Plain Radiography of R & L Heart using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2061ZZ,ICD10-PCS,Plain Radiography of R & L Heart using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B206YZZ,ICD10-PCS,Plain Radiography of Right and Left Heart using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2070ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2071ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B207YZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2080ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2081ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B208YZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B20F0ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B20F1ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B20FYZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using Other Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2100ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2101ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B210YZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using Other Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2110ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2111ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B211YZZ,ICD10-PCS,Fluoroscopy of Multiple Coronary Arteries using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2120ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2121ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B212YZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2130ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2131ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B213YZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2140ZZ,ICD10-PCS,Fluoroscopy of Right Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2141ZZ,ICD10-PCS,Fluoroscopy of Right Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B214YZZ,ICD10-PCS,Fluoroscopy of Right Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2150ZZ,ICD10-PCS,Fluoroscopy of Left Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2151ZZ,ICD10-PCS,Fluoroscopy of Left Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B215YZZ,ICD10-PCS,Fluoroscopy of Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2160ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2161ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B216YZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2170ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2171ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B217YZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2180ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B2181ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B218YZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B21F0ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B21F1ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,B21FYZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Other Contrast,,Fee Schedule,8271.00
Blue Shield,HMO,C8929,CPT4/HCPCS,Tte w or wo fol wcon,doppler,,Fee Schedule,3198.57
Blue Shield,HMO,C8930,CPT4/HCPCS,Tte w or w/o contr, cont ecg,,Fee Schedule,3198.57
Blue Shield,HMO,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Fee Schedule,6876.92
Blue Shield,HMO,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Fee Schedule,6876.92
Blue Shield,HMO,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Fee Schedule,6876.92
Blue Shield,HMO,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,Fee Schedule,6876.92
Blue Shield,HMO,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,Fee Schedule,6876.92
Blue Shield,HMO,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,Fee Schedule,6876.92
Blue Shield,HMO,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Fee Schedule,6876.92
Blue Shield,HMO,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Fee Schedule,6876.92
Blue Shield,HMO,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,Fee Schedule,6876.92
Blue Shield,HMO,C9739,CPT4/HCPCS,Cystoscopy prostatic imp 1-3,,Fee Schedule,4280.44
Blue Shield,HMO,C9740,CPT4/HCPCS,Cysto impl 4 or more,,Fee Schedule,4280.44
Blue Shield,HMO,C9742,CPT4/HCPCS,Laryngoscopy with injection,,Fee Schedule,4280.44
Blue Shield,HMO,C9748,CPT4/HCPCS,Prostatic rf water vapor tx,,Fee Schedule,12850.71
Blue Shield,HMO,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Fee Schedule,3198.57
Blue Shield,HMO,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Fee Schedule,4280.44
Blue Shield,HMO,G0106,CPT4/HCPCS,Colon CA screen;barium enema,,Case Rate,1130.25
Blue Shield,HMO,G0120,CPT4/HCPCS,Colon ca scrn; barium enema,,Case Rate,1130.25
Blue Shield,HMO,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Fee Schedule,4280.44
Blue Shield,HMO,G0122,CPT4/HCPCS,Colon ca scrn; barium enema,,Case Rate,1106.19
Blue Shield,HMO,G0130,CPT4/HCPCS,Single energy x-ray study,,Case Rate,409.91
Blue Shield,HMO,G0168,CPT4/HCPCS,Wound closure by adhesive,,Fee Schedule,3198.57
Blue Shield,HMO,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,Fee Schedule,4280.44
Blue Shield,HMO,G0277,CPT4/HCPCS,Hbot, full body chamber, 30m,,Fee Schedule,4280.44
Blue Shield,HMO,G0279,CPT4/HCPCS,Tomosynthesis, mammo,,Fee Schedule,4280.44
Blue Shield,HMO,G0288,CPT4/HCPCS,Recon, CTA for surg plan,,Case Rate,5201.81
Blue Shield,HMO,G0297,CPT4/HCPCS,Ldct for lung ca screen,,Fee Schedule,4280.44
Blue Shield,HMO,G0392,CPT4/HCPCS,AV fistula or graft arterial,,Fee Schedule,12850.71
Blue Shield,HMO,G0393,CPT4/HCPCS,AV fistula or graft venous,,Fee Schedule,12850.71
Blue Shield,HMO,Q0035,CPT4/HCPCS,Cardiokymography,,Case Rate,190.91
Blue Shield,HMO,Q0092,CPT4/HCPCS,Set up port xray equipment,,Case Rate,158.01
Blue Shield,HMO,X2A5312,ICD10-PCS,Cereb Filtr, Brach L Carotid Art, Perc, New Tech 2,,Fee Schedule,8271.00
Blue Shield,HMO,X2RF032,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Open, New Tech 2,,Fee Schedule,8271.00
Blue Shield,HMO,X2RF432,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Perc Endo, New Tech 2,,Fee Schedule,8271.00
Blue Shield,HMO,,,Clinic Visit,,Case Rate,60.00
Blue Shield,HMO,,,NICU/Newborn - Level I,,Per Diem,946.00
Blue Shield,HMO,,,CCU,,Per Diem,4250.00
Blue Shield,HMO,,,ICU,,Per Diem,4250.00
Blue Shield,HMO,,,Medical Surgical,,Per Diem,4250.00
Blue Shield,HMO,,,Pediatrics,,Per Diem,4250.00
Blue Shield,HMO,,,NICU/Newborn - Level II,,Per Diem,5990.00
Blue Shield,HMO,,,NICU/Newborn - Level III,,Per Diem,5990.00
Blue Shield,HMO,,,NICU/Newborn - Level IV,,Per Diem,5990.00
Blue Shield,POS,001U074,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U076,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U077,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U079,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U0J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U0J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U0J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U0J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U0K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U0K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U0K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U0K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,001U374,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U376,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U377,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U379,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U3J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U3J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U3J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U3J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U3K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U3K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U3K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,001U3K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0033T,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,Fee Schedule,3198.57
Blue Shield,POS,005T0ZZ,ICD10-PCS,Destruction of Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,005T3ZZ,ICD10-PCS,Destruction of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,005T4ZZ,ICD10-PCS,Destruction of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,005W0ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,005W3ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,005W4ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,005X0ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,005X3ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,005X4ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,005Y0ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,005Y3ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,005Y4ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,Fee Schedule,3198.57
Blue Shield,POS,008W0ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,008W3ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,008W4ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,008X0ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,008X3ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,008X4ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,008Y0ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,008Y3ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,008Y4ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,009T00Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,009T0ZX,ICD10-PCS,Drainage of Spinal Meninges, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,POS,009T0ZZ,ICD10-PCS,DRAINAGE OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,009T30Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,009T3ZX,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,009T3ZZ,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,009T40Z,ICD10-PCS,Drain of Spinal Meninges with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,009T4ZX,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,009T4ZZ,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,009U00Z,ICD10-PCS,Drainage of Spinal Canal with Drainage Device, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,009U0ZX,ICD10-PCS,Drainage of Spinal Canal, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,POS,009U0ZZ,ICD10-PCS,DRAINAGE OF SPINAL CANAL OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,009W00Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,009W0ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,POS,009W0ZZ,ICD10-PCS,DRAINAGE OF CERVICAL SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,009W30Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,009W3ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,009W3ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,009W40Z,ICD10-PCS,Drain of Cerv Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,009W4ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,009W4ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,009X00Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,009X0ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,POS,009X0ZZ,ICD10-PCS,DRAINAGE OF THORACIC SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,009X30Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,009X3ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,009X3ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,009X40Z,ICD10-PCS,Drain of Thor Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,009X4ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,009X4ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,009Y00Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,009Y0ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,POS,009Y0ZZ,ICD10-PCS,DRAINAGE OF LUMBAR SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,009Y30Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,009Y3ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,009Y3ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,009Y40Z,ICD10-PCS,Drain of Lum Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,009Y4ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,009Y4ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00BT0ZX,ICD10-PCS,Excision of Spinal Meninges, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,POS,00BT0ZZ,ICD10-PCS,EXCISION OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,00BT3ZX,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,00BT3ZZ,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00BT4ZX,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,00BT4ZZ,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00BW0ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,POS,00BW0ZZ,ICD10-PCS,EXCISION OF CERVICAL SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,00BW3ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,00BW3ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00BW4ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,00BW4ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00BX0ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,POS,00BX0ZZ,ICD10-PCS,EXCISION OF THORACIC SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,00BX3ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,00BX3ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00BX4ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,00BX4ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00BY0ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,POS,00BY0ZZ,ICD10-PCS,EXCISION OF LUMBAR SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,00BY3ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,00BY3ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00BY4ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,POS,00BY4ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00C30ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00C33ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00C34ZZ,ICD10-PCS,Extirpate of Matter from Cran Epidur Spc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00CT0ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00CT3ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00CT4ZZ,ICD10-PCS,Extirpate of Matter from Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00CW0ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00CW3ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00CW4ZZ,ICD10-PCS,Extirpate matter from Cerv Spinal Cord, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,00CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00CX4ZZ,ICD10-PCS,Extirpate matter from Thor Spinal Cord, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,00CY0ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00CY3ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00CY4ZZ,ICD10-PCS,Extirpate of Matter from Lum Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00DT0ZZ,ICD10-PCS,EXTRACTION OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,00DT3ZZ,ICD10-PCS,Extraction of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00DT4ZZ,ICD10-PCS,Extraction of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00FU0ZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,00FU3ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00FU4ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00FUXZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL EXTERNAL APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,00HU02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HU0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HU32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HU3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HU42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HU4MZ,ICD10-PCS,Insert of Neuro Lead into Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HV02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HV0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HV32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HV3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HV42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00HV4MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00JU0ZZ,ICD10-PCS,INSPECTION OF SPINAL CANAL OPEN,,Fee Schedule,8271.00
Blue Shield,POS,00JU3ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00JU4ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,00JV0ZZ,ICD10-PCS,INSPECTION OF SPINAL CORD OPEN APPR,,Fee Schedule,8271.00
Blue Shield,POS,00JV3ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00JV4ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NT0ZZ,ICD10-PCS,Release Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NT3ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NT4ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NW0ZZ,ICD10-PCS,Release Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NW3ZZ,ICD10-PCS,Release Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NW4ZZ,ICD10-PCS,Release Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NX0ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NX3ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NX4ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NY0ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NY3ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00NY4ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU00Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU02Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU03Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU30Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU32Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU33Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU40Z,ICD10-PCS,Removal of Drain Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU43Z,ICD10-PCS,Remove of Infusion Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PU4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV00Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV02Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV03Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV07Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV0KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV30Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV32Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV33Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV37Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV3KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV40Z,ICD10-PCS,Removal of Drain Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV43Z,ICD10-PCS,Removal of Infusion Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV47Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV4KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00PV4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QT0ZZ,ICD10-PCS,Repair Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QT3ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QT4ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QW0ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QW3ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QW4ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QX0ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QX3ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QX4ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QY0ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QY3ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00QY4ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,00SW0ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00SW3ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00SW4ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00SX0ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00SX3ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00SX4ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00SY0ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00SY3ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,00SY4ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00UT07Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00UT0JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00UT0KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00UT37Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00UT3JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00UT3KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00UT47Z,ICD10-PCS,Supplement Spinal Meninges w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,00UT4JZ,ICD10-PCS,Supplement Spinal Meninges w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,00UT4KZ,ICD10-PCS,Supplement Spinal Meninges w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,00WU00Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU03Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU30Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU33Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU40Z,ICD10-PCS,Revision of Drain Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WU4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV00Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV03Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV07Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV0KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV30Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV33Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV37Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV3KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV40Z,ICD10-PCS,Revision of Drain Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV47Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV4KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,00WV4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Fee Schedule,12850.71
Blue Shield,POS,01510ZZ,ICD10-PCS,Destruction of Cervical Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,01514ZZ,ICD10-PCS,Destruction of Cervical Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,01580ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,01584ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,015B0ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,015B4ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,015R0ZZ,ICD10-PCS,DESTRUCTION OF SACRAL NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,015R4ZZ,ICD10-PCS,Destruction of Sacral Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0163T,CPT4/HCPCS,LUMB ARTIF DISKECTOMY ADDL,,Fee Schedule,3198.57
Blue Shield,POS,0164T,CPT4/HCPCS,REMOVE LUMB ARTIF DISC ADDL,,Fee Schedule,3198.57
Blue Shield,POS,0165T,CPT4/HCPCS,REVISE LUMB ARTIF DISC ADDL,,Fee Schedule,3198.57
Blue Shield,POS,01810ZZ,ICD10-PCS,DIVISION OF CERVICAL NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,01813ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,01814ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Fee Schedule,4891.93
Blue Shield,POS,01880ZZ,ICD10-PCS,DIVISION OF THORACIC NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,01883ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,01884ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,018B0ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE OPEN APPR,,Fee Schedule,8271.00
Blue Shield,POS,018B3ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE PERCUTANEOUS APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,018B4ZZ,ICD10-PCS,Division of Lumbar Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,018R0ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE OPEN APPR,,Fee Schedule,8271.00
Blue Shield,POS,018R3ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE PERQ APPR,,Fee Schedule,8271.00
Blue Shield,POS,018R4ZZ,ICD10-PCS,Division of Sacral Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,0190T,CPT4/HCPCS,PLACE INTRAOC RADIATION SRC,,Fee Schedule,3198.57
Blue Shield,POS,0191T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Fee Schedule,12850.71
Blue Shield,POS,0200T,CPT4/HCPCS,PERQ SACRAL AUGMT UNILAT INJ,,Fee Schedule,3198.57
Blue Shield,POS,0201T,CPT4/HCPCS,PERQ SACRAL AUGMT BILAT INJ,,Fee Schedule,3198.57
Blue Shield,POS,0207T,CPT4/HCPCS,CLEAR EYELID GLAND W/HEAT,,Fee Schedule,987.79
Blue Shield,POS,0210083,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0210088,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,0210089,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021008C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021008F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021008W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0210093,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0210098,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,0210099,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021009C,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021009F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021009W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,02100A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,02100AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100AW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02100J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02100JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100JW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02100K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02100KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02100KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100KW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02100ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0210483,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0210488,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0210489,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021048C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021048F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021048W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0210493,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0210498,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0210499,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021049C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021049F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021049W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104AW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104JW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104KW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02104Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02104Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02104Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02104ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02104ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0211083,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0211088,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,0211089,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021108C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021108F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021108W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0211093,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0211098,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,0211099,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021109C,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021109F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021109W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,02110A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,02110AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110AW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02110J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02110JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110JW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02110K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02110KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02110KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110KW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02110ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0211483,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0211488,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0211489,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021148C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021148F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021148W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0211493,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0211498,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0211499,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021149C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021149F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021149W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114AW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114JW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114KW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02114Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02114Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02114Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02114ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02114ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0212083,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0212088,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,0212089,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021208C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021208F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021208W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0212093,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0212098,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,0212099,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021209C,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021209F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021209W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,02120A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,02120AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120AW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02120J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02120JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120JW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02120K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02120KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02120KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120KW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02120ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0212483,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0212488,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0212489,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021248C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021248F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021248W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0212493,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0212498,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0212499,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021249C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021249F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021249W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124AW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124JW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124KW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02124Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02124Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02124Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02124ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02124ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0213083,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,0213088,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,0213089,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021308C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021308F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021308W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0213093,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0213098,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,0213099,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021309C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021309F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021309W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02130KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02130ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0213483,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0213488,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0213489,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021348C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021348F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021348W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0213493,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0213498,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0213499,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021349C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021349F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021349W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02134Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02134Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02134Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02134ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02134ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,POS,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,POS,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,POS,021608P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021608Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021608R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021609P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021609Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021609R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160AR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160JR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160KR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160ZQ,ICD10-PCS,Bypass Right Atrium to Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02160ZR,ICD10-PCS,Bypass Right Atrium to Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021648P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021648Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021648R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021649P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021649Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021649R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02164AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02164AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02164AR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02164JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02164JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02164JR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02164KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02164KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02164KR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02164Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02164ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02164ZQ,ICD10-PCS,Bypass Right Atrium to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02164ZR,ICD10-PCS,Bypass Right Atrium to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,POS,021708P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021708Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021708R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021709P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021709Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021709R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170AR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170JR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170KR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170ZQ,ICD10-PCS,Bypass Left Atrium to Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02170ZR,ICD10-PCS,Bypass Left Atrium to Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021748P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021748Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021748R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021749P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021749Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021749R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02174AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02174AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02174AR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02174JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02174JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02174JR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02174KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02174KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02174KR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02174ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02174ZQ,ICD10-PCS,Bypass Left Atrium to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02174ZR,ICD10-PCS,Bypass Left Atrium to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,POS,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,POS,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,Fee Schedule,987.79
Blue Shield,POS,021K08P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K08Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K08R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K09P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K09Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K09R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K0AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K0AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K0AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K0JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K0JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K0JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K0KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K0KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K0KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021K0Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K0Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K0ZC,ICD10-PCS,Bypass Right Ventricle to Thoracic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K0ZF,ICD10-PCS,Bypass Right Ventricle to Abdominal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K0ZP,ICD10-PCS,Bypass Right Ventricle to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K0ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K0ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K0ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K48P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K48Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K48R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K49P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K49Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K49R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K4AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K4AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K4AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K4JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K4JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K4JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K4KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K4KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K4KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021K4Z5,ICD10-PCS,Bypass Right Ventricle to Cor Circ, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K4Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K4Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K4ZC,ICD10-PCS,Bypass Right Ventricle to Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K4ZF,ICD10-PCS,Bypass Right Ventricle to Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K4ZP,ICD10-PCS,Bypass Right Ventricle to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K4ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K4ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021K4ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L08P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L08Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L08R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L09P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L09Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L09R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L0AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L0AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L0AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L0JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L0JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L0JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L0KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L0KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L0KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021L0Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L0Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L0ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L0ZF,ICD10-PCS,Bypass Left Ventricle to Abdominal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L0ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L0ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L0ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L0ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L48P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L48Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L48R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L49P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L49Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L49R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L4AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L4AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L4AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L4JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L4JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L4JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L4KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L4KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L4KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021L4Z5,ICD10-PCS,Bypass Left Ventricle to Cor Circ, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L4Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L4Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L4ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L4ZF,ICD10-PCS,Bypass Left Ventricle to Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L4ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L4ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L4ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021L4ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021V08P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V08Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V08R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V09P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V09Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V09R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V0AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V0AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V0AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V0JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V0JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V0JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V0KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V0KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V0KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021V0ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021V0ZQ,ICD10-PCS,Bypass Superior Vena Cava to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021V0ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021V48P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V48Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V48R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V49P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V49Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V49R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V4AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V4AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V4AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V4JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V4JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V4JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V4KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V4KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V4KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021V4ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021V4ZQ,ICD10-PCS,BYPASS SUPERIOR VENA CAVA TO RT PULM ART PC ENDO,,Fee Schedule,8271.00
Blue Shield,POS,021V4ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021W08B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W08D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W08P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W08Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W08R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W09B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W09D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W09P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W09Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W09R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021W0ZB,ICD10-PCS,Bypass Thoracic Aorta, Descending to Subclav, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021W0ZD,ICD10-PCS,Bypass Thoracic Aorta, Descending to Carotid, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021W0ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021W0ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021W0ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021W48B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W48D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W48P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W48Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W48R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W49B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W49D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W49P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W49Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W49R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021W4ZB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021W4ZD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021W4ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021W4ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021W4ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021X08B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X08D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X08P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X08Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X08R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X09B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X09D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X09P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X09Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X09R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,021X0ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021X0ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021X0ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021X0ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021X0ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,021X48B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X48D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X48P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X48Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X48R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X49B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X49D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X49P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X49Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X49R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,021X4ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021X4ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021X4ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021X4ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,021X4ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,Fee Schedule,987.79
Blue Shield,POS,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Fee Schedule,987.79
Blue Shield,POS,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Fee Schedule,987.79
Blue Shield,POS,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,POS,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,POS,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Fee Schedule,9548.66
Blue Shield,POS,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,Fee Schedule,9548.66
Blue Shield,POS,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Fee Schedule,9548.66
Blue Shield,POS,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Fee Schedule,9548.66
Blue Shield,POS,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,Fee Schedule,9548.66
Blue Shield,POS,0249T,CPT4/HCPCS,LIGATION HEMORRHOID W/US,,Fee Schedule,4280.44
Blue Shield,POS,024F07J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,024F08J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,024F0JJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,024F0KJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,024G072,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,024G082,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,024G0J2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,024G0K2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,024J072,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,024J082,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,024J0J2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,024J0K2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,02540ZZ,ICD10-PCS,Destruction of Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02543ZZ,ICD10-PCS,Destruction of Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02544ZZ,ICD10-PCS,Destruction of Coronary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0254T,CPT4/HCPCS,EVASC RPR ILIAC ART BIFUR,,Fee Schedule,3198.57
Blue Shield,POS,02550ZZ,ICD10-PCS,Destruction of Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02553ZZ,ICD10-PCS,Destruction of Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02560ZZ,ICD10-PCS,Destruction of Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02563ZZ,ICD10-PCS,Destruction of Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02570ZZ,ICD10-PCS,Destruction of Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02573ZZ,ICD10-PCS,Destruction of Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02580ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02583ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02590ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02593ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025D0ZZ,ICD10-PCS,Destruction of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025D3ZZ,ICD10-PCS,Destruction of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025D4ZZ,ICD10-PCS,Destruction of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,025F0ZZ,ICD10-PCS,Destruction of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025F3ZZ,ICD10-PCS,Destruction of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025G0ZZ,ICD10-PCS,Destruction of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025G3ZZ,ICD10-PCS,Destruction of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025H0ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025H3ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025J0ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025J3ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025K0ZZ,ICD10-PCS,Destruction of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025K3ZZ,ICD10-PCS,Destruction of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025L0ZZ,ICD10-PCS,Destruction of Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025L3ZZ,ICD10-PCS,Destruction of Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025M0ZZ,ICD10-PCS,Destruction of Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025M3ZZ,ICD10-PCS,Destruction of Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025P0ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025P3ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025P4ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,025Q0ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025Q3ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025Q4ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,025R0ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025R3ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025R4ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,025S0ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025S3ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025S4ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,025T0ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025T3ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025T4ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,025V0ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025V3ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,025V4ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,025W0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025W3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,025W4ZZ,ICD10-PCS,Destruction of Thor Aorta Desc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,025X0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,025X3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,025X4ZZ,ICD10-PCS,Destruction of Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,Fee Schedule,7902.34
Blue Shield,POS,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,Fee Schedule,6049.05
Blue Shield,POS,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,Fee Schedule,6049.05
Blue Shield,POS,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,Fee Schedule,9304.07
Blue Shield,POS,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,Fee Schedule,9304.07
Blue Shield,POS,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,Fee Schedule,4891.93
Blue Shield,POS,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,Fee Schedule,9304.07
Blue Shield,POS,0270046,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,POS,027004Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270056,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027005Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270066,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027006Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270076,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027007Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02700D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02700DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02700E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02700EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02700F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02700FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02700G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02700GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02700T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,POS,02700TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02700Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02700ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270346,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027034Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270356,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027035Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270366,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027036Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270376,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027037Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02703D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02703DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02703E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02703EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02703F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02703FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02703G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02703GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02703T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02703TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02703Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02703ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270446,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027044Z,ICD10-PCS,Dilate of 1 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270456,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027045Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270466,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027046Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270476,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027047Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02704D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02704DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02704E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02704EZ,ICD10-PCS,Dilate of 1 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02704F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02704FZ,ICD10-PCS,Dilate of 1 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02704G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02704GZ,ICD10-PCS,Dilate of 1 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02704T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02704TZ,ICD10-PCS,Dilate 1 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02704Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02704ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,Fee Schedule,9304.07
Blue Shield,POS,0271046,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,POS,027104Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271056,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027105Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271066,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027106Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271076,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027107Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02710D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02710DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02710E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02710EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02710F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02710FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02710G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02710GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02710T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,POS,02710TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02710Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02710ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271346,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027134Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271356,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027135Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271366,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027136Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271376,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027137Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02713D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02713DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02713E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02713EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02713F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02713FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02713G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02713GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02713T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02713TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02713Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02713ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271446,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027144Z,ICD10-PCS,Dilate of 2 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271456,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027145Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271466,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027146Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271476,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027147Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02714D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02714DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02714E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02714EZ,ICD10-PCS,Dilate of 2 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02714F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02714FZ,ICD10-PCS,Dilate of 2 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02714G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02714GZ,ICD10-PCS,Dilate of 2 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02714T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02714TZ,ICD10-PCS,Dilate 2 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02714Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02714ZZ,ICD10-PCS,Dilation of 2 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,Fee Schedule,9304.07
Blue Shield,POS,0272046,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,POS,027204Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272056,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027205Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272066,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027206Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272076,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027207Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02720D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02720DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02720E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02720EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02720F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02720FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02720G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02720GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02720T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,POS,02720TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02720Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02720ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272346,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027234Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272356,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027235Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272366,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027236Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272376,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027237Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02723D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02723DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02723E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02723EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02723F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02723FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02723G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02723GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02723T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02723TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02723Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02723ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272446,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027244Z,ICD10-PCS,Dilate of 3 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272456,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027245Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272466,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027246Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272476,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027247Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02724D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02724DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02724E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02724EZ,ICD10-PCS,Dilate of 3 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02724F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02724FZ,ICD10-PCS,Dilate of 3 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02724G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02724GZ,ICD10-PCS,Dilate of 3 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02724T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02724TZ,ICD10-PCS,Dilate 3 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02724Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02724ZZ,ICD10-PCS,Dilation of 3 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0272T,CPT4/HCPCS,INTERROGATE CRTD SNS DEV,,Fee Schedule,987.79
Blue Shield,POS,0273046,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,POS,027304Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273056,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,POS,027305Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273066,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,POS,027306Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273076,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,POS,027307Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02730D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02730DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02730E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02730EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02730F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02730FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02730G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,POS,02730GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02730T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,POS,02730TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02730Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02730ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273346,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027334Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273356,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027335Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273366,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027336Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273376,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027337Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02733D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02733DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02733E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02733EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02733F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02733FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02733G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02733GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02733T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02733TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02733Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02733ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273446,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027344Z,ICD10-PCS,Dilate 4+ Cor Art w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0273456,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027345Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273466,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027346Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273476,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027347Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02734D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02734DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02734E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02734EZ,ICD10-PCS,Dilate of 4+ Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02734F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02734FZ,ICD10-PCS,Dilate of 4+ Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02734G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02734GZ,ICD10-PCS,Dilate 4+ Cor Art w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02734T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02734TZ,ICD10-PCS,Dilate 4+ Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02734Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02734ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0273T,CPT4/HCPCS,INTERROGATE CRTD SNS W/PGRMG,,Fee Schedule,987.79
Blue Shield,POS,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,Fee Schedule,9548.66
Blue Shield,POS,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,Fee Schedule,9548.66
Blue Shield,POS,0278T,CPT4/HCPCS,TEMPR,,Fee Schedule,987.79
Blue Shield,POS,027F04Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,POS,027F0DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027F0ZZ,ICD10-PCS,Dilation of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027F34Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027F3DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027F3ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,027F44Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027F4DZ,ICD10-PCS,Dilate of Aortic Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,027F4ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,027G04Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,POS,027G0DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027G0ZZ,ICD10-PCS,Dilation of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027G34Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027G3DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027G3ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,027G44Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027G4DZ,ICD10-PCS,Dilate of Mitral Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,027G4ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,027H04Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027H0DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027H0ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027H34Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027H3DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027H3ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,027H44Z,ICD10-PCS,Dilate Pulm Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027H4DZ,ICD10-PCS,Dilation of Pulm Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,027H4ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,027J04Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,POS,027J0DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027J0ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027J34Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027J3DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027J3ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,027J44Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027J4DZ,ICD10-PCS,Dilate Tricusp Valve w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027J4ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,027K04Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027K0DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027K0ZZ,ICD10-PCS,Dilation of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027K34Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027K3DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027K3ZZ,ICD10-PCS,Dilation of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,027K44Z,ICD10-PCS,Dilate R Ventricle w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027K4DZ,ICD10-PCS,Dilate of R Ventricle with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,027K4ZZ,ICD10-PCS,Dilation of Right Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,027R04T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,POS,027R0DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027R0ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,027R34T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,POS,027R3DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,027R3ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,027R44T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027R4DT,ICD10-PCS,Dilate Ductus Arterio w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,027R4ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02890ZZ,ICD10-PCS,Division of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02893ZZ,ICD10-PCS,Division of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02894ZZ,ICD10-PCS,Division of Chordae Tendineae, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,028D0ZZ,ICD10-PCS,Division of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,028D3ZZ,ICD10-PCS,Division of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,028D4ZZ,ICD10-PCS,Division of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0295T,CPT4/HCPCS,EXT ECG COMPLETE,,Fee Schedule,987.79
Blue Shield,POS,0296T,CPT4/HCPCS,EXT ECG RECORDING,,Fee Schedule,987.79
Blue Shield,POS,0297T,CPT4/HCPCS,EXT ECG SCAN W/REPORT,,Fee Schedule,987.79
Blue Shield,POS,0298T,CPT4/HCPCS,EXT ECG REVIEW AND INTERP,,Fee Schedule,987.79
Blue Shield,POS,02B40ZZ,ICD10-PCS,Excision of Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B43ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B44ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B50ZZ,ICD10-PCS,Excision of Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B53ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B54ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B60ZZ,ICD10-PCS,Excision of Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B63ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B64ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B70ZZ,ICD10-PCS,Excision of Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B73ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B74ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B80ZZ,ICD10-PCS,Excision of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B83ZZ,ICD10-PCS,Excision of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B90ZZ,ICD10-PCS,Excision of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02B93ZZ,ICD10-PCS,Excision of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BD0ZZ,ICD10-PCS,Excision of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BD3ZZ,ICD10-PCS,Excision of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BD4ZZ,ICD10-PCS,Excision of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BF0ZZ,ICD10-PCS,Excision of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BF3ZZ,ICD10-PCS,Excision of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BG0ZZ,ICD10-PCS,Excision of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BG3ZZ,ICD10-PCS,Excision of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BH0ZZ,ICD10-PCS,Excision of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BH3ZZ,ICD10-PCS,Excision of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BJ0ZZ,ICD10-PCS,Excision of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BJ3ZZ,ICD10-PCS,Excision of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BK0ZZ,ICD10-PCS,Excision of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BK3ZZ,ICD10-PCS,Excision of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BK4ZZ,ICD10-PCS,Excision of Right Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BL0ZZ,ICD10-PCS,Excision of Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BL3ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BL4ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BM0ZZ,ICD10-PCS,Excision of Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BM3ZZ,ICD10-PCS,Excision of Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BP0ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BP3ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BP4ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BQ0ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BQ3ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BQ4ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BR0ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BR3ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BR4ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BS0ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BS3ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BS4ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BT0ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BT3ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BT4ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BV0ZZ,ICD10-PCS,Excision of Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BV3ZZ,ICD10-PCS,Excision of Superior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BV4ZZ,ICD10-PCS,Excision of Superior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BW0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BW3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BW4ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BX0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BX3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02BX4ZZ,ICD10-PCS,Excision of Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C00Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C00ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C03Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C03ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C04Z6,ICD10-PCS,Extirpate matter from 1 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02C04ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C10Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C10ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C13Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C13ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C14Z6,ICD10-PCS,Extirpate matter from 2 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02C14ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C20Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C20ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C23Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C23ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C24Z6,ICD10-PCS,Extirpate matter from 3 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02C24ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C30Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C30ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C33Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C33ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C34Z6,ICD10-PCS,Extirpate matter from 4+ Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02C34ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C40ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C43ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02C44ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02CD0ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02CD3ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02CD4ZZ,ICD10-PCS,Extirpate matter from Papillary Muscle, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02CW0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02CW3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02CW4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Desc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02CX4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02FN0ZZ,ICD10-PCS,Fragmentation in Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02FN3ZZ,ICD10-PCS,Fragmentation in Pericardium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02FN4ZZ,ICD10-PCS,Fragmentation in Pericardium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H402Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H403Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H40DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H40KZ,ICD10-PCS,Insertion of Defibrillator Lead into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H40NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H432Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H433Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H43DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H43NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H442Z,ICD10-PCS,Insertion of Monitor Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H443Z,ICD10-PCS,Insertion of Infusion Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H44DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H44KZ,ICD10-PCS,Insertion of Defib Lead into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H44NZ,ICD10-PCS,Insert of Intracard Pacer into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H60KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H63KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H64KZ,ICD10-PCS,Insertion of Defib Lead into R Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H70KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H73KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02H74KZ,ICD10-PCS,Insertion of Defib Lead into L Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HA0RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HA3RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HA4RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HK0KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HK3KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HK4KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HL0KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HL3DZ,ICD10-PCS,Insertion of Intralum Dev into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HL3KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HL3NZ,ICD10-PCS,Insertion of Intracard Pacer into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HL4KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HN0KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HN3KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HN4KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HP0DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HP3DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HP4DZ,ICD10-PCS,Insert of Intralum Dev into Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HQ0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HQ3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HQ4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HR0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HR3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HR4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HS02Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HS0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HS32Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HS3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HS42Z,ICD10-PCS,Insert of Monitor Dev into R Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HS4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HT02Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HT0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HT32Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HT3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HT42Z,ICD10-PCS,Insert of Monitor Dev into L Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HT4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HW02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HW0DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HW32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HW3DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HW42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Desc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02HW4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Desc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02HX02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HX0DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HX32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HX3DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02HX42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Asc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02HX4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Asc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02K80ZZ,ICD10-PCS,Map Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02K83ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02K84ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02LH0CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02LH0DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02LH0ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02LH3CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02LH3DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02LH3ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02LH4CZ,ICD10-PCS,Occlusion Pulm Valve w Extralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02LH4DZ,ICD10-PCS,Occlusion Pulm Valve w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02LH4ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02N40ZZ,ICD10-PCS,Release Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02N43ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02N44ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02N80ZZ,ICD10-PCS,Release Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02N83ZZ,ICD10-PCS,Release Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02N84ZZ,ICD10-PCS,Release Conduction Mechanism, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02N90ZZ,ICD10-PCS,Release Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02N93ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02N94ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02ND0ZZ,ICD10-PCS,Release Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02ND3ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02ND4ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02NF0ZZ,ICD10-PCS,Release Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02NG0ZZ,ICD10-PCS,Release Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02NH0ZZ,ICD10-PCS,Release Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02NJ0ZZ,ICD10-PCS,Release Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02NK0ZZ,ICD10-PCS,Release Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02NK3ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02NK4ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02NL0ZZ,ICD10-PCS,Release Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02NL3ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02NL4ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY02Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY03Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY07Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY08Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY0CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY0DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY0JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY0KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY32Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY33Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY37Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY38Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY3CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY3DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY3JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY3KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY42Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY43Z,ICD10-PCS,Remove of Infusion Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY47Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY48Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY4CZ,ICD10-PCS,Remove of Extralum Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY4DZ,ICD10-PCS,Remove of Intralum Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY4JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02PY4KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q00ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q03ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q04ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q10ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q13ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q14ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q20ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q23ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q24ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q30ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q33ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q34ZZ,ICD10-PCS,Repair 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q40ZZ,ICD10-PCS,Repair Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q43ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q44ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q50ZZ,ICD10-PCS,Repair Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q53ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q54ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q60ZZ,ICD10-PCS,Repair Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q63ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q64ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q70ZZ,ICD10-PCS,Repair Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q73ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q74ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q80ZZ,ICD10-PCS,Repair Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q83ZZ,ICD10-PCS,Repair Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q84ZZ,ICD10-PCS,Repair Conduction Mechanism, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q90ZZ,ICD10-PCS,Repair Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q93ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02Q94ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QA0ZZ,ICD10-PCS,Repair Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QA3ZZ,ICD10-PCS,Repair Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QA4ZZ,ICD10-PCS,Repair Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QB0ZZ,ICD10-PCS,Repair Right Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QB3ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QB4ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QC0ZZ,ICD10-PCS,Repair Left Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QC3ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QC4ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QD0ZZ,ICD10-PCS,Repair Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QD3ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QD4ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QF0ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QF0ZZ,ICD10-PCS,Repair Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QF3ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QF3ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QF4ZJ,ICD10-PCS,Repair Aort Valve created from Trunc Vlv, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QF4ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QG0ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QG0ZZ,ICD10-PCS,Repair Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QG3ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QG3ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QG4ZE,ICD10-PCS,Repair Mitral Valve fr L AV Vlv, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02QG4ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QH0ZZ,ICD10-PCS,Repair Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QH3ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QH4ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QJ0ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QJ0ZZ,ICD10-PCS,Repair Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QJ3ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QJ3ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QJ4ZG,ICD10-PCS,Repair Tricusp Valve fr R AV Vlv, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02QJ4ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QK0ZZ,ICD10-PCS,Repair Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QK3ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QK4ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QL0ZZ,ICD10-PCS,Repair Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QL3ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QL4ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QM0ZZ,ICD10-PCS,Repair Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QM3ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QM4ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QN0ZZ,ICD10-PCS,Repair Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QN3ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02QN4ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R507Z,ICD10-PCS,Replacement of Atrial Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R508Z,ICD10-PCS,Replacement of Atrial Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R50JZ,ICD10-PCS,Replacement of Atrial Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R50KZ,ICD10-PCS,Replacement of Atrial Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R547Z,ICD10-PCS,Replace of Atrial Sept with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R548Z,ICD10-PCS,Replace of Atrial Sept with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R54JZ,ICD10-PCS,Replace of Atrial Sept with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R54KZ,ICD10-PCS,Replace of Atrial Sept with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R607Z,ICD10-PCS,Replacement of Right Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R608Z,ICD10-PCS,Replacement of Right Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R60JZ,ICD10-PCS,Replacement of Right Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R60KZ,ICD10-PCS,Replacement of Right Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R647Z,ICD10-PCS,Replacement of R Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R648Z,ICD10-PCS,Replacement of R Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R64JZ,ICD10-PCS,Replacement of R Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R64KZ,ICD10-PCS,Replacement of R Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R707Z,ICD10-PCS,Replacement of Left Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R708Z,ICD10-PCS,Replacement of Left Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R70JZ,ICD10-PCS,Replacement of Left Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R70KZ,ICD10-PCS,Replacement of Left Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R747Z,ICD10-PCS,Replacement of L Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R748Z,ICD10-PCS,Replacement of L Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R74JZ,ICD10-PCS,Replacement of L Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R74KZ,ICD10-PCS,Replacement of L Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R907Z,ICD10-PCS,Replace of Chordae Tendineae with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R908Z,ICD10-PCS,Replace of Chordae Tendineae with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R90JZ,ICD10-PCS,Replace of Chordae Tendineae with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R90KZ,ICD10-PCS,Replace of Chordae Tendineae with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02R947Z,ICD10-PCS,Replace Chordae Tendineae w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02R948Z,ICD10-PCS,Replace Chordae Tendineae w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02R94JZ,ICD10-PCS,Replace Chordae Tendineae w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02R94KZ,ICD10-PCS,Replace Chordae Tendineae w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RD07Z,ICD10-PCS,Replace of Papillary Muscle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RD08Z,ICD10-PCS,Replace of Papillary Muscle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RD0JZ,ICD10-PCS,Replace of Papillary Muscle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RD0KZ,ICD10-PCS,Replace of Papillary Muscle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RD47Z,ICD10-PCS,Replace Papillary Muscle w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RD48Z,ICD10-PCS,Replace Papillary Muscle w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RD4JZ,ICD10-PCS,Replace Papillary Muscle w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RD4KZ,ICD10-PCS,Replace Papillary Muscle w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RF07Z,ICD10-PCS,Replacement of Aortic Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RF08Z,ICD10-PCS,Replacement of Aortic Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RF0JZ,ICD10-PCS,Replacement of Aortic Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RF0KZ,ICD10-PCS,Replacement of Aortic Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RF47Z,ICD10-PCS,Replace of Aortic Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RF48Z,ICD10-PCS,Replace of Aortic Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RF4JZ,ICD10-PCS,Replace of Aortic Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RF4KZ,ICD10-PCS,Replace of Aortic Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG07Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG08Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG0JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG0KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG37Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG38Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG3JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG3KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG47Z,ICD10-PCS,Replace of Mitral Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG48Z,ICD10-PCS,Replace of Mitral Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG4JZ,ICD10-PCS,Replace of Mitral Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RG4KZ,ICD10-PCS,Replace of Mitral Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RH07Z,ICD10-PCS,Replacement of Pulmonary Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RH08Z,ICD10-PCS,Replacement of Pulm Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RH0JZ,ICD10-PCS,Replacement of Pulmonary Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RH0KZ,ICD10-PCS,Replacement of Pulm Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RH47Z,ICD10-PCS,Replacement of Pulm Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RH48Z,ICD10-PCS,Replace of Pulm Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RH4JZ,ICD10-PCS,Replacement of Pulm Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RH4KZ,ICD10-PCS,Replace of Pulm Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RJ07Z,ICD10-PCS,Replacement of Tricuspid Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RJ08Z,ICD10-PCS,Replacement of Tricusp Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RJ0JZ,ICD10-PCS,Replacement of Tricuspid Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RJ0KZ,ICD10-PCS,Replacement of Tricusp Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RJ47Z,ICD10-PCS,Replace of Tricusp Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RJ48Z,ICD10-PCS,Replace of Tricusp Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RJ4JZ,ICD10-PCS,Replace of Tricusp Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RJ4KZ,ICD10-PCS,Replace of Tricusp Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RK07Z,ICD10-PCS,Replacement of Right Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RK08Z,ICD10-PCS,Replacement of R Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RK0JZ,ICD10-PCS,Replacement of Right Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RK0KZ,ICD10-PCS,Replacement of R Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RK47Z,ICD10-PCS,Replace of R Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RK48Z,ICD10-PCS,Replace of R Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RK4JZ,ICD10-PCS,Replace of R Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RK4KZ,ICD10-PCS,Replace of R Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RL07Z,ICD10-PCS,Replacement of Left Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RL08Z,ICD10-PCS,Replacement of Left Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RL0JZ,ICD10-PCS,Replacement of Left Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RL0KZ,ICD10-PCS,Replacement of Left Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RL47Z,ICD10-PCS,Replace of L Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RL48Z,ICD10-PCS,Replace of L Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RL4JZ,ICD10-PCS,Replace of L Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RL4KZ,ICD10-PCS,Replace of L Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RM07Z,ICD10-PCS,Replace of Ventricular Sept with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RM08Z,ICD10-PCS,Replace of Ventricular Sept with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RM0JZ,ICD10-PCS,Replace of Ventricular Sept with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RM0KZ,ICD10-PCS,Replace of Ventricular Sept with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RM47Z,ICD10-PCS,Replace Ventricular Sept w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RM48Z,ICD10-PCS,Replace Ventricular Sept w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RM4KZ,ICD10-PCS,Replace Ventricular Sept w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RN07Z,ICD10-PCS,Replacement of Pericardium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RN08Z,ICD10-PCS,Replacement of Pericardium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RN0JZ,ICD10-PCS,Replacement of Pericardium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RN0KZ,ICD10-PCS,Replacement of Pericardium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RN47Z,ICD10-PCS,Replace of Pericardium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RN48Z,ICD10-PCS,Replace of Pericardium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RN4JZ,ICD10-PCS,Replace of Pericardium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RN4KZ,ICD10-PCS,Replace of Pericardium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RP07Z,ICD10-PCS,Replacement of Pulmonary Trunk with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RP08Z,ICD10-PCS,Replacement of Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RP0JZ,ICD10-PCS,Replacement of Pulmonary Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RP0KZ,ICD10-PCS,Replacement of Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RP47Z,ICD10-PCS,Replacement of Pulm Trunk with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RP48Z,ICD10-PCS,Replace of Pulm Trunk with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RP4JZ,ICD10-PCS,Replacement of Pulm Trunk with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RP4KZ,ICD10-PCS,Replace of Pulm Trunk with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RQ07Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RQ08Z,ICD10-PCS,Replacement of R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RQ0JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RQ0KZ,ICD10-PCS,Replacement of R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RQ47Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RQ48Z,ICD10-PCS,Replace of R Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RQ4JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RQ4KZ,ICD10-PCS,Replace of R Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RR07Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RR08Z,ICD10-PCS,Replacement of L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RR0JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RR0KZ,ICD10-PCS,Replacement of L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RR47Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RR48Z,ICD10-PCS,Replace of L Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RR4JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RR4KZ,ICD10-PCS,Replace of L Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RS07Z,ICD10-PCS,Replacement of R Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RS08Z,ICD10-PCS,Replacement of R Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RS0JZ,ICD10-PCS,Replacement of R Pulm Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RS0KZ,ICD10-PCS,Replacement of R Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RS47Z,ICD10-PCS,Replace of R Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RS48Z,ICD10-PCS,Replace of R Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RS4JZ,ICD10-PCS,Replace of R Pulm Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RS4KZ,ICD10-PCS,Replace of R Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RT07Z,ICD10-PCS,Replacement of L Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RT08Z,ICD10-PCS,Replacement of L Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RT0JZ,ICD10-PCS,Replacement of L Pulm Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RT0KZ,ICD10-PCS,Replacement of L Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RT47Z,ICD10-PCS,Replace of L Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RT48Z,ICD10-PCS,Replace of L Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RT4JZ,ICD10-PCS,Replace of L Pulm Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RT4KZ,ICD10-PCS,Replace of L Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RV07Z,ICD10-PCS,Replacement of Sup Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RV08Z,ICD10-PCS,Replacement of Sup Vena Cava with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RV0JZ,ICD10-PCS,Replacement of Sup Vena Cava with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RV0KZ,ICD10-PCS,Replacement of Sup Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RV47Z,ICD10-PCS,Replace of Sup Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RV48Z,ICD10-PCS,Replace of Sup Vena Cava with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RV4JZ,ICD10-PCS,Replace of Sup Vena Cava with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RV4KZ,ICD10-PCS,Replace of Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RW07Z,ICD10-PCS,Replacement of Thor Aorta Desc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RW08Z,ICD10-PCS,Replace of Thor Aorta Desc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RW0JZ,ICD10-PCS,Replacement of Thor Aorta Desc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RW0KZ,ICD10-PCS,Replace of Thor Aorta Desc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RW47Z,ICD10-PCS,Replace Thor Aorta Desc w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RW48Z,ICD10-PCS,Replace Thor Aorta Desc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RW4JZ,ICD10-PCS,Replace Thor Aorta Desc w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RW4KZ,ICD10-PCS,Replace Thor Aorta Desc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RX07Z,ICD10-PCS,Replacement of Thor Aorta Asc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RX08Z,ICD10-PCS,Replacement of Thor Aorta Asc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RX0JZ,ICD10-PCS,Replacement of Thor Aorta Asc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RX0KZ,ICD10-PCS,Replacement of Thor Aorta Asc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RX47Z,ICD10-PCS,Replace of Thor Aorta Asc with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RX48Z,ICD10-PCS,Replace Thor Aorta Asc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02RX4JZ,ICD10-PCS,Replace of Thor Aorta Asc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02RX4KZ,ICD10-PCS,Replace Thor Aorta Asc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02S00ZZ,ICD10-PCS,Reposition Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02S10ZZ,ICD10-PCS,Reposition Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02SP0ZZ,ICD10-PCS,Reposition Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02SQ0ZZ,ICD10-PCS,Reposition Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02SR0ZZ,ICD10-PCS,Reposition Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02SS0ZZ,ICD10-PCS,Reposition Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02ST0ZZ,ICD10-PCS,Reposition Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02SV0ZZ,ICD10-PCS,Reposition Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02SW0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02SX0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02T80ZZ,ICD10-PCS,Resection of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02T83ZZ,ICD10-PCS,Resection of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02T90ZZ,ICD10-PCS,Resection of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02T93ZZ,ICD10-PCS,Resection of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02T94ZZ,ICD10-PCS,Resection of Chordae Tendineae, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02TD0ZZ,ICD10-PCS,Resection of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02TD3ZZ,ICD10-PCS,Resection of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02TD4ZZ,ICD10-PCS,Resection of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U507Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U508Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U50JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U50KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U537Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U538Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U53JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U53KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U547Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U548Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U54JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U54KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U607Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U608Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U60JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U60KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U637Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U638Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U63JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U63KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U647Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U648Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U64JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U64KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U707Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U708Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U70JZ,ICD10-PCS,Supplement Left Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U70KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U737Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U738Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U73KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U747Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U748Z,ICD10-PCS,Supplement Left Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U74KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U907Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U908Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U90JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U90KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U937Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U938Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U93JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U93KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02U947Z,ICD10-PCS,Supplement Chordae Tendineae w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02U948Z,ICD10-PCS,Supplement Chordae Tendineae w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02U94JZ,ICD10-PCS,Supplement Chordae Tendineae w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02U94KZ,ICD10-PCS,Supplement Chordae Tendineae w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UA07Z,ICD10-PCS,Supplement Heart with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA08Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA0JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA0KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA37Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA38Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA3JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA3KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA47Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA48Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA4JZ,ICD10-PCS,Supplement Heart with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UA4KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UD07Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UD08Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UD0JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UD0KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UD37Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UD38Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UD3JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UD3KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UD47Z,ICD10-PCS,Supplement Papillary Muscle w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UD48Z,ICD10-PCS,Supplement Papillary Muscle w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UD4JZ,ICD10-PCS,Supplement Papillary Muscle w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UD4KZ,ICD10-PCS,Supplement Papillary Muscle w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UF07J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UF07Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF08J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UF08Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF0JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UF0JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF0KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UF0KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF37J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UF37Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF38J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UF38Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF3JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UF3JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF3KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UF3KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF47J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UF47Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF48J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UF48Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF4JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UF4JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UF4KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UF4KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG07E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UG07Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG08E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UG08Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG0JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UG0JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG0KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UG0KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG37E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UG37Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG38E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UG38Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG3JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UG3JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG3KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UG3KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG47E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UG47Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG48E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UG48Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG4JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UG4JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UG4KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UG4KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH07Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH08Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH0JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH0KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH37Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH38Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH3JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH3KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH47Z,ICD10-PCS,Supplement Pulm Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH48Z,ICD10-PCS,Supplement Pulm Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH4JZ,ICD10-PCS,Supplement Pulm Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UH4KZ,ICD10-PCS,Supplement Pulm Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ07G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UJ07Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ08G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UJ08Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ0JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UJ0JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ0KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,02UJ0KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ37G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UJ37Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ38G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UJ38Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ3JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UJ3JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ3KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02UJ3KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ47G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UJ47Z,ICD10-PCS,Supplement Tricusp Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ48G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UJ48Z,ICD10-PCS,Supplement Tricusp Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ4JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UJ4JZ,ICD10-PCS,Supplement Tricusp Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UJ4KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UJ4KZ,ICD10-PCS,Supplement Tricusp Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK07Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK08Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK0JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK0KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK37Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK38Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK3JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK3KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK47Z,ICD10-PCS,Supplement R Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK48Z,ICD10-PCS,Supplement R Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK4JZ,ICD10-PCS,Supplement R Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UK4KZ,ICD10-PCS,Supplement R Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL07Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL08Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL0JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL0KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL37Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL38Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL3JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL3KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL47Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL48Z,ICD10-PCS,Supplement L Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL4JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UL4KZ,ICD10-PCS,Supplement L Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UM07Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UM08Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UM0JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UM0KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UM37Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UM38Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UM3JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UM3KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UM47Z,ICD10-PCS,Supplement Ventricular Sept w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UM48Z,ICD10-PCS,Supplement Ventricular Sept w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UM4JZ,ICD10-PCS,Supplement Ventricular Sept w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UM4KZ,ICD10-PCS,Supplement Ventricular Sept w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UN07Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN08Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN0JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN0KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN37Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN38Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN3JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN3KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN47Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN48Z,ICD10-PCS,Supplement Pericardium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN4JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UN4KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UP07Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UP08Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UP0KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UP37Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UP38Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UP3KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UP47Z,ICD10-PCS,Supplement Pulm Trunk with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UP48Z,ICD10-PCS,Supplement Pulm Trunk with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UP4KZ,ICD10-PCS,Supplement Pulm Trunk with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UQ07Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UQ08Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UQ0KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UQ37Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UQ38Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UQ3KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UQ47Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UQ48Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UQ4KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UR07Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UR08Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UR0KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UR37Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UR38Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UR3KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UR47Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UR48Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UR4KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02US07Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02US08Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02US0KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02US37Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02US38Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02US3KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02US47Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02US48Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02US4KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UT07Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UT08Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UT0KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UT37Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UT38Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UT3KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UT47Z,ICD10-PCS,Supplement L Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UT48Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UT4KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UV07Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UV08Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UV0KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UV37Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UV38Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UV3KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UV47Z,ICD10-PCS,Supplement Sup Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UV48Z,ICD10-PCS,Supplement Sup Vena Cava with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UV4KZ,ICD10-PCS,Supplement Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UW07Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UW08Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UW0KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UW37Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UW38Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UW3JZ,ICD10-PCS,Supplement Thor Aorta Desc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UW3KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UW47Z,ICD10-PCS,Supplement Thor Aorta Desc w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UW48Z,ICD10-PCS,Supplement Thor Aorta Desc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UW4JZ,ICD10-PCS,Supplement Thor Aorta Desc w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UW4KZ,ICD10-PCS,Supplement Thor Aorta Desc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UX07Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UX08Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UX0KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UX37Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UX38Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UX3JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UX3KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UX47Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UX48Z,ICD10-PCS,Supplement Thor Aorta Asc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02UX4JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02UX4KZ,ICD10-PCS,Supplement Thor Aorta Asc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02VA0CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02VA0ZZ,ICD10-PCS,Restriction of Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02VA3CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02VA3ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,02VA4CZ,ICD10-PCS,Restriction of Heart with Extralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02VA4ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,02VW0DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02VW0EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Open,,Fee Schedule,8271.00
Blue Shield,POS,02VW0FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Open,,Fee Schedule,8271.00
Blue Shield,POS,02VW3DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02VW3EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02VW3FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02VW4DZ,ICD10-PCS,Restrict Thor Aorta Desc w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02VW4EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02VW4FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02VX0DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02VX0EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Open,,Fee Schedule,8271.00
Blue Shield,POS,02VX0FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Open,,Fee Schedule,8271.00
Blue Shield,POS,02VX3DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02VX3EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02VX3FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc,,Fee Schedule,8271.00
Blue Shield,POS,02VX4DZ,ICD10-PCS,Restrict Thor Aorta Asc w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02VX4EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02VX4FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,02W50JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02W54JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WF07Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WF08Z,ICD10-PCS,Revision of Zooplastic Tissue in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WF0JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WF0KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WF47Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WF48Z,ICD10-PCS,Revision of Zooplastic in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WF4JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WF4KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WG07Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WG08Z,ICD10-PCS,Revision of Zooplastic Tissue in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WG0JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WG0KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WG47Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WG48Z,ICD10-PCS,Revision of Zooplastic in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WG4JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WG4KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WH07Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WH08Z,ICD10-PCS,Revision of Zooplastic Tissue in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WH0JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WH0KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WH47Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WH48Z,ICD10-PCS,Revision of Zooplastic in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WH4JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WH4KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WJ07Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WJ08Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WJ0JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WJ0KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WJ47Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WJ48Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WJ4JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WJ4KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WM0JZ,ICD10-PCS,Revision of Synth Sub in Ventricular Sept, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WM4JZ,ICD10-PCS,Revise of Synth Sub in Ventricular Sept, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY02Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY03Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY07Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY08Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY0CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY0DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY0JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY0KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY32Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY33Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY37Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY38Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY3CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY3DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY3JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY3KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY42Z,ICD10-PCS,Revision of Monitor Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY43Z,ICD10-PCS,Revision of Infusion Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY47Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY48Z,ICD10-PCS,Revision of Zooplastic in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY4CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY4DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY4JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,02WY4KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Fee Schedule,7902.34
Blue Shield,POS,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Fee Schedule,6876.92
Blue Shield,POS,031309M,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,031309N,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,03130AM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,03130AN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,03130JM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,03130JN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,03130KM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,03130KN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,03130ZM,ICD10-PCS,Bypass Right Subclavian Artery to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03130ZN,ICD10-PCS,Bypass Right Subclavian Artery to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Fee Schedule,6876.92
Blue Shield,POS,031409M,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,031409N,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,03140AM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,03140AN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,03140JM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,03140JN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,03140KM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,03140KN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,03140ZM,ICD10-PCS,Bypass Left Subclavian Artery to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03140ZN,ICD10-PCS,Bypass Left Subclavian Artery to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Fee Schedule,6876.92
Blue Shield,POS,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Fee Schedule,3198.57
Blue Shield,POS,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Fee Schedule,3198.57
Blue Shield,POS,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,Fee Schedule,3198.57
Blue Shield,POS,0331T,CPT4/HCPCS,HEART SYMP IMAGE PLNR,,Fee Schedule,987.79
Blue Shield,POS,0332T,CPT4/HCPCS,HEART SYMP IMAGE PLNR SPECT,,Fee Schedule,987.79
Blue Shield,POS,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Fee Schedule,6876.92
Blue Shield,POS,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,Fee Schedule,3198.57
Blue Shield,POS,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,Fee Schedule,3198.57
Blue Shield,POS,0342T,CPT4/HCPCS,THXP APHERESIS W/HDL DELIP,,Fee Schedule,6049.05
Blue Shield,POS,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Fee Schedule,987.79
Blue Shield,POS,03500ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03503ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03504ZZ,ICD10-PCS,Destruction of R Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03510ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03513ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03514ZZ,ICD10-PCS,Destruction of L Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03520ZZ,ICD10-PCS,Destruction of Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03523ZZ,ICD10-PCS,Destruction of Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03524ZZ,ICD10-PCS,Destruction of Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03530ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03533ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03534ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03540ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03543ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03544ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0375T,CPT4/HCPCS,TOTAL DISC ARTHRP ANT APPR,,Fee Schedule,987.79
Blue Shield,POS,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Fee Schedule,3198.57
Blue Shield,POS,0377T,CPT4/HCPCS,ANOSCPY INJ AGENT FOR INCONT,,Fee Schedule,6049.05
Blue Shield,POS,0378T,CPT4/HCPCS,VISUAL FIELD ASSMNT REV/RPRT,,Fee Schedule,6049.05
Blue Shield,POS,0379T,CPT4/HCPCS,VIS FIELD ASSMNT TECH SUPPT,,Fee Schedule,6049.05
Blue Shield,POS,0380T,CPT4/HCPCS,COMP ANIMAT RET IMAG SERIES,,Fee Schedule,6049.05
Blue Shield,POS,0387T,CPT4/HCPCS,LEADLESS PM INS/RPL VENTR,,Fee Schedule,6876.92
Blue Shield,POS,0388T,CPT4/HCPCS,LEADLESS PM REMOVE VENTR,,Fee Schedule,6876.92
Blue Shield,POS,0394T,CPT4/HCPCS,HDR ELCTRNC SKN SURF BRCHYTX,,Fee Schedule,12850.71
Blue Shield,POS,0395T,CPT4/HCPCS,HDR ELCTR NTRST/NTRCV BRCHTX,,Fee Schedule,12850.71
Blue Shield,POS,03B00ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B03ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B04ZZ,ICD10-PCS,Excision of R Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B10ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B13ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B14ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B20ZZ,ICD10-PCS,Excision of Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B23ZZ,ICD10-PCS,Excision of Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B24ZZ,ICD10-PCS,Excision of Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B30ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B33ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B34ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B40ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B43ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03B44ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R007Z,ICD10-PCS,Replacement of R Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R00JZ,ICD10-PCS,Replacement of R Int Mamm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R00KZ,ICD10-PCS,Replacement of R Int Mamm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R047Z,ICD10-PCS,Replace of R Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R04JZ,ICD10-PCS,Replace of R Int Mamm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R04KZ,ICD10-PCS,Replace R Int Mamm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,03R107Z,ICD10-PCS,Replacement of L Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R10JZ,ICD10-PCS,Replacement of L Int Mamm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R10KZ,ICD10-PCS,Replacement of L Int Mamm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R147Z,ICD10-PCS,Replace of L Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R14JZ,ICD10-PCS,Replace of L Int Mamm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R14KZ,ICD10-PCS,Replace L Int Mamm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,03R207Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R20JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R20KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R247Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R24JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R24KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R307Z,ICD10-PCS,Replacement of R Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R30JZ,ICD10-PCS,Replacement of R Subclav Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R30KZ,ICD10-PCS,Replacement of R Subclav Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R347Z,ICD10-PCS,Replace of R Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R34JZ,ICD10-PCS,Replace of R Subclav Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R34KZ,ICD10-PCS,Replace of R Subclav Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R407Z,ICD10-PCS,Replacement of L Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R40JZ,ICD10-PCS,Replacement of L Subclav Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R40KZ,ICD10-PCS,Replacement of L Subclav Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R447Z,ICD10-PCS,Replace of L Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R44JZ,ICD10-PCS,Replace of L Subclav Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03R44KZ,ICD10-PCS,Replace of L Subclav Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S00ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S03ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S04ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S10ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S13ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S14ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S20ZZ,ICD10-PCS,Reposition Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S23ZZ,ICD10-PCS,Reposition Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S24ZZ,ICD10-PCS,Reposition Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S30ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S33ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S34ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S40ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S43ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S44ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S50ZZ,ICD10-PCS,Reposition Right Axillary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S53ZZ,ICD10-PCS,Reposition Right Axillary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S54ZZ,ICD10-PCS,Reposition Right Axillary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S60ZZ,ICD10-PCS,Reposition Left Axillary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S63ZZ,ICD10-PCS,Reposition Left Axillary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S64ZZ,ICD10-PCS,Reposition Left Axillary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S70ZZ,ICD10-PCS,Reposition Right Brachial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S73ZZ,ICD10-PCS,Reposition Right Brachial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S74ZZ,ICD10-PCS,Reposition Right Brachial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S80ZZ,ICD10-PCS,Reposition Left Brachial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S83ZZ,ICD10-PCS,Reposition Left Brachial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S84ZZ,ICD10-PCS,Reposition Left Brachial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S90ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S93ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03S94ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SA0ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SA3ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SA4ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SB0ZZ,ICD10-PCS,Reposition Right Radial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SB3ZZ,ICD10-PCS,Reposition Right Radial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SB4ZZ,ICD10-PCS,Reposition Right Radial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SC0ZZ,ICD10-PCS,Reposition Left Radial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SC3ZZ,ICD10-PCS,Reposition Left Radial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SC4ZZ,ICD10-PCS,Reposition Left Radial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SD0ZZ,ICD10-PCS,Reposition Right Hand Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SD3ZZ,ICD10-PCS,Reposition Right Hand Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SD4ZZ,ICD10-PCS,Reposition Right Hand Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SF0ZZ,ICD10-PCS,Reposition Left Hand Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SF3ZZ,ICD10-PCS,Reposition Left Hand Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SF4ZZ,ICD10-PCS,Reposition Left Hand Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SG0ZZ,ICD10-PCS,Reposition Intracranial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SG3ZZ,ICD10-PCS,Reposition Intracranial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SG4ZZ,ICD10-PCS,Reposition Intracranial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SH0ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SH3ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SH4ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SJ0ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SJ3ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SJ4ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SK0ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SK3ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SK4ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SL0ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SL3ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SL4ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SM0ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SM3ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SM4ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SN0ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SN3ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SN4ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SP0ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SP3ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SP4ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SQ0ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SQ3ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SQ4ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SR0ZZ,ICD10-PCS,Reposition Face Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SR3ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SR4ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SS0ZZ,ICD10-PCS,Reposition Right Temporal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SS3ZZ,ICD10-PCS,Reposition Right Temporal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SS4ZZ,ICD10-PCS,Reposition Right Temporal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03ST0ZZ,ICD10-PCS,Reposition Left Temporal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03ST3ZZ,ICD10-PCS,Reposition Left Temporal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03ST4ZZ,ICD10-PCS,Reposition Left Temporal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SU0ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SU3ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SU4ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SV0ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SV3ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SV4ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SY0ZZ,ICD10-PCS,Reposition Upper Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SY3ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,03SY4ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U007Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U037Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U047Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U107Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U137Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U147Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U207Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U237Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U247Z,ICD10-PCS,Supplement Innom Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U307Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U337Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U347Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U407Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U437Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U447Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U507Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U537Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U547Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U607Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U637Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U647Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U707Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U737Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U747Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U807Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U837Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U847Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U907Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U937Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03U947Z,ICD10-PCS,Supplement R Ulnar Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UA07Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UA37Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UA47Z,ICD10-PCS,Supplement L Ulnar Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UB07Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UB37Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UB47Z,ICD10-PCS,Supplement R Radial Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UC07Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UC37Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UC47Z,ICD10-PCS,Supplement L Radial Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UD07Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UD37Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UD47Z,ICD10-PCS,Supplement R Hand Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UF07Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UF37Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UF47Z,ICD10-PCS,Supplement L Hand Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UG07Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UG37Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UG47Z,ICD10-PCS,Supplement Intracran Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UH07Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UH37Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UH47Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UJ07Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UJ37Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UJ47Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UK07Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UK37Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UK47Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UL07Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UL37Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UL47Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UM07Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UM37Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UM47Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UN07Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UN37Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UN47Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UP07Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UP37Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UP47Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UQ07Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UQ37Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UQ47Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UR07Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UR37Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UR47Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03US07Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03US37Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03US47Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UT07Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UT37Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UT47Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UU07Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UU37Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UU47Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UV07Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UV37Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UV47Z,ICD10-PCS,Supplement L Thyroid Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UY07Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UY37Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,03UY47Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Fee Schedule,3198.57
Blue Shield,POS,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Fee Schedule,6876.92
Blue Shield,POS,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Fee Schedule,3198.57
Blue Shield,POS,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Fee Schedule,3198.57
Blue Shield,POS,0410090,ICD10-PCS,BYPASS ABD AORTA ABD AORTA AUTO VENOUS TISS OPN,,Fee Schedule,8271.00
Blue Shield,POS,0410091,ICD10-PCS,Bypass Abd Aorta to Celiac Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0410092,ICD10-PCS,Bypass Abd Aorta to Mesent Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0410093,ICD10-PCS,BP ABDOMINAL AORTA RT RENL ART AUTO VEN TISS OPN,,Fee Schedule,8271.00
Blue Shield,POS,0410094,ICD10-PCS,BP ABD AORTA LT RENAL ARTERY AUTO VEN TISS OPN,,Fee Schedule,8271.00
Blue Shield,POS,0410095,ICD10-PCS,Bypass Abd Aorta to B Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0410096,ICD10-PCS,Bypass Abd Aorta to R Com Ilia with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0410097,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,0410098,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,0410099,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,041009B,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,041009C,ICD10-PCS,BP ABD AO B INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,041009D,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,041009F,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,041009G,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,041009H,ICD10-PCS,BP ABD AO RT FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,041009J,ICD10-PCS,BP ABD AO LT FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,041009K,ICD10-PCS,BYPS ABD AO B FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,041009Q,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,041009R,ICD10-PCS,BYPS ABD AO LOW ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100A0,ICD10-PCS,BYPS ABD AO ABD AO AUTO ART TISSUE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100A1,ICD10-PCS,BP ABD AO CELIAC ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100A2,ICD10-PCS,BYPS ABD AO MES ART AUTO ART TISSUE OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100A3,ICD10-PCS,BP ABD AO RT RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100A4,ICD10-PCS,BP ABD AO LT RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100A5,ICD10-PCS,BP ABD AO B RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100A6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100A7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100A8,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100A9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100AB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100AC,ICD10-PCS,BP ABDOMINAL AO BIL INTRL ILIAC ART AUTO ART OPN,,Fee Schedule,8271.00
Blue Shield,POS,04100AD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100AF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100AG,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100AH,ICD10-PCS,BP ABD AO RT FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100AJ,ICD10-PCS,BP ABD AO LT FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100AK,ICD10-PCS,BYPS ABD AO B FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100AQ,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100AR,ICD10-PCS,BYPS ABD AO LOW ART AUTO ART TISSUE OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100J0,ICD10-PCS,BYPASS ABD AO ABD AO SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100J1,ICD10-PCS,BYPS ABD AO CELIAC ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100J2,ICD10-PCS,BYPASS ABD AO MES ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100J3,ICD10-PCS,BYPS ABD AO RT RENL ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100J4,ICD10-PCS,BYPS ABD AO LT RENL ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100J5,ICD10-PCS,BYPS ABD AO BIL RENL ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100J6,ICD10-PCS,BP ABD AO RT COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100J7,ICD10-PCS,BP ABD AO LT COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100J8,ICD10-PCS,BP ABD AO B COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100J9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100JB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100JC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100JD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100JF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100JG,ICD10-PCS,BP ABD AO B EXT ILIAC ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100JH,ICD10-PCS,BYPS ABD AO RT FEM ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100JJ,ICD10-PCS,BYPS ABD AO LT FEM ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100JK,ICD10-PCS,BYPS ABD AO BIL FEM ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100JQ,ICD10-PCS,BP ABD AO LOW EXTREM ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100JR,ICD10-PCS,BYPASS ABD AO LOW ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100K0,ICD10-PCS,BP ABD AO ABD AO NONAUTO TISS SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100K1,ICD10-PCS,BP ABD AO CELIAC ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100K2,ICD10-PCS,BP ABD AO MES ART NONAUTO TISS SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100K3,ICD10-PCS,BP ABD AO RT RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100K4,ICD10-PCS,BP ABD AO LT RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100K5,ICD10-PCS,BP ABD AO B RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100K6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100K7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100K8,ICD10-PCS,BP ABD AO B CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100K9,ICD10-PCS,BP ABD AO RT IIA NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100KB,ICD10-PCS,BP ABD AO LT IIA NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100KC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100KD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100KF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100KG,ICD10-PCS,BP ABD AO B EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100KH,ICD10-PCS,BP ABD AO RT FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100KJ,ICD10-PCS,BP ABD AO LT FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100KK,ICD10-PCS,BP ABD AO B FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100KQ,ICD10-PCS,BP ABD AO LOW EXT ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,POS,04100KR,ICD10-PCS,BP ABD AO LOW ART NONAUTO TISS SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100Z0,ICD10-PCS,BYPASS ABD AORTA ABDOMINAL AORTA OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100Z1,ICD10-PCS,BYPASS ABD AORTA CELIAC ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100Z2,ICD10-PCS,BYPASS ABD AORTA MESENTERIC ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100Z3,ICD10-PCS,BYPASS ABD AORTA RT RENAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100Z4,ICD10-PCS,BYPASS ABD AORTA LT RENAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100Z5,ICD10-PCS,BYPASS ABDDOMINAL AORTA BILATERAL RENAL ART OPEN,,Fee Schedule,8271.00
Blue Shield,POS,04100Z6,ICD10-PCS,BYPASS ABD AO RT COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100Z7,ICD10-PCS,BYPASS ABD AO LT COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100Z8,ICD10-PCS,BYPASS ABD AO BIL COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100Z9,ICD10-PCS,BYPASS ABD AO RT INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100ZB,ICD10-PCS,BYPASS ABD AO LT INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100ZC,ICD10-PCS,BYPASS ABD AO BIL INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100ZD,ICD10-PCS,BYPASS ABD AORTA RT EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100ZF,ICD10-PCS,BYPASS ABD AORTA LT EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100ZG,ICD10-PCS,BYPASS ABD AO BIL EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100ZH,ICD10-PCS,BYPASS ABD AORTA RT FEMORAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100ZJ,ICD10-PCS,BYPASS ABD AORTA LT FEMORAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100ZK,ICD10-PCS,BYPASS ABD AO BIL FEMORAL ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,POS,04100ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04100ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0410490,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0410491,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0410492,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0410493,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0410494,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0410495,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0410496,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0410497,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0410498,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0410499,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041049B,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041049C,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041049D,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041049F,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041049G,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041049H,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041049J,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041049K,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041049Q,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041049R,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104A0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104A1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104A2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104A3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104A4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104A5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104A6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104A7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104A8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104A9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104AB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104AC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104AD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104AF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104AG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104AH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104AJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104AK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104AQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104AR,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104J0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104J1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104J2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104J3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104J4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104J5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104J6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104J7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104J8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104J9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104JB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104JC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104JD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104JF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104JG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104JH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104JJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104JK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104JQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104JR,ICD10-PCS,Bypass Abd Aorta to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104K0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104K1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104K2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104K3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104K4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104K5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104K6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104K7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104K8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104K9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104KB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104KC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104KD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104KF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104KG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104KH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104KJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104KK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104KQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104KR,ICD10-PCS,Bypass Abd Aorta to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04104Z0,ICD10-PCS,Bypass Abdominal Aorta to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104Z1,ICD10-PCS,Bypass Abdominal Aorta to Celiac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104Z2,ICD10-PCS,Bypass Abdominal Aorta to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104Z3,ICD10-PCS,Bypass Abdominal Aorta to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104Z4,ICD10-PCS,Bypass Abdominal Aorta to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104Z5,ICD10-PCS,Bypass Abdominal Aorta to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104Z6,ICD10-PCS,Bypass Abdominal Aorta to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104Z7,ICD10-PCS,Bypass Abdominal Aorta to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104Z8,ICD10-PCS,Bypass Abdominal Aorta to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104Z9,ICD10-PCS,Bypass Abdominal Aorta to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104ZB,ICD10-PCS,Bypass Abdominal Aorta to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104ZC,ICD10-PCS,Bypass Abdominal Aorta to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104ZD,ICD10-PCS,Bypass Abdominal Aorta to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104ZF,ICD10-PCS,Bypass Abdominal Aorta to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104ZG,ICD10-PCS,Bypass Abdominal Aorta to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104ZH,ICD10-PCS,Bypass Abdominal Aorta to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104ZJ,ICD10-PCS,Bypass Abdominal Aorta to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104ZK,ICD10-PCS,Bypass Abdominal Aorta to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04104ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Fee Schedule,3198.57
Blue Shield,POS,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Fee Schedule,3198.57
Blue Shield,POS,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Fee Schedule,4891.93
Blue Shield,POS,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Fee Schedule,4891.93
Blue Shield,POS,0414093,ICD10-PCS,Bypass Splenic Art to R Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0414094,ICD10-PCS,Bypass Splenic Art to L Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0414095,ICD10-PCS,Bypass Splenic Art to B Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04140A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,04140A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,04140A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,04140J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,04140J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,04140J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,04140K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,04140K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,04140K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,04140Z3,ICD10-PCS,Bypass Splenic Artery to Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04140Z4,ICD10-PCS,Bypass Splenic Artery to Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04140Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0414493,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0414494,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0414495,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04144A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04144A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04144A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04144J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04144J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04144J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04144K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04144K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04144K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04144Z3,ICD10-PCS,Bypass Splenic Artery to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04144Z4,ICD10-PCS,Bypass Splenic Artery to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04144Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Fee Schedule,4891.93
Blue Shield,POS,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Fee Schedule,4891.93
Blue Shield,POS,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Fee Schedule,4891.93
Blue Shield,POS,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Fee Schedule,987.79
Blue Shield,POS,041C090,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C091,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C092,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C093,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C094,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C095,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C096,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C097,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C098,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C099,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C09B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C09C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C09D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C09F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C09G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C09H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C09J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C09K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C09Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C09R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041C0Z0,ICD10-PCS,Bypass Right Common Iliac Artery to Abd Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0Z3,ICD10-PCS,Bypass Right Common Iliac Artery to R Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0Z4,ICD10-PCS,Bypass Right Common Iliac Artery to L Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0Z5,ICD10-PCS,Bypass Right Common Iliac Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0ZH,ICD10-PCS,Bypass Right Common Iliac Artery to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0ZJ,ICD10-PCS,Bypass Right Common Iliac Artery to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0ZK,ICD10-PCS,Bypass Right Common Iliac Artery to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C0ZR,ICD10-PCS,Bypass Right Common Iliac Artery to Low Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C490,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C491,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C492,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C493,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C494,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C495,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C496,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C497,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C498,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C499,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C49B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C49C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C49D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C49F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C49G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C49H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C49J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C49K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C49Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C49R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041C4Z0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4Z3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4Z4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4Z5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4ZH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4ZJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4ZK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041C4ZR,ICD10-PCS,Bypass R Com Iliac Art to Low Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D090,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D091,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D092,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D093,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D094,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D095,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D096,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D097,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D098,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D099,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D09B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D09C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D09D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D09F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D09G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D09H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D09J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D09K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D09Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D09R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041D0Z0,ICD10-PCS,Bypass Left Common Iliac Artery to Abd Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0Z1,ICD10-PCS,Bypass Left Common Iliac Artery to Celiac Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0Z2,ICD10-PCS,Bypass Left Common Iliac Artery to Mesent Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0Z3,ICD10-PCS,Bypass Left Common Iliac Artery to R Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0Z4,ICD10-PCS,Bypass Left Common Iliac Artery to L Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0Z5,ICD10-PCS,Bypass Left Common Iliac Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0Z6,ICD10-PCS,Bypass Left Common Iliac Artery to R Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0Z7,ICD10-PCS,Bypass Left Common Iliac Artery to L Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0Z8,ICD10-PCS,Bypass Left Common Iliac Artery to B Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0Z9,ICD10-PCS,Bypass Left Common Iliac Artery to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0ZB,ICD10-PCS,Bypass Left Common Iliac Artery to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0ZC,ICD10-PCS,Bypass Left Common Iliac Artery to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0ZD,ICD10-PCS,Bypass Left Common Iliac Artery to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0ZF,ICD10-PCS,Bypass Left Common Iliac Artery to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0ZG,ICD10-PCS,Bypass Left Common Iliac Artery to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0ZH,ICD10-PCS,Bypass Left Common Iliac Artery to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0ZJ,ICD10-PCS,Bypass Left Common Iliac Artery to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0ZK,ICD10-PCS,Bypass Left Common Iliac Artery to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0ZQ,ICD10-PCS,Bypass Left Common Iliac Artery to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D0ZR,ICD10-PCS,Bypass Left Common Iliac Artery to Low Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D490,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D491,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D492,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D493,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D494,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D495,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D496,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D497,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D498,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D499,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D49B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D49C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D49D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D49F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D49G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D49H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D49J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D49K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D49Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D49R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041D4Z0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4Z1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4Z2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4Z3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4Z4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4Z5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4Z6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4Z7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4Z8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4Z9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4ZB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4ZC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4ZD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4ZF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4ZG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4ZH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4ZJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4ZK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4ZQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041D4ZR,ICD10-PCS,Bypass L Com Iliac Art to Low Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E099,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E09B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E09C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E09D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E09F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E09G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E09H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E09J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E09K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E09P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E09Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041E0Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E0ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E0ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E0ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E0ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E0ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E0ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E0ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E0ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E0ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E0ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E499,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E49B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E49C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E49D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E49F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E49G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E49H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E49J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E49K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E49P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E49Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041E4Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E4ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E4ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E4ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E4ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E4ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E4ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E4ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E4ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E4ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041E4ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F099,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F09B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F09C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F09D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F09F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F09G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F09H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F09J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F09K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F09P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F09Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041F0Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F0ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F0ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F0ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F0ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F0ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F0ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F0ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F0ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F0ZP,ICD10-PCS,Bypass Left Internal Iliac Artery to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F0ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F499,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F49B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F49C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F49D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F49F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F49G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F49H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F49J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F49K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F49P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F49Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041F4Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F4ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F4ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F4ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F4ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F4ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F4ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F4ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F4ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F4ZP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041F4ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H099,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H09B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H09C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H09D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H09F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H09G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H09H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H09J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H09K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H09P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H09Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041H0Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H0ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H0ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H0ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H0ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H0ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H0ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H0ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H0ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H0ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H0ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H499,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H49B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H49C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H49D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H49F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H49G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H49H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H49J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H49K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H49P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H49Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041H4Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H4ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H4ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H4ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H4ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H4ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H4ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H4ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H4ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H4ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041H4ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J099,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J09B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J09C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J09D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J09F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J09G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J09H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J09J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J09K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J09P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J09Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,041J0Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J0ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J0ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J0ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J0ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J0ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J0ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J0ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J0ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J0ZP,ICD10-PCS,Bypass Left External Iliac Artery to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J0ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J499,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J49B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J49C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J49D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J49F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J49G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J49H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J49J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J49K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J49P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J49Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,041J4Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J4ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J4ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J4ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J4ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J4ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J4ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J4ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J4ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J4ZP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,041J4ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Fee Schedule,987.79
Blue Shield,POS,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Fee Schedule,987.79
Blue Shield,POS,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Fee Schedule,4891.93
Blue Shield,POS,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Fee Schedule,4891.93
Blue Shield,POS,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Fee Schedule,4891.93
Blue Shield,POS,0443T,CPT4/HCPCS,R-T SPCTRL ALYS PRST8 TISS,,Fee Schedule,4280.44
Blue Shield,POS,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Fee Schedule,3198.57
Blue Shield,POS,04500ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04503ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04504ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Fee Schedule,3198.57
Blue Shield,POS,04510ZZ,ICD10-PCS,Destruction of Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04513ZZ,ICD10-PCS,Destruction of Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04514ZZ,ICD10-PCS,Destruction of Celiac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,Fee Schedule,987.79
Blue Shield,POS,04520ZZ,ICD10-PCS,Destruction of Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04523ZZ,ICD10-PCS,Destruction of Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04524ZZ,ICD10-PCS,Destruction of Gastric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,Fee Schedule,987.79
Blue Shield,POS,04530ZZ,ICD10-PCS,Destruction of Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04533ZZ,ICD10-PCS,Destruction of Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04534ZZ,ICD10-PCS,Destruction of Hepatic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Fee Schedule,987.79
Blue Shield,POS,04540ZZ,ICD10-PCS,Destruction of Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04543ZZ,ICD10-PCS,Destruction of Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04544ZZ,ICD10-PCS,Destruction of Splenic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Fee Schedule,987.79
Blue Shield,POS,04550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04554ZZ,ICD10-PCS,Destruction of Sup Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,Fee Schedule,987.79
Blue Shield,POS,04560ZZ,ICD10-PCS,Destruction of Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04563ZZ,ICD10-PCS,Destruction of Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04564ZZ,ICD10-PCS,Destruction of Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,Fee Schedule,987.79
Blue Shield,POS,04570ZZ,ICD10-PCS,Destruction of Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04573ZZ,ICD10-PCS,Destruction of Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04574ZZ,ICD10-PCS,Destruction of Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Fee Schedule,987.79
Blue Shield,POS,04580ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04583ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04584ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Fee Schedule,987.79
Blue Shield,POS,04590ZZ,ICD10-PCS,Destruction of Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04593ZZ,ICD10-PCS,Destruction of Right Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04594ZZ,ICD10-PCS,Destruction of Right Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,Fee Schedule,987.79
Blue Shield,POS,045A0ZZ,ICD10-PCS,Destruction of Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,045A3ZZ,ICD10-PCS,Destruction of Left Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,045A4ZZ,ICD10-PCS,Destruction of Left Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,045B0ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,045B3ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,045B4ZZ,ICD10-PCS,Destruction of Inf Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,045C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,045C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,045C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,045D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,045D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,045D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,045E0ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,045E3ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,045E4ZZ,ICD10-PCS,Destruction of R Int Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,045F0ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,045F3ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,045F4ZZ,ICD10-PCS,Destruction of L Int Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,045H0ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,045H3ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,045H4ZZ,ICD10-PCS,Destruction of R Ext Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,045J0ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,045J3ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,045J4ZZ,ICD10-PCS,Destruction of L Ext Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Fee Schedule,987.79
Blue Shield,POS,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,Fee Schedule,987.79
Blue Shield,POS,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,Fee Schedule,3198.57
Blue Shield,POS,0474T,CPT4/HCPCS,INSJ AQUEOUS DRG DEV IO RSVR,,Fee Schedule,3198.57
Blue Shield,POS,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Fee Schedule,4891.93
Blue Shield,POS,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Fee Schedule,4891.93
Blue Shield,POS,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Fee Schedule,6049.05
Blue Shield,POS,0482T,CPT4/HCPCS,ABSL QUAN MYOCRD BLD FLO PET,,Fee Schedule,3198.57
Blue Shield,POS,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,Fee Schedule,3198.57
Blue Shield,POS,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,Fee Schedule,3198.57
Blue Shield,POS,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Fee Schedule,6049.05
Blue Shield,POS,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Fee Schedule,6049.05
Blue Shield,POS,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Fee Schedule,4891.93
Blue Shield,POS,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Fee Schedule,4891.93
Blue Shield,POS,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,Fee Schedule,3198.57
Blue Shield,POS,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Fee Schedule,4280.44
Blue Shield,POS,04B00ZZ,ICD10-PCS,Excision of Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B03ZZ,ICD10-PCS,Excision of Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B04ZZ,ICD10-PCS,Excision of Abdominal Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B10ZZ,ICD10-PCS,Excision of Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B13ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B14ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B20ZZ,ICD10-PCS,Excision of Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B23ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B24ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B30ZZ,ICD10-PCS,Excision of Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B33ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B34ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B40ZZ,ICD10-PCS,Excision of Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B43ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B44ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B60ZZ,ICD10-PCS,Excision of Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B63ZZ,ICD10-PCS,Excision of Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B64ZZ,ICD10-PCS,Excision of Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B70ZZ,ICD10-PCS,Excision of Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B73ZZ,ICD10-PCS,Excision of Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B74ZZ,ICD10-PCS,Excision of Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B80ZZ,ICD10-PCS,Excision of Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B83ZZ,ICD10-PCS,Excision of Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B84ZZ,ICD10-PCS,Excision of Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B90ZZ,ICD10-PCS,Excision of Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B93ZZ,ICD10-PCS,Excision of Right Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04B94ZZ,ICD10-PCS,Excision of Right Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BA0ZZ,ICD10-PCS,Excision of Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BA3ZZ,ICD10-PCS,Excision of Left Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BA4ZZ,ICD10-PCS,Excision of Left Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BB0ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BB3ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BB4ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BE0ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BE3ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BE4ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BF0ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BF3ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BF4ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BH0ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BH3ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BH4ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BJ0ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BJ3ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04BJ4ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04C00ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04C03ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04C04ZZ,ICD10-PCS,Extirpation of Matter from Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R007Z,ICD10-PCS,Replacement of Abdominal Aorta with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R00JZ,ICD10-PCS,Replacement of Abdominal Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R00KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R047Z,ICD10-PCS,Replacement of Abd Aorta with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R04JZ,ICD10-PCS,Replacement of Abd Aorta with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R04KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R107Z,ICD10-PCS,Replacement of Celiac Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R10JZ,ICD10-PCS,Replacement of Celiac Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R10KZ,ICD10-PCS,Replacement of Celiac Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R147Z,ICD10-PCS,Replacement of Celiac Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R14JZ,ICD10-PCS,Replacement of Celiac Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R14KZ,ICD10-PCS,Replace of Celiac Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R207Z,ICD10-PCS,Replacement of Gastric Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R20JZ,ICD10-PCS,Replacement of Gastric Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R20KZ,ICD10-PCS,Replacement of Gastric Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R247Z,ICD10-PCS,Replace of Gastric Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R24JZ,ICD10-PCS,Replace of Gastric Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R24KZ,ICD10-PCS,Replace of Gastric Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R307Z,ICD10-PCS,Replacement of Hepatic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R30JZ,ICD10-PCS,Replacement of Hepatic Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R30KZ,ICD10-PCS,Replacement of Hepatic Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R347Z,ICD10-PCS,Replace of Hepatic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R34JZ,ICD10-PCS,Replace of Hepatic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R34KZ,ICD10-PCS,Replace of Hepatic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R407Z,ICD10-PCS,Replacement of Splenic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R40JZ,ICD10-PCS,Replacement of Splenic Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R40KZ,ICD10-PCS,Replacement of Splenic Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R447Z,ICD10-PCS,Replace of Splenic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R44JZ,ICD10-PCS,Replace of Splenic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R44KZ,ICD10-PCS,Replace of Splenic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R507Z,ICD10-PCS,Replacement of Sup Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R50JZ,ICD10-PCS,Replacement of Sup Mesent Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R50KZ,ICD10-PCS,Replacement of Sup Mesent Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R547Z,ICD10-PCS,Replace of Sup Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R54JZ,ICD10-PCS,Replace of Sup Mesent Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R54KZ,ICD10-PCS,Replace Sup Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04R607Z,ICD10-PCS,Replacement of R Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R60JZ,ICD10-PCS,Replacement of R Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R60KZ,ICD10-PCS,Replacement of R Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R647Z,ICD10-PCS,Replace of R Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R64JZ,ICD10-PCS,Replace of R Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R64KZ,ICD10-PCS,Replace of R Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R707Z,ICD10-PCS,Replacement of L Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R70JZ,ICD10-PCS,Replacement of L Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R70KZ,ICD10-PCS,Replacement of L Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R747Z,ICD10-PCS,Replace of L Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R74JZ,ICD10-PCS,Replace of L Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R74KZ,ICD10-PCS,Replace of L Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R807Z,ICD10-PCS,Replacement of Mid Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R80JZ,ICD10-PCS,Replacement of Mid Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R80KZ,ICD10-PCS,Replacement of Mid Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R847Z,ICD10-PCS,Replace of Mid Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R84JZ,ICD10-PCS,Replace of Mid Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R84KZ,ICD10-PCS,Replace of Mid Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R907Z,ICD10-PCS,Replacement of R Renal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R90JZ,ICD10-PCS,Replacement of R Renal Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R90KZ,ICD10-PCS,Replacement of R Renal Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R947Z,ICD10-PCS,Replace of R Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R94JZ,ICD10-PCS,Replace of R Renal Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04R94KZ,ICD10-PCS,Replace of R Renal Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RA07Z,ICD10-PCS,Replacement of L Renal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RA0JZ,ICD10-PCS,Replacement of L Renal Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RA0KZ,ICD10-PCS,Replacement of L Renal Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RA47Z,ICD10-PCS,Replace of L Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RA4JZ,ICD10-PCS,Replace of L Renal Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RA4KZ,ICD10-PCS,Replace of L Renal Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RB07Z,ICD10-PCS,Replacement of Inf Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RB0JZ,ICD10-PCS,Replacement of Inf Mesent Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RB0KZ,ICD10-PCS,Replacement of Inf Mesent Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RB47Z,ICD10-PCS,Replace of Inf Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RB4JZ,ICD10-PCS,Replace of Inf Mesent Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RB4KZ,ICD10-PCS,Replace Inf Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RC07Z,ICD10-PCS,Replacement of R Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RC0JZ,ICD10-PCS,Replacement of R Com Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RC0KZ,ICD10-PCS,Replace of R Com Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RC47Z,ICD10-PCS,Replace R Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RC4JZ,ICD10-PCS,Replace R Com Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RC4KZ,ICD10-PCS,Replace R Com Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RD07Z,ICD10-PCS,Replacement of L Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RD0JZ,ICD10-PCS,Replacement of L Com Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RD0KZ,ICD10-PCS,Replace of L Com Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RD47Z,ICD10-PCS,Replace L Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RD4JZ,ICD10-PCS,Replace L Com Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RD4KZ,ICD10-PCS,Replace L Com Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RE07Z,ICD10-PCS,Replacement of R Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RE0JZ,ICD10-PCS,Replacement of R Int Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RE0KZ,ICD10-PCS,Replace of R Int Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RE47Z,ICD10-PCS,Replace R Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RE4JZ,ICD10-PCS,Replace R Int Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RE4KZ,ICD10-PCS,Replace R Int Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RF07Z,ICD10-PCS,Replacement of L Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RF0JZ,ICD10-PCS,Replacement of L Int Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RF0KZ,ICD10-PCS,Replace of L Int Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RF47Z,ICD10-PCS,Replace L Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RF4JZ,ICD10-PCS,Replace L Int Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RF4KZ,ICD10-PCS,Replace L Int Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RH07Z,ICD10-PCS,Replacement of R Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RH0JZ,ICD10-PCS,Replacement of R Ext Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RH0KZ,ICD10-PCS,Replace of R Ext Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RH47Z,ICD10-PCS,Replace R Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RH4JZ,ICD10-PCS,Replace R Ext Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RH4KZ,ICD10-PCS,Replace R Ext Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RJ07Z,ICD10-PCS,Replacement of L Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RJ0JZ,ICD10-PCS,Replacement of L Ext Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RJ0KZ,ICD10-PCS,Replace of L Ext Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04RJ47Z,ICD10-PCS,Replace L Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RJ4JZ,ICD10-PCS,Replace L Ext Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04RJ4KZ,ICD10-PCS,Replace L Ext Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04S00ZZ,ICD10-PCS,Reposition Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S03ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S04ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S10ZZ,ICD10-PCS,Reposition Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S13ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S14ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S20ZZ,ICD10-PCS,Reposition Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S23ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S24ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S30ZZ,ICD10-PCS,Reposition Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S33ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S34ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S40ZZ,ICD10-PCS,Reposition Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S43ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S44ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S60ZZ,ICD10-PCS,Reposition Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S63ZZ,ICD10-PCS,Reposition Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S64ZZ,ICD10-PCS,Reposition Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S70ZZ,ICD10-PCS,Reposition Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S73ZZ,ICD10-PCS,Reposition Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S74ZZ,ICD10-PCS,Reposition Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S80ZZ,ICD10-PCS,Reposition Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S83ZZ,ICD10-PCS,Reposition Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04S84ZZ,ICD10-PCS,Reposition Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SB0ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SB3ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SB4ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SE0ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SE3ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SE4ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SF0ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SF3ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SF4ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SH0ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SH3ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SH4ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SJ0ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SJ3ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SJ4ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SK0ZZ,ICD10-PCS,Reposition Right Femoral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SK3ZZ,ICD10-PCS,Reposition Right Femoral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SK4ZZ,ICD10-PCS,Reposition Right Femoral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SL0ZZ,ICD10-PCS,Reposition Left Femoral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SL3ZZ,ICD10-PCS,Reposition Left Femoral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SL4ZZ,ICD10-PCS,Reposition Left Femoral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SM0ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SM3ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SM4ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SN0ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SN3ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SN4ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SP0ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SP3ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SP4ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SQ0ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SQ3ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SQ4ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SR0ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SR3ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SR4ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SS0ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SS3ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SS4ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04ST0ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04ST3ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04ST4ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SU0ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SU3ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SU4ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SV0ZZ,ICD10-PCS,Reposition Right Foot Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SV3ZZ,ICD10-PCS,Reposition Right Foot Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SV4ZZ,ICD10-PCS,Reposition Right Foot Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SW0ZZ,ICD10-PCS,Reposition Left Foot Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SW3ZZ,ICD10-PCS,Reposition Left Foot Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SW4ZZ,ICD10-PCS,Reposition Left Foot Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SY0ZZ,ICD10-PCS,Reposition Lower Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SY3ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,04SY4ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U007Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U037Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U047Z,ICD10-PCS,Supplement Abd Aorta with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U107Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U137Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U147Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U207Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U237Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U247Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U307Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U337Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U347Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U407Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U437Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U447Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U507Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U537Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U547Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U607Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U637Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U647Z,ICD10-PCS,Supplement R Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U707Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U737Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U747Z,ICD10-PCS,Supplement L Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U807Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U837Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U847Z,ICD10-PCS,Supplement Mid Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U907Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U937Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04U947Z,ICD10-PCS,Supplement R Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UA07Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UA37Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UA47Z,ICD10-PCS,Supplement L Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UB07Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UB37Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UB47Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UC07Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UC37Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UC47Z,ICD10-PCS,Supplement R Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04UD07Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UD37Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UD47Z,ICD10-PCS,Supplement L Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04UE07Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UE37Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UE47Z,ICD10-PCS,Supplement R Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04UF07Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UF37Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UF47Z,ICD10-PCS,Supplement L Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04UH07Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UH37Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UH47Z,ICD10-PCS,Supplement R Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04UJ07Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UJ37Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UJ47Z,ICD10-PCS,Supplement L Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,04UK07Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UK37Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UK47Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UL07Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UL37Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UL47Z,ICD10-PCS,Supplement L Femor Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UM07Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UM37Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UM47Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UN07Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UN37Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UN47Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UP07Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UP37Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UP47Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UQ07Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UQ37Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UQ47Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UR07Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UR37Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UR47Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04US07Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04US37Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04US47Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UT07Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UT37Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UT47Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UU07Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UU37Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UU47Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UV07Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UV37Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UV47Z,ICD10-PCS,Supplement R Foot Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UW07Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UW37Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UW47Z,ICD10-PCS,Supplement L Foot Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UY07Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UY37Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,04UY47Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,051007Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,051009Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05100AY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05100JY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05100KY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05100ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,051047Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,051049Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05104AY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05104JY,ICD10-PCS,BYPASS AZYGOS VEIN UP VEIN SYNTH SUB PERC ENDO,,Fee Schedule,8271.00
Blue Shield,POS,05104KY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05104ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,051107Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,051109Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,05110AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,05110JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,05110KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,05110ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,051147Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,051149Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05114AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05114JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05114KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05114ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,051307Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,051309Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05130AY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05130JY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05130KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,05130ZY,ICD10-PCS,Bypass Right Innominate Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,051347Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,051349Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05134AY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05134JY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05134KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05134ZY,ICD10-PCS,Bypass Right Innominate Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,051407Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,051409Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05140AY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05140JY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05140KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,05140ZY,ICD10-PCS,Bypass Left Innominate Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,051447Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,051449Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05144AY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05144JY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05144KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05144ZY,ICD10-PCS,Bypass Left Innominate Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,051507Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,051509Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,05150AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,05150JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,05150KY,ICD10-PCS,BYPS RT SV UP VEIN NONAUT SUB OPEN,,Fee Schedule,8271.00
Blue Shield,POS,05150ZY,ICD10-PCS,Bypass Right Subclavian Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,051547Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,051549Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05154AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05154JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05154KY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05154ZY,ICD10-PCS,Bypass Right Subclavian Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,051607Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,051609Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,POS,05160AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,POS,05160JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,05160KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,POS,05160ZY,ICD10-PCS,Bypass Left Subclavian Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,051647Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,051649Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05164AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05164JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05164KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05164ZY,ICD10-PCS,Bypass Left Subclavian Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05500ZZ,ICD10-PCS,Destruction of Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05503ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05504ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,05510ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05513ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05514ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05530ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05533ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05534ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05540ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05543ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05544ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05550ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05553ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05554ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05560ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05563ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05564ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B00ZZ,ICD10-PCS,Excision of Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B03ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B04ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B10ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B13ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B14ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B30ZZ,ICD10-PCS,Excision of Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B33ZZ,ICD10-PCS,Excision of Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B34ZZ,ICD10-PCS,Excision of Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B40ZZ,ICD10-PCS,Excision of Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B43ZZ,ICD10-PCS,Excision of Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B44ZZ,ICD10-PCS,Excision of Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B50ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B53ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B54ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B60ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B63ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05B64ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R007Z,ICD10-PCS,Replacement of Azygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R00JZ,ICD10-PCS,Replacement of Azygos Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R00KZ,ICD10-PCS,Replacement of Azygos Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R047Z,ICD10-PCS,Replace of Azygos Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R04JZ,ICD10-PCS,Replace of Azygos Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R04KZ,ICD10-PCS,Replace of Azygos Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R107Z,ICD10-PCS,Replacement of Hemiazygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R10JZ,ICD10-PCS,Replacement of Hemiazygos Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R10KZ,ICD10-PCS,Replace of Hemiazygos Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R147Z,ICD10-PCS,Replace Hemiazygos Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05R14JZ,ICD10-PCS,Replace Hemiazygos Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05R14KZ,ICD10-PCS,Replace Hemiazygos Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05R307Z,ICD10-PCS,Replacement of R Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R30JZ,ICD10-PCS,Replacement of R Innom Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R30KZ,ICD10-PCS,Replacement of R Innom Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R347Z,ICD10-PCS,Replace of R Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R34JZ,ICD10-PCS,Replace of R Innom Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R34KZ,ICD10-PCS,Replace of R Innom Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R407Z,ICD10-PCS,Replacement of L Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R40JZ,ICD10-PCS,Replacement of L Innom Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R40KZ,ICD10-PCS,Replacement of L Innom Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R447Z,ICD10-PCS,Replace of L Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R44JZ,ICD10-PCS,Replace of L Innom Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R44KZ,ICD10-PCS,Replace of L Innom Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R507Z,ICD10-PCS,Replacement of R Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R50JZ,ICD10-PCS,Replacement of R Subclav Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R50KZ,ICD10-PCS,Replacement of R Subclav Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R547Z,ICD10-PCS,Replace of R Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R54JZ,ICD10-PCS,Replace of R Subclav Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R54KZ,ICD10-PCS,Replace R Subclav Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05R607Z,ICD10-PCS,Replacement of L Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R60JZ,ICD10-PCS,Replacement of L Subclav Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R60KZ,ICD10-PCS,Replacement of L Subclav Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R647Z,ICD10-PCS,Replace of L Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R64JZ,ICD10-PCS,Replace of L Subclav Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05R64KZ,ICD10-PCS,Replace L Subclav Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05S00ZZ,ICD10-PCS,Reposition Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S03ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S04ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S10ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S13ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S14ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S30ZZ,ICD10-PCS,Reposition Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S33ZZ,ICD10-PCS,Reposition Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S34ZZ,ICD10-PCS,Reposition Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S40ZZ,ICD10-PCS,Reposition Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S43ZZ,ICD10-PCS,Reposition Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S44ZZ,ICD10-PCS,Reposition Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S50ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S53ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S54ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S60ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S63ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S64ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S70ZZ,ICD10-PCS,Reposition Right Axillary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S73ZZ,ICD10-PCS,REPOSITION RIGHT AXILLARY VEIN PERQ,,Fee Schedule,8271.00
Blue Shield,POS,05S74ZZ,ICD10-PCS,Reposition Right Axillary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S80ZZ,ICD10-PCS,Reposition Left Axillary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S83ZZ,ICD10-PCS,Reposition Left Axillary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S84ZZ,ICD10-PCS,Reposition Left Axillary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S90ZZ,ICD10-PCS,Reposition Right Brachial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S93ZZ,ICD10-PCS,Reposition Right Brachial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05S94ZZ,ICD10-PCS,Reposition Right Brachial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SA0ZZ,ICD10-PCS,Reposition Left Brachial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SA3ZZ,ICD10-PCS,Reposition Left Brachial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SA4ZZ,ICD10-PCS,Reposition Left Brachial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SB0ZZ,ICD10-PCS,Reposition Right Basilic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SB3ZZ,ICD10-PCS,Reposition Right Basilic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SB4ZZ,ICD10-PCS,Reposition Right Basilic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SC0ZZ,ICD10-PCS,Reposition Left Basilic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SC3ZZ,ICD10-PCS,Reposition Left Basilic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SC4ZZ,ICD10-PCS,Reposition Left Basilic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SD0ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SD3ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SD4ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SF0ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SF3ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SF4ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SG0ZZ,ICD10-PCS,Reposition Right Hand Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SG3ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SG4ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SH0ZZ,ICD10-PCS,Reposition Left Hand Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SH3ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SH4ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SL0ZZ,ICD10-PCS,Reposition Intracranial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SL3ZZ,ICD10-PCS,Reposition Intracranial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SL4ZZ,ICD10-PCS,Reposition Intracranial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SM0ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SM3ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SM4ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SN0ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SN3ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SN4ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SP0ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SP3ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SP4ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SQ0ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SQ3ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SQ4ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SR0ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SR3ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SR4ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SS0ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SS3ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SS4ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05ST0ZZ,ICD10-PCS,Reposition Right Face Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05ST3ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05ST4ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SV0ZZ,ICD10-PCS,Reposition Left Face Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SV3ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SV4ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SY0ZZ,ICD10-PCS,Reposition Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SY3ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,05SY4ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U007Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U037Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U047Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U107Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U137Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U147Z,ICD10-PCS,Supplement Hemiazygos Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05U307Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U337Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U347Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U407Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U437Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U447Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U507Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U537Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U547Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U607Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U637Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U647Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U707Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U737Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U747Z,ICD10-PCS,Supplement R Axilla Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U807Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U837Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U847Z,ICD10-PCS,Supplement L Axilla Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U907Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U937Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05U947Z,ICD10-PCS,Supplement R Brach Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UA07Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UA37Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UA47Z,ICD10-PCS,Supplement L Brach Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UB07Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UB37Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UB47Z,ICD10-PCS,Supplement R Basilic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UC07Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UC37Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UC47Z,ICD10-PCS,Supplement L Basilic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UD07Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UD37Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UD47Z,ICD10-PCS,Supplement R Cephalic Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05UF07Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UF37Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UF47Z,ICD10-PCS,Supplement L Cephalic Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05UG07Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UG37Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UG47Z,ICD10-PCS,Supplement R Hand Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UH07Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UH37Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UH47Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UL07Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UL37Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UL47Z,ICD10-PCS,Supplement Intracran Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UM07Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UM37Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UM47Z,ICD10-PCS,Supplement R Int Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05UN07Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UN37Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UN47Z,ICD10-PCS,Supplement L Int Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05UP07Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UP37Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UP47Z,ICD10-PCS,Supplement R Ext Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05UQ07Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UQ37Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UQ47Z,ICD10-PCS,Supplement L Ext Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,05UR07Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UR37Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UR47Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05US07Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05US37Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05US47Z,ICD10-PCS,Supplement L Verteb Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UT07Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UT37Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UT47Z,ICD10-PCS,Supplement R Face Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UV07Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UV37Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UV47Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UY07Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UY37Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,05UY47Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06500ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06503ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06504ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06510ZZ,ICD10-PCS,Destruction of Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06513ZZ,ICD10-PCS,Destruction of Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06514ZZ,ICD10-PCS,Destruction of Splenic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06520ZZ,ICD10-PCS,Destruction of Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06523ZZ,ICD10-PCS,Destruction of Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06524ZZ,ICD10-PCS,Destruction of Gastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06540ZZ,ICD10-PCS,Destruction of Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06543ZZ,ICD10-PCS,Destruction of Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06544ZZ,ICD10-PCS,Destruction of Hepatic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06554ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06560ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06563ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06564ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06570ZZ,ICD10-PCS,Destruction of Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06573ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06574ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06580ZZ,ICD10-PCS,Destruction of Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06583ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06584ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06590ZZ,ICD10-PCS,Destruction of Right Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06593ZZ,ICD10-PCS,Destruction of Right Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06594ZZ,ICD10-PCS,Destruction of Right Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,065B0ZZ,ICD10-PCS,Destruction of Left Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,065B3ZZ,ICD10-PCS,Destruction of Left Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,065B4ZZ,ICD10-PCS,Destruction of Left Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,065C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,065C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,065C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,065D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,065D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,065D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,065F0ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,065F3ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,065F4ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,065G0ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,065G3ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,065G4ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,065H0ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,065H3ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,065H4ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,065J0ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,065J3ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,065J4ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B00ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B03ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B04ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B10ZZ,ICD10-PCS,Excision of Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B13ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B14ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B20ZZ,ICD10-PCS,Excision of Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B23ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B24ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B40ZZ,ICD10-PCS,Excision of Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B43ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B44ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B60ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B63ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B64ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B70ZZ,ICD10-PCS,Excision of Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B73ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B74ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B80ZZ,ICD10-PCS,Excision of Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B83ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B84ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B90ZZ,ICD10-PCS,Excision of Right Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B93ZZ,ICD10-PCS,Excision of Right Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06B94ZZ,ICD10-PCS,Excision of Right Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BB0ZZ,ICD10-PCS,Excision of Left Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BB3ZZ,ICD10-PCS,Excision of Left Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BB4ZZ,ICD10-PCS,Excision of Left Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BF0ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BF3ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BF4ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BG0ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BG3ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BG4ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BH0ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BH3ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BH4ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BJ0ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BJ3ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06BJ4ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R007Z,ICD10-PCS,Replacement of Inf Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R00JZ,ICD10-PCS,Replacement of Inf Vena Cava with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R00KZ,ICD10-PCS,Replacement of Inf Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R047Z,ICD10-PCS,Replace of Inf Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R04JZ,ICD10-PCS,Replace of Inf Vena Cava with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R04KZ,ICD10-PCS,Replace of Inf Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R107Z,ICD10-PCS,Replacement of Splenic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R10JZ,ICD10-PCS,Replacement of Splenic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R10KZ,ICD10-PCS,Replacement of Splenic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R147Z,ICD10-PCS,Replace of Splenic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R14JZ,ICD10-PCS,Replace of Splenic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R14KZ,ICD10-PCS,Replace of Splenic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R207Z,ICD10-PCS,Replacement of Gastric Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R20JZ,ICD10-PCS,Replacement of Gastric Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R20KZ,ICD10-PCS,Replacement of Gastric Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R247Z,ICD10-PCS,Replace of Gastric Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R24JZ,ICD10-PCS,Replace of Gastric Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R24KZ,ICD10-PCS,Replace of Gastric Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R407Z,ICD10-PCS,Replacement of Hepatic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R40JZ,ICD10-PCS,Replacement of Hepatic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R40KZ,ICD10-PCS,Replacement of Hepatic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R447Z,ICD10-PCS,Replace of Hepatic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R44JZ,ICD10-PCS,Replace of Hepatic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R44KZ,ICD10-PCS,Replace of Hepatic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R507Z,ICD10-PCS,Replacement of Sup Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R50JZ,ICD10-PCS,Replacement of Sup Mesent Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R50KZ,ICD10-PCS,Replace of Sup Mesent Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R547Z,ICD10-PCS,Replace Sup Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06R54JZ,ICD10-PCS,Replace Sup Mesent Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06R54KZ,ICD10-PCS,Replace Sup Mesent Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06R607Z,ICD10-PCS,Replacement of Inf Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R60JZ,ICD10-PCS,Replacement of Inf Mesent Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R60KZ,ICD10-PCS,Replace of Inf Mesent Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R647Z,ICD10-PCS,Replace Inf Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06R64JZ,ICD10-PCS,Replace Inf Mesent Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06R64KZ,ICD10-PCS,Replace Inf Mesent Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06R707Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R70JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R70KZ,ICD10-PCS,Replacement of Colic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R747Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R74JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R74KZ,ICD10-PCS,Replace of Colic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R807Z,ICD10-PCS,Replacement of Portal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R80JZ,ICD10-PCS,Replacement of Portal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R80KZ,ICD10-PCS,Replacement of Portal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R847Z,ICD10-PCS,Replace of Portal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R84JZ,ICD10-PCS,Replace of Portal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R84KZ,ICD10-PCS,Replace of Portal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R907Z,ICD10-PCS,Replacement of R Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R90JZ,ICD10-PCS,Replacement of R Renal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R90KZ,ICD10-PCS,Replacement of R Renal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R947Z,ICD10-PCS,Replace of R Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R94JZ,ICD10-PCS,Replace of R Renal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06R94KZ,ICD10-PCS,Replace of R Renal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RB07Z,ICD10-PCS,Replacement of Left Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RB0JZ,ICD10-PCS,Replacement of Left Renal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RB0KZ,ICD10-PCS,Replacement of L Renal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RB47Z,ICD10-PCS,Replace of L Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RB4JZ,ICD10-PCS,Replace of L Renal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RB4KZ,ICD10-PCS,Replace of L Renal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RC07Z,ICD10-PCS,Replace of R Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RC0JZ,ICD10-PCS,Replace of R Com Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RC0KZ,ICD10-PCS,Replace of R Com Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RC47Z,ICD10-PCS,Replace R Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RC4JZ,ICD10-PCS,Replace R Com Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RC4KZ,ICD10-PCS,Replace R Com Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RD07Z,ICD10-PCS,Replace of L Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RD0JZ,ICD10-PCS,Replace of L Com Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RD0KZ,ICD10-PCS,Replace of L Com Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RD47Z,ICD10-PCS,Replace L Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RD4JZ,ICD10-PCS,Replace L Com Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RD4KZ,ICD10-PCS,Replace L Com Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RF07Z,ICD10-PCS,Replace of R Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RF0JZ,ICD10-PCS,Replace of R Ext Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RF0KZ,ICD10-PCS,Replace of R Ext Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RF47Z,ICD10-PCS,Replace R Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RF4JZ,ICD10-PCS,Replace R Ext Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RF4KZ,ICD10-PCS,Replace R Ext Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RG07Z,ICD10-PCS,Replace of L Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RG0JZ,ICD10-PCS,Replace of L Ext Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RG0KZ,ICD10-PCS,Replace of L Ext Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RG47Z,ICD10-PCS,Replace L Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RG4JZ,ICD10-PCS,Replace L Ext Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RG4KZ,ICD10-PCS,Replace L Ext Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RH07Z,ICD10-PCS,Replacement of R Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RH0JZ,ICD10-PCS,Replacement of R Hypogast Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RH0KZ,ICD10-PCS,Replace of R Hypogast Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RH47Z,ICD10-PCS,Replace R Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RH4JZ,ICD10-PCS,Replace R Hypogast Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RH4KZ,ICD10-PCS,Replace R Hypogast Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RJ07Z,ICD10-PCS,Replacement of L Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RJ0JZ,ICD10-PCS,Replacement of L Hypogast Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RJ0KZ,ICD10-PCS,Replace of L Hypogast Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06RJ47Z,ICD10-PCS,Replace L Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RJ4JZ,ICD10-PCS,Replace L Hypogast Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06RJ4KZ,ICD10-PCS,Replace L Hypogast Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06S00ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S03ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S04ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S10ZZ,ICD10-PCS,Reposition Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S13ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S14ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S20ZZ,ICD10-PCS,Reposition Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S23ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S24ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S30ZZ,ICD10-PCS,Reposition Esophageal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S33ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S34ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S40ZZ,ICD10-PCS,Reposition Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S43ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S44ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S60ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S63ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S64ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S70ZZ,ICD10-PCS,Reposition Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S73ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S74ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S80ZZ,ICD10-PCS,Reposition Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S83ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06S84ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SF0ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SF3ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SF4ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SG0ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SG3ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SG4ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SH0ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SH3ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SH4ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SJ0ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SJ3ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SJ4ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SM0ZZ,ICD10-PCS,Reposition Right Femoral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SM3ZZ,ICD10-PCS,Reposition Right Femoral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SM4ZZ,ICD10-PCS,Reposition Right Femoral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SN0ZZ,ICD10-PCS,Reposition Left Femoral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SN3ZZ,ICD10-PCS,Reposition Left Femoral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SN4ZZ,ICD10-PCS,Reposition Left Femoral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SP0ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SP3ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SP4ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SQ0ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SQ3ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SQ4ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SR0ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SR3ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SR4ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SS0ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SS3ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SS4ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06ST0ZZ,ICD10-PCS,Reposition Right Foot Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06ST3ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06ST4ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SV0ZZ,ICD10-PCS,Reposition Left Foot Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SV3ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SV4ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SY0ZZ,ICD10-PCS,Reposition Lower Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SY3ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,06SY4ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U007Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U037Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U047Z,ICD10-PCS,Supplement Inf Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U107Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U137Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U147Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U207Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U237Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U247Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U307Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U337Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U347Z,ICD10-PCS,Supplement Esophageal Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06U407Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U437Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U447Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U507Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U537Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U547Z,ICD10-PCS,Supplement Sup Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06U607Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U637Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U647Z,ICD10-PCS,Supplement Inf Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06U707Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U737Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U747Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U807Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U837Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U847Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U907Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U937Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06U947Z,ICD10-PCS,Supplement R Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UB07Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UB37Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UB47Z,ICD10-PCS,Supplement L Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UC07Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UC37Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UC47Z,ICD10-PCS,Supplement R Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06UD07Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UD37Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UD47Z,ICD10-PCS,Supplement L Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06UF07Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UF37Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UF47Z,ICD10-PCS,Supplement R Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06UG07Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UG37Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UG47Z,ICD10-PCS,Supplement L Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06UH07Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UH37Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UH47Z,ICD10-PCS,Supplement R Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06UJ07Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UJ37Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UJ47Z,ICD10-PCS,Supplement L Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06UM07Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UM37Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UM47Z,ICD10-PCS,Supplement R Femor Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UN07Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UN37Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UN47Z,ICD10-PCS,Supplement L Femor Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UP07Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UP37Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UP47Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UQ07Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UQ37Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UQ47Z,ICD10-PCS,Supplement L Saphenous with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UR07Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UR37Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UR47Z,ICD10-PCS,Supplement R Less Saphenous w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06US07Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06US37Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06US47Z,ICD10-PCS,Supplement L Less Saphenous w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,06UT07Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UT37Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UT47Z,ICD10-PCS,Supplement R Foot Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UV07Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UV37Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UV47Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UY07Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UY37Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,06UY47Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0JH608Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0JH638Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0JH808Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0JH838Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS304Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS30ZZ,ICD10-PCS,Reposition Cervical Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS334Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS33ZZ,ICD10-PCS,Reposition Cervical Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS344Z,ICD10-PCS,Reposition Cervcal Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS34ZZ,ICD10-PCS,Reposition Cervical Vertebra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS3XZZ,ICD10-PCS,Reposition Cervical Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS404Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS40ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS434Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS43ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS444Z,ICD10-PCS,Reposition Thor Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS44ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0PS4XZZ,ICD10-PCS,Reposition Thoracic Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS004Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS00ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS034Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS03ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS044Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS04ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS0XZZ,ICD10-PCS,Reposition Lumbar Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS104Z,ICD10-PCS,Reposition Sacrum with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS10ZZ,ICD10-PCS,Reposition Sacrum, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS134Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS13ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS144Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS14ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QS1XZZ,ICD10-PCS,Reposition Sacrum, External Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QSS04Z,ICD10-PCS,Reposition Coccyx with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QSS0ZZ,ICD10-PCS,Reposition Coccyx, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QSS34Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QSS3ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QSS44Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QSS4ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,0QSSXZZ,ICD10-PCS,Reposition Coccyx, External Approach,,Fee Schedule,8271.00
Blue Shield,POS,0R530ZZ,ICD10-PCS,Destruction of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0R550ZZ,ICD10-PCS,Destruction of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0R590ZZ,ICD10-PCS,Destruction of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0R5B0ZZ,ICD10-PCS,Destruction of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB00ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB03ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB04ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB10ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB13ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB14ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB30ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB33ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB34ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB40ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB43ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB44ZZ,ICD10-PCS,Excision of C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB50ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB53ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB54ZZ,ICD10-PCS,Excision of C-thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB60ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB63ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB64ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB90ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB93ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RB94ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RBA0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RBA3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RBA4ZZ,ICD10-PCS,Excision of T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RBB0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RBB3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RBB4ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG0070,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG0071,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG007J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG00A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG00A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG00AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG00J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG00J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG00JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG00K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG00K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG00KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG00Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG00Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG00ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG0370,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG0371,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG037J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG03A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG03A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG03AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG03J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG03J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG03JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG03K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG03K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG03KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG03Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG03Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG03ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG0470,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG0471,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG047J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG04A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG04A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG04AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG04J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG04J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG04JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG04K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG04K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG04KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG04Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG04Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG04ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG1070,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG1071,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG107J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG10A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG10A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG10AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG10J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG10J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG10JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG10K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG10K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG10KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG10Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG10Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG10ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG1370,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG1371,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG137J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG13A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG13A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG13AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG13J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG13J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG13JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG13K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG13K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG13KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG13Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG13Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG13ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG1470,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG1471,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG147J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG14A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG14A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG14AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG14J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG14J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG14JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG14K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG14K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG14KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG14Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG14Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG14ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG2070,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG2071,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG207J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG20A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG20A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG20AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG20J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG20J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG20JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG20K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG20K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG20KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG20Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG20Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG20ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG2370,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG2371,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG237J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG23A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG23A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG23AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG23J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG23J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG23JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG23K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG23K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG23KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG23Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG23Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG23ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG2470,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG2471,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG247J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG24A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG24A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG24AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG24J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG24J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG24JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG24K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG24K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG24KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG24Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG24Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG24ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG4070,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG4071,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG407J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG40A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG40A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG40AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG40J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG40J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG40JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG40K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG40K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG40KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG40Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG40Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG40ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG4370,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG4371,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG437J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG43A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG43A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG43AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG43J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG43J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG43JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG43K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG43K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG43KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG43Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG43Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG43ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG4470,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG4471,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG447J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG44A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG44A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG44AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG44J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG44J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG44JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG44K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG44K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG44KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG44Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG44Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG44ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG6070,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG6071,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG607J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG60A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG60A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG60AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG60J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG60J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG60JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG60K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG60K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG60KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG60Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG60Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG60ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG6370,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG6371,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG637J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG63A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG63A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG63AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG63J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG63J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG63JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG63K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG63K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG63KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG63Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG63Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG63ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG6470,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG6471,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG647J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG64A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG64A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG64AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG64J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG64J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG64JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG64K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG64K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG64KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG64Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG64Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG64ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG7070,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG7071,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG707J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG70A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG70A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG70AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG70J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG70J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG70JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG70K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG70K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG70KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG70Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG70Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG70ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG7370,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG7371,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG737J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG73A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG73A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG73AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG73J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG73J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG73JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG73K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG73K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG73KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG73Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG73Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG73ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG7470,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG7471,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG747J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG74A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG74A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG74AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG74J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG74J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG74JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG74K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG74K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG74KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG74Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG74Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG74ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG8070,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG8071,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG807J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG80A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG80A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG80AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG80J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG80J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG80JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG80K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG80K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG80KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RG80Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG80Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG80ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG8370,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG8371,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG837J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG83A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG83A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG83AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG83J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG83J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG83JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG83K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG83K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG83KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RG83Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG83Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG83ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG8470,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG8471,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG847J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG84A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG84A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG84AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG84J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG84J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG84JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG84K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG84K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG84KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RG84Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG84Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RG84ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RGA070,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA071,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA07J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RGA0ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RGA370,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA371,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA37J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RGA3ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RGA470,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA471,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA47J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RGA4ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH00BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH03BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RH04CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Occip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH04DZ,ICD10-PCS,Insert of Facet Stabl Dev into Occip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH10BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH10CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH10DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH13BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH13CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH13DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH14BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Cerv Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RH14CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Cerv Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH14DZ,ICD10-PCS,Insert of Facet Stabl Dev into Cerv Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH40BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RH40CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH40DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH43BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RH43CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH43DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH44BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RH44CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH44DZ,ICD10-PCS,Insert of Facet Stabl Dev into C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH60BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH60CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH60DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH63BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH63CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH63DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH64BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Thor Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RH64CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RH64DZ,ICD10-PCS,Insert of Facet Stabl Dev into Thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RHA0BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Open,,Fee Schedule,8271.00
Blue Shield,POS,0RHA0CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RHA0DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RHA3BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0RHA3CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RHA3DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RHA4BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0RHA4CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RHA4DZ,ICD10-PCS,Insert of Facet Stabl Dev into T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RR30JZ,ICD10-PCS,Replacement of Cerv Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RR50JZ,ICD10-PCS,Replacement of C-thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RR90JZ,ICD10-PCS,Replacement of Thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RRB0JZ,ICD10-PCS,Replacement of T-lum Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RT30ZZ,ICD10-PCS,Resection of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RT40ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RT50ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RT90ZZ,ICD10-PCS,Resection of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RTB0ZZ,ICD10-PCS,Resection of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU00JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU03JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU04JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU10JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU13JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU14JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU40JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU43JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU44JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU50JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU53JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU54JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU60JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU63JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RU64JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RUA0JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RUA3JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RUA4JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RW30JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RW33JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RW34JZ,ICD10-PCS,Revision of Synth Sub in Cerv Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RW50JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RW53JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RW54JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RW90JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RW93JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RW94JZ,ICD10-PCS,Revision of Synth Sub in Thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RWB0JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RWB3JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0RWB4JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0S520ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0S523ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0S524ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0S540ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0S543ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0S544ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB00ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB03ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB04ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB20ZZ,ICD10-PCS,EXCISION LUMBAR VERTEBRAL DISC OPEN,,Fee Schedule,8271.00
Blue Shield,POS,0SB23ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB24ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB30ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,POS,0SB33ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB34ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB40ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL DISC OPEN,,Fee Schedule,8271.00
Blue Shield,POS,0SB43ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB44ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB50ZZ,ICD10-PCS,EXCISION SACROCOCCYGEAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,POS,0SB53ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB54ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB60ZZ,ICD10-PCS,EXCISION OF COCCYGEAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,POS,0SB63ZZ,ICD10-PCS,Excision of Coccygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB64ZZ,ICD10-PCS,Excision of Coccygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB70ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB73ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB74ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB80ZZ,ICD10-PCS,EXCISION LEFT SACROILIAC JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,POS,0SB83ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SB84ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG0070,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG0071,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG007J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG00A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG00A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG00AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG00J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG00J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG00JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG00K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG00K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG00KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG00Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG00Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG00ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG0370,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG0371,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG037J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG03A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG03A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG03AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG03J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG03J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG03JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG03K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG03K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG03KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG03Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG03Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG03ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG0470,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG0471,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG047J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG04A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG04A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG04AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG04J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG04J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG04JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG04K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG04K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG04KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG04Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG04Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG04ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG1070,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG1071,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG107J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG10A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG10A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG10AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG10J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG10J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG10JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG10K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG10K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG10KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG10Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG10Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG10ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG1370,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG1371,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG137J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG13A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG13A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG13AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG13J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG13J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG13JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG13K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG13K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG13KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG13Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG13Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG13ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG1470,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG1471,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG147J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG14A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG14A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG14AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG14J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG14J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG14JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG14K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG14K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG14KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG14Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG14Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG14ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG3070,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG3071,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG307J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG30A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG30A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG30AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG30J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG30J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG30JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG30K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG30K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG30KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SG30Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG30Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG30ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG3370,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG3371,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG337J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG33A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG33A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG33AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG33J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG33J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG33JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG33K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG33K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG33KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SG33Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG33Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG33ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG3470,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG3471,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG347J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG34A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG34A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG34AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG34J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG34J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG34JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG34K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG34K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG34KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG34Z0,ICD10-PCS,Fusion of Lumsac Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG34Z1,ICD10-PCS,Fusion of Lumsac Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG34ZJ,ICD10-PCS,Fusion of Lumsac Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG504Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG507Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG50JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG50KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG50ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG534Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG537Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG53JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG53KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG53ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG544Z,ICD10-PCS,Fusion of Sacrococcygeal Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG547Z,ICD10-PCS,Fusion Sacrococcygeal Jt w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG54JZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG54KZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG54ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG604Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG607Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG60JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG60KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG60ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG634Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG637Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG63JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG63KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG63ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG644Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG647Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG64JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG64KZ,ICD10-PCS,Fusion of Coccygeal Jt with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG64ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG704Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG707Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG70JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG70KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG70ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG734Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG737Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG73JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG73KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG73ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG744Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG747Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG74JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG74KZ,ICD10-PCS,Fusion R Sacroiliac Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG74ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG804Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG807Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG80JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG80KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG80ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG834Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG837Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG83JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG83KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG83ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG844Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG847Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG84JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SG84KZ,ICD10-PCS,Fusion L Sacroiliac Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SG84ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH00BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH03BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lum Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SH04CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH04DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH30BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SH30CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH30DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH33BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc,,Fee Schedule,8271.00
Blue Shield,POS,0SH33CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH33DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH34BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SH34CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Lumsac Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SH34DZ,ICD10-PCS,Insert of Facet Stabl Dev into Lumsac Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR20JZ,ICD10-PCS,Replacement of Lum Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR40JZ,ICD10-PCS,Replacement of Lumsac Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR9019,ICD10-PCS,Replacement of R Hip Jt with Metal, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR901A,ICD10-PCS,Replacement of R Hip Jt with Metal, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR901Z,ICD10-PCS,Replacement of Right Hip Joint with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR9029,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SR902A,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SR902Z,ICD10-PCS,Replacement of R Hip Jt with Metal on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR9039,ICD10-PCS,Replacement of R Hip Jt with Ceramic, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR903A,ICD10-PCS,Replace of R Hip Jt with Ceramic, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR903Z,ICD10-PCS,REPLACE RT HIP JOINT CERAMIC SYNTH SUBST OPEN,,Fee Schedule,8271.00
Blue Shield,POS,0SR9049,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SR904A,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SR904Z,ICD10-PCS,Replacement of R Hip Jt with Ceramic on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR907Z,ICD10-PCS,Replacement of Right Hip Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR90J9,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR90JA,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR90JZ,ICD10-PCS,Replacement of Right Hip Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SR90KZ,ICD10-PCS,Replacement of R Hip Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRA009,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRA00A,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRA00Z,ICD10-PCS,REPLACEMENT RT HIP JOINT ACETAB SURF POLYETHYLENE SYNTH SUBS,,Fee Schedule,8271.00
Blue Shield,POS,0SRA019,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRA01A,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRA01Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRA039,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRA03A,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRA03Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRA07Z,ICD10-PCS,Replace of R Hip Jt, Acetab with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRA0J9,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRA0JA,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRA0JZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRA0KZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB019,ICD10-PCS,Replacement of L Hip Jt with Metal, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB01A,ICD10-PCS,Replacement of L Hip Jt with Metal, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB01Z,ICD10-PCS,Replacement of Left Hip Joint with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB029,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRB02A,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRB02Z,ICD10-PCS,Replacement of L Hip Jt with Metal on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB039,ICD10-PCS,Replacement of L Hip Jt with Ceramic, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB03A,ICD10-PCS,Replace of L Hip Jt with Ceramic, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB03Z,ICD10-PCS,Replacement of Left Hip Joint with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB049,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRB04A,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRB04Z,ICD10-PCS,Replacement of L Hip Jt with Ceramic on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB07Z,ICD10-PCS,Replacement of Left Hip Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB0J9,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB0JA,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB0JZ,ICD10-PCS,Replacement of Left Hip Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRB0KZ,ICD10-PCS,Replacement of Left Hip Joint with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRC07Z,ICD10-PCS,Replacement of R Knee Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRC0J9,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRC0JA,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRC0JZ,ICD10-PCS,Replacement of R Knee Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRC0KZ,ICD10-PCS,Replacement of R Knee Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRD07Z,ICD10-PCS,Replacement of Left Knee Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRD0J9,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRD0JA,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRD0JZ,ICD10-PCS,Replacement of Left Knee Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRD0KZ,ICD10-PCS,Replacement of L Knee Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRE009,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRE00A,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRE00Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Polyeth, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRE019,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRE01A,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRE01Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRE039,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRE03A,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRE03Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRE07Z,ICD10-PCS,Replace of L Hip Jt, Acetab with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRE0J9,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRE0JA,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRE0JZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRE0KZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRR019,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRR01A,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRR01Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRR039,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRR03A,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRR03Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRR07Z,ICD10-PCS,Replace of R Hip Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRR0J9,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRR0JA,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRR0JZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRR0KZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRS019,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRS01A,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRS01Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRS039,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRS03A,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRS03Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRS07Z,ICD10-PCS,Replace of L Hip Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRS0J9,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRS0JA,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRS0JZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRS0KZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRT07Z,ICD10-PCS,Replace of R Knee Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRT0J9,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRT0JA,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRT0JZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRT0KZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRU07Z,ICD10-PCS,Replace of L Knee Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRU0J9,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRU0JA,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRU0JZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRU0KZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRV07Z,ICD10-PCS,Replace of R Knee Jt, Tibial with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRV0J9,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRV0JA,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRV0JZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRV0KZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRW07Z,ICD10-PCS,Replace of L Knee Jt, Tibial with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRW0J9,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRW0JA,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,POS,0SRW0JZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SRW0KZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0ST20ZZ,ICD10-PCS,Resection of Lumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0ST40ZZ,ICD10-PCS,Resection of Lumbosacral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU00JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU03JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU04JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU30JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU33JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU34JZ,ICD10-PCS,Supplement Lumsac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU50JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU53JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU54JZ,ICD10-PCS,Supplement Sacrococcygeal Jt w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,POS,0SU60JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU63JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU64JZ,ICD10-PCS,Supplement Coccygeal Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SU90BZ,ICD10-PCS,Supplement Right Hip Joint with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SUA0BZ,ICD10-PCS,Supplement R Hip Jt, Acetab with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SUB0BZ,ICD10-PCS,Supplement Left Hip Joint with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SUE0BZ,ICD10-PCS,Supplement L Hip Jt, Acetab with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SUR0BZ,ICD10-PCS,Supplement R Hip Jt, Femoral with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SUS0BZ,ICD10-PCS,Supplement L Hip Jt, Femoral with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SW20JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SW23JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SW24JZ,ICD10-PCS,Revision of Synth Sub in Lum Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SW40JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SW43JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SW44JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SW90JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SW93JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SW94JZ,ICD10-PCS,Revision of Synth Sub in R Hip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SWB0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SWB3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SWB4JZ,ICD10-PCS,Revision of Synth Sub in L Hip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SWC0JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SWC3JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SWC4JZ,ICD10-PCS,Revision of Synth Sub in R Knee Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SWD0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SWD3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,0SWD4JZ,ICD10-PCS,Revision of Synth Sub in L Knee Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0WFD0ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,0WFD3ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,0WFD4ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,POS,0WFDXZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, External Approach,,Fee Schedule,8271.00
Blue Shield,POS,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Fee Schedule,987.79
Blue Shield,POS,10022,CPT4/HCPCS,FNA W/IMAGE,,Fee Schedule,3198.57
Blue Shield,POS,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Fee Schedule,3198.57
Blue Shield,POS,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Fee Schedule,3198.57
Blue Shield,POS,10040,CPT4/HCPCS,ACNE SURGERY,,Fee Schedule,987.79
Blue Shield,POS,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Fee Schedule,987.79
Blue Shield,POS,10061,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,10080,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Fee Schedule,987.79
Blue Shield,POS,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Fee Schedule,3198.57
Blue Shield,POS,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,POS,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,POS,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Fee Schedule,3198.57
Blue Shield,POS,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Fee Schedule,987.79
Blue Shield,POS,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Fee Schedule,4280.44
Blue Shield,POS,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Fee Schedule,987.79
Blue Shield,POS,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Fee Schedule,987.79
Blue Shield,POS,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,Fee Schedule,3198.57
Blue Shield,POS,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,Fee Schedule,3198.57
Blue Shield,POS,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,Fee Schedule,3198.57
Blue Shield,POS,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,Fee Schedule,987.79
Blue Shield,POS,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Fee Schedule,4280.44
Blue Shield,POS,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Fee Schedule,4280.44
Blue Shield,POS,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Fee Schedule,4280.44
Blue Shield,POS,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,POS,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,POS,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,POS,11055,CPT4/HCPCS,TRIM SKIN LESION,,Fee Schedule,987.79
Blue Shield,POS,11056,CPT4/HCPCS,TRIM SKIN LESIONS 2 TO 4,,Fee Schedule,987.79
Blue Shield,POS,11057,CPT4/HCPCS,TRIM SKIN LESIONS OVER 4,,Fee Schedule,987.79
Blue Shield,POS,11100,CPT4/HCPCS,BIOPSY SKIN LESION,,Fee Schedule,987.79
Blue Shield,POS,11101,CPT4/HCPCS,BIOPSY SKIN ADD-ON,,Fee Schedule,987.79
Blue Shield,POS,11200,CPT4/HCPCS,REMOVAL OF SKIN TAGS 2.0 CM,,Fee Schedule,987.79
Blue Shield,POS,11305,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Fee Schedule,987.79
Blue Shield,POS,11306,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Fee Schedule,987.79
Blue Shield,POS,11307,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Fee Schedule,987.79
Blue Shield,POS,11308,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Fee Schedule,987.79
Blue Shield,POS,11310,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Fee Schedule,987.79
Blue Shield,POS,11311,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Fee Schedule,987.79
Blue Shield,POS,11312,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Fee Schedule,987.79
Blue Shield,POS,11313,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Fee Schedule,987.79
Blue Shield,POS,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,Fee Schedule,3198.57
Blue Shield,POS,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,POS,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,POS,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,Fee Schedule,3198.57
Blue Shield,POS,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,Fee Schedule,3198.57
Blue Shield,POS,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,Fee Schedule,4280.44
Blue Shield,POS,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Fee Schedule,3198.57
Blue Shield,POS,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Fee Schedule,3198.57
Blue Shield,POS,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Fee Schedule,3198.57
Blue Shield,POS,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Fee Schedule,3198.57
Blue Shield,POS,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Fee Schedule,4280.44
Blue Shield,POS,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,POS,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Fee Schedule,3198.57
Blue Shield,POS,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,POS,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,POS,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Fee Schedule,3198.57
Blue Shield,POS,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Fee Schedule,3198.57
Blue Shield,POS,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,POS,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,POS,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,POS,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,POS,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,POS,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,POS,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,POS,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Fee Schedule,3198.57
Blue Shield,POS,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,POS,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,POS,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Fee Schedule,3198.57
Blue Shield,POS,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Fee Schedule,4280.44
Blue Shield,POS,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,POS,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Fee Schedule,3198.57
Blue Shield,POS,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Fee Schedule,3198.57
Blue Shield,POS,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Fee Schedule,3198.57
Blue Shield,POS,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Fee Schedule,3198.57
Blue Shield,POS,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Fee Schedule,4280.44
Blue Shield,POS,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Fee Schedule,4280.44
Blue Shield,POS,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Fee Schedule,3198.57
Blue Shield,POS,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Fee Schedule,3198.57
Blue Shield,POS,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Fee Schedule,3198.57
Blue Shield,POS,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Fee Schedule,3198.57
Blue Shield,POS,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Fee Schedule,4280.44
Blue Shield,POS,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Fee Schedule,4280.44
Blue Shield,POS,11719,CPT4/HCPCS,TRIM NAIL(S) ANY NUMBER,,Fee Schedule,987.79
Blue Shield,POS,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Fee Schedule,987.79
Blue Shield,POS,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Fee Schedule,987.79
Blue Shield,POS,11730,CPT4/HCPCS,REMOVAL OF NAIL PLATE,,Fee Schedule,987.79
Blue Shield,POS,11732,CPT4/HCPCS,REMOVE NAIL PLATE ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,11740,CPT4/HCPCS,DRAIN BLOOD FROM UNDER NAIL,,Fee Schedule,987.79
Blue Shield,POS,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,POS,11755,CPT4/HCPCS,BIOPSY NAIL UNIT,,Fee Schedule,3198.57
Blue Shield,POS,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,POS,11762,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,POS,11765,CPT4/HCPCS,EXCISION OF NAIL FOLD TOE,,Fee Schedule,987.79
Blue Shield,POS,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Fee Schedule,4891.93
Blue Shield,POS,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Fee Schedule,4891.93
Blue Shield,POS,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Fee Schedule,4891.93
Blue Shield,POS,11900,CPT4/HCPCS,INJECT SKIN LESIONS 7,,Fee Schedule,987.79
Blue Shield,POS,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Fee Schedule,3198.57
Blue Shield,POS,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Fee Schedule,987.79
Blue Shield,POS,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Fee Schedule,987.79
Blue Shield,POS,11950,CPT4/HCPCS,TX CONTOUR DEFECTS 1 CC/<,,Fee Schedule,987.79
Blue Shield,POS,11951,CPT4/HCPCS,TX CONTOUR DEFECTS 1.1-5.0CC,,Fee Schedule,987.79
Blue Shield,POS,11952,CPT4/HCPCS,TX CONTOUR DEFECTS 5.1-10CC,,Fee Schedule,987.79
Blue Shield,POS,11954,CPT4/HCPCS,TX CONTOUR DEFECTS >10.0 CC,,Fee Schedule,987.79
Blue Shield,POS,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Fee Schedule,4280.44
Blue Shield,POS,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Fee Schedule,4891.93
Blue Shield,POS,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Fee Schedule,3198.57
Blue Shield,POS,11976,CPT4/HCPCS,REMOVE CONTRACEPTIVE CAPSULE,,Fee Schedule,3198.57
Blue Shield,POS,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Fee Schedule,987.79
Blue Shield,POS,11981,CPT4/HCPCS,INSERT DRUG IMPLANT DEVICE,,Fee Schedule,987.79
Blue Shield,POS,11982,CPT4/HCPCS,REMOVE DRUG IMPLANT DEVICE,,Fee Schedule,987.79
Blue Shield,POS,11983,CPT4/HCPCS,REMOVE/INSERT DRUG IMPLANT,,Fee Schedule,3198.57
Blue Shield,POS,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Fee Schedule,987.79
Blue Shield,POS,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,Fee Schedule,987.79
Blue Shield,POS,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Fee Schedule,987.79
Blue Shield,POS,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Fee Schedule,4280.44
Blue Shield,POS,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Fee Schedule,4280.44
Blue Shield,POS,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Fee Schedule,4280.44
Blue Shield,POS,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,Fee Schedule,987.79
Blue Shield,POS,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,Fee Schedule,987.79
Blue Shield,POS,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Fee Schedule,987.79
Blue Shield,POS,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Fee Schedule,987.79
Blue Shield,POS,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Fee Schedule,4280.44
Blue Shield,POS,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Fee Schedule,4280.44
Blue Shield,POS,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Fee Schedule,4280.44
Blue Shield,POS,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Fee Schedule,3198.57
Blue Shield,POS,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Fee Schedule,3198.57
Blue Shield,POS,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Fee Schedule,3198.57
Blue Shield,POS,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Fee Schedule,3198.57
Blue Shield,POS,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Fee Schedule,4280.44
Blue Shield,POS,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Fee Schedule,4280.44
Blue Shield,POS,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Fee Schedule,4280.44
Blue Shield,POS,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Fee Schedule,4280.44
Blue Shield,POS,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Fee Schedule,3198.57
Blue Shield,POS,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Fee Schedule,3198.57
Blue Shield,POS,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Fee Schedule,4280.44
Blue Shield,POS,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Fee Schedule,4280.44
Blue Shield,POS,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Fee Schedule,4280.44
Blue Shield,POS,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Fee Schedule,4280.44
Blue Shield,POS,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Fee Schedule,3198.57
Blue Shield,POS,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Fee Schedule,3198.57
Blue Shield,POS,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Fee Schedule,3198.57
Blue Shield,POS,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Fee Schedule,4280.44
Blue Shield,POS,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Fee Schedule,4280.44
Blue Shield,POS,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Fee Schedule,4280.44
Blue Shield,POS,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Fee Schedule,4280.44
Blue Shield,POS,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Fee Schedule,4280.44
Blue Shield,POS,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,POS,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Fee Schedule,3198.57
Blue Shield,POS,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Fee Schedule,4280.44
Blue Shield,POS,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,POS,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Fee Schedule,3198.57
Blue Shield,POS,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,4280.44
Blue Shield,POS,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,4891.93
Blue Shield,POS,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,3198.57
Blue Shield,POS,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Fee Schedule,4891.93
Blue Shield,POS,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,POS,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Fee Schedule,3198.57
Blue Shield,POS,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Fee Schedule,4280.44
Blue Shield,POS,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,POS,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Fee Schedule,4891.93
Blue Shield,POS,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Fee Schedule,4891.93
Blue Shield,POS,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Fee Schedule,4891.93
Blue Shield,POS,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Fee Schedule,4280.44
Blue Shield,POS,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Fee Schedule,4891.93
Blue Shield,POS,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Fee Schedule,4891.93
Blue Shield,POS,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Fee Schedule,4891.93
Blue Shield,POS,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Fee Schedule,4891.93
Blue Shield,POS,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Fee Schedule,3198.57
Blue Shield,POS,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Fee Schedule,4891.93
Blue Shield,POS,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,POS,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Fee Schedule,3198.57
Blue Shield,POS,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Fee Schedule,4280.44
Blue Shield,POS,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Fee Schedule,3198.57
Blue Shield,POS,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,POS,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Fee Schedule,4891.93
Blue Shield,POS,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,POS,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,POS,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Fee Schedule,3198.57
Blue Shield,POS,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,POS,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Fee Schedule,4891.93
Blue Shield,POS,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,POS,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,POS,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Fee Schedule,3198.57
Blue Shield,POS,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,POS,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Fee Schedule,3198.57
Blue Shield,POS,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Fee Schedule,3198.57
Blue Shield,POS,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Fee Schedule,4280.44
Blue Shield,POS,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Fee Schedule,3198.57
Blue Shield,POS,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Fee Schedule,3198.57
Blue Shield,POS,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Fee Schedule,4891.93
Blue Shield,POS,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Fee Schedule,4280.44
Blue Shield,POS,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,POS,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,POS,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Fee Schedule,4891.93
Blue Shield,POS,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4891.93
Blue Shield,POS,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Fee Schedule,4280.44
Blue Shield,POS,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,POS,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,POS,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Fee Schedule,987.79
Blue Shield,POS,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Fee Schedule,4280.44
Blue Shield,POS,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Fee Schedule,987.79
Blue Shield,POS,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Fee Schedule,4280.44
Blue Shield,POS,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Fee Schedule,987.79
Blue Shield,POS,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Fee Schedule,4280.44
Blue Shield,POS,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Fee Schedule,987.79
Blue Shield,POS,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Fee Schedule,4891.93
Blue Shield,POS,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Fee Schedule,4891.93
Blue Shield,POS,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Fee Schedule,4891.93
Blue Shield,POS,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Fee Schedule,4891.93
Blue Shield,POS,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Fee Schedule,4891.93
Blue Shield,POS,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Fee Schedule,4891.93
Blue Shield,POS,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Fee Schedule,6049.05
Blue Shield,POS,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Fee Schedule,4891.93
Blue Shield,POS,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Fee Schedule,6876.92
Blue Shield,POS,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Fee Schedule,4891.93
Blue Shield,POS,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Fee Schedule,4891.93
Blue Shield,POS,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Fee Schedule,4891.93
Blue Shield,POS,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Fee Schedule,4891.93
Blue Shield,POS,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Fee Schedule,4891.93
Blue Shield,POS,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Fee Schedule,4891.93
Blue Shield,POS,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Fee Schedule,4280.44
Blue Shield,POS,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,POS,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,POS,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,POS,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Fee Schedule,4891.93
Blue Shield,POS,15775,CPT4/HCPCS,HAIR TRNSPL 1-15 PUNCH GRFTS,,Fee Schedule,4891.93
Blue Shield,POS,15776,CPT4/HCPCS,HAIR TRNSPL >15 PUNCH GRAFTS,,Fee Schedule,4891.93
Blue Shield,POS,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,Fee Schedule,4891.93
Blue Shield,POS,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,Fee Schedule,3198.57
Blue Shield,POS,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,Fee Schedule,3198.57
Blue Shield,POS,15783,CPT4/HCPCS,DERMABRASION SUPRFL ANY SITE,,Fee Schedule,987.79
Blue Shield,POS,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,Fee Schedule,987.79
Blue Shield,POS,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,Fee Schedule,987.79
Blue Shield,POS,15788,CPT4/HCPCS,CHEMICAL PEEL FACE EPIDERM,,Fee Schedule,987.79
Blue Shield,POS,15789,CPT4/HCPCS,CHEMICAL PEEL FACE DERMAL,,Fee Schedule,987.79
Blue Shield,POS,15792,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Fee Schedule,987.79
Blue Shield,POS,15793,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Fee Schedule,987.79
Blue Shield,POS,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Fee Schedule,3198.57
Blue Shield,POS,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Fee Schedule,4891.93
Blue Shield,POS,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Fee Schedule,4891.93
Blue Shield,POS,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Fee Schedule,4891.93
Blue Shield,POS,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Fee Schedule,6876.92
Blue Shield,POS,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Fee Schedule,4891.93
Blue Shield,POS,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Fee Schedule,4891.93
Blue Shield,POS,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Fee Schedule,4891.93
Blue Shield,POS,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Fee Schedule,4891.93
Blue Shield,POS,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Fee Schedule,6876.92
Blue Shield,POS,15830,CPT4/HCPCS,EXC SKIN ABD,,Fee Schedule,4891.93
Blue Shield,POS,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Fee Schedule,4891.93
Blue Shield,POS,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Fee Schedule,4891.93
Blue Shield,POS,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Fee Schedule,4891.93
Blue Shield,POS,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Fee Schedule,4891.93
Blue Shield,POS,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Fee Schedule,3198.57
Blue Shield,POS,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Fee Schedule,3198.57
Blue Shield,POS,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Fee Schedule,3198.57
Blue Shield,POS,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Fee Schedule,3198.57
Blue Shield,POS,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Fee Schedule,6049.05
Blue Shield,POS,15847,CPT4/HCPCS,EXC SKIN ABD ADD-ON,,Fee Schedule,4891.93
Blue Shield,POS,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Fee Schedule,3198.57
Blue Shield,POS,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Fee Schedule,3198.57
Blue Shield,POS,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Fee Schedule,3198.57
Blue Shield,POS,15860,CPT4/HCPCS,TEST FOR BLOOD FLOW IN GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Fee Schedule,4891.93
Blue Shield,POS,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Fee Schedule,4891.93
Blue Shield,POS,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Fee Schedule,4891.93
Blue Shield,POS,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Fee Schedule,4891.93
Blue Shield,POS,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Fee Schedule,4891.93
Blue Shield,POS,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Fee Schedule,6049.05
Blue Shield,POS,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,POS,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,POS,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,POS,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,POS,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,POS,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,POS,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,POS,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,POS,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,POS,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,POS,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,POS,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,POS,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,POS,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,POS,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,POS,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,POS,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,POS,15999,CPT4/HCPCS,REMOVAL OF PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,POS,16000,CPT4/HCPCS,INITIAL TREATMENT OF BURN(S),,Fee Schedule,987.79
Blue Shield,POS,16020,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN S,,Fee Schedule,987.79
Blue Shield,POS,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Fee Schedule,4280.44
Blue Shield,POS,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Fee Schedule,4280.44
Blue Shield,POS,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Fee Schedule,3198.57
Blue Shield,POS,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,Fee Schedule,3198.57
Blue Shield,POS,17000,CPT4/HCPCS,DESTRUCT PREMALG LESION,,Fee Schedule,987.79
Blue Shield,POS,17003,CPT4/HCPCS,DESTRUCT PREMALG LES 2-14,,Fee Schedule,987.79
Blue Shield,POS,17004,CPT4/HCPCS,DESTROY PREMAL LESIONS 15/>,,Fee Schedule,987.79
Blue Shield,POS,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,POS,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,POS,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,POS,17110,CPT4/HCPCS,DESTRUCT B9 LESION 1-14,,Fee Schedule,987.79
Blue Shield,POS,17111,CPT4/HCPCS,DESTRUCT LESION 15 OR MORE,,Fee Schedule,987.79
Blue Shield,POS,17250,CPT4/HCPCS,CHEM CAUT OF GRANLTJ TISSUE,,Fee Schedule,987.79
Blue Shield,POS,17260,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17261,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17262,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17263,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17264,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17266,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17270,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17271,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17272,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17273,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17274,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17276,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17280,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17281,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17282,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17283,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17284,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17286,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,17311,CPT4/HCPCS,MOHS 1 STAGE H/N/HF/G,,Fee Schedule,3198.57
Blue Shield,POS,17312,CPT4/HCPCS,MOHS ADDL STAGE,,Fee Schedule,3198.57
Blue Shield,POS,17313,CPT4/HCPCS,MOHS 1 STAGE T/A/L,,Fee Schedule,3198.57
Blue Shield,POS,17314,CPT4/HCPCS,MOHS ADDL STAGE T/A/L,,Fee Schedule,3198.57
Blue Shield,POS,17315,CPT4/HCPCS,MOHS SURG ADDL BLOCK,,Fee Schedule,3198.57
Blue Shield,POS,17340,CPT4/HCPCS,CRYOTHERAPY OF SKIN,,Fee Schedule,987.79
Blue Shield,POS,17360,CPT4/HCPCS,SKIN PEEL THERAPY,,Fee Schedule,987.79
Blue Shield,POS,17380,CPT4/HCPCS,HAIR REMOVAL BY ELECTROLYSIS,,Fee Schedule,987.79
Blue Shield,POS,17999,CPT4/HCPCS,SKIN TISSUE PROCEDURE,,Fee Schedule,987.79
Blue Shield,POS,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Fee Schedule,987.79
Blue Shield,POS,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Fee Schedule,987.79
Blue Shield,POS,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Fee Schedule,4280.44
Blue Shield,POS,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Fee Schedule,4280.44
Blue Shield,POS,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Fee Schedule,4280.44
Blue Shield,POS,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Fee Schedule,4280.44
Blue Shield,POS,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Fee Schedule,3198.57
Blue Shield,POS,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Fee Schedule,4280.44
Blue Shield,POS,19105,CPT4/HCPCS,CRYOSURG ABLATE FA EACH,,Fee Schedule,3198.57
Blue Shield,POS,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Fee Schedule,4280.44
Blue Shield,POS,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Fee Schedule,4891.93
Blue Shield,POS,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Fee Schedule,4891.93
Blue Shield,POS,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Fee Schedule,4891.93
Blue Shield,POS,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Fee Schedule,4891.93
Blue Shield,POS,19260,CPT4/HCPCS,REMOVAL OF CHEST WALL LESION,,Fee Schedule,3198.57
Blue Shield,POS,19271,CPT4/HCPCS,REVISION OF CHEST WALL,,Fee Schedule,4280.44
Blue Shield,POS,19272,CPT4/HCPCS,EXTENSIVE CHEST WALL SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Fee Schedule,12850.71
Blue Shield,POS,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Fee Schedule,12850.71
Blue Shield,POS,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Fee Schedule,12850.71
Blue Shield,POS,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Fee Schedule,12850.71
Blue Shield,POS,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Fee Schedule,6049.05
Blue Shield,POS,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Fee Schedule,4891.93
Blue Shield,POS,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Fee Schedule,9548.66
Blue Shield,POS,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Fee Schedule,6049.05
Blue Shield,POS,19304,CPT4/HCPCS,MAST SUBQ,,Fee Schedule,6049.05
Blue Shield,POS,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Fee Schedule,6049.05
Blue Shield,POS,19318,CPT4/HCPCS,BREAST REDUCTION,,Fee Schedule,6049.05
Blue Shield,POS,19324,CPT4/HCPCS,ENLARGE BREAST,,Fee Schedule,6049.05
Blue Shield,POS,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Fee Schedule,12850.71
Blue Shield,POS,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Fee Schedule,3198.57
Blue Shield,POS,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Fee Schedule,3198.57
Blue Shield,POS,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Fee Schedule,4280.44
Blue Shield,POS,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Fee Schedule,4891.93
Blue Shield,POS,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,POS,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Fee Schedule,6049.05
Blue Shield,POS,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Fee Schedule,6876.92
Blue Shield,POS,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,Fee Schedule,4280.44
Blue Shield,POS,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Fee Schedule,7902.34
Blue Shield,POS,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Fee Schedule,6876.92
Blue Shield,POS,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,Fee Schedule,4891.93
Blue Shield,POS,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,Fee Schedule,6049.05
Blue Shield,POS,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,Fee Schedule,6049.05
Blue Shield,POS,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Fee Schedule,6049.05
Blue Shield,POS,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Fee Schedule,6049.05
Blue Shield,POS,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Fee Schedule,6876.92
Blue Shield,POS,19396,CPT4/HCPCS,DESIGN CUSTOM BREAST IMPLANT,,Fee Schedule,7902.34
Blue Shield,POS,19499,CPT4/HCPCS,BREAST SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,POS,20005,CPT4/HCPCS,I&D ABSCESS SUBFASCIAL,,Fee Schedule,4280.44
Blue Shield,POS,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,Fee Schedule,3198.57
Blue Shield,POS,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,Fee Schedule,4280.44
Blue Shield,POS,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,Fee Schedule,4280.44
Blue Shield,POS,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Fee Schedule,3198.57
Blue Shield,POS,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,Fee Schedule,9548.66
Blue Shield,POS,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Fee Schedule,4280.44
Blue Shield,POS,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Fee Schedule,4891.93
Blue Shield,POS,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Fee Schedule,3198.57
Blue Shield,POS,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Fee Schedule,3198.57
Blue Shield,POS,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Fee Schedule,4280.44
Blue Shield,POS,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Fee Schedule,4280.44
Blue Shield,POS,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Fee Schedule,4891.93
Blue Shield,POS,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Fee Schedule,4891.93
Blue Shield,POS,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Fee Schedule,4891.93
Blue Shield,POS,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Fee Schedule,987.79
Blue Shield,POS,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,POS,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,4891.93
Blue Shield,POS,20526,CPT4/HCPCS,THER INJECTION CARP TUNNEL,,Fee Schedule,987.79
Blue Shield,POS,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Fee Schedule,987.79
Blue Shield,POS,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Fee Schedule,987.79
Blue Shield,POS,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Fee Schedule,987.79
Blue Shield,POS,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Fee Schedule,987.79
Blue Shield,POS,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Fee Schedule,987.79
Blue Shield,POS,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Fee Schedule,3198.57
Blue Shield,POS,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,POS,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,POS,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,POS,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,POS,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,POS,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,POS,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Fee Schedule,987.79
Blue Shield,POS,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Fee Schedule,987.79
Blue Shield,POS,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Fee Schedule,4891.93
Blue Shield,POS,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Fee Schedule,3198.57
Blue Shield,POS,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Fee Schedule,3198.57
Blue Shield,POS,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Fee Schedule,3198.57
Blue Shield,POS,20664,CPT4/HCPCS,APPLICATION OF HALO,,Fee Schedule,3198.57
Blue Shield,POS,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Fee Schedule,3198.57
Blue Shield,POS,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Fee Schedule,4891.93
Blue Shield,POS,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Fee Schedule,4280.44
Blue Shield,POS,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Fee Schedule,4891.93
Blue Shield,POS,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Fee Schedule,4891.93
Blue Shield,POS,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Fee Schedule,4891.93
Blue Shield,POS,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Fee Schedule,4280.44
Blue Shield,POS,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,Fee Schedule,7902.34
Blue Shield,POS,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,Fee Schedule,12850.71
Blue Shield,POS,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,Fee Schedule,12850.71
Blue Shield,POS,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Fee Schedule,12850.71
Blue Shield,POS,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Fee Schedule,12850.71
Blue Shield,POS,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Fee Schedule,12850.71
Blue Shield,POS,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Fee Schedule,12850.71
Blue Shield,POS,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,Fee Schedule,7902.34
Blue Shield,POS,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,POS,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,POS,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,POS,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,POS,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,20926,CPT4/HCPCS,REMOVAL OF TISSUE FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Fee Schedule,3198.57
Blue Shield,POS,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Fee Schedule,987.79
Blue Shield,POS,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Fee Schedule,9548.66
Blue Shield,POS,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,Fee Schedule,7902.34
Blue Shield,POS,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,Fee Schedule,6876.92
Blue Shield,POS,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Fee Schedule,7902.34
Blue Shield,POS,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Fee Schedule,9548.66
Blue Shield,POS,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Fee Schedule,9548.66
Blue Shield,POS,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Fee Schedule,6049.05
Blue Shield,POS,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Fee Schedule,9548.66
Blue Shield,POS,20974,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Fee Schedule,987.79
Blue Shield,POS,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Fee Schedule,4280.44
Blue Shield,POS,20979,CPT4/HCPCS,US BONE STIMULATION,,Fee Schedule,987.79
Blue Shield,POS,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Fee Schedule,9548.66
Blue Shield,POS,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Fee Schedule,9548.66
Blue Shield,POS,20999,CPT4/HCPCS,MUSCULOSKELETAL SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Fee Schedule,4280.44
Blue Shield,POS,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Fee Schedule,4280.44
Blue Shield,POS,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Fee Schedule,4891.93
Blue Shield,POS,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Fee Schedule,4891.93
Blue Shield,POS,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Fee Schedule,4280.44
Blue Shield,POS,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Fee Schedule,4280.44
Blue Shield,POS,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Fee Schedule,6049.05
Blue Shield,POS,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Fee Schedule,6049.05
Blue Shield,POS,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Fee Schedule,6049.05
Blue Shield,POS,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Fee Schedule,4891.93
Blue Shield,POS,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Fee Schedule,4280.44
Blue Shield,POS,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Fee Schedule,4280.44
Blue Shield,POS,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Fee Schedule,4280.44
Blue Shield,POS,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Fee Schedule,9548.66
Blue Shield,POS,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Fee Schedule,9548.66
Blue Shield,POS,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Fee Schedule,4891.93
Blue Shield,POS,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Fee Schedule,4280.44
Blue Shield,POS,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Fee Schedule,4891.93
Blue Shield,POS,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Fee Schedule,3198.57
Blue Shield,POS,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,6049.05
Blue Shield,POS,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,POS,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,POS,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,POS,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,POS,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,POS,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,POS,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,POS,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,POS,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,POS,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,POS,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,POS,21089,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,POS,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Fee Schedule,4280.44
Blue Shield,POS,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Fee Schedule,3198.57
Blue Shield,POS,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,6049.05
Blue Shield,POS,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,POS,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,POS,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,POS,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Fee Schedule,6049.05
Blue Shield,POS,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Fee Schedule,12850.71
Blue Shield,POS,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,6049.05
Blue Shield,POS,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,9548.66
Blue Shield,POS,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,9548.66
Blue Shield,POS,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,Fee Schedule,4891.93
Blue Shield,POS,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,Fee Schedule,6049.05
Blue Shield,POS,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,Fee Schedule,6049.05
Blue Shield,POS,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,Fee Schedule,6876.92
Blue Shield,POS,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,Fee Schedule,6876.92
Blue Shield,POS,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,Fee Schedule,9548.66
Blue Shield,POS,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Fee Schedule,4891.93
Blue Shield,POS,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Fee Schedule,6049.05
Blue Shield,POS,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Fee Schedule,6049.05
Blue Shield,POS,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Fee Schedule,6049.05
Blue Shield,POS,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Fee Schedule,9548.66
Blue Shield,POS,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6876.92
Blue Shield,POS,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6876.92
Blue Shield,POS,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6049.05
Blue Shield,POS,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,Fee Schedule,4891.93
Blue Shield,POS,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Fee Schedule,3198.57
Blue Shield,POS,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,Fee Schedule,4280.44
Blue Shield,POS,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Fee Schedule,9548.66
Blue Shield,POS,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Fee Schedule,9548.66
Blue Shield,POS,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Fee Schedule,6876.92
Blue Shield,POS,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Fee Schedule,9548.66
Blue Shield,POS,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Fee Schedule,6876.92
Blue Shield,POS,21210,CPT4/HCPCS,FACE BONE GRAFT,,Fee Schedule,9548.66
Blue Shield,POS,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Fee Schedule,9548.66
Blue Shield,POS,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Fee Schedule,9548.66
Blue Shield,POS,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Fee Schedule,9548.66
Blue Shield,POS,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6049.05
Blue Shield,POS,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6876.92
Blue Shield,POS,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6876.92
Blue Shield,POS,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Fee Schedule,9548.66
Blue Shield,POS,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,POS,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,POS,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Fee Schedule,6049.05
Blue Shield,POS,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,POS,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,POS,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Fee Schedule,4280.44
Blue Shield,POS,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,Fee Schedule,4280.44
Blue Shield,POS,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,POS,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,POS,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,POS,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,POS,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,4280.44
Blue Shield,POS,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Fee Schedule,6876.92
Blue Shield,POS,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Fee Schedule,9548.66
Blue Shield,POS,21280,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,6876.92
Blue Shield,POS,21282,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,6876.92
Blue Shield,POS,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Fee Schedule,3198.57
Blue Shield,POS,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Fee Schedule,3198.57
Blue Shield,POS,21299,CPT4/HCPCS,CRANIO/MAXILLOFACIAL SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Fee Schedule,4280.44
Blue Shield,POS,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Fee Schedule,4280.44
Blue Shield,POS,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Fee Schedule,4280.44
Blue Shield,POS,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Fee Schedule,6049.05
Blue Shield,POS,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Fee Schedule,6876.92
Blue Shield,POS,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Fee Schedule,9548.66
Blue Shield,POS,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Fee Schedule,6049.05
Blue Shield,POS,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Fee Schedule,4280.44
Blue Shield,POS,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Fee Schedule,6049.05
Blue Shield,POS,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Fee Schedule,6876.92
Blue Shield,POS,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Fee Schedule,6049.05
Blue Shield,POS,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Fee Schedule,3198.57
Blue Shield,POS,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Fee Schedule,4280.44
Blue Shield,POS,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Fee Schedule,9548.66
Blue Shield,POS,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Fee Schedule,3198.57
Blue Shield,POS,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Fee Schedule,3198.57
Blue Shield,POS,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Fee Schedule,3198.57
Blue Shield,POS,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Fee Schedule,3198.57
Blue Shield,POS,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Fee Schedule,4280.44
Blue Shield,POS,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Fee Schedule,3198.57
Blue Shield,POS,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Fee Schedule,3198.57
Blue Shield,POS,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Fee Schedule,3198.57
Blue Shield,POS,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Fee Schedule,9548.66
Blue Shield,POS,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Fee Schedule,3198.57
Blue Shield,POS,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Fee Schedule,4280.44
Blue Shield,POS,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Fee Schedule,4891.93
Blue Shield,POS,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Fee Schedule,9548.66
Blue Shield,POS,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Fee Schedule,9548.66
Blue Shield,POS,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,Fee Schedule,3198.57
Blue Shield,POS,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6876.92
Blue Shield,POS,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6876.92
Blue Shield,POS,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,9548.66
Blue Shield,POS,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Fee Schedule,3198.57
Blue Shield,POS,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Fee Schedule,4280.44
Blue Shield,POS,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Fee Schedule,4891.93
Blue Shield,POS,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Fee Schedule,4280.44
Blue Shield,POS,21499,CPT4/HCPCS,HEAD SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,POS,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Fee Schedule,4280.44
Blue Shield,POS,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Fee Schedule,4280.44
Blue Shield,POS,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,3198.57
Blue Shield,POS,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Fee Schedule,3198.57
Blue Shield,POS,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,POS,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,POS,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Fee Schedule,3198.57
Blue Shield,POS,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,POS,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,POS,21615,CPT4/HCPCS,REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,POS,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,Fee Schedule,4280.44
Blue Shield,POS,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Fee Schedule,3198.57
Blue Shield,POS,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,Fee Schedule,4280.44
Blue Shield,POS,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Fee Schedule,3198.57
Blue Shield,POS,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4280.44
Blue Shield,POS,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,Fee Schedule,4280.44
Blue Shield,POS,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4891.93
Blue Shield,POS,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4891.93
Blue Shield,POS,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Fee Schedule,4280.44
Blue Shield,POS,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Fee Schedule,9548.66
Blue Shield,POS,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Fee Schedule,9548.66
Blue Shield,POS,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,Fee Schedule,3198.57
Blue Shield,POS,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Fee Schedule,4891.93
Blue Shield,POS,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,21899,CPT4/HCPCS,NECK/CHEST SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Fee Schedule,3198.57
Blue Shield,POS,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Fee Schedule,4280.44
Blue Shield,POS,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,POS,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Fee Schedule,4891.93
Blue Shield,POS,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,POS,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Fee Schedule,9548.66
Blue Shield,POS,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Fee Schedule,9548.66
Blue Shield,POS,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Fee Schedule,9548.66
Blue Shield,POS,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Fee Schedule,9548.66
Blue Shield,POS,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Fee Schedule,3198.57
Blue Shield,POS,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Fee Schedule,3198.57
Blue Shield,POS,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Fee Schedule,3198.57
Blue Shield,POS,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,POS,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,Fee Schedule,4891.93
Blue Shield,POS,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,Fee Schedule,4280.44
Blue Shield,POS,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,Fee Schedule,4891.93
Blue Shield,POS,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,POS,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,Fee Schedule,4891.93
Blue Shield,POS,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,Fee Schedule,4280.44
Blue Shield,POS,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,Fee Schedule,4891.93
Blue Shield,POS,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,POS,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Fee Schedule,3198.57
Blue Shield,POS,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Fee Schedule,4280.44
Blue Shield,POS,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Fee Schedule,4891.93
Blue Shield,POS,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Fee Schedule,3198.57
Blue Shield,POS,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Fee Schedule,4280.44
Blue Shield,POS,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Fee Schedule,6876.92
Blue Shield,POS,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Fee Schedule,6876.92
Blue Shield,POS,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Fee Schedule,9548.66
Blue Shield,POS,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,6876.92
Blue Shield,POS,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,6876.92
Blue Shield,POS,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,9548.66
Blue Shield,POS,22532,CPT4/HCPCS,LAT THORAX SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,POS,22533,CPT4/HCPCS,LAT LUMBAR SPINE FUSION,,Fee Schedule,3198.57
Blue Shield,POS,22534,CPT4/HCPCS,LAT THOR/LUMB ADDL SEG,,Fee Schedule,3198.57
Blue Shield,POS,22548,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,POS,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Fee Schedule,4891.93
Blue Shield,POS,22554,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,6876.92
Blue Shield,POS,22556,CPT4/HCPCS,THORAX SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,POS,22558,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,POS,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,Fee Schedule,3198.57
Blue Shield,POS,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,Fee Schedule,7902.34
Blue Shield,POS,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,Fee Schedule,4891.93
Blue Shield,POS,22595,CPT4/HCPCS,NECK SPINAL FUSION,,Fee Schedule,4280.44
Blue Shield,POS,22600,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,POS,22610,CPT4/HCPCS,THORAX SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,POS,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,9548.66
Blue Shield,POS,22614,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,9548.66
Blue Shield,POS,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,POS,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,3198.57
Blue Shield,POS,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,Fee Schedule,7902.34
Blue Shield,POS,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,3198.57
Blue Shield,POS,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,Fee Schedule,4280.44
Blue Shield,POS,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,Fee Schedule,6876.92
Blue Shield,POS,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,Fee Schedule,6876.92
Blue Shield,POS,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,Fee Schedule,6049.05
Blue Shield,POS,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,Fee Schedule,6049.05
Blue Shield,POS,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,Fee Schedule,6876.92
Blue Shield,POS,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,Fee Schedule,6876.92
Blue Shield,POS,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,Fee Schedule,6876.92
Blue Shield,POS,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,Fee Schedule,3198.57
Blue Shield,POS,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,Fee Schedule,4280.44
Blue Shield,POS,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Fee Schedule,987.79
Blue Shield,POS,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Fee Schedule,3198.57
Blue Shield,POS,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Fee Schedule,3198.57
Blue Shield,POS,22899,CPT4/HCPCS,SPINE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Fee Schedule,6049.05
Blue Shield,POS,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,POS,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Fee Schedule,4891.93
Blue Shield,POS,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,22999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Fee Schedule,4891.93
Blue Shield,POS,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Fee Schedule,4280.44
Blue Shield,POS,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,POS,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Fee Schedule,3198.57
Blue Shield,POS,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Fee Schedule,4891.93
Blue Shield,POS,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Fee Schedule,4891.93
Blue Shield,POS,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Fee Schedule,3198.57
Blue Shield,POS,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Fee Schedule,4280.44
Blue Shield,POS,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,POS,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,POS,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Fee Schedule,4891.93
Blue Shield,POS,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,POS,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Fee Schedule,9548.66
Blue Shield,POS,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Fee Schedule,6049.05
Blue Shield,POS,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Fee Schedule,6049.05
Blue Shield,POS,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Fee Schedule,6049.05
Blue Shield,POS,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Fee Schedule,6876.92
Blue Shield,POS,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Fee Schedule,6876.92
Blue Shield,POS,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Fee Schedule,6876.92
Blue Shield,POS,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6049.05
Blue Shield,POS,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6876.92
Blue Shield,POS,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6876.92
Blue Shield,POS,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6049.05
Blue Shield,POS,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6876.92
Blue Shield,POS,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6876.92
Blue Shield,POS,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Fee Schedule,4280.44
Blue Shield,POS,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,4280.44
Blue Shield,POS,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Fee Schedule,6049.05
Blue Shield,POS,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Fee Schedule,6049.05
Blue Shield,POS,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,6049.05
Blue Shield,POS,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Fee Schedule,6049.05
Blue Shield,POS,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Fee Schedule,6876.92
Blue Shield,POS,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,Fee Schedule,4280.44
Blue Shield,POS,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,Fee Schedule,4280.44
Blue Shield,POS,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,Fee Schedule,4891.93
Blue Shield,POS,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,POS,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Fee Schedule,4280.44
Blue Shield,POS,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Fee Schedule,9548.66
Blue Shield,POS,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Fee Schedule,987.79
Blue Shield,POS,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Fee Schedule,6876.92
Blue Shield,POS,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Fee Schedule,9548.66
Blue Shield,POS,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Fee Schedule,9548.66
Blue Shield,POS,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Fee Schedule,4280.44
Blue Shield,POS,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Fee Schedule,4280.44
Blue Shield,POS,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Fee Schedule,6876.92
Blue Shield,POS,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Fee Schedule,9548.66
Blue Shield,POS,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Fee Schedule,6876.92
Blue Shield,POS,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Fee Schedule,9548.66
Blue Shield,POS,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Fee Schedule,6049.05
Blue Shield,POS,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Fee Schedule,6049.05
Blue Shield,POS,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,POS,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,POS,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,POS,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,POS,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,POS,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,POS,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Fee Schedule,12850.71
Blue Shield,POS,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Fee Schedule,4891.93
Blue Shield,POS,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,POS,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,POS,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Fee Schedule,6049.05
Blue Shield,POS,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Fee Schedule,9548.66
Blue Shield,POS,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Fee Schedule,4891.93
Blue Shield,POS,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Fee Schedule,4891.93
Blue Shield,POS,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,POS,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,POS,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Fee Schedule,3198.57
Blue Shield,POS,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Fee Schedule,3198.57
Blue Shield,POS,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6876.92
Blue Shield,POS,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Fee Schedule,3198.57
Blue Shield,POS,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Fee Schedule,6049.05
Blue Shield,POS,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,POS,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,Fee Schedule,4891.93
Blue Shield,POS,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,POS,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,23929,CPT4/HCPCS,SHOULDER SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Fee Schedule,3198.57
Blue Shield,POS,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Fee Schedule,4280.44
Blue Shield,POS,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,POS,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Fee Schedule,3198.57
Blue Shield,POS,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Fee Schedule,4280.44
Blue Shield,POS,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,POS,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,POS,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,POS,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Fee Schedule,3198.57
Blue Shield,POS,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,POS,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Fee Schedule,6049.05
Blue Shield,POS,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Fee Schedule,4891.93
Blue Shield,POS,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,4280.44
Blue Shield,POS,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,POS,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,POS,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Fee Schedule,4891.93
Blue Shield,POS,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,POS,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,POS,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Fee Schedule,4891.93
Blue Shield,POS,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Fee Schedule,4891.93
Blue Shield,POS,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,4891.93
Blue Shield,POS,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Fee Schedule,4280.44
Blue Shield,POS,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Fee Schedule,3198.57
Blue Shield,POS,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Fee Schedule,9548.66
Blue Shield,POS,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Fee Schedule,9548.66
Blue Shield,POS,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Fee Schedule,4891.93
Blue Shield,POS,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Fee Schedule,4280.44
Blue Shield,POS,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Fee Schedule,4891.93
Blue Shield,POS,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,POS,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,POS,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Fee Schedule,3198.57
Blue Shield,POS,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Fee Schedule,6049.05
Blue Shield,POS,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Fee Schedule,6049.05
Blue Shield,POS,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Fee Schedule,4891.93
Blue Shield,POS,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Fee Schedule,4891.93
Blue Shield,POS,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Fee Schedule,4891.93
Blue Shield,POS,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Fee Schedule,4891.93
Blue Shield,POS,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Fee Schedule,4891.93
Blue Shield,POS,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Fee Schedule,4891.93
Blue Shield,POS,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,POS,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Fee Schedule,4891.93
Blue Shield,POS,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Fee Schedule,6049.05
Blue Shield,POS,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Fee Schedule,9548.66
Blue Shield,POS,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Fee Schedule,4280.44
Blue Shield,POS,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Fee Schedule,9548.66
Blue Shield,POS,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Fee Schedule,4891.93
Blue Shield,POS,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Fee Schedule,4891.93
Blue Shield,POS,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Fee Schedule,4891.93
Blue Shield,POS,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,POS,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,POS,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,POS,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Fee Schedule,9548.66
Blue Shield,POS,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Fee Schedule,6876.92
Blue Shield,POS,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Fee Schedule,6876.92
Blue Shield,POS,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Fee Schedule,7902.34
Blue Shield,POS,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Fee Schedule,9548.66
Blue Shield,POS,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,6049.05
Blue Shield,POS,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,6049.05
Blue Shield,POS,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,4891.93
Blue Shield,POS,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Fee Schedule,4891.93
Blue Shield,POS,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Fee Schedule,4891.93
Blue Shield,POS,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,POS,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Fee Schedule,4891.93
Blue Shield,POS,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6876.92
Blue Shield,POS,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,6876.92
Blue Shield,POS,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,POS,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,POS,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Fee Schedule,3198.57
Blue Shield,POS,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Fee Schedule,4280.44
Blue Shield,POS,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,Fee Schedule,3198.57
Blue Shield,POS,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,Fee Schedule,9548.66
Blue Shield,POS,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,Fee Schedule,9548.66
Blue Shield,POS,24999,CPT4/HCPCS,UPPER ARM/ELBOW SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Fee Schedule,4891.93
Blue Shield,POS,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Fee Schedule,4891.93
Blue Shield,POS,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Fee Schedule,4891.93
Blue Shield,POS,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Fee Schedule,4891.93
Blue Shield,POS,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Fee Schedule,4891.93
Blue Shield,POS,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Fee Schedule,4891.93
Blue Shield,POS,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Fee Schedule,3198.57
Blue Shield,POS,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Fee Schedule,4280.44
Blue Shield,POS,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,POS,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,POS,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Fee Schedule,4280.44
Blue Shield,POS,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,POS,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Fee Schedule,4891.93
Blue Shield,POS,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Fee Schedule,4891.93
Blue Shield,POS,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Fee Schedule,4891.93
Blue Shield,POS,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Fee Schedule,4891.93
Blue Shield,POS,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Fee Schedule,4280.44
Blue Shield,POS,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,POS,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Fee Schedule,6049.05
Blue Shield,POS,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Fee Schedule,4891.93
Blue Shield,POS,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Fee Schedule,4891.93
Blue Shield,POS,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Fee Schedule,4891.93
Blue Shield,POS,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Fee Schedule,4891.93
Blue Shield,POS,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Fee Schedule,6049.05
Blue Shield,POS,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Fee Schedule,6049.05
Blue Shield,POS,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Fee Schedule,6049.05
Blue Shield,POS,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,POS,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,POS,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,POS,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,POS,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Fee Schedule,4891.93
Blue Shield,POS,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Fee Schedule,4891.93
Blue Shield,POS,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Fee Schedule,4891.93
Blue Shield,POS,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,4280.44
Blue Shield,POS,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,4280.44
Blue Shield,POS,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Fee Schedule,9548.66
Blue Shield,POS,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Fee Schedule,4891.93
Blue Shield,POS,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Fee Schedule,6049.05
Blue Shield,POS,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,6049.05
Blue Shield,POS,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,6049.05
Blue Shield,POS,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,POS,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,POS,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,POS,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Fee Schedule,3198.57
Blue Shield,POS,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,POS,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4280.44
Blue Shield,POS,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,POS,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,POS,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,POS,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,POS,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Fee Schedule,6049.05
Blue Shield,POS,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Fee Schedule,6049.05
Blue Shield,POS,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,POS,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,POS,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Fee Schedule,4891.93
Blue Shield,POS,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Fee Schedule,4891.93
Blue Shield,POS,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,POS,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Fee Schedule,6049.05
Blue Shield,POS,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Fee Schedule,4891.93
Blue Shield,POS,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Fee Schedule,4891.93
Blue Shield,POS,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,POS,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,POS,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Fee Schedule,4891.93
Blue Shield,POS,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Fee Schedule,6876.92
Blue Shield,POS,25350,CPT4/HCPCS,REVISION OF RADIUS,,Fee Schedule,4891.93
Blue Shield,POS,25355,CPT4/HCPCS,REVISION OF RADIUS,,Fee Schedule,4891.93
Blue Shield,POS,25360,CPT4/HCPCS,REVISION OF ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,POS,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Fee Schedule,6049.05
Blue Shield,POS,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,POS,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Fee Schedule,4280.44
Blue Shield,POS,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Fee Schedule,6049.05
Blue Shield,POS,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,POS,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,POS,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Fee Schedule,6049.05
Blue Shield,POS,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Fee Schedule,6049.05
Blue Shield,POS,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Fee Schedule,6049.05
Blue Shield,POS,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,POS,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,POS,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,POS,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,POS,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,POS,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Fee Schedule,9548.66
Blue Shield,POS,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Fee Schedule,6876.92
Blue Shield,POS,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Fee Schedule,6876.92
Blue Shield,POS,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,POS,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,POS,25490,CPT4/HCPCS,REINFORCE RADIUS,,Fee Schedule,4891.93
Blue Shield,POS,25491,CPT4/HCPCS,REINFORCE ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,987.79
Blue Shield,POS,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,3198.57
Blue Shield,POS,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,4891.93
Blue Shield,POS,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,3198.57
Blue Shield,POS,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,6049.05
Blue Shield,POS,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,6876.92
Blue Shield,POS,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,987.79
Blue Shield,POS,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,3198.57
Blue Shield,POS,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,987.79
Blue Shield,POS,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,4280.44
Blue Shield,POS,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,987.79
Blue Shield,POS,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,4891.93
Blue Shield,POS,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Fee Schedule,4891.93
Blue Shield,POS,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Fee Schedule,6876.92
Blue Shield,POS,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Fee Schedule,6876.92
Blue Shield,POS,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Fee Schedule,6876.92
Blue Shield,POS,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Fee Schedule,7902.34
Blue Shield,POS,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Fee Schedule,7902.34
Blue Shield,POS,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Fee Schedule,6049.05
Blue Shield,POS,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,POS,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,POS,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Fee Schedule,6049.05
Blue Shield,POS,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Fee Schedule,6876.92
Blue Shield,POS,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Fee Schedule,6876.92
Blue Shield,POS,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,POS,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,POS,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4891.93
Blue Shield,POS,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Fee Schedule,3198.57
Blue Shield,POS,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Fee Schedule,4891.93
Blue Shield,POS,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,25927,CPT4/HCPCS,AMPUTATION OF HAND,,Fee Schedule,4280.44
Blue Shield,POS,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,25999,CPT4/HCPCS,FOREARM OR WRIST SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,26010,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Fee Schedule,987.79
Blue Shield,POS,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,POS,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Fee Schedule,3198.57
Blue Shield,POS,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Fee Schedule,4280.44
Blue Shield,POS,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Fee Schedule,4280.44
Blue Shield,POS,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Fee Schedule,4280.44
Blue Shield,POS,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,POS,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Fee Schedule,4280.44
Blue Shield,POS,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Fee Schedule,4280.44
Blue Shield,POS,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,POS,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,POS,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Fee Schedule,4280.44
Blue Shield,POS,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Fee Schedule,3198.57
Blue Shield,POS,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Fee Schedule,3198.57
Blue Shield,POS,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,POS,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,POS,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Fee Schedule,4891.93
Blue Shield,POS,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Fee Schedule,4891.93
Blue Shield,POS,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Fee Schedule,6049.05
Blue Shield,POS,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Fee Schedule,4280.44
Blue Shield,POS,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Fee Schedule,4891.93
Blue Shield,POS,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Fee Schedule,4891.93
Blue Shield,POS,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Fee Schedule,4891.93
Blue Shield,POS,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Fee Schedule,6049.05
Blue Shield,POS,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,POS,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Fee Schedule,4280.44
Blue Shield,POS,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Fee Schedule,4891.93
Blue Shield,POS,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Fee Schedule,9548.66
Blue Shield,POS,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Fee Schedule,4891.93
Blue Shield,POS,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Fee Schedule,4891.93
Blue Shield,POS,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Fee Schedule,4891.93
Blue Shield,POS,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Fee Schedule,4280.44
Blue Shield,POS,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Fee Schedule,4280.44
Blue Shield,POS,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Fee Schedule,987.79
Blue Shield,POS,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Fee Schedule,987.79
Blue Shield,POS,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,3198.57
Blue Shield,POS,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,POS,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,POS,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,POS,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,POS,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,POS,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,POS,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,POS,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,POS,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,POS,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,POS,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Fee Schedule,4891.93
Blue Shield,POS,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Fee Schedule,4280.44
Blue Shield,POS,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Fee Schedule,4280.44
Blue Shield,POS,26476,CPT4/HCPCS,TENDON LENGTHENING,,Fee Schedule,3198.57
Blue Shield,POS,26477,CPT4/HCPCS,TENDON SHORTENING,,Fee Schedule,3198.57
Blue Shield,POS,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Fee Schedule,3198.57
Blue Shield,POS,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Fee Schedule,3198.57
Blue Shield,POS,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Fee Schedule,4280.44
Blue Shield,POS,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Fee Schedule,4891.93
Blue Shield,POS,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Fee Schedule,4891.93
Blue Shield,POS,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Fee Schedule,4891.93
Blue Shield,POS,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Fee Schedule,4891.93
Blue Shield,POS,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Fee Schedule,6049.05
Blue Shield,POS,26499,CPT4/HCPCS,REVISION OF FINGER,,Fee Schedule,4891.93
Blue Shield,POS,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,POS,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,POS,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Fee Schedule,4891.93
Blue Shield,POS,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Fee Schedule,3198.57
Blue Shield,POS,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Fee Schedule,4891.93
Blue Shield,POS,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Fee Schedule,4891.93
Blue Shield,POS,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Fee Schedule,4891.93
Blue Shield,POS,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Fee Schedule,9548.66
Blue Shield,POS,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Fee Schedule,6876.92
Blue Shield,POS,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Fee Schedule,6876.92
Blue Shield,POS,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Fee Schedule,6049.05
Blue Shield,POS,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Fee Schedule,9548.66
Blue Shield,POS,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,POS,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Fee Schedule,6049.05
Blue Shield,POS,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,POS,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Fee Schedule,4280.44
Blue Shield,POS,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Fee Schedule,9548.66
Blue Shield,POS,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Fee Schedule,9548.66
Blue Shield,POS,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Fee Schedule,9548.66
Blue Shield,POS,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Fee Schedule,4891.93
Blue Shield,POS,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,Fee Schedule,9548.66
Blue Shield,POS,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,4280.44
Blue Shield,POS,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,4891.93
Blue Shield,POS,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,6049.05
Blue Shield,POS,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Fee Schedule,6876.92
Blue Shield,POS,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Fee Schedule,6876.92
Blue Shield,POS,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Fee Schedule,4891.93
Blue Shield,POS,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Fee Schedule,6876.92
Blue Shield,POS,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Fee Schedule,6876.92
Blue Shield,POS,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Fee Schedule,6876.92
Blue Shield,POS,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Fee Schedule,4891.93
Blue Shield,POS,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Fee Schedule,4891.93
Blue Shield,POS,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Fee Schedule,4280.44
Blue Shield,POS,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,POS,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,POS,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,POS,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,9548.66
Blue Shield,POS,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6049.05
Blue Shield,POS,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,POS,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,4280.44
Blue Shield,POS,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6876.92
Blue Shield,POS,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,POS,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,POS,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Fee Schedule,4280.44
Blue Shield,POS,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6049.05
Blue Shield,POS,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Fee Schedule,6876.92
Blue Shield,POS,26841,CPT4/HCPCS,FUSION OF THUMB,,Fee Schedule,6049.05
Blue Shield,POS,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Fee Schedule,4891.93
Blue Shield,POS,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Fee Schedule,4891.93
Blue Shield,POS,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Fee Schedule,6049.05
Blue Shield,POS,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Fee Schedule,4891.93
Blue Shield,POS,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Fee Schedule,4280.44
Blue Shield,POS,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,POS,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Fee Schedule,4891.93
Blue Shield,POS,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Fee Schedule,4891.93
Blue Shield,POS,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Fee Schedule,4280.44
Blue Shield,POS,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Fee Schedule,6049.05
Blue Shield,POS,26989,CPT4/HCPCS,HAND/FINGER SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Fee Schedule,3198.57
Blue Shield,POS,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Fee Schedule,3198.57
Blue Shield,POS,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,6049.05
Blue Shield,POS,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4280.44
Blue Shield,POS,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,3198.57
Blue Shield,POS,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Fee Schedule,3198.57
Blue Shield,POS,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,Fee Schedule,3198.57
Blue Shield,POS,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Fee Schedule,6049.05
Blue Shield,POS,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Fee Schedule,4280.44
Blue Shield,POS,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Fee Schedule,4891.93
Blue Shield,POS,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,POS,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,Fee Schedule,4280.44
Blue Shield,POS,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,POS,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Fee Schedule,4280.44
Blue Shield,POS,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,POS,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Fee Schedule,4891.93
Blue Shield,POS,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,POS,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Fee Schedule,4891.93
Blue Shield,POS,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Fee Schedule,4891.93
Blue Shield,POS,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,Fee Schedule,3198.57
Blue Shield,POS,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Fee Schedule,6049.05
Blue Shield,POS,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Fee Schedule,6876.92
Blue Shield,POS,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Fee Schedule,6876.92
Blue Shield,POS,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Fee Schedule,6876.92
Blue Shield,POS,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Fee Schedule,6876.92
Blue Shield,POS,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Fee Schedule,6876.92
Blue Shield,POS,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,Fee Schedule,4891.93
Blue Shield,POS,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,Fee Schedule,6049.05
Blue Shield,POS,27075,CPT4/HCPCS,RESECT HIP TUMOR,,Fee Schedule,7902.34
Blue Shield,POS,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,Fee Schedule,6049.05
Blue Shield,POS,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,Fee Schedule,9548.66
Blue Shield,POS,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,Fee Schedule,4891.93
Blue Shield,POS,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Fee Schedule,4280.44
Blue Shield,POS,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,POS,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Fee Schedule,4891.93
Blue Shield,POS,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,POS,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,POS,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Fee Schedule,3198.57
Blue Shield,POS,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Fee Schedule,4891.93
Blue Shield,POS,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Fee Schedule,6049.05
Blue Shield,POS,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Fee Schedule,6049.05
Blue Shield,POS,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Fee Schedule,6049.05
Blue Shield,POS,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Fee Schedule,6049.05
Blue Shield,POS,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Fee Schedule,4280.44
Blue Shield,POS,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Fee Schedule,4280.44
Blue Shield,POS,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,Fee Schedule,4280.44
Blue Shield,POS,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Fee Schedule,4891.93
Blue Shield,POS,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Fee Schedule,6049.05
Blue Shield,POS,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,6876.92
Blue Shield,POS,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,4891.93
Blue Shield,POS,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,4891.93
Blue Shield,POS,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,Fee Schedule,3198.57
Blue Shield,POS,27146,CPT4/HCPCS,INCISION OF HIP BONE,,Fee Schedule,4891.93
Blue Shield,POS,27147,CPT4/HCPCS,REVISION OF HIP BONE,,Fee Schedule,4891.93
Blue Shield,POS,27151,CPT4/HCPCS,INCISION OF HIP BONES,,Fee Schedule,6049.05
Blue Shield,POS,27156,CPT4/HCPCS,REVISION OF HIP BONES,,Fee Schedule,6049.05
Blue Shield,POS,27158,CPT4/HCPCS,REVISION OF PELVIS,,Fee Schedule,4891.93
Blue Shield,POS,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,Fee Schedule,4280.44
Blue Shield,POS,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,Fee Schedule,4280.44
Blue Shield,POS,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,Fee Schedule,4280.44
Blue Shield,POS,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,POS,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,POS,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,POS,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,POS,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,Fee Schedule,3198.57
Blue Shield,POS,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,POS,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,POS,27187,CPT4/HCPCS,REINFORCE HIP BONES,,Fee Schedule,4280.44
Blue Shield,POS,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Fee Schedule,3198.57
Blue Shield,POS,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Fee Schedule,4280.44
Blue Shield,POS,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,Fee Schedule,3198.57
Blue Shield,POS,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Fee Schedule,4891.93
Blue Shield,POS,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Fee Schedule,6049.05
Blue Shield,POS,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,27267,CPT4/HCPCS,CLTX THIGH FX,,Fee Schedule,4280.44
Blue Shield,POS,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,Fee Schedule,4280.44
Blue Shield,POS,27269,CPT4/HCPCS,OPTX THIGH FX,,Fee Schedule,6876.92
Blue Shield,POS,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Fee Schedule,4280.44
Blue Shield,POS,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Fee Schedule,4891.93
Blue Shield,POS,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,Fee Schedule,4280.44
Blue Shield,POS,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,Fee Schedule,3198.57
Blue Shield,POS,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,POS,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,POS,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Fee Schedule,4891.93
Blue Shield,POS,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Fee Schedule,4280.44
Blue Shield,POS,27299,CPT4/HCPCS,PELVIS/HIP JOINT SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Fee Schedule,4891.93
Blue Shield,POS,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Fee Schedule,4280.44
Blue Shield,POS,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,POS,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,POS,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,POS,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,POS,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Fee Schedule,4280.44
Blue Shield,POS,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Fee Schedule,4280.44
Blue Shield,POS,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,POS,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Fee Schedule,4891.93
Blue Shield,POS,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Fee Schedule,6049.05
Blue Shield,POS,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,POS,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,POS,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,POS,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,POS,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,POS,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,POS,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Fee Schedule,4891.93
Blue Shield,POS,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Fee Schedule,4891.93
Blue Shield,POS,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Fee Schedule,6049.05
Blue Shield,POS,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Fee Schedule,6049.05
Blue Shield,POS,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Fee Schedule,6049.05
Blue Shield,POS,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Fee Schedule,4891.93
Blue Shield,POS,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Fee Schedule,6876.92
Blue Shield,POS,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Fee Schedule,6876.92
Blue Shield,POS,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Fee Schedule,6876.92
Blue Shield,POS,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,Fee Schedule,4891.93
Blue Shield,POS,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,9548.66
Blue Shield,POS,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Fee Schedule,3198.57
Blue Shield,POS,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Fee Schedule,4891.93
Blue Shield,POS,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Fee Schedule,4891.93
Blue Shield,POS,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Fee Schedule,3198.57
Blue Shield,POS,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4280.44
Blue Shield,POS,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,POS,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Fee Schedule,4280.44
Blue Shield,POS,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,POS,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,POS,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,POS,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Fee Schedule,4891.93
Blue Shield,POS,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,POS,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Fee Schedule,6049.05
Blue Shield,POS,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Fee Schedule,6049.05
Blue Shield,POS,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Fee Schedule,6049.05
Blue Shield,POS,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Fee Schedule,12850.71
Blue Shield,POS,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Fee Schedule,12850.71
Blue Shield,POS,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,POS,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Fee Schedule,4891.93
Blue Shield,POS,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Fee Schedule,4891.93
Blue Shield,POS,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Fee Schedule,9548.66
Blue Shield,POS,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Fee Schedule,4891.93
Blue Shield,POS,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Fee Schedule,9548.66
Blue Shield,POS,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,4891.93
Blue Shield,POS,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,6049.05
Blue Shield,POS,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,6049.05
Blue Shield,POS,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Fee Schedule,6049.05
Blue Shield,POS,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,POS,27437,CPT4/HCPCS,REVISE KNEECAP,,Fee Schedule,6049.05
Blue Shield,POS,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Fee Schedule,6876.92
Blue Shield,POS,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,7902.34
Blue Shield,POS,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,POS,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,POS,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,POS,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,4280.44
Blue Shield,POS,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,12850.71
Blue Shield,POS,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Fee Schedule,4891.93
Blue Shield,POS,27448,CPT4/HCPCS,INCISION OF THIGH,,Fee Schedule,3198.57
Blue Shield,POS,27450,CPT4/HCPCS,INCISION OF THIGH,,Fee Schedule,4280.44
Blue Shield,POS,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,Fee Schedule,4891.93
Blue Shield,POS,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,Fee Schedule,4280.44
Blue Shield,POS,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,Fee Schedule,3198.57
Blue Shield,POS,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,Fee Schedule,4280.44
Blue Shield,POS,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,Fee Schedule,4891.93
Blue Shield,POS,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,Fee Schedule,4280.44
Blue Shield,POS,27470,CPT4/HCPCS,REPAIR OF THIGH,,Fee Schedule,4891.93
Blue Shield,POS,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,Fee Schedule,4891.93
Blue Shield,POS,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,POS,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,POS,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,POS,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,POS,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Fee Schedule,4891.93
Blue Shield,POS,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,POS,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,POS,27495,CPT4/HCPCS,REINFORCE THIGH,,Fee Schedule,4891.93
Blue Shield,POS,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,6876.92
Blue Shield,POS,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,POS,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,POS,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,POS,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,3198.57
Blue Shield,POS,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,3198.57
Blue Shield,POS,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,4280.44
Blue Shield,POS,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Fee Schedule,7902.34
Blue Shield,POS,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Fee Schedule,3198.57
Blue Shield,POS,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Fee Schedule,3198.57
Blue Shield,POS,27580,CPT4/HCPCS,FUSION OF KNEE,,Fee Schedule,4891.93
Blue Shield,POS,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,POS,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,POS,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,POS,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,Fee Schedule,3198.57
Blue Shield,POS,27599,CPT4/HCPCS,LEG SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,POS,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,POS,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,POS,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Fee Schedule,4280.44
Blue Shield,POS,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Fee Schedule,4280.44
Blue Shield,POS,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Fee Schedule,3198.57
Blue Shield,POS,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Fee Schedule,3198.57
Blue Shield,POS,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Fee Schedule,4280.44
Blue Shield,POS,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,POS,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Fee Schedule,4891.93
Blue Shield,POS,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Fee Schedule,3198.57
Blue Shield,POS,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Fee Schedule,4280.44
Blue Shield,POS,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,POS,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Fee Schedule,4280.44
Blue Shield,POS,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Fee Schedule,4891.93
Blue Shield,POS,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Fee Schedule,6049.05
Blue Shield,POS,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,POS,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,POS,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Fee Schedule,4891.93
Blue Shield,POS,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,POS,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,POS,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,POS,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Fee Schedule,4280.44
Blue Shield,POS,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Fee Schedule,4280.44
Blue Shield,POS,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,Fee Schedule,6049.05
Blue Shield,POS,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,Fee Schedule,6049.05
Blue Shield,POS,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Fee Schedule,4891.93
Blue Shield,POS,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Fee Schedule,4280.44
Blue Shield,POS,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,3198.57
Blue Shield,POS,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,POS,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,POS,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,POS,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Fee Schedule,4280.44
Blue Shield,POS,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Fee Schedule,4891.93
Blue Shield,POS,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Fee Schedule,4280.44
Blue Shield,POS,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Fee Schedule,4891.93
Blue Shield,POS,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Fee Schedule,6049.05
Blue Shield,POS,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Fee Schedule,6049.05
Blue Shield,POS,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Fee Schedule,4891.93
Blue Shield,POS,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Fee Schedule,4280.44
Blue Shield,POS,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,POS,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Fee Schedule,4280.44
Blue Shield,POS,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Fee Schedule,6876.92
Blue Shield,POS,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,POS,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,POS,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Fee Schedule,4280.44
Blue Shield,POS,27705,CPT4/HCPCS,INCISION OF TIBIA,,Fee Schedule,4280.44
Blue Shield,POS,27707,CPT4/HCPCS,INCISION OF FIBULA,,Fee Schedule,4280.44
Blue Shield,POS,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Fee Schedule,4280.44
Blue Shield,POS,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,POS,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,POS,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Fee Schedule,4280.44
Blue Shield,POS,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Fee Schedule,4280.44
Blue Shield,POS,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Fee Schedule,4891.93
Blue Shield,POS,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,POS,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Fee Schedule,4891.93
Blue Shield,POS,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,POS,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Fee Schedule,4280.44
Blue Shield,POS,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Fee Schedule,4280.44
Blue Shield,POS,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,POS,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,POS,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,POS,27745,CPT4/HCPCS,REINFORCE TIBIA,,Fee Schedule,4891.93
Blue Shield,POS,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Fee Schedule,3198.57
Blue Shield,POS,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Fee Schedule,3198.57
Blue Shield,POS,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Fee Schedule,4891.93
Blue Shield,POS,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Fee Schedule,4280.44
Blue Shield,POS,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Fee Schedule,4280.44
Blue Shield,POS,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Fee Schedule,6049.05
Blue Shield,POS,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Fee Schedule,4280.44
Blue Shield,POS,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Fee Schedule,3198.57
Blue Shield,POS,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Fee Schedule,6049.05
Blue Shield,POS,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Fee Schedule,6049.05
Blue Shield,POS,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,3198.57
Blue Shield,POS,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,POS,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,POS,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Fee Schedule,3198.57
Blue Shield,POS,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Fee Schedule,4891.93
Blue Shield,POS,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,POS,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,POS,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,POS,27899,CPT4/HCPCS,LEG/ANKLE SURGERY PROCEDURE,,Fee Schedule,987.79
Blue Shield,POS,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Fee Schedule,3198.57
Blue Shield,POS,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Fee Schedule,4891.93
Blue Shield,POS,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Fee Schedule,4891.93
Blue Shield,POS,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Fee Schedule,4891.93
Blue Shield,POS,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,POS,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Fee Schedule,4891.93
Blue Shield,POS,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Fee Schedule,4891.93
Blue Shield,POS,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Fee Schedule,4280.44
Blue Shield,POS,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Fee Schedule,4280.44
Blue Shield,POS,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Fee Schedule,4280.44
Blue Shield,POS,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Fee Schedule,6049.05
Blue Shield,POS,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Fee Schedule,4280.44
Blue Shield,POS,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Fee Schedule,4891.93
Blue Shield,POS,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,POS,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Fee Schedule,4891.93
Blue Shield,POS,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Fee Schedule,4891.93
Blue Shield,POS,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Fee Schedule,4891.93
Blue Shield,POS,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Fee Schedule,4280.44
Blue Shield,POS,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Fee Schedule,4280.44
Blue Shield,POS,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Fee Schedule,4280.44
Blue Shield,POS,28055,CPT4/HCPCS,NEURECTOMY FOOT,,Fee Schedule,4891.93
Blue Shield,POS,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Fee Schedule,4280.44
Blue Shield,POS,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,POS,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Fee Schedule,4891.93
Blue Shield,POS,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Fee Schedule,4891.93
Blue Shield,POS,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4891.93
Blue Shield,POS,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,POS,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,POS,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4891.93
Blue Shield,POS,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Fee Schedule,4891.93
Blue Shield,POS,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Fee Schedule,4280.44
Blue Shield,POS,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,POS,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,POS,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4280.44
Blue Shield,POS,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,POS,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,POS,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Fee Schedule,4891.93
Blue Shield,POS,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,POS,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,POS,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,POS,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,POS,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Fee Schedule,4891.93
Blue Shield,POS,28116,CPT4/HCPCS,REVISION OF FOOT,,Fee Schedule,4891.93
Blue Shield,POS,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Fee Schedule,6049.05
Blue Shield,POS,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Fee Schedule,6049.05
Blue Shield,POS,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Fee Schedule,9548.66
Blue Shield,POS,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Fee Schedule,4891.93
Blue Shield,POS,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,POS,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,POS,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Fee Schedule,4891.93
Blue Shield,POS,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,POS,28150,CPT4/HCPCS,REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,POS,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,POS,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,POS,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Fee Schedule,4891.93
Blue Shield,POS,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Fee Schedule,4891.93
Blue Shield,POS,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Fee Schedule,4891.93
Blue Shield,POS,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,POS,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,POS,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,6049.05
Blue Shield,POS,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,POS,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,POS,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,POS,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,POS,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,POS,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Fee Schedule,3198.57
Blue Shield,POS,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Fee Schedule,3198.57
Blue Shield,POS,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Fee Schedule,3198.57
Blue Shield,POS,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Fee Schedule,4891.93
Blue Shield,POS,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Fee Schedule,4891.93
Blue Shield,POS,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Fee Schedule,4280.44
Blue Shield,POS,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,POS,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Fee Schedule,4280.44
Blue Shield,POS,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,POS,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Fee Schedule,4891.93
Blue Shield,POS,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,POS,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Fee Schedule,6049.05
Blue Shield,POS,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Fee Schedule,3198.57
Blue Shield,POS,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Fee Schedule,4891.93
Blue Shield,POS,28280,CPT4/HCPCS,FUSION OF TOES,,Fee Schedule,4280.44
Blue Shield,POS,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Fee Schedule,4891.93
Blue Shield,POS,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Fee Schedule,6049.05
Blue Shield,POS,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Fee Schedule,4891.93
Blue Shield,POS,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Fee Schedule,4891.93
Blue Shield,POS,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Fee Schedule,4891.93
Blue Shield,POS,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4280.44
Blue Shield,POS,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,POS,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,POS,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,POS,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,POS,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,6876.92
Blue Shield,POS,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Fee Schedule,4280.44
Blue Shield,POS,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Fee Schedule,4280.44
Blue Shield,POS,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Fee Schedule,4280.44
Blue Shield,POS,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Fee Schedule,4891.93
Blue Shield,POS,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,6049.05
Blue Shield,POS,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,6049.05
Blue Shield,POS,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,4280.44
Blue Shield,POS,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Fee Schedule,6049.05
Blue Shield,POS,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Fee Schedule,4891.93
Blue Shield,POS,28312,CPT4/HCPCS,REVISION OF TOE,,Fee Schedule,4891.93
Blue Shield,POS,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Fee Schedule,4280.44
Blue Shield,POS,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Fee Schedule,6049.05
Blue Shield,POS,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,POS,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Fee Schedule,6049.05
Blue Shield,POS,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Fee Schedule,6049.05
Blue Shield,POS,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Fee Schedule,6049.05
Blue Shield,POS,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Fee Schedule,6049.05
Blue Shield,POS,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Fee Schedule,6049.05
Blue Shield,POS,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,Fee Schedule,6876.92
Blue Shield,POS,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Fee Schedule,6049.05
Blue Shield,POS,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,POS,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,3198.57
Blue Shield,POS,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,4891.93
Blue Shield,POS,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,POS,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,POS,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,POS,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,POS,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,987.79
Blue Shield,POS,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,POS,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,POS,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,POS,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,POS,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,POS,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,POS,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,POS,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Fee Schedule,6876.92
Blue Shield,POS,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,POS,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,POS,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,POS,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,POS,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,Fee Schedule,3198.57
Blue Shield,POS,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Fee Schedule,3198.57
Blue Shield,POS,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Fee Schedule,4280.44
Blue Shield,POS,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Fee Schedule,4280.44
Blue Shield,POS,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Fee Schedule,4280.44
Blue Shield,POS,28899,CPT4/HCPCS,FOOT/TOES SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,POS,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,POS,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,POS,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,POS,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,POS,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,POS,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,POS,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,Fee Schedule,987.79
Blue Shield,POS,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Fee Schedule,987.79
Blue Shield,POS,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Fee Schedule,987.79
Blue Shield,POS,29065,CPT4/HCPCS,APPLICATION OF LONG ARM CAST,,Fee Schedule,987.79
Blue Shield,POS,29075,CPT4/HCPCS,APPLICATION OF FOREARM CAST,,Fee Schedule,987.79
Blue Shield,POS,29085,CPT4/HCPCS,APPLY HAND/WRIST CAST,,Fee Schedule,987.79
Blue Shield,POS,29086,CPT4/HCPCS,APPLY FINGER CAST,,Fee Schedule,987.79
Blue Shield,POS,29105,CPT4/HCPCS,APPLY LONG ARM SPLINT,,Fee Schedule,987.79
Blue Shield,POS,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Fee Schedule,987.79
Blue Shield,POS,29126,CPT4/HCPCS,APPLY FOREARM SPLINT,,Fee Schedule,987.79
Blue Shield,POS,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Fee Schedule,987.79
Blue Shield,POS,29131,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Fee Schedule,987.79
Blue Shield,POS,29200,CPT4/HCPCS,STRAPPING OF CHEST,,Fee Schedule,987.79
Blue Shield,POS,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Fee Schedule,987.79
Blue Shield,POS,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Fee Schedule,987.79
Blue Shield,POS,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Fee Schedule,987.79
Blue Shield,POS,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Fee Schedule,987.79
Blue Shield,POS,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Fee Schedule,987.79
Blue Shield,POS,29345,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,POS,29355,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,POS,29358,CPT4/HCPCS,APPLY LONG LEG CAST BRACE,,Fee Schedule,987.79
Blue Shield,POS,29365,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,POS,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,POS,29425,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,POS,29435,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,POS,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,Fee Schedule,987.79
Blue Shield,POS,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,Fee Schedule,987.79
Blue Shield,POS,29450,CPT4/HCPCS,APPLICATION OF LEG CAST,,Fee Schedule,987.79
Blue Shield,POS,29505,CPT4/HCPCS,APPLICATION LONG LEG SPLINT,,Fee Schedule,987.79
Blue Shield,POS,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Fee Schedule,987.79
Blue Shield,POS,29520,CPT4/HCPCS,STRAPPING OF HIP,,Fee Schedule,987.79
Blue Shield,POS,29530,CPT4/HCPCS,STRAPPING OF KNEE,,Fee Schedule,987.79
Blue Shield,POS,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,Fee Schedule,987.79
Blue Shield,POS,29550,CPT4/HCPCS,STRAPPING OF TOES,,Fee Schedule,987.79
Blue Shield,POS,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Fee Schedule,987.79
Blue Shield,POS,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,Fee Schedule,987.79
Blue Shield,POS,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,Fee Schedule,7902.34
Blue Shield,POS,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,POS,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,POS,29710,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,POS,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,Fee Schedule,987.79
Blue Shield,POS,29730,CPT4/HCPCS,WINDOWING OF CAST,,Fee Schedule,987.79
Blue Shield,POS,29740,CPT4/HCPCS,WEDGING OF CAST,,Fee Schedule,987.79
Blue Shield,POS,29750,CPT4/HCPCS,WEDGING OF CLUBFOOT CAST,,Fee Schedule,987.79
Blue Shield,POS,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,Fee Schedule,987.79
Blue Shield,POS,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Fee Schedule,4891.93
Blue Shield,POS,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Fee Schedule,4891.93
Blue Shield,POS,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Fee Schedule,4891.93
Blue Shield,POS,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Fee Schedule,4891.93
Blue Shield,POS,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Fee Schedule,4891.93
Blue Shield,POS,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Fee Schedule,4891.93
Blue Shield,POS,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Fee Schedule,4891.93
Blue Shield,POS,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Fee Schedule,4891.93
Blue Shield,POS,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Fee Schedule,6876.92
Blue Shield,POS,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Fee Schedule,4891.93
Blue Shield,POS,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Fee Schedule,4891.93
Blue Shield,POS,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Fee Schedule,6876.92
Blue Shield,POS,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Fee Schedule,4891.93
Blue Shield,POS,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Fee Schedule,4891.93
Blue Shield,POS,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Fee Schedule,4891.93
Blue Shield,POS,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Fee Schedule,12850.71
Blue Shield,POS,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Fee Schedule,6049.05
Blue Shield,POS,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Fee Schedule,6049.05
Blue Shield,POS,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Fee Schedule,12850.71
Blue Shield,POS,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Fee Schedule,6049.05
Blue Shield,POS,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Fee Schedule,12850.71
Blue Shield,POS,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Fee Schedule,12850.71
Blue Shield,POS,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Fee Schedule,12850.71
Blue Shield,POS,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Fee Schedule,4891.93
Blue Shield,POS,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Fee Schedule,4891.93
Blue Shield,POS,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6876.92
Blue Shield,POS,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Fee Schedule,12850.71
Blue Shield,POS,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Fee Schedule,4891.93
Blue Shield,POS,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,POS,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,POS,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Fee Schedule,4891.93
Blue Shield,POS,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Fee Schedule,4891.93
Blue Shield,POS,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Fee Schedule,4891.93
Blue Shield,POS,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Fee Schedule,6049.05
Blue Shield,POS,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Fee Schedule,6049.05
Blue Shield,POS,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Fee Schedule,6049.05
Blue Shield,POS,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Fee Schedule,6049.05
Blue Shield,POS,29999,CPT4/HCPCS,ARTHROSCOPY OF JOINT,,Fee Schedule,6876.92
Blue Shield,POS,30000,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,POS,30020,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,POS,30100,CPT4/HCPCS,INTRANASAL BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Fee Schedule,4280.44
Blue Shield,POS,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Fee Schedule,4280.44
Blue Shield,POS,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Fee Schedule,4891.93
Blue Shield,POS,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Fee Schedule,4891.93
Blue Shield,POS,30120,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,3198.57
Blue Shield,POS,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,POS,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Fee Schedule,4280.44
Blue Shield,POS,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Fee Schedule,4891.93
Blue Shield,POS,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Fee Schedule,4280.44
Blue Shield,POS,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Fee Schedule,4891.93
Blue Shield,POS,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Fee Schedule,6049.05
Blue Shield,POS,30200,CPT4/HCPCS,INJECTION TREATMENT OF NOSE,,Fee Schedule,4280.44
Blue Shield,POS,30210,CPT4/HCPCS,NASAL SINUS THERAPY,,Fee Schedule,3198.57
Blue Shield,POS,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Fee Schedule,3198.57
Blue Shield,POS,30300,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,POS,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,POS,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,POS,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6049.05
Blue Shield,POS,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6876.92
Blue Shield,POS,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6876.92
Blue Shield,POS,30430,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,4891.93
Blue Shield,POS,30435,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,6876.92
Blue Shield,POS,30450,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,9548.66
Blue Shield,POS,30460,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,9548.66
Blue Shield,POS,30462,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,12850.71
Blue Shield,POS,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Fee Schedule,12850.71
Blue Shield,POS,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Fee Schedule,6049.05
Blue Shield,POS,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Fee Schedule,6876.92
Blue Shield,POS,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Fee Schedule,6876.92
Blue Shield,POS,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Fee Schedule,4280.44
Blue Shield,POS,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Fee Schedule,6049.05
Blue Shield,POS,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Fee Schedule,6049.05
Blue Shield,POS,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Fee Schedule,9548.66
Blue Shield,POS,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Fee Schedule,9548.66
Blue Shield,POS,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Fee Schedule,3198.57
Blue Shield,POS,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Fee Schedule,3198.57
Blue Shield,POS,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,987.79
Blue Shield,POS,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,POS,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,POS,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,POS,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Fee Schedule,4280.44
Blue Shield,POS,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Fee Schedule,4891.93
Blue Shield,POS,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Fee Schedule,6049.05
Blue Shield,POS,30999,CPT4/HCPCS,NASAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Fee Schedule,3198.57
Blue Shield,POS,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Fee Schedule,3198.57
Blue Shield,POS,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4280.44
Blue Shield,POS,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,POS,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Fee Schedule,6049.05
Blue Shield,POS,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,Fee Schedule,6049.05
Blue Shield,POS,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Fee Schedule,4280.44
Blue Shield,POS,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Fee Schedule,4280.44
Blue Shield,POS,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,POS,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,POS,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,POS,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,POS,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,POS,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,POS,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,POS,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Fee Schedule,6876.92
Blue Shield,POS,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,4280.44
Blue Shield,POS,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,6876.92
Blue Shield,POS,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,4891.93
Blue Shield,POS,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Fee Schedule,4891.93
Blue Shield,POS,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Fee Schedule,4891.93
Blue Shield,POS,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Fee Schedule,987.79
Blue Shield,POS,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Fee Schedule,4280.44
Blue Shield,POS,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Fee Schedule,3198.57
Blue Shield,POS,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4280.44
Blue Shield,POS,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,POS,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,6049.05
Blue Shield,POS,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4280.44
Blue Shield,POS,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Fee Schedule,6876.92
Blue Shield,POS,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Fee Schedule,6876.92
Blue Shield,POS,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Fee Schedule,4891.93
Blue Shield,POS,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Fee Schedule,6876.92
Blue Shield,POS,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,POS,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Fee Schedule,6876.92
Blue Shield,POS,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Fee Schedule,6876.92
Blue Shield,POS,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,POS,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Fee Schedule,4891.93
Blue Shield,POS,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,POS,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,POS,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,POS,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,POS,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Fee Schedule,3198.57
Blue Shield,POS,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Fee Schedule,3198.57
Blue Shield,POS,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Fee Schedule,4280.44
Blue Shield,POS,31295,CPT4/HCPCS,NSL/SINS NDSC SURG MAX SINS,,Fee Schedule,3198.57
Blue Shield,POS,31296,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT SINS,,Fee Schedule,3198.57
Blue Shield,POS,31297,CPT4/HCPCS,NSL/SINS NDSC SURG SPHN SINS,,Fee Schedule,3198.57
Blue Shield,POS,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Fee Schedule,3198.57
Blue Shield,POS,31299,CPT4/HCPCS,SINUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Fee Schedule,6876.92
Blue Shield,POS,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,POS,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,POS,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,POS,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,7902.34
Blue Shield,POS,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,POS,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,POS,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,POS,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,POS,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,Fee Schedule,7902.34
Blue Shield,POS,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,Fee Schedule,9548.66
Blue Shield,POS,31400,CPT4/HCPCS,REVISION OF LARYNX,,Fee Schedule,4280.44
Blue Shield,POS,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Fee Schedule,4280.44
Blue Shield,POS,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Fee Schedule,3198.57
Blue Shield,POS,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Fee Schedule,987.79
Blue Shield,POS,31505,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Fee Schedule,4280.44
Blue Shield,POS,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Fee Schedule,4280.44
Blue Shield,POS,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Fee Schedule,4280.44
Blue Shield,POS,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Fee Schedule,4280.44
Blue Shield,POS,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Fee Schedule,3198.57
Blue Shield,POS,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Fee Schedule,3198.57
Blue Shield,POS,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Fee Schedule,3198.57
Blue Shield,POS,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Fee Schedule,4280.44
Blue Shield,POS,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Fee Schedule,3198.57
Blue Shield,POS,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Fee Schedule,4280.44
Blue Shield,POS,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Fee Schedule,4280.44
Blue Shield,POS,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,POS,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Fee Schedule,4891.93
Blue Shield,POS,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Fee Schedule,4280.44
Blue Shield,POS,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Fee Schedule,4891.93
Blue Shield,POS,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Fee Schedule,4891.93
Blue Shield,POS,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Fee Schedule,6049.05
Blue Shield,POS,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Fee Schedule,4891.93
Blue Shield,POS,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Fee Schedule,4891.93
Blue Shield,POS,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,POS,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,POS,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,POS,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,POS,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Fee Schedule,6876.92
Blue Shield,POS,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Fee Schedule,6876.92
Blue Shield,POS,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Fee Schedule,4280.44
Blue Shield,POS,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Fee Schedule,4280.44
Blue Shield,POS,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Fee Schedule,4280.44
Blue Shield,POS,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Fee Schedule,4280.44
Blue Shield,POS,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Fee Schedule,4280.44
Blue Shield,POS,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Fee Schedule,987.79
Blue Shield,POS,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Fee Schedule,4280.44
Blue Shield,POS,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Fee Schedule,4280.44
Blue Shield,POS,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Fee Schedule,4280.44
Blue Shield,POS,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Fee Schedule,3198.57
Blue Shield,POS,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Fee Schedule,6876.92
Blue Shield,POS,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Fee Schedule,6049.05
Blue Shield,POS,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Fee Schedule,4280.44
Blue Shield,POS,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Fee Schedule,6876.92
Blue Shield,POS,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Fee Schedule,6876.92
Blue Shield,POS,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Fee Schedule,6876.92
Blue Shield,POS,31595,CPT4/HCPCS,LARYNX NERVE SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,31599,CPT4/HCPCS,LARYNX SURGERY PROCEDURE,,Fee Schedule,6049.05
Blue Shield,POS,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,POS,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,POS,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,3198.57
Blue Shield,POS,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,POS,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,POS,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,POS,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Fee Schedule,3198.57
Blue Shield,POS,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Fee Schedule,4280.44
Blue Shield,POS,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Fee Schedule,4280.44
Blue Shield,POS,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Fee Schedule,3198.57
Blue Shield,POS,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Fee Schedule,3198.57
Blue Shield,POS,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Fee Schedule,4280.44
Blue Shield,POS,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Fee Schedule,4280.44
Blue Shield,POS,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Fee Schedule,4280.44
Blue Shield,POS,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Fee Schedule,4891.93
Blue Shield,POS,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Fee Schedule,4280.44
Blue Shield,POS,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Fee Schedule,4280.44
Blue Shield,POS,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Fee Schedule,4280.44
Blue Shield,POS,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Fee Schedule,4280.44
Blue Shield,POS,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Fee Schedule,3198.57
Blue Shield,POS,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Fee Schedule,3198.57
Blue Shield,POS,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Fee Schedule,4280.44
Blue Shield,POS,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,POS,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Fee Schedule,6049.05
Blue Shield,POS,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Fee Schedule,6049.05
Blue Shield,POS,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Fee Schedule,4280.44
Blue Shield,POS,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Fee Schedule,4280.44
Blue Shield,POS,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Fee Schedule,4280.44
Blue Shield,POS,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Fee Schedule,3198.57
Blue Shield,POS,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Fee Schedule,3198.57
Blue Shield,POS,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Fee Schedule,4280.44
Blue Shield,POS,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Fee Schedule,4280.44
Blue Shield,POS,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Fee Schedule,4280.44
Blue Shield,POS,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Fee Schedule,4280.44
Blue Shield,POS,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Fee Schedule,3198.57
Blue Shield,POS,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Fee Schedule,4280.44
Blue Shield,POS,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Fee Schedule,4891.93
Blue Shield,POS,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Fee Schedule,3198.57
Blue Shield,POS,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Fee Schedule,3198.57
Blue Shield,POS,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Fee Schedule,3198.57
Blue Shield,POS,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,6876.92
Blue Shield,POS,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,POS,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,POS,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,POS,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,Fee Schedule,4891.93
Blue Shield,POS,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,Fee Schedule,4280.44
Blue Shield,POS,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Fee Schedule,4280.44
Blue Shield,POS,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Fee Schedule,4891.93
Blue Shield,POS,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Fee Schedule,6049.05
Blue Shield,POS,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Fee Schedule,6049.05
Blue Shield,POS,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Fee Schedule,3198.57
Blue Shield,POS,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Fee Schedule,6049.05
Blue Shield,POS,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Fee Schedule,3198.57
Blue Shield,POS,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Fee Schedule,4280.44
Blue Shield,POS,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Fee Schedule,4280.44
Blue Shield,POS,31899,CPT4/HCPCS,AIRWAYS SURGICAL PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,Fee Schedule,3198.57
Blue Shield,POS,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,Fee Schedule,3198.57
Blue Shield,POS,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,Fee Schedule,7902.34
Blue Shield,POS,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,Fee Schedule,7902.34
Blue Shield,POS,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,Fee Schedule,7902.34
Blue Shield,POS,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,POS,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,Fee Schedule,4280.44
Blue Shield,POS,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,POS,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,POS,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Fee Schedule,3198.57
Blue Shield,POS,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Fee Schedule,3198.57
Blue Shield,POS,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,POS,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,Fee Schedule,3198.57
Blue Shield,POS,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,Fee Schedule,3198.57
Blue Shield,POS,32215,CPT4/HCPCS,TREAT CHEST LINING,,Fee Schedule,3198.57
Blue Shield,POS,32220,CPT4/HCPCS,RELEASE OF LUNG,,Fee Schedule,4280.44
Blue Shield,POS,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,Fee Schedule,3198.57
Blue Shield,POS,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,Fee Schedule,3198.57
Blue Shield,POS,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,Fee Schedule,4280.44
Blue Shield,POS,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Fee Schedule,3198.57
Blue Shield,POS,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Fee Schedule,3198.57
Blue Shield,POS,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,POS,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,POS,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,Fee Schedule,4280.44
Blue Shield,POS,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,Fee Schedule,4280.44
Blue Shield,POS,32482,CPT4/HCPCS,BILOBECTOMY,,Fee Schedule,4280.44
Blue Shield,POS,32484,CPT4/HCPCS,SEGMENTECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,Fee Schedule,4280.44
Blue Shield,POS,32488,CPT4/HCPCS,COMPLETION PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,POS,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,Fee Schedule,4280.44
Blue Shield,POS,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,Fee Schedule,7902.34
Blue Shield,POS,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,Fee Schedule,3198.57
Blue Shield,POS,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Fee Schedule,3198.57
Blue Shield,POS,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Fee Schedule,3198.57
Blue Shield,POS,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Fee Schedule,987.79
Blue Shield,POS,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Fee Schedule,987.79
Blue Shield,POS,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,POS,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Fee Schedule,3198.57
Blue Shield,POS,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Fee Schedule,3198.57
Blue Shield,POS,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Fee Schedule,3198.57
Blue Shield,POS,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Fee Schedule,3198.57
Blue Shield,POS,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Fee Schedule,3198.57
Blue Shield,POS,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Fee Schedule,987.79
Blue Shield,POS,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Fee Schedule,7902.34
Blue Shield,POS,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Fee Schedule,7902.34
Blue Shield,POS,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Fee Schedule,7902.34
Blue Shield,POS,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Fee Schedule,7902.34
Blue Shield,POS,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Fee Schedule,7902.34
Blue Shield,POS,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Fee Schedule,7902.34
Blue Shield,POS,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,Fee Schedule,3198.57
Blue Shield,POS,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,Fee Schedule,3198.57
Blue Shield,POS,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,Fee Schedule,3198.57
Blue Shield,POS,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,Fee Schedule,3198.57
Blue Shield,POS,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,Fee Schedule,3198.57
Blue Shield,POS,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,Fee Schedule,3198.57
Blue Shield,POS,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,Fee Schedule,3198.57
Blue Shield,POS,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,Fee Schedule,3198.57
Blue Shield,POS,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,Fee Schedule,3198.57
Blue Shield,POS,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,Fee Schedule,3198.57
Blue Shield,POS,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Fee Schedule,3198.57
Blue Shield,POS,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,Fee Schedule,3198.57
Blue Shield,POS,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,Fee Schedule,7902.34
Blue Shield,POS,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,Fee Schedule,987.79
Blue Shield,POS,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,Fee Schedule,987.79
Blue Shield,POS,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,Fee Schedule,7902.34
Blue Shield,POS,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,Fee Schedule,7902.34
Blue Shield,POS,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,Fee Schedule,7902.34
Blue Shield,POS,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,Fee Schedule,7902.34
Blue Shield,POS,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,Fee Schedule,7902.34
Blue Shield,POS,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,Fee Schedule,987.79
Blue Shield,POS,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,Fee Schedule,3198.57
Blue Shield,POS,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,Fee Schedule,3198.57
Blue Shield,POS,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,Fee Schedule,4280.44
Blue Shield,POS,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,Fee Schedule,4280.44
Blue Shield,POS,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,POS,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,Fee Schedule,6876.92
Blue Shield,POS,32852,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Fee Schedule,7902.34
Blue Shield,POS,32853,CPT4/HCPCS,LUNG TRANSPLANT DOUBLE,,Fee Schedule,7902.34
Blue Shield,POS,32854,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Fee Schedule,9548.66
Blue Shield,POS,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,Fee Schedule,3198.57
Blue Shield,POS,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Fee Schedule,4280.44
Blue Shield,POS,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Fee Schedule,4280.44
Blue Shield,POS,32940,CPT4/HCPCS,REVISION OF LUNG,,Fee Schedule,3198.57
Blue Shield,POS,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,Fee Schedule,3198.57
Blue Shield,POS,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Fee Schedule,4280.44
Blue Shield,POS,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,Fee Schedule,3198.57
Blue Shield,POS,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Fee Schedule,4280.44
Blue Shield,POS,32999,CPT4/HCPCS,CHEST SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,33010,CPT4/HCPCS,DRAINAGE OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,POS,33011,CPT4/HCPCS,REPEAT DRAINAGE OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,POS,33015,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,POS,33020,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,POS,33025,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,POS,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,POS,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,POS,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,Fee Schedule,3198.57
Blue Shield,POS,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,Fee Schedule,4891.93
Blue Shield,POS,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,Fee Schedule,3198.57
Blue Shield,POS,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,Fee Schedule,3198.57
Blue Shield,POS,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Fee Schedule,12850.71
Blue Shield,POS,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Fee Schedule,12850.71
Blue Shield,POS,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Fee Schedule,12850.71
Blue Shield,POS,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Fee Schedule,12850.71
Blue Shield,POS,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Fee Schedule,12850.71
Blue Shield,POS,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Fee Schedule,12850.71
Blue Shield,POS,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Fee Schedule,12850.71
Blue Shield,POS,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Fee Schedule,12850.71
Blue Shield,POS,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Fee Schedule,12850.71
Blue Shield,POS,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Fee Schedule,12850.71
Blue Shield,POS,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Fee Schedule,12850.71
Blue Shield,POS,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Fee Schedule,12850.71
Blue Shield,POS,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Fee Schedule,12850.71
Blue Shield,POS,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Fee Schedule,3198.57
Blue Shield,POS,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Fee Schedule,4280.44
Blue Shield,POS,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Fee Schedule,4280.44
Blue Shield,POS,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Fee Schedule,4280.44
Blue Shield,POS,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Fee Schedule,4891.93
Blue Shield,POS,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Fee Schedule,4891.93
Blue Shield,POS,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Fee Schedule,4280.44
Blue Shield,POS,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Fee Schedule,4280.44
Blue Shield,POS,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Fee Schedule,4280.44
Blue Shield,POS,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Fee Schedule,3198.57
Blue Shield,POS,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Fee Schedule,3198.57
Blue Shield,POS,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Fee Schedule,4891.93
Blue Shield,POS,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Fee Schedule,4891.93
Blue Shield,POS,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Fee Schedule,4891.93
Blue Shield,POS,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,POS,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,POS,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,POS,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Fee Schedule,12850.71
Blue Shield,POS,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Fee Schedule,4891.93
Blue Shield,POS,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,POS,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Fee Schedule,4891.93
Blue Shield,POS,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Fee Schedule,12850.71
Blue Shield,POS,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,POS,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,POS,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,POS,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Fee Schedule,4280.44
Blue Shield,POS,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Fee Schedule,4280.44
Blue Shield,POS,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Fee Schedule,4280.44
Blue Shield,POS,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Fee Schedule,4280.44
Blue Shield,POS,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Fee Schedule,12850.71
Blue Shield,POS,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Fee Schedule,987.79
Blue Shield,POS,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Fee Schedule,4891.93
Blue Shield,POS,33282,CPT4/HCPCS,IMPLANT PAT-ACTIVE HT RECORD,,Fee Schedule,12850.71
Blue Shield,POS,33284,CPT4/HCPCS,REMOVE PAT-ACTIVE HT RECORD,,Fee Schedule,3198.57
Blue Shield,POS,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,Fee Schedule,3198.57
Blue Shield,POS,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,Fee Schedule,4280.44
Blue Shield,POS,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Fee Schedule,3198.57
Blue Shield,POS,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,Fee Schedule,4280.44
Blue Shield,POS,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Fee Schedule,4280.44
Blue Shield,POS,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Fee Schedule,4891.93
Blue Shield,POS,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,Fee Schedule,9304.07
Blue Shield,POS,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,Fee Schedule,7902.34
Blue Shield,POS,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,POS,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,POS,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,POS,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,POS,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,Fee Schedule,987.79
Blue Shield,POS,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,POS,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,POS,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,POS,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,POS,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,POS,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,Fee Schedule,4891.93
Blue Shield,POS,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,4891.93
Blue Shield,POS,33406,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,6049.05
Blue Shield,POS,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,4891.93
Blue Shield,POS,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,POS,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,6876.92
Blue Shield,POS,33413,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,6876.92
Blue Shield,POS,33414,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,POS,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,Fee Schedule,4891.93
Blue Shield,POS,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,Fee Schedule,4891.93
Blue Shield,POS,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,POS,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Fee Schedule,987.79
Blue Shield,POS,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Fee Schedule,987.79
Blue Shield,POS,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,3198.57
Blue Shield,POS,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,4280.44
Blue Shield,POS,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,4280.44
Blue Shield,POS,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,4891.93
Blue Shield,POS,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,6049.05
Blue Shield,POS,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,Fee Schedule,4891.93
Blue Shield,POS,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Fee Schedule,4280.44
Blue Shield,POS,33463,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Fee Schedule,4280.44
Blue Shield,POS,33464,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Fee Schedule,4891.93
Blue Shield,POS,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,Fee Schedule,4891.93
Blue Shield,POS,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Fee Schedule,6049.05
Blue Shield,POS,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,POS,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,POS,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,POS,33475,CPT4/HCPCS,REPLACEMENT PULMONARY VALVE,,Fee Schedule,6049.05
Blue Shield,POS,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,4280.44
Blue Shield,POS,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,Fee Schedule,987.79
Blue Shield,POS,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,4280.44
Blue Shield,POS,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,Fee Schedule,4891.93
Blue Shield,POS,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Fee Schedule,4280.44
Blue Shield,POS,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,Fee Schedule,4891.93
Blue Shield,POS,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Fee Schedule,4891.93
Blue Shield,POS,33505,CPT4/HCPCS,REPAIR ARTERY W/TUNNEL,,Fee Schedule,6049.05
Blue Shield,POS,33506,CPT4/HCPCS,REPAIR ARTERY TRANSLOCATION,,Fee Schedule,6049.05
Blue Shield,POS,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,Fee Schedule,3198.57
Blue Shield,POS,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,Fee Schedule,3198.57
Blue Shield,POS,33622,CPT4/HCPCS,REDO COMPL CARDIAC ANOMALY,,Fee Schedule,3198.57
Blue Shield,POS,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,Fee Schedule,3198.57
Blue Shield,POS,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,Fee Schedule,3198.57
Blue Shield,POS,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,Fee Schedule,3198.57
Blue Shield,POS,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,Fee Schedule,987.79
Blue Shield,POS,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,Fee Schedule,987.79
Blue Shield,POS,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,Fee Schedule,987.79
Blue Shield,POS,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,Fee Schedule,987.79
Blue Shield,POS,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,POS,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,POS,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,POS,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,POS,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,POS,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,POS,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Fee Schedule,987.79
Blue Shield,POS,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,Fee Schedule,987.79
Blue Shield,POS,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,Fee Schedule,987.79
Blue Shield,POS,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,Fee Schedule,987.79
Blue Shield,POS,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,Fee Schedule,9304.07
Blue Shield,POS,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,Fee Schedule,9304.07
Blue Shield,POS,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,Fee Schedule,9304.07
Blue Shield,POS,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,Fee Schedule,9304.07
Blue Shield,POS,33999,CPT4/HCPCS,CARDIAC SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,POS,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,POS,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,POS,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,POS,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,3198.57
Blue Shield,POS,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,POS,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,3198.57
Blue Shield,POS,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,POS,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,POS,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,Fee Schedule,9548.66
Blue Shield,POS,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,Fee Schedule,9548.66
Blue Shield,POS,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,Fee Schedule,9548.66
Blue Shield,POS,34530,CPT4/HCPCS,LEG VEIN FUSION,,Fee Schedule,9548.66
Blue Shield,POS,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Fee Schedule,3198.57
Blue Shield,POS,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Fee Schedule,3198.57
Blue Shield,POS,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Fee Schedule,3198.57
Blue Shield,POS,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Fee Schedule,3198.57
Blue Shield,POS,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Fee Schedule,3198.57
Blue Shield,POS,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Fee Schedule,3198.57
Blue Shield,POS,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Fee Schedule,3198.57
Blue Shield,POS,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Fee Schedule,3198.57
Blue Shield,POS,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Fee Schedule,3198.57
Blue Shield,POS,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Fee Schedule,3198.57
Blue Shield,POS,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Fee Schedule,3198.57
Blue Shield,POS,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Fee Schedule,3198.57
Blue Shield,POS,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Fee Schedule,3198.57
Blue Shield,POS,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Fee Schedule,3198.57
Blue Shield,POS,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Fee Schedule,3198.57
Blue Shield,POS,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Fee Schedule,3198.57
Blue Shield,POS,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,Fee Schedule,987.79
Blue Shield,POS,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,Fee Schedule,987.79
Blue Shield,POS,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,Fee Schedule,987.79
Blue Shield,POS,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,Fee Schedule,987.79
Blue Shield,POS,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,Fee Schedule,987.79
Blue Shield,POS,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,Fee Schedule,987.79
Blue Shield,POS,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,Fee Schedule,987.79
Blue Shield,POS,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,Fee Schedule,987.79
Blue Shield,POS,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,Fee Schedule,3198.57
Blue Shield,POS,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,7902.34
Blue Shield,POS,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,Fee Schedule,3198.57
Blue Shield,POS,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,Fee Schedule,3198.57
Blue Shield,POS,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4280.44
Blue Shield,POS,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,4280.44
Blue Shield,POS,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4891.93
Blue Shield,POS,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,4280.44
Blue Shield,POS,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4891.93
Blue Shield,POS,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,Fee Schedule,3198.57
Blue Shield,POS,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,Fee Schedule,4280.44
Blue Shield,POS,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,Fee Schedule,3198.57
Blue Shield,POS,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,Fee Schedule,3198.57
Blue Shield,POS,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,Fee Schedule,3198.57
Blue Shield,POS,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,POS,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,POS,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,POS,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,POS,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,POS,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,POS,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,POS,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,POS,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,POS,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,POS,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,POS,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,POS,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,POS,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,POS,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,POS,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,7902.34
Blue Shield,POS,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,6049.05
Blue Shield,POS,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,4280.44
Blue Shield,POS,35371,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35390,CPT4/HCPCS,REOPERATION CAROTID ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,35400,CPT4/HCPCS,ANGIOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,Fee Schedule,9548.66
Blue Shield,POS,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,Fee Schedule,3198.57
Blue Shield,POS,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,Fee Schedule,3198.57
Blue Shield,POS,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,Fee Schedule,3198.57
Blue Shield,POS,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,Fee Schedule,3198.57
Blue Shield,POS,35510,CPT4/HCPCS,ART BYP GRFT CAROTID-BRCHIAL,,Fee Schedule,3198.57
Blue Shield,POS,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,Fee Schedule,3198.57
Blue Shield,POS,35512,CPT4/HCPCS,ART BYP GRFT SUBCLAV-BRCHIAL,,Fee Schedule,3198.57
Blue Shield,POS,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,Fee Schedule,3198.57
Blue Shield,POS,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,Fee Schedule,3198.57
Blue Shield,POS,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,Fee Schedule,3198.57
Blue Shield,POS,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,Fee Schedule,3198.57
Blue Shield,POS,35522,CPT4/HCPCS,ART BYP GRFT AXILL-BRACHIAL,,Fee Schedule,3198.57
Blue Shield,POS,35525,CPT4/HCPCS,ART BYP GRFT BRACHIAL-BRCHL,,Fee Schedule,3198.57
Blue Shield,POS,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,Fee Schedule,3198.57
Blue Shield,POS,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,Fee Schedule,4280.44
Blue Shield,POS,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,Fee Schedule,3198.57
Blue Shield,POS,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,Fee Schedule,4280.44
Blue Shield,POS,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,POS,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,Fee Schedule,3198.57
Blue Shield,POS,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,Fee Schedule,4280.44
Blue Shield,POS,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,Fee Schedule,3198.57
Blue Shield,POS,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,Fee Schedule,3198.57
Blue Shield,POS,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Fee Schedule,3198.57
Blue Shield,POS,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Fee Schedule,3198.57
Blue Shield,POS,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,POS,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,Fee Schedule,4280.44
Blue Shield,POS,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,Fee Schedule,4280.44
Blue Shield,POS,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,Fee Schedule,3198.57
Blue Shield,POS,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,POS,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,POS,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,Fee Schedule,3198.57
Blue Shield,POS,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,Fee Schedule,3198.57
Blue Shield,POS,35623,CPT4/HCPCS,ART BYP AXILLARY-POP-TIBIAL,,Fee Schedule,3198.57
Blue Shield,POS,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,Fee Schedule,3198.57
Blue Shield,POS,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,Fee Schedule,4280.44
Blue Shield,POS,35636,CPT4/HCPCS,ART BYP SPENORENAL,,Fee Schedule,3198.57
Blue Shield,POS,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,Fee Schedule,3198.57
Blue Shield,POS,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,Fee Schedule,3198.57
Blue Shield,POS,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,Fee Schedule,4280.44
Blue Shield,POS,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,Fee Schedule,3198.57
Blue Shield,POS,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,Fee Schedule,3198.57
Blue Shield,POS,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,Fee Schedule,3198.57
Blue Shield,POS,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,POS,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,Fee Schedule,3198.57
Blue Shield,POS,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,Fee Schedule,3198.57
Blue Shield,POS,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,Fee Schedule,3198.57
Blue Shield,POS,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Fee Schedule,3198.57
Blue Shield,POS,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Fee Schedule,3198.57
Blue Shield,POS,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,Fee Schedule,3198.57
Blue Shield,POS,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,Fee Schedule,3198.57
Blue Shield,POS,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,Fee Schedule,3198.57
Blue Shield,POS,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,Fee Schedule,6049.05
Blue Shield,POS,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,Fee Schedule,6049.05
Blue Shield,POS,35691,CPT4/HCPCS,ART TRNSPOSJ VERTBRL CAROTID,,Fee Schedule,3198.57
Blue Shield,POS,35693,CPT4/HCPCS,ART TRNSPOSJ SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,POS,35694,CPT4/HCPCS,ART TRNSPOSJ SUBCLAV CAROTID,,Fee Schedule,3198.57
Blue Shield,POS,35695,CPT4/HCPCS,ART TRNSPOSJ CAROTID SUBCLAV,,Fee Schedule,3198.57
Blue Shield,POS,35697,CPT4/HCPCS,REIMPLANT ARTERY EACH,,Fee Schedule,3198.57
Blue Shield,POS,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,Fee Schedule,3198.57
Blue Shield,POS,35721,CPT4/HCPCS,EXPLORATION FEMORAL ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35741,CPT4/HCPCS,EXPLORATION POPLITEAL ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,35761,CPT4/HCPCS,EXPLORATION OF ARTERY/VEIN,,Fee Schedule,6876.92
Blue Shield,POS,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,Fee Schedule,3198.57
Blue Shield,POS,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,Fee Schedule,3198.57
Blue Shield,POS,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,Fee Schedule,3198.57
Blue Shield,POS,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,Fee Schedule,6049.05
Blue Shield,POS,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,Fee Schedule,3198.57
Blue Shield,POS,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Fee Schedule,12850.71
Blue Shield,POS,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Fee Schedule,12850.71
Blue Shield,POS,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Fee Schedule,9548.66
Blue Shield,POS,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Fee Schedule,9548.66
Blue Shield,POS,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,Fee Schedule,3198.57
Blue Shield,POS,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,Fee Schedule,6876.92
Blue Shield,POS,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,Fee Schedule,4891.93
Blue Shield,POS,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,Fee Schedule,4280.44
Blue Shield,POS,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Fee Schedule,3198.57
Blue Shield,POS,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Fee Schedule,3198.57
Blue Shield,POS,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Fee Schedule,3198.57
Blue Shield,POS,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Fee Schedule,3198.57
Blue Shield,POS,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Fee Schedule,3198.57
Blue Shield,POS,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Fee Schedule,3198.57
Blue Shield,POS,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Fee Schedule,3198.57
Blue Shield,POS,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Fee Schedule,3198.57
Blue Shield,POS,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Fee Schedule,3198.57
Blue Shield,POS,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Fee Schedule,4891.93
Blue Shield,POS,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,POS,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Fee Schedule,3198.57
Blue Shield,POS,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Fee Schedule,3198.57
Blue Shield,POS,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Fee Schedule,3198.57
Blue Shield,POS,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Fee Schedule,987.79
Blue Shield,POS,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Fee Schedule,3198.57
Blue Shield,POS,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Fee Schedule,3198.57
Blue Shield,POS,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Fee Schedule,3198.57
Blue Shield,POS,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Fee Schedule,3198.57
Blue Shield,POS,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Fee Schedule,3198.57
Blue Shield,POS,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Fee Schedule,3198.57
Blue Shield,POS,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Fee Schedule,3198.57
Blue Shield,POS,36468,CPT4/HCPCS,NJX SCLRSNT SPIDER VEINS,,Fee Schedule,3198.57
Blue Shield,POS,36470,CPT4/HCPCS,NJX SCLRSNT 1 INCMPTNT VEIN,,Fee Schedule,3198.57
Blue Shield,POS,36471,CPT4/HCPCS,NJX SCLRSNT MLT INCMPTNT VN,,Fee Schedule,3198.57
Blue Shield,POS,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,POS,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,POS,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Fee Schedule,6876.92
Blue Shield,POS,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,POS,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Fee Schedule,6876.92
Blue Shield,POS,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Fee Schedule,6876.92
Blue Shield,POS,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Fee Schedule,6876.92
Blue Shield,POS,36511,CPT4/HCPCS,APHERESIS WBC,,Fee Schedule,3198.57
Blue Shield,POS,36512,CPT4/HCPCS,APHERESIS RBC,,Fee Schedule,3198.57
Blue Shield,POS,36513,CPT4/HCPCS,APHERESIS PLATELETS,,Fee Schedule,3198.57
Blue Shield,POS,36514,CPT4/HCPCS,APHERESIS PLASMA,,Fee Schedule,3198.57
Blue Shield,POS,36516,CPT4/HCPCS,APHERESIS IMMUNOADS SLCTV,,Fee Schedule,9548.66
Blue Shield,POS,36522,CPT4/HCPCS,PHOTOPHERESIS,,Fee Schedule,9548.66
Blue Shield,POS,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,POS,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,POS,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,POS,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,POS,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,12850.71
Blue Shield,POS,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,POS,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,POS,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,POS,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,POS,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Fee Schedule,3198.57
Blue Shield,POS,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,POS,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,POS,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Fee Schedule,3198.57
Blue Shield,POS,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,POS,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Fee Schedule,987.79
Blue Shield,POS,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,POS,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Fee Schedule,3198.57
Blue Shield,POS,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Fee Schedule,987.79
Blue Shield,POS,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Fee Schedule,987.79
Blue Shield,POS,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,POS,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,POS,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,POS,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Fee Schedule,9548.66
Blue Shield,POS,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Fee Schedule,4891.93
Blue Shield,POS,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Fee Schedule,4891.93
Blue Shield,POS,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Fee Schedule,4891.93
Blue Shield,POS,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,Fee Schedule,3198.57
Blue Shield,POS,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,POS,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,POS,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Fee Schedule,12850.71
Blue Shield,POS,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Fee Schedule,6049.05
Blue Shield,POS,36833,CPT4/HCPCS,AV FISTULA REVISION,,Fee Schedule,6049.05
Blue Shield,POS,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Fee Schedule,6049.05
Blue Shield,POS,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Fee Schedule,9548.66
Blue Shield,POS,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Fee Schedule,4280.44
Blue Shield,POS,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Fee Schedule,4891.93
Blue Shield,POS,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,POS,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,POS,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,POS,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,POS,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,POS,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,POS,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Fee Schedule,6049.05
Blue Shield,POS,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Fee Schedule,6049.05
Blue Shield,POS,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Fee Schedule,6049.05
Blue Shield,POS,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,POS,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,4280.44
Blue Shield,POS,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,POS,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,POS,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,Fee Schedule,3198.57
Blue Shield,POS,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,Fee Schedule,3198.57
Blue Shield,POS,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Fee Schedule,3198.57
Blue Shield,POS,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Fee Schedule,4891.93
Blue Shield,POS,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Fee Schedule,4891.93
Blue Shield,POS,37186,CPT4/HCPCS,SEC ART THROMBECTOMY ADD-ON,,Fee Schedule,4891.93
Blue Shield,POS,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Fee Schedule,4891.93
Blue Shield,POS,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Fee Schedule,4891.93
Blue Shield,POS,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Fee Schedule,4280.44
Blue Shield,POS,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Fee Schedule,4280.44
Blue Shield,POS,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Fee Schedule,4280.44
Blue Shield,POS,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,Fee Schedule,3198.57
Blue Shield,POS,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,POS,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Fee Schedule,4891.93
Blue Shield,POS,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Fee Schedule,4891.93
Blue Shield,POS,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Fee Schedule,4891.93
Blue Shield,POS,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Fee Schedule,4891.93
Blue Shield,POS,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Fee Schedule,987.79
Blue Shield,POS,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Fee Schedule,987.79
Blue Shield,POS,37220,CPT4/HCPCS,ILIAC REVASC,,Fee Schedule,6049.05
Blue Shield,POS,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,POS,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Fee Schedule,6049.05
Blue Shield,POS,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Fee Schedule,6049.05
Blue Shield,POS,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Fee Schedule,6049.05
Blue Shield,POS,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Fee Schedule,6049.05
Blue Shield,POS,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,POS,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Fee Schedule,6049.05
Blue Shield,POS,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Fee Schedule,6049.05
Blue Shield,POS,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Fee Schedule,6049.05
Blue Shield,POS,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,POS,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Fee Schedule,6049.05
Blue Shield,POS,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Fee Schedule,6049.05
Blue Shield,POS,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Fee Schedule,6049.05
Blue Shield,POS,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Fee Schedule,6049.05
Blue Shield,POS,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Fee Schedule,6049.05
Blue Shield,POS,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Fee Schedule,6049.05
Blue Shield,POS,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Fee Schedule,6049.05
Blue Shield,POS,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Fee Schedule,6049.05
Blue Shield,POS,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Fee Schedule,6049.05
Blue Shield,POS,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Fee Schedule,987.79
Blue Shield,POS,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Fee Schedule,987.79
Blue Shield,POS,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Fee Schedule,987.79
Blue Shield,POS,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Fee Schedule,987.79
Blue Shield,POS,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Fee Schedule,3198.57
Blue Shield,POS,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Fee Schedule,3198.57
Blue Shield,POS,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Fee Schedule,6876.92
Blue Shield,POS,37501,CPT4/HCPCS,VASCULAR ENDOSCOPY PROCEDURE,,Fee Schedule,6876.92
Blue Shield,POS,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,Fee Schedule,6049.05
Blue Shield,POS,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,6049.05
Blue Shield,POS,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,POS,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,POS,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Fee Schedule,4891.93
Blue Shield,POS,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,POS,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,POS,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Fee Schedule,7902.34
Blue Shield,POS,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Fee Schedule,4280.44
Blue Shield,POS,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Fee Schedule,3198.57
Blue Shield,POS,37700,CPT4/HCPCS,REVISE LEG VEIN,,Fee Schedule,4280.44
Blue Shield,POS,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Fee Schedule,4891.93
Blue Shield,POS,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Fee Schedule,4891.93
Blue Shield,POS,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Fee Schedule,4891.93
Blue Shield,POS,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Fee Schedule,4891.93
Blue Shield,POS,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Fee Schedule,6876.92
Blue Shield,POS,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Fee Schedule,7902.34
Blue Shield,POS,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Fee Schedule,7902.34
Blue Shield,POS,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Fee Schedule,4891.93
Blue Shield,POS,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Fee Schedule,4891.93
Blue Shield,POS,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,Fee Schedule,4280.44
Blue Shield,POS,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Fee Schedule,4891.93
Blue Shield,POS,37799,CPT4/HCPCS,VASCULAR SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Fee Schedule,3198.57
Blue Shield,POS,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,Fee Schedule,3198.57
Blue Shield,POS,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Fee Schedule,3198.57
Blue Shield,POS,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,Fee Schedule,3198.57
Blue Shield,POS,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Fee Schedule,9548.66
Blue Shield,POS,38129,CPT4/HCPCS,LAPAROSCOPE PROC SPLEEN,,Fee Schedule,7902.34
Blue Shield,POS,38204,CPT4/HCPCS,BL DONOR SEARCH MANAGEMENT,,Fee Schedule,3198.57
Blue Shield,POS,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,Fee Schedule,3198.57
Blue Shield,POS,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,Fee Schedule,3198.57
Blue Shield,POS,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,Fee Schedule,3198.57
Blue Shield,POS,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,Fee Schedule,3198.57
Blue Shield,POS,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,Fee Schedule,3198.57
Blue Shield,POS,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,Fee Schedule,3198.57
Blue Shield,POS,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,Fee Schedule,3198.57
Blue Shield,POS,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,Fee Schedule,3198.57
Blue Shield,POS,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,Fee Schedule,3198.57
Blue Shield,POS,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,Fee Schedule,3198.57
Blue Shield,POS,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,Fee Schedule,3198.57
Blue Shield,POS,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Fee Schedule,987.79
Blue Shield,POS,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Fee Schedule,987.79
Blue Shield,POS,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Fee Schedule,987.79
Blue Shield,POS,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Fee Schedule,3198.57
Blue Shield,POS,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Fee Schedule,6049.05
Blue Shield,POS,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Fee Schedule,3198.57
Blue Shield,POS,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Fee Schedule,3198.57
Blue Shield,POS,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,Fee Schedule,3198.57
Blue Shield,POS,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Fee Schedule,3198.57
Blue Shield,POS,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Fee Schedule,3198.57
Blue Shield,POS,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Fee Schedule,4280.44
Blue Shield,POS,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Fee Schedule,4280.44
Blue Shield,POS,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,POS,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,POS,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,POS,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,POS,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,POS,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,POS,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Fee Schedule,4280.44
Blue Shield,POS,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Fee Schedule,4891.93
Blue Shield,POS,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Fee Schedule,6049.05
Blue Shield,POS,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,POS,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,POS,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Fee Schedule,12850.71
Blue Shield,POS,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Fee Schedule,12850.71
Blue Shield,POS,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Fee Schedule,12850.71
Blue Shield,POS,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Fee Schedule,12850.71
Blue Shield,POS,38589,CPT4/HCPCS,LAPAROSCOPE PROC LYMPHATIC,,Fee Schedule,7902.34
Blue Shield,POS,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,POS,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,POS,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,POS,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,POS,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Fee Schedule,6049.05
Blue Shield,POS,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,POS,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,POS,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,POS,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,POS,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,POS,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,POS,38999,CPT4/HCPCS,BLOOD/LYMPH SYSTEM PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,POS,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,POS,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,Fee Schedule,3198.57
Blue Shield,POS,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,Fee Schedule,3198.57
Blue Shield,POS,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Fee Schedule,7902.34
Blue Shield,POS,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Fee Schedule,7902.34
Blue Shield,POS,39499,CPT4/HCPCS,CHEST PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,Fee Schedule,3198.57
Blue Shield,POS,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,12850.71
Blue Shield,POS,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,3198.57
Blue Shield,POS,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,3198.57
Blue Shield,POS,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,Fee Schedule,3198.57
Blue Shield,POS,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,Fee Schedule,3198.57
Blue Shield,POS,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,Fee Schedule,3198.57
Blue Shield,POS,39599,CPT4/HCPCS,DIAPHRAGM SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,40490,CPT4/HCPCS,BIOPSY OF LIP,,Fee Schedule,3198.57
Blue Shield,POS,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,POS,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,POS,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,POS,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Fee Schedule,4280.44
Blue Shield,POS,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Fee Schedule,4280.44
Blue Shield,POS,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Fee Schedule,4280.44
Blue Shield,POS,40650,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,POS,40652,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,POS,40654,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,POS,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,POS,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,POS,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,POS,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,POS,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,4891.93
Blue Shield,POS,40799,CPT4/HCPCS,LIP SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,POS,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,987.79
Blue Shield,POS,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,POS,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Fee Schedule,987.79
Blue Shield,POS,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Fee Schedule,3198.57
Blue Shield,POS,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Fee Schedule,3198.57
Blue Shield,POS,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,POS,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,POS,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,POS,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,POS,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Fee Schedule,3198.57
Blue Shield,POS,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,POS,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Fee Schedule,987.79
Blue Shield,POS,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Fee Schedule,3198.57
Blue Shield,POS,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4280.44
Blue Shield,POS,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4891.93
Blue Shield,POS,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4891.93
Blue Shield,POS,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,6876.92
Blue Shield,POS,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,6876.92
Blue Shield,POS,40899,CPT4/HCPCS,MOUTH SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,POS,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Fee Schedule,3198.57
Blue Shield,POS,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Fee Schedule,3198.57
Blue Shield,POS,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Fee Schedule,3198.57
Blue Shield,POS,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Fee Schedule,4280.44
Blue Shield,POS,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Fee Schedule,3198.57
Blue Shield,POS,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,POS,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,POS,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,POS,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,POS,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Fee Schedule,3198.57
Blue Shield,POS,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,POS,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Fee Schedule,6876.92
Blue Shield,POS,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Fee Schedule,3198.57
Blue Shield,POS,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,Fee Schedule,4891.93
Blue Shield,POS,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,POS,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,POS,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,POS,41500,CPT4/HCPCS,FIXATION OF TONGUE,,Fee Schedule,3198.57
Blue Shield,POS,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Fee Schedule,4891.93
Blue Shield,POS,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Fee Schedule,4280.44
Blue Shield,POS,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Fee Schedule,4280.44
Blue Shield,POS,41599,CPT4/HCPCS,TONGUE AND MOUTH SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Fee Schedule,3198.57
Blue Shield,POS,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Fee Schedule,6049.05
Blue Shield,POS,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Fee Schedule,4280.44
Blue Shield,POS,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Fee Schedule,3198.57
Blue Shield,POS,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Fee Schedule,3198.57
Blue Shield,POS,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,POS,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,6049.05
Blue Shield,POS,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,POS,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,POS,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,POS,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,POS,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Fee Schedule,4280.44
Blue Shield,POS,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,POS,41870,CPT4/HCPCS,GUM GRAFT,,Fee Schedule,6049.05
Blue Shield,POS,41872,CPT4/HCPCS,REPAIR GUM,,Fee Schedule,4280.44
Blue Shield,POS,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Fee Schedule,6049.05
Blue Shield,POS,41899,CPT4/HCPCS,DENTAL SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,POS,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Fee Schedule,4280.44
Blue Shield,POS,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Fee Schedule,3198.57
Blue Shield,POS,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,POS,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,POS,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,POS,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Fee Schedule,6049.05
Blue Shield,POS,42140,CPT4/HCPCS,EXCISION OF UVULA,,Fee Schedule,4280.44
Blue Shield,POS,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Fee Schedule,6876.92
Blue Shield,POS,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Fee Schedule,4280.44
Blue Shield,POS,42180,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,3198.57
Blue Shield,POS,42182,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,4280.44
Blue Shield,POS,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,POS,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,POS,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,POS,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,9548.66
Blue Shield,POS,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,POS,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,9548.66
Blue Shield,POS,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Fee Schedule,6876.92
Blue Shield,POS,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,Fee Schedule,9548.66
Blue Shield,POS,42235,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,6876.92
Blue Shield,POS,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Fee Schedule,6049.05
Blue Shield,POS,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Fee Schedule,987.79
Blue Shield,POS,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,POS,42299,CPT4/HCPCS,PALATE/UVULA SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,POS,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,4280.44
Blue Shield,POS,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,POS,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,POS,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,POS,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,POS,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,POS,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Fee Schedule,987.79
Blue Shield,POS,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Fee Schedule,4280.44
Blue Shield,POS,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Fee Schedule,4891.93
Blue Shield,POS,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Fee Schedule,4891.93
Blue Shield,POS,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,4891.93
Blue Shield,POS,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,POS,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,POS,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,POS,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,4891.93
Blue Shield,POS,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Fee Schedule,4891.93
Blue Shield,POS,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Fee Schedule,4280.44
Blue Shield,POS,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Fee Schedule,4891.93
Blue Shield,POS,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Fee Schedule,6049.05
Blue Shield,POS,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,4891.93
Blue Shield,POS,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,6049.05
Blue Shield,POS,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,6049.05
Blue Shield,POS,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,42650,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Fee Schedule,3198.57
Blue Shield,POS,42660,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Fee Schedule,3198.57
Blue Shield,POS,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Fee Schedule,6049.05
Blue Shield,POS,42699,CPT4/HCPCS,SALIVARY SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,POS,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Fee Schedule,4280.44
Blue Shield,POS,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Fee Schedule,3198.57
Blue Shield,POS,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Fee Schedule,4280.44
Blue Shield,POS,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Fee Schedule,4280.44
Blue Shield,POS,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,POS,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Fee Schedule,4891.93
Blue Shield,POS,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Fee Schedule,6876.92
Blue Shield,POS,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Fee Schedule,4891.93
Blue Shield,POS,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Fee Schedule,6876.92
Blue Shield,POS,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Fee Schedule,6049.05
Blue Shield,POS,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Fee Schedule,6049.05
Blue Shield,POS,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,POS,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,POS,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,POS,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,POS,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,6049.05
Blue Shield,POS,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,9548.66
Blue Shield,POS,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,4891.93
Blue Shield,POS,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Fee Schedule,4891.93
Blue Shield,POS,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Fee Schedule,4891.93
Blue Shield,POS,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Fee Schedule,9548.66
Blue Shield,POS,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Fee Schedule,9548.66
Blue Shield,POS,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Fee Schedule,4891.93
Blue Shield,POS,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Fee Schedule,3198.57
Blue Shield,POS,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Fee Schedule,4280.44
Blue Shield,POS,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,POS,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Fee Schedule,4280.44
Blue Shield,POS,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,POS,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,POS,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,4280.44
Blue Shield,POS,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,POS,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,POS,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,4891.93
Blue Shield,POS,42999,CPT4/HCPCS,THROAT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,POS,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,POS,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Fee Schedule,3198.57
Blue Shield,POS,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Fee Schedule,3198.57
Blue Shield,POS,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,POS,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,POS,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,Fee Schedule,6049.05
Blue Shield,POS,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,POS,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,POS,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,POS,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,POS,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,POS,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,POS,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,POS,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,POS,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Fee Schedule,6049.05
Blue Shield,POS,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Fee Schedule,3198.57
Blue Shield,POS,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Fee Schedule,3198.57
Blue Shield,POS,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Fee Schedule,3198.57
Blue Shield,POS,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Fee Schedule,3198.57
Blue Shield,POS,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Fee Schedule,3198.57
Blue Shield,POS,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Fee Schedule,3198.57
Blue Shield,POS,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Fee Schedule,3198.57
Blue Shield,POS,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Fee Schedule,3198.57
Blue Shield,POS,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Fee Schedule,3198.57
Blue Shield,POS,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Fee Schedule,3198.57
Blue Shield,POS,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Fee Schedule,3198.57
Blue Shield,POS,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Fee Schedule,3198.57
Blue Shield,POS,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Fee Schedule,3198.57
Blue Shield,POS,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Fee Schedule,3198.57
Blue Shield,POS,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Fee Schedule,3198.57
Blue Shield,POS,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Fee Schedule,3198.57
Blue Shield,POS,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Fee Schedule,3198.57
Blue Shield,POS,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Fee Schedule,3198.57
Blue Shield,POS,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Fee Schedule,3198.57
Blue Shield,POS,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Fee Schedule,3198.57
Blue Shield,POS,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Fee Schedule,3198.57
Blue Shield,POS,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Fee Schedule,3198.57
Blue Shield,POS,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Fee Schedule,4280.44
Blue Shield,POS,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Fee Schedule,3198.57
Blue Shield,POS,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Fee Schedule,4280.44
Blue Shield,POS,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Fee Schedule,4280.44
Blue Shield,POS,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Fee Schedule,3198.57
Blue Shield,POS,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Fee Schedule,3198.57
Blue Shield,POS,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Fee Schedule,4280.44
Blue Shield,POS,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Fee Schedule,3198.57
Blue Shield,POS,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Fee Schedule,3198.57
Blue Shield,POS,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Fee Schedule,4280.44
Blue Shield,POS,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Fee Schedule,4280.44
Blue Shield,POS,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Fee Schedule,4280.44
Blue Shield,POS,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Fee Schedule,4280.44
Blue Shield,POS,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Fee Schedule,4280.44
Blue Shield,POS,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Fee Schedule,4280.44
Blue Shield,POS,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Fee Schedule,4280.44
Blue Shield,POS,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Fee Schedule,4280.44
Blue Shield,POS,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,POS,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Fee Schedule,4280.44
Blue Shield,POS,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Fee Schedule,4280.44
Blue Shield,POS,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Fee Schedule,4280.44
Blue Shield,POS,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Fee Schedule,4280.44
Blue Shield,POS,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Fee Schedule,3198.57
Blue Shield,POS,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Fee Schedule,3198.57
Blue Shield,POS,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Fee Schedule,4280.44
Blue Shield,POS,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Fee Schedule,6049.05
Blue Shield,POS,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Fee Schedule,4891.93
Blue Shield,POS,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Fee Schedule,4280.44
Blue Shield,POS,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Fee Schedule,4280.44
Blue Shield,POS,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Fee Schedule,4280.44
Blue Shield,POS,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Fee Schedule,4280.44
Blue Shield,POS,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Fee Schedule,4280.44
Blue Shield,POS,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Fee Schedule,4280.44
Blue Shield,POS,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Fee Schedule,4280.44
Blue Shield,POS,43270,CPT4/HCPCS,EGD LESION ABLATION,,Fee Schedule,4280.44
Blue Shield,POS,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Fee Schedule,4280.44
Blue Shield,POS,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Fee Schedule,4280.44
Blue Shield,POS,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Fee Schedule,4280.44
Blue Shield,POS,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Fee Schedule,4280.44
Blue Shield,POS,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Fee Schedule,4280.44
Blue Shield,POS,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Fee Schedule,12850.71
Blue Shield,POS,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Fee Schedule,7902.34
Blue Shield,POS,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Fee Schedule,9548.66
Blue Shield,POS,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,Fee Schedule,3198.57
Blue Shield,POS,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Fee Schedule,6049.05
Blue Shield,POS,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Fee Schedule,3198.57
Blue Shield,POS,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,Fee Schedule,3198.57
Blue Shield,POS,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,Fee Schedule,3198.57
Blue Shield,POS,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,Fee Schedule,3198.57
Blue Shield,POS,43289,CPT4/HCPCS,LAPAROSCOPE PROC ESOPH,,Fee Schedule,7902.34
Blue Shield,POS,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,POS,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Fee Schedule,4280.44
Blue Shield,POS,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,POS,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Fee Schedule,4891.93
Blue Shield,POS,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,Fee Schedule,6876.92
Blue Shield,POS,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,Fee Schedule,6876.92
Blue Shield,POS,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,Fee Schedule,3198.57
Blue Shield,POS,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,Fee Schedule,3198.57
Blue Shield,POS,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,Fee Schedule,3198.57
Blue Shield,POS,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,Fee Schedule,3198.57
Blue Shield,POS,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,Fee Schedule,3198.57
Blue Shield,POS,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,Fee Schedule,3198.57
Blue Shield,POS,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Fee Schedule,3198.57
Blue Shield,POS,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Fee Schedule,3198.57
Blue Shield,POS,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Fee Schedule,3198.57
Blue Shield,POS,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Fee Schedule,3198.57
Blue Shield,POS,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Fee Schedule,3198.57
Blue Shield,POS,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Fee Schedule,3198.57
Blue Shield,POS,43338,CPT4/HCPCS,ESOPH LENGTHENING,,Fee Schedule,3198.57
Blue Shield,POS,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,POS,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,POS,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Fee Schedule,4891.93
Blue Shield,POS,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Fee Schedule,4891.93
Blue Shield,POS,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,Fee Schedule,3198.57
Blue Shield,POS,43401,CPT4/HCPCS,ESOPHAGUS SURGERY FOR VEINS,,Fee Schedule,3198.57
Blue Shield,POS,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,POS,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Fee Schedule,3198.57
Blue Shield,POS,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Fee Schedule,4280.44
Blue Shield,POS,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Fee Schedule,3198.57
Blue Shield,POS,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Fee Schedule,3198.57
Blue Shield,POS,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Fee Schedule,3198.57
Blue Shield,POS,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,POS,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,POS,43496,CPT4/HCPCS,FREE JEJUNUM FLAP MICROVASC,,Fee Schedule,3198.57
Blue Shield,POS,43499,CPT4/HCPCS,ESOPHAGUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Fee Schedule,3198.57
Blue Shield,POS,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Fee Schedule,3198.57
Blue Shield,POS,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Fee Schedule,3198.57
Blue Shield,POS,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Fee Schedule,3198.57
Blue Shield,POS,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,Fee Schedule,3198.57
Blue Shield,POS,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,Fee Schedule,3198.57
Blue Shield,POS,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,POS,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,POS,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,POS,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,POS,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,POS,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,POS,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,POS,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,POS,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,POS,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,POS,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Fee Schedule,3198.57
Blue Shield,POS,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Fee Schedule,3198.57
Blue Shield,POS,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Fee Schedule,4280.44
Blue Shield,POS,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Fee Schedule,4280.44
Blue Shield,POS,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Fee Schedule,12850.71
Blue Shield,POS,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Fee Schedule,12850.71
Blue Shield,POS,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Fee Schedule,12850.71
Blue Shield,POS,43659,CPT4/HCPCS,LAPAROSCOPE PROC STOM,,Fee Schedule,7902.34
Blue Shield,POS,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Fee Schedule,987.79
Blue Shield,POS,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Fee Schedule,987.79
Blue Shield,POS,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Fee Schedule,987.79
Blue Shield,POS,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Fee Schedule,987.79
Blue Shield,POS,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Fee Schedule,987.79
Blue Shield,POS,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Fee Schedule,987.79
Blue Shield,POS,43760,CPT4/HCPCS,CHANGE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,POS,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Fee Schedule,987.79
Blue Shield,POS,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,POS,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,POS,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,POS,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,POS,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Fee Schedule,6049.05
Blue Shield,POS,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,Fee Schedule,9548.66
Blue Shield,POS,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,Fee Schedule,3198.57
Blue Shield,POS,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,POS,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,POS,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,POS,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,POS,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,Fee Schedule,3198.57
Blue Shield,POS,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,Fee Schedule,3198.57
Blue Shield,POS,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,Fee Schedule,4280.44
Blue Shield,POS,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,Fee Schedule,4891.93
Blue Shield,POS,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,Fee Schedule,4891.93
Blue Shield,POS,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,POS,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,POS,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,POS,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,POS,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Fee Schedule,3198.57
Blue Shield,POS,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,POS,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,POS,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,POS,43999,CPT4/HCPCS,STOMACH SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Fee Schedule,3198.57
Blue Shield,POS,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Fee Schedule,3198.57
Blue Shield,POS,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,Fee Schedule,3198.57
Blue Shield,POS,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,Fee Schedule,3198.57
Blue Shield,POS,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,Fee Schedule,4891.93
Blue Shield,POS,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,Fee Schedule,6049.05
Blue Shield,POS,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,POS,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,Fee Schedule,3198.57
Blue Shield,POS,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,Fee Schedule,3198.57
Blue Shield,POS,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,Fee Schedule,3198.57
Blue Shield,POS,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,Fee Schedule,3198.57
Blue Shield,POS,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,Fee Schedule,3198.57
Blue Shield,POS,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,POS,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,POS,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,4280.44
Blue Shield,POS,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,POS,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,POS,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,4891.93
Blue Shield,POS,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,POS,44150,CPT4/HCPCS,REMOVAL OF COLON,,Fee Schedule,4280.44
Blue Shield,POS,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,POS,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,POS,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,POS,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Fee Schedule,4891.93
Blue Shield,POS,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Fee Schedule,4891.93
Blue Shield,POS,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Fee Schedule,4891.93
Blue Shield,POS,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,Fee Schedule,3198.57
Blue Shield,POS,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44205,CPT4/HCPCS,LAP COLECTOMY PART W/ILEUM,,Fee Schedule,3198.57
Blue Shield,POS,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,Fee Schedule,12850.71
Blue Shield,POS,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Fee Schedule,12850.71
Blue Shield,POS,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Fee Schedule,12850.71
Blue Shield,POS,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Fee Schedule,7902.34
Blue Shield,POS,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,Fee Schedule,7902.34
Blue Shield,POS,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Fee Schedule,7902.34
Blue Shield,POS,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Fee Schedule,6876.92
Blue Shield,POS,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Fee Schedule,6876.92
Blue Shield,POS,44238,CPT4/HCPCS,LAPAROSCOPE PROC INTESTINE,,Fee Schedule,7902.34
Blue Shield,POS,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,Fee Schedule,3198.57
Blue Shield,POS,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,Fee Schedule,4280.44
Blue Shield,POS,44320,CPT4/HCPCS,COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,Fee Schedule,3198.57
Blue Shield,POS,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,4891.93
Blue Shield,POS,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Fee Schedule,4280.44
Blue Shield,POS,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Fee Schedule,12850.71
Blue Shield,POS,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Fee Schedule,4280.44
Blue Shield,POS,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Fee Schedule,12850.71
Blue Shield,POS,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Fee Schedule,3198.57
Blue Shield,POS,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Fee Schedule,4891.93
Blue Shield,POS,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Fee Schedule,3198.57
Blue Shield,POS,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Fee Schedule,3198.57
Blue Shield,POS,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Fee Schedule,3198.57
Blue Shield,POS,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,POS,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Fee Schedule,3198.57
Blue Shield,POS,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Fee Schedule,3198.57
Blue Shield,POS,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Fee Schedule,3198.57
Blue Shield,POS,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Fee Schedule,3198.57
Blue Shield,POS,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,POS,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Fee Schedule,3198.57
Blue Shield,POS,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Fee Schedule,3198.57
Blue Shield,POS,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Fee Schedule,3198.57
Blue Shield,POS,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Fee Schedule,3198.57
Blue Shield,POS,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,POS,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,Fee Schedule,3198.57
Blue Shield,POS,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,Fee Schedule,3198.57
Blue Shield,POS,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,Fee Schedule,3198.57
Blue Shield,POS,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,POS,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,POS,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,POS,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,POS,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Fee Schedule,3198.57
Blue Shield,POS,44799,CPT4/HCPCS,UNLISTED PX SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,44800,CPT4/HCPCS,EXCISION OF BOWEL POUCH,,Fee Schedule,3198.57
Blue Shield,POS,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,Fee Schedule,3198.57
Blue Shield,POS,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,Fee Schedule,3198.57
Blue Shield,POS,44899,CPT4/HCPCS,BOWEL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,Fee Schedule,3198.57
Blue Shield,POS,44950,CPT4/HCPCS,APPENDECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,44960,CPT4/HCPCS,APPENDECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Fee Schedule,7902.34
Blue Shield,POS,44979,CPT4/HCPCS,LAPAROSCOPE PROC APP,,Fee Schedule,7902.34
Blue Shield,POS,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Fee Schedule,3198.57
Blue Shield,POS,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Fee Schedule,4280.44
Blue Shield,POS,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,POS,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,POS,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,POS,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Fee Schedule,4280.44
Blue Shield,POS,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,POS,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,POS,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,Fee Schedule,4280.44
Blue Shield,POS,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,POS,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,Fee Schedule,4280.44
Blue Shield,POS,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,45126,CPT4/HCPCS,PELVIC EXENTERATION,,Fee Schedule,6049.05
Blue Shield,POS,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,POS,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,POS,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,Fee Schedule,4280.44
Blue Shield,POS,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Fee Schedule,4280.44
Blue Shield,POS,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Fee Schedule,4280.44
Blue Shield,POS,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Fee Schedule,7902.34
Blue Shield,POS,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Fee Schedule,7902.34
Blue Shield,POS,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Fee Schedule,12850.71
Blue Shield,POS,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Fee Schedule,3198.57
Blue Shield,POS,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Fee Schedule,3198.57
Blue Shield,POS,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Fee Schedule,3198.57
Blue Shield,POS,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Fee Schedule,3198.57
Blue Shield,POS,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,POS,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,POS,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,POS,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Fee Schedule,3198.57
Blue Shield,POS,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Fee Schedule,3198.57
Blue Shield,POS,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Fee Schedule,3198.57
Blue Shield,POS,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Fee Schedule,9548.66
Blue Shield,POS,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Fee Schedule,3198.57
Blue Shield,POS,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Fee Schedule,3198.57
Blue Shield,POS,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Fee Schedule,3198.57
Blue Shield,POS,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Fee Schedule,3198.57
Blue Shield,POS,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Fee Schedule,3198.57
Blue Shield,POS,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Fee Schedule,3198.57
Blue Shield,POS,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Fee Schedule,3198.57
Blue Shield,POS,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Fee Schedule,3198.57
Blue Shield,POS,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Fee Schedule,3198.57
Blue Shield,POS,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Fee Schedule,3198.57
Blue Shield,POS,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,POS,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Fee Schedule,3198.57
Blue Shield,POS,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,POS,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Fee Schedule,4280.44
Blue Shield,POS,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Fee Schedule,4280.44
Blue Shield,POS,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Fee Schedule,4280.44
Blue Shield,POS,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Fee Schedule,4280.44
Blue Shield,POS,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Fee Schedule,4280.44
Blue Shield,POS,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Fee Schedule,4280.44
Blue Shield,POS,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Fee Schedule,3198.57
Blue Shield,POS,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Fee Schedule,3198.57
Blue Shield,POS,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,POS,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Fee Schedule,3198.57
Blue Shield,POS,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Fee Schedule,3198.57
Blue Shield,POS,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,POS,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Fee Schedule,3198.57
Blue Shield,POS,45399,CPT4/HCPCS,UNLISTED PROCEDURE COLON,,Fee Schedule,3198.57
Blue Shield,POS,45499,CPT4/HCPCS,LAPAROSCOPE PROC RECTUM,,Fee Schedule,4891.93
Blue Shield,POS,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Fee Schedule,4280.44
Blue Shield,POS,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Fee Schedule,4280.44
Blue Shield,POS,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Fee Schedule,987.79
Blue Shield,POS,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,POS,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,POS,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,Fee Schedule,3198.57
Blue Shield,POS,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Fee Schedule,4280.44
Blue Shield,POS,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Fee Schedule,3198.57
Blue Shield,POS,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Fee Schedule,3198.57
Blue Shield,POS,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,POS,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,POS,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,POS,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Fee Schedule,3198.57
Blue Shield,POS,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Fee Schedule,3198.57
Blue Shield,POS,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Fee Schedule,3198.57
Blue Shield,POS,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Fee Schedule,4280.44
Blue Shield,POS,45999,CPT4/HCPCS,RECTUM SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Fee Schedule,4891.93
Blue Shield,POS,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Fee Schedule,3198.57
Blue Shield,POS,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4891.93
Blue Shield,POS,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Fee Schedule,3198.57
Blue Shield,POS,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,POS,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Fee Schedule,3198.57
Blue Shield,POS,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Fee Schedule,4280.44
Blue Shield,POS,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Fee Schedule,3198.57
Blue Shield,POS,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Fee Schedule,3198.57
Blue Shield,POS,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Fee Schedule,4280.44
Blue Shield,POS,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Fee Schedule,4891.93
Blue Shield,POS,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Fee Schedule,4891.93
Blue Shield,POS,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Fee Schedule,4891.93
Blue Shield,POS,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Fee Schedule,4891.93
Blue Shield,POS,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Fee Schedule,4891.93
Blue Shield,POS,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Fee Schedule,6049.05
Blue Shield,POS,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Fee Schedule,6049.05
Blue Shield,POS,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Fee Schedule,4891.93
Blue Shield,POS,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Fee Schedule,4891.93
Blue Shield,POS,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Fee Schedule,6049.05
Blue Shield,POS,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Fee Schedule,3198.57
Blue Shield,POS,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Fee Schedule,6049.05
Blue Shield,POS,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Fee Schedule,3198.57
Blue Shield,POS,46500,CPT4/HCPCS,INJECTION INTO HEMORRHOID(S),,Fee Schedule,3198.57
Blue Shield,POS,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Fee Schedule,3198.57
Blue Shield,POS,46600,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY SPX,,Fee Schedule,987.79
Blue Shield,POS,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Fee Schedule,987.79
Blue Shield,POS,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Fee Schedule,3198.57
Blue Shield,POS,46606,CPT4/HCPCS,ANOSCOPY AND BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Fee Schedule,3198.57
Blue Shield,POS,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Fee Schedule,3198.57
Blue Shield,POS,46611,CPT4/HCPCS,ANOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Fee Schedule,3198.57
Blue Shield,POS,46615,CPT4/HCPCS,ANOSCOPY,,Fee Schedule,4280.44
Blue Shield,POS,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Fee Schedule,4891.93
Blue Shield,POS,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Fee Schedule,3198.57
Blue Shield,POS,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Fee Schedule,3198.57
Blue Shield,POS,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,Fee Schedule,7902.34
Blue Shield,POS,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,Fee Schedule,3198.57
Blue Shield,POS,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,Fee Schedule,3198.57
Blue Shield,POS,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,3198.57
Blue Shield,POS,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,4891.93
Blue Shield,POS,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,4280.44
Blue Shield,POS,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,Fee Schedule,6049.05
Blue Shield,POS,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,6876.92
Blue Shield,POS,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,7902.34
Blue Shield,POS,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,9548.66
Blue Shield,POS,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,POS,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,3198.57
Blue Shield,POS,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Fee Schedule,4891.93
Blue Shield,POS,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Fee Schedule,4280.44
Blue Shield,POS,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4280.44
Blue Shield,POS,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,POS,46762,CPT4/HCPCS,IMPLANT ARTIFICIAL SPHINCTER,,Fee Schedule,9548.66
Blue Shield,POS,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,987.79
Blue Shield,POS,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,POS,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Fee Schedule,987.79
Blue Shield,POS,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Fee Schedule,3198.57
Blue Shield,POS,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,3198.57
Blue Shield,POS,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Fee Schedule,3198.57
Blue Shield,POS,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Fee Schedule,4280.44
Blue Shield,POS,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Fee Schedule,3198.57
Blue Shield,POS,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Fee Schedule,3198.57
Blue Shield,POS,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Fee Schedule,3198.57
Blue Shield,POS,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Fee Schedule,6049.05
Blue Shield,POS,46999,CPT4/HCPCS,ANUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Fee Schedule,3198.57
Blue Shield,POS,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,Fee Schedule,3198.57
Blue Shield,POS,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,Fee Schedule,3198.57
Blue Shield,POS,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,Fee Schedule,3198.57
Blue Shield,POS,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,4891.93
Blue Shield,POS,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,POS,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,POS,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,POS,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,Fee Schedule,6876.92
Blue Shield,POS,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,Fee Schedule,12850.71
Blue Shield,POS,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,6049.05
Blue Shield,POS,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,6876.92
Blue Shield,POS,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,7902.34
Blue Shield,POS,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,Fee Schedule,3198.57
Blue Shield,POS,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,3198.57
Blue Shield,POS,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,4280.44
Blue Shield,POS,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,6049.05
Blue Shield,POS,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,3198.57
Blue Shield,POS,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Fee Schedule,9548.66
Blue Shield,POS,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Fee Schedule,9548.66
Blue Shield,POS,47379,CPT4/HCPCS,LAPAROSCOPE PROCEDURE LIVER,,Fee Schedule,7902.34
Blue Shield,POS,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Fee Schedule,3198.57
Blue Shield,POS,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Fee Schedule,3198.57
Blue Shield,POS,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Fee Schedule,9548.66
Blue Shield,POS,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Fee Schedule,9548.66
Blue Shield,POS,47399,CPT4/HCPCS,LIVER SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,Fee Schedule,4280.44
Blue Shield,POS,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,Fee Schedule,3198.57
Blue Shield,POS,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,Fee Schedule,3198.57
Blue Shield,POS,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,Fee Schedule,3198.57
Blue Shield,POS,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,POS,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,POS,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Fee Schedule,4891.93
Blue Shield,POS,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Fee Schedule,4891.93
Blue Shield,POS,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Fee Schedule,4891.93
Blue Shield,POS,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Fee Schedule,4891.93
Blue Shield,POS,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Fee Schedule,4891.93
Blue Shield,POS,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Fee Schedule,4891.93
Blue Shield,POS,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Fee Schedule,3198.57
Blue Shield,POS,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,POS,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,POS,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,POS,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Fee Schedule,4891.93
Blue Shield,POS,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Fee Schedule,4891.93
Blue Shield,POS,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Fee Schedule,4891.93
Blue Shield,POS,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Fee Schedule,4891.93
Blue Shield,POS,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Fee Schedule,4280.44
Blue Shield,POS,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,POS,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,POS,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,POS,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,12850.71
Blue Shield,POS,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Fee Schedule,9548.66
Blue Shield,POS,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Fee Schedule,9548.66
Blue Shield,POS,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Fee Schedule,9548.66
Blue Shield,POS,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Fee Schedule,3198.57
Blue Shield,POS,47579,CPT4/HCPCS,LAPAROSCOPE PROC BILIARY,,Fee Schedule,7902.34
Blue Shield,POS,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,POS,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,POS,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,POS,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,POS,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,POS,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,Fee Schedule,3198.57
Blue Shield,POS,47701,CPT4/HCPCS,BILE DUCT REVISION,,Fee Schedule,4280.44
Blue Shield,POS,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Fee Schedule,3198.57
Blue Shield,POS,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Fee Schedule,4280.44
Blue Shield,POS,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,Fee Schedule,3198.57
Blue Shield,POS,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,Fee Schedule,3198.57
Blue Shield,POS,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,Fee Schedule,4280.44
Blue Shield,POS,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,4280.44
Blue Shield,POS,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,4280.44
Blue Shield,POS,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,Fee Schedule,3198.57
Blue Shield,POS,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,Fee Schedule,3198.57
Blue Shield,POS,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,Fee Schedule,3198.57
Blue Shield,POS,47999,CPT4/HCPCS,BILE TRACT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,Fee Schedule,4280.44
Blue Shield,POS,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,Fee Schedule,4280.44
Blue Shield,POS,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,Fee Schedule,3198.57
Blue Shield,POS,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,Fee Schedule,3198.57
Blue Shield,POS,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Fee Schedule,3198.57
Blue Shield,POS,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,Fee Schedule,3198.57
Blue Shield,POS,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,3198.57
Blue Shield,POS,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,3198.57
Blue Shield,POS,48146,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,4280.44
Blue Shield,POS,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,Fee Schedule,3198.57
Blue Shield,POS,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,6049.05
Blue Shield,POS,48152,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6049.05
Blue Shield,POS,48153,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6876.92
Blue Shield,POS,48154,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6049.05
Blue Shield,POS,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,Fee Schedule,4280.44
Blue Shield,POS,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,Fee Schedule,4280.44
Blue Shield,POS,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,Fee Schedule,3198.57
Blue Shield,POS,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Fee Schedule,3198.57
Blue Shield,POS,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,48545,CPT4/HCPCS,PANCREATORRHAPHY,,Fee Schedule,3198.57
Blue Shield,POS,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,Fee Schedule,3198.57
Blue Shield,POS,48550,CPT4/HCPCS,DONOR PANCREATECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,48554,CPT4/HCPCS,TRANSPL ALLOGRAFT PANCREAS,,Fee Schedule,3198.57
Blue Shield,POS,48556,CPT4/HCPCS,REMOVAL ALLOGRAFT PANCREAS,,Fee Schedule,3198.57
Blue Shield,POS,48999,CPT4/HCPCS,PANCREAS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,POS,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,POS,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Fee Schedule,3198.57
Blue Shield,POS,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,Fee Schedule,3198.57
Blue Shield,POS,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,Fee Schedule,3198.57
Blue Shield,POS,49082,CPT4/HCPCS,ABD PARACENTESIS,,Fee Schedule,987.79
Blue Shield,POS,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Fee Schedule,3198.57
Blue Shield,POS,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Fee Schedule,4891.93
Blue Shield,POS,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Fee Schedule,3198.57
Blue Shield,POS,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Fee Schedule,3198.57
Blue Shield,POS,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,Fee Schedule,4891.93
Blue Shield,POS,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,Fee Schedule,3198.57
Blue Shield,POS,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Fee Schedule,6049.05
Blue Shield,POS,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,Fee Schedule,3198.57
Blue Shield,POS,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Fee Schedule,4891.93
Blue Shield,POS,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Fee Schedule,6049.05
Blue Shield,POS,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Fee Schedule,6049.05
Blue Shield,POS,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Fee Schedule,7902.34
Blue Shield,POS,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Fee Schedule,4891.93
Blue Shield,POS,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Fee Schedule,4891.93
Blue Shield,POS,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,49329,CPT4/HCPCS,LAPARO PROC ABDM/PER/OMENT,,Fee Schedule,7902.34
Blue Shield,POS,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Fee Schedule,4280.44
Blue Shield,POS,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Fee Schedule,3198.57
Blue Shield,POS,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Fee Schedule,3198.57
Blue Shield,POS,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Fee Schedule,3198.57
Blue Shield,POS,49411,CPT4/HCPCS,INS MARK ABD/PEL FOR RT PERQ,,Fee Schedule,987.79
Blue Shield,POS,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Fee Schedule,4280.44
Blue Shield,POS,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Fee Schedule,12850.71
Blue Shield,POS,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Fee Schedule,3198.57
Blue Shield,POS,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Fee Schedule,3198.57
Blue Shield,POS,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Fee Schedule,3198.57
Blue Shield,POS,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Fee Schedule,3198.57
Blue Shield,POS,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Fee Schedule,4280.44
Blue Shield,POS,49428,CPT4/HCPCS,LIGATION OF SHUNT,,Fee Schedule,3198.57
Blue Shield,POS,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Fee Schedule,4891.93
Blue Shield,POS,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Fee Schedule,3198.57
Blue Shield,POS,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Fee Schedule,4280.44
Blue Shield,POS,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Fee Schedule,4280.44
Blue Shield,POS,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Fee Schedule,4280.44
Blue Shield,POS,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Fee Schedule,4280.44
Blue Shield,POS,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Fee Schedule,4280.44
Blue Shield,POS,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Fee Schedule,4280.44
Blue Shield,POS,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Fee Schedule,4280.44
Blue Shield,POS,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Fee Schedule,4280.44
Blue Shield,POS,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Fee Schedule,3198.57
Blue Shield,POS,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Fee Schedule,6876.92
Blue Shield,POS,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Fee Schedule,6876.92
Blue Shield,POS,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Fee Schedule,6049.05
Blue Shield,POS,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Fee Schedule,6049.05
Blue Shield,POS,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Fee Schedule,6049.05
Blue Shield,POS,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Fee Schedule,12850.71
Blue Shield,POS,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Fee Schedule,6049.05
Blue Shield,POS,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Fee Schedule,12850.71
Blue Shield,POS,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Fee Schedule,9548.66
Blue Shield,POS,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Fee Schedule,12850.71
Blue Shield,POS,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Fee Schedule,6049.05
Blue Shield,POS,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Fee Schedule,4280.44
Blue Shield,POS,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Fee Schedule,6876.92
Blue Shield,POS,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Fee Schedule,12850.71
Blue Shield,POS,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Fee Schedule,6876.92
Blue Shield,POS,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Fee Schedule,12850.71
Blue Shield,POS,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Fee Schedule,6049.05
Blue Shield,POS,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Fee Schedule,12850.71
Blue Shield,POS,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Fee Schedule,6049.05
Blue Shield,POS,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Fee Schedule,12850.71
Blue Shield,POS,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Fee Schedule,9548.66
Blue Shield,POS,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Fee Schedule,6049.05
Blue Shield,POS,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Fee Schedule,12850.71
Blue Shield,POS,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Fee Schedule,6049.05
Blue Shield,POS,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Fee Schedule,12850.71
Blue Shield,POS,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Fee Schedule,6049.05
Blue Shield,POS,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Fee Schedule,12850.71
Blue Shield,POS,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Fee Schedule,4891.93
Blue Shield,POS,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,6049.05
Blue Shield,POS,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,9548.66
Blue Shield,POS,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,3198.57
Blue Shield,POS,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,3198.57
Blue Shield,POS,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,6049.05
Blue Shield,POS,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Fee Schedule,6049.05
Blue Shield,POS,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Fee Schedule,9548.66
Blue Shield,POS,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Fee Schedule,7902.34
Blue Shield,POS,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Fee Schedule,7902.34
Blue Shield,POS,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Fee Schedule,7902.34
Blue Shield,POS,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Fee Schedule,7902.34
Blue Shield,POS,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Fee Schedule,7902.34
Blue Shield,POS,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Fee Schedule,7902.34
Blue Shield,POS,49659,CPT4/HCPCS,LAPARO PROC HERNIA REPAIR,,Fee Schedule,9548.66
Blue Shield,POS,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,Fee Schedule,3198.57
Blue Shield,POS,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,Fee Schedule,4280.44
Blue Shield,POS,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,Fee Schedule,3198.57
Blue Shield,POS,49906,CPT4/HCPCS,FREE OMENTAL FLAP MICROVASC,,Fee Schedule,3198.57
Blue Shield,POS,49999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Fee Schedule,4891.93
Blue Shield,POS,4A020N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,4A020N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,POS,4A020N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Open,,Fee Schedule,8271.00
Blue Shield,POS,4A023FZ,ICD10-PCS,Measurement of Cardiac Rhythm, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,POS,4A023N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,4A023N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,POS,4A023N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Perc,,Fee Schedule,8271.00
Blue Shield,POS,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Fee Schedule,4280.44
Blue Shield,POS,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,9548.66
Blue Shield,POS,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,3198.57
Blue Shield,POS,50065,CPT4/HCPCS,INCISION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50070,CPT4/HCPCS,INCISION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,4280.44
Blue Shield,POS,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,9548.66
Blue Shield,POS,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,9548.66
Blue Shield,POS,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,Fee Schedule,3198.57
Blue Shield,POS,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,3198.57
Blue Shield,POS,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Fee Schedule,3198.57
Blue Shield,POS,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,Fee Schedule,3198.57
Blue Shield,POS,50220,CPT4/HCPCS,REMOVE KIDNEY OPEN,,Fee Schedule,3198.57
Blue Shield,POS,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,Fee Schedule,3198.57
Blue Shield,POS,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,Fee Schedule,3198.57
Blue Shield,POS,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Fee Schedule,3198.57
Blue Shield,POS,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Fee Schedule,4280.44
Blue Shield,POS,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,Fee Schedule,4280.44
Blue Shield,POS,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,POS,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,POS,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,Fee Schedule,3198.57
Blue Shield,POS,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Fee Schedule,4891.93
Blue Shield,POS,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Fee Schedule,6049.05
Blue Shield,POS,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,Fee Schedule,4280.44
Blue Shield,POS,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Fee Schedule,4280.44
Blue Shield,POS,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Fee Schedule,4280.44
Blue Shield,POS,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Fee Schedule,4280.44
Blue Shield,POS,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Fee Schedule,4280.44
Blue Shield,POS,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Fee Schedule,4280.44
Blue Shield,POS,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Fee Schedule,4280.44
Blue Shield,POS,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,POS,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Fee Schedule,987.79
Blue Shield,POS,50395,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Fee Schedule,3198.57
Blue Shield,POS,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Fee Schedule,3198.57
Blue Shield,POS,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Fee Schedule,3198.57
Blue Shield,POS,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Fee Schedule,3198.57
Blue Shield,POS,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Fee Schedule,3198.57
Blue Shield,POS,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Fee Schedule,3198.57
Blue Shield,POS,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Fee Schedule,3198.57
Blue Shield,POS,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Fee Schedule,3198.57
Blue Shield,POS,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Fee Schedule,3198.57
Blue Shield,POS,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,Fee Schedule,3198.57
Blue Shield,POS,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Fee Schedule,4280.44
Blue Shield,POS,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Fee Schedule,4280.44
Blue Shield,POS,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Fee Schedule,7902.34
Blue Shield,POS,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Fee Schedule,9548.66
Blue Shield,POS,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Fee Schedule,9548.66
Blue Shield,POS,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Fee Schedule,7902.34
Blue Shield,POS,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,50546,CPT4/HCPCS,LAPAROSCOPIC NEPHRECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Fee Schedule,3198.57
Blue Shield,POS,50549,CPT4/HCPCS,LAPAROSCOPE PROC RENAL,,Fee Schedule,7902.34
Blue Shield,POS,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,POS,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,POS,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Fee Schedule,9548.66
Blue Shield,POS,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,POS,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,POS,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Fee Schedule,12850.71
Blue Shield,POS,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Fee Schedule,6876.92
Blue Shield,POS,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Fee Schedule,4891.93
Blue Shield,POS,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Fee Schedule,3198.57
Blue Shield,POS,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Fee Schedule,3198.57
Blue Shield,POS,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,POS,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,POS,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,POS,50650,CPT4/HCPCS,REMOVAL OF URETER,,Fee Schedule,3198.57
Blue Shield,POS,50660,CPT4/HCPCS,REMOVAL OF URETER,,Fee Schedule,3198.57
Blue Shield,POS,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,Fee Schedule,987.79
Blue Shield,POS,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Fee Schedule,3198.57
Blue Shield,POS,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,POS,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,POS,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,POS,50700,CPT4/HCPCS,REVISION OF URETER,,Fee Schedule,3198.57
Blue Shield,POS,50715,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,POS,50722,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,POS,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,Fee Schedule,3198.57
Blue Shield,POS,50727,CPT4/HCPCS,REVISE URETER,,Fee Schedule,3198.57
Blue Shield,POS,50728,CPT4/HCPCS,REVISE URETER,,Fee Schedule,3198.57
Blue Shield,POS,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Fee Schedule,3198.57
Blue Shield,POS,50760,CPT4/HCPCS,FUSION OF URETERS,,Fee Schedule,3198.57
Blue Shield,POS,50770,CPT4/HCPCS,SPLICING OF URETERS,,Fee Schedule,3198.57
Blue Shield,POS,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,POS,50782,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,POS,50783,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,POS,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,POS,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,Fee Schedule,3198.57
Blue Shield,POS,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Fee Schedule,3198.57
Blue Shield,POS,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Fee Schedule,4891.93
Blue Shield,POS,50830,CPT4/HCPCS,REVISE URINE FLOW,,Fee Schedule,4891.93
Blue Shield,POS,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,Fee Schedule,3198.57
Blue Shield,POS,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,Fee Schedule,3198.57
Blue Shield,POS,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,Fee Schedule,3198.57
Blue Shield,POS,50900,CPT4/HCPCS,REPAIR OF URETER,,Fee Schedule,3198.57
Blue Shield,POS,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,50940,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,POS,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Fee Schedule,9548.66
Blue Shield,POS,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Fee Schedule,12850.71
Blue Shield,POS,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Fee Schedule,12850.71
Blue Shield,POS,50949,CPT4/HCPCS,LAPAROSCOPE PROC URETER,,Fee Schedule,7902.34
Blue Shield,POS,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Fee Schedule,3198.57
Blue Shield,POS,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Fee Schedule,3198.57
Blue Shield,POS,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,POS,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,POS,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Fee Schedule,3198.57
Blue Shield,POS,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,POS,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,POS,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Fee Schedule,6049.05
Blue Shield,POS,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Fee Schedule,6049.05
Blue Shield,POS,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Fee Schedule,6049.05
Blue Shield,POS,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Fee Schedule,6049.05
Blue Shield,POS,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Fee Schedule,6049.05
Blue Shield,POS,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,POS,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Fee Schedule,6049.05
Blue Shield,POS,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,Fee Schedule,987.79
Blue Shield,POS,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Fee Schedule,3198.57
Blue Shield,POS,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Fee Schedule,3198.57
Blue Shield,POS,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Fee Schedule,6049.05
Blue Shield,POS,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,6049.05
Blue Shield,POS,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,3198.57
Blue Shield,POS,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,3198.57
Blue Shield,POS,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,Fee Schedule,3198.57
Blue Shield,POS,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Fee Schedule,3198.57
Blue Shield,POS,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Fee Schedule,3198.57
Blue Shield,POS,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,Fee Schedule,3198.57
Blue Shield,POS,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,Fee Schedule,4280.44
Blue Shield,POS,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Fee Schedule,4891.93
Blue Shield,POS,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,POS,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Fee Schedule,4891.93
Blue Shield,POS,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,POS,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,POS,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,Fee Schedule,6049.05
Blue Shield,POS,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,Fee Schedule,4891.93
Blue Shield,POS,51700,CPT4/HCPCS,IRRIGATION OF BLADDER,,Fee Schedule,987.79
Blue Shield,POS,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Fee Schedule,987.79
Blue Shield,POS,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Fee Schedule,3198.57
Blue Shield,POS,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Fee Schedule,4891.93
Blue Shield,POS,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Fee Schedule,987.79
Blue Shield,POS,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Fee Schedule,3198.57
Blue Shield,POS,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Fee Schedule,3198.57
Blue Shield,POS,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Fee Schedule,3198.57
Blue Shield,POS,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Fee Schedule,3198.57
Blue Shield,POS,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Fee Schedule,3198.57
Blue Shield,POS,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,Fee Schedule,987.79
Blue Shield,POS,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,Fee Schedule,987.79
Blue Shield,POS,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Fee Schedule,987.79
Blue Shield,POS,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Fee Schedule,3198.57
Blue Shield,POS,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,Fee Schedule,987.79
Blue Shield,POS,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Fee Schedule,987.79
Blue Shield,POS,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,Fee Schedule,987.79
Blue Shield,POS,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Fee Schedule,3198.57
Blue Shield,POS,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Fee Schedule,3198.57
Blue Shield,POS,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Fee Schedule,3198.57
Blue Shield,POS,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Fee Schedule,3198.57
Blue Shield,POS,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Fee Schedule,3198.57
Blue Shield,POS,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Fee Schedule,3198.57
Blue Shield,POS,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Fee Schedule,3198.57
Blue Shield,POS,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,Fee Schedule,3198.57
Blue Shield,POS,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,Fee Schedule,4891.93
Blue Shield,POS,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,Fee Schedule,4280.44
Blue Shield,POS,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,Fee Schedule,3198.57
Blue Shield,POS,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Fee Schedule,9548.66
Blue Shield,POS,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Fee Schedule,12850.71
Blue Shield,POS,51999,CPT4/HCPCS,LAPAROSCOPE PROC BLA,,Fee Schedule,6049.05
Blue Shield,POS,52000,CPT4/HCPCS,CYSTOSCOPY,,Fee Schedule,3198.57
Blue Shield,POS,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Fee Schedule,4280.44
Blue Shield,POS,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Fee Schedule,4280.44
Blue Shield,POS,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Fee Schedule,4280.44
Blue Shield,POS,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Fee Schedule,4280.44
Blue Shield,POS,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Fee Schedule,4280.44
Blue Shield,POS,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,POS,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,POS,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Fee Schedule,6049.05
Blue Shield,POS,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,3198.57
Blue Shield,POS,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Fee Schedule,4280.44
Blue Shield,POS,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Fee Schedule,4280.44
Blue Shield,POS,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,POS,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Fee Schedule,12850.71
Blue Shield,POS,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Fee Schedule,4280.44
Blue Shield,POS,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Fee Schedule,3198.57
Blue Shield,POS,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Fee Schedule,4280.44
Blue Shield,POS,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,6876.92
Blue Shield,POS,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Fee Schedule,6049.05
Blue Shield,POS,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Fee Schedule,4280.44
Blue Shield,POS,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Fee Schedule,4891.93
Blue Shield,POS,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,POS,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,POS,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,POS,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,POS,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Fee Schedule,4891.93
Blue Shield,POS,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Fee Schedule,4891.93
Blue Shield,POS,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Fee Schedule,4891.93
Blue Shield,POS,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Fee Schedule,6049.05
Blue Shield,POS,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Fee Schedule,6049.05
Blue Shield,POS,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Fee Schedule,6049.05
Blue Shield,POS,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Fee Schedule,6049.05
Blue Shield,POS,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Fee Schedule,6049.05
Blue Shield,POS,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Fee Schedule,4891.93
Blue Shield,POS,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Fee Schedule,6049.05
Blue Shield,POS,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Fee Schedule,987.79
Blue Shield,POS,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Fee Schedule,987.79
Blue Shield,POS,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Fee Schedule,4891.93
Blue Shield,POS,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Fee Schedule,4891.93
Blue Shield,POS,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Fee Schedule,6049.05
Blue Shield,POS,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Fee Schedule,4280.44
Blue Shield,POS,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Fee Schedule,4280.44
Blue Shield,POS,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Fee Schedule,12850.71
Blue Shield,POS,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Fee Schedule,12850.71
Blue Shield,POS,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Fee Schedule,6049.05
Blue Shield,POS,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,53000,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,53010,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,53020,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,53025,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,POS,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Fee Schedule,4891.93
Blue Shield,POS,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Fee Schedule,3198.57
Blue Shield,POS,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Fee Schedule,6876.92
Blue Shield,POS,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Fee Schedule,6876.92
Blue Shield,POS,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,POS,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,POS,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Fee Schedule,4891.93
Blue Shield,POS,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Fee Schedule,4280.44
Blue Shield,POS,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Fee Schedule,4280.44
Blue Shield,POS,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,POS,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,POS,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Fee Schedule,4280.44
Blue Shield,POS,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Fee Schedule,4280.44
Blue Shield,POS,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Fee Schedule,4891.93
Blue Shield,POS,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Fee Schedule,4280.44
Blue Shield,POS,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,POS,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Fee Schedule,4891.93
Blue Shield,POS,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Fee Schedule,4280.44
Blue Shield,POS,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,POS,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Fee Schedule,4280.44
Blue Shield,POS,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Fee Schedule,4280.44
Blue Shield,POS,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Fee Schedule,3198.57
Blue Shield,POS,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Fee Schedule,4280.44
Blue Shield,POS,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Fee Schedule,3198.57
Blue Shield,POS,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Fee Schedule,3198.57
Blue Shield,POS,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Fee Schedule,3198.57
Blue Shield,POS,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,Fee Schedule,3198.57
Blue Shield,POS,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Fee Schedule,3198.57
Blue Shield,POS,53450,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,53460,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Fee Schedule,7902.34
Blue Shield,POS,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,POS,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,POS,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,POS,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,POS,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Fee Schedule,4280.44
Blue Shield,POS,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,3198.57
Blue Shield,POS,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,3198.57
Blue Shield,POS,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,4280.44
Blue Shield,POS,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,4280.44
Blue Shield,POS,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,987.79
Blue Shield,POS,53660,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,987.79
Blue Shield,POS,53661,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,987.79
Blue Shield,POS,53665,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Fee Schedule,12850.71
Blue Shield,POS,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Fee Schedule,12850.71
Blue Shield,POS,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Fee Schedule,3198.57
Blue Shield,POS,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Fee Schedule,987.79
Blue Shield,POS,53899,CPT4/HCPCS,UROLOGY SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Fee Schedule,4280.44
Blue Shield,POS,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Fee Schedule,4280.44
Blue Shield,POS,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Fee Schedule,6049.05
Blue Shield,POS,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,987.79
Blue Shield,POS,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,4280.44
Blue Shield,POS,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,Fee Schedule,987.79
Blue Shield,POS,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,POS,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,POS,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,POS,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Fee Schedule,3198.57
Blue Shield,POS,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Fee Schedule,3198.57
Blue Shield,POS,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,4280.44
Blue Shield,POS,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,3198.57
Blue Shield,POS,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Fee Schedule,4280.44
Blue Shield,POS,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Fee Schedule,3198.57
Blue Shield,POS,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,Fee Schedule,3198.57
Blue Shield,POS,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,Fee Schedule,4280.44
Blue Shield,POS,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Fee Schedule,3198.57
Blue Shield,POS,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Fee Schedule,4280.44
Blue Shield,POS,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Fee Schedule,4280.44
Blue Shield,POS,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Fee Schedule,4280.44
Blue Shield,POS,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Fee Schedule,4280.44
Blue Shield,POS,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Fee Schedule,4280.44
Blue Shield,POS,54200,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,987.79
Blue Shield,POS,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,6049.05
Blue Shield,POS,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,3198.57
Blue Shield,POS,54231,CPT4/HCPCS,DYNAMIC CAVERNOSOMETRY,,Fee Schedule,4280.44
Blue Shield,POS,54235,CPT4/HCPCS,PENILE INJECTION,,Fee Schedule,987.79
Blue Shield,POS,54240,CPT4/HCPCS,PENIS STUDY,,Fee Schedule,987.79
Blue Shield,POS,54250,CPT4/HCPCS,PENIS STUDY,,Fee Schedule,987.79
Blue Shield,POS,54300,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,4891.93
Blue Shield,POS,54304,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,4891.93
Blue Shield,POS,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,POS,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,POS,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,POS,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,POS,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,POS,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,POS,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,POS,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,4891.93
Blue Shield,POS,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,3198.57
Blue Shield,POS,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,4280.44
Blue Shield,POS,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Fee Schedule,4891.93
Blue Shield,POS,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,54380,CPT4/HCPCS,REPAIR PENIS,,Fee Schedule,4891.93
Blue Shield,POS,54385,CPT4/HCPCS,REPAIR PENIS,,Fee Schedule,4891.93
Blue Shield,POS,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,Fee Schedule,4280.44
Blue Shield,POS,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,POS,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,POS,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,POS,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,POS,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,POS,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Fee Schedule,4891.93
Blue Shield,POS,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Fee Schedule,3198.57
Blue Shield,POS,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Fee Schedule,4891.93
Blue Shield,POS,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Fee Schedule,4891.93
Blue Shield,POS,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Fee Schedule,3198.57
Blue Shield,POS,54420,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,6049.05
Blue Shield,POS,54430,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,3198.57
Blue Shield,POS,54435,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,6049.05
Blue Shield,POS,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Fee Schedule,6049.05
Blue Shield,POS,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,Fee Schedule,987.79
Blue Shield,POS,54440,CPT4/HCPCS,REPAIR OF PENIS,,Fee Schedule,6049.05
Blue Shield,POS,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Fee Schedule,3198.57
Blue Shield,POS,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Fee Schedule,3198.57
Blue Shield,POS,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Fee Schedule,3198.57
Blue Shield,POS,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Fee Schedule,4280.44
Blue Shield,POS,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Fee Schedule,4891.93
Blue Shield,POS,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Fee Schedule,4891.93
Blue Shield,POS,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Fee Schedule,6049.05
Blue Shield,POS,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Fee Schedule,6049.05
Blue Shield,POS,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Fee Schedule,3198.57
Blue Shield,POS,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Fee Schedule,6049.05
Blue Shield,POS,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Fee Schedule,4891.93
Blue Shield,POS,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Fee Schedule,6049.05
Blue Shield,POS,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Fee Schedule,3198.57
Blue Shield,POS,54660,CPT4/HCPCS,REVISION OF TESTIS,,Fee Schedule,4280.44
Blue Shield,POS,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Fee Schedule,4891.93
Blue Shield,POS,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Fee Schedule,4891.93
Blue Shield,POS,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Fee Schedule,12850.71
Blue Shield,POS,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Fee Schedule,12850.71
Blue Shield,POS,54699,CPT4/HCPCS,LAPAROSCOPE PROC TESTIS,,Fee Schedule,7902.34
Blue Shield,POS,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Fee Schedule,4280.44
Blue Shield,POS,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Fee Schedule,3198.57
Blue Shield,POS,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Fee Schedule,4891.93
Blue Shield,POS,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Fee Schedule,6049.05
Blue Shield,POS,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Fee Schedule,4891.93
Blue Shield,POS,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Fee Schedule,6049.05
Blue Shield,POS,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Fee Schedule,3198.57
Blue Shield,POS,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Fee Schedule,6049.05
Blue Shield,POS,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Fee Schedule,6049.05
Blue Shield,POS,55000,CPT4/HCPCS,DRAINAGE OF HYDROCELE,,Fee Schedule,987.79
Blue Shield,POS,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Fee Schedule,4891.93
Blue Shield,POS,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Fee Schedule,6876.92
Blue Shield,POS,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Fee Schedule,6049.05
Blue Shield,POS,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Fee Schedule,4280.44
Blue Shield,POS,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Fee Schedule,4280.44
Blue Shield,POS,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Fee Schedule,3198.57
Blue Shield,POS,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Fee Schedule,3198.57
Blue Shield,POS,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Fee Schedule,4280.44
Blue Shield,POS,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Fee Schedule,4280.44
Blue Shield,POS,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Fee Schedule,4280.44
Blue Shield,POS,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Fee Schedule,3198.57
Blue Shield,POS,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Fee Schedule,4891.93
Blue Shield,POS,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Fee Schedule,6049.05
Blue Shield,POS,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Fee Schedule,6049.05
Blue Shield,POS,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Fee Schedule,6049.05
Blue Shield,POS,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Fee Schedule,6876.92
Blue Shield,POS,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Fee Schedule,12850.71
Blue Shield,POS,55559,CPT4/HCPCS,LAPARO PROC SPERMATIC CORD,,Fee Schedule,7902.34
Blue Shield,POS,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,POS,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,POS,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,POS,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Fee Schedule,3198.57
Blue Shield,POS,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Fee Schedule,4280.44
Blue Shield,POS,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Fee Schedule,4280.44
Blue Shield,POS,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Fee Schedule,4280.44
Blue Shield,POS,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,POS,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,POS,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,POS,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Fee Schedule,4280.44
Blue Shield,POS,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,55870,CPT4/HCPCS,ELECTROEJACULATION,,Fee Schedule,3198.57
Blue Shield,POS,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Fee Schedule,12850.71
Blue Shield,POS,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Fee Schedule,12850.71
Blue Shield,POS,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Fee Schedule,12850.71
Blue Shield,POS,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Fee Schedule,12850.71
Blue Shield,POS,55899,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Fee Schedule,3198.57
Blue Shield,POS,55970,CPT4/HCPCS,SEX TRANSFORMATION M TO F,,Fee Schedule,3198.57
Blue Shield,POS,55980,CPT4/HCPCS,SEX TRANSFORMATION F TO M,,Fee Schedule,3198.57
Blue Shield,POS,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,POS,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Fee Schedule,3198.57
Blue Shield,POS,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Fee Schedule,4280.44
Blue Shield,POS,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Fee Schedule,3198.57
Blue Shield,POS,56442,CPT4/HCPCS,HYMENOTOMY,,Fee Schedule,3198.57
Blue Shield,POS,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Fee Schedule,4280.44
Blue Shield,POS,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Fee Schedule,4891.93
Blue Shield,POS,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,POS,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,POS,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Fee Schedule,6876.92
Blue Shield,POS,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Fee Schedule,9548.66
Blue Shield,POS,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Fee Schedule,3198.57
Blue Shield,POS,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Fee Schedule,4891.93
Blue Shield,POS,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Fee Schedule,4891.93
Blue Shield,POS,56805,CPT4/HCPCS,REPAIR CLITORIS,,Fee Schedule,4891.93
Blue Shield,POS,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Fee Schedule,6876.92
Blue Shield,POS,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Fee Schedule,987.79
Blue Shield,POS,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Fee Schedule,987.79
Blue Shield,POS,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Fee Schedule,3198.57
Blue Shield,POS,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Fee Schedule,4280.44
Blue Shield,POS,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Fee Schedule,3198.57
Blue Shield,POS,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Fee Schedule,3198.57
Blue Shield,POS,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Fee Schedule,4891.93
Blue Shield,POS,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Fee Schedule,3198.57
Blue Shield,POS,57100,CPT4/HCPCS,BIOPSY OF VAGINA,,Fee Schedule,987.79
Blue Shield,POS,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Fee Schedule,4280.44
Blue Shield,POS,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Fee Schedule,4891.93
Blue Shield,POS,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Fee Schedule,6876.92
Blue Shield,POS,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Fee Schedule,6876.92
Blue Shield,POS,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Fee Schedule,3198.57
Blue Shield,POS,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Fee Schedule,4280.44
Blue Shield,POS,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Fee Schedule,4280.44
Blue Shield,POS,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Fee Schedule,6876.92
Blue Shield,POS,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Fee Schedule,4280.44
Blue Shield,POS,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Fee Schedule,4280.44
Blue Shield,POS,57150,CPT4/HCPCS,TREAT VAGINA INFECTION,,Fee Schedule,987.79
Blue Shield,POS,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Fee Schedule,4280.44
Blue Shield,POS,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Fee Schedule,987.79
Blue Shield,POS,57160,CPT4/HCPCS,INSERT PESSARY/OTHER DEVICE,,Fee Schedule,987.79
Blue Shield,POS,57170,CPT4/HCPCS,FITTING OF DIAPHRAGM/CAP,,Fee Schedule,987.79
Blue Shield,POS,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,Fee Schedule,3198.57
Blue Shield,POS,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Fee Schedule,3198.57
Blue Shield,POS,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Fee Schedule,4280.44
Blue Shield,POS,57220,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,POS,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Fee Schedule,4891.93
Blue Shield,POS,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Fee Schedule,6876.92
Blue Shield,POS,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Fee Schedule,6876.92
Blue Shield,POS,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Fee Schedule,6876.92
Blue Shield,POS,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Fee Schedule,9548.66
Blue Shield,POS,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Fee Schedule,6876.92
Blue Shield,POS,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Fee Schedule,4891.93
Blue Shield,POS,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,Fee Schedule,4891.93
Blue Shield,POS,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Fee Schedule,4891.93
Blue Shield,POS,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Fee Schedule,3198.57
Blue Shield,POS,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Fee Schedule,6876.92
Blue Shield,POS,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Fee Schedule,4891.93
Blue Shield,POS,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Fee Schedule,9548.66
Blue Shield,POS,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Fee Schedule,9548.66
Blue Shield,POS,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Fee Schedule,6876.92
Blue Shield,POS,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Fee Schedule,6876.92
Blue Shield,POS,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,57295,CPT4/HCPCS,REVISE VAG GRAFT VIA VAGINA,,Fee Schedule,3198.57
Blue Shield,POS,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Fee Schedule,4891.93
Blue Shield,POS,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Fee Schedule,4891.93
Blue Shield,POS,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,Fee Schedule,4891.93
Blue Shield,POS,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,Fee Schedule,3198.57
Blue Shield,POS,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Fee Schedule,6876.92
Blue Shield,POS,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Fee Schedule,3198.57
Blue Shield,POS,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Fee Schedule,6876.92
Blue Shield,POS,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Fee Schedule,6876.92
Blue Shield,POS,57335,CPT4/HCPCS,REPAIR VAGINA,,Fee Schedule,3198.57
Blue Shield,POS,57400,CPT4/HCPCS,DILATION OF VAGINA,,Fee Schedule,4280.44
Blue Shield,POS,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Fee Schedule,4280.44
Blue Shield,POS,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,POS,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Fee Schedule,987.79
Blue Shield,POS,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Fee Schedule,987.79
Blue Shield,POS,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Fee Schedule,6049.05
Blue Shield,POS,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Fee Schedule,7902.34
Blue Shield,POS,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Fee Schedule,6876.92
Blue Shield,POS,57452,CPT4/HCPCS,EXAM OF CERVIX W/SCOPE,,Fee Schedule,987.79
Blue Shield,POS,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Fee Schedule,3198.57
Blue Shield,POS,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Fee Schedule,987.79
Blue Shield,POS,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Fee Schedule,3198.57
Blue Shield,POS,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Fee Schedule,4280.44
Blue Shield,POS,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Fee Schedule,4891.93
Blue Shield,POS,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Fee Schedule,3198.57
Blue Shield,POS,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Fee Schedule,987.79
Blue Shield,POS,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,POS,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Fee Schedule,3198.57
Blue Shield,POS,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Fee Schedule,4280.44
Blue Shield,POS,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,POS,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,POS,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Fee Schedule,4891.93
Blue Shield,POS,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,Fee Schedule,4280.44
Blue Shield,POS,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Fee Schedule,3198.57
Blue Shield,POS,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,Fee Schedule,3198.57
Blue Shield,POS,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Fee Schedule,4891.93
Blue Shield,POS,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,Fee Schedule,6876.92
Blue Shield,POS,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Fee Schedule,6876.92
Blue Shield,POS,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Fee Schedule,4891.93
Blue Shield,POS,57700,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,3198.57
Blue Shield,POS,57720,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,4891.93
Blue Shield,POS,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Fee Schedule,4280.44
Blue Shield,POS,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Fee Schedule,987.79
Blue Shield,POS,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Fee Schedule,987.79
Blue Shield,POS,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Fee Schedule,4280.44
Blue Shield,POS,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Fee Schedule,6876.92
Blue Shield,POS,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Fee Schedule,6876.92
Blue Shield,POS,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,Fee Schedule,6876.92
Blue Shield,POS,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,4280.44
Blue Shield,POS,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,Fee Schedule,6049.05
Blue Shield,POS,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Fee Schedule,3198.57
Blue Shield,POS,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Fee Schedule,3198.57
Blue Shield,POS,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,Fee Schedule,3198.57
Blue Shield,POS,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Fee Schedule,3198.57
Blue Shield,POS,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Fee Schedule,3198.57
Blue Shield,POS,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Fee Schedule,3198.57
Blue Shield,POS,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Fee Schedule,3198.57
Blue Shield,POS,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Fee Schedule,3198.57
Blue Shield,POS,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Fee Schedule,3198.57
Blue Shield,POS,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,Fee Schedule,3198.57
Blue Shield,POS,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Fee Schedule,3198.57
Blue Shield,POS,58300,CPT4/HCPCS,INSERT INTRAUTERINE DEVICE,,Fee Schedule,987.79
Blue Shield,POS,58301,CPT4/HCPCS,REMOVE INTRAUTERINE DEVICE,,Fee Schedule,987.79
Blue Shield,POS,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Fee Schedule,987.79
Blue Shield,POS,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Fee Schedule,987.79
Blue Shield,POS,58323,CPT4/HCPCS,SPERM WASHING,,Fee Schedule,987.79
Blue Shield,POS,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Fee Schedule,4891.93
Blue Shield,POS,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Fee Schedule,4280.44
Blue Shield,POS,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Fee Schedule,4891.93
Blue Shield,POS,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Fee Schedule,6049.05
Blue Shield,POS,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Fee Schedule,9548.66
Blue Shield,POS,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,POS,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,POS,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Fee Schedule,3198.57
Blue Shield,POS,58540,CPT4/HCPCS,REVISION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,POS,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Fee Schedule,6049.05
Blue Shield,POS,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Fee Schedule,6049.05
Blue Shield,POS,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Fee Schedule,6049.05
Blue Shield,POS,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Fee Schedule,6049.05
Blue Shield,POS,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Fee Schedule,12850.71
Blue Shield,POS,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Fee Schedule,12850.71
Blue Shield,POS,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Fee Schedule,12850.71
Blue Shield,POS,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Fee Schedule,12850.71
Blue Shield,POS,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Fee Schedule,12850.71
Blue Shield,POS,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Fee Schedule,12850.71
Blue Shield,POS,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Fee Schedule,3198.57
Blue Shield,POS,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Fee Schedule,4891.93
Blue Shield,POS,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Fee Schedule,4280.44
Blue Shield,POS,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Fee Schedule,4891.93
Blue Shield,POS,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Fee Schedule,4891.93
Blue Shield,POS,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Fee Schedule,4891.93
Blue Shield,POS,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Fee Schedule,6049.05
Blue Shield,POS,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Fee Schedule,9548.66
Blue Shield,POS,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Fee Schedule,6876.92
Blue Shield,POS,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Fee Schedule,6876.92
Blue Shield,POS,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Fee Schedule,6876.92
Blue Shield,POS,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Fee Schedule,6876.92
Blue Shield,POS,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,Fee Schedule,6876.92
Blue Shield,POS,58578,CPT4/HCPCS,LAPARO PROC UTERUS,,Fee Schedule,7902.34
Blue Shield,POS,58579,CPT4/HCPCS,HYSTEROSCOPE PROCEDURE,,Fee Schedule,4891.93
Blue Shield,POS,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Fee Schedule,6876.92
Blue Shield,POS,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Fee Schedule,3198.57
Blue Shield,POS,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Fee Schedule,4891.93
Blue Shield,POS,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Fee Schedule,6876.92
Blue Shield,POS,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Fee Schedule,6876.92
Blue Shield,POS,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Fee Schedule,6876.92
Blue Shield,POS,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Fee Schedule,4891.93
Blue Shield,POS,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Fee Schedule,4891.93
Blue Shield,POS,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Fee Schedule,6876.92
Blue Shield,POS,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Fee Schedule,6876.92
Blue Shield,POS,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Fee Schedule,6049.05
Blue Shield,POS,58679,CPT4/HCPCS,LAPARO PROC OVIDUCT-OVARY,,Fee Schedule,7902.34
Blue Shield,POS,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Fee Schedule,3198.57
Blue Shield,POS,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Fee Schedule,3198.57
Blue Shield,POS,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Fee Schedule,3198.57
Blue Shield,POS,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Fee Schedule,3198.57
Blue Shield,POS,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Fee Schedule,3198.57
Blue Shield,POS,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Fee Schedule,3198.57
Blue Shield,POS,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Fee Schedule,3198.57
Blue Shield,POS,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Fee Schedule,4891.93
Blue Shield,POS,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Fee Schedule,3198.57
Blue Shield,POS,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Fee Schedule,4891.93
Blue Shield,POS,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Fee Schedule,3198.57
Blue Shield,POS,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Fee Schedule,3198.57
Blue Shield,POS,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Fee Schedule,4891.93
Blue Shield,POS,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Fee Schedule,6876.92
Blue Shield,POS,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Fee Schedule,6876.92
Blue Shield,POS,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Fee Schedule,3198.57
Blue Shield,POS,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,Fee Schedule,3198.57
Blue Shield,POS,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,3198.57
Blue Shield,POS,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,3198.57
Blue Shield,POS,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,4280.44
Blue Shield,POS,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,Fee Schedule,4891.93
Blue Shield,POS,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,Fee Schedule,4891.93
Blue Shield,POS,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,POS,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Fee Schedule,4891.93
Blue Shield,POS,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Fee Schedule,3198.57
Blue Shield,POS,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Fee Schedule,3198.57
Blue Shield,POS,58999,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Fee Schedule,3198.57
Blue Shield,POS,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Fee Schedule,3198.57
Blue Shield,POS,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,Fee Schedule,3198.57
Blue Shield,POS,59015,CPT4/HCPCS,CHORION BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,59020,CPT4/HCPCS,FETAL CONTRACT STRESS TEST,,Fee Schedule,987.79
Blue Shield,POS,59025,CPT4/HCPCS,FETAL NON-STRESS TEST,,Fee Schedule,987.79
Blue Shield,POS,59030,CPT4/HCPCS,FETAL SCALP BLOOD SAMPLE,,Fee Schedule,3198.57
Blue Shield,POS,59050,CPT4/HCPCS,FETAL MONITOR W/REPORT,,Fee Schedule,987.79
Blue Shield,POS,59051,CPT4/HCPCS,FETAL MONITOR/INTERPRET ONLY,,Fee Schedule,987.79
Blue Shield,POS,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Fee Schedule,3198.57
Blue Shield,POS,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Fee Schedule,3198.57
Blue Shield,POS,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Fee Schedule,3198.57
Blue Shield,POS,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Fee Schedule,3198.57
Blue Shield,POS,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,Fee Schedule,9548.66
Blue Shield,POS,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,POS,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,POS,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,POS,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,POS,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,POS,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,POS,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,POS,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,POS,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Fee Schedule,4891.93
Blue Shield,POS,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Fee Schedule,987.79
Blue Shield,POS,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Fee Schedule,4280.44
Blue Shield,POS,59320,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,3198.57
Blue Shield,POS,59325,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,POS,59350,CPT4/HCPCS,REPAIR OF UTERUS,,Fee Schedule,4280.44
Blue Shield,POS,59400,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,POS,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,POS,59410,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,POS,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,Fee Schedule,987.79
Blue Shield,POS,59414,CPT4/HCPCS,DELIVER PLACENTA,,Fee Schedule,4280.44
Blue Shield,POS,59425,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,Fee Schedule,987.79
Blue Shield,POS,59426,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,Fee Schedule,3198.57
Blue Shield,POS,59430,CPT4/HCPCS,CARE AFTER DELIVERY,,Fee Schedule,987.79
Blue Shield,POS,59510,CPT4/HCPCS,CESAREAN DELIVERY,,Fee Schedule,4891.93
Blue Shield,POS,59514,CPT4/HCPCS,CESAREAN DELIVERY ONLY,,Fee Schedule,4891.93
Blue Shield,POS,59515,CPT4/HCPCS,CESAREAN DELIVERY,,Fee Schedule,4891.93
Blue Shield,POS,59525,CPT4/HCPCS,REMOVE UTERUS AFTER CESAREAN,,Fee Schedule,3198.57
Blue Shield,POS,59610,CPT4/HCPCS,VBAC DELIVERY,,Fee Schedule,4280.44
Blue Shield,POS,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Fee Schedule,4280.44
Blue Shield,POS,59614,CPT4/HCPCS,VBAC CARE AFTER DELIVERY,,Fee Schedule,4280.44
Blue Shield,POS,59618,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY,,Fee Schedule,4891.93
Blue Shield,POS,59620,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY ONLY,,Fee Schedule,4891.93
Blue Shield,POS,59622,CPT4/HCPCS,ATTEMPTED VBAC AFTER CARE,,Fee Schedule,4891.93
Blue Shield,POS,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,POS,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,POS,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,POS,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Fee Schedule,4280.44
Blue Shield,POS,59840,CPT4/HCPCS,ABORTION,,Fee Schedule,6876.92
Blue Shield,POS,59841,CPT4/HCPCS,ABORTION,,Fee Schedule,6876.92
Blue Shield,POS,59850,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,POS,59851,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,POS,59852,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,POS,59855,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,POS,59856,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,POS,59857,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,POS,59866,CPT4/HCPCS,ABORTION (MPR),,Fee Schedule,3198.57
Blue Shield,POS,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Fee Schedule,6876.92
Blue Shield,POS,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Fee Schedule,6876.92
Blue Shield,POS,59897,CPT4/HCPCS,FETAL INVAS PX W/US,,Fee Schedule,3198.57
Blue Shield,POS,59898,CPT4/HCPCS,LAPARO PROC OB CARE/DELIVER,,Fee Schedule,7902.34
Blue Shield,POS,59899,CPT4/HCPCS,MATERNITY CARE PROCEDURE,,Fee Schedule,987.79
Blue Shield,POS,5A02110,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,POS,5A02116,ICD10-PCS,Assist with Cardiac Output using Other Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,POS,5A0211D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,POS,5A02210,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,POS,5A02216,ICD10-PCS,Assistance with Cardiac Output using Other Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,POS,5A0221D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,POS,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Fee Schedule,3198.57
Blue Shield,POS,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Fee Schedule,987.79
Blue Shield,POS,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Fee Schedule,4280.44
Blue Shield,POS,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Fee Schedule,9548.66
Blue Shield,POS,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Fee Schedule,9548.66
Blue Shield,POS,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,POS,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,POS,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,POS,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,POS,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Fee Schedule,9548.66
Blue Shield,POS,60270,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,3198.57
Blue Shield,POS,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,3198.57
Blue Shield,POS,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Fee Schedule,6049.05
Blue Shield,POS,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Fee Schedule,6049.05
Blue Shield,POS,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Fee Schedule,987.79
Blue Shield,POS,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Fee Schedule,9548.66
Blue Shield,POS,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Fee Schedule,3198.57
Blue Shield,POS,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Fee Schedule,3198.57
Blue Shield,POS,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Fee Schedule,4891.93
Blue Shield,POS,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,3198.57
Blue Shield,POS,60521,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,3198.57
Blue Shield,POS,60522,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,4280.44
Blue Shield,POS,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Fee Schedule,3198.57
Blue Shield,POS,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Fee Schedule,3198.57
Blue Shield,POS,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Fee Schedule,4280.44
Blue Shield,POS,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Fee Schedule,4891.93
Blue Shield,POS,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Fee Schedule,3198.57
Blue Shield,POS,60659,CPT4/HCPCS,LAPARO PROC ENDOCRINE,,Fee Schedule,7902.34
Blue Shield,POS,60699,CPT4/HCPCS,ENDOCRINE SURGERY PROCEDURE,,Fee Schedule,9548.66
Blue Shield,POS,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,POS,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,POS,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,POS,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Fee Schedule,3198.57
Blue Shield,POS,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Fee Schedule,3198.57
Blue Shield,POS,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Fee Schedule,3198.57
Blue Shield,POS,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,61105,CPT4/HCPCS,TWIST DRILL HOLE,,Fee Schedule,3198.57
Blue Shield,POS,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,Fee Schedule,3198.57
Blue Shield,POS,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,POS,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,Fee Schedule,3198.57
Blue Shield,POS,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,POS,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,POS,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,Fee Schedule,3198.57
Blue Shield,POS,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,POS,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,Fee Schedule,3198.57
Blue Shield,POS,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Fee Schedule,4891.93
Blue Shield,POS,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Fee Schedule,3198.57
Blue Shield,POS,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Fee Schedule,3198.57
Blue Shield,POS,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Fee Schedule,4280.44
Blue Shield,POS,61305,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Fee Schedule,4891.93
Blue Shield,POS,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,POS,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,POS,61314,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,POS,61315,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4891.93
Blue Shield,POS,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Fee Schedule,3198.57
Blue Shield,POS,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,POS,61321,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4891.93
Blue Shield,POS,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,Fee Schedule,4280.44
Blue Shield,POS,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,Fee Schedule,4280.44
Blue Shield,POS,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,Fee Schedule,9548.66
Blue Shield,POS,61332,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,6049.05
Blue Shield,POS,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,Fee Schedule,4891.93
Blue Shield,POS,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,POS,61343,CPT4/HCPCS,INCISE SKULL (PRESS RELIEF),,Fee Schedule,4891.93
Blue Shield,POS,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,Fee Schedule,4891.93
Blue Shield,POS,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Fee Schedule,4891.93
Blue Shield,POS,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,61480,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Fee Schedule,3198.57
Blue Shield,POS,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,Fee Schedule,3198.57
Blue Shield,POS,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4891.93
Blue Shield,POS,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Fee Schedule,6049.05
Blue Shield,POS,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Fee Schedule,4280.44
Blue Shield,POS,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,POS,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,6876.92
Blue Shield,POS,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Fee Schedule,6876.92
Blue Shield,POS,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,9548.66
Blue Shield,POS,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,7902.34
Blue Shield,POS,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Fee Schedule,4891.93
Blue Shield,POS,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4891.93
Blue Shield,POS,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,9548.66
Blue Shield,POS,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,7902.34
Blue Shield,POS,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,POS,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,POS,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,POS,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,POS,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,6049.05
Blue Shield,POS,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4280.44
Blue Shield,POS,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,POS,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,6049.05
Blue Shield,POS,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,POS,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,POS,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,POS,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,POS,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,Fee Schedule,7902.34
Blue Shield,POS,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Fee Schedule,6049.05
Blue Shield,POS,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Fee Schedule,4280.44
Blue Shield,POS,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Fee Schedule,3198.57
Blue Shield,POS,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Fee Schedule,3198.57
Blue Shield,POS,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,Fee Schedule,3198.57
Blue Shield,POS,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,Fee Schedule,4280.44
Blue Shield,POS,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Fee Schedule,4280.44
Blue Shield,POS,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Fee Schedule,6049.05
Blue Shield,POS,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Fee Schedule,4891.93
Blue Shield,POS,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Fee Schedule,6049.05
Blue Shield,POS,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,POS,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Fee Schedule,6049.05
Blue Shield,POS,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,Fee Schedule,4280.44
Blue Shield,POS,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Fee Schedule,4891.93
Blue Shield,POS,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Fee Schedule,7902.34
Blue Shield,POS,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6049.05
Blue Shield,POS,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6876.92
Blue Shield,POS,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,7902.34
Blue Shield,POS,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6876.92
Blue Shield,POS,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,POS,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,POS,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,Fee Schedule,6049.05
Blue Shield,POS,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,POS,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,POS,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,POS,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,Fee Schedule,6049.05
Blue Shield,POS,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,POS,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,POS,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,Fee Schedule,6049.05
Blue Shield,POS,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,4891.93
Blue Shield,POS,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6049.05
Blue Shield,POS,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6049.05
Blue Shield,POS,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6876.92
Blue Shield,POS,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6876.92
Blue Shield,POS,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,7902.34
Blue Shield,POS,61610,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,4280.44
Blue Shield,POS,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,3198.57
Blue Shield,POS,61612,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,4280.44
Blue Shield,POS,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,Fee Schedule,7902.34
Blue Shield,POS,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Fee Schedule,6049.05
Blue Shield,POS,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Fee Schedule,7902.34
Blue Shield,POS,61618,CPT4/HCPCS,REPAIR DURA,,Fee Schedule,3198.57
Blue Shield,POS,61619,CPT4/HCPCS,REPAIR DURA,,Fee Schedule,4280.44
Blue Shield,POS,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Fee Schedule,7902.34
Blue Shield,POS,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,Fee Schedule,3198.57
Blue Shield,POS,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Fee Schedule,9548.66
Blue Shield,POS,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,Fee Schedule,987.79
Blue Shield,POS,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,Fee Schedule,987.79
Blue Shield,POS,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,POS,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,6876.92
Blue Shield,POS,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,POS,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,POS,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Fee Schedule,7902.34
Blue Shield,POS,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Fee Schedule,7902.34
Blue Shield,POS,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,Fee Schedule,7902.34
Blue Shield,POS,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,Fee Schedule,7902.34
Blue Shield,POS,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,Fee Schedule,3198.57
Blue Shield,POS,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,6049.05
Blue Shield,POS,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,4891.93
Blue Shield,POS,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,4280.44
Blue Shield,POS,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,Fee Schedule,6049.05
Blue Shield,POS,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,Fee Schedule,3198.57
Blue Shield,POS,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,Fee Schedule,3198.57
Blue Shield,POS,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,4280.44
Blue Shield,POS,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,Fee Schedule,4280.44
Blue Shield,POS,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Fee Schedule,4891.93
Blue Shield,POS,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Fee Schedule,4891.93
Blue Shield,POS,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,Case Rate,4361.03
Blue Shield,POS,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,Case Rate,935.23
Blue Shield,POS,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,Case Rate,4361.03
Blue Shield,POS,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,Case Rate,1293.58
Blue Shield,POS,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Case Rate,764.05
Blue Shield,POS,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,POS,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,4280.44
Blue Shield,POS,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Fee Schedule,3198.57
Blue Shield,POS,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Fee Schedule,3198.57
Blue Shield,POS,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Fee Schedule,4280.44
Blue Shield,POS,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Fee Schedule,3198.57
Blue Shield,POS,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,POS,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Fee Schedule,4891.93
Blue Shield,POS,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Fee Schedule,4280.44
Blue Shield,POS,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Fee Schedule,4891.93
Blue Shield,POS,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Fee Schedule,3198.57
Blue Shield,POS,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,Fee Schedule,3198.57
Blue Shield,POS,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,Fee Schedule,3198.57
Blue Shield,POS,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,Fee Schedule,4280.44
Blue Shield,POS,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,POS,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Fee Schedule,4891.93
Blue Shield,POS,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,Fee Schedule,4280.44
Blue Shield,POS,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,Fee Schedule,4280.44
Blue Shield,POS,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,POS,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,POS,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,Fee Schedule,3198.57
Blue Shield,POS,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,Fee Schedule,3198.57
Blue Shield,POS,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,Fee Schedule,3198.57
Blue Shield,POS,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,POS,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,Fee Schedule,3198.57
Blue Shield,POS,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,Fee Schedule,3198.57
Blue Shield,POS,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,Fee Schedule,4280.44
Blue Shield,POS,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,Fee Schedule,3198.57
Blue Shield,POS,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,Fee Schedule,4280.44
Blue Shield,POS,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,Fee Schedule,3198.57
Blue Shield,POS,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,4280.44
Blue Shield,POS,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,POS,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,POS,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Fee Schedule,3198.57
Blue Shield,POS,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,POS,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,Fee Schedule,3198.57
Blue Shield,POS,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,POS,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,POS,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Fee Schedule,3198.57
Blue Shield,POS,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Fee Schedule,4280.44
Blue Shield,POS,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,Fee Schedule,3198.57
Blue Shield,POS,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,POS,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,POS,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Fee Schedule,3198.57
Blue Shield,POS,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Fee Schedule,3198.57
Blue Shield,POS,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Fee Schedule,3198.57
Blue Shield,POS,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Fee Schedule,3198.57
Blue Shield,POS,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Fee Schedule,3198.57
Blue Shield,POS,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Fee Schedule,3198.57
Blue Shield,POS,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Fee Schedule,3198.57
Blue Shield,POS,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Fee Schedule,3198.57
Blue Shield,POS,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Fee Schedule,3198.57
Blue Shield,POS,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Fee Schedule,3198.57
Blue Shield,POS,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Fee Schedule,3198.57
Blue Shield,POS,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Fee Schedule,12850.71
Blue Shield,POS,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Fee Schedule,3198.57
Blue Shield,POS,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Fee Schedule,4891.93
Blue Shield,POS,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,POS,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,POS,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,POS,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,POS,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,POS,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,POS,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,POS,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,POS,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,POS,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,POS,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,POS,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,POS,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Fee Schedule,4280.44
Blue Shield,POS,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Fee Schedule,9548.66
Blue Shield,POS,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Fee Schedule,4280.44
Blue Shield,POS,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Fee Schedule,4280.44
Blue Shield,POS,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,POS,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,POS,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Fee Schedule,4280.44
Blue Shield,POS,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Fee Schedule,3198.57
Blue Shield,POS,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Fee Schedule,3198.57
Blue Shield,POS,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,Fee Schedule,987.79
Blue Shield,POS,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Fee Schedule,987.79
Blue Shield,POS,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Fee Schedule,9548.66
Blue Shield,POS,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Fee Schedule,9548.66
Blue Shield,POS,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Fee Schedule,9548.66
Blue Shield,POS,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Fee Schedule,9548.66
Blue Shield,POS,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Fee Schedule,9548.66
Blue Shield,POS,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Fee Schedule,9548.66
Blue Shield,POS,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Fee Schedule,9548.66
Blue Shield,POS,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Fee Schedule,9548.66
Blue Shield,POS,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Fee Schedule,9548.66
Blue Shield,POS,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,9548.66
Blue Shield,POS,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Fee Schedule,9548.66
Blue Shield,POS,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Fee Schedule,9548.66
Blue Shield,POS,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Fee Schedule,9548.66
Blue Shield,POS,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Fee Schedule,9548.66
Blue Shield,POS,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Fee Schedule,3198.57
Blue Shield,POS,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Fee Schedule,3198.57
Blue Shield,POS,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Fee Schedule,9548.66
Blue Shield,POS,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Fee Schedule,9548.66
Blue Shield,POS,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Fee Schedule,9548.66
Blue Shield,POS,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Fee Schedule,9548.66
Blue Shield,POS,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Fee Schedule,9548.66
Blue Shield,POS,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Fee Schedule,9548.66
Blue Shield,POS,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Fee Schedule,9548.66
Blue Shield,POS,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Fee Schedule,9548.66
Blue Shield,POS,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Fee Schedule,9548.66
Blue Shield,POS,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Fee Schedule,4891.93
Blue Shield,POS,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Fee Schedule,3198.57
Blue Shield,POS,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,Fee Schedule,4891.93
Blue Shield,POS,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Fee Schedule,4891.93
Blue Shield,POS,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,Fee Schedule,6876.92
Blue Shield,POS,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Fee Schedule,4891.93
Blue Shield,POS,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Fee Schedule,4891.93
Blue Shield,POS,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Fee Schedule,4891.93
Blue Shield,POS,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,Fee Schedule,4280.44
Blue Shield,POS,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Fee Schedule,4280.44
Blue Shield,POS,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Fee Schedule,4891.93
Blue Shield,POS,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,POS,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,POS,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,Fee Schedule,3198.57
Blue Shield,POS,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,Fee Schedule,3198.57
Blue Shield,POS,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,Fee Schedule,3198.57
Blue Shield,POS,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,Fee Schedule,4280.44
Blue Shield,POS,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,Fee Schedule,4280.44
Blue Shield,POS,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,Fee Schedule,4280.44
Blue Shield,POS,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,Fee Schedule,4280.44
Blue Shield,POS,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,Fee Schedule,4280.44
Blue Shield,POS,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,Fee Schedule,4891.93
Blue Shield,POS,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,Fee Schedule,4280.44
Blue Shield,POS,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,Fee Schedule,6876.92
Blue Shield,POS,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,Fee Schedule,6876.92
Blue Shield,POS,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,Fee Schedule,6876.92
Blue Shield,POS,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Fee Schedule,4280.44
Blue Shield,POS,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Fee Schedule,4280.44
Blue Shield,POS,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Fee Schedule,3198.57
Blue Shield,POS,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Fee Schedule,3198.57
Blue Shield,POS,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,Fee Schedule,4891.93
Blue Shield,POS,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Fee Schedule,4891.93
Blue Shield,POS,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Fee Schedule,4891.93
Blue Shield,POS,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Fee Schedule,4280.44
Blue Shield,POS,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,Fee Schedule,4280.44
Blue Shield,POS,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,Fee Schedule,4280.44
Blue Shield,POS,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,Fee Schedule,4280.44
Blue Shield,POS,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,Fee Schedule,4280.44
Blue Shield,POS,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,Fee Schedule,4891.93
Blue Shield,POS,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,Fee Schedule,4891.93
Blue Shield,POS,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,Fee Schedule,4891.93
Blue Shield,POS,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,Fee Schedule,4280.44
Blue Shield,POS,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,Fee Schedule,6049.05
Blue Shield,POS,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,Fee Schedule,6049.05
Blue Shield,POS,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,Fee Schedule,6049.05
Blue Shield,POS,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,Fee Schedule,6876.92
Blue Shield,POS,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,Fee Schedule,4280.44
Blue Shield,POS,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,Fee Schedule,4891.93
Blue Shield,POS,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,Fee Schedule,4891.93
Blue Shield,POS,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,Fee Schedule,4891.93
Blue Shield,POS,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,Fee Schedule,4891.93
Blue Shield,POS,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,Fee Schedule,6049.05
Blue Shield,POS,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,Fee Schedule,6049.05
Blue Shield,POS,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,Fee Schedule,4891.93
Blue Shield,POS,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Fee Schedule,4280.44
Blue Shield,POS,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Fee Schedule,3198.57
Blue Shield,POS,63615,CPT4/HCPCS,REMOVE LESION OF SPINAL CORD,,Fee Schedule,4280.44
Blue Shield,POS,63620,CPT4/HCPCS,SRS SPINAL LESION,,Case Rate,4361.03
Blue Shield,POS,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,Case Rate,1075.84
Blue Shield,POS,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,4280.44
Blue Shield,POS,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,POS,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Fee Schedule,4280.44
Blue Shield,POS,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Fee Schedule,4280.44
Blue Shield,POS,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Fee Schedule,4280.44
Blue Shield,POS,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Fee Schedule,4280.44
Blue Shield,POS,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Fee Schedule,4280.44
Blue Shield,POS,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Fee Schedule,3198.57
Blue Shield,POS,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,3198.57
Blue Shield,POS,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,3198.57
Blue Shield,POS,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,4280.44
Blue Shield,POS,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,4280.44
Blue Shield,POS,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Fee Schedule,3198.57
Blue Shield,POS,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Fee Schedule,3198.57
Blue Shield,POS,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,Fee Schedule,3198.57
Blue Shield,POS,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Fee Schedule,3198.57
Blue Shield,POS,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Fee Schedule,12850.71
Blue Shield,POS,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Fee Schedule,4891.93
Blue Shield,POS,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Fee Schedule,4280.44
Blue Shield,POS,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Fee Schedule,3198.57
Blue Shield,POS,64402,CPT4/HCPCS,N BLOCK INJ FACIAL,,Fee Schedule,3198.57
Blue Shield,POS,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Fee Schedule,987.79
Blue Shield,POS,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Fee Schedule,3198.57
Blue Shield,POS,64410,CPT4/HCPCS,N BLOCK INJ PHRENIC,,Fee Schedule,3198.57
Blue Shield,POS,64413,CPT4/HCPCS,N BLOCK INJ CERVICAL PLEXUS,,Fee Schedule,3198.57
Blue Shield,POS,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Fee Schedule,3198.57
Blue Shield,POS,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Fee Schedule,3198.57
Blue Shield,POS,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Fee Schedule,3198.57
Blue Shield,POS,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Fee Schedule,3198.57
Blue Shield,POS,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Fee Schedule,3198.57
Blue Shield,POS,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Fee Schedule,3198.57
Blue Shield,POS,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Fee Schedule,3198.57
Blue Shield,POS,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Fee Schedule,3198.57
Blue Shield,POS,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Fee Schedule,987.79
Blue Shield,POS,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,Fee Schedule,3198.57
Blue Shield,POS,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,Fee Schedule,3198.57
Blue Shield,POS,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Fee Schedule,3198.57
Blue Shield,POS,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Fee Schedule,3198.57
Blue Shield,POS,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Fee Schedule,3198.57
Blue Shield,POS,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Fee Schedule,3198.57
Blue Shield,POS,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Fee Schedule,3198.57
Blue Shield,POS,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Fee Schedule,3198.57
Blue Shield,POS,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Fee Schedule,3198.57
Blue Shield,POS,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Fee Schedule,3198.57
Blue Shield,POS,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Fee Schedule,3198.57
Blue Shield,POS,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Fee Schedule,3198.57
Blue Shield,POS,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Fee Schedule,3198.57
Blue Shield,POS,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Fee Schedule,3198.57
Blue Shield,POS,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Fee Schedule,3198.57
Blue Shield,POS,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Fee Schedule,3198.57
Blue Shield,POS,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Fee Schedule,3198.57
Blue Shield,POS,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Fee Schedule,3198.57
Blue Shield,POS,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Fee Schedule,3198.57
Blue Shield,POS,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Fee Schedule,3198.57
Blue Shield,POS,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Fee Schedule,3198.57
Blue Shield,POS,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Fee Schedule,3198.57
Blue Shield,POS,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Fee Schedule,3198.57
Blue Shield,POS,64508,CPT4/HCPCS,N BLOCK CAROTID SINUS S/P,,Fee Schedule,3198.57
Blue Shield,POS,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Fee Schedule,3198.57
Blue Shield,POS,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Fee Schedule,3198.57
Blue Shield,POS,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Fee Schedule,3198.57
Blue Shield,POS,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Fee Schedule,3198.57
Blue Shield,POS,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,Fee Schedule,987.79
Blue Shield,POS,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,POS,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,POS,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,POS,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Fee Schedule,987.79
Blue Shield,POS,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Fee Schedule,4280.44
Blue Shield,POS,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Fee Schedule,4280.44
Blue Shield,POS,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Fee Schedule,4280.44
Blue Shield,POS,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,POS,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,POS,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,POS,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Fee Schedule,3198.57
Blue Shield,POS,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Fee Schedule,4280.44
Blue Shield,POS,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Fee Schedule,3198.57
Blue Shield,POS,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Fee Schedule,987.79
Blue Shield,POS,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Fee Schedule,3198.57
Blue Shield,POS,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Fee Schedule,3198.57
Blue Shield,POS,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Fee Schedule,987.79
Blue Shield,POS,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Fee Schedule,987.79
Blue Shield,POS,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Fee Schedule,3198.57
Blue Shield,POS,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Fee Schedule,4891.93
Blue Shield,POS,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Fee Schedule,4891.93
Blue Shield,POS,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Fee Schedule,3198.57
Blue Shield,POS,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Fee Schedule,3198.57
Blue Shield,POS,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Fee Schedule,3198.57
Blue Shield,POS,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Fee Schedule,3198.57
Blue Shield,POS,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Fee Schedule,987.79
Blue Shield,POS,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Fee Schedule,987.79
Blue Shield,POS,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Fee Schedule,4280.44
Blue Shield,POS,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Fee Schedule,4280.44
Blue Shield,POS,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Fee Schedule,4891.93
Blue Shield,POS,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Fee Schedule,4280.44
Blue Shield,POS,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Fee Schedule,4280.44
Blue Shield,POS,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Fee Schedule,3198.57
Blue Shield,POS,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Fee Schedule,3198.57
Blue Shield,POS,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Fee Schedule,4280.44
Blue Shield,POS,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,Fee Schedule,4280.44
Blue Shield,POS,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Fee Schedule,4280.44
Blue Shield,POS,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Fee Schedule,4891.93
Blue Shield,POS,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Fee Schedule,4280.44
Blue Shield,POS,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Fee Schedule,4891.93
Blue Shield,POS,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Fee Schedule,4280.44
Blue Shield,POS,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Fee Schedule,4891.93
Blue Shield,POS,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Fee Schedule,4891.93
Blue Shield,POS,64787,CPT4/HCPCS,IMPLANT NERVE END,,Fee Schedule,4280.44
Blue Shield,POS,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Fee Schedule,4891.93
Blue Shield,POS,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Fee Schedule,4891.93
Blue Shield,POS,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Fee Schedule,4891.93
Blue Shield,POS,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Fee Schedule,4280.44
Blue Shield,POS,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,POS,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,POS,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,POS,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,Fee Schedule,4280.44
Blue Shield,POS,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,6049.05
Blue Shield,POS,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,6049.05
Blue Shield,POS,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,Fee Schedule,6049.05
Blue Shield,POS,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Fee Schedule,6049.05
Blue Shield,POS,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4891.93
Blue Shield,POS,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4891.93
Blue Shield,POS,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64859,CPT4/HCPCS,NERVE SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Fee Schedule,4891.93
Blue Shield,POS,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Fee Schedule,4891.93
Blue Shield,POS,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Fee Schedule,4891.93
Blue Shield,POS,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Fee Schedule,6049.05
Blue Shield,POS,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Fee Schedule,3198.57
Blue Shield,POS,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Fee Schedule,4280.44
Blue Shield,POS,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Fee Schedule,4891.93
Blue Shield,POS,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Fee Schedule,4891.93
Blue Shield,POS,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Fee Schedule,4280.44
Blue Shield,POS,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Fee Schedule,4280.44
Blue Shield,POS,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Fee Schedule,4280.44
Blue Shield,POS,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Fee Schedule,4280.44
Blue Shield,POS,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Fee Schedule,4280.44
Blue Shield,POS,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Fee Schedule,4280.44
Blue Shield,POS,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Fee Schedule,4891.93
Blue Shield,POS,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Fee Schedule,4891.93
Blue Shield,POS,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Fee Schedule,4891.93
Blue Shield,POS,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Fee Schedule,4891.93
Blue Shield,POS,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,POS,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,POS,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Fee Schedule,4280.44
Blue Shield,POS,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Fee Schedule,3198.57
Blue Shield,POS,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Fee Schedule,6049.05
Blue Shield,POS,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,POS,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Fee Schedule,6049.05
Blue Shield,POS,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Fee Schedule,6049.05
Blue Shield,POS,64999,CPT4/HCPCS,NERVOUS SYSTEM SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,65091,CPT4/HCPCS,REVISE EYE,,Fee Schedule,4891.93
Blue Shield,POS,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Fee Schedule,4891.93
Blue Shield,POS,65101,CPT4/HCPCS,REMOVAL OF EYE,,Fee Schedule,4891.93
Blue Shield,POS,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Fee Schedule,4891.93
Blue Shield,POS,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Fee Schedule,6049.05
Blue Shield,POS,65110,CPT4/HCPCS,REMOVAL OF EYE,,Fee Schedule,6876.92
Blue Shield,POS,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Fee Schedule,9548.66
Blue Shield,POS,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Fee Schedule,9548.66
Blue Shield,POS,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,POS,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,POS,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,POS,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,POS,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,POS,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,POS,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Fee Schedule,3198.57
Blue Shield,POS,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,POS,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,POS,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,POS,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,POS,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,4280.44
Blue Shield,POS,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,4891.93
Blue Shield,POS,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,6049.05
Blue Shield,POS,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,4280.44
Blue Shield,POS,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,4280.44
Blue Shield,POS,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,3198.57
Blue Shield,POS,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,POS,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,POS,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,POS,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,3198.57
Blue Shield,POS,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Fee Schedule,4891.93
Blue Shield,POS,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,3198.57
Blue Shield,POS,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Fee Schedule,4280.44
Blue Shield,POS,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,4280.44
Blue Shield,POS,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,6876.92
Blue Shield,POS,65430,CPT4/HCPCS,CORNEAL SMEAR,,Fee Schedule,987.79
Blue Shield,POS,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Fee Schedule,3198.57
Blue Shield,POS,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Fee Schedule,3198.57
Blue Shield,POS,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Fee Schedule,3198.57
Blue Shield,POS,65600,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,4280.44
Blue Shield,POS,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,POS,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,POS,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,POS,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,POS,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Fee Schedule,7902.34
Blue Shield,POS,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,Fee Schedule,3198.57
Blue Shield,POS,65760,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,9548.66
Blue Shield,POS,65765,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,9548.66
Blue Shield,POS,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,POS,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Fee Schedule,9548.66
Blue Shield,POS,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Fee Schedule,9548.66
Blue Shield,POS,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Fee Schedule,6049.05
Blue Shield,POS,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Fee Schedule,6049.05
Blue Shield,POS,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Fee Schedule,987.79
Blue Shield,POS,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Fee Schedule,987.79
Blue Shield,POS,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,POS,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,POS,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,POS,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Fee Schedule,9548.66
Blue Shield,POS,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,3198.57
Blue Shield,POS,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,4891.93
Blue Shield,POS,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,4280.44
Blue Shield,POS,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Fee Schedule,3198.57
Blue Shield,POS,65850,CPT4/HCPCS,INCISION OF EYE,,Fee Schedule,6049.05
Blue Shield,POS,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Fee Schedule,3198.57
Blue Shield,POS,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,POS,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,POS,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,POS,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,POS,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,POS,65900,CPT4/HCPCS,REMOVE EYE LESION,,Fee Schedule,6876.92
Blue Shield,POS,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Fee Schedule,9548.66
Blue Shield,POS,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Fee Schedule,6876.92
Blue Shield,POS,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Fee Schedule,3198.57
Blue Shield,POS,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Fee Schedule,3198.57
Blue Shield,POS,66130,CPT4/HCPCS,REMOVE EYE LESION,,Fee Schedule,9548.66
Blue Shield,POS,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,66172,CPT4/HCPCS,INCISION OF EYE,,Fee Schedule,6049.05
Blue Shield,POS,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Fee Schedule,4280.44
Blue Shield,POS,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Fee Schedule,4280.44
Blue Shield,POS,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,POS,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Fee Schedule,6876.92
Blue Shield,POS,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Fee Schedule,4280.44
Blue Shield,POS,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Fee Schedule,4280.44
Blue Shield,POS,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Fee Schedule,4280.44
Blue Shield,POS,66220,CPT4/HCPCS,REPAIR EYE LESION,,Fee Schedule,4891.93
Blue Shield,POS,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Fee Schedule,6049.05
Blue Shield,POS,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Fee Schedule,4280.44
Blue Shield,POS,66500,CPT4/HCPCS,INCISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,POS,66505,CPT4/HCPCS,INCISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,POS,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Fee Schedule,4891.93
Blue Shield,POS,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,POS,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,POS,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,POS,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,POS,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Fee Schedule,4891.93
Blue Shield,POS,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,POS,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,POS,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Fee Schedule,4280.44
Blue Shield,POS,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Fee Schedule,4280.44
Blue Shield,POS,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,POS,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,POS,66761,CPT4/HCPCS,REVISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,POS,66762,CPT4/HCPCS,REVISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,POS,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Fee Schedule,3198.57
Blue Shield,POS,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Fee Schedule,3198.57
Blue Shield,POS,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Fee Schedule,4280.44
Blue Shield,POS,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Fee Schedule,6049.05
Blue Shield,POS,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Fee Schedule,6049.05
Blue Shield,POS,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,6049.05
Blue Shield,POS,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,9548.66
Blue Shield,POS,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,6049.05
Blue Shield,POS,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6049.05
Blue Shield,POS,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6876.92
Blue Shield,POS,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6876.92
Blue Shield,POS,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Fee Schedule,9304.07
Blue Shield,POS,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Fee Schedule,9304.07
Blue Shield,POS,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Fee Schedule,9304.07
Blue Shield,POS,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Fee Schedule,7902.34
Blue Shield,POS,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Fee Schedule,7902.34
Blue Shield,POS,66999,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Fee Schedule,6049.05
Blue Shield,POS,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Fee Schedule,6049.05
Blue Shield,POS,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Fee Schedule,3198.57
Blue Shield,POS,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Fee Schedule,3198.57
Blue Shield,POS,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Fee Schedule,6049.05
Blue Shield,POS,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Fee Schedule,3198.57
Blue Shield,POS,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Fee Schedule,3198.57
Blue Shield,POS,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Fee Schedule,4280.44
Blue Shield,POS,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Fee Schedule,6049.05
Blue Shield,POS,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Fee Schedule,9548.66
Blue Shield,POS,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Fee Schedule,9548.66
Blue Shield,POS,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Fee Schedule,4891.93
Blue Shield,POS,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Fee Schedule,4891.93
Blue Shield,POS,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Fee Schedule,4891.93
Blue Shield,POS,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Fee Schedule,3198.57
Blue Shield,POS,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Fee Schedule,3198.57
Blue Shield,POS,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,6876.92
Blue Shield,POS,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,9548.66
Blue Shield,POS,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,4891.93
Blue Shield,POS,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Fee Schedule,9548.66
Blue Shield,POS,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Fee Schedule,4280.44
Blue Shield,POS,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Fee Schedule,4280.44
Blue Shield,POS,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Fee Schedule,4280.44
Blue Shield,POS,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Fee Schedule,4280.44
Blue Shield,POS,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Fee Schedule,3198.57
Blue Shield,POS,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,3198.57
Blue Shield,POS,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,3198.57
Blue Shield,POS,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,6876.92
Blue Shield,POS,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Fee Schedule,3198.57
Blue Shield,POS,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Fee Schedule,3198.57
Blue Shield,POS,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Fee Schedule,3198.57
Blue Shield,POS,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Fee Schedule,3198.57
Blue Shield,POS,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Fee Schedule,3198.57
Blue Shield,POS,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Fee Schedule,7902.34
Blue Shield,POS,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Fee Schedule,4891.93
Blue Shield,POS,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Fee Schedule,4891.93
Blue Shield,POS,67299,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Fee Schedule,4891.93
Blue Shield,POS,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Fee Schedule,6049.05
Blue Shield,POS,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Fee Schedule,6049.05
Blue Shield,POS,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Fee Schedule,6049.05
Blue Shield,POS,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Fee Schedule,6049.05
Blue Shield,POS,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Fee Schedule,6049.05
Blue Shield,POS,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Fee Schedule,6049.05
Blue Shield,POS,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Fee Schedule,6049.05
Blue Shield,POS,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Fee Schedule,6049.05
Blue Shield,POS,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Fee Schedule,6049.05
Blue Shield,POS,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Fee Schedule,6049.05
Blue Shield,POS,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Fee Schedule,6049.05
Blue Shield,POS,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Fee Schedule,3198.57
Blue Shield,POS,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,Fee Schedule,3198.57
Blue Shield,POS,67399,CPT4/HCPCS,UNLISTED PX EXTRAOCULAR MUSC,,Fee Schedule,6049.05
Blue Shield,POS,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,4891.93
Blue Shield,POS,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Fee Schedule,6049.05
Blue Shield,POS,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,POS,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,POS,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Fee Schedule,7902.34
Blue Shield,POS,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Fee Schedule,3198.57
Blue Shield,POS,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,POS,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,POS,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,POS,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Fee Schedule,7902.34
Blue Shield,POS,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,POS,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,POS,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,POS,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,POS,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Fee Schedule,6049.05
Blue Shield,POS,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Fee Schedule,4280.44
Blue Shield,POS,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Fee Schedule,7902.34
Blue Shield,POS,67599,CPT4/HCPCS,ORBIT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Fee Schedule,987.79
Blue Shield,POS,67710,CPT4/HCPCS,INCISION OF EYELID,,Fee Schedule,3198.57
Blue Shield,POS,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Fee Schedule,3198.57
Blue Shield,POS,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Fee Schedule,987.79
Blue Shield,POS,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Fee Schedule,3198.57
Blue Shield,POS,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Fee Schedule,987.79
Blue Shield,POS,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Fee Schedule,4280.44
Blue Shield,POS,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Fee Schedule,987.79
Blue Shield,POS,67820,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,3198.57
Blue Shield,POS,67825,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,3198.57
Blue Shield,POS,67830,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,4280.44
Blue Shield,POS,67835,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,4280.44
Blue Shield,POS,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Fee Schedule,3198.57
Blue Shield,POS,67850,CPT4/HCPCS,TREAT EYELID LESION,,Fee Schedule,3198.57
Blue Shield,POS,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Fee Schedule,3198.57
Blue Shield,POS,67880,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,POS,67882,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,POS,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Fee Schedule,6049.05
Blue Shield,POS,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,POS,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,POS,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,POS,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,POS,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,POS,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,POS,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,POS,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,POS,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Fee Schedule,3198.57
Blue Shield,POS,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,POS,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,3198.57
Blue Shield,POS,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,POS,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,POS,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,POS,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4280.44
Blue Shield,POS,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,POS,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,POS,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Fee Schedule,4280.44
Blue Shield,POS,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Fee Schedule,4280.44
Blue Shield,POS,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,POS,67950,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4280.44
Blue Shield,POS,67961,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,POS,67966,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,POS,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,POS,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,POS,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,POS,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,POS,67999,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4280.44
Blue Shield,POS,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Fee Schedule,4280.44
Blue Shield,POS,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,Fee Schedule,987.79
Blue Shield,POS,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Fee Schedule,3198.57
Blue Shield,POS,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,3198.57
Blue Shield,POS,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,4280.44
Blue Shield,POS,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,4280.44
Blue Shield,POS,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,3198.57
Blue Shield,POS,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,Fee Schedule,987.79
Blue Shield,POS,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,POS,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,POS,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,POS,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,POS,68330,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,6049.05
Blue Shield,POS,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,POS,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Fee Schedule,6049.05
Blue Shield,POS,68360,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,4280.44
Blue Shield,POS,68362,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,4280.44
Blue Shield,POS,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Fee Schedule,3198.57
Blue Shield,POS,68399,CPT4/HCPCS,EYELID LINING SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Fee Schedule,987.79
Blue Shield,POS,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Fee Schedule,4280.44
Blue Shield,POS,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,POS,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Fee Schedule,4891.93
Blue Shield,POS,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Fee Schedule,4891.93
Blue Shield,POS,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Fee Schedule,3198.57
Blue Shield,POS,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Fee Schedule,4891.93
Blue Shield,POS,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Fee Schedule,3198.57
Blue Shield,POS,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Fee Schedule,4280.44
Blue Shield,POS,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Fee Schedule,4891.93
Blue Shield,POS,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Fee Schedule,4891.93
Blue Shield,POS,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Fee Schedule,4280.44
Blue Shield,POS,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,POS,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Fee Schedule,6049.05
Blue Shield,POS,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Fee Schedule,6049.05
Blue Shield,POS,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Fee Schedule,6049.05
Blue Shield,POS,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,POS,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Fee Schedule,987.79
Blue Shield,POS,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Fee Schedule,6049.05
Blue Shield,POS,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,POS,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,3198.57
Blue Shield,POS,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,4280.44
Blue Shield,POS,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,4280.44
Blue Shield,POS,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Fee Schedule,3198.57
Blue Shield,POS,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Fee Schedule,3198.57
Blue Shield,POS,68899,CPT4/HCPCS,TEAR DUCT SYSTEM SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Fee Schedule,987.79
Blue Shield,POS,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Fee Schedule,3198.57
Blue Shield,POS,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Fee Schedule,987.79
Blue Shield,POS,69090,CPT4/HCPCS,PIERCE EARLOBES,,Fee Schedule,987.79
Blue Shield,POS,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,Fee Schedule,3198.57
Blue Shield,POS,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,Fee Schedule,4280.44
Blue Shield,POS,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Fee Schedule,3198.57
Blue Shield,POS,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Fee Schedule,4280.44
Blue Shield,POS,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,POS,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,POS,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,POS,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Fee Schedule,987.79
Blue Shield,POS,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Fee Schedule,3198.57
Blue Shield,POS,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Fee Schedule,987.79
Blue Shield,POS,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Fee Schedule,987.79
Blue Shield,POS,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Fee Schedule,987.79
Blue Shield,POS,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Fee Schedule,4280.44
Blue Shield,POS,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Fee Schedule,4891.93
Blue Shield,POS,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Fee Schedule,4891.93
Blue Shield,POS,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Fee Schedule,9548.66
Blue Shield,POS,69399,CPT4/HCPCS,OUTER EAR SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,POS,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Fee Schedule,3198.57
Blue Shield,POS,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Fee Schedule,4891.93
Blue Shield,POS,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Fee Schedule,3198.57
Blue Shield,POS,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Fee Schedule,3198.57
Blue Shield,POS,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Fee Schedule,4891.93
Blue Shield,POS,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Fee Schedule,4891.93
Blue Shield,POS,69450,CPT4/HCPCS,EARDRUM REVISION,,Fee Schedule,3198.57
Blue Shield,POS,69501,CPT4/HCPCS,MASTOIDECTOMY,,Fee Schedule,9548.66
Blue Shield,POS,69502,CPT4/HCPCS,MASTOIDECTOMY,,Fee Schedule,9548.66
Blue Shield,POS,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Fee Schedule,9548.66
Blue Shield,POS,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Fee Schedule,9548.66
Blue Shield,POS,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Fee Schedule,9548.66
Blue Shield,POS,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,Fee Schedule,7902.34
Blue Shield,POS,69540,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,4280.44
Blue Shield,POS,69550,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,6876.92
Blue Shield,POS,69552,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,9548.66
Blue Shield,POS,69554,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,6876.92
Blue Shield,POS,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,POS,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,POS,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,POS,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,POS,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,POS,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Fee Schedule,6049.05
Blue Shield,POS,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Fee Schedule,4280.44
Blue Shield,POS,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,POS,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,POS,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,POS,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,POS,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,POS,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,POS,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,POS,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,POS,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,POS,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,POS,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,POS,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,POS,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Fee Schedule,9548.66
Blue Shield,POS,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,POS,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,POS,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,POS,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Fee Schedule,6049.05
Blue Shield,POS,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Fee Schedule,6049.05
Blue Shield,POS,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Fee Schedule,4891.93
Blue Shield,POS,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Fee Schedule,4891.93
Blue Shield,POS,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Fee Schedule,4891.93
Blue Shield,POS,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Fee Schedule,6049.05
Blue Shield,POS,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Fee Schedule,3198.57
Blue Shield,POS,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Fee Schedule,12850.71
Blue Shield,POS,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Fee Schedule,12850.71
Blue Shield,POS,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Fee Schedule,12850.71
Blue Shield,POS,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Fee Schedule,12850.71
Blue Shield,POS,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,POS,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,POS,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,POS,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,POS,69799,CPT4/HCPCS,MIDDLE EAR SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,POS,69801,CPT4/HCPCS,INCISE INNER EAR,,Fee Schedule,6876.92
Blue Shield,POS,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Fee Schedule,9548.66
Blue Shield,POS,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Fee Schedule,9548.66
Blue Shield,POS,69905,CPT4/HCPCS,REMOVE INNER EAR,,Fee Schedule,9548.66
Blue Shield,POS,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,POS,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Fee Schedule,9548.66
Blue Shield,POS,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Fee Schedule,9548.66
Blue Shield,POS,69949,CPT4/HCPCS,INNER EAR SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,POS,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,Fee Schedule,9548.66
Blue Shield,POS,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,9548.66
Blue Shield,POS,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,Fee Schedule,9548.66
Blue Shield,POS,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Fee Schedule,9548.66
Blue Shield,POS,69979,CPT4/HCPCS,TEMPORAL BONE SURGERY,,Fee Schedule,3198.57
Blue Shield,POS,70010,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Case Rate,2177.00
Blue Shield,POS,70015,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Case Rate,686.66
Blue Shield,POS,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,Case Rate,205.35
Blue Shield,POS,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,Case Rate,258.27
Blue Shield,POS,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,Case Rate,314.46
Blue Shield,POS,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Case Rate,314.46
Blue Shield,POS,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Case Rate,400.29
Blue Shield,POS,70134,CPT4/HCPCS,X-RAY EXAM OF MIDDLE EAR,,Case Rate,376.23
Blue Shield,POS,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Case Rate,314.46
Blue Shield,POS,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Case Rate,400.29
Blue Shield,POS,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,Case Rate,258.27
Blue Shield,POS,70170,CPT4/HCPCS,X-RAY EXAM OF TEAR DUCT,,Case Rate,481.31
Blue Shield,POS,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Case Rate,314.46
Blue Shield,POS,70200,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Case Rate,400.29
Blue Shield,POS,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Case Rate,314.46
Blue Shield,POS,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Case Rate,400.29
Blue Shield,POS,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,Case Rate,205.35
Blue Shield,POS,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Case Rate,314.46
Blue Shield,POS,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Case Rate,452.44
Blue Shield,POS,70300,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Case Rate,137.98
Blue Shield,POS,70310,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Case Rate,205.35
Blue Shield,POS,70320,CPT4/HCPCS,FULL MOUTH X-RAY OF TEETH,,Case Rate,400.29
Blue Shield,POS,70328,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Case Rate,243.84
Blue Shield,POS,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,Case Rate,429.16
Blue Shield,POS,70332,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Case Rate,1058.85
Blue Shield,POS,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,Case Rate,5646.30
Blue Shield,POS,70350,CPT4/HCPCS,X-RAY HEAD FOR ORTHODONTIA,,Case Rate,186.10
Blue Shield,POS,70355,CPT4/HCPCS,PANORAMIC X-RAY OF JAWS,,Case Rate,290.40
Blue Shield,POS,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,Case Rate,205.35
Blue Shield,POS,70370,CPT4/HCPCS,THROAT X-RAY & FLUOROSCOPY,,Case Rate,658.56
Blue Shield,POS,70371,CPT4/HCPCS,SPEECH EVALUATION COMPLEX,,Case Rate,1058.85
Blue Shield,POS,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,Case Rate,338.52
Blue Shield,POS,70390,CPT4/HCPCS,X-RAY EXAM OF SALIVARY DUCT,,Case Rate,905.66
Blue Shield,POS,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,Case Rate,2381.57
Blue Shield,POS,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,Case Rate,2849.22
Blue Shield,POS,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,Case Rate,3565.53
Blue Shield,POS,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,Case Rate,2381.57
Blue Shield,POS,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,Case Rate,2849.22
Blue Shield,POS,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,Case Rate,3565.53
Blue Shield,POS,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,Case Rate,2381.57
Blue Shield,POS,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,Case Rate,2849.22
Blue Shield,POS,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,Case Rate,3565.53
Blue Shield,POS,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,Case Rate,2381.57
Blue Shield,POS,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,Case Rate,2849.22
Blue Shield,POS,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,Case Rate,3565.53
Blue Shield,POS,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,Case Rate,5358.37
Blue Shield,POS,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,Case Rate,5358.37
Blue Shield,POS,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,Case Rate,5565.61
Blue Shield,POS,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,Case Rate,6680.50
Blue Shield,POS,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,Case Rate,12358.33
Blue Shield,POS,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,Case Rate,5646.30
Blue Shield,POS,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,Case Rate,5646.30
Blue Shield,POS,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,Case Rate,11059.38
Blue Shield,POS,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,Case Rate,5646.30
Blue Shield,POS,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,Case Rate,5646.30
Blue Shield,POS,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,Case Rate,11059.38
Blue Shield,POS,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,Case Rate,5646.30
Blue Shield,POS,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,Case Rate,6773.29
Blue Shield,POS,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,Case Rate,12547.94
Blue Shield,POS,70554,CPT4/HCPCS,FMRI BRAIN BY TECH,,Case Rate,6533.00
Blue Shield,POS,70557,CPT4/HCPCS,MRI BRAIN W/O DYE,,Case Rate,7560.21
Blue Shield,POS,70558,CPT4/HCPCS,MRI BRAIN W/DYE,,Case Rate,8361.57
Blue Shield,POS,70559,CPT4/HCPCS,MRI BRAIN W/O & W/DYE,,Case Rate,8400.06
Blue Shield,POS,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,Case Rate,143.57
Blue Shield,POS,71046,CPT4/HCPCS,X-RAY EXAM CHEST 2 VIEWS,,Case Rate,263.86
Blue Shield,POS,71047,CPT4/HCPCS,X-RAY EXAM CHEST 3 VIEWS,,Case Rate,336.04
Blue Shield,POS,71048,CPT4/HCPCS,X-RAY EXAM CHEST 4+ VIEWS,,Case Rate,345.66
Blue Shield,POS,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,Case Rate,290.40
Blue Shield,POS,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,Case Rate,338.52
Blue Shield,POS,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,Case Rate,400.29
Blue Shield,POS,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,Case Rate,452.44
Blue Shield,POS,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,Case Rate,328.89
Blue Shield,POS,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,Case Rate,357.76
Blue Shield,POS,71250,CPT4/HCPCS,CT THORAX DX C-,,Case Rate,2978.36
Blue Shield,POS,71260,CPT4/HCPCS,CT THORAX DX C+,,Case Rate,3565.53
Blue Shield,POS,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,Case Rate,4458.30
Blue Shield,POS,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,Case Rate,6133.38
Blue Shield,POS,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,Case Rate,5589.81
Blue Shield,POS,71551,CPT4/HCPCS,MRI CHEST W/DYE,,Case Rate,6700.67
Blue Shield,POS,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,Case Rate,12293.78
Blue Shield,POS,71555,CPT4/HCPCS,MRI ANGIO CHEST W OR W/O DYE,,Case Rate,5646.30
Blue Shield,POS,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,Case Rate,205.35
Blue Shield,POS,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,Case Rate,304.83
Blue Shield,POS,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,Case Rate,452.44
Blue Shield,POS,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,Case Rate,567.92
Blue Shield,POS,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,Case Rate,328.89
Blue Shield,POS,72072,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 3VWS,,Case Rate,376.23
Blue Shield,POS,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,Case Rate,462.06
Blue Shield,POS,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,Case Rate,338.52
Blue Shield,POS,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,Case Rate,340.85
Blue Shield,POS,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,Case Rate,619.92
Blue Shield,POS,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,Case Rate,672.85
Blue Shield,POS,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,Case Rate,807.58
Blue Shield,POS,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,Case Rate,338.52
Blue Shield,POS,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,Case Rate,462.06
Blue Shield,POS,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,Case Rate,596.79
Blue Shield,POS,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,Case Rate,452.44
Blue Shield,POS,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,POS,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,Case Rate,3565.53
Blue Shield,POS,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,POS,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,POS,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,Case Rate,3565.53
Blue Shield,POS,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,POS,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,POS,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,Case Rate,3565.53
Blue Shield,POS,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,POS,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,Case Rate,5646.30
Blue Shield,POS,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,Case Rate,6773.29
Blue Shield,POS,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,Case Rate,6263.11
Blue Shield,POS,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,Case Rate,6773.29
Blue Shield,POS,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,Case Rate,6263.11
Blue Shield,POS,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,Case Rate,6773.29
Blue Shield,POS,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,POS,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,POS,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,POS,72159,CPT4/HCPCS,MR ANGIO SPINE W/O&W/DYE,,Case Rate,6142.82
Blue Shield,POS,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Case Rate,258.27
Blue Shield,POS,72190,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Case Rate,338.52
Blue Shield,POS,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,Case Rate,5964.97
Blue Shield,POS,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,Case Rate,2978.36
Blue Shield,POS,72193,CPT4/HCPCS,CT PELVIS W/DYE,,Case Rate,3450.82
Blue Shield,POS,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,Case Rate,4272.98
Blue Shield,POS,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,Case Rate,5589.81
Blue Shield,POS,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,Case Rate,6700.67
Blue Shield,POS,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,Case Rate,12390.60
Blue Shield,POS,72198,CPT4/HCPCS,MR ANGIO PELVIS W/O & W/DYE,,Case Rate,5646.30
Blue Shield,POS,72200,CPT4/HCPCS,X-RAY EXAM SI JOINTS,,Case Rate,258.27
Blue Shield,POS,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,Case Rate,314.46
Blue Shield,POS,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,Case Rate,290.40
Blue Shield,POS,72240,CPT4/HCPCS,MYELOGRAPHY NECK SPINE,,Case Rate,2396.00
Blue Shield,POS,72255,CPT4/HCPCS,MYELOGRAPHY THORACIC SPINE,,Case Rate,2177.00
Blue Shield,POS,72265,CPT4/HCPCS,MYELOGRAPHY L-S SPINE,,Case Rate,2056.71
Blue Shield,POS,72270,CPT4/HCPCS,MYELOGPHY 2/> SPINE REGIONS,,Case Rate,3077.85
Blue Shield,POS,72275,CPT4/HCPCS,EPIDUROGRAPHY,,Case Rate,1099.20
Blue Shield,POS,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,Case Rate,4220.06
Blue Shield,POS,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,Case Rate,3952.94
Blue Shield,POS,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,Case Rate,258.27
Blue Shield,POS,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,Case Rate,258.27
Blue Shield,POS,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Case Rate,234.22
Blue Shield,POS,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Case Rate,290.40
Blue Shield,POS,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,Case Rate,1058.85
Blue Shield,POS,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,Case Rate,338.52
Blue Shield,POS,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,Case Rate,290.40
Blue Shield,POS,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Case Rate,258.27
Blue Shield,POS,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Case Rate,290.40
Blue Shield,POS,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,Case Rate,1058.85
Blue Shield,POS,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,Case Rate,258.27
Blue Shield,POS,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,Case Rate,243.84
Blue Shield,POS,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Case Rate,243.84
Blue Shield,POS,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Case Rate,263.08
Blue Shield,POS,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,Case Rate,800.58
Blue Shield,POS,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,Case Rate,243.84
Blue Shield,POS,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,Case Rate,263.08
Blue Shield,POS,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,Case Rate,205.35
Blue Shield,POS,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,Case Rate,2492.24
Blue Shield,POS,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,Case Rate,2978.36
Blue Shield,POS,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,Case Rate,3742.00
Blue Shield,POS,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,Case Rate,5450.13
Blue Shield,POS,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,Case Rate,5565.61
Blue Shield,POS,73219,CPT4/HCPCS,MRI UPPER EXTREMITY W/DYE,,Case Rate,6680.50
Blue Shield,POS,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,Case Rate,12358.33
Blue Shield,POS,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,Case Rate,5565.61
Blue Shield,POS,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,Case Rate,6680.50
Blue Shield,POS,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,Case Rate,12358.33
Blue Shield,POS,73225,CPT4/HCPCS,MR ANGIO UPR EXTR W/O&W/DYE,,Case Rate,5535.63
Blue Shield,POS,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,Case Rate,273.49
Blue Shield,POS,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,Case Rate,403.40
Blue Shield,POS,73503,CPT4/HCPCS,X-RAY EXAM HIP UNI 4/> VIEWS,,Case Rate,499.63
Blue Shield,POS,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,Case Rate,379.34
Blue Shield,POS,73522,CPT4/HCPCS,X-RAY EXAM HIPS BI 3-4 VIEWS,,Case Rate,451.52
Blue Shield,POS,73523,CPT4/HCPCS,X-RAY EXAM HIPS BI 5/> VIEWS,,Case Rate,542.94
Blue Shield,POS,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,Case Rate,1058.85
Blue Shield,POS,73551,CPT4/HCPCS,X-RAY EXAM OF FEMUR 1,,Case Rate,259.05
Blue Shield,POS,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,Case Rate,307.17
Blue Shield,POS,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,Case Rate,258.27
Blue Shield,POS,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,Case Rate,290.40
Blue Shield,POS,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,Case Rate,314.46
Blue Shield,POS,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,Case Rate,243.84
Blue Shield,POS,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,Case Rate,1317.13
Blue Shield,POS,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,Case Rate,258.27
Blue Shield,POS,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,Case Rate,243.84
Blue Shield,POS,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Case Rate,243.84
Blue Shield,POS,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Case Rate,263.08
Blue Shield,POS,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,Case Rate,1058.85
Blue Shield,POS,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Case Rate,243.84
Blue Shield,POS,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Case Rate,263.08
Blue Shield,POS,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,Case Rate,234.22
Blue Shield,POS,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,Case Rate,205.35
Blue Shield,POS,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,Case Rate,2492.24
Blue Shield,POS,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,Case Rate,2978.36
Blue Shield,POS,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,Case Rate,3742.00
Blue Shield,POS,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,Case Rate,5450.13
Blue Shield,POS,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,Case Rate,5565.61
Blue Shield,POS,73719,CPT4/HCPCS,MRI LOWER EXTREMITY W/DYE,,Case Rate,6680.50
Blue Shield,POS,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,Case Rate,12358.33
Blue Shield,POS,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,Case Rate,5565.61
Blue Shield,POS,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,Case Rate,6680.50
Blue Shield,POS,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,Case Rate,12358.33
Blue Shield,POS,73725,CPT4/HCPCS,MR ANG LWR EXT W OR W/O DYE,,Case Rate,5646.30
Blue Shield,POS,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,Case Rate,244.62
Blue Shield,POS,74019,CPT4/HCPCS,X-RAY EXAM ABDOMEN 2 VIEWS,,Case Rate,292.73
Blue Shield,POS,74021,CPT4/HCPCS,X-RAY EXAM ABDOMEN 3+ VIEWS,,Case Rate,340.85
Blue Shield,POS,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,Case Rate,376.23
Blue Shield,POS,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,Case Rate,2849.22
Blue Shield,POS,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,Case Rate,3450.82
Blue Shield,POS,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,Case Rate,4272.98
Blue Shield,POS,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,Case Rate,6451.62
Blue Shield,POS,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,Case Rate,5964.97
Blue Shield,POS,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,Case Rate,1866.13
Blue Shield,POS,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,Case Rate,3559.83
Blue Shield,POS,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,Case Rate,4704.99
Blue Shield,POS,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,Case Rate,5589.81
Blue Shield,POS,74182,CPT4/HCPCS,MRI ABDOMEN W/DYE,,Case Rate,6700.67
Blue Shield,POS,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,Case Rate,12390.60
Blue Shield,POS,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,Case Rate,5646.30
Blue Shield,POS,74190,CPT4/HCPCS,X-RAY EXAM OF PERITONEUM,,Case Rate,658.56
Blue Shield,POS,74210,CPT4/HCPCS,X-RAY XM PHRNX&/CRV ESOPH C+,,Case Rate,596.79
Blue Shield,POS,74220,CPT4/HCPCS,X-RAY XM ESOPHAGUS 1CNTRST,,Case Rate,596.79
Blue Shield,POS,74230,CPT4/HCPCS,X-RAY XM SWLNG FUNCJ C+,,Case Rate,658.56
Blue Shield,POS,74235,CPT4/HCPCS,REMOVE ESOPHAGUS OBSTRUCTION,,Case Rate,1317.13
Blue Shield,POS,74240,CPT4/HCPCS,X-RAY XM UPR GI TRC 1CNTRST,,Case Rate,734.77
Blue Shield,POS,74241,CPT4/HCPCS,X-RAY UPPER GI DELAY W/KUB,,Case Rate,749.21
Blue Shield,POS,74245,CPT4/HCPCS,X-RAY UPPER GI&SMALL INTEST,,Case Rate,1202.43
Blue Shield,POS,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,Case Rate,834.26
Blue Shield,POS,74247,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,Case Rate,857.54
Blue Shield,POS,74249,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,Case Rate,1302.69
Blue Shield,POS,74250,CPT4/HCPCS,X-RAY XM SM INT 1CNTRST STD,,Case Rate,658.56
Blue Shield,POS,74251,CPT4/HCPCS,X-RAY XM SM INT 2CNTRST STD,,Case Rate,658.56
Blue Shield,POS,74260,CPT4/HCPCS,X-RAY EXAM OF SMALL BOWEL,,Case Rate,749.21
Blue Shield,POS,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,Case Rate,6620.02
Blue Shield,POS,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,Case Rate,7442.81
Blue Shield,POS,74263,CPT4/HCPCS,CT COLONOGRAPHY SCREENING,,Case Rate,7866.23
Blue Shield,POS,74270,CPT4/HCPCS,X-RAY XM COLON 1CNTRST STD,,Case Rate,867.17
Blue Shield,POS,74280,CPT4/HCPCS,X-RAY XM COLON 2CNTRST STD,,Case Rate,1130.25
Blue Shield,POS,74283,CPT4/HCPCS,THER NMA RDCTJ INTUS/OBSTRCJ,,Case Rate,1297.88
Blue Shield,POS,74290,CPT4/HCPCS,CONTRAST X-RAY GALLBLADDER,,Case Rate,376.23
Blue Shield,POS,74300,CPT4/HCPCS,X-RAY BILE DUCTS/PANCREAS,,Case Rate,443.59
Blue Shield,POS,74301,CPT4/HCPCS,X-RAYS AT SURGERY ADD-ON,,Case Rate,257.50
Blue Shield,POS,74328,CPT4/HCPCS,X-RAY BILE DUCT ENDOSCOPY,,Case Rate,1593.87
Blue Shield,POS,74329,CPT4/HCPCS,X-RAY FOR PANCREAS ENDOSCOPY,,Case Rate,1593.87
Blue Shield,POS,74330,CPT4/HCPCS,X-RAY BILE/PANC ENDOSCOPY,,Case Rate,1593.87
Blue Shield,POS,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,Case Rate,1317.13
Blue Shield,POS,74355,CPT4/HCPCS,X-RAY GUIDE INTESTINAL TUBE,,Case Rate,1317.13
Blue Shield,POS,74360,CPT4/HCPCS,X-RAY GUIDE GI DILATION,,Case Rate,1593.87
Blue Shield,POS,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,Case Rate,3077.85
Blue Shield,POS,74400,CPT4/HCPCS,UROGRAPHY IV +-KUB TOMOG,,Case Rate,857.54
Blue Shield,POS,74410,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BOLUS,,Case Rate,987.46
Blue Shield,POS,74415,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BLS W/NF,,Case Rate,1068.48
Blue Shield,POS,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,Case Rate,1317.13
Blue Shield,POS,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,Case Rate,658.56
Blue Shield,POS,74430,CPT4/HCPCS,CONTRAST X-RAY BLADDER,,Case Rate,534.24
Blue Shield,POS,74440,CPT4/HCPCS,X-RAY MALE GENITAL TRACT,,Case Rate,567.92
Blue Shield,POS,74445,CPT4/HCPCS,X-RAY EXAM OF PENIS,,Case Rate,567.92
Blue Shield,POS,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Case Rate,734.77
Blue Shield,POS,74455,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Case Rate,800.58
Blue Shield,POS,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,Case Rate,629.69
Blue Shield,POS,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,Case Rate,1593.87
Blue Shield,POS,74710,CPT4/HCPCS,X-RAY MEASUREMENT OF PELVIS,,Case Rate,534.24
Blue Shield,POS,74712,CPT4/HCPCS,MRI FETAL SNGL/1ST GESTATION,,Case Rate,4444.39
Blue Shield,POS,74713,CPT4/HCPCS,MRI FETAL EA ADDL GESTATION,,Case Rate,1904.63
Blue Shield,POS,74740,CPT4/HCPCS,X-RAY FEMALE GENITAL TRACT,,Case Rate,658.56
Blue Shield,POS,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,Case Rate,1593.87
Blue Shield,POS,74775,CPT4/HCPCS,X-RAY EXAM OF PERINEUM,,Case Rate,734.77
Blue Shield,POS,75557,CPT4/HCPCS,CARDIAC MRI FOR MORPH,,Case Rate,5321.40
Blue Shield,POS,75559,CPT4/HCPCS,CARDIAC MRI W/STRESS IMG,,Case Rate,8044.78
Blue Shield,POS,75561,CPT4/HCPCS,CARDIAC MRI FOR MORPH W/DYE,,Case Rate,7575.87
Blue Shield,POS,75563,CPT4/HCPCS,CARD MRI W/STRESS IMG & DYE,,Case Rate,9456.44
Blue Shield,POS,75565,CPT4/HCPCS,CARD MRI VELOC FLOW MAPPING,,Case Rate,1052.97
Blue Shield,POS,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,Case Rate,1231.00
Blue Shield,POS,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,Case Rate,692.10
Blue Shield,POS,75573,CPT4/HCPCS,CT HRT W/3D IMAGE CONGEN,,Case Rate,826.82
Blue Shield,POS,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,Case Rate,6186.98
Blue Shield,POS,75600,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Case Rate,6344.13
Blue Shield,POS,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Case Rate,6344.13
Blue Shield,POS,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,Case Rate,6344.13
Blue Shield,POS,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,Case Rate,6615.28
Blue Shield,POS,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,Case Rate,7841.51
Blue Shield,POS,75705,CPT4/HCPCS,ARTERY X-RAYS SPINE,,Case Rate,6344.13
Blue Shield,POS,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,Case Rate,6344.13
Blue Shield,POS,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,Case Rate,6344.13
Blue Shield,POS,75726,CPT4/HCPCS,ARTERY X-RAYS ABDOMEN,,Case Rate,6344.13
Blue Shield,POS,75731,CPT4/HCPCS,ARTERY X-RAYS ADRENAL GLAND,,Case Rate,6344.13
Blue Shield,POS,75733,CPT4/HCPCS,ARTERY X-RAYS ADRENALS,,Case Rate,6344.13
Blue Shield,POS,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,Case Rate,6344.13
Blue Shield,POS,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Case Rate,6344.13
Blue Shield,POS,75743,CPT4/HCPCS,ARTERY X-RAYS LUNGS,,Case Rate,6344.13
Blue Shield,POS,75746,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Case Rate,6344.13
Blue Shield,POS,75756,CPT4/HCPCS,ARTERY X-RAYS CHEST,,Case Rate,6344.13
Blue Shield,POS,75774,CPT4/HCPCS,ARTERY X-RAY EACH VESSEL,,Case Rate,6344.13
Blue Shield,POS,75801,CPT4/HCPCS,LYMPH VESSEL X-RAY ARM/LEG,,Case Rate,2734.52
Blue Shield,POS,75803,CPT4/HCPCS,LYMPH VESSEL X-RAY ARMS/LEGS,,Case Rate,2734.52
Blue Shield,POS,75805,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Case Rate,3077.85
Blue Shield,POS,75807,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Case Rate,3077.85
Blue Shield,POS,75809,CPT4/HCPCS,NONVASCULAR SHUNT X-RAY,,Case Rate,400.29
Blue Shield,POS,75810,CPT4/HCPCS,VEIN X-RAY SPLEEN/LIVER,,Case Rate,6344.13
Blue Shield,POS,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,Case Rate,481.31
Blue Shield,POS,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,Case Rate,744.40
Blue Shield,POS,75825,CPT4/HCPCS,VEIN X-RAY TRUNK,,Case Rate,6344.13
Blue Shield,POS,75827,CPT4/HCPCS,VEIN X-RAY CHEST,,Case Rate,6344.13
Blue Shield,POS,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,Case Rate,6344.13
Blue Shield,POS,75833,CPT4/HCPCS,VEIN X-RAY KIDNEYS,,Case Rate,6344.13
Blue Shield,POS,75840,CPT4/HCPCS,VEIN X-RAY ADRENAL GLAND,,Case Rate,6344.13
Blue Shield,POS,75842,CPT4/HCPCS,VEIN X-RAY ADRENAL GLANDS,,Case Rate,6344.13
Blue Shield,POS,75860,CPT4/HCPCS,VEIN X-RAY NECK,,Case Rate,6344.13
Blue Shield,POS,75870,CPT4/HCPCS,VEIN X-RAY SKULL,,Case Rate,6344.13
Blue Shield,POS,75872,CPT4/HCPCS,VEIN X-RAY SKULL EPIDURAL,,Case Rate,6344.13
Blue Shield,POS,75880,CPT4/HCPCS,VEIN X-RAY EYE SOCKET,,Case Rate,481.31
Blue Shield,POS,75885,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Case Rate,6344.13
Blue Shield,POS,75887,CPT4/HCPCS,VEIN X-RAY LIVER W/O HEMODYN,,Case Rate,6344.13
Blue Shield,POS,75889,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Case Rate,6344.13
Blue Shield,POS,75891,CPT4/HCPCS,VEIN X-RAY LIVER,,Case Rate,6344.13
Blue Shield,POS,75893,CPT4/HCPCS,VENOUS SAMPLING BY CATHETER,,Case Rate,6344.13
Blue Shield,POS,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,Case Rate,12166.12
Blue Shield,POS,75898,CPT4/HCPCS,FOLLOW-UP ANGIOGRAPHY,,Case Rate,534.24
Blue Shield,POS,75901,CPT4/HCPCS,REMOVE CVA DEVICE OBSTRUCT,,Case Rate,965.17
Blue Shield,POS,75902,CPT4/HCPCS,REMOVE CVA LUMEN OBSTRUCT,,Case Rate,965.17
Blue Shield,POS,75970,CPT4/HCPCS,VASCULAR BIOPSY,,Case Rate,5818.74
Blue Shield,POS,75984,CPT4/HCPCS,XRAY CONTROL CATHETER CHANGE,,Case Rate,987.46
Blue Shield,POS,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,Case Rate,1593.87
Blue Shield,POS,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,Case Rate,658.56
Blue Shield,POS,76001,CPT4/HCPCS,FLUOROSCOPE EXAM EXTENSIVE,,Case Rate,1317.13
Blue Shield,POS,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,Case Rate,258.27
Blue Shield,POS,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,Case Rate,534.24
Blue Shield,POS,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,Case Rate,205.35
Blue Shield,POS,76100,CPT4/HCPCS,X-RAY EXAM OF BODY SECTION,,Case Rate,629.69
Blue Shield,POS,76101,CPT4/HCPCS,COMPLEX BODY SECTION X-RAY,,Case Rate,720.34
Blue Shield,POS,76102,CPT4/HCPCS,COMPLEX BODY SECTION X-RAYS,,Case Rate,881.60
Blue Shield,POS,76120,CPT4/HCPCS,CINE/VIDEO X-RAYS,,Case Rate,534.24
Blue Shield,POS,76125,CPT4/HCPCS,CINE/VIDEO X-RAYS ADD-ON,,Case Rate,400.29
Blue Shield,POS,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Case Rate,1682.66
Blue Shield,POS,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Case Rate,1775.45
Blue Shield,POS,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,Case Rate,1761.50
Blue Shield,POS,76390,CPT4/HCPCS,MR SPECTROSCOPY,,Case Rate,5535.63
Blue Shield,POS,76393,CPT4/HCPCS,MR GUIDANCE FOR NEEDLE PLACE,,Case Rate,5630.16
Blue Shield,POS,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,Case Rate,720.34
Blue Shield,POS,76510,CPT4/HCPCS,OPH US DX B-SCAN&QUAN A-SCAN,,Case Rate,1077.18
Blue Shield,POS,76511,CPT4/HCPCS,OPH US DX QUAN A-SCAN ONLY,,Case Rate,360.24
Blue Shield,POS,76512,CPT4/HCPCS,OPH US DX B-SCAN,,Case Rate,386.78
Blue Shield,POS,76513,CPT4/HCPCS,OPH US DX ANT SGM US UNI/BI,,Case Rate,425.27
Blue Shield,POS,76514,CPT4/HCPCS,ECHO EXAM OF EYE THICKNESS,,Case Rate,32.90
Blue Shield,POS,76516,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,259.20
Blue Shield,POS,76519,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,297.69
Blue Shield,POS,76529,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,282.48
Blue Shield,POS,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,Case Rate,720.34
Blue Shield,POS,76604,CPT4/HCPCS,US EXAM CHEST,,Case Rate,658.56
Blue Shield,POS,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,Case Rate,961.55
Blue Shield,POS,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,Case Rate,735.40
Blue Shield,POS,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,Case Rate,997.08
Blue Shield,POS,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,Case Rate,720.34
Blue Shield,POS,76706,CPT4/HCPCS,US ABDL AORTA SCREEN AAA,,Case Rate,899.00
Blue Shield,POS,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,Case Rate,997.08
Blue Shield,POS,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,Case Rate,720.34
Blue Shield,POS,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,Case Rate,1478.24
Blue Shield,POS,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,Case Rate,720.34
Blue Shield,POS,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,Case Rate,1058.85
Blue Shield,POS,76802,CPT4/HCPCS,OB US < 14 WKS ADDL FETUS,,Case Rate,558.44
Blue Shield,POS,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,Case Rate,1058.85
Blue Shield,POS,76810,CPT4/HCPCS,OB US >= 14 WKS ADDL FETUS,,Case Rate,598.79
Blue Shield,POS,76811,CPT4/HCPCS,OB US DETAILED SNGL FETUS,,Case Rate,1876.79
Blue Shield,POS,76812,CPT4/HCPCS,OB US DETAILED ADDL FETUS,,Case Rate,675.44
Blue Shield,POS,76813,CPT4/HCPCS,OB US NUCHAL MEAS 1 GEST,,Case Rate,888.89
Blue Shield,POS,76814,CPT4/HCPCS,OB US NUCHAL MEAS ADD-ON,,Case Rate,460.66
Blue Shield,POS,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,Case Rate,720.34
Blue Shield,POS,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,Case Rate,563.11
Blue Shield,POS,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,Case Rate,755.57
Blue Shield,POS,76818,CPT4/HCPCS,FETAL BIOPHYS PROFILE W/NST,,Case Rate,819.83
Blue Shield,POS,76819,CPT4/HCPCS,FETAL BIOPHYS PROFIL W/O NST,,Case Rate,819.83
Blue Shield,POS,76820,CPT4/HCPCS,UMBILICAL ARTERY ECHO,,Case Rate,823.08
Blue Shield,POS,76821,CPT4/HCPCS,MIDDLE CEREBRAL ARTERY ECHO,,Case Rate,823.08
Blue Shield,POS,76825,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,997.08
Blue Shield,POS,76826,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,361.80
Blue Shield,POS,76827,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,880.82
Blue Shield,POS,76828,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,571.18
Blue Shield,POS,76830,CPT4/HCPCS,TRANSVAGINAL US NON-OB,,Case Rate,771.71
Blue Shield,POS,76831,CPT4/HCPCS,ECHO EXAM UTERUS,,Case Rate,771.71
Blue Shield,POS,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,Case Rate,771.71
Blue Shield,POS,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,Case Rate,779.63
Blue Shield,POS,76870,CPT4/HCPCS,US EXAM SCROTUM,,Case Rate,771.71
Blue Shield,POS,76872,CPT4/HCPCS,US TRANSRECTAL,,Case Rate,935.31
Blue Shield,POS,76873,CPT4/HCPCS,ECHOGRAP TRANS R PROS STUDY,,Case Rate,1074.99
Blue Shield,POS,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,Case Rate,1221.38
Blue Shield,POS,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,Case Rate,143.57
Blue Shield,POS,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,Case Rate,771.71
Blue Shield,POS,76886,CPT4/HCPCS,US EXAM INFANT HIPS STATIC,,Case Rate,720.34
Blue Shield,POS,76930,CPT4/HCPCS,ECHO GUIDE CARDIOCENTESIS,,Case Rate,771.71
Blue Shield,POS,76932,CPT4/HCPCS,ECHO GUIDE FOR HEART BIOPSY,,Case Rate,771.71
Blue Shield,POS,76936,CPT4/HCPCS,ECHO GUIDE FOR ARTERY REPAIR,,Case Rate,3178.12
Blue Shield,POS,76937,CPT4/HCPCS,US GUIDE VASCULAR ACCESS,,Case Rate,218.37
Blue Shield,POS,76940,CPT4/HCPCS,US GUIDE TISSUE ABLATION,,Case Rate,848.36
Blue Shield,POS,76941,CPT4/HCPCS,ECHO GUIDE FOR TRANSFUSION,,Case Rate,768.45
Blue Shield,POS,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,Case Rate,1262.50
Blue Shield,POS,76945,CPT4/HCPCS,ECHO GUIDE VILLUS SAMPLING,,Case Rate,768.45
Blue Shield,POS,76946,CPT4/HCPCS,ECHO GUIDE FOR AMNIOCENTESIS,,Case Rate,771.71
Blue Shield,POS,76948,CPT4/HCPCS,ECHO GUIDE OVA ASPIRATION,,Case Rate,771.71
Blue Shield,POS,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,Case Rate,2806.70
Blue Shield,POS,76970,CPT4/HCPCS,ULTRASOUND EXAM FOLLOW-UP,,Case Rate,534.24
Blue Shield,POS,76975,CPT4/HCPCS,GI ENDOSCOPIC ULTRASOUND,,Case Rate,771.71
Blue Shield,POS,76977,CPT4/HCPCS,US BONE DENSITY MEASURE,,Case Rate,419.54
Blue Shield,POS,77001,CPT4/HCPCS,FLUOROGUIDE FOR VEIN DEVICE,,Case Rate,1228.82
Blue Shield,POS,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,Case Rate,514.21
Blue Shield,POS,77003,CPT4/HCPCS,FLUOROGUIDE FOR SPINE INJECT,,Case Rate,316.94
Blue Shield,POS,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,Case Rate,9388.52
Blue Shield,POS,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,Case Rate,1040.35
Blue Shield,POS,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Case Rate,2066.19
Blue Shield,POS,77021,CPT4/HCPCS,MRI GUIDANCE NDL PLMT RS&I,,Case Rate,4436.87
Blue Shield,POS,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,Case Rate,292.25
Blue Shield,POS,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,Case Rate,764.72
Blue Shield,POS,77058,CPT4/HCPCS,MRI ONE BREAST,,Case Rate,10066.59
Blue Shield,POS,77059,CPT4/HCPCS,MRI BOTH BREASTS,,Case Rate,10147.57
Blue Shield,POS,77063,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Case Rate,345.66
Blue Shield,POS,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,Case Rate,996.15
Blue Shield,POS,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,Case Rate,1494.93
Blue Shield,POS,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,Case Rate,1514.18
Blue Shield,POS,77071,CPT4/HCPCS,X-RAY STRESS VIEW,,Case Rate,389.89
Blue Shield,POS,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,Case Rate,171.66
Blue Shield,POS,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,Case Rate,284.81
Blue Shield,POS,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,Case Rate,606.41
Blue Shield,POS,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,Case Rate,984.98
Blue Shield,POS,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,Case Rate,852.58
Blue Shield,POS,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,Case Rate,279.22
Blue Shield,POS,77078,CPT4/HCPCS,CT BONE DENSITY AXIAL,,Case Rate,279.22
Blue Shield,POS,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,Case Rate,419.83
Blue Shield,POS,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,Case Rate,323.30
Blue Shield,POS,77084,CPT4/HCPCS,MAGNETIC IMAGE BONE MARROW,,Case Rate,6651.93
Blue Shield,POS,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,Case Rate,552.56
Blue Shield,POS,77086,CPT4/HCPCS,FRACTURE ASSESSMENT VIA DXA,,Case Rate,360.09
Blue Shield,POS,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,1747.06
Blue Shield,POS,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,2810.73
Blue Shield,POS,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,3283.19
Blue Shield,POS,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,Case Rate,4411.49
Blue Shield,POS,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,Case Rate,14084.07
Blue Shield,POS,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,Case Rate,677.81
Blue Shield,POS,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,Case Rate,14084.07
Blue Shield,POS,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,Case Rate,985.61
Blue Shield,POS,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,Case Rate,1803.58
Blue Shield,POS,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,Case Rate,1529.32
Blue Shield,POS,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,Case Rate,1996.05
Blue Shield,POS,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,Case Rate,2708.17
Blue Shield,POS,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,Case Rate,2038.24
Blue Shield,POS,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,Case Rate,248.65
Blue Shield,POS,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,677.81
Blue Shield,POS,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,958.59
Blue Shield,POS,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,1637.17
Blue Shield,POS,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,1503.23
Blue Shield,POS,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,Case Rate,3362.55
Blue Shield,POS,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,1756.69
Blue Shield,POS,77371,CPT4/HCPCS,SRS MULTISOURCE,,Case Rate,14607.62
Blue Shield,POS,77372,CPT4/HCPCS,SRS LINEAR BASED,,Case Rate,11085.51
Blue Shield,POS,77373,CPT4/HCPCS,SBRT DELIVERY,,Case Rate,20679.89
Blue Shield,POS,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,Case Rate,8995.00
Blue Shield,POS,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,Case Rate,8995.00
Blue Shield,POS,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,900.85
Blue Shield,POS,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,900.85
Blue Shield,POS,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,1054.04
Blue Shield,POS,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,1178.37
Blue Shield,POS,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,Case Rate,300.02
Blue Shield,POS,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,Case Rate,1139.87
Blue Shield,POS,77435,CPT4/HCPCS,SBRT MANAGEMENT,,Case Rate,2498.08
Blue Shield,POS,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,Case Rate,1402.14
Blue Shield,POS,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,Case Rate,5622.24
Blue Shield,POS,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,Case Rate,6586.41
Blue Shield,POS,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,Case Rate,6586.41
Blue Shield,POS,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,Case Rate,9965.84
Blue Shield,POS,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,Case Rate,9965.84
Blue Shield,POS,77600,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,POS,77605,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2051.90
Blue Shield,POS,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,POS,77615,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2051.90
Blue Shield,POS,77620,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,POS,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Case Rate,673.00
Blue Shield,POS,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Case Rate,1269.01
Blue Shield,POS,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Case Rate,1818.46
Blue Shield,POS,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Case Rate,2258.02
Blue Shield,POS,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,2307.25
Blue Shield,POS,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,3792.49
Blue Shield,POS,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,2984.91
Blue Shield,POS,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,5436.51
Blue Shield,POS,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,8579.43
Blue Shield,POS,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Case Rate,2586.92
Blue Shield,POS,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Case Rate,224.59
Blue Shield,POS,77790,CPT4/HCPCS,RADIATION HANDLING,,Case Rate,248.65
Blue Shield,POS,78012,CPT4/HCPCS,THYROID UPTAKE MEASUREMENT,,Case Rate,1048.16
Blue Shield,POS,78013,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Case Rate,2725.86
Blue Shield,POS,78014,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Case Rate,3110.79
Blue Shield,POS,78015,CPT4/HCPCS,THYROID MET IMAGING,,Case Rate,1302.69
Blue Shield,POS,78016,CPT4/HCPCS,THYROID MET IMAGING/STUDIES,,Case Rate,1751.88
Blue Shield,POS,78018,CPT4/HCPCS,THYROID MET IMAGING BODY,,Case Rate,2739.33
Blue Shield,POS,78020,CPT4/HCPCS,THYROID MET UPTAKE,,Case Rate,686.80
Blue Shield,POS,78070,CPT4/HCPCS,PARATHYROID PLANAR IMAGING,,Case Rate,924.91
Blue Shield,POS,78071,CPT4/HCPCS,PARATHYRD PLANAR W/WO SUBTRJ,,Case Rate,4337.76
Blue Shield,POS,78075,CPT4/HCPCS,ADRENAL CORTEX & MEDULLA IMG,,Case Rate,2739.33
Blue Shield,POS,78102,CPT4/HCPCS,BONE MARROW IMAGING LTD,,Case Rate,1029.98
Blue Shield,POS,78103,CPT4/HCPCS,BONE MARROW IMAGING MULT,,Case Rate,1598.68
Blue Shield,POS,78104,CPT4/HCPCS,BONE MARROW IMAGING BODY,,Case Rate,2056.71
Blue Shield,POS,78110,CPT4/HCPCS,PLASMA VOLUME SINGLE,,Case Rate,481.31
Blue Shield,POS,78111,CPT4/HCPCS,PLASMA VOLUME MULTIPLE,,Case Rate,1302.69
Blue Shield,POS,78120,CPT4/HCPCS,RED CELL MASS SINGLE,,Case Rate,881.60
Blue Shield,POS,78121,CPT4/HCPCS,RED CELL MASS MULTIPLE,,Case Rate,1461.48
Blue Shield,POS,78122,CPT4/HCPCS,BLOOD VOLUME,,Case Rate,2319.80
Blue Shield,POS,78130,CPT4/HCPCS,RED CELL SURVIVAL STUDY,,Case Rate,1432.61
Blue Shield,POS,78135,CPT4/HCPCS,RED CELL SURVIVAL KINETICS,,Case Rate,2453.74
Blue Shield,POS,78140,CPT4/HCPCS,RED CELL SEQUESTRATION,,Case Rate,1985.31
Blue Shield,POS,78185,CPT4/HCPCS,SPLEEN IMAGING,,Case Rate,1192.80
Blue Shield,POS,78191,CPT4/HCPCS,PLATELET SURVIVAL,,Case Rate,3690.63
Blue Shield,POS,78195,CPT4/HCPCS,LYMPH SYSTEM IMAGING,,Case Rate,2056.71
Blue Shield,POS,78201,CPT4/HCPCS,LIVER IMAGING,,Case Rate,1192.80
Blue Shield,POS,78202,CPT4/HCPCS,LIVER IMAGING WITH FLOW,,Case Rate,1447.04
Blue Shield,POS,78205,CPT4/HCPCS,LIVER IMAGING (3D),,Case Rate,2978.36
Blue Shield,POS,78206,CPT4/HCPCS,LIVER IMAGE (3D) WITH FLOW,,Case Rate,2897.67
Blue Shield,POS,78215,CPT4/HCPCS,LIVER AND SPLEEN IMAGING,,Case Rate,1475.91
Blue Shield,POS,78216,CPT4/HCPCS,LIVER & SPLEEN IMAGE/FLOW,,Case Rate,1751.88
Blue Shield,POS,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Case Rate,4145.29
Blue Shield,POS,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Case Rate,5756.41
Blue Shield,POS,78230,CPT4/HCPCS,SALIVARY GLAND IMAGING,,Case Rate,1101.38
Blue Shield,POS,78231,CPT4/HCPCS,SERIAL SALIVARY IMAGING,,Case Rate,1598.68
Blue Shield,POS,78232,CPT4/HCPCS,SALIVARY GLAND FUNCTION EXAM,,Case Rate,1780.75
Blue Shield,POS,78258,CPT4/HCPCS,ESOPHAGEAL MOTILITY STUDY,,Case Rate,1447.04
Blue Shield,POS,78261,CPT4/HCPCS,GASTRIC MUCOSA IMAGING,,Case Rate,2066.33
Blue Shield,POS,78262,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX EXAM,,Case Rate,2143.32
Blue Shield,POS,78264,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,2080.77
Blue Shield,POS,78265,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,4918.41
Blue Shield,POS,78266,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,5885.55
Blue Shield,POS,78270,CPT4/HCPCS,VIT B-12 ABSORPTION EXAM,,Case Rate,786.15
Blue Shield,POS,78271,CPT4/HCPCS,VIT B-12 ABSRP EXAM INT FAC,,Case Rate,834.26
Blue Shield,POS,78272,CPT4/HCPCS,VIT B-12 ABSORP COMBINED,,Case Rate,1173.56
Blue Shield,POS,78278,CPT4/HCPCS,ACUTE GI BLOOD LOSS IMAGING,,Case Rate,2453.74
Blue Shield,POS,78282,CPT4/HCPCS,GI PROTEIN LOSS EXAM,,Case Rate,758.83
Blue Shield,POS,78290,CPT4/HCPCS,MECKELS DIVERT EXAM,,Case Rate,1536.91
Blue Shield,POS,78291,CPT4/HCPCS,LEVEEN/SHUNT PATENCY EXAM,,Case Rate,1546.53
Blue Shield,POS,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Per Diem,4250.00
Blue Shield,POS,78300,CPT4/HCPCS,BONE IMAGING LIMITED AREA,,Case Rate,1259.39
Blue Shield,POS,78305,CPT4/HCPCS,BONE IMAGING MULTIPLE AREAS,,Case Rate,1847.33
Blue Shield,POS,78306,CPT4/HCPCS,BONE IMAGING WHOLE BODY,,Case Rate,2152.94
Blue Shield,POS,78315,CPT4/HCPCS,BONE IMAGING 3 PHASE,,Case Rate,2410.44
Blue Shield,POS,78320,CPT4/HCPCS,BONE IMAGING (3D),,Case Rate,2978.36
Blue Shield,POS,78350,CPT4/HCPCS,BONE MINERAL SINGLE PHOTON,,Case Rate,385.86
Blue Shield,POS,78351,CPT4/HCPCS,BONE MINERAL DUAL PHOTON,,Case Rate,148.38
Blue Shield,POS,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Per Diem,4250.00
Blue Shield,POS,78414,CPT4/HCPCS,NON-IMAGING HEART FUNCTION,,Case Rate,701.87
Blue Shield,POS,78428,CPT4/HCPCS,CARDIAC SHUNT IMAGING,,Case Rate,1139.87
Blue Shield,POS,78445,CPT4/HCPCS,VASCULAR FLOW IMAGING,,Case Rate,944.15
Blue Shield,POS,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,Case Rate,2073.03
Blue Shield,POS,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,Case Rate,4007.31
Blue Shield,POS,78453,CPT4/HCPCS,HT MUSCLE IMAGE PLANAR SING,,Case Rate,1933.50
Blue Shield,POS,78454,CPT4/HCPCS,HT MUSC IMAGE PLANAR MULT,,Case Rate,1625.55
Blue Shield,POS,78456,CPT4/HCPCS,ACUTE VENOUS THROMBUS IMAGE,,Case Rate,2041.65
Blue Shield,POS,78457,CPT4/HCPCS,VENOUS THROMBOSIS IMAGING,,Case Rate,1336.37
Blue Shield,POS,78458,CPT4/HCPCS,VEN THROMBOSIS IMAGES BILAT,,Case Rate,2028.62
Blue Shield,POS,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,Case Rate,2362.32
Blue Shield,POS,78466,CPT4/HCPCS,HEART INFARCT IMAGE,,Case Rate,1317.13
Blue Shield,POS,78468,CPT4/HCPCS,HEART INFARCT IMAGE (EF),,Case Rate,1847.33
Blue Shield,POS,78469,CPT4/HCPCS,HEART INFARCT IMAGE (3D),,Case Rate,2634.25
Blue Shield,POS,78472,CPT4/HCPCS,GATED HEART PLANAR SINGLE,,Case Rate,2781.86
Blue Shield,POS,78473,CPT4/HCPCS,GATED HEART MULTIPLE,,Case Rate,4158.28
Blue Shield,POS,78481,CPT4/HCPCS,HEART FIRST PASS SINGLE,,Case Rate,2634.25
Blue Shield,POS,78483,CPT4/HCPCS,HEART FIRST PASS MULTIPLE,,Case Rate,3961.78
Blue Shield,POS,78491,CPT4/HCPCS,MYOCRD IMG PET 1STD RST/STRS,,Case Rate,2396.00
Blue Shield,POS,78492,CPT4/HCPCS,MYOCRD IMG PET MLT RST&STRS,,Case Rate,2983.17
Blue Shield,POS,78494,CPT4/HCPCS,HEART IMAGE SPECT,,Case Rate,3537.29
Blue Shield,POS,78496,CPT4/HCPCS,HEART FIRST PASS ADD-ON,,Case Rate,3537.29
Blue Shield,POS,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Per Diem,4250.00
Blue Shield,POS,78579,CPT4/HCPCS,LUNG VENTILATION IMAGING,,Case Rate,2139.62
Blue Shield,POS,78580,CPT4/HCPCS,LUNG PERFUSION IMAGING,,Case Rate,1727.82
Blue Shield,POS,78582,CPT4/HCPCS,LUNG VENTILAT&PERFUS IMAGING,,Case Rate,3837.35
Blue Shield,POS,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Case Rate,2293.59
Blue Shield,POS,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Case Rate,3717.06
Blue Shield,POS,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Per Diem,4250.00
Blue Shield,POS,78600,CPT4/HCPCS,BRAIN IMAGE < 4 VIEWS,,Case Rate,1447.04
Blue Shield,POS,78601,CPT4/HCPCS,BRAIN IMAGE W/FLOW < 4 VIEWS,,Case Rate,1713.38
Blue Shield,POS,78605,CPT4/HCPCS,BRAIN IMAGE 4+ VIEWS,,Case Rate,1713.38
Blue Shield,POS,78606,CPT4/HCPCS,BRAIN IMAGE W/FLOW 4 + VIEWS,,Case Rate,1951.63
Blue Shield,POS,78607,CPT4/HCPCS,BRAIN IMAGING (3D),,Case Rate,3307.25
Blue Shield,POS,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,Case Rate,18766.19
Blue Shield,POS,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,Case Rate,745.95
Blue Shield,POS,78610,CPT4/HCPCS,BRAIN FLOW IMAGING ONLY,,Case Rate,800.58
Blue Shield,POS,78630,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Case Rate,2538.80
Blue Shield,POS,78635,CPT4/HCPCS,CSF VENTRICULOGRAPHY,,Case Rate,1288.26
Blue Shield,POS,78645,CPT4/HCPCS,CSF SHUNT EVALUATION,,Case Rate,1727.82
Blue Shield,POS,78647,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Case Rate,2978.36
Blue Shield,POS,78650,CPT4/HCPCS,CSF LEAKAGE IMAGING,,Case Rate,2339.04
Blue Shield,POS,78660,CPT4/HCPCS,NUCLEAR EXAM OF TEAR FLOW,,Case Rate,1068.48
Blue Shield,POS,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Per Diem,4250.00
Blue Shield,POS,78700,CPT4/HCPCS,KIDNEY IMAGING MORPHOL,,Case Rate,1536.91
Blue Shield,POS,78701,CPT4/HCPCS,KIDNEY IMAGING WITH FLOW,,Case Rate,1790.37
Blue Shield,POS,78707,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/O DRUG,,Case Rate,2248.40
Blue Shield,POS,78708,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/DRUG,,Case Rate,2248.40
Blue Shield,POS,78709,CPT4/HCPCS,K FLOW/FUNCT IMAGE MULTIPLE,,Case Rate,2248.40
Blue Shield,POS,78710,CPT4/HCPCS,KIDNEY IMAGING (3D),,Case Rate,2978.36
Blue Shield,POS,78725,CPT4/HCPCS,KIDNEY FUNCTION STUDY,,Case Rate,905.66
Blue Shield,POS,78730,CPT4/HCPCS,URINARY BLADDER RETENTION,,Case Rate,734.77
Blue Shield,POS,78740,CPT4/HCPCS,URETERAL REFLUX STUDY,,Case Rate,1068.48
Blue Shield,POS,78761,CPT4/HCPCS,TESTICULAR IMAGING W/FLOW,,Case Rate,1613.12
Blue Shield,POS,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Per Diem,4250.00
Blue Shield,POS,78800,CPT4/HCPCS,RP LOCLZJ TUM 1 AREA 1 D IMG,,Case Rate,1713.38
Blue Shield,POS,78801,CPT4/HCPCS,RP LOCLZJ TUM 2+AREA 1+D IMG,,Case Rate,2128.89
Blue Shield,POS,78802,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 1 D IMG,,Case Rate,2791.48
Blue Shield,POS,78803,CPT4/HCPCS,RP LOCLZJ TUM SPECT 1 AREA,,Case Rate,3307.25
Blue Shield,POS,78804,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 2+D IMG,,Case Rate,2185.22
Blue Shield,POS,78805,CPT4/HCPCS,ABSCESS IMAGING LTD AREA,,Case Rate,1713.38
Blue Shield,POS,78806,CPT4/HCPCS,ABSCESS IMAGING WHOLE BODY,,Case Rate,3244.70
Blue Shield,POS,78807,CPT4/HCPCS,NUCLEAR LOCALIZATION/ABSCESS,,Case Rate,3307.25
Blue Shield,POS,78811,CPT4/HCPCS,PET IMAGE LTD AREA,,Case Rate,17587.83
Blue Shield,POS,78812,CPT4/HCPCS,PET IMAGE SKULL-THIGH,,Case Rate,18766.19
Blue Shield,POS,78813,CPT4/HCPCS,PET IMAGE FULL BODY,,Case Rate,19935.71
Blue Shield,POS,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,Case Rate,17587.83
Blue Shield,POS,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,Case Rate,18766.19
Blue Shield,POS,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,Case Rate,19935.71
Blue Shield,POS,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Case Rate,1317.13
Blue Shield,POS,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,Case Rate,1317.13
Blue Shield,POS,79200,CPT4/HCPCS,NUCLEAR RX INTRACAV ADMIN,,Case Rate,1317.13
Blue Shield,POS,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Case Rate,711.49
Blue Shield,POS,79403,CPT4/HCPCS,HEMATOPOIETIC NUCLEAR TX,,Case Rate,2120.67
Blue Shield,POS,79440,CPT4/HCPCS,NUCLEAR RX INTRA-ARTICULAR,,Case Rate,1317.13
Blue Shield,POS,79445,CPT4/HCPCS,NUCLEAR RX INTRA-ARTERIAL,,Case Rate,1325.20
Blue Shield,POS,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Per Diem,4250.00
Blue Shield,POS,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Per Diem,4250.00
Blue Shield,POS,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Per Diem,4250.00
Blue Shield,POS,80050,CPT4/HCPCS,GENERAL HEALTH PANEL,,Case Rate,572.58
Blue Shield,POS,80055,CPT4/HCPCS,OBSTETRIC PANEL,,Case Rate,654.38
Blue Shield,POS,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Per Diem,4250.00
Blue Shield,POS,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Per Diem,4250.00
Blue Shield,POS,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Per Diem,4250.00
Blue Shield,POS,85396,CPT4/HCPCS,CLOTTING ASSAY WHOLE BLOOD,,Case Rate,93.12
Blue Shield,POS,86077,CPT4/HCPCS,PHYS BLOOD BANK SERV XMATCH,,Case Rate,199.76
Blue Shield,POS,86078,CPT4/HCPCS,PHYS BLOOD BANK SERV REACTJ,,Case Rate,233.44
Blue Shield,POS,86079,CPT4/HCPCS,PHYS BLOOD BANK SERV AUTHRJ,,Case Rate,228.63
Blue Shield,POS,86486,CPT4/HCPCS,SKIN TEST NOS ANTIGEN,,Case Rate,70.62
Blue Shield,POS,86490,CPT4/HCPCS,COCCIDIOIDOMYCOSIS SKIN TEST,,Case Rate,147.61
Blue Shield,POS,86510,CPT4/HCPCS,HISTOPLASMOSIS SKIN TEST,,Case Rate,162.04
Blue Shield,POS,86580,CPT4/HCPCS,TB INTRADERMAL TEST,,Case Rate,133.17
Blue Shield,POS,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,Case Rate,226.15
Blue Shield,POS,86860,CPT4/HCPCS,RBC ANTIBODY ELUTION,,Case Rate,226.15
Blue Shield,POS,86870,CPT4/HCPCS,RBC ANTIBODY IDENTIFICATION,,Case Rate,399.37
Blue Shield,POS,86890,CPT4/HCPCS,AUTOLOGOUS BLOOD PROCESS,,Case Rate,914.21
Blue Shield,POS,86891,CPT4/HCPCS,AUTOLOGOUS BLOOD OP SALVAGE,,Case Rate,1424.24
Blue Shield,POS,86910,CPT4/HCPCS,BLOOD TYPING PATERNITY TEST,,Case Rate,250.20
Blue Shield,POS,86911,CPT4/HCPCS,BLOOD TYPING ANTIGEN SYSTEM,,Case Rate,192.47
Blue Shield,POS,86920,CPT4/HCPCS,COMPATIBILITY TEST SPIN,,Case Rate,250.20
Blue Shield,POS,86921,CPT4/HCPCS,COMPATIBILITY TEST INCUBATE,,Case Rate,226.15
Blue Shield,POS,86922,CPT4/HCPCS,COMPATIBILITY TEST ANTIGLOB,,Case Rate,134.73
Blue Shield,POS,86927,CPT4/HCPCS,PLASMA FRESH FROZEN,,Case Rate,125.10
Blue Shield,POS,86930,CPT4/HCPCS,FROZEN BLOOD PREP,,Case Rate,1140.36
Blue Shield,POS,86931,CPT4/HCPCS,FROZEN BLOOD THAW,,Case Rate,1255.83
Blue Shield,POS,86932,CPT4/HCPCS,FROZEN BLOOD FREEZE/THAW,,Case Rate,1366.50
Blue Shield,POS,86945,CPT4/HCPCS,BLOOD PRODUCT/IRRADIATION,,Case Rate,341.63
Blue Shield,POS,86950,CPT4/HCPCS,LEUKACYTE TRANSFUSION,,Case Rate,625.51
Blue Shield,POS,86965,CPT4/HCPCS,POOLING BLOOD PLATELETS,,Case Rate,158.78
Blue Shield,POS,86970,CPT4/HCPCS,RBC PRETX INCUBATJ W/CHEMICL,,Case Rate,182.84
Blue Shield,POS,86971,CPT4/HCPCS,RBC PRETX INCUBATJ W/ENZYMES,,Case Rate,182.84
Blue Shield,POS,86972,CPT4/HCPCS,RBC PRETX INCUBATJ W/DENSITY,,Case Rate,173.22
Blue Shield,POS,86975,CPT4/HCPCS,RBC SERUM PRETX INCUBJ DRUGS,,Case Rate,115.48
Blue Shield,POS,86976,CPT4/HCPCS,RBC SERUM PRETX ID DILUTION,,Case Rate,91.42
Blue Shield,POS,86977,CPT4/HCPCS,RBC SERUM PRETX INCUBJ/INHIB,,Case Rate,115.48
Blue Shield,POS,86978,CPT4/HCPCS,RBC PRETREATMENT SERUM,,Case Rate,250.20
Blue Shield,POS,86985,CPT4/HCPCS,SPLIT BLOOD OR PRODUCTS,,Case Rate,240.58
Blue Shield,POS,88104,CPT4/HCPCS,CYTOPATH FL NONGYN SMEARS,,Case Rate,248.65
Blue Shield,POS,88106,CPT4/HCPCS,CYTOPATH FL NONGYN FILTER,,Case Rate,186.10
Blue Shield,POS,88108,CPT4/HCPCS,CYTOPATH CONCENTRATE TECH,,Case Rate,277.52
Blue Shield,POS,88112,CPT4/HCPCS,CYTOPATH CELL ENHANCE TECH,,Case Rate,715.38
Blue Shield,POS,88120,CPT4/HCPCS,CYTP URNE 3-5 PROBES EA SPEC,,Case Rate,5718.69
Blue Shield,POS,88121,CPT4/HCPCS,CYTP URINE 3-5 PROBES CMPTR,,Case Rate,4796.42
Blue Shield,POS,88125,CPT4/HCPCS,FORENSIC CYTOPATHOLOGY,,Case Rate,71.40
Blue Shield,POS,88160,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,344.88
Blue Shield,POS,88161,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,325.64
Blue Shield,POS,88162,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,171.66
Blue Shield,POS,88172,CPT4/HCPCS,CYTP DX EVAL FNA 1ST EA SITE,,Case Rate,195.72
Blue Shield,POS,88173,CPT4/HCPCS,CYTOPATH EVAL FNA REPORT,,Case Rate,561.41
Blue Shield,POS,88177,CPT4/HCPCS,CYTP FNA EVAL EA ADDL,,Case Rate,90.64
Blue Shield,POS,88182,CPT4/HCPCS,CELL MARKER STUDY,,Case Rate,617.59
Blue Shield,POS,88184,CPT4/HCPCS,FLOWCYTOMETRY/ TC 1 MARKER,,Case Rate,643.20
Blue Shield,POS,88185,CPT4/HCPCS,FLOWCYTOMETRY/TC ADD-ON,,Case Rate,316.01
Blue Shield,POS,88187,CPT4/HCPCS,FLOWCYTOMETRY/READ 2-8,,Case Rate,220.56
Blue Shield,POS,88188,CPT4/HCPCS,FLOWCYTOMETRY/READ 9-15,,Case Rate,278.30
Blue Shield,POS,88189,CPT4/HCPCS,FLOWCYTOMETRY/READ 16 & >,,Case Rate,364.91
Blue Shield,POS,88291,CPT4/HCPCS,CYTO/MOLECULAR REPORT,,Case Rate,89.87
Blue Shield,POS,88300,CPT4/HCPCS,SURGICAL PATH GROSS,,Case Rate,119.51
Blue Shield,POS,88302,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,311.20
Blue Shield,POS,88304,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,378.56
Blue Shield,POS,88305,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,689.77
Blue Shield,POS,88307,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,967.29
Blue Shield,POS,88309,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,1106.82
Blue Shield,POS,88311,CPT4/HCPCS,DECALCIFY TISSUE,,Case Rate,47.34
Blue Shield,POS,88312,CPT4/HCPCS,SPECIAL STAINS GROUP 1,,Case Rate,538.13
Blue Shield,POS,88313,CPT4/HCPCS,SPECIAL STAINS GROUP 2,,Case Rate,475.57
Blue Shield,POS,88314,CPT4/HCPCS,HISTOCHEMICAL STAINS ADD-ON,,Case Rate,340.07
Blue Shield,POS,88319,CPT4/HCPCS,ENZYME HISTOCHEMISTRY,,Case Rate,806.80
Blue Shield,POS,88323,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Case Rate,417.06
Blue Shield,POS,88331,CPT4/HCPCS,PATH CONSULT INTRAOP 1 BLOC,,Case Rate,237.47
Blue Shield,POS,88332,CPT4/HCPCS,PATH CONSULT INTRAOP ADDL,,Case Rate,123.55
Blue Shield,POS,88333,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 1,,Case Rate,280.78
Blue Shield,POS,88334,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 2,,Case Rate,171.66
Blue Shield,POS,88341,CPT4/HCPCS,IMMUNOHISTO ANTB ADDL SLIDE,,Case Rate,610.30
Blue Shield,POS,88342,CPT4/HCPCS,IMMUNOHISTO ANTB 1ST STAIN,,Case Rate,479.61
Blue Shield,POS,88344,CPT4/HCPCS,IMMUNOHISTO ANTIBODY SLIDE,,Case Rate,1033.72
Blue Shield,POS,88346,CPT4/HCPCS,IMMUNOFLUOR ANTB 1ST STAIN,,Case Rate,522.91
Blue Shield,POS,88348,CPT4/HCPCS,ELECTRON MICROSCOPY,,Case Rate,3790.93
Blue Shield,POS,88350,CPT4/HCPCS,IMMUNOFLUOR ANTB ADDL STAIN,,Case Rate,591.05
Blue Shield,POS,88355,CPT4/HCPCS,ANALYSIS SKELETAL MUSCLE,,Case Rate,890.30
Blue Shield,POS,88356,CPT4/HCPCS,ANALYSIS NERVE,,Case Rate,798.10
Blue Shield,POS,88358,CPT4/HCPCS,ANALYSIS TUMOR,,Case Rate,100.41
Blue Shield,POS,88360,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/MANUAL,,Case Rate,614.33
Blue Shield,POS,88361,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/COMPUT,,Case Rate,1077.18
Blue Shield,POS,88362,CPT4/HCPCS,NERVE TEASING PREPARATIONS,,Case Rate,1693.84
Blue Shield,POS,88363,CPT4/HCPCS,XM ARCHIVE TISSUE MOLEC ANAL,,Case Rate,60.22
Blue Shield,POS,88364,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,942.30
Blue Shield,POS,88365,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,874.16
Blue Shield,POS,88366,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,1158.82
Blue Shield,POS,88367,CPT4/HCPCS,INSITU HYBRIDIZATION AUTO,,Case Rate,1741.96
Blue Shield,POS,88368,CPT4/HCPCS,INSITU HYBRIDIZATION MANUAL,,Case Rate,1419.58
Blue Shield,POS,88369,CPT4/HCPCS,M/PHMTRC ALYSISHQUANT/SEMIQ,,Case Rate,653.60
Blue Shield,POS,88373,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,523.69
Blue Shield,POS,88374,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,2150.02
Blue Shield,POS,88377,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,2000.86
Blue Shield,POS,88381,CPT4/HCPCS,MICRODISSECTION MANUAL,,Case Rate,2004.89
Blue Shield,POS,88387,CPT4/HCPCS,TISS EXAM MOLECULAR STUDY,,Case Rate,105.08
Blue Shield,POS,88388,CPT4/HCPCS,TISS EX MOLECUL STUDY ADD-ON,,Case Rate,52.15
Blue Shield,POS,89049,CPT4/HCPCS,CHCT FOR MAL HYPERTHERMIA,,Case Rate,1737.15
Blue Shield,POS,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Case Rate,404.18
Blue Shield,POS,89230,CPT4/HCPCS,COLLECT SWEAT FOR TEST,,Case Rate,769.86
Blue Shield,POS,89250,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Case Rate,12919.22
Blue Shield,POS,90801,CPT4/HCPCS,PSY DX INTERVIEW,,Case Rate,312.90
Blue Shield,POS,90802,CPT4/HCPCS,INTAC PSY DX INTERVIEW,,Case Rate,345.81
Blue Shield,POS,90804,CPT4/HCPCS,PSYTX OFFICE 20-30 MIN,,Case Rate,117.96
Blue Shield,POS,90805,CPT4/HCPCS,PSYTX OFF 20-30 MIN W/E&M,,Case Rate,127.58
Blue Shield,POS,90806,CPT4/HCPCS,PSYTX OFF 45-50 MIN,,Case Rate,174.92
Blue Shield,POS,90807,CPT4/HCPCS,PSYTX OFF 45-50 MIN W/E&M,,Case Rate,193.39
Blue Shield,POS,90808,CPT4/HCPCS,PSYTX OFFICE 75-80 MIN,,Case Rate,259.98
Blue Shield,POS,90809,CPT4/HCPCS,PSYTX OFF 75-80 W/E&M,,Case Rate,283.26
Blue Shield,POS,90810,CPT4/HCPCS,INTAC PSYTX OFF 20-30 MIN,,Case Rate,131.62
Blue Shield,POS,90811,CPT4/HCPCS,INTAC PSYTX 20-30 W/E&M,,Case Rate,141.24
Blue Shield,POS,90812,CPT4/HCPCS,INTAC PSYTX OFF 45-50 MIN,,Case Rate,184.54
Blue Shield,POS,90813,CPT4/HCPCS,INTAC PSYTX 45-50 MIN W/E&M,,Case Rate,203.01
Blue Shield,POS,90814,CPT4/HCPCS,INTAC PSYTX OFF 75-80 MIN,,Case Rate,274.41
Blue Shield,POS,90815,CPT4/HCPCS,INTAC PSYTX 75-80 W/E&M,,Case Rate,288.07
Blue Shield,POS,90816,CPT4/HCPCS,PSYTX HOSP 20-30 MIN,,Case Rate,166.08
Blue Shield,POS,90817,CPT4/HCPCS,PSYTX HOSP 20-30 MIN W/E&M,,Case Rate,185.32
Blue Shield,POS,90818,CPT4/HCPCS,PSYTX HOSP 45-50 MIN,,Case Rate,223.04
Blue Shield,POS,90819,CPT4/HCPCS,PSYTX HOSP 45-50 MIN W/E&M,,Case Rate,246.32
Blue Shield,POS,90821,CPT4/HCPCS,PSYTX HOSP 75-80 MIN,,Case Rate,312.90
Blue Shield,POS,90822,CPT4/HCPCS,PSYTX HOSP 75-80 MIN W/E&M,,Case Rate,340.22
Blue Shield,POS,90823,CPT4/HCPCS,INTAC PSYTX HOSP 20-30 MIN,,Case Rate,175.70
Blue Shield,POS,90824,CPT4/HCPCS,INTAC PSYTX HSP 20-30 W/E&M,,Case Rate,198.98
Blue Shield,POS,90826,CPT4/HCPCS,INTAC PSYTX HOSP 45-50 MIN,,Case Rate,241.51
Blue Shield,POS,90827,CPT4/HCPCS,INTAC PSYTX HSP 45-50 W/E&M,,Case Rate,255.94
Blue Shield,POS,90828,CPT4/HCPCS,INTAC PSYTX HOSP 75-80 MIN,,Case Rate,317.72
Blue Shield,POS,90829,CPT4/HCPCS,INTAC PSYTX HSP 75-80 W/E&M,,Case Rate,345.81
Blue Shield,POS,90845,CPT4/HCPCS,PSYCHOANALYSIS,,Case Rate,170.11
Blue Shield,POS,90846,CPT4/HCPCS,FAMILY PSYTX W/O PT 50 MIN,,Case Rate,223.04
Blue Shield,POS,90847,CPT4/HCPCS,FAMILY PSYTX W/PT 50 MIN,,Case Rate,255.94
Blue Shield,POS,90849,CPT4/HCPCS,MULTIPLE FAMILY GROUP PSYTX,,Case Rate,104.30
Blue Shield,POS,90853,CPT4/HCPCS,GROUP PSYCHOTHERAPY,,Case Rate,100.27
Blue Shield,POS,90857,CPT4/HCPCS,INTAC GROUP PSYTX,,Case Rate,105.08
Blue Shield,POS,90862,CPT4/HCPCS,MEDICATION MANAGEMENT,,Case Rate,137.98
Blue Shield,POS,90865,CPT4/HCPCS,NARCOSYNTHESIS,,Case Rate,361.17
Blue Shield,POS,90867,CPT4/HCPCS,TCRANIAL MAGN STIM TX PLAN,,Fee Schedule,987.79
Blue Shield,POS,90868,CPT4/HCPCS,TCRANIAL MAGN STIM TX DELI,,Fee Schedule,987.79
Blue Shield,POS,90869,CPT4/HCPCS,TCRAN MAGN STIM REDETEMINE,,Fee Schedule,3198.57
Blue Shield,POS,90870,CPT4/HCPCS,ELECTROCONVULSIVE THERAPY,,Case Rate,203.79
Blue Shield,POS,90875,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,Case Rate,150.86
Blue Shield,POS,90876,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,Case Rate,231.88
Blue Shield,POS,90880,CPT4/HCPCS,HYPNOTHERAPY,,Case Rate,207.83
Blue Shield,POS,90885,CPT4/HCPCS,PSY EVALUATION OF RECORDS,,Case Rate,113.92
Blue Shield,POS,90887,CPT4/HCPCS,CONSULTATION WITH FAMILY,,Case Rate,179.73
Blue Shield,POS,90935,CPT4/HCPCS,HEMODIALYSIS ONE EVALUATION,,Case Rate,338.52
Blue Shield,POS,90937,CPT4/HCPCS,HEMODIALYSIS REPEATED EVAL,,Case Rate,494.97
Blue Shield,POS,90940,CPT4/HCPCS,HEMODIALYSIS ACCESS STUDY,,Case Rate,629.69
Blue Shield,POS,90945,CPT4/HCPCS,DIALYSIS ONE EVALUATION,,Case Rate,348.14
Blue Shield,POS,90947,CPT4/HCPCS,DIALYSIS REPEATED EVAL,,Case Rate,504.59
Blue Shield,POS,90997,CPT4/HCPCS,HEMOPERFUSION,,Case Rate,341.77
Blue Shield,POS,91010,CPT4/HCPCS,ESOPHAGUS MOTILITY STUDY,,Case Rate,1121.26
Blue Shield,POS,91013,CPT4/HCPCS,ESOPHGL MOTIL W/STIM/PERFUS,,Case Rate,186.88
Blue Shield,POS,91020,CPT4/HCPCS,GASTRIC MOTILITY STUDIES,,Case Rate,1203.05
Blue Shield,POS,91022,CPT4/HCPCS,DUODENAL MOTILITY STUDY,,Case Rate,1900.74
Blue Shield,POS,91030,CPT4/HCPCS,ACID PERFUSION OF ESOPHAGUS,,Case Rate,1004.08
Blue Shield,POS,91034,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX TEST,,Case Rate,2381.90
Blue Shield,POS,91035,CPT4/HCPCS,G-ESOPH REFLX TST W/ELECTROD,,Case Rate,4951.31
Blue Shield,POS,91037,CPT4/HCPCS,ESOPH IMPED FUNCTION TEST,,Case Rate,1270.42
Blue Shield,POS,91038,CPT4/HCPCS,ESOPH IMPED FUNCT TEST > 1HR,,Case Rate,904.73
Blue Shield,POS,91040,CPT4/HCPCS,ESOPH BALLOON DISTENSION TST,,Case Rate,5215.95
Blue Shield,POS,91060,CPT4/HCPCS,GASTRIC SALINE LOAD TEST,,Case Rate,85.05
Blue Shield,POS,91065,CPT4/HCPCS,BREATH HYDROGEN/METHANE TEST,,Case Rate,917.47
Blue Shield,POS,91110,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,Case Rate,9569.70
Blue Shield,POS,91111,CPT4/HCPCS,ESOPHAGEAL CAPSULE ENDOSCOPY,,Case Rate,8760.42
Blue Shield,POS,91112,CPT4/HCPCS,GI WIRELESS CAPSULE MEASURE,,Fee Schedule,4280.44
Blue Shield,POS,91120,CPT4/HCPCS,RECTAL SENSATION TEST,,Case Rate,5135.71
Blue Shield,POS,91122,CPT4/HCPCS,ANAL PRESSURE RECORD,,Case Rate,2659.42
Blue Shield,POS,91132,CPT4/HCPCS,ELECTROGASTROGRAPHY,,Case Rate,190.91
Blue Shield,POS,91133,CPT4/HCPCS,ELECTROGASTROGRAPHY W/TEST,,Case Rate,243.06
Blue Shield,POS,91200,CPT4/HCPCS,LIVER ELASTOGRAPHY,,Case Rate,287.92
Blue Shield,POS,92002,CPT4/HCPCS,EYE EXAM NEW PATIENT,,Case Rate,474.80
Blue Shield,POS,92004,CPT4/HCPCS,EYE EXAM NEW PATIENT,,Case Rate,834.11
Blue Shield,POS,92012,CPT4/HCPCS,EYE EXAM ESTABLISH PATIENT,,Case Rate,503.67
Blue Shield,POS,92014,CPT4/HCPCS,EYE EXAM&TX ESTAB PT 1/>VST,,Case Rate,690.54
Blue Shield,POS,92015,CPT4/HCPCS,DETERMINE REFRACTIVE STATE,,Case Rate,720.97
Blue Shield,POS,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,Case Rate,543.08
Blue Shield,POS,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,Case Rate,281.55
Blue Shield,POS,92020,CPT4/HCPCS,SPECIAL EYE EVALUATION,,Case Rate,167.63
Blue Shield,POS,92025,CPT4/HCPCS,CORNEAL TOPOGRAPHY,,Case Rate,158.01
Blue Shield,POS,92060,CPT4/HCPCS,SPECIAL EYE EVALUATION,,Case Rate,210.93
Blue Shield,POS,92065,CPT4/HCPCS,ORTHOPTIC/PLEOPTIC TRAINING,,Case Rate,191.69
Blue Shield,POS,92071,CPT4/HCPCS,CONTACT LENS FITTING FOR TX,,Case Rate,175.70
Blue Shield,POS,92072,CPT4/HCPCS,FIT CONTAC LENS FOR MANAGMNT,,Case Rate,395.63
Blue Shield,POS,92081,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,340.85
Blue Shield,POS,92082,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,465.95
Blue Shield,POS,92083,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,538.13
Blue Shield,POS,92100,CPT4/HCPCS,SERIAL TONOMETRY EXAM(S),,Case Rate,657.64
Blue Shield,POS,92132,CPT4/HCPCS,CMPTR OPHTH DX IMG ANT SEGMT,,Fee Schedule,987.79
Blue Shield,POS,92133,CPT4/HCPCS,CMPTR OPHTH IMG OPTIC NERVE,,Fee Schedule,987.79
Blue Shield,POS,92134,CPT4/HCPCS,CPTR OPHTH DX IMG POST SEGMT,,Fee Schedule,987.79
Blue Shield,POS,92136,CPT4/HCPCS,OPHTHALMIC BIOMETRY,,Case Rate,749.98
Blue Shield,POS,92140,CPT4/HCPCS,GLAUCOMA PROVOCATIVE TESTS,,Case Rate,480.39
Blue Shield,POS,92225,CPT4/HCPCS,SPECIAL EYE EXAM INITIAL,,Case Rate,109.89
Blue Shield,POS,92226,CPT4/HCPCS,SPECIAL EYE EXAM SUBSEQUENT,,Case Rate,105.08
Blue Shield,POS,92227,CPT4/HCPCS,IMG RTA DETCJ/MNTR DS STAFF,,Case Rate,162.82
Blue Shield,POS,92228,CPT4/HCPCS,IMG RTA DETC/MNTR DS PHY/QHP,,Case Rate,177.25
Blue Shield,POS,92230,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Case Rate,744.25
Blue Shield,POS,92235,CPT4/HCPCS,FLUORESCEIN ANGRPH UNI/BI,,Case Rate,1255.98
Blue Shield,POS,92240,CPT4/HCPCS,ICG ANGIOGRAPHY UNI/BI,,Case Rate,3171.01
Blue Shield,POS,92250,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Case Rate,740.21
Blue Shield,POS,92260,CPT4/HCPCS,OPHTHALMOSCOPY/DYNAMOMETRY,,Case Rate,129.14
Blue Shield,POS,92265,CPT4/HCPCS,EYE MUSCLE EVALUATION,,Case Rate,777.93
Blue Shield,POS,92270,CPT4/HCPCS,ELECTRO-OCULOGRAPHY,,Case Rate,595.09
Blue Shield,POS,92275,CPT4/HCPCS,ELECTRORETINOGRAPHY,,Case Rate,734.62
Blue Shield,POS,92283,CPT4/HCPCS,COLOR VISION EXAMINATION,,Case Rate,369.72
Blue Shield,POS,92284,CPT4/HCPCS,DARK ADAPTATION EYE EXAM,,Case Rate,1072.22
Blue Shield,POS,92285,CPT4/HCPCS,EYE PHOTOGRAPHY,,Case Rate,475.57
Blue Shield,POS,92286,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,Case Rate,1485.24
Blue Shield,POS,92287,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,Case Rate,1158.05
Blue Shield,POS,92310,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,555.04
Blue Shield,POS,92311,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,536.57
Blue Shield,POS,92312,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,531.76
Blue Shield,POS,92313,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,518.10
Blue Shield,POS,92314,CPT4/HCPCS,PRESCRIPTION OF CONTACT LENS,,Case Rate,456.33
Blue Shield,POS,92315,CPT4/HCPCS,RX CNTACT LENS APHAKIA 1 EYE,,Case Rate,413.02
Blue Shield,POS,92316,CPT4/HCPCS,RX CNTACT LENS APHAKIA 2 EYE,,Case Rate,445.93
Blue Shield,POS,92317,CPT4/HCPCS,RX CORNEOSCLERAL CNTACT LENS,,Case Rate,456.33
Blue Shield,POS,92325,CPT4/HCPCS,MODIFICATION OF CONTACT LENS,,Case Rate,196.50
Blue Shield,POS,92326,CPT4/HCPCS,REPLACEMENT OF CONTACT LENS,,Case Rate,808.50
Blue Shield,POS,92340,CPT4/HCPCS,FIT SPECTACLES MONOFOCAL,,Case Rate,340.85
Blue Shield,POS,92341,CPT4/HCPCS,FIT SPECTACLES BIFOCAL,,Case Rate,360.09
Blue Shield,POS,92342,CPT4/HCPCS,FIT SPECTACLES MULTIFOCAL,,Case Rate,369.72
Blue Shield,POS,92352,CPT4/HCPCS,FIT APHAKIA SPECTCL MONOFOCL,,Case Rate,331.23
Blue Shield,POS,92353,CPT4/HCPCS,FIT APHAKIA SPECTCL MULTIFOC,,Case Rate,359.32
Blue Shield,POS,92354,CPT4/HCPCS,FIT SPECTACLES SINGLE SYSTEM,,Case Rate,4317.88
Blue Shield,POS,92355,CPT4/HCPCS,FIT SPECTACLES COMPOUND LENS,,Case Rate,2092.28
Blue Shield,POS,92358,CPT4/HCPCS,APHAKIA PROSTH SERVICE TEMP,,Case Rate,486.90
Blue Shield,POS,92370,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,Case Rate,272.71
Blue Shield,POS,92371,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,Case Rate,306.39
Blue Shield,POS,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,Case Rate,554.26
Blue Shield,POS,92504,CPT4/HCPCS,EAR MICROSCOPY EXAMINATION,,Case Rate,244.62
Blue Shield,POS,92506,CPT4/HCPCS,SPEECH/HEARING EVALUATION,,Case Rate,1263.13
Blue Shield,POS,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,542.16
Blue Shield,POS,92508,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,249.43
Blue Shield,POS,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,Case Rate,1609.56
Blue Shield,POS,92512,CPT4/HCPCS,NASAL FUNCTION STUDIES,,Case Rate,556.59
Blue Shield,POS,92516,CPT4/HCPCS,FACIAL NERVE FUNCTION TEST,,Case Rate,581.43
Blue Shield,POS,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,Case Rate,257.50
Blue Shield,POS,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,Case Rate,797.18
Blue Shield,POS,92537,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,Fee Schedule,987.79
Blue Shield,POS,92538,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,Fee Schedule,987.79
Blue Shield,POS,92540,CPT4/HCPCS,BASIC VESTIBULAR EVALUATION,,Case Rate,220.56
Blue Shield,POS,92541,CPT4/HCPCS,SPONTANEOUS NYSTAGMUS TEST,,Case Rate,383.38
Blue Shield,POS,92542,CPT4/HCPCS,POSITIONAL NYSTAGMUS TEST,,Case Rate,441.12
Blue Shield,POS,92543,CPT4/HCPCS,CALORIC VESTIBULAR TEST,,Case Rate,234.99
Blue Shield,POS,92544,CPT4/HCPCS,OPTOKINETIC NYSTAGMUS TEST,,Case Rate,354.51
Blue Shield,POS,92545,CPT4/HCPCS,OSCILLATING TRACKING TEST,,Case Rate,335.26
Blue Shield,POS,92546,CPT4/HCPCS,SINUSOIDAL ROTATIONAL TEST,,Case Rate,811.61
Blue Shield,POS,92547,CPT4/HCPCS,SUPPLEMENTAL ELECTRICAL TEST,,Case Rate,577.54
Blue Shield,POS,92548,CPT4/HCPCS,CDP-SOT 6 COND W/I&R,,Case Rate,1462.25
Blue Shield,POS,92550,CPT4/HCPCS,TYMPANOMETRY & REFLEX THRESH,,Case Rate,105.08
Blue Shield,POS,92552,CPT4/HCPCS,PURE TONE AUDIOMETRY AIR,,Case Rate,227.85
Blue Shield,POS,92553,CPT4/HCPCS,AUDIOMETRY AIR & BONE,,Case Rate,341.77
Blue Shield,POS,92555,CPT4/HCPCS,SPEECH THRESHOLD AUDIOMETRY,,Case Rate,194.17
Blue Shield,POS,92556,CPT4/HCPCS,SPEECH AUDIOMETRY COMPLETE,,Case Rate,298.47
Blue Shield,POS,92557,CPT4/HCPCS,COMPREHENSIVE HEARING TEST,,Case Rate,621.00
Blue Shield,POS,92561,CPT4/HCPCS,BEKESY AUDIOMETRY DIAGNOSIS,,Case Rate,370.64
Blue Shield,POS,92562,CPT4/HCPCS,LOUDNESS BALANCE TEST,,Case Rate,208.60
Blue Shield,POS,92563,CPT4/HCPCS,TONE DECAY HEARING TEST,,Case Rate,194.17
Blue Shield,POS,92564,CPT4/HCPCS,SISI HEARING TEST,,Case Rate,246.32
Blue Shield,POS,92565,CPT4/HCPCS,STENGER TEST PURE TONE,,Case Rate,203.79
Blue Shield,POS,92567,CPT4/HCPCS,TYMPANOMETRY,,Case Rate,274.41
Blue Shield,POS,92568,CPT4/HCPCS,ACOUSTIC REFL THRESHOLD TST,,Case Rate,194.17
Blue Shield,POS,92570,CPT4/HCPCS,ACOUSTIC IMMITANCE TESTING,,Case Rate,128.36
Blue Shield,POS,92571,CPT4/HCPCS,FILTERED SPEECH HEARING TEST,,Case Rate,198.98
Blue Shield,POS,92572,CPT4/HCPCS,STAGGERED SPONDAIC WORD TEST,,Case Rate,47.34
Blue Shield,POS,92575,CPT4/HCPCS,SENSORINEURAL ACUITY TEST,,Case Rate,152.42
Blue Shield,POS,92576,CPT4/HCPCS,SYNTHETIC SENTENCE TEST,,Case Rate,231.88
Blue Shield,POS,92577,CPT4/HCPCS,STENGER TEST SPEECH,,Case Rate,374.68
Blue Shield,POS,92579,CPT4/HCPCS,VISUAL AUDIOMETRY (VRA),,Case Rate,375.45
Blue Shield,POS,92582,CPT4/HCPCS,CONDITIONING PLAY AUDIOMETRY,,Case Rate,375.45
Blue Shield,POS,92583,CPT4/HCPCS,SELECT PICTURE AUDIOMETRY,,Case Rate,460.51
Blue Shield,POS,92584,CPT4/HCPCS,ELECTROCOCHLEOGRAPHY,,Case Rate,1282.82
Blue Shield,POS,92585,CPT4/HCPCS,AUDITOR EVOKE POTENT COMPRE,,Case Rate,951.44
Blue Shield,POS,92586,CPT4/HCPCS,AUDITOR EVOKE POTENT LIMIT,,Case Rate,951.44
Blue Shield,POS,92587,CPT4/HCPCS,EVOKED AUDITORY TEST LIMITED,,Case Rate,674.70
Blue Shield,POS,92588,CPT4/HCPCS,EVOKED AUDITORY TST COMPLETE,,Case Rate,759.76
Blue Shield,POS,92596,CPT4/HCPCS,EAR PROTECTOR EVALUATION,,Case Rate,308.09
Blue Shield,POS,92597,CPT4/HCPCS,ORAL SPEECH DEVICE EVAL,,Case Rate,825.27
Blue Shield,POS,92601,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM <7,,Case Rate,1669.01
Blue Shield,POS,92602,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT <7,,Case Rate,1163.78
Blue Shield,POS,92603,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM 7/>,,Case Rate,1101.23
Blue Shield,POS,92604,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT 7/>,,Case Rate,735.55
Blue Shield,POS,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,Case Rate,1569.52
Blue Shield,POS,92608,CPT4/HCPCS,EX FOR SPEECH DEVICE RX ADDL,,Case Rate,342.55
Blue Shield,POS,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,Case Rate,786.00
Blue Shield,POS,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,Case Rate,1687.47
Blue Shield,POS,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,Case Rate,1687.47
Blue Shield,POS,92612,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) VID,,Case Rate,1339.33
Blue Shield,POS,92613,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) I&R,,Case Rate,212.64
Blue Shield,POS,92614,CPT4/HCPCS,LARYNGOSCOPIC SENSORY VID,,Case Rate,1223.86
Blue Shield,POS,92615,CPT4/HCPCS,LARYNGOSCOPIC SENSORY I&R,,Case Rate,188.58
Blue Shield,POS,92616,CPT4/HCPCS,FEES W/LARYNGEAL SENSE TEST,,Case Rate,1660.16
Blue Shield,POS,92617,CPT4/HCPCS,FEES W/LARYNGEAL SENSE I&R,,Case Rate,231.88
Blue Shield,POS,92618,CPT4/HCPCS,EX FOR NONSPEECH DEV RX ADD,,Case Rate,137.21
Blue Shield,POS,92620,CPT4/HCPCS,AUDITORY FUNCTION 60 MIN,,Case Rate,572.73
Blue Shield,POS,92621,CPT4/HCPCS,AUDITORY FUNCTION + 15 MIN,,Case Rate,144.50
Blue Shield,POS,92625,CPT4/HCPCS,TINNITUS ASSESSMENT,,Case Rate,563.11
Blue Shield,POS,92626,CPT4/HCPCS,EVAL AUD FUNCJ 1ST HOUR,,Case Rate,1082.76
Blue Shield,POS,92627,CPT4/HCPCS,EVAL AUD FUNCJ EA ADDL 15,,Case Rate,272.71
Blue Shield,POS,92640,CPT4/HCPCS,AUD BRAINSTEM IMPLT PROGRAMG,,Case Rate,677.66
Blue Shield,POS,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Fee Schedule,6876.92
Blue Shield,POS,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Fee Schedule,6876.92
Blue Shield,POS,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Fee Schedule,6876.92
Blue Shield,POS,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Fee Schedule,6876.92
Blue Shield,POS,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Fee Schedule,6876.92
Blue Shield,POS,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Fee Schedule,6876.92
Blue Shield,POS,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Fee Schedule,6876.92
Blue Shield,POS,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Fee Schedule,6876.92
Blue Shield,POS,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Fee Schedule,6876.92
Blue Shield,POS,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Fee Schedule,6876.92
Blue Shield,POS,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Fee Schedule,6876.92
Blue Shield,POS,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Fee Schedule,6876.92
Blue Shield,POS,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Fee Schedule,6876.92
Blue Shield,POS,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,Case Rate,2138.66
Blue Shield,POS,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,Case Rate,41.75
Blue Shield,POS,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Case Rate,3074.00
Blue Shield,POS,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,Case Rate,1122.63
Blue Shield,POS,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,Case Rate,574.58
Blue Shield,POS,92971,CPT4/HCPCS,CARDIOASSIST EXTERNAL,,Case Rate,433.19
Blue Shield,POS,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Case Rate,1558.60
Blue Shield,POS,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Case Rate,4073.37
Blue Shield,POS,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,Case Rate,2300.55
Blue Shield,POS,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,Case Rate,1159.12
Blue Shield,POS,92980,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Case Rate,3336.19
Blue Shield,POS,92981,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Case Rate,901.29
Blue Shield,POS,92982,CPT4/HCPCS,CORONARY ARTERY DILATION,,Case Rate,2491.09
Blue Shield,POS,92984,CPT4/HCPCS,CORONARY ARTERY DILATION,,Case Rate,642.87
Blue Shield,POS,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,Fee Schedule,12850.71
Blue Shield,POS,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,12850.71
Blue Shield,POS,92990,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,12850.71
Blue Shield,POS,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,3198.57
Blue Shield,POS,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,3198.57
Blue Shield,POS,92995,CPT4/HCPCS,CORONARY ATHERECTOMY,,Case Rate,2730.26
Blue Shield,POS,92996,CPT4/HCPCS,CORONARY ATHERECTOMY ADD-ON,,Case Rate,651.42
Blue Shield,POS,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Fee Schedule,9548.66
Blue Shield,POS,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Fee Schedule,9548.66
Blue Shield,POS,93000,CPT4/HCPCS,ELECTROCARDIOGRAM COMPLETE,,Case Rate,257.50
Blue Shield,POS,93005,CPT4/HCPCS,ELECTROCARDIOGRAM TRACING,,Case Rate,224.59
Blue Shield,POS,93010,CPT4/HCPCS,ELECTROCARDIOGRAM REPORT,,Case Rate,32.90
Blue Shield,POS,93015,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,999.56
Blue Shield,POS,93016,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,89.87
Blue Shield,POS,93017,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,857.54
Blue Shield,POS,93018,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,56.96
Blue Shield,POS,93024,CPT4/HCPCS,CARDIAC DRUG STRESS TEST,,Case Rate,571.18
Blue Shield,POS,93025,CPT4/HCPCS,MICROVOLT T-WAVE ASSESS,,Case Rate,3840.75
Blue Shield,POS,93040,CPT4/HCPCS,RHYTHM ECG WITH REPORT,,Case Rate,104.30
Blue Shield,POS,93041,CPT4/HCPCS,RHYTHM ECG TRACING,,Case Rate,76.21
Blue Shield,POS,93042,CPT4/HCPCS,RHYTHM ECG REPORT,,Case Rate,28.09
Blue Shield,POS,93050,CPT4/HCPCS,ART PRESSURE WAVEFORM ANALYS,,Fee Schedule,987.79
Blue Shield,POS,93224,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,1838.63
Blue Shield,POS,93225,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,628.92
Blue Shield,POS,93226,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,1110.23
Blue Shield,POS,93227,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,99.49
Blue Shield,POS,93268,CPT4/HCPCS,ECG RECORD/REVIEW,,Case Rate,3702.44
Blue Shield,POS,93270,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,Case Rate,628.92
Blue Shield,POS,93271,CPT4/HCPCS,ECG/MONITORING AND ANALYSIS,,Case Rate,2978.84
Blue Shield,POS,93272,CPT4/HCPCS,ECG/REVIEW INTERPRET ONLY,,Case Rate,99.49
Blue Shield,POS,93278,CPT4/HCPCS,ECG/SIGNAL-AVERAGED,,Case Rate,597.71
Blue Shield,POS,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,1954.89
Blue Shield,POS,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,990.71
Blue Shield,POS,93307,CPT4/HCPCS,TTE W/O DOPPLER COMPLETE,,Case Rate,1954.89
Blue Shield,POS,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,Case Rate,990.71
Blue Shield,POS,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,1940.60
Blue Shield,POS,93313,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,125.25
Blue Shield,POS,93314,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,1940.60
Blue Shield,POS,93315,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,522.28
Blue Shield,POS,93316,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,135.65
Blue Shield,POS,93317,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,354.65
Blue Shield,POS,93318,CPT4/HCPCS,ECHO TRANSESOPHAGEAL INTRAOP,,Case Rate,1598.68
Blue Shield,POS,93320,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,876.01
Blue Shield,POS,93321,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,571.18
Blue Shield,POS,93325,CPT4/HCPCS,DOPPLER COLOR FLOW ADD-ON,,Case Rate,1484.90
Blue Shield,POS,93350,CPT4/HCPCS,STRESS TTE ONLY,,Case Rate,904.10
Blue Shield,POS,93451,CPT4/HCPCS,RIGHT HEART CATH,,Fee Schedule,9548.66
Blue Shield,POS,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Fee Schedule,9548.66
Blue Shield,POS,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Fee Schedule,9548.66
Blue Shield,POS,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Fee Schedule,9548.66
Blue Shield,POS,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Fee Schedule,9548.66
Blue Shield,POS,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Fee Schedule,9548.66
Blue Shield,POS,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Fee Schedule,9548.66
Blue Shield,POS,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,POS,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Fee Schedule,9548.66
Blue Shield,POS,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,POS,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,POS,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Fee Schedule,987.79
Blue Shield,POS,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Fee Schedule,3198.57
Blue Shield,POS,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Fee Schedule,3198.57
Blue Shield,POS,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,POS,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,POS,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,POS,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,POS,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Case Rate,4064.90
Blue Shield,POS,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Case Rate,5222.42
Blue Shield,POS,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Case Rate,995.53
Blue Shield,POS,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Case Rate,567.14
Blue Shield,POS,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Case Rate,857.54
Blue Shield,POS,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Case Rate,1377.35
Blue Shield,POS,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Case Rate,694.72
Blue Shield,POS,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Case Rate,823.86
Blue Shield,POS,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Case Rate,1530.50
Blue Shield,POS,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,162.04
Blue Shield,POS,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,162.04
Blue Shield,POS,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Case Rate,2011.85
Blue Shield,POS,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3913.81
Blue Shield,POS,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,6701.11
Blue Shield,POS,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,1212.05
Blue Shield,POS,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,1999.75
Blue Shield,POS,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Case Rate,1622.74
Blue Shield,POS,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Case Rate,1009.96
Blue Shield,POS,93631,CPT4/HCPCS,HEART PACING MAPPING,,Case Rate,3218.90
Blue Shield,POS,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Case Rate,3633.81
Blue Shield,POS,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3633.81
Blue Shield,POS,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3633.81
Blue Shield,POS,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,2430.87
Blue Shield,POS,93651,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,3506.45
Blue Shield,POS,93652,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,3816.25
Blue Shield,POS,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Fee Schedule,9548.66
Blue Shield,POS,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Fee Schedule,9548.66
Blue Shield,POS,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Fee Schedule,9548.66
Blue Shield,POS,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Fee Schedule,9548.66
Blue Shield,POS,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Fee Schedule,9548.66
Blue Shield,POS,93660,CPT4/HCPCS,TILT TABLE EVALUATION,,Case Rate,821.23
Blue Shield,POS,93662,CPT4/HCPCS,INTRACARDIAC ECG (ICE),,Case Rate,1718.19
Blue Shield,POS,93668,CPT4/HCPCS,PERIPHERAL VASCULAR REHAB,,Case Rate,663.38
Blue Shield,POS,93701,CPT4/HCPCS,BIOIMPEDANCE CV ANALYSIS,,Case Rate,461.14
Blue Shield,POS,93724,CPT4/HCPCS,ANALYZE PACEMAKER SYSTEM,,Case Rate,2011.85
Blue Shield,POS,93740,CPT4/HCPCS,TEMPERATURE GRADIENT STUDIES,,Case Rate,81.02
Blue Shield,POS,93750,CPT4/HCPCS,INTERROGATION VAD IN PERSON,,Case Rate,164.52
Blue Shield,POS,93770,CPT4/HCPCS,MEASURE VENOUS PRESSURE,,Case Rate,18.47
Blue Shield,POS,93784,CPT4/HCPCS,AMBL BP MNTR W/SOFTWARE,,Case Rate,757.91
Blue Shield,POS,93786,CPT4/HCPCS,AMBL BP MNTR W/SW REC ONLY,,Case Rate,441.89
Blue Shield,POS,93788,CPT4/HCPCS,AMBL BP MNTR W/SW A/R,,Case Rate,249.43
Blue Shield,POS,93790,CPT4/HCPCS,AMBL BP MNTR W/SW I&R,,Case Rate,66.59
Blue Shield,POS,93797,CPT4/HCPCS,CARDIAC REHAB,,Case Rate,148.38
Blue Shield,POS,93798,CPT4/HCPCS,CARDIAC REHAB/MONITOR,,Case Rate,225.37
Blue Shield,POS,93880,CPT4/HCPCS,EXTRACRANIAL BILAT STUDY,,Case Rate,2051.42
Blue Shield,POS,93882,CPT4/HCPCS,EXTRACRANIAL UNI/LTD STUDY,,Case Rate,1469.69
Blue Shield,POS,93886,CPT4/HCPCS,INTRACRANIAL COMPLETE STUDY,,Case Rate,2130.11
Blue Shield,POS,93888,CPT4/HCPCS,INTRACRANIAL LIMITED STUDY,,Case Rate,1451.37
Blue Shield,POS,93890,CPT4/HCPCS,TCD VASOREACTIVITY STUDY,,Case Rate,2322.57
Blue Shield,POS,93892,CPT4/HCPCS,TCD EMBOLI DETECT W/O INJ,,Case Rate,2418.80
Blue Shield,POS,93893,CPT4/HCPCS,TCD EMBOLI DETECT W/INJ,,Case Rate,2356.25
Blue Shield,POS,93922,CPT4/HCPCS,UPR/L XTREMITY ART 2 LEVELS,,Case Rate,937.79
Blue Shield,POS,93923,CPT4/HCPCS,UPR/LXTR ART STDY 3+ LVLS,,Case Rate,1460.07
Blue Shield,POS,93924,CPT4/HCPCS,LWR XTR VASC STDY BILAT,,Case Rate,1828.23
Blue Shield,POS,93925,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Case Rate,2388.23
Blue Shield,POS,93926,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Case Rate,1709.50
Blue Shield,POS,93930,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Case Rate,1924.76
Blue Shield,POS,93931,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Case Rate,1400.78
Blue Shield,POS,93965,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,885.64
Blue Shield,POS,93970,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,1960.92
Blue Shield,POS,93971,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,1412.88
Blue Shield,POS,93975,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,2685.15
Blue Shield,POS,93976,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1593.39
Blue Shield,POS,93978,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1765.98
Blue Shield,POS,93979,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1299.73
Blue Shield,POS,93980,CPT4/HCPCS,PENILE VASCULAR STUDY,,Case Rate,2239.85
Blue Shield,POS,93981,CPT4/HCPCS,PENILE VASCULAR STUDY,,Case Rate,2271.05
Blue Shield,POS,93982,CPT4/HCPCS,ANEURYSM PRESSURE SENS STUDY,,Case Rate,388.96
Blue Shield,POS,93990,CPT4/HCPCS,DOPPLER FLOW TESTING,,Case Rate,1695.06
Blue Shield,POS,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,Case Rate,223.96
Blue Shield,POS,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,Case Rate,182.99
Blue Shield,POS,94004,CPT4/HCPCS,VENT MGMT NF PER DAY,,Case Rate,131.62
Blue Shield,POS,94005,CPT4/HCPCS,HOME VENT MGMT SUPERVISION,,Case Rate,356.21
Blue Shield,POS,94010,CPT4/HCPCS,BREATHING CAPACITY TEST,,Case Rate,306.39
Blue Shield,POS,94011,CPT4/HCPCS,SPIROMETRY UP TO 2 YRS OLD,,Case Rate,318.49
Blue Shield,POS,94012,CPT4/HCPCS,SPIRMTRY W/BRNCHDIL INF-2 YR,,Case Rate,484.57
Blue Shield,POS,94013,CPT4/HCPCS,MEAS LUNG VOL THRU 2 YRS,,Case Rate,98.71
Blue Shield,POS,94014,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,Case Rate,377.79
Blue Shield,POS,94015,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,Case Rate,292.73
Blue Shield,POS,94016,CPT4/HCPCS,REVIEW PATIENT SPIROMETRY,,Case Rate,89.87
Blue Shield,POS,94060,CPT4/HCPCS,EVALUATION OF WHEEZING,,Case Rate,514.99
Blue Shield,POS,94070,CPT4/HCPCS,EVALUATION OF WHEEZING,,Case Rate,1387.60
Blue Shield,POS,94150,CPT4/HCPCS,VITAL CAPACITY TEST,,Case Rate,220.56
Blue Shield,POS,94200,CPT4/HCPCS,LUNG FUNCTION TEST (MBC/MVV),,Case Rate,205.35
Blue Shield,POS,94250,CPT4/HCPCS,EXPIRED GAS COLLECTION,,Case Rate,302.36
Blue Shield,POS,94375,CPT4/HCPCS,RESPIRATORY FLOW VOLUME LOOP,,Case Rate,253.46
Blue Shield,POS,94400,CPT4/HCPCS,CO2 BREATHING RESPONSE CURVE,,Case Rate,370.64
Blue Shield,POS,94450,CPT4/HCPCS,HYPOXIA RESPONSE CURVE,,Case Rate,277.52
Blue Shield,POS,94452,CPT4/HCPCS,HAST W/REPORT,,Case Rate,455.55
Blue Shield,POS,94453,CPT4/HCPCS,HAST W/OXYGEN TITRATE,,Case Rate,676.88
Blue Shield,POS,94610,CPT4/HCPCS,SURFACTANT ADMIN THRU TUBE,,Case Rate,273.30
Blue Shield,POS,94620,CPT4/HCPCS,PULMONARY STRESS TEST/SIMPLE,,Case Rate,1108.52
Blue Shield,POS,94621,CPT4/HCPCS,CARDIOPULM EXERCISE TESTING,,Case Rate,824.64
Blue Shield,POS,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,Case Rate,162.04
Blue Shield,POS,94644,CPT4/HCPCS,CBT 1ST HOUR,,Case Rate,450.74
Blue Shield,POS,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,Case Rate,171.66
Blue Shield,POS,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,Case Rate,328.89
Blue Shield,POS,94662,CPT4/HCPCS,NEG PRESS VENTILATION CNP,,Case Rate,122.77
Blue Shield,POS,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,Case Rate,170.11
Blue Shield,POS,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,Case Rate,280.00
Blue Shield,POS,94668,CPT4/HCPCS,CHEST WALL MANIPULATION,,Case Rate,229.40
Blue Shield,POS,94680,CPT4/HCPCS,EXHALED AIR ANALYSIS O2,,Case Rate,895.11
Blue Shield,POS,94681,CPT4/HCPCS,EXHALED AIR ANALYSIS O2/CO2,,Case Rate,1275.38
Blue Shield,POS,94690,CPT4/HCPCS,EXHALED AIR ANALYSIS,,Case Rate,954.40
Blue Shield,POS,94726,CPT4/HCPCS,PULM FUNCT TST PLETHYSMOGRAP,,Case Rate,585.46
Blue Shield,POS,94727,CPT4/HCPCS,PULM FUNCTION TEST BY GAS,,Case Rate,422.65
Blue Shield,POS,94728,CPT4/HCPCS,AIRWY RESIST BY OSCILLOMETRY,,Case Rate,422.65
Blue Shield,POS,94729,CPT4/HCPCS,CO/MEMBANE DIFFUSE CAPACITY,,Case Rate,639.17
Blue Shield,POS,94750,CPT4/HCPCS,PULMONARY COMPLIANCE STUDY,,Case Rate,632.03
Blue Shield,POS,94760,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,27.32
Blue Shield,POS,94761,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,57.89
Blue Shield,POS,94762,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,232.81
Blue Shield,POS,94770,CPT4/HCPCS,EXHALED CARBON DIOXIDE TEST,,Case Rate,812.54
Blue Shield,POS,94780,CPT4/HCPCS,CARS/BD TST INFT-12MO 60 MIN,,Case Rate,98.71
Blue Shield,POS,94781,CPT4/HCPCS,CARS/BD TST INFT-12MO +30MIN,,Case Rate,32.90
Blue Shield,POS,95004,CPT4/HCPCS,PERCUT ALLERGY SKIN TESTS,,Case Rate,52.15
Blue Shield,POS,95010,CPT4/HCPCS,PERCUT ALLERGY TITRATE TEST,,Case Rate,158.01
Blue Shield,POS,95012,CPT4/HCPCS,EXHALED NITRIC OXIDE MEAS,,Case Rate,234.99
Blue Shield,POS,95015,CPT4/HCPCS,ID ALLERGY TITRATE-DRUG/BUG,,Case Rate,71.40
Blue Shield,POS,95024,CPT4/HCPCS,ICUT ALLERGY TEST DRUG/BUG,,Case Rate,76.21
Blue Shield,POS,95027,CPT4/HCPCS,ICUT ALLERGY TITRATE-AIRBORN,,Case Rate,76.21
Blue Shield,POS,95028,CPT4/HCPCS,ICUT ALLERGY TEST-DELAYED,,Case Rate,119.51
Blue Shield,POS,95044,CPT4/HCPCS,ALLERGY PATCH TESTS,,Case Rate,105.08
Blue Shield,POS,95052,CPT4/HCPCS,PHOTO PATCH TEST,,Case Rate,129.14
Blue Shield,POS,95056,CPT4/HCPCS,PHOTOSENSITIVITY TESTS,,Case Rate,90.64
Blue Shield,POS,95060,CPT4/HCPCS,EYE ALLERGY TESTS,,Case Rate,176.48
Blue Shield,POS,95065,CPT4/HCPCS,NOSE ALLERGY TEST,,Case Rate,105.08
Blue Shield,POS,95070,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,Case Rate,1109.93
Blue Shield,POS,95071,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,Case Rate,1417.88
Blue Shield,POS,95075,CPT4/HCPCS,INGESTION CHALLENGE TEST,,Case Rate,406.66
Blue Shield,POS,95115,CPT4/HCPCS,IMMUNOTHERAPY ONE INJECTION,,Case Rate,190.91
Blue Shield,POS,95117,CPT4/HCPCS,IMMUNOTHERAPY INJECTIONS,,Case Rate,248.65
Blue Shield,POS,95144,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,95.46
Blue Shield,POS,95145,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,158.01
Blue Shield,POS,95146,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,215.75
Blue Shield,POS,95147,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,206.12
Blue Shield,POS,95148,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,283.11
Blue Shield,POS,95149,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,388.96
Blue Shield,POS,95165,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,95.46
Blue Shield,POS,95170,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,66.59
Blue Shield,POS,95180,CPT4/HCPCS,RAPID DESENSITIZATION,,Case Rate,997.71
Blue Shield,POS,95250,CPT4/HCPCS,CONT GLUC MNTR PHYS/QHP EQP,,Case Rate,1842.08
Blue Shield,POS,95251,CPT4/HCPCS,CONT GLUC MNTR ANALYSIS I&R,,Case Rate,99.49
Blue Shield,POS,95800,CPT4/HCPCS,SLP STDY UNATTENDED,,Case Rate,2087.47
Blue Shield,POS,95801,CPT4/HCPCS,SLP STDY UNATND W/ANAL,,Case Rate,643.98
Blue Shield,POS,95805,CPT4/HCPCS,MULTIPLE SLEEP LATENCY TEST,,Case Rate,7643.31
Blue Shield,POS,95806,CPT4/HCPCS,SLEEP STUDY UNATT&RESP EFFT,,Case Rate,1703.28
Blue Shield,POS,95807,CPT4/HCPCS,SLEEP STUDY ATTENDED,,Case Rate,5529.60
Blue Shield,POS,95808,CPT4/HCPCS,POLYSOM ANY AGE 1-3> PARAM,,Case Rate,5933.77
Blue Shield,POS,95810,CPT4/HCPCS,POLYSOM 6/> YRS 4/> PARAM,,Case Rate,7791.06
Blue Shield,POS,95811,CPT4/HCPCS,POLYSOM 6/>YRS CPAP 4/> PARM,,Case Rate,8439.85
Blue Shield,POS,95812,CPT4/HCPCS,EEG 41-60 MINUTES,,Case Rate,1709.20
Blue Shield,POS,95813,CPT4/HCPCS,EEG EXTND MNTR 61-119 MIN,,Case Rate,2079.70
Blue Shield,POS,95816,CPT4/HCPCS,EEG AWAKE AND DROWSY,,Case Rate,1329.86
Blue Shield,POS,95819,CPT4/HCPCS,EEG AWAKE AND ASLEEP,,Case Rate,1594.50
Blue Shield,POS,95822,CPT4/HCPCS,EEG COMA OR SLEEP ONLY,,Case Rate,1928.98
Blue Shield,POS,95824,CPT4/HCPCS,EEG CEREBRAL DEATH ONLY,,Case Rate,802.14
Blue Shield,POS,95827,CPT4/HCPCS,EEG ALL NIGHT RECORDING,,Case Rate,1163.16
Blue Shield,POS,95829,CPT4/HCPCS,SURGERY ELECTROCORTICOGRAM,,Case Rate,13947.35
Blue Shield,POS,95830,CPT4/HCPCS,INSERT ELECTRODES FOR EEG,,Case Rate,1632.21
Blue Shield,POS,95831,CPT4/HCPCS,LIMB MUSCLE TESTING MANUAL,,Case Rate,225.37
Blue Shield,POS,95832,CPT4/HCPCS,HAND MUSCLE TESTING MANUAL,,Case Rate,166.85
Blue Shield,POS,95833,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,Case Rate,287.14
Blue Shield,POS,95834,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,Case Rate,315.24
Blue Shield,POS,95851,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,Case Rate,177.25
Blue Shield,POS,95852,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,Case Rate,129.14
Blue Shield,POS,95857,CPT4/HCPCS,CHOLINESTERASE CHALLENGE,,Case Rate,296.77
Blue Shield,POS,95860,CPT4/HCPCS,MUSCLE TEST ONE LIMB,,Case Rate,503.67
Blue Shield,POS,95861,CPT4/HCPCS,MUSCLE TEST 2 LIMBS,,Case Rate,380.27
Blue Shield,POS,95863,CPT4/HCPCS,MUSCLE TEST 3 LIMBS,,Case Rate,476.50
Blue Shield,POS,95864,CPT4/HCPCS,MUSCLE TEST 4 LIMBS,,Case Rate,909.69
Blue Shield,POS,95865,CPT4/HCPCS,MUSCLE TEST LARYNX,,Case Rate,339.29
Blue Shield,POS,95866,CPT4/HCPCS,MUSCLE TEST HEMIDIAPHRAGM,,Case Rate,406.03
Blue Shield,POS,95867,CPT4/HCPCS,MUSCLE TEST CRAN NERV UNILAT,,Case Rate,295.21
Blue Shield,POS,95868,CPT4/HCPCS,MUSCLE TEST CRAN NERVE BILAT,,Case Rate,356.99
Blue Shield,POS,95869,CPT4/HCPCS,MUSCLE TEST THOR PARASPINAL,,Case Rate,113.92
Blue Shield,POS,95870,CPT4/HCPCS,MUSCLE TEST NONPARASPINAL,,Case Rate,113.92
Blue Shield,POS,95872,CPT4/HCPCS,MUSCLE TEST ONE FIBER,,Case Rate,308.87
Blue Shield,POS,95873,CPT4/HCPCS,GUIDE NERV DESTR ELEC STIM,,Case Rate,104.30
Blue Shield,POS,95874,CPT4/HCPCS,GUIDE NERV DESTR NEEDLE EMG,,Case Rate,104.30
Blue Shield,POS,95875,CPT4/HCPCS,LIMB EXERCISE TEST,,Case Rate,505.37
Blue Shield,POS,95885,CPT4/HCPCS,MUSC TST DONE W/NERV TST LIM,,Case Rate,538.13
Blue Shield,POS,95886,CPT4/HCPCS,MUSC TEST DONE W/N TEST COMP,,Case Rate,566.99
Blue Shield,POS,95887,CPT4/HCPCS,MUSC TST DONE W/N TST NONEXT,,Case Rate,576.62
Blue Shield,POS,95900,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,Case Rate,537.35
Blue Shield,POS,95903,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,Case Rate,465.17
Blue Shield,POS,95904,CPT4/HCPCS,SENSE NERVE CONDUCTION TEST,,Case Rate,469.98
Blue Shield,POS,95905,CPT4/HCPCS,MOTOR &/ SENS NRVE CNDJ TEST,,Case Rate,975.98
Blue Shield,POS,95920,CPT4/HCPCS,INTRAOP NERVE TEST ADD-ON,,Case Rate,658.56
Blue Shield,POS,95921,CPT4/HCPCS,AUTONOMIC NRV PARASYM INERVJ,,Case Rate,186.10
Blue Shield,POS,95922,CPT4/HCPCS,AUTONOMIC NRV ADRENRG INERVJ,,Case Rate,186.10
Blue Shield,POS,95923,CPT4/HCPCS,AUTONOMIC NRV SYST FUNJ TEST,,Case Rate,830.86
Blue Shield,POS,95925,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,POS,95926,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,POS,95927,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,POS,95928,CPT4/HCPCS,C MOTOR EVOKED UPPR LIMBS,,Case Rate,1152.46
Blue Shield,POS,95929,CPT4/HCPCS,C MOTOR EVOKED LWR LIMBS,,Case Rate,1243.88
Blue Shield,POS,95930,CPT4/HCPCS,VISUAL EP TEST CNS W/I&R,,Case Rate,619.92
Blue Shield,POS,95933,CPT4/HCPCS,BLINK REFLEX TEST,,Case Rate,404.32
Blue Shield,POS,95934,CPT4/HCPCS,H-REFLEX TEST,,Case Rate,113.92
Blue Shield,POS,95936,CPT4/HCPCS,H-REFLEX TEST,,Case Rate,113.92
Blue Shield,POS,95937,CPT4/HCPCS,NEUROMUSCULAR JUNCTION TEST,,Case Rate,171.66
Blue Shield,POS,95938,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,3563.08
Blue Shield,POS,95939,CPT4/HCPCS,C MOTOR EVOKED UPR&LWR LIMBS,,Case Rate,4919.19
Blue Shield,POS,95950,CPT4/HCPCS,AMBULATORY EEG MONITORING,,Case Rate,2016.33
Blue Shield,POS,95951,CPT4/HCPCS,EEG MONITORING/VIDEORECORD,,Case Rate,1360.88
Blue Shield,POS,95953,CPT4/HCPCS,EEG MONITORING/COMPUTER,,Case Rate,3228.86
Blue Shield,POS,95954,CPT4/HCPCS,EEG MONITORING/GIVING DRUGS,,Case Rate,1583.17
Blue Shield,POS,95955,CPT4/HCPCS,EEG DURING SURGERY,,Case Rate,1016.47
Blue Shield,POS,95956,CPT4/HCPCS,EEG MONITOR TECHNOL ATTENDED,,Case Rate,6351.61
Blue Shield,POS,95957,CPT4/HCPCS,EEG DIGITAL ANALYSIS,,Case Rate,871.20
Blue Shield,POS,95958,CPT4/HCPCS,EEG MONITORING/FUNCTION TEST,,Case Rate,894.48
Blue Shield,POS,95961,CPT4/HCPCS,ELECTRODE STIMULATION BRAIN,,Case Rate,658.56
Blue Shield,POS,95962,CPT4/HCPCS,ELECTRODE STIM BRAIN ADD-ON,,Case Rate,658.56
Blue Shield,POS,95965,CPT4/HCPCS,MEG SPONTANEOUS,,Case Rate,22488.95
Blue Shield,POS,95966,CPT4/HCPCS,MEG EVOKED SINGLE,,Case Rate,11263.72
Blue Shield,POS,95967,CPT4/HCPCS,MEG EVOKED EACH ADDL,,Case Rate,9507.03
Blue Shield,POS,95970,CPT4/HCPCS,ALYS NPGT W/O PRGRMG,,Case Rate,421.09
Blue Shield,POS,95971,CPT4/HCPCS,ALYS SMPL SP/PN NPGT W/PRGRM,,Case Rate,355.43
Blue Shield,POS,95972,CPT4/HCPCS,ALYS CPLX SP/PN NPGT W/PRGRM,,Case Rate,638.69
Blue Shield,POS,95973,CPT4/HCPCS,ANALYZE NEUROSTIM COMPLEX,,Case Rate,326.56
Blue Shield,POS,95974,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,Case Rate,882.53
Blue Shield,POS,95975,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,Case Rate,476.65
Blue Shield,POS,95978,CPT4/HCPCS,ANALYZE NEUROSTIM BRAIN/1H,,Case Rate,1006.07
Blue Shield,POS,95979,CPT4/HCPCS,ANALYZ NEUROSTIM BRAIN ADDON,,Case Rate,450.89
Blue Shield,POS,95980,CPT4/HCPCS,IO ANAL GAST N-STIM INIT,,Case Rate,148.53
Blue Shield,POS,95981,CPT4/HCPCS,IO ANAL GAST N-STIM SUBSQ,,Case Rate,65.81
Blue Shield,POS,95982,CPT4/HCPCS,IO GA N-STIM SUBSQ W/REPROG,,Case Rate,106.78
Blue Shield,POS,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Case Rate,745.95
Blue Shield,POS,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Case Rate,726.70
Blue Shield,POS,96000,CPT4/HCPCS,MOTION ANALYSIS VIDEO/3D,,Case Rate,299.39
Blue Shield,POS,96001,CPT4/HCPCS,MOTION TEST W/FT PRESS MEAS,,Case Rate,357.91
Blue Shield,POS,96002,CPT4/HCPCS,DYNAMIC SURFACE EMG,,Case Rate,80.24
Blue Shield,POS,96003,CPT4/HCPCS,DYNAMIC FINE WIRE EMG,,Case Rate,65.81
Blue Shield,POS,96004,CPT4/HCPCS,PHYS REVIEW OF MOTION TESTS,,Case Rate,496.67
Blue Shield,POS,96040,CPT4/HCPCS,GENETIC COUNSELING 30 MIN,,Case Rate,470.76
Blue Shield,POS,96101,CPT4/HCPCS,PSYCHO TESTING BY PSYCH/PHYS,,Case Rate,178.96
Blue Shield,POS,96102,CPT4/HCPCS,PSYCHO TESTING BY TECHNICIAN,,Case Rate,47.34
Blue Shield,POS,96103,CPT4/HCPCS,PSYCHO TESTING ADMIN BY COMP,,Case Rate,51.37
Blue Shield,POS,96105,CPT4/HCPCS,ASSESSMENT OF APHASIA,,Case Rate,924.28
Blue Shield,POS,96110,CPT4/HCPCS,DEVELOPMENTAL SCREEN W/SCORE,,Case Rate,164.04
Blue Shield,POS,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,Case Rate,332.45
Blue Shield,POS,96116,CPT4/HCPCS,NUBHVL XM PHYS/QHP 1ST HR,,Case Rate,279.52
Blue Shield,POS,96118,CPT4/HCPCS,NEUROPSYCH TST BY PSYCH/PHYS,,Case Rate,231.40
Blue Shield,POS,96119,CPT4/HCPCS,NEUROPSYCH TESTING BY TEC,,Case Rate,120.73
Blue Shield,POS,96120,CPT4/HCPCS,NEUROPSYCH TST ADMIN W/COMP,,Case Rate,51.37
Blue Shield,POS,96125,CPT4/HCPCS,COGNITIVE TEST BY HC PRO,,Case Rate,242.58
Blue Shield,POS,96150,CPT4/HCPCS,ASSESS HLTH/BEHAVE INIT,,Case Rate,47.34
Blue Shield,POS,96151,CPT4/HCPCS,ASSESS HLTH/BEHAVE SUBSEQ,,Case Rate,47.34
Blue Shield,POS,96152,CPT4/HCPCS,INTERVENE HLTH/BEHAVE INDIV,,Case Rate,42.53
Blue Shield,POS,96153,CPT4/HCPCS,INTERVENE HLTH/BEHAVE GROUP,,Case Rate,13.66
Blue Shield,POS,96154,CPT4/HCPCS,INTERV HLTH/BEHAV FAM W/PT,,Case Rate,42.53
Blue Shield,POS,96155,CPT4/HCPCS,INTERV HLTH/BEHAV FAM NO PT,,Case Rate,56.18
Blue Shield,POS,96360,CPT4/HCPCS,HYDRATION IV INFUSION INIT,,Case Rate,648.94
Blue Shield,POS,96361,CPT4/HCPCS,HYDRATE IV INFUSION ADD-ON,,Case Rate,165.30
Blue Shield,POS,96365,CPT4/HCPCS,THER/PROPH/DIAG IV INF INIT,,Case Rate,788.48
Blue Shield,POS,96366,CPT4/HCPCS,THER/PROPH/DIAG IV INF ADDON,,Case Rate,194.17
Blue Shield,POS,96367,CPT4/HCPCS,TX/PROPH/DG ADDL SEQ IV INF,,Case Rate,343.33
Blue Shield,POS,96368,CPT4/HCPCS,THER/DIAG CONCURRENT INF,,Case Rate,179.73
Blue Shield,POS,96369,CPT4/HCPCS,SC THER INFUSION UP TO 1 HR,,Case Rate,1881.49
Blue Shield,POS,96370,CPT4/HCPCS,SC THER INFUSION ADDL HR,,Case Rate,121.99
Blue Shield,POS,96371,CPT4/HCPCS,SC THER INFUSION RESET PUMP,,Case Rate,985.61
Blue Shield,POS,96372,CPT4/HCPCS,THER/PROPH/DIAG INJ SC/IM,,Case Rate,210.93
Blue Shield,POS,96373,CPT4/HCPCS,THER/PROPH/DIAG INJ IA,,Case Rate,152.42
Blue Shield,POS,96374,CPT4/HCPCS,THER/PROPH/DIAG INJ IV PUSH,,Case Rate,632.03
Blue Shield,POS,96375,CPT4/HCPCS,TX/PRO/DX INJ NEW DRUG ADDON,,Case Rate,256.72
Blue Shield,POS,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,Case Rate,899.00
Blue Shield,POS,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,Case Rate,345.66
Blue Shield,POS,96405,CPT4/HCPCS,CHEMO INTRALESIONAL UP TO 7,,Case Rate,122.77
Blue Shield,POS,96406,CPT4/HCPCS,CHEMO INTRALESIONAL OVER 7,,Case Rate,146.83
Blue Shield,POS,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,Case Rate,1357.03
Blue Shield,POS,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,Case Rate,741.14
Blue Shield,POS,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,Case Rate,1769.27
Blue Shield,POS,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,Case Rate,341.00
Blue Shield,POS,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,Case Rate,1985.80
Blue Shield,POS,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,Case Rate,855.84
Blue Shield,POS,96420,CPT4/HCPCS,CHEMO IA PUSH TECNIQUE,,Case Rate,1326.60
Blue Shield,POS,96422,CPT4/HCPCS,CHEMO IA INFUSION UP TO 1 HR,,Case Rate,1860.69
Blue Shield,POS,96423,CPT4/HCPCS,CHEMO IA INFUSE EACH ADDL HR,,Case Rate,927.09
Blue Shield,POS,96425,CPT4/HCPCS,CHEMOTHERAPY INFUSION METHOD,,Case Rate,2207.13
Blue Shield,POS,96440,CPT4/HCPCS,CHEMOTHERAPY INTRACAVITARY,,Case Rate,549.75
Blue Shield,POS,96446,CPT4/HCPCS,CHEMOTX ADMN PRTL CAVITY,,Case Rate,119.66
Blue Shield,POS,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,Case Rate,435.67
Blue Shield,POS,96521,CPT4/HCPCS,REFILL/MAINT PORTABLE PUMP,,Case Rate,1530.25
Blue Shield,POS,96522,CPT4/HCPCS,REFILL/MAINT PUMP/RESVR SYST,,Case Rate,1332.97
Blue Shield,POS,96523,CPT4/HCPCS,IRRIG DRUG DELIVERY DEVICE,,Case Rate,311.98
Blue Shield,POS,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,Case Rate,187.02
Blue Shield,POS,96567,CPT4/HCPCS,PDT DSTR PRMLG LES SKN,,Case Rate,1815.69
Blue Shield,POS,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,Case Rate,241.65
Blue Shield,POS,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,Case Rate,108.34
Blue Shield,POS,96900,CPT4/HCPCS,ULTRAVIOLET LIGHT THERAPY,,Case Rate,277.52
Blue Shield,POS,96902,CPT4/HCPCS,TRICHOGRAM,,Case Rate,52.15
Blue Shield,POS,96910,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-B,,Case Rate,978.46
Blue Shield,POS,96912,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-A,,Case Rate,1261.57
Blue Shield,POS,96913,CPT4/HCPCS,PHOTOCHEMOTHERAPY UV-A OR B,,Case Rate,1796.59
Blue Shield,POS,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,Case Rate,287.14
Blue Shield,POS,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,Case Rate,276.74
Blue Shield,POS,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,Case Rate,526.17
Blue Shield,POS,96931,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,987.79
Blue Shield,POS,96932,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,6049.05
Blue Shield,POS,96933,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,987.79
Blue Shield,POS,97001,CPT4/HCPCS,PT EVALUATION,,Case Rate,342.55
Blue Shield,POS,97002,CPT4/HCPCS,PT RE-EVALUATION,,Case Rate,205.35
Blue Shield,POS,97003,CPT4/HCPCS,OT EVALUATION,,Case Rate,399.51
Blue Shield,POS,97004,CPT4/HCPCS,OT RE-EVALUATION,,Case Rate,272.71
Blue Shield,POS,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Case Rate,37.72
Blue Shield,POS,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Case Rate,71.40
Blue Shield,POS,97014,CPT4/HCPCS,ELECTRIC STIMULATION THERAPY,,Case Rate,90.64
Blue Shield,POS,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Case Rate,119.51
Blue Shield,POS,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Case Rate,85.83
Blue Shield,POS,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Case Rate,162.82
Blue Shield,POS,97024,CPT4/HCPCS,DIATHERMY EG MICROWAVE,,Case Rate,42.53
Blue Shield,POS,97026,CPT4/HCPCS,INFRARED THERAPY,,Case Rate,37.72
Blue Shield,POS,97028,CPT4/HCPCS,ULTRAVIOLET THERAPY,,Case Rate,42.53
Blue Shield,POS,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Case Rate,100.27
Blue Shield,POS,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Case Rate,215.75
Blue Shield,POS,97034,CPT4/HCPCS,CONTRAST BATH THERAPY,,Case Rate,100.27
Blue Shield,POS,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Case Rate,52.15
Blue Shield,POS,97036,CPT4/HCPCS,HYDROTHERAPY,,Case Rate,215.75
Blue Shield,POS,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Case Rate,162.04
Blue Shield,POS,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Case Rate,167.63
Blue Shield,POS,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Case Rate,259.05
Blue Shield,POS,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Case Rate,138.76
Blue Shield,POS,97124,CPT4/HCPCS,MASSAGE THERAPY,,Case Rate,133.95
Blue Shield,POS,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Case Rate,143.57
Blue Shield,POS,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Case Rate,109.89
Blue Shield,POS,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Case Rate,186.88
Blue Shield,POS,97532,CPT4/HCPCS,COGNITIVE SKILLS DEVELOPMENT,,Case Rate,109.89
Blue Shield,POS,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Case Rate,133.95
Blue Shield,POS,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Case Rate,182.06
Blue Shield,POS,97537,CPT4/HCPCS,COMMUNITY/WORK REINTEGRATION,,Case Rate,138.76
Blue Shield,POS,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Case Rate,143.57
Blue Shield,POS,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Fee Schedule,987.79
Blue Shield,POS,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Fee Schedule,987.79
Blue Shield,POS,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,Case Rate,65.81
Blue Shield,POS,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,Case Rate,74.65
Blue Shield,POS,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,Case Rate,166.85
Blue Shield,POS,97755,CPT4/HCPCS,ASSISTIVE TECHNOLOGY ASSESS,,Case Rate,142.79
Blue Shield,POS,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,Case Rate,214.19
Blue Shield,POS,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,Case Rate,166.85
Blue Shield,POS,97762,CPT4/HCPCS,C/O FOR ORTHOTIC/PROSTH USE,,Case Rate,359.32
Blue Shield,POS,97802,CPT4/HCPCS,MEDICAL NUTRITION INDIV IN,,Case Rate,230.18
Blue Shield,POS,97803,CPT4/HCPCS,MED NUTRITION INDIV SUBSEQ,,Case Rate,230.18
Blue Shield,POS,97804,CPT4/HCPCS,MEDICAL NUTRITION GROUP,,Case Rate,95.46
Blue Shield,POS,99170,CPT4/HCPCS,ANOGENITAL EXAM CHILD W IMAG,,Case Rate,883.93
Blue Shield,POS,99172,CPT4/HCPCS,OCULAR FUNCTION SCREEN,,Case Rate,262.31
Blue Shield,POS,99175,CPT4/HCPCS,INDUCTION OF VOMITING,,Case Rate,713.97
Blue Shield,POS,99183,CPT4/HCPCS,HYPERBARIC OXYGEN THERAPY,,Case Rate,1628.33
Blue Shield,POS,99184,CPT4/HCPCS,HYPOTHERMIA ILL NEONATE,,Fee Schedule,987.79
Blue Shield,POS,99190,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,7464.76
Blue Shield,POS,99191,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,5593.37
Blue Shield,POS,99192,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,3732.38
Blue Shield,POS,99195,CPT4/HCPCS,PHLEBOTOMY,,Case Rate,219.78
Blue Shield,POS,B2000ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2001ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B200YZZ,ICD10-PCS,Plain Radiography of Single Cor Art using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2010ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2011ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B201YZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2020ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2021ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B202YZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2030ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2031ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B203YZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2040ZZ,ICD10-PCS,Plain Radiography of Right Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2041ZZ,ICD10-PCS,Plain Radiography of Right Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B204YZZ,ICD10-PCS,Plain Radiography of Right Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2050ZZ,ICD10-PCS,Plain Radiography of Left Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2051ZZ,ICD10-PCS,Plain Radiography of Left Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B205YZZ,ICD10-PCS,Plain Radiography of Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2060ZZ,ICD10-PCS,Plain Radiography of R & L Heart using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2061ZZ,ICD10-PCS,Plain Radiography of R & L Heart using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B206YZZ,ICD10-PCS,Plain Radiography of Right and Left Heart using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2070ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2071ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B207YZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2080ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2081ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B208YZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B20F0ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B20F1ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B20FYZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using Other Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2100ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2101ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B210YZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using Other Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2110ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2111ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B211YZZ,ICD10-PCS,Fluoroscopy of Multiple Coronary Arteries using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2120ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2121ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B212YZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2130ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2131ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B213YZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2140ZZ,ICD10-PCS,Fluoroscopy of Right Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2141ZZ,ICD10-PCS,Fluoroscopy of Right Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B214YZZ,ICD10-PCS,Fluoroscopy of Right Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2150ZZ,ICD10-PCS,Fluoroscopy of Left Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2151ZZ,ICD10-PCS,Fluoroscopy of Left Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B215YZZ,ICD10-PCS,Fluoroscopy of Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2160ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2161ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B216YZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2170ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2171ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B217YZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2180ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B2181ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B218YZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B21F0ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B21F1ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,POS,B21FYZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Other Contrast,,Fee Schedule,8271.00
Blue Shield,POS,C8929,CPT4/HCPCS,Tte w or wo fol wcon,doppler,,Fee Schedule,3198.57
Blue Shield,POS,C8930,CPT4/HCPCS,Tte w or w/o contr, cont ecg,,Fee Schedule,3198.57
Blue Shield,POS,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Fee Schedule,6876.92
Blue Shield,POS,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Fee Schedule,6876.92
Blue Shield,POS,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Fee Schedule,6876.92
Blue Shield,POS,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,Fee Schedule,6876.92
Blue Shield,POS,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,Fee Schedule,6876.92
Blue Shield,POS,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,Fee Schedule,6876.92
Blue Shield,POS,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Fee Schedule,6876.92
Blue Shield,POS,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Fee Schedule,6876.92
Blue Shield,POS,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,Fee Schedule,6876.92
Blue Shield,POS,C9739,CPT4/HCPCS,Cystoscopy prostatic imp 1-3,,Fee Schedule,4280.44
Blue Shield,POS,C9740,CPT4/HCPCS,Cysto impl 4 or more,,Fee Schedule,4280.44
Blue Shield,POS,C9742,CPT4/HCPCS,Laryngoscopy with injection,,Fee Schedule,4280.44
Blue Shield,POS,C9748,CPT4/HCPCS,Prostatic rf water vapor tx,,Fee Schedule,12850.71
Blue Shield,POS,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Fee Schedule,3198.57
Blue Shield,POS,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Fee Schedule,4280.44
Blue Shield,POS,G0106,CPT4/HCPCS,Colon CA screen;barium enema,,Case Rate,1130.25
Blue Shield,POS,G0120,CPT4/HCPCS,Colon ca scrn; barium enema,,Case Rate,1130.25
Blue Shield,POS,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Fee Schedule,4280.44
Blue Shield,POS,G0122,CPT4/HCPCS,Colon ca scrn; barium enema,,Case Rate,1106.19
Blue Shield,POS,G0130,CPT4/HCPCS,Single energy x-ray study,,Case Rate,409.91
Blue Shield,POS,G0168,CPT4/HCPCS,Wound closure by adhesive,,Fee Schedule,3198.57
Blue Shield,POS,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,Fee Schedule,4280.44
Blue Shield,POS,G0277,CPT4/HCPCS,Hbot, full body chamber, 30m,,Fee Schedule,4280.44
Blue Shield,POS,G0279,CPT4/HCPCS,Tomosynthesis, mammo,,Fee Schedule,4280.44
Blue Shield,POS,G0288,CPT4/HCPCS,Recon, CTA for surg plan,,Case Rate,5201.81
Blue Shield,POS,G0297,CPT4/HCPCS,Ldct for lung ca screen,,Fee Schedule,4280.44
Blue Shield,POS,G0392,CPT4/HCPCS,AV fistula or graft arterial,,Fee Schedule,12850.71
Blue Shield,POS,G0393,CPT4/HCPCS,AV fistula or graft venous,,Fee Schedule,12850.71
Blue Shield,POS,Q0035,CPT4/HCPCS,Cardiokymography,,Case Rate,190.91
Blue Shield,POS,Q0092,CPT4/HCPCS,Set up port xray equipment,,Case Rate,158.01
Blue Shield,POS,X2A5312,ICD10-PCS,Cereb Filtr, Brach L Carotid Art, Perc, New Tech 2,,Fee Schedule,8271.00
Blue Shield,POS,X2RF032,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Open, New Tech 2,,Fee Schedule,8271.00
Blue Shield,POS,X2RF432,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Perc Endo, New Tech 2,,Fee Schedule,8271.00
Blue Shield,POS,,,Clinic Visit,,Case Rate,60.00
Blue Shield,POS,,,NICU/Newborn - Level I,,Per Diem,946.00
Blue Shield,POS,,,CCU,,Per Diem,4250.00
Blue Shield,POS,,,ICU,,Per Diem,4250.00
Blue Shield,POS,,,Medical Surgical,,Per Diem,4250.00
Blue Shield,POS,,,Pediatrics,,Per Diem,4250.00
Blue Shield,POS,,,NICU/Newborn - Level II,,Per Diem,5990.00
Blue Shield,POS,,,NICU/Newborn - Level III,,Per Diem,5990.00
Blue Shield,POS,,,NICU/Newborn - Level IV,,Per Diem,5990.00
Blue Shield,PPO,001U074,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U076,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U077,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U079,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U0J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U0J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U0J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U0J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U0K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U0K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U0K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U0K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,001U374,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U376,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U377,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U379,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U3J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U3J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U3J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U3J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U3K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U3K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U3K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,001U3K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0033T,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,Fee Schedule,3198.57
Blue Shield,PPO,005T0ZZ,ICD10-PCS,Destruction of Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005T3ZZ,ICD10-PCS,Destruction of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005T4ZZ,ICD10-PCS,Destruction of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005W0ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005W3ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005W4ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005X0ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005X3ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005X4ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005Y0ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005Y3ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,005Y4ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,Fee Schedule,3198.57
Blue Shield,PPO,008W0ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,008W3ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,008W4ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,008X0ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,008X3ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,008X4ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,008Y0ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,008Y3ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,008Y4ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009T00Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009T0ZX,ICD10-PCS,Drainage of Spinal Meninges, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,PPO,009T0ZZ,ICD10-PCS,DRAINAGE OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,009T30Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009T3ZX,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,009T3ZZ,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009T40Z,ICD10-PCS,Drain of Spinal Meninges with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009T4ZX,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,009T4ZZ,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009U00Z,ICD10-PCS,Drainage of Spinal Canal with Drainage Device, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009U0ZX,ICD10-PCS,Drainage of Spinal Canal, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,PPO,009U0ZZ,ICD10-PCS,DRAINAGE OF SPINAL CANAL OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,009W00Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009W0ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,PPO,009W0ZZ,ICD10-PCS,DRAINAGE OF CERVICAL SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,009W30Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009W3ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,009W3ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009W40Z,ICD10-PCS,Drain of Cerv Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009W4ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,009W4ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009X00Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009X0ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,PPO,009X0ZZ,ICD10-PCS,DRAINAGE OF THORACIC SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,009X30Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009X3ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,009X3ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009X40Z,ICD10-PCS,Drain of Thor Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009X4ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,009X4ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009Y00Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009Y0ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,PPO,009Y0ZZ,ICD10-PCS,DRAINAGE OF LUMBAR SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,009Y30Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009Y3ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,009Y3ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009Y40Z,ICD10-PCS,Drain of Lum Spinal Cord with Drain Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,009Y4ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,009Y4ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00BT0ZX,ICD10-PCS,Excision of Spinal Meninges, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,PPO,00BT0ZZ,ICD10-PCS,EXCISION OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,00BT3ZX,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,00BT3ZZ,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00BT4ZX,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,00BT4ZZ,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00BW0ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,PPO,00BW0ZZ,ICD10-PCS,EXCISION OF CERVICAL SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,00BW3ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,00BW3ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00BW4ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,00BW4ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00BX0ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,PPO,00BX0ZZ,ICD10-PCS,EXCISION OF THORACIC SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,00BX3ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,00BX3ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00BX4ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,00BX4ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00BY0ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Open Approach, Diagnostic,,Fee Schedule,8271.00
Blue Shield,PPO,00BY0ZZ,ICD10-PCS,EXCISION OF LUMBAR SPINAL CORD OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,00BY3ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,00BY3ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00BY4ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,Fee Schedule,8271.00
Blue Shield,PPO,00BY4ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00C30ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00C33ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00C34ZZ,ICD10-PCS,Extirpate of Matter from Cran Epidur Spc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00CT0ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00CT3ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00CT4ZZ,ICD10-PCS,Extirpate of Matter from Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00CW0ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00CW3ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00CW4ZZ,ICD10-PCS,Extirpate matter from Cerv Spinal Cord, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,00CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00CX4ZZ,ICD10-PCS,Extirpate matter from Thor Spinal Cord, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,00CY0ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00CY3ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00CY4ZZ,ICD10-PCS,Extirpate of Matter from Lum Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00DT0ZZ,ICD10-PCS,EXTRACTION OF SPINAL MENINGES OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,00DT3ZZ,ICD10-PCS,Extraction of Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00DT4ZZ,ICD10-PCS,Extraction of Spinal Meninges, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00FU0ZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,00FU3ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00FU4ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00FUXZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL EXTERNAL APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,00HU02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HU0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HU32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HU3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HU42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HU4MZ,ICD10-PCS,Insert of Neuro Lead into Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HV02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HV0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HV32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HV3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HV42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00HV4MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00JU0ZZ,ICD10-PCS,INSPECTION OF SPINAL CANAL OPEN,,Fee Schedule,8271.00
Blue Shield,PPO,00JU3ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00JU4ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00JV0ZZ,ICD10-PCS,INSPECTION OF SPINAL CORD OPEN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,00JV3ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00JV4ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NT0ZZ,ICD10-PCS,Release Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NT3ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NT4ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NW0ZZ,ICD10-PCS,Release Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NW3ZZ,ICD10-PCS,Release Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NW4ZZ,ICD10-PCS,Release Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NX0ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NX3ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NX4ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NY0ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NY3ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00NY4ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU00Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU02Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU03Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU30Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU32Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU33Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU40Z,ICD10-PCS,Removal of Drain Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU43Z,ICD10-PCS,Remove of Infusion Dev from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PU4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV00Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV02Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV03Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV07Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV0KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV30Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV32Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV33Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV37Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV3KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV40Z,ICD10-PCS,Removal of Drain Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV43Z,ICD10-PCS,Removal of Infusion Dev from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV47Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV4KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00PV4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QT0ZZ,ICD10-PCS,Repair Spinal Meninges, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QT3ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QT4ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QW0ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QW3ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QW4ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QX0ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QX3ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QX4ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QY0ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QY3ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00QY4ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00SW0ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00SW3ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00SW4ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00SX0ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00SX3ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00SX4ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00SY0ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00SY3ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00SY4ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00UT07Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00UT0JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00UT0KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00UT37Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00UT3JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00UT3KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00UT47Z,ICD10-PCS,Supplement Spinal Meninges w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,00UT4JZ,ICD10-PCS,Supplement Spinal Meninges w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,00UT4KZ,ICD10-PCS,Supplement Spinal Meninges w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,00WU00Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU03Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU30Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU33Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU40Z,ICD10-PCS,Revision of Drain Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WU4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV00Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV03Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV07Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV0KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV30Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV33Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV37Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV3KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV40Z,ICD10-PCS,Revision of Drain Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV47Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV4KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,00WV4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Fee Schedule,12850.71
Blue Shield,PPO,01510ZZ,ICD10-PCS,Destruction of Cervical Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,01514ZZ,ICD10-PCS,Destruction of Cervical Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,01580ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,01584ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,015B0ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,015B4ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,015R0ZZ,ICD10-PCS,DESTRUCTION OF SACRAL NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,015R4ZZ,ICD10-PCS,Destruction of Sacral Nerve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0163T,CPT4/HCPCS,LUMB ARTIF DISKECTOMY ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,0164T,CPT4/HCPCS,REMOVE LUMB ARTIF DISC ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,0165T,CPT4/HCPCS,REVISE LUMB ARTIF DISC ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,01810ZZ,ICD10-PCS,DIVISION OF CERVICAL NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,01813ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,01814ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Fee Schedule,4891.93
Blue Shield,PPO,01880ZZ,ICD10-PCS,DIVISION OF THORACIC NERVE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,01883ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,01884ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,018B0ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE OPEN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,018B3ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE PERCUTANEOUS APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,018B4ZZ,ICD10-PCS,Division of Lumbar Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,018R0ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE OPEN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,018R3ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE PERQ APPR,,Fee Schedule,8271.00
Blue Shield,PPO,018R4ZZ,ICD10-PCS,Division of Sacral Nerve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0190T,CPT4/HCPCS,PLACE INTRAOC RADIATION SRC,,Fee Schedule,3198.57
Blue Shield,PPO,0191T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Fee Schedule,12850.71
Blue Shield,PPO,0200T,CPT4/HCPCS,PERQ SACRAL AUGMT UNILAT INJ,,Fee Schedule,3198.57
Blue Shield,PPO,0201T,CPT4/HCPCS,PERQ SACRAL AUGMT BILAT INJ,,Fee Schedule,3198.57
Blue Shield,PPO,0207T,CPT4/HCPCS,CLEAR EYELID GLAND W/HEAT,,Fee Schedule,987.79
Blue Shield,PPO,0210083,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0210088,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0210089,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021008C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021008F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021008W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0210093,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0210098,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0210099,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021009C,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021009F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021009W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02100A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02100AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100AW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02100J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02100JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100JW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02100K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02100KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02100KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100KW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02100ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0210483,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0210488,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0210489,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021048C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021048F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021048W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0210493,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0210498,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0210499,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021049C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021049F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021049W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104AW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104JW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104KW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02104Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02104Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02104Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02104ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02104ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0211083,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0211088,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0211089,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021108C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021108F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021108W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0211093,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0211098,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0211099,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021109C,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021109F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021109W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02110A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02110AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110AW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02110J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02110JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110JW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02110K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02110KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02110KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110KW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02110ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0211483,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0211488,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0211489,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021148C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021148F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021148W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0211493,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0211498,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0211499,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021149C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021149F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021149W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114AW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114JW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114KW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02114Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02114Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02114Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02114ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02114ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0212083,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0212088,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0212089,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021208C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021208F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021208W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0212093,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0212098,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0212099,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021209C,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021209F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021209W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02120A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02120AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120AW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02120J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02120JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120JW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02120K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02120KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02120KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120KW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02120ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0212483,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0212488,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0212489,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021248C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021248F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021248W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0212493,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0212498,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0212499,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021249C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021249F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021249W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124AW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124JW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124KW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02124Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02124Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02124Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02124ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02124ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0213083,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0213088,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0213089,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021308C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021308F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021308W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0213093,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0213098,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0213099,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021309C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021309F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021309W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02130KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02130ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0213483,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0213488,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0213489,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021348C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021348F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021348W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0213493,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0213498,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0213499,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021349C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021349F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021349W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02134Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02134Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02134Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02134ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02134ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,PPO,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,PPO,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,PPO,021608P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021608Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021608R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021609P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021609Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021609R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160AR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160JR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160KR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160ZQ,ICD10-PCS,Bypass Right Atrium to Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02160ZR,ICD10-PCS,Bypass Right Atrium to Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021648P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021648Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021648R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021649P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021649Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021649R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02164AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02164AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02164AR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02164JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02164JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02164JR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02164KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02164KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02164KR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02164Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02164ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02164ZQ,ICD10-PCS,Bypass Right Atrium to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02164ZR,ICD10-PCS,Bypass Right Atrium to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,PPO,021708P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021708Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021708R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021709P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021709Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021709R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170AR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170JR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170KR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170ZQ,ICD10-PCS,Bypass Left Atrium to Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02170ZR,ICD10-PCS,Bypass Left Atrium to Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021748P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021748Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021748R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021749P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021749Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021749R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02174AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02174AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02174AR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02174JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02174JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02174JR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02174KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02174KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02174KR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02174ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02174ZQ,ICD10-PCS,Bypass Left Atrium to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02174ZR,ICD10-PCS,Bypass Left Atrium to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,PPO,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,PPO,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,Fee Schedule,987.79
Blue Shield,PPO,021K08P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K08Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K08R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K09P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K09Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K09R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K0AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K0AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K0AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K0JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K0JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K0JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K0KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K0KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K0KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021K0Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K0Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K0ZC,ICD10-PCS,Bypass Right Ventricle to Thoracic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K0ZF,ICD10-PCS,Bypass Right Ventricle to Abdominal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K0ZP,ICD10-PCS,Bypass Right Ventricle to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K0ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K0ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K0ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K48P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K48Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K48R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K49P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K49Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K49R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K4AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K4AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K4AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K4JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K4JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K4JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K4KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K4KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K4KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021K4Z5,ICD10-PCS,Bypass Right Ventricle to Cor Circ, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K4Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K4Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K4ZC,ICD10-PCS,Bypass Right Ventricle to Thor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K4ZF,ICD10-PCS,Bypass Right Ventricle to Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K4ZP,ICD10-PCS,Bypass Right Ventricle to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K4ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K4ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021K4ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L08P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L08Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L08R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L09P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L09Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L09R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L0AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L0AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L0AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L0JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L0JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L0JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L0KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L0KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L0KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021L0Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L0Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L0ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L0ZF,ICD10-PCS,Bypass Left Ventricle to Abdominal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L0ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L0ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L0ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L0ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L48P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L48Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L48R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L49P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L49Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L49R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L4AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L4AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L4AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L4JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L4JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L4JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L4KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L4KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L4KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021L4Z5,ICD10-PCS,Bypass Left Ventricle to Cor Circ, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L4Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L4Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L4ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L4ZF,ICD10-PCS,Bypass Left Ventricle to Abd Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L4ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L4ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L4ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021L4ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021V08P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V08Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V08R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V09P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V09Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V09R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V0AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V0AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V0AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V0JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V0JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V0JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V0KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V0KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V0KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021V0ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021V0ZQ,ICD10-PCS,Bypass Superior Vena Cava to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021V0ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021V48P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V48Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V48R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V49P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V49Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V49R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V4AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V4AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V4AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V4JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V4JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V4JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V4KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V4KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V4KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021V4ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021V4ZQ,ICD10-PCS,BYPASS SUPERIOR VENA CAVA TO RT PULM ART PC ENDO,,Fee Schedule,8271.00
Blue Shield,PPO,021V4ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021W08B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W08D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W08P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W08Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W08R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W09B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W09D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W09P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W09Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W09R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021W0ZB,ICD10-PCS,Bypass Thoracic Aorta, Descending to Subclav, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021W0ZD,ICD10-PCS,Bypass Thoracic Aorta, Descending to Carotid, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021W0ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021W0ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021W0ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021W48B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W48D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W48P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W48Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W48R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W49B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W49D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W49P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W49Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W49R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021W4ZB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021W4ZD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021W4ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021W4ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021W4ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021X08B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X08D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X08P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X08Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X08R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X09B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X09D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X09P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X09Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X09R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,021X0ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021X0ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021X0ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021X0ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021X0ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021X48B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X48D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X48P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X48Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X48R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X49B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X49D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X49P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X49Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X49R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,021X4ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021X4ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021X4ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021X4ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,021X4ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,Fee Schedule,987.79
Blue Shield,PPO,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Fee Schedule,987.79
Blue Shield,PPO,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Fee Schedule,987.79
Blue Shield,PPO,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Fee Schedule,987.79
Blue Shield,PPO,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Fee Schedule,987.79
Blue Shield,PPO,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Fee Schedule,9548.66
Blue Shield,PPO,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,Fee Schedule,9548.66
Blue Shield,PPO,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Fee Schedule,9548.66
Blue Shield,PPO,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Fee Schedule,9548.66
Blue Shield,PPO,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,Fee Schedule,9548.66
Blue Shield,PPO,0249T,CPT4/HCPCS,LIGATION HEMORRHOID W/US,,Fee Schedule,4280.44
Blue Shield,PPO,024F07J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024F08J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024F0JJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024F0KJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024G072,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024G082,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024G0J2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024G0K2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024J072,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024J082,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024J0J2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,024J0K2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,02540ZZ,ICD10-PCS,Destruction of Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02543ZZ,ICD10-PCS,Destruction of Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02544ZZ,ICD10-PCS,Destruction of Coronary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0254T,CPT4/HCPCS,EVASC RPR ILIAC ART BIFUR,,Fee Schedule,3198.57
Blue Shield,PPO,02550ZZ,ICD10-PCS,Destruction of Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02553ZZ,ICD10-PCS,Destruction of Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02560ZZ,ICD10-PCS,Destruction of Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02563ZZ,ICD10-PCS,Destruction of Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02570ZZ,ICD10-PCS,Destruction of Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02573ZZ,ICD10-PCS,Destruction of Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02580ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02583ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02590ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02593ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025D0ZZ,ICD10-PCS,Destruction of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025D3ZZ,ICD10-PCS,Destruction of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025D4ZZ,ICD10-PCS,Destruction of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025F0ZZ,ICD10-PCS,Destruction of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025F3ZZ,ICD10-PCS,Destruction of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025G0ZZ,ICD10-PCS,Destruction of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025G3ZZ,ICD10-PCS,Destruction of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025H0ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025H3ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025J0ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025J3ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025K0ZZ,ICD10-PCS,Destruction of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025K3ZZ,ICD10-PCS,Destruction of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025L0ZZ,ICD10-PCS,Destruction of Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025L3ZZ,ICD10-PCS,Destruction of Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025M0ZZ,ICD10-PCS,Destruction of Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025M3ZZ,ICD10-PCS,Destruction of Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025P0ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025P3ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025P4ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025Q0ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025Q3ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025Q4ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025R0ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025R3ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025R4ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025S0ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025S3ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025S4ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025T0ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025T3ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025T4ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025V0ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025V3ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025V4ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025W0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025W3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025W4ZZ,ICD10-PCS,Destruction of Thor Aorta Desc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025X0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025X3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,025X4ZZ,ICD10-PCS,Destruction of Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,Fee Schedule,7902.34
Blue Shield,PPO,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,Fee Schedule,6049.05
Blue Shield,PPO,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,Fee Schedule,6049.05
Blue Shield,PPO,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,Fee Schedule,9304.07
Blue Shield,PPO,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,Fee Schedule,9304.07
Blue Shield,PPO,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,Fee Schedule,4891.93
Blue Shield,PPO,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,Fee Schedule,9304.07
Blue Shield,PPO,0270046,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027004Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270056,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027005Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270066,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027006Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270076,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027007Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02700D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02700DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02700E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02700EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02700F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02700FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02700G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02700GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02700T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02700TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02700Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02700ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270346,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027034Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270356,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027035Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270366,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027036Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270376,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027037Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02703D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02703DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02703E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02703EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02703F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02703FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02703G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02703GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02703T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02703TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02703Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02703ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270446,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027044Z,ICD10-PCS,Dilate of 1 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270456,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027045Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270466,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027046Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270476,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027047Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02704D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02704DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02704E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02704EZ,ICD10-PCS,Dilate of 1 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02704F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02704FZ,ICD10-PCS,Dilate of 1 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02704G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02704GZ,ICD10-PCS,Dilate of 1 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02704T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02704TZ,ICD10-PCS,Dilate 1 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02704Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02704ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,Fee Schedule,9304.07
Blue Shield,PPO,0271046,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027104Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271056,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027105Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271066,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027106Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271076,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027107Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02710D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02710DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02710E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02710EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02710F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02710FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02710G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02710GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02710T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02710TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02710Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02710ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271346,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027134Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271356,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027135Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271366,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027136Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271376,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027137Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02713D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02713DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02713E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02713EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02713F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02713FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02713G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02713GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02713T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02713TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02713Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02713ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271446,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027144Z,ICD10-PCS,Dilate of 2 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271456,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027145Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271466,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027146Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271476,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027147Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02714D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02714DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02714E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02714EZ,ICD10-PCS,Dilate of 2 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02714F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02714FZ,ICD10-PCS,Dilate of 2 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02714G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02714GZ,ICD10-PCS,Dilate of 2 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02714T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02714TZ,ICD10-PCS,Dilate 2 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02714Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02714ZZ,ICD10-PCS,Dilation of 2 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,Fee Schedule,9304.07
Blue Shield,PPO,0272046,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027204Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272056,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027205Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272066,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027206Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272076,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027207Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02720D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02720DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02720E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02720EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02720F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02720FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02720G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02720GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02720T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02720TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02720Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02720ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272346,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027234Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272356,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027235Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272366,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027236Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272376,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027237Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02723D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02723DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02723E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02723EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02723F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02723FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02723G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02723GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02723T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02723TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02723Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02723ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272446,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027244Z,ICD10-PCS,Dilate of 3 Cor Art with Drug-elut Intra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272456,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027245Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272466,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027246Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272476,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027247Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02724D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02724DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02724E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02724EZ,ICD10-PCS,Dilate of 3 Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02724F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02724FZ,ICD10-PCS,Dilate of 3 Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02724G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02724GZ,ICD10-PCS,Dilate of 3 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02724T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02724TZ,ICD10-PCS,Dilate 3 Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02724Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02724ZZ,ICD10-PCS,Dilation of 3 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0272T,CPT4/HCPCS,INTERROGATE CRTD SNS DEV,,Fee Schedule,987.79
Blue Shield,PPO,0273046,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027304Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273056,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027305Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273066,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027306Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273076,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027307Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02730D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02730DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02730E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02730EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02730F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02730FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02730G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02730GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02730T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02730TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02730Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02730ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273346,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027334Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273356,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027335Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273366,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027336Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273376,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027337Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02733D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02733DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02733E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02733EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02733F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02733FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02733G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02733GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02733T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02733TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02733Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02733ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273446,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027344Z,ICD10-PCS,Dilate 4+ Cor Art w Drug-elut Intra, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0273456,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027345Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273466,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027346Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273476,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027347Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02734D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02734DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02734E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02734EZ,ICD10-PCS,Dilate of 4+ Cor Art with 2 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02734F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02734FZ,ICD10-PCS,Dilate of 4+ Cor Art with 3 Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02734G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02734GZ,ICD10-PCS,Dilate 4+ Cor Art w 4+ Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02734T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02734TZ,ICD10-PCS,Dilate 4+ Cor Art w Radioact Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02734Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02734ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0273T,CPT4/HCPCS,INTERROGATE CRTD SNS W/PGRMG,,Fee Schedule,987.79
Blue Shield,PPO,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,Fee Schedule,9548.66
Blue Shield,PPO,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,Fee Schedule,9548.66
Blue Shield,PPO,0278T,CPT4/HCPCS,TEMPR,,Fee Schedule,987.79
Blue Shield,PPO,027F04Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027F0DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027F0ZZ,ICD10-PCS,Dilation of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027F34Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027F3DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027F3ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027F44Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027F4DZ,ICD10-PCS,Dilate of Aortic Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027F4ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027G04Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027G0DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027G0ZZ,ICD10-PCS,Dilation of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027G34Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027G3DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027G3ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027G44Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027G4DZ,ICD10-PCS,Dilate of Mitral Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027G4ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027H04Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027H0DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027H0ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027H34Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027H3DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027H3ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027H44Z,ICD10-PCS,Dilate Pulm Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027H4DZ,ICD10-PCS,Dilation of Pulm Valve with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027H4ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027J04Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027J0DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027J0ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027J34Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027J3DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027J3ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027J44Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027J4DZ,ICD10-PCS,Dilate Tricusp Valve w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027J4ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027K04Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027K0DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027K0ZZ,ICD10-PCS,Dilation of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027K34Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027K3DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027K3ZZ,ICD10-PCS,Dilation of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027K44Z,ICD10-PCS,Dilate R Ventricle w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027K4DZ,ICD10-PCS,Dilate of R Ventricle with Intralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027K4ZZ,ICD10-PCS,Dilation of Right Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027R04T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Open,,Fee Schedule,8271.00
Blue Shield,PPO,027R0DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027R0ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027R34T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,027R3DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027R3ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,027R44T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027R4DT,ICD10-PCS,Dilate Ductus Arterio w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,027R4ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02890ZZ,ICD10-PCS,Division of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02893ZZ,ICD10-PCS,Division of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02894ZZ,ICD10-PCS,Division of Chordae Tendineae, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,028D0ZZ,ICD10-PCS,Division of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,028D3ZZ,ICD10-PCS,Division of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,028D4ZZ,ICD10-PCS,Division of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0295T,CPT4/HCPCS,EXT ECG COMPLETE,,Fee Schedule,987.79
Blue Shield,PPO,0296T,CPT4/HCPCS,EXT ECG RECORDING,,Fee Schedule,987.79
Blue Shield,PPO,0297T,CPT4/HCPCS,EXT ECG SCAN W/REPORT,,Fee Schedule,987.79
Blue Shield,PPO,0298T,CPT4/HCPCS,EXT ECG REVIEW AND INTERP,,Fee Schedule,987.79
Blue Shield,PPO,02B40ZZ,ICD10-PCS,Excision of Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B43ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B44ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B50ZZ,ICD10-PCS,Excision of Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B53ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B54ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B60ZZ,ICD10-PCS,Excision of Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B63ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B64ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B70ZZ,ICD10-PCS,Excision of Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B73ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B74ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B80ZZ,ICD10-PCS,Excision of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B83ZZ,ICD10-PCS,Excision of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B90ZZ,ICD10-PCS,Excision of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02B93ZZ,ICD10-PCS,Excision of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BD0ZZ,ICD10-PCS,Excision of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BD3ZZ,ICD10-PCS,Excision of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BD4ZZ,ICD10-PCS,Excision of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BF0ZZ,ICD10-PCS,Excision of Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BF3ZZ,ICD10-PCS,Excision of Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BG0ZZ,ICD10-PCS,Excision of Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BG3ZZ,ICD10-PCS,Excision of Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BH0ZZ,ICD10-PCS,Excision of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BH3ZZ,ICD10-PCS,Excision of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BJ0ZZ,ICD10-PCS,Excision of Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BJ3ZZ,ICD10-PCS,Excision of Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BK0ZZ,ICD10-PCS,Excision of Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BK3ZZ,ICD10-PCS,Excision of Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BK4ZZ,ICD10-PCS,Excision of Right Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BL0ZZ,ICD10-PCS,Excision of Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BL3ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BL4ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BM0ZZ,ICD10-PCS,Excision of Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BM3ZZ,ICD10-PCS,Excision of Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BP0ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BP3ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BP4ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BQ0ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BQ3ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BQ4ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BR0ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BR3ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BR4ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BS0ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BS3ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BS4ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BT0ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BT3ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BT4ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BV0ZZ,ICD10-PCS,Excision of Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BV3ZZ,ICD10-PCS,Excision of Superior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BV4ZZ,ICD10-PCS,Excision of Superior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BW0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BW3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BW4ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BX0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BX3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02BX4ZZ,ICD10-PCS,Excision of Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C00Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C00ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C03Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C03ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C04Z6,ICD10-PCS,Extirpate matter from 1 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02C04ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C10Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C10ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C13Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C13ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C14Z6,ICD10-PCS,Extirpate matter from 2 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02C14ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C20Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C20ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C23Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C23ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C24Z6,ICD10-PCS,Extirpate matter from 3 Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02C24ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C30Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C30ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C33Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C33ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C34Z6,ICD10-PCS,Extirpate matter from 4+ Cor Art, Bifurc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02C34ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C40ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C43ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02C44ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02CD0ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02CD3ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02CD4ZZ,ICD10-PCS,Extirpate matter from Papillary Muscle, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02CW0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02CW3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02CW4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Desc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02CX4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Asc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02FN0ZZ,ICD10-PCS,Fragmentation in Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02FN3ZZ,ICD10-PCS,Fragmentation in Pericardium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02FN4ZZ,ICD10-PCS,Fragmentation in Pericardium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H402Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H403Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H40DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H40KZ,ICD10-PCS,Insertion of Defibrillator Lead into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H40NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H432Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H433Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H43DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H43NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H442Z,ICD10-PCS,Insertion of Monitor Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H443Z,ICD10-PCS,Insertion of Infusion Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H44DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H44KZ,ICD10-PCS,Insertion of Defib Lead into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H44NZ,ICD10-PCS,Insert of Intracard Pacer into Cor Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H60KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H63KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H64KZ,ICD10-PCS,Insertion of Defib Lead into R Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H70KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H73KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02H74KZ,ICD10-PCS,Insertion of Defib Lead into L Atrium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HA0RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HA3RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HA4RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HK0KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HK3KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HK4KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HL0KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HL3DZ,ICD10-PCS,Insertion of Intralum Dev into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HL3KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HL3NZ,ICD10-PCS,Insertion of Intracard Pacer into L Ventricle, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HL4KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HN0KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HN3KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HN4KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HP0DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HP3DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HP4DZ,ICD10-PCS,Insert of Intralum Dev into Pulm Trunk, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HQ0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HQ3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HQ4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HR0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HR3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HR4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HS02Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HS0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HS32Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HS3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HS42Z,ICD10-PCS,Insert of Monitor Dev into R Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HS4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HT02Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HT0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HT32Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HT3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HT42Z,ICD10-PCS,Insert of Monitor Dev into L Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HT4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HW02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HW0DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HW32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HW3DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HW42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Desc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02HW4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Desc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02HX02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HX0DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HX32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HX3DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02HX42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Asc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02HX4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Asc, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02K80ZZ,ICD10-PCS,Map Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02K83ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02K84ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02LH0CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02LH0DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02LH0ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02LH3CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02LH3DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02LH3ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02LH4CZ,ICD10-PCS,Occlusion Pulm Valve w Extralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02LH4DZ,ICD10-PCS,Occlusion Pulm Valve w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02LH4ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02N40ZZ,ICD10-PCS,Release Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02N43ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02N44ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02N80ZZ,ICD10-PCS,Release Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02N83ZZ,ICD10-PCS,Release Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02N84ZZ,ICD10-PCS,Release Conduction Mechanism, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02N90ZZ,ICD10-PCS,Release Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02N93ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02N94ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02ND0ZZ,ICD10-PCS,Release Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02ND3ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02ND4ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02NF0ZZ,ICD10-PCS,Release Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02NG0ZZ,ICD10-PCS,Release Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02NH0ZZ,ICD10-PCS,Release Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02NJ0ZZ,ICD10-PCS,Release Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02NK0ZZ,ICD10-PCS,Release Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02NK3ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02NK4ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02NL0ZZ,ICD10-PCS,Release Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02NL3ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02NL4ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY02Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY03Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY07Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY08Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY0CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY0DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY0JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY0KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY32Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY33Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY37Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY38Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY3CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY3DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY3JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY3KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY42Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY43Z,ICD10-PCS,Remove of Infusion Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY47Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY48Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY4CZ,ICD10-PCS,Remove of Extralum Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY4DZ,ICD10-PCS,Remove of Intralum Dev from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY4JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02PY4KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q00ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q03ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q04ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q10ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q13ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q14ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q20ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q23ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q24ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q30ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q33ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q34ZZ,ICD10-PCS,Repair 4+ Cor Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q40ZZ,ICD10-PCS,Repair Coronary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q43ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q44ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q50ZZ,ICD10-PCS,Repair Atrial Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q53ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q54ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q60ZZ,ICD10-PCS,Repair Right Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q63ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q64ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q70ZZ,ICD10-PCS,Repair Left Atrium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q73ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q74ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q80ZZ,ICD10-PCS,Repair Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q83ZZ,ICD10-PCS,Repair Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q84ZZ,ICD10-PCS,Repair Conduction Mechanism, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q90ZZ,ICD10-PCS,Repair Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q93ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02Q94ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QA0ZZ,ICD10-PCS,Repair Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QA3ZZ,ICD10-PCS,Repair Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QA4ZZ,ICD10-PCS,Repair Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QB0ZZ,ICD10-PCS,Repair Right Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QB3ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QB4ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QC0ZZ,ICD10-PCS,Repair Left Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QC3ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QC4ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QD0ZZ,ICD10-PCS,Repair Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QD3ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QD4ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QF0ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QF0ZZ,ICD10-PCS,Repair Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QF3ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QF3ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QF4ZJ,ICD10-PCS,Repair Aort Valve created from Trunc Vlv, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QF4ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QG0ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QG0ZZ,ICD10-PCS,Repair Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QG3ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QG3ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QG4ZE,ICD10-PCS,Repair Mitral Valve fr L AV Vlv, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02QG4ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QH0ZZ,ICD10-PCS,Repair Pulmonary Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QH3ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QH4ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QJ0ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QJ0ZZ,ICD10-PCS,Repair Tricuspid Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QJ3ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QJ3ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QJ4ZG,ICD10-PCS,Repair Tricusp Valve fr R AV Vlv, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02QJ4ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QK0ZZ,ICD10-PCS,Repair Right Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QK3ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QK4ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QL0ZZ,ICD10-PCS,Repair Left Ventricle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QL3ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QL4ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QM0ZZ,ICD10-PCS,Repair Ventricular Septum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QM3ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QM4ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QN0ZZ,ICD10-PCS,Repair Pericardium, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QN3ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02QN4ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R507Z,ICD10-PCS,Replacement of Atrial Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R508Z,ICD10-PCS,Replacement of Atrial Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R50JZ,ICD10-PCS,Replacement of Atrial Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R50KZ,ICD10-PCS,Replacement of Atrial Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R547Z,ICD10-PCS,Replace of Atrial Sept with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R548Z,ICD10-PCS,Replace of Atrial Sept with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R54JZ,ICD10-PCS,Replace of Atrial Sept with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R54KZ,ICD10-PCS,Replace of Atrial Sept with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R607Z,ICD10-PCS,Replacement of Right Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R608Z,ICD10-PCS,Replacement of Right Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R60JZ,ICD10-PCS,Replacement of Right Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R60KZ,ICD10-PCS,Replacement of Right Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R647Z,ICD10-PCS,Replacement of R Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R648Z,ICD10-PCS,Replacement of R Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R64JZ,ICD10-PCS,Replacement of R Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R64KZ,ICD10-PCS,Replacement of R Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R707Z,ICD10-PCS,Replacement of Left Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R708Z,ICD10-PCS,Replacement of Left Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R70JZ,ICD10-PCS,Replacement of Left Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R70KZ,ICD10-PCS,Replacement of Left Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R747Z,ICD10-PCS,Replacement of L Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R748Z,ICD10-PCS,Replacement of L Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R74JZ,ICD10-PCS,Replacement of L Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R74KZ,ICD10-PCS,Replacement of L Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R907Z,ICD10-PCS,Replace of Chordae Tendineae with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R908Z,ICD10-PCS,Replace of Chordae Tendineae with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R90JZ,ICD10-PCS,Replace of Chordae Tendineae with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R90KZ,ICD10-PCS,Replace of Chordae Tendineae with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02R947Z,ICD10-PCS,Replace Chordae Tendineae w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02R948Z,ICD10-PCS,Replace Chordae Tendineae w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02R94JZ,ICD10-PCS,Replace Chordae Tendineae w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02R94KZ,ICD10-PCS,Replace Chordae Tendineae w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RD07Z,ICD10-PCS,Replace of Papillary Muscle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RD08Z,ICD10-PCS,Replace of Papillary Muscle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RD0JZ,ICD10-PCS,Replace of Papillary Muscle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RD0KZ,ICD10-PCS,Replace of Papillary Muscle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RD47Z,ICD10-PCS,Replace Papillary Muscle w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RD48Z,ICD10-PCS,Replace Papillary Muscle w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RD4JZ,ICD10-PCS,Replace Papillary Muscle w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RD4KZ,ICD10-PCS,Replace Papillary Muscle w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RF07Z,ICD10-PCS,Replacement of Aortic Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RF08Z,ICD10-PCS,Replacement of Aortic Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RF0JZ,ICD10-PCS,Replacement of Aortic Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RF0KZ,ICD10-PCS,Replacement of Aortic Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RF47Z,ICD10-PCS,Replace of Aortic Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RF48Z,ICD10-PCS,Replace of Aortic Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RF4JZ,ICD10-PCS,Replace of Aortic Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RF4KZ,ICD10-PCS,Replace of Aortic Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG07Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG08Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG0JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG0KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG37Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG38Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG3JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG3KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG47Z,ICD10-PCS,Replace of Mitral Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG48Z,ICD10-PCS,Replace of Mitral Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG4JZ,ICD10-PCS,Replace of Mitral Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RG4KZ,ICD10-PCS,Replace of Mitral Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RH07Z,ICD10-PCS,Replacement of Pulmonary Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RH08Z,ICD10-PCS,Replacement of Pulm Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RH0JZ,ICD10-PCS,Replacement of Pulmonary Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RH0KZ,ICD10-PCS,Replacement of Pulm Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RH47Z,ICD10-PCS,Replacement of Pulm Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RH48Z,ICD10-PCS,Replace of Pulm Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RH4JZ,ICD10-PCS,Replacement of Pulm Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RH4KZ,ICD10-PCS,Replace of Pulm Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RJ07Z,ICD10-PCS,Replacement of Tricuspid Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RJ08Z,ICD10-PCS,Replacement of Tricusp Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RJ0JZ,ICD10-PCS,Replacement of Tricuspid Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RJ0KZ,ICD10-PCS,Replacement of Tricusp Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RJ47Z,ICD10-PCS,Replace of Tricusp Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RJ48Z,ICD10-PCS,Replace of Tricusp Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RJ4JZ,ICD10-PCS,Replace of Tricusp Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RJ4KZ,ICD10-PCS,Replace of Tricusp Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RK07Z,ICD10-PCS,Replacement of Right Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RK08Z,ICD10-PCS,Replacement of R Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RK0JZ,ICD10-PCS,Replacement of Right Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RK0KZ,ICD10-PCS,Replacement of R Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RK47Z,ICD10-PCS,Replace of R Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RK48Z,ICD10-PCS,Replace of R Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RK4JZ,ICD10-PCS,Replace of R Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RK4KZ,ICD10-PCS,Replace of R Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RL07Z,ICD10-PCS,Replacement of Left Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RL08Z,ICD10-PCS,Replacement of Left Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RL0JZ,ICD10-PCS,Replacement of Left Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RL0KZ,ICD10-PCS,Replacement of Left Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RL47Z,ICD10-PCS,Replace of L Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RL48Z,ICD10-PCS,Replace of L Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RL4JZ,ICD10-PCS,Replace of L Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RL4KZ,ICD10-PCS,Replace of L Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RM07Z,ICD10-PCS,Replace of Ventricular Sept with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RM08Z,ICD10-PCS,Replace of Ventricular Sept with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RM0JZ,ICD10-PCS,Replace of Ventricular Sept with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RM0KZ,ICD10-PCS,Replace of Ventricular Sept with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RM47Z,ICD10-PCS,Replace Ventricular Sept w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RM48Z,ICD10-PCS,Replace Ventricular Sept w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RM4KZ,ICD10-PCS,Replace Ventricular Sept w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RN07Z,ICD10-PCS,Replacement of Pericardium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RN08Z,ICD10-PCS,Replacement of Pericardium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RN0JZ,ICD10-PCS,Replacement of Pericardium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RN0KZ,ICD10-PCS,Replacement of Pericardium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RN47Z,ICD10-PCS,Replace of Pericardium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RN48Z,ICD10-PCS,Replace of Pericardium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RN4JZ,ICD10-PCS,Replace of Pericardium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RN4KZ,ICD10-PCS,Replace of Pericardium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RP07Z,ICD10-PCS,Replacement of Pulmonary Trunk with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RP08Z,ICD10-PCS,Replacement of Pulm Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RP0JZ,ICD10-PCS,Replacement of Pulmonary Trunk with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RP0KZ,ICD10-PCS,Replacement of Pulm Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RP47Z,ICD10-PCS,Replacement of Pulm Trunk with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RP48Z,ICD10-PCS,Replace of Pulm Trunk with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RP4JZ,ICD10-PCS,Replacement of Pulm Trunk with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RP4KZ,ICD10-PCS,Replace of Pulm Trunk with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RQ07Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RQ08Z,ICD10-PCS,Replacement of R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RQ0JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RQ0KZ,ICD10-PCS,Replacement of R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RQ47Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RQ48Z,ICD10-PCS,Replace of R Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RQ4JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RQ4KZ,ICD10-PCS,Replace of R Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RR07Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RR08Z,ICD10-PCS,Replacement of L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RR0JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RR0KZ,ICD10-PCS,Replacement of L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RR47Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RR48Z,ICD10-PCS,Replace of L Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RR4JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RR4KZ,ICD10-PCS,Replace of L Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RS07Z,ICD10-PCS,Replacement of R Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RS08Z,ICD10-PCS,Replacement of R Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RS0JZ,ICD10-PCS,Replacement of R Pulm Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RS0KZ,ICD10-PCS,Replacement of R Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RS47Z,ICD10-PCS,Replace of R Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RS48Z,ICD10-PCS,Replace of R Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RS4JZ,ICD10-PCS,Replace of R Pulm Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RS4KZ,ICD10-PCS,Replace of R Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RT07Z,ICD10-PCS,Replacement of L Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RT08Z,ICD10-PCS,Replacement of L Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RT0JZ,ICD10-PCS,Replacement of L Pulm Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RT0KZ,ICD10-PCS,Replacement of L Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RT47Z,ICD10-PCS,Replace of L Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RT48Z,ICD10-PCS,Replace of L Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RT4JZ,ICD10-PCS,Replace of L Pulm Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RT4KZ,ICD10-PCS,Replace of L Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RV07Z,ICD10-PCS,Replacement of Sup Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RV08Z,ICD10-PCS,Replacement of Sup Vena Cava with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RV0JZ,ICD10-PCS,Replacement of Sup Vena Cava with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RV0KZ,ICD10-PCS,Replacement of Sup Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RV47Z,ICD10-PCS,Replace of Sup Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RV48Z,ICD10-PCS,Replace of Sup Vena Cava with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RV4JZ,ICD10-PCS,Replace of Sup Vena Cava with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RV4KZ,ICD10-PCS,Replace of Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RW07Z,ICD10-PCS,Replacement of Thor Aorta Desc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RW08Z,ICD10-PCS,Replace of Thor Aorta Desc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RW0JZ,ICD10-PCS,Replacement of Thor Aorta Desc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RW0KZ,ICD10-PCS,Replace of Thor Aorta Desc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RW47Z,ICD10-PCS,Replace Thor Aorta Desc w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RW48Z,ICD10-PCS,Replace Thor Aorta Desc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RW4JZ,ICD10-PCS,Replace Thor Aorta Desc w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RW4KZ,ICD10-PCS,Replace Thor Aorta Desc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RX07Z,ICD10-PCS,Replacement of Thor Aorta Asc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RX08Z,ICD10-PCS,Replacement of Thor Aorta Asc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RX0JZ,ICD10-PCS,Replacement of Thor Aorta Asc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RX0KZ,ICD10-PCS,Replacement of Thor Aorta Asc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RX47Z,ICD10-PCS,Replace of Thor Aorta Asc with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RX48Z,ICD10-PCS,Replace Thor Aorta Asc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02RX4JZ,ICD10-PCS,Replace of Thor Aorta Asc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02RX4KZ,ICD10-PCS,Replace Thor Aorta Asc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02S00ZZ,ICD10-PCS,Reposition Coronary Artery, One Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02S10ZZ,ICD10-PCS,Reposition Coronary Artery, Two Arteries, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02SP0ZZ,ICD10-PCS,Reposition Pulmonary Trunk, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02SQ0ZZ,ICD10-PCS,Reposition Right Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02SR0ZZ,ICD10-PCS,Reposition Left Pulmonary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02SS0ZZ,ICD10-PCS,Reposition Right Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02ST0ZZ,ICD10-PCS,Reposition Left Pulmonary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02SV0ZZ,ICD10-PCS,Reposition Superior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02SW0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Descending, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02SX0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Ascending/Arch, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02T80ZZ,ICD10-PCS,Resection of Conduction Mechanism, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02T83ZZ,ICD10-PCS,Resection of Conduction Mechanism, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02T90ZZ,ICD10-PCS,Resection of Chordae Tendineae, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02T93ZZ,ICD10-PCS,Resection of Chordae Tendineae, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02T94ZZ,ICD10-PCS,Resection of Chordae Tendineae, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02TD0ZZ,ICD10-PCS,Resection of Papillary Muscle, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02TD3ZZ,ICD10-PCS,Resection of Papillary Muscle, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02TD4ZZ,ICD10-PCS,Resection of Papillary Muscle, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U507Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U508Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U50JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U50KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U537Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U538Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U53JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U53KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U547Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U548Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U54JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U54KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U607Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U608Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U60JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U60KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U637Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U638Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U63JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U63KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U647Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U648Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U64JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U64KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U707Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U708Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U70JZ,ICD10-PCS,Supplement Left Atrium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U70KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U737Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U738Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U73KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U747Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U748Z,ICD10-PCS,Supplement Left Atrium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U74KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U907Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U908Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U90JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U90KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U937Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U938Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U93JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U93KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02U947Z,ICD10-PCS,Supplement Chordae Tendineae w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02U948Z,ICD10-PCS,Supplement Chordae Tendineae w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02U94JZ,ICD10-PCS,Supplement Chordae Tendineae w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02U94KZ,ICD10-PCS,Supplement Chordae Tendineae w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UA07Z,ICD10-PCS,Supplement Heart with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA08Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA0JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA0KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA37Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA38Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA3JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA3KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA47Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA48Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA4JZ,ICD10-PCS,Supplement Heart with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UA4KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UD07Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UD08Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UD0JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UD0KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UD37Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UD38Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UD3JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UD3KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UD47Z,ICD10-PCS,Supplement Papillary Muscle w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UD48Z,ICD10-PCS,Supplement Papillary Muscle w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UD4JZ,ICD10-PCS,Supplement Papillary Muscle w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UD4KZ,ICD10-PCS,Supplement Papillary Muscle w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UF07J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UF07Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF08J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UF08Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF0JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UF0JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF0KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UF0KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF37J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UF37Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF38J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UF38Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF3JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UF3JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF3KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UF3KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF47J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UF47Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF48J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UF48Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF4JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UF4JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UF4KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UF4KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG07E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UG07Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG08E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UG08Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG0JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UG0JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG0KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UG0KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG37E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UG37Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG38E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UG38Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG3JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UG3JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG3KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UG3KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG47E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UG47Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG48E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UG48Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG4JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UG4JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UG4KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UG4KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH07Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH08Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH0JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH0KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH37Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH38Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH3JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH3KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH47Z,ICD10-PCS,Supplement Pulm Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH48Z,ICD10-PCS,Supplement Pulm Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH4JZ,ICD10-PCS,Supplement Pulm Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UH4KZ,ICD10-PCS,Supplement Pulm Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ07G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ07Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ08G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ08Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ0JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ0JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ0KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ0KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ37G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ37Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ38G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ38Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ3JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ3JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ3KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ3KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ47G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ47Z,ICD10-PCS,Supplement Tricusp Valve with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ48G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ48Z,ICD10-PCS,Supplement Tricusp Valve with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ4JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ4JZ,ICD10-PCS,Supplement Tricusp Valve with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ4KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UJ4KZ,ICD10-PCS,Supplement Tricusp Valve with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK07Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK08Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK0JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK0KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK37Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK38Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK3JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK3KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK47Z,ICD10-PCS,Supplement R Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK48Z,ICD10-PCS,Supplement R Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK4JZ,ICD10-PCS,Supplement R Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UK4KZ,ICD10-PCS,Supplement R Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL07Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL08Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL0JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL0KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL37Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL38Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL3JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL3KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL47Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL48Z,ICD10-PCS,Supplement L Ventricle with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL4JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UL4KZ,ICD10-PCS,Supplement L Ventricle with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UM07Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UM08Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UM0JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UM0KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UM37Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UM38Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UM3JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UM3KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UM47Z,ICD10-PCS,Supplement Ventricular Sept w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UM48Z,ICD10-PCS,Supplement Ventricular Sept w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UM4JZ,ICD10-PCS,Supplement Ventricular Sept w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UM4KZ,ICD10-PCS,Supplement Ventricular Sept w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UN07Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN08Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN0JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN0KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN37Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN38Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN3JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN3KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN47Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN48Z,ICD10-PCS,Supplement Pericardium with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN4JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UN4KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UP07Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UP08Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UP0KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UP37Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UP38Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UP3KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UP47Z,ICD10-PCS,Supplement Pulm Trunk with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UP48Z,ICD10-PCS,Supplement Pulm Trunk with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UP4KZ,ICD10-PCS,Supplement Pulm Trunk with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UQ07Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UQ08Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UQ0KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UQ37Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UQ38Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UQ3KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UQ47Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UQ48Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UQ4KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UR07Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UR08Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UR0KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UR37Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UR38Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UR3KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UR47Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UR48Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UR4KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02US07Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02US08Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02US0KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02US37Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02US38Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02US3KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02US47Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02US48Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02US4KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UT07Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UT08Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UT0KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UT37Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UT38Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UT3KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UT47Z,ICD10-PCS,Supplement L Pulm Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UT48Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UT4KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UV07Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UV08Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UV0KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UV37Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UV38Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UV3KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UV47Z,ICD10-PCS,Supplement Sup Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UV48Z,ICD10-PCS,Supplement Sup Vena Cava with Zooplastic, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UV4KZ,ICD10-PCS,Supplement Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UW07Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UW08Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UW0KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UW37Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UW38Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UW3JZ,ICD10-PCS,Supplement Thor Aorta Desc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UW3KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UW47Z,ICD10-PCS,Supplement Thor Aorta Desc w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UW48Z,ICD10-PCS,Supplement Thor Aorta Desc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UW4JZ,ICD10-PCS,Supplement Thor Aorta Desc w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UW4KZ,ICD10-PCS,Supplement Thor Aorta Desc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UX07Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UX08Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UX0KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UX37Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UX38Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UX3JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UX3KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UX47Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UX48Z,ICD10-PCS,Supplement Thor Aorta Asc w Zooplastic, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02UX4JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02UX4KZ,ICD10-PCS,Supplement Thor Aorta Asc w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02VA0CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02VA0ZZ,ICD10-PCS,Restriction of Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02VA3CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02VA3ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02VA4CZ,ICD10-PCS,Restriction of Heart with Extralum Dev, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02VA4ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02VW0DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02VW0EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02VW0FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02VW3DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02VW3EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02VW3FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02VW4DZ,ICD10-PCS,Restrict Thor Aorta Desc w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02VW4EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02VW4FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02VX0DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02VX0EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02VX0FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Open,,Fee Schedule,8271.00
Blue Shield,PPO,02VX3DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02VX3EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02VX3FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,02VX4DZ,ICD10-PCS,Restrict Thor Aorta Asc w Intralum Dev, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02VX4EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02VX4FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,02W50JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02W54JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WF07Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WF08Z,ICD10-PCS,Revision of Zooplastic Tissue in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WF0JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WF0KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WF47Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WF48Z,ICD10-PCS,Revision of Zooplastic in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WF4JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WF4KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WG07Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WG08Z,ICD10-PCS,Revision of Zooplastic Tissue in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WG0JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WG0KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WG47Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WG48Z,ICD10-PCS,Revision of Zooplastic in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WG4JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WG4KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WH07Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WH08Z,ICD10-PCS,Revision of Zooplastic Tissue in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WH0JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WH0KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WH47Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WH48Z,ICD10-PCS,Revision of Zooplastic in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WH4JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WH4KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WJ07Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WJ08Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WJ0JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WJ0KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WJ47Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WJ48Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WJ4JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WJ4KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WM0JZ,ICD10-PCS,Revision of Synth Sub in Ventricular Sept, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WM4JZ,ICD10-PCS,Revise of Synth Sub in Ventricular Sept, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY02Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY03Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY07Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY08Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY0CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY0DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY0JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY0KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY32Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY33Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY37Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY38Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY3CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY3DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY3JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY3KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY42Z,ICD10-PCS,Revision of Monitor Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY43Z,ICD10-PCS,Revision of Infusion Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY47Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY48Z,ICD10-PCS,Revision of Zooplastic in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY4CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY4DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY4JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,02WY4KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Fee Schedule,7902.34
Blue Shield,PPO,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Fee Schedule,6876.92
Blue Shield,PPO,031309M,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,031309N,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03130AM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03130AN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03130JM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03130JN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03130KM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03130KN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03130ZM,ICD10-PCS,Bypass Right Subclavian Artery to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03130ZN,ICD10-PCS,Bypass Right Subclavian Artery to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Fee Schedule,6876.92
Blue Shield,PPO,031409M,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,031409N,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03140AM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03140AN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03140JM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03140JN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03140KM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03140KN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,03140ZM,ICD10-PCS,Bypass Left Subclavian Artery to R Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03140ZN,ICD10-PCS,Bypass Left Subclavian Artery to L Pulm Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Fee Schedule,6876.92
Blue Shield,PPO,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Fee Schedule,3198.57
Blue Shield,PPO,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Fee Schedule,3198.57
Blue Shield,PPO,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,Fee Schedule,3198.57
Blue Shield,PPO,0331T,CPT4/HCPCS,HEART SYMP IMAGE PLNR,,Fee Schedule,987.79
Blue Shield,PPO,0332T,CPT4/HCPCS,HEART SYMP IMAGE PLNR SPECT,,Fee Schedule,987.79
Blue Shield,PPO,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Fee Schedule,6876.92
Blue Shield,PPO,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,Fee Schedule,3198.57
Blue Shield,PPO,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,Fee Schedule,3198.57
Blue Shield,PPO,0342T,CPT4/HCPCS,THXP APHERESIS W/HDL DELIP,,Fee Schedule,6049.05
Blue Shield,PPO,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Fee Schedule,987.79
Blue Shield,PPO,03500ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03503ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03504ZZ,ICD10-PCS,Destruction of R Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03510ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03513ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03514ZZ,ICD10-PCS,Destruction of L Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03520ZZ,ICD10-PCS,Destruction of Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03523ZZ,ICD10-PCS,Destruction of Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03524ZZ,ICD10-PCS,Destruction of Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03530ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03533ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03534ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03540ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03543ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03544ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0375T,CPT4/HCPCS,TOTAL DISC ARTHRP ANT APPR,,Fee Schedule,987.79
Blue Shield,PPO,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Fee Schedule,3198.57
Blue Shield,PPO,0377T,CPT4/HCPCS,ANOSCPY INJ AGENT FOR INCONT,,Fee Schedule,6049.05
Blue Shield,PPO,0378T,CPT4/HCPCS,VISUAL FIELD ASSMNT REV/RPRT,,Fee Schedule,6049.05
Blue Shield,PPO,0379T,CPT4/HCPCS,VIS FIELD ASSMNT TECH SUPPT,,Fee Schedule,6049.05
Blue Shield,PPO,0380T,CPT4/HCPCS,COMP ANIMAT RET IMAG SERIES,,Fee Schedule,6049.05
Blue Shield,PPO,0387T,CPT4/HCPCS,LEADLESS PM INS/RPL VENTR,,Fee Schedule,6876.92
Blue Shield,PPO,0388T,CPT4/HCPCS,LEADLESS PM REMOVE VENTR,,Fee Schedule,6876.92
Blue Shield,PPO,0394T,CPT4/HCPCS,HDR ELCTRNC SKN SURF BRCHYTX,,Fee Schedule,12850.71
Blue Shield,PPO,0395T,CPT4/HCPCS,HDR ELCTR NTRST/NTRCV BRCHTX,,Fee Schedule,12850.71
Blue Shield,PPO,03B00ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B03ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B04ZZ,ICD10-PCS,Excision of R Int Mamm Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B10ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B13ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B14ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B20ZZ,ICD10-PCS,Excision of Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B23ZZ,ICD10-PCS,Excision of Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B24ZZ,ICD10-PCS,Excision of Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B30ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B33ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B34ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B40ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B43ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03B44ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R007Z,ICD10-PCS,Replacement of R Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R00JZ,ICD10-PCS,Replacement of R Int Mamm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R00KZ,ICD10-PCS,Replacement of R Int Mamm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R047Z,ICD10-PCS,Replace of R Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R04JZ,ICD10-PCS,Replace of R Int Mamm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R04KZ,ICD10-PCS,Replace R Int Mamm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,03R107Z,ICD10-PCS,Replacement of L Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R10JZ,ICD10-PCS,Replacement of L Int Mamm Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R10KZ,ICD10-PCS,Replacement of L Int Mamm Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R147Z,ICD10-PCS,Replace of L Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R14JZ,ICD10-PCS,Replace of L Int Mamm Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R14KZ,ICD10-PCS,Replace L Int Mamm Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,03R207Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R20JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R20KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R247Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R24JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R24KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R307Z,ICD10-PCS,Replacement of R Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R30JZ,ICD10-PCS,Replacement of R Subclav Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R30KZ,ICD10-PCS,Replacement of R Subclav Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R347Z,ICD10-PCS,Replace of R Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R34JZ,ICD10-PCS,Replace of R Subclav Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R34KZ,ICD10-PCS,Replace of R Subclav Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R407Z,ICD10-PCS,Replacement of L Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R40JZ,ICD10-PCS,Replacement of L Subclav Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R40KZ,ICD10-PCS,Replacement of L Subclav Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R447Z,ICD10-PCS,Replace of L Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R44JZ,ICD10-PCS,Replace of L Subclav Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03R44KZ,ICD10-PCS,Replace of L Subclav Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S00ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S03ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S04ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S10ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S13ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S14ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S20ZZ,ICD10-PCS,Reposition Innominate Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S23ZZ,ICD10-PCS,Reposition Innominate Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S24ZZ,ICD10-PCS,Reposition Innominate Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S30ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S33ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S34ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S40ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S43ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S44ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S50ZZ,ICD10-PCS,Reposition Right Axillary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S53ZZ,ICD10-PCS,Reposition Right Axillary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S54ZZ,ICD10-PCS,Reposition Right Axillary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S60ZZ,ICD10-PCS,Reposition Left Axillary Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S63ZZ,ICD10-PCS,Reposition Left Axillary Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S64ZZ,ICD10-PCS,Reposition Left Axillary Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S70ZZ,ICD10-PCS,Reposition Right Brachial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S73ZZ,ICD10-PCS,Reposition Right Brachial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S74ZZ,ICD10-PCS,Reposition Right Brachial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S80ZZ,ICD10-PCS,Reposition Left Brachial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S83ZZ,ICD10-PCS,Reposition Left Brachial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S84ZZ,ICD10-PCS,Reposition Left Brachial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S90ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S93ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03S94ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SA0ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SA3ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SA4ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SB0ZZ,ICD10-PCS,Reposition Right Radial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SB3ZZ,ICD10-PCS,Reposition Right Radial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SB4ZZ,ICD10-PCS,Reposition Right Radial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SC0ZZ,ICD10-PCS,Reposition Left Radial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SC3ZZ,ICD10-PCS,Reposition Left Radial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SC4ZZ,ICD10-PCS,Reposition Left Radial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SD0ZZ,ICD10-PCS,Reposition Right Hand Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SD3ZZ,ICD10-PCS,Reposition Right Hand Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SD4ZZ,ICD10-PCS,Reposition Right Hand Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SF0ZZ,ICD10-PCS,Reposition Left Hand Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SF3ZZ,ICD10-PCS,Reposition Left Hand Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SF4ZZ,ICD10-PCS,Reposition Left Hand Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SG0ZZ,ICD10-PCS,Reposition Intracranial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SG3ZZ,ICD10-PCS,Reposition Intracranial Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SG4ZZ,ICD10-PCS,Reposition Intracranial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SH0ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SH3ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SH4ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SJ0ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SJ3ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SJ4ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SK0ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SK3ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SK4ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SL0ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SL3ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SL4ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SM0ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SM3ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SM4ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SN0ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SN3ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SN4ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SP0ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SP3ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SP4ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SQ0ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SQ3ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SQ4ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SR0ZZ,ICD10-PCS,Reposition Face Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SR3ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SR4ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SS0ZZ,ICD10-PCS,Reposition Right Temporal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SS3ZZ,ICD10-PCS,Reposition Right Temporal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SS4ZZ,ICD10-PCS,Reposition Right Temporal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03ST0ZZ,ICD10-PCS,Reposition Left Temporal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03ST3ZZ,ICD10-PCS,Reposition Left Temporal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03ST4ZZ,ICD10-PCS,Reposition Left Temporal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SU0ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SU3ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SU4ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SV0ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SV3ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SV4ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SY0ZZ,ICD10-PCS,Reposition Upper Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SY3ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03SY4ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U007Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U037Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U047Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U107Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U137Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U147Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U207Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U237Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U247Z,ICD10-PCS,Supplement Innom Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U307Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U337Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U347Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U407Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U437Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U447Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U507Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U537Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U547Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U607Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U637Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U647Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U707Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U737Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U747Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U807Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U837Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U847Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U907Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U937Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03U947Z,ICD10-PCS,Supplement R Ulnar Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UA07Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UA37Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UA47Z,ICD10-PCS,Supplement L Ulnar Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UB07Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UB37Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UB47Z,ICD10-PCS,Supplement R Radial Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UC07Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UC37Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UC47Z,ICD10-PCS,Supplement L Radial Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UD07Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UD37Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UD47Z,ICD10-PCS,Supplement R Hand Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UF07Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UF37Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UF47Z,ICD10-PCS,Supplement L Hand Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UG07Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UG37Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UG47Z,ICD10-PCS,Supplement Intracran Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UH07Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UH37Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UH47Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UJ07Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UJ37Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UJ47Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UK07Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UK37Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UK47Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UL07Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UL37Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UL47Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UM07Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UM37Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UM47Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UN07Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UN37Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UN47Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UP07Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UP37Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UP47Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UQ07Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UQ37Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UQ47Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UR07Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UR37Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UR47Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03US07Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03US37Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03US47Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UT07Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UT37Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UT47Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UU07Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UU37Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UU47Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UV07Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UV37Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UV47Z,ICD10-PCS,Supplement L Thyroid Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UY07Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UY37Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,03UY47Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Fee Schedule,3198.57
Blue Shield,PPO,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Fee Schedule,6876.92
Blue Shield,PPO,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Fee Schedule,3198.57
Blue Shield,PPO,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Fee Schedule,3198.57
Blue Shield,PPO,0410090,ICD10-PCS,BYPASS ABD AORTA ABD AORTA AUTO VENOUS TISS OPN,,Fee Schedule,8271.00
Blue Shield,PPO,0410091,ICD10-PCS,Bypass Abd Aorta to Celiac Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0410092,ICD10-PCS,Bypass Abd Aorta to Mesent Art with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0410093,ICD10-PCS,BP ABDOMINAL AORTA RT RENL ART AUTO VEN TISS OPN,,Fee Schedule,8271.00
Blue Shield,PPO,0410094,ICD10-PCS,BP ABD AORTA LT RENAL ARTERY AUTO VEN TISS OPN,,Fee Schedule,8271.00
Blue Shield,PPO,0410095,ICD10-PCS,Bypass Abd Aorta to B Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0410096,ICD10-PCS,Bypass Abd Aorta to R Com Ilia with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0410097,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,0410098,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,0410099,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,041009B,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,041009C,ICD10-PCS,BP ABD AO B INTRL ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,041009D,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,041009F,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO VEN OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,041009G,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,041009H,ICD10-PCS,BP ABD AO RT FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,041009J,ICD10-PCS,BP ABD AO LT FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,041009K,ICD10-PCS,BYPS ABD AO B FEM ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,041009Q,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO VEN TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,041009R,ICD10-PCS,BYPS ABD AO LOW ART AUTO VEN TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100A0,ICD10-PCS,BYPS ABD AO ABD AO AUTO ART TISSUE OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100A1,ICD10-PCS,BP ABD AO CELIAC ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100A2,ICD10-PCS,BYPS ABD AO MES ART AUTO ART TISSUE OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100A3,ICD10-PCS,BP ABD AO RT RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100A4,ICD10-PCS,BP ABD AO LT RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100A5,ICD10-PCS,BP ABD AO B RENL ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100A6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100A7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100A8,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100A9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100AB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100AC,ICD10-PCS,BP ABDOMINAL AO BIL INTRL ILIAC ART AUTO ART OPN,,Fee Schedule,8271.00
Blue Shield,PPO,04100AD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100AF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO ART OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100AG,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100AH,ICD10-PCS,BP ABD AO RT FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100AJ,ICD10-PCS,BP ABD AO LT FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100AK,ICD10-PCS,BYPS ABD AO B FEM ART AUTO ART TISS OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100AQ,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO ART TISS OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100AR,ICD10-PCS,BYPS ABD AO LOW ART AUTO ART TISSUE OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100J0,ICD10-PCS,BYPASS ABD AO ABD AO SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100J1,ICD10-PCS,BYPS ABD AO CELIAC ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100J2,ICD10-PCS,BYPASS ABD AO MES ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100J3,ICD10-PCS,BYPS ABD AO RT RENL ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100J4,ICD10-PCS,BYPS ABD AO LT RENL ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100J5,ICD10-PCS,BYPS ABD AO BIL RENL ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100J6,ICD10-PCS,BP ABD AO RT COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100J7,ICD10-PCS,BP ABD AO LT COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100J8,ICD10-PCS,BP ABD AO B COMMON ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100J9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100JB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART SYN SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100JC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100JD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100JF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART SYN SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100JG,ICD10-PCS,BP ABD AO B EXT ILIAC ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100JH,ICD10-PCS,BYPS ABD AO RT FEM ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100JJ,ICD10-PCS,BYPS ABD AO LT FEM ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100JK,ICD10-PCS,BYPS ABD AO BIL FEM ART SYNTH SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100JQ,ICD10-PCS,BP ABD AO LOW EXTREM ART SYN SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100JR,ICD10-PCS,BYPASS ABD AO LOW ART SYNTH SUBST OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100K0,ICD10-PCS,BP ABD AO ABD AO NONAUTO TISS SUBST OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100K1,ICD10-PCS,BP ABD AO CELIAC ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100K2,ICD10-PCS,BP ABD AO MES ART NONAUTO TISS SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100K3,ICD10-PCS,BP ABD AO RT RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100K4,ICD10-PCS,BP ABD AO LT RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100K5,ICD10-PCS,BP ABD AO B RENL ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100K6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100K7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100K8,ICD10-PCS,BP ABD AO B CMN ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100K9,ICD10-PCS,BP ABD AO RT IIA NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100KB,ICD10-PCS,BP ABD AO LT IIA NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100KC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100KD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100KF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100KG,ICD10-PCS,BP ABD AO B EXT ILIAC ART NONAUTO SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100KH,ICD10-PCS,BP ABD AO RT FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100KJ,ICD10-PCS,BP ABD AO LT FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100KK,ICD10-PCS,BP ABD AO B FEM ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100KQ,ICD10-PCS,BP ABD AO LOW EXT ART NONAUTO TISS SUB OPN APPR,,Fee Schedule,8271.00
Blue Shield,PPO,04100KR,ICD10-PCS,BP ABD AO LOW ART NONAUTO TISS SUB OPN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100Z0,ICD10-PCS,BYPASS ABD AORTA ABDOMINAL AORTA OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100Z1,ICD10-PCS,BYPASS ABD AORTA CELIAC ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100Z2,ICD10-PCS,BYPASS ABD AORTA MESENTERIC ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100Z3,ICD10-PCS,BYPASS ABD AORTA RT RENAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100Z4,ICD10-PCS,BYPASS ABD AORTA LT RENAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100Z5,ICD10-PCS,BYPASS ABDDOMINAL AORTA BILATERAL RENAL ART OPEN,,Fee Schedule,8271.00
Blue Shield,PPO,04100Z6,ICD10-PCS,BYPASS ABD AO RT COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100Z7,ICD10-PCS,BYPASS ABD AO LT COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100Z8,ICD10-PCS,BYPASS ABD AO BIL COMMON ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100Z9,ICD10-PCS,BYPASS ABD AO RT INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100ZB,ICD10-PCS,BYPASS ABD AO LT INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100ZC,ICD10-PCS,BYPASS ABD AO BIL INTRL ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100ZD,ICD10-PCS,BYPASS ABD AORTA RT EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100ZF,ICD10-PCS,BYPASS ABD AORTA LT EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100ZG,ICD10-PCS,BYPASS ABD AO BIL EXT ILIAC ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100ZH,ICD10-PCS,BYPASS ABD AORTA RT FEMORAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100ZJ,ICD10-PCS,BYPASS ABD AORTA LT FEMORAL ARTERY OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100ZK,ICD10-PCS,BYPASS ABD AO BIL FEMORAL ART OPEN APPROACH,,Fee Schedule,8271.00
Blue Shield,PPO,04100ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04100ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0410490,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0410491,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0410492,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0410493,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0410494,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0410495,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0410496,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0410497,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0410498,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0410499,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041049B,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041049C,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041049D,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041049F,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041049G,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041049H,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041049J,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041049K,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041049Q,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041049R,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104A0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104A1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104A2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104A3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104A4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104A5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104A6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104A7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104A8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104A9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104AB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104AC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104AD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104AF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104AG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104AH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104AJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104AK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104AQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104AR,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104J0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104J1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104J2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104J3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104J4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104J5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104J6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104J7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104J8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104J9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104JB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104JC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104JD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104JF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104JG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104JH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104JJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104JK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104JQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104JR,ICD10-PCS,Bypass Abd Aorta to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104K0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104K1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104K2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104K3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104K4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104K5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104K6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104K7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104K8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104K9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104KB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104KC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104KD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104KF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104KG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104KH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104KJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104KK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104KQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104KR,ICD10-PCS,Bypass Abd Aorta to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04104Z0,ICD10-PCS,Bypass Abdominal Aorta to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104Z1,ICD10-PCS,Bypass Abdominal Aorta to Celiac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104Z2,ICD10-PCS,Bypass Abdominal Aorta to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104Z3,ICD10-PCS,Bypass Abdominal Aorta to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104Z4,ICD10-PCS,Bypass Abdominal Aorta to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104Z5,ICD10-PCS,Bypass Abdominal Aorta to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104Z6,ICD10-PCS,Bypass Abdominal Aorta to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104Z7,ICD10-PCS,Bypass Abdominal Aorta to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104Z8,ICD10-PCS,Bypass Abdominal Aorta to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104Z9,ICD10-PCS,Bypass Abdominal Aorta to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104ZB,ICD10-PCS,Bypass Abdominal Aorta to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104ZC,ICD10-PCS,Bypass Abdominal Aorta to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104ZD,ICD10-PCS,Bypass Abdominal Aorta to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104ZF,ICD10-PCS,Bypass Abdominal Aorta to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104ZG,ICD10-PCS,Bypass Abdominal Aorta to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104ZH,ICD10-PCS,Bypass Abdominal Aorta to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104ZJ,ICD10-PCS,Bypass Abdominal Aorta to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104ZK,ICD10-PCS,Bypass Abdominal Aorta to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04104ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Fee Schedule,3198.57
Blue Shield,PPO,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Fee Schedule,3198.57
Blue Shield,PPO,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Fee Schedule,4891.93
Blue Shield,PPO,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Fee Schedule,4891.93
Blue Shield,PPO,0414093,ICD10-PCS,Bypass Splenic Art to R Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0414094,ICD10-PCS,Bypass Splenic Art to L Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0414095,ICD10-PCS,Bypass Splenic Art to B Renal A with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04140A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,04140A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,04140A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,04140J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,04140J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,04140J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,04140K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,04140K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,04140K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,04140Z3,ICD10-PCS,Bypass Splenic Artery to Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04140Z4,ICD10-PCS,Bypass Splenic Artery to Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04140Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0414493,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0414494,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0414495,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04144A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04144A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04144A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04144J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04144J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04144J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04144K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04144K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04144K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04144Z3,ICD10-PCS,Bypass Splenic Artery to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04144Z4,ICD10-PCS,Bypass Splenic Artery to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04144Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Fee Schedule,4891.93
Blue Shield,PPO,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Fee Schedule,4891.93
Blue Shield,PPO,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Fee Schedule,4891.93
Blue Shield,PPO,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Fee Schedule,987.79
Blue Shield,PPO,041C090,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C091,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C092,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C093,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C094,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C095,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C096,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C097,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C098,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C099,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C09B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C09C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C09D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C09F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C09G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C09H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C09J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C09K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C09Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C09R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041C0Z0,ICD10-PCS,Bypass Right Common Iliac Artery to Abd Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0Z3,ICD10-PCS,Bypass Right Common Iliac Artery to R Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0Z4,ICD10-PCS,Bypass Right Common Iliac Artery to L Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0Z5,ICD10-PCS,Bypass Right Common Iliac Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0ZH,ICD10-PCS,Bypass Right Common Iliac Artery to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0ZJ,ICD10-PCS,Bypass Right Common Iliac Artery to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0ZK,ICD10-PCS,Bypass Right Common Iliac Artery to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C0ZR,ICD10-PCS,Bypass Right Common Iliac Artery to Low Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C490,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C491,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C492,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C493,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C494,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C495,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C496,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C497,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C498,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C499,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C49B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C49C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C49D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C49F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C49G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C49H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C49J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C49K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C49Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C49R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041C4Z0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4Z3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4Z4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4Z5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4ZH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4ZJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4ZK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041C4ZR,ICD10-PCS,Bypass R Com Iliac Art to Low Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D090,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D091,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D092,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D093,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D094,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D095,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D096,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D097,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D098,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D099,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D09B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D09C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D09D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D09F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D09G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D09H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D09J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D09K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D09Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D09R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041D0Z0,ICD10-PCS,Bypass Left Common Iliac Artery to Abd Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0Z1,ICD10-PCS,Bypass Left Common Iliac Artery to Celiac Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0Z2,ICD10-PCS,Bypass Left Common Iliac Artery to Mesent Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0Z3,ICD10-PCS,Bypass Left Common Iliac Artery to R Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0Z4,ICD10-PCS,Bypass Left Common Iliac Artery to L Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0Z5,ICD10-PCS,Bypass Left Common Iliac Artery to B Renal A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0Z6,ICD10-PCS,Bypass Left Common Iliac Artery to R Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0Z7,ICD10-PCS,Bypass Left Common Iliac Artery to L Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0Z8,ICD10-PCS,Bypass Left Common Iliac Artery to B Com Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0Z9,ICD10-PCS,Bypass Left Common Iliac Artery to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0ZB,ICD10-PCS,Bypass Left Common Iliac Artery to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0ZC,ICD10-PCS,Bypass Left Common Iliac Artery to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0ZD,ICD10-PCS,Bypass Left Common Iliac Artery to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0ZF,ICD10-PCS,Bypass Left Common Iliac Artery to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0ZG,ICD10-PCS,Bypass Left Common Iliac Artery to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0ZH,ICD10-PCS,Bypass Left Common Iliac Artery to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0ZJ,ICD10-PCS,Bypass Left Common Iliac Artery to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0ZK,ICD10-PCS,Bypass Left Common Iliac Artery to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0ZQ,ICD10-PCS,Bypass Left Common Iliac Artery to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D0ZR,ICD10-PCS,Bypass Left Common Iliac Artery to Low Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D490,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D491,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D492,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D493,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D494,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D495,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D496,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D497,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D498,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D499,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D49B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D49C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D49D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D49F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D49G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D49H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D49J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D49K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D49Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D49R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041D4Z0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4Z1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4Z2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4Z3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4Z4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4Z5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4Z6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4Z7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4Z8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4Z9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4ZB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4ZC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4ZD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4ZF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4ZG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4ZH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4ZJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4ZK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4ZQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041D4ZR,ICD10-PCS,Bypass L Com Iliac Art to Low Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E099,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E09B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E09C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E09D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E09F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E09G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E09H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E09J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E09K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E09P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E09Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041E0Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E0ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E0ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E0ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E0ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E0ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E0ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E0ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E0ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E0ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E0ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E499,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E49B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E49C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E49D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E49F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E49G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E49H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E49J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E49K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E49P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E49Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041E4Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E4ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E4ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E4ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E4ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E4ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E4ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E4ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E4ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E4ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041E4ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F099,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F09B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F09C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F09D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F09F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F09G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F09H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F09J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F09K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F09P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F09Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041F0Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F0ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F0ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F0ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F0ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F0ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F0ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F0ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F0ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F0ZP,ICD10-PCS,Bypass Left Internal Iliac Artery to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F0ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F499,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F49B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F49C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F49D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F49F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F49G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F49H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F49J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F49K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F49P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F49Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041F4Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F4ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F4ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F4ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F4ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F4ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F4ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F4ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F4ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F4ZP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041F4ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H099,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H09B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H09C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H09D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H09F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H09G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H09H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H09J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H09K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H09P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H09Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041H0Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H0ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H0ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H0ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H0ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H0ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H0ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H0ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H0ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H0ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H0ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H499,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H49B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H49C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H49D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H49F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H49G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H49H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H49J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H49K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H49P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H49Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041H4Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H4ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H4ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H4ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H4ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H4ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H4ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H4ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H4ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H4ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041H4ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J099,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J09B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J09C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J09D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J09F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J09G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J09H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J09J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J09K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J09P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J09Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,041J0Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J0ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J0ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J0ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J0ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J0ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J0ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J0ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J0ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J0ZP,ICD10-PCS,Bypass Left External Iliac Artery to Foot Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J0ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J499,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J49B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J49C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J49D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J49F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J49G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J49H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J49J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J49K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J49P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J49Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,041J4Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J4ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J4ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J4ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J4ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J4ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J4ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J4ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J4ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J4ZP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,041J4ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Fee Schedule,987.79
Blue Shield,PPO,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Fee Schedule,987.79
Blue Shield,PPO,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Fee Schedule,4891.93
Blue Shield,PPO,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Fee Schedule,4891.93
Blue Shield,PPO,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Fee Schedule,4891.93
Blue Shield,PPO,0443T,CPT4/HCPCS,R-T SPCTRL ALYS PRST8 TISS,,Fee Schedule,4280.44
Blue Shield,PPO,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Fee Schedule,3198.57
Blue Shield,PPO,04500ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04503ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04504ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Fee Schedule,3198.57
Blue Shield,PPO,04510ZZ,ICD10-PCS,Destruction of Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04513ZZ,ICD10-PCS,Destruction of Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04514ZZ,ICD10-PCS,Destruction of Celiac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,Fee Schedule,987.79
Blue Shield,PPO,04520ZZ,ICD10-PCS,Destruction of Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04523ZZ,ICD10-PCS,Destruction of Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04524ZZ,ICD10-PCS,Destruction of Gastric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,Fee Schedule,987.79
Blue Shield,PPO,04530ZZ,ICD10-PCS,Destruction of Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04533ZZ,ICD10-PCS,Destruction of Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04534ZZ,ICD10-PCS,Destruction of Hepatic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Fee Schedule,987.79
Blue Shield,PPO,04540ZZ,ICD10-PCS,Destruction of Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04543ZZ,ICD10-PCS,Destruction of Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04544ZZ,ICD10-PCS,Destruction of Splenic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Fee Schedule,987.79
Blue Shield,PPO,04550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04554ZZ,ICD10-PCS,Destruction of Sup Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,Fee Schedule,987.79
Blue Shield,PPO,04560ZZ,ICD10-PCS,Destruction of Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04563ZZ,ICD10-PCS,Destruction of Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04564ZZ,ICD10-PCS,Destruction of Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,Fee Schedule,987.79
Blue Shield,PPO,04570ZZ,ICD10-PCS,Destruction of Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04573ZZ,ICD10-PCS,Destruction of Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04574ZZ,ICD10-PCS,Destruction of Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Fee Schedule,987.79
Blue Shield,PPO,04580ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04583ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04584ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Fee Schedule,987.79
Blue Shield,PPO,04590ZZ,ICD10-PCS,Destruction of Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04593ZZ,ICD10-PCS,Destruction of Right Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04594ZZ,ICD10-PCS,Destruction of Right Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,Fee Schedule,987.79
Blue Shield,PPO,045A0ZZ,ICD10-PCS,Destruction of Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045A3ZZ,ICD10-PCS,Destruction of Left Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045A4ZZ,ICD10-PCS,Destruction of Left Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045B0ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045B3ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045B4ZZ,ICD10-PCS,Destruction of Inf Mesent Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045E0ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045E3ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045E4ZZ,ICD10-PCS,Destruction of R Int Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045F0ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045F3ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045F4ZZ,ICD10-PCS,Destruction of L Int Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045H0ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045H3ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045H4ZZ,ICD10-PCS,Destruction of R Ext Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045J0ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045J3ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,045J4ZZ,ICD10-PCS,Destruction of L Ext Iliac Art, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Fee Schedule,987.79
Blue Shield,PPO,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,Fee Schedule,987.79
Blue Shield,PPO,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,Fee Schedule,3198.57
Blue Shield,PPO,0474T,CPT4/HCPCS,INSJ AQUEOUS DRG DEV IO RSVR,,Fee Schedule,3198.57
Blue Shield,PPO,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Fee Schedule,4891.93
Blue Shield,PPO,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Fee Schedule,4891.93
Blue Shield,PPO,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Fee Schedule,6049.05
Blue Shield,PPO,0482T,CPT4/HCPCS,ABSL QUAN MYOCRD BLD FLO PET,,Fee Schedule,3198.57
Blue Shield,PPO,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,Fee Schedule,3198.57
Blue Shield,PPO,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,Fee Schedule,3198.57
Blue Shield,PPO,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Fee Schedule,6049.05
Blue Shield,PPO,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Fee Schedule,6049.05
Blue Shield,PPO,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Fee Schedule,4891.93
Blue Shield,PPO,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Fee Schedule,4891.93
Blue Shield,PPO,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,Fee Schedule,3198.57
Blue Shield,PPO,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Fee Schedule,4280.44
Blue Shield,PPO,04B00ZZ,ICD10-PCS,Excision of Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B03ZZ,ICD10-PCS,Excision of Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B04ZZ,ICD10-PCS,Excision of Abdominal Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B10ZZ,ICD10-PCS,Excision of Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B13ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B14ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B20ZZ,ICD10-PCS,Excision of Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B23ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B24ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B30ZZ,ICD10-PCS,Excision of Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B33ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B34ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B40ZZ,ICD10-PCS,Excision of Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B43ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B44ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B60ZZ,ICD10-PCS,Excision of Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B63ZZ,ICD10-PCS,Excision of Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B64ZZ,ICD10-PCS,Excision of Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B70ZZ,ICD10-PCS,Excision of Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B73ZZ,ICD10-PCS,Excision of Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B74ZZ,ICD10-PCS,Excision of Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B80ZZ,ICD10-PCS,Excision of Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B83ZZ,ICD10-PCS,Excision of Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B84ZZ,ICD10-PCS,Excision of Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B90ZZ,ICD10-PCS,Excision of Right Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B93ZZ,ICD10-PCS,Excision of Right Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04B94ZZ,ICD10-PCS,Excision of Right Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BA0ZZ,ICD10-PCS,Excision of Left Renal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BA3ZZ,ICD10-PCS,Excision of Left Renal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BA4ZZ,ICD10-PCS,Excision of Left Renal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BB0ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BB3ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BB4ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BE0ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BE3ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BE4ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BF0ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BF3ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BF4ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BH0ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BH3ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BH4ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BJ0ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BJ3ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04BJ4ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04C00ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04C03ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04C04ZZ,ICD10-PCS,Extirpation of Matter from Abd Aorta, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R007Z,ICD10-PCS,Replacement of Abdominal Aorta with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R00JZ,ICD10-PCS,Replacement of Abdominal Aorta with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R00KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R047Z,ICD10-PCS,Replacement of Abd Aorta with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R04JZ,ICD10-PCS,Replacement of Abd Aorta with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R04KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R107Z,ICD10-PCS,Replacement of Celiac Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R10JZ,ICD10-PCS,Replacement of Celiac Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R10KZ,ICD10-PCS,Replacement of Celiac Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R147Z,ICD10-PCS,Replacement of Celiac Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R14JZ,ICD10-PCS,Replacement of Celiac Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R14KZ,ICD10-PCS,Replace of Celiac Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R207Z,ICD10-PCS,Replacement of Gastric Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R20JZ,ICD10-PCS,Replacement of Gastric Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R20KZ,ICD10-PCS,Replacement of Gastric Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R247Z,ICD10-PCS,Replace of Gastric Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R24JZ,ICD10-PCS,Replace of Gastric Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R24KZ,ICD10-PCS,Replace of Gastric Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R307Z,ICD10-PCS,Replacement of Hepatic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R30JZ,ICD10-PCS,Replacement of Hepatic Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R30KZ,ICD10-PCS,Replacement of Hepatic Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R347Z,ICD10-PCS,Replace of Hepatic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R34JZ,ICD10-PCS,Replace of Hepatic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R34KZ,ICD10-PCS,Replace of Hepatic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R407Z,ICD10-PCS,Replacement of Splenic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R40JZ,ICD10-PCS,Replacement of Splenic Artery with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R40KZ,ICD10-PCS,Replacement of Splenic Artery with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R447Z,ICD10-PCS,Replace of Splenic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R44JZ,ICD10-PCS,Replace of Splenic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R44KZ,ICD10-PCS,Replace of Splenic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R507Z,ICD10-PCS,Replacement of Sup Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R50JZ,ICD10-PCS,Replacement of Sup Mesent Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R50KZ,ICD10-PCS,Replacement of Sup Mesent Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R547Z,ICD10-PCS,Replace of Sup Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R54JZ,ICD10-PCS,Replace of Sup Mesent Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R54KZ,ICD10-PCS,Replace Sup Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04R607Z,ICD10-PCS,Replacement of R Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R60JZ,ICD10-PCS,Replacement of R Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R60KZ,ICD10-PCS,Replacement of R Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R647Z,ICD10-PCS,Replace of R Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R64JZ,ICD10-PCS,Replace of R Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R64KZ,ICD10-PCS,Replace of R Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R707Z,ICD10-PCS,Replacement of L Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R70JZ,ICD10-PCS,Replacement of L Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R70KZ,ICD10-PCS,Replacement of L Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R747Z,ICD10-PCS,Replace of L Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R74JZ,ICD10-PCS,Replace of L Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R74KZ,ICD10-PCS,Replace of L Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R807Z,ICD10-PCS,Replacement of Mid Colic Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R80JZ,ICD10-PCS,Replacement of Mid Colic Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R80KZ,ICD10-PCS,Replacement of Mid Colic Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R847Z,ICD10-PCS,Replace of Mid Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R84JZ,ICD10-PCS,Replace of Mid Colic Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R84KZ,ICD10-PCS,Replace of Mid Colic Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R907Z,ICD10-PCS,Replacement of R Renal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R90JZ,ICD10-PCS,Replacement of R Renal Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R90KZ,ICD10-PCS,Replacement of R Renal Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R947Z,ICD10-PCS,Replace of R Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R94JZ,ICD10-PCS,Replace of R Renal Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04R94KZ,ICD10-PCS,Replace of R Renal Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RA07Z,ICD10-PCS,Replacement of L Renal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RA0JZ,ICD10-PCS,Replacement of L Renal Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RA0KZ,ICD10-PCS,Replacement of L Renal Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RA47Z,ICD10-PCS,Replace of L Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RA4JZ,ICD10-PCS,Replace of L Renal Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RA4KZ,ICD10-PCS,Replace of L Renal Art with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RB07Z,ICD10-PCS,Replacement of Inf Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RB0JZ,ICD10-PCS,Replacement of Inf Mesent Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RB0KZ,ICD10-PCS,Replacement of Inf Mesent Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RB47Z,ICD10-PCS,Replace of Inf Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RB4JZ,ICD10-PCS,Replace of Inf Mesent Art with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RB4KZ,ICD10-PCS,Replace Inf Mesent Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RC07Z,ICD10-PCS,Replacement of R Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RC0JZ,ICD10-PCS,Replacement of R Com Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RC0KZ,ICD10-PCS,Replace of R Com Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RC47Z,ICD10-PCS,Replace R Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RC4JZ,ICD10-PCS,Replace R Com Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RC4KZ,ICD10-PCS,Replace R Com Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RD07Z,ICD10-PCS,Replacement of L Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RD0JZ,ICD10-PCS,Replacement of L Com Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RD0KZ,ICD10-PCS,Replace of L Com Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RD47Z,ICD10-PCS,Replace L Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RD4JZ,ICD10-PCS,Replace L Com Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RD4KZ,ICD10-PCS,Replace L Com Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RE07Z,ICD10-PCS,Replacement of R Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RE0JZ,ICD10-PCS,Replacement of R Int Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RE0KZ,ICD10-PCS,Replace of R Int Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RE47Z,ICD10-PCS,Replace R Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RE4JZ,ICD10-PCS,Replace R Int Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RE4KZ,ICD10-PCS,Replace R Int Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RF07Z,ICD10-PCS,Replacement of L Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RF0JZ,ICD10-PCS,Replacement of L Int Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RF0KZ,ICD10-PCS,Replace of L Int Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RF47Z,ICD10-PCS,Replace L Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RF4JZ,ICD10-PCS,Replace L Int Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RF4KZ,ICD10-PCS,Replace L Int Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RH07Z,ICD10-PCS,Replacement of R Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RH0JZ,ICD10-PCS,Replacement of R Ext Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RH0KZ,ICD10-PCS,Replace of R Ext Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RH47Z,ICD10-PCS,Replace R Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RH4JZ,ICD10-PCS,Replace R Ext Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RH4KZ,ICD10-PCS,Replace R Ext Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RJ07Z,ICD10-PCS,Replacement of L Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RJ0JZ,ICD10-PCS,Replacement of L Ext Iliac Art with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RJ0KZ,ICD10-PCS,Replace of L Ext Iliac Art with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04RJ47Z,ICD10-PCS,Replace L Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RJ4JZ,ICD10-PCS,Replace L Ext Iliac Art w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04RJ4KZ,ICD10-PCS,Replace L Ext Iliac Art w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04S00ZZ,ICD10-PCS,Reposition Abdominal Aorta, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S03ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S04ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S10ZZ,ICD10-PCS,Reposition Celiac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S13ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S14ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S20ZZ,ICD10-PCS,Reposition Gastric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S23ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S24ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S30ZZ,ICD10-PCS,Reposition Hepatic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S33ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S34ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S40ZZ,ICD10-PCS,Reposition Splenic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S43ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S44ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S60ZZ,ICD10-PCS,Reposition Right Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S63ZZ,ICD10-PCS,Reposition Right Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S64ZZ,ICD10-PCS,Reposition Right Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S70ZZ,ICD10-PCS,Reposition Left Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S73ZZ,ICD10-PCS,Reposition Left Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S74ZZ,ICD10-PCS,Reposition Left Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S80ZZ,ICD10-PCS,Reposition Middle Colic Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S83ZZ,ICD10-PCS,Reposition Middle Colic Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04S84ZZ,ICD10-PCS,Reposition Middle Colic Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SB0ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SB3ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SB4ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SE0ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SE3ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SE4ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SF0ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SF3ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SF4ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SH0ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SH3ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SH4ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SJ0ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SJ3ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SJ4ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SK0ZZ,ICD10-PCS,Reposition Right Femoral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SK3ZZ,ICD10-PCS,Reposition Right Femoral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SK4ZZ,ICD10-PCS,Reposition Right Femoral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SL0ZZ,ICD10-PCS,Reposition Left Femoral Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SL3ZZ,ICD10-PCS,Reposition Left Femoral Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SL4ZZ,ICD10-PCS,Reposition Left Femoral Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SM0ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SM3ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SM4ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SN0ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SN3ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SN4ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SP0ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SP3ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SP4ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SQ0ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SQ3ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SQ4ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SR0ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SR3ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SR4ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SS0ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SS3ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SS4ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04ST0ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04ST3ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04ST4ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SU0ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SU3ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SU4ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SV0ZZ,ICD10-PCS,Reposition Right Foot Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SV3ZZ,ICD10-PCS,Reposition Right Foot Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SV4ZZ,ICD10-PCS,Reposition Right Foot Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SW0ZZ,ICD10-PCS,Reposition Left Foot Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SW3ZZ,ICD10-PCS,Reposition Left Foot Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SW4ZZ,ICD10-PCS,Reposition Left Foot Artery, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SY0ZZ,ICD10-PCS,Reposition Lower Artery, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SY3ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04SY4ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U007Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U037Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U047Z,ICD10-PCS,Supplement Abd Aorta with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U107Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U137Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U147Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U207Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U237Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U247Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U307Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U337Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U347Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U407Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U437Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U447Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U507Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U537Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U547Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U607Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U637Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U647Z,ICD10-PCS,Supplement R Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U707Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U737Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U747Z,ICD10-PCS,Supplement L Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U807Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U837Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U847Z,ICD10-PCS,Supplement Mid Colic Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U907Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U937Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04U947Z,ICD10-PCS,Supplement R Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UA07Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UA37Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UA47Z,ICD10-PCS,Supplement L Renal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UB07Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UB37Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UB47Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UC07Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UC37Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UC47Z,ICD10-PCS,Supplement R Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04UD07Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UD37Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UD47Z,ICD10-PCS,Supplement L Com Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04UE07Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UE37Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UE47Z,ICD10-PCS,Supplement R Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04UF07Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UF37Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UF47Z,ICD10-PCS,Supplement L Int Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04UH07Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UH37Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UH47Z,ICD10-PCS,Supplement R Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04UJ07Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UJ37Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UJ47Z,ICD10-PCS,Supplement L Ext Iliac Art w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,04UK07Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UK37Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UK47Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UL07Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UL37Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UL47Z,ICD10-PCS,Supplement L Femor Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UM07Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UM37Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UM47Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UN07Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UN37Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UN47Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UP07Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UP37Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UP47Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UQ07Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UQ37Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UQ47Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UR07Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UR37Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UR47Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04US07Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04US37Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04US47Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UT07Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UT37Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UT47Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UU07Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UU37Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UU47Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UV07Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UV37Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UV47Z,ICD10-PCS,Supplement R Foot Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UW07Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UW37Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UW47Z,ICD10-PCS,Supplement L Foot Art with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UY07Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UY37Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,04UY47Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051007Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051009Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05100AY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05100JY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05100KY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05100ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051047Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,051049Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05104AY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05104JY,ICD10-PCS,BYPASS AZYGOS VEIN UP VEIN SYNTH SUB PERC ENDO,,Fee Schedule,8271.00
Blue Shield,PPO,05104KY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05104ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051107Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,051109Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05110AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05110JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05110KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05110ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051147Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,051149Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05114AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05114JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05114KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05114ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051307Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051309Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05130AY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05130JY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05130KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05130ZY,ICD10-PCS,Bypass Right Innominate Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051347Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,051349Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05134AY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05134JY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05134KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05134ZY,ICD10-PCS,Bypass Right Innominate Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051407Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051409Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Vn, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05140AY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Art, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05140JY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05140KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05140ZY,ICD10-PCS,Bypass Left Innominate Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051447Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,051449Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05144AY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05144JY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05144KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05144ZY,ICD10-PCS,Bypass Left Innominate Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051507Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,051509Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05150AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05150JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05150KY,ICD10-PCS,BYPS RT SV UP VEIN NONAUT SUB OPEN,,Fee Schedule,8271.00
Blue Shield,PPO,05150ZY,ICD10-PCS,Bypass Right Subclavian Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051547Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,051549Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05154AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05154JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05154KY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05154ZY,ICD10-PCS,Bypass Right Subclavian Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051607Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,051609Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05160AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05160JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05160KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Open,,Fee Schedule,8271.00
Blue Shield,PPO,05160ZY,ICD10-PCS,Bypass Left Subclavian Vein to Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,051647Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,051649Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05164AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05164JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05164KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05164ZY,ICD10-PCS,Bypass Left Subclavian Vein to Up Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05500ZZ,ICD10-PCS,Destruction of Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05503ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05504ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05510ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05513ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05514ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05530ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05533ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05534ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05540ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05543ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05544ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05550ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05553ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05554ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05560ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05563ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05564ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B00ZZ,ICD10-PCS,Excision of Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B03ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B04ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B10ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B13ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B14ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B30ZZ,ICD10-PCS,Excision of Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B33ZZ,ICD10-PCS,Excision of Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B34ZZ,ICD10-PCS,Excision of Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B40ZZ,ICD10-PCS,Excision of Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B43ZZ,ICD10-PCS,Excision of Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B44ZZ,ICD10-PCS,Excision of Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B50ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B53ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B54ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B60ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B63ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05B64ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R007Z,ICD10-PCS,Replacement of Azygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R00JZ,ICD10-PCS,Replacement of Azygos Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R00KZ,ICD10-PCS,Replacement of Azygos Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R047Z,ICD10-PCS,Replace of Azygos Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R04JZ,ICD10-PCS,Replace of Azygos Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R04KZ,ICD10-PCS,Replace of Azygos Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R107Z,ICD10-PCS,Replacement of Hemiazygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R10JZ,ICD10-PCS,Replacement of Hemiazygos Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R10KZ,ICD10-PCS,Replace of Hemiazygos Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R147Z,ICD10-PCS,Replace Hemiazygos Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05R14JZ,ICD10-PCS,Replace Hemiazygos Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05R14KZ,ICD10-PCS,Replace Hemiazygos Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05R307Z,ICD10-PCS,Replacement of R Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R30JZ,ICD10-PCS,Replacement of R Innom Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R30KZ,ICD10-PCS,Replacement of R Innom Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R347Z,ICD10-PCS,Replace of R Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R34JZ,ICD10-PCS,Replace of R Innom Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R34KZ,ICD10-PCS,Replace of R Innom Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R407Z,ICD10-PCS,Replacement of L Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R40JZ,ICD10-PCS,Replacement of L Innom Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R40KZ,ICD10-PCS,Replacement of L Innom Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R447Z,ICD10-PCS,Replace of L Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R44JZ,ICD10-PCS,Replace of L Innom Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R44KZ,ICD10-PCS,Replace of L Innom Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R507Z,ICD10-PCS,Replacement of R Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R50JZ,ICD10-PCS,Replacement of R Subclav Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R50KZ,ICD10-PCS,Replacement of R Subclav Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R547Z,ICD10-PCS,Replace of R Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R54JZ,ICD10-PCS,Replace of R Subclav Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R54KZ,ICD10-PCS,Replace R Subclav Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05R607Z,ICD10-PCS,Replacement of L Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R60JZ,ICD10-PCS,Replacement of L Subclav Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R60KZ,ICD10-PCS,Replacement of L Subclav Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R647Z,ICD10-PCS,Replace of L Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R64JZ,ICD10-PCS,Replace of L Subclav Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05R64KZ,ICD10-PCS,Replace L Subclav Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05S00ZZ,ICD10-PCS,Reposition Azygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S03ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S04ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S10ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S13ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S14ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S30ZZ,ICD10-PCS,Reposition Right Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S33ZZ,ICD10-PCS,Reposition Right Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S34ZZ,ICD10-PCS,Reposition Right Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S40ZZ,ICD10-PCS,Reposition Left Innominate Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S43ZZ,ICD10-PCS,Reposition Left Innominate Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S44ZZ,ICD10-PCS,Reposition Left Innominate Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S50ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S53ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S54ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S60ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S63ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S64ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S70ZZ,ICD10-PCS,Reposition Right Axillary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S73ZZ,ICD10-PCS,REPOSITION RIGHT AXILLARY VEIN PERQ,,Fee Schedule,8271.00
Blue Shield,PPO,05S74ZZ,ICD10-PCS,Reposition Right Axillary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S80ZZ,ICD10-PCS,Reposition Left Axillary Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S83ZZ,ICD10-PCS,Reposition Left Axillary Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S84ZZ,ICD10-PCS,Reposition Left Axillary Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S90ZZ,ICD10-PCS,Reposition Right Brachial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S93ZZ,ICD10-PCS,Reposition Right Brachial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05S94ZZ,ICD10-PCS,Reposition Right Brachial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SA0ZZ,ICD10-PCS,Reposition Left Brachial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SA3ZZ,ICD10-PCS,Reposition Left Brachial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SA4ZZ,ICD10-PCS,Reposition Left Brachial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SB0ZZ,ICD10-PCS,Reposition Right Basilic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SB3ZZ,ICD10-PCS,Reposition Right Basilic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SB4ZZ,ICD10-PCS,Reposition Right Basilic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SC0ZZ,ICD10-PCS,Reposition Left Basilic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SC3ZZ,ICD10-PCS,Reposition Left Basilic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SC4ZZ,ICD10-PCS,Reposition Left Basilic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SD0ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SD3ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SD4ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SF0ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SF3ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SF4ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SG0ZZ,ICD10-PCS,Reposition Right Hand Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SG3ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SG4ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SH0ZZ,ICD10-PCS,Reposition Left Hand Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SH3ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SH4ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SL0ZZ,ICD10-PCS,Reposition Intracranial Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SL3ZZ,ICD10-PCS,Reposition Intracranial Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SL4ZZ,ICD10-PCS,Reposition Intracranial Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SM0ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SM3ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SM4ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SN0ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SN3ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SN4ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SP0ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SP3ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SP4ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SQ0ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SQ3ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SQ4ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SR0ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SR3ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SR4ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SS0ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SS3ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SS4ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05ST0ZZ,ICD10-PCS,Reposition Right Face Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05ST3ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05ST4ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SV0ZZ,ICD10-PCS,Reposition Left Face Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SV3ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SV4ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SY0ZZ,ICD10-PCS,Reposition Upper Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SY3ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05SY4ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U007Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U037Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U047Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U107Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U137Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U147Z,ICD10-PCS,Supplement Hemiazygos Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05U307Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U337Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U347Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U407Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U437Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U447Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U507Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U537Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U547Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U607Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U637Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U647Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U707Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U737Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U747Z,ICD10-PCS,Supplement R Axilla Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U807Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U837Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U847Z,ICD10-PCS,Supplement L Axilla Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U907Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U937Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05U947Z,ICD10-PCS,Supplement R Brach Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UA07Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UA37Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UA47Z,ICD10-PCS,Supplement L Brach Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UB07Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UB37Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UB47Z,ICD10-PCS,Supplement R Basilic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UC07Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UC37Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UC47Z,ICD10-PCS,Supplement L Basilic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UD07Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UD37Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UD47Z,ICD10-PCS,Supplement R Cephalic Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05UF07Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UF37Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UF47Z,ICD10-PCS,Supplement L Cephalic Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05UG07Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UG37Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UG47Z,ICD10-PCS,Supplement R Hand Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UH07Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UH37Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UH47Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UL07Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UL37Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UL47Z,ICD10-PCS,Supplement Intracran Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UM07Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UM37Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UM47Z,ICD10-PCS,Supplement R Int Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05UN07Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UN37Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UN47Z,ICD10-PCS,Supplement L Int Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05UP07Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UP37Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UP47Z,ICD10-PCS,Supplement R Ext Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05UQ07Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UQ37Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UQ47Z,ICD10-PCS,Supplement L Ext Jugular Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,05UR07Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UR37Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UR47Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05US07Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05US37Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05US47Z,ICD10-PCS,Supplement L Verteb Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UT07Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UT37Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UT47Z,ICD10-PCS,Supplement R Face Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UV07Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UV37Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UV47Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UY07Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UY37Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,05UY47Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06500ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06503ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06504ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06510ZZ,ICD10-PCS,Destruction of Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06513ZZ,ICD10-PCS,Destruction of Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06514ZZ,ICD10-PCS,Destruction of Splenic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06520ZZ,ICD10-PCS,Destruction of Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06523ZZ,ICD10-PCS,Destruction of Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06524ZZ,ICD10-PCS,Destruction of Gastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06540ZZ,ICD10-PCS,Destruction of Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06543ZZ,ICD10-PCS,Destruction of Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06544ZZ,ICD10-PCS,Destruction of Hepatic Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06554ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06560ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06563ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06564ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06570ZZ,ICD10-PCS,Destruction of Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06573ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06574ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06580ZZ,ICD10-PCS,Destruction of Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06583ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06584ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06590ZZ,ICD10-PCS,Destruction of Right Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06593ZZ,ICD10-PCS,Destruction of Right Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06594ZZ,ICD10-PCS,Destruction of Right Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065B0ZZ,ICD10-PCS,Destruction of Left Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065B3ZZ,ICD10-PCS,Destruction of Left Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065B4ZZ,ICD10-PCS,Destruction of Left Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065F0ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065F3ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065F4ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065G0ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065G3ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065G4ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065H0ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065H3ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065H4ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065J0ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065J3ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,065J4ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B00ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B03ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B04ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B10ZZ,ICD10-PCS,Excision of Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B13ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B14ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B20ZZ,ICD10-PCS,Excision of Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B23ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B24ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B40ZZ,ICD10-PCS,Excision of Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B43ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B44ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B60ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B63ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B64ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B70ZZ,ICD10-PCS,Excision of Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B73ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B74ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B80ZZ,ICD10-PCS,Excision of Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B83ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B84ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B90ZZ,ICD10-PCS,Excision of Right Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B93ZZ,ICD10-PCS,Excision of Right Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06B94ZZ,ICD10-PCS,Excision of Right Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BB0ZZ,ICD10-PCS,Excision of Left Renal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BB3ZZ,ICD10-PCS,Excision of Left Renal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BB4ZZ,ICD10-PCS,Excision of Left Renal Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BF0ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BF3ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BF4ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BG0ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BG3ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BG4ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BH0ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BH3ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BH4ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BJ0ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BJ3ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06BJ4ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R007Z,ICD10-PCS,Replacement of Inf Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R00JZ,ICD10-PCS,Replacement of Inf Vena Cava with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R00KZ,ICD10-PCS,Replacement of Inf Vena Cava with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R047Z,ICD10-PCS,Replace of Inf Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R04JZ,ICD10-PCS,Replace of Inf Vena Cava with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R04KZ,ICD10-PCS,Replace of Inf Vena Cava with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R107Z,ICD10-PCS,Replacement of Splenic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R10JZ,ICD10-PCS,Replacement of Splenic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R10KZ,ICD10-PCS,Replacement of Splenic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R147Z,ICD10-PCS,Replace of Splenic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R14JZ,ICD10-PCS,Replace of Splenic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R14KZ,ICD10-PCS,Replace of Splenic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R207Z,ICD10-PCS,Replacement of Gastric Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R20JZ,ICD10-PCS,Replacement of Gastric Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R20KZ,ICD10-PCS,Replacement of Gastric Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R247Z,ICD10-PCS,Replace of Gastric Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R24JZ,ICD10-PCS,Replace of Gastric Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R24KZ,ICD10-PCS,Replace of Gastric Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R407Z,ICD10-PCS,Replacement of Hepatic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R40JZ,ICD10-PCS,Replacement of Hepatic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R40KZ,ICD10-PCS,Replacement of Hepatic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R447Z,ICD10-PCS,Replace of Hepatic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R44JZ,ICD10-PCS,Replace of Hepatic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R44KZ,ICD10-PCS,Replace of Hepatic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R507Z,ICD10-PCS,Replacement of Sup Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R50JZ,ICD10-PCS,Replacement of Sup Mesent Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R50KZ,ICD10-PCS,Replace of Sup Mesent Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R547Z,ICD10-PCS,Replace Sup Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06R54JZ,ICD10-PCS,Replace Sup Mesent Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06R54KZ,ICD10-PCS,Replace Sup Mesent Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06R607Z,ICD10-PCS,Replacement of Inf Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R60JZ,ICD10-PCS,Replacement of Inf Mesent Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R60KZ,ICD10-PCS,Replace of Inf Mesent Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R647Z,ICD10-PCS,Replace Inf Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06R64JZ,ICD10-PCS,Replace Inf Mesent Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06R64KZ,ICD10-PCS,Replace Inf Mesent Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06R707Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R70JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R70KZ,ICD10-PCS,Replacement of Colic Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R747Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R74JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R74KZ,ICD10-PCS,Replace of Colic Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R807Z,ICD10-PCS,Replacement of Portal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R80JZ,ICD10-PCS,Replacement of Portal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R80KZ,ICD10-PCS,Replacement of Portal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R847Z,ICD10-PCS,Replace of Portal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R84JZ,ICD10-PCS,Replace of Portal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R84KZ,ICD10-PCS,Replace of Portal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R907Z,ICD10-PCS,Replacement of R Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R90JZ,ICD10-PCS,Replacement of R Renal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R90KZ,ICD10-PCS,Replacement of R Renal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R947Z,ICD10-PCS,Replace of R Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R94JZ,ICD10-PCS,Replace of R Renal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06R94KZ,ICD10-PCS,Replace of R Renal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RB07Z,ICD10-PCS,Replacement of Left Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RB0JZ,ICD10-PCS,Replacement of Left Renal Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RB0KZ,ICD10-PCS,Replacement of L Renal Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RB47Z,ICD10-PCS,Replace of L Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RB4JZ,ICD10-PCS,Replace of L Renal Vein with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RB4KZ,ICD10-PCS,Replace of L Renal Vein with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RC07Z,ICD10-PCS,Replace of R Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RC0JZ,ICD10-PCS,Replace of R Com Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RC0KZ,ICD10-PCS,Replace of R Com Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RC47Z,ICD10-PCS,Replace R Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RC4JZ,ICD10-PCS,Replace R Com Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RC4KZ,ICD10-PCS,Replace R Com Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RD07Z,ICD10-PCS,Replace of L Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RD0JZ,ICD10-PCS,Replace of L Com Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RD0KZ,ICD10-PCS,Replace of L Com Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RD47Z,ICD10-PCS,Replace L Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RD4JZ,ICD10-PCS,Replace L Com Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RD4KZ,ICD10-PCS,Replace L Com Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RF07Z,ICD10-PCS,Replace of R Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RF0JZ,ICD10-PCS,Replace of R Ext Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RF0KZ,ICD10-PCS,Replace of R Ext Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RF47Z,ICD10-PCS,Replace R Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RF4JZ,ICD10-PCS,Replace R Ext Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RF4KZ,ICD10-PCS,Replace R Ext Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RG07Z,ICD10-PCS,Replace of L Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RG0JZ,ICD10-PCS,Replace of L Ext Iliac Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RG0KZ,ICD10-PCS,Replace of L Ext Iliac Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RG47Z,ICD10-PCS,Replace L Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RG4JZ,ICD10-PCS,Replace L Ext Iliac Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RG4KZ,ICD10-PCS,Replace L Ext Iliac Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RH07Z,ICD10-PCS,Replacement of R Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RH0JZ,ICD10-PCS,Replacement of R Hypogast Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RH0KZ,ICD10-PCS,Replace of R Hypogast Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RH47Z,ICD10-PCS,Replace R Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RH4JZ,ICD10-PCS,Replace R Hypogast Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RH4KZ,ICD10-PCS,Replace R Hypogast Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RJ07Z,ICD10-PCS,Replacement of L Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RJ0JZ,ICD10-PCS,Replacement of L Hypogast Vein with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RJ0KZ,ICD10-PCS,Replace of L Hypogast Vein with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06RJ47Z,ICD10-PCS,Replace L Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RJ4JZ,ICD10-PCS,Replace L Hypogast Vein w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06RJ4KZ,ICD10-PCS,Replace L Hypogast Vein w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06S00ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S03ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S04ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S10ZZ,ICD10-PCS,Reposition Splenic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S13ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S14ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S20ZZ,ICD10-PCS,Reposition Gastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S23ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S24ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S30ZZ,ICD10-PCS,Reposition Esophageal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S33ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S34ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S40ZZ,ICD10-PCS,Reposition Hepatic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S43ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S44ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S60ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S63ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S64ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S70ZZ,ICD10-PCS,Reposition Colic Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S73ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S74ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S80ZZ,ICD10-PCS,Reposition Portal Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S83ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06S84ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SF0ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SF3ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SF4ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SG0ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SG3ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SG4ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SH0ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SH3ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SH4ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SJ0ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SJ3ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SJ4ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SM0ZZ,ICD10-PCS,Reposition Right Femoral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SM3ZZ,ICD10-PCS,Reposition Right Femoral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SM4ZZ,ICD10-PCS,Reposition Right Femoral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SN0ZZ,ICD10-PCS,Reposition Left Femoral Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SN3ZZ,ICD10-PCS,Reposition Left Femoral Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SN4ZZ,ICD10-PCS,Reposition Left Femoral Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SP0ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SP3ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SP4ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SQ0ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SQ3ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SQ4ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SR0ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SR3ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SR4ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SS0ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SS3ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SS4ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06ST0ZZ,ICD10-PCS,Reposition Right Foot Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06ST3ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06ST4ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SV0ZZ,ICD10-PCS,Reposition Left Foot Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SV3ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SV4ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SY0ZZ,ICD10-PCS,Reposition Lower Vein, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SY3ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06SY4ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U007Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U037Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U047Z,ICD10-PCS,Supplement Inf Vena Cava with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U107Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U137Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U147Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U207Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U237Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U247Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U307Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U337Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U347Z,ICD10-PCS,Supplement Esophageal Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06U407Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U437Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U447Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U507Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U537Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U547Z,ICD10-PCS,Supplement Sup Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06U607Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U637Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U647Z,ICD10-PCS,Supplement Inf Mesent Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06U707Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U737Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U747Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U807Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U837Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U847Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U907Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U937Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06U947Z,ICD10-PCS,Supplement R Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UB07Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UB37Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UB47Z,ICD10-PCS,Supplement L Renal Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UC07Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UC37Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UC47Z,ICD10-PCS,Supplement R Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06UD07Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UD37Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UD47Z,ICD10-PCS,Supplement L Com Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06UF07Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UF37Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UF47Z,ICD10-PCS,Supplement R Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06UG07Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UG37Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UG47Z,ICD10-PCS,Supplement L Ext Iliac Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06UH07Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UH37Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UH47Z,ICD10-PCS,Supplement R Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06UJ07Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UJ37Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UJ47Z,ICD10-PCS,Supplement L Hypogast Vein w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06UM07Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UM37Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UM47Z,ICD10-PCS,Supplement R Femor Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UN07Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UN37Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UN47Z,ICD10-PCS,Supplement L Femor Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UP07Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UP37Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UP47Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UQ07Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UQ37Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UQ47Z,ICD10-PCS,Supplement L Saphenous with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UR07Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UR37Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UR47Z,ICD10-PCS,Supplement R Less Saphenous w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06US07Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06US37Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06US47Z,ICD10-PCS,Supplement L Less Saphenous w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,06UT07Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UT37Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UT47Z,ICD10-PCS,Supplement R Foot Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UV07Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UV37Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UV47Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UY07Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UY37Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,06UY47Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0JH608Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0JH638Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0JH808Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0JH838Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS304Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS30ZZ,ICD10-PCS,Reposition Cervical Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS334Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS33ZZ,ICD10-PCS,Reposition Cervical Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS344Z,ICD10-PCS,Reposition Cervcal Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS34ZZ,ICD10-PCS,Reposition Cervical Vertebra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS3XZZ,ICD10-PCS,Reposition Cervical Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS404Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS40ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS434Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS43ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS444Z,ICD10-PCS,Reposition Thor Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS44ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0PS4XZZ,ICD10-PCS,Reposition Thoracic Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS004Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS00ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS034Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS03ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS044Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS04ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS0XZZ,ICD10-PCS,Reposition Lumbar Vertebra, External Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS104Z,ICD10-PCS,Reposition Sacrum with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS10ZZ,ICD10-PCS,Reposition Sacrum, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS134Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS13ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS144Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS14ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QS1XZZ,ICD10-PCS,Reposition Sacrum, External Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QSS04Z,ICD10-PCS,Reposition Coccyx with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QSS0ZZ,ICD10-PCS,Reposition Coccyx, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QSS34Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QSS3ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QSS44Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QSS4ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0QSSXZZ,ICD10-PCS,Reposition Coccyx, External Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0R530ZZ,ICD10-PCS,Destruction of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0R550ZZ,ICD10-PCS,Destruction of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0R590ZZ,ICD10-PCS,Destruction of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0R5B0ZZ,ICD10-PCS,Destruction of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB00ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB03ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB04ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB10ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB13ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB14ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB30ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB33ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB34ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB40ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB43ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB44ZZ,ICD10-PCS,Excision of C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB50ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB53ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB54ZZ,ICD10-PCS,Excision of C-thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB60ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB63ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB64ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB90ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB93ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RB94ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RBA0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RBA3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RBA4ZZ,ICD10-PCS,Excision of T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RBB0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RBB3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RBB4ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG0070,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG0071,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG007J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG00ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG0370,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG0371,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG037J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG03ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG0470,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG0471,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG047J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG04ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG1070,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG1071,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG107J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG10ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG1370,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG1371,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG137J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG13ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG1470,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG1471,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG147J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG14ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG2070,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG2071,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG207J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG20ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG2370,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG2371,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG237J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG23ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG2470,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG2471,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG247J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG24ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG4070,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG4071,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG407J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG40ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG4370,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG4371,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG437J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG43ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG4470,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG4471,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG447J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG44ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG6070,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG6071,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG607J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG60ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG6370,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG6371,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG637J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG63ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG6470,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG6471,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG647J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG64ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG7070,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG7071,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG707J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG70ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG7370,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG7371,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG737J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG73ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG7470,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG7471,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG747J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG74ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG8070,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG8071,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG807J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG80ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG8370,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG8371,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG837J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG83ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG8470,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG8471,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG847J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RG84ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA070,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA071,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA07J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA0ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA370,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA371,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA37J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA3ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA470,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA471,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA47J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RGA4ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH00BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH03BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RH04CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Occip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH04DZ,ICD10-PCS,Insert of Facet Stabl Dev into Occip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH10BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH10CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH10DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH13BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH13CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH13DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH14BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Cerv Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RH14CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Cerv Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH14DZ,ICD10-PCS,Insert of Facet Stabl Dev into Cerv Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH40BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RH40CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH40DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH43BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RH43CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH43DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH44BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RH44CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH44DZ,ICD10-PCS,Insert of Facet Stabl Dev into C-thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH60BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH60CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH60DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH63BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH63CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH63DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH64BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Thor Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RH64CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RH64DZ,ICD10-PCS,Insert of Facet Stabl Dev into Thor Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RHA0BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0RHA0CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RHA0DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RHA3BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0RHA3CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RHA3DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RHA4BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0RHA4CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RHA4DZ,ICD10-PCS,Insert of Facet Stabl Dev into T-lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RR30JZ,ICD10-PCS,Replacement of Cerv Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RR50JZ,ICD10-PCS,Replacement of C-thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RR90JZ,ICD10-PCS,Replacement of Thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RRB0JZ,ICD10-PCS,Replacement of T-lum Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RT30ZZ,ICD10-PCS,Resection of Cervical Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RT40ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RT50ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RT90ZZ,ICD10-PCS,Resection of Thoracic Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RTB0ZZ,ICD10-PCS,Resection of Thoracolumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU00JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU03JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU04JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU10JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU13JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU14JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU40JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU43JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU44JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU50JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU53JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU54JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU60JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU63JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RU64JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RUA0JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RUA3JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RUA4JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RW30JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RW33JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RW34JZ,ICD10-PCS,Revision of Synth Sub in Cerv Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RW50JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RW53JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RW54JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RW90JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RW93JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RW94JZ,ICD10-PCS,Revision of Synth Sub in Thor Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RWB0JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RWB3JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0RWB4JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0S520ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0S523ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0S524ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0S540ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0S543ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0S544ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB00ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB03ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB04ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB20ZZ,ICD10-PCS,EXCISION LUMBAR VERTEBRAL DISC OPEN,,Fee Schedule,8271.00
Blue Shield,PPO,0SB23ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB24ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB30ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,PPO,0SB33ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB34ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB40ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL DISC OPEN,,Fee Schedule,8271.00
Blue Shield,PPO,0SB43ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB44ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB50ZZ,ICD10-PCS,EXCISION SACROCOCCYGEAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,PPO,0SB53ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB54ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB60ZZ,ICD10-PCS,EXCISION OF COCCYGEAL JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,PPO,0SB63ZZ,ICD10-PCS,Excision of Coccygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB64ZZ,ICD10-PCS,Excision of Coccygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB70ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB73ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB74ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB80ZZ,ICD10-PCS,EXCISION LEFT SACROILIAC JOINT OPEN,,Fee Schedule,8271.00
Blue Shield,PPO,0SB83ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SB84ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG0070,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG0071,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG007J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG00ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG0370,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG0371,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG037J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG03ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG0470,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG0471,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG047J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG04ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG1070,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG1071,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG107J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG10ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG1370,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG1371,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG137J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG13ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG1470,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG1471,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG147J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG14ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG3070,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG3071,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG307J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG30ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG3370,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG3371,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG337J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG33ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG3470,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG3471,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG347J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34Z0,ICD10-PCS,Fusion of Lumsac Jt, Ant Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34Z1,ICD10-PCS,Fusion of Lumsac Jt, Post Appr P Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG34ZJ,ICD10-PCS,Fusion of Lumsac Jt, Post Appr A Col, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG504Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG507Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG50JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG50KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG50ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG534Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG537Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG53JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG53KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG53ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG544Z,ICD10-PCS,Fusion of Sacrococcygeal Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG547Z,ICD10-PCS,Fusion Sacrococcygeal Jt w Autol Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG54JZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG54KZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG54ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG604Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG607Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG60JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG60KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG60ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG634Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG637Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG63JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG63KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG63ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG644Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG647Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG64JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG64KZ,ICD10-PCS,Fusion of Coccygeal Jt with Nonaut Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG64ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Endoscopic Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG704Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG707Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG70JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG70KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG70ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG734Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG737Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG73JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG73KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG73ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG744Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG747Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG74JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG74KZ,ICD10-PCS,Fusion R Sacroiliac Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG74ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG804Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG807Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG80JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG80KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG80ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG834Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG837Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG83JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG83KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG83ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG844Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Int Fix, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG847Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG84JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SG84KZ,ICD10-PCS,Fusion L Sacroiliac Jt w Nonaut Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SG84ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH00BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH03BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lum Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SH04CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH04DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH30BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SH30CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH30DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH33BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,0SH33CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH33DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH34BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SH34CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Lumsac Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SH34DZ,ICD10-PCS,Insert of Facet Stabl Dev into Lumsac Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR20JZ,ICD10-PCS,Replacement of Lum Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR40JZ,ICD10-PCS,Replacement of Lumsac Disc with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR9019,ICD10-PCS,Replacement of R Hip Jt with Metal, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR901A,ICD10-PCS,Replacement of R Hip Jt with Metal, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR901Z,ICD10-PCS,Replacement of Right Hip Joint with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR9029,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SR902A,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SR902Z,ICD10-PCS,Replacement of R Hip Jt with Metal on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR9039,ICD10-PCS,Replacement of R Hip Jt with Ceramic, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR903A,ICD10-PCS,Replace of R Hip Jt with Ceramic, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR903Z,ICD10-PCS,REPLACE RT HIP JOINT CERAMIC SYNTH SUBST OPEN,,Fee Schedule,8271.00
Blue Shield,PPO,0SR9049,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SR904A,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SR904Z,ICD10-PCS,Replacement of R Hip Jt with Ceramic on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR907Z,ICD10-PCS,Replacement of Right Hip Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR90J9,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR90JA,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR90JZ,ICD10-PCS,Replacement of Right Hip Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SR90KZ,ICD10-PCS,Replacement of R Hip Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA009,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA00A,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA00Z,ICD10-PCS,REPLACEMENT RT HIP JOINT ACETAB SURF POLYETHYLENE SYNTH SUBS,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA019,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA01A,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA01Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA039,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA03A,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA03Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA07Z,ICD10-PCS,Replace of R Hip Jt, Acetab with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA0J9,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA0JA,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA0JZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRA0KZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB019,ICD10-PCS,Replacement of L Hip Jt with Metal, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB01A,ICD10-PCS,Replacement of L Hip Jt with Metal, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB01Z,ICD10-PCS,Replacement of Left Hip Joint with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB029,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB02A,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB02Z,ICD10-PCS,Replacement of L Hip Jt with Metal on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB039,ICD10-PCS,Replacement of L Hip Jt with Ceramic, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB03A,ICD10-PCS,Replace of L Hip Jt with Ceramic, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB03Z,ICD10-PCS,Replacement of Left Hip Joint with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB049,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB04A,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB04Z,ICD10-PCS,Replacement of L Hip Jt with Ceramic on Poly, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB07Z,ICD10-PCS,Replacement of Left Hip Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB0J9,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB0JA,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB0JZ,ICD10-PCS,Replacement of Left Hip Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRB0KZ,ICD10-PCS,Replacement of Left Hip Joint with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRC07Z,ICD10-PCS,Replacement of R Knee Jt with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRC0J9,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRC0JA,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRC0JZ,ICD10-PCS,Replacement of R Knee Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRC0KZ,ICD10-PCS,Replacement of R Knee Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRD07Z,ICD10-PCS,Replacement of Left Knee Joint with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRD0J9,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Cement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRD0JA,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Uncement, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRD0JZ,ICD10-PCS,Replacement of Left Knee Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRD0KZ,ICD10-PCS,Replacement of L Knee Jt with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE009,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE00A,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE00Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Polyeth, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE019,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE01A,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE01Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE039,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE03A,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE03Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE07Z,ICD10-PCS,Replace of L Hip Jt, Acetab with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE0J9,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE0JA,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE0JZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRE0KZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR019,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR01A,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR01Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR039,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR03A,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR03Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR07Z,ICD10-PCS,Replace of R Hip Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR0J9,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR0JA,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR0JZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRR0KZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS019,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS01A,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS01Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Metal, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS039,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS03A,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS03Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Ceramic, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS07Z,ICD10-PCS,Replace of L Hip Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS0J9,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS0JA,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS0JZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRS0KZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRT07Z,ICD10-PCS,Replace of R Knee Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRT0J9,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRT0JA,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRT0JZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRT0KZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRU07Z,ICD10-PCS,Replace of L Knee Jt, Femoral with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRU0J9,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRU0JA,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRU0JZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRU0KZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRV07Z,ICD10-PCS,Replace of R Knee Jt, Tibial with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRV0J9,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRV0JA,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRV0JZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRV0KZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRW07Z,ICD10-PCS,Replace of L Knee Jt, Tibial with Autol Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRW0J9,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Cement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRW0JA,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Uncement, Open,,Fee Schedule,8271.00
Blue Shield,PPO,0SRW0JZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SRW0KZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Nonaut Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0ST20ZZ,ICD10-PCS,Resection of Lumbar Vertebral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0ST40ZZ,ICD10-PCS,Resection of Lumbosacral Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU00JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU03JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU04JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU30JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU33JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU34JZ,ICD10-PCS,Supplement Lumsac Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU50JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU53JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU54JZ,ICD10-PCS,Supplement Sacrococcygeal Jt w Synth Sub, Perc Endo,,Fee Schedule,8271.00
Blue Shield,PPO,0SU60JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU63JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU64JZ,ICD10-PCS,Supplement Coccygeal Jt with Synth Sub, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SU90BZ,ICD10-PCS,Supplement Right Hip Joint with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SUA0BZ,ICD10-PCS,Supplement R Hip Jt, Acetab with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SUB0BZ,ICD10-PCS,Supplement Left Hip Joint with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SUE0BZ,ICD10-PCS,Supplement L Hip Jt, Acetab with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SUR0BZ,ICD10-PCS,Supplement R Hip Jt, Femoral with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SUS0BZ,ICD10-PCS,Supplement L Hip Jt, Femoral with Resurf Dev, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SW20JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SW23JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SW24JZ,ICD10-PCS,Revision of Synth Sub in Lum Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SW40JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SW43JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SW44JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SW90JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SW93JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SW94JZ,ICD10-PCS,Revision of Synth Sub in R Hip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SWB0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SWB3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SWB4JZ,ICD10-PCS,Revision of Synth Sub in L Hip Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SWC0JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SWC3JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SWC4JZ,ICD10-PCS,Revision of Synth Sub in R Knee Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SWD0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SWD3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0SWD4JZ,ICD10-PCS,Revision of Synth Sub in L Knee Jt, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0WFD0ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0WFD3ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0WFD4ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Perc Endo Approach,,Fee Schedule,8271.00
Blue Shield,PPO,0WFDXZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, External Approach,,Fee Schedule,8271.00
Blue Shield,PPO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Fee Schedule,987.79
Blue Shield,PPO,10022,CPT4/HCPCS,FNA W/IMAGE,,Fee Schedule,3198.57
Blue Shield,PPO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Fee Schedule,3198.57
Blue Shield,PPO,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Fee Schedule,3198.57
Blue Shield,PPO,10040,CPT4/HCPCS,ACNE SURGERY,,Fee Schedule,987.79
Blue Shield,PPO,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Fee Schedule,987.79
Blue Shield,PPO,10061,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,10080,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Fee Schedule,987.79
Blue Shield,PPO,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Fee Schedule,3198.57
Blue Shield,PPO,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,PPO,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,PPO,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Fee Schedule,3198.57
Blue Shield,PPO,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Fee Schedule,987.79
Blue Shield,PPO,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Fee Schedule,4280.44
Blue Shield,PPO,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Fee Schedule,987.79
Blue Shield,PPO,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Fee Schedule,987.79
Blue Shield,PPO,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,Fee Schedule,3198.57
Blue Shield,PPO,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,Fee Schedule,3198.57
Blue Shield,PPO,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,Fee Schedule,3198.57
Blue Shield,PPO,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,Fee Schedule,987.79
Blue Shield,PPO,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Fee Schedule,4280.44
Blue Shield,PPO,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Fee Schedule,4280.44
Blue Shield,PPO,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Fee Schedule,4280.44
Blue Shield,PPO,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,PPO,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,PPO,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,PPO,11055,CPT4/HCPCS,TRIM SKIN LESION,,Fee Schedule,987.79
Blue Shield,PPO,11056,CPT4/HCPCS,TRIM SKIN LESIONS 2 TO 4,,Fee Schedule,987.79
Blue Shield,PPO,11057,CPT4/HCPCS,TRIM SKIN LESIONS OVER 4,,Fee Schedule,987.79
Blue Shield,PPO,11100,CPT4/HCPCS,BIOPSY SKIN LESION,,Fee Schedule,987.79
Blue Shield,PPO,11101,CPT4/HCPCS,BIOPSY SKIN ADD-ON,,Fee Schedule,987.79
Blue Shield,PPO,11200,CPT4/HCPCS,REMOVAL OF SKIN TAGS 2.0 CM,,Fee Schedule,987.79
Blue Shield,PPO,11305,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Fee Schedule,987.79
Blue Shield,PPO,11306,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Fee Schedule,987.79
Blue Shield,PPO,11307,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Fee Schedule,987.79
Blue Shield,PPO,11308,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Fee Schedule,987.79
Blue Shield,PPO,11310,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Fee Schedule,987.79
Blue Shield,PPO,11311,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Fee Schedule,987.79
Blue Shield,PPO,11312,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Fee Schedule,987.79
Blue Shield,PPO,11313,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Fee Schedule,987.79
Blue Shield,PPO,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,Fee Schedule,3198.57
Blue Shield,PPO,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,PPO,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,PPO,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,Fee Schedule,3198.57
Blue Shield,PPO,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,Fee Schedule,3198.57
Blue Shield,PPO,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,Fee Schedule,4280.44
Blue Shield,PPO,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Fee Schedule,3198.57
Blue Shield,PPO,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Fee Schedule,3198.57
Blue Shield,PPO,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Fee Schedule,3198.57
Blue Shield,PPO,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Fee Schedule,3198.57
Blue Shield,PPO,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Fee Schedule,4280.44
Blue Shield,PPO,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Fee Schedule,3198.57
Blue Shield,PPO,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,PPO,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,PPO,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Fee Schedule,3198.57
Blue Shield,PPO,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Fee Schedule,3198.57
Blue Shield,PPO,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,PPO,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,PPO,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,PPO,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,PPO,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,PPO,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Fee Schedule,4280.44
Blue Shield,PPO,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Fee Schedule,3198.57
Blue Shield,PPO,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Fee Schedule,3198.57
Blue Shield,PPO,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Fee Schedule,3198.57
Blue Shield,PPO,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Fee Schedule,3198.57
Blue Shield,PPO,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Fee Schedule,3198.57
Blue Shield,PPO,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Fee Schedule,3198.57
Blue Shield,PPO,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Fee Schedule,3198.57
Blue Shield,PPO,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Fee Schedule,3198.57
Blue Shield,PPO,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Fee Schedule,4280.44
Blue Shield,PPO,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Fee Schedule,3198.57
Blue Shield,PPO,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Fee Schedule,3198.57
Blue Shield,PPO,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Fee Schedule,3198.57
Blue Shield,PPO,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Fee Schedule,3198.57
Blue Shield,PPO,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Fee Schedule,4280.44
Blue Shield,PPO,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,11719,CPT4/HCPCS,TRIM NAIL(S) ANY NUMBER,,Fee Schedule,987.79
Blue Shield,PPO,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Fee Schedule,987.79
Blue Shield,PPO,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Fee Schedule,987.79
Blue Shield,PPO,11730,CPT4/HCPCS,REMOVAL OF NAIL PLATE,,Fee Schedule,987.79
Blue Shield,PPO,11732,CPT4/HCPCS,REMOVE NAIL PLATE ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,11740,CPT4/HCPCS,DRAIN BLOOD FROM UNDER NAIL,,Fee Schedule,987.79
Blue Shield,PPO,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,PPO,11755,CPT4/HCPCS,BIOPSY NAIL UNIT,,Fee Schedule,3198.57
Blue Shield,PPO,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,PPO,11762,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED,,Fee Schedule,3198.57
Blue Shield,PPO,11765,CPT4/HCPCS,EXCISION OF NAIL FOLD TOE,,Fee Schedule,987.79
Blue Shield,PPO,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Fee Schedule,4891.93
Blue Shield,PPO,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Fee Schedule,4891.93
Blue Shield,PPO,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Fee Schedule,4891.93
Blue Shield,PPO,11900,CPT4/HCPCS,INJECT SKIN LESIONS 7,,Fee Schedule,987.79
Blue Shield,PPO,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Fee Schedule,3198.57
Blue Shield,PPO,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Fee Schedule,987.79
Blue Shield,PPO,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Fee Schedule,987.79
Blue Shield,PPO,11950,CPT4/HCPCS,TX CONTOUR DEFECTS 1 CC/<,,Fee Schedule,987.79
Blue Shield,PPO,11951,CPT4/HCPCS,TX CONTOUR DEFECTS 1.1-5.0CC,,Fee Schedule,987.79
Blue Shield,PPO,11952,CPT4/HCPCS,TX CONTOUR DEFECTS 5.1-10CC,,Fee Schedule,987.79
Blue Shield,PPO,11954,CPT4/HCPCS,TX CONTOUR DEFECTS >10.0 CC,,Fee Schedule,987.79
Blue Shield,PPO,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Fee Schedule,4280.44
Blue Shield,PPO,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Fee Schedule,4891.93
Blue Shield,PPO,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Fee Schedule,3198.57
Blue Shield,PPO,11976,CPT4/HCPCS,REMOVE CONTRACEPTIVE CAPSULE,,Fee Schedule,3198.57
Blue Shield,PPO,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Fee Schedule,987.79
Blue Shield,PPO,11981,CPT4/HCPCS,INSERT DRUG IMPLANT DEVICE,,Fee Schedule,987.79
Blue Shield,PPO,11982,CPT4/HCPCS,REMOVE DRUG IMPLANT DEVICE,,Fee Schedule,987.79
Blue Shield,PPO,11983,CPT4/HCPCS,REMOVE/INSERT DRUG IMPLANT,,Fee Schedule,3198.57
Blue Shield,PPO,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Fee Schedule,987.79
Blue Shield,PPO,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,Fee Schedule,987.79
Blue Shield,PPO,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Fee Schedule,987.79
Blue Shield,PPO,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Fee Schedule,4280.44
Blue Shield,PPO,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Fee Schedule,4280.44
Blue Shield,PPO,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Fee Schedule,4280.44
Blue Shield,PPO,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,Fee Schedule,987.79
Blue Shield,PPO,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,Fee Schedule,987.79
Blue Shield,PPO,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Fee Schedule,987.79
Blue Shield,PPO,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Fee Schedule,987.79
Blue Shield,PPO,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Fee Schedule,4280.44
Blue Shield,PPO,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Fee Schedule,4280.44
Blue Shield,PPO,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Fee Schedule,4280.44
Blue Shield,PPO,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Fee Schedule,3198.57
Blue Shield,PPO,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Fee Schedule,3198.57
Blue Shield,PPO,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Fee Schedule,4280.44
Blue Shield,PPO,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Fee Schedule,4280.44
Blue Shield,PPO,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Fee Schedule,4280.44
Blue Shield,PPO,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Fee Schedule,4280.44
Blue Shield,PPO,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Fee Schedule,3198.57
Blue Shield,PPO,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Fee Schedule,3198.57
Blue Shield,PPO,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Fee Schedule,4280.44
Blue Shield,PPO,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Fee Schedule,4280.44
Blue Shield,PPO,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Fee Schedule,4280.44
Blue Shield,PPO,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Fee Schedule,4280.44
Blue Shield,PPO,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Fee Schedule,3198.57
Blue Shield,PPO,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Fee Schedule,3198.57
Blue Shield,PPO,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Fee Schedule,3198.57
Blue Shield,PPO,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Fee Schedule,4280.44
Blue Shield,PPO,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Fee Schedule,4280.44
Blue Shield,PPO,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Fee Schedule,4280.44
Blue Shield,PPO,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Fee Schedule,4280.44
Blue Shield,PPO,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Fee Schedule,4280.44
Blue Shield,PPO,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Fee Schedule,3198.57
Blue Shield,PPO,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Fee Schedule,4280.44
Blue Shield,PPO,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Fee Schedule,3198.57
Blue Shield,PPO,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,4280.44
Blue Shield,PPO,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,4891.93
Blue Shield,PPO,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Fee Schedule,3198.57
Blue Shield,PPO,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Fee Schedule,3198.57
Blue Shield,PPO,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Fee Schedule,4280.44
Blue Shield,PPO,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Fee Schedule,4280.44
Blue Shield,PPO,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Fee Schedule,4891.93
Blue Shield,PPO,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Fee Schedule,4891.93
Blue Shield,PPO,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Fee Schedule,4891.93
Blue Shield,PPO,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Fee Schedule,4280.44
Blue Shield,PPO,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Fee Schedule,4891.93
Blue Shield,PPO,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Fee Schedule,4891.93
Blue Shield,PPO,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Fee Schedule,4891.93
Blue Shield,PPO,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Fee Schedule,4891.93
Blue Shield,PPO,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Fee Schedule,3198.57
Blue Shield,PPO,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Fee Schedule,4891.93
Blue Shield,PPO,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,PPO,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Fee Schedule,3198.57
Blue Shield,PPO,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Fee Schedule,4280.44
Blue Shield,PPO,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Fee Schedule,3198.57
Blue Shield,PPO,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,PPO,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Fee Schedule,4891.93
Blue Shield,PPO,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,PPO,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,PPO,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,PPO,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Fee Schedule,4891.93
Blue Shield,PPO,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,PPO,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Fee Schedule,4280.44
Blue Shield,PPO,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Fee Schedule,3198.57
Blue Shield,PPO,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,PPO,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Fee Schedule,3198.57
Blue Shield,PPO,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Fee Schedule,4280.44
Blue Shield,PPO,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Fee Schedule,3198.57
Blue Shield,PPO,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Fee Schedule,3198.57
Blue Shield,PPO,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Fee Schedule,4891.93
Blue Shield,PPO,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Fee Schedule,4280.44
Blue Shield,PPO,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,PPO,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,PPO,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Fee Schedule,4891.93
Blue Shield,PPO,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4891.93
Blue Shield,PPO,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Fee Schedule,4280.44
Blue Shield,PPO,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,PPO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Fee Schedule,4280.44
Blue Shield,PPO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Fee Schedule,987.79
Blue Shield,PPO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Fee Schedule,4280.44
Blue Shield,PPO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Fee Schedule,987.79
Blue Shield,PPO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Fee Schedule,4280.44
Blue Shield,PPO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Fee Schedule,987.79
Blue Shield,PPO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Fee Schedule,4280.44
Blue Shield,PPO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Fee Schedule,987.79
Blue Shield,PPO,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Fee Schedule,4891.93
Blue Shield,PPO,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Fee Schedule,4891.93
Blue Shield,PPO,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Fee Schedule,4891.93
Blue Shield,PPO,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Fee Schedule,4891.93
Blue Shield,PPO,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Fee Schedule,4891.93
Blue Shield,PPO,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Fee Schedule,4891.93
Blue Shield,PPO,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Fee Schedule,6049.05
Blue Shield,PPO,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Fee Schedule,4891.93
Blue Shield,PPO,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Fee Schedule,6876.92
Blue Shield,PPO,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Fee Schedule,4891.93
Blue Shield,PPO,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Fee Schedule,4891.93
Blue Shield,PPO,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Fee Schedule,4891.93
Blue Shield,PPO,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Fee Schedule,4891.93
Blue Shield,PPO,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Fee Schedule,4891.93
Blue Shield,PPO,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Fee Schedule,4891.93
Blue Shield,PPO,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Fee Schedule,4280.44
Blue Shield,PPO,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,PPO,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,PPO,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Fee Schedule,6876.92
Blue Shield,PPO,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Fee Schedule,4891.93
Blue Shield,PPO,15775,CPT4/HCPCS,HAIR TRNSPL 1-15 PUNCH GRFTS,,Fee Schedule,4891.93
Blue Shield,PPO,15776,CPT4/HCPCS,HAIR TRNSPL >15 PUNCH GRAFTS,,Fee Schedule,4891.93
Blue Shield,PPO,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,Fee Schedule,4891.93
Blue Shield,PPO,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,Fee Schedule,3198.57
Blue Shield,PPO,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,Fee Schedule,3198.57
Blue Shield,PPO,15783,CPT4/HCPCS,DERMABRASION SUPRFL ANY SITE,,Fee Schedule,987.79
Blue Shield,PPO,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,Fee Schedule,987.79
Blue Shield,PPO,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,Fee Schedule,987.79
Blue Shield,PPO,15788,CPT4/HCPCS,CHEMICAL PEEL FACE EPIDERM,,Fee Schedule,987.79
Blue Shield,PPO,15789,CPT4/HCPCS,CHEMICAL PEEL FACE DERMAL,,Fee Schedule,987.79
Blue Shield,PPO,15792,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Fee Schedule,987.79
Blue Shield,PPO,15793,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Fee Schedule,987.79
Blue Shield,PPO,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Fee Schedule,3198.57
Blue Shield,PPO,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Fee Schedule,6876.92
Blue Shield,PPO,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Fee Schedule,4891.93
Blue Shield,PPO,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Fee Schedule,4891.93
Blue Shield,PPO,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Fee Schedule,4891.93
Blue Shield,PPO,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Fee Schedule,4891.93
Blue Shield,PPO,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Fee Schedule,6876.92
Blue Shield,PPO,15830,CPT4/HCPCS,EXC SKIN ABD,,Fee Schedule,4891.93
Blue Shield,PPO,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Fee Schedule,4891.93
Blue Shield,PPO,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Fee Schedule,4891.93
Blue Shield,PPO,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Fee Schedule,4891.93
Blue Shield,PPO,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Fee Schedule,4891.93
Blue Shield,PPO,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Fee Schedule,3198.57
Blue Shield,PPO,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Fee Schedule,3198.57
Blue Shield,PPO,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Fee Schedule,3198.57
Blue Shield,PPO,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Fee Schedule,3198.57
Blue Shield,PPO,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Fee Schedule,6049.05
Blue Shield,PPO,15847,CPT4/HCPCS,EXC SKIN ABD ADD-ON,,Fee Schedule,4891.93
Blue Shield,PPO,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Fee Schedule,3198.57
Blue Shield,PPO,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Fee Schedule,3198.57
Blue Shield,PPO,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Fee Schedule,3198.57
Blue Shield,PPO,15860,CPT4/HCPCS,TEST FOR BLOOD FLOW IN GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Fee Schedule,4891.93
Blue Shield,PPO,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Fee Schedule,4891.93
Blue Shield,PPO,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Fee Schedule,4891.93
Blue Shield,PPO,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Fee Schedule,4891.93
Blue Shield,PPO,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Fee Schedule,4891.93
Blue Shield,PPO,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Fee Schedule,6049.05
Blue Shield,PPO,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,PPO,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,PPO,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,PPO,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,PPO,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,PPO,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,PPO,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,PPO,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,PPO,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,PPO,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,PPO,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,PPO,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,PPO,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,PPO,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,PPO,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,PPO,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,PPO,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Fee Schedule,6049.05
Blue Shield,PPO,15999,CPT4/HCPCS,REMOVAL OF PRESSURE SORE,,Fee Schedule,4891.93
Blue Shield,PPO,16000,CPT4/HCPCS,INITIAL TREATMENT OF BURN(S),,Fee Schedule,987.79
Blue Shield,PPO,16020,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN S,,Fee Schedule,987.79
Blue Shield,PPO,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Fee Schedule,4280.44
Blue Shield,PPO,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Fee Schedule,4280.44
Blue Shield,PPO,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Fee Schedule,3198.57
Blue Shield,PPO,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,Fee Schedule,3198.57
Blue Shield,PPO,17000,CPT4/HCPCS,DESTRUCT PREMALG LESION,,Fee Schedule,987.79
Blue Shield,PPO,17003,CPT4/HCPCS,DESTRUCT PREMALG LES 2-14,,Fee Schedule,987.79
Blue Shield,PPO,17004,CPT4/HCPCS,DESTROY PREMAL LESIONS 15/>,,Fee Schedule,987.79
Blue Shield,PPO,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,PPO,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,PPO,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,987.79
Blue Shield,PPO,17110,CPT4/HCPCS,DESTRUCT B9 LESION 1-14,,Fee Schedule,987.79
Blue Shield,PPO,17111,CPT4/HCPCS,DESTRUCT LESION 15 OR MORE,,Fee Schedule,987.79
Blue Shield,PPO,17250,CPT4/HCPCS,CHEM CAUT OF GRANLTJ TISSUE,,Fee Schedule,987.79
Blue Shield,PPO,17260,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17261,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17262,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17263,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17264,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17266,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17270,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17271,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17272,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17273,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17274,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17276,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17280,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17281,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17282,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17283,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17284,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17286,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,17311,CPT4/HCPCS,MOHS 1 STAGE H/N/HF/G,,Fee Schedule,3198.57
Blue Shield,PPO,17312,CPT4/HCPCS,MOHS ADDL STAGE,,Fee Schedule,3198.57
Blue Shield,PPO,17313,CPT4/HCPCS,MOHS 1 STAGE T/A/L,,Fee Schedule,3198.57
Blue Shield,PPO,17314,CPT4/HCPCS,MOHS ADDL STAGE T/A/L,,Fee Schedule,3198.57
Blue Shield,PPO,17315,CPT4/HCPCS,MOHS SURG ADDL BLOCK,,Fee Schedule,3198.57
Blue Shield,PPO,17340,CPT4/HCPCS,CRYOTHERAPY OF SKIN,,Fee Schedule,987.79
Blue Shield,PPO,17360,CPT4/HCPCS,SKIN PEEL THERAPY,,Fee Schedule,987.79
Blue Shield,PPO,17380,CPT4/HCPCS,HAIR REMOVAL BY ELECTROLYSIS,,Fee Schedule,987.79
Blue Shield,PPO,17999,CPT4/HCPCS,SKIN TISSUE PROCEDURE,,Fee Schedule,987.79
Blue Shield,PPO,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Fee Schedule,987.79
Blue Shield,PPO,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Fee Schedule,987.79
Blue Shield,PPO,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Fee Schedule,4280.44
Blue Shield,PPO,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Fee Schedule,4280.44
Blue Shield,PPO,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Fee Schedule,4280.44
Blue Shield,PPO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Fee Schedule,4280.44
Blue Shield,PPO,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Fee Schedule,3198.57
Blue Shield,PPO,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Fee Schedule,4280.44
Blue Shield,PPO,19105,CPT4/HCPCS,CRYOSURG ABLATE FA EACH,,Fee Schedule,3198.57
Blue Shield,PPO,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Fee Schedule,4280.44
Blue Shield,PPO,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Fee Schedule,4891.93
Blue Shield,PPO,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Fee Schedule,4891.93
Blue Shield,PPO,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Fee Schedule,4891.93
Blue Shield,PPO,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Fee Schedule,4891.93
Blue Shield,PPO,19260,CPT4/HCPCS,REMOVAL OF CHEST WALL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,19271,CPT4/HCPCS,REVISION OF CHEST WALL,,Fee Schedule,4280.44
Blue Shield,PPO,19272,CPT4/HCPCS,EXTENSIVE CHEST WALL SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Fee Schedule,12850.71
Blue Shield,PPO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Fee Schedule,12850.71
Blue Shield,PPO,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Fee Schedule,12850.71
Blue Shield,PPO,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Fee Schedule,12850.71
Blue Shield,PPO,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Fee Schedule,6049.05
Blue Shield,PPO,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Fee Schedule,4891.93
Blue Shield,PPO,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Fee Schedule,9548.66
Blue Shield,PPO,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Fee Schedule,6049.05
Blue Shield,PPO,19304,CPT4/HCPCS,MAST SUBQ,,Fee Schedule,6049.05
Blue Shield,PPO,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Fee Schedule,6049.05
Blue Shield,PPO,19318,CPT4/HCPCS,BREAST REDUCTION,,Fee Schedule,6049.05
Blue Shield,PPO,19324,CPT4/HCPCS,ENLARGE BREAST,,Fee Schedule,6049.05
Blue Shield,PPO,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Fee Schedule,12850.71
Blue Shield,PPO,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Fee Schedule,3198.57
Blue Shield,PPO,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Fee Schedule,3198.57
Blue Shield,PPO,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Fee Schedule,4280.44
Blue Shield,PPO,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Fee Schedule,4891.93
Blue Shield,PPO,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,PPO,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Fee Schedule,6049.05
Blue Shield,PPO,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Fee Schedule,6876.92
Blue Shield,PPO,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,Fee Schedule,4280.44
Blue Shield,PPO,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Fee Schedule,7902.34
Blue Shield,PPO,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Fee Schedule,6876.92
Blue Shield,PPO,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,Fee Schedule,4891.93
Blue Shield,PPO,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,Fee Schedule,6049.05
Blue Shield,PPO,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,Fee Schedule,6049.05
Blue Shield,PPO,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Fee Schedule,6049.05
Blue Shield,PPO,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Fee Schedule,6049.05
Blue Shield,PPO,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Fee Schedule,6876.92
Blue Shield,PPO,19396,CPT4/HCPCS,DESIGN CUSTOM BREAST IMPLANT,,Fee Schedule,7902.34
Blue Shield,PPO,19499,CPT4/HCPCS,BREAST SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,PPO,20005,CPT4/HCPCS,I&D ABSCESS SUBFASCIAL,,Fee Schedule,4280.44
Blue Shield,PPO,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,Fee Schedule,3198.57
Blue Shield,PPO,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,Fee Schedule,4280.44
Blue Shield,PPO,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,Fee Schedule,4280.44
Blue Shield,PPO,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Fee Schedule,3198.57
Blue Shield,PPO,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,Fee Schedule,9548.66
Blue Shield,PPO,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Fee Schedule,4280.44
Blue Shield,PPO,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Fee Schedule,4891.93
Blue Shield,PPO,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Fee Schedule,3198.57
Blue Shield,PPO,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Fee Schedule,3198.57
Blue Shield,PPO,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Fee Schedule,4280.44
Blue Shield,PPO,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Fee Schedule,4280.44
Blue Shield,PPO,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Fee Schedule,4891.93
Blue Shield,PPO,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Fee Schedule,4891.93
Blue Shield,PPO,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Fee Schedule,4891.93
Blue Shield,PPO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Fee Schedule,987.79
Blue Shield,PPO,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,PPO,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,4891.93
Blue Shield,PPO,20526,CPT4/HCPCS,THER INJECTION CARP TUNNEL,,Fee Schedule,987.79
Blue Shield,PPO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Fee Schedule,987.79
Blue Shield,PPO,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Fee Schedule,987.79
Blue Shield,PPO,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Fee Schedule,987.79
Blue Shield,PPO,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Fee Schedule,987.79
Blue Shield,PPO,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Fee Schedule,987.79
Blue Shield,PPO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Fee Schedule,3198.57
Blue Shield,PPO,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,PPO,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,PPO,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,PPO,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,PPO,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Fee Schedule,987.79
Blue Shield,PPO,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Fee Schedule,987.79
Blue Shield,PPO,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Fee Schedule,987.79
Blue Shield,PPO,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Fee Schedule,987.79
Blue Shield,PPO,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Fee Schedule,4891.93
Blue Shield,PPO,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Fee Schedule,3198.57
Blue Shield,PPO,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Fee Schedule,3198.57
Blue Shield,PPO,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Fee Schedule,3198.57
Blue Shield,PPO,20664,CPT4/HCPCS,APPLICATION OF HALO,,Fee Schedule,3198.57
Blue Shield,PPO,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Fee Schedule,3198.57
Blue Shield,PPO,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Fee Schedule,4891.93
Blue Shield,PPO,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Fee Schedule,4280.44
Blue Shield,PPO,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Fee Schedule,4891.93
Blue Shield,PPO,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Fee Schedule,4891.93
Blue Shield,PPO,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Fee Schedule,4891.93
Blue Shield,PPO,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Fee Schedule,4280.44
Blue Shield,PPO,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,Fee Schedule,7902.34
Blue Shield,PPO,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,Fee Schedule,12850.71
Blue Shield,PPO,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,Fee Schedule,12850.71
Blue Shield,PPO,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Fee Schedule,12850.71
Blue Shield,PPO,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Fee Schedule,12850.71
Blue Shield,PPO,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Fee Schedule,12850.71
Blue Shield,PPO,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Fee Schedule,12850.71
Blue Shield,PPO,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,Fee Schedule,7902.34
Blue Shield,PPO,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,PPO,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,PPO,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,PPO,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Fee Schedule,4891.93
Blue Shield,PPO,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,20926,CPT4/HCPCS,REMOVAL OF TISSUE FOR GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Fee Schedule,3198.57
Blue Shield,PPO,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Fee Schedule,987.79
Blue Shield,PPO,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Fee Schedule,9548.66
Blue Shield,PPO,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,Fee Schedule,7902.34
Blue Shield,PPO,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,Fee Schedule,6876.92
Blue Shield,PPO,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Fee Schedule,7902.34
Blue Shield,PPO,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Fee Schedule,9548.66
Blue Shield,PPO,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Fee Schedule,9548.66
Blue Shield,PPO,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Fee Schedule,6049.05
Blue Shield,PPO,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Fee Schedule,9548.66
Blue Shield,PPO,20974,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Fee Schedule,987.79
Blue Shield,PPO,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Fee Schedule,4280.44
Blue Shield,PPO,20979,CPT4/HCPCS,US BONE STIMULATION,,Fee Schedule,987.79
Blue Shield,PPO,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Fee Schedule,9548.66
Blue Shield,PPO,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Fee Schedule,9548.66
Blue Shield,PPO,20999,CPT4/HCPCS,MUSCULOSKELETAL SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Fee Schedule,4280.44
Blue Shield,PPO,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Fee Schedule,4891.93
Blue Shield,PPO,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Fee Schedule,4891.93
Blue Shield,PPO,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Fee Schedule,4280.44
Blue Shield,PPO,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Fee Schedule,4280.44
Blue Shield,PPO,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Fee Schedule,6049.05
Blue Shield,PPO,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Fee Schedule,6049.05
Blue Shield,PPO,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Fee Schedule,6049.05
Blue Shield,PPO,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Fee Schedule,4891.93
Blue Shield,PPO,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Fee Schedule,4280.44
Blue Shield,PPO,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Fee Schedule,4280.44
Blue Shield,PPO,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Fee Schedule,9548.66
Blue Shield,PPO,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Fee Schedule,9548.66
Blue Shield,PPO,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Fee Schedule,4280.44
Blue Shield,PPO,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Fee Schedule,4891.93
Blue Shield,PPO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Fee Schedule,3198.57
Blue Shield,PPO,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,6049.05
Blue Shield,PPO,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,PPO,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,PPO,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,PPO,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,PPO,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,PPO,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,PPO,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,PPO,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,PPO,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,PPO,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,PPO,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,9548.66
Blue Shield,PPO,21089,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,PPO,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Fee Schedule,4280.44
Blue Shield,PPO,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Fee Schedule,3198.57
Blue Shield,PPO,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,6049.05
Blue Shield,PPO,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,PPO,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,PPO,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Fee Schedule,9548.66
Blue Shield,PPO,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Fee Schedule,6049.05
Blue Shield,PPO,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Fee Schedule,12850.71
Blue Shield,PPO,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,6049.05
Blue Shield,PPO,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,9548.66
Blue Shield,PPO,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Fee Schedule,9548.66
Blue Shield,PPO,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,Fee Schedule,4891.93
Blue Shield,PPO,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,Fee Schedule,6049.05
Blue Shield,PPO,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,Fee Schedule,6049.05
Blue Shield,PPO,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,Fee Schedule,6876.92
Blue Shield,PPO,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,Fee Schedule,6876.92
Blue Shield,PPO,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,Fee Schedule,9548.66
Blue Shield,PPO,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Fee Schedule,4891.93
Blue Shield,PPO,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Fee Schedule,6049.05
Blue Shield,PPO,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Fee Schedule,6049.05
Blue Shield,PPO,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Fee Schedule,6049.05
Blue Shield,PPO,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Fee Schedule,9548.66
Blue Shield,PPO,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6876.92
Blue Shield,PPO,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6876.92
Blue Shield,PPO,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Fee Schedule,6049.05
Blue Shield,PPO,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,Fee Schedule,4891.93
Blue Shield,PPO,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Fee Schedule,3198.57
Blue Shield,PPO,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,Fee Schedule,4280.44
Blue Shield,PPO,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Fee Schedule,9548.66
Blue Shield,PPO,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Fee Schedule,9548.66
Blue Shield,PPO,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Fee Schedule,6876.92
Blue Shield,PPO,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Fee Schedule,9548.66
Blue Shield,PPO,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Fee Schedule,6876.92
Blue Shield,PPO,21210,CPT4/HCPCS,FACE BONE GRAFT,,Fee Schedule,9548.66
Blue Shield,PPO,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Fee Schedule,9548.66
Blue Shield,PPO,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Fee Schedule,9548.66
Blue Shield,PPO,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Fee Schedule,9548.66
Blue Shield,PPO,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Fee Schedule,9548.66
Blue Shield,PPO,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,PPO,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,PPO,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Fee Schedule,6049.05
Blue Shield,PPO,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,PPO,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Fee Schedule,9548.66
Blue Shield,PPO,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Fee Schedule,4280.44
Blue Shield,PPO,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,Fee Schedule,4280.44
Blue Shield,PPO,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,PPO,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,PPO,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,PPO,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,9548.66
Blue Shield,PPO,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,Fee Schedule,4280.44
Blue Shield,PPO,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Fee Schedule,6876.92
Blue Shield,PPO,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Fee Schedule,9548.66
Blue Shield,PPO,21280,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,6876.92
Blue Shield,PPO,21282,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,6876.92
Blue Shield,PPO,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Fee Schedule,3198.57
Blue Shield,PPO,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Fee Schedule,3198.57
Blue Shield,PPO,21299,CPT4/HCPCS,CRANIO/MAXILLOFACIAL SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Fee Schedule,4280.44
Blue Shield,PPO,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Fee Schedule,4280.44
Blue Shield,PPO,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Fee Schedule,4280.44
Blue Shield,PPO,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Fee Schedule,6049.05
Blue Shield,PPO,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Fee Schedule,6876.92
Blue Shield,PPO,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Fee Schedule,9548.66
Blue Shield,PPO,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Fee Schedule,6049.05
Blue Shield,PPO,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Fee Schedule,4280.44
Blue Shield,PPO,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Fee Schedule,6049.05
Blue Shield,PPO,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Fee Schedule,6876.92
Blue Shield,PPO,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Fee Schedule,6049.05
Blue Shield,PPO,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Fee Schedule,3198.57
Blue Shield,PPO,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Fee Schedule,4280.44
Blue Shield,PPO,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Fee Schedule,9548.66
Blue Shield,PPO,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Fee Schedule,3198.57
Blue Shield,PPO,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Fee Schedule,3198.57
Blue Shield,PPO,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Fee Schedule,3198.57
Blue Shield,PPO,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Fee Schedule,3198.57
Blue Shield,PPO,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Fee Schedule,4280.44
Blue Shield,PPO,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Fee Schedule,3198.57
Blue Shield,PPO,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Fee Schedule,3198.57
Blue Shield,PPO,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Fee Schedule,3198.57
Blue Shield,PPO,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Fee Schedule,9548.66
Blue Shield,PPO,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Fee Schedule,3198.57
Blue Shield,PPO,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Fee Schedule,4280.44
Blue Shield,PPO,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Fee Schedule,4891.93
Blue Shield,PPO,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,Fee Schedule,3198.57
Blue Shield,PPO,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6876.92
Blue Shield,PPO,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6876.92
Blue Shield,PPO,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Fee Schedule,9548.66
Blue Shield,PPO,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Fee Schedule,3198.57
Blue Shield,PPO,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Fee Schedule,4280.44
Blue Shield,PPO,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Fee Schedule,4891.93
Blue Shield,PPO,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Fee Schedule,4280.44
Blue Shield,PPO,21499,CPT4/HCPCS,HEAD SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,PPO,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Fee Schedule,4280.44
Blue Shield,PPO,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Fee Schedule,4280.44
Blue Shield,PPO,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,3198.57
Blue Shield,PPO,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Fee Schedule,3198.57
Blue Shield,PPO,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,PPO,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,PPO,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Fee Schedule,3198.57
Blue Shield,PPO,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,PPO,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,PPO,21615,CPT4/HCPCS,REMOVAL OF RIB,,Fee Schedule,4280.44
Blue Shield,PPO,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,Fee Schedule,4280.44
Blue Shield,PPO,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Fee Schedule,3198.57
Blue Shield,PPO,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,Fee Schedule,4280.44
Blue Shield,PPO,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Fee Schedule,3198.57
Blue Shield,PPO,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4280.44
Blue Shield,PPO,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,Fee Schedule,4280.44
Blue Shield,PPO,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4891.93
Blue Shield,PPO,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Fee Schedule,4891.93
Blue Shield,PPO,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Fee Schedule,4280.44
Blue Shield,PPO,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Fee Schedule,9548.66
Blue Shield,PPO,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Fee Schedule,9548.66
Blue Shield,PPO,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,Fee Schedule,3198.57
Blue Shield,PPO,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Fee Schedule,4891.93
Blue Shield,PPO,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,21899,CPT4/HCPCS,NECK/CHEST SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Fee Schedule,3198.57
Blue Shield,PPO,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Fee Schedule,4280.44
Blue Shield,PPO,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,PPO,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Fee Schedule,9548.66
Blue Shield,PPO,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Fee Schedule,9548.66
Blue Shield,PPO,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Fee Schedule,9548.66
Blue Shield,PPO,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Fee Schedule,9548.66
Blue Shield,PPO,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Fee Schedule,3198.57
Blue Shield,PPO,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Fee Schedule,3198.57
Blue Shield,PPO,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Fee Schedule,3198.57
Blue Shield,PPO,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,PPO,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,Fee Schedule,4891.93
Blue Shield,PPO,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,Fee Schedule,4280.44
Blue Shield,PPO,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,Fee Schedule,4891.93
Blue Shield,PPO,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,PPO,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,Fee Schedule,4891.93
Blue Shield,PPO,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,Fee Schedule,4280.44
Blue Shield,PPO,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,Fee Schedule,4891.93
Blue Shield,PPO,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,Fee Schedule,3198.57
Blue Shield,PPO,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Fee Schedule,3198.57
Blue Shield,PPO,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Fee Schedule,4280.44
Blue Shield,PPO,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Fee Schedule,4891.93
Blue Shield,PPO,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Fee Schedule,3198.57
Blue Shield,PPO,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Fee Schedule,4280.44
Blue Shield,PPO,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Fee Schedule,6876.92
Blue Shield,PPO,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Fee Schedule,6876.92
Blue Shield,PPO,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Fee Schedule,9548.66
Blue Shield,PPO,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,6876.92
Blue Shield,PPO,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,6876.92
Blue Shield,PPO,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Fee Schedule,9548.66
Blue Shield,PPO,22532,CPT4/HCPCS,LAT THORAX SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,PPO,22533,CPT4/HCPCS,LAT LUMBAR SPINE FUSION,,Fee Schedule,3198.57
Blue Shield,PPO,22534,CPT4/HCPCS,LAT THOR/LUMB ADDL SEG,,Fee Schedule,3198.57
Blue Shield,PPO,22548,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,PPO,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Fee Schedule,4891.93
Blue Shield,PPO,22554,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,6876.92
Blue Shield,PPO,22556,CPT4/HCPCS,THORAX SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,PPO,22558,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,PPO,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,Fee Schedule,3198.57
Blue Shield,PPO,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,Fee Schedule,7902.34
Blue Shield,PPO,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,Fee Schedule,4891.93
Blue Shield,PPO,22595,CPT4/HCPCS,NECK SPINAL FUSION,,Fee Schedule,4280.44
Blue Shield,PPO,22600,CPT4/HCPCS,NECK SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,PPO,22610,CPT4/HCPCS,THORAX SPINE FUSION,,Fee Schedule,4280.44
Blue Shield,PPO,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,9548.66
Blue Shield,PPO,22614,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,9548.66
Blue Shield,PPO,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,Fee Schedule,4891.93
Blue Shield,PPO,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,3198.57
Blue Shield,PPO,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,Fee Schedule,7902.34
Blue Shield,PPO,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Fee Schedule,3198.57
Blue Shield,PPO,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,Fee Schedule,4280.44
Blue Shield,PPO,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,Fee Schedule,6876.92
Blue Shield,PPO,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,Fee Schedule,6876.92
Blue Shield,PPO,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,Fee Schedule,6049.05
Blue Shield,PPO,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,Fee Schedule,6049.05
Blue Shield,PPO,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,Fee Schedule,6876.92
Blue Shield,PPO,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,Fee Schedule,6876.92
Blue Shield,PPO,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,Fee Schedule,6876.92
Blue Shield,PPO,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,Fee Schedule,3198.57
Blue Shield,PPO,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,Fee Schedule,4280.44
Blue Shield,PPO,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Fee Schedule,987.79
Blue Shield,PPO,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Fee Schedule,3198.57
Blue Shield,PPO,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Fee Schedule,3198.57
Blue Shield,PPO,22899,CPT4/HCPCS,SPINE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Fee Schedule,6049.05
Blue Shield,PPO,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,PPO,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Fee Schedule,4891.93
Blue Shield,PPO,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,22999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Fee Schedule,4891.93
Blue Shield,PPO,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Fee Schedule,4280.44
Blue Shield,PPO,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Fee Schedule,3198.57
Blue Shield,PPO,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Fee Schedule,4891.93
Blue Shield,PPO,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Fee Schedule,3198.57
Blue Shield,PPO,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Fee Schedule,4280.44
Blue Shield,PPO,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,PPO,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,PPO,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Fee Schedule,9548.66
Blue Shield,PPO,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Fee Schedule,6049.05
Blue Shield,PPO,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Fee Schedule,6876.92
Blue Shield,PPO,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Fee Schedule,6876.92
Blue Shield,PPO,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Fee Schedule,6876.92
Blue Shield,PPO,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6049.05
Blue Shield,PPO,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6876.92
Blue Shield,PPO,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Fee Schedule,6876.92
Blue Shield,PPO,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6049.05
Blue Shield,PPO,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6876.92
Blue Shield,PPO,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Fee Schedule,6876.92
Blue Shield,PPO,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,4280.44
Blue Shield,PPO,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Fee Schedule,6049.05
Blue Shield,PPO,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Fee Schedule,6049.05
Blue Shield,PPO,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,6049.05
Blue Shield,PPO,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Fee Schedule,6049.05
Blue Shield,PPO,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Fee Schedule,6876.92
Blue Shield,PPO,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,Fee Schedule,4280.44
Blue Shield,PPO,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,Fee Schedule,4280.44
Blue Shield,PPO,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,Fee Schedule,4891.93
Blue Shield,PPO,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,PPO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Fee Schedule,4280.44
Blue Shield,PPO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Fee Schedule,9548.66
Blue Shield,PPO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Fee Schedule,987.79
Blue Shield,PPO,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Fee Schedule,6876.92
Blue Shield,PPO,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Fee Schedule,9548.66
Blue Shield,PPO,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Fee Schedule,9548.66
Blue Shield,PPO,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Fee Schedule,4280.44
Blue Shield,PPO,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Fee Schedule,4280.44
Blue Shield,PPO,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Fee Schedule,6876.92
Blue Shield,PPO,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Fee Schedule,9548.66
Blue Shield,PPO,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Fee Schedule,6876.92
Blue Shield,PPO,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Fee Schedule,9548.66
Blue Shield,PPO,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,PPO,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,PPO,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,PPO,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,PPO,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,6876.92
Blue Shield,PPO,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Fee Schedule,9548.66
Blue Shield,PPO,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Fee Schedule,12850.71
Blue Shield,PPO,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,PPO,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,PPO,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Fee Schedule,6049.05
Blue Shield,PPO,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Fee Schedule,9548.66
Blue Shield,PPO,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Fee Schedule,4891.93
Blue Shield,PPO,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Fee Schedule,4891.93
Blue Shield,PPO,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,PPO,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,PPO,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Fee Schedule,3198.57
Blue Shield,PPO,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Fee Schedule,3198.57
Blue Shield,PPO,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6876.92
Blue Shield,PPO,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Fee Schedule,3198.57
Blue Shield,PPO,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Fee Schedule,9548.66
Blue Shield,PPO,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,Fee Schedule,4891.93
Blue Shield,PPO,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,23929,CPT4/HCPCS,SHOULDER SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Fee Schedule,3198.57
Blue Shield,PPO,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Fee Schedule,4280.44
Blue Shield,PPO,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Fee Schedule,3198.57
Blue Shield,PPO,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Fee Schedule,4280.44
Blue Shield,PPO,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,PPO,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Fee Schedule,4280.44
Blue Shield,PPO,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Fee Schedule,3198.57
Blue Shield,PPO,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Fee Schedule,6049.05
Blue Shield,PPO,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Fee Schedule,4891.93
Blue Shield,PPO,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Fee Schedule,4280.44
Blue Shield,PPO,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Fee Schedule,4891.93
Blue Shield,PPO,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Fee Schedule,4891.93
Blue Shield,PPO,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Fee Schedule,4891.93
Blue Shield,PPO,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,4891.93
Blue Shield,PPO,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Fee Schedule,4280.44
Blue Shield,PPO,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Fee Schedule,3198.57
Blue Shield,PPO,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Fee Schedule,9548.66
Blue Shield,PPO,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Fee Schedule,9548.66
Blue Shield,PPO,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Fee Schedule,4280.44
Blue Shield,PPO,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Fee Schedule,4891.93
Blue Shield,PPO,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,PPO,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,PPO,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Fee Schedule,3198.57
Blue Shield,PPO,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Fee Schedule,6049.05
Blue Shield,PPO,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Fee Schedule,6049.05
Blue Shield,PPO,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Fee Schedule,4891.93
Blue Shield,PPO,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Fee Schedule,4891.93
Blue Shield,PPO,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Fee Schedule,4891.93
Blue Shield,PPO,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,PPO,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Fee Schedule,6049.05
Blue Shield,PPO,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Fee Schedule,9548.66
Blue Shield,PPO,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Fee Schedule,4280.44
Blue Shield,PPO,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Fee Schedule,9548.66
Blue Shield,PPO,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Fee Schedule,4891.93
Blue Shield,PPO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Fee Schedule,4891.93
Blue Shield,PPO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Fee Schedule,4891.93
Blue Shield,PPO,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Fee Schedule,9548.66
Blue Shield,PPO,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Fee Schedule,6876.92
Blue Shield,PPO,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Fee Schedule,6876.92
Blue Shield,PPO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Fee Schedule,7902.34
Blue Shield,PPO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Fee Schedule,9548.66
Blue Shield,PPO,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,6049.05
Blue Shield,PPO,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,6049.05
Blue Shield,PPO,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Fee Schedule,4891.93
Blue Shield,PPO,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Fee Schedule,4891.93
Blue Shield,PPO,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,PPO,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Fee Schedule,4891.93
Blue Shield,PPO,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,6876.92
Blue Shield,PPO,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,6876.92
Blue Shield,PPO,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Fee Schedule,3198.57
Blue Shield,PPO,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Fee Schedule,4280.44
Blue Shield,PPO,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,Fee Schedule,3198.57
Blue Shield,PPO,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,Fee Schedule,9548.66
Blue Shield,PPO,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,Fee Schedule,9548.66
Blue Shield,PPO,24999,CPT4/HCPCS,UPPER ARM/ELBOW SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Fee Schedule,4891.93
Blue Shield,PPO,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Fee Schedule,4891.93
Blue Shield,PPO,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Fee Schedule,4891.93
Blue Shield,PPO,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Fee Schedule,4891.93
Blue Shield,PPO,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Fee Schedule,4891.93
Blue Shield,PPO,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Fee Schedule,4891.93
Blue Shield,PPO,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Fee Schedule,3198.57
Blue Shield,PPO,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Fee Schedule,4280.44
Blue Shield,PPO,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,PPO,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Fee Schedule,4280.44
Blue Shield,PPO,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,PPO,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Fee Schedule,4891.93
Blue Shield,PPO,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Fee Schedule,4891.93
Blue Shield,PPO,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Fee Schedule,4891.93
Blue Shield,PPO,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Fee Schedule,4891.93
Blue Shield,PPO,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Fee Schedule,6049.05
Blue Shield,PPO,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Fee Schedule,4891.93
Blue Shield,PPO,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Fee Schedule,4891.93
Blue Shield,PPO,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Fee Schedule,4891.93
Blue Shield,PPO,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Fee Schedule,4891.93
Blue Shield,PPO,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Fee Schedule,6049.05
Blue Shield,PPO,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Fee Schedule,6049.05
Blue Shield,PPO,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Fee Schedule,6049.05
Blue Shield,PPO,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,PPO,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,PPO,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,PPO,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Fee Schedule,4891.93
Blue Shield,PPO,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Fee Schedule,4891.93
Blue Shield,PPO,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Fee Schedule,4891.93
Blue Shield,PPO,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Fee Schedule,4891.93
Blue Shield,PPO,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,4280.44
Blue Shield,PPO,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,4280.44
Blue Shield,PPO,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Fee Schedule,9548.66
Blue Shield,PPO,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Fee Schedule,4891.93
Blue Shield,PPO,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Fee Schedule,6049.05
Blue Shield,PPO,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Fee Schedule,6049.05
Blue Shield,PPO,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Fee Schedule,6049.05
Blue Shield,PPO,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,PPO,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,PPO,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,PPO,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Fee Schedule,3198.57
Blue Shield,PPO,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,PPO,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4280.44
Blue Shield,PPO,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,PPO,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,PPO,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,4891.93
Blue Shield,PPO,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Fee Schedule,6049.05
Blue Shield,PPO,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Fee Schedule,6049.05
Blue Shield,PPO,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Fee Schedule,4891.93
Blue Shield,PPO,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Fee Schedule,4891.93
Blue Shield,PPO,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Fee Schedule,4891.93
Blue Shield,PPO,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Fee Schedule,4891.93
Blue Shield,PPO,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Fee Schedule,4891.93
Blue Shield,PPO,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Fee Schedule,6876.92
Blue Shield,PPO,25350,CPT4/HCPCS,REVISION OF RADIUS,,Fee Schedule,4891.93
Blue Shield,PPO,25355,CPT4/HCPCS,REVISION OF RADIUS,,Fee Schedule,4891.93
Blue Shield,PPO,25360,CPT4/HCPCS,REVISION OF ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,PPO,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Fee Schedule,6049.05
Blue Shield,PPO,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,PPO,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Fee Schedule,4280.44
Blue Shield,PPO,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Fee Schedule,6049.05
Blue Shield,PPO,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,PPO,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Fee Schedule,6049.05
Blue Shield,PPO,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Fee Schedule,6049.05
Blue Shield,PPO,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Fee Schedule,6049.05
Blue Shield,PPO,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Fee Schedule,6049.05
Blue Shield,PPO,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Fee Schedule,9548.66
Blue Shield,PPO,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Fee Schedule,6876.92
Blue Shield,PPO,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Fee Schedule,6876.92
Blue Shield,PPO,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,25490,CPT4/HCPCS,REINFORCE RADIUS,,Fee Schedule,4891.93
Blue Shield,PPO,25491,CPT4/HCPCS,REINFORCE ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,987.79
Blue Shield,PPO,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,3198.57
Blue Shield,PPO,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,4891.93
Blue Shield,PPO,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,3198.57
Blue Shield,PPO,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,6049.05
Blue Shield,PPO,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Fee Schedule,6876.92
Blue Shield,PPO,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,987.79
Blue Shield,PPO,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,3198.57
Blue Shield,PPO,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,987.79
Blue Shield,PPO,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,4280.44
Blue Shield,PPO,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,987.79
Blue Shield,PPO,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Fee Schedule,4891.93
Blue Shield,PPO,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Fee Schedule,4891.93
Blue Shield,PPO,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Fee Schedule,6876.92
Blue Shield,PPO,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Fee Schedule,6876.92
Blue Shield,PPO,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Fee Schedule,6876.92
Blue Shield,PPO,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Fee Schedule,7902.34
Blue Shield,PPO,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Fee Schedule,7902.34
Blue Shield,PPO,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Fee Schedule,6049.05
Blue Shield,PPO,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Fee Schedule,6876.92
Blue Shield,PPO,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Fee Schedule,6876.92
Blue Shield,PPO,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,PPO,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4280.44
Blue Shield,PPO,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,Fee Schedule,4891.93
Blue Shield,PPO,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Fee Schedule,3198.57
Blue Shield,PPO,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Fee Schedule,4891.93
Blue Shield,PPO,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,25927,CPT4/HCPCS,AMPUTATION OF HAND,,Fee Schedule,4280.44
Blue Shield,PPO,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,25999,CPT4/HCPCS,FOREARM OR WRIST SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,26010,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Fee Schedule,987.79
Blue Shield,PPO,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,PPO,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Fee Schedule,3198.57
Blue Shield,PPO,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Fee Schedule,4280.44
Blue Shield,PPO,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Fee Schedule,4280.44
Blue Shield,PPO,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Fee Schedule,4280.44
Blue Shield,PPO,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,PPO,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Fee Schedule,4280.44
Blue Shield,PPO,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Fee Schedule,4280.44
Blue Shield,PPO,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Fee Schedule,3198.57
Blue Shield,PPO,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Fee Schedule,3198.57
Blue Shield,PPO,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,PPO,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,PPO,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Fee Schedule,4891.93
Blue Shield,PPO,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Fee Schedule,4891.93
Blue Shield,PPO,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Fee Schedule,6049.05
Blue Shield,PPO,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Fee Schedule,4280.44
Blue Shield,PPO,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Fee Schedule,4891.93
Blue Shield,PPO,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Fee Schedule,4891.93
Blue Shield,PPO,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Fee Schedule,4891.93
Blue Shield,PPO,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Fee Schedule,6049.05
Blue Shield,PPO,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Fee Schedule,4280.44
Blue Shield,PPO,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Fee Schedule,4891.93
Blue Shield,PPO,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Fee Schedule,9548.66
Blue Shield,PPO,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Fee Schedule,4891.93
Blue Shield,PPO,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Fee Schedule,4891.93
Blue Shield,PPO,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Fee Schedule,4891.93
Blue Shield,PPO,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Fee Schedule,4280.44
Blue Shield,PPO,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Fee Schedule,4280.44
Blue Shield,PPO,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Fee Schedule,987.79
Blue Shield,PPO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Fee Schedule,987.79
Blue Shield,PPO,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,3198.57
Blue Shield,PPO,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Fee Schedule,4891.93
Blue Shield,PPO,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Fee Schedule,4280.44
Blue Shield,PPO,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Fee Schedule,4280.44
Blue Shield,PPO,26476,CPT4/HCPCS,TENDON LENGTHENING,,Fee Schedule,3198.57
Blue Shield,PPO,26477,CPT4/HCPCS,TENDON SHORTENING,,Fee Schedule,3198.57
Blue Shield,PPO,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Fee Schedule,3198.57
Blue Shield,PPO,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Fee Schedule,3198.57
Blue Shield,PPO,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Fee Schedule,4280.44
Blue Shield,PPO,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Fee Schedule,4891.93
Blue Shield,PPO,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Fee Schedule,4891.93
Blue Shield,PPO,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Fee Schedule,4891.93
Blue Shield,PPO,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Fee Schedule,6049.05
Blue Shield,PPO,26499,CPT4/HCPCS,REVISION OF FINGER,,Fee Schedule,4891.93
Blue Shield,PPO,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,PPO,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Fee Schedule,6049.05
Blue Shield,PPO,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Fee Schedule,4891.93
Blue Shield,PPO,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Fee Schedule,3198.57
Blue Shield,PPO,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Fee Schedule,4891.93
Blue Shield,PPO,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Fee Schedule,4891.93
Blue Shield,PPO,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Fee Schedule,9548.66
Blue Shield,PPO,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Fee Schedule,6049.05
Blue Shield,PPO,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Fee Schedule,4280.44
Blue Shield,PPO,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Fee Schedule,9548.66
Blue Shield,PPO,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Fee Schedule,9548.66
Blue Shield,PPO,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Fee Schedule,9548.66
Blue Shield,PPO,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Fee Schedule,4891.93
Blue Shield,PPO,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,Fee Schedule,9548.66
Blue Shield,PPO,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,4280.44
Blue Shield,PPO,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,4891.93
Blue Shield,PPO,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Fee Schedule,6049.05
Blue Shield,PPO,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Fee Schedule,6876.92
Blue Shield,PPO,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Fee Schedule,6876.92
Blue Shield,PPO,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Fee Schedule,4891.93
Blue Shield,PPO,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Fee Schedule,6876.92
Blue Shield,PPO,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Fee Schedule,6876.92
Blue Shield,PPO,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Fee Schedule,6876.92
Blue Shield,PPO,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Fee Schedule,4891.93
Blue Shield,PPO,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Fee Schedule,4891.93
Blue Shield,PPO,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Fee Schedule,4280.44
Blue Shield,PPO,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Fee Schedule,6049.05
Blue Shield,PPO,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,PPO,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,PPO,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,9548.66
Blue Shield,PPO,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6049.05
Blue Shield,PPO,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,PPO,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,4280.44
Blue Shield,PPO,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6876.92
Blue Shield,PPO,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,PPO,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,PPO,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Fee Schedule,4280.44
Blue Shield,PPO,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Fee Schedule,6049.05
Blue Shield,PPO,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Fee Schedule,6876.92
Blue Shield,PPO,26841,CPT4/HCPCS,FUSION OF THUMB,,Fee Schedule,6049.05
Blue Shield,PPO,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Fee Schedule,6049.05
Blue Shield,PPO,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Fee Schedule,4280.44
Blue Shield,PPO,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Fee Schedule,4891.93
Blue Shield,PPO,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Fee Schedule,4280.44
Blue Shield,PPO,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Fee Schedule,6049.05
Blue Shield,PPO,26989,CPT4/HCPCS,HAND/FINGER SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Fee Schedule,3198.57
Blue Shield,PPO,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Fee Schedule,3198.57
Blue Shield,PPO,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,6049.05
Blue Shield,PPO,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4280.44
Blue Shield,PPO,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,Fee Schedule,3198.57
Blue Shield,PPO,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Fee Schedule,3198.57
Blue Shield,PPO,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,Fee Schedule,3198.57
Blue Shield,PPO,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Fee Schedule,6049.05
Blue Shield,PPO,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,Fee Schedule,4280.44
Blue Shield,PPO,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,PPO,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Fee Schedule,4280.44
Blue Shield,PPO,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,PPO,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,Fee Schedule,3198.57
Blue Shield,PPO,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Fee Schedule,6049.05
Blue Shield,PPO,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Fee Schedule,6876.92
Blue Shield,PPO,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Fee Schedule,6876.92
Blue Shield,PPO,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Fee Schedule,6876.92
Blue Shield,PPO,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Fee Schedule,6876.92
Blue Shield,PPO,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Fee Schedule,6876.92
Blue Shield,PPO,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,Fee Schedule,4891.93
Blue Shield,PPO,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,Fee Schedule,6049.05
Blue Shield,PPO,27075,CPT4/HCPCS,RESECT HIP TUMOR,,Fee Schedule,7902.34
Blue Shield,PPO,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,Fee Schedule,6049.05
Blue Shield,PPO,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,Fee Schedule,9548.66
Blue Shield,PPO,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,Fee Schedule,4891.93
Blue Shield,PPO,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Fee Schedule,4280.44
Blue Shield,PPO,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,PPO,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Fee Schedule,4891.93
Blue Shield,PPO,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,PPO,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,PPO,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Fee Schedule,3198.57
Blue Shield,PPO,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Fee Schedule,4891.93
Blue Shield,PPO,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Fee Schedule,6049.05
Blue Shield,PPO,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Fee Schedule,6049.05
Blue Shield,PPO,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Fee Schedule,6049.05
Blue Shield,PPO,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Fee Schedule,6049.05
Blue Shield,PPO,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Fee Schedule,4280.44
Blue Shield,PPO,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Fee Schedule,4280.44
Blue Shield,PPO,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,Fee Schedule,4280.44
Blue Shield,PPO,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Fee Schedule,4891.93
Blue Shield,PPO,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Fee Schedule,6049.05
Blue Shield,PPO,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,6876.92
Blue Shield,PPO,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,4891.93
Blue Shield,PPO,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Fee Schedule,4891.93
Blue Shield,PPO,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,Fee Schedule,3198.57
Blue Shield,PPO,27146,CPT4/HCPCS,INCISION OF HIP BONE,,Fee Schedule,4891.93
Blue Shield,PPO,27147,CPT4/HCPCS,REVISION OF HIP BONE,,Fee Schedule,4891.93
Blue Shield,PPO,27151,CPT4/HCPCS,INCISION OF HIP BONES,,Fee Schedule,6049.05
Blue Shield,PPO,27156,CPT4/HCPCS,REVISION OF HIP BONES,,Fee Schedule,6049.05
Blue Shield,PPO,27158,CPT4/HCPCS,REVISION OF PELVIS,,Fee Schedule,4891.93
Blue Shield,PPO,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,Fee Schedule,4280.44
Blue Shield,PPO,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,Fee Schedule,4280.44
Blue Shield,PPO,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,Fee Schedule,4280.44
Blue Shield,PPO,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,PPO,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,PPO,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,PPO,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,PPO,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,Fee Schedule,3198.57
Blue Shield,PPO,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,PPO,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,Fee Schedule,3198.57
Blue Shield,PPO,27187,CPT4/HCPCS,REINFORCE HIP BONES,,Fee Schedule,4280.44
Blue Shield,PPO,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Fee Schedule,3198.57
Blue Shield,PPO,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Fee Schedule,4280.44
Blue Shield,PPO,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,Fee Schedule,3198.57
Blue Shield,PPO,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Fee Schedule,4891.93
Blue Shield,PPO,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Fee Schedule,6049.05
Blue Shield,PPO,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,27267,CPT4/HCPCS,CLTX THIGH FX,,Fee Schedule,4280.44
Blue Shield,PPO,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,Fee Schedule,4280.44
Blue Shield,PPO,27269,CPT4/HCPCS,OPTX THIGH FX,,Fee Schedule,6876.92
Blue Shield,PPO,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,Fee Schedule,3198.57
Blue Shield,PPO,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Fee Schedule,4891.93
Blue Shield,PPO,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Fee Schedule,4280.44
Blue Shield,PPO,27299,CPT4/HCPCS,PELVIS/HIP JOINT SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Fee Schedule,4280.44
Blue Shield,PPO,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,PPO,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,PPO,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Fee Schedule,3198.57
Blue Shield,PPO,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Fee Schedule,4280.44
Blue Shield,PPO,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Fee Schedule,4280.44
Blue Shield,PPO,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Fee Schedule,4280.44
Blue Shield,PPO,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Fee Schedule,4891.93
Blue Shield,PPO,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Fee Schedule,6049.05
Blue Shield,PPO,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,PPO,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,PPO,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,PPO,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,PPO,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,PPO,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Fee Schedule,4891.93
Blue Shield,PPO,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Fee Schedule,6049.05
Blue Shield,PPO,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Fee Schedule,6049.05
Blue Shield,PPO,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Fee Schedule,6049.05
Blue Shield,PPO,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Fee Schedule,4891.93
Blue Shield,PPO,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Fee Schedule,6876.92
Blue Shield,PPO,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Fee Schedule,6876.92
Blue Shield,PPO,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Fee Schedule,6876.92
Blue Shield,PPO,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,Fee Schedule,4891.93
Blue Shield,PPO,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Fee Schedule,9548.66
Blue Shield,PPO,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Fee Schedule,3198.57
Blue Shield,PPO,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Fee Schedule,4891.93
Blue Shield,PPO,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Fee Schedule,4891.93
Blue Shield,PPO,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Fee Schedule,3198.57
Blue Shield,PPO,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4280.44
Blue Shield,PPO,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,PPO,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Fee Schedule,4280.44
Blue Shield,PPO,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,PPO,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,PPO,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Fee Schedule,4891.93
Blue Shield,PPO,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Fee Schedule,4891.93
Blue Shield,PPO,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Fee Schedule,6049.05
Blue Shield,PPO,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Fee Schedule,6049.05
Blue Shield,PPO,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Fee Schedule,6049.05
Blue Shield,PPO,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Fee Schedule,6049.05
Blue Shield,PPO,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Fee Schedule,12850.71
Blue Shield,PPO,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Fee Schedule,12850.71
Blue Shield,PPO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Fee Schedule,4891.93
Blue Shield,PPO,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Fee Schedule,4891.93
Blue Shield,PPO,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Fee Schedule,9548.66
Blue Shield,PPO,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Fee Schedule,4891.93
Blue Shield,PPO,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Fee Schedule,9548.66
Blue Shield,PPO,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,4891.93
Blue Shield,PPO,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,6049.05
Blue Shield,PPO,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Fee Schedule,6049.05
Blue Shield,PPO,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Fee Schedule,6049.05
Blue Shield,PPO,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,27437,CPT4/HCPCS,REVISE KNEECAP,,Fee Schedule,6049.05
Blue Shield,PPO,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Fee Schedule,6876.92
Blue Shield,PPO,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,7902.34
Blue Shield,PPO,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Fee Schedule,12850.71
Blue Shield,PPO,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Fee Schedule,4891.93
Blue Shield,PPO,27448,CPT4/HCPCS,INCISION OF THIGH,,Fee Schedule,3198.57
Blue Shield,PPO,27450,CPT4/HCPCS,INCISION OF THIGH,,Fee Schedule,4280.44
Blue Shield,PPO,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,Fee Schedule,4891.93
Blue Shield,PPO,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,Fee Schedule,4280.44
Blue Shield,PPO,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,Fee Schedule,3198.57
Blue Shield,PPO,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,Fee Schedule,4280.44
Blue Shield,PPO,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,Fee Schedule,4891.93
Blue Shield,PPO,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,Fee Schedule,4280.44
Blue Shield,PPO,27470,CPT4/HCPCS,REPAIR OF THIGH,,Fee Schedule,4891.93
Blue Shield,PPO,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,Fee Schedule,4891.93
Blue Shield,PPO,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,PPO,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,PPO,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,PPO,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Fee Schedule,3198.57
Blue Shield,PPO,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,PPO,27495,CPT4/HCPCS,REINFORCE THIGH,,Fee Schedule,4891.93
Blue Shield,PPO,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,6876.92
Blue Shield,PPO,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,PPO,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,PPO,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Fee Schedule,4891.93
Blue Shield,PPO,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,3198.57
Blue Shield,PPO,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,3198.57
Blue Shield,PPO,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Fee Schedule,4280.44
Blue Shield,PPO,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Fee Schedule,7902.34
Blue Shield,PPO,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Fee Schedule,3198.57
Blue Shield,PPO,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Fee Schedule,3198.57
Blue Shield,PPO,27580,CPT4/HCPCS,FUSION OF KNEE,,Fee Schedule,4891.93
Blue Shield,PPO,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,PPO,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,PPO,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Fee Schedule,4280.44
Blue Shield,PPO,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,Fee Schedule,3198.57
Blue Shield,PPO,27599,CPT4/HCPCS,LEG SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,PPO,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,PPO,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,PPO,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Fee Schedule,4280.44
Blue Shield,PPO,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Fee Schedule,4280.44
Blue Shield,PPO,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Fee Schedule,3198.57
Blue Shield,PPO,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Fee Schedule,3198.57
Blue Shield,PPO,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Fee Schedule,3198.57
Blue Shield,PPO,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Fee Schedule,4280.44
Blue Shield,PPO,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Fee Schedule,4280.44
Blue Shield,PPO,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Fee Schedule,4891.93
Blue Shield,PPO,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,PPO,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Fee Schedule,6049.05
Blue Shield,PPO,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Fee Schedule,4891.93
Blue Shield,PPO,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Fee Schedule,4280.44
Blue Shield,PPO,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Fee Schedule,4280.44
Blue Shield,PPO,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,Fee Schedule,6049.05
Blue Shield,PPO,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,Fee Schedule,6049.05
Blue Shield,PPO,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Fee Schedule,4891.93
Blue Shield,PPO,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Fee Schedule,4280.44
Blue Shield,PPO,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,3198.57
Blue Shield,PPO,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,PPO,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,PPO,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Fee Schedule,4280.44
Blue Shield,PPO,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Fee Schedule,4280.44
Blue Shield,PPO,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Fee Schedule,4891.93
Blue Shield,PPO,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Fee Schedule,4280.44
Blue Shield,PPO,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Fee Schedule,4891.93
Blue Shield,PPO,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Fee Schedule,6049.05
Blue Shield,PPO,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Fee Schedule,4280.44
Blue Shield,PPO,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,PPO,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Fee Schedule,4280.44
Blue Shield,PPO,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Fee Schedule,4280.44
Blue Shield,PPO,27705,CPT4/HCPCS,INCISION OF TIBIA,,Fee Schedule,4280.44
Blue Shield,PPO,27707,CPT4/HCPCS,INCISION OF FIBULA,,Fee Schedule,4280.44
Blue Shield,PPO,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Fee Schedule,4280.44
Blue Shield,PPO,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,PPO,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,PPO,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Fee Schedule,4280.44
Blue Shield,PPO,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Fee Schedule,4280.44
Blue Shield,PPO,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Fee Schedule,4891.93
Blue Shield,PPO,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,Fee Schedule,4891.93
Blue Shield,PPO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Fee Schedule,4891.93
Blue Shield,PPO,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,PPO,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Fee Schedule,4280.44
Blue Shield,PPO,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Fee Schedule,4280.44
Blue Shield,PPO,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,PPO,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,PPO,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Fee Schedule,4280.44
Blue Shield,PPO,27745,CPT4/HCPCS,REINFORCE TIBIA,,Fee Schedule,4891.93
Blue Shield,PPO,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Fee Schedule,3198.57
Blue Shield,PPO,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Fee Schedule,3198.57
Blue Shield,PPO,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Fee Schedule,4891.93
Blue Shield,PPO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Fee Schedule,4280.44
Blue Shield,PPO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Fee Schedule,4280.44
Blue Shield,PPO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Fee Schedule,6049.05
Blue Shield,PPO,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Fee Schedule,3198.57
Blue Shield,PPO,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Fee Schedule,6049.05
Blue Shield,PPO,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,3198.57
Blue Shield,PPO,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,PPO,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Fee Schedule,4280.44
Blue Shield,PPO,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Fee Schedule,3198.57
Blue Shield,PPO,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Fee Schedule,4891.93
Blue Shield,PPO,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,PPO,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,PPO,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Fee Schedule,4891.93
Blue Shield,PPO,27899,CPT4/HCPCS,LEG/ANKLE SURGERY PROCEDURE,,Fee Schedule,987.79
Blue Shield,PPO,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Fee Schedule,3198.57
Blue Shield,PPO,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Fee Schedule,4891.93
Blue Shield,PPO,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Fee Schedule,4891.93
Blue Shield,PPO,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,PPO,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Fee Schedule,4891.93
Blue Shield,PPO,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Fee Schedule,4280.44
Blue Shield,PPO,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Fee Schedule,6049.05
Blue Shield,PPO,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Fee Schedule,4280.44
Blue Shield,PPO,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Fee Schedule,4280.44
Blue Shield,PPO,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Fee Schedule,4891.93
Blue Shield,PPO,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Fee Schedule,4891.93
Blue Shield,PPO,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Fee Schedule,4891.93
Blue Shield,PPO,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Fee Schedule,4280.44
Blue Shield,PPO,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Fee Schedule,4280.44
Blue Shield,PPO,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Fee Schedule,4280.44
Blue Shield,PPO,28055,CPT4/HCPCS,NEURECTOMY FOOT,,Fee Schedule,4891.93
Blue Shield,PPO,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Fee Schedule,4280.44
Blue Shield,PPO,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,PPO,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Fee Schedule,4891.93
Blue Shield,PPO,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Fee Schedule,4891.93
Blue Shield,PPO,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4891.93
Blue Shield,PPO,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,PPO,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Fee Schedule,4280.44
Blue Shield,PPO,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4891.93
Blue Shield,PPO,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Fee Schedule,4891.93
Blue Shield,PPO,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Fee Schedule,4280.44
Blue Shield,PPO,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,PPO,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,PPO,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Fee Schedule,4280.44
Blue Shield,PPO,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,PPO,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Fee Schedule,4891.93
Blue Shield,PPO,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Fee Schedule,4891.93
Blue Shield,PPO,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,PPO,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,PPO,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,PPO,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,PPO,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Fee Schedule,4891.93
Blue Shield,PPO,28116,CPT4/HCPCS,REVISION OF FOOT,,Fee Schedule,4891.93
Blue Shield,PPO,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Fee Schedule,6049.05
Blue Shield,PPO,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Fee Schedule,6049.05
Blue Shield,PPO,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Fee Schedule,9548.66
Blue Shield,PPO,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Fee Schedule,4891.93
Blue Shield,PPO,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,PPO,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,PPO,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Fee Schedule,4891.93
Blue Shield,PPO,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Fee Schedule,4891.93
Blue Shield,PPO,28150,CPT4/HCPCS,REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,PPO,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,PPO,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Fee Schedule,4891.93
Blue Shield,PPO,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Fee Schedule,4891.93
Blue Shield,PPO,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Fee Schedule,4891.93
Blue Shield,PPO,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Fee Schedule,4891.93
Blue Shield,PPO,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,PPO,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,PPO,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Fee Schedule,6049.05
Blue Shield,PPO,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Fee Schedule,3198.57
Blue Shield,PPO,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Fee Schedule,3198.57
Blue Shield,PPO,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Fee Schedule,3198.57
Blue Shield,PPO,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Fee Schedule,4891.93
Blue Shield,PPO,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Fee Schedule,4280.44
Blue Shield,PPO,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Fee Schedule,4280.44
Blue Shield,PPO,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Fee Schedule,4891.93
Blue Shield,PPO,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Fee Schedule,4891.93
Blue Shield,PPO,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Fee Schedule,4891.93
Blue Shield,PPO,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Fee Schedule,6049.05
Blue Shield,PPO,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Fee Schedule,3198.57
Blue Shield,PPO,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Fee Schedule,4891.93
Blue Shield,PPO,28280,CPT4/HCPCS,FUSION OF TOES,,Fee Schedule,4280.44
Blue Shield,PPO,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Fee Schedule,4891.93
Blue Shield,PPO,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Fee Schedule,6049.05
Blue Shield,PPO,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Fee Schedule,4891.93
Blue Shield,PPO,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Fee Schedule,4891.93
Blue Shield,PPO,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Fee Schedule,4891.93
Blue Shield,PPO,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4280.44
Blue Shield,PPO,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,PPO,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,PPO,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,PPO,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,4891.93
Blue Shield,PPO,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Fee Schedule,6876.92
Blue Shield,PPO,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Fee Schedule,4280.44
Blue Shield,PPO,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Fee Schedule,4280.44
Blue Shield,PPO,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Fee Schedule,4280.44
Blue Shield,PPO,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Fee Schedule,4891.93
Blue Shield,PPO,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,6049.05
Blue Shield,PPO,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,6049.05
Blue Shield,PPO,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Fee Schedule,4280.44
Blue Shield,PPO,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Fee Schedule,6049.05
Blue Shield,PPO,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Fee Schedule,4891.93
Blue Shield,PPO,28312,CPT4/HCPCS,REVISION OF TOE,,Fee Schedule,4891.93
Blue Shield,PPO,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Fee Schedule,4280.44
Blue Shield,PPO,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Fee Schedule,6049.05
Blue Shield,PPO,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,PPO,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Fee Schedule,6049.05
Blue Shield,PPO,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Fee Schedule,6049.05
Blue Shield,PPO,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Fee Schedule,6049.05
Blue Shield,PPO,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Fee Schedule,6049.05
Blue Shield,PPO,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Fee Schedule,6049.05
Blue Shield,PPO,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,Fee Schedule,6876.92
Blue Shield,PPO,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Fee Schedule,6049.05
Blue Shield,PPO,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,987.79
Blue Shield,PPO,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,3198.57
Blue Shield,PPO,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Fee Schedule,4891.93
Blue Shield,PPO,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Fee Schedule,6049.05
Blue Shield,PPO,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Fee Schedule,987.79
Blue Shield,PPO,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Fee Schedule,4891.93
Blue Shield,PPO,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Fee Schedule,4280.44
Blue Shield,PPO,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,987.79
Blue Shield,PPO,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,3198.57
Blue Shield,PPO,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Fee Schedule,4891.93
Blue Shield,PPO,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,PPO,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,PPO,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,PPO,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,PPO,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,PPO,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Fee Schedule,6876.92
Blue Shield,PPO,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Fee Schedule,6049.05
Blue Shield,PPO,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Fee Schedule,6049.05
Blue Shield,PPO,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,Fee Schedule,3198.57
Blue Shield,PPO,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Fee Schedule,3198.57
Blue Shield,PPO,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Fee Schedule,4280.44
Blue Shield,PPO,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Fee Schedule,4280.44
Blue Shield,PPO,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Fee Schedule,4280.44
Blue Shield,PPO,28899,CPT4/HCPCS,FOOT/TOES SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,PPO,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,PPO,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,PPO,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,PPO,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,PPO,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,PPO,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,Fee Schedule,987.79
Blue Shield,PPO,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,Fee Schedule,987.79
Blue Shield,PPO,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Fee Schedule,987.79
Blue Shield,PPO,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Fee Schedule,987.79
Blue Shield,PPO,29065,CPT4/HCPCS,APPLICATION OF LONG ARM CAST,,Fee Schedule,987.79
Blue Shield,PPO,29075,CPT4/HCPCS,APPLICATION OF FOREARM CAST,,Fee Schedule,987.79
Blue Shield,PPO,29085,CPT4/HCPCS,APPLY HAND/WRIST CAST,,Fee Schedule,987.79
Blue Shield,PPO,29086,CPT4/HCPCS,APPLY FINGER CAST,,Fee Schedule,987.79
Blue Shield,PPO,29105,CPT4/HCPCS,APPLY LONG ARM SPLINT,,Fee Schedule,987.79
Blue Shield,PPO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Fee Schedule,987.79
Blue Shield,PPO,29126,CPT4/HCPCS,APPLY FOREARM SPLINT,,Fee Schedule,987.79
Blue Shield,PPO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Fee Schedule,987.79
Blue Shield,PPO,29131,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Fee Schedule,987.79
Blue Shield,PPO,29200,CPT4/HCPCS,STRAPPING OF CHEST,,Fee Schedule,987.79
Blue Shield,PPO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Fee Schedule,987.79
Blue Shield,PPO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Fee Schedule,987.79
Blue Shield,PPO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Fee Schedule,987.79
Blue Shield,PPO,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Fee Schedule,987.79
Blue Shield,PPO,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Fee Schedule,987.79
Blue Shield,PPO,29345,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,PPO,29355,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,PPO,29358,CPT4/HCPCS,APPLY LONG LEG CAST BRACE,,Fee Schedule,987.79
Blue Shield,PPO,29365,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Fee Schedule,987.79
Blue Shield,PPO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,PPO,29425,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,PPO,29435,CPT4/HCPCS,APPLY SHORT LEG CAST,,Fee Schedule,987.79
Blue Shield,PPO,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,Fee Schedule,987.79
Blue Shield,PPO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,Fee Schedule,987.79
Blue Shield,PPO,29450,CPT4/HCPCS,APPLICATION OF LEG CAST,,Fee Schedule,987.79
Blue Shield,PPO,29505,CPT4/HCPCS,APPLICATION LONG LEG SPLINT,,Fee Schedule,987.79
Blue Shield,PPO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Fee Schedule,987.79
Blue Shield,PPO,29520,CPT4/HCPCS,STRAPPING OF HIP,,Fee Schedule,987.79
Blue Shield,PPO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,Fee Schedule,987.79
Blue Shield,PPO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,Fee Schedule,987.79
Blue Shield,PPO,29550,CPT4/HCPCS,STRAPPING OF TOES,,Fee Schedule,987.79
Blue Shield,PPO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Fee Schedule,987.79
Blue Shield,PPO,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,Fee Schedule,987.79
Blue Shield,PPO,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,Fee Schedule,7902.34
Blue Shield,PPO,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,PPO,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,PPO,29710,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Fee Schedule,987.79
Blue Shield,PPO,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,Fee Schedule,987.79
Blue Shield,PPO,29730,CPT4/HCPCS,WINDOWING OF CAST,,Fee Schedule,987.79
Blue Shield,PPO,29740,CPT4/HCPCS,WEDGING OF CAST,,Fee Schedule,987.79
Blue Shield,PPO,29750,CPT4/HCPCS,WEDGING OF CLUBFOOT CAST,,Fee Schedule,987.79
Blue Shield,PPO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,Fee Schedule,987.79
Blue Shield,PPO,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Fee Schedule,4891.93
Blue Shield,PPO,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Fee Schedule,4891.93
Blue Shield,PPO,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Fee Schedule,4891.93
Blue Shield,PPO,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Fee Schedule,4891.93
Blue Shield,PPO,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Fee Schedule,4891.93
Blue Shield,PPO,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Fee Schedule,4891.93
Blue Shield,PPO,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Fee Schedule,4891.93
Blue Shield,PPO,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Fee Schedule,4891.93
Blue Shield,PPO,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Fee Schedule,6876.92
Blue Shield,PPO,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Fee Schedule,4891.93
Blue Shield,PPO,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Fee Schedule,4891.93
Blue Shield,PPO,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Fee Schedule,6876.92
Blue Shield,PPO,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Fee Schedule,4891.93
Blue Shield,PPO,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Fee Schedule,4891.93
Blue Shield,PPO,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Fee Schedule,4891.93
Blue Shield,PPO,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Fee Schedule,12850.71
Blue Shield,PPO,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Fee Schedule,6049.05
Blue Shield,PPO,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Fee Schedule,6049.05
Blue Shield,PPO,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Fee Schedule,12850.71
Blue Shield,PPO,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Fee Schedule,6049.05
Blue Shield,PPO,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Fee Schedule,12850.71
Blue Shield,PPO,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Fee Schedule,12850.71
Blue Shield,PPO,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Fee Schedule,12850.71
Blue Shield,PPO,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Fee Schedule,4891.93
Blue Shield,PPO,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Fee Schedule,4891.93
Blue Shield,PPO,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6876.92
Blue Shield,PPO,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Fee Schedule,12850.71
Blue Shield,PPO,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Fee Schedule,4891.93
Blue Shield,PPO,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,PPO,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,PPO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Fee Schedule,4891.93
Blue Shield,PPO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Fee Schedule,4891.93
Blue Shield,PPO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Fee Schedule,4891.93
Blue Shield,PPO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Fee Schedule,6049.05
Blue Shield,PPO,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Fee Schedule,6049.05
Blue Shield,PPO,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Fee Schedule,6049.05
Blue Shield,PPO,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Fee Schedule,6049.05
Blue Shield,PPO,29999,CPT4/HCPCS,ARTHROSCOPY OF JOINT,,Fee Schedule,6876.92
Blue Shield,PPO,30000,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,PPO,30020,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,PPO,30100,CPT4/HCPCS,INTRANASAL BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Fee Schedule,4280.44
Blue Shield,PPO,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Fee Schedule,4280.44
Blue Shield,PPO,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Fee Schedule,4891.93
Blue Shield,PPO,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Fee Schedule,4891.93
Blue Shield,PPO,30120,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,3198.57
Blue Shield,PPO,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Fee Schedule,3198.57
Blue Shield,PPO,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Fee Schedule,4891.93
Blue Shield,PPO,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Fee Schedule,4280.44
Blue Shield,PPO,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Fee Schedule,4891.93
Blue Shield,PPO,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Fee Schedule,6049.05
Blue Shield,PPO,30200,CPT4/HCPCS,INJECTION TREATMENT OF NOSE,,Fee Schedule,4280.44
Blue Shield,PPO,30210,CPT4/HCPCS,NASAL SINUS THERAPY,,Fee Schedule,3198.57
Blue Shield,PPO,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Fee Schedule,3198.57
Blue Shield,PPO,30300,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,PPO,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,PPO,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,PPO,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6049.05
Blue Shield,PPO,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6876.92
Blue Shield,PPO,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Fee Schedule,6876.92
Blue Shield,PPO,30430,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,4891.93
Blue Shield,PPO,30435,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,6876.92
Blue Shield,PPO,30450,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,9548.66
Blue Shield,PPO,30460,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,9548.66
Blue Shield,PPO,30462,CPT4/HCPCS,REVISION OF NOSE,,Fee Schedule,12850.71
Blue Shield,PPO,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Fee Schedule,12850.71
Blue Shield,PPO,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Fee Schedule,6049.05
Blue Shield,PPO,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Fee Schedule,6876.92
Blue Shield,PPO,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Fee Schedule,6876.92
Blue Shield,PPO,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Fee Schedule,4280.44
Blue Shield,PPO,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Fee Schedule,6049.05
Blue Shield,PPO,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Fee Schedule,6049.05
Blue Shield,PPO,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Fee Schedule,9548.66
Blue Shield,PPO,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Fee Schedule,9548.66
Blue Shield,PPO,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Fee Schedule,3198.57
Blue Shield,PPO,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Fee Schedule,3198.57
Blue Shield,PPO,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,987.79
Blue Shield,PPO,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,PPO,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,PPO,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Fee Schedule,3198.57
Blue Shield,PPO,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Fee Schedule,4280.44
Blue Shield,PPO,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Fee Schedule,4891.93
Blue Shield,PPO,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Fee Schedule,6049.05
Blue Shield,PPO,30999,CPT4/HCPCS,NASAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Fee Schedule,3198.57
Blue Shield,PPO,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Fee Schedule,3198.57
Blue Shield,PPO,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4280.44
Blue Shield,PPO,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,PPO,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Fee Schedule,6049.05
Blue Shield,PPO,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,Fee Schedule,6049.05
Blue Shield,PPO,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Fee Schedule,4280.44
Blue Shield,PPO,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Fee Schedule,4280.44
Blue Shield,PPO,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,PPO,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,PPO,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,PPO,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,PPO,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,PPO,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,PPO,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Fee Schedule,6049.05
Blue Shield,PPO,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Fee Schedule,6876.92
Blue Shield,PPO,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,4280.44
Blue Shield,PPO,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,6876.92
Blue Shield,PPO,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Fee Schedule,4891.93
Blue Shield,PPO,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Fee Schedule,4891.93
Blue Shield,PPO,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Fee Schedule,4891.93
Blue Shield,PPO,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Fee Schedule,987.79
Blue Shield,PPO,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Fee Schedule,4280.44
Blue Shield,PPO,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Fee Schedule,3198.57
Blue Shield,PPO,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4280.44
Blue Shield,PPO,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,PPO,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,6049.05
Blue Shield,PPO,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4280.44
Blue Shield,PPO,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Fee Schedule,6876.92
Blue Shield,PPO,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Fee Schedule,6876.92
Blue Shield,PPO,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Fee Schedule,4891.93
Blue Shield,PPO,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Fee Schedule,6876.92
Blue Shield,PPO,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,PPO,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Fee Schedule,6876.92
Blue Shield,PPO,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Fee Schedule,6876.92
Blue Shield,PPO,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Fee Schedule,4891.93
Blue Shield,PPO,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Fee Schedule,4891.93
Blue Shield,PPO,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,PPO,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,4891.93
Blue Shield,PPO,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,PPO,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Fee Schedule,3198.57
Blue Shield,PPO,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Fee Schedule,3198.57
Blue Shield,PPO,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Fee Schedule,3198.57
Blue Shield,PPO,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Fee Schedule,4280.44
Blue Shield,PPO,31295,CPT4/HCPCS,NSL/SINS NDSC SURG MAX SINS,,Fee Schedule,3198.57
Blue Shield,PPO,31296,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT SINS,,Fee Schedule,3198.57
Blue Shield,PPO,31297,CPT4/HCPCS,NSL/SINS NDSC SURG SPHN SINS,,Fee Schedule,3198.57
Blue Shield,PPO,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Fee Schedule,3198.57
Blue Shield,PPO,31299,CPT4/HCPCS,SINUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Fee Schedule,6876.92
Blue Shield,PPO,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,PPO,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,PPO,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,PPO,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,7902.34
Blue Shield,PPO,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,PPO,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,PPO,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6049.05
Blue Shield,PPO,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Fee Schedule,6876.92
Blue Shield,PPO,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,Fee Schedule,7902.34
Blue Shield,PPO,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,Fee Schedule,9548.66
Blue Shield,PPO,31400,CPT4/HCPCS,REVISION OF LARYNX,,Fee Schedule,4280.44
Blue Shield,PPO,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Fee Schedule,4280.44
Blue Shield,PPO,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Fee Schedule,3198.57
Blue Shield,PPO,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Fee Schedule,987.79
Blue Shield,PPO,31505,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Fee Schedule,4280.44
Blue Shield,PPO,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Fee Schedule,4280.44
Blue Shield,PPO,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Fee Schedule,4280.44
Blue Shield,PPO,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Fee Schedule,4280.44
Blue Shield,PPO,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Fee Schedule,3198.57
Blue Shield,PPO,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Fee Schedule,3198.57
Blue Shield,PPO,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Fee Schedule,3198.57
Blue Shield,PPO,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Fee Schedule,4280.44
Blue Shield,PPO,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Fee Schedule,3198.57
Blue Shield,PPO,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Fee Schedule,4280.44
Blue Shield,PPO,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Fee Schedule,4280.44
Blue Shield,PPO,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,PPO,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Fee Schedule,4891.93
Blue Shield,PPO,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Fee Schedule,4280.44
Blue Shield,PPO,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Fee Schedule,4891.93
Blue Shield,PPO,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Fee Schedule,4891.93
Blue Shield,PPO,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Fee Schedule,6049.05
Blue Shield,PPO,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Fee Schedule,4891.93
Blue Shield,PPO,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Fee Schedule,4891.93
Blue Shield,PPO,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,PPO,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,PPO,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,PPO,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Fee Schedule,6876.92
Blue Shield,PPO,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Fee Schedule,6876.92
Blue Shield,PPO,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Fee Schedule,6876.92
Blue Shield,PPO,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Fee Schedule,4280.44
Blue Shield,PPO,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Fee Schedule,4280.44
Blue Shield,PPO,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Fee Schedule,4280.44
Blue Shield,PPO,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Fee Schedule,4280.44
Blue Shield,PPO,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Fee Schedule,4280.44
Blue Shield,PPO,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Fee Schedule,987.79
Blue Shield,PPO,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Fee Schedule,4280.44
Blue Shield,PPO,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Fee Schedule,4280.44
Blue Shield,PPO,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Fee Schedule,4280.44
Blue Shield,PPO,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Fee Schedule,3198.57
Blue Shield,PPO,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Fee Schedule,6876.92
Blue Shield,PPO,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Fee Schedule,6049.05
Blue Shield,PPO,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Fee Schedule,4280.44
Blue Shield,PPO,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Fee Schedule,6876.92
Blue Shield,PPO,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Fee Schedule,6876.92
Blue Shield,PPO,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Fee Schedule,6876.92
Blue Shield,PPO,31595,CPT4/HCPCS,LARYNX NERVE SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,31599,CPT4/HCPCS,LARYNX SURGERY PROCEDURE,,Fee Schedule,6049.05
Blue Shield,PPO,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,PPO,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,PPO,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,3198.57
Blue Shield,PPO,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,PPO,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,Fee Schedule,6049.05
Blue Shield,PPO,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,PPO,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Fee Schedule,3198.57
Blue Shield,PPO,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Fee Schedule,4280.44
Blue Shield,PPO,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Fee Schedule,4280.44
Blue Shield,PPO,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Fee Schedule,3198.57
Blue Shield,PPO,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Fee Schedule,3198.57
Blue Shield,PPO,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Fee Schedule,4280.44
Blue Shield,PPO,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Fee Schedule,4280.44
Blue Shield,PPO,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Fee Schedule,4280.44
Blue Shield,PPO,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Fee Schedule,4891.93
Blue Shield,PPO,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Fee Schedule,4280.44
Blue Shield,PPO,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Fee Schedule,4280.44
Blue Shield,PPO,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Fee Schedule,4280.44
Blue Shield,PPO,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Fee Schedule,4280.44
Blue Shield,PPO,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Fee Schedule,4280.44
Blue Shield,PPO,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,PPO,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Fee Schedule,6049.05
Blue Shield,PPO,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Fee Schedule,6049.05
Blue Shield,PPO,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Fee Schedule,4280.44
Blue Shield,PPO,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Fee Schedule,4280.44
Blue Shield,PPO,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Fee Schedule,4280.44
Blue Shield,PPO,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Fee Schedule,3198.57
Blue Shield,PPO,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Fee Schedule,3198.57
Blue Shield,PPO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Fee Schedule,4280.44
Blue Shield,PPO,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Fee Schedule,4280.44
Blue Shield,PPO,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Fee Schedule,4280.44
Blue Shield,PPO,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Fee Schedule,4280.44
Blue Shield,PPO,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Fee Schedule,3198.57
Blue Shield,PPO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Fee Schedule,4280.44
Blue Shield,PPO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Fee Schedule,4891.93
Blue Shield,PPO,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Fee Schedule,3198.57
Blue Shield,PPO,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Fee Schedule,3198.57
Blue Shield,PPO,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,6876.92
Blue Shield,PPO,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,PPO,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,PPO,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,Fee Schedule,4280.44
Blue Shield,PPO,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,Fee Schedule,4891.93
Blue Shield,PPO,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,Fee Schedule,4280.44
Blue Shield,PPO,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Fee Schedule,4280.44
Blue Shield,PPO,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Fee Schedule,4891.93
Blue Shield,PPO,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Fee Schedule,6049.05
Blue Shield,PPO,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Fee Schedule,6049.05
Blue Shield,PPO,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Fee Schedule,3198.57
Blue Shield,PPO,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Fee Schedule,6049.05
Blue Shield,PPO,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Fee Schedule,3198.57
Blue Shield,PPO,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Fee Schedule,4280.44
Blue Shield,PPO,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Fee Schedule,4280.44
Blue Shield,PPO,31899,CPT4/HCPCS,AIRWAYS SURGICAL PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,Fee Schedule,3198.57
Blue Shield,PPO,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,Fee Schedule,3198.57
Blue Shield,PPO,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,Fee Schedule,7902.34
Blue Shield,PPO,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,Fee Schedule,7902.34
Blue Shield,PPO,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,Fee Schedule,7902.34
Blue Shield,PPO,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,PPO,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,Fee Schedule,4280.44
Blue Shield,PPO,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,PPO,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Fee Schedule,3198.57
Blue Shield,PPO,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Fee Schedule,3198.57
Blue Shield,PPO,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,PPO,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,Fee Schedule,3198.57
Blue Shield,PPO,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,Fee Schedule,3198.57
Blue Shield,PPO,32215,CPT4/HCPCS,TREAT CHEST LINING,,Fee Schedule,3198.57
Blue Shield,PPO,32220,CPT4/HCPCS,RELEASE OF LUNG,,Fee Schedule,4280.44
Blue Shield,PPO,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,Fee Schedule,3198.57
Blue Shield,PPO,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,Fee Schedule,3198.57
Blue Shield,PPO,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,Fee Schedule,4280.44
Blue Shield,PPO,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Fee Schedule,3198.57
Blue Shield,PPO,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Fee Schedule,3198.57
Blue Shield,PPO,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,Fee Schedule,4280.44
Blue Shield,PPO,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,Fee Schedule,4280.44
Blue Shield,PPO,32482,CPT4/HCPCS,BILOBECTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,32484,CPT4/HCPCS,SEGMENTECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,32488,CPT4/HCPCS,COMPLETION PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,Fee Schedule,4280.44
Blue Shield,PPO,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,Fee Schedule,7902.34
Blue Shield,PPO,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,Fee Schedule,3198.57
Blue Shield,PPO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Fee Schedule,3198.57
Blue Shield,PPO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Fee Schedule,987.79
Blue Shield,PPO,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Fee Schedule,987.79
Blue Shield,PPO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,PPO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Fee Schedule,3198.57
Blue Shield,PPO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Fee Schedule,3198.57
Blue Shield,PPO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Fee Schedule,3198.57
Blue Shield,PPO,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Fee Schedule,3198.57
Blue Shield,PPO,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Fee Schedule,3198.57
Blue Shield,PPO,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Fee Schedule,987.79
Blue Shield,PPO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Fee Schedule,7902.34
Blue Shield,PPO,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Fee Schedule,7902.34
Blue Shield,PPO,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Fee Schedule,7902.34
Blue Shield,PPO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Fee Schedule,7902.34
Blue Shield,PPO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Fee Schedule,7902.34
Blue Shield,PPO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Fee Schedule,7902.34
Blue Shield,PPO,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,Fee Schedule,3198.57
Blue Shield,PPO,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,Fee Schedule,3198.57
Blue Shield,PPO,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,Fee Schedule,3198.57
Blue Shield,PPO,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,Fee Schedule,3198.57
Blue Shield,PPO,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,Fee Schedule,3198.57
Blue Shield,PPO,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,Fee Schedule,3198.57
Blue Shield,PPO,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,Fee Schedule,3198.57
Blue Shield,PPO,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,Fee Schedule,3198.57
Blue Shield,PPO,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,Fee Schedule,3198.57
Blue Shield,PPO,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,Fee Schedule,3198.57
Blue Shield,PPO,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Fee Schedule,3198.57
Blue Shield,PPO,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,Fee Schedule,3198.57
Blue Shield,PPO,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,Fee Schedule,7902.34
Blue Shield,PPO,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,Fee Schedule,987.79
Blue Shield,PPO,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,Fee Schedule,987.79
Blue Shield,PPO,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,Fee Schedule,7902.34
Blue Shield,PPO,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,Fee Schedule,7902.34
Blue Shield,PPO,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,Fee Schedule,7902.34
Blue Shield,PPO,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,Fee Schedule,7902.34
Blue Shield,PPO,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,Fee Schedule,7902.34
Blue Shield,PPO,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,Fee Schedule,987.79
Blue Shield,PPO,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,Fee Schedule,3198.57
Blue Shield,PPO,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,Fee Schedule,3198.57
Blue Shield,PPO,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,Fee Schedule,4280.44
Blue Shield,PPO,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,Fee Schedule,4280.44
Blue Shield,PPO,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,Fee Schedule,6876.92
Blue Shield,PPO,32852,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Fee Schedule,7902.34
Blue Shield,PPO,32853,CPT4/HCPCS,LUNG TRANSPLANT DOUBLE,,Fee Schedule,7902.34
Blue Shield,PPO,32854,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Fee Schedule,9548.66
Blue Shield,PPO,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,Fee Schedule,3198.57
Blue Shield,PPO,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Fee Schedule,4280.44
Blue Shield,PPO,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Fee Schedule,4280.44
Blue Shield,PPO,32940,CPT4/HCPCS,REVISION OF LUNG,,Fee Schedule,3198.57
Blue Shield,PPO,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,Fee Schedule,3198.57
Blue Shield,PPO,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Fee Schedule,4280.44
Blue Shield,PPO,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,Fee Schedule,3198.57
Blue Shield,PPO,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Fee Schedule,4280.44
Blue Shield,PPO,32999,CPT4/HCPCS,CHEST SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,33010,CPT4/HCPCS,DRAINAGE OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,PPO,33011,CPT4/HCPCS,REPEAT DRAINAGE OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,PPO,33015,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,PPO,33020,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,PPO,33025,CPT4/HCPCS,INCISION OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,PPO,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Fee Schedule,3198.57
Blue Shield,PPO,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Fee Schedule,4280.44
Blue Shield,PPO,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,Fee Schedule,3198.57
Blue Shield,PPO,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,Fee Schedule,4891.93
Blue Shield,PPO,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,Fee Schedule,3198.57
Blue Shield,PPO,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,Fee Schedule,3198.57
Blue Shield,PPO,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Fee Schedule,12850.71
Blue Shield,PPO,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Fee Schedule,12850.71
Blue Shield,PPO,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Fee Schedule,12850.71
Blue Shield,PPO,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Fee Schedule,12850.71
Blue Shield,PPO,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Fee Schedule,12850.71
Blue Shield,PPO,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Fee Schedule,12850.71
Blue Shield,PPO,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Fee Schedule,12850.71
Blue Shield,PPO,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Fee Schedule,12850.71
Blue Shield,PPO,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Fee Schedule,12850.71
Blue Shield,PPO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Fee Schedule,12850.71
Blue Shield,PPO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Fee Schedule,12850.71
Blue Shield,PPO,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Fee Schedule,12850.71
Blue Shield,PPO,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Fee Schedule,12850.71
Blue Shield,PPO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Fee Schedule,3198.57
Blue Shield,PPO,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Fee Schedule,4280.44
Blue Shield,PPO,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Fee Schedule,4280.44
Blue Shield,PPO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Fee Schedule,4280.44
Blue Shield,PPO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Fee Schedule,4891.93
Blue Shield,PPO,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Fee Schedule,4891.93
Blue Shield,PPO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Fee Schedule,4280.44
Blue Shield,PPO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Fee Schedule,4280.44
Blue Shield,PPO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Fee Schedule,4280.44
Blue Shield,PPO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Fee Schedule,3198.57
Blue Shield,PPO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Fee Schedule,3198.57
Blue Shield,PPO,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Fee Schedule,4891.93
Blue Shield,PPO,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Fee Schedule,4891.93
Blue Shield,PPO,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Fee Schedule,4891.93
Blue Shield,PPO,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Fee Schedule,12850.71
Blue Shield,PPO,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Fee Schedule,4891.93
Blue Shield,PPO,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Fee Schedule,4891.93
Blue Shield,PPO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Fee Schedule,12850.71
Blue Shield,PPO,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,PPO,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,PPO,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Fee Schedule,4280.44
Blue Shield,PPO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Fee Schedule,4280.44
Blue Shield,PPO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Fee Schedule,4280.44
Blue Shield,PPO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Fee Schedule,4280.44
Blue Shield,PPO,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Fee Schedule,4280.44
Blue Shield,PPO,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Fee Schedule,12850.71
Blue Shield,PPO,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Fee Schedule,987.79
Blue Shield,PPO,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Fee Schedule,4891.93
Blue Shield,PPO,33282,CPT4/HCPCS,IMPLANT PAT-ACTIVE HT RECORD,,Fee Schedule,12850.71
Blue Shield,PPO,33284,CPT4/HCPCS,REMOVE PAT-ACTIVE HT RECORD,,Fee Schedule,3198.57
Blue Shield,PPO,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,Fee Schedule,4280.44
Blue Shield,PPO,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Fee Schedule,3198.57
Blue Shield,PPO,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,Fee Schedule,4280.44
Blue Shield,PPO,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Fee Schedule,4280.44
Blue Shield,PPO,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Fee Schedule,4891.93
Blue Shield,PPO,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,Fee Schedule,9304.07
Blue Shield,PPO,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,Fee Schedule,7902.34
Blue Shield,PPO,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,PPO,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,PPO,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,PPO,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Fee Schedule,9548.66
Blue Shield,PPO,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,Fee Schedule,987.79
Blue Shield,PPO,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,PPO,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,PPO,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Fee Schedule,12850.71
Blue Shield,PPO,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,PPO,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,PPO,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,Fee Schedule,4891.93
Blue Shield,PPO,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,4891.93
Blue Shield,PPO,33406,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,6049.05
Blue Shield,PPO,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Fee Schedule,4891.93
Blue Shield,PPO,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,PPO,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,6876.92
Blue Shield,PPO,33413,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Fee Schedule,6876.92
Blue Shield,PPO,33414,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,PPO,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,Fee Schedule,4891.93
Blue Shield,PPO,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,Fee Schedule,4891.93
Blue Shield,PPO,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Fee Schedule,4891.93
Blue Shield,PPO,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Fee Schedule,987.79
Blue Shield,PPO,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Fee Schedule,987.79
Blue Shield,PPO,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,3198.57
Blue Shield,PPO,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,4280.44
Blue Shield,PPO,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,4280.44
Blue Shield,PPO,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,4891.93
Blue Shield,PPO,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Fee Schedule,6049.05
Blue Shield,PPO,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,Fee Schedule,4891.93
Blue Shield,PPO,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Fee Schedule,4280.44
Blue Shield,PPO,33463,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Fee Schedule,4280.44
Blue Shield,PPO,33464,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Fee Schedule,4891.93
Blue Shield,PPO,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,Fee Schedule,4891.93
Blue Shield,PPO,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Fee Schedule,6049.05
Blue Shield,PPO,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,PPO,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,PPO,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,4280.44
Blue Shield,PPO,33475,CPT4/HCPCS,REPLACEMENT PULMONARY VALVE,,Fee Schedule,6049.05
Blue Shield,PPO,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,4280.44
Blue Shield,PPO,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,Fee Schedule,987.79
Blue Shield,PPO,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,4280.44
Blue Shield,PPO,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,Fee Schedule,4891.93
Blue Shield,PPO,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Fee Schedule,4280.44
Blue Shield,PPO,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,Fee Schedule,4891.93
Blue Shield,PPO,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Fee Schedule,4891.93
Blue Shield,PPO,33505,CPT4/HCPCS,REPAIR ARTERY W/TUNNEL,,Fee Schedule,6049.05
Blue Shield,PPO,33506,CPT4/HCPCS,REPAIR ARTERY TRANSLOCATION,,Fee Schedule,6049.05
Blue Shield,PPO,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,Fee Schedule,3198.57
Blue Shield,PPO,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,Fee Schedule,3198.57
Blue Shield,PPO,33622,CPT4/HCPCS,REDO COMPL CARDIAC ANOMALY,,Fee Schedule,3198.57
Blue Shield,PPO,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,Fee Schedule,3198.57
Blue Shield,PPO,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,Fee Schedule,3198.57
Blue Shield,PPO,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,Fee Schedule,3198.57
Blue Shield,PPO,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,Fee Schedule,987.79
Blue Shield,PPO,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,Fee Schedule,987.79
Blue Shield,PPO,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,Fee Schedule,987.79
Blue Shield,PPO,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,Fee Schedule,987.79
Blue Shield,PPO,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,PPO,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,PPO,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,PPO,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,PPO,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,PPO,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Fee Schedule,987.79
Blue Shield,PPO,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Fee Schedule,987.79
Blue Shield,PPO,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,Fee Schedule,987.79
Blue Shield,PPO,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,Fee Schedule,987.79
Blue Shield,PPO,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,Fee Schedule,987.79
Blue Shield,PPO,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,Fee Schedule,9304.07
Blue Shield,PPO,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,Fee Schedule,9304.07
Blue Shield,PPO,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,Fee Schedule,9304.07
Blue Shield,PPO,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,Fee Schedule,9304.07
Blue Shield,PPO,33999,CPT4/HCPCS,CARDIAC SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,PPO,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,PPO,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,PPO,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,Fee Schedule,9548.66
Blue Shield,PPO,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,3198.57
Blue Shield,PPO,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,PPO,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,3198.57
Blue Shield,PPO,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,PPO,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Fee Schedule,9548.66
Blue Shield,PPO,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,Fee Schedule,9548.66
Blue Shield,PPO,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,Fee Schedule,9548.66
Blue Shield,PPO,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,Fee Schedule,9548.66
Blue Shield,PPO,34530,CPT4/HCPCS,LEG VEIN FUSION,,Fee Schedule,9548.66
Blue Shield,PPO,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Fee Schedule,3198.57
Blue Shield,PPO,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Fee Schedule,3198.57
Blue Shield,PPO,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Fee Schedule,3198.57
Blue Shield,PPO,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Fee Schedule,3198.57
Blue Shield,PPO,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Fee Schedule,3198.57
Blue Shield,PPO,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Fee Schedule,3198.57
Blue Shield,PPO,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Fee Schedule,3198.57
Blue Shield,PPO,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Fee Schedule,3198.57
Blue Shield,PPO,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Fee Schedule,3198.57
Blue Shield,PPO,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Fee Schedule,3198.57
Blue Shield,PPO,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Fee Schedule,3198.57
Blue Shield,PPO,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Fee Schedule,3198.57
Blue Shield,PPO,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Fee Schedule,3198.57
Blue Shield,PPO,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Fee Schedule,3198.57
Blue Shield,PPO,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Fee Schedule,3198.57
Blue Shield,PPO,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,Fee Schedule,987.79
Blue Shield,PPO,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,Fee Schedule,987.79
Blue Shield,PPO,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,Fee Schedule,987.79
Blue Shield,PPO,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,Fee Schedule,987.79
Blue Shield,PPO,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,Fee Schedule,987.79
Blue Shield,PPO,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,Fee Schedule,987.79
Blue Shield,PPO,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,Fee Schedule,987.79
Blue Shield,PPO,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,Fee Schedule,987.79
Blue Shield,PPO,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,Fee Schedule,3198.57
Blue Shield,PPO,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,7902.34
Blue Shield,PPO,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,Fee Schedule,3198.57
Blue Shield,PPO,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,Fee Schedule,3198.57
Blue Shield,PPO,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4280.44
Blue Shield,PPO,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,4280.44
Blue Shield,PPO,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4891.93
Blue Shield,PPO,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,4280.44
Blue Shield,PPO,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Fee Schedule,4891.93
Blue Shield,PPO,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,Fee Schedule,3198.57
Blue Shield,PPO,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,Fee Schedule,4280.44
Blue Shield,PPO,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,Fee Schedule,3198.57
Blue Shield,PPO,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,Fee Schedule,3198.57
Blue Shield,PPO,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,Fee Schedule,3198.57
Blue Shield,PPO,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,PPO,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,PPO,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,PPO,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,PPO,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,PPO,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,PPO,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,4280.44
Blue Shield,PPO,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Fee Schedule,7902.34
Blue Shield,PPO,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,7902.34
Blue Shield,PPO,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,6049.05
Blue Shield,PPO,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,4280.44
Blue Shield,PPO,35371,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35390,CPT4/HCPCS,REOPERATION CAROTID ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,35400,CPT4/HCPCS,ANGIOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,Fee Schedule,9548.66
Blue Shield,PPO,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,Fee Schedule,3198.57
Blue Shield,PPO,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,Fee Schedule,3198.57
Blue Shield,PPO,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,Fee Schedule,3198.57
Blue Shield,PPO,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,Fee Schedule,3198.57
Blue Shield,PPO,35510,CPT4/HCPCS,ART BYP GRFT CAROTID-BRCHIAL,,Fee Schedule,3198.57
Blue Shield,PPO,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,Fee Schedule,3198.57
Blue Shield,PPO,35512,CPT4/HCPCS,ART BYP GRFT SUBCLAV-BRCHIAL,,Fee Schedule,3198.57
Blue Shield,PPO,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,Fee Schedule,3198.57
Blue Shield,PPO,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,Fee Schedule,3198.57
Blue Shield,PPO,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,Fee Schedule,3198.57
Blue Shield,PPO,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,Fee Schedule,3198.57
Blue Shield,PPO,35522,CPT4/HCPCS,ART BYP GRFT AXILL-BRACHIAL,,Fee Schedule,3198.57
Blue Shield,PPO,35525,CPT4/HCPCS,ART BYP GRFT BRACHIAL-BRCHL,,Fee Schedule,3198.57
Blue Shield,PPO,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,Fee Schedule,3198.57
Blue Shield,PPO,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,Fee Schedule,4280.44
Blue Shield,PPO,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,Fee Schedule,3198.57
Blue Shield,PPO,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,Fee Schedule,4280.44
Blue Shield,PPO,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,PPO,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,Fee Schedule,3198.57
Blue Shield,PPO,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,Fee Schedule,4280.44
Blue Shield,PPO,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,Fee Schedule,3198.57
Blue Shield,PPO,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,Fee Schedule,3198.57
Blue Shield,PPO,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Fee Schedule,3198.57
Blue Shield,PPO,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Fee Schedule,3198.57
Blue Shield,PPO,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,PPO,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,Fee Schedule,4280.44
Blue Shield,PPO,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,Fee Schedule,4280.44
Blue Shield,PPO,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,Fee Schedule,3198.57
Blue Shield,PPO,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,PPO,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,PPO,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,Fee Schedule,3198.57
Blue Shield,PPO,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,Fee Schedule,3198.57
Blue Shield,PPO,35623,CPT4/HCPCS,ART BYP AXILLARY-POP-TIBIAL,,Fee Schedule,3198.57
Blue Shield,PPO,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,Fee Schedule,3198.57
Blue Shield,PPO,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,Fee Schedule,4280.44
Blue Shield,PPO,35636,CPT4/HCPCS,ART BYP SPENORENAL,,Fee Schedule,3198.57
Blue Shield,PPO,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,Fee Schedule,3198.57
Blue Shield,PPO,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,Fee Schedule,3198.57
Blue Shield,PPO,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,Fee Schedule,4280.44
Blue Shield,PPO,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,Fee Schedule,3198.57
Blue Shield,PPO,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,Fee Schedule,3198.57
Blue Shield,PPO,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,Fee Schedule,3198.57
Blue Shield,PPO,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,Fee Schedule,3198.57
Blue Shield,PPO,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,Fee Schedule,3198.57
Blue Shield,PPO,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,Fee Schedule,3198.57
Blue Shield,PPO,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,Fee Schedule,3198.57
Blue Shield,PPO,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Fee Schedule,3198.57
Blue Shield,PPO,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Fee Schedule,3198.57
Blue Shield,PPO,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,Fee Schedule,3198.57
Blue Shield,PPO,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,Fee Schedule,3198.57
Blue Shield,PPO,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,Fee Schedule,3198.57
Blue Shield,PPO,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,Fee Schedule,6049.05
Blue Shield,PPO,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,Fee Schedule,6049.05
Blue Shield,PPO,35691,CPT4/HCPCS,ART TRNSPOSJ VERTBRL CAROTID,,Fee Schedule,3198.57
Blue Shield,PPO,35693,CPT4/HCPCS,ART TRNSPOSJ SUBCLAVIAN,,Fee Schedule,3198.57
Blue Shield,PPO,35694,CPT4/HCPCS,ART TRNSPOSJ SUBCLAV CAROTID,,Fee Schedule,3198.57
Blue Shield,PPO,35695,CPT4/HCPCS,ART TRNSPOSJ CAROTID SUBCLAV,,Fee Schedule,3198.57
Blue Shield,PPO,35697,CPT4/HCPCS,REIMPLANT ARTERY EACH,,Fee Schedule,3198.57
Blue Shield,PPO,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,Fee Schedule,3198.57
Blue Shield,PPO,35721,CPT4/HCPCS,EXPLORATION FEMORAL ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35741,CPT4/HCPCS,EXPLORATION POPLITEAL ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,35761,CPT4/HCPCS,EXPLORATION OF ARTERY/VEIN,,Fee Schedule,6876.92
Blue Shield,PPO,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,Fee Schedule,3198.57
Blue Shield,PPO,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,Fee Schedule,3198.57
Blue Shield,PPO,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,Fee Schedule,3198.57
Blue Shield,PPO,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,Fee Schedule,6049.05
Blue Shield,PPO,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,Fee Schedule,3198.57
Blue Shield,PPO,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Fee Schedule,12850.71
Blue Shield,PPO,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Fee Schedule,12850.71
Blue Shield,PPO,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Fee Schedule,9548.66
Blue Shield,PPO,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Fee Schedule,9548.66
Blue Shield,PPO,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,Fee Schedule,3198.57
Blue Shield,PPO,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,Fee Schedule,6876.92
Blue Shield,PPO,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,Fee Schedule,4891.93
Blue Shield,PPO,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,Fee Schedule,4280.44
Blue Shield,PPO,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Fee Schedule,3198.57
Blue Shield,PPO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Fee Schedule,3198.57
Blue Shield,PPO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Fee Schedule,3198.57
Blue Shield,PPO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Fee Schedule,3198.57
Blue Shield,PPO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Fee Schedule,3198.57
Blue Shield,PPO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Fee Schedule,3198.57
Blue Shield,PPO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Fee Schedule,3198.57
Blue Shield,PPO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Fee Schedule,3198.57
Blue Shield,PPO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Fee Schedule,3198.57
Blue Shield,PPO,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Fee Schedule,4891.93
Blue Shield,PPO,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,PPO,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Fee Schedule,3198.57
Blue Shield,PPO,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Fee Schedule,3198.57
Blue Shield,PPO,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Fee Schedule,3198.57
Blue Shield,PPO,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Fee Schedule,987.79
Blue Shield,PPO,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Fee Schedule,3198.57
Blue Shield,PPO,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Fee Schedule,3198.57
Blue Shield,PPO,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Fee Schedule,3198.57
Blue Shield,PPO,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Fee Schedule,3198.57
Blue Shield,PPO,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Fee Schedule,3198.57
Blue Shield,PPO,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Fee Schedule,3198.57
Blue Shield,PPO,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Fee Schedule,3198.57
Blue Shield,PPO,36468,CPT4/HCPCS,NJX SCLRSNT SPIDER VEINS,,Fee Schedule,3198.57
Blue Shield,PPO,36470,CPT4/HCPCS,NJX SCLRSNT 1 INCMPTNT VEIN,,Fee Schedule,3198.57
Blue Shield,PPO,36471,CPT4/HCPCS,NJX SCLRSNT MLT INCMPTNT VN,,Fee Schedule,3198.57
Blue Shield,PPO,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,PPO,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,PPO,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Fee Schedule,6876.92
Blue Shield,PPO,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Fee Schedule,6876.92
Blue Shield,PPO,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Fee Schedule,6876.92
Blue Shield,PPO,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Fee Schedule,6876.92
Blue Shield,PPO,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Fee Schedule,6876.92
Blue Shield,PPO,36511,CPT4/HCPCS,APHERESIS WBC,,Fee Schedule,3198.57
Blue Shield,PPO,36512,CPT4/HCPCS,APHERESIS RBC,,Fee Schedule,3198.57
Blue Shield,PPO,36513,CPT4/HCPCS,APHERESIS PLATELETS,,Fee Schedule,3198.57
Blue Shield,PPO,36514,CPT4/HCPCS,APHERESIS PLASMA,,Fee Schedule,3198.57
Blue Shield,PPO,36516,CPT4/HCPCS,APHERESIS IMMUNOADS SLCTV,,Fee Schedule,9548.66
Blue Shield,PPO,36522,CPT4/HCPCS,PHOTOPHERESIS,,Fee Schedule,9548.66
Blue Shield,PPO,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,PPO,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,PPO,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,PPO,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,PPO,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Fee Schedule,12850.71
Blue Shield,PPO,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,PPO,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Fee Schedule,3198.57
Blue Shield,PPO,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,PPO,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Fee Schedule,6876.92
Blue Shield,PPO,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Fee Schedule,3198.57
Blue Shield,PPO,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Fee Schedule,987.79
Blue Shield,PPO,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Fee Schedule,3198.57
Blue Shield,PPO,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Fee Schedule,3198.57
Blue Shield,PPO,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Fee Schedule,987.79
Blue Shield,PPO,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Fee Schedule,987.79
Blue Shield,PPO,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,PPO,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,PPO,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Fee Schedule,4891.93
Blue Shield,PPO,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Fee Schedule,9548.66
Blue Shield,PPO,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Fee Schedule,4891.93
Blue Shield,PPO,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Fee Schedule,4891.93
Blue Shield,PPO,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Fee Schedule,4891.93
Blue Shield,PPO,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,Fee Schedule,3198.57
Blue Shield,PPO,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Fee Schedule,12850.71
Blue Shield,PPO,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Fee Schedule,6049.05
Blue Shield,PPO,36833,CPT4/HCPCS,AV FISTULA REVISION,,Fee Schedule,6049.05
Blue Shield,PPO,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Fee Schedule,6049.05
Blue Shield,PPO,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Fee Schedule,9548.66
Blue Shield,PPO,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Fee Schedule,4280.44
Blue Shield,PPO,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Fee Schedule,4891.93
Blue Shield,PPO,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,PPO,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,PPO,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Fee Schedule,9548.66
Blue Shield,PPO,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,PPO,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,PPO,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Fee Schedule,12850.71
Blue Shield,PPO,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Fee Schedule,6049.05
Blue Shield,PPO,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Fee Schedule,6049.05
Blue Shield,PPO,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Fee Schedule,6049.05
Blue Shield,PPO,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,PPO,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,4280.44
Blue Shield,PPO,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,PPO,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,Fee Schedule,3198.57
Blue Shield,PPO,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,Fee Schedule,3198.57
Blue Shield,PPO,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,Fee Schedule,3198.57
Blue Shield,PPO,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Fee Schedule,3198.57
Blue Shield,PPO,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Fee Schedule,4891.93
Blue Shield,PPO,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Fee Schedule,4891.93
Blue Shield,PPO,37186,CPT4/HCPCS,SEC ART THROMBECTOMY ADD-ON,,Fee Schedule,4891.93
Blue Shield,PPO,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Fee Schedule,4891.93
Blue Shield,PPO,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Fee Schedule,4891.93
Blue Shield,PPO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Fee Schedule,4280.44
Blue Shield,PPO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Fee Schedule,4280.44
Blue Shield,PPO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Fee Schedule,4280.44
Blue Shield,PPO,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,Fee Schedule,3198.57
Blue Shield,PPO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,PPO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Fee Schedule,4891.93
Blue Shield,PPO,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Fee Schedule,4891.93
Blue Shield,PPO,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Fee Schedule,4891.93
Blue Shield,PPO,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Fee Schedule,4891.93
Blue Shield,PPO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Fee Schedule,987.79
Blue Shield,PPO,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Fee Schedule,987.79
Blue Shield,PPO,37220,CPT4/HCPCS,ILIAC REVASC,,Fee Schedule,6049.05
Blue Shield,PPO,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,PPO,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Fee Schedule,6049.05
Blue Shield,PPO,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Fee Schedule,6049.05
Blue Shield,PPO,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Fee Schedule,6049.05
Blue Shield,PPO,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Fee Schedule,6049.05
Blue Shield,PPO,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,PPO,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Fee Schedule,6049.05
Blue Shield,PPO,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Fee Schedule,6049.05
Blue Shield,PPO,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Fee Schedule,6049.05
Blue Shield,PPO,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Fee Schedule,6049.05
Blue Shield,PPO,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Fee Schedule,6049.05
Blue Shield,PPO,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Fee Schedule,6049.05
Blue Shield,PPO,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Fee Schedule,6049.05
Blue Shield,PPO,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Fee Schedule,6049.05
Blue Shield,PPO,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Fee Schedule,6049.05
Blue Shield,PPO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Fee Schedule,6049.05
Blue Shield,PPO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Fee Schedule,6049.05
Blue Shield,PPO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Fee Schedule,6049.05
Blue Shield,PPO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Fee Schedule,6049.05
Blue Shield,PPO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Fee Schedule,987.79
Blue Shield,PPO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Fee Schedule,987.79
Blue Shield,PPO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Fee Schedule,987.79
Blue Shield,PPO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Fee Schedule,987.79
Blue Shield,PPO,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Fee Schedule,3198.57
Blue Shield,PPO,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Fee Schedule,3198.57
Blue Shield,PPO,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Fee Schedule,6876.92
Blue Shield,PPO,37501,CPT4/HCPCS,VASCULAR ENDOSCOPY PROCEDURE,,Fee Schedule,6876.92
Blue Shield,PPO,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,Fee Schedule,6049.05
Blue Shield,PPO,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,6049.05
Blue Shield,PPO,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,PPO,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,PPO,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Fee Schedule,4891.93
Blue Shield,PPO,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,PPO,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Fee Schedule,7902.34
Blue Shield,PPO,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Fee Schedule,7902.34
Blue Shield,PPO,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Fee Schedule,4280.44
Blue Shield,PPO,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Fee Schedule,3198.57
Blue Shield,PPO,37700,CPT4/HCPCS,REVISE LEG VEIN,,Fee Schedule,4280.44
Blue Shield,PPO,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Fee Schedule,4891.93
Blue Shield,PPO,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Fee Schedule,4891.93
Blue Shield,PPO,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Fee Schedule,4891.93
Blue Shield,PPO,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Fee Schedule,4891.93
Blue Shield,PPO,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Fee Schedule,6876.92
Blue Shield,PPO,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Fee Schedule,7902.34
Blue Shield,PPO,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Fee Schedule,7902.34
Blue Shield,PPO,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Fee Schedule,4891.93
Blue Shield,PPO,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Fee Schedule,4891.93
Blue Shield,PPO,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,Fee Schedule,4280.44
Blue Shield,PPO,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Fee Schedule,4891.93
Blue Shield,PPO,37799,CPT4/HCPCS,VASCULAR SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Fee Schedule,3198.57
Blue Shield,PPO,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,Fee Schedule,3198.57
Blue Shield,PPO,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Fee Schedule,3198.57
Blue Shield,PPO,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,Fee Schedule,3198.57
Blue Shield,PPO,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Fee Schedule,9548.66
Blue Shield,PPO,38129,CPT4/HCPCS,LAPAROSCOPE PROC SPLEEN,,Fee Schedule,7902.34
Blue Shield,PPO,38204,CPT4/HCPCS,BL DONOR SEARCH MANAGEMENT,,Fee Schedule,3198.57
Blue Shield,PPO,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,Fee Schedule,3198.57
Blue Shield,PPO,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,Fee Schedule,3198.57
Blue Shield,PPO,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,Fee Schedule,3198.57
Blue Shield,PPO,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,Fee Schedule,3198.57
Blue Shield,PPO,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,Fee Schedule,3198.57
Blue Shield,PPO,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,Fee Schedule,3198.57
Blue Shield,PPO,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,Fee Schedule,3198.57
Blue Shield,PPO,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,Fee Schedule,3198.57
Blue Shield,PPO,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,Fee Schedule,3198.57
Blue Shield,PPO,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,Fee Schedule,3198.57
Blue Shield,PPO,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,Fee Schedule,3198.57
Blue Shield,PPO,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Fee Schedule,987.79
Blue Shield,PPO,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Fee Schedule,987.79
Blue Shield,PPO,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Fee Schedule,987.79
Blue Shield,PPO,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Fee Schedule,3198.57
Blue Shield,PPO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Fee Schedule,6049.05
Blue Shield,PPO,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Fee Schedule,3198.57
Blue Shield,PPO,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Fee Schedule,3198.57
Blue Shield,PPO,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,Fee Schedule,3198.57
Blue Shield,PPO,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Fee Schedule,3198.57
Blue Shield,PPO,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Fee Schedule,3198.57
Blue Shield,PPO,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Fee Schedule,4280.44
Blue Shield,PPO,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,PPO,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,PPO,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,PPO,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,PPO,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,PPO,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,PPO,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Fee Schedule,4280.44
Blue Shield,PPO,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Fee Schedule,4891.93
Blue Shield,PPO,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Fee Schedule,6049.05
Blue Shield,PPO,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,PPO,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,PPO,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Fee Schedule,12850.71
Blue Shield,PPO,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Fee Schedule,12850.71
Blue Shield,PPO,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Fee Schedule,12850.71
Blue Shield,PPO,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Fee Schedule,12850.71
Blue Shield,PPO,38589,CPT4/HCPCS,LAPAROSCOPE PROC LYMPHATIC,,Fee Schedule,7902.34
Blue Shield,PPO,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,PPO,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,PPO,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Fee Schedule,4891.93
Blue Shield,PPO,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,PPO,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Fee Schedule,6049.05
Blue Shield,PPO,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,PPO,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,PPO,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Fee Schedule,4280.44
Blue Shield,PPO,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,PPO,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,PPO,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,Fee Schedule,3198.57
Blue Shield,PPO,38999,CPT4/HCPCS,BLOOD/LYMPH SYSTEM PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,PPO,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,Fee Schedule,3198.57
Blue Shield,PPO,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,Fee Schedule,3198.57
Blue Shield,PPO,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,Fee Schedule,3198.57
Blue Shield,PPO,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Fee Schedule,7902.34
Blue Shield,PPO,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Fee Schedule,7902.34
Blue Shield,PPO,39499,CPT4/HCPCS,CHEST PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,Fee Schedule,3198.57
Blue Shield,PPO,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,12850.71
Blue Shield,PPO,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,3198.57
Blue Shield,PPO,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Fee Schedule,3198.57
Blue Shield,PPO,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,Fee Schedule,3198.57
Blue Shield,PPO,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,Fee Schedule,3198.57
Blue Shield,PPO,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,Fee Schedule,3198.57
Blue Shield,PPO,39599,CPT4/HCPCS,DIAPHRAGM SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,40490,CPT4/HCPCS,BIOPSY OF LIP,,Fee Schedule,3198.57
Blue Shield,PPO,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,PPO,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,PPO,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Fee Schedule,4280.44
Blue Shield,PPO,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Fee Schedule,4280.44
Blue Shield,PPO,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Fee Schedule,4280.44
Blue Shield,PPO,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Fee Schedule,4280.44
Blue Shield,PPO,40650,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,PPO,40652,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,PPO,40654,CPT4/HCPCS,REPAIR LIP,,Fee Schedule,4891.93
Blue Shield,PPO,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,PPO,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,PPO,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,PPO,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,9548.66
Blue Shield,PPO,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Fee Schedule,4891.93
Blue Shield,PPO,40799,CPT4/HCPCS,LIP SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,PPO,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,987.79
Blue Shield,PPO,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,PPO,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Fee Schedule,987.79
Blue Shield,PPO,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Fee Schedule,3198.57
Blue Shield,PPO,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Fee Schedule,3198.57
Blue Shield,PPO,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,PPO,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,PPO,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,PPO,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,PPO,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Fee Schedule,3198.57
Blue Shield,PPO,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,PPO,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Fee Schedule,987.79
Blue Shield,PPO,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Fee Schedule,3198.57
Blue Shield,PPO,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4280.44
Blue Shield,PPO,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4891.93
Blue Shield,PPO,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,4891.93
Blue Shield,PPO,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,6876.92
Blue Shield,PPO,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Fee Schedule,6876.92
Blue Shield,PPO,40899,CPT4/HCPCS,MOUTH SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Fee Schedule,3198.57
Blue Shield,PPO,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Fee Schedule,3198.57
Blue Shield,PPO,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Fee Schedule,3198.57
Blue Shield,PPO,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Fee Schedule,4280.44
Blue Shield,PPO,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Fee Schedule,3198.57
Blue Shield,PPO,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Fee Schedule,3198.57
Blue Shield,PPO,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Fee Schedule,6876.92
Blue Shield,PPO,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Fee Schedule,3198.57
Blue Shield,PPO,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,Fee Schedule,4891.93
Blue Shield,PPO,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,PPO,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,PPO,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Fee Schedule,4280.44
Blue Shield,PPO,41500,CPT4/HCPCS,FIXATION OF TONGUE,,Fee Schedule,3198.57
Blue Shield,PPO,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Fee Schedule,4891.93
Blue Shield,PPO,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Fee Schedule,4280.44
Blue Shield,PPO,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Fee Schedule,4280.44
Blue Shield,PPO,41599,CPT4/HCPCS,TONGUE AND MOUTH SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Fee Schedule,3198.57
Blue Shield,PPO,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Fee Schedule,6049.05
Blue Shield,PPO,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Fee Schedule,4280.44
Blue Shield,PPO,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Fee Schedule,3198.57
Blue Shield,PPO,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Fee Schedule,3198.57
Blue Shield,PPO,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,6049.05
Blue Shield,PPO,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Fee Schedule,4280.44
Blue Shield,PPO,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Fee Schedule,4280.44
Blue Shield,PPO,41870,CPT4/HCPCS,GUM GRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,41872,CPT4/HCPCS,REPAIR GUM,,Fee Schedule,4280.44
Blue Shield,PPO,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Fee Schedule,6049.05
Blue Shield,PPO,41899,CPT4/HCPCS,DENTAL SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,PPO,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Fee Schedule,4280.44
Blue Shield,PPO,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Fee Schedule,3198.57
Blue Shield,PPO,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,PPO,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,PPO,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Fee Schedule,4280.44
Blue Shield,PPO,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Fee Schedule,6049.05
Blue Shield,PPO,42140,CPT4/HCPCS,EXCISION OF UVULA,,Fee Schedule,4280.44
Blue Shield,PPO,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Fee Schedule,6876.92
Blue Shield,PPO,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Fee Schedule,4280.44
Blue Shield,PPO,42180,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,3198.57
Blue Shield,PPO,42182,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,4280.44
Blue Shield,PPO,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,PPO,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,PPO,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,PPO,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,9548.66
Blue Shield,PPO,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,6876.92
Blue Shield,PPO,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Fee Schedule,9548.66
Blue Shield,PPO,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Fee Schedule,6876.92
Blue Shield,PPO,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,Fee Schedule,9548.66
Blue Shield,PPO,42235,CPT4/HCPCS,REPAIR PALATE,,Fee Schedule,6876.92
Blue Shield,PPO,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Fee Schedule,6049.05
Blue Shield,PPO,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Fee Schedule,987.79
Blue Shield,PPO,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Fee Schedule,4280.44
Blue Shield,PPO,42299,CPT4/HCPCS,PALATE/UVULA SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,PPO,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,4280.44
Blue Shield,PPO,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,PPO,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Fee Schedule,3198.57
Blue Shield,PPO,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,PPO,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,PPO,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Fee Schedule,4280.44
Blue Shield,PPO,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Fee Schedule,987.79
Blue Shield,PPO,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Fee Schedule,4280.44
Blue Shield,PPO,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Fee Schedule,4891.93
Blue Shield,PPO,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Fee Schedule,4891.93
Blue Shield,PPO,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,4891.93
Blue Shield,PPO,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,PPO,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,PPO,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,9548.66
Blue Shield,PPO,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Fee Schedule,4891.93
Blue Shield,PPO,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Fee Schedule,4891.93
Blue Shield,PPO,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Fee Schedule,4280.44
Blue Shield,PPO,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Fee Schedule,4891.93
Blue Shield,PPO,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Fee Schedule,6049.05
Blue Shield,PPO,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,4891.93
Blue Shield,PPO,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,6049.05
Blue Shield,PPO,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Fee Schedule,6049.05
Blue Shield,PPO,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,42650,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Fee Schedule,3198.57
Blue Shield,PPO,42660,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Fee Schedule,3198.57
Blue Shield,PPO,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Fee Schedule,6049.05
Blue Shield,PPO,42699,CPT4/HCPCS,SALIVARY SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,PPO,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Fee Schedule,4280.44
Blue Shield,PPO,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Fee Schedule,3198.57
Blue Shield,PPO,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Fee Schedule,4280.44
Blue Shield,PPO,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Fee Schedule,4280.44
Blue Shield,PPO,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Fee Schedule,987.79
Blue Shield,PPO,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Fee Schedule,4891.93
Blue Shield,PPO,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Fee Schedule,6876.92
Blue Shield,PPO,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Fee Schedule,4891.93
Blue Shield,PPO,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Fee Schedule,6876.92
Blue Shield,PPO,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Fee Schedule,6049.05
Blue Shield,PPO,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Fee Schedule,6049.05
Blue Shield,PPO,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,PPO,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,PPO,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,PPO,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Fee Schedule,6049.05
Blue Shield,PPO,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,6049.05
Blue Shield,PPO,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,9548.66
Blue Shield,PPO,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Fee Schedule,4891.93
Blue Shield,PPO,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Fee Schedule,4891.93
Blue Shield,PPO,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Fee Schedule,4891.93
Blue Shield,PPO,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Fee Schedule,9548.66
Blue Shield,PPO,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Fee Schedule,9548.66
Blue Shield,PPO,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Fee Schedule,4891.93
Blue Shield,PPO,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Fee Schedule,4280.44
Blue Shield,PPO,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,PPO,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Fee Schedule,4280.44
Blue Shield,PPO,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,PPO,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,PPO,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Fee Schedule,4280.44
Blue Shield,PPO,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,PPO,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,3198.57
Blue Shield,PPO,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Fee Schedule,4891.93
Blue Shield,PPO,42999,CPT4/HCPCS,THROAT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,PPO,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,PPO,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Fee Schedule,3198.57
Blue Shield,PPO,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Fee Schedule,3198.57
Blue Shield,PPO,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,PPO,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,PPO,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,Fee Schedule,6049.05
Blue Shield,PPO,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,PPO,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,PPO,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,6049.05
Blue Shield,PPO,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,PPO,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,PPO,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,PPO,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Fee Schedule,4891.93
Blue Shield,PPO,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,PPO,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Fee Schedule,6049.05
Blue Shield,PPO,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Fee Schedule,3198.57
Blue Shield,PPO,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Fee Schedule,3198.57
Blue Shield,PPO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Fee Schedule,3198.57
Blue Shield,PPO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Fee Schedule,3198.57
Blue Shield,PPO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Fee Schedule,3198.57
Blue Shield,PPO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Fee Schedule,3198.57
Blue Shield,PPO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Fee Schedule,3198.57
Blue Shield,PPO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Fee Schedule,3198.57
Blue Shield,PPO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Fee Schedule,3198.57
Blue Shield,PPO,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Fee Schedule,3198.57
Blue Shield,PPO,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Fee Schedule,3198.57
Blue Shield,PPO,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Fee Schedule,3198.57
Blue Shield,PPO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Fee Schedule,3198.57
Blue Shield,PPO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Fee Schedule,3198.57
Blue Shield,PPO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Fee Schedule,3198.57
Blue Shield,PPO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Fee Schedule,3198.57
Blue Shield,PPO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Fee Schedule,3198.57
Blue Shield,PPO,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Fee Schedule,3198.57
Blue Shield,PPO,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Fee Schedule,3198.57
Blue Shield,PPO,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Fee Schedule,3198.57
Blue Shield,PPO,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Fee Schedule,3198.57
Blue Shield,PPO,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Fee Schedule,3198.57
Blue Shield,PPO,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Fee Schedule,4280.44
Blue Shield,PPO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Fee Schedule,3198.57
Blue Shield,PPO,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Fee Schedule,4280.44
Blue Shield,PPO,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Fee Schedule,4280.44
Blue Shield,PPO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Fee Schedule,3198.57
Blue Shield,PPO,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Fee Schedule,3198.57
Blue Shield,PPO,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Fee Schedule,4280.44
Blue Shield,PPO,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Fee Schedule,3198.57
Blue Shield,PPO,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Fee Schedule,3198.57
Blue Shield,PPO,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Fee Schedule,4280.44
Blue Shield,PPO,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Fee Schedule,4280.44
Blue Shield,PPO,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Fee Schedule,4280.44
Blue Shield,PPO,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Fee Schedule,4280.44
Blue Shield,PPO,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Fee Schedule,4280.44
Blue Shield,PPO,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Fee Schedule,4280.44
Blue Shield,PPO,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Fee Schedule,4280.44
Blue Shield,PPO,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Fee Schedule,4280.44
Blue Shield,PPO,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,PPO,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Fee Schedule,4280.44
Blue Shield,PPO,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Fee Schedule,4280.44
Blue Shield,PPO,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Fee Schedule,4280.44
Blue Shield,PPO,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Fee Schedule,4280.44
Blue Shield,PPO,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Fee Schedule,3198.57
Blue Shield,PPO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Fee Schedule,3198.57
Blue Shield,PPO,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Fee Schedule,4280.44
Blue Shield,PPO,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Fee Schedule,6049.05
Blue Shield,PPO,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Fee Schedule,4891.93
Blue Shield,PPO,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Fee Schedule,4280.44
Blue Shield,PPO,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Fee Schedule,4280.44
Blue Shield,PPO,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Fee Schedule,4280.44
Blue Shield,PPO,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Fee Schedule,4280.44
Blue Shield,PPO,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Fee Schedule,4280.44
Blue Shield,PPO,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Fee Schedule,4280.44
Blue Shield,PPO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Fee Schedule,4280.44
Blue Shield,PPO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Fee Schedule,4280.44
Blue Shield,PPO,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Fee Schedule,4280.44
Blue Shield,PPO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Fee Schedule,4280.44
Blue Shield,PPO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Fee Schedule,4280.44
Blue Shield,PPO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Fee Schedule,4280.44
Blue Shield,PPO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Fee Schedule,4280.44
Blue Shield,PPO,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Fee Schedule,12850.71
Blue Shield,PPO,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Fee Schedule,7902.34
Blue Shield,PPO,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Fee Schedule,9548.66
Blue Shield,PPO,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,Fee Schedule,3198.57
Blue Shield,PPO,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Fee Schedule,6049.05
Blue Shield,PPO,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Fee Schedule,3198.57
Blue Shield,PPO,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,Fee Schedule,3198.57
Blue Shield,PPO,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,Fee Schedule,3198.57
Blue Shield,PPO,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,Fee Schedule,3198.57
Blue Shield,PPO,43289,CPT4/HCPCS,LAPAROSCOPE PROC ESOPH,,Fee Schedule,7902.34
Blue Shield,PPO,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,PPO,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Fee Schedule,4280.44
Blue Shield,PPO,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Fee Schedule,4280.44
Blue Shield,PPO,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Fee Schedule,4891.93
Blue Shield,PPO,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,Fee Schedule,6876.92
Blue Shield,PPO,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,Fee Schedule,6876.92
Blue Shield,PPO,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,Fee Schedule,3198.57
Blue Shield,PPO,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,Fee Schedule,3198.57
Blue Shield,PPO,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,Fee Schedule,3198.57
Blue Shield,PPO,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,Fee Schedule,3198.57
Blue Shield,PPO,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,Fee Schedule,3198.57
Blue Shield,PPO,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,Fee Schedule,3198.57
Blue Shield,PPO,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Fee Schedule,3198.57
Blue Shield,PPO,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Fee Schedule,3198.57
Blue Shield,PPO,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Fee Schedule,3198.57
Blue Shield,PPO,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Fee Schedule,3198.57
Blue Shield,PPO,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Fee Schedule,3198.57
Blue Shield,PPO,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Fee Schedule,3198.57
Blue Shield,PPO,43338,CPT4/HCPCS,ESOPH LENGTHENING,,Fee Schedule,3198.57
Blue Shield,PPO,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,PPO,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,PPO,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Fee Schedule,4891.93
Blue Shield,PPO,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Fee Schedule,4891.93
Blue Shield,PPO,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,Fee Schedule,3198.57
Blue Shield,PPO,43401,CPT4/HCPCS,ESOPHAGUS SURGERY FOR VEINS,,Fee Schedule,3198.57
Blue Shield,PPO,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,PPO,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Fee Schedule,4280.44
Blue Shield,PPO,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Fee Schedule,3198.57
Blue Shield,PPO,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,PPO,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,Fee Schedule,3198.57
Blue Shield,PPO,43496,CPT4/HCPCS,FREE JEJUNUM FLAP MICROVASC,,Fee Schedule,3198.57
Blue Shield,PPO,43499,CPT4/HCPCS,ESOPHAGUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Fee Schedule,3198.57
Blue Shield,PPO,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Fee Schedule,3198.57
Blue Shield,PPO,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Fee Schedule,3198.57
Blue Shield,PPO,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Fee Schedule,3198.57
Blue Shield,PPO,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,Fee Schedule,3198.57
Blue Shield,PPO,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,Fee Schedule,3198.57
Blue Shield,PPO,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,PPO,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,PPO,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,Fee Schedule,4280.44
Blue Shield,PPO,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,PPO,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,PPO,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,PPO,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,PPO,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Fee Schedule,3198.57
Blue Shield,PPO,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Fee Schedule,3198.57
Blue Shield,PPO,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Fee Schedule,3198.57
Blue Shield,PPO,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Fee Schedule,4280.44
Blue Shield,PPO,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Fee Schedule,4280.44
Blue Shield,PPO,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Fee Schedule,12850.71
Blue Shield,PPO,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Fee Schedule,12850.71
Blue Shield,PPO,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Fee Schedule,12850.71
Blue Shield,PPO,43659,CPT4/HCPCS,LAPAROSCOPE PROC STOM,,Fee Schedule,7902.34
Blue Shield,PPO,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Fee Schedule,987.79
Blue Shield,PPO,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Fee Schedule,987.79
Blue Shield,PPO,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Fee Schedule,987.79
Blue Shield,PPO,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Fee Schedule,987.79
Blue Shield,PPO,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Fee Schedule,987.79
Blue Shield,PPO,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Fee Schedule,987.79
Blue Shield,PPO,43760,CPT4/HCPCS,CHANGE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Fee Schedule,987.79
Blue Shield,PPO,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,PPO,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,PPO,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,PPO,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Fee Schedule,6049.05
Blue Shield,PPO,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Fee Schedule,6049.05
Blue Shield,PPO,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,Fee Schedule,9548.66
Blue Shield,PPO,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,Fee Schedule,3198.57
Blue Shield,PPO,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,Fee Schedule,3198.57
Blue Shield,PPO,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,Fee Schedule,3198.57
Blue Shield,PPO,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,Fee Schedule,4280.44
Blue Shield,PPO,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,Fee Schedule,4891.93
Blue Shield,PPO,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,Fee Schedule,4891.93
Blue Shield,PPO,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,PPO,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,PPO,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,PPO,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,PPO,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,PPO,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,PPO,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Fee Schedule,3198.57
Blue Shield,PPO,43999,CPT4/HCPCS,STOMACH SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Fee Schedule,3198.57
Blue Shield,PPO,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Fee Schedule,3198.57
Blue Shield,PPO,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,Fee Schedule,3198.57
Blue Shield,PPO,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,Fee Schedule,3198.57
Blue Shield,PPO,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,Fee Schedule,4891.93
Blue Shield,PPO,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,Fee Schedule,6049.05
Blue Shield,PPO,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,Fee Schedule,3198.57
Blue Shield,PPO,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,Fee Schedule,3198.57
Blue Shield,PPO,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,Fee Schedule,3198.57
Blue Shield,PPO,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,Fee Schedule,3198.57
Blue Shield,PPO,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,Fee Schedule,3198.57
Blue Shield,PPO,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,Fee Schedule,3198.57
Blue Shield,PPO,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,PPO,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,PPO,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,4280.44
Blue Shield,PPO,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,PPO,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,PPO,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,4891.93
Blue Shield,PPO,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Fee Schedule,3198.57
Blue Shield,PPO,44150,CPT4/HCPCS,REMOVAL OF COLON,,Fee Schedule,4280.44
Blue Shield,PPO,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,PPO,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,PPO,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Fee Schedule,4891.93
Blue Shield,PPO,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Fee Schedule,4891.93
Blue Shield,PPO,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Fee Schedule,4891.93
Blue Shield,PPO,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Fee Schedule,4891.93
Blue Shield,PPO,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44205,CPT4/HCPCS,LAP COLECTOMY PART W/ILEUM,,Fee Schedule,3198.57
Blue Shield,PPO,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,Fee Schedule,12850.71
Blue Shield,PPO,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Fee Schedule,12850.71
Blue Shield,PPO,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Fee Schedule,12850.71
Blue Shield,PPO,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Fee Schedule,7902.34
Blue Shield,PPO,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,Fee Schedule,7902.34
Blue Shield,PPO,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Fee Schedule,7902.34
Blue Shield,PPO,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Fee Schedule,6876.92
Blue Shield,PPO,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Fee Schedule,6876.92
Blue Shield,PPO,44238,CPT4/HCPCS,LAPAROSCOPE PROC INTESTINE,,Fee Schedule,7902.34
Blue Shield,PPO,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,Fee Schedule,3198.57
Blue Shield,PPO,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,Fee Schedule,4280.44
Blue Shield,PPO,44320,CPT4/HCPCS,COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,Fee Schedule,3198.57
Blue Shield,PPO,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,4891.93
Blue Shield,PPO,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Fee Schedule,4280.44
Blue Shield,PPO,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Fee Schedule,12850.71
Blue Shield,PPO,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Fee Schedule,4280.44
Blue Shield,PPO,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Fee Schedule,12850.71
Blue Shield,PPO,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Fee Schedule,3198.57
Blue Shield,PPO,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Fee Schedule,4891.93
Blue Shield,PPO,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Fee Schedule,3198.57
Blue Shield,PPO,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Fee Schedule,3198.57
Blue Shield,PPO,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Fee Schedule,3198.57
Blue Shield,PPO,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,PPO,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Fee Schedule,3198.57
Blue Shield,PPO,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Fee Schedule,3198.57
Blue Shield,PPO,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Fee Schedule,3198.57
Blue Shield,PPO,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Fee Schedule,3198.57
Blue Shield,PPO,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,PPO,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Fee Schedule,3198.57
Blue Shield,PPO,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Fee Schedule,3198.57
Blue Shield,PPO,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Fee Schedule,3198.57
Blue Shield,PPO,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Fee Schedule,3198.57
Blue Shield,PPO,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,PPO,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,Fee Schedule,3198.57
Blue Shield,PPO,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,Fee Schedule,3198.57
Blue Shield,PPO,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Fee Schedule,3198.57
Blue Shield,PPO,44799,CPT4/HCPCS,UNLISTED PX SMALL INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,44800,CPT4/HCPCS,EXCISION OF BOWEL POUCH,,Fee Schedule,3198.57
Blue Shield,PPO,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,Fee Schedule,3198.57
Blue Shield,PPO,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,Fee Schedule,3198.57
Blue Shield,PPO,44899,CPT4/HCPCS,BOWEL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,Fee Schedule,3198.57
Blue Shield,PPO,44950,CPT4/HCPCS,APPENDECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,44960,CPT4/HCPCS,APPENDECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Fee Schedule,7902.34
Blue Shield,PPO,44979,CPT4/HCPCS,LAPAROSCOPE PROC APP,,Fee Schedule,7902.34
Blue Shield,PPO,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Fee Schedule,3198.57
Blue Shield,PPO,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Fee Schedule,4280.44
Blue Shield,PPO,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,PPO,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,PPO,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,PPO,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,4280.44
Blue Shield,PPO,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,PPO,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,Fee Schedule,4280.44
Blue Shield,PPO,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,Fee Schedule,3198.57
Blue Shield,PPO,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,Fee Schedule,4280.44
Blue Shield,PPO,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,45126,CPT4/HCPCS,PELVIC EXENTERATION,,Fee Schedule,6049.05
Blue Shield,PPO,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,PPO,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,PPO,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,Fee Schedule,4280.44
Blue Shield,PPO,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Fee Schedule,4280.44
Blue Shield,PPO,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Fee Schedule,4280.44
Blue Shield,PPO,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Fee Schedule,7902.34
Blue Shield,PPO,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Fee Schedule,7902.34
Blue Shield,PPO,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Fee Schedule,12850.71
Blue Shield,PPO,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Fee Schedule,3198.57
Blue Shield,PPO,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Fee Schedule,3198.57
Blue Shield,PPO,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Fee Schedule,3198.57
Blue Shield,PPO,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Fee Schedule,3198.57
Blue Shield,PPO,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,PPO,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,PPO,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Fee Schedule,3198.57
Blue Shield,PPO,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Fee Schedule,3198.57
Blue Shield,PPO,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Fee Schedule,3198.57
Blue Shield,PPO,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Fee Schedule,3198.57
Blue Shield,PPO,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Fee Schedule,9548.66
Blue Shield,PPO,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Fee Schedule,3198.57
Blue Shield,PPO,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Fee Schedule,3198.57
Blue Shield,PPO,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Fee Schedule,3198.57
Blue Shield,PPO,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Fee Schedule,3198.57
Blue Shield,PPO,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Fee Schedule,3198.57
Blue Shield,PPO,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Fee Schedule,3198.57
Blue Shield,PPO,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Fee Schedule,3198.57
Blue Shield,PPO,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Fee Schedule,3198.57
Blue Shield,PPO,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Fee Schedule,3198.57
Blue Shield,PPO,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Fee Schedule,3198.57
Blue Shield,PPO,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,PPO,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Fee Schedule,3198.57
Blue Shield,PPO,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Fee Schedule,4280.44
Blue Shield,PPO,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Fee Schedule,4280.44
Blue Shield,PPO,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Fee Schedule,4280.44
Blue Shield,PPO,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Fee Schedule,4280.44
Blue Shield,PPO,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Fee Schedule,4280.44
Blue Shield,PPO,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Fee Schedule,4280.44
Blue Shield,PPO,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Fee Schedule,4280.44
Blue Shield,PPO,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Fee Schedule,3198.57
Blue Shield,PPO,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Fee Schedule,3198.57
Blue Shield,PPO,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Fee Schedule,3198.57
Blue Shield,PPO,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Fee Schedule,3198.57
Blue Shield,PPO,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Fee Schedule,3198.57
Blue Shield,PPO,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,PPO,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Fee Schedule,3198.57
Blue Shield,PPO,45399,CPT4/HCPCS,UNLISTED PROCEDURE COLON,,Fee Schedule,3198.57
Blue Shield,PPO,45499,CPT4/HCPCS,LAPAROSCOPE PROC RECTUM,,Fee Schedule,4891.93
Blue Shield,PPO,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Fee Schedule,4280.44
Blue Shield,PPO,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Fee Schedule,4280.44
Blue Shield,PPO,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Fee Schedule,987.79
Blue Shield,PPO,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,PPO,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,PPO,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,Fee Schedule,3198.57
Blue Shield,PPO,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Fee Schedule,4280.44
Blue Shield,PPO,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Fee Schedule,3198.57
Blue Shield,PPO,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Fee Schedule,3198.57
Blue Shield,PPO,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Fee Schedule,3198.57
Blue Shield,PPO,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Fee Schedule,3198.57
Blue Shield,PPO,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Fee Schedule,3198.57
Blue Shield,PPO,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Fee Schedule,3198.57
Blue Shield,PPO,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Fee Schedule,4280.44
Blue Shield,PPO,45999,CPT4/HCPCS,RECTUM SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Fee Schedule,4891.93
Blue Shield,PPO,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Fee Schedule,3198.57
Blue Shield,PPO,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4891.93
Blue Shield,PPO,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Fee Schedule,3198.57
Blue Shield,PPO,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,PPO,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Fee Schedule,3198.57
Blue Shield,PPO,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Fee Schedule,4280.44
Blue Shield,PPO,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Fee Schedule,3198.57
Blue Shield,PPO,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Fee Schedule,3198.57
Blue Shield,PPO,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Fee Schedule,4280.44
Blue Shield,PPO,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Fee Schedule,4891.93
Blue Shield,PPO,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Fee Schedule,4891.93
Blue Shield,PPO,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Fee Schedule,4891.93
Blue Shield,PPO,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Fee Schedule,4891.93
Blue Shield,PPO,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Fee Schedule,4891.93
Blue Shield,PPO,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Fee Schedule,6049.05
Blue Shield,PPO,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Fee Schedule,6049.05
Blue Shield,PPO,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Fee Schedule,4891.93
Blue Shield,PPO,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Fee Schedule,4891.93
Blue Shield,PPO,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Fee Schedule,6049.05
Blue Shield,PPO,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Fee Schedule,3198.57
Blue Shield,PPO,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Fee Schedule,6049.05
Blue Shield,PPO,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Fee Schedule,3198.57
Blue Shield,PPO,46500,CPT4/HCPCS,INJECTION INTO HEMORRHOID(S),,Fee Schedule,3198.57
Blue Shield,PPO,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Fee Schedule,3198.57
Blue Shield,PPO,46600,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY SPX,,Fee Schedule,987.79
Blue Shield,PPO,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Fee Schedule,987.79
Blue Shield,PPO,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Fee Schedule,3198.57
Blue Shield,PPO,46606,CPT4/HCPCS,ANOSCOPY AND BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Fee Schedule,3198.57
Blue Shield,PPO,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Fee Schedule,3198.57
Blue Shield,PPO,46611,CPT4/HCPCS,ANOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Fee Schedule,3198.57
Blue Shield,PPO,46615,CPT4/HCPCS,ANOSCOPY,,Fee Schedule,4280.44
Blue Shield,PPO,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Fee Schedule,4891.93
Blue Shield,PPO,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Fee Schedule,3198.57
Blue Shield,PPO,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Fee Schedule,3198.57
Blue Shield,PPO,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,Fee Schedule,7902.34
Blue Shield,PPO,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,Fee Schedule,3198.57
Blue Shield,PPO,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,Fee Schedule,3198.57
Blue Shield,PPO,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,3198.57
Blue Shield,PPO,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,4891.93
Blue Shield,PPO,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Fee Schedule,4280.44
Blue Shield,PPO,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,Fee Schedule,6049.05
Blue Shield,PPO,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,6876.92
Blue Shield,PPO,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,7902.34
Blue Shield,PPO,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Fee Schedule,9548.66
Blue Shield,PPO,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,PPO,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,3198.57
Blue Shield,PPO,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Fee Schedule,4891.93
Blue Shield,PPO,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Fee Schedule,4280.44
Blue Shield,PPO,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4280.44
Blue Shield,PPO,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Fee Schedule,4891.93
Blue Shield,PPO,46762,CPT4/HCPCS,IMPLANT ARTIFICIAL SPHINCTER,,Fee Schedule,9548.66
Blue Shield,PPO,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,987.79
Blue Shield,PPO,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,PPO,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Fee Schedule,987.79
Blue Shield,PPO,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Fee Schedule,3198.57
Blue Shield,PPO,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Fee Schedule,3198.57
Blue Shield,PPO,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Fee Schedule,3198.57
Blue Shield,PPO,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Fee Schedule,4280.44
Blue Shield,PPO,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Fee Schedule,3198.57
Blue Shield,PPO,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Fee Schedule,3198.57
Blue Shield,PPO,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Fee Schedule,3198.57
Blue Shield,PPO,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Fee Schedule,6049.05
Blue Shield,PPO,46999,CPT4/HCPCS,ANUS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Fee Schedule,3198.57
Blue Shield,PPO,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,Fee Schedule,3198.57
Blue Shield,PPO,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,Fee Schedule,3198.57
Blue Shield,PPO,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,Fee Schedule,3198.57
Blue Shield,PPO,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,4891.93
Blue Shield,PPO,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,PPO,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,PPO,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Fee Schedule,6876.92
Blue Shield,PPO,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,Fee Schedule,6876.92
Blue Shield,PPO,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,Fee Schedule,12850.71
Blue Shield,PPO,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,6049.05
Blue Shield,PPO,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,6876.92
Blue Shield,PPO,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Fee Schedule,7902.34
Blue Shield,PPO,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,Fee Schedule,3198.57
Blue Shield,PPO,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,4280.44
Blue Shield,PPO,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,6049.05
Blue Shield,PPO,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Fee Schedule,9548.66
Blue Shield,PPO,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Fee Schedule,9548.66
Blue Shield,PPO,47379,CPT4/HCPCS,LAPAROSCOPE PROCEDURE LIVER,,Fee Schedule,7902.34
Blue Shield,PPO,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Fee Schedule,3198.57
Blue Shield,PPO,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Fee Schedule,3198.57
Blue Shield,PPO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Fee Schedule,9548.66
Blue Shield,PPO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Fee Schedule,9548.66
Blue Shield,PPO,47399,CPT4/HCPCS,LIVER SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,Fee Schedule,4280.44
Blue Shield,PPO,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,Fee Schedule,3198.57
Blue Shield,PPO,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,Fee Schedule,3198.57
Blue Shield,PPO,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,Fee Schedule,3198.57
Blue Shield,PPO,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Fee Schedule,4891.93
Blue Shield,PPO,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Fee Schedule,4891.93
Blue Shield,PPO,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Fee Schedule,4891.93
Blue Shield,PPO,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Fee Schedule,4891.93
Blue Shield,PPO,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Fee Schedule,4891.93
Blue Shield,PPO,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Fee Schedule,4891.93
Blue Shield,PPO,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Fee Schedule,3198.57
Blue Shield,PPO,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,PPO,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,PPO,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Fee Schedule,4891.93
Blue Shield,PPO,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Fee Schedule,4891.93
Blue Shield,PPO,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Fee Schedule,4891.93
Blue Shield,PPO,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Fee Schedule,4891.93
Blue Shield,PPO,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Fee Schedule,4891.93
Blue Shield,PPO,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Fee Schedule,4280.44
Blue Shield,PPO,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,PPO,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,PPO,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,4891.93
Blue Shield,PPO,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Fee Schedule,12850.71
Blue Shield,PPO,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Fee Schedule,9548.66
Blue Shield,PPO,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Fee Schedule,9548.66
Blue Shield,PPO,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Fee Schedule,9548.66
Blue Shield,PPO,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,47579,CPT4/HCPCS,LAPAROSCOPE PROC BILIARY,,Fee Schedule,7902.34
Blue Shield,PPO,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,Fee Schedule,3198.57
Blue Shield,PPO,47701,CPT4/HCPCS,BILE DUCT REVISION,,Fee Schedule,4280.44
Blue Shield,PPO,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Fee Schedule,3198.57
Blue Shield,PPO,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Fee Schedule,4280.44
Blue Shield,PPO,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,Fee Schedule,3198.57
Blue Shield,PPO,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,Fee Schedule,3198.57
Blue Shield,PPO,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,Fee Schedule,4280.44
Blue Shield,PPO,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,4280.44
Blue Shield,PPO,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Fee Schedule,4280.44
Blue Shield,PPO,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,Fee Schedule,3198.57
Blue Shield,PPO,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,Fee Schedule,3198.57
Blue Shield,PPO,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,Fee Schedule,3198.57
Blue Shield,PPO,47999,CPT4/HCPCS,BILE TRACT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,Fee Schedule,4280.44
Blue Shield,PPO,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,Fee Schedule,4280.44
Blue Shield,PPO,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,Fee Schedule,3198.57
Blue Shield,PPO,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,Fee Schedule,3198.57
Blue Shield,PPO,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Fee Schedule,3198.57
Blue Shield,PPO,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,Fee Schedule,3198.57
Blue Shield,PPO,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,3198.57
Blue Shield,PPO,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,3198.57
Blue Shield,PPO,48146,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,Fee Schedule,3198.57
Blue Shield,PPO,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Fee Schedule,6049.05
Blue Shield,PPO,48152,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6049.05
Blue Shield,PPO,48153,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6876.92
Blue Shield,PPO,48154,CPT4/HCPCS,PANCREATECTOMY,,Fee Schedule,6049.05
Blue Shield,PPO,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,Fee Schedule,4280.44
Blue Shield,PPO,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,Fee Schedule,4280.44
Blue Shield,PPO,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,Fee Schedule,3198.57
Blue Shield,PPO,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Fee Schedule,3198.57
Blue Shield,PPO,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,48545,CPT4/HCPCS,PANCREATORRHAPHY,,Fee Schedule,3198.57
Blue Shield,PPO,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,Fee Schedule,3198.57
Blue Shield,PPO,48550,CPT4/HCPCS,DONOR PANCREATECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,48554,CPT4/HCPCS,TRANSPL ALLOGRAFT PANCREAS,,Fee Schedule,3198.57
Blue Shield,PPO,48556,CPT4/HCPCS,REMOVAL ALLOGRAFT PANCREAS,,Fee Schedule,3198.57
Blue Shield,PPO,48999,CPT4/HCPCS,PANCREAS SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,PPO,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,PPO,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Fee Schedule,3198.57
Blue Shield,PPO,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,Fee Schedule,3198.57
Blue Shield,PPO,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,Fee Schedule,3198.57
Blue Shield,PPO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Fee Schedule,987.79
Blue Shield,PPO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Fee Schedule,3198.57
Blue Shield,PPO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Fee Schedule,4891.93
Blue Shield,PPO,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Fee Schedule,3198.57
Blue Shield,PPO,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Fee Schedule,3198.57
Blue Shield,PPO,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,Fee Schedule,4891.93
Blue Shield,PPO,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,Fee Schedule,3198.57
Blue Shield,PPO,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Fee Schedule,6049.05
Blue Shield,PPO,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,Fee Schedule,3198.57
Blue Shield,PPO,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Fee Schedule,4891.93
Blue Shield,PPO,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Fee Schedule,6049.05
Blue Shield,PPO,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Fee Schedule,6049.05
Blue Shield,PPO,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Fee Schedule,7902.34
Blue Shield,PPO,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Fee Schedule,4891.93
Blue Shield,PPO,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Fee Schedule,4891.93
Blue Shield,PPO,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,49329,CPT4/HCPCS,LAPARO PROC ABDM/PER/OMENT,,Fee Schedule,7902.34
Blue Shield,PPO,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Fee Schedule,4280.44
Blue Shield,PPO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Fee Schedule,3198.57
Blue Shield,PPO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Fee Schedule,3198.57
Blue Shield,PPO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Fee Schedule,3198.57
Blue Shield,PPO,49411,CPT4/HCPCS,INS MARK ABD/PEL FOR RT PERQ,,Fee Schedule,987.79
Blue Shield,PPO,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Fee Schedule,4280.44
Blue Shield,PPO,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Fee Schedule,12850.71
Blue Shield,PPO,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Fee Schedule,3198.57
Blue Shield,PPO,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Fee Schedule,3198.57
Blue Shield,PPO,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Fee Schedule,3198.57
Blue Shield,PPO,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Fee Schedule,3198.57
Blue Shield,PPO,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Fee Schedule,4280.44
Blue Shield,PPO,49428,CPT4/HCPCS,LIGATION OF SHUNT,,Fee Schedule,3198.57
Blue Shield,PPO,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Fee Schedule,4891.93
Blue Shield,PPO,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Fee Schedule,3198.57
Blue Shield,PPO,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Fee Schedule,4280.44
Blue Shield,PPO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Fee Schedule,4280.44
Blue Shield,PPO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Fee Schedule,4280.44
Blue Shield,PPO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Fee Schedule,4280.44
Blue Shield,PPO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Fee Schedule,4280.44
Blue Shield,PPO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Fee Schedule,4280.44
Blue Shield,PPO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Fee Schedule,4280.44
Blue Shield,PPO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Fee Schedule,4280.44
Blue Shield,PPO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Fee Schedule,6876.92
Blue Shield,PPO,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Fee Schedule,6876.92
Blue Shield,PPO,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Fee Schedule,6049.05
Blue Shield,PPO,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Fee Schedule,6049.05
Blue Shield,PPO,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Fee Schedule,6049.05
Blue Shield,PPO,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Fee Schedule,12850.71
Blue Shield,PPO,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Fee Schedule,6049.05
Blue Shield,PPO,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Fee Schedule,12850.71
Blue Shield,PPO,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Fee Schedule,9548.66
Blue Shield,PPO,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Fee Schedule,12850.71
Blue Shield,PPO,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Fee Schedule,6049.05
Blue Shield,PPO,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Fee Schedule,4280.44
Blue Shield,PPO,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Fee Schedule,6876.92
Blue Shield,PPO,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Fee Schedule,12850.71
Blue Shield,PPO,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Fee Schedule,6876.92
Blue Shield,PPO,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Fee Schedule,12850.71
Blue Shield,PPO,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Fee Schedule,6049.05
Blue Shield,PPO,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Fee Schedule,12850.71
Blue Shield,PPO,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Fee Schedule,6049.05
Blue Shield,PPO,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Fee Schedule,12850.71
Blue Shield,PPO,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Fee Schedule,9548.66
Blue Shield,PPO,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Fee Schedule,6049.05
Blue Shield,PPO,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Fee Schedule,12850.71
Blue Shield,PPO,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Fee Schedule,6049.05
Blue Shield,PPO,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Fee Schedule,12850.71
Blue Shield,PPO,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Fee Schedule,6049.05
Blue Shield,PPO,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Fee Schedule,12850.71
Blue Shield,PPO,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Fee Schedule,4891.93
Blue Shield,PPO,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,9548.66
Blue Shield,PPO,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Fee Schedule,6049.05
Blue Shield,PPO,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Fee Schedule,9548.66
Blue Shield,PPO,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Fee Schedule,7902.34
Blue Shield,PPO,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Fee Schedule,7902.34
Blue Shield,PPO,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Fee Schedule,7902.34
Blue Shield,PPO,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Fee Schedule,7902.34
Blue Shield,PPO,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Fee Schedule,7902.34
Blue Shield,PPO,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Fee Schedule,7902.34
Blue Shield,PPO,49659,CPT4/HCPCS,LAPARO PROC HERNIA REPAIR,,Fee Schedule,9548.66
Blue Shield,PPO,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,Fee Schedule,3198.57
Blue Shield,PPO,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,Fee Schedule,4280.44
Blue Shield,PPO,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,Fee Schedule,3198.57
Blue Shield,PPO,49906,CPT4/HCPCS,FREE OMENTAL FLAP MICROVASC,,Fee Schedule,3198.57
Blue Shield,PPO,49999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Fee Schedule,4891.93
Blue Shield,PPO,4A020N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,4A020N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Open Approach,,Fee Schedule,8271.00
Blue Shield,PPO,4A020N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Open,,Fee Schedule,8271.00
Blue Shield,PPO,4A023FZ,ICD10-PCS,Measurement of Cardiac Rhythm, Percutaneous Approach,,Fee Schedule,8271.00
Blue Shield,PPO,4A023N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,4A023N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Perc Approach,,Fee Schedule,8271.00
Blue Shield,PPO,4A023N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Perc,,Fee Schedule,8271.00
Blue Shield,PPO,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Fee Schedule,4280.44
Blue Shield,PPO,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,9548.66
Blue Shield,PPO,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,3198.57
Blue Shield,PPO,50065,CPT4/HCPCS,INCISION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50070,CPT4/HCPCS,INCISION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,4280.44
Blue Shield,PPO,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,9548.66
Blue Shield,PPO,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,9548.66
Blue Shield,PPO,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,Fee Schedule,3198.57
Blue Shield,PPO,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Fee Schedule,3198.57
Blue Shield,PPO,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Fee Schedule,3198.57
Blue Shield,PPO,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,Fee Schedule,3198.57
Blue Shield,PPO,50220,CPT4/HCPCS,REMOVE KIDNEY OPEN,,Fee Schedule,3198.57
Blue Shield,PPO,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,Fee Schedule,3198.57
Blue Shield,PPO,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,Fee Schedule,3198.57
Blue Shield,PPO,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Fee Schedule,4280.44
Blue Shield,PPO,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,Fee Schedule,4280.44
Blue Shield,PPO,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,PPO,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,PPO,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,Fee Schedule,3198.57
Blue Shield,PPO,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Fee Schedule,4891.93
Blue Shield,PPO,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Fee Schedule,6049.05
Blue Shield,PPO,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,Fee Schedule,4280.44
Blue Shield,PPO,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Fee Schedule,4280.44
Blue Shield,PPO,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Fee Schedule,4280.44
Blue Shield,PPO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Fee Schedule,4280.44
Blue Shield,PPO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Fee Schedule,4280.44
Blue Shield,PPO,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Fee Schedule,4280.44
Blue Shield,PPO,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Fee Schedule,4280.44
Blue Shield,PPO,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Fee Schedule,3198.57
Blue Shield,PPO,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Fee Schedule,987.79
Blue Shield,PPO,50395,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Fee Schedule,3198.57
Blue Shield,PPO,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Fee Schedule,3198.57
Blue Shield,PPO,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Fee Schedule,3198.57
Blue Shield,PPO,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Fee Schedule,3198.57
Blue Shield,PPO,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Fee Schedule,3198.57
Blue Shield,PPO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Fee Schedule,3198.57
Blue Shield,PPO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Fee Schedule,3198.57
Blue Shield,PPO,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Fee Schedule,4280.44
Blue Shield,PPO,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Fee Schedule,4280.44
Blue Shield,PPO,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Fee Schedule,7902.34
Blue Shield,PPO,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Fee Schedule,9548.66
Blue Shield,PPO,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Fee Schedule,9548.66
Blue Shield,PPO,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Fee Schedule,7902.34
Blue Shield,PPO,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,50546,CPT4/HCPCS,LAPAROSCOPIC NEPHRECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50549,CPT4/HCPCS,LAPAROSCOPE PROC RENAL,,Fee Schedule,7902.34
Blue Shield,PPO,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,PPO,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,PPO,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Fee Schedule,9548.66
Blue Shield,PPO,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,PPO,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,PPO,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Fee Schedule,12850.71
Blue Shield,PPO,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Fee Schedule,6876.92
Blue Shield,PPO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Fee Schedule,4891.93
Blue Shield,PPO,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Fee Schedule,3198.57
Blue Shield,PPO,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,PPO,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,PPO,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,PPO,50650,CPT4/HCPCS,REMOVAL OF URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50660,CPT4/HCPCS,REMOVAL OF URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,Fee Schedule,987.79
Blue Shield,PPO,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Fee Schedule,3198.57
Blue Shield,PPO,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,PPO,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,PPO,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Fee Schedule,3198.57
Blue Shield,PPO,50700,CPT4/HCPCS,REVISION OF URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50715,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50722,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50727,CPT4/HCPCS,REVISE URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50728,CPT4/HCPCS,REVISE URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Fee Schedule,3198.57
Blue Shield,PPO,50760,CPT4/HCPCS,FUSION OF URETERS,,Fee Schedule,3198.57
Blue Shield,PPO,50770,CPT4/HCPCS,SPLICING OF URETERS,,Fee Schedule,3198.57
Blue Shield,PPO,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,50782,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,50783,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,Fee Schedule,3198.57
Blue Shield,PPO,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Fee Schedule,4891.93
Blue Shield,PPO,50830,CPT4/HCPCS,REVISE URINE FLOW,,Fee Schedule,4891.93
Blue Shield,PPO,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,Fee Schedule,3198.57
Blue Shield,PPO,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,Fee Schedule,3198.57
Blue Shield,PPO,50900,CPT4/HCPCS,REPAIR OF URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,50940,CPT4/HCPCS,RELEASE OF URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Fee Schedule,9548.66
Blue Shield,PPO,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Fee Schedule,12850.71
Blue Shield,PPO,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Fee Schedule,12850.71
Blue Shield,PPO,50949,CPT4/HCPCS,LAPAROSCOPE PROC URETER,,Fee Schedule,7902.34
Blue Shield,PPO,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Fee Schedule,3198.57
Blue Shield,PPO,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,PPO,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,PPO,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Fee Schedule,3198.57
Blue Shield,PPO,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,PPO,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Fee Schedule,3198.57
Blue Shield,PPO,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Fee Schedule,6049.05
Blue Shield,PPO,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Fee Schedule,6049.05
Blue Shield,PPO,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Fee Schedule,6049.05
Blue Shield,PPO,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Fee Schedule,6049.05
Blue Shield,PPO,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Fee Schedule,6049.05
Blue Shield,PPO,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,Fee Schedule,3198.57
Blue Shield,PPO,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Fee Schedule,6049.05
Blue Shield,PPO,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,Fee Schedule,987.79
Blue Shield,PPO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Fee Schedule,3198.57
Blue Shield,PPO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Fee Schedule,3198.57
Blue Shield,PPO,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Fee Schedule,6049.05
Blue Shield,PPO,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,6049.05
Blue Shield,PPO,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,3198.57
Blue Shield,PPO,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Fee Schedule,3198.57
Blue Shield,PPO,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,Fee Schedule,3198.57
Blue Shield,PPO,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Fee Schedule,3198.57
Blue Shield,PPO,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,Fee Schedule,3198.57
Blue Shield,PPO,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,Fee Schedule,4280.44
Blue Shield,PPO,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Fee Schedule,4891.93
Blue Shield,PPO,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,PPO,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Fee Schedule,4891.93
Blue Shield,PPO,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,PPO,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Fee Schedule,4891.93
Blue Shield,PPO,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,Fee Schedule,6049.05
Blue Shield,PPO,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,Fee Schedule,4891.93
Blue Shield,PPO,51700,CPT4/HCPCS,IRRIGATION OF BLADDER,,Fee Schedule,987.79
Blue Shield,PPO,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Fee Schedule,987.79
Blue Shield,PPO,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Fee Schedule,4891.93
Blue Shield,PPO,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Fee Schedule,987.79
Blue Shield,PPO,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Fee Schedule,3198.57
Blue Shield,PPO,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Fee Schedule,3198.57
Blue Shield,PPO,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Fee Schedule,3198.57
Blue Shield,PPO,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Fee Schedule,3198.57
Blue Shield,PPO,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Fee Schedule,3198.57
Blue Shield,PPO,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,Fee Schedule,987.79
Blue Shield,PPO,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,Fee Schedule,987.79
Blue Shield,PPO,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Fee Schedule,987.79
Blue Shield,PPO,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Fee Schedule,3198.57
Blue Shield,PPO,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,Fee Schedule,987.79
Blue Shield,PPO,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Fee Schedule,987.79
Blue Shield,PPO,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,Fee Schedule,987.79
Blue Shield,PPO,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Fee Schedule,3198.57
Blue Shield,PPO,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Fee Schedule,3198.57
Blue Shield,PPO,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Fee Schedule,3198.57
Blue Shield,PPO,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Fee Schedule,3198.57
Blue Shield,PPO,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,Fee Schedule,3198.57
Blue Shield,PPO,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,Fee Schedule,4891.93
Blue Shield,PPO,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,Fee Schedule,4280.44
Blue Shield,PPO,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Fee Schedule,9548.66
Blue Shield,PPO,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Fee Schedule,12850.71
Blue Shield,PPO,51999,CPT4/HCPCS,LAPAROSCOPE PROC BLA,,Fee Schedule,6049.05
Blue Shield,PPO,52000,CPT4/HCPCS,CYSTOSCOPY,,Fee Schedule,3198.57
Blue Shield,PPO,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Fee Schedule,4280.44
Blue Shield,PPO,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Fee Schedule,4280.44
Blue Shield,PPO,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Fee Schedule,4280.44
Blue Shield,PPO,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Fee Schedule,4280.44
Blue Shield,PPO,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Fee Schedule,4280.44
Blue Shield,PPO,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,PPO,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,PPO,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Fee Schedule,6049.05
Blue Shield,PPO,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,3198.57
Blue Shield,PPO,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Fee Schedule,4280.44
Blue Shield,PPO,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Fee Schedule,4280.44
Blue Shield,PPO,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4891.93
Blue Shield,PPO,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Fee Schedule,12850.71
Blue Shield,PPO,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Fee Schedule,4280.44
Blue Shield,PPO,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Fee Schedule,3198.57
Blue Shield,PPO,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Fee Schedule,4280.44
Blue Shield,PPO,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,6876.92
Blue Shield,PPO,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Fee Schedule,6049.05
Blue Shield,PPO,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Fee Schedule,4280.44
Blue Shield,PPO,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Fee Schedule,4891.93
Blue Shield,PPO,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,PPO,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,PPO,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,PPO,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Fee Schedule,4891.93
Blue Shield,PPO,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Fee Schedule,4891.93
Blue Shield,PPO,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Fee Schedule,4891.93
Blue Shield,PPO,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Fee Schedule,4891.93
Blue Shield,PPO,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Fee Schedule,6049.05
Blue Shield,PPO,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Fee Schedule,6049.05
Blue Shield,PPO,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Fee Schedule,6049.05
Blue Shield,PPO,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Fee Schedule,6049.05
Blue Shield,PPO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Fee Schedule,6049.05
Blue Shield,PPO,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Fee Schedule,4891.93
Blue Shield,PPO,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Fee Schedule,6049.05
Blue Shield,PPO,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Fee Schedule,987.79
Blue Shield,PPO,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Fee Schedule,987.79
Blue Shield,PPO,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Fee Schedule,4891.93
Blue Shield,PPO,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Fee Schedule,4891.93
Blue Shield,PPO,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Fee Schedule,6049.05
Blue Shield,PPO,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Fee Schedule,4280.44
Blue Shield,PPO,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Fee Schedule,4280.44
Blue Shield,PPO,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Fee Schedule,12850.71
Blue Shield,PPO,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Fee Schedule,12850.71
Blue Shield,PPO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Fee Schedule,6049.05
Blue Shield,PPO,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,53000,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,53010,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,53020,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,53025,CPT4/HCPCS,INCISION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,PPO,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Fee Schedule,4891.93
Blue Shield,PPO,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Fee Schedule,3198.57
Blue Shield,PPO,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Fee Schedule,6876.92
Blue Shield,PPO,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Fee Schedule,6876.92
Blue Shield,PPO,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,PPO,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,PPO,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Fee Schedule,4891.93
Blue Shield,PPO,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Fee Schedule,4280.44
Blue Shield,PPO,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Fee Schedule,4280.44
Blue Shield,PPO,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,PPO,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Fee Schedule,4280.44
Blue Shield,PPO,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Fee Schedule,4280.44
Blue Shield,PPO,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Fee Schedule,4280.44
Blue Shield,PPO,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Fee Schedule,4891.93
Blue Shield,PPO,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Fee Schedule,4280.44
Blue Shield,PPO,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,PPO,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Fee Schedule,4891.93
Blue Shield,PPO,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Fee Schedule,4280.44
Blue Shield,PPO,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4280.44
Blue Shield,PPO,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Fee Schedule,4280.44
Blue Shield,PPO,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Fee Schedule,4280.44
Blue Shield,PPO,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Fee Schedule,3198.57
Blue Shield,PPO,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Fee Schedule,4280.44
Blue Shield,PPO,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Fee Schedule,3198.57
Blue Shield,PPO,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Fee Schedule,3198.57
Blue Shield,PPO,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Fee Schedule,3198.57
Blue Shield,PPO,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,Fee Schedule,3198.57
Blue Shield,PPO,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Fee Schedule,3198.57
Blue Shield,PPO,53450,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,53460,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Fee Schedule,7902.34
Blue Shield,PPO,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,PPO,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,PPO,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,PPO,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Fee Schedule,4280.44
Blue Shield,PPO,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Fee Schedule,4280.44
Blue Shield,PPO,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,3198.57
Blue Shield,PPO,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,3198.57
Blue Shield,PPO,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,4280.44
Blue Shield,PPO,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,4280.44
Blue Shield,PPO,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Fee Schedule,987.79
Blue Shield,PPO,53660,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,987.79
Blue Shield,PPO,53661,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,987.79
Blue Shield,PPO,53665,CPT4/HCPCS,DILATION OF URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Fee Schedule,12850.71
Blue Shield,PPO,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Fee Schedule,12850.71
Blue Shield,PPO,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Fee Schedule,3198.57
Blue Shield,PPO,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Fee Schedule,987.79
Blue Shield,PPO,53899,CPT4/HCPCS,UROLOGY SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Fee Schedule,4280.44
Blue Shield,PPO,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Fee Schedule,4280.44
Blue Shield,PPO,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Fee Schedule,6049.05
Blue Shield,PPO,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,987.79
Blue Shield,PPO,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,4280.44
Blue Shield,PPO,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,Fee Schedule,987.79
Blue Shield,PPO,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,PPO,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,PPO,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Fee Schedule,3198.57
Blue Shield,PPO,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Fee Schedule,3198.57
Blue Shield,PPO,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Fee Schedule,3198.57
Blue Shield,PPO,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,4280.44
Blue Shield,PPO,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,3198.57
Blue Shield,PPO,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Fee Schedule,4280.44
Blue Shield,PPO,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Fee Schedule,3198.57
Blue Shield,PPO,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,Fee Schedule,3198.57
Blue Shield,PPO,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,Fee Schedule,4280.44
Blue Shield,PPO,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Fee Schedule,3198.57
Blue Shield,PPO,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Fee Schedule,4280.44
Blue Shield,PPO,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Fee Schedule,4280.44
Blue Shield,PPO,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Fee Schedule,4280.44
Blue Shield,PPO,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Fee Schedule,4280.44
Blue Shield,PPO,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Fee Schedule,4280.44
Blue Shield,PPO,54200,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,987.79
Blue Shield,PPO,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,6049.05
Blue Shield,PPO,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Fee Schedule,3198.57
Blue Shield,PPO,54231,CPT4/HCPCS,DYNAMIC CAVERNOSOMETRY,,Fee Schedule,4280.44
Blue Shield,PPO,54235,CPT4/HCPCS,PENILE INJECTION,,Fee Schedule,987.79
Blue Shield,PPO,54240,CPT4/HCPCS,PENIS STUDY,,Fee Schedule,987.79
Blue Shield,PPO,54250,CPT4/HCPCS,PENIS STUDY,,Fee Schedule,987.79
Blue Shield,PPO,54300,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,4891.93
Blue Shield,PPO,54304,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,4891.93
Blue Shield,PPO,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,PPO,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,PPO,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,PPO,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,PPO,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,PPO,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,PPO,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,PPO,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,4891.93
Blue Shield,PPO,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,3198.57
Blue Shield,PPO,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Fee Schedule,4280.44
Blue Shield,PPO,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Fee Schedule,4891.93
Blue Shield,PPO,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,54380,CPT4/HCPCS,REPAIR PENIS,,Fee Schedule,4891.93
Blue Shield,PPO,54385,CPT4/HCPCS,REPAIR PENIS,,Fee Schedule,4891.93
Blue Shield,PPO,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,Fee Schedule,4280.44
Blue Shield,PPO,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,PPO,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Fee Schedule,4891.93
Blue Shield,PPO,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,PPO,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,PPO,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Fee Schedule,4891.93
Blue Shield,PPO,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Fee Schedule,4891.93
Blue Shield,PPO,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Fee Schedule,3198.57
Blue Shield,PPO,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Fee Schedule,4891.93
Blue Shield,PPO,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Fee Schedule,4891.93
Blue Shield,PPO,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Fee Schedule,3198.57
Blue Shield,PPO,54420,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,6049.05
Blue Shield,PPO,54430,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,3198.57
Blue Shield,PPO,54435,CPT4/HCPCS,REVISION OF PENIS,,Fee Schedule,6049.05
Blue Shield,PPO,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Fee Schedule,6049.05
Blue Shield,PPO,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,Fee Schedule,987.79
Blue Shield,PPO,54440,CPT4/HCPCS,REPAIR OF PENIS,,Fee Schedule,6049.05
Blue Shield,PPO,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Fee Schedule,3198.57
Blue Shield,PPO,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Fee Schedule,3198.57
Blue Shield,PPO,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Fee Schedule,3198.57
Blue Shield,PPO,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Fee Schedule,4280.44
Blue Shield,PPO,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Fee Schedule,4891.93
Blue Shield,PPO,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Fee Schedule,4891.93
Blue Shield,PPO,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Fee Schedule,6049.05
Blue Shield,PPO,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Fee Schedule,6049.05
Blue Shield,PPO,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Fee Schedule,3198.57
Blue Shield,PPO,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Fee Schedule,6049.05
Blue Shield,PPO,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Fee Schedule,4891.93
Blue Shield,PPO,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Fee Schedule,6049.05
Blue Shield,PPO,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Fee Schedule,3198.57
Blue Shield,PPO,54660,CPT4/HCPCS,REVISION OF TESTIS,,Fee Schedule,4280.44
Blue Shield,PPO,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Fee Schedule,4891.93
Blue Shield,PPO,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Fee Schedule,4891.93
Blue Shield,PPO,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Fee Schedule,12850.71
Blue Shield,PPO,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Fee Schedule,12850.71
Blue Shield,PPO,54699,CPT4/HCPCS,LAPAROSCOPE PROC TESTIS,,Fee Schedule,7902.34
Blue Shield,PPO,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Fee Schedule,4280.44
Blue Shield,PPO,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Fee Schedule,3198.57
Blue Shield,PPO,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Fee Schedule,4891.93
Blue Shield,PPO,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Fee Schedule,6049.05
Blue Shield,PPO,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Fee Schedule,4891.93
Blue Shield,PPO,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Fee Schedule,6049.05
Blue Shield,PPO,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Fee Schedule,3198.57
Blue Shield,PPO,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Fee Schedule,6049.05
Blue Shield,PPO,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Fee Schedule,6049.05
Blue Shield,PPO,55000,CPT4/HCPCS,DRAINAGE OF HYDROCELE,,Fee Schedule,987.79
Blue Shield,PPO,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Fee Schedule,4891.93
Blue Shield,PPO,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Fee Schedule,6876.92
Blue Shield,PPO,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Fee Schedule,6049.05
Blue Shield,PPO,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Fee Schedule,4280.44
Blue Shield,PPO,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Fee Schedule,4280.44
Blue Shield,PPO,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Fee Schedule,3198.57
Blue Shield,PPO,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Fee Schedule,3198.57
Blue Shield,PPO,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Fee Schedule,4280.44
Blue Shield,PPO,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Fee Schedule,4280.44
Blue Shield,PPO,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Fee Schedule,4280.44
Blue Shield,PPO,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Fee Schedule,3198.57
Blue Shield,PPO,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Fee Schedule,4891.93
Blue Shield,PPO,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Fee Schedule,6049.05
Blue Shield,PPO,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Fee Schedule,6049.05
Blue Shield,PPO,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Fee Schedule,6049.05
Blue Shield,PPO,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Fee Schedule,6876.92
Blue Shield,PPO,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Fee Schedule,12850.71
Blue Shield,PPO,55559,CPT4/HCPCS,LAPARO PROC SPERMATIC CORD,,Fee Schedule,7902.34
Blue Shield,PPO,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,PPO,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,PPO,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Fee Schedule,3198.57
Blue Shield,PPO,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Fee Schedule,3198.57
Blue Shield,PPO,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Fee Schedule,4280.44
Blue Shield,PPO,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Fee Schedule,4280.44
Blue Shield,PPO,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Fee Schedule,4280.44
Blue Shield,PPO,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,PPO,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,PPO,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,Fee Schedule,3198.57
Blue Shield,PPO,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Fee Schedule,4280.44
Blue Shield,PPO,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,55870,CPT4/HCPCS,ELECTROEJACULATION,,Fee Schedule,3198.57
Blue Shield,PPO,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Fee Schedule,12850.71
Blue Shield,PPO,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Fee Schedule,12850.71
Blue Shield,PPO,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Fee Schedule,12850.71
Blue Shield,PPO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Fee Schedule,12850.71
Blue Shield,PPO,55899,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Fee Schedule,3198.57
Blue Shield,PPO,55970,CPT4/HCPCS,SEX TRANSFORMATION M TO F,,Fee Schedule,3198.57
Blue Shield,PPO,55980,CPT4/HCPCS,SEX TRANSFORMATION F TO M,,Fee Schedule,3198.57
Blue Shield,PPO,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,PPO,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Fee Schedule,3198.57
Blue Shield,PPO,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Fee Schedule,4280.44
Blue Shield,PPO,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Fee Schedule,3198.57
Blue Shield,PPO,56442,CPT4/HCPCS,HYMENOTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Fee Schedule,4280.44
Blue Shield,PPO,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Fee Schedule,4891.93
Blue Shield,PPO,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,PPO,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Fee Schedule,3198.57
Blue Shield,PPO,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Fee Schedule,6876.92
Blue Shield,PPO,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Fee Schedule,9548.66
Blue Shield,PPO,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Fee Schedule,3198.57
Blue Shield,PPO,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Fee Schedule,4891.93
Blue Shield,PPO,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Fee Schedule,4891.93
Blue Shield,PPO,56805,CPT4/HCPCS,REPAIR CLITORIS,,Fee Schedule,4891.93
Blue Shield,PPO,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Fee Schedule,6876.92
Blue Shield,PPO,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Fee Schedule,987.79
Blue Shield,PPO,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Fee Schedule,987.79
Blue Shield,PPO,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Fee Schedule,3198.57
Blue Shield,PPO,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Fee Schedule,4280.44
Blue Shield,PPO,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Fee Schedule,3198.57
Blue Shield,PPO,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Fee Schedule,3198.57
Blue Shield,PPO,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Fee Schedule,4891.93
Blue Shield,PPO,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Fee Schedule,3198.57
Blue Shield,PPO,57100,CPT4/HCPCS,BIOPSY OF VAGINA,,Fee Schedule,987.79
Blue Shield,PPO,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Fee Schedule,4280.44
Blue Shield,PPO,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Fee Schedule,4891.93
Blue Shield,PPO,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Fee Schedule,6876.92
Blue Shield,PPO,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Fee Schedule,6876.92
Blue Shield,PPO,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Fee Schedule,3198.57
Blue Shield,PPO,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Fee Schedule,4280.44
Blue Shield,PPO,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Fee Schedule,4280.44
Blue Shield,PPO,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Fee Schedule,6876.92
Blue Shield,PPO,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Fee Schedule,4280.44
Blue Shield,PPO,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Fee Schedule,4280.44
Blue Shield,PPO,57150,CPT4/HCPCS,TREAT VAGINA INFECTION,,Fee Schedule,987.79
Blue Shield,PPO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Fee Schedule,4280.44
Blue Shield,PPO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Fee Schedule,987.79
Blue Shield,PPO,57160,CPT4/HCPCS,INSERT PESSARY/OTHER DEVICE,,Fee Schedule,987.79
Blue Shield,PPO,57170,CPT4/HCPCS,FITTING OF DIAPHRAGM/CAP,,Fee Schedule,987.79
Blue Shield,PPO,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,Fee Schedule,3198.57
Blue Shield,PPO,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Fee Schedule,3198.57
Blue Shield,PPO,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Fee Schedule,4280.44
Blue Shield,PPO,57220,CPT4/HCPCS,REVISION OF URETHRA,,Fee Schedule,4891.93
Blue Shield,PPO,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Fee Schedule,4891.93
Blue Shield,PPO,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Fee Schedule,6876.92
Blue Shield,PPO,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Fee Schedule,6876.92
Blue Shield,PPO,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Fee Schedule,6876.92
Blue Shield,PPO,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Fee Schedule,9548.66
Blue Shield,PPO,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Fee Schedule,6876.92
Blue Shield,PPO,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Fee Schedule,4891.93
Blue Shield,PPO,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,Fee Schedule,4891.93
Blue Shield,PPO,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Fee Schedule,4891.93
Blue Shield,PPO,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Fee Schedule,3198.57
Blue Shield,PPO,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Fee Schedule,6876.92
Blue Shield,PPO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Fee Schedule,4891.93
Blue Shield,PPO,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Fee Schedule,9548.66
Blue Shield,PPO,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Fee Schedule,9548.66
Blue Shield,PPO,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Fee Schedule,6876.92
Blue Shield,PPO,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Fee Schedule,6876.92
Blue Shield,PPO,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,57295,CPT4/HCPCS,REVISE VAG GRAFT VIA VAGINA,,Fee Schedule,3198.57
Blue Shield,PPO,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Fee Schedule,4891.93
Blue Shield,PPO,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Fee Schedule,4891.93
Blue Shield,PPO,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,Fee Schedule,4891.93
Blue Shield,PPO,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,Fee Schedule,3198.57
Blue Shield,PPO,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Fee Schedule,6876.92
Blue Shield,PPO,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Fee Schedule,6876.92
Blue Shield,PPO,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Fee Schedule,6876.92
Blue Shield,PPO,57335,CPT4/HCPCS,REPAIR VAGINA,,Fee Schedule,3198.57
Blue Shield,PPO,57400,CPT4/HCPCS,DILATION OF VAGINA,,Fee Schedule,4280.44
Blue Shield,PPO,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Fee Schedule,4280.44
Blue Shield,PPO,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Fee Schedule,4280.44
Blue Shield,PPO,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Fee Schedule,987.79
Blue Shield,PPO,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Fee Schedule,987.79
Blue Shield,PPO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Fee Schedule,6049.05
Blue Shield,PPO,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Fee Schedule,7902.34
Blue Shield,PPO,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Fee Schedule,6876.92
Blue Shield,PPO,57452,CPT4/HCPCS,EXAM OF CERVIX W/SCOPE,,Fee Schedule,987.79
Blue Shield,PPO,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Fee Schedule,3198.57
Blue Shield,PPO,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Fee Schedule,987.79
Blue Shield,PPO,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Fee Schedule,3198.57
Blue Shield,PPO,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Fee Schedule,4280.44
Blue Shield,PPO,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Fee Schedule,4891.93
Blue Shield,PPO,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Fee Schedule,3198.57
Blue Shield,PPO,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Fee Schedule,987.79
Blue Shield,PPO,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,PPO,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Fee Schedule,3198.57
Blue Shield,PPO,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Fee Schedule,4280.44
Blue Shield,PPO,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,PPO,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,PPO,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Fee Schedule,4891.93
Blue Shield,PPO,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,Fee Schedule,4280.44
Blue Shield,PPO,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Fee Schedule,3198.57
Blue Shield,PPO,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,Fee Schedule,3198.57
Blue Shield,PPO,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Fee Schedule,4891.93
Blue Shield,PPO,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,Fee Schedule,6876.92
Blue Shield,PPO,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Fee Schedule,6876.92
Blue Shield,PPO,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Fee Schedule,4891.93
Blue Shield,PPO,57700,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,3198.57
Blue Shield,PPO,57720,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,4891.93
Blue Shield,PPO,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Fee Schedule,4280.44
Blue Shield,PPO,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Fee Schedule,987.79
Blue Shield,PPO,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Fee Schedule,987.79
Blue Shield,PPO,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Fee Schedule,4280.44
Blue Shield,PPO,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Fee Schedule,6876.92
Blue Shield,PPO,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Fee Schedule,6876.92
Blue Shield,PPO,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,Fee Schedule,6876.92
Blue Shield,PPO,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,Fee Schedule,6049.05
Blue Shield,PPO,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Fee Schedule,3198.57
Blue Shield,PPO,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Fee Schedule,3198.57
Blue Shield,PPO,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,Fee Schedule,3198.57
Blue Shield,PPO,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Fee Schedule,3198.57
Blue Shield,PPO,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Fee Schedule,3198.57
Blue Shield,PPO,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Fee Schedule,3198.57
Blue Shield,PPO,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Fee Schedule,3198.57
Blue Shield,PPO,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Fee Schedule,3198.57
Blue Shield,PPO,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Fee Schedule,3198.57
Blue Shield,PPO,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,Fee Schedule,3198.57
Blue Shield,PPO,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Fee Schedule,3198.57
Blue Shield,PPO,58300,CPT4/HCPCS,INSERT INTRAUTERINE DEVICE,,Fee Schedule,987.79
Blue Shield,PPO,58301,CPT4/HCPCS,REMOVE INTRAUTERINE DEVICE,,Fee Schedule,987.79
Blue Shield,PPO,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Fee Schedule,987.79
Blue Shield,PPO,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Fee Schedule,987.79
Blue Shield,PPO,58323,CPT4/HCPCS,SPERM WASHING,,Fee Schedule,987.79
Blue Shield,PPO,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Fee Schedule,4891.93
Blue Shield,PPO,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Fee Schedule,4280.44
Blue Shield,PPO,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Fee Schedule,4891.93
Blue Shield,PPO,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Fee Schedule,6049.05
Blue Shield,PPO,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Fee Schedule,9548.66
Blue Shield,PPO,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,PPO,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,PPO,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Fee Schedule,3198.57
Blue Shield,PPO,58540,CPT4/HCPCS,REVISION OF UTERUS,,Fee Schedule,3198.57
Blue Shield,PPO,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Fee Schedule,6049.05
Blue Shield,PPO,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Fee Schedule,6049.05
Blue Shield,PPO,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Fee Schedule,6049.05
Blue Shield,PPO,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Fee Schedule,6049.05
Blue Shield,PPO,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Fee Schedule,12850.71
Blue Shield,PPO,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Fee Schedule,12850.71
Blue Shield,PPO,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Fee Schedule,12850.71
Blue Shield,PPO,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Fee Schedule,12850.71
Blue Shield,PPO,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Fee Schedule,12850.71
Blue Shield,PPO,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Fee Schedule,12850.71
Blue Shield,PPO,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Fee Schedule,3198.57
Blue Shield,PPO,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Fee Schedule,4891.93
Blue Shield,PPO,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Fee Schedule,4280.44
Blue Shield,PPO,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Fee Schedule,4891.93
Blue Shield,PPO,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Fee Schedule,4891.93
Blue Shield,PPO,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Fee Schedule,4891.93
Blue Shield,PPO,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Fee Schedule,6049.05
Blue Shield,PPO,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Fee Schedule,9548.66
Blue Shield,PPO,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Fee Schedule,6876.92
Blue Shield,PPO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Fee Schedule,6876.92
Blue Shield,PPO,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Fee Schedule,6876.92
Blue Shield,PPO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Fee Schedule,6876.92
Blue Shield,PPO,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,Fee Schedule,6876.92
Blue Shield,PPO,58578,CPT4/HCPCS,LAPARO PROC UTERUS,,Fee Schedule,7902.34
Blue Shield,PPO,58579,CPT4/HCPCS,HYSTEROSCOPE PROCEDURE,,Fee Schedule,4891.93
Blue Shield,PPO,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Fee Schedule,6876.92
Blue Shield,PPO,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Fee Schedule,4891.93
Blue Shield,PPO,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Fee Schedule,6876.92
Blue Shield,PPO,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Fee Schedule,6876.92
Blue Shield,PPO,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Fee Schedule,6876.92
Blue Shield,PPO,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Fee Schedule,4891.93
Blue Shield,PPO,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Fee Schedule,4891.93
Blue Shield,PPO,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Fee Schedule,6876.92
Blue Shield,PPO,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Fee Schedule,6876.92
Blue Shield,PPO,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Fee Schedule,6049.05
Blue Shield,PPO,58679,CPT4/HCPCS,LAPARO PROC OVIDUCT-OVARY,,Fee Schedule,7902.34
Blue Shield,PPO,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Fee Schedule,3198.57
Blue Shield,PPO,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Fee Schedule,3198.57
Blue Shield,PPO,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Fee Schedule,3198.57
Blue Shield,PPO,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Fee Schedule,3198.57
Blue Shield,PPO,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Fee Schedule,3198.57
Blue Shield,PPO,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Fee Schedule,4891.93
Blue Shield,PPO,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Fee Schedule,3198.57
Blue Shield,PPO,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Fee Schedule,4891.93
Blue Shield,PPO,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Fee Schedule,3198.57
Blue Shield,PPO,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Fee Schedule,3198.57
Blue Shield,PPO,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Fee Schedule,4891.93
Blue Shield,PPO,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Fee Schedule,6876.92
Blue Shield,PPO,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Fee Schedule,6876.92
Blue Shield,PPO,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Fee Schedule,3198.57
Blue Shield,PPO,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,Fee Schedule,3198.57
Blue Shield,PPO,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,3198.57
Blue Shield,PPO,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,3198.57
Blue Shield,PPO,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Fee Schedule,4280.44
Blue Shield,PPO,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,Fee Schedule,4891.93
Blue Shield,PPO,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,Fee Schedule,4891.93
Blue Shield,PPO,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Fee Schedule,3198.57
Blue Shield,PPO,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Fee Schedule,4891.93
Blue Shield,PPO,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Fee Schedule,3198.57
Blue Shield,PPO,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Fee Schedule,3198.57
Blue Shield,PPO,58999,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Fee Schedule,3198.57
Blue Shield,PPO,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Fee Schedule,3198.57
Blue Shield,PPO,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,Fee Schedule,3198.57
Blue Shield,PPO,59015,CPT4/HCPCS,CHORION BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,59020,CPT4/HCPCS,FETAL CONTRACT STRESS TEST,,Fee Schedule,987.79
Blue Shield,PPO,59025,CPT4/HCPCS,FETAL NON-STRESS TEST,,Fee Schedule,987.79
Blue Shield,PPO,59030,CPT4/HCPCS,FETAL SCALP BLOOD SAMPLE,,Fee Schedule,3198.57
Blue Shield,PPO,59050,CPT4/HCPCS,FETAL MONITOR W/REPORT,,Fee Schedule,987.79
Blue Shield,PPO,59051,CPT4/HCPCS,FETAL MONITOR/INTERPRET ONLY,,Fee Schedule,987.79
Blue Shield,PPO,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Fee Schedule,3198.57
Blue Shield,PPO,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Fee Schedule,3198.57
Blue Shield,PPO,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Fee Schedule,3198.57
Blue Shield,PPO,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Fee Schedule,3198.57
Blue Shield,PPO,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,Fee Schedule,9548.66
Blue Shield,PPO,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,PPO,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,PPO,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,PPO,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,PPO,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,PPO,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,PPO,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,PPO,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Fee Schedule,9548.66
Blue Shield,PPO,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Fee Schedule,4891.93
Blue Shield,PPO,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Fee Schedule,987.79
Blue Shield,PPO,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Fee Schedule,4280.44
Blue Shield,PPO,59320,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,3198.57
Blue Shield,PPO,59325,CPT4/HCPCS,REVISION OF CERVIX,,Fee Schedule,4280.44
Blue Shield,PPO,59350,CPT4/HCPCS,REPAIR OF UTERUS,,Fee Schedule,4280.44
Blue Shield,PPO,59400,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,PPO,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,PPO,59410,CPT4/HCPCS,OBSTETRICAL CARE,,Fee Schedule,4280.44
Blue Shield,PPO,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,Fee Schedule,987.79
Blue Shield,PPO,59414,CPT4/HCPCS,DELIVER PLACENTA,,Fee Schedule,4280.44
Blue Shield,PPO,59425,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,Fee Schedule,987.79
Blue Shield,PPO,59426,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,Fee Schedule,3198.57
Blue Shield,PPO,59430,CPT4/HCPCS,CARE AFTER DELIVERY,,Fee Schedule,987.79
Blue Shield,PPO,59510,CPT4/HCPCS,CESAREAN DELIVERY,,Fee Schedule,4891.93
Blue Shield,PPO,59514,CPT4/HCPCS,CESAREAN DELIVERY ONLY,,Fee Schedule,4891.93
Blue Shield,PPO,59515,CPT4/HCPCS,CESAREAN DELIVERY,,Fee Schedule,4891.93
Blue Shield,PPO,59525,CPT4/HCPCS,REMOVE UTERUS AFTER CESAREAN,,Fee Schedule,3198.57
Blue Shield,PPO,59610,CPT4/HCPCS,VBAC DELIVERY,,Fee Schedule,4280.44
Blue Shield,PPO,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Fee Schedule,4280.44
Blue Shield,PPO,59614,CPT4/HCPCS,VBAC CARE AFTER DELIVERY,,Fee Schedule,4280.44
Blue Shield,PPO,59618,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY,,Fee Schedule,4891.93
Blue Shield,PPO,59620,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY ONLY,,Fee Schedule,4891.93
Blue Shield,PPO,59622,CPT4/HCPCS,ATTEMPTED VBAC AFTER CARE,,Fee Schedule,4891.93
Blue Shield,PPO,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,PPO,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,PPO,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Fee Schedule,6876.92
Blue Shield,PPO,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Fee Schedule,4280.44
Blue Shield,PPO,59840,CPT4/HCPCS,ABORTION,,Fee Schedule,6876.92
Blue Shield,PPO,59841,CPT4/HCPCS,ABORTION,,Fee Schedule,6876.92
Blue Shield,PPO,59850,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,PPO,59851,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,PPO,59852,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,PPO,59855,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,PPO,59856,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,PPO,59857,CPT4/HCPCS,ABORTION,,Fee Schedule,4891.93
Blue Shield,PPO,59866,CPT4/HCPCS,ABORTION (MPR),,Fee Schedule,3198.57
Blue Shield,PPO,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Fee Schedule,6876.92
Blue Shield,PPO,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Fee Schedule,6876.92
Blue Shield,PPO,59897,CPT4/HCPCS,FETAL INVAS PX W/US,,Fee Schedule,3198.57
Blue Shield,PPO,59898,CPT4/HCPCS,LAPARO PROC OB CARE/DELIVER,,Fee Schedule,7902.34
Blue Shield,PPO,59899,CPT4/HCPCS,MATERNITY CARE PROCEDURE,,Fee Schedule,987.79
Blue Shield,PPO,5A02110,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,PPO,5A02116,ICD10-PCS,Assist with Cardiac Output using Other Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,PPO,5A0211D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Intermittent,,Fee Schedule,8271.00
Blue Shield,PPO,5A02210,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,PPO,5A02216,ICD10-PCS,Assistance with Cardiac Output using Other Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,PPO,5A0221D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Continuous,,Fee Schedule,8271.00
Blue Shield,PPO,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Fee Schedule,3198.57
Blue Shield,PPO,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Fee Schedule,987.79
Blue Shield,PPO,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Fee Schedule,4280.44
Blue Shield,PPO,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Fee Schedule,9548.66
Blue Shield,PPO,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Fee Schedule,9548.66
Blue Shield,PPO,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,PPO,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,PPO,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,PPO,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,9548.66
Blue Shield,PPO,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Fee Schedule,9548.66
Blue Shield,PPO,60270,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,3198.57
Blue Shield,PPO,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Fee Schedule,3198.57
Blue Shield,PPO,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Fee Schedule,6049.05
Blue Shield,PPO,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Fee Schedule,6049.05
Blue Shield,PPO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Fee Schedule,987.79
Blue Shield,PPO,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Fee Schedule,9548.66
Blue Shield,PPO,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Fee Schedule,3198.57
Blue Shield,PPO,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Fee Schedule,3198.57
Blue Shield,PPO,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Fee Schedule,4891.93
Blue Shield,PPO,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,3198.57
Blue Shield,PPO,60521,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,3198.57
Blue Shield,PPO,60522,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Fee Schedule,4280.44
Blue Shield,PPO,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Fee Schedule,3198.57
Blue Shield,PPO,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Fee Schedule,3198.57
Blue Shield,PPO,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Fee Schedule,4280.44
Blue Shield,PPO,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Fee Schedule,4891.93
Blue Shield,PPO,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Fee Schedule,3198.57
Blue Shield,PPO,60659,CPT4/HCPCS,LAPARO PROC ENDOCRINE,,Fee Schedule,7902.34
Blue Shield,PPO,60699,CPT4/HCPCS,ENDOCRINE SURGERY PROCEDURE,,Fee Schedule,9548.66
Blue Shield,PPO,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,PPO,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,PPO,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Fee Schedule,3198.57
Blue Shield,PPO,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Fee Schedule,3198.57
Blue Shield,PPO,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Fee Schedule,3198.57
Blue Shield,PPO,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Fee Schedule,3198.57
Blue Shield,PPO,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,61105,CPT4/HCPCS,TWIST DRILL HOLE,,Fee Schedule,3198.57
Blue Shield,PPO,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,Fee Schedule,3198.57
Blue Shield,PPO,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,PPO,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,Fee Schedule,3198.57
Blue Shield,PPO,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,PPO,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,PPO,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,Fee Schedule,3198.57
Blue Shield,PPO,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Fee Schedule,3198.57
Blue Shield,PPO,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,Fee Schedule,3198.57
Blue Shield,PPO,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Fee Schedule,4891.93
Blue Shield,PPO,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Fee Schedule,3198.57
Blue Shield,PPO,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Fee Schedule,3198.57
Blue Shield,PPO,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Fee Schedule,4280.44
Blue Shield,PPO,61305,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Fee Schedule,4891.93
Blue Shield,PPO,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,PPO,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,PPO,61314,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,PPO,61315,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4891.93
Blue Shield,PPO,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Fee Schedule,3198.57
Blue Shield,PPO,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4280.44
Blue Shield,PPO,61321,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Fee Schedule,4891.93
Blue Shield,PPO,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,Fee Schedule,4280.44
Blue Shield,PPO,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,Fee Schedule,9548.66
Blue Shield,PPO,61332,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,6049.05
Blue Shield,PPO,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,Fee Schedule,3198.57
Blue Shield,PPO,61343,CPT4/HCPCS,INCISE SKULL (PRESS RELIEF),,Fee Schedule,4891.93
Blue Shield,PPO,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,Fee Schedule,4891.93
Blue Shield,PPO,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Fee Schedule,4891.93
Blue Shield,PPO,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,61480,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,Fee Schedule,3198.57
Blue Shield,PPO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4891.93
Blue Shield,PPO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Fee Schedule,6049.05
Blue Shield,PPO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Fee Schedule,4280.44
Blue Shield,PPO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,PPO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,6876.92
Blue Shield,PPO,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Fee Schedule,6876.92
Blue Shield,PPO,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,9548.66
Blue Shield,PPO,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,7902.34
Blue Shield,PPO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Fee Schedule,4891.93
Blue Shield,PPO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4891.93
Blue Shield,PPO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,9548.66
Blue Shield,PPO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,7902.34
Blue Shield,PPO,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,PPO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,PPO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,PPO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,Fee Schedule,3198.57
Blue Shield,PPO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Fee Schedule,6049.05
Blue Shield,PPO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4280.44
Blue Shield,PPO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,PPO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,6049.05
Blue Shield,PPO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,PPO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,PPO,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,PPO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,Fee Schedule,4280.44
Blue Shield,PPO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,Fee Schedule,7902.34
Blue Shield,PPO,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Fee Schedule,6049.05
Blue Shield,PPO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Fee Schedule,4280.44
Blue Shield,PPO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Fee Schedule,3198.57
Blue Shield,PPO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Fee Schedule,3198.57
Blue Shield,PPO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,Fee Schedule,3198.57
Blue Shield,PPO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,Fee Schedule,4280.44
Blue Shield,PPO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Fee Schedule,4280.44
Blue Shield,PPO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Fee Schedule,6049.05
Blue Shield,PPO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Fee Schedule,4891.93
Blue Shield,PPO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Fee Schedule,6049.05
Blue Shield,PPO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Fee Schedule,4891.93
Blue Shield,PPO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Fee Schedule,6049.05
Blue Shield,PPO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,Fee Schedule,4280.44
Blue Shield,PPO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Fee Schedule,4891.93
Blue Shield,PPO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Fee Schedule,7902.34
Blue Shield,PPO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6049.05
Blue Shield,PPO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6876.92
Blue Shield,PPO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,7902.34
Blue Shield,PPO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Fee Schedule,6876.92
Blue Shield,PPO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,PPO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,PPO,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,Fee Schedule,6049.05
Blue Shield,PPO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,PPO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,PPO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Fee Schedule,7902.34
Blue Shield,PPO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,Fee Schedule,6049.05
Blue Shield,PPO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,PPO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,Fee Schedule,6876.92
Blue Shield,PPO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,Fee Schedule,6049.05
Blue Shield,PPO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,4891.93
Blue Shield,PPO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6049.05
Blue Shield,PPO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6876.92
Blue Shield,PPO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,6876.92
Blue Shield,PPO,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Fee Schedule,7902.34
Blue Shield,PPO,61610,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,4280.44
Blue Shield,PPO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,3198.57
Blue Shield,PPO,61612,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Fee Schedule,4280.44
Blue Shield,PPO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,Fee Schedule,7902.34
Blue Shield,PPO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Fee Schedule,6049.05
Blue Shield,PPO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Fee Schedule,7902.34
Blue Shield,PPO,61618,CPT4/HCPCS,REPAIR DURA,,Fee Schedule,3198.57
Blue Shield,PPO,61619,CPT4/HCPCS,REPAIR DURA,,Fee Schedule,4280.44
Blue Shield,PPO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Fee Schedule,7902.34
Blue Shield,PPO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,Fee Schedule,3198.57
Blue Shield,PPO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Fee Schedule,9548.66
Blue Shield,PPO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,Fee Schedule,987.79
Blue Shield,PPO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,Fee Schedule,987.79
Blue Shield,PPO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,PPO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,6876.92
Blue Shield,PPO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,PPO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Fee Schedule,9548.66
Blue Shield,PPO,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Fee Schedule,7902.34
Blue Shield,PPO,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Fee Schedule,7902.34
Blue Shield,PPO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,Fee Schedule,7902.34
Blue Shield,PPO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,Fee Schedule,7902.34
Blue Shield,PPO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,Fee Schedule,3198.57
Blue Shield,PPO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,6049.05
Blue Shield,PPO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,4891.93
Blue Shield,PPO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Fee Schedule,4280.44
Blue Shield,PPO,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,Fee Schedule,6049.05
Blue Shield,PPO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,Fee Schedule,3198.57
Blue Shield,PPO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,Fee Schedule,3198.57
Blue Shield,PPO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Fee Schedule,4280.44
Blue Shield,PPO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,Fee Schedule,4280.44
Blue Shield,PPO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Fee Schedule,4891.93
Blue Shield,PPO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Fee Schedule,4891.93
Blue Shield,PPO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,Case Rate,4361.03
Blue Shield,PPO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,Case Rate,935.23
Blue Shield,PPO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,Case Rate,4361.03
Blue Shield,PPO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,Case Rate,1293.58
Blue Shield,PPO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Case Rate,764.05
Blue Shield,PPO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,PPO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,4280.44
Blue Shield,PPO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Fee Schedule,3198.57
Blue Shield,PPO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Fee Schedule,4280.44
Blue Shield,PPO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Fee Schedule,3198.57
Blue Shield,PPO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,PPO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Fee Schedule,4891.93
Blue Shield,PPO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Fee Schedule,4280.44
Blue Shield,PPO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Fee Schedule,4891.93
Blue Shield,PPO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Fee Schedule,3198.57
Blue Shield,PPO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,Fee Schedule,3198.57
Blue Shield,PPO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,Fee Schedule,3198.57
Blue Shield,PPO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,Fee Schedule,4280.44
Blue Shield,PPO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,PPO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Fee Schedule,4891.93
Blue Shield,PPO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,Fee Schedule,4280.44
Blue Shield,PPO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,Fee Schedule,4280.44
Blue Shield,PPO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,PPO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Fee Schedule,3198.57
Blue Shield,PPO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,Fee Schedule,3198.57
Blue Shield,PPO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,Fee Schedule,3198.57
Blue Shield,PPO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,Fee Schedule,3198.57
Blue Shield,PPO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,Fee Schedule,3198.57
Blue Shield,PPO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,Fee Schedule,3198.57
Blue Shield,PPO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,Fee Schedule,4280.44
Blue Shield,PPO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,Fee Schedule,3198.57
Blue Shield,PPO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,Fee Schedule,4280.44
Blue Shield,PPO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,Fee Schedule,3198.57
Blue Shield,PPO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,4280.44
Blue Shield,PPO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,PPO,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,PPO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Fee Schedule,3198.57
Blue Shield,PPO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,PPO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,Fee Schedule,3198.57
Blue Shield,PPO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,PPO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,PPO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Fee Schedule,3198.57
Blue Shield,PPO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Fee Schedule,4280.44
Blue Shield,PPO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,Fee Schedule,3198.57
Blue Shield,PPO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,PPO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,Fee Schedule,3198.57
Blue Shield,PPO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Fee Schedule,3198.57
Blue Shield,PPO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Fee Schedule,3198.57
Blue Shield,PPO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Fee Schedule,3198.57
Blue Shield,PPO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Fee Schedule,3198.57
Blue Shield,PPO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Fee Schedule,3198.57
Blue Shield,PPO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Fee Schedule,3198.57
Blue Shield,PPO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Fee Schedule,3198.57
Blue Shield,PPO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Fee Schedule,3198.57
Blue Shield,PPO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Fee Schedule,3198.57
Blue Shield,PPO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Fee Schedule,3198.57
Blue Shield,PPO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Fee Schedule,12850.71
Blue Shield,PPO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Fee Schedule,3198.57
Blue Shield,PPO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Fee Schedule,4891.93
Blue Shield,PPO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,PPO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,PPO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,PPO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Fee Schedule,3198.57
Blue Shield,PPO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,PPO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,PPO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,PPO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,PPO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,PPO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Fee Schedule,3198.57
Blue Shield,PPO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,PPO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Fee Schedule,3198.57
Blue Shield,PPO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Fee Schedule,4280.44
Blue Shield,PPO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Fee Schedule,9548.66
Blue Shield,PPO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Fee Schedule,4280.44
Blue Shield,PPO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Fee Schedule,4280.44
Blue Shield,PPO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,PPO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Fee Schedule,4280.44
Blue Shield,PPO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Fee Schedule,4280.44
Blue Shield,PPO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Fee Schedule,3198.57
Blue Shield,PPO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Fee Schedule,3198.57
Blue Shield,PPO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,Fee Schedule,987.79
Blue Shield,PPO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Fee Schedule,987.79
Blue Shield,PPO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Fee Schedule,9548.66
Blue Shield,PPO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Fee Schedule,9548.66
Blue Shield,PPO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Fee Schedule,9548.66
Blue Shield,PPO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Fee Schedule,9548.66
Blue Shield,PPO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Fee Schedule,9548.66
Blue Shield,PPO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Fee Schedule,9548.66
Blue Shield,PPO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Fee Schedule,9548.66
Blue Shield,PPO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Fee Schedule,9548.66
Blue Shield,PPO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Fee Schedule,9548.66
Blue Shield,PPO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,9548.66
Blue Shield,PPO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Fee Schedule,9548.66
Blue Shield,PPO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Fee Schedule,9548.66
Blue Shield,PPO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Fee Schedule,9548.66
Blue Shield,PPO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Fee Schedule,9548.66
Blue Shield,PPO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Fee Schedule,3198.57
Blue Shield,PPO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Fee Schedule,3198.57
Blue Shield,PPO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Fee Schedule,9548.66
Blue Shield,PPO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Fee Schedule,9548.66
Blue Shield,PPO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Fee Schedule,9548.66
Blue Shield,PPO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Fee Schedule,9548.66
Blue Shield,PPO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Fee Schedule,9548.66
Blue Shield,PPO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Fee Schedule,9548.66
Blue Shield,PPO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Fee Schedule,9548.66
Blue Shield,PPO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Fee Schedule,9548.66
Blue Shield,PPO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Fee Schedule,9548.66
Blue Shield,PPO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Fee Schedule,4891.93
Blue Shield,PPO,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Fee Schedule,3198.57
Blue Shield,PPO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,Fee Schedule,4891.93
Blue Shield,PPO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Fee Schedule,4891.93
Blue Shield,PPO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,Fee Schedule,6876.92
Blue Shield,PPO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Fee Schedule,4891.93
Blue Shield,PPO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Fee Schedule,4891.93
Blue Shield,PPO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Fee Schedule,4891.93
Blue Shield,PPO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,Fee Schedule,4280.44
Blue Shield,PPO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Fee Schedule,4280.44
Blue Shield,PPO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Fee Schedule,4891.93
Blue Shield,PPO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,PPO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Fee Schedule,4280.44
Blue Shield,PPO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,Fee Schedule,3198.57
Blue Shield,PPO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,Fee Schedule,3198.57
Blue Shield,PPO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,Fee Schedule,4280.44
Blue Shield,PPO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,Fee Schedule,4280.44
Blue Shield,PPO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,Fee Schedule,4280.44
Blue Shield,PPO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,Fee Schedule,4280.44
Blue Shield,PPO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,Fee Schedule,4280.44
Blue Shield,PPO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,Fee Schedule,4891.93
Blue Shield,PPO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,Fee Schedule,4280.44
Blue Shield,PPO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,Fee Schedule,6876.92
Blue Shield,PPO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,Fee Schedule,6876.92
Blue Shield,PPO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,Fee Schedule,6876.92
Blue Shield,PPO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Fee Schedule,4280.44
Blue Shield,PPO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Fee Schedule,4280.44
Blue Shield,PPO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Fee Schedule,3198.57
Blue Shield,PPO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Fee Schedule,3198.57
Blue Shield,PPO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,Fee Schedule,4891.93
Blue Shield,PPO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Fee Schedule,4891.93
Blue Shield,PPO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Fee Schedule,4891.93
Blue Shield,PPO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Fee Schedule,4280.44
Blue Shield,PPO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,Fee Schedule,4280.44
Blue Shield,PPO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,Fee Schedule,4280.44
Blue Shield,PPO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,Fee Schedule,4280.44
Blue Shield,PPO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,Fee Schedule,4280.44
Blue Shield,PPO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,Fee Schedule,4891.93
Blue Shield,PPO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,Fee Schedule,4891.93
Blue Shield,PPO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,Fee Schedule,4891.93
Blue Shield,PPO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,Fee Schedule,4280.44
Blue Shield,PPO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,Fee Schedule,6049.05
Blue Shield,PPO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,Fee Schedule,6049.05
Blue Shield,PPO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,Fee Schedule,6049.05
Blue Shield,PPO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,Fee Schedule,6876.92
Blue Shield,PPO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,Fee Schedule,4280.44
Blue Shield,PPO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,Fee Schedule,4891.93
Blue Shield,PPO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,Fee Schedule,4891.93
Blue Shield,PPO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,Fee Schedule,4891.93
Blue Shield,PPO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,Fee Schedule,4891.93
Blue Shield,PPO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,Fee Schedule,6049.05
Blue Shield,PPO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,Fee Schedule,6049.05
Blue Shield,PPO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,Fee Schedule,4891.93
Blue Shield,PPO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Fee Schedule,4280.44
Blue Shield,PPO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Fee Schedule,3198.57
Blue Shield,PPO,63615,CPT4/HCPCS,REMOVE LESION OF SPINAL CORD,,Fee Schedule,4280.44
Blue Shield,PPO,63620,CPT4/HCPCS,SRS SPINAL LESION,,Case Rate,4361.03
Blue Shield,PPO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,Case Rate,1075.84
Blue Shield,PPO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,4280.44
Blue Shield,PPO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,PPO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Fee Schedule,4280.44
Blue Shield,PPO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Fee Schedule,4280.44
Blue Shield,PPO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Fee Schedule,4280.44
Blue Shield,PPO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Fee Schedule,4280.44
Blue Shield,PPO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Fee Schedule,4280.44
Blue Shield,PPO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Fee Schedule,3198.57
Blue Shield,PPO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,3198.57
Blue Shield,PPO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,3198.57
Blue Shield,PPO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,4280.44
Blue Shield,PPO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Fee Schedule,4280.44
Blue Shield,PPO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Fee Schedule,3198.57
Blue Shield,PPO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Fee Schedule,3198.57
Blue Shield,PPO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,Fee Schedule,3198.57
Blue Shield,PPO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Fee Schedule,3198.57
Blue Shield,PPO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Fee Schedule,12850.71
Blue Shield,PPO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Fee Schedule,4891.93
Blue Shield,PPO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Fee Schedule,4280.44
Blue Shield,PPO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Fee Schedule,3198.57
Blue Shield,PPO,64402,CPT4/HCPCS,N BLOCK INJ FACIAL,,Fee Schedule,3198.57
Blue Shield,PPO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Fee Schedule,987.79
Blue Shield,PPO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Fee Schedule,3198.57
Blue Shield,PPO,64410,CPT4/HCPCS,N BLOCK INJ PHRENIC,,Fee Schedule,3198.57
Blue Shield,PPO,64413,CPT4/HCPCS,N BLOCK INJ CERVICAL PLEXUS,,Fee Schedule,3198.57
Blue Shield,PPO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Fee Schedule,3198.57
Blue Shield,PPO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Fee Schedule,3198.57
Blue Shield,PPO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Fee Schedule,3198.57
Blue Shield,PPO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Fee Schedule,3198.57
Blue Shield,PPO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Fee Schedule,3198.57
Blue Shield,PPO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Fee Schedule,3198.57
Blue Shield,PPO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Fee Schedule,3198.57
Blue Shield,PPO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Fee Schedule,3198.57
Blue Shield,PPO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Fee Schedule,987.79
Blue Shield,PPO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,Fee Schedule,3198.57
Blue Shield,PPO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,Fee Schedule,3198.57
Blue Shield,PPO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Fee Schedule,3198.57
Blue Shield,PPO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Fee Schedule,3198.57
Blue Shield,PPO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Fee Schedule,3198.57
Blue Shield,PPO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Fee Schedule,3198.57
Blue Shield,PPO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Fee Schedule,3198.57
Blue Shield,PPO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Fee Schedule,3198.57
Blue Shield,PPO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Fee Schedule,3198.57
Blue Shield,PPO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Fee Schedule,3198.57
Blue Shield,PPO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Fee Schedule,3198.57
Blue Shield,PPO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Fee Schedule,3198.57
Blue Shield,PPO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Fee Schedule,3198.57
Blue Shield,PPO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Fee Schedule,3198.57
Blue Shield,PPO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Fee Schedule,3198.57
Blue Shield,PPO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Fee Schedule,3198.57
Blue Shield,PPO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Fee Schedule,3198.57
Blue Shield,PPO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Fee Schedule,3198.57
Blue Shield,PPO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Fee Schedule,3198.57
Blue Shield,PPO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Fee Schedule,3198.57
Blue Shield,PPO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Fee Schedule,3198.57
Blue Shield,PPO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Fee Schedule,3198.57
Blue Shield,PPO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Fee Schedule,3198.57
Blue Shield,PPO,64508,CPT4/HCPCS,N BLOCK CAROTID SINUS S/P,,Fee Schedule,3198.57
Blue Shield,PPO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Fee Schedule,3198.57
Blue Shield,PPO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Fee Schedule,3198.57
Blue Shield,PPO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Fee Schedule,3198.57
Blue Shield,PPO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Fee Schedule,3198.57
Blue Shield,PPO,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,Fee Schedule,987.79
Blue Shield,PPO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,PPO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,PPO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,PPO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Fee Schedule,987.79
Blue Shield,PPO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Fee Schedule,4280.44
Blue Shield,PPO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Fee Schedule,4280.44
Blue Shield,PPO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Fee Schedule,4280.44
Blue Shield,PPO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,PPO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,3198.57
Blue Shield,PPO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Fee Schedule,12850.71
Blue Shield,PPO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Fee Schedule,3198.57
Blue Shield,PPO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Fee Schedule,4280.44
Blue Shield,PPO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Fee Schedule,3198.57
Blue Shield,PPO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Fee Schedule,987.79
Blue Shield,PPO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Fee Schedule,3198.57
Blue Shield,PPO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Fee Schedule,3198.57
Blue Shield,PPO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Fee Schedule,987.79
Blue Shield,PPO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Fee Schedule,987.79
Blue Shield,PPO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Fee Schedule,3198.57
Blue Shield,PPO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Fee Schedule,4891.93
Blue Shield,PPO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Fee Schedule,4891.93
Blue Shield,PPO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Fee Schedule,3198.57
Blue Shield,PPO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Fee Schedule,3198.57
Blue Shield,PPO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Fee Schedule,3198.57
Blue Shield,PPO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Fee Schedule,3198.57
Blue Shield,PPO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Fee Schedule,987.79
Blue Shield,PPO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Fee Schedule,987.79
Blue Shield,PPO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Fee Schedule,4280.44
Blue Shield,PPO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Fee Schedule,4280.44
Blue Shield,PPO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Fee Schedule,4891.93
Blue Shield,PPO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Fee Schedule,4280.44
Blue Shield,PPO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Fee Schedule,4280.44
Blue Shield,PPO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Fee Schedule,3198.57
Blue Shield,PPO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Fee Schedule,3198.57
Blue Shield,PPO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Fee Schedule,4280.44
Blue Shield,PPO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,Fee Schedule,4280.44
Blue Shield,PPO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Fee Schedule,4280.44
Blue Shield,PPO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Fee Schedule,4280.44
Blue Shield,PPO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,64787,CPT4/HCPCS,IMPLANT NERVE END,,Fee Schedule,4280.44
Blue Shield,PPO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Fee Schedule,4280.44
Blue Shield,PPO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,PPO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,PPO,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,4280.44
Blue Shield,PPO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,Fee Schedule,4280.44
Blue Shield,PPO,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,6049.05
Blue Shield,PPO,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Fee Schedule,6049.05
Blue Shield,PPO,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,Fee Schedule,6049.05
Blue Shield,PPO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Fee Schedule,6049.05
Blue Shield,PPO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4891.93
Blue Shield,PPO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Fee Schedule,4891.93
Blue Shield,PPO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64859,CPT4/HCPCS,NERVE SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Fee Schedule,4891.93
Blue Shield,PPO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Fee Schedule,4891.93
Blue Shield,PPO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Fee Schedule,4891.93
Blue Shield,PPO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Fee Schedule,6049.05
Blue Shield,PPO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Fee Schedule,3198.57
Blue Shield,PPO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Fee Schedule,4280.44
Blue Shield,PPO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Fee Schedule,4891.93
Blue Shield,PPO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Fee Schedule,4891.93
Blue Shield,PPO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Fee Schedule,4280.44
Blue Shield,PPO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Fee Schedule,4891.93
Blue Shield,PPO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Fee Schedule,4891.93
Blue Shield,PPO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Fee Schedule,4891.93
Blue Shield,PPO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Fee Schedule,4891.93
Blue Shield,PPO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,PPO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Fee Schedule,4280.44
Blue Shield,PPO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Fee Schedule,4280.44
Blue Shield,PPO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Fee Schedule,3198.57
Blue Shield,PPO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Fee Schedule,6049.05
Blue Shield,PPO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Fee Schedule,6049.05
Blue Shield,PPO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Fee Schedule,6049.05
Blue Shield,PPO,64999,CPT4/HCPCS,NERVOUS SYSTEM SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,65091,CPT4/HCPCS,REVISE EYE,,Fee Schedule,4891.93
Blue Shield,PPO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Fee Schedule,4891.93
Blue Shield,PPO,65101,CPT4/HCPCS,REMOVAL OF EYE,,Fee Schedule,4891.93
Blue Shield,PPO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Fee Schedule,4891.93
Blue Shield,PPO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Fee Schedule,6049.05
Blue Shield,PPO,65110,CPT4/HCPCS,REMOVAL OF EYE,,Fee Schedule,6876.92
Blue Shield,PPO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Fee Schedule,9548.66
Blue Shield,PPO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Fee Schedule,9548.66
Blue Shield,PPO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,PPO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,PPO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,PPO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,PPO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Fee Schedule,4280.44
Blue Shield,PPO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Fee Schedule,4891.93
Blue Shield,PPO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Fee Schedule,3198.57
Blue Shield,PPO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,PPO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,PPO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,PPO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,987.79
Blue Shield,PPO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,4280.44
Blue Shield,PPO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,4891.93
Blue Shield,PPO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Fee Schedule,6049.05
Blue Shield,PPO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,4280.44
Blue Shield,PPO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,4280.44
Blue Shield,PPO,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,PPO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,PPO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,6049.05
Blue Shield,PPO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Fee Schedule,3198.57
Blue Shield,PPO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Fee Schedule,4891.93
Blue Shield,PPO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,3198.57
Blue Shield,PPO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Fee Schedule,4280.44
Blue Shield,PPO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,4280.44
Blue Shield,PPO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Fee Schedule,6876.92
Blue Shield,PPO,65430,CPT4/HCPCS,CORNEAL SMEAR,,Fee Schedule,987.79
Blue Shield,PPO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Fee Schedule,3198.57
Blue Shield,PPO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Fee Schedule,3198.57
Blue Shield,PPO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,65600,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,4280.44
Blue Shield,PPO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Fee Schedule,7902.34
Blue Shield,PPO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,65760,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,9548.66
Blue Shield,PPO,65765,CPT4/HCPCS,REVISION OF CORNEA,,Fee Schedule,9548.66
Blue Shield,PPO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Fee Schedule,9548.66
Blue Shield,PPO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Fee Schedule,6049.05
Blue Shield,PPO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Fee Schedule,6049.05
Blue Shield,PPO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Fee Schedule,987.79
Blue Shield,PPO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Fee Schedule,987.79
Blue Shield,PPO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Fee Schedule,9548.66
Blue Shield,PPO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Fee Schedule,9548.66
Blue Shield,PPO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,3198.57
Blue Shield,PPO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,4891.93
Blue Shield,PPO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Fee Schedule,4280.44
Blue Shield,PPO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Fee Schedule,3198.57
Blue Shield,PPO,65850,CPT4/HCPCS,INCISION OF EYE,,Fee Schedule,6049.05
Blue Shield,PPO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Fee Schedule,3198.57
Blue Shield,PPO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,PPO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,PPO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Fee Schedule,6049.05
Blue Shield,PPO,65900,CPT4/HCPCS,REMOVE EYE LESION,,Fee Schedule,6876.92
Blue Shield,PPO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Fee Schedule,9548.66
Blue Shield,PPO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Fee Schedule,6876.92
Blue Shield,PPO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Fee Schedule,3198.57
Blue Shield,PPO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Fee Schedule,3198.57
Blue Shield,PPO,66130,CPT4/HCPCS,REMOVE EYE LESION,,Fee Schedule,9548.66
Blue Shield,PPO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,66172,CPT4/HCPCS,INCISION OF EYE,,Fee Schedule,6049.05
Blue Shield,PPO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Fee Schedule,4280.44
Blue Shield,PPO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Fee Schedule,4280.44
Blue Shield,PPO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Fee Schedule,4280.44
Blue Shield,PPO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Fee Schedule,6876.92
Blue Shield,PPO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Fee Schedule,4280.44
Blue Shield,PPO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Fee Schedule,4280.44
Blue Shield,PPO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Fee Schedule,4280.44
Blue Shield,PPO,66220,CPT4/HCPCS,REPAIR EYE LESION,,Fee Schedule,4891.93
Blue Shield,PPO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Fee Schedule,6049.05
Blue Shield,PPO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Fee Schedule,4280.44
Blue Shield,PPO,66500,CPT4/HCPCS,INCISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,PPO,66505,CPT4/HCPCS,INCISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,PPO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Fee Schedule,4891.93
Blue Shield,PPO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,PPO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,PPO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,PPO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Fee Schedule,4891.93
Blue Shield,PPO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Fee Schedule,4891.93
Blue Shield,PPO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,PPO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,PPO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Fee Schedule,4280.44
Blue Shield,PPO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Fee Schedule,4280.44
Blue Shield,PPO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,PPO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Fee Schedule,4280.44
Blue Shield,PPO,66761,CPT4/HCPCS,REVISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,PPO,66762,CPT4/HCPCS,REVISION OF IRIS,,Fee Schedule,3198.57
Blue Shield,PPO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Fee Schedule,3198.57
Blue Shield,PPO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Fee Schedule,3198.57
Blue Shield,PPO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Fee Schedule,4280.44
Blue Shield,PPO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Fee Schedule,6049.05
Blue Shield,PPO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Fee Schedule,6049.05
Blue Shield,PPO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,6049.05
Blue Shield,PPO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,9548.66
Blue Shield,PPO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Fee Schedule,6049.05
Blue Shield,PPO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6049.05
Blue Shield,PPO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6876.92
Blue Shield,PPO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Fee Schedule,6876.92
Blue Shield,PPO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Fee Schedule,9304.07
Blue Shield,PPO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Fee Schedule,9304.07
Blue Shield,PPO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Fee Schedule,9304.07
Blue Shield,PPO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Fee Schedule,7902.34
Blue Shield,PPO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Fee Schedule,7902.34
Blue Shield,PPO,66999,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Fee Schedule,6049.05
Blue Shield,PPO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Fee Schedule,6049.05
Blue Shield,PPO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Fee Schedule,3198.57
Blue Shield,PPO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Fee Schedule,3198.57
Blue Shield,PPO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Fee Schedule,6049.05
Blue Shield,PPO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Fee Schedule,3198.57
Blue Shield,PPO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Fee Schedule,3198.57
Blue Shield,PPO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Fee Schedule,4280.44
Blue Shield,PPO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Fee Schedule,6049.05
Blue Shield,PPO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Fee Schedule,9548.66
Blue Shield,PPO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Fee Schedule,9548.66
Blue Shield,PPO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Fee Schedule,4891.93
Blue Shield,PPO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Fee Schedule,4891.93
Blue Shield,PPO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Fee Schedule,4891.93
Blue Shield,PPO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Fee Schedule,3198.57
Blue Shield,PPO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Fee Schedule,3198.57
Blue Shield,PPO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,6876.92
Blue Shield,PPO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,9548.66
Blue Shield,PPO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,Fee Schedule,4891.93
Blue Shield,PPO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Fee Schedule,9548.66
Blue Shield,PPO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Fee Schedule,4280.44
Blue Shield,PPO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Fee Schedule,4280.44
Blue Shield,PPO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Fee Schedule,4280.44
Blue Shield,PPO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Fee Schedule,4280.44
Blue Shield,PPO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Fee Schedule,3198.57
Blue Shield,PPO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,3198.57
Blue Shield,PPO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Fee Schedule,6876.92
Blue Shield,PPO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Fee Schedule,3198.57
Blue Shield,PPO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Fee Schedule,3198.57
Blue Shield,PPO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Fee Schedule,3198.57
Blue Shield,PPO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Fee Schedule,3198.57
Blue Shield,PPO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Fee Schedule,3198.57
Blue Shield,PPO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Fee Schedule,7902.34
Blue Shield,PPO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Fee Schedule,4891.93
Blue Shield,PPO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Fee Schedule,4891.93
Blue Shield,PPO,67299,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Fee Schedule,4891.93
Blue Shield,PPO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Fee Schedule,6049.05
Blue Shield,PPO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Fee Schedule,6049.05
Blue Shield,PPO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Fee Schedule,6049.05
Blue Shield,PPO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Fee Schedule,6049.05
Blue Shield,PPO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Fee Schedule,6049.05
Blue Shield,PPO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Fee Schedule,6049.05
Blue Shield,PPO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Fee Schedule,6049.05
Blue Shield,PPO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Fee Schedule,6049.05
Blue Shield,PPO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Fee Schedule,6049.05
Blue Shield,PPO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Fee Schedule,6049.05
Blue Shield,PPO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Fee Schedule,6049.05
Blue Shield,PPO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Fee Schedule,3198.57
Blue Shield,PPO,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,Fee Schedule,3198.57
Blue Shield,PPO,67399,CPT4/HCPCS,UNLISTED PX EXTRAOCULAR MUSC,,Fee Schedule,6049.05
Blue Shield,PPO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,4891.93
Blue Shield,PPO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Fee Schedule,6049.05
Blue Shield,PPO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,PPO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,PPO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Fee Schedule,7902.34
Blue Shield,PPO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Fee Schedule,3198.57
Blue Shield,PPO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,PPO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,PPO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,PPO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Fee Schedule,7902.34
Blue Shield,PPO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Fee Schedule,6876.92
Blue Shield,PPO,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,PPO,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,PPO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Fee Schedule,987.79
Blue Shield,PPO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Fee Schedule,6049.05
Blue Shield,PPO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Fee Schedule,4280.44
Blue Shield,PPO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Fee Schedule,7902.34
Blue Shield,PPO,67599,CPT4/HCPCS,ORBIT SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Fee Schedule,987.79
Blue Shield,PPO,67710,CPT4/HCPCS,INCISION OF EYELID,,Fee Schedule,3198.57
Blue Shield,PPO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Fee Schedule,3198.57
Blue Shield,PPO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Fee Schedule,987.79
Blue Shield,PPO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Fee Schedule,3198.57
Blue Shield,PPO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Fee Schedule,987.79
Blue Shield,PPO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Fee Schedule,4280.44
Blue Shield,PPO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Fee Schedule,987.79
Blue Shield,PPO,67820,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,3198.57
Blue Shield,PPO,67825,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,3198.57
Blue Shield,PPO,67830,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,4280.44
Blue Shield,PPO,67835,CPT4/HCPCS,REVISE EYELASHES,,Fee Schedule,4280.44
Blue Shield,PPO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Fee Schedule,3198.57
Blue Shield,PPO,67850,CPT4/HCPCS,TREAT EYELID LESION,,Fee Schedule,3198.57
Blue Shield,PPO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Fee Schedule,3198.57
Blue Shield,PPO,67880,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,67882,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Fee Schedule,6049.05
Blue Shield,PPO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,PPO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,PPO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,PPO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,PPO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6876.92
Blue Shield,PPO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,PPO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,PPO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,PPO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Fee Schedule,3198.57
Blue Shield,PPO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,PPO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,3198.57
Blue Shield,PPO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,PPO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,PPO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4891.93
Blue Shield,PPO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,4280.44
Blue Shield,PPO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,PPO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Fee Schedule,6049.05
Blue Shield,PPO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Fee Schedule,4280.44
Blue Shield,PPO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Fee Schedule,4280.44
Blue Shield,PPO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Fee Schedule,3198.57
Blue Shield,PPO,67950,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4280.44
Blue Shield,PPO,67961,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,67966,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Fee Schedule,4891.93
Blue Shield,PPO,67999,CPT4/HCPCS,REVISION OF EYELID,,Fee Schedule,4280.44
Blue Shield,PPO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Fee Schedule,4280.44
Blue Shield,PPO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,Fee Schedule,987.79
Blue Shield,PPO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Fee Schedule,3198.57
Blue Shield,PPO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,3198.57
Blue Shield,PPO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,4280.44
Blue Shield,PPO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,4280.44
Blue Shield,PPO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Fee Schedule,3198.57
Blue Shield,PPO,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,Fee Schedule,987.79
Blue Shield,PPO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,PPO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,PPO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,PPO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,PPO,68330,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,6049.05
Blue Shield,PPO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Fee Schedule,6049.05
Blue Shield,PPO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Fee Schedule,6049.05
Blue Shield,PPO,68360,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,4280.44
Blue Shield,PPO,68362,CPT4/HCPCS,REVISE EYELID LINING,,Fee Schedule,4280.44
Blue Shield,PPO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Fee Schedule,3198.57
Blue Shield,PPO,68399,CPT4/HCPCS,EYELID LINING SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Fee Schedule,987.79
Blue Shield,PPO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Fee Schedule,4280.44
Blue Shield,PPO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Fee Schedule,4891.93
Blue Shield,PPO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Fee Schedule,4891.93
Blue Shield,PPO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Fee Schedule,3198.57
Blue Shield,PPO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Fee Schedule,4891.93
Blue Shield,PPO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Fee Schedule,3198.57
Blue Shield,PPO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Fee Schedule,4280.44
Blue Shield,PPO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Fee Schedule,4891.93
Blue Shield,PPO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Fee Schedule,4891.93
Blue Shield,PPO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Fee Schedule,4280.44
Blue Shield,PPO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Fee Schedule,6049.05
Blue Shield,PPO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Fee Schedule,6049.05
Blue Shield,PPO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Fee Schedule,6049.05
Blue Shield,PPO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Fee Schedule,987.79
Blue Shield,PPO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Fee Schedule,6049.05
Blue Shield,PPO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,3198.57
Blue Shield,PPO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,4280.44
Blue Shield,PPO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Fee Schedule,4280.44
Blue Shield,PPO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Fee Schedule,3198.57
Blue Shield,PPO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Fee Schedule,3198.57
Blue Shield,PPO,68899,CPT4/HCPCS,TEAR DUCT SYSTEM SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Fee Schedule,987.79
Blue Shield,PPO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Fee Schedule,3198.57
Blue Shield,PPO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Fee Schedule,987.79
Blue Shield,PPO,69090,CPT4/HCPCS,PIERCE EARLOBES,,Fee Schedule,987.79
Blue Shield,PPO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,Fee Schedule,3198.57
Blue Shield,PPO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,Fee Schedule,4280.44
Blue Shield,PPO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Fee Schedule,3198.57
Blue Shield,PPO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Fee Schedule,4280.44
Blue Shield,PPO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,PPO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Fee Schedule,4280.44
Blue Shield,PPO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,Fee Schedule,4891.93
Blue Shield,PPO,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Fee Schedule,987.79
Blue Shield,PPO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Fee Schedule,3198.57
Blue Shield,PPO,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Fee Schedule,987.79
Blue Shield,PPO,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Fee Schedule,987.79
Blue Shield,PPO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Fee Schedule,987.79
Blue Shield,PPO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Fee Schedule,4280.44
Blue Shield,PPO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Fee Schedule,4891.93
Blue Shield,PPO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Fee Schedule,4891.93
Blue Shield,PPO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Fee Schedule,9548.66
Blue Shield,PPO,69399,CPT4/HCPCS,OUTER EAR SURGERY PROCEDURE,,Fee Schedule,3198.57
Blue Shield,PPO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Fee Schedule,3198.57
Blue Shield,PPO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Fee Schedule,4891.93
Blue Shield,PPO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Fee Schedule,3198.57
Blue Shield,PPO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Fee Schedule,3198.57
Blue Shield,PPO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Fee Schedule,4891.93
Blue Shield,PPO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Fee Schedule,4891.93
Blue Shield,PPO,69450,CPT4/HCPCS,EARDRUM REVISION,,Fee Schedule,3198.57
Blue Shield,PPO,69501,CPT4/HCPCS,MASTOIDECTOMY,,Fee Schedule,9548.66
Blue Shield,PPO,69502,CPT4/HCPCS,MASTOIDECTOMY,,Fee Schedule,9548.66
Blue Shield,PPO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Fee Schedule,9548.66
Blue Shield,PPO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Fee Schedule,9548.66
Blue Shield,PPO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Fee Schedule,9548.66
Blue Shield,PPO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,Fee Schedule,7902.34
Blue Shield,PPO,69540,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,4280.44
Blue Shield,PPO,69550,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,6876.92
Blue Shield,PPO,69552,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,9548.66
Blue Shield,PPO,69554,CPT4/HCPCS,REMOVE EAR LESION,,Fee Schedule,6876.92
Blue Shield,PPO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,PPO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,PPO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,PPO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,PPO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Fee Schedule,9548.66
Blue Shield,PPO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Fee Schedule,6049.05
Blue Shield,PPO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Fee Schedule,4280.44
Blue Shield,PPO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,PPO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,PPO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,6876.92
Blue Shield,PPO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,PPO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,PPO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Fee Schedule,9548.66
Blue Shield,PPO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,PPO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,PPO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,PPO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,PPO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,PPO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,PPO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Fee Schedule,9548.66
Blue Shield,PPO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,PPO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,PPO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Fee Schedule,6876.92
Blue Shield,PPO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Fee Schedule,6049.05
Blue Shield,PPO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Fee Schedule,6049.05
Blue Shield,PPO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Fee Schedule,4891.93
Blue Shield,PPO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Fee Schedule,4891.93
Blue Shield,PPO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Fee Schedule,4891.93
Blue Shield,PPO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Fee Schedule,6049.05
Blue Shield,PPO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Fee Schedule,3198.57
Blue Shield,PPO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Fee Schedule,12850.71
Blue Shield,PPO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Fee Schedule,12850.71
Blue Shield,PPO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Fee Schedule,12850.71
Blue Shield,PPO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Fee Schedule,12850.71
Blue Shield,PPO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,PPO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,PPO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,PPO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Fee Schedule,6876.92
Blue Shield,PPO,69799,CPT4/HCPCS,MIDDLE EAR SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,PPO,69801,CPT4/HCPCS,INCISE INNER EAR,,Fee Schedule,6876.92
Blue Shield,PPO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Fee Schedule,9548.66
Blue Shield,PPO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Fee Schedule,9548.66
Blue Shield,PPO,69905,CPT4/HCPCS,REMOVE INNER EAR,,Fee Schedule,9548.66
Blue Shield,PPO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Fee Schedule,9548.66
Blue Shield,PPO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Fee Schedule,9548.66
Blue Shield,PPO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Fee Schedule,9548.66
Blue Shield,PPO,69949,CPT4/HCPCS,INNER EAR SURGERY PROCEDURE,,Fee Schedule,4280.44
Blue Shield,PPO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,Fee Schedule,9548.66
Blue Shield,PPO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Fee Schedule,9548.66
Blue Shield,PPO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,Fee Schedule,9548.66
Blue Shield,PPO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Fee Schedule,9548.66
Blue Shield,PPO,69979,CPT4/HCPCS,TEMPORAL BONE SURGERY,,Fee Schedule,3198.57
Blue Shield,PPO,70010,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Case Rate,2177.00
Blue Shield,PPO,70015,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Case Rate,686.66
Blue Shield,PPO,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,Case Rate,205.35
Blue Shield,PPO,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,Case Rate,258.27
Blue Shield,PPO,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,Case Rate,314.46
Blue Shield,PPO,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Case Rate,314.46
Blue Shield,PPO,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Case Rate,400.29
Blue Shield,PPO,70134,CPT4/HCPCS,X-RAY EXAM OF MIDDLE EAR,,Case Rate,376.23
Blue Shield,PPO,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Case Rate,314.46
Blue Shield,PPO,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Case Rate,400.29
Blue Shield,PPO,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,Case Rate,258.27
Blue Shield,PPO,70170,CPT4/HCPCS,X-RAY EXAM OF TEAR DUCT,,Case Rate,481.31
Blue Shield,PPO,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Case Rate,314.46
Blue Shield,PPO,70200,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Case Rate,400.29
Blue Shield,PPO,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Case Rate,314.46
Blue Shield,PPO,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Case Rate,400.29
Blue Shield,PPO,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,Case Rate,205.35
Blue Shield,PPO,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Case Rate,314.46
Blue Shield,PPO,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Case Rate,452.44
Blue Shield,PPO,70300,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Case Rate,137.98
Blue Shield,PPO,70310,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Case Rate,205.35
Blue Shield,PPO,70320,CPT4/HCPCS,FULL MOUTH X-RAY OF TEETH,,Case Rate,400.29
Blue Shield,PPO,70328,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Case Rate,243.84
Blue Shield,PPO,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,Case Rate,429.16
Blue Shield,PPO,70332,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Case Rate,1058.85
Blue Shield,PPO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,Case Rate,5646.30
Blue Shield,PPO,70350,CPT4/HCPCS,X-RAY HEAD FOR ORTHODONTIA,,Case Rate,186.10
Blue Shield,PPO,70355,CPT4/HCPCS,PANORAMIC X-RAY OF JAWS,,Case Rate,290.40
Blue Shield,PPO,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,Case Rate,205.35
Blue Shield,PPO,70370,CPT4/HCPCS,THROAT X-RAY & FLUOROSCOPY,,Case Rate,658.56
Blue Shield,PPO,70371,CPT4/HCPCS,SPEECH EVALUATION COMPLEX,,Case Rate,1058.85
Blue Shield,PPO,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,Case Rate,338.52
Blue Shield,PPO,70390,CPT4/HCPCS,X-RAY EXAM OF SALIVARY DUCT,,Case Rate,905.66
Blue Shield,PPO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,Case Rate,2381.57
Blue Shield,PPO,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,Case Rate,2849.22
Blue Shield,PPO,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,Case Rate,3565.53
Blue Shield,PPO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,Case Rate,2381.57
Blue Shield,PPO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,Case Rate,2849.22
Blue Shield,PPO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,Case Rate,3565.53
Blue Shield,PPO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,Case Rate,2381.57
Blue Shield,PPO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,Case Rate,2849.22
Blue Shield,PPO,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,Case Rate,3565.53
Blue Shield,PPO,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,Case Rate,2381.57
Blue Shield,PPO,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,Case Rate,2849.22
Blue Shield,PPO,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,Case Rate,3565.53
Blue Shield,PPO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,Case Rate,5358.37
Blue Shield,PPO,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,Case Rate,5358.37
Blue Shield,PPO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,Case Rate,5565.61
Blue Shield,PPO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,Case Rate,6680.50
Blue Shield,PPO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,Case Rate,12358.33
Blue Shield,PPO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,Case Rate,5646.30
Blue Shield,PPO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,Case Rate,5646.30
Blue Shield,PPO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,Case Rate,11059.38
Blue Shield,PPO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,Case Rate,5646.30
Blue Shield,PPO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,Case Rate,5646.30
Blue Shield,PPO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,Case Rate,11059.38
Blue Shield,PPO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,Case Rate,5646.30
Blue Shield,PPO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,Case Rate,6773.29
Blue Shield,PPO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,Case Rate,12547.94
Blue Shield,PPO,70554,CPT4/HCPCS,FMRI BRAIN BY TECH,,Case Rate,6533.00
Blue Shield,PPO,70557,CPT4/HCPCS,MRI BRAIN W/O DYE,,Case Rate,7560.21
Blue Shield,PPO,70558,CPT4/HCPCS,MRI BRAIN W/DYE,,Case Rate,8361.57
Blue Shield,PPO,70559,CPT4/HCPCS,MRI BRAIN W/O & W/DYE,,Case Rate,8400.06
Blue Shield,PPO,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,Case Rate,143.57
Blue Shield,PPO,71046,CPT4/HCPCS,X-RAY EXAM CHEST 2 VIEWS,,Case Rate,263.86
Blue Shield,PPO,71047,CPT4/HCPCS,X-RAY EXAM CHEST 3 VIEWS,,Case Rate,336.04
Blue Shield,PPO,71048,CPT4/HCPCS,X-RAY EXAM CHEST 4+ VIEWS,,Case Rate,345.66
Blue Shield,PPO,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,Case Rate,290.40
Blue Shield,PPO,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,Case Rate,338.52
Blue Shield,PPO,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,Case Rate,400.29
Blue Shield,PPO,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,Case Rate,452.44
Blue Shield,PPO,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,Case Rate,328.89
Blue Shield,PPO,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,Case Rate,357.76
Blue Shield,PPO,71250,CPT4/HCPCS,CT THORAX DX C-,,Case Rate,2978.36
Blue Shield,PPO,71260,CPT4/HCPCS,CT THORAX DX C+,,Case Rate,3565.53
Blue Shield,PPO,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,Case Rate,4458.30
Blue Shield,PPO,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,Case Rate,6133.38
Blue Shield,PPO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,Case Rate,5589.81
Blue Shield,PPO,71551,CPT4/HCPCS,MRI CHEST W/DYE,,Case Rate,6700.67
Blue Shield,PPO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,Case Rate,12293.78
Blue Shield,PPO,71555,CPT4/HCPCS,MRI ANGIO CHEST W OR W/O DYE,,Case Rate,5646.30
Blue Shield,PPO,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,Case Rate,205.35
Blue Shield,PPO,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,Case Rate,304.83
Blue Shield,PPO,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,Case Rate,452.44
Blue Shield,PPO,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,Case Rate,567.92
Blue Shield,PPO,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,Case Rate,328.89
Blue Shield,PPO,72072,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 3VWS,,Case Rate,376.23
Blue Shield,PPO,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,Case Rate,462.06
Blue Shield,PPO,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,Case Rate,338.52
Blue Shield,PPO,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,Case Rate,340.85
Blue Shield,PPO,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,Case Rate,619.92
Blue Shield,PPO,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,Case Rate,672.85
Blue Shield,PPO,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,Case Rate,807.58
Blue Shield,PPO,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,Case Rate,338.52
Blue Shield,PPO,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,Case Rate,462.06
Blue Shield,PPO,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,Case Rate,596.79
Blue Shield,PPO,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,Case Rate,452.44
Blue Shield,PPO,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,PPO,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,Case Rate,3565.53
Blue Shield,PPO,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,PPO,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,PPO,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,Case Rate,3565.53
Blue Shield,PPO,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,PPO,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,Case Rate,2978.36
Blue Shield,PPO,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,Case Rate,3565.53
Blue Shield,PPO,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,Case Rate,4458.30
Blue Shield,PPO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,Case Rate,5646.30
Blue Shield,PPO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,Case Rate,6773.29
Blue Shield,PPO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,Case Rate,6263.11
Blue Shield,PPO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,Case Rate,6773.29
Blue Shield,PPO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,Case Rate,6263.11
Blue Shield,PPO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,Case Rate,6773.29
Blue Shield,PPO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,PPO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,PPO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,Case Rate,12547.94
Blue Shield,PPO,72159,CPT4/HCPCS,MR ANGIO SPINE W/O&W/DYE,,Case Rate,6142.82
Blue Shield,PPO,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Case Rate,258.27
Blue Shield,PPO,72190,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Case Rate,338.52
Blue Shield,PPO,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,Case Rate,5964.97
Blue Shield,PPO,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,Case Rate,2978.36
Blue Shield,PPO,72193,CPT4/HCPCS,CT PELVIS W/DYE,,Case Rate,3450.82
Blue Shield,PPO,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,Case Rate,4272.98
Blue Shield,PPO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,Case Rate,5589.81
Blue Shield,PPO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,Case Rate,6700.67
Blue Shield,PPO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,Case Rate,12390.60
Blue Shield,PPO,72198,CPT4/HCPCS,MR ANGIO PELVIS W/O & W/DYE,,Case Rate,5646.30
Blue Shield,PPO,72200,CPT4/HCPCS,X-RAY EXAM SI JOINTS,,Case Rate,258.27
Blue Shield,PPO,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,Case Rate,314.46
Blue Shield,PPO,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,Case Rate,290.40
Blue Shield,PPO,72240,CPT4/HCPCS,MYELOGRAPHY NECK SPINE,,Case Rate,2396.00
Blue Shield,PPO,72255,CPT4/HCPCS,MYELOGRAPHY THORACIC SPINE,,Case Rate,2177.00
Blue Shield,PPO,72265,CPT4/HCPCS,MYELOGRAPHY L-S SPINE,,Case Rate,2056.71
Blue Shield,PPO,72270,CPT4/HCPCS,MYELOGPHY 2/> SPINE REGIONS,,Case Rate,3077.85
Blue Shield,PPO,72275,CPT4/HCPCS,EPIDUROGRAPHY,,Case Rate,1099.20
Blue Shield,PPO,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,Case Rate,4220.06
Blue Shield,PPO,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,Case Rate,3952.94
Blue Shield,PPO,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,Case Rate,258.27
Blue Shield,PPO,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,Case Rate,258.27
Blue Shield,PPO,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Case Rate,234.22
Blue Shield,PPO,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Case Rate,290.40
Blue Shield,PPO,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,Case Rate,1058.85
Blue Shield,PPO,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,Case Rate,338.52
Blue Shield,PPO,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,Case Rate,290.40
Blue Shield,PPO,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Case Rate,258.27
Blue Shield,PPO,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Case Rate,290.40
Blue Shield,PPO,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,Case Rate,1058.85
Blue Shield,PPO,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,Case Rate,258.27
Blue Shield,PPO,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,Case Rate,243.84
Blue Shield,PPO,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Case Rate,243.84
Blue Shield,PPO,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Case Rate,263.08
Blue Shield,PPO,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,Case Rate,800.58
Blue Shield,PPO,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,Case Rate,243.84
Blue Shield,PPO,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,Case Rate,263.08
Blue Shield,PPO,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,Case Rate,205.35
Blue Shield,PPO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,Case Rate,2492.24
Blue Shield,PPO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,Case Rate,2978.36
Blue Shield,PPO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,Case Rate,3742.00
Blue Shield,PPO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,Case Rate,5450.13
Blue Shield,PPO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,Case Rate,5565.61
Blue Shield,PPO,73219,CPT4/HCPCS,MRI UPPER EXTREMITY W/DYE,,Case Rate,6680.50
Blue Shield,PPO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,Case Rate,12358.33
Blue Shield,PPO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,Case Rate,5565.61
Blue Shield,PPO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,Case Rate,6680.50
Blue Shield,PPO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,Case Rate,12358.33
Blue Shield,PPO,73225,CPT4/HCPCS,MR ANGIO UPR EXTR W/O&W/DYE,,Case Rate,5535.63
Blue Shield,PPO,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,Case Rate,273.49
Blue Shield,PPO,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,Case Rate,403.40
Blue Shield,PPO,73503,CPT4/HCPCS,X-RAY EXAM HIP UNI 4/> VIEWS,,Case Rate,499.63
Blue Shield,PPO,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,Case Rate,379.34
Blue Shield,PPO,73522,CPT4/HCPCS,X-RAY EXAM HIPS BI 3-4 VIEWS,,Case Rate,451.52
Blue Shield,PPO,73523,CPT4/HCPCS,X-RAY EXAM HIPS BI 5/> VIEWS,,Case Rate,542.94
Blue Shield,PPO,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,Case Rate,1058.85
Blue Shield,PPO,73551,CPT4/HCPCS,X-RAY EXAM OF FEMUR 1,,Case Rate,259.05
Blue Shield,PPO,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,Case Rate,307.17
Blue Shield,PPO,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,Case Rate,258.27
Blue Shield,PPO,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,Case Rate,290.40
Blue Shield,PPO,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,Case Rate,314.46
Blue Shield,PPO,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,Case Rate,243.84
Blue Shield,PPO,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,Case Rate,1317.13
Blue Shield,PPO,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,Case Rate,258.27
Blue Shield,PPO,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,Case Rate,243.84
Blue Shield,PPO,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Case Rate,243.84
Blue Shield,PPO,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Case Rate,263.08
Blue Shield,PPO,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,Case Rate,1058.85
Blue Shield,PPO,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Case Rate,243.84
Blue Shield,PPO,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Case Rate,263.08
Blue Shield,PPO,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,Case Rate,234.22
Blue Shield,PPO,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,Case Rate,205.35
Blue Shield,PPO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,Case Rate,2492.24
Blue Shield,PPO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,Case Rate,2978.36
Blue Shield,PPO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,Case Rate,3742.00
Blue Shield,PPO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,Case Rate,5450.13
Blue Shield,PPO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,Case Rate,5565.61
Blue Shield,PPO,73719,CPT4/HCPCS,MRI LOWER EXTREMITY W/DYE,,Case Rate,6680.50
Blue Shield,PPO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,Case Rate,12358.33
Blue Shield,PPO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,Case Rate,5565.61
Blue Shield,PPO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,Case Rate,6680.50
Blue Shield,PPO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,Case Rate,12358.33
Blue Shield,PPO,73725,CPT4/HCPCS,MR ANG LWR EXT W OR W/O DYE,,Case Rate,5646.30
Blue Shield,PPO,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,Case Rate,244.62
Blue Shield,PPO,74019,CPT4/HCPCS,X-RAY EXAM ABDOMEN 2 VIEWS,,Case Rate,292.73
Blue Shield,PPO,74021,CPT4/HCPCS,X-RAY EXAM ABDOMEN 3+ VIEWS,,Case Rate,340.85
Blue Shield,PPO,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,Case Rate,376.23
Blue Shield,PPO,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,Case Rate,2849.22
Blue Shield,PPO,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,Case Rate,3450.82
Blue Shield,PPO,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,Case Rate,4272.98
Blue Shield,PPO,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,Case Rate,6451.62
Blue Shield,PPO,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,Case Rate,5964.97
Blue Shield,PPO,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,Case Rate,1866.13
Blue Shield,PPO,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,Case Rate,3559.83
Blue Shield,PPO,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,Case Rate,4704.99
Blue Shield,PPO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,Case Rate,5589.81
Blue Shield,PPO,74182,CPT4/HCPCS,MRI ABDOMEN W/DYE,,Case Rate,6700.67
Blue Shield,PPO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,Case Rate,12390.60
Blue Shield,PPO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,Case Rate,5646.30
Blue Shield,PPO,74190,CPT4/HCPCS,X-RAY EXAM OF PERITONEUM,,Case Rate,658.56
Blue Shield,PPO,74210,CPT4/HCPCS,X-RAY XM PHRNX&/CRV ESOPH C+,,Case Rate,596.79
Blue Shield,PPO,74220,CPT4/HCPCS,X-RAY XM ESOPHAGUS 1CNTRST,,Case Rate,596.79
Blue Shield,PPO,74230,CPT4/HCPCS,X-RAY XM SWLNG FUNCJ C+,,Case Rate,658.56
Blue Shield,PPO,74235,CPT4/HCPCS,REMOVE ESOPHAGUS OBSTRUCTION,,Case Rate,1317.13
Blue Shield,PPO,74240,CPT4/HCPCS,X-RAY XM UPR GI TRC 1CNTRST,,Case Rate,734.77
Blue Shield,PPO,74241,CPT4/HCPCS,X-RAY UPPER GI DELAY W/KUB,,Case Rate,749.21
Blue Shield,PPO,74245,CPT4/HCPCS,X-RAY UPPER GI&SMALL INTEST,,Case Rate,1202.43
Blue Shield,PPO,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,Case Rate,834.26
Blue Shield,PPO,74247,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,Case Rate,857.54
Blue Shield,PPO,74249,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,Case Rate,1302.69
Blue Shield,PPO,74250,CPT4/HCPCS,X-RAY XM SM INT 1CNTRST STD,,Case Rate,658.56
Blue Shield,PPO,74251,CPT4/HCPCS,X-RAY XM SM INT 2CNTRST STD,,Case Rate,658.56
Blue Shield,PPO,74260,CPT4/HCPCS,X-RAY EXAM OF SMALL BOWEL,,Case Rate,749.21
Blue Shield,PPO,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,Case Rate,6620.02
Blue Shield,PPO,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,Case Rate,7442.81
Blue Shield,PPO,74263,CPT4/HCPCS,CT COLONOGRAPHY SCREENING,,Case Rate,7866.23
Blue Shield,PPO,74270,CPT4/HCPCS,X-RAY XM COLON 1CNTRST STD,,Case Rate,867.17
Blue Shield,PPO,74280,CPT4/HCPCS,X-RAY XM COLON 2CNTRST STD,,Case Rate,1130.25
Blue Shield,PPO,74283,CPT4/HCPCS,THER NMA RDCTJ INTUS/OBSTRCJ,,Case Rate,1297.88
Blue Shield,PPO,74290,CPT4/HCPCS,CONTRAST X-RAY GALLBLADDER,,Case Rate,376.23
Blue Shield,PPO,74300,CPT4/HCPCS,X-RAY BILE DUCTS/PANCREAS,,Case Rate,443.59
Blue Shield,PPO,74301,CPT4/HCPCS,X-RAYS AT SURGERY ADD-ON,,Case Rate,257.50
Blue Shield,PPO,74328,CPT4/HCPCS,X-RAY BILE DUCT ENDOSCOPY,,Case Rate,1593.87
Blue Shield,PPO,74329,CPT4/HCPCS,X-RAY FOR PANCREAS ENDOSCOPY,,Case Rate,1593.87
Blue Shield,PPO,74330,CPT4/HCPCS,X-RAY BILE/PANC ENDOSCOPY,,Case Rate,1593.87
Blue Shield,PPO,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,Case Rate,1317.13
Blue Shield,PPO,74355,CPT4/HCPCS,X-RAY GUIDE INTESTINAL TUBE,,Case Rate,1317.13
Blue Shield,PPO,74360,CPT4/HCPCS,X-RAY GUIDE GI DILATION,,Case Rate,1593.87
Blue Shield,PPO,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,Case Rate,3077.85
Blue Shield,PPO,74400,CPT4/HCPCS,UROGRAPHY IV +-KUB TOMOG,,Case Rate,857.54
Blue Shield,PPO,74410,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BOLUS,,Case Rate,987.46
Blue Shield,PPO,74415,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BLS W/NF,,Case Rate,1068.48
Blue Shield,PPO,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,Case Rate,1317.13
Blue Shield,PPO,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,Case Rate,658.56
Blue Shield,PPO,74430,CPT4/HCPCS,CONTRAST X-RAY BLADDER,,Case Rate,534.24
Blue Shield,PPO,74440,CPT4/HCPCS,X-RAY MALE GENITAL TRACT,,Case Rate,567.92
Blue Shield,PPO,74445,CPT4/HCPCS,X-RAY EXAM OF PENIS,,Case Rate,567.92
Blue Shield,PPO,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Case Rate,734.77
Blue Shield,PPO,74455,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Case Rate,800.58
Blue Shield,PPO,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,Case Rate,629.69
Blue Shield,PPO,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,Case Rate,1593.87
Blue Shield,PPO,74710,CPT4/HCPCS,X-RAY MEASUREMENT OF PELVIS,,Case Rate,534.24
Blue Shield,PPO,74712,CPT4/HCPCS,MRI FETAL SNGL/1ST GESTATION,,Case Rate,4444.39
Blue Shield,PPO,74713,CPT4/HCPCS,MRI FETAL EA ADDL GESTATION,,Case Rate,1904.63
Blue Shield,PPO,74740,CPT4/HCPCS,X-RAY FEMALE GENITAL TRACT,,Case Rate,658.56
Blue Shield,PPO,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,Case Rate,1593.87
Blue Shield,PPO,74775,CPT4/HCPCS,X-RAY EXAM OF PERINEUM,,Case Rate,734.77
Blue Shield,PPO,75557,CPT4/HCPCS,CARDIAC MRI FOR MORPH,,Case Rate,5321.40
Blue Shield,PPO,75559,CPT4/HCPCS,CARDIAC MRI W/STRESS IMG,,Case Rate,8044.78
Blue Shield,PPO,75561,CPT4/HCPCS,CARDIAC MRI FOR MORPH W/DYE,,Case Rate,7575.87
Blue Shield,PPO,75563,CPT4/HCPCS,CARD MRI W/STRESS IMG & DYE,,Case Rate,9456.44
Blue Shield,PPO,75565,CPT4/HCPCS,CARD MRI VELOC FLOW MAPPING,,Case Rate,1052.97
Blue Shield,PPO,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,Case Rate,1231.00
Blue Shield,PPO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,Case Rate,692.10
Blue Shield,PPO,75573,CPT4/HCPCS,CT HRT W/3D IMAGE CONGEN,,Case Rate,826.82
Blue Shield,PPO,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,Case Rate,6186.98
Blue Shield,PPO,75600,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Case Rate,6344.13
Blue Shield,PPO,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Case Rate,6344.13
Blue Shield,PPO,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,Case Rate,6344.13
Blue Shield,PPO,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,Case Rate,6615.28
Blue Shield,PPO,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,Case Rate,7841.51
Blue Shield,PPO,75705,CPT4/HCPCS,ARTERY X-RAYS SPINE,,Case Rate,6344.13
Blue Shield,PPO,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,Case Rate,6344.13
Blue Shield,PPO,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,Case Rate,6344.13
Blue Shield,PPO,75726,CPT4/HCPCS,ARTERY X-RAYS ABDOMEN,,Case Rate,6344.13
Blue Shield,PPO,75731,CPT4/HCPCS,ARTERY X-RAYS ADRENAL GLAND,,Case Rate,6344.13
Blue Shield,PPO,75733,CPT4/HCPCS,ARTERY X-RAYS ADRENALS,,Case Rate,6344.13
Blue Shield,PPO,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,Case Rate,6344.13
Blue Shield,PPO,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Case Rate,6344.13
Blue Shield,PPO,75743,CPT4/HCPCS,ARTERY X-RAYS LUNGS,,Case Rate,6344.13
Blue Shield,PPO,75746,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Case Rate,6344.13
Blue Shield,PPO,75756,CPT4/HCPCS,ARTERY X-RAYS CHEST,,Case Rate,6344.13
Blue Shield,PPO,75774,CPT4/HCPCS,ARTERY X-RAY EACH VESSEL,,Case Rate,6344.13
Blue Shield,PPO,75801,CPT4/HCPCS,LYMPH VESSEL X-RAY ARM/LEG,,Case Rate,2734.52
Blue Shield,PPO,75803,CPT4/HCPCS,LYMPH VESSEL X-RAY ARMS/LEGS,,Case Rate,2734.52
Blue Shield,PPO,75805,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Case Rate,3077.85
Blue Shield,PPO,75807,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Case Rate,3077.85
Blue Shield,PPO,75809,CPT4/HCPCS,NONVASCULAR SHUNT X-RAY,,Case Rate,400.29
Blue Shield,PPO,75810,CPT4/HCPCS,VEIN X-RAY SPLEEN/LIVER,,Case Rate,6344.13
Blue Shield,PPO,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,Case Rate,481.31
Blue Shield,PPO,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,Case Rate,744.40
Blue Shield,PPO,75825,CPT4/HCPCS,VEIN X-RAY TRUNK,,Case Rate,6344.13
Blue Shield,PPO,75827,CPT4/HCPCS,VEIN X-RAY CHEST,,Case Rate,6344.13
Blue Shield,PPO,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,Case Rate,6344.13
Blue Shield,PPO,75833,CPT4/HCPCS,VEIN X-RAY KIDNEYS,,Case Rate,6344.13
Blue Shield,PPO,75840,CPT4/HCPCS,VEIN X-RAY ADRENAL GLAND,,Case Rate,6344.13
Blue Shield,PPO,75842,CPT4/HCPCS,VEIN X-RAY ADRENAL GLANDS,,Case Rate,6344.13
Blue Shield,PPO,75860,CPT4/HCPCS,VEIN X-RAY NECK,,Case Rate,6344.13
Blue Shield,PPO,75870,CPT4/HCPCS,VEIN X-RAY SKULL,,Case Rate,6344.13
Blue Shield,PPO,75872,CPT4/HCPCS,VEIN X-RAY SKULL EPIDURAL,,Case Rate,6344.13
Blue Shield,PPO,75880,CPT4/HCPCS,VEIN X-RAY EYE SOCKET,,Case Rate,481.31
Blue Shield,PPO,75885,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Case Rate,6344.13
Blue Shield,PPO,75887,CPT4/HCPCS,VEIN X-RAY LIVER W/O HEMODYN,,Case Rate,6344.13
Blue Shield,PPO,75889,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Case Rate,6344.13
Blue Shield,PPO,75891,CPT4/HCPCS,VEIN X-RAY LIVER,,Case Rate,6344.13
Blue Shield,PPO,75893,CPT4/HCPCS,VENOUS SAMPLING BY CATHETER,,Case Rate,6344.13
Blue Shield,PPO,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,Case Rate,12166.12
Blue Shield,PPO,75898,CPT4/HCPCS,FOLLOW-UP ANGIOGRAPHY,,Case Rate,534.24
Blue Shield,PPO,75901,CPT4/HCPCS,REMOVE CVA DEVICE OBSTRUCT,,Case Rate,965.17
Blue Shield,PPO,75902,CPT4/HCPCS,REMOVE CVA LUMEN OBSTRUCT,,Case Rate,965.17
Blue Shield,PPO,75970,CPT4/HCPCS,VASCULAR BIOPSY,,Case Rate,5818.74
Blue Shield,PPO,75984,CPT4/HCPCS,XRAY CONTROL CATHETER CHANGE,,Case Rate,987.46
Blue Shield,PPO,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,Case Rate,1593.87
Blue Shield,PPO,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,Case Rate,658.56
Blue Shield,PPO,76001,CPT4/HCPCS,FLUOROSCOPE EXAM EXTENSIVE,,Case Rate,1317.13
Blue Shield,PPO,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,Case Rate,258.27
Blue Shield,PPO,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,Case Rate,534.24
Blue Shield,PPO,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,Case Rate,205.35
Blue Shield,PPO,76100,CPT4/HCPCS,X-RAY EXAM OF BODY SECTION,,Case Rate,629.69
Blue Shield,PPO,76101,CPT4/HCPCS,COMPLEX BODY SECTION X-RAY,,Case Rate,720.34
Blue Shield,PPO,76102,CPT4/HCPCS,COMPLEX BODY SECTION X-RAYS,,Case Rate,881.60
Blue Shield,PPO,76120,CPT4/HCPCS,CINE/VIDEO X-RAYS,,Case Rate,534.24
Blue Shield,PPO,76125,CPT4/HCPCS,CINE/VIDEO X-RAYS ADD-ON,,Case Rate,400.29
Blue Shield,PPO,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Case Rate,1682.66
Blue Shield,PPO,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Case Rate,1775.45
Blue Shield,PPO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,Case Rate,1761.50
Blue Shield,PPO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,Case Rate,5535.63
Blue Shield,PPO,76393,CPT4/HCPCS,MR GUIDANCE FOR NEEDLE PLACE,,Case Rate,5630.16
Blue Shield,PPO,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,Case Rate,720.34
Blue Shield,PPO,76510,CPT4/HCPCS,OPH US DX B-SCAN&QUAN A-SCAN,,Case Rate,1077.18
Blue Shield,PPO,76511,CPT4/HCPCS,OPH US DX QUAN A-SCAN ONLY,,Case Rate,360.24
Blue Shield,PPO,76512,CPT4/HCPCS,OPH US DX B-SCAN,,Case Rate,386.78
Blue Shield,PPO,76513,CPT4/HCPCS,OPH US DX ANT SGM US UNI/BI,,Case Rate,425.27
Blue Shield,PPO,76514,CPT4/HCPCS,ECHO EXAM OF EYE THICKNESS,,Case Rate,32.90
Blue Shield,PPO,76516,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,259.20
Blue Shield,PPO,76519,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,297.69
Blue Shield,PPO,76529,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,282.48
Blue Shield,PPO,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,Case Rate,720.34
Blue Shield,PPO,76604,CPT4/HCPCS,US EXAM CHEST,,Case Rate,658.56
Blue Shield,PPO,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,Case Rate,961.55
Blue Shield,PPO,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,Case Rate,735.40
Blue Shield,PPO,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,Case Rate,997.08
Blue Shield,PPO,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,Case Rate,720.34
Blue Shield,PPO,76706,CPT4/HCPCS,US ABDL AORTA SCREEN AAA,,Case Rate,899.00
Blue Shield,PPO,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,Case Rate,997.08
Blue Shield,PPO,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,Case Rate,720.34
Blue Shield,PPO,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,Case Rate,1478.24
Blue Shield,PPO,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,Case Rate,720.34
Blue Shield,PPO,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,Case Rate,1058.85
Blue Shield,PPO,76802,CPT4/HCPCS,OB US < 14 WKS ADDL FETUS,,Case Rate,558.44
Blue Shield,PPO,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,Case Rate,1058.85
Blue Shield,PPO,76810,CPT4/HCPCS,OB US >= 14 WKS ADDL FETUS,,Case Rate,598.79
Blue Shield,PPO,76811,CPT4/HCPCS,OB US DETAILED SNGL FETUS,,Case Rate,1876.79
Blue Shield,PPO,76812,CPT4/HCPCS,OB US DETAILED ADDL FETUS,,Case Rate,675.44
Blue Shield,PPO,76813,CPT4/HCPCS,OB US NUCHAL MEAS 1 GEST,,Case Rate,888.89
Blue Shield,PPO,76814,CPT4/HCPCS,OB US NUCHAL MEAS ADD-ON,,Case Rate,460.66
Blue Shield,PPO,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,Case Rate,720.34
Blue Shield,PPO,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,Case Rate,563.11
Blue Shield,PPO,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,Case Rate,755.57
Blue Shield,PPO,76818,CPT4/HCPCS,FETAL BIOPHYS PROFILE W/NST,,Case Rate,819.83
Blue Shield,PPO,76819,CPT4/HCPCS,FETAL BIOPHYS PROFIL W/O NST,,Case Rate,819.83
Blue Shield,PPO,76820,CPT4/HCPCS,UMBILICAL ARTERY ECHO,,Case Rate,823.08
Blue Shield,PPO,76821,CPT4/HCPCS,MIDDLE CEREBRAL ARTERY ECHO,,Case Rate,823.08
Blue Shield,PPO,76825,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,997.08
Blue Shield,PPO,76826,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,361.80
Blue Shield,PPO,76827,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,880.82
Blue Shield,PPO,76828,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,571.18
Blue Shield,PPO,76830,CPT4/HCPCS,TRANSVAGINAL US NON-OB,,Case Rate,771.71
Blue Shield,PPO,76831,CPT4/HCPCS,ECHO EXAM UTERUS,,Case Rate,771.71
Blue Shield,PPO,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,Case Rate,771.71
Blue Shield,PPO,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,Case Rate,779.63
Blue Shield,PPO,76870,CPT4/HCPCS,US EXAM SCROTUM,,Case Rate,771.71
Blue Shield,PPO,76872,CPT4/HCPCS,US TRANSRECTAL,,Case Rate,935.31
Blue Shield,PPO,76873,CPT4/HCPCS,ECHOGRAP TRANS R PROS STUDY,,Case Rate,1074.99
Blue Shield,PPO,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,Case Rate,1221.38
Blue Shield,PPO,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,Case Rate,143.57
Blue Shield,PPO,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,Case Rate,771.71
Blue Shield,PPO,76886,CPT4/HCPCS,US EXAM INFANT HIPS STATIC,,Case Rate,720.34
Blue Shield,PPO,76930,CPT4/HCPCS,ECHO GUIDE CARDIOCENTESIS,,Case Rate,771.71
Blue Shield,PPO,76932,CPT4/HCPCS,ECHO GUIDE FOR HEART BIOPSY,,Case Rate,771.71
Blue Shield,PPO,76936,CPT4/HCPCS,ECHO GUIDE FOR ARTERY REPAIR,,Case Rate,3178.12
Blue Shield,PPO,76937,CPT4/HCPCS,US GUIDE VASCULAR ACCESS,,Case Rate,218.37
Blue Shield,PPO,76940,CPT4/HCPCS,US GUIDE TISSUE ABLATION,,Case Rate,848.36
Blue Shield,PPO,76941,CPT4/HCPCS,ECHO GUIDE FOR TRANSFUSION,,Case Rate,768.45
Blue Shield,PPO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,Case Rate,1262.50
Blue Shield,PPO,76945,CPT4/HCPCS,ECHO GUIDE VILLUS SAMPLING,,Case Rate,768.45
Blue Shield,PPO,76946,CPT4/HCPCS,ECHO GUIDE FOR AMNIOCENTESIS,,Case Rate,771.71
Blue Shield,PPO,76948,CPT4/HCPCS,ECHO GUIDE OVA ASPIRATION,,Case Rate,771.71
Blue Shield,PPO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,Case Rate,2806.70
Blue Shield,PPO,76970,CPT4/HCPCS,ULTRASOUND EXAM FOLLOW-UP,,Case Rate,534.24
Blue Shield,PPO,76975,CPT4/HCPCS,GI ENDOSCOPIC ULTRASOUND,,Case Rate,771.71
Blue Shield,PPO,76977,CPT4/HCPCS,US BONE DENSITY MEASURE,,Case Rate,419.54
Blue Shield,PPO,77001,CPT4/HCPCS,FLUOROGUIDE FOR VEIN DEVICE,,Case Rate,1228.82
Blue Shield,PPO,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,Case Rate,514.21
Blue Shield,PPO,77003,CPT4/HCPCS,FLUOROGUIDE FOR SPINE INJECT,,Case Rate,316.94
Blue Shield,PPO,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,Case Rate,9388.52
Blue Shield,PPO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,Case Rate,1040.35
Blue Shield,PPO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Case Rate,2066.19
Blue Shield,PPO,77021,CPT4/HCPCS,MRI GUIDANCE NDL PLMT RS&I,,Case Rate,4436.87
Blue Shield,PPO,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,Case Rate,292.25
Blue Shield,PPO,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,Case Rate,764.72
Blue Shield,PPO,77058,CPT4/HCPCS,MRI ONE BREAST,,Case Rate,10066.59
Blue Shield,PPO,77059,CPT4/HCPCS,MRI BOTH BREASTS,,Case Rate,10147.57
Blue Shield,PPO,77063,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Case Rate,345.66
Blue Shield,PPO,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,Case Rate,996.15
Blue Shield,PPO,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,Case Rate,1494.93
Blue Shield,PPO,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,Case Rate,1514.18
Blue Shield,PPO,77071,CPT4/HCPCS,X-RAY STRESS VIEW,,Case Rate,389.89
Blue Shield,PPO,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,Case Rate,171.66
Blue Shield,PPO,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,Case Rate,284.81
Blue Shield,PPO,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,Case Rate,606.41
Blue Shield,PPO,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,Case Rate,984.98
Blue Shield,PPO,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,Case Rate,852.58
Blue Shield,PPO,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,Case Rate,279.22
Blue Shield,PPO,77078,CPT4/HCPCS,CT BONE DENSITY AXIAL,,Case Rate,279.22
Blue Shield,PPO,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,Case Rate,419.83
Blue Shield,PPO,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,Case Rate,323.30
Blue Shield,PPO,77084,CPT4/HCPCS,MAGNETIC IMAGE BONE MARROW,,Case Rate,6651.93
Blue Shield,PPO,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,Case Rate,552.56
Blue Shield,PPO,77086,CPT4/HCPCS,FRACTURE ASSESSMENT VIA DXA,,Case Rate,360.09
Blue Shield,PPO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,1747.06
Blue Shield,PPO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,2810.73
Blue Shield,PPO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,3283.19
Blue Shield,PPO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,Case Rate,4411.49
Blue Shield,PPO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,Case Rate,14084.07
Blue Shield,PPO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,Case Rate,677.81
Blue Shield,PPO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,Case Rate,14084.07
Blue Shield,PPO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,Case Rate,985.61
Blue Shield,PPO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,Case Rate,1803.58
Blue Shield,PPO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,Case Rate,1529.32
Blue Shield,PPO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,Case Rate,1996.05
Blue Shield,PPO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,Case Rate,2708.17
Blue Shield,PPO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,Case Rate,2038.24
Blue Shield,PPO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,Case Rate,248.65
Blue Shield,PPO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,677.81
Blue Shield,PPO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,958.59
Blue Shield,PPO,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,1637.17
Blue Shield,PPO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,1503.23
Blue Shield,PPO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,Case Rate,3362.55
Blue Shield,PPO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,1756.69
Blue Shield,PPO,77371,CPT4/HCPCS,SRS MULTISOURCE,,Case Rate,14607.62
Blue Shield,PPO,77372,CPT4/HCPCS,SRS LINEAR BASED,,Case Rate,11085.51
Blue Shield,PPO,77373,CPT4/HCPCS,SBRT DELIVERY,,Case Rate,20679.89
Blue Shield,PPO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,Case Rate,8995.00
Blue Shield,PPO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,Case Rate,8995.00
Blue Shield,PPO,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,900.85
Blue Shield,PPO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,900.85
Blue Shield,PPO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,1054.04
Blue Shield,PPO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,1178.37
Blue Shield,PPO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,Case Rate,300.02
Blue Shield,PPO,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,Case Rate,1139.87
Blue Shield,PPO,77435,CPT4/HCPCS,SBRT MANAGEMENT,,Case Rate,2498.08
Blue Shield,PPO,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,Case Rate,1402.14
Blue Shield,PPO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,Case Rate,5622.24
Blue Shield,PPO,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,Case Rate,6586.41
Blue Shield,PPO,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,Case Rate,6586.41
Blue Shield,PPO,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,Case Rate,9965.84
Blue Shield,PPO,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,Case Rate,9965.84
Blue Shield,PPO,77600,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,PPO,77605,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2051.90
Blue Shield,PPO,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,PPO,77615,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2051.90
Blue Shield,PPO,77620,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,1536.91
Blue Shield,PPO,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Case Rate,673.00
Blue Shield,PPO,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Case Rate,1269.01
Blue Shield,PPO,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Case Rate,1818.46
Blue Shield,PPO,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Case Rate,2258.02
Blue Shield,PPO,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,2307.25
Blue Shield,PPO,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,3792.49
Blue Shield,PPO,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,2984.91
Blue Shield,PPO,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,5436.51
Blue Shield,PPO,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,8579.43
Blue Shield,PPO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Case Rate,2586.92
Blue Shield,PPO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Case Rate,224.59
Blue Shield,PPO,77790,CPT4/HCPCS,RADIATION HANDLING,,Case Rate,248.65
Blue Shield,PPO,78012,CPT4/HCPCS,THYROID UPTAKE MEASUREMENT,,Case Rate,1048.16
Blue Shield,PPO,78013,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Case Rate,2725.86
Blue Shield,PPO,78014,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Case Rate,3110.79
Blue Shield,PPO,78015,CPT4/HCPCS,THYROID MET IMAGING,,Case Rate,1302.69
Blue Shield,PPO,78016,CPT4/HCPCS,THYROID MET IMAGING/STUDIES,,Case Rate,1751.88
Blue Shield,PPO,78018,CPT4/HCPCS,THYROID MET IMAGING BODY,,Case Rate,2739.33
Blue Shield,PPO,78020,CPT4/HCPCS,THYROID MET UPTAKE,,Case Rate,686.80
Blue Shield,PPO,78070,CPT4/HCPCS,PARATHYROID PLANAR IMAGING,,Case Rate,924.91
Blue Shield,PPO,78071,CPT4/HCPCS,PARATHYRD PLANAR W/WO SUBTRJ,,Case Rate,4337.76
Blue Shield,PPO,78075,CPT4/HCPCS,ADRENAL CORTEX & MEDULLA IMG,,Case Rate,2739.33
Blue Shield,PPO,78102,CPT4/HCPCS,BONE MARROW IMAGING LTD,,Case Rate,1029.98
Blue Shield,PPO,78103,CPT4/HCPCS,BONE MARROW IMAGING MULT,,Case Rate,1598.68
Blue Shield,PPO,78104,CPT4/HCPCS,BONE MARROW IMAGING BODY,,Case Rate,2056.71
Blue Shield,PPO,78110,CPT4/HCPCS,PLASMA VOLUME SINGLE,,Case Rate,481.31
Blue Shield,PPO,78111,CPT4/HCPCS,PLASMA VOLUME MULTIPLE,,Case Rate,1302.69
Blue Shield,PPO,78120,CPT4/HCPCS,RED CELL MASS SINGLE,,Case Rate,881.60
Blue Shield,PPO,78121,CPT4/HCPCS,RED CELL MASS MULTIPLE,,Case Rate,1461.48
Blue Shield,PPO,78122,CPT4/HCPCS,BLOOD VOLUME,,Case Rate,2319.80
Blue Shield,PPO,78130,CPT4/HCPCS,RED CELL SURVIVAL STUDY,,Case Rate,1432.61
Blue Shield,PPO,78135,CPT4/HCPCS,RED CELL SURVIVAL KINETICS,,Case Rate,2453.74
Blue Shield,PPO,78140,CPT4/HCPCS,RED CELL SEQUESTRATION,,Case Rate,1985.31
Blue Shield,PPO,78185,CPT4/HCPCS,SPLEEN IMAGING,,Case Rate,1192.80
Blue Shield,PPO,78191,CPT4/HCPCS,PLATELET SURVIVAL,,Case Rate,3690.63
Blue Shield,PPO,78195,CPT4/HCPCS,LYMPH SYSTEM IMAGING,,Case Rate,2056.71
Blue Shield,PPO,78201,CPT4/HCPCS,LIVER IMAGING,,Case Rate,1192.80
Blue Shield,PPO,78202,CPT4/HCPCS,LIVER IMAGING WITH FLOW,,Case Rate,1447.04
Blue Shield,PPO,78205,CPT4/HCPCS,LIVER IMAGING (3D),,Case Rate,2978.36
Blue Shield,PPO,78206,CPT4/HCPCS,LIVER IMAGE (3D) WITH FLOW,,Case Rate,2897.67
Blue Shield,PPO,78215,CPT4/HCPCS,LIVER AND SPLEEN IMAGING,,Case Rate,1475.91
Blue Shield,PPO,78216,CPT4/HCPCS,LIVER & SPLEEN IMAGE/FLOW,,Case Rate,1751.88
Blue Shield,PPO,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Case Rate,4145.29
Blue Shield,PPO,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Case Rate,5756.41
Blue Shield,PPO,78230,CPT4/HCPCS,SALIVARY GLAND IMAGING,,Case Rate,1101.38
Blue Shield,PPO,78231,CPT4/HCPCS,SERIAL SALIVARY IMAGING,,Case Rate,1598.68
Blue Shield,PPO,78232,CPT4/HCPCS,SALIVARY GLAND FUNCTION EXAM,,Case Rate,1780.75
Blue Shield,PPO,78258,CPT4/HCPCS,ESOPHAGEAL MOTILITY STUDY,,Case Rate,1447.04
Blue Shield,PPO,78261,CPT4/HCPCS,GASTRIC MUCOSA IMAGING,,Case Rate,2066.33
Blue Shield,PPO,78262,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX EXAM,,Case Rate,2143.32
Blue Shield,PPO,78264,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,2080.77
Blue Shield,PPO,78265,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,4918.41
Blue Shield,PPO,78266,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Case Rate,5885.55
Blue Shield,PPO,78270,CPT4/HCPCS,VIT B-12 ABSORPTION EXAM,,Case Rate,786.15
Blue Shield,PPO,78271,CPT4/HCPCS,VIT B-12 ABSRP EXAM INT FAC,,Case Rate,834.26
Blue Shield,PPO,78272,CPT4/HCPCS,VIT B-12 ABSORP COMBINED,,Case Rate,1173.56
Blue Shield,PPO,78278,CPT4/HCPCS,ACUTE GI BLOOD LOSS IMAGING,,Case Rate,2453.74
Blue Shield,PPO,78282,CPT4/HCPCS,GI PROTEIN LOSS EXAM,,Case Rate,758.83
Blue Shield,PPO,78290,CPT4/HCPCS,MECKELS DIVERT EXAM,,Case Rate,1536.91
Blue Shield,PPO,78291,CPT4/HCPCS,LEVEEN/SHUNT PATENCY EXAM,,Case Rate,1546.53
Blue Shield,PPO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Per Diem,5692.00
Blue Shield,PPO,78300,CPT4/HCPCS,BONE IMAGING LIMITED AREA,,Case Rate,1259.39
Blue Shield,PPO,78305,CPT4/HCPCS,BONE IMAGING MULTIPLE AREAS,,Case Rate,1847.33
Blue Shield,PPO,78306,CPT4/HCPCS,BONE IMAGING WHOLE BODY,,Case Rate,2152.94
Blue Shield,PPO,78315,CPT4/HCPCS,BONE IMAGING 3 PHASE,,Case Rate,2410.44
Blue Shield,PPO,78320,CPT4/HCPCS,BONE IMAGING (3D),,Case Rate,2978.36
Blue Shield,PPO,78350,CPT4/HCPCS,BONE MINERAL SINGLE PHOTON,,Case Rate,385.86
Blue Shield,PPO,78351,CPT4/HCPCS,BONE MINERAL DUAL PHOTON,,Case Rate,148.38
Blue Shield,PPO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Per Diem,5692.00
Blue Shield,PPO,78414,CPT4/HCPCS,NON-IMAGING HEART FUNCTION,,Case Rate,701.87
Blue Shield,PPO,78428,CPT4/HCPCS,CARDIAC SHUNT IMAGING,,Case Rate,1139.87
Blue Shield,PPO,78445,CPT4/HCPCS,VASCULAR FLOW IMAGING,,Case Rate,944.15
Blue Shield,PPO,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,Case Rate,2073.03
Blue Shield,PPO,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,Case Rate,4007.31
Blue Shield,PPO,78453,CPT4/HCPCS,HT MUSCLE IMAGE PLANAR SING,,Case Rate,1933.50
Blue Shield,PPO,78454,CPT4/HCPCS,HT MUSC IMAGE PLANAR MULT,,Case Rate,1625.55
Blue Shield,PPO,78456,CPT4/HCPCS,ACUTE VENOUS THROMBUS IMAGE,,Case Rate,2041.65
Blue Shield,PPO,78457,CPT4/HCPCS,VENOUS THROMBOSIS IMAGING,,Case Rate,1336.37
Blue Shield,PPO,78458,CPT4/HCPCS,VEN THROMBOSIS IMAGES BILAT,,Case Rate,2028.62
Blue Shield,PPO,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,Case Rate,2362.32
Blue Shield,PPO,78466,CPT4/HCPCS,HEART INFARCT IMAGE,,Case Rate,1317.13
Blue Shield,PPO,78468,CPT4/HCPCS,HEART INFARCT IMAGE (EF),,Case Rate,1847.33
Blue Shield,PPO,78469,CPT4/HCPCS,HEART INFARCT IMAGE (3D),,Case Rate,2634.25
Blue Shield,PPO,78472,CPT4/HCPCS,GATED HEART PLANAR SINGLE,,Case Rate,2781.86
Blue Shield,PPO,78473,CPT4/HCPCS,GATED HEART MULTIPLE,,Case Rate,4158.28
Blue Shield,PPO,78481,CPT4/HCPCS,HEART FIRST PASS SINGLE,,Case Rate,2634.25
Blue Shield,PPO,78483,CPT4/HCPCS,HEART FIRST PASS MULTIPLE,,Case Rate,3961.78
Blue Shield,PPO,78491,CPT4/HCPCS,MYOCRD IMG PET 1STD RST/STRS,,Case Rate,2396.00
Blue Shield,PPO,78492,CPT4/HCPCS,MYOCRD IMG PET MLT RST&STRS,,Case Rate,2983.17
Blue Shield,PPO,78494,CPT4/HCPCS,HEART IMAGE SPECT,,Case Rate,3537.29
Blue Shield,PPO,78496,CPT4/HCPCS,HEART FIRST PASS ADD-ON,,Case Rate,3537.29
Blue Shield,PPO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Per Diem,5692.00
Blue Shield,PPO,78579,CPT4/HCPCS,LUNG VENTILATION IMAGING,,Case Rate,2139.62
Blue Shield,PPO,78580,CPT4/HCPCS,LUNG PERFUSION IMAGING,,Case Rate,1727.82
Blue Shield,PPO,78582,CPT4/HCPCS,LUNG VENTILAT&PERFUS IMAGING,,Case Rate,3837.35
Blue Shield,PPO,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Case Rate,2293.59
Blue Shield,PPO,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Case Rate,3717.06
Blue Shield,PPO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Per Diem,5692.00
Blue Shield,PPO,78600,CPT4/HCPCS,BRAIN IMAGE < 4 VIEWS,,Case Rate,1447.04
Blue Shield,PPO,78601,CPT4/HCPCS,BRAIN IMAGE W/FLOW < 4 VIEWS,,Case Rate,1713.38
Blue Shield,PPO,78605,CPT4/HCPCS,BRAIN IMAGE 4+ VIEWS,,Case Rate,1713.38
Blue Shield,PPO,78606,CPT4/HCPCS,BRAIN IMAGE W/FLOW 4 + VIEWS,,Case Rate,1951.63
Blue Shield,PPO,78607,CPT4/HCPCS,BRAIN IMAGING (3D),,Case Rate,3307.25
Blue Shield,PPO,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,Case Rate,18766.19
Blue Shield,PPO,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,Case Rate,745.95
Blue Shield,PPO,78610,CPT4/HCPCS,BRAIN FLOW IMAGING ONLY,,Case Rate,800.58
Blue Shield,PPO,78630,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Case Rate,2538.80
Blue Shield,PPO,78635,CPT4/HCPCS,CSF VENTRICULOGRAPHY,,Case Rate,1288.26
Blue Shield,PPO,78645,CPT4/HCPCS,CSF SHUNT EVALUATION,,Case Rate,1727.82
Blue Shield,PPO,78647,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Case Rate,2978.36
Blue Shield,PPO,78650,CPT4/HCPCS,CSF LEAKAGE IMAGING,,Case Rate,2339.04
Blue Shield,PPO,78660,CPT4/HCPCS,NUCLEAR EXAM OF TEAR FLOW,,Case Rate,1068.48
Blue Shield,PPO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Per Diem,5692.00
Blue Shield,PPO,78700,CPT4/HCPCS,KIDNEY IMAGING MORPHOL,,Case Rate,1536.91
Blue Shield,PPO,78701,CPT4/HCPCS,KIDNEY IMAGING WITH FLOW,,Case Rate,1790.37
Blue Shield,PPO,78707,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/O DRUG,,Case Rate,2248.40
Blue Shield,PPO,78708,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/DRUG,,Case Rate,2248.40
Blue Shield,PPO,78709,CPT4/HCPCS,K FLOW/FUNCT IMAGE MULTIPLE,,Case Rate,2248.40
Blue Shield,PPO,78710,CPT4/HCPCS,KIDNEY IMAGING (3D),,Case Rate,2978.36
Blue Shield,PPO,78725,CPT4/HCPCS,KIDNEY FUNCTION STUDY,,Case Rate,905.66
Blue Shield,PPO,78730,CPT4/HCPCS,URINARY BLADDER RETENTION,,Case Rate,734.77
Blue Shield,PPO,78740,CPT4/HCPCS,URETERAL REFLUX STUDY,,Case Rate,1068.48
Blue Shield,PPO,78761,CPT4/HCPCS,TESTICULAR IMAGING W/FLOW,,Case Rate,1613.12
Blue Shield,PPO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Per Diem,5692.00
Blue Shield,PPO,78800,CPT4/HCPCS,RP LOCLZJ TUM 1 AREA 1 D IMG,,Case Rate,1713.38
Blue Shield,PPO,78801,CPT4/HCPCS,RP LOCLZJ TUM 2+AREA 1+D IMG,,Case Rate,2128.89
Blue Shield,PPO,78802,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 1 D IMG,,Case Rate,2791.48
Blue Shield,PPO,78803,CPT4/HCPCS,RP LOCLZJ TUM SPECT 1 AREA,,Case Rate,3307.25
Blue Shield,PPO,78804,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 2+D IMG,,Case Rate,2185.22
Blue Shield,PPO,78805,CPT4/HCPCS,ABSCESS IMAGING LTD AREA,,Case Rate,1713.38
Blue Shield,PPO,78806,CPT4/HCPCS,ABSCESS IMAGING WHOLE BODY,,Case Rate,3244.70
Blue Shield,PPO,78807,CPT4/HCPCS,NUCLEAR LOCALIZATION/ABSCESS,,Case Rate,3307.25
Blue Shield,PPO,78811,CPT4/HCPCS,PET IMAGE LTD AREA,,Case Rate,17587.83
Blue Shield,PPO,78812,CPT4/HCPCS,PET IMAGE SKULL-THIGH,,Case Rate,18766.19
Blue Shield,PPO,78813,CPT4/HCPCS,PET IMAGE FULL BODY,,Case Rate,19935.71
Blue Shield,PPO,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,Case Rate,17587.83
Blue Shield,PPO,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,Case Rate,18766.19
Blue Shield,PPO,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,Case Rate,19935.71
Blue Shield,PPO,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Case Rate,1317.13
Blue Shield,PPO,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,Case Rate,1317.13
Blue Shield,PPO,79200,CPT4/HCPCS,NUCLEAR RX INTRACAV ADMIN,,Case Rate,1317.13
Blue Shield,PPO,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Case Rate,711.49
Blue Shield,PPO,79403,CPT4/HCPCS,HEMATOPOIETIC NUCLEAR TX,,Case Rate,2120.67
Blue Shield,PPO,79440,CPT4/HCPCS,NUCLEAR RX INTRA-ARTICULAR,,Case Rate,1317.13
Blue Shield,PPO,79445,CPT4/HCPCS,NUCLEAR RX INTRA-ARTERIAL,,Case Rate,1325.20
Blue Shield,PPO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Per Diem,5692.00
Blue Shield,PPO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Per Diem,5692.00
Blue Shield,PPO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Per Diem,5692.00
Blue Shield,PPO,80050,CPT4/HCPCS,GENERAL HEALTH PANEL,,Case Rate,572.58
Blue Shield,PPO,80055,CPT4/HCPCS,OBSTETRIC PANEL,,Case Rate,654.38
Blue Shield,PPO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Per Diem,5692.00
Blue Shield,PPO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Per Diem,5692.00
Blue Shield,PPO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Per Diem,5692.00
Blue Shield,PPO,85396,CPT4/HCPCS,CLOTTING ASSAY WHOLE BLOOD,,Case Rate,93.12
Blue Shield,PPO,86077,CPT4/HCPCS,PHYS BLOOD BANK SERV XMATCH,,Case Rate,199.76
Blue Shield,PPO,86078,CPT4/HCPCS,PHYS BLOOD BANK SERV REACTJ,,Case Rate,233.44
Blue Shield,PPO,86079,CPT4/HCPCS,PHYS BLOOD BANK SERV AUTHRJ,,Case Rate,228.63
Blue Shield,PPO,86486,CPT4/HCPCS,SKIN TEST NOS ANTIGEN,,Case Rate,70.62
Blue Shield,PPO,86490,CPT4/HCPCS,COCCIDIOIDOMYCOSIS SKIN TEST,,Case Rate,147.61
Blue Shield,PPO,86510,CPT4/HCPCS,HISTOPLASMOSIS SKIN TEST,,Case Rate,162.04
Blue Shield,PPO,86580,CPT4/HCPCS,TB INTRADERMAL TEST,,Case Rate,133.17
Blue Shield,PPO,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,Case Rate,226.15
Blue Shield,PPO,86860,CPT4/HCPCS,RBC ANTIBODY ELUTION,,Case Rate,226.15
Blue Shield,PPO,86870,CPT4/HCPCS,RBC ANTIBODY IDENTIFICATION,,Case Rate,399.37
Blue Shield,PPO,86890,CPT4/HCPCS,AUTOLOGOUS BLOOD PROCESS,,Case Rate,914.21
Blue Shield,PPO,86891,CPT4/HCPCS,AUTOLOGOUS BLOOD OP SALVAGE,,Case Rate,1424.24
Blue Shield,PPO,86910,CPT4/HCPCS,BLOOD TYPING PATERNITY TEST,,Case Rate,250.20
Blue Shield,PPO,86911,CPT4/HCPCS,BLOOD TYPING ANTIGEN SYSTEM,,Case Rate,192.47
Blue Shield,PPO,86920,CPT4/HCPCS,COMPATIBILITY TEST SPIN,,Case Rate,250.20
Blue Shield,PPO,86921,CPT4/HCPCS,COMPATIBILITY TEST INCUBATE,,Case Rate,226.15
Blue Shield,PPO,86922,CPT4/HCPCS,COMPATIBILITY TEST ANTIGLOB,,Case Rate,134.73
Blue Shield,PPO,86927,CPT4/HCPCS,PLASMA FRESH FROZEN,,Case Rate,125.10
Blue Shield,PPO,86930,CPT4/HCPCS,FROZEN BLOOD PREP,,Case Rate,1140.36
Blue Shield,PPO,86931,CPT4/HCPCS,FROZEN BLOOD THAW,,Case Rate,1255.83
Blue Shield,PPO,86932,CPT4/HCPCS,FROZEN BLOOD FREEZE/THAW,,Case Rate,1366.50
Blue Shield,PPO,86945,CPT4/HCPCS,BLOOD PRODUCT/IRRADIATION,,Case Rate,341.63
Blue Shield,PPO,86950,CPT4/HCPCS,LEUKACYTE TRANSFUSION,,Case Rate,625.51
Blue Shield,PPO,86965,CPT4/HCPCS,POOLING BLOOD PLATELETS,,Case Rate,158.78
Blue Shield,PPO,86970,CPT4/HCPCS,RBC PRETX INCUBATJ W/CHEMICL,,Case Rate,182.84
Blue Shield,PPO,86971,CPT4/HCPCS,RBC PRETX INCUBATJ W/ENZYMES,,Case Rate,182.84
Blue Shield,PPO,86972,CPT4/HCPCS,RBC PRETX INCUBATJ W/DENSITY,,Case Rate,173.22
Blue Shield,PPO,86975,CPT4/HCPCS,RBC SERUM PRETX INCUBJ DRUGS,,Case Rate,115.48
Blue Shield,PPO,86976,CPT4/HCPCS,RBC SERUM PRETX ID DILUTION,,Case Rate,91.42
Blue Shield,PPO,86977,CPT4/HCPCS,RBC SERUM PRETX INCUBJ/INHIB,,Case Rate,115.48
Blue Shield,PPO,86978,CPT4/HCPCS,RBC PRETREATMENT SERUM,,Case Rate,250.20
Blue Shield,PPO,86985,CPT4/HCPCS,SPLIT BLOOD OR PRODUCTS,,Case Rate,240.58
Blue Shield,PPO,88104,CPT4/HCPCS,CYTOPATH FL NONGYN SMEARS,,Case Rate,248.65
Blue Shield,PPO,88106,CPT4/HCPCS,CYTOPATH FL NONGYN FILTER,,Case Rate,186.10
Blue Shield,PPO,88108,CPT4/HCPCS,CYTOPATH CONCENTRATE TECH,,Case Rate,277.52
Blue Shield,PPO,88112,CPT4/HCPCS,CYTOPATH CELL ENHANCE TECH,,Case Rate,715.38
Blue Shield,PPO,88120,CPT4/HCPCS,CYTP URNE 3-5 PROBES EA SPEC,,Case Rate,5718.69
Blue Shield,PPO,88121,CPT4/HCPCS,CYTP URINE 3-5 PROBES CMPTR,,Case Rate,4796.42
Blue Shield,PPO,88125,CPT4/HCPCS,FORENSIC CYTOPATHOLOGY,,Case Rate,71.40
Blue Shield,PPO,88160,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,344.88
Blue Shield,PPO,88161,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,325.64
Blue Shield,PPO,88162,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Case Rate,171.66
Blue Shield,PPO,88172,CPT4/HCPCS,CYTP DX EVAL FNA 1ST EA SITE,,Case Rate,195.72
Blue Shield,PPO,88173,CPT4/HCPCS,CYTOPATH EVAL FNA REPORT,,Case Rate,561.41
Blue Shield,PPO,88177,CPT4/HCPCS,CYTP FNA EVAL EA ADDL,,Case Rate,90.64
Blue Shield,PPO,88182,CPT4/HCPCS,CELL MARKER STUDY,,Case Rate,617.59
Blue Shield,PPO,88184,CPT4/HCPCS,FLOWCYTOMETRY/ TC 1 MARKER,,Case Rate,643.20
Blue Shield,PPO,88185,CPT4/HCPCS,FLOWCYTOMETRY/TC ADD-ON,,Case Rate,316.01
Blue Shield,PPO,88187,CPT4/HCPCS,FLOWCYTOMETRY/READ 2-8,,Case Rate,220.56
Blue Shield,PPO,88188,CPT4/HCPCS,FLOWCYTOMETRY/READ 9-15,,Case Rate,278.30
Blue Shield,PPO,88189,CPT4/HCPCS,FLOWCYTOMETRY/READ 16 & >,,Case Rate,364.91
Blue Shield,PPO,88291,CPT4/HCPCS,CYTO/MOLECULAR REPORT,,Case Rate,89.87
Blue Shield,PPO,88300,CPT4/HCPCS,SURGICAL PATH GROSS,,Case Rate,119.51
Blue Shield,PPO,88302,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,311.20
Blue Shield,PPO,88304,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,378.56
Blue Shield,PPO,88305,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,689.77
Blue Shield,PPO,88307,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,967.29
Blue Shield,PPO,88309,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Case Rate,1106.82
Blue Shield,PPO,88311,CPT4/HCPCS,DECALCIFY TISSUE,,Case Rate,47.34
Blue Shield,PPO,88312,CPT4/HCPCS,SPECIAL STAINS GROUP 1,,Case Rate,538.13
Blue Shield,PPO,88313,CPT4/HCPCS,SPECIAL STAINS GROUP 2,,Case Rate,475.57
Blue Shield,PPO,88314,CPT4/HCPCS,HISTOCHEMICAL STAINS ADD-ON,,Case Rate,340.07
Blue Shield,PPO,88319,CPT4/HCPCS,ENZYME HISTOCHEMISTRY,,Case Rate,806.80
Blue Shield,PPO,88323,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Case Rate,417.06
Blue Shield,PPO,88331,CPT4/HCPCS,PATH CONSULT INTRAOP 1 BLOC,,Case Rate,237.47
Blue Shield,PPO,88332,CPT4/HCPCS,PATH CONSULT INTRAOP ADDL,,Case Rate,123.55
Blue Shield,PPO,88333,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 1,,Case Rate,280.78
Blue Shield,PPO,88334,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 2,,Case Rate,171.66
Blue Shield,PPO,88341,CPT4/HCPCS,IMMUNOHISTO ANTB ADDL SLIDE,,Case Rate,610.30
Blue Shield,PPO,88342,CPT4/HCPCS,IMMUNOHISTO ANTB 1ST STAIN,,Case Rate,479.61
Blue Shield,PPO,88344,CPT4/HCPCS,IMMUNOHISTO ANTIBODY SLIDE,,Case Rate,1033.72
Blue Shield,PPO,88346,CPT4/HCPCS,IMMUNOFLUOR ANTB 1ST STAIN,,Case Rate,522.91
Blue Shield,PPO,88348,CPT4/HCPCS,ELECTRON MICROSCOPY,,Case Rate,3790.93
Blue Shield,PPO,88350,CPT4/HCPCS,IMMUNOFLUOR ANTB ADDL STAIN,,Case Rate,591.05
Blue Shield,PPO,88355,CPT4/HCPCS,ANALYSIS SKELETAL MUSCLE,,Case Rate,890.30
Blue Shield,PPO,88356,CPT4/HCPCS,ANALYSIS NERVE,,Case Rate,798.10
Blue Shield,PPO,88358,CPT4/HCPCS,ANALYSIS TUMOR,,Case Rate,100.41
Blue Shield,PPO,88360,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/MANUAL,,Case Rate,614.33
Blue Shield,PPO,88361,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/COMPUT,,Case Rate,1077.18
Blue Shield,PPO,88362,CPT4/HCPCS,NERVE TEASING PREPARATIONS,,Case Rate,1693.84
Blue Shield,PPO,88363,CPT4/HCPCS,XM ARCHIVE TISSUE MOLEC ANAL,,Case Rate,60.22
Blue Shield,PPO,88364,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,942.30
Blue Shield,PPO,88365,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,874.16
Blue Shield,PPO,88366,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Case Rate,1158.82
Blue Shield,PPO,88367,CPT4/HCPCS,INSITU HYBRIDIZATION AUTO,,Case Rate,1741.96
Blue Shield,PPO,88368,CPT4/HCPCS,INSITU HYBRIDIZATION MANUAL,,Case Rate,1419.58
Blue Shield,PPO,88369,CPT4/HCPCS,M/PHMTRC ALYSISHQUANT/SEMIQ,,Case Rate,653.60
Blue Shield,PPO,88373,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,523.69
Blue Shield,PPO,88374,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,2150.02
Blue Shield,PPO,88377,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Case Rate,2000.86
Blue Shield,PPO,88381,CPT4/HCPCS,MICRODISSECTION MANUAL,,Case Rate,2004.89
Blue Shield,PPO,88387,CPT4/HCPCS,TISS EXAM MOLECULAR STUDY,,Case Rate,105.08
Blue Shield,PPO,88388,CPT4/HCPCS,TISS EX MOLECUL STUDY ADD-ON,,Case Rate,52.15
Blue Shield,PPO,89049,CPT4/HCPCS,CHCT FOR MAL HYPERTHERMIA,,Case Rate,1737.15
Blue Shield,PPO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Case Rate,404.18
Blue Shield,PPO,89230,CPT4/HCPCS,COLLECT SWEAT FOR TEST,,Case Rate,769.86
Blue Shield,PPO,89250,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Case Rate,12919.22
Blue Shield,PPO,90801,CPT4/HCPCS,PSY DX INTERVIEW,,Case Rate,312.90
Blue Shield,PPO,90802,CPT4/HCPCS,INTAC PSY DX INTERVIEW,,Case Rate,345.81
Blue Shield,PPO,90804,CPT4/HCPCS,PSYTX OFFICE 20-30 MIN,,Case Rate,117.96
Blue Shield,PPO,90805,CPT4/HCPCS,PSYTX OFF 20-30 MIN W/E&M,,Case Rate,127.58
Blue Shield,PPO,90806,CPT4/HCPCS,PSYTX OFF 45-50 MIN,,Case Rate,174.92
Blue Shield,PPO,90807,CPT4/HCPCS,PSYTX OFF 45-50 MIN W/E&M,,Case Rate,193.39
Blue Shield,PPO,90808,CPT4/HCPCS,PSYTX OFFICE 75-80 MIN,,Case Rate,259.98
Blue Shield,PPO,90809,CPT4/HCPCS,PSYTX OFF 75-80 W/E&M,,Case Rate,283.26
Blue Shield,PPO,90810,CPT4/HCPCS,INTAC PSYTX OFF 20-30 MIN,,Case Rate,131.62
Blue Shield,PPO,90811,CPT4/HCPCS,INTAC PSYTX 20-30 W/E&M,,Case Rate,141.24
Blue Shield,PPO,90812,CPT4/HCPCS,INTAC PSYTX OFF 45-50 MIN,,Case Rate,184.54
Blue Shield,PPO,90813,CPT4/HCPCS,INTAC PSYTX 45-50 MIN W/E&M,,Case Rate,203.01
Blue Shield,PPO,90814,CPT4/HCPCS,INTAC PSYTX OFF 75-80 MIN,,Case Rate,274.41
Blue Shield,PPO,90815,CPT4/HCPCS,INTAC PSYTX 75-80 W/E&M,,Case Rate,288.07
Blue Shield,PPO,90816,CPT4/HCPCS,PSYTX HOSP 20-30 MIN,,Case Rate,166.08
Blue Shield,PPO,90817,CPT4/HCPCS,PSYTX HOSP 20-30 MIN W/E&M,,Case Rate,185.32
Blue Shield,PPO,90818,CPT4/HCPCS,PSYTX HOSP 45-50 MIN,,Case Rate,223.04
Blue Shield,PPO,90819,CPT4/HCPCS,PSYTX HOSP 45-50 MIN W/E&M,,Case Rate,246.32
Blue Shield,PPO,90821,CPT4/HCPCS,PSYTX HOSP 75-80 MIN,,Case Rate,312.90
Blue Shield,PPO,90822,CPT4/HCPCS,PSYTX HOSP 75-80 MIN W/E&M,,Case Rate,340.22
Blue Shield,PPO,90823,CPT4/HCPCS,INTAC PSYTX HOSP 20-30 MIN,,Case Rate,175.70
Blue Shield,PPO,90824,CPT4/HCPCS,INTAC PSYTX HSP 20-30 W/E&M,,Case Rate,198.98
Blue Shield,PPO,90826,CPT4/HCPCS,INTAC PSYTX HOSP 45-50 MIN,,Case Rate,241.51
Blue Shield,PPO,90827,CPT4/HCPCS,INTAC PSYTX HSP 45-50 W/E&M,,Case Rate,255.94
Blue Shield,PPO,90828,CPT4/HCPCS,INTAC PSYTX HOSP 75-80 MIN,,Case Rate,317.72
Blue Shield,PPO,90829,CPT4/HCPCS,INTAC PSYTX HSP 75-80 W/E&M,,Case Rate,345.81
Blue Shield,PPO,90845,CPT4/HCPCS,PSYCHOANALYSIS,,Case Rate,170.11
Blue Shield,PPO,90846,CPT4/HCPCS,FAMILY PSYTX W/O PT 50 MIN,,Case Rate,223.04
Blue Shield,PPO,90847,CPT4/HCPCS,FAMILY PSYTX W/PT 50 MIN,,Case Rate,255.94
Blue Shield,PPO,90849,CPT4/HCPCS,MULTIPLE FAMILY GROUP PSYTX,,Case Rate,104.30
Blue Shield,PPO,90853,CPT4/HCPCS,GROUP PSYCHOTHERAPY,,Case Rate,100.27
Blue Shield,PPO,90857,CPT4/HCPCS,INTAC GROUP PSYTX,,Case Rate,105.08
Blue Shield,PPO,90862,CPT4/HCPCS,MEDICATION MANAGEMENT,,Case Rate,137.98
Blue Shield,PPO,90865,CPT4/HCPCS,NARCOSYNTHESIS,,Case Rate,361.17
Blue Shield,PPO,90867,CPT4/HCPCS,TCRANIAL MAGN STIM TX PLAN,,Fee Schedule,987.79
Blue Shield,PPO,90868,CPT4/HCPCS,TCRANIAL MAGN STIM TX DELI,,Fee Schedule,987.79
Blue Shield,PPO,90869,CPT4/HCPCS,TCRAN MAGN STIM REDETEMINE,,Fee Schedule,3198.57
Blue Shield,PPO,90870,CPT4/HCPCS,ELECTROCONVULSIVE THERAPY,,Case Rate,203.79
Blue Shield,PPO,90875,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,Case Rate,150.86
Blue Shield,PPO,90876,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,Case Rate,231.88
Blue Shield,PPO,90880,CPT4/HCPCS,HYPNOTHERAPY,,Case Rate,207.83
Blue Shield,PPO,90885,CPT4/HCPCS,PSY EVALUATION OF RECORDS,,Case Rate,113.92
Blue Shield,PPO,90887,CPT4/HCPCS,CONSULTATION WITH FAMILY,,Case Rate,179.73
Blue Shield,PPO,90935,CPT4/HCPCS,HEMODIALYSIS ONE EVALUATION,,Case Rate,338.52
Blue Shield,PPO,90937,CPT4/HCPCS,HEMODIALYSIS REPEATED EVAL,,Case Rate,494.97
Blue Shield,PPO,90940,CPT4/HCPCS,HEMODIALYSIS ACCESS STUDY,,Case Rate,629.69
Blue Shield,PPO,90945,CPT4/HCPCS,DIALYSIS ONE EVALUATION,,Case Rate,348.14
Blue Shield,PPO,90947,CPT4/HCPCS,DIALYSIS REPEATED EVAL,,Case Rate,504.59
Blue Shield,PPO,90997,CPT4/HCPCS,HEMOPERFUSION,,Case Rate,341.77
Blue Shield,PPO,91010,CPT4/HCPCS,ESOPHAGUS MOTILITY STUDY,,Case Rate,1121.26
Blue Shield,PPO,91013,CPT4/HCPCS,ESOPHGL MOTIL W/STIM/PERFUS,,Case Rate,186.88
Blue Shield,PPO,91020,CPT4/HCPCS,GASTRIC MOTILITY STUDIES,,Case Rate,1203.05
Blue Shield,PPO,91022,CPT4/HCPCS,DUODENAL MOTILITY STUDY,,Case Rate,1900.74
Blue Shield,PPO,91030,CPT4/HCPCS,ACID PERFUSION OF ESOPHAGUS,,Case Rate,1004.08
Blue Shield,PPO,91034,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX TEST,,Case Rate,2381.90
Blue Shield,PPO,91035,CPT4/HCPCS,G-ESOPH REFLX TST W/ELECTROD,,Case Rate,4951.31
Blue Shield,PPO,91037,CPT4/HCPCS,ESOPH IMPED FUNCTION TEST,,Case Rate,1270.42
Blue Shield,PPO,91038,CPT4/HCPCS,ESOPH IMPED FUNCT TEST > 1HR,,Case Rate,904.73
Blue Shield,PPO,91040,CPT4/HCPCS,ESOPH BALLOON DISTENSION TST,,Case Rate,5215.95
Blue Shield,PPO,91060,CPT4/HCPCS,GASTRIC SALINE LOAD TEST,,Case Rate,85.05
Blue Shield,PPO,91065,CPT4/HCPCS,BREATH HYDROGEN/METHANE TEST,,Case Rate,917.47
Blue Shield,PPO,91110,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,Case Rate,9569.70
Blue Shield,PPO,91111,CPT4/HCPCS,ESOPHAGEAL CAPSULE ENDOSCOPY,,Case Rate,8760.42
Blue Shield,PPO,91112,CPT4/HCPCS,GI WIRELESS CAPSULE MEASURE,,Fee Schedule,4280.44
Blue Shield,PPO,91120,CPT4/HCPCS,RECTAL SENSATION TEST,,Case Rate,5135.71
Blue Shield,PPO,91122,CPT4/HCPCS,ANAL PRESSURE RECORD,,Case Rate,2659.42
Blue Shield,PPO,91132,CPT4/HCPCS,ELECTROGASTROGRAPHY,,Case Rate,190.91
Blue Shield,PPO,91133,CPT4/HCPCS,ELECTROGASTROGRAPHY W/TEST,,Case Rate,243.06
Blue Shield,PPO,91200,CPT4/HCPCS,LIVER ELASTOGRAPHY,,Case Rate,287.92
Blue Shield,PPO,92002,CPT4/HCPCS,EYE EXAM NEW PATIENT,,Case Rate,474.80
Blue Shield,PPO,92004,CPT4/HCPCS,EYE EXAM NEW PATIENT,,Case Rate,834.11
Blue Shield,PPO,92012,CPT4/HCPCS,EYE EXAM ESTABLISH PATIENT,,Case Rate,503.67
Blue Shield,PPO,92014,CPT4/HCPCS,EYE EXAM&TX ESTAB PT 1/>VST,,Case Rate,690.54
Blue Shield,PPO,92015,CPT4/HCPCS,DETERMINE REFRACTIVE STATE,,Case Rate,720.97
Blue Shield,PPO,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,Case Rate,543.08
Blue Shield,PPO,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,Case Rate,281.55
Blue Shield,PPO,92020,CPT4/HCPCS,SPECIAL EYE EVALUATION,,Case Rate,167.63
Blue Shield,PPO,92025,CPT4/HCPCS,CORNEAL TOPOGRAPHY,,Case Rate,158.01
Blue Shield,PPO,92060,CPT4/HCPCS,SPECIAL EYE EVALUATION,,Case Rate,210.93
Blue Shield,PPO,92065,CPT4/HCPCS,ORTHOPTIC/PLEOPTIC TRAINING,,Case Rate,191.69
Blue Shield,PPO,92071,CPT4/HCPCS,CONTACT LENS FITTING FOR TX,,Case Rate,175.70
Blue Shield,PPO,92072,CPT4/HCPCS,FIT CONTAC LENS FOR MANAGMNT,,Case Rate,395.63
Blue Shield,PPO,92081,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,340.85
Blue Shield,PPO,92082,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,465.95
Blue Shield,PPO,92083,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,Case Rate,538.13
Blue Shield,PPO,92100,CPT4/HCPCS,SERIAL TONOMETRY EXAM(S),,Case Rate,657.64
Blue Shield,PPO,92132,CPT4/HCPCS,CMPTR OPHTH DX IMG ANT SEGMT,,Fee Schedule,987.79
Blue Shield,PPO,92133,CPT4/HCPCS,CMPTR OPHTH IMG OPTIC NERVE,,Fee Schedule,987.79
Blue Shield,PPO,92134,CPT4/HCPCS,CPTR OPHTH DX IMG POST SEGMT,,Fee Schedule,987.79
Blue Shield,PPO,92136,CPT4/HCPCS,OPHTHALMIC BIOMETRY,,Case Rate,749.98
Blue Shield,PPO,92140,CPT4/HCPCS,GLAUCOMA PROVOCATIVE TESTS,,Case Rate,480.39
Blue Shield,PPO,92225,CPT4/HCPCS,SPECIAL EYE EXAM INITIAL,,Case Rate,109.89
Blue Shield,PPO,92226,CPT4/HCPCS,SPECIAL EYE EXAM SUBSEQUENT,,Case Rate,105.08
Blue Shield,PPO,92227,CPT4/HCPCS,IMG RTA DETCJ/MNTR DS STAFF,,Case Rate,162.82
Blue Shield,PPO,92228,CPT4/HCPCS,IMG RTA DETC/MNTR DS PHY/QHP,,Case Rate,177.25
Blue Shield,PPO,92230,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Case Rate,744.25
Blue Shield,PPO,92235,CPT4/HCPCS,FLUORESCEIN ANGRPH UNI/BI,,Case Rate,1255.98
Blue Shield,PPO,92240,CPT4/HCPCS,ICG ANGIOGRAPHY UNI/BI,,Case Rate,3171.01
Blue Shield,PPO,92250,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,Case Rate,740.21
Blue Shield,PPO,92260,CPT4/HCPCS,OPHTHALMOSCOPY/DYNAMOMETRY,,Case Rate,129.14
Blue Shield,PPO,92265,CPT4/HCPCS,EYE MUSCLE EVALUATION,,Case Rate,777.93
Blue Shield,PPO,92270,CPT4/HCPCS,ELECTRO-OCULOGRAPHY,,Case Rate,595.09
Blue Shield,PPO,92275,CPT4/HCPCS,ELECTRORETINOGRAPHY,,Case Rate,734.62
Blue Shield,PPO,92283,CPT4/HCPCS,COLOR VISION EXAMINATION,,Case Rate,369.72
Blue Shield,PPO,92284,CPT4/HCPCS,DARK ADAPTATION EYE EXAM,,Case Rate,1072.22
Blue Shield,PPO,92285,CPT4/HCPCS,EYE PHOTOGRAPHY,,Case Rate,475.57
Blue Shield,PPO,92286,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,Case Rate,1485.24
Blue Shield,PPO,92287,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,Case Rate,1158.05
Blue Shield,PPO,92310,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,555.04
Blue Shield,PPO,92311,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,536.57
Blue Shield,PPO,92312,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,531.76
Blue Shield,PPO,92313,CPT4/HCPCS,CONTACT LENS FITTING,,Case Rate,518.10
Blue Shield,PPO,92314,CPT4/HCPCS,PRESCRIPTION OF CONTACT LENS,,Case Rate,456.33
Blue Shield,PPO,92315,CPT4/HCPCS,RX CNTACT LENS APHAKIA 1 EYE,,Case Rate,413.02
Blue Shield,PPO,92316,CPT4/HCPCS,RX CNTACT LENS APHAKIA 2 EYE,,Case Rate,445.93
Blue Shield,PPO,92317,CPT4/HCPCS,RX CORNEOSCLERAL CNTACT LENS,,Case Rate,456.33
Blue Shield,PPO,92325,CPT4/HCPCS,MODIFICATION OF CONTACT LENS,,Case Rate,196.50
Blue Shield,PPO,92326,CPT4/HCPCS,REPLACEMENT OF CONTACT LENS,,Case Rate,808.50
Blue Shield,PPO,92340,CPT4/HCPCS,FIT SPECTACLES MONOFOCAL,,Case Rate,340.85
Blue Shield,PPO,92341,CPT4/HCPCS,FIT SPECTACLES BIFOCAL,,Case Rate,360.09
Blue Shield,PPO,92342,CPT4/HCPCS,FIT SPECTACLES MULTIFOCAL,,Case Rate,369.72
Blue Shield,PPO,92352,CPT4/HCPCS,FIT APHAKIA SPECTCL MONOFOCL,,Case Rate,331.23
Blue Shield,PPO,92353,CPT4/HCPCS,FIT APHAKIA SPECTCL MULTIFOC,,Case Rate,359.32
Blue Shield,PPO,92354,CPT4/HCPCS,FIT SPECTACLES SINGLE SYSTEM,,Case Rate,4317.88
Blue Shield,PPO,92355,CPT4/HCPCS,FIT SPECTACLES COMPOUND LENS,,Case Rate,2092.28
Blue Shield,PPO,92358,CPT4/HCPCS,APHAKIA PROSTH SERVICE TEMP,,Case Rate,486.90
Blue Shield,PPO,92370,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,Case Rate,272.71
Blue Shield,PPO,92371,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,Case Rate,306.39
Blue Shield,PPO,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,Case Rate,554.26
Blue Shield,PPO,92504,CPT4/HCPCS,EAR MICROSCOPY EXAMINATION,,Case Rate,244.62
Blue Shield,PPO,92506,CPT4/HCPCS,SPEECH/HEARING EVALUATION,,Case Rate,1263.13
Blue Shield,PPO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,542.16
Blue Shield,PPO,92508,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,249.43
Blue Shield,PPO,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,Case Rate,1609.56
Blue Shield,PPO,92512,CPT4/HCPCS,NASAL FUNCTION STUDIES,,Case Rate,556.59
Blue Shield,PPO,92516,CPT4/HCPCS,FACIAL NERVE FUNCTION TEST,,Case Rate,581.43
Blue Shield,PPO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,Case Rate,257.50
Blue Shield,PPO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,Case Rate,797.18
Blue Shield,PPO,92537,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,Fee Schedule,987.79
Blue Shield,PPO,92538,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,Fee Schedule,987.79
Blue Shield,PPO,92540,CPT4/HCPCS,BASIC VESTIBULAR EVALUATION,,Case Rate,220.56
Blue Shield,PPO,92541,CPT4/HCPCS,SPONTANEOUS NYSTAGMUS TEST,,Case Rate,383.38
Blue Shield,PPO,92542,CPT4/HCPCS,POSITIONAL NYSTAGMUS TEST,,Case Rate,441.12
Blue Shield,PPO,92543,CPT4/HCPCS,CALORIC VESTIBULAR TEST,,Case Rate,234.99
Blue Shield,PPO,92544,CPT4/HCPCS,OPTOKINETIC NYSTAGMUS TEST,,Case Rate,354.51
Blue Shield,PPO,92545,CPT4/HCPCS,OSCILLATING TRACKING TEST,,Case Rate,335.26
Blue Shield,PPO,92546,CPT4/HCPCS,SINUSOIDAL ROTATIONAL TEST,,Case Rate,811.61
Blue Shield,PPO,92547,CPT4/HCPCS,SUPPLEMENTAL ELECTRICAL TEST,,Case Rate,577.54
Blue Shield,PPO,92548,CPT4/HCPCS,CDP-SOT 6 COND W/I&R,,Case Rate,1462.25
Blue Shield,PPO,92550,CPT4/HCPCS,TYMPANOMETRY & REFLEX THRESH,,Case Rate,105.08
Blue Shield,PPO,92552,CPT4/HCPCS,PURE TONE AUDIOMETRY AIR,,Case Rate,227.85
Blue Shield,PPO,92553,CPT4/HCPCS,AUDIOMETRY AIR & BONE,,Case Rate,341.77
Blue Shield,PPO,92555,CPT4/HCPCS,SPEECH THRESHOLD AUDIOMETRY,,Case Rate,194.17
Blue Shield,PPO,92556,CPT4/HCPCS,SPEECH AUDIOMETRY COMPLETE,,Case Rate,298.47
Blue Shield,PPO,92557,CPT4/HCPCS,COMPREHENSIVE HEARING TEST,,Case Rate,621.00
Blue Shield,PPO,92561,CPT4/HCPCS,BEKESY AUDIOMETRY DIAGNOSIS,,Case Rate,370.64
Blue Shield,PPO,92562,CPT4/HCPCS,LOUDNESS BALANCE TEST,,Case Rate,208.60
Blue Shield,PPO,92563,CPT4/HCPCS,TONE DECAY HEARING TEST,,Case Rate,194.17
Blue Shield,PPO,92564,CPT4/HCPCS,SISI HEARING TEST,,Case Rate,246.32
Blue Shield,PPO,92565,CPT4/HCPCS,STENGER TEST PURE TONE,,Case Rate,203.79
Blue Shield,PPO,92567,CPT4/HCPCS,TYMPANOMETRY,,Case Rate,274.41
Blue Shield,PPO,92568,CPT4/HCPCS,ACOUSTIC REFL THRESHOLD TST,,Case Rate,194.17
Blue Shield,PPO,92570,CPT4/HCPCS,ACOUSTIC IMMITANCE TESTING,,Case Rate,128.36
Blue Shield,PPO,92571,CPT4/HCPCS,FILTERED SPEECH HEARING TEST,,Case Rate,198.98
Blue Shield,PPO,92572,CPT4/HCPCS,STAGGERED SPONDAIC WORD TEST,,Case Rate,47.34
Blue Shield,PPO,92575,CPT4/HCPCS,SENSORINEURAL ACUITY TEST,,Case Rate,152.42
Blue Shield,PPO,92576,CPT4/HCPCS,SYNTHETIC SENTENCE TEST,,Case Rate,231.88
Blue Shield,PPO,92577,CPT4/HCPCS,STENGER TEST SPEECH,,Case Rate,374.68
Blue Shield,PPO,92579,CPT4/HCPCS,VISUAL AUDIOMETRY (VRA),,Case Rate,375.45
Blue Shield,PPO,92582,CPT4/HCPCS,CONDITIONING PLAY AUDIOMETRY,,Case Rate,375.45
Blue Shield,PPO,92583,CPT4/HCPCS,SELECT PICTURE AUDIOMETRY,,Case Rate,460.51
Blue Shield,PPO,92584,CPT4/HCPCS,ELECTROCOCHLEOGRAPHY,,Case Rate,1282.82
Blue Shield,PPO,92585,CPT4/HCPCS,AUDITOR EVOKE POTENT COMPRE,,Case Rate,951.44
Blue Shield,PPO,92586,CPT4/HCPCS,AUDITOR EVOKE POTENT LIMIT,,Case Rate,951.44
Blue Shield,PPO,92587,CPT4/HCPCS,EVOKED AUDITORY TEST LIMITED,,Case Rate,674.70
Blue Shield,PPO,92588,CPT4/HCPCS,EVOKED AUDITORY TST COMPLETE,,Case Rate,759.76
Blue Shield,PPO,92596,CPT4/HCPCS,EAR PROTECTOR EVALUATION,,Case Rate,308.09
Blue Shield,PPO,92597,CPT4/HCPCS,ORAL SPEECH DEVICE EVAL,,Case Rate,825.27
Blue Shield,PPO,92601,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM <7,,Case Rate,1669.01
Blue Shield,PPO,92602,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT <7,,Case Rate,1163.78
Blue Shield,PPO,92603,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM 7/>,,Case Rate,1101.23
Blue Shield,PPO,92604,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT 7/>,,Case Rate,735.55
Blue Shield,PPO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,Case Rate,1569.52
Blue Shield,PPO,92608,CPT4/HCPCS,EX FOR SPEECH DEVICE RX ADDL,,Case Rate,342.55
Blue Shield,PPO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,Case Rate,786.00
Blue Shield,PPO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,Case Rate,1687.47
Blue Shield,PPO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,Case Rate,1687.47
Blue Shield,PPO,92612,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) VID,,Case Rate,1339.33
Blue Shield,PPO,92613,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) I&R,,Case Rate,212.64
Blue Shield,PPO,92614,CPT4/HCPCS,LARYNGOSCOPIC SENSORY VID,,Case Rate,1223.86
Blue Shield,PPO,92615,CPT4/HCPCS,LARYNGOSCOPIC SENSORY I&R,,Case Rate,188.58
Blue Shield,PPO,92616,CPT4/HCPCS,FEES W/LARYNGEAL SENSE TEST,,Case Rate,1660.16
Blue Shield,PPO,92617,CPT4/HCPCS,FEES W/LARYNGEAL SENSE I&R,,Case Rate,231.88
Blue Shield,PPO,92618,CPT4/HCPCS,EX FOR NONSPEECH DEV RX ADD,,Case Rate,137.21
Blue Shield,PPO,92620,CPT4/HCPCS,AUDITORY FUNCTION 60 MIN,,Case Rate,572.73
Blue Shield,PPO,92621,CPT4/HCPCS,AUDITORY FUNCTION + 15 MIN,,Case Rate,144.50
Blue Shield,PPO,92625,CPT4/HCPCS,TINNITUS ASSESSMENT,,Case Rate,563.11
Blue Shield,PPO,92626,CPT4/HCPCS,EVAL AUD FUNCJ 1ST HOUR,,Case Rate,1082.76
Blue Shield,PPO,92627,CPT4/HCPCS,EVAL AUD FUNCJ EA ADDL 15,,Case Rate,272.71
Blue Shield,PPO,92640,CPT4/HCPCS,AUD BRAINSTEM IMPLT PROGRAMG,,Case Rate,677.66
Blue Shield,PPO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Fee Schedule,6876.92
Blue Shield,PPO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Fee Schedule,6876.92
Blue Shield,PPO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Fee Schedule,6876.92
Blue Shield,PPO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Fee Schedule,6876.92
Blue Shield,PPO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Fee Schedule,6876.92
Blue Shield,PPO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Fee Schedule,6876.92
Blue Shield,PPO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Fee Schedule,6876.92
Blue Shield,PPO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Fee Schedule,6876.92
Blue Shield,PPO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Fee Schedule,6876.92
Blue Shield,PPO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Fee Schedule,6876.92
Blue Shield,PPO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Fee Schedule,6876.92
Blue Shield,PPO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Fee Schedule,6876.92
Blue Shield,PPO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Fee Schedule,6876.92
Blue Shield,PPO,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,Case Rate,2138.66
Blue Shield,PPO,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,Case Rate,41.75
Blue Shield,PPO,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Case Rate,3074.00
Blue Shield,PPO,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,Case Rate,1122.63
Blue Shield,PPO,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,Case Rate,574.58
Blue Shield,PPO,92971,CPT4/HCPCS,CARDIOASSIST EXTERNAL,,Case Rate,433.19
Blue Shield,PPO,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Case Rate,1558.60
Blue Shield,PPO,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Case Rate,4073.37
Blue Shield,PPO,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,Case Rate,2300.55
Blue Shield,PPO,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,Case Rate,1159.12
Blue Shield,PPO,92980,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Case Rate,3336.19
Blue Shield,PPO,92981,CPT4/HCPCS,INSERT INTRACORONARY STENT,,Case Rate,901.29
Blue Shield,PPO,92982,CPT4/HCPCS,CORONARY ARTERY DILATION,,Case Rate,2491.09
Blue Shield,PPO,92984,CPT4/HCPCS,CORONARY ARTERY DILATION,,Case Rate,642.87
Blue Shield,PPO,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,Fee Schedule,12850.71
Blue Shield,PPO,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Fee Schedule,12850.71
Blue Shield,PPO,92990,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Fee Schedule,12850.71
Blue Shield,PPO,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,3198.57
Blue Shield,PPO,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Fee Schedule,3198.57
Blue Shield,PPO,92995,CPT4/HCPCS,CORONARY ATHERECTOMY,,Case Rate,2730.26
Blue Shield,PPO,92996,CPT4/HCPCS,CORONARY ATHERECTOMY ADD-ON,,Case Rate,651.42
Blue Shield,PPO,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Fee Schedule,9548.66
Blue Shield,PPO,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Fee Schedule,9548.66
Blue Shield,PPO,93000,CPT4/HCPCS,ELECTROCARDIOGRAM COMPLETE,,Case Rate,257.50
Blue Shield,PPO,93005,CPT4/HCPCS,ELECTROCARDIOGRAM TRACING,,Case Rate,224.59
Blue Shield,PPO,93010,CPT4/HCPCS,ELECTROCARDIOGRAM REPORT,,Case Rate,32.90
Blue Shield,PPO,93015,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,999.56
Blue Shield,PPO,93016,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,89.87
Blue Shield,PPO,93017,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,857.54
Blue Shield,PPO,93018,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Case Rate,56.96
Blue Shield,PPO,93024,CPT4/HCPCS,CARDIAC DRUG STRESS TEST,,Case Rate,571.18
Blue Shield,PPO,93025,CPT4/HCPCS,MICROVOLT T-WAVE ASSESS,,Case Rate,3840.75
Blue Shield,PPO,93040,CPT4/HCPCS,RHYTHM ECG WITH REPORT,,Case Rate,104.30
Blue Shield,PPO,93041,CPT4/HCPCS,RHYTHM ECG TRACING,,Case Rate,76.21
Blue Shield,PPO,93042,CPT4/HCPCS,RHYTHM ECG REPORT,,Case Rate,28.09
Blue Shield,PPO,93050,CPT4/HCPCS,ART PRESSURE WAVEFORM ANALYS,,Fee Schedule,987.79
Blue Shield,PPO,93224,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,1838.63
Blue Shield,PPO,93225,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,628.92
Blue Shield,PPO,93226,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,1110.23
Blue Shield,PPO,93227,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,Case Rate,99.49
Blue Shield,PPO,93268,CPT4/HCPCS,ECG RECORD/REVIEW,,Case Rate,3702.44
Blue Shield,PPO,93270,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,Case Rate,628.92
Blue Shield,PPO,93271,CPT4/HCPCS,ECG/MONITORING AND ANALYSIS,,Case Rate,2978.84
Blue Shield,PPO,93272,CPT4/HCPCS,ECG/REVIEW INTERPRET ONLY,,Case Rate,99.49
Blue Shield,PPO,93278,CPT4/HCPCS,ECG/SIGNAL-AVERAGED,,Case Rate,597.71
Blue Shield,PPO,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,1954.89
Blue Shield,PPO,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,990.71
Blue Shield,PPO,93307,CPT4/HCPCS,TTE W/O DOPPLER COMPLETE,,Case Rate,1954.89
Blue Shield,PPO,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,Case Rate,990.71
Blue Shield,PPO,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,1940.60
Blue Shield,PPO,93313,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,125.25
Blue Shield,PPO,93314,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,1940.60
Blue Shield,PPO,93315,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,522.28
Blue Shield,PPO,93316,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,135.65
Blue Shield,PPO,93317,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,354.65
Blue Shield,PPO,93318,CPT4/HCPCS,ECHO TRANSESOPHAGEAL INTRAOP,,Case Rate,1598.68
Blue Shield,PPO,93320,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,876.01
Blue Shield,PPO,93321,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,571.18
Blue Shield,PPO,93325,CPT4/HCPCS,DOPPLER COLOR FLOW ADD-ON,,Case Rate,1484.90
Blue Shield,PPO,93350,CPT4/HCPCS,STRESS TTE ONLY,,Case Rate,904.10
Blue Shield,PPO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Fee Schedule,9548.66
Blue Shield,PPO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Fee Schedule,9548.66
Blue Shield,PPO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Fee Schedule,9548.66
Blue Shield,PPO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Fee Schedule,9548.66
Blue Shield,PPO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Fee Schedule,9548.66
Blue Shield,PPO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Fee Schedule,9548.66
Blue Shield,PPO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Fee Schedule,9548.66
Blue Shield,PPO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,PPO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Fee Schedule,9548.66
Blue Shield,PPO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,PPO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Fee Schedule,9548.66
Blue Shield,PPO,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Fee Schedule,987.79
Blue Shield,PPO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Fee Schedule,3198.57
Blue Shield,PPO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Fee Schedule,3198.57
Blue Shield,PPO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,PPO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,PPO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,PPO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Fee Schedule,9548.66
Blue Shield,PPO,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Case Rate,4064.90
Blue Shield,PPO,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Case Rate,5222.42
Blue Shield,PPO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Case Rate,995.53
Blue Shield,PPO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Case Rate,567.14
Blue Shield,PPO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Case Rate,857.54
Blue Shield,PPO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Case Rate,1377.35
Blue Shield,PPO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Case Rate,694.72
Blue Shield,PPO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Case Rate,823.86
Blue Shield,PPO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Case Rate,1530.50
Blue Shield,PPO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,162.04
Blue Shield,PPO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,162.04
Blue Shield,PPO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Case Rate,2011.85
Blue Shield,PPO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3913.81
Blue Shield,PPO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,6701.11
Blue Shield,PPO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,1212.05
Blue Shield,PPO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,1999.75
Blue Shield,PPO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Case Rate,1622.74
Blue Shield,PPO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Case Rate,1009.96
Blue Shield,PPO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Case Rate,3218.90
Blue Shield,PPO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Case Rate,3633.81
Blue Shield,PPO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3633.81
Blue Shield,PPO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,3633.81
Blue Shield,PPO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,2430.87
Blue Shield,PPO,93651,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,3506.45
Blue Shield,PPO,93652,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Case Rate,3816.25
Blue Shield,PPO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Fee Schedule,9548.66
Blue Shield,PPO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Fee Schedule,9548.66
Blue Shield,PPO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Fee Schedule,9548.66
Blue Shield,PPO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Fee Schedule,9548.66
Blue Shield,PPO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Fee Schedule,9548.66
Blue Shield,PPO,93660,CPT4/HCPCS,TILT TABLE EVALUATION,,Case Rate,821.23
Blue Shield,PPO,93662,CPT4/HCPCS,INTRACARDIAC ECG (ICE),,Case Rate,1718.19
Blue Shield,PPO,93668,CPT4/HCPCS,PERIPHERAL VASCULAR REHAB,,Case Rate,663.38
Blue Shield,PPO,93701,CPT4/HCPCS,BIOIMPEDANCE CV ANALYSIS,,Case Rate,461.14
Blue Shield,PPO,93724,CPT4/HCPCS,ANALYZE PACEMAKER SYSTEM,,Case Rate,2011.85
Blue Shield,PPO,93740,CPT4/HCPCS,TEMPERATURE GRADIENT STUDIES,,Case Rate,81.02
Blue Shield,PPO,93750,CPT4/HCPCS,INTERROGATION VAD IN PERSON,,Case Rate,164.52
Blue Shield,PPO,93770,CPT4/HCPCS,MEASURE VENOUS PRESSURE,,Case Rate,18.47
Blue Shield,PPO,93784,CPT4/HCPCS,AMBL BP MNTR W/SOFTWARE,,Case Rate,757.91
Blue Shield,PPO,93786,CPT4/HCPCS,AMBL BP MNTR W/SW REC ONLY,,Case Rate,441.89
Blue Shield,PPO,93788,CPT4/HCPCS,AMBL BP MNTR W/SW A/R,,Case Rate,249.43
Blue Shield,PPO,93790,CPT4/HCPCS,AMBL BP MNTR W/SW I&R,,Case Rate,66.59
Blue Shield,PPO,93797,CPT4/HCPCS,CARDIAC REHAB,,Case Rate,148.38
Blue Shield,PPO,93798,CPT4/HCPCS,CARDIAC REHAB/MONITOR,,Case Rate,225.37
Blue Shield,PPO,93880,CPT4/HCPCS,EXTRACRANIAL BILAT STUDY,,Case Rate,2051.42
Blue Shield,PPO,93882,CPT4/HCPCS,EXTRACRANIAL UNI/LTD STUDY,,Case Rate,1469.69
Blue Shield,PPO,93886,CPT4/HCPCS,INTRACRANIAL COMPLETE STUDY,,Case Rate,2130.11
Blue Shield,PPO,93888,CPT4/HCPCS,INTRACRANIAL LIMITED STUDY,,Case Rate,1451.37
Blue Shield,PPO,93890,CPT4/HCPCS,TCD VASOREACTIVITY STUDY,,Case Rate,2322.57
Blue Shield,PPO,93892,CPT4/HCPCS,TCD EMBOLI DETECT W/O INJ,,Case Rate,2418.80
Blue Shield,PPO,93893,CPT4/HCPCS,TCD EMBOLI DETECT W/INJ,,Case Rate,2356.25
Blue Shield,PPO,93922,CPT4/HCPCS,UPR/L XTREMITY ART 2 LEVELS,,Case Rate,937.79
Blue Shield,PPO,93923,CPT4/HCPCS,UPR/LXTR ART STDY 3+ LVLS,,Case Rate,1460.07
Blue Shield,PPO,93924,CPT4/HCPCS,LWR XTR VASC STDY BILAT,,Case Rate,1828.23
Blue Shield,PPO,93925,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Case Rate,2388.23
Blue Shield,PPO,93926,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Case Rate,1709.50
Blue Shield,PPO,93930,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Case Rate,1924.76
Blue Shield,PPO,93931,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Case Rate,1400.78
Blue Shield,PPO,93965,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,885.64
Blue Shield,PPO,93970,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,1960.92
Blue Shield,PPO,93971,CPT4/HCPCS,EXTREMITY STUDY,,Case Rate,1412.88
Blue Shield,PPO,93975,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,2685.15
Blue Shield,PPO,93976,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1593.39
Blue Shield,PPO,93978,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1765.98
Blue Shield,PPO,93979,CPT4/HCPCS,VASCULAR STUDY,,Case Rate,1299.73
Blue Shield,PPO,93980,CPT4/HCPCS,PENILE VASCULAR STUDY,,Case Rate,2239.85
Blue Shield,PPO,93981,CPT4/HCPCS,PENILE VASCULAR STUDY,,Case Rate,2271.05
Blue Shield,PPO,93982,CPT4/HCPCS,ANEURYSM PRESSURE SENS STUDY,,Case Rate,388.96
Blue Shield,PPO,93990,CPT4/HCPCS,DOPPLER FLOW TESTING,,Case Rate,1695.06
Blue Shield,PPO,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,Case Rate,223.96
Blue Shield,PPO,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,Case Rate,182.99
Blue Shield,PPO,94004,CPT4/HCPCS,VENT MGMT NF PER DAY,,Case Rate,131.62
Blue Shield,PPO,94005,CPT4/HCPCS,HOME VENT MGMT SUPERVISION,,Case Rate,356.21
Blue Shield,PPO,94010,CPT4/HCPCS,BREATHING CAPACITY TEST,,Case Rate,306.39
Blue Shield,PPO,94011,CPT4/HCPCS,SPIROMETRY UP TO 2 YRS OLD,,Case Rate,318.49
Blue Shield,PPO,94012,CPT4/HCPCS,SPIRMTRY W/BRNCHDIL INF-2 YR,,Case Rate,484.57
Blue Shield,PPO,94013,CPT4/HCPCS,MEAS LUNG VOL THRU 2 YRS,,Case Rate,98.71
Blue Shield,PPO,94014,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,Case Rate,377.79
Blue Shield,PPO,94015,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,Case Rate,292.73
Blue Shield,PPO,94016,CPT4/HCPCS,REVIEW PATIENT SPIROMETRY,,Case Rate,89.87
Blue Shield,PPO,94060,CPT4/HCPCS,EVALUATION OF WHEEZING,,Case Rate,514.99
Blue Shield,PPO,94070,CPT4/HCPCS,EVALUATION OF WHEEZING,,Case Rate,1387.60
Blue Shield,PPO,94150,CPT4/HCPCS,VITAL CAPACITY TEST,,Case Rate,220.56
Blue Shield,PPO,94200,CPT4/HCPCS,LUNG FUNCTION TEST (MBC/MVV),,Case Rate,205.35
Blue Shield,PPO,94250,CPT4/HCPCS,EXPIRED GAS COLLECTION,,Case Rate,302.36
Blue Shield,PPO,94375,CPT4/HCPCS,RESPIRATORY FLOW VOLUME LOOP,,Case Rate,253.46
Blue Shield,PPO,94400,CPT4/HCPCS,CO2 BREATHING RESPONSE CURVE,,Case Rate,370.64
Blue Shield,PPO,94450,CPT4/HCPCS,HYPOXIA RESPONSE CURVE,,Case Rate,277.52
Blue Shield,PPO,94452,CPT4/HCPCS,HAST W/REPORT,,Case Rate,455.55
Blue Shield,PPO,94453,CPT4/HCPCS,HAST W/OXYGEN TITRATE,,Case Rate,676.88
Blue Shield,PPO,94610,CPT4/HCPCS,SURFACTANT ADMIN THRU TUBE,,Case Rate,273.30
Blue Shield,PPO,94620,CPT4/HCPCS,PULMONARY STRESS TEST/SIMPLE,,Case Rate,1108.52
Blue Shield,PPO,94621,CPT4/HCPCS,CARDIOPULM EXERCISE TESTING,,Case Rate,824.64
Blue Shield,PPO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,Case Rate,162.04
Blue Shield,PPO,94644,CPT4/HCPCS,CBT 1ST HOUR,,Case Rate,450.74
Blue Shield,PPO,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,Case Rate,171.66
Blue Shield,PPO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,Case Rate,328.89
Blue Shield,PPO,94662,CPT4/HCPCS,NEG PRESS VENTILATION CNP,,Case Rate,122.77
Blue Shield,PPO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,Case Rate,170.11
Blue Shield,PPO,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,Case Rate,280.00
Blue Shield,PPO,94668,CPT4/HCPCS,CHEST WALL MANIPULATION,,Case Rate,229.40
Blue Shield,PPO,94680,CPT4/HCPCS,EXHALED AIR ANALYSIS O2,,Case Rate,895.11
Blue Shield,PPO,94681,CPT4/HCPCS,EXHALED AIR ANALYSIS O2/CO2,,Case Rate,1275.38
Blue Shield,PPO,94690,CPT4/HCPCS,EXHALED AIR ANALYSIS,,Case Rate,954.40
Blue Shield,PPO,94726,CPT4/HCPCS,PULM FUNCT TST PLETHYSMOGRAP,,Case Rate,585.46
Blue Shield,PPO,94727,CPT4/HCPCS,PULM FUNCTION TEST BY GAS,,Case Rate,422.65
Blue Shield,PPO,94728,CPT4/HCPCS,AIRWY RESIST BY OSCILLOMETRY,,Case Rate,422.65
Blue Shield,PPO,94729,CPT4/HCPCS,CO/MEMBANE DIFFUSE CAPACITY,,Case Rate,639.17
Blue Shield,PPO,94750,CPT4/HCPCS,PULMONARY COMPLIANCE STUDY,,Case Rate,632.03
Blue Shield,PPO,94760,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,27.32
Blue Shield,PPO,94761,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,57.89
Blue Shield,PPO,94762,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,Case Rate,232.81
Blue Shield,PPO,94770,CPT4/HCPCS,EXHALED CARBON DIOXIDE TEST,,Case Rate,812.54
Blue Shield,PPO,94780,CPT4/HCPCS,CARS/BD TST INFT-12MO 60 MIN,,Case Rate,98.71
Blue Shield,PPO,94781,CPT4/HCPCS,CARS/BD TST INFT-12MO +30MIN,,Case Rate,32.90
Blue Shield,PPO,95004,CPT4/HCPCS,PERCUT ALLERGY SKIN TESTS,,Case Rate,52.15
Blue Shield,PPO,95010,CPT4/HCPCS,PERCUT ALLERGY TITRATE TEST,,Case Rate,158.01
Blue Shield,PPO,95012,CPT4/HCPCS,EXHALED NITRIC OXIDE MEAS,,Case Rate,234.99
Blue Shield,PPO,95015,CPT4/HCPCS,ID ALLERGY TITRATE-DRUG/BUG,,Case Rate,71.40
Blue Shield,PPO,95024,CPT4/HCPCS,ICUT ALLERGY TEST DRUG/BUG,,Case Rate,76.21
Blue Shield,PPO,95027,CPT4/HCPCS,ICUT ALLERGY TITRATE-AIRBORN,,Case Rate,76.21
Blue Shield,PPO,95028,CPT4/HCPCS,ICUT ALLERGY TEST-DELAYED,,Case Rate,119.51
Blue Shield,PPO,95044,CPT4/HCPCS,ALLERGY PATCH TESTS,,Case Rate,105.08
Blue Shield,PPO,95052,CPT4/HCPCS,PHOTO PATCH TEST,,Case Rate,129.14
Blue Shield,PPO,95056,CPT4/HCPCS,PHOTOSENSITIVITY TESTS,,Case Rate,90.64
Blue Shield,PPO,95060,CPT4/HCPCS,EYE ALLERGY TESTS,,Case Rate,176.48
Blue Shield,PPO,95065,CPT4/HCPCS,NOSE ALLERGY TEST,,Case Rate,105.08
Blue Shield,PPO,95070,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,Case Rate,1109.93
Blue Shield,PPO,95071,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,Case Rate,1417.88
Blue Shield,PPO,95075,CPT4/HCPCS,INGESTION CHALLENGE TEST,,Case Rate,406.66
Blue Shield,PPO,95115,CPT4/HCPCS,IMMUNOTHERAPY ONE INJECTION,,Case Rate,190.91
Blue Shield,PPO,95117,CPT4/HCPCS,IMMUNOTHERAPY INJECTIONS,,Case Rate,248.65
Blue Shield,PPO,95144,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,95.46
Blue Shield,PPO,95145,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,158.01
Blue Shield,PPO,95146,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,215.75
Blue Shield,PPO,95147,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,206.12
Blue Shield,PPO,95148,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,283.11
Blue Shield,PPO,95149,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,388.96
Blue Shield,PPO,95165,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,95.46
Blue Shield,PPO,95170,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,Case Rate,66.59
Blue Shield,PPO,95180,CPT4/HCPCS,RAPID DESENSITIZATION,,Case Rate,997.71
Blue Shield,PPO,95250,CPT4/HCPCS,CONT GLUC MNTR PHYS/QHP EQP,,Case Rate,1842.08
Blue Shield,PPO,95251,CPT4/HCPCS,CONT GLUC MNTR ANALYSIS I&R,,Case Rate,99.49
Blue Shield,PPO,95800,CPT4/HCPCS,SLP STDY UNATTENDED,,Case Rate,2087.47
Blue Shield,PPO,95801,CPT4/HCPCS,SLP STDY UNATND W/ANAL,,Case Rate,643.98
Blue Shield,PPO,95805,CPT4/HCPCS,MULTIPLE SLEEP LATENCY TEST,,Case Rate,7643.31
Blue Shield,PPO,95806,CPT4/HCPCS,SLEEP STUDY UNATT&RESP EFFT,,Case Rate,1703.28
Blue Shield,PPO,95807,CPT4/HCPCS,SLEEP STUDY ATTENDED,,Case Rate,5529.60
Blue Shield,PPO,95808,CPT4/HCPCS,POLYSOM ANY AGE 1-3> PARAM,,Case Rate,5933.77
Blue Shield,PPO,95810,CPT4/HCPCS,POLYSOM 6/> YRS 4/> PARAM,,Case Rate,7791.06
Blue Shield,PPO,95811,CPT4/HCPCS,POLYSOM 6/>YRS CPAP 4/> PARM,,Case Rate,8439.85
Blue Shield,PPO,95812,CPT4/HCPCS,EEG 41-60 MINUTES,,Case Rate,1709.20
Blue Shield,PPO,95813,CPT4/HCPCS,EEG EXTND MNTR 61-119 MIN,,Case Rate,2079.70
Blue Shield,PPO,95816,CPT4/HCPCS,EEG AWAKE AND DROWSY,,Case Rate,1329.86
Blue Shield,PPO,95819,CPT4/HCPCS,EEG AWAKE AND ASLEEP,,Case Rate,1594.50
Blue Shield,PPO,95822,CPT4/HCPCS,EEG COMA OR SLEEP ONLY,,Case Rate,1928.98
Blue Shield,PPO,95824,CPT4/HCPCS,EEG CEREBRAL DEATH ONLY,,Case Rate,802.14
Blue Shield,PPO,95827,CPT4/HCPCS,EEG ALL NIGHT RECORDING,,Case Rate,1163.16
Blue Shield,PPO,95829,CPT4/HCPCS,SURGERY ELECTROCORTICOGRAM,,Case Rate,13947.35
Blue Shield,PPO,95830,CPT4/HCPCS,INSERT ELECTRODES FOR EEG,,Case Rate,1632.21
Blue Shield,PPO,95831,CPT4/HCPCS,LIMB MUSCLE TESTING MANUAL,,Case Rate,225.37
Blue Shield,PPO,95832,CPT4/HCPCS,HAND MUSCLE TESTING MANUAL,,Case Rate,166.85
Blue Shield,PPO,95833,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,Case Rate,287.14
Blue Shield,PPO,95834,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,Case Rate,315.24
Blue Shield,PPO,95851,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,Case Rate,177.25
Blue Shield,PPO,95852,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,Case Rate,129.14
Blue Shield,PPO,95857,CPT4/HCPCS,CHOLINESTERASE CHALLENGE,,Case Rate,296.77
Blue Shield,PPO,95860,CPT4/HCPCS,MUSCLE TEST ONE LIMB,,Case Rate,503.67
Blue Shield,PPO,95861,CPT4/HCPCS,MUSCLE TEST 2 LIMBS,,Case Rate,380.27
Blue Shield,PPO,95863,CPT4/HCPCS,MUSCLE TEST 3 LIMBS,,Case Rate,476.50
Blue Shield,PPO,95864,CPT4/HCPCS,MUSCLE TEST 4 LIMBS,,Case Rate,909.69
Blue Shield,PPO,95865,CPT4/HCPCS,MUSCLE TEST LARYNX,,Case Rate,339.29
Blue Shield,PPO,95866,CPT4/HCPCS,MUSCLE TEST HEMIDIAPHRAGM,,Case Rate,406.03
Blue Shield,PPO,95867,CPT4/HCPCS,MUSCLE TEST CRAN NERV UNILAT,,Case Rate,295.21
Blue Shield,PPO,95868,CPT4/HCPCS,MUSCLE TEST CRAN NERVE BILAT,,Case Rate,356.99
Blue Shield,PPO,95869,CPT4/HCPCS,MUSCLE TEST THOR PARASPINAL,,Case Rate,113.92
Blue Shield,PPO,95870,CPT4/HCPCS,MUSCLE TEST NONPARASPINAL,,Case Rate,113.92
Blue Shield,PPO,95872,CPT4/HCPCS,MUSCLE TEST ONE FIBER,,Case Rate,308.87
Blue Shield,PPO,95873,CPT4/HCPCS,GUIDE NERV DESTR ELEC STIM,,Case Rate,104.30
Blue Shield,PPO,95874,CPT4/HCPCS,GUIDE NERV DESTR NEEDLE EMG,,Case Rate,104.30
Blue Shield,PPO,95875,CPT4/HCPCS,LIMB EXERCISE TEST,,Case Rate,505.37
Blue Shield,PPO,95885,CPT4/HCPCS,MUSC TST DONE W/NERV TST LIM,,Case Rate,538.13
Blue Shield,PPO,95886,CPT4/HCPCS,MUSC TEST DONE W/N TEST COMP,,Case Rate,566.99
Blue Shield,PPO,95887,CPT4/HCPCS,MUSC TST DONE W/N TST NONEXT,,Case Rate,576.62
Blue Shield,PPO,95900,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,Case Rate,537.35
Blue Shield,PPO,95903,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,Case Rate,465.17
Blue Shield,PPO,95904,CPT4/HCPCS,SENSE NERVE CONDUCTION TEST,,Case Rate,469.98
Blue Shield,PPO,95905,CPT4/HCPCS,MOTOR &/ SENS NRVE CNDJ TEST,,Case Rate,975.98
Blue Shield,PPO,95920,CPT4/HCPCS,INTRAOP NERVE TEST ADD-ON,,Case Rate,658.56
Blue Shield,PPO,95921,CPT4/HCPCS,AUTONOMIC NRV PARASYM INERVJ,,Case Rate,186.10
Blue Shield,PPO,95922,CPT4/HCPCS,AUTONOMIC NRV ADRENRG INERVJ,,Case Rate,186.10
Blue Shield,PPO,95923,CPT4/HCPCS,AUTONOMIC NRV SYST FUNJ TEST,,Case Rate,830.86
Blue Shield,PPO,95925,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,PPO,95926,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,PPO,95927,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,462.06
Blue Shield,PPO,95928,CPT4/HCPCS,C MOTOR EVOKED UPPR LIMBS,,Case Rate,1152.46
Blue Shield,PPO,95929,CPT4/HCPCS,C MOTOR EVOKED LWR LIMBS,,Case Rate,1243.88
Blue Shield,PPO,95930,CPT4/HCPCS,VISUAL EP TEST CNS W/I&R,,Case Rate,619.92
Blue Shield,PPO,95933,CPT4/HCPCS,BLINK REFLEX TEST,,Case Rate,404.32
Blue Shield,PPO,95934,CPT4/HCPCS,H-REFLEX TEST,,Case Rate,113.92
Blue Shield,PPO,95936,CPT4/HCPCS,H-REFLEX TEST,,Case Rate,113.92
Blue Shield,PPO,95937,CPT4/HCPCS,NEUROMUSCULAR JUNCTION TEST,,Case Rate,171.66
Blue Shield,PPO,95938,CPT4/HCPCS,SOMATOSENSORY TESTING,,Case Rate,3563.08
Blue Shield,PPO,95939,CPT4/HCPCS,C MOTOR EVOKED UPR&LWR LIMBS,,Case Rate,4919.19
Blue Shield,PPO,95950,CPT4/HCPCS,AMBULATORY EEG MONITORING,,Case Rate,2016.33
Blue Shield,PPO,95951,CPT4/HCPCS,EEG MONITORING/VIDEORECORD,,Case Rate,1360.88
Blue Shield,PPO,95953,CPT4/HCPCS,EEG MONITORING/COMPUTER,,Case Rate,3228.86
Blue Shield,PPO,95954,CPT4/HCPCS,EEG MONITORING/GIVING DRUGS,,Case Rate,1583.17
Blue Shield,PPO,95955,CPT4/HCPCS,EEG DURING SURGERY,,Case Rate,1016.47
Blue Shield,PPO,95956,CPT4/HCPCS,EEG MONITOR TECHNOL ATTENDED,,Case Rate,6351.61
Blue Shield,PPO,95957,CPT4/HCPCS,EEG DIGITAL ANALYSIS,,Case Rate,871.20
Blue Shield,PPO,95958,CPT4/HCPCS,EEG MONITORING/FUNCTION TEST,,Case Rate,894.48
Blue Shield,PPO,95961,CPT4/HCPCS,ELECTRODE STIMULATION BRAIN,,Case Rate,658.56
Blue Shield,PPO,95962,CPT4/HCPCS,ELECTRODE STIM BRAIN ADD-ON,,Case Rate,658.56
Blue Shield,PPO,95965,CPT4/HCPCS,MEG SPONTANEOUS,,Case Rate,22488.95
Blue Shield,PPO,95966,CPT4/HCPCS,MEG EVOKED SINGLE,,Case Rate,11263.72
Blue Shield,PPO,95967,CPT4/HCPCS,MEG EVOKED EACH ADDL,,Case Rate,9507.03
Blue Shield,PPO,95970,CPT4/HCPCS,ALYS NPGT W/O PRGRMG,,Case Rate,421.09
Blue Shield,PPO,95971,CPT4/HCPCS,ALYS SMPL SP/PN NPGT W/PRGRM,,Case Rate,355.43
Blue Shield,PPO,95972,CPT4/HCPCS,ALYS CPLX SP/PN NPGT W/PRGRM,,Case Rate,638.69
Blue Shield,PPO,95973,CPT4/HCPCS,ANALYZE NEUROSTIM COMPLEX,,Case Rate,326.56
Blue Shield,PPO,95974,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,Case Rate,882.53
Blue Shield,PPO,95975,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,Case Rate,476.65
Blue Shield,PPO,95978,CPT4/HCPCS,ANALYZE NEUROSTIM BRAIN/1H,,Case Rate,1006.07
Blue Shield,PPO,95979,CPT4/HCPCS,ANALYZ NEUROSTIM BRAIN ADDON,,Case Rate,450.89
Blue Shield,PPO,95980,CPT4/HCPCS,IO ANAL GAST N-STIM INIT,,Case Rate,148.53
Blue Shield,PPO,95981,CPT4/HCPCS,IO ANAL GAST N-STIM SUBSQ,,Case Rate,65.81
Blue Shield,PPO,95982,CPT4/HCPCS,IO GA N-STIM SUBSQ W/REPROG,,Case Rate,106.78
Blue Shield,PPO,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Case Rate,745.95
Blue Shield,PPO,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Case Rate,726.70
Blue Shield,PPO,96000,CPT4/HCPCS,MOTION ANALYSIS VIDEO/3D,,Case Rate,299.39
Blue Shield,PPO,96001,CPT4/HCPCS,MOTION TEST W/FT PRESS MEAS,,Case Rate,357.91
Blue Shield,PPO,96002,CPT4/HCPCS,DYNAMIC SURFACE EMG,,Case Rate,80.24
Blue Shield,PPO,96003,CPT4/HCPCS,DYNAMIC FINE WIRE EMG,,Case Rate,65.81
Blue Shield,PPO,96004,CPT4/HCPCS,PHYS REVIEW OF MOTION TESTS,,Case Rate,496.67
Blue Shield,PPO,96040,CPT4/HCPCS,GENETIC COUNSELING 30 MIN,,Case Rate,470.76
Blue Shield,PPO,96101,CPT4/HCPCS,PSYCHO TESTING BY PSYCH/PHYS,,Case Rate,178.96
Blue Shield,PPO,96102,CPT4/HCPCS,PSYCHO TESTING BY TECHNICIAN,,Case Rate,47.34
Blue Shield,PPO,96103,CPT4/HCPCS,PSYCHO TESTING ADMIN BY COMP,,Case Rate,51.37
Blue Shield,PPO,96105,CPT4/HCPCS,ASSESSMENT OF APHASIA,,Case Rate,924.28
Blue Shield,PPO,96110,CPT4/HCPCS,DEVELOPMENTAL SCREEN W/SCORE,,Case Rate,164.04
Blue Shield,PPO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,Case Rate,332.45
Blue Shield,PPO,96116,CPT4/HCPCS,NUBHVL XM PHYS/QHP 1ST HR,,Case Rate,279.52
Blue Shield,PPO,96118,CPT4/HCPCS,NEUROPSYCH TST BY PSYCH/PHYS,,Case Rate,231.40
Blue Shield,PPO,96119,CPT4/HCPCS,NEUROPSYCH TESTING BY TEC,,Case Rate,120.73
Blue Shield,PPO,96120,CPT4/HCPCS,NEUROPSYCH TST ADMIN W/COMP,,Case Rate,51.37
Blue Shield,PPO,96125,CPT4/HCPCS,COGNITIVE TEST BY HC PRO,,Case Rate,242.58
Blue Shield,PPO,96150,CPT4/HCPCS,ASSESS HLTH/BEHAVE INIT,,Case Rate,47.34
Blue Shield,PPO,96151,CPT4/HCPCS,ASSESS HLTH/BEHAVE SUBSEQ,,Case Rate,47.34
Blue Shield,PPO,96152,CPT4/HCPCS,INTERVENE HLTH/BEHAVE INDIV,,Case Rate,42.53
Blue Shield,PPO,96153,CPT4/HCPCS,INTERVENE HLTH/BEHAVE GROUP,,Case Rate,13.66
Blue Shield,PPO,96154,CPT4/HCPCS,INTERV HLTH/BEHAV FAM W/PT,,Case Rate,42.53
Blue Shield,PPO,96155,CPT4/HCPCS,INTERV HLTH/BEHAV FAM NO PT,,Case Rate,56.18
Blue Shield,PPO,96360,CPT4/HCPCS,HYDRATION IV INFUSION INIT,,Case Rate,648.94
Blue Shield,PPO,96361,CPT4/HCPCS,HYDRATE IV INFUSION ADD-ON,,Case Rate,165.30
Blue Shield,PPO,96365,CPT4/HCPCS,THER/PROPH/DIAG IV INF INIT,,Case Rate,788.48
Blue Shield,PPO,96366,CPT4/HCPCS,THER/PROPH/DIAG IV INF ADDON,,Case Rate,194.17
Blue Shield,PPO,96367,CPT4/HCPCS,TX/PROPH/DG ADDL SEQ IV INF,,Case Rate,343.33
Blue Shield,PPO,96368,CPT4/HCPCS,THER/DIAG CONCURRENT INF,,Case Rate,179.73
Blue Shield,PPO,96369,CPT4/HCPCS,SC THER INFUSION UP TO 1 HR,,Case Rate,1881.49
Blue Shield,PPO,96370,CPT4/HCPCS,SC THER INFUSION ADDL HR,,Case Rate,121.99
Blue Shield,PPO,96371,CPT4/HCPCS,SC THER INFUSION RESET PUMP,,Case Rate,985.61
Blue Shield,PPO,96372,CPT4/HCPCS,THER/PROPH/DIAG INJ SC/IM,,Case Rate,210.93
Blue Shield,PPO,96373,CPT4/HCPCS,THER/PROPH/DIAG INJ IA,,Case Rate,152.42
Blue Shield,PPO,96374,CPT4/HCPCS,THER/PROPH/DIAG INJ IV PUSH,,Case Rate,632.03
Blue Shield,PPO,96375,CPT4/HCPCS,TX/PRO/DX INJ NEW DRUG ADDON,,Case Rate,256.72
Blue Shield,PPO,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,Case Rate,899.00
Blue Shield,PPO,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,Case Rate,345.66
Blue Shield,PPO,96405,CPT4/HCPCS,CHEMO INTRALESIONAL UP TO 7,,Case Rate,122.77
Blue Shield,PPO,96406,CPT4/HCPCS,CHEMO INTRALESIONAL OVER 7,,Case Rate,146.83
Blue Shield,PPO,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,Case Rate,1357.03
Blue Shield,PPO,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,Case Rate,741.14
Blue Shield,PPO,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,Case Rate,1769.27
Blue Shield,PPO,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,Case Rate,341.00
Blue Shield,PPO,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,Case Rate,1985.80
Blue Shield,PPO,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,Case Rate,855.84
Blue Shield,PPO,96420,CPT4/HCPCS,CHEMO IA PUSH TECNIQUE,,Case Rate,1326.60
Blue Shield,PPO,96422,CPT4/HCPCS,CHEMO IA INFUSION UP TO 1 HR,,Case Rate,1860.69
Blue Shield,PPO,96423,CPT4/HCPCS,CHEMO IA INFUSE EACH ADDL HR,,Case Rate,927.09
Blue Shield,PPO,96425,CPT4/HCPCS,CHEMOTHERAPY INFUSION METHOD,,Case Rate,2207.13
Blue Shield,PPO,96440,CPT4/HCPCS,CHEMOTHERAPY INTRACAVITARY,,Case Rate,549.75
Blue Shield,PPO,96446,CPT4/HCPCS,CHEMOTX ADMN PRTL CAVITY,,Case Rate,119.66
Blue Shield,PPO,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,Case Rate,435.67
Blue Shield,PPO,96521,CPT4/HCPCS,REFILL/MAINT PORTABLE PUMP,,Case Rate,1530.25
Blue Shield,PPO,96522,CPT4/HCPCS,REFILL/MAINT PUMP/RESVR SYST,,Case Rate,1332.97
Blue Shield,PPO,96523,CPT4/HCPCS,IRRIG DRUG DELIVERY DEVICE,,Case Rate,311.98
Blue Shield,PPO,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,Case Rate,187.02
Blue Shield,PPO,96567,CPT4/HCPCS,PDT DSTR PRMLG LES SKN,,Case Rate,1815.69
Blue Shield,PPO,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,Case Rate,241.65
Blue Shield,PPO,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,Case Rate,108.34
Blue Shield,PPO,96900,CPT4/HCPCS,ULTRAVIOLET LIGHT THERAPY,,Case Rate,277.52
Blue Shield,PPO,96902,CPT4/HCPCS,TRICHOGRAM,,Case Rate,52.15
Blue Shield,PPO,96910,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-B,,Case Rate,978.46
Blue Shield,PPO,96912,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-A,,Case Rate,1261.57
Blue Shield,PPO,96913,CPT4/HCPCS,PHOTOCHEMOTHERAPY UV-A OR B,,Case Rate,1796.59
Blue Shield,PPO,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,Case Rate,287.14
Blue Shield,PPO,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,Case Rate,276.74
Blue Shield,PPO,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,Case Rate,526.17
Blue Shield,PPO,96931,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,987.79
Blue Shield,PPO,96932,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,6049.05
Blue Shield,PPO,96933,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,Fee Schedule,987.79
Blue Shield,PPO,97001,CPT4/HCPCS,PT EVALUATION,,Case Rate,342.55
Blue Shield,PPO,97002,CPT4/HCPCS,PT RE-EVALUATION,,Case Rate,205.35
Blue Shield,PPO,97003,CPT4/HCPCS,OT EVALUATION,,Case Rate,399.51
Blue Shield,PPO,97004,CPT4/HCPCS,OT RE-EVALUATION,,Case Rate,272.71
Blue Shield,PPO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Case Rate,37.72
Blue Shield,PPO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Case Rate,71.40
Blue Shield,PPO,97014,CPT4/HCPCS,ELECTRIC STIMULATION THERAPY,,Case Rate,90.64
Blue Shield,PPO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Case Rate,119.51
Blue Shield,PPO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Case Rate,85.83
Blue Shield,PPO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Case Rate,162.82
Blue Shield,PPO,97024,CPT4/HCPCS,DIATHERMY EG MICROWAVE,,Case Rate,42.53
Blue Shield,PPO,97026,CPT4/HCPCS,INFRARED THERAPY,,Case Rate,37.72
Blue Shield,PPO,97028,CPT4/HCPCS,ULTRAVIOLET THERAPY,,Case Rate,42.53
Blue Shield,PPO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Case Rate,100.27
Blue Shield,PPO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Case Rate,215.75
Blue Shield,PPO,97034,CPT4/HCPCS,CONTRAST BATH THERAPY,,Case Rate,100.27
Blue Shield,PPO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Case Rate,52.15
Blue Shield,PPO,97036,CPT4/HCPCS,HYDROTHERAPY,,Case Rate,215.75
Blue Shield,PPO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Case Rate,162.04
Blue Shield,PPO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Case Rate,167.63
Blue Shield,PPO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Case Rate,259.05
Blue Shield,PPO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Case Rate,138.76
Blue Shield,PPO,97124,CPT4/HCPCS,MASSAGE THERAPY,,Case Rate,133.95
Blue Shield,PPO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Case Rate,143.57
Blue Shield,PPO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Case Rate,109.89
Blue Shield,PPO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Case Rate,186.88
Blue Shield,PPO,97532,CPT4/HCPCS,COGNITIVE SKILLS DEVELOPMENT,,Case Rate,109.89
Blue Shield,PPO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Case Rate,133.95
Blue Shield,PPO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Case Rate,182.06
Blue Shield,PPO,97537,CPT4/HCPCS,COMMUNITY/WORK REINTEGRATION,,Case Rate,138.76
Blue Shield,PPO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Case Rate,143.57
Blue Shield,PPO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Fee Schedule,987.79
Blue Shield,PPO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Fee Schedule,987.79
Blue Shield,PPO,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,Case Rate,65.81
Blue Shield,PPO,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,Case Rate,74.65
Blue Shield,PPO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,Case Rate,166.85
Blue Shield,PPO,97755,CPT4/HCPCS,ASSISTIVE TECHNOLOGY ASSESS,,Case Rate,142.79
Blue Shield,PPO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,Case Rate,214.19
Blue Shield,PPO,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,Case Rate,166.85
Blue Shield,PPO,97762,CPT4/HCPCS,C/O FOR ORTHOTIC/PROSTH USE,,Case Rate,359.32
Blue Shield,PPO,97802,CPT4/HCPCS,MEDICAL NUTRITION INDIV IN,,Case Rate,230.18
Blue Shield,PPO,97803,CPT4/HCPCS,MED NUTRITION INDIV SUBSEQ,,Case Rate,230.18
Blue Shield,PPO,97804,CPT4/HCPCS,MEDICAL NUTRITION GROUP,,Case Rate,95.46
Blue Shield,PPO,99170,CPT4/HCPCS,ANOGENITAL EXAM CHILD W IMAG,,Case Rate,883.93
Blue Shield,PPO,99172,CPT4/HCPCS,OCULAR FUNCTION SCREEN,,Case Rate,262.31
Blue Shield,PPO,99175,CPT4/HCPCS,INDUCTION OF VOMITING,,Case Rate,713.97
Blue Shield,PPO,99183,CPT4/HCPCS,HYPERBARIC OXYGEN THERAPY,,Case Rate,1628.33
Blue Shield,PPO,99184,CPT4/HCPCS,HYPOTHERMIA ILL NEONATE,,Fee Schedule,987.79
Blue Shield,PPO,99190,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,7464.76
Blue Shield,PPO,99191,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,5593.37
Blue Shield,PPO,99192,CPT4/HCPCS,SPECIAL PUMP SERVICES,,Case Rate,3732.38
Blue Shield,PPO,99195,CPT4/HCPCS,PHLEBOTOMY,,Case Rate,219.78
Blue Shield,PPO,B2000ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2001ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B200YZZ,ICD10-PCS,Plain Radiography of Single Cor Art using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2010ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2011ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B201YZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2020ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2021ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B202YZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2030ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2031ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B203YZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2040ZZ,ICD10-PCS,Plain Radiography of Right Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2041ZZ,ICD10-PCS,Plain Radiography of Right Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B204YZZ,ICD10-PCS,Plain Radiography of Right Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2050ZZ,ICD10-PCS,Plain Radiography of Left Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2051ZZ,ICD10-PCS,Plain Radiography of Left Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B205YZZ,ICD10-PCS,Plain Radiography of Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2060ZZ,ICD10-PCS,Plain Radiography of R & L Heart using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2061ZZ,ICD10-PCS,Plain Radiography of R & L Heart using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B206YZZ,ICD10-PCS,Plain Radiography of Right and Left Heart using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2070ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2071ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B207YZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2080ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2081ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B208YZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B20F0ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B20F1ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B20FYZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using Other Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2100ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2101ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B210YZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using Other Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2110ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2111ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B211YZZ,ICD10-PCS,Fluoroscopy of Multiple Coronary Arteries using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2120ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2121ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B212YZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2130ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2131ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B213YZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2140ZZ,ICD10-PCS,Fluoroscopy of Right Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2141ZZ,ICD10-PCS,Fluoroscopy of Right Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B214YZZ,ICD10-PCS,Fluoroscopy of Right Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2150ZZ,ICD10-PCS,Fluoroscopy of Left Heart using High Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2151ZZ,ICD10-PCS,Fluoroscopy of Left Heart using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B215YZZ,ICD10-PCS,Fluoroscopy of Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2160ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2161ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B216YZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using Other Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2170ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2171ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B217YZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2180ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B2181ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using L Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B218YZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using Oth Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B21F0ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using H Osm Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B21F1ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Low Osmolar Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,B21FYZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Other Contrast,,Fee Schedule,8271.00
Blue Shield,PPO,C8929,CPT4/HCPCS,Tte w or wo fol wcon,doppler,,Fee Schedule,3198.57
Blue Shield,PPO,C8930,CPT4/HCPCS,Tte w or w/o contr, cont ecg,,Fee Schedule,3198.57
Blue Shield,PPO,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Fee Schedule,6876.92
Blue Shield,PPO,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Fee Schedule,6876.92
Blue Shield,PPO,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Fee Schedule,6876.92
Blue Shield,PPO,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,Fee Schedule,6876.92
Blue Shield,PPO,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,Fee Schedule,6876.92
Blue Shield,PPO,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,Fee Schedule,6876.92
Blue Shield,PPO,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Fee Schedule,6876.92
Blue Shield,PPO,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Fee Schedule,6876.92
Blue Shield,PPO,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,Fee Schedule,6876.92
Blue Shield,PPO,C9739,CPT4/HCPCS,Cystoscopy prostatic imp 1-3,,Fee Schedule,4280.44
Blue Shield,PPO,C9740,CPT4/HCPCS,Cysto impl 4 or more,,Fee Schedule,4280.44
Blue Shield,PPO,C9742,CPT4/HCPCS,Laryngoscopy with injection,,Fee Schedule,4280.44
Blue Shield,PPO,C9748,CPT4/HCPCS,Prostatic rf water vapor tx,,Fee Schedule,12850.71
Blue Shield,PPO,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Fee Schedule,3198.57
Blue Shield,PPO,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Fee Schedule,4280.44
Blue Shield,PPO,G0106,CPT4/HCPCS,Colon CA screen;barium enema,,Case Rate,1130.25
Blue Shield,PPO,G0120,CPT4/HCPCS,Colon ca scrn; barium enema,,Case Rate,1130.25
Blue Shield,PPO,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Fee Schedule,4280.44
Blue Shield,PPO,G0122,CPT4/HCPCS,Colon ca scrn; barium enema,,Case Rate,1106.19
Blue Shield,PPO,G0130,CPT4/HCPCS,Single energy x-ray study,,Case Rate,409.91
Blue Shield,PPO,G0168,CPT4/HCPCS,Wound closure by adhesive,,Fee Schedule,3198.57
Blue Shield,PPO,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,Fee Schedule,4280.44
Blue Shield,PPO,G0277,CPT4/HCPCS,Hbot, full body chamber, 30m,,Fee Schedule,4280.44
Blue Shield,PPO,G0279,CPT4/HCPCS,Tomosynthesis, mammo,,Fee Schedule,4280.44
Blue Shield,PPO,G0288,CPT4/HCPCS,Recon, CTA for surg plan,,Case Rate,5201.81
Blue Shield,PPO,G0297,CPT4/HCPCS,Ldct for lung ca screen,,Fee Schedule,4280.44
Blue Shield,PPO,G0392,CPT4/HCPCS,AV fistula or graft arterial,,Fee Schedule,12850.71
Blue Shield,PPO,G0393,CPT4/HCPCS,AV fistula or graft venous,,Fee Schedule,12850.71
Blue Shield,PPO,Q0035,CPT4/HCPCS,Cardiokymography,,Case Rate,190.91
Blue Shield,PPO,Q0092,CPT4/HCPCS,Set up port xray equipment,,Case Rate,158.01
Blue Shield,PPO,X2A5312,ICD10-PCS,Cereb Filtr, Brach L Carotid Art, Perc, New Tech 2,,Fee Schedule,8271.00
Blue Shield,PPO,X2RF032,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Open, New Tech 2,,Fee Schedule,8271.00
Blue Shield,PPO,X2RF432,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Perc Endo, New Tech 2,,Fee Schedule,8271.00
Blue Shield,PPO,,,Clinic Visit,,Case Rate,60.00
Blue Shield,PPO,,,NICU/Newborn - Level I,,Per Diem,946.00
Blue Shield,PPO,,,CCU,,Per Diem,5692.00
Blue Shield,PPO,,,ICU,,Per Diem,5692.00
Blue Shield,PPO,,,Medical Surgical,,Per Diem,5692.00
Blue Shield,PPO,,,Pediatrics,,Per Diem,5692.00
Blue Shield,PPO,,,NICU/Newborn - Level II,,Per Diem,7077.00
Blue Shield,PPO,,,NICU/Newborn - Level III,,Per Diem,7077.00
Blue Shield,PPO,,,NICU/Newborn - Level IV,,Per Diem,7077.00
Cash Price - Pay Today,,29086,CPT4/HCPCS,APPLY FINGER CAST,,Pay At Time of Service,200.00
Cash Price - Pay Today,,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Pay At Time of Service,200.00
Cash Price - Pay Today,,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Pay At Time of Service,100.00
Cash Price - Pay Today,,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Pay At Time of Service,100.00
Cash Price - Pay Today,,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Pay At Time of Service,100.00
Cash Price - Pay Today,,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Pay At Time of Service,100.00
Cash Price - Pay Today,,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Pay At Time of Service,200.00
Cash Price - Pay Today,,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Pay At Time of Service,404.00
Cash Price - Pay Today,,36415,CPT4/HCPCS,ROUTINE VENIPUNCTURE,,Pay At Time of Service,3.45
Cash Price - Pay Today,,59025,CPT4/HCPCS,FETAL NON-STRESS TEST,,Pay At Time of Service,100.00
Cash Price - Pay Today,,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,Pay At Time of Service,450.00
Cash Price - Pay Today,,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,Pay At Time of Service,57.00
Cash Price - Pay Today,,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,Pay At Time of Service,375.00
Cash Price - Pay Today,,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,Pay At Time of Service,375.00
Cash Price - Pay Today,,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,71010,CPT4/HCPCS,CHEST X-RAY 1 VIEW FRONTAL,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71020,CPT4/HCPCS,CHEST X-RAY 2VW FRONTAL&LATL,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71021,CPT4/HCPCS,CHEST X-RAY FRNT LAT LORDOTC,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71030,CPT4/HCPCS,CHEST X-RAY 4/> VIEWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71035,CPT4/HCPCS,CHEST X-RAY SPECIAL VIEWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71260,CPT4/HCPCS,CT THORAX DX C+,,Pay At Time of Service,375.00
Cash Price - Pay Today,,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,Pay At Time of Service,375.00
Cash Price - Pay Today,,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,Pay At Time of Service,375.00
Cash Price - Pay Today,,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,72193,CPT4/HCPCS,CT PELVIS W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,Pay At Time of Service,375.00
Cash Price - Pay Today,,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,Pay At Time of Service,350.00
Cash Price - Pay Today,,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,Pay At Time of Service,350.00
Cash Price - Pay Today,,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,Pay At Time of Service,350.00
Cash Price - Pay Today,,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,Pay At Time of Service,57.00
Cash Price - Pay Today,,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73510,CPT4/HCPCS,X-RAY EXAM OF HIP,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,Pay At Time of Service,350.00
Cash Price - Pay Today,,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,Pay At Time of Service,350.00
Cash Price - Pay Today,,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,Pay At Time of Service,350.00
Cash Price - Pay Today,,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,Pay At Time of Service,57.00
Cash Price - Pay Today,,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,Pay At Time of Service,57.00
Cash Price - Pay Today,,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,74000,CPT4/HCPCS,X-RAY EXAM OF ABDOMEN,,Pay At Time of Service,57.00
Cash Price - Pay Today,,74010,CPT4/HCPCS,X-RAY EXAM OF ABDOMEN,,Pay At Time of Service,57.00
Cash Price - Pay Today,,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,Pay At Time of Service,57.00
Cash Price - Pay Today,,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,Pay At Time of Service,300.00
Cash Price - Pay Today,,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,Pay At Time of Service,300.00
Cash Price - Pay Today,,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,Pay At Time of Service,450.00
Cash Price - Pay Today,,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,Pay At Time of Service,450.00
Cash Price - Pay Today,,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,Pay At Time of Service,450.00
Cash Price - Pay Today,,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,Pay At Time of Service,550.00
Cash Price - Pay Today,,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,Pay At Time of Service,300.00
Cash Price - Pay Today,,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,Pay At Time of Service,350.00
Cash Price - Pay Today,,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,Pay At Time of Service,3650.00
Cash Price - Pay Today,,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Pay At Time of Service,350.00
Cash Price - Pay Today,,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,Pay At Time of Service,3650.00
Cash Price - Pay Today,,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,Pay At Time of Service,100.00
Cash Price - Pay Today,,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,Pay At Time of Service,375.00
Cash Price - Pay Today,,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75791,CPT4/HCPCS,AV DIALYSIS SHUNT IMAGING,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,Pay At Time of Service,3650.00
Cash Price - Pay Today,,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,Pay At Time of Service,3650.00
Cash Price - Pay Today,,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,Pay At Time of Service,3650.00
Cash Price - Pay Today,,75860,CPT4/HCPCS,VEIN X-RAY NECK,,Pay At Time of Service,3650.00
Cash Price - Pay Today,,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,Pay At Time of Service,1500.00
Cash Price - Pay Today,,75962,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75964,CPT4/HCPCS,REPAIR ARTERY BLOCKAGE EACH,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75966,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75968,CPT4/HCPCS,REPAIR ARTERY BLOCKAGE EACH,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75978,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,Pay At Time of Service,1500.00
Cash Price - Pay Today,,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,Pay At Time of Service,57.00
Cash Price - Pay Today,,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,Pay At Time of Service,57.00
Cash Price - Pay Today,,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,Pay At Time of Service,300.00
Cash Price - Pay Today,,76497,CPT4/HCPCS,CT PROCEDURE,,Pay At Time of Service,375.00
Cash Price - Pay Today,,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76604,CPT4/HCPCS,US EXAM CHEST,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,Pay At Time of Service,100.00
Cash Price - Pay Today,,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,Pay At Time of Service,100.00
Cash Price - Pay Today,,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,Pay At Time of Service,150.00
Cash Price - Pay Today,,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76870,CPT4/HCPCS,US EXAM SCROTUM,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,Pay At Time of Service,150.00
Cash Price - Pay Today,,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,Pay At Time of Service,1500.00
Cash Price - Pay Today,,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,Pay At Time of Service,350.00
Cash Price - Pay Today,,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,Pay At Time of Service,350.00
Cash Price - Pay Today,,77055,CPT4/HCPCS,MAMMOGRAM ONE BREAST,,Pay At Time of Service,100.00
Cash Price - Pay Today,,77057,CPT4/HCPCS,MAMMOGRAM SCREENING,,Pay At Time of Service,50.00
Cash Price - Pay Today,,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,Pay At Time of Service,57.00
Cash Price - Pay Today,,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,Pay At Time of Service,300.00
Cash Price - Pay Today,,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,Pay At Time of Service,57.00
Cash Price - Pay Today,,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,Pay At Time of Service,57.00
Cash Price - Pay Today,,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,Pay At Time of Service,57.00
Cash Price - Pay Today,,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,Pay At Time of Service,57.00
Cash Price - Pay Today,,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,Pay At Time of Service,350.00
Cash Price - Pay Today,,80048,CPT4/HCPCS,METABOLIC PANEL TOTAL CA,,Pay At Time of Service,13.25
Cash Price - Pay Today,,80053,CPT4/HCPCS,COMPREHEN METABOLIC PANEL,,Pay At Time of Service,16.55
Cash Price - Pay Today,,80061,CPT4/HCPCS,LIPID PANEL,,Pay At Time of Service,20.98
Cash Price - Pay Today,,80150,CPT4/HCPCS,ASSAY OF AMIKACIN,,Pay At Time of Service,23.62
Cash Price - Pay Today,,80158,CPT4/HCPCS,DRUG ASSAY CYCLOSPORINE,,Pay At Time of Service,28.28
Cash Price - Pay Today,,80164,CPT4/HCPCS,ASSAY DIPROPYLACETIC ACD TOT,,Pay At Time of Service,21.23
Cash Price - Pay Today,,80170,CPT4/HCPCS,ASSAY OF GENTAMICIN,,Pay At Time of Service,25.67
Cash Price - Pay Today,,80178,CPT4/HCPCS,ASSAY OF LITHIUM,,Pay At Time of Service,10.36
Cash Price - Pay Today,,80200,CPT4/HCPCS,ASSAY OF TOBRAMYCIN,,Pay At Time of Service,25.25
Cash Price - Pay Today,,80202,CPT4/HCPCS,ASSAY OF VANCOMYCIN,,Pay At Time of Service,21.23
Cash Price - Pay Today,,80299,CPT4/HCPCS,QUANTITATIVE ASSAY DRUG,,Pay At Time of Service,21.46
Cash Price - Pay Today,,81003,CPT4/HCPCS,URINALYSIS AUTO W/O SCOPE,,Pay At Time of Service,3.52
Cash Price - Pay Today,,81005,CPT4/HCPCS,URINALYSIS,,Pay At Time of Service,3.39
Cash Price - Pay Today,,81025,CPT4/HCPCS,URINE PREGNANCY TEST,,Pay At Time of Service,8.64
Cash Price - Pay Today,,81206,CPT4/HCPCS,BCR/ABL1 GENE MAJOR BP,,Pay At Time of Service,256.85
Cash Price - Pay Today,,81261,CPT4/HCPCS,IGH GENE REARRANGE AMP METH,,Pay At Time of Service,310.15
Cash Price - Pay Today,,81270,CPT4/HCPCS,JAK2 GENE,,Pay At Time of Service,143.60
Cash Price - Pay Today,,81315,CPT4/HCPCS,PML/RARALPHA COM BREAKPOINTS,,Pay At Time of Service,324.76
Cash Price - Pay Today,,81376,CPT4/HCPCS,HLA II TYPING 1 LOCUS LR,,Pay At Time of Service,191.46
Cash Price - Pay Today,,82010,CPT4/HCPCS,ACETONE ASSAY,,Pay At Time of Service,12.80
Cash Price - Pay Today,,82042,CPT4/HCPCS,OTHER SOURCE ALBUMIN QUAN EA,,Pay At Time of Service,8.11
Cash Price - Pay Today,,82043,CPT4/HCPCS,UR ALBUMIN QUANTITATIVE,,Pay At Time of Service,9.05
Cash Price - Pay Today,,82088,CPT4/HCPCS,ASSAY OF ALDOSTERONE,,Pay At Time of Service,63.84
Cash Price - Pay Today,,82103,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN TOTAL,,Pay At Time of Service,21.04
Cash Price - Pay Today,,82105,CPT4/HCPCS,ALPHA-FETOPROTEIN SERUM,,Pay At Time of Service,26.28
Cash Price - Pay Today,,82108,CPT4/HCPCS,ASSAY OF ALUMINUM,,Pay At Time of Service,39.92
Cash Price - Pay Today,,82128,CPT4/HCPCS,AMINO ACIDS MULT QUAL,,Pay At Time of Service,21.72
Cash Price - Pay Today,,82131,CPT4/HCPCS,AMINO ACIDS SINGLE QUANT,,Pay At Time of Service,26.43
Cash Price - Pay Today,,82135,CPT4/HCPCS,ASSAY AMINOLEVULINIC ACID,,Pay At Time of Service,25.77
Cash Price - Pay Today,,82139,CPT4/HCPCS,AMINO ACIDS QUAN 6 OR MORE,,Pay At Time of Service,26.42
Cash Price - Pay Today,,82143,CPT4/HCPCS,AMNIOTIC FLUID SCAN,,Pay At Time of Service,10.75
Cash Price - Pay Today,,82150,CPT4/HCPCS,ASSAY OF AMYLASE,,Pay At Time of Service,10.15
Cash Price - Pay Today,,82157,CPT4/HCPCS,ASSAY OF ANDROSTENEDIONE,,Pay At Time of Service,45.86
Cash Price - Pay Today,,82164,CPT4/HCPCS,ANGIOTENSIN I ENZYME TEST,,Pay At Time of Service,22.87
Cash Price - Pay Today,,82172,CPT4/HCPCS,ASSAY OF APOLIPOPROTEIN,,Pay At Time of Service,23.44
Cash Price - Pay Today,,82175,CPT4/HCPCS,ASSAY OF ARSENIC,,Pay At Time of Service,29.72
Cash Price - Pay Today,,82232,CPT4/HCPCS,ASSAY OF BETA-2 PROTEIN,,Pay At Time of Service,25.35
Cash Price - Pay Today,,82247,CPT4/HCPCS,BILIRUBIN TOTAL,,Pay At Time of Service,7.85
Cash Price - Pay Today,,82300,CPT4/HCPCS,ASSAY OF CADMIUM,,Pay At Time of Service,36.25
Cash Price - Pay Today,,82306,CPT4/HCPCS,VITAMIN D 25 HYDROXY,,Pay At Time of Service,46.38
Cash Price - Pay Today,,82310,CPT4/HCPCS,ASSAY OF CALCIUM,,Pay At Time of Service,8.09
Cash Price - Pay Today,,82340,CPT4/HCPCS,ASSAY OF CALCIUM IN URINE,,Pay At Time of Service,9.44
Cash Price - Pay Today,,82375,CPT4/HCPCS,ASSAY CARBOXYHB QUANT,,Pay At Time of Service,19.30
Cash Price - Pay Today,,82378,CPT4/HCPCS,CARCINOEMBRYONIC ANTIGEN,,Pay At Time of Service,29.72
Cash Price - Pay Today,,82379,CPT4/HCPCS,ASSAY OF CARNITINE,,Pay At Time of Service,26.42
Cash Price - Pay Today,,82383,CPT4/HCPCS,ASSAY BLOOD CATECHOLAMINES,,Pay At Time of Service,39.26
Cash Price - Pay Today,,82384,CPT4/HCPCS,ASSAY THREE CATECHOLAMINES,,Pay At Time of Service,39.56
Cash Price - Pay Today,,82397,CPT4/HCPCS,CHEMILUMINESCENT ASSAY,,Pay At Time of Service,22.13
Cash Price - Pay Today,,82435,CPT4/HCPCS,ASSAY OF BLOOD CHLORIDE,,Pay At Time of Service,7.20
Cash Price - Pay Today,,82436,CPT4/HCPCS,ASSAY OF URINE CHLORIDE,,Pay At Time of Service,7.88
Cash Price - Pay Today,,82438,CPT4/HCPCS,ASSAY OTHER FLUID CHLORIDES,,Pay At Time of Service,7.66
Cash Price - Pay Today,,82465,CPT4/HCPCS,ASSAY BLD/SERUM CHOLESTEROL,,Pay At Time of Service,6.81
Cash Price - Pay Today,,82507,CPT4/HCPCS,ASSAY OF CITRATE,,Pay At Time of Service,43.55
Cash Price - Pay Today,,82523,CPT4/HCPCS,COLLAGEN CROSSLINKS,,Pay At Time of Service,29.07
Cash Price - Pay Today,,82525,CPT4/HCPCS,ASSAY OF COPPER,,Pay At Time of Service,19.43
Cash Price - Pay Today,,82530,CPT4/HCPCS,CORTISOL FREE,,Pay At Time of Service,26.17
Cash Price - Pay Today,,82533,CPT4/HCPCS,TOTAL CORTISOL,,Pay At Time of Service,25.54
Cash Price - Pay Today,,82542,CPT4/HCPCS,COL CHROMOTOGRAPHY QUAL/QUAN,,Pay At Time of Service,28.29
Cash Price - Pay Today,,82552,CPT4/HCPCS,ASSAY OF CPK IN BLOOD,,Pay At Time of Service,20.99
Cash Price - Pay Today,,82553,CPT4/HCPCS,CREATINE MB FRACTION,,Pay At Time of Service,18.09
Cash Price - Pay Today,,82570,CPT4/HCPCS,ASSAY OF URINE CREATININE,,Pay At Time of Service,8.11
Cash Price - Pay Today,,82575,CPT4/HCPCS,CREATININE CLEARANCE TEST,,Pay At Time of Service,14.81
Cash Price - Pay Today,,82595,CPT4/HCPCS,ASSAY OF CRYOGLOBULIN,,Pay At Time of Service,10.13
Cash Price - Pay Today,,82652,CPT4/HCPCS,VIT D 1 25-DIHYDROXY,,Pay At Time of Service,50.74
Cash Price - Pay Today,,82657,CPT4/HCPCS,ENZYME CELL ACTIVITY,,Pay At Time of Service,28.29
Cash Price - Pay Today,,82670,CPT4/HCPCS,ASSAY OF TOTAL ESTRADIOL,,Pay At Time of Service,43.77
Cash Price - Pay Today,,82693,CPT4/HCPCS,ASSAY OF ETHYLENE GLYCOL,,Pay At Time of Service,23.33
Cash Price - Pay Today,,82728,CPT4/HCPCS,ASSAY OF FERRITIN,,Pay At Time of Service,21.36
Cash Price - Pay Today,,82784,CPT4/HCPCS,ASSAY IGA/IGD/IGG/IGM EACH,,Pay At Time of Service,14.57
Cash Price - Pay Today,,82785,CPT4/HCPCS,ASSAY OF IGE,,Pay At Time of Service,25.79
Cash Price - Pay Today,,82787,CPT4/HCPCS,IGG 1 2 3 OR 4 EACH,,Pay At Time of Service,12.56
Cash Price - Pay Today,,82945,CPT4/HCPCS,GLUCOSE OTHER FLUID,,Pay At Time of Service,6.15
Cash Price - Pay Today,,82947,CPT4/HCPCS,ASSAY GLUCOSE BLOOD QUANT,,Pay At Time of Service,6.15
Cash Price - Pay Today,,82950,CPT4/HCPCS,GLUCOSE TEST,,Pay At Time of Service,7.44
Cash Price - Pay Today,,82951,CPT4/HCPCS,GLUCOSE TOLERANCE TEST (GTT),,Pay At Time of Service,20.16
Cash Price - Pay Today,,82977,CPT4/HCPCS,ASSAY OF GGT,,Pay At Time of Service,11.28
Cash Price - Pay Today,,83001,CPT4/HCPCS,ASSAY OF GONADOTROPIN (FSH),,Pay At Time of Service,29.11
Cash Price - Pay Today,,83002,CPT4/HCPCS,ASSAY OF GONADOTROPIN (LH),,Pay At Time of Service,29.00
Cash Price - Pay Today,,83010,CPT4/HCPCS,ASSAY OF HAPTOGLOBIN QUANT,,Pay At Time of Service,19.70
Cash Price - Pay Today,,83013,CPT4/HCPCS,H PYLORI (C-13) BREATH,,Pay At Time of Service,105.51
Cash Price - Pay Today,,83018,CPT4/HCPCS,HEAVY METAL QUANT EACH NES,,Pay At Time of Service,34.41
Cash Price - Pay Today,,83090,CPT4/HCPCS,ASSAY OF HOMOCYSTINE,,Pay At Time of Service,26.43
Cash Price - Pay Today,,83150,CPT4/HCPCS,ASSAY OF HOMOVANILLIC ACID,,Pay At Time of Service,30.31
Cash Price - Pay Today,,83497,CPT4/HCPCS,ASSAY OF 5-HIAA,,Pay At Time of Service,20.19
Cash Price - Pay Today,,83498,CPT4/HCPCS,ASSAY OF PROGESTERONE 17-D,,Pay At Time of Service,42.56
Cash Price - Pay Today,,83500,CPT4/HCPCS,ASSAY FREE HYDROXYPROLINE,,Pay At Time of Service,35.48
Cash Price - Pay Today,,83516,CPT4/HCPCS,IMMUNOASSAY NONANTIBODY,,Pay At Time of Service,14.54
Cash Price - Pay Today,,83519,CPT4/HCPCS,RIA NONANTIBODY,,Pay At Time of Service,21.16
Cash Price - Pay Today,,83520,CPT4/HCPCS,IMMUNOASSAY QUANT NOS NONAB,,Pay At Time of Service,20.27
Cash Price - Pay Today,,83525,CPT4/HCPCS,ASSAY OF INSULIN,,Pay At Time of Service,17.91
Cash Price - Pay Today,,83540,CPT4/HCPCS,ASSAY OF IRON,,Pay At Time of Service,10.14
Cash Price - Pay Today,,83605,CPT4/HCPCS,ASSAY OF LACTIC ACID,,Pay At Time of Service,16.73
Cash Price - Pay Today,,83615,CPT4/HCPCS,LACTATE (LD) (LDH) ENZYME,,Pay At Time of Service,9.45
Cash Price - Pay Today,,83655,CPT4/HCPCS,ASSAY OF LEAD,,Pay At Time of Service,18.96
Cash Price - Pay Today,,83661,CPT4/HCPCS,L/S RATIO FETAL LUNG,,Pay At Time of Service,34.44
Cash Price - Pay Today,,83663,CPT4/HCPCS,FLUORO POLARIZE FETAL LUNG,,Pay At Time of Service,29.62
Cash Price - Pay Today,,83690,CPT4/HCPCS,ASSAY OF LIPASE,,Pay At Time of Service,10.79
Cash Price - Pay Today,,83701,CPT4/HCPCS,LIPOPROTEIN BLD HR FRACTION,,Pay At Time of Service,38.89
Cash Price - Pay Today,,83704,CPT4/HCPCS,LIPOPROTEIN BLD QUAN PART,,Pay At Time of Service,49.43
Cash Price - Pay Today,,83718,CPT4/HCPCS,ASSAY OF LIPOPROTEIN,,Pay At Time of Service,12.83
Cash Price - Pay Today,,83721,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,Pay At Time of Service,14.95
Cash Price - Pay Today,,83727,CPT4/HCPCS,ASSAY OF LRH HORMONE,,Pay At Time of Service,26.93
Cash Price - Pay Today,,83735,CPT4/HCPCS,ASSAY OF MAGNESIUM,,Pay At Time of Service,10.49
Cash Price - Pay Today,,83789,CPT4/HCPCS,MASS SPECTROMETRY QUAL/QUAN,,Pay At Time of Service,28.29
Cash Price - Pay Today,,83825,CPT4/HCPCS,ASSAY OF MERCURY,,Pay At Time of Service,25.46
Cash Price - Pay Today,,83835,CPT4/HCPCS,ASSAY OF METANEPHRINES,,Pay At Time of Service,26.53
Cash Price - Pay Today,,83873,CPT4/HCPCS,ASSAY OF CSF PROTEIN,,Pay At Time of Service,26.96
Cash Price - Pay Today,,83874,CPT4/HCPCS,ASSAY OF MYOGLOBIN,,Pay At Time of Service,20.23
Cash Price - Pay Today,,83880,CPT4/HCPCS,ASSAY OF NATRIURETIC PEPTIDE,,Pay At Time of Service,53.18
Cash Price - Pay Today,,83883,CPT4/HCPCS,ASSAY NEPHELOMETRY NOT SPEC,,Pay At Time of Service,21.30
Cash Price - Pay Today,,83916,CPT4/HCPCS,OLIGOCLONAL BANDS,,Pay At Time of Service,31.50
Cash Price - Pay Today,,83921,CPT4/HCPCS,ORGANIC ACID SINGLE QUANT,,Pay At Time of Service,25.77
Cash Price - Pay Today,,83930,CPT4/HCPCS,ASSAY OF BLOOD OSMOLALITY,,Pay At Time of Service,10.36
Cash Price - Pay Today,,83935,CPT4/HCPCS,ASSAY OF URINE OSMOLALITY,,Pay At Time of Service,10.68
Cash Price - Pay Today,,83937,CPT4/HCPCS,ASSAY OF OSTEOCALCIN,,Pay At Time of Service,19.84
Cash Price - Pay Today,,83945,CPT4/HCPCS,ASSAY OF OXALATE,,Pay At Time of Service,20.16
Cash Price - Pay Today,,83970,CPT4/HCPCS,ASSAY OF PARATHORMONE,,Pay At Time of Service,64.66
Cash Price - Pay Today,,84030,CPT4/HCPCS,ASSAY OF BLOOD PKU,,Pay At Time of Service,8.61
Cash Price - Pay Today,,84075,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,Pay At Time of Service,8.11
Cash Price - Pay Today,,84081,CPT4/HCPCS,ASSAY PHOSPHATIDYLGLYCEROL,,Pay At Time of Service,25.87
Cash Price - Pay Today,,84105,CPT4/HCPCS,ASSAY OF URINE PHOSPHORUS,,Pay At Time of Service,8.11
Cash Price - Pay Today,,84120,CPT4/HCPCS,ASSAY OF URINE PORPHYRINS,,Pay At Time of Service,23.05
Cash Price - Pay Today,,84132,CPT4/HCPCS,ASSAY OF SERUM POTASSIUM,,Pay At Time of Service,7.20
Cash Price - Pay Today,,84133,CPT4/HCPCS,ASSAY OF URINE POTASSIUM,,Pay At Time of Service,6.74
Cash Price - Pay Today,,84134,CPT4/HCPCS,ASSAY OF PREALBUMIN,,Pay At Time of Service,22.85
Cash Price - Pay Today,,84144,CPT4/HCPCS,ASSAY OF PROGESTERONE,,Pay At Time of Service,32.68
Cash Price - Pay Today,,84145,CPT4/HCPCS,PROCALCITONIN (PCT),,Pay At Time of Service,41.96
Cash Price - Pay Today,,84146,CPT4/HCPCS,ASSAY OF PROLACTIN,,Pay At Time of Service,30.36
Cash Price - Pay Today,,84153,CPT4/HCPCS,ASSAY OF PSA TOTAL,,Pay At Time of Service,28.82
Cash Price - Pay Today,,84156,CPT4/HCPCS,ASSAY OF PROTEIN URINE,,Pay At Time of Service,5.75
Cash Price - Pay Today,,84157,CPT4/HCPCS,ASSAY OF PROTEIN OTHER,,Pay At Time of Service,5.75
Cash Price - Pay Today,,84165,CPT4/HCPCS,PROTEIN E-PHORESIS SERUM,,Pay At Time of Service,16.82
Cash Price - Pay Today,,84166,CPT4/HCPCS,PROTEIN E-PHORESIS/URINE/CSF,,Pay At Time of Service,27.93
Cash Price - Pay Today,,84181,CPT4/HCPCS,WESTERN BLOT TEST,,Pay At Time of Service,26.68
Cash Price - Pay Today,,84182,CPT4/HCPCS,PROTEIN WESTERN BLOT TEST,,Pay At Time of Service,28.20
Cash Price - Pay Today,,84202,CPT4/HCPCS,ASSAY RBC PROTOPORPHYRIN,,Pay At Time of Service,22.47
Cash Price - Pay Today,,84238,CPT4/HCPCS,ASSAY NONENDOCRINE RECEPTOR,,Pay At Time of Service,57.29
Cash Price - Pay Today,,84255,CPT4/HCPCS,ASSAY OF SELENIUM,,Pay At Time of Service,40.00
Cash Price - Pay Today,,84260,CPT4/HCPCS,ASSAY OF SEROTONIN,,Pay At Time of Service,48.53
Cash Price - Pay Today,,84295,CPT4/HCPCS,ASSAY OF SERUM SODIUM,,Pay At Time of Service,7.54
Cash Price - Pay Today,,84300,CPT4/HCPCS,ASSAY OF URINE SODIUM,,Pay At Time of Service,7.62
Cash Price - Pay Today,,84302,CPT4/HCPCS,ASSAY OF SWEAT SODIUM,,Pay At Time of Service,7.62
Cash Price - Pay Today,,84311,CPT4/HCPCS,SPECTROPHOTOMETRY,,Pay At Time of Service,10.95
Cash Price - Pay Today,,84376,CPT4/HCPCS,SUGARS SINGLE QUAL,,Pay At Time of Service,8.61
Cash Price - Pay Today,,84378,CPT4/HCPCS,SUGARS SINGLE QUANT,,Pay At Time of Service,18.05
Cash Price - Pay Today,,84402,CPT4/HCPCS,ASSAY OF FREE TESTOSTERONE,,Pay At Time of Service,39.89
Cash Price - Pay Today,,84403,CPT4/HCPCS,ASSAY OF TOTAL TESTOSTERONE,,Pay At Time of Service,40.45
Cash Price - Pay Today,,84439,CPT4/HCPCS,ASSAY OF FREE THYROXINE,,Pay At Time of Service,14.12
Cash Price - Pay Today,,84442,CPT4/HCPCS,ASSAY OF THYROID ACTIVITY,,Pay At Time of Service,23.16
Cash Price - Pay Today,,84443,CPT4/HCPCS,ASSAY THYROID STIM HORMONE,,Pay At Time of Service,26.32
Cash Price - Pay Today,,84466,CPT4/HCPCS,ASSAY OF TRANSFERRIN,,Pay At Time of Service,20.00
Cash Price - Pay Today,,84479,CPT4/HCPCS,ASSAY OF THYROID (T3 OR T4),,Pay At Time of Service,10.13
Cash Price - Pay Today,,84481,CPT4/HCPCS,FREE ASSAY (FT-3),,Pay At Time of Service,26.53
Cash Price - Pay Today,,84484,CPT4/HCPCS,ASSAY OF TROPONIN QUANT,,Pay At Time of Service,15.41
Cash Price - Pay Today,,84520,CPT4/HCPCS,ASSAY OF UREA NITROGEN,,Pay At Time of Service,6.19
Cash Price - Pay Today,,84540,CPT4/HCPCS,ASSAY OF URINE/UREA-N,,Pay At Time of Service,7.44
Cash Price - Pay Today,,84560,CPT4/HCPCS,ASSAY OF URINE/URIC ACID,,Pay At Time of Service,7.44
Cash Price - Pay Today,,84585,CPT4/HCPCS,ASSAY OF URINE VMA,,Pay At Time of Service,24.28
Cash Price - Pay Today,,84600,CPT4/HCPCS,ASSAY OF VOLATILES,,Pay At Time of Service,25.18
Cash Price - Pay Today,,84630,CPT4/HCPCS,ASSAY OF ZINC,,Pay At Time of Service,17.84
Cash Price - Pay Today,,85007,CPT4/HCPCS,BL SMEAR W/DIFF WBC COUNT,,Pay At Time of Service,5.38
Cash Price - Pay Today,,85018,CPT4/HCPCS,HEMOGLOBIN,,Pay At Time of Service,3.71
Cash Price - Pay Today,,85025,CPT4/HCPCS,COMPLETE CBC W/AUTO DIFF WBC,,Pay At Time of Service,12.18
Cash Price - Pay Today,,85240,CPT4/HCPCS,CLOT FACTOR VIII AHG 1 STAGE,,Pay At Time of Service,28.05
Cash Price - Pay Today,,85245,CPT4/HCPCS,CLOT FACTOR VIII VW RISTOCTN,,Pay At Time of Service,35.94
Cash Price - Pay Today,,85250,CPT4/HCPCS,CLOT FACTOR IX PTC/CHRSTMAS,,Pay At Time of Service,29.83
Cash Price - Pay Today,,85300,CPT4/HCPCS,ANTITHROMBIN III ACTIVITY,,Pay At Time of Service,18.57
Cash Price - Pay Today,,85301,CPT4/HCPCS,ANTITHROMBIN III ANTIGEN,,Pay At Time of Service,16.94
Cash Price - Pay Today,,85306,CPT4/HCPCS,CLOT INHIBIT PROT S FREE,,Pay At Time of Service,24.01
Cash Price - Pay Today,,85335,CPT4/HCPCS,FACTOR INHIBITOR TEST,,Pay At Time of Service,20.16
Cash Price - Pay Today,,85362,CPT4/HCPCS,FIBRIN DEGRADATION PRODUCTS,,Pay At Time of Service,10.79
Cash Price - Pay Today,,85378,CPT4/HCPCS,FIBRIN DEGRADE SEMIQUANT,,Pay At Time of Service,11.18
Cash Price - Pay Today,,85397,CPT4/HCPCS,CLOTTING FUNCT ACTIVITY,,Pay At Time of Service,35.94
Cash Price - Pay Today,,85576,CPT4/HCPCS,BLOOD PLATELET AGGREGATION,,Pay At Time of Service,33.66
Cash Price - Pay Today,,85597,CPT4/HCPCS,PHOSPHOLIPID PLTLT NEUTRALIZ,,Pay At Time of Service,28.16
Cash Price - Pay Today,,85610,CPT4/HCPCS,PROTHROMBIN TIME,,Pay At Time of Service,6.16
Cash Price - Pay Today,,85660,CPT4/HCPCS,RBC SICKLE CELL TEST,,Pay At Time of Service,8.64
Cash Price - Pay Today,,85730,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,Pay At Time of Service,9.41
Cash Price - Pay Today,,85810,CPT4/HCPCS,BLOOD VISCOSITY EXAMINATION,,Pay At Time of Service,18.29
Cash Price - Pay Today,,86000,CPT4/HCPCS,AGGLUTININS FEBRILE ANTIGEN,,Pay At Time of Service,10.94
Cash Price - Pay Today,,86001,CPT4/HCPCS,ALLERGEN SPECIFIC IGG,,Pay At Time of Service,8.18
Cash Price - Pay Today,,86003,CPT4/HCPCS,ALLG SPEC IGE CRUDE XTRC EA,,Pay At Time of Service,8.18
Cash Price - Pay Today,,86021,CPT4/HCPCS,WBC ANTIBODY IDENTIFICATION,,Pay At Time of Service,23.59
Cash Price - Pay Today,,86022,CPT4/HCPCS,PLATELET ANTIBODIES,,Pay At Time of Service,28.77
Cash Price - Pay Today,,86023,CPT4/HCPCS,IMMUNOGLOBULIN ASSAY,,Pay At Time of Service,19.52
Cash Price - Pay Today,,86038,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES,,Pay At Time of Service,18.94
Cash Price - Pay Today,,86063,CPT4/HCPCS,ANTISTREPTOLYSIN O SCREEN,,Pay At Time of Service,9.04
Cash Price - Pay Today,,86147,CPT4/HCPCS,CARDIOLIPIN ANTIBODY EA IG,,Pay At Time of Service,28.82
Cash Price - Pay Today,,86160,CPT4/HCPCS,COMPLEMENT ANTIGEN,,Pay At Time of Service,18.80
Cash Price - Pay Today,,86171,CPT4/HCPCS,COMPLEMENT FIXATION EACH,,Pay At Time of Service,15.69
Cash Price - Pay Today,,86226,CPT4/HCPCS,DNA ANTIBODY SINGLE STRAND,,Pay At Time of Service,18.96
Cash Price - Pay Today,,86235,CPT4/HCPCS,NUCLEAR ANTIGEN ANTIBODY,,Pay At Time of Service,28.09
Cash Price - Pay Today,,86255,CPT4/HCPCS,FLUORESCENT ANTIBODY SCREEN,,Pay At Time of Service,18.87
Cash Price - Pay Today,,86256,CPT4/HCPCS,FLUORESCENT ANTIBODY TITER,,Pay At Time of Service,18.87
Cash Price - Pay Today,,86300,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 15-3,,Pay At Time of Service,32.60
Cash Price - Pay Today,,86304,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 125,,Pay At Time of Service,32.60
Cash Price - Pay Today,,86308,CPT4/HCPCS,HETEROPHILE ANTIBODY SCREEN,,Pay At Time of Service,8.11
Cash Price - Pay Today,,86316,CPT4/HCPCS,IMMUNOASSAY TUMOR OTHER,,Pay At Time of Service,32.60
Cash Price - Pay Today,,86317,CPT4/HCPCS,IMMUNOASSAY INFECTIOUS AGENT,,Pay At Time of Service,23.48
Cash Price - Pay Today,,86331,CPT4/HCPCS,IMMUNODIFFUSION OUCHTERLONY,,Pay At Time of Service,18.77
Cash Price - Pay Today,,86332,CPT4/HCPCS,IMMUNE COMPLEX ASSAY,,Pay At Time of Service,38.18
Cash Price - Pay Today,,86334,CPT4/HCPCS,IMMUNOFIX E-PHORESIS SERUM,,Pay At Time of Service,35.01
Cash Price - Pay Today,,86335,CPT4/HCPCS,IMMUNFIX E-PHORSIS/URINE/CSF,,Pay At Time of Service,45.97
Cash Price - Pay Today,,86337,CPT4/HCPCS,INSULIN ANTIBODIES,,Pay At Time of Service,33.53
Cash Price - Pay Today,,86341,CPT4/HCPCS,ISLET CELL ANTIBODY,,Pay At Time of Service,26.02
Cash Price - Pay Today,,86355,CPT4/HCPCS,B CELLS TOTAL COUNT,,Pay At Time of Service,59.10
Cash Price - Pay Today,,86356,CPT4/HCPCS,MONONUCLEAR CELL ANTIGEN,,Pay At Time of Service,41.94
Cash Price - Pay Today,,86376,CPT4/HCPCS,MICROSOMAL ANTIBODY EACH,,Pay At Time of Service,22.79
Cash Price - Pay Today,,86403,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY SCRN,,Pay At Time of Service,15.96
Cash Price - Pay Today,,86431,CPT4/HCPCS,RHEUMATOID FACTOR QUANT,,Pay At Time of Service,8.89
Cash Price - Pay Today,,86480,CPT4/HCPCS,TB TEST CELL IMMUN MEASURE,,Pay At Time of Service,97.09
Cash Price - Pay Today,,86592,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUAL,,Pay At Time of Service,6.69
Cash Price - Pay Today,,86603,CPT4/HCPCS,ADENOVIRUS ANTIBODY,,Pay At Time of Service,20.15
Cash Price - Pay Today,,86606,CPT4/HCPCS,ASPERGILLUS ANTIBODY,,Pay At Time of Service,23.59
Cash Price - Pay Today,,86609,CPT4/HCPCS,BACTERIUM ANTIBODY,,Pay At Time of Service,20.18
Cash Price - Pay Today,,86611,CPT4/HCPCS,BARTONELLA ANTIBODY,,Pay At Time of Service,15.95
Cash Price - Pay Today,,86615,CPT4/HCPCS,BORDETELLA ANTIBODY,,Pay At Time of Service,20.67
Cash Price - Pay Today,,86617,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Pay At Time of Service,24.27
Cash Price - Pay Today,,86618,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Pay At Time of Service,26.68
Cash Price - Pay Today,,86631,CPT4/HCPCS,CHLAMYDIA ANTIBODY,,Pay At Time of Service,18.53
Cash Price - Pay Today,,86635,CPT4/HCPCS,COCCIDIOIDES ANTIBODY,,Pay At Time of Service,17.97
Cash Price - Pay Today,,86638,CPT4/HCPCS,Q FEVER ANTIBODY,,Pay At Time of Service,18.99
Cash Price - Pay Today,,86641,CPT4/HCPCS,CRYPTOCOCCUS ANTIBODY,,Pay At Time of Service,20.82
Cash Price - Pay Today,,86644,CPT4/HCPCS,CMV ANTIBODY,,Pay At Time of Service,22.55
Cash Price - Pay Today,,86645,CPT4/HCPCS,CMV ANTIBODY IGM,,Pay At Time of Service,26.39
Cash Price - Pay Today,,86651,CPT4/HCPCS,ENCEPHALITIS CALIFORN ANTBDY,,Pay At Time of Service,20.67
Cash Price - Pay Today,,86658,CPT4/HCPCS,ENTEROVIRUS ANTIBODY,,Pay At Time of Service,20.41
Cash Price - Pay Today,,86664,CPT4/HCPCS,EPSTEIN-BARR NUCLEAR ANTIGEN,,Pay At Time of Service,23.97
Cash Price - Pay Today,,86665,CPT4/HCPCS,EPSTEIN-BARR CAPSID VCA,,Pay At Time of Service,27.30
Cash Price - Pay Today,,86671,CPT4/HCPCS,FUNGUS NES ANTIBODY,,Pay At Time of Service,19.19
Cash Price - Pay Today,,86677,CPT4/HCPCS,HELICOBACTER PYLORI ANTIBODY,,Pay At Time of Service,22.74
Cash Price - Pay Today,,86682,CPT4/HCPCS,HELMINTH ANTIBODY,,Pay At Time of Service,20.38
Cash Price - Pay Today,,86687,CPT4/HCPCS,HTLV-I ANTIBODY,,Pay At Time of Service,13.14
Cash Price - Pay Today,,86689,CPT4/HCPCS,HTLV/HIV CONFIRMJ ANTIBODY,,Pay At Time of Service,30.33
Cash Price - Pay Today,,86692,CPT4/HCPCS,HEPATITIS DELTA AGENT ANTBDY,,Pay At Time of Service,26.89
Cash Price - Pay Today,,86694,CPT4/HCPCS,HERPES SIMPLEX NES ANTBDY,,Pay At Time of Service,22.55
Cash Price - Pay Today,,86695,CPT4/HCPCS,HERPES SIMPLEX TYPE 1 TEST,,Pay At Time of Service,20.67
Cash Price - Pay Today,,86696,CPT4/HCPCS,HERPES SIMPLEX TYPE 2 TEST,,Pay At Time of Service,30.33
Cash Price - Pay Today,,86698,CPT4/HCPCS,HISTOPLASMA ANTIBODY,,Pay At Time of Service,19.57
Cash Price - Pay Today,,86703,CPT4/HCPCS,HIV-1/HIV-2 1 RESULT ANTBDY,,Pay At Time of Service,21.47
Cash Price - Pay Today,,86705,CPT4/HCPCS,HEP B CORE ANTIBODY IGM,,Pay At Time of Service,18.45
Cash Price - Pay Today,,86706,CPT4/HCPCS,HEP B SURFACE ANTIBODY,,Pay At Time of Service,16.82
Cash Price - Pay Today,,86709,CPT4/HCPCS,HEPATITIS A IGM ANTIBODY,,Pay At Time of Service,17.63
Cash Price - Pay Today,,86710,CPT4/HCPCS,INFLUENZA VIRUS ANTIBODY,,Pay At Time of Service,21.23
Cash Price - Pay Today,,86713,CPT4/HCPCS,LEGIONELLA ANTIBODY,,Pay At Time of Service,23.98
Cash Price - Pay Today,,86717,CPT4/HCPCS,LEISHMANIA ANTIBODY,,Pay At Time of Service,19.18
Cash Price - Pay Today,,86727,CPT4/HCPCS,LYMPH CHORIOMENINGITIS AB,,Pay At Time of Service,20.15
Cash Price - Pay Today,,86735,CPT4/HCPCS,MUMPS ANTIBODY,,Pay At Time of Service,20.44
Cash Price - Pay Today,,86738,CPT4/HCPCS,MYCOPLASMA ANTIBODY,,Pay At Time of Service,20.75
Cash Price - Pay Today,,86747,CPT4/HCPCS,PARVOVIRUS ANTIBODY,,Pay At Time of Service,23.55
Cash Price - Pay Today,,86753,CPT4/HCPCS,PROTOZOA ANTIBODY NOS,,Pay At Time of Service,19.40
Cash Price - Pay Today,,86757,CPT4/HCPCS,RICKETTSIA ANTIBODY,,Pay At Time of Service,30.33
Cash Price - Pay Today,,86762,CPT4/HCPCS,RUBELLA ANTIBODY,,Pay At Time of Service,22.55
Cash Price - Pay Today,,86765,CPT4/HCPCS,RUBEOLA ANTIBODY,,Pay At Time of Service,20.18
Cash Price - Pay Today,,86777,CPT4/HCPCS,TOXOPLASMA ANTIBODY,,Pay At Time of Service,22.55
Cash Price - Pay Today,,86778,CPT4/HCPCS,TOXOPLASMA ANTIBODY IGM,,Pay At Time of Service,22.56
Cash Price - Pay Today,,86780,CPT4/HCPCS,TREPONEMA PALLIDUM,,Pay At Time of Service,20.73
Cash Price - Pay Today,,86787,CPT4/HCPCS,VARICELLA-ZOSTER ANTIBODY,,Pay At Time of Service,20.18
Cash Price - Pay Today,,86789,CPT4/HCPCS,WEST NILE VIRUS ANTIBODY,,Pay At Time of Service,22.55
Cash Price - Pay Today,,86790,CPT4/HCPCS,VIRUS ANTIBODY NOS,,Pay At Time of Service,20.18
Cash Price - Pay Today,,86803,CPT4/HCPCS,HEPATITIS C AB TEST,,Pay At Time of Service,22.36
Cash Price - Pay Today,,86812,CPT4/HCPCS,HLA TYPING A B OR C,,Pay At Time of Service,40.43
Cash Price - Pay Today,,86813,CPT4/HCPCS,HLA TYPING A B OR C,,Pay At Time of Service,90.85
Cash Price - Pay Today,,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,Pay At Time of Service,5.99
Cash Price - Pay Today,,86880,CPT4/HCPCS,COOMBS TEST DIRECT,,Pay At Time of Service,8.43
Cash Price - Pay Today,,86886,CPT4/HCPCS,COOMBS TEST INDIRECT TITER,,Pay At Time of Service,8.11
Cash Price - Pay Today,,86900,CPT4/HCPCS,BLOOD TYPING SEROLOGIC ABO,,Pay At Time of Service,4.68
Cash Price - Pay Today,,86901,CPT4/HCPCS,BLOOD TYPING SEROLOGIC RH(D),,Pay At Time of Service,4.68
Cash Price - Pay Today,,86902,CPT4/HCPCS,BLOOD TYPE ANTIGEN DONOR EA,,Pay At Time of Service,5.99
Cash Price - Pay Today,,86904,CPT4/HCPCS,BLOOD TYPING PATIENT SERUM,,Pay At Time of Service,14.90
Cash Price - Pay Today,,86905,CPT4/HCPCS,BLOOD TYPING RBC ANTIGENS,,Pay At Time of Service,5.99
Cash Price - Pay Today,,86906,CPT4/HCPCS,BLD TYPING SEROLOGIC RH PHNT,,Pay At Time of Service,12.13
Cash Price - Pay Today,,86941,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS,,Pay At Time of Service,18.96
Cash Price - Pay Today,,87015,CPT4/HCPCS,SPECIMEN INFECT AGNT CONCNTJ,,Pay At Time of Service,10.45
Cash Price - Pay Today,,87045,CPT4/HCPCS,FECES CULTURE AEROBIC BACT,,Pay At Time of Service,14.79
Cash Price - Pay Today,,87046,CPT4/HCPCS,STOOL CULTR AEROBIC BACT EA,,Pay At Time of Service,14.79
Cash Price - Pay Today,,87070,CPT4/HCPCS,CULTURE OTHR SPECIMN AEROBIC,,Pay At Time of Service,13.50
Cash Price - Pay Today,,87071,CPT4/HCPCS,CULTURE AEROBIC QUANT OTHER,,Pay At Time of Service,14.79
Cash Price - Pay Today,,87075,CPT4/HCPCS,CULTR BACTERIA EXCEPT BLOOD,,Pay At Time of Service,14.83
Cash Price - Pay Today,,87076,CPT4/HCPCS,CULTURE ANAEROBE IDENT EACH,,Pay At Time of Service,12.65
Cash Price - Pay Today,,87077,CPT4/HCPCS,CULTURE AEROBIC IDENTIFY,,Pay At Time of Service,12.65
Cash Price - Pay Today,,87081,CPT4/HCPCS,CULTURE SCREEN ONLY,,Pay At Time of Service,10.38
Cash Price - Pay Today,,87101,CPT4/HCPCS,SKIN FUNGI CULTURE,,Pay At Time of Service,12.07
Cash Price - Pay Today,,87102,CPT4/HCPCS,FUNGUS ISOLATION CULTURE,,Pay At Time of Service,13.17
Cash Price - Pay Today,,87103,CPT4/HCPCS,BLOOD FUNGUS CULTURE,,Pay At Time of Service,14.12
Cash Price - Pay Today,,87106,CPT4/HCPCS,FUNGI IDENTIFICATION YEAST,,Pay At Time of Service,16.18
Cash Price - Pay Today,,87109,CPT4/HCPCS,MYCOPLASMA,,Pay At Time of Service,24.10
Cash Price - Pay Today,,87110,CPT4/HCPCS,CHLAMYDIA CULTURE,,Pay At Time of Service,30.69
Cash Price - Pay Today,,87116,CPT4/HCPCS,MYCOBACTERIA CULTURE,,Pay At Time of Service,16.92
Cash Price - Pay Today,,87118,CPT4/HCPCS,MYCOBACTERIC IDENTIFICATION,,Pay At Time of Service,17.15
Cash Price - Pay Today,,87147,CPT4/HCPCS,CULTURE TYPE IMMUNOLOGIC,,Pay At Time of Service,8.11
Cash Price - Pay Today,,87149,CPT4/HCPCS,DNA/RNA DIRECT PROBE,,Pay At Time of Service,31.42
Cash Price - Pay Today,,87177,CPT4/HCPCS,OVA AND PARASITES SMEARS,,Pay At Time of Service,13.94
Cash Price - Pay Today,,87181,CPT4/HCPCS,MICROBE SUSCEPTIBLE DIFFUSE,,Pay At Time of Service,4.51
Cash Price - Pay Today,,87184,CPT4/HCPCS,MICROBE SUSCEPTIBLE DISK,,Pay At Time of Service,10.80
Cash Price - Pay Today,,87186,CPT4/HCPCS,MICROBE SUSCEPTIBLE MIC,,Pay At Time of Service,13.55
Cash Price - Pay Today,,87188,CPT4/HCPCS,MICROBE SUSCEPT MACROBROTH,,Pay At Time of Service,10.40
Cash Price - Pay Today,,87190,CPT4/HCPCS,MICROBE SUSCEPT MYCOBACTERI,,Pay At Time of Service,8.86
Cash Price - Pay Today,,87205,CPT4/HCPCS,SMEAR GRAM STAIN,,Pay At Time of Service,6.69
Cash Price - Pay Today,,87206,CPT4/HCPCS,SMEAR FLUORESCENT/ACID STAI,,Pay At Time of Service,8.43
Cash Price - Pay Today,,87207,CPT4/HCPCS,SMEAR SPECIAL STAIN,,Pay At Time of Service,9.38
Cash Price - Pay Today,,87210,CPT4/HCPCS,SMEAR WET MOUNT SALINE/INK,,Pay At Time of Service,6.69
Cash Price - Pay Today,,87220,CPT4/HCPCS,TISSUE EXAM FOR FUNGI,,Pay At Time of Service,6.69
Cash Price - Pay Today,,87230,CPT4/HCPCS,ASSAY TOXIN OR ANTITOXIN,,Pay At Time of Service,30.93
Cash Price - Pay Today,,87252,CPT4/HCPCS,VIRUS INOCULATION TISSUE,,Pay At Time of Service,40.84
Cash Price - Pay Today,,87254,CPT4/HCPCS,VIRUS INOCULATION SHELL VIA,,Pay At Time of Service,30.65
Cash Price - Pay Today,,87260,CPT4/HCPCS,ADENOVIRUS AG IF,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87265,CPT4/HCPCS,PERTUSSIS AG IF,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87270,CPT4/HCPCS,CHLAMYDIA TRACHOMATIS AG IF,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87274,CPT4/HCPCS,HERPES SIMPLEX 1 AG IF,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87275,CPT4/HCPCS,INFLUENZA B AG IF,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87278,CPT4/HCPCS,LEGION PNEUMOPHILIA AG IF,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87279,CPT4/HCPCS,PARAINFLUENZA AG IF,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87280,CPT4/HCPCS,RESPIRATORY SYNCYTIAL AG IF,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87324,CPT4/HCPCS,CLOSTRIDIUM AG IA,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87329,CPT4/HCPCS,GIARDIA AG IA,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87337,CPT4/HCPCS,ENTAMOEB HIST GROUP AG IA,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87340,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,Pay At Time of Service,16.18
Cash Price - Pay Today,,87385,CPT4/HCPCS,HISTOPLASMA CAPSUL AG IA,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87390,CPT4/HCPCS,HIV-1 AG IA,,Pay At Time of Service,27.63
Cash Price - Pay Today,,87400,CPT4/HCPCS,INFLUENZA A/B AG IA,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87425,CPT4/HCPCS,ROTAVIRUS AG IA,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87449,CPT4/HCPCS,AG DETECT NOS IA MULT,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87471,CPT4/HCPCS,BARTONELLA DNA AMP PROBE,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87476,CPT4/HCPCS,LYME DIS DNA AMP PROBE,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87486,CPT4/HCPCS,CHYLMD PNEUM DNA AMP PROBE,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87490,CPT4/HCPCS,CHYLMD TRACH DNA DIR PROBE,,Pay At Time of Service,31.42
Cash Price - Pay Today,,87491,CPT4/HCPCS,CHYLMD TRACH DNA AMP PROBE,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87497,CPT4/HCPCS,CYTOMEG DNA QUANT,,Pay At Time of Service,67.10
Cash Price - Pay Today,,87516,CPT4/HCPCS,HEPATITIS B DNA AMP PROBE,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87521,CPT4/HCPCS,HEPATITIS C PROBE&RVRS TRNSC,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87522,CPT4/HCPCS,HEPATITIS C REVRS TRNSCRPJ,,Pay At Time of Service,67.10
Cash Price - Pay Today,,87529,CPT4/HCPCS,HSV DNA AMP PROBE,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87535,CPT4/HCPCS,HIV-1 PROBE&REVERSE TRNSCRPJ,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87536,CPT4/HCPCS,HIV-1 QUANT&REVRSE TRNSCRPJ,,Pay At Time of Service,133.31
Cash Price - Pay Today,,87556,CPT4/HCPCS,M.TUBERCULO DNA AMP PROBE,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87591,CPT4/HCPCS,N.GONORRHOEAE DNA AMP PROB,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87797,CPT4/HCPCS,DETECT AGENT NOS DNA DIR,,Pay At Time of Service,31.42
Cash Price - Pay Today,,87798,CPT4/HCPCS,DETECT AGENT NOS DNA AMP,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87799,CPT4/HCPCS,DETECT AGENT NOS DNA QUANT,,Pay At Time of Service,67.10
Cash Price - Pay Today,,87899,CPT4/HCPCS,AGENT NOS ASSAY W/OPTIC,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87901,CPT4/HCPCS,GENOTYPE DNA HIV REVERSE T,,Pay At Time of Service,403.29
Cash Price - Pay Today,,88142,CPT4/HCPCS,CYTOPATH C/V THIN LAYER,,Pay At Time of Service,31.74
Cash Price - Pay Today,,88164,CPT4/HCPCS,CYTOPATH TBS C/V MANUAL,,Pay At Time of Service,16.55
Cash Price - Pay Today,,88230,CPT4/HCPCS,TISSUE CULTURE LYMPHOCYTE,,Pay At Time of Service,182.49
Cash Price - Pay Today,,88233,CPT4/HCPCS,TISSUE CULTURE SKIN/BIOPSY,,Pay At Time of Service,220.45
Cash Price - Pay Today,,88235,CPT4/HCPCS,TISSUE CULTURE PLACENTA,,Pay At Time of Service,230.69
Cash Price - Pay Today,,88237,CPT4/HCPCS,TISSUE CULTURE BONE MARROW,,Pay At Time of Service,197.87
Cash Price - Pay Today,,88262,CPT4/HCPCS,CHROMOSOME ANALYSIS 15-20,,Pay At Time of Service,195.26
Cash Price - Pay Today,,88264,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,Pay At Time of Service,195.26
Cash Price - Pay Today,,88271,CPT4/HCPCS,CYTOGENETICS DNA PROBE,,Pay At Time of Service,33.55
Cash Price - Pay Today,,88273,CPT4/HCPCS,CYTOGENETICS 10-30,,Pay At Time of Service,50.34
Cash Price - Pay Today,,88274,CPT4/HCPCS,CYTOGENETICS 25-99,,Pay At Time of Service,54.53
Cash Price - Pay Today,,88275,CPT4/HCPCS,CYTOGENETICS 100-300,,Pay At Time of Service,62.91
Cash Price - Pay Today,,89051,CPT4/HCPCS,BODY FLUID CELL COUNT,,Pay At Time of Service,8.63
Cash Price - Pay Today,,89125,CPT4/HCPCS,SPECIMEN FAT STAIN,,Pay At Time of Service,6.76
Cash Price - Pay Today,,89160,CPT4/HCPCS,EXAM FECES FOR MEAT FIBERS,,Pay At Time of Service,5.77
Cash Price - Pay Today,,91110,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,Pay At Time of Service,475.00
Cash Price - Pay Today,,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,Pay At Time of Service,125.00
Cash Price - Pay Today,,92585,CPT4/HCPCS,AUDITOR EVOKE POTENT COMPRE,,Pay At Time of Service,299.20
Cash Price - Pay Today,,92586,CPT4/HCPCS,AUDITOR EVOKE POTENT LIMIT,,Pay At Time of Service,176.18
Cash Price - Pay Today,,92587,CPT4/HCPCS,EVOKED AUDITORY TEST LIMITED,,Pay At Time of Service,299.20
Cash Price - Pay Today,,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Pay At Time of Service,703.00
Cash Price - Pay Today,,93017,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Pay At Time of Service,299.20
Cash Price - Pay Today,,93288,CPT4/HCPCS,INTERROG EVL PM/LDLS PM IP,,Pay At Time of Service,45.65
Cash Price - Pay Today,,93293,CPT4/HCPCS,PM PHONE R-STRIP DEVICE EVAL,,Pay At Time of Service,45.65
Cash Price - Pay Today,,93296,CPT4/HCPCS,REM INTERROG EVL PM/IDS,,Pay At Time of Service,45.65
Cash Price - Pay Today,,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,Pay At Time of Service,948.65
Cash Price - Pay Today,,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,Pay At Time of Service,565.94
Cash Price - Pay Today,,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,Pay At Time of Service,208.54
Cash Price - Pay Today,,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Pay At Time of Service,948.65
Cash Price - Pay Today,,93351,CPT4/HCPCS,STRESS TTE COMPLETE,,Pay At Time of Service,565.94
Cash Price - Pay Today,,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Pay At Time of Service,3010.00
Cash Price - Pay Today,,93880,CPT4/HCPCS,EXTRACRANIAL BILAT STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93882,CPT4/HCPCS,EXTRACRANIAL UNI/LTD STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93925,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93926,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93930,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93931,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93970,CPT4/HCPCS,EXTREMITY STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93971,CPT4/HCPCS,EXTREMITY STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93975,CPT4/HCPCS,VASCULAR STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93976,CPT4/HCPCS,VASCULAR STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93978,CPT4/HCPCS,VASCULAR STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93979,CPT4/HCPCS,VASCULAR STUDY,,Pay At Time of Service,150.00
Cash Price - Pay Today,,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,Pay At Time of Service,202.94
Cash Price - Pay Today,,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,Pay At Time of Service,202.94
Cash Price - Pay Today,,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,Pay At Time of Service,202.94
Cash Price - Pay Today,,94726,CPT4/HCPCS,PULM FUNCT TST PLETHYSMOGRAP,,Pay At Time of Service,299.20
Cash Price - Pay Today,,94727,CPT4/HCPCS,PULM FUNCTION TEST BY GAS,,Pay At Time of Service,176.18
Cash Price - Pay Today,,94775,CPT4/HCPCS,PED HOME APNEA REC HK-UP,,Pay At Time of Service,176.18
Cash Price - Pay Today,,95822,CPT4/HCPCS,EEG COMA OR SLEEP ONLY,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95956,CPT4/HCPCS,EEG MONITOR TECHNOL ATTENDED,,Pay At Time of Service,538.41
Cash Price - Pay Today,,97001,CPT4/HCPCS,PT EVALUATION,,Pay At Time of Service,125.00
Cash Price - Pay Today,,97003,CPT4/HCPCS,OT EVALUATION,,Pay At Time of Service,125.00
Cash Price - Pay Today,,G0479,CPT4/HCPCS,Drug test presump not opt,,Pay At Time of Service,91.14
Cash Price - Pay Today,,G0480,CPT4/HCPCS,Drug test def 1-7 classes,,Pay At Time of Service,91.93
Cash Price - Pay Today,,20670,CPT4/HCPCS,Pin Fixator Removal,,Pay At Time of Service,1800.00
Cash Price - Pay Today,,29065,CPT4/HCPCS,Cast Long Arm,,Pay At Time of Service,350.00
Cash Price - Pay Today,,29075,CPT4/HCPCS,Cast Short Arm,,Pay At Time of Service,350.00
Cash Price - Pay Today,,29085,CPT4/HCPCS,Cast Guantlet,,Pay At Time of Service,350.00
Cash Price - Pay Today,,29105,CPT4/HCPCS,Splint Long Arm,,Pay At Time of Service,200.00
Cash Price - Pay Today,,29325,CPT4/HCPCS,Cast 1 1/2 Spica Or Both Legs,,Pay At Time of Service,500.00
Cash Price - Pay Today,,29345,CPT4/HCPCS,Long Leg Cast (Thigh to Toes),,Pay At Time of Service,350.00
Cash Price - Pay Today,,29365,CPT4/HCPCS,Cast Cylinder,,Pay At Time of Service,350.00
Cash Price - Pay Today,,29425,CPT4/HCPCS,Cast Walker St or Amb Type,,Pay At Time of Service,350.00
Cash Price - Pay Today,,29440,CPT4/HCPCS,Adding Walker tp Prev Cast,,Pay At Time of Service,50.00
Cash Price - Pay Today,,29450,CPT4/HCPCS,Cast Clubfoot,,Pay At Time of Service,250.00
Cash Price - Pay Today,,29505,CPT4/HCPCS,Splint Long Leg,,Pay At Time of Service,200.00
Cash Price - Pay Today,,29700,CPT4/HCPCS,Removal/Bivalving Short Arm or Short Leg Cast,,Pay At Time of Service,408.00
Cash Price - Pay Today,,29705,CPT4/HCPCS,Removal/Bivalving Full Arm Or Full Leg Cast,,Pay At Time of Service,408.00
Cash Price - Pay Today,,29710,CPT4/HCPCS,Removal Shoulder or Hip Spica,,Pay At Time of Service,500.00
Cash Price - Pay Today,,29720,CPT4/HCPCS,Repair Spica/Body Cast/Jacket,,Pay At Time of Service,268.00
Cash Price - Pay Today,,29730,CPT4/HCPCS,Windowing of Cast,,Pay At Time of Service,268.00
Cash Price - Pay Today,,29740,CPT4/HCPCS,Wedging of Cast,,Pay At Time of Service,268.00
Cash Price - Pay Today,,29799,CPT4/HCPCS,Unlisted Proc Cast/Strap,,Pay At Time of Service,268.00
Cash Price - Pay Today,,36600,CPT4/HCPCS,Arterial Puncture,,Pay At Time of Service,123.81
Cash Price - Pay Today,,45382,CPT4/HCPCS,EUS Needle w/Balloon - Inactive,,Pay At Time of Service,475.00
Cash Price - Pay Today,,46946,CPT4/HCPCS,HET Probe (ligation device) - Inactive,,Pay At Time of Service,475.00
Cash Price - Pay Today,,70015,CPT4/HCPCS,Cisterno S&I,,Pay At Time of Service,350.00
Cash Price - Pay Today,,71023,CPT4/HCPCS,Chest 2 View & Fluoro,,Pay At Time of Service,57.00
Cash Price - Pay Today,,71034,CPT4/HCPCS,Chest 4 View & Fluoro,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72190,CPT4/HCPCS,Pelvis Judet Views,,Pay At Time of Service,57.00
Cash Price - Pay Today,,72240,CPT4/HCPCS,Cervical Myelogram S&I,,Pay At Time of Service,350.00
Cash Price - Pay Today,,72255,CPT4/HCPCS,Thoracic Myelogram S&I,,Pay At Time of Service,350.00
Cash Price - Pay Today,,72265,CPT4/HCPCS,Lumbar Myelogram S&I,,Pay At Time of Service,350.00
Cash Price - Pay Today,,72270,CPT4/HCPCS,Combined Myelogram S&I,,Pay At Time of Service,350.00
Cash Price - Pay Today,,72291,CPT4/HCPCS,Vertebro Plasty/Augment S&I,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,74190,CPT4/HCPCS,Peritoneogram S&I,,Pay At Time of Service,3650.00
Cash Price - Pay Today,,74220,CPT4/HCPCS,Esophogram,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74230,CPT4/HCPCS,Modfd Ba Swallow/Video,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74240,CPT4/HCPCS,Simple Gi,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74246,CPT4/HCPCS,Ugi,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74249,CPT4/HCPCS,Ugi & Sml Bowel Series,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74250,CPT4/HCPCS,Small Bowel Series,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74270,CPT4/HCPCS,Ba Enema W/Wo Kub,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74280,CPT4/HCPCS,Air Contrast Enema,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74283,CPT4/HCPCS,Therapeutic Ba Enema,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74330,CPT4/HCPCS,Ercp S&I,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74400,CPT4/HCPCS,Ivp W/Wo Lams,,Pay At Time of Service,150.00
Cash Price - Pay Today,,74415,CPT4/HCPCS,Nephrotomogram,,Pay At Time of Service,350.00
Cash Price - Pay Today,,74430,CPT4/HCPCS,Cystogram S&I,,Pay At Time of Service,350.00
Cash Price - Pay Today,,74455,CPT4/HCPCS,Voiding Cystogram S&I,,Pay At Time of Service,350.00
Cash Price - Pay Today,,74740,CPT4/HCPCS,Hysterosalpingogram S&I,,Pay At Time of Service,350.00
Cash Price - Pay Today,,75705,CPT4/HCPCS,IR Spinal Select,,Pay At Time of Service,3650.00
Cash Price - Pay Today,,75726,CPT4/HCPCS,Visceral Angio Sel/Supr/Se S&I,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75743,CPT4/HCPCS,Pulmonary Angio Sel Bil S&I,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75746,CPT4/HCPCS,Pulm Angio Non-Sel S&I,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75809,CPT4/HCPCS,Shuntogram S&I,,Pay At Time of Service,350.00
Cash Price - Pay Today,,75825,CPT4/HCPCS,Inferior Venacavagram S&I,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75827,CPT4/HCPCS,Superior Venacavagram S&I,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75833,CPT4/HCPCS,Renal Venogram S&I Bilateral,,Pay At Time of Service,3650.00
Cash Price - Pay Today,,75872,CPT4/HCPCS,Epidural Venogram,,Pay At Time of Service,3650.00
Cash Price - Pay Today,,75885,CPT4/HCPCS,Perchepporto W Hemo Eva S&I,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75889,CPT4/HCPCS,Hepatic Veno Hemodyn Ev S&I,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,75893,CPT4/HCPCS,Venous Sampling S&I,,Pay At Time of Service,5450.00
Cash Price - Pay Today,,76100,CPT4/HCPCS,Lams/Tomography,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76390,CPT4/HCPCS,Mri Spectroscopy,,Pay At Time of Service,450.00
Cash Price - Pay Today,,76831,CPT4/HCPCS,Hysterosonography,,Pay At Time of Service,350.00
Cash Price - Pay Today,,76872,CPT4/HCPCS,Us Transrectal,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76886,CPT4/HCPCS,Us Infant Hips No Radiologist,,Pay At Time of Service,150.00
Cash Price - Pay Today,,76936,CPT4/HCPCS,Us Guide Compression Repair,,Pay At Time of Service,150.00
Cash Price - Pay Today,,77002,CPT4/HCPCS,Spinal Puncture Fluoro Guided,,Pay At Time of Service,350.00
Cash Price - Pay Today,,77071,CPT4/HCPCS,Stress Views Any Joint,,Pay At Time of Service,57.00
Cash Price - Pay Today,,77081,CPT4/HCPCS,Bone Density Periphal Dxa,,Pay At Time of Service,57.00
Cash Price - Pay Today,,77085,CPT4/HCPCS,Bone Density Axial Dxa,,Pay At Time of Service,57.00
Cash Price - Pay Today,,78012,CPT4/HCPCS,Rn Thyroid Uptake + Scan,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78013,CPT4/HCPCS,Rn Thyroid Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78018,CPT4/HCPCS,Thyr Ca Met Imag Whole Body,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78070,CPT4/HCPCS,Parathyroid Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78071,CPT4/HCPCS,Rn Parathyroid Spect Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78104,CPT4/HCPCS,Bone Marrow Imag Whole Body,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78195,CPT4/HCPCS,Lymphatics Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78201,CPT4/HCPCS,Liver Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78202,CPT4/HCPCS,Rbc Liver/Hemangioma Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78205,CPT4/HCPCS,Spect Liver Scan,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78215,CPT4/HCPCS,Liver Spleen Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78226,CPT4/HCPCS,RN Cholangiogr,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78227,CPT4/HCPCS,Rn Hida Scan w/EF,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78262,CPT4/HCPCS,Gi Reflux Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78264,CPT4/HCPCS,Gastric Emptying,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78278,CPT4/HCPCS,Acute Gi Blood Loss Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78290,CPT4/HCPCS,Bowel Imaging Meckels,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78300,CPT4/HCPCS,Bone Imag Lim,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78305,CPT4/HCPCS,Bone Imag Mult,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78306,CPT4/HCPCS,Bone Imag Whol,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78315,CPT4/HCPCS,3Phase Bone Im,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78320,CPT4/HCPCS,Spect Bone Scan,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78445,CPT4/HCPCS,Xr Vasc Fl Img,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78456,CPT4/HCPCS,Rn Acute Thrombosis Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78458,CPT4/HCPCS,Rn Veno Bilat,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78459,CPT4/HCPCS,PET MYOCARD VIABILITY,,Pay At Time of Service,1300.00
Cash Price - Pay Today,,78472,CPT4/HCPCS,G Heart Imagng,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78481,CPT4/HCPCS,Gated Heart First Pass,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78579,CPT4/HCPCS,Lung Vent Sb,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78582,CPT4/HCPCS,Pulm Perf/Vent Scan,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78597,CPT4/HCPCS,Pulm Perf Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78605,CPT4/HCPCS,Brain Imgaging Complete,,Pay At Time of Service,550.00
Cash Price - Pay Today,,78606,CPT4/HCPCS,Rn Brain Imag W/Vasculr Flow C,,Pay At Time of Service,550.00
Cash Price - Pay Today,,78607,CPT4/HCPCS,Spect Brain Scan,,Pay At Time of Service,550.00
Cash Price - Pay Today,,78608,CPT4/HCPCS,Pet Brain Metabolic,,Pay At Time of Service,1300.00
Cash Price - Pay Today,,78609,CPT4/HCPCS,Pet Brain Perfusion,,Pay At Time of Service,1300.00
Cash Price - Pay Today,,78630,CPT4/HCPCS,Rn Cisterno,,Pay At Time of Service,1650.00
Cash Price - Pay Today,,78645,CPT4/HCPCS,Rn Csf Shunt Evaluation,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78700,CPT4/HCPCS,Renal Imaging Only,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78707,CPT4/HCPCS,Renal Imaging W Flow/Function,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78708,CPT4/HCPCS,Renal Imaging Flow/Func W/Capt,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78725,CPT4/HCPCS,Renal Function Gfr,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78740,CPT4/HCPCS,Rn Ureteral Reflux Study,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78761,CPT4/HCPCS,Testicular Imaging,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78801,CPT4/HCPCS,Tumor Local Mult Areas,,Pay At Time of Service,350.00
Cash Price - Pay Today,,78805,CPT4/HCPCS,Abcess Localization,,Pay At Time of Service,1650.00
Cash Price - Pay Today,,78806,CPT4/HCPCS,Indium Wbc Imaging,,Pay At Time of Service,1600.00
Cash Price - Pay Today,,78814,CPT4/HCPCS,Pet/Ct Tumorimag Limited Area,,Pay At Time of Service,1300.00
Cash Price - Pay Today,,78815,CPT4/HCPCS,Pet/Ct Limited Skull - Thigh,,Pay At Time of Service,1300.00
Cash Price - Pay Today,,78816,CPT4/HCPCS,Pet/Ct Limited Whole Body,,Pay At Time of Service,1300.00
Cash Price - Pay Today,,80051,CPT4/HCPCS,Electrolyte Panel,,Pay At Time of Service,10.98
Cash Price - Pay Today,,80069,CPT4/HCPCS,Renal Function Panel,,Pay At Time of Service,13.60
Cash Price - Pay Today,,80074,CPT4/HCPCS,Acute Hepatitis Panel,,Pay At Time of Service,74.62
Cash Price - Pay Today,,80076,CPT4/HCPCS,Liver Panel,,Pay At Time of Service,12.80
Cash Price - Pay Today,,80156,CPT4/HCPCS,Tegretol,,Pay At Time of Service,22.82
Cash Price - Pay Today,,80162,CPT4/HCPCS,Digoxin,,Pay At Time of Service,20.80
Cash Price - Pay Today,,80168,CPT4/HCPCS,Zarontin,,Pay At Time of Service,25.60
Cash Price - Pay Today,,80176,CPT4/HCPCS,Lidocaine,,Pay At Time of Service,23.01
Cash Price - Pay Today,,80184,CPT4/HCPCS,Phenobarbital,,Pay At Time of Service,17.94
Cash Price - Pay Today,,80185,CPT4/HCPCS,Phentoin (Dilantin),,Pay At Time of Service,20.77
Cash Price - Pay Today,,80186,CPT4/HCPCS,Phenytoin Free,,Pay At Time of Service,21.56
Cash Price - Pay Today,,80188,CPT4/HCPCS,Primidone Test,,Pay At Time of Service,26.00
Cash Price - Pay Today,,80192,CPT4/HCPCS,Procainamide,,Pay At Time of Service,26.24
Cash Price - Pay Today,,80194,CPT4/HCPCS,Quinidine,,Pay At Time of Service,22.87
Cash Price - Pay Today,,80195,CPT4/HCPCS,Sirolimus,,Pay At Time of Service,21.52
Cash Price - Pay Today,,80197,CPT4/HCPCS,Tacrolimus by LC MS MS HS,,Pay At Time of Service,21.52
Cash Price - Pay Today,,80198,CPT4/HCPCS,Theophylline,,Pay At Time of Service,22.16
Cash Price - Pay Today,,80201,CPT4/HCPCS,Topiramate,,Pay At Time of Service,18.68
Cash Price - Pay Today,,81000,CPT4/HCPCS,Specific Gravity,,Pay At Time of Service,4.97
Cash Price - Pay Today,,81001,CPT4/HCPCS,UA With Microscopic,,Pay At Time of Service,4.97
Cash Price - Pay Today,,81050,CPT4/HCPCS,Total Volume_3,,Pay At Time of Service,4.70
Cash Price - Pay Today,,81207,CPT4/HCPCS,BCR/ABL Minor By PCR,,Pay At Time of Service,226.89
Cash Price - Pay Today,,81210,CPT4/HCPCS,Braf,,Pay At Time of Service,205.83
Cash Price - Pay Today,,81211,CPT4/HCPCS,BRCA1 BRA2 Comprehensive,,Pay At Time of Service,2507.25
Cash Price - Pay Today,,81219,CPT4/HCPCS,Calreticulin Mutation Analysis,,Pay At Time of Service,190.53
Cash Price - Pay Today,,81225,CPT4/HCPCS,Accutype Cyp2C19 Genotype,,Pay At Time of Service,335.06
Cash Price - Pay Today,,81235,CPT4/HCPCS,EGFR Mutation By PCR,,Pay At Time of Service,378.94
Cash Price - Pay Today,,81240,CPT4/HCPCS,Factor II Mutation Analysis,,Pay At Time of Service,77.08
Cash Price - Pay Today,,81241,CPT4/HCPCS,Factor V Leiden Mutation Test,,Pay At Time of Service,95.73
Cash Price - Pay Today,,81256,CPT4/HCPCS,Hemochromatosis DNA,,Pay At Time of Service,102.40
Cash Price - Pay Today,,81275,CPT4/HCPCS,Kras By PCR,,Pay At Time of Service,226.77
Cash Price - Pay Today,,81291,CPT4/HCPCS,MTHFR Mutation DNA Analysis,,Pay At Time of Service,68.38
Cash Price - Pay Today,,81301,CPT4/HCPCS,MSI PCR (Tumor & Normal),,Pay At Time of Service,453.61
Cash Price - Pay Today,,81310,CPT4/HCPCS,CLL Prognostic Panel Comprehensive,,Pay At Time of Service,283.79
Cash Price - Pay Today,,81340,CPT4/HCPCS,T-Cell Clonality Beta By PCR,,Pay At Time of Service,327.28
Cash Price - Pay Today,,81342,CPT4/HCPCS,T-Cell Clonality Gamma By PCR,,Pay At Time of Service,315.65
Cash Price - Pay Today,,81374,CPT4/HCPCS,HLA Typing I Low Res 1 AG,,Pay At Time of Service,113.96
Cash Price - Pay Today,,81381,CPT4/HCPCS,HLA Typing I High Res 1 Allele,,Pay At Time of Service,148.17
Cash Price - Pay Today,,81382,CPT4/HCPCS,Celiac Genetics,,Pay At Time of Service,193.75
Cash Price - Pay Today,,82017,CPT4/HCPCS,Acylcarnitine Plasma,,Pay At Time of Service,26.42
Cash Price - Pay Today,,82024,CPT4/HCPCS,ACTH Plasma,,Pay At Time of Service,60.50
Cash Price - Pay Today,,82030,CPT4/HCPCS,Urine Cyclic AMP,,Pay At Time of Service,40.41
Cash Price - Pay Today,,82085,CPT4/HCPCS,Aldolase,,Pay At Time of Service,15.20
Cash Price - Pay Today,,82104,CPT4/HCPCS,Alpha 1 Antitrypsin Phenotype,,Pay At Time of Service,22.65
Cash Price - Pay Today,,82107,CPT4/HCPCS,Alpha Fetoprotein AFP L-3,,Pay At Time of Service,100.90
Cash Price - Pay Today,,82140,CPT4/HCPCS,Ammonia,,Pay At Time of Service,22.83
Cash Price - Pay Today,,82180,CPT4/HCPCS,Vitamin C,,Pay At Time of Service,15.48
Cash Price - Pay Today,,82190,CPT4/HCPCS,Stool Potassium,,Pay At Time of Service,23.36
Cash Price - Pay Today,,82239,CPT4/HCPCS,Bile Acids,,Pay At Time of Service,26.83
Cash Price - Pay Today,,82248,CPT4/HCPCS,Bilirubin Direct,,Pay At Time of Service,7.85
Cash Price - Pay Today,,82270,CPT4/HCPCS,Occult Blood X3_ Stool - Inactive,,Pay At Time of Service,5.09
Cash Price - Pay Today,,82271,CPT4/HCPCS,Occult Blood Gastric,,Pay At Time of Service,5.09
Cash Price - Pay Today,,82272,CPT4/HCPCS,Stool Occult Blood,,Pay At Time of Service,5.09
Cash Price - Pay Today,,82274,CPT4/HCPCS,Fecal Globin By IHC,,Pay At Time of Service,24.92
Cash Price - Pay Today,,82308,CPT4/HCPCS,Calcitonin,,Pay At Time of Service,41.96
Cash Price - Pay Today,,82330,CPT4/HCPCS,Ionized Calcium,,Pay At Time of Service,21.42
Cash Price - Pay Today,,82365,CPT4/HCPCS,Stone Analysis,,Pay At Time of Service,20.19
Cash Price - Pay Today,,82373,CPT4/HCPCS,Carbohydrate Deficient Transferrin,,Pay At Time of Service,28.29
Cash Price - Pay Today,,82374,CPT4/HCPCS,CO2,,Pay At Time of Service,7.66
Cash Price - Pay Today,,82380,CPT4/HCPCS,Carotene,,Pay At Time of Service,14.46
Cash Price - Pay Today,,82382,CPT4/HCPCS,Urine Catecholamines Random,,Pay At Time of Service,26.93
Cash Price - Pay Today,,82390,CPT4/HCPCS,Ceruloplasmin,,Pay At Time of Service,16.82
Cash Price - Pay Today,,82480,CPT4/HCPCS,Cholinesterase,,Pay At Time of Service,12.34
Cash Price - Pay Today,,82495,CPT4/HCPCS,Chromium,,Pay At Time of Service,31.77
Cash Price - Pay Today,,82540,CPT4/HCPCS,Creatine 24HR Urine Quest,,Pay At Time of Service,7.27
Cash Price - Pay Today,,82550,CPT4/HCPCS,CPK,,Pay At Time of Service,10.20
Cash Price - Pay Today,,82565,CPT4/HCPCS,Creatinine_Serum,,Pay At Time of Service,8.03
Cash Price - Pay Today,,82600,CPT4/HCPCS,Cyanide,,Pay At Time of Service,30.39
Cash Price - Pay Today,,82607,CPT4/HCPCS,Vitamin B12,,Pay At Time of Service,23.62
Cash Price - Pay Today,,82608,CPT4/HCPCS,Vitamin B12 Binding Capacity Unsaturated,,Pay At Time of Service,22.44
Cash Price - Pay Today,,82610,CPT4/HCPCS,Cystatin C,,Pay At Time of Service,21.30
Cash Price - Pay Today,,82626,CPT4/HCPCS,DHEA,,Pay At Time of Service,39.58
Cash Price - Pay Today,,82627,CPT4/HCPCS,DHEA Sulfate,,Pay At Time of Service,34.83
Cash Price - Pay Today,,82633,CPT4/HCPCS,Deoxycorticosterone,,Pay At Time of Service,48.53
Cash Price - Pay Today,,82634,CPT4/HCPCS,Deoxycortisol 11,,Pay At Time of Service,45.86
Cash Price - Pay Today,,82656,CPT4/HCPCS,Pancreatic Elastase 1,,Pay At Time of Service,14.54
Cash Price - Pay Today,,82668,CPT4/HCPCS,Erythropoietin,,Pay At Time of Service,29.44
Cash Price - Pay Today,,82671,CPT4/HCPCS,Estrogens Fractionated,,Pay At Time of Service,50.60
Cash Price - Pay Today,,82672,CPT4/HCPCS,Estrogens Total,,Pay At Time of Service,33.99
Cash Price - Pay Today,,82677,CPT4/HCPCS,Estriol,,Pay At Time of Service,37.88
Cash Price - Pay Today,,82679,CPT4/HCPCS,Estrone,,Pay At Time of Service,39.10
Cash Price - Pay Today,,82705,CPT4/HCPCS,Stool Fat Qualitative Quest,,Pay At Time of Service,7.97
Cash Price - Pay Today,,82710,CPT4/HCPCS,Fecal Lipids Total,,Pay At Time of Service,26.32
Cash Price - Pay Today,,82726,CPT4/HCPCS,Peroxisomal Panel,,Pay At Time of Service,28.29
Cash Price - Pay Today,,82731,CPT4/HCPCS,Fetal Fibronectin,,Pay At Time of Service,100.90
Cash Price - Pay Today,,82746,CPT4/HCPCS,Folate,,Pay At Time of Service,23.03
Cash Price - Pay Today,,82747,CPT4/HCPCS,Folate RBC,,Pay At Time of Service,27.13
Cash Price - Pay Today,,82757,CPT4/HCPCS,Fructose,,Pay At Time of Service,27.16
Cash Price - Pay Today,,82760,CPT4/HCPCS,Galactose Quant,,Pay At Time of Service,17.54
Cash Price - Pay Today,,82800,CPT4/HCPCS,Blood Gas PH,,Pay At Time of Service,13.26
Cash Price - Pay Today,,82803,CPT4/HCPCS,Arterial Blood Gas Analy,,Pay At Time of Service,30.31
Cash Price - Pay Today,,82941,CPT4/HCPCS,Gastrin,,Pay At Time of Service,27.62
Cash Price - Pay Today,,82943,CPT4/HCPCS,Glucagon,,Pay At Time of Service,22.38
Cash Price - Pay Today,,82948,CPT4/HCPCS,Glucose_Roche Glucometer,,Pay At Time of Service,4.97
Cash Price - Pay Today,,82955,CPT4/HCPCS,G6PD,,Pay At Time of Service,15.19
Cash Price - Pay Today,,82985,CPT4/HCPCS,Fructosamine,,Pay At Time of Service,23.62
Cash Price - Pay Today,,83003,CPT4/HCPCS,Growth Hormone,,Pay At Time of Service,26.13
Cash Price - Pay Today,,83015,CPT4/HCPCS,Urine Heavy Metals 1 Random,,Pay At Time of Service,29.50
Cash Price - Pay Today,,83020,CPT4/HCPCS,Hemoglobinopathy Evaluation,,Pay At Time of Service,20.16
Cash Price - Pay Today,,83021,CPT4/HCPCS,Fetal Hemoglobin Whole Blood,,Pay At Time of Service,28.29
Cash Price - Pay Today,,83033,CPT4/HCPCS,APT,,Pay At Time of Service,9.34
Cash Price - Pay Today,,83036,CPT4/HCPCS,Hemoglobin A1C,,Pay At Time of Service,15.20
Cash Price - Pay Today,,83051,CPT4/HCPCS,Hemoglobin Plasma,,Pay At Time of Service,11.45
Cash Price - Pay Today,,83070,CPT4/HCPCS,Urine Hemosiderin Qualitative,,Pay At Time of Service,7.44
Cash Price - Pay Today,,83080,CPT4/HCPCS,Hexosaminidase A and Total,,Pay At Time of Service,26.42
Cash Price - Pay Today,,83491,CPT4/HCPCS,Hydroxycorticosteroids 17,,Pay At Time of Service,27.45
Cash Price - Pay Today,,83505,CPT4/HCPCS,Hydroxyproline Total Random Ux - Inactive,,Pay At Time of Service,38.09
Cash Price - Pay Today,,83550,CPT4/HCPCS,Iron Binding Capacity,,Pay At Time of Service,11.56
Cash Price - Pay Today,,83586,CPT4/HCPCS,Urine Ketosteroids 17 24HR,,Pay At Time of Service,20.06
Cash Price - Pay Today,,83593,CPT4/HCPCS,Urine Ketosteroids 17 Fractionated 24HR,,Pay At Time of Service,41.19
Cash Price - Pay Today,,83625,CPT4/HCPCS,LDH Isoenzymes,,Pay At Time of Service,20.04
Cash Price - Pay Today,,83630,CPT4/HCPCS,Lactoferrin Stool (Ibd-Check),,Pay At Time of Service,30.75
Cash Price - Pay Today,,83695,CPT4/HCPCS,Lipoprotein A,,Pay At Time of Service,20.27
Cash Price - Pay Today,,83698,CPT4/HCPCS,LP Pla2,,Pay At Time of Service,53.18
Cash Price - Pay Today,,83700,CPT4/HCPCS,Lipoprotein Electrophoresis,,Pay At Time of Service,17.63
Cash Price - Pay Today,,83785,CPT4/HCPCS,Manganese,,Pay At Time of Service,38.54
Cash Price - Pay Today,,83864,CPT4/HCPCS,Urine Glycosaminoglycans,,Pay At Time of Service,31.20
Cash Price - Pay Today,,83915,CPT4/HCPCS,Nucleotidase 5,,Pay At Time of Service,17.47
Cash Price - Pay Today,,83918,CPT4/HCPCS,Pernicious Anemia Panel,,Pay At Time of Service,25.77
Cash Price - Pay Today,,83919,CPT4/HCPCS,Urine Organic Acids Quantitative,,Pay At Time of Service,25.77
Cash Price - Pay Today,,83950,CPT4/HCPCS,Her2 Oncoprotein-Inactive,,Pay At Time of Service,100.90
Cash Price - Pay Today,,83986,CPT4/HCPCS,PH,,Pay At Time of Service,5.61
Cash Price - Pay Today,,83993,CPT4/HCPCS,Calprotectin, Stool,,Pay At Time of Service,30.75
Cash Price - Pay Today,,84060,CPT4/HCPCS,Acid Phosphatase Total-Inactive,,Pay At Time of Service,11.57
Cash Price - Pay Today,,84080,CPT4/HCPCS,Alkaline Phosphatase Isoenzyme 2,,Pay At Time of Service,23.16
Cash Price - Pay Today,,84100,CPT4/HCPCS,Phosphorus,,Pay At Time of Service,7.43
Cash Price - Pay Today,,84106,CPT4/HCPCS,Phorphobilinogen Gl-Inactive,,Pay At Time of Service,6.70
Cash Price - Pay Today,,84110,CPT4/HCPCS,Urine Porphobilinogen Random,,Pay At Time of Service,13.23
Cash Price - Pay Today,,84112,CPT4/HCPCS,Amnisure Analysis,,Pay At Time of Service,100.90
Cash Price - Pay Today,,84119,CPT4/HCPCS,Urine Porphyrins Fractionated Random,,Pay At Time of Service,13.50
Cash Price - Pay Today,,84140,CPT4/HCPCS,Pregnenolone,,Pay At Time of Service,32.38
Cash Price - Pay Today,,84143,CPT4/HCPCS,Hydroxypregnenolone 17 Serum,,Pay At Time of Service,35.74
Cash Price - Pay Today,,84154,CPT4/HCPCS,PSA Free,,Pay At Time of Service,28.82
Cash Price - Pay Today,,84155,CPT4/HCPCS,Total Protein,,Pay At Time of Service,5.75
Cash Price - Pay Today,,84160,CPT4/HCPCS,Urine Protein 12HR,,Pay At Time of Service,8.11
Cash Price - Pay Today,,84206,CPT4/HCPCS,Proinsulin,,Pay At Time of Service,27.90
Cash Price - Pay Today,,84207,CPT4/HCPCS,Vitamin B6 Plasma,,Pay At Time of Service,44.01
Cash Price - Pay Today,,84210,CPT4/HCPCS,Pyruvate,,Pay At Time of Service,17.01
Cash Price - Pay Today,,84220,CPT4/HCPCS,Pyruvate Kinase Quantitative-Inactive,,Pay At Time of Service,14.79
Cash Price - Pay Today,,84233,CPT4/HCPCS,Receptor Assav Group 5-Inactive,,Pay At Time of Service,100.90
Cash Price - Pay Today,,84234,CPT4/HCPCS,ER PR on Paraffin Block-Inactive,,Pay At Time of Service,101.64
Cash Price - Pay Today,,84235,CPT4/HCPCS,Breast Cancer Profile 2 Frozen-Inactive,,Pay At Time of Service,81.99
Cash Price - Pay Today,,84244,CPT4/HCPCS,Renin Activity Plasma by LC_MS_MS,,Pay At Time of Service,34.45
Cash Price - Pay Today,,84252,CPT4/HCPCS,Vitamin B2 Plasma,,Pay At Time of Service,31.71
Cash Price - Pay Today,,84270,CPT4/HCPCS,Sex Hormone Binding Globulin,,Pay At Time of Service,34.05
Cash Price - Pay Today,,84275,CPT4/HCPCS,Lipid Associated Sialic Acid,,Pay At Time of Service,21.04
Cash Price - Pay Today,,84305,CPT4/HCPCS,IgF I,,Pay At Time of Service,28.82
Cash Price - Pay Today,,84307,CPT4/HCPCS,Somatostin,,Pay At Time of Service,28.63
Cash Price - Pay Today,,84425,CPT4/HCPCS,Vitamin B1 Plasma,,Pay At Time of Service,33.26
Cash Price - Pay Today,,84432,CPT4/HCPCS,Thyroglobulin Panel,,Pay At Time of Service,25.16
Cash Price - Pay Today,,84436,CPT4/HCPCS,T4 Total,,Pay At Time of Service,10.75
Cash Price - Pay Today,,84445,CPT4/HCPCS,Thyroid Stimulating Immunoglobulin,,Pay At Time of Service,79.66
Cash Price - Pay Today,,84446,CPT4/HCPCS,Vitamin E,,Pay At Time of Service,22.21
Cash Price - Pay Today,,84450,CPT4/HCPCS,SGOT,,Pay At Time of Service,8.11
Cash Price - Pay Today,,84460,CPT4/HCPCS,SGPT,,Pay At Time of Service,8.30
Cash Price - Pay Today,,84478,CPT4/HCPCS,Triglycerides,,Pay At Time of Service,9.01
Cash Price - Pay Today,,84480,CPT4/HCPCS,T3 Total,,Pay At Time of Service,22.21
Cash Price - Pay Today,,84482,CPT4/HCPCS,T3 Reverse,,Pay At Time of Service,24.69
Cash Price - Pay Today,,84510,CPT4/HCPCS,Tyrosine,,Pay At Time of Service,16.30
Cash Price - Pay Today,,84550,CPT4/HCPCS,Uric Acid,,Pay At Time of Service,7.08
Cash Price - Pay Today,,84586,CPT4/HCPCS,Vasoactive Intestinal Polypeptide,,Pay At Time of Service,19.84
Cash Price - Pay Today,,84588,CPT4/HCPCS,Arginine Vasopressin,,Pay At Time of Service,53.18
Cash Price - Pay Today,,84590,CPT4/HCPCS,Vitamin A,,Pay At Time of Service,18.18
Cash Price - Pay Today,,84591,CPT4/HCPCS,Vitamin B3,,Pay At Time of Service,18.18
Cash Price - Pay Today,,84597,CPT4/HCPCS,Vitamin K,,Pay At Time of Service,21.49
Cash Price - Pay Today,,84620,CPT4/HCPCS,Xylose Fasting,,Pay At Time of Service,18.56
Cash Price - Pay Today,,84681,CPT4/HCPCS,C Peptide,,Pay At Time of Service,28.72
Cash Price - Pay Today,,84702,CPT4/HCPCS,HCG Quantitative,,Pay At Time of Service,23.59
Cash Price - Pay Today,,84703,CPT4/HCPCS,Beta HCG Scr,,Pay At Time of Service,11.78
Cash Price - Pay Today,,85014,CPT4/HCPCS,Hematocrit,,Pay At Time of Service,3.71
Cash Price - Pay Today,,85027,CPT4/HCPCS,Complete Blood Count With Manual Diff,,Pay At Time of Service,10.13
Cash Price - Pay Today,,85045,CPT4/HCPCS,Automated Retic Count,,Pay At Time of Service,6.27
Cash Price - Pay Today,,85048,CPT4/HCPCS,White Blood Count,,Pay At Time of Service,3.98
Cash Price - Pay Today,,85049,CPT4/HCPCS,Platelet Count,,Pay At Time of Service,7.02
Cash Price - Pay Today,,85210,CPT4/HCPCS,Factor II Activity,,Pay At Time of Service,20.34
Cash Price - Pay Today,,85220,CPT4/HCPCS,Factor V Activity Clotting,,Pay At Time of Service,27.65
Cash Price - Pay Today,,85230,CPT4/HCPCS,Factor VII Activity Clotting,,Pay At Time of Service,28.05
Cash Price - Pay Today,,85246,CPT4/HCPCS,Von Willebrand Factor Antigen,,Pay At Time of Service,35.94
Cash Price - Pay Today,,85247,CPT4/HCPCS,Von Willebrand Factor Antigen Multimeric,,Pay At Time of Service,35.94
Cash Price - Pay Today,,85260,CPT4/HCPCS,Factor X Activity Clotting,,Pay At Time of Service,28.05
Cash Price - Pay Today,,85270,CPT4/HCPCS,Factor XI Activity Clotting Test,,Pay At Time of Service,28.05
Cash Price - Pay Today,,85280,CPT4/HCPCS,Factor XII Activity Test,,Pay At Time of Service,30.31
Cash Price - Pay Today,,85290,CPT4/HCPCS,Factor XIII Functional,,Pay At Time of Service,25.60
Cash Price - Pay Today,,85302,CPT4/HCPCS,Protein C Antigen,,Pay At Time of Service,18.83
Cash Price - Pay Today,,85303,CPT4/HCPCS,Protein C Activity,,Pay At Time of Service,21.67
Cash Price - Pay Today,,85305,CPT4/HCPCS,Protein S Antigen,,Pay At Time of Service,18.18
Cash Price - Pay Today,,85347,CPT4/HCPCS,Activated Clotting Time,,Pay At Time of Service,6.67
Cash Price - Pay Today,,85360,CPT4/HCPCS,Euglobulin Clot Lysis Time,,Pay At Time of Service,13.17
Cash Price - Pay Today,,85384,CPT4/HCPCS,Fibrinogen,,Pay At Time of Service,13.31
Cash Price - Pay Today,,85410,CPT4/HCPCS,Alpha 2 Antiplasmin,,Pay At Time of Service,12.07
Cash Price - Pay Today,,85415,CPT4/HCPCS,Plasminogen Activator AG,,Pay At Time of Service,26.93
Cash Price - Pay Today,,85420,CPT4/HCPCS,Plasminogen Activity,,Pay At Time of Service,10.23
Cash Price - Pay Today,,85520,CPT4/HCPCS,Heparin Anti Xa Low Molecular Weight Heparin,,Pay At Time of Service,20.50
Cash Price - Pay Today,,85540,CPT4/HCPCS,Lap Stain-Inactive,,Pay At Time of Service,13.48
Cash Price - Pay Today,,85549,CPT4/HCPCS,Lysozyme,,Pay At Time of Service,29.37
Cash Price - Pay Today,,85557,CPT4/HCPCS,RBC Fragility,,Pay At Time of Service,20.93
Cash Price - Pay Today,,85613,CPT4/HCPCS,DRVVT Screen With Reflex,,Pay At Time of Service,15.01
Cash Price - Pay Today,,85651,CPT4/HCPCS,ESR,,Pay At Time of Service,5.56
Cash Price - Pay Today,,85670,CPT4/HCPCS,Thrombin Clotting Time,,Pay At Time of Service,9.04
Cash Price - Pay Today,,85732,CPT4/HCPCS,Mixing Studies PTT,,Pay At Time of Service,10.13
Cash Price - Pay Today,,86005,CPT4/HCPCS,Allergy Mold Profile IgE,,Pay At Time of Service,8.38
Cash Price - Pay Today,,86140,CPT4/HCPCS,C Reactive Protein,,Pay At Time of Service,8.11
Cash Price - Pay Today,,86141,CPT4/HCPCS,Cardio CRP,,Pay At Time of Service,20.27
Cash Price - Pay Today,,86146,CPT4/HCPCS,Antiphospholipid Antibody Panel,,Pay At Time of Service,28.82
Cash Price - Pay Today,,86148,CPT4/HCPCS,Phosphatidylserine Antibodies IgA IgG IgM A,,Pay At Time of Service,25.17
Cash Price - Pay Today,,86156,CPT4/HCPCS,Cold Agglutinins,,Pay At Time of Service,10.49
Cash Price - Pay Today,,86161,CPT4/HCPCS,C1 Inhibitor Functional,,Pay At Time of Service,18.80
Cash Price - Pay Today,,86162,CPT4/HCPCS,Complement Total,,Pay At Time of Service,31.83
Cash Price - Pay Today,,86200,CPT4/HCPCS,Cyclic Citrullinated Peptide Antibody IgG,,Pay At Time of Service,20.27
Cash Price - Pay Today,,86215,CPT4/HCPCS,DNAse B Antibody,,Pay At Time of Service,20.76
Cash Price - Pay Today,,86225,CPT4/HCPCS,DNA Antibody Double Stranded,,Pay At Time of Service,21.52
Cash Price - Pay Today,,86301,CPT4/HCPCS,CA 19 9,,Pay At Time of Service,32.60
Cash Price - Pay Today,,86320,CPT4/HCPCS,Serum Protein Immunoelectrophoresis,,Pay At Time of Service,35.11
Cash Price - Pay Today,,86327,CPT4/HCPCS,C3 Nephritic Factor,,Pay At Time of Service,35.55
Cash Price - Pay Today,,86329,CPT4/HCPCS,C4 Binding Protein Plasma,,Pay At Time of Service,21.72
Cash Price - Pay Today,,86336,CPT4/HCPCS,Inhibin A,,Pay At Time of Service,24.41
Cash Price - Pay Today,,86340,CPT4/HCPCS,Intrinsic Factor Blocking Antibody,,Pay At Time of Service,23.62
Cash Price - Pay Today,,86344,CPT4/HCPCS,Arc Monocyte Monolayer Assay,,Pay At Time of Service,12.51
Cash Price - Pay Today,,86353,CPT4/HCPCS,Epstein-Barr Nuclear Agab(Csf),,Pay At Time of Service,76.81
Cash Price - Pay Today,,86357,CPT4/HCPCS,Natural Killer Cells,,Pay At Time of Service,59.10
Cash Price - Pay Today,,86359,CPT4/HCPCS,Lymphocyte Subset Panel 3,,Pay At Time of Service,59.10
Cash Price - Pay Today,,86360,CPT4/HCPCS,Lymphocyte Subset Panel 4,,Pay At Time of Service,73.61
Cash Price - Pay Today,,86361,CPT4/HCPCS,Lymphocyte Subset Panel 5,,Pay At Time of Service,41.94
Cash Price - Pay Today,,86382,CPT4/HCPCS,Interferon Beta IgG by Elisa,,Pay At Time of Service,26.50
Cash Price - Pay Today,,86406,CPT4/HCPCS,Cryptococcus Ag Titer Fee,,Pay At Time of Service,16.66
Cash Price - Pay Today,,86430,CPT4/HCPCS,Rheumatoid Factor_Quest,,Pay At Time of Service,8.89
Cash Price - Pay Today,,86612,CPT4/HCPCS,Blastomyces Antibody by Immunodiffusion Serum,,Pay At Time of Service,20.22
Cash Price - Pay Today,,86622,CPT4/HCPCS,Brucella Antibodies IgG and IgM,,Pay At Time of Service,13.66
Cash Price - Pay Today,,86628,CPT4/HCPCS,Candida Albicans Antibody,,Pay At Time of Service,18.80
Cash Price - Pay Today,,86632,CPT4/HCPCS,Chlamydia Species Antibodies IgM,,Pay At Time of Service,19.87
Cash Price - Pay Today,,86648,CPT4/HCPCS,Diphtheria Antibody,,Pay At Time of Service,20.04
Cash Price - Pay Today,,86653,CPT4/HCPCS,Arbovirus AB Panel IFA,,Pay At Time of Service,20.67
Cash Price - Pay Today,,86663,CPT4/HCPCS,EBV Ea D Ab IgG,,Pay At Time of Service,20.55
Cash Price - Pay Today,,86666,CPT4/HCPCS,Ehrlichia Antibody Panel,,Pay At Time of Service,15.95
Cash Price - Pay Today,,86668,CPT4/HCPCS,Tularemia Antibody-Inactive,,Pay At Time of Service,16.30
Cash Price - Pay Today,,86674,CPT4/HCPCS,Giardia Lamblia Antibody,,Pay At Time of Service,23.06
Cash Price - Pay Today,,86684,CPT4/HCPCS,Haemophilus Influenza B Vaccine Response,,Pay At Time of Service,24.82
Cash Price - Pay Today,,86701,CPT4/HCPCS,HIV 1/2 Antibody Differentiation,,Pay At Time of Service,13.93
Cash Price - Pay Today,,86704,CPT4/HCPCS,Hepatitis B Core Antibody Total,,Pay At Time of Service,18.87
Cash Price - Pay Today,,86707,CPT4/HCPCS,Hepatitis Be Antibody,,Pay At Time of Service,18.12
Cash Price - Pay Today,,86708,CPT4/HCPCS,Hepatitis A Ab_Total_Quest,,Pay At Time of Service,19.40
Cash Price - Pay Today,,86711,CPT4/HCPCS,JC Polyoma Virus AB,,Pay At Time of Service,22.55
Cash Price - Pay Today,,86720,CPT4/HCPCS,Leptospira Antibody,,Pay At Time of Service,14.54
Cash Price - Pay Today,,86723,CPT4/HCPCS,CSF Listeria Antibodies,,Pay At Time of Service,20.67
Cash Price - Pay Today,,86729,CPT4/HCPCS,Lymphogranuloma Venereum Differentiation,,Pay At Time of Service,18.71
Cash Price - Pay Today,,86750,CPT4/HCPCS,Malaria Antibodies IgG by IFA,,Pay At Time of Service,20.67
Cash Price - Pay Today,,86768,CPT4/HCPCS,Salmonella Total Antibody by EIA,,Pay At Time of Service,20.67
Cash Price - Pay Today,,86774,CPT4/HCPCS,Tetanus Antitoxoid Antibody,,Pay At Time of Service,23.18
Cash Price - Pay Today,,86793,CPT4/HCPCS,Yersinia Enterocolitica MAT,,Pay At Time of Service,20.67
Cash Price - Pay Today,,86800,CPT4/HCPCS,Thyroglobulin Antibody Test,,Pay At Time of Service,24.92
Cash Price - Pay Today,,86804,CPT4/HCPCS,Hepatitis C Antibody RIBA,,Pay At Time of Service,24.27
Cash Price - Pay Today,,86817,CPT4/HCPCS,HLA DRB DQB1 Typing,,Pay At Time of Service,100.85
Cash Price - Pay Today,,87040,CPT4/HCPCS,Culture Blood,,Pay At Time of Service,16.18
Cash Price - Pay Today,,87073,CPT4/HCPCS,Quant Ana Bact Culture-Inactive,,Pay At Time of Service,14.79
Cash Price - Pay Today,,87086,CPT4/HCPCS,Urine Culture With Colony Count,,Pay At Time of Service,12.65
Cash Price - Pay Today,,87088,CPT4/HCPCS,Presumptive Id'S, Multple Orgs,,Pay At Time of Service,12.68
Cash Price - Pay Today,,87107,CPT4/HCPCS,Fungal Id-Inactive,,Pay At Time of Service,16.18
Cash Price - Pay Today,,87172,CPT4/HCPCS,Pinworm Exam,,Pay At Time of Service,6.69
Cash Price - Pay Today,,87176,CPT4/HCPCS,Homogenization, Tissue Culture-Inactive,,Pay At Time of Service,9.21
Cash Price - Pay Today,,87185,CPT4/HCPCS,Beta_Lactamase Induction,,Pay At Time of Service,4.51
Cash Price - Pay Today,,87197,CPT4/HCPCS,Antimicrob Se Inhib(Schlicter)-Inactive,,Pay At Time of Service,23.36
Cash Price - Pay Today,,87250,CPT4/HCPCS,Culture Virus,,Pay At Time of Service,30.65
Cash Price - Pay Today,,87253,CPT4/HCPCS,Enterovirus Typing-Inactive,,Pay At Time of Service,14.39
Cash Price - Pay Today,,87255,CPT4/HCPCS,Herpes Simplex Virus Culture,,Pay At Time of Service,53.05
Cash Price - Pay Today,,87276,CPT4/HCPCS,Influenza A_B_DFA_Focus,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87281,CPT4/HCPCS,Pneumocystis Jiro Carinii DFA,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87290,CPT4/HCPCS,Varicella Zoster Direct Detection by DFA,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87301,CPT4/HCPCS,Stool Adenovirus Ag Detection EIA,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87305,CPT4/HCPCS,Aspergillus Antigen,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87328,CPT4/HCPCS,Cryptosporidium Ag,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87335,CPT4/HCPCS,E Coli 0157 Immunoassay,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87338,CPT4/HCPCS,Helicobacter Pylori AG EIA Stool,,Pay At Time of Service,22.53
Cash Price - Pay Today,,87341,CPT4/HCPCS,HBSAG Confirmation,,Pay At Time of Service,16.18
Cash Price - Pay Today,,87350,CPT4/HCPCS,Hepatitis Be Antigen,,Pay At Time of Service,18.05
Cash Price - Pay Today,,87389,CPT4/HCPCS,HIV1/2 AG,AB 4th Gen w/Reflex,,Pay At Time of Service,37.72
Cash Price - Pay Today,,87420,CPT4/HCPCS,Rsv Quick Test, Now,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87427,CPT4/HCPCS,E.Coli, Enterohemorrhagic,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87496,CPT4/HCPCS,CMV DNA Qualitative by RT PCR,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87498,CPT4/HCPCS,Enterovirus RNA, QL RT-PCR,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87502,CPT4/HCPCS,Influenza A/B,,Pay At Time of Service,133.31
Cash Price - Pay Today,,87503,CPT4/HCPCS,H1N1 BY RNA PCR,,Pay At Time of Service,32.53
Cash Price - Pay Today,,87506,CPT4/HCPCS,Norovirus RNA QL RT PCR,,Pay At Time of Service,334.35
Cash Price - Pay Today,,87517,CPT4/HCPCS,Hepatitis B Viral DNA Quantitative by PCR,,Pay At Time of Service,67.10
Cash Price - Pay Today,,87532,CPT4/HCPCS,Herpes Virus 6 DNA by PCR,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87538,CPT4/HCPCS,HIV 2 DNA and RNA Qualitative by PCR,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87540,CPT4/HCPCS,Legionella Urinary Ag_Focus,,Pay At Time of Service,31.42
Cash Price - Pay Today,,87541,CPT4/HCPCS,Legionella DNA by PCR Focus,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87550,CPT4/HCPCS,Afb Gene Probe Mtb/Mai,,Pay At Time of Service,31.42
Cash Price - Pay Today,,87555,CPT4/HCPCS,Mtub, Maic Gene Probe,,Pay At Time of Service,31.42
Cash Price - Pay Today,,87561,CPT4/HCPCS,Mycobact Avium Com DNA QL RTPC,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87581,CPT4/HCPCS,Mycoplasma Pneum DNA QL RT PCR,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87582,CPT4/HCPCS,Mycoplasma Pneum, Dna Pcr-Inactive,,Pay At Time of Service,65.41
Cash Price - Pay Today,,87590,CPT4/HCPCS,Gc Dna Probe-Inactive,,Pay At Time of Service,31.42
Cash Price - Pay Today,,87592,CPT4/HCPCS,Chlamydia and N Gonorrheae,,Pay At Time of Service,67.10
Cash Price - Pay Today,,87624,CPT4/HCPCS,HPV HR Reflex,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87653,CPT4/HCPCS,Group B Streptococcus by PCR,,Pay At Time of Service,54.97
Cash Price - Pay Today,,87800,CPT4/HCPCS,Chlamy.Trac/Neiss/Gonorroeae,,Pay At Time of Service,62.84
Cash Price - Pay Today,,87801,CPT4/HCPCS,Donor HIV1/HCV/HBV w/Reflex,,Pay At Time of Service,109.96
Cash Price - Pay Today,,87880,CPT4/HCPCS,Group A Strep Screen Rapid,,Pay At Time of Service,14.54
Cash Price - Pay Today,,87902,CPT4/HCPCS,Hepatitis C Viral RNA Genotype LiPA,,Pay At Time of Service,403.29
Cash Price - Pay Today,,87903,CPT4/HCPCS,HIV 1 Virtual Phenotype,,Pay At Time of Service,765.49
Cash Price - Pay Today,,87906,CPT4/HCPCS,HIV-1 Coreceptor Tropism,,Pay At Time of Service,201.65
Cash Price - Pay Today,,88150,CPT4/HCPCS,Pap Smear, Gyn (Cdc),,Pay At Time of Service,16.55
Cash Price - Pay Today,,88239,CPT4/HCPCS,Chromosome Analysis Solid Tumor,,Pay At Time of Service,231.09
Cash Price - Pay Today,,88245,CPT4/HCPCS,Chromosome-Study-Breakage-Inactive,,Pay At Time of Service,233.20
Cash Price - Pay Today,,88261,CPT4/HCPCS,Chr Anlys,5Cells 1Kryo Wb,,Pay At Time of Service,276.87
Cash Price - Pay Today,,88269,CPT4/HCPCS,Chromosome & Afp-Amniotic Flui-Inactive,,Pay At Time of Service,260.56
Cash Price - Pay Today,,88280,CPT4/HCPCS,Chromosone Anlys Add Kryo,Ea,,Pay At Time of Service,39.32
Cash Price - Pay Today,,88285,CPT4/HCPCS,Chr Anlys,Add Cells Ea Study,,Pay At Time of Service,29.76
Cash Price - Pay Today,,88289,CPT4/HCPCS,Chromosome Analysis High Resolution,,Pay At Time of Service,14.39
Cash Price - Pay Today,,88740,CPT4/HCPCS,Tcom Monitor,,Pay At Time of Service,7.85
Cash Price - Pay Today,,89050,CPT4/HCPCS,Urine Eosinophils,,Pay At Time of Service,7.41
Cash Price - Pay Today,,89055,CPT4/HCPCS,Stool For WBCs,,Pay At Time of Service,6.69
Cash Price - Pay Today,,89060,CPT4/HCPCS,Fluid Crystals,,Pay At Time of Service,11.21
Cash Price - Pay Today,,89190,CPT4/HCPCS,Eosinophil Count Direct-Inactive,,Pay At Time of Service,7.44
Cash Price - Pay Today,,89220,CPT4/HCPCS,Sputum Induction,,Pay At Time of Service,138.77
Cash Price - Pay Today,,89320,CPT4/HCPCS,Semen Analysis Complete,,Pay At Time of Service,18.87
Cash Price - Pay Today,,89321,CPT4/HCPCS,Semen Analysis_Post Vasectomy,,Pay At Time of Service,18.87
Cash Price - Pay Today,,89325,CPT4/HCPCS,Sperm Antibodies IgA_ IgG,,Pay At Time of Service,16.72
Cash Price - Pay Today,,89331,CPT4/HCPCS,Urine Post Ejaculate For Sperm,,Pay At Time of Service,30.69
Cash Price - Pay Today,,91034,CPT4/HCPCS,GI Reflux Study,,Pay At Time of Service,538.41
Cash Price - Pay Today,,92938,CPT4/HCPCS,Add Vessel W/Bare Metal Grafts,,Pay At Time of Service,11267.00
Cash Price - Pay Today,,93005,CPT4/HCPCS,Ecg,,Pay At Time of Service,75.96
Cash Price - Pay Today,,93225,CPT4/HCPCS,Holter Recording,,Pay At Time of Service,123.81
Cash Price - Pay Today,,93226,CPT4/HCPCS,Holter Scan/Analysis,,Pay At Time of Service,123.81
Cash Price - Pay Today,,93278,CPT4/HCPCS,Saecg,,Pay At Time of Service,75.96
Cash Price - Pay Today,,93279,CPT4/HCPCS,Ppm Single Interrogation,,Pay At Time of Service,45.65
Cash Price - Pay Today,,93280,CPT4/HCPCS,Ppm Dual Interrogation,,Pay At Time of Service,45.65
Cash Price - Pay Today,,93285,CPT4/HCPCS,ILR Reprogramming - Inactive,,Pay At Time of Service,34.00
Cash Price - Pay Today,,93291,CPT4/HCPCS,ILR Interrogation/Analysis - Inactive,,Pay At Time of Service,34.00
Cash Price - Pay Today,,93298,CPT4/HCPCS,InPatient Loop Recordr Express,,Pay At Time of Service,34.00
Cash Price - Pay Today,,93299,CPT4/HCPCS,ILR Remote Acquisition Tech - Inactive,,Pay At Time of Service,34.00
Cash Price - Pay Today,,93306,CPT4/HCPCS,Adult Echo Complete,,Pay At Time of Service,565.94
Cash Price - Pay Today,,93318,CPT4/HCPCS,Tee Icu,,Pay At Time of Service,948.65
Cash Price - Pay Today,,93631,CPT4/HCPCS,Intra Op Pacing Mapping - Inactive,,Pay At Time of Service,5547.00
Cash Price - Pay Today,,93886,CPT4/HCPCS,Tcd Complete,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93888,CPT4/HCPCS,Tcd Limited,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93890,CPT4/HCPCS,Tcd Vasoreactive,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93892,CPT4/HCPCS,Tcd W/O Microbubble,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93922,CPT4/HCPCS,Abi/Plethy/Segment/Tcpo2 Ltd,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93923,CPT4/HCPCS,Abi/Plethy/Segment/Tcpo2,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93924,CPT4/HCPCS,Art Exam W/ Treadmill,,Pay At Time of Service,150.00
Cash Price - Pay Today,,93990,CPT4/HCPCS,Dialysis Access Graft Eval,,Pay At Time of Service,150.00
Cash Price - Pay Today,,94002,CPT4/HCPCS,Initial Ventilator Day,,Pay At Time of Service,620.68
Cash Price - Pay Today,,94003,CPT4/HCPCS,Ventilator Daily,,Pay At Time of Service,620.68
Cash Price - Pay Today,,94010,CPT4/HCPCS,Pulmonary Spirometry,,Pay At Time of Service,176.18
Cash Price - Pay Today,,94060,CPT4/HCPCS,Complete Pulm Funct Test,,Pay At Time of Service,299.20
Cash Price - Pay Today,,94070,CPT4/HCPCS,Broncho Challenge,,Pay At Time of Service,299.20
Cash Price - Pay Today,,94150,CPT4/HCPCS,Vital Capacity Total,,Pay At Time of Service,176.18
Cash Price - Pay Today,,94610,CPT4/HCPCS,Surfactant Administration,,Pay At Time of Service,202.94
Cash Price - Pay Today,,94620,CPT4/HCPCS,Pulmonary Stress Testng Simple,,Pay At Time of Service,123.81
Cash Price - Pay Today,,94621,CPT4/HCPCS,Pulmonary Stress Test Complex,,Pay At Time of Service,299.20
Cash Price - Pay Today,,94667,CPT4/HCPCS,Pd & Percussion Treatment,,Pay At Time of Service,123.81
Cash Price - Pay Today,,94770,CPT4/HCPCS,Etco2 Monitor,,Pay At Time of Service,299.20
Cash Price - Pay Today,,94772,CPT4/HCPCS,Pneumogram Monitoring,,Pay At Time of Service,538.41
Cash Price - Pay Today,,95782,CPT4/HCPCS,Polysom <6 yrs 4/ > Paramtrs,,Pay At Time of Service,786.00
Cash Price - Pay Today,,95783,CPT4/HCPCS,Polysom <6yrs CPAP/Bilvl,,Pay At Time of Service,860.00
Cash Price - Pay Today,,95801,CPT4/HCPCS,Sleep Study Unattended w/Analy,,Pay At Time of Service,123.81
Cash Price - Pay Today,,95805,CPT4/HCPCS,Mslt/Mwt W/Poly,,Pay At Time of Service,786.00
Cash Price - Pay Today,,95812,CPT4/HCPCS,EEG 41-60 Minutes,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95813,CPT4/HCPCS,EEG over 1 hour,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95816,CPT4/HCPCS,Eeg Awake,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95819,CPT4/HCPCS,Eeg Awake & Asleep,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95824,CPT4/HCPCS,Eeg Cereb Death,,Pay At Time of Service,538.41
Cash Price - Pay Today,,95907,CPT4/HCPCS,Nerve Conduction 1-2 Studies,,Pay At Time of Service,176.18
Cash Price - Pay Today,,95908,CPT4/HCPCS,Nerve Conduction 3-4 Studies,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95909,CPT4/HCPCS,Nerve Conduction 5-6 Studies,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95910,CPT4/HCPCS,Nerve Conduction 7-8 Studies,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95911,CPT4/HCPCS,Nerve Conduction 9-10 Studies,,Pay At Time of Service,538.41
Cash Price - Pay Today,,95912,CPT4/HCPCS,Nerve Conduction 11-12 Studies,,Pay At Time of Service,538.41
Cash Price - Pay Today,,95913,CPT4/HCPCS,NRV Conduction 13 or >Studies,,Pay At Time of Service,538.41
Cash Price - Pay Today,,95925,CPT4/HCPCS,Ser Upper Ext,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95926,CPT4/HCPCS,Ser Lower Ext,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95930,CPT4/HCPCS,Evoked Potential-Visual,,Pay At Time of Service,299.20
Cash Price - Pay Today,,95938,CPT4/HCPCS,Sep Upper & Lower Limbs,,Pay At Time of Service,538.41
Cash Price - Pay Today,,95951,CPT4/HCPCS,Telemetry Eeg 24 Hours,,Pay At Time of Service,1162.90
Cash Price - Pay Today,,96450,CPT4/HCPCS,Intrathecal Chemo Admin,,Pay At Time of Service,150.00
Cash Price - Pay Today,,98960,CPT4/HCPCS,Hlth Ed-New Patient 15 Min- Inactive,,Pay At Time of Service,120.00
Cash Price - Pay Today,,99406,CPT4/HCPCS,Smoking Cessation Counseling,,Pay At Time of Service,36.82
Cash Price - Pay Today,,C9600,CPT4/HCPCS,PTCA W/Drug Eluting Stent,,Pay At Time of Service,11267.00
Cash Price - Pay Today,,C9601,CPT4/HCPCS,Add Vessel Ptca W/Drug E St,,Pay At Time of Service,11267.00
Cash Price - Pay Today,,C9603,CPT4/HCPCS,Add PTCRA W/Des,,Pay At Time of Service,11267.00
Cash Price - Pay Today,,C9604,CPT4/HCPCS,PTCA W/ Des Grafts,,Pay At Time of Service,11267.00
Cash Price - Pay Today,,C9605,CPT4/HCPCS,Add Vessel W/Des Grafts,,Pay At Time of Service,11267.00
Cash Price - Pay Today,,C9606,CPT4/HCPCS,Stemi W/Des,,Pay At Time of Service,11267.00
Cash Price - Pay Today,,C9607,CPT4/HCPCS,CTO W/Des,,Pay At Time of Service,11267.00
Cash Price - Pay Today,,C9608,CPT4/HCPCS,Add CTO W/Des,,Pay At Time of Service,11267.00
Cash Price - Pay Today,,G0103,CPT4/HCPCS,PSA Screen,,Pay At Time of Service,28.82
Cash Price - Pay Today,,P9612,CPT4/HCPCS,Catheterize For Urine Spec,,Pay At Time of Service,3.45
Cash Price - Pay Today,,Q0114,CPT4/HCPCS,Fern Test,,Pay At Time of Service,11.21
Cash Price - Prompt Pay,,29086,CPT4/HCPCS,APPLY FINGER CAST,,Pay Within 30 Days of Service,200.00
Cash Price - Prompt Pay,,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Pay Within 30 Days of Service,200.00
Cash Price - Prompt Pay,,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Pay Within 30 Days of Service,100.00
Cash Price - Prompt Pay,,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Pay Within 30 Days of Service,100.00
Cash Price - Prompt Pay,,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Pay Within 30 Days of Service,100.00
Cash Price - Prompt Pay,,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Pay Within 30 Days of Service,100.00
Cash Price - Prompt Pay,,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Pay Within 30 Days of Service,200.00
Cash Price - Prompt Pay,,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Pay Within 30 Days of Service,404.00
Cash Price - Prompt Pay,,36415,CPT4/HCPCS,ROUTINE VENIPUNCTURE,,Pay Within 30 Days of Service,7.50
Cash Price - Prompt Pay,,59025,CPT4/HCPCS,FETAL NON-STRESS TEST,,Pay Within 30 Days of Service,100.00
Cash Price - Prompt Pay,,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,71010,CPT4/HCPCS,CHEST X-RAY 1 VIEW FRONTAL,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71020,CPT4/HCPCS,CHEST X-RAY 2VW FRONTAL&LATL,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71021,CPT4/HCPCS,CHEST X-RAY FRNT LAT LORDOTC,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71030,CPT4/HCPCS,CHEST X-RAY 4/> VIEWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71035,CPT4/HCPCS,CHEST X-RAY SPECIAL VIEWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71260,CPT4/HCPCS,CT THORAX DX C+,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,72193,CPT4/HCPCS,CT PELVIS W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73510,CPT4/HCPCS,X-RAY EXAM OF HIP,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,74000,CPT4/HCPCS,X-RAY EXAM OF ABDOMEN,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,74010,CPT4/HCPCS,X-RAY EXAM OF ABDOMEN,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,Pay Within 30 Days of Service,4650.00
Cash Price - Prompt Pay,,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,Pay Within 30 Days of Service,4650.00
Cash Price - Prompt Pay,,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,Pay Within 30 Days of Service,190.00
Cash Price - Prompt Pay,,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75791,CPT4/HCPCS,AV DIALYSIS SHUNT IMAGING,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,Pay Within 30 Days of Service,4650.00
Cash Price - Prompt Pay,,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,Pay Within 30 Days of Service,4650.00
Cash Price - Prompt Pay,,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,Pay Within 30 Days of Service,4650.00
Cash Price - Prompt Pay,,75860,CPT4/HCPCS,VEIN X-RAY NECK,,Pay Within 30 Days of Service,4650.00
Cash Price - Prompt Pay,,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,75962,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75964,CPT4/HCPCS,REPAIR ARTERY BLOCKAGE EACH,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75966,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75968,CPT4/HCPCS,REPAIR ARTERY BLOCKAGE EACH,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75978,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,76497,CPT4/HCPCS,CT PROCEDURE,,Pay Within 30 Days of Service,1350.00
Cash Price - Prompt Pay,,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76604,CPT4/HCPCS,US EXAM CHEST,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,Pay Within 30 Days of Service,190.00
Cash Price - Prompt Pay,,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,Pay Within 30 Days of Service,190.00
Cash Price - Prompt Pay,,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76870,CPT4/HCPCS,US EXAM SCROTUM,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,77055,CPT4/HCPCS,MAMMOGRAM ONE BREAST,,Pay Within 30 Days of Service,190.00
Cash Price - Prompt Pay,,77057,CPT4/HCPCS,MAMMOGRAM SCREENING,,Pay Within 30 Days of Service,50.00
Cash Price - Prompt Pay,,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,Pay Within 30 Days of Service,1200.00
Cash Price - Prompt Pay,,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,80048,CPT4/HCPCS,METABOLIC PANEL TOTAL CA,,Pay Within 30 Days of Service,28.80
Cash Price - Prompt Pay,,80053,CPT4/HCPCS,COMPREHEN METABOLIC PANEL,,Pay Within 30 Days of Service,35.98
Cash Price - Prompt Pay,,80061,CPT4/HCPCS,LIPID PANEL,,Pay Within 30 Days of Service,45.60
Cash Price - Prompt Pay,,80150,CPT4/HCPCS,ASSAY OF AMIKACIN,,Pay Within 30 Days of Service,51.35
Cash Price - Prompt Pay,,80158,CPT4/HCPCS,DRUG ASSAY CYCLOSPORINE,,Pay Within 30 Days of Service,61.48
Cash Price - Prompt Pay,,80164,CPT4/HCPCS,ASSAY DIPROPYLACETIC ACD TOT,,Pay Within 30 Days of Service,46.15
Cash Price - Prompt Pay,,80170,CPT4/HCPCS,ASSAY OF GENTAMICIN,,Pay Within 30 Days of Service,55.80
Cash Price - Prompt Pay,,80178,CPT4/HCPCS,ASSAY OF LITHIUM,,Pay Within 30 Days of Service,22.52
Cash Price - Prompt Pay,,80200,CPT4/HCPCS,ASSAY OF TOBRAMYCIN,,Pay Within 30 Days of Service,54.90
Cash Price - Prompt Pay,,80202,CPT4/HCPCS,ASSAY OF VANCOMYCIN,,Pay Within 30 Days of Service,46.15
Cash Price - Prompt Pay,,80299,CPT4/HCPCS,QUANTITATIVE ASSAY DRUG,,Pay Within 30 Days of Service,46.65
Cash Price - Prompt Pay,,81003,CPT4/HCPCS,URINALYSIS AUTO W/O SCOPE,,Pay Within 30 Days of Service,7.65
Cash Price - Prompt Pay,,81005,CPT4/HCPCS,URINALYSIS,,Pay Within 30 Days of Service,7.38
Cash Price - Prompt Pay,,81025,CPT4/HCPCS,URINE PREGNANCY TEST,,Pay Within 30 Days of Service,18.77
Cash Price - Prompt Pay,,81206,CPT4/HCPCS,BCR/ABL1 GENE MAJOR BP,,Pay Within 30 Days of Service,558.38
Cash Price - Prompt Pay,,81261,CPT4/HCPCS,IGH GENE REARRANGE AMP METH,,Pay Within 30 Days of Service,674.25
Cash Price - Prompt Pay,,81270,CPT4/HCPCS,JAK2 GENE,,Pay Within 30 Days of Service,312.18
Cash Price - Prompt Pay,,81315,CPT4/HCPCS,PML/RARALPHA COM BREAKPOINTS,,Pay Within 30 Days of Service,706.00
Cash Price - Prompt Pay,,81376,CPT4/HCPCS,HLA II TYPING 1 LOCUS LR,,Pay Within 30 Days of Service,416.23
Cash Price - Prompt Pay,,82010,CPT4/HCPCS,ACETONE ASSAY,,Pay Within 30 Days of Service,27.83
Cash Price - Prompt Pay,,82042,CPT4/HCPCS,OTHER SOURCE ALBUMIN QUAN EA,,Pay Within 30 Days of Service,17.63
Cash Price - Prompt Pay,,82043,CPT4/HCPCS,UR ALBUMIN QUANTITATIVE,,Pay Within 30 Days of Service,19.68
Cash Price - Prompt Pay,,82088,CPT4/HCPCS,ASSAY OF ALDOSTERONE,,Pay Within 30 Days of Service,138.78
Cash Price - Prompt Pay,,82103,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN TOTAL,,Pay Within 30 Days of Service,45.75
Cash Price - Prompt Pay,,82105,CPT4/HCPCS,ALPHA-FETOPROTEIN SERUM,,Pay Within 30 Days of Service,57.13
Cash Price - Prompt Pay,,82108,CPT4/HCPCS,ASSAY OF ALUMINUM,,Pay Within 30 Days of Service,86.78
Cash Price - Prompt Pay,,82128,CPT4/HCPCS,AMINO ACIDS MULT QUAL,,Pay Within 30 Days of Service,47.23
Cash Price - Prompt Pay,,82131,CPT4/HCPCS,AMINO ACIDS SINGLE QUANT,,Pay Within 30 Days of Service,57.45
Cash Price - Prompt Pay,,82135,CPT4/HCPCS,ASSAY AMINOLEVULINIC ACID,,Pay Within 30 Days of Service,56.02
Cash Price - Prompt Pay,,82139,CPT4/HCPCS,AMINO ACIDS QUAN 6 OR MORE,,Pay Within 30 Days of Service,57.42
Cash Price - Prompt Pay,,82143,CPT4/HCPCS,AMNIOTIC FLUID SCAN,,Pay Within 30 Days of Service,23.38
Cash Price - Prompt Pay,,82150,CPT4/HCPCS,ASSAY OF AMYLASE,,Pay Within 30 Days of Service,22.07
Cash Price - Prompt Pay,,82157,CPT4/HCPCS,ASSAY OF ANDROSTENEDIONE,,Pay Within 30 Days of Service,99.70
Cash Price - Prompt Pay,,82164,CPT4/HCPCS,ANGIOTENSIN I ENZYME TEST,,Pay Within 30 Days of Service,49.73
Cash Price - Prompt Pay,,82172,CPT4/HCPCS,ASSAY OF APOLIPOPROTEIN,,Pay Within 30 Days of Service,50.95
Cash Price - Prompt Pay,,82175,CPT4/HCPCS,ASSAY OF ARSENIC,,Pay Within 30 Days of Service,64.60
Cash Price - Prompt Pay,,82232,CPT4/HCPCS,ASSAY OF BETA-2 PROTEIN,,Pay Within 30 Days of Service,55.10
Cash Price - Prompt Pay,,82247,CPT4/HCPCS,BILIRUBIN TOTAL,,Pay Within 30 Days of Service,17.07
Cash Price - Prompt Pay,,82300,CPT4/HCPCS,ASSAY OF CADMIUM,,Pay Within 30 Days of Service,78.80
Cash Price - Prompt Pay,,82306,CPT4/HCPCS,VITAMIN D 25 HYDROXY,,Pay Within 30 Days of Service,100.82
Cash Price - Prompt Pay,,82310,CPT4/HCPCS,ASSAY OF CALCIUM,,Pay Within 30 Days of Service,17.57
Cash Price - Prompt Pay,,82340,CPT4/HCPCS,ASSAY OF CALCIUM IN URINE,,Pay Within 30 Days of Service,20.53
Cash Price - Prompt Pay,,82375,CPT4/HCPCS,ASSAY CARBOXYHB QUANT,,Pay Within 30 Days of Service,41.95
Cash Price - Prompt Pay,,82378,CPT4/HCPCS,CARCINOEMBRYONIC ANTIGEN,,Pay Within 30 Days of Service,64.60
Cash Price - Prompt Pay,,82379,CPT4/HCPCS,ASSAY OF CARNITINE,,Pay Within 30 Days of Service,57.42
Cash Price - Prompt Pay,,82383,CPT4/HCPCS,ASSAY BLOOD CATECHOLAMINES,,Pay Within 30 Days of Service,85.35
Cash Price - Prompt Pay,,82384,CPT4/HCPCS,ASSAY THREE CATECHOLAMINES,,Pay Within 30 Days of Service,86.00
Cash Price - Prompt Pay,,82397,CPT4/HCPCS,CHEMILUMINESCENT ASSAY,,Pay Within 30 Days of Service,48.10
Cash Price - Prompt Pay,,82435,CPT4/HCPCS,ASSAY OF BLOOD CHLORIDE,,Pay Within 30 Days of Service,15.65
Cash Price - Prompt Pay,,82436,CPT4/HCPCS,ASSAY OF URINE CHLORIDE,,Pay Within 30 Days of Service,17.13
Cash Price - Prompt Pay,,82438,CPT4/HCPCS,ASSAY OTHER FLUID CHLORIDES,,Pay Within 30 Days of Service,16.65
Cash Price - Prompt Pay,,82465,CPT4/HCPCS,ASSAY BLD/SERUM CHOLESTEROL,,Pay Within 30 Days of Service,14.80
Cash Price - Prompt Pay,,82507,CPT4/HCPCS,ASSAY OF CITRATE,,Pay Within 30 Days of Service,94.67
Cash Price - Prompt Pay,,82523,CPT4/HCPCS,COLLAGEN CROSSLINKS,,Pay Within 30 Days of Service,63.20
Cash Price - Prompt Pay,,82525,CPT4/HCPCS,ASSAY OF COPPER,,Pay Within 30 Days of Service,42.25
Cash Price - Prompt Pay,,82530,CPT4/HCPCS,CORTISOL FREE,,Pay Within 30 Days of Service,56.90
Cash Price - Prompt Pay,,82533,CPT4/HCPCS,TOTAL CORTISOL,,Pay Within 30 Days of Service,55.53
Cash Price - Prompt Pay,,82542,CPT4/HCPCS,COL CHROMOTOGRAPHY QUAL/QUAN,,Pay Within 30 Days of Service,61.50
Cash Price - Prompt Pay,,82552,CPT4/HCPCS,ASSAY OF CPK IN BLOOD,,Pay Within 30 Days of Service,45.63
Cash Price - Prompt Pay,,82553,CPT4/HCPCS,CREATINE MB FRACTION,,Pay Within 30 Days of Service,39.33
Cash Price - Prompt Pay,,82570,CPT4/HCPCS,ASSAY OF URINE CREATININE,,Pay Within 30 Days of Service,17.63
Cash Price - Prompt Pay,,82575,CPT4/HCPCS,CREATININE CLEARANCE TEST,,Pay Within 30 Days of Service,32.20
Cash Price - Prompt Pay,,82595,CPT4/HCPCS,ASSAY OF CRYOGLOBULIN,,Pay Within 30 Days of Service,22.03
Cash Price - Prompt Pay,,82652,CPT4/HCPCS,VIT D 1 25-DIHYDROXY,,Pay Within 30 Days of Service,110.30
Cash Price - Prompt Pay,,82657,CPT4/HCPCS,ENZYME CELL ACTIVITY,,Pay Within 30 Days of Service,61.50
Cash Price - Prompt Pay,,82670,CPT4/HCPCS,ASSAY OF TOTAL ESTRADIOL,,Pay Within 30 Days of Service,95.15
Cash Price - Prompt Pay,,82693,CPT4/HCPCS,ASSAY OF ETHYLENE GLYCOL,,Pay Within 30 Days of Service,50.72
Cash Price - Prompt Pay,,82728,CPT4/HCPCS,ASSAY OF FERRITIN,,Pay Within 30 Days of Service,46.42
Cash Price - Prompt Pay,,82784,CPT4/HCPCS,ASSAY IGA/IGD/IGG/IGM EACH,,Pay Within 30 Days of Service,31.68
Cash Price - Prompt Pay,,82785,CPT4/HCPCS,ASSAY OF IGE,,Pay Within 30 Days of Service,56.08
Cash Price - Prompt Pay,,82787,CPT4/HCPCS,IGG 1 2 3 OR 4 EACH,,Pay Within 30 Days of Service,27.30
Cash Price - Prompt Pay,,82945,CPT4/HCPCS,GLUCOSE OTHER FLUID,,Pay Within 30 Days of Service,13.38
Cash Price - Prompt Pay,,82947,CPT4/HCPCS,ASSAY GLUCOSE BLOOD QUANT,,Pay Within 30 Days of Service,13.38
Cash Price - Prompt Pay,,82950,CPT4/HCPCS,GLUCOSE TEST,,Pay Within 30 Days of Service,16.18
Cash Price - Prompt Pay,,82951,CPT4/HCPCS,GLUCOSE TOLERANCE TEST (GTT),,Pay Within 30 Days of Service,43.83
Cash Price - Prompt Pay,,82977,CPT4/HCPCS,ASSAY OF GGT,,Pay Within 30 Days of Service,24.53
Cash Price - Prompt Pay,,83001,CPT4/HCPCS,ASSAY OF GONADOTROPIN (FSH),,Pay Within 30 Days of Service,63.27
Cash Price - Prompt Pay,,83002,CPT4/HCPCS,ASSAY OF GONADOTROPIN (LH),,Pay Within 30 Days of Service,63.05
Cash Price - Prompt Pay,,83010,CPT4/HCPCS,ASSAY OF HAPTOGLOBIN QUANT,,Pay Within 30 Days of Service,42.82
Cash Price - Prompt Pay,,83013,CPT4/HCPCS,H PYLORI (C-13) BREATH,,Pay Within 30 Days of Service,229.38
Cash Price - Prompt Pay,,83018,CPT4/HCPCS,HEAVY METAL QUANT EACH NES,,Pay Within 30 Days of Service,74.80
Cash Price - Prompt Pay,,83090,CPT4/HCPCS,ASSAY OF HOMOCYSTINE,,Pay Within 30 Days of Service,57.45
Cash Price - Prompt Pay,,83150,CPT4/HCPCS,ASSAY OF HOMOVANILLIC ACID,,Pay Within 30 Days of Service,65.90
Cash Price - Prompt Pay,,83497,CPT4/HCPCS,ASSAY OF 5-HIAA,,Pay Within 30 Days of Service,43.90
Cash Price - Prompt Pay,,83498,CPT4/HCPCS,ASSAY OF PROGESTERONE 17-D,,Pay Within 30 Days of Service,92.52
Cash Price - Prompt Pay,,83500,CPT4/HCPCS,ASSAY FREE HYDROXYPROLINE,,Pay Within 30 Days of Service,77.13
Cash Price - Prompt Pay,,83516,CPT4/HCPCS,IMMUNOASSAY NONANTIBODY,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,83519,CPT4/HCPCS,RIA NONANTIBODY,,Pay Within 30 Days of Service,46.00
Cash Price - Prompt Pay,,83520,CPT4/HCPCS,IMMUNOASSAY QUANT NOS NONAB,,Pay Within 30 Days of Service,44.07
Cash Price - Prompt Pay,,83525,CPT4/HCPCS,ASSAY OF INSULIN,,Pay Within 30 Days of Service,38.92
Cash Price - Prompt Pay,,83540,CPT4/HCPCS,ASSAY OF IRON,,Pay Within 30 Days of Service,22.05
Cash Price - Prompt Pay,,83605,CPT4/HCPCS,ASSAY OF LACTIC ACID,,Pay Within 30 Days of Service,36.38
Cash Price - Prompt Pay,,83615,CPT4/HCPCS,LACTATE (LD) (LDH) ENZYME,,Pay Within 30 Days of Service,20.55
Cash Price - Prompt Pay,,83655,CPT4/HCPCS,ASSAY OF LEAD,,Pay Within 30 Days of Service,41.22
Cash Price - Prompt Pay,,83661,CPT4/HCPCS,L/S RATIO FETAL LUNG,,Pay Within 30 Days of Service,74.88
Cash Price - Prompt Pay,,83663,CPT4/HCPCS,FLUORO POLARIZE FETAL LUNG,,Pay Within 30 Days of Service,64.40
Cash Price - Prompt Pay,,83690,CPT4/HCPCS,ASSAY OF LIPASE,,Pay Within 30 Days of Service,23.45
Cash Price - Prompt Pay,,83701,CPT4/HCPCS,LIPOPROTEIN BLD HR FRACTION,,Pay Within 30 Days of Service,84.55
Cash Price - Prompt Pay,,83704,CPT4/HCPCS,LIPOPROTEIN BLD QUAN PART,,Pay Within 30 Days of Service,107.45
Cash Price - Prompt Pay,,83718,CPT4/HCPCS,ASSAY OF LIPOPROTEIN,,Pay Within 30 Days of Service,27.90
Cash Price - Prompt Pay,,83721,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,Pay Within 30 Days of Service,32.50
Cash Price - Prompt Pay,,83727,CPT4/HCPCS,ASSAY OF LRH HORMONE,,Pay Within 30 Days of Service,58.55
Cash Price - Prompt Pay,,83735,CPT4/HCPCS,ASSAY OF MAGNESIUM,,Pay Within 30 Days of Service,22.80
Cash Price - Prompt Pay,,83789,CPT4/HCPCS,MASS SPECTROMETRY QUAL/QUAN,,Pay Within 30 Days of Service,61.50
Cash Price - Prompt Pay,,83825,CPT4/HCPCS,ASSAY OF MERCURY,,Pay Within 30 Days of Service,55.35
Cash Price - Prompt Pay,,83835,CPT4/HCPCS,ASSAY OF METANEPHRINES,,Pay Within 30 Days of Service,57.67
Cash Price - Prompt Pay,,83873,CPT4/HCPCS,ASSAY OF CSF PROTEIN,,Pay Within 30 Days of Service,58.60
Cash Price - Prompt Pay,,83874,CPT4/HCPCS,ASSAY OF MYOGLOBIN,,Pay Within 30 Days of Service,43.98
Cash Price - Prompt Pay,,83880,CPT4/HCPCS,ASSAY OF NATRIURETIC PEPTIDE,,Pay Within 30 Days of Service,115.60
Cash Price - Prompt Pay,,83883,CPT4/HCPCS,ASSAY NEPHELOMETRY NOT SPEC,,Pay Within 30 Days of Service,46.30
Cash Price - Prompt Pay,,83916,CPT4/HCPCS,OLIGOCLONAL BANDS,,Pay Within 30 Days of Service,68.47
Cash Price - Prompt Pay,,83921,CPT4/HCPCS,ORGANIC ACID SINGLE QUANT,,Pay Within 30 Days of Service,56.02
Cash Price - Prompt Pay,,83930,CPT4/HCPCS,ASSAY OF BLOOD OSMOLALITY,,Pay Within 30 Days of Service,22.52
Cash Price - Prompt Pay,,83935,CPT4/HCPCS,ASSAY OF URINE OSMOLALITY,,Pay Within 30 Days of Service,23.22
Cash Price - Prompt Pay,,83937,CPT4/HCPCS,ASSAY OF OSTEOCALCIN,,Pay Within 30 Days of Service,43.13
Cash Price - Prompt Pay,,83945,CPT4/HCPCS,ASSAY OF OXALATE,,Pay Within 30 Days of Service,43.83
Cash Price - Prompt Pay,,83970,CPT4/HCPCS,ASSAY OF PARATHORMONE,,Pay Within 30 Days of Service,140.57
Cash Price - Prompt Pay,,84030,CPT4/HCPCS,ASSAY OF BLOOD PKU,,Pay Within 30 Days of Service,18.73
Cash Price - Prompt Pay,,84075,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,Pay Within 30 Days of Service,17.63
Cash Price - Prompt Pay,,84081,CPT4/HCPCS,ASSAY PHOSPHATIDYLGLYCEROL,,Pay Within 30 Days of Service,56.25
Cash Price - Prompt Pay,,84105,CPT4/HCPCS,ASSAY OF URINE PHOSPHORUS,,Pay Within 30 Days of Service,17.63
Cash Price - Prompt Pay,,84120,CPT4/HCPCS,ASSAY OF URINE PORPHYRINS,,Pay Within 30 Days of Service,50.10
Cash Price - Prompt Pay,,84132,CPT4/HCPCS,ASSAY OF SERUM POTASSIUM,,Pay Within 30 Days of Service,15.65
Cash Price - Prompt Pay,,84133,CPT4/HCPCS,ASSAY OF URINE POTASSIUM,,Pay Within 30 Days of Service,14.65
Cash Price - Prompt Pay,,84134,CPT4/HCPCS,ASSAY OF PREALBUMIN,,Pay Within 30 Days of Service,49.68
Cash Price - Prompt Pay,,84144,CPT4/HCPCS,ASSAY OF PROGESTERONE,,Pay Within 30 Days of Service,71.05
Cash Price - Prompt Pay,,84145,CPT4/HCPCS,PROCALCITONIN (PCT),,Pay Within 30 Days of Service,91.23
Cash Price - Prompt Pay,,84146,CPT4/HCPCS,ASSAY OF PROLACTIN,,Pay Within 30 Days of Service,66.00
Cash Price - Prompt Pay,,84153,CPT4/HCPCS,ASSAY OF PSA TOTAL,,Pay Within 30 Days of Service,62.65
Cash Price - Prompt Pay,,84156,CPT4/HCPCS,ASSAY OF PROTEIN URINE,,Pay Within 30 Days of Service,12.50
Cash Price - Prompt Pay,,84157,CPT4/HCPCS,ASSAY OF PROTEIN OTHER,,Pay Within 30 Days of Service,12.50
Cash Price - Prompt Pay,,84165,CPT4/HCPCS,PROTEIN E-PHORESIS SERUM,,Pay Within 30 Days of Service,36.58
Cash Price - Prompt Pay,,84166,CPT4/HCPCS,PROTEIN E-PHORESIS/URINE/CSF,,Pay Within 30 Days of Service,60.72
Cash Price - Prompt Pay,,84181,CPT4/HCPCS,WESTERN BLOT TEST,,Pay Within 30 Days of Service,58.00
Cash Price - Prompt Pay,,84182,CPT4/HCPCS,PROTEIN WESTERN BLOT TEST,,Pay Within 30 Days of Service,61.30
Cash Price - Prompt Pay,,84202,CPT4/HCPCS,ASSAY RBC PROTOPORPHYRIN,,Pay Within 30 Days of Service,48.85
Cash Price - Prompt Pay,,84238,CPT4/HCPCS,ASSAY NONENDOCRINE RECEPTOR,,Pay Within 30 Days of Service,124.55
Cash Price - Prompt Pay,,84255,CPT4/HCPCS,ASSAY OF SELENIUM,,Pay Within 30 Days of Service,86.95
Cash Price - Prompt Pay,,84260,CPT4/HCPCS,ASSAY OF SEROTONIN,,Pay Within 30 Days of Service,105.50
Cash Price - Prompt Pay,,84295,CPT4/HCPCS,ASSAY OF SERUM SODIUM,,Pay Within 30 Days of Service,16.40
Cash Price - Prompt Pay,,84300,CPT4/HCPCS,ASSAY OF URINE SODIUM,,Pay Within 30 Days of Service,16.57
Cash Price - Prompt Pay,,84302,CPT4/HCPCS,ASSAY OF SWEAT SODIUM,,Pay Within 30 Days of Service,16.57
Cash Price - Prompt Pay,,84311,CPT4/HCPCS,SPECTROPHOTOMETRY,,Pay Within 30 Days of Service,23.80
Cash Price - Prompt Pay,,84376,CPT4/HCPCS,SUGARS SINGLE QUAL,,Pay Within 30 Days of Service,18.73
Cash Price - Prompt Pay,,84378,CPT4/HCPCS,SUGARS SINGLE QUANT,,Pay Within 30 Days of Service,39.25
Cash Price - Prompt Pay,,84402,CPT4/HCPCS,ASSAY OF FREE TESTOSTERONE,,Pay Within 30 Days of Service,86.72
Cash Price - Prompt Pay,,84403,CPT4/HCPCS,ASSAY OF TOTAL TESTOSTERONE,,Pay Within 30 Days of Service,87.93
Cash Price - Prompt Pay,,84439,CPT4/HCPCS,ASSAY OF FREE THYROXINE,,Pay Within 30 Days of Service,30.70
Cash Price - Prompt Pay,,84442,CPT4/HCPCS,ASSAY OF THYROID ACTIVITY,,Pay Within 30 Days of Service,50.35
Cash Price - Prompt Pay,,84443,CPT4/HCPCS,ASSAY THYROID STIM HORMONE,,Pay Within 30 Days of Service,57.23
Cash Price - Prompt Pay,,84466,CPT4/HCPCS,ASSAY OF TRANSFERRIN,,Pay Within 30 Days of Service,43.48
Cash Price - Prompt Pay,,84479,CPT4/HCPCS,ASSAY OF THYROID (T3 OR T4),,Pay Within 30 Days of Service,22.03
Cash Price - Prompt Pay,,84481,CPT4/HCPCS,FREE ASSAY (FT-3),,Pay Within 30 Days of Service,57.67
Cash Price - Prompt Pay,,84484,CPT4/HCPCS,ASSAY OF TROPONIN QUANT,,Pay Within 30 Days of Service,33.50
Cash Price - Prompt Pay,,84520,CPT4/HCPCS,ASSAY OF UREA NITROGEN,,Pay Within 30 Days of Service,13.45
Cash Price - Prompt Pay,,84540,CPT4/HCPCS,ASSAY OF URINE/UREA-N,,Pay Within 30 Days of Service,16.18
Cash Price - Prompt Pay,,84560,CPT4/HCPCS,ASSAY OF URINE/URIC ACID,,Pay Within 30 Days of Service,16.18
Cash Price - Prompt Pay,,84585,CPT4/HCPCS,ASSAY OF URINE VMA,,Pay Within 30 Days of Service,52.77
Cash Price - Prompt Pay,,84600,CPT4/HCPCS,ASSAY OF VOLATILES,,Pay Within 30 Days of Service,54.75
Cash Price - Prompt Pay,,84630,CPT4/HCPCS,ASSAY OF ZINC,,Pay Within 30 Days of Service,38.77
Cash Price - Prompt Pay,,85007,CPT4/HCPCS,BL SMEAR W/DIFF WBC COUNT,,Pay Within 30 Days of Service,11.70
Cash Price - Prompt Pay,,85018,CPT4/HCPCS,HEMOGLOBIN,,Pay Within 30 Days of Service,8.08
Cash Price - Prompt Pay,,85025,CPT4/HCPCS,COMPLETE CBC W/AUTO DIFF WBC,,Pay Within 30 Days of Service,26.48
Cash Price - Prompt Pay,,85240,CPT4/HCPCS,CLOT FACTOR VIII AHG 1 STAGE,,Pay Within 30 Days of Service,60.98
Cash Price - Prompt Pay,,85245,CPT4/HCPCS,CLOT FACTOR VIII VW RISTOCTN,,Pay Within 30 Days of Service,78.13
Cash Price - Prompt Pay,,85250,CPT4/HCPCS,CLOT FACTOR IX PTC/CHRSTMAS,,Pay Within 30 Days of Service,64.85
Cash Price - Prompt Pay,,85300,CPT4/HCPCS,ANTITHROMBIN III ACTIVITY,,Pay Within 30 Days of Service,40.38
Cash Price - Prompt Pay,,85301,CPT4/HCPCS,ANTITHROMBIN III ANTIGEN,,Pay Within 30 Days of Service,36.83
Cash Price - Prompt Pay,,85306,CPT4/HCPCS,CLOT INHIBIT PROT S FREE,,Pay Within 30 Days of Service,52.20
Cash Price - Prompt Pay,,85335,CPT4/HCPCS,FACTOR INHIBITOR TEST,,Pay Within 30 Days of Service,43.83
Cash Price - Prompt Pay,,85362,CPT4/HCPCS,FIBRIN DEGRADATION PRODUCTS,,Pay Within 30 Days of Service,23.45
Cash Price - Prompt Pay,,85378,CPT4/HCPCS,FIBRIN DEGRADE SEMIQUANT,,Pay Within 30 Days of Service,24.30
Cash Price - Prompt Pay,,85397,CPT4/HCPCS,CLOTTING FUNCT ACTIVITY,,Pay Within 30 Days of Service,78.13
Cash Price - Prompt Pay,,85576,CPT4/HCPCS,BLOOD PLATELET AGGREGATION,,Pay Within 30 Days of Service,73.17
Cash Price - Prompt Pay,,85597,CPT4/HCPCS,PHOSPHOLIPID PLTLT NEUTRALIZ,,Pay Within 30 Days of Service,61.22
Cash Price - Prompt Pay,,85610,CPT4/HCPCS,PROTHROMBIN TIME,,Pay Within 30 Days of Service,13.40
Cash Price - Prompt Pay,,85660,CPT4/HCPCS,RBC SICKLE CELL TEST,,Pay Within 30 Days of Service,18.77
Cash Price - Prompt Pay,,85730,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,Pay Within 30 Days of Service,20.45
Cash Price - Prompt Pay,,85810,CPT4/HCPCS,BLOOD VISCOSITY EXAMINATION,,Pay Within 30 Days of Service,39.75
Cash Price - Prompt Pay,,86000,CPT4/HCPCS,AGGLUTININS FEBRILE ANTIGEN,,Pay Within 30 Days of Service,23.77
Cash Price - Prompt Pay,,86001,CPT4/HCPCS,ALLERGEN SPECIFIC IGG,,Pay Within 30 Days of Service,17.78
Cash Price - Prompt Pay,,86003,CPT4/HCPCS,ALLG SPEC IGE CRUDE XTRC EA,,Pay Within 30 Days of Service,17.78
Cash Price - Prompt Pay,,86021,CPT4/HCPCS,WBC ANTIBODY IDENTIFICATION,,Pay Within 30 Days of Service,51.28
Cash Price - Prompt Pay,,86022,CPT4/HCPCS,PLATELET ANTIBODIES,,Pay Within 30 Days of Service,62.55
Cash Price - Prompt Pay,,86023,CPT4/HCPCS,IMMUNOGLOBULIN ASSAY,,Pay Within 30 Days of Service,42.42
Cash Price - Prompt Pay,,86038,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES,,Pay Within 30 Days of Service,41.17
Cash Price - Prompt Pay,,86063,CPT4/HCPCS,ANTISTREPTOLYSIN O SCREEN,,Pay Within 30 Days of Service,19.65
Cash Price - Prompt Pay,,86147,CPT4/HCPCS,CARDIOLIPIN ANTIBODY EA IG,,Pay Within 30 Days of Service,62.65
Cash Price - Prompt Pay,,86160,CPT4/HCPCS,COMPLEMENT ANTIGEN,,Pay Within 30 Days of Service,40.88
Cash Price - Prompt Pay,,86171,CPT4/HCPCS,COMPLEMENT FIXATION EACH,,Pay Within 30 Days of Service,34.10
Cash Price - Prompt Pay,,86226,CPT4/HCPCS,DNA ANTIBODY SINGLE STRAND,,Pay Within 30 Days of Service,41.22
Cash Price - Prompt Pay,,86235,CPT4/HCPCS,NUCLEAR ANTIGEN ANTIBODY,,Pay Within 30 Days of Service,61.08
Cash Price - Prompt Pay,,86255,CPT4/HCPCS,FLUORESCENT ANTIBODY SCREEN,,Pay Within 30 Days of Service,41.02
Cash Price - Prompt Pay,,86256,CPT4/HCPCS,FLUORESCENT ANTIBODY TITER,,Pay Within 30 Days of Service,41.02
Cash Price - Prompt Pay,,86300,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 15-3,,Pay Within 30 Days of Service,70.88
Cash Price - Prompt Pay,,86304,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 125,,Pay Within 30 Days of Service,70.88
Cash Price - Prompt Pay,,86308,CPT4/HCPCS,HETEROPHILE ANTIBODY SCREEN,,Pay Within 30 Days of Service,17.63
Cash Price - Prompt Pay,,86316,CPT4/HCPCS,IMMUNOASSAY TUMOR OTHER,,Pay Within 30 Days of Service,70.88
Cash Price - Prompt Pay,,86317,CPT4/HCPCS,IMMUNOASSAY INFECTIOUS AGENT,,Pay Within 30 Days of Service,51.05
Cash Price - Prompt Pay,,86331,CPT4/HCPCS,IMMUNODIFFUSION OUCHTERLONY,,Pay Within 30 Days of Service,40.80
Cash Price - Prompt Pay,,86332,CPT4/HCPCS,IMMUNE COMPLEX ASSAY,,Pay Within 30 Days of Service,83.00
Cash Price - Prompt Pay,,86334,CPT4/HCPCS,IMMUNOFIX E-PHORESIS SERUM,,Pay Within 30 Days of Service,76.10
Cash Price - Prompt Pay,,86335,CPT4/HCPCS,IMMUNFIX E-PHORSIS/URINE/CSF,,Pay Within 30 Days of Service,99.92
Cash Price - Prompt Pay,,86337,CPT4/HCPCS,INSULIN ANTIBODIES,,Pay Within 30 Days of Service,72.90
Cash Price - Prompt Pay,,86341,CPT4/HCPCS,ISLET CELL ANTIBODY,,Pay Within 30 Days of Service,56.57
Cash Price - Prompt Pay,,86355,CPT4/HCPCS,B CELLS TOTAL COUNT,,Pay Within 30 Days of Service,128.47
Cash Price - Prompt Pay,,86356,CPT4/HCPCS,MONONUCLEAR CELL ANTIGEN,,Pay Within 30 Days of Service,91.17
Cash Price - Prompt Pay,,86376,CPT4/HCPCS,MICROSOMAL ANTIBODY EACH,,Pay Within 30 Days of Service,49.55
Cash Price - Prompt Pay,,86403,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY SCRN,,Pay Within 30 Days of Service,34.70
Cash Price - Prompt Pay,,86431,CPT4/HCPCS,RHEUMATOID FACTOR QUANT,,Pay Within 30 Days of Service,19.33
Cash Price - Prompt Pay,,86480,CPT4/HCPCS,TB TEST CELL IMMUN MEASURE,,Pay Within 30 Days of Service,211.08
Cash Price - Prompt Pay,,86592,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUAL,,Pay Within 30 Days of Service,14.55
Cash Price - Prompt Pay,,86603,CPT4/HCPCS,ADENOVIRUS ANTIBODY,,Pay Within 30 Days of Service,43.80
Cash Price - Prompt Pay,,86606,CPT4/HCPCS,ASPERGILLUS ANTIBODY,,Pay Within 30 Days of Service,51.28
Cash Price - Prompt Pay,,86609,CPT4/HCPCS,BACTERIUM ANTIBODY,,Pay Within 30 Days of Service,43.88
Cash Price - Prompt Pay,,86611,CPT4/HCPCS,BARTONELLA ANTIBODY,,Pay Within 30 Days of Service,34.67
Cash Price - Prompt Pay,,86615,CPT4/HCPCS,BORDETELLA ANTIBODY,,Pay Within 30 Days of Service,44.92
Cash Price - Prompt Pay,,86617,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Pay Within 30 Days of Service,52.75
Cash Price - Prompt Pay,,86618,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Pay Within 30 Days of Service,58.00
Cash Price - Prompt Pay,,86631,CPT4/HCPCS,CHLAMYDIA ANTIBODY,,Pay Within 30 Days of Service,40.27
Cash Price - Prompt Pay,,86635,CPT4/HCPCS,COCCIDIOIDES ANTIBODY,,Pay Within 30 Days of Service,39.08
Cash Price - Prompt Pay,,86638,CPT4/HCPCS,Q FEVER ANTIBODY,,Pay Within 30 Days of Service,41.28
Cash Price - Prompt Pay,,86641,CPT4/HCPCS,CRYPTOCOCCUS ANTIBODY,,Pay Within 30 Days of Service,45.25
Cash Price - Prompt Pay,,86644,CPT4/HCPCS,CMV ANTIBODY,,Pay Within 30 Days of Service,49.02
Cash Price - Prompt Pay,,86645,CPT4/HCPCS,CMV ANTIBODY IGM,,Pay Within 30 Days of Service,57.38
Cash Price - Prompt Pay,,86651,CPT4/HCPCS,ENCEPHALITIS CALIFORN ANTBDY,,Pay Within 30 Days of Service,44.92
Cash Price - Prompt Pay,,86658,CPT4/HCPCS,ENTEROVIRUS ANTIBODY,,Pay Within 30 Days of Service,44.38
Cash Price - Prompt Pay,,86664,CPT4/HCPCS,EPSTEIN-BARR NUCLEAR ANTIGEN,,Pay Within 30 Days of Service,52.10
Cash Price - Prompt Pay,,86665,CPT4/HCPCS,EPSTEIN-BARR CAPSID VCA,,Pay Within 30 Days of Service,59.35
Cash Price - Prompt Pay,,86671,CPT4/HCPCS,FUNGUS NES ANTIBODY,,Pay Within 30 Days of Service,41.73
Cash Price - Prompt Pay,,86677,CPT4/HCPCS,HELICOBACTER PYLORI ANTIBODY,,Pay Within 30 Days of Service,49.42
Cash Price - Prompt Pay,,86682,CPT4/HCPCS,HELMINTH ANTIBODY,,Pay Within 30 Days of Service,44.30
Cash Price - Prompt Pay,,86687,CPT4/HCPCS,HTLV-I ANTIBODY,,Pay Within 30 Days of Service,28.57
Cash Price - Prompt Pay,,86689,CPT4/HCPCS,HTLV/HIV CONFIRMJ ANTIBODY,,Pay Within 30 Days of Service,65.92
Cash Price - Prompt Pay,,86692,CPT4/HCPCS,HEPATITIS DELTA AGENT ANTBDY,,Pay Within 30 Days of Service,58.45
Cash Price - Prompt Pay,,86694,CPT4/HCPCS,HERPES SIMPLEX NES ANTBDY,,Pay Within 30 Days of Service,49.02
Cash Price - Prompt Pay,,86695,CPT4/HCPCS,HERPES SIMPLEX TYPE 1 TEST,,Pay Within 30 Days of Service,44.92
Cash Price - Prompt Pay,,86696,CPT4/HCPCS,HERPES SIMPLEX TYPE 2 TEST,,Pay Within 30 Days of Service,65.92
Cash Price - Prompt Pay,,86698,CPT4/HCPCS,HISTOPLASMA ANTIBODY,,Pay Within 30 Days of Service,42.55
Cash Price - Prompt Pay,,86703,CPT4/HCPCS,HIV-1/HIV-2 1 RESULT ANTBDY,,Pay Within 30 Days of Service,46.68
Cash Price - Prompt Pay,,86705,CPT4/HCPCS,HEP B CORE ANTIBODY IGM,,Pay Within 30 Days of Service,40.10
Cash Price - Prompt Pay,,86706,CPT4/HCPCS,HEP B SURFACE ANTIBODY,,Pay Within 30 Days of Service,36.58
Cash Price - Prompt Pay,,86709,CPT4/HCPCS,HEPATITIS A IGM ANTIBODY,,Pay Within 30 Days of Service,38.33
Cash Price - Prompt Pay,,86710,CPT4/HCPCS,INFLUENZA VIRUS ANTIBODY,,Pay Within 30 Days of Service,46.15
Cash Price - Prompt Pay,,86713,CPT4/HCPCS,LEGIONELLA ANTIBODY,,Pay Within 30 Days of Service,52.13
Cash Price - Prompt Pay,,86717,CPT4/HCPCS,LEISHMANIA ANTIBODY,,Pay Within 30 Days of Service,41.70
Cash Price - Prompt Pay,,86727,CPT4/HCPCS,LYMPH CHORIOMENINGITIS AB,,Pay Within 30 Days of Service,43.80
Cash Price - Prompt Pay,,86735,CPT4/HCPCS,MUMPS ANTIBODY,,Pay Within 30 Days of Service,44.42
Cash Price - Prompt Pay,,86738,CPT4/HCPCS,MYCOPLASMA ANTIBODY,,Pay Within 30 Days of Service,45.10
Cash Price - Prompt Pay,,86747,CPT4/HCPCS,PARVOVIRUS ANTIBODY,,Pay Within 30 Days of Service,51.20
Cash Price - Prompt Pay,,86753,CPT4/HCPCS,PROTOZOA ANTIBODY NOS,,Pay Within 30 Days of Service,42.18
Cash Price - Prompt Pay,,86757,CPT4/HCPCS,RICKETTSIA ANTIBODY,,Pay Within 30 Days of Service,65.92
Cash Price - Prompt Pay,,86762,CPT4/HCPCS,RUBELLA ANTIBODY,,Pay Within 30 Days of Service,49.02
Cash Price - Prompt Pay,,86765,CPT4/HCPCS,RUBEOLA ANTIBODY,,Pay Within 30 Days of Service,43.88
Cash Price - Prompt Pay,,86777,CPT4/HCPCS,TOXOPLASMA ANTIBODY,,Pay Within 30 Days of Service,49.02
Cash Price - Prompt Pay,,86778,CPT4/HCPCS,TOXOPLASMA ANTIBODY IGM,,Pay Within 30 Days of Service,49.05
Cash Price - Prompt Pay,,86780,CPT4/HCPCS,TREPONEMA PALLIDUM,,Pay Within 30 Days of Service,45.08
Cash Price - Prompt Pay,,86787,CPT4/HCPCS,VARICELLA-ZOSTER ANTIBODY,,Pay Within 30 Days of Service,43.88
Cash Price - Prompt Pay,,86789,CPT4/HCPCS,WEST NILE VIRUS ANTIBODY,,Pay Within 30 Days of Service,49.02
Cash Price - Prompt Pay,,86790,CPT4/HCPCS,VIRUS ANTIBODY NOS,,Pay Within 30 Days of Service,43.88
Cash Price - Prompt Pay,,86803,CPT4/HCPCS,HEPATITIS C AB TEST,,Pay Within 30 Days of Service,48.60
Cash Price - Prompt Pay,,86812,CPT4/HCPCS,HLA TYPING A B OR C,,Pay Within 30 Days of Service,87.90
Cash Price - Prompt Pay,,86813,CPT4/HCPCS,HLA TYPING A B OR C,,Pay Within 30 Days of Service,197.50
Cash Price - Prompt Pay,,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,Pay Within 30 Days of Service,13.03
Cash Price - Prompt Pay,,86880,CPT4/HCPCS,COOMBS TEST DIRECT,,Pay Within 30 Days of Service,18.32
Cash Price - Prompt Pay,,86886,CPT4/HCPCS,COOMBS TEST INDIRECT TITER,,Pay Within 30 Days of Service,17.63
Cash Price - Prompt Pay,,86900,CPT4/HCPCS,BLOOD TYPING SEROLOGIC ABO,,Pay Within 30 Days of Service,10.18
Cash Price - Prompt Pay,,86901,CPT4/HCPCS,BLOOD TYPING SEROLOGIC RH(D),,Pay Within 30 Days of Service,10.18
Cash Price - Prompt Pay,,86902,CPT4/HCPCS,BLOOD TYPE ANTIGEN DONOR EA,,Pay Within 30 Days of Service,13.03
Cash Price - Prompt Pay,,86904,CPT4/HCPCS,BLOOD TYPING PATIENT SERUM,,Pay Within 30 Days of Service,32.40
Cash Price - Prompt Pay,,86905,CPT4/HCPCS,BLOOD TYPING RBC ANTIGENS,,Pay Within 30 Days of Service,13.03
Cash Price - Prompt Pay,,86906,CPT4/HCPCS,BLD TYPING SEROLOGIC RH PHNT,,Pay Within 30 Days of Service,26.38
Cash Price - Prompt Pay,,86941,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS,,Pay Within 30 Days of Service,41.22
Cash Price - Prompt Pay,,87015,CPT4/HCPCS,SPECIMEN INFECT AGNT CONCNTJ,,Pay Within 30 Days of Service,22.73
Cash Price - Prompt Pay,,87045,CPT4/HCPCS,FECES CULTURE AEROBIC BACT,,Pay Within 30 Days of Service,32.15
Cash Price - Prompt Pay,,87046,CPT4/HCPCS,STOOL CULTR AEROBIC BACT EA,,Pay Within 30 Days of Service,32.15
Cash Price - Prompt Pay,,87070,CPT4/HCPCS,CULTURE OTHR SPECIMN AEROBIC,,Pay Within 30 Days of Service,29.35
Cash Price - Prompt Pay,,87071,CPT4/HCPCS,CULTURE AEROBIC QUANT OTHER,,Pay Within 30 Days of Service,32.15
Cash Price - Prompt Pay,,87075,CPT4/HCPCS,CULTR BACTERIA EXCEPT BLOOD,,Pay Within 30 Days of Service,32.25
Cash Price - Prompt Pay,,87076,CPT4/HCPCS,CULTURE ANAEROBE IDENT EACH,,Pay Within 30 Days of Service,27.50
Cash Price - Prompt Pay,,87077,CPT4/HCPCS,CULTURE AEROBIC IDENTIFY,,Pay Within 30 Days of Service,27.50
Cash Price - Prompt Pay,,87081,CPT4/HCPCS,CULTURE SCREEN ONLY,,Pay Within 30 Days of Service,22.57
Cash Price - Prompt Pay,,87101,CPT4/HCPCS,SKIN FUNGI CULTURE,,Pay Within 30 Days of Service,26.25
Cash Price - Prompt Pay,,87102,CPT4/HCPCS,FUNGUS ISOLATION CULTURE,,Pay Within 30 Days of Service,28.63
Cash Price - Prompt Pay,,87103,CPT4/HCPCS,BLOOD FUNGUS CULTURE,,Pay Within 30 Days of Service,30.70
Cash Price - Prompt Pay,,87106,CPT4/HCPCS,FUNGI IDENTIFICATION YEAST,,Pay Within 30 Days of Service,35.17
Cash Price - Prompt Pay,,87109,CPT4/HCPCS,MYCOPLASMA,,Pay Within 30 Days of Service,52.40
Cash Price - Prompt Pay,,87110,CPT4/HCPCS,CHLAMYDIA CULTURE,,Pay Within 30 Days of Service,66.73
Cash Price - Prompt Pay,,87116,CPT4/HCPCS,MYCOBACTERIA CULTURE,,Pay Within 30 Days of Service,36.78
Cash Price - Prompt Pay,,87118,CPT4/HCPCS,MYCOBACTERIC IDENTIFICATION,,Pay Within 30 Days of Service,37.27
Cash Price - Prompt Pay,,87147,CPT4/HCPCS,CULTURE TYPE IMMUNOLOGIC,,Pay Within 30 Days of Service,17.63
Cash Price - Prompt Pay,,87149,CPT4/HCPCS,DNA/RNA DIRECT PROBE,,Pay Within 30 Days of Service,68.30
Cash Price - Prompt Pay,,87177,CPT4/HCPCS,OVA AND PARASITES SMEARS,,Pay Within 30 Days of Service,30.30
Cash Price - Prompt Pay,,87181,CPT4/HCPCS,MICROBE SUSCEPTIBLE DIFFUSE,,Pay Within 30 Days of Service,9.80
Cash Price - Prompt Pay,,87184,CPT4/HCPCS,MICROBE SUSCEPTIBLE DISK,,Pay Within 30 Days of Service,23.48
Cash Price - Prompt Pay,,87186,CPT4/HCPCS,MICROBE SUSCEPTIBLE MIC,,Pay Within 30 Days of Service,29.45
Cash Price - Prompt Pay,,87188,CPT4/HCPCS,MICROBE SUSCEPT MACROBROTH,,Pay Within 30 Days of Service,22.60
Cash Price - Prompt Pay,,87190,CPT4/HCPCS,MICROBE SUSCEPT MYCOBACTERI,,Pay Within 30 Days of Service,19.25
Cash Price - Prompt Pay,,87205,CPT4/HCPCS,SMEAR GRAM STAIN,,Pay Within 30 Days of Service,14.55
Cash Price - Prompt Pay,,87206,CPT4/HCPCS,SMEAR FLUORESCENT/ACID STAI,,Pay Within 30 Days of Service,18.32
Cash Price - Prompt Pay,,87207,CPT4/HCPCS,SMEAR SPECIAL STAIN,,Pay Within 30 Days of Service,20.40
Cash Price - Prompt Pay,,87210,CPT4/HCPCS,SMEAR WET MOUNT SALINE/INK,,Pay Within 30 Days of Service,14.55
Cash Price - Prompt Pay,,87220,CPT4/HCPCS,TISSUE EXAM FOR FUNGI,,Pay Within 30 Days of Service,14.55
Cash Price - Prompt Pay,,87230,CPT4/HCPCS,ASSAY TOXIN OR ANTITOXIN,,Pay Within 30 Days of Service,67.25
Cash Price - Prompt Pay,,87252,CPT4/HCPCS,VIRUS INOCULATION TISSUE,,Pay Within 30 Days of Service,88.77
Cash Price - Prompt Pay,,87254,CPT4/HCPCS,VIRUS INOCULATION SHELL VIA,,Pay Within 30 Days of Service,66.63
Cash Price - Prompt Pay,,87260,CPT4/HCPCS,ADENOVIRUS AG IF,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87265,CPT4/HCPCS,PERTUSSIS AG IF,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87270,CPT4/HCPCS,CHLAMYDIA TRACHOMATIS AG IF,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87274,CPT4/HCPCS,HERPES SIMPLEX 1 AG IF,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87275,CPT4/HCPCS,INFLUENZA B AG IF,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87278,CPT4/HCPCS,LEGION PNEUMOPHILIA AG IF,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87279,CPT4/HCPCS,PARAINFLUENZA AG IF,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87280,CPT4/HCPCS,RESPIRATORY SYNCYTIAL AG IF,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87324,CPT4/HCPCS,CLOSTRIDIUM AG IA,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87329,CPT4/HCPCS,GIARDIA AG IA,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87337,CPT4/HCPCS,ENTAMOEB HIST GROUP AG IA,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87340,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,Pay Within 30 Days of Service,35.17
Cash Price - Prompt Pay,,87385,CPT4/HCPCS,HISTOPLASMA CAPSUL AG IA,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87390,CPT4/HCPCS,HIV-1 AG IA,,Pay Within 30 Days of Service,60.08
Cash Price - Prompt Pay,,87400,CPT4/HCPCS,INFLUENZA A/B AG IA,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87425,CPT4/HCPCS,ROTAVIRUS AG IA,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87449,CPT4/HCPCS,AG DETECT NOS IA MULT,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87471,CPT4/HCPCS,BARTONELLA DNA AMP PROBE,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87476,CPT4/HCPCS,LYME DIS DNA AMP PROBE,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87486,CPT4/HCPCS,CHYLMD PNEUM DNA AMP PROBE,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87490,CPT4/HCPCS,CHYLMD TRACH DNA DIR PROBE,,Pay Within 30 Days of Service,68.30
Cash Price - Prompt Pay,,87491,CPT4/HCPCS,CHYLMD TRACH DNA AMP PROBE,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87497,CPT4/HCPCS,CYTOMEG DNA QUANT,,Pay Within 30 Days of Service,145.88
Cash Price - Prompt Pay,,87516,CPT4/HCPCS,HEPATITIS B DNA AMP PROBE,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87521,CPT4/HCPCS,HEPATITIS C PROBE&RVRS TRNSC,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87522,CPT4/HCPCS,HEPATITIS C REVRS TRNSCRPJ,,Pay Within 30 Days of Service,145.88
Cash Price - Prompt Pay,,87529,CPT4/HCPCS,HSV DNA AMP PROBE,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87535,CPT4/HCPCS,HIV-1 PROBE&REVERSE TRNSCRPJ,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87536,CPT4/HCPCS,HIV-1 QUANT&REVRSE TRNSCRPJ,,Pay Within 30 Days of Service,289.80
Cash Price - Prompt Pay,,87556,CPT4/HCPCS,M.TUBERCULO DNA AMP PROBE,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87591,CPT4/HCPCS,N.GONORRHOEAE DNA AMP PROB,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87797,CPT4/HCPCS,DETECT AGENT NOS DNA DIR,,Pay Within 30 Days of Service,68.30
Cash Price - Prompt Pay,,87798,CPT4/HCPCS,DETECT AGENT NOS DNA AMP,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87799,CPT4/HCPCS,DETECT AGENT NOS DNA QUANT,,Pay Within 30 Days of Service,145.88
Cash Price - Prompt Pay,,87899,CPT4/HCPCS,AGENT NOS ASSAY W/OPTIC,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87901,CPT4/HCPCS,GENOTYPE DNA HIV REVERSE T,,Pay Within 30 Days of Service,876.73
Cash Price - Prompt Pay,,88142,CPT4/HCPCS,CYTOPATH C/V THIN LAYER,,Pay Within 30 Days of Service,69.00
Cash Price - Prompt Pay,,88164,CPT4/HCPCS,CYTOPATH TBS C/V MANUAL,,Pay Within 30 Days of Service,35.98
Cash Price - Prompt Pay,,88230,CPT4/HCPCS,TISSUE CULTURE LYMPHOCYTE,,Pay Within 30 Days of Service,396.73
Cash Price - Prompt Pay,,88233,CPT4/HCPCS,TISSUE CULTURE SKIN/BIOPSY,,Pay Within 30 Days of Service,479.25
Cash Price - Prompt Pay,,88235,CPT4/HCPCS,TISSUE CULTURE PLACENTA,,Pay Within 30 Days of Service,501.50
Cash Price - Prompt Pay,,88237,CPT4/HCPCS,TISSUE CULTURE BONE MARROW,,Pay Within 30 Days of Service,430.15
Cash Price - Prompt Pay,,88262,CPT4/HCPCS,CHROMOSOME ANALYSIS 15-20,,Pay Within 30 Days of Service,424.47
Cash Price - Prompt Pay,,88264,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,Pay Within 30 Days of Service,424.47
Cash Price - Prompt Pay,,88271,CPT4/HCPCS,CYTOGENETICS DNA PROBE,,Pay Within 30 Days of Service,72.93
Cash Price - Prompt Pay,,88273,CPT4/HCPCS,CYTOGENETICS 10-30,,Pay Within 30 Days of Service,109.43
Cash Price - Prompt Pay,,88274,CPT4/HCPCS,CYTOGENETICS 25-99,,Pay Within 30 Days of Service,118.55
Cash Price - Prompt Pay,,88275,CPT4/HCPCS,CYTOGENETICS 100-300,,Pay Within 30 Days of Service,136.75
Cash Price - Prompt Pay,,89051,CPT4/HCPCS,BODY FLUID CELL COUNT,,Pay Within 30 Days of Service,18.75
Cash Price - Prompt Pay,,89125,CPT4/HCPCS,SPECIMEN FAT STAIN,,Pay Within 30 Days of Service,14.70
Cash Price - Prompt Pay,,89160,CPT4/HCPCS,EXAM FECES FOR MEAT FIBERS,,Pay Within 30 Days of Service,12.55
Cash Price - Prompt Pay,,91110,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,Pay Within 30 Days of Service,575.00
Cash Price - Prompt Pay,,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,Pay Within 30 Days of Service,125.00
Cash Price - Prompt Pay,,92585,CPT4/HCPCS,AUDITOR EVOKE POTENT COMPRE,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,92586,CPT4/HCPCS,AUDITOR EVOKE POTENT LIMIT,,Pay Within 30 Days of Service,383.00
Cash Price - Prompt Pay,,92587,CPT4/HCPCS,EVOKED AUDITORY TEST LIMITED,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Pay Within 30 Days of Service,703.00
Cash Price - Prompt Pay,,93017,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,Pay Within 30 Days of Service,650.42
Cash Price - Prompt Pay,,93288,CPT4/HCPCS,INTERROG EVL PM/LDLS PM IP,,Pay Within 30 Days of Service,99.25
Cash Price - Prompt Pay,,93293,CPT4/HCPCS,PM PHONE R-STRIP DEVICE EVAL,,Pay Within 30 Days of Service,99.25
Cash Price - Prompt Pay,,93296,CPT4/HCPCS,REM INTERROG EVL PM/IDS,,Pay Within 30 Days of Service,99.25
Cash Price - Prompt Pay,,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,Pay Within 30 Days of Service,2062.27
Cash Price - Prompt Pay,,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,Pay Within 30 Days of Service,1230.30
Cash Price - Prompt Pay,,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,Pay Within 30 Days of Service,453.32
Cash Price - Prompt Pay,,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Pay Within 30 Days of Service,2062.27
Cash Price - Prompt Pay,,93351,CPT4/HCPCS,STRESS TTE COMPLETE,,Pay Within 30 Days of Service,1230.30
Cash Price - Prompt Pay,,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Pay Within 30 Days of Service,3010.00
Cash Price - Prompt Pay,,93880,CPT4/HCPCS,EXTRACRANIAL BILAT STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93882,CPT4/HCPCS,EXTRACRANIAL UNI/LTD STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93925,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93926,CPT4/HCPCS,LOWER EXTREMITY STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93930,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93931,CPT4/HCPCS,UPPER EXTREMITY STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93970,CPT4/HCPCS,EXTREMITY STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93971,CPT4/HCPCS,EXTREMITY STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93975,CPT4/HCPCS,VASCULAR STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93976,CPT4/HCPCS,VASCULAR STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93978,CPT4/HCPCS,VASCULAR STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93979,CPT4/HCPCS,VASCULAR STUDY,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,Pay Within 30 Days of Service,441.18
Cash Price - Prompt Pay,,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,Pay Within 30 Days of Service,441.18
Cash Price - Prompt Pay,,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,Pay Within 30 Days of Service,441.18
Cash Price - Prompt Pay,,94726,CPT4/HCPCS,PULM FUNCT TST PLETHYSMOGRAP,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,94727,CPT4/HCPCS,PULM FUNCTION TEST BY GAS,,Pay Within 30 Days of Service,383.00
Cash Price - Prompt Pay,,94775,CPT4/HCPCS,PED HOME APNEA REC HK-UP,,Pay Within 30 Days of Service,383.00
Cash Price - Prompt Pay,,95822,CPT4/HCPCS,EEG COMA OR SLEEP ONLY,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95956,CPT4/HCPCS,EEG MONITOR TECHNOL ATTENDED,,Pay Within 30 Days of Service,1170.45
Cash Price - Prompt Pay,,97001,CPT4/HCPCS,PT EVALUATION,,Pay Within 30 Days of Service,125.00
Cash Price - Prompt Pay,,97003,CPT4/HCPCS,OT EVALUATION,,Pay Within 30 Days of Service,125.00
Cash Price - Prompt Pay,,G0479,CPT4/HCPCS,Drug test presump not opt,,Pay Within 30 Days of Service,198.13
Cash Price - Prompt Pay,,G0480,CPT4/HCPCS,Drug test def 1-7 classes,,Pay Within 30 Days of Service,199.85
Cash Price - Prompt Pay,,20670,CPT4/HCPCS,Pin Fixator Removal,,Pay Within 30 Days of Service,1800.00
Cash Price - Prompt Pay,,29065,CPT4/HCPCS,Cast Long Arm,,Pay Within 30 Days of Service,350.00
Cash Price - Prompt Pay,,29075,CPT4/HCPCS,Cast Short Arm,,Pay Within 30 Days of Service,350.00
Cash Price - Prompt Pay,,29085,CPT4/HCPCS,Cast Guantlet,,Pay Within 30 Days of Service,350.00
Cash Price - Prompt Pay,,29105,CPT4/HCPCS,Splint Long Arm,,Pay Within 30 Days of Service,200.00
Cash Price - Prompt Pay,,29325,CPT4/HCPCS,Cast 1 1/2 Spica Or Both Legs,,Pay Within 30 Days of Service,500.00
Cash Price - Prompt Pay,,29345,CPT4/HCPCS,Long Leg Cast (Thigh to Toes),,Pay Within 30 Days of Service,350.00
Cash Price - Prompt Pay,,29365,CPT4/HCPCS,Cast Cylinder,,Pay Within 30 Days of Service,350.00
Cash Price - Prompt Pay,,29425,CPT4/HCPCS,Cast Walker St or Amb Type,,Pay Within 30 Days of Service,350.00
Cash Price - Prompt Pay,,29440,CPT4/HCPCS,Adding Walker tp Prev Cast,,Pay Within 30 Days of Service,50.00
Cash Price - Prompt Pay,,29450,CPT4/HCPCS,Cast Clubfoot,,Pay Within 30 Days of Service,250.00
Cash Price - Prompt Pay,,29505,CPT4/HCPCS,Splint Long Leg,,Pay Within 30 Days of Service,200.00
Cash Price - Prompt Pay,,29700,CPT4/HCPCS,Removal/Bivalving Short Arm or Short Leg Cast,,Pay Within 30 Days of Service,408.00
Cash Price - Prompt Pay,,29705,CPT4/HCPCS,Removal/Bivalving Full Arm Or Full Leg Cast,,Pay Within 30 Days of Service,408.00
Cash Price - Prompt Pay,,29710,CPT4/HCPCS,Removal Shoulder or Hip Spica,,Pay Within 30 Days of Service,500.00
Cash Price - Prompt Pay,,29720,CPT4/HCPCS,Repair Spica/Body Cast/Jacket,,Pay Within 30 Days of Service,268.00
Cash Price - Prompt Pay,,29730,CPT4/HCPCS,Windowing of Cast,,Pay Within 30 Days of Service,268.00
Cash Price - Prompt Pay,,29740,CPT4/HCPCS,Wedging of Cast,,Pay Within 30 Days of Service,268.00
Cash Price - Prompt Pay,,29799,CPT4/HCPCS,Unlisted Proc Cast/Strap,,Pay Within 30 Days of Service,268.00
Cash Price - Prompt Pay,,36600,CPT4/HCPCS,Arterial Puncture,,Pay Within 30 Days of Service,269.15
Cash Price - Prompt Pay,,45382,CPT4/HCPCS,EUS Needle w/Balloon - Inactive,,Pay Within 30 Days of Service,575.00
Cash Price - Prompt Pay,,46946,CPT4/HCPCS,HET Probe (ligation device) - Inactive,,Pay Within 30 Days of Service,575.00
Cash Price - Prompt Pay,,70015,CPT4/HCPCS,Cisterno S&I,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,71023,CPT4/HCPCS,Chest 2 View & Fluoro,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,71034,CPT4/HCPCS,Chest 4 View & Fluoro,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72190,CPT4/HCPCS,Pelvis Judet Views,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,72240,CPT4/HCPCS,Cervical Myelogram S&I,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,72255,CPT4/HCPCS,Thoracic Myelogram S&I,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,72265,CPT4/HCPCS,Lumbar Myelogram S&I,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,72270,CPT4/HCPCS,Combined Myelogram S&I,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,72291,CPT4/HCPCS,Vertebro Plasty/Augment S&I,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,74190,CPT4/HCPCS,Peritoneogram S&I,,Pay Within 30 Days of Service,4650.00
Cash Price - Prompt Pay,,74220,CPT4/HCPCS,Esophogram,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74230,CPT4/HCPCS,Modfd Ba Swallow/Video,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74240,CPT4/HCPCS,Simple Gi,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74246,CPT4/HCPCS,Ugi,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74249,CPT4/HCPCS,Ugi & Sml Bowel Series,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74250,CPT4/HCPCS,Small Bowel Series,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74270,CPT4/HCPCS,Ba Enema W/Wo Kub,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74280,CPT4/HCPCS,Air Contrast Enema,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74283,CPT4/HCPCS,Therapeutic Ba Enema,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74330,CPT4/HCPCS,Ercp S&I,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74400,CPT4/HCPCS,Ivp W/Wo Lams,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,74415,CPT4/HCPCS,Nephrotomogram,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,74430,CPT4/HCPCS,Cystogram S&I,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,74455,CPT4/HCPCS,Voiding Cystogram S&I,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,74740,CPT4/HCPCS,Hysterosalpingogram S&I,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,75705,CPT4/HCPCS,IR Spinal Select,,Pay Within 30 Days of Service,4650.00
Cash Price - Prompt Pay,,75726,CPT4/HCPCS,Visceral Angio Sel/Supr/Se S&I,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75743,CPT4/HCPCS,Pulmonary Angio Sel Bil S&I,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75746,CPT4/HCPCS,Pulm Angio Non-Sel S&I,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75809,CPT4/HCPCS,Shuntogram S&I,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,75825,CPT4/HCPCS,Inferior Venacavagram S&I,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75827,CPT4/HCPCS,Superior Venacavagram S&I,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75833,CPT4/HCPCS,Renal Venogram S&I Bilateral,,Pay Within 30 Days of Service,4650.00
Cash Price - Prompt Pay,,75872,CPT4/HCPCS,Epidural Venogram,,Pay Within 30 Days of Service,4650.00
Cash Price - Prompt Pay,,75885,CPT4/HCPCS,Perchepporto W Hemo Eva S&I,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75889,CPT4/HCPCS,Hepatic Veno Hemodyn Ev S&I,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,75893,CPT4/HCPCS,Venous Sampling S&I,,Pay Within 30 Days of Service,6450.00
Cash Price - Prompt Pay,,76100,CPT4/HCPCS,Lams/Tomography,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76390,CPT4/HCPCS,Mri Spectroscopy,,Pay Within 30 Days of Service,1850.00
Cash Price - Prompt Pay,,76831,CPT4/HCPCS,Hysterosonography,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,76872,CPT4/HCPCS,Us Transrectal,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76886,CPT4/HCPCS,Us Infant Hips No Radiologist,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,76936,CPT4/HCPCS,Us Guide Compression Repair,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,77002,CPT4/HCPCS,Spinal Puncture Fluoro Guided,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,77071,CPT4/HCPCS,Stress Views Any Joint,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,77081,CPT4/HCPCS,Bone Density Periphal Dxa,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,77085,CPT4/HCPCS,Bone Density Axial Dxa,,Pay Within 30 Days of Service,140.00
Cash Price - Prompt Pay,,78012,CPT4/HCPCS,Rn Thyroid Uptake + Scan,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78013,CPT4/HCPCS,Rn Thyroid Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78018,CPT4/HCPCS,Thyr Ca Met Imag Whole Body,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78070,CPT4/HCPCS,Parathyroid Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78071,CPT4/HCPCS,Rn Parathyroid Spect Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78104,CPT4/HCPCS,Bone Marrow Imag Whole Body,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78195,CPT4/HCPCS,Lymphatics Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78201,CPT4/HCPCS,Liver Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78202,CPT4/HCPCS,Rbc Liver/Hemangioma Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78205,CPT4/HCPCS,Spect Liver Scan,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78215,CPT4/HCPCS,Liver Spleen Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78226,CPT4/HCPCS,RN Cholangiogr,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78227,CPT4/HCPCS,Rn Hida Scan w/EF,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78262,CPT4/HCPCS,Gi Reflux Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78264,CPT4/HCPCS,Gastric Emptying,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78278,CPT4/HCPCS,Acute Gi Blood Loss Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78290,CPT4/HCPCS,Bowel Imaging Meckels,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78300,CPT4/HCPCS,Bone Imag Lim,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78305,CPT4/HCPCS,Bone Imag Mult,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78306,CPT4/HCPCS,Bone Imag Whol,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78315,CPT4/HCPCS,3Phase Bone Im,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78320,CPT4/HCPCS,Spect Bone Scan,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78445,CPT4/HCPCS,Xr Vasc Fl Img,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78456,CPT4/HCPCS,Rn Acute Thrombosis Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78458,CPT4/HCPCS,Rn Veno Bilat,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78459,CPT4/HCPCS,PET MYOCARD VIABILITY,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,78472,CPT4/HCPCS,G Heart Imagng,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78481,CPT4/HCPCS,Gated Heart First Pass,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78579,CPT4/HCPCS,Lung Vent Sb,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78582,CPT4/HCPCS,Pulm Perf/Vent Scan,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78597,CPT4/HCPCS,Pulm Perf Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78605,CPT4/HCPCS,Brain Imgaging Complete,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,78606,CPT4/HCPCS,Rn Brain Imag W/Vasculr Flow C,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,78607,CPT4/HCPCS,Spect Brain Scan,,Pay Within 30 Days of Service,2100.00
Cash Price - Prompt Pay,,78608,CPT4/HCPCS,Pet Brain Metabolic,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,78609,CPT4/HCPCS,Pet Brain Perfusion,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,78630,CPT4/HCPCS,Rn Cisterno,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,78645,CPT4/HCPCS,Rn Csf Shunt Evaluation,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78700,CPT4/HCPCS,Renal Imaging Only,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78707,CPT4/HCPCS,Renal Imaging W Flow/Function,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78708,CPT4/HCPCS,Renal Imaging Flow/Func W/Capt,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78725,CPT4/HCPCS,Renal Function Gfr,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78740,CPT4/HCPCS,Rn Ureteral Reflux Study,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78761,CPT4/HCPCS,Testicular Imaging,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78801,CPT4/HCPCS,Tumor Local Mult Areas,,Pay Within 30 Days of Service,1400.00
Cash Price - Prompt Pay,,78805,CPT4/HCPCS,Abcess Localization,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,78806,CPT4/HCPCS,Indium Wbc Imaging,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,78814,CPT4/HCPCS,Pet/Ct Tumorimag Limited Area,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,78815,CPT4/HCPCS,Pet/Ct Limited Skull - Thigh,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,78816,CPT4/HCPCS,Pet/Ct Limited Whole Body,,Pay Within 30 Days of Service,2750.00
Cash Price - Prompt Pay,,80051,CPT4/HCPCS,Electrolyte Panel,,Pay Within 30 Days of Service,23.88
Cash Price - Prompt Pay,,80069,CPT4/HCPCS,Renal Function Panel,,Pay Within 30 Days of Service,29.57
Cash Price - Prompt Pay,,80074,CPT4/HCPCS,Acute Hepatitis Panel,,Pay Within 30 Days of Service,162.22
Cash Price - Prompt Pay,,80076,CPT4/HCPCS,Liver Panel,,Pay Within 30 Days of Service,27.83
Cash Price - Prompt Pay,,80156,CPT4/HCPCS,Tegretol,,Pay Within 30 Days of Service,49.60
Cash Price - Prompt Pay,,80162,CPT4/HCPCS,Digoxin,,Pay Within 30 Days of Service,45.23
Cash Price - Prompt Pay,,80168,CPT4/HCPCS,Zarontin,,Pay Within 30 Days of Service,55.65
Cash Price - Prompt Pay,,80176,CPT4/HCPCS,Lidocaine,,Pay Within 30 Days of Service,50.03
Cash Price - Prompt Pay,,80184,CPT4/HCPCS,Phenobarbital,,Pay Within 30 Days of Service,39.00
Cash Price - Prompt Pay,,80185,CPT4/HCPCS,Phentoin (Dilantin),,Pay Within 30 Days of Service,45.15
Cash Price - Prompt Pay,,80186,CPT4/HCPCS,Phenytoin Free,,Pay Within 30 Days of Service,46.88
Cash Price - Prompt Pay,,80188,CPT4/HCPCS,Primidone Test,,Pay Within 30 Days of Service,56.52
Cash Price - Prompt Pay,,80192,CPT4/HCPCS,Procainamide,,Pay Within 30 Days of Service,57.05
Cash Price - Prompt Pay,,80194,CPT4/HCPCS,Quinidine,,Pay Within 30 Days of Service,49.73
Cash Price - Prompt Pay,,80195,CPT4/HCPCS,Sirolimus,,Pay Within 30 Days of Service,46.78
Cash Price - Prompt Pay,,80197,CPT4/HCPCS,Tacrolimus by LC MS MS HS,,Pay Within 30 Days of Service,46.78
Cash Price - Prompt Pay,,80198,CPT4/HCPCS,Theophylline,,Pay Within 30 Days of Service,48.17
Cash Price - Prompt Pay,,80201,CPT4/HCPCS,Topiramate,,Pay Within 30 Days of Service,40.60
Cash Price - Prompt Pay,,81000,CPT4/HCPCS,Specific Gravity,,Pay Within 30 Days of Service,10.80
Cash Price - Prompt Pay,,81001,CPT4/HCPCS,UA With Microscopic,,Pay Within 30 Days of Service,10.80
Cash Price - Prompt Pay,,81050,CPT4/HCPCS,Total Volume_3,,Pay Within 30 Days of Service,10.23
Cash Price - Prompt Pay,,81207,CPT4/HCPCS,BCR/ABL Minor By PCR,,Pay Within 30 Days of Service,493.25
Cash Price - Prompt Pay,,81210,CPT4/HCPCS,Braf,,Pay Within 30 Days of Service,447.45
Cash Price - Prompt Pay,,81211,CPT4/HCPCS,BRCA1 BRA2 Comprehensive,,Pay Within 30 Days of Service,5450.55
Cash Price - Prompt Pay,,81219,CPT4/HCPCS,Calreticulin Mutation Analysis,,Pay Within 30 Days of Service,414.20
Cash Price - Prompt Pay,,81225,CPT4/HCPCS,Accutype Cyp2C19 Genotype,,Pay Within 30 Days of Service,728.40
Cash Price - Prompt Pay,,81235,CPT4/HCPCS,EGFR Mutation By PCR,,Pay Within 30 Days of Service,823.77
Cash Price - Prompt Pay,,81240,CPT4/HCPCS,Factor II Mutation Analysis,,Pay Within 30 Days of Service,167.57
Cash Price - Prompt Pay,,81241,CPT4/HCPCS,Factor V Leiden Mutation Test,,Pay Within 30 Days of Service,208.10
Cash Price - Prompt Pay,,81256,CPT4/HCPCS,Hemochromatosis DNA,,Pay Within 30 Days of Service,222.60
Cash Price - Prompt Pay,,81275,CPT4/HCPCS,Kras By PCR,,Pay Within 30 Days of Service,492.98
Cash Price - Prompt Pay,,81291,CPT4/HCPCS,MTHFR Mutation DNA Analysis,,Pay Within 30 Days of Service,148.65
Cash Price - Prompt Pay,,81301,CPT4/HCPCS,MSI PCR (Tumor & Normal),,Pay Within 30 Days of Service,986.10
Cash Price - Prompt Pay,,81310,CPT4/HCPCS,CLL Prognostic Panel Comprehensive,,Pay Within 30 Days of Service,616.93
Cash Price - Prompt Pay,,81340,CPT4/HCPCS,T-Cell Clonality Beta By PCR,,Pay Within 30 Days of Service,711.47
Cash Price - Prompt Pay,,81342,CPT4/HCPCS,T-Cell Clonality Gamma By PCR,,Pay Within 30 Days of Service,686.20
Cash Price - Prompt Pay,,81374,CPT4/HCPCS,HLA Typing I Low Res 1 AG,,Pay Within 30 Days of Service,247.75
Cash Price - Prompt Pay,,81381,CPT4/HCPCS,HLA Typing I High Res 1 Allele,,Pay Within 30 Days of Service,322.10
Cash Price - Prompt Pay,,81382,CPT4/HCPCS,Celiac Genetics,,Pay Within 30 Days of Service,421.20
Cash Price - Prompt Pay,,82017,CPT4/HCPCS,Acylcarnitine Plasma,,Pay Within 30 Days of Service,57.42
Cash Price - Prompt Pay,,82024,CPT4/HCPCS,ACTH Plasma,,Pay Within 30 Days of Service,131.53
Cash Price - Prompt Pay,,82030,CPT4/HCPCS,Urine Cyclic AMP,,Pay Within 30 Days of Service,87.85
Cash Price - Prompt Pay,,82085,CPT4/HCPCS,Aldolase,,Pay Within 30 Days of Service,33.05
Cash Price - Prompt Pay,,82104,CPT4/HCPCS,Alpha 1 Antitrypsin Phenotype,,Pay Within 30 Days of Service,49.25
Cash Price - Prompt Pay,,82107,CPT4/HCPCS,Alpha Fetoprotein AFP L-3,,Pay Within 30 Days of Service,219.35
Cash Price - Prompt Pay,,82140,CPT4/HCPCS,Ammonia,,Pay Within 30 Days of Service,49.63
Cash Price - Prompt Pay,,82180,CPT4/HCPCS,Vitamin C,,Pay Within 30 Days of Service,33.65
Cash Price - Prompt Pay,,82190,CPT4/HCPCS,Stool Potassium,,Pay Within 30 Days of Service,50.77
Cash Price - Prompt Pay,,82239,CPT4/HCPCS,Bile Acids,,Pay Within 30 Days of Service,58.32
Cash Price - Prompt Pay,,82248,CPT4/HCPCS,Bilirubin Direct,,Pay Within 30 Days of Service,17.07
Cash Price - Prompt Pay,,82270,CPT4/HCPCS,Occult Blood X3_ Stool - Inactive,,Pay Within 30 Days of Service,11.07
Cash Price - Prompt Pay,,82271,CPT4/HCPCS,Occult Blood Gastric,,Pay Within 30 Days of Service,11.07
Cash Price - Prompt Pay,,82272,CPT4/HCPCS,Stool Occult Blood,,Pay Within 30 Days of Service,11.07
Cash Price - Prompt Pay,,82274,CPT4/HCPCS,Fecal Globin By IHC,,Pay Within 30 Days of Service,54.18
Cash Price - Prompt Pay,,82308,CPT4/HCPCS,Calcitonin,,Pay Within 30 Days of Service,91.23
Cash Price - Prompt Pay,,82330,CPT4/HCPCS,Ionized Calcium,,Pay Within 30 Days of Service,46.57
Cash Price - Prompt Pay,,82365,CPT4/HCPCS,Stone Analysis,,Pay Within 30 Days of Service,43.90
Cash Price - Prompt Pay,,82373,CPT4/HCPCS,Carbohydrate Deficient Transferrin,,Pay Within 30 Days of Service,61.50
Cash Price - Prompt Pay,,82374,CPT4/HCPCS,CO2,,Pay Within 30 Days of Service,16.65
Cash Price - Prompt Pay,,82380,CPT4/HCPCS,Carotene,,Pay Within 30 Days of Service,31.43
Cash Price - Prompt Pay,,82382,CPT4/HCPCS,Urine Catecholamines Random,,Pay Within 30 Days of Service,58.55
Cash Price - Prompt Pay,,82390,CPT4/HCPCS,Ceruloplasmin,,Pay Within 30 Days of Service,36.58
Cash Price - Prompt Pay,,82480,CPT4/HCPCS,Cholinesterase,,Pay Within 30 Days of Service,26.83
Cash Price - Prompt Pay,,82495,CPT4/HCPCS,Chromium,,Pay Within 30 Days of Service,69.08
Cash Price - Prompt Pay,,82540,CPT4/HCPCS,Creatine 24HR Urine Quest,,Pay Within 30 Days of Service,15.80
Cash Price - Prompt Pay,,82550,CPT4/HCPCS,CPK,,Pay Within 30 Days of Service,22.17
Cash Price - Prompt Pay,,82565,CPT4/HCPCS,Creatinine_Serum,,Pay Within 30 Days of Service,17.45
Cash Price - Prompt Pay,,82600,CPT4/HCPCS,Cyanide,,Pay Within 30 Days of Service,66.08
Cash Price - Prompt Pay,,82607,CPT4/HCPCS,Vitamin B12,,Pay Within 30 Days of Service,51.35
Cash Price - Prompt Pay,,82608,CPT4/HCPCS,Vitamin B12 Binding Capacity Unsaturated,,Pay Within 30 Days of Service,48.78
Cash Price - Prompt Pay,,82610,CPT4/HCPCS,Cystatin C,,Pay Within 30 Days of Service,46.30
Cash Price - Prompt Pay,,82626,CPT4/HCPCS,DHEA,,Pay Within 30 Days of Service,86.05
Cash Price - Prompt Pay,,82627,CPT4/HCPCS,DHEA Sulfate,,Pay Within 30 Days of Service,75.72
Cash Price - Prompt Pay,,82633,CPT4/HCPCS,Deoxycorticosterone,,Pay Within 30 Days of Service,105.50
Cash Price - Prompt Pay,,82634,CPT4/HCPCS,Deoxycortisol 11,,Pay Within 30 Days of Service,99.70
Cash Price - Prompt Pay,,82656,CPT4/HCPCS,Pancreatic Elastase 1,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,82668,CPT4/HCPCS,Erythropoietin,,Pay Within 30 Days of Service,64.00
Cash Price - Prompt Pay,,82671,CPT4/HCPCS,Estrogens Fractionated,,Pay Within 30 Days of Service,110.00
Cash Price - Prompt Pay,,82672,CPT4/HCPCS,Estrogens Total,,Pay Within 30 Days of Service,73.90
Cash Price - Prompt Pay,,82677,CPT4/HCPCS,Estriol,,Pay Within 30 Days of Service,82.35
Cash Price - Prompt Pay,,82679,CPT4/HCPCS,Estrone,,Pay Within 30 Days of Service,85.00
Cash Price - Prompt Pay,,82705,CPT4/HCPCS,Stool Fat Qualitative Quest,,Pay Within 30 Days of Service,17.32
Cash Price - Prompt Pay,,82710,CPT4/HCPCS,Fecal Lipids Total,,Pay Within 30 Days of Service,57.23
Cash Price - Prompt Pay,,82726,CPT4/HCPCS,Peroxisomal Panel,,Pay Within 30 Days of Service,61.50
Cash Price - Prompt Pay,,82731,CPT4/HCPCS,Fetal Fibronectin,,Pay Within 30 Days of Service,219.35
Cash Price - Prompt Pay,,82746,CPT4/HCPCS,Folate,,Pay Within 30 Days of Service,50.08
Cash Price - Prompt Pay,,82747,CPT4/HCPCS,Folate RBC,,Pay Within 30 Days of Service,58.98
Cash Price - Prompt Pay,,82757,CPT4/HCPCS,Fructose,,Pay Within 30 Days of Service,59.05
Cash Price - Prompt Pay,,82760,CPT4/HCPCS,Galactose Quant,,Pay Within 30 Days of Service,38.13
Cash Price - Prompt Pay,,82800,CPT4/HCPCS,Blood Gas PH,,Pay Within 30 Days of Service,28.82
Cash Price - Prompt Pay,,82803,CPT4/HCPCS,Arterial Blood Gas Analy,,Pay Within 30 Days of Service,65.90
Cash Price - Prompt Pay,,82941,CPT4/HCPCS,Gastrin,,Pay Within 30 Days of Service,60.05
Cash Price - Prompt Pay,,82943,CPT4/HCPCS,Glucagon,,Pay Within 30 Days of Service,48.65
Cash Price - Prompt Pay,,82948,CPT4/HCPCS,Glucose_Roche Glucometer,,Pay Within 30 Days of Service,10.80
Cash Price - Prompt Pay,,82955,CPT4/HCPCS,G6PD,,Pay Within 30 Days of Service,33.03
Cash Price - Prompt Pay,,82985,CPT4/HCPCS,Fructosamine,,Pay Within 30 Days of Service,51.35
Cash Price - Prompt Pay,,83003,CPT4/HCPCS,Growth Hormone,,Pay Within 30 Days of Service,56.80
Cash Price - Prompt Pay,,83015,CPT4/HCPCS,Urine Heavy Metals 1 Random,,Pay Within 30 Days of Service,64.13
Cash Price - Prompt Pay,,83020,CPT4/HCPCS,Hemoglobinopathy Evaluation,,Pay Within 30 Days of Service,43.83
Cash Price - Prompt Pay,,83021,CPT4/HCPCS,Fetal Hemoglobin Whole Blood,,Pay Within 30 Days of Service,61.50
Cash Price - Prompt Pay,,83033,CPT4/HCPCS,APT,,Pay Within 30 Days of Service,20.30
Cash Price - Prompt Pay,,83036,CPT4/HCPCS,Hemoglobin A1C,,Pay Within 30 Days of Service,33.05
Cash Price - Prompt Pay,,83051,CPT4/HCPCS,Hemoglobin Plasma,,Pay Within 30 Days of Service,24.90
Cash Price - Prompt Pay,,83070,CPT4/HCPCS,Urine Hemosiderin Qualitative,,Pay Within 30 Days of Service,16.18
Cash Price - Prompt Pay,,83080,CPT4/HCPCS,Hexosaminidase A and Total,,Pay Within 30 Days of Service,57.42
Cash Price - Prompt Pay,,83491,CPT4/HCPCS,Hydroxycorticosteroids 17,,Pay Within 30 Days of Service,59.68
Cash Price - Prompt Pay,,83505,CPT4/HCPCS,Hydroxyproline Total Random Ux - Inactive,,Pay Within 30 Days of Service,82.80
Cash Price - Prompt Pay,,83550,CPT4/HCPCS,Iron Binding Capacity,,Pay Within 30 Days of Service,25.13
Cash Price - Prompt Pay,,83586,CPT4/HCPCS,Urine Ketosteroids 17 24HR,,Pay Within 30 Days of Service,43.60
Cash Price - Prompt Pay,,83593,CPT4/HCPCS,Urine Ketosteroids 17 Fractionated 24HR,,Pay Within 30 Days of Service,89.55
Cash Price - Prompt Pay,,83625,CPT4/HCPCS,LDH Isoenzymes,,Pay Within 30 Days of Service,43.58
Cash Price - Prompt Pay,,83630,CPT4/HCPCS,Lactoferrin Stool (Ibd-Check),,Pay Within 30 Days of Service,66.85
Cash Price - Prompt Pay,,83695,CPT4/HCPCS,Lipoprotein A,,Pay Within 30 Days of Service,44.07
Cash Price - Prompt Pay,,83698,CPT4/HCPCS,LP Pla2,,Pay Within 30 Days of Service,115.60
Cash Price - Prompt Pay,,83700,CPT4/HCPCS,Lipoprotein Electrophoresis,,Pay Within 30 Days of Service,38.33
Cash Price - Prompt Pay,,83785,CPT4/HCPCS,Manganese,,Pay Within 30 Days of Service,83.77
Cash Price - Prompt Pay,,83864,CPT4/HCPCS,Urine Glycosaminoglycans,,Pay Within 30 Days of Service,67.83
Cash Price - Prompt Pay,,83915,CPT4/HCPCS,Nucleotidase 5,,Pay Within 30 Days of Service,37.98
Cash Price - Prompt Pay,,83918,CPT4/HCPCS,Pernicious Anemia Panel,,Pay Within 30 Days of Service,56.02
Cash Price - Prompt Pay,,83919,CPT4/HCPCS,Urine Organic Acids Quantitative,,Pay Within 30 Days of Service,56.02
Cash Price - Prompt Pay,,83950,CPT4/HCPCS,Her2 Oncoprotein-Inactive,,Pay Within 30 Days of Service,219.35
Cash Price - Prompt Pay,,83986,CPT4/HCPCS,PH,,Pay Within 30 Days of Service,12.20
Cash Price - Prompt Pay,,83993,CPT4/HCPCS,Calprotectin, Stool,,Pay Within 30 Days of Service,66.85
Cash Price - Prompt Pay,,84060,CPT4/HCPCS,Acid Phosphatase Total-Inactive,,Pay Within 30 Days of Service,25.15
Cash Price - Prompt Pay,,84080,CPT4/HCPCS,Alkaline Phosphatase Isoenzyme 2,,Pay Within 30 Days of Service,50.35
Cash Price - Prompt Pay,,84100,CPT4/HCPCS,Phosphorus,,Pay Within 30 Days of Service,16.15
Cash Price - Prompt Pay,,84106,CPT4/HCPCS,Phorphobilinogen Gl-Inactive,,Pay Within 30 Days of Service,14.57
Cash Price - Prompt Pay,,84110,CPT4/HCPCS,Urine Porphobilinogen Random,,Pay Within 30 Days of Service,28.75
Cash Price - Prompt Pay,,84112,CPT4/HCPCS,Amnisure Analysis,,Pay Within 30 Days of Service,219.35
Cash Price - Prompt Pay,,84119,CPT4/HCPCS,Urine Porphyrins Fractionated Random,,Pay Within 30 Days of Service,29.35
Cash Price - Prompt Pay,,84140,CPT4/HCPCS,Pregnenolone,,Pay Within 30 Days of Service,70.40
Cash Price - Prompt Pay,,84143,CPT4/HCPCS,Hydroxypregnenolone 17 Serum,,Pay Within 30 Days of Service,77.70
Cash Price - Prompt Pay,,84154,CPT4/HCPCS,PSA Free,,Pay Within 30 Days of Service,62.65
Cash Price - Prompt Pay,,84155,CPT4/HCPCS,Total Protein,,Pay Within 30 Days of Service,12.50
Cash Price - Prompt Pay,,84160,CPT4/HCPCS,Urine Protein 12HR,,Pay Within 30 Days of Service,17.63
Cash Price - Prompt Pay,,84206,CPT4/HCPCS,Proinsulin,,Pay Within 30 Days of Service,60.65
Cash Price - Prompt Pay,,84207,CPT4/HCPCS,Vitamin B6 Plasma,,Pay Within 30 Days of Service,95.68
Cash Price - Prompt Pay,,84210,CPT4/HCPCS,Pyruvate,,Pay Within 30 Days of Service,36.97
Cash Price - Prompt Pay,,84220,CPT4/HCPCS,Pyruvate Kinase Quantitative-Inactive,,Pay Within 30 Days of Service,32.15
Cash Price - Prompt Pay,,84233,CPT4/HCPCS,Receptor Assav Group 5-Inactive,,Pay Within 30 Days of Service,219.35
Cash Price - Prompt Pay,,84234,CPT4/HCPCS,ER PR on Paraffin Block-Inactive,,Pay Within 30 Days of Service,220.95
Cash Price - Prompt Pay,,84235,CPT4/HCPCS,Breast Cancer Profile 2 Frozen-Inactive,,Pay Within 30 Days of Service,178.25
Cash Price - Prompt Pay,,84244,CPT4/HCPCS,Renin Activity Plasma by LC_MS_MS,,Pay Within 30 Days of Service,74.90
Cash Price - Prompt Pay,,84252,CPT4/HCPCS,Vitamin B2 Plasma,,Pay Within 30 Days of Service,68.92
Cash Price - Prompt Pay,,84270,CPT4/HCPCS,Sex Hormone Binding Globulin,,Pay Within 30 Days of Service,74.03
Cash Price - Prompt Pay,,84275,CPT4/HCPCS,Lipid Associated Sialic Acid,,Pay Within 30 Days of Service,45.75
Cash Price - Prompt Pay,,84305,CPT4/HCPCS,IgF I,,Pay Within 30 Days of Service,62.65
Cash Price - Prompt Pay,,84307,CPT4/HCPCS,Somatostin,,Pay Within 30 Days of Service,62.25
Cash Price - Prompt Pay,,84425,CPT4/HCPCS,Vitamin B1 Plasma,,Pay Within 30 Days of Service,72.30
Cash Price - Prompt Pay,,84432,CPT4/HCPCS,Thyroglobulin Panel,,Pay Within 30 Days of Service,54.70
Cash Price - Prompt Pay,,84436,CPT4/HCPCS,T4 Total,,Pay Within 30 Days of Service,23.38
Cash Price - Prompt Pay,,84445,CPT4/HCPCS,Thyroid Stimulating Immunoglobulin,,Pay Within 30 Days of Service,173.17
Cash Price - Prompt Pay,,84446,CPT4/HCPCS,Vitamin E,,Pay Within 30 Days of Service,48.27
Cash Price - Prompt Pay,,84450,CPT4/HCPCS,SGOT,,Pay Within 30 Days of Service,17.63
Cash Price - Prompt Pay,,84460,CPT4/HCPCS,SGPT,,Pay Within 30 Days of Service,18.05
Cash Price - Prompt Pay,,84478,CPT4/HCPCS,Triglycerides,,Pay Within 30 Days of Service,19.57
Cash Price - Prompt Pay,,84480,CPT4/HCPCS,T3 Total,,Pay Within 30 Days of Service,48.27
Cash Price - Prompt Pay,,84482,CPT4/HCPCS,T3 Reverse,,Pay Within 30 Days of Service,53.67
Cash Price - Prompt Pay,,84510,CPT4/HCPCS,Tyrosine,,Pay Within 30 Days of Service,35.42
Cash Price - Prompt Pay,,84550,CPT4/HCPCS,Uric Acid,,Pay Within 30 Days of Service,15.40
Cash Price - Prompt Pay,,84586,CPT4/HCPCS,Vasoactive Intestinal Polypeptide,,Pay Within 30 Days of Service,43.13
Cash Price - Prompt Pay,,84588,CPT4/HCPCS,Arginine Vasopressin,,Pay Within 30 Days of Service,115.60
Cash Price - Prompt Pay,,84590,CPT4/HCPCS,Vitamin A,,Pay Within 30 Days of Service,39.52
Cash Price - Prompt Pay,,84591,CPT4/HCPCS,Vitamin B3,,Pay Within 30 Days of Service,39.52
Cash Price - Prompt Pay,,84597,CPT4/HCPCS,Vitamin K,,Pay Within 30 Days of Service,46.73
Cash Price - Prompt Pay,,84620,CPT4/HCPCS,Xylose Fasting,,Pay Within 30 Days of Service,40.35
Cash Price - Prompt Pay,,84681,CPT4/HCPCS,C Peptide,,Pay Within 30 Days of Service,62.42
Cash Price - Prompt Pay,,84702,CPT4/HCPCS,HCG Quantitative,,Pay Within 30 Days of Service,51.28
Cash Price - Prompt Pay,,84703,CPT4/HCPCS,Beta HCG Scr,,Pay Within 30 Days of Service,25.60
Cash Price - Prompt Pay,,85014,CPT4/HCPCS,Hematocrit,,Pay Within 30 Days of Service,8.08
Cash Price - Prompt Pay,,85027,CPT4/HCPCS,Complete Blood Count With Manual Diff,,Pay Within 30 Days of Service,22.03
Cash Price - Prompt Pay,,85045,CPT4/HCPCS,Automated Retic Count,,Pay Within 30 Days of Service,13.63
Cash Price - Prompt Pay,,85048,CPT4/HCPCS,White Blood Count,,Pay Within 30 Days of Service,8.65
Cash Price - Prompt Pay,,85049,CPT4/HCPCS,Platelet Count,,Pay Within 30 Days of Service,15.25
Cash Price - Prompt Pay,,85210,CPT4/HCPCS,Factor II Activity,,Pay Within 30 Days of Service,44.23
Cash Price - Prompt Pay,,85220,CPT4/HCPCS,Factor V Activity Clotting,,Pay Within 30 Days of Service,60.10
Cash Price - Prompt Pay,,85230,CPT4/HCPCS,Factor VII Activity Clotting,,Pay Within 30 Days of Service,60.98
Cash Price - Prompt Pay,,85246,CPT4/HCPCS,Von Willebrand Factor Antigen,,Pay Within 30 Days of Service,78.13
Cash Price - Prompt Pay,,85247,CPT4/HCPCS,Von Willebrand Factor Antigen Multimeric,,Pay Within 30 Days of Service,78.13
Cash Price - Prompt Pay,,85260,CPT4/HCPCS,Factor X Activity Clotting,,Pay Within 30 Days of Service,60.98
Cash Price - Prompt Pay,,85270,CPT4/HCPCS,Factor XI Activity Clotting Test,,Pay Within 30 Days of Service,60.98
Cash Price - Prompt Pay,,85280,CPT4/HCPCS,Factor XII Activity Test,,Pay Within 30 Days of Service,65.90
Cash Price - Prompt Pay,,85290,CPT4/HCPCS,Factor XIII Functional,,Pay Within 30 Days of Service,55.65
Cash Price - Prompt Pay,,85302,CPT4/HCPCS,Protein C Antigen,,Pay Within 30 Days of Service,40.93
Cash Price - Prompt Pay,,85303,CPT4/HCPCS,Protein C Activity,,Pay Within 30 Days of Service,47.10
Cash Price - Prompt Pay,,85305,CPT4/HCPCS,Protein S Antigen,,Pay Within 30 Days of Service,39.52
Cash Price - Prompt Pay,,85347,CPT4/HCPCS,Activated Clotting Time,,Pay Within 30 Days of Service,14.50
Cash Price - Prompt Pay,,85360,CPT4/HCPCS,Euglobulin Clot Lysis Time,,Pay Within 30 Days of Service,28.63
Cash Price - Prompt Pay,,85384,CPT4/HCPCS,Fibrinogen,,Pay Within 30 Days of Service,28.93
Cash Price - Prompt Pay,,85410,CPT4/HCPCS,Alpha 2 Antiplasmin,,Pay Within 30 Days of Service,26.25
Cash Price - Prompt Pay,,85415,CPT4/HCPCS,Plasminogen Activator AG,,Pay Within 30 Days of Service,58.55
Cash Price - Prompt Pay,,85420,CPT4/HCPCS,Plasminogen Activity,,Pay Within 30 Days of Service,22.25
Cash Price - Prompt Pay,,85520,CPT4/HCPCS,Heparin Anti Xa Low Molecular Weight Heparin,,Pay Within 30 Days of Service,44.57
Cash Price - Prompt Pay,,85540,CPT4/HCPCS,Lap Stain-Inactive,,Pay Within 30 Days of Service,29.30
Cash Price - Prompt Pay,,85549,CPT4/HCPCS,Lysozyme,,Pay Within 30 Days of Service,63.85
Cash Price - Prompt Pay,,85557,CPT4/HCPCS,RBC Fragility,,Pay Within 30 Days of Service,45.50
Cash Price - Prompt Pay,,85613,CPT4/HCPCS,DRVVT Screen With Reflex,,Pay Within 30 Days of Service,32.63
Cash Price - Prompt Pay,,85651,CPT4/HCPCS,ESR,,Pay Within 30 Days of Service,12.07
Cash Price - Prompt Pay,,85670,CPT4/HCPCS,Thrombin Clotting Time,,Pay Within 30 Days of Service,19.65
Cash Price - Prompt Pay,,85732,CPT4/HCPCS,Mixing Studies PTT,,Pay Within 30 Days of Service,22.03
Cash Price - Prompt Pay,,86005,CPT4/HCPCS,Allergy Mold Profile IgE,,Pay Within 30 Days of Service,18.23
Cash Price - Prompt Pay,,86140,CPT4/HCPCS,C Reactive Protein,,Pay Within 30 Days of Service,17.63
Cash Price - Prompt Pay,,86141,CPT4/HCPCS,Cardio CRP,,Pay Within 30 Days of Service,44.07
Cash Price - Prompt Pay,,86146,CPT4/HCPCS,Antiphospholipid Antibody Panel,,Pay Within 30 Days of Service,62.65
Cash Price - Prompt Pay,,86148,CPT4/HCPCS,Phosphatidylserine Antibodies IgA IgG IgM A,,Pay Within 30 Days of Service,54.73
Cash Price - Prompt Pay,,86156,CPT4/HCPCS,Cold Agglutinins,,Pay Within 30 Days of Service,22.80
Cash Price - Prompt Pay,,86161,CPT4/HCPCS,C1 Inhibitor Functional,,Pay Within 30 Days of Service,40.88
Cash Price - Prompt Pay,,86162,CPT4/HCPCS,Complement Total,,Pay Within 30 Days of Service,69.20
Cash Price - Prompt Pay,,86200,CPT4/HCPCS,Cyclic Citrullinated Peptide Antibody IgG,,Pay Within 30 Days of Service,44.07
Cash Price - Prompt Pay,,86215,CPT4/HCPCS,DNAse B Antibody,,Pay Within 30 Days of Service,45.13
Cash Price - Prompt Pay,,86225,CPT4/HCPCS,DNA Antibody Double Stranded,,Pay Within 30 Days of Service,46.78
Cash Price - Prompt Pay,,86301,CPT4/HCPCS,CA 19 9,,Pay Within 30 Days of Service,70.88
Cash Price - Prompt Pay,,86320,CPT4/HCPCS,Serum Protein Immunoelectrophoresis,,Pay Within 30 Days of Service,76.33
Cash Price - Prompt Pay,,86327,CPT4/HCPCS,C3 Nephritic Factor,,Pay Within 30 Days of Service,77.28
Cash Price - Prompt Pay,,86329,CPT4/HCPCS,C4 Binding Protein Plasma,,Pay Within 30 Days of Service,47.23
Cash Price - Prompt Pay,,86336,CPT4/HCPCS,Inhibin A,,Pay Within 30 Days of Service,53.08
Cash Price - Prompt Pay,,86340,CPT4/HCPCS,Intrinsic Factor Blocking Antibody,,Pay Within 30 Days of Service,51.35
Cash Price - Prompt Pay,,86344,CPT4/HCPCS,Arc Monocyte Monolayer Assay,,Pay Within 30 Days of Service,27.20
Cash Price - Prompt Pay,,86353,CPT4/HCPCS,Epstein-Barr Nuclear Agab(Csf),,Pay Within 30 Days of Service,166.98
Cash Price - Prompt Pay,,86357,CPT4/HCPCS,Natural Killer Cells,,Pay Within 30 Days of Service,128.47
Cash Price - Prompt Pay,,86359,CPT4/HCPCS,Lymphocyte Subset Panel 3,,Pay Within 30 Days of Service,128.47
Cash Price - Prompt Pay,,86360,CPT4/HCPCS,Lymphocyte Subset Panel 4,,Pay Within 30 Days of Service,160.03
Cash Price - Prompt Pay,,86361,CPT4/HCPCS,Lymphocyte Subset Panel 5,,Pay Within 30 Days of Service,91.17
Cash Price - Prompt Pay,,86382,CPT4/HCPCS,Interferon Beta IgG by Elisa,,Pay Within 30 Days of Service,57.60
Cash Price - Prompt Pay,,86406,CPT4/HCPCS,Cryptococcus Ag Titer Fee,,Pay Within 30 Days of Service,36.23
Cash Price - Prompt Pay,,86430,CPT4/HCPCS,Rheumatoid Factor_Quest,,Pay Within 30 Days of Service,19.33
Cash Price - Prompt Pay,,86612,CPT4/HCPCS,Blastomyces Antibody by Immunodiffusion Serum,,Pay Within 30 Days of Service,43.95
Cash Price - Prompt Pay,,86622,CPT4/HCPCS,Brucella Antibodies IgG and IgM,,Pay Within 30 Days of Service,29.70
Cash Price - Prompt Pay,,86628,CPT4/HCPCS,Candida Albicans Antibody,,Pay Within 30 Days of Service,40.88
Cash Price - Prompt Pay,,86632,CPT4/HCPCS,Chlamydia Species Antibodies IgM,,Pay Within 30 Days of Service,43.20
Cash Price - Prompt Pay,,86648,CPT4/HCPCS,Diphtheria Antibody,,Pay Within 30 Days of Service,43.58
Cash Price - Prompt Pay,,86653,CPT4/HCPCS,Arbovirus AB Panel IFA,,Pay Within 30 Days of Service,44.92
Cash Price - Prompt Pay,,86663,CPT4/HCPCS,EBV Ea D Ab IgG,,Pay Within 30 Days of Service,44.68
Cash Price - Prompt Pay,,86666,CPT4/HCPCS,Ehrlichia Antibody Panel,,Pay Within 30 Days of Service,34.67
Cash Price - Prompt Pay,,86668,CPT4/HCPCS,Tularemia Antibody-Inactive,,Pay Within 30 Days of Service,35.42
Cash Price - Prompt Pay,,86674,CPT4/HCPCS,Giardia Lamblia Antibody,,Pay Within 30 Days of Service,50.13
Cash Price - Prompt Pay,,86684,CPT4/HCPCS,Haemophilus Influenza B Vaccine Response,,Pay Within 30 Days of Service,53.95
Cash Price - Prompt Pay,,86701,CPT4/HCPCS,HIV 1/2 Antibody Differentiation,,Pay Within 30 Days of Service,30.27
Cash Price - Prompt Pay,,86704,CPT4/HCPCS,Hepatitis B Core Antibody Total,,Pay Within 30 Days of Service,41.02
Cash Price - Prompt Pay,,86707,CPT4/HCPCS,Hepatitis Be Antibody,,Pay Within 30 Days of Service,39.40
Cash Price - Prompt Pay,,86708,CPT4/HCPCS,Hepatitis A Ab_Total_Quest,,Pay Within 30 Days of Service,42.18
Cash Price - Prompt Pay,,86711,CPT4/HCPCS,JC Polyoma Virus AB,,Pay Within 30 Days of Service,49.02
Cash Price - Prompt Pay,,86720,CPT4/HCPCS,Leptospira Antibody,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,86723,CPT4/HCPCS,CSF Listeria Antibodies,,Pay Within 30 Days of Service,44.92
Cash Price - Prompt Pay,,86729,CPT4/HCPCS,Lymphogranuloma Venereum Differentiation,,Pay Within 30 Days of Service,40.67
Cash Price - Prompt Pay,,86750,CPT4/HCPCS,Malaria Antibodies IgG by IFA,,Pay Within 30 Days of Service,44.92
Cash Price - Prompt Pay,,86768,CPT4/HCPCS,Salmonella Total Antibody by EIA,,Pay Within 30 Days of Service,44.92
Cash Price - Prompt Pay,,86774,CPT4/HCPCS,Tetanus Antitoxoid Antibody,,Pay Within 30 Days of Service,50.40
Cash Price - Prompt Pay,,86793,CPT4/HCPCS,Yersinia Enterocolitica MAT,,Pay Within 30 Days of Service,44.92
Cash Price - Prompt Pay,,86800,CPT4/HCPCS,Thyroglobulin Antibody Test,,Pay Within 30 Days of Service,54.18
Cash Price - Prompt Pay,,86804,CPT4/HCPCS,Hepatitis C Antibody RIBA,,Pay Within 30 Days of Service,52.75
Cash Price - Prompt Pay,,86817,CPT4/HCPCS,HLA DRB DQB1 Typing,,Pay Within 30 Days of Service,219.25
Cash Price - Prompt Pay,,87040,CPT4/HCPCS,Culture Blood,,Pay Within 30 Days of Service,35.17
Cash Price - Prompt Pay,,87073,CPT4/HCPCS,Quant Ana Bact Culture-Inactive,,Pay Within 30 Days of Service,32.15
Cash Price - Prompt Pay,,87086,CPT4/HCPCS,Urine Culture With Colony Count,,Pay Within 30 Days of Service,27.50
Cash Price - Prompt Pay,,87088,CPT4/HCPCS,Presumptive Id'S, Multple Orgs,,Pay Within 30 Days of Service,27.57
Cash Price - Prompt Pay,,87107,CPT4/HCPCS,Fungal Id-Inactive,,Pay Within 30 Days of Service,35.17
Cash Price - Prompt Pay,,87172,CPT4/HCPCS,Pinworm Exam,,Pay Within 30 Days of Service,14.55
Cash Price - Prompt Pay,,87176,CPT4/HCPCS,Homogenization, Tissue Culture-Inactive,,Pay Within 30 Days of Service,20.02
Cash Price - Prompt Pay,,87185,CPT4/HCPCS,Beta_Lactamase Induction,,Pay Within 30 Days of Service,9.80
Cash Price - Prompt Pay,,87197,CPT4/HCPCS,Antimicrob Se Inhib(Schlicter)-Inactive,,Pay Within 30 Days of Service,50.77
Cash Price - Prompt Pay,,87250,CPT4/HCPCS,Culture Virus,,Pay Within 30 Days of Service,66.63
Cash Price - Prompt Pay,,87253,CPT4/HCPCS,Enterovirus Typing-Inactive,,Pay Within 30 Days of Service,31.27
Cash Price - Prompt Pay,,87255,CPT4/HCPCS,Herpes Simplex Virus Culture,,Pay Within 30 Days of Service,115.33
Cash Price - Prompt Pay,,87276,CPT4/HCPCS,Influenza A_B_DFA_Focus,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87281,CPT4/HCPCS,Pneumocystis Jiro Carinii DFA,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87290,CPT4/HCPCS,Varicella Zoster Direct Detection by DFA,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87301,CPT4/HCPCS,Stool Adenovirus Ag Detection EIA,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87305,CPT4/HCPCS,Aspergillus Antigen,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87328,CPT4/HCPCS,Cryptosporidium Ag,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87335,CPT4/HCPCS,E Coli 0157 Immunoassay,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87338,CPT4/HCPCS,Helicobacter Pylori AG EIA Stool,,Pay Within 30 Days of Service,48.98
Cash Price - Prompt Pay,,87341,CPT4/HCPCS,HBSAG Confirmation,,Pay Within 30 Days of Service,35.17
Cash Price - Prompt Pay,,87350,CPT4/HCPCS,Hepatitis Be Antigen,,Pay Within 30 Days of Service,39.25
Cash Price - Prompt Pay,,87389,CPT4/HCPCS,HIV1/2 AG,AB 4th Gen w/Reflex,,Pay Within 30 Days of Service,82.00
Cash Price - Prompt Pay,,87420,CPT4/HCPCS,Rsv Quick Test, Now,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87427,CPT4/HCPCS,E.Coli, Enterohemorrhagic,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87496,CPT4/HCPCS,CMV DNA Qualitative by RT PCR,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87498,CPT4/HCPCS,Enterovirus RNA, QL RT-PCR,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87502,CPT4/HCPCS,Influenza A/B,,Pay Within 30 Days of Service,289.80
Cash Price - Prompt Pay,,87503,CPT4/HCPCS,H1N1 BY RNA PCR,,Pay Within 30 Days of Service,70.72
Cash Price - Prompt Pay,,87506,CPT4/HCPCS,Norovirus RNA QL RT PCR,,Pay Within 30 Days of Service,726.85
Cash Price - Prompt Pay,,87517,CPT4/HCPCS,Hepatitis B Viral DNA Quantitative by PCR,,Pay Within 30 Days of Service,145.88
Cash Price - Prompt Pay,,87532,CPT4/HCPCS,Herpes Virus 6 DNA by PCR,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87538,CPT4/HCPCS,HIV 2 DNA and RNA Qualitative by PCR,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87540,CPT4/HCPCS,Legionella Urinary Ag_Focus,,Pay Within 30 Days of Service,68.30
Cash Price - Prompt Pay,,87541,CPT4/HCPCS,Legionella DNA by PCR Focus,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87550,CPT4/HCPCS,Afb Gene Probe Mtb/Mai,,Pay Within 30 Days of Service,68.30
Cash Price - Prompt Pay,,87555,CPT4/HCPCS,Mtub, Maic Gene Probe,,Pay Within 30 Days of Service,68.30
Cash Price - Prompt Pay,,87561,CPT4/HCPCS,Mycobact Avium Com DNA QL RTPC,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87581,CPT4/HCPCS,Mycoplasma Pneum DNA QL RT PCR,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87582,CPT4/HCPCS,Mycoplasma Pneum, Dna Pcr-Inactive,,Pay Within 30 Days of Service,142.20
Cash Price - Prompt Pay,,87590,CPT4/HCPCS,Gc Dna Probe-Inactive,,Pay Within 30 Days of Service,68.30
Cash Price - Prompt Pay,,87592,CPT4/HCPCS,Chlamydia and N Gonorrheae,,Pay Within 30 Days of Service,145.88
Cash Price - Prompt Pay,,87624,CPT4/HCPCS,HPV HR Reflex,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87653,CPT4/HCPCS,Group B Streptococcus by PCR,,Pay Within 30 Days of Service,119.50
Cash Price - Prompt Pay,,87800,CPT4/HCPCS,Chlamy.Trac/Neiss/Gonorroeae,,Pay Within 30 Days of Service,136.60
Cash Price - Prompt Pay,,87801,CPT4/HCPCS,Donor HIV1/HCV/HBV w/Reflex,,Pay Within 30 Days of Service,239.05
Cash Price - Prompt Pay,,87880,CPT4/HCPCS,Group A Strep Screen Rapid,,Pay Within 30 Days of Service,31.60
Cash Price - Prompt Pay,,87902,CPT4/HCPCS,Hepatitis C Viral RNA Genotype LiPA,,Pay Within 30 Days of Service,876.73
Cash Price - Prompt Pay,,87903,CPT4/HCPCS,HIV 1 Virtual Phenotype,,Pay Within 30 Days of Service,1664.10
Cash Price - Prompt Pay,,87906,CPT4/HCPCS,HIV-1 Coreceptor Tropism,,Pay Within 30 Days of Service,438.38
Cash Price - Prompt Pay,,88150,CPT4/HCPCS,Pap Smear, Gyn (Cdc),,Pay Within 30 Days of Service,35.98
Cash Price - Prompt Pay,,88239,CPT4/HCPCS,Chromosome Analysis Solid Tumor,,Pay Within 30 Days of Service,502.38
Cash Price - Prompt Pay,,88245,CPT4/HCPCS,Chromosome-Study-Breakage-Inactive,,Pay Within 30 Days of Service,506.95
Cash Price - Prompt Pay,,88261,CPT4/HCPCS,Chr Anlys,5Cells 1Kryo Wb,,Pay Within 30 Days of Service,601.90
Cash Price - Prompt Pay,,88269,CPT4/HCPCS,Chromosome & Afp-Amniotic Flui-Inactive,,Pay Within 30 Days of Service,566.42
Cash Price - Prompt Pay,,88280,CPT4/HCPCS,Chromosone Anlys Add Kryo,Ea,,Pay Within 30 Days of Service,85.47
Cash Price - Prompt Pay,,88285,CPT4/HCPCS,Chr Anlys,Add Cells Ea Study,,Pay Within 30 Days of Service,64.70
Cash Price - Prompt Pay,,88289,CPT4/HCPCS,Chromosome Analysis High Resolution,,Pay Within 30 Days of Service,31.27
Cash Price - Prompt Pay,,88740,CPT4/HCPCS,Tcom Monitor,,Pay Within 30 Days of Service,17.07
Cash Price - Prompt Pay,,89050,CPT4/HCPCS,Urine Eosinophils,,Pay Within 30 Days of Service,16.10
Cash Price - Prompt Pay,,89055,CPT4/HCPCS,Stool For WBCs,,Pay Within 30 Days of Service,14.55
Cash Price - Prompt Pay,,89060,CPT4/HCPCS,Fluid Crystals,,Pay Within 30 Days of Service,24.38
Cash Price - Prompt Pay,,89190,CPT4/HCPCS,Eosinophil Count Direct-Inactive,,Pay Within 30 Days of Service,16.18
Cash Price - Prompt Pay,,89220,CPT4/HCPCS,Sputum Induction,,Pay Within 30 Days of Service,301.67
Cash Price - Prompt Pay,,89320,CPT4/HCPCS,Semen Analysis Complete,,Pay Within 30 Days of Service,41.02
Cash Price - Prompt Pay,,89321,CPT4/HCPCS,Semen Analysis_Post Vasectomy,,Pay Within 30 Days of Service,41.02
Cash Price - Prompt Pay,,89325,CPT4/HCPCS,Sperm Antibodies IgA_ IgG,,Pay Within 30 Days of Service,36.35
Cash Price - Prompt Pay,,89331,CPT4/HCPCS,Urine Post Ejaculate For Sperm,,Pay Within 30 Days of Service,66.73
Cash Price - Prompt Pay,,91034,CPT4/HCPCS,GI Reflux Study,,Pay Within 30 Days of Service,1170.45
Cash Price - Prompt Pay,,92938,CPT4/HCPCS,Add Vessel W/Bare Metal Grafts,,Pay Within 30 Days of Service,11267.00
Cash Price - Prompt Pay,,93005,CPT4/HCPCS,Ecg,,Pay Within 30 Days of Service,165.12
Cash Price - Prompt Pay,,93225,CPT4/HCPCS,Holter Recording,,Pay Within 30 Days of Service,269.15
Cash Price - Prompt Pay,,93226,CPT4/HCPCS,Holter Scan/Analysis,,Pay Within 30 Days of Service,269.15
Cash Price - Prompt Pay,,93278,CPT4/HCPCS,Saecg,,Pay Within 30 Days of Service,165.12
Cash Price - Prompt Pay,,93279,CPT4/HCPCS,Ppm Single Interrogation,,Pay Within 30 Days of Service,99.25
Cash Price - Prompt Pay,,93280,CPT4/HCPCS,Ppm Dual Interrogation,,Pay Within 30 Days of Service,99.25
Cash Price - Prompt Pay,,93285,CPT4/HCPCS,ILR Reprogramming - Inactive,,Pay Within 30 Days of Service,34.00
Cash Price - Prompt Pay,,93291,CPT4/HCPCS,ILR Interrogation/Analysis - Inactive,,Pay Within 30 Days of Service,34.00
Cash Price - Prompt Pay,,93298,CPT4/HCPCS,InPatient Loop Recordr Express,,Pay Within 30 Days of Service,34.00
Cash Price - Prompt Pay,,93299,CPT4/HCPCS,ILR Remote Acquisition Tech - Inactive,,Pay Within 30 Days of Service,34.00
Cash Price - Prompt Pay,,93306,CPT4/HCPCS,Adult Echo Complete,,Pay Within 30 Days of Service,1230.30
Cash Price - Prompt Pay,,93318,CPT4/HCPCS,Tee Icu,,Pay Within 30 Days of Service,2062.27
Cash Price - Prompt Pay,,93631,CPT4/HCPCS,Intra Op Pacing Mapping - Inactive,,Pay Within 30 Days of Service,5547.00
Cash Price - Prompt Pay,,93886,CPT4/HCPCS,Tcd Complete,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93888,CPT4/HCPCS,Tcd Limited,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93890,CPT4/HCPCS,Tcd Vasoreactive,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93892,CPT4/HCPCS,Tcd W/O Microbubble,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93922,CPT4/HCPCS,Abi/Plethy/Segment/Tcpo2 Ltd,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93923,CPT4/HCPCS,Abi/Plethy/Segment/Tcpo2,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93924,CPT4/HCPCS,Art Exam W/ Treadmill,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,93990,CPT4/HCPCS,Dialysis Access Graft Eval,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,94002,CPT4/HCPCS,Initial Ventilator Day,,Pay Within 30 Days of Service,1349.30
Cash Price - Prompt Pay,,94003,CPT4/HCPCS,Ventilator Daily,,Pay Within 30 Days of Service,1349.30
Cash Price - Prompt Pay,,94010,CPT4/HCPCS,Pulmonary Spirometry,,Pay Within 30 Days of Service,383.00
Cash Price - Prompt Pay,,94060,CPT4/HCPCS,Complete Pulm Funct Test,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,94070,CPT4/HCPCS,Broncho Challenge,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,94150,CPT4/HCPCS,Vital Capacity Total,,Pay Within 30 Days of Service,383.00
Cash Price - Prompt Pay,,94610,CPT4/HCPCS,Surfactant Administration,,Pay Within 30 Days of Service,441.18
Cash Price - Prompt Pay,,94620,CPT4/HCPCS,Pulmonary Stress Testng Simple,,Pay Within 30 Days of Service,269.15
Cash Price - Prompt Pay,,94621,CPT4/HCPCS,Pulmonary Stress Test Complex,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,94667,CPT4/HCPCS,Pd & Percussion Treatment,,Pay Within 30 Days of Service,269.15
Cash Price - Prompt Pay,,94770,CPT4/HCPCS,Etco2 Monitor,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,94772,CPT4/HCPCS,Pneumogram Monitoring,,Pay Within 30 Days of Service,1170.45
Cash Price - Prompt Pay,,95782,CPT4/HCPCS,Polysom <6 yrs 4/ > Paramtrs,,Pay Within 30 Days of Service,786.00
Cash Price - Prompt Pay,,95783,CPT4/HCPCS,Polysom <6yrs CPAP/Bilvl,,Pay Within 30 Days of Service,860.00
Cash Price - Prompt Pay,,95801,CPT4/HCPCS,Sleep Study Unattended w/Analy,,Pay Within 30 Days of Service,269.15
Cash Price - Prompt Pay,,95805,CPT4/HCPCS,Mslt/Mwt W/Poly,,Pay Within 30 Days of Service,786.00
Cash Price - Prompt Pay,,95812,CPT4/HCPCS,EEG 41-60 Minutes,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95813,CPT4/HCPCS,EEG over 1 hour,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95816,CPT4/HCPCS,Eeg Awake,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95819,CPT4/HCPCS,Eeg Awake & Asleep,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95824,CPT4/HCPCS,Eeg Cereb Death,,Pay Within 30 Days of Service,1170.45
Cash Price - Prompt Pay,,95907,CPT4/HCPCS,Nerve Conduction 1-2 Studies,,Pay Within 30 Days of Service,383.00
Cash Price - Prompt Pay,,95908,CPT4/HCPCS,Nerve Conduction 3-4 Studies,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95909,CPT4/HCPCS,Nerve Conduction 5-6 Studies,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95910,CPT4/HCPCS,Nerve Conduction 7-8 Studies,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95911,CPT4/HCPCS,Nerve Conduction 9-10 Studies,,Pay Within 30 Days of Service,1170.45
Cash Price - Prompt Pay,,95912,CPT4/HCPCS,Nerve Conduction 11-12 Studies,,Pay Within 30 Days of Service,1170.45
Cash Price - Prompt Pay,,95913,CPT4/HCPCS,NRV Conduction 13 or >Studies,,Pay Within 30 Days of Service,1170.45
Cash Price - Prompt Pay,,95925,CPT4/HCPCS,Ser Upper Ext,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95926,CPT4/HCPCS,Ser Lower Ext,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95930,CPT4/HCPCS,Evoked Potential-Visual,,Pay Within 30 Days of Service,650.43
Cash Price - Prompt Pay,,95938,CPT4/HCPCS,Sep Upper & Lower Limbs,,Pay Within 30 Days of Service,1170.45
Cash Price - Prompt Pay,,95951,CPT4/HCPCS,Telemetry Eeg 24 Hours,,Pay Within 30 Days of Service,2528.04
Cash Price - Prompt Pay,,96450,CPT4/HCPCS,Intrathecal Chemo Admin,,Pay Within 30 Days of Service,390.00
Cash Price - Prompt Pay,,98960,CPT4/HCPCS,Hlth Ed-New Patient 15 Min- Inactive,,Pay Within 30 Days of Service,120.00
Cash Price - Prompt Pay,,99406,CPT4/HCPCS,Smoking Cessation Counseling,,Pay Within 30 Days of Service,80.05
Cash Price - Prompt Pay,,C9600,CPT4/HCPCS,PTCA W/Drug Eluting Stent,,Pay Within 30 Days of Service,11267.00
Cash Price - Prompt Pay,,C9601,CPT4/HCPCS,Add Vessel Ptca W/Drug E St,,Pay Within 30 Days of Service,11267.00
Cash Price - Prompt Pay,,C9603,CPT4/HCPCS,Add PTCRA W/Des,,Pay Within 30 Days of Service,11267.00
Cash Price - Prompt Pay,,C9604,CPT4/HCPCS,PTCA W/ Des Grafts,,Pay Within 30 Days of Service,11267.00
Cash Price - Prompt Pay,,C9605,CPT4/HCPCS,Add Vessel W/Des Grafts,,Pay Within 30 Days of Service,11267.00
Cash Price - Prompt Pay,,C9606,CPT4/HCPCS,Stemi W/Des,,Pay Within 30 Days of Service,11267.00
Cash Price - Prompt Pay,,C9607,CPT4/HCPCS,CTO W/Des,,Pay Within 30 Days of Service,11267.00
Cash Price - Prompt Pay,,C9608,CPT4/HCPCS,Add CTO W/Des,,Pay Within 30 Days of Service,11267.00
Cash Price - Prompt Pay,,G0103,CPT4/HCPCS,PSA Screen,,Pay Within 30 Days of Service,62.65
Cash Price - Prompt Pay,,P9612,CPT4/HCPCS,Catheterize For Urine Spec,,Pay Within 30 Days of Service,7.50
Cash Price - Prompt Pay,,Q0114,CPT4/HCPCS,Fern Test,,Pay Within 30 Days of Service,24.38
Chargemaster Item,,05000027,SPSI,Intensive Care Unit MC,,Per Svc,20240.00
Chargemaster Item,,05000036,SPSI,Trauma Intensive Care Unit MC,,Per Svc,22266.00
Chargemaster Item,,05000045,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,10000008,SPSI,Definitive Observation Unit 6,,Per Svc,11138.00
Chargemaster Item,,10000016,SPSI,Definitive Observation Unit 6 MC,,Per Svc,11138.00
Chargemaster Item,,10000024,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,10000032,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,10000040,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,10000057,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,10000172,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,1001007,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,1001008,SPSI,Trauma Intensive Care Unit,,Per Svc,22266.00
Chargemaster Item,,1001009,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,1001010,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,1001011,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,1001015,SPSI,Intensive Care Unit MC,,Per Svc,20240.00
Chargemaster Item,,1001016,SPSI,Trauma Intensive Care Unit MC,,Per Svc,22266.00
Chargemaster Item,,1001017,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,1001019,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,1001025,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,10010262,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,10010270,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,1001034,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,1001043,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,12000001,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,12000014,SPSI,Observation Continuation,,First 89 Minutes,331.00
Chargemaster Item,,12005005,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,12005013,SPSI,Med Surg 5 Unit MC,,Per Svc,7950.00
Chargemaster Item,,12005014,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,12005021,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,12900007,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,13000005,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,13000013,SPSI,Observation Continuation,,First 89 Minutes,331.00
Chargemaster Item,,13000120,SPSI,Hospice Day,,Per Svc,151.00
Chargemaster Item,,13005004,SPSI,Med Surg 4 Unit,,Per Svc,7950.00
Chargemaster Item,,13005005,SPSI,Med Surg 4 Unit,,Per Svc,7950.00
Chargemaster Item,,13005006,SPSI,Med Surg 4 Unit,,Per Svc,7950.00
Chargemaster Item,,13005007,SPSI,Med Surg 4 Unit,,Per Svc,7950.00
Chargemaster Item,,13005008,SPSI,Med Surg 4 Unit,,Per Svc,7950.00
Chargemaster Item,,13005012,SPSI,Med Surg 4 Unit MC,,Per Svc,7950.00
Chargemaster Item,,13005020,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,13005038,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,13900006,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,18000001,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,18006007,SPSI,Pediatrics Unit,,Per Svc,7950.00
Chargemaster Item,,18006015,SPSI,Pediatrics Unit MC,,Per Svc,7950.00
Chargemaster Item,,18006023,SPSI,Observation Continuation,,First 89 Minutes,331.00
Chargemaster Item,,18006031,SPSI,Neonatal Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,18006049,SPSI,Nursery Unit,,Per Svc,4268.00
Chargemaster Item,,1900000,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,19992197,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,19992205,SPSI,Observation Continuation,,First 89 Minutes,331.00
Chargemaster Item,,20007001,SPSI,Ldrp Unit,,Per Svc,7950.00
Chargemaster Item,,20007019,SPSI,Ldrp Unit MC,,Per Svc,7950.00
Chargemaster Item,,20007027,SPSI,Neonatal Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,20007035,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,20007050,SPSI,Med Surg 4 Unit,,Per Svc,7950.00
Chargemaster Item,,20008009,SPSI,Nursery Unit,,Per Svc,4268.00
Chargemaster Item,,20008017,SPSI,Ldrp Unit,,Per Svc,7950.00
Chargemaster Item,,20900007,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,2100006,SPSI,Trauma Intensive Care Unit,,Per Svc,22266.00
Chargemaster Item,,2100007,SPSI,Trauma Intensive Care Unit MC,,Per Svc,22266.00
Chargemaster Item,,2100014,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,2100020,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,2100032,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,2100041,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,21008008,SPSI,Nursery Unit,,Per Svc,4268.00
Chargemaster Item,,2190007,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,25000002,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,25000003,SPSI,Observation Continuation,,First 89 Minutes,331.00
Chargemaster Item,,25019589,SPSI,Anesthesia For Version,,Per Svc,1113.00
Chargemaster Item,,25019605,SPSI,Anesthesia For Vag Del,,Per Svc,915.00
Chargemaster Item,,25019670,SPSI,Epidural,,Per Svc,1156.00
Chargemaster Item,,25019688,SPSI,Epidural C-Section,,Per Svc,459.00
Chargemaster Item,,25021213,SPSI,Arista,,Per Svc,525.00
Chargemaster Item,,25021312,SPSI,Prevalon Mat,,Per Svc,1058.00
Chargemaster Item,,25102005,SPSI,Level I Ob/Gyn time,,First 60 Minutes,9383.00
Chargemaster Item,,25102021,SPSI,Level II Ob/Gyn time,,First 60 Minutes,11857.00
Chargemaster Item,,25102047,SPSI,Level III Ob/Gyn time,,First 60 Minutes,16001.00
Chargemaster Item,,25102088,SPSI,Insert Cath,,Per Svc,993.00
Chargemaster Item,,25102237,SPSI,Gen/Spinal Anes,,First 60 Minutes,1787.00
Chargemaster Item,,25102252,SPSI,A-Line,,Per Svc,943.00
Chargemaster Item,,25102260,SPSI,Lta-Kit,,Per Svc,129.00
Chargemaster Item,,25102310,SPSI,Blood Transfusion,,Per Svc,1860.00
Chargemaster Item,,25102328,SPSI,Blood Transfusion,,Per Svc,1860.00
Chargemaster Item,,25103607,SPSI,Second Surgery,,Per Svc,9173.00
Chargemaster Item,,25103706,SPSI,Cancelled Case,,Per Svc,1149.00
Chargemaster Item,,25103805,SPSI,Additional Nurse,,Per Svc,1087.00
Chargemaster Item,,25110008,SPSI,Delivery,,Per Svc,11605.00
Chargemaster Item,,25120049,SPSI,Recovery Rm Hr,,First 60 Minutes,1530.00
Chargemaster Item,,25151002,SPSI,Block/Epidural/Blood Patch,,Per Svc,1076.00
Chargemaster Item,,25201120,SPSI,Blood Warmer,,Per Svc,654.00
Chargemaster Item,,25201351,SPSI,Swan Ganz Catheter Set Up,,Per Svc,4269.00
Chargemaster Item,,25201369,SPSI,Central Venous Pressure Line,,Per Svc,1366.00
Chargemaster Item,,25207879,SPSI,Surgicel 2X14,,Per Svc,784.00
Chargemaster Item,,25210014,SPSI,Skin Staple,,Per Svc,869.43
Chargemaster Item,,25210089,SPSI,Hemoclip,,Per Svc,212.00
Chargemaster Item,,25210147,SPSI,Steridrape,,Per Svc,553.27
Chargemaster Item,,25210154,SPSI,Surgiflo Hemostat Matrix Plus,,Per Svc,381.00
Chargemaster Item,,25211152,SPSI,Spinal Tray,,Per Svc,905.00
Chargemaster Item,,25300005,SPSI,Vaginal Packing 2 Inch,,Per Svc,65.00
Chargemaster Item,,25300013,SPSI,Vacurette,,Per Svc,178.00
Chargemaster Item,,25300021,SPSI,Aspiration Tubing,,Per Svc,234.00
Chargemaster Item,,25300047,SPSI,Adh Barrier,,Per Svc,12746.00
Chargemaster Item,,25300054,SPSI,Thermo Therapy,,Per Svc,65.00
Chargemaster Item,,25300062,SPSI,Lma,,Per Svc,52.00
Chargemaster Item,,25300070,SPSI,Dermabond,,Per Svc,392.00
Chargemaster Item,,25300104,SPSI,Nasal Trumpet,,Per Svc,40.00
Chargemaster Item,,25300112,SPSI,On Q Pain Pumps,,Per Svc,2203.00
Chargemaster Item,,25400003,SPSI,Miscellaneous Supply,,Per Svc,0.01
Chargemaster Item,,25562695,SPSI,Anesthesia For Version,,Per Svc,1113.00
Chargemaster Item,,25578361,SPSI,Anesthesia For Vag Del,,Per Svc,915.00
Chargemaster Item,,25582651,SPSI,Epidural,,Per Svc,1156.00
Chargemaster Item,,25589995,SPSI,Cerclage Removal,,Per Svc,4148.00
Chargemaster Item,,25590217,SPSI,Non-Stress Test,,Per Svc,2069.00
Chargemaster Item,,25598970,SPSI,Pubs,,Per Svc,2067.00
Chargemaster Item,,25598988,SPSI,Version,,Per Svc,2067.00
Chargemaster Item,,25722356,SPSI,Block/Epidural/Blood Patch,,Per Svc,1076.00
Chargemaster Item,,25729989,SPSI,IV Push Single/Initial Drug,,Per Svc,454.00
Chargemaster Item,,25743279,SPSI,IV Push Sequential Ea New Med,,Per Svc,454.00
Chargemaster Item,,25743287,SPSI,Inj Subcutenousc/Intramus,,Per Svc,234.00
Chargemaster Item,,25768003,SPSI,Ultra Sound,,Per Svc,3371.00
Chargemaster Item,,25768011,SPSI,NST Additonal Visit,,Per Svc,2069.00
Chargemaster Item,,25768193,SPSI,Bpp With Nst,,Per Svc,2411.00
Chargemaster Item,,25769472,SPSI,Amniocentesis,,Per Svc,1687.00
Chargemaster Item,,25769993,SPSI,Bpp W/O Nst,,Per Svc,601.00
Chargemaster Item,,25778275,SPSI,Spinal Tray,,Per Svc,905.00
Chargemaster Item,,25850009,SPSI,Flo-Seal,,Per Svc,609.00
Chargemaster Item,,25900655,SPSI,Admin Influenza Virus Vaccine,,Per Svc,332.00
Chargemaster Item,,25900663,SPSI,IV Infusion Initial IVPB,,Per Svc,637.00
Chargemaster Item,,25907742,SPSI,IV Push Single/Initial Drug,,Per Svc,454.00
Chargemaster Item,,25907759,SPSI,IV Push Sequential Ea New Med,,Per Svc,454.00
Chargemaster Item,,25907825,SPSI,Inj Subcutenousc/Intramus,,Per Svc,234.00
Chargemaster Item,,25992116,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,270A4265,SPSI,General Supplies A4265,,Per Svc,0.01
Chargemaster Item,,270A4265,SPSI,General Supplies A4265,,Per Svc,0.01
Chargemaster Item,,270A4265,SPSI,General Supplies A4265,,Per Svc,0.01
Chargemaster Item,,270A4265,SPSI,General Supplies A4265,,Per Svc,0.01
Chargemaster Item,,270A4340,SPSI,General Supplies A4340,,Per Svc,0.01
Chargemaster Item,,270A4340,SPSI,General Supplies A4340,,Per Svc,0.01
Chargemaster Item,,270A4340,SPSI,General Supplies A4340,,Per Svc,0.01
Chargemaster Item,,270A4340,SPSI,General Supplies A4340,,Per Svc,0.01
Chargemaster Item,,270A4349,SPSI,General Supplies A4349,,Per Svc,0.01
Chargemaster Item,,270A4349,SPSI,General Supplies A4349,,Per Svc,0.01
Chargemaster Item,,270A4349,SPSI,General Supplies A4349,,Per Svc,0.01
Chargemaster Item,,270A4349,SPSI,General Supplies A4349,,Per Svc,0.01
Chargemaster Item,,270A4565,SPSI,General Supplies A4565,,Per Svc,0.01
Chargemaster Item,,270A4565,SPSI,General Supplies A4565,,Per Svc,0.01
Chargemaster Item,,270A4565,SPSI,General Supplies A4565,,Per Svc,0.01
Chargemaster Item,,270A4565,SPSI,General Supplies A4565,,Per Svc,0.01
Chargemaster Item,,270A4648,SPSI,General Supplies A4648,,Per Svc,0.01
Chargemaster Item,,270A4648,SPSI,General Supplies A4648,,Per Svc,0.01
Chargemaster Item,,270A4648,SPSI,General Supplies A4648,,Per Svc,0.01
Chargemaster Item,,270A4648,SPSI,General Supplies A4648,,Per Svc,0.01
Chargemaster Item,,270A6021,SPSI,General Supplies A6021,,Per Svc,0.01
Chargemaster Item,,270A6021,SPSI,General Supplies A6021,,Per Svc,0.01
Chargemaster Item,,270A6021,SPSI,General Supplies A6021,,Per Svc,0.01
Chargemaster Item,,270A6021,SPSI,General Supplies A6021,,Per Svc,0.01
Chargemaster Item,,270A6025,SPSI,General Supplies A6025,,Per Svc,0.01
Chargemaster Item,,270A6025,SPSI,General Supplies A6025,,Per Svc,0.01
Chargemaster Item,,270A6025,SPSI,General Supplies A6025,,Per Svc,0.01
Chargemaster Item,,270A6025,SPSI,General Supplies A6025,,Per Svc,0.01
Chargemaster Item,,270A6196,SPSI,General Supplies A6196,,Per Svc,0.01
Chargemaster Item,,270A6196,SPSI,General Supplies A6196,,Per Svc,0.01
Chargemaster Item,,270A6196,SPSI,General Supplies A6196,,Per Svc,0.01
Chargemaster Item,,270A6196,SPSI,General Supplies A6196,,Per Svc,0.01
Chargemaster Item,,270A6197,SPSI,General Supplies A6197,,Per Svc,0.01
Chargemaster Item,,270A6197,SPSI,General Supplies A6197,,Per Svc,0.01
Chargemaster Item,,270A6197,SPSI,General Supplies A6197,,Per Svc,0.01
Chargemaster Item,,270A6197,SPSI,General Supplies A6197,,Per Svc,0.01
Chargemaster Item,,270A6206,SPSI,General Supplies A6206,,Per Svc,0.01
Chargemaster Item,,270A6206,SPSI,General Supplies A6206,,Per Svc,0.01
Chargemaster Item,,270A6206,SPSI,General Supplies A6206,,Per Svc,0.01
Chargemaster Item,,270A6206,SPSI,General Supplies A6206,,Per Svc,0.01
Chargemaster Item,,270A6209,SPSI,General Supplies A6209,,Per Svc,0.01
Chargemaster Item,,270A6209,SPSI,General Supplies A6209,,Per Svc,0.01
Chargemaster Item,,270A6209,SPSI,General Supplies A6209,,Per Svc,0.01
Chargemaster Item,,270A6209,SPSI,General Supplies A6209,,Per Svc,0.01
Chargemaster Item,,270A6212,SPSI,General Supplies A6212,,Per Svc,0.01
Chargemaster Item,,270A6212,SPSI,General Supplies A6212,,Per Svc,0.01
Chargemaster Item,,270A6212,SPSI,General Supplies A6212,,Per Svc,0.01
Chargemaster Item,,270A6212,SPSI,General Supplies A6212,,Per Svc,0.01
Chargemaster Item,,270A6213,SPSI,General Supplies A6213,,Per Svc,0.01
Chargemaster Item,,270A6213,SPSI,General Supplies A6213,,Per Svc,0.01
Chargemaster Item,,270A6213,SPSI,General Supplies A6213,,Per Svc,0.01
Chargemaster Item,,270A6213,SPSI,General Supplies A6213,,Per Svc,0.01
Chargemaster Item,,270A6214,SPSI,General Supplies A6214,,Per Svc,0.01
Chargemaster Item,,270A6214,SPSI,General Supplies A6214,,Per Svc,0.01
Chargemaster Item,,270A6214,SPSI,General Supplies A6214,,Per Svc,0.01
Chargemaster Item,,270A6214,SPSI,General Supplies A6214,,Per Svc,0.01
Chargemaster Item,,270A6219,SPSI,General Supplies A6219,,Per Svc,0.01
Chargemaster Item,,270A6219,SPSI,General Supplies A6219,,Per Svc,0.01
Chargemaster Item,,270A6219,SPSI,General Supplies A6219,,Per Svc,0.01
Chargemaster Item,,270A6219,SPSI,General Supplies A6219,,Per Svc,0.01
Chargemaster Item,,270A6222,SPSI,General Supplies A6222,,Per Svc,0.01
Chargemaster Item,,270A6222,SPSI,General Supplies A6222,,Per Svc,0.01
Chargemaster Item,,270A6222,SPSI,General Supplies A6222,,Per Svc,0.01
Chargemaster Item,,270A6222,SPSI,General Supplies A6222,,Per Svc,0.01
Chargemaster Item,,270A6223,SPSI,General Supplies A6223,,Per Svc,0.01
Chargemaster Item,,270A6223,SPSI,General Supplies A6223,,Per Svc,0.01
Chargemaster Item,,270A6223,SPSI,General Supplies A6223,,Per Svc,0.01
Chargemaster Item,,270A6223,SPSI,General Supplies A6223,,Per Svc,0.01
Chargemaster Item,,270A6224,SPSI,General Supplies A6224,,Per Svc,0.01
Chargemaster Item,,270A6224,SPSI,General Supplies A6224,,Per Svc,0.01
Chargemaster Item,,270A6224,SPSI,General Supplies A6224,,Per Svc,0.01
Chargemaster Item,,270A6224,SPSI,General Supplies A6224,,Per Svc,0.01
Chargemaster Item,,270A6234,SPSI,General Supplies A6234,,Per Svc,0.01
Chargemaster Item,,270A6234,SPSI,General Supplies A6234,,Per Svc,0.01
Chargemaster Item,,270A6234,SPSI,General Supplies A6234,,Per Svc,0.01
Chargemaster Item,,270A6234,SPSI,General Supplies A6234,,Per Svc,0.01
Chargemaster Item,,270A6235,SPSI,General Supplies A6235,,Per Svc,0.01
Chargemaster Item,,270A6235,SPSI,General Supplies A6235,,Per Svc,0.01
Chargemaster Item,,270A6235,SPSI,General Supplies A6235,,Per Svc,0.01
Chargemaster Item,,270A6235,SPSI,General Supplies A6235,,Per Svc,0.01
Chargemaster Item,,270A6238,SPSI,General Supplies A6238,,Per Svc,0.01
Chargemaster Item,,270A6238,SPSI,General Supplies A6238,,Per Svc,0.01
Chargemaster Item,,270A6238,SPSI,General Supplies A6238,,Per Svc,0.01
Chargemaster Item,,270A6238,SPSI,General Supplies A6238,,Per Svc,0.01
Chargemaster Item,,270A6255,SPSI,General Supplies A6255,,Per Svc,0.01
Chargemaster Item,,270A6255,SPSI,General Supplies A6255,,Per Svc,0.01
Chargemaster Item,,270A6255,SPSI,General Supplies A6255,,Per Svc,0.01
Chargemaster Item,,270A6255,SPSI,General Supplies A6255,,Per Svc,0.01
Chargemaster Item,,270A6257,SPSI,General Supplies A6257,,Per Svc,0.01
Chargemaster Item,,270A6257,SPSI,General Supplies A6257,,Per Svc,0.01
Chargemaster Item,,270A6257,SPSI,General Supplies A6257,,Per Svc,0.01
Chargemaster Item,,270A6257,SPSI,General Supplies A6257,,Per Svc,0.01
Chargemaster Item,,270A6258,SPSI,General Supplies A6258,,Per Svc,0.01
Chargemaster Item,,270A6258,SPSI,General Supplies A6258,,Per Svc,0.01
Chargemaster Item,,270A6258,SPSI,General Supplies A6258,,Per Svc,0.01
Chargemaster Item,,270A6258,SPSI,General Supplies A6258,,Per Svc,0.01
Chargemaster Item,,270A6259,SPSI,General Supplies A6259,,Per Svc,0.01
Chargemaster Item,,270A6259,SPSI,General Supplies A6259,,Per Svc,0.01
Chargemaster Item,,270A6259,SPSI,General Supplies A6259,,Per Svc,0.01
Chargemaster Item,,270A6259,SPSI,General Supplies A6259,,Per Svc,0.01
Chargemaster Item,,270A6454,SPSI,General Supplies A6454,,Per Svc,0.01
Chargemaster Item,,270A6454,SPSI,General Supplies A6454,,Per Svc,0.01
Chargemaster Item,,270A6454,SPSI,General Supplies A6454,,Per Svc,0.01
Chargemaster Item,,270A6454,SPSI,General Supplies A6454,,Per Svc,0.01
Chargemaster Item,,270B4082,SPSI,General Supplies B4082,,Per Svc,0.01
Chargemaster Item,,270B4082,SPSI,General Supplies B4082,,Per Svc,0.01
Chargemaster Item,,270B4082,SPSI,General Supplies B4082,,Per Svc,0.01
Chargemaster Item,,270B4082,SPSI,General Supplies B4082,,Per Svc,0.01
Chargemaster Item,,270B4087,SPSI,General Supplies B4087,,Per Svc,0.01
Chargemaster Item,,270B4087,SPSI,General Supplies B4087,,Per Svc,0.01
Chargemaster Item,,270B4087,SPSI,General Supplies B4087,,Per Svc,0.01
Chargemaster Item,,270B4087,SPSI,General Supplies B4087,,Per Svc,0.01
Chargemaster Item,,270B4088,SPSI,General Supplies B4088,,Per Svc,0.01
Chargemaster Item,,270B4088,SPSI,General Supplies B4088,,Per Svc,0.01
Chargemaster Item,,270B4088,SPSI,General Supplies B4088,,Per Svc,0.01
Chargemaster Item,,270B4088,SPSI,General Supplies B4088,,Per Svc,0.01
Chargemaster Item,,270C1713,SPSI,General Supplies C1713,,Per Svc,0.01
Chargemaster Item,,270C1713,SPSI,General Supplies C1713,,Per Svc,0.01
Chargemaster Item,,270C1713,SPSI,General Supplies C1713,,Per Svc,0.01
Chargemaster Item,,270C1713,SPSI,General Supplies C1713,,Per Svc,0.01
Chargemaster Item,,270C1715,SPSI,General Supplies C1715,,Per Svc,0.01
Chargemaster Item,,270C1715,SPSI,General Supplies C1715,,Per Svc,0.01
Chargemaster Item,,270C1715,SPSI,General Supplies C1715,,Per Svc,0.01
Chargemaster Item,,270C1715,SPSI,General Supplies C1715,,Per Svc,0.01
Chargemaster Item,,270C1716,SPSI,General Supplies C1716,,Per Svc,0.01
Chargemaster Item,,270C1716,SPSI,General Supplies C1716,,Per Svc,0.01
Chargemaster Item,,270C1716,SPSI,General Supplies C1716,,Per Svc,0.01
Chargemaster Item,,270C1716,SPSI,General Supplies C1716,,Per Svc,0.01
Chargemaster Item,,270C1721,SPSI,General Supplies C1721,,Per Svc,0.01
Chargemaster Item,,270C1721,SPSI,General Supplies C1721,,Per Svc,0.01
Chargemaster Item,,270C1721,SPSI,General Supplies C1721,,Per Svc,0.01
Chargemaster Item,,270C1721,SPSI,General Supplies C1721,,Per Svc,0.01
Chargemaster Item,,270C1722,SPSI,General Supplies C1722,,Per Svc,0.01
Chargemaster Item,,270C1722,SPSI,General Supplies C1722,,Per Svc,0.01
Chargemaster Item,,270C1722,SPSI,General Supplies C1722,,Per Svc,0.01
Chargemaster Item,,270C1722,SPSI,General Supplies C1722,,Per Svc,0.01
Chargemaster Item,,270C1724,SPSI,General Supplies C1724,,Per Svc,0.01
Chargemaster Item,,270C1724,SPSI,General Supplies C1724,,Per Svc,0.01
Chargemaster Item,,270C1724,SPSI,General Supplies C1724,,Per Svc,0.01
Chargemaster Item,,270C1724,SPSI,General Supplies C1724,,Per Svc,0.01
Chargemaster Item,,270C1725,SPSI,General Supplies C1725,,Per Svc,0.01
Chargemaster Item,,270C1725,SPSI,General Supplies C1725,,Per Svc,0.01
Chargemaster Item,,270C1725,SPSI,General Supplies C1725,,Per Svc,0.01
Chargemaster Item,,270C1725,SPSI,General Supplies C1725,,Per Svc,0.01
Chargemaster Item,,270C1726,SPSI,General Supplies C1726,,Per Svc,0.01
Chargemaster Item,,270C1726,SPSI,General Supplies C1726,,Per Svc,0.01
Chargemaster Item,,270C1726,SPSI,General Supplies C1726,,Per Svc,0.01
Chargemaster Item,,270C1726,SPSI,General Supplies C1726,,Per Svc,0.01
Chargemaster Item,,270C1727,SPSI,General Supplies C1727,,Per Svc,0.01
Chargemaster Item,,270C1727,SPSI,General Supplies C1727,,Per Svc,0.01
Chargemaster Item,,270C1727,SPSI,General Supplies C1727,,Per Svc,0.01
Chargemaster Item,,270C1727,SPSI,General Supplies C1727,,Per Svc,0.01
Chargemaster Item,,270C1729,SPSI,General Supplies C1729,,Per Svc,0.01
Chargemaster Item,,270C1729,SPSI,General Supplies C1729,,Per Svc,0.01
Chargemaster Item,,270C1729,SPSI,General Supplies C1729,,Per Svc,0.01
Chargemaster Item,,270C1729,SPSI,General Supplies C1729,,Per Svc,0.01
Chargemaster Item,,270C1730,SPSI,General Supplies C1730,,Per Svc,0.01
Chargemaster Item,,270C1730,SPSI,General Supplies C1730,,Per Svc,0.01
Chargemaster Item,,270C1730,SPSI,General Supplies C1730,,Per Svc,0.01
Chargemaster Item,,270C1730,SPSI,General Supplies C1730,,Per Svc,0.01
Chargemaster Item,,270C1731,SPSI,General Supplies C1731,,Per Svc,0.01
Chargemaster Item,,270C1731,SPSI,General Supplies C1731,,Per Svc,0.01
Chargemaster Item,,270C1731,SPSI,General Supplies C1731,,Per Svc,0.01
Chargemaster Item,,270C1731,SPSI,General Supplies C1731,,Per Svc,0.01
Chargemaster Item,,270C1733,SPSI,General Supplies C1733,,Per Svc,0.01
Chargemaster Item,,270C1733,SPSI,General Supplies C1733,,Per Svc,0.01
Chargemaster Item,,270C1733,SPSI,General Supplies C1733,,Per Svc,0.01
Chargemaster Item,,270C1733,SPSI,General Supplies C1733,,Per Svc,0.01
Chargemaster Item,,270C1750,SPSI,General Supplies C1750,,Per Svc,0.01
Chargemaster Item,,270C1750,SPSI,General Supplies C1750,,Per Svc,0.01
Chargemaster Item,,270C1750,SPSI,General Supplies C1750,,Per Svc,0.01
Chargemaster Item,,270C1750,SPSI,General Supplies C1750,,Per Svc,0.01
Chargemaster Item,,270C1751,SPSI,General Supplies C1751,,Per Svc,0.01
Chargemaster Item,,270C1751,SPSI,General Supplies C1751,,Per Svc,0.01
Chargemaster Item,,270C1751,SPSI,General Supplies C1751,,Per Svc,0.01
Chargemaster Item,,270C1751,SPSI,General Supplies C1751,,Per Svc,0.01
Chargemaster Item,,270C1752,SPSI,General Supplies C1752,,Per Svc,0.01
Chargemaster Item,,270C1752,SPSI,General Supplies C1752,,Per Svc,0.01
Chargemaster Item,,270C1752,SPSI,General Supplies C1752,,Per Svc,0.01
Chargemaster Item,,270C1752,SPSI,General Supplies C1752,,Per Svc,0.01
Chargemaster Item,,270C1753,SPSI,General Supplies C1753,,Per Svc,0.01
Chargemaster Item,,270C1753,SPSI,General Supplies C1753,,Per Svc,0.01
Chargemaster Item,,270C1753,SPSI,General Supplies C1753,,Per Svc,0.01
Chargemaster Item,,270C1753,SPSI,General Supplies C1753,,Per Svc,0.01
Chargemaster Item,,270C1755,SPSI,General Supplies C1755,,Per Svc,0.01
Chargemaster Item,,270C1755,SPSI,General Supplies C1755,,Per Svc,0.01
Chargemaster Item,,270C1755,SPSI,General Supplies C1755,,Per Svc,0.01
Chargemaster Item,,270C1755,SPSI,General Supplies C1755,,Per Svc,0.01
Chargemaster Item,,270C1757,SPSI,General Supplies C1757,,Per Svc,0.01
Chargemaster Item,,270C1757,SPSI,General Supplies C1757,,Per Svc,0.01
Chargemaster Item,,270C1757,SPSI,General Supplies C1757,,Per Svc,0.01
Chargemaster Item,,270C1757,SPSI,General Supplies C1757,,Per Svc,0.01
Chargemaster Item,,270C1758,SPSI,General Supplies C1758,,Per Svc,0.01
Chargemaster Item,,270C1758,SPSI,General Supplies C1758,,Per Svc,0.01
Chargemaster Item,,270C1758,SPSI,General Supplies C1758,,Per Svc,0.01
Chargemaster Item,,270C1758,SPSI,General Supplies C1758,,Per Svc,0.01
Chargemaster Item,,270C1760,SPSI,General Supplies C1760,,Per Svc,0.01
Chargemaster Item,,270C1760,SPSI,General Supplies C1760,,Per Svc,0.01
Chargemaster Item,,270C1760,SPSI,General Supplies C1760,,Per Svc,0.01
Chargemaster Item,,270C1760,SPSI,General Supplies C1760,,Per Svc,0.01
Chargemaster Item,,270C1762,SPSI,General Supplies C1762,,Per Svc,0.01
Chargemaster Item,,270C1762,SPSI,General Supplies C1762,,Per Svc,0.01
Chargemaster Item,,270C1762,SPSI,General Supplies C1762,,Per Svc,0.01
Chargemaster Item,,270C1762,SPSI,General Supplies C1762,,Per Svc,0.01
Chargemaster Item,,270C1763,SPSI,General Supplies C1763,,Per Svc,0.01
Chargemaster Item,,270C1763,SPSI,General Supplies C1763,,Per Svc,0.01
Chargemaster Item,,270C1763,SPSI,General Supplies C1763,,Per Svc,0.01
Chargemaster Item,,270C1763,SPSI,General Supplies C1763,,Per Svc,0.01
Chargemaster Item,,270C1764,SPSI,General Supplies C1764,,Per Svc,0.01
Chargemaster Item,,270C1764,SPSI,General Supplies C1764,,Per Svc,0.01
Chargemaster Item,,270C1764,SPSI,General Supplies C1764,,Per Svc,0.01
Chargemaster Item,,270C1764,SPSI,General Supplies C1764,,Per Svc,0.01
Chargemaster Item,,270C1766,SPSI,General Supplies C1766,,Per Svc,0.01
Chargemaster Item,,270C1766,SPSI,General Supplies C1766,,Per Svc,0.01
Chargemaster Item,,270C1766,SPSI,General Supplies C1766,,Per Svc,0.01
Chargemaster Item,,270C1766,SPSI,General Supplies C1766,,Per Svc,0.01
Chargemaster Item,,270C1767,SPSI,General Supplies C1767,,Per Svc,0.01
Chargemaster Item,,270C1767,SPSI,General Supplies C1767,,Per Svc,0.01
Chargemaster Item,,270C1767,SPSI,General Supplies C1767,,Per Svc,0.01
Chargemaster Item,,270C1767,SPSI,General Supplies C1767,,Per Svc,0.01
Chargemaster Item,,270C1768,SPSI,General Supplies C1768,,Per Svc,0.01
Chargemaster Item,,270C1768,SPSI,General Supplies C1768,,Per Svc,0.01
Chargemaster Item,,270C1768,SPSI,General Supplies C1768,,Per Svc,0.01
Chargemaster Item,,270C1768,SPSI,General Supplies C1768,,Per Svc,0.01
Chargemaster Item,,270C1769,SPSI,General Supplies C1769,,Per Svc,0.01
Chargemaster Item,,270C1769,SPSI,General Supplies C1769,,Per Svc,0.01
Chargemaster Item,,270C1769,SPSI,General Supplies C1769,,Per Svc,0.01
Chargemaster Item,,270C1769,SPSI,General Supplies C1769,,Per Svc,0.01
Chargemaster Item,,270C1771,SPSI,General Supplies C1771,,Per Svc,0.01
Chargemaster Item,,270C1771,SPSI,General Supplies C1771,,Per Svc,0.01
Chargemaster Item,,270C1771,SPSI,General Supplies C1771,,Per Svc,0.01
Chargemaster Item,,270C1771,SPSI,General Supplies C1771,,Per Svc,0.01
Chargemaster Item,,270C1772,SPSI,General Supplies C1772,,Per Svc,0.01
Chargemaster Item,,270C1772,SPSI,General Supplies C1772,,Per Svc,0.01
Chargemaster Item,,270C1772,SPSI,General Supplies C1772,,Per Svc,0.01
Chargemaster Item,,270C1772,SPSI,General Supplies C1772,,Per Svc,0.01
Chargemaster Item,,270C1773,SPSI,General Supplies C1773,,Per Svc,0.01
Chargemaster Item,,270C1773,SPSI,General Supplies C1773,,Per Svc,0.01
Chargemaster Item,,270C1773,SPSI,General Supplies C1773,,Per Svc,0.01
Chargemaster Item,,270C1773,SPSI,General Supplies C1773,,Per Svc,0.01
Chargemaster Item,,270C1776,SPSI,General Supplies C1776,,Per Svc,0.01
Chargemaster Item,,270C1776,SPSI,General Supplies C1776,,Per Svc,0.01
Chargemaster Item,,270C1776,SPSI,General Supplies C1776,,Per Svc,0.01
Chargemaster Item,,270C1776,SPSI,General Supplies C1776,,Per Svc,0.01
Chargemaster Item,,270C1777,SPSI,General Supplies C1777,,Per Svc,0.01
Chargemaster Item,,270C1777,SPSI,General Supplies C1777,,Per Svc,0.01
Chargemaster Item,,270C1777,SPSI,General Supplies C1777,,Per Svc,0.01
Chargemaster Item,,270C1777,SPSI,General Supplies C1777,,Per Svc,0.01
Chargemaster Item,,270C1778,SPSI,General Supplies C1778,,Per Svc,0.01
Chargemaster Item,,270C1778,SPSI,General Supplies C1778,,Per Svc,0.01
Chargemaster Item,,270C1778,SPSI,General Supplies C1778,,Per Svc,0.01
Chargemaster Item,,270C1778,SPSI,General Supplies C1778,,Per Svc,0.01
Chargemaster Item,,270C1781,SPSI,General Supplies C1781,,Per Svc,0.01
Chargemaster Item,,270C1781,SPSI,General Supplies C1781,,Per Svc,0.01
Chargemaster Item,,270C1781,SPSI,General Supplies C1781,,Per Svc,0.01
Chargemaster Item,,270C1781,SPSI,General Supplies C1781,,Per Svc,0.01
Chargemaster Item,,270C1783,SPSI,General Supplies C1783,,Per Svc,0.01
Chargemaster Item,,270C1783,SPSI,General Supplies C1783,,Per Svc,0.01
Chargemaster Item,,270C1783,SPSI,General Supplies C1783,,Per Svc,0.01
Chargemaster Item,,270C1783,SPSI,General Supplies C1783,,Per Svc,0.01
Chargemaster Item,,270C1785,SPSI,General Supplies C1785,,Per Svc,0.01
Chargemaster Item,,270C1785,SPSI,General Supplies C1785,,Per Svc,0.01
Chargemaster Item,,270C1785,SPSI,General Supplies C1785,,Per Svc,0.01
Chargemaster Item,,270C1785,SPSI,General Supplies C1785,,Per Svc,0.01
Chargemaster Item,,270C1786,SPSI,General Supplies C1786,,Per Svc,0.01
Chargemaster Item,,270C1786,SPSI,General Supplies C1786,,Per Svc,0.01
Chargemaster Item,,270C1786,SPSI,General Supplies C1786,,Per Svc,0.01
Chargemaster Item,,270C1786,SPSI,General Supplies C1786,,Per Svc,0.01
Chargemaster Item,,270C1787,SPSI,General Supplies C1787,,Per Svc,0.01
Chargemaster Item,,270C1787,SPSI,General Supplies C1787,,Per Svc,0.01
Chargemaster Item,,270C1787,SPSI,General Supplies C1787,,Per Svc,0.01
Chargemaster Item,,270C1787,SPSI,General Supplies C1787,,Per Svc,0.01
Chargemaster Item,,270C1788,SPSI,General Supplies C1788,,Per Svc,0.01
Chargemaster Item,,270C1788,SPSI,General Supplies C1788,,Per Svc,0.01
Chargemaster Item,,270C1788,SPSI,General Supplies C1788,,Per Svc,0.01
Chargemaster Item,,270C1788,SPSI,General Supplies C1788,,Per Svc,0.01
Chargemaster Item,,270C1789,SPSI,General Supplies C1789,,Per Svc,0.01
Chargemaster Item,,270C1789,SPSI,General Supplies C1789,,Per Svc,0.01
Chargemaster Item,,270C1789,SPSI,General Supplies C1789,,Per Svc,0.01
Chargemaster Item,,270C1789,SPSI,General Supplies C1789,,Per Svc,0.01
Chargemaster Item,,270C1817,SPSI,General Supplies C1817,,Per Svc,0.01
Chargemaster Item,,270C1817,SPSI,General Supplies C1817,,Per Svc,0.01
Chargemaster Item,,270C1817,SPSI,General Supplies C1817,,Per Svc,0.01
Chargemaster Item,,270C1817,SPSI,General Supplies C1817,,Per Svc,0.01
Chargemaster Item,,270C1821,SPSI,General Supplies C1821,,Per Svc,0.01
Chargemaster Item,,270C1821,SPSI,General Supplies C1821,,Per Svc,0.01
Chargemaster Item,,270C1821,SPSI,General Supplies C1821,,Per Svc,0.01
Chargemaster Item,,270C1821,SPSI,General Supplies C1821,,Per Svc,0.01
Chargemaster Item,,270C1874,SPSI,General Supplies C1874,,Per Svc,0.01
Chargemaster Item,,270C1874,SPSI,General Supplies C1874,,Per Svc,0.01
Chargemaster Item,,270C1874,SPSI,General Supplies C1874,,Per Svc,0.01
Chargemaster Item,,270C1874,SPSI,General Supplies C1874,,Per Svc,0.01
Chargemaster Item,,270C1875,SPSI,General Supplies C1875,,Per Svc,0.01
Chargemaster Item,,270C1875,SPSI,General Supplies C1875,,Per Svc,0.01
Chargemaster Item,,270C1875,SPSI,General Supplies C1875,,Per Svc,0.01
Chargemaster Item,,270C1875,SPSI,General Supplies C1875,,Per Svc,0.01
Chargemaster Item,,270C1876,SPSI,General Supplies C1876,,Per Svc,0.01
Chargemaster Item,,270C1876,SPSI,General Supplies C1876,,Per Svc,0.01
Chargemaster Item,,270C1876,SPSI,General Supplies C1876,,Per Svc,0.01
Chargemaster Item,,270C1876,SPSI,General Supplies C1876,,Per Svc,0.01
Chargemaster Item,,270C1880,SPSI,General Supplies C1880,,Per Svc,0.01
Chargemaster Item,,270C1880,SPSI,General Supplies C1880,,Per Svc,0.01
Chargemaster Item,,270C1880,SPSI,General Supplies C1880,,Per Svc,0.01
Chargemaster Item,,270C1880,SPSI,General Supplies C1880,,Per Svc,0.01
Chargemaster Item,,270C1881,SPSI,General Supplies C1881,,Per Svc,0.01
Chargemaster Item,,270C1881,SPSI,General Supplies C1881,,Per Svc,0.01
Chargemaster Item,,270C1881,SPSI,General Supplies C1881,,Per Svc,0.01
Chargemaster Item,,270C1881,SPSI,General Supplies C1881,,Per Svc,0.01
Chargemaster Item,,270C1882,SPSI,General Supplies C1882,,Per Svc,0.01
Chargemaster Item,,270C1882,SPSI,General Supplies C1882,,Per Svc,0.01
Chargemaster Item,,270C1882,SPSI,General Supplies C1882,,Per Svc,0.01
Chargemaster Item,,270C1882,SPSI,General Supplies C1882,,Per Svc,0.01
Chargemaster Item,,270C1883,SPSI,General Supplies C1883,,Per Svc,0.01
Chargemaster Item,,270C1883,SPSI,General Supplies C1883,,Per Svc,0.01
Chargemaster Item,,270C1883,SPSI,General Supplies C1883,,Per Svc,0.01
Chargemaster Item,,270C1883,SPSI,General Supplies C1883,,Per Svc,0.01
Chargemaster Item,,270C1884,SPSI,General Supplies C1884,,Per Svc,0.01
Chargemaster Item,,270C1884,SPSI,General Supplies C1884,,Per Svc,0.01
Chargemaster Item,,270C1884,SPSI,General Supplies C1884,,Per Svc,0.01
Chargemaster Item,,270C1884,SPSI,General Supplies C1884,,Per Svc,0.01
Chargemaster Item,,270C1887,SPSI,General Supplies C1887,,Per Svc,0.01
Chargemaster Item,,270C1887,SPSI,General Supplies C1887,,Per Svc,0.01
Chargemaster Item,,270C1887,SPSI,General Supplies C1887,,Per Svc,0.01
Chargemaster Item,,270C1887,SPSI,General Supplies C1887,,Per Svc,0.01
Chargemaster Item,,270C1889,SPSI,General Supplies C1889,,Per Svc,0.01
Chargemaster Item,,270C1889,SPSI,General Supplies C1889,,Per Svc,0.01
Chargemaster Item,,270C1889,SPSI,General Supplies C1889,,Per Svc,0.01
Chargemaster Item,,270C1889,SPSI,General Supplies C1889,,Per Svc,0.01
Chargemaster Item,,270C1892,SPSI,General Supplies C1892,,Per Svc,0.01
Chargemaster Item,,270C1892,SPSI,General Supplies C1892,,Per Svc,0.01
Chargemaster Item,,270C1892,SPSI,General Supplies C1892,,Per Svc,0.01
Chargemaster Item,,270C1892,SPSI,General Supplies C1892,,Per Svc,0.01
Chargemaster Item,,270C1893,SPSI,General Supplies C1893,,Per Svc,0.01
Chargemaster Item,,270C1893,SPSI,General Supplies C1893,,Per Svc,0.01
Chargemaster Item,,270C1893,SPSI,General Supplies C1893,,Per Svc,0.01
Chargemaster Item,,270C1893,SPSI,General Supplies C1893,,Per Svc,0.01
Chargemaster Item,,270C1894,SPSI,General Supplies C1894,,Per Svc,0.01
Chargemaster Item,,270C1894,SPSI,General Supplies C1894,,Per Svc,0.01
Chargemaster Item,,270C1894,SPSI,General Supplies C1894,,Per Svc,0.01
Chargemaster Item,,270C1894,SPSI,General Supplies C1894,,Per Svc,0.01
Chargemaster Item,,270C1897,SPSI,General Supplies C1897,,Per Svc,0.01
Chargemaster Item,,270C1897,SPSI,General Supplies C1897,,Per Svc,0.01
Chargemaster Item,,270C1897,SPSI,General Supplies C1897,,Per Svc,0.01
Chargemaster Item,,270C1897,SPSI,General Supplies C1897,,Per Svc,0.01
Chargemaster Item,,270C1898,SPSI,General Supplies C1898,,Per Svc,0.01
Chargemaster Item,,270C1898,SPSI,General Supplies C1898,,Per Svc,0.01
Chargemaster Item,,270C1898,SPSI,General Supplies C1898,,Per Svc,0.01
Chargemaster Item,,270C1898,SPSI,General Supplies C1898,,Per Svc,0.01
Chargemaster Item,,270C1900,SPSI,General Supplies C1900,,Per Svc,0.01
Chargemaster Item,,270C1900,SPSI,General Supplies C1900,,Per Svc,0.01
Chargemaster Item,,270C1900,SPSI,General Supplies C1900,,Per Svc,0.01
Chargemaster Item,,270C1900,SPSI,General Supplies C1900,,Per Svc,0.01
Chargemaster Item,,270C2617,SPSI,General Supplies C2617,,Per Svc,0.01
Chargemaster Item,,270C2617,SPSI,General Supplies C2617,,Per Svc,0.01
Chargemaster Item,,270C2617,SPSI,General Supplies C2617,,Per Svc,0.01
Chargemaster Item,,270C2617,SPSI,General Supplies C2617,,Per Svc,0.01
Chargemaster Item,,270C2618,SPSI,General Supplies C2618,,Per Svc,0.01
Chargemaster Item,,270C2618,SPSI,General Supplies C2618,,Per Svc,0.01
Chargemaster Item,,270C2618,SPSI,General Supplies C2618,,Per Svc,0.01
Chargemaster Item,,270C2618,SPSI,General Supplies C2618,,Per Svc,0.01
Chargemaster Item,,270C2623,SPSI,General Supplies C2623,,Per Svc,0.01
Chargemaster Item,,270C2623,SPSI,General Supplies C2623,,Per Svc,0.01
Chargemaster Item,,270C2623,SPSI,General Supplies C2623,,Per Svc,0.01
Chargemaster Item,,270C2623,SPSI,General Supplies C2623,,Per Svc,0.01
Chargemaster Item,,270C2625,SPSI,General Supplies C2625,,Per Svc,0.01
Chargemaster Item,,270C2625,SPSI,General Supplies C2625,,Per Svc,0.01
Chargemaster Item,,270C2625,SPSI,General Supplies C2625,,Per Svc,0.01
Chargemaster Item,,270C2625,SPSI,General Supplies C2625,,Per Svc,0.01
Chargemaster Item,,270C2627,SPSI,General Supplies C2627,,Per Svc,0.01
Chargemaster Item,,270C2627,SPSI,General Supplies C2627,,Per Svc,0.01
Chargemaster Item,,270C2627,SPSI,General Supplies C2627,,Per Svc,0.01
Chargemaster Item,,270C2627,SPSI,General Supplies C2627,,Per Svc,0.01
Chargemaster Item,,270C2628,SPSI,General Supplies C2628,,Per Svc,0.01
Chargemaster Item,,270C2628,SPSI,General Supplies C2628,,Per Svc,0.01
Chargemaster Item,,270C2628,SPSI,General Supplies C2628,,Per Svc,0.01
Chargemaster Item,,270C2628,SPSI,General Supplies C2628,,Per Svc,0.01
Chargemaster Item,,270C2630,SPSI,General Supplies C2630,,Per Svc,0.01
Chargemaster Item,,270C2630,SPSI,General Supplies C2630,,Per Svc,0.01
Chargemaster Item,,270C2630,SPSI,General Supplies C2630,,Per Svc,0.01
Chargemaster Item,,270C2630,SPSI,General Supplies C2630,,Per Svc,0.01
Chargemaster Item,,270C2639,SPSI,General Supplies C2639,,Per Svc,0.01
Chargemaster Item,,270C2639,SPSI,General Supplies C2639,,Per Svc,0.01
Chargemaster Item,,270C2639,SPSI,General Supplies C2639,,Per Svc,0.01
Chargemaster Item,,270C2639,SPSI,General Supplies C2639,,Per Svc,0.01
Chargemaster Item,,270C9250,SPSI,General Supplies C9250,,Per Svc,0.01
Chargemaster Item,,270C9250,SPSI,General Supplies C9250,,Per Svc,0.01
Chargemaster Item,,270C9250,SPSI,General Supplies C9250,,Per Svc,0.01
Chargemaster Item,,270C9250,SPSI,General Supplies C9250,,Per Svc,0.01
Chargemaster Item,,270C9352,SPSI,General Supplies C9352,,Per Svc,0.01
Chargemaster Item,,270C9352,SPSI,General Supplies C9352,,Per Svc,0.01
Chargemaster Item,,270C9352,SPSI,General Supplies C9352,,Per Svc,0.01
Chargemaster Item,,270C9352,SPSI,General Supplies C9352,,Per Svc,0.01
Chargemaster Item,,270C9353,SPSI,General Supplies C9353,,Per Svc,0.01
Chargemaster Item,,270C9353,SPSI,General Supplies C9353,,Per Svc,0.01
Chargemaster Item,,270C9353,SPSI,General Supplies C9353,,Per Svc,0.01
Chargemaster Item,,270C9353,SPSI,General Supplies C9353,,Per Svc,0.01
Chargemaster Item,,270C9363,SPSI,General Supplies C9363,,Per Svc,0.01
Chargemaster Item,,270C9363,SPSI,General Supplies C9363,,Per Svc,0.01
Chargemaster Item,,270C9363,SPSI,General Supplies C9363,,Per Svc,0.01
Chargemaster Item,,270C9363,SPSI,General Supplies C9363,,Per Svc,0.01
Chargemaster Item,,270E0191,SPSI,General Supplies E0191,,Per Svc,0.01
Chargemaster Item,,270E0191,SPSI,General Supplies E0191,,Per Svc,0.01
Chargemaster Item,,270E0191,SPSI,General Supplies E0191,,Per Svc,0.01
Chargemaster Item,,270E0191,SPSI,General Supplies E0191,,Per Svc,0.01
Chargemaster Item,,270E0235,SPSI,General Supplies E0235,,Per Svc,0.01
Chargemaster Item,,270E0235,SPSI,General Supplies E0235,,Per Svc,0.01
Chargemaster Item,,270E0235,SPSI,General Supplies E0235,,Per Svc,0.01
Chargemaster Item,,270E0235,SPSI,General Supplies E0235,,Per Svc,0.01
Chargemaster Item,,270L0113,SPSI,General Supplies L0113,,Per Svc,0.01
Chargemaster Item,,270L0113,SPSI,General Supplies L0113,,Per Svc,0.01
Chargemaster Item,,270L0113,SPSI,General Supplies L0113,,Per Svc,0.01
Chargemaster Item,,270L0113,SPSI,General Supplies L0113,,Per Svc,0.01
Chargemaster Item,,270L0120,SPSI,General Supplies L0120,,Per Svc,0.01
Chargemaster Item,,270L0120,SPSI,General Supplies L0120,,Per Svc,0.01
Chargemaster Item,,270L0120,SPSI,General Supplies L0120,,Per Svc,0.01
Chargemaster Item,,270L0120,SPSI,General Supplies L0120,,Per Svc,0.01
Chargemaster Item,,270L0172,SPSI,General Supplies L0172,,Per Svc,0.01
Chargemaster Item,,270L0172,SPSI,General Supplies L0172,,Per Svc,0.01
Chargemaster Item,,270L0172,SPSI,General Supplies L0172,,Per Svc,0.01
Chargemaster Item,,270L0172,SPSI,General Supplies L0172,,Per Svc,0.01
Chargemaster Item,,270L0174,SPSI,General Supplies L0174,,Per Svc,0.01
Chargemaster Item,,270L0174,SPSI,General Supplies L0174,,Per Svc,0.01
Chargemaster Item,,270L0174,SPSI,General Supplies L0174,,Per Svc,0.01
Chargemaster Item,,270L0174,SPSI,General Supplies L0174,,Per Svc,0.01
Chargemaster Item,,270L0625,SPSI,General Supplies L0625,,Per Svc,0.01
Chargemaster Item,,270L0625,SPSI,General Supplies L0625,,Per Svc,0.01
Chargemaster Item,,270L0625,SPSI,General Supplies L0625,,Per Svc,0.01
Chargemaster Item,,270L0625,SPSI,General Supplies L0625,,Per Svc,0.01
Chargemaster Item,,270L1820,SPSI,General Supplies L1820,,Per Svc,0.01
Chargemaster Item,,270L1820,SPSI,General Supplies L1820,,Per Svc,0.01
Chargemaster Item,,270L1820,SPSI,General Supplies L1820,,Per Svc,0.01
Chargemaster Item,,270L1820,SPSI,General Supplies L1820,,Per Svc,0.01
Chargemaster Item,,270L1830,SPSI,General Supplies L1830,,Per Svc,0.01
Chargemaster Item,,270L1830,SPSI,General Supplies L1830,,Per Svc,0.01
Chargemaster Item,,270L1830,SPSI,General Supplies L1830,,Per Svc,0.01
Chargemaster Item,,270L1830,SPSI,General Supplies L1830,,Per Svc,0.01
Chargemaster Item,,270L1832,SPSI,General Supplies L1832,,Per Svc,0.01
Chargemaster Item,,270L1832,SPSI,General Supplies L1832,,Per Svc,0.01
Chargemaster Item,,270L1832,SPSI,General Supplies L1832,,Per Svc,0.01
Chargemaster Item,,270L1832,SPSI,General Supplies L1832,,Per Svc,0.01
Chargemaster Item,,270L1902,SPSI,General Supplies L1902,,Per Svc,0.01
Chargemaster Item,,270L1902,SPSI,General Supplies L1902,,Per Svc,0.01
Chargemaster Item,,270L1902,SPSI,General Supplies L1902,,Per Svc,0.01
Chargemaster Item,,270L1902,SPSI,General Supplies L1902,,Per Svc,0.01
Chargemaster Item,,270L1930,SPSI,General Supplies L1930,,Per Svc,0.01
Chargemaster Item,,270L1930,SPSI,General Supplies L1930,,Per Svc,0.01
Chargemaster Item,,270L1930,SPSI,General Supplies L1930,,Per Svc,0.01
Chargemaster Item,,270L1930,SPSI,General Supplies L1930,,Per Svc,0.01
Chargemaster Item,,270L3260,SPSI,General Supplies L3260,,Per Svc,0.01
Chargemaster Item,,270L3260,SPSI,General Supplies L3260,,Per Svc,0.01
Chargemaster Item,,270L3260,SPSI,General Supplies L3260,,Per Svc,0.01
Chargemaster Item,,270L3260,SPSI,General Supplies L3260,,Per Svc,0.01
Chargemaster Item,,270L3650,SPSI,General Supplies L3650,,Per Svc,0.01
Chargemaster Item,,270L3650,SPSI,General Supplies L3650,,Per Svc,0.01
Chargemaster Item,,270L3650,SPSI,General Supplies L3650,,Per Svc,0.01
Chargemaster Item,,270L3650,SPSI,General Supplies L3650,,Per Svc,0.01
Chargemaster Item,,270L3670,SPSI,General Supplies L3670,,Per Svc,0.01
Chargemaster Item,,270L3670,SPSI,General Supplies L3670,,Per Svc,0.01
Chargemaster Item,,270L3670,SPSI,General Supplies L3670,,Per Svc,0.01
Chargemaster Item,,270L3670,SPSI,General Supplies L3670,,Per Svc,0.01
Chargemaster Item,,270L3807,SPSI,General Supplies L3807,,Per Svc,0.01
Chargemaster Item,,270L3807,SPSI,General Supplies L3807,,Per Svc,0.01
Chargemaster Item,,270L3807,SPSI,General Supplies L3807,,Per Svc,0.01
Chargemaster Item,,270L3807,SPSI,General Supplies L3807,,Per Svc,0.01
Chargemaster Item,,270L3809,SPSI,General Supplies L3809,,Per Svc,0.01
Chargemaster Item,,270L3809,SPSI,General Supplies L3809,,Per Svc,0.01
Chargemaster Item,,270L3809,SPSI,General Supplies L3809,,Per Svc,0.01
Chargemaster Item,,270L3809,SPSI,General Supplies L3809,,Per Svc,0.01
Chargemaster Item,,270L3908,SPSI,General Supplies L3908,,Per Svc,0.01
Chargemaster Item,,270L3908,SPSI,General Supplies L3908,,Per Svc,0.01
Chargemaster Item,,270L3908,SPSI,General Supplies L3908,,Per Svc,0.01
Chargemaster Item,,270L3908,SPSI,General Supplies L3908,,Per Svc,0.01
Chargemaster Item,,270L3917,SPSI,General Supplies L3917,,Per Svc,0.01
Chargemaster Item,,270L3917,SPSI,General Supplies L3917,,Per Svc,0.01
Chargemaster Item,,270L3917,SPSI,General Supplies L3917,,Per Svc,0.01
Chargemaster Item,,270L3917,SPSI,General Supplies L3917,,Per Svc,0.01
Chargemaster Item,,270L3923,SPSI,General Supplies L3923,,Per Svc,0.01
Chargemaster Item,,270L3923,SPSI,General Supplies L3923,,Per Svc,0.01
Chargemaster Item,,270L3923,SPSI,General Supplies L3923,,Per Svc,0.01
Chargemaster Item,,270L3923,SPSI,General Supplies L3923,,Per Svc,0.01
Chargemaster Item,,270L4386,SPSI,General Supplies L4386,,Per Svc,0.01
Chargemaster Item,,270L4386,SPSI,General Supplies L4386,,Per Svc,0.01
Chargemaster Item,,270L4386,SPSI,General Supplies L4386,,Per Svc,0.01
Chargemaster Item,,270L4386,SPSI,General Supplies L4386,,Per Svc,0.01
Chargemaster Item,,270L4387,SPSI,General Supplies L4387,,Per Svc,0.01
Chargemaster Item,,270L4387,SPSI,General Supplies L4387,,Per Svc,0.01
Chargemaster Item,,270L4387,SPSI,General Supplies L4387,,Per Svc,0.01
Chargemaster Item,,270L4387,SPSI,General Supplies L4387,,Per Svc,0.01
Chargemaster Item,,270L5000,SPSI,General Supplies L5000,,Per Svc,0.01
Chargemaster Item,,270L5000,SPSI,General Supplies L5000,,Per Svc,0.01
Chargemaster Item,,270L5000,SPSI,General Supplies L5000,,Per Svc,0.01
Chargemaster Item,,270L5000,SPSI,General Supplies L5000,,Per Svc,0.01
Chargemaster Item,,270L8000,SPSI,General Supplies L8000,,Per Svc,0.01
Chargemaster Item,,270L8000,SPSI,General Supplies L8000,,Per Svc,0.01
Chargemaster Item,,270L8000,SPSI,General Supplies L8000,,Per Svc,0.01
Chargemaster Item,,270L8000,SPSI,General Supplies L8000,,Per Svc,0.01
Chargemaster Item,,270L8501,SPSI,General Supplies L8501,,Per Svc,0.01
Chargemaster Item,,270L8501,SPSI,General Supplies L8501,,Per Svc,0.01
Chargemaster Item,,270L8501,SPSI,General Supplies L8501,,Per Svc,0.01
Chargemaster Item,,270L8501,SPSI,General Supplies L8501,,Per Svc,0.01
Chargemaster Item,,270L8600,SPSI,General Supplies L8600,,Per Svc,0.01
Chargemaster Item,,270L8600,SPSI,General Supplies L8600,,Per Svc,0.01
Chargemaster Item,,270L8600,SPSI,General Supplies L8600,,Per Svc,0.01
Chargemaster Item,,270L8600,SPSI,General Supplies L8600,,Per Svc,0.01
Chargemaster Item,,270L8612,SPSI,General Supplies L8612,,Per Svc,0.01
Chargemaster Item,,270L8612,SPSI,General Supplies L8612,,Per Svc,0.01
Chargemaster Item,,270L8612,SPSI,General Supplies L8612,,Per Svc,0.01
Chargemaster Item,,270L8612,SPSI,General Supplies L8612,,Per Svc,0.01
Chargemaster Item,,270L8699,SPSI,General Supplies L8699,,Per Svc,0.01
Chargemaster Item,,270L8699,SPSI,General Supplies L8699,,Per Svc,0.01
Chargemaster Item,,270L8699,SPSI,General Supplies L8699,,Per Svc,0.01
Chargemaster Item,,270L8699,SPSI,General Supplies L8699,,Per Svc,0.01
Chargemaster Item,,270Q4100,SPSI,General Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,270Q4100,SPSI,General Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,270Q4100,SPSI,General Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,270Q4100,SPSI,General Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,270Q4102,SPSI,General Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,270Q4102,SPSI,General Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,270Q4102,SPSI,General Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,270Q4102,SPSI,General Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,270Q4110,SPSI,General Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,270Q4110,SPSI,General Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,270Q4110,SPSI,General Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,270Q4110,SPSI,General Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,270Q4114,SPSI,General Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,270Q4114,SPSI,General Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,270Q4114,SPSI,General Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,270Q4114,SPSI,General Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,270Q4116,SPSI,General Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,270Q4116,SPSI,General Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,270Q4116,SPSI,General Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,270Q4116,SPSI,General Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,270Q4118,SPSI,General Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,270Q4118,SPSI,General Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,270Q4118,SPSI,General Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,270Q4118,SPSI,General Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,270Q4125,SPSI,General Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,270Q4125,SPSI,General Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,270Q4125,SPSI,General Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,270Q4125,SPSI,General Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,270Q4128,SPSI,General Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,270Q4128,SPSI,General Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,270Q4128,SPSI,General Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,270Q4128,SPSI,General Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,270Q4130,SPSI,General Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,270Q4130,SPSI,General Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,270Q4130,SPSI,General Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,270Q4130,SPSI,General Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,270Q4133,SPSI,General Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,270Q4133,SPSI,General Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,270Q4133,SPSI,General Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,270Q4133,SPSI,General Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,270Q4155,SPSI,General Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,270Q4155,SPSI,General Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,270Q4155,SPSI,General Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,270Q4155,SPSI,General Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,270Q4166,SPSI,General Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,270Q4166,SPSI,General Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,270Q4166,SPSI,General Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,270Q4166,SPSI,General Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,270Q9963,SPSI,General Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,270Q9963,SPSI,General Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,270Q9963,SPSI,General Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,270Q9963,SPSI,General Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,270Q9967,SPSI,General Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,270Q9967,SPSI,General Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,270Q9967,SPSI,General Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,270Q9967,SPSI,General Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,270V2630,SPSI,General Supplies V2630,,Per Svc,0.01
Chargemaster Item,,270V2630,SPSI,General Supplies V2630,,Per Svc,0.01
Chargemaster Item,,270V2630,SPSI,General Supplies V2630,,Per Svc,0.01
Chargemaster Item,,270V2630,SPSI,General Supplies V2630,,Per Svc,0.01
Chargemaster Item,,270V2632,SPSI,General Supplies V2632,,Per Svc,0.01
Chargemaster Item,,270V2632,SPSI,General Supplies V2632,,Per Svc,0.01
Chargemaster Item,,270V2632,SPSI,General Supplies V2632,,Per Svc,0.01
Chargemaster Item,,270V2632,SPSI,General Supplies V2632,,Per Svc,0.01
Chargemaster Item,,270V2790,SPSI,General Supplies V2790,,Per Svc,0.01
Chargemaster Item,,270V2790,SPSI,General Supplies V2790,,Per Svc,0.01
Chargemaster Item,,270V2790,SPSI,General Supplies V2790,,Per Svc,0.01
Chargemaster Item,,270V2790,SPSI,General Supplies V2790,,Per Svc,0.01
Chargemaster Item,,270XXXXX,SPSI,General Supplies,,Per Svc,0.01
Chargemaster Item,,270XXXXX,SPSI,General Supplies,,Per Svc,0.01
Chargemaster Item,,270XXXXX,SPSI,General Supplies,,Per Svc,0.01
Chargemaster Item,,270XXXXX,SPSI,General Supplies,,Per Svc,0.01
Chargemaster Item,,27100106,SPSI,Access External Cath,,Per Svc,227.00
Chargemaster Item,,27100114,SPSI,Implant Access Catheter,,Per Svc,227.00
Chargemaster Item,,27100130,SPSI,Catheter Suppl,,Per Svc,227.00
Chargemaster Item,,27100478,SPSI,Thera Phlebotomy,,Per Svc,553.00
Chargemaster Item,,27100494,SPSI,Picc Insertion,,Per Svc,5817.00
Chargemaster Item,,27103704,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,27104009,SPSI,Level 1 Procedure,,First 60 Minutes,15635.00
Chargemaster Item,,27104025,SPSI,Level 2 Procedure,,First 60 Minutes,19929.00
Chargemaster Item,,27104041,SPSI,Level 3 Procedure,,First 60 Minutes,28129.00
Chargemaster Item,,271A4265,SPSI,Non-Sterile Supplies A4265,,Per Svc,0.01
Chargemaster Item,,271A4265,SPSI,Non-Sterile Supplies A4265,,Per Svc,0.01
Chargemaster Item,,271A4265,SPSI,Non-Sterile Supplies A4265,,Per Svc,0.01
Chargemaster Item,,271A4265,SPSI,Non-Sterile Supplies A4265,,Per Svc,0.01
Chargemaster Item,,271A4340,SPSI,Non-Sterile Supplies A4340,,Per Svc,0.01
Chargemaster Item,,271A4340,SPSI,Non-Sterile Supplies A4340,,Per Svc,0.01
Chargemaster Item,,271A4340,SPSI,Non-Sterile Supplies A4340,,Per Svc,0.01
Chargemaster Item,,271A4340,SPSI,Non-Sterile Supplies A4340,,Per Svc,0.01
Chargemaster Item,,271A4349,SPSI,Non-Sterile Supplies A4349,,Per Svc,0.01
Chargemaster Item,,271A4349,SPSI,Non-Sterile Supplies A4349,,Per Svc,0.01
Chargemaster Item,,271A4349,SPSI,Non-Sterile Supplies A4349,,Per Svc,0.01
Chargemaster Item,,271A4349,SPSI,Non-Sterile Supplies A4349,,Per Svc,0.01
Chargemaster Item,,271A4565,SPSI,Non-Sterile Supplies A4565,,Per Svc,0.01
Chargemaster Item,,271A4565,SPSI,Non-Sterile Supplies A4565,,Per Svc,0.01
Chargemaster Item,,271A4565,SPSI,Non-Sterile Supplies A4565,,Per Svc,0.01
Chargemaster Item,,271A4565,SPSI,Non-Sterile Supplies A4565,,Per Svc,0.01
Chargemaster Item,,271A4648,SPSI,Non-Sterile Supplies A4648,,Per Svc,0.01
Chargemaster Item,,271A4648,SPSI,Non-Sterile Supplies A4648,,Per Svc,0.01
Chargemaster Item,,271A4648,SPSI,Non-Sterile Supplies A4648,,Per Svc,0.01
Chargemaster Item,,271A4648,SPSI,Non-Sterile Supplies A4648,,Per Svc,0.01
Chargemaster Item,,271A6021,SPSI,Non-Sterile Supplies A6021,,Per Svc,0.01
Chargemaster Item,,271A6021,SPSI,Non-Sterile Supplies A6021,,Per Svc,0.01
Chargemaster Item,,271A6021,SPSI,Non-Sterile Supplies A6021,,Per Svc,0.01
Chargemaster Item,,271A6021,SPSI,Non-Sterile Supplies A6021,,Per Svc,0.01
Chargemaster Item,,271A6025,SPSI,Non-Sterile Supplies A6025,,Per Svc,0.01
Chargemaster Item,,271A6025,SPSI,Non-Sterile Supplies A6025,,Per Svc,0.01
Chargemaster Item,,271A6025,SPSI,Non-Sterile Supplies A6025,,Per Svc,0.01
Chargemaster Item,,271A6025,SPSI,Non-Sterile Supplies A6025,,Per Svc,0.01
Chargemaster Item,,271A6196,SPSI,Non-Sterile Supplies A6196,,Per Svc,0.01
Chargemaster Item,,271A6196,SPSI,Non-Sterile Supplies A6196,,Per Svc,0.01
Chargemaster Item,,271A6196,SPSI,Non-Sterile Supplies A6196,,Per Svc,0.01
Chargemaster Item,,271A6196,SPSI,Non-Sterile Supplies A6196,,Per Svc,0.01
Chargemaster Item,,271A6197,SPSI,Non-Sterile Supplies A6197,,Per Svc,0.01
Chargemaster Item,,271A6197,SPSI,Non-Sterile Supplies A6197,,Per Svc,0.01
Chargemaster Item,,271A6197,SPSI,Non-Sterile Supplies A6197,,Per Svc,0.01
Chargemaster Item,,271A6197,SPSI,Non-Sterile Supplies A6197,,Per Svc,0.01
Chargemaster Item,,271A6206,SPSI,Non-Sterile Supplies A6206,,Per Svc,0.01
Chargemaster Item,,271A6206,SPSI,Non-Sterile Supplies A6206,,Per Svc,0.01
Chargemaster Item,,271A6206,SPSI,Non-Sterile Supplies A6206,,Per Svc,0.01
Chargemaster Item,,271A6206,SPSI,Non-Sterile Supplies A6206,,Per Svc,0.01
Chargemaster Item,,271A6209,SPSI,Non-Sterile Supplies A6209,,Per Svc,0.01
Chargemaster Item,,271A6209,SPSI,Non-Sterile Supplies A6209,,Per Svc,0.01
Chargemaster Item,,271A6209,SPSI,Non-Sterile Supplies A6209,,Per Svc,0.01
Chargemaster Item,,271A6209,SPSI,Non-Sterile Supplies A6209,,Per Svc,0.01
Chargemaster Item,,271A6212,SPSI,Non-Sterile Supplies A6212,,Per Svc,0.01
Chargemaster Item,,271A6212,SPSI,Non-Sterile Supplies A6212,,Per Svc,0.01
Chargemaster Item,,271A6212,SPSI,Non-Sterile Supplies A6212,,Per Svc,0.01
Chargemaster Item,,271A6212,SPSI,Non-Sterile Supplies A6212,,Per Svc,0.01
Chargemaster Item,,271A6213,SPSI,Non-Sterile Supplies A6213,,Per Svc,0.01
Chargemaster Item,,271A6213,SPSI,Non-Sterile Supplies A6213,,Per Svc,0.01
Chargemaster Item,,271A6213,SPSI,Non-Sterile Supplies A6213,,Per Svc,0.01
Chargemaster Item,,271A6213,SPSI,Non-Sterile Supplies A6213,,Per Svc,0.01
Chargemaster Item,,271A6214,SPSI,Non-Sterile Supplies A6214,,Per Svc,0.01
Chargemaster Item,,271A6214,SPSI,Non-Sterile Supplies A6214,,Per Svc,0.01
Chargemaster Item,,271A6214,SPSI,Non-Sterile Supplies A6214,,Per Svc,0.01
Chargemaster Item,,271A6214,SPSI,Non-Sterile Supplies A6214,,Per Svc,0.01
Chargemaster Item,,271A6219,SPSI,Non-Sterile Supplies A6219,,Per Svc,0.01
Chargemaster Item,,271A6219,SPSI,Non-Sterile Supplies A6219,,Per Svc,0.01
Chargemaster Item,,271A6219,SPSI,Non-Sterile Supplies A6219,,Per Svc,0.01
Chargemaster Item,,271A6219,SPSI,Non-Sterile Supplies A6219,,Per Svc,0.01
Chargemaster Item,,271A6222,SPSI,Non-Sterile Supplies A6222,,Per Svc,0.01
Chargemaster Item,,271A6222,SPSI,Non-Sterile Supplies A6222,,Per Svc,0.01
Chargemaster Item,,271A6222,SPSI,Non-Sterile Supplies A6222,,Per Svc,0.01
Chargemaster Item,,271A6222,SPSI,Non-Sterile Supplies A6222,,Per Svc,0.01
Chargemaster Item,,271A6223,SPSI,Non-Sterile Supplies A6223,,Per Svc,0.01
Chargemaster Item,,271A6223,SPSI,Non-Sterile Supplies A6223,,Per Svc,0.01
Chargemaster Item,,271A6223,SPSI,Non-Sterile Supplies A6223,,Per Svc,0.01
Chargemaster Item,,271A6223,SPSI,Non-Sterile Supplies A6223,,Per Svc,0.01
Chargemaster Item,,271A6224,SPSI,Non-Sterile Supplies A6224,,Per Svc,0.01
Chargemaster Item,,271A6224,SPSI,Non-Sterile Supplies A6224,,Per Svc,0.01
Chargemaster Item,,271A6224,SPSI,Non-Sterile Supplies A6224,,Per Svc,0.01
Chargemaster Item,,271A6224,SPSI,Non-Sterile Supplies A6224,,Per Svc,0.01
Chargemaster Item,,271A6234,SPSI,Non-Sterile Supplies A6234,,Per Svc,0.01
Chargemaster Item,,271A6234,SPSI,Non-Sterile Supplies A6234,,Per Svc,0.01
Chargemaster Item,,271A6234,SPSI,Non-Sterile Supplies A6234,,Per Svc,0.01
Chargemaster Item,,271A6234,SPSI,Non-Sterile Supplies A6234,,Per Svc,0.01
Chargemaster Item,,271A6235,SPSI,Non-Sterile Supplies A6235,,Per Svc,0.01
Chargemaster Item,,271A6235,SPSI,Non-Sterile Supplies A6235,,Per Svc,0.01
Chargemaster Item,,271A6235,SPSI,Non-Sterile Supplies A6235,,Per Svc,0.01
Chargemaster Item,,271A6235,SPSI,Non-Sterile Supplies A6235,,Per Svc,0.01
Chargemaster Item,,271A6238,SPSI,Non-Sterile Supplies A6238,,Per Svc,0.01
Chargemaster Item,,271A6238,SPSI,Non-Sterile Supplies A6238,,Per Svc,0.01
Chargemaster Item,,271A6238,SPSI,Non-Sterile Supplies A6238,,Per Svc,0.01
Chargemaster Item,,271A6238,SPSI,Non-Sterile Supplies A6238,,Per Svc,0.01
Chargemaster Item,,271A6255,SPSI,Non-Sterile Supplies A6255,,Per Svc,0.01
Chargemaster Item,,271A6255,SPSI,Non-Sterile Supplies A6255,,Per Svc,0.01
Chargemaster Item,,271A6255,SPSI,Non-Sterile Supplies A6255,,Per Svc,0.01
Chargemaster Item,,271A6255,SPSI,Non-Sterile Supplies A6255,,Per Svc,0.01
Chargemaster Item,,271A6257,SPSI,Non-Sterile Supplies A6257,,Per Svc,0.01
Chargemaster Item,,271A6257,SPSI,Non-Sterile Supplies A6257,,Per Svc,0.01
Chargemaster Item,,271A6257,SPSI,Non-Sterile Supplies A6257,,Per Svc,0.01
Chargemaster Item,,271A6257,SPSI,Non-Sterile Supplies A6257,,Per Svc,0.01
Chargemaster Item,,271A6258,SPSI,Non-Sterile Supplies A6258,,Per Svc,0.01
Chargemaster Item,,271A6258,SPSI,Non-Sterile Supplies A6258,,Per Svc,0.01
Chargemaster Item,,271A6258,SPSI,Non-Sterile Supplies A6258,,Per Svc,0.01
Chargemaster Item,,271A6258,SPSI,Non-Sterile Supplies A6258,,Per Svc,0.01
Chargemaster Item,,271A6259,SPSI,Non-Sterile Supplies A6259,,Per Svc,0.01
Chargemaster Item,,271A6259,SPSI,Non-Sterile Supplies A6259,,Per Svc,0.01
Chargemaster Item,,271A6259,SPSI,Non-Sterile Supplies A6259,,Per Svc,0.01
Chargemaster Item,,271A6259,SPSI,Non-Sterile Supplies A6259,,Per Svc,0.01
Chargemaster Item,,271A6454,SPSI,Non-Sterile Supplies A6454,,Per Svc,0.01
Chargemaster Item,,271A6454,SPSI,Non-Sterile Supplies A6454,,Per Svc,0.01
Chargemaster Item,,271A6454,SPSI,Non-Sterile Supplies A6454,,Per Svc,0.01
Chargemaster Item,,271A6454,SPSI,Non-Sterile Supplies A6454,,Per Svc,0.01
Chargemaster Item,,271B4082,SPSI,Non-Sterile Supplies B4082,,Per Svc,0.01
Chargemaster Item,,271B4082,SPSI,Non-Sterile Supplies B4082,,Per Svc,0.01
Chargemaster Item,,271B4082,SPSI,Non-Sterile Supplies B4082,,Per Svc,0.01
Chargemaster Item,,271B4082,SPSI,Non-Sterile Supplies B4082,,Per Svc,0.01
Chargemaster Item,,271B4087,SPSI,Non-Sterile Supplies B4087,,Per Svc,0.01
Chargemaster Item,,271B4087,SPSI,Non-Sterile Supplies B4087,,Per Svc,0.01
Chargemaster Item,,271B4087,SPSI,Non-Sterile Supplies B4087,,Per Svc,0.01
Chargemaster Item,,271B4087,SPSI,Non-Sterile Supplies B4087,,Per Svc,0.01
Chargemaster Item,,271B4088,SPSI,Non-Sterile Supplies B4088,,Per Svc,0.01
Chargemaster Item,,271B4088,SPSI,Non-Sterile Supplies B4088,,Per Svc,0.01
Chargemaster Item,,271B4088,SPSI,Non-Sterile Supplies B4088,,Per Svc,0.01
Chargemaster Item,,271B4088,SPSI,Non-Sterile Supplies B4088,,Per Svc,0.01
Chargemaster Item,,271C1713,SPSI,Non-Sterile Supplies C1713,,Per Svc,0.01
Chargemaster Item,,271C1713,SPSI,Non-Sterile Supplies C1713,,Per Svc,0.01
Chargemaster Item,,271C1713,SPSI,Non-Sterile Supplies C1713,,Per Svc,0.01
Chargemaster Item,,271C1713,SPSI,Non-Sterile Supplies C1713,,Per Svc,0.01
Chargemaster Item,,271C1715,SPSI,Non-Sterile Supplies C1715,,Per Svc,0.01
Chargemaster Item,,271C1715,SPSI,Non-Sterile Supplies C1715,,Per Svc,0.01
Chargemaster Item,,271C1715,SPSI,Non-Sterile Supplies C1715,,Per Svc,0.01
Chargemaster Item,,271C1715,SPSI,Non-Sterile Supplies C1715,,Per Svc,0.01
Chargemaster Item,,271C1716,SPSI,Non-Sterile Supplies C1716,,Per Svc,0.01
Chargemaster Item,,271C1716,SPSI,Non-Sterile Supplies C1716,,Per Svc,0.01
Chargemaster Item,,271C1716,SPSI,Non-Sterile Supplies C1716,,Per Svc,0.01
Chargemaster Item,,271C1716,SPSI,Non-Sterile Supplies C1716,,Per Svc,0.01
Chargemaster Item,,271C1721,SPSI,Non-Sterile Supplies C1721,,Per Svc,0.01
Chargemaster Item,,271C1721,SPSI,Non-Sterile Supplies C1721,,Per Svc,0.01
Chargemaster Item,,271C1721,SPSI,Non-Sterile Supplies C1721,,Per Svc,0.01
Chargemaster Item,,271C1721,SPSI,Non-Sterile Supplies C1721,,Per Svc,0.01
Chargemaster Item,,271C1722,SPSI,Non-Sterile Supplies C1722,,Per Svc,0.01
Chargemaster Item,,271C1722,SPSI,Non-Sterile Supplies C1722,,Per Svc,0.01
Chargemaster Item,,271C1722,SPSI,Non-Sterile Supplies C1722,,Per Svc,0.01
Chargemaster Item,,271C1722,SPSI,Non-Sterile Supplies C1722,,Per Svc,0.01
Chargemaster Item,,271C1724,SPSI,Non-Sterile Supplies C1724,,Per Svc,0.01
Chargemaster Item,,271C1724,SPSI,Non-Sterile Supplies C1724,,Per Svc,0.01
Chargemaster Item,,271C1724,SPSI,Non-Sterile Supplies C1724,,Per Svc,0.01
Chargemaster Item,,271C1724,SPSI,Non-Sterile Supplies C1724,,Per Svc,0.01
Chargemaster Item,,271C1725,SPSI,Non-Sterile Supplies C1725,,Per Svc,0.01
Chargemaster Item,,271C1725,SPSI,Non-Sterile Supplies C1725,,Per Svc,0.01
Chargemaster Item,,271C1725,SPSI,Non-Sterile Supplies C1725,,Per Svc,0.01
Chargemaster Item,,271C1725,SPSI,Non-Sterile Supplies C1725,,Per Svc,0.01
Chargemaster Item,,271C1726,SPSI,Non-Sterile Supplies C1726,,Per Svc,0.01
Chargemaster Item,,271C1726,SPSI,Non-Sterile Supplies C1726,,Per Svc,0.01
Chargemaster Item,,271C1726,SPSI,Non-Sterile Supplies C1726,,Per Svc,0.01
Chargemaster Item,,271C1726,SPSI,Non-Sterile Supplies C1726,,Per Svc,0.01
Chargemaster Item,,271C1727,SPSI,Non-Sterile Supplies C1727,,Per Svc,0.01
Chargemaster Item,,271C1727,SPSI,Non-Sterile Supplies C1727,,Per Svc,0.01
Chargemaster Item,,271C1727,SPSI,Non-Sterile Supplies C1727,,Per Svc,0.01
Chargemaster Item,,271C1727,SPSI,Non-Sterile Supplies C1727,,Per Svc,0.01
Chargemaster Item,,271C1729,SPSI,Non-Sterile Supplies C1729,,Per Svc,0.01
Chargemaster Item,,271C1729,SPSI,Non-Sterile Supplies C1729,,Per Svc,0.01
Chargemaster Item,,271C1729,SPSI,Non-Sterile Supplies C1729,,Per Svc,0.01
Chargemaster Item,,271C1729,SPSI,Non-Sterile Supplies C1729,,Per Svc,0.01
Chargemaster Item,,271C1730,SPSI,Non-Sterile Supplies C1730,,Per Svc,0.01
Chargemaster Item,,271C1730,SPSI,Non-Sterile Supplies C1730,,Per Svc,0.01
Chargemaster Item,,271C1730,SPSI,Non-Sterile Supplies C1730,,Per Svc,0.01
Chargemaster Item,,271C1730,SPSI,Non-Sterile Supplies C1730,,Per Svc,0.01
Chargemaster Item,,271C1731,SPSI,Non-Sterile Supplies C1731,,Per Svc,0.01
Chargemaster Item,,271C1731,SPSI,Non-Sterile Supplies C1731,,Per Svc,0.01
Chargemaster Item,,271C1731,SPSI,Non-Sterile Supplies C1731,,Per Svc,0.01
Chargemaster Item,,271C1731,SPSI,Non-Sterile Supplies C1731,,Per Svc,0.01
Chargemaster Item,,271C1733,SPSI,Non-Sterile Supplies C1733,,Per Svc,0.01
Chargemaster Item,,271C1733,SPSI,Non-Sterile Supplies C1733,,Per Svc,0.01
Chargemaster Item,,271C1733,SPSI,Non-Sterile Supplies C1733,,Per Svc,0.01
Chargemaster Item,,271C1733,SPSI,Non-Sterile Supplies C1733,,Per Svc,0.01
Chargemaster Item,,271C1750,SPSI,Non-Sterile Supplies C1750,,Per Svc,0.01
Chargemaster Item,,271C1750,SPSI,Non-Sterile Supplies C1750,,Per Svc,0.01
Chargemaster Item,,271C1750,SPSI,Non-Sterile Supplies C1750,,Per Svc,0.01
Chargemaster Item,,271C1750,SPSI,Non-Sterile Supplies C1750,,Per Svc,0.01
Chargemaster Item,,271C1751,SPSI,Non-Sterile Supplies C1751,,Per Svc,0.01
Chargemaster Item,,271C1751,SPSI,Non-Sterile Supplies C1751,,Per Svc,0.01
Chargemaster Item,,271C1751,SPSI,Non-Sterile Supplies C1751,,Per Svc,0.01
Chargemaster Item,,271C1751,SPSI,Non-Sterile Supplies C1751,,Per Svc,0.01
Chargemaster Item,,271C1752,SPSI,Non-Sterile Supplies C1752,,Per Svc,0.01
Chargemaster Item,,271C1752,SPSI,Non-Sterile Supplies C1752,,Per Svc,0.01
Chargemaster Item,,271C1752,SPSI,Non-Sterile Supplies C1752,,Per Svc,0.01
Chargemaster Item,,271C1752,SPSI,Non-Sterile Supplies C1752,,Per Svc,0.01
Chargemaster Item,,271C1753,SPSI,Non-Sterile Supplies C1753,,Per Svc,0.01
Chargemaster Item,,271C1753,SPSI,Non-Sterile Supplies C1753,,Per Svc,0.01
Chargemaster Item,,271C1753,SPSI,Non-Sterile Supplies C1753,,Per Svc,0.01
Chargemaster Item,,271C1753,SPSI,Non-Sterile Supplies C1753,,Per Svc,0.01
Chargemaster Item,,271C1755,SPSI,Non-Sterile Supplies C1755,,Per Svc,0.01
Chargemaster Item,,271C1755,SPSI,Non-Sterile Supplies C1755,,Per Svc,0.01
Chargemaster Item,,271C1755,SPSI,Non-Sterile Supplies C1755,,Per Svc,0.01
Chargemaster Item,,271C1755,SPSI,Non-Sterile Supplies C1755,,Per Svc,0.01
Chargemaster Item,,271C1757,SPSI,Non-Sterile Supplies C1757,,Per Svc,0.01
Chargemaster Item,,271C1757,SPSI,Non-Sterile Supplies C1757,,Per Svc,0.01
Chargemaster Item,,271C1757,SPSI,Non-Sterile Supplies C1757,,Per Svc,0.01
Chargemaster Item,,271C1757,SPSI,Non-Sterile Supplies C1757,,Per Svc,0.01
Chargemaster Item,,271C1758,SPSI,Non-Sterile Supplies C1758,,Per Svc,0.01
Chargemaster Item,,271C1758,SPSI,Non-Sterile Supplies C1758,,Per Svc,0.01
Chargemaster Item,,271C1758,SPSI,Non-Sterile Supplies C1758,,Per Svc,0.01
Chargemaster Item,,271C1758,SPSI,Non-Sterile Supplies C1758,,Per Svc,0.01
Chargemaster Item,,271C1760,SPSI,Non-Sterile Supplies C1760,,Per Svc,0.01
Chargemaster Item,,271C1760,SPSI,Non-Sterile Supplies C1760,,Per Svc,0.01
Chargemaster Item,,271C1760,SPSI,Non-Sterile Supplies C1760,,Per Svc,0.01
Chargemaster Item,,271C1760,SPSI,Non-Sterile Supplies C1760,,Per Svc,0.01
Chargemaster Item,,271C1762,SPSI,Non-Sterile Supplies C1762,,Per Svc,0.01
Chargemaster Item,,271C1762,SPSI,Non-Sterile Supplies C1762,,Per Svc,0.01
Chargemaster Item,,271C1762,SPSI,Non-Sterile Supplies C1762,,Per Svc,0.01
Chargemaster Item,,271C1762,SPSI,Non-Sterile Supplies C1762,,Per Svc,0.01
Chargemaster Item,,271C1763,SPSI,Non-Sterile Supplies C1763,,Per Svc,0.01
Chargemaster Item,,271C1763,SPSI,Non-Sterile Supplies C1763,,Per Svc,0.01
Chargemaster Item,,271C1763,SPSI,Non-Sterile Supplies C1763,,Per Svc,0.01
Chargemaster Item,,271C1763,SPSI,Non-Sterile Supplies C1763,,Per Svc,0.01
Chargemaster Item,,271C1764,SPSI,Non-Sterile Supplies C1764,,Per Svc,0.01
Chargemaster Item,,271C1764,SPSI,Non-Sterile Supplies C1764,,Per Svc,0.01
Chargemaster Item,,271C1764,SPSI,Non-Sterile Supplies C1764,,Per Svc,0.01
Chargemaster Item,,271C1764,SPSI,Non-Sterile Supplies C1764,,Per Svc,0.01
Chargemaster Item,,271C1766,SPSI,Non-Sterile Supplies C1766,,Per Svc,0.01
Chargemaster Item,,271C1766,SPSI,Non-Sterile Supplies C1766,,Per Svc,0.01
Chargemaster Item,,271C1766,SPSI,Non-Sterile Supplies C1766,,Per Svc,0.01
Chargemaster Item,,271C1766,SPSI,Non-Sterile Supplies C1766,,Per Svc,0.01
Chargemaster Item,,271C1767,SPSI,Non-Sterile Supplies C1767,,Per Svc,0.01
Chargemaster Item,,271C1767,SPSI,Non-Sterile Supplies C1767,,Per Svc,0.01
Chargemaster Item,,271C1767,SPSI,Non-Sterile Supplies C1767,,Per Svc,0.01
Chargemaster Item,,271C1767,SPSI,Non-Sterile Supplies C1767,,Per Svc,0.01
Chargemaster Item,,271C1768,SPSI,Non-Sterile Supplies C1768,,Per Svc,0.01
Chargemaster Item,,271C1768,SPSI,Non-Sterile Supplies C1768,,Per Svc,0.01
Chargemaster Item,,271C1768,SPSI,Non-Sterile Supplies C1768,,Per Svc,0.01
Chargemaster Item,,271C1768,SPSI,Non-Sterile Supplies C1768,,Per Svc,0.01
Chargemaster Item,,271C1769,SPSI,Non-Sterile Supplies C1769,,Per Svc,0.01
Chargemaster Item,,271C1769,SPSI,Non-Sterile Supplies C1769,,Per Svc,0.01
Chargemaster Item,,271C1769,SPSI,Non-Sterile Supplies C1769,,Per Svc,0.01
Chargemaster Item,,271C1769,SPSI,Non-Sterile Supplies C1769,,Per Svc,0.01
Chargemaster Item,,271C1771,SPSI,Non-Sterile Supplies C1771,,Per Svc,0.01
Chargemaster Item,,271C1771,SPSI,Non-Sterile Supplies C1771,,Per Svc,0.01
Chargemaster Item,,271C1771,SPSI,Non-Sterile Supplies C1771,,Per Svc,0.01
Chargemaster Item,,271C1771,SPSI,Non-Sterile Supplies C1771,,Per Svc,0.01
Chargemaster Item,,271C1772,SPSI,Non-Sterile Supplies C1772,,Per Svc,0.01
Chargemaster Item,,271C1772,SPSI,Non-Sterile Supplies C1772,,Per Svc,0.01
Chargemaster Item,,271C1772,SPSI,Non-Sterile Supplies C1772,,Per Svc,0.01
Chargemaster Item,,271C1772,SPSI,Non-Sterile Supplies C1772,,Per Svc,0.01
Chargemaster Item,,271C1773,SPSI,Non-Sterile Supplies C1773,,Per Svc,0.01
Chargemaster Item,,271C1773,SPSI,Non-Sterile Supplies C1773,,Per Svc,0.01
Chargemaster Item,,271C1773,SPSI,Non-Sterile Supplies C1773,,Per Svc,0.01
Chargemaster Item,,271C1773,SPSI,Non-Sterile Supplies C1773,,Per Svc,0.01
Chargemaster Item,,271C1776,SPSI,Non-Sterile Supplies C1776,,Per Svc,0.01
Chargemaster Item,,271C1776,SPSI,Non-Sterile Supplies C1776,,Per Svc,0.01
Chargemaster Item,,271C1776,SPSI,Non-Sterile Supplies C1776,,Per Svc,0.01
Chargemaster Item,,271C1776,SPSI,Non-Sterile Supplies C1776,,Per Svc,0.01
Chargemaster Item,,271C1777,SPSI,Non-Sterile Supplies C1777,,Per Svc,0.01
Chargemaster Item,,271C1777,SPSI,Non-Sterile Supplies C1777,,Per Svc,0.01
Chargemaster Item,,271C1777,SPSI,Non-Sterile Supplies C1777,,Per Svc,0.01
Chargemaster Item,,271C1777,SPSI,Non-Sterile Supplies C1777,,Per Svc,0.01
Chargemaster Item,,271C1778,SPSI,Non-Sterile Supplies C1778,,Per Svc,0.01
Chargemaster Item,,271C1778,SPSI,Non-Sterile Supplies C1778,,Per Svc,0.01
Chargemaster Item,,271C1778,SPSI,Non-Sterile Supplies C1778,,Per Svc,0.01
Chargemaster Item,,271C1778,SPSI,Non-Sterile Supplies C1778,,Per Svc,0.01
Chargemaster Item,,271C1781,SPSI,Non-Sterile Supplies C1781,,Per Svc,0.01
Chargemaster Item,,271C1781,SPSI,Non-Sterile Supplies C1781,,Per Svc,0.01
Chargemaster Item,,271C1781,SPSI,Non-Sterile Supplies C1781,,Per Svc,0.01
Chargemaster Item,,271C1781,SPSI,Non-Sterile Supplies C1781,,Per Svc,0.01
Chargemaster Item,,271C1783,SPSI,Non-Sterile Supplies C1783,,Per Svc,0.01
Chargemaster Item,,271C1783,SPSI,Non-Sterile Supplies C1783,,Per Svc,0.01
Chargemaster Item,,271C1783,SPSI,Non-Sterile Supplies C1783,,Per Svc,0.01
Chargemaster Item,,271C1783,SPSI,Non-Sterile Supplies C1783,,Per Svc,0.01
Chargemaster Item,,271C1785,SPSI,Non-Sterile Supplies C1785,,Per Svc,0.01
Chargemaster Item,,271C1785,SPSI,Non-Sterile Supplies C1785,,Per Svc,0.01
Chargemaster Item,,271C1785,SPSI,Non-Sterile Supplies C1785,,Per Svc,0.01
Chargemaster Item,,271C1785,SPSI,Non-Sterile Supplies C1785,,Per Svc,0.01
Chargemaster Item,,271C1786,SPSI,Non-Sterile Supplies C1786,,Per Svc,0.01
Chargemaster Item,,271C1786,SPSI,Non-Sterile Supplies C1786,,Per Svc,0.01
Chargemaster Item,,271C1786,SPSI,Non-Sterile Supplies C1786,,Per Svc,0.01
Chargemaster Item,,271C1786,SPSI,Non-Sterile Supplies C1786,,Per Svc,0.01
Chargemaster Item,,271C1787,SPSI,Non-Sterile Supplies C1787,,Per Svc,0.01
Chargemaster Item,,271C1787,SPSI,Non-Sterile Supplies C1787,,Per Svc,0.01
Chargemaster Item,,271C1787,SPSI,Non-Sterile Supplies C1787,,Per Svc,0.01
Chargemaster Item,,271C1787,SPSI,Non-Sterile Supplies C1787,,Per Svc,0.01
Chargemaster Item,,271C1788,SPSI,Non-Sterile Supplies C1788,,Per Svc,0.01
Chargemaster Item,,271C1788,SPSI,Non-Sterile Supplies C1788,,Per Svc,0.01
Chargemaster Item,,271C1788,SPSI,Non-Sterile Supplies C1788,,Per Svc,0.01
Chargemaster Item,,271C1788,SPSI,Non-Sterile Supplies C1788,,Per Svc,0.01
Chargemaster Item,,271C1789,SPSI,Non-Sterile Supplies C1789,,Per Svc,0.01
Chargemaster Item,,271C1789,SPSI,Non-Sterile Supplies C1789,,Per Svc,0.01
Chargemaster Item,,271C1789,SPSI,Non-Sterile Supplies C1789,,Per Svc,0.01
Chargemaster Item,,271C1789,SPSI,Non-Sterile Supplies C1789,,Per Svc,0.01
Chargemaster Item,,271C1817,SPSI,Non-Sterile Supplies C1817,,Per Svc,0.01
Chargemaster Item,,271C1817,SPSI,Non-Sterile Supplies C1817,,Per Svc,0.01
Chargemaster Item,,271C1817,SPSI,Non-Sterile Supplies C1817,,Per Svc,0.01
Chargemaster Item,,271C1817,SPSI,Non-Sterile Supplies C1817,,Per Svc,0.01
Chargemaster Item,,271C1821,SPSI,Non-Sterile Supplies C1821,,Per Svc,0.01
Chargemaster Item,,271C1821,SPSI,Non-Sterile Supplies C1821,,Per Svc,0.01
Chargemaster Item,,271C1821,SPSI,Non-Sterile Supplies C1821,,Per Svc,0.01
Chargemaster Item,,271C1821,SPSI,Non-Sterile Supplies C1821,,Per Svc,0.01
Chargemaster Item,,271C1874,SPSI,Non-Sterile Supplies C1874,,Per Svc,0.01
Chargemaster Item,,271C1874,SPSI,Non-Sterile Supplies C1874,,Per Svc,0.01
Chargemaster Item,,271C1874,SPSI,Non-Sterile Supplies C1874,,Per Svc,0.01
Chargemaster Item,,271C1874,SPSI,Non-Sterile Supplies C1874,,Per Svc,0.01
Chargemaster Item,,271C1875,SPSI,Non-Sterile Supplies C1875,,Per Svc,0.01
Chargemaster Item,,271C1875,SPSI,Non-Sterile Supplies C1875,,Per Svc,0.01
Chargemaster Item,,271C1875,SPSI,Non-Sterile Supplies C1875,,Per Svc,0.01
Chargemaster Item,,271C1875,SPSI,Non-Sterile Supplies C1875,,Per Svc,0.01
Chargemaster Item,,271C1876,SPSI,Non-Sterile Supplies C1876,,Per Svc,0.01
Chargemaster Item,,271C1876,SPSI,Non-Sterile Supplies C1876,,Per Svc,0.01
Chargemaster Item,,271C1876,SPSI,Non-Sterile Supplies C1876,,Per Svc,0.01
Chargemaster Item,,271C1876,SPSI,Non-Sterile Supplies C1876,,Per Svc,0.01
Chargemaster Item,,271C1880,SPSI,Non-Sterile Supplies C1880,,Per Svc,0.01
Chargemaster Item,,271C1880,SPSI,Non-Sterile Supplies C1880,,Per Svc,0.01
Chargemaster Item,,271C1880,SPSI,Non-Sterile Supplies C1880,,Per Svc,0.01
Chargemaster Item,,271C1880,SPSI,Non-Sterile Supplies C1880,,Per Svc,0.01
Chargemaster Item,,271C1881,SPSI,Non-Sterile Supplies C1881,,Per Svc,0.01
Chargemaster Item,,271C1881,SPSI,Non-Sterile Supplies C1881,,Per Svc,0.01
Chargemaster Item,,271C1881,SPSI,Non-Sterile Supplies C1881,,Per Svc,0.01
Chargemaster Item,,271C1881,SPSI,Non-Sterile Supplies C1881,,Per Svc,0.01
Chargemaster Item,,271C1882,SPSI,Non-Sterile Supplies C1882,,Per Svc,0.01
Chargemaster Item,,271C1882,SPSI,Non-Sterile Supplies C1882,,Per Svc,0.01
Chargemaster Item,,271C1882,SPSI,Non-Sterile Supplies C1882,,Per Svc,0.01
Chargemaster Item,,271C1882,SPSI,Non-Sterile Supplies C1882,,Per Svc,0.01
Chargemaster Item,,271C1883,SPSI,Non-Sterile Supplies C1883,,Per Svc,0.01
Chargemaster Item,,271C1883,SPSI,Non-Sterile Supplies C1883,,Per Svc,0.01
Chargemaster Item,,271C1883,SPSI,Non-Sterile Supplies C1883,,Per Svc,0.01
Chargemaster Item,,271C1883,SPSI,Non-Sterile Supplies C1883,,Per Svc,0.01
Chargemaster Item,,271C1884,SPSI,Non-Sterile Supplies C1884,,Per Svc,0.01
Chargemaster Item,,271C1884,SPSI,Non-Sterile Supplies C1884,,Per Svc,0.01
Chargemaster Item,,271C1884,SPSI,Non-Sterile Supplies C1884,,Per Svc,0.01
Chargemaster Item,,271C1884,SPSI,Non-Sterile Supplies C1884,,Per Svc,0.01
Chargemaster Item,,271C1887,SPSI,Non-Sterile Supplies C1887,,Per Svc,0.01
Chargemaster Item,,271C1887,SPSI,Non-Sterile Supplies C1887,,Per Svc,0.01
Chargemaster Item,,271C1887,SPSI,Non-Sterile Supplies C1887,,Per Svc,0.01
Chargemaster Item,,271C1887,SPSI,Non-Sterile Supplies C1887,,Per Svc,0.01
Chargemaster Item,,271C1889,SPSI,Non-Sterile Supplies C1889,,Per Svc,0.01
Chargemaster Item,,271C1889,SPSI,Non-Sterile Supplies C1889,,Per Svc,0.01
Chargemaster Item,,271C1889,SPSI,Non-Sterile Supplies C1889,,Per Svc,0.01
Chargemaster Item,,271C1889,SPSI,Non-Sterile Supplies C1889,,Per Svc,0.01
Chargemaster Item,,271C1892,SPSI,Non-Sterile Supplies C1892,,Per Svc,0.01
Chargemaster Item,,271C1892,SPSI,Non-Sterile Supplies C1892,,Per Svc,0.01
Chargemaster Item,,271C1892,SPSI,Non-Sterile Supplies C1892,,Per Svc,0.01
Chargemaster Item,,271C1892,SPSI,Non-Sterile Supplies C1892,,Per Svc,0.01
Chargemaster Item,,271C1893,SPSI,Non-Sterile Supplies C1893,,Per Svc,0.01
Chargemaster Item,,271C1893,SPSI,Non-Sterile Supplies C1893,,Per Svc,0.01
Chargemaster Item,,271C1893,SPSI,Non-Sterile Supplies C1893,,Per Svc,0.01
Chargemaster Item,,271C1893,SPSI,Non-Sterile Supplies C1893,,Per Svc,0.01
Chargemaster Item,,271C1894,SPSI,Non-Sterile Supplies C1894,,Per Svc,0.01
Chargemaster Item,,271C1894,SPSI,Non-Sterile Supplies C1894,,Per Svc,0.01
Chargemaster Item,,271C1894,SPSI,Non-Sterile Supplies C1894,,Per Svc,0.01
Chargemaster Item,,271C1894,SPSI,Non-Sterile Supplies C1894,,Per Svc,0.01
Chargemaster Item,,271C1897,SPSI,Non-Sterile Supplies C1897,,Per Svc,0.01
Chargemaster Item,,271C1897,SPSI,Non-Sterile Supplies C1897,,Per Svc,0.01
Chargemaster Item,,271C1897,SPSI,Non-Sterile Supplies C1897,,Per Svc,0.01
Chargemaster Item,,271C1897,SPSI,Non-Sterile Supplies C1897,,Per Svc,0.01
Chargemaster Item,,271C1898,SPSI,Non-Sterile Supplies C1898,,Per Svc,0.01
Chargemaster Item,,271C1898,SPSI,Non-Sterile Supplies C1898,,Per Svc,0.01
Chargemaster Item,,271C1898,SPSI,Non-Sterile Supplies C1898,,Per Svc,0.01
Chargemaster Item,,271C1898,SPSI,Non-Sterile Supplies C1898,,Per Svc,0.01
Chargemaster Item,,271C1900,SPSI,Non-Sterile Supplies C1900,,Per Svc,0.01
Chargemaster Item,,271C1900,SPSI,Non-Sterile Supplies C1900,,Per Svc,0.01
Chargemaster Item,,271C1900,SPSI,Non-Sterile Supplies C1900,,Per Svc,0.01
Chargemaster Item,,271C1900,SPSI,Non-Sterile Supplies C1900,,Per Svc,0.01
Chargemaster Item,,271C2617,SPSI,Non-Sterile Supplies C2617,,Per Svc,0.01
Chargemaster Item,,271C2617,SPSI,Non-Sterile Supplies C2617,,Per Svc,0.01
Chargemaster Item,,271C2617,SPSI,Non-Sterile Supplies C2617,,Per Svc,0.01
Chargemaster Item,,271C2617,SPSI,Non-Sterile Supplies C2617,,Per Svc,0.01
Chargemaster Item,,271C2618,SPSI,Non-Sterile Supplies C2618,,Per Svc,0.01
Chargemaster Item,,271C2618,SPSI,Non-Sterile Supplies C2618,,Per Svc,0.01
Chargemaster Item,,271C2618,SPSI,Non-Sterile Supplies C2618,,Per Svc,0.01
Chargemaster Item,,271C2618,SPSI,Non-Sterile Supplies C2618,,Per Svc,0.01
Chargemaster Item,,271C2623,SPSI,Non-Sterile Supplies C2623,,Per Svc,0.01
Chargemaster Item,,271C2623,SPSI,Non-Sterile Supplies C2623,,Per Svc,0.01
Chargemaster Item,,271C2623,SPSI,Non-Sterile Supplies C2623,,Per Svc,0.01
Chargemaster Item,,271C2623,SPSI,Non-Sterile Supplies C2623,,Per Svc,0.01
Chargemaster Item,,271C2625,SPSI,Non-Sterile Supplies C2625,,Per Svc,0.01
Chargemaster Item,,271C2625,SPSI,Non-Sterile Supplies C2625,,Per Svc,0.01
Chargemaster Item,,271C2625,SPSI,Non-Sterile Supplies C2625,,Per Svc,0.01
Chargemaster Item,,271C2625,SPSI,Non-Sterile Supplies C2625,,Per Svc,0.01
Chargemaster Item,,271C2627,SPSI,Non-Sterile Supplies C2627,,Per Svc,0.01
Chargemaster Item,,271C2627,SPSI,Non-Sterile Supplies C2627,,Per Svc,0.01
Chargemaster Item,,271C2627,SPSI,Non-Sterile Supplies C2627,,Per Svc,0.01
Chargemaster Item,,271C2627,SPSI,Non-Sterile Supplies C2627,,Per Svc,0.01
Chargemaster Item,,271C2628,SPSI,Non-Sterile Supplies C2628,,Per Svc,0.01
Chargemaster Item,,271C2628,SPSI,Non-Sterile Supplies C2628,,Per Svc,0.01
Chargemaster Item,,271C2628,SPSI,Non-Sterile Supplies C2628,,Per Svc,0.01
Chargemaster Item,,271C2628,SPSI,Non-Sterile Supplies C2628,,Per Svc,0.01
Chargemaster Item,,271C2630,SPSI,Non-Sterile Supplies C2630,,Per Svc,0.01
Chargemaster Item,,271C2630,SPSI,Non-Sterile Supplies C2630,,Per Svc,0.01
Chargemaster Item,,271C2630,SPSI,Non-Sterile Supplies C2630,,Per Svc,0.01
Chargemaster Item,,271C2630,SPSI,Non-Sterile Supplies C2630,,Per Svc,0.01
Chargemaster Item,,271C2639,SPSI,Non-Sterile Supplies C2639,,Per Svc,0.01
Chargemaster Item,,271C2639,SPSI,Non-Sterile Supplies C2639,,Per Svc,0.01
Chargemaster Item,,271C2639,SPSI,Non-Sterile Supplies C2639,,Per Svc,0.01
Chargemaster Item,,271C2639,SPSI,Non-Sterile Supplies C2639,,Per Svc,0.01
Chargemaster Item,,271C9250,SPSI,Non-Sterile Supplies C9250,,Per Svc,0.01
Chargemaster Item,,271C9250,SPSI,Non-Sterile Supplies C9250,,Per Svc,0.01
Chargemaster Item,,271C9250,SPSI,Non-Sterile Supplies C9250,,Per Svc,0.01
Chargemaster Item,,271C9250,SPSI,Non-Sterile Supplies C9250,,Per Svc,0.01
Chargemaster Item,,271C9352,SPSI,Non-Sterile Supplies C9352,,Per Svc,0.01
Chargemaster Item,,271C9352,SPSI,Non-Sterile Supplies C9352,,Per Svc,0.01
Chargemaster Item,,271C9352,SPSI,Non-Sterile Supplies C9352,,Per Svc,0.01
Chargemaster Item,,271C9352,SPSI,Non-Sterile Supplies C9352,,Per Svc,0.01
Chargemaster Item,,271C9353,SPSI,Non-Sterile Supplies C9353,,Per Svc,0.01
Chargemaster Item,,271C9353,SPSI,Non-Sterile Supplies C9353,,Per Svc,0.01
Chargemaster Item,,271C9353,SPSI,Non-Sterile Supplies C9353,,Per Svc,0.01
Chargemaster Item,,271C9353,SPSI,Non-Sterile Supplies C9353,,Per Svc,0.01
Chargemaster Item,,271C9363,SPSI,Non-Sterile Supplies C9363,,Per Svc,0.01
Chargemaster Item,,271C9363,SPSI,Non-Sterile Supplies C9363,,Per Svc,0.01
Chargemaster Item,,271C9363,SPSI,Non-Sterile Supplies C9363,,Per Svc,0.01
Chargemaster Item,,271C9363,SPSI,Non-Sterile Supplies C9363,,Per Svc,0.01
Chargemaster Item,,271E0191,SPSI,Non-Sterile Supplies E0191,,Per Svc,0.01
Chargemaster Item,,271E0191,SPSI,Non-Sterile Supplies E0191,,Per Svc,0.01
Chargemaster Item,,271E0191,SPSI,Non-Sterile Supplies E0191,,Per Svc,0.01
Chargemaster Item,,271E0191,SPSI,Non-Sterile Supplies E0191,,Per Svc,0.01
Chargemaster Item,,271E0235,SPSI,Non-Sterile Supplies E0235,,Per Svc,0.01
Chargemaster Item,,271E0235,SPSI,Non-Sterile Supplies E0235,,Per Svc,0.01
Chargemaster Item,,271E0235,SPSI,Non-Sterile Supplies E0235,,Per Svc,0.01
Chargemaster Item,,271E0235,SPSI,Non-Sterile Supplies E0235,,Per Svc,0.01
Chargemaster Item,,271L0113,SPSI,Non-Sterile Supplies L0113,,Per Svc,0.01
Chargemaster Item,,271L0113,SPSI,Non-Sterile Supplies L0113,,Per Svc,0.01
Chargemaster Item,,271L0113,SPSI,Non-Sterile Supplies L0113,,Per Svc,0.01
Chargemaster Item,,271L0113,SPSI,Non-Sterile Supplies L0113,,Per Svc,0.01
Chargemaster Item,,271L0120,SPSI,Non-Sterile Supplies L0120,,Per Svc,0.01
Chargemaster Item,,271L0120,SPSI,Non-Sterile Supplies L0120,,Per Svc,0.01
Chargemaster Item,,271L0120,SPSI,Non-Sterile Supplies L0120,,Per Svc,0.01
Chargemaster Item,,271L0120,SPSI,Non-Sterile Supplies L0120,,Per Svc,0.01
Chargemaster Item,,271L0172,SPSI,Non-Sterile Supplies L0172,,Per Svc,0.01
Chargemaster Item,,271L0172,SPSI,Non-Sterile Supplies L0172,,Per Svc,0.01
Chargemaster Item,,271L0172,SPSI,Non-Sterile Supplies L0172,,Per Svc,0.01
Chargemaster Item,,271L0172,SPSI,Non-Sterile Supplies L0172,,Per Svc,0.01
Chargemaster Item,,271L0174,SPSI,Non-Sterile Supplies L0174,,Per Svc,0.01
Chargemaster Item,,271L0174,SPSI,Non-Sterile Supplies L0174,,Per Svc,0.01
Chargemaster Item,,271L0174,SPSI,Non-Sterile Supplies L0174,,Per Svc,0.01
Chargemaster Item,,271L0174,SPSI,Non-Sterile Supplies L0174,,Per Svc,0.01
Chargemaster Item,,271L0625,SPSI,Non-Sterile Supplies L0625,,Per Svc,0.01
Chargemaster Item,,271L0625,SPSI,Non-Sterile Supplies L0625,,Per Svc,0.01
Chargemaster Item,,271L0625,SPSI,Non-Sterile Supplies L0625,,Per Svc,0.01
Chargemaster Item,,271L0625,SPSI,Non-Sterile Supplies L0625,,Per Svc,0.01
Chargemaster Item,,271L1820,SPSI,Non-Sterile Supplies L1820,,Per Svc,0.01
Chargemaster Item,,271L1820,SPSI,Non-Sterile Supplies L1820,,Per Svc,0.01
Chargemaster Item,,271L1820,SPSI,Non-Sterile Supplies L1820,,Per Svc,0.01
Chargemaster Item,,271L1820,SPSI,Non-Sterile Supplies L1820,,Per Svc,0.01
Chargemaster Item,,271L1830,SPSI,Non-Sterile Supplies L1830,,Per Svc,0.01
Chargemaster Item,,271L1830,SPSI,Non-Sterile Supplies L1830,,Per Svc,0.01
Chargemaster Item,,271L1830,SPSI,Non-Sterile Supplies L1830,,Per Svc,0.01
Chargemaster Item,,271L1830,SPSI,Non-Sterile Supplies L1830,,Per Svc,0.01
Chargemaster Item,,271L1832,SPSI,Non-Sterile Supplies L1832,,Per Svc,0.01
Chargemaster Item,,271L1832,SPSI,Non-Sterile Supplies L1832,,Per Svc,0.01
Chargemaster Item,,271L1832,SPSI,Non-Sterile Supplies L1832,,Per Svc,0.01
Chargemaster Item,,271L1832,SPSI,Non-Sterile Supplies L1832,,Per Svc,0.01
Chargemaster Item,,271L1902,SPSI,Non-Sterile Supplies L1902,,Per Svc,0.01
Chargemaster Item,,271L1902,SPSI,Non-Sterile Supplies L1902,,Per Svc,0.01
Chargemaster Item,,271L1902,SPSI,Non-Sterile Supplies L1902,,Per Svc,0.01
Chargemaster Item,,271L1902,SPSI,Non-Sterile Supplies L1902,,Per Svc,0.01
Chargemaster Item,,271L1930,SPSI,Non-Sterile Supplies L1930,,Per Svc,0.01
Chargemaster Item,,271L1930,SPSI,Non-Sterile Supplies L1930,,Per Svc,0.01
Chargemaster Item,,271L1930,SPSI,Non-Sterile Supplies L1930,,Per Svc,0.01
Chargemaster Item,,271L1930,SPSI,Non-Sterile Supplies L1930,,Per Svc,0.01
Chargemaster Item,,271L3260,SPSI,Non-Sterile Supplies L3260,,Per Svc,0.01
Chargemaster Item,,271L3260,SPSI,Non-Sterile Supplies L3260,,Per Svc,0.01
Chargemaster Item,,271L3260,SPSI,Non-Sterile Supplies L3260,,Per Svc,0.01
Chargemaster Item,,271L3260,SPSI,Non-Sterile Supplies L3260,,Per Svc,0.01
Chargemaster Item,,271L3650,SPSI,Non-Sterile Supplies L3650,,Per Svc,0.01
Chargemaster Item,,271L3650,SPSI,Non-Sterile Supplies L3650,,Per Svc,0.01
Chargemaster Item,,271L3650,SPSI,Non-Sterile Supplies L3650,,Per Svc,0.01
Chargemaster Item,,271L3650,SPSI,Non-Sterile Supplies L3650,,Per Svc,0.01
Chargemaster Item,,271L3670,SPSI,Non-Sterile Supplies L3670,,Per Svc,0.01
Chargemaster Item,,271L3670,SPSI,Non-Sterile Supplies L3670,,Per Svc,0.01
Chargemaster Item,,271L3670,SPSI,Non-Sterile Supplies L3670,,Per Svc,0.01
Chargemaster Item,,271L3670,SPSI,Non-Sterile Supplies L3670,,Per Svc,0.01
Chargemaster Item,,271L3807,SPSI,Non-Sterile Supplies L3807,,Per Svc,0.01
Chargemaster Item,,271L3807,SPSI,Non-Sterile Supplies L3807,,Per Svc,0.01
Chargemaster Item,,271L3807,SPSI,Non-Sterile Supplies L3807,,Per Svc,0.01
Chargemaster Item,,271L3807,SPSI,Non-Sterile Supplies L3807,,Per Svc,0.01
Chargemaster Item,,271L3809,SPSI,Non-Sterile Supplies L3809,,Per Svc,0.01
Chargemaster Item,,271L3809,SPSI,Non-Sterile Supplies L3809,,Per Svc,0.01
Chargemaster Item,,271L3809,SPSI,Non-Sterile Supplies L3809,,Per Svc,0.01
Chargemaster Item,,271L3809,SPSI,Non-Sterile Supplies L3809,,Per Svc,0.01
Chargemaster Item,,271L3908,SPSI,Non-Sterile Supplies L3908,,Per Svc,0.01
Chargemaster Item,,271L3908,SPSI,Non-Sterile Supplies L3908,,Per Svc,0.01
Chargemaster Item,,271L3908,SPSI,Non-Sterile Supplies L3908,,Per Svc,0.01
Chargemaster Item,,271L3908,SPSI,Non-Sterile Supplies L3908,,Per Svc,0.01
Chargemaster Item,,271L3917,SPSI,Non-Sterile Supplies L3917,,Per Svc,0.01
Chargemaster Item,,271L3917,SPSI,Non-Sterile Supplies L3917,,Per Svc,0.01
Chargemaster Item,,271L3917,SPSI,Non-Sterile Supplies L3917,,Per Svc,0.01
Chargemaster Item,,271L3917,SPSI,Non-Sterile Supplies L3917,,Per Svc,0.01
Chargemaster Item,,271L3923,SPSI,Non-Sterile Supplies L3923,,Per Svc,0.01
Chargemaster Item,,271L3923,SPSI,Non-Sterile Supplies L3923,,Per Svc,0.01
Chargemaster Item,,271L3923,SPSI,Non-Sterile Supplies L3923,,Per Svc,0.01
Chargemaster Item,,271L3923,SPSI,Non-Sterile Supplies L3923,,Per Svc,0.01
Chargemaster Item,,271L4386,SPSI,Non-Sterile Supplies L4386,,Per Svc,0.01
Chargemaster Item,,271L4386,SPSI,Non-Sterile Supplies L4386,,Per Svc,0.01
Chargemaster Item,,271L4386,SPSI,Non-Sterile Supplies L4386,,Per Svc,0.01
Chargemaster Item,,271L4386,SPSI,Non-Sterile Supplies L4386,,Per Svc,0.01
Chargemaster Item,,271L4387,SPSI,Non-Sterile Supplies L4387,,Per Svc,0.01
Chargemaster Item,,271L4387,SPSI,Non-Sterile Supplies L4387,,Per Svc,0.01
Chargemaster Item,,271L4387,SPSI,Non-Sterile Supplies L4387,,Per Svc,0.01
Chargemaster Item,,271L4387,SPSI,Non-Sterile Supplies L4387,,Per Svc,0.01
Chargemaster Item,,271L5000,SPSI,Non-Sterile Supplies L5000,,Per Svc,0.01
Chargemaster Item,,271L5000,SPSI,Non-Sterile Supplies L5000,,Per Svc,0.01
Chargemaster Item,,271L5000,SPSI,Non-Sterile Supplies L5000,,Per Svc,0.01
Chargemaster Item,,271L5000,SPSI,Non-Sterile Supplies L5000,,Per Svc,0.01
Chargemaster Item,,271L8000,SPSI,Non-Sterile Supplies L8000,,Per Svc,0.01
Chargemaster Item,,271L8000,SPSI,Non-Sterile Supplies L8000,,Per Svc,0.01
Chargemaster Item,,271L8000,SPSI,Non-Sterile Supplies L8000,,Per Svc,0.01
Chargemaster Item,,271L8000,SPSI,Non-Sterile Supplies L8000,,Per Svc,0.01
Chargemaster Item,,271L8501,SPSI,Non-Sterile Supplies L8501,,Per Svc,0.01
Chargemaster Item,,271L8501,SPSI,Non-Sterile Supplies L8501,,Per Svc,0.01
Chargemaster Item,,271L8501,SPSI,Non-Sterile Supplies L8501,,Per Svc,0.01
Chargemaster Item,,271L8501,SPSI,Non-Sterile Supplies L8501,,Per Svc,0.01
Chargemaster Item,,271L8600,SPSI,Non-Sterile Supplies L8600,,Per Svc,0.01
Chargemaster Item,,271L8600,SPSI,Non-Sterile Supplies L8600,,Per Svc,0.01
Chargemaster Item,,271L8600,SPSI,Non-Sterile Supplies L8600,,Per Svc,0.01
Chargemaster Item,,271L8600,SPSI,Non-Sterile Supplies L8600,,Per Svc,0.01
Chargemaster Item,,271L8612,SPSI,Non-Sterile Supplies L8612,,Per Svc,0.01
Chargemaster Item,,271L8612,SPSI,Non-Sterile Supplies L8612,,Per Svc,0.01
Chargemaster Item,,271L8612,SPSI,Non-Sterile Supplies L8612,,Per Svc,0.01
Chargemaster Item,,271L8612,SPSI,Non-Sterile Supplies L8612,,Per Svc,0.01
Chargemaster Item,,271L8699,SPSI,Non-Sterile Supplies L8699,,Per Svc,0.01
Chargemaster Item,,271L8699,SPSI,Non-Sterile Supplies L8699,,Per Svc,0.01
Chargemaster Item,,271L8699,SPSI,Non-Sterile Supplies L8699,,Per Svc,0.01
Chargemaster Item,,271L8699,SPSI,Non-Sterile Supplies L8699,,Per Svc,0.01
Chargemaster Item,,271Q4100,SPSI,Non-Sterile Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,271Q4100,SPSI,Non-Sterile Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,271Q4100,SPSI,Non-Sterile Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,271Q4100,SPSI,Non-Sterile Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,271Q4102,SPSI,Non-Sterile Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,271Q4102,SPSI,Non-Sterile Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,271Q4102,SPSI,Non-Sterile Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,271Q4102,SPSI,Non-Sterile Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,271Q4110,SPSI,Non-Sterile Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,271Q4110,SPSI,Non-Sterile Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,271Q4110,SPSI,Non-Sterile Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,271Q4110,SPSI,Non-Sterile Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,271Q4114,SPSI,Non-Sterile Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,271Q4114,SPSI,Non-Sterile Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,271Q4114,SPSI,Non-Sterile Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,271Q4114,SPSI,Non-Sterile Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,271Q4116,SPSI,Non-Sterile Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,271Q4116,SPSI,Non-Sterile Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,271Q4116,SPSI,Non-Sterile Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,271Q4116,SPSI,Non-Sterile Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,271Q4118,SPSI,Non-Sterile Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,271Q4118,SPSI,Non-Sterile Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,271Q4118,SPSI,Non-Sterile Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,271Q4118,SPSI,Non-Sterile Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,271Q4125,SPSI,Non-Sterile Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,271Q4125,SPSI,Non-Sterile Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,271Q4125,SPSI,Non-Sterile Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,271Q4125,SPSI,Non-Sterile Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,271Q4128,SPSI,Non-Sterile Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,271Q4128,SPSI,Non-Sterile Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,271Q4128,SPSI,Non-Sterile Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,271Q4128,SPSI,Non-Sterile Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,271Q4130,SPSI,Non-Sterile Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,271Q4130,SPSI,Non-Sterile Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,271Q4130,SPSI,Non-Sterile Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,271Q4130,SPSI,Non-Sterile Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,271Q4133,SPSI,Non-Sterile Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,271Q4133,SPSI,Non-Sterile Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,271Q4133,SPSI,Non-Sterile Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,271Q4133,SPSI,Non-Sterile Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,271Q4155,SPSI,Non-Sterile Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,271Q4155,SPSI,Non-Sterile Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,271Q4155,SPSI,Non-Sterile Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,271Q4155,SPSI,Non-Sterile Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,271Q4166,SPSI,Non-Sterile Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,271Q4166,SPSI,Non-Sterile Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,271Q4166,SPSI,Non-Sterile Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,271Q4166,SPSI,Non-Sterile Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,271Q9963,SPSI,Non-Sterile Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,271Q9963,SPSI,Non-Sterile Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,271Q9963,SPSI,Non-Sterile Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,271Q9963,SPSI,Non-Sterile Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,271Q9967,SPSI,Non-Sterile Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,271Q9967,SPSI,Non-Sterile Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,271Q9967,SPSI,Non-Sterile Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,271Q9967,SPSI,Non-Sterile Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,271V2630,SPSI,Non-Sterile Supplies V2630,,Per Svc,0.01
Chargemaster Item,,271V2630,SPSI,Non-Sterile Supplies V2630,,Per Svc,0.01
Chargemaster Item,,271V2630,SPSI,Non-Sterile Supplies V2630,,Per Svc,0.01
Chargemaster Item,,271V2630,SPSI,Non-Sterile Supplies V2630,,Per Svc,0.01
Chargemaster Item,,271V2632,SPSI,Non-Sterile Supplies V2632,,Per Svc,0.01
Chargemaster Item,,271V2632,SPSI,Non-Sterile Supplies V2632,,Per Svc,0.01
Chargemaster Item,,271V2632,SPSI,Non-Sterile Supplies V2632,,Per Svc,0.01
Chargemaster Item,,271V2632,SPSI,Non-Sterile Supplies V2632,,Per Svc,0.01
Chargemaster Item,,271V2790,SPSI,Non-Sterile Supplies V2790,,Per Svc,0.01
Chargemaster Item,,271V2790,SPSI,Non-Sterile Supplies V2790,,Per Svc,0.01
Chargemaster Item,,271V2790,SPSI,Non-Sterile Supplies V2790,,Per Svc,0.01
Chargemaster Item,,271V2790,SPSI,Non-Sterile Supplies V2790,,Per Svc,0.01
Chargemaster Item,,271XXXXX,SPSI,Non-Sterile Supplies,,Per Svc,0.01
Chargemaster Item,,271XXXXX,SPSI,Non-Sterile Supplies,,Per Svc,0.01
Chargemaster Item,,271XXXXX,SPSI,Non-Sterile Supplies,,Per Svc,0.01
Chargemaster Item,,271XXXXX,SPSI,Non-Sterile Supplies,,Per Svc,0.01
Chargemaster Item,,27200005,SPSI,Rec/Rm #1,,First 60 Minutes,2147.00
Chargemaster Item,,27200104,SPSI,Rec/Rm #2,,First 60 Minutes,2580.00
Chargemaster Item,,27200203,SPSI,Rec/Rm #3,,First 60 Minutes,4488.00
Chargemaster Item,,27200302,SPSI,Rec/Rm Isolat,,First 60 Minutes,42999.00
Chargemaster Item,,272A4265,SPSI,Sterile Supplies A4265,,Per Svc,0.01
Chargemaster Item,,272A4265,SPSI,Sterile Supplies A4265,,Per Svc,0.01
Chargemaster Item,,272A4265,SPSI,Sterile Supplies A4265,,Per Svc,0.01
Chargemaster Item,,272A4265,SPSI,Sterile Supplies A4265,,Per Svc,0.01
Chargemaster Item,,272A4314,SPSI,Sterile Supplies A4314,,Per Svc,0.01
Chargemaster Item,,272A4314,SPSI,Sterile Supplies A4314,,Per Svc,0.01
Chargemaster Item,,272A4314,SPSI,Sterile Supplies A4314,,Per Svc,0.01
Chargemaster Item,,272A4314,SPSI,Sterile Supplies A4314,,Per Svc,0.01
Chargemaster Item,,272A4315,SPSI,Sterile Supplies A4315,,Per Svc,0.01
Chargemaster Item,,272A4315,SPSI,Sterile Supplies A4315,,Per Svc,0.01
Chargemaster Item,,272A4315,SPSI,Sterile Supplies A4315,,Per Svc,0.01
Chargemaster Item,,272A4315,SPSI,Sterile Supplies A4315,,Per Svc,0.01
Chargemaster Item,,272A4338,SPSI,Sterile Supplies A4338,,Per Svc,0.01
Chargemaster Item,,272A4338,SPSI,Sterile Supplies A4338,,Per Svc,0.01
Chargemaster Item,,272A4338,SPSI,Sterile Supplies A4338,,Per Svc,0.01
Chargemaster Item,,272A4338,SPSI,Sterile Supplies A4338,,Per Svc,0.01
Chargemaster Item,,272A4340,SPSI,Sterile Supplies A4340,,Per Svc,0.01
Chargemaster Item,,272A4340,SPSI,Sterile Supplies A4340,,Per Svc,0.01
Chargemaster Item,,272A4340,SPSI,Sterile Supplies A4340,,Per Svc,0.01
Chargemaster Item,,272A4340,SPSI,Sterile Supplies A4340,,Per Svc,0.01
Chargemaster Item,,272A4346,SPSI,Sterile Supplies A4346,,Per Svc,0.01
Chargemaster Item,,272A4346,SPSI,Sterile Supplies A4346,,Per Svc,0.01
Chargemaster Item,,272A4346,SPSI,Sterile Supplies A4346,,Per Svc,0.01
Chargemaster Item,,272A4346,SPSI,Sterile Supplies A4346,,Per Svc,0.01
Chargemaster Item,,272A4349,SPSI,Sterile Supplies A4349,,Per Svc,0.01
Chargemaster Item,,272A4349,SPSI,Sterile Supplies A4349,,Per Svc,0.01
Chargemaster Item,,272A4349,SPSI,Sterile Supplies A4349,,Per Svc,0.01
Chargemaster Item,,272A4349,SPSI,Sterile Supplies A4349,,Per Svc,0.01
Chargemaster Item,,272A4565,SPSI,Sterile Supplies A4565,,Per Svc,0.01
Chargemaster Item,,272A4565,SPSI,Sterile Supplies A4565,,Per Svc,0.01
Chargemaster Item,,272A4565,SPSI,Sterile Supplies A4565,,Per Svc,0.01
Chargemaster Item,,272A4565,SPSI,Sterile Supplies A4565,,Per Svc,0.01
Chargemaster Item,,272A4648,SPSI,Sterile Supplies A4648,,Per Svc,0.01
Chargemaster Item,,272A4648,SPSI,Sterile Supplies A4648,,Per Svc,0.01
Chargemaster Item,,272A4648,SPSI,Sterile Supplies A4648,,Per Svc,0.01
Chargemaster Item,,272A4648,SPSI,Sterile Supplies A4648,,Per Svc,0.01
Chargemaster Item,,272A6021,SPSI,Sterile Supplies A6021,,Per Svc,0.01
Chargemaster Item,,272A6021,SPSI,Sterile Supplies A6021,,Per Svc,0.01
Chargemaster Item,,272A6021,SPSI,Sterile Supplies A6021,,Per Svc,0.01
Chargemaster Item,,272A6021,SPSI,Sterile Supplies A6021,,Per Svc,0.01
Chargemaster Item,,272A6025,SPSI,Sterile Supplies A6025,,Per Svc,0.01
Chargemaster Item,,272A6025,SPSI,Sterile Supplies A6025,,Per Svc,0.01
Chargemaster Item,,272A6025,SPSI,Sterile Supplies A6025,,Per Svc,0.01
Chargemaster Item,,272A6025,SPSI,Sterile Supplies A6025,,Per Svc,0.01
Chargemaster Item,,272A6196,SPSI,Sterile Supplies A6196,,Per Svc,0.01
Chargemaster Item,,272A6196,SPSI,Sterile Supplies A6196,,Per Svc,0.01
Chargemaster Item,,272A6196,SPSI,Sterile Supplies A6196,,Per Svc,0.01
Chargemaster Item,,272A6196,SPSI,Sterile Supplies A6196,,Per Svc,0.01
Chargemaster Item,,272A6197,SPSI,Sterile Supplies A6197,,Per Svc,0.01
Chargemaster Item,,272A6197,SPSI,Sterile Supplies A6197,,Per Svc,0.01
Chargemaster Item,,272A6197,SPSI,Sterile Supplies A6197,,Per Svc,0.01
Chargemaster Item,,272A6197,SPSI,Sterile Supplies A6197,,Per Svc,0.01
Chargemaster Item,,272A6206,SPSI,Sterile Supplies A6206,,Per Svc,0.01
Chargemaster Item,,272A6206,SPSI,Sterile Supplies A6206,,Per Svc,0.01
Chargemaster Item,,272A6206,SPSI,Sterile Supplies A6206,,Per Svc,0.01
Chargemaster Item,,272A6206,SPSI,Sterile Supplies A6206,,Per Svc,0.01
Chargemaster Item,,272A6209,SPSI,Sterile Supplies A6209,,Per Svc,0.01
Chargemaster Item,,272A6209,SPSI,Sterile Supplies A6209,,Per Svc,0.01
Chargemaster Item,,272A6209,SPSI,Sterile Supplies A6209,,Per Svc,0.01
Chargemaster Item,,272A6209,SPSI,Sterile Supplies A6209,,Per Svc,0.01
Chargemaster Item,,272A6212,SPSI,Sterile Supplies A6212,,Per Svc,0.01
Chargemaster Item,,272A6212,SPSI,Sterile Supplies A6212,,Per Svc,0.01
Chargemaster Item,,272A6212,SPSI,Sterile Supplies A6212,,Per Svc,0.01
Chargemaster Item,,272A6212,SPSI,Sterile Supplies A6212,,Per Svc,0.01
Chargemaster Item,,272A6213,SPSI,Sterile Supplies A6213,,Per Svc,0.01
Chargemaster Item,,272A6213,SPSI,Sterile Supplies A6213,,Per Svc,0.01
Chargemaster Item,,272A6213,SPSI,Sterile Supplies A6213,,Per Svc,0.01
Chargemaster Item,,272A6213,SPSI,Sterile Supplies A6213,,Per Svc,0.01
Chargemaster Item,,272A6214,SPSI,Sterile Supplies A6214,,Per Svc,0.01
Chargemaster Item,,272A6214,SPSI,Sterile Supplies A6214,,Per Svc,0.01
Chargemaster Item,,272A6214,SPSI,Sterile Supplies A6214,,Per Svc,0.01
Chargemaster Item,,272A6214,SPSI,Sterile Supplies A6214,,Per Svc,0.01
Chargemaster Item,,272A6219,SPSI,Sterile Supplies A6219,,Per Svc,0.01
Chargemaster Item,,272A6219,SPSI,Sterile Supplies A6219,,Per Svc,0.01
Chargemaster Item,,272A6219,SPSI,Sterile Supplies A6219,,Per Svc,0.01
Chargemaster Item,,272A6219,SPSI,Sterile Supplies A6219,,Per Svc,0.01
Chargemaster Item,,272A6220,SPSI,Sterile Supplies A6220,,Per Svc,0.01
Chargemaster Item,,272A6220,SPSI,Sterile Supplies A6220,,Per Svc,0.01
Chargemaster Item,,272A6220,SPSI,Sterile Supplies A6220,,Per Svc,0.01
Chargemaster Item,,272A6222,SPSI,Sterile Supplies A6222,,Per Svc,0.01
Chargemaster Item,,272A6222,SPSI,Sterile Supplies A6222,,Per Svc,0.01
Chargemaster Item,,272A6222,SPSI,Sterile Supplies A6222,,Per Svc,0.01
Chargemaster Item,,272A6222,SPSI,Sterile Supplies A6222,,Per Svc,0.01
Chargemaster Item,,272A6223,SPSI,Sterile Supplies A6223,,Per Svc,0.01
Chargemaster Item,,272A6223,SPSI,Sterile Supplies A6223,,Per Svc,0.01
Chargemaster Item,,272A6223,SPSI,Sterile Supplies A6223,,Per Svc,0.01
Chargemaster Item,,272A6223,SPSI,Sterile Supplies A6223,,Per Svc,0.01
Chargemaster Item,,272A6224,SPSI,Sterile Supplies A6224,,Per Svc,0.01
Chargemaster Item,,272A6224,SPSI,Sterile Supplies A6224,,Per Svc,0.01
Chargemaster Item,,272A6224,SPSI,Sterile Supplies A6224,,Per Svc,0.01
Chargemaster Item,,272A6224,SPSI,Sterile Supplies A6224,,Per Svc,0.01
Chargemaster Item,,272A6234,SPSI,Sterile Supplies A6234,,Per Svc,0.01
Chargemaster Item,,272A6234,SPSI,Sterile Supplies A6234,,Per Svc,0.01
Chargemaster Item,,272A6234,SPSI,Sterile Supplies A6234,,Per Svc,0.01
Chargemaster Item,,272A6234,SPSI,Sterile Supplies A6234,,Per Svc,0.01
Chargemaster Item,,272A6235,SPSI,Sterile Supplies A6235,,Per Svc,0.01
Chargemaster Item,,272A6235,SPSI,Sterile Supplies A6235,,Per Svc,0.01
Chargemaster Item,,272A6235,SPSI,Sterile Supplies A6235,,Per Svc,0.01
Chargemaster Item,,272A6235,SPSI,Sterile Supplies A6235,,Per Svc,0.01
Chargemaster Item,,272A6238,SPSI,Sterile Supplies A6238,,Per Svc,0.01
Chargemaster Item,,272A6238,SPSI,Sterile Supplies A6238,,Per Svc,0.01
Chargemaster Item,,272A6238,SPSI,Sterile Supplies A6238,,Per Svc,0.01
Chargemaster Item,,272A6238,SPSI,Sterile Supplies A6238,,Per Svc,0.01
Chargemaster Item,,272A6255,SPSI,Sterile Supplies A6255,,Per Svc,0.01
Chargemaster Item,,272A6255,SPSI,Sterile Supplies A6255,,Per Svc,0.01
Chargemaster Item,,272A6255,SPSI,Sterile Supplies A6255,,Per Svc,0.01
Chargemaster Item,,272A6255,SPSI,Sterile Supplies A6255,,Per Svc,0.01
Chargemaster Item,,272A6257,SPSI,Sterile Supplies A6257,,Per Svc,0.01
Chargemaster Item,,272A6257,SPSI,Sterile Supplies A6257,,Per Svc,0.01
Chargemaster Item,,272A6257,SPSI,Sterile Supplies A6257,,Per Svc,0.01
Chargemaster Item,,272A6257,SPSI,Sterile Supplies A6257,,Per Svc,0.01
Chargemaster Item,,272A6258,SPSI,Sterile Supplies A6258,,Per Svc,0.01
Chargemaster Item,,272A6258,SPSI,Sterile Supplies A6258,,Per Svc,0.01
Chargemaster Item,,272A6258,SPSI,Sterile Supplies A6258,,Per Svc,0.01
Chargemaster Item,,272A6258,SPSI,Sterile Supplies A6258,,Per Svc,0.01
Chargemaster Item,,272A6259,SPSI,Sterile Supplies A6259,,Per Svc,0.01
Chargemaster Item,,272A6259,SPSI,Sterile Supplies A6259,,Per Svc,0.01
Chargemaster Item,,272A6259,SPSI,Sterile Supplies A6259,,Per Svc,0.01
Chargemaster Item,,272A6259,SPSI,Sterile Supplies A6259,,Per Svc,0.01
Chargemaster Item,,272A6454,SPSI,Sterile Supplies A6454,,Per Svc,0.01
Chargemaster Item,,272A6454,SPSI,Sterile Supplies A6454,,Per Svc,0.01
Chargemaster Item,,272A6454,SPSI,Sterile Supplies A6454,,Per Svc,0.01
Chargemaster Item,,272A6454,SPSI,Sterile Supplies A6454,,Per Svc,0.01
Chargemaster Item,,272B4082,SPSI,Sterile Supplies B4082,,Per Svc,0.01
Chargemaster Item,,272B4082,SPSI,Sterile Supplies B4082,,Per Svc,0.01
Chargemaster Item,,272B4082,SPSI,Sterile Supplies B4082,,Per Svc,0.01
Chargemaster Item,,272B4082,SPSI,Sterile Supplies B4082,,Per Svc,0.01
Chargemaster Item,,272B4087,SPSI,Sterile Supplies B4087,,Per Svc,0.01
Chargemaster Item,,272B4087,SPSI,Sterile Supplies B4087,,Per Svc,0.01
Chargemaster Item,,272B4087,SPSI,Sterile Supplies B4087,,Per Svc,0.01
Chargemaster Item,,272B4087,SPSI,Sterile Supplies B4087,,Per Svc,0.01
Chargemaster Item,,272B4088,SPSI,Sterile Supplies B4088,,Per Svc,0.01
Chargemaster Item,,272B4088,SPSI,Sterile Supplies B4088,,Per Svc,0.01
Chargemaster Item,,272B4088,SPSI,Sterile Supplies B4088,,Per Svc,0.01
Chargemaster Item,,272B4088,SPSI,Sterile Supplies B4088,,Per Svc,0.01
Chargemaster Item,,272C1713,SPSI,Sterile Supplies C1713,,Per Svc,0.01
Chargemaster Item,,272C1713,SPSI,Sterile Supplies C1713,,Per Svc,0.01
Chargemaster Item,,272C1713,SPSI,Sterile Supplies C1713,,Per Svc,0.01
Chargemaster Item,,272C1713,SPSI,Sterile Supplies C1713,,Per Svc,0.01
Chargemaster Item,,272C1715,SPSI,Sterile Supplies C1715,,Per Svc,0.01
Chargemaster Item,,272C1715,SPSI,Sterile Supplies C1715,,Per Svc,0.01
Chargemaster Item,,272C1715,SPSI,Sterile Supplies C1715,,Per Svc,0.01
Chargemaster Item,,272C1715,SPSI,Sterile Supplies C1715,,Per Svc,0.01
Chargemaster Item,,272C1716,SPSI,Sterile Supplies C1716,,Per Svc,0.01
Chargemaster Item,,272C1716,SPSI,Sterile Supplies C1716,,Per Svc,0.01
Chargemaster Item,,272C1716,SPSI,Sterile Supplies C1716,,Per Svc,0.01
Chargemaster Item,,272C1716,SPSI,Sterile Supplies C1716,,Per Svc,0.01
Chargemaster Item,,272C1721,SPSI,Sterile Supplies C1721,,Per Svc,0.01
Chargemaster Item,,272C1721,SPSI,Sterile Supplies C1721,,Per Svc,0.01
Chargemaster Item,,272C1721,SPSI,Sterile Supplies C1721,,Per Svc,0.01
Chargemaster Item,,272C1721,SPSI,Sterile Supplies C1721,,Per Svc,0.01
Chargemaster Item,,272C1722,SPSI,Sterile Supplies C1722,,Per Svc,0.01
Chargemaster Item,,272C1722,SPSI,Sterile Supplies C1722,,Per Svc,0.01
Chargemaster Item,,272C1722,SPSI,Sterile Supplies C1722,,Per Svc,0.01
Chargemaster Item,,272C1722,SPSI,Sterile Supplies C1722,,Per Svc,0.01
Chargemaster Item,,272C1724,SPSI,Sterile Supplies C1724,,Per Svc,0.01
Chargemaster Item,,272C1724,SPSI,Sterile Supplies C1724,,Per Svc,0.01
Chargemaster Item,,272C1724,SPSI,Sterile Supplies C1724,,Per Svc,0.01
Chargemaster Item,,272C1724,SPSI,Sterile Supplies C1724,,Per Svc,0.01
Chargemaster Item,,272C1725,SPSI,Sterile Supplies C1725,,Per Svc,0.01
Chargemaster Item,,272C1725,SPSI,Sterile Supplies C1725,,Per Svc,0.01
Chargemaster Item,,272C1725,SPSI,Sterile Supplies C1725,,Per Svc,0.01
Chargemaster Item,,272C1725,SPSI,Sterile Supplies C1725,,Per Svc,0.01
Chargemaster Item,,272C1726,SPSI,Sterile Supplies C1726,,Per Svc,0.01
Chargemaster Item,,272C1726,SPSI,Sterile Supplies C1726,,Per Svc,0.01
Chargemaster Item,,272C1726,SPSI,Sterile Supplies C1726,,Per Svc,0.01
Chargemaster Item,,272C1726,SPSI,Sterile Supplies C1726,,Per Svc,0.01
Chargemaster Item,,272C1727,SPSI,Sterile Supplies C1727,,Per Svc,0.01
Chargemaster Item,,272C1727,SPSI,Sterile Supplies C1727,,Per Svc,0.01
Chargemaster Item,,272C1727,SPSI,Sterile Supplies C1727,,Per Svc,0.01
Chargemaster Item,,272C1727,SPSI,Sterile Supplies C1727,,Per Svc,0.01
Chargemaster Item,,272C1729,SPSI,Sterile Supplies C1729,,Per Svc,0.01
Chargemaster Item,,272C1729,SPSI,Sterile Supplies C1729,,Per Svc,0.01
Chargemaster Item,,272C1729,SPSI,Sterile Supplies C1729,,Per Svc,0.01
Chargemaster Item,,272C1729,SPSI,Sterile Supplies C1729,,Per Svc,0.01
Chargemaster Item,,272C1730,SPSI,Sterile Supplies C1730,,Per Svc,0.01
Chargemaster Item,,272C1730,SPSI,Sterile Supplies C1730,,Per Svc,0.01
Chargemaster Item,,272C1730,SPSI,Sterile Supplies C1730,,Per Svc,0.01
Chargemaster Item,,272C1730,SPSI,Sterile Supplies C1730,,Per Svc,0.01
Chargemaster Item,,272C1731,SPSI,Sterile Supplies C1731,,Per Svc,0.01
Chargemaster Item,,272C1731,SPSI,Sterile Supplies C1731,,Per Svc,0.01
Chargemaster Item,,272C1731,SPSI,Sterile Supplies C1731,,Per Svc,0.01
Chargemaster Item,,272C1731,SPSI,Sterile Supplies C1731,,Per Svc,0.01
Chargemaster Item,,272C1733,SPSI,Sterile Supplies C1733,,Per Svc,0.01
Chargemaster Item,,272C1733,SPSI,Sterile Supplies C1733,,Per Svc,0.01
Chargemaster Item,,272C1733,SPSI,Sterile Supplies C1733,,Per Svc,0.01
Chargemaster Item,,272C1733,SPSI,Sterile Supplies C1733,,Per Svc,0.01
Chargemaster Item,,272C1750,SPSI,Sterile Supplies C1750,,Per Svc,0.01
Chargemaster Item,,272C1750,SPSI,Sterile Supplies C1750,,Per Svc,0.01
Chargemaster Item,,272C1750,SPSI,Sterile Supplies C1750,,Per Svc,0.01
Chargemaster Item,,272C1750,SPSI,Sterile Supplies C1750,,Per Svc,0.01
Chargemaster Item,,272C1751,SPSI,Sterile Supplies C1751,,Per Svc,0.01
Chargemaster Item,,272C1751,SPSI,Sterile Supplies C1751,,Per Svc,0.01
Chargemaster Item,,272C1751,SPSI,Sterile Supplies C1751,,Per Svc,0.01
Chargemaster Item,,272C1751,SPSI,Sterile Supplies C1751,,Per Svc,0.01
Chargemaster Item,,272C1752,SPSI,Sterile Supplies C1752,,Per Svc,0.01
Chargemaster Item,,272C1752,SPSI,Sterile Supplies C1752,,Per Svc,0.01
Chargemaster Item,,272C1752,SPSI,Sterile Supplies C1752,,Per Svc,0.01
Chargemaster Item,,272C1752,SPSI,Sterile Supplies C1752,,Per Svc,0.01
Chargemaster Item,,272C1753,SPSI,Sterile Supplies C1753,,Per Svc,0.01
Chargemaster Item,,272C1753,SPSI,Sterile Supplies C1753,,Per Svc,0.01
Chargemaster Item,,272C1753,SPSI,Sterile Supplies C1753,,Per Svc,0.01
Chargemaster Item,,272C1753,SPSI,Sterile Supplies C1753,,Per Svc,0.01
Chargemaster Item,,272C1755,SPSI,Sterile Supplies C1755,,Per Svc,0.01
Chargemaster Item,,272C1755,SPSI,Sterile Supplies C1755,,Per Svc,0.01
Chargemaster Item,,272C1755,SPSI,Sterile Supplies C1755,,Per Svc,0.01
Chargemaster Item,,272C1755,SPSI,Sterile Supplies C1755,,Per Svc,0.01
Chargemaster Item,,272C1757,SPSI,Sterile Supplies C1757,,Per Svc,0.01
Chargemaster Item,,272C1757,SPSI,Sterile Supplies C1757,,Per Svc,0.01
Chargemaster Item,,272C1757,SPSI,Sterile Supplies C1757,,Per Svc,0.01
Chargemaster Item,,272C1757,SPSI,Sterile Supplies C1757,,Per Svc,0.01
Chargemaster Item,,272C1758,SPSI,Sterile Supplies C1758,,Per Svc,0.01
Chargemaster Item,,272C1758,SPSI,Sterile Supplies C1758,,Per Svc,0.01
Chargemaster Item,,272C1758,SPSI,Sterile Supplies C1758,,Per Svc,0.01
Chargemaster Item,,272C1758,SPSI,Sterile Supplies C1758,,Per Svc,0.01
Chargemaster Item,,272C1760,SPSI,Sterile Supplies C1760,,Per Svc,0.01
Chargemaster Item,,272C1760,SPSI,Sterile Supplies C1760,,Per Svc,0.01
Chargemaster Item,,272C1760,SPSI,Sterile Supplies C1760,,Per Svc,0.01
Chargemaster Item,,272C1760,SPSI,Sterile Supplies C1760,,Per Svc,0.01
Chargemaster Item,,272C1762,SPSI,Sterile Supplies C1762,,Per Svc,0.01
Chargemaster Item,,272C1762,SPSI,Sterile Supplies C1762,,Per Svc,0.01
Chargemaster Item,,272C1762,SPSI,Sterile Supplies C1762,,Per Svc,0.01
Chargemaster Item,,272C1762,SPSI,Sterile Supplies C1762,,Per Svc,0.01
Chargemaster Item,,272C1763,SPSI,Sterile Supplies C1763,,Per Svc,0.01
Chargemaster Item,,272C1763,SPSI,Sterile Supplies C1763,,Per Svc,0.01
Chargemaster Item,,272C1763,SPSI,Sterile Supplies C1763,,Per Svc,0.01
Chargemaster Item,,272C1763,SPSI,Sterile Supplies C1763,,Per Svc,0.01
Chargemaster Item,,272C1764,SPSI,Sterile Supplies C1764,,Per Svc,0.01
Chargemaster Item,,272C1764,SPSI,Sterile Supplies C1764,,Per Svc,0.01
Chargemaster Item,,272C1764,SPSI,Sterile Supplies C1764,,Per Svc,0.01
Chargemaster Item,,272C1764,SPSI,Sterile Supplies C1764,,Per Svc,0.01
Chargemaster Item,,272C1766,SPSI,Sterile Supplies C1766,,Per Svc,0.01
Chargemaster Item,,272C1766,SPSI,Sterile Supplies C1766,,Per Svc,0.01
Chargemaster Item,,272C1766,SPSI,Sterile Supplies C1766,,Per Svc,0.01
Chargemaster Item,,272C1766,SPSI,Sterile Supplies C1766,,Per Svc,0.01
Chargemaster Item,,272C1767,SPSI,Sterile Supplies C1767,,Per Svc,0.01
Chargemaster Item,,272C1767,SPSI,Sterile Supplies C1767,,Per Svc,0.01
Chargemaster Item,,272C1767,SPSI,Sterile Supplies C1767,,Per Svc,0.01
Chargemaster Item,,272C1767,SPSI,Sterile Supplies C1767,,Per Svc,0.01
Chargemaster Item,,272C1768,SPSI,Sterile Supplies C1768,,Per Svc,0.01
Chargemaster Item,,272C1768,SPSI,Sterile Supplies C1768,,Per Svc,0.01
Chargemaster Item,,272C1768,SPSI,Sterile Supplies C1768,,Per Svc,0.01
Chargemaster Item,,272C1768,SPSI,Sterile Supplies C1768,,Per Svc,0.01
Chargemaster Item,,272C1769,SPSI,Sterile Supplies C1769,,Per Svc,0.01
Chargemaster Item,,272C1769,SPSI,Sterile Supplies C1769,,Per Svc,0.01
Chargemaster Item,,272C1769,SPSI,Sterile Supplies C1769,,Per Svc,0.01
Chargemaster Item,,272C1769,SPSI,Sterile Supplies C1769,,Per Svc,0.01
Chargemaster Item,,272C1771,SPSI,Sterile Supplies C1771,,Per Svc,0.01
Chargemaster Item,,272C1771,SPSI,Sterile Supplies C1771,,Per Svc,0.01
Chargemaster Item,,272C1771,SPSI,Sterile Supplies C1771,,Per Svc,0.01
Chargemaster Item,,272C1771,SPSI,Sterile Supplies C1771,,Per Svc,0.01
Chargemaster Item,,272C1772,SPSI,Sterile Supplies C1772,,Per Svc,0.01
Chargemaster Item,,272C1772,SPSI,Sterile Supplies C1772,,Per Svc,0.01
Chargemaster Item,,272C1772,SPSI,Sterile Supplies C1772,,Per Svc,0.01
Chargemaster Item,,272C1772,SPSI,Sterile Supplies C1772,,Per Svc,0.01
Chargemaster Item,,272C1773,SPSI,Sterile Supplies C1773,,Per Svc,0.01
Chargemaster Item,,272C1773,SPSI,Sterile Supplies C1773,,Per Svc,0.01
Chargemaster Item,,272C1773,SPSI,Sterile Supplies C1773,,Per Svc,0.01
Chargemaster Item,,272C1773,SPSI,Sterile Supplies C1773,,Per Svc,0.01
Chargemaster Item,,272C1776,SPSI,Sterile Supplies C1776,,Per Svc,0.01
Chargemaster Item,,272C1776,SPSI,Sterile Supplies C1776,,Per Svc,0.01
Chargemaster Item,,272C1776,SPSI,Sterile Supplies C1776,,Per Svc,0.01
Chargemaster Item,,272C1776,SPSI,Sterile Supplies C1776,,Per Svc,0.01
Chargemaster Item,,272C1777,SPSI,Sterile Supplies C1777,,Per Svc,0.01
Chargemaster Item,,272C1777,SPSI,Sterile Supplies C1777,,Per Svc,0.01
Chargemaster Item,,272C1777,SPSI,Sterile Supplies C1777,,Per Svc,0.01
Chargemaster Item,,272C1777,SPSI,Sterile Supplies C1777,,Per Svc,0.01
Chargemaster Item,,272C1778,SPSI,Sterile Supplies C1778,,Per Svc,0.01
Chargemaster Item,,272C1778,SPSI,Sterile Supplies C1778,,Per Svc,0.01
Chargemaster Item,,272C1778,SPSI,Sterile Supplies C1778,,Per Svc,0.01
Chargemaster Item,,272C1778,SPSI,Sterile Supplies C1778,,Per Svc,0.01
Chargemaster Item,,272C1781,SPSI,Sterile Supplies C1781,,Per Svc,0.01
Chargemaster Item,,272C1781,SPSI,Sterile Supplies C1781,,Per Svc,0.01
Chargemaster Item,,272C1781,SPSI,Sterile Supplies C1781,,Per Svc,0.01
Chargemaster Item,,272C1781,SPSI,Sterile Supplies C1781,,Per Svc,0.01
Chargemaster Item,,272C1783,SPSI,Sterile Supplies C1783,,Per Svc,0.01
Chargemaster Item,,272C1783,SPSI,Sterile Supplies C1783,,Per Svc,0.01
Chargemaster Item,,272C1783,SPSI,Sterile Supplies C1783,,Per Svc,0.01
Chargemaster Item,,272C1783,SPSI,Sterile Supplies C1783,,Per Svc,0.01
Chargemaster Item,,272C1785,SPSI,Sterile Supplies C1785,,Per Svc,0.01
Chargemaster Item,,272C1785,SPSI,Sterile Supplies C1785,,Per Svc,0.01
Chargemaster Item,,272C1785,SPSI,Sterile Supplies C1785,,Per Svc,0.01
Chargemaster Item,,272C1785,SPSI,Sterile Supplies C1785,,Per Svc,0.01
Chargemaster Item,,272C1786,SPSI,Sterile Supplies C1786,,Per Svc,0.01
Chargemaster Item,,272C1786,SPSI,Sterile Supplies C1786,,Per Svc,0.01
Chargemaster Item,,272C1786,SPSI,Sterile Supplies C1786,,Per Svc,0.01
Chargemaster Item,,272C1786,SPSI,Sterile Supplies C1786,,Per Svc,0.01
Chargemaster Item,,272C1787,SPSI,Sterile Supplies C1787,,Per Svc,0.01
Chargemaster Item,,272C1787,SPSI,Sterile Supplies C1787,,Per Svc,0.01
Chargemaster Item,,272C1787,SPSI,Sterile Supplies C1787,,Per Svc,0.01
Chargemaster Item,,272C1787,SPSI,Sterile Supplies C1787,,Per Svc,0.01
Chargemaster Item,,272C1788,SPSI,Sterile Supplies C1788,,Per Svc,0.01
Chargemaster Item,,272C1788,SPSI,Sterile Supplies C1788,,Per Svc,0.01
Chargemaster Item,,272C1788,SPSI,Sterile Supplies C1788,,Per Svc,0.01
Chargemaster Item,,272C1788,SPSI,Sterile Supplies C1788,,Per Svc,0.01
Chargemaster Item,,272C1789,SPSI,Sterile Supplies C1789,,Per Svc,0.01
Chargemaster Item,,272C1789,SPSI,Sterile Supplies C1789,,Per Svc,0.01
Chargemaster Item,,272C1789,SPSI,Sterile Supplies C1789,,Per Svc,0.01
Chargemaster Item,,272C1789,SPSI,Sterile Supplies C1789,,Per Svc,0.01
Chargemaster Item,,272C1817,SPSI,Sterile Supplies C1817,,Per Svc,0.01
Chargemaster Item,,272C1817,SPSI,Sterile Supplies C1817,,Per Svc,0.01
Chargemaster Item,,272C1817,SPSI,Sterile Supplies C1817,,Per Svc,0.01
Chargemaster Item,,272C1817,SPSI,Sterile Supplies C1817,,Per Svc,0.01
Chargemaster Item,,272C1821,SPSI,Sterile Supplies C1821,,Per Svc,0.01
Chargemaster Item,,272C1821,SPSI,Sterile Supplies C1821,,Per Svc,0.01
Chargemaster Item,,272C1821,SPSI,Sterile Supplies C1821,,Per Svc,0.01
Chargemaster Item,,272C1821,SPSI,Sterile Supplies C1821,,Per Svc,0.01
Chargemaster Item,,272C1874,SPSI,Sterile Supplies C1874,,Per Svc,0.01
Chargemaster Item,,272C1874,SPSI,Sterile Supplies C1874,,Per Svc,0.01
Chargemaster Item,,272C1874,SPSI,Sterile Supplies C1874,,Per Svc,0.01
Chargemaster Item,,272C1874,SPSI,Sterile Supplies C1874,,Per Svc,0.01
Chargemaster Item,,272C1875,SPSI,Sterile Supplies C1875,,Per Svc,0.01
Chargemaster Item,,272C1875,SPSI,Sterile Supplies C1875,,Per Svc,0.01
Chargemaster Item,,272C1875,SPSI,Sterile Supplies C1875,,Per Svc,0.01
Chargemaster Item,,272C1875,SPSI,Sterile Supplies C1875,,Per Svc,0.01
Chargemaster Item,,272C1876,SPSI,Sterile Supplies C1876,,Per Svc,0.01
Chargemaster Item,,272C1876,SPSI,Sterile Supplies C1876,,Per Svc,0.01
Chargemaster Item,,272C1876,SPSI,Sterile Supplies C1876,,Per Svc,0.01
Chargemaster Item,,272C1876,SPSI,Sterile Supplies C1876,,Per Svc,0.01
Chargemaster Item,,272C1880,SPSI,Sterile Supplies C1880,,Per Svc,0.01
Chargemaster Item,,272C1880,SPSI,Sterile Supplies C1880,,Per Svc,0.01
Chargemaster Item,,272C1880,SPSI,Sterile Supplies C1880,,Per Svc,0.01
Chargemaster Item,,272C1880,SPSI,Sterile Supplies C1880,,Per Svc,0.01
Chargemaster Item,,272C1881,SPSI,Sterile Supplies C1881,,Per Svc,0.01
Chargemaster Item,,272C1881,SPSI,Sterile Supplies C1881,,Per Svc,0.01
Chargemaster Item,,272C1881,SPSI,Sterile Supplies C1881,,Per Svc,0.01
Chargemaster Item,,272C1881,SPSI,Sterile Supplies C1881,,Per Svc,0.01
Chargemaster Item,,272C1882,SPSI,Sterile Supplies C1882,,Per Svc,0.01
Chargemaster Item,,272C1882,SPSI,Sterile Supplies C1882,,Per Svc,0.01
Chargemaster Item,,272C1882,SPSI,Sterile Supplies C1882,,Per Svc,0.01
Chargemaster Item,,272C1882,SPSI,Sterile Supplies C1882,,Per Svc,0.01
Chargemaster Item,,272C1883,SPSI,Sterile Supplies C1883,,Per Svc,0.01
Chargemaster Item,,272C1883,SPSI,Sterile Supplies C1883,,Per Svc,0.01
Chargemaster Item,,272C1883,SPSI,Sterile Supplies C1883,,Per Svc,0.01
Chargemaster Item,,272C1883,SPSI,Sterile Supplies C1883,,Per Svc,0.01
Chargemaster Item,,272C1884,SPSI,Sterile Supplies C1884,,Per Svc,0.01
Chargemaster Item,,272C1884,SPSI,Sterile Supplies C1884,,Per Svc,0.01
Chargemaster Item,,272C1884,SPSI,Sterile Supplies C1884,,Per Svc,0.01
Chargemaster Item,,272C1884,SPSI,Sterile Supplies C1884,,Per Svc,0.01
Chargemaster Item,,272C1887,SPSI,Sterile Supplies C1887,,Per Svc,0.01
Chargemaster Item,,272C1887,SPSI,Sterile Supplies C1887,,Per Svc,0.01
Chargemaster Item,,272C1887,SPSI,Sterile Supplies C1887,,Per Svc,0.01
Chargemaster Item,,272C1887,SPSI,Sterile Supplies C1887,,Per Svc,0.01
Chargemaster Item,,272C1889,SPSI,Sterile Supplies C1889,,Per Svc,0.01
Chargemaster Item,,272C1889,SPSI,Sterile Supplies C1889,,Per Svc,0.01
Chargemaster Item,,272C1889,SPSI,Sterile Supplies C1889,,Per Svc,0.01
Chargemaster Item,,272C1889,SPSI,Sterile Supplies C1889,,Per Svc,0.01
Chargemaster Item,,272C1892,SPSI,Sterile Supplies C1892,,Per Svc,0.01
Chargemaster Item,,272C1892,SPSI,Sterile Supplies C1892,,Per Svc,0.01
Chargemaster Item,,272C1892,SPSI,Sterile Supplies C1892,,Per Svc,0.01
Chargemaster Item,,272C1892,SPSI,Sterile Supplies C1892,,Per Svc,0.01
Chargemaster Item,,272C1893,SPSI,Sterile Supplies C1893,,Per Svc,0.01
Chargemaster Item,,272C1893,SPSI,Sterile Supplies C1893,,Per Svc,0.01
Chargemaster Item,,272C1893,SPSI,Sterile Supplies C1893,,Per Svc,0.01
Chargemaster Item,,272C1893,SPSI,Sterile Supplies C1893,,Per Svc,0.01
Chargemaster Item,,272C1894,SPSI,Sterile Supplies C1894,,Per Svc,0.01
Chargemaster Item,,272C1894,SPSI,Sterile Supplies C1894,,Per Svc,0.01
Chargemaster Item,,272C1894,SPSI,Sterile Supplies C1894,,Per Svc,0.01
Chargemaster Item,,272C1894,SPSI,Sterile Supplies C1894,,Per Svc,0.01
Chargemaster Item,,272C1897,SPSI,Sterile Supplies C1897,,Per Svc,0.01
Chargemaster Item,,272C1897,SPSI,Sterile Supplies C1897,,Per Svc,0.01
Chargemaster Item,,272C1897,SPSI,Sterile Supplies C1897,,Per Svc,0.01
Chargemaster Item,,272C1897,SPSI,Sterile Supplies C1897,,Per Svc,0.01
Chargemaster Item,,272C1898,SPSI,Sterile Supplies C1898,,Per Svc,0.01
Chargemaster Item,,272C1898,SPSI,Sterile Supplies C1898,,Per Svc,0.01
Chargemaster Item,,272C1898,SPSI,Sterile Supplies C1898,,Per Svc,0.01
Chargemaster Item,,272C1898,SPSI,Sterile Supplies C1898,,Per Svc,0.01
Chargemaster Item,,272C1900,SPSI,Sterile Supplies C1900,,Per Svc,0.01
Chargemaster Item,,272C1900,SPSI,Sterile Supplies C1900,,Per Svc,0.01
Chargemaster Item,,272C1900,SPSI,Sterile Supplies C1900,,Per Svc,0.01
Chargemaster Item,,272C1900,SPSI,Sterile Supplies C1900,,Per Svc,0.01
Chargemaster Item,,272C2617,SPSI,Sterile Supplies C2617,,Per Svc,0.01
Chargemaster Item,,272C2617,SPSI,Sterile Supplies C2617,,Per Svc,0.01
Chargemaster Item,,272C2617,SPSI,Sterile Supplies C2617,,Per Svc,0.01
Chargemaster Item,,272C2617,SPSI,Sterile Supplies C2617,,Per Svc,0.01
Chargemaster Item,,272C2618,SPSI,Sterile Supplies C2618,,Per Svc,0.01
Chargemaster Item,,272C2618,SPSI,Sterile Supplies C2618,,Per Svc,0.01
Chargemaster Item,,272C2618,SPSI,Sterile Supplies C2618,,Per Svc,0.01
Chargemaster Item,,272C2618,SPSI,Sterile Supplies C2618,,Per Svc,0.01
Chargemaster Item,,272C2623,SPSI,Sterile Supplies C2623,,Per Svc,0.01
Chargemaster Item,,272C2623,SPSI,Sterile Supplies C2623,,Per Svc,0.01
Chargemaster Item,,272C2623,SPSI,Sterile Supplies C2623,,Per Svc,0.01
Chargemaster Item,,272C2623,SPSI,Sterile Supplies C2623,,Per Svc,0.01
Chargemaster Item,,272C2625,SPSI,Sterile Supplies C2625,,Per Svc,0.01
Chargemaster Item,,272C2625,SPSI,Sterile Supplies C2625,,Per Svc,0.01
Chargemaster Item,,272C2625,SPSI,Sterile Supplies C2625,,Per Svc,0.01
Chargemaster Item,,272C2625,SPSI,Sterile Supplies C2625,,Per Svc,0.01
Chargemaster Item,,272C2627,SPSI,Sterile Supplies C2627,,Per Svc,0.01
Chargemaster Item,,272C2627,SPSI,Sterile Supplies C2627,,Per Svc,0.01
Chargemaster Item,,272C2627,SPSI,Sterile Supplies C2627,,Per Svc,0.01
Chargemaster Item,,272C2627,SPSI,Sterile Supplies C2627,,Per Svc,0.01
Chargemaster Item,,272C2628,SPSI,Sterile Supplies C2628,,Per Svc,0.01
Chargemaster Item,,272C2628,SPSI,Sterile Supplies C2628,,Per Svc,0.01
Chargemaster Item,,272C2628,SPSI,Sterile Supplies C2628,,Per Svc,0.01
Chargemaster Item,,272C2628,SPSI,Sterile Supplies C2628,,Per Svc,0.01
Chargemaster Item,,272C2630,SPSI,Sterile Supplies C2630,,Per Svc,0.01
Chargemaster Item,,272C2630,SPSI,Sterile Supplies C2630,,Per Svc,0.01
Chargemaster Item,,272C2630,SPSI,Sterile Supplies C2630,,Per Svc,0.01
Chargemaster Item,,272C2630,SPSI,Sterile Supplies C2630,,Per Svc,0.01
Chargemaster Item,,272C2639,SPSI,Sterile Supplies C2639,,Per Svc,0.01
Chargemaster Item,,272C2639,SPSI,Sterile Supplies C2639,,Per Svc,0.01
Chargemaster Item,,272C2639,SPSI,Sterile Supplies C2639,,Per Svc,0.01
Chargemaster Item,,272C2639,SPSI,Sterile Supplies C2639,,Per Svc,0.01
Chargemaster Item,,272C9250,SPSI,Sterile Supplies C9250,,Per Svc,0.01
Chargemaster Item,,272C9250,SPSI,Sterile Supplies C9250,,Per Svc,0.01
Chargemaster Item,,272C9250,SPSI,Sterile Supplies C9250,,Per Svc,0.01
Chargemaster Item,,272C9250,SPSI,Sterile Supplies C9250,,Per Svc,0.01
Chargemaster Item,,272C9352,SPSI,Sterile Supplies C9352,,Per Svc,0.01
Chargemaster Item,,272C9352,SPSI,Sterile Supplies C9352,,Per Svc,0.01
Chargemaster Item,,272C9352,SPSI,Sterile Supplies C9352,,Per Svc,0.01
Chargemaster Item,,272C9352,SPSI,Sterile Supplies C9352,,Per Svc,0.01
Chargemaster Item,,272C9353,SPSI,Sterile Supplies C9353,,Per Svc,0.01
Chargemaster Item,,272C9353,SPSI,Sterile Supplies C9353,,Per Svc,0.01
Chargemaster Item,,272C9353,SPSI,Sterile Supplies C9353,,Per Svc,0.01
Chargemaster Item,,272C9353,SPSI,Sterile Supplies C9353,,Per Svc,0.01
Chargemaster Item,,272C9363,SPSI,Sterile Supplies C9363,,Per Svc,0.01
Chargemaster Item,,272C9363,SPSI,Sterile Supplies C9363,,Per Svc,0.01
Chargemaster Item,,272C9363,SPSI,Sterile Supplies C9363,,Per Svc,0.01
Chargemaster Item,,272C9363,SPSI,Sterile Supplies C9363,,Per Svc,0.01
Chargemaster Item,,272E0191,SPSI,Sterile Supplies E0191,,Per Svc,0.01
Chargemaster Item,,272E0191,SPSI,Sterile Supplies E0191,,Per Svc,0.01
Chargemaster Item,,272E0191,SPSI,Sterile Supplies E0191,,Per Svc,0.01
Chargemaster Item,,272E0191,SPSI,Sterile Supplies E0191,,Per Svc,0.01
Chargemaster Item,,272E0235,SPSI,Sterile Supplies E0235,,Per Svc,0.01
Chargemaster Item,,272E0235,SPSI,Sterile Supplies E0235,,Per Svc,0.01
Chargemaster Item,,272E0235,SPSI,Sterile Supplies E0235,,Per Svc,0.01
Chargemaster Item,,272E0235,SPSI,Sterile Supplies E0235,,Per Svc,0.01
Chargemaster Item,,272L0113,SPSI,Sterile Supplies L0113,,Per Svc,0.01
Chargemaster Item,,272L0113,SPSI,Sterile Supplies L0113,,Per Svc,0.01
Chargemaster Item,,272L0113,SPSI,Sterile Supplies L0113,,Per Svc,0.01
Chargemaster Item,,272L0113,SPSI,Sterile Supplies L0113,,Per Svc,0.01
Chargemaster Item,,272L0120,SPSI,Sterile Supplies L0120,,Per Svc,0.01
Chargemaster Item,,272L0120,SPSI,Sterile Supplies L0120,,Per Svc,0.01
Chargemaster Item,,272L0120,SPSI,Sterile Supplies L0120,,Per Svc,0.01
Chargemaster Item,,272L0120,SPSI,Sterile Supplies L0120,,Per Svc,0.01
Chargemaster Item,,272L0172,SPSI,Sterile Supplies L0172,,Per Svc,0.01
Chargemaster Item,,272L0172,SPSI,Sterile Supplies L0172,,Per Svc,0.01
Chargemaster Item,,272L0172,SPSI,Sterile Supplies L0172,,Per Svc,0.01
Chargemaster Item,,272L0172,SPSI,Sterile Supplies L0172,,Per Svc,0.01
Chargemaster Item,,272L0174,SPSI,Sterile Supplies L0174,,Per Svc,0.01
Chargemaster Item,,272L0174,SPSI,Sterile Supplies L0174,,Per Svc,0.01
Chargemaster Item,,272L0174,SPSI,Sterile Supplies L0174,,Per Svc,0.01
Chargemaster Item,,272L0174,SPSI,Sterile Supplies L0174,,Per Svc,0.01
Chargemaster Item,,272L0625,SPSI,Sterile Supplies L0625,,Per Svc,0.01
Chargemaster Item,,272L0625,SPSI,Sterile Supplies L0625,,Per Svc,0.01
Chargemaster Item,,272L0625,SPSI,Sterile Supplies L0625,,Per Svc,0.01
Chargemaster Item,,272L0625,SPSI,Sterile Supplies L0625,,Per Svc,0.01
Chargemaster Item,,272L1820,SPSI,Sterile Supplies L1820,,Per Svc,0.01
Chargemaster Item,,272L1820,SPSI,Sterile Supplies L1820,,Per Svc,0.01
Chargemaster Item,,272L1820,SPSI,Sterile Supplies L1820,,Per Svc,0.01
Chargemaster Item,,272L1820,SPSI,Sterile Supplies L1820,,Per Svc,0.01
Chargemaster Item,,272L1830,SPSI,Sterile Supplies L1830,,Per Svc,0.01
Chargemaster Item,,272L1830,SPSI,Sterile Supplies L1830,,Per Svc,0.01
Chargemaster Item,,272L1830,SPSI,Sterile Supplies L1830,,Per Svc,0.01
Chargemaster Item,,272L1830,SPSI,Sterile Supplies L1830,,Per Svc,0.01
Chargemaster Item,,272L1832,SPSI,Sterile Supplies L1832,,Per Svc,0.01
Chargemaster Item,,272L1832,SPSI,Sterile Supplies L1832,,Per Svc,0.01
Chargemaster Item,,272L1832,SPSI,Sterile Supplies L1832,,Per Svc,0.01
Chargemaster Item,,272L1832,SPSI,Sterile Supplies L1832,,Per Svc,0.01
Chargemaster Item,,272L1902,SPSI,Sterile Supplies L1902,,Per Svc,0.01
Chargemaster Item,,272L1902,SPSI,Sterile Supplies L1902,,Per Svc,0.01
Chargemaster Item,,272L1902,SPSI,Sterile Supplies L1902,,Per Svc,0.01
Chargemaster Item,,272L1902,SPSI,Sterile Supplies L1902,,Per Svc,0.01
Chargemaster Item,,272L1930,SPSI,Sterile Supplies L1930,,Per Svc,0.01
Chargemaster Item,,272L1930,SPSI,Sterile Supplies L1930,,Per Svc,0.01
Chargemaster Item,,272L1930,SPSI,Sterile Supplies L1930,,Per Svc,0.01
Chargemaster Item,,272L1930,SPSI,Sterile Supplies L1930,,Per Svc,0.01
Chargemaster Item,,272L3260,SPSI,Sterile Supplies L3260,,Per Svc,0.01
Chargemaster Item,,272L3260,SPSI,Sterile Supplies L3260,,Per Svc,0.01
Chargemaster Item,,272L3260,SPSI,Sterile Supplies L3260,,Per Svc,0.01
Chargemaster Item,,272L3260,SPSI,Sterile Supplies L3260,,Per Svc,0.01
Chargemaster Item,,272L3650,SPSI,Sterile Supplies L3650,,Per Svc,0.01
Chargemaster Item,,272L3650,SPSI,Sterile Supplies L3650,,Per Svc,0.01
Chargemaster Item,,272L3650,SPSI,Sterile Supplies L3650,,Per Svc,0.01
Chargemaster Item,,272L3650,SPSI,Sterile Supplies L3650,,Per Svc,0.01
Chargemaster Item,,272L3670,SPSI,Sterile Supplies L3670,,Per Svc,0.01
Chargemaster Item,,272L3670,SPSI,Sterile Supplies L3670,,Per Svc,0.01
Chargemaster Item,,272L3670,SPSI,Sterile Supplies L3670,,Per Svc,0.01
Chargemaster Item,,272L3670,SPSI,Sterile Supplies L3670,,Per Svc,0.01
Chargemaster Item,,272L3807,SPSI,Sterile Supplies L3807,,Per Svc,0.01
Chargemaster Item,,272L3807,SPSI,Sterile Supplies L3807,,Per Svc,0.01
Chargemaster Item,,272L3807,SPSI,Sterile Supplies L3807,,Per Svc,0.01
Chargemaster Item,,272L3807,SPSI,Sterile Supplies L3807,,Per Svc,0.01
Chargemaster Item,,272L3809,SPSI,Sterile Supplies L3809,,Per Svc,0.01
Chargemaster Item,,272L3809,SPSI,Sterile Supplies L3809,,Per Svc,0.01
Chargemaster Item,,272L3809,SPSI,Sterile Supplies L3809,,Per Svc,0.01
Chargemaster Item,,272L3809,SPSI,Sterile Supplies L3809,,Per Svc,0.01
Chargemaster Item,,272L3908,SPSI,Sterile Supplies L3908,,Per Svc,0.01
Chargemaster Item,,272L3908,SPSI,Sterile Supplies L3908,,Per Svc,0.01
Chargemaster Item,,272L3908,SPSI,Sterile Supplies L3908,,Per Svc,0.01
Chargemaster Item,,272L3908,SPSI,Sterile Supplies L3908,,Per Svc,0.01
Chargemaster Item,,272L3917,SPSI,Sterile Supplies L3917,,Per Svc,0.01
Chargemaster Item,,272L3917,SPSI,Sterile Supplies L3917,,Per Svc,0.01
Chargemaster Item,,272L3917,SPSI,Sterile Supplies L3917,,Per Svc,0.01
Chargemaster Item,,272L3917,SPSI,Sterile Supplies L3917,,Per Svc,0.01
Chargemaster Item,,272L3923,SPSI,Sterile Supplies L3923,,Per Svc,0.01
Chargemaster Item,,272L3923,SPSI,Sterile Supplies L3923,,Per Svc,0.01
Chargemaster Item,,272L3923,SPSI,Sterile Supplies L3923,,Per Svc,0.01
Chargemaster Item,,272L3923,SPSI,Sterile Supplies L3923,,Per Svc,0.01
Chargemaster Item,,272L4386,SPSI,Sterile Supplies L4386,,Per Svc,0.01
Chargemaster Item,,272L4386,SPSI,Sterile Supplies L4386,,Per Svc,0.01
Chargemaster Item,,272L4386,SPSI,Sterile Supplies L4386,,Per Svc,0.01
Chargemaster Item,,272L4386,SPSI,Sterile Supplies L4386,,Per Svc,0.01
Chargemaster Item,,272L4387,SPSI,Sterile Supplies L4387,,Per Svc,0.01
Chargemaster Item,,272L4387,SPSI,Sterile Supplies L4387,,Per Svc,0.01
Chargemaster Item,,272L4387,SPSI,Sterile Supplies L4387,,Per Svc,0.01
Chargemaster Item,,272L4387,SPSI,Sterile Supplies L4387,,Per Svc,0.01
Chargemaster Item,,272L5000,SPSI,Sterile Supplies L5000,,Per Svc,0.01
Chargemaster Item,,272L5000,SPSI,Sterile Supplies L5000,,Per Svc,0.01
Chargemaster Item,,272L5000,SPSI,Sterile Supplies L5000,,Per Svc,0.01
Chargemaster Item,,272L5000,SPSI,Sterile Supplies L5000,,Per Svc,0.01
Chargemaster Item,,272L8000,SPSI,Sterile Supplies L8000,,Per Svc,0.01
Chargemaster Item,,272L8000,SPSI,Sterile Supplies L8000,,Per Svc,0.01
Chargemaster Item,,272L8000,SPSI,Sterile Supplies L8000,,Per Svc,0.01
Chargemaster Item,,272L8000,SPSI,Sterile Supplies L8000,,Per Svc,0.01
Chargemaster Item,,272L8501,SPSI,Sterile Supplies L8501,,Per Svc,0.01
Chargemaster Item,,272L8501,SPSI,Sterile Supplies L8501,,Per Svc,0.01
Chargemaster Item,,272L8501,SPSI,Sterile Supplies L8501,,Per Svc,0.01
Chargemaster Item,,272L8501,SPSI,Sterile Supplies L8501,,Per Svc,0.01
Chargemaster Item,,272L8600,SPSI,Sterile Supplies L8600,,Per Svc,0.01
Chargemaster Item,,272L8600,SPSI,Sterile Supplies L8600,,Per Svc,0.01
Chargemaster Item,,272L8600,SPSI,Sterile Supplies L8600,,Per Svc,0.01
Chargemaster Item,,272L8600,SPSI,Sterile Supplies L8600,,Per Svc,0.01
Chargemaster Item,,272L8612,SPSI,Sterile Supplies L8612,,Per Svc,0.01
Chargemaster Item,,272L8612,SPSI,Sterile Supplies L8612,,Per Svc,0.01
Chargemaster Item,,272L8612,SPSI,Sterile Supplies L8612,,Per Svc,0.01
Chargemaster Item,,272L8612,SPSI,Sterile Supplies L8612,,Per Svc,0.01
Chargemaster Item,,272L8699,SPSI,Sterile Supplies L8699,,Per Svc,0.01
Chargemaster Item,,272L8699,SPSI,Sterile Supplies L8699,,Per Svc,0.01
Chargemaster Item,,272L8699,SPSI,Sterile Supplies L8699,,Per Svc,0.01
Chargemaster Item,,272L8699,SPSI,Sterile Supplies L8699,,Per Svc,0.01
Chargemaster Item,,272Q4100,SPSI,Sterile Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,272Q4100,SPSI,Sterile Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,272Q4100,SPSI,Sterile Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,272Q4100,SPSI,Sterile Supplies Q4100,,Per Svc,0.01
Chargemaster Item,,272Q4102,SPSI,Sterile Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,272Q4102,SPSI,Sterile Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,272Q4102,SPSI,Sterile Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,272Q4102,SPSI,Sterile Supplies Q4102,,Per Svc,0.01
Chargemaster Item,,272Q4110,SPSI,Sterile Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,272Q4110,SPSI,Sterile Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,272Q4110,SPSI,Sterile Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,272Q4110,SPSI,Sterile Supplies Q4110,,Per Svc,0.01
Chargemaster Item,,272Q4114,SPSI,Sterile Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,272Q4114,SPSI,Sterile Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,272Q4114,SPSI,Sterile Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,272Q4114,SPSI,Sterile Supplies Q4114,,Per Svc,0.01
Chargemaster Item,,272Q4116,SPSI,Sterile Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,272Q4116,SPSI,Sterile Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,272Q4116,SPSI,Sterile Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,272Q4116,SPSI,Sterile Supplies Q4116,,Per Svc,0.01
Chargemaster Item,,272Q4118,SPSI,Sterile Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,272Q4118,SPSI,Sterile Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,272Q4118,SPSI,Sterile Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,272Q4118,SPSI,Sterile Supplies Q4118,,Per Svc,0.01
Chargemaster Item,,272Q4125,SPSI,Sterile Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,272Q4125,SPSI,Sterile Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,272Q4125,SPSI,Sterile Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,272Q4125,SPSI,Sterile Supplies Q4125,,Per Svc,0.01
Chargemaster Item,,272Q4128,SPSI,Sterile Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,272Q4128,SPSI,Sterile Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,272Q4128,SPSI,Sterile Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,272Q4128,SPSI,Sterile Supplies Q4128,,Per Svc,0.01
Chargemaster Item,,272Q4130,SPSI,Sterile Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,272Q4130,SPSI,Sterile Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,272Q4130,SPSI,Sterile Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,272Q4130,SPSI,Sterile Supplies Q4130,,Per Svc,0.01
Chargemaster Item,,272Q4133,SPSI,Sterile Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,272Q4133,SPSI,Sterile Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,272Q4133,SPSI,Sterile Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,272Q4133,SPSI,Sterile Supplies Q4133,,Per Svc,0.01
Chargemaster Item,,272Q4155,SPSI,Sterile Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,272Q4155,SPSI,Sterile Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,272Q4155,SPSI,Sterile Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,272Q4155,SPSI,Sterile Supplies Q4155,,Per Svc,0.01
Chargemaster Item,,272Q4166,SPSI,Sterile Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,272Q4166,SPSI,Sterile Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,272Q4166,SPSI,Sterile Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,272Q4166,SPSI,Sterile Supplies Q4166,,Per Svc,0.01
Chargemaster Item,,272Q9963,SPSI,Sterile Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,272Q9963,SPSI,Sterile Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,272Q9963,SPSI,Sterile Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,272Q9963,SPSI,Sterile Supplies Q9963,,Per Svc,0.01
Chargemaster Item,,272Q9967,SPSI,Sterile Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,272Q9967,SPSI,Sterile Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,272Q9967,SPSI,Sterile Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,272Q9967,SPSI,Sterile Supplies Q9967,,Per Svc,0.01
Chargemaster Item,,272V2630,SPSI,Sterile Supplies V2630,,Per Svc,0.01
Chargemaster Item,,272V2630,SPSI,Sterile Supplies V2630,,Per Svc,0.01
Chargemaster Item,,272V2630,SPSI,Sterile Supplies V2630,,Per Svc,0.01
Chargemaster Item,,272V2630,SPSI,Sterile Supplies V2630,,Per Svc,0.01
Chargemaster Item,,272V2632,SPSI,Sterile Supplies V2632,,Per Svc,0.01
Chargemaster Item,,272V2632,SPSI,Sterile Supplies V2632,,Per Svc,0.01
Chargemaster Item,,272V2632,SPSI,Sterile Supplies V2632,,Per Svc,0.01
Chargemaster Item,,272V2632,SPSI,Sterile Supplies V2632,,Per Svc,0.01
Chargemaster Item,,272V2790,SPSI,Sterile Supplies V2790,,Per Svc,0.01
Chargemaster Item,,272V2790,SPSI,Sterile Supplies V2790,,Per Svc,0.01
Chargemaster Item,,272V2790,SPSI,Sterile Supplies V2790,,Per Svc,0.01
Chargemaster Item,,272V2790,SPSI,Sterile Supplies V2790,,Per Svc,0.01
Chargemaster Item,,272XXXXX,SPSI,Sterile Supplies,,Per Svc,0.01
Chargemaster Item,,272XXXXX,SPSI,Sterile Supplies,,Per Svc,0.01
Chargemaster Item,,272XXXXX,SPSI,Sterile Supplies,,Per Svc,0.01
Chargemaster Item,,272XXXXX,SPSI,Sterile Supplies,,Per Svc,0.01
Chargemaster Item,,27300003,SPSI,IV Infusion Initial IVPB,,Per Svc,637.00
Chargemaster Item,,27300045,SPSI,IV Push Single/Initial Drug,,Per Svc,454.00
Chargemaster Item,,27300052,SPSI,IV Push Sequential Ea New Med,,Per Svc,454.00
Chargemaster Item,,27300581,SPSI,IV Hydration,,Every 60 Minutes,1227.00
Chargemaster Item,,27315001,SPSI,Endotracheal Intubation,,Per Svc,845.00
Chargemaster Item,,27315027,SPSI,Change Tracheostomy Tube,,Per Svc,549.00
Chargemaster Item,,27316058,SPSI,Perc Trac,,Per Svc,1438.00
Chargemaster Item,,27316223,SPSI,Bronchoscopy,,Per Svc,5276.00
Chargemaster Item,,27320209,SPSI,Chest Tube Insertion,,Per Svc,3114.00
Chargemaster Item,,27332113,SPSI,Temp Pacer Insertion,,Per Svc,11209.00
Chargemaster Item,,27339670,SPSI,Iabp Insertion,,Per Svc,15415.00
Chargemaster Item,,27360007,SPSI,Cvp Insertion,,Per Svc,291.00
Chargemaster Item,,27361401,SPSI,Art Line Insertion,,Per Svc,2446.00
Chargemaster Item,,27364306,SPSI,Blood Transfusion,,Per Svc,1860.00
Chargemaster Item,,27369008,SPSI,Bedside Procedure,,Per Svc,2153.00
Chargemaster Item,,27382217,SPSI,Bone Marrow Biopsy,,Per Svc,601.00
Chargemaster Item,,273A4265,SPSI,Take-Home Suppies A4265,,Per Svc,0.01
Chargemaster Item,,273A4265,SPSI,Take-Home Suppies A4265,,Per Svc,0.01
Chargemaster Item,,273A4265,SPSI,Take-Home Suppies A4265,,Per Svc,0.01
Chargemaster Item,,273A4265,SPSI,Take-Home Suppies A4265,,Per Svc,0.01
Chargemaster Item,,273A4340,SPSI,Take-Home Suppies A4340,,Per Svc,0.01
Chargemaster Item,,273A4340,SPSI,Take-Home Suppies A4340,,Per Svc,0.01
Chargemaster Item,,273A4340,SPSI,Take-Home Suppies A4340,,Per Svc,0.01
Chargemaster Item,,273A4340,SPSI,Take-Home Suppies A4340,,Per Svc,0.01
Chargemaster Item,,273A4349,SPSI,Take-Home Suppies A4349,,Per Svc,0.01
Chargemaster Item,,273A4349,SPSI,Take-Home Suppies A4349,,Per Svc,0.01
Chargemaster Item,,273A4349,SPSI,Take-Home Suppies A4349,,Per Svc,0.01
Chargemaster Item,,273A4349,SPSI,Take-Home Suppies A4349,,Per Svc,0.01
Chargemaster Item,,273A4565,SPSI,Take-Home Suppies A4565,,Per Svc,0.01
Chargemaster Item,,273A4565,SPSI,Take-Home Suppies A4565,,Per Svc,0.01
Chargemaster Item,,273A4565,SPSI,Take-Home Suppies A4565,,Per Svc,0.01
Chargemaster Item,,273A4565,SPSI,Take-Home Suppies A4565,,Per Svc,0.01
Chargemaster Item,,273A4648,SPSI,Take-Home Suppies A4648,,Per Svc,0.01
Chargemaster Item,,273A4648,SPSI,Take-Home Suppies A4648,,Per Svc,0.01
Chargemaster Item,,273A4648,SPSI,Take-Home Suppies A4648,,Per Svc,0.01
Chargemaster Item,,273A4648,SPSI,Take-Home Suppies A4648,,Per Svc,0.01
Chargemaster Item,,273A6021,SPSI,Take-Home Suppies A6021,,Per Svc,0.01
Chargemaster Item,,273A6021,SPSI,Take-Home Suppies A6021,,Per Svc,0.01
Chargemaster Item,,273A6021,SPSI,Take-Home Suppies A6021,,Per Svc,0.01
Chargemaster Item,,273A6021,SPSI,Take-Home Suppies A6021,,Per Svc,0.01
Chargemaster Item,,273A6025,SPSI,Take-Home Suppies A6025,,Per Svc,0.01
Chargemaster Item,,273A6025,SPSI,Take-Home Suppies A6025,,Per Svc,0.01
Chargemaster Item,,273A6025,SPSI,Take-Home Suppies A6025,,Per Svc,0.01
Chargemaster Item,,273A6025,SPSI,Take-Home Suppies A6025,,Per Svc,0.01
Chargemaster Item,,273A6196,SPSI,Take-Home Suppies A6196,,Per Svc,0.01
Chargemaster Item,,273A6196,SPSI,Take-Home Suppies A6196,,Per Svc,0.01
Chargemaster Item,,273A6196,SPSI,Take-Home Suppies A6196,,Per Svc,0.01
Chargemaster Item,,273A6196,SPSI,Take-Home Suppies A6196,,Per Svc,0.01
Chargemaster Item,,273A6197,SPSI,Take-Home Suppies A6197,,Per Svc,0.01
Chargemaster Item,,273A6197,SPSI,Take-Home Suppies A6197,,Per Svc,0.01
Chargemaster Item,,273A6197,SPSI,Take-Home Suppies A6197,,Per Svc,0.01
Chargemaster Item,,273A6197,SPSI,Take-Home Suppies A6197,,Per Svc,0.01
Chargemaster Item,,273A6206,SPSI,Take-Home Suppies A6206,,Per Svc,0.01
Chargemaster Item,,273A6206,SPSI,Take-Home Suppies A6206,,Per Svc,0.01
Chargemaster Item,,273A6206,SPSI,Take-Home Suppies A6206,,Per Svc,0.01
Chargemaster Item,,273A6206,SPSI,Take-Home Suppies A6206,,Per Svc,0.01
Chargemaster Item,,273A6209,SPSI,Take-Home Suppies A6209,,Per Svc,0.01
Chargemaster Item,,273A6209,SPSI,Take-Home Suppies A6209,,Per Svc,0.01
Chargemaster Item,,273A6209,SPSI,Take-Home Suppies A6209,,Per Svc,0.01
Chargemaster Item,,273A6209,SPSI,Take-Home Suppies A6209,,Per Svc,0.01
Chargemaster Item,,273A6212,SPSI,Take-Home Suppies A6212,,Per Svc,0.01
Chargemaster Item,,273A6212,SPSI,Take-Home Suppies A6212,,Per Svc,0.01
Chargemaster Item,,273A6212,SPSI,Take-Home Suppies A6212,,Per Svc,0.01
Chargemaster Item,,273A6212,SPSI,Take-Home Suppies A6212,,Per Svc,0.01
Chargemaster Item,,273A6213,SPSI,Take-Home Suppies A6213,,Per Svc,0.01
Chargemaster Item,,273A6213,SPSI,Take-Home Suppies A6213,,Per Svc,0.01
Chargemaster Item,,273A6213,SPSI,Take-Home Suppies A6213,,Per Svc,0.01
Chargemaster Item,,273A6213,SPSI,Take-Home Suppies A6213,,Per Svc,0.01
Chargemaster Item,,273A6214,SPSI,Take-Home Suppies A6214,,Per Svc,0.01
Chargemaster Item,,273A6214,SPSI,Take-Home Suppies A6214,,Per Svc,0.01
Chargemaster Item,,273A6214,SPSI,Take-Home Suppies A6214,,Per Svc,0.01
Chargemaster Item,,273A6214,SPSI,Take-Home Suppies A6214,,Per Svc,0.01
Chargemaster Item,,273A6219,SPSI,Take-Home Suppies A6219,,Per Svc,0.01
Chargemaster Item,,273A6219,SPSI,Take-Home Suppies A6219,,Per Svc,0.01
Chargemaster Item,,273A6219,SPSI,Take-Home Suppies A6219,,Per Svc,0.01
Chargemaster Item,,273A6219,SPSI,Take-Home Suppies A6219,,Per Svc,0.01
Chargemaster Item,,273A6222,SPSI,Take-Home Suppies A6222,,Per Svc,0.01
Chargemaster Item,,273A6222,SPSI,Take-Home Suppies A6222,,Per Svc,0.01
Chargemaster Item,,273A6222,SPSI,Take-Home Suppies A6222,,Per Svc,0.01
Chargemaster Item,,273A6222,SPSI,Take-Home Suppies A6222,,Per Svc,0.01
Chargemaster Item,,273A6223,SPSI,Take-Home Suppies A6223,,Per Svc,0.01
Chargemaster Item,,273A6223,SPSI,Take-Home Suppies A6223,,Per Svc,0.01
Chargemaster Item,,273A6223,SPSI,Take-Home Suppies A6223,,Per Svc,0.01
Chargemaster Item,,273A6223,SPSI,Take-Home Suppies A6223,,Per Svc,0.01
Chargemaster Item,,273A6224,SPSI,Take-Home Suppies A6224,,Per Svc,0.01
Chargemaster Item,,273A6224,SPSI,Take-Home Suppies A6224,,Per Svc,0.01
Chargemaster Item,,273A6224,SPSI,Take-Home Suppies A6224,,Per Svc,0.01
Chargemaster Item,,273A6224,SPSI,Take-Home Suppies A6224,,Per Svc,0.01
Chargemaster Item,,273A6234,SPSI,Take-Home Suppies A6234,,Per Svc,0.01
Chargemaster Item,,273A6234,SPSI,Take-Home Suppies A6234,,Per Svc,0.01
Chargemaster Item,,273A6234,SPSI,Take-Home Suppies A6234,,Per Svc,0.01
Chargemaster Item,,273A6234,SPSI,Take-Home Suppies A6234,,Per Svc,0.01
Chargemaster Item,,273A6235,SPSI,Take-Home Suppies A6235,,Per Svc,0.01
Chargemaster Item,,273A6235,SPSI,Take-Home Suppies A6235,,Per Svc,0.01
Chargemaster Item,,273A6235,SPSI,Take-Home Suppies A6235,,Per Svc,0.01
Chargemaster Item,,273A6235,SPSI,Take-Home Suppies A6235,,Per Svc,0.01
Chargemaster Item,,273A6238,SPSI,Take-Home Suppies A6238,,Per Svc,0.01
Chargemaster Item,,273A6238,SPSI,Take-Home Suppies A6238,,Per Svc,0.01
Chargemaster Item,,273A6238,SPSI,Take-Home Suppies A6238,,Per Svc,0.01
Chargemaster Item,,273A6238,SPSI,Take-Home Suppies A6238,,Per Svc,0.01
Chargemaster Item,,273A6255,SPSI,Take-Home Suppies A6255,,Per Svc,0.01
Chargemaster Item,,273A6255,SPSI,Take-Home Suppies A6255,,Per Svc,0.01
Chargemaster Item,,273A6255,SPSI,Take-Home Suppies A6255,,Per Svc,0.01
Chargemaster Item,,273A6255,SPSI,Take-Home Suppies A6255,,Per Svc,0.01
Chargemaster Item,,273A6257,SPSI,Take-Home Suppies A6257,,Per Svc,0.01
Chargemaster Item,,273A6257,SPSI,Take-Home Suppies A6257,,Per Svc,0.01
Chargemaster Item,,273A6257,SPSI,Take-Home Suppies A6257,,Per Svc,0.01
Chargemaster Item,,273A6257,SPSI,Take-Home Suppies A6257,,Per Svc,0.01
Chargemaster Item,,273A6258,SPSI,Take-Home Suppies A6258,,Per Svc,0.01
Chargemaster Item,,273A6258,SPSI,Take-Home Suppies A6258,,Per Svc,0.01
Chargemaster Item,,273A6258,SPSI,Take-Home Suppies A6258,,Per Svc,0.01
Chargemaster Item,,273A6258,SPSI,Take-Home Suppies A6258,,Per Svc,0.01
Chargemaster Item,,273A6259,SPSI,Take-Home Suppies A6259,,Per Svc,0.01
Chargemaster Item,,273A6259,SPSI,Take-Home Suppies A6259,,Per Svc,0.01
Chargemaster Item,,273A6259,SPSI,Take-Home Suppies A6259,,Per Svc,0.01
Chargemaster Item,,273A6259,SPSI,Take-Home Suppies A6259,,Per Svc,0.01
Chargemaster Item,,273A6454,SPSI,Take-Home Suppies A6454,,Per Svc,0.01
Chargemaster Item,,273A6454,SPSI,Take-Home Suppies A6454,,Per Svc,0.01
Chargemaster Item,,273A6454,SPSI,Take-Home Suppies A6454,,Per Svc,0.01
Chargemaster Item,,273A6454,SPSI,Take-Home Suppies A6454,,Per Svc,0.01
Chargemaster Item,,273B4082,SPSI,Take-Home Suppies B4082,,Per Svc,0.01
Chargemaster Item,,273B4082,SPSI,Take-Home Suppies B4082,,Per Svc,0.01
Chargemaster Item,,273B4082,SPSI,Take-Home Suppies B4082,,Per Svc,0.01
Chargemaster Item,,273B4082,SPSI,Take-Home Suppies B4082,,Per Svc,0.01
Chargemaster Item,,273B4087,SPSI,Take-Home Suppies B4087,,Per Svc,0.01
Chargemaster Item,,273B4087,SPSI,Take-Home Suppies B4087,,Per Svc,0.01
Chargemaster Item,,273B4087,SPSI,Take-Home Suppies B4087,,Per Svc,0.01
Chargemaster Item,,273B4087,SPSI,Take-Home Suppies B4087,,Per Svc,0.01
Chargemaster Item,,273B4088,SPSI,Take-Home Suppies B4088,,Per Svc,0.01
Chargemaster Item,,273B4088,SPSI,Take-Home Suppies B4088,,Per Svc,0.01
Chargemaster Item,,273B4088,SPSI,Take-Home Suppies B4088,,Per Svc,0.01
Chargemaster Item,,273B4088,SPSI,Take-Home Suppies B4088,,Per Svc,0.01
Chargemaster Item,,273C1713,SPSI,Take-Home Suppies C1713,,Per Svc,0.01
Chargemaster Item,,273C1713,SPSI,Take-Home Suppies C1713,,Per Svc,0.01
Chargemaster Item,,273C1713,SPSI,Take-Home Suppies C1713,,Per Svc,0.01
Chargemaster Item,,273C1713,SPSI,Take-Home Suppies C1713,,Per Svc,0.01
Chargemaster Item,,273C1715,SPSI,Take-Home Suppies C1715,,Per Svc,0.01
Chargemaster Item,,273C1715,SPSI,Take-Home Suppies C1715,,Per Svc,0.01
Chargemaster Item,,273C1715,SPSI,Take-Home Suppies C1715,,Per Svc,0.01
Chargemaster Item,,273C1715,SPSI,Take-Home Suppies C1715,,Per Svc,0.01
Chargemaster Item,,273C1716,SPSI,Take-Home Suppies C1716,,Per Svc,0.01
Chargemaster Item,,273C1716,SPSI,Take-Home Suppies C1716,,Per Svc,0.01
Chargemaster Item,,273C1716,SPSI,Take-Home Suppies C1716,,Per Svc,0.01
Chargemaster Item,,273C1716,SPSI,Take-Home Suppies C1716,,Per Svc,0.01
Chargemaster Item,,273C1721,SPSI,Take-Home Suppies C1721,,Per Svc,0.01
Chargemaster Item,,273C1721,SPSI,Take-Home Suppies C1721,,Per Svc,0.01
Chargemaster Item,,273C1721,SPSI,Take-Home Suppies C1721,,Per Svc,0.01
Chargemaster Item,,273C1721,SPSI,Take-Home Suppies C1721,,Per Svc,0.01
Chargemaster Item,,273C1722,SPSI,Take-Home Suppies C1722,,Per Svc,0.01
Chargemaster Item,,273C1722,SPSI,Take-Home Suppies C1722,,Per Svc,0.01
Chargemaster Item,,273C1722,SPSI,Take-Home Suppies C1722,,Per Svc,0.01
Chargemaster Item,,273C1722,SPSI,Take-Home Suppies C1722,,Per Svc,0.01
Chargemaster Item,,273C1724,SPSI,Take-Home Suppies C1724,,Per Svc,0.01
Chargemaster Item,,273C1724,SPSI,Take-Home Suppies C1724,,Per Svc,0.01
Chargemaster Item,,273C1724,SPSI,Take-Home Suppies C1724,,Per Svc,0.01
Chargemaster Item,,273C1724,SPSI,Take-Home Suppies C1724,,Per Svc,0.01
Chargemaster Item,,273C1725,SPSI,Take-Home Suppies C1725,,Per Svc,0.01
Chargemaster Item,,273C1725,SPSI,Take-Home Suppies C1725,,Per Svc,0.01
Chargemaster Item,,273C1725,SPSI,Take-Home Suppies C1725,,Per Svc,0.01
Chargemaster Item,,273C1725,SPSI,Take-Home Suppies C1725,,Per Svc,0.01
Chargemaster Item,,273C1726,SPSI,Take-Home Suppies C1726,,Per Svc,0.01
Chargemaster Item,,273C1726,SPSI,Take-Home Suppies C1726,,Per Svc,0.01
Chargemaster Item,,273C1726,SPSI,Take-Home Suppies C1726,,Per Svc,0.01
Chargemaster Item,,273C1726,SPSI,Take-Home Suppies C1726,,Per Svc,0.01
Chargemaster Item,,273C1727,SPSI,Take-Home Suppies C1727,,Per Svc,0.01
Chargemaster Item,,273C1727,SPSI,Take-Home Suppies C1727,,Per Svc,0.01
Chargemaster Item,,273C1727,SPSI,Take-Home Suppies C1727,,Per Svc,0.01
Chargemaster Item,,273C1727,SPSI,Take-Home Suppies C1727,,Per Svc,0.01
Chargemaster Item,,273C1729,SPSI,Take-Home Suppies C1729,,Per Svc,0.01
Chargemaster Item,,273C1729,SPSI,Take-Home Suppies C1729,,Per Svc,0.01
Chargemaster Item,,273C1729,SPSI,Take-Home Suppies C1729,,Per Svc,0.01
Chargemaster Item,,273C1729,SPSI,Take-Home Suppies C1729,,Per Svc,0.01
Chargemaster Item,,273C1730,SPSI,Take-Home Suppies C1730,,Per Svc,0.01
Chargemaster Item,,273C1730,SPSI,Take-Home Suppies C1730,,Per Svc,0.01
Chargemaster Item,,273C1730,SPSI,Take-Home Suppies C1730,,Per Svc,0.01
Chargemaster Item,,273C1730,SPSI,Take-Home Suppies C1730,,Per Svc,0.01
Chargemaster Item,,273C1731,SPSI,Take-Home Suppies C1731,,Per Svc,0.01
Chargemaster Item,,273C1731,SPSI,Take-Home Suppies C1731,,Per Svc,0.01
Chargemaster Item,,273C1731,SPSI,Take-Home Suppies C1731,,Per Svc,0.01
Chargemaster Item,,273C1731,SPSI,Take-Home Suppies C1731,,Per Svc,0.01
Chargemaster Item,,273C1733,SPSI,Take-Home Suppies C1733,,Per Svc,0.01
Chargemaster Item,,273C1733,SPSI,Take-Home Suppies C1733,,Per Svc,0.01
Chargemaster Item,,273C1733,SPSI,Take-Home Suppies C1733,,Per Svc,0.01
Chargemaster Item,,273C1733,SPSI,Take-Home Suppies C1733,,Per Svc,0.01
Chargemaster Item,,273C1750,SPSI,Take-Home Suppies C1750,,Per Svc,0.01
Chargemaster Item,,273C1750,SPSI,Take-Home Suppies C1750,,Per Svc,0.01
Chargemaster Item,,273C1750,SPSI,Take-Home Suppies C1750,,Per Svc,0.01
Chargemaster Item,,273C1750,SPSI,Take-Home Suppies C1750,,Per Svc,0.01
Chargemaster Item,,273C1751,SPSI,Take-Home Suppies C1751,,Per Svc,0.01
Chargemaster Item,,273C1751,SPSI,Take-Home Suppies C1751,,Per Svc,0.01
Chargemaster Item,,273C1751,SPSI,Take-Home Suppies C1751,,Per Svc,0.01
Chargemaster Item,,273C1751,SPSI,Take-Home Suppies C1751,,Per Svc,0.01
Chargemaster Item,,273C1752,SPSI,Take-Home Suppies C1752,,Per Svc,0.01
Chargemaster Item,,273C1752,SPSI,Take-Home Suppies C1752,,Per Svc,0.01
Chargemaster Item,,273C1752,SPSI,Take-Home Suppies C1752,,Per Svc,0.01
Chargemaster Item,,273C1752,SPSI,Take-Home Suppies C1752,,Per Svc,0.01
Chargemaster Item,,273C1753,SPSI,Take-Home Suppies C1753,,Per Svc,0.01
Chargemaster Item,,273C1753,SPSI,Take-Home Suppies C1753,,Per Svc,0.01
Chargemaster Item,,273C1753,SPSI,Take-Home Suppies C1753,,Per Svc,0.01
Chargemaster Item,,273C1753,SPSI,Take-Home Suppies C1753,,Per Svc,0.01
Chargemaster Item,,273C1755,SPSI,Take-Home Suppies C1755,,Per Svc,0.01
Chargemaster Item,,273C1755,SPSI,Take-Home Suppies C1755,,Per Svc,0.01
Chargemaster Item,,273C1755,SPSI,Take-Home Suppies C1755,,Per Svc,0.01
Chargemaster Item,,273C1755,SPSI,Take-Home Suppies C1755,,Per Svc,0.01
Chargemaster Item,,273C1757,SPSI,Take-Home Suppies C1757,,Per Svc,0.01
Chargemaster Item,,273C1757,SPSI,Take-Home Suppies C1757,,Per Svc,0.01
Chargemaster Item,,273C1757,SPSI,Take-Home Suppies C1757,,Per Svc,0.01
Chargemaster Item,,273C1757,SPSI,Take-Home Suppies C1757,,Per Svc,0.01
Chargemaster Item,,273C1758,SPSI,Take-Home Suppies C1758,,Per Svc,0.01
Chargemaster Item,,273C1758,SPSI,Take-Home Suppies C1758,,Per Svc,0.01
Chargemaster Item,,273C1758,SPSI,Take-Home Suppies C1758,,Per Svc,0.01
Chargemaster Item,,273C1758,SPSI,Take-Home Suppies C1758,,Per Svc,0.01
Chargemaster Item,,273C1760,SPSI,Take-Home Suppies C1760,,Per Svc,0.01
Chargemaster Item,,273C1760,SPSI,Take-Home Suppies C1760,,Per Svc,0.01
Chargemaster Item,,273C1760,SPSI,Take-Home Suppies C1760,,Per Svc,0.01
Chargemaster Item,,273C1760,SPSI,Take-Home Suppies C1760,,Per Svc,0.01
Chargemaster Item,,273C1762,SPSI,Take-Home Suppies C1762,,Per Svc,0.01
Chargemaster Item,,273C1762,SPSI,Take-Home Suppies C1762,,Per Svc,0.01
Chargemaster Item,,273C1762,SPSI,Take-Home Suppies C1762,,Per Svc,0.01
Chargemaster Item,,273C1762,SPSI,Take-Home Suppies C1762,,Per Svc,0.01
Chargemaster Item,,273C1763,SPSI,Take-Home Suppies C1763,,Per Svc,0.01
Chargemaster Item,,273C1763,SPSI,Take-Home Suppies C1763,,Per Svc,0.01
Chargemaster Item,,273C1763,SPSI,Take-Home Suppies C1763,,Per Svc,0.01
Chargemaster Item,,273C1763,SPSI,Take-Home Suppies C1763,,Per Svc,0.01
Chargemaster Item,,273C1764,SPSI,Take-Home Suppies C1764,,Per Svc,0.01
Chargemaster Item,,273C1764,SPSI,Take-Home Suppies C1764,,Per Svc,0.01
Chargemaster Item,,273C1764,SPSI,Take-Home Suppies C1764,,Per Svc,0.01
Chargemaster Item,,273C1764,SPSI,Take-Home Suppies C1764,,Per Svc,0.01
Chargemaster Item,,273C1766,SPSI,Take-Home Suppies C1766,,Per Svc,0.01
Chargemaster Item,,273C1766,SPSI,Take-Home Suppies C1766,,Per Svc,0.01
Chargemaster Item,,273C1766,SPSI,Take-Home Suppies C1766,,Per Svc,0.01
Chargemaster Item,,273C1766,SPSI,Take-Home Suppies C1766,,Per Svc,0.01
Chargemaster Item,,273C1767,SPSI,Take-Home Suppies C1767,,Per Svc,0.01
Chargemaster Item,,273C1767,SPSI,Take-Home Suppies C1767,,Per Svc,0.01
Chargemaster Item,,273C1767,SPSI,Take-Home Suppies C1767,,Per Svc,0.01
Chargemaster Item,,273C1767,SPSI,Take-Home Suppies C1767,,Per Svc,0.01
Chargemaster Item,,273C1768,SPSI,Take-Home Suppies C1768,,Per Svc,0.01
Chargemaster Item,,273C1768,SPSI,Take-Home Suppies C1768,,Per Svc,0.01
Chargemaster Item,,273C1768,SPSI,Take-Home Suppies C1768,,Per Svc,0.01
Chargemaster Item,,273C1768,SPSI,Take-Home Suppies C1768,,Per Svc,0.01
Chargemaster Item,,273C1769,SPSI,Take-Home Suppies C1769,,Per Svc,0.01
Chargemaster Item,,273C1769,SPSI,Take-Home Suppies C1769,,Per Svc,0.01
Chargemaster Item,,273C1769,SPSI,Take-Home Suppies C1769,,Per Svc,0.01
Chargemaster Item,,273C1769,SPSI,Take-Home Suppies C1769,,Per Svc,0.01
Chargemaster Item,,273C1771,SPSI,Take-Home Suppies C1771,,Per Svc,0.01
Chargemaster Item,,273C1771,SPSI,Take-Home Suppies C1771,,Per Svc,0.01
Chargemaster Item,,273C1771,SPSI,Take-Home Suppies C1771,,Per Svc,0.01
Chargemaster Item,,273C1771,SPSI,Take-Home Suppies C1771,,Per Svc,0.01
Chargemaster Item,,273C1772,SPSI,Take-Home Suppies C1772,,Per Svc,0.01
Chargemaster Item,,273C1772,SPSI,Take-Home Suppies C1772,,Per Svc,0.01
Chargemaster Item,,273C1772,SPSI,Take-Home Suppies C1772,,Per Svc,0.01
Chargemaster Item,,273C1772,SPSI,Take-Home Suppies C1772,,Per Svc,0.01
Chargemaster Item,,273C1773,SPSI,Take-Home Suppies C1773,,Per Svc,0.01
Chargemaster Item,,273C1773,SPSI,Take-Home Suppies C1773,,Per Svc,0.01
Chargemaster Item,,273C1773,SPSI,Take-Home Suppies C1773,,Per Svc,0.01
Chargemaster Item,,273C1773,SPSI,Take-Home Suppies C1773,,Per Svc,0.01
Chargemaster Item,,273C1776,SPSI,Take-Home Suppies C1776,,Per Svc,0.01
Chargemaster Item,,273C1776,SPSI,Take-Home Suppies C1776,,Per Svc,0.01
Chargemaster Item,,273C1776,SPSI,Take-Home Suppies C1776,,Per Svc,0.01
Chargemaster Item,,273C1776,SPSI,Take-Home Suppies C1776,,Per Svc,0.01
Chargemaster Item,,273C1777,SPSI,Take-Home Suppies C1777,,Per Svc,0.01
Chargemaster Item,,273C1777,SPSI,Take-Home Suppies C1777,,Per Svc,0.01
Chargemaster Item,,273C1777,SPSI,Take-Home Suppies C1777,,Per Svc,0.01
Chargemaster Item,,273C1777,SPSI,Take-Home Suppies C1777,,Per Svc,0.01
Chargemaster Item,,273C1778,SPSI,Take-Home Suppies C1778,,Per Svc,0.01
Chargemaster Item,,273C1778,SPSI,Take-Home Suppies C1778,,Per Svc,0.01
Chargemaster Item,,273C1778,SPSI,Take-Home Suppies C1778,,Per Svc,0.01
Chargemaster Item,,273C1778,SPSI,Take-Home Suppies C1778,,Per Svc,0.01
Chargemaster Item,,273C1781,SPSI,Take-Home Suppies C1781,,Per Svc,0.01
Chargemaster Item,,273C1781,SPSI,Take-Home Suppies C1781,,Per Svc,0.01
Chargemaster Item,,273C1781,SPSI,Take-Home Suppies C1781,,Per Svc,0.01
Chargemaster Item,,273C1781,SPSI,Take-Home Suppies C1781,,Per Svc,0.01
Chargemaster Item,,273C1783,SPSI,Take-Home Suppies C1783,,Per Svc,0.01
Chargemaster Item,,273C1783,SPSI,Take-Home Suppies C1783,,Per Svc,0.01
Chargemaster Item,,273C1783,SPSI,Take-Home Suppies C1783,,Per Svc,0.01
Chargemaster Item,,273C1783,SPSI,Take-Home Suppies C1783,,Per Svc,0.01
Chargemaster Item,,273C1785,SPSI,Take-Home Suppies C1785,,Per Svc,0.01
Chargemaster Item,,273C1785,SPSI,Take-Home Suppies C1785,,Per Svc,0.01
Chargemaster Item,,273C1785,SPSI,Take-Home Suppies C1785,,Per Svc,0.01
Chargemaster Item,,273C1785,SPSI,Take-Home Suppies C1785,,Per Svc,0.01
Chargemaster Item,,273C1786,SPSI,Take-Home Suppies C1786,,Per Svc,0.01
Chargemaster Item,,273C1786,SPSI,Take-Home Suppies C1786,,Per Svc,0.01
Chargemaster Item,,273C1786,SPSI,Take-Home Suppies C1786,,Per Svc,0.01
Chargemaster Item,,273C1786,SPSI,Take-Home Suppies C1786,,Per Svc,0.01
Chargemaster Item,,273C1787,SPSI,Take-Home Suppies C1787,,Per Svc,0.01
Chargemaster Item,,273C1787,SPSI,Take-Home Suppies C1787,,Per Svc,0.01
Chargemaster Item,,273C1787,SPSI,Take-Home Suppies C1787,,Per Svc,0.01
Chargemaster Item,,273C1787,SPSI,Take-Home Suppies C1787,,Per Svc,0.01
Chargemaster Item,,273C1788,SPSI,Take-Home Suppies C1788,,Per Svc,0.01
Chargemaster Item,,273C1788,SPSI,Take-Home Suppies C1788,,Per Svc,0.01
Chargemaster Item,,273C1788,SPSI,Take-Home Suppies C1788,,Per Svc,0.01
Chargemaster Item,,273C1788,SPSI,Take-Home Suppies C1788,,Per Svc,0.01
Chargemaster Item,,273C1789,SPSI,Take-Home Suppies C1789,,Per Svc,0.01
Chargemaster Item,,273C1789,SPSI,Take-Home Suppies C1789,,Per Svc,0.01
Chargemaster Item,,273C1789,SPSI,Take-Home Suppies C1789,,Per Svc,0.01
Chargemaster Item,,273C1789,SPSI,Take-Home Suppies C1789,,Per Svc,0.01
Chargemaster Item,,273C1817,SPSI,Take-Home Suppies C1817,,Per Svc,0.01
Chargemaster Item,,273C1817,SPSI,Take-Home Suppies C1817,,Per Svc,0.01
Chargemaster Item,,273C1817,SPSI,Take-Home Suppies C1817,,Per Svc,0.01
Chargemaster Item,,273C1817,SPSI,Take-Home Suppies C1817,,Per Svc,0.01
Chargemaster Item,,273C1821,SPSI,Take-Home Suppies C1821,,Per Svc,0.01
Chargemaster Item,,273C1821,SPSI,Take-Home Suppies C1821,,Per Svc,0.01
Chargemaster Item,,273C1821,SPSI,Take-Home Suppies C1821,,Per Svc,0.01
Chargemaster Item,,273C1821,SPSI,Take-Home Suppies C1821,,Per Svc,0.01
Chargemaster Item,,273C1874,SPSI,Take-Home Suppies C1874,,Per Svc,0.01
Chargemaster Item,,273C1874,SPSI,Take-Home Suppies C1874,,Per Svc,0.01
Chargemaster Item,,273C1874,SPSI,Take-Home Suppies C1874,,Per Svc,0.01
Chargemaster Item,,273C1874,SPSI,Take-Home Suppies C1874,,Per Svc,0.01
Chargemaster Item,,273C1875,SPSI,Take-Home Suppies C1875,,Per Svc,0.01
Chargemaster Item,,273C1875,SPSI,Take-Home Suppies C1875,,Per Svc,0.01
Chargemaster Item,,273C1875,SPSI,Take-Home Suppies C1875,,Per Svc,0.01
Chargemaster Item,,273C1875,SPSI,Take-Home Suppies C1875,,Per Svc,0.01
Chargemaster Item,,273C1876,SPSI,Take-Home Suppies C1876,,Per Svc,0.01
Chargemaster Item,,273C1876,SPSI,Take-Home Suppies C1876,,Per Svc,0.01
Chargemaster Item,,273C1876,SPSI,Take-Home Suppies C1876,,Per Svc,0.01
Chargemaster Item,,273C1876,SPSI,Take-Home Suppies C1876,,Per Svc,0.01
Chargemaster Item,,273C1880,SPSI,Take-Home Suppies C1880,,Per Svc,0.01
Chargemaster Item,,273C1880,SPSI,Take-Home Suppies C1880,,Per Svc,0.01
Chargemaster Item,,273C1880,SPSI,Take-Home Suppies C1880,,Per Svc,0.01
Chargemaster Item,,273C1880,SPSI,Take-Home Suppies C1880,,Per Svc,0.01
Chargemaster Item,,273C1881,SPSI,Take-Home Suppies C1881,,Per Svc,0.01
Chargemaster Item,,273C1881,SPSI,Take-Home Suppies C1881,,Per Svc,0.01
Chargemaster Item,,273C1881,SPSI,Take-Home Suppies C1881,,Per Svc,0.01
Chargemaster Item,,273C1881,SPSI,Take-Home Suppies C1881,,Per Svc,0.01
Chargemaster Item,,273C1882,SPSI,Take-Home Suppies C1882,,Per Svc,0.01
Chargemaster Item,,273C1882,SPSI,Take-Home Suppies C1882,,Per Svc,0.01
Chargemaster Item,,273C1882,SPSI,Take-Home Suppies C1882,,Per Svc,0.01
Chargemaster Item,,273C1882,SPSI,Take-Home Suppies C1882,,Per Svc,0.01
Chargemaster Item,,273C1883,SPSI,Take-Home Suppies C1883,,Per Svc,0.01
Chargemaster Item,,273C1883,SPSI,Take-Home Suppies C1883,,Per Svc,0.01
Chargemaster Item,,273C1883,SPSI,Take-Home Suppies C1883,,Per Svc,0.01
Chargemaster Item,,273C1883,SPSI,Take-Home Suppies C1883,,Per Svc,0.01
Chargemaster Item,,273C1884,SPSI,Take-Home Suppies C1884,,Per Svc,0.01
Chargemaster Item,,273C1884,SPSI,Take-Home Suppies C1884,,Per Svc,0.01
Chargemaster Item,,273C1884,SPSI,Take-Home Suppies C1884,,Per Svc,0.01
Chargemaster Item,,273C1884,SPSI,Take-Home Suppies C1884,,Per Svc,0.01
Chargemaster Item,,273C1887,SPSI,Take-Home Suppies C1887,,Per Svc,0.01
Chargemaster Item,,273C1887,SPSI,Take-Home Suppies C1887,,Per Svc,0.01
Chargemaster Item,,273C1887,SPSI,Take-Home Suppies C1887,,Per Svc,0.01
Chargemaster Item,,273C1887,SPSI,Take-Home Suppies C1887,,Per Svc,0.01
Chargemaster Item,,273C1889,SPSI,Take-Home Suppies C1889,,Per Svc,0.01
Chargemaster Item,,273C1889,SPSI,Take-Home Suppies C1889,,Per Svc,0.01
Chargemaster Item,,273C1889,SPSI,Take-Home Suppies C1889,,Per Svc,0.01
Chargemaster Item,,273C1889,SPSI,Take-Home Suppies C1889,,Per Svc,0.01
Chargemaster Item,,273C1892,SPSI,Take-Home Suppies C1892,,Per Svc,0.01
Chargemaster Item,,273C1892,SPSI,Take-Home Suppies C1892,,Per Svc,0.01
Chargemaster Item,,273C1892,SPSI,Take-Home Suppies C1892,,Per Svc,0.01
Chargemaster Item,,273C1892,SPSI,Take-Home Suppies C1892,,Per Svc,0.01
Chargemaster Item,,273C1893,SPSI,Take-Home Suppies C1893,,Per Svc,0.01
Chargemaster Item,,273C1893,SPSI,Take-Home Suppies C1893,,Per Svc,0.01
Chargemaster Item,,273C1893,SPSI,Take-Home Suppies C1893,,Per Svc,0.01
Chargemaster Item,,273C1893,SPSI,Take-Home Suppies C1893,,Per Svc,0.01
Chargemaster Item,,273C1894,SPSI,Take-Home Suppies C1894,,Per Svc,0.01
Chargemaster Item,,273C1894,SPSI,Take-Home Suppies C1894,,Per Svc,0.01
Chargemaster Item,,273C1894,SPSI,Take-Home Suppies C1894,,Per Svc,0.01
Chargemaster Item,,273C1894,SPSI,Take-Home Suppies C1894,,Per Svc,0.01
Chargemaster Item,,273C1897,SPSI,Take-Home Suppies C1897,,Per Svc,0.01
Chargemaster Item,,273C1897,SPSI,Take-Home Suppies C1897,,Per Svc,0.01
Chargemaster Item,,273C1897,SPSI,Take-Home Suppies C1897,,Per Svc,0.01
Chargemaster Item,,273C1897,SPSI,Take-Home Suppies C1897,,Per Svc,0.01
Chargemaster Item,,273C1898,SPSI,Take-Home Suppies C1898,,Per Svc,0.01
Chargemaster Item,,273C1898,SPSI,Take-Home Suppies C1898,,Per Svc,0.01
Chargemaster Item,,273C1898,SPSI,Take-Home Suppies C1898,,Per Svc,0.01
Chargemaster Item,,273C1898,SPSI,Take-Home Suppies C1898,,Per Svc,0.01
Chargemaster Item,,273C1900,SPSI,Take-Home Suppies C1900,,Per Svc,0.01
Chargemaster Item,,273C1900,SPSI,Take-Home Suppies C1900,,Per Svc,0.01
Chargemaster Item,,273C1900,SPSI,Take-Home Suppies C1900,,Per Svc,0.01
Chargemaster Item,,273C1900,SPSI,Take-Home Suppies C1900,,Per Svc,0.01
Chargemaster Item,,273C2617,SPSI,Take-Home Suppies C2617,,Per Svc,0.01
Chargemaster Item,,273C2617,SPSI,Take-Home Suppies C2617,,Per Svc,0.01
Chargemaster Item,,273C2617,SPSI,Take-Home Suppies C2617,,Per Svc,0.01
Chargemaster Item,,273C2617,SPSI,Take-Home Suppies C2617,,Per Svc,0.01
Chargemaster Item,,273C2618,SPSI,Take-Home Suppies C2618,,Per Svc,0.01
Chargemaster Item,,273C2618,SPSI,Take-Home Suppies C2618,,Per Svc,0.01
Chargemaster Item,,273C2618,SPSI,Take-Home Suppies C2618,,Per Svc,0.01
Chargemaster Item,,273C2618,SPSI,Take-Home Suppies C2618,,Per Svc,0.01
Chargemaster Item,,273C2623,SPSI,Take-Home Suppies C2623,,Per Svc,0.01
Chargemaster Item,,273C2623,SPSI,Take-Home Suppies C2623,,Per Svc,0.01
Chargemaster Item,,273C2623,SPSI,Take-Home Suppies C2623,,Per Svc,0.01
Chargemaster Item,,273C2623,SPSI,Take-Home Suppies C2623,,Per Svc,0.01
Chargemaster Item,,273C2625,SPSI,Take-Home Suppies C2625,,Per Svc,0.01
Chargemaster Item,,273C2625,SPSI,Take-Home Suppies C2625,,Per Svc,0.01
Chargemaster Item,,273C2625,SPSI,Take-Home Suppies C2625,,Per Svc,0.01
Chargemaster Item,,273C2625,SPSI,Take-Home Suppies C2625,,Per Svc,0.01
Chargemaster Item,,273C2627,SPSI,Take-Home Suppies C2627,,Per Svc,0.01
Chargemaster Item,,273C2627,SPSI,Take-Home Suppies C2627,,Per Svc,0.01
Chargemaster Item,,273C2627,SPSI,Take-Home Suppies C2627,,Per Svc,0.01
Chargemaster Item,,273C2627,SPSI,Take-Home Suppies C2627,,Per Svc,0.01
Chargemaster Item,,273C2628,SPSI,Take-Home Suppies C2628,,Per Svc,0.01
Chargemaster Item,,273C2628,SPSI,Take-Home Suppies C2628,,Per Svc,0.01
Chargemaster Item,,273C2628,SPSI,Take-Home Suppies C2628,,Per Svc,0.01
Chargemaster Item,,273C2628,SPSI,Take-Home Suppies C2628,,Per Svc,0.01
Chargemaster Item,,273C2630,SPSI,Take-Home Suppies C2630,,Per Svc,0.01
Chargemaster Item,,273C2630,SPSI,Take-Home Suppies C2630,,Per Svc,0.01
Chargemaster Item,,273C2630,SPSI,Take-Home Suppies C2630,,Per Svc,0.01
Chargemaster Item,,273C2630,SPSI,Take-Home Suppies C2630,,Per Svc,0.01
Chargemaster Item,,273C2639,SPSI,Take-Home Suppies C2639,,Per Svc,0.01
Chargemaster Item,,273C2639,SPSI,Take-Home Suppies C2639,,Per Svc,0.01
Chargemaster Item,,273C2639,SPSI,Take-Home Suppies C2639,,Per Svc,0.01
Chargemaster Item,,273C2639,SPSI,Take-Home Suppies C2639,,Per Svc,0.01
Chargemaster Item,,273C9250,SPSI,Take-Home Suppies C9250,,Per Svc,0.01
Chargemaster Item,,273C9250,SPSI,Take-Home Suppies C9250,,Per Svc,0.01
Chargemaster Item,,273C9250,SPSI,Take-Home Suppies C9250,,Per Svc,0.01
Chargemaster Item,,273C9250,SPSI,Take-Home Suppies C9250,,Per Svc,0.01
Chargemaster Item,,273C9352,SPSI,Take-Home Suppies C9352,,Per Svc,0.01
Chargemaster Item,,273C9352,SPSI,Take-Home Suppies C9352,,Per Svc,0.01
Chargemaster Item,,273C9352,SPSI,Take-Home Suppies C9352,,Per Svc,0.01
Chargemaster Item,,273C9352,SPSI,Take-Home Suppies C9352,,Per Svc,0.01
Chargemaster Item,,273C9353,SPSI,Take-Home Suppies C9353,,Per Svc,0.01
Chargemaster Item,,273C9353,SPSI,Take-Home Suppies C9353,,Per Svc,0.01
Chargemaster Item,,273C9353,SPSI,Take-Home Suppies C9353,,Per Svc,0.01
Chargemaster Item,,273C9353,SPSI,Take-Home Suppies C9353,,Per Svc,0.01
Chargemaster Item,,273C9363,SPSI,Take-Home Suppies C9363,,Per Svc,0.01
Chargemaster Item,,273C9363,SPSI,Take-Home Suppies C9363,,Per Svc,0.01
Chargemaster Item,,273C9363,SPSI,Take-Home Suppies C9363,,Per Svc,0.01
Chargemaster Item,,273C9363,SPSI,Take-Home Suppies C9363,,Per Svc,0.01
Chargemaster Item,,273E0191,SPSI,Take-Home Suppies E0191,,Per Svc,0.01
Chargemaster Item,,273E0191,SPSI,Take-Home Suppies E0191,,Per Svc,0.01
Chargemaster Item,,273E0191,SPSI,Take-Home Suppies E0191,,Per Svc,0.01
Chargemaster Item,,273E0191,SPSI,Take-Home Suppies E0191,,Per Svc,0.01
Chargemaster Item,,273E0235,SPSI,Take-Home Suppies E0235,,Per Svc,0.01
Chargemaster Item,,273E0235,SPSI,Take-Home Suppies E0235,,Per Svc,0.01
Chargemaster Item,,273E0235,SPSI,Take-Home Suppies E0235,,Per Svc,0.01
Chargemaster Item,,273E0235,SPSI,Take-Home Suppies E0235,,Per Svc,0.01
Chargemaster Item,,273L0113,SPSI,Take-Home Suppies L0113,,Per Svc,0.01
Chargemaster Item,,273L0113,SPSI,Take-Home Suppies L0113,,Per Svc,0.01
Chargemaster Item,,273L0113,SPSI,Take-Home Suppies L0113,,Per Svc,0.01
Chargemaster Item,,273L0113,SPSI,Take-Home Suppies L0113,,Per Svc,0.01
Chargemaster Item,,273L0120,SPSI,Take-Home Suppies L0120,,Per Svc,0.01
Chargemaster Item,,273L0120,SPSI,Take-Home Suppies L0120,,Per Svc,0.01
Chargemaster Item,,273L0120,SPSI,Take-Home Suppies L0120,,Per Svc,0.01
Chargemaster Item,,273L0120,SPSI,Take-Home Suppies L0120,,Per Svc,0.01
Chargemaster Item,,273L0172,SPSI,Take-Home Suppies L0172,,Per Svc,0.01
Chargemaster Item,,273L0172,SPSI,Take-Home Suppies L0172,,Per Svc,0.01
Chargemaster Item,,273L0172,SPSI,Take-Home Suppies L0172,,Per Svc,0.01
Chargemaster Item,,273L0172,SPSI,Take-Home Suppies L0172,,Per Svc,0.01
Chargemaster Item,,273L0174,SPSI,Take-Home Suppies L0174,,Per Svc,0.01
Chargemaster Item,,273L0174,SPSI,Take-Home Suppies L0174,,Per Svc,0.01
Chargemaster Item,,273L0174,SPSI,Take-Home Suppies L0174,,Per Svc,0.01
Chargemaster Item,,273L0174,SPSI,Take-Home Suppies L0174,,Per Svc,0.01
Chargemaster Item,,273L0625,SPSI,Take-Home Suppies L0625,,Per Svc,0.01
Chargemaster Item,,273L0625,SPSI,Take-Home Suppies L0625,,Per Svc,0.01
Chargemaster Item,,273L0625,SPSI,Take-Home Suppies L0625,,Per Svc,0.01
Chargemaster Item,,273L0625,SPSI,Take-Home Suppies L0625,,Per Svc,0.01
Chargemaster Item,,273L1820,SPSI,Take-Home Suppies L1820,,Per Svc,0.01
Chargemaster Item,,273L1820,SPSI,Take-Home Suppies L1820,,Per Svc,0.01
Chargemaster Item,,273L1820,SPSI,Take-Home Suppies L1820,,Per Svc,0.01
Chargemaster Item,,273L1820,SPSI,Take-Home Suppies L1820,,Per Svc,0.01
Chargemaster Item,,273L1830,SPSI,Take-Home Suppies L1830,,Per Svc,0.01
Chargemaster Item,,273L1830,SPSI,Take-Home Suppies L1830,,Per Svc,0.01
Chargemaster Item,,273L1830,SPSI,Take-Home Suppies L1830,,Per Svc,0.01
Chargemaster Item,,273L1830,SPSI,Take-Home Suppies L1830,,Per Svc,0.01
Chargemaster Item,,273L1832,SPSI,Take-Home Suppies L1832,,Per Svc,0.01
Chargemaster Item,,273L1832,SPSI,Take-Home Suppies L1832,,Per Svc,0.01
Chargemaster Item,,273L1832,SPSI,Take-Home Suppies L1832,,Per Svc,0.01
Chargemaster Item,,273L1832,SPSI,Take-Home Suppies L1832,,Per Svc,0.01
Chargemaster Item,,273L1902,SPSI,Take-Home Suppies L1902,,Per Svc,0.01
Chargemaster Item,,273L1902,SPSI,Take-Home Suppies L1902,,Per Svc,0.01
Chargemaster Item,,273L1902,SPSI,Take-Home Suppies L1902,,Per Svc,0.01
Chargemaster Item,,273L1902,SPSI,Take-Home Suppies L1902,,Per Svc,0.01
Chargemaster Item,,273L1930,SPSI,Take-Home Suppies L1930,,Per Svc,0.01
Chargemaster Item,,273L1930,SPSI,Take-Home Suppies L1930,,Per Svc,0.01
Chargemaster Item,,273L1930,SPSI,Take-Home Suppies L1930,,Per Svc,0.01
Chargemaster Item,,273L1930,SPSI,Take-Home Suppies L1930,,Per Svc,0.01
Chargemaster Item,,273L3260,SPSI,Take-Home Suppies L3260,,Per Svc,0.01
Chargemaster Item,,273L3260,SPSI,Take-Home Suppies L3260,,Per Svc,0.01
Chargemaster Item,,273L3260,SPSI,Take-Home Suppies L3260,,Per Svc,0.01
Chargemaster Item,,273L3260,SPSI,Take-Home Suppies L3260,,Per Svc,0.01
Chargemaster Item,,273L3650,SPSI,Take-Home Suppies L3650,,Per Svc,0.01
Chargemaster Item,,273L3650,SPSI,Take-Home Suppies L3650,,Per Svc,0.01
Chargemaster Item,,273L3650,SPSI,Take-Home Suppies L3650,,Per Svc,0.01
Chargemaster Item,,273L3650,SPSI,Take-Home Suppies L3650,,Per Svc,0.01
Chargemaster Item,,273L3670,SPSI,Take-Home Suppies L3670,,Per Svc,0.01
Chargemaster Item,,273L3670,SPSI,Take-Home Suppies L3670,,Per Svc,0.01
Chargemaster Item,,273L3670,SPSI,Take-Home Suppies L3670,,Per Svc,0.01
Chargemaster Item,,273L3670,SPSI,Take-Home Suppies L3670,,Per Svc,0.01
Chargemaster Item,,273L3807,SPSI,Take-Home Suppies L3807,,Per Svc,0.01
Chargemaster Item,,273L3807,SPSI,Take-Home Suppies L3807,,Per Svc,0.01
Chargemaster Item,,273L3807,SPSI,Take-Home Suppies L3807,,Per Svc,0.01
Chargemaster Item,,273L3807,SPSI,Take-Home Suppies L3807,,Per Svc,0.01
Chargemaster Item,,273L3809,SPSI,Take-Home Suppies L3809,,Per Svc,0.01
Chargemaster Item,,273L3809,SPSI,Take-Home Suppies L3809,,Per Svc,0.01
Chargemaster Item,,273L3809,SPSI,Take-Home Suppies L3809,,Per Svc,0.01
Chargemaster Item,,273L3809,SPSI,Take-Home Suppies L3809,,Per Svc,0.01
Chargemaster Item,,273L3908,SPSI,Take-Home Suppies L3908,,Per Svc,0.01
Chargemaster Item,,273L3908,SPSI,Take-Home Suppies L3908,,Per Svc,0.01
Chargemaster Item,,273L3908,SPSI,Take-Home Suppies L3908,,Per Svc,0.01
Chargemaster Item,,273L3908,SPSI,Take-Home Suppies L3908,,Per Svc,0.01
Chargemaster Item,,273L3917,SPSI,Take-Home Suppies L3917,,Per Svc,0.01
Chargemaster Item,,273L3917,SPSI,Take-Home Suppies L3917,,Per Svc,0.01
Chargemaster Item,,273L3917,SPSI,Take-Home Suppies L3917,,Per Svc,0.01
Chargemaster Item,,273L3917,SPSI,Take-Home Suppies L3917,,Per Svc,0.01
Chargemaster Item,,273L3923,SPSI,Take-Home Suppies L3923,,Per Svc,0.01
Chargemaster Item,,273L3923,SPSI,Take-Home Suppies L3923,,Per Svc,0.01
Chargemaster Item,,273L3923,SPSI,Take-Home Suppies L3923,,Per Svc,0.01
Chargemaster Item,,273L3923,SPSI,Take-Home Suppies L3923,,Per Svc,0.01
Chargemaster Item,,273L4386,SPSI,Take-Home Suppies L4386,,Per Svc,0.01
Chargemaster Item,,273L4386,SPSI,Take-Home Suppies L4386,,Per Svc,0.01
Chargemaster Item,,273L4386,SPSI,Take-Home Suppies L4386,,Per Svc,0.01
Chargemaster Item,,273L4386,SPSI,Take-Home Suppies L4386,,Per Svc,0.01
Chargemaster Item,,273L4387,SPSI,Take-Home Suppies L4387,,Per Svc,0.01
Chargemaster Item,,273L4387,SPSI,Take-Home Suppies L4387,,Per Svc,0.01
Chargemaster Item,,273L4387,SPSI,Take-Home Suppies L4387,,Per Svc,0.01
Chargemaster Item,,273L4387,SPSI,Take-Home Suppies L4387,,Per Svc,0.01
Chargemaster Item,,273L5000,SPSI,Take-Home Suppies L5000,,Per Svc,0.01
Chargemaster Item,,273L5000,SPSI,Take-Home Suppies L5000,,Per Svc,0.01
Chargemaster Item,,273L5000,SPSI,Take-Home Suppies L5000,,Per Svc,0.01
Chargemaster Item,,273L5000,SPSI,Take-Home Suppies L5000,,Per Svc,0.01
Chargemaster Item,,273L8000,SPSI,Take-Home Suppies L8000,,Per Svc,0.01
Chargemaster Item,,273L8000,SPSI,Take-Home Suppies L8000,,Per Svc,0.01
Chargemaster Item,,273L8000,SPSI,Take-Home Suppies L8000,,Per Svc,0.01
Chargemaster Item,,273L8000,SPSI,Take-Home Suppies L8000,,Per Svc,0.01
Chargemaster Item,,273L8501,SPSI,Take-Home Suppies L8501,,Per Svc,0.01
Chargemaster Item,,273L8501,SPSI,Take-Home Suppies L8501,,Per Svc,0.01
Chargemaster Item,,273L8501,SPSI,Take-Home Suppies L8501,,Per Svc,0.01
Chargemaster Item,,273L8501,SPSI,Take-Home Suppies L8501,,Per Svc,0.01
Chargemaster Item,,273L8600,SPSI,Take-Home Suppies L8600,,Per Svc,0.01
Chargemaster Item,,273L8600,SPSI,Take-Home Suppies L8600,,Per Svc,0.01
Chargemaster Item,,273L8600,SPSI,Take-Home Suppies L8600,,Per Svc,0.01
Chargemaster Item,,273L8600,SPSI,Take-Home Suppies L8600,,Per Svc,0.01
Chargemaster Item,,273L8612,SPSI,Take-Home Suppies L8612,,Per Svc,0.01
Chargemaster Item,,273L8612,SPSI,Take-Home Suppies L8612,,Per Svc,0.01
Chargemaster Item,,273L8612,SPSI,Take-Home Suppies L8612,,Per Svc,0.01
Chargemaster Item,,273L8612,SPSI,Take-Home Suppies L8612,,Per Svc,0.01
Chargemaster Item,,273L8699,SPSI,Take-Home Suppies L8699,,Per Svc,0.01
Chargemaster Item,,273L8699,SPSI,Take-Home Suppies L8699,,Per Svc,0.01
Chargemaster Item,,273L8699,SPSI,Take-Home Suppies L8699,,Per Svc,0.01
Chargemaster Item,,273L8699,SPSI,Take-Home Suppies L8699,,Per Svc,0.01
Chargemaster Item,,273Q4100,SPSI,Take-Home Suppies Q4100,,Per Svc,0.01
Chargemaster Item,,273Q4100,SPSI,Take-Home Suppies Q4100,,Per Svc,0.01
Chargemaster Item,,273Q4100,SPSI,Take-Home Suppies Q4100,,Per Svc,0.01
Chargemaster Item,,273Q4100,SPSI,Take-Home Suppies Q4100,,Per Svc,0.01
Chargemaster Item,,273Q4102,SPSI,Take-Home Suppies Q4102,,Per Svc,0.01
Chargemaster Item,,273Q4102,SPSI,Take-Home Suppies Q4102,,Per Svc,0.01
Chargemaster Item,,273Q4102,SPSI,Take-Home Suppies Q4102,,Per Svc,0.01
Chargemaster Item,,273Q4102,SPSI,Take-Home Suppies Q4102,,Per Svc,0.01
Chargemaster Item,,273Q4110,SPSI,Take-Home Suppies Q4110,,Per Svc,0.01
Chargemaster Item,,273Q4110,SPSI,Take-Home Suppies Q4110,,Per Svc,0.01
Chargemaster Item,,273Q4110,SPSI,Take-Home Suppies Q4110,,Per Svc,0.01
Chargemaster Item,,273Q4110,SPSI,Take-Home Suppies Q4110,,Per Svc,0.01
Chargemaster Item,,273Q4114,SPSI,Take-Home Suppies Q4114,,Per Svc,0.01
Chargemaster Item,,273Q4114,SPSI,Take-Home Suppies Q4114,,Per Svc,0.01
Chargemaster Item,,273Q4114,SPSI,Take-Home Suppies Q4114,,Per Svc,0.01
Chargemaster Item,,273Q4114,SPSI,Take-Home Suppies Q4114,,Per Svc,0.01
Chargemaster Item,,273Q4116,SPSI,Take-Home Suppies Q4116,,Per Svc,0.01
Chargemaster Item,,273Q4116,SPSI,Take-Home Suppies Q4116,,Per Svc,0.01
Chargemaster Item,,273Q4116,SPSI,Take-Home Suppies Q4116,,Per Svc,0.01
Chargemaster Item,,273Q4116,SPSI,Take-Home Suppies Q4116,,Per Svc,0.01
Chargemaster Item,,273Q4118,SPSI,Take-Home Suppies Q4118,,Per Svc,0.01
Chargemaster Item,,273Q4118,SPSI,Take-Home Suppies Q4118,,Per Svc,0.01
Chargemaster Item,,273Q4118,SPSI,Take-Home Suppies Q4118,,Per Svc,0.01
Chargemaster Item,,273Q4118,SPSI,Take-Home Suppies Q4118,,Per Svc,0.01
Chargemaster Item,,273Q4125,SPSI,Take-Home Suppies Q4125,,Per Svc,0.01
Chargemaster Item,,273Q4125,SPSI,Take-Home Suppies Q4125,,Per Svc,0.01
Chargemaster Item,,273Q4125,SPSI,Take-Home Suppies Q4125,,Per Svc,0.01
Chargemaster Item,,273Q4125,SPSI,Take-Home Suppies Q4125,,Per Svc,0.01
Chargemaster Item,,273Q4128,SPSI,Take-Home Suppies Q4128,,Per Svc,0.01
Chargemaster Item,,273Q4128,SPSI,Take-Home Suppies Q4128,,Per Svc,0.01
Chargemaster Item,,273Q4128,SPSI,Take-Home Suppies Q4128,,Per Svc,0.01
Chargemaster Item,,273Q4128,SPSI,Take-Home Suppies Q4128,,Per Svc,0.01
Chargemaster Item,,273Q4130,SPSI,Take-Home Suppies Q4130,,Per Svc,0.01
Chargemaster Item,,273Q4130,SPSI,Take-Home Suppies Q4130,,Per Svc,0.01
Chargemaster Item,,273Q4130,SPSI,Take-Home Suppies Q4130,,Per Svc,0.01
Chargemaster Item,,273Q4130,SPSI,Take-Home Suppies Q4130,,Per Svc,0.01
Chargemaster Item,,273Q4133,SPSI,Take-Home Suppies Q4133,,Per Svc,0.01
Chargemaster Item,,273Q4133,SPSI,Take-Home Suppies Q4133,,Per Svc,0.01
Chargemaster Item,,273Q4133,SPSI,Take-Home Suppies Q4133,,Per Svc,0.01
Chargemaster Item,,273Q4133,SPSI,Take-Home Suppies Q4133,,Per Svc,0.01
Chargemaster Item,,273Q4155,SPSI,Take-Home Suppies Q4155,,Per Svc,0.01
Chargemaster Item,,273Q4155,SPSI,Take-Home Suppies Q4155,,Per Svc,0.01
Chargemaster Item,,273Q4155,SPSI,Take-Home Suppies Q4155,,Per Svc,0.01
Chargemaster Item,,273Q4155,SPSI,Take-Home Suppies Q4155,,Per Svc,0.01
Chargemaster Item,,273Q4166,SPSI,Take-Home Suppies Q4166,,Per Svc,0.01
Chargemaster Item,,273Q4166,SPSI,Take-Home Suppies Q4166,,Per Svc,0.01
Chargemaster Item,,273Q4166,SPSI,Take-Home Suppies Q4166,,Per Svc,0.01
Chargemaster Item,,273Q4166,SPSI,Take-Home Suppies Q4166,,Per Svc,0.01
Chargemaster Item,,273Q9963,SPSI,Take-Home Suppies Q9963,,Per Svc,0.01
Chargemaster Item,,273Q9963,SPSI,Take-Home Suppies Q9963,,Per Svc,0.01
Chargemaster Item,,273Q9963,SPSI,Take-Home Suppies Q9963,,Per Svc,0.01
Chargemaster Item,,273Q9963,SPSI,Take-Home Suppies Q9963,,Per Svc,0.01
Chargemaster Item,,273Q9967,SPSI,Take-Home Suppies Q9967,,Per Svc,0.01
Chargemaster Item,,273Q9967,SPSI,Take-Home Suppies Q9967,,Per Svc,0.01
Chargemaster Item,,273Q9967,SPSI,Take-Home Suppies Q9967,,Per Svc,0.01
Chargemaster Item,,273Q9967,SPSI,Take-Home Suppies Q9967,,Per Svc,0.01
Chargemaster Item,,273V2630,SPSI,Take-Home Suppies V2630,,Per Svc,0.01
Chargemaster Item,,273V2630,SPSI,Take-Home Suppies V2630,,Per Svc,0.01
Chargemaster Item,,273V2630,SPSI,Take-Home Suppies V2630,,Per Svc,0.01
Chargemaster Item,,273V2630,SPSI,Take-Home Suppies V2630,,Per Svc,0.01
Chargemaster Item,,273V2632,SPSI,Take-Home Suppies V2632,,Per Svc,0.01
Chargemaster Item,,273V2632,SPSI,Take-Home Suppies V2632,,Per Svc,0.01
Chargemaster Item,,273V2632,SPSI,Take-Home Suppies V2632,,Per Svc,0.01
Chargemaster Item,,273V2632,SPSI,Take-Home Suppies V2632,,Per Svc,0.01
Chargemaster Item,,273V2790,SPSI,Take-Home Suppies V2790,,Per Svc,0.01
Chargemaster Item,,273V2790,SPSI,Take-Home Suppies V2790,,Per Svc,0.01
Chargemaster Item,,273V2790,SPSI,Take-Home Suppies V2790,,Per Svc,0.01
Chargemaster Item,,273V2790,SPSI,Take-Home Suppies V2790,,Per Svc,0.01
Chargemaster Item,,273XXXXX,SPSI,Take-Home Suppies,,Per Svc,0.01
Chargemaster Item,,273XXXXX,SPSI,Take-Home Suppies,,Per Svc,0.01
Chargemaster Item,,273XXXXX,SPSI,Take-Home Suppies,,Per Svc,0.01
Chargemaster Item,,273XXXXX,SPSI,Take-Home Suppies,,Per Svc,0.01
Chargemaster Item,,27410000,SPSI,Venous Blood Collection,,Per Svc,59.00
Chargemaster Item,,27437607,SPSI,Change Peg Tube,,Per Svc,519.00
Chargemaster Item,,274A4265,SPSI,Prosthetic/Orthotic Devices A4265,,Per Svc,0.01
Chargemaster Item,,274A4265,SPSI,Prosthetic/Orthotic Devices A4265,,Per Svc,0.01
Chargemaster Item,,274A4265,SPSI,Prosthetic/Orthotic Devices A4265,,Per Svc,0.01
Chargemaster Item,,274A4265,SPSI,Prosthetic/Orthotic Devices A4265,,Per Svc,0.01
Chargemaster Item,,274A4340,SPSI,Prosthetic/Orthotic Devices A4340,,Per Svc,0.01
Chargemaster Item,,274A4340,SPSI,Prosthetic/Orthotic Devices A4340,,Per Svc,0.01
Chargemaster Item,,274A4340,SPSI,Prosthetic/Orthotic Devices A4340,,Per Svc,0.01
Chargemaster Item,,274A4340,SPSI,Prosthetic/Orthotic Devices A4340,,Per Svc,0.01
Chargemaster Item,,274A4349,SPSI,Prosthetic/Orthotic Devices A4349,,Per Svc,0.01
Chargemaster Item,,274A4349,SPSI,Prosthetic/Orthotic Devices A4349,,Per Svc,0.01
Chargemaster Item,,274A4349,SPSI,Prosthetic/Orthotic Devices A4349,,Per Svc,0.01
Chargemaster Item,,274A4349,SPSI,Prosthetic/Orthotic Devices A4349,,Per Svc,0.01
Chargemaster Item,,274A4565,SPSI,Prosthetic/Orthotic Devices A4565,,Per Svc,0.01
Chargemaster Item,,274A4565,SPSI,Prosthetic/Orthotic Devices A4565,,Per Svc,0.01
Chargemaster Item,,274A4565,SPSI,Prosthetic/Orthotic Devices A4565,,Per Svc,0.01
Chargemaster Item,,274A4565,SPSI,Prosthetic/Orthotic Devices A4565,,Per Svc,0.01
Chargemaster Item,,274A4648,SPSI,Prosthetic/Orthotic Devices A4648,,Per Svc,0.01
Chargemaster Item,,274A4648,SPSI,Prosthetic/Orthotic Devices A4648,,Per Svc,0.01
Chargemaster Item,,274A4648,SPSI,Prosthetic/Orthotic Devices A4648,,Per Svc,0.01
Chargemaster Item,,274A4648,SPSI,Prosthetic/Orthotic Devices A4648,,Per Svc,0.01
Chargemaster Item,,274A6021,SPSI,Prosthetic/Orthotic Devices A6021,,Per Svc,0.01
Chargemaster Item,,274A6021,SPSI,Prosthetic/Orthotic Devices A6021,,Per Svc,0.01
Chargemaster Item,,274A6021,SPSI,Prosthetic/Orthotic Devices A6021,,Per Svc,0.01
Chargemaster Item,,274A6021,SPSI,Prosthetic/Orthotic Devices A6021,,Per Svc,0.01
Chargemaster Item,,274A6025,SPSI,Prosthetic/Orthotic Devices A6025,,Per Svc,0.01
Chargemaster Item,,274A6025,SPSI,Prosthetic/Orthotic Devices A6025,,Per Svc,0.01
Chargemaster Item,,274A6025,SPSI,Prosthetic/Orthotic Devices A6025,,Per Svc,0.01
Chargemaster Item,,274A6025,SPSI,Prosthetic/Orthotic Devices A6025,,Per Svc,0.01
Chargemaster Item,,274A6196,SPSI,Prosthetic/Orthotic Devices A6196,,Per Svc,0.01
Chargemaster Item,,274A6196,SPSI,Prosthetic/Orthotic Devices A6196,,Per Svc,0.01
Chargemaster Item,,274A6196,SPSI,Prosthetic/Orthotic Devices A6196,,Per Svc,0.01
Chargemaster Item,,274A6196,SPSI,Prosthetic/Orthotic Devices A6196,,Per Svc,0.01
Chargemaster Item,,274A6197,SPSI,Prosthetic/Orthotic Devices A6197,,Per Svc,0.01
Chargemaster Item,,274A6197,SPSI,Prosthetic/Orthotic Devices A6197,,Per Svc,0.01
Chargemaster Item,,274A6197,SPSI,Prosthetic/Orthotic Devices A6197,,Per Svc,0.01
Chargemaster Item,,274A6197,SPSI,Prosthetic/Orthotic Devices A6197,,Per Svc,0.01
Chargemaster Item,,274A6206,SPSI,Prosthetic/Orthotic Devices A6206,,Per Svc,0.01
Chargemaster Item,,274A6206,SPSI,Prosthetic/Orthotic Devices A6206,,Per Svc,0.01
Chargemaster Item,,274A6206,SPSI,Prosthetic/Orthotic Devices A6206,,Per Svc,0.01
Chargemaster Item,,274A6206,SPSI,Prosthetic/Orthotic Devices A6206,,Per Svc,0.01
Chargemaster Item,,274A6209,SPSI,Prosthetic/Orthotic Devices A6209,,Per Svc,0.01
Chargemaster Item,,274A6209,SPSI,Prosthetic/Orthotic Devices A6209,,Per Svc,0.01
Chargemaster Item,,274A6209,SPSI,Prosthetic/Orthotic Devices A6209,,Per Svc,0.01
Chargemaster Item,,274A6209,SPSI,Prosthetic/Orthotic Devices A6209,,Per Svc,0.01
Chargemaster Item,,274A6212,SPSI,Prosthetic/Orthotic Devices A6212,,Per Svc,0.01
Chargemaster Item,,274A6212,SPSI,Prosthetic/Orthotic Devices A6212,,Per Svc,0.01
Chargemaster Item,,274A6212,SPSI,Prosthetic/Orthotic Devices A6212,,Per Svc,0.01
Chargemaster Item,,274A6212,SPSI,Prosthetic/Orthotic Devices A6212,,Per Svc,0.01
Chargemaster Item,,274A6213,SPSI,Prosthetic/Orthotic Devices A6213,,Per Svc,0.01
Chargemaster Item,,274A6213,SPSI,Prosthetic/Orthotic Devices A6213,,Per Svc,0.01
Chargemaster Item,,274A6213,SPSI,Prosthetic/Orthotic Devices A6213,,Per Svc,0.01
Chargemaster Item,,274A6213,SPSI,Prosthetic/Orthotic Devices A6213,,Per Svc,0.01
Chargemaster Item,,274A6214,SPSI,Prosthetic/Orthotic Devices A6214,,Per Svc,0.01
Chargemaster Item,,274A6214,SPSI,Prosthetic/Orthotic Devices A6214,,Per Svc,0.01
Chargemaster Item,,274A6214,SPSI,Prosthetic/Orthotic Devices A6214,,Per Svc,0.01
Chargemaster Item,,274A6214,SPSI,Prosthetic/Orthotic Devices A6214,,Per Svc,0.01
Chargemaster Item,,274A6219,SPSI,Prosthetic/Orthotic Devices A6219,,Per Svc,0.01
Chargemaster Item,,274A6219,SPSI,Prosthetic/Orthotic Devices A6219,,Per Svc,0.01
Chargemaster Item,,274A6219,SPSI,Prosthetic/Orthotic Devices A6219,,Per Svc,0.01
Chargemaster Item,,274A6219,SPSI,Prosthetic/Orthotic Devices A6219,,Per Svc,0.01
Chargemaster Item,,274A6222,SPSI,Prosthetic/Orthotic Devices A6222,,Per Svc,0.01
Chargemaster Item,,274A6222,SPSI,Prosthetic/Orthotic Devices A6222,,Per Svc,0.01
Chargemaster Item,,274A6222,SPSI,Prosthetic/Orthotic Devices A6222,,Per Svc,0.01
Chargemaster Item,,274A6222,SPSI,Prosthetic/Orthotic Devices A6222,,Per Svc,0.01
Chargemaster Item,,274A6223,SPSI,Prosthetic/Orthotic Devices A6223,,Per Svc,0.01
Chargemaster Item,,274A6223,SPSI,Prosthetic/Orthotic Devices A6223,,Per Svc,0.01
Chargemaster Item,,274A6223,SPSI,Prosthetic/Orthotic Devices A6223,,Per Svc,0.01
Chargemaster Item,,274A6223,SPSI,Prosthetic/Orthotic Devices A6223,,Per Svc,0.01
Chargemaster Item,,274A6224,SPSI,Prosthetic/Orthotic Devices A6224,,Per Svc,0.01
Chargemaster Item,,274A6224,SPSI,Prosthetic/Orthotic Devices A6224,,Per Svc,0.01
Chargemaster Item,,274A6224,SPSI,Prosthetic/Orthotic Devices A6224,,Per Svc,0.01
Chargemaster Item,,274A6224,SPSI,Prosthetic/Orthotic Devices A6224,,Per Svc,0.01
Chargemaster Item,,274A6234,SPSI,Prosthetic/Orthotic Devices A6234,,Per Svc,0.01
Chargemaster Item,,274A6234,SPSI,Prosthetic/Orthotic Devices A6234,,Per Svc,0.01
Chargemaster Item,,274A6234,SPSI,Prosthetic/Orthotic Devices A6234,,Per Svc,0.01
Chargemaster Item,,274A6234,SPSI,Prosthetic/Orthotic Devices A6234,,Per Svc,0.01
Chargemaster Item,,274A6235,SPSI,Prosthetic/Orthotic Devices A6235,,Per Svc,0.01
Chargemaster Item,,274A6235,SPSI,Prosthetic/Orthotic Devices A6235,,Per Svc,0.01
Chargemaster Item,,274A6235,SPSI,Prosthetic/Orthotic Devices A6235,,Per Svc,0.01
Chargemaster Item,,274A6235,SPSI,Prosthetic/Orthotic Devices A6235,,Per Svc,0.01
Chargemaster Item,,274A6238,SPSI,Prosthetic/Orthotic Devices A6238,,Per Svc,0.01
Chargemaster Item,,274A6238,SPSI,Prosthetic/Orthotic Devices A6238,,Per Svc,0.01
Chargemaster Item,,274A6238,SPSI,Prosthetic/Orthotic Devices A6238,,Per Svc,0.01
Chargemaster Item,,274A6238,SPSI,Prosthetic/Orthotic Devices A6238,,Per Svc,0.01
Chargemaster Item,,274A6255,SPSI,Prosthetic/Orthotic Devices A6255,,Per Svc,0.01
Chargemaster Item,,274A6255,SPSI,Prosthetic/Orthotic Devices A6255,,Per Svc,0.01
Chargemaster Item,,274A6255,SPSI,Prosthetic/Orthotic Devices A6255,,Per Svc,0.01
Chargemaster Item,,274A6255,SPSI,Prosthetic/Orthotic Devices A6255,,Per Svc,0.01
Chargemaster Item,,274A6257,SPSI,Prosthetic/Orthotic Devices A6257,,Per Svc,0.01
Chargemaster Item,,274A6257,SPSI,Prosthetic/Orthotic Devices A6257,,Per Svc,0.01
Chargemaster Item,,274A6257,SPSI,Prosthetic/Orthotic Devices A6257,,Per Svc,0.01
Chargemaster Item,,274A6257,SPSI,Prosthetic/Orthotic Devices A6257,,Per Svc,0.01
Chargemaster Item,,274A6258,SPSI,Prosthetic/Orthotic Devices A6258,,Per Svc,0.01
Chargemaster Item,,274A6258,SPSI,Prosthetic/Orthotic Devices A6258,,Per Svc,0.01
Chargemaster Item,,274A6258,SPSI,Prosthetic/Orthotic Devices A6258,,Per Svc,0.01
Chargemaster Item,,274A6258,SPSI,Prosthetic/Orthotic Devices A6258,,Per Svc,0.01
Chargemaster Item,,274A6259,SPSI,Prosthetic/Orthotic Devices A6259,,Per Svc,0.01
Chargemaster Item,,274A6259,SPSI,Prosthetic/Orthotic Devices A6259,,Per Svc,0.01
Chargemaster Item,,274A6259,SPSI,Prosthetic/Orthotic Devices A6259,,Per Svc,0.01
Chargemaster Item,,274A6259,SPSI,Prosthetic/Orthotic Devices A6259,,Per Svc,0.01
Chargemaster Item,,274A6454,SPSI,Prosthetic/Orthotic Devices A6454,,Per Svc,0.01
Chargemaster Item,,274A6454,SPSI,Prosthetic/Orthotic Devices A6454,,Per Svc,0.01
Chargemaster Item,,274A6454,SPSI,Prosthetic/Orthotic Devices A6454,,Per Svc,0.01
Chargemaster Item,,274A6454,SPSI,Prosthetic/Orthotic Devices A6454,,Per Svc,0.01
Chargemaster Item,,274B4082,SPSI,Prosthetic/Orthotic Devices B4082,,Per Svc,0.01
Chargemaster Item,,274B4082,SPSI,Prosthetic/Orthotic Devices B4082,,Per Svc,0.01
Chargemaster Item,,274B4082,SPSI,Prosthetic/Orthotic Devices B4082,,Per Svc,0.01
Chargemaster Item,,274B4082,SPSI,Prosthetic/Orthotic Devices B4082,,Per Svc,0.01
Chargemaster Item,,274B4087,SPSI,Prosthetic/Orthotic Devices B4087,,Per Svc,0.01
Chargemaster Item,,274B4087,SPSI,Prosthetic/Orthotic Devices B4087,,Per Svc,0.01
Chargemaster Item,,274B4087,SPSI,Prosthetic/Orthotic Devices B4087,,Per Svc,0.01
Chargemaster Item,,274B4087,SPSI,Prosthetic/Orthotic Devices B4087,,Per Svc,0.01
Chargemaster Item,,274B4088,SPSI,Prosthetic/Orthotic Devices B4088,,Per Svc,0.01
Chargemaster Item,,274B4088,SPSI,Prosthetic/Orthotic Devices B4088,,Per Svc,0.01
Chargemaster Item,,274B4088,SPSI,Prosthetic/Orthotic Devices B4088,,Per Svc,0.01
Chargemaster Item,,274B4088,SPSI,Prosthetic/Orthotic Devices B4088,,Per Svc,0.01
Chargemaster Item,,274C1713,SPSI,Prosthetic/Orthotic Devices C1713,,Per Svc,0.01
Chargemaster Item,,274C1713,SPSI,Prosthetic/Orthotic Devices C1713,,Per Svc,0.01
Chargemaster Item,,274C1713,SPSI,Prosthetic/Orthotic Devices C1713,,Per Svc,0.01
Chargemaster Item,,274C1713,SPSI,Prosthetic/Orthotic Devices C1713,,Per Svc,0.01
Chargemaster Item,,274C1715,SPSI,Prosthetic/Orthotic Devices C1715,,Per Svc,0.01
Chargemaster Item,,274C1715,SPSI,Prosthetic/Orthotic Devices C1715,,Per Svc,0.01
Chargemaster Item,,274C1715,SPSI,Prosthetic/Orthotic Devices C1715,,Per Svc,0.01
Chargemaster Item,,274C1715,SPSI,Prosthetic/Orthotic Devices C1715,,Per Svc,0.01
Chargemaster Item,,274C1716,SPSI,Prosthetic/Orthotic Devices C1716,,Per Svc,0.01
Chargemaster Item,,274C1716,SPSI,Prosthetic/Orthotic Devices C1716,,Per Svc,0.01
Chargemaster Item,,274C1716,SPSI,Prosthetic/Orthotic Devices C1716,,Per Svc,0.01
Chargemaster Item,,274C1716,SPSI,Prosthetic/Orthotic Devices C1716,,Per Svc,0.01
Chargemaster Item,,274C1721,SPSI,Prosthetic/Orthotic Devices C1721,,Per Svc,0.01
Chargemaster Item,,274C1721,SPSI,Prosthetic/Orthotic Devices C1721,,Per Svc,0.01
Chargemaster Item,,274C1721,SPSI,Prosthetic/Orthotic Devices C1721,,Per Svc,0.01
Chargemaster Item,,274C1721,SPSI,Prosthetic/Orthotic Devices C1721,,Per Svc,0.01
Chargemaster Item,,274C1722,SPSI,Prosthetic/Orthotic Devices C1722,,Per Svc,0.01
Chargemaster Item,,274C1722,SPSI,Prosthetic/Orthotic Devices C1722,,Per Svc,0.01
Chargemaster Item,,274C1722,SPSI,Prosthetic/Orthotic Devices C1722,,Per Svc,0.01
Chargemaster Item,,274C1722,SPSI,Prosthetic/Orthotic Devices C1722,,Per Svc,0.01
Chargemaster Item,,274C1724,SPSI,Prosthetic/Orthotic Devices C1724,,Per Svc,0.01
Chargemaster Item,,274C1724,SPSI,Prosthetic/Orthotic Devices C1724,,Per Svc,0.01
Chargemaster Item,,274C1724,SPSI,Prosthetic/Orthotic Devices C1724,,Per Svc,0.01
Chargemaster Item,,274C1724,SPSI,Prosthetic/Orthotic Devices C1724,,Per Svc,0.01
Chargemaster Item,,274C1725,SPSI,Prosthetic/Orthotic Devices C1725,,Per Svc,0.01
Chargemaster Item,,274C1725,SPSI,Prosthetic/Orthotic Devices C1725,,Per Svc,0.01
Chargemaster Item,,274C1725,SPSI,Prosthetic/Orthotic Devices C1725,,Per Svc,0.01
Chargemaster Item,,274C1725,SPSI,Prosthetic/Orthotic Devices C1725,,Per Svc,0.01
Chargemaster Item,,274C1726,SPSI,Prosthetic/Orthotic Devices C1726,,Per Svc,0.01
Chargemaster Item,,274C1726,SPSI,Prosthetic/Orthotic Devices C1726,,Per Svc,0.01
Chargemaster Item,,274C1726,SPSI,Prosthetic/Orthotic Devices C1726,,Per Svc,0.01
Chargemaster Item,,274C1726,SPSI,Prosthetic/Orthotic Devices C1726,,Per Svc,0.01
Chargemaster Item,,274C1727,SPSI,Prosthetic/Orthotic Devices C1727,,Per Svc,0.01
Chargemaster Item,,274C1727,SPSI,Prosthetic/Orthotic Devices C1727,,Per Svc,0.01
Chargemaster Item,,274C1727,SPSI,Prosthetic/Orthotic Devices C1727,,Per Svc,0.01
Chargemaster Item,,274C1727,SPSI,Prosthetic/Orthotic Devices C1727,,Per Svc,0.01
Chargemaster Item,,274C1729,SPSI,Prosthetic/Orthotic Devices C1729,,Per Svc,0.01
Chargemaster Item,,274C1729,SPSI,Prosthetic/Orthotic Devices C1729,,Per Svc,0.01
Chargemaster Item,,274C1729,SPSI,Prosthetic/Orthotic Devices C1729,,Per Svc,0.01
Chargemaster Item,,274C1729,SPSI,Prosthetic/Orthotic Devices C1729,,Per Svc,0.01
Chargemaster Item,,274C1730,SPSI,Prosthetic/Orthotic Devices C1730,,Per Svc,0.01
Chargemaster Item,,274C1730,SPSI,Prosthetic/Orthotic Devices C1730,,Per Svc,0.01
Chargemaster Item,,274C1730,SPSI,Prosthetic/Orthotic Devices C1730,,Per Svc,0.01
Chargemaster Item,,274C1730,SPSI,Prosthetic/Orthotic Devices C1730,,Per Svc,0.01
Chargemaster Item,,274C1731,SPSI,Prosthetic/Orthotic Devices C1731,,Per Svc,0.01
Chargemaster Item,,274C1731,SPSI,Prosthetic/Orthotic Devices C1731,,Per Svc,0.01
Chargemaster Item,,274C1731,SPSI,Prosthetic/Orthotic Devices C1731,,Per Svc,0.01
Chargemaster Item,,274C1731,SPSI,Prosthetic/Orthotic Devices C1731,,Per Svc,0.01
Chargemaster Item,,274C1733,SPSI,Prosthetic/Orthotic Devices C1733,,Per Svc,0.01
Chargemaster Item,,274C1733,SPSI,Prosthetic/Orthotic Devices C1733,,Per Svc,0.01
Chargemaster Item,,274C1733,SPSI,Prosthetic/Orthotic Devices C1733,,Per Svc,0.01
Chargemaster Item,,274C1733,SPSI,Prosthetic/Orthotic Devices C1733,,Per Svc,0.01
Chargemaster Item,,274C1750,SPSI,Prosthetic/Orthotic Devices C1750,,Per Svc,0.01
Chargemaster Item,,274C1750,SPSI,Prosthetic/Orthotic Devices C1750,,Per Svc,0.01
Chargemaster Item,,274C1750,SPSI,Prosthetic/Orthotic Devices C1750,,Per Svc,0.01
Chargemaster Item,,274C1750,SPSI,Prosthetic/Orthotic Devices C1750,,Per Svc,0.01
Chargemaster Item,,274C1751,SPSI,Prosthetic/Orthotic Devices C1751,,Per Svc,0.01
Chargemaster Item,,274C1751,SPSI,Prosthetic/Orthotic Devices C1751,,Per Svc,0.01
Chargemaster Item,,274C1751,SPSI,Prosthetic/Orthotic Devices C1751,,Per Svc,0.01
Chargemaster Item,,274C1751,SPSI,Prosthetic/Orthotic Devices C1751,,Per Svc,0.01
Chargemaster Item,,274C1752,SPSI,Prosthetic/Orthotic Devices C1752,,Per Svc,0.01
Chargemaster Item,,274C1752,SPSI,Prosthetic/Orthotic Devices C1752,,Per Svc,0.01
Chargemaster Item,,274C1752,SPSI,Prosthetic/Orthotic Devices C1752,,Per Svc,0.01
Chargemaster Item,,274C1752,SPSI,Prosthetic/Orthotic Devices C1752,,Per Svc,0.01
Chargemaster Item,,274C1753,SPSI,Prosthetic/Orthotic Devices C1753,,Per Svc,0.01
Chargemaster Item,,274C1753,SPSI,Prosthetic/Orthotic Devices C1753,,Per Svc,0.01
Chargemaster Item,,274C1753,SPSI,Prosthetic/Orthotic Devices C1753,,Per Svc,0.01
Chargemaster Item,,274C1753,SPSI,Prosthetic/Orthotic Devices C1753,,Per Svc,0.01
Chargemaster Item,,274C1755,SPSI,Prosthetic/Orthotic Devices C1755,,Per Svc,0.01
Chargemaster Item,,274C1755,SPSI,Prosthetic/Orthotic Devices C1755,,Per Svc,0.01
Chargemaster Item,,274C1755,SPSI,Prosthetic/Orthotic Devices C1755,,Per Svc,0.01
Chargemaster Item,,274C1755,SPSI,Prosthetic/Orthotic Devices C1755,,Per Svc,0.01
Chargemaster Item,,274C1757,SPSI,Prosthetic/Orthotic Devices C1757,,Per Svc,0.01
Chargemaster Item,,274C1757,SPSI,Prosthetic/Orthotic Devices C1757,,Per Svc,0.01
Chargemaster Item,,274C1757,SPSI,Prosthetic/Orthotic Devices C1757,,Per Svc,0.01
Chargemaster Item,,274C1757,SPSI,Prosthetic/Orthotic Devices C1757,,Per Svc,0.01
Chargemaster Item,,274C1758,SPSI,Prosthetic/Orthotic Devices C1758,,Per Svc,0.01
Chargemaster Item,,274C1758,SPSI,Prosthetic/Orthotic Devices C1758,,Per Svc,0.01
Chargemaster Item,,274C1758,SPSI,Prosthetic/Orthotic Devices C1758,,Per Svc,0.01
Chargemaster Item,,274C1758,SPSI,Prosthetic/Orthotic Devices C1758,,Per Svc,0.01
Chargemaster Item,,274C1760,SPSI,Prosthetic/Orthotic Devices C1760,,Per Svc,0.01
Chargemaster Item,,274C1760,SPSI,Prosthetic/Orthotic Devices C1760,,Per Svc,0.01
Chargemaster Item,,274C1760,SPSI,Prosthetic/Orthotic Devices C1760,,Per Svc,0.01
Chargemaster Item,,274C1760,SPSI,Prosthetic/Orthotic Devices C1760,,Per Svc,0.01
Chargemaster Item,,274C1762,SPSI,Prosthetic/Orthotic Devices C1762,,Per Svc,0.01
Chargemaster Item,,274C1762,SPSI,Prosthetic/Orthotic Devices C1762,,Per Svc,0.01
Chargemaster Item,,274C1762,SPSI,Prosthetic/Orthotic Devices C1762,,Per Svc,0.01
Chargemaster Item,,274C1762,SPSI,Prosthetic/Orthotic Devices C1762,,Per Svc,0.01
Chargemaster Item,,274C1763,SPSI,Prosthetic/Orthotic Devices C1763,,Per Svc,0.01
Chargemaster Item,,274C1763,SPSI,Prosthetic/Orthotic Devices C1763,,Per Svc,0.01
Chargemaster Item,,274C1763,SPSI,Prosthetic/Orthotic Devices C1763,,Per Svc,0.01
Chargemaster Item,,274C1763,SPSI,Prosthetic/Orthotic Devices C1763,,Per Svc,0.01
Chargemaster Item,,274C1764,SPSI,Prosthetic/Orthotic Devices C1764,,Per Svc,0.01
Chargemaster Item,,274C1764,SPSI,Prosthetic/Orthotic Devices C1764,,Per Svc,0.01
Chargemaster Item,,274C1764,SPSI,Prosthetic/Orthotic Devices C1764,,Per Svc,0.01
Chargemaster Item,,274C1764,SPSI,Prosthetic/Orthotic Devices C1764,,Per Svc,0.01
Chargemaster Item,,274C1766,SPSI,Prosthetic/Orthotic Devices C1766,,Per Svc,0.01
Chargemaster Item,,274C1766,SPSI,Prosthetic/Orthotic Devices C1766,,Per Svc,0.01
Chargemaster Item,,274C1766,SPSI,Prosthetic/Orthotic Devices C1766,,Per Svc,0.01
Chargemaster Item,,274C1766,SPSI,Prosthetic/Orthotic Devices C1766,,Per Svc,0.01
Chargemaster Item,,274C1767,SPSI,Prosthetic/Orthotic Devices C1767,,Per Svc,0.01
Chargemaster Item,,274C1767,SPSI,Prosthetic/Orthotic Devices C1767,,Per Svc,0.01
Chargemaster Item,,274C1767,SPSI,Prosthetic/Orthotic Devices C1767,,Per Svc,0.01
Chargemaster Item,,274C1767,SPSI,Prosthetic/Orthotic Devices C1767,,Per Svc,0.01
Chargemaster Item,,274C1768,SPSI,Prosthetic/Orthotic Devices C1768,,Per Svc,0.01
Chargemaster Item,,274C1768,SPSI,Prosthetic/Orthotic Devices C1768,,Per Svc,0.01
Chargemaster Item,,274C1768,SPSI,Prosthetic/Orthotic Devices C1768,,Per Svc,0.01
Chargemaster Item,,274C1768,SPSI,Prosthetic/Orthotic Devices C1768,,Per Svc,0.01
Chargemaster Item,,274C1769,SPSI,Prosthetic/Orthotic Devices C1769,,Per Svc,0.01
Chargemaster Item,,274C1769,SPSI,Prosthetic/Orthotic Devices C1769,,Per Svc,0.01
Chargemaster Item,,274C1769,SPSI,Prosthetic/Orthotic Devices C1769,,Per Svc,0.01
Chargemaster Item,,274C1769,SPSI,Prosthetic/Orthotic Devices C1769,,Per Svc,0.01
Chargemaster Item,,274C1771,SPSI,Prosthetic/Orthotic Devices C1771,,Per Svc,0.01
Chargemaster Item,,274C1771,SPSI,Prosthetic/Orthotic Devices C1771,,Per Svc,0.01
Chargemaster Item,,274C1771,SPSI,Prosthetic/Orthotic Devices C1771,,Per Svc,0.01
Chargemaster Item,,274C1771,SPSI,Prosthetic/Orthotic Devices C1771,,Per Svc,0.01
Chargemaster Item,,274C1772,SPSI,Prosthetic/Orthotic Devices C1772,,Per Svc,0.01
Chargemaster Item,,274C1772,SPSI,Prosthetic/Orthotic Devices C1772,,Per Svc,0.01
Chargemaster Item,,274C1772,SPSI,Prosthetic/Orthotic Devices C1772,,Per Svc,0.01
Chargemaster Item,,274C1772,SPSI,Prosthetic/Orthotic Devices C1772,,Per Svc,0.01
Chargemaster Item,,274C1773,SPSI,Prosthetic/Orthotic Devices C1773,,Per Svc,0.01
Chargemaster Item,,274C1773,SPSI,Prosthetic/Orthotic Devices C1773,,Per Svc,0.01
Chargemaster Item,,274C1773,SPSI,Prosthetic/Orthotic Devices C1773,,Per Svc,0.01
Chargemaster Item,,274C1773,SPSI,Prosthetic/Orthotic Devices C1773,,Per Svc,0.01
Chargemaster Item,,274C1776,SPSI,Prosthetic/Orthotic Devices C1776,,Per Svc,0.01
Chargemaster Item,,274C1776,SPSI,Prosthetic/Orthotic Devices C1776,,Per Svc,0.01
Chargemaster Item,,274C1776,SPSI,Prosthetic/Orthotic Devices C1776,,Per Svc,0.01
Chargemaster Item,,274C1776,SPSI,Prosthetic/Orthotic Devices C1776,,Per Svc,0.01
Chargemaster Item,,274C1777,SPSI,Prosthetic/Orthotic Devices C1777,,Per Svc,0.01
Chargemaster Item,,274C1777,SPSI,Prosthetic/Orthotic Devices C1777,,Per Svc,0.01
Chargemaster Item,,274C1777,SPSI,Prosthetic/Orthotic Devices C1777,,Per Svc,0.01
Chargemaster Item,,274C1777,SPSI,Prosthetic/Orthotic Devices C1777,,Per Svc,0.01
Chargemaster Item,,274C1778,SPSI,Prosthetic/Orthotic Devices C1778,,Per Svc,0.01
Chargemaster Item,,274C1778,SPSI,Prosthetic/Orthotic Devices C1778,,Per Svc,0.01
Chargemaster Item,,274C1778,SPSI,Prosthetic/Orthotic Devices C1778,,Per Svc,0.01
Chargemaster Item,,274C1778,SPSI,Prosthetic/Orthotic Devices C1778,,Per Svc,0.01
Chargemaster Item,,274C1781,SPSI,Prosthetic/Orthotic Devices C1781,,Per Svc,0.01
Chargemaster Item,,274C1781,SPSI,Prosthetic/Orthotic Devices C1781,,Per Svc,0.01
Chargemaster Item,,274C1781,SPSI,Prosthetic/Orthotic Devices C1781,,Per Svc,0.01
Chargemaster Item,,274C1781,SPSI,Prosthetic/Orthotic Devices C1781,,Per Svc,0.01
Chargemaster Item,,274C1783,SPSI,Prosthetic/Orthotic Devices C1783,,Per Svc,0.01
Chargemaster Item,,274C1783,SPSI,Prosthetic/Orthotic Devices C1783,,Per Svc,0.01
Chargemaster Item,,274C1783,SPSI,Prosthetic/Orthotic Devices C1783,,Per Svc,0.01
Chargemaster Item,,274C1783,SPSI,Prosthetic/Orthotic Devices C1783,,Per Svc,0.01
Chargemaster Item,,274C1785,SPSI,Prosthetic/Orthotic Devices C1785,,Per Svc,0.01
Chargemaster Item,,274C1785,SPSI,Prosthetic/Orthotic Devices C1785,,Per Svc,0.01
Chargemaster Item,,274C1785,SPSI,Prosthetic/Orthotic Devices C1785,,Per Svc,0.01
Chargemaster Item,,274C1785,SPSI,Prosthetic/Orthotic Devices C1785,,Per Svc,0.01
Chargemaster Item,,274C1786,SPSI,Prosthetic/Orthotic Devices C1786,,Per Svc,0.01
Chargemaster Item,,274C1786,SPSI,Prosthetic/Orthotic Devices C1786,,Per Svc,0.01
Chargemaster Item,,274C1786,SPSI,Prosthetic/Orthotic Devices C1786,,Per Svc,0.01
Chargemaster Item,,274C1786,SPSI,Prosthetic/Orthotic Devices C1786,,Per Svc,0.01
Chargemaster Item,,274C1787,SPSI,Prosthetic/Orthotic Devices C1787,,Per Svc,0.01
Chargemaster Item,,274C1787,SPSI,Prosthetic/Orthotic Devices C1787,,Per Svc,0.01
Chargemaster Item,,274C1787,SPSI,Prosthetic/Orthotic Devices C1787,,Per Svc,0.01
Chargemaster Item,,274C1787,SPSI,Prosthetic/Orthotic Devices C1787,,Per Svc,0.01
Chargemaster Item,,274C1788,SPSI,Prosthetic/Orthotic Devices C1788,,Per Svc,0.01
Chargemaster Item,,274C1788,SPSI,Prosthetic/Orthotic Devices C1788,,Per Svc,0.01
Chargemaster Item,,274C1788,SPSI,Prosthetic/Orthotic Devices C1788,,Per Svc,0.01
Chargemaster Item,,274C1788,SPSI,Prosthetic/Orthotic Devices C1788,,Per Svc,0.01
Chargemaster Item,,274C1789,SPSI,Prosthetic/Orthotic Devices C1789,,Per Svc,0.01
Chargemaster Item,,274C1789,SPSI,Prosthetic/Orthotic Devices C1789,,Per Svc,0.01
Chargemaster Item,,274C1789,SPSI,Prosthetic/Orthotic Devices C1789,,Per Svc,0.01
Chargemaster Item,,274C1789,SPSI,Prosthetic/Orthotic Devices C1789,,Per Svc,0.01
Chargemaster Item,,274C1817,SPSI,Prosthetic/Orthotic Devices C1817,,Per Svc,0.01
Chargemaster Item,,274C1817,SPSI,Prosthetic/Orthotic Devices C1817,,Per Svc,0.01
Chargemaster Item,,274C1817,SPSI,Prosthetic/Orthotic Devices C1817,,Per Svc,0.01
Chargemaster Item,,274C1817,SPSI,Prosthetic/Orthotic Devices C1817,,Per Svc,0.01
Chargemaster Item,,274C1821,SPSI,Prosthetic/Orthotic Devices C1821,,Per Svc,0.01
Chargemaster Item,,274C1821,SPSI,Prosthetic/Orthotic Devices C1821,,Per Svc,0.01
Chargemaster Item,,274C1821,SPSI,Prosthetic/Orthotic Devices C1821,,Per Svc,0.01
Chargemaster Item,,274C1821,SPSI,Prosthetic/Orthotic Devices C1821,,Per Svc,0.01
Chargemaster Item,,274C1874,SPSI,Prosthetic/Orthotic Devices C1874,,Per Svc,0.01
Chargemaster Item,,274C1874,SPSI,Prosthetic/Orthotic Devices C1874,,Per Svc,0.01
Chargemaster Item,,274C1874,SPSI,Prosthetic/Orthotic Devices C1874,,Per Svc,0.01
Chargemaster Item,,274C1874,SPSI,Prosthetic/Orthotic Devices C1874,,Per Svc,0.01
Chargemaster Item,,274C1875,SPSI,Prosthetic/Orthotic Devices C1875,,Per Svc,0.01
Chargemaster Item,,274C1875,SPSI,Prosthetic/Orthotic Devices C1875,,Per Svc,0.01
Chargemaster Item,,274C1875,SPSI,Prosthetic/Orthotic Devices C1875,,Per Svc,0.01
Chargemaster Item,,274C1875,SPSI,Prosthetic/Orthotic Devices C1875,,Per Svc,0.01
Chargemaster Item,,274C1876,SPSI,Prosthetic/Orthotic Devices C1876,,Per Svc,0.01
Chargemaster Item,,274C1876,SPSI,Prosthetic/Orthotic Devices C1876,,Per Svc,0.01
Chargemaster Item,,274C1876,SPSI,Prosthetic/Orthotic Devices C1876,,Per Svc,0.01
Chargemaster Item,,274C1876,SPSI,Prosthetic/Orthotic Devices C1876,,Per Svc,0.01
Chargemaster Item,,274C1880,SPSI,Prosthetic/Orthotic Devices C1880,,Per Svc,0.01
Chargemaster Item,,274C1880,SPSI,Prosthetic/Orthotic Devices C1880,,Per Svc,0.01
Chargemaster Item,,274C1880,SPSI,Prosthetic/Orthotic Devices C1880,,Per Svc,0.01
Chargemaster Item,,274C1880,SPSI,Prosthetic/Orthotic Devices C1880,,Per Svc,0.01
Chargemaster Item,,274C1881,SPSI,Prosthetic/Orthotic Devices C1881,,Per Svc,0.01
Chargemaster Item,,274C1881,SPSI,Prosthetic/Orthotic Devices C1881,,Per Svc,0.01
Chargemaster Item,,274C1881,SPSI,Prosthetic/Orthotic Devices C1881,,Per Svc,0.01
Chargemaster Item,,274C1881,SPSI,Prosthetic/Orthotic Devices C1881,,Per Svc,0.01
Chargemaster Item,,274C1882,SPSI,Prosthetic/Orthotic Devices C1882,,Per Svc,0.01
Chargemaster Item,,274C1882,SPSI,Prosthetic/Orthotic Devices C1882,,Per Svc,0.01
Chargemaster Item,,274C1882,SPSI,Prosthetic/Orthotic Devices C1882,,Per Svc,0.01
Chargemaster Item,,274C1882,SPSI,Prosthetic/Orthotic Devices C1882,,Per Svc,0.01
Chargemaster Item,,274C1883,SPSI,Prosthetic/Orthotic Devices C1883,,Per Svc,0.01
Chargemaster Item,,274C1883,SPSI,Prosthetic/Orthotic Devices C1883,,Per Svc,0.01
Chargemaster Item,,274C1883,SPSI,Prosthetic/Orthotic Devices C1883,,Per Svc,0.01
Chargemaster Item,,274C1883,SPSI,Prosthetic/Orthotic Devices C1883,,Per Svc,0.01
Chargemaster Item,,274C1884,SPSI,Prosthetic/Orthotic Devices C1884,,Per Svc,0.01
Chargemaster Item,,274C1884,SPSI,Prosthetic/Orthotic Devices C1884,,Per Svc,0.01
Chargemaster Item,,274C1884,SPSI,Prosthetic/Orthotic Devices C1884,,Per Svc,0.01
Chargemaster Item,,274C1884,SPSI,Prosthetic/Orthotic Devices C1884,,Per Svc,0.01
Chargemaster Item,,274C1887,SPSI,Prosthetic/Orthotic Devices C1887,,Per Svc,0.01
Chargemaster Item,,274C1887,SPSI,Prosthetic/Orthotic Devices C1887,,Per Svc,0.01
Chargemaster Item,,274C1887,SPSI,Prosthetic/Orthotic Devices C1887,,Per Svc,0.01
Chargemaster Item,,274C1887,SPSI,Prosthetic/Orthotic Devices C1887,,Per Svc,0.01
Chargemaster Item,,274C1889,SPSI,Prosthetic/Orthotic Devices C1889,,Per Svc,0.01
Chargemaster Item,,274C1889,SPSI,Prosthetic/Orthotic Devices C1889,,Per Svc,0.01
Chargemaster Item,,274C1889,SPSI,Prosthetic/Orthotic Devices C1889,,Per Svc,0.01
Chargemaster Item,,274C1889,SPSI,Prosthetic/Orthotic Devices C1889,,Per Svc,0.01
Chargemaster Item,,274C1892,SPSI,Prosthetic/Orthotic Devices C1892,,Per Svc,0.01
Chargemaster Item,,274C1892,SPSI,Prosthetic/Orthotic Devices C1892,,Per Svc,0.01
Chargemaster Item,,274C1892,SPSI,Prosthetic/Orthotic Devices C1892,,Per Svc,0.01
Chargemaster Item,,274C1892,SPSI,Prosthetic/Orthotic Devices C1892,,Per Svc,0.01
Chargemaster Item,,274C1893,SPSI,Prosthetic/Orthotic Devices C1893,,Per Svc,0.01
Chargemaster Item,,274C1893,SPSI,Prosthetic/Orthotic Devices C1893,,Per Svc,0.01
Chargemaster Item,,274C1893,SPSI,Prosthetic/Orthotic Devices C1893,,Per Svc,0.01
Chargemaster Item,,274C1893,SPSI,Prosthetic/Orthotic Devices C1893,,Per Svc,0.01
Chargemaster Item,,274C1894,SPSI,Prosthetic/Orthotic Devices C1894,,Per Svc,0.01
Chargemaster Item,,274C1894,SPSI,Prosthetic/Orthotic Devices C1894,,Per Svc,0.01
Chargemaster Item,,274C1894,SPSI,Prosthetic/Orthotic Devices C1894,,Per Svc,0.01
Chargemaster Item,,274C1894,SPSI,Prosthetic/Orthotic Devices C1894,,Per Svc,0.01
Chargemaster Item,,274C1897,SPSI,Prosthetic/Orthotic Devices C1897,,Per Svc,0.01
Chargemaster Item,,274C1897,SPSI,Prosthetic/Orthotic Devices C1897,,Per Svc,0.01
Chargemaster Item,,274C1897,SPSI,Prosthetic/Orthotic Devices C1897,,Per Svc,0.01
Chargemaster Item,,274C1897,SPSI,Prosthetic/Orthotic Devices C1897,,Per Svc,0.01
Chargemaster Item,,274C1898,SPSI,Prosthetic/Orthotic Devices C1898,,Per Svc,0.01
Chargemaster Item,,274C1898,SPSI,Prosthetic/Orthotic Devices C1898,,Per Svc,0.01
Chargemaster Item,,274C1898,SPSI,Prosthetic/Orthotic Devices C1898,,Per Svc,0.01
Chargemaster Item,,274C1898,SPSI,Prosthetic/Orthotic Devices C1898,,Per Svc,0.01
Chargemaster Item,,274C1900,SPSI,Prosthetic/Orthotic Devices C1900,,Per Svc,0.01
Chargemaster Item,,274C1900,SPSI,Prosthetic/Orthotic Devices C1900,,Per Svc,0.01
Chargemaster Item,,274C1900,SPSI,Prosthetic/Orthotic Devices C1900,,Per Svc,0.01
Chargemaster Item,,274C1900,SPSI,Prosthetic/Orthotic Devices C1900,,Per Svc,0.01
Chargemaster Item,,274C2617,SPSI,Prosthetic/Orthotic Devices C2617,,Per Svc,0.01
Chargemaster Item,,274C2617,SPSI,Prosthetic/Orthotic Devices C2617,,Per Svc,0.01
Chargemaster Item,,274C2617,SPSI,Prosthetic/Orthotic Devices C2617,,Per Svc,0.01
Chargemaster Item,,274C2617,SPSI,Prosthetic/Orthotic Devices C2617,,Per Svc,0.01
Chargemaster Item,,274C2618,SPSI,Prosthetic/Orthotic Devices C2618,,Per Svc,0.01
Chargemaster Item,,274C2618,SPSI,Prosthetic/Orthotic Devices C2618,,Per Svc,0.01
Chargemaster Item,,274C2618,SPSI,Prosthetic/Orthotic Devices C2618,,Per Svc,0.01
Chargemaster Item,,274C2618,SPSI,Prosthetic/Orthotic Devices C2618,,Per Svc,0.01
Chargemaster Item,,274C2623,SPSI,Prosthetic/Orthotic Devices C2623,,Per Svc,0.01
Chargemaster Item,,274C2623,SPSI,Prosthetic/Orthotic Devices C2623,,Per Svc,0.01
Chargemaster Item,,274C2623,SPSI,Prosthetic/Orthotic Devices C2623,,Per Svc,0.01
Chargemaster Item,,274C2623,SPSI,Prosthetic/Orthotic Devices C2623,,Per Svc,0.01
Chargemaster Item,,274C2625,SPSI,Prosthetic/Orthotic Devices C2625,,Per Svc,0.01
Chargemaster Item,,274C2625,SPSI,Prosthetic/Orthotic Devices C2625,,Per Svc,0.01
Chargemaster Item,,274C2625,SPSI,Prosthetic/Orthotic Devices C2625,,Per Svc,0.01
Chargemaster Item,,274C2625,SPSI,Prosthetic/Orthotic Devices C2625,,Per Svc,0.01
Chargemaster Item,,274C2627,SPSI,Prosthetic/Orthotic Devices C2627,,Per Svc,0.01
Chargemaster Item,,274C2627,SPSI,Prosthetic/Orthotic Devices C2627,,Per Svc,0.01
Chargemaster Item,,274C2627,SPSI,Prosthetic/Orthotic Devices C2627,,Per Svc,0.01
Chargemaster Item,,274C2627,SPSI,Prosthetic/Orthotic Devices C2627,,Per Svc,0.01
Chargemaster Item,,274C2628,SPSI,Prosthetic/Orthotic Devices C2628,,Per Svc,0.01
Chargemaster Item,,274C2628,SPSI,Prosthetic/Orthotic Devices C2628,,Per Svc,0.01
Chargemaster Item,,274C2628,SPSI,Prosthetic/Orthotic Devices C2628,,Per Svc,0.01
Chargemaster Item,,274C2628,SPSI,Prosthetic/Orthotic Devices C2628,,Per Svc,0.01
Chargemaster Item,,274C2630,SPSI,Prosthetic/Orthotic Devices C2630,,Per Svc,0.01
Chargemaster Item,,274C2630,SPSI,Prosthetic/Orthotic Devices C2630,,Per Svc,0.01
Chargemaster Item,,274C2630,SPSI,Prosthetic/Orthotic Devices C2630,,Per Svc,0.01
Chargemaster Item,,274C2630,SPSI,Prosthetic/Orthotic Devices C2630,,Per Svc,0.01
Chargemaster Item,,274C2639,SPSI,Prosthetic/Orthotic Devices C2639,,Per Svc,0.01
Chargemaster Item,,274C2639,SPSI,Prosthetic/Orthotic Devices C2639,,Per Svc,0.01
Chargemaster Item,,274C2639,SPSI,Prosthetic/Orthotic Devices C2639,,Per Svc,0.01
Chargemaster Item,,274C2639,SPSI,Prosthetic/Orthotic Devices C2639,,Per Svc,0.01
Chargemaster Item,,274C9250,SPSI,Prosthetic/Orthotic Devices C9250,,Per Svc,0.01
Chargemaster Item,,274C9250,SPSI,Prosthetic/Orthotic Devices C9250,,Per Svc,0.01
Chargemaster Item,,274C9250,SPSI,Prosthetic/Orthotic Devices C9250,,Per Svc,0.01
Chargemaster Item,,274C9250,SPSI,Prosthetic/Orthotic Devices C9250,,Per Svc,0.01
Chargemaster Item,,274C9352,SPSI,Prosthetic/Orthotic Devices C9352,,Per Svc,0.01
Chargemaster Item,,274C9352,SPSI,Prosthetic/Orthotic Devices C9352,,Per Svc,0.01
Chargemaster Item,,274C9352,SPSI,Prosthetic/Orthotic Devices C9352,,Per Svc,0.01
Chargemaster Item,,274C9352,SPSI,Prosthetic/Orthotic Devices C9352,,Per Svc,0.01
Chargemaster Item,,274C9353,SPSI,Prosthetic/Orthotic Devices C9353,,Per Svc,0.01
Chargemaster Item,,274C9353,SPSI,Prosthetic/Orthotic Devices C9353,,Per Svc,0.01
Chargemaster Item,,274C9353,SPSI,Prosthetic/Orthotic Devices C9353,,Per Svc,0.01
Chargemaster Item,,274C9353,SPSI,Prosthetic/Orthotic Devices C9353,,Per Svc,0.01
Chargemaster Item,,274C9363,SPSI,Prosthetic/Orthotic Devices C9363,,Per Svc,0.01
Chargemaster Item,,274C9363,SPSI,Prosthetic/Orthotic Devices C9363,,Per Svc,0.01
Chargemaster Item,,274C9363,SPSI,Prosthetic/Orthotic Devices C9363,,Per Svc,0.01
Chargemaster Item,,274C9363,SPSI,Prosthetic/Orthotic Devices C9363,,Per Svc,0.01
Chargemaster Item,,274E0191,SPSI,Prosthetic/Orthotic Devices E0191,,Per Svc,0.01
Chargemaster Item,,274E0191,SPSI,Prosthetic/Orthotic Devices E0191,,Per Svc,0.01
Chargemaster Item,,274E0191,SPSI,Prosthetic/Orthotic Devices E0191,,Per Svc,0.01
Chargemaster Item,,274E0191,SPSI,Prosthetic/Orthotic Devices E0191,,Per Svc,0.01
Chargemaster Item,,274E0235,SPSI,Prosthetic/Orthotic Devices E0235,,Per Svc,0.01
Chargemaster Item,,274E0235,SPSI,Prosthetic/Orthotic Devices E0235,,Per Svc,0.01
Chargemaster Item,,274E0235,SPSI,Prosthetic/Orthotic Devices E0235,,Per Svc,0.01
Chargemaster Item,,274E0235,SPSI,Prosthetic/Orthotic Devices E0235,,Per Svc,0.01
Chargemaster Item,,274L0113,SPSI,Prosthetic/Orthotic Devices L0113,,Per Svc,0.01
Chargemaster Item,,274L0113,SPSI,Prosthetic/Orthotic Devices L0113,,Per Svc,0.01
Chargemaster Item,,274L0113,SPSI,Prosthetic/Orthotic Devices L0113,,Per Svc,0.01
Chargemaster Item,,274L0113,SPSI,Prosthetic/Orthotic Devices L0113,,Per Svc,0.01
Chargemaster Item,,274L0120,SPSI,Prosthetic/Orthotic Devices L0120,,Per Svc,0.01
Chargemaster Item,,274L0120,SPSI,Prosthetic/Orthotic Devices L0120,,Per Svc,0.01
Chargemaster Item,,274L0120,SPSI,Prosthetic/Orthotic Devices L0120,,Per Svc,0.01
Chargemaster Item,,274L0120,SPSI,Prosthetic/Orthotic Devices L0120,,Per Svc,0.01
Chargemaster Item,,274L0172,SPSI,Prosthetic/Orthotic Devices L0172,,Per Svc,0.01
Chargemaster Item,,274L0172,SPSI,Prosthetic/Orthotic Devices L0172,,Per Svc,0.01
Chargemaster Item,,274L0172,SPSI,Prosthetic/Orthotic Devices L0172,,Per Svc,0.01
Chargemaster Item,,274L0172,SPSI,Prosthetic/Orthotic Devices L0172,,Per Svc,0.01
Chargemaster Item,,274L0174,SPSI,Prosthetic/Orthotic Devices L0174,,Per Svc,0.01
Chargemaster Item,,274L0174,SPSI,Prosthetic/Orthotic Devices L0174,,Per Svc,0.01
Chargemaster Item,,274L0174,SPSI,Prosthetic/Orthotic Devices L0174,,Per Svc,0.01
Chargemaster Item,,274L0174,SPSI,Prosthetic/Orthotic Devices L0174,,Per Svc,0.01
Chargemaster Item,,274L0625,SPSI,Prosthetic/Orthotic Devices L0625,,Per Svc,0.01
Chargemaster Item,,274L0625,SPSI,Prosthetic/Orthotic Devices L0625,,Per Svc,0.01
Chargemaster Item,,274L0625,SPSI,Prosthetic/Orthotic Devices L0625,,Per Svc,0.01
Chargemaster Item,,274L0625,SPSI,Prosthetic/Orthotic Devices L0625,,Per Svc,0.01
Chargemaster Item,,274L1820,SPSI,Prosthetic/Orthotic Devices L1820,,Per Svc,0.01
Chargemaster Item,,274L1820,SPSI,Prosthetic/Orthotic Devices L1820,,Per Svc,0.01
Chargemaster Item,,274L1820,SPSI,Prosthetic/Orthotic Devices L1820,,Per Svc,0.01
Chargemaster Item,,274L1820,SPSI,Prosthetic/Orthotic Devices L1820,,Per Svc,0.01
Chargemaster Item,,274L1830,SPSI,Prosthetic/Orthotic Devices L1830,,Per Svc,0.01
Chargemaster Item,,274L1830,SPSI,Prosthetic/Orthotic Devices L1830,,Per Svc,0.01
Chargemaster Item,,274L1830,SPSI,Prosthetic/Orthotic Devices L1830,,Per Svc,0.01
Chargemaster Item,,274L1830,SPSI,Prosthetic/Orthotic Devices L1830,,Per Svc,0.01
Chargemaster Item,,274L1832,SPSI,Prosthetic/Orthotic Devices L1832,,Per Svc,0.01
Chargemaster Item,,274L1832,SPSI,Prosthetic/Orthotic Devices L1832,,Per Svc,0.01
Chargemaster Item,,274L1832,SPSI,Prosthetic/Orthotic Devices L1832,,Per Svc,0.01
Chargemaster Item,,274L1832,SPSI,Prosthetic/Orthotic Devices L1832,,Per Svc,0.01
Chargemaster Item,,274L1902,SPSI,Prosthetic/Orthotic Devices L1902,,Per Svc,0.01
Chargemaster Item,,274L1902,SPSI,Prosthetic/Orthotic Devices L1902,,Per Svc,0.01
Chargemaster Item,,274L1902,SPSI,Prosthetic/Orthotic Devices L1902,,Per Svc,0.01
Chargemaster Item,,274L1902,SPSI,Prosthetic/Orthotic Devices L1902,,Per Svc,0.01
Chargemaster Item,,274L1930,SPSI,Prosthetic/Orthotic Devices L1930,,Per Svc,0.01
Chargemaster Item,,274L1930,SPSI,Prosthetic/Orthotic Devices L1930,,Per Svc,0.01
Chargemaster Item,,274L1930,SPSI,Prosthetic/Orthotic Devices L1930,,Per Svc,0.01
Chargemaster Item,,274L1930,SPSI,Prosthetic/Orthotic Devices L1930,,Per Svc,0.01
Chargemaster Item,,274L3260,SPSI,Prosthetic/Orthotic Devices L3260,,Per Svc,0.01
Chargemaster Item,,274L3260,SPSI,Prosthetic/Orthotic Devices L3260,,Per Svc,0.01
Chargemaster Item,,274L3260,SPSI,Prosthetic/Orthotic Devices L3260,,Per Svc,0.01
Chargemaster Item,,274L3260,SPSI,Prosthetic/Orthotic Devices L3260,,Per Svc,0.01
Chargemaster Item,,274L3650,SPSI,Prosthetic/Orthotic Devices L3650,,Per Svc,0.01
Chargemaster Item,,274L3650,SPSI,Prosthetic/Orthotic Devices L3650,,Per Svc,0.01
Chargemaster Item,,274L3650,SPSI,Prosthetic/Orthotic Devices L3650,,Per Svc,0.01
Chargemaster Item,,274L3650,SPSI,Prosthetic/Orthotic Devices L3650,,Per Svc,0.01
Chargemaster Item,,274L3670,SPSI,Prosthetic/Orthotic Devices L3670,,Per Svc,0.01
Chargemaster Item,,274L3670,SPSI,Prosthetic/Orthotic Devices L3670,,Per Svc,0.01
Chargemaster Item,,274L3670,SPSI,Prosthetic/Orthotic Devices L3670,,Per Svc,0.01
Chargemaster Item,,274L3670,SPSI,Prosthetic/Orthotic Devices L3670,,Per Svc,0.01
Chargemaster Item,,274L3807,SPSI,Prosthetic/Orthotic Devices L3807,,Per Svc,0.01
Chargemaster Item,,274L3807,SPSI,Prosthetic/Orthotic Devices L3807,,Per Svc,0.01
Chargemaster Item,,274L3807,SPSI,Prosthetic/Orthotic Devices L3807,,Per Svc,0.01
Chargemaster Item,,274L3807,SPSI,Prosthetic/Orthotic Devices L3807,,Per Svc,0.01
Chargemaster Item,,274L3809,SPSI,Prosthetic/Orthotic Devices L3809,,Per Svc,0.01
Chargemaster Item,,274L3809,SPSI,Prosthetic/Orthotic Devices L3809,,Per Svc,0.01
Chargemaster Item,,274L3809,SPSI,Prosthetic/Orthotic Devices L3809,,Per Svc,0.01
Chargemaster Item,,274L3809,SPSI,Prosthetic/Orthotic Devices L3809,,Per Svc,0.01
Chargemaster Item,,274L3908,SPSI,Prosthetic/Orthotic Devices L3908,,Per Svc,0.01
Chargemaster Item,,274L3908,SPSI,Prosthetic/Orthotic Devices L3908,,Per Svc,0.01
Chargemaster Item,,274L3908,SPSI,Prosthetic/Orthotic Devices L3908,,Per Svc,0.01
Chargemaster Item,,274L3908,SPSI,Prosthetic/Orthotic Devices L3908,,Per Svc,0.01
Chargemaster Item,,274L3917,SPSI,Prosthetic/Orthotic Devices L3917,,Per Svc,0.01
Chargemaster Item,,274L3917,SPSI,Prosthetic/Orthotic Devices L3917,,Per Svc,0.01
Chargemaster Item,,274L3917,SPSI,Prosthetic/Orthotic Devices L3917,,Per Svc,0.01
Chargemaster Item,,274L3917,SPSI,Prosthetic/Orthotic Devices L3917,,Per Svc,0.01
Chargemaster Item,,274L3923,SPSI,Prosthetic/Orthotic Devices L3923,,Per Svc,0.01
Chargemaster Item,,274L3923,SPSI,Prosthetic/Orthotic Devices L3923,,Per Svc,0.01
Chargemaster Item,,274L3923,SPSI,Prosthetic/Orthotic Devices L3923,,Per Svc,0.01
Chargemaster Item,,274L3923,SPSI,Prosthetic/Orthotic Devices L3923,,Per Svc,0.01
Chargemaster Item,,274L4386,SPSI,Prosthetic/Orthotic Devices L4386,,Per Svc,0.01
Chargemaster Item,,274L4386,SPSI,Prosthetic/Orthotic Devices L4386,,Per Svc,0.01
Chargemaster Item,,274L4386,SPSI,Prosthetic/Orthotic Devices L4386,,Per Svc,0.01
Chargemaster Item,,274L4386,SPSI,Prosthetic/Orthotic Devices L4386,,Per Svc,0.01
Chargemaster Item,,274L4387,SPSI,Prosthetic/Orthotic Devices L4387,,Per Svc,0.01
Chargemaster Item,,274L4387,SPSI,Prosthetic/Orthotic Devices L4387,,Per Svc,0.01
Chargemaster Item,,274L4387,SPSI,Prosthetic/Orthotic Devices L4387,,Per Svc,0.01
Chargemaster Item,,274L4387,SPSI,Prosthetic/Orthotic Devices L4387,,Per Svc,0.01
Chargemaster Item,,274L5000,SPSI,Prosthetic/Orthotic Devices L5000,,Per Svc,0.01
Chargemaster Item,,274L5000,SPSI,Prosthetic/Orthotic Devices L5000,,Per Svc,0.01
Chargemaster Item,,274L5000,SPSI,Prosthetic/Orthotic Devices L5000,,Per Svc,0.01
Chargemaster Item,,274L5000,SPSI,Prosthetic/Orthotic Devices L5000,,Per Svc,0.01
Chargemaster Item,,274L8000,SPSI,Prosthetic/Orthotic Devices L8000,,Per Svc,0.01
Chargemaster Item,,274L8000,SPSI,Prosthetic/Orthotic Devices L8000,,Per Svc,0.01
Chargemaster Item,,274L8000,SPSI,Prosthetic/Orthotic Devices L8000,,Per Svc,0.01
Chargemaster Item,,274L8000,SPSI,Prosthetic/Orthotic Devices L8000,,Per Svc,0.01
Chargemaster Item,,274L8501,SPSI,Prosthetic/Orthotic Devices L8501,,Per Svc,0.01
Chargemaster Item,,274L8501,SPSI,Prosthetic/Orthotic Devices L8501,,Per Svc,0.01
Chargemaster Item,,274L8501,SPSI,Prosthetic/Orthotic Devices L8501,,Per Svc,0.01
Chargemaster Item,,274L8501,SPSI,Prosthetic/Orthotic Devices L8501,,Per Svc,0.01
Chargemaster Item,,274L8600,SPSI,Prosthetic/Orthotic Devices L8600,,Per Svc,0.01
Chargemaster Item,,274L8600,SPSI,Prosthetic/Orthotic Devices L8600,,Per Svc,0.01
Chargemaster Item,,274L8600,SPSI,Prosthetic/Orthotic Devices L8600,,Per Svc,0.01
Chargemaster Item,,274L8600,SPSI,Prosthetic/Orthotic Devices L8600,,Per Svc,0.01
Chargemaster Item,,274L8606,SPSI,Prosthetic/Orthotic Devices L8606,,Per Svc,0.01
Chargemaster Item,,274L8606,SPSI,Prosthetic/Orthotic Devices L8606,,Per Svc,0.01
Chargemaster Item,,274L8606,SPSI,Prosthetic/Orthotic Devices L8606,,Per Svc,0.01
Chargemaster Item,,274L8606,SPSI,Prosthetic/Orthotic Devices L8606,,Per Svc,0.01
Chargemaster Item,,274L8612,SPSI,Prosthetic/Orthotic Devices L8612,,Per Svc,0.01
Chargemaster Item,,274L8612,SPSI,Prosthetic/Orthotic Devices L8612,,Per Svc,0.01
Chargemaster Item,,274L8612,SPSI,Prosthetic/Orthotic Devices L8612,,Per Svc,0.01
Chargemaster Item,,274L8612,SPSI,Prosthetic/Orthotic Devices L8612,,Per Svc,0.01
Chargemaster Item,,274L8699,SPSI,Prosthetic/Orthotic Devices L8699,,Per Svc,0.01
Chargemaster Item,,274L8699,SPSI,Prosthetic/Orthotic Devices L8699,,Per Svc,0.01
Chargemaster Item,,274L8699,SPSI,Prosthetic/Orthotic Devices L8699,,Per Svc,0.01
Chargemaster Item,,274L8699,SPSI,Prosthetic/Orthotic Devices L8699,,Per Svc,0.01
Chargemaster Item,,274Q4100,SPSI,Prosthetic/Orthotic Devices Q4100,,Per Svc,0.01
Chargemaster Item,,274Q4100,SPSI,Prosthetic/Orthotic Devices Q4100,,Per Svc,0.01
Chargemaster Item,,274Q4100,SPSI,Prosthetic/Orthotic Devices Q4100,,Per Svc,0.01
Chargemaster Item,,274Q4100,SPSI,Prosthetic/Orthotic Devices Q4100,,Per Svc,0.01
Chargemaster Item,,274Q4102,SPSI,Prosthetic/Orthotic Devices Q4102,,Per Svc,0.01
Chargemaster Item,,274Q4102,SPSI,Prosthetic/Orthotic Devices Q4102,,Per Svc,0.01
Chargemaster Item,,274Q4102,SPSI,Prosthetic/Orthotic Devices Q4102,,Per Svc,0.01
Chargemaster Item,,274Q4102,SPSI,Prosthetic/Orthotic Devices Q4102,,Per Svc,0.01
Chargemaster Item,,274Q4110,SPSI,Prosthetic/Orthotic Devices Q4110,,Per Svc,0.01
Chargemaster Item,,274Q4110,SPSI,Prosthetic/Orthotic Devices Q4110,,Per Svc,0.01
Chargemaster Item,,274Q4110,SPSI,Prosthetic/Orthotic Devices Q4110,,Per Svc,0.01
Chargemaster Item,,274Q4110,SPSI,Prosthetic/Orthotic Devices Q4110,,Per Svc,0.01
Chargemaster Item,,274Q4114,SPSI,Prosthetic/Orthotic Devices Q4114,,Per Svc,0.01
Chargemaster Item,,274Q4114,SPSI,Prosthetic/Orthotic Devices Q4114,,Per Svc,0.01
Chargemaster Item,,274Q4114,SPSI,Prosthetic/Orthotic Devices Q4114,,Per Svc,0.01
Chargemaster Item,,274Q4114,SPSI,Prosthetic/Orthotic Devices Q4114,,Per Svc,0.01
Chargemaster Item,,274Q4116,SPSI,Prosthetic/Orthotic Devices Q4116,,Per Svc,0.01
Chargemaster Item,,274Q4116,SPSI,Prosthetic/Orthotic Devices Q4116,,Per Svc,0.01
Chargemaster Item,,274Q4116,SPSI,Prosthetic/Orthotic Devices Q4116,,Per Svc,0.01
Chargemaster Item,,274Q4116,SPSI,Prosthetic/Orthotic Devices Q4116,,Per Svc,0.01
Chargemaster Item,,274Q4118,SPSI,Prosthetic/Orthotic Devices Q4118,,Per Svc,0.01
Chargemaster Item,,274Q4118,SPSI,Prosthetic/Orthotic Devices Q4118,,Per Svc,0.01
Chargemaster Item,,274Q4118,SPSI,Prosthetic/Orthotic Devices Q4118,,Per Svc,0.01
Chargemaster Item,,274Q4118,SPSI,Prosthetic/Orthotic Devices Q4118,,Per Svc,0.01
Chargemaster Item,,274Q4125,SPSI,Prosthetic/Orthotic Devices Q4125,,Per Svc,0.01
Chargemaster Item,,274Q4125,SPSI,Prosthetic/Orthotic Devices Q4125,,Per Svc,0.01
Chargemaster Item,,274Q4125,SPSI,Prosthetic/Orthotic Devices Q4125,,Per Svc,0.01
Chargemaster Item,,274Q4125,SPSI,Prosthetic/Orthotic Devices Q4125,,Per Svc,0.01
Chargemaster Item,,274Q4128,SPSI,Prosthetic/Orthotic Devices Q4128,,Per Svc,0.01
Chargemaster Item,,274Q4128,SPSI,Prosthetic/Orthotic Devices Q4128,,Per Svc,0.01
Chargemaster Item,,274Q4128,SPSI,Prosthetic/Orthotic Devices Q4128,,Per Svc,0.01
Chargemaster Item,,274Q4128,SPSI,Prosthetic/Orthotic Devices Q4128,,Per Svc,0.01
Chargemaster Item,,274Q4130,SPSI,Prosthetic/Orthotic Devices Q4130,,Per Svc,0.01
Chargemaster Item,,274Q4130,SPSI,Prosthetic/Orthotic Devices Q4130,,Per Svc,0.01
Chargemaster Item,,274Q4130,SPSI,Prosthetic/Orthotic Devices Q4130,,Per Svc,0.01
Chargemaster Item,,274Q4130,SPSI,Prosthetic/Orthotic Devices Q4130,,Per Svc,0.01
Chargemaster Item,,274Q4133,SPSI,Prosthetic/Orthotic Devices Q4133,,Per Svc,0.01
Chargemaster Item,,274Q4133,SPSI,Prosthetic/Orthotic Devices Q4133,,Per Svc,0.01
Chargemaster Item,,274Q4133,SPSI,Prosthetic/Orthotic Devices Q4133,,Per Svc,0.01
Chargemaster Item,,274Q4133,SPSI,Prosthetic/Orthotic Devices Q4133,,Per Svc,0.01
Chargemaster Item,,274Q4155,SPSI,Prosthetic/Orthotic Devices Q4155,,Per Svc,0.01
Chargemaster Item,,274Q4155,SPSI,Prosthetic/Orthotic Devices Q4155,,Per Svc,0.01
Chargemaster Item,,274Q4155,SPSI,Prosthetic/Orthotic Devices Q4155,,Per Svc,0.01
Chargemaster Item,,274Q4155,SPSI,Prosthetic/Orthotic Devices Q4155,,Per Svc,0.01
Chargemaster Item,,274Q4166,SPSI,Prosthetic/Orthotic Devices Q4166,,Per Svc,0.01
Chargemaster Item,,274Q4166,SPSI,Prosthetic/Orthotic Devices Q4166,,Per Svc,0.01
Chargemaster Item,,274Q4166,SPSI,Prosthetic/Orthotic Devices Q4166,,Per Svc,0.01
Chargemaster Item,,274Q4166,SPSI,Prosthetic/Orthotic Devices Q4166,,Per Svc,0.01
Chargemaster Item,,274Q9963,SPSI,Prosthetic/Orthotic Devices Q9963,,Per Svc,0.01
Chargemaster Item,,274Q9963,SPSI,Prosthetic/Orthotic Devices Q9963,,Per Svc,0.01
Chargemaster Item,,274Q9963,SPSI,Prosthetic/Orthotic Devices Q9963,,Per Svc,0.01
Chargemaster Item,,274Q9963,SPSI,Prosthetic/Orthotic Devices Q9963,,Per Svc,0.01
Chargemaster Item,,274Q9967,SPSI,Prosthetic/Orthotic Devices Q9967,,Per Svc,0.01
Chargemaster Item,,274Q9967,SPSI,Prosthetic/Orthotic Devices Q9967,,Per Svc,0.01
Chargemaster Item,,274Q9967,SPSI,Prosthetic/Orthotic Devices Q9967,,Per Svc,0.01
Chargemaster Item,,274Q9967,SPSI,Prosthetic/Orthotic Devices Q9967,,Per Svc,0.01
Chargemaster Item,,274V2630,SPSI,Prosthetic/Orthotic Devices V2630,,Per Svc,0.01
Chargemaster Item,,274V2630,SPSI,Prosthetic/Orthotic Devices V2630,,Per Svc,0.01
Chargemaster Item,,274V2630,SPSI,Prosthetic/Orthotic Devices V2630,,Per Svc,0.01
Chargemaster Item,,274V2630,SPSI,Prosthetic/Orthotic Devices V2630,,Per Svc,0.01
Chargemaster Item,,274V2632,SPSI,Prosthetic/Orthotic Devices V2632,,Per Svc,0.01
Chargemaster Item,,274V2632,SPSI,Prosthetic/Orthotic Devices V2632,,Per Svc,0.01
Chargemaster Item,,274V2632,SPSI,Prosthetic/Orthotic Devices V2632,,Per Svc,0.01
Chargemaster Item,,274V2632,SPSI,Prosthetic/Orthotic Devices V2632,,Per Svc,0.01
Chargemaster Item,,274V2790,SPSI,Prosthetic/Orthotic Devices V2790,,Per Svc,0.01
Chargemaster Item,,274V2790,SPSI,Prosthetic/Orthotic Devices V2790,,Per Svc,0.01
Chargemaster Item,,274V2790,SPSI,Prosthetic/Orthotic Devices V2790,,Per Svc,0.01
Chargemaster Item,,274V2790,SPSI,Prosthetic/Orthotic Devices V2790,,Per Svc,0.01
Chargemaster Item,,274XXXXX,SPSI,Prosthetic/Orthotic Devices,,Per Svc,0.01
Chargemaster Item,,274XXXXX,SPSI,Prosthetic/Orthotic Devices,,Per Svc,0.01
Chargemaster Item,,274XXXXX,SPSI,Prosthetic/Orthotic Devices,,Per Svc,0.01
Chargemaster Item,,274XXXXX,SPSI,Prosthetic/Orthotic Devices,,Per Svc,0.01
Chargemaster Item,,275A4265,SPSI,Pacemaker A4265,,Per Svc,0.01
Chargemaster Item,,275A4265,SPSI,Pacemaker A4265,,Per Svc,0.01
Chargemaster Item,,275A4265,SPSI,Pacemaker A4265,,Per Svc,0.01
Chargemaster Item,,275A4265,SPSI,Pacemaker A4265,,Per Svc,0.01
Chargemaster Item,,275A4340,SPSI,Pacemaker A4340,,Per Svc,0.01
Chargemaster Item,,275A4340,SPSI,Pacemaker A4340,,Per Svc,0.01
Chargemaster Item,,275A4340,SPSI,Pacemaker A4340,,Per Svc,0.01
Chargemaster Item,,275A4340,SPSI,Pacemaker A4340,,Per Svc,0.01
Chargemaster Item,,275A4349,SPSI,Pacemaker A4349,,Per Svc,0.01
Chargemaster Item,,275A4349,SPSI,Pacemaker A4349,,Per Svc,0.01
Chargemaster Item,,275A4349,SPSI,Pacemaker A4349,,Per Svc,0.01
Chargemaster Item,,275A4349,SPSI,Pacemaker A4349,,Per Svc,0.01
Chargemaster Item,,275A4565,SPSI,Pacemaker A4565,,Per Svc,0.01
Chargemaster Item,,275A4565,SPSI,Pacemaker A4565,,Per Svc,0.01
Chargemaster Item,,275A4565,SPSI,Pacemaker A4565,,Per Svc,0.01
Chargemaster Item,,275A4565,SPSI,Pacemaker A4565,,Per Svc,0.01
Chargemaster Item,,275A4648,SPSI,Pacemaker A4648,,Per Svc,0.01
Chargemaster Item,,275A4648,SPSI,Pacemaker A4648,,Per Svc,0.01
Chargemaster Item,,275A4648,SPSI,Pacemaker A4648,,Per Svc,0.01
Chargemaster Item,,275A4648,SPSI,Pacemaker A4648,,Per Svc,0.01
Chargemaster Item,,275A6021,SPSI,Pacemaker A6021,,Per Svc,0.01
Chargemaster Item,,275A6021,SPSI,Pacemaker A6021,,Per Svc,0.01
Chargemaster Item,,275A6021,SPSI,Pacemaker A6021,,Per Svc,0.01
Chargemaster Item,,275A6021,SPSI,Pacemaker A6021,,Per Svc,0.01
Chargemaster Item,,275A6025,SPSI,Pacemaker A6025,,Per Svc,0.01
Chargemaster Item,,275A6025,SPSI,Pacemaker A6025,,Per Svc,0.01
Chargemaster Item,,275A6025,SPSI,Pacemaker A6025,,Per Svc,0.01
Chargemaster Item,,275A6025,SPSI,Pacemaker A6025,,Per Svc,0.01
Chargemaster Item,,275A6196,SPSI,Pacemaker A6196,,Per Svc,0.01
Chargemaster Item,,275A6196,SPSI,Pacemaker A6196,,Per Svc,0.01
Chargemaster Item,,275A6196,SPSI,Pacemaker A6196,,Per Svc,0.01
Chargemaster Item,,275A6196,SPSI,Pacemaker A6196,,Per Svc,0.01
Chargemaster Item,,275A6197,SPSI,Pacemaker A6197,,Per Svc,0.01
Chargemaster Item,,275A6197,SPSI,Pacemaker A6197,,Per Svc,0.01
Chargemaster Item,,275A6197,SPSI,Pacemaker A6197,,Per Svc,0.01
Chargemaster Item,,275A6197,SPSI,Pacemaker A6197,,Per Svc,0.01
Chargemaster Item,,275A6206,SPSI,Pacemaker A6206,,Per Svc,0.01
Chargemaster Item,,275A6206,SPSI,Pacemaker A6206,,Per Svc,0.01
Chargemaster Item,,275A6206,SPSI,Pacemaker A6206,,Per Svc,0.01
Chargemaster Item,,275A6206,SPSI,Pacemaker A6206,,Per Svc,0.01
Chargemaster Item,,275A6209,SPSI,Pacemaker A6209,,Per Svc,0.01
Chargemaster Item,,275A6209,SPSI,Pacemaker A6209,,Per Svc,0.01
Chargemaster Item,,275A6209,SPSI,Pacemaker A6209,,Per Svc,0.01
Chargemaster Item,,275A6209,SPSI,Pacemaker A6209,,Per Svc,0.01
Chargemaster Item,,275A6212,SPSI,Pacemaker A6212,,Per Svc,0.01
Chargemaster Item,,275A6212,SPSI,Pacemaker A6212,,Per Svc,0.01
Chargemaster Item,,275A6212,SPSI,Pacemaker A6212,,Per Svc,0.01
Chargemaster Item,,275A6212,SPSI,Pacemaker A6212,,Per Svc,0.01
Chargemaster Item,,275A6213,SPSI,Pacemaker A6213,,Per Svc,0.01
Chargemaster Item,,275A6213,SPSI,Pacemaker A6213,,Per Svc,0.01
Chargemaster Item,,275A6213,SPSI,Pacemaker A6213,,Per Svc,0.01
Chargemaster Item,,275A6213,SPSI,Pacemaker A6213,,Per Svc,0.01
Chargemaster Item,,275A6214,SPSI,Pacemaker A6214,,Per Svc,0.01
Chargemaster Item,,275A6214,SPSI,Pacemaker A6214,,Per Svc,0.01
Chargemaster Item,,275A6214,SPSI,Pacemaker A6214,,Per Svc,0.01
Chargemaster Item,,275A6214,SPSI,Pacemaker A6214,,Per Svc,0.01
Chargemaster Item,,275A6219,SPSI,Pacemaker A6219,,Per Svc,0.01
Chargemaster Item,,275A6219,SPSI,Pacemaker A6219,,Per Svc,0.01
Chargemaster Item,,275A6219,SPSI,Pacemaker A6219,,Per Svc,0.01
Chargemaster Item,,275A6219,SPSI,Pacemaker A6219,,Per Svc,0.01
Chargemaster Item,,275A6222,SPSI,Pacemaker A6222,,Per Svc,0.01
Chargemaster Item,,275A6222,SPSI,Pacemaker A6222,,Per Svc,0.01
Chargemaster Item,,275A6222,SPSI,Pacemaker A6222,,Per Svc,0.01
Chargemaster Item,,275A6222,SPSI,Pacemaker A6222,,Per Svc,0.01
Chargemaster Item,,275A6223,SPSI,Pacemaker A6223,,Per Svc,0.01
Chargemaster Item,,275A6223,SPSI,Pacemaker A6223,,Per Svc,0.01
Chargemaster Item,,275A6223,SPSI,Pacemaker A6223,,Per Svc,0.01
Chargemaster Item,,275A6223,SPSI,Pacemaker A6223,,Per Svc,0.01
Chargemaster Item,,275A6224,SPSI,Pacemaker A6224,,Per Svc,0.01
Chargemaster Item,,275A6224,SPSI,Pacemaker A6224,,Per Svc,0.01
Chargemaster Item,,275A6224,SPSI,Pacemaker A6224,,Per Svc,0.01
Chargemaster Item,,275A6224,SPSI,Pacemaker A6224,,Per Svc,0.01
Chargemaster Item,,275A6234,SPSI,Pacemaker A6234,,Per Svc,0.01
Chargemaster Item,,275A6234,SPSI,Pacemaker A6234,,Per Svc,0.01
Chargemaster Item,,275A6234,SPSI,Pacemaker A6234,,Per Svc,0.01
Chargemaster Item,,275A6234,SPSI,Pacemaker A6234,,Per Svc,0.01
Chargemaster Item,,275A6235,SPSI,Pacemaker A6235,,Per Svc,0.01
Chargemaster Item,,275A6235,SPSI,Pacemaker A6235,,Per Svc,0.01
Chargemaster Item,,275A6235,SPSI,Pacemaker A6235,,Per Svc,0.01
Chargemaster Item,,275A6235,SPSI,Pacemaker A6235,,Per Svc,0.01
Chargemaster Item,,275A6238,SPSI,Pacemaker A6238,,Per Svc,0.01
Chargemaster Item,,275A6238,SPSI,Pacemaker A6238,,Per Svc,0.01
Chargemaster Item,,275A6238,SPSI,Pacemaker A6238,,Per Svc,0.01
Chargemaster Item,,275A6238,SPSI,Pacemaker A6238,,Per Svc,0.01
Chargemaster Item,,275A6255,SPSI,Pacemaker A6255,,Per Svc,0.01
Chargemaster Item,,275A6255,SPSI,Pacemaker A6255,,Per Svc,0.01
Chargemaster Item,,275A6255,SPSI,Pacemaker A6255,,Per Svc,0.01
Chargemaster Item,,275A6255,SPSI,Pacemaker A6255,,Per Svc,0.01
Chargemaster Item,,275A6257,SPSI,Pacemaker A6257,,Per Svc,0.01
Chargemaster Item,,275A6257,SPSI,Pacemaker A6257,,Per Svc,0.01
Chargemaster Item,,275A6257,SPSI,Pacemaker A6257,,Per Svc,0.01
Chargemaster Item,,275A6257,SPSI,Pacemaker A6257,,Per Svc,0.01
Chargemaster Item,,275A6258,SPSI,Pacemaker A6258,,Per Svc,0.01
Chargemaster Item,,275A6258,SPSI,Pacemaker A6258,,Per Svc,0.01
Chargemaster Item,,275A6258,SPSI,Pacemaker A6258,,Per Svc,0.01
Chargemaster Item,,275A6258,SPSI,Pacemaker A6258,,Per Svc,0.01
Chargemaster Item,,275A6259,SPSI,Pacemaker A6259,,Per Svc,0.01
Chargemaster Item,,275A6259,SPSI,Pacemaker A6259,,Per Svc,0.01
Chargemaster Item,,275A6259,SPSI,Pacemaker A6259,,Per Svc,0.01
Chargemaster Item,,275A6259,SPSI,Pacemaker A6259,,Per Svc,0.01
Chargemaster Item,,275A6454,SPSI,Pacemaker A6454,,Per Svc,0.01
Chargemaster Item,,275A6454,SPSI,Pacemaker A6454,,Per Svc,0.01
Chargemaster Item,,275A6454,SPSI,Pacemaker A6454,,Per Svc,0.01
Chargemaster Item,,275A6454,SPSI,Pacemaker A6454,,Per Svc,0.01
Chargemaster Item,,275B4082,SPSI,Pacemaker B4082,,Per Svc,0.01
Chargemaster Item,,275B4082,SPSI,Pacemaker B4082,,Per Svc,0.01
Chargemaster Item,,275B4082,SPSI,Pacemaker B4082,,Per Svc,0.01
Chargemaster Item,,275B4082,SPSI,Pacemaker B4082,,Per Svc,0.01
Chargemaster Item,,275B4087,SPSI,Pacemaker B4087,,Per Svc,0.01
Chargemaster Item,,275B4087,SPSI,Pacemaker B4087,,Per Svc,0.01
Chargemaster Item,,275B4087,SPSI,Pacemaker B4087,,Per Svc,0.01
Chargemaster Item,,275B4087,SPSI,Pacemaker B4087,,Per Svc,0.01
Chargemaster Item,,275B4088,SPSI,Pacemaker B4088,,Per Svc,0.01
Chargemaster Item,,275B4088,SPSI,Pacemaker B4088,,Per Svc,0.01
Chargemaster Item,,275B4088,SPSI,Pacemaker B4088,,Per Svc,0.01
Chargemaster Item,,275B4088,SPSI,Pacemaker B4088,,Per Svc,0.01
Chargemaster Item,,275C1713,SPSI,Pacemaker C1713,,Per Svc,0.01
Chargemaster Item,,275C1713,SPSI,Pacemaker C1713,,Per Svc,0.01
Chargemaster Item,,275C1713,SPSI,Pacemaker C1713,,Per Svc,0.01
Chargemaster Item,,275C1713,SPSI,Pacemaker C1713,,Per Svc,0.01
Chargemaster Item,,275C1715,SPSI,Pacemaker C1715,,Per Svc,0.01
Chargemaster Item,,275C1715,SPSI,Pacemaker C1715,,Per Svc,0.01
Chargemaster Item,,275C1715,SPSI,Pacemaker C1715,,Per Svc,0.01
Chargemaster Item,,275C1715,SPSI,Pacemaker C1715,,Per Svc,0.01
Chargemaster Item,,275C1716,SPSI,Pacemaker C1716,,Per Svc,0.01
Chargemaster Item,,275C1716,SPSI,Pacemaker C1716,,Per Svc,0.01
Chargemaster Item,,275C1716,SPSI,Pacemaker C1716,,Per Svc,0.01
Chargemaster Item,,275C1716,SPSI,Pacemaker C1716,,Per Svc,0.01
Chargemaster Item,,275C1721,SPSI,Pacemaker C1721,,Per Svc,0.01
Chargemaster Item,,275C1721,SPSI,Pacemaker C1721,,Per Svc,0.01
Chargemaster Item,,275C1721,SPSI,Pacemaker C1721,,Per Svc,0.01
Chargemaster Item,,275C1721,SPSI,Pacemaker C1721,,Per Svc,0.01
Chargemaster Item,,275C1722,SPSI,Pacemaker C1722,,Per Svc,0.01
Chargemaster Item,,275C1722,SPSI,Pacemaker C1722,,Per Svc,0.01
Chargemaster Item,,275C1722,SPSI,Pacemaker C1722,,Per Svc,0.01
Chargemaster Item,,275C1722,SPSI,Pacemaker C1722,,Per Svc,0.01
Chargemaster Item,,275C1724,SPSI,Pacemaker C1724,,Per Svc,0.01
Chargemaster Item,,275C1724,SPSI,Pacemaker C1724,,Per Svc,0.01
Chargemaster Item,,275C1724,SPSI,Pacemaker C1724,,Per Svc,0.01
Chargemaster Item,,275C1724,SPSI,Pacemaker C1724,,Per Svc,0.01
Chargemaster Item,,275C1725,SPSI,Pacemaker C1725,,Per Svc,0.01
Chargemaster Item,,275C1725,SPSI,Pacemaker C1725,,Per Svc,0.01
Chargemaster Item,,275C1725,SPSI,Pacemaker C1725,,Per Svc,0.01
Chargemaster Item,,275C1725,SPSI,Pacemaker C1725,,Per Svc,0.01
Chargemaster Item,,275C1726,SPSI,Pacemaker C1726,,Per Svc,0.01
Chargemaster Item,,275C1726,SPSI,Pacemaker C1726,,Per Svc,0.01
Chargemaster Item,,275C1726,SPSI,Pacemaker C1726,,Per Svc,0.01
Chargemaster Item,,275C1726,SPSI,Pacemaker C1726,,Per Svc,0.01
Chargemaster Item,,275C1727,SPSI,Pacemaker C1727,,Per Svc,0.01
Chargemaster Item,,275C1727,SPSI,Pacemaker C1727,,Per Svc,0.01
Chargemaster Item,,275C1727,SPSI,Pacemaker C1727,,Per Svc,0.01
Chargemaster Item,,275C1727,SPSI,Pacemaker C1727,,Per Svc,0.01
Chargemaster Item,,275C1729,SPSI,Pacemaker C1729,,Per Svc,0.01
Chargemaster Item,,275C1729,SPSI,Pacemaker C1729,,Per Svc,0.01
Chargemaster Item,,275C1729,SPSI,Pacemaker C1729,,Per Svc,0.01
Chargemaster Item,,275C1729,SPSI,Pacemaker C1729,,Per Svc,0.01
Chargemaster Item,,275C1730,SPSI,Pacemaker C1730,,Per Svc,0.01
Chargemaster Item,,275C1730,SPSI,Pacemaker C1730,,Per Svc,0.01
Chargemaster Item,,275C1730,SPSI,Pacemaker C1730,,Per Svc,0.01
Chargemaster Item,,275C1730,SPSI,Pacemaker C1730,,Per Svc,0.01
Chargemaster Item,,275C1731,SPSI,Pacemaker C1731,,Per Svc,0.01
Chargemaster Item,,275C1731,SPSI,Pacemaker C1731,,Per Svc,0.01
Chargemaster Item,,275C1731,SPSI,Pacemaker C1731,,Per Svc,0.01
Chargemaster Item,,275C1731,SPSI,Pacemaker C1731,,Per Svc,0.01
Chargemaster Item,,275C1733,SPSI,Pacemaker C1733,,Per Svc,0.01
Chargemaster Item,,275C1733,SPSI,Pacemaker C1733,,Per Svc,0.01
Chargemaster Item,,275C1733,SPSI,Pacemaker C1733,,Per Svc,0.01
Chargemaster Item,,275C1733,SPSI,Pacemaker C1733,,Per Svc,0.01
Chargemaster Item,,275C1750,SPSI,Pacemaker C1750,,Per Svc,0.01
Chargemaster Item,,275C1750,SPSI,Pacemaker C1750,,Per Svc,0.01
Chargemaster Item,,275C1750,SPSI,Pacemaker C1750,,Per Svc,0.01
Chargemaster Item,,275C1750,SPSI,Pacemaker C1750,,Per Svc,0.01
Chargemaster Item,,275C1751,SPSI,Pacemaker C1751,,Per Svc,0.01
Chargemaster Item,,275C1751,SPSI,Pacemaker C1751,,Per Svc,0.01
Chargemaster Item,,275C1751,SPSI,Pacemaker C1751,,Per Svc,0.01
Chargemaster Item,,275C1751,SPSI,Pacemaker C1751,,Per Svc,0.01
Chargemaster Item,,275C1752,SPSI,Pacemaker C1752,,Per Svc,0.01
Chargemaster Item,,275C1752,SPSI,Pacemaker C1752,,Per Svc,0.01
Chargemaster Item,,275C1752,SPSI,Pacemaker C1752,,Per Svc,0.01
Chargemaster Item,,275C1752,SPSI,Pacemaker C1752,,Per Svc,0.01
Chargemaster Item,,275C1753,SPSI,Pacemaker C1753,,Per Svc,0.01
Chargemaster Item,,275C1753,SPSI,Pacemaker C1753,,Per Svc,0.01
Chargemaster Item,,275C1753,SPSI,Pacemaker C1753,,Per Svc,0.01
Chargemaster Item,,275C1753,SPSI,Pacemaker C1753,,Per Svc,0.01
Chargemaster Item,,275C1755,SPSI,Pacemaker C1755,,Per Svc,0.01
Chargemaster Item,,275C1755,SPSI,Pacemaker C1755,,Per Svc,0.01
Chargemaster Item,,275C1755,SPSI,Pacemaker C1755,,Per Svc,0.01
Chargemaster Item,,275C1755,SPSI,Pacemaker C1755,,Per Svc,0.01
Chargemaster Item,,275C1757,SPSI,Pacemaker C1757,,Per Svc,0.01
Chargemaster Item,,275C1757,SPSI,Pacemaker C1757,,Per Svc,0.01
Chargemaster Item,,275C1757,SPSI,Pacemaker C1757,,Per Svc,0.01
Chargemaster Item,,275C1757,SPSI,Pacemaker C1757,,Per Svc,0.01
Chargemaster Item,,275C1758,SPSI,Pacemaker C1758,,Per Svc,0.01
Chargemaster Item,,275C1758,SPSI,Pacemaker C1758,,Per Svc,0.01
Chargemaster Item,,275C1758,SPSI,Pacemaker C1758,,Per Svc,0.01
Chargemaster Item,,275C1758,SPSI,Pacemaker C1758,,Per Svc,0.01
Chargemaster Item,,275C1760,SPSI,Pacemaker C1760,,Per Svc,0.01
Chargemaster Item,,275C1760,SPSI,Pacemaker C1760,,Per Svc,0.01
Chargemaster Item,,275C1760,SPSI,Pacemaker C1760,,Per Svc,0.01
Chargemaster Item,,275C1760,SPSI,Pacemaker C1760,,Per Svc,0.01
Chargemaster Item,,275C1762,SPSI,Pacemaker C1762,,Per Svc,0.01
Chargemaster Item,,275C1762,SPSI,Pacemaker C1762,,Per Svc,0.01
Chargemaster Item,,275C1762,SPSI,Pacemaker C1762,,Per Svc,0.01
Chargemaster Item,,275C1762,SPSI,Pacemaker C1762,,Per Svc,0.01
Chargemaster Item,,275C1763,SPSI,Pacemaker C1763,,Per Svc,0.01
Chargemaster Item,,275C1763,SPSI,Pacemaker C1763,,Per Svc,0.01
Chargemaster Item,,275C1763,SPSI,Pacemaker C1763,,Per Svc,0.01
Chargemaster Item,,275C1763,SPSI,Pacemaker C1763,,Per Svc,0.01
Chargemaster Item,,275C1764,SPSI,Pacemaker C1764,,Per Svc,0.01
Chargemaster Item,,275C1764,SPSI,Pacemaker C1764,,Per Svc,0.01
Chargemaster Item,,275C1764,SPSI,Pacemaker C1764,,Per Svc,0.01
Chargemaster Item,,275C1764,SPSI,Pacemaker C1764,,Per Svc,0.01
Chargemaster Item,,275C1766,SPSI,Pacemaker C1766,,Per Svc,0.01
Chargemaster Item,,275C1766,SPSI,Pacemaker C1766,,Per Svc,0.01
Chargemaster Item,,275C1766,SPSI,Pacemaker C1766,,Per Svc,0.01
Chargemaster Item,,275C1766,SPSI,Pacemaker C1766,,Per Svc,0.01
Chargemaster Item,,275C1767,SPSI,Pacemaker C1767,,Per Svc,0.01
Chargemaster Item,,275C1767,SPSI,Pacemaker C1767,,Per Svc,0.01
Chargemaster Item,,275C1767,SPSI,Pacemaker C1767,,Per Svc,0.01
Chargemaster Item,,275C1767,SPSI,Pacemaker C1767,,Per Svc,0.01
Chargemaster Item,,275C1768,SPSI,Pacemaker C1768,,Per Svc,0.01
Chargemaster Item,,275C1768,SPSI,Pacemaker C1768,,Per Svc,0.01
Chargemaster Item,,275C1768,SPSI,Pacemaker C1768,,Per Svc,0.01
Chargemaster Item,,275C1768,SPSI,Pacemaker C1768,,Per Svc,0.01
Chargemaster Item,,275C1769,SPSI,Pacemaker C1769,,Per Svc,0.01
Chargemaster Item,,275C1769,SPSI,Pacemaker C1769,,Per Svc,0.01
Chargemaster Item,,275C1769,SPSI,Pacemaker C1769,,Per Svc,0.01
Chargemaster Item,,275C1769,SPSI,Pacemaker C1769,,Per Svc,0.01
Chargemaster Item,,275C1771,SPSI,Pacemaker C1771,,Per Svc,0.01
Chargemaster Item,,275C1771,SPSI,Pacemaker C1771,,Per Svc,0.01
Chargemaster Item,,275C1771,SPSI,Pacemaker C1771,,Per Svc,0.01
Chargemaster Item,,275C1771,SPSI,Pacemaker C1771,,Per Svc,0.01
Chargemaster Item,,275C1772,SPSI,Pacemaker C1772,,Per Svc,0.01
Chargemaster Item,,275C1772,SPSI,Pacemaker C1772,,Per Svc,0.01
Chargemaster Item,,275C1772,SPSI,Pacemaker C1772,,Per Svc,0.01
Chargemaster Item,,275C1772,SPSI,Pacemaker C1772,,Per Svc,0.01
Chargemaster Item,,275C1773,SPSI,Pacemaker C1773,,Per Svc,0.01
Chargemaster Item,,275C1773,SPSI,Pacemaker C1773,,Per Svc,0.01
Chargemaster Item,,275C1773,SPSI,Pacemaker C1773,,Per Svc,0.01
Chargemaster Item,,275C1773,SPSI,Pacemaker C1773,,Per Svc,0.01
Chargemaster Item,,275C1776,SPSI,Pacemaker C1776,,Per Svc,0.01
Chargemaster Item,,275C1776,SPSI,Pacemaker C1776,,Per Svc,0.01
Chargemaster Item,,275C1776,SPSI,Pacemaker C1776,,Per Svc,0.01
Chargemaster Item,,275C1776,SPSI,Pacemaker C1776,,Per Svc,0.01
Chargemaster Item,,275C1777,SPSI,Pacemaker C1777,,Per Svc,0.01
Chargemaster Item,,275C1777,SPSI,Pacemaker C1777,,Per Svc,0.01
Chargemaster Item,,275C1777,SPSI,Pacemaker C1777,,Per Svc,0.01
Chargemaster Item,,275C1777,SPSI,Pacemaker C1777,,Per Svc,0.01
Chargemaster Item,,275C1778,SPSI,Pacemaker C1778,,Per Svc,0.01
Chargemaster Item,,275C1778,SPSI,Pacemaker C1778,,Per Svc,0.01
Chargemaster Item,,275C1778,SPSI,Pacemaker C1778,,Per Svc,0.01
Chargemaster Item,,275C1778,SPSI,Pacemaker C1778,,Per Svc,0.01
Chargemaster Item,,275C1781,SPSI,Pacemaker C1781,,Per Svc,0.01
Chargemaster Item,,275C1781,SPSI,Pacemaker C1781,,Per Svc,0.01
Chargemaster Item,,275C1781,SPSI,Pacemaker C1781,,Per Svc,0.01
Chargemaster Item,,275C1781,SPSI,Pacemaker C1781,,Per Svc,0.01
Chargemaster Item,,275C1783,SPSI,Pacemaker C1783,,Per Svc,0.01
Chargemaster Item,,275C1783,SPSI,Pacemaker C1783,,Per Svc,0.01
Chargemaster Item,,275C1783,SPSI,Pacemaker C1783,,Per Svc,0.01
Chargemaster Item,,275C1783,SPSI,Pacemaker C1783,,Per Svc,0.01
Chargemaster Item,,275C1785,SPSI,Pacemaker C1785,,Per Svc,0.01
Chargemaster Item,,275C1785,SPSI,Pacemaker C1785,,Per Svc,0.01
Chargemaster Item,,275C1785,SPSI,Pacemaker C1785,,Per Svc,0.01
Chargemaster Item,,275C1785,SPSI,Pacemaker C1785,,Per Svc,0.01
Chargemaster Item,,275C1786,SPSI,Pacemaker C1786,,Per Svc,0.01
Chargemaster Item,,275C1786,SPSI,Pacemaker C1786,,Per Svc,0.01
Chargemaster Item,,275C1786,SPSI,Pacemaker C1786,,Per Svc,0.01
Chargemaster Item,,275C1786,SPSI,Pacemaker C1786,,Per Svc,0.01
Chargemaster Item,,275C1787,SPSI,Pacemaker C1787,,Per Svc,0.01
Chargemaster Item,,275C1787,SPSI,Pacemaker C1787,,Per Svc,0.01
Chargemaster Item,,275C1787,SPSI,Pacemaker C1787,,Per Svc,0.01
Chargemaster Item,,275C1787,SPSI,Pacemaker C1787,,Per Svc,0.01
Chargemaster Item,,275C1788,SPSI,Pacemaker C1788,,Per Svc,0.01
Chargemaster Item,,275C1788,SPSI,Pacemaker C1788,,Per Svc,0.01
Chargemaster Item,,275C1788,SPSI,Pacemaker C1788,,Per Svc,0.01
Chargemaster Item,,275C1788,SPSI,Pacemaker C1788,,Per Svc,0.01
Chargemaster Item,,275C1789,SPSI,Pacemaker C1789,,Per Svc,0.01
Chargemaster Item,,275C1789,SPSI,Pacemaker C1789,,Per Svc,0.01
Chargemaster Item,,275C1789,SPSI,Pacemaker C1789,,Per Svc,0.01
Chargemaster Item,,275C1789,SPSI,Pacemaker C1789,,Per Svc,0.01
Chargemaster Item,,275C1817,SPSI,Pacemaker C1817,,Per Svc,0.01
Chargemaster Item,,275C1817,SPSI,Pacemaker C1817,,Per Svc,0.01
Chargemaster Item,,275C1817,SPSI,Pacemaker C1817,,Per Svc,0.01
Chargemaster Item,,275C1817,SPSI,Pacemaker C1817,,Per Svc,0.01
Chargemaster Item,,275C1821,SPSI,Pacemaker C1821,,Per Svc,0.01
Chargemaster Item,,275C1821,SPSI,Pacemaker C1821,,Per Svc,0.01
Chargemaster Item,,275C1821,SPSI,Pacemaker C1821,,Per Svc,0.01
Chargemaster Item,,275C1821,SPSI,Pacemaker C1821,,Per Svc,0.01
Chargemaster Item,,275C1874,SPSI,Pacemaker C1874,,Per Svc,0.01
Chargemaster Item,,275C1874,SPSI,Pacemaker C1874,,Per Svc,0.01
Chargemaster Item,,275C1874,SPSI,Pacemaker C1874,,Per Svc,0.01
Chargemaster Item,,275C1874,SPSI,Pacemaker C1874,,Per Svc,0.01
Chargemaster Item,,275C1875,SPSI,Pacemaker C1875,,Per Svc,0.01
Chargemaster Item,,275C1875,SPSI,Pacemaker C1875,,Per Svc,0.01
Chargemaster Item,,275C1875,SPSI,Pacemaker C1875,,Per Svc,0.01
Chargemaster Item,,275C1875,SPSI,Pacemaker C1875,,Per Svc,0.01
Chargemaster Item,,275C1876,SPSI,Pacemaker C1876,,Per Svc,0.01
Chargemaster Item,,275C1876,SPSI,Pacemaker C1876,,Per Svc,0.01
Chargemaster Item,,275C1876,SPSI,Pacemaker C1876,,Per Svc,0.01
Chargemaster Item,,275C1876,SPSI,Pacemaker C1876,,Per Svc,0.01
Chargemaster Item,,275C1880,SPSI,Pacemaker C1880,,Per Svc,0.01
Chargemaster Item,,275C1880,SPSI,Pacemaker C1880,,Per Svc,0.01
Chargemaster Item,,275C1880,SPSI,Pacemaker C1880,,Per Svc,0.01
Chargemaster Item,,275C1880,SPSI,Pacemaker C1880,,Per Svc,0.01
Chargemaster Item,,275C1881,SPSI,Pacemaker C1881,,Per Svc,0.01
Chargemaster Item,,275C1881,SPSI,Pacemaker C1881,,Per Svc,0.01
Chargemaster Item,,275C1881,SPSI,Pacemaker C1881,,Per Svc,0.01
Chargemaster Item,,275C1881,SPSI,Pacemaker C1881,,Per Svc,0.01
Chargemaster Item,,275C1882,SPSI,Pacemaker C1882,,Per Svc,0.01
Chargemaster Item,,275C1882,SPSI,Pacemaker C1882,,Per Svc,0.01
Chargemaster Item,,275C1882,SPSI,Pacemaker C1882,,Per Svc,0.01
Chargemaster Item,,275C1882,SPSI,Pacemaker C1882,,Per Svc,0.01
Chargemaster Item,,275C1883,SPSI,Pacemaker C1883,,Per Svc,0.01
Chargemaster Item,,275C1883,SPSI,Pacemaker C1883,,Per Svc,0.01
Chargemaster Item,,275C1883,SPSI,Pacemaker C1883,,Per Svc,0.01
Chargemaster Item,,275C1883,SPSI,Pacemaker C1883,,Per Svc,0.01
Chargemaster Item,,275C1884,SPSI,Pacemaker C1884,,Per Svc,0.01
Chargemaster Item,,275C1884,SPSI,Pacemaker C1884,,Per Svc,0.01
Chargemaster Item,,275C1884,SPSI,Pacemaker C1884,,Per Svc,0.01
Chargemaster Item,,275C1884,SPSI,Pacemaker C1884,,Per Svc,0.01
Chargemaster Item,,275C1887,SPSI,Pacemaker C1887,,Per Svc,0.01
Chargemaster Item,,275C1887,SPSI,Pacemaker C1887,,Per Svc,0.01
Chargemaster Item,,275C1887,SPSI,Pacemaker C1887,,Per Svc,0.01
Chargemaster Item,,275C1887,SPSI,Pacemaker C1887,,Per Svc,0.01
Chargemaster Item,,275C1889,SPSI,Pacemaker C1889,,Per Svc,0.01
Chargemaster Item,,275C1889,SPSI,Pacemaker C1889,,Per Svc,0.01
Chargemaster Item,,275C1889,SPSI,Pacemaker C1889,,Per Svc,0.01
Chargemaster Item,,275C1889,SPSI,Pacemaker C1889,,Per Svc,0.01
Chargemaster Item,,275C1892,SPSI,Pacemaker C1892,,Per Svc,0.01
Chargemaster Item,,275C1892,SPSI,Pacemaker C1892,,Per Svc,0.01
Chargemaster Item,,275C1892,SPSI,Pacemaker C1892,,Per Svc,0.01
Chargemaster Item,,275C1892,SPSI,Pacemaker C1892,,Per Svc,0.01
Chargemaster Item,,275C1893,SPSI,Pacemaker C1893,,Per Svc,0.01
Chargemaster Item,,275C1893,SPSI,Pacemaker C1893,,Per Svc,0.01
Chargemaster Item,,275C1893,SPSI,Pacemaker C1893,,Per Svc,0.01
Chargemaster Item,,275C1893,SPSI,Pacemaker C1893,,Per Svc,0.01
Chargemaster Item,,275C1894,SPSI,Pacemaker C1894,,Per Svc,0.01
Chargemaster Item,,275C1894,SPSI,Pacemaker C1894,,Per Svc,0.01
Chargemaster Item,,275C1894,SPSI,Pacemaker C1894,,Per Svc,0.01
Chargemaster Item,,275C1894,SPSI,Pacemaker C1894,,Per Svc,0.01
Chargemaster Item,,275C1897,SPSI,Pacemaker C1897,,Per Svc,0.01
Chargemaster Item,,275C1897,SPSI,Pacemaker C1897,,Per Svc,0.01
Chargemaster Item,,275C1897,SPSI,Pacemaker C1897,,Per Svc,0.01
Chargemaster Item,,275C1897,SPSI,Pacemaker C1897,,Per Svc,0.01
Chargemaster Item,,275C1898,SPSI,Pacemaker C1898,,Per Svc,0.01
Chargemaster Item,,275C1898,SPSI,Pacemaker C1898,,Per Svc,0.01
Chargemaster Item,,275C1898,SPSI,Pacemaker C1898,,Per Svc,0.01
Chargemaster Item,,275C1898,SPSI,Pacemaker C1898,,Per Svc,0.01
Chargemaster Item,,275C1900,SPSI,Pacemaker C1900,,Per Svc,0.01
Chargemaster Item,,275C1900,SPSI,Pacemaker C1900,,Per Svc,0.01
Chargemaster Item,,275C1900,SPSI,Pacemaker C1900,,Per Svc,0.01
Chargemaster Item,,275C1900,SPSI,Pacemaker C1900,,Per Svc,0.01
Chargemaster Item,,275C2617,SPSI,Pacemaker C2617,,Per Svc,0.01
Chargemaster Item,,275C2617,SPSI,Pacemaker C2617,,Per Svc,0.01
Chargemaster Item,,275C2617,SPSI,Pacemaker C2617,,Per Svc,0.01
Chargemaster Item,,275C2617,SPSI,Pacemaker C2617,,Per Svc,0.01
Chargemaster Item,,275C2618,SPSI,Pacemaker C2618,,Per Svc,0.01
Chargemaster Item,,275C2618,SPSI,Pacemaker C2618,,Per Svc,0.01
Chargemaster Item,,275C2618,SPSI,Pacemaker C2618,,Per Svc,0.01
Chargemaster Item,,275C2618,SPSI,Pacemaker C2618,,Per Svc,0.01
Chargemaster Item,,275C2623,SPSI,Pacemaker C2623,,Per Svc,0.01
Chargemaster Item,,275C2623,SPSI,Pacemaker C2623,,Per Svc,0.01
Chargemaster Item,,275C2623,SPSI,Pacemaker C2623,,Per Svc,0.01
Chargemaster Item,,275C2623,SPSI,Pacemaker C2623,,Per Svc,0.01
Chargemaster Item,,275C2625,SPSI,Pacemaker C2625,,Per Svc,0.01
Chargemaster Item,,275C2625,SPSI,Pacemaker C2625,,Per Svc,0.01
Chargemaster Item,,275C2625,SPSI,Pacemaker C2625,,Per Svc,0.01
Chargemaster Item,,275C2625,SPSI,Pacemaker C2625,,Per Svc,0.01
Chargemaster Item,,275C2627,SPSI,Pacemaker C2627,,Per Svc,0.01
Chargemaster Item,,275C2627,SPSI,Pacemaker C2627,,Per Svc,0.01
Chargemaster Item,,275C2627,SPSI,Pacemaker C2627,,Per Svc,0.01
Chargemaster Item,,275C2627,SPSI,Pacemaker C2627,,Per Svc,0.01
Chargemaster Item,,275C2628,SPSI,Pacemaker C2628,,Per Svc,0.01
Chargemaster Item,,275C2628,SPSI,Pacemaker C2628,,Per Svc,0.01
Chargemaster Item,,275C2628,SPSI,Pacemaker C2628,,Per Svc,0.01
Chargemaster Item,,275C2628,SPSI,Pacemaker C2628,,Per Svc,0.01
Chargemaster Item,,275C2630,SPSI,Pacemaker C2630,,Per Svc,0.01
Chargemaster Item,,275C2630,SPSI,Pacemaker C2630,,Per Svc,0.01
Chargemaster Item,,275C2630,SPSI,Pacemaker C2630,,Per Svc,0.01
Chargemaster Item,,275C2630,SPSI,Pacemaker C2630,,Per Svc,0.01
Chargemaster Item,,275C2639,SPSI,Pacemaker C2639,,Per Svc,0.01
Chargemaster Item,,275C2639,SPSI,Pacemaker C2639,,Per Svc,0.01
Chargemaster Item,,275C2639,SPSI,Pacemaker C2639,,Per Svc,0.01
Chargemaster Item,,275C2639,SPSI,Pacemaker C2639,,Per Svc,0.01
Chargemaster Item,,275C9250,SPSI,Pacemaker C9250,,Per Svc,0.01
Chargemaster Item,,275C9250,SPSI,Pacemaker C9250,,Per Svc,0.01
Chargemaster Item,,275C9250,SPSI,Pacemaker C9250,,Per Svc,0.01
Chargemaster Item,,275C9250,SPSI,Pacemaker C9250,,Per Svc,0.01
Chargemaster Item,,275C9352,SPSI,Pacemaker C9352,,Per Svc,0.01
Chargemaster Item,,275C9352,SPSI,Pacemaker C9352,,Per Svc,0.01
Chargemaster Item,,275C9352,SPSI,Pacemaker C9352,,Per Svc,0.01
Chargemaster Item,,275C9352,SPSI,Pacemaker C9352,,Per Svc,0.01
Chargemaster Item,,275C9353,SPSI,Pacemaker C9353,,Per Svc,0.01
Chargemaster Item,,275C9353,SPSI,Pacemaker C9353,,Per Svc,0.01
Chargemaster Item,,275C9353,SPSI,Pacemaker C9353,,Per Svc,0.01
Chargemaster Item,,275C9353,SPSI,Pacemaker C9353,,Per Svc,0.01
Chargemaster Item,,275C9363,SPSI,Pacemaker C9363,,Per Svc,0.01
Chargemaster Item,,275C9363,SPSI,Pacemaker C9363,,Per Svc,0.01
Chargemaster Item,,275C9363,SPSI,Pacemaker C9363,,Per Svc,0.01
Chargemaster Item,,275C9363,SPSI,Pacemaker C9363,,Per Svc,0.01
Chargemaster Item,,275E0191,SPSI,Pacemaker E0191,,Per Svc,0.01
Chargemaster Item,,275E0191,SPSI,Pacemaker E0191,,Per Svc,0.01
Chargemaster Item,,275E0191,SPSI,Pacemaker E0191,,Per Svc,0.01
Chargemaster Item,,275E0191,SPSI,Pacemaker E0191,,Per Svc,0.01
Chargemaster Item,,275E0235,SPSI,Pacemaker E0235,,Per Svc,0.01
Chargemaster Item,,275E0235,SPSI,Pacemaker E0235,,Per Svc,0.01
Chargemaster Item,,275E0235,SPSI,Pacemaker E0235,,Per Svc,0.01
Chargemaster Item,,275E0235,SPSI,Pacemaker E0235,,Per Svc,0.01
Chargemaster Item,,275L0113,SPSI,Pacemaker L0113,,Per Svc,0.01
Chargemaster Item,,275L0113,SPSI,Pacemaker L0113,,Per Svc,0.01
Chargemaster Item,,275L0113,SPSI,Pacemaker L0113,,Per Svc,0.01
Chargemaster Item,,275L0113,SPSI,Pacemaker L0113,,Per Svc,0.01
Chargemaster Item,,275L0120,SPSI,Pacemaker L0120,,Per Svc,0.01
Chargemaster Item,,275L0120,SPSI,Pacemaker L0120,,Per Svc,0.01
Chargemaster Item,,275L0120,SPSI,Pacemaker L0120,,Per Svc,0.01
Chargemaster Item,,275L0120,SPSI,Pacemaker L0120,,Per Svc,0.01
Chargemaster Item,,275L0172,SPSI,Pacemaker L0172,,Per Svc,0.01
Chargemaster Item,,275L0172,SPSI,Pacemaker L0172,,Per Svc,0.01
Chargemaster Item,,275L0172,SPSI,Pacemaker L0172,,Per Svc,0.01
Chargemaster Item,,275L0172,SPSI,Pacemaker L0172,,Per Svc,0.01
Chargemaster Item,,275L0174,SPSI,Pacemaker L0174,,Per Svc,0.01
Chargemaster Item,,275L0174,SPSI,Pacemaker L0174,,Per Svc,0.01
Chargemaster Item,,275L0174,SPSI,Pacemaker L0174,,Per Svc,0.01
Chargemaster Item,,275L0174,SPSI,Pacemaker L0174,,Per Svc,0.01
Chargemaster Item,,275L0625,SPSI,Pacemaker L0625,,Per Svc,0.01
Chargemaster Item,,275L0625,SPSI,Pacemaker L0625,,Per Svc,0.01
Chargemaster Item,,275L0625,SPSI,Pacemaker L0625,,Per Svc,0.01
Chargemaster Item,,275L0625,SPSI,Pacemaker L0625,,Per Svc,0.01
Chargemaster Item,,275L1820,SPSI,Pacemaker L1820,,Per Svc,0.01
Chargemaster Item,,275L1820,SPSI,Pacemaker L1820,,Per Svc,0.01
Chargemaster Item,,275L1820,SPSI,Pacemaker L1820,,Per Svc,0.01
Chargemaster Item,,275L1820,SPSI,Pacemaker L1820,,Per Svc,0.01
Chargemaster Item,,275L1830,SPSI,Pacemaker L1830,,Per Svc,0.01
Chargemaster Item,,275L1830,SPSI,Pacemaker L1830,,Per Svc,0.01
Chargemaster Item,,275L1830,SPSI,Pacemaker L1830,,Per Svc,0.01
Chargemaster Item,,275L1830,SPSI,Pacemaker L1830,,Per Svc,0.01
Chargemaster Item,,275L1832,SPSI,Pacemaker L1832,,Per Svc,0.01
Chargemaster Item,,275L1832,SPSI,Pacemaker L1832,,Per Svc,0.01
Chargemaster Item,,275L1832,SPSI,Pacemaker L1832,,Per Svc,0.01
Chargemaster Item,,275L1832,SPSI,Pacemaker L1832,,Per Svc,0.01
Chargemaster Item,,275L1902,SPSI,Pacemaker L1902,,Per Svc,0.01
Chargemaster Item,,275L1902,SPSI,Pacemaker L1902,,Per Svc,0.01
Chargemaster Item,,275L1902,SPSI,Pacemaker L1902,,Per Svc,0.01
Chargemaster Item,,275L1902,SPSI,Pacemaker L1902,,Per Svc,0.01
Chargemaster Item,,275L1930,SPSI,Pacemaker L1930,,Per Svc,0.01
Chargemaster Item,,275L1930,SPSI,Pacemaker L1930,,Per Svc,0.01
Chargemaster Item,,275L1930,SPSI,Pacemaker L1930,,Per Svc,0.01
Chargemaster Item,,275L1930,SPSI,Pacemaker L1930,,Per Svc,0.01
Chargemaster Item,,275L3260,SPSI,Pacemaker L3260,,Per Svc,0.01
Chargemaster Item,,275L3260,SPSI,Pacemaker L3260,,Per Svc,0.01
Chargemaster Item,,275L3260,SPSI,Pacemaker L3260,,Per Svc,0.01
Chargemaster Item,,275L3260,SPSI,Pacemaker L3260,,Per Svc,0.01
Chargemaster Item,,275L3650,SPSI,Pacemaker L3650,,Per Svc,0.01
Chargemaster Item,,275L3650,SPSI,Pacemaker L3650,,Per Svc,0.01
Chargemaster Item,,275L3650,SPSI,Pacemaker L3650,,Per Svc,0.01
Chargemaster Item,,275L3650,SPSI,Pacemaker L3650,,Per Svc,0.01
Chargemaster Item,,275L3670,SPSI,Pacemaker L3670,,Per Svc,0.01
Chargemaster Item,,275L3670,SPSI,Pacemaker L3670,,Per Svc,0.01
Chargemaster Item,,275L3670,SPSI,Pacemaker L3670,,Per Svc,0.01
Chargemaster Item,,275L3670,SPSI,Pacemaker L3670,,Per Svc,0.01
Chargemaster Item,,275L3807,SPSI,Pacemaker L3807,,Per Svc,0.01
Chargemaster Item,,275L3807,SPSI,Pacemaker L3807,,Per Svc,0.01
Chargemaster Item,,275L3807,SPSI,Pacemaker L3807,,Per Svc,0.01
Chargemaster Item,,275L3807,SPSI,Pacemaker L3807,,Per Svc,0.01
Chargemaster Item,,275L3809,SPSI,Pacemaker L3809,,Per Svc,0.01
Chargemaster Item,,275L3809,SPSI,Pacemaker L3809,,Per Svc,0.01
Chargemaster Item,,275L3809,SPSI,Pacemaker L3809,,Per Svc,0.01
Chargemaster Item,,275L3809,SPSI,Pacemaker L3809,,Per Svc,0.01
Chargemaster Item,,275L3908,SPSI,Pacemaker L3908,,Per Svc,0.01
Chargemaster Item,,275L3908,SPSI,Pacemaker L3908,,Per Svc,0.01
Chargemaster Item,,275L3908,SPSI,Pacemaker L3908,,Per Svc,0.01
Chargemaster Item,,275L3908,SPSI,Pacemaker L3908,,Per Svc,0.01
Chargemaster Item,,275L3917,SPSI,Pacemaker L3917,,Per Svc,0.01
Chargemaster Item,,275L3917,SPSI,Pacemaker L3917,,Per Svc,0.01
Chargemaster Item,,275L3917,SPSI,Pacemaker L3917,,Per Svc,0.01
Chargemaster Item,,275L3917,SPSI,Pacemaker L3917,,Per Svc,0.01
Chargemaster Item,,275L3923,SPSI,Pacemaker L3923,,Per Svc,0.01
Chargemaster Item,,275L3923,SPSI,Pacemaker L3923,,Per Svc,0.01
Chargemaster Item,,275L3923,SPSI,Pacemaker L3923,,Per Svc,0.01
Chargemaster Item,,275L3923,SPSI,Pacemaker L3923,,Per Svc,0.01
Chargemaster Item,,275L4386,SPSI,Pacemaker L4386,,Per Svc,0.01
Chargemaster Item,,275L4386,SPSI,Pacemaker L4386,,Per Svc,0.01
Chargemaster Item,,275L4386,SPSI,Pacemaker L4386,,Per Svc,0.01
Chargemaster Item,,275L4386,SPSI,Pacemaker L4386,,Per Svc,0.01
Chargemaster Item,,275L4387,SPSI,Pacemaker L4387,,Per Svc,0.01
Chargemaster Item,,275L4387,SPSI,Pacemaker L4387,,Per Svc,0.01
Chargemaster Item,,275L4387,SPSI,Pacemaker L4387,,Per Svc,0.01
Chargemaster Item,,275L4387,SPSI,Pacemaker L4387,,Per Svc,0.01
Chargemaster Item,,275L5000,SPSI,Pacemaker L5000,,Per Svc,0.01
Chargemaster Item,,275L5000,SPSI,Pacemaker L5000,,Per Svc,0.01
Chargemaster Item,,275L5000,SPSI,Pacemaker L5000,,Per Svc,0.01
Chargemaster Item,,275L5000,SPSI,Pacemaker L5000,,Per Svc,0.01
Chargemaster Item,,275L8000,SPSI,Pacemaker L8000,,Per Svc,0.01
Chargemaster Item,,275L8000,SPSI,Pacemaker L8000,,Per Svc,0.01
Chargemaster Item,,275L8000,SPSI,Pacemaker L8000,,Per Svc,0.01
Chargemaster Item,,275L8000,SPSI,Pacemaker L8000,,Per Svc,0.01
Chargemaster Item,,275L8501,SPSI,Pacemaker L8501,,Per Svc,0.01
Chargemaster Item,,275L8501,SPSI,Pacemaker L8501,,Per Svc,0.01
Chargemaster Item,,275L8501,SPSI,Pacemaker L8501,,Per Svc,0.01
Chargemaster Item,,275L8501,SPSI,Pacemaker L8501,,Per Svc,0.01
Chargemaster Item,,275L8600,SPSI,Pacemaker L8600,,Per Svc,0.01
Chargemaster Item,,275L8600,SPSI,Pacemaker L8600,,Per Svc,0.01
Chargemaster Item,,275L8600,SPSI,Pacemaker L8600,,Per Svc,0.01
Chargemaster Item,,275L8600,SPSI,Pacemaker L8600,,Per Svc,0.01
Chargemaster Item,,275L8612,SPSI,Pacemaker L8612,,Per Svc,0.01
Chargemaster Item,,275L8612,SPSI,Pacemaker L8612,,Per Svc,0.01
Chargemaster Item,,275L8612,SPSI,Pacemaker L8612,,Per Svc,0.01
Chargemaster Item,,275L8612,SPSI,Pacemaker L8612,,Per Svc,0.01
Chargemaster Item,,275L8699,SPSI,Pacemaker L8699,,Per Svc,0.01
Chargemaster Item,,275L8699,SPSI,Pacemaker L8699,,Per Svc,0.01
Chargemaster Item,,275L8699,SPSI,Pacemaker L8699,,Per Svc,0.01
Chargemaster Item,,275L8699,SPSI,Pacemaker L8699,,Per Svc,0.01
Chargemaster Item,,275Q4100,SPSI,Pacemaker Q4100,,Per Svc,0.01
Chargemaster Item,,275Q4100,SPSI,Pacemaker Q4100,,Per Svc,0.01
Chargemaster Item,,275Q4100,SPSI,Pacemaker Q4100,,Per Svc,0.01
Chargemaster Item,,275Q4100,SPSI,Pacemaker Q4100,,Per Svc,0.01
Chargemaster Item,,275Q4102,SPSI,Pacemaker Q4102,,Per Svc,0.01
Chargemaster Item,,275Q4102,SPSI,Pacemaker Q4102,,Per Svc,0.01
Chargemaster Item,,275Q4102,SPSI,Pacemaker Q4102,,Per Svc,0.01
Chargemaster Item,,275Q4102,SPSI,Pacemaker Q4102,,Per Svc,0.01
Chargemaster Item,,275Q4110,SPSI,Pacemaker Q4110,,Per Svc,0.01
Chargemaster Item,,275Q4110,SPSI,Pacemaker Q4110,,Per Svc,0.01
Chargemaster Item,,275Q4110,SPSI,Pacemaker Q4110,,Per Svc,0.01
Chargemaster Item,,275Q4110,SPSI,Pacemaker Q4110,,Per Svc,0.01
Chargemaster Item,,275Q4114,SPSI,Pacemaker Q4114,,Per Svc,0.01
Chargemaster Item,,275Q4114,SPSI,Pacemaker Q4114,,Per Svc,0.01
Chargemaster Item,,275Q4114,SPSI,Pacemaker Q4114,,Per Svc,0.01
Chargemaster Item,,275Q4114,SPSI,Pacemaker Q4114,,Per Svc,0.01
Chargemaster Item,,275Q4116,SPSI,Pacemaker Q4116,,Per Svc,0.01
Chargemaster Item,,275Q4116,SPSI,Pacemaker Q4116,,Per Svc,0.01
Chargemaster Item,,275Q4116,SPSI,Pacemaker Q4116,,Per Svc,0.01
Chargemaster Item,,275Q4116,SPSI,Pacemaker Q4116,,Per Svc,0.01
Chargemaster Item,,275Q4118,SPSI,Pacemaker Q4118,,Per Svc,0.01
Chargemaster Item,,275Q4118,SPSI,Pacemaker Q4118,,Per Svc,0.01
Chargemaster Item,,275Q4118,SPSI,Pacemaker Q4118,,Per Svc,0.01
Chargemaster Item,,275Q4118,SPSI,Pacemaker Q4118,,Per Svc,0.01
Chargemaster Item,,275Q4125,SPSI,Pacemaker Q4125,,Per Svc,0.01
Chargemaster Item,,275Q4125,SPSI,Pacemaker Q4125,,Per Svc,0.01
Chargemaster Item,,275Q4125,SPSI,Pacemaker Q4125,,Per Svc,0.01
Chargemaster Item,,275Q4125,SPSI,Pacemaker Q4125,,Per Svc,0.01
Chargemaster Item,,275Q4128,SPSI,Pacemaker Q4128,,Per Svc,0.01
Chargemaster Item,,275Q4128,SPSI,Pacemaker Q4128,,Per Svc,0.01
Chargemaster Item,,275Q4128,SPSI,Pacemaker Q4128,,Per Svc,0.01
Chargemaster Item,,275Q4128,SPSI,Pacemaker Q4128,,Per Svc,0.01
Chargemaster Item,,275Q4130,SPSI,Pacemaker Q4130,,Per Svc,0.01
Chargemaster Item,,275Q4130,SPSI,Pacemaker Q4130,,Per Svc,0.01
Chargemaster Item,,275Q4130,SPSI,Pacemaker Q4130,,Per Svc,0.01
Chargemaster Item,,275Q4130,SPSI,Pacemaker Q4130,,Per Svc,0.01
Chargemaster Item,,275Q4133,SPSI,Pacemaker Q4133,,Per Svc,0.01
Chargemaster Item,,275Q4133,SPSI,Pacemaker Q4133,,Per Svc,0.01
Chargemaster Item,,275Q4133,SPSI,Pacemaker Q4133,,Per Svc,0.01
Chargemaster Item,,275Q4133,SPSI,Pacemaker Q4133,,Per Svc,0.01
Chargemaster Item,,275Q4155,SPSI,Pacemaker Q4155,,Per Svc,0.01
Chargemaster Item,,275Q4155,SPSI,Pacemaker Q4155,,Per Svc,0.01
Chargemaster Item,,275Q4155,SPSI,Pacemaker Q4155,,Per Svc,0.01
Chargemaster Item,,275Q4155,SPSI,Pacemaker Q4155,,Per Svc,0.01
Chargemaster Item,,275Q4166,SPSI,Pacemaker Q4166,,Per Svc,0.01
Chargemaster Item,,275Q4166,SPSI,Pacemaker Q4166,,Per Svc,0.01
Chargemaster Item,,275Q4166,SPSI,Pacemaker Q4166,,Per Svc,0.01
Chargemaster Item,,275Q4166,SPSI,Pacemaker Q4166,,Per Svc,0.01
Chargemaster Item,,275Q9963,SPSI,Pacemaker Q9963,,Per Svc,0.01
Chargemaster Item,,275Q9963,SPSI,Pacemaker Q9963,,Per Svc,0.01
Chargemaster Item,,275Q9963,SPSI,Pacemaker Q9963,,Per Svc,0.01
Chargemaster Item,,275Q9963,SPSI,Pacemaker Q9963,,Per Svc,0.01
Chargemaster Item,,275Q9967,SPSI,Pacemaker Q9967,,Per Svc,0.01
Chargemaster Item,,275Q9967,SPSI,Pacemaker Q9967,,Per Svc,0.01
Chargemaster Item,,275Q9967,SPSI,Pacemaker Q9967,,Per Svc,0.01
Chargemaster Item,,275Q9967,SPSI,Pacemaker Q9967,,Per Svc,0.01
Chargemaster Item,,275V2630,SPSI,Pacemaker V2630,,Per Svc,0.01
Chargemaster Item,,275V2630,SPSI,Pacemaker V2630,,Per Svc,0.01
Chargemaster Item,,275V2630,SPSI,Pacemaker V2630,,Per Svc,0.01
Chargemaster Item,,275V2630,SPSI,Pacemaker V2630,,Per Svc,0.01
Chargemaster Item,,275V2632,SPSI,Pacemaker V2632,,Per Svc,0.01
Chargemaster Item,,275V2632,SPSI,Pacemaker V2632,,Per Svc,0.01
Chargemaster Item,,275V2632,SPSI,Pacemaker V2632,,Per Svc,0.01
Chargemaster Item,,275V2632,SPSI,Pacemaker V2632,,Per Svc,0.01
Chargemaster Item,,275V2790,SPSI,Pacemaker V2790,,Per Svc,0.01
Chargemaster Item,,275V2790,SPSI,Pacemaker V2790,,Per Svc,0.01
Chargemaster Item,,275V2790,SPSI,Pacemaker V2790,,Per Svc,0.01
Chargemaster Item,,275V2790,SPSI,Pacemaker V2790,,Per Svc,0.01
Chargemaster Item,,275XXXXX,SPSI,Pacemaker,,Per Svc,0.01
Chargemaster Item,,275XXXXX,SPSI,Pacemaker,,Per Svc,0.01
Chargemaster Item,,275XXXXX,SPSI,Pacemaker,,Per Svc,0.01
Chargemaster Item,,275XXXXX,SPSI,Pacemaker,,Per Svc,0.01
Chargemaster Item,,276A4265,SPSI,Intracular Lens A4265,,Per Svc,0.01
Chargemaster Item,,276A4265,SPSI,Intracular Lens A4265,,Per Svc,0.01
Chargemaster Item,,276A4265,SPSI,Intracular Lens A4265,,Per Svc,0.01
Chargemaster Item,,276A4265,SPSI,Intracular Lens A4265,,Per Svc,0.01
Chargemaster Item,,276A4340,SPSI,Intracular Lens A4340,,Per Svc,0.01
Chargemaster Item,,276A4340,SPSI,Intracular Lens A4340,,Per Svc,0.01
Chargemaster Item,,276A4340,SPSI,Intracular Lens A4340,,Per Svc,0.01
Chargemaster Item,,276A4340,SPSI,Intracular Lens A4340,,Per Svc,0.01
Chargemaster Item,,276A4349,SPSI,Intracular Lens A4349,,Per Svc,0.01
Chargemaster Item,,276A4349,SPSI,Intracular Lens A4349,,Per Svc,0.01
Chargemaster Item,,276A4349,SPSI,Intracular Lens A4349,,Per Svc,0.01
Chargemaster Item,,276A4349,SPSI,Intracular Lens A4349,,Per Svc,0.01
Chargemaster Item,,276A4565,SPSI,Intracular Lens A4565,,Per Svc,0.01
Chargemaster Item,,276A4565,SPSI,Intracular Lens A4565,,Per Svc,0.01
Chargemaster Item,,276A4565,SPSI,Intracular Lens A4565,,Per Svc,0.01
Chargemaster Item,,276A4565,SPSI,Intracular Lens A4565,,Per Svc,0.01
Chargemaster Item,,276A4648,SPSI,Intracular Lens A4648,,Per Svc,0.01
Chargemaster Item,,276A4648,SPSI,Intracular Lens A4648,,Per Svc,0.01
Chargemaster Item,,276A4648,SPSI,Intracular Lens A4648,,Per Svc,0.01
Chargemaster Item,,276A4648,SPSI,Intracular Lens A4648,,Per Svc,0.01
Chargemaster Item,,276A6021,SPSI,Intracular Lens A6021,,Per Svc,0.01
Chargemaster Item,,276A6021,SPSI,Intracular Lens A6021,,Per Svc,0.01
Chargemaster Item,,276A6021,SPSI,Intracular Lens A6021,,Per Svc,0.01
Chargemaster Item,,276A6021,SPSI,Intracular Lens A6021,,Per Svc,0.01
Chargemaster Item,,276A6025,SPSI,Intracular Lens A6025,,Per Svc,0.01
Chargemaster Item,,276A6025,SPSI,Intracular Lens A6025,,Per Svc,0.01
Chargemaster Item,,276A6025,SPSI,Intracular Lens A6025,,Per Svc,0.01
Chargemaster Item,,276A6025,SPSI,Intracular Lens A6025,,Per Svc,0.01
Chargemaster Item,,276A6196,SPSI,Intracular Lens A6196,,Per Svc,0.01
Chargemaster Item,,276A6196,SPSI,Intracular Lens A6196,,Per Svc,0.01
Chargemaster Item,,276A6196,SPSI,Intracular Lens A6196,,Per Svc,0.01
Chargemaster Item,,276A6196,SPSI,Intracular Lens A6196,,Per Svc,0.01
Chargemaster Item,,276A6197,SPSI,Intracular Lens A6197,,Per Svc,0.01
Chargemaster Item,,276A6197,SPSI,Intracular Lens A6197,,Per Svc,0.01
Chargemaster Item,,276A6197,SPSI,Intracular Lens A6197,,Per Svc,0.01
Chargemaster Item,,276A6197,SPSI,Intracular Lens A6197,,Per Svc,0.01
Chargemaster Item,,276A6206,SPSI,Intracular Lens A6206,,Per Svc,0.01
Chargemaster Item,,276A6206,SPSI,Intracular Lens A6206,,Per Svc,0.01
Chargemaster Item,,276A6206,SPSI,Intracular Lens A6206,,Per Svc,0.01
Chargemaster Item,,276A6206,SPSI,Intracular Lens A6206,,Per Svc,0.01
Chargemaster Item,,276A6209,SPSI,Intracular Lens A6209,,Per Svc,0.01
Chargemaster Item,,276A6209,SPSI,Intracular Lens A6209,,Per Svc,0.01
Chargemaster Item,,276A6209,SPSI,Intracular Lens A6209,,Per Svc,0.01
Chargemaster Item,,276A6209,SPSI,Intracular Lens A6209,,Per Svc,0.01
Chargemaster Item,,276A6212,SPSI,Intracular Lens A6212,,Per Svc,0.01
Chargemaster Item,,276A6212,SPSI,Intracular Lens A6212,,Per Svc,0.01
Chargemaster Item,,276A6212,SPSI,Intracular Lens A6212,,Per Svc,0.01
Chargemaster Item,,276A6212,SPSI,Intracular Lens A6212,,Per Svc,0.01
Chargemaster Item,,276A6213,SPSI,Intracular Lens A6213,,Per Svc,0.01
Chargemaster Item,,276A6213,SPSI,Intracular Lens A6213,,Per Svc,0.01
Chargemaster Item,,276A6213,SPSI,Intracular Lens A6213,,Per Svc,0.01
Chargemaster Item,,276A6213,SPSI,Intracular Lens A6213,,Per Svc,0.01
Chargemaster Item,,276A6214,SPSI,Intracular Lens A6214,,Per Svc,0.01
Chargemaster Item,,276A6214,SPSI,Intracular Lens A6214,,Per Svc,0.01
Chargemaster Item,,276A6214,SPSI,Intracular Lens A6214,,Per Svc,0.01
Chargemaster Item,,276A6214,SPSI,Intracular Lens A6214,,Per Svc,0.01
Chargemaster Item,,276A6219,SPSI,Intracular Lens A6219,,Per Svc,0.01
Chargemaster Item,,276A6219,SPSI,Intracular Lens A6219,,Per Svc,0.01
Chargemaster Item,,276A6219,SPSI,Intracular Lens A6219,,Per Svc,0.01
Chargemaster Item,,276A6219,SPSI,Intracular Lens A6219,,Per Svc,0.01
Chargemaster Item,,276A6222,SPSI,Intracular Lens A6222,,Per Svc,0.01
Chargemaster Item,,276A6222,SPSI,Intracular Lens A6222,,Per Svc,0.01
Chargemaster Item,,276A6222,SPSI,Intracular Lens A6222,,Per Svc,0.01
Chargemaster Item,,276A6222,SPSI,Intracular Lens A6222,,Per Svc,0.01
Chargemaster Item,,276A6223,SPSI,Intracular Lens A6223,,Per Svc,0.01
Chargemaster Item,,276A6223,SPSI,Intracular Lens A6223,,Per Svc,0.01
Chargemaster Item,,276A6223,SPSI,Intracular Lens A6223,,Per Svc,0.01
Chargemaster Item,,276A6223,SPSI,Intracular Lens A6223,,Per Svc,0.01
Chargemaster Item,,276A6224,SPSI,Intracular Lens A6224,,Per Svc,0.01
Chargemaster Item,,276A6224,SPSI,Intracular Lens A6224,,Per Svc,0.01
Chargemaster Item,,276A6224,SPSI,Intracular Lens A6224,,Per Svc,0.01
Chargemaster Item,,276A6224,SPSI,Intracular Lens A6224,,Per Svc,0.01
Chargemaster Item,,276A6234,SPSI,Intracular Lens A6234,,Per Svc,0.01
Chargemaster Item,,276A6234,SPSI,Intracular Lens A6234,,Per Svc,0.01
Chargemaster Item,,276A6234,SPSI,Intracular Lens A6234,,Per Svc,0.01
Chargemaster Item,,276A6234,SPSI,Intracular Lens A6234,,Per Svc,0.01
Chargemaster Item,,276A6235,SPSI,Intracular Lens A6235,,Per Svc,0.01
Chargemaster Item,,276A6235,SPSI,Intracular Lens A6235,,Per Svc,0.01
Chargemaster Item,,276A6235,SPSI,Intracular Lens A6235,,Per Svc,0.01
Chargemaster Item,,276A6235,SPSI,Intracular Lens A6235,,Per Svc,0.01
Chargemaster Item,,276A6238,SPSI,Intracular Lens A6238,,Per Svc,0.01
Chargemaster Item,,276A6238,SPSI,Intracular Lens A6238,,Per Svc,0.01
Chargemaster Item,,276A6238,SPSI,Intracular Lens A6238,,Per Svc,0.01
Chargemaster Item,,276A6238,SPSI,Intracular Lens A6238,,Per Svc,0.01
Chargemaster Item,,276A6255,SPSI,Intracular Lens A6255,,Per Svc,0.01
Chargemaster Item,,276A6255,SPSI,Intracular Lens A6255,,Per Svc,0.01
Chargemaster Item,,276A6255,SPSI,Intracular Lens A6255,,Per Svc,0.01
Chargemaster Item,,276A6255,SPSI,Intracular Lens A6255,,Per Svc,0.01
Chargemaster Item,,276A6257,SPSI,Intracular Lens A6257,,Per Svc,0.01
Chargemaster Item,,276A6257,SPSI,Intracular Lens A6257,,Per Svc,0.01
Chargemaster Item,,276A6257,SPSI,Intracular Lens A6257,,Per Svc,0.01
Chargemaster Item,,276A6257,SPSI,Intracular Lens A6257,,Per Svc,0.01
Chargemaster Item,,276A6258,SPSI,Intracular Lens A6258,,Per Svc,0.01
Chargemaster Item,,276A6258,SPSI,Intracular Lens A6258,,Per Svc,0.01
Chargemaster Item,,276A6258,SPSI,Intracular Lens A6258,,Per Svc,0.01
Chargemaster Item,,276A6258,SPSI,Intracular Lens A6258,,Per Svc,0.01
Chargemaster Item,,276A6259,SPSI,Intracular Lens A6259,,Per Svc,0.01
Chargemaster Item,,276A6259,SPSI,Intracular Lens A6259,,Per Svc,0.01
Chargemaster Item,,276A6259,SPSI,Intracular Lens A6259,,Per Svc,0.01
Chargemaster Item,,276A6259,SPSI,Intracular Lens A6259,,Per Svc,0.01
Chargemaster Item,,276A6454,SPSI,Intracular Lens A6454,,Per Svc,0.01
Chargemaster Item,,276A6454,SPSI,Intracular Lens A6454,,Per Svc,0.01
Chargemaster Item,,276A6454,SPSI,Intracular Lens A6454,,Per Svc,0.01
Chargemaster Item,,276A6454,SPSI,Intracular Lens A6454,,Per Svc,0.01
Chargemaster Item,,276B4082,SPSI,Intracular Lens B4082,,Per Svc,0.01
Chargemaster Item,,276B4082,SPSI,Intracular Lens B4082,,Per Svc,0.01
Chargemaster Item,,276B4082,SPSI,Intracular Lens B4082,,Per Svc,0.01
Chargemaster Item,,276B4082,SPSI,Intracular Lens B4082,,Per Svc,0.01
Chargemaster Item,,276B4087,SPSI,Intracular Lens B4087,,Per Svc,0.01
Chargemaster Item,,276B4087,SPSI,Intracular Lens B4087,,Per Svc,0.01
Chargemaster Item,,276B4087,SPSI,Intracular Lens B4087,,Per Svc,0.01
Chargemaster Item,,276B4087,SPSI,Intracular Lens B4087,,Per Svc,0.01
Chargemaster Item,,276B4088,SPSI,Intracular Lens B4088,,Per Svc,0.01
Chargemaster Item,,276B4088,SPSI,Intracular Lens B4088,,Per Svc,0.01
Chargemaster Item,,276B4088,SPSI,Intracular Lens B4088,,Per Svc,0.01
Chargemaster Item,,276B4088,SPSI,Intracular Lens B4088,,Per Svc,0.01
Chargemaster Item,,276C1713,SPSI,Intracular Lens C1713,,Per Svc,0.01
Chargemaster Item,,276C1713,SPSI,Intracular Lens C1713,,Per Svc,0.01
Chargemaster Item,,276C1713,SPSI,Intracular Lens C1713,,Per Svc,0.01
Chargemaster Item,,276C1713,SPSI,Intracular Lens C1713,,Per Svc,0.01
Chargemaster Item,,276C1715,SPSI,Intracular Lens C1715,,Per Svc,0.01
Chargemaster Item,,276C1715,SPSI,Intracular Lens C1715,,Per Svc,0.01
Chargemaster Item,,276C1715,SPSI,Intracular Lens C1715,,Per Svc,0.01
Chargemaster Item,,276C1715,SPSI,Intracular Lens C1715,,Per Svc,0.01
Chargemaster Item,,276C1716,SPSI,Intracular Lens C1716,,Per Svc,0.01
Chargemaster Item,,276C1716,SPSI,Intracular Lens C1716,,Per Svc,0.01
Chargemaster Item,,276C1716,SPSI,Intracular Lens C1716,,Per Svc,0.01
Chargemaster Item,,276C1716,SPSI,Intracular Lens C1716,,Per Svc,0.01
Chargemaster Item,,276C1721,SPSI,Intracular Lens C1721,,Per Svc,0.01
Chargemaster Item,,276C1721,SPSI,Intracular Lens C1721,,Per Svc,0.01
Chargemaster Item,,276C1721,SPSI,Intracular Lens C1721,,Per Svc,0.01
Chargemaster Item,,276C1721,SPSI,Intracular Lens C1721,,Per Svc,0.01
Chargemaster Item,,276C1722,SPSI,Intracular Lens C1722,,Per Svc,0.01
Chargemaster Item,,276C1722,SPSI,Intracular Lens C1722,,Per Svc,0.01
Chargemaster Item,,276C1722,SPSI,Intracular Lens C1722,,Per Svc,0.01
Chargemaster Item,,276C1722,SPSI,Intracular Lens C1722,,Per Svc,0.01
Chargemaster Item,,276C1724,SPSI,Intracular Lens C1724,,Per Svc,0.01
Chargemaster Item,,276C1724,SPSI,Intracular Lens C1724,,Per Svc,0.01
Chargemaster Item,,276C1724,SPSI,Intracular Lens C1724,,Per Svc,0.01
Chargemaster Item,,276C1724,SPSI,Intracular Lens C1724,,Per Svc,0.01
Chargemaster Item,,276C1725,SPSI,Intracular Lens C1725,,Per Svc,0.01
Chargemaster Item,,276C1725,SPSI,Intracular Lens C1725,,Per Svc,0.01
Chargemaster Item,,276C1725,SPSI,Intracular Lens C1725,,Per Svc,0.01
Chargemaster Item,,276C1725,SPSI,Intracular Lens C1725,,Per Svc,0.01
Chargemaster Item,,276C1726,SPSI,Intracular Lens C1726,,Per Svc,0.01
Chargemaster Item,,276C1726,SPSI,Intracular Lens C1726,,Per Svc,0.01
Chargemaster Item,,276C1726,SPSI,Intracular Lens C1726,,Per Svc,0.01
Chargemaster Item,,276C1726,SPSI,Intracular Lens C1726,,Per Svc,0.01
Chargemaster Item,,276C1727,SPSI,Intracular Lens C1727,,Per Svc,0.01
Chargemaster Item,,276C1727,SPSI,Intracular Lens C1727,,Per Svc,0.01
Chargemaster Item,,276C1727,SPSI,Intracular Lens C1727,,Per Svc,0.01
Chargemaster Item,,276C1727,SPSI,Intracular Lens C1727,,Per Svc,0.01
Chargemaster Item,,276C1729,SPSI,Intracular Lens C1729,,Per Svc,0.01
Chargemaster Item,,276C1729,SPSI,Intracular Lens C1729,,Per Svc,0.01
Chargemaster Item,,276C1729,SPSI,Intracular Lens C1729,,Per Svc,0.01
Chargemaster Item,,276C1729,SPSI,Intracular Lens C1729,,Per Svc,0.01
Chargemaster Item,,276C1730,SPSI,Intracular Lens C1730,,Per Svc,0.01
Chargemaster Item,,276C1730,SPSI,Intracular Lens C1730,,Per Svc,0.01
Chargemaster Item,,276C1730,SPSI,Intracular Lens C1730,,Per Svc,0.01
Chargemaster Item,,276C1730,SPSI,Intracular Lens C1730,,Per Svc,0.01
Chargemaster Item,,276C1731,SPSI,Intracular Lens C1731,,Per Svc,0.01
Chargemaster Item,,276C1731,SPSI,Intracular Lens C1731,,Per Svc,0.01
Chargemaster Item,,276C1731,SPSI,Intracular Lens C1731,,Per Svc,0.01
Chargemaster Item,,276C1731,SPSI,Intracular Lens C1731,,Per Svc,0.01
Chargemaster Item,,276C1733,SPSI,Intracular Lens C1733,,Per Svc,0.01
Chargemaster Item,,276C1733,SPSI,Intracular Lens C1733,,Per Svc,0.01
Chargemaster Item,,276C1733,SPSI,Intracular Lens C1733,,Per Svc,0.01
Chargemaster Item,,276C1733,SPSI,Intracular Lens C1733,,Per Svc,0.01
Chargemaster Item,,276C1750,SPSI,Intracular Lens C1750,,Per Svc,0.01
Chargemaster Item,,276C1750,SPSI,Intracular Lens C1750,,Per Svc,0.01
Chargemaster Item,,276C1750,SPSI,Intracular Lens C1750,,Per Svc,0.01
Chargemaster Item,,276C1750,SPSI,Intracular Lens C1750,,Per Svc,0.01
Chargemaster Item,,276C1751,SPSI,Intracular Lens C1751,,Per Svc,0.01
Chargemaster Item,,276C1751,SPSI,Intracular Lens C1751,,Per Svc,0.01
Chargemaster Item,,276C1751,SPSI,Intracular Lens C1751,,Per Svc,0.01
Chargemaster Item,,276C1751,SPSI,Intracular Lens C1751,,Per Svc,0.01
Chargemaster Item,,276C1752,SPSI,Intracular Lens C1752,,Per Svc,0.01
Chargemaster Item,,276C1752,SPSI,Intracular Lens C1752,,Per Svc,0.01
Chargemaster Item,,276C1752,SPSI,Intracular Lens C1752,,Per Svc,0.01
Chargemaster Item,,276C1752,SPSI,Intracular Lens C1752,,Per Svc,0.01
Chargemaster Item,,276C1753,SPSI,Intracular Lens C1753,,Per Svc,0.01
Chargemaster Item,,276C1753,SPSI,Intracular Lens C1753,,Per Svc,0.01
Chargemaster Item,,276C1753,SPSI,Intracular Lens C1753,,Per Svc,0.01
Chargemaster Item,,276C1753,SPSI,Intracular Lens C1753,,Per Svc,0.01
Chargemaster Item,,276C1755,SPSI,Intracular Lens C1755,,Per Svc,0.01
Chargemaster Item,,276C1755,SPSI,Intracular Lens C1755,,Per Svc,0.01
Chargemaster Item,,276C1755,SPSI,Intracular Lens C1755,,Per Svc,0.01
Chargemaster Item,,276C1755,SPSI,Intracular Lens C1755,,Per Svc,0.01
Chargemaster Item,,276C1757,SPSI,Intracular Lens C1757,,Per Svc,0.01
Chargemaster Item,,276C1757,SPSI,Intracular Lens C1757,,Per Svc,0.01
Chargemaster Item,,276C1757,SPSI,Intracular Lens C1757,,Per Svc,0.01
Chargemaster Item,,276C1757,SPSI,Intracular Lens C1757,,Per Svc,0.01
Chargemaster Item,,276C1758,SPSI,Intracular Lens C1758,,Per Svc,0.01
Chargemaster Item,,276C1758,SPSI,Intracular Lens C1758,,Per Svc,0.01
Chargemaster Item,,276C1758,SPSI,Intracular Lens C1758,,Per Svc,0.01
Chargemaster Item,,276C1758,SPSI,Intracular Lens C1758,,Per Svc,0.01
Chargemaster Item,,276C1760,SPSI,Intracular Lens C1760,,Per Svc,0.01
Chargemaster Item,,276C1760,SPSI,Intracular Lens C1760,,Per Svc,0.01
Chargemaster Item,,276C1760,SPSI,Intracular Lens C1760,,Per Svc,0.01
Chargemaster Item,,276C1760,SPSI,Intracular Lens C1760,,Per Svc,0.01
Chargemaster Item,,276C1762,SPSI,Intracular Lens C1762,,Per Svc,0.01
Chargemaster Item,,276C1762,SPSI,Intracular Lens C1762,,Per Svc,0.01
Chargemaster Item,,276C1762,SPSI,Intracular Lens C1762,,Per Svc,0.01
Chargemaster Item,,276C1762,SPSI,Intracular Lens C1762,,Per Svc,0.01
Chargemaster Item,,276C1763,SPSI,Intracular Lens C1763,,Per Svc,0.01
Chargemaster Item,,276C1763,SPSI,Intracular Lens C1763,,Per Svc,0.01
Chargemaster Item,,276C1763,SPSI,Intracular Lens C1763,,Per Svc,0.01
Chargemaster Item,,276C1763,SPSI,Intracular Lens C1763,,Per Svc,0.01
Chargemaster Item,,276C1764,SPSI,Intracular Lens C1764,,Per Svc,0.01
Chargemaster Item,,276C1764,SPSI,Intracular Lens C1764,,Per Svc,0.01
Chargemaster Item,,276C1764,SPSI,Intracular Lens C1764,,Per Svc,0.01
Chargemaster Item,,276C1764,SPSI,Intracular Lens C1764,,Per Svc,0.01
Chargemaster Item,,276C1766,SPSI,Intracular Lens C1766,,Per Svc,0.01
Chargemaster Item,,276C1766,SPSI,Intracular Lens C1766,,Per Svc,0.01
Chargemaster Item,,276C1766,SPSI,Intracular Lens C1766,,Per Svc,0.01
Chargemaster Item,,276C1766,SPSI,Intracular Lens C1766,,Per Svc,0.01
Chargemaster Item,,276C1767,SPSI,Intracular Lens C1767,,Per Svc,0.01
Chargemaster Item,,276C1767,SPSI,Intracular Lens C1767,,Per Svc,0.01
Chargemaster Item,,276C1767,SPSI,Intracular Lens C1767,,Per Svc,0.01
Chargemaster Item,,276C1767,SPSI,Intracular Lens C1767,,Per Svc,0.01
Chargemaster Item,,276C1768,SPSI,Intracular Lens C1768,,Per Svc,0.01
Chargemaster Item,,276C1768,SPSI,Intracular Lens C1768,,Per Svc,0.01
Chargemaster Item,,276C1768,SPSI,Intracular Lens C1768,,Per Svc,0.01
Chargemaster Item,,276C1768,SPSI,Intracular Lens C1768,,Per Svc,0.01
Chargemaster Item,,276C1769,SPSI,Intracular Lens C1769,,Per Svc,0.01
Chargemaster Item,,276C1769,SPSI,Intracular Lens C1769,,Per Svc,0.01
Chargemaster Item,,276C1769,SPSI,Intracular Lens C1769,,Per Svc,0.01
Chargemaster Item,,276C1769,SPSI,Intracular Lens C1769,,Per Svc,0.01
Chargemaster Item,,276C1771,SPSI,Intracular Lens C1771,,Per Svc,0.01
Chargemaster Item,,276C1771,SPSI,Intracular Lens C1771,,Per Svc,0.01
Chargemaster Item,,276C1771,SPSI,Intracular Lens C1771,,Per Svc,0.01
Chargemaster Item,,276C1771,SPSI,Intracular Lens C1771,,Per Svc,0.01
Chargemaster Item,,276C1772,SPSI,Intracular Lens C1772,,Per Svc,0.01
Chargemaster Item,,276C1772,SPSI,Intracular Lens C1772,,Per Svc,0.01
Chargemaster Item,,276C1772,SPSI,Intracular Lens C1772,,Per Svc,0.01
Chargemaster Item,,276C1772,SPSI,Intracular Lens C1772,,Per Svc,0.01
Chargemaster Item,,276C1773,SPSI,Intracular Lens C1773,,Per Svc,0.01
Chargemaster Item,,276C1773,SPSI,Intracular Lens C1773,,Per Svc,0.01
Chargemaster Item,,276C1773,SPSI,Intracular Lens C1773,,Per Svc,0.01
Chargemaster Item,,276C1773,SPSI,Intracular Lens C1773,,Per Svc,0.01
Chargemaster Item,,276C1776,SPSI,Intracular Lens C1776,,Per Svc,0.01
Chargemaster Item,,276C1776,SPSI,Intracular Lens C1776,,Per Svc,0.01
Chargemaster Item,,276C1776,SPSI,Intracular Lens C1776,,Per Svc,0.01
Chargemaster Item,,276C1776,SPSI,Intracular Lens C1776,,Per Svc,0.01
Chargemaster Item,,276C1777,SPSI,Intracular Lens C1777,,Per Svc,0.01
Chargemaster Item,,276C1777,SPSI,Intracular Lens C1777,,Per Svc,0.01
Chargemaster Item,,276C1777,SPSI,Intracular Lens C1777,,Per Svc,0.01
Chargemaster Item,,276C1777,SPSI,Intracular Lens C1777,,Per Svc,0.01
Chargemaster Item,,276C1778,SPSI,Intracular Lens C1778,,Per Svc,0.01
Chargemaster Item,,276C1778,SPSI,Intracular Lens C1778,,Per Svc,0.01
Chargemaster Item,,276C1778,SPSI,Intracular Lens C1778,,Per Svc,0.01
Chargemaster Item,,276C1778,SPSI,Intracular Lens C1778,,Per Svc,0.01
Chargemaster Item,,276C1780,SPSI,Intracular Lens C1780,,Per Svc,0.01
Chargemaster Item,,276C1780,SPSI,Intracular Lens C1780,,Per Svc,0.01
Chargemaster Item,,276C1780,SPSI,Intracular Lens C1780,,Per Svc,0.01
Chargemaster Item,,276C1780,SPSI,Intracular Lens C1780,,Per Svc,0.01
Chargemaster Item,,276C1781,SPSI,Intracular Lens C1781,,Per Svc,0.01
Chargemaster Item,,276C1781,SPSI,Intracular Lens C1781,,Per Svc,0.01
Chargemaster Item,,276C1781,SPSI,Intracular Lens C1781,,Per Svc,0.01
Chargemaster Item,,276C1781,SPSI,Intracular Lens C1781,,Per Svc,0.01
Chargemaster Item,,276C1783,SPSI,Intracular Lens C1783,,Per Svc,0.01
Chargemaster Item,,276C1783,SPSI,Intracular Lens C1783,,Per Svc,0.01
Chargemaster Item,,276C1783,SPSI,Intracular Lens C1783,,Per Svc,0.01
Chargemaster Item,,276C1783,SPSI,Intracular Lens C1783,,Per Svc,0.01
Chargemaster Item,,276C1785,SPSI,Intracular Lens C1785,,Per Svc,0.01
Chargemaster Item,,276C1785,SPSI,Intracular Lens C1785,,Per Svc,0.01
Chargemaster Item,,276C1785,SPSI,Intracular Lens C1785,,Per Svc,0.01
Chargemaster Item,,276C1785,SPSI,Intracular Lens C1785,,Per Svc,0.01
Chargemaster Item,,276C1786,SPSI,Intracular Lens C1786,,Per Svc,0.01
Chargemaster Item,,276C1786,SPSI,Intracular Lens C1786,,Per Svc,0.01
Chargemaster Item,,276C1786,SPSI,Intracular Lens C1786,,Per Svc,0.01
Chargemaster Item,,276C1786,SPSI,Intracular Lens C1786,,Per Svc,0.01
Chargemaster Item,,276C1787,SPSI,Intracular Lens C1787,,Per Svc,0.01
Chargemaster Item,,276C1787,SPSI,Intracular Lens C1787,,Per Svc,0.01
Chargemaster Item,,276C1787,SPSI,Intracular Lens C1787,,Per Svc,0.01
Chargemaster Item,,276C1787,SPSI,Intracular Lens C1787,,Per Svc,0.01
Chargemaster Item,,276C1788,SPSI,Intracular Lens C1788,,Per Svc,0.01
Chargemaster Item,,276C1788,SPSI,Intracular Lens C1788,,Per Svc,0.01
Chargemaster Item,,276C1788,SPSI,Intracular Lens C1788,,Per Svc,0.01
Chargemaster Item,,276C1788,SPSI,Intracular Lens C1788,,Per Svc,0.01
Chargemaster Item,,276C1789,SPSI,Intracular Lens C1789,,Per Svc,0.01
Chargemaster Item,,276C1789,SPSI,Intracular Lens C1789,,Per Svc,0.01
Chargemaster Item,,276C1789,SPSI,Intracular Lens C1789,,Per Svc,0.01
Chargemaster Item,,276C1789,SPSI,Intracular Lens C1789,,Per Svc,0.01
Chargemaster Item,,276C1817,SPSI,Intracular Lens C1817,,Per Svc,0.01
Chargemaster Item,,276C1817,SPSI,Intracular Lens C1817,,Per Svc,0.01
Chargemaster Item,,276C1817,SPSI,Intracular Lens C1817,,Per Svc,0.01
Chargemaster Item,,276C1817,SPSI,Intracular Lens C1817,,Per Svc,0.01
Chargemaster Item,,276C1821,SPSI,Intracular Lens C1821,,Per Svc,0.01
Chargemaster Item,,276C1821,SPSI,Intracular Lens C1821,,Per Svc,0.01
Chargemaster Item,,276C1821,SPSI,Intracular Lens C1821,,Per Svc,0.01
Chargemaster Item,,276C1821,SPSI,Intracular Lens C1821,,Per Svc,0.01
Chargemaster Item,,276C1874,SPSI,Intracular Lens C1874,,Per Svc,0.01
Chargemaster Item,,276C1874,SPSI,Intracular Lens C1874,,Per Svc,0.01
Chargemaster Item,,276C1874,SPSI,Intracular Lens C1874,,Per Svc,0.01
Chargemaster Item,,276C1874,SPSI,Intracular Lens C1874,,Per Svc,0.01
Chargemaster Item,,276C1875,SPSI,Intracular Lens C1875,,Per Svc,0.01
Chargemaster Item,,276C1875,SPSI,Intracular Lens C1875,,Per Svc,0.01
Chargemaster Item,,276C1875,SPSI,Intracular Lens C1875,,Per Svc,0.01
Chargemaster Item,,276C1875,SPSI,Intracular Lens C1875,,Per Svc,0.01
Chargemaster Item,,276C1876,SPSI,Intracular Lens C1876,,Per Svc,0.01
Chargemaster Item,,276C1876,SPSI,Intracular Lens C1876,,Per Svc,0.01
Chargemaster Item,,276C1876,SPSI,Intracular Lens C1876,,Per Svc,0.01
Chargemaster Item,,276C1876,SPSI,Intracular Lens C1876,,Per Svc,0.01
Chargemaster Item,,276C1880,SPSI,Intracular Lens C1880,,Per Svc,0.01
Chargemaster Item,,276C1880,SPSI,Intracular Lens C1880,,Per Svc,0.01
Chargemaster Item,,276C1880,SPSI,Intracular Lens C1880,,Per Svc,0.01
Chargemaster Item,,276C1880,SPSI,Intracular Lens C1880,,Per Svc,0.01
Chargemaster Item,,276C1881,SPSI,Intracular Lens C1881,,Per Svc,0.01
Chargemaster Item,,276C1881,SPSI,Intracular Lens C1881,,Per Svc,0.01
Chargemaster Item,,276C1881,SPSI,Intracular Lens C1881,,Per Svc,0.01
Chargemaster Item,,276C1881,SPSI,Intracular Lens C1881,,Per Svc,0.01
Chargemaster Item,,276C1882,SPSI,Intracular Lens C1882,,Per Svc,0.01
Chargemaster Item,,276C1882,SPSI,Intracular Lens C1882,,Per Svc,0.01
Chargemaster Item,,276C1882,SPSI,Intracular Lens C1882,,Per Svc,0.01
Chargemaster Item,,276C1882,SPSI,Intracular Lens C1882,,Per Svc,0.01
Chargemaster Item,,276C1883,SPSI,Intracular Lens C1883,,Per Svc,0.01
Chargemaster Item,,276C1883,SPSI,Intracular Lens C1883,,Per Svc,0.01
Chargemaster Item,,276C1883,SPSI,Intracular Lens C1883,,Per Svc,0.01
Chargemaster Item,,276C1883,SPSI,Intracular Lens C1883,,Per Svc,0.01
Chargemaster Item,,276C1884,SPSI,Intracular Lens C1884,,Per Svc,0.01
Chargemaster Item,,276C1884,SPSI,Intracular Lens C1884,,Per Svc,0.01
Chargemaster Item,,276C1884,SPSI,Intracular Lens C1884,,Per Svc,0.01
Chargemaster Item,,276C1884,SPSI,Intracular Lens C1884,,Per Svc,0.01
Chargemaster Item,,276C1887,SPSI,Intracular Lens C1887,,Per Svc,0.01
Chargemaster Item,,276C1887,SPSI,Intracular Lens C1887,,Per Svc,0.01
Chargemaster Item,,276C1887,SPSI,Intracular Lens C1887,,Per Svc,0.01
Chargemaster Item,,276C1887,SPSI,Intracular Lens C1887,,Per Svc,0.01
Chargemaster Item,,276C1889,SPSI,Intracular Lens C1889,,Per Svc,0.01
Chargemaster Item,,276C1889,SPSI,Intracular Lens C1889,,Per Svc,0.01
Chargemaster Item,,276C1889,SPSI,Intracular Lens C1889,,Per Svc,0.01
Chargemaster Item,,276C1889,SPSI,Intracular Lens C1889,,Per Svc,0.01
Chargemaster Item,,276C1892,SPSI,Intracular Lens C1892,,Per Svc,0.01
Chargemaster Item,,276C1892,SPSI,Intracular Lens C1892,,Per Svc,0.01
Chargemaster Item,,276C1892,SPSI,Intracular Lens C1892,,Per Svc,0.01
Chargemaster Item,,276C1892,SPSI,Intracular Lens C1892,,Per Svc,0.01
Chargemaster Item,,276C1893,SPSI,Intracular Lens C1893,,Per Svc,0.01
Chargemaster Item,,276C1893,SPSI,Intracular Lens C1893,,Per Svc,0.01
Chargemaster Item,,276C1893,SPSI,Intracular Lens C1893,,Per Svc,0.01
Chargemaster Item,,276C1893,SPSI,Intracular Lens C1893,,Per Svc,0.01
Chargemaster Item,,276C1894,SPSI,Intracular Lens C1894,,Per Svc,0.01
Chargemaster Item,,276C1894,SPSI,Intracular Lens C1894,,Per Svc,0.01
Chargemaster Item,,276C1894,SPSI,Intracular Lens C1894,,Per Svc,0.01
Chargemaster Item,,276C1894,SPSI,Intracular Lens C1894,,Per Svc,0.01
Chargemaster Item,,276C1897,SPSI,Intracular Lens C1897,,Per Svc,0.01
Chargemaster Item,,276C1897,SPSI,Intracular Lens C1897,,Per Svc,0.01
Chargemaster Item,,276C1897,SPSI,Intracular Lens C1897,,Per Svc,0.01
Chargemaster Item,,276C1897,SPSI,Intracular Lens C1897,,Per Svc,0.01
Chargemaster Item,,276C1898,SPSI,Intracular Lens C1898,,Per Svc,0.01
Chargemaster Item,,276C1898,SPSI,Intracular Lens C1898,,Per Svc,0.01
Chargemaster Item,,276C1898,SPSI,Intracular Lens C1898,,Per Svc,0.01
Chargemaster Item,,276C1898,SPSI,Intracular Lens C1898,,Per Svc,0.01
Chargemaster Item,,276C1900,SPSI,Intracular Lens C1900,,Per Svc,0.01
Chargemaster Item,,276C1900,SPSI,Intracular Lens C1900,,Per Svc,0.01
Chargemaster Item,,276C1900,SPSI,Intracular Lens C1900,,Per Svc,0.01
Chargemaster Item,,276C1900,SPSI,Intracular Lens C1900,,Per Svc,0.01
Chargemaster Item,,276C2617,SPSI,Intracular Lens C2617,,Per Svc,0.01
Chargemaster Item,,276C2617,SPSI,Intracular Lens C2617,,Per Svc,0.01
Chargemaster Item,,276C2617,SPSI,Intracular Lens C2617,,Per Svc,0.01
Chargemaster Item,,276C2617,SPSI,Intracular Lens C2617,,Per Svc,0.01
Chargemaster Item,,276C2618,SPSI,Intracular Lens C2618,,Per Svc,0.01
Chargemaster Item,,276C2618,SPSI,Intracular Lens C2618,,Per Svc,0.01
Chargemaster Item,,276C2618,SPSI,Intracular Lens C2618,,Per Svc,0.01
Chargemaster Item,,276C2618,SPSI,Intracular Lens C2618,,Per Svc,0.01
Chargemaster Item,,276C2623,SPSI,Intracular Lens C2623,,Per Svc,0.01
Chargemaster Item,,276C2623,SPSI,Intracular Lens C2623,,Per Svc,0.01
Chargemaster Item,,276C2623,SPSI,Intracular Lens C2623,,Per Svc,0.01
Chargemaster Item,,276C2623,SPSI,Intracular Lens C2623,,Per Svc,0.01
Chargemaster Item,,276C2625,SPSI,Intracular Lens C2625,,Per Svc,0.01
Chargemaster Item,,276C2625,SPSI,Intracular Lens C2625,,Per Svc,0.01
Chargemaster Item,,276C2625,SPSI,Intracular Lens C2625,,Per Svc,0.01
Chargemaster Item,,276C2625,SPSI,Intracular Lens C2625,,Per Svc,0.01
Chargemaster Item,,276C2627,SPSI,Intracular Lens C2627,,Per Svc,0.01
Chargemaster Item,,276C2627,SPSI,Intracular Lens C2627,,Per Svc,0.01
Chargemaster Item,,276C2627,SPSI,Intracular Lens C2627,,Per Svc,0.01
Chargemaster Item,,276C2627,SPSI,Intracular Lens C2627,,Per Svc,0.01
Chargemaster Item,,276C2628,SPSI,Intracular Lens C2628,,Per Svc,0.01
Chargemaster Item,,276C2628,SPSI,Intracular Lens C2628,,Per Svc,0.01
Chargemaster Item,,276C2628,SPSI,Intracular Lens C2628,,Per Svc,0.01
Chargemaster Item,,276C2628,SPSI,Intracular Lens C2628,,Per Svc,0.01
Chargemaster Item,,276C2630,SPSI,Intracular Lens C2630,,Per Svc,0.01
Chargemaster Item,,276C2630,SPSI,Intracular Lens C2630,,Per Svc,0.01
Chargemaster Item,,276C2630,SPSI,Intracular Lens C2630,,Per Svc,0.01
Chargemaster Item,,276C2630,SPSI,Intracular Lens C2630,,Per Svc,0.01
Chargemaster Item,,276C2639,SPSI,Intracular Lens C2639,,Per Svc,0.01
Chargemaster Item,,276C2639,SPSI,Intracular Lens C2639,,Per Svc,0.01
Chargemaster Item,,276C2639,SPSI,Intracular Lens C2639,,Per Svc,0.01
Chargemaster Item,,276C2639,SPSI,Intracular Lens C2639,,Per Svc,0.01
Chargemaster Item,,276C9250,SPSI,Intracular Lens C9250,,Per Svc,0.01
Chargemaster Item,,276C9250,SPSI,Intracular Lens C9250,,Per Svc,0.01
Chargemaster Item,,276C9250,SPSI,Intracular Lens C9250,,Per Svc,0.01
Chargemaster Item,,276C9250,SPSI,Intracular Lens C9250,,Per Svc,0.01
Chargemaster Item,,276C9352,SPSI,Intracular Lens C9352,,Per Svc,0.01
Chargemaster Item,,276C9352,SPSI,Intracular Lens C9352,,Per Svc,0.01
Chargemaster Item,,276C9352,SPSI,Intracular Lens C9352,,Per Svc,0.01
Chargemaster Item,,276C9352,SPSI,Intracular Lens C9352,,Per Svc,0.01
Chargemaster Item,,276C9353,SPSI,Intracular Lens C9353,,Per Svc,0.01
Chargemaster Item,,276C9353,SPSI,Intracular Lens C9353,,Per Svc,0.01
Chargemaster Item,,276C9353,SPSI,Intracular Lens C9353,,Per Svc,0.01
Chargemaster Item,,276C9353,SPSI,Intracular Lens C9353,,Per Svc,0.01
Chargemaster Item,,276C9363,SPSI,Intracular Lens C9363,,Per Svc,0.01
Chargemaster Item,,276C9363,SPSI,Intracular Lens C9363,,Per Svc,0.01
Chargemaster Item,,276C9363,SPSI,Intracular Lens C9363,,Per Svc,0.01
Chargemaster Item,,276C9363,SPSI,Intracular Lens C9363,,Per Svc,0.01
Chargemaster Item,,276E0191,SPSI,Intracular Lens E0191,,Per Svc,0.01
Chargemaster Item,,276E0191,SPSI,Intracular Lens E0191,,Per Svc,0.01
Chargemaster Item,,276E0191,SPSI,Intracular Lens E0191,,Per Svc,0.01
Chargemaster Item,,276E0191,SPSI,Intracular Lens E0191,,Per Svc,0.01
Chargemaster Item,,276E0235,SPSI,Intracular Lens E0235,,Per Svc,0.01
Chargemaster Item,,276E0235,SPSI,Intracular Lens E0235,,Per Svc,0.01
Chargemaster Item,,276E0235,SPSI,Intracular Lens E0235,,Per Svc,0.01
Chargemaster Item,,276E0235,SPSI,Intracular Lens E0235,,Per Svc,0.01
Chargemaster Item,,276L0113,SPSI,Intracular Lens L0113,,Per Svc,0.01
Chargemaster Item,,276L0113,SPSI,Intracular Lens L0113,,Per Svc,0.01
Chargemaster Item,,276L0113,SPSI,Intracular Lens L0113,,Per Svc,0.01
Chargemaster Item,,276L0113,SPSI,Intracular Lens L0113,,Per Svc,0.01
Chargemaster Item,,276L0120,SPSI,Intracular Lens L0120,,Per Svc,0.01
Chargemaster Item,,276L0120,SPSI,Intracular Lens L0120,,Per Svc,0.01
Chargemaster Item,,276L0120,SPSI,Intracular Lens L0120,,Per Svc,0.01
Chargemaster Item,,276L0120,SPSI,Intracular Lens L0120,,Per Svc,0.01
Chargemaster Item,,276L0172,SPSI,Intracular Lens L0172,,Per Svc,0.01
Chargemaster Item,,276L0172,SPSI,Intracular Lens L0172,,Per Svc,0.01
Chargemaster Item,,276L0172,SPSI,Intracular Lens L0172,,Per Svc,0.01
Chargemaster Item,,276L0172,SPSI,Intracular Lens L0172,,Per Svc,0.01
Chargemaster Item,,276L0174,SPSI,Intracular Lens L0174,,Per Svc,0.01
Chargemaster Item,,276L0174,SPSI,Intracular Lens L0174,,Per Svc,0.01
Chargemaster Item,,276L0174,SPSI,Intracular Lens L0174,,Per Svc,0.01
Chargemaster Item,,276L0174,SPSI,Intracular Lens L0174,,Per Svc,0.01
Chargemaster Item,,276L0625,SPSI,Intracular Lens L0625,,Per Svc,0.01
Chargemaster Item,,276L0625,SPSI,Intracular Lens L0625,,Per Svc,0.01
Chargemaster Item,,276L0625,SPSI,Intracular Lens L0625,,Per Svc,0.01
Chargemaster Item,,276L0625,SPSI,Intracular Lens L0625,,Per Svc,0.01
Chargemaster Item,,276L1820,SPSI,Intracular Lens L1820,,Per Svc,0.01
Chargemaster Item,,276L1820,SPSI,Intracular Lens L1820,,Per Svc,0.01
Chargemaster Item,,276L1820,SPSI,Intracular Lens L1820,,Per Svc,0.01
Chargemaster Item,,276L1820,SPSI,Intracular Lens L1820,,Per Svc,0.01
Chargemaster Item,,276L1830,SPSI,Intracular Lens L1830,,Per Svc,0.01
Chargemaster Item,,276L1830,SPSI,Intracular Lens L1830,,Per Svc,0.01
Chargemaster Item,,276L1830,SPSI,Intracular Lens L1830,,Per Svc,0.01
Chargemaster Item,,276L1830,SPSI,Intracular Lens L1830,,Per Svc,0.01
Chargemaster Item,,276L1832,SPSI,Intracular Lens L1832,,Per Svc,0.01
Chargemaster Item,,276L1832,SPSI,Intracular Lens L1832,,Per Svc,0.01
Chargemaster Item,,276L1832,SPSI,Intracular Lens L1832,,Per Svc,0.01
Chargemaster Item,,276L1832,SPSI,Intracular Lens L1832,,Per Svc,0.01
Chargemaster Item,,276L1902,SPSI,Intracular Lens L1902,,Per Svc,0.01
Chargemaster Item,,276L1902,SPSI,Intracular Lens L1902,,Per Svc,0.01
Chargemaster Item,,276L1902,SPSI,Intracular Lens L1902,,Per Svc,0.01
Chargemaster Item,,276L1902,SPSI,Intracular Lens L1902,,Per Svc,0.01
Chargemaster Item,,276L1930,SPSI,Intracular Lens L1930,,Per Svc,0.01
Chargemaster Item,,276L1930,SPSI,Intracular Lens L1930,,Per Svc,0.01
Chargemaster Item,,276L1930,SPSI,Intracular Lens L1930,,Per Svc,0.01
Chargemaster Item,,276L1930,SPSI,Intracular Lens L1930,,Per Svc,0.01
Chargemaster Item,,276L3260,SPSI,Intracular Lens L3260,,Per Svc,0.01
Chargemaster Item,,276L3260,SPSI,Intracular Lens L3260,,Per Svc,0.01
Chargemaster Item,,276L3260,SPSI,Intracular Lens L3260,,Per Svc,0.01
Chargemaster Item,,276L3260,SPSI,Intracular Lens L3260,,Per Svc,0.01
Chargemaster Item,,276L3650,SPSI,Intracular Lens L3650,,Per Svc,0.01
Chargemaster Item,,276L3650,SPSI,Intracular Lens L3650,,Per Svc,0.01
Chargemaster Item,,276L3650,SPSI,Intracular Lens L3650,,Per Svc,0.01
Chargemaster Item,,276L3650,SPSI,Intracular Lens L3650,,Per Svc,0.01
Chargemaster Item,,276L3670,SPSI,Intracular Lens L3670,,Per Svc,0.01
Chargemaster Item,,276L3670,SPSI,Intracular Lens L3670,,Per Svc,0.01
Chargemaster Item,,276L3670,SPSI,Intracular Lens L3670,,Per Svc,0.01
Chargemaster Item,,276L3670,SPSI,Intracular Lens L3670,,Per Svc,0.01
Chargemaster Item,,276L3807,SPSI,Intracular Lens L3807,,Per Svc,0.01
Chargemaster Item,,276L3807,SPSI,Intracular Lens L3807,,Per Svc,0.01
Chargemaster Item,,276L3807,SPSI,Intracular Lens L3807,,Per Svc,0.01
Chargemaster Item,,276L3807,SPSI,Intracular Lens L3807,,Per Svc,0.01
Chargemaster Item,,276L3809,SPSI,Intracular Lens L3809,,Per Svc,0.01
Chargemaster Item,,276L3809,SPSI,Intracular Lens L3809,,Per Svc,0.01
Chargemaster Item,,276L3809,SPSI,Intracular Lens L3809,,Per Svc,0.01
Chargemaster Item,,276L3809,SPSI,Intracular Lens L3809,,Per Svc,0.01
Chargemaster Item,,276L3908,SPSI,Intracular Lens L3908,,Per Svc,0.01
Chargemaster Item,,276L3908,SPSI,Intracular Lens L3908,,Per Svc,0.01
Chargemaster Item,,276L3908,SPSI,Intracular Lens L3908,,Per Svc,0.01
Chargemaster Item,,276L3908,SPSI,Intracular Lens L3908,,Per Svc,0.01
Chargemaster Item,,276L3917,SPSI,Intracular Lens L3917,,Per Svc,0.01
Chargemaster Item,,276L3917,SPSI,Intracular Lens L3917,,Per Svc,0.01
Chargemaster Item,,276L3917,SPSI,Intracular Lens L3917,,Per Svc,0.01
Chargemaster Item,,276L3917,SPSI,Intracular Lens L3917,,Per Svc,0.01
Chargemaster Item,,276L3923,SPSI,Intracular Lens L3923,,Per Svc,0.01
Chargemaster Item,,276L3923,SPSI,Intracular Lens L3923,,Per Svc,0.01
Chargemaster Item,,276L3923,SPSI,Intracular Lens L3923,,Per Svc,0.01
Chargemaster Item,,276L3923,SPSI,Intracular Lens L3923,,Per Svc,0.01
Chargemaster Item,,276L4386,SPSI,Intracular Lens L4386,,Per Svc,0.01
Chargemaster Item,,276L4386,SPSI,Intracular Lens L4386,,Per Svc,0.01
Chargemaster Item,,276L4386,SPSI,Intracular Lens L4386,,Per Svc,0.01
Chargemaster Item,,276L4386,SPSI,Intracular Lens L4386,,Per Svc,0.01
Chargemaster Item,,276L4387,SPSI,Intracular Lens L4387,,Per Svc,0.01
Chargemaster Item,,276L4387,SPSI,Intracular Lens L4387,,Per Svc,0.01
Chargemaster Item,,276L4387,SPSI,Intracular Lens L4387,,Per Svc,0.01
Chargemaster Item,,276L4387,SPSI,Intracular Lens L4387,,Per Svc,0.01
Chargemaster Item,,276L5000,SPSI,Intracular Lens L5000,,Per Svc,0.01
Chargemaster Item,,276L5000,SPSI,Intracular Lens L5000,,Per Svc,0.01
Chargemaster Item,,276L5000,SPSI,Intracular Lens L5000,,Per Svc,0.01
Chargemaster Item,,276L5000,SPSI,Intracular Lens L5000,,Per Svc,0.01
Chargemaster Item,,276L8000,SPSI,Intracular Lens L8000,,Per Svc,0.01
Chargemaster Item,,276L8000,SPSI,Intracular Lens L8000,,Per Svc,0.01
Chargemaster Item,,276L8000,SPSI,Intracular Lens L8000,,Per Svc,0.01
Chargemaster Item,,276L8000,SPSI,Intracular Lens L8000,,Per Svc,0.01
Chargemaster Item,,276L8501,SPSI,Intracular Lens L8501,,Per Svc,0.01
Chargemaster Item,,276L8501,SPSI,Intracular Lens L8501,,Per Svc,0.01
Chargemaster Item,,276L8501,SPSI,Intracular Lens L8501,,Per Svc,0.01
Chargemaster Item,,276L8501,SPSI,Intracular Lens L8501,,Per Svc,0.01
Chargemaster Item,,276L8600,SPSI,Intracular Lens L8600,,Per Svc,0.01
Chargemaster Item,,276L8600,SPSI,Intracular Lens L8600,,Per Svc,0.01
Chargemaster Item,,276L8600,SPSI,Intracular Lens L8600,,Per Svc,0.01
Chargemaster Item,,276L8600,SPSI,Intracular Lens L8600,,Per Svc,0.01
Chargemaster Item,,276L8612,SPSI,Intracular Lens L8612,,Per Svc,0.01
Chargemaster Item,,276L8612,SPSI,Intracular Lens L8612,,Per Svc,0.01
Chargemaster Item,,276L8612,SPSI,Intracular Lens L8612,,Per Svc,0.01
Chargemaster Item,,276L8612,SPSI,Intracular Lens L8612,,Per Svc,0.01
Chargemaster Item,,276L8699,SPSI,Intracular Lens L8699,,Per Svc,0.01
Chargemaster Item,,276L8699,SPSI,Intracular Lens L8699,,Per Svc,0.01
Chargemaster Item,,276L8699,SPSI,Intracular Lens L8699,,Per Svc,0.01
Chargemaster Item,,276L8699,SPSI,Intracular Lens L8699,,Per Svc,0.01
Chargemaster Item,,276Q4100,SPSI,Intracular Lens Q4100,,Per Svc,0.01
Chargemaster Item,,276Q4100,SPSI,Intracular Lens Q4100,,Per Svc,0.01
Chargemaster Item,,276Q4100,SPSI,Intracular Lens Q4100,,Per Svc,0.01
Chargemaster Item,,276Q4100,SPSI,Intracular Lens Q4100,,Per Svc,0.01
Chargemaster Item,,276Q4102,SPSI,Intracular Lens Q4102,,Per Svc,0.01
Chargemaster Item,,276Q4102,SPSI,Intracular Lens Q4102,,Per Svc,0.01
Chargemaster Item,,276Q4102,SPSI,Intracular Lens Q4102,,Per Svc,0.01
Chargemaster Item,,276Q4102,SPSI,Intracular Lens Q4102,,Per Svc,0.01
Chargemaster Item,,276Q4110,SPSI,Intracular Lens Q4110,,Per Svc,0.01
Chargemaster Item,,276Q4110,SPSI,Intracular Lens Q4110,,Per Svc,0.01
Chargemaster Item,,276Q4110,SPSI,Intracular Lens Q4110,,Per Svc,0.01
Chargemaster Item,,276Q4110,SPSI,Intracular Lens Q4110,,Per Svc,0.01
Chargemaster Item,,276Q4114,SPSI,Intracular Lens Q4114,,Per Svc,0.01
Chargemaster Item,,276Q4114,SPSI,Intracular Lens Q4114,,Per Svc,0.01
Chargemaster Item,,276Q4114,SPSI,Intracular Lens Q4114,,Per Svc,0.01
Chargemaster Item,,276Q4114,SPSI,Intracular Lens Q4114,,Per Svc,0.01
Chargemaster Item,,276Q4116,SPSI,Intracular Lens Q4116,,Per Svc,0.01
Chargemaster Item,,276Q4116,SPSI,Intracular Lens Q4116,,Per Svc,0.01
Chargemaster Item,,276Q4116,SPSI,Intracular Lens Q4116,,Per Svc,0.01
Chargemaster Item,,276Q4116,SPSI,Intracular Lens Q4116,,Per Svc,0.01
Chargemaster Item,,276Q4118,SPSI,Intracular Lens Q4118,,Per Svc,0.01
Chargemaster Item,,276Q4118,SPSI,Intracular Lens Q4118,,Per Svc,0.01
Chargemaster Item,,276Q4118,SPSI,Intracular Lens Q4118,,Per Svc,0.01
Chargemaster Item,,276Q4118,SPSI,Intracular Lens Q4118,,Per Svc,0.01
Chargemaster Item,,276Q4125,SPSI,Intracular Lens Q4125,,Per Svc,0.01
Chargemaster Item,,276Q4125,SPSI,Intracular Lens Q4125,,Per Svc,0.01
Chargemaster Item,,276Q4125,SPSI,Intracular Lens Q4125,,Per Svc,0.01
Chargemaster Item,,276Q4125,SPSI,Intracular Lens Q4125,,Per Svc,0.01
Chargemaster Item,,276Q4128,SPSI,Intracular Lens Q4128,,Per Svc,0.01
Chargemaster Item,,276Q4128,SPSI,Intracular Lens Q4128,,Per Svc,0.01
Chargemaster Item,,276Q4128,SPSI,Intracular Lens Q4128,,Per Svc,0.01
Chargemaster Item,,276Q4128,SPSI,Intracular Lens Q4128,,Per Svc,0.01
Chargemaster Item,,276Q4130,SPSI,Intracular Lens Q4130,,Per Svc,0.01
Chargemaster Item,,276Q4130,SPSI,Intracular Lens Q4130,,Per Svc,0.01
Chargemaster Item,,276Q4130,SPSI,Intracular Lens Q4130,,Per Svc,0.01
Chargemaster Item,,276Q4130,SPSI,Intracular Lens Q4130,,Per Svc,0.01
Chargemaster Item,,276Q4133,SPSI,Intracular Lens Q4133,,Per Svc,0.01
Chargemaster Item,,276Q4133,SPSI,Intracular Lens Q4133,,Per Svc,0.01
Chargemaster Item,,276Q4133,SPSI,Intracular Lens Q4133,,Per Svc,0.01
Chargemaster Item,,276Q4133,SPSI,Intracular Lens Q4133,,Per Svc,0.01
Chargemaster Item,,276Q4155,SPSI,Intracular Lens Q4155,,Per Svc,0.01
Chargemaster Item,,276Q4155,SPSI,Intracular Lens Q4155,,Per Svc,0.01
Chargemaster Item,,276Q4155,SPSI,Intracular Lens Q4155,,Per Svc,0.01
Chargemaster Item,,276Q4155,SPSI,Intracular Lens Q4155,,Per Svc,0.01
Chargemaster Item,,276Q4166,SPSI,Intracular Lens Q4166,,Per Svc,0.01
Chargemaster Item,,276Q4166,SPSI,Intracular Lens Q4166,,Per Svc,0.01
Chargemaster Item,,276Q4166,SPSI,Intracular Lens Q4166,,Per Svc,0.01
Chargemaster Item,,276Q4166,SPSI,Intracular Lens Q4166,,Per Svc,0.01
Chargemaster Item,,276Q9963,SPSI,Intracular Lens Q9963,,Per Svc,0.01
Chargemaster Item,,276Q9963,SPSI,Intracular Lens Q9963,,Per Svc,0.01
Chargemaster Item,,276Q9963,SPSI,Intracular Lens Q9963,,Per Svc,0.01
Chargemaster Item,,276Q9963,SPSI,Intracular Lens Q9963,,Per Svc,0.01
Chargemaster Item,,276Q9967,SPSI,Intracular Lens Q9967,,Per Svc,0.01
Chargemaster Item,,276Q9967,SPSI,Intracular Lens Q9967,,Per Svc,0.01
Chargemaster Item,,276Q9967,SPSI,Intracular Lens Q9967,,Per Svc,0.01
Chargemaster Item,,276Q9967,SPSI,Intracular Lens Q9967,,Per Svc,0.01
Chargemaster Item,,276V2630,SPSI,Intracular Lens V2630,,Per Svc,0.01
Chargemaster Item,,276V2630,SPSI,Intracular Lens V2630,,Per Svc,0.01
Chargemaster Item,,276V2630,SPSI,Intracular Lens V2630,,Per Svc,0.01
Chargemaster Item,,276V2630,SPSI,Intracular Lens V2630,,Per Svc,0.01
Chargemaster Item,,276V2632,SPSI,Intracular Lens V2632,,Per Svc,0.01
Chargemaster Item,,276V2632,SPSI,Intracular Lens V2632,,Per Svc,0.01
Chargemaster Item,,276V2632,SPSI,Intracular Lens V2632,,Per Svc,0.01
Chargemaster Item,,276V2632,SPSI,Intracular Lens V2632,,Per Svc,0.01
Chargemaster Item,,276V2632A,SPSI,Intracular Lens V2632A,,Per Svc,0.01
Chargemaster Item,,276V2632A,SPSI,Intracular Lens V2632A,,Per Svc,0.01
Chargemaster Item,,276V2632A,SPSI,Intracular Lens V2632A,,Per Svc,0.01
Chargemaster Item,,276V2632A,SPSI,Intracular Lens V2632A,,Per Svc,0.01
Chargemaster Item,,276V2787,SPSI,Intracular Lens V2787,,Per Svc,0.01
Chargemaster Item,,276V2787,SPSI,Intracular Lens V2787,,Per Svc,0.01
Chargemaster Item,,276V2787,SPSI,Intracular Lens V2787,,Per Svc,0.01
Chargemaster Item,,276V2787,SPSI,Intracular Lens V2787,,Per Svc,0.01
Chargemaster Item,,276V2788,SPSI,Intracular Lens V2788,,Per Svc,0.01
Chargemaster Item,,276V2788,SPSI,Intracular Lens V2788,,Per Svc,0.01
Chargemaster Item,,276V2788,SPSI,Intracular Lens V2788,,Per Svc,0.01
Chargemaster Item,,276V2788,SPSI,Intracular Lens V2788,,Per Svc,0.01
Chargemaster Item,,276V2788A,SPSI,Intracular Lens V2788A,,Per Svc,0.01
Chargemaster Item,,276V2788A,SPSI,Intracular Lens V2788A,,Per Svc,0.01
Chargemaster Item,,276V2788A,SPSI,Intracular Lens V2788A,,Per Svc,0.01
Chargemaster Item,,276V2788A,SPSI,Intracular Lens V2788A,,Per Svc,0.01
Chargemaster Item,,276V2790,SPSI,Intracular Lens V2790,,Per Svc,0.01
Chargemaster Item,,276V2790,SPSI,Intracular Lens V2790,,Per Svc,0.01
Chargemaster Item,,276V2790,SPSI,Intracular Lens V2790,,Per Svc,0.01
Chargemaster Item,,276V2790,SPSI,Intracular Lens V2790,,Per Svc,0.01
Chargemaster Item,,276XXXXX,SPSI,Intracular Lens,,Per Svc,0.01
Chargemaster Item,,276XXXXX,SPSI,Intracular Lens,,Per Svc,0.01
Chargemaster Item,,276XXXXX,SPSI,Intracular Lens,,Per Svc,0.01
Chargemaster Item,,276XXXXX,SPSI,Intracular Lens,,Per Svc,0.01
Chargemaster Item,,278A4265,SPSI,Other Implants A4265,,Per Svc,0.01
Chargemaster Item,,278A4265,SPSI,Other Implants A4265,,Per Svc,0.01
Chargemaster Item,,278A4265,SPSI,Other Implants A4265,,Per Svc,0.01
Chargemaster Item,,278A4265,SPSI,Other Implants A4265,,Per Svc,0.01
Chargemaster Item,,278A4340,SPSI,Other Implants A4340,,Per Svc,0.01
Chargemaster Item,,278A4340,SPSI,Other Implants A4340,,Per Svc,0.01
Chargemaster Item,,278A4340,SPSI,Other Implants A4340,,Per Svc,0.01
Chargemaster Item,,278A4340,SPSI,Other Implants A4340,,Per Svc,0.01
Chargemaster Item,,278A4349,SPSI,Other Implants A4349,,Per Svc,0.01
Chargemaster Item,,278A4349,SPSI,Other Implants A4349,,Per Svc,0.01
Chargemaster Item,,278A4349,SPSI,Other Implants A4349,,Per Svc,0.01
Chargemaster Item,,278A4349,SPSI,Other Implants A4349,,Per Svc,0.01
Chargemaster Item,,278A4565,SPSI,Other Implants A4565,,Per Svc,0.01
Chargemaster Item,,278A4565,SPSI,Other Implants A4565,,Per Svc,0.01
Chargemaster Item,,278A4565,SPSI,Other Implants A4565,,Per Svc,0.01
Chargemaster Item,,278A4565,SPSI,Other Implants A4565,,Per Svc,0.01
Chargemaster Item,,278A4648,SPSI,Other Implants A4648,,Per Svc,0.01
Chargemaster Item,,278A4648,SPSI,Other Implants A4648,,Per Svc,0.01
Chargemaster Item,,278A4648,SPSI,Other Implants A4648,,Per Svc,0.01
Chargemaster Item,,278A4648,SPSI,Other Implants A4648,,Per Svc,0.01
Chargemaster Item,,278A6021,SPSI,Other Implants A6021,,Per Svc,0.01
Chargemaster Item,,278A6021,SPSI,Other Implants A6021,,Per Svc,0.01
Chargemaster Item,,278A6021,SPSI,Other Implants A6021,,Per Svc,0.01
Chargemaster Item,,278A6021,SPSI,Other Implants A6021,,Per Svc,0.01
Chargemaster Item,,278A6025,SPSI,Other Implants A6025,,Per Svc,0.01
Chargemaster Item,,278A6025,SPSI,Other Implants A6025,,Per Svc,0.01
Chargemaster Item,,278A6025,SPSI,Other Implants A6025,,Per Svc,0.01
Chargemaster Item,,278A6025,SPSI,Other Implants A6025,,Per Svc,0.01
Chargemaster Item,,278A6196,SPSI,Other Implants A6196,,Per Svc,0.01
Chargemaster Item,,278A6196,SPSI,Other Implants A6196,,Per Svc,0.01
Chargemaster Item,,278A6196,SPSI,Other Implants A6196,,Per Svc,0.01
Chargemaster Item,,278A6196,SPSI,Other Implants A6196,,Per Svc,0.01
Chargemaster Item,,278A6197,SPSI,Other Implants A6197,,Per Svc,0.01
Chargemaster Item,,278A6197,SPSI,Other Implants A6197,,Per Svc,0.01
Chargemaster Item,,278A6197,SPSI,Other Implants A6197,,Per Svc,0.01
Chargemaster Item,,278A6197,SPSI,Other Implants A6197,,Per Svc,0.01
Chargemaster Item,,278A6206,SPSI,Other Implants A6206,,Per Svc,0.01
Chargemaster Item,,278A6206,SPSI,Other Implants A6206,,Per Svc,0.01
Chargemaster Item,,278A6206,SPSI,Other Implants A6206,,Per Svc,0.01
Chargemaster Item,,278A6206,SPSI,Other Implants A6206,,Per Svc,0.01
Chargemaster Item,,278A6209,SPSI,Other Implants A6209,,Per Svc,0.01
Chargemaster Item,,278A6209,SPSI,Other Implants A6209,,Per Svc,0.01
Chargemaster Item,,278A6209,SPSI,Other Implants A6209,,Per Svc,0.01
Chargemaster Item,,278A6209,SPSI,Other Implants A6209,,Per Svc,0.01
Chargemaster Item,,278A6212,SPSI,Other Implants A6212,,Per Svc,0.01
Chargemaster Item,,278A6212,SPSI,Other Implants A6212,,Per Svc,0.01
Chargemaster Item,,278A6212,SPSI,Other Implants A6212,,Per Svc,0.01
Chargemaster Item,,278A6212,SPSI,Other Implants A6212,,Per Svc,0.01
Chargemaster Item,,278A6213,SPSI,Other Implants A6213,,Per Svc,0.01
Chargemaster Item,,278A6213,SPSI,Other Implants A6213,,Per Svc,0.01
Chargemaster Item,,278A6213,SPSI,Other Implants A6213,,Per Svc,0.01
Chargemaster Item,,278A6213,SPSI,Other Implants A6213,,Per Svc,0.01
Chargemaster Item,,278A6214,SPSI,Other Implants A6214,,Per Svc,0.01
Chargemaster Item,,278A6214,SPSI,Other Implants A6214,,Per Svc,0.01
Chargemaster Item,,278A6214,SPSI,Other Implants A6214,,Per Svc,0.01
Chargemaster Item,,278A6214,SPSI,Other Implants A6214,,Per Svc,0.01
Chargemaster Item,,278A6219,SPSI,Other Implants A6219,,Per Svc,0.01
Chargemaster Item,,278A6219,SPSI,Other Implants A6219,,Per Svc,0.01
Chargemaster Item,,278A6219,SPSI,Other Implants A6219,,Per Svc,0.01
Chargemaster Item,,278A6219,SPSI,Other Implants A6219,,Per Svc,0.01
Chargemaster Item,,278A6222,SPSI,Other Implants A6222,,Per Svc,0.01
Chargemaster Item,,278A6222,SPSI,Other Implants A6222,,Per Svc,0.01
Chargemaster Item,,278A6222,SPSI,Other Implants A6222,,Per Svc,0.01
Chargemaster Item,,278A6222,SPSI,Other Implants A6222,,Per Svc,0.01
Chargemaster Item,,278A6223,SPSI,Other Implants A6223,,Per Svc,0.01
Chargemaster Item,,278A6223,SPSI,Other Implants A6223,,Per Svc,0.01
Chargemaster Item,,278A6223,SPSI,Other Implants A6223,,Per Svc,0.01
Chargemaster Item,,278A6223,SPSI,Other Implants A6223,,Per Svc,0.01
Chargemaster Item,,278A6224,SPSI,Other Implants A6224,,Per Svc,0.01
Chargemaster Item,,278A6224,SPSI,Other Implants A6224,,Per Svc,0.01
Chargemaster Item,,278A6224,SPSI,Other Implants A6224,,Per Svc,0.01
Chargemaster Item,,278A6224,SPSI,Other Implants A6224,,Per Svc,0.01
Chargemaster Item,,278A6234,SPSI,Other Implants A6234,,Per Svc,0.01
Chargemaster Item,,278A6234,SPSI,Other Implants A6234,,Per Svc,0.01
Chargemaster Item,,278A6234,SPSI,Other Implants A6234,,Per Svc,0.01
Chargemaster Item,,278A6234,SPSI,Other Implants A6234,,Per Svc,0.01
Chargemaster Item,,278A6235,SPSI,Other Implants A6235,,Per Svc,0.01
Chargemaster Item,,278A6235,SPSI,Other Implants A6235,,Per Svc,0.01
Chargemaster Item,,278A6235,SPSI,Other Implants A6235,,Per Svc,0.01
Chargemaster Item,,278A6235,SPSI,Other Implants A6235,,Per Svc,0.01
Chargemaster Item,,278A6238,SPSI,Other Implants A6238,,Per Svc,0.01
Chargemaster Item,,278A6238,SPSI,Other Implants A6238,,Per Svc,0.01
Chargemaster Item,,278A6238,SPSI,Other Implants A6238,,Per Svc,0.01
Chargemaster Item,,278A6238,SPSI,Other Implants A6238,,Per Svc,0.01
Chargemaster Item,,278A6255,SPSI,Other Implants A6255,,Per Svc,0.01
Chargemaster Item,,278A6255,SPSI,Other Implants A6255,,Per Svc,0.01
Chargemaster Item,,278A6255,SPSI,Other Implants A6255,,Per Svc,0.01
Chargemaster Item,,278A6255,SPSI,Other Implants A6255,,Per Svc,0.01
Chargemaster Item,,278A6257,SPSI,Other Implants A6257,,Per Svc,0.01
Chargemaster Item,,278A6257,SPSI,Other Implants A6257,,Per Svc,0.01
Chargemaster Item,,278A6257,SPSI,Other Implants A6257,,Per Svc,0.01
Chargemaster Item,,278A6257,SPSI,Other Implants A6257,,Per Svc,0.01
Chargemaster Item,,278A6258,SPSI,Other Implants A6258,,Per Svc,0.01
Chargemaster Item,,278A6258,SPSI,Other Implants A6258,,Per Svc,0.01
Chargemaster Item,,278A6258,SPSI,Other Implants A6258,,Per Svc,0.01
Chargemaster Item,,278A6258,SPSI,Other Implants A6258,,Per Svc,0.01
Chargemaster Item,,278A6259,SPSI,Other Implants A6259,,Per Svc,0.01
Chargemaster Item,,278A6259,SPSI,Other Implants A6259,,Per Svc,0.01
Chargemaster Item,,278A6259,SPSI,Other Implants A6259,,Per Svc,0.01
Chargemaster Item,,278A6259,SPSI,Other Implants A6259,,Per Svc,0.01
Chargemaster Item,,278A6454,SPSI,Other Implants A6454,,Per Svc,0.01
Chargemaster Item,,278A6454,SPSI,Other Implants A6454,,Per Svc,0.01
Chargemaster Item,,278A6454,SPSI,Other Implants A6454,,Per Svc,0.01
Chargemaster Item,,278A6454,SPSI,Other Implants A6454,,Per Svc,0.01
Chargemaster Item,,278A7521,SPSI,Other Implants A7521,,Per Svc,0.01
Chargemaster Item,,278A7521,SPSI,Other Implants A7521,,Per Svc,0.01
Chargemaster Item,,278A7521,SPSI,Other Implants A7521,,Per Svc,0.01
Chargemaster Item,,278A7521,SPSI,Other Implants A7521,,Per Svc,0.01
Chargemaster Item,,278B4082,SPSI,Other Implants B4082,,Per Svc,0.01
Chargemaster Item,,278B4082,SPSI,Other Implants B4082,,Per Svc,0.01
Chargemaster Item,,278B4082,SPSI,Other Implants B4082,,Per Svc,0.01
Chargemaster Item,,278B4082,SPSI,Other Implants B4082,,Per Svc,0.01
Chargemaster Item,,278B4087,SPSI,Other Implants B4087,,Per Svc,0.01
Chargemaster Item,,278B4087,SPSI,Other Implants B4087,,Per Svc,0.01
Chargemaster Item,,278B4087,SPSI,Other Implants B4087,,Per Svc,0.01
Chargemaster Item,,278B4087,SPSI,Other Implants B4087,,Per Svc,0.01
Chargemaster Item,,278B4088,SPSI,Other Implants B4088,,Per Svc,0.01
Chargemaster Item,,278B4088,SPSI,Other Implants B4088,,Per Svc,0.01
Chargemaster Item,,278B4088,SPSI,Other Implants B4088,,Per Svc,0.01
Chargemaster Item,,278B4088,SPSI,Other Implants B4088,,Per Svc,0.01
Chargemaster Item,,278C1713,SPSI,Other Implants C1713,,Per Svc,0.01
Chargemaster Item,,278C1713,SPSI,Other Implants C1713,,Per Svc,0.01
Chargemaster Item,,278C1713,SPSI,Other Implants C1713,,Per Svc,0.01
Chargemaster Item,,278C1713,SPSI,Other Implants C1713,,Per Svc,0.01
Chargemaster Item,,278C1715,SPSI,Other Implants C1715,,Per Svc,0.01
Chargemaster Item,,278C1715,SPSI,Other Implants C1715,,Per Svc,0.01
Chargemaster Item,,278C1715,SPSI,Other Implants C1715,,Per Svc,0.01
Chargemaster Item,,278C1715,SPSI,Other Implants C1715,,Per Svc,0.01
Chargemaster Item,,278C1716,SPSI,Other Implants C1716,,Per Svc,0.01
Chargemaster Item,,278C1716,SPSI,Other Implants C1716,,Per Svc,0.01
Chargemaster Item,,278C1716,SPSI,Other Implants C1716,,Per Svc,0.01
Chargemaster Item,,278C1716,SPSI,Other Implants C1716,,Per Svc,0.01
Chargemaster Item,,278C1721,SPSI,Other Implants C1721,,Per Svc,0.01
Chargemaster Item,,278C1721,SPSI,Other Implants C1721,,Per Svc,0.01
Chargemaster Item,,278C1721,SPSI,Other Implants C1721,,Per Svc,0.01
Chargemaster Item,,278C1721,SPSI,Other Implants C1721,,Per Svc,0.01
Chargemaster Item,,278C1722,SPSI,Other Implants C1722,,Per Svc,0.01
Chargemaster Item,,278C1722,SPSI,Other Implants C1722,,Per Svc,0.01
Chargemaster Item,,278C1722,SPSI,Other Implants C1722,,Per Svc,0.01
Chargemaster Item,,278C1722,SPSI,Other Implants C1722,,Per Svc,0.01
Chargemaster Item,,278C1724,SPSI,Other Implants C1724,,Per Svc,0.01
Chargemaster Item,,278C1724,SPSI,Other Implants C1724,,Per Svc,0.01
Chargemaster Item,,278C1724,SPSI,Other Implants C1724,,Per Svc,0.01
Chargemaster Item,,278C1724,SPSI,Other Implants C1724,,Per Svc,0.01
Chargemaster Item,,278C1725,SPSI,Other Implants C1725,,Per Svc,0.01
Chargemaster Item,,278C1725,SPSI,Other Implants C1725,,Per Svc,0.01
Chargemaster Item,,278C1725,SPSI,Other Implants C1725,,Per Svc,0.01
Chargemaster Item,,278C1725,SPSI,Other Implants C1725,,Per Svc,0.01
Chargemaster Item,,278C1726,SPSI,Other Implants C1726,,Per Svc,0.01
Chargemaster Item,,278C1726,SPSI,Other Implants C1726,,Per Svc,0.01
Chargemaster Item,,278C1726,SPSI,Other Implants C1726,,Per Svc,0.01
Chargemaster Item,,278C1726,SPSI,Other Implants C1726,,Per Svc,0.01
Chargemaster Item,,278C1727,SPSI,Other Implants C1727,,Per Svc,0.01
Chargemaster Item,,278C1727,SPSI,Other Implants C1727,,Per Svc,0.01
Chargemaster Item,,278C1727,SPSI,Other Implants C1727,,Per Svc,0.01
Chargemaster Item,,278C1727,SPSI,Other Implants C1727,,Per Svc,0.01
Chargemaster Item,,278C1729,SPSI,Other Implants C1729,,Per Svc,0.01
Chargemaster Item,,278C1729,SPSI,Other Implants C1729,,Per Svc,0.01
Chargemaster Item,,278C1729,SPSI,Other Implants C1729,,Per Svc,0.01
Chargemaster Item,,278C1729,SPSI,Other Implants C1729,,Per Svc,0.01
Chargemaster Item,,278C1730,SPSI,Other Implants C1730,,Per Svc,0.01
Chargemaster Item,,278C1730,SPSI,Other Implants C1730,,Per Svc,0.01
Chargemaster Item,,278C1730,SPSI,Other Implants C1730,,Per Svc,0.01
Chargemaster Item,,278C1730,SPSI,Other Implants C1730,,Per Svc,0.01
Chargemaster Item,,278C1731,SPSI,Other Implants C1731,,Per Svc,0.01
Chargemaster Item,,278C1731,SPSI,Other Implants C1731,,Per Svc,0.01
Chargemaster Item,,278C1731,SPSI,Other Implants C1731,,Per Svc,0.01
Chargemaster Item,,278C1731,SPSI,Other Implants C1731,,Per Svc,0.01
Chargemaster Item,,278C1733,SPSI,Other Implants C1733,,Per Svc,0.01
Chargemaster Item,,278C1733,SPSI,Other Implants C1733,,Per Svc,0.01
Chargemaster Item,,278C1733,SPSI,Other Implants C1733,,Per Svc,0.01
Chargemaster Item,,278C1733,SPSI,Other Implants C1733,,Per Svc,0.01
Chargemaster Item,,278C1750,SPSI,Other Implants C1750,,Per Svc,0.01
Chargemaster Item,,278C1750,SPSI,Other Implants C1750,,Per Svc,0.01
Chargemaster Item,,278C1750,SPSI,Other Implants C1750,,Per Svc,0.01
Chargemaster Item,,278C1750,SPSI,Other Implants C1750,,Per Svc,0.01
Chargemaster Item,,278C1751,SPSI,Other Implants C1751,,Per Svc,0.01
Chargemaster Item,,278C1751,SPSI,Other Implants C1751,,Per Svc,0.01
Chargemaster Item,,278C1751,SPSI,Other Implants C1751,,Per Svc,0.01
Chargemaster Item,,278C1751,SPSI,Other Implants C1751,,Per Svc,0.01
Chargemaster Item,,278C1752,SPSI,Other Implants C1752,,Per Svc,0.01
Chargemaster Item,,278C1752,SPSI,Other Implants C1752,,Per Svc,0.01
Chargemaster Item,,278C1752,SPSI,Other Implants C1752,,Per Svc,0.01
Chargemaster Item,,278C1752,SPSI,Other Implants C1752,,Per Svc,0.01
Chargemaster Item,,278C1753,SPSI,Other Implants C1753,,Per Svc,0.01
Chargemaster Item,,278C1753,SPSI,Other Implants C1753,,Per Svc,0.01
Chargemaster Item,,278C1753,SPSI,Other Implants C1753,,Per Svc,0.01
Chargemaster Item,,278C1753,SPSI,Other Implants C1753,,Per Svc,0.01
Chargemaster Item,,278C1755,SPSI,Other Implants C1755,,Per Svc,0.01
Chargemaster Item,,278C1755,SPSI,Other Implants C1755,,Per Svc,0.01
Chargemaster Item,,278C1755,SPSI,Other Implants C1755,,Per Svc,0.01
Chargemaster Item,,278C1755,SPSI,Other Implants C1755,,Per Svc,0.01
Chargemaster Item,,278C1757,SPSI,Other Implants C1757,,Per Svc,0.01
Chargemaster Item,,278C1757,SPSI,Other Implants C1757,,Per Svc,0.01
Chargemaster Item,,278C1757,SPSI,Other Implants C1757,,Per Svc,0.01
Chargemaster Item,,278C1757,SPSI,Other Implants C1757,,Per Svc,0.01
Chargemaster Item,,278C1758,SPSI,Other Implants C1758,,Per Svc,0.01
Chargemaster Item,,278C1758,SPSI,Other Implants C1758,,Per Svc,0.01
Chargemaster Item,,278C1758,SPSI,Other Implants C1758,,Per Svc,0.01
Chargemaster Item,,278C1758,SPSI,Other Implants C1758,,Per Svc,0.01
Chargemaster Item,,278C1760,SPSI,Other Implants C1760,,Per Svc,0.01
Chargemaster Item,,278C1760,SPSI,Other Implants C1760,,Per Svc,0.01
Chargemaster Item,,278C1760,SPSI,Other Implants C1760,,Per Svc,0.01
Chargemaster Item,,278C1760,SPSI,Other Implants C1760,,Per Svc,0.01
Chargemaster Item,,278C1762,SPSI,Other Implants C1762,,Per Svc,0.01
Chargemaster Item,,278C1762,SPSI,Other Implants C1762,,Per Svc,0.01
Chargemaster Item,,278C1762,SPSI,Other Implants C1762,,Per Svc,0.01
Chargemaster Item,,278C1762,SPSI,Other Implants C1762,,Per Svc,0.01
Chargemaster Item,,278C1763,SPSI,Other Implants C1763,,Per Svc,0.01
Chargemaster Item,,278C1763,SPSI,Other Implants C1763,,Per Svc,0.01
Chargemaster Item,,278C1763,SPSI,Other Implants C1763,,Per Svc,0.01
Chargemaster Item,,278C1763,SPSI,Other Implants C1763,,Per Svc,0.01
Chargemaster Item,,278C1764,SPSI,Other Implants C1764,,Per Svc,0.01
Chargemaster Item,,278C1764,SPSI,Other Implants C1764,,Per Svc,0.01
Chargemaster Item,,278C1764,SPSI,Other Implants C1764,,Per Svc,0.01
Chargemaster Item,,278C1764,SPSI,Other Implants C1764,,Per Svc,0.01
Chargemaster Item,,278C1765,SPSI,Other Implants C1765,,Per Svc,0.01
Chargemaster Item,,278C1765,SPSI,Other Implants C1765,,Per Svc,0.01
Chargemaster Item,,278C1765,SPSI,Other Implants C1765,,Per Svc,0.01
Chargemaster Item,,278C1765,SPSI,Other Implants C1765,,Per Svc,0.01
Chargemaster Item,,278C1766,SPSI,Other Implants C1766,,Per Svc,0.01
Chargemaster Item,,278C1766,SPSI,Other Implants C1766,,Per Svc,0.01
Chargemaster Item,,278C1766,SPSI,Other Implants C1766,,Per Svc,0.01
Chargemaster Item,,278C1766,SPSI,Other Implants C1766,,Per Svc,0.01
Chargemaster Item,,278C1767,SPSI,Other Implants C1767,,Per Svc,0.01
Chargemaster Item,,278C1767,SPSI,Other Implants C1767,,Per Svc,0.01
Chargemaster Item,,278C1767,SPSI,Other Implants C1767,,Per Svc,0.01
Chargemaster Item,,278C1767,SPSI,Other Implants C1767,,Per Svc,0.01
Chargemaster Item,,278C1768,SPSI,Other Implants C1768,,Per Svc,0.01
Chargemaster Item,,278C1768,SPSI,Other Implants C1768,,Per Svc,0.01
Chargemaster Item,,278C1768,SPSI,Other Implants C1768,,Per Svc,0.01
Chargemaster Item,,278C1768,SPSI,Other Implants C1768,,Per Svc,0.01
Chargemaster Item,,278C1769,SPSI,Other Implants C1769,,Per Svc,0.01
Chargemaster Item,,278C1769,SPSI,Other Implants C1769,,Per Svc,0.01
Chargemaster Item,,278C1769,SPSI,Other Implants C1769,,Per Svc,0.01
Chargemaster Item,,278C1769,SPSI,Other Implants C1769,,Per Svc,0.01
Chargemaster Item,,278C1771,SPSI,Other Implants C1771,,Per Svc,0.01
Chargemaster Item,,278C1771,SPSI,Other Implants C1771,,Per Svc,0.01
Chargemaster Item,,278C1771,SPSI,Other Implants C1771,,Per Svc,0.01
Chargemaster Item,,278C1771,SPSI,Other Implants C1771,,Per Svc,0.01
Chargemaster Item,,278C1772,SPSI,Other Implants C1772,,Per Svc,0.01
Chargemaster Item,,278C1772,SPSI,Other Implants C1772,,Per Svc,0.01
Chargemaster Item,,278C1772,SPSI,Other Implants C1772,,Per Svc,0.01
Chargemaster Item,,278C1772,SPSI,Other Implants C1772,,Per Svc,0.01
Chargemaster Item,,278C1773,SPSI,Other Implants C1773,,Per Svc,0.01
Chargemaster Item,,278C1773,SPSI,Other Implants C1773,,Per Svc,0.01
Chargemaster Item,,278C1773,SPSI,Other Implants C1773,,Per Svc,0.01
Chargemaster Item,,278C1773,SPSI,Other Implants C1773,,Per Svc,0.01
Chargemaster Item,,278C1776,SPSI,Other Implants C1776,,Per Svc,0.01
Chargemaster Item,,278C1776,SPSI,Other Implants C1776,,Per Svc,0.01
Chargemaster Item,,278C1776,SPSI,Other Implants C1776,,Per Svc,0.01
Chargemaster Item,,278C1776,SPSI,Other Implants C1776,,Per Svc,0.01
Chargemaster Item,,278C1777,SPSI,Other Implants C1777,,Per Svc,0.01
Chargemaster Item,,278C1777,SPSI,Other Implants C1777,,Per Svc,0.01
Chargemaster Item,,278C1777,SPSI,Other Implants C1777,,Per Svc,0.01
Chargemaster Item,,278C1777,SPSI,Other Implants C1777,,Per Svc,0.01
Chargemaster Item,,278C1778,SPSI,Other Implants C1778,,Per Svc,0.01
Chargemaster Item,,278C1778,SPSI,Other Implants C1778,,Per Svc,0.01
Chargemaster Item,,278C1778,SPSI,Other Implants C1778,,Per Svc,0.01
Chargemaster Item,,278C1778,SPSI,Other Implants C1778,,Per Svc,0.01
Chargemaster Item,,278C1781,SPSI,Other Implants C1781,,Per Svc,0.01
Chargemaster Item,,278C1781,SPSI,Other Implants C1781,,Per Svc,0.01
Chargemaster Item,,278C1781,SPSI,Other Implants C1781,,Per Svc,0.01
Chargemaster Item,,278C1781,SPSI,Other Implants C1781,,Per Svc,0.01
Chargemaster Item,,278C1783,SPSI,Other Implants C1783,,Per Svc,0.01
Chargemaster Item,,278C1783,SPSI,Other Implants C1783,,Per Svc,0.01
Chargemaster Item,,278C1783,SPSI,Other Implants C1783,,Per Svc,0.01
Chargemaster Item,,278C1783,SPSI,Other Implants C1783,,Per Svc,0.01
Chargemaster Item,,278C1785,SPSI,Other Implants C1785,,Per Svc,0.01
Chargemaster Item,,278C1785,SPSI,Other Implants C1785,,Per Svc,0.01
Chargemaster Item,,278C1785,SPSI,Other Implants C1785,,Per Svc,0.01
Chargemaster Item,,278C1785,SPSI,Other Implants C1785,,Per Svc,0.01
Chargemaster Item,,278C1786,SPSI,Other Implants C1786,,Per Svc,0.01
Chargemaster Item,,278C1786,SPSI,Other Implants C1786,,Per Svc,0.01
Chargemaster Item,,278C1786,SPSI,Other Implants C1786,,Per Svc,0.01
Chargemaster Item,,278C1786,SPSI,Other Implants C1786,,Per Svc,0.01
Chargemaster Item,,278C1787,SPSI,Other Implants C1787,,Per Svc,0.01
Chargemaster Item,,278C1787,SPSI,Other Implants C1787,,Per Svc,0.01
Chargemaster Item,,278C1787,SPSI,Other Implants C1787,,Per Svc,0.01
Chargemaster Item,,278C1787,SPSI,Other Implants C1787,,Per Svc,0.01
Chargemaster Item,,278C1788,SPSI,Other Implants C1788,,Per Svc,0.01
Chargemaster Item,,278C1788,SPSI,Other Implants C1788,,Per Svc,0.01
Chargemaster Item,,278C1788,SPSI,Other Implants C1788,,Per Svc,0.01
Chargemaster Item,,278C1788,SPSI,Other Implants C1788,,Per Svc,0.01
Chargemaster Item,,278C1789,SPSI,Other Implants C1789,,Per Svc,0.01
Chargemaster Item,,278C1789,SPSI,Other Implants C1789,,Per Svc,0.01
Chargemaster Item,,278C1789,SPSI,Other Implants C1789,,Per Svc,0.01
Chargemaster Item,,278C1789,SPSI,Other Implants C1789,,Per Svc,0.01
Chargemaster Item,,278C1817,SPSI,Other Implants C1817,,Per Svc,0.01
Chargemaster Item,,278C1817,SPSI,Other Implants C1817,,Per Svc,0.01
Chargemaster Item,,278C1817,SPSI,Other Implants C1817,,Per Svc,0.01
Chargemaster Item,,278C1817,SPSI,Other Implants C1817,,Per Svc,0.01
Chargemaster Item,,278C1821,SPSI,Other Implants C1821,,Per Svc,0.01
Chargemaster Item,,278C1821,SPSI,Other Implants C1821,,Per Svc,0.01
Chargemaster Item,,278C1821,SPSI,Other Implants C1821,,Per Svc,0.01
Chargemaster Item,,278C1821,SPSI,Other Implants C1821,,Per Svc,0.01
Chargemaster Item,,278C1874,SPSI,Other Implants C1874,,Per Svc,0.01
Chargemaster Item,,278C1874,SPSI,Other Implants C1874,,Per Svc,0.01
Chargemaster Item,,278C1874,SPSI,Other Implants C1874,,Per Svc,0.01
Chargemaster Item,,278C1874,SPSI,Other Implants C1874,,Per Svc,0.01
Chargemaster Item,,278C1875,SPSI,Other Implants C1875,,Per Svc,0.01
Chargemaster Item,,278C1875,SPSI,Other Implants C1875,,Per Svc,0.01
Chargemaster Item,,278C1875,SPSI,Other Implants C1875,,Per Svc,0.01
Chargemaster Item,,278C1875,SPSI,Other Implants C1875,,Per Svc,0.01
Chargemaster Item,,278C1876,SPSI,Other Implants C1876,,Per Svc,0.01
Chargemaster Item,,278C1876,SPSI,Other Implants C1876,,Per Svc,0.01
Chargemaster Item,,278C1876,SPSI,Other Implants C1876,,Per Svc,0.01
Chargemaster Item,,278C1876,SPSI,Other Implants C1876,,Per Svc,0.01
Chargemaster Item,,278C1880,SPSI,Other Implants C1880,,Per Svc,0.01
Chargemaster Item,,278C1880,SPSI,Other Implants C1880,,Per Svc,0.01
Chargemaster Item,,278C1880,SPSI,Other Implants C1880,,Per Svc,0.01
Chargemaster Item,,278C1880,SPSI,Other Implants C1880,,Per Svc,0.01
Chargemaster Item,,278C1881,SPSI,Other Implants C1881,,Per Svc,0.01
Chargemaster Item,,278C1881,SPSI,Other Implants C1881,,Per Svc,0.01
Chargemaster Item,,278C1881,SPSI,Other Implants C1881,,Per Svc,0.01
Chargemaster Item,,278C1881,SPSI,Other Implants C1881,,Per Svc,0.01
Chargemaster Item,,278C1882,SPSI,Other Implants C1882,,Per Svc,0.01
Chargemaster Item,,278C1882,SPSI,Other Implants C1882,,Per Svc,0.01
Chargemaster Item,,278C1882,SPSI,Other Implants C1882,,Per Svc,0.01
Chargemaster Item,,278C1882,SPSI,Other Implants C1882,,Per Svc,0.01
Chargemaster Item,,278C1883,SPSI,Other Implants C1883,,Per Svc,0.01
Chargemaster Item,,278C1883,SPSI,Other Implants C1883,,Per Svc,0.01
Chargemaster Item,,278C1883,SPSI,Other Implants C1883,,Per Svc,0.01
Chargemaster Item,,278C1883,SPSI,Other Implants C1883,,Per Svc,0.01
Chargemaster Item,,278C1884,SPSI,Other Implants C1884,,Per Svc,0.01
Chargemaster Item,,278C1884,SPSI,Other Implants C1884,,Per Svc,0.01
Chargemaster Item,,278C1884,SPSI,Other Implants C1884,,Per Svc,0.01
Chargemaster Item,,278C1884,SPSI,Other Implants C1884,,Per Svc,0.01
Chargemaster Item,,278C1886,SPSI,Other Implants C1886,,Per Svc,0.01
Chargemaster Item,,278C1886,SPSI,Other Implants C1886,,Per Svc,0.01
Chargemaster Item,,278C1886,SPSI,Other Implants C1886,,Per Svc,0.01
Chargemaster Item,,278C1886,SPSI,Other Implants C1886,,Per Svc,0.01
Chargemaster Item,,278C1887,SPSI,Other Implants C1887,,Per Svc,0.01
Chargemaster Item,,278C1887,SPSI,Other Implants C1887,,Per Svc,0.01
Chargemaster Item,,278C1887,SPSI,Other Implants C1887,,Per Svc,0.01
Chargemaster Item,,278C1887,SPSI,Other Implants C1887,,Per Svc,0.01
Chargemaster Item,,278C1889,SPSI,Other Implants C1889,,Per Svc,0.01
Chargemaster Item,,278C1889,SPSI,Other Implants C1889,,Per Svc,0.01
Chargemaster Item,,278C1889,SPSI,Other Implants C1889,,Per Svc,0.01
Chargemaster Item,,278C1889,SPSI,Other Implants C1889,,Per Svc,0.01
Chargemaster Item,,278C1892,SPSI,Other Implants C1892,,Per Svc,0.01
Chargemaster Item,,278C1892,SPSI,Other Implants C1892,,Per Svc,0.01
Chargemaster Item,,278C1892,SPSI,Other Implants C1892,,Per Svc,0.01
Chargemaster Item,,278C1892,SPSI,Other Implants C1892,,Per Svc,0.01
Chargemaster Item,,278C1893,SPSI,Other Implants C1893,,Per Svc,0.01
Chargemaster Item,,278C1893,SPSI,Other Implants C1893,,Per Svc,0.01
Chargemaster Item,,278C1893,SPSI,Other Implants C1893,,Per Svc,0.01
Chargemaster Item,,278C1893,SPSI,Other Implants C1893,,Per Svc,0.01
Chargemaster Item,,278C1894,SPSI,Other Implants C1894,,Per Svc,0.01
Chargemaster Item,,278C1894,SPSI,Other Implants C1894,,Per Svc,0.01
Chargemaster Item,,278C1894,SPSI,Other Implants C1894,,Per Svc,0.01
Chargemaster Item,,278C1894,SPSI,Other Implants C1894,,Per Svc,0.01
Chargemaster Item,,278C1897,SPSI,Other Implants C1897,,Per Svc,0.01
Chargemaster Item,,278C1897,SPSI,Other Implants C1897,,Per Svc,0.01
Chargemaster Item,,278C1897,SPSI,Other Implants C1897,,Per Svc,0.01
Chargemaster Item,,278C1897,SPSI,Other Implants C1897,,Per Svc,0.01
Chargemaster Item,,278C1898,SPSI,Other Implants C1898,,Per Svc,0.01
Chargemaster Item,,278C1898,SPSI,Other Implants C1898,,Per Svc,0.01
Chargemaster Item,,278C1898,SPSI,Other Implants C1898,,Per Svc,0.01
Chargemaster Item,,278C1898,SPSI,Other Implants C1898,,Per Svc,0.01
Chargemaster Item,,278C1900,SPSI,Other Implants C1900,,Per Svc,0.01
Chargemaster Item,,278C1900,SPSI,Other Implants C1900,,Per Svc,0.01
Chargemaster Item,,278C1900,SPSI,Other Implants C1900,,Per Svc,0.01
Chargemaster Item,,278C1900,SPSI,Other Implants C1900,,Per Svc,0.01
Chargemaster Item,,278C2617,SPSI,Other Implants C2617,,Per Svc,0.01
Chargemaster Item,,278C2617,SPSI,Other Implants C2617,,Per Svc,0.01
Chargemaster Item,,278C2617,SPSI,Other Implants C2617,,Per Svc,0.01
Chargemaster Item,,278C2617,SPSI,Other Implants C2617,,Per Svc,0.01
Chargemaster Item,,278C2618,SPSI,Other Implants C2618,,Per Svc,0.01
Chargemaster Item,,278C2618,SPSI,Other Implants C2618,,Per Svc,0.01
Chargemaster Item,,278C2618,SPSI,Other Implants C2618,,Per Svc,0.01
Chargemaster Item,,278C2618,SPSI,Other Implants C2618,,Per Svc,0.01
Chargemaster Item,,278C2623,SPSI,Other Implants C2623,,Per Svc,0.01
Chargemaster Item,,278C2623,SPSI,Other Implants C2623,,Per Svc,0.01
Chargemaster Item,,278C2623,SPSI,Other Implants C2623,,Per Svc,0.01
Chargemaster Item,,278C2623,SPSI,Other Implants C2623,,Per Svc,0.01
Chargemaster Item,,278C2625,SPSI,Other Implants C2625,,Per Svc,0.01
Chargemaster Item,,278C2625,SPSI,Other Implants C2625,,Per Svc,0.01
Chargemaster Item,,278C2625,SPSI,Other Implants C2625,,Per Svc,0.01
Chargemaster Item,,278C2625,SPSI,Other Implants C2625,,Per Svc,0.01
Chargemaster Item,,278C2627,SPSI,Other Implants C2627,,Per Svc,0.01
Chargemaster Item,,278C2627,SPSI,Other Implants C2627,,Per Svc,0.01
Chargemaster Item,,278C2627,SPSI,Other Implants C2627,,Per Svc,0.01
Chargemaster Item,,278C2627,SPSI,Other Implants C2627,,Per Svc,0.01
Chargemaster Item,,278C2628,SPSI,Other Implants C2628,,Per Svc,0.01
Chargemaster Item,,278C2628,SPSI,Other Implants C2628,,Per Svc,0.01
Chargemaster Item,,278C2628,SPSI,Other Implants C2628,,Per Svc,0.01
Chargemaster Item,,278C2628,SPSI,Other Implants C2628,,Per Svc,0.01
Chargemaster Item,,278C2630,SPSI,Other Implants C2630,,Per Svc,0.01
Chargemaster Item,,278C2630,SPSI,Other Implants C2630,,Per Svc,0.01
Chargemaster Item,,278C2630,SPSI,Other Implants C2630,,Per Svc,0.01
Chargemaster Item,,278C2630,SPSI,Other Implants C2630,,Per Svc,0.01
Chargemaster Item,,278C2639,SPSI,Other Implants C2639,,Per Svc,0.01
Chargemaster Item,,278C2639,SPSI,Other Implants C2639,,Per Svc,0.01
Chargemaster Item,,278C2639,SPSI,Other Implants C2639,,Per Svc,0.01
Chargemaster Item,,278C2639,SPSI,Other Implants C2639,,Per Svc,0.01
Chargemaster Item,,278C9250,SPSI,Other Implants C9250,,Per Svc,0.01
Chargemaster Item,,278C9250,SPSI,Other Implants C9250,,Per Svc,0.01
Chargemaster Item,,278C9250,SPSI,Other Implants C9250,,Per Svc,0.01
Chargemaster Item,,278C9250,SPSI,Other Implants C9250,,Per Svc,0.01
Chargemaster Item,,278C9352,SPSI,Other Implants C9352,,Per Svc,0.01
Chargemaster Item,,278C9352,SPSI,Other Implants C9352,,Per Svc,0.01
Chargemaster Item,,278C9352,SPSI,Other Implants C9352,,Per Svc,0.01
Chargemaster Item,,278C9352,SPSI,Other Implants C9352,,Per Svc,0.01
Chargemaster Item,,278C9353,SPSI,Other Implants C9353,,Per Svc,0.01
Chargemaster Item,,278C9353,SPSI,Other Implants C9353,,Per Svc,0.01
Chargemaster Item,,278C9353,SPSI,Other Implants C9353,,Per Svc,0.01
Chargemaster Item,,278C9353,SPSI,Other Implants C9353,,Per Svc,0.01
Chargemaster Item,,278C9363,SPSI,Other Implants C9363,,Per Svc,0.01
Chargemaster Item,,278C9363,SPSI,Other Implants C9363,,Per Svc,0.01
Chargemaster Item,,278C9363,SPSI,Other Implants C9363,,Per Svc,0.01
Chargemaster Item,,278C9363,SPSI,Other Implants C9363,,Per Svc,0.01
Chargemaster Item,,278E0191,SPSI,Other Implants E0191,,Per Svc,0.01
Chargemaster Item,,278E0191,SPSI,Other Implants E0191,,Per Svc,0.01
Chargemaster Item,,278E0191,SPSI,Other Implants E0191,,Per Svc,0.01
Chargemaster Item,,278E0191,SPSI,Other Implants E0191,,Per Svc,0.01
Chargemaster Item,,278E0235,SPSI,Other Implants E0235,,Per Svc,0.01
Chargemaster Item,,278E0235,SPSI,Other Implants E0235,,Per Svc,0.01
Chargemaster Item,,278E0235,SPSI,Other Implants E0235,,Per Svc,0.01
Chargemaster Item,,278E0235,SPSI,Other Implants E0235,,Per Svc,0.01
Chargemaster Item,,278L0113,SPSI,Other Implants L0113,,Per Svc,0.01
Chargemaster Item,,278L0113,SPSI,Other Implants L0113,,Per Svc,0.01
Chargemaster Item,,278L0113,SPSI,Other Implants L0113,,Per Svc,0.01
Chargemaster Item,,278L0113,SPSI,Other Implants L0113,,Per Svc,0.01
Chargemaster Item,,278L0120,SPSI,Other Implants L0120,,Per Svc,0.01
Chargemaster Item,,278L0120,SPSI,Other Implants L0120,,Per Svc,0.01
Chargemaster Item,,278L0120,SPSI,Other Implants L0120,,Per Svc,0.01
Chargemaster Item,,278L0120,SPSI,Other Implants L0120,,Per Svc,0.01
Chargemaster Item,,278L0172,SPSI,Other Implants L0172,,Per Svc,0.01
Chargemaster Item,,278L0172,SPSI,Other Implants L0172,,Per Svc,0.01
Chargemaster Item,,278L0172,SPSI,Other Implants L0172,,Per Svc,0.01
Chargemaster Item,,278L0172,SPSI,Other Implants L0172,,Per Svc,0.01
Chargemaster Item,,278L0174,SPSI,Other Implants L0174,,Per Svc,0.01
Chargemaster Item,,278L0174,SPSI,Other Implants L0174,,Per Svc,0.01
Chargemaster Item,,278L0174,SPSI,Other Implants L0174,,Per Svc,0.01
Chargemaster Item,,278L0174,SPSI,Other Implants L0174,,Per Svc,0.01
Chargemaster Item,,278L0625,SPSI,Other Implants L0625,,Per Svc,0.01
Chargemaster Item,,278L0625,SPSI,Other Implants L0625,,Per Svc,0.01
Chargemaster Item,,278L0625,SPSI,Other Implants L0625,,Per Svc,0.01
Chargemaster Item,,278L0625,SPSI,Other Implants L0625,,Per Svc,0.01
Chargemaster Item,,278L1820,SPSI,Other Implants L1820,,Per Svc,0.01
Chargemaster Item,,278L1820,SPSI,Other Implants L1820,,Per Svc,0.01
Chargemaster Item,,278L1820,SPSI,Other Implants L1820,,Per Svc,0.01
Chargemaster Item,,278L1820,SPSI,Other Implants L1820,,Per Svc,0.01
Chargemaster Item,,278L1830,SPSI,Other Implants L1830,,Per Svc,0.01
Chargemaster Item,,278L1830,SPSI,Other Implants L1830,,Per Svc,0.01
Chargemaster Item,,278L1830,SPSI,Other Implants L1830,,Per Svc,0.01
Chargemaster Item,,278L1830,SPSI,Other Implants L1830,,Per Svc,0.01
Chargemaster Item,,278L1832,SPSI,Other Implants L1832,,Per Svc,0.01
Chargemaster Item,,278L1832,SPSI,Other Implants L1832,,Per Svc,0.01
Chargemaster Item,,278L1832,SPSI,Other Implants L1832,,Per Svc,0.01
Chargemaster Item,,278L1832,SPSI,Other Implants L1832,,Per Svc,0.01
Chargemaster Item,,278L1902,SPSI,Other Implants L1902,,Per Svc,0.01
Chargemaster Item,,278L1902,SPSI,Other Implants L1902,,Per Svc,0.01
Chargemaster Item,,278L1902,SPSI,Other Implants L1902,,Per Svc,0.01
Chargemaster Item,,278L1902,SPSI,Other Implants L1902,,Per Svc,0.01
Chargemaster Item,,278L1930,SPSI,Other Implants L1930,,Per Svc,0.01
Chargemaster Item,,278L1930,SPSI,Other Implants L1930,,Per Svc,0.01
Chargemaster Item,,278L1930,SPSI,Other Implants L1930,,Per Svc,0.01
Chargemaster Item,,278L1930,SPSI,Other Implants L1930,,Per Svc,0.01
Chargemaster Item,,278L3260,SPSI,Other Implants L3260,,Per Svc,0.01
Chargemaster Item,,278L3260,SPSI,Other Implants L3260,,Per Svc,0.01
Chargemaster Item,,278L3260,SPSI,Other Implants L3260,,Per Svc,0.01
Chargemaster Item,,278L3260,SPSI,Other Implants L3260,,Per Svc,0.01
Chargemaster Item,,278L3650,SPSI,Other Implants L3650,,Per Svc,0.01
Chargemaster Item,,278L3650,SPSI,Other Implants L3650,,Per Svc,0.01
Chargemaster Item,,278L3650,SPSI,Other Implants L3650,,Per Svc,0.01
Chargemaster Item,,278L3650,SPSI,Other Implants L3650,,Per Svc,0.01
Chargemaster Item,,278L3670,SPSI,Other Implants L3670,,Per Svc,0.01
Chargemaster Item,,278L3670,SPSI,Other Implants L3670,,Per Svc,0.01
Chargemaster Item,,278L3670,SPSI,Other Implants L3670,,Per Svc,0.01
Chargemaster Item,,278L3670,SPSI,Other Implants L3670,,Per Svc,0.01
Chargemaster Item,,278L3807,SPSI,Other Implants L3807,,Per Svc,0.01
Chargemaster Item,,278L3807,SPSI,Other Implants L3807,,Per Svc,0.01
Chargemaster Item,,278L3807,SPSI,Other Implants L3807,,Per Svc,0.01
Chargemaster Item,,278L3807,SPSI,Other Implants L3807,,Per Svc,0.01
Chargemaster Item,,278L3809,SPSI,Other Implants L3809,,Per Svc,0.01
Chargemaster Item,,278L3809,SPSI,Other Implants L3809,,Per Svc,0.01
Chargemaster Item,,278L3809,SPSI,Other Implants L3809,,Per Svc,0.01
Chargemaster Item,,278L3809,SPSI,Other Implants L3809,,Per Svc,0.01
Chargemaster Item,,278L3908,SPSI,Other Implants L3908,,Per Svc,0.01
Chargemaster Item,,278L3908,SPSI,Other Implants L3908,,Per Svc,0.01
Chargemaster Item,,278L3908,SPSI,Other Implants L3908,,Per Svc,0.01
Chargemaster Item,,278L3908,SPSI,Other Implants L3908,,Per Svc,0.01
Chargemaster Item,,278L3917,SPSI,Other Implants L3917,,Per Svc,0.01
Chargemaster Item,,278L3917,SPSI,Other Implants L3917,,Per Svc,0.01
Chargemaster Item,,278L3917,SPSI,Other Implants L3917,,Per Svc,0.01
Chargemaster Item,,278L3917,SPSI,Other Implants L3917,,Per Svc,0.01
Chargemaster Item,,278L3923,SPSI,Other Implants L3923,,Per Svc,0.01
Chargemaster Item,,278L3923,SPSI,Other Implants L3923,,Per Svc,0.01
Chargemaster Item,,278L3923,SPSI,Other Implants L3923,,Per Svc,0.01
Chargemaster Item,,278L3923,SPSI,Other Implants L3923,,Per Svc,0.01
Chargemaster Item,,278L4386,SPSI,Other Implants L4386,,Per Svc,0.01
Chargemaster Item,,278L4386,SPSI,Other Implants L4386,,Per Svc,0.01
Chargemaster Item,,278L4386,SPSI,Other Implants L4386,,Per Svc,0.01
Chargemaster Item,,278L4386,SPSI,Other Implants L4386,,Per Svc,0.01
Chargemaster Item,,278L4387,SPSI,Other Implants L4387,,Per Svc,0.01
Chargemaster Item,,278L4387,SPSI,Other Implants L4387,,Per Svc,0.01
Chargemaster Item,,278L4387,SPSI,Other Implants L4387,,Per Svc,0.01
Chargemaster Item,,278L4387,SPSI,Other Implants L4387,,Per Svc,0.01
Chargemaster Item,,278L5000,SPSI,Other Implants L5000,,Per Svc,0.01
Chargemaster Item,,278L5000,SPSI,Other Implants L5000,,Per Svc,0.01
Chargemaster Item,,278L5000,SPSI,Other Implants L5000,,Per Svc,0.01
Chargemaster Item,,278L5000,SPSI,Other Implants L5000,,Per Svc,0.01
Chargemaster Item,,278L8000,SPSI,Other Implants L8000,,Per Svc,0.01
Chargemaster Item,,278L8000,SPSI,Other Implants L8000,,Per Svc,0.01
Chargemaster Item,,278L8000,SPSI,Other Implants L8000,,Per Svc,0.01
Chargemaster Item,,278L8000,SPSI,Other Implants L8000,,Per Svc,0.01
Chargemaster Item,,278L8501,SPSI,Other Implants L8501,,Per Svc,0.01
Chargemaster Item,,278L8501,SPSI,Other Implants L8501,,Per Svc,0.01
Chargemaster Item,,278L8501,SPSI,Other Implants L8501,,Per Svc,0.01
Chargemaster Item,,278L8501,SPSI,Other Implants L8501,,Per Svc,0.01
Chargemaster Item,,278L8600,SPSI,Other Implants L8600,,Per Svc,0.01
Chargemaster Item,,278L8600,SPSI,Other Implants L8600,,Per Svc,0.01
Chargemaster Item,,278L8600,SPSI,Other Implants L8600,,Per Svc,0.01
Chargemaster Item,,278L8600,SPSI,Other Implants L8600,,Per Svc,0.01
Chargemaster Item,,278L8612,SPSI,Other Implants L8612,,Per Svc,0.01
Chargemaster Item,,278L8612,SPSI,Other Implants L8612,,Per Svc,0.01
Chargemaster Item,,278L8612,SPSI,Other Implants L8612,,Per Svc,0.01
Chargemaster Item,,278L8612,SPSI,Other Implants L8612,,Per Svc,0.01
Chargemaster Item,,278L8680,SPSI,Other Implants L8680,,Per Svc,0.01
Chargemaster Item,,278L8680,SPSI,Other Implants L8680,,Per Svc,0.01
Chargemaster Item,,278L8680,SPSI,Other Implants L8680,,Per Svc,0.01
Chargemaster Item,,278L8680,SPSI,Other Implants L8680,,Per Svc,0.01
Chargemaster Item,,278L8699,SPSI,Other Implants L8699,,Per Svc,0.01
Chargemaster Item,,278L8699,SPSI,Other Implants L8699,,Per Svc,0.01
Chargemaster Item,,278L8699,SPSI,Other Implants L8699,,Per Svc,0.01
Chargemaster Item,,278L8699,SPSI,Other Implants L8699,,Per Svc,0.01
Chargemaster Item,,278Q4100,SPSI,Other Implants Q4100,,Per Svc,0.01
Chargemaster Item,,278Q4100,SPSI,Other Implants Q4100,,Per Svc,0.01
Chargemaster Item,,278Q4100,SPSI,Other Implants Q4100,,Per Svc,0.01
Chargemaster Item,,278Q4100,SPSI,Other Implants Q4100,,Per Svc,0.01
Chargemaster Item,,278Q4102,SPSI,Other Implants Q4102,,Per Svc,0.01
Chargemaster Item,,278Q4102,SPSI,Other Implants Q4102,,Per Svc,0.01
Chargemaster Item,,278Q4102,SPSI,Other Implants Q4102,,Per Svc,0.01
Chargemaster Item,,278Q4102,SPSI,Other Implants Q4102,,Per Svc,0.01
Chargemaster Item,,278Q4110,SPSI,Other Implants Q4110,,Per Svc,0.01
Chargemaster Item,,278Q4110,SPSI,Other Implants Q4110,,Per Svc,0.01
Chargemaster Item,,278Q4110,SPSI,Other Implants Q4110,,Per Svc,0.01
Chargemaster Item,,278Q4110,SPSI,Other Implants Q4110,,Per Svc,0.01
Chargemaster Item,,278Q4114,SPSI,Other Implants Q4114,,Per Svc,0.01
Chargemaster Item,,278Q4114,SPSI,Other Implants Q4114,,Per Svc,0.01
Chargemaster Item,,278Q4114,SPSI,Other Implants Q4114,,Per Svc,0.01
Chargemaster Item,,278Q4114,SPSI,Other Implants Q4114,,Per Svc,0.01
Chargemaster Item,,278Q4116,SPSI,Other Implants Q4116,,Per Svc,0.01
Chargemaster Item,,278Q4116,SPSI,Other Implants Q4116,,Per Svc,0.01
Chargemaster Item,,278Q4116,SPSI,Other Implants Q4116,,Per Svc,0.01
Chargemaster Item,,278Q4116,SPSI,Other Implants Q4116,,Per Svc,0.01
Chargemaster Item,,278Q4118,SPSI,Other Implants Q4118,,Per Svc,0.01
Chargemaster Item,,278Q4118,SPSI,Other Implants Q4118,,Per Svc,0.01
Chargemaster Item,,278Q4118,SPSI,Other Implants Q4118,,Per Svc,0.01
Chargemaster Item,,278Q4118,SPSI,Other Implants Q4118,,Per Svc,0.01
Chargemaster Item,,278Q4125,SPSI,Other Implants Q4125,,Per Svc,0.01
Chargemaster Item,,278Q4125,SPSI,Other Implants Q4125,,Per Svc,0.01
Chargemaster Item,,278Q4125,SPSI,Other Implants Q4125,,Per Svc,0.01
Chargemaster Item,,278Q4125,SPSI,Other Implants Q4125,,Per Svc,0.01
Chargemaster Item,,278Q4128,SPSI,Other Implants Q4128,,Per Svc,0.01
Chargemaster Item,,278Q4128,SPSI,Other Implants Q4128,,Per Svc,0.01
Chargemaster Item,,278Q4128,SPSI,Other Implants Q4128,,Per Svc,0.01
Chargemaster Item,,278Q4128,SPSI,Other Implants Q4128,,Per Svc,0.01
Chargemaster Item,,278Q4130,SPSI,Other Implants Q4130,,Per Svc,0.01
Chargemaster Item,,278Q4130,SPSI,Other Implants Q4130,,Per Svc,0.01
Chargemaster Item,,278Q4130,SPSI,Other Implants Q4130,,Per Svc,0.01
Chargemaster Item,,278Q4130,SPSI,Other Implants Q4130,,Per Svc,0.01
Chargemaster Item,,278Q4133,SPSI,Other Implants Q4133,,Per Svc,0.01
Chargemaster Item,,278Q4133,SPSI,Other Implants Q4133,,Per Svc,0.01
Chargemaster Item,,278Q4133,SPSI,Other Implants Q4133,,Per Svc,0.01
Chargemaster Item,,278Q4133,SPSI,Other Implants Q4133,,Per Svc,0.01
Chargemaster Item,,278Q4155,SPSI,Other Implants Q4155,,Per Svc,0.01
Chargemaster Item,,278Q4155,SPSI,Other Implants Q4155,,Per Svc,0.01
Chargemaster Item,,278Q4155,SPSI,Other Implants Q4155,,Per Svc,0.01
Chargemaster Item,,278Q4155,SPSI,Other Implants Q4155,,Per Svc,0.01
Chargemaster Item,,278Q4166,SPSI,Other Implants Q4166,,Per Svc,0.01
Chargemaster Item,,278Q4166,SPSI,Other Implants Q4166,,Per Svc,0.01
Chargemaster Item,,278Q4166,SPSI,Other Implants Q4166,,Per Svc,0.01
Chargemaster Item,,278Q4166,SPSI,Other Implants Q4166,,Per Svc,0.01
Chargemaster Item,,278Q4186,SPSI,Other Implants Q4186,,Per Svc,0.01
Chargemaster Item,,278Q4186,SPSI,Other Implants Q4186,,Per Svc,0.01
Chargemaster Item,,278Q4186,SPSI,Other Implants Q4186,,Per Svc,0.01
Chargemaster Item,,278Q4186,SPSI,Other Implants Q4186,,Per Svc,0.01
Chargemaster Item,,278Q9963,SPSI,Other Implants Q9963,,Per Svc,0.01
Chargemaster Item,,278Q9963,SPSI,Other Implants Q9963,,Per Svc,0.01
Chargemaster Item,,278Q9963,SPSI,Other Implants Q9963,,Per Svc,0.01
Chargemaster Item,,278Q9963,SPSI,Other Implants Q9963,,Per Svc,0.01
Chargemaster Item,,278Q9967,SPSI,Other Implants Q9967,,Per Svc,0.01
Chargemaster Item,,278Q9967,SPSI,Other Implants Q9967,,Per Svc,0.01
Chargemaster Item,,278Q9967,SPSI,Other Implants Q9967,,Per Svc,0.01
Chargemaster Item,,278Q9967,SPSI,Other Implants Q9967,,Per Svc,0.01
Chargemaster Item,,278V2630,SPSI,Other Implants V2630,,Per Svc,0.01
Chargemaster Item,,278V2630,SPSI,Other Implants V2630,,Per Svc,0.01
Chargemaster Item,,278V2630,SPSI,Other Implants V2630,,Per Svc,0.01
Chargemaster Item,,278V2630,SPSI,Other Implants V2630,,Per Svc,0.01
Chargemaster Item,,278V2632,SPSI,Other Implants V2632,,Per Svc,0.01
Chargemaster Item,,278V2632,SPSI,Other Implants V2632,,Per Svc,0.01
Chargemaster Item,,278V2632,SPSI,Other Implants V2632,,Per Svc,0.01
Chargemaster Item,,278V2632,SPSI,Other Implants V2632,,Per Svc,0.01
Chargemaster Item,,278V2790,SPSI,Other Implants V2790,,Per Svc,0.01
Chargemaster Item,,278V2790,SPSI,Other Implants V2790,,Per Svc,0.01
Chargemaster Item,,278V2790,SPSI,Other Implants V2790,,Per Svc,0.01
Chargemaster Item,,278V2790,SPSI,Other Implants V2790,,Per Svc,0.01
Chargemaster Item,,278XXXXX,SPSI,Other Implants,,Per Svc,0.01
Chargemaster Item,,278XXXXX,SPSI,Other Implants,,Per Svc,0.01
Chargemaster Item,,278XXXXX,SPSI,Other Implants,,Per Svc,0.01
Chargemaster Item,,278XXXXX,SPSI,Other Implants,,Per Svc,0.01
Chargemaster Item,,27901115,SPSI,Hip Implants,,Per Svc,0.01
Chargemaster Item,,27901123,SPSI,Shoulder Implants,,Per Svc,0.01
Chargemaster Item,,27901131,SPSI,Ankle Implants,,Per Svc,0.01
Chargemaster Item,,27901149,SPSI,Elbow Implants,,Per Svc,0.01
Chargemaster Item,,27901156,SPSI,Knee Implants,,Per Svc,0.01
Chargemaster Item,,27901164,SPSI,Hand Implants,,Per Svc,0.01
Chargemaster Item,,27901172,SPSI,Arm Implants,,Per Svc,0.01
Chargemaster Item,,27901180,SPSI,Leg Implants,,Per Svc,0.01
Chargemaster Item,,27901198,SPSI,Pelvic Implants,,Per Svc,0.01
Chargemaster Item,,27901214,SPSI,Face Implants,,Per Svc,0.01
Chargemaster Item,,27901222,SPSI,Head Implants,,Per Svc,0.01
Chargemaster Item,,27929603,SPSI,Cardioversion,,Per Svc,18029.00
Chargemaster Item,,27935030,SPSI,Swan Ganz Insertion,,Per Svc,3144.00
Chargemaster Item,,27990001,SPSI,Blood Transfusion,,Per Svc,1860.00
Chargemaster Item,,27990019,SPSI,BT Catheter,,Per Svc,10000.00
Chargemaster Item,,27990027,SPSI,Bronchoscopy,,Per Svc,5276.00
Chargemaster Item,,27990035,SPSI,Bone Marrow Biopsy,,Per Svc,601.00
Chargemaster Item,,27990043,SPSI,Change Peg Tube,,Per Svc,519.00
Chargemaster Item,,27990050,SPSI,Endotracheal Intubation,,Per Svc,845.00
Chargemaster Item,,27990068,SPSI,K Wires,,Per Svc,300.00
Chargemaster Item,,27990076,SPSI,K Wires Hole,,Per Svc,96.00
Chargemaster Item,,27990084,SPSI,Rush Pin Light,,Per Svc,216.00
Chargemaster Item,,27990092,SPSI,Generator Neuro W Rechg Batt,,Per Svc,69960.00
Chargemaster Item,,27990100,SPSI,Generator Neurostimulator,,Per Svc,46640.00
Chargemaster Item,,27990118,SPSI,Painmgmt Electrode,,Per Svc,22800.00
Chargemaster Item,,27990126,SPSI,Painmgmt Electrode Extension,,Per Svc,7000.00
Chargemaster Item,,27990134,SPSI,Painmgmt Pump,,Per Svc,40660.00
Chargemaster Item,,27990142,SPSI,St Pin Dia Tro,,Per Svc,688.00
Chargemaster Item,,27990159,SPSI,Catheter Intraspinal,,Per Svc,3468.00
Chargemaster Item,,27990167,SPSI,Mammary Implant,,Per Svc,7192.00
Chargemaster Item,,27990175,SPSI,Urinary Sphincter Device,,Per Svc,40820.00
Chargemaster Item,,27990183,SPSI,Wires,,Per Svc,72.00
Chargemaster Item,,27990191,SPSI,Gigli Saw,,Per Svc,243.00
Chargemaster Item,,27990209,SPSI,Arch Bars,,Per Svc,344.00
Chargemaster Item,,27990217,SPSI,Arch Bar Wire,,Per Svc,28.00
Chargemaster Item,,27990225,SPSI,Avitene,,Per Svc,1138.00
Chargemaster Item,,27990233,SPSI,Bili Probe Fog,,Per Svc,827.00
Chargemaster Item,,27990241,SPSI,Gill Br Biopsy,,Per Svc,1266.00
Chargemaster Item,,27990258,SPSI,Bone Wax,,Per Svc,10528.00
Chargemaster Item,,27990266,SPSI,Malecot Cath,,Per Svc,39.00
Chargemaster Item,,27990274,SPSI,Cath Mushroom,,Per Svc,29.00
Chargemaster Item,,27990282,SPSI,Chafin Tube,,Per Svc,515.00
Chargemaster Item,,27990290,SPSI,Rub Ch Tube,,Per Svc,231.00
Chargemaster Item,,27990308,SPSI,Cholecyst Cath,,Per Svc,623.00
Chargemaster Item,,27990316,SPSI,Colon Tube,,Per Svc,65.00
Chargemaster Item,,27990324,SPSI,Colostomy Rod,,Per Svc,52.00
Chargemaster Item,,27990332,SPSI,Coloplast Ur B,,Per Svc,95.00
Chargemaster Item,,27990340,SPSI,Derm Bld Brown,,Per Svc,515.00
Chargemaster Item,,27990357,SPSI,Cath Embo Fogt,,Per Svc,136.00
Chargemaster Item,,27990365,SPSI,Cath Embofogt Irri,,Per Svc,82.00
Chargemaster Item,,27990373,SPSI,Gelfoam Sm,,Per Svc,48.00
Chargemaster Item,,27990381,SPSI,Gelfoam Lg 100,,Per Svc,144.00
Chargemaster Item,,27990399,SPSI,Inf Feed Tube,,Per Svc,980.00
Chargemaster Item,,27990407,SPSI,Jav Bypass Can,,Per Svc,243.00
Chargemaster Item,,27990415,SPSI,Jejunosto Cath,,Per Svc,1211.00
Chargemaster Item,,27990423,SPSI,Leond Gl Tube,,Per Svc,1072.00
Chargemaster Item,,27990431,SPSI,Levine Tub Rub,,Per Svc,91.00
Chargemaster Item,,27990449,SPSI,Mesh,,Per Svc,792.00
Chargemaster Item,,27990456,SPSI,Bone Fibula Whole,,Per Svc,2872.00
Chargemaster Item,,27990464,SPSI,Oxycel Cotton,,Per Svc,75.00
Chargemaster Item,,27990472,SPSI,Sump Dr Bard,,Per Svc,834.00
Chargemaster Item,,27990480,SPSI,Surgicel 2X3,,Per Svc,439.00
Chargemaster Item,,27990498,SPSI,Surgicel 2X14,,Per Svc,784.00
Chargemaster Item,,27990506,SPSI,Teflon Pledget,,Per Svc,1440.00
Chargemaster Item,,27990514,SPSI,T Tubes,,Per Svc,144.00
Chargemaster Item,,27990522,SPSI,Trach T Fome,,Per Svc,220.00
Chargemaster Item,,27990530,SPSI,Uret Cath Coude All,,Per Svc,68.00
Chargemaster Item,,27990548,SPSI,Cath Uret Cone All,,Per Svc,56.00
Chargemaster Item,,27990555,SPSI,Cath Uret Spiral All,,Per Svc,51.00
Chargemaster Item,,27990563,SPSI,Cath Uret Round All,,Per Svc,32.00
Chargemaster Item,,27990571,SPSI,Cath Uret Whistle,,Per Svc,40.00
Chargemaster Item,,27990589,SPSI,Vacurette,,Per Svc,178.00
Chargemaster Item,,27990597,SPSI,Catheter Hemodialysis,,Per Svc,1444.00
Chargemaster Item,,27990605,SPSI,Stamey Suprapubic Cathater,,Per Svc,220.00
Chargemaster Item,,27990613,SPSI,Double J Catheter,,Per Svc,504.00
Chargemaster Item,,27990621,SPSI,Vaginal Packing 2 Inch,,Per Svc,65.00
Chargemaster Item,,27990639,SPSI,Javid By-P Can,,Per Svc,231.00
Chargemaster Item,,27990647,SPSI,Caut Disp Opth,,Per Svc,204.00
Chargemaster Item,,27990654,SPSI,Trephine Disp,,Per Svc,380.00
Chargemaster Item,,27990662,SPSI,Aspiration Tubing,,Per Svc,234.00
Chargemaster Item,,27990670,SPSI,Ta Foticulator Head Stapler,,Per Svc,3188.00
Chargemaster Item,,27990688,SPSI,Gia/Ta Staple Refill,,Per Svc,1230.10
Chargemaster Item,,27990696,SPSI,Skin-Starle,,Per Svc,812.53
Chargemaster Item,,27990704,SPSI,Gia/Ta Multifire Stapler,,Per Svc,3290.59
Chargemaster Item,,27990712,SPSI,Eea Staple,,Per Svc,6857.00
Chargemaster Item,,27990720,SPSI,Bone Cement,,Per Svc,3808.00
Chargemaster Item,,27990738,SPSI,Cosmetic Intraocular Lens,,Per Svc,0.01
Chargemaster Item,,27990746,SPSI,Hemoclip,,Per Svc,212.00
Chargemaster Item,,27990753,SPSI,Hemovac Cath,,Per Svc,740.00
Chargemaster Item,,27990761,SPSI,I/A-Pack Hi,,Per Svc,291.00
Chargemaster Item,,27990779,SPSI,Steridrape,,Per Svc,553.27
Chargemaster Item,,27990787,SPSI,Superblade,,Per Svc,199.00
Chargemaster Item,,27990795,SPSI,Midas Rex Drill,,Per Svc,1001.00
Chargemaster Item,,27990803,SPSI,Waterpik,,Per Svc,628.04
Chargemaster Item,,27990811,SPSI,Bone Stimulator,,Per Svc,11980.00
Chargemaster Item,,27990829,SPSI,Bone Staples,,Per Svc,14000.00
Chargemaster Item,,27990837,SPSI,Corneal Transplant,,Per Svc,13000.00
Chargemaster Item,,27990845,SPSI,Cranioplasty Kit,,Per Svc,522.00
Chargemaster Item,,27990852,SPSI,Denver Shunt,,Per Svc,1804.00
Chargemaster Item,,27990860,SPSI,Dialysis Shunt,,Per Svc,1940.00
Chargemaster Item,,27990878,SPSI,Broviac Cath,,Per Svc,1300.00
Chargemaster Item,,27990886,SPSI,Ear Tubes,,Per Svc,404.00
Chargemaster Item,,27990894,SPSI,Femoral Prosthesis,,Per Svc,2660.00
Chargemaster Item,,27990902,SPSI,Hydroceph Shunt,,Per Svc,1184.00
Chargemaster Item,,27990910,SPSI,Intraocular Lens,,Per Svc,600.00
Chargemaster Item,,27990928,SPSI,Orthoblast/Bone,,Per Svc,0.01
Chargemaster Item,,27990936,SPSI,Miscellaneous Iol,,Per Svc,3940.00
Chargemaster Item,,27990944,SPSI,Occular Implant,,Per Svc,560.00
Chargemaster Item,,27990951,SPSI,Pacemaker Gen,,Per Svc,107221.00
Chargemaster Item,,27990969,SPSI,Pacemaker Lead,,Per Svc,21260.00
Chargemaster Item,,27990977,SPSI,Retinal Band,,Per Svc,328.00
Chargemaster Item,,27990985,SPSI,Silastic Implant,,Per Svc,7228.00
Chargemaster Item,,27990993,SPSI,Bone Chips,,Per Svc,0.01
Chargemaster Item,,27991009,SPSI,Bone Blocks/Strips,,Per Svc,3156.00
Chargemaster Item,,27991017,SPSI,Spinal Tray,,Per Svc,905.00
Chargemaster Item,,27991025,SPSI,Penile Prosthesis,,Per Svc,41024.00
Chargemaster Item,,27991033,SPSI,Endo Prosthesis Urolume,,Per Svc,39896.00
Chargemaster Item,,27991041,SPSI,Transvaginal Tack,,Per Svc,5750.00
Chargemaster Item,,27991058,SPSI,Suture Anchor,,Per Svc,1624.00
Chargemaster Item,,27991066,SPSI,Transvag Tape,,Per Svc,5032.00
Chargemaster Item,,27991074,SPSI,Brachytherapy Needle,,Per Svc,52.00
Chargemaster Item,,27991082,SPSI,Gynecare Morcellator,,Per Svc,2620.00
Chargemaster Item,,27991090,SPSI,Dermograft Matrix,,Per Svc,5400.00
Chargemaster Item,,27991108,SPSI,Thermachoice Cath,,Per Svc,4640.00
Chargemaster Item,,27991116,SPSI,Bronchial Stent,,Per Svc,1900.00
Chargemaster Item,,27991124,SPSI,Cath Brachy Tx Seed Adm,,Per Svc,3900.00
Chargemaster Item,,27991132,SPSI,Brachy Seed,,Per Svc,320.00
Chargemaster Item,,27991140,SPSI,Mesh (Kugel),,Per Svc,4208.00
Chargemaster Item,,27991157,SPSI,Mesh (Composix) 3X6,,Per Svc,5204.00
Chargemaster Item,,27991165,SPSI,Mesh (Composix) 4X8,,Per Svc,7496.00
Chargemaster Item,,27991173,SPSI,Mesh (Composix) 6X8,,Per Svc,8080.00
Chargemaster Item,,27991181,SPSI,Mesh (Composix) 8X10,,Per Svc,9400.00
Chargemaster Item,,27991199,SPSI,Bulking Agent,,Per Svc,1236.00
Chargemaster Item,,27991207,SPSI,Dermabond,,Per Svc,392.00
Chargemaster Item,,27991215,SPSI,Hemostatic Seal Matrix,,Per Svc,1796.00
Chargemaster Item,,27991223,SPSI,Hemostatic Seal Hemaseal,,Per Svc,2380.00
Chargemaster Item,,27991231,SPSI,Adh Barrier,,Per Svc,12746.00
Chargemaster Item,,27991249,SPSI,Endo Suture Device,,Per Svc,2921.00
Chargemaster Item,,27991256,SPSI,Biopsy Device,,Per Svc,2994.00
Chargemaster Item,,27991264,SPSI,Canister Disp,,Per Svc,12.00
Chargemaster Item,,27991272,SPSI,Lagrimal Duct Implant,,Per Svc,560.00
Chargemaster Item,,27991280,SPSI,Laser Eye,,Per Svc,2002.00
Chargemaster Item,,27991298,SPSI,Lma,,Per Svc,52.00
Chargemaster Item,,27991306,SPSI,Thermo-Therapy,,Per Svc,84.00
Chargemaster Item,,27991314,SPSI,Conray,,Per Svc,65.00
Chargemaster Item,,27991322,SPSI,Isovue,,Per Svc,654.00
Chargemaster Item,,27991330,SPSI,Versapoint Disposable,,Per Svc,829.00
Chargemaster Item,,27991348,SPSI,Pat Programmer, Neurostimulato,,Per Svc,3600.00
Chargemaster Item,,27991355,SPSI,Baerveldt Shunt,,Per Svc,1680.00
Chargemaster Item,,27991363,SPSI,Mini Plates,,Per Svc,3012.00
Chargemaster Item,,27991371,SPSI,Plate Tubular,,Per Svc,2404.00
Chargemaster Item,,27991389,SPSI,Plate Lcp,,Per Svc,7244.00
Chargemaster Item,,27991397,SPSI,Plate T,,Per Svc,2224.00
Chargemaster Item,,27991405,SPSI,Plate L,,Per Svc,1388.00
Chargemaster Item,,27991413,SPSI,Bone Screw Cancellous,,Per Svc,280.00
Chargemaster Item,,27991421,SPSI,Bone Screw Cannulated,,Per Svc,1331.00
Chargemaster Item,,27991439,SPSI,Washer,,Per Svc,424.00
Chargemaster Item,,27991447,SPSI,Washer Threaded,,Per Svc,424.00
Chargemaster Item,,27991454,SPSI,Cardiovascular Patch,,Per Svc,828.00
Chargemaster Item,,27991462,SPSI,Cardiovascular Graft St Short,,Per Svc,4848.00
Chargemaster Item,,27991470,SPSI,Cardiovascular Graft Bifurca,,Per Svc,3480.00
Chargemaster Item,,27991488,SPSI,Cardiovascular Graft St Long,,Per Svc,7900.00
Chargemaster Item,,27991496,SPSI,Saw Blades,,Per Svc,865.60
Chargemaster Item,,27991504,SPSI,Burrs,,Per Svc,722.00
Chargemaster Item,,27991512,SPSI,Pain Pump/Generatord Supplies,,Per Svc,1407.00
Chargemaster Item,,27991520,SPSI,Meniscal Screw,,Per Svc,688.00
Chargemaster Item,,27991538,SPSI,Meniscal Screw Applier,,Per Svc,748.00
Chargemaster Item,,27991546,SPSI,Laser,,Per Svc,2157.83
Chargemaster Item,,27991553,SPSI,Bone Fibula Segment,,Per Svc,3008.00
Chargemaster Item,,27991561,SPSI,Bone Illiac,,Per Svc,4372.00
Chargemaster Item,,27991579,SPSI,Bone Cancellous Chips,,Per Svc,1148.00
Chargemaster Item,,27991587,SPSI,Bone Cortical Shaft,,Per Svc,3808.00
Chargemaster Item,,27991595,SPSI,Hemi Bone Patellar Tendon,,Per Svc,13980.00
Chargemaster Item,,27991603,SPSI,Achilles Tendon,,Per Svc,7200.00
Chargemaster Item,,27991611,SPSI,Tibialis Tendon,,Per Svc,6400.00
Chargemaster Item,,27991629,SPSI,Frozen Bone,,Per Svc,4840.00
Chargemaster Item,,27991637,SPSI,Pericardium Patch,,Per Svc,396.00
Chargemaster Item,,27991645,SPSI,Spinal Fusion Implants,,Per Svc,14572.00
Chargemaster Item,,27991652,SPSI,Spine Plates,,Per Svc,6760.00
Chargemaster Item,,27991660,SPSI,Spinal Screw,,Per Svc,424.00
Chargemaster Item,,27991678,SPSI,Cath Intradiscal,,Per Svc,4800.00
Chargemaster Item,,27991686,SPSI,Intradiscal Needle,,Per Svc,500.00
Chargemaster Item,,27991694,SPSI,Interstim Test Kit,,Per Svc,17460.00
Chargemaster Item,,27991702,SPSI,Lead Introducer,,Per Svc,800.00
Chargemaster Item,,27991710,SPSI,Extensions,,Per Svc,2380.00
Chargemaster Item,,27991728,SPSI,Interstim Lead,,Per Svc,14400.00
Chargemaster Item,,27991736,SPSI,External Fixator Upper,,Per Svc,14400.00
Chargemaster Item,,27991744,SPSI,Resorbable Pin,,Per Svc,1680.00
Chargemaster Item,,27991751,SPSI,Resorbable Screw,,Per Svc,1608.00
Chargemaster Item,,27991769,SPSI,On-Q Pain Pumps,,Per Svc,1124.00
Chargemaster Item,,27991777,SPSI,Infuse Bone Graft,,Per Svc,14400.00
Chargemaster Item,,27991785,SPSI,Tissue Patch,,Per Svc,9600.00
Chargemaster Item,,27991793,SPSI,Tr Bone Plate,,Per Svc,4720.00
Chargemaster Item,,27991801,SPSI,Tr Bone Screw,,Per Svc,496.00
Chargemaster Item,,27991819,SPSI,Accutrak Ibone,,Per Svc,1540.00
Chargemaster Item,,27991827,SPSI,Bone Filler 5Cc,,Per Svc,4980.00
Chargemaster Item,,27991835,SPSI,Delivery Syringe,,Per Svc,1098.00
Chargemaster Item,,27991843,SPSI,Pin/Drill Set,,Per Svc,412.00
Chargemaster Item,,27991850,SPSI,Pain Access Kit,,Per Svc,600.00
Chargemaster Item,,27991868,SPSI,Absorable Bead,,Per Svc,2620.00
Chargemaster Item,,27991876,SPSI,Pain Mgt Needle,,Per Svc,277.00
Chargemaster Item,,27991884,SPSI,Finger Implant,,Per Svc,8360.00
Chargemaster Item,,27991892,SPSI,Locking Plate Small,,Per Svc,1436.00
Chargemaster Item,,27991900,SPSI,Locking Plate Large,,Per Svc,2848.00
Chargemaster Item,,27991918,SPSI,Locking Screw,,Per Svc,792.00
Chargemaster Item,,27991926,SPSI,Locking Cannulated Screw,,Per Svc,1740.00
Chargemaster Item,,27991934,SPSI,Harmonic Blade/Sheer,,Per Svc,2378.00
Chargemaster Item,,27991942,SPSI,Bioglue Cartridge,,Per Svc,3633.00
Chargemaster Item,,27991959,SPSI,Tissue Replac,,Per Svc,41048.00
Chargemaster Item,,27991967,SPSI,Meniscus Tissue,,Per Svc,100000.00
Chargemaster Item,,27991975,SPSI,Bone Patellar Tendon Whole,,Per Svc,12756.00
Chargemaster Item,,27991983,SPSI,Ligature,,Per Svc,3865.86
Chargemaster Item,,27991991,SPSI,Staple Line Strip,,Per Svc,876.00
Chargemaster Item,,27992007,SPSI,Rectal Washout Kit,,Per Svc,1113.00
Chargemaster Item,,27992015,SPSI,Tissue Membrane,,Per Svc,5032.00
Chargemaster Item,,27992023,SPSI,Osteochondral Allograft,,Per Svc,0.01
Chargemaster Item,,27992031,SPSI,Coblador Wand,,Per Svc,1275.00
Chargemaster Item,,27992049,SPSI,Toe Implant,,Per Svc,6196.00
Chargemaster Item,,27992056,SPSI,Fallopian Ring,,Per Svc,3200.00
Chargemaster Item,,27992064,SPSI,Presbyopia-Correcting Io Lens,,Per Svc,3580.00
Chargemaster Item,,27992072,SPSI,Toric Lens,,Per Svc,1980.00
Chargemaster Item,,27992080,SPSI,Wires Guide,,Per Svc,640.00
Chargemaster Item,,27992098,SPSI,Lg French Sheaths Introducer,,Per Svc,720.00
Chargemaster Item,,27992106,SPSI,Reg French Shealth Introducer,,Per Svc,320.00
Chargemaster Item,,27992114,SPSI,Catheters Dilating,,Per Svc,2630.00
Chargemaster Item,,27992122,SPSI,Calcium Bone Filler,,Per Svc,8680.00
Chargemaster Item,,27992130,SPSI,Testicular Implant,,Per Svc,5044.00
Chargemaster Item,,27992148,SPSI,De-Clotting Cath,,Per Svc,3600.00
Chargemaster Item,,27992155,SPSI,Level 1 Procedure,,First 60 Minutes,15635.00
Chargemaster Item,,27992171,SPSI,Level 2 Procedure,,First 60 Minutes,19929.00
Chargemaster Item,,27992692,SPSI,Level 3 Procedure,,First 60 Minutes,28129.00
Chargemaster Item,,27992718,SPSI,Rec/Rm #1,,First 60 Minutes,2147.00
Chargemaster Item,,27992734,SPSI,Rec/Rm #2,,First 60 Minutes,2580.00
Chargemaster Item,,27992759,SPSI,Rec/Rm #3,,First 60 Minutes,4488.00
Chargemaster Item,,27992775,SPSI,Rec/Rm Isolat,,First 60 Minutes,42999.00
Chargemaster Item,,27992791,SPSI,Local--Mac,,First 60 Minutes,786.00
Chargemaster Item,,27992817,SPSI,General Anesthesia,,First 60 Minutes,1753.00
Chargemaster Item,,27992833,SPSI,A-Line,,Per Svc,943.00
Chargemaster Item,,27992841,SPSI,Lta-Kit,,Per Svc,129.00
Chargemaster Item,,27992858,SPSI,Bier Block,,Per Svc,718.00
Chargemaster Item,,27992866,SPSI,Epidural Block,,Per Svc,1769.00
Chargemaster Item,,27992874,SPSI,Blood/Fluid Warmer,,Per Svc,543.00
Chargemaster Item,,27992882,SPSI,Trigger Point Injection,,Per Svc,410.00
Chargemaster Item,,27992890,SPSI,Additional Trigger Point Inj,,Per Svc,209.00
Chargemaster Item,,27992908,SPSI,02 Cannula,,Per Svc,3.00
Chargemaster Item,,27992916,SPSI,02 Mask,,Per Svc,30.00
Chargemaster Item,,27992932,SPSI,Spinal Anesthesia,,First 60 Minutes,1095.00
Chargemaster Item,,27992957,SPSI,Conventional Io Lens,,Per Svc,1.00
Chargemaster Item,,27992965,SPSI,Intubation Device,,Per Svc,311.65
Chargemaster Item,,27992973,SPSI,Pleur-Vac,,Per Svc,1875.00
Chargemaster Item,,27992981,SPSI,Peri-Vac,,Per Svc,980.00
Chargemaster Item,,27992999,SPSI,Valvulotome,,Per Svc,2970.00
Chargemaster Item,,27993005,SPSI,Port Indwelling Imp,,Per Svc,1341.00
Chargemaster Item,,27993013,SPSI,Silo Bag,,Per Svc,1234.00
Chargemaster Item,,27993021,SPSI,Entellus Balloon,,Per Svc,1875.00
Chargemaster Item,,27993039,SPSI,Urethral Sphincter,,Per Svc,0.01
Chargemaster Item,,27993047,SPSI,Marker Tissue Impl,,Per Svc,0.01
Chargemaster Item,,27993054,SPSI,Anchor,,Per Svc,0.01
Chargemaster Item,,27993062,SPSI,Cath Atherect Direct,,Per Svc,0.01
Chargemaster Item,,27993070,SPSI,Needle Brachytherapy,,Per Svc,0.01
Chargemaster Item,,27993088,SPSI,Icd Dual Chamber,,Per Svc,0.01
Chargemaster Item,,27993096,SPSI,Icd Single Chamber,,Per Svc,0.01
Chargemaster Item,,27993104,SPSI,Cath Atherect Rotat,,Per Svc,0.01
Chargemaster Item,,27993112,SPSI,Cath Angio Non-Laser,,Per Svc,0.01
Chargemaster Item,,27993120,SPSI,Cath Balloon Non-Vasc,,Per Svc,0.01
Chargemaster Item,,27993138,SPSI,Cath Balloon Non-Vasc Insert,,Per Svc,0.01
Chargemaster Item,,27993146,SPSI,Cath Brachyseed Adm,,Per Svc,0.01
Chargemaster Item,,27993161,SPSI,Cath Ep Non 3D <=19,,Per Svc,0.01
Chargemaster Item,,27993179,SPSI,Cath Ep Non 3D >=20,,Per Svc,0.01
Chargemaster Item,,27993187,SPSI,Cath Abl Ep 3D/Vect,,Per Svc,0.01
Chargemaster Item,,27993195,SPSI,Cath Abl Ep No3D/Vec,,Per Svc,0.01
Chargemaster Item,,27993203,SPSI,Cath Hem/Per Chronic,,Per Svc,0.01
Chargemaster Item,,27993211,SPSI,Cath Inf No Dialysis,,Per Svc,0.01
Chargemaster Item,,27993229,SPSI,Cath Hem/Per Acute,,Per Svc,0.01
Chargemaster Item,,27993237,SPSI,Cath Intravasc Us,,Per Svc,0.01
Chargemaster Item,,27993252,SPSI,Cath Thrombec/Embo,,Per Svc,0.01
Chargemaster Item,,27993278,SPSI,Cath Intracrdic Echo,,Per Svc,0.01
Chargemaster Item,,27993294,SPSI,Tissue Human,,Per Svc,0.01
Chargemaster Item,,27993302,SPSI,Tissue Synth,,Per Svc,0.01
Chargemaster Item,,27993310,SPSI,Recrdr Cardiac Impl,,Per Svc,0.01
Chargemaster Item,,27993336,SPSI,Introducer Steerble Nonpeel,,Per Svc,0.01
Chargemaster Item,,27993344,SPSI,Generator Neurostim,,Per Svc,0.01
Chargemaster Item,,27993351,SPSI,Graft Vascular,,Per Svc,0.01
Chargemaster Item,,27993369,SPSI,Guidewire,,Per Svc,0.01
Chargemaster Item,,27993377,SPSI,Coil Imag Mag Reson,,Per Svc,0.01
Chargemaster Item,,27993385,SPSI,Insert Urinary W/Slng,,Per Svc,0.01
Chargemaster Item,,27993393,SPSI,Pump Inf Impl Prog,,Per Svc,0.01
Chargemaster Item,,27993401,SPSI,Retrvl Insert Device,,Per Svc,0.01
Chargemaster Item,,27993419,SPSI,Implantable Joint Device,,Per Svc,0.01
Chargemaster Item,,27993427,SPSI,Lead Cardiac Sngl Coil,,Per Svc,0.01
Chargemaster Item,,27993435,SPSI,Lead Neurostim,,Per Svc,0.01
Chargemaster Item,,27993443,SPSI,Lead Pacer Vdd,,Per Svc,0.01
Chargemaster Item,,27993450,SPSI,Lens Iol New Tech,,Per Svc,0.01
Chargemaster Item,,27993468,SPSI,Mesh Implantable,,Per Svc,0.01
Chargemaster Item,,27993484,SPSI,Pacer Dual Rr,,Per Svc,0.01
Chargemaster Item,,27993492,SPSI,Pacer Single Rr,,Per Svc,0.01
Chargemaster Item,,27993500,SPSI,Programmer Interstim,,Per Svc,0.01
Chargemaster Item,,27993526,SPSI,Prosth Breast,,Per Svc,0.01
Chargemaster Item,,27993534,SPSI,Prosth Penile Inflt,,Per Svc,0.01
Chargemaster Item,,27993542,SPSI,Prosth Urnary Sphnctr,,Per Svc,0.01
Chargemaster Item,,27993559,SPSI,Receiver/Transmit Neuros,,Per Svc,0.01
Chargemaster Item,,27993567,SPSI,Septal Impl Sys Card,,Per Svc,0.01
Chargemaster Item,,27993575,SPSI,Neuro Rechg Bat Sys,,Per Svc,0.01
Chargemaster Item,,27993583,SPSI,Interspinous Implant,,Per Svc,0.01
Chargemaster Item,,27993591,SPSI,Stent Coat W/Delvry,,Per Svc,0.01
Chargemaster Item,,27993609,SPSI,Stent Coat W/O Delivery,,Per Svc,0.01
Chargemaster Item,,27993617,SPSI,Stent Non W/Delvry,,Per Svc,0.01
Chargemaster Item,,27993625,SPSI,Stent Non W/O Delvry,,Per Svc,0.01
Chargemaster Item,,27993633,SPSI,Matrl For Vocal Cord,,Per Svc,0.01
Chargemaster Item,,27993641,SPSI,Filter Vena Cava,,Per Svc,0.01
Chargemaster Item,,27993658,SPSI,Dialysis Access Sys,,Per Svc,0.01
Chargemaster Item,,27993666,SPSI,Icd Def Not Sgl/Dual,,Per Svc,0.01
Chargemaster Item,,27993674,SPSI,Adapt/Extn/Pacing/Neurost Ld,,Per Svc,0.01
Chargemaster Item,,27993682,SPSI,Embolization Protect Sys,,Per Svc,0.01
Chargemaster Item,,27993690,SPSI,Cath Angio Laser,,Per Svc,0.01
Chargemaster Item,,27993708,SPSI,Cath Guide,,Per Svc,0.01
Chargemaster Item,,27993716,SPSI,Cath Abl Non-Cardiac,,Per Svc,0.01
Chargemaster Item,,27993724,SPSI,Pump Inf Impl N/Prog Perm,,Per Svc,0.01
Chargemaster Item,,27993732,SPSI,Introducer Fix Crv Peel,,Per Svc,0.01
Chargemaster Item,,27993740,SPSI,Introducer Fix Crv Nonpeel,,Per Svc,0.01
Chargemaster Item,,27993765,SPSI,Lead Cardiac Dual Coil,,Per Svc,0.01
Chargemaster Item,,27993773,SPSI,Lead Cardiac Non Sgl/Dual,,Per Svc,0.01
Chargemaster Item,,27993781,SPSI,Lead Neuro Test Kit,,Per Svc,0.01
Chargemaster Item,,27993799,SPSI,Lead Pacer Non Vdd,,Per Svc,0.01
Chargemaster Item,,27993807,SPSI,Lead Pacer Card/Defib,,Per Svc,0.01
Chargemaster Item,,27993815,SPSI,Lead Coronary Venous,,Per Svc,0.01
Chargemaster Item,,27993823,SPSI,Sealant Pulmonary,,Per Svc,0.01
Chargemaster Item,,27993831,SPSI,Stent Tmp W/O Delvry,,Per Svc,0.01
Chargemaster Item,,27993849,SPSI,Probe Cryoablation,,Per Svc,0.01
Chargemaster Item,,27993856,SPSI,Pacer Dual Non Rr,,Per Svc,0.01
Chargemaster Item,,27993864,SPSI,Pacer Single Non Rr,,Per Svc,0.01
Chargemaster Item,,27993872,SPSI,Pacer Nonsng Or Dual,,Per Svc,0.01
Chargemaster Item,,27993880,SPSI,Prosth Penile No Inflt,,Per Svc,0.01
Chargemaster Item,,27993898,SPSI,Stent Temp W/Delivery,,Per Svc,0.01
Chargemaster Item,,27993906,SPSI,Pump Inf Impl Np Tmp,,Per Svc,0.01
Chargemaster Item,,27993922,SPSI,Cath Occlusion,,Per Svc,0.01
Chargemaster Item,,27993930,SPSI,Introducer Laser,,Per Svc,0.01
Chargemaster Item,,27993948,SPSI,Cath Abl Cool-Tip,,Per Svc,0.01
Chargemaster Item,,27993955,SPSI,Insert Urinary Wo Slng,,Per Svc,0.01
Chargemaster Item,,27993963,SPSI,Neurawrap Nerve Protector Cm,,Per Svc,0.01
Chargemaster Item,,27993971,SPSI,Bulk Agent Collagen 2.5,,Per Svc,0.01
Chargemaster Item,,27993989,SPSI,Gel Bladder Deflux,,Per Svc,0.01
Chargemaster Item,,27993997,SPSI,Bulk Agent Durasph Inj,,Per Svc,0.01
Chargemaster Item,,27994003,SPSI,Bulk Agent Synth 1.0,,Per Svc,0.01
Chargemaster Item,,27994011,SPSI,Tegress Urethral Implant,,Per Svc,0.01
Chargemaster Item,,27994029,SPSI,Prosth Cochlear,,Per Svc,0.01
Chargemaster Item,,27994037,SPSI,Aud Osseo Dev Int Ext Comp,,Per Svc,0.01
Chargemaster Item,,27994045,SPSI,Graftjacket Per Sqcm,,Per Svc,0.01
Chargemaster Item,,27994052,SPSI,Anterior Chamber Iol,,Per Svc,0.01
Chargemaster Item,,27994060,SPSI,Posterior Chambr Iol,,Per Svc,0.01
Chargemaster Item,,27994078,SPSI,Amniograft,,Per Svc,0.01
Chargemaster Item,,27994086,SPSI,Miscellaneous Supply,,Per Svc,0.01
Chargemaster Item,,27994102,SPSI,Miscellaneous Implant,,Per Svc,0.01
Chargemaster Item,,27994110,SPSI,Neuro Stimulator Implants,,Per Svc,0.01
Chargemaster Item,,27994144,SPSI,Urology Implant,,Per Svc,0.01
Chargemaster Item,,27994219,SPSI,Uro Pet Suture,,Per Svc,3900.00
Chargemaster Item,,27994227,SPSI,Biosorb Implant,,Per Svc,4000.00
Chargemaster Item,,27994326,SPSI,Sm Battery Wound Care,,Per Svc,990.00
Chargemaster Item,,27994334,SPSI,Chemotherapy Infusion,,Per Svc,1605.00
Chargemaster Item,,27994342,SPSI,Chemo IV Ea Add Hr,,Per Svc,549.00
Chargemaster Item,,27994359,SPSI,Chemo Prolong Infuse w/ Pump,,Per Svc,1605.00
Chargemaster Item,,27994367,SPSI,Chemo Injection,,Per Svc,620.00
Chargemaster Item,,27994375,SPSI,Litho Level 1 Procedure,,First 60 Minutes,27450.00
Chargemaster Item,,27994383,SPSI,Litho Level 2 Procedure,,First 60 Minutes,29738.00
Chargemaster Item,,27994391,SPSI,Litho Level 3 Procedure,,First 60 Minutes,32025.00
Chargemaster Item,,27995000,SPSI,Inflation Device,,Per Svc,289.00
Chargemaster Item,,27995018,SPSI,Accessory Pack,,Per Svc,555.00
Chargemaster Item,,27995026,SPSI,External Fixation Lower,,Per Svc,9928.00
Chargemaster Item,,27996008,SPSI,Robot Instrument Charge,,Per Svc,1470.00
Chargemaster Item,,27996016,SPSI,Implant Accessory,,Per Svc,1176.48
Chargemaster Item,,27996024,SPSI,Nasal Septal Splint,,Per Svc,146.25
Chargemaster Item,,27996032,SPSI,PRP,,Per Svc,874.00
Chargemaster Item,,27996040,SPSI,Tissue Implant,,Per Svc,0.01
Chargemaster Item,,27996057,SPSI,Silikon Oil,,Per Svc,896.57
Chargemaster Item,,27996073,SPSI,Skin Substitue Graft,,Per Svc,0.01
Chargemaster Item,,27996099,SPSI,Stravix Cryo Tissue,,Per Svc,0.01
Chargemaster Item,,27996107,SPSI,Integra Flowable Wound Matrix,,Per Svc,0.01
Chargemaster Item,,27996115,SPSI,Epifix Dehyd.Human Amnion Grft,,Per Svc,0.01
Chargemaster Item,,27996123,SPSI,Lens Intraoc Post UV AbsorbMultifocal,,Per Svc,3980.00
Chargemaster Item,,27996131,SPSI,Glaucoma Valve Flexible Plate,,Per Svc,2800.00
Chargemaster Item,,28203727,SPSI,Gigli Saw,,Per Svc,243.00
Chargemaster Item,,28205128,SPSI,Avitene,,Per Svc,1138.00
Chargemaster Item,,28205136,SPSI,Bronchial Ultrasound Caths,,Per Svc,4164.00
Chargemaster Item,,28205151,SPSI,Bili Probe Fog,,Per Svc,827.00
Chargemaster Item,,28205219,SPSI,Gill Br Biopsy,,Per Svc,1266.00
Chargemaster Item,,28205276,SPSI,Bone Wax,,Per Svc,10528.00
Chargemaster Item,,28205490,SPSI,Chafin Tube,,Per Svc,515.00
Chargemaster Item,,28205557,SPSI,Rub Ch Tube,,Per Svc,231.00
Chargemaster Item,,28205573,SPSI,Cholecyst Cath,,Per Svc,623.00
Chargemaster Item,,28205672,SPSI,Colon Tube,,Per Svc,65.00
Chargemaster Item,,28205730,SPSI,Colostomy Rod,,Per Svc,52.00
Chargemaster Item,,28205755,SPSI,Coloplast Ur B,,Per Svc,95.00
Chargemaster Item,,28205789,SPSI,Intraluminal G.I.Tube,,Per Svc,369.80
Chargemaster Item,,28205839,SPSI,Derm Bld Brown,,Per Svc,515.00
Chargemaster Item,,28206290,SPSI,Gelfoam Sm,,Per Svc,48.00
Chargemaster Item,,28206316,SPSI,Gelfoam Lg 100,,Per Svc,144.00
Chargemaster Item,,28206670,SPSI,Jav Bypass Can,,Per Svc,243.00
Chargemaster Item,,28206696,SPSI,Jejunosto Cath,,Per Svc,1211.00
Chargemaster Item,,28206795,SPSI,Leond Gl Tube,,Per Svc,1072.00
Chargemaster Item,,28207272,SPSI,Oxycel Cotton,,Per Svc,75.00
Chargemaster Item,,28207819,SPSI,Sump Dr Bard,,Per Svc,834.00
Chargemaster Item,,28207850,SPSI,Surgicel 2X3,,Per Svc,439.00
Chargemaster Item,,28207876,SPSI,Surgicel 2X14,,Per Svc,784.00
Chargemaster Item,,28208056,SPSI,T Tubes,,Per Svc,144.00
Chargemaster Item,,28208239,SPSI,Vacurette,,Per Svc,178.00
Chargemaster Item,,28208346,SPSI,Vaginal Packing 2 Inch,,Per Svc,65.00
Chargemaster Item,,28208833,SPSI,Javid By-P Can,,Per Svc,231.00
Chargemaster Item,,28209013,SPSI,Caut Disp Opth,,Per Svc,204.00
Chargemaster Item,,28209278,SPSI,Trephine Disp,,Per Svc,380.00
Chargemaster Item,,28209682,SPSI,Aspiration Tubing,,Per Svc,234.00
Chargemaster Item,,28209989,SPSI,Ta Foticulator Head Stapler,,Per Svc,3188.00
Chargemaster Item,,28209997,SPSI,Gia/Ta Staple Refill,,Per Svc,1230.10
Chargemaster Item,,28210011,SPSI,Skin-Starle,,Per Svc,812.53
Chargemaster Item,,28210029,SPSI,Gia/Ta Multifire Stapler,,Per Svc,3290.59
Chargemaster Item,,28210037,SPSI,Eea Staple,,Per Svc,6857.00
Chargemaster Item,,28210045,SPSI,Rapid Blood Transfusion Supply,,Per Svc,500.00
Chargemaster Item,,28210086,SPSI,Hemoclip,,Per Svc,212.00
Chargemaster Item,,28210094,SPSI,Hemovac Cath,,Per Svc,740.00
Chargemaster Item,,28210102,SPSI,Robot Instrument Charge,,Per Svc,1470.00
Chargemaster Item,,28210110,SPSI,I/A-Pack Hi,,Per Svc,291.00
Chargemaster Item,,28210144,SPSI,Steridrape,,Per Svc,553.27
Chargemaster Item,,28210151,SPSI,Superblade,,Per Svc,199.00
Chargemaster Item,,28210169,SPSI,Midas Rex Drill,,Per Svc,1001.00
Chargemaster Item,,28210177,SPSI,Waterpik,,Per Svc,628.04
Chargemaster Item,,28210185,SPSI,Zip Dressing,,Per Svc,270.00
Chargemaster Item,,28210201,SPSI,Implant Accessory,,Per Svc,1176.48
Chargemaster Item,,28210243,SPSI,Cranioplasty Kit,,Per Svc,522.00
Chargemaster Item,,28210300,SPSI,Chest Catheter Drain,,Per Svc,1396.00
Chargemaster Item,,28210409,SPSI,Lumbar Monitor Drain,,Per Svc,0.01
Chargemaster Item,,28210508,SPSI,Nasal Septal Splint,,Per Svc,146.25
Chargemaster Item,,28210607,SPSI,Neuro / Vascular Monitoring,,Per Svc,1188.87
Chargemaster Item,,28210615,SPSI,PRP,,Per Svc,874.00
Chargemaster Item,,28211159,SPSI,Spinal Tray,,Per Svc,905.00
Chargemaster Item,,28212777,SPSI,Dermabond,,Per Svc,392.00
Chargemaster Item,,28212819,SPSI,Endo Suture Device,,Per Svc,2921.00
Chargemaster Item,,28212827,SPSI,Biopsy Device,,Per Svc,2994.00
Chargemaster Item,,28212835,SPSI,Canister Disp,,Per Svc,12.00
Chargemaster Item,,28212850,SPSI,Laser Eye,,Per Svc,2002.00
Chargemaster Item,,28212868,SPSI,Lma,,Per Svc,52.00
Chargemaster Item,,28212876,SPSI,Thermo-Therapy,,Per Svc,84.00
Chargemaster Item,,28212884,SPSI,Conray,,Per Svc,65.00
Chargemaster Item,,28212892,SPSI,Isovue,,Per Svc,654.00
Chargemaster Item,,28212900,SPSI,Versapoint Disposable,,Per Svc,829.00
Chargemaster Item,,28213379,SPSI,Saw Blades,,Per Svc,865.60
Chargemaster Item,,28213387,SPSI,Burrs,,Per Svc,722.00
Chargemaster Item,,28213403,SPSI,Pain Pump/Generatord Supplies,,Per Svc,1407.00
Chargemaster Item,,28213411,SPSI,Ortho Cable Supplies,,Per Svc,2307.00
Chargemaster Item,,28213478,SPSI,Meniscal Screw Applier,,Per Svc,748.00
Chargemaster Item,,28213486,SPSI,Cell Saver Setup Perfusion Ser,,Per Svc,515.00
Chargemaster Item,,28213494,SPSI,Cell Saver Hrs Perfusion Serv,,Per Svc,515.00
Chargemaster Item,,28213502,SPSI,Cell Saver Standby Perfusion S,,Per Svc,1375.00
Chargemaster Item,,28213510,SPSI,Laser,,Per Svc,2157.83
Chargemaster Item,,28214021,SPSI,Delivery Syringe,,Per Svc,1098.00
Chargemaster Item,,28214039,SPSI,Pin/Drill Set,,Per Svc,412.00
Chargemaster Item,,28214062,SPSI,Pain Mgt Needle,,Per Svc,277.00
Chargemaster Item,,28214088,SPSI,Pleur-Vac,,Per Svc,1875.00
Chargemaster Item,,28214096,SPSI,Peri-Vac,,Per Svc,980.00
Chargemaster Item,,28214104,SPSI,Cusapak,,Per Svc,1667.00
Chargemaster Item,,28214112,SPSI,Bipolar Cord,,Per Svc,334.00
Chargemaster Item,,28214187,SPSI,Harmonic Blade/Sheer,,Per Svc,2378.00
Chargemaster Item,,28214195,SPSI,Bioglue Cartridge,,Per Svc,3633.00
Chargemaster Item,,28214229,SPSI,Ligature,,Per Svc,3865.86
Chargemaster Item,,28214237,SPSI,Staple Line Strip,,Per Svc,876.00
Chargemaster Item,,28214245,SPSI,Rectal Washout Kit,,Per Svc,1113.00
Chargemaster Item,,28214260,SPSI,Coblador Wand,,Per Svc,1275.00
Chargemaster Item,,28214310,SPSI,Valvulotome,,Per Svc,2970.00
Chargemaster Item,,28214336,SPSI,Cusa,,Per Svc,2817.00
Chargemaster Item,,28214419,SPSI,Silo Bag,,Per Svc,1234.00
Chargemaster Item,,28216885,SPSI,Intubation Device,,Per Svc,311.65
Chargemaster Item,,28220093,SPSI,Catheters Dilating,,Per Svc,2630.00
Chargemaster Item,,28220143,SPSI,Inflation Device,,Per Svc,289.00
Chargemaster Item,,28220150,SPSI,Sm Battery Wound Care,,Per Svc,990.00
Chargemaster Item,,28220168,SPSI,Abthera Dressing,,Per Svc,736.00
Chargemaster Item,,28220184,SPSI,Accessory Pack,,Per Svc,555.00
Chargemaster Item,,29102217,SPSI,Local--Mac,,First 60 Minutes,786.00
Chargemaster Item,,29102233,SPSI,General Anesthesia,,First 60 Minutes,1753.00
Chargemaster Item,,29102258,SPSI,A-Line,,Per Svc,943.00
Chargemaster Item,,29102266,SPSI,Lta-Kit,,Per Svc,129.00
Chargemaster Item,,29102274,SPSI,Spinal Anesthesia,,First 60 Minutes,1095.00
Chargemaster Item,,29102605,SPSI,Cvp Line/Ohs,,Per Svc,2908.00
Chargemaster Item,,29150604,SPSI,Bier Block,,Per Svc,718.00
Chargemaster Item,,29151008,SPSI,Epidural Block,,Per Svc,1769.00
Chargemaster Item,,29201126,SPSI,Blood/Fluid Warmer,,Per Svc,543.00
Chargemaster Item,,29201357,SPSI,Swan-Ganz Catheter Set Up,,Per Svc,3350.00
Chargemaster Item,,29201365,SPSI,Central Venous Pressure Line,,Per Svc,1366.00
Chargemaster Item,,29201381,SPSI,02 Cannula,,Per Svc,3.00
Chargemaster Item,,29201423,SPSI,02 Mask,,Per Svc,30.00
Chargemaster Item,,29205507,SPSI,Trigger Point Injection,,Per Svc,410.00
Chargemaster Item,,29205515,SPSI,Additional Trigger Point Inj,,Per Svc,209.00
Chargemaster Item,,30003511,SPSI,Icd Generation Dual Chamber,,Per Svc,91495.00
Chargemaster Item,,3002508,SPSI,Cardiac Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,3002510,SPSI,Cardiac Intensive Care Unit MC,,Per Svc,20240.00
Chargemaster Item,,3002511,SPSI,Trauma Intensive Care Unit,,Per Svc,22266.00
Chargemaster Item,,3002512,SPSI,Cardiac Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,3002516,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,3002529,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,3002538,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,30200000,SPSI,Lemaitre Vasc Pruitt F3 Shunt,,Per Svc,569.00
Chargemaster Item,,30200018,SPSI,Entellus Balloon,,Per Svc,1875.00
Chargemaster Item,,30200026,SPSI,Urethral Sphincter,,Per Svc,0.01
Chargemaster Item,,30200034,SPSI,Orthoblast/Bone,,Per Svc,0.01
Chargemaster Item,,30200042,SPSI,Osteochondral Allograft,,Per Svc,0.01
Chargemaster Item,,30202634,SPSI,K Wires,,Per Svc,300.00
Chargemaster Item,,30202659,SPSI,K Wires Hole,,Per Svc,96.00
Chargemaster Item,,30202972,SPSI,Rush Pin Light,,Per Svc,216.00
Chargemaster Item,,30203392,SPSI,St Pin Dia Tro,,Per Svc,688.00
Chargemaster Item,,30203657,SPSI,Wires,,Per Svc,72.00
Chargemaster Item,,30205090,SPSI,Arch Bars,,Per Svc,344.00
Chargemaster Item,,30205116,SPSI,Arch Bar Wire,,Per Svc,28.00
Chargemaster Item,,30205413,SPSI,Malecot Cath,,Per Svc,39.00
Chargemaster Item,,30205421,SPSI,BT Catheter,,Per Svc,10000.00
Chargemaster Item,,30205439,SPSI,Cath Mushroom,,Per Svc,29.00
Chargemaster Item,,30205884,SPSI,Meniscus Tissue,,Per Svc,100000.00
Chargemaster Item,,30205959,SPSI,Cath Embo Fogt,,Per Svc,136.00
Chargemaster Item,,30205975,SPSI,Cath Embofogt Irri,,Per Svc,82.00
Chargemaster Item,,30206577,SPSI,Inf Feed Tube,,Per Svc,980.00
Chargemaster Item,,30206858,SPSI,Levine Tub Rub,,Per Svc,91.00
Chargemaster Item,,30206932,SPSI,Mesh,,Per Svc,792.00
Chargemaster Item,,30207997,SPSI,Teflon Pledget,,Per Svc,1440.00
Chargemaster Item,,30208078,SPSI,Trach T Fome,,Per Svc,220.00
Chargemaster Item,,30208136,SPSI,Uret Cath Coude All,,Per Svc,68.00
Chargemaster Item,,30208151,SPSI,Cath Uret Cone All,,Per Svc,56.00
Chargemaster Item,,30208177,SPSI,Cath Uret Spiral All,,Per Svc,51.00
Chargemaster Item,,30208193,SPSI,Cath Uret Round All,,Per Svc,32.00
Chargemaster Item,,30208201,SPSI,Catheter Hemodialysis,,Per Svc,1444.00
Chargemaster Item,,30208219,SPSI,Cath Uret Whistle,,Per Svc,40.00
Chargemaster Item,,30208300,SPSI,Stamey Suprapubic Cathater,,Per Svc,220.00
Chargemaster Item,,30208326,SPSI,Double J Catheter,,Per Svc,504.00
Chargemaster Item,,30210041,SPSI,Bone Cement,,Per Svc,3808.00
Chargemaster Item,,30210199,SPSI,Bone Stimulator,,Per Svc,11980.00
Chargemaster Item,,30210215,SPSI,Bone Staples,,Per Svc,14000.00
Chargemaster Item,,30210231,SPSI,Corneal Transplant,,Per Svc,13000.00
Chargemaster Item,,30210256,SPSI,Denver Shunt,,Per Svc,1804.00
Chargemaster Item,,30210264,SPSI,Dialysis Shunt,,Per Svc,1940.00
Chargemaster Item,,30210272,SPSI,Broviac Cath,,Per Svc,1300.00
Chargemaster Item,,30210280,SPSI,Ear Tubes,,Per Svc,404.00
Chargemaster Item,,30210306,SPSI,Femoral Prosthesis,,Per Svc,2660.00
Chargemaster Item,,30210314,SPSI,Hydroceph Shunt,,Per Svc,1184.00
Chargemaster Item,,30210330,SPSI,Intraocular Lens,,Per Svc,600.00
Chargemaster Item,,30210348,SPSI,Cosmetic Intraocular Lens,,Per Svc,0.01
Chargemaster Item,,30210363,SPSI,Occular Implant,,Per Svc,560.00
Chargemaster Item,,30210371,SPSI,Miscellaneous Iol,,Per Svc,3940.00
Chargemaster Item,,30210389,SPSI,Pacemaker Gen,,Per Svc,107221.00
Chargemaster Item,,30210397,SPSI,Pacemaker Lead,,Per Svc,21260.00
Chargemaster Item,,30210405,SPSI,Rib / Sternum Implant,,Per Svc,0.01
Chargemaster Item,,30210421,SPSI,Retinal Band,,Per Svc,328.00
Chargemaster Item,,30210447,SPSI,Silastic Implant,,Per Svc,7228.00
Chargemaster Item,,30210454,SPSI,Hip Implants,,Per Svc,0.01
Chargemaster Item,,30210462,SPSI,Shoulder Implants,,Per Svc,0.01
Chargemaster Item,,30210470,SPSI,Ankle Implants,,Per Svc,0.01
Chargemaster Item,,30210488,SPSI,Elbow Implants,,Per Svc,0.01
Chargemaster Item,,30210496,SPSI,Knee Implants,,Per Svc,0.01
Chargemaster Item,,30210504,SPSI,Hand Implants,,Per Svc,0.01
Chargemaster Item,,30210512,SPSI,Arm Implants,,Per Svc,0.01
Chargemaster Item,,30210520,SPSI,Leg Implants,,Per Svc,0.01
Chargemaster Item,,30210538,SPSI,Pelvic Implants,,Per Svc,0.01
Chargemaster Item,,30210546,SPSI,Face Implants,,Per Svc,0.01
Chargemaster Item,,30210553,SPSI,Head Implants,,Per Svc,0.01
Chargemaster Item,,30212112,SPSI,Generator Neuro W Rechg Batt,,Per Svc,69960.00
Chargemaster Item,,30212393,SPSI,Penile Prosthesis,,Per Svc,41024.00
Chargemaster Item,,30212394,SPSI,Lumbar Peritoneal Shunt Imp Ip,,Per Svc,0.01
Chargemaster Item,,30212401,SPSI,Brachytherapy Needle,,Per Svc,52.00
Chargemaster Item,,30212419,SPSI,Gynecare Morcellator,,Per Svc,2620.00
Chargemaster Item,,30212435,SPSI,Dermograft Matrix,,Per Svc,5400.00
Chargemaster Item,,30212443,SPSI,Thermachoice Cath,,Per Svc,4640.00
Chargemaster Item,,30212450,SPSI,Bronchial Stent,,Per Svc,1900.00
Chargemaster Item,,30212559,SPSI,Bone Chips,,Per Svc,0.01
Chargemaster Item,,30212567,SPSI,Endo Prosthesis Urolume,,Per Svc,39896.00
Chargemaster Item,,30212575,SPSI,Transvaginal Tack,,Per Svc,5750.00
Chargemaster Item,,30212583,SPSI,Suture Anchor,,Per Svc,1624.00
Chargemaster Item,,30212591,SPSI,Transvag Tape,,Per Svc,5032.00
Chargemaster Item,,30212609,SPSI,Bone Blocks/Strips,,Per Svc,3156.00
Chargemaster Item,,30212617,SPSI,Generator Neurostimulator,,Per Svc,46640.00
Chargemaster Item,,30212625,SPSI,Painmgmt Electrode,,Per Svc,22800.00
Chargemaster Item,,30212633,SPSI,Painmgmt Electrode Extension,,Per Svc,7000.00
Chargemaster Item,,30212641,SPSI,Painmgmt Pump,,Per Svc,40660.00
Chargemaster Item,,30212658,SPSI,Catheter Intraspinal,,Per Svc,3468.00
Chargemaster Item,,30212666,SPSI,Mammary Implant,,Per Svc,7192.00
Chargemaster Item,,30212674,SPSI,Brachy Seed,,Per Svc,320.00
Chargemaster Item,,30212716,SPSI,Mesh (Kugel),,Per Svc,4208.00
Chargemaster Item,,30212724,SPSI,Mesh (Composix) 3X6,,Per Svc,5204.00
Chargemaster Item,,30212732,SPSI,Mesh (Composix) 4X8,,Per Svc,7496.00
Chargemaster Item,,30212740,SPSI,Mesh (Composix) 6X8,,Per Svc,8080.00
Chargemaster Item,,30212757,SPSI,Mesh (Composix) 8X10,,Per Svc,9400.00
Chargemaster Item,,30212765,SPSI,Bulking Agent,,Per Svc,1236.00
Chargemaster Item,,30212781,SPSI,Hemostatic Seal Matrix,,Per Svc,1796.00
Chargemaster Item,,30212799,SPSI,Hemostatic Seal Hemaseal,,Per Svc,2380.00
Chargemaster Item,,30212807,SPSI,Adh Barrier,,Per Svc,12746.00
Chargemaster Item,,30212849,SPSI,Lagrimal Duct Implant,,Per Svc,560.00
Chargemaster Item,,30212914,SPSI,Pat Programmer, Neurostimulato,,Per Svc,3600.00
Chargemaster Item,,30212922,SPSI,Baerveldt Shunt,,Per Svc,1680.00
Chargemaster Item,,30212930,SPSI,Total Hip Femoral Stem Np,,Per Svc,15628.00
Chargemaster Item,,30212948,SPSI,Total Hip Femoral Stem Lp,,Per Svc,15272.00
Chargemaster Item,,30212955,SPSI,Total Hip Apollo Stem,,Per Svc,4200.00
Chargemaster Item,,30212963,SPSI,Total Hip Shell,,Per Svc,4844.00
Chargemaster Item,,30212971,SPSI,Total Hip Durasel Insert,,Per Svc,4400.00
Chargemaster Item,,30212989,SPSI,Total Hip Centralizer,,Per Svc,320.00
Chargemaster Item,,30212997,SPSI,Total Hip Head 32 & 26Mm,,Per Svc,2564.00
Chargemaster Item,,30213003,SPSI,Total Hip Head 38Mm,,Per Svc,2532.00
Chargemaster Item,,30213011,SPSI,Total Hip Cement Plug,,Per Svc,2188.00
Chargemaster Item,,30213029,SPSI,Total Hip Bipolar Head,,Per Svc,2312.00
Chargemaster Item,,30213037,SPSI,Total Knee Femoral Porous,,Per Svc,16288.00
Chargemaster Item,,30213045,SPSI,Total Knee Femoral Nonporous,,Per Svc,13536.00
Chargemaster Item,,30213052,SPSI,Total Knee B/P Porous,,Per Svc,6980.00
Chargemaster Item,,30213060,SPSI,Total Knee B/P Non Porous,,Per Svc,5012.00
Chargemaster Item,,30213078,SPSI,Total Knee Tibial Insert,,Per Svc,4580.00
Chargemaster Item,,30213086,SPSI,Total Knee Patella M/B,,Per Svc,5012.00
Chargemaster Item,,30213094,SPSI,Total Knee Patella Poly,,Per Svc,2928.00
Chargemaster Item,,30213102,SPSI,Total Screw 6.5Mm,,Per Svc,432.00
Chargemaster Item,,30213169,SPSI,Hydrocephalus Shunt,,Per Svc,13786.00
Chargemaster Item,,30213177,SPSI,External Fixation Lower,,Per Svc,9928.00
Chargemaster Item,,30213185,SPSI,Im Nail Upper,,Per Svc,8820.00
Chargemaster Item,,30213193,SPSI,Im Nail Upper Lower,,Per Svc,9460.00
Chargemaster Item,,30213201,SPSI,Mini Plates,,Per Svc,3012.00
Chargemaster Item,,30213219,SPSI,Plate Tubular,,Per Svc,2404.00
Chargemaster Item,,30213227,SPSI,Plate Lcp,,Per Svc,7244.00
Chargemaster Item,,30213235,SPSI,Plate T,,Per Svc,2224.00
Chargemaster Item,,30213243,SPSI,Plate L,,Per Svc,1388.00
Chargemaster Item,,30213250,SPSI,Bone Screw Cancellous,,Per Svc,280.00
Chargemaster Item,,30213268,SPSI,Bone Screw Cannulated,,Per Svc,1331.00
Chargemaster Item,,30213276,SPSI,Washer,,Per Svc,424.00
Chargemaster Item,,30213284,SPSI,Washer Threaded,,Per Svc,424.00
Chargemaster Item,,30213292,SPSI,Cardiovascular Patch,,Per Svc,828.00
Chargemaster Item,,30213300,SPSI,Cardiovascular Graft St Short,,Per Svc,4848.00
Chargemaster Item,,30213318,SPSI,Cardiovascular Graft Bifurca,,Per Svc,3480.00
Chargemaster Item,,30213326,SPSI,Cardiovascular Graft St Long,,Per Svc,7900.00
Chargemaster Item,,30213425,SPSI,Total Hip Femoral Stem Ha,,Per Svc,15620.00
Chargemaster Item,,30213433,SPSI,Total Hip Shell Revision,,Per Svc,5116.00
Chargemaster Item,,30213441,SPSI,Total Hip Revision,,Per Svc,22928.00
Chargemaster Item,,30213458,SPSI,Total Knee Revision,,Per Svc,42620.00
Chargemaster Item,,30213466,SPSI,Meniscal Screw,,Per Svc,688.00
Chargemaster Item,,30213524,SPSI,Bone Fibula Segment,,Per Svc,3008.00
Chargemaster Item,,30213532,SPSI,Bone Illiac,,Per Svc,4372.00
Chargemaster Item,,30213540,SPSI,Bone Cancellous Chips,,Per Svc,1148.00
Chargemaster Item,,30213557,SPSI,Bone Fibula Whole,,Per Svc,2872.00
Chargemaster Item,,30213565,SPSI,Bone Cortical Shaft,,Per Svc,3808.00
Chargemaster Item,,30213573,SPSI,Hemi Bone Patellar Tendon,,Per Svc,13980.00
Chargemaster Item,,30213607,SPSI,Achilles Tendon,,Per Svc,7200.00
Chargemaster Item,,30213615,SPSI,Tibialis Tendon,,Per Svc,6400.00
Chargemaster Item,,30213623,SPSI,Frozen Bone,,Per Svc,4840.00
Chargemaster Item,,30213631,SPSI,Pericardium Patch,,Per Svc,396.00
Chargemaster Item,,30213649,SPSI,Dura Sub,,Per Svc,3500.00
Chargemaster Item,,30213664,SPSI,Spinal Fusion Implants,,Per Svc,14572.00
Chargemaster Item,,30213672,SPSI,Spine Plates,,Per Svc,6760.00
Chargemaster Item,,30213680,SPSI,Spinal Screw,,Per Svc,424.00
Chargemaster Item,,30213706,SPSI,Total Ankle Replacement,,Per Svc,13500.00
Chargemaster Item,,30213714,SPSI,Partial Ankle Replacement,,Per Svc,13500.00
Chargemaster Item,,30213730,SPSI,Hip Plate Implantable,,Per Svc,5936.00
Chargemaster Item,,30213748,SPSI,Hip Lag Screw Implantable,,Per Svc,2420.00
Chargemaster Item,,30213755,SPSI,Hip Bone Screw,,Per Svc,84.00
Chargemaster Item,,30213763,SPSI,Hip Compression Screw,,Per Svc,840.00
Chargemaster Item,,30213771,SPSI,Cath Intradiscal,,Per Svc,4800.00
Chargemaster Item,,30213789,SPSI,Intradiscal Needle,,Per Svc,500.00
Chargemaster Item,,30213797,SPSI,Interstim Test Kit,,Per Svc,17460.00
Chargemaster Item,,30213821,SPSI,Lead Introducer,,Per Svc,800.00
Chargemaster Item,,30213839,SPSI,Extensions,,Per Svc,2380.00
Chargemaster Item,,30213847,SPSI,Interstim Lead,,Per Svc,14400.00
Chargemaster Item,,30213854,SPSI,External Fixator Upper,,Per Svc,14400.00
Chargemaster Item,,30213862,SPSI,Ventricular Cath Drain,,Per Svc,1132.00
Chargemaster Item,,30213888,SPSI,Resorbable Pin,,Per Svc,1680.00
Chargemaster Item,,30213896,SPSI,Resorbable Screw,,Per Svc,1608.00
Chargemaster Item,,30213904,SPSI,Sugita Aneurysm Clip,,Per Svc,1360.00
Chargemaster Item,,30213912,SPSI,On-Q Pain Pumps,,Per Svc,1124.00
Chargemaster Item,,30213920,SPSI,Infuse Bone Graft,,Per Svc,14400.00
Chargemaster Item,,30213938,SPSI,Shoulder Humeral Stem,,Per Svc,16214.00
Chargemaster Item,,30213946,SPSI,Shoulder Humeral Head,,Per Svc,6340.00
Chargemaster Item,,30213961,SPSI,Tissue Patch,,Per Svc,9600.00
Chargemaster Item,,30213987,SPSI,Tr Bone Plate,,Per Svc,4720.00
Chargemaster Item,,30213995,SPSI,Tr Bone Screw,,Per Svc,496.00
Chargemaster Item,,30214001,SPSI,Accutrak Ibone,,Per Svc,1540.00
Chargemaster Item,,30214019,SPSI,Bone Filler 5Cc,,Per Svc,4980.00
Chargemaster Item,,30214043,SPSI,Pain Access Kit,,Per Svc,600.00
Chargemaster Item,,30214050,SPSI,Absorable Bead,,Per Svc,2620.00
Chargemaster Item,,30214076,SPSI,Cath Thor 36Fr R Angle,,Per Svc,946.00
Chargemaster Item,,30214134,SPSI,Locking Plate Small,,Per Svc,1436.00
Chargemaster Item,,30214142,SPSI,Locking Plate Large,,Per Svc,2848.00
Chargemaster Item,,30214159,SPSI,Locking Screw,,Per Svc,792.00
Chargemaster Item,,30214167,SPSI,Locking Cannulated Screw,,Per Svc,1740.00
Chargemaster Item,,30214209,SPSI,Tissue Replac,,Per Svc,41048.00
Chargemaster Item,,30214217,SPSI,Bone Patellar Tendon Whole,,Per Svc,12756.00
Chargemaster Item,,30214258,SPSI,Tissue Membrane,,Per Svc,5032.00
Chargemaster Item,,30214274,SPSI,Toe Implant,,Per Svc,6196.00
Chargemaster Item,,30214282,SPSI,Calcium Bone Filler,,Per Svc,8680.00
Chargemaster Item,,30214290,SPSI,Cardiovascular Graft/Ring,,Per Svc,6488.00
Chargemaster Item,,30214308,SPSI,Infuse Bone Graft Large,,Per Svc,21800.00
Chargemaster Item,,30214324,SPSI,Testicular Implant,,Per Svc,5044.00
Chargemaster Item,,30214407,SPSI,Port Indwelling Imp,,Per Svc,1341.00
Chargemaster Item,,30214506,SPSI,Fallopian Ring,,Per Svc,3200.00
Chargemaster Item,,30214605,SPSI,Presbyopia-Correcting Io Lens,,Per Svc,3580.00
Chargemaster Item,,30214613,SPSI,Toric Lens,,Per Svc,1980.00
Chargemaster Item,,30214621,SPSI,Conventional Io Lens,,Per Svc,1.00
Chargemaster Item,,30215115,SPSI,Finger Implant,,Per Svc,8360.00
Chargemaster Item,,30215123,SPSI,Cath Brachy Tx Seed Adm,,Per Svc,3900.00
Chargemaster Item,,30215131,SPSI,De-Clotting Cath,,Per Svc,3600.00
Chargemaster Item,,30215149,SPSI,Urinary Sphincter Device,,Per Svc,40820.00
Chargemaster Item,,30220008,SPSI,Implant Bifurcated Graft,,Per Svc,43180.00
Chargemaster Item,,30220016,SPSI,Implant Thoracic Graft,,Per Svc,63900.00
Chargemaster Item,,30220024,SPSI,Implant Iliac Graft,,Per Svc,20000.00
Chargemaster Item,,30220032,SPSI,Implant Billiary,,Per Svc,10000.00
Chargemaster Item,,30220040,SPSI,Implant Proximal Cuff,,Per Svc,13580.00
Chargemaster Item,,30220057,SPSI,Wires Specialty,,Per Svc,430.00
Chargemaster Item,,30220065,SPSI,Wires Guide,,Per Svc,640.00
Chargemaster Item,,30220073,SPSI,Lg French Sheaths Introducer,,Per Svc,720.00
Chargemaster Item,,30220081,SPSI,Reg French Shealth Introducer,,Per Svc,320.00
Chargemaster Item,,30220107,SPSI,Catheters Angiographic,,Per Svc,400.00
Chargemaster Item,,30220115,SPSI,Balloons Aortic,,Per Svc,1040.00
Chargemaster Item,,30220123,SPSI,Balloons Peripheral,,Per Svc,1200.00
Chargemaster Item,,30220131,SPSI,Balloons Angioplasy,,Per Svc,1040.00
Chargemaster Item,,30220156,SPSI,Snares Abbott,,Per Svc,1000.00
Chargemaster Item,,30220164,SPSI,Csf Catheter System,,Per Svc,800.00
Chargemaster Item,,30220172,SPSI,Catheter Ivus,,Per Svc,3600.00
Chargemaster Item,,30220180,SPSI,Marker Tissue Impl,,Per Svc,0.01
Chargemaster Item,,30220198,SPSI,Anchor,,Per Svc,0.01
Chargemaster Item,,30220206,SPSI,Cath Atherect Direct,,Per Svc,0.01
Chargemaster Item,,30220214,SPSI,Needle Brachytherapy,,Per Svc,0.01
Chargemaster Item,,30220222,SPSI,Icd Dual Chamber,,Per Svc,0.01
Chargemaster Item,,30220230,SPSI,Icd Single Chamber,,Per Svc,0.01
Chargemaster Item,,30220248,SPSI,Cath Atherect Rotat,,Per Svc,0.01
Chargemaster Item,,30220255,SPSI,Cath Angio Non-Laser,,Per Svc,0.01
Chargemaster Item,,30220263,SPSI,Cath Balloon Non-Vasc,,Per Svc,0.01
Chargemaster Item,,30220271,SPSI,Cath Balloon Non-Vasc Insert,,Per Svc,0.01
Chargemaster Item,,30220289,SPSI,Cath Brachyseed Adm,,Per Svc,0.01
Chargemaster Item,,30220305,SPSI,Cath Ep Non 3D <=19,,Per Svc,0.01
Chargemaster Item,,30220313,SPSI,Cath Ep Non 3D >=20,,Per Svc,0.01
Chargemaster Item,,30220321,SPSI,Cath Abl Ep 3D/Vect,,Per Svc,0.01
Chargemaster Item,,30220339,SPSI,Cath Abl Ep No3D/Vec,,Per Svc,0.01
Chargemaster Item,,30220347,SPSI,Cath Hem/Per Chronic,,Per Svc,0.01
Chargemaster Item,,30220354,SPSI,Cath Inf No Dialysis,,Per Svc,0.01
Chargemaster Item,,30220362,SPSI,Cath Hem/Per Acute,,Per Svc,0.01
Chargemaster Item,,30220370,SPSI,Cath Intravasc Us,,Per Svc,0.01
Chargemaster Item,,30220396,SPSI,Cath Thrombec/Embo,,Per Svc,0.01
Chargemaster Item,,30220412,SPSI,Cath Intracrdic Echo,,Per Svc,0.01
Chargemaster Item,,30220438,SPSI,Tissue Human,,Per Svc,0.01
Chargemaster Item,,30220446,SPSI,Tissue Synth,,Per Svc,0.01
Chargemaster Item,,30220453,SPSI,Recrdr Cardiac Impl,,Per Svc,0.01
Chargemaster Item,,30220479,SPSI,Introducer Steerble Nonpeel,,Per Svc,0.01
Chargemaster Item,,30220487,SPSI,Generator Neurostim,,Per Svc,0.01
Chargemaster Item,,30220495,SPSI,Graft Vascular,,Per Svc,0.01
Chargemaster Item,,30220503,SPSI,Guidewire,,Per Svc,0.01
Chargemaster Item,,30220511,SPSI,Coil Imag Mag Reson,,Per Svc,0.01
Chargemaster Item,,30220529,SPSI,Insert Urinary W/Slng,,Per Svc,0.01
Chargemaster Item,,30220537,SPSI,Pump Inf Impl Prog,,Per Svc,0.01
Chargemaster Item,,30220545,SPSI,Retrvl Insert Device,,Per Svc,0.01
Chargemaster Item,,30220552,SPSI,Implantable Joint Device,,Per Svc,0.01
Chargemaster Item,,30220560,SPSI,Lead Cardiac Sngl Coil,,Per Svc,0.01
Chargemaster Item,,30220578,SPSI,Lead Neurostim,,Per Svc,0.01
Chargemaster Item,,30220586,SPSI,Lead Pacer Vdd,,Per Svc,0.01
Chargemaster Item,,30220594,SPSI,Lens Iol New Tech,,Per Svc,0.01
Chargemaster Item,,30220602,SPSI,Mesh Implantable,,Per Svc,0.01
Chargemaster Item,,30220628,SPSI,Pacer Dual Rr,,Per Svc,0.01
Chargemaster Item,,30220636,SPSI,Pacer Single Rr,,Per Svc,0.01
Chargemaster Item,,30220644,SPSI,Programmer Interstim,,Per Svc,0.01
Chargemaster Item,,30220669,SPSI,Prosth Breast,,Per Svc,0.01
Chargemaster Item,,30220677,SPSI,Prosth Penile Inflt,,Per Svc,0.01
Chargemaster Item,,30220685,SPSI,Prosth Urnary Sphnctr,,Per Svc,0.01
Chargemaster Item,,30220693,SPSI,Receiver/Transmit Neuros,,Per Svc,0.01
Chargemaster Item,,30220701,SPSI,Septal Impl Sys Card,,Per Svc,0.01
Chargemaster Item,,30220719,SPSI,Neuro Rechg Bat Sys,,Per Svc,0.01
Chargemaster Item,,30220727,SPSI,Interspinous Implant,,Per Svc,0.01
Chargemaster Item,,30220735,SPSI,Stent Coat W/Delvry,,Per Svc,0.01
Chargemaster Item,,30220743,SPSI,Stent Coat W/O Delivery,,Per Svc,0.01
Chargemaster Item,,30220750,SPSI,Stent Non W/Delvry,,Per Svc,0.01
Chargemaster Item,,30220768,SPSI,Stent Non W/O Delvry,,Per Svc,0.01
Chargemaster Item,,30220776,SPSI,Matrl For Vocal Cord,,Per Svc,0.01
Chargemaster Item,,30220784,SPSI,Filter Vena Cava,,Per Svc,0.01
Chargemaster Item,,30220792,SPSI,Dialysis Access Sys,,Per Svc,0.01
Chargemaster Item,,30220800,SPSI,Icd Def Not Sgl/Dual,,Per Svc,0.01
Chargemaster Item,,30220818,SPSI,Adapt/Extn/Pacing/Neurost Ld,,Per Svc,0.01
Chargemaster Item,,30220826,SPSI,Embolization Protect Sys,,Per Svc,0.01
Chargemaster Item,,30220834,SPSI,Cath Angio Laser,,Per Svc,0.01
Chargemaster Item,,30220842,SPSI,Cath Guide,,Per Svc,0.01
Chargemaster Item,,30220859,SPSI,Cath Abl Non-Cardiac,,Per Svc,0.01
Chargemaster Item,,30220867,SPSI,Pump Inf Impl N/Prog Perm,,Per Svc,0.01
Chargemaster Item,,30220875,SPSI,Introducer Fix Crv Peel,,Per Svc,0.01
Chargemaster Item,,30220883,SPSI,Introducer Fix Crv Nonpeel,,Per Svc,0.01
Chargemaster Item,,30220909,SPSI,Lead Cardiac Dual Coil,,Per Svc,0.01
Chargemaster Item,,30220917,SPSI,Lead Cardiac Non Sgl/Dual,,Per Svc,0.01
Chargemaster Item,,30220925,SPSI,Lead Neuro Test Kit,,Per Svc,0.01
Chargemaster Item,,30220933,SPSI,Lead Pacer Non Vdd,,Per Svc,0.01
Chargemaster Item,,30220941,SPSI,Lead Pacer Card/Defib,,Per Svc,0.01
Chargemaster Item,,30220958,SPSI,Lead Coronary Venous,,Per Svc,0.01
Chargemaster Item,,30220966,SPSI,Sealant Pulmonary,,Per Svc,0.01
Chargemaster Item,,30220974,SPSI,Stent Tmp W/O Delvry,,Per Svc,0.01
Chargemaster Item,,30220982,SPSI,Probe Cryoablation,,Per Svc,0.01
Chargemaster Item,,30220990,SPSI,Pacer Dual Non Rr,,Per Svc,0.01
Chargemaster Item,,30221006,SPSI,Pacer Single Non Rr,,Per Svc,0.01
Chargemaster Item,,30221014,SPSI,Pacer Nonsng Or Dual,,Per Svc,0.01
Chargemaster Item,,30221022,SPSI,Prosth Penile No Inflt,,Per Svc,0.01
Chargemaster Item,,30221030,SPSI,Stent Temp W/Delivery,,Per Svc,0.01
Chargemaster Item,,30221048,SPSI,Pump Inf Impl Np Tmp,,Per Svc,0.01
Chargemaster Item,,30221063,SPSI,Cath Occlusion,,Per Svc,0.01
Chargemaster Item,,30221071,SPSI,Introducer Laser,,Per Svc,0.01
Chargemaster Item,,30221089,SPSI,Cath Abl Cool-Tip,,Per Svc,0.01
Chargemaster Item,,30221097,SPSI,Insert Urinary Wo Slng,,Per Svc,0.01
Chargemaster Item,,30221105,SPSI,Neurawrap Nerve Protector Cm,,Per Svc,0.01
Chargemaster Item,,30221113,SPSI,Bulk Agent Collagen 2.5,,Per Svc,0.01
Chargemaster Item,,30221121,SPSI,Gel Bladder Deflux,,Per Svc,0.01
Chargemaster Item,,30221139,SPSI,Bulk Agent Durasph Inj,,Per Svc,0.01
Chargemaster Item,,30221147,SPSI,Bulk Agent Synth 1.0,,Per Svc,0.01
Chargemaster Item,,30221154,SPSI,Tegress Urethral Implant,,Per Svc,0.01
Chargemaster Item,,30221162,SPSI,Prosth Cochlear,,Per Svc,0.01
Chargemaster Item,,30221170,SPSI,Aud Osseo Dev Int Ext Comp,,Per Svc,0.01
Chargemaster Item,,30221188,SPSI,Graftjacket Per Sqcm,,Per Svc,0.01
Chargemaster Item,,30221196,SPSI,Anterior Chamber Iol,,Per Svc,0.01
Chargemaster Item,,30221204,SPSI,Posterior Chambr Iol,,Per Svc,0.01
Chargemaster Item,,30221212,SPSI,Amniograft,,Per Svc,0.01
Chargemaster Item,,30221220,SPSI,Miscellaneous Supply,,Per Svc,0.01
Chargemaster Item,,30221246,SPSI,Miscellaneous Implant,,Per Svc,0.01
Chargemaster Item,,30221253,SPSI,Radial Head,,Per Svc,0.01
Chargemaster Item,,30221261,SPSI,Biosorb Implant,,Per Svc,4000.00
Chargemaster Item,,30221279,SPSI,Neuro Stimulator Implants,,Per Svc,0.01
Chargemaster Item,,30221287,SPSI,Urology Implant,,Per Svc,0.01
Chargemaster Item,,30221295,SPSI,Integra Flowable Wound Matrix,,Per Svc,0.01
Chargemaster Item,,30221303,SPSI,Uro Pet Suture,,Per Svc,3900.00
Chargemaster Item,,30221311,SPSI,Epifix Dehyd.Human Amnion Grft,,Per Svc,0.01
Chargemaster Item,,30221402,SPSI,Stravix Cryo Tissue,,Per Svc,0.01
Chargemaster Item,,30222012,SPSI,Tissue Implant,,Per Svc,0.01
Chargemaster Item,,30222129,SPSI,Silikon Oil,,Per Svc,896.57
Chargemaster Item,,30222137,SPSI,Skin Substitue Graft,,Per Svc,0.01
Chargemaster Item,,30272116,SPSI,Glaucoma Valve Flexible Plate,,Per Svc,2800.00
Chargemaster Item,,30721161,SPSI,Pedicle Screw Monitoring,,Per Svc,2000.00
Chargemaster Item,,30721179,SPSI,Lens Intraoc Post UV AbsorbMultifocal,,Per Svc,3980.00
Chargemaster Item,,31000011,SPSI,Guide Wire Pneumothoriax 70cm,,Per Svc,436.00
Chargemaster Item,,31000029,SPSI,Drain Valve Pneumothorax,,Per Svc,435.00
Chargemaster Item,,31100001,SPSI,Walker,,Per Svc,154.00
Chargemaster Item,,31100019,SPSI,Wheelchair,,Per Svc,827.00
Chargemaster Item,,31100027,SPSI,Catheter Xtrn Cnvn Optm 25mm,,Per Svc,141.00
Chargemaster Item,,31100035,SPSI,Catheter Xtrn Cnvn Optm 28mm,,Per Svc,141.00
Chargemaster Item,,31100043,SPSI,Catheter Xtrn Cnvn Optm 30mm,,Per Svc,141.00
Chargemaster Item,,31100050,SPSI,Catheter Xtrn Cnvn Optm 35mm,,Per Svc,141.00
Chargemaster Item,,31100068,SPSI,Catheter Xtrn Cnvn Optm 40mm,,Per Svc,141.00
Chargemaster Item,,31100076,SPSI,Catheter Xtrn Cnvn Shrt 21mm,,Per Svc,141.00
Chargemaster Item,,31100084,SPSI,Catheter Xtrn Cnvn Shrt 25mm,,Per Svc,141.00
Chargemaster Item,,31100092,SPSI,Catheter Xtrn Cnvn Shrt 30mm,,Per Svc,141.00
Chargemaster Item,,31100118,SPSI,Catheter Xtrn Cnvn Shrt 35mm,,Per Svc,141.00
Chargemaster Item,,31101652,SPSI,Bile Bag,,Per Svc,469.00
Chargemaster Item,,31101702,SPSI,Drainage Bag,,Per Svc,292.00
Chargemaster Item,,31101728,SPSI,Urine Bag Leg Sm,,Per Svc,218.00
Chargemaster Item,,31101744,SPSI,Urine Bag Leg Lg,,Per Svc,171.00
Chargemaster Item,,31101801,SPSI,Tube F/Feeding Bag Spike,,Per Svc,26.00
Chargemaster Item,,31101850,SPSI,Bag Incontinent,,Per Svc,321.00
Chargemaster Item,,31103500,SPSI,Ace Wrap 2 In,,Per Svc,28.00
Chargemaster Item,,31103559,SPSI,Ace Wrap 3 In,,Per Svc,30.00
Chargemaster Item,,31103609,SPSI,Ace Wrap 4 In,,Per Svc,37.00
Chargemaster Item,,31103658,SPSI,Ace Wrap 6 In,,Per Svc,55.00
Chargemaster Item,,31103666,SPSI,Bandage Gelocast 4 Inch,,Per Svc,54.00
Chargemaster Item,,31105455,SPSI,Sitz Bath,,Per Svc,171.00
Chargemaster Item,,31105851,SPSI,Pelvic Belt Lg,,Per Svc,321.00
Chargemaster Item,,31105869,SPSI,Rib Belt Fem U,,Per Svc,218.00
Chargemaster Item,,31105976,SPSI,Rib Belt Male,,Per Svc,218.00
Chargemaster Item,,31105984,SPSI,Belt Posey Safety Large,,Per Svc,387.00
Chargemaster Item,,31106131,SPSI,Abd Binder Mal,,Per Svc,512.00
Chargemaster Item,,31106149,SPSI,Abd Binder Fem,,Per Svc,512.00
Chargemaster Item,,31109192,SPSI,Cannister F/Vac W/Gel,,Per Svc,132.28
Chargemaster Item,,31109259,SPSI,Cannula Nazal,,Per Svc,36.00
Chargemaster Item,,31109283,SPSI,Cath Cholangiography Oper,,Per Svc,297.00
Chargemaster Item,,31109804,SPSI,Cath Triple Lumen 12Fr,,Per Svc,633.00
Chargemaster Item,,31109952,SPSI,Trach Extra Horizontal #7,,Per Svc,585.00
Chargemaster Item,,31109960,SPSI,Trach 8.0Mm Cuff W/Suction#8,,Per Svc,556.00
Chargemaster Item,,31109978,SPSI,Trach 7.0Mm Cuff W/Suction,,Per Svc,556.00
Chargemaster Item,,31110190,SPSI,Cath Pigtail 6Fr,,Per Svc,448.00
Chargemaster Item,,31110216,SPSI,Cath 7Fr Therm Oil,,Per Svc,1225.00
Chargemaster Item,,31110414,SPSI,Cath Cvp Dual Lumen Jrsf,,Per Svc,1589.00
Chargemaster Item,,31110422,SPSI,Surg Catheter,,Per Svc,647.00
Chargemaster Item,,31110448,SPSI,Cath Cvp Dual Lumen 501J,,Per Svc,1464.00
Chargemaster Item,,31110471,SPSI,Cath,6Fr,,Per Svc,448.00
Chargemaster Item,,31110513,SPSI,Cath Arterial 301Ra,,Per Svc,577.00
Chargemaster Item,,31110521,SPSI,Cardiac Cath,,Per Svc,1183.00
Chargemaster Item,,31110539,SPSI,Cath, Arterial 301Fa,,Per Svc,577.00
Chargemaster Item,,31110547,SPSI,Tray Femoral Artery Pressure,,Per Svc,381.00
Chargemaster Item,,31110554,SPSI,Cath, Arterial 300Ra,,Per Svc,577.00
Chargemaster Item,,31110570,SPSI,Cath Cva Dual Lumen 401J,,Per Svc,1589.00
Chargemaster Item,,31110604,SPSI,Vip Catheter,,Per Svc,1831.00
Chargemaster Item,,31110612,SPSI,Radial Art Cath Set,,Per Svc,427.00
Chargemaster Item,,31110687,SPSI,Cath,Swan 8Fr,,Per Svc,2052.00
Chargemaster Item,,31110901,SPSI,Cath Foley 8 Fr,,Per Svc,556.00
Chargemaster Item,,31110950,SPSI,Cath Foley 10 Fr,,Per Svc,470.00
Chargemaster Item,,31111008,SPSI,Cath Foley 12 Fr W/5 Cc Bad,,Per Svc,369.00
Chargemaster Item,,31111057,SPSI,Cath Foley 14 Fr W/5 Cc Bad,,Per Svc,365.00
Chargemaster Item,,31111107,SPSI,Cath Foley 16 Fr W/5 Cc Bag,,Per Svc,297.00
Chargemaster Item,,31111156,SPSI,Cath Foley 18 Fr W/5 Cc Bag,,Per Svc,297.00
Chargemaster Item,,31111206,SPSI,Cath Foley 20 Fr W/5 Cc Bag,,Per Svc,297.00
Chargemaster Item,,31111255,SPSI,Cath Foley 22F w/5cc Bag,,Per Svc,36.00
Chargemaster Item,,31111305,SPSI,Cath Foley 24 Fr W/5 Cc Bag,,Per Svc,297.00
Chargemaster Item,,31111313,SPSI,Cath Foley 26 Fr W/5 Cc Bag,,Per Svc,297.00
Chargemaster Item,,31111453,SPSI,Cath Foley Coude 20 Fr,,Per Svc,589.00
Chargemaster Item,,31111503,SPSI,Cath Foley Coude 22 Fr,,Per Svc,591.00
Chargemaster Item,,31111651,SPSI,Cath Foley 16 Fr W/30 Cc Bag,,Per Svc,340.00
Chargemaster Item,,31111669,SPSI,Cath Foley Coude 16Fr 5Cc,,Per Svc,427.00
Chargemaster Item,,31111685,SPSI,Cath Foley 20 Fr 2Way,,Per Svc,382.00
Chargemaster Item,,31111693,SPSI,Cath Foley 20 Fr W/30 Cc 3W,,Per Svc,576.00
Chargemaster Item,,31111701,SPSI,Cath Foley 22 Fr W/30 Cc Bag,,Per Svc,420.00
Chargemaster Item,,31111750,SPSI,Cath Foley 24 Fr W/30 Cc Bag,,Per Svc,340.00
Chargemaster Item,,31111784,SPSI,Cath Foley 18F,,Per Svc,577.00
Chargemaster Item,,31111800,SPSI,Cath Paceport,,Per Svc,1362.00
Chargemaster Item,,31111909,SPSI,Cath Foley 22Fr 3Way,,Per Svc,470.00
Chargemaster Item,,31111917,SPSI,Cath Foley 24 Fr 3Way,,Per Svc,470.00
Chargemaster Item,,31111974,SPSI,Cath Mahur 11.5Frx16Cm Curved,,Per Svc,1314.00
Chargemaster Item,,31111990,SPSI,Cath Dbl Lum Fem Marhurkar,,Per Svc,1680.00
Chargemaster Item,,31112220,SPSI,Cath Pacing 5Fr,,Per Svc,1725.00
Chargemaster Item,,31112253,SPSI,Specimen Tube,,Per Svc,171.00
Chargemaster Item,,31112261,SPSI,Cath Mini 5 Fr,,Per Svc,171.00
Chargemaster Item,,31112303,SPSI,Sur Catheter,,Per Svc,1894.00
Chargemaster Item,,31112857,SPSI,Cath Leg Strap,,Per Svc,537.00
Chargemaster Item,,31112881,SPSI,Cath Suction,,Per Svc,65.00
Chargemaster Item,,31112899,SPSI,Cath Suction 8Fr,,Per Svc,58.00
Chargemaster Item,,31113004,SPSI,Cath Suction 10 7R,,Per Svc,331.00
Chargemaster Item,,31113012,SPSI,No Pour Suction Kit 10 Fr,,Per Svc,74.00
Chargemaster Item,,31113103,SPSI,Suction Trach Care 14Fr,,Per Svc,570.00
Chargemaster Item,,31113111,SPSI,No Pour Suction Kit 14 Fr,,Per Svc,74.00
Chargemaster Item,,31113129,SPSI,Cath Suction 14Fr Steri,,Per Svc,570.00
Chargemaster Item,,31113137,SPSI,Kit Cath Ecc Neonate,,Per Svc,292.00
Chargemaster Item,,31113145,SPSI,Cath Oral Suct 10FR,,Per Svc,5.00
Chargemaster Item,,31113269,SPSI,Valve, Heimlich Thoracic Drain,,Per Svc,410.00
Chargemaster Item,,31113517,SPSI,Cath Trocar 10Fr,,Per Svc,558.00
Chargemaster Item,,31113525,SPSI,Cath Trocar 12 Fr,,Per Svc,514.00
Chargemaster Item,,31113566,SPSI,Cath Trocar 24Fr,,Per Svc,251.00
Chargemaster Item,,31113574,SPSI,Cath Thor 36Fr R Angle,,Per Svc,946.00
Chargemaster Item,,31113582,SPSI,Cath Trocar Sz 24Fr,,Per Svc,498.00
Chargemaster Item,,31114507,SPSI,Calazime,,Per Svc,26.00
Chargemaster Item,,31114986,SPSI,Nutrashield Skin Protectant,,Per Svc,26.00
Chargemaster Item,,31115975,SPSI,Cervi Coll Sm,,Per Svc,271.00
Chargemaster Item,,31115983,SPSI,Cervi Coll Med,,Per Svc,271.00
Chargemaster Item,,31115991,SPSI,Cervi Coll Lg,,Per Svc,271.00
Chargemaster Item,,31116809,SPSI,Nylon Tx Cord,,Per Svc,193.00
Chargemaster Item,,31130768,SPSI,Pleurvac Auto Traps Peds,,Per Svc,1135.00
Chargemaster Item,,31130776,SPSI,Pleur Evak Auto Trans,,Per Svc,1841.00
Chargemaster Item,,31130800,SPSI,Drainage Set,,Per Svc,1583.00
Chargemaster Item,,31131428,SPSI,Dsg V.A.C. Granufoam Med,,Per Svc,194.08
Chargemaster Item,,31131436,SPSI,Dsg V.A.C. Granufoam Sml,,Per Svc,139.48
Chargemaster Item,,31131444,SPSI,Dressing Lg F/Vac Canister,,Per Svc,212.28
Chargemaster Item,,31131451,SPSI,Dressing Versafoam Large,,Per Svc,53.28
Chargemaster Item,,31131550,SPSI,Dressing Mepitel 2X3,,Per Svc,22.00
Chargemaster Item,,31131568,SPSI,Dressing Mepitel One 3X4,,Per Svc,28.00
Chargemaster Item,,31131618,SPSI,Dressing, Sorbsan 4 X 4,,Per Svc,297.00
Chargemaster Item,,31131626,SPSI,Dressing, Sorbsan 4 X 8,,Per Svc,498.00
Chargemaster Item,,31131634,SPSI,Dressing Tegaderm Central Line,,Per Svc,74.00
Chargemaster Item,,31131659,SPSI,Dressing Mepilex Bor 9.2X9.2,,Per Svc,58.00
Chargemaster Item,,31131667,SPSI,Dressing Mepilex 7.2x7.2,,Per Svc,39.00
Chargemaster Item,,31131675,SPSI,Dressing Mepilex 4X4,,Per Svc,15.00
Chargemaster Item,,31132392,SPSI,Cath Pacing 6Fr,,Per Svc,1610.00
Chargemaster Item,,31132491,SPSI,Femstop Plus,,Per Svc,850.00
Chargemaster Item,,31132558,SPSI,Enema Kit,,Per Svc,91.00
Chargemaster Item,,31132657,SPSI,Mini Trach Kit Ii,,Per Svc,924.00
Chargemaster Item,,31134554,SPSI,Excercisor Incentive Flowmeter,,Per Svc,130.00
Chargemaster Item,,31135916,SPSI,Filter Kit Pre Dilution,,Per Svc,1244.00
Chargemaster Item,,31145915,SPSI,Set Prismaflex M100,,Per Svc,1242.00
Chargemaster Item,,31153125,SPSI,Forcep Thumb 5In Sterile,,Per Svc,46.00
Chargemaster Item,,31153158,SPSI,Hemostat Str Kelly 5 1/2In Ster,,Per Svc,76.00
Chargemaster Item,,31156276,SPSI,Guide Wire SPD,,Per Svc,378.00
Chargemaster Item,,31156292,SPSI,Guide Wire Teflon Cvd.7.5,,Per Svc,654.00
Chargemaster Item,,31156409,SPSI,Heelboot Regular,,Per Svc,485.00
Chargemaster Item,,31156417,SPSI,Heelboot Large,,Per Svc,485.00
Chargemaster Item,,31157316,SPSI,Shoulder Ortho 1Mb Sm,,Per Svc,488.00
Chargemaster Item,,31157324,SPSI,Shoulder Ortho 1Mb Md,,Per Svc,488.00
Chargemaster Item,,31157332,SPSI,Shoulder Ortho 1Mmo Lg,,Per Svc,488.00
Chargemaster Item,,31157340,SPSI,Shoulder Ortho 1Mmo Xlg,,Per Svc,488.00
Chargemaster Item,,31157357,SPSI,Immobilizer, Knee 24Inch,,Per Svc,1089.00
Chargemaster Item,,31157803,SPSI,Sheath Intro Kit Percut,,Per Svc,1049.00
Chargemaster Item,,31157837,SPSI,Tray Percutaneous Intro Set,,Per Svc,2015.00
Chargemaster Item,,31157845,SPSI,Tray Percutaneous Trach Intro,,Per Svc,2357.00
Chargemaster Item,,31157878,SPSI,Percutaneous Trach,,Per Svc,342.00
Chargemaster Item,,31158058,SPSI,Peritoneal Kit Lavage Arrow,,Per Svc,1005.00
Chargemaster Item,,31158256,SPSI,Venous Press Set,,Per Svc,470.00
Chargemaster Item,,31158413,SPSI,Spike F/Pca Pump Set,,Per Svc,699.00
Chargemaster Item,,31158884,SPSI,Pneumothorax Kit,,Per Svc,1823.00
Chargemaster Item,,31161672,SPSI,Dressing Mepilex Border 4x10,,Per Svc,34.00
Chargemaster Item,,31161680,SPSI,Dressing Mepilex Ag 4x8,,Per Svc,123.00
Chargemaster Item,,31161698,SPSI,Dressing Border Post Op Mepilex,,Per Svc,36.00
Chargemaster Item,,31161706,SPSI,Dressing Mepilex Ag 4x12,,Per Svc,174.00
Chargemaster Item,,31161714,SPSI,Dressing Border Mepilex 4x8,,Per Svc,31.00
Chargemaster Item,,31161722,SPSI,Dressing Mepilex Ag 4x10,,Per Svc,154.00
Chargemaster Item,,31162209,SPSI,Monitor Set,,Per Svc,588.00
Chargemaster Item,,31162258,SPSI,Monitor Double Electrode,,Per Svc,859.00
Chargemaster Item,,31162266,SPSI,Electrode External Pacing,,Per Svc,1772.00
Chargemaster Item,,31162282,SPSI,Monitor Triple Electrode,,Per Svc,1362.00
Chargemaster Item,,31162290,SPSI,Monitor Electode Sin Line,,Per Svc,621.00
Chargemaster Item,,31162365,SPSI,Mon Pressure Set,,Per Svc,621.00
Chargemaster Item,,31162787,SPSI,Needle Biopsy,,Per Svc,529.00
Chargemaster Item,,31162845,SPSI,Ill Needle Disp,,Per Svc,588.00
Chargemaster Item,,31162878,SPSI,Biopsy Needle,,Per Svc,724.00
Chargemaster Item,,31165368,SPSI,Ostomy Supply,,Per Svc,140.00
Chargemaster Item,,31165376,SPSI,Cream Skin Repair,,Per Svc,17.00
Chargemaster Item,,31165541,SPSI,Ostomy Adhesive,,Per Svc,413.00
Chargemaster Item,,31165566,SPSI,Ostomy Hytape 1In,,Per Svc,218.00
Chargemaster Item,,31165624,SPSI,Dressing Cgf Duo Derm 6X7Inch,,Per Svc,542.00
Chargemaster Item,,31165632,SPSI,Dressin 4X4 Ext Thin Duoderm,,Per Svc,239.00
Chargemaster Item,,31165640,SPSI,Dressing 6X5 Ext Thin Duoderm,,Per Svc,353.00
Chargemaster Item,,31165681,SPSI,Closure,Tail Drain Pouch,,Per Svc,103.00
Chargemaster Item,,31165749,SPSI,Dressing Op Site Wound 4X4.75,,Per Svc,74.00
Chargemaster Item,,31165756,SPSI,Dress Op Site Wound 4X10Inch,,Per Svc,149.00
Chargemaster Item,,31165764,SPSI,Dress Op Site Wound 6X10Inch,,Per Svc,166.00
Chargemaster Item,,31165780,SPSI,Dressing Wound Cgf 8X8Inch,,Per Svc,733.00
Chargemaster Item,,31165798,SPSI,Collector Wound Drain W/Barier,,Per Svc,588.00
Chargemaster Item,,31165822,SPSI,Stomahesive 4X4 Inch,,Per Svc,266.00
Chargemaster Item,,31167158,SPSI,Gauze Packing Iodaf 1/4 In,,Per Svc,239.00
Chargemaster Item,,31167208,SPSI,Gauze Packing Iodaf 1/2 In,,Per Svc,247.00
Chargemaster Item,,31167257,SPSI,Gauze Packing Iodaf 1 In,,Per Svc,292.00
Chargemaster Item,,31167307,SPSI,Gauze Packing Plain 1/4 In,,Per Svc,220.00
Chargemaster Item,,31167356,SPSI,Gauze Packing Plain 1/2 In,,Per Svc,241.00
Chargemaster Item,,31167455,SPSI,Gauze Packing Plain 1 In,,Per Svc,271.00
Chargemaster Item,,31167604,SPSI,Pad Gaymar,,Per Svc,673.00
Chargemaster Item,,31167646,SPSI,Pad Aqua 18X24,,Per Svc,621.00
Chargemaster Item,,31167711,SPSI,Kit Danninger Cpm,,Per Svc,69.00
Chargemaster Item,,31169402,SPSI,Perineal Pads,,Per Svc,76.00
Chargemaster Item,,31173214,SPSI,Powder Stoma Adhesive,,Per Svc,488.00
Chargemaster Item,,31173602,SPSI,Breast Sys Single Tray,,Per Svc,839.00
Chargemaster Item,,31173610,SPSI,Breast Egnell Hand Tray,,Per Svc,782.00
Chargemaster Item,,31173628,SPSI,Breast Sys Dual Tray,,Per Svc,1103.00
Chargemaster Item,,31174006,SPSI,Suture Remover,,Per Svc,227.00
Chargemaster Item,,31175607,SPSI,Cushion Ring,,Per Svc,741.00
Chargemaster Item,,31177801,SPSI,Sheath 9Fr,,Per Svc,809.00
Chargemaster Item,,31178106,SPSI,Shoe Post Op Mens Small,,Per Svc,320.00
Chargemaster Item,,31178155,SPSI,Post Shoe M Md,,Per Svc,320.00
Chargemaster Item,,31178205,SPSI,Post Shoe M Lg,,Per Svc,320.00
Chargemaster Item,,31178254,SPSI,Post Shoe L Sm,,Per Svc,320.00
Chargemaster Item,,31178304,SPSI,Post Shoe L Md,,Per Svc,320.00
Chargemaster Item,,31178353,SPSI,Post Shoe L Lg,,Per Svc,320.00
Chargemaster Item,,31178403,SPSI,Cast Shoe Sm,,Per Svc,292.00
Chargemaster Item,,31178452,SPSI,Cast Shoe Md,,Per Svc,292.00
Chargemaster Item,,31178502,SPSI,Cast Shoe Lg,,Per Svc,292.00
Chargemaster Item,,31179047,SPSI,Sling Arm Sm,,Per Svc,193.00
Chargemaster Item,,31179054,SPSI,Sling Arm Med,,Per Svc,193.00
Chargemaster Item,,31179062,SPSI,Sling Arm Lg,,Per Svc,194.00
Chargemaster Item,,31182454,SPSI,Container Eval 250Ml,,Per Svc,76.00
Chargemaster Item,,31182504,SPSI,Container Evac 500Ml,,Per Svc,76.00
Chargemaster Item,,31182553,SPSI,Container Evac 1000Ml,,Per Svc,91.00
Chargemaster Item,,31183783,SPSI,Solution P.Dial 4.25% 2000Cc,,Per Svc,187.00
Chargemaster Item,,31183817,SPSI,Dialysate 5L,,Per Svc,167.00
Chargemaster Item,,31183833,SPSI,Pe D 1.5% 2000Ml,00941-0409-06,Per Svc,467.00
Chargemaster Item,,31183866,SPSI,Dialysis 1.5% Dianea,,Per Svc,161.00
Chargemaster Item,,31183874,SPSI,Pe D 2.5%2000Ml,,Per Svc,467.00
Chargemaster Item,,31183890,SPSI,Dialysis 2.5% Dianea,,Per Svc,166.00
Chargemaster Item,,31183916,SPSI,Sol Iv Sterile Saline 4Oz,,Per Svc,420.00
Chargemaster Item,,31184005,SPSI,Prismasate BGK4/2.5,,Per Svc,153.00
Chargemaster Item,,31184013,SPSI,Prismasol BGK4/2.5 PV,,Per Svc,157.00
Chargemaster Item,,31184054,SPSI,Prisma solution replace fluid,,Per Svc,145.00
Chargemaster Item,,31184203,SPSI,Splint Ac,,Per Svc,470.00
Chargemaster Item,,31184450,SPSI,Splint Basket,,Per Svc,118.00
Chargemaster Item,,31184484,SPSI,Splint Clav Md,,Per Svc,298.00
Chargemaster Item,,31184492,SPSI,Splint Clav Lg,,Per Svc,298.00
Chargemaster Item,,31185002,SPSI,Splint Cla Xsm,,Per Svc,273.00
Chargemaster Item,,31185408,SPSI,Splint Knee Un,,Per Svc,511.00
Chargemaster Item,,31186703,SPSI,Splint Wrist 7,,Per Svc,470.00
Chargemaster Item,,31186711,SPSI,Splint Writ 10,,Per Svc,395.00
Chargemaster Item,,31186729,SPSI,Splint Cock-Up,,Per Svc,654.00
Chargemaster Item,,31190457,SPSI,Tub Stockin 2,,Per Svc,62.00
Chargemaster Item,,31190903,SPSI,Stocking Anti-Emb Knee Xl-R,,Per Svc,302.00
Chargemaster Item,,31190952,SPSI,Stocking Anti-Emb Knee M-L,,Per Svc,302.00
Chargemaster Item,,31191000,SPSI,Stocking Anti-Emb Knee L-L,,Per Svc,302.00
Chargemaster Item,,31191059,SPSI,Stocking Anti-Emb Knee Xl-L,,Per Svc,302.00
Chargemaster Item,,31191109,SPSI,Stocking Anti-Emb Thigh S-S,,Per Svc,427.00
Chargemaster Item,,31191158,SPSI,Stocking Anti-Emb Thigh S-R,,Per Svc,427.00
Chargemaster Item,,31191208,SPSI,Stocking Anti-Emb Knee S-L,,Per Svc,427.00
Chargemaster Item,,31191257,SPSI,Stocking Anti-Emb Thigh M-S,,Per Svc,427.00
Chargemaster Item,,31191307,SPSI,Stocking Anti-Emb Thigh M-R,,Per Svc,427.00
Chargemaster Item,,31191356,SPSI,Stocking Anti-Emb Thigh M-L,,Per Svc,427.00
Chargemaster Item,,31191406,SPSI,Stocking Anti-Emb Thigh L-S,,Per Svc,427.00
Chargemaster Item,,31191455,SPSI,Stocking Anti-Emb Thigh L-R,,Per Svc,427.00
Chargemaster Item,,31191505,SPSI,Stocking Anti-Emb Thigh L-L,,Per Svc,427.00
Chargemaster Item,,31191554,SPSI,Stocking Anti-Emb Knee Sm/R,,Per Svc,302.00
Chargemaster Item,,31191604,SPSI,Stocking Anti-Emb Knee M-R,,Per Svc,302.00
Chargemaster Item,,31191612,SPSI,Stockings,Anti-Embolism,X-Large/Long,,Per Svc,12.00
Chargemaster Item,,31191620,SPSI,Garment Regular Foot,,Per Svc,39.00
Chargemaster Item,,31191638,SPSI,Garment, Alt Leg Press, Regular, Thigh,,,Per Svc,31.00
Chargemaster Item,,31191646,SPSI,Garment,Foot Comp Lg,,Per Svc,42.00
Chargemaster Item,,31191653,SPSI,Stocking Anti-Emb Knee L-R,,Per Svc,302.00
Chargemaster Item,,31191679,SPSI,Sleeve Seq Comp Device Med,,Per Svc,380.00
Chargemaster Item,,31191687,SPSI,Sleeve Seq Comp Device Small,,Per Svc,380.00
Chargemaster Item,,31191695,SPSI,Sleeve Seq Comp Device Large,,Per Svc,380.00
Chargemaster Item,,31191766,SPSI,Garment Thigh Lg,,Per Svc,41.00
Chargemaster Item,,31192057,SPSI,Suspensory Swimmer Med,,Per Svc,272.00
Chargemaster Item,,31192065,SPSI,Suspensory Swimmer Lg,,Per Svc,269.00
Chargemaster Item,,31192156,SPSI,Stapler Skin D&G App 35W,,Per Svc,1801.00
Chargemaster Item,,31192248,SPSI,Suture DSS 35,,Per Svc,953.00
Chargemaster Item,,31193089,SPSI,Cholecystectomy Tray,,Per Svc,4780.00
Chargemaster Item,,31197411,SPSI,Adhesive Dermabond,,Per Svc,485.00
Chargemaster Item,,31205818,SPSI,Syringe Ltakit,,Per Svc,266.00
Chargemaster Item,,31208317,SPSI,Sensor LNCS Adtx SpO2 Reproc,,Per Svc,15.00
Chargemaster Item,,31208325,SPSI,Sensor LNCS Neo3 SpO2Reproc,,Per Svc,18.00
Chargemaster Item,,31211154,SPSI,Tray Lumbar Puncture,,Per Svc,576.00
Chargemaster Item,,31211402,SPSI,Tray Basic Biopsy,,Per Svc,576.00
Chargemaster Item,,31211725,SPSI,Tray Circ Disp,,Per Svc,529.00
Chargemaster Item,,31211964,SPSI,Tray Dressing,,Per Svc,446.00
Chargemaster Item,,31212202,SPSI,Tray Epidural Cont Flex Tip,,Per Svc,621.00
Chargemaster Item,,31212236,SPSI,Tray, Epidural,,Per Svc,621.00
Chargemaster Item,,31212251,SPSI,Catheter Tray B,,Per Svc,381.00
Chargemaster Item,,31212269,SPSI,Tray Fol 18Fr,,Per Svc,381.00
Chargemaster Item,,31212277,SPSI,Cvp Mult Lum Tray,,Per Svc,1282.00
Chargemaster Item,,31212301,SPSI,Tray Cvp Double Lum Cath 8Fr,,Per Svc,780.00
Chargemaster Item,,31213002,SPSI,Tray Lumbar Puncture Adult,,Per Svc,588.00
Chargemaster Item,,31213028,SPSI,Tray L/P Infant,,Per Svc,535.00
Chargemaster Item,,31213051,SPSI,Tray Lumbar Puncture Ped/Inf,,Per Svc,608.00
Chargemaster Item,,31213069,SPSI,Quinton Subclavian Tray,,Per Svc,1301.00
Chargemaster Item,,31213077,SPSI,Quinton Femoral Tray,,Per Svc,1301.00
Chargemaster Item,,31213259,SPSI,Tray Cvp Triple Lum Cath 7Fr,,Per Svc,735.00
Chargemaster Item,,31213309,SPSI,Tray Cup Double Lumen 7Fr X 18,,Per Svc,1332.00
Chargemaster Item,,31213317,SPSI,Tray Uri-Cath 5Fr,,Per Svc,853.00
Chargemaster Item,,31213358,SPSI,Procedure Tray B,,Per Svc,1549.00
Chargemaster Item,,31213655,SPSI,Tray Sut Remover Deluxe,,Per Svc,149.00
Chargemaster Item,,31213697,SPSI,Er Suture Pack,,Per Svc,489.00
Chargemaster Item,,31213762,SPSI,Procedure Tray A,,Per Svc,1323.00
Chargemaster Item,,31213911,SPSI,Trach Care Tray,,Per Svc,138.00
Chargemaster Item,,31213952,SPSI,Catheter Tray A,,Per Svc,297.00
Chargemaster Item,,31214059,SPSI,Urinemeter W/O Cath,,Per Svc,467.00
Chargemaster Item,,31214075,SPSI,Urinemeter W/16Fr Biocath,,Per Svc,914.00
Chargemaster Item,,31214091,SPSI,Tray Urinemeter W/18 Fr Cath,,Per Svc,914.00
Chargemaster Item,,31214554,SPSI,Asperating Tb,,Per Svc,310.00
Chargemaster Item,,31215007,SPSI,Tube Connecting,,Per Svc,42.00
Chargemaster Item,,31215072,SPSI,Tray Mity Vac,,Per Svc,682.00
Chargemaster Item,,31215130,SPSI,Tube Et Low Pro 3.0 Fr,,Per Svc,352.00
Chargemaster Item,,31215163,SPSI,Tube, Et Low Pro 5.0 Fr,,Per Svc,331.00
Chargemaster Item,,31215189,SPSI,Tube Et Low Pro 6.0 Fr,,Per Svc,314.00
Chargemaster Item,,31215197,SPSI,Trach Tube Endo 4.0Mm,,Per Svc,318.00
Chargemaster Item,,31215205,SPSI,Trach Tube Endo 4.5Mm,,Per Svc,318.00
Chargemaster Item,,31215213,SPSI,Tube, Et Low Pro 6.5 Fr,,Per Svc,331.00
Chargemaster Item,,31215239,SPSI,Trach Tube Endo 5.5Mm,,Per Svc,318.00
Chargemaster Item,,31215254,SPSI,Trach Tube Endo 6.5Mm,,Per Svc,318.00
Chargemaster Item,,31215262,SPSI,Trach Tube Endo 7.0Mm,,Per Svc,318.00
Chargemaster Item,,31215270,SPSI,Endotrach Tube,,Per Svc,318.00
Chargemaster Item,,31215288,SPSI,Trach Tube Endo 8.0Mm,,Per Svc,318.00
Chargemaster Item,,31215296,SPSI,Endotrach Tube 8.5mm,,Per Svc,6.00
Chargemaster Item,,31215304,SPSI,Tube Endotrach 9.0 Mm St,,Per Svc,171.00
Chargemaster Item,,31215361,SPSI,Entriflex Fd Tube,,Per Svc,556.00
Chargemaster Item,,31215619,SPSI,Tube Lavage 32Fr,,Per Svc,420.00
Chargemaster Item,,31215643,SPSI,Cath Triple Lumen Precept,,Per Svc,1977.00
Chargemaster Item,,31215650,SPSI,Dressing Aquacel Ag 4X4,,Per Svc,841.00
Chargemaster Item,,31215668,SPSI,Bag Flexiseal Convatec,,Per Svc,460.00
Chargemaster Item,,31215684,SPSI,Kit Insertion Drain Pleuravac,,Per Svc,452.00
Chargemaster Item,,31215718,SPSI,Foley Lubrisil 16Fr Lf,,Per Svc,113.00
Chargemaster Item,,31215767,SPSI,Et Hilo Evac 6.0,,Per Svc,115.00
Chargemaster Item,,31215783,SPSI,Et Hilo Evac 7.0,,Per Svc,103.00
Chargemaster Item,,31215791,SPSI,Et Hilo Evac 7.5,,Per Svc,105.00
Chargemaster Item,,31215809,SPSI,Et Hilo Evac 8.0,,Per Svc,105.00
Chargemaster Item,,31215817,SPSI,Et Hilo Evac 8.5,,Per Svc,105.00
Chargemaster Item,,31215882,SPSI,Pouch Ost Drainable 6-8 Day,,Per Svc,129.00
Chargemaster Item,,31216005,SPSI,Pressure Tube,,Per Svc,103.00
Chargemaster Item,,31216625,SPSI,Line Drainage Pleura X,,Per Svc,148.00
Chargemaster Item,,31216633,SPSI,Wafer Ost 2 3/4 6-8 Day Wear,,Per Svc,80.00
Chargemaster Item,,31216641,SPSI,Pouch Ost Drainable 2 3/4,,Per Svc,80.00
Chargemaster Item,,31216658,SPSI,Pouch Urostomy 2 3/4Inch,,Per Svc,4.00
Chargemaster Item,,31216674,SPSI,Tray Double Lumen W/Kit,,Per Svc,384.00
Chargemaster Item,,31216765,SPSI,Trach Tube Endo 2.5Mm W/O Cuff,,Per Svc,208.00
Chargemaster Item,,31216773,SPSI,Trach Tube Endo 3.0Mm W/O Cuff,,Per Svc,208.00
Chargemaster Item,,31216781,SPSI,Trach Tube Endo 3.5Mm W/O Cuff,,Per Svc,208.00
Chargemaster Item,,31216799,SPSI,Trach Tube Endo 4.0Mm W/O Cuff,,Per Svc,208.00
Chargemaster Item,,31216807,SPSI,Tube Trach Ped 3.5,,Per Svc,1598.00
Chargemaster Item,,31216815,SPSI,Tube, Trach Ped 4.0,,Per Svc,1598.00
Chargemaster Item,,31217011,SPSI,Cannula 8Mm F/Sz9 Trach,,Per Svc,180.00
Chargemaster Item,,31217029,SPSI,Cannual Shiley Inner 8,,Per Svc,46.00
Chargemaster Item,,31217045,SPSI,Cannula Inner Size 7,,Per Svc,42.00
Chargemaster Item,,31217052,SPSI,Tube Trach Ped 3.0,,Per Svc,1598.00
Chargemaster Item,,31217060,SPSI,Cannula Inner Size 8,,Per Svc,42.00
Chargemaster Item,,31217094,SPSI,Cannula 7Mm F/Sz8 Trach,,Per Svc,180.00
Chargemaster Item,,31217102,SPSI,Trach Flex 8.0Mm Cuff,,Per Svc,1282.00
Chargemaster Item,,31217110,SPSI,Tube Trach Flex 7.0 Mm Cuff,,Per Svc,1282.00
Chargemaster Item,,31217128,SPSI,Cannula 6.0 Mm F/Sz 7 Trach,,Per Svc,180.00
Chargemaster Item,,31217136,SPSI,Cannula 5.0 Mm F/Sz 6 Trach,,Per Svc,180.00
Chargemaster Item,,31217144,SPSI,Tube Trach Flex 6.0 Mm,,Per Svc,1282.00
Chargemaster Item,,31217193,SPSI,Catheter Iupc,,Per Svc,101.00
Chargemaster Item,,31217219,SPSI,Cannula Inner Xtra Length Sz7,,Per Svc,46.00
Chargemaster Item,,31217367,SPSI,Stocking Ted Thigh 2Xl Short,,Per Svc,46.00
Chargemaster Item,,31217375,SPSI,Stocking Ted Thigh Xl Short,,Per Svc,46.00
Chargemaster Item,,31217409,SPSI,Trach Tube System Plume Away,,Per Svc,974.00
Chargemaster Item,,31217417,SPSI,Kit Catheter Zassi 4Cm,,Per Svc,2157.00
Chargemaster Item,,31217524,SPSI,Sensor Pediatric Lncs Pdt,,Per Svc,65.00
Chargemaster Item,,31217532,SPSI,Sensor Neonatal Lncs Neo-L,,Per Svc,91.00
Chargemaster Item,,31217540,SPSI,Picc Triple Lumen W/ Intro 6Fr,,Per Svc,1710.00
Chargemaster Item,,31217557,SPSI,Picc Dual Lumen 5Fr B,,Per Svc,1406.00
Chargemaster Item,,31218274,SPSI,Retractor Csection 11-17Cm,,Per Svc,526.00
Chargemaster Item,,31218282,SPSI,Retractor Csection 2-4Cm,,Per Svc,143.00
Chargemaster Item,,31218399,SPSI,Garment Compression Calf Lg,,Per Svc,130.00
Chargemaster Item,,31218407,SPSI,Garment Compression Calf,,Per Svc,130.00
Chargemaster Item,,31218431,SPSI,Compression Garmet Bariatric,,Per Svc,250.00
Chargemaster Item,,31218449,SPSI,Tray Insertion Picc Neonatal,,Per Svc,65.00
Chargemaster Item,,31218589,SPSI,Et Tube 3.5Mm,,Per Svc,128.00
Chargemaster Item,,31218597,SPSI,Et Tube 4.0Mm,,Per Svc,209.00
Chargemaster Item,,31218613,SPSI,Et Tube 5.0Mm,,Per Svc,227.00
Chargemaster Item,,31218662,SPSI,Latch Assist,,Per Svc,39.00
Chargemaster Item,,31218696,SPSI,Vacuum Kiwi,,Per Svc,898.00
Chargemaster Item,,31218753,SPSI,Picc Single Lumen 4Fr,,Per Svc,1188.00
Chargemaster Item,,31218761,SPSI,Picc Dual Lumen 5Fr A,,Per Svc,1188.00
Chargemaster Item,,31400005,SPSI,Trapeze Bar,,Per Svc,1052.00
Chargemaster Item,,31400054,SPSI,Ankle Foot Orthosis,,Per Svc,5805.00
Chargemaster Item,,31400070,SPSI,Comp Fracture Brace W/Pelic,,Per Svc,17415.00
Chargemaster Item,,31400088,SPSI,Hip Reduction Brace,,Per Svc,16443.00
Chargemaster Item,,31400096,SPSI,Jewett Back Brace,,Per Svc,4839.00
Chargemaster Item,,31400120,SPSI,Shoulder Abduct,,Per Svc,1583.00
Chargemaster Item,,31400138,SPSI,Lumbra/Sacro Support,,Per Svc,3159.00
Chargemaster Item,,31400161,SPSI,Halo Unit 1201,,Per Svc,23881.00
Chargemaster Item,,31400187,SPSI,Coban Bandage 3X5,,Per Svc,91.00
Chargemaster Item,,31400203,SPSI,Cervica Tract,,Per Svc,2029.00
Chargemaster Item,,31400245,SPSI,80010 Knee Splint,,Per Svc,589.00
Chargemaster Item,,31400286,SPSI,Universal Brac,,Per Svc,1301.00
Chargemaster Item,,31400302,SPSI,Bucks Traction,,Per Svc,1165.00
Chargemaster Item,,31400310,SPSI,Wound Vac Therapy,,Per Svc,621.00
Chargemaster Item,,31400757,SPSI,Total Collar,,Per Svc,629.00
Chargemaster Item,,31400815,SPSI,Splint 3Inch,,Per Svc,4.00
Chargemaster Item,,31400823,SPSI,Splint 4Inch,,Per Svc,4.00
Chargemaster Item,,31400997,SPSI,Ortho Orthodic Device,,Per Svc,5623.00
Chargemaster Item,,31410236,SPSI,Synth Stock 2,,Per Svc,97.00
Chargemaster Item,,31410244,SPSI,Synth Stock 3B,,Per Svc,110.00
Chargemaster Item,,31410251,SPSI,Synth Stock 3A,,Per Svc,127.00
Chargemaster Item,,31410269,SPSI,Synth Stock 6,,Per Svc,179.00
Chargemaster Item,,31410301,SPSI,Synth Pad 2,,Per Svc,77.00
Chargemaster Item,,31410319,SPSI,Synth Pad 3,,Per Svc,101.00
Chargemaster Item,,31410327,SPSI,Synth Pad 4,,Per Svc,127.00
Chargemaster Item,,31410335,SPSI,Synth Pad 6,,Per Svc,167.00
Chargemaster Item,,31410400,SPSI,Synth Cast 2,,Per Svc,500.00
Chargemaster Item,,31410418,SPSI,Synth Cast 3,,Per Svc,357.00
Chargemaster Item,,31410426,SPSI,Synth Cast 4,,Per Svc,498.00
Chargemaster Item,,31410434,SPSI,Synth Cast 5,,Per Svc,559.00
Chargemaster Item,,31410509,SPSI,Padding Cotton Undercast 2Inch,,Per Svc,37.00
Chargemaster Item,,31410517,SPSI,Padding Cotton Undercast 3Inch,,Per Svc,62.00
Chargemaster Item,,31410525,SPSI,Padding Cotton Undercast 4Inch,,Per Svc,77.00
Chargemaster Item,,31410533,SPSI,Padding Cotton Undercast 6Inch,,Per Svc,97.00
Chargemaster Item,,31410608,SPSI,Plaster Roll 3,,Per Svc,131.00
Chargemaster Item,,31410616,SPSI,Plaster Roll 4,,Per Svc,163.00
Chargemaster Item,,31410624,SPSI,Plaster Roll 6,,Per Svc,150.00
Chargemaster Item,,31410632,SPSI,Spling 3X15,,Per Svc,14.00
Chargemaster Item,,31410640,SPSI,Splint 4X15,,Per Svc,14.00
Chargemaster Item,,31410657,SPSI,Spling 5X30,,Per Svc,28.00
Chargemaster Item,,31410707,SPSI,Felt,,Per Svc,183.00
Chargemaster Item,,31410756,SPSI,Bulky Jones,,Per Svc,322.00
Chargemaster Item,,31422553,SPSI,Pads-Cpm,,Per Svc,733.00
Chargemaster Item,,31423007,SPSI,Hypothermia Pads,,Per Svc,962.00
Chargemaster Item,,31430044,SPSI,Tray, Hemmorrhage Nasal St,,Per Svc,1154.00
Chargemaster Item,,31430051,SPSI,Tray, Thoracotomy Adult Er,,Per Svc,2015.00
Chargemaster Item,,31430101,SPSI,Tray, Myringotomy Sterile,,Per Svc,558.00
Chargemaster Item,,31440084,SPSI,Cart Percutaneous Trach,,Per Svc,2517.00
Chargemaster Item,,31441066,SPSI,Curasalt Packing Strip 1/2Inch,,Per Svc,175.00
Chargemaster Item,,31441090,SPSI,Pouch Oval Adult,,Per Svc,175.00
Chargemaster Item,,31450174,SPSI,Triadyne Bed,,Per Svc,1569.00
Chargemaster Item,,31450182,SPSI,Barikare Bed,,Per Svc,1452.00
Chargemaster Item,,31450216,SPSI,Bed Advanta/Zone Air,,Per Svc,1340.00
Chargemaster Item,,31450224,SPSI,Fluid-Airbed,,Per Svc,1569.00
Chargemaster Item,,31450232,SPSI,Cpm-9000,,Per Svc,1354.00
Chargemaster Item,,31450257,SPSI,Ice Therapy,,Per Svc,1354.00
Chargemaster Item,,31450307,SPSI,Citadel Bed,,Per Svc,1938.00
Chargemaster Item,,31450315,SPSI,Bed, Rotoprone Per Day,,Per Svc,4135.00
Chargemaster Item,,31450356,SPSI,Foot Pump,,Per Svc,500.00
Chargemaster Item,,31450406,SPSI,Foot Pad Reg,,Per Svc,925.00
Chargemaster Item,,31450455,SPSI,Foot Pad Lge,,Per Svc,925.00
Chargemaster Item,,31450505,SPSI,Cold Ther Pad,,Per Svc,925.00
Chargemaster Item,,31460355,SPSI,Wound Vacuum Canister,,Per Svc,395.00
Chargemaster Item,,31460405,SPSI,Wound Vac Dressing Small,,Per Svc,407.00
Chargemaster Item,,31460454,SPSI,Wound Vac Dressing Medium,,Per Svc,502.00
Chargemaster Item,,31460504,SPSI,Wound Vac Dressing Large,,Per Svc,611.00
Chargemaster Item,,31485147,SPSI,Bed Safe Enclosure Posey,,Per Svc,322.00
Chargemaster Item,,31486723,SPSI,Tray Bone Marrow Biopsy,,Per Svc,132.00
Chargemaster Item,,31608722,SPSI,Sensor,Neonatal,Lnop,Pulse Oximeter,,Per Svc,17.00
Chargemaster Item,,31608730,SPSI,Sensor,Neonatal,Adhesive,Lnop,,Per Svc,16.00
Chargemaster Item,,31608748,SPSI,Sensor,Pediatric,Adh,Sensative,Lnop,,Per Svc,13.00
Chargemaster Item,,31608755,SPSI,Sensor Nellcor,,Per Svc,331.00
Chargemaster Item,,31608763,SPSI,Sensor,Nellcor,,Per Svc,352.00
Chargemaster Item,,31608789,SPSI,Sensor,Adult,Lncs-Adtx,Spo2,,Per Svc,13.00
Chargemaster Item,,31609605,SPSI,Tray Spinal Anes,,Per Svc,604.00
Chargemaster Item,,31611007,SPSI,VeraFlo Dressing Kit SM,,Per Svc,392.00
Chargemaster Item,,31611015,SPSI,VeraFlo Dressing Kit MED,,Per Svc,460.00
Chargemaster Item,,31611023,SPSI,VeraFlo Dressing Kit LRG,,Per Svc,864.00
Chargemaster Item,,31611031,SPSI,VeraFlo Cleanse Dressg Kit MED,,Per Svc,552.00
Chargemaster Item,,31611049,SPSI,VeraLink Cassette,,Per Svc,230.00
Chargemaster Item,,31611155,SPSI,Manamed Post OP Knee Brace,,Per Svc,460.00
Chargemaster Item,,31611163,SPSI,CAM Walker Boot Hi-Top, XSM,,Per Svc,107.00
Chargemaster Item,,31611171,SPSI,CAM Walker Boot Hi-Top, SM,,Per Svc,93.00
Chargemaster Item,,31611189,SPSI,CAM Walker Boot Hi-Top, Med,,Per Svc,93.00
Chargemaster Item,,31611197,SPSI,CAM Walker Boot Hi-Top, Lrg,,Per Svc,93.00
Chargemaster Item,,31611205,SPSI,CAM Walker Boot Hi-Top, XLrg,,Per Svc,107.00
Chargemaster Item,,31611213,SPSI,AFO Men, Left,,Per Svc,220.00
Chargemaster Item,,31611221,SPSI,AFO Men, Right,,Per Svc,220.00
Chargemaster Item,,31611239,SPSI,AFO Women, Left,,Per Svc,220.00
Chargemaster Item,,31611247,SPSI,AFO Women, Right,,Per Svc,220.00
Chargemaster Item,,31611254,SPSI,Lumbar Sacral Orthosis LSO,,Per Svc,532.00
Chargemaster Item,,31611262,SPSI,Thoracic Lumbar Sacral Orthosi,,Per Svc,947.00
Chargemaster Item,,31626675,SPSI,Plate Tubular 1/3 59MM 5Hole,,Per Svc,1758.00
Chargemaster Item,,31648058,SPSI,Bed Bariaire W/Scale,,Per Svc,1701.00
Chargemaster Item,,31648108,SPSI,Bed Barimaxx It,,Per Svc,1715.00
Chargemaster Item,,31677339,SPSI,Cath Ventricular Kit,,Per Svc,2045.00
Chargemaster Item,,31761802,SPSI,Catheter Presep Oxim 8.5F 16Cm,,Per Svc,1620.00
Chargemaster Item,,31836000,SPSI,Press, Alt Leg, Calf,,Per Svc,41.00
Chargemaster Item,,31836059,SPSI,Garment, alt leg, regular, thigh,,Per Svc,67.00
Chargemaster Item,,31836109,SPSI,Press, alt leg, large, calf,,Per Svc,46.00
Chargemaster Item,,31836158,SPSI,Garment, Foot Regular,,Per Svc,74.00
Chargemaster Item,,31836208,SPSI,Garment, Thigh Large,,Per Svc,71.00
Chargemaster Item,,31836257,SPSI,Garment, Foot Comp Large,,Per Svc,77.00
Chargemaster Item,,31836307,SPSI,Garment, Alt Leg, Xlarge, Calf,,Per Svc,69.00
Chargemaster Item,,31836349,SPSI,Tray Lumbar,,Per Svc,540.00
Chargemaster Item,,31836356,SPSI,Catheter,,Per Svc,841.00
Chargemaster Item,,31836364,SPSI,Catheter Suction,,Per Svc,305.00
Chargemaster Item,,31836372,SPSI,Pouch Adhesive,,Per Svc,449.00
Chargemaster Item,,31836380,SPSI,Drain Pouch,,Per Svc,118.00
Chargemaster Item,,31836398,SPSI,Dressing Duoderm,,Per Svc,324.00
Chargemaster Item,,31836406,SPSI,Splint,,Per Svc,647.00
Chargemaster Item,,31882996,SPSI,Cath Pneumothorax Pigtail,,Per Svc,436.00
Chargemaster Item,,31900004,SPSI,Finger Splint All Sizes,,Per Svc,5.00
Chargemaster Item,,31900012,SPSI,Urostomy Pouch All Sizes,,Per Svc,10.00
Chargemaster Item,,31900020,SPSI,Wrist Brace All Sizes,,Per Svc,15.00
Chargemaster Item,,31900038,SPSI,Ted Hose All Sizes,,Per Svc,44.00
Chargemaster Item,,31900046,SPSI,Ace Wrap All Sizes,,Per Svc,48.00
Chargemaster Item,,31900053,SPSI,Mepilex All Sizes,,Per Svc,55.00
Chargemaster Item,,31900061,SPSI,Compression Sock All Sizes,,Per Svc,77.00
Chargemaster Item,,31900079,SPSI,Pulse Ox Monitor Neonate All Sizes,,Per Svc,92.00
Chargemaster Item,,31900087,SPSI,Ostomy Pouch All Sizes,,Per Svc,122.00
Chargemaster Item,,31900095,SPSI,ET Tube All Sizes,,Per Svc,141.00
Chargemaster Item,,31900103,SPSI,Suction Catheter All Sizes,,Per Svc,142.00
Chargemaster Item,,31900111,SPSI,Tegaderm All Sizes,,Per Svc,143.00
Chargemaster Item,,31900129,SPSI,Trach Cannula All Sizes,,Per Svc,146.00
Chargemaster Item,,31900137,SPSI,Prismasol Fluid All Sizes,,Per Svc,159.00
Chargemaster Item,,31900145,SPSI,Arm Sling All Sizes,,Per Svc,200.00
Chargemaster Item,,31900152,SPSI,Leg Bag All Sizes,,Per Svc,201.00
Chargemaster Item,,31900160,SPSI,Suture Removal Tray All Sizes,,Per Svc,233.00
Chargemaster Item,,31900178,SPSI,Gauze Packing All Sizes,,Per Svc,274.00
Chargemaster Item,,31900186,SPSI,Male Athletic Supporter All Sizes,,Per Svc,279.00
Chargemaster Item,,31900194,SPSI,Catheter All Sizes,,Per Svc,311.00
Chargemaster Item,,31900202,SPSI,Post Op Shoe All Sizes,,Per Svc,319.00
Chargemaster Item,,31900210,SPSI,Sorbsan All Sizes,,Per Svc,343.00
Chargemaster Item,,31900228,SPSI,Catheter Tray All Sizes,,Per Svc,393.00
Chargemaster Item,,31900236,SPSI,SCD Sleeve All Sizes,,Per Svc,430.00
Chargemaster Item,,31900244,SPSI,Wrist Splint All Sizes,,Per Svc,433.00
Chargemaster Item,,31900251,SPSI,Shoulder Splint All Sizes,,Per Svc,488.00
Chargemaster Item,,31900269,SPSI,Duoderm All Sizes,,Per Svc,510.00
Chargemaster Item,,31900277,SPSI,Wound Vac Dressing All Sizes,,Per Svc,520.00
Chargemaster Item,,31900285,SPSI,Abdominal Binder All Sizes,,Per Svc,527.00
Chargemaster Item,,31900293,SPSI,Trach Care Kit All Sizes,,Per Svc,588.00
Chargemaster Item,,31900319,SPSI,Catheter Tray with Urinometer All Sizes,,Per Svc,942.00
Chargemaster Item,,31900327,SPSI,Breast Pump All Sizes,,Per Svc,1049.00
Chargemaster Item,,31900335,SPSI,CVP Tray All Sizes,,Per Svc,1068.00
Chargemaster Item,,31900343,SPSI,Chest Tube Drainage Set All Sizes,,Per Svc,1561.00
Chargemaster Item,,31900350,SPSI,Trach Tray All Sizes,,Per Svc,2350.00
Chargemaster Item,,32102188,SPSI,Cystoscopy,,Per Svc,15252.00
Chargemaster Item,,32102212,SPSI,Local Mac Anesthesia,,First 60 Minutes,982.00
Chargemaster Item,,32102238,SPSI,General/Spinal Anes,,First 60 Minutes,2842.00
Chargemaster Item,,32102253,SPSI,Epidural Anethesia,,First 60 Minutes,5715.00
Chargemaster Item,,32102261,SPSI,Lta Kit,,Per Svc,164.00
Chargemaster Item,,32102279,SPSI,Resection Electrode,,Per Svc,2530.37
Chargemaster Item,,32120008,SPSI,Recovery Room,,First 60 Minutes,1305.00
Chargemaster Item,,32121865,SPSI,Lma,,Per Svc,52.00
Chargemaster Item,,32210064,SPSI,Button Prostatectomy,,Per Svc,20766.00
Chargemaster Item,,32210072,SPSI,Cryosurgery Prostate,,Per Svc,66095.00
Chargemaster Item,,32210080,SPSI,Cryosurgery Probe,,Per Svc,8800.00
Chargemaster Item,,32210155,SPSI,IV Fluid,,Per Svc,46.00
Chargemaster Item,,32210163,SPSI,2L Foley Bag,,Per Svc,130.00
Chargemaster Item,,32210171,SPSI,500ml Leg Bag,,Per Svc,23.91
Chargemaster Item,,32210189,SPSI,Indwelling Cath,,Per Svc,17.99
Chargemaster Item,,32210197,SPSI,Sraight Cath,,Per Svc,18.00
Chargemaster Item,,32210205,SPSI,Foley Catheter Set,,Per Svc,125.00
Chargemaster Item,,32211005,SPSI,Bladder Botox Injection,,Per Svc,233.00
Chargemaster Item,,32211013,SPSI,Catheterization Kit,,Per Svc,291.00
Chargemaster Item,,32211021,SPSI,Retrograde Urethrogram S&I,,Per Svc,1329.00
Chargemaster Item,,32211039,SPSI,Inj Retro Urethrogram,,Per Svc,290.00
Chargemaster Item,,32211047,SPSI,TURBT,,Per Svc,14733.00
Chargemaster Item,,32211054,SPSI,Cysto Pack,,Per Svc,509.76
Chargemaster Item,,32211104,SPSI,Electrodes,,Per Svc,3355.00
Chargemaster Item,,32211203,SPSI,Catheter Ureteral,,Per Svc,685.00
Chargemaster Item,,32211252,SPSI,Ureteral Stent,,Per Svc,536.00
Chargemaster Item,,32211609,SPSI,Grasping Forceps,,Per Svc,1694.00
Chargemaster Item,,32211633,SPSI,Ureteral Sheath,,Per Svc,532.00
Chargemaster Item,,32211674,SPSI,Cath Dual Lumen Ureteral,,Per Svc,424.00
Chargemaster Item,,32211690,SPSI,Nottingham Dicators,,Per Svc,590.00
Chargemaster Item,,32211757,SPSI,Baer Hugger,,Per Svc,309.86
Chargemaster Item,,32211765,SPSI,Marker Tissue Impl,,Per Svc,0.01
Chargemaster Item,,32211773,SPSI,Anchor,,Per Svc,0.01
Chargemaster Item,,32211781,SPSI,Cath Atherect Direct,,Per Svc,0.01
Chargemaster Item,,32211799,SPSI,Needle Brachytherapy,,Per Svc,0.01
Chargemaster Item,,32211807,SPSI,Icd Dual Chamber,,Per Svc,0.01
Chargemaster Item,,32211815,SPSI,Icd Single Chamber,,Per Svc,0.01
Chargemaster Item,,32211823,SPSI,Cath Atherect Rotat,,Per Svc,0.01
Chargemaster Item,,32211831,SPSI,Cath Angio Non-Laser,,Per Svc,0.01
Chargemaster Item,,32211849,SPSI,Cath Balloon Non-Vasc,,Per Svc,0.01
Chargemaster Item,,32211856,SPSI,Cath Balloon Non-Vasc Insert,,Per Svc,0.01
Chargemaster Item,,32211864,SPSI,Cath Brachyseed Adm,,Per Svc,0.01
Chargemaster Item,,32211880,SPSI,Cath Ep Non 3D <=19,,Per Svc,0.01
Chargemaster Item,,32211898,SPSI,Cath Ep Non 3D >=20,,Per Svc,0.01
Chargemaster Item,,32211906,SPSI,Cath Abl Ep 3D/Vect,,Per Svc,0.01
Chargemaster Item,,32211914,SPSI,Cath Abl Ep No3D/Vec,,Per Svc,0.01
Chargemaster Item,,32211922,SPSI,Cath Hem/Per Chronic,,Per Svc,0.01
Chargemaster Item,,32211930,SPSI,Cath Inf No Dialysis,,Per Svc,0.01
Chargemaster Item,,32211948,SPSI,Cath Hem/Per Acute,,Per Svc,0.01
Chargemaster Item,,32211955,SPSI,Cath Intravasc Us,,Per Svc,0.01
Chargemaster Item,,32211971,SPSI,Cath Thrombec/Embo,,Per Svc,0.01
Chargemaster Item,,32211997,SPSI,Cath Intracrdic Echo,,Per Svc,0.01
Chargemaster Item,,32212011,SPSI,Tissue Human,,Per Svc,0.01
Chargemaster Item,,32212029,SPSI,Tissue Synth,,Per Svc,0.01
Chargemaster Item,,32212037,SPSI,Recrdr Cardiac Impl,,Per Svc,0.01
Chargemaster Item,,32212052,SPSI,Introducer Steerble Nonpeel,,Per Svc,0.01
Chargemaster Item,,32212060,SPSI,Generator Neurostim,,Per Svc,0.01
Chargemaster Item,,32212078,SPSI,Graft Vascular,,Per Svc,0.01
Chargemaster Item,,32212086,SPSI,Guidewire,,Per Svc,0.01
Chargemaster Item,,32212094,SPSI,Coil Imag Mag Reson,,Per Svc,0.01
Chargemaster Item,,32212102,SPSI,Insert Urinary W/Slng,,Per Svc,0.01
Chargemaster Item,,32212110,SPSI,Pump Inf Impl Prog,,Per Svc,0.01
Chargemaster Item,,32212128,SPSI,Retrvl Insert Device,,Per Svc,0.01
Chargemaster Item,,32212136,SPSI,Implantable Joint Device,,Per Svc,0.01
Chargemaster Item,,32212144,SPSI,Lead Cardiac Sngl Coil,,Per Svc,0.01
Chargemaster Item,,32212151,SPSI,Lead Neurostim,,Per Svc,0.01
Chargemaster Item,,32212169,SPSI,Lead Pacer Vdd,,Per Svc,0.01
Chargemaster Item,,32212177,SPSI,Lens Iol New Tech,,Per Svc,0.01
Chargemaster Item,,32212185,SPSI,Mesh Implantable,,Per Svc,0.01
Chargemaster Item,,32212201,SPSI,Pacer Dual Rr,,Per Svc,0.01
Chargemaster Item,,32212219,SPSI,Pacer Single Rr,,Per Svc,0.01
Chargemaster Item,,32212227,SPSI,Programmer Interstim,,Per Svc,0.01
Chargemaster Item,,32212243,SPSI,Prosth Breast,,Per Svc,0.01
Chargemaster Item,,32212250,SPSI,Prosth Penile Inflt,,Per Svc,0.01
Chargemaster Item,,32212268,SPSI,Prosth Urnary Sphnctr,,Per Svc,0.01
Chargemaster Item,,32212276,SPSI,Receiver/Transmit Neuros,,Per Svc,0.01
Chargemaster Item,,32212284,SPSI,Septal Impl Sys Card,,Per Svc,0.01
Chargemaster Item,,32212292,SPSI,Neuro Rechg Bat Sys,,Per Svc,0.01
Chargemaster Item,,32212300,SPSI,Interspinous Implant,,Per Svc,0.01
Chargemaster Item,,32212318,SPSI,Stent Coat W/Delvry,,Per Svc,0.01
Chargemaster Item,,32212326,SPSI,Stent Coat W/O Delivery,,Per Svc,0.01
Chargemaster Item,,32212334,SPSI,Stent Non W/Delvry,,Per Svc,0.01
Chargemaster Item,,32212342,SPSI,Stent Non W/O Delvry,,Per Svc,0.01
Chargemaster Item,,32212359,SPSI,Matrl For Vocal Cord,,Per Svc,0.01
Chargemaster Item,,32212367,SPSI,Filter Vena Cava,,Per Svc,0.01
Chargemaster Item,,32212375,SPSI,Dialysis Access Sys,,Per Svc,0.01
Chargemaster Item,,32212383,SPSI,Icd Def Not Sgl/Dual,,Per Svc,0.01
Chargemaster Item,,32212391,SPSI,Adapt/Extn/Pacing/Neurost Ld,,Per Svc,0.01
Chargemaster Item,,32212409,SPSI,Embolization Protect Sys,,Per Svc,0.01
Chargemaster Item,,32212417,SPSI,Cath Angio Laser,,Per Svc,0.01
Chargemaster Item,,32212425,SPSI,Cath Guide,,Per Svc,0.01
Chargemaster Item,,32212433,SPSI,Cath Abl Non-Cardiac,,Per Svc,0.01
Chargemaster Item,,32212441,SPSI,Pump Inf Impl N/Prog Perm,,Per Svc,0.01
Chargemaster Item,,32212458,SPSI,Introducer Fix Crv Peel,,Per Svc,0.01
Chargemaster Item,,32212466,SPSI,Introducer Fix Crv Nonpeel,,Per Svc,0.01
Chargemaster Item,,32212482,SPSI,Lead Cardiac Dual Coil,,Per Svc,0.01
Chargemaster Item,,32212490,SPSI,Lead Cardiac Non Sgl/Dual,,Per Svc,0.01
Chargemaster Item,,32212508,SPSI,Lead Neuro Test Kit,,Per Svc,0.01
Chargemaster Item,,32212516,SPSI,Lead Pacer Non Vdd,,Per Svc,0.01
Chargemaster Item,,32212524,SPSI,Lead Pacer Card/Defib,,Per Svc,0.01
Chargemaster Item,,32212532,SPSI,Lead Coronary Venous,,Per Svc,0.01
Chargemaster Item,,32212540,SPSI,Sealant Pulmonary,,Per Svc,0.01
Chargemaster Item,,32212557,SPSI,Stent Tmp W/O Delvry,,Per Svc,0.01
Chargemaster Item,,32212565,SPSI,Probe Cryoablation,,Per Svc,0.01
Chargemaster Item,,32212573,SPSI,Pacer Dual Non Rr,,Per Svc,0.01
Chargemaster Item,,32212581,SPSI,Pacer Single Non Rr,,Per Svc,0.01
Chargemaster Item,,32212599,SPSI,Pacer Nonsng Or Dual,,Per Svc,0.01
Chargemaster Item,,32212607,SPSI,Prosth Penile No Inflt,,Per Svc,0.01
Chargemaster Item,,32212615,SPSI,Stent Temp W/Delivery,,Per Svc,0.01
Chargemaster Item,,32212623,SPSI,Pump Inf Impl Np Tmp,,Per Svc,0.01
Chargemaster Item,,32212649,SPSI,Cath Occlusion,,Per Svc,0.01
Chargemaster Item,,32212656,SPSI,Introducer Laser,,Per Svc,0.01
Chargemaster Item,,32212664,SPSI,Cath Abl Cool-Tip,,Per Svc,0.01
Chargemaster Item,,32212672,SPSI,Insert Urinary Wo Slng,,Per Svc,0.01
Chargemaster Item,,32212680,SPSI,Neurawrap Nerve Protector Cm,,Per Svc,0.01
Chargemaster Item,,32212698,SPSI,Bulk Agent Collagen 2.5,,Per Svc,0.01
Chargemaster Item,,32212706,SPSI,Gel Bladder Deflux,,Per Svc,0.01
Chargemaster Item,,32212714,SPSI,Bulk Agent Durasph Inj,,Per Svc,0.01
Chargemaster Item,,32212722,SPSI,Bulk Agent Synth 1.0,,Per Svc,0.01
Chargemaster Item,,32212730,SPSI,Tegress Urethral Implant,,Per Svc,0.01
Chargemaster Item,,32212748,SPSI,Prosth Cochlear,,Per Svc,0.01
Chargemaster Item,,32212755,SPSI,Aud Osseo Dev Int Ext Comp,,Per Svc,0.01
Chargemaster Item,,32212763,SPSI,Graftjacket Per Sqcm,,Per Svc,0.01
Chargemaster Item,,32212771,SPSI,Anterior Chamber Iol,,Per Svc,0.01
Chargemaster Item,,32212789,SPSI,Posterior Chambr Iol,,Per Svc,0.01
Chargemaster Item,,32212797,SPSI,Amniograft,,Per Svc,0.01
Chargemaster Item,,32212805,SPSI,Miscellaneous Supply,,Per Svc,0.01
Chargemaster Item,,32212821,SPSI,Miscellaneous Implant,,Per Svc,0.01
Chargemaster Item,,32216889,SPSI,Et Tubes,,Per Svc,701.00
Chargemaster Item,,32400103,SPSI,Coons Bent Wire Gd 35/146,,Per Svc,235.00
Chargemaster Item,,32400202,SPSI,Guide Wire Litho,,Per Svc,312.00
Chargemaster Item,,32400301,SPSI,Stone Basket,,Per Svc,1852.00
Chargemaster Item,,32400707,SPSI,Balloon Dilator,,Per Svc,973.00
Chargemaster Item,,32505919,SPSI,Eswl,,Per Svc,63282.00
Chargemaster Item,,32505950,SPSI,Bilateral Eswl,,Per Svc,92470.00
Chargemaster Item,,32511024,SPSI,Suprapubic Cath Insertion,,Per Svc,7055.00
Chargemaster Item,,32520009,SPSI,Cystoscopy/Ureteroscopy/Stone Extraction,,Per Svc,39671.00
Chargemaster Item,,32520074,SPSI,Cysto W Washings,,Per Svc,45273.00
Chargemaster Item,,32522047,SPSI,Biopsy,,Per Svc,41326.00
Chargemaster Item,,32522609,SPSI,Hydrodistention,,Per Svc,14395.00
Chargemaster Item,,32522815,SPSI,Cysto Dilit Tx Stricture,,Per Svc,16660.00
Chargemaster Item,,32523102,SPSI,Stent Removal,,Per Svc,18313.00
Chargemaster Item,,32523177,SPSI,Litholapaxyá Simple,,Per Svc,34687.00
Chargemaster Item,,32523185,SPSI,Litholapaxy,,Per Svc,37839.00
Chargemaster Item,,32523326,SPSI,Stent Placement,,Per Svc,19275.00
Chargemaster Item,,32523334,SPSI,Cystoureteroscopy,,Per Svc,38411.00
Chargemaster Item,,32523359,SPSI,Dilation,,Per Svc,26871.00
Chargemaster Item,,32523375,SPSI,Laser Lithotripsy,,Per Svc,55928.00
Chargemaster Item,,32523383,SPSI,Fulguration,,Per Svc,37037.00
Chargemaster Item,,32523391,SPSI,Resection of Lesion,,Per Svc,44639.00
Chargemaster Item,,32523805,SPSI,Bilat Stent Placement,,Per Svc,25156.00
Chargemaster Item,,32526485,SPSI,Pvp Laser Procedure,,Per Svc,41883.00
Chargemaster Item,,32744005,SPSI,Abdomen 1 View,,Per Svc,1095.00
Chargemaster Item,,32744203,SPSI,Retrograde Pyelogram,,Per Svc,5128.00
Chargemaster Item,,32744229,SPSI,Bilat Retrogra,,Per Svc,5142.00
Chargemaster Item,,32744252,SPSI,Ante Lpgrm/Nphgrm S&I,,Per Svc,1976.00
Chargemaster Item,,32760001,SPSI,Fluoroscopy Up To 1Hr,,Per Svc,3928.00
Chargemaster Item,,32767113,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,32767121,SPSI,Blood Transfusion,,Per Svc,1860.00
Chargemaster Item,,32767212,SPSI,Bilat Cystoureteroscopy,,Per Svc,47658.00
Chargemaster Item,,32767220,SPSI,Bilat Stone Removal,,Per Svc,29454.00
Chargemaster Item,,32767238,SPSI,Bilat w/Dilation,,Per Svc,32205.00
Chargemaster Item,,32767246,SPSI,Bilat Laser Lithotripsy,,Per Svc,80713.00
Chargemaster Item,,32767253,SPSI,Deflux,,Per Svc,40184.00
Chargemaster Item,,32767311,SPSI,IV Infusion Initial IVPB,,Per Svc,637.00
Chargemaster Item,,33000019,SPSI,Open Heart Surgery,,First 60 Minutes,103516.00
Chargemaster Item,,33000050,SPSI,ECMO Daily Mgmt,,Per Svc,20240.00
Chargemaster Item,,33000068,SPSI,ECMO Initiation,,Per Svc,28129.00
Chargemaster Item,,33000100,SPSI,Heart Lung Machine,,Per Svc,28896.00
Chargemaster Item,,33000159,SPSI,Hlm Set-Up A-Veingraft,,Per Svc,34132.00
Chargemaster Item,,33000209,SPSI,Hlm Set-Up B-Valve,,Per Svc,34132.00
Chargemaster Item,,33000258,SPSI,Left Heart Assist Pump,,First 60 Minutes,8719.00
Chargemaster Item,,33000365,SPSI,HMS Cartridge,,Per Svc,42.86
Chargemaster Item,,33000373,SPSI,Arterial femoral cannula,,Per Svc,830.00
Chargemaster Item,,33000381,SPSI,Venous femoral cannula,,Per Svc,978.00
Chargemaster Item,,33000399,SPSI,Ecmo Oxygen,,Per Svc,2390.00
Chargemaster Item,,33000407,SPSI,Ecmo Pack,,Per Svc,1648.00
Chargemaster Item,,33000415,SPSI,Ecmo Tube Pack,,Per Svc,58.00
Chargemaster Item,,33000423,SPSI,Ecmo Blood Bag Set,,Per Svc,58.00
Chargemaster Item,,33000449,SPSI,Bipolar Pacing Wire,,Per Svc,139.00
Chargemaster Item,,33000456,SPSI,Bipolar Temporary Wire,,Per Svc,139.00
Chargemaster Item,,33000464,SPSI,AtriClip Flex,,Per Svc,3800.00
Chargemaster Item,,33000472,SPSI,Endo Vascular Kit,,Per Svc,1951.00
Chargemaster Item,,33000480,SPSI,Cobra Knot Mini,,Per Svc,1565.00
Chargemaster Item,,33000498,SPSI,Cobra Knot MIS,,Per Svc,1788.00
Chargemaster Item,,33000506,SPSI,Cobra Knot Single,,Per Svc,115.00
Chargemaster Item,,33000514,SPSI,Cobra Fusion Ablation System,,Per Svc,11975.00
Chargemaster Item,,33000522,SPSI,Cyro Ablation Probe,,Per Svc,3513.00
Chargemaster Item,,33000530,SPSI,Isolator Transpolar Pen,,Per Svc,2076.00
Chargemaster Item,,33000548,SPSI,Isolator Syn Surg Ablation Sys,,Per Svc,4302.00
Chargemaster Item,,33000555,SPSI,Marker Tissue Impl,,Per Svc,0.01
Chargemaster Item,,33000563,SPSI,Anchor,,Per Svc,0.01
Chargemaster Item,,33000571,SPSI,Cath Atherect Direct,,Per Svc,0.01
Chargemaster Item,,33000589,SPSI,Needle Brachytherapy,,Per Svc,0.01
Chargemaster Item,,33000597,SPSI,Icd Dual Chamber,,Per Svc,0.01
Chargemaster Item,,33000605,SPSI,Icd Single Chamber,,Per Svc,0.01
Chargemaster Item,,33000613,SPSI,Cath Atherect Rotat,,Per Svc,0.01
Chargemaster Item,,33000621,SPSI,Cath Angio Non-Laser,,Per Svc,0.01
Chargemaster Item,,33000639,SPSI,Cath Balloon Non-Vasc,,Per Svc,0.01
Chargemaster Item,,33000647,SPSI,Cath Balloon Non-Vasc Insert,,Per Svc,0.01
Chargemaster Item,,33000654,SPSI,Cath Brachyseed Adm,,Per Svc,0.01
Chargemaster Item,,33000670,SPSI,Cath Ep Non 3D <=19,,Per Svc,0.01
Chargemaster Item,,33000688,SPSI,Cath Ep Non 3D >=20,,Per Svc,0.01
Chargemaster Item,,33000696,SPSI,Cath Abl Ep 3D/Vect,,Per Svc,0.01
Chargemaster Item,,33000712,SPSI,Cath Abl Ep No3D/Vec,,Per Svc,0.01
Chargemaster Item,,33000720,SPSI,Cath Hem/Per Chronic,,Per Svc,0.01
Chargemaster Item,,33000738,SPSI,Cath Inf No Dialysis,,Per Svc,0.01
Chargemaster Item,,33000746,SPSI,Cath Hem/Per Acute,,Per Svc,0.01
Chargemaster Item,,33000753,SPSI,Cath Intravasc Us,,Per Svc,0.01
Chargemaster Item,,33000779,SPSI,Cath Thrombec/Embo,,Per Svc,0.01
Chargemaster Item,,33000795,SPSI,Cath Intracrdic Echo,,Per Svc,0.01
Chargemaster Item,,33000811,SPSI,Tissue Human,,Per Svc,0.01
Chargemaster Item,,33000829,SPSI,Tissue Synth,,Per Svc,0.01
Chargemaster Item,,33000837,SPSI,Recrdr Cardiac Impl,,Per Svc,0.01
Chargemaster Item,,33000852,SPSI,Introducer Steerble Nonpeel,,Per Svc,0.01
Chargemaster Item,,33000860,SPSI,Generator Neurostim,,Per Svc,0.01
Chargemaster Item,,33000878,SPSI,Graft Vascular,,Per Svc,0.01
Chargemaster Item,,33000886,SPSI,Guidewire,,Per Svc,0.01
Chargemaster Item,,33000894,SPSI,Coil Imag Mag Reson,,Per Svc,0.01
Chargemaster Item,,33000902,SPSI,Insert Urinary W/Slng,,Per Svc,0.01
Chargemaster Item,,33000910,SPSI,Pump Inf Impl Prog,,Per Svc,0.01
Chargemaster Item,,33000928,SPSI,Retrvl Insert Device,,Per Svc,0.01
Chargemaster Item,,33000936,SPSI,Implantable Joint Device,,Per Svc,0.01
Chargemaster Item,,33000944,SPSI,Lead Cardiac Sngl Coil,,Per Svc,0.01
Chargemaster Item,,33000951,SPSI,Lead Neurostim,,Per Svc,0.01
Chargemaster Item,,33000969,SPSI,Lead Pacer Vdd,,Per Svc,0.01
Chargemaster Item,,33000977,SPSI,Lens Iol New Tech,,Per Svc,0.01
Chargemaster Item,,33000985,SPSI,Mesh Implantable,,Per Svc,0.01
Chargemaster Item,,33001009,SPSI,Pacer Dual Rr,,Per Svc,0.01
Chargemaster Item,,33001017,SPSI,Pacer Single Rr,,Per Svc,0.01
Chargemaster Item,,33001025,SPSI,Programmer Interstim,,Per Svc,0.01
Chargemaster Item,,33001041,SPSI,Prosth Breast,,Per Svc,0.01
Chargemaster Item,,33001058,SPSI,Prosth Penile Inflt,,Per Svc,0.01
Chargemaster Item,,33001066,SPSI,Prosth Urnary Sphnctr,,Per Svc,0.01
Chargemaster Item,,33001074,SPSI,Receiver/Transmit Neuros,,Per Svc,0.01
Chargemaster Item,,33001082,SPSI,Septal Impl Sys Card,,Per Svc,0.01
Chargemaster Item,,33001090,SPSI,Neuro Rechg Bat Sys,,Per Svc,0.01
Chargemaster Item,,33001108,SPSI,Interspinous Implant,,Per Svc,0.01
Chargemaster Item,,33001116,SPSI,Stent Coat W/Delvry,,Per Svc,0.01
Chargemaster Item,,33001124,SPSI,Stent Coat W/O Delivery,,Per Svc,0.01
Chargemaster Item,,33001132,SPSI,Stent Non W/Delvry,,Per Svc,0.01
Chargemaster Item,,33001140,SPSI,Stent Non W/O Delvry,,Per Svc,0.01
Chargemaster Item,,33001157,SPSI,Matrl For Vocal Cord,,Per Svc,0.01
Chargemaster Item,,33001165,SPSI,Filter Vena Cava,,Per Svc,0.01
Chargemaster Item,,33001173,SPSI,Dialysis Access Sys,,Per Svc,0.01
Chargemaster Item,,33001181,SPSI,Icd Def Not Sgl/Dual,,Per Svc,0.01
Chargemaster Item,,33001199,SPSI,Adapt/Extn/Pacing/Neurost Ld,,Per Svc,0.01
Chargemaster Item,,33001207,SPSI,Embolization Protect Sys,,Per Svc,0.01
Chargemaster Item,,33001215,SPSI,Cath Angio Laser,,Per Svc,0.01
Chargemaster Item,,33001223,SPSI,Cath Guide,,Per Svc,0.01
Chargemaster Item,,33001231,SPSI,Cath Abl Non-Cardiac,,Per Svc,0.01
Chargemaster Item,,33001249,SPSI,Pump Inf Impl N/Prog Perm,,Per Svc,0.01
Chargemaster Item,,33001256,SPSI,Introducer Fix Crv Peel,,Per Svc,0.01
Chargemaster Item,,33001264,SPSI,Introducer Fix Crv Nonpeel,,Per Svc,0.01
Chargemaster Item,,33001280,SPSI,Lead Cardiac Dual Coil,,Per Svc,0.01
Chargemaster Item,,33001298,SPSI,Lead Cardiac Non Sgl/Dual,,Per Svc,0.01
Chargemaster Item,,33001306,SPSI,Lead Neuro Test Kit,,Per Svc,0.01
Chargemaster Item,,33001314,SPSI,Lead Pacer Non Vdd,,Per Svc,0.01
Chargemaster Item,,33001322,SPSI,Lead Pacer Card/Defib,,Per Svc,0.01
Chargemaster Item,,33001330,SPSI,Lead Coronary Venous,,Per Svc,0.01
Chargemaster Item,,33001348,SPSI,Sealant Pulmonary,,Per Svc,0.01
Chargemaster Item,,33001355,SPSI,Stent Tmp W/O Delvry,,Per Svc,0.01
Chargemaster Item,,33001363,SPSI,Probe Cryoablation,,Per Svc,0.01
Chargemaster Item,,33001371,SPSI,Pacer Dual Non Rr,,Per Svc,0.01
Chargemaster Item,,33001389,SPSI,Pacer Single Non Rr,,Per Svc,0.01
Chargemaster Item,,33001397,SPSI,Pacer Nonsng Or Dual,,Per Svc,0.01
Chargemaster Item,,33001405,SPSI,Prosth Penile No Inflt,,Per Svc,0.01
Chargemaster Item,,33001413,SPSI,Stent Temp W/Delivery,,Per Svc,0.01
Chargemaster Item,,33001421,SPSI,Pump Inf Impl Np Tmp,,Per Svc,0.01
Chargemaster Item,,33001447,SPSI,Cath Occlusion,,Per Svc,0.01
Chargemaster Item,,33001454,SPSI,Introducer Laser,,Per Svc,0.01
Chargemaster Item,,33001462,SPSI,Cath Abl Cool-Tip,,Per Svc,0.01
Chargemaster Item,,33001470,SPSI,Insert Urinary Wo Slng,,Per Svc,0.01
Chargemaster Item,,33001488,SPSI,Neurawrap Nerve Protector Cm,,Per Svc,0.01
Chargemaster Item,,33001496,SPSI,Bulk Agent Collagen 2.5,,Per Svc,0.01
Chargemaster Item,,33001504,SPSI,Gel Bladder Deflux,,Per Svc,0.01
Chargemaster Item,,33001512,SPSI,Bulk Agent Durasph Inj,,Per Svc,0.01
Chargemaster Item,,33001520,SPSI,Bulk Agent Synth 1.0,,Per Svc,0.01
Chargemaster Item,,33001538,SPSI,Tegress Urethral Implant,,Per Svc,0.01
Chargemaster Item,,33001546,SPSI,Prosth Cochlear,,Per Svc,0.01
Chargemaster Item,,33001553,SPSI,Aud Osseo Dev Int Ext Comp,,Per Svc,0.01
Chargemaster Item,,33001561,SPSI,Graftjacket Per Sqcm,,Per Svc,0.01
Chargemaster Item,,33001579,SPSI,Anterior Chamber Iol,,Per Svc,0.01
Chargemaster Item,,33001587,SPSI,Posterior Chambr Iol,,Per Svc,0.01
Chargemaster Item,,33001595,SPSI,Amniograft,,Per Svc,0.01
Chargemaster Item,,33001603,SPSI,Miscellaneous Supply,,Per Svc,0.01
Chargemaster Item,,33001629,SPSI,Miscellaneous Implant,,Per Svc,0.01
Chargemaster Item,,33001637,SPSI,Stent noncoated Implant,,Per Svc,11200.00
Chargemaster Item,,33102237,SPSI,General Anesthesia-Open Heart,,First 60 Minutes,8146.00
Chargemaster Item,,33102302,SPSI,Ohs Anesth Supply Kit,,Per Svc,543.00
Chargemaster Item,,33102401,SPSI,Arterial Line,,Per Svc,1635.00
Chargemaster Item,,33102450,SPSI,Ima Kit,,Per Svc,2741.00
Chargemaster Item,,33102500,SPSI,Swan-Ganz Catheter Set-Up,,Per Svc,5345.00
Chargemaster Item,,33102559,SPSI,Oximetric Swan,,Per Svc,5412.00
Chargemaster Item,,33102609,SPSI,Central Venous Pressure Line,,Per Svc,1366.00
Chargemaster Item,,33102708,SPSI,Lta Kit,,Per Svc,164.00
Chargemaster Item,,33130808,SPSI,Pleur-Evac,,Per Svc,1734.00
Chargemaster Item,,33200015,SPSI,Dispos Aortic Punch,,Per Svc,1062.00
Chargemaster Item,,33200056,SPSI,Centrimed Pump,,Per Svc,4265.00
Chargemaster Item,,33200106,SPSI,Hemoclips,,Per Svc,212.00
Chargemaster Item,,33200155,SPSI,Suction Tip,,Per Svc,980.00
Chargemaster Item,,33200205,SPSI,Cell Saver,,Per Svc,4381.00
Chargemaster Item,,33200254,SPSI,Cdi Sensor,,Per Svc,4839.00
Chargemaster Item,,33200304,SPSI,Med Cassette,,Per Svc,401.00
Chargemaster Item,,33200353,SPSI,Retroplegia Cannula,,Per Svc,2593.00
Chargemaster Item,,33200403,SPSI,Ohs Veingraft Sutures,,Per Svc,1850.00
Chargemaster Item,,33200502,SPSI,Ohs Valve Sutures-Mitral,,Per Svc,4839.00
Chargemaster Item,,33200601,SPSI,Datascope Balloon Catheter,,Per Svc,3040.00
Chargemaster Item,,33200700,SPSI,Ohs Supply Kit,,Per Svc,12059.00
Chargemaster Item,,33200809,SPSI,Teflon Felt,,Per Svc,760.00
Chargemaster Item,,33200908,SPSI,Left Atrial Pressure Line,,Per Svc,1054.00
Chargemaster Item,,33201005,SPSI,Post-Op Bleeder Supply Kit,,Per Svc,3005.00
Chargemaster Item,,33201104,SPSI,Veingraft Kit,,Per Svc,2920.00
Chargemaster Item,,33201203,SPSI,Valve Kit,,Per Svc,960.00
Chargemaster Item,,33201401,SPSI,Aortic Valve,,Per Svc,26480.00
Chargemaster Item,,33201500,SPSI,Mitral Valve,,Per Svc,25956.00
Chargemaster Item,,33201609,SPSI,Composite Valve,,Per Svc,30000.00
Chargemaster Item,,33201708,SPSI,Patch Material,,Per Svc,2320.00
Chargemaster Item,,33201807,SPSI,Vascular Graft,,Per Svc,3600.00
Chargemaster Item,,33201906,SPSI,Ohs Valve Sutures-Aortic,,Per Svc,6126.00
Chargemaster Item,,33363110,SPSI,Coronary Perfusion Cannula,,Per Svc,365.00
Chargemaster Item,,33363128,SPSI,Cts Ultima Opcab System,,Per Svc,3505.00
Chargemaster Item,,33363136,SPSI,Flo-Thru,,Per Svc,363.00
Chargemaster Item,,33363144,SPSI,Occluder,,Per Svc,363.00
Chargemaster Item,,33363151,SPSI,Stealth Spring Clip 6Mm,,Per Svc,155.00
Chargemaster Item,,33363169,SPSI,Sternum Blade Rev Saw Blade,,Per Svc,339.00
Chargemaster Item,,33363177,SPSI,Harmonic Blade,,Per Svc,767.00
Chargemaster Item,,33363185,SPSI,Visuflo Wand W Malleable Tube,,Per Svc,335.00
Chargemaster Item,,33363193,SPSI,Blake Drain,,Per Svc,246.00
Chargemaster Item,,33363201,SPSI,Balloon Cath,,Per Svc,1668.00
Chargemaster Item,,33363219,SPSI,Peri-Vac,,Per Svc,980.00
Chargemaster Item,,33363227,SPSI,Cath Thor 36Fr R Angle,,Per Svc,946.00
Chargemaster Item,,33363235,SPSI,Maze Procedure,,Per Svc,36299.00
Chargemaster Item,,33363243,SPSI,Bioglue Cartrid,,Per Svc,3082.00
Chargemaster Item,,33363268,SPSI,Staple Line Strip,,Per Svc,876.00
Chargemaster Item,,33363276,SPSI,Duran Ring,,Per Svc,12340.00
Chargemaster Item,,33363334,SPSI,Leukoguard Filt,,Per Svc,870.00
Chargemaster Item,,33363441,SPSI,Heoconcentr,,Per Svc,485.24
Chargemaster Item,,33363557,SPSI,Emboaortic Filt,,Per Svc,1786.00
Chargemaster Item,,33363565,SPSI,Endoscopic Vein Harvest,,Per Svc,3372.42
Chargemaster Item,,33363573,SPSI,Tee Echo,,Per Svc,7028.00
Chargemaster Item,,33363623,SPSI,Annuloplasty Ring,,Per Svc,13540.00
Chargemaster Item,,33363631,SPSI,Ecmo Centrimag,,Per Svc,17863.00
Chargemaster Item,,33935354,SPSI,Intra-Aortic Balloon Pump,,First 60 Minutes,15390.00
Chargemaster Item,,34000141,SPSI,Art Line Insertion,,Per Svc,2446.00
Chargemaster Item,,34000166,SPSI,Stent Carotid,,Per Svc,12475.00
Chargemaster Item,,34000174,SPSI,Stat Flowable Hemostat,,Per Svc,1221.00
Chargemaster Item,,34000190,SPSI,Antibacterial Envelope,,Per Svc,5436.00
Chargemaster Item,,34000216,SPSI,Sheath Periph,,Per Svc,521.00
Chargemaster Item,,34000217,SPSI,Amplatzer PFO Occluder,,Per Svc,39980.00
Chargemaster Item,,34000224,SPSI,Pressure Wire,,Per Svc,4853.00
Chargemaster Item,,34000257,SPSI,Femoral Artery Angio,,Per Svc,6672.00
Chargemaster Item,,34000265,SPSI,Supravalvular Aortography,,Per Svc,7659.00
Chargemaster Item,,34000273,SPSI,Femoral Access w/closure,,Per Svc,2446.00
Chargemaster Item,,34000315,SPSI,CVA US Guidance,,Per Svc,2297.00
Chargemaster Item,,34000349,SPSI,LT Heart Cath LT Vent S&I,,Per Svc,51757.00
Chargemaster Item,,34000356,SPSI,RT & LT Heath Cath, LFT Vent, S&I,,Per Svc,57239.00
Chargemaster Item,,34000364,SPSI,Cath Plcmnt For Coro Angio,,Per Svc,14874.00
Chargemaster Item,,34000372,SPSI,Cath Plcmt Coro Angio, Byps,,Per Svc,20924.00
Chargemaster Item,,34000380,SPSI,Cath Plcmnt RHC, Coro Angio,,Per Svc,37553.00
Chargemaster Item,,34000398,SPSI,RT Hrt Artery/Graft Angio,,Per Svc,46794.00
Chargemaster Item,,34000406,SPSI,Cath Plcmt W/LT Vent, Coron,,Per Svc,69058.00
Chargemaster Item,,34000414,SPSI,Cath Plcmt, W/O LT Vent, Coron,,Per Svc,57558.00
Chargemaster Item,,34000415,SPSI,PFO Closure with Implant,,Per Svc,22056.00
Chargemaster Item,,34000422,SPSI,LHC, Coro Angio, LT Vent, Byps,,Per Svc,75047.00
Chargemaster Item,,34000430,SPSI,LHC, Coro Angio W/O LT Vent,,Per Svc,63542.00
Chargemaster Item,,34000448,SPSI,Cath Plcmnt RT/LT Cath LT Vent,,Per Svc,71959.00
Chargemaster Item,,34000455,SPSI,Cath Placmnt RT/LT W/O LT Vent,,Per Svc,60454.00
Chargemaster Item,,34000463,SPSI,Cath RT/LT Cath, LT Vent, BYPS,,Per Svc,77943.00
Chargemaster Item,,34000471,SPSI,Cath RT/LT CTH W/O LT Ven, Byps,,Per Svc,66442.00
Chargemaster Item,,34000489,SPSI,LFT Hrt Cath Trans Punct,,Per Svc,11774.00
Chargemaster Item,,34000497,SPSI,Pharmacologic Agent Admin,,Per Svc,1683.00
Chargemaster Item,,34000513,SPSI,LT Heart Cath W/O LT Vent,,Per Svc,40252.00
Chargemaster Item,,34000521,SPSI,RT Heart Cath,,Per Svc,25870.00
Chargemaster Item,,34000539,SPSI,RT & LT Heart Cath, W/O Lft Ven,,Per Svc,45736.00
Chargemaster Item,,34000620,SPSI,Remove & Replace PM Gen Single,,Per Svc,21983.00
Chargemaster Item,,34000638,SPSI,Remove & Replace PM Gen Dual,,Per Svc,50356.00
Chargemaster Item,,34000646,SPSI,PTCA W/Bare Metal Grafts,,Per Svc,103929.00
Chargemaster Item,,34000653,SPSI,Add Vessel W/Bare Metal Grafts,,Per Svc,52032.00
Chargemaster Item,,34000661,SPSI,PTCA W/ Des Grafts,,Per Svc,105635.00
Chargemaster Item,,34000679,SPSI,Add Vessel W/Des Grafts,,Per Svc,78843.00
Chargemaster Item,,34000687,SPSI,PTCRA W/Bare Metal (BM) Stent,,Per Svc,109187.00
Chargemaster Item,,34000695,SPSI,Add Vessel PTCRA W/Bare,,Per Svc,64594.00
Chargemaster Item,,34000703,SPSI,PTCRA W/Des,,Per Svc,134303.00
Chargemaster Item,,34000711,SPSI,Add PTCRA W/Des,,Per Svc,85546.00
Chargemaster Item,,34000729,SPSI,Stemi W/Bare,,Per Svc,103929.00
Chargemaster Item,,34000737,SPSI,Stemi W/Des,,Per Svc,124356.00
Chargemaster Item,,34000745,SPSI,CTO W/Bare,,Per Svc,103929.00
Chargemaster Item,,34000752,SPSI,Add CTO W/Bare,,Per Svc,61253.00
Chargemaster Item,,34000760,SPSI,CTO W/Des,,Per Svc,124356.00
Chargemaster Item,,34000778,SPSI,Add CTO W/Des,,Per Svc,66974.00
Chargemaster Item,,34000786,SPSI,Embolization Vascular Plug,,Per Svc,5000.00
Chargemaster Item,,34000794,SPSI,Hematoma Evacuation,,Per Svc,16214.00
Chargemaster Item,,34000802,SPSI,Cto Device,,Per Svc,2697.00
Chargemaster Item,,34000810,SPSI,Iliac PTA,,Per Svc,31772.00
Chargemaster Item,,34000828,SPSI,Iliac Stent with or w/o PTA,,Per Svc,80525.00
Chargemaster Item,,34000836,SPSI,Additional Vessel Iliac PTA,,Per Svc,37423.00
Chargemaster Item,,34000844,SPSI,Addtnl Stent Iliac Territory,,Per Svc,37423.00
Chargemaster Item,,34000851,SPSI,Femoral PTA,,Per Svc,37423.00
Chargemaster Item,,34000869,SPSI,Femoral Atherectomy,,Per Svc,80525.00
Chargemaster Item,,34000870,SPSI,Atherectomy+PTA Iliac+S&I,,Per Svc,74217.00
Chargemaster Item,,34000877,SPSI,Femoral Stent,,Per Svc,80525.00
Chargemaster Item,,34000885,SPSI,Femoral Stent + Atherectomy,,Per Svc,135778.00
Chargemaster Item,,34000893,SPSI,Tibial PTA,,Per Svc,37423.00
Chargemaster Item,,34000901,SPSI,Tibial/Popiteal Atherectomy,,Per Svc,80525.00
Chargemaster Item,,34000919,SPSI,Tibial Stent,,Per Svc,80525.00
Chargemaster Item,,34000927,SPSI,Tibial Stent + Atherectomy,,Per Svc,135778.00
Chargemaster Item,,34000935,SPSI,Add vess Tibial/Peroneal PTA,,Per Svc,37423.00
Chargemaster Item,,34000943,SPSI,Additional Vessel Atherectomy,,Per Svc,80525.00
Chargemaster Item,,34000968,SPSI,Impella, Insertion LV Device,,Per Svc,18403.00
Chargemaster Item,,34000976,SPSI,Impella, 2.5 Catheter,,Per Svc,31250.00
Chargemaster Item,,34000984,SPSI,Impella, 5.0 Catheter,,Per Svc,35000.00
Chargemaster Item,,34000992,SPSI,Pleural Catheter Insertion,,Per Svc,4543.00
Chargemaster Item,,34001008,SPSI,Dermabond,,Per Svc,392.00
Chargemaster Item,,34001016,SPSI,Sub-Q Generator,,Per Svc,108245.00
Chargemaster Item,,34001024,SPSI,Sub-Q Lead,,Per Svc,23195.00
Chargemaster Item,,34001040,SPSI,Thrombectomy, Fem, Pop, Iliac,,Per Svc,22777.00
Chargemaster Item,,34001057,SPSI,Thrombectomy,Pop,Tib,Peroneal,,Per Svc,22777.00
Chargemaster Item,,34001065,SPSI,Throbmolysis Inf. Subseq day,,Per Svc,15815.00
Chargemaster Item,,34001073,SPSI,Thrombolysis Cath Removal,,Per Svc,15815.00
Chargemaster Item,,34001081,SPSI,Subclavian PTA/ Stent/ S&I,,Per Svc,68088.00
Chargemaster Item,,34001099,SPSI,Insert Swan Ganz/CICU,,Per Svc,11144.00
Chargemaster Item,,34001107,SPSI,Cautery Tool,,Per Svc,999.00
Chargemaster Item,,34001115,SPSI,Impella, CP catheter,,Per Svc,47103.00
Chargemaster Item,,34001131,SPSI,Drug Coated Balloon,,Per Svc,2870.00
Chargemaster Item,,34001149,SPSI,Wound Debridment,,Per Svc,1480.00
Chargemaster Item,,34001156,SPSI,Plcmt Iliac Art Occlusion Device,,Per Svc,4474.00
Chargemaster Item,,34001164,SPSI,Aortic Balloon Valvuloplasty,,Per Svc,30129.00
Chargemaster Item,,34001172,SPSI,EP Steerable Introducer,,Per Svc,1998.00
Chargemaster Item,,34001180,SPSI,Navx EP Patch Pack set,,Per Svc,2919.00
Chargemaster Item,,34001198,SPSI,TAVR,,Per Svc,11502.00
Chargemaster Item,,34001206,SPSI,TAVR Add-On,,Per Svc,7061.00
Chargemaster Item,,34001214,SPSI,Sapien 3 THV System,,Per Svc,130000.00
Chargemaster Item,,34001222,SPSI,Valvuloplasty Balloon,,Per Svc,3161.00
Chargemaster Item,,34001230,SPSI,Percutaneous Tracheostomy,,Per Svc,12983.00
Chargemaster Item,,34001248,SPSI,Insert Nasojeuunal Tube,,Per Svc,1572.00
Chargemaster Item,,34001255,SPSI,PTA Upper Extremity Arterial,,Per Svc,60183.00
Chargemaster Item,,34001268,SPSI,PTA Upper Extremity Arterial Add Vessel,,Per Svc,67423.00
Chargemaster Item,,34001271,SPSI,Venous PTA,,Per Svc,30273.00
Chargemaster Item,,34001313,SPSI,Placement Aorto-Biiliac Stent,,Per Svc,44263.00
Chargemaster Item,,34001321,SPSI,TAVR Open Axillary Approach,,Per Svc,48362.00
Chargemaster Item,,34001339,SPSI,Cann w/Dilator AngoVac 180,,Per Svc,58000.00
Chargemaster Item,,34001347,SPSI,Removal of right atrial mass,,Per Svc,21891.31
Chargemaster Item,,34001354,SPSI,Insert cannula Extrcorp infusn,,Per Svc,1500.00
Chargemaster Item,,34001362,SPSI,Intro cath Vena Cava Sup/inf,,Per Svc,3628.91
Chargemaster Item,,34001370,SPSI,Thrombectomy dialysis circuit,,Per Svc,14611.00
Chargemaster Item,,34001386,SPSI,Venous mechanical thrombectomy,,Per Svc,10663.00
Chargemaster Item,,34001396,SPSI,Place catheter in vein,,Per Svc,3865.00
Chargemaster Item,,34001404,SPSI,Venous Stent Initial Vein,,Per Svc,38676.00
Chargemaster Item,,34001743,SPSI,Navistar Ablation Caths,,Per Svc,15599.00
Chargemaster Item,,34011205,SPSI,Auto Injector,,Per Svc,1218.00
Chargemaster Item,,34011304,SPSI,Polymer Seal Kit,,Per Svc,4000.00
Chargemaster Item,,34012344,SPSI,Detachable .018 Coil,,Per Svc,3400.00
Chargemaster Item,,34017574,SPSI,Catheter Thrombectomy,,Per Svc,3293.00
Chargemaster Item,,34017582,SPSI,Chest Tube Insertion,,Per Svc,3114.00
Chargemaster Item,,34021014,SPSI,Venous Embolization w/S&I,,Per Svc,14471.00
Chargemaster Item,,34029025,SPSI,Ins Filter Wire,,Per Svc,5703.00
Chargemaster Item,,34081745,SPSI,Thermocool Nav Cath,,Per Svc,19025.00
Chargemaster Item,,34082503,SPSI,Stent Drug Eluting,,Per Svc,7625.00
Chargemaster Item,,34100404,SPSI,Vascular Access Device,,Per Svc,465.00
Chargemaster Item,,34100503,SPSI,Deca Nav Caths,,Per Svc,9116.00
Chargemaster Item,,34100511,SPSI,Non-Nav Ablation Caths,,Per Svc,10010.00
Chargemaster Item,,34100529,SPSI,20-Pole Non-Nav Caths,,Per Svc,9617.00
Chargemaster Item,,34100537,SPSI,Thermo Coolflow Tubing,,Per Svc,571.00
Chargemaster Item,,34100545,SPSI,Ivus Non-Coro Initial Vess,,Per Svc,5804.00
Chargemaster Item,,34100552,SPSI,Ivus Non-Coro Ea Add Vess,,Per Svc,3517.00
Chargemaster Item,,34100560,SPSI,Si Ivus Non Coro,,Per Svc,1772.00
Chargemaster Item,,34101014,SPSI,Impella Removal LV Device,,Per Svc,5040.00
Chargemaster Item,,34101022,SPSI,IABP Device Removal,,Per Svc,3672.00
Chargemaster Item,,34101030,SPSI,Conray 30ml,,Per Svc,33.00
Chargemaster Item,,34101048,SPSI,Nonionic Contrast 100ml,,Per Svc,41.00
Chargemaster Item,,34101055,SPSI,Noionic Conrtast 50ml,,Per Svc,41.00
Chargemaster Item,,34188706,SPSI,SHEATHLESS GUIDE CATH,,Per Svc,369.00
Chargemaster Item,,34189910,SPSI,Crt-D Lv Lead,,Per Svc,12500.00
Chargemaster Item,,34212316,SPSI,Visipaque 50Ml,,Per Svc,95.00
Chargemaster Item,,34212340,SPSI,Visipaque 100Ml,,Per Svc,159.00
Chargemaster Item,,34255612,SPSI,Tryton Stent,,Per Svc,37500.00
Chargemaster Item,,34255620,SPSI,EluNir Drug Coated Stent,,Per Svc,7625.00
Chargemaster Item,,34320101,SPSI,ENDO Repair TAA,,Per Svc,41893.00
Chargemaster Item,,34330100,SPSI,Pericardiocentesis,,Per Svc,5192.00
Chargemaster Item,,34332064,SPSI,Insert/Replace Ppm Gen A Ld,,Per Svc,44206.00
Chargemaster Item,,34332072,SPSI,Insert/Replace PPM Gen V Ld,,Per Svc,48033.00
Chargemaster Item,,34332080,SPSI,Insert/Replace Ppm Gen Lds,,Per Svc,53559.00
Chargemaster Item,,34332106,SPSI,Insert/Replace Temp Pacer,,Per Svc,14534.00
Chargemaster Item,,34332114,SPSI,Ins/Repl Ppm Sngl Generator,,Per Svc,17745.00
Chargemaster Item,,34332122,SPSI,Ins/Repl Ppm Dual Generator,,Per Svc,45384.00
Chargemaster Item,,34332148,SPSI,PPM System Upgrade,,Per Svc,44590.00
Chargemaster Item,,34332155,SPSI,Repo Ppm/Icld,,Per Svc,23109.00
Chargemaster Item,,34332163,SPSI,Insert Single Ppm Or Icd Lead,,Per Svc,23092.00
Chargemaster Item,,34332171,SPSI,Insert Dual Ppm Or Icd Leads,,Per Svc,20980.00
Chargemaster Item,,34332197,SPSI,Repair Single Ppm/Icd Lead,,Per Svc,13303.00
Chargemaster Item,,34332205,SPSI,ICD/PPM Repair 2 Transv Leads,,Per Svc,14888.00
Chargemaster Item,,34332213,SPSI,PPM BIV Gen Insertion Only,,Per Svc,32286.00
Chargemaster Item,,34332221,SPSI,PPM Pocket Revision,,Per Svc,16960.00
Chargemaster Item,,34332239,SPSI,ICD Pocket Revision,,Per Svc,13668.00
Chargemaster Item,,34332254,SPSI,Lv Ld Imp W/New Syst Upgrade,,Per Svc,35364.00
Chargemaster Item,,34332262,SPSI,Repo Prv Lv Ld,,Per Svc,17295.00
Chargemaster Item,,34332296,SPSI,PPM BIV Gen Only Rem & Repl,,Per Svc,36513.00
Chargemaster Item,,34332312,SPSI,ICD BIV Gen Insertion Only,,Per Svc,94289.00
Chargemaster Item,,34332338,SPSI,Removal Of Ppm Generator,,Per Svc,12588.00
Chargemaster Item,,34332346,SPSI,Removal Temporary Pacer,,Per Svc,6534.00
Chargemaster Item,,34332353,SPSI,Removal Of Ppm Dual Chbr Leads,,Per Svc,11613.00
Chargemaster Item,,34332403,SPSI,Insert Icd Generator, Single,,Per Svc,66094.00
Chargemaster Item,,34332411,SPSI,Removal Of ICD Generator,,Per Svc,7533.00
Chargemaster Item,,34332437,SPSI,Insert Icd Generator, Dual/BI-V,,Per Svc,76443.00
Chargemaster Item,,34332445,SPSI,Extraction Icd Lead(S),,Per Svc,7336.00
Chargemaster Item,,34332486,SPSI,Insert Icd Gen Dual + Leads,,Per Svc,85579.00
Chargemaster Item,,34332494,SPSI,Insert Icd Gen Single + Lead,,Per Svc,66094.00
Chargemaster Item,,34332502,SPSI,Bi-V Icd Generator,,Per Svc,120860.00
Chargemaster Item,,34332528,SPSI,Biv Pacer Generator,,Per Svc,45000.00
Chargemaster Item,,34332627,SPSI,ICD Gen Single Remove & Replace,,Per Svc,92493.00
Chargemaster Item,,34332635,SPSI,ICD Gen Dual Remove & Replace,,Per Svc,95330.00
Chargemaster Item,,34332643,SPSI,ICD BIV Gen Remove & Replace,,Per Svc,99136.00
Chargemaster Item,,34332700,SPSI,ICD Implant Sq Ld System w/Dft,,Per Svc,97418.00
Chargemaster Item,,34332718,SPSI,ICD Insert Sq Lead Only,,Per Svc,43462.00
Chargemaster Item,,34332726,SPSI,ICD Extract Sq Rv Lead Only,,Per Svc,13047.00
Chargemaster Item,,34332734,SPSI,ICD Reposition Sq ICD Ld Only,,Per Svc,12683.00
Chargemaster Item,,34332825,SPSI,Implant Loop Recorder,,Per Svc,56599.00
Chargemaster Item,,34332841,SPSI,ILR Removal,,Per Svc,6851.00
Chargemaster Item,,34339671,SPSI,Iabp Insertion,,Per Svc,15415.00
Chargemaster Item,,34339994,SPSI,Lv Lead Add To Prev System,,Per Svc,35388.00
Chargemaster Item,,34348250,SPSI,AAA Prox/Dist Extend Init Vess,,Per Svc,22816.00
Chargemaster Item,,34354704,SPSI,PTA Tiblperone,,Per Svc,1963.00
Chargemaster Item,,34354712,SPSI,PTA Visc/Renal,,Per Svc,2284.00
Chargemaster Item,,34354720,SPSI,Pta Aorta,,Per Svc,1481.00
Chargemaster Item,,34354738,SPSI,Pta Iliac Art,,Per Svc,1463.00
Chargemaster Item,,34354746,SPSI,Pta Fem/Pop Art,,Per Svc,1785.00
Chargemaster Item,,34354753,SPSI,PTA Brachiocep,,Per Svc,2209.00
Chargemaster Item,,34361493,SPSI,Intro Needle,,Per Svc,518.00
Chargemaster Item,,34362004,SPSI,Intro Cath Aorta,,Per Svc,687.00
Chargemaster Item,,34362152,SPSI,1St Ord Vas Fam,,Per Svc,1121.00
Chargemaster Item,,34362160,SPSI,2Nd Ord Vas Fam,,Per Svc,1292.00
Chargemaster Item,,34362178,SPSI,3Rd Ord Vas Fam,,Per Svc,1537.00
Chargemaster Item,,34362186,SPSI,Add 2Nd 3Rd Ord,,Per Svc,271.00
Chargemaster Item,,34362442,SPSI,1St Ord Abd/Leg,,Per Svc,981.00
Chargemaster Item,,34362459,SPSI,Fem Art Angiogram,,Per Svc,6630.00
Chargemaster Item,,34362467,SPSI,Cath Plcmt 2Nd,,Per Svc,1292.00
Chargemaster Item,,34362475,SPSI,Cath Plcmt 3Rd,,Per Svc,1580.00
Chargemaster Item,,34362483,SPSI,Cath Plcmnt Add 2nd,3rd&Beyond,,Per Svc,252.00
Chargemaster Item,,34364307,SPSI,Blood Transfusion,,Per Svc,1860.00
Chargemaster Item,,34365569,SPSI,Insertion Central Venous Cath,,Per Svc,3951.00
Chargemaster Item,,34366203,SPSI,Arterial Monitoring,,Per Svc,726.00
Chargemaster Item,,34372011,SPSI,Infusion Throm,,Per Svc,1878.00
Chargemaster Item,,34372045,SPSI,Cath Occl/Emb,,Per Svc,4474.00
Chargemaster Item,,34372052,SPSI,Stent Placemnt,,Per Svc,8469.00
Chargemaster Item,,34372060,SPSI,Peripheral Stent Add Vessel,,Per Svc,5604.00
Chargemaster Item,,34372078,SPSI,PTA Subclavian,,Per Svc,31741.00
Chargemaster Item,,34372086,SPSI,Hypothermia Cath Insertion Kit,,Per Svc,8584.00
Chargemaster Item,,34372094,SPSI,Us Guide Emboliz S&I,,Per Svc,6525.00
Chargemaster Item,,34372102,SPSI,Pericardiocentesis Tray,,Per Svc,455.00
Chargemaster Item,,34407205,SPSI,Transsepal Needle,,Per Svc,1677.00
Chargemaster Item,,34500108,SPSI,Catheter Coronay,,Per Svc,69.00
Chargemaster Item,,34500116,SPSI,Periph Diagnostic Cath,,Per Svc,130.00
Chargemaster Item,,34501007,SPSI,Intra Aortic Ballon Cath,,Per Svc,5303.00
Chargemaster Item,,34501205,SPSI,Sheath Any Diameter Any Length,,Per Svc,77.00
Chargemaster Item,,34501551,SPSI,Swan Ganz S-Tip,,Per Svc,515.00
Chargemaster Item,,34590018,SPSI,Deflectable Quad Cath,,Per Svc,2378.00
Chargemaster Item,,34590026,SPSI,Deflectable Octa/Deca Caths,,Per Svc,3397.00
Chargemaster Item,,34590216,SPSI,R/2 Pads,,Per Svc,308.00
Chargemaster Item,,34590224,SPSI,Grounding Pad,,Per Svc,201.00
Chargemaster Item,,34590331,SPSI,Ptca Wire,,Per Svc,554.00
Chargemaster Item,,34590356,SPSI,PTCA Magnet Exchange Device,,Per Svc,2356.00
Chargemaster Item,,34590562,SPSI,R-Heart Technology Burr,,Per Svc,13832.00
Chargemaster Item,,34590679,SPSI,Transfer Catheter,,Per Svc,2947.00
Chargemaster Item,,34590760,SPSI,Infusion Catheter,,Per Svc,320.00
Chargemaster Item,,34591065,SPSI,Rc 5000 Rotoblader Setup,,Per Svc,4173.00
Chargemaster Item,,34591107,SPSI,Ep Arterial Transducer,,Per Svc,413.00
Chargemaster Item,,34591115,SPSI,C/S Drape,,Per Svc,112.00
Chargemaster Item,,34592006,SPSI,Indwelling Staples,,Per Svc,416.00
Chargemaster Item,,34592055,SPSI,Sterile Sleeve,,Per Svc,201.00
Chargemaster Item,,34595017,SPSI,Epi Ablation Pack,,Per Svc,1854.00
Chargemaster Item,,34595025,SPSI,Implant Pack,,Per Svc,1854.00
Chargemaster Item,,34595041,SPSI,Icd Generator Single Chamber,,Per Svc,88680.00
Chargemaster Item,,34595066,SPSI,Icd Generation Dual Chamber,,Per Svc,91495.00
Chargemaster Item,,34595082,SPSI,Icd Rvlead Dual Coil,,Per Svc,20500.00
Chargemaster Item,,34595751,SPSI,Smart Touch Thermo Caths,,Per Svc,19025.00
Chargemaster Item,,34595892,SPSI,Left Heart Pack,,Per Svc,1384.00
Chargemaster Item,,34595900,SPSI,Specialty Wire,,Per Svc,1074.00
Chargemaster Item,,34595918,SPSI,Accessory Cath Ptca,,Per Svc,1221.00
Chargemaster Item,,34596015,SPSI,Perclose Suture,,Per Svc,1100.00
Chargemaster Item,,34597039,SPSI,Ivus Coronary Ultrasound,,Per Svc,12207.00
Chargemaster Item,,34597047,SPSI,Catheter Ivus -Car,,Per Svc,5026.00
Chargemaster Item,,34597112,SPSI,Cautery Pencil,,Per Svc,81.00
Chargemaster Item,,34597120,SPSI,Vascular Closure Device,,Per Svc,940.00
Chargemaster Item,,34597898,SPSI,20-Pole Nav Caths,,Per Svc,12230.00
Chargemaster Item,,34598003,SPSI,Catheter Angio Balloon,,Per Svc,1248.00
Chargemaster Item,,34598466,SPSI,Singlet Transducer,,Per Svc,91.00
Chargemaster Item,,34598565,SPSI,Cutting Balloon,,Per Svc,6067.00
Chargemaster Item,,34598680,SPSI,Bare Metal Stent Any Size,,Per Svc,3750.00
Chargemaster Item,,34599712,SPSI,Fixed Quad Caths,,Per Svc,854.00
Chargemaster Item,,34599720,SPSI,60 Cm Guiding Intro Sheath,,Per Svc,1145.00
Chargemaster Item,,34599753,SPSI,Fixed Deca/Cs Caths,,Per Svc,1705.00
Chargemaster Item,,34599902,SPSI,Septishield,,Per Svc,85.00
Chargemaster Item,,34599928,SPSI,Vicryl Suture-Undyed,,Per Svc,173.00
Chargemaster Item,,34599936,SPSI,Vicryl Suture-Dyed,,Per Svc,173.00
Chargemaster Item,,34599944,SPSI,Suture Various Types,,Per Svc,215.00
Chargemaster Item,,34599951,SPSI,3-0 Silk Suture,,Per Svc,173.00
Chargemaster Item,,34599985,SPSI,Intracardiac Echo,,Per Svc,3084.00
Chargemaster Item,,34600106,SPSI,Angioplasty Assessory Kit,,Per Svc,251.00
Chargemaster Item,,34600817,SPSI,Indeflator-Plus,,Per Svc,295.00
Chargemaster Item,,34600874,SPSI,Nonionic Contrast,,Per Svc,2826.00
Chargemaster Item,,34601419,SPSI,Swan Monitoring,,Per Svc,271.00
Chargemaster Item,,34700930,SPSI,Radial Hemo Arm Band,,Per Svc,162.00
Chargemaster Item,,34700948,SPSI,Ptca Guiding Cath All Sizes,,Per Svc,363.00
Chargemaster Item,,34701037,SPSI,Stent Removal Kit,,Per Svc,5199.00
Chargemaster Item,,34756056,SPSI,Thoracic Aortogram S&I,,Per Svc,10531.00
Chargemaster Item,,34756254,SPSI,Abd Aortogram S&I,,Per Svc,7450.00
Chargemaster Item,,34756304,SPSI,Abd Aortogram W/Runoffs S&I,,Per Svc,8143.00
Chargemaster Item,,34756502,SPSI,Interp Arch S&I,,Per Svc,7058.00
Chargemaster Item,,34756650,SPSI,Cer/Carotid Angio S&I Right,,Per Svc,8575.00
Chargemaster Item,,34756809,SPSI,Carotid/Cerv Bil Ang S&I,,Per Svc,11574.00
Chargemaster Item,,34757021,SPSI,Peripheral Balloon All Sizes,,Per Svc,2116.00
Chargemaster Item,,34757153,SPSI,Ext Angio S&I Unilateral,,Per Svc,6235.00
Chargemaster Item,,34757179,SPSI,Ext Angio S&I Bilateral,,Per Svc,5849.00
Chargemaster Item,,34757369,SPSI,Pelvic Angio S&I,,Per Svc,6038.00
Chargemaster Item,,34757740,SPSI,Angio Add S&I,,Per Svc,5148.00
Chargemaster Item,,34758029,SPSI,Guide Wire All Lengths,,Per Svc,97.00
Chargemaster Item,,34758045,SPSI,Embolization Coils,,Per Svc,5820.00
Chargemaster Item,,34758128,SPSI,Pressure Wire Study,,Per Svc,19508.00
Chargemaster Item,,34758136,SPSI,Pressure Wire, Add Vess,,Per Svc,1522.00
Chargemaster Item,,34758151,SPSI,Biliary Stent,,Per Svc,9000.00
Chargemaster Item,,34758607,SPSI,Inj Venogram,,Per Svc,502.00
Chargemaster Item,,34758987,SPSI,Angio F/U S&I,,Per Svc,1241.00
Chargemaster Item,,34759605,SPSI,Non-Coronary Stent Any Size,,Per Svc,8975.00
Chargemaster Item,,34759647,SPSI,Pta Other Addl Peripheral S&I,,Per Svc,8472.00
Chargemaster Item,,34759662,SPSI,Pta Renal/Visc S&I,,Per Svc,8039.00
Chargemaster Item,,34759688,SPSI,Pta Addl Visceral Ves S&I,,Per Svc,6551.00
Chargemaster Item,,34761205,SPSI,Cine/Videoradiography,,Per Svc,661.00
Chargemaster Item,,34764993,SPSI,Cs Venogram W/O Implant,,Per Svc,6321.00
Chargemaster Item,,34769422,SPSI,Us Needle Placement S&I,,Per Svc,2545.00
Chargemaster Item,,34770016,SPSI,Cva Fluoro Guidance,,Per Svc,2208.00
Chargemaster Item,,34777045,SPSI,AAA Main Body Graft,,Per Svc,60000.00
Chargemaster Item,,34777052,SPSI,AAA Contra Graft,,Per Svc,24775.00
Chargemaster Item,,34777060,SPSI,AAA Extender,,Per Svc,27548.00
Chargemaster Item,,34777078,SPSI,AAA Sheath,,Per Svc,1475.00
Chargemaster Item,,34800003,SPSI,Std Thermo Swan,,Per Svc,394.00
Chargemaster Item,,34810051,SPSI,Lead Pacemaker Transvenous,,Per Svc,2750.00
Chargemaster Item,,34810069,SPSI,Pcmkr, Other than Transvenous,,Per Svc,2750.00
Chargemaster Item,,34810150,SPSI,PPM Generator, Dual,,Per Svc,30000.00
Chargemaster Item,,34810432,SPSI,Cook Sheath (All Sizes),,Per Svc,902.00
Chargemaster Item,,34810515,SPSI,Cardioform Septal Occluder,,Per Svc,31644.00
Chargemaster Item,,34810523,SPSI,Iliac Extension Stent,,Per Svc,19900.00
Chargemaster Item,,34810531,SPSI,Aortic Extension Stent,,Per Svc,30300.00
Chargemaster Item,,34810556,SPSI,Thoracic Stent System,,Per Svc,73980.00
Chargemaster Item,,34810564,SPSI,Endoanchor System,,Per Svc,7044.00
Chargemaster Item,,34810572,SPSI,Endoanchor With Screws,,Per Svc,19000.00
Chargemaster Item,,34810606,SPSI,PPM Generator, Single,,Per Svc,27230.00
Chargemaster Item,,34880021,SPSI,Admin Influenza Virus Vaccine,,Per Svc,332.00
Chargemaster Item,,34880039,SPSI,Admin Pneumococcal Vaccine,,Per Svc,332.00
Chargemaster Item,,34880054,SPSI,Endovasc Repair Aaa W/Sm Tube,,Per Svc,41893.00
Chargemaster Item,,34880062,SPSI,Endovasc Repair Aaa W/Mod Prst,,Per Svc,44263.00
Chargemaster Item,,34880070,SPSI,Endo Rep Aaa Infrarenal W/Mod,,Per Svc,57991.00
Chargemaster Item,,34880088,SPSI,Endovasc Repair Aaa W/Uni Prst,,Per Svc,32221.00
Chargemaster Item,,34880096,SPSI,Endovasc Repair Aaa W/Unifem,,Per Svc,53440.00
Chargemaster Item,,34880120,SPSI,AAA Stent Main Body + 1 Limb,,Per Svc,100151.00
Chargemaster Item,,34900035,SPSI,IR LT AV Shunt w/Stent + PTA,,Per Svc,16970.00
Chargemaster Item,,34900043,SPSI,IR RT AV Shunt w/Stent + PTA,,Per Svc,16970.00
Chargemaster Item,,34900050,SPSI,Intravascular Lithotripsy,,Per Svc,9908.00
Chargemaster Item,,34907659,SPSI,IV Infusion Initial IVPB,,Per Svc,637.00
Chargemaster Item,,34907667,SPSI,Iv Infuse, Each Addl Hr,,Per Svc,611.00
Chargemaster Item,,34929505,SPSI,Resuscitation CPR,,Per Svc,2386.00
Chargemaster Item,,34929539,SPSI,Temp Transcutaneous Pacing,,Per Svc,12442.00
Chargemaster Item,,34929604,SPSI,Cardioversion,,Per Svc,18029.00
Chargemaster Item,,34929612,SPSI,Cardioversion Elect Int,,Per Svc,11131.00
Chargemaster Item,,34929737,SPSI,Thrombectomy, Coronary,,Per Svc,10348.00
Chargemaster Item,,34929794,SPSI,Additional Ivus Vessel Cor,,Per Svc,8771.00
Chargemaster Item,,34929828,SPSI,Angioplasty Single Vessel,,Per Svc,93966.00
Chargemaster Item,,34929844,SPSI,Additional Vessel PTCA,,Per Svc,61253.00
Chargemaster Item,,34929950,SPSI,PTCA Perc Cor Atherectomy,,Per Svc,77083.00
Chargemaster Item,,34929968,SPSI,Additional Vessel,,Per Svc,29207.00
Chargemaster Item,,34930032,SPSI,Ext Venogram S&I,,Per Svc,3862.00
Chargemaster Item,,34930040,SPSI,Filter Wire,,Per Svc,10191.00
Chargemaster Item,,34930057,SPSI,12 Ld Ekg W/Oint,,Per Svc,1343.00
Chargemaster Item,,34930156,SPSI,Pharmacological Stress Study,,Per Svc,569.00
Chargemaster Item,,34932863,SPSI,Per-Procedural PPM Eval,,Per Svc,2669.00
Chargemaster Item,,34932871,SPSI,Peri-Procedural ICD Eval,,Per Svc,1113.00
Chargemaster Item,,34932897,SPSI,ICD Single Dual Or Bv Interr,,Per Svc,2550.00
Chargemaster Item,,34932962,SPSI,ICD Remote Transmission Tech,,Per Svc,1727.00
Chargemaster Item,,34933085,SPSI,2D Lmtd,,Per Svc,2460.00
Chargemaster Item,,34936005,SPSI,Bundle Of His Recording,,Per Svc,11413.00
Chargemaster Item,,34936021,SPSI,Intra-Atrial Recording,,Per Svc,9854.00
Chargemaster Item,,34936039,SPSI,RT Vent Recording,,Per Svc,12383.00
Chargemaster Item,,34936096,SPSI,Tachycardia Mapping,,Per Svc,16179.00
Chargemaster Item,,34936104,SPSI,Intraatrial Pacing,,Per Svc,6200.00
Chargemaster Item,,34936120,SPSI,Intraventicular Pacing,,Per Svc,6200.00
Chargemaster Item,,34936138,SPSI,3D Mapping (Add On),,Per Svc,13041.00
Chargemaster Item,,34936187,SPSI,Arrhym Induction/Pacing,,Per Svc,18173.00
Chargemaster Item,,34936195,SPSI,EPS 3 Cath Conduction Study,,Per Svc,25211.00
Chargemaster Item,,34936203,SPSI,Eps 3Cath With Induction,,Per Svc,16299.00
Chargemaster Item,,34936211,SPSI,Eps Cs/La Added To Prim Proc,,Per Svc,16299.00
Chargemaster Item,,34936229,SPSI,Eps Lv Added To Primary Proc,,Per Svc,13702.00
Chargemaster Item,,34936237,SPSI,Eps Pes Post Drug Infusion,,Per Svc,14909.00
Chargemaster Item,,34936245,SPSI,EPS Follow Up/Pacing/Record,,Per Svc,33444.00
Chargemaster Item,,34936401,SPSI,Eval Icd Leads(S) Only,,Per Svc,5614.00
Chargemaster Item,,34936419,SPSI,Eval Icd Implant Gen/Lead(S),,Per Svc,8959.00
Chargemaster Item,,34936427,SPSI,Eval Icd Gen Follow-Up,,Per Svc,5364.00
Chargemaster Item,,34936443,SPSI,ICD Sq Lead Dft Follow-Up,,Per Svc,8374.00
Chargemaster Item,,34936500,SPSI,Ablation Avn Including Tpm,,Per Svc,43932.00
Chargemaster Item,,34936534,SPSI,Complete EPS w/ SVT ablation,,Per Svc,63933.00
Chargemaster Item,,34936542,SPSI,Complete EPS w/ VT ablation+3D,,Per Svc,78739.00
Chargemaster Item,,34936559,SPSI,Ablation of 2nd mechanism site,,Per Svc,2407.00
Chargemaster Item,,34936567,SPSI,AFIB EPS+transseptal+PVI,,Per Svc,75707.00
Chargemaster Item,,34936575,SPSI,Add AF abl after initial PVI,,Per Svc,2407.00
Chargemaster Item,,34936609,SPSI,Tilt Table Test,,Per Svc,5933.00
Chargemaster Item,,34937243,SPSI,Non-Invasive Prog Stim Via PPM,,Per Svc,2594.00
Chargemaster Item,,34940007,SPSI,Visceral Angio Sel/Supr/Se S&I,,Per Svc,5692.00
Chargemaster Item,,34940015,SPSI,Renal Venogram Unilateral S&I,,Per Svc,4794.00
Chargemaster Item,,34952606,SPSI,Loop Recorder,,Per Svc,26475.00
Chargemaster Item,,34952630,SPSI,Guide Wire,,Per Svc,3651.00
Chargemaster Item,,34952648,SPSI,Sheath,,Per Svc,3651.00
Chargemaster Item,,34952655,SPSI,Insert LAA Device,,Per Svc,34788.00
Chargemaster Item,,34952663,SPSI,Watchman Access System,,Per Svc,2170.00
Chargemaster Item,,34952671,SPSI,Watchman LAA Device,,Per Svc,73782.00
Chargemaster Item,,34952689,SPSI,TEE Intraoperative LAA implant,,Per Svc,7854.00
Chargemaster Item,,34952697,SPSI,Vascular Litho Catheter,,Per Svc,4812.00
Chargemaster Item,,34980003,SPSI,PTCA W/Drug Eluting Stent,,Per Svc,124356.00
Chargemaster Item,,34980011,SPSI,PTCA W/BARE METAL STENT,,Per Svc,103929.00
Chargemaster Item,,34980029,SPSI,Add Vessel Ptca W/Drug E St,,Per Svc,81345.00
Chargemaster Item,,34980037,SPSI,Addl Vessel PTCA W/Bare M Stent,,Per Svc,61253.00
Chargemaster Item,,34980060,SPSI,Thromboendart Femoral Common,,Per Svc,19088.12
Chargemaster Item,,34992016,SPSI,Clinic Visit New Patient Minimum,,Per Svc,162.00
Chargemaster Item,,34992024,SPSI,Clinic Visit New Patient Limited,,Per Svc,195.00
Chargemaster Item,,34992032,SPSI,Clinic Visit New Patient Low Complex,,Per Svc,228.00
Chargemaster Item,,34992040,SPSI,Clinic Visit New Patient Mod Complex,,Per Svc,271.00
Chargemaster Item,,34992057,SPSI,Clinic Visit New Patient High,,Per Svc,403.00
Chargemaster Item,,34992115,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,34992123,SPSI,Clinic Visit Est Limited,,Per Svc,171.00
Chargemaster Item,,34992131,SPSI,Clinic Visit Est Low Complex,,Per Svc,186.00
Chargemaster Item,,34992149,SPSI,Clinic Visit Est Mod Complex,,Per Svc,238.00
Chargemaster Item,,34992156,SPSI,Clinic Visit Est High,,Per Svc,305.00
Chargemaster Item,,34992180,SPSI,Direct Admit To Observation,,Per Svc,494.00
Chargemaster Item,,34998005,SPSI,Duplicity Perf Lipid Micro Inj,11994-0011-01,Per Svc,0.01
Chargemaster Item,,34998013,SPSI,Bubble Study,,Per Svc,652.00
Chargemaster Item,,34998021,SPSI,Leadless V PPM Ins/Replace,,Per Svc,38941.52
Chargemaster Item,,34998039,SPSI,Leadless V PPM Removal Only,,Per Svc,11946.00
Chargemaster Item,,34998047,SPSI,Leadless PPM Generator Single,,Per Svc,46655.00
Chargemaster Item,,34998054,SPSI,Peri-Proc Eval/Prog post Proc,,Per Svc,2262.00
Chargemaster Item,,34998088,SPSI,Tee Adult,,Per Svc,6579.00
Chargemaster Item,,34998096,SPSI,TEE with IEA,,Per Svc,8927.00
Chargemaster Item,,34998120,SPSI,Ablation Cath,,Per Svc,7350.00
Chargemaster Item,,34998138,SPSI,Misc EP Supply,,Per Svc,558.00
Chargemaster Item,,34998146,SPSI,Leadless PPM Gen Ins/Repl,,Per Svc,48033.00
Chargemaster Item,,34998153,SPSI,Leadless PPM Gen Removal ONLY,,Per Svc,12588.00
Chargemaster Item,,34998161,SPSI,Peri-Proc Eval/Prog. post Proc,,Per Svc,2670.00
Chargemaster Item,,34998187,SPSI,Insert CardioMEMS PA Sensor,,Per Svc,37235.00
Chargemaster Item,,34998195,SPSI,PTA via LT AV Shunt,,Per Svc,14254.00
Chargemaster Item,,34998203,SPSI,PTA via RT AV Shunt,,Per Svc,14254.00
Chargemaster Item,,34998211,SPSI,CardioMEMS PA Sensor w/delivery sys,,Per Svc,99800.00
Chargemaster Item,,34998222,SPSI,PTA Via Dialysis Circuit,,Per Svc,9381.00
Chargemaster Item,,34998237,SPSI,Angiogram via AV Shunt Assess,,Per Svc,6174.00
Chargemaster Item,,34999912,SPSI,Leadless PPM Gen Removal/Repositioning,,Per Svc,12588.00
Chargemaster Item,,34999920,SPSI,AAA Delayed Placement Distal Extension,,Per Svc,119456.00
Chargemaster Item,,34999930,SPSI,AAA TransCath Fix Endo Graft,,Per Svc,4474.00
Chargemaster Item,,35000017,SPSI,Procedure in Children's Center,,Per Svc,1891.00
Chargemaster Item,,35000025,SPSI,Deep Implant Removal,,Per Svc,6250.00
Chargemaster Item,,35000033,SPSI,Manual Closed Reduction,,Per Svc,1800.00
Chargemaster Item,,35000041,SPSI,Total Fracture Care Simple,,Per Svc,1800.00
Chargemaster Item,,35000058,SPSI,Total Fracture Care Complex,,Per Svc,3000.00
Chargemaster Item,,35023696,SPSI,Clinic Visit New Patient High,,Per Svc,403.00
Chargemaster Item,,35023894,SPSI,Team Conf 30 Min,,Per Svc,56.00
Chargemaster Item,,35023902,SPSI,Nurse Assessment,,Per Svc,160.00
Chargemaster Item,,35023910,SPSI,Social Worker Assessment,,Per Svc,102.00
Chargemaster Item,,35300003,SPSI,HRI Coordinator,,Per Svc,560.00
Chargemaster Item,,35300011,SPSI,Clinic Visit Est High,,Per Svc,305.00
Chargemaster Item,,35300029,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,35300037,SPSI,Clinic Visit New Patient Mod Complex,,Per Svc,271.00
Chargemaster Item,,35300045,SPSI,Clinic Visit Est Mod Complex,,Per Svc,238.00
Chargemaster Item,,35300052,SPSI,Clinic Visit Est Low Complex,,Per Svc,186.00
Chargemaster Item,,35300060,SPSI,Ippb Treatment,,Per Svc,446.00
Chargemaster Item,,35300078,SPSI,Admin Influenza Virus Vaccine,,Per Svc,332.00
Chargemaster Item,,35400001,SPSI,Shoulder To Hand (Long Arm),,Per Svc,1080.00
Chargemaster Item,,35400019,SPSI,Elbow To Finger (Short Arm),,Per Svc,1080.00
Chargemaster Item,,35400027,SPSI,Hand-Low Forearm (Guantlet),,Per Svc,1080.00
Chargemaster Item,,35400035,SPSI,Finger (Eg:Contracture),,Per Svc,614.00
Chargemaster Item,,35400050,SPSI,1 1/2 Spica Or Both Legs,,Per Svc,1200.00
Chargemaster Item,,35400068,SPSI,Long Leg Cast (Thigh to Toes),,Per Svc,1080.00
Chargemaster Item,,35400076,SPSI,Long Leg Cast, Walk Or Amb,,Per Svc,1200.00
Chargemaster Item,,35400084,SPSI,Long Leg Cast Brace,,Per Svc,1080.00
Chargemaster Item,,35400092,SPSI,Cylinder Cast (Thigh To Ankle),,Per Svc,1200.00
Chargemaster Item,,35400100,SPSI,Short Leg Cast,,Per Svc,1080.00
Chargemaster Item,,35400118,SPSI,Short Leg Cast, Walk Or Amb,,Per Svc,1200.00
Chargemaster Item,,35400126,SPSI,Cast (Ptb),,Per Svc,1200.00
Chargemaster Item,,35400134,SPSI,Adding Walker Prev Cast,,Per Svc,684.00
Chargemaster Item,,35400142,SPSI,Clubfoot Cast Long Or Short,,Per Svc,684.00
Chargemaster Item,,35400159,SPSI,Removal/Bivalving Short Arm or Short Leg Cast,,Per Svc,538.00
Chargemaster Item,,35400167,SPSI,Removal/Bivalving Full Arm Or Full Leg Cast,,Per Svc,538.00
Chargemaster Item,,35400175,SPSI,Remov Should Or Hip Spica Ect,,Per Svc,1200.00
Chargemaster Item,,35400191,SPSI,Repair Spica/Body Cast/Jacket,,Per Svc,353.00
Chargemaster Item,,35400209,SPSI,Windowing Of Cast,,Per Svc,450.00
Chargemaster Item,,35400217,SPSI,Wedging Of Cast,,Per Svc,450.00
Chargemaster Item,,35400233,SPSI,Unlisted Proc Cast/Strap,,Per Svc,450.00
Chargemaster Item,,35400241,SPSI,Long Arm Splint,,Per Svc,964.00
Chargemaster Item,,35400258,SPSI,Short Arm Splint,,Per Svc,1233.00
Chargemaster Item,,35400266,SPSI,Finger Splint (Static),,Per Svc,1233.00
Chargemaster Item,,35400279,SPSI,Shoulder Strapping,,Per Svc,614.00
Chargemaster Item,,35400287,SPSI,Elbow/Wrist Strapping,,Per Svc,614.00
Chargemaster Item,,35400290,SPSI,Hand/Finger Strapping,,Per Svc,675.00
Chargemaster Item,,35400308,SPSI,Long Leg Splint,,Per Svc,603.00
Chargemaster Item,,35400316,SPSI,Short Leg Splint,,Per Svc,357.00
Chargemaster Item,,35400324,SPSI,Unna Boot,,Per Svc,607.00
Chargemaster Item,,35400340,SPSI,Pin Fixator Removal,,Per Svc,9682.00
Chargemaster Item,,35400357,SPSI,Cast Supplies Minimum,,Per Svc,656.00
Chargemaster Item,,35400365,SPSI,Cast Supplies Moderate,,Per Svc,1094.00
Chargemaster Item,,35400373,SPSI,Cast Supplies Maximum,,Per Svc,875.00
Chargemaster Item,,35494721,SPSI,Pft Plethysmography,,Per Svc,788.00
Chargemaster Item,,35500003,SPSI,Procedure Min,,Per Svc,1177.00
Chargemaster Item,,35500016,SPSI,Influenza Vac 6-35 Months,,Per Svc,228.70
Chargemaster Item,,35500024,SPSI,Influenza Vacc 3yrs and up,,Per Svc,1715.70
Chargemaster Item,,35500032,SPSI,Influenza Vacc 18 yrs and up,,Per Svc,319.20
Chargemaster Item,,35500040,SPSI,Influenza Peds 6-35 mths,,Per Svc,2314.55
Chargemaster Item,,35992184,SPSI,Treat Humerus Fracture,,Per Svc,787.00
Chargemaster Item,,35992213,SPSI,Teleheatlh Facility Fee,,Per Svc,106.60
Chargemaster Item,,35996372,SPSI,Inj Subcutenousc/Intramus,,Per Svc,234.00
Chargemaster Item,,36000008,SPSI,Abiraterone Acetate 250mG Po,,Per Svc,438.90
Chargemaster Item,,36001006,SPSI,Ponatinib 14mG Po,,Per Svc,2453.40
Chargemaster Item,,36002004,SPSI,Ponatinib 15mG Po,,Per Svc,18716.00
Chargemaster Item,,36002012,SPSI,5% Dextrose Flush 2mL Syringe,,Per Svc,10.00
Chargemaster Item,,36003002,SPSI,Vandetanib 100mG Po,,Per Svc,1029.60
Chargemaster Item,,36004000,SPSI,Ruxolitinib Phosphate 25mG Po,,Per Svc,727.00
Chargemaster Item,,36004018,SPSI,Vandetanib 300mG Po,,Per Svc,2059.40
Chargemaster Item,,36004026,SPSI,Influenza QIV 65 yrs and up,,Per Svc,395.75
Chargemaster Item,,36005007,SPSI,Necitumumab 800mG Inj,,Per Svc,16320.00
Chargemaster Item,,36005015,SPSI,Azithromycin 2mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36005973,SPSI,PRAXBIND 2.5GM INJ,,Per Svc,11130.00
Chargemaster Item,,36006005,SPSI,Crizotinib 200mG Po,,Per Svc,7034.10
Chargemaster Item,,36006013,SPSI,Celecoxib 400mg Cap,,Per Svc,116.25
Chargemaster Item,,36007003,SPSI,Crizotinib 250mG Po,,Per Svc,7034.10
Chargemaster Item,,36008001,SPSI,Lenvatinib 4mG Po,,Per Svc,14348.00
Chargemaster Item,,36009009,SPSI,Lenvatinib 10mG Po,,Per Svc,14348.00
Chargemaster Item,,36010015,SPSI,Selenium 2.5% 118ml Lotion,,Per Svc,329.20
Chargemaster Item,,36010023,SPSI,Sinemet Cr 25-100Mg Po,,Per Svc,14.50
Chargemaster Item,,36010031,SPSI,IV 50% Dextrose/Water 500ml,,Per Svc,132.30
Chargemaster Item,,36010049,SPSI,Peramivir 200mg Inj,,Per Svc,199.50
Chargemaster Item,,36010056,SPSI,Isentress 100mg Granule Po,,Per Svc,83.60
Chargemaster Item,,36015006,SPSI,Sod Chl Bacteriostatic 0.9% 30mL,,Per Svc,18.60
Chargemaster Item,,36017101,SPSI,Erythromycin 0.5% 3.5Gm Oint,,Per Svc,197.55
Chargemaster Item,,36019016,SPSI,Vancomycin/D5W 5mG/mL 1mL,,Per Svc,10.00
Chargemaster Item,,36020006,SPSI,Clobazam 20mG Po,67386031501,Per Svc,169.80
Chargemaster Item,,36024123,SPSI,Calcium Gluc 1000mG/50mL NS,,Per Svc,248.85
Chargemaster Item,,36025104,SPSI,Ranitidine OS 15mG/mL 1mL,,Per Svc,10.00
Chargemaster Item,,36027001,SPSI,Avycaz 1.25Gm a,,Per Svc,558.85
Chargemaster Item,,36027019,SPSI,Avycaz 2.5Gm a,,Per Svc,4521.00
Chargemaster Item,,36027027,SPSI,Avycaz 1250mG,,Per Svc,558.85
Chargemaster Item,,36027035,SPSI,Avycaz 2500mG,,Per Svc,1117.70
Chargemaster Item,,36029015,SPSI,Topiramate 20mG/mL 2.5mL Oral,,Per Svc,43.40
Chargemaster Item,,36030005,SPSI,Mening Vac A,C,Y,W Inj,,Per Svc,1371.70
Chargemaster Item,,36032001,SPSI,Levonorgestrel 52mG IUS,,Per Svc,4721.20
Chargemaster Item,,36034023,SPSI,Diltiazem 1mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36036010,SPSI,Leucovorin 500mG Inj,,Per Svc,1360.80
Chargemaster Item,,36038008,SPSI,Clobazam 10mG Po,67386031401,Per Svc,253.45
Chargemaster Item,,36040004,SPSI,Cosyntropin 0.25mG Inj,,Per Svc,1342.95
Chargemaster Item,,36040012,SPSI,Cosyntropin 1mCg Inj,,Per Svc,10.00
Chargemaster Item,,36040020,SPSI,Cosyntropin 10mCq Inj,,Per Svc,53.75
Chargemaster Item,,36040152,SPSI,Cyproheptadine 2Mg Oral SUSP,,Per Svc,10.00
Chargemaster Item,,36040202,SPSI,Actifed,,Per Svc,0.15
Chargemaster Item,,36040251,SPSI,Diphenhydramine 25mg Po,,Per Svc,35.50
Chargemaster Item,,36040269,SPSI,Diphenhydramine 50Mg Po,,Per Svc,65.10
Chargemaster Item,,36040285,SPSI,Diphenhydramine 25mg Oral Lig,,Per Svc,35.90
Chargemaster Item,,36040293,SPSI,Permethrin 5% 60Gm Crm,,Per Svc,139.45
Chargemaster Item,,36040301,SPSI,Diphenhydramine 50mg Inj,,Per Svc,49.15
Chargemaster Item,,36040400,SPSI,Chlortrim 4Mg,,Per Svc,17.95
Chargemaster Item,,36040459,SPSI,Chlorpheniramine 4Mg Po,,Per Svc,12.30
Chargemaster Item,,36040475,SPSI,Chlorpheniramine 12Mg Po,,Per Svc,57.35
Chargemaster Item,,36040517,SPSI,Deconamine Sr Po,,Per Svc,129.90
Chargemaster Item,,36040525,SPSI,Hismanal 10Mg,,Per Svc,33.00
Chargemaster Item,,36040541,SPSI,Diphenhydramine 1% Crm 28.4Gm,,Per Svc,39.60
Chargemaster Item,,36040566,SPSI,Dimetapp 5Ml Oral Liq,,Per Svc,10.00
Chargemaster Item,,36040590,SPSI,Dimetapp 4Oz,,Per Svc,5.85
Chargemaster Item,,36040624,SPSI,Naldecon Tab,,Per Svc,34.05
Chargemaster Item,,36040699,SPSI,Entex Liq 1 Dose,,Per Svc,45.50
Chargemaster Item,,36040707,SPSI,Cyproheptadine 4Mg Po,,Per Svc,10.00
Chargemaster Item,,36040715,SPSI,Promethazine 12.5Mg Supp,,Per Svc,213.55
Chargemaster Item,,36040723,SPSI,Promethazine 25Mg Supp,,Per Svc,92.40
Chargemaster Item,,36040731,SPSI,Promethazine 50Mg Supp,,Per Svc,375.60
Chargemaster Item,,36040756,SPSI,Promethazine 12.5Mg Po,,Per Svc,29.90
Chargemaster Item,,36040780,SPSI,Fexofenadine 60Mg Po,,Per Svc,15.85
Chargemaster Item,,36040806,SPSI,Promethazine 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36040855,SPSI,Promethazine 25mg Inj,,Per Svc,97.90
Chargemaster Item,,36040863,SPSI,Cortrosyn 0.25Mg Inj,,Per Svc,379.45
Chargemaster Item,,36040871,SPSI,Loratadine/Pse Po,,Per Svc,10.00
Chargemaster Item,,36040889,SPSI,Loratadine 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36040913,SPSI,Cetirizine 5Mg Po,,Per Svc,26.15
Chargemaster Item,,36040921,SPSI,Cetirizine 1Mg Oral Syrup,,Per Svc,16.40
Chargemaster Item,,36041002,SPSI,Trabectedin 1mG,,Per Svc,11016.00
Chargemaster Item,,36042000,SPSI,Misoprostol 25mCg Tab,,Per Svc,10.00
Chargemaster Item,,36043123,SPSI,0.9% NaCl 100mL minibag plus,,Per Svc,62.60
Chargemaster Item,,36045003,SPSI,Sod Chl 0.45% Flush 2.5mL Syr,,Per Svc,10.00
Chargemaster Item,,36048122,SPSI,Sod Chl 23.4% 120mEq/30mL Inj,,Per Svc,23.65
Chargemaster Item,,36052009,SPSI,Estonogestrel 68mG Implant,,Per Svc,4674.10
Chargemaster Item,,36054005,SPSI,Spironolactone 12.5mG Tab,,Per Svc,10.00
Chargemaster Item,,36058014,SPSI,Fentanyl 0.1mG Inj,,Per Svc,10.00
Chargemaster Item,,36059004,SPSI,Insulin R/0.9% NaCl 100U/100mL,,Per Svc,1008.00
Chargemaster Item,,36061000,SPSI,Erythromycin 40mG/mL 1mL Syr,,Per Svc,47.35
Chargemaster Item,,36062123,SPSI,Sterile Water 10mL,,Per Svc,11.15
Chargemaster Item,,36066039,SPSI,Milrinone 0.2mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36071124,SPSI,Troph3.5%/Dex10%/Cal Glu 250mL,,Per Svc,512.40
Chargemaster Item,,36071132,SPSI,Acetic Acid 500mL Irrig,,Per Svc,38.65
Chargemaster Item,,36071140,SPSI,Fentanyl 2500mCg/50mL Inj,,Per Svc,420.00
Chargemaster Item,,36076123,SPSI,Bupivacaine Liposome 1.3% 20mL,,Per Svc,4087.95
Chargemaster Item,,36077006,SPSI,Pot Acetate Inj 2mEq/mL 20mL,,Per Svc,338.65
Chargemaster Item,,36077014,SPSI,Pot Ace 4mEq 2mL Oral Soln 2mL,,Per Svc,10.00
Chargemaster Item,,36079002,SPSI,Triptorelin Pamoate 11.25mG Inj,,Per Svc,6564.80
Chargemaster Item,,36080018,SPSI,Nelfinavir 250Mg Po,,Per Svc,39.80
Chargemaster Item,,36080026,SPSI,Minocycline 100Mg Po,,Per Svc,42.85
Chargemaster Item,,36080034,SPSI,Clarithromycin 500Mg Po,,Per Svc,85.45
Chargemaster Item,,36080042,SPSI,Itraconazole 10Mg Oral Liq,,Per Svc,575.80
Chargemaster Item,,36080059,SPSI,Ceftaroline 400mG,,Per Svc,2118.60
Chargemaster Item,,36080067,SPSI,Dapsone 100Mg Po,,Per Svc,35.30
Chargemaster Item,,36080075,SPSI,Mupirocin 2% 15Gm Crm,,Per Svc,1128.55
Chargemaster Item,,36080083,SPSI,Pyrimethamine 25Mg Po,,Per Svc,4500.00
Chargemaster Item,,36080091,SPSI,Ceftaroline 600mG,,Per Svc,2118.60
Chargemaster Item,,36080109,SPSI,Lamivudine/Zidovudine 150Mg/300Mg Po,,Per Svc,174.70
Chargemaster Item,,36080117,SPSI,Clofarabine 20mG Inj,,Per Svc,13964.40
Chargemaster Item,,36080125,SPSI,Zosyn 4500mG,,Per Svc,718.00
Chargemaster Item,,36080133,SPSI,Ampicillin 250mG,,Per Svc,44.00
Chargemaster Item,,36080141,SPSI,Ampicillin 500mG,,Per Svc,46.30
Chargemaster Item,,36080158,SPSI,Ampicillin 1 Gm,,Per Svc,63.00
Chargemaster Item,,36080166,SPSI,Iv Floxin 400Mg Ivpb 100Ml,,Per Svc,344.70
Chargemaster Item,,36080174,SPSI,Terbinafine 250Mg Po,,Per Svc,137.05
Chargemaster Item,,36080182,SPSI,Mupirocin 2% 30Gm Oint,,Per Svc,1470.65
Chargemaster Item,,36080190,SPSI,Tipranavir 250 Mg Po,,Per Svc,175.65
Chargemaster Item,,36080208,SPSI,Ampicillin 2 Gm,,Per Svc,175.90
Chargemaster Item,,36080216,SPSI,Nystatin Ora Liq 16Oz,,Per Svc,36.05
Chargemaster Item,,36080224,SPSI,Voriconazole 200Mg Po,,Per Svc,1554.40
Chargemaster Item,,36080240,SPSI,Voriconazole 200mG,,Per Svc,1879.80
Chargemaster Item,,36080257,SPSI,Hydroxychloroquine 200Mg Po,,Per Svc,46.10
Chargemaster Item,,36080265,SPSI,Ceftaroline 600 Mg Inj,,Per Svc,320.65
Chargemaster Item,,36080273,SPSI,Famciclovir 250Mg Po,,Per Svc,44.20
Chargemaster Item,,36080281,SPSI,Peginterferon Alfa-2A 180Mcg Inj,,Per Svc,6128.95
Chargemaster Item,,36080299,SPSI,Ivermectin 3Mg Po,,Per Svc,52.20
Chargemaster Item,,36080307,SPSI,Ceftaroline 400Mg Inj,,Per Svc,325.65
Chargemaster Item,,36080323,SPSI,Dalfopristin/Quinupristin 500Mg Inj,,Per Svc,5111.60
Chargemaster Item,,36080331,SPSI,Ceftaroline 10Mg Inj,,Per Svc,197.55
Chargemaster Item,,36080356,SPSI,Chloramphenicol 1Gm Inj,,Per Svc,1120.80
Chargemaster Item,,36080364,SPSI,Erythromycin Ethylsuc 200Mg Oral Liq,,Per Svc,237.00
Chargemaster Item,,36080406,SPSI,Erythromycin 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36080455,SPSI,Erythromycin 500Mg Po,,Per Svc,62.65
Chargemaster Item,,36080463,SPSI,Valacyclovir 500Mg Po,,Per Svc,75.80
Chargemaster Item,,36080471,SPSI,Meropenem 500mG Inj,,Per Svc,10.00
Chargemaster Item,,36080489,SPSI,Magnesium 40G/1000mL,,Per Svc,105.20
Chargemaster Item,,36080554,SPSI,Erythromycin 500Mg Inj,,Per Svc,959.20
Chargemaster Item,,36080562,SPSI,Erythromycin 0.5% 1Gm Ophth Oint,,Per Svc,91.35
Chargemaster Item,,36080612,SPSI,Iv Erthromycin 500Mg Pb 100Ml,,Per Svc,234.80
Chargemaster Item,,36080646,SPSI,Amoxicillin 50Mg/Ml 1 Dose,,Per Svc,31.30
Chargemaster Item,,36080653,SPSI,Amoxicillin 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36080679,SPSI,Amoxicillin 250Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36080687,SPSI,Augmentin 250Mg Po,,Per Svc,47.25
Chargemaster Item,,36080695,SPSI,Augmentin 500Mg Po,,Per Svc,32.25
Chargemaster Item,,36080703,SPSI,Amoxicillin 500Mg Po,,Per Svc,43.25
Chargemaster Item,,36080711,SPSI,Augmentin 875Mg Po,,Per Svc,34.00
Chargemaster Item,,36080737,SPSI,Vanocomycin 125 MG Oral Liquid,,Per Svc,10.00
Chargemaster Item,,36080752,SPSI,Ampicillin 250Mg Po,,Per Svc,12.30
Chargemaster Item,,36080760,SPSI,Ampicillin 125Mg/5Ml 100Ml,,Per Svc,212.55
Chargemaster Item,,36080778,SPSI,Ampicillin 250Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36080794,SPSI,Minocycline 100mG Inj,,Per Svc,1121.40
Chargemaster Item,,36080802,SPSI,Ampicillin 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36080851,SPSI,Albendazole 200Mg Po,,Per Svc,3057.70
Chargemaster Item,,36080877,SPSI,Zosyn 1125mg inj,,Per Svc,10.00
Chargemaster Item,,36080885,SPSI,Augmntn 250/5 75,,Per Svc,325.65
Chargemaster Item,,36080901,SPSI,Ampicillin 250mg Inj,,Per Svc,187.20
Chargemaster Item,,36080935,SPSI,Amoxicillin 250Mg/5Ml 100Cc,,Per Svc,208.00
Chargemaster Item,,36080950,SPSI,Ampicillin 500mg Inj,,Per Svc,147.05
Chargemaster Item,,36080968,SPSI,Augmentin 250Mg Oral Susp,,Per Svc,513.75
Chargemaster Item,,36080984,SPSI,Unasyn 1500mG,,Per Svc,10.00
Chargemaster Item,,36080992,SPSI,Zidovudine 200 mG,,Per Svc,250.55
Chargemaster Item,,36081008,SPSI,Ertapenem 1Gm Inj,,Per Svc,1575.00
Chargemaster Item,,36081016,SPSI,Fluconazole 100Mg Po,,Per Svc,29.30
Chargemaster Item,,36081024,SPSI,Fluconazole 200Mg Po,,Per Svc,182.50
Chargemaster Item,,36081032,SPSI,Azithromycin 250Mg Po,,Per Svc,77.60
Chargemaster Item,,36081040,SPSI,Daptomycin 500mG Inj,,Per Svc,2672.95
Chargemaster Item,,36081057,SPSI,Tenofovir 300Mg Po,,Per Svc,504.10
Chargemaster Item,,36081065,SPSI,Meropenem 1 Gm Inj,,Per Svc,845.55
Chargemaster Item,,36081073,SPSI,Lamivudine 100Mg Po,,Per Svc,204.85
Chargemaster Item,,36081081,SPSI,Nystatin 5Ml Oral Susp,,Per Svc,217.90
Chargemaster Item,,36081099,SPSI,Caspofungin 5mG,,Per Svc,247.50
Chargemaster Item,,36081107,SPSI,Streptomycin 1Gm Inj,,Per Svc,984.40
Chargemaster Item,,36081115,SPSI,Lamivudine 10Mg Oral Liq,,Per Svc,10.00
Chargemaster Item,,36081123,SPSI,Fluconazole 50Mg Po,,Per Svc,755.70
Chargemaster Item,,36081131,SPSI,Azithromycin 500mg Inj,,Per Svc,93.65
Chargemaster Item,,36081149,SPSI,Azithromycin 600Mg Po,,Per Svc,195.60
Chargemaster Item,,36081156,SPSI,Saquinavar 200Mg Po,,Per Svc,30.75
Chargemaster Item,,36081164,SPSI,Piperacillin/Tazobac 1.125 Gm Inj,,Per Svc,122.10
Chargemaster Item,,36081172,SPSI,Caspofungin 50mG,,Per Svc,4255.15
Chargemaster Item,,36081180,SPSI,Caspofungin 70mG,,Per Svc,4421.15
Chargemaster Item,,36081198,SPSI,Fosamprenavir 700Mg Po,,Per Svc,174.30
Chargemaster Item,,36081206,SPSI,Ritonavir 100Mg Po,,Per Svc,108.05
Chargemaster Item,,36081214,SPSI,Atazanavir 200Mg Po,,Per Svc,107.55
Chargemaster Item,,36081222,SPSI,Iv Unasyn 1.5Gm Ivpb 50Ml,,Per Svc,144.15
Chargemaster Item,,36081230,SPSI,Iv Unasyn 3Gm Ivpb 100Ml,,Per Svc,144.15
Chargemaster Item,,36081248,SPSI,Drotrecogin Alpha 5Mg Vial,,Per Svc,2277.45
Chargemaster Item,,36081255,SPSI,Drotrecogin Alpha 20Mg Vial,,Per Svc,6073.05
Chargemaster Item,,36081263,SPSI,Ciprofloxacin 200Mg Inj,,Per Svc,290.70
Chargemaster Item,,36081271,SPSI,Ciprofloxacin 200mG / 100mL,,Per Svc,30.15
Chargemaster Item,,36081289,SPSI,Ciprofloxin 250Mg Oral Susp,,Per Svc,48.00
Chargemaster Item,,36081297,SPSI,Ciprofloxacin 400mG / 200mL,,Per Svc,37.15
Chargemaster Item,,36081305,SPSI,Iv Gatifloxacin 400Mg Ivpb,,Per Svc,568.05
Chargemaster Item,,36081313,SPSI,Fluconazole 400mG / 200mL,,Per Svc,160.55
Chargemaster Item,,36081321,SPSI,Atazanavir 150Mg Po,,Per Svc,604.80
Chargemaster Item,,36081339,SPSI,Adefovir 10Mg Po,,Per Svc,398.60
Chargemaster Item,,36081347,SPSI,Nevirapine 50Mg Oral Susp,,Per Svc,41.35
Chargemaster Item,,36081354,SPSI,Zosyn 2.25 Gm,,Per Svc,305.30
Chargemaster Item,,36081362,SPSI,Zosyn 3.375 Gm,,Per Svc,200.35
Chargemaster Item,,36081370,SPSI,Ganciclovir 500Mg Po,,Per Svc,212.55
Chargemaster Item,,36081388,SPSI,Flucytosine 250Mg Po,,Per Svc,393.75
Chargemaster Item,,36081396,SPSI,Azithromycin 100mg/5ml oral,,Per Svc,253.50
Chargemaster Item,,36081404,SPSI,Zosyn 4.5 Gm,,Per Svc,253.80
Chargemaster Item,,36081412,SPSI,Flucytosine 500Mg Po,,Per Svc,1873.50
Chargemaster Item,,36081420,SPSI,Verapamil Sr 240Mg,,Per Svc,53.70
Chargemaster Item,,36081438,SPSI,Isoniazad 100Mg Inj,,Per Svc,3696.65
Chargemaster Item,,36081446,SPSI,Zosyn 2.25 Gm / 50mL,,Per Svc,439.45
Chargemaster Item,,36081453,SPSI,Azithromycin 200mg Oral Susp,,Per Svc,305.25
Chargemaster Item,,36081461,SPSI,Ciprofloxacin 250Mg Po,,Per Svc,84.20
Chargemaster Item,,36081479,SPSI,Ciprofloxacin 500Mg Po,,Per Svc,53.55
Chargemaster Item,,36081487,SPSI,Fluconazole 200Mg/100Ml Ivpb,,Per Svc,105.85
Chargemaster Item,,36081495,SPSI,Zosyn 3.375 Gm / 50mL,,Per Svc,288.45
Chargemaster Item,,36081503,SPSI,Rifampin 100Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36081511,SPSI,Rifampin 150Mg Po,,Per Svc,20.90
Chargemaster Item,,36081529,SPSI,Fluconazole 200mG / 100mL,,Per Svc,142.80
Chargemaster Item,,36081537,SPSI,Fluconazole 100Mg Oral Susp,,Per Svc,502.65
Chargemaster Item,,36081545,SPSI,Dicloxacillin 500Mg Po,,Per Svc,10.80
Chargemaster Item,,36081552,SPSI,Zosyn 4.5 Gm /100 mL,,Per Svc,284.25
Chargemaster Item,,36081578,SPSI,Dicloxacillin 250Mg Po,,Per Svc,41.50
Chargemaster Item,,36081602,SPSI,Efavirenz 200Mg Po,,Per Svc,123.60
Chargemaster Item,,36081610,SPSI,Efavirenz 100Mg Po,,Per Svc,36.55
Chargemaster Item,,36081628,SPSI,Didanosine Ec 400Mg Po,,Per Svc,83.35
Chargemaster Item,,36081636,SPSI,Didanosine Ec 200 Mg Po,,Per Svc,79.60
Chargemaster Item,,36081644,SPSI,Didanosine Ec 250 Mg Po,,Per Svc,53.80
Chargemaster Item,,36081651,SPSI,Ritonavir/Lopinavir 5Ml Oral Susp,,Per Svc,80.80
Chargemaster Item,,36081685,SPSI,Moxifloxacin 0.5% 3Ml Ophth Sol,,Per Svc,2138.20
Chargemaster Item,,36081693,SPSI,Aminosalicylic Acid 4Gm Packet,,Per Svc,84.00
Chargemaster Item,,36081701,SPSI,Delaviridine 200Mg Po,,Per Svc,31.20
Chargemaster Item,,36081719,SPSI,Rifampin 6Mg Inj,,Per Svc,22.45
Chargemaster Item,,36081727,SPSI,Emtricitabine 200Mg Po,,Per Svc,286.55
Chargemaster Item,,36081735,SPSI,Ticarcillin/Clavulanate 3.1Gm Inj,,Per Svc,224.30
Chargemaster Item,,36081743,SPSI,Aztreonam 2Gm Inj,,Per Svc,730.80
Chargemaster Item,,36081750,SPSI,Moxifloxacin 400Mg Po,,Per Svc,383.55
Chargemaster Item,,36081768,SPSI,Tobramycin 1.2Gm Inj,,Per Svc,2205.00
Chargemaster Item,,36081776,SPSI,Erythromycin 200Mg/5Ml 30Ml,,Per Svc,3.90
Chargemaster Item,,36081784,SPSI,Valganciclovir 450Mg Po,,Per Svc,1113.85
Chargemaster Item,,36081792,SPSI,Tobramycin 300Mg Inhalation Sol,,Per Svc,1064.05
Chargemaster Item,,36081818,SPSI,Stavudine 15Mg Po,,Per Svc,55.55
Chargemaster Item,,36081826,SPSI,Abacavir 300Mg Po,,Per Svc,105.40
Chargemaster Item,,36081834,SPSI,Rimantadine 100Mg Po,,Per Svc,49.75
Chargemaster Item,,36081842,SPSI,Zidovudine 100Mg Po,,Per Svc,33.80
Chargemaster Item,,36081859,SPSI,Nafcillin 1Gm Inj,,Per Svc,153.30
Chargemaster Item,,36081867,SPSI,Caspofungin 5Mg Inj,,Per Svc,247.50
Chargemaster Item,,36081891,SPSI,Aztreonam 1Gm Inj,,Per Svc,365.40
Chargemaster Item,,36081909,SPSI,Nafcillin 2Gm Inj,,Per Svc,175.90
Chargemaster Item,,36081925,SPSI,Prednisolone 5Mg Oral Liq,,Per Svc,43.55
Chargemaster Item,,36081933,SPSI,Pediazole Liq 200Cc,,Per Svc,192.20
Chargemaster Item,,36081958,SPSI,Pediazole 1 Dose,,Per Svc,21.20
Chargemaster Item,,36081966,SPSI,Famciclovir 500Mg Po,,Per Svc,71.30
Chargemaster Item,,36081974,SPSI,Cepodoxime 200Mg Po,,Per Svc,94.90
Chargemaster Item,,36081982,SPSI,Trizvir PO,,Per Svc,579.60
Chargemaster Item,,36081990,SPSI,Ampicillin 125Mg Oral Susp,,Per Svc,48.05
Chargemaster Item,,36082006,SPSI,Zanamivir Inhaler,,Per Svc,37.15
Chargemaster Item,,36082014,SPSI,Rifaximin 200Mg Po,,Per Svc,260.95
Chargemaster Item,,36082022,SPSI,Ceftazidime 0.5Gm,,Per Svc,162.70
Chargemaster Item,,36082030,SPSI,Anidulafungin 100 mG,,Per Svc,2268.00
Chargemaster Item,,36082048,SPSI,Enfuvirtide 90mG Inj,,Per Svc,752.95
Chargemaster Item,,36082055,SPSI,Darunavir 300mg,,Per Svc,86.05
Chargemaster Item,,36082063,SPSI,Rocephin 250 mG Inj,,Per Svc,2073.60
Chargemaster Item,,36082071,SPSI,Ceftazidime 500Mg Inj,,Per Svc,162.70
Chargemaster Item,,36082089,SPSI,Amphotericin B Liposome 50mG,,Per Svc,3114.00
Chargemaster Item,,36082097,SPSI,Amphotericin B Complex 100mG,,Per Svc,3114.00
Chargemaster Item,,36082105,SPSI,Atazanavir 100Mg Po,,Per Svc,86.70
Chargemaster Item,,36082113,SPSI,Foscarnet 6000mG,,Per Svc,1156.90
Chargemaster Item,,36082121,SPSI,Raltegravir 400Mg Po,,Per Svc,390.40
Chargemaster Item,,36082139,SPSI,KALETRA 80/20MG 1ML SUSP,,Per Svc,201.60
Chargemaster Item,,36082147,SPSI,Isoniazid 250 MG 5ML Oral Liq,,Per Svc,10.00
Chargemaster Item,,36082154,SPSI,Bicillin CR 1.2 Mill Units,,Per Svc,1580.55
Chargemaster Item,,36082162,SPSI,Tigecycline 50mG,,Per Svc,1965.60
Chargemaster Item,,36082170,SPSI,Colistimetate 150Mg Inj,,Per Svc,598.50
Chargemaster Item,,36082188,SPSI,Ramelteon 8Mg Po,,Per Svc,34.65
Chargemaster Item,,36082196,SPSI,Fidaxomicin 200MG PO,,Per Svc,2435.50
Chargemaster Item,,36082204,SPSI,Rifaximin 550Mg Po,,Per Svc,497.40
Chargemaster Item,,36082212,SPSI,Zidovudine 50Mg Oral Liq,,Per Svc,1354.10
Chargemaster Item,,36082220,SPSI,Cefepime 0.5Gm Inj,,Per Svc,255.41
Chargemaster Item,,36082238,SPSI,Etravirine 100Mg Po,,Per Svc,111.30
Chargemaster Item,,36082246,SPSI,Lopinavir/Ritonavir 200Mg/50Mg Po,,Per Svc,80.55
Chargemaster Item,,36082253,SPSI,Moxifloxacin 400mG / 200mL,,Per Svc,643.35
Chargemaster Item,,36082261,SPSI,Ceftazidime 0.5Gm a,,Per Svc,136.60
Chargemaster Item,,36082279,SPSI,Ceftazidime 1Gm Inj,,Per Svc,132.30
Chargemaster Item,,36082287,SPSI,Oseltamivir 30 MG 5ML Oral Liq,,Per Svc,159.50
Chargemaster Item,,36082295,SPSI,Oseltamivir 30Mg Oral Susp,,Per Svc,51.20
Chargemaster Item,,36082303,SPSI,Oseltamivir 75Mg Po,,Per Svc,162.10
Chargemaster Item,,36082311,SPSI,Posaconazole 200Mg Oral Susp,,Per Svc,863.75
Chargemaster Item,,36082329,SPSI,Cefotetan 1gm Inj,,Per Svc,298.55
Chargemaster Item,,36082337,SPSI,Emtricitabine/Tenofovir 200/300Mg Po,,Per Svc,356.90
Chargemaster Item,,36082345,SPSI,Didanosine 50Mg Oral Liq,,Per Svc,14.70
Chargemaster Item,,36082352,SPSI,Ceftazidime 2Gm Inj,,Per Svc,274.05
Chargemaster Item,,36082360,SPSI,Ceftazidime 1000mG Inj,,Per Svc,10.00
Chargemaster Item,,36082378,SPSI,Iv Cefotan 1Gm Ivpb 50Ml,,Per Svc,273.80
Chargemaster Item,,36082386,SPSI,Ceftriaxone 250mG,,Per Svc,10.00
Chargemaster Item,,36082394,SPSI,Cefuroxime 250Mg Po,,Per Svc,69.70
Chargemaster Item,,36082402,SPSI,Bicillin Cr 100,000 Units,,Per Svc,357.00
Chargemaster Item,,36082410,SPSI,Cefotetan 2Gm Inj,,Per Svc,484.70
Chargemaster Item,,36082428,SPSI,Cefotetan 500Mg Inj,,Per Svc,10.00
Chargemaster Item,,36082436,SPSI,Ceftriaxone 500mG,,Per Svc,11.95
Chargemaster Item,,36082444,SPSI,Cefotetan 1Gm / 50mL,,Per Svc,228.60
Chargemaster Item,,36082451,SPSI,Cefotetan 1gm,,Per Svc,242.35
Chargemaster Item,,36082469,SPSI,Ceftazidime 1Gm / 50mL,,Per Svc,187.75
Chargemaster Item,,36082501,SPSI,Bicillin La 100, 000 Units,,Per Svc,421.50
Chargemaster Item,,36082519,SPSI,Oritavancin 400mg Inj,,Per Svc,5800.00
Chargemaster Item,,36082535,SPSI,Dalbavancin 500mg Inj,,Per Svc,9208.20
Chargemaster Item,,36082576,SPSI,Darunavir 600mg Po,,Per Svc,340.10
Chargemaster Item,,36082626,SPSI,Sulfasalazine EC 500mg Po,,Per Svc,46.35
Chargemaster Item,,36082659,SPSI,Tobramycin 20MG INJ,,Per Svc,10.70
Chargemaster Item,,36082667,SPSI,Linezolid 600Mg Po,,Per Svc,1965.90
Chargemaster Item,,36082683,SPSI,Itraconazole 10Mg Inj,,Per Svc,22.75
Chargemaster Item,,36082691,SPSI,Linezolid 600mG /300mL,,Per Svc,916.35
Chargemaster Item,,36082709,SPSI,Mycobutin 150Mg,,Per Svc,94.10
Chargemaster Item,,36082733,SPSI,Suprax 100Mg/5Ml 50Ml,,Per Svc,277.40
Chargemaster Item,,36082758,SPSI,Avycaz 1.25Gm,,Per Svc,559.45
Chargemaster Item,,36082766,SPSI,Avycaz 2.5Gm,,Per Svc,1117.70
Chargemaster Item,,36082782,SPSI,Penicillin G Sod 5 Mil Units Inj,,Per Svc,604.80
Chargemaster Item,,36082790,SPSI,Piperacillin 3 Gm Inj,,Per Svc,81.70
Chargemaster Item,,36082808,SPSI,Penicillin G Pot 5 Milli Units,,Per Svc,159.50
Chargemaster Item,,36082816,SPSI,Pentamidine 300Mg Inj,,Per Svc,214.40
Chargemaster Item,,36082832,SPSI,Darunavir 800mg Po,,Per Svc,709.70
Chargemaster Item,,36082899,SPSI,Piperacillin 4 Gm Inj,,Per Svc,325.65
Chargemaster Item,,36082907,SPSI,Pen Vk 250 Po,,Per Svc,17.95
Chargemaster Item,,36082915,SPSI,Pen Vk 250 100,,Per Svc,10.00
Chargemaster Item,,36082923,SPSI,Cefotetan 2Gm / 50mL a,,Per Svc,326.85
Chargemaster Item,,36082949,SPSI,Healon Duet Pro Combo Pk,,Per Svc,1701.35
Chargemaster Item,,36082956,SPSI,Pen Vk 500 Po,,Per Svc,18.25
Chargemaster Item,,36082964,SPSI,Piperacillin 2 Gm Inj,,Per Svc,212.55
Chargemaster Item,,36082980,SPSI,Piperacillin 1 Gm Inj,,Per Svc,129.90
Chargemaster Item,,36082998,SPSI,Cefepime 0.5G,,Per Svc,185.90
Chargemaster Item,,36083004,SPSI,Wycillin 600K UNITS,,Per Svc,220.50
Chargemaster Item,,36083012,SPSI,Metronidazole 100Mg Oral Susp,,Per Svc,20.40
Chargemaster Item,,36083020,SPSI,Chloroquine 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36083046,SPSI,Levofloxacin 250mG / 50mL,,Per Svc,90.95
Chargemaster Item,,36083053,SPSI,Atovaquone/Proguanil 250Mg/100Mg Po,,Per Svc,75.10
Chargemaster Item,,36083061,SPSI,Levofloxacin 500mG /100mL,,Per Svc,349.00
Chargemaster Item,,36083079,SPSI,Levofloxacin 750mG /150mL,,Per Svc,81.90
Chargemaster Item,,36083087,SPSI,Penicillin G Procaine 0.6 Milli Units,,Per Svc,418.30
Chargemaster Item,,36083103,SPSI,Quinine Sulf 324Mg Po,,Per Svc,74.25
Chargemaster Item,,36083137,SPSI,Pyrimethamine 6.25Mg Oral Susp,,Per Svc,2362.50
Chargemaster Item,,36083186,SPSI,Stavudine 40Mg Po,,Per Svc,31.70
Chargemaster Item,,36083244,SPSI,Ribavirin 200Mg Po,,Per Svc,104.15
Chargemaster Item,,36083251,SPSI,Demeclocycline 150Mg Po,,Per Svc,97.00
Chargemaster Item,,36083301,SPSI,Trimetrexate 25Mg Inj,,Per Svc,365.25
Chargemaster Item,,36083400,SPSI,Zerbaxa 150mg,,Per Svc,172.20
Chargemaster Item,,36083459,SPSI,Zerbaxa 1500mg,,Per Svc,1435.65
Chargemaster Item,,36083483,SPSI,Stavudine 20Mg Po,,Per Svc,57.65
Chargemaster Item,,36083491,SPSI,Stavudine 30Mg Po,,Per Svc,29.35
Chargemaster Item,,36083525,SPSI,Levofloxacin 250Mg Po,,Per Svc,154.65
Chargemaster Item,,36083533,SPSI,Levofloxacin 500Mgpo,,Per Svc,138.10
Chargemaster Item,,36083541,SPSI,Levofloxacin 250Mg Inj,,Per Svc,228.80
Chargemaster Item,,36083574,SPSI,Levofloxacin 250Mg/50Ml Ivpb,,Per Svc,211.45
Chargemaster Item,,36083806,SPSI,Tetracycline 250Mg Po,,Per Svc,82.75
Chargemaster Item,,36084002,SPSI,Cefepime 500mG Inj a,,Per Svc,10.00
Chargemaster Item,,36084010,SPSI,Cefepime 1Gm Inj,,Per Svc,213.45
Chargemaster Item,,36084028,SPSI,Cefepime 2Gm Inj,,Per Svc,423.80
Chargemaster Item,,36084036,SPSI,Cefepime 1Gm / 50mL,,Per Svc,278.90
Chargemaster Item,,36084044,SPSI,Cefepime 2Gm / 50mL,,Per Svc,306.10
Chargemaster Item,,36084150,SPSI,Doxycycline 50Mg Po,,Per Svc,12.50
Chargemaster Item,,36084200,SPSI,Doxycycline 100Mg Po,,Per Svc,58.70
Chargemaster Item,,36084309,SPSI,Doxycycline 100Mg Inj,,Per Svc,304.40
Chargemaster Item,,36084374,SPSI,Doxycycline 20Mg Po,,Per Svc,65.90
Chargemaster Item,,36084606,SPSI,Clarithromycin 250Mg Po,,Per Svc,61.55
Chargemaster Item,,36084614,SPSI,Biaxin 250Mg/5Ml Susp 1 Dose,,Per Svc,88.75
Chargemaster Item,,36084622,SPSI,Clarithromycin 250Mg Oral Susp,,Per Svc,60.85
Chargemaster Item,,36084713,SPSI,Cefepime 500Mg Inj,,Per Svc,185.90
Chargemaster Item,,36084804,SPSI,Lamivudine 150Mg Po,,Per Svc,76.15
Chargemaster Item,,36085009,SPSI,Bacitracin 50M Units Inj,,Per Svc,139.75
Chargemaster Item,,36085017,SPSI,Bicillin LA 0.6 Mill Units,,Per Svc,232.70
Chargemaster Item,,36085025,SPSI,Bicillin LA 1.2 Mill Units,,Per Svc,554.10
Chargemaster Item,,36085033,SPSI,Cefuroxime 100Mg Inj,,Per Svc,33.20
Chargemaster Item,,36085041,SPSI,Bicillin LA 2.4 Mill Units,,Per Svc,1120.05
Chargemaster Item,,36085058,SPSI,Cefazolin 0.5Gm Inj,,Per Svc,91.75
Chargemaster Item,,36085066,SPSI,Cefazolin 1000mG Inj,,Per Svc,10.00
Chargemaster Item,,36085074,SPSI,Cefadroxil 500Mg Po,,Per Svc,26.80
Chargemaster Item,,36085082,SPSI,Cefazolin 2000mG Inj,,Per Svc,367.00
Chargemaster Item,,36085090,SPSI,Ancef 500Mg Inj,,Per Svc,57.60
Chargemaster Item,,36085108,SPSI,Cefotaxime 1Gm Inj a,,Per Svc,27.70
Chargemaster Item,,36085116,SPSI,Cefotaxime 2Gm Inj,,Per Svc,97.65
Chargemaster Item,,36085124,SPSI,Cefoxitin 1Gm Inj a,,Per Svc,125.35
Chargemaster Item,,36085132,SPSI,Erythromycin Ethylsuc 40Mg Oral Susp,,Per Svc,58.15
Chargemaster Item,,36085140,SPSI,Cefoxitin 2gm Inj,,Per Svc,126.00
Chargemaster Item,,36085157,SPSI,Ceftriaxone 0.25Gm,,Per Svc,20.70
Chargemaster Item,,36085165,SPSI,Ceftriaxone 1 Gm,,Per Svc,20.05
Chargemaster Item,,36085173,SPSI,Cefazolin 500mg Inj,,Per Svc,53.15
Chargemaster Item,,36085181,SPSI,Ceftriaxone 2 Gm,,Per Svc,35.90
Chargemaster Item,,36085199,SPSI,Ceftriaxone 0.5Gm,,Per Svc,220.50
Chargemaster Item,,36085207,SPSI,Ceftriaxone 1 Gm / 50mL Premix,,Per Svc,189.40
Chargemaster Item,,36085215,SPSI,Ceftriaxone 2 Gm / 50mL,,Per Svc,223.95
Chargemaster Item,,36085223,SPSI,Amikacin 500mG,,Per Svc,77.20
Chargemaster Item,,36085231,SPSI,Amikacin 1000mG,,Per Svc,77.20
Chargemaster Item,,36085249,SPSI,Cefazolin 1Gm / 50 mL,,Per Svc,26.25
Chargemaster Item,,36085264,SPSI,Gentamicin 80mG / 50mL,,Per Svc,44.00
Chargemaster Item,,36085272,SPSI,Gentamycin 100mG / 100mL,,Per Svc,44.85
Chargemaster Item,,36085280,SPSI,Gentamycin 80mG,,Per Svc,13.95
Chargemaster Item,,36085298,SPSI,Cefazolin 1Gm / 50mL Duplex,,Per Svc,75.55
Chargemaster Item,,36085306,SPSI,Cephalexin 250Mg Po,,Per Svc,12.70
Chargemaster Item,,36085314,SPSI,Cefazolin 1Gm / 50mL Premix,,Per Svc,73.50
Chargemaster Item,,36085322,SPSI,Cefazolin 2Gm / 50ml,,Per Svc,252.00
Chargemaster Item,,36085330,SPSI,Cefuroxime 750Mg Inj,,Per Svc,37.80
Chargemaster Item,,36085348,SPSI,Cefoxitin 1Gm / 50mL,,Per Svc,159.80
Chargemaster Item,,36085355,SPSI,Cephalexin 500Mg Po,,Per Svc,14.20
Chargemaster Item,,36085363,SPSI,Ceftriaxone 1Gm / 50mL Duplex,,Per Svc,334.10
Chargemaster Item,,36085371,SPSI,Cefixime 100Mg Oral Susp,,Per Svc,36.10
Chargemaster Item,,36085397,SPSI,Rocephin 250mg,,Per Svc,20.70
Chargemaster Item,,36085421,SPSI,Cefotaxime 1GM inj,,Per Svc,119.50
Chargemaster Item,,36085454,SPSI,Keflex 250Mg/5Ml Liq 1 Dose,,Per Svc,301.90
Chargemaster Item,,36085587,SPSI,Cefoxitin 1Gm Inj,,Per Svc,125.35
Chargemaster Item,,36085595,SPSI,Cefoxitin 1000mg Inj,,Per Svc,10.00
Chargemaster Item,,36085603,SPSI,Clindamycin 150Mg Po,,Per Svc,10.00
Chargemaster Item,,36085629,SPSI,Clindamycin 300Mg Po,,Per Svc,66.45
Chargemaster Item,,36085637,SPSI,Iv Claforan 1Gm Ivpb 50Ml,,Per Svc,310.65
Chargemaster Item,,36085652,SPSI,Clindamycin 300Mg Inj,,Per Svc,85.45
Chargemaster Item,,36085678,SPSI,Clindamycin 600Mg Inj,,Per Svc,219.75
Chargemaster Item,,36085702,SPSI,IV Clindamycin 900 MG 50 ML IVPB,,Per Svc,276.60
Chargemaster Item,,36085710,SPSI,Cleocin 600Mg Po,,Per Svc,26.30
Chargemaster Item,,36085736,SPSI,Gentamycin 20Mg Inj,,Per Svc,49.65
Chargemaster Item,,36085801,SPSI,Gentamycin 80mg Inj,,Per Svc,106.25
Chargemaster Item,,36085819,SPSI,Amikacin 100Mg Inj,,Per Svc,10.00
Chargemaster Item,,36085884,SPSI,Cefotaxime 1000mG,,Per Svc,10.00
Chargemaster Item,,36085892,SPSI,Keflex 250MG/5ML 200ML,,Per Svc,325.65
Chargemaster Item,,36085900,SPSI,Clindamycin 900mG 50mL,,Per Svc,268.50
Chargemaster Item,,36085918,SPSI,Clindamycin 900mG 6mL,,Per Svc,133.90
Chargemaster Item,,36085975,SPSI,Keflex 125MG/5ML 200ML,,Per Svc,325.65
Chargemaster Item,,36085991,SPSI,Gentamycin 40Mg Inj,,Per Svc,60.40
Chargemaster Item,,36086007,SPSI,Tobramycin 80MG INJ,,Per Svc,25.00
Chargemaster Item,,36086015,SPSI,Primaxin 250mG,,Per Svc,123.50
Chargemaster Item,,36086023,SPSI,Primaxin 500mG,,Per Svc,246.95
Chargemaster Item,,36086031,SPSI,Vancomycin 1000mG,,Per Svc,71.30
Chargemaster Item,,36086049,SPSI,Vancomycin 500mG,,Per Svc,105.55
Chargemaster Item,,36086056,SPSI,Vancomycin 1000mG / 200mL,,Per Svc,269.65
Chargemaster Item,,36086064,SPSI,Primaxin 250 Mg Inj.,,Per Svc,10.00
Chargemaster Item,,36086072,SPSI,Penicillin G Procaine 1.2 Milli Units,,Per Svc,696.45
Chargemaster Item,,36086080,SPSI,Sulfasalazine 500mG PO a,,Per Svc,10.00
Chargemaster Item,,36086098,SPSI,Sulfasalazine EC 500mG PO a,,Per Svc,24.90
Chargemaster Item,,36086122,SPSI,Clindamycin 75Mg Oral Susp,,Per Svc,32.55
Chargemaster Item,,36086155,SPSI,Neomycin 500Mg Po,,Per Svc,17.10
Chargemaster Item,,36086189,SPSI,Neomycin 500 Iv,,Per Svc,273.20
Chargemaster Item,,36086197,SPSI,Elotuzumab 300mG Inj,,Per Svc,7210.60
Chargemaster Item,,36086205,SPSI,Polymyxin B 5Mu Inj,,Per Svc,143.35
Chargemaster Item,,36086262,SPSI,Vancomycin 500mg Inj,,Per Svc,1097.65
Chargemaster Item,,36086270,SPSI,Vancomycin 500Mg Oral Liq,,Per Svc,59.50
Chargemaster Item,,36086296,SPSI,Vancomycin 250Mg Po,,Per Svc,606.60
Chargemaster Item,,36086346,SPSI,Vancomycin 125Mg Po,,Per Svc,329.05
Chargemaster Item,,36086353,SPSI,Ethambutol 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36086379,SPSI,Ethambutol 400Mg Po,,Per Svc,21.30
Chargemaster Item,,36086387,SPSI,Vancocin Liq (See 36086270),,Per Svc,141.75
Chargemaster Item,,36086452,SPSI,Isoniazid 300Mg Po,,Per Svc,10.00
Chargemaster Item,,36086460,SPSI,Pyraznamde 500 Po,,Per Svc,53.55
Chargemaster Item,,36086478,SPSI,Isoniazid 100Mg Po,,Per Svc,29.90
Chargemaster Item,,36086494,SPSI,Rifampin Oral Liq 1Ml,,Per Svc,22.15
Chargemaster Item,,36086502,SPSI,Rifampin 300Mg Po,,Per Svc,13.95
Chargemaster Item,,36086577,SPSI,Rifampin 600Mg Inj,,Per Svc,2249.85
Chargemaster Item,,36086619,SPSI,Quinine 5Gr,,Per Svc,67.70
Chargemaster Item,,36086957,SPSI,Sulfasalazine 500Mg Po,,Per Svc,74.10
Chargemaster Item,,36086973,SPSI,Sulfasalazine 25Mg Oral Liq,,Per Svc,62.00
Chargemaster Item,,36087096,SPSI,Sulfadiazine 500Mg Po,,Per Svc,53.05
Chargemaster Item,,36087104,SPSI,Mepron 750Mg/5Ml Susp,,Per Svc,417.80
Chargemaster Item,,36087443,SPSI,Flagyl 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36087450,SPSI,Flagyl 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36087468,SPSI,Metronidazole 500Mg Inj,,Per Svc,28.50
Chargemaster Item,,36087609,SPSI,Nitrofurantoin 100Mg Po,,Per Svc,38.65
Chargemaster Item,,36087658,SPSI,Nitrofurantoin 25Mg Oral Susp,,Per Svc,249.25
Chargemaster Item,,36087864,SPSI,Sulfamethox/Trimetho 800/160Mg Inj,,Per Svc,158.05
Chargemaster Item,,36087955,SPSI,Sulfametho/Trimetho 400/80Mg Po,,Per Svc,10.00
Chargemaster Item,,36087971,SPSI,Sulfamethox/Trimetho 800/160Mg Po,,Per Svc,36.25
Chargemaster Item,,36087989,SPSI,Sulfamethox/Trimetho 800/160Mg Oral Susp,,Per Svc,87.70
Chargemaster Item,,36088003,SPSI,Acyclovir 500mG,,Per Svc,168.00
Chargemaster Item,,36088011,SPSI,Adenosine 6mG Inj,,Per Svc,200.35
Chargemaster Item,,36088029,SPSI,Proloprim 100,,Per Svc,10.20
Chargemaster Item,,36088037,SPSI,Adenosine 90mG Inj,,Per Svc,2167.30
Chargemaster Item,,36088060,SPSI,Nitrofurantoin 50Mg Po,,Per Svc,23.05
Chargemaster Item,,36088078,SPSI,Macrodantin,,Per Svc,93.85
Chargemaster Item,,36088151,SPSI,Neomycin/Polymyxin 1Ml Inj,,Per Svc,167.35
Chargemaster Item,,36088169,SPSI,Phenazopyridine 50Mg Oral Susp,,Per Svc,26.80
Chargemaster Item,,36088201,SPSI,Phenazopyridine 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36088227,SPSI,Phenazopyridine 200Mg Po,,Per Svc,51.25
Chargemaster Item,,36088334,SPSI,Acyclovir 400Mg Po,,Per Svc,22.80
Chargemaster Item,,36088342,SPSI,Acyclovir 200Mg Oral Susp,,Per Svc,52.80
Chargemaster Item,,36088359,SPSI,Urised Po,,Per Svc,33.90
Chargemaster Item,,36088474,SPSI,Praziquantel 600Mg Po,,Per Svc,2291.95
Chargemaster Item,,36088508,SPSI,Amantadine 100Mg Po,,Per Svc,39.05
Chargemaster Item,,36088516,SPSI,Amantadine 100Mg Oral Liq,,Per Svc,27.00
Chargemaster Item,,36088532,SPSI,Acyclovir 200Mg Po,,Per Svc,16.05
Chargemaster Item,,36088557,SPSI,Amphotericin B 50Mg Inj,,Per Svc,478.80
Chargemaster Item,,36088573,SPSI,Acyclovir 5% 15Gm Oint,,Per Svc,4187.40
Chargemaster Item,,36088599,SPSI,Acyclovir 5Mg Inj,,Per Svc,16.80
Chargemaster Item,,36088615,SPSI,Ketoconazole 200Mg Po,,Per Svc,39.80
Chargemaster Item,,36088649,SPSI,Mycelex Troche,,Per Svc,33.80
Chargemaster Item,,36089100,SPSI,Indinavir 400Mg Po,,Per Svc,41.15
Chargemaster Item,,36089308,SPSI,Sporonox 100Mg,,Per Svc,117.60
Chargemaster Item,,36089407,SPSI,Viramune 200Mg,,Per Svc,118.85
Chargemaster Item,,36090009,SPSI,Unasyn 1.5 Gm,,Per Svc,95.75
Chargemaster Item,,36090017,SPSI,Unasyn 3 Gm,,Per Svc,180.70
Chargemaster Item,,36090165,SPSI,Gentamicin 80Mg/2Ml,,Per Svc,119.30
Chargemaster Item,,36090207,SPSI,Unasyn 1.5Gm Inj,,Per Svc,116.20
Chargemaster Item,,36091197,SPSI,Cycloserine 250 Mg Po,,Per Svc,877.80
Chargemaster Item,,36092120,SPSI,Levetiracetam 100mG/mL 1mL Po,,Per Svc,10.00
Chargemaster Item,,36094001,SPSI,Elotuzumab 400mG Inj,,Per Svc,9614.20
Chargemaster Item,,36094019,SPSI,Retacrit 40000 esrd,,Per Svc,2223.70
Chargemaster Item,,36097004,SPSI,Vismodegib 150mG Po,,Per Svc,1538.20
Chargemaster Item,,36097012,SPSI,Lugol's Strong Iodine Sol 8mL,,Per Svc,114.85
Chargemaster Item,,36099000,SPSI,Ziextenzo 6mG Inj,,Per Svc,23553.20
Chargemaster Item,,36100014,SPSI,Ipilimumab 1mg Inj,,Per Svc,532.70
Chargemaster Item,,36100022,SPSI,Bicalutamide 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36100030,SPSI,Etoposide 50Mg Oral,,Per Svc,1054.60
Chargemaster Item,,36100048,SPSI,Irinotecan 20mg Inj,,Per Svc,317.45
Chargemaster Item,,36100055,SPSI,Mitoxantrone 20mG,,Per Svc,4045.85
Chargemaster Item,,36100063,SPSI,Topotecan 4mG,,Per Svc,1719.90
Chargemaster Item,,36100071,SPSI,Docetaxel 1mg Inj,,Per Svc,291.35
Chargemaster Item,,36100089,SPSI,Abatacept 250mG,,Per Svc,5880.20
Chargemaster Item,,36100097,SPSI,Rituximab 100mg Inj,,Per Svc,3212.40
Chargemaster Item,,36100105,SPSI,Fludarabine 50Mg Inj,,Per Svc,2514.25
Chargemaster Item,,36100113,SPSI,Leuprolide Acetate 7.5Mg 1M,,Per Svc,9386.10
Chargemaster Item,,36100121,SPSI,Leuprolide Acet 3.75Mg 1M,,Per Svc,7802.20
Chargemaster Item,,36100139,SPSI,Cabazitaxel 60mG Inj,,Per Svc,65851.55
Chargemaster Item,,36100147,SPSI,Imatinab 100Mg Po,,Per Svc,1179.90
Chargemaster Item,,36100154,SPSI,Thyrotropin 0.9Mg Inj,,Per Svc,5982.00
Chargemaster Item,,36100162,SPSI,Oxaliplatin 50mG Inj,,Per Svc,682.50
Chargemaster Item,,36100170,SPSI,Erlotinib 150Mg Po,,Per Svc,3393.10
Chargemaster Item,,36100188,SPSI,Temozolomide 5Mg Po,,Per Svc,104.80
Chargemaster Item,,36100196,SPSI,Ramucirumab 100mG Inj,,Per Svc,6930.00
Chargemaster Item,,36100204,SPSI,Doxorubic Hcl 10mg Inj,,Per Svc,255.20
Chargemaster Item,,36100212,SPSI,Floxuridine 500Mg Inj,,Per Svc,1499.40
Chargemaster Item,,36100220,SPSI,Ixabepilone 1mg Inj,,Per Svc,336.80
Chargemaster Item,,36100238,SPSI,Paclitaxel Protein Bound 100mG,,Per Svc,8268.05
Chargemaster Item,,36100246,SPSI,Aldesleukin 22Mm Units,,Per Svc,23423.50
Chargemaster Item,,36100253,SPSI,Pegaspargase 3750 Iu 5Ml Inj,,Per Svc,3532.50
Chargemaster Item,,36100261,SPSI,Benamustine 1Mg Inj,,Per Svc,277.65
Chargemaster Item,,36100279,SPSI,Deferoxamine 2000mG,,Per Svc,932.40
Chargemaster Item,,36100287,SPSI,Eribulin 1Mg Inj,,Per Svc,7008.00
Chargemaster Item,,36100295,SPSI,Docetaxel 20mG Inj,,Per Svc,3139.65
Chargemaster Item,,36100303,SPSI,Melphalan 2Mg Oral,,Per Svc,142.60
Chargemaster Item,,36100311,SPSI,Idarubicin 10mG inj,,Per Svc,1337.90
Chargemaster Item,,36100329,SPSI,Cytarabine Lipo 50mG Inj,,Per Svc,17784.00
Chargemaster Item,,36100337,SPSI,Panitumumab 400mG,,Per Svc,29353.45
Chargemaster Item,,36100345,SPSI,Decitabine 50mG Inj,,Per Svc,5700.00
Chargemaster Item,,36100352,SPSI,Docetaxel 80mG Inj,,Per Svc,2610.00
Chargemaster Item,,36100360,SPSI,Doxorubicin Liposome 10Mg Inj,,Per Svc,1591.35
Chargemaster Item,,36100378,SPSI,Doxorubicin 10mG,,Per Svc,131.25
Chargemaster Item,,36100386,SPSI,Erlotinib 100Mg Po,,Per Svc,2999.85
Chargemaster Item,,36100394,SPSI,Cyclophosphamide 100Mg/10Ml,,Per Svc,927.15
Chargemaster Item,,36100402,SPSI,Bleomycin Sulf 15Units Inj,,Per Svc,720.70
Chargemaster Item,,36100410,SPSI,Pertuzumab 1mg Inj,,Per Svc,185.20
Chargemaster Item,,36100428,SPSI,Doxorubicin 50mG Inj,,Per Svc,305.05
Chargemaster Item,,36100436,SPSI,Cisplatin 10mg Inj,,Per Svc,279.70
Chargemaster Item,,36100444,SPSI,Doxorubiicn Liposome 20mG Inj,,Per Svc,5814.00
Chargemaster Item,,36100469,SPSI,Carboplatin 50mg Inj,,Per Svc,242.00
Chargemaster Item,,36100477,SPSI,Exemestane 25Mg Po,,Per Svc,462.65
Chargemaster Item,,36100485,SPSI,Doxorubicin Liposome 50mG Inj,,Per Svc,14535.50
Chargemaster Item,,36100493,SPSI,Erlotinib 100mg PO a,,Per Svc,798.36
Chargemaster Item,,36100501,SPSI,Fluorouracil 500mG Inj a,,Per Svc,48.95
Chargemaster Item,,36100519,SPSI,Arsenic Trioxide 10mG,,Per Svc,3598.35
Chargemaster Item,,36100527,SPSI,Bortezomib 3.5mG,,Per Svc,13465.20
Chargemaster Item,,36100535,SPSI,Cetuximab 10mg,,Per Svc,346.85
Chargemaster Item,,36100543,SPSI,Fluorouracil 1Gm Inj,,Per Svc,297.00
Chargemaster Item,,36100550,SPSI,Cyclophosphamide 1000mG Inj,,Per Svc,4413.30
Chargemaster Item,,36100568,SPSI,Fluorouracil 2.5Gm Inj,,Per Svc,742.50
Chargemaster Item,,36100576,SPSI,Fluorouracil 5Gm Inj,,Per Svc,419.60
Chargemaster Item,,36100584,SPSI,Gemcitabine 200mG Inj,,Per Svc,1695.35
Chargemaster Item,,36100592,SPSI,Cyclophosphamide 50mG PO,,Per Svc,180.40
Chargemaster Item,,36100600,SPSI,Gefitnib 250Mg Po,,Per Svc,131.05
Chargemaster Item,,36100618,SPSI,Dactinomycin 500mCg Inj,,Per Svc,11150.45
Chargemaster Item,,36100626,SPSI,Capecitabine 150Mg Po,,Per Svc,170.85
Chargemaster Item,,36100634,SPSI,Epirubicin 50mG Inj,,Per Svc,586.45
Chargemaster Item,,36100642,SPSI,Gemcitabine 1000mG Inj,,Per Svc,578.75
Chargemaster Item,,36100659,SPSI,Rasburicase 1.5mG,,Per Svc,5202.75
Chargemaster Item,,36100667,SPSI,Megestrol 625Mg Oral Susp,,Per Svc,386.95
Chargemaster Item,,36100675,SPSI,Gemcitabine 2000mG Inj,,Per Svc,2740.00
Chargemaster Item,,36100683,SPSI,Sunitinib 50Mg Po,,Per Svc,3674.95
Chargemaster Item,,36100691,SPSI,Temsirolimus 25mG,,Per Svc,10617.55
Chargemaster Item,,36100709,SPSI,Cytarabine 500mG Inj,,Per Svc,368.50
Chargemaster Item,,36100717,SPSI,Azacitidine 100mG,,Per Svc,5040.00
Chargemaster Item,,36100725,SPSI,Idarubicin 20mG Inj,,Per Svc,1251.80
Chargemaster Item,,36100733,SPSI,Bevacizumab 10mg Inj,,Per Svc,1004.15
Chargemaster Item,,36100741,SPSI,Ipilimumab 50mG,,Per Svc,44343.30
Chargemaster Item,,36100758,SPSI,Ipilimumab 200mG,,Per Svc,177372.80
Chargemaster Item,,36100766,SPSI,Irinotecan 40mG Inj,,Per Svc,634.90
Chargemaster Item,,36100774,SPSI,Vinorelbine 50mG,,Per Svc,1134.00
Chargemaster Item,,36100782,SPSI,Irinotecan 100mG,,Per Svc,787.50
Chargemaster Item,,36100790,SPSI,Ixabepilone 15mG Inj,,Per Svc,5052.00
Chargemaster Item,,36100808,SPSI,Dacarbazine 200mG,,Per Svc,215.35
Chargemaster Item,,36100816,SPSI,Ixabepilone 45mG Inj,,Per Svc,18942.05
Chargemaster Item,,36100824,SPSI,Rituximab 100mG,,Per Svc,5637.10
Chargemaster Item,,36100832,SPSI,Rituximab 500mG,,Per Svc,28185.60
Chargemaster Item,,36100840,SPSI,Temozolomide 100mG PO,,Per Svc,3360.95
Chargemaster Item,,36100857,SPSI,Tretinon 10Mg Po,,Per Svc,392.20
Chargemaster Item,,36100865,SPSI,Temozolomide 20mG PO,,Per Svc,495.90
Chargemaster Item,,36100873,SPSI,Estramustine 140Mg Po,,Per Svc,192.35
Chargemaster Item,,36100881,SPSI,Daunorubicin 20mG Inj,,Per Svc,1690.20
Chargemaster Item,,36100899,SPSI,Interferon Alfa -2B 10 Mill Units,,Per Svc,3023.90
Chargemaster Item,,36100907,SPSI,Fluorouracil 500mg Inj,,Per Svc,100.45
Chargemaster Item,,36100915,SPSI,Interferon Beta-1B 0.3mG,,Per Svc,2673.05
Chargemaster Item,,36100923,SPSI,Interferon Alfa-2A 9 Mill Units,,Per Svc,792.00
Chargemaster Item,,36100931,SPSI,Valrubicin 200mg Inj,,Per Svc,8696.90
Chargemaster Item,,36100949,SPSI,Interferon Gamma 1B 3Mil Units,,Per Svc,1297.00
Chargemaster Item,,36100956,SPSI,Denileukin 300Mcg Inj,,Per Svc,7632.95
Chargemaster Item,,36100964,SPSI,Gliadil 8 Wafers,,Per Svc,116138.00
Chargemaster Item,,36100972,SPSI,Asparaginase 10000 Units Inj,,Per Svc,357.25
Chargemaster Item,,36100980,SPSI,Gliadel 1 Wafer,,Per Svc,14517.25
Chargemaster Item,,36100998,SPSI,Procarbazine 50Mg Po,,Per Svc,614.90
Chargemaster Item,,36101004,SPSI,Gemtuzumab Ozagamicin 5Mg Inj,,Per Svc,13489.85
Chargemaster Item,,36101012,SPSI,Leuprolide Acetate 1Mg Inj,,Per Svc,239.05
Chargemaster Item,,36101020,SPSI,Hydroxyurea 500Mg Po,,Per Svc,11.05
Chargemaster Item,,36101038,SPSI,Azathioprine 50Mg Po,,Per Svc,24.70
Chargemaster Item,,36101046,SPSI,Cladribine 10mG Inj,,Per Svc,2610.00
Chargemaster Item,,36101053,SPSI,Chlorambucil 2Mg Po,,Per Svc,255.45
Chargemaster Item,,36101061,SPSI,Anastrozole 1Mg Po,,Per Svc,141.75
Chargemaster Item,,36101079,SPSI,Ifosfamide 1Gm Inj,,Per Svc,836.45
Chargemaster Item,,36101087,SPSI,Mesna 1000mG,,Per Svc,415.80
Chargemaster Item,,36101095,SPSI,Carfilzomib 60mG Inj,,Per Svc,9463.20
Chargemaster Item,,36101103,SPSI,Denosumab 60mG Inj,,Per Svc,7314.35
Chargemaster Item,,36101111,SPSI,Etoposide 100mG Inj,,Per Svc,118.00
Chargemaster Item,,36101129,SPSI,Megestrol 40Mg Po,,Per Svc,11.05
Chargemaster Item,,36101137,SPSI,Etoposide 500mG Inj,,Per Svc,3700.00
Chargemaster Item,,36101145,SPSI,Leuprolide Acet 45mG,,Per Svc,55786.20
Chargemaster Item,,36101152,SPSI,Leuprolide Acet 22mG,,Per Svc,27892.70
Chargemaster Item,,36101160,SPSI,Methotrexate 50mG,,Per Svc,55.45
Chargemaster Item,,36101178,SPSI,Methotrexate 1gm,,Per Svc,623.70
Chargemaster Item,,36101186,SPSI,Mitomycin 5 mG Inj,,Per Svc,3320.65
Chargemaster Item,,36101194,SPSI,Ganciclovir Sod 500Mg Inj,,Per Svc,1375.10
Chargemaster Item,,36101202,SPSI,Letrozole 2.5Mg Po,,Per Svc,190.35
Chargemaster Item,,36101210,SPSI,Mitomyin 20mG Inj,,Per Svc,4107.85
Chargemaster Item,,36101228,SPSI,Paclitaxel 30mG,,Per Svc,1080.00
Chargemaster Item,,36101236,SPSI,Paclitaxel 100mG,,Per Svc,420.00
Chargemaster Item,,36101244,SPSI,Paclitaxel 300mG,,Per Svc,620.80
Chargemaster Item,,36101251,SPSI,Mitomycin 5mg Iv,,Per Svc,928.10
Chargemaster Item,,36101277,SPSI,Tamoxifen 10Mg Po,,Per Svc,19.95
Chargemaster Item,,36101285,SPSI,Sterile Water 100mL,,Per Svc,51.45
Chargemaster Item,,36101293,SPSI,Methotrexate 2.5Mg Po,,Per Svc,61.45
Chargemaster Item,,36101301,SPSI,Methotrexate Sod 5Mg Inj,,Per Svc,120.35
Chargemaster Item,,36101319,SPSI,Methotrexate 50Mg Inj,,Per Svc,284.40
Chargemaster Item,,36101327,SPSI,Coag Factor Xa, recomb 100mG,,Per Svc,16500.00
Chargemaster Item,,36101335,SPSI,Pemetrexed 500 mG,,Per Svc,21228.00
Chargemaster Item,,36101350,SPSI,Vincristine 2mG,,Per Svc,379.25
Chargemaster Item,,36101384,SPSI,Capecitabine 500Mg Po,,Per Svc,283.40
Chargemaster Item,,36101442,SPSI,Mercaptopurine 50Mg Po,,Per Svc,85.90
Chargemaster Item,,36101459,SPSI,Fulvestrant 250mG Inj,,Per Svc,5817.15
Chargemaster Item,,36101467,SPSI,Carfilzomib 30mG Inj,,Per Svc,9035.00
Chargemaster Item,,36101475,SPSI,Pegfilgrastim 6mG,,Per Svc,37386.35
Chargemaster Item,,36101483,SPSI,Nivolumab 40mG,,Per Svc,6293.00
Chargemaster Item,,36101491,SPSI,Pertuzumab 420mG,,Per Svc,30827.20
Chargemaster Item,,36101509,SPSI,Denosumab 120mG Inj,,Per Svc,13702.45
Chargemaster Item,,36101517,SPSI,Paclitaxol 1mG,,Per Svc,584.20
Chargemaster Item,,36101525,SPSI,Cytarabine 100mG,,Per Svc,59.85
Chargemaster Item,,36101533,SPSI,Cytarabine 1000mg,,Per Svc,252.00
Chargemaster Item,,36101541,SPSI,Cytarabine 2Gm,,Per Svc,231.65
Chargemaster Item,,36101558,SPSI,Obinutuzumab 1000mG,,Per Svc,39306.00
Chargemaster Item,,36101608,SPSI,Thiotepa 15Mg Iv,,Per Svc,3570.00
Chargemaster Item,,36101707,SPSI,Etoposide 10Mg Inj,,Per Svc,80.20
Chargemaster Item,,36101715,SPSI,Bendamustine 25mG,,Per Svc,3337.60
Chargemaster Item,,36101723,SPSI,Bendamustine 100mG,,Per Svc,17830.80
Chargemaster Item,,36101731,SPSI,Bevacizumab 100mG,,Per Svc,4781.65
Chargemaster Item,,36101749,SPSI,Bevacizumab 400mG,,Per Svc,19126.55
Chargemaster Item,,36101756,SPSI,Bleomycin Sulf 30 units,,Per Svc,592.60
Chargemaster Item,,36101764,SPSI,Bortezomib 2.5mG,,Per Svc,5750.00
Chargemaster Item,,36101772,SPSI,Carboplatin 150mG,,Per Svc,264.60
Chargemaster Item,,36101780,SPSI,Carboplatin 450mG,,Per Svc,2170.35
Chargemaster Item,,36101798,SPSI,Carboplatin 600mG,,Per Svc,1246.90
Chargemaster Item,,36101806,SPSI,Cetuximab 100mG,,Per Svc,3825.00
Chargemaster Item,,36101814,SPSI,Cetuximab 200mG Inj,,Per Svc,7650.00
Chargemaster Item,,36101822,SPSI,Cisplatin 100mG Inj,,Per Svc,507.80
Chargemaster Item,,36101830,SPSI,Cisplatin 50mG Inj,,Per Svc,544.50
Chargemaster Item,,36101848,SPSI,Cyclophosphamide 500mG,,Per Svc,4614.75
Chargemaster Item,,36101855,SPSI,Cyclophosphamide 2000mG,,Per Svc,8790.00
Chargemaster Item,,36101905,SPSI,Gemcitabine Hcl 200mg Inj,,Per Svc,283.05
Chargemaster Item,,36105229,SPSI,Cidofovir 375Mg,,Per Svc,4440.00
Chargemaster Item,,36105575,SPSI,Amifostine 500Mg Inj,,Per Svc,2824.75
Chargemaster Item,,36105666,SPSI,Vinblastine Sulf 1Mg Inj,,Per Svc,542.65
Chargemaster Item,,36105708,SPSI,Trastuzumab 440mG,,Per Svc,27428.20
Chargemaster Item,,36106003,SPSI,Phenol EZ Swab,,Per Svc,73.70
Chargemaster Item,,36107001,SPSI,Lapatinib Ditosylate 250mG Po,,Per Svc,271.80
Chargemaster Item,,36109122,SPSI,Coagulation Factor VIIa 1000mCg Inj,,Per Svc,13.45
Chargemaster Item,,36111128,SPSI,Loperamide 2mG/15mL Liq,,Per Svc,25.50
Chargemaster Item,,36112126,SPSI,Non-Formulary Drug,,Per Svc,0.01
Chargemaster Item,,36120210,SPSI,Pyridostigmine 60Mg Po,,Per Svc,13.45
Chargemaster Item,,36120228,SPSI,Pyridostigmine 10Mg Inj,,Per Svc,403.20
Chargemaster Item,,36120236,SPSI,Ipratropium 0.06% 15Ml,,Per Svc,145.00
Chargemaster Item,,36120269,SPSI,Pyridostigmine 180Mg Po,,Per Svc,364.90
Chargemaster Item,,36120277,SPSI,Pilocarpine 5Mg Po,,Per Svc,17.00
Chargemaster Item,,36120301,SPSI,Neostigmine 10mG Inj,,Per Svc,210.30
Chargemaster Item,,36120319,SPSI,Neostigmine 0.5Mg Inj,,Per Svc,873.10
Chargemaster Item,,36120327,SPSI,Rocuronium 50mg Inj,,Per Svc,266.90
Chargemaster Item,,36120335,SPSI,Physostigmine 2Mg Inj,,Per Svc,986.35
Chargemaster Item,,36120343,SPSI,Edrophonium 150Mg Inj,,Per Svc,1008.00
Chargemaster Item,,36120368,SPSI,Bethanechol 1Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36120392,SPSI,Enlon Plus,,Per Svc,183.40
Chargemaster Item,,36120400,SPSI,Bethanechol 10Mg Po,,Per Svc,28.55
Chargemaster Item,,36120459,SPSI,Bethanechol 25Mg Po,,Per Svc,18.70
Chargemaster Item,,36120509,SPSI,Donepezil 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36120806,SPSI,Rivastigmine 3Mg Po,,Per Svc,47.00
Chargemaster Item,,36120848,SPSI,Rivastigmine 1.5Mg Po,,Per Svc,65.65
Chargemaster Item,,36120855,SPSI,Atropine 1Mg Inh,,Per Svc,57.50
Chargemaster Item,,36120863,SPSI,Tiotropium 18Mcg Inhaler,,Per Svc,1071.75
Chargemaster Item,,36120871,SPSI,Tiotropium 2 Puffs Inhalation,,Per Svc,50.60
Chargemaster Item,,36120889,SPSI,Rivastigmine 9.5Mg/24Hr Patch,,Per Svc,177.45
Chargemaster Item,,36120897,SPSI,Rivastigmine 4.6Mg/24Hr Patch,,Per Svc,288.00
Chargemaster Item,,36121002,SPSI,Phenylephrine 1000mCg / 10mL,,Per Svc,10.00
Chargemaster Item,,36121093,SPSI,Racepinephrine 2.25% 0.5Ml Nebulize,,Per Svc,56.70
Chargemaster Item,,36121127,SPSI,Formoterol 0.012Mg Po,,Per Svc,63.00
Chargemaster Item,,36121150,SPSI,Salmeterol 50Mcg Inhalr,,Per Svc,2884.15
Chargemaster Item,,36121192,SPSI,Cafergot 100Mg/1Mg Po,,Per Svc,14.90
Chargemaster Item,,36121226,SPSI,Phenylephrine 100 MCG/ML 1ML,,Per Svc,114.60
Chargemaster Item,,36121309,SPSI,Ephedrine 5MG/ML 10ML,,Per Svc,127.25
Chargemaster Item,,36121440,SPSI,Dicyclomine 20Mg Inj,,Per Svc,1059.15
Chargemaster Item,,36121457,SPSI,Dicyclomine 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36121515,SPSI,Albuterol 0.5% Inhal 0.5Ml,,Per Svc,10.00
Chargemaster Item,,36121523,SPSI,Albuterol 0.5% 20Ml Sol,,Per Svc,131.80
Chargemaster Item,,36121606,SPSI,Levalbuterol Inhaler 15Gm,,Per Svc,319.00
Chargemaster Item,,36121663,SPSI,Benztropine 2mG,,Per Svc,787.50
Chargemaster Item,,36121671,SPSI,Benztropine 1Mg Po,,Per Svc,10.00
Chargemaster Item,,36121689,SPSI,Benztropine 0.5Mg Po,,Per Svc,10.00
Chargemaster Item,,36121754,SPSI,Donnatal Tab,,Per Svc,103.85
Chargemaster Item,,36121853,SPSI,Phenoxybenzamine 10Mg Po,,Per Svc,3023.80
Chargemaster Item,,36121895,SPSI,Baclofen 10Mg Inj,,Per Svc,673.20
Chargemaster Item,,36121903,SPSI,Donnatol 5Ml Oral Elixir,,Per Svc,126.10
Chargemaster Item,,36121929,SPSI,Hyoscyamine 0.375Mg Po,,Per Svc,14.90
Chargemaster Item,,36121945,SPSI,HYOSCYAMINE 0.125MG ORAL LIQ,,Per Svc,209.25
Chargemaster Item,,36121959,SPSI,Heparin 0.45%NS 10Un Inj,,Per Svc,10.00
Chargemaster Item,,36121986,SPSI,Hyoscyamine 0.125Mg Po,,Per Svc,10.00
Chargemaster Item,,36121994,SPSI,Lioresal 10 Mg,,Per Svc,10.00
Chargemaster Item,,36122000,SPSI,Glycopyrrolate 0.2mG Inh,,Per Svc,88.20
Chargemaster Item,,36122018,SPSI,Glycopyrrolate 0.4mG,,Per Svc,83.15
Chargemaster Item,,36122026,SPSI,Botulinum Toxin Type B 100 Units Inj,,Per Svc,813.00
Chargemaster Item,,36122042,SPSI,Midodrine 2.5Mg Po,,Per Svc,15.00
Chargemaster Item,,36122059,SPSI,Midodrine 5Mg Po,,Per Svc,21.55
Chargemaster Item,,36122075,SPSI,Lioresal 10000mCg IT,,Per Svc,2908.50
Chargemaster Item,,36122083,SPSI,Metoclopramide 10mg Po,,Per Svc,35.90
Chargemaster Item,,36122091,SPSI,Metoclopramide 10mg Inj,,Per Svc,14.60
Chargemaster Item,,36122109,SPSI,Propantheline 15Mg Po,,Per Svc,31.50
Chargemaster Item,,36122125,SPSI,Carisoprolol 350Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36122141,SPSI,Glycopyrolate 1Mg Inj,,Per Svc,378.00
Chargemaster Item,,36122166,SPSI,Glycopyrolate 0.2Mg Inj,,Per Svc,344.50
Chargemaster Item,,36122208,SPSI,Scopolamine 0.4Mg Inj,,Per Svc,298.00
Chargemaster Item,,36122224,SPSI,Glycopyrolate 200Mcg Liq,,Per Svc,88.20
Chargemaster Item,,36122232,SPSI,Paregoric 2Mg Oral Liq,,Per Svc,67.35
Chargemaster Item,,36122240,SPSI,Metoclopramide 10Mg Oral Liq,,Per Svc,23.40
Chargemaster Item,,36122257,SPSI,Trihexyphenidyl 2Mg Po,,Per Svc,10.00
Chargemaster Item,,36122265,SPSI,Metoclopramide 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36122299,SPSI,Metaxalone 800Mg Po,,Per Svc,43.35
Chargemaster Item,,36122315,SPSI,Galantamine 4Mg Po,,Per Svc,26.80
Chargemaster Item,,36122323,SPSI,Galantamine 8Mg Po,,Per Svc,33.40
Chargemaster Item,,36122364,SPSI,Tizanidine 4Mg Po,,Per Svc,26.80
Chargemaster Item,,36122372,SPSI,Baclofen 5Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36122406,SPSI,Cisatracurium 20Mg Inj,,Per Svc,346.60
Chargemaster Item,,36123008,SPSI,Dobutamine 250mG inj a,,Per Svc,103.85
Chargemaster Item,,36123016,SPSI,Dobutamine 500mG /250mL,,Per Svc,439.65
Chargemaster Item,,36123024,SPSI,Dopamine 400mG Inj,,Per Svc,23.75
Chargemaster Item,,36123032,SPSI,Dopamine 400mG / 250mL,,Per Svc,153.50
Chargemaster Item,,36123040,SPSI,Alupent Inhal,,Per Svc,76.60
Chargemaster Item,,36123057,SPSI,Ipratropium 0.06% Nsl Spr 15ml,,Per Svc,1004.95
Chargemaster Item,,36123065,SPSI,Epinephrine 1mG / 1mL Inj,,Per Svc,183.75
Chargemaster Item,,36123073,SPSI,Ipratropium 0.03% NSL Spray 30ML,,Per Svc,2680.10
Chargemaster Item,,36123081,SPSI,Epinephrine 30mG /30mL,,Per Svc,276.45
Chargemaster Item,,36123099,SPSI,Milrinone 20mG /100mL,,Per Svc,191.50
Chargemaster Item,,36123107,SPSI,Milrinone 10mG 10mL,,Per Svc,10.00
Chargemaster Item,,36123115,SPSI,Albuterol 1mg 0.2ml Inh Sol,,Per Svc,10.00
Chargemaster Item,,36123123,SPSI,Phenylephrine 10mG / 1mL,,Per Svc,146.05
Chargemaster Item,,36123131,SPSI,Phenylephrine 50mG / 5mL,,Per Svc,157.50
Chargemaster Item,,36123156,SPSI,Fluticasone/Salmeterol 250/50,,Per Svc,136.60
Chargemaster Item,,36123164,SPSI,Fluticasone/Salmeterol 500/50,,Per Svc,222.60
Chargemaster Item,,36123172,SPSI,Fluticasone/Salmeterol 100/50,,Per Svc,136.60
Chargemaster Item,,36123198,SPSI,Neonatal TPN,,Per Svc,619.50
Chargemaster Item,,36123271,SPSI,Dobutamine 250Mg Inj,,Per Svc,349.45
Chargemaster Item,,36123370,SPSI,Ephedrine Sulfate 25Mg Po,,Per Svc,65.90
Chargemaster Item,,36123396,SPSI,Milrinone 5Mg Inj,,Per Svc,156.05
Chargemaster Item,,36123404,SPSI,Ephedrine 50Mg Inj,,Per Svc,595.90
Chargemaster Item,,36123438,SPSI,Milrinone 5Mg 100Ml,,Per Svc,65.60
Chargemaster Item,,36123453,SPSI,Epinephrin 0.1mg Inj,,Per Svc,78.30
Chargemaster Item,,36123495,SPSI,Dopamine 40Mg Inj,,Per Svc,26.75
Chargemaster Item,,36123685,SPSI,Xopenex 2 Inhal Puffs,,Per Svc,87.85
Chargemaster Item,,36123693,SPSI,Budesonide/Formoterol 2 Puffs Inhale,,Per Svc,79.15
Chargemaster Item,,36123701,SPSI,Isoproterenol 1Mg Inj,,Per Svc,4800.00
Chargemaster Item,,36123719,SPSI,Ipratropium 0.02% 2.5ml,,Per Svc,10.00
Chargemaster Item,,36123727,SPSI,Ipratropium Inhaler 12.9Gm,,Per Svc,1173.60
Chargemaster Item,,36123735,SPSI,Proventil Syrup 2Mg/5Ml 1 Dose,,Per Svc,123.90
Chargemaster Item,,36123750,SPSI,Levophed 1Mg/1Ml 4Ml,,Per Svc,254.95
Chargemaster Item,,36123768,SPSI,Albuterol 0.083% 3Ml,,Per Svc,11.05
Chargemaster Item,,36123776,SPSI,Phenylephrine 10Mg Inj,,Per Svc,126.50
Chargemaster Item,,36123792,SPSI,Albuterol 8Gm Inhaler,,Per Svc,591.10
Chargemaster Item,,36123800,SPSI,Pseudoephedrine 30Mg Po,,Per Svc,11.85
Chargemaster Item,,36123818,SPSI,Albuterol 2Mg Po,,Per Svc,78.45
Chargemaster Item,,36123826,SPSI,Albuterol 4Mg Po,,Per Svc,20.90
Chargemaster Item,,36123834,SPSI,Albuterol Inhalation 2 Puffs,,Per Svc,10.00
Chargemaster Item,,36123842,SPSI,Ipratropium Inhal 2 Puffs,,Per Svc,13.60
Chargemaster Item,,36123859,SPSI,Sudafed 60Mg (See 36123800),,Per Svc,17.95
Chargemaster Item,,36123875,SPSI,SYMBICORT 80/4.5MG,,Per Svc,2286.25
Chargemaster Item,,36123883,SPSI,Symbicort 160/4.5Mg,,Per Svc,2630.00
Chargemaster Item,,36123891,SPSI,IV Norepinephrine16 MG/250ML,,Per Svc,287.75
Chargemaster Item,,36123917,SPSI,IV Norepinephrine 4MG/250ML,,Per Svc,345.60
Chargemaster Item,,36123933,SPSI,IV Norepinephrine 8MG/250ML,,Per Svc,118.35
Chargemaster Item,,36123982,SPSI,Terbutaline 1Mg Inh,,Per Svc,39.40
Chargemaster Item,,36124006,SPSI,Terbutaline 2.5Mg Po,,Per Svc,21.20
Chargemaster Item,,36124105,SPSI,Levalbuterol 0.63Mg 3Ml,,Per Svc,70.45
Chargemaster Item,,36124113,SPSI,Levalbuterol 1.25mG/0.5mL Inh Soln,,Per Svc,119.56
Chargemaster Item,,36124121,SPSI,Levalbuterol 0.5Mg Inh Sol,,Per Svc,141.30
Chargemaster Item,,36124139,SPSI,Levalbuterol 0.5mg Neb,,Per Svc,87.85
Chargemaster Item,,36124162,SPSI,Terbutaline 1Mg Inj,,Per Svc,50.40
Chargemaster Item,,36125300,SPSI,Dihydroergotamine 1Mg Inj,,Per Svc,1655.00
Chargemaster Item,,36125375,SPSI,Acet/Dichloralphen/Isometh Po,,Per Svc,26.70
Chargemaster Item,,36125417,SPSI,Clotrimazole 1% Vaginal Crm 45Gm,,Per Svc,100.80
Chargemaster Item,,36126001,SPSI,Atracurium 100mG 10mL,,Per Svc,158.75
Chargemaster Item,,36126019,SPSI,Atracurium 50mG 5mL,,Per Svc,79.40
Chargemaster Item,,36126027,SPSI,Dantrolene 20Mg Inj,,Per Svc,375.00
Chargemaster Item,,36126035,SPSI,Dantrium 25Mg Po,,Per Svc,20.90
Chargemaster Item,,36126175,SPSI,Cyclobenzaprine 10Mg Po,,Per Svc,10.20
Chargemaster Item,,36126258,SPSI,Pavulon 1Mg/Ml 10Ml Vial,,Per Svc,59.75
Chargemaster Item,,36126290,SPSI,Flumazenil 0.5Mg Inj,,Per Svc,85.70
Chargemaster Item,,36126308,SPSI,Methocarbamol 500Mg Po,,Per Svc,10.10
Chargemaster Item,,36126357,SPSI,Methocarbamol 750Mg Po,,Per Svc,10.00
Chargemaster Item,,36126365,SPSI,Methocarbamol 1Gm Inj,,Per Svc,352.80
Chargemaster Item,,36126423,SPSI,Glycopyrolate 1Mg Po,,Per Svc,13.75
Chargemaster Item,,36126506,SPSI,Carisoprodol 3250Mg Po,,Per Svc,12.50
Chargemaster Item,,36126605,SPSI,Succinylcholine 200mG,,Per Svc,251.80
Chargemaster Item,,36126662,SPSI,Mivcron 2Mg/Ml 5Ml,,Per Svc,289.70
Chargemaster Item,,36126720,SPSI,Atracurium 100Mg Inj,,Per Svc,381.05
Chargemaster Item,,36126746,SPSI,Vecuronium 10Mg,,Per Svc,91.15
Chargemaster Item,,36126803,SPSI,Neostigmine 15Mg Po,,Per Svc,36.20
Chargemaster Item,,36128064,SPSI,Hydrocod/Apap 10-325Mg Po,,Per Svc,16.50
Chargemaster Item,,36128072,SPSI,Varenicline 0.5Mg Po,,Per Svc,26.45
Chargemaster Item,,36129005,SPSI,Darbepoetin Alfa 300mCg Inj,,Per Svc,13932.00
Chargemaster Item,,36133122,SPSI,Methyl Salicylate/Menthol 85Gm,,Per Svc,23.65
Chargemaster Item,,36135002,SPSI,Enhertu 1mG Inj,,Per Svc,13775.80
Chargemaster Item,,36136802,SPSI,Sirolimus 2Mg Oral Liq,,Per Svc,736.80
Chargemaster Item,,36136810,SPSI,Hyaluronate 20Mg/2Ml,,Per Svc,9789.85
Chargemaster Item,,36136828,SPSI,Heparin 100U 1mL Inj,,Per Svc,35.40
Chargemaster Item,,36138006,SPSI,Heparin 1000U Inj,,Per Svc,92.35
Chargemaster Item,,36145001,SPSI,Lomustine 5mG Po,,Per Svc,146.40
Chargemaster Item,,36145019,SPSI,Chlorothiazide 5mG/mL Inj 1mL,,Per Svc,13.15
Chargemaster Item,,36146009,SPSI,Dabrafenib Mesylate 50mG Po,,Per Svc,333.90
Chargemaster Item,,36150118,SPSI,0.9% Sod Chl 150mL,,Per Svc,20.05
Chargemaster Item,,36150126,SPSI,Start TPN AA3.5/Dex10/Cal 150,,Per Svc,114.94
Chargemaster Item,,36152007,SPSI,Venetoclax 10mG Po,,Per Svc,137.60
Chargemaster Item,,36154003,SPSI,Symbicort 80/4.5mCg Inh 2puffs,,Per Svc,185.50
Chargemaster Item,,36155000,SPSI,Mechlorethamine Hcl 10mG,,Per Svc,1126.20
Chargemaster Item,,36156008,SPSI,Dextrose 5% M-Bag 100mL,,Per Svc,83.58
Chargemaster Item,,36159127,SPSI,5% Dextrose Inj 25mL,,Per Svc,28.75
Chargemaster Item,,36160000,SPSI,Albumin 25% 12.5Gm 50mL,,Per Svc,1043.30
Chargemaster Item,,36160018,SPSI,Albumin 25% 25 Gm 100mL,,Per Svc,2086.55
Chargemaster Item,,36160026,SPSI,Albumin 5% 12.5Gm 250mL,,Per Svc,1181.25
Chargemaster Item,,36160034,SPSI,Albumn 5% 25Gm 500mL,,Per Svc,2086.55
Chargemaster Item,,36160042,SPSI,Sorafenib Tosylate 200mG Po,,Per Svc,663.20
Chargemaster Item,,36160059,SPSI,Albumin 25% 50Ml Infusion,,Per Svc,697.35
Chargemaster Item,,36160125,SPSI,Albumin 5% 50Ml Infusion,,Per Svc,10.00
Chargemaster Item,,36160133,SPSI,5% Dextrose 25mL Syringe,,Per Svc,61.70
Chargemaster Item,,36160141,SPSI,Albumin 5% 250Ml Infusion,,Per Svc,648.35
Chargemaster Item,,36162006,SPSI,Amino Acid4.25%/Dext10% 2000mL,,Per Svc,830.35
Chargemaster Item,,36162121,SPSI,Vancomycin 1Gm/200mL,,Per Svc,269.65
Chargemaster Item,,36168128,SPSI,Clonidine 1000mCg/10mL inj,,Per Svc,529.20
Chargemaster Item,,36170009,SPSI,Nelarabine 250mG Inj,,Per Svc,2748.00
Chargemaster Item,,36176014,SPSI,Amino Acids 5%/Dext 20% 1000ml,,Per Svc,493.70
Chargemaster Item,,36176022,SPSI,Gentamicin NS 2mG mL 1mL,,Per Svc,10.00
Chargemaster Item,,36177012,SPSI,Ampho B Lipo 1mG/mL Inj,,Per Svc,62.25
Chargemaster Item,,36178002,SPSI,Venetoclax 50mG Po,,Per Svc,260.70
Chargemaster Item,,36179000,SPSI,Silver Sulfadiazine 1% 400Gm,,Per Svc,1625.20
Chargemaster Item,,36180016,SPSI,Iv Kcl 20Meq/Water 100Ml,,Per Svc,57.25
Chargemaster Item,,36180057,SPSI,Iv Cardizem 125Mg/D5W 125Ml,,Per Svc,342.15
Chargemaster Item,,36180065,SPSI,Iv Kcl 40Meq/Water 100Ml,,Per Svc,84.30
Chargemaster Item,,36180073,SPSI,Iv Zithro 500Mg/D5W 250Ml,,Per Svc,338.25
Chargemaster Item,,36180099,SPSI,Iv Synercid 500Mg/D5W 100Ml,,Per Svc,498.60
Chargemaster Item,,36180107,SPSI,Iv 5% Dex/Ns & Kcl 40Meq 1L,,Per Svc,356.40
Chargemaster Item,,36180123,SPSI,Iv 5% Dex/Ns & Kcl 20Meq 1L,,Per Svc,355.45
Chargemaster Item,,36180206,SPSI,Iv 5% Dex/.45Ns & Kcl 20Meq 1L,,Per Svc,126.55
Chargemaster Item,,36180214,SPSI,Iv 5% Dex/.45Ns & Kcl 30Meq 1L,,Per Svc,355.45
Chargemaster Item,,36180222,SPSI,Iv 5% Dex/.45Ns & Kcl 40Meq 1L,,Per Svc,355.45
Chargemaster Item,,36180321,SPSI,Iv 5% Dex/Water & Kcl 40Meq 1L,,Per Svc,355.45
Chargemaster Item,,36180404,SPSI,Acetic Acid 1000Ml Irrig,,Per Svc,28.70
Chargemaster Item,,36180503,SPSI,Iv 5% Dex/Water & Nitro 50Mg,,Per Svc,367.70
Chargemaster Item,,36180511,SPSI,Iv 5% Dex/Water & Nitro 100Mg,,Per Svc,366.15
Chargemaster Item,,36180552,SPSI,Steril Water 500Ml Irrig,,Per Svc,59.15
Chargemaster Item,,36180602,SPSI,Sterile Water 1000Ml Irrig,,Per Svc,32.35
Chargemaster Item,,36180701,SPSI,Normal Saline 250Ml Irrig,,Per Svc,41.70
Chargemaster Item,,36180750,SPSI,Normal Saline 500Ml Irrig,,Per Svc,30.25
Chargemaster Item,,36180800,SPSI,Normal Saline 1000Ml Irrig,,Per Svc,160.25
Chargemaster Item,,36180818,SPSI,Normal Saline 3000Ml Irrig,,Per Svc,133.65
Chargemaster Item,,36181105,SPSI,Iv Dext 70% 500Ml,,Per Svc,412.50
Chargemaster Item,,36181154,SPSI,Hyskon 100Ml,,Per Svc,325.65
Chargemaster Item,,36181303,SPSI,Iv Dextran 40%/Dext 5% 500Ml,,Per Svc,334.20
Chargemaster Item,,36181394,SPSI,Iv 5% Dext /Ns,,Per Svc,220.80
Chargemaster Item,,36181402,SPSI,5% Dext / NS 1000mL,,Per Svc,55.55
Chargemaster Item,,36181410,SPSI,IV 5% Dext / NS 500mL,,Per Svc,51.05
Chargemaster Item,,36181436,SPSI,Iv D5/0.2% Nacl 250Cc,,Per Svc,104.15
Chargemaster Item,,36181444,SPSI,Iv 5% Dex/O.2Ns 500Ml,,Per Svc,178.85
Chargemaster Item,,36181451,SPSI,Iv 5% Dext .2%,,Per Svc,67.10
Chargemaster Item,,36181550,SPSI,Iv 5% Dext/.45% Nacl 1L,,Per Svc,58.40
Chargemaster Item,,36181568,SPSI,Iv 5% Dext/0.45% Nacl 250Ml,,Per Svc,104.25
Chargemaster Item,,36181576,SPSI,Iv 5% Dext/0.45% Nacl 500Ml,,Per Svc,50.95
Chargemaster Item,,36181790,SPSI,Iv 5% Dext/Lr 500Ml,,Per Svc,67.40
Chargemaster Item,,36181808,SPSI,Iv 5% Dext/Lr Il,,Per Svc,61.55
Chargemaster Item,,36181881,SPSI,Isotonic Solutionn 1000Ml,,Per Svc,212.55
Chargemaster Item,,36181956,SPSI,Iv 5% Dext/ 50,,Per Svc,62.60
Chargemaster Item,,36182004,SPSI,Iv 5% Dext/250,,Per Svc,26.80
Chargemaster Item,,36182038,SPSI,Ivpb Diluent,,Per Svc,142.10
Chargemaster Item,,36182046,SPSI,Isotonic Solution 100Ml,,Per Svc,184.35
Chargemaster Item,,36182053,SPSI,Iv 5% Dext/100,,Per Svc,27.30
Chargemaster Item,,36182103,SPSI,Iv 5% Dext/500,,Per Svc,27.50
Chargemaster Item,,36182152,SPSI,Iv 5% Dext/Water 1000Ml,,Per Svc,54.80
Chargemaster Item,,36182178,SPSI,Iv 10% Dext 250,,Per Svc,56.20
Chargemaster Item,,36182186,SPSI,Iv 10% Dext 500,,Per Svc,63.40
Chargemaster Item,,36182194,SPSI,Iv 10% Dext/.45% Ns 1000Ml,,Per Svc,212.55
Chargemaster Item,,36182202,SPSI,Iv 10% Dext/L,,Per Svc,66.15
Chargemaster Item,,36182301,SPSI,Iv 20% Dex 500,,Per Svc,146.70
Chargemaster Item,,36182319,SPSI,Iv 50% Dext/Water 500Ml,,Per Svc,155.60
Chargemaster Item,,36182962,SPSI,Iv Plasmalyte A 1000Ml,,Per Svc,10.00
Chargemaster Item,,36182970,SPSI,Iv Tham 500Ml,,Per Svc,851.00
Chargemaster Item,,36182988,SPSI,Iv Plasmalyte A 500Ml,,Per Svc,10.00
Chargemaster Item,,36183002,SPSI,Iv Elc 48 250,,Per Svc,212.55
Chargemaster Item,,36183010,SPSI,Magnesium Sulf 1000mG,,Per Svc,14.70
Chargemaster Item,,36183028,SPSI,Magnesium Sulf 10,000mG,,Per Svc,47.80
Chargemaster Item,,36183036,SPSI,Magnesium Sulf 5000mG,,Per Svc,950.75
Chargemaster Item,,36183044,SPSI,Iv 10% Dext/0.2Ns 250Ml,,Per Svc,178.85
Chargemaster Item,,36183051,SPSI,Iv Elc 48 500,,Per Svc,10.00
Chargemaster Item,,36183119,SPSI,Iv Lact Ringer,,Per Svc,55.75
Chargemaster Item,,36183309,SPSI,Mannitol 20% 500Ml Iv,,Per Svc,219.75
Chargemaster Item,,36183457,SPSI,Iv Ns 100,,Per Svc,26.15
Chargemaster Item,,36183507,SPSI,Iv Ns 250,,Per Svc,42.40
Chargemaster Item,,36183556,SPSI,Iv Ns 500,,Per Svc,45.90
Chargemaster Item,,36183606,SPSI,Iv Ns 1L,,Per Svc,53.25
Chargemaster Item,,36183614,SPSI,Iv Nacl Slush 1000Ml,,Per Svc,212.80
Chargemaster Item,,36183663,SPSI,Heparin 1000 units / 500mL,,Per Svc,45.15
Chargemaster Item,,36183689,SPSI,Iv Lidocaine 2Gm/D5W 500Ml,,Per Svc,77.90
Chargemaster Item,,36183697,SPSI,Iv Dopamine 400Mg/D5W 250Ml,,Per Svc,357.40
Chargemaster Item,,36183713,SPSI,Iv Fentanyl 1000Mcg/100Ml,,Per Svc,475.75
Chargemaster Item,,36183721,SPSI,Iv Fentanyl 2500Mcg/500Ml,,Per Svc,710.30
Chargemaster Item,,36183739,SPSI,Iv Dobutrex 500Mg/D5W 25Oml,,Per Svc,267.85
Chargemaster Item,,36183747,SPSI,Iv Dobutrex 1Gm/D5W 250Ml,,Per Svc,509.35
Chargemaster Item,,36183754,SPSI,IV 5% Sod Chl,,Per Svc,76.15
Chargemaster Item,,36183762,SPSI,Iv 3% Sod Chl,,Per Svc,72.75
Chargemaster Item,,36183770,SPSI,Iv Solution 1000Cc,,Per Svc,212.10
Chargemaster Item,,36183788,SPSI,Iv Solution 500Cc,,Per Svc,180.90
Chargemaster Item,,36183796,SPSI,Iv Solution 250Cc,,Per Svc,175.55
Chargemaster Item,,36183804,SPSI,Iv .45% Nacl 1000Ml,,Per Svc,64.60
Chargemaster Item,,36183812,SPSI,Cardioplegia Sol 1000Ml,,Per Svc,160.45
Chargemaster Item,,36183820,SPSI,Iv 0.45% Sod. Chloride 500Ml,,Per Svc,50.95
Chargemaster Item,,36183838,SPSI,Iv Mag Sulf 2Gm/100Ml,,Per Svc,165.60
Chargemaster Item,,36183846,SPSI,Iv Mag Sulfate 40Gm/Isot Sol L,,Per Svc,325.65
Chargemaster Item,,36183861,SPSI,Magnesium Sulf 500Mg Inj,,Per Svc,97.40
Chargemaster Item,,36183903,SPSI,Iv Hespan 500Ml,,Per Svc,215.25
Chargemaster Item,,36184059,SPSI,Hydrogen Peroxide 3% 30ml,,Per Svc,10.00
Chargemaster Item,,36184075,SPSI,Amino Acid 10% Adult,,Per Svc,627.05
Chargemaster Item,,36184158,SPSI,Starter Tpn NICU,,Per Svc,1150.00
Chargemaster Item,,36185007,SPSI,Std Tpn (See 36185023),,Per Svc,325.65
Chargemaster Item,,36185023,SPSI,Amino Acid 10% Pediatric,,Per Svc,342.30
Chargemaster Item,,36185106,SPSI,Fat Emulsion 10% 500Ml,,Per Svc,606.50
Chargemaster Item,,36185114,SPSI,Fat Emulsion 20% 500Ml,,Per Svc,477.45
Chargemaster Item,,36185171,SPSI,Fat Emulsion 20% 100Ml,,Per Svc,353.10
Chargemaster Item,,36185197,SPSI,Heparin 25,000 Units/D5W 250Ml,,Per Svc,205.75
Chargemaster Item,,36185221,SPSI,Fat Emulsion 20% 250Ml,,Per Svc,436.60
Chargemaster Item,,36185312,SPSI,Iv Cordarone 150Mg/50Ml,,Per Svc,540.60
Chargemaster Item,,36185320,SPSI,Iv Cordarone 450Mg/250Ml,,Per Svc,1132.45
Chargemaster Item,,36185403,SPSI,Iv Corlopam 10Mg/250Ml,,Per Svc,990.45
Chargemaster Item,,36186005,SPSI,Iv Ancep 1Gm Ivpb,,Per Svc,291.00
Chargemaster Item,,36186054,SPSI,Iv Ancef 2Gm Ivpb,,Per Svc,292.60
Chargemaster Item,,36186062,SPSI,Iv Ativan 100Mg/1Ooml,,Per Svc,1694.25
Chargemaster Item,,36186070,SPSI,Iv Anticog/Citrate 500Ml,,Per Svc,54.55
Chargemaster Item,,36186088,SPSI,Iv Kcl 20Meq/H20 50Ml,,Per Svc,41.05
Chargemaster Item,,36186096,SPSI,Iv Ativan 50Mg/50Ml,,Per Svc,992.20
Chargemaster Item,,36186104,SPSI,Iv Aminoph 500Mg/500Ml D5W,,Per Svc,370.50
Chargemaster Item,,36186112,SPSI,Iv Apresoline 10Mg Ivpb,,Per Svc,288.60
Chargemaster Item,,36186120,SPSI,Iv Cefotan 2Gms Ivpb,,Per Svc,390.80
Chargemaster Item,,36186138,SPSI,Iv Cipro 200Mg Ivpb,,Per Svc,10.00
Chargemaster Item,,36186146,SPSI,Iv Cardene 25Mg/250Ml,,Per Svc,722.65
Chargemaster Item,,36186153,SPSI,Vancomycin 750mG Inj,,Per Svc,157.00
Chargemaster Item,,36186161,SPSI,Iv Vibramycin 100Mg/250Ml,,Per Svc,286.75
Chargemaster Item,,36186179,SPSI,Iv Vibramycin 200Mg/250Ml,,Per Svc,303.70
Chargemaster Item,,36186187,SPSI,Iv Zantac 150Mg/250Ml Ivpb,,Per Svc,280.60
Chargemaster Item,,36186195,SPSI,Iv Zantac 50Mg/50Ml Ivpb,,Per Svc,278.40
Chargemaster Item,,36186203,SPSI,Iv Zinacef 1.5Gm/50Ml Ivpb,,Per Svc,277.10
Chargemaster Item,,36186211,SPSI,Iv Zinacef 750Mg/50Ml Ivpb,,Per Svc,272.85
Chargemaster Item,,36186237,SPSI,Iv Zosyn 2.25Gm/50Ml Ivpb,,Per Svc,280.25
Chargemaster Item,,36186245,SPSI,Iv Zosyn 3.375Gm/50Ml Ivpb,,Per Svc,292.60
Chargemaster Item,,36186252,SPSI,Iv Zosyn 4.5Gm/50Ml Ivpb,,Per Svc,302.65
Chargemaster Item,,36186260,SPSI,Iv Midazolam 50Mg/100Ml,,Per Svc,568.05
Chargemaster Item,,36186278,SPSI,Phenobarbital 4mG/mL 1mL Po,,Per Svc,10.00
Chargemaster Item,,36186310,SPSI,Hep B Immune Glob 5mL Soln Inj,,Per Svc,1612.80
Chargemaster Item,,36186328,SPSI,Iv Clindamycin 300Mg Ivpb,,Per Svc,359.90
Chargemaster Item,,36186336,SPSI,Iv Clindamycin 600Mg Ivpb,,Per Svc,141.75
Chargemaster Item,,36186344,SPSI,Iv 5% Dex/.45Ns/Kcl 10Meq Il,,Per Svc,376.65
Chargemaster Item,,36186351,SPSI,Iv 5% Dex/Water/Kcl 20Meq Il,,Per Svc,376.65
Chargemaster Item,,36186369,SPSI,Iv Diflucan 200Mg Ivpb,,Per Svc,82.60
Chargemaster Item,,36186377,SPSI,Iv Lr /Pitocin 10U Il,,Per Svc,374.40
Chargemaster Item,,36186385,SPSI,Iv Lr /Pitocin 20U Il,,Per Svc,377.25
Chargemaster Item,,36186401,SPSI,Iv Ampicillin 1Gm Ivpb,,Per Svc,286.40
Chargemaster Item,,36186427,SPSI,Iv Epinephrine 4Mg/250Ml,,Per Svc,271.15
Chargemaster Item,,36186435,SPSI,Iv Flagyl Igm/200Ml Ivpb,,Per Svc,298.15
Chargemaster Item,,36186443,SPSI,Iv Flagyl 750Mg/150Ml Ivpb,,Per Svc,287.70
Chargemaster Item,,36186450,SPSI,Iv Ampicillin 2Gm Ivpb,,Per Svc,290.30
Chargemaster Item,,36186500,SPSI,Iv Erthromycin 1Gm Ivpb,,Per Svc,301.60
Chargemaster Item,,36186518,SPSI,Iv Reg Insulin 1U/Ml Sol,,Per Svc,419.35
Chargemaster Item,,36186526,SPSI,Iv Gent 100Mg Ivpb,,Per Svc,61.85
Chargemaster Item,,36186534,SPSI,Iv Gent 60Mg Ivpb,,Per Svc,273.20
Chargemaster Item,,36186542,SPSI,Iv Gent 80Mg Ivpb,,Per Svc,57.25
Chargemaster Item,,36186567,SPSI,Iv Nipride 50Mg/250Ml,,Per Svc,273.55
Chargemaster Item,,36186609,SPSI,Iv Vancomycin 1Gm Ivpb,,Per Svc,201.30
Chargemaster Item,,36186625,SPSI,Iv Lvaquin 250Mg/50Ml Ivpb,,Per Svc,56.70
Chargemaster Item,,36186633,SPSI,Iv Levaquin 500Mg/100Ml Ivpb,,Per Svc,82.90
Chargemaster Item,,36186658,SPSI,Iv Mefoxin 1000Mg Inj,,Per Svc,267.85
Chargemaster Item,,36186666,SPSI,Iv Nafcil 1Gm Ivpb,,Per Svc,262.80
Chargemaster Item,,36186708,SPSI,Iv Fortaz 1Gm 1Vpb,,Per Svc,245.95
Chargemaster Item,,36186724,SPSI,Iv Nafcil 2Gm Ivpb,,Per Svc,334.20
Chargemaster Item,,36186740,SPSI,Iv Lasix 250Mg/250Ml,,Per Svc,483.80
Chargemaster Item,,36186757,SPSI,Metronidazole 500Mg/100Ml Iv,,Per Svc,26.55
Chargemaster Item,,36186765,SPSI,Iv Phenylephrine 40Mg/250Ml,,Per Svc,272.00
Chargemaster Item,,36186807,SPSI,Iv Cipro 400Mg/200Ml Ivpb,,Per Svc,449.35
Chargemaster Item,,36186823,SPSI,Iv Pen G Imu/50Ml Ivpb,,Per Svc,284.25
Chargemaster Item,,36186831,SPSI,Iv Pen G 5Mu/50Ml Ivpb,,Per Svc,359.10
Chargemaster Item,,36186849,SPSI,Iv Pepcid 20Mg Ivpb,,Per Svc,281.55
Chargemaster Item,,36186856,SPSI,Iv Pepcid 40Mg Ivpb,,Per Svc,287.55
Chargemaster Item,,36186872,SPSI,Iv Pipracil 2Gm Ivpb,,Per Svc,298.65
Chargemaster Item,,36186880,SPSI,Iv Pipracil 3Gm Ivpb,,Per Svc,302.65
Chargemaster Item,,36186898,SPSI,Iv Pipracil 4Gm Ivpb,,Per Svc,311.25
Chargemaster Item,,36186906,SPSI,Iv Primaxin 250 Mg Ivpb,,Per Svc,308.75
Chargemaster Item,,36186914,SPSI,Iv Primaxin 500Mg Ivpb,,Per Svc,337.75
Chargemaster Item,,36186922,SPSI,Iv Reglan 10Mg/50Ml Ivpb,,Per Svc,276.50
Chargemaster Item,,36186930,SPSI,Iv Reopro 9Mg/50Ml D5W,,Per Svc,1470.55
Chargemaster Item,,36186948,SPSI,Iv Rocephin 2Gm/50Ml Ivpb,,Per Svc,245.30
Chargemaster Item,,36186955,SPSI,Iv Tagamet 300Mg/50Ml Ivpb,,Per Svc,282.15
Chargemaster Item,,36186963,SPSI,Iv Tagamet 1200Ml/250Ml,,Per Svc,278.40
Chargemaster Item,,36186971,SPSI,Iv Tobra 60Mg/50Ml Ivpb,,Per Svc,280.60
Chargemaster Item,,36186989,SPSI,Iv Tobra 80Mg/50Ml,,Per Svc,280.60
Chargemaster Item,,36186997,SPSI,Iv Vancocin 500Mg Ivpb,,Per Svc,281.45
Chargemaster Item,,36187003,SPSI,Iv Ertapenem 1Gm Ivpb,,Per Svc,404.95
Chargemaster Item,,36190007,SPSI,Lidocaine 2% 5mL MPF Inj,,Per Svc,87.10
Chargemaster Item,,36190015,SPSI,Lidocaine 2% 30mL Jelly,,Per Svc,962.65
Chargemaster Item,,36190023,SPSI,Lidocaine 1% 30mL Inj,,Per Svc,138.90
Chargemaster Item,,36190031,SPSI,Lidocaine 2% Jelly 30mL,,Per Svc,87.10
Chargemaster Item,,36190049,SPSI,Lidocaine 2% 5mL MPF,,Per Svc,35.90
Chargemaster Item,,36190056,SPSI,Lidocaine 1% 20mL,,Per Svc,39.15
Chargemaster Item,,36190064,SPSI,Lidocaine 1% 30mL,,Per Svc,138.90
Chargemaster Item,,36190072,SPSI,Atropine 1mG 10mL Inj,,Per Svc,63.55
Chargemaster Item,,36190080,SPSI,Atropine 8mG Inj,,Per Svc,442.25
Chargemaster Item,,36190098,SPSI,Atropine 0.4mG Inj,,Per Svc,39.25
Chargemaster Item,,36190106,SPSI,Atropine 1mG 1mL Inj,,Per Svc,144.40
Chargemaster Item,,36190114,SPSI,Atropine 1mG Inhalation,,Per Svc,144.40
Chargemaster Item,,36190304,SPSI,Atropine 0.01mg Inj,,Per Svc,7.65
Chargemaster Item,,36190494,SPSI,Dextrose 50% 50Ml Vial,,Per Svc,168.00
Chargemaster Item,,36190502,SPSI,Dextrose 50% 50Ml Inj,,Per Svc,166.95
Chargemaster Item,,36190601,SPSI,Epinephrine 1mG / 10mL,,Per Svc,121.15
Chargemaster Item,,36190650,SPSI,Lidocaine/Epinephrine 1.5% 5Ml Inj,,Per Svc,61.20
Chargemaster Item,,36190668,SPSI,Lidocaine/Epinephrine 1.5% 30Ml Inj,,Per Svc,104.50
Chargemaster Item,,36190684,SPSI,Lidocaine 1% 5mL MPF Inj,,Per Svc,17.55
Chargemaster Item,,36190692,SPSI,Lido 1% 30 Syr,,Per Svc,254.05
Chargemaster Item,,36190700,SPSI,Lidocaine 0.5% Mpf 50Ml Inj,,Per Svc,48.70
Chargemaster Item,,36190718,SPSI,Lidocaine 1% 20mL MDV,,Per Svc,97.65
Chargemaster Item,,36190726,SPSI,Lidocaine/Epinephrine 1% 20Ml Inj,,Per Svc,26.80
Chargemaster Item,,36190759,SPSI,Lidocaine 2% Mpf 5Ml Inj,,Per Svc,219.95
Chargemaster Item,,36190767,SPSI,Lidocaine 2% 20ml Inj,,Per Svc,26.35
Chargemaster Item,,36190775,SPSI,Lidocaine 1% 2mL,,Per Svc,14.20
Chargemaster Item,,36190858,SPSI,Xylocaine 2% 10Ml,,Per Svc,117.50
Chargemaster Item,,36190908,SPSI,Phytonadione 1Mg Syringe Inj,,Per Svc,67.00
Chargemaster Item,,36190940,SPSI,Sodium Acetate 40Meq Inj,,Per Svc,39.70
Chargemaster Item,,36190957,SPSI,Sodium Bicarbonate 4.2% 10Ml Inj,,Per Svc,136.20
Chargemaster Item,,36191005,SPSI,Sodium Bicarbonate 8.4% 50Ml Inj,,Per Svc,298.85
Chargemaster Item,,36191013,SPSI,Sodium Bicarb 50mEQ 50ml Vial,,Per Svc,133.05
Chargemaster Item,,36191021,SPSI,Sodium Bicarb 50mEQ 50ml Syringe,,Per Svc,133.05
Chargemaster Item,,36193001,SPSI,Daratumumab 400mG Inj,,Per Svc,12713.30
Chargemaster Item,,36193019,SPSI,Meningococcal B Vacc Inj,,Per Svc,4299.75
Chargemaster Item,,36199008,SPSI,Afatinib Dimaleate 30mG Po,,Per Svc,1006.80
Chargemaster Item,,36199016,SPSI,Afatinib Dimaleate 40mG Po,,Per Svc,4549.10
Chargemaster Item,,36200004,SPSI,Argatroban 250mG,,Per Svc,3000.00
Chargemaster Item,,36200012,SPSI,Ticlid 250Mg,,Per Svc,10.00
Chargemaster Item,,36200020,SPSI,Warfarin 2.5Mg Po,,Per Svc,10.00
Chargemaster Item,,36200038,SPSI,Dalteparin Sod 2500 IU Inj,,Per Svc,275.40
Chargemaster Item,,36200046,SPSI,Dalteparin Sod 5000 IU Inj,,Per Svc,446.65
Chargemaster Item,,36200053,SPSI,Warfarin 1Mg Po,,Per Svc,10.00
Chargemaster Item,,36200061,SPSI,Enoxaparin 30mG Inj,,Per Svc,75.20
Chargemaster Item,,36200079,SPSI,Enoxaparin 40mG Inj,,Per Svc,100.05
Chargemaster Item,,36200087,SPSI,Enoxaparin 60mG Inj,,Per Svc,150.35
Chargemaster Item,,36200095,SPSI,Enoxaparin 80mG Inj,,Per Svc,200.35
Chargemaster Item,,36200103,SPSI,Lepirudin 50Mg Inj,,Per Svc,1780.45
Chargemaster Item,,36200111,SPSI,Enoxaparin Sod 10mg Inj,,Per Svc,54.95
Chargemaster Item,,36200129,SPSI,Dalteparin Sod 2500Iu Inj,,Per Svc,178.85
Chargemaster Item,,36200137,SPSI,Sargramostin 250mCg,,Per Svc,3118.60
Chargemaster Item,,36200145,SPSI,Enoxaparin 100mG Inj,,Per Svc,250.55
Chargemaster Item,,36200152,SPSI,Enoxaparin 120mG Inj,,Per Svc,300.50
Chargemaster Item,,36200160,SPSI,Etidronate 200Mg Po,,Per Svc,45.35
Chargemaster Item,,36200178,SPSI,Enoxaparin 150mG Inj,,Per Svc,375.60
Chargemaster Item,,36200186,SPSI,Etidronate Disodium 300Mg Inj,,Per Svc,365.15
Chargemaster Item,,36200194,SPSI,Prasugrel 10Mg Po,,Per Svc,192.80
Chargemaster Item,,36200202,SPSI,Enoxaparin 300mG Inj,,Per Svc,3125.85
Chargemaster Item,,36200210,SPSI,Epoetin 2000 units ESRD,,Per Svc,1420.00
Chargemaster Item,,36200228,SPSI,Epoetin 4000 Units ESRD,,Per Svc,2964.00
Chargemaster Item,,36200236,SPSI,Epoetin 10000 Units ESRD,,Per Svc,3168.20
Chargemaster Item,,36200244,SPSI,Epoetin 20000 Units ESRD,,Per Svc,4457.00
Chargemaster Item,,36200251,SPSI,Ferrous Gluconate 324Mg Po,,Per Svc,10.00
Chargemaster Item,,36200269,SPSI,Bivalirudin 250mG,,Per Svc,5850.00
Chargemaster Item,,36200277,SPSI,Ferrous Sulfate 15Mg Po,,Per Svc,16.15
Chargemaster Item,,36200285,SPSI,Epoetin 40000 Units ESRD,,Per Svc,6173.15
Chargemaster Item,,36200293,SPSI,Epoetin 2000 Units Non-ESRD,,Per Svc,673.60
Chargemaster Item,,36200301,SPSI,Epoetin 4000 Units Non-ESRD,,Per Svc,835.60
Chargemaster Item,,36200319,SPSI,Warfarin 2Mg Po,,Per Svc,10.00
Chargemaster Item,,36200327,SPSI,Epoetin 10000 Units Non-ESRD,,Per Svc,3367.25
Chargemaster Item,,36200335,SPSI,Ferrous Sulfate 300Mg Oral Liq,,Per Svc,32.85
Chargemaster Item,,36200343,SPSI,Epoetin 20000 Units Non-ESRD,,Per Svc,3220.55
Chargemaster Item,,36200350,SPSI,Epoetin 40000 Units Non-ESRD,,Per Svc,6414.00
Chargemaster Item,,36200368,SPSI,Heparin 1000 units Inj,,Per Svc,20.05
Chargemaster Item,,36200376,SPSI,Warfarin 3Mg Po,,Per Svc,10.00
Chargemaster Item,,36200384,SPSI,Warfarin 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36200392,SPSI,Gel Foam Gelatin Pwd 1Gm,,Per Svc,954.15
Chargemaster Item,,36200400,SPSI,Ferrous Sulfate 325Mg Po,,Per Svc,10.00
Chargemaster Item,,36200418,SPSI,Iron Sucrose Complex 100mG,,Per Svc,630.00
Chargemaster Item,,36200426,SPSI,Ferric Gluconate 62.5mG Inj,,Per Svc,400.70
Chargemaster Item,,36200434,SPSI,Avitene 1Gm,,Per Svc,1391.90
Chargemaster Item,,36200442,SPSI,Gel Foam Sponge 100,,Per Svc,524.90
Chargemaster Item,,36200459,SPSI,Gel Foam 12-7Mm Sponge,,Per Svc,108.25
Chargemaster Item,,36200467,SPSI,Gel Film 12.5 Ophth Film,,Per Svc,2819.65
Chargemaster Item,,36200475,SPSI,Gel Film Compressed Sponge 100Cm,,Per Svc,523.85
Chargemaster Item,,36200483,SPSI,Calciparin 5000Units Inj,,Per Svc,144.75
Chargemaster Item,,36200491,SPSI,Gelfilm 125 Ophth Film,,Per Svc,12149.15
Chargemaster Item,,36200509,SPSI,Heparin 1000u,,Per Svc,147.05
Chargemaster Item,,36200517,SPSI,Heparin 5000 units Inj,,Per Svc,32.75
Chargemaster Item,,36200525,SPSI,Heparin Lock 10 units Inj,,Per Svc,10.00
Chargemaster Item,,36200533,SPSI,Heparin 10000 units Inj,,Per Svc,78.10
Chargemaster Item,,36200541,SPSI,Heparin Lock 10Units/Ml 10Ml,,Per Svc,40.85
Chargemaster Item,,36200558,SPSI,Heparin 25000 units / 250mL,,Per Svc,177.15
Chargemaster Item,,36200566,SPSI,Heparin 50000 units Inj,,Per Svc,125.80
Chargemaster Item,,36200574,SPSI,Heparin lock 50 Units Inj,,Per Svc,28.75
Chargemaster Item,,36200582,SPSI,Heparin Lock 500 units Inj,,Per Svc,26.15
Chargemaster Item,,36200608,SPSI,Heparin 1 Unit/Ml 1Ml,,Per Svc,105.70
Chargemaster Item,,36200616,SPSI,Heparin 10,000 units 10mL,,Per Svc,36.45
Chargemaster Item,,36200624,SPSI,Epoetin 1000 Units ESRD,,Per Svc,238.25
Chargemaster Item,,36200632,SPSI,Epoetin 100 units ESRD,,Per Svc,444.50
Chargemaster Item,,36200640,SPSI,Protamine 50mG 10mL,,Per Svc,154.90
Chargemaster Item,,36200657,SPSI,Protamine 250mG 25mL,,Per Svc,464.40
Chargemaster Item,,36200715,SPSI,Heparin 25,000 Units,,Per Svc,325.65
Chargemaster Item,,36200731,SPSI,Argatroban 5Mg Inj,,Per Svc,230.10
Chargemaster Item,,36200806,SPSI,Iron Dextran Complex 100mG,,Per Svc,350.60
Chargemaster Item,,36200830,SPSI,Reteplase 18.1Mg Per Vial,,Per Svc,13029.65
Chargemaster Item,,36200871,SPSI,Aminocaproic Acid 5Gm Inj,,Per Svc,82.65
Chargemaster Item,,36200889,SPSI,Aminocaproic Acid 500Mg Po,,Per Svc,256.50
Chargemaster Item,,36200905,SPSI,Protamine Inj (See 36200913),,Per Svc,73.25
Chargemaster Item,,36200913,SPSI,Protamine 10mg Inj,,Per Svc,114.55
Chargemaster Item,,36200921,SPSI,Heparin 1 Unit/Ml 5Ml,,Per Svc,39.80
Chargemaster Item,,36200939,SPSI,Heparin 1 Unit/Ml 3Ml,,Per Svc,10.00
Chargemaster Item,,36200947,SPSI,Pentoxifylline 400Mg Po,,Per Svc,10.00
Chargemaster Item,,36200954,SPSI,Thrombin 1000 Units,,Per Svc,412.80
Chargemaster Item,,36200962,SPSI,Thrombin 5000 Units,,Per Svc,904.25
Chargemaster Item,,36200988,SPSI,Thrombin 20000 Units,,Per Svc,3566.35
Chargemaster Item,,36201002,SPSI,Filgrastim (G-CSF) 300mCg Inj,,Per Svc,2473.05
Chargemaster Item,,36201010,SPSI,Filgrastim (G-CSF) 480mCg Inj,,Per Svc,2633.90
Chargemaster Item,,36201028,SPSI,Apixaban 5mg Po,,Per Svc,93.25
Chargemaster Item,,36201036,SPSI,Dabigatran 150Mg Po,,Per Svc,72.90
Chargemaster Item,,36201044,SPSI,Dabigatran 75Mg Po,,Per Svc,90.85
Chargemaster Item,,36201051,SPSI,Fondaparinux 0.5Mg Inj,,Per Svc,385.95
Chargemaster Item,,36201069,SPSI,Apixaban 2.5mg Po,,Per Svc,93.25
Chargemaster Item,,36201077,SPSI,Fondaparinux 2.5mG Inj,,Per Svc,700.75
Chargemaster Item,,36201085,SPSI,Filgrastim 0.001Mg Inj,,Per Svc,311.50
Chargemaster Item,,36201093,SPSI,Fondaparinux 5mG Inj,,Per Svc,1649.05
Chargemaster Item,,36201101,SPSI,Rivaroxaban 15mg Po,,Per Svc,188.15
Chargemaster Item,,36201119,SPSI,Edoxaban 15mg Po,,Per Svc,152.65
Chargemaster Item,,36201127,SPSI,Rivaroxaban 20mg Po,,Per Svc,402.25
Chargemaster Item,,36201135,SPSI,Fondaparinux 7.5mG Inj,,Per Svc,1649.05
Chargemaster Item,,36201143,SPSI,Fondaparinux 10mG Inj,,Per Svc,1649.05
Chargemaster Item,,36201150,SPSI,Romiplostim 250mCg,,Per Svc,8740.00
Chargemaster Item,,36201168,SPSI,Daratumumab 100mG Inj,,Per Svc,3178.30
Chargemaster Item,,36201200,SPSI,Edoxaban 30mg Po,,Per Svc,10.00
Chargemaster Item,,36201234,SPSI,Starter TPN w/ Heparin 250mL,,Per Svc,503.15
Chargemaster Item,,36201275,SPSI,Romiplostim Inj 10MCG,,Per Svc,317.75
Chargemaster Item,,36201283,SPSI,Rivaroxaban 10Mg Po,,Per Svc,188.15
Chargemaster Item,,36201291,SPSI,Ticagrelor 90Mg Po,,Per Svc,78.55
Chargemaster Item,,36201309,SPSI,Filgrastim 15Mcg Inj,,Per Svc,534.30
Chargemaster Item,,36201416,SPSI,Filgrastim (TBO) 1mCg,,Per Svc,63.80
Chargemaster Item,,36201432,SPSI,Levothyroxine 20mCg/mL Inj,,Per Svc,354.76
Chargemaster Item,,36201440,SPSI,Remdesivir 100mg 20mL Inj,,Per Svc,2600.00
Chargemaster Item,,36201457,SPSI,Filgrastim (G-CSF) 1 mCg,,Per Svc,123.70
Chargemaster Item,,36202000,SPSI,Venetoclax 100mG Po,,Per Svc,516.00
Chargemaster Item,,36202059,SPSI,Tranexamic Acid 1Gm/10Ml,,Per Svc,378.00
Chargemaster Item,,36202109,SPSI,Prothrombin Complx 1 units,,Per Svc,110.40
Chargemaster Item,,36202117,SPSI,Prothrombin Complx 500 units,,Per Svc,7250.00
Chargemaster Item,,36204006,SPSI,Alteplase 1Mg Inj,,Per Svc,381.55
Chargemaster Item,,36204014,SPSI,Diazoxide 50Mg Oral Susp,,Per Svc,136.00
Chargemaster Item,,36204022,SPSI,Alteplase 2mG,,Per Svc,1928.55
Chargemaster Item,,36204030,SPSI,Alteplase 100mG,,Per Svc,52802.15
Chargemaster Item,,36204048,SPSI,Factor IX Nonrecombinant Per Unit,,Per Svc,5.90
Chargemaster Item,,36204055,SPSI,Factor Viii C Human,,Per Svc,5.00
Chargemaster Item,,36204097,SPSI,Factor Viii Per 1 Unit,,Per Svc,7.80
Chargemaster Item,,36204105,SPSI,Factor Ix Recombinant Per Unit,,Per Svc,85.15
Chargemaster Item,,36204113,SPSI,Factor Viii Porcine Per Unit,,Per Svc,134.00
Chargemaster Item,,36204121,SPSI,Factor Vii 1 Mcg Recombinate,,Per Svc,13.00
Chargemaster Item,,36204519,SPSI,Epoprostenol 12500Ng/50mL Inj,,Per Svc,497.70
Chargemaster Item,,36207009,SPSI,Afatinib Dimaleate 20mG Po,,Per Svc,1006.80
Chargemaster Item,,36207017,SPSI,Pentostatin 10mG Inj,,Per Svc,29058.60
Chargemaster Item,,36208015,SPSI,Desmopressin NS 1mCg Inj,,Per Svc,98.85
Chargemaster Item,,36210100,SPSI,Argatroban NS 5mG Inj,,Per Svc,33.60
Chargemaster Item,,36211407,SPSI,Glucose 40% Oral Gel 1.2Gm,,Per Svc,10.00
Chargemaster Item,,36211415,SPSI,Glucose 40% gel 0.4Gm/mL 3mL Po,,Per Svc,12.25
Chargemaster Item,,36214005,SPSI,Doxorubicin 200mG Inj,,Per Svc,811.45
Chargemaster Item,,36214013,SPSI,Vanco/D5W 1250mG/250mL,,Per Svc,92.45
Chargemaster Item,,36217008,SPSI,Zidovudine D5W 100mG Inj,,Per Svc,10.00
Chargemaster Item,,36218006,SPSI,Lisinopril 2.5mG Tab,,Per Svc,10.00
Chargemaster Item,,36219004,SPSI,Sod Hyaluronate 18mG/mL 0.85mL,,Per Svc,399.55
Chargemaster Item,,36219129,SPSI,Albumin 5% 2.5Gm 50mL Infusion,,Per Svc,311.10
Chargemaster Item,,36224129,SPSI,Chloramphenicol 1000mG Inj,,Per Svc,490.35
Chargemaster Item,,36226017,SPSI,Zoledronic Acid 5mG/100mL,,Per Svc,8820.00
Chargemaster Item,,36230001,SPSI,Ketorolac 15mG,,Per Svc,30.50
Chargemaster Item,,36235000,SPSI,Ethacrynate Sod D5w 1mG mL 1mL,,Per Svc,217.75
Chargemaster Item,,36236008,SPSI,Naproxen 125mG/5mL Oral,,Per Svc,10.60
Chargemaster Item,,36240000,SPSI,Alteplase 50mG,,Per Svc,26401.10
Chargemaster Item,,36240018,SPSI,Digoxin 125Mcg Oral Liq,,Per Svc,236.25
Chargemaster Item,,36240026,SPSI,Propranolol La 60Mg Po,,Per Svc,44.30
Chargemaster Item,,36240034,SPSI,Nadolol 20Mg Po,,Per Svc,10.00
Chargemaster Item,,36240059,SPSI,Lidocaine 100mg 5ml Inj,,Per Svc,89.65
Chargemaster Item,,36240075,SPSI,Labetalol 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36240083,SPSI,Colestipol 5Gm Pkt,,Per Svc,45.90
Chargemaster Item,,36240091,SPSI,Olmesartan 20Mg Po,,Per Svc,20.60
Chargemaster Item,,36240109,SPSI,Nadolol 40Mg Po,,Per Svc,64.60
Chargemaster Item,,36240125,SPSI,Colesevelam 625Mg Po,,Per Svc,15.25
Chargemaster Item,,36240133,SPSI,Rosuvastatin 10Mg Po,,Per Svc,47.45
Chargemaster Item,,36240158,SPSI,Nesiritide 1.5mG Inj,,Per Svc,6351.05
Chargemaster Item,,36240166,SPSI,Losartan 50Mg Po,,Per Svc,20.15
Chargemaster Item,,36240174,SPSI,Minoxidil 10Mg Po,,Per Svc,22.25
Chargemaster Item,,36240182,SPSI,Digoxin Immune Fab 40Mg Inj,,Per Svc,21834.00
Chargemaster Item,,36240216,SPSI,Dofetilide 0.125Mg Po,,Per Svc,85.95
Chargemaster Item,,36240232,SPSI,Amiodarone 200Mg Po,,Per Svc,83.35
Chargemaster Item,,36240240,SPSI,Lovastatin 40Mg Po,,Per Svc,67.30
Chargemaster Item,,36240257,SPSI,Flecainide 50 MG PO,,Per Svc,21.20
Chargemaster Item,,36240273,SPSI,Nifedipine 10Mg Po,,Per Svc,13.15
Chargemaster Item,,36240299,SPSI,Verapamil 80Po,,Per Svc,10.00
Chargemaster Item,,36240307,SPSI,Verapamil 120Mg Po,,Per Svc,12.10
Chargemaster Item,,36240323,SPSI,Fenofibrate 130Mg Po,,Per Svc,72.65
Chargemaster Item,,36240331,SPSI,Diltiazem 30Mg Po,,Per Svc,10.50
Chargemaster Item,,36240349,SPSI,Diltiazem 60Mg Po,,Per Svc,29.30
Chargemaster Item,,36240356,SPSI,Rosuvastatin 40mG,,Per Svc,44.85
Chargemaster Item,,36240372,SPSI,Carrasyn V 3Oz Gel,,Per Svc,98.50
Chargemaster Item,,36240380,SPSI,Digoxin 125Mcg Po,,Per Svc,10.00
Chargemaster Item,,36240406,SPSI,Metoprolol 5Mg Inj,,Per Svc,33.90
Chargemaster Item,,36240414,SPSI,Digoxin 250Mcg Po,,Per Svc,22.70
Chargemaster Item,,36240422,SPSI,Omega-3 Acid Ethyl Esters,,Per Svc,13.45
Chargemaster Item,,36240448,SPSI,Digoxin 500Mcg Inj,,Per Svc,12.80
Chargemaster Item,,36240455,SPSI,Digoxin 100Mcg Inj,,Per Svc,90.60
Chargemaster Item,,36240463,SPSI,Dronedarone 400Mg Po,,Per Svc,138.30
Chargemaster Item,,36240471,SPSI,Atorvastatin 80mG,,Per Svc,34.20
Chargemaster Item,,36240489,SPSI,Metoprolol 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36240513,SPSI,Fenofibrate 48Mg Po,,Per Svc,21.40
Chargemaster Item,,36240521,SPSI,Fenofibrate 145Mg Po,,Per Svc,54.10
Chargemaster Item,,36240539,SPSI,Lidocaine 2% 100mG 5mL,,Per Svc,41.50
Chargemaster Item,,36240562,SPSI,Lidocaine 100Mg 5Ml Syringe,,Per Svc,185.10
Chargemaster Item,,36240570,SPSI,Norpace 100 Mg,,Per Svc,55.75
Chargemaster Item,,36240588,SPSI,Disopyramide 150Mg Po,,Per Svc,65.95
Chargemaster Item,,36240604,SPSI,Ramipril 2.5Mg Po,,Per Svc,24.40
Chargemaster Item,,36240612,SPSI,Labetalol 20mg Inj,,Per Svc,86.40
Chargemaster Item,,36240620,SPSI,Ramipril 1.25Mg Po,,Per Svc,20.35
Chargemaster Item,,36240679,SPSI,Mexiletine 150Mg Po,,Per Svc,11.45
Chargemaster Item,,36240687,SPSI,Procainamide 1Gm Inj,,Per Svc,1548.00
Chargemaster Item,,36240695,SPSI,Procainamide 1000mG,,Per Svc,1088.45
Chargemaster Item,,36240703,SPSI,Mexiletine 200Mg Po,,Per Svc,31.80
Chargemaster Item,,36240729,SPSI,Atorvastatin 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36240745,SPSI,Propranolol 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36240760,SPSI,Labetolol 200 Tab,,Per Svc,10.00
Chargemaster Item,,36240802,SPSI,Propranolol 40Mg Po,,Per Svc,14.50
Chargemaster Item,,36240836,SPSI,Propranolol 60Mg Po,,Per Svc,21.95
Chargemaster Item,,36240844,SPSI,Propranolol La 160Mg Po,,Per Svc,41.20
Chargemaster Item,,36240851,SPSI,Propranolol La 80Mg Po,,Per Svc,52.20
Chargemaster Item,,36240869,SPSI,Carvedilol 3.125Mg Po,,Per Svc,23.85
Chargemaster Item,,36240877,SPSI,Norpace Cr 150 Mg,,Per Svc,56.90
Chargemaster Item,,36240901,SPSI,Propranolol 1Mg Inj,,Per Svc,100.80
Chargemaster Item,,36240927,SPSI,Quinaglute Dur,,Per Svc,12.30
Chargemaster Item,,36240943,SPSI,Carvedilol 25Mg Po,,Per Svc,30.25
Chargemaster Item,,36240968,SPSI,Carvedilol 6.25Mg Po,,Per Svc,31.00
Chargemaster Item,,36240984,SPSI,Quinidine 200Mg Po,,Per Svc,10.00
Chargemaster Item,,36240992,SPSI,Verapamil 5Mg Inj,,Per Svc,37.05
Chargemaster Item,,36241008,SPSI,Guanfacine 1Mg Po,,Per Svc,10.00
Chargemaster Item,,36241016,SPSI,Amiodarone 150mG,,Per Svc,26.25
Chargemaster Item,,36241024,SPSI,Atenolol/Chlorthalidone 50/25Mg Po,,Per Svc,36.60
Chargemaster Item,,36241032,SPSI,Sildenafil Oral Liq 10Ml,,Per Svc,53.15
Chargemaster Item,,36241040,SPSI,Amiodarone 450mG,,Per Svc,55.25
Chargemaster Item,,36241057,SPSI,Amiodarone 150mG / 100 mL,,Per Svc,188.50
Chargemaster Item,,36241065,SPSI,Atenolol 50Mg Po,,Per Svc,90.95
Chargemaster Item,,36241073,SPSI,Amiodarone 360mG / 200mL,,Per Svc,581.40
Chargemaster Item,,36241107,SPSI,Univasc 7.5Mg Tab,,Per Svc,32.75
Chargemaster Item,,36241115,SPSI,Acebutolol 200Mg Po,,Per Svc,41.90
Chargemaster Item,,36241123,SPSI,Papaverine 150Mg Po,,Per Svc,10.00
Chargemaster Item,,36241149,SPSI,Sildenafil 20Mg Po,,Per Svc,212.40
Chargemaster Item,,36241172,SPSI,Felodipine 2.5Mg Po,,Per Svc,13.00
Chargemaster Item,,36241180,SPSI,Niacin Er 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36241198,SPSI,Atenolol 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36241206,SPSI,Pramoxine/Hydrocortisone 10Gm Foam,,Per Svc,846.20
Chargemaster Item,,36241255,SPSI,Valsartan 80Mg Po,,Per Svc,47.80
Chargemaster Item,,36241289,SPSI,Nicardipine 20Mg Po,,Per Svc,23.40
Chargemaster Item,,36241297,SPSI,Enalapril/Hctz 10/25Mg Po,,Per Svc,26.85
Chargemaster Item,,36241305,SPSI,Timolol 5Mg Po,,Per Svc,14.50
Chargemaster Item,,36241313,SPSI,Procardia Xl 30Mg,,Per Svc,42.95
Chargemaster Item,,36241321,SPSI,Nifedipine Er 60Mg Po,,Per Svc,69.75
Chargemaster Item,,36241339,SPSI,Nifedipine Er 90Mg Po,,Per Svc,27.85
Chargemaster Item,,36241347,SPSI,Pravachol 10Mg,,Per Svc,57.35
Chargemaster Item,,36241396,SPSI,Diltiazem 125Mg Inj,,Per Svc,105.00
Chargemaster Item,,36241404,SPSI,Propafenone 150Mg Po,,Per Svc,10.00
Chargemaster Item,,36241420,SPSI,Cardene 25Mg Inj,,Per Svc,292.65
Chargemaster Item,,36241453,SPSI,Terazosin 1Mg Po,,Per Svc,15.25
Chargemaster Item,,36241461,SPSI,Terazosin 2Mg Po,,Per Svc,26.85
Chargemaster Item,,36241479,SPSI,Terazosin 5Mg Po,,Per Svc,15.25
Chargemaster Item,,36241487,SPSI,Amiodarone 30Mg Inj,,Per Svc,30.55
Chargemaster Item,,36241495,SPSI,Colestid 1Gm Po,,Per Svc,26.55
Chargemaster Item,,36241503,SPSI,Nicardipine 30Mg Po,,Per Svc,33.50
Chargemaster Item,,36241511,SPSI,Bisoprolol 5Mg Po,,Per Svc,14.20
Chargemaster Item,,36241529,SPSI,Atorvastatin 20Mg Po,,Per Svc,12.50
Chargemaster Item,,36241537,SPSI,Hydralazine Oral 1Mg/Ml,,Per Svc,18.90
Chargemaster Item,,36241545,SPSI,Atorvastatin 40Mg Po,,Per Svc,72.85
Chargemaster Item,,36241552,SPSI,Diltiazem 25Mg Inj,,Per Svc,26.65
Chargemaster Item,,36241560,SPSI,Diltiazem 50Mg Inj,,Per Svc,39.90
Chargemaster Item,,36241578,SPSI,Diltiazem Cd 300Mg Po,,Per Svc,28.15
Chargemaster Item,,36241586,SPSI,Losartan 25Mg Po,,Per Svc,16.90
Chargemaster Item,,36241602,SPSI,Sildenafil 10Mg Inj,,Per Svc,2638.00
Chargemaster Item,,36241610,SPSI,Ibutilide Fumarate 1Mg Inj,,Per Svc,740.50
Chargemaster Item,,36241644,SPSI,Pravachol 40mg,,Per Svc,90.60
Chargemaster Item,,36241651,SPSI,Pravastatin 20Mg Po,,Per Svc,26.25
Chargemaster Item,,36241669,SPSI,Diltiazem Cd 120Mg Po,,Per Svc,10.00
Chargemaster Item,,36241685,SPSI,Benazepril 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36241693,SPSI,Isosorbide Mono 30Mg Po,,Per Svc,13.55
Chargemaster Item,,36241743,SPSI,Sotalol 80Mg Po,,Per Svc,24.35
Chargemaster Item,,36241768,SPSI,Aggrenox 200Mg/25Mg Cap,,Per Svc,27.85
Chargemaster Item,,36241800,SPSI,Fluvastin Xl 80Mg Po,,Per Svc,135.65
Chargemaster Item,,36241842,SPSI,Fluvastin 20Mg Po,,Per Svc,28.25
Chargemaster Item,,36241867,SPSI,Bisoprol/Hctz 5/6.25Mg Po,,Per Svc,12.30
Chargemaster Item,,36241875,SPSI,Fenoldopam 10Mg/Ml Inj,,Per Svc,3898.45
Chargemaster Item,,36241891,SPSI,Nitric Oxide 1 Hour,,Per Svc,249.00
Chargemaster Item,,36241966,SPSI,Amlodipine/Benazepril 2.5Mg/10Mg Po,,Per Svc,49.60
Chargemaster Item,,36241974,SPSI,Amlodipine/Benazepril 5Mg/10Mg Po,,Per Svc,22.45
Chargemaster Item,,36241982,SPSI,Amlodipine/Benazepril 5Mg/20Mg Po,,Per Svc,40.00
Chargemaster Item,,36242006,SPSI,Clevidipine 50mG,,Per Svc,7622.50
Chargemaster Item,,36242014,SPSI,Gemfibroxil 600Mg Po,,Per Svc,10.00
Chargemaster Item,,36242022,SPSI,Tolvapatan 15Mg Po,,Per Svc,2704.80
Chargemaster Item,,36242030,SPSI,Carnitor 1GM/10ML Oral Sol 100,,Per Svc,20.60
Chargemaster Item,,36242048,SPSI,Losartan/Hctz 50Mg/12.5Mg Po,,Per Svc,25.95
Chargemaster Item,,36242055,SPSI,Betaxolol 10Mg Po,,Per Svc,33.50
Chargemaster Item,,36242063,SPSI,Levocarnitine 330Mg Po,,Per Svc,11.55
Chargemaster Item,,36242097,SPSI,Diltiazem Sr 90Mg Po,,Per Svc,49.05
Chargemaster Item,,36242105,SPSI,Verapamil 100Mg Po,,Per Svc,34.85
Chargemaster Item,,36242113,SPSI,Verapamil Sr 120Mg,,Per Svc,11.15
Chargemaster Item,,36242121,SPSI,Verapamil Sr 180Mg Po,,Per Svc,13.85
Chargemaster Item,,36242154,SPSI,Diltiazem Cd 180Mg Po,,Per Svc,21.20
Chargemaster Item,,36242162,SPSI,Questran 4 Gm,,Per Svc,34.95
Chargemaster Item,,36242170,SPSI,Lovastatin 20Mg Cap,,Per Svc,26.85
Chargemaster Item,,36242188,SPSI,Lovastatin 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36242196,SPSI,Candesartan 4Mg Po,,Per Svc,33.30
Chargemaster Item,,36242204,SPSI,Candesartan 8Mg Po,,Per Svc,66.60
Chargemaster Item,,36242212,SPSI,Candesartan 16Mg Po,,Per Svc,37.05
Chargemaster Item,,36242238,SPSI,Isradipine 2.5Mg Po,,Per Svc,25.00
Chargemaster Item,,36242246,SPSI,Nicardipine 45Mg Po,,Per Svc,126.00
Chargemaster Item,,36242253,SPSI,Metoprolol Xl 50Mg Po,,Per Svc,13.00
Chargemaster Item,,36242279,SPSI,IV Nicardipine 20 MG/200 ML,,Per Svc,1254.20
Chargemaster Item,,36242287,SPSI,Metoprolol 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36242295,SPSI,IV Nicardipine 40MG/200 ML,,Per Svc,286.75
Chargemaster Item,,36242303,SPSI,Metoprolol Xl 25Mg Po,,Per Svc,21.65
Chargemaster Item,,36242311,SPSI,Quinapril 20Mg Po,,Per Svc,13.45
Chargemaster Item,,36242329,SPSI,Quinapril 5Mg Po,,Per Svc,13.25
Chargemaster Item,,36242337,SPSI,Quinapril 10Mg Po,,Per Svc,26.85
Chargemaster Item,,36242345,SPSI,Ziac 10Mg/6.25Mg Po,,Per Svc,11.95
Chargemaster Item,,36242352,SPSI,Simvastatin 20Mg Po,,Per Svc,100.60
Chargemaster Item,,36242360,SPSI,Simvastatin 5Mg Po,,Per Svc,27.60
Chargemaster Item,,36242386,SPSI,Simvastatin 10Mg Po,,Per Svc,26.45
Chargemaster Item,,36242394,SPSI,Carvedilol Cr 40mg Po,,Per Svc,88.15
Chargemaster Item,,36242402,SPSI,Fenofibrate 54Mg Po,,Per Svc,68.20
Chargemaster Item,,36242410,SPSI,Fenofibrate 67Mg Po,,Per Svc,11.15
Chargemaster Item,,36242428,SPSI,Fenofibrate 160Mg Po,,Per Svc,74.85
Chargemaster Item,,36242436,SPSI,Fenofibrate 200Mg Po,,Per Svc,72.65
Chargemaster Item,,36242444,SPSI,Nebivolol 5Mg Po,,Per Svc,61.30
Chargemaster Item,,36242451,SPSI,Carvedilol Cr 10Mg Po,,Per Svc,115.60
Chargemaster Item,,36242485,SPSI,Nicardipine Sr 30mg Po,,Per Svc,79.80
Chargemaster Item,,36242501,SPSI,Nisoldipine 8.5mG PO,,Per Svc,64.45
Chargemaster Item,,36242519,SPSI,Valsartan 40Mg Po,,Per Svc,40.85
Chargemaster Item,,36242550,SPSI,Clevidipine 1Mg Inj,,Per Svc,2006.40
Chargemaster Item,,36242584,SPSI,Nimodipine 60mg/20ml Oral Sol,,Per Svc,1029.95
Chargemaster Item,,36242600,SPSI,Valsartan/Hctz 80/12.5Mg Po,,Per Svc,35.50
Chargemaster Item,,36242618,SPSI,Valsartan/Hctz 160/12.5Mg Po,,Per Svc,38.55
Chargemaster Item,,36242659,SPSI,Carvedilol Cr 20Mg Po,,Per Svc,88.15
Chargemaster Item,,36242667,SPSI,ATENOLOL 2MG ORAL 20ML LIQ,,Per Svc,10.00
Chargemaster Item,,36242907,SPSI,Irbesartan 150Mg Po,,Per Svc,32.85
Chargemaster Item,,36242923,SPSI,Irbesartan 75Mg Po,,Per Svc,72.85
Chargemaster Item,,36242972,SPSI,Ezetimibe/Simvast 10/10Mg Po,,Per Svc,94.90
Chargemaster Item,,36242980,SPSI,Ezetimibe/Simvast 10/20Mg Po,,Per Svc,94.90
Chargemaster Item,,36242998,SPSI,Ezetimibe/Simvast 10/40Mg Po,,Per Svc,94.90
Chargemaster Item,,36243004,SPSI,Ezetimibe/Simvast 10/80Mg Po,,Per Svc,94.90
Chargemaster Item,,36243012,SPSI,Avalide 150/12.5mg Po,,Per Svc,95.75
Chargemaster Item,,36243046,SPSI,Epaned 1Mg/Ml Oral Sol,,Per Svc,23.95
Chargemaster Item,,36243053,SPSI,Lotensin 20Mg/12.5Mg Po,,Per Svc,10.00
Chargemaster Item,,36243061,SPSI,Lotensin 10Mg/12.5Mg Po,,Per Svc,11.35
Chargemaster Item,,36243103,SPSI,Monopril 10Mg Po,,Per Svc,15.85
Chargemaster Item,,36243111,SPSI,Doxazosin 1Mg Po,,Per Svc,10.70
Chargemaster Item,,36243129,SPSI,Questran Light 1 Pkt,,Per Svc,53.65
Chargemaster Item,,36243145,SPSI,Amlodipine 10Mg Po,,Per Svc,41.85
Chargemaster Item,,36243152,SPSI,Amlodipine 2.5Mg Po,,Per Svc,16.70
Chargemaster Item,,36243160,SPSI,Telmisartan 20Mg Po,,Per Svc,90.60
Chargemaster Item,,36243186,SPSI,Telmisartan 80Mg Po,,Per Svc,57.95
Chargemaster Item,,36243194,SPSI,AMLODIPINE 1MG 1ML ORAL LIQ,,Per Svc,10.00
Chargemaster Item,,36243202,SPSI,Methyldopa 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36243210,SPSI,Methyldopate 250Mg Inj,,Per Svc,504.00
Chargemaster Item,,36243251,SPSI,Methyldopa 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36243269,SPSI,Ezetimbe 10mg Po,,Per Svc,130.20
Chargemaster Item,,36243277,SPSI,Enalaprilat 125Mcg Inj,,Per Svc,10.00
Chargemaster Item,,36243285,SPSI,Duraclon 1Mg/10Ml,,Per Svc,1209.60
Chargemaster Item,,36243293,SPSI,Olmesartan 5Mg,,Per Svc,19.85
Chargemaster Item,,36243319,SPSI,Amlodipine 5Mg Po,,Per Svc,17.20
Chargemaster Item,,36243327,SPSI,Alfentanil 500Mcg,,Per Svc,80.00
Chargemaster Item,,36243350,SPSI,Enalapril 0.5Mg Oral Susp,,Per Svc,29.90
Chargemaster Item,,36243392,SPSI,Captopril 1Mg Oral Liq,,Per Svc,10.00
Chargemaster Item,,36243400,SPSI,Hydralazine 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36243418,SPSI,Captopril 12.5Mg Po,,Per Svc,10.00
Chargemaster Item,,36243426,SPSI,Captopril 6.25Mg Po,,Per Svc,10.00
Chargemaster Item,,36243434,SPSI,Perindopril 4Mg Po,,Per Svc,23.20
Chargemaster Item,,36243442,SPSI,Enalapril 2.5Mg Po,,Per Svc,10.00
Chargemaster Item,,36243459,SPSI,Hydralazine 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36243475,SPSI,Enalapril 10Mg Po,,Per Svc,24.45
Chargemaster Item,,36243491,SPSI,Enalaprilat 2.50Mg Inj,,Per Svc,90.00
Chargemaster Item,,36243517,SPSI,Irbesartan/Hctz 300Mg/12.5Mg Po,,Per Svc,68.30
Chargemaster Item,,36243525,SPSI,Hydralazine 20Mg Inj,,Per Svc,189.00
Chargemaster Item,,36243533,SPSI,Clonidine 0.3Mg Patch,,Per Svc,236.55
Chargemaster Item,,36243541,SPSI,Trandolapril/Verapamil 2/180Mg Po,,Per Svc,62.45
Chargemaster Item,,36243558,SPSI,Clonidine 0.1Mg Po,,Per Svc,10.00
Chargemaster Item,,36243566,SPSI,Clonidine 0.3Mg Po,,Per Svc,10.00
Chargemaster Item,,36243582,SPSI,Captopril 25Mg Po,,Per Svc,18.90
Chargemaster Item,,36243608,SPSI,Catapres 0.2Mg,,Per Svc,29.90
Chargemaster Item,,36243616,SPSI,Aliskeren 150Mg Po,,Per Svc,87.25
Chargemaster Item,,36243632,SPSI,Nimodipine 30Mg Po,,Per Svc,193.30
Chargemaster Item,,36243665,SPSI,CLONIDINE 10MCG 0.5ML ORAL LIQ,,Per Svc,10.00
Chargemaster Item,,36243673,SPSI,Clonidine 0.1Mg Patch,,Per Svc,347.75
Chargemaster Item,,36243681,SPSI,Clonidine 0,2Mg Patch,,Per Svc,174.30
Chargemaster Item,,36243699,SPSI,Minoxidil 2.5Mg Po,,Per Svc,17.85
Chargemaster Item,,36243715,SPSI,Entresto 24/26MG PO,,Per Svc,106.90
Chargemaster Item,,36243723,SPSI,Entresto 97/103MG,,Per Svc,106.90
Chargemaster Item,,36243764,SPSI,Prazosin 1Mg Po,,Per Svc,10.00
Chargemaster Item,,36243772,SPSI,Prazosin 2Mg Po,,Per Svc,73.00
Chargemaster Item,,36243780,SPSI,Prazosin 5Mg Po,,Per Svc,22.60
Chargemaster Item,,36243806,SPSI,Nitroprusside 50Mg Inj,,Per Svc,1638.00
Chargemaster Item,,36243863,SPSI,Doxazosine 4Mg Po,,Per Svc,10.00
Chargemaster Item,,36243897,SPSI,Phentolamine 5Mg Inj,,Per Svc,2674.95
Chargemaster Item,,36243954,SPSI,Trandolapril 2Mg Po,,Per Svc,12.40
Chargemaster Item,,36245504,SPSI,Isosorbide Din 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36245587,SPSI,Isordil 30Mg,,Per Svc,49.85
Chargemaster Item,,36245603,SPSI,Isosorbide Din 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36245611,SPSI,Isosorbide Din 40Mg Po,,Per Svc,21.10
Chargemaster Item,,36245793,SPSI,Isosorbide Mono 20Mg P0,,Per Svc,10.00
Chargemaster Item,,36245850,SPSI,Nitroglycerin 2.5Mg Po,,Per Svc,10.00
Chargemaster Item,,36245900,SPSI,Nitroglycerin 6.5Mg Po,,Per Svc,10.60
Chargemaster Item,,36245942,SPSI,Nitrol Oint 60Gm,,Per Svc,260.80
Chargemaster Item,,36245959,SPSI,Nitroglyc .3/25,,Per Svc,62.00
Chargemaster Item,,36245967,SPSI,Nitroglycerin 2% 1Gm Oint Pkt,,Per Svc,29.00
Chargemaster Item,,36245991,SPSI,Nitroglycerin 0.4Mg Po #25,,Per Svc,179.95
Chargemaster Item,,36246007,SPSI,Nitroglycerin 0.4Mg Po,,Per Svc,15.75
Chargemaster Item,,36246015,SPSI,Nitroglycerine 50Mg Inj,,Per Svc,170.65
Chargemaster Item,,36246023,SPSI,Nitroglycerin 0.4mg/Hr Patch,,Per Svc,66.15
Chargemaster Item,,36246031,SPSI,Nitroglycerin 0.2Mg/Hr Patch,,Per Svc,59.00
Chargemaster Item,,36246072,SPSI,Nitroglycerine 100Mg Inj,,Per Svc,265.65
Chargemaster Item,,36246106,SPSI,Nitro-Dur 0.3Mg/Hr Patch,,Per Svc,66.15
Chargemaster Item,,36246114,SPSI,Labetalol 100Mg Inj,,Per Svc,44.50
Chargemaster Item,,36246122,SPSI,Nitroglycerin 0.1Mg/Hr Patch,,Per Svc,19.55
Chargemaster Item,,36246148,SPSI,Nitroglycerin Spray 12Gm,,Per Svc,5195.00
Chargemaster Item,,36246155,SPSI,Nitroglycerin 0.6Mg/Hr Patch,,Per Svc,71.70
Chargemaster Item,,36246403,SPSI,Dipyridmole 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36246510,SPSI,Diltiazem Sr 60Mg Po,,Per Svc,33.30
Chargemaster Item,,36246536,SPSI,Benazepril 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36246551,SPSI,Vasodilan 20Mg,,Per Svc,80.80
Chargemaster Item,,36246569,SPSI,Indera Susp 1Mg/Ml 1 Dose,,Per Svc,10.00
Chargemaster Item,,36246593,SPSI,Benazepril 40Mg Po,,Per Svc,10.20
Chargemaster Item,,36246627,SPSI,Ramipril 5Mg Po,,Per Svc,21.40
Chargemaster Item,,36246700,SPSI,Felodipine 5Mg Po,,Per Svc,14.30
Chargemaster Item,,36250207,SPSI,Insulin lispro 3mL inj,,Per Svc,1335.00
Chargemaster Item,,36250231,SPSI,Zidovudine 100mG/10mL Oral,,Per Svc,25.20
Chargemaster Item,,36250256,SPSI,DOXYLAMINE 25MG PO,,Per Svc,10.00
Chargemaster Item,,36250264,SPSI,FOSFOMYCIN 3GM PWD ORAL,,Per Svc,499.05
Chargemaster Item,,36250272,SPSI,Heparin 100U/mL 10mL Inj,,Per Svc,143.75
Chargemaster Item,,36255016,SPSI,Ketamine 50mG/5mL Syr,,Per Svc,52.50
Chargemaster Item,,36255024,SPSI,Darzalex Faspro 1800mG Inj,,Per Svc,45444.00
Chargemaster Item,,36262004,SPSI,Everolumus 5mG Po,,Per Svc,2064.40
Chargemaster Item,,36264000,SPSI,Morphine 1mG/0.5mL Oral,,Per Svc,10.00
Chargemaster Item,,36266005,SPSI,Leucovorin 200mG Inj,,Per Svc,277.95
Chargemaster Item,,36270007,SPSI,Everolums 10mG Po,,Per Svc,2064.40
Chargemaster Item,,36280006,SPSI,Hydromorphone 1mG Inj,,Per Svc,32.25
Chargemaster Item,,36280014,SPSI,Ortho Periarticular Inj,,Per Svc,244.10
Chargemaster Item,,36280022,SPSI,Hydromorphone 2mG Inj a,,Per Svc,34.55
Chargemaster Item,,36280030,SPSI,Enflurane 250Ml,,Per Svc,407.35
Chargemaster Item,,36280048,SPSI,Oxycodone Cr 80Mg Po,,Per Svc,121.05
Chargemaster Item,,36280055,SPSI,Morphine Sa 15Mg Po,,Per Svc,19.65
Chargemaster Item,,36280063,SPSI,Acetaminophen 1000mG,,Per Svc,547.60
Chargemaster Item,,36280071,SPSI,Oxydocone Cr 40Mg Po,,Per Svc,99.25
Chargemaster Item,,36280089,SPSI,Acetaminophen 650mG,,Per Svc,330.15
Chargemaster Item,,36280097,SPSI,Morphine Er 30Mg Po,,Per Svc,35.50
Chargemaster Item,,36280105,SPSI,Acetaminophen 10Mg Inj,,Per Svc,49.65
Chargemaster Item,,36280113,SPSI,Oxycodone/Acet 10/325Mg Po,,Per Svc,35.40
Chargemaster Item,,36280121,SPSI,Morphine Er 60Mg Po,,Per Svc,119.40
Chargemaster Item,,36280139,SPSI,Acetaminophen 10mG,,Per Svc,10.00
Chargemaster Item,,36280170,SPSI,Fentanyl 12Mcg/Hr Patch,,Per Svc,144.90
Chargemaster Item,,36280188,SPSI,Lamotrigine 5Mg Po,,Per Svc,32.05
Chargemaster Item,,36280196,SPSI,Hydromorphone 25Mg/50Ml Pca Syringe,,Per Svc,176.20
Chargemaster Item,,36280212,SPSI,Ibuprofen 20Mg Inj,,Per Svc,2737.45
Chargemaster Item,,36280220,SPSI,Diclofenac 75Mg Po,,Per Svc,18.50
Chargemaster Item,,36280253,SPSI,Escitalopram 10Mg Po,,Per Svc,29.40
Chargemaster Item,,36280261,SPSI,Diclofenac 50Mg Po,,Per Svc,15.45
Chargemaster Item,,36280295,SPSI,Aspirin 325Mg Po,,Per Svc,35.40
Chargemaster Item,,36280329,SPSI,Aspirin 300Mg Supp,,Per Svc,15.35
Chargemaster Item,,36280337,SPSI,Aspirin 600Mg Supp,,Per Svc,15.85
Chargemaster Item,,36280352,SPSI,Arthrotec 75Mg Po,,Per Svc,38.90
Chargemaster Item,,36280360,SPSI,Aspirin 5gr Ec Po,,Per Svc,10.00
Chargemaster Item,,36280378,SPSI,Oxycodone 20Mg Oral Liq,,Per Svc,76.55
Chargemaster Item,,36280386,SPSI,Aspirin Buffered 325Mg Po,,Per Svc,10.00
Chargemaster Item,,36280394,SPSI,Oxycodone 5Mg Po,,Per Svc,18.80
Chargemaster Item,,36280402,SPSI,Indomethacin 25mg Ooral Liq,,Per Svc,474.20
Chargemaster Item,,36280410,SPSI,Asa 10Gr Ec,,Per Svc,0.05
Chargemaster Item,,36280428,SPSI,Aspirin Ec 325Mg Po,,Per Svc,0.15
Chargemaster Item,,36280436,SPSI,Salsalate 500Mg Po,,Per Svc,92.30
Chargemaster Item,,36280451,SPSI,Indomethacin 50mg Supp,,Per Svc,2142.00
Chargemaster Item,,36280477,SPSI,B&O 16.2Mg/30Mg Supp,,Per Svc,288.95
Chargemaster Item,,36280493,SPSI,Capital W/Codeine Liq 1 Dose,,Per Svc,45.50
Chargemaster Item,,36280501,SPSI,Codeine 15Mg Po,,Per Svc,55.80
Chargemaster Item,,36280543,SPSI,Aspirin 81Mg Po,,Per Svc,10.00
Chargemaster Item,,36280550,SPSI,Codeine 30Mg Po,,Per Svc,62.00
Chargemaster Item,,36280568,SPSI,Remifentanyl 1Mg Inj,,Per Svc,772.30
Chargemaster Item,,36280576,SPSI,Aspirin 81Mg Chewable,,Per Svc,10.00
Chargemaster Item,,36280584,SPSI,Hydromorphone 40mG 20mL,,Per Svc,260.50
Chargemaster Item,,36280592,SPSI,Hydromorphone 50mG 5mL,,Per Svc,132.45
Chargemaster Item,,36280600,SPSI,Hydromorphone 4mG,,Per Svc,32.25
Chargemaster Item,,36280634,SPSI,Fentanyl Loz 1200Mcg,,Per Svc,136.15
Chargemaster Item,,36280659,SPSI,Codeine 30Mg Inj,,Per Svc,15.35
Chargemaster Item,,36280667,SPSI,Oxycodone 80Mg Po,,Per Svc,52.00
Chargemaster Item,,36280683,SPSI,Oxycodone 40Mg Po,,Per Svc,79.55
Chargemaster Item,,36280691,SPSI,Clozapine 25Mg Po,,Per Svc,13.85
Chargemaster Item,,36280709,SPSI,Clozapine 100Mg Po,,Per Svc,167.60
Chargemaster Item,,36280717,SPSI,Sulindac 150Mg Po,,Per Svc,12.80
Chargemaster Item,,36280725,SPSI,Sulindac 200Mg Po,,Per Svc,10.00
Chargemaster Item,,36280758,SPSI,Hydromorphone 2Mg Po,,Per Svc,18.40
Chargemaster Item,,36280774,SPSI,Sertraline 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36280782,SPSI,Sertraline 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36280808,SPSI,Hydromorphone 4Mg Po,,Per Svc,22.60
Chargemaster Item,,36280857,SPSI,Hydromorphone 2mg Inj,,Per Svc,117.05
Chargemaster Item,,36280956,SPSI,Hydromorphone 4Mg Inj,,Per Svc,158.55
Chargemaster Item,,36280964,SPSI,Dilaudid 0.1Mg/Cc Pca Syringe,,Per Svc,313.25
Chargemaster Item,,36281004,SPSI,Morphine 10mG PF,,Per Svc,85.15
Chargemaster Item,,36281012,SPSI,Lacosamide 200MG Inj,,Per Svc,952.90
Chargemaster Item,,36281020,SPSI,Dilvalproex Er 250mg Po,,Per Svc,22.35
Chargemaster Item,,36281038,SPSI,Dilvalproex Dr 250mg Po,,Per Svc,20.15
Chargemaster Item,,36281046,SPSI,Morphine 5mG PF,,Per Svc,77.05
Chargemaster Item,,36281053,SPSI,Methadone 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36281061,SPSI,Lacosamide 150Mg Oral Liq,,Per Svc,290.65
Chargemaster Item,,36281079,SPSI,Olanzapine Odt 10Mg Po,,Per Svc,34.20
Chargemaster Item,,36281087,SPSI,Ziprasidone 20mG,,Per Svc,626.00
Chargemaster Item,,36281095,SPSI,Olanzapine Odt 5Mg Po,,Per Svc,149.85
Chargemaster Item,,36281103,SPSI,Methadone 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36281111,SPSI,Morphnine 200mG PF,,Per Svc,2620.70
Chargemaster Item,,36281129,SPSI,Levetiracetam 500Mg Oral Sol,,Per Svc,98.20
Chargemaster Item,,36281137,SPSI,Pregabalin 25Mg Po,,Per Svc,61.20
Chargemaster Item,,36281145,SPSI,Aripiprazole 5mG PO,,Per Svc,337.15
Chargemaster Item,,36281152,SPSI,Morphine 500mG PF,,Per Svc,4456.00
Chargemaster Item,,36281160,SPSI,Risperidone 37.5Mg Inj,,Per Svc,4362.95
Chargemaster Item,,36281178,SPSI,Morphine Sulf 10Mg Pf Inj,,Per Svc,49.65
Chargemaster Item,,36281186,SPSI,Topiramate 6Mg 100Ml Liq,,Per Svc,11.05
Chargemaster Item,,36281194,SPSI,Lamotrigine 100Mg Po,,Per Svc,49.90
Chargemaster Item,,36281202,SPSI,Topiramate 100Mg Po,,Per Svc,73.10
Chargemaster Item,,36281210,SPSI,Levetiracetam 500Mg Po,,Per Svc,33.20
Chargemaster Item,,36281228,SPSI,Levetiracetam 500mG Inj,,Per Svc,132.30
Chargemaster Item,,36281236,SPSI,Topiramate 25Mg Po,,Per Svc,30.65
Chargemaster Item,,36281244,SPSI,Topiranate 15Mg Po,,Per Svc,25.40
Chargemaster Item,,36281251,SPSI,Aspirin/Codeine 325Mgg/30Mg Po,,Per Svc,1.50
Chargemaster Item,,36281269,SPSI,Thiothixene 10Mg Po,,Per Svc,35.30
Chargemaster Item,,36281277,SPSI,Fluvoxamine 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36281285,SPSI,Levetiracetam 1000mG / 100mL,,Per Svc,625.05
Chargemaster Item,,36281293,SPSI,Lamotrigine 25Mg Po,,Per Svc,43.60
Chargemaster Item,,36281301,SPSI,Levetiracetam 500mG / 100mL,,Per Svc,375.05
Chargemaster Item,,36281319,SPSI,Indomethacin 1Mg Inj,,Per Svc,3173.65
Chargemaster Item,,36281327,SPSI,Levetiracetam 1500mG / 100mL,,Per Svc,935.45
Chargemaster Item,,36281335,SPSI,Morphine 100mG / 100mL,,Per Svc,663.90
Chargemaster Item,,36281343,SPSI,Fioricet 325Mg/50Mg/40Mg Po,,Per Svc,10.00
Chargemaster Item,,36281350,SPSI,Clomipramine 25Mg Po,,Per Svc,444.80
Chargemaster Item,,36281368,SPSI,Fiorinal 325Mg/50Mg/40Mg Po,,Per Svc,76.55
Chargemaster Item,,36281384,SPSI,Fiorinal/Codeine 30Mg Po,,Per Svc,42.10
Chargemaster Item,,36281392,SPSI,Piroxicam 20Mg Po,,Per Svc,17.00
Chargemaster Item,,36281400,SPSI,Indomethacin 25Mg Po,,Per Svc,12.30
Chargemaster Item,,36281426,SPSI,Aripiprazole 10Mg Po,,Per Svc,337.15
Chargemaster Item,,36281434,SPSI,Aripiprazole 15Mg Po,,Per Svc,99.50
Chargemaster Item,,36281442,SPSI,Ammonia Inhalent,,Per Svc,0.70
Chargemaster Item,,36281475,SPSI,Ketorolac 10Mg Po,,Per Svc,13.45
Chargemaster Item,,36281491,SPSI,Methylnaltrexone 12Mg Inj,,Per Svc,1455.85
Chargemaster Item,,36281517,SPSI,Risperidone 1Mg Po,,Per Svc,47.90
Chargemaster Item,,36281525,SPSI,Risperidone 2Mg Po,,Per Svc,31.70
Chargemaster Item,,36281541,SPSI,Tiagabine 2Mg Po,,Per Svc,70.35
Chargemaster Item,,36281566,SPSI,Etodolac 300Mg Po,,Per Svc,10.00
Chargemaster Item,,36281582,SPSI,Mirtazapine 15Mg Po,,Per Svc,45.35
Chargemaster Item,,36281590,SPSI,Mirtazapine 30Mg Po,,Per Svc,46.35
Chargemaster Item,,36281608,SPSI,Bupropion 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36281616,SPSI,Bupropion 75Mg Po,,Per Svc,15.25
Chargemaster Item,,36281624,SPSI,Citalopram 20Mg Po,,Per Svc,28.25
Chargemaster Item,,36281657,SPSI,Bupropion Sr 150Mg Po,,Per Svc,19.00
Chargemaster Item,,36281665,SPSI,Bupropion Sr 100Mg Po,,Per Svc,17.75
Chargemaster Item,,36281681,SPSI,Citalopram 10Mg Po,,Per Svc,25.50
Chargemaster Item,,36281699,SPSI,Ziprasidone 20mG Oral Sol,,Per Svc,522.50
Chargemaster Item,,36281707,SPSI,Etodolac 200Mg Po,,Per Svc,17.75
Chargemaster Item,,36281715,SPSI,Felbamate 400Mg Po,,Per Svc,54.80
Chargemaster Item,,36281723,SPSI,Nabumetone 500Mg Po,,Per Svc,19.10
Chargemaster Item,,36281731,SPSI,Felbamate 600Mg Oral Susp,,Per Svc,144.50
Chargemaster Item,,36281780,SPSI,Nefazodone 100Mg Po,,Per Svc,13.65
Chargemaster Item,,36281798,SPSI,Nefazodone 50Mg Po,,Per Svc,49.25
Chargemaster Item,,36281814,SPSI,Ranolazine 500Mg,,Per Svc,78.65
Chargemaster Item,,36281822,SPSI,Doxepin 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36281830,SPSI,Tranylcypromine 10Mg Po,,Per Svc,74.25
Chargemaster Item,,36281848,SPSI,Duloxetine 20Mg Po,,Per Svc,62.25
Chargemaster Item,,36281855,SPSI,Meperidine 25Mg Inj,,Per Svc,74.95
Chargemaster Item,,36281863,SPSI,Pregabalin 50Mg Po,,Per Svc,76.35
Chargemaster Item,,36281871,SPSI,Pregabalin 75Mg Po,,Per Svc,139.55
Chargemaster Item,,36281889,SPSI,Pregabalin 300Mg Po,,Per Svc,106.15
Chargemaster Item,,36281897,SPSI,Fluphenazine Dec 125mG Inj,,Per Svc,1952.60
Chargemaster Item,,36281905,SPSI,Meperidine 50MG INJ,,Per Svc,77.50
Chargemaster Item,,36281913,SPSI,Haloperidol Dec 50Mg Inj,,Per Svc,299.90
Chargemaster Item,,36281921,SPSI,Levetiracetam 10mg Inj,,Per Svc,49.65
Chargemaster Item,,36281939,SPSI,Naltrexone 50Mg,,Per Svc,28.75
Chargemaster Item,,36281947,SPSI,Olanzapine 10Mg Inj,,Per Svc,324.30
Chargemaster Item,,36281962,SPSI,Duloxetine 30Mg Po,,Per Svc,98.90
Chargemaster Item,,36281970,SPSI,Paroxetine 37.5Mg Po,,Per Svc,63.55
Chargemaster Item,,36281988,SPSI,Olanzapine 10mg Inj a,,Per Svc,563.20
Chargemaster Item,,36282002,SPSI,Meperidine 100mg Inj,,Per Svc,72.55
Chargemaster Item,,36282010,SPSI,Diclofenac Oph 0.1% 5mL,,Per Svc,438.20
Chargemaster Item,,36282036,SPSI,Dexmedetomidine 200Mcg/50Ml IV,,Per Svc,562.20
Chargemaster Item,,36282119,SPSI,Zaleplon 5Mg Po,,Per Svc,48.50
Chargemaster Item,,36282127,SPSI,Lorazepam 0.5mG,,Per Svc,108.85
Chargemaster Item,,36282143,SPSI,Caffeine/Benzoate 500Mg Inj,,Per Svc,241.30
Chargemaster Item,,36282150,SPSI,Lorazepam 2Mg Oral Liq,,Per Svc,16.80
Chargemaster Item,,36282184,SPSI,Temazepam 7.5Mg Po,,Per Svc,87.70
Chargemaster Item,,36282192,SPSI,Morphine 100mg/100ml IVPB,,Per Svc,10.00
Chargemaster Item,,36282200,SPSI,Morphine 15Mg,,Per Svc,70.20
Chargemaster Item,,36282226,SPSI,Oxycodone 10Mg Po,,Per Svc,117.10
Chargemaster Item,,36282234,SPSI,Oxycodone 20Mg Po,,Per Svc,124.65
Chargemaster Item,,36282275,SPSI,Morphine 4mg Inj,,Per Svc,23.75
Chargemaster Item,,36282291,SPSI,Morphine 30Mg Po,,Per Svc,16.15
Chargemaster Item,,36282309,SPSI,Morphine 60Mg Po,,Per Svc,65.20
Chargemaster Item,,36282317,SPSI,Morphine 15Mg Po,,Per Svc,10.00
Chargemaster Item,,36282325,SPSI,Dexmedetomidine 200Mcg Inj,,Per Svc,529.20
Chargemaster Item,,36282341,SPSI,Methadone 15Mg Oral Sol,,Per Svc,12.60
Chargemaster Item,,36282358,SPSI,Morphine 10Mg Inj,,Per Svc,23.75
Chargemaster Item,,36282366,SPSI,Morphine 100Mg Po,,Per Svc,80.20
Chargemaster Item,,36282408,SPSI,Methadone 1Mg/Ml 1Ml,,Per Svc,131.25
Chargemaster Item,,36282424,SPSI,Morphine Liq 10Mg/5Ml 1 Dose,,Per Svc,10.00
Chargemaster Item,,36282432,SPSI,Morphine 10Mg Oral Liq,,Per Svc,46.10
Chargemaster Item,,36282440,SPSI,Roxanol Liq 30Cc,,Per Svc,26.95
Chargemaster Item,,36282473,SPSI,Ketoprofen 75Mg Po,,Per Svc,14.80
Chargemaster Item,,36282507,SPSI,Ibuprofen 200mg Po,,Per Svc,10.00
Chargemaster Item,,36282515,SPSI,Ibuprofen 800Mg Po,,Per Svc,47.85
Chargemaster Item,,36282523,SPSI,Naproxen 500Mg Po,,Per Svc,39.05
Chargemaster Item,,36282549,SPSI,Ibuprofen 600mg Po,,Per Svc,10.00
Chargemaster Item,,36282556,SPSI,Ibuprofen 400Mg,,Per Svc,10.00
Chargemaster Item,,36282572,SPSI,Naproxen 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36282580,SPSI,Naproxen 375Mg Po,,Per Svc,70.75
Chargemaster Item,,36282598,SPSI,Nalbuphine 10Mg Inj,,Per Svc,45.70
Chargemaster Item,,36282614,SPSI,Riluzole 50Mg Po,,Per Svc,390.60
Chargemaster Item,,36282671,SPSI,Percocet 5 Tab,,Per Svc,14.40
Chargemaster Item,,36282689,SPSI,Buspirone 5Mg Po,,Per Svc,12.10
Chargemaster Item,,36282697,SPSI,Buspirone 10Mg Po,,Per Svc,14.05
Chargemaster Item,,36282754,SPSI,Propoxyphen 65,,Per Svc,14.35
Chargemaster Item,,36282788,SPSI,Ibuprofen 100mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36282838,SPSI,Aspercreme 1.25Oz,,Per Svc,8.25
Chargemaster Item,,36282861,SPSI,Valproate 500Mg Inj,,Per Svc,399.65
Chargemaster Item,,36282879,SPSI,Astramorph 2Mg Inj,,Per Svc,300.65
Chargemaster Item,,36282895,SPSI,Rufinamide 400Mg Po,,Per Svc,302.80
Chargemaster Item,,36282929,SPSI,Morphine 20Mg Po,,Per Svc,54.80
Chargemaster Item,,36282937,SPSI,Morphine 50Mg Po,,Per Svc,99.65
Chargemaster Item,,36282960,SPSI,Gabapetin 300Mg Po,,Per Svc,14.50
Chargemaster Item,,36282986,SPSI,Gabapetin 100Mg Po,,Per Svc,10.90
Chargemaster Item,,36282994,SPSI,Fentanyl 0.01MG Inj,,Per Svc,103.15
Chargemaster Item,,36283000,SPSI,Butorphanol 1mG Inj a,,Per Svc,37.80
Chargemaster Item,,36283018,SPSI,Butorphanol 2mG,,Per Svc,75.60
Chargemaster Item,,36283026,SPSI,Sufentanil 100Mcg Inj,,Per Svc,233.00
Chargemaster Item,,36283034,SPSI,Caffeine Cit 14Mg Oral Sol,,Per Svc,111.70
Chargemaster Item,,36283042,SPSI,Fentanyl 100mCg Inj a,,Per Svc,26.25
Chargemaster Item,,36283059,SPSI,Darvocet N 100,,Per Svc,9.55
Chargemaster Item,,36283067,SPSI,Fentanyl 100mcg Inj,,Per Svc,26.25
Chargemaster Item,,36283075,SPSI,Sublimaze 5Ml,,Per Svc,114.20
Chargemaster Item,,36283083,SPSI,Stalevo 150mg Po,,Per Svc,96.40
Chargemaster Item,,36283091,SPSI,Fentanyl 250mCg Inj,,Per Svc,23.50
Chargemaster Item,,36283109,SPSI,Fentanyl 500mCg Inj,,Per Svc,14.20
Chargemaster Item,,36283117,SPSI,Butorphanol 1Mg Inj,,Per Svc,273.90
Chargemaster Item,,36283125,SPSI,Fentanyl 1000mCg Inj,,Per Svc,80.00
Chargemaster Item,,36283133,SPSI,Ketorolac 30mG Inj,,Per Svc,63.00
Chargemaster Item,,36283141,SPSI,Ketorolac 60mG Inj,,Per Svc,22.05
Chargemaster Item,,36283158,SPSI,Carbidop/Levodop/Entacap 18.75/75/200Mg Po,,Per Svc,96.40
Chargemaster Item,,36283166,SPSI,Fentanyl 2000 mCg / 100mL,,Per Svc,240.70
Chargemaster Item,,36283174,SPSI,Sufenta 1Ml,,Per Svc,46.00
Chargemaster Item,,36283190,SPSI,Fentanyl Loz 400Mcg,,Per Svc,72.15
Chargemaster Item,,36283216,SPSI,Fentanyl Loz 200Mcg,,Per Svc,56.95
Chargemaster Item,,36283224,SPSI,Fentanyl Loz 1600Mcg,,Per Svc,167.95
Chargemaster Item,,36283232,SPSI,Fentanyl Loz 600Mcg,,Per Svc,88.40
Chargemaster Item,,36283240,SPSI,Acetaminophen 650mg Oral Sol,,Per Svc,16.80
Chargemaster Item,,36283265,SPSI,Fentanyl Loz 800Mcg,,Per Svc,104.75
Chargemaster Item,,36283273,SPSI,Rasagiline 0.5Mg Po,,Per Svc,328.65
Chargemaster Item,,36283281,SPSI,Tylenol 500Mg 2 Tabs,,Per Svc,6.00
Chargemaster Item,,36283299,SPSI,Ketorolac 15mg Inj,,Per Svc,177.65
Chargemaster Item,,36283315,SPSI,Acetaminophen/Codeine 120/12Mg Oral Sol,,Per Svc,15.55
Chargemaster Item,,36283323,SPSI,Tylenol Elixir,,Per Svc,3.10
Chargemaster Item,,36283331,SPSI,Acetaminophen 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36283349,SPSI,Acetaminophen 200Mg Oral Susp,,Per Svc,0.70
Chargemaster Item,,36283364,SPSI,Zonisamide 100Mg Po,,Per Svc,19.00
Chargemaster Item,,36283372,SPSI,Acetaminophen 160mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36283380,SPSI,Zonisamide 50Mg Po,,Per Svc,36.00
Chargemaster Item,,36283398,SPSI,Acetaminophen 325mg Po,,Per Svc,10.00
Chargemaster Item,,36283406,SPSI,Tylenol #2 Tab,,Per Svc,26.85
Chargemaster Item,,36283422,SPSI,Paroxetine 20Mg Po,,Per Svc,28.65
Chargemaster Item,,36283430,SPSI,Paroxetine 30Mg Po,,Per Svc,64.95
Chargemaster Item,,36283448,SPSI,Acetaminophen 80Mg Po,,Per Svc,10.00
Chargemaster Item,,36283455,SPSI,Acetaminophen/Codeine 300/30Mg Po,,Per Svc,76.25
Chargemaster Item,,36283463,SPSI,Ziprasidone 20Mg Po,,Per Svc,94.10
Chargemaster Item,,36283471,SPSI,Paroxetine 10Mg Po,,Per Svc,32.45
Chargemaster Item,,36283489,SPSI,Tyleno Infant Drops 1Dose,,Per Svc,14.35
Chargemaster Item,,36283497,SPSI,Paroxetine 12.5Mg Po,,Per Svc,85.70
Chargemaster Item,,36283505,SPSI,Acetaminophen/Codeine 300/60Mg Po,,Per Svc,10.20
Chargemaster Item,,36283513,SPSI,Tylenol Supp,,Per Svc,10.00
Chargemaster Item,,36283521,SPSI,Acetaminophen 120mg Supp,,Per Svc,10.00
Chargemaster Item,,36283539,SPSI,Acetaminophen 325Mg Supp,,Per Svc,10.00
Chargemaster Item,,36283547,SPSI,Hydrocod/Acet 7.5/325Mg 15ML,,Per Svc,51.25
Chargemaster Item,,36283562,SPSI,Acetaminophen 80Mg Supp,,Per Svc,10.00
Chargemaster Item,,36283588,SPSI,Caffeine Cit 60Mg Oral Sol,,Per Svc,65.45
Chargemaster Item,,36283596,SPSI,Caffeine Cit 20mG Inj,,Per Svc,236.25
Chargemaster Item,,36283612,SPSI,Fentanyl 25Mcg/Hr Patch,,Per Svc,394.30
Chargemaster Item,,36283620,SPSI,Fentanyl 50Mcg/Hr Patch,,Per Svc,681.65
Chargemaster Item,,36283638,SPSI,Fentanyl 100Mcg/Hr Patch,,Per Svc,1453.60
Chargemaster Item,,36283646,SPSI,Fentanyl 75Mcg/Hr Patch,,Per Svc,1106.30
Chargemaster Item,,36283653,SPSI,Hydrocod/Apap 5-500mg Po,,Per Svc,47.25
Chargemaster Item,,36283661,SPSI,Hydrocodone/Apap 5Mg/325Mg Po,,Per Svc,10.50
Chargemaster Item,,36283679,SPSI,Ziprasidone 80Mg Po,,Per Svc,114.25
Chargemaster Item,,36283687,SPSI,Hydrocod/Apap 7.5-650mg Po,,Per Svc,40.50
Chargemaster Item,,36283695,SPSI,Hydrocodon/Ibu.5Mg/200Mg Po,,Per Svc,21.75
Chargemaster Item,,36283703,SPSI,Hydrocod/Apap 10-650Mg,,Per Svc,54.00
Chargemaster Item,,36283711,SPSI,Hydrocod/Apap 7.5-325Mg Po,,Per Svc,10.10
Chargemaster Item,,36283737,SPSI,Capsaicin 0.25% 60Gm Crm,,Per Svc,101.95
Chargemaster Item,,36283760,SPSI,Lithium Carb Er 300mg Po,,Per Svc,10.00
Chargemaster Item,,36283778,SPSI,Sinemet Cr 25/250Mg,,Per Svc,51.25
Chargemaster Item,,36283802,SPSI,Eletriptan 20Mg Po,,Per Svc,784.65
Chargemaster Item,,36283901,SPSI,Fluoxetine 90Mg Po,,Per Svc,138.10
Chargemaster Item,,36283927,SPSI,Reteplase 10 Unit Inj Kit,,Per Svc,2496.95
Chargemaster Item,,36283950,SPSI,Fluoxetine 20Mg Oral Liq,,Per Svc,74.05
Chargemaster Item,,36283984,SPSI,Meloxicam 15Mg Po,,Per Svc,36.95
Chargemaster Item,,36284008,SPSI,Magnesium Sulf 1 Gm,,Per Svc,15.10
Chargemaster Item,,36284016,SPSI,Gabapentin 600mG PO,,Per Svc,19.20
Chargemaster Item,,36284024,SPSI,Magnesiun Sulf 2 Gm 50 mL,,Per Svc,402.50
Chargemaster Item,,36284032,SPSI,Gabapentin 250mG Oral Liq,,Per Svc,159.40
Chargemaster Item,,36284040,SPSI,Gabapentin 400mG PO,,Per Svc,12.80
Chargemaster Item,,36284057,SPSI,Magnesium Sulf 4 Gm / 50mL,,Per Svc,102.15
Chargemaster Item,,36284065,SPSI,Magnesium Sulf 5 Gm,,Per Svc,208.55
Chargemaster Item,,36284073,SPSI,Divalproex 125Mg Sprinkle Po,,Per Svc,10.00
Chargemaster Item,,36284081,SPSI,Magnesium Sulf 10 Gm,,Per Svc,1901.50
Chargemaster Item,,36284099,SPSI,Naloxone 2mG Inj,,Per Svc,415.80
Chargemaster Item,,36284107,SPSI,Divalproex 250Mg Po,,Per Svc,70.85
Chargemaster Item,,36284115,SPSI,Divalproex 125Mg Po,,Per Svc,29.90
Chargemaster Item,,36284123,SPSI,Divalproex 500Mg Po,,Per Svc,39.05
Chargemaster Item,,36284131,SPSI,Magnesium Sulf 20 Gm / 500mL,,Per Svc,70.55
Chargemaster Item,,36284149,SPSI,Phenytoin 100mG Inj,,Per Svc,16.90
Chargemaster Item,,36284156,SPSI,Valproate 250mg Oral Liq,,Per Svc,22.70
Chargemaster Item,,36284164,SPSI,Phenytoin 250mG Inj,,Per Svc,51.05
Chargemaster Item,,36284198,SPSI,Narcan 1Mg Inj (See 36284099),,Per Svc,250.00
Chargemaster Item,,36284214,SPSI,Klonopin 0.5Mg,,Per Svc,10.00
Chargemaster Item,,36284222,SPSI,Clonazepam 1Mg Po,,Per Svc,10.00
Chargemaster Item,,36284230,SPSI,Valproic Acid 250Mg Po,,Per Svc,18.50
Chargemaster Item,,36284248,SPSI,Phenytoin 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36284255,SPSI,Phenytoin 100mg Po,,Per Svc,10.00
Chargemaster Item,,36284263,SPSI,Phenytoin 100Mg Oral Susp,,Per Svc,90.70
Chargemaster Item,,36284271,SPSI,Retacrit 10000U esrd,,Per Svc,1389.80
Chargemaster Item,,36284305,SPSI,Phenytoin 50mg Inj,,Per Svc,10.00
Chargemaster Item,,36284321,SPSI,Phenytoin 30Mg Po,,Per Svc,10.00
Chargemaster Item,,36284388,SPSI,Fluoxetine 20 Mg Po,,Per Svc,26.05
Chargemaster Item,,36284420,SPSI,Celecoxib 100Mg Po,,Per Svc,48.50
Chargemaster Item,,36284495,SPSI,Toradol 30Mg (See 36283299),,Per Svc,102.70
Chargemaster Item,,36284511,SPSI,Primidone 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36284545,SPSI,Magnesium Sulfate 500Mg Inj,,Per Svc,104.60
Chargemaster Item,,36284552,SPSI,Primidone 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36284602,SPSI,Oxcarbazepine 150Mg Po,,Per Svc,15.85
Chargemaster Item,,36284610,SPSI,Oxcarbazepine 300Mg Po,,Per Svc,24.25
Chargemaster Item,,36284628,SPSI,Oxcarbazepine 300Mg Oral Susp,,Per Svc,57.35
Chargemaster Item,,36284644,SPSI,Zolpidem 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36284651,SPSI,Fluoxetine 10Mg Po,,Per Svc,12.40
Chargemaster Item,,36284701,SPSI,Ethosuximide 250Mg Po,,Per Svc,46.60
Chargemaster Item,,36284719,SPSI,Ethosuximide 250Mg Oral Liq,,Per Svc,26.05
Chargemaster Item,,36285153,SPSI,Nortriptyline 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36285161,SPSI,Nortriptyline 125Mg Po,,Per Svc,10.00
Chargemaster Item,,36285179,SPSI,Pancrease Po,,Per Svc,21.95
Chargemaster Item,,36285203,SPSI,Amitriptyline 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36285252,SPSI,Amitriptyline 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36285401,SPSI,Amitriptylline 100Mg Po,,Per Svc,19.10
Chargemaster Item,,36285518,SPSI,Eucerin Cream 40Z,,Per Svc,53.85
Chargemaster Item,,36285617,SPSI,Trazodone 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36285633,SPSI,Norfloxacin 400Mg Po,,Per Svc,67.65
Chargemaster Item,,36285641,SPSI,Nasalcrom 1-Each,,Per Svc,110.90
Chargemaster Item,,36285690,SPSI,Doxepin 10Mg Oral Liq,,Per Svc,6.50
Chargemaster Item,,36285757,SPSI,Doxepin 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36285773,SPSI,Doxepin 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36285815,SPSI,Desipramine 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36285823,SPSI,Desipramine 50Mg Po,,Per Svc,27.55
Chargemaster Item,,36285831,SPSI,Imipramine 10Mg Po,,Per Svc,103.00
Chargemaster Item,,36285856,SPSI,Imipramine 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36285872,SPSI,Thiothixene 2Mg Po,,Per Svc,88.10
Chargemaster Item,,36285880,SPSI,Thiothixene 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36285914,SPSI,Amitriptyl/Perphenaz 2/10Mg Po,,Per Svc,81.90
Chargemaster Item,,36285922,SPSI,Amitriptyl/Perphenaz 2/25Mg Po,,Per Svc,21.05
Chargemaster Item,,36285963,SPSI,Vivactil 5Mg,,Per Svc,60.15
Chargemaster Item,,36286003,SPSI,Lorazepam 2mG Inj a,,Per Svc,73.40
Chargemaster Item,,36286011,SPSI,Haldol 1/2 Mg,,Per Svc,10.00
Chargemaster Item,,36286029,SPSI,Lorazepam 20mG Inj,,Per Svc,417.40
Chargemaster Item,,36286037,SPSI,Haloperidol 2Mg O,,Per Svc,11.45
Chargemaster Item,,36286045,SPSI,Haloperidol 5Mg Po,,Per Svc,15.65
Chargemaster Item,,36286052,SPSI,Haloperidol 10Mg Po,,Per Svc,79.20
Chargemaster Item,,36286060,SPSI,Haloperidol 5mg Inj,,Per Svc,75.50
Chargemaster Item,,36286078,SPSI,Hyroxyzine 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36286086,SPSI,Hydroxyzine 25Mg Po,,Per Svc,39.40
Chargemaster Item,,36286128,SPSI,Hydroxyzine 10Mg Oral Liq,,Per Svc,36.45
Chargemaster Item,,36286144,SPSI,Lorazepam 0.5Mg Po,,Per Svc,10.00
Chargemaster Item,,36286151,SPSI,Lorazepam 1Mg Po,,Per Svc,10.00
Chargemaster Item,,36286193,SPSI,Desipramine 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36286201,SPSI,Chlordiazepoxide 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36286268,SPSI,Lorazepam 2mg Inj,,Per Svc,28.10
Chargemaster Item,,36286300,SPSI,Chlordiazepoxide 25Mg Po,,Per Svc,56.50
Chargemaster Item,,36286342,SPSI,Lithium 300Mg Po,,Per Svc,10.00
Chargemaster Item,,36286359,SPSI,Haloperidol 10Mg Oral Liq,,Per Svc,40.00
Chargemaster Item,,36286383,SPSI,Quetiapine 25Mg Po,,Per Svc,39.70
Chargemaster Item,,36286391,SPSI,Quetiapine 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36286409,SPSI,Quetiapine 200Mg Po,,Per Svc,11.95
Chargemaster Item,,36286417,SPSI,Quetiapine 300Mg Po,,Per Svc,65.10
Chargemaster Item,,36286425,SPSI,Olanzapine 5Mg Po,,Per Svc,138.80
Chargemaster Item,,36286433,SPSI,Olanzapine 2.5Mg Po,,Per Svc,117.60
Chargemaster Item,,36286441,SPSI,Olanzapine 10Mg Po,,Per Svc,209.15
Chargemaster Item,,36286482,SPSI,Carbamazepine 300Mg Po,,Per Svc,20.05
Chargemaster Item,,36286508,SPSI,Lithium 300Mg Oral Sol,,Per Svc,10.00
Chargemaster Item,,36286573,SPSI,Carbamazepine Xr 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36286581,SPSI,Tramadol/Acetaminophen 37.5/325Mg Po,,Per Svc,22.15
Chargemaster Item,,36286599,SPSI,Carbamazepine Xr 200Mg Po,,Per Svc,20.05
Chargemaster Item,,36286656,SPSI,Chlordiazepoxide/Clidinium 5Mg/2.5Mg Po,,Per Svc,10.00
Chargemaster Item,,36286706,SPSI,Thioridazine 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36286714,SPSI,Indapamide 2.5Mg Po,,Per Svc,16.30
Chargemaster Item,,36286730,SPSI,Thioridazine 25Mg Po Oral Liq,,Per Svc,44.50
Chargemaster Item,,36286755,SPSI,Thioridazine 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36286821,SPSI,Thioridazine 100Mg Po,,Per Svc,12.50
Chargemaster Item,,36286896,SPSI,Fluphenazine 250Mg Inj,,Per Svc,2304.75
Chargemaster Item,,36286912,SPSI,Fluphenazine 1Mg Po,,Per Svc,10.00
Chargemaster Item,,36286938,SPSI,Fluphenazine 5Mg Po,,Per Svc,11.95
Chargemaster Item,,36286953,SPSI,Serax 10Mg Cap,,Per Svc,19.75
Chargemaster Item,,36287001,SPSI,Oxazepam 15Mg Po,,Per Svc,10.00
Chargemaster Item,,36287019,SPSI,Chlorpromazine 5mG PO a,,Per Svc,85.45
Chargemaster Item,,36287027,SPSI,Chlorpromazine 10mG PO,,Per Svc,45.15
Chargemaster Item,,36287035,SPSI,Diazepam 10mG Inj,,Per Svc,77.20
Chargemaster Item,,36287043,SPSI,Diazepam 50mG Inj,,Per Svc,2489.50
Chargemaster Item,,36287100,SPSI,Trifluoperazine 1Mg Po,,Per Svc,10.00
Chargemaster Item,,36287118,SPSI,Apripirazole 2mG PO,,Per Svc,192.70
Chargemaster Item,,36287175,SPSI,Stelazine 10Mg/Ml Conc 1 Dose,,Per Svc,63.75
Chargemaster Item,,36287209,SPSI,Trifluoperazine 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36287217,SPSI,Clorazepate 7.5Mg Po,,Per Svc,65.40
Chargemaster Item,,36287241,SPSI,Chlorpromazine 100Mg Po,,Per Svc,11.55
Chargemaster Item,,36287258,SPSI,Chlorpromazine 25mG PO,,Per Svc,10.00
Chargemaster Item,,36287266,SPSI,Thorazine 10Mg Po,,Per Svc,66.95
Chargemaster Item,,36287290,SPSI,Chlorpromazine 10Mg Oral Liq,,Per Svc,66.95
Chargemaster Item,,36287357,SPSI,Chlorpromazine 25Mg Inj,,Per Svc,331.15
Chargemaster Item,,36287365,SPSI,Alprazolam 1Mg Po,,Per Svc,14.70
Chargemaster Item,,36287407,SPSI,Thorazine Inj,,Per Svc,282.05
Chargemaster Item,,36287423,SPSI,Trilafon 4Mg Tab,,Per Svc,19.75
Chargemaster Item,,36287449,SPSI,Alprazolam 0.5Mg Po,,Per Svc,23.90
Chargemaster Item,,36287456,SPSI,Diazepam 2mG PO,,Per Svc,17.85
Chargemaster Item,,36287498,SPSI,Alprazolam 0.25mG PO,,Per Svc,18.25
Chargemaster Item,,36287506,SPSI,Diazepam 5Mg Po,,Per Svc,35.60
Chargemaster Item,,36287514,SPSI,Halcion .125Mg Tab,,Per Svc,10.00
Chargemaster Item,,36287522,SPSI,Midazolam 10Mg Oral Liq,,Per Svc,51.25
Chargemaster Item,,36287548,SPSI,Midazolam 2Mg Oral Liq,,Per Svc,68.30
Chargemaster Item,,36287605,SPSI,Diazepam 5Mg Inj,,Per Svc,304.50
Chargemaster Item,,36287647,SPSI,Vermox 100Mg,,Per Svc,161.80
Chargemaster Item,,36287696,SPSI,Modafinil 200Mg Po,,Per Svc,418.95
Chargemaster Item,,36287720,SPSI,Diazepam 5Mg Oral Liq,,Per Svc,25.60
Chargemaster Item,,36287803,SPSI,Hydroxyzine 100Mg Inj,,Per Svc,445.30
Chargemaster Item,,36287852,SPSI,Tramadol 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36287902,SPSI,Venlafaxine 37.5Mg Po,,Per Svc,21.00
Chargemaster Item,,36287928,SPSI,Venlafaxine 50Mg Po,,Per Svc,22.15
Chargemaster Item,,36287936,SPSI,Venlafaxine 75Mg Po,,Per Svc,82.55
Chargemaster Item,,36287944,SPSI,Venlafaxine Xr 37.5Mg Po,,Per Svc,46.85
Chargemaster Item,,36287951,SPSI,Venlafaxine Xr 75Mg Po,,Per Svc,78.35
Chargemaster Item,,36287985,SPSI,Chlorpromazine 5mg PO,,Per Svc,103.05
Chargemaster Item,,36288017,SPSI,Everolumus 2.5mG Po,,Per Svc,1973.60
Chargemaster Item,,36288041,SPSI,Doxapram 400mG Inj,,Per Svc,610.05
Chargemaster Item,,36288256,SPSI,Dextroamphentamine 5Mg Po,,Per Svc,20.50
Chargemaster Item,,36288306,SPSI,Methylphenidate 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36288470,SPSI,Esmolol 250mG / 250mL,,Per Svc,2806.05
Chargemaster Item,,36288488,SPSI,Esmolol 100Mg Inj,,Per Svc,181.25
Chargemaster Item,,36288520,SPSI,Methohexital 500Mg Inj,,Per Svc,893.45
Chargemaster Item,,36288587,SPSI,Chloral Hydrate 500Mg Oral Liq,,Per Svc,43.45
Chargemaster Item,,36288595,SPSI,Flurazepam 15Mg Po,,Per Svc,63.55
Chargemaster Item,,36288769,SPSI,Pentobarbital 100 mG Inj,,Per Svc,688.25
Chargemaster Item,,36288892,SPSI,Phenobarbital 32.4 mG PO,,Per Svc,10.00
Chargemaster Item,,36288926,SPSI,Phenobarbital 60Mg Po,,Per Svc,19.10
Chargemaster Item,,36288942,SPSI,Phenobarbital 20Mg Oral Liq,,Per Svc,10.20
Chargemaster Item,,36288959,SPSI,Phenobarbital 60Mg Inj,,Per Svc,211.85
Chargemaster Item,,36288983,SPSI,Phenobarbital 130mG,,Per Svc,45.55
Chargemaster Item,,36288991,SPSI,Phenobarbital 10Mg Inj,,Per Svc,42.30
Chargemaster Item,,36289007,SPSI,Fosphenytoin 100mG Inj,,Per Svc,169.10
Chargemaster Item,,36289015,SPSI,Atomoxetine 80mg Po,,Per Svc,194.65
Chargemaster Item,,36289023,SPSI,Fosphenytoin 500mG Inj,,Per Svc,1253.90
Chargemaster Item,,36289031,SPSI,Phenobarbital 65mG,,Per Svc,274.90
Chargemaster Item,,36289049,SPSI,Midazolam 2mG Inj,,Per Svc,10.00
Chargemaster Item,,36289056,SPSI,Fosphenytoin 50Mg Inj,,Per Svc,353.60
Chargemaster Item,,36289064,SPSI,Midazolam 5mG 1mL Inj,,Per Svc,17.10
Chargemaster Item,,36289072,SPSI,Entacapone 200Mg Po,,Per Svc,71.50
Chargemaster Item,,36289080,SPSI,Stalevo 100 200/100,,Per Svc,96.40
Chargemaster Item,,36289098,SPSI,Carbidop/Levodop/Entacap 12.5/50/200Mg Po,,Per Svc,96.40
Chargemaster Item,,36289106,SPSI,Pramipexole 0,25mG PO,,Per Svc,26.90
Chargemaster Item,,36289114,SPSI,Pramipexole 0.5Mg Po,,Per Svc,33.70
Chargemaster Item,,36289122,SPSI,Pramipexole 0.125Mg Po,,Per Svc,22.15
Chargemaster Item,,36289130,SPSI,Midazolam 5mG 5mL Inj,,Per Svc,12.30
Chargemaster Item,,36289148,SPSI,Pramipexole 1Mg Po,,Per Svc,70.30
Chargemaster Item,,36289155,SPSI,Memanitine 5Mg Po,,Per Svc,93.35
Chargemaster Item,,36289163,SPSI,Midazolam 10mG Inj,,Per Svc,14.70
Chargemaster Item,,36289171,SPSI,Atomoxetine 10Mg Po,,Per Svc,166.10
Chargemaster Item,,36289189,SPSI,Atomoxetine 25Mg Po,,Per Svc,149.40
Chargemaster Item,,36289197,SPSI,Rizatriptan 10Mg Po,,Per Svc,397.30
Chargemaster Item,,36289205,SPSI,Ropinirole 0.25Mg Po,,Per Svc,10.00
Chargemaster Item,,36289213,SPSI,Ropinirole 1Mg Po,,Per Svc,10.00
Chargemaster Item,,36289221,SPSI,Ropinirole 2Mg Po,,Per Svc,31.80
Chargemaster Item,,36289239,SPSI,Midazolam 50mG Inj,,Per Svc,85.25
Chargemaster Item,,36289247,SPSI,Propofol 200mG Inj,,Per Svc,53.95
Chargemaster Item,,36289254,SPSI,Ropinirole 0.5Mg Po,,Per Svc,22.15
Chargemaster Item,,36289262,SPSI,Atomoxetine 60Mg Po,,Per Svc,180.40
Chargemaster Item,,36289270,SPSI,Propofol 1000mG Inj,,Per Svc,269.45
Chargemaster Item,,36289320,SPSI,Temazepam 15Mg Po,,Per Svc,10.00
Chargemaster Item,,36289502,SPSI,Pentothal 25Mg/Ml 500Mg Syring,,Per Svc,325.65
Chargemaster Item,,36289551,SPSI,Surital 5g Inj,,Per Svc,290.40
Chargemaster Item,,36289569,SPSI,Propofol 1Gm 100Ml,,Per Svc,308.35
Chargemaster Item,,36289577,SPSI,Propofol 10mg IV,,Per Svc,30.55
Chargemaster Item,,36289593,SPSI,Etomidate 20Mg Inj,,Per Svc,123.60
Chargemaster Item,,36289809,SPSI,Midazolam 1mg Inj,,Per Svc,26.40
Chargemaster Item,,36289908,SPSI,Risperdone 0.25Mg Po,,Per Svc,37.60
Chargemaster Item,,36289932,SPSI,Risperidone 1Mg Oral Liq,,Per Svc,1760.55
Chargemaster Item,,36289940,SPSI,Risperdone .05Mg Po,,Per Svc,43.90
Chargemaster Item,,36290112,SPSI,Smolflipid 20% 100mL,,Per Svc,13.85
Chargemaster Item,,36290229,SPSI,Cetacaine 5Gm,,Per Svc,661.70
Chargemaster Item,,36290336,SPSI,Ephedrine 5mG/mL 5mL,,Per Svc,99.75
Chargemaster Item,,36290443,SPSI,Digoxin 50mCg/mL Po,,Per Svc,28.15
Chargemaster Item,,36291003,SPSI,Romiplostim 500mCg,,Per Svc,13232.00
Chargemaster Item,,36293005,SPSI,Nafcillin D5W 20mG mL 1mL,,Per Svc,10.00
Chargemaster Item,,36296002,SPSI,Enzalutamide 40mG Po,,Per Svc,496.20
Chargemaster Item,,36296010,SPSI,Everolumus 7.5mG Po,,Per Svc,2064.40
Chargemaster Item,,36298123,SPSI,Zidovudine 10mG/mL 1mL Po,,Per Svc,10.00
Chargemaster Item,,36299006,SPSI,Lanreotide 120mG Inj,,Per Svc,47802.00
Chargemaster Item,,36299014,SPSI,AA5%/Ca/lytes/dex20% 1000mL,,Per Svc,498.35
Chargemaster Item,,36301000,SPSI,Epoprostenol 12,500 nG Inj,,Per Svc,487.55
Chargemaster Item,,36301125,SPSI,Epoprostenol 5000nG/50mL Inj,,Per Svc,248.85
Chargemaster Item,,36301133,SPSI,Epi 0.025%/Lido 0.75% 0.8mL Syr,,Per Svc,280.00
Chargemaster Item,,36302008,SPSI,Tranexamic Acid 500mG/10mL Liq,,Per Svc,193.40
Chargemaster Item,,36303121,SPSI,5% Dextrose 50mL Syringe,,Per Svc,123.45
Chargemaster Item,,36304004,SPSI,Everolumus 2mG Po,,Per Svc,1963.60
Chargemaster Item,,36307007,SPSI,Lanreotide 60mG Inj,,Per Svc,16348.00
Chargemaster Item,,36315000,SPSI,Ferric Carboxymaltose 750mG Inj,,Per Svc,6714.05
Chargemaster Item,,36315018,SPSI,Ferric Carboxymaltose 750mG/15 mL,,Per Svc,2897.55
Chargemaster Item,,36315026,SPSI,Lanreotide 90mG Inj,,Per Svc,21772.00
Chargemaster Item,,36316032,SPSI,Propranol/D5W 0.1mG/mL Inj 1mL,,Per Svc,10.10
Chargemaster Item,,36320000,SPSI,Everolumus 3mG Po,,Per Svc,1983.40
Chargemaster Item,,36324002,SPSI,Netupitant/Palonosetron Hcl 300mG/0.5mG Po,,Per Svc,1055.20
Chargemaster Item,,36330009,SPSI,Vasopressin 0.1 Unit/ml,,Per Svc,102.05
Chargemaster Item,,36333003,SPSI,Carmustine 100mG Inj,,Per Svc,13990.60
Chargemaster Item,,36335008,SPSI,Brentuximab Vedotin 50mG,,Per Svc,47760.00
Chargemaster Item,,36337012,SPSI,Pegfilgrastim 6mg/0.6mL Kit,,Per Svc,37386.35
Chargemaster Item,,36338010,SPSI,Insulin Regular, human 3mL Inj,,Per Svc,1284.70
Chargemaster Item,,36338515,SPSI,Velaglucerase 400 units,,Per Svc,8262.00
Chargemaster Item,,36342004,SPSI,Testosterone Enanthate 200mG Inj,,Per Svc,381.00
Chargemaster Item,,36343002,SPSI,Talc Sterile 3 Gm,,Per Svc,1312.50
Chargemaster Item,,36345007,SPSI,Phytonadione 2.5mG Oral Liq,,Per Svc,30.35
Chargemaster Item,,36345015,SPSI,Phytonadione 2.5mG 2.5mL Oral Liq 2.5mL,,Per Svc,202.60
Chargemaster Item,,36346005,SPSI,Nilotinib Hcl 200mG Po,,Per Svc,402.60
Chargemaster Item,,36353001,SPSI,Nilotinib Hcl 150mG Po,,Per Svc,402.60
Chargemaster Item,,36357002,SPSI,Fat Emulsion 20% 1Gm 5mL,,Per Svc,31.70
Chargemaster Item,,36360089,SPSI,Isosulfan Blue 1MG,,Per Svc,211.75
Chargemaster Item,,36360113,SPSI,Corticotropin 40 Units Inj,,Per Svc,333.75
Chargemaster Item,,36360261,SPSI,Fluorescein 10% 5Ml Inj,,Per Svc,586.95
Chargemaster Item,,36360352,SPSI,Ppd 1 Tu,,Per Svc,71.30
Chargemaster Item,,36360402,SPSI,Tuberculin 5Units Inj,,Per Svc,39.60
Chargemaster Item,,36360600,SPSI,Indigotindisulfonate 0.8% 5Ml Inj,,Per Svc,194.05
Chargemaster Item,,36360931,SPSI,Sincalide 5mCg,,Per Svc,1274.70
Chargemaster Item,,36360949,SPSI,Arginine 10% 300Ml Inj,,Per Svc,469.15
Chargemaster Item,,36360956,SPSI,Fluorescein Strip,,Per Svc,10.00
Chargemaster Item,,36360964,SPSI,Methacholine 100mG,,Per Svc,945.00
Chargemaster Item,,36361004,SPSI,Ethiodized 37% Oil 10Ml Inj,,Per Svc,124.30
Chargemaster Item,,36361103,SPSI,Arginine 10% 5Ml Oral Liq,,Per Svc,10.00
Chargemaster Item,,36361202,SPSI,Indocyanine Green 25mg Inj,,Per Svc,1522.30
Chargemaster Item,,36361806,SPSI,Regadenosan 0.4mG,,Per Svc,3061.30
Chargemaster Item,,36363018,SPSI,Furosemide 10mG mL 1mL Inj,,Per Svc,33.35
Chargemaster Item,,36364008,SPSI,Imiglucerase 400 Units Inj,,Per Svc,6344.00
Chargemaster Item,,36365005,SPSI,Metoprolol 12.5mG Tab,,Per Svc,10.00
Chargemaster Item,,36366003,SPSI,Atezolizumab 840mG/14mL Inj,,Per Svc,38614.90
Chargemaster Item,,36368504,SPSI,Pen G Sod D5W 0.05mmU mL 1mL,,Per Svc,10.00
Chargemaster Item,,36368694,SPSI,Albuterol 1.25mG/3mL 0.042%Inh,,Per Svc,17.45
Chargemaster Item,,36370005,SPSI,Methimazole 5mG/1.7mL PO,,Per Svc,10.70
Chargemaster Item,,36370013,SPSI,Digoxin/D5W 25mCg/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36380004,SPSI,Morphine 2mG/mL Oral,,Per Svc,10.00
Chargemaster Item,,36380111,SPSI,Morphine 0.4mG/mL Oral,,Per Svc,10.00
Chargemaster Item,,36381127,SPSI,Ropivacaine 0.2% 100mL Inj,,Per Svc,498.75
Chargemaster Item,,36383008,SPSI,Alpha1 Protein Inhib (Human),,Per Svc,13.55
Chargemaster Item,,36386878,SPSI,Clindamycin 18mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36388122,SPSI,Bacteriostatic water 30mL,,Per Svc,14.30
Chargemaster Item,,36392009,SPSI,Pralatrexate 40mG Inj,,Per Svc,21649.40
Chargemaster Item,,36396000,SPSI,Leuprolide Acetate 30mG Inj,,Per Svc,2152.20
Chargemaster Item,,36397008,SPSI,Trametinib Dimethyl Sulfoxide 0.5mG Po,,Per Svc,549.00
Chargemaster Item,,36400000,SPSI,Aldactazide 5mG 5mL Oral Sol,,Per Svc,10.00
Chargemaster Item,,36400109,SPSI,Instant Glucos,,Per Svc,43.20
Chargemaster Item,,36400117,SPSI,Potassium Citrate 5Meq Po,,Per Svc,56.05
Chargemaster Item,,36400216,SPSI,Ammonium Chloride 100Meq/20Ml,,Per Svc,329.70
Chargemaster Item,,36400257,SPSI,Sodium Bicarbonate 650Mg Po,,Per Svc,10.00
Chargemaster Item,,36400265,SPSI,Sodium Bicarb 5Gr,,Per Svc,0.05
Chargemaster Item,,36400273,SPSI,Bicitra 30Ml Oral Sol,,Per Svc,31.30
Chargemaster Item,,36400299,SPSI,Citric Acid/Potassium Citrate 30Ml Oral Liq,,Per Svc,49.05
Chargemaster Item,,36400307,SPSI,Kayexalate Ene,,Per Svc,595.35
Chargemaster Item,,36400315,SPSI,Bicitra 15Ml,,Per Svc,73.00
Chargemaster Item,,36400323,SPSI,Kayexalate Oral 1 Dose,,Per Svc,110.65
Chargemaster Item,,36400331,SPSI,Cal Glubionate Oral Liq 30ml,,Per Svc,10.00
Chargemaster Item,,36400349,SPSI,Bumetanide 1mg Inj,,Per Svc,35.60
Chargemaster Item,,36400356,SPSI,Potassium Citrate 10Meq Po,,Per Svc,11.85
Chargemaster Item,,36400398,SPSI,Spironolactone 100Mg Po,,Per Svc,14.70
Chargemaster Item,,36400406,SPSI,Spironolactone 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36400414,SPSI,Spironolactone 4Mg Oral Sol,,Per Svc,10.00
Chargemaster Item,,36400455,SPSI,Acetazolamide 250mg Po,,Per Svc,10.00
Chargemaster Item,,36400489,SPSI,Acetic Acid 2% Otic Drops 15ml,,Per Svc,189.00
Chargemaster Item,,36400505,SPSI,Acetazolamide 500Mg Inj (Diamox),,Per Svc,346.70
Chargemaster Item,,36400513,SPSI,Acetazolamide 500Mg Inj,,Per Svc,522.90
Chargemaster Item,,36400612,SPSI,Chlorothiazide 500Mg Inj,,Per Svc,1309.90
Chargemaster Item,,36400638,SPSI,Chlorothiazide 50Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36400653,SPSI,Triamterene/Hctz 37.5/25 Po,,Per Svc,10.00
Chargemaster Item,,36400695,SPSI,Triamterene 50Mg Po,,Per Svc,120.75
Chargemaster Item,,36400703,SPSI,Triamterene 100Mg Po,,Per Svc,116.50
Chargemaster Item,,36400752,SPSI,Ethacrynic 25Mg Po,,Per Svc,307.95
Chargemaster Item,,36400851,SPSI,Ethacrynate 50Mg Inj,,Per Svc,22794.00
Chargemaster Item,,36400943,SPSI,Calcium Acetate 667Mg Po,,Per Svc,11.35
Chargemaster Item,,36400968,SPSI,Metolazone 1Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36401008,SPSI,Furosemide 20mG Inj a,,Per Svc,55.00
Chargemaster Item,,36401016,SPSI,Cal Glubionate 5ml Oral Liq,,Per Svc,0.65
Chargemaster Item,,36401024,SPSI,Furosemide 40mG Inj,,Per Svc,38.65
Chargemaster Item,,36401032,SPSI,Furosemide 100mG Inj,,Per Svc,76.85
Chargemaster Item,,36401057,SPSI,Hydrochlorothiazide 25Mg Po,,Per Svc,35.60
Chargemaster Item,,36401073,SPSI,Sod Chloride 3% 15ml Inhal,,Per Svc,10.00
Chargemaster Item,,36401123,SPSI,Magnesium Carbonate 1Gm / 5mL Liq,,Per Svc,10.00
Chargemaster Item,,36401131,SPSI,Cal Carbonate 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36401149,SPSI,Chlorthalidone 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36401164,SPSI,Lanthanum 500Mg,,Per Svc,151.30
Chargemaster Item,,36401206,SPSI,Zinc Gluconate 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36401248,SPSI,Bumetanide 1Mg Po,,Per Svc,13.65
Chargemaster Item,,36401255,SPSI,Furosemide 20mG PO,,Per Svc,10.00
Chargemaster Item,,36401271,SPSI,Furosemide 40Mg Oral Liq,,Per Svc,25.85
Chargemaster Item,,36401289,SPSI,Sod Chloride 10% 15ml Inhal,,Per Svc,10.00
Chargemaster Item,,36401297,SPSI,Chromic 40meq 10ml,,Per Svc,246.25
Chargemaster Item,,36401305,SPSI,Furosemide 40Mg Po,,Per Svc,10.00
Chargemaster Item,,36401404,SPSI,Furosemide 20mg Inj,,Per Svc,101.25
Chargemaster Item,,36401545,SPSI,Potassium Phosphate 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36401578,SPSI,Medium Chain Triglycerides 5Ml,,Per Svc,67.60
Chargemaster Item,,36401594,SPSI,Triamterene/Hctz 50/25 Po,,Per Svc,29.50
Chargemaster Item,,36401602,SPSI,Mannitol 25% 12.5Gm 50Ml,,Per Svc,28.75
Chargemaster Item,,36401644,SPSI,Methazolamide 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36401669,SPSI,Amiloride/Hctz 5Mg/50Mg Po,,Per Svc,46.35
Chargemaster Item,,36401677,SPSI,NeutraPhos 250mG Pkt,,Per Svc,685.25
Chargemaster Item,,36401685,SPSI,NeutraPhos 250mG PO,,Per Svc,10.00
Chargemaster Item,,36401800,SPSI,Metolazone 2.5Mg Po,,Per Svc,10.00
Chargemaster Item,,36401818,SPSI,Metolazone 5Mg Po,,Per Svc,15.55
Chargemaster Item,,36401826,SPSI,Calcium Citrate 950Mg Po,,Per Svc,10.00
Chargemaster Item,,36401859,SPSI,Cal Gluconate 100Mg Oral Liq,,Per Svc,2.00
Chargemaster Item,,36401875,SPSI,Cal Citrate 200Mg Po,,Per Svc,0.10
Chargemaster Item,,36401883,SPSI,Furosemide 5Mg Oral Liq,,Per Svc,10.00
Chargemaster Item,,36402006,SPSI,Potassium Chloride 2mEq PO,,Per Svc,12.60
Chargemaster Item,,36402014,SPSI,Potassium Chl 20mEq / D5NS 1000mL,,Per Svc,105.40
Chargemaster Item,,36402022,SPSI,Potassium Chl 20mEq/D5N45 1000mL,,Per Svc,63.85
Chargemaster Item,,36402030,SPSI,Potassium Chl 10mEq/D5N45 1000mL,,Per Svc,109.20
Chargemaster Item,,36402048,SPSI,Potassium Chl 20mEq /NS 1000mL,,Per Svc,105.40
Chargemaster Item,,36402055,SPSI,Potassium Chl 30mEq/ D5N45 1000mL,,Per Svc,96.60
Chargemaster Item,,36402063,SPSI,Potassium Chl 40mEq/D5N45 1000mL,,Per Svc,105.55
Chargemaster Item,,36402071,SPSI,Potassium Chl 20mEq/50mL,,Per Svc,32.80
Chargemaster Item,,36402089,SPSI,Potassium Chl 40mEq/100mL,,Per Svc,43.80
Chargemaster Item,,36402097,SPSI,Potassium Chl 20mEq/100mL,,Per Svc,44.10
Chargemaster Item,,36402105,SPSI,Potassium Chl 20mEq/N45 1000mL,,Per Svc,78.10
Chargemaster Item,,36402162,SPSI,Potassium Chloride 10mEq PO,,Per Svc,10.00
Chargemaster Item,,36402170,SPSI,Potassium Chloride 20Meq Po,,Per Svc,10.00
Chargemaster Item,,36402188,SPSI,Sodium Chloride 23.4% 30Ml Inj,,Per Svc,23.60
Chargemaster Item,,36402196,SPSI,Ethyl Alcohol 98% 1Ml,,Per Svc,466.20
Chargemaster Item,,36402220,SPSI,Conivaptan 20mG / 100mL,,Per Svc,4094.70
Chargemaster Item,,36402238,SPSI,Arginine/Glutamine/Calcium Hmb 19.3Gm,,Per Svc,55.20
Chargemaster Item,,36402246,SPSI,Torsemide 50mG,,Per Svc,118.35
Chargemaster Item,,36402253,SPSI,Torsemide 20Mg Po,,Per Svc,10.00
Chargemaster Item,,36402261,SPSI,Torsemide 5Mg Po,,Per Svc,16.05
Chargemaster Item,,36402287,SPSI,Lysine 10% 5Ml Oral Liq,,Per Svc,10.00
Chargemaster Item,,36402337,SPSI,Sodium Chloride1Gm Po,,Per Svc,10.00
Chargemaster Item,,36402352,SPSI,Potassium Chloride 8Meq Po,,Per Svc,10.00
Chargemaster Item,,36402394,SPSI,Beneprotein 6Gm Pkt,,Per Svc,2.30
Chargemaster Item,,36402402,SPSI,Multi-Trace Elements Neonatal,,Per Svc,134.50
Chargemaster Item,,36402410,SPSI,Hydrochlorothiazide 5Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36402428,SPSI,Protein 30Ml Liq,,Per Svc,12.65
Chargemaster Item,,36402436,SPSI,Potassium Acetate 40Meq Inj,,Per Svc,42.85
Chargemaster Item,,36402444,SPSI,Magnesium Chloride 64Mg Po,,Per Svc,10.00
Chargemaster Item,,36402493,SPSI,Potassium Chloride 2Meq Oral Liq,,Per Svc,69.75
Chargemaster Item,,36402535,SPSI,Potassium Phosphate 45Mmol Inj,,Per Svc,176.00
Chargemaster Item,,36402618,SPSI,Potassium Chlorider 10% 15Ml Oral Liq,,Per Svc,74.35
Chargemaster Item,,36402626,SPSI,Dextrose 10% 5Ml Inj,,Per Svc,83.40
Chargemaster Item,,36402659,SPSI,KCL 10% 15 ml,,Per Svc,195.30
Chargemaster Item,,36402691,SPSI,Bumetanide 0.25Mg Inj,,Per Svc,10.00
Chargemaster Item,,36402766,SPSI,Kcl 20% 15Ml,,Per Svc,1.50
Chargemaster Item,,36402774,SPSI,Sod Chloride 2-5 Meg Oral 1 Do,,Per Svc,2.15
Chargemaster Item,,36402782,SPSI,Sodium Chloride 12Meq Oral Liq,,Per Svc,10.00
Chargemaster Item,,36402808,SPSI,Sodium Chloride 0.9% 3Ml Neb,,Per Svc,10.00
Chargemaster Item,,36402816,SPSI,Calcitriol 0.7Mcg Oral Liq,,Per Svc,87.70
Chargemaster Item,,36402832,SPSI,Amiloride 5Mg Po,,Per Svc,13.15
Chargemaster Item,,36402857,SPSI,Selenium 400Mcg Inj,,Per Svc,232.70
Chargemaster Item,,36402865,SPSI,Multi-Trace Elements Ped,,Per Svc,141.10
Chargemaster Item,,36402873,SPSI,Multi-Trace Elements Adult,,Per Svc,562.30
Chargemaster Item,,36402881,SPSI,Cysteine 50Mg Inj,,Per Svc,104.20
Chargemaster Item,,36402907,SPSI,Potassium Chloride 2mEq Inj,,Per Svc,52.10
Chargemaster Item,,36402956,SPSI,Dextrose 25% 10Ml Inj,,Per Svc,105.30
Chargemaster Item,,36403103,SPSI,Probenecid 500Mg Po,,Per Svc,39.70
Chargemaster Item,,36403202,SPSI,Colbenemid 0.5Mg/5Gm Po,,Per Svc,172.50
Chargemaster Item,,36403335,SPSI,Epoprostenol 5,000 nG Inj,,Per Svc,568.80
Chargemaster Item,,36403343,SPSI,Heparin 1000U/mL Inj 2mL,,Per Svc,312.00
Chargemaster Item,,36404002,SPSI,Ramucirumab 500mG Inj,,Per Svc,4330.00
Chargemaster Item,,36406007,SPSI,Lurasidon 40mG Po,,Per Svc,513.85
Chargemaster Item,,36407005,SPSI,Cocaine Nasal Sol 4% 4mL,,Per Svc,3087.00
Chargemaster Item,,36408003,SPSI,Romidepsin 10mG Inj,,Per Svc,12060.25
Chargemaster Item,,36413128,SPSI,0.9% Sod Chl 10mL flush,,Per Svc,10.00
Chargemaster Item,,36414001,SPSI,Dopamine D5W 40mG Inj,,Per Svc,10.00
Chargemaster Item,,36415115,SPSI,0.9% Sod Chl 3mL flush,,Per Svc,10.00
Chargemaster Item,,36423671,SPSI,RYANODEX 250MG INJ,,Per Svc,14913.65
Chargemaster Item,,36425007,SPSI,Lorazepam 0.25mG Tab,,Per Svc,10.00
Chargemaster Item,,36429306,SPSI,Milrinone 0.1mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36430007,SPSI,Entresto 49/51mG Po,,Per Svc,106.90
Chargemaster Item,,36430015,SPSI,Meropenem 1Gm/50mL,,Per Svc,321.85
Chargemaster Item,,36432003,SPSI,Ado-Trastuzumab Emtansine 100mG Inj,,Per Svc,18375.65
Chargemaster Item,,36435006,SPSI,Tocilizumab 80mG Inj,,Per Svc,1418.40
Chargemaster Item,,36435014,SPSI,Bio-K+ 50 Billion Po,,Per Svc,24.90
Chargemaster Item,,36436004,SPSI,Aspirin 1mG/mL 325mL,,Per Svc,10.00
Chargemaster Item,,36440014,SPSI,Dornase 1Mg Nebulized Inhalation,,Per Svc,1134.10
Chargemaster Item,,36440022,SPSI,Hyaluronidase 150 Units,,Per Svc,703.10
Chargemaster Item,,36440030,SPSI,Ado-Trastuzumab Emtansine 160mG Inj,,Per Svc,29401.10
Chargemaster Item,,36440469,SPSI,Hyaluronidase 200 Units,,Per Svc,64.95
Chargemaster Item,,36440477,SPSI,Galsulfase 5Mg Vial,,Per Svc,7020.00
Chargemaster Item,,36443117,SPSI,Pot Phos 3mMol/1mL Po,,Per Svc,10.00
Chargemaster Item,,36444040,SPSI,Talc Sterile 4 Gm,,Per Svc,441.00
Chargemaster Item,,36447001,SPSI,Flulaval Quad Vac (6mos+),,Per Svc,423.90
Chargemaster Item,,36448009,SPSI,Meropenem 500mG/50mL,,Per Svc,237.50
Chargemaster Item,,36449007,SPSI,Triptorelin Pamoate 3.75mG Inj,,Per Svc,2188.40
Chargemaster Item,,36450005,SPSI,Tocilizumab 400mG Inj,,Per Svc,7091.20
Chargemaster Item,,36450013,SPSI,Tocilizumab 400mG 20mL Inj,,Per Svc,13834.80
Chargemaster Item,,36453009,SPSI,Baloxavir 40mG Tab 80mG dose,,Per Svc,2520.00
Chargemaster Item,,36454007,SPSI,Suboxone FLM 8mG/2mG SL,,Per Svc,113.20
Chargemaster Item,,36455004,SPSI,Ixazomib Citrate 2.3mG Po,,Per Svc,12024.00
Chargemaster Item,,36456014,SPSI,Pediatric TPN,,Per Svc,703.50
Chargemaster Item,,36460004,SPSI,Dasatinib 20mG Po,,Per Svc,3082.70
Chargemaster Item,,36463008,SPSI,Ixazomib Citrate 3mG Po,,Per Svc,12024.00
Chargemaster Item,,36464006,SPSI,Tocilizumab 162mG Inj,,Per Svc,3357.20
Chargemaster Item,,36466001,SPSI,Retacrit 4000U non-esrd,,Per Svc,556.00
Chargemaster Item,,36469013,SPSI,Povidone Iodne 5% Ophth 30mL,,Per Svc,208.15
Chargemaster Item,,36471001,SPSI,Ixazomib Citrate 4mG Po,,Per Svc,12024.00
Chargemaster Item,,36472009,SPSI,Altretamine 50mG Po,,Per Svc,68.40
Chargemaster Item,,36475002,SPSI,Avelumab 200mG/10mL Inj,,Per Svc,9867.20
Chargemaster Item,,36476000,SPSI,Tocilizumab 200mG Inj,,Per Svc,3545.60
Chargemaster Item,,36476125,SPSI,Ropivacaine 0.2% 20mL Inj,,Per Svc,63.00
Chargemaster Item,,36476133,SPSI,Tocilizumab 200mG 10mL Inj,,Per Svc,6917.40
Chargemaster Item,,36476146,SPSI,Insulin NPH human isophane 3mL Inj,,Per Svc,722.65
Chargemaster Item,,36480150,SPSI,Pedia Relief Cgh/Cold 5mL,,Per Svc,50.50
Chargemaster Item,,36480218,SPSI,Dextromethorphan 30Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36480234,SPSI,Benzoin Compound Tincture 60Ml,,Per Svc,71.30
Chargemaster Item,,36480267,SPSI,Hycodan Liq 1 Dose,,Per Svc,129.90
Chargemaster Item,,36480309,SPSI,Mucomyst 10%,,Per Svc,46.15
Chargemaster Item,,36480358,SPSI,Acetylcysteine 20% 30Ml,,Per Svc,136.90
Chargemaster Item,,36480374,SPSI,Dimetane Dc 1 Dose,,Per Svc,45.95
Chargemaster Item,,36480481,SPSI,Lortab Liq 25Mg/5Ml 1 Dose,,Per Svc,70.30
Chargemaster Item,,36480556,SPSI,Promethazine Vc/Cod 5Ml,,Per Svc,23.30
Chargemaster Item,,36480606,SPSI,Promethazine 6.25Mg Oral Liq,,Per Svc,10.00
Chargemaster Item,,36480622,SPSI,Promethazine/Dextromethor 5Ml Oral Liq,,Per Svc,10.00
Chargemaster Item,,36480705,SPSI,Promethazine/Codeine 5Ml Oral Liq,,Per Svc,10.00
Chargemaster Item,,36480804,SPSI,Promethazine/Cod/Phenyle 5Ml Oral Liq,,Per Svc,17.85
Chargemaster Item,,36480846,SPSI,Guaifenesin 600Mg Po,,Per Svc,10.00
Chargemaster Item,,36480853,SPSI,Guaifenesin 5Ml Oral Liq,,Per Svc,10.00
Chargemaster Item,,36481000,SPSI,Guaifenesin/Dextrometh 5Ml Oral Liq,,Per Svc,18.90
Chargemaster Item,,36481018,SPSI,Triptorelin Pamoate 22.5mG Inj,,Per Svc,13129.60
Chargemaster Item,,36481059,SPSI,Guaifenesin/Codeine 5Ml Oral Liq,,Per Svc,10.00
Chargemaster Item,,36481091,SPSI,Potassim Iodide 1Gm 30mL,,Per Svc,237.00
Chargemaster Item,,36481125,SPSI,Chlorpheniram/Hydrocodone 10/8Mg Oral Susp,,Per Svc,35.20
Chargemaster Item,,36481216,SPSI,Benzonatate 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36481224,SPSI,Acetylcysteine 20% 4Ml,,Per Svc,150.20
Chargemaster Item,,36481505,SPSI,Roflumilast 500mcg Po,,Per Svc,77.20
Chargemaster Item,,36482008,SPSI,Retacrit 10000U non-esrd,,Per Svc,1389.80
Chargemaster Item,,36484251,SPSI,Acetylcystein 1000Mg Inh,,Per Svc,2390.90
Chargemaster Item,,36489128,SPSI,Vancomycin 5Gm Inj,,Per Svc,1120.55
Chargemaster Item,,36490001,SPSI,Retacrit 40000 non-esrd,,Per Svc,2223.70
Chargemaster Item,,36491009,SPSI,Calcium Acetate 667mG Tab,,Per Svc,1442.00
Chargemaster Item,,36492007,SPSI,Haemoph B Poly Conj-Tet Tox/PF,,Per Svc,286.15
Chargemaster Item,,36493005,SPSI,Pembrolizumab 100mG Inj,,Per Svc,28741.20
Chargemaster Item,,36493120,SPSI,Rho D Immune Glob 300mCg Inj Soln,,Per Svc,1486.80
Chargemaster Item,,36494714,SPSI,PRE PEN 0.25ML INJ,,Per Svc,397.35
Chargemaster Item,,36496008,SPSI,Idelalisib 100mG Po,,Per Svc,637.20
Chargemaster Item,,36496016,SPSI,Lenalidomide 5mG Po,,Per Svc,2388.80
Chargemaster Item,,36499002,SPSI,Histrelin AC 50mG Implant,,Per Svc,12000.00
Chargemaster Item,,36500122,SPSI,0.9% Sod Chl 50mL Vial,,Per Svc,26.15
Chargemaster Item,,36503001,SPSI,Sod Chl M-BG 0.9% 50mL,,Per Svc,146.00
Chargemaster Item,,36504017,SPSI,Antithrombin III per 1 Unit,,Per Svc,28.45
Chargemaster Item,,36505006,SPSI,Mag Sulfate 120mG/2mL,,Per Svc,10.00
Chargemaster Item,,36508125,SPSI,Vancomycin 1Gm Inj,,Per Svc,71.30
Chargemaster Item,,36511236,SPSI,Midazolam 0.25mG/0.5mL IV,,Per Svc,10.00
Chargemaster Item,,36514008,SPSI,Lomustine 10mG Po,,Per Svc,240.00
Chargemaster Item,,36517001,SPSI,Infliximab-dyyb 100mG Inj,,Per Svc,5677.70
Chargemaster Item,,36520005,SPSI,Desmopressin 40 mCg,,Per Svc,3619.50
Chargemaster Item,,36520013,SPSI,Desmopressin 4 mCg,,Per Svc,760.10
Chargemaster Item,,36520021,SPSI,Idelalisib 150mG Po,,Per Svc,637.20
Chargemaster Item,,36520054,SPSI,Cosopt Plus 5Ml Ophth Sol,,Per Svc,1612.15
Chargemaster Item,,36520088,SPSI,Ciprodex Otic 7.5ml Susp,,Per Svc,2974.85
Chargemaster Item,,36520096,SPSI,Ciprofloxacin Hc 10Ml Otic Sol,,Per Svc,3979.90
Chargemaster Item,,36520112,SPSI,Ofloxacin 0.3% 10Ml Otic Sol,,Per Svc,3239.90
Chargemaster Item,,36520120,SPSI,Ofloxacin 0.3% 5mL Ophth Sol,,Per Svc,136.30
Chargemaster Item,,36520138,SPSI,Ciprofloxacin 0.3% 3.5Gm Ophth Oint,,Per Svc,2700.90
Chargemaster Item,,36520153,SPSI,Diclofenac 0.1% 2.5Ml Ophth Sol,,Per Svc,470.10
Chargemaster Item,,36520161,SPSI,Tetracaine 0.5% 0.6ml Opth Sol,,Per Svc,102.45
Chargemaster Item,,36520187,SPSI,Atropine 1% 2Ml Ophth Sol,,Per Svc,411.40
Chargemaster Item,,36520203,SPSI,Acetazolamide 25Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36520211,SPSI,Oxymetazolein Nasal Spray 1Oz,,Per Svc,20.15
Chargemaster Item,,36520237,SPSI,Anestacon Opth,,Per Svc,75.55
Chargemaster Item,,36520245,SPSI,Duovisc Vixcoelastic Kit,,Per Svc,3172.35
Chargemaster Item,,36520260,SPSI,Olopatadine 0.1% 5Ml Ophth Sol,,Per Svc,3661.65
Chargemaster Item,,36520278,SPSI,Proparacaine 0.5% 15ml Ophth Sol,,Per Svc,155.50
Chargemaster Item,,36520294,SPSI,Budesonide Nasal Spray 8.6Gm,,Per Svc,1872.90
Chargemaster Item,,36520302,SPSI,Atropine 1% 3.5Gm Ophth Oint,,Per Svc,220.60
Chargemaster Item,,36520351,SPSI,Auralgan Otic Drops 14Ml,,Per Svc,106.55
Chargemaster Item,,36520377,SPSI,Sulfacetamide 10% 5Ml Ophth Sol,,Per Svc,418.25
Chargemaster Item,,36520385,SPSI,Chlorhexidine 12% 15Ml Oral Rinse,,Per Svc,10.00
Chargemaster Item,,36520393,SPSI,Balance Salt Plus Sol 500ml,,Per Svc,973.35
Chargemaster Item,,36520401,SPSI,Bacitracin 3.5Gm Ophth Oint,,Per Svc,57.45
Chargemaster Item,,36520419,SPSI,Balance Salt Sol 500Ml,,Per Svc,346.20
Chargemaster Item,,36520427,SPSI,Balance Salt Sol 15Ml,,Per Svc,104.05
Chargemaster Item,,36520435,SPSI,Fluorometholone 0.1% 5Ml Ophth Sol,,Per Svc,168.95
Chargemaster Item,,36520443,SPSI,Polymyxin B/Trimethoprim 10Ml Ophth Sol,,Per Svc,958.45
Chargemaster Item,,36520450,SPSI,Levofloxacin 0.5% 5Ml Ophth Sol,,Per Svc,787.50
Chargemaster Item,,36520468,SPSI,Trifluridine 1% 7.5ml O/s,,Per Svc,647.55
Chargemaster Item,,36520476,SPSI,Acetic Acid 2% Otic Sol,,Per Svc,175.10
Chargemaster Item,,36520492,SPSI,Chloraseptic Spray 1.5Oz,,Per Svc,20.35
Chargemaster Item,,36520559,SPSI,Loteprednol 0.2% 5Ml Ophth Sol,,Per Svc,2842.55
Chargemaster Item,,36520575,SPSI,Loteprednol 0.5% 5Ml Ophth Sol,,Per Svc,2995.25
Chargemaster Item,,36520591,SPSI,Flunisolide Nasal Spr 25Ml,,Per Svc,937.95
Chargemaster Item,,36520617,SPSI,Azelastine Nasl Spray 34Ml,,Per Svc,1104.60
Chargemaster Item,,36520633,SPSI,Cortisporin 7.5Ml Ophth Sol,,Per Svc,661.60
Chargemaster Item,,36520641,SPSI,Cortispor Opth,,Per Svc,360.45
Chargemaster Item,,36520658,SPSI,Cortisporin Otic 10Ml Sol,,Per Svc,183.25
Chargemaster Item,,36520666,SPSI,Cortisporin Otic 10Ml Susp,,Per Svc,203.40
Chargemaster Item,,36520682,SPSI,Hurricaine Spray,,Per Svc,68.45
Chargemaster Item,,36520690,SPSI,Cepacol 1 Lozenge,,Per Svc,10.00
Chargemaster Item,,36520708,SPSI,Cyclopentolate 1% 2ml Ophth Sol,,Per Svc,176.40
Chargemaster Item,,36520716,SPSI,Mometasone 17Gm Nasal Spray,,Per Svc,3168.05
Chargemaster Item,,36520732,SPSI,Chloraseptic 1 Lozenge,,Per Svc,0.60
Chargemaster Item,,36520757,SPSI,Cyclpentolate 2% 2Ml Ophth Sol,,Per Svc,439.00
Chargemaster Item,,36520765,SPSI,Triamincinolone Aq 16.5Gm Nasal Spray,,Per Svc,196.55
Chargemaster Item,,36520773,SPSI,Cyclomydril 2Ml Ophth Sol,,Per Svc,350.70
Chargemaster Item,,36520799,SPSI,Fluticasone Nasal Spray 16Gm,,Per Svc,790.35
Chargemaster Item,,36520807,SPSI,Balanced Salt Sol 30Ml,,Per Svc,230.60
Chargemaster Item,,36520815,SPSI,Blephamide 0.2% 2.5Ml Ophth Sol,,Per Svc,336.10
Chargemaster Item,,36520823,SPSI,Desmopressin 0.01% 5Ml Nasal Spray,,Per Svc,4457.45
Chargemaster Item,,36520831,SPSI,Blephamide 0.2%/10% 3.5Gm Ophth Oint,,Per Svc,1833.20
Chargemaster Item,,36520849,SPSI,Sodium Chloride 5% 15Ml Ophth Sol,,Per Svc,154.90
Chargemaster Item,,36520856,SPSI,Sodium Chloride 2% 15Ml Ophth Sol,,Per Svc,191.30
Chargemaster Item,,36520864,SPSI,Desmopressin 1Mcg Inj,,Per Svc,193.40
Chargemaster Item,,36520872,SPSI,Desmopressin 0.01% 2.5Ml Nasal Sol,,Per Svc,2577.75
Chargemaster Item,,36520880,SPSI,Azelastine 0.05% 6Ml Ophth Sol,,Per Svc,1458.45
Chargemaster Item,,36520922,SPSI,Beclomethasone 0.042% Nasal Spr 25Gm,,Per Svc,3696.30
Chargemaster Item,,36520930,SPSI,Ayr Saline Mist 14.1Gm,,Per Svc,7.95
Chargemaster Item,,36521003,SPSI,Dexamethasone 0.1% 5Ml Ophth Sol,,Per Svc,665.25
Chargemaster Item,,36521011,SPSI,Dexamethasone 0.5mG 5mL Oral Sol,,Per Svc,10.00
Chargemaster Item,,36521029,SPSI,Dexamethasone 10mG 10mL Oral Sol,,Per Svc,69.30
Chargemaster Item,,36521144,SPSI,Benzocaine 10% Gel 0.25Oz.,,Per Svc,10.00
Chargemaster Item,,36521193,SPSI,Brimonidine 0.1% 5ml Opth Sol,,Per Svc,2015.50
Chargemaster Item,,36521201,SPSI,Brimonidine 0.2% 5ml Opth Sol,,Per Svc,35.20
Chargemaster Item,,36521219,SPSI,Fml Forte Ophth Sol Sml,,Per Svc,1924.75
Chargemaster Item,,36521250,SPSI,Garamycin Opth,,Per Svc,137.35
Chargemaster Item,,36521268,SPSI,Brimonidine 0.15% 5Ml Ophth Sol,,Per Svc,385.70
Chargemaster Item,,36521284,SPSI,Bbrinzolamide 1% 10Ml Ophth Sol,,Per Svc,3885.65
Chargemaster Item,,36521300,SPSI,Garamycin 0.3% 5Ml Ophth Sol,,Per Svc,50.00
Chargemaster Item,,36521326,SPSI,Tetravisc O/S 5Ml,,Per Svc,280.00
Chargemaster Item,,36521359,SPSI,Homatropine 5% 5Ml Ophth Sol,,Per Svc,294.10
Chargemaster Item,,36521367,SPSI,Vancomycin 3.1% 16Ml Ophth Sol,,Per Svc,168.00
Chargemaster Item,,36521375,SPSI,Bimatoprost 0.03% 2.5Ml Ophth Sol,,Per Svc,2481.80
Chargemaster Item,,36521383,SPSI,Lacrilube Ophth Oint 3.5Gm,,Per Svc,108.15
Chargemaster Item,,36521409,SPSI,Carbamide Peroxide 10% 15Ml,,Per Svc,22.45
Chargemaster Item,,36521425,SPSI,Lidocaine 2% 10Ml Urojet,,Per Svc,80.75
Chargemaster Item,,36521458,SPSI,Dexameth/Neomyc/Polym 5Ml Ophth Sol,,Per Svc,89.35
Chargemaster Item,,36521466,SPSI,Isopto Hyocine 1/4% Ophth Sol,,Per Svc,291.40
Chargemaster Item,,36521474,SPSI,Hypromellose 0.5% 15Ml O/S,,Per Svc,325.70
Chargemaster Item,,36521508,SPSI,Dexameth/Neomyc/Polym 3.5Gm Ophth Oint,,Per Svc,2455.65
Chargemaster Item,,36521516,SPSI,Cocaine Sol 40Mg/Ml 4Ml,,Per Svc,2342.75
Chargemaster Item,,36521557,SPSI,Acetylcholine 10mG 2mL Ophth Sol,,Per Svc,1246.15
Chargemaster Item,,36521565,SPSI,Carbachol 0.01% 1.5Ml Ophth Sol,,Per Svc,424.40
Chargemaster Item,,36521599,SPSI,Tropicamide 0.5% 15Ml Ophth Sol,,Per Svc,105.00
Chargemaster Item,,36521623,SPSI,Tropicamide 1% 3ml Ophth Sol,,Per Svc,19.55
Chargemaster Item,,36521649,SPSI,Cyclopentolate 0.5% 15Ml Ophth Sol,,Per Svc,958.65
Chargemaster Item,,36521664,SPSI,Latanoprost 0.005% 2.5Ml Ophth Sol,,Per Svc,1704.70
Chargemaster Item,,36521672,SPSI,Perfludron 7Ml,,Per Svc,4200.00
Chargemaster Item,,36521706,SPSI,Dorzolamide 2% 10mL Ophth Sol,,Per Svc,955.10
Chargemaster Item,,36521755,SPSI,Neomy/Polymy/Gramicidin 10Ml Ophth Sol,,Per Svc,208.85
Chargemaster Item,,36521763,SPSI,Neomy/Polymy/Bacitracin 3.5Gm Ophth Oint,,Per Svc,62.90
Chargemaster Item,,36521805,SPSI,Lidocaine 3.5% 5Ml Ophth Gel,,Per Svc,278.80
Chargemaster Item,,36521912,SPSI,Neosynephrine 10% Opth 1Cc,,Per Svc,325.65
Chargemaster Item,,36521938,SPSI,Phenylephrine 0.25% 15Ml Nasal Spray,,Per Svc,39.90
Chargemaster Item,,36521946,SPSI,Phenylephrine 0.5% 15Ml Nasal Spray,,Per Svc,39.90
Chargemaster Item,,36521961,SPSI,Phenylephrine 0.125% 15Ml Nasal Drop,,Per Svc,40.30
Chargemaster Item,,36521979,SPSI,Phenylephrine 0.25% 15Ml Nasal Drops,,Per Svc,50.80
Chargemaster Item,,36521995,SPSI,Phenylephrine 1% 15Ml Nasal Drops,,Per Svc,38.65
Chargemaster Item,,36522001,SPSI,Phenylephrine 10% 5ml Ophth Sol,,Per Svc,65.50
Chargemaster Item,,36522019,SPSI,Timolol GFS Opth Sol 0.5% 5mL,,Per Svc,2652.30
Chargemaster Item,,36522027,SPSI,Timolol Opth Sol 0.5% 5mL,,Per Svc,178.50
Chargemaster Item,,36522043,SPSI,Phenylephrine 2.5% 3Ml Ophth Sol,,Per Svc,153.10
Chargemaster Item,,36522050,SPSI,Busulfan 2mG Po,,Per Svc,129.90
Chargemaster Item,,36522068,SPSI,Lomustine 40mG Po,,Per Svc,644.60
Chargemaster Item,,36522100,SPSI,Gatifloxicin 5ml 0.5%,,Per Svc,2204.35
Chargemaster Item,,36522191,SPSI,Pilocarpine 0.5% 15Ml Ophth Sol,,Per Svc,201.35
Chargemaster Item,,36522209,SPSI,Pilocarpine 1% 15Ml Ophth Sol,,Per Svc,1106.05
Chargemaster Item,,36522217,SPSI,Pilocarpine 2% 2Ml Ophth Sol,,Per Svc,396.80
Chargemaster Item,,36522225,SPSI,Magic Mouthwash 119mL Susp,,Per Svc,484.25
Chargemaster Item,,36522258,SPSI,Pilocarpine 2% 15mL Ophth Sol,,Per Svc,1199.10
Chargemaster Item,,36522316,SPSI,Pilocarpine 4% 2Ml Ophth Sol,,Per Svc,416.05
Chargemaster Item,,36522324,SPSI,Pilocarpine Hs 4% 4Gm Ophth Gel,,Per Svc,426.60
Chargemaster Item,,36522357,SPSI,Bacitracin/Polymyxin 3.5Gm Ophth Oint,,Per Svc,121.70
Chargemaster Item,,36522373,SPSI,Pred Forte 1% 1mL Ophth Sol,,Per Svc,349.55
Chargemaster Item,,36522399,SPSI,Dipivefrin 0.15 5Ml Ophth Sol,,Per Svc,305.65
Chargemaster Item,,36522456,SPSI,Sulfacetamide 10% 15Ml Ophth Sol,,Per Svc,52.10
Chargemaster Item,,36522472,SPSI,Hypromellose 2.5% 15Ml O/S,,Per Svc,81.90
Chargemaster Item,,36522530,SPSI,Ketorolac 0.5% 5ml Ophth Sol,,Per Svc,3305.10
Chargemaster Item,,36522555,SPSI,Timolol 0.25% 5Ml Ophth Sol,,Per Svc,195.20
Chargemaster Item,,36522563,SPSI,Timolol 0.5% 5Ml Ophth Sol,,Per Svc,108.80
Chargemaster Item,,36522571,SPSI,Tobrex Opth 0.3% 5Ml,,Per Svc,1286.05
Chargemaster Item,,36522597,SPSI,Tobramycin 0.3% 3.5Gm Ophth Sol,,Per Svc,2700.90
Chargemaster Item,,36522605,SPSI,Tobradex 5Ml,,Per Svc,997.70
Chargemaster Item,,36522613,SPSI,Dexametha/Tobramycin 3.5Gm Ophth Oint,,Per Svc,2875.45
Chargemaster Item,,36522753,SPSI,Tetracaine 0.5% 4mL Ophth Sol,,Per Svc,128.85
Chargemaster Item,,36522837,SPSI,Trypan Blue Sol 0.5Ml Opht,,Per Svc,420.00
Chargemaster Item,,36522902,SPSI,Ciprofloxacin 0.3% 5Ml Ophth Sol,,Per Svc,343.05
Chargemaster Item,,36523157,SPSI,Visine Opth,,Per Svc,18.25
Chargemaster Item,,36523173,SPSI,Artificial Tears 15Ml Ophth Sol,,Per Svc,58.40
Chargemaster Item,,36523223,SPSI,Travoprost 0.004% 2.5Ml,,Per Svc,2316.70
Chargemaster Item,,36523256,SPSI,Acetic Acid/Hydrocort 10Ml Otic Sol,,Per Svc,2114.70
Chargemaster Item,,36523264,SPSI,Acetazolamide 25Mg 30Ml Liq,,Per Svc,122.50
Chargemaster Item,,36523298,SPSI,Naphazoline 0.1% 15Ml Ophth Sol,,Per Svc,46.95
Chargemaster Item,,36523314,SPSI,Apraclonidine 0.5% 5Ml Ophth Sol,,Per Svc,2102.20
Chargemaster Item,,36523355,SPSI,Rimexolone 1% 5Ml Ophth Sol,,Per Svc,1416.85
Chargemaster Item,,36523405,SPSI,Carboxymethycellulose 1% 0.4Ml,,Per Svc,10.00
Chargemaster Item,,36523413,SPSI,Metipranolol 0.3% 5Ml Ophth Sol,,Per Svc,239.95
Chargemaster Item,,36524007,SPSI,Prednisolone Ace 1% 5mL,,Per Svc,580.85
Chargemaster Item,,36524015,SPSI,Acetazolamide 500mg Po,,Per Svc,66.05
Chargemaster Item,,36524023,SPSI,Ondansetron 2mG ODT,,Per Svc,117.10
Chargemaster Item,,36524106,SPSI,Brimonidine 0.15% 5ml O/S,,Per Svc,2148.85
Chargemaster Item,,36525012,SPSI,Tranexamic 1000mG/100mL NACL,,Per Svc,352.80
Chargemaster Item,,36526002,SPSI,Vancomycin 1250mG Inj,,Per Svc,325.60
Chargemaster Item,,36526127,SPSI,Vancomycin 1.25Gm/D5w 250mL,,Per Svc,215.75
Chargemaster Item,,36530004,SPSI,Lomustine 100mG Po,,Per Svc,1611.60
Chargemaster Item,,36530012,SPSI,Glutose15 Gel 40% 15Gm,,Per Svc,10.00
Chargemaster Item,,36531507,SPSI,Ursodiol 50Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36532323,SPSI,Aztreonam 20mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36533008,SPSI,Sod Bicarb 4.2% 5mL Inj,,Per Svc,96.20
Chargemaster Item,,36534006,SPSI,Pot Acetate Inj 2mEq/mL 50mL,,Per Svc,270.70
Chargemaster Item,,36542116,SPSI,Dexmedetomidine 400mCg/100mL,,Per Svc,1058.40
Chargemaster Item,,36547008,SPSI,Leuprolide Acetate 7.5mG SyrKit,,Per Svc,2710.15
Chargemaster Item,,36554004,SPSI,Leuprolide Ace 45mG Syr,,Per Svc,16260.80
Chargemaster Item,,36557122,SPSI,Hyaluronate Sod 15mG/mL 2mL,,Per Svc,2868.00
Chargemaster Item,,36558005,SPSI,Rotavirus Vaccine Oral,,Per Svc,1522.40
Chargemaster Item,,36558013,SPSI,Tramadol 25mG Tab,,Per Svc,10.00
Chargemaster Item,,36558021,SPSI,Trastuzumab-DKST 150mG Inj,,Per Svc,7947.95
Chargemaster Item,,36559128,SPSI,Insulin R 0.5Unit/0.5mL,,Per Svc,10.00
Chargemaster Item,,36560001,SPSI,Dolasetron Mesylate 12.5mG,,Per Svc,626.40
Chargemaster Item,,36560019,SPSI,Dolasetron Mesylate 100mG,,Per Svc,3132.00
Chargemaster Item,,36560027,SPSI,Latobacillus 1Gm Pkt,,Per Svc,10.00
Chargemaster Item,,36560126,SPSI,Activated Charcoal 25Gm,,Per Svc,185.35
Chargemaster Item,,36560134,SPSI,Misoprostol 200Mg Po,,Per Svc,20.15
Chargemaster Item,,36560167,SPSI,Magnesium Gluconate 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36560183,SPSI,Balsalazide 750Mg Po,,Per Svc,27.70
Chargemaster Item,,36560191,SPSI,Bismuth Subsalicylate 30Ml Oral Susp,,Per Svc,10.00
Chargemaster Item,,36560290,SPSI,Milk Of Magnesia 30Ml Oral Susp,,Per Svc,24.55
Chargemaster Item,,36560399,SPSI,Myla/Don/Lidov,,Per Svc,42.65
Chargemaster Item,,36560423,SPSI,Polyethylene Glycol 17Gm Packet,,Per Svc,19.75
Chargemaster Item,,36560431,SPSI,Sucralfate 1Gm Po,,Per Svc,15.65
Chargemaster Item,,36560456,SPSI,Docusate Sod 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36560480,SPSI,Calcium Carbonate 750Mg Po,,Per Svc,10.00
Chargemaster Item,,36560506,SPSI,Lactobacillus Po,,Per Svc,0.35
Chargemaster Item,,36560548,SPSI,Docusate Sod 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36560613,SPSI,Sucralfate 1Gm Oral Susp,,Per Svc,105.65
Chargemaster Item,,36560639,SPSI,Famotidine 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36560647,SPSI,Famotidine 20Mg Oral Susp,,Per Svc,92.95
Chargemaster Item,,36560704,SPSI,Bisacodyl 5Mg Po,,Per Svc,39.70
Chargemaster Item,,36560720,SPSI,Mylanta Liq 1 Dose,,Per Svc,36.25
Chargemaster Item,,36560787,SPSI,Aluminum Hydrox 30Ml Oral Susp,,Per Svc,10.00
Chargemaster Item,,36560795,SPSI,Calcium Carbonate 1250Mg Oral Susp,,Per Svc,29.40
Chargemaster Item,,36560803,SPSI,Bisacodyl 10Mg Supp,,Per Svc,13.15
Chargemaster Item,,36560829,SPSI,Fleets Enema Adult,,Per Svc,12.20
Chargemaster Item,,36560837,SPSI,Fleets Enema Pediatric,,Per Svc,15.75
Chargemaster Item,,36560845,SPSI,Fleets Enema Mineral Oil,,Per Svc,21.85
Chargemaster Item,,36560852,SPSI,Fleets Phosphosoda 45Ml,,Per Svc,6.50
Chargemaster Item,,36560878,SPSI,Cal Polycarbophil 625Mg Po,,Per Svc,10.00
Chargemaster Item,,36560902,SPSI,Glycerin Ped 2.8G/2.7mL Supp,,Per Svc,57.65
Chargemaster Item,,36560944,SPSI,Calcium Carbonate 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36560969,SPSI,Glycerin Adult Supp,,Per Svc,10.00
Chargemaster Item,,36560993,SPSI,Loperamide 2Mg Oral Liq,,Per Svc,20.80
Chargemaster Item,,36561058,SPSI,Esomepazole 20Mg Po,,Per Svc,71.40
Chargemaster Item,,36561074,SPSI,Loperamide 2Mg Po,,Per Svc,14.80
Chargemaster Item,,36561082,SPSI,Methycellulose 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36561157,SPSI,Kaopectat 15 Ml,,Per Svc,13.45
Chargemaster Item,,36561215,SPSI,Floranex Granules,,Per Svc,12.10
Chargemaster Item,,36561264,SPSI,Olsalazine 250Mg Po,,Per Svc,52.00
Chargemaster Item,,36561272,SPSI,Ranitidine 50mG Inj,,Per Svc,162.45
Chargemaster Item,,36561280,SPSI,Ranitidine 150Mg Po,,Per Svc,10.00
Chargemaster Item,,36561306,SPSI,Atropine/Diphenoxylate 0.025Mg/2.5Mg Po,,Per Svc,12.60
Chargemaster Item,,36561322,SPSI,Famotidine 20Mg Inj,,Per Svc,10.00
Chargemaster Item,,36561348,SPSI,Lubiprostone 24Mcg Po,,Per Svc,87.30
Chargemaster Item,,36561355,SPSI,Lubiprostone 8Mcg Po,,Per Svc,77.90
Chargemaster Item,,36561421,SPSI,Atropine/Diphenoxylate 5Ml Oral Liq,,Per Svc,73.50
Chargemaster Item,,36561447,SPSI,Golytely Powder 4000Ml,,Per Svc,199.10
Chargemaster Item,,36561454,SPSI,Magnesium Citrate 300Ml Oral Sol,,Per Svc,18.25
Chargemaster Item,,36561462,SPSI,Magnesium Oxide 400Mg Po,,Per Svc,10.00
Chargemaster Item,,36561470,SPSI,Castor Oil 4Oz,,Per Svc,46.50
Chargemaster Item,,36561504,SPSI,Psyllium 6Gm Packet,,Per Svc,10.00
Chargemaster Item,,36561579,SPSI,Mineral Oil 30Ml Oral Liq,,Per Svc,10.00
Chargemaster Item,,36561587,SPSI,Mineral Oil Sterile Topica 25Ml,,Per Svc,48.50
Chargemaster Item,,36561629,SPSI,Docusate Sod 100Mg Oral Liq,,Per Svc,10.00
Chargemaster Item,,36561744,SPSI,Sodium Phosphare 15mmoL 15mL,,Per Svc,183.55
Chargemaster Item,,36561769,SPSI,Granisetron 1Mg Po,,Per Svc,620.05
Chargemaster Item,,36561777,SPSI,Granisetron 1mG Inj,,Per Svc,247.60
Chargemaster Item,,36561827,SPSI,Simethicone 40Mg Oral Liq,,Per Svc,10.00
Chargemaster Item,,36561850,SPSI,Simethicone 80Mg Po,,Per Svc,35.50
Chargemaster Item,,36561918,SPSI,Famotidine 20mg Po,,Per Svc,10.00
Chargemaster Item,,36561983,SPSI,Magaldate 5Ml Oral Liq,,Per Svc,7.65
Chargemaster Item,,36562007,SPSI,Aprepitant 40mG,,Per Svc,1154.35
Chargemaster Item,,36562015,SPSI,Aprepitant 125mG,,Per Svc,3343.10
Chargemaster Item,,36562023,SPSI,Pepto Bismol 1 Tab,,Per Svc,10.00
Chargemaster Item,,36562031,SPSI,Diclegis 10mg/10mg PO,,Per Svc,86.40
Chargemaster Item,,36562049,SPSI,Fosaprepitant 150mG Inj,,Per Svc,4216.40
Chargemaster Item,,36562080,SPSI,Zantac Liq 15Mg/Ml 1 Dose,,Per Svc,72.65
Chargemaster Item,,36562155,SPSI,Sennosides 8.6Mg Po,,Per Svc,10.00
Chargemaster Item,,36562163,SPSI,Lansoprazole 30Mg Po,,Per Svc,23.20
Chargemaster Item,,36562189,SPSI,Cimetidine 300Mg Oral Liq,,Per Svc,21.95
Chargemaster Item,,36562197,SPSI,Sennosides 8.8Mg Oral Liq,,Per Svc,20.80
Chargemaster Item,,36562213,SPSI,Omeprazole 20Mg Po,,Per Svc,69.20
Chargemaster Item,,36562221,SPSI,Sennosides/Docusate Po,,Per Svc,10.00
Chargemaster Item,,36562239,SPSI,Sorbitol 70% 30Ml Oral Liq,,Per Svc,23.50
Chargemaster Item,,36562247,SPSI,Trimethobenzamide 300Mg Po,,Per Svc,16.05
Chargemaster Item,,36562254,SPSI,Surfak 240 Mg,,Per Svc,12.40
Chargemaster Item,,36562262,SPSI,Sorbitol Solution/Saccharin 5Ml Oral Liq,,Per Svc,420.00
Chargemaster Item,,36562270,SPSI,Simple Syrup 25% 10Ml Oral Liq,,Per Svc,0.50
Chargemaster Item,,36562296,SPSI,Tagamet Inj,,Per Svc,129.90
Chargemaster Item,,36562338,SPSI,Aprepitant 5Mg Po,,Per Svc,68.50
Chargemaster Item,,36562353,SPSI,Ranitidine 2.5Mg Inj,,Per Svc,10.00
Chargemaster Item,,36562361,SPSI,Cimetidine 400Mg Po,,Per Svc,18.25
Chargemaster Item,,36562528,SPSI,Meclizine 12.5Mg Po,,Per Svc,12.30
Chargemaster Item,,36562536,SPSI,Dronabinol 2.5Mg Po,,Per Svc,137.55
Chargemaster Item,,36562569,SPSI,Ondansetron 4Mg Odt,,Per Svc,234.05
Chargemaster Item,,36562577,SPSI,Ondansetron 8mg Odt,,Per Svc,389.85
Chargemaster Item,,36562585,SPSI,Prochloperazine 5Mg Oral Liq,,Per Svc,46.65
Chargemaster Item,,36562601,SPSI,Prochloperazine 10mg Inj,,Per Svc,233.10
Chargemaster Item,,36562643,SPSI,Dolasetron Mesylate 10mg Inj,,Per Svc,313.20
Chargemaster Item,,36562650,SPSI,Prochloperazine 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36562676,SPSI,Dolasetron 100Mg Po,,Per Svc,1203.40
Chargemaster Item,,36562692,SPSI,Palonosetron HCL 250mCg,,Per Svc,2520.00
Chargemaster Item,,36562700,SPSI,Prochloperazine 10Mg Po,,Per Svc,568.05
Chargemaster Item,,36562734,SPSI,Suclear Bowel Prep,,Per Svc,1221.45
Chargemaster Item,,36562866,SPSI,Compazine Supp,,Per Svc,56.95
Chargemaster Item,,36562874,SPSI,Prochlorperazine 25Mg Supp,,Per Svc,110.15
Chargemaster Item,,36562882,SPSI,Tropicamide 1% Ophth Soln,,Per Svc,149.10
Chargemaster Item,,36562890,SPSI,Mesalamine 4Gm Enema,,Per Svc,256.40
Chargemaster Item,,36562916,SPSI,Lansoprazole 7.5Mg Oral Liq,,Per Svc,16.30
Chargemaster Item,,36562940,SPSI,Scopalamine 1.5Mg/72Hr Patch,,Per Svc,95.95
Chargemaster Item,,36562957,SPSI,Dramamine 50 Mg Inj,,Per Svc,83.05
Chargemaster Item,,36562973,SPSI,Lamsoprazole 25 mG ODT PO,,Per Svc,174.30
Chargemaster Item,,36562981,SPSI,Lamsoprazole Odt 30Mg Po,,Per Svc,165.60
Chargemaster Item,,36563005,SPSI,Mesalamine 1Gm Supp,,Per Svc,401.10
Chargemaster Item,,36563062,SPSI,Pancreaze 10.5k/25k/43750 Po,,Per Svc,37.80
Chargemaster Item,,36563070,SPSI,Pancreaze 42k/10k/17.5k,,Per Svc,15.10
Chargemaster Item,,36563088,SPSI,Creon 6k/19k/30k,,Per Svc,19.65
Chargemaster Item,,36563096,SPSI,Zenpep 5k/17k/27k,,Per Svc,21.30
Chargemaster Item,,36563252,SPSI,Trimethobenzamide 200 Inj,,Per Svc,82.45
Chargemaster Item,,36563260,SPSI,Mesalamine 500Mg Po,,Per Svc,76.55
Chargemaster Item,,36563393,SPSI,Metoclopramide 2Mg Oral Liq,,Per Svc,10.00
Chargemaster Item,,36563500,SPSI,Ipecac 30 Ml,,Per Svc,102.55
Chargemaster Item,,36563807,SPSI,Misoprostol 100Mg Po,,Per Svc,14.40
Chargemaster Item,,36564003,SPSI,Ondansetron 4mG Inj,,Per Svc,10.00
Chargemaster Item,,36564011,SPSI,Ondansetron 40 Mg Inj,,Per Svc,262.50
Chargemaster Item,,36564029,SPSI,Ondansetron 1mg Inj,,Per Svc,53.50
Chargemaster Item,,36564037,SPSI,Raberprazole 20Mg Po,,Per Svc,112.75
Chargemaster Item,,36564201,SPSI,Omeprazole 10Mg Po,,Per Svc,62.80
Chargemaster Item,,36564284,SPSI,Pantoprazole 20Mg Po,,Per Svc,39.90
Chargemaster Item,,36564300,SPSI,Protonix 40Mg Tab,,Per Svc,55.35
Chargemaster Item,,36564359,SPSI,Pantoprazole 40mg Inj,,Per Svc,81.90
Chargemaster Item,,36564367,SPSI,Omeprazole 5Mg Oral Liq,,Per Svc,14.90
Chargemaster Item,,36564409,SPSI,Mesalamine 400Mg Po,,Per Svc,37.30
Chargemaster Item,,36564433,SPSI,Benadryl 50 Mg Po,,Per Svc,0.50
Chargemaster Item,,36565000,SPSI,Ofatumumab 100mG Inj,,Per Svc,2003.40
Chargemaster Item,,36568004,SPSI,Vemurafenib 240mG Po,,Per Svc,271.20
Chargemaster Item,,36573129,SPSI,0.9% Sod Chl 50mL Syr,,Per Svc,252.00
Chargemaster Item,,36573137,SPSI,Quinidine Gluc 324mG Er Tab,,Per Svc,126.84
Chargemaster Item,,36574002,SPSI,Bupivacaine/Epi 0.25% 50mL Inj,,Per Svc,226.10
Chargemaster Item,,36575009,SPSI,Pazopanib Hcl 200mG Po,,Per Svc,1532.60
Chargemaster Item,,36575017,SPSI,Mag Sulfate 8.12mEq/2ml,,Per Svc,164.26
Chargemaster Item,,36575025,SPSI,0.45% Sodium Chloride 50mL,,Per Svc,10.00
Chargemaster Item,,36577005,SPSI,Levetiracetam NS 10mG Inj,,Per Svc,10.00
Chargemaster Item,,36582112,SPSI,Cangrelor Tetrasodium 50mG Inj,,Per Svc,4494.00
Chargemaster Item,,36583003,SPSI,Sod Phos 15mmol 5mL,,Per Svc,408.70
Chargemaster Item,,36584001,SPSI,Hydrochlorothiazide 25mG Tab,,Per Svc,10.00
Chargemaster Item,,36585008,SPSI,Vincristine Sulfate Liposome 15mG Inj,,Per Svc,47221.80
Chargemaster Item,,36586006,SPSI,Ceritinib 150mG Po,,Per Svc,28148.60
Chargemaster Item,,36586014,SPSI,Eculizumab 300mG Inj,,Per Svc,34152.00
Chargemaster Item,,36587004,SPSI,Axitinib 1mG Po,,Per Svc,33407.20
Chargemaster Item,,36588002,SPSI,Axitinib 5mG Po,,Per Svc,877.00
Chargemaster Item,,36589000,SPSI,Bosutinib 100mG Po,,Per Svc,480.60
Chargemaster Item,,36590008,SPSI,Bosutinib 500mG Po,,Per Svc,1922.40
Chargemaster Item,,36591006,SPSI,Cabozantinib 100mG Po,,Per Svc,57174.00
Chargemaster Item,,36591014,SPSI,Sod Phos 3mMol/mL Oral Liq 1mL,,Per Svc,36.95
Chargemaster Item,,36592004,SPSI,Cabozantinib 140mG Po,,Per Svc,57174.00
Chargemaster Item,,36593002,SPSI,Cabozantinib 60mG Po,,Per Svc,57174.00
Chargemaster Item,,36594000,SPSI,Ibrutinib 140mG Po,,Per Svc,493.60
Chargemaster Item,,36594018,SPSI,Dexamethasone 1mG Inj,,Per Svc,10.00
Chargemaster Item,,36595007,SPSI,Palbociclib 75mG Po,,Per Svc,2086.40
Chargemaster Item,,36595015,SPSI,Sugammadex Sodium 200mG Inj,,Per Svc,1256.75
Chargemaster Item,,36596005,SPSI,Palbociclib 100mG Po,,Per Svc,2086.40
Chargemaster Item,,36597003,SPSI,Palbociclib 125mG Po,,Per Svc,2086.40
Chargemaster Item,,36603009,SPSI,Sugammadex Sodium 500mG Inj,,Per Svc,2092.75
Chargemaster Item,,36604007,SPSI,Sodium Acetate 4mEq/ml Inj,,Per Svc,253.70
Chargemaster Item,,36605004,SPSI,Sodium Citrate 4% 200mG/5mL,,Per Svc,70.00
Chargemaster Item,,36607000,SPSI,Natalizumab 300mG/15 mL,,Per Svc,24000.00
Chargemaster Item,,36609006,SPSI,Dasatinib 80mG Po,,Per Svc,1504.60
Chargemaster Item,,36609014,SPSI,Goserelin Acetate Implant 3.6mG Inj,,Per Svc,5493.00
Chargemaster Item,,36610137,SPSI,Magnesium Sulfate/Water 2Gm/50mL,,Per Svc,183.75
Chargemaster Item,,36610145,SPSI,Magnesium Sulfate 1 Gm/100 Ml,,Per Svc,93.25
Chargemaster Item,,36614006,SPSI,Trastuzumab 150mG Inj,,Per Svc,9350.50
Chargemaster Item,,36614105,SPSI,Methadone 0.5mG/0.5mL Oral,,Per Svc,10.00
Chargemaster Item,,36614113,SPSI,Sodium Chloride 3% Iv Soln 1mL,,Per Svc,10.00
Chargemaster Item,,36622124,SPSI,Vabomere 1Gm/1Gm Inj,,Per Svc,2245.30
Chargemaster Item,,36624005,SPSI,Trastuzumab-DKST 420mG Inj,,Per Svc,22183.55
Chargemaster Item,,36624013,SPSI,Fluorouracil 5000mG Inj,,Per Svc,962.50
Chargemaster Item,,36626000,SPSI,Vorinostat 100mG Po,,Per Svc,455.20
Chargemaster Item,,36630002,SPSI,Thioguanine 40mG Po,,Per Svc,140.40
Chargemaster Item,,36634004,SPSI,Labetalol 5mG/mL 4mL vial,,Per Svc,57.75
Chargemaster Item,,36636009,SPSI,Darbepoetin Alfa 100mCg Inj Non-ESRD,,Per Svc,2964.00
Chargemaster Item,,36640282,SPSI,Cyanide Antidote Kit,,Per Svc,1491.15
Chargemaster Item,,36640290,SPSI,Penicillamine 250Mg Po,,Per Svc,3299.75
Chargemaster Item,,36640324,SPSI,Deferoxamine 500Mg Inj,,Per Svc,428.95
Chargemaster Item,,36641413,SPSI,Vecuronium/Water 0.5mG/mL Inj,,Per Svc,10.00
Chargemaster Item,,36645679,SPSI,Hydrocortisone 1mG Oral Susp,,Per Svc,10.00
Chargemaster Item,,36646016,SPSI,Dextrose M-BG 5% 50mL,,Per Svc,146.00
Chargemaster Item,,36647006,SPSI,Vincristine 1mG Inj,,Per Svc,303.60
Chargemaster Item,,36655009,SPSI,Pot Phos 3mmol/1ml Oral Liq,,Per Svc,26.90
Chargemaster Item,,36655017,SPSI,Baricitinib 2mG Tab,,Per Svc,1268.40
Chargemaster Item,,36661007,SPSI,Panobinostat Lactate 10mG Po,,Per Svc,4888.80
Chargemaster Item,,36662013,SPSI,Irinotecan Liposomal 43mG/10mL Inj,,Per Svc,12912.00
Chargemaster Item,,36663136,SPSI,Erythromycin 5mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36664001,SPSI,Retacrit 4000U esrd,,Per Svc,556.00
Chargemaster Item,,36664019,SPSI,Albumin 25% Iv 0.25G mL 1mL,,Per Svc,15.10
Chargemaster Item,,36666006,SPSI,Zoledronic Acid 5mG Inj,,Per Svc,5202.40
Chargemaster Item,,36667012,SPSI,Medium Chain Triglyc Oral 15mL,,Per Svc,2664.90
Chargemaster Item,,36669000,SPSI,Metronidazole NS 5mGmL 1mL,,Per Svc,10.00
Chargemaster Item,,36671238,SPSI,Coag Factor Xa, recomb 200mG,,Per Svc,33000.00
Chargemaster Item,,36672004,SPSI,Goserelin Acetate Implant 10.8mG Inj,,Per Svc,11434.50
Chargemaster Item,,36677011,SPSI,Pentobarbital 1000mG/20mL,,Per Svc,6882.45
Chargemaster Item,,36679009,SPSI,Panobinostat Lactate 15mG Po,,Per Svc,4888.80
Chargemaster Item,,36680007,SPSI,Prednisone 5mG PO,,Per Svc,10.00
Chargemaster Item,,36680015,SPSI,Prednisone 1mG PO a,,Per Svc,10.00
Chargemaster Item,,36680023,SPSI,Dexamethasone 4mG Inj,,Per Svc,10.90
Chargemaster Item,,36680031,SPSI,Dexamethasone 10mG inj,,Per Svc,950.15
Chargemaster Item,,36680049,SPSI,Dexamethasone 20mG Inj,,Per Svc,24.55
Chargemaster Item,,36680106,SPSI,Metformin 500Mg Po,,Per Svc,12.80
Chargemaster Item,,36680114,SPSI,Metformin 850Mg Po,,Per Svc,12.30
Chargemaster Item,,36680122,SPSI,Testosterone 5Mg/24Hr Patch,,Per Svc,214.75
Chargemaster Item,,36680213,SPSI,Arginine 4.5Gm Pkt,,Per Svc,4.15
Chargemaster Item,,36680254,SPSI,Miglitol 25Mg Po,,Per Svc,34.65
Chargemaster Item,,36680262,SPSI,Miglitol 50Mg Po,,Per Svc,35.80
Chargemaster Item,,36680486,SPSI,Celestone Soluspan 6Mg/Ml,,Per Svc,471.25
Chargemaster Item,,36680494,SPSI,Budesonide 3Mg Po,,Per Svc,217.65
Chargemaster Item,,36680528,SPSI,Fludrocortisone 0.1Mg Po,,Per Svc,24.90
Chargemaster Item,,36680536,SPSI,Flutamide 125Mg Po,,Per Svc,52.40
Chargemaster Item,,36680544,SPSI,Hydrocortisone 1% 1.5Gm Crm Pkt,,Per Svc,10.00
Chargemaster Item,,36680585,SPSI,Beclomethasone Inhaler 8.7Gm,,Per Svc,2118.90
Chargemaster Item,,36680593,SPSI,Fluticasone 110Mcg 12Gm Inhaler,,Per Svc,3157.45
Chargemaster Item,,36680601,SPSI,Fluticasone 220Mcg 12Gm Inhaler,,Per Svc,4904.35
Chargemaster Item,,36680619,SPSI,Fluticasone 44Mcg 12Gm Inhaler,,Per Svc,2358.50
Chargemaster Item,,36680627,SPSI,Budesonide Inhaler 180Mcg,,Per Svc,2978.45
Chargemaster Item,,36680643,SPSI,Triamcinolone 200mG,,Per Svc,598.60
Chargemaster Item,,36680692,SPSI,Acarbose 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36680700,SPSI,Triamcinolone 40mG,,Per Svc,107.10
Chargemaster Item,,36680759,SPSI,Pulmicort 0.25Mg/ 2Ml,,Per Svc,218.25
Chargemaster Item,,36680767,SPSI,Pulmicort 0.5mg/2ml,,Per Svc,116.35
Chargemaster Item,,36680791,SPSI,Triamcinolone 0.1% 15Gm Oint,,Per Svc,58.60
Chargemaster Item,,36680825,SPSI,Dexamethasone 10mG PO,,Per Svc,70.60
Chargemaster Item,,36680833,SPSI,Testosterone 2.5Mg/24Hr Patch,,Per Svc,107.40
Chargemaster Item,,36680841,SPSI,Triamcinolone 0.1% 15Gm Crm,,Per Svc,58.60
Chargemaster Item,,36680908,SPSI,Danazol 50Mg Po,,Per Svc,22.25
Chargemaster Item,,36681005,SPSI,Dexamethasone 0.5mG PO,,Per Svc,10.00
Chargemaster Item,,36681013,SPSI,Dexamethasone 1mG PO,,Per Svc,10.00
Chargemaster Item,,36681021,SPSI,Dexamethasone 4mG Po,,Per Svc,15.55
Chargemaster Item,,36681039,SPSI,Methylprednisolone 80mG,,Per Svc,231.10
Chargemaster Item,,36681047,SPSI,Methylprednisolone 400mG,,Per Svc,1156.25
Chargemaster Item,,36681054,SPSI,Methylprednisolone 4mG,,Per Svc,22.60
Chargemaster Item,,36681062,SPSI,Methylprednisolone 16mG,,Per Svc,23.95
Chargemaster Item,,36681070,SPSI,Levonorgestrel 1.5mg Po,,Per Svc,383.90
Chargemaster Item,,36681088,SPSI,Hydrocortisone 100Mg Enema,,Per Svc,132.85
Chargemaster Item,,36681096,SPSI,Estrogen/Medroxyprog 0.625/2.5Mg Po,,Per Svc,59.40
Chargemaster Item,,36681104,SPSI,Cortizone 10Mg,,Per Svc,10.00
Chargemaster Item,,36681112,SPSI,Estradiol 0.075Mg/24H Patch Weekly,,Per Svc,243.70
Chargemaster Item,,36681120,SPSI,Dexameth Intensol 0.25mg Liq,,Per Svc,11.05
Chargemaster Item,,36681138,SPSI,Dexameth 0.25mg Oral Liq,,Per Svc,57.10
Chargemaster Item,,36681153,SPSI,Cortisone 25Mg Po,,Per Svc,32.75
Chargemaster Item,,36681161,SPSI,Estropipate 0.75Mg,,Per Svc,10.00
Chargemaster Item,,36681203,SPSI,Estrogen Synthetic 0.625Mg Po,,Per Svc,59.40
Chargemaster Item,,36681211,SPSI,Estrogen Synthetic 0.9Mg Po,,Per Svc,59.40
Chargemaster Item,,36681245,SPSI,Medroxyprogesterone 150mG Inj,,Per Svc,567.00
Chargemaster Item,,36681260,SPSI,Estradiol 0.5Mg Po,,Per Svc,14.30
Chargemaster Item,,36681278,SPSI,Evista 60Mg Tab,,Per Svc,83.15
Chargemaster Item,,36681286,SPSI,Methylprednisolone 80Mg Inj,,Per Svc,506.00
Chargemaster Item,,36681310,SPSI,Estradiol 0.05Mg/24H Patch Weekly,,Per Svc,243.70
Chargemaster Item,,36681328,SPSI,Norethidrone 5Mg Po,,Per Svc,27.85
Chargemaster Item,,36681351,SPSI,Estratest H.S. 0.625Mg/1.25Mg Po,,Per Svc,37.80
Chargemaster Item,,36681393,SPSI,Decadron Special Dilution,,Per Svc,11.75
Chargemaster Item,,36681708,SPSI,Dexamethasone 0.25Mg Po,,Per Svc,37.75
Chargemaster Item,,36681856,SPSI,Dexamethasone 1Mg Inh,,Per Svc,24.80
Chargemaster Item,,36682003,SPSI,Hydrocortisone 100mG Inj,,Per Svc,169.25
Chargemaster Item,,36682011,SPSI,Insulin Regular 1 Unit,,Per Svc,1.50
Chargemaster Item,,36682029,SPSI,Insulin Nph 1 Unit,,Per Svc,1.50
Chargemaster Item,,36682037,SPSI,Insulin Lantus 1 Unit,,Per Svc,34.75
Chargemaster Item,,36682045,SPSI,Insulin Apidra 1 Unit,,Per Svc,13.60
Chargemaster Item,,36682052,SPSI,Insulin Levemir 1 Unit,,Per Svc,24.15
Chargemaster Item,,36682060,SPSI,Insulin 70/30 1 Units,,Per Svc,1.50
Chargemaster Item,,36682078,SPSI,Insulin 75/25 1 Unit,,Per Svc,7.55
Chargemaster Item,,36682086,SPSI,Insulin Humalog 1 Unit,,Per Svc,10.00
Chargemaster Item,,36682094,SPSI,Hydrocortisone 250mG,,Per Svc,313.00
Chargemaster Item,,36682102,SPSI,Hydrocortisone 500mG,,Per Svc,626.10
Chargemaster Item,,36682110,SPSI,Hydrocortisone 10Mg Po,,Per Svc,60.50
Chargemaster Item,,36682128,SPSI,Glyberide/Metormin 1.25/250Mg Po,,Per Svc,47.85
Chargemaster Item,,36682136,SPSI,Octreotide Depot 10mG,,Per Svc,6609.00
Chargemaster Item,,36682144,SPSI,Glyberide/Metormin 5/500Mg Po,,Per Svc,52.50
Chargemaster Item,,36682151,SPSI,Metformin Er 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36682169,SPSI,Hydrocortisone 20Mg Po,,Per Svc,10.50
Chargemaster Item,,36682177,SPSI,Insulin Levemir 5 Units,,Per Svc,115.15
Chargemaster Item,,36682185,SPSI,Sitagliptin 50Mg Po,,Per Svc,189.55
Chargemaster Item,,36682193,SPSI,Teriparatide 600mCg,,Per Svc,20559.00
Chargemaster Item,,36682201,SPSI,Methylprednisolone 4Mg Po,,Per Svc,34.05
Chargemaster Item,,36682219,SPSI,Insulin Lantus 1 units,,Per Svc,357.30
Chargemaster Item,,36682227,SPSI,Octreotide Deoot 20mG,,Per Svc,17802.00
Chargemaster Item,,36682235,SPSI,Insulin Apidra 5 units,,Per Svc,38.60
Chargemaster Item,,36682243,SPSI,Octreotide Depot 30mG,,Per Svc,26657.20
Chargemaster Item,,36682250,SPSI,Oxandrolone 2.5Mg Po,,Per Svc,72.75
Chargemaster Item,,36682268,SPSI,Octreotide ER 10mG,,Per Svc,12452.85
Chargemaster Item,,36682276,SPSI,Octreotide ER 20mG,,Per Svc,16315.50
Chargemaster Item,,36682292,SPSI,Ganciclovir D5W 500mG Inj,,Per Svc,20.15
Chargemaster Item,,36682300,SPSI,0.45% Sodium Chloride 100mL,,Per Svc,10.00
Chargemaster Item,,36682391,SPSI,Prednisone 5Mg Oral Liq,,Per Svc,39.05
Chargemaster Item,,36682409,SPSI,Insulin Lantus 50 Units,,Per Svc,306.90
Chargemaster Item,,36682458,SPSI,Insulin Humalog 50 Units,,Per Svc,147.20
Chargemaster Item,,36682532,SPSI,Octreotide Depot Inj 1MG,,Per Svc,24431.20
Chargemaster Item,,36682557,SPSI,Prednisone 1mg PO,,Per Svc,64.70
Chargemaster Item,,36682565,SPSI,Prednisone 10mG Po,,Per Svc,18.15
Chargemaster Item,,36682573,SPSI,Prednisone 20mG PO,,Per Svc,35.90
Chargemaster Item,,36682672,SPSI,Somatropin 0.4Mg Inj,,Per Svc,700.15
Chargemaster Item,,36682698,SPSI,Prednisolone 9mg Oral Sol,,Per Svc,10.00
Chargemaster Item,,36682706,SPSI,Pioglitazone 15Mg Po,,Per Svc,59.65
Chargemaster Item,,36682714,SPSI,Pioglitazone 30Mg Po,,Per Svc,57.60
Chargemaster Item,,36682755,SPSI,Nateglinide 120Mg Po,,Per Svc,35.30
Chargemaster Item,,36682763,SPSI,Nateglinide 60Mg Po,,Per Svc,16.70
Chargemaster Item,,36682813,SPSI,Glimepirde 2Mg Po,,Per Svc,10.00
Chargemaster Item,,36682821,SPSI,Glimepirde 4Mg Po,,Per Svc,60.45
Chargemaster Item,,36682847,SPSI,Hydroccortisone 1mG Inj,,Per Svc,10.00
Chargemaster Item,,36682854,SPSI,Hydrocortisone Sod Suc 100Mg Inj,,Per Svc,385.90
Chargemaster Item,,36682870,SPSI,Prednisolone 15mG / 5mL,,Per Svc,42.50
Chargemaster Item,,36682888,SPSI,Hydrocortisone 5Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36682904,SPSI,Rosiglitazone 2Mg Po,,Per Svc,56.00
Chargemaster Item,,36682953,SPSI,Rosiglitazone 4Mg Po,,Per Svc,83.00
Chargemaster Item,,36682995,SPSI,Desmopressin 0.1Mg Po,,Per Svc,31.50
Chargemaster Item,,36683001,SPSI,Calcitonin 200 Units 3.7Ml Nasal Spray,,Per Svc,3441.80
Chargemaster Item,,36683019,SPSI,Methylprednisone 125mG,,Per Svc,122.10
Chargemaster Item,,36683027,SPSI,Methylprednisone 500mG,,Per Svc,291.25
Chargemaster Item,,36683035,SPSI,Methylprednisone 1000mG,,Per Svc,527.85
Chargemaster Item,,36683043,SPSI,Methylprednisone 2 Gm,,Per Svc,1047.15
Chargemaster Item,,36683050,SPSI,Methylprednisolone 40mg Inj,,Per Svc,75.80
Chargemaster Item,,36683068,SPSI,Regorafenib 40mG Po,,Per Svc,2022.40
Chargemaster Item,,36683100,SPSI,Methylprednisolone 125mg Inj,,Per Svc,10.00
Chargemaster Item,,36683159,SPSI,Progesterone 100Mg Po,,Per Svc,23.20
Chargemaster Item,,36683209,SPSI,Repaglinde 2mG PO,,Per Svc,17.85
Chargemaster Item,,36683217,SPSI,Repaglinde 0.5Mg Po,,Per Svc,39.25
Chargemaster Item,,36683225,SPSI,Repaglinde 1Mg Po,,Per Svc,39.25
Chargemaster Item,,36683233,SPSI,Progesterone 50Mg Inj,,Per Svc,42.85
Chargemaster Item,,36683266,SPSI,Hydroxyprogesterone 250mG Inj,,Per Svc,20700.00
Chargemaster Item,,36683308,SPSI,Fluoxymesterone 10Mg Po,,Per Svc,80.45
Chargemaster Item,,36683399,SPSI,Finasteride 5Mg Po,,Per Svc,13.00
Chargemaster Item,,36683480,SPSI,Birth Control 2 Tabs,,Per Svc,89.30
Chargemaster Item,,36683928,SPSI,Estradiol Valerate 100mG Inj,,Per Svc,1515.25
Chargemaster Item,,36683936,SPSI,Estradiol Cypionate 25mG 5mL Inj,,Per Svc,1326.70
Chargemaster Item,,36684009,SPSI,Pamidronate 30mG,,Per Svc,174.00
Chargemaster Item,,36684017,SPSI,Pamidronate 90mG,,Per Svc,1178.85
Chargemaster Item,,36684025,SPSI,Dopamine 1mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36684066,SPSI,Sodium Chloride 0.65% 45Ml Nasal Drops,,Per Svc,22.05
Chargemaster Item,,36684074,SPSI,Flurbiprofen 0.03% 2.5ml Ophth Sol,,Per Svc,453.60
Chargemaster Item,,36684090,SPSI,Pamidronate 30 Mg Inj,,Per Svc,371.35
Chargemaster Item,,36684157,SPSI,Estrogen Conjugated 0.3Mg Po,,Per Svc,17.55
Chargemaster Item,,36684165,SPSI,Estradiol 0.1Mg/24H Patch Weekly,,Per Svc,243.70
Chargemaster Item,,36684173,SPSI,Estradiol 0.025Mg/24H Patch Weekly,,Per Svc,243.70
Chargemaster Item,,36684199,SPSI,Estradiol 0.05Mg/24H Patch Bi-Weekly,,Per Svc,130.85
Chargemaster Item,,36684207,SPSI,Estrogen Conjugated 0.625Mg Po,,Per Svc,50.10
Chargemaster Item,,36684223,SPSI,Estrogen Conjugated 0.9Mg Po,,Per Svc,16.40
Chargemaster Item,,36684272,SPSI,Estrogen Conjugated 42.5Gm Vag Crm,,Per Svc,4706.85
Chargemaster Item,,36684306,SPSI,Estrogen Conjugated 25mg inj,,Per Svc,3739.70
Chargemaster Item,,36684355,SPSI,Estradiol 0.1Mg Patch Bi-Weekly,,Per Svc,131.75
Chargemaster Item,,36684363,SPSI,Estradiol 0.025Mg/24Hr Patch Bi-Weekly,,Per Svc,127.80
Chargemaster Item,,36684470,SPSI,Estrogen Esterified 0.625Mg Po,,Per Svc,14.90
Chargemaster Item,,36684603,SPSI,Insulin Reg 10Ml,,Per Svc,213.30
Chargemaster Item,,36684629,SPSI,Insulin Nph 10Ml,,Per Svc,3874.10
Chargemaster Item,,36684652,SPSI,Insulin Sliding Scale 5 Units,,Per Svc,9.05
Chargemaster Item,,36684728,SPSI,Insulin 70/30 5 Units,,Per Svc,214.10
Chargemaster Item,,36684744,SPSI,Insulin Spec Dilut 5 Units,,Per Svc,9.05
Chargemaster Item,,36684751,SPSI,Chlorpropamide 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36684777,SPSI,Glyburide 2.5Mg Po,,Per Svc,10.00
Chargemaster Item,,36684785,SPSI,Glyburide 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36684900,SPSI,Glucagon 1Mg Imj,,Per Svc,2148.30
Chargemaster Item,,36684918,SPSI,Glipizide 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36684926,SPSI,Glipizide 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36684934,SPSI,Glipizide 2.5Mg Po,,Per Svc,14.30
Chargemaster Item,,36684983,SPSI,Glucotrol XL 10Mg,,Per Svc,10.00
Chargemaster Item,,36685014,SPSI,Insulin 50/50 5 Units,,Per Svc,33.20
Chargemaster Item,,36685048,SPSI,Insulin Reg 5 Units,,Per Svc,1873.60
Chargemaster Item,,36685089,SPSI,Insulin 75/25 5 Units,,Per Svc,410.40
Chargemaster Item,,36685097,SPSI,Insulin Humalog 1 Units,,Per Svc,346.10
Chargemaster Item,,36685170,SPSI,Insulin Nph 5 Units,,Per Svc,1873.60
Chargemaster Item,,36685303,SPSI,Tolinase 250Mg,,Per Svc,10.00
Chargemaster Item,,36685451,SPSI,Cal Gluconate 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36685618,SPSI,Cal Gluconate 10% 10ML Inj,,Per Svc,115.30
Chargemaster Item,,36685634,SPSI,Cal Gluc Sol 30Ml,,Per Svc,10.00
Chargemaster Item,,36686004,SPSI,Testosterone 200 mG,,Per Svc,252.00
Chargemaster Item,,36686012,SPSI,Testosterone 2000 mG,,Per Svc,1463.40
Chargemaster Item,,36686301,SPSI,Vasopressin 20U Inj,,Per Svc,2265.40
Chargemaster Item,,36686558,SPSI,Provera 10Mg,,Per Svc,31.70
Chargemaster Item,,36686566,SPSI,Testosterone 1mg inj,,Per Svc,9.55
Chargemaster Item,,36686590,SPSI,Medroxyprogesterone 2.5Mg Po,,Per Svc,56.30
Chargemaster Item,,36687010,SPSI,Panobinostat Lactate 20mG Po,,Per Svc,428.80
Chargemaster Item,,36687051,SPSI,Calcimar 400Units Inj,,Per Svc,10841.35
Chargemaster Item,,36687077,SPSI,Cal Carbonate 600Mg Po,,Per Svc,10.00
Chargemaster Item,,36687143,SPSI,Liothyronine 5Mcg Po,,Per Svc,10.00
Chargemaster Item,,36687150,SPSI,Liothyronine 25 Mcg,,Per Svc,19.30
Chargemaster Item,,36687408,SPSI,Propylthiouracil 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36687457,SPSI,Levothyroxine 0.1Mg Po,,Per Svc,15.65
Chargemaster Item,,36687465,SPSI,Levothyroxine 0.05Mg Po,,Per Svc,22.45
Chargemaster Item,,36687473,SPSI,Levothyroxine O.88Mg Po,,Per Svc,10.00
Chargemaster Item,,36687499,SPSI,Levothroxine 0.112Mg Po,,Per Svc,10.00
Chargemaster Item,,36687507,SPSI,Levothyroxine 0.15Mg Po,,Per Svc,41.50
Chargemaster Item,,36687531,SPSI,Levothyroxine 0.125Mg Po,,Per Svc,10.00
Chargemaster Item,,36687549,SPSI,Levothyroxine 0.025Mg Po,,Per Svc,10.00
Chargemaster Item,,36687564,SPSI,Levothyroxine 25Mcg Oral Liq,,Per Svc,10.00
Chargemaster Item,,36687580,SPSI,Levothyroxine 0.075Mg Po,,Per Svc,10.00
Chargemaster Item,,36687614,SPSI,Levothyroxine 200Mcg Inj,,Per Svc,1330.35
Chargemaster Item,,36687622,SPSI,Methimazole 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36687630,SPSI,Methimazole 10Mg Po,,Per Svc,10.00
Chargemaster Item,,36687671,SPSI,Levothyroxine 0.175Mg Po,,Per Svc,10.00
Chargemaster Item,,36687705,SPSI,Thryoid 30Mg,,Per Svc,10.00
Chargemaster Item,,36687754,SPSI,Thyroid 60Mg,,Per Svc,10.00
Chargemaster Item,,36687804,SPSI,Thyroid 120Mg Po,,Per Svc,81.90
Chargemaster Item,,36687903,SPSI,Levothroxine 0.137Mg Po,,Per Svc,15.65
Chargemaster Item,,36689008,SPSI,Naphazoline 0.012% 30mL,,Per Svc,92.35
Chargemaster Item,,36689016,SPSI,Calcium Chloride 10% 10Ml Inj,,Per Svc,254.75
Chargemaster Item,,36689022,SPSI,Pen G K/NS 0.01mmU/mL 1mL,,Per Svc,10.00
Chargemaster Item,,36690121,SPSI,Miltefosine 50 mG Po,,Per Svc,2857.15
Chargemaster Item,,36691004,SPSI,Morphine Sulf 20mG/mL Oral 1mL,,Per Svc,11.76
Chargemaster Item,,36694008,SPSI,Rolapitant Hcl 90mG Po,,Per Svc,12060.20
Chargemaster Item,,36696003,SPSI,Dapagliflozin 5mG Po,,Per Svc,289.65
Chargemaster Item,,36696011,SPSI,Acetaminophen 325mG Tab,,Per Svc,10.00
Chargemaster Item,,36696029,SPSI,Aspirin 325mG Tab,,Per Svc,10.00
Chargemaster Item,,36699007,SPSI,Paclitaxel 300mg Inj,,Per Svc,1584.00
Chargemaster Item,,36703114,SPSI,Sod Bicarb 150mEq/1000mL D5W,,Per Svc,281.70
Chargemaster Item,,36708006,SPSI,Plerixafor 24mG Inj,,Per Svc,2561.80
Chargemaster Item,,36712107,SPSI,Meropenem NS 100mG Inj,,Per Svc,10.00
Chargemaster Item,,36712115,SPSI,Heparin 4000U/1000mL NS,,Per Svc,179.55
Chargemaster Item,,36713006,SPSI,Caspofungin NS 5mG Inj,,Per Svc,15.80
Chargemaster Item,,36717106,SPSI,Voriconazole D5W 10mG Inj,,Per Svc,62.72
Chargemaster Item,,36717122,SPSI,Dexamethasone 120mG/30mL Inj,,Per Svc,302.40
Chargemaster Item,,36718005,SPSI,Immune Globulin 2.5mG Inj,,Per Svc,2220.00
Chargemaster Item,,36720001,SPSI,Ropivacaine 40 mG,,Per Svc,71.65
Chargemaster Item,,36720019,SPSI,Ropivacaine 200 mG / 100 mL,,Per Svc,472.95
Chargemaster Item,,36720027,SPSI,Ropivacaine 150mG,,Per Svc,210.25
Chargemaster Item,,36720035,SPSI,Lidocaine Epi 2% 20mL MPF,,Per Svc,161.40
Chargemaster Item,,36720043,SPSI,Lidocaine Epi 2% 20mL MDV,,Per Svc,37.70
Chargemaster Item,,36720092,SPSI,Exparel 1.3% 20ml inj,,Per Svc,3883.05
Chargemaster Item,,36720126,SPSI,Chloroprocaine 2% 2.5ML,,Per Svc,268.50
Chargemaster Item,,36720167,SPSI,Buffered Lidocaine 1% 0.25 ML,,Per Svc,120.15
Chargemaster Item,,36720225,SPSI,Oxylocaine 2% Jelly 5Ml,,Per Svc,54.00
Chargemaster Item,,36720266,SPSI,Lidocaine 2% 5Ml Topical Jelly,,Per Svc,88.20
Chargemaster Item,,36720274,SPSI,Lidocaine/Epinephrine 2% 1.7Ml Inj,,Per Svc,10.00
Chargemaster Item,,36720282,SPSI,Lidocaine 4% 50Ml Top Sol,,Per Svc,504.00
Chargemaster Item,,36720308,SPSI,Lidocaine 5% 35Gm Oint,,Per Svc,2835.10
Chargemaster Item,,36720316,SPSI,Lidocaine/Epinephrine 2% 20Ml Inj,,Per Svc,229.70
Chargemaster Item,,36720332,SPSI,Lidocaine 4% 5Ml Inj,,Per Svc,79.30
Chargemaster Item,,36720340,SPSI,Lidocaine 2% 20Ml Oral Viscous Liq,,Per Svc,11.35
Chargemaster Item,,36720357,SPSI,Lidocaine Visc,,Per Svc,73.85
Chargemaster Item,,36720365,SPSI,Tambocor 100Mg Tab.,,Per Svc,59.05
Chargemaster Item,,36720399,SPSI,Lidocaine 1% 10Ml Inj,,Per Svc,26.65
Chargemaster Item,,36720407,SPSI,Lidocaine 4% 5Gm Top Crm,,Per Svc,504.75
Chargemaster Item,,36720431,SPSI,Lidocaine 0.5%/Epi 50Ml Inj,,Per Svc,43.60
Chargemaster Item,,36720456,SPSI,Lidocaine 0.5% 50Ml Inj,,Per Svc,52.40
Chargemaster Item,,36720464,SPSI,Chloroprocaine 3% 20Ml Inj,,Per Svc,282.05
Chargemaster Item,,36720472,SPSI,Flecainide 10Mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36720761,SPSI,Ropivacaine 1Mg Inj,,Per Svc,34.40
Chargemaster Item,,36721009,SPSI,Palonosetron Hcl 0.25mG Inj,,Per Svc,4888.80
Chargemaster Item,,36721017,SPSI,Morphine PFS 5mG/mL Inj,,Per Svc,75.85
Chargemaster Item,,36722106,SPSI,Tetracaine 2% 118Ml Topical Sol,,Per Svc,325.65
Chargemaster Item,,36722114,SPSI,Tetracaine 1% 2Ml,,Per Svc,956.85
Chargemaster Item,,36722809,SPSI,Bupivacaine/Dextrose 0.75% Ml,,Per Svc,13.65
Chargemaster Item,,36722973,SPSI,Bupivcaine 0.25% 30Ml,,Per Svc,178.85
Chargemaster Item,,36722981,SPSI,Bupivacaine/Epinephrine 0.5% 30Ml,,Per Svc,59.10
Chargemaster Item,,36723005,SPSI,Bupivacaine 0.25% 30Ml,,Per Svc,54.60
Chargemaster Item,,36723021,SPSI,Bupivacaine 0.5% 30ml,,Per Svc,22.90
Chargemaster Item,,36723039,SPSI,Bupivacaine 0.75% 30Ml,,Per Svc,41.15
Chargemaster Item,,36723047,SPSI,Bupivacaine/Epinephrine 0.25% 30Ml,,Per Svc,113.95
Chargemaster Item,,36723054,SPSI,Marcain .5% Epi,,Per Svc,215.15
Chargemaster Item,,36723062,SPSI,Trifluridine/Tipiracil Hcl 15mG Po,,Per Svc,570.40
Chargemaster Item,,36723153,SPSI,Bupivacaine/Epinephrine 0.75% 30Ml,,Per Svc,304.50
Chargemaster Item,,36723203,SPSI,Nesacaine 2% 30Ml,,Per Svc,277.20
Chargemaster Item,,36723401,SPSI,Lidocaine 5%/7.5% Dextrose 2Ml Inj,,Per Svc,115.00
Chargemaster Item,,36724003,SPSI,Pot Acetate 4mEq/2mL Oral Liq,,Per Svc,56.00
Chargemaster Item,,36726008,SPSI,Immune Globulin 5Gm Inj,,Per Svc,4440.00
Chargemaster Item,,36726016,SPSI,AA4.25%/Ca/lytes/Dex10% 2000mL,,Per Svc,893.55
Chargemaster Item,,36727006,SPSI,Ziv-Aflibercept 100mG Inj,,Per Svc,8000.00
Chargemaster Item,,36728004,SPSI,Buprenorphine SL 2mG Tab,,Per Svc,113.25
Chargemaster Item,,36735009,SPSI,Ziv-Aflibercept 200mG Inj,,Per Svc,16000.00
Chargemaster Item,,36736007,SPSI,Ergocalciferol 50000U Oral Liq,,Per Svc,109.60
Chargemaster Item,,36736015,SPSI,Tacrolimus 1mG/mL Oral Syr,,Per Svc,60.21
Chargemaster Item,,36743003,SPSI,Degarelix Acetate 120mG Inj,,Per Svc,2848.00
Chargemaster Item,,36743011,SPSI,Metronidazole 50mG Oral Liq,,Per Svc,10.00
Chargemaster Item,,36745016,SPSI,0.9% Sod Chl 10mL,,Per Svc,10.00
Chargemaster Item,,36748002,SPSI,Mag Sulfate 2.03mEq/0.5mL Oral,,Per Svc,10.00
Chargemaster Item,,36750008,SPSI,Degarelix Acetate 80mG Inj,,Per Svc,2700.00
Chargemaster Item,,36751006,SPSI,Carvedilol 1.56mG Tab,,Per Svc,11.25
Chargemaster Item,,36753002,SPSI,Bevacizumab-awwb 400mG Inj,,Per Svc,16257.60
Chargemaster Item,,36756005,SPSI,Sterile Water Irrig 250mL,,Per Svc,40.70
Chargemaster Item,,36760007,SPSI,Oxytocin 10 Units,,Per Svc,13.25
Chargemaster Item,,36760015,SPSI,Oxytocin 20 Units / 1000mL,,Per Svc,121.30
Chargemaster Item,,36760254,SPSI,Methrgine 0.2Mg Po,,Per Svc,119.50
Chargemaster Item,,36760304,SPSI,Methylergonovine 0.2Mg Inj,,Per Svc,324.25
Chargemaster Item,,36760353,SPSI,Oxytocin 10Units Inj,,Per Svc,156.60
Chargemaster Item,,36760387,SPSI,Carboprost 250Mcg Inj,,Per Svc,4465.85
Chargemaster Item,,36760429,SPSI,Prostin E2 Supp,,Per Svc,13249.00
Chargemaster Item,,36760437,SPSI,Alprostadil 0.5mG,,Per Svc,1494.05
Chargemaster Item,,36760502,SPSI,Dinoprostone Vaginal Insert,,Per Svc,3858.95
Chargemaster Item,,36761120,SPSI,Selenium 600mCg/10mL,,Per Svc,10290.00
Chargemaster Item,,36764009,SPSI,Pomalidomide 1mG Po,,Per Svc,2561.80
Chargemaster Item,,36766004,SPSI,Dabrafenib Mesylate 75mG Po,,Per Svc,3860.40
Chargemaster Item,,36768000,SPSI,Dexrazoxane 250mG Inj,,Per Svc,2959.55
Chargemaster Item,,36769008,SPSI,Siltuximab 100mG Inj,,Per Svc,3535.00
Chargemaster Item,,36769016,SPSI,Metocloprmide 0.5mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36771004,SPSI,Clobazam 2.5mG Liq,67386031321,Per Svc,221.95
Chargemaster Item,,36773000,SPSI,Mycophenolate DR 180mG Tab,,Per Svc,48.00
Chargemaster Item,,36773018,SPSI,Quetiapine 12.5mG,,Per Svc,20.80
Chargemaster Item,,36777001,SPSI,Siltuximab 400mG Inj,,Per Svc,14139.60
Chargemaster Item,,36779122,SPSI,Sevelamer Carbonate 0.8Gm Po,,Per Svc,119.20
Chargemaster Item,,36779130,SPSI,Bevacizumab-awwb 100mG Inj,,Per Svc,4064.40
Chargemaster Item,,36780013,SPSI,Pomalidomide 2mG Po,,Per Svc,2561.80
Chargemaster Item,,36782001,SPSI,Toremifene Citrate 60mG Po,,Per Svc,233.40
Chargemaster Item,,36782019,SPSI,Linagliptin 5mG Po,597014090,Per Svc,183.25
Chargemaster Item,,36787000,SPSI,Dasatinib 140mG Po,,Per Svc,11112.45
Chargemaster Item,,36789125,SPSI,Adult TPN,,Per Svc,703.50
Chargemaster Item,,36792000,SPSI,Olaparib 50mG Po,,Per Svc,449.40
Chargemaster Item,,36793016,SPSI,Clonazepam 0.25mG ODT,,Per Svc,13.65
Chargemaster Item,,36797983,SPSI,Symbcort 160/4.5mCg Inh 2puffs,,Per Svc,213.60
Chargemaster Item,,36798007,SPSI,Pomalidomide 3mG Po,,Per Svc,2561.80
Chargemaster Item,,36800001,SPSI,Hepatitis B IM/Globulin 1mL,,Per Svc,549.40
Chargemaster Item,,36800019,SPSI,Hepatitis B IM/Globulin 5mL,,Per Svc,2075.70
Chargemaster Item,,36800027,SPSI,Immune Glob (IGG) 2mL,,Per Svc,256.60
Chargemaster Item,,36800035,SPSI,Immune Glob (IGG) 10mL,,Per Svc,234.45
Chargemaster Item,,36800043,SPSI,Immune Globulin 5Gm,,Per Svc,3330.00
Chargemaster Item,,36800050,SPSI,Immune Globulin 10Gm,,Per Svc,5809.00
Chargemaster Item,,36800068,SPSI,Immune Globulin 20Gm,,Per Svc,12672.00
Chargemaster Item,,36800076,SPSI,Immune Globulin 40Gm,,Per Svc,25344.00
Chargemaster Item,,36800084,SPSI,Palivizumab 50mG Inj a,,Per Svc,8981.60
Chargemaster Item,,36800092,SPSI,Palivizumab 100mG Inj,,Per Svc,16959.85
Chargemaster Item,,36800100,SPSI,WinRho 300mCg (1500 units),,Per Svc,3398.40
Chargemaster Item,,36800118,SPSI,WinRho 1000mCg (5000 units),,Per Svc,7489.40
Chargemaster Item,,36800126,SPSI,WinRho 500mCg (2500 units),,Per Svc,3734.10
Chargemaster Item,,36800134,SPSI,WinRho 3000mCg (15000 units),,Per Svc,22353.95
Chargemaster Item,,36800167,SPSI,Hepatitis B Imm Globulin 0.5Ml,,Per Svc,918.95
Chargemaster Item,,36800175,SPSI,HIB-1 Mune Vaccine 1 Vial,,Per Svc,439.55
Chargemaster Item,,36800183,SPSI,Menomune Vaccine,,Per Svc,462.50
Chargemaster Item,,36800209,SPSI,Hepatitis B Vaccine 1Ml Adult,,Per Svc,639.05
Chargemaster Item,,36800217,SPSI,Hepatitis B Imm Globulin 5Ml,,Per Svc,3686.40
Chargemaster Item,,36800225,SPSI,Hepatitis B Vaccine 0.5Ml Peds,,Per Svc,255.15
Chargemaster Item,,36800258,SPSI,Immune Globulin Im 1Ml,,Per Svc,481.35
Chargemaster Item,,36800266,SPSI,Immune Globulin Im 5Ml,,Per Svc,2406.10
Chargemaster Item,,36800274,SPSI,Rho D Imm Globulin 100IU,,Per Svc,296.80
Chargemaster Item,,36800290,SPSI,Immune Globulin 500Mg Inj,,Per Svc,121.80
Chargemaster Item,,36800308,SPSI,Varicella Zoster Immune Globulin,,Per Svc,430.65
Chargemaster Item,,36800357,SPSI,Rho D Immune Glob 300Mcg,,Per Svc,1297.45
Chargemaster Item,,36800365,SPSI,Rho (D) Immune Globulin 300mCg,,Per Svc,1552.05
Chargemaster Item,,36800373,SPSI,Immune Glubulin 0.5gm,,Per Svc,390.25
Chargemaster Item,,36800381,SPSI,RHO(D) Immune Globulin 100 iu,,Per Svc,296.80
Chargemaster Item,,36800399,SPSI,Suboxone 2mG/0.5mG SL Tab,,Per Svc,145.75
Chargemaster Item,,36800407,SPSI,Tetanus Immune Glob 250 U Inj,,Per Svc,4757.85
Chargemaster Item,,36800431,SPSI,Palivizumab 50Mg Inj,,Per Svc,5492.00
Chargemaster Item,,36800506,SPSI,Diptheria Tet,,Per Svc,900.90
Chargemaster Item,,36800514,SPSI,Dipth/Tet/Acell Pert Adult Syringe,,Per Svc,514.30
Chargemaster Item,,36800522,SPSI,Meningococcal Conjugate,,Per Svc,6226.95
Chargemaster Item,,36800548,SPSI,Inactivated Polio Virus,,Per Svc,4208.50
Chargemaster Item,,36800571,SPSI,Pneumococcal 23 Valent Vaccine,,Per Svc,1325.40
Chargemaster Item,,36800589,SPSI,Dipth/Tet/Acell Pert Ped,,Per Svc,333.90
Chargemaster Item,,36800639,SPSI,Rabies Immune Globulin 300Units Inj,,Per Svc,3747.10
Chargemaster Item,,36800647,SPSI,Influenza Vac 6-35 Months,,Per Svc,228.70
Chargemaster Item,,36800654,SPSI,Influenza Vacc 3yrs and up,,Per Svc,1715.70
Chargemaster Item,,36800662,SPSI,Influenza Vacc 18 yrs and up,,Per Svc,319.20
Chargemaster Item,,36800670,SPSI,Influenza Peds 6-35 mths,,Per Svc,2314.55
Chargemaster Item,,36800738,SPSI,Influenza 65yrs and up,,Per Svc,927.70
Chargemaster Item,,36800779,SPSI,Candida Skin Test,,Per Svc,1499.40
Chargemaster Item,,36801009,SPSI,Antivenom Black Widow,,Per Svc,349.15
Chargemaster Item,,36801017,SPSI,Phytonadione 5mG/5mL Po,,Per Svc,173.70
Chargemaster Item,,36801025,SPSI,Human Papillomavirus 0.5Ml Vaccine,,Per Svc,2733.65
Chargemaster Item,,36801033,SPSI,Varicella-Zoster Vaccine,,Per Svc,2811.25
Chargemaster Item,,36801058,SPSI,Antivenin Crotalidae 1000mG / Vial,,Per Svc,19188.00
Chargemaster Item,,36801066,SPSI,Comvax Vacine,,Per Svc,263.50
Chargemaster Item,,36801074,SPSI,Rotavirus Vaccine,,Per Svc,1063.55
Chargemaster Item,,36801082,SPSI,Rabies Vaccine 2.5Units Inj,,Per Svc,4246.20
Chargemaster Item,,36801108,SPSI,Pediarix Vaccine,,Per Svc,989.40
Chargemaster Item,,36801207,SPSI,Botulinum Toxin Type A 100 Units,,Per Svc,3606.00
Chargemaster Item,,36801306,SPSI,Varicella Virus Vaccine,,Per Svc,1387.05
Chargemaster Item,,36801405,SPSI,Measles/Mumps/Rubella Vaccine,,Per Svc,986.60
Chargemaster Item,,36801504,SPSI,Prevnar Vaccine,,Per Svc,2372.15
Chargemaster Item,,36801603,SPSI,Hepatitis A Vaccine 1440Units Adult,,Per Svc,764.50
Chargemaster Item,,36801652,SPSI,Hepatitis A Vaccine 720Units Peds,,Per Svc,412.85
Chargemaster Item,,36801702,SPSI,Hydralazine 0.5mG/0.5mL IV,,Per Svc,10.00
Chargemaster Item,,36810000,SPSI,Ferumoxytol 510mG Inj,,Per Svc,2462.80
Chargemaster Item,,36810018,SPSI,Mitotane 500mG Po,,Per Svc,103.50
Chargemaster Item,,36812006,SPSI,Genvoya 150/150/200/10mG,,Per Svc,1297.80
Chargemaster Item,,36814002,SPSI,Pomalidomide 4mG Po,,Per Svc,2453.40
Chargemaster Item,,36815009,SPSI,Nivolumab 100mG Inj,,Per Svc,16208.00
Chargemaster Item,,36817005,SPSI,Mirabegron 25mG ER Tab,,Per Svc,161.40
Chargemaster Item,,36817120,SPSI,AntiCoag Cit Dex Sol A 750mL,,Per Svc,49.15
Chargemaster Item,,36835122,SPSI,Heparin 100U/mL Inj 1mL,,Per Svc,13.15
Chargemaster Item,,36836005,SPSI,Warfarin 7.5mG Po,,Per Svc,82.80
Chargemaster Item,,36840007,SPSI,Clobetasol 0.05% 15 Gm Crm,,Per Svc,1346.40
Chargemaster Item,,36840015,SPSI,Clobetasol 0.05% 15Gm Oint a,,Per Svc,1632.25
Chargemaster Item,,36840023,SPSI,Betaxolol 0.25% 10Ml Ophth Sol,,Per Svc,3912.70
Chargemaster Item,,36840056,SPSI,Metronidazole 0.75% 70Gm Vaginal Gel,,Per Svc,1711.90
Chargemaster Item,,36840064,SPSI,Metronidazole 0.75% 45Gm Topgel,,Per Svc,1793.95
Chargemaster Item,,36840072,SPSI,Miconazole 100Mg Supp,,Per Svc,17.35
Chargemaster Item,,36840080,SPSI,Ciclopirox 0.77% 15Gm Crm,,Per Svc,515.85
Chargemaster Item,,36840114,SPSI,Clindamycn 1% Gel 75Ml,,Per Svc,1960.45
Chargemaster Item,,36840122,SPSI,Cortisporin 3.5Gm Ophth Oint,,Per Svc,683.05
Chargemaster Item,,36840130,SPSI,Cetaphil Skin 4Oz Cleanser,,Per Svc,42.20
Chargemaster Item,,36840155,SPSI,Econazole 1% 15Gm Cream,,Per Svc,1141.90
Chargemaster Item,,36840163,SPSI,Clobetasol 0.05% 15Gm Oint,,Per Svc,453.70
Chargemaster Item,,36840171,SPSI,Bacitracin Oint 28Gm,,Per Svc,54.20
Chargemaster Item,,36840189,SPSI,Fluocinonide 0.05% 60M Top Sol,,Per Svc,1020.50
Chargemaster Item,,36840197,SPSI,Betaxolol 0.5% 5Ml Ophth Sol,,Per Svc,281.70
Chargemaster Item,,36840213,SPSI,Levobunol 0.5% 5Ml Ophth Sol,,Per Svc,756.95
Chargemaster Item,,36840239,SPSI,Clindamycin T 1% 60Ml Lotion,,Per Svc,1797.30
Chargemaster Item,,36840247,SPSI,Betamethasone 0.05% Lot 60Ml,,Per Svc,503.90
Chargemaster Item,,36840254,SPSI,Mupirocin 2% 1Gm Nasal Oint.,,Per Svc,191.95
Chargemaster Item,,36840296,SPSI,Betamethasone/Clotrimazole 0.05%/1% 15Gm Crm,,Per Svc,737.10
Chargemaster Item,,36840304,SPSI,Clotrimazole 1% 15Gm Crm,,Per Svc,54.95
Chargemaster Item,,36840320,SPSI,Betamethasone 0.05% Crm 45Gm,,Per Svc,1109.35
Chargemaster Item,,36840338,SPSI,Dimethyl Sulfoxide 50% 50Ml,,Per Svc,3711.55
Chargemaster Item,,36840346,SPSI,Monistat Derm Crm 15Gm,,Per Svc,34.65
Chargemaster Item,,36840353,SPSI,Clotrimazole 1% 30Gm Crm,,Per Svc,365.50
Chargemaster Item,,36840379,SPSI,Miconazole 200Mg Vaginal Supp,,Per Svc,151.30
Chargemaster Item,,36840387,SPSI,Miconazole 2% 45Gm Vaginal Crm,,Per Svc,78.10
Chargemaster Item,,36840403,SPSI,Nystatin/Triamcinolone 15Gm Crm,,Per Svc,1175.35
Chargemaster Item,,36840411,SPSI,Clindamycin 1% Lotion 60Ml,,Per Svc,1261.90
Chargemaster Item,,36840437,SPSI,Gentamicin 0.1% Top Oint 15Gm,,Per Svc,66.45
Chargemaster Item,,36840478,SPSI,Hydrocortisone/Iodoquinol 28.4Gm Crm,,Per Svc,1810.60
Chargemaster Item,,36840486,SPSI,Cortisporin Crm 7.5Gm,,Per Svc,434.60
Chargemaster Item,,36840494,SPSI,Ketoconazole 2% 15Gm Crm,,Per Svc,324.45
Chargemaster Item,,36840502,SPSI,Nystatin/Triamcinolone 15Gm Oint,,Per Svc,1175.35
Chargemaster Item,,36840510,SPSI,Clotrimazole 1% 30Ml Topical Sol,,Per Svc,784.65
Chargemaster Item,,36840528,SPSI,Becaplermin Gel 15Gm,,Per Svc,5523.40
Chargemaster Item,,36840569,SPSI,Cortisporin Oint 15Gms,,Per Svc,2002.65
Chargemaster Item,,36840585,SPSI,Calazime Skin Paste 4Oz,,Per Svc,129.05
Chargemaster Item,,36840593,SPSI,Balmex Oint 4Oz,,Per Svc,29.60
Chargemaster Item,,36840619,SPSI,Ketoconazole 2% 120Ml Shampoo,,Per Svc,275.30
Chargemaster Item,,36840627,SPSI,Cadexomer Iodine 1.4Oz Gel,,Per Svc,1439.15
Chargemaster Item,,36840635,SPSI,Fluocinonide 0.05% 15Gm Gel,,Per Svc,1217.70
Chargemaster Item,,36840643,SPSI,Miconazole 2% 85Gm Powder,,Per Svc,61.10
Chargemaster Item,,36840668,SPSI,Monetasone 0.1% 15Gm Cream,,Per Svc,110.15
Chargemaster Item,,36840676,SPSI,Terconazole 80Mg Vaginal Supp,,Per Svc,142.30
Chargemaster Item,,36840684,SPSI,Terconazole 0.4% 45Gm Crm,,Per Svc,452.25
Chargemaster Item,,36840692,SPSI,Lidocaine 5% Patch,,Per Svc,142.70
Chargemaster Item,,36840700,SPSI,Mucostatin Oin (See 36841104),,Per Svc,128.15
Chargemaster Item,,36840718,SPSI,Bacitracin/Polymyxin Oint Packet,,Per Svc,10.00
Chargemaster Item,,36840734,SPSI,A&D Oint 5Gm Pkt,,Per Svc,1.10
Chargemaster Item,,36840742,SPSI,Piperonyl Butoxide/Pyrethrins 60Ml Shampoo,,Per Svc,122.65
Chargemaster Item,,36840817,SPSI,Terbinafine 1% 12Gm Crm,,Per Svc,84.40
Chargemaster Item,,36840833,SPSI,Sween Crm 2Oz,,Per Svc,101.75
Chargemaster Item,,36840882,SPSI,Cetaphil 8Oz Lot,,Per Svc,53.75
Chargemaster Item,,36840890,SPSI,Neomycin/Polymyxin 10Ml Otic Sol,,Per Svc,373.05
Chargemaster Item,,36840924,SPSI,Bacitra/Neomy/Polymy 28Gm Oint,,Per Svc,37.80
Chargemaster Item,,36840932,SPSI,Bacitac/Neomy/Polymy Oint Pkt,,Per Svc,10.00
Chargemaster Item,,36840957,SPSI,Nystatin 15Gm Crm,,Per Svc,183.75
Chargemaster Item,,36840973,SPSI,Neomycin/Polymyxin 15Gm Crm,,Per Svc,19.65
Chargemaster Item,,36841005,SPSI,Dasatinib 50mG Po,,Per Svc,834.80
Chargemaster Item,,36841039,SPSI,Pramoxine 1% Foam 15gm,,Per Svc,550.50
Chargemaster Item,,36841104,SPSI,Nystatin 15Gm Oint,,Per Svc,176.40
Chargemaster Item,,36841153,SPSI,Nystatin 15Gm Powder,,Per Svc,288.35
Chargemaster Item,,36841161,SPSI,Tretinion 0.25% 45Gm Crm,,Per Svc,2384.95
Chargemaster Item,,36841203,SPSI,Nystatin Vag,,Per Svc,145.40
Chargemaster Item,,36841278,SPSI,Polysporin Oin,,Per Svc,36.95
Chargemaster Item,,36841294,SPSI,Sulfanilamide 15% 120Gm Crm,,Per Svc,166.30
Chargemaster Item,,36841302,SPSI,Tinactin Cr,,Per Svc,61.10
Chargemaster Item,,36841351,SPSI,Tolnaftate 1% 45Gm Powder,,Per Svc,64.70
Chargemaster Item,,36841500,SPSI,Selenium Sulfide 1% Shampoo 207Ml,,Per Svc,48.00
Chargemaster Item,,36841559,SPSI,Silver Sulfadiazine 1% 25Gm Crm,,Per Svc,94.40
Chargemaster Item,,36841757,SPSI,Povidone Iodine 30Ml Oint,,Per Svc,154.10
Chargemaster Item,,36841765,SPSI,Povidine Oint Pkt,,Per Svc,34.65
Chargemaster Item,,36841807,SPSI,Hydrocortisone 0.5% 28Gm Crm,,Per Svc,37.60
Chargemaster Item,,36841856,SPSI,Hydrocortisone 1% 28Gm Crm,,Per Svc,41.90
Chargemaster Item,,36841914,SPSI,Hydrocortisone 1% 118Ml Lotion,,Per Svc,10.00
Chargemaster Item,,36841955,SPSI,Hydrocortisone 1% 28Gm Oint,,Per Svc,67.95
Chargemaster Item,,36841963,SPSI,Fluocinonide 0.05% 60Gm Gel,,Per Svc,450.35
Chargemaster Item,,36842003,SPSI,Kenalog Crm,,Per Svc,129.90
Chargemaster Item,,36842011,SPSI,Triamcinolone Orabase 1% 5Gm,,Per Svc,367.20
Chargemaster Item,,36842029,SPSI,Kenalog Spray,,Per Svc,116.65
Chargemaster Item,,36842045,SPSI,Triamcinolone 1% 60Ml Lotion,,Per Svc,945.00
Chargemaster Item,,36842060,SPSI,Fluocinonide 0.05% 15Gm Crm,,Per Svc,478.30
Chargemaster Item,,36842086,SPSI,Lidex Oint,,Per Svc,742.90
Chargemaster Item,,36842094,SPSI,Fluocinonide 0.05% 15Gm Oint,,Per Svc,189.10
Chargemaster Item,,36842102,SPSI,Talc Sterile 5Gms,,Per Svc,1955.00
Chargemaster Item,,36842144,SPSI,Benzoyl Peroxide 5% 1.5Oz,,Per Svc,1186.90
Chargemaster Item,,36842151,SPSI,Ilex Skin Protectant 2Oz,,Per Svc,95.95
Chargemaster Item,,36842169,SPSI,Ammonium Lact 12% Crm 140Gm,,Per Svc,233.95
Chargemaster Item,,36842193,SPSI,Talc Intrapleural Aerosol 4Gm,,Per Svc,138.60
Chargemaster Item,,36842201,SPSI,Aloe Vera/Glycerin 14.1Gm Gel,,Per Svc,32.35
Chargemaster Item,,36842227,SPSI,Triamcinolone Aerosol Spray 63Gm,,Per Svc,3178.00
Chargemaster Item,,36842318,SPSI,Urea 10% Crm 142Gm,,Per Svc,122.95
Chargemaster Item,,36842391,SPSI,Ammonium Lactate 12% 5Oz Lotion,,Per Svc,79.30
Chargemaster Item,,36842805,SPSI,Bacitracin Oint 0.9Gm Pkt,,Per Svc,10.00
Chargemaster Item,,36843001,SPSI,Menthol / Methyl Salicylate Crm,,Per Svc,5.05
Chargemaster Item,,36843019,SPSI,Menthol / Methyl Salicylate Oint,,Per Svc,19.95
Chargemaster Item,,36843050,SPSI,A-D Oint,,Per Svc,1.10
Chargemaster Item,,36843068,SPSI,Bengay Oint,,Per Svc,4.85
Chargemaster Item,,36843084,SPSI,Tacrolimus 0.03% 30Gm Oint,,Per Svc,2784.50
Chargemaster Item,,36843175,SPSI,Collagenase 30Gm Oint,,Per Svc,2580.50
Chargemaster Item,,36843209,SPSI,Calamine Lotion 4Oz,,Per Svc,44.75
Chargemaster Item,,36843217,SPSI,Caladryl Lotion 180Ml,,Per Svc,58.30
Chargemaster Item,,36843258,SPSI,Nupercain Oint,,Per Svc,63.00
Chargemaster Item,,36843266,SPSI,Clindamycin Vaginal 2% 40Gm Crm,,Per Svc,2424.15
Chargemaster Item,,36843605,SPSI,Hydrogen Peroxide 2% 473Ml,,Per Svc,3.15
Chargemaster Item,,36843654,SPSI,Zinc Oxide 28Gm Oint,,Per Svc,70.40
Chargemaster Item,,36843688,SPSI,Aluminum Acet Powder Pkt,,Per Svc,11.85
Chargemaster Item,,36843753,SPSI,Silver Nitrate Applicator,,Per Svc,10.00
Chargemaster Item,,36843761,SPSI,Zinc Oxide Oint 1Oz,,Per Svc,1111.30
Chargemaster Item,,36843779,SPSI,Pramoxine 1% 15Gm Foam,,Per Svc,325.65
Chargemaster Item,,36843902,SPSI,Petrolatum 28.35 Gm Jelly,,Per Svc,29.80
Chargemaster Item,,36843910,SPSI,Anusol Hc Cr,,Per Svc,916.95
Chargemaster Item,,36843928,SPSI,Anusol Supp,,Per Svc,1.65
Chargemaster Item,,36843936,SPSI,Hydrocortisone 25Mg Supp,,Per Svc,237.85
Chargemaster Item,,36843944,SPSI,Anusol Oint 30Gm,,Per Svc,106.55
Chargemaster Item,,36843977,SPSI,Phenylephrine 0.25% Supp,,Per Svc,10.00
Chargemaster Item,,36843993,SPSI,Phenylephrine/Shark Liver Oil 30Gm Oint,,Per Svc,121.60
Chargemaster Item,,36844009,SPSI,Glycerin/Witch Hazel Pads,,Per Svc,10.00
Chargemaster Item,,36844017,SPSI,Venelex 60Gm Oint,,Per Svc,393.75
Chargemaster Item,,36844025,SPSI,Venelex 30Gm Oint,,Per Svc,250.40
Chargemaster Item,,36844116,SPSI,Petrolatum 5Gm Pkt,,Per Svc,11.25
Chargemaster Item,,36844124,SPSI,Cetacaine Spry 56Gm,,Per Svc,353.45
Chargemaster Item,,36844140,SPSI,Dermal Wound Gel,,Per Svc,88.35
Chargemaster Item,,36844157,SPSI,Dermoplast Spray 56Ml,,Per Svc,57.10
Chargemaster Item,,36844215,SPSI,Lansinon 0.25Oz,,Per Svc,24.80
Chargemaster Item,,36844322,SPSI,Carbamide Peroxide 6.5% 15Ml Otic Sol,,Per Svc,18.25
Chargemaster Item,,36844355,SPSI,Trolamine 10% 60Gm Crm,,Per Svc,28.15
Chargemaster Item,,36844876,SPSI,Penciclovir 1% 1.5Gm Crm,,Per Svc,4871.95
Chargemaster Item,,36844884,SPSI,Calcipotriene 0.005% Crm 60Gm,,Per Svc,3045.85
Chargemaster Item,,36844892,SPSI,Imiquimod 5% 0.25Gm Crm Pkt,,Per Svc,78.75
Chargemaster Item,,36844900,SPSI,Trypsin/Balsam Peru/Castor Oil 60Gm Oint,,Per Svc,254.45
Chargemaster Item,,36844918,SPSI,Fluorouracil 5% 40Gm Cream,,Per Svc,1071.00
Chargemaster Item,,36844926,SPSI,Surgi Lube 127Gm Jelly,,Per Svc,33.30
Chargemaster Item,,36844934,SPSI,Tazarotene 1% 30 Gm Crm,,Per Svc,2540.35
Chargemaster Item,,36844942,SPSI,Trichloroacetic Acid 15Ml,,Per Svc,266.50
Chargemaster Item,,36844967,SPSI,Pimecrolimus 1% 30Gm Crm,,Per Svc,3768.05
Chargemaster Item,,36857126,SPSI,Potassium Chl 2mEq/mL 10mL,,Per Svc,12.60
Chargemaster Item,,36859007,SPSI,Baloxavir 20mG Tab 40mG dose,,Per Svc,2520.00
Chargemaster Item,,36860039,SPSI,Ceftriaxone D5W 250mG Inj,,Per Svc,10.00
Chargemaster Item,,36860195,SPSI,Combivent 14.7Gms,,Per Svc,5069.10
Chargemaster Item,,36860229,SPSI,Aminophylline 5Mg Inj,,Per Svc,10.00
Chargemaster Item,,36860500,SPSI,Aminophyllin 500mG,,Per Svc,88.20
Chargemaster Item,,36860971,SPSI,Ditropan 5Mg,,Per Svc,10.00
Chargemaster Item,,36860997,SPSI,Oxybutynin 5Mg Oral Liq,,Per Svc,10.00
Chargemaster Item,,36861003,SPSI,Papaverine 60mG,,Per Svc,450.75
Chargemaster Item,,36861011,SPSI,Papaverine 300mG,,Per Svc,63.00
Chargemaster Item,,36861029,SPSI,Sanctura Xr 60mg Po,,Per Svc,78.65
Chargemaster Item,,36861037,SPSI,Trospuim 20Mg Po,,Per Svc,44.50
Chargemaster Item,,36861052,SPSI,Oxybutynin Xl 5Mg Po,,Per Svc,30.05
Chargemaster Item,,36861060,SPSI,Tolterodione La 4Mg Po,,Per Svc,148.90
Chargemaster Item,,36861078,SPSI,Tolterodione La 2Mg Po,,Per Svc,142.30
Chargemaster Item,,36861086,SPSI,Tolterodione 1Mg Po,,Per Svc,90.20
Chargemaster Item,,36861102,SPSI,Darifenacin 7.5Mg Po,,Per Svc,160.00
Chargemaster Item,,36861318,SPSI,Papaverine 60Mg Inj,,Per Svc,241.95
Chargemaster Item,,36861326,SPSI,Oxybutynin 3.9Mg/24Hr Biweekly Patch,,Per Svc,36.55
Chargemaster Item,,36861359,SPSI,Solifenacin 5Mg Po,,Per Svc,90.10
Chargemaster Item,,36861607,SPSI,Flavoxate 100Mg Po,,Per Svc,15.35
Chargemaster Item,,36861789,SPSI,Triamcinolone Inhaler 20Gm,,Per Svc,890.50
Chargemaster Item,,36861797,SPSI,Beclomethasone 40Mcg 8.72Gm Inhaler,,Per Svc,1582.65
Chargemaster Item,,36861854,SPSI,Slophyllin 80Mg/15Ml 1 Dose,,Per Svc,131.45
Chargemaster Item,,36861862,SPSI,Slophln 80/15 30,,Per Svc,45.50
Chargemaster Item,,36862001,SPSI,Theophylline Sr-12 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36862019,SPSI,Theophylline Sr-12 200Mg Po,,Per Svc,19.10
Chargemaster Item,,36862027,SPSI,Theophrlline Sr-12 300Mg Po,,Per Svc,49.60
Chargemaster Item,,36862407,SPSI,Theophylline Sr-24 200Mg Po,,Per Svc,25.60
Chargemaster Item,,36862456,SPSI,Theophylline Sr-24 300Mg Po,,Per Svc,46.25
Chargemaster Item,,36862704,SPSI,Theophylline Sr-24 100Mg Po,,Per Svc,17.20
Chargemaster Item,,36862712,SPSI,Uniphyl 200Mg,,Per Svc,49.55
Chargemaster Item,,36864908,SPSI,PROGESTERONE 100MG VAG SUPP,,Per Svc,94.20
Chargemaster Item,,36865004,SPSI,Ruxolitinib Phosphate 5mG Po,,Per Svc,727.00
Chargemaster Item,,36866002,SPSI,Dasatinib 100mG Po,,Per Svc,1504.60
Chargemaster Item,,36869014,SPSI,0.9% Sod Chl 25mL,,Per Svc,30.25
Chargemaster Item,,36873008,SPSI,Ruxolitinib Phosphate 10mG Po,,Per Svc,727.00
Chargemaster Item,,36873016,SPSI,Mineral Oil Sterile 10mL,,Per Svc,134.95
Chargemaster Item,,36876126,SPSI,Ampho B 0.1mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36878007,SPSI,Polymyxin B Sulfate 0.5Mu 10mL,,Per Svc,151.20
Chargemaster Item,,36880003,SPSI,Leucovorin 50mG Inj a,,Per Svc,126.00
Chargemaster Item,,36880011,SPSI,Leucovorin 100mG Inj,,Per Svc,252.00
Chargemaster Item,,36880029,SPSI,Leucovorin 350mG Inj,,Per Svc,248.75
Chargemaster Item,,36880136,SPSI,Eye Vitamin Supplement Po,,Per Svc,10.00
Chargemaster Item,,36880144,SPSI,Folic Acid 400Mcg Po,,Per Svc,10.00
Chargemaster Item,,36880151,SPSI,Vitamin E 200 Units Po,,Per Svc,10.00
Chargemaster Item,,36880177,SPSI,Aquaphor Oint 1.75Oz,,Per Svc,57.65
Chargemaster Item,,36880185,SPSI,Vitamin A 10,000U Po,,Per Svc,10.00
Chargemaster Item,,36880201,SPSI,Paricalcitol 5 mCg,,Per Svc,190.90
Chargemaster Item,,36880268,SPSI,Multivitamin/Minerals 15Ml Oral Liq,,Per Svc,10.00
Chargemaster Item,,36880342,SPSI,Cyanocobalamin 0.1Mg Inj,,Per Svc,27.20
Chargemaster Item,,36880359,SPSI,Cyanocobalamin 1000Mcg Inj,,Per Svc,91.75
Chargemaster Item,,36880367,SPSI,Cyanocobalamin 100Mcg Po,,Per Svc,10.00
Chargemaster Item,,36880375,SPSI,Cyanocobalamin 1000 Mcg Po,,Per Svc,10.00
Chargemaster Item,,36880409,SPSI,Vitamin B Complex Po,,Per Svc,10.00
Chargemaster Item,,36880433,SPSI,Cecon Oral Sol,,Per Svc,0.35
Chargemaster Item,,36880441,SPSI,Ascorbic Acid 500Mg Oral Syrup,,Per Svc,10.00
Chargemaster Item,,36880466,SPSI,Vitamin B Comples/Vitamin C Po,,Per Svc,10.00
Chargemaster Item,,36880508,SPSI,Aquasole 15 Units Oral Liq,,Per Svc,10.00
Chargemaster Item,,36880524,SPSI,Calmoseptine 2.5Oz,,Per Svc,42.00
Chargemaster Item,,36880607,SPSI,Folic Acid 1Mg Po,,Per Svc,10.00
Chargemaster Item,,36880615,SPSI,Folic Acid 1Mg Oral Liq,,Per Svc,33.60
Chargemaster Item,,36880623,SPSI,Folic Acid Liq 1 Dose,,Per Svc,35.90
Chargemaster Item,,36880706,SPSI,Folic Acid 5Mg Inj,,Per Svc,568.45
Chargemaster Item,,36880755,SPSI,Leucovorin 50mg Inj,,Per Svc,242.45
Chargemaster Item,,36880805,SPSI,Niacin 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36880813,SPSI,Cyano Kit,,Per Svc,3432.00
Chargemaster Item,,36880821,SPSI,Riboflavin 25mg Po,,Per Svc,11.95
Chargemaster Item,,36880839,SPSI,Niacin Er 500Mg Po,,Per Svc,18.80
Chargemaster Item,,36880847,SPSI,Niacin 250Mg Po,,Per Svc,10.00
Chargemaster Item,,36880854,SPSI,Niacin 100Mg Po,,Per Svc,0.05
Chargemaster Item,,36881001,SPSI,Pyridoxine 25Mg Po,,Per Svc,10.00
Chargemaster Item,,36881019,SPSI,Pyridoxine 100Mg Inj,,Per Svc,191.50
Chargemaster Item,,36881027,SPSI,Ruxolitinib Phosphate 15mG Po,,Per Svc,727.00
Chargemaster Item,,36881035,SPSI,Doxercalciferol 2.5Mcg Po,,Per Svc,397.75
Chargemaster Item,,36881050,SPSI,Pyridoxine 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36881068,SPSI,Ascorbic Acid 500Mg Inj,,Per Svc,126.00
Chargemaster Item,,36881076,SPSI,Cholecalciferol 1000Units Po,,Per Svc,10.00
Chargemaster Item,,36881084,SPSI,Calciferol 1200units/0.15ml Or,,Per Svc,10.00
Chargemaster Item,,36881100,SPSI,Thiamine 200mG Inj,,Per Svc,36.55
Chargemaster Item,,36881118,SPSI,Cholecalciferol 400Units Po,,Per Svc,10.00
Chargemaster Item,,36881167,SPSI,Paricalcitol 1Mcg Po,,Per Svc,163.90
Chargemaster Item,,36881209,SPSI,Thiamine 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36881308,SPSI,Ascorbic Acid 500Mg Po,,Per Svc,10.00
Chargemaster Item,,36881373,SPSI,Calcitriol 0.5Mcg Po,,Per Svc,20.05
Chargemaster Item,,36881381,SPSI,Calcitriol 1mCg,,Per Svc,63.00
Chargemaster Item,,36881399,SPSI,Calcitrol 1Mcg Oral Liq,,Per Svc,69.95
Chargemaster Item,,36881407,SPSI,Vit D 50,000,,Per Svc,23.95
Chargemaster Item,,36881423,SPSI,Vit D 2001U/Drop 1 Dose,,Per Svc,4.15
Chargemaster Item,,36881431,SPSI,Ergocalciferol 1200Units Oral Liq,,Per Svc,10.00
Chargemaster Item,,36881498,SPSI,Vitamin E 15 Units Oral Liq,,Per Svc,0.65
Chargemaster Item,,36881555,SPSI,Vitamin E 400,,Per Svc,10.00
Chargemaster Item,,36881605,SPSI,Phytonadione 10mG Inj,,Per Svc,607.85
Chargemaster Item,,36881712,SPSI,Mephytoin 5Mg,,Per Svc,644.65
Chargemaster Item,,36881852,SPSI,Doxercalciferol 0.5Mcg Po,,Per Svc,171.70
Chargemaster Item,,36881902,SPSI,Albee C Cap,,Per Svc,10.00
Chargemaster Item,,36882041,SPSI,Prenatal Vitamin,,Per Svc,3.50
Chargemaster Item,,36882066,SPSI,Prenatal W/Folic Acid 1Mg,,Per Svc,10.00
Chargemaster Item,,36882157,SPSI,Multiviamin po,,Per Svc,10.00
Chargemaster Item,,36882223,SPSI,Multivitamin 1Ml Oral Drop,,Per Svc,18.80
Chargemaster Item,,36882280,SPSI,Multivitamin/Hematinic Po,,Per Svc,25.20
Chargemaster Item,,36882306,SPSI,Multivitamin/Minerals Po,,Per Svc,10.00
Chargemaster Item,,36882389,SPSI,Oyster Shell Calcium/Vit D 500Mg/200Po,,Per Svc,10.00
Chargemaster Item,,36882439,SPSI,Oyster Shell Calcium 500Mg Po,,Per Svc,0.15
Chargemaster Item,,36882579,SPSI,Poly Vi Floro 25Mg 50 Ml,,Per Svc,256.35
Chargemaster Item,,36882587,SPSI,Zestril 10Mg,,Per Svc,12.25
Chargemaster Item,,36882595,SPSI,Lisinopril 20Mg Po,,Per Svc,13.85
Chargemaster Item,,36882603,SPSI,Mvi Conc Vial,,Per Svc,199.20
Chargemaster Item,,36882629,SPSI,Mvi-12 10Ml Inj,,Per Svc,89.65
Chargemaster Item,,36882637,SPSI,Lisinopril 5Mg Po,,Per Svc,10.00
Chargemaster Item,,36882645,SPSI,Aquadeks 1Ml Oral Liq,,Per Svc,10.00
Chargemaster Item,,36882652,SPSI,Multivitamin 5Ml Oral Liq,,Per Svc,0.35
Chargemaster Item,,36882694,SPSI,Poly Vit Oral Syringe,,Per Svc,9.55
Chargemaster Item,,36882702,SPSI,Zinc Sulfate 220Mg Po,,Per Svc,10.00
Chargemaster Item,,36882710,SPSI,Zinc Sulf 1Mg Inj,,Per Svc,615.30
Chargemaster Item,,36882728,SPSI,Multivitamins/Fluoride 1Ml Oral Drop,,Per Svc,10.00
Chargemaster Item,,36883635,SPSI,Vidaylin Drps 50,,Per Svc,38.90
Chargemaster Item,,36888006,SPSI,Atezolizumab 1200mG/20 mL Inj,,Per Svc,54082.50
Chargemaster Item,,36888014,SPSI,Peginterferon Alfa-2B 300mCg,,Per Svc,18385.00
Chargemaster Item,,36891000,SPSI,Blinatumomab 35mCg Inj,,Per Svc,13857.40
Chargemaster Item,,36892008,SPSI,Levothyroxine 100mCg/5mL Inj,,Per Svc,1773.80
Chargemaster Item,,36895001,SPSI,Ibandronate Sodium 150mG Po,,Per Svc,105.00
Chargemaster Item,,36897007,SPSI,Hydroxchlorquin 25mG/mL 8mL Po,,Per Svc,45.70
Chargemaster Item,,36899003,SPSI,Ruxolitinib Phosphate 20mG Po,,Per Svc,727.00
Chargemaster Item,,36901007,SPSI,Skintegrity Hydrogel 4oz,,Per Svc,92.30
Chargemaster Item,,36904118,SPSI,Morphine 2Mg/Ml 1Ml Cpj,,Per Svc,54.25
Chargemaster Item,,36906006,SPSI,Omacetaxine Mepesuccinate 3.5mG Inj,,Per Svc,3828.00
Chargemaster Item,,36906014,SPSI,Peginterferon Alfa-2B 200mCg,,Per Svc,9192.40
Chargemaster Item,,36906022,SPSI,Cyclobenzaprine 5mG Tab,,Per Svc,12.90
Chargemaster Item,,36908002,SPSI,Linezolid D5W 200mG Inj,,Per Svc,10.00
Chargemaster Item,,36909000,SPSI,Zonisamide 10mG/mL Sol 10mL,,Per Svc,10.00
Chargemaster Item,,36915007,SPSI,Pegloticase 8mG Inj,,Per Svc,21343.20
Chargemaster Item,,36916005,SPSI,Cobimetinib Fumarate 20mG Po,,Per Svc,415.60
Chargemaster Item,,36917128,SPSI,Clevidipine 50mG/100mL Inj,,Per Svc,1755.70
Chargemaster Item,,36918126,SPSI,Carboxymeth/Glycer 0.5%/0.9%PF,,Per Svc,10.00
Chargemaster Item,,36918134,SPSI,Fosphenytoin D5w 50MgPe Inj,,Per Svc,64.55
Chargemaster Item,,36920007,SPSI,Eptifibatide 20mG Inj,,Per Svc,2190.40
Chargemaster Item,,36920015,SPSI,Eptiifibatide 75mG Inj,,Per Svc,3264.30
Chargemaster Item,,36920023,SPSI,Methylene Blue 50mG Inj,,Per Svc,260.30
Chargemaster Item,,36920031,SPSI,Infliximab 100mG Inj,,Per Svc,7006.90
Chargemaster Item,,36920049,SPSI,Octreotide 50mCg,,Per Svc,174.40
Chargemaster Item,,36920056,SPSI,Octreotide 100mCg,,Per Svc,338.20
Chargemaster Item,,36920064,SPSI,Zoledronic 1Mg Inj,,Per Svc,4071.00
Chargemaster Item,,36920072,SPSI,Zafirlukast 20Mg Po,,Per Svc,31.40
Chargemaster Item,,36920080,SPSI,Ursodilo 300Mg Po,,Per Svc,55.35
Chargemaster Item,,36920098,SPSI,Octreotide 500mCg,,Per Svc,1631.40
Chargemaster Item,,36920106,SPSI,Charcoal Susp.,,Per Svc,65.85
Chargemaster Item,,36920114,SPSI,Eptifibatide 5Mg Inj,,Per Svc,261.80
Chargemaster Item,,36920122,SPSI,Tacrolimus 0.5mG PO a,,Per Svc,23.40
Chargemaster Item,,36920130,SPSI,Oprelvekin 5Mg Inj,,Per Svc,1648.50
Chargemaster Item,,36920148,SPSI,Dakins Irrig 0.125%,,Per Svc,121.30
Chargemaster Item,,36920155,SPSI,Abciximab (Reopro) 10Mg Inj,,Per Svc,6567.20
Chargemaster Item,,36920163,SPSI,Tirofiban 250 mcg Inj,,Per Svc,319.00
Chargemaster Item,,36920171,SPSI,Dakins 1/4% Half Strength Irrig 473Ml,,Per Svc,121.30
Chargemaster Item,,36920189,SPSI,Tacrolimus 1 mG PO,,Per Svc,46.85
Chargemaster Item,,36920197,SPSI,Tacrolimus 5 mG PO,,Per Svc,212.30
Chargemaster Item,,36920205,SPSI,Tirofiban 5000 mCg,,Per Svc,3115.90
Chargemaster Item,,36920213,SPSI,Tamsulosin 0.4Mg Po,,Per Svc,44.20
Chargemaster Item,,36920221,SPSI,Anagrelide 0.5Mg Po,,Per Svc,15.65
Chargemaster Item,,36920239,SPSI,Anagrelide 1Mg Po,,Per Svc,21.05
Chargemaster Item,,36920247,SPSI,Ethanolamine Oleate 100Mg Inj,,Per Svc,2565.05
Chargemaster Item,,36920254,SPSI,Tirofiban 12500 mCg,,Per Svc,3106.85
Chargemaster Item,,36920262,SPSI,Levocarnitine 1Gm Inj,,Per Svc,138.60
Chargemaster Item,,36920270,SPSI,Zoledronic 4mG Inj,,Per Svc,5534.90
Chargemaster Item,,36920288,SPSI,Zoledronic 4mG / 100 mL,,Per Svc,2268.00
Chargemaster Item,,36920296,SPSI,Clopidogrel 300Mg Po,,Per Svc,279.60
Chargemaster Item,,36920304,SPSI,Allopurinol 100Mg Po,,Per Svc,10.00
Chargemaster Item,,36920312,SPSI,Cyclosporine 100Mg Oral Liq,,Per Svc,79.40
Chargemaster Item,,36920320,SPSI,Cyclosporine 250Mg Inj,,Per Svc,718.85
Chargemaster Item,,36920338,SPSI,Sandimune 100Mg Oral Susp,,Per Svc,4264.50
Chargemaster Item,,36920346,SPSI,Clopidogrel 75Mg Po,,Per Svc,44.30
Chargemaster Item,,36920353,SPSI,Allopurinol 300Mg Po,,Per Svc,10.00
Chargemaster Item,,36920361,SPSI,Azathioprine 100Mg Inj,,Per Svc,860.25
Chargemaster Item,,36920379,SPSI,Leflunomide 10Mg Po,,Per Svc,516.40
Chargemaster Item,,36920395,SPSI,Alfuzosin 10Mg Po,,Per Svc,44.20
Chargemaster Item,,36920403,SPSI,Colchicine 0.6Mg Po,,Per Svc,88.00
Chargemaster Item,,36920411,SPSI,Cyclosporin 100mg Po,,Per Svc,184.50
Chargemaster Item,,36920429,SPSI,Cyclosporin 25Mg Po,,Per Svc,46.20
Chargemaster Item,,36920437,SPSI,Intal Inhaler 14.2 Gm,,Per Svc,285.45
Chargemaster Item,,36920445,SPSI,Cromolyn 10 Mg Inh,,Per Svc,38.60
Chargemaster Item,,36920452,SPSI,Interferon Beta 1A 44mCg IM,,Per Svc,3590.20
Chargemaster Item,,36920478,SPSI,Lymphocyte Immune Globulin 250Mg Inj,,Per Svc,11963.00
Chargemaster Item,,36920486,SPSI,Maxair Inhaler 25.6Gms,,Per Svc,1841.20
Chargemaster Item,,36920494,SPSI,Octreotide 0.025MG Inj,,Per Svc,128.65
Chargemaster Item,,36920502,SPSI,Risedronate 35Mg Po,,Per Svc,1074.15
Chargemaster Item,,36920510,SPSI,Dutasteride 0.5Mg Po,,Per Svc,83.25
Chargemaster Item,,36920528,SPSI,Saliva Substitute 1.5Oz,,Per Svc,55.35
Chargemaster Item,,36920536,SPSI,Sevelamer 800 Mg PO,,Per Svc,84.95
Chargemaster Item,,36920544,SPSI,Allopurinol 500Mg Inj,,Per Svc,23922.35
Chargemaster Item,,36920551,SPSI,Leflunomide 20Mg Po,,Per Svc,82.45
Chargemaster Item,,36920569,SPSI,Nicotine 2Mg Gum,,Per Svc,10.00
Chargemaster Item,,36920577,SPSI,Sinemet 10/100,,Per Svc,10.00
Chargemaster Item,,36920585,SPSI,Carbidopa/Levodopa 25/250Mg Po,,Per Svc,10.60
Chargemaster Item,,36920593,SPSI,Carbidopa/Levodopa 25/100Mg Po,,Per Svc,10.00
Chargemaster Item,,36920601,SPSI,Carbamazepine 200mg Po,,Per Svc,36.00
Chargemaster Item,,36920619,SPSI,Tegretol 100Mg,,Per Svc,10.00
Chargemaster Item,,36920627,SPSI,Carbamazepine 200Mg Oral Susp,,Per Svc,47.80
Chargemaster Item,,36920635,SPSI,Selegiline 5Mg Po,,Per Svc,42.00
Chargemaster Item,,36920643,SPSI,Lisinopril/Hctz 20/12.5Mg Po,,Per Svc,15.10
Chargemaster Item,,36920676,SPSI,Mycophenolate 250Mg Po,,Per Svc,48.00
Chargemaster Item,,36920684,SPSI,Tacrolimus 1Mg Po,,Per Svc,37.95
Chargemaster Item,,36920692,SPSI,Tacrolimus 5Mg Inj,,Per Svc,2619.65
Chargemaster Item,,36920700,SPSI,Methylene Blue 10mG,,Per Svc,5145.80
Chargemaster Item,,36920718,SPSI,Isosulfan Blue 50mG Inj,,Per Svc,5306.55
Chargemaster Item,,36920726,SPSI,Filgrastin 300Mcg Inj,,Per Svc,1211.70
Chargemaster Item,,36920734,SPSI,Fomepizole 1500mG Inj,,Per Svc,6560.00
Chargemaster Item,,36920742,SPSI,Filgrastin 480mcg Inj,,Per Svc,1929.55
Chargemaster Item,,36920759,SPSI,Ursodiol 250Mg Po,,Per Svc,28.15
Chargemaster Item,,36920783,SPSI,Renagel,,Per Svc,94.80
Chargemaster Item,,36920791,SPSI,Interferon Beta-1A 44mCg SQ,,Per Svc,3803.80
Chargemaster Item,,36920809,SPSI,Sucrose 24% 2Ml Oral Syrup,,Per Svc,10.00
Chargemaster Item,,36920817,SPSI,Bromocriptine 2.5Mg Po,,Per Svc,65.85
Chargemaster Item,,36920825,SPSI,Epoetin 1000U Inj Non-ESRD,,Per Svc,342.00
Chargemaster Item,,36920833,SPSI,Adenosine 1Mg Inj,,Per Svc,122.00
Chargemaster Item,,36920841,SPSI,Cinacalcet 30Mg Po,,Per Svc,324.65
Chargemaster Item,,36920858,SPSI,Risedronate 5Mg Po,,Per Svc,146.35
Chargemaster Item,,36920866,SPSI,Risedronate 30Mg Po,,Per Svc,178.10
Chargemaster Item,,36920874,SPSI,Poractant 120Mg Inhalation,,Per Svc,1351.95
Chargemaster Item,,36920882,SPSI,Poractant 240Mg Inhalation,,Per Svc,5056.50
Chargemaster Item,,36920890,SPSI,Saccharamyces 250Mg Packet,,Per Svc,12.60
Chargemaster Item,,36920908,SPSI,Dexrazoxane 500mG Inj,,Per Svc,2818.60
Chargemaster Item,,36920916,SPSI,Pralidoxime 1000mG,,Per Svc,2496.95
Chargemaster Item,,36920924,SPSI,Nimodipine 30mG/5mL Oral Syr,,Per Svc,662.05
Chargemaster Item,,36920940,SPSI,Dakins Irrig 0.25%,,Per Svc,121.30
Chargemaster Item,,36920957,SPSI,Singulair 10Mg,,Per Svc,52.30
Chargemaster Item,,36920965,SPSI,Montelukast 5Mg Po,,Per Svc,95.85
Chargemaster Item,,36920981,SPSI,Montelukast 4Mg Po,,Per Svc,59.45
Chargemaster Item,,36921005,SPSI,Acetylcysteine 6000mG,,Per Svc,2368.80
Chargemaster Item,,36921013,SPSI,Nicotine 21Mg/Day Patch,,Per Svc,22.45
Chargemaster Item,,36921021,SPSI,Acetylcysteine 800mG Inh,,Per Svc,157.10
Chargemaster Item,,36921039,SPSI,Acetylcysteine 3000mG Inh,,Per Svc,101.00
Chargemaster Item,,36921047,SPSI,Leuprolide Acetate 22.5mG SyrKit,,Per Svc,8130.40
Chargemaster Item,,36921104,SPSI,Febuxostat 40Mg Po,,Per Svc,138.60
Chargemaster Item,,36921203,SPSI,Acetylcysteine 100mg Inj,,Per Svc,157.10
Chargemaster Item,,36921302,SPSI,Tacrolimus 0.5Mg Po,,Per Svc,32.20
Chargemaster Item,,36921351,SPSI,Levoleucovorin 50mG,,Per Svc,25813.60
Chargemaster Item,,36921401,SPSI,Sod Thiosulfate 25% 50ml,,Per Svc,1123.50
Chargemaster Item,,36921609,SPSI,Allopurinol 100mg Oral Susp,,Per Svc,10.00
Chargemaster Item,,36922011,SPSI,Sod Hyaluronate 16Mg/2Ml Inj,,Per Svc,1965.60
Chargemaster Item,,36922029,SPSI,Alendronate Na 70Mg Po,,Per Svc,402.70
Chargemaster Item,,36922037,SPSI,Alendronate Na 5Mg Po,,Per Svc,30.75
Chargemaster Item,,36922045,SPSI,Alendronate Na 35Mg Po,,Per Svc,215.15
Chargemaster Item,,36922052,SPSI,Tenecteplase 50mG,,Per Svc,36226.40
Chargemaster Item,,36922060,SPSI,Hyaluronate 14Mg/Ml 0.85Ml,,Per Svc,1920.25
Chargemaster Item,,36922078,SPSI,Leucovorin 25Mg Po,,Per Svc,143.75
Chargemaster Item,,36922086,SPSI,Leucovorin 5Mg Po,,Per Svc,29.40
Chargemaster Item,,36922102,SPSI,Thalidomide 50Mg Po,,Per Svc,2368.70
Chargemaster Item,,36922136,SPSI,Thalidomide 200Mg Po,,Per Svc,3979.60
Chargemaster Item,,36922151,SPSI,Ketamine 500mG Inj,,Per Svc,103.20
Chargemaster Item,,36922177,SPSI,Cilostazol 50Mg Po,,Per Svc,10.00
Chargemaster Item,,36922185,SPSI,Cilostazol 100Mg Po,,Per Svc,19.10
Chargemaster Item,,36922250,SPSI,Epoprostenol 500mCg Inj,,Per Svc,139.20
Chargemaster Item,,36922300,SPSI,Desflurane 240Ml Inhalation,,Per Svc,2018.75
Chargemaster Item,,36922334,SPSI,Isoflurane 100Ml,,Per Svc,196.05
Chargemaster Item,,36922359,SPSI,Ultane 250Ml,,Per Svc,2368.80
Chargemaster Item,,36922417,SPSI,Nicotine 7Mg/24Hr Patch,,Per Svc,26.45
Chargemaster Item,,36922425,SPSI,Nicotine 14Mg/24Hr Patch,,Per Svc,22.45
Chargemaster Item,,36922466,SPSI,Lactulose 20Gm Oral Liq,,Per Svc,10.00
Chargemaster Item,,36922607,SPSI,Basalgel 500,,Per Svc,0.50
Chargemaster Item,,36922623,SPSI,Cabergoline 0.5Mg Po,,Per Svc,384.95
Chargemaster Item,,36922755,SPSI,Calcitriol 0.25Mcg Po,,Per Svc,13.45
Chargemaster Item,,36922763,SPSI,Glycerin 0.5Ml,,Per Svc,10.00
Chargemaster Item,,36923209,SPSI,Sumatriptan 25Mg Po,,Per Svc,284.05
Chargemaster Item,,36923217,SPSI,Sumatriptan 6Mg Inj,,Per Svc,302.40
Chargemaster Item,,36923308,SPSI,Alendronate Na 10Mg Po,,Per Svc,48.05
Chargemaster Item,,36923340,SPSI,Alum Powder 1 Gm,,Per Svc,34596.00
Chargemaster Item,,36923357,SPSI,Sirolimus 1Mg Po,,Per Svc,386.80
Chargemaster Item,,36923399,SPSI,Let 4%/2.25%/2% 3Ml Top Sol,,Per Svc,155.95
Chargemaster Item,,36923415,SPSI,Ferric Subsulfate 30Ml,,Per Svc,148.15
Chargemaster Item,,36923423,SPSI,Mineral Oil/Petrolatum 99Gm Crm,,Per Svc,183.00
Chargemaster Item,,36923506,SPSI,Pentosan 100Mg Po,,Per Svc,116.05
Chargemaster Item,,36923605,SPSI,Mycophenolate 200Mg Oral Susp,,Per Svc,108.80
Chargemaster Item,,36923704,SPSI,Anasept Gel 3Oz,,Per Svc,325.65
Chargemaster Item,,36923803,SPSI,Mycophentolate 360mG po,,Per Svc,106.35
Chargemaster Item,,36923829,SPSI,Mesna 400mg Po,,Per Svc,356.65
Chargemaster Item,,36924009,SPSI,Hemin 313mG Inj,,Per Svc,43389.25
Chargemaster Item,,36924017,SPSI,Cyclosporine 25Mg Po Modified,,Per Svc,14.50
Chargemaster Item,,36924041,SPSI,Cyclosporine 100Mg PO Modified,,Per Svc,107.50
Chargemaster Item,,36929016,SPSI,Sterile Water 1000mL,,Per Svc,33.40
Chargemaster Item,,36929024,SPSI,Sacituzumab Govitecan-hziy 180mG Inj,,Per Svc,12075.00
Chargemaster Item,,36930014,SPSI,Meperidine 25mG/mL 1mL Cpj,,Per Svc,74.95
Chargemaster Item,,36932002,SPSI,Osimertinib Mesylate 40mG Po,,Per Svc,1895.00
Chargemaster Item,,36934008,SPSI,Ivabradine 5mG Po,,Per Svc,92.95
Chargemaster Item,,36935005,SPSI,Fluconazole NS 200mG Inj,,Per Svc,10.00
Chargemaster Item,,36936011,SPSI,5% Dextrose Inj 150mL,,Per Svc,20.70
Chargemaster Item,,36938009,SPSI,Busulfan 60mG Inj,,Per Svc,6818.20
Chargemaster Item,,36938017,SPSI,Nimodipine 60mG/10mL Oral Syr,,Per Svc,1324.20
Chargemaster Item,,36940120,SPSI,Ropivacaine 0.5% 30mL Inj,,Per Svc,273.55
Chargemaster Item,,36944718,SPSI,OMIDRIA 1% / 3% INTRAOCULAR 4ML,,Per Svc,4882.50
Chargemaster Item,,36945004,SPSI,Belinostat 500mG Inj,,Per Svc,8056.40
Chargemaster Item,,36959005,SPSI,Leuprolide Ace 11.25mG 3Mo Kit,,Per Svc,5027.81
Chargemaster Item,,36960003,SPSI,Trametinib Dimethyl Sulfoxide 2mG Po,,Per Svc,1397.20
Chargemaster Item,,36961001,SPSI,Pain Ease Mist 3.9 Oz.,,Per Svc,476.00
Chargemaster Item,,36965002,SPSI,Osimertinib Mesylate 80mG Po,,Per Svc,1895.00
Chargemaster Item,,36965010,SPSI,Buprenorphine SL 8mG,,Per Svc,89.05
Chargemaster Item,,36969129,SPSI,Lorazepam 0.5mG0.5mL Inj,,Per Svc,10.00
Chargemaster Item,,36969137,SPSI,Vecuronium/Water 1mG/mL Inj 1mL,,Per Svc,10.00
Chargemaster Item,,36970002,SPSI,Talimogene Laherparepvec 1Million PFU,,Per Svc,271.50
Chargemaster Item,,36971000,SPSI,Sod Bicarb 5meq/5ml Oral Liq,,Per Svc,13.35
Chargemaster Item,,36974004,SPSI,Buproprion XL 150mG Po,,Per Svc,106.60
Chargemaster Item,,36975001,SPSI,Rocuronium 100mg Inj,,Per Svc,81.35
Chargemaster Item,,36975019,SPSI,Pen G K D5W 0.05mmU mL 1mL,,Per Svc,10.00
Chargemaster Item,,36976009,SPSI,Exparel 1.3% 10ml Inj,,Per Svc,4816.00
Chargemaster Item,,36978005,SPSI,Famotidine NS 4mG mL 1mL,,Per Svc,10.00
Chargemaster Item,,36979003,SPSI,Bexarotene 75mG Po,,Per Svc,716.20
Chargemaster Item,,36979011,SPSI,Isosorbide Dinit 40mG ER Cap,,Per Svc,58.70
Chargemaster Item,,36982007,SPSI,Alectinib Hcl 150mG Po,,Per Svc,333.00
Chargemaster Item,,36987006,SPSI,Alvimopan 12mG Cap,,Per Svc,2080.15
Chargemaster Item,,36988004,SPSI,Talimogene Laherparepvec 100 Million PFU,,Per Svc,18110.40
Chargemaster Item,,36989010,SPSI,Nivolumab 240mG/24mL,,Per Svc,38899.20
Chargemaster Item,,36990000,SPSI,Peginterferon Alfa-2B 600mCg,,Per Svc,9291.60
Chargemaster Item,,36990018,SPSI,Teniposide 50mG Inj,,Per Svc,11007.20
Chargemaster Item,,36990026,SPSI,Juven 7Gm/7Gm/2.5Gm Pkt,,Per Svc,25.30
Chargemaster Item,,36990034,SPSI,Arsenic Trioxide 12mG Inj,,Per Svc,5346.00
Chargemaster Item,,36990125,SPSI,Clindamycin 1% Gel 60mL,,Per Svc,4481.05
Chargemaster Item,,36994002,SPSI,Pralatrexate 20mG Inj,,Per Svc,37432.00
Chargemaster Item,,36996007,SPSI,Melphalan Hydrochloride 50mG Inj,,Per Svc,4288.40
Chargemaster Item,,36996015,SPSI,Pegaspargase 3750 Units Inj,,Per Svc,98199.05
Chargemaster Item,,36996023,SPSI,Avelumab 200mG Inj,,Per Svc,9296.75
Chargemaster Item,,36996031,SPSI,Avelumab 200mG Inj.,,Per Svc,9296.75
Chargemaster Item,,36996049,SPSI,Fluorescein Sodium 1mG Strip,,Per Svc,10.00
Chargemaster Item,,36996056,SPSI,Hydrogen Peroxide 3% 237mL,,Per Svc,10.00
Chargemaster Item,,36996064,SPSI,Betrixaban 40mG Po,,Per Svc,189.00
Chargemaster Item,,36996072,SPSI,Betrixaban 80mG Po,,Per Svc,189.00
Chargemaster Item,,36996114,SPSI,Acetylcysteine 10% 400mG 4mL,,Per Svc,104.60
Chargemaster Item,,36997013,SPSI,Dopamine 200mG Inj,,Per Svc,73.35
Chargemaster Item,,36997021,SPSI,Durvalumab 120mG Inj,,Per Svc,5199.60
Chargemaster Item,,36997039,SPSI,Durvalumab 500mG Inj,,Per Svc,21665.05
Chargemaster Item,,37000007,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,37000015,SPSI,Clinic Visit Est Limited,,Per Svc,171.00
Chargemaster Item,,37000023,SPSI,Clinic Visit Est Low Complex,,Per Svc,186.00
Chargemaster Item,,37000031,SPSI,Clinic Visit Est High,,Per Svc,305.00
Chargemaster Item,,37000049,SPSI,Thera Phlebotomy,,Per Svc,553.00
Chargemaster Item,,37000056,SPSI,Clinic Visit New Patient Minimum,,Per Svc,162.00
Chargemaster Item,,37000064,SPSI,Clinic Visit New Patient Limited,,Per Svc,195.00
Chargemaster Item,,37000072,SPSI,Clinic Visit New Patient Low Complex,,Per Svc,228.00
Chargemaster Item,,37000080,SPSI,Clinic Visit New Patient Mod Complex,,Per Svc,271.00
Chargemaster Item,,37000098,SPSI,Clinic Visit New Patient High,,Per Svc,403.00
Chargemaster Item,,37000106,SPSI,Clinic Visit Est Mod Complex,,Per Svc,238.00
Chargemaster Item,,37000122,SPSI,Appl On-Body Injectr xSubq Inj,,Per Svc,268.00
Chargemaster Item,,37000130,SPSI,Iv Hydration Ea Add Hr,,Per Svc,611.00
Chargemaster Item,,37000148,SPSI,Ct Bone Marrow Aspiration,,Per Svc,4482.00
Chargemaster Item,,37000155,SPSI,Ct Bone Marrow Biopsy,,Per Svc,4482.00
Chargemaster Item,,37000163,SPSI,Admin Influenza Virus Vaccine,,Per Svc,332.00
Chargemaster Item,,37000171,SPSI,Admin Pneumococcal Vaccine,,Per Svc,332.00
Chargemaster Item,,37000189,SPSI,Bone Marrow Aspirate & Biopsy,,Per Svc,7092.00
Chargemaster Item,,37000197,SPSI,ABD Paracentesis,,Per Svc,4396.00
Chargemaster Item,,37001104,SPSI,Chemo Extended IV Infusion W/Pump,,Per Svc,383.00
Chargemaster Item,,37364151,SPSI,Venous Blood Collection,,Per Svc,59.00
Chargemaster Item,,37365913,SPSI,Infusion Therapy,,Per Svc,66.00
Chargemaster Item,,37365931,SPSI,Declot Vascular Device,,Per Svc,1378.00
Chargemaster Item,,37382211,SPSI,Peri-Vac,,Per Svc,980.00
Chargemaster Item,,37382223,SPSI,Dx Bone Marrow Bx & Aspir,,Per Svc,7837.00
Chargemaster Item,,37963601,SPSI,Hydration IV Infusion Initial,,Per Svc,1257.00
Chargemaster Item,,37963651,SPSI,IV Infusion Initial IVPB,,Per Svc,637.00
Chargemaster Item,,37963661,SPSI,Iv Infuse, Each Addl Hr,,Per Svc,611.00
Chargemaster Item,,37963671,SPSI,IV Sequential Infusion Up to 1 Hr IVPB New Med,,Per Svc,1131.00
Chargemaster Item,,37963681,SPSI,IV Concurrent Infuse 2 IVPB at Same Time,,Per Svc,1227.00
Chargemaster Item,,37963721,SPSI,Inj Subcutenousc/Intramus,,Per Svc,234.00
Chargemaster Item,,37963741,SPSI,IV Push Single/Initial Drug,,Per Svc,454.00
Chargemaster Item,,37963751,SPSI,IV Push Sequential Ea New Med,,Per Svc,454.00
Chargemaster Item,,37964011,SPSI,Chemo Anti Neopl SQ IM,,Per Svc,293.00
Chargemaster Item,,37964021,SPSI,Chemo Hormon Antineopl SQ IM,,Per Svc,293.00
Chargemaster Item,,37964091,SPSI,Chemo IV Push Single Drug,,Per Svc,1194.00
Chargemaster Item,,37964111,SPSI,Chemo IV Push Addl Drug,,Per Svc,638.00
Chargemaster Item,,37964131,SPSI,Chemo Infusion,,Per Svc,1437.00
Chargemaster Item,,37964151,SPSI,Chemo Iv Ea Addi Hr,,Per Svc,490.00
Chargemaster Item,,37964162,SPSI,Chemo Prolong Infuse W Pump,,Per Svc,1437.00
Chargemaster Item,,37964173,SPSI,Each Additional Seq Infusion - Chemo Pump,,Per Svc,1258.00
Chargemaster Item,,37965218,SPSI,Refill/Maint Portable Pump,,Per Svc,1194.00
Chargemaster Item,,37965237,SPSI,Irrigation For Drug Delivery,,Per Svc,589.00
Chargemaster Item,,38000212,SPSI,Nutritional Therapy Each 15,,Per Svc,150.00
Chargemaster Item,,38000220,SPSI,Nutritional Follow-up Each 15 min,,Per Svc,150.00
Chargemaster Item,,38000238,SPSI,Nutri-Ante Grp30Min,,Per Svc,222.00
Chargemaster Item,,38000261,SPSI,Health Ed Initial Per Day,,Per Svc,170.00
Chargemaster Item,,38000352,SPSI,Diabetes Training Per 30 Min,,Per Svc,693.00
Chargemaster Item,,38000360,SPSI,Diabetes Train Grp Per 30Min,,Per Svc,426.00
Chargemaster Item,,38952503,SPSI,Monitor Glucose Cont <72 Hrs,,Per Svc,1049.00
Chargemaster Item,,38992111,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,38992137,SPSI,Clinic Visit Est Low Complex,,Per Svc,186.00
Chargemaster Item,,38992145,SPSI,Teleheatlh Facility Fee,,Per Svc,106.60
Chargemaster Item,,3900008,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,39046313,SPSI,Consult Facility,,Per Svc,693.00
Chargemaster Item,,39046321,SPSI,Established Patient Facility,,Per Svc,693.00
Chargemaster Item,,39192968,SPSI,Mammosite Catheter Placement Hdr,,Per Svc,14210.00
Chargemaster Item,,39217906,SPSI,X-HDR Iridium 192,,Per Svc,6096.00
Chargemaster Item,,39296009,SPSI,X-Strontium-89 Per Mci,,Per Svc,4820.00
Chargemaster Item,,39296058,SPSI,X-Samarium-153 1 Dose < 150mCi,,Per Svc,63095.00
Chargemaster Item,,39558762,SPSI,Interstitial Tracking Device Placement,,Per Svc,1598.00
Chargemaster Item,,39571559,SPSI,GYN HDR Ovoids/Tandem,,Per Svc,6831.00
Chargemaster Item,,39571567,SPSI,GYN Vaginal Cylinder for HDR,,Per Svc,2392.00
Chargemaster Item,,39702527,SPSI,Srs 1 Tx &1St Sbrt Tx Delivery,,Per Svc,34326.00
Chargemaster Item,,39702535,SPSI,Sts 2-5 Tx Delivery,,Per Svc,14170.00
Chargemaster Item,,39769421,SPSI,US Guid Localization Device,,Per Svc,2497.00
Chargemaster Item,,39769427,SPSI,Us Needle Placement S&I,,Per Svc,2545.00
Chargemaster Item,,39769658,SPSI,US Guidance for Brachytherapy,,Per Svc,1030.00
Chargemaster Item,,39770144,SPSI,Ct Guide Plcmnt Rad Tx Fields,,Per Svc,2185.00
Chargemaster Item,,39772645,SPSI,Place Endorectal Applicator Hdr,,Per Svc,8328.00
Chargemaster Item,,39772649,SPSI,Place Endorectal App,,Per Svc,8328.00
Chargemaster Item,,39772801,SPSI,Simulation Aided Simple,,Per Svc,2107.00
Chargemaster Item,,39772850,SPSI,Simulation Aided Intermediate,,Per Svc,4353.00
Chargemaster Item,,39772900,SPSI,Simulation Aided Complex,,Per Svc,5604.00
Chargemaster Item,,39772934,SPSI,4D Resp Motion Management,,Per Svc,3271.00
Chargemaster Item,,39772959,SPSI,3D SBRT SRS Planning,,Per Svc,24677.00
Chargemaster Item,,39773007,SPSI,3D/IMRT/ Basic Dosimetry,,Per Svc,1562.00
Chargemaster Item,,39773015,SPSI,IMRT Planning,,Per Svc,26471.00
Chargemaster Item,,39773056,SPSI,Teletherapy Isodose Simple,,Per Svc,2153.00
Chargemaster Item,,39773064,SPSI,Teletherapy Isodose-Simp,,Per Svc,6841.00
Chargemaster Item,,39773072,SPSI,Teletherapy Isodose-Comp,,Per Svc,11034.00
Chargemaster Item,,39773155,SPSI,Teletherapy Isodose Complex,,Per Svc,3222.00
Chargemaster Item,,39773163,SPSI,Brachytherapy Isodose-Simp,,Per Svc,4304.00
Chargemaster Item,,39773171,SPSI,Brachytherapy Isodose Plan-I,,Per Svc,5573.00
Chargemaster Item,,39773189,SPSI,Brachytherapy Isodose-Comp,,Per Svc,7449.00
Chargemaster Item,,39773213,SPSI,Special Teletherapy Beam Plan,,Per Svc,4373.00
Chargemaster Item,,39773312,SPSI,Spec Dosim TLD/Micro,,Per Svc,748.00
Chargemaster Item,,39773320,SPSI,Treatment Devices Simple,,Per Svc,1560.00
Chargemaster Item,,39773338,SPSI,Treatment Devices Intermediate,,Per Svc,2228.00
Chargemaster Item,,39773346,SPSI,Treatment Devices Complex,,Per Svc,3934.00
Chargemaster Item,,39773361,SPSI,Contd Med Physics Per 5 Tx,,Per Svc,2452.00
Chargemaster Item,,39773387,SPSI,Devices MLC,,Per Svc,19579.00
Chargemaster Item,,39773700,SPSI,Special Med Rad Physics,,Per Svc,2864.00
Chargemaster Item,,39773726,SPSI,SRS Cranial 1 Tx,,Per Svc,42139.00
Chargemaster Item,,39773734,SPSI,SRT Body 1-5 Tx,,Per Svc,18099.00
Chargemaster Item,,39773858,SPSI,IMRT TX Breast & Prostate-Simp,,Per Svc,17190.00
Chargemaster Item,,39773866,SPSI,IMRT TX All Other-Comp,,Per Svc,20057.00
Chargemaster Item,,39773874,SPSI,CBCT Guidance for 3D TX,,Per Svc,1010.00
Chargemaster Item,,39774021,SPSI,Radiation TX - Simple,,Per Svc,1729.00
Chargemaster Item,,39774070,SPSI,Radiation TX-Interm,,Per Svc,2354.00
Chargemaster Item,,39774120,SPSI,Radiation TX-Comp & Electron,,Per Svc,2595.00
Chargemaster Item,,39774153,SPSI,Port Films Weekly,,Per Svc,541.00
Chargemaster Item,,39774708,SPSI,Special Trt Procedure,,Per Svc,8622.00
Chargemaster Item,,39777784,SPSI,Interstit Implant-C,,Per Svc,3559.00
Chargemaster Item,,39777842,SPSI,HDR >12 Channels,,Per Svc,15829.00
Chargemaster Item,,39777875,SPSI,HDR 1 Channel,,Per Svc,15829.00
Chargemaster Item,,39777883,SPSI,HDR 2-12 Channels,,Per Svc,15829.00
Chargemaster Item,,39777891,SPSI,Surface Appl Radioelement,,Per Svc,283.00
Chargemaster Item,,39777909,SPSI,Supervision/Handle/Loading Rad Mat,,Per Svc,305.00
Chargemaster Item,,39780002,SPSI,Endorectal HDR Applicator,,Per Svc,8328.00
Chargemaster Item,,39780010,SPSI,Phosphorus-32 Sod Per Mci,,Per Svc,2207.00
Chargemaster Item,,39790050,SPSI,Oral Radiopharm Therapy,,Per Svc,3549.00
Chargemaster Item,,39791009,SPSI,Infusion Radioelement,,Per Svc,1356.00
Chargemaster Item,,39791017,SPSI,IV Radiopharm Therapy,,Per Svc,3851.00
Chargemaster Item,,39795174,SPSI,Iodine 131 Per Mci,,Per Svc,169.00
Chargemaster Item,,39954227,SPSI,In-111 Zevalin Per Dose,,Per Svc,17054.00
Chargemaster Item,,39954326,SPSI,Y-90 Zevalin Per Dose,,Per Svc,146175.00
Chargemaster Item,,39960612,SPSI,Xofiigo per microCurie,,Per Svc,465.00
Chargemaster Item,,39990726,SPSI,Mammosite Care Kit,,Per Svc,485.00
Chargemaster Item,,39992169,SPSI,Facility Outpatient Follow-up 25 Level 1,,Per Svc,153.00
Chargemaster Item,,39992177,SPSI,Facility Outpatient Follow-up 25 Level 2,,Per Svc,171.00
Chargemaster Item,,39992185,SPSI,Facility Outpatient Follow-up 25 Level 3,,Per Svc,186.00
Chargemaster Item,,39992193,SPSI,Facility Outpatient Follow-up 25 Level 4,,Per Svc,202.00
Chargemaster Item,,39992201,SPSI,Facility Outpatient Follow-up 25 Level 5,,Per Svc,305.00
Chargemaster Item,,39992219,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,39992227,SPSI,Clinic Visit Est Limited,,Per Svc,171.00
Chargemaster Item,,39992235,SPSI,Clinic Visit Est Low Complex,,Per Svc,186.00
Chargemaster Item,,39992243,SPSI,Clinic Visit Est Very Complex,,Per Svc,202.00
Chargemaster Item,,39992250,SPSI,Clinic Visit Est High,,Per Svc,305.00
Chargemaster Item,,39992367inact,SPSI,Clinic Visit Est Mod Complex,,Per Svc,238.00
Chargemaster Item,,4000006,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,4000014,SPSI,Observation Continuation,,First 89 Minutes,331.00
Chargemaster Item,,40015828,SPSI,Ultravist 300 Per Ml,,Per Svc,1.00
Chargemaster Item,,40015836,SPSI,Ultravist 370 Per Ml,,Per Svc,1.00
Chargemaster Item,,40015851,SPSI,Hocm Per 1Ml Cystoconray Ii,,Per Svc,1.00
Chargemaster Item,,4003000,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,4003001,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,4003002,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,4003004,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,4003018,SPSI,Definitive Observation Unit 3 MC,,Per Svc,11138.00
Chargemaster Item,,4003019,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,4003020,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,4003027,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,4003036,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,40192809,SPSI,LT Breast Localization Complte,,Per Svc,3168.00
Chargemaster Item,,40192817,SPSI,RT Breast Localization Complte,,Per Svc,3168.00
Chargemaster Item,,40192825,SPSI,Breast Loc Ea Addl Lesion,,Per Svc,3037.00
Chargemaster Item,,40202202,SPSI,Perc Bx Bone Sprficial,,Per Svc,4339.00
Chargemaster Item,,40202251,SPSI,Perc Bx Bone Deep,,Per Svc,4913.00
Chargemaster Item,,40205015,SPSI,Inj Fistula/Sinus Tract,,Per Svc,246.00
Chargemaster Item,,40206005,SPSI,US Inj Small Joint/Bursa,,Per Svc,705.00
Chargemaster Item,,40206054,SPSI,US Inj Intermediate Joint/Bursa,,Per Svc,703.00
Chargemaster Item,,40206096,SPSI,Inj Major Joint Or Bursa,,Per Svc,598.00
Chargemaster Item,,40206104,SPSI,Aspiration Right Shoulder,,Per Svc,598.00
Chargemaster Item,,40206112,SPSI,Aspiration Left Shoulder,,Per Svc,598.00
Chargemaster Item,,40206120,SPSI,Aspiration Right Hip,,Per Svc,598.00
Chargemaster Item,,40206138,SPSI,Aspiration Left Hip,,Per Svc,598.00
Chargemaster Item,,40206146,SPSI,Aspiration Right Knee,,Per Svc,598.00
Chargemaster Item,,40206153,SPSI,Flur Guide Ndl Plcmnt Spine,,Per Svc,1939.00
Chargemaster Item,,40206161,SPSI,Aspiration Left Knee,,Per Svc,598.00
Chargemaster Item,,40206161INACTV,SPSI,US Inj Major Joint/Bursa,,Per Svc,598.00
Chargemaster Item,,40233504,SPSI,Inj Shoulder Arth,,Per Svc,234.00
Chargemaster Item,,40242208,SPSI,Inj Elbow Arth,,Per Svc,332.00
Chargemaster Item,,40252462,SPSI,Inj Wrist Arthrogram,,Per Svc,405.00
Chargemaster Item,,40270936,SPSI,Inj Hip Arth,,Per Svc,538.00
Chargemaster Item,,40273708,SPSI,Inj Knee Arth,,Per Svc,267.00
Chargemaster Item,,40276487,SPSI,Inj Ankle Arthrogram,,Per Svc,250.00
Chargemaster Item,,40324204,SPSI,Perc Bx Lung,,Per Svc,6178.00
Chargemaster Item,,40360059,SPSI,Inj Venogram,,Per Svc,502.00
Chargemaster Item,,40425506,SPSI,Xr Inj Sialogr,,Per Svc,316.00
Chargemaster Item,,40432155,SPSI,Removal Fb Esoph,,Per Svc,2901.00
Chargemaster Item,,40494270,SPSI,Inj Shunt Evaluation,,Per Svc,706.00
Chargemaster Item,,40494403,SPSI,Xr Inject Inguinal Hernio,,Per Svc,8718.00
Chargemaster Item,,40503906,SPSI,Perc Renal Cyst Aspiration,,Per Svc,2542.00
Chargemaster Item,,40504300,SPSI,RT Nephrogram Exist Access Comp,,Per Svc,5244.00
Chargemaster Item,,40504318,SPSI,LT Nephromgram Exist Access Comp,,Per Svc,5244.00
Chargemaster Item,,40516007,SPSI,Inj Cysto/Vcug,,Per Svc,385.00
Chargemaster Item,,40516106,SPSI,Inj Retro Urethrogram,,Per Svc,290.00
Chargemaster Item,,40583403,SPSI,Inj Sonohystero/Hystero,,Per Svc,373.00
Chargemaster Item,,40610537,SPSI,Inj Cisterno,,Per Svc,4841.00
Chargemaster Item,,40622706,SPSI,Spinal Puncture,,Per Svc,556.00
Chargemaster Item,,40622847,SPSI,Inj Cerv Myelo,,Per Svc,1186.00
Chargemaster Item,,40622854,SPSI,Inj Thor Myelo,,Per Svc,1186.00
Chargemaster Item,,40622862,SPSI,Inj Lumb Myelo,,Per Svc,1186.00
Chargemaster Item,,40622870,SPSI,Inj Cb Myelogr,,Per Svc,1186.00
Chargemaster Item,,40623043,SPSI,Lumbar Myelogram Intrathecal I,,Per Svc,2120.00
Chargemaster Item,,40700106,SPSI,Cisterno S&I,,Per Svc,4209.00
Chargemaster Item,,40700304,SPSI,Eye Foreign Body,,Per Svc,799.00
Chargemaster Item,,40701005,SPSI,Mandible Limited,,Per Svc,1361.00
Chargemaster Item,,40701104,SPSI,Mandible Complete,,Per Svc,1361.00
Chargemaster Item,,40701203,SPSI,Mastoids Limited,,Per Svc,626.00
Chargemaster Item,,40701302,SPSI,Mastoids Complete,,Per Svc,868.00
Chargemaster Item,,40701401,SPSI,Lim Facial Bones,,Per Svc,1016.00
Chargemaster Item,,40701500,SPSI,Facial Bones,,Per Svc,1221.00
Chargemaster Item,,40701609,SPSI,Nasal Bones,,Per Svc,941.00
Chargemaster Item,,40701906,SPSI,Optic Foramina,,Per Svc,773.00
Chargemaster Item,,40702102,SPSI,Sinuses Limited,,Per Svc,966.00
Chargemaster Item,,40702201,SPSI,Sinuses Complete,,Per Svc,1399.00
Chargemaster Item,,40702409,SPSI,Sella Turcica,,Per Svc,701.00
Chargemaster Item,,40702508,SPSI,Skull 4 Views,,Per Svc,1554.00
Chargemaster Item,,40702516,SPSI,Skull 2 Views,,Per Svc,963.00
Chargemaster Item,,40702607,SPSI,Skull Complete,,Per Svc,1554.00
Chargemaster Item,,40703308,SPSI,Tm Joints Bilateral,,Per Svc,1617.00
Chargemaster Item,,40703605,SPSI,Neck Soft Tissue,,Per Svc,663.00
Chargemaster Item,,40703803,SPSI,Salivary Gland,,Per Svc,891.00
Chargemaster Item,,40703902,SPSI,Lumbar Sp 4 Plus Views,,Per Svc,2537.00
Chargemaster Item,,40710113,SPSI,Port Chest 1 View,,Per Svc,730.00
Chargemaster Item,,40710121,SPSI,Chest 1 View,,Per Svc,730.00
Chargemaster Item,,40710204,SPSI,Chest 2 View,,Per Svc,919.00
Chargemaster Item,,40710212,SPSI,Chest 3 Views,,Per Svc,1178.00
Chargemaster Item,,40710303,SPSI,Chest 4 Views,,Per Svc,1547.00
Chargemaster Item,,40710360,SPSI,Chest Lung Biopsy S&I,,Per Svc,1939.00
Chargemaster Item,,40710378,SPSI,Cxr Picc Ln Plcmnt,,Per Svc,935.00
Chargemaster Item,,40711004,SPSI,Ribs W/ Pa Cxr Right,,Per Svc,1082.00
Chargemaster Item,,40711012,SPSI,Ribs W/ Pa Cxr Left,,Per Svc,1082.00
Chargemaster Item,,40711020,SPSI,Ribs Right,,Per Svc,949.00
Chargemaster Item,,40711038,SPSI,Ribs Left,,Per Svc,949.00
Chargemaster Item,,40711103,SPSI,Bilat Ribs,,Per Svc,1275.00
Chargemaster Item,,40711111,SPSI,Bilat Ribs W/ Pa Cxr,,Per Svc,1363.00
Chargemaster Item,,40711202,SPSI,Sternum,,Per Svc,779.00
Chargemaster Item,,40711301,SPSI,Sternoclavicular Joints,,Per Svc,803.00
Chargemaster Item,,40720203,SPSI,Spine 1 View,,Per Svc,752.00
Chargemaster Item,,40720401,SPSI,Cervical Spine 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,40720500,SPSI,Cervical Spine 4 or 5 Views,,Per Svc,1453.00
Chargemaster Item,,40720526,SPSI,Cerv Spine 6 Or More Views,,Per Svc,1865.00
Chargemaster Item,,40720708,SPSI,Thoracic Spine 4 Plus Views,,Per Svc,1414.00
Chargemaster Item,,40720716,SPSI,Thoracic Spine 2 Views,,Per Svc,1071.00
Chargemaster Item,,40720807,SPSI,Thoracolumbar min 2 Views,,Per Svc,944.00
Chargemaster Item,,40720815,SPSI,Entire Spine/Scoliosis 1 View,,Per Svc,1185.00
Chargemaster Item,,40720823,SPSI,Entire Spine/Scoliosis 2/3 Vws,,Per Svc,1383.00
Chargemaster Item,,40720831,SPSI,ENTIRE SPINE/SCOLIOSIS 4 OR 5 VWS,,Per Svc,1383.00
Chargemaster Item,,40720849,SPSI,ENTIRE SPINE/SCOLIOSIS 6 VWS,,Per Svc,1383.00
Chargemaster Item,,40720922,SPSI,Lumbar Sp 2 Or 3 Views,,Per Svc,930.00
Chargemaster Item,,40721003,SPSI,Lumbar Spine 4 Views,,Per Svc,1112.00
Chargemaster Item,,40721102,SPSI,Ls Spine,,Per Svc,1112.00
Chargemaster Item,,40721144,SPSI,Ls Spine & Bending Views,,Per Svc,1979.00
Chargemaster Item,,40721201,SPSI,Ls Spine Only Bending Views,,Per Svc,1134.00
Chargemaster Item,,40721706,SPSI,Pelvis 1 View,,Per Svc,941.00
Chargemaster Item,,40721805,SPSI,Pelvis 2 Views,,Per Svc,941.00
Chargemaster Item,,40721904,SPSI,Pelvis Judet Views,,Per Svc,867.00
Chargemaster Item,,40722027,SPSI,Sacroiliac Joints,,Per Svc,843.00
Chargemaster Item,,40722209,SPSI,Sacrum & Coccyx,,Per Svc,794.00
Chargemaster Item,,40722506,SPSI,Cervical Myelogram S&I,,Per Svc,2185.00
Chargemaster Item,,40722555,SPSI,Thoracic Myelogram S&I,,Per Svc,2724.00
Chargemaster Item,,40722654,SPSI,Lumbar Myelogram S&I,,Per Svc,2120.00
Chargemaster Item,,40722704,SPSI,Combined Myelogram S&I,,Per Svc,4970.00
Chargemaster Item,,40722951,SPSI,Lumbar Diskography S&I,,Per Svc,10388.00
Chargemaster Item,,40729972,SPSI,Metastatic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,40729980,SPSI,Metabolic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,40730004,SPSI,Clavicle Right,,Per Svc,710.00
Chargemaster Item,,40730012,SPSI,Clavicle Left,,Per Svc,710.00
Chargemaster Item,,40730103,SPSI,Scapula Right,,Per Svc,1030.00
Chargemaster Item,,40730111,SPSI,Scapula Left,,Per Svc,1030.00
Chargemaster Item,,40730202,SPSI,Shoulder 1 View Right,,Per Svc,869.00
Chargemaster Item,,40730210,SPSI,Shoulder 1 View Left,,Per Svc,869.00
Chargemaster Item,,40730301,SPSI,Shoulder 2 Views Right,,Per Svc,978.00
Chargemaster Item,,40730319,SPSI,Shoulder 2 Views Left,,Per Svc,978.00
Chargemaster Item,,40730400,SPSI,Shoulder Arthrogram S&I Right,,Per Svc,2641.00
Chargemaster Item,,40730418,SPSI,Shoulder Arthrogram S&I Left,,Per Svc,2641.00
Chargemaster Item,,40730509,SPSI,Acromioclavicular Joints,,Per Svc,903.00
Chargemaster Item,,40730608,SPSI,Humerus Right,,Per Svc,850.00
Chargemaster Item,,40730616,SPSI,Humerus Left,,Per Svc,850.00
Chargemaster Item,,40730707,SPSI,Elbow 2 Views Right,,Per Svc,886.00
Chargemaster Item,,40730715,SPSI,Elbow 2 Views Left,,Per Svc,886.00
Chargemaster Item,,40730806,SPSI,Elbow 4 Views Right,,Per Svc,1102.00
Chargemaster Item,,40730814,SPSI,Elbow 4 Views Left,,Per Svc,1102.00
Chargemaster Item,,40730855,SPSI,Elbow Arthrogram S&I Right,,Per Svc,2975.00
Chargemaster Item,,40730863,SPSI,Elbow Arthrogram S&I Left,,Per Svc,2975.00
Chargemaster Item,,40730905,SPSI,Forearm Right,,Per Svc,705.00
Chargemaster Item,,40730913,SPSI,Forearm Left,,Per Svc,705.00
Chargemaster Item,,40730921,SPSI,Uext Infant Left,,Per Svc,703.00
Chargemaster Item,,40730939,SPSI,Uext Infant Right,,Per Svc,703.00
Chargemaster Item,,40731002,SPSI,Wrist 2 View Right,,Per Svc,861.00
Chargemaster Item,,40731010,SPSI,Wrist 2 View Left,,Per Svc,861.00
Chargemaster Item,,40731101,SPSI,Wrist 4 View Right,,Per Svc,1022.00
Chargemaster Item,,40731127,SPSI,Wrist 4 View Left,,Per Svc,1022.00
Chargemaster Item,,40731150,SPSI,Wrist Arthrogram S&I Right,,Per Svc,2334.00
Chargemaster Item,,40731176,SPSI,Wrist Arthrogram S&I Left,,Per Svc,2334.00
Chargemaster Item,,40731200,SPSI,Hand 2 Views Right,,Per Svc,671.00
Chargemaster Item,,40731218,SPSI,Hand 2 Views Left,,Per Svc,671.00
Chargemaster Item,,40731242,SPSI,Pa Hands/Wrist,,Per Svc,671.00
Chargemaster Item,,40731309,SPSI,Hand 3 Views Right,,Per Svc,850.00
Chargemaster Item,,40731317,SPSI,Hand 3 Views Left,,Per Svc,850.00
Chargemaster Item,,40731408,SPSI,Finger(S) Right,,Per Svc,611.00
Chargemaster Item,,40731416,SPSI,Finger(S) Left,,Per Svc,611.00
Chargemaster Item,,40735003,SPSI,Hip 1 View Right,,Per Svc,703.00
Chargemaster Item,,40735011,SPSI,Hip 1 View Left,,Per Svc,703.00
Chargemaster Item,,40735021,SPSI,RT HIP 2 or 3 VIEWS,,Per Svc,941.00
Chargemaster Item,,40735029,SPSI,LT Hip 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,40735219,SPSI,Bilat Hips w or wo Pelvis,,Per Svc,1647.00
Chargemaster Item,,40735250,SPSI,Hip Arthrogram S&I Right,,Per Svc,2641.00
Chargemaster Item,,40735268,SPSI,Hip Arthrogram S&I Left,,Per Svc,2641.00
Chargemaster Item,,40735508,SPSI,Femur Right,,Per Svc,850.00
Chargemaster Item,,40735516,SPSI,Femur Left,,Per Svc,783.00
Chargemaster Item,,40735607,SPSI,Knee 1 Or 2 Views Right,,Per Svc,743.00
Chargemaster Item,,40735615,SPSI,Knee 1 Or 2 Views Left,,Per Svc,743.00
Chargemaster Item,,40735656,SPSI,Ap Bil Knees Standing,,Per Svc,1274.00
Chargemaster Item,,40735698,SPSI,Knee 3 Views Left,,Per Svc,846.00
Chargemaster Item,,40735706,SPSI,Knee 3 Views Right,,Per Svc,846.00
Chargemaster Item,,40735714,SPSI,Patella Right,,Per Svc,846.00
Chargemaster Item,,40735722,SPSI,Patella Left,,Per Svc,846.00
Chargemaster Item,,40735805,SPSI,Knee Arthrogram S&I Right,,Per Svc,3396.00
Chargemaster Item,,40735813,SPSI,Knee Arthrogram S&I Left,,Per Svc,3396.00
Chargemaster Item,,40735904,SPSI,Tibia & Fibia Right,,Per Svc,795.00
Chargemaster Item,,40735912,SPSI,Tibia & Fibia Left,,Per Svc,795.00
Chargemaster Item,,40735920,SPSI,Lext Infant Left,,Per Svc,687.00
Chargemaster Item,,40735938,SPSI,Lext Infant Right,,Per Svc,687.00
Chargemaster Item,,40736001,SPSI,Ankle 2 Views Right,,Per Svc,817.00
Chargemaster Item,,40736019,SPSI,Ankle 2 Views Left,,Per Svc,817.00
Chargemaster Item,,40736100,SPSI,Ankle 4 Views Right,,Per Svc,1061.00
Chargemaster Item,,40736118,SPSI,Ankle 4 Views Left,,Per Svc,1061.00
Chargemaster Item,,40736159,SPSI,Ankle Arthrogram S&I Right,,Per Svc,2975.00
Chargemaster Item,,40736167,SPSI,Ankle Arthrogram S&I Left,,Per Svc,2975.00
Chargemaster Item,,40736209,SPSI,Foot 2 Views Right,,Per Svc,788.00
Chargemaster Item,,40736217,SPSI,Foot 2 Views Left,,Per Svc,788.00
Chargemaster Item,,40736308,SPSI,Foot 3 Views Right,,Per Svc,1011.00
Chargemaster Item,,40736316,SPSI,Foot 3 Views Left,,Per Svc,1011.00
Chargemaster Item,,40736506,SPSI,Os Calcis Right,,Per Svc,710.00
Chargemaster Item,,40736514,SPSI,Os Calcis Left,,Per Svc,710.00
Chargemaster Item,,40736605,SPSI,Toe/Toes Right,,Per Svc,622.00
Chargemaster Item,,40736613,SPSI,Toe/Toes Left,,Per Svc,622.00
Chargemaster Item,,40740003,SPSI,Abdomen 1 View,,Per Svc,1095.00
Chargemaster Item,,40740011,SPSI,Kub,,Per Svc,1095.00
Chargemaster Item,,40740037,SPSI,Port Abd-Ng Catheter Plcmt,,Per Svc,1095.00
Chargemaster Item,,40740102,SPSI,Abdomen 2 Views,,Per Svc,711.00
Chargemaster Item,,40740201,SPSI,Abd Series/Pa Chest,,Per Svc,1095.00
Chargemaster Item,,40742207,SPSI,Esophogram,,Per Svc,1522.00
Chargemaster Item,,40742314,SPSI,Modfd Ba Swallow/Video,,Per Svc,1772.00
Chargemaster Item,,40742355,SPSI,Removal Fb Esoph W/Bal S&I,,Per Svc,3874.00
Chargemaster Item,,40742405,SPSI,UGI Single Contrast,,Per Svc,2097.00
Chargemaster Item,,40742421,SPSI,UGI Double Contrast,,Per Svc,2178.00
Chargemaster Item,,40742454,SPSI,UGI & SM BOWEL,,Per Svc,3385.00
Chargemaster Item,,40742504,SPSI,Small Bowel Series,,Per Svc,1316.00
Chargemaster Item,,40742702,SPSI,Ba Enema W/Wo Kub,,Per Svc,2251.00
Chargemaster Item,,40742710,SPSI,Colon Ca Scrn/Colonscopy Be,,Per Svc,2282.00
Chargemaster Item,,40742751,SPSI,Air Contrast Enema,,Per Svc,2933.00
Chargemaster Item,,40742835,SPSI,Therapeutic Ba Enema,,Per Svc,1983.00
Chargemaster Item,,40743007,SPSI,Surg Cholangiogram S&I,,Per Svc,1340.00
Chargemaster Item,,40743056,SPSI,Postop Cholangio Complete,,Per Svc,1076.00
Chargemaster Item,,40743304,SPSI,Ercp S&I,,Per Svc,4188.00
Chargemaster Item,,40743403,SPSI,Intro Long Gi W/Flouro,,Per Svc,3827.00
Chargemaster Item,,40744005,SPSI,Ivp W/Wo Lams,,Per Svc,1734.00
Chargemaster Item,,40744153,SPSI,Nephrotomogram,,Per Svc,2972.00
Chargemaster Item,,40744203,SPSI,Retrograde Pyelogram,,Per Svc,5128.00
Chargemaster Item,,40744211,SPSI,Rkc Retro Pyelogram,,Per Svc,3372.00
Chargemaster Item,,40744252,SPSI,Ante Lpgrm/Nphgrm S&I,,Per Svc,1976.00
Chargemaster Item,,40744302,SPSI,Cystogram S&I,,Per Svc,1339.00
Chargemaster Item,,40744500,SPSI,Retrograde Urethrogram S&I,,Per Svc,1329.00
Chargemaster Item,,40744559,SPSI,Voiding Cystogram S&I,,Per Svc,1586.00
Chargemaster Item,,40747404,SPSI,Hysterosalpingogram S&I,,Per Svc,1790.00
Chargemaster Item,,40757122,SPSI,Ext Angio S&I Right,,Per Svc,5985.00
Chargemaster Item,,40757130,SPSI,Ext Angio S&I Left,,Per Svc,5985.00
Chargemaster Item,,40758096,SPSI,Shuntogram S&I,,Per Svc,2813.00
Chargemaster Item,,40758203,SPSI,Ext Venogram S&I Right,,Per Svc,2925.00
Chargemaster Item,,40758211,SPSI,Ext Venogram S&I Left,,Per Svc,2925.00
Chargemaster Item,,40759714,SPSI,Ext Venogram S&I Bilateral,,Per Svc,4102.00
Chargemaster Item,,40760001,SPSI,Fluoroscopy Up To 1Hr,,Per Svc,3928.00
Chargemaster Item,,40760035,SPSI,Fluoro Guide Ndl Plcmt,,Per Svc,1939.00
Chargemaster Item,,40760100,SPSI,Nose-Rectum Child Iv,,Per Svc,716.00
Chargemaster Item,,40760209,SPSI,Bone Age Studies,,Per Svc,1034.00
Chargemaster Item,,40760407,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,40760621,SPSI,Osseous Survey Complete,,Per Svc,4402.00
Chargemaster Item,,40760639,SPSI,Osseous Survey Limited,,Per Svc,2135.00
Chargemaster Item,,40760654,SPSI,Infant Osseous Survey,,Per Svc,1545.00
Chargemaster Item,,40760662,SPSI,Ap Standing Feet,,Per Svc,671.00
Chargemaster Item,,40760829,SPSI,Abscess-Fistula-Sinus Tract,,Per Svc,1442.00
Chargemaster Item,,40760951,SPSI,Digital Surgical Specimen,,Per Svc,978.00
Chargemaster Item,,40761009,SPSI,Lams/Tomography,,Per Svc,1803.00
Chargemaster Item,,40770026,SPSI,Spinal Puncture Fluoro Guided,,Per Svc,1939.00
Chargemaster Item,,40770521,SPSI,Mammography Unilateral Left,,Per Svc,752.00
Chargemaster Item,,40770539,SPSI,Mammography Unilateral Right,,Per Svc,752.00
Chargemaster Item,,40770547,SPSI,Digital Bilat Eklund Mamm,,Per Svc,923.00
Chargemaster Item,,40770554,SPSI,Digital Mammography Left,,Per Svc,752.00
Chargemaster Item,,40770562,SPSI,Digital Bilat Mammogram,,Per Svc,826.00
Chargemaster Item,,40770562INACTV,SPSI,Digital Bilateral Mammography,,Per Svc,826.00
Chargemaster Item,,40770570,SPSI,Digital Screening Mammography,,Per Svc,633.00
Chargemaster Item,,40770588,SPSI,Digital Mammography Right,,Per Svc,752.00
Chargemaster Item,,40770711,SPSI,Stress Views Any Joint,,Per Svc,1146.00
Chargemaster Item,,40964504,SPSI,Intrathecal Chemo Admin,,Per Svc,2473.00
Chargemaster Item,,40990731,SPSI,Us Micromark Clip,,Per Svc,723.00
Chargemaster Item,,40990764,SPSI,Gastrografin 4 Oz,,Per Svc,226.00
Chargemaster Item,,40990806,SPSI,Myelogram Tray,,Per Svc,168.00
Chargemaster Item,,40990814,SPSI,Lumbar Puncture Tray,,Per Svc,554.00
Chargemaster Item,,40992505,SPSI,Temno Needles,,Per Svc,168.00
Chargemaster Item,,41000001,SPSI,Moderate Sedation <5/Yrs Int,,Every 15 Minutes,305.00
Chargemaster Item,,41000019,SPSI,Moderate Sedation >5/Yrs Initial,,Every 15 Minutes,303.00
Chargemaster Item,,41190505,SPSI,Pet/Ct Tumorimag Limited Area,,Per Svc,19321.00
Chargemaster Item,,41190604,SPSI,Pet/Ct Limited Skull - Thigh,,Per Svc,19321.00
Chargemaster Item,,41190703,SPSI,Pet/Ct Limited Whole Body,,Per Svc,19321.00
Chargemaster Item,,41387929,SPSI,Inj Radioactive Tracer,,Per Svc,487.00
Chargemaster Item,,41610700,SPSI,Csf Shunt Injection,,Per Svc,4038.00
Chargemaster Item,,41742412,SPSI,Small Intestine Follow,,Per Svc,1316.00
Chargemaster Item,,41780008,SPSI,Rn Thyroid Uptake + Scan,,Per Svc,1723.00
Chargemaster Item,,41780107,SPSI,Rn Thyroid Imaging,,Per Svc,2418.00
Chargemaster Item,,41780180,SPSI,Thyr Ca Met Imag Whole Body,,Per Svc,5455.00
Chargemaster Item,,41780701,SPSI,Parathyroid Imaging,,Per Svc,1917.00
Chargemaster Item,,41780719,SPSI,Rn Parathyroid Spect Imaging,,Per Svc,1764.00
Chargemaster Item,,41781048,SPSI,Bone Marrow Imag Whole Body,,Per Svc,4435.00
Chargemaster Item,,41781956,SPSI,Lymphatics Imaging,,Per Svc,4087.00
Chargemaster Item,,41782012,SPSI,Liver Imaging,,Per Svc,3010.00
Chargemaster Item,,41782020,SPSI,Rbc Liver/Hemangioma Imaging,,Per Svc,2881.00
Chargemaster Item,,41782053,SPSI,Spect Liver Scan,,Per Svc,8425.00
Chargemaster Item,,41782152,SPSI,Liver Spleen Imaging,,Per Svc,2949.00
Chargemaster Item,,41782277,SPSI,Rn Hida Scan w/EF,,Per Svc,3745.00
Chargemaster Item,,41782624,SPSI,Gi Reflux Imaging,,Per Svc,4238.00
Chargemaster Item,,41782640,SPSI,Gastric Emptying,,Per Svc,4123.00
Chargemaster Item,,41782780,SPSI,Acute Gi Blood Loss Imaging,,Per Svc,4960.00
Chargemaster Item,,41782905,SPSI,Bowel Imaging Meckels,,Per Svc,3058.00
Chargemaster Item,,41782954,SPSI,RN Cholangiogr,,Per Svc,3602.00
Chargemaster Item,,41783002,SPSI,Bone Imag Lim,,Per Svc,2782.00
Chargemaster Item,,41783051,SPSI,Bone Imag Mult,,Per Svc,4236.00
Chargemaster Item,,41783077,SPSI,Bone Imag Whol,,Per Svc,5628.00
Chargemaster Item,,41783150,SPSI,3Phase Bone Im,,Per Svc,4796.00
Chargemaster Item,,41783200,SPSI,Spect Bone Scan,,Per Svc,7565.00
Chargemaster Item,,41784117,SPSI,Gated Heart First Pass,,Per Svc,7424.00
Chargemaster Item,,41784356,SPSI,G Heart Imagng,,Per Svc,5514.00
Chargemaster Item,,41784455,SPSI,Xr Vasc Fl Img,,Per Svc,2718.00
Chargemaster Item,,41784513,SPSI,Limited Adeno Spect Heart,,Per Svc,10309.00
Chargemaster Item,,41784521,SPSI,Spect Heart W/Parmaceutical,,Per Svc,10309.00
Chargemaster Item,,41784539,SPSI,Limited Spect Heart,,Per Svc,10309.00
Chargemaster Item,,41784547,SPSI,Spect Heart,,Per Svc,10309.00
Chargemaster Item,,41784570,SPSI,PET MYOCARD VIABILITY,,Per Svc,41110.00
Chargemaster Item,,41784588,SPSI,Rn Veno Bilat,,Per Svc,5862.00
Chargemaster Item,,41784596,SPSI,Rn Acute Thrombosis Imaging,,Per Svc,5862.00
Chargemaster Item,,41785809,SPSI,Pulm Perf Imaging,,Per Svc,4420.00
Chargemaster Item,,41785858,SPSI,Pulm Perf/Vent Scan,,Per Svc,7099.00
Chargemaster Item,,41785916,SPSI,Lung Vent Sb,,Per Svc,1021.00
Chargemaster Item,,41786062,SPSI,Brain Imgaging Complete,,Per Svc,4820.00
Chargemaster Item,,41786070,SPSI,Spect Brain Scan,,Per Svc,9364.00
Chargemaster Item,,41786088,SPSI,Rn Brain Imag W/Vasculr Flow C,,Per Svc,3985.00
Chargemaster Item,,41786096,SPSI,Pet Brain Perfusion,,Per Svc,37847.00
Chargemaster Item,,41786187,SPSI,Pet Brain Metabolic,,Per Svc,41110.00
Chargemaster Item,,41786450,SPSI,Rn Csf Shunt Evaluation,,Per Svc,3166.00
Chargemaster Item,,41786997,SPSI,Rn Cisterno,,Per Svc,5140.00
Chargemaster Item,,41787003,SPSI,Renal Imaging Only,,Per Svc,3092.00
Chargemaster Item,,41787011,SPSI,Renal Imaging W Flow/Function,,Per Svc,4582.00
Chargemaster Item,,41787086,SPSI,Renal Imaging Flow/Func W/Capt,,Per Svc,4582.00
Chargemaster Item,,41787250,SPSI,Renal Function Gfr,,Per Svc,2449.00
Chargemaster Item,,41787409,SPSI,Rn Ureteral Reflux Study,,Per Svc,3199.00
Chargemaster Item,,41787607,SPSI,Testicular Imaging,,Per Svc,4533.00
Chargemaster Item,,41788001,SPSI,Tumor Local Mult Areas,,Per Svc,4820.00
Chargemaster Item,,41788027,SPSI,Tumor Localization Wb,,Per Svc,7634.00
Chargemaster Item,,41788035,SPSI,Tumor Wb W Octreoscan,,Per Svc,7634.00
Chargemaster Item,,41788050,SPSI,Abcess Localization,,Per Svc,3864.00
Chargemaster Item,,41788068,SPSI,Indium Wbc Imaging,,Per Svc,5621.00
Chargemaster Item,,41788092,SPSI,Tumor Wb Mibg,,Per Svc,7634.00
Chargemaster Item,,41788449,SPSI,Tumor Wb W/ Prostas,,Per Svc,7634.00
Chargemaster Item,,41789108,SPSI,X-Tc 99M Medronate,,Per Svc,219.00
Chargemaster Item,,41789116,SPSI,X-Tl 201 Per Mci,,Per Svc,350.00
Chargemaster Item,,41789124,SPSI,X-Tc 99M Sestamibi,,Per Svc,614.00
Chargemaster Item,,41789132,SPSI,X-Tc 99M Albumin Aggregated,,Per Svc,336.00
Chargemaster Item,,41789140,SPSI,X-Xe 133 Per 10 Mci,,Per Svc,331.00
Chargemaster Item,,41789157,SPSI,Tc 99M Dtpa,,Per Svc,264.00
Chargemaster Item,,41789173,SPSI,X-Tc 99M Mag3 Per Study Dose,,Per Svc,254.00
Chargemaster Item,,41789181,SPSI,X-Tc 99M Succimer,,Per Svc,1607.00
Chargemaster Item,,41789199,SPSI,X-TC 99M PYP,,Per Svc,308.00
Chargemaster Item,,41789207,SPSI,X-Tc 99M Exametazime,,Per Svc,3940.00
Chargemaster Item,,41789223,SPSI,X-In 111 Dtpa Per 0.5Mci,,Per Svc,10379.00
Chargemaster Item,,41789231,SPSI,X-Ga 67 Per Mci,,Per Svc,213.00
Chargemaster Item,,41789272,SPSI,X-I-131 Mibg .5Mci,,Per Svc,6405.00
Chargemaster Item,,41789306,SPSI,X-Tl 201 .5 Mcc,,Per Svc,350.00
Chargemaster Item,,41789918,SPSI,X-I-123 Cap Per Uci,,Per Svc,260.00
Chargemaster Item,,41789926,SPSI,I-131 Capsule,,Per Svc,264.00
Chargemaster Item,,41789934,SPSI,X-Tc 99M Sul Colloid,,Per Svc,333.00
Chargemaster Item,,41789942,SPSI,In-111 Oxyquinoline Per 0.5 Mc,,Per Svc,10983.00
Chargemaster Item,,41789959,SPSI,X-Tc 99M Mebrofenin,,Per Svc,399.00
Chargemaster Item,,41789967,SPSI,X-Tc 99M Rbc Label Per Mci,,Per Svc,40.00
Chargemaster Item,,41789975,SPSI,X-Tc 99M Pentetate,,Per Svc,152.00
Chargemaster Item,,41789983,SPSI,Tc99 Sulfur Colloid Per Dose,,Per Svc,333.00
Chargemaster Item,,41789991,SPSI,X-Tc 99M Tetrofosmin,,Per Svc,765.00
Chargemaster Item,,41790007,SPSI,Oral Radiopharm Therapy,,Per Svc,3549.00
Chargemaster Item,,41791104,SPSI,F18 Fdg,,Per Svc,7099.00
Chargemaster Item,,41791203,SPSI,In 111 Pentetreotide up to 6 MCI,,Per Svc,5465.00
Chargemaster Item,,41799016,SPSI,X-I-131 Per Mci,,Per Svc,827.00
Chargemaster Item,,41799024,SPSI,Iodine 131/Mci,,Per Svc,1019.00
Chargemaster Item,,41799081,SPSI,F18 Florbetapir per study dose,,Per Svc,14163.00
Chargemaster Item,,41799107,SPSI,In 111 Prostascint,,Per Svc,9698.00
Chargemaster Item,,41799115,SPSI,Amyvid,,Per Svc,12398.00
Chargemaster Item,,41880121,SPSI,Fluciclovine F-18,,Per Svc,1834.00
Chargemaster Item,,41889908,SPSI,I-123 Cap Per 100 Microcuries,,Per Svc,260.00
Chargemaster Item,,42000026,SPSI,US Perc Liver Albation,,Per Svc,18671.00
Chargemaster Item,,42000034,SPSI,US Perc Lung Albation,,Per Svc,18287.00
Chargemaster Item,,42000042,SPSI,US Ablation Guidance,,Per Svc,1343.00
Chargemaster Item,,42000059,SPSI,Ablation Prob,,Per Svc,11241.00
Chargemaster Item,,42025924,SPSI,Us Extremity Complete Nonvasc,,Per Svc,2080.00
Chargemaster Item,,42100008,SPSI,Us Surgical Code,,Per Svc,737.00
Chargemaster Item,,42100222,SPSI,US Fine Needle Aspiration,,Per Svc,3808.00
Chargemaster Item,,42190009,SPSI,Us Cystasp Breast,,Per Svc,463.00
Chargemaster Item,,42190017,SPSI,Addl Cyst Aspiration,,Per Svc,467.00
Chargemaster Item,,42190827,SPSI,US RT Breast BX Complete,,Per Svc,6901.00
Chargemaster Item,,42190835,SPSI,US LT Breast BX Complete,,Per Svc,6901.00
Chargemaster Item,,42190843,SPSI,US Ea Addl Lesion Breast BX,,Per Svc,2695.00
Chargemaster Item,,42192849,SPSI,US LT Breast Localization Complt,,Per Svc,2829.00
Chargemaster Item,,42192856,SPSI,US RT Breast Localizatn Complt,,Per Svc,2829.00
Chargemaster Item,,42192864,SPSI,US ea addl lesion breast LOC,,Per Svc,2697.00
Chargemaster Item,,42202069,SPSI,Us Soft Tissue Ndl Biopsy,,Per Svc,3838.00
Chargemaster Item,,42206003,SPSI,US Inj Small Joint/Bursa,,Per Svc,705.00
Chargemaster Item,,42206052,SPSI,US Inj Intermediate Joint/Bursa,,Per Svc,703.00
Chargemaster Item,,42206102,SPSI,US Inj Major Joint/Bursa,,Per Svc,598.00
Chargemaster Item,,42206128,SPSI,Aspirate/Inj Ganglion Cyst,,Per Svc,790.00
Chargemaster Item,,42215509,SPSI,Bx Soft Tissue Neck/Chest,,Per Svc,783.00
Chargemaster Item,,42320002,SPSI,Thoracentesis,,Per Svc,1413.00
Chargemaster Item,,42320028,SPSI,Thoracentesis/Cath Plcmt,,Per Svc,2608.00
Chargemaster Item,,42325555,SPSI,CT Thoracentesis Complete,,Per Svc,7877.00
Chargemaster Item,,42372045,SPSI,Us Perc Thrombin Inj,,Per Svc,17209.00
Chargemaster Item,,42385054,SPSI,NDL BX Lymph Nodes Sprfcl,,Per Svc,1498.00
Chargemaster Item,,42424002,SPSI,Ndl Bx Salivary Gland,,Per Svc,4745.00
Chargemaster Item,,42470005,SPSI,Perc Bx Liver,,Per Svc,3410.00
Chargemaster Item,,42490219,SPSI,Peritoneal Abscess Drain,,Per Svc,6407.00
Chargemaster Item,,42490615,SPSI,Retroperi Abscess Drain,,Per Svc,7182.00
Chargemaster Item,,42490839,SPSI,US Paracentesis Complete,,Per Svc,3484.00
Chargemaster Item,,42491803,SPSI,Perc Bx Abd/Retroperitoneal,,Per Svc,4122.00
Chargemaster Item,,42494054,SPSI,CT Drainage Complete,,Per Svc,4658.00
Chargemaster Item,,42502005,SPSI,Perc Bx Renal,,Per Svc,6178.00
Chargemaster Item,,42557009,SPSI,Us Prostate Bx,,Per Svc,1852.00
Chargemaster Item,,42583401,SPSI,Inj Sonohystero/Hystero,,Per Svc,373.00
Chargemaster Item,,42600007,SPSI,Us Thyroid Cyst Asp,,Per Svc,1787.00
Chargemaster Item,,42601005,SPSI,Perc Bx Thyroid,,Per Svc,1581.00
Chargemaster Item,,42758946,SPSI,Us Guide Emboliz S&I,,Per Svc,6525.00
Chargemaster Item,,42759894,SPSI,Ct Drain/Speci Coll S&I,,Per Svc,2257.00
Chargemaster Item,,42760983,SPSI,US Surg Specimen,,Per Svc,978.00
Chargemaster Item,,42765172,SPSI,Neo-Natal Cranial Sonogram,,Per Svc,1961.00
Chargemaster Item,,42765354,SPSI,Us Soft Tissue Head/Neck,,Per Svc,1957.00
Chargemaster Item,,42766048,SPSI,US Limited Chest,,Per Svc,1501.00
Chargemaster Item,,42766428,SPSI,US Breast Rt Limited,,Per Svc,936.00
Chargemaster Item,,42766436,SPSI,US Breast Lt Limited,,Per Svc,936.00
Chargemaster Item,,42766451,SPSI,US Breast Rt Complete,,Per Svc,1356.00
Chargemaster Item,,42766469,SPSI,US Breast Lt Complete,,Per Svc,1355.00
Chargemaster Item,,42767004,SPSI,Abdomen Sonogram,,Per Svc,2703.00
Chargemaster Item,,42767053,SPSI,Abd Sono Lim,,Per Svc,2045.00
Chargemaster Item,,42767202,SPSI,Gb/Ruq Sonogram,,Per Svc,2045.00
Chargemaster Item,,42767301,SPSI,Renal Sonogram,,Per Svc,2734.00
Chargemaster Item,,42767657,SPSI,Aorta Sonogram,,Per Svc,2734.00
Chargemaster Item,,42767707,SPSI,Us Screening Aaa,,Per Svc,1539.00
Chargemaster Item,,42767731,SPSI,Retroperitoneal Us Limited,,Per Svc,1694.00
Chargemaster Item,,42767749,SPSI,Us Renal Trnsplnt W/Doppler,,Per Svc,1784.00
Chargemaster Item,,42767756,SPSI,Retroperitoneal Us Lmt Right,,Per Svc,1694.00
Chargemaster Item,,42767764,SPSI,Retroperitoneal Us Lmt Left,,Per Svc,1694.00
Chargemaster Item,,42768002,SPSI,Us Spinal Canal,,Per Svc,2254.00
Chargemaster Item,,42768028,SPSI,Ob <14Wks Ea Addl Gestation,,Per Svc,2185.00
Chargemaster Item,,42768051,SPSI,Ob Us <14 Wks,,Per Svc,2906.00
Chargemaster Item,,42768093,SPSI,Ob Us 2Nd/3Rd Trim Ea Add Gest,,Per Svc,2183.00
Chargemaster Item,,42768101,SPSI,Ob Us 2Nd/3Rd Trimester,,Per Svc,2936.00
Chargemaster Item,,42768150,SPSI,Lim Ob Sono,,Per Svc,2685.00
Chargemaster Item,,42768168,SPSI,Ob Follow-Up,,Per Svc,1325.00
Chargemaster Item,,42768184,SPSI,Ob Us Follow-Up Add Gest,,Per Svc,1325.00
Chargemaster Item,,42768192,SPSI,Us Ob Transvaginal,,Per Svc,1181.00
Chargemaster Item,,42768192INACTV,SPSI,Ob Us Transvaginal,,Per Svc,1178.00
Chargemaster Item,,42768200,SPSI,Plcenta Loc Sono,,Per Svc,2685.00
Chargemaster Item,,42768317,SPSI,Hysterosonography,,Per Svc,1537.00
Chargemaster Item,,42768325,SPSI,Us Nonob Transvaginal,,Per Svc,1878.00
Chargemaster Item,,42768507,SPSI,Pelvic Nonob Us,,Per Svc,2546.00
Chargemaster Item,,42768572,SPSI,Fu/Limited Pelvic Us,,Per Svc,1472.00
Chargemaster Item,,42768705,SPSI,Scrotal Sonogram,,Per Svc,2204.00
Chargemaster Item,,42768721,SPSI,Us Transrectal,,Per Svc,2499.00
Chargemaster Item,,42768812,SPSI,Us Rt Extrmty Lim Nonvascular,,Per Svc,2080.00
Chargemaster Item,,42768820,SPSI,Us Lt Extrmty Lim Nonvascular,,Per Svc,2080.00
Chargemaster Item,,42768853,SPSI,Us Infant Hips W/Radiologist,,Per Svc,1139.00
Chargemaster Item,,42768861,SPSI,Us Infant Hips No Radiologist,,Per Svc,1141.00
Chargemaster Item,,42769208,SPSI,Carotid Duplex,,Per Svc,3717.00
Chargemaster Item,,42769364,SPSI,Us Guide Compression Repair,,Per Svc,2485.00
Chargemaster Item,,42769372,SPSI,Us Cyst Asp Rt Brreast S+I,,Per Svc,2708.00
Chargemaster Item,,42769380,SPSI,Us Guide Cyst Asp S+I,,Per Svc,2708.00
Chargemaster Item,,42769398,SPSI,Us Cyst Asp Lt Breast S+I,,Per Svc,2708.00
Chargemaster Item,,42769455,SPSI,Us Rt Renal Bx S+I,,Per Svc,2708.00
Chargemaster Item,,42769463,SPSI,Us Lt Renal Bx S+I,,Per Svc,2708.00
Chargemaster Item,,42769471,SPSI,Us Guide Ndl Plcmnt,,Per Svc,2704.00
Chargemaster Item,,42769505,SPSI,Us Guid For Tx,,Per Svc,1890.00
Chargemaster Item,,42769604,SPSI,Us Guide Bx S+I,,Per Svc,2708.00
Chargemaster Item,,42769653,SPSI,Us Guide Interstitial Radioelement,,Per Svc,1731.00
Chargemaster Item,,42769869,SPSI,Us Guide Intraoperative S&I,,Per Svc,3798.00
Chargemaster Item,,42938829,SPSI,Lim/Fu Carotid Duplex,,Per Svc,2014.00
Chargemaster Item,,42939256,SPSI,Lwrext Arterial Duplex Bilat,,Per Svc,2973.00
Chargemaster Item,,42939264,SPSI,Lext Arterial Duplex Left,,Per Svc,1617.00
Chargemaster Item,,42939272,SPSI,Lext Arterial Duplex Right,,Per Svc,1617.00
Chargemaster Item,,42939306,SPSI,Upper Ext Arterial Duplex Scan,,Per Svc,2681.00
Chargemaster Item,,42939314,SPSI,Upper Ext Art Duplex Scan Right,,Per Svc,1624.00
Chargemaster Item,,42939322,SPSI,Upper Ext Art Duplex Scan Left,,Per Svc,1624.00
Chargemaster Item,,42939702,SPSI,Us Venous Bilat Uprext Duplex,,Per Svc,3588.00
Chargemaster Item,,42939710,SPSI,US Venous Rt Uprext Duplex,,Per Svc,2921.00
Chargemaster Item,,42939728,SPSI,Us Venous Lt Uprext Duplex,,Per Svc,2921.00
Chargemaster Item,,42939736,SPSI,Us Venous Bilat Lwrext Duplex,,Per Svc,3307.00
Chargemaster Item,,42939744,SPSI,Us Venous Rt Lwrext Duplex,,Per Svc,2692.00
Chargemaster Item,,42939751,SPSI,Us Visceral Duplex Scan,,Per Svc,2520.00
Chargemaster Item,,42939769,SPSI,US Visceral Limited Duplex Scan,,Per Svc,2180.00
Chargemaster Item,,42939785,SPSI,Bypass Grafts Duplex Scan,,Per Svc,2678.00
Chargemaster Item,,42939793,SPSI,Lim Bypass Grafts Duplex Scan,,Per Svc,1350.00
Chargemaster Item,,42939801,SPSI,Us Venous Lt Lwrext Duplex,,Per Svc,2692.00
Chargemaster Item,,42939900,SPSI,US Elastography Organ,,Per Svc,533.00
Chargemaster Item,,42939918,SPSI,US Elastography Tissue Lesion,,Per Svc,533.00
Chargemaster Item,,42939926,SPSI,US Ea Addl Elastography Lesion,,Per Svc,380.00
Chargemaster Item,,42990721,SPSI,Us Bx Ndl/S,,Per Svc,338.00
Chargemaster Item,,42990739,SPSI,Us Bx Tray,,Per Svc,210.00
Chargemaster Item,,42990747,SPSI,Us Foley Cath Kit,,Per Svc,66.00
Chargemaster Item,,42990754,SPSI,Us Thoracentesis Tray,,Per Svc,165.00
Chargemaster Item,,42990762,SPSI,Us Hystero Tray,,Per Svc,296.00
Chargemaster Item,,42990788,SPSI,Us Centesis Ndl,,Per Svc,99.00
Chargemaster Item,,42990804,SPSI,Us Temno Ndl,,Per Svc,117.00
Chargemaster Item,,42990812,SPSI,Us Trucut Ndl,,Per Svc,142.00
Chargemaster Item,,42990820,SPSI,Drainage Cath,,Per Svc,408.00
Chargemaster Item,,42990838,SPSI,Suction Bag 500Ml,,Per Svc,100.00
Chargemaster Item,,42990846,SPSI,Suction Bag 1000Ml,,Per Svc,111.00
Chargemaster Item,,42990853,SPSI,Us Breast Bx Supplies,,Per Svc,267.00
Chargemaster Item,,42990861,SPSI,Us 11G Encore Probe,,Per Svc,1558.00
Chargemaster Item,,42990879,SPSI,Us Micromark Clip,,Per Svc,723.00
Chargemaster Item,,43200112,SPSI,Neo-Natal Cranial Sonogram,,Per Svc,1961.00
Chargemaster Item,,43200229,SPSI,Us Soft Tissue Head/Neck,,Per Svc,1957.00
Chargemaster Item,,43200330,SPSI,US Limited Chest,,Per Svc,1501.00
Chargemaster Item,,43200559,SPSI,US Breast Rt Complete,,Per Svc,1356.00
Chargemaster Item,,43200666,SPSI,US Breast Lt Complete,,Per Svc,1355.00
Chargemaster Item,,43200880,SPSI,Abdomen Sonogram,,Per Svc,2703.00
Chargemaster Item,,43200997,SPSI,Abd Sono Lim,,Per Svc,2045.00
Chargemaster Item,,43201003,SPSI,Gb/Ruq Sonogram,,Per Svc,2045.00
Chargemaster Item,,43201110,SPSI,Renal Sonogram,,Per Svc,2734.00
Chargemaster Item,,43201227,SPSI,Aorta Sonogram,,Per Svc,2734.00
Chargemaster Item,,43201334,SPSI,Rt Renal Lim Sono,,Per Svc,1654.00
Chargemaster Item,,43201441,SPSI,Lt Renal Lim Sono,,Per Svc,1654.00
Chargemaster Item,,43201557,SPSI,Us Spinal Canal,,Per Svc,2254.00
Chargemaster Item,,43201664,SPSI,Ob <14Wks Ea Addl Gestation,,Per Svc,2185.00
Chargemaster Item,,43201771,SPSI,Ob Us <14 Wks,,Per Svc,2906.00
Chargemaster Item,,43201888,SPSI,Ob Us 2Nd/3Rd Trim Ea Add Gest,,Per Svc,2183.00
Chargemaster Item,,43201995,SPSI,Ob Us 2Nd/3Rd Trimester,,Per Svc,2936.00
Chargemaster Item,,43202001,SPSI,Lim Ob Sono,,Per Svc,2685.00
Chargemaster Item,,43202118,SPSI,Ob Follow-Up,,Per Svc,1325.00
Chargemaster Item,,43202225,SPSI,Ob Us Follow-Up Add Gest,,Per Svc,1325.00
Chargemaster Item,,43202332,SPSI,Plcenta Loc Sono,,Per Svc,2685.00
Chargemaster Item,,43202449,SPSI,Pelvic Nonob Us,,Per Svc,2546.00
Chargemaster Item,,43202555,SPSI,Fu/Limited Pelvic Us,,Per Svc,1472.00
Chargemaster Item,,43202662,SPSI,Scrotal Sonogram,,Per Svc,2204.00
Chargemaster Item,,43202779,SPSI,Us Rt Extrmty Lim Nonvascular,,Per Svc,2080.00
Chargemaster Item,,43202886,SPSI,Us Lt Extrmty Lim Nonvascular,,Per Svc,2080.00
Chargemaster Item,,43202993,SPSI,Us Infant Hips W/Radiologist,,Per Svc,1139.00
Chargemaster Item,,43203009,SPSI,Carotid Duplex,,Per Svc,3717.00
Chargemaster Item,,43203223,SPSI,Lim/Fu Carotid Duplex,,Per Svc,2014.00
Chargemaster Item,,43203330,SPSI,Lwrext Arterial Duplex Bilat,,Per Svc,2973.00
Chargemaster Item,,43203447,SPSI,Lext Arterial Duplex Left,,Per Svc,1617.00
Chargemaster Item,,43203553,SPSI,Lext Arterial Duplex Right,,Per Svc,1617.00
Chargemaster Item,,43203660,SPSI,Upper Ext Arterial Duplex Scan,,Per Svc,2681.00
Chargemaster Item,,43203777,SPSI,Upper Ext Art Duplex Scan Right,,Per Svc,1624.00
Chargemaster Item,,43203884,SPSI,Upper Ext Art Duplex Scan Left,,Per Svc,1624.00
Chargemaster Item,,43203991,SPSI,Duplex Scan Bilat Ext Veins,,Per Svc,3812.00
Chargemaster Item,,43204007,SPSI,Right Ext Duplex Scan,,Per Svc,2921.00
Chargemaster Item,,43204114,SPSI,Left Ext Duplex Scan,,Per Svc,2921.00
Chargemaster Item,,43204221,SPSI,Bypass Grafts Duplex Scan,,Per Svc,2678.00
Chargemaster Item,,43204338,SPSI,Lim Bypass Grafts Duplex Scan,,Per Svc,1350.00
Chargemaster Item,,43220441,SPSI,Us Visceral Duplex Scan,,Per Svc,2520.00
Chargemaster Item,,43220482,SPSI,Us Renal Trnsplnt W/Doppler,,Per Svc,1784.00
Chargemaster Item,,43220490,SPSI,Us Renal Trnsplnt W/O Doppler,,Per Svc,1654.00
Chargemaster Item,,43220508,SPSI,Us Renal Transplant W/Doppler,,Per Svc,1743.00
Chargemaster Item,,43220516,SPSI,Us Venous Bilat Uprext Duplex,,Per Svc,3588.00
Chargemaster Item,,43220524,SPSI,Us Venous Lt Uprext Duplex,,Per Svc,2921.00
Chargemaster Item,,43220532,SPSI,US Venous Rt Uprext Duplex,,Per Svc,2921.00
Chargemaster Item,,43220540,SPSI,Us Venous Bilat Lwrext Duplex,,Per Svc,3307.00
Chargemaster Item,,43220557,SPSI,Us Venous Lt Lwrext Duplex,,Per Svc,2692.00
Chargemaster Item,,43220565,SPSI,Us Venous Rt Lwrext Duplex,,Per Svc,2692.00
Chargemaster Item,,43220607,SPSI,Us Renal Transplant Wo Doppler,,Per Svc,1654.00
Chargemaster Item,,43220607INACTV,SPSI,Retroperitoneal Us Limited,,Per Svc,1694.00
Chargemaster Item,,43220619,SPSI,US Visceral Limited Duplex Scan,,Per Svc,2180.00
Chargemaster Item,,43226133,SPSI,Us Screening Aaa,,Per Svc,1539.00
Chargemaster Item,,43226208,SPSI,Ob Us Transvaginal,,Per Svc,1178.00
Chargemaster Item,,43226216,SPSI,Us Nonob Transvaginal,,Per Svc,1878.00
Chargemaster Item,,43226224,SPSI,Us Extremity Complete Nonvasc,,Per Svc,2080.00
Chargemaster Item,,43550458,SPSI,Ob Re-Revaluation Sonogram,,Per Svc,1099.00
Chargemaster Item,,43990724,SPSI,Gadavist Per Cc,50419-325-02,Per Svc,14.00
Chargemaster Item,,44000008,SPSI,Moderate Sedation <5/Yrs Int,,Every 15 Minutes,305.00
Chargemaster Item,,44000016,SPSI,Moderate Sedation >5/Yrs Initial,,Every 15 Minutes,303.00
Chargemaster Item,,44000107,SPSI,Perc Renal Ablation,,Per Svc,19069.00
Chargemaster Item,,44000115,SPSI,Perc Liver Albation,,Per Svc,18686.00
Chargemaster Item,,44000123,SPSI,Perc Lung Albation,,Per Svc,18302.00
Chargemaster Item,,44000131,SPSI,CT Ablation Guidance,,Per Svc,3213.00
Chargemaster Item,,44000149,SPSI,Ablation Prob,,Per Svc,11241.00
Chargemaster Item,,44000420,SPSI,Ct Head Perfusion Analysis,,Per Svc,7134.00
Chargemaster Item,,44001121,SPSI,Perc Renal Ablation Cryo,,Per Svc,25696.00
Chargemaster Item,,44001139,SPSI,Perc Liver Ablation Cryo,,Per Svc,25095.00
Chargemaster Item,,44001147,SPSI,Ablation Probe Cryo,,Per Svc,7426.00
Chargemaster Item,,44001444,SPSI,Ct Heart Cacs Wo Contrast,,Per Svc,9316.00
Chargemaster Item,,44001451,SPSI,Ct Heart Structure W Contrast,,Per Svc,11547.00
Chargemaster Item,,44001501,SPSI,Ct Heart W Cont Cong Disease,,Per Svc,11569.00
Chargemaster Item,,44015865,SPSI,Locm Per 1Ml Ultravist 370,,Per Svc,1.00
Chargemaster Item,,44015873,SPSI,Hocm Per 1Ml Cystoconray Ii,,Per Svc,1.00
Chargemaster Item,,44100006,SPSI,CT Surgical Code,,Per Svc,886.00
Chargemaster Item,,44202067,SPSI,Perc Bx Muscle,,Per Svc,4197.00
Chargemaster Item,,44202075,SPSI,Bx Soft Tissue Neck,,Per Svc,4197.00
Chargemaster Item,,44202083,SPSI,Bx Extremity Soft Tissue,,Per Svc,4197.00
Chargemaster Item,,44202091,SPSI,Ct Soft Tissue Ndl Biopsy,,Per Svc,3547.00
Chargemaster Item,,44202208,SPSI,Perc Bx Bone Sprficial,,Per Svc,4339.00
Chargemaster Item,,44202257,SPSI,Perc Bx Bone Deep,,Per Svc,4913.00
Chargemaster Item,,44205011,SPSI,Inj Fistula/Sinus Tract,,Per Svc,246.00
Chargemaster Item,,44206100,SPSI,US Inj Major Joint/Bursa,,Per Svc,598.00
Chargemaster Item,,44206126,SPSI,Aspiration/Inj Ganglion Cyst,,Per Svc,670.00
Chargemaster Item,,44215507,SPSI,Bx Soft Tissue Neck/Chest,,Per Svc,783.00
Chargemaster Item,,44320000,SPSI,Thoracentesis,,Per Svc,1413.00
Chargemaster Item,,44320026,SPSI,Thoracentesis/Cath Plcmt,,Per Svc,2608.00
Chargemaster Item,,44324002,SPSI,Perc Bx Pleura,,Per Svc,4691.00
Chargemaster Item,,44324051,SPSI,Perc Bx Lung,,Per Svc,6178.00
Chargemaster Item,,44325553,SPSI,CT Thoracentesis Complete,,Per Svc,7877.00
Chargemaster Item,,44382208,SPSI,Ct Bone Marrow Aspiration,,Per Svc,4482.00
Chargemaster Item,,44382216,SPSI,Ct Bone Marrow Biopsy,,Per Svc,4482.00
Chargemaster Item,,44385052,SPSI,NDL BX Lymph Nodes Sprfcl,,Per Svc,1498.00
Chargemaster Item,,44424000,SPSI,Ndl Bx Salivary Gland,,Per Svc,4745.00
Chargemaster Item,,44470003,SPSI,Perc Bx Liver,,Per Svc,3410.00
Chargemaster Item,,44481026,SPSI,Perc Bx Pancreas,,Per Svc,3715.00
Chargemaster Item,,44490209,SPSI,Peritoneal Abscess Drain,,Per Svc,6407.00
Chargemaster Item,,44490605,SPSI,Retroperi Abscess Drain,,Per Svc,7182.00
Chargemaster Item,,44490837,SPSI,US Paracentesis Complete,,Per Svc,3484.00
Chargemaster Item,,44491801,SPSI,Perc Bx Abd/Retroperitoneal,,Per Svc,4122.00
Chargemaster Item,,44494052,SPSI,CT Drainage Complete,,Per Svc,4658.00
Chargemaster Item,,44502003,SPSI,Perc Bx Renal,,Per Svc,6178.00
Chargemaster Item,,44503902,SPSI,Perc Renal Cyst Aspiration,,Per Svc,2542.00
Chargemaster Item,,44601003,SPSI,Perc Bx Thyroid,,Per Svc,1581.00
Chargemaster Item,,44601011,SPSI,Natl Decision Sup CareSelect,,Per Svc,0.01
Chargemaster Item,,44622678,SPSI,Interdiscal Perc Aspiration,,Per Svc,4247.00
Chargemaster Item,,44622843,SPSI,Inj Cisterno,,Per Svc,4841.00
Chargemaster Item,,44700243,SPSI,Ct Head W Contrast,,Per Svc,8262.00
Chargemaster Item,,44700250,SPSI,Ct Head Wocont,,Per Svc,7593.00
Chargemaster Item,,44700257,SPSI,Ct Head Wo Contrast,,Per Svc,7578.00
Chargemaster Item,,44700268,SPSI,Ct Head Stroke Protocol,,Per Svc,7593.00
Chargemaster Item,,44700334,SPSI,Ct Orbit W Con,,Per Svc,8263.00
Chargemaster Item,,44700359,SPSI,Ct Head W/Wo Contrast,,Per Svc,11250.00
Chargemaster Item,,44700375,SPSI,Ct Orbit Wo Cn,,Per Svc,7136.00
Chargemaster Item,,44704500,SPSI,Ct Temprl W/Wo,,Per Svc,10211.00
Chargemaster Item,,44704609,SPSI,Ct Temporal W,,Per Svc,8263.00
Chargemaster Item,,44704609INACTV,SPSI,Ct Orbit W Contrast,,Per Svc,8580.00
Chargemaster Item,,44704807,SPSI,Ct Sinuses W Contrast,,Per Svc,9076.00
Chargemaster Item,,44704823,SPSI,Ct Orbit W/Wo Contrast,,Per Svc,10191.00
Chargemaster Item,,44704831,SPSI,Ct Temporal Wo,,Per Svc,7136.00
Chargemaster Item,,44704831INACTV,SPSI,Ct Orbit Wo Contrast,,Per Svc,7122.00
Chargemaster Item,,44704864,SPSI,Ct Facial Bones Wo Contrast,,Per Svc,4628.00
Chargemaster Item,,44704872,SPSI,Ct Facial Bones W Contrast,,Per Svc,9076.00
Chargemaster Item,,44704880,SPSI,Ct Maxillofacial Wo/W Contrast,,Per Svc,9130.00
Chargemaster Item,,44704898,SPSI,Ct Sinuses Wo Contrast,,Per Svc,4628.00
Chargemaster Item,,44704906,SPSI,Ct Neck Wo Contrast,,Per Svc,6131.00
Chargemaster Item,,44704914,SPSI,Ct Neck W Contrast,,Per Svc,7277.00
Chargemaster Item,,44704922,SPSI,Ct Neck Wo/W Contrast,,Per Svc,9140.00
Chargemaster Item,,44704963,SPSI,Cta Head B,,Per Svc,1849.00
Chargemaster Item,,44704989,SPSI,Cta Neck,,Per Svc,1788.00
Chargemaster Item,,44712503,SPSI,Ct Chest Wo Contrast,,Per Svc,7998.00
Chargemaster Item,,44712529,SPSI,CT Chest Screening,,Per Svc,443.00
Chargemaster Item,,44712537,SPSI,CT Thorax Screen w/o Contrast,,Per Svc,7998.00
Chargemaster Item,,44712602,SPSI,Ct Thorax W Contrast,,Per Svc,9389.00
Chargemaster Item,,44712701,SPSI,Ct Thorax W/Wo Contrast,,Per Svc,10329.00
Chargemaster Item,,44712750,SPSI,Ct Chest Angio,,Per Svc,4716.00
Chargemaster Item,,44714863,SPSI,Ct Maxilla/Mand Wo,,Per Svc,4637.00
Chargemaster Item,,44714962,SPSI,Cta Head A,,Per Svc,1849.00
Chargemaster Item,,44714962INACTV,SPSI,Cta Head,,Per Svc,1846.00
Chargemaster Item,,44721256,SPSI,Ct Cervical Spine Wo Contrast,,Per Svc,9407.00
Chargemaster Item,,44721264,SPSI,Ct Cervical Spine W Contrast,,Per Svc,10195.00
Chargemaster Item,,44721272,SPSI,Ct Cervical Spine W/Wo Contrst,,Per Svc,10989.00
Chargemaster Item,,44721280,SPSI,Ct Thoracic Spine Wo Contrast,,Per Svc,7113.00
Chargemaster Item,,44721298,SPSI,Ct Thoracic Spine W Contrast,,Per Svc,8644.00
Chargemaster Item,,44721306,SPSI,Ct Thoracic Wo/W Contrast,,Per Svc,10839.00
Chargemaster Item,,44721314,SPSI,Ct Lumbar Spine Wo Contrast,,Per Svc,9034.00
Chargemaster Item,,44721322,SPSI,Ct Lumbar Spine W Contrast,,Per Svc,10416.00
Chargemaster Item,,44721330,SPSI,Ct Lumbar Spine W/Wo Contrast,,Per Svc,12959.00
Chargemaster Item,,44721918,SPSI,Ct Pelvis Angio,,Per Svc,3748.00
Chargemaster Item,,44721926,SPSI,Ct Pelvis Wo Contrast,,Per Svc,7585.00
Chargemaster Item,,44721934,SPSI,Ct Pelvis W Contrast,,Per Svc,8560.00
Chargemaster Item,,44721942,SPSI,Ct Pelvis W/Wo Contrast,,Per Svc,10794.00
Chargemaster Item,,44722858,SPSI,Cerv/Thor Diskography S&I,,Per Svc,10504.00
Chargemaster Item,,44722957,SPSI,Lumbar Diskography S&I,,Per Svc,10388.00
Chargemaster Item,,44732006,SPSI,Ct Upper Ext Wo Contrast Right,,Per Svc,6913.00
Chargemaster Item,,44732014,SPSI,Ct Rt Upext W,,Per Svc,7078.00
Chargemaster Item,,44732022,SPSI,Ct Upper Ext W/Wo Contrast Right,,Per Svc,11762.00
Chargemaster Item,,44732030,SPSI,Ct Upper Ext Wo Contrast Left,,Per Svc,6913.00
Chargemaster Item,,44732048,SPSI,Ct Lt Upext W,,Per Svc,7078.00
Chargemaster Item,,44732063,SPSI,Ct Rt Shoulder Arthrogram,,Per Svc,7063.00
Chargemaster Item,,44732063INACTV,SPSI,Ct Upper Ext W Contrast Right,,Per Svc,7349.00
Chargemaster Item,,44732071,SPSI,Ct Lt Shoulder Arthrogram,,Per Svc,7063.00
Chargemaster Item,,44732071INACTV,SPSI,Ct Upper Ext W Contrast Left,,Per Svc,7349.00
Chargemaster Item,,44732089,SPSI,Cta Uext Right,,Per Svc,2427.00
Chargemaster Item,,44732097,SPSI,Cta Uext Left,,Per Svc,2427.00
Chargemaster Item,,44737005,SPSI,Ct Lower Ext Wo Contrast Right,,Per Svc,6845.00
Chargemaster Item,,44737013,SPSI,Ct Lower Ext W Contrast Right,,Per Svc,7750.00
Chargemaster Item,,44737021,SPSI,Ct Lower Ext W/Wo Cont Right,,Per Svc,11466.00
Chargemaster Item,,44737039,SPSI,Ct Lower Ext Wo Contrast Left,,Per Svc,6845.00
Chargemaster Item,,44737047,SPSI,Ct Lower Ext W Contrast Left,,Per Svc,7750.00
Chargemaster Item,,44737054,SPSI,Ct Lower Ext W/Wo Cont Left,,Per Svc,11466.00
Chargemaster Item,,44737062,SPSI,Cta Lower Ext Right,,Per Svc,2305.00
Chargemaster Item,,44737070,SPSI,Cta Lower Ext Left,,Per Svc,2305.00
Chargemaster Item,,44741502,SPSI,Ct Abdomen Wo Contrast,,Per Svc,7377.00
Chargemaster Item,,44741601,SPSI,Ct Abdomen W Contrast,,Per Svc,9193.00
Chargemaster Item,,44741700,SPSI,Ct Abdomen W/Wo Contrast,,Per Svc,11693.00
Chargemaster Item,,44741742,SPSI,CT Angio Abdomen & Pelvis,,Per Svc,6788.00
Chargemaster Item,,44741759,SPSI,Ct Abdomen Angio,,Per Svc,3038.00
Chargemaster Item,,44741767,SPSI,Ct Abd & Pelvis Wo Contrast,,Per Svc,16615.00
Chargemaster Item,,44741775,SPSI,Ct Abd & Pelvis With Contrast,,Per Svc,19676.00
Chargemaster Item,,44741783,SPSI,Ct Abd/Pel Wo/W 1/Both Areas,,Per Svc,24929.00
Chargemaster Item,,44742617,SPSI,Ct Colonography Wo Contrast,,Per Svc,3251.00
Chargemaster Item,,44742625,SPSI,Ct Colonography W Contrast,,Per Svc,3533.00
Chargemaster Item,,44742633,SPSI,Ct Colonography Screening,,Per Svc,2980.00
Chargemaster Item,,44755742,SPSI,Cta Heart Complete,,Per Svc,5157.00
Chargemaster Item,,44756351,SPSI,Cta Aorta-Ilio,,Per Svc,2936.00
Chargemaster Item,,44759892,SPSI,Ct Drain/Speci Coll S&I,,Per Svc,2257.00
Chargemaster Item,,44760403,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,44763555,SPSI,Ct Guide Stereotactic Loc,,Per Svc,11358.00
Chargemaster Item,,44763605,SPSI,Ct Biopsy S+I,,Per Svc,7151.00
Chargemaster Item,,44763613,SPSI,Ct Rt Lung Bx S+I,,Per Svc,7151.00
Chargemaster Item,,44763621,SPSI,Ct Lt Lung Bx S+I,,Per Svc,7151.00
Chargemaster Item,,44763639,SPSI,Ct Rt Renal Bx S+I,,Per Svc,7151.00
Chargemaster Item,,44763647,SPSI,Ct Lt Renal Bx S+I,,Per Svc,7151.00
Chargemaster Item,,44763654,SPSI,Ct Cyst Aspiration S+I,,Per Svc,7151.00
Chargemaster Item,,44763704,SPSI,Ct Guide Plcmnt Rad Tx Fields,,Per Svc,2185.00
Chargemaster Item,,44763803,SPSI,CT Limited Abdomen,,Per Svc,2446.00
Chargemaster Item,,44763829,SPSI,CT Lim Head,,Per Svc,2449.00
Chargemaster Item,,44764975,SPSI,Ct Colonography,,Per Svc,3282.00
Chargemaster Item,,44990737,SPSI,Drainage Cath,,Per Svc,408.00
Chargemaster Item,,44990745,SPSI,Pneumothorax Catheter,,Per Svc,465.00
Chargemaster Item,,44990760,SPSI,Temno Needles,,Per Svc,168.00
Chargemaster Item,,44990786,SPSI,Turner Bx Wdl Addl,,Per Svc,104.00
Chargemaster Item,,44990802,SPSI,Visipaque 320 Per Ml,,Per Svc,1.00
Chargemaster Item,,44990810,SPSI,Ultravist 300 Per Ml,,Per Svc,1.00
Chargemaster Item,,44990828,SPSI,Ultravist 370 Per Ml,,Per Svc,1.00
Chargemaster Item,,44990836,SPSI,Suction Bag 500Ml,,Per Svc,100.00
Chargemaster Item,,44990844,SPSI,Suction Bag 1000Ml,,Per Svc,111.00
Chargemaster Item,,44990851,SPSI,Omnipaque 350,,Per Svc,1.00
Chargemaster Item,,45000007,SPSI,Moderate Sedation <5/Yrs Int,,Every 15 Minutes,305.00
Chargemaster Item,,45000015,SPSI,Moderate Sedation >5/Yrs Initial,,Every 15 Minutes,303.00
Chargemaster Item,,45000039,SPSI,MRI Perc Liver Albation,,Per Svc,19069.00
Chargemaster Item,,45000041,SPSI,MRI Perc Lung Albation,,Per Svc,18686.00
Chargemaster Item,,45000056,SPSI,US Renal Ablation Perc RF,,Per Svc,18302.00
Chargemaster Item,,45000064,SPSI,MRI Ablation Guidance,,Per Svc,3712.00
Chargemaster Item,,45000072,SPSI,Ablation Prob,,Per Svc,11241.00
Chargemaster Item,,45000080,SPSI,MRI Enterography,,Per Svc,12459.00
Chargemaster Item,,45000098,SPSI,MRI Enterography PLVS,,Per Svc,12459.00
Chargemaster Item,,45026093,SPSI,Eovist Per Ml,,Per Svc,120.00
Chargemaster Item,,45190782,SPSI,MRI Lt Breast Bx Complete,,Per Svc,12289.00
Chargemaster Item,,45190857,SPSI,MRI Rt Breast Bx Complete,,Per Svc,12289.00
Chargemaster Item,,45190865,SPSI,MRI Ea Addl Lesion Breast Bx,,Per Svc,8075.00
Chargemaster Item,,45192861,SPSI,MRI Lt Breast Loc Complete,,Per Svc,8208.00
Chargemaster Item,,45192879,SPSI,MRI Rt Breast Loc Complete,,Per Svc,8208.00
Chargemaster Item,,45192887,SPSI,MRI Breast Loc Ea Addl Lesion,,Per Svc,8075.00
Chargemaster Item,,45703360,SPSI,Mri Tmj'S,,Per Svc,4843.00
Chargemaster Item,,45705407,SPSI,Mri Neck,,Per Svc,9601.00
Chargemaster Item,,45705431,SPSI,Mri Orbt-Face-Neck Wo Contrast,,Per Svc,9601.00
Chargemaster Item,,45705472,SPSI,Mra Neck Wo,,Per Svc,8850.00
Chargemaster Item,,45705480,SPSI,Mri Orbt/Face/Neck W Contrast,,Per Svc,10987.00
Chargemaster Item,,45705498,SPSI,Mri Orb/Face/Neck W/Wo,,Per Svc,11013.00
Chargemaster Item,,45705506,SPSI,Mra Head Wo,,Per Svc,8003.00
Chargemaster Item,,45705514,SPSI,Mri Brain Wo Contrast,,Per Svc,10549.00
Chargemaster Item,,45705522,SPSI,Mri Lim Brain,,Per Svc,10549.00
Chargemaster Item,,45705530,SPSI,Mri Brain Wo/W Contrast,,Per Svc,14319.00
Chargemaster Item,,45705555,SPSI,Mra Head W Contrast,,Per Svc,9077.00
Chargemaster Item,,45705563,SPSI,Mra Head Wo/W Contrast,,Per Svc,11728.00
Chargemaster Item,,45705571,SPSI,Mra Neck W Contrast,,Per Svc,4878.00
Chargemaster Item,,45705589,SPSI,Mra Neck Wo/W Contrast,,Per Svc,12934.00
Chargemaster Item,,45705597,SPSI,Mri Brain W Contrast,,Per Svc,13143.00
Chargemaster Item,,45715505,SPSI,Mri Chest,,Per Svc,10194.00
Chargemaster Item,,45715521,SPSI,Mri Chest Wo/W Contrast,,Per Svc,12276.00
Chargemaster Item,,45715554,SPSI,Mra Chest W/ Contrast,,Per Svc,2925.00
Chargemaster Item,,45715562,SPSI,Mra Chest Wo Contrast,,Per Svc,1911.00
Chargemaster Item,,45715570,SPSI,Mra Chest W/Wo Contrast,,Per Svc,2509.00
Chargemaster Item,,45721404,SPSI,Mri Spinal Cord,,Per Svc,10501.00
Chargemaster Item,,45721412,SPSI,Mri Lumbar Wo Contrast,,Per Svc,9897.00
Chargemaster Item,,45721420,SPSI,Mri Cervical Wo Contrast,,Per Svc,10501.00
Chargemaster Item,,45721438,SPSI,Mri Thoracic Wo Contrast,,Per Svc,8853.00
Chargemaster Item,,45721453,SPSI,MRI Lim Cervical,,Per Svc,10501.00
Chargemaster Item,,45721487,SPSI,MRI Lim Lumbar,,Per Svc,9897.00
Chargemaster Item,,45721503,SPSI,Mri Cervical W Contrast,,Per Svc,3235.00
Chargemaster Item,,45721511,SPSI,Mri Thoracic W Contrast,,Per Svc,9833.00
Chargemaster Item,,45721529,SPSI,Mri Lumbar W Contrast,,Per Svc,10653.00
Chargemaster Item,,45721552,SPSI,MRI Lim Thoracic,,Per Svc,10735.00
Chargemaster Item,,45721560,SPSI,Mri Cerv Wo/W Contrast,,Per Svc,11857.00
Chargemaster Item,,45721578,SPSI,Mri Thoracic Wo/W Contrast,,Per Svc,10735.00
Chargemaster Item,,45721586,SPSI,Mri Lumbar Wo/W Contrast,,Per Svc,11707.00
Chargemaster Item,,45721958,SPSI,Mri Pelvis Wo Contrast,,Per Svc,9639.00
Chargemaster Item,,45721966,SPSI,Mri Pelvis With Contrast,,Per Svc,9639.00
Chargemaster Item,,45721974,SPSI,Mri Pelvis Wo/W Contrast,,Per Svc,12459.00
Chargemaster Item,,45721982,SPSI,Mra Pelvis Wo/W Contrast,,Per Svc,2841.00
Chargemaster Item,,45721990,SPSI,Mra Pel W/O Con,,Per Svc,1717.00
Chargemaster Item,,45722006,SPSI,Mra Pelvis W Contrast,,Per Svc,2919.00
Chargemaster Item,,45732187,SPSI,Mri Uext Wo Contrast Right,,Per Svc,7982.00
Chargemaster Item,,45732195,SPSI,Mri Uext Wo Contrast Left,,Per Svc,7982.00
Chargemaster Item,,45732211,SPSI,Mri Left Shoulder Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,45732229,SPSI,Mri Right Shoulder Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,45732237,SPSI,Mri Lt Elbow Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,45732245,SPSI,Mri Rt Elbow Wo Contrast,,Per Svc,6950.00
Chargemaster Item,,45732252,SPSI,Mri Left Wrist Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,45732260,SPSI,Mri Right Wrist Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,45732278,SPSI,Mra Uext W Contrast,,Per Svc,6722.00
Chargemaster Item,,45732286,SPSI,Mra Lt Uext W Contrast,,Per Svc,6722.00
Chargemaster Item,,45732294,SPSI,Mri Rt Shoulder W Contrast,,Per Svc,6192.00
Chargemaster Item,,45732302,SPSI,Mri Lt Knee Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,45732310,SPSI,Mri Rt Knee Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,45732328,SPSI,Mri Lt Ankle Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,45732336,SPSI,Mri Rt Ankle Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,45732344,SPSI,Mri Lt Shoulder W Contrast,,Per Svc,6192.00
Chargemaster Item,,45732351,SPSI,Mri Rt Shoulder Wo/W Contrast,,Per Svc,9306.00
Chargemaster Item,,45732369,SPSI,Mri Lt Shoulder Wo/W Contrast,,Per Svc,9306.00
Chargemaster Item,,45732377,SPSI,Mri Rt Elbow W Contrast,,Per Svc,6192.00
Chargemaster Item,,45732385,SPSI,Mri Lt Elbow W Contrast,,Per Svc,6192.00
Chargemaster Item,,45732393,SPSI,Mri Rt Elbow W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,45732401,SPSI,Mri Upr Ext W/Wo Contrast Right,,Per Svc,9779.00
Chargemaster Item,,45732419,SPSI,Mri Upr Ext W/Wo Contrast Left,,Per Svc,9779.00
Chargemaster Item,,45732427,SPSI,Mra Rt Uext Wo,,Per Svc,6722.00
Chargemaster Item,,45732435,SPSI,Mra Lt Uext Wo,,Per Svc,6722.00
Chargemaster Item,,45732468,SPSI,Mri Lt Elbow W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,45732476,SPSI,Mri Rt Wrist W Contrast,,Per Svc,6192.00
Chargemaster Item,,45732484,SPSI,Mri Lt Wrist W Contrast,,Per Svc,6192.00
Chargemaster Item,,45732492,SPSI,Mri Rt Wrist W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,45732500,SPSI,Mri Lt Wrist W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,45732518,SPSI,Mra Bil Lext W/Contrast,,Per Svc,5203.00
Chargemaster Item,,45732526,SPSI,Mri Lext (Not Joint) Wo Cont Right,,Per Svc,8900.00
Chargemaster Item,,45732534,SPSI,Mri Lext (Not Joint) Wo Cont Left,,Per Svc,8900.00
Chargemaster Item,,45732542,SPSI,Mra Rt Uext Wo/W Contrast,,Per Svc,6707.00
Chargemaster Item,,45732559,SPSI,Mra Lt Uext Wo/W Contrast,,Per Svc,6722.00
Chargemaster Item,,45736006,SPSI,Mra Bil Lext Wo Contrast,,Per Svc,2722.00
Chargemaster Item,,45736014,SPSI,Mra Bil Lext Wo/W Contrast,,Per Svc,6120.00
Chargemaster Item,,45737228,SPSI,Mri Lext W Contrast Right,,Per Svc,6363.00
Chargemaster Item,,45737236,SPSI,Mri Lt Knee W Contrast,,Per Svc,6349.00
Chargemaster Item,,45737244,SPSI,Mri Rt Knee W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,45737269,SPSI,Mri Lext Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,45737277,SPSI,Mri Lt Knee W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,45737285,SPSI,Mri Hip W Contrast,,Per Svc,6363.00
Chargemaster Item,,45737293,SPSI,Mri Lext W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,45737301,SPSI,Mri Lext (Not Joint) Right,,Per Svc,12230.00
Chargemaster Item,,45737319,SPSI,Mri Lext (Not Joint) Left,,Per Svc,12230.00
Chargemaster Item,,45737343,SPSI,Mra Rt Lext W/ Contrast,,Per Svc,5213.00
Chargemaster Item,,45737350,SPSI,Mra Lt Lext W/ Contrast,,Per Svc,5213.00
Chargemaster Item,,45737368,SPSI,Mri Rt Ankle W Contrast,,Per Svc,6349.00
Chargemaster Item,,45737368INACTV,SPSI,Mri Lext W Contrast,,Per Svc,6335.00
Chargemaster Item,,45737376,SPSI,Mri Lt Ankle W Contrast,,Per Svc,6349.00
Chargemaster Item,,45737384,SPSI,Mri Rt Ankle W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,45737392,SPSI,Mri Lt Ankle W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,45737400,SPSI,Mra Rt Lext Wo Contrast,,Per Svc,2722.00
Chargemaster Item,,45737418,SPSI,Mra Lt Lext Wo Contrast,,Per Svc,2722.00
Chargemaster Item,,45737426,SPSI,Mra Rt Lext W/Wo Contrast,,Per Svc,6120.00
Chargemaster Item,,45737434,SPSI,Mra Lt Lext W/Wo Contrast,,Per Svc,6120.00
Chargemaster Item,,45741816,SPSI,Mri Abd Wo Contrast,,Per Svc,10194.00
Chargemaster Item,,45741832,SPSI,Mri Abdomen Wo/W Contrast,,Per Svc,12459.00
Chargemaster Item,,45741857,SPSI,Mra Abd With Contrast,,Per Svc,6039.00
Chargemaster Item,,45741865,SPSI,Mra Abdomen Wo Contrast,,Per Svc,2280.00
Chargemaster Item,,45741873,SPSI,Mra Abdomen W W/O Contrast,,Per Svc,5953.00
Chargemaster Item,,45755527,SPSI,Mri Cardiac Morphology,,Per Svc,12189.00
Chargemaster Item,,45755535,SPSI,Mri Cardiac W/Contrast,,Per Svc,12189.00
Chargemaster Item,,45755543,SPSI,Mri Cardiac Complete,,Per Svc,10947.00
Chargemaster Item,,45755550,SPSI,Mri Cardiac Limited,,Per Svc,5815.00
Chargemaster Item,,45760915,SPSI,Mri Lt Breast Wo/W Contrast,,Per Svc,10044.00
Chargemaster Item,,45760923,SPSI,Mri Rt Breast Wo/W Contrast,,Per Svc,10044.00
Chargemaster Item,,45760949,SPSI,Mri Bilat Breast W/ Contrast,,Per Svc,10224.00
Chargemaster Item,,45760956,SPSI,Mri Rt Breast W/ Contrast,,Per Svc,8947.00
Chargemaster Item,,45760964,SPSI,Mri Lt Breast W/ Contrast,,Per Svc,8947.00
Chargemaster Item,,45760972,SPSI,Mri Bilat Breast Wo/W Contrast,,Per Svc,10911.00
Chargemaster Item,,45770609,SPSI,Mri Breast Wo Contrast Right,,Per Svc,2688.00
Chargemaster Item,,45770617,SPSI,Mri Breast Wo Contrast Left,,Per Svc,2688.00
Chargemaster Item,,45770666,SPSI,Mri Bilat Breast Wo Contrast,,Per Svc,6879.00
Chargemaster Item,,45991700,SPSI,Gadolinium Per Cc,,Per Svc,5.00
Chargemaster Item,,45998952,SPSI,Encor Mri Probe Set,,Per Svc,4678.00
Chargemaster Item,,45998960,SPSI,Encor Mri Gelmark Ultra Bx,,Per Svc,831.00
Chargemaster Item,,45998986,SPSI,Encor Mri Vacuum Package,,Per Svc,214.00
Chargemaster Item,,45998994,SPSI,Multihance Gadobenate Per Ml,,Per Svc,24.00
Chargemaster Item,,45999000,SPSI,Gadavist Per Cc,50419-325-02,Per Svc,14.00
Chargemaster Item,,46100236,SPSI,US Fine Needle Aspiration,,Per Svc,3808.00
Chargemaster Item,,46100244,SPSI,Breast Loc Wire,,Per Svc,1290.00
Chargemaster Item,,46125522,SPSI,RT Breast Localization Complte,,Per Svc,3168.00
Chargemaster Item,,46125530,SPSI,Breast Loc Ea Addl Lesion,,Per Svc,3037.00
Chargemaster Item,,46125548,SPSI,US LT Breast Localization Complt,,Per Svc,2829.00
Chargemaster Item,,46125555,SPSI,US RT Breast Localizatn Complt,,Per Svc,2829.00
Chargemaster Item,,46190005,SPSI,Us Cystasp Breast,,Per Svc,463.00
Chargemaster Item,,46190013,SPSI,Addl Cyst Aspiration,,Per Svc,467.00
Chargemaster Item,,46190302,SPSI,Inj Mamm Ductogram,,Per Svc,266.00
Chargemaster Item,,46190799,SPSI,US RT Breast BX Complete,,Per Svc,6901.00
Chargemaster Item,,46190807,SPSI,Stereotactic Rt Brst Bx Complt,,Per Svc,9715.00
Chargemaster Item,,46190815,SPSI,Stereotactic Lt Brst Bx Complt,,Per Svc,9715.00
Chargemaster Item,,46190823,SPSI,Ea Addl Lesion Breast Bx,,Per Svc,3038.00
Chargemaster Item,,46190831,SPSI,US LT Breast BX Complete,,Per Svc,6901.00
Chargemaster Item,,46190849,SPSI,US Ea Addl Lesion Breast BX,,Per Svc,2695.00
Chargemaster Item,,46215505,SPSI,Bx Soft Tissue Neck/Chest,,Per Svc,783.00
Chargemaster Item,,46215513,SPSI,LT Breast Localization Complte,,Per Svc,3168.00
Chargemaster Item,,46215612,SPSI,Us Breast Loc Ea Addl Lesion,,Per Svc,3039.00
Chargemaster Item,,46221206,SPSI,RFID Loc Marker,,Per Svc,2020.00
Chargemaster Item,,46385050,SPSI,Ndl Biopsy Lymph Node,,Per Svc,1266.00
Chargemaster Item,,46700001,SPSI,Diagnostic Tomo Unilateral,,Per Svc,178.00
Chargemaster Item,,46700019,SPSI,Diagnostic Tomo Bilateral,,Per Svc,178.00
Chargemaster Item,,46760419,SPSI,LT Breast Loc Stereo Guidance,,Per Svc,1029.00
Chargemaster Item,,46760427,SPSI,RT Breast Loc Stereo Guidance,,Per Svc,1029.00
Chargemaster Item,,46760435,SPSI,Breast Loc Ea Addl Lesion Stereo,,Per Svc,1029.00
Chargemaster Item,,46760526,SPSI,Digital Screening Mammography,,Per Svc,633.00
Chargemaster Item,,46760534,SPSI,Digital Bilateral Mammography,,Per Svc,826.00
Chargemaster Item,,46760542,SPSI,Digital Right Mammography,,Per Svc,764.00
Chargemaster Item,,46760559,SPSI,Digital Left Mammography,,Per Svc,764.00
Chargemaster Item,,46761912,SPSI,Digital Eklund Mammography,,Per Svc,827.00
Chargemaster Item,,46761920,SPSI,Digital Rt Eklund Mamm,,Per Svc,764.00
Chargemaster Item,,46761938,SPSI,Digital Lt Eklund Mamm,,Per Svc,764.00
Chargemaster Item,,46766424,SPSI,US Breast Rt Limited,,Per Svc,936.00
Chargemaster Item,,46766432,SPSI,US Breast Lt Limited,,Per Svc,936.00
Chargemaster Item,,46766465,SPSI,US Breast Rt Complete,,Per Svc,1356.00
Chargemaster Item,,46766473,SPSI,US Breast Lt Complete,,Per Svc,1355.00
Chargemaster Item,,46769386,SPSI,Us Cystasp Rt Breast,,Per Svc,2707.00
Chargemaster Item,,46769394,SPSI,Us Cystasp Lt Breast,,Per Svc,2707.00
Chargemaster Item,,46769410,SPSI,Us Guided Lymph Node Bx,,Per Svc,2707.00
Chargemaster Item,,46769444,SPSI,Us Guide Ndl Plcmnt,,Per Svc,2704.00
Chargemaster Item,,46769980,SPSI,Surg Spcmn Film,,Per Svc,978.00
Chargemaster Item,,46769998,SPSI,Digital Surgical Specimen,,Per Svc,978.00
Chargemaster Item,,46770517,SPSI,Low Cost Screen Mam Comb w/ Cad,,Per Svc,75.00
Chargemaster Item,,46770525,SPSI,Digital RT Mamm Comb W/Cad,,Per Svc,938.00
Chargemaster Item,,46770533,SPSI,Mamm Ductogram S&I Right,,Per Svc,2920.00
Chargemaster Item,,46770541,SPSI,Ductogram Multi S+I Right,,Per Svc,4079.00
Chargemaster Item,,46770558,SPSI,Rt Mamm Clip Placement,,Per Svc,764.00
Chargemaster Item,,46770566,SPSI,Bilat Mamm Clip Placement,,Per Svc,827.00
Chargemaster Item,,46770582,SPSI,Lt Mamm Clip Placement,,Per Svc,764.00
Chargemaster Item,,46770590,SPSI,Digital Screen Mam Comb w/ CAD,,Per Svc,809.00
Chargemaster Item,,46770608,SPSI,Digital Bilat Mam Comb/Cad,,Per Svc,1000.00
Chargemaster Item,,46770616,SPSI,Digital Rt Eklund Mam Comb/Cad,,Per Svc,937.00
Chargemaster Item,,46770624,SPSI,Digital Lt Eklund Mam Comb/Cad,,Per Svc,937.00
Chargemaster Item,,46770632,SPSI,Digital Bilat Eklund Mam Cad,,Per Svc,998.00
Chargemaster Item,,46770640,SPSI,Digital LT Mam Comb Mode/CAD,,Per Svc,938.00
Chargemaster Item,,46770657,SPSI,Screening Tomosynthesis,,Per Svc,178.00
Chargemaster Item,,46770707,SPSI,Eklund Screening Combo w/CAD,,Per Svc,809.00
Chargemaster Item,,46770715,SPSI,Lt Eklund Screen Combo w/CAD,,Per Svc,633.00
Chargemaster Item,,46770723,SPSI,Rt Eklund Screen Combo w/CAD,,Per Svc,633.00
Chargemaster Item,,46771531,SPSI,Mamm Ductogram S&I Left,,Per Svc,2920.00
Chargemaster Item,,46771549,SPSI,Ductogram Multi S+I Left,,Per Svc,4079.00
Chargemaster Item,,46990008,SPSI,Breast Bx Supplies,,Per Svc,267.00
Chargemaster Item,,46990032,SPSI,Micromark Clip,,Per Svc,554.00
Chargemaster Item,,46990040,SPSI,Breast Bx Ndl,,Per Svc,467.00
Chargemaster Item,,46990081,SPSI,Celero 12G Vac Core Ndl,,Per Svc,2267.00
Chargemaster Item,,46990099,SPSI,Celeromark Bx Marker,,Per Svc,760.00
Chargemaster Item,,46990107,SPSI,Tissue Marker Coil,,Per Svc,300.00
Chargemaster Item,,46990115,SPSI,Securemark,,Per Svc,285.00
Chargemaster Item,,46990123,SPSI,Hologic Marker,,Per Svc,285.00
Chargemaster Item,,46990131,SPSI,Senomark,,Per Svc,300.00
Chargemaster Item,,46990149,SPSI,12G Encore Probe,,Per Svc,1470.00
Chargemaster Item,,47494059,SPSI,CT Drainage Complete,,Per Svc,4658.00
Chargemaster Item,,48000004,SPSI,Moderate Sedation <5/Yrs Int,,Every 15 Minutes,305.00
Chargemaster Item,,48000012,SPSI,Moderate Sedation >5/Yrs Initial,,Every 15 Minutes,303.00
Chargemaster Item,,48000038,SPSI,IR RT AV Shunt,,Per Svc,6176.00
Chargemaster Item,,48000046,SPSI,IR LT AV Shunt w/PTA,,Per Svc,14259.00
Chargemaster Item,,48000053,SPSI,IR RT AV Shunt w/PTA,,Per Svc,14259.00
Chargemaster Item,,48000061,SPSI,IR LT AV Shunt w/Stent + PTA,,Per Svc,16970.00
Chargemaster Item,,48000079,SPSI,IR RT AV Shunt w/Stent + PTA,,Per Svc,16970.00
Chargemaster Item,,48000087,SPSI,IR LT AV Shunt w/Thromb,,Per Svc,12116.00
Chargemaster Item,,48000095,SPSI,IR RT AV Shunt w/Thromb,,Per Svc,12116.00
Chargemaster Item,,48000103,SPSI,IR LT AV Shunt w/Thromb + PTA,,Per Svc,15937.00
Chargemaster Item,,48000111,SPSI,IR RT AV Shunt w/Thromb + PTA,,Per Svc,15937.00
Chargemaster Item,,48000129,SPSI,IR LT AV Shnt w/Thrmb/PTA/Stnt,,Per Svc,28302.00
Chargemaster Item,,48000137,SPSI,IR RT AV Shnt w/Thrmb/PTA/Stnt,,Per Svc,28302.00
Chargemaster Item,,48000145,SPSI,PTA Central Venous/Dialysis,,Per Svc,9385.00
Chargemaster Item,,48000152,SPSI,PTA Ctrl Venous/Dialysis Stent,,Per Svc,2711.00
Chargemaster Item,,48000160,SPSI,Embo Dialysis Circuit,,Per Svc,4622.00
Chargemaster Item,,48000178,SPSI,PTA Artery Other,,Per Svc,9385.00
Chargemaster Item,,48000186,SPSI,PTA Artery Additional Other,,Per Svc,8464.00
Chargemaster Item,,48000194,SPSI,PTA Venous Non/Dialysis,,Per Svc,9385.00
Chargemaster Item,,48000202,SPSI,PTA Venous Addt Non/Dialysis,,Per Svc,11195.00
Chargemaster Item,,48000210,SPSI,IR Removal Tunnel CVS Sq Device,,Per Svc,6176.00
Chargemaster Item,,48000228,SPSI,IR LT AV Shunt,,Per Svc,6176.00
Chargemaster Item,,48000236,SPSI,IR Verterbo Plasty Cervicothoracic,,Per Svc,14486.00
Chargemaster Item,,48000244,SPSI,IR Verterbo Plasty Lumbarsacral,,Per Svc,14486.00
Chargemaster Item,,48000251,SPSI,IR Verterbo Plasty Ea Additional,,Per Svc,585.00
Chargemaster Item,,48000269,SPSI,IR Kyphoplasty Thoracic,,Per Svc,14486.00
Chargemaster Item,,48000277,SPSI,IR Kyphoplasty Lumbar,,Per Svc,14486.00
Chargemaster Item,,48000285,SPSI,IR Kyphoplasty Ea Additional,,Per Svc,585.00
Chargemaster Item,,48000293,SPSI,IR Internal Mammary S + I,,Per Svc,14053.00
Chargemaster Item,,48000301,SPSI,Neuro Tray,,Per Svc,1532.00
Chargemaster Item,,48000319,SPSI,Pump C,,Per Svc,14500.00
Chargemaster Item,,48000327,SPSI,IR Transcath Infusn Non Thromb,,Per Svc,14478.00
Chargemaster Item,,48000343,SPSI,IR AAA Endovasc Extensn S + I,,Per Svc,13245.00
Chargemaster Item,,48000368,SPSI,IR Iliac Endo Occlusion Device,,Per Svc,4460.00
Chargemaster Item,,48000376,SPSI,IR AAA Endovas Stent 1 Limb,,Per Svc,44124.00
Chargemaster Item,,48000384,SPSI,IR AAA Endovas Stent 2 Limbs,,Per Svc,57811.00
Chargemaster Item,,48000392,SPSI,IR AAA Endovas Unibody,,Per Svc,32120.00
Chargemaster Item,,48000400,SPSI,IR AAA Endovas Aorto -Iliac,,Per Svc,53274.00
Chargemaster Item,,48000418,SPSI,IR AAA Endovas Repr Aor SmTube,,Per Svc,41762.00
Chargemaster Item,,48000426,SPSI,IR Aortic/Iliac Stent Extentn,,Per Svc,22744.00
Chargemaster Item,,48000434,SPSI,IR Aortic/Iliac Stnt Extnd Add,,Per Svc,7052.00
Chargemaster Item,,48000442,SPSI,IR Endovas Iliac Repr W/Graft,,Per Svc,9693.00
Chargemaster Item,,48000459,SPSI,IR Cath/Wire J,,Per Svc,3598.00
Chargemaster Item,,48000467,SPSI,IR Cath/Wire K,,Per Svc,4598.00
Chargemaster Item,,48000475,SPSI,IR Cath/Wire L,,Per Svc,5998.00
Chargemaster Item,,48000483,SPSI,IR Cath/Wire M,,Per Svc,7398.00
Chargemaster Item,,48000491,SPSI,IR Cath/Wire N,,Per Svc,8798.00
Chargemaster Item,,48000509,SPSI,IR Cath/Wire O,,Per Svc,10398.00
Chargemaster Item,,48000517,SPSI,IR Cath/Wire P,,Per Svc,11998.00
Chargemaster Item,,48015796,SPSI,Visipaque 320 Per Ml,,Per Svc,1.00
Chargemaster Item,,48015804,SPSI,Ultravist 300 Per Ml,,Per Svc,1.00
Chargemaster Item,,48015812,SPSI,Ultravist 370 Per Ml,,Per Svc,1.00
Chargemaster Item,,48015937,SPSI,C-Pta Balloons E,,Per Svc,2000.00
Chargemaster Item,,48015945,SPSI,C-PTA Balloons F,,Per Svc,2400.00
Chargemaster Item,,48026033,SPSI,Abscess-Fistula-Sinus Tract,,Per Svc,1442.00
Chargemaster Item,,48026041,SPSI,Inj Fistula/Sinus Tract,,Per Svc,246.00
Chargemaster Item,,48026058,SPSI,Inj Drainage Catheter,,Per Svc,2384.00
Chargemaster Item,,48026066,SPSI,Xchange Drainage Catheter,,Per Svc,14143.00
Chargemaster Item,,48100002,SPSI,Procedure Min,,Per Svc,1177.00
Chargemaster Item,,48110001,SPSI,Angio Surgical Code,,Per Svc,783.00
Chargemaster Item,,48225205,SPSI,Perc Thor Vertebro,,Per Svc,5962.00
Chargemaster Item,,48225213,SPSI,Perc Lumb Vertebro,,Per Svc,5962.00
Chargemaster Item,,48225221,SPSI,Perc Vert Addl,,Per Svc,585.00
Chargemaster Item,,48225239,SPSI,Perc T-Spine Augmentation,,Per Svc,14486.00
Chargemaster Item,,48225247,SPSI,Perc L-Spine Augmentation,,Per Svc,14486.00
Chargemaster Item,,48225254,SPSI,Perc Addl Spine Augmentation,,Per Svc,585.00
Chargemaster Item,,48256119,SPSI,Tube Feed Kangaroo 10Fr x 43In,,Per Svc,456.00
Chargemaster Item,,48256127,SPSI,Tube Feed Kangaroo 12Fr x 43In,,Per Svc,456.00
Chargemaster Item,,48280010,SPSI,Insert Tunld Pleural Cath Cuff,,Per Svc,5803.00
Chargemaster Item,,48280028,SPSI,Removal Tunld Pleural Cath Cuff,,Per Svc,1728.00
Chargemaster Item,,48280036,SPSI,Non-Vascular Kit C,,Per Svc,1885.00
Chargemaster Item,,48280044,SPSI,Non-Vascular Kit D,,Per Svc,4312.00
Chargemaster Item,,48300040,SPSI,Stent Coated/CovW/DelSys A2600,,Per Svc,10400.00
Chargemaster Item,,48300057,SPSI,Stent Coated/CovW/DelSys B3500,,Per Svc,14000.00
Chargemaster Item,,48300065,SPSI,Stent NonCoated/NonCovW/DelSys,,Per Svc,14000.00
Chargemaster Item,,48319115,SPSI,Pta Lt Iliac Artery Complete,,Per Svc,10857.00
Chargemaster Item,,48319164,SPSI,Pta Lt Fem-Pop Artery Complete,,Per Svc,11195.00
Chargemaster Item,,48319180,SPSI,Pta Lt Tibial-Pero Artery Comp,,Per Svc,11373.00
Chargemaster Item,,48319214,SPSI,Lt Iliac Stent Plcmnt Comp,,Per Svc,9693.00
Chargemaster Item,,48319248,SPSI,Lt Fem-Pop Stent Plcmnt Comp,,Per Svc,11251.00
Chargemaster Item,,48319263,SPSI,Lt Tibial-Pero Stent Comp,,Per Svc,11251.00
Chargemaster Item,,48320014,SPSI,Drug Coated Balloon A,,Per Svc,6000.00
Chargemaster Item,,48320022,SPSI,Drug Coated Balloon B,,Per Svc,8000.00
Chargemaster Item,,48320030,SPSI,Drug Coated Balloon C,,Per Svc,10000.00
Chargemaster Item,,48320055,SPSI,Chemical Pleurodesis,,Per Svc,409.00
Chargemaster Item,,48320196,SPSI,Insert Tunld Pleural Cath,,Per Svc,589.00
Chargemaster Item,,48320204,SPSI,Thoracostomy Catheter Plcmnt,,Per Svc,573.00
Chargemaster Item,,48354708,SPSI,Pta Tibioper Art,,Per Svc,1761.00
Chargemaster Item,,48354716,SPSI,Pta Visceral/Renal Art,,Per Svc,2040.00
Chargemaster Item,,48354724,SPSI,Pta Aorta,,Per Svc,1481.00
Chargemaster Item,,48354732,SPSI,Pta Iliac Art,,Per Svc,1463.00
Chargemaster Item,,48354740,SPSI,Pta Fem/Pop Art,,Per Svc,1785.00
Chargemaster Item,,48354757,SPSI,Pta Brac/Ceph Art,,Per Svc,1981.00
Chargemaster Item,,48354765,SPSI,Pta Venous,,Per Svc,1447.00
Chargemaster Item,,48360028,SPSI,Intro Needle/Cath Vein,,Per Svc,180.00
Chargemaster Item,,48360069,SPSI,Inj Venogram,,Per Svc,502.00
Chargemaster Item,,48360119,SPSI,Cath Intro Sup/Inf Vena Cava,,Per Svc,359.00
Chargemaster Item,,48360127,SPSI,Sel Cath Plcmt Ven 2Nd Order,,Per Svc,818.00
Chargemaster Item,,48360135,SPSI,Cath Intro Rt/Main Pulm,,Per Svc,480.00
Chargemaster Item,,48360143,SPSI,Sel Cath Plcmt R Or L Pulm,,Per Svc,721.00
Chargemaster Item,,48360150,SPSI,Sel Cath Plcmt Seg Pulm,,Per Svc,721.00
Chargemaster Item,,48360176,SPSI,Sel Cath Plcmt Ven 1St Order,,Per Svc,542.00
Chargemaster Item,,48361000,SPSI,Cath Intro Carotid/Vertebral,,Per Svc,637.00
Chargemaster Item,,48361208,SPSI,Cath Intro Retro Brachial Art,,Per Svc,637.00
Chargemaster Item,,48361406,SPSI,Intr Cath/Needle Extremity Art,,Per Svc,482.00
Chargemaster Item,,48361455,SPSI,Intro Needle/Cath Av Shunt,,Per Svc,130.00
Chargemaster Item,,48361463,SPSI,Recovery Room,,First 60 Minutes,1305.00
Chargemaster Item,,48361471,SPSI,Init.Intro Ndl/Cath Av Shunt,,Per Svc,114.00
Chargemaster Item,,48361489,SPSI,Addl Intro Ndl/Cath Av Shunt,,Per Svc,119.00
Chargemaster Item,,48361604,SPSI,Cath Intro Translum Aortic,,Per Svc,480.00
Chargemaster Item,,48362008,SPSI,Cath Intro Aorta,,Per Svc,727.00
Chargemaster Item,,48362164,SPSI,Sel Cath Plcmt Thor In 2Nd Ord,,Per Svc,1364.00
Chargemaster Item,,48362172,SPSI,Sel Cath Plcmt Thor In 3Rd Ord,,Per Svc,1625.00
Chargemaster Item,,48362180,SPSI,Sel Cath Plcmt Thor Addl,,Per Svc,272.00
Chargemaster Item,,48362206,SPSI,Cath Plcmnt Cervicerbrl Arch,,Per Svc,6641.00
Chargemaster Item,,48362214,SPSI,Sel Cath Plcmt Thor 1St Ord,,Per Svc,1118.00
Chargemaster Item,,48362222,SPSI,Cath Plcmnt Arch Ext Carotid,,Per Svc,8444.00
Chargemaster Item,,48362230,SPSI,Cath Plcmnt Arch Int-Ext Caro,,Per Svc,8444.00
Chargemaster Item,,48362248,SPSI,Cath Plcmnt Internal Carotid,,Per Svc,8444.00
Chargemaster Item,,48362255,SPSI,Cath Plcmnt Subclav/Innominate,,Per Svc,8444.00
Chargemaster Item,,48362263,SPSI,Cath Plcmnt Vertebral,,Per Svc,9514.00
Chargemaster Item,,48362271,SPSI,Cath Plcmnt External Carotid,,Per Svc,7185.00
Chargemaster Item,,48362289,SPSI,Cath Plcmnt Ea Addl Ica/Vert,,Per Svc,6641.00
Chargemaster Item,,48362461,SPSI,Sel Cath Plcmt Abd/Le 2Nd Ord,,Per Svc,1364.00
Chargemaster Item,,48362479,SPSI,Sel Cath Plcmt Abd/Le 3Rd Ord,,Per Svc,1663.00
Chargemaster Item,,48362487,SPSI,Sel Cath Plcmt Abd/Le Addl,,Per Svc,272.00
Chargemaster Item,,48362503,SPSI,Cath Abdle 1St,,Per Svc,1269.00
Chargemaster Item,,48362511,SPSI,RT Renal Angio Complete,,Per Svc,9690.00
Chargemaster Item,,48362529,SPSI,Bilat Renal Angio Complete,,Per Svc,8913.00
Chargemaster Item,,48362552,SPSI,LT Renal Angio Complete,,Per Svc,9690.00
Chargemaster Item,,48364814,SPSI,Perc Portal Vein Cath,,Per Svc,1516.00
Chargemaster Item,,48364897,SPSI,Nontunneled Cv Access,,Per Svc,5936.00
Chargemaster Item,,48364939,SPSI,Reposition Cv Cath,,Per Svc,288.00
Chargemaster Item,,48365001,SPSI,Cath Venous Sampling,,Per Svc,560.00
Chargemaster Item,,48365332,SPSI,Insertion Tunneled Cv Access,,Per Svc,1320.00
Chargemaster Item,,48365340,SPSI,Reposition Venous Cath,,Per Svc,1120.00
Chargemaster Item,,48365357,SPSI,Removal Venous Port,,Per Svc,1021.00
Chargemaster Item,,48365506,SPSI,Declot By Thrombo Agent,,Per Svc,64.00
Chargemaster Item,,48365613,SPSI,Tunneled Cva W/Subcut Port,,Per Svc,1117.00
Chargemaster Item,,48365688,SPSI,Picc Insertion Under 5 Yrs,,Per Svc,1117.00
Chargemaster Item,,48365696,SPSI,Picc Insertion,,Per Svc,5817.00
Chargemaster Item,,48365720,SPSI,Peripheral Cv Access,,Per Svc,22006.00
Chargemaster Item,,48365753,SPSI,Repair Cv Access,,Per Svc,1120.00
Chargemaster Item,,48365803,SPSI,Rplcmnt Cv Access Nontunneled,,Per Svc,1028.00
Chargemaster Item,,48365811,SPSI,Rplcmnt Cv Access,,Per Svc,1028.00
Chargemaster Item,,48365845,SPSI,Replacement Picc,,Per Svc,1028.00
Chargemaster Item,,48365951,SPSI,Removal Fibrin Sheath Obstruct,,Per Svc,637.00
Chargemaster Item,,48365969,SPSI,Removal Intracath Obstruction,,Per Svc,637.00
Chargemaster Item,,48365985,SPSI,Cv Cath Inj/Eval W/Fluoro,,Per Svc,175.00
Chargemaster Item,,48366207,SPSI,Arterial Sampling Cath/Cann,,Per Svc,161.00
Chargemaster Item,,48368609,SPSI,Declotting Wo Balloon,,Per Svc,161.00
Chargemaster Item,,48368617,SPSI,Declotting W Balloon,,Per Svc,318.00
Chargemaster Item,,48368708,SPSI,Perc Thromb Dialysis,,Per Svc,374.00
Chargemaster Item,,48371405,SPSI,Venous Anastomosis Porto-Caval,,Per Svc,4949.00
Chargemaster Item,,48371827,SPSI,Tips Insertion,,Per Svc,1965.00
Chargemaster Item,,48371835,SPSI,Tips Revision,,Per Svc,999.00
Chargemaster Item,,48371843,SPSI,Arterial Mech Thrombectomy IR,,Per Svc,9929.00
Chargemaster Item,,48371850,SPSI,Arterial Addl Mech Thrombec IR,,Per Svc,4522.00
Chargemaster Item,,48371868,SPSI,2Ndary Arterial Mech Thrombec IR,,Per Svc,4582.00
Chargemaster Item,,48371876,SPSI,Venous Mech Thrombectomy,,Per Svc,10143.00
Chargemaster Item,,48371884,SPSI,Venous Repeat Mech Thrombec,,Per Svc,11110.00
Chargemaster Item,,48371918,SPSI,IVC Filter Placement Complete,,Per Svc,6573.00
Chargemaster Item,,48371926,SPSI,Reposition IVC Filter,,Per Svc,7696.00
Chargemaster Item,,48371934,SPSI,Retrieval IVC Filter,,Per Svc,7330.00
Chargemaster Item,,48371959,SPSI,Transcath Cerebral Thromb,,Per Svc,1130.00
Chargemaster Item,,48372015,SPSI,Transcath Therapy Arterial Compl IR,,Per Svc,9929.00
Chargemaster Item,,48372031,SPSI,Transcath Retrieval FB Complete,,Per Svc,1417.00
Chargemaster Item,,48372049,SPSI,Perc Transcath Occl/Emboliz,,Per Svc,4622.00
Chargemaster Item,,48372056,SPSI,Stent Placement Other,,Per Svc,2628.00
Chargemaster Item,,48372064,SPSI,Stent Addl Other,,Per Svc,1331.00
Chargemaster Item,,48372072,SPSI,Open Plcmt Intrav Stent,,Per Svc,2711.00
Chargemaster Item,,48372080,SPSI,Vew Open Stent Addl,,Per Svc,1424.00
Chargemaster Item,,48372106,SPSI,Ufe S+I W/Imaging Guidance,,Per Svc,37231.00
Chargemaster Item,,48372122,SPSI,Transcath Ther Venous Compl,,Per Svc,8534.00
Chargemaster Item,,48372148,SPSI,Cessation Thrombolysis Comp,,Per Svc,8534.00
Chargemaster Item,,48372155,SPSI,IR CA Stent w/Embolic Protect complete,,Per Svc,2765.00
Chargemaster Item,,48372163,SPSI,IR CA Stent wo/Embolic Protect complete,,Per Svc,2671.00
Chargemaster Item,,48372171,SPSI,IR Transcath PLC Retrograde,,Per Svc,22058.00
Chargemaster Item,,48372189,SPSI,IR Transcath PLC Antegrade,,Per Svc,22058.00
Chargemaster Item,,48372205,SPSI,Pta Rt Iliac Artery Complete,,Per Svc,10857.00
Chargemaster Item,,48372213,SPSI,Rt Iliac Stent Plcment Comp,,Per Svc,9693.00
Chargemaster Item,,48372221,SPSI,Pta Addl Iliac Vessel,,Per Svc,9590.00
Chargemaster Item,,48372239,SPSI,Stent Addl Iliac Vessel,,Per Svc,8274.00
Chargemaster Item,,48372247,SPSI,Pta Rt Fem-Pop Artery Complete,,Per Svc,11195.00
Chargemaster Item,,48372262,SPSI,Rt Fem-Pop Stent Plcmnt Comp,,Per Svc,11251.00
Chargemaster Item,,48372288,SPSI,Pta Rt Tibial-Pero Artery Comp,,Per Svc,11373.00
Chargemaster Item,,48372304,SPSI,Rt Tibial-Pero Stent Comp,,Per Svc,11251.00
Chargemaster Item,,48372320,SPSI,Pta Addl Tibial-Peroneal,,Per Svc,9590.00
Chargemaster Item,,48372346,SPSI,Stent Addl Tibial-Pero Vessel,,Per Svc,8532.00
Chargemaster Item,,48372361,SPSI,IR Artery Stent Other,,Per Svc,2711.00
Chargemaster Item,,48372379,SPSI,Stent Addl Each Artery,,Per Svc,1424.00
Chargemaster Item,,48372387,SPSI,IR Vein Stent Other,,Per Svc,2711.00
Chargemaster Item,,48372395,SPSI,Stent Addl Each Vein,,Per Svc,1424.00
Chargemaster Item,,48372411,SPSI,IR Vein Embo,,Per Svc,4622.00
Chargemaster Item,,48372429,SPSI,IR Artery Embo,,Per Svc,4622.00
Chargemaster Item,,48372437,SPSI,IR UF Embo Tumor\Organ,,Per Svc,23739.00
Chargemaster Item,,48372445,SPSI,IR Artery\Vein Embo Hemorrhage,,Per Svc,4622.00
Chargemaster Item,,48376206,SPSI,Perc Ivc Filter Plcmt,,Per Svc,2679.00
Chargemaster Item,,48437503,SPSI,Perc Plcmnt Gastrostomy Cath,,Per Svc,637.00
Chargemaster Item,,48437602,SPSI,Xchange Gastro-Cath Wo Imaging,,Per Svc,2986.00
Chargemaster Item,,48437610,SPSI,Reposition Gastro-Cath,,Per Svc,291.00
Chargemaster Item,,48445001,SPSI,Plcmnt Long G Catheter,,Per Svc,2073.00
Chargemaster Item,,48475313,SPSI,INJ EXISTING CHOLI TUBE COMPLETE,,Per Svc,5567.00
Chargemaster Item,,48475321,SPSI,NEW PERC TRANS CHOLI COMPLETE,,Per Svc,17094.00
Chargemaster Item,,48475339,SPSI,PERC BILARY EXT DRAIN CATH COMPLETE,,Per Svc,17675.00
Chargemaster Item,,48475347,SPSI,PERC BILI INT/EXT DRAIN CATH COMPLETE,,Per Svc,16942.00
Chargemaster Item,,48475354,SPSI,CONVER EXT BILI DRAIN CATH COMPLETE,,Per Svc,13014.00
Chargemaster Item,,48475362,SPSI,EXCHANGE BILI CATH COMPLETE,,Per Svc,13014.00
Chargemaster Item,,48475371,SPSI,REMOVE BILI DRAINAGE COMPLETE,,Per Svc,1579.00
Chargemaster Item,,48475388,SPSI,BILI STENT PLACE EXIS TUBE COMPLETE,,Per Svc,10397.00
Chargemaster Item,,48475396,SPSI,BILI STENT PLACE W/O TUBE COMPLETE,,Per Svc,21295.00
Chargemaster Item,,48475404,SPSI,BILI STENT PLACE W/ NEW TUBE COMPL,,Per Svc,24909.00
Chargemaster Item,,48475412,SPSI,PLACE BILI CATH FOR GI SCOPE,,Per Svc,16942.00
Chargemaster Item,,48475421,SPSI,PTA BILIARY EA DUCT,,Per Svc,5735.00
Chargemaster Item,,48475446,SPSI,BILIARY DUCT STONE REMOVAL,,Per Svc,4117.00
Chargemaster Item,,48475552,SPSI,Perc Bili Dilat Wo Stent,,Per Svc,1433.00
Chargemaster Item,,48475560,SPSI,Per Bili Dilat W Stent,,Per Svc,1602.00
Chargemaster Item,,48491856,SPSI,SCLEROTHERAPY,,Per Svc,4368.00
Chargemaster Item,,48494009,SPSI,Inj Peritoneal Cavity,,Per Svc,193.00
Chargemaster Item,,48494181,SPSI,IR Peritoneal Tunnel Cath,,Per Svc,13698.00
Chargemaster Item,,48494413,SPSI,Place Duod/Jej Cath W/Fluoro,,Per Svc,7762.00
Chargemaster Item,,48494421,SPSI,Place Colonic Cath W/Fluoro,,Per Svc,9964.00
Chargemaster Item,,48494462,SPSI,Conversion Tube to GJ Complt,,Per Svc,2767.00
Chargemaster Item,,48494504,SPSI,Replace G Catheter W/Fluoro,,Per Svc,2702.00
Chargemaster Item,,48494512,SPSI,Replace Duod/Jej Cath W/Fluoro,,Per Svc,2702.00
Chargemaster Item,,48494520,SPSI,Replace G/Jej Cathtr W/Fluoro,,Per Svc,2702.00
Chargemaster Item,,48494603,SPSI,Mechanical Removal W/Fluoro,,Per Svc,2767.00
Chargemaster Item,,48494652,SPSI,Fluoro Exam Gast/Colon Cath,,Per Svc,1265.00
Chargemaster Item,,48503825,SPSI,Perc Remove & Replace Ureteral,,Per Svc,5667.00
Chargemaster Item,,48503841,SPSI,Perc Removal Ureteral,,Per Svc,5667.00
Chargemaster Item,,48503874,SPSI,Ext/Int Ureteral Exchange,,Per Svc,2107.00
Chargemaster Item,,48503890,SPSI,Remove Nephrostomy Catheter,,Per Svc,727.00
Chargemaster Item,,48503908,SPSI,Inj/Asp Renal Cyst,,Per Svc,442.00
Chargemaster Item,,48503957,SPSI,Intro Guide W/Dilat Ure,,Per Svc,729.00
Chargemaster Item,,48504302,SPSI,RT NEPHROGRAM NEW ACCESS COMP,,Per Svc,6594.00
Chargemaster Item,,48504303,SPSI,LT NEPHROGRAM NEW ACCESS COMP,,Per Svc,6594.00
Chargemaster Item,,48504311,SPSI,RT Nephrogram Exist Access Comp,,Per Svc,5244.00
Chargemaster Item,,48504312,SPSI,LT Nephromgram Exist Access Comp,,Per Svc,5244.00
Chargemaster Item,,48504328,SPSI,RT PERC NEPHROSTOMY PLMT COMPLETE,,Per Svc,8794.00
Chargemaster Item,,48504329,SPSI,LT PERC NEPHROSTOMY PLMT COMPLETE,,Per Svc,8794.00
Chargemaster Item,,48504336,SPSI,RT NEPHURET CATH NEW PLMT COMP,,Per Svc,12921.00
Chargemaster Item,,48504337,SPSI,LT NEPHURET CATH NEW PLMT COMP,,Per Svc,12921.00
Chargemaster Item,,48504344,SPSI,RT NEPH CATH CONVRT NEPHURET COMP,,Per Svc,5239.00
Chargemaster Item,,48504345,SPSI,LT NEPH CATH CONVRT NEPHURET COMP,,Per Svc,5239.00
Chargemaster Item,,48504351,SPSI,RT NEPHRO CATH EXCHANGE COMPLETE,,Per Svc,6056.00
Chargemaster Item,,48504352,SPSI,LT NEPHRO CATH EXCHANGE COMPLETE,,Per Svc,6056.00
Chargemaster Item,,48506885,SPSI,Ileal Conduit Catheter Xchange,,Per Svc,2107.00
Chargemaster Item,,48506935,SPSI,RT URETERAL STENT EXIST CATH COMP,,Per Svc,6343.00
Chargemaster Item,,48506936,SPSI,LT URETERAL STENT EXIST CATH COMP,,Per Svc,6343.00
Chargemaster Item,,48506943,SPSI,RT URETERAL STENT NEW WO/CATH COMP,,Per Svc,9290.00
Chargemaster Item,,48506944,SPSI,LT URETERAL STENT NEW WO/CATH COMP,,Per Svc,9290.00
Chargemaster Item,,48506951,SPSI,RT URETERAL STENT NEW W/CATH COMP,,Per Svc,11119.00
Chargemaster Item,,48506952,SPSI,LT URETERAL STENT NEW W/CATH COMP,,Per Svc,11119.00
Chargemaster Item,,48507065,SPSI,RT PTA URETERAL,,Per Svc,4868.00
Chargemaster Item,,48507066,SPSI,LT PTA URETERAL,,Per Svc,4868.00
Chargemaster Item,,48511026,SPSI,Insert Of Suprapubic Catheter,,Per Svc,5667.00
Chargemaster Item,,48523351,SPSI,Scope Ureter Dilation,,Per Svc,385.00
Chargemaster Item,,48583454,SPSI,Intro Fallopian Tube Cath,,Per Svc,1075.00
Chargemaster Item,,48616239,SPSI,IR Balloon Test Occlusion,,Per Svc,12844.00
Chargemaster Item,,48616247,SPSI,IR CNS Embolization,,Per Svc,14068.00
Chargemaster Item,,48616262,SPSI,IR Head and Neck Embolization,,Per Svc,14068.00
Chargemaster Item,,48616304,SPSI,IR Balloon Angioplasty Athero,,Per Svc,14068.00
Chargemaster Item,,48616353,SPSI,IR Intracranial Stent,,Per Svc,19930.00
Chargemaster Item,,48616403,SPSI,IR Balloon Dilation Vasospasm,,Per Svc,12844.00
Chargemaster Item,,48616411,SPSI,Each add Dilation Same Family,,Per Svc,3470.00
Chargemaster Item,,48616429,SPSI,Each add Dilation Diff Family,,Per Svc,3470.00
Chargemaster Item,,48616452,SPSI,ART MECH THROMBEC/INF INTERCRAN,,Per Svc,19133.00
Chargemaster Item,,48616502,SPSI,INFUS NON THROMBO NEURO COMP,,Per Svc,14478.00
Chargemaster Item,,48616511,SPSI,EA ADD INFUS NON THROMBO NEURO,,Per Svc,6120.00
Chargemaster Item,,48622906,SPSI,Inj Lumbar Each Level,,Per Svc,478.00
Chargemaster Item,,48622914,SPSI,Inj Cerv/Thor Each Level,,Per Svc,478.00
Chargemaster Item,,48722854,SPSI,Cerv/Thor Diskography S&I,,Per Svc,10504.00
Chargemaster Item,,48722953,SPSI,Lumbar Diskography S&I,,Per Svc,10388.00
Chargemaster Item,,48741904,SPSI,Peritoneogram S&I,,Per Svc,3847.00
Chargemaster Item,,48743058,SPSI,Postop Cholangio Complete,,Per Svc,1076.00
Chargemaster Item,,48743405,SPSI,Intro Long Gi W/Flouro,,Per Svc,3827.00
Chargemaster Item,,48743504,SPSI,Perc Plcmt G Catheter Complete,,Per Svc,3375.00
Chargemaster Item,,48743629,SPSI,Perc Bili Dilat W Stent S+I,,Per Svc,4789.00
Chargemaster Item,,48743637,SPSI,Perc Bili Dilat Wo Stent S+I,,Per Svc,4789.00
Chargemaster Item,,48744254,SPSI,Rt Ante Lpgrm/Nphgrm S-I,,Per Svc,2016.00
Chargemaster Item,,48744262,SPSI,Lt Ante Lpgrm/Nphgrm S-I,,Per Svc,2016.00
Chargemaster Item,,48744262INACTV,SPSI,Ante Lpgrm/Nphgrm S&I,,Per Svc,1976.00
Chargemaster Item,,48744718,SPSI,Renal Cyst S&I Right,,Per Svc,1536.00
Chargemaster Item,,48744726,SPSI,Renal Cyst S&I Left,,Per Svc,1536.00
Chargemaster Item,,48744858,SPSI,Rt Ureter Dilat S+I,,Per Svc,4552.00
Chargemaster Item,,48744874,SPSI,Lt Ureter Dilat S+I,,Per Svc,4552.00
Chargemaster Item,,48744882,SPSI,Rt Nephros Dilat S+I,,Per Svc,4552.00
Chargemaster Item,,48744890,SPSI,Lt Nephros Dilat S+I,,Per Svc,4552.00
Chargemaster Item,,48747422,SPSI,Fallopian Tube Transcath Si,,Per Svc,4123.00
Chargemaster Item,,48747430,SPSI,Fallopian Tube Transcath Si Right,,Per Svc,4123.00
Chargemaster Item,,48747448,SPSI,Fallopian Tube Transcath Si Left,,Per Svc,4123.00
Chargemaster Item,,48756050,SPSI,Thoracic Aortogram S&I,,Per Svc,10531.00
Chargemaster Item,,48756258,SPSI,Abd Aortogram S&I,,Per Svc,7450.00
Chargemaster Item,,48756308,SPSI,Abd Aortogram W/Runoffs S&I,,Per Svc,8143.00
Chargemaster Item,,48756654,SPSI,Cer/Carotid Angio S&I Right,,Per Svc,8575.00
Chargemaster Item,,48756803,SPSI,Carotid/Cerv Bil Ang S&I,,Per Svc,11574.00
Chargemaster Item,,48756852,SPSI,Vert/Cerv/Intr Ang S&I Right,,Per Svc,8877.00
Chargemaster Item,,48757058,SPSI,IR Spinal Select,,Per Svc,5692.00
Chargemaster Item,,48757108,SPSI,Ext Angio S&I Right,,Per Svc,5985.00
Chargemaster Item,,48757116,SPSI,Ext Angio S&I Left,,Per Svc,5985.00
Chargemaster Item,,48757165,SPSI,Ext Angio S&I Bilateral,,Per Svc,5849.00
Chargemaster Item,,48757264,SPSI,Visceral Angio Sel/Supr/Se S&I,,Per Svc,5692.00
Chargemaster Item,,48757363,SPSI,Pelvic Angio S+I Selective,,Per Svc,6458.00
Chargemaster Item,,48757363INACTV,SPSI,Pelvic Angio S&I,,Per Svc,6038.00
Chargemaster Item,,48757371,SPSI,Pelvic Angio S&I Right,,Per Svc,6458.00
Chargemaster Item,,48757389,SPSI,Pelvic Angio S&I Left,,Per Svc,6458.00
Chargemaster Item,,48757413,SPSI,Pulm Angio S&I Right,,Per Svc,5263.00
Chargemaster Item,,48757421,SPSI,Pulm Angio S&I Left,,Per Svc,5263.00
Chargemaster Item,,48757439,SPSI,Pulmonary Angio Sel Bil S&I,,Per Svc,6532.00
Chargemaster Item,,48757462,SPSI,Pulm Angio Non-Sel S&I,,Per Svc,2785.00
Chargemaster Item,,48757744,SPSI,Angio Add S&I,,Per Svc,5148.00
Chargemaster Item,,48757918,SPSI,Rt Av Shunt Angio S+I,,Per Svc,6057.00
Chargemaster Item,,48757926,SPSI,Lt Av Shunt Angio S+I,,Per Svc,6057.00
Chargemaster Item,,48757934,SPSI,Alternate Access Av Shunt Right,,Per Svc,6057.00
Chargemaster Item,,48758213,SPSI,Ext Venogram S&I Right,,Per Svc,2925.00
Chargemaster Item,,48758221,SPSI,Ext Venogram S&I Bilateral,,Per Svc,4102.00
Chargemaster Item,,48758239,SPSI,Ext Venogram S&I Left,,Per Svc,2925.00
Chargemaster Item,,48758320,SPSI,Renal Venogram S&I Right,,Per Svc,4794.00
Chargemaster Item,,48758338,SPSI,Renal Venogram S&I Bilateral,,Per Svc,4794.00
Chargemaster Item,,48758346,SPSI,Renal Venogram S&I Left,,Per Svc,4794.00
Chargemaster Item,,48758619,SPSI,Jug/Sinus Veno S&I Right,,Per Svc,4794.00
Chargemaster Item,,48758627,SPSI,Jug/Sinus Veno S&I Left,,Per Svc,4794.00
Chargemaster Item,,48758726,SPSI,Epidural Venogram,,Per Svc,4827.00
Chargemaster Item,,48758858,SPSI,Perchepporto W Hemo Eva S&I,,Per Svc,6374.00
Chargemaster Item,,48758890,SPSI,Hepatic Veno Hemodyn Ev S&I,,Per Svc,6374.00
Chargemaster Item,,48758932,SPSI,Venous Sampling S&I,,Per Svc,4810.00
Chargemaster Item,,48758940,SPSI,Us Guide Emboliz S&I,,Per Svc,6525.00
Chargemaster Item,,48758981,SPSI,Angio F/U S&I,,Per Svc,1241.00
Chargemaster Item,,48759005,SPSI,S&I Xchng Art Cath,,Per Svc,6360.00
Chargemaster Item,,48759013,SPSI,Removal Fibrinsheath Obstr S&I,,Per Svc,6384.00
Chargemaster Item,,48759021,SPSI,Removal Ic Obstruction S&I,,Per Svc,6384.00
Chargemaster Item,,48759054,SPSI,Superior Venacavagram S&I,,Per Svc,5715.00
Chargemaster Item,,48759450,SPSI,Inferior Venacavagram S&I,,Per Svc,5715.00
Chargemaster Item,,48759617,SPSI,Perc Transcath Retrieval S&I,,Per Svc,4010.00
Chargemaster Item,,48759625,SPSI,Pta Rt Tib/Perph Ari S+I,,Per Svc,7303.00
Chargemaster Item,,48759633,SPSI,Pta Lt Tib/Perph Art S+I,,Per Svc,7303.00
Chargemaster Item,,48759641,SPSI,Pta Rt Fem/Pop Art S_I,,Per Svc,7303.00
Chargemaster Item,,48759658,SPSI,Pta Lt Fem/Pop Art S+I,,Per Svc,7303.00
Chargemaster Item,,48759666,SPSI,Pta Renal/Visc S&I,,Per Svc,8039.00
Chargemaster Item,,48759682,SPSI,Pta Addl Visceral Ves S&I,,Per Svc,6551.00
Chargemaster Item,,48759690,SPSI,Pta Rt Brac/Ceph Art S+I,,Per Svc,7303.00
Chargemaster Item,,48759708,SPSI,Pta Lt Brac/Ceph Art S+I,,Per Svc,7303.00
Chargemaster Item,,48759732,SPSI,Pta Other Addl Peripheral S&I,,Per Svc,8472.00
Chargemaster Item,,48759740,SPSI,Pta Rt Iliac Art S+I,,Per Svc,7303.00
Chargemaster Item,,48759757,SPSI,Pta Lt Iliac Art S+I,,Per Svc,7303.00
Chargemaster Item,,48759765,SPSI,Pta Renal/Visc S&I Right,,Per Svc,8764.00
Chargemaster Item,,48759773,SPSI,Pta Renal/Visc S&I Left,,Per Svc,8764.00
Chargemaster Item,,48759799,SPSI,Pta Venous S&I Right,,Per Svc,7938.00
Chargemaster Item,,48759849,SPSI,Chng Perc/Cath S&I,,Per Svc,2270.00
Chargemaster Item,,48759898,SPSI,Ct Drain/Speci Coll S&I,,Per Svc,2257.00
Chargemaster Item,,48759989,SPSI,Cva Fluoro Guidance,,Per Svc,2208.00
Chargemaster Item,,48760003,SPSI,Fluoroscopy Up To 1Hr,,Per Svc,3928.00
Chargemaster Item,,48760037,SPSI,Fluoro Guide Ndl Plcmt,,Per Svc,1939.00
Chargemaster Item,,48769376,SPSI,CVA US Guidance,,Per Svc,2297.00
Chargemaster Item,,48769434,SPSI,Us Needle Placement S&I,,Per Svc,2545.00
Chargemaster Item,,48770612,SPSI,Bilat Mamm Clip Placement,,Per Svc,827.00
Chargemaster Item,,48965230,SPSI,Irrigation For Drug Delivery,,Per Svc,589.00
Chargemaster Item,,48990881,SPSI,Angio Pack A,,Per Svc,543.00
Chargemaster Item,,48990899,SPSI,Cath/Wire A,,Per Svc,66.00
Chargemaster Item,,48990899INACTV,SPSI,Cath/Wire A,,Per Svc,66.00
Chargemaster Item,,48990907,SPSI,Cath/Wire B,,Per Svc,139.00
Chargemaster Item,,48990907INACTV,SPSI,Cath/Wire B,,Per Svc,139.00
Chargemaster Item,,48990915,SPSI,Cath/Wire C,,Per Svc,276.00
Chargemaster Item,,48990915INACTV,SPSI,Cath/Wire C,,Per Svc,276.00
Chargemaster Item,,48990923,SPSI,Cath/Wire D,,Per Svc,826.00
Chargemaster Item,,48990931,SPSI,Cath/Wire E,,Per Svc,449.00
Chargemaster Item,,48990931INACTV,SPSI,Cath/Wire E,,Per Svc,449.00
Chargemaster Item,,48990949,SPSI,Cath/Wire F,,Per Svc,676.00
Chargemaster Item,,48990949INACTV,SPSI,Cath/Wire F,,Per Svc,676.00
Chargemaster Item,,48990956,SPSI,Cath/Wire G,,Per Svc,899.00
Chargemaster Item,,48990956INACTV,SPSI,Cath/Wire G,,Per Svc,899.00
Chargemaster Item,,48990964,SPSI,Cath/Wire H,,Per Svc,1123.00
Chargemaster Item,,48990964INACTV,SPSI,Cath/Wire H,,Per Svc,1123.00
Chargemaster Item,,48990998,SPSI,Angio Pack B,,Per Svc,803.00
Chargemaster Item,,48991004,SPSI,Angio Pack C,,Per Svc,1072.00
Chargemaster Item,,48991012,SPSI,H-Palmaz Stents,,Per Svc,4176.00
Chargemaster Item,,48991020,SPSI,Stent W/Delivery System A,,Per Svc,5780.00
Chargemaster Item,,48991038,SPSI,Stent W/Delivery System B,,Per Svc,11090.00
Chargemaster Item,,48991046,SPSI,Impla/Ivc Filters,,Per Svc,4940.00
Chargemaster Item,,48991061,SPSI,Stent W/O Delivery System A,,Per Svc,4176.00
Chargemaster Item,,48991079,SPSI,Declotting Devices,,Per Svc,5490.00
Chargemaster Item,,48991087,SPSI,Pta Balloons A,,Per Svc,558.00
Chargemaster Item,,48991095,SPSI,Pta Balloons B,,Per Svc,1350.00
Chargemaster Item,,48991103,SPSI,Pta Balloons C,,Per Svc,1358.00
Chargemaster Item,,48991111,SPSI,Pta Balloons D,,Per Svc,1800.00
Chargemaster Item,,48991129,SPSI,Cntrl Venous Kit A,,Per Svc,516.16
Chargemaster Item,,48991137,SPSI,Non-Vascular Kit A,,Per Svc,399.84
Chargemaster Item,,48991145,SPSI,Non-Vascular Kit B,,Per Svc,788.00
Chargemaster Item,,48991152,SPSI,Cntrl Venous Kit B,,Per Svc,1100.00
Chargemaster Item,,48992077,SPSI,Vertebro Augment Kit A,,Per Svc,29871.00
Chargemaster Item,,48992085,SPSI,Sterile Barium,,Per Svc,469.00
Chargemaster Item,,48992093,SPSI,Cranioplasty Kit,,Per Svc,522.00
Chargemaster Item,,48992101,SPSI,Bone Needle,,Per Svc,1687.00
Chargemaster Item,,48992119,SPSI,Closure Device,,Per Svc,840.00
Chargemaster Item,,48992127,SPSI,Embolic Agent,,Per Svc,509.00
Chargemaster Item,,48992135,SPSI,Tunneled Cv Cath,,Per Svc,1000.00
Chargemaster Item,,48992192,SPSI,C-Arwtrero Perc Thrombo Cath,,Per Svc,2660.00
Chargemaster Item,,48992291,SPSI,Hemostasis Pad,,Per Svc,981.00
Chargemaster Item,,48992309,SPSI,Pumpset Short Cath,,Per Svc,7039.00
Chargemaster Item,,48992317,SPSI,Pumpset Long Cath,,Per Svc,7039.00
Chargemaster Item,,48992333,SPSI,Pleural Drainage Kit,,Per Svc,775.00
Chargemaster Item,,48992341,SPSI,Nitrous Oxide,,Per Svc,169.00
Chargemaster Item,,48992358,SPSI,Cryo Balloon,,Per Svc,7939.00
Chargemaster Item,,48992366,SPSI,Cryo Inflation Device,,Per Svc,3180.00
Chargemaster Item,,48992374,SPSI,Cutting Balloon,,Per Svc,6067.00
Chargemaster Item,,48992382,SPSI,Tray, Quinton,,Per Svc,520.00
Chargemaster Item,,48992390,SPSI,Central Line Insertion Tray,,Per Svc,1171.00
Chargemaster Item,,48992416,SPSI,Port Indwelling Imp,,Per Svc,1341.00
Chargemaster Item,,48992432,SPSI,Cath Declot Balloon,,Per Svc,308.00
Chargemaster Item,,48992440,SPSI,Adhesive Dermabond,,Per Svc,485.00
Chargemaster Item,,48992457,SPSI,Catheter Ash Repair Kit,,Per Svc,907.00
Chargemaster Item,,48992465,SPSI,Hemostasis Foam,,Per Svc,1231.00
Chargemaster Item,,48992473,SPSI,Cath/Wire 1,,Per Svc,76.00
Chargemaster Item,,48992499,SPSI,IR Neuro Stent D,,Per Svc,53200.00
Chargemaster Item,,48992507,SPSI,Vertebro Augment Kit B,,Per Svc,18095.00
Chargemaster Item,,48992515,SPSI,Vertebro Augment Kit C,,Per Svc,9689.00
Chargemaster Item,,48992523,SPSI,Stent Flair Cov W/Del Sys,,Per Svc,19149.00
Chargemaster Item,,48992531,SPSI,Stent Coated/CovW/Del Sys C4500,,Per Svc,19149.00
Chargemaster Item,,48992549,SPSI,Lifestent W/ Del Sys,,Per Svc,7216.00
Chargemaster Item,,48992556,SPSI,Stent Luminex W/ Del Sys,,Per Svc,7216.00
Chargemaster Item,,48992564,SPSI,Neuro Coil,,Per Svc,8279.00
Chargemaster Item,,48992572,SPSI,Neuro Embolic Glue,,Per Svc,12686.00
Chargemaster Item,,48992580,SPSI,Neuro Balloons,,Per Svc,6102.00
Chargemaster Item,,48992598,SPSI,Neuro Stent A,,Per Svc,8300.00
Chargemaster Item,,48992606,SPSI,Neuro Stent B,,Per Svc,16601.00
Chargemaster Item,,48992614,SPSI,Neuro Cath/Wire A,,Per Svc,4340.00
Chargemaster Item,,48992623,SPSI,Neuro Cath/Wire B,,Per Svc,8680.00
Chargemaster Item,,48992630,SPSI,Neuro Cath/Wire C,,Per Svc,13020.00
Chargemaster Item,,48992648,SPSI,Neuro Protection Device,,Per Svc,5425.00
Chargemaster Item,,48992655,SPSI,Neuro Embolectmy Cath,,Per Svc,36397.00
Chargemaster Item,,48992663,SPSI,RT Paravrt Fct Inj CRV/THRC L1,,Per Svc,4323.00
Chargemaster Item,,48992671,SPSI,Paravrt Fct Inj CRV/THRC L2,,Per Svc,2383.00
Chargemaster Item,,48992689,SPSI,Paravrt Fct Inj CRV/THRC L3,,Per Svc,2383.00
Chargemaster Item,,48992697,SPSI,RT Paravrt Fct Inj LMBR/SAC L1,,Per Svc,4430.00
Chargemaster Item,,48992705,SPSI,Paravrt Fct Inj LMBR/SAC L2,,Per Svc,2587.00
Chargemaster Item,,48992713,SPSI,Paravrt Fct Inj LMBR/SAC L3,,Per Svc,2587.00
Chargemaster Item,,48992721,SPSI,LT Paravrt Fct Inj CRV/THRC L1,,Per Svc,4323.00
Chargemaster Item,,48992739,SPSI,LT Paravrt Fct Inj LMBR/SAC L1,,Per Svc,4430.00
Chargemaster Item,,48992754,SPSI,XR 3D Rend W/Interp W/O IND,,Per Svc,739.00
Chargemaster Item,,48992762,SPSI,XR 3D Rend W/Ind PostProcess,,Per Svc,1012.00
Chargemaster Item,,48993000,SPSI,Device Emb Assist 22mm-32mm,,Per Svc,4300.00
Chargemaster Item,,48993018,SPSI,Coil Sys 10 Frme Finsh Cmplx,,Per Svc,1795.00
Chargemaster Item,,48993026,SPSI,Coil Sys 10 Finsh Helical,,Per Svc,1395.00
Chargemaster Item,,48993034,SPSI,Coil Sys 10 Filling Helical,,Per Svc,995.00
Chargemaster Item,,48993042,SPSI,Coil System 18 Framing Cmplx,,Per Svc,1995.00
Chargemaster Item,,4900007,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,49015886,SPSI,Gadolinium Per Cc,,Per Svc,5.00
Chargemaster Item,,49026099,SPSI,Eovist Per Ml,,Per Svc,120.00
Chargemaster Item,,49377328,SPSI,Mri Lt Shoulder W/Wo Contrast,,Per Svc,9267.00
Chargemaster Item,,49703366,SPSI,Mri Tmj'S,,Per Svc,4843.00
Chargemaster Item,,49705403,SPSI,Mri Neck,,Per Svc,9601.00
Chargemaster Item,,49705437,SPSI,Mri Orbt-Face-Neck Wo Contrast,,Per Svc,9601.00
Chargemaster Item,,49705486,SPSI,Mri Orbt/Face/Neck W Contrast,,Per Svc,10987.00
Chargemaster Item,,49705494,SPSI,Mri Orb/Face/Neck W/Wo,,Per Svc,11013.00
Chargemaster Item,,49705502,SPSI,Mra Head Wo,,Per Svc,8003.00
Chargemaster Item,,49705510,SPSI,Mri Brain Wo Contrast,,Per Svc,10549.00
Chargemaster Item,,49705528,SPSI,Mri Lim Brain,,Per Svc,10549.00
Chargemaster Item,,49705536,SPSI,Mri Brain Wo/W Contrast,,Per Svc,14319.00
Chargemaster Item,,49705551,SPSI,Mra Neck Wo,,Per Svc,8850.00
Chargemaster Item,,49705569,SPSI,Mra Neck W Contrast,,Per Svc,4878.00
Chargemaster Item,,49705577,SPSI,Mri Brain W Contrast,,Per Svc,13143.00
Chargemaster Item,,49705593,SPSI,Mra Neck Wo/W Contrast,,Per Svc,12934.00
Chargemaster Item,,49705601,SPSI,Mra Head W Contrast,,Per Svc,9077.00
Chargemaster Item,,49705619,SPSI,Mra Head Wo/W Contrast,,Per Svc,11728.00
Chargemaster Item,,49715501,SPSI,Mri Chest,,Per Svc,10194.00
Chargemaster Item,,49715527,SPSI,Mri Chest Wo/W Contrast,,Per Svc,12276.00
Chargemaster Item,,49715568,SPSI,Mra Chest Wo Contrast,,Per Svc,1911.00
Chargemaster Item,,49715576,SPSI,Mra Chest W/Wo Contrast,,Per Svc,2509.00
Chargemaster Item,,49721400,SPSI,Mri Spinal Cord,,Per Svc,10501.00
Chargemaster Item,,49721418,SPSI,Mri Lumbar Wo Contrast,,Per Svc,9897.00
Chargemaster Item,,49721426,SPSI,Mri Cervical Wo Contrast,,Per Svc,10501.00
Chargemaster Item,,49721434,SPSI,Mri Thoracic Wo Contrast,,Per Svc,8853.00
Chargemaster Item,,49721442,SPSI,Mri Pelvis Wo Contrast,,Per Svc,9639.00
Chargemaster Item,,49721459,SPSI,MRI Lim Cervical,,Per Svc,10501.00
Chargemaster Item,,49721475,SPSI,Mri Thoracic W Contrast,,Per Svc,9833.00
Chargemaster Item,,49721483,SPSI,MRI Lim Lumbar,,Per Svc,9897.00
Chargemaster Item,,49721509,SPSI,Mri Cervical W Contrast,,Per Svc,3235.00
Chargemaster Item,,49721517,SPSI,Mri Lumbar W Contrast,,Per Svc,10653.00
Chargemaster Item,,49721558,SPSI,MRI Lim Thoracic,,Per Svc,10735.00
Chargemaster Item,,49721566,SPSI,Mri Cerv Wo/W Contrast,,Per Svc,11857.00
Chargemaster Item,,49721574,SPSI,Mri Thoracic Wo/W Contrast,,Per Svc,10735.00
Chargemaster Item,,49721582,SPSI,Mri Lumbar Wo/W Contrast,,Per Svc,11707.00
Chargemaster Item,,49721962,SPSI,Mri Pelvis With Contrast,,Per Svc,9639.00
Chargemaster Item,,49721970,SPSI,Mri Pelvis Wo/W Contrast,,Per Svc,12459.00
Chargemaster Item,,49721996,SPSI,Mra Pelvis Wo/W Contrast,,Per Svc,2841.00
Chargemaster Item,,49722002,SPSI,Mra Pelvis W Contrast,,Per Svc,2919.00
Chargemaster Item,,49731219,SPSI,Mri Upr Ext W/Wo Contrast Right,,Per Svc,9779.00
Chargemaster Item,,49731227,SPSI,Mri Upr Ext W/Wo Contrast Left,,Per Svc,9779.00
Chargemaster Item,,49731276,SPSI,Mri Rt Shoulder W/Wo Contrast,,Per Svc,9267.00
Chargemaster Item,,49732183,SPSI,Mri Uext Wo Contrast Right,,Per Svc,7982.00
Chargemaster Item,,49732191,SPSI,Mri Uext Wo Contrast Left,,Per Svc,7982.00
Chargemaster Item,,49732217,SPSI,Mri Left Shoulder Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,49732225,SPSI,Mri Right Shoulder Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,49732233,SPSI,Mri Lt Elbow Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,49732241,SPSI,Mri Rt Elbow,,Per Svc,6921.00
Chargemaster Item,,49732258,SPSI,Mri Left Wrist Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,49732266,SPSI,Mri Right Wrist Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,49732274,SPSI,Mra Rt Uext W Contrast B,,Per Svc,6693.00
Chargemaster Item,,49732290,SPSI,Mri Lext (Not Joint) Wo Cont Right,,Per Svc,8900.00
Chargemaster Item,,49732308,SPSI,Mri Lt Knee Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,49732316,SPSI,Mri Rt Knee Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,49732324,SPSI,Mri Lt Ankle Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,49732332,SPSI,Mri Rt Ankle Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,49732340,SPSI,Mri Lext (Not Joint) Wo Cont Left,,Per Svc,8900.00
Chargemaster Item,,49732357,SPSI,Mra Rt Uext W Contrast A,,Per Svc,6693.00
Chargemaster Item,,49732449,SPSI,Mri Rt Shoulder W Contrast,,Per Svc,6192.00
Chargemaster Item,,49732456,SPSI,Mri Lt Shoulder W Contrast,,Per Svc,6192.00
Chargemaster Item,,49732548,SPSI,Mra Rt Uext Wo/W Contrast,,Per Svc,6707.00
Chargemaster Item,,49732555,SPSI,Mra Lt Uext Wo W/ Contrast,,Per Svc,6693.00
Chargemaster Item,,49732563,SPSI,Mri Rt Elbow W Contrast,,Per Svc,6192.00
Chargemaster Item,,49732571,SPSI,Mri Lt Elbow W Contrast,,Per Svc,6192.00
Chargemaster Item,,49732589,SPSI,Mri Rt Elbow W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,49732597,SPSI,Mri Lt Elbow W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,49732605,SPSI,Mri Rt Wrist W Contrast,,Per Svc,6192.00
Chargemaster Item,,49732613,SPSI,Mri Lt Wrist W Contrast,,Per Svc,6192.00
Chargemaster Item,,49732621,SPSI,Mri Rt Wrist W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,49732639,SPSI,Mri Lt Wrist W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,49732647,SPSI,Mra Bil Lext W/Contrast,,Per Svc,5203.00
Chargemaster Item,,49736002,SPSI,Mra Bil Lext Wo Contrast,,Per Svc,2722.00
Chargemaster Item,,49736010,SPSI,Mra Bil Lext Wo/W Contrast,,Per Svc,6120.00
Chargemaster Item,,49736028,SPSI,Mri Rt Knee W Contrast,,Per Svc,6335.00
Chargemaster Item,,49736036,SPSI,Mri Lt Knee W Contrast,,Per Svc,6349.00
Chargemaster Item,,49736044,SPSI,Mri Rt Knee W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,49737216,SPSI,Mri Lext (Not Joint) Right,,Per Svc,12230.00
Chargemaster Item,,49737224,SPSI,Mri Lext (Not Joint) Left,,Per Svc,12230.00
Chargemaster Item,,49737265,SPSI,Mri Lext Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,49737299,SPSI,Mri Lt Knee W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,49737307,SPSI,Mri Lext W Contrast,,Per Svc,6335.00
Chargemaster Item,,49737323,SPSI,Mri Lext W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,49737364,SPSI,Mri Rt Ankle W Contrast,,Per Svc,6349.00
Chargemaster Item,,49737364INACTV,SPSI,Mri Lext W Contrast Right,,Per Svc,6363.00
Chargemaster Item,,49737372,SPSI,Mri Lt Ankle W Contrast,,Per Svc,6349.00
Chargemaster Item,,49737380,SPSI,Mri Rt Ankle W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,49737398,SPSI,Mri Lt Ankle W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,49737406,SPSI,Mra Rt Lext Wo Contrast,,Per Svc,2722.00
Chargemaster Item,,49737414,SPSI,Mra Lt Lext Wo Contrast,,Per Svc,2722.00
Chargemaster Item,,49737422,SPSI,Mra Rt Lext W/Wo Contrast,,Per Svc,6120.00
Chargemaster Item,,49737430,SPSI,Mra Lt Lext W/Wo Contrast,,Per Svc,6120.00
Chargemaster Item,,49741812,SPSI,Mri Abd Wo Contrast,,Per Svc,10194.00
Chargemaster Item,,49741838,SPSI,Mri Abdomen Wo/W Contrast,,Per Svc,12459.00
Chargemaster Item,,49741861,SPSI,Mra Abdomen Wo Contrast,,Per Svc,2280.00
Chargemaster Item,,49741879,SPSI,Mra Abdomen W W/O Contrast,,Per Svc,5953.00
Chargemaster Item,,49763907,SPSI,Mri Spectroscopy,,Per Svc,2560.00
Chargemaster Item,,49770514,SPSI,Mri Lt Breast Wo/W Contrast,,Per Svc,10044.00
Chargemaster Item,,49770522,SPSI,Mri Rt Breast Wo/W Contrast,,Per Svc,10044.00
Chargemaster Item,,49770530,SPSI,Mri Bilat Breast Wo/W Contrast,,Per Svc,10911.00
Chargemaster Item,,49770589,SPSI,Mri Rt Breast W/ Contrast,,Per Svc,8947.00
Chargemaster Item,,49770597,SPSI,Mri Lt Breast W/ Contrast,,Per Svc,8947.00
Chargemaster Item,,49770621,SPSI,Mri Breast Wo Contrast Right,,Per Svc,2688.00
Chargemaster Item,,49770639,SPSI,Mri Breast Wo Contrast Left,,Per Svc,2688.00
Chargemaster Item,,49770647,SPSI,Mri Bilat Breast W/ Contrast,,Per Svc,10224.00
Chargemaster Item,,49770654,SPSI,Mri Bilat Breast Wo Contrast,,Per Svc,6879.00
Chargemaster Item,,49990716,SPSI,Multihance Gadobenate Per Ml,,Per Svc,24.00
Chargemaster Item,,50000017,SPSI,Fern Test,,Per Svc,214.00
Chargemaster Item,,50000033,SPSI,Coagulation Time Activated,,Per Svc,7.00
Chargemaster Item,,50000041,SPSI,Fibrinogen Activity,,Per Svc,14.00
Chargemaster Item,,50000058,SPSI,Platelet Aggregation In Vitro Ea,,Per Svc,35.00
Chargemaster Item,,50000066,SPSI,Fibrinolysins Or Coagulopathy SC,,Per Svc,9.00
Chargemaster Item,,5000009,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,5000018,SPSI,Trauma Intensive Care Unit,,Per Svc,22266.00
Chargemaster Item,,5000054,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,5000063,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,50810076,SPSI,Urine Post Ejaculate For Sperm,,Per Svc,561.00
Chargemaster Item,,50810092,SPSI,Specific Gravity,,Per Svc,110.00
Chargemaster Item,,50810100,SPSI,UA With Microscopic,,Per Svc,335.00
Chargemaster Item,,50810308,SPSI,Urinalysis,,Per Svc,335.00
Chargemaster Item,,50827302,SPSI,Fibrinogen,,Per Svc,408.00
Chargemaster Item,,50827310,SPSI,Fetal Fibronectin,,Per Svc,2496.00
Chargemaster Item,,50829969,SPSI,Urine Pregnancy Test,,Per Svc,323.00
Chargemaster Item,,50830538,SPSI,Sickle Cell Screen,,Per Svc,214.00
Chargemaster Item,,50838804,SPSI,Brain Natriuretic Peptide,,Per Svc,701.00
Chargemaster Item,,50850072,SPSI,Manual Differential,,Per Svc,156.00
Chargemaster Item,,50850148,SPSI,Hematocrit,,Per Svc,119.00
Chargemaster Item,,50850163,SPSI,White Blood Count,,Per Svc,262.00
Chargemaster Item,,50850189,SPSI,Hemoglobin,,Per Svc,100.00
Chargemaster Item,,50850213,SPSI,Complete Blood Count,,Per Svc,442.00
Chargemaster Item,,50850221,SPSI,Complete Blood Count w/ Auto Diff,,Per Svc,432.00
Chargemaster Item,,50850452,SPSI,Automated Retic Count,,Per Svc,214.00
Chargemaster Item,,50853621,SPSI,Fibrin Degradation Products,,Per Svc,353.00
Chargemaster Item,,50853639,SPSI,D-Dimer,,Per Svc,346.00
Chargemaster Item,,50853787,SPSI,D Dimer POCT,,Per Svc,346.00
Chargemaster Item,,50855766,SPSI,Platelet Function Screen Collagen Epi,,Per Svc,406.00
Chargemaster Item,,50855774,SPSI,Platelet Func Collagen_ADP,,Per Svc,406.00
Chargemaster Item,,50855907,SPSI,Platelet Count,,Per Svc,262.00
Chargemaster Item,,50856186,SPSI,Protime With INR,,Per Svc,296.00
Chargemaster Item,,50856517,SPSI,ESR,,Per Svc,212.00
Chargemaster Item,,50857309,SPSI,APTT,,Per Svc,408.00
Chargemaster Item,,50857325,SPSI,Mixing Studies PTT,,Per Svc,1007.00
Chargemaster Item,,50872076,SPSI,Blood Parasites,,Per Svc,353.00
Chargemaster Item,,50890508,SPSI,Urine Eosinophils,,Per Svc,228.00
Chargemaster Item,,50890516,SPSI,Fluid Cell Count And Differential,,Per Svc,288.00
Chargemaster Item,,50890524,SPSI,Fluid Crystals,,Per Svc,203.00
Chargemaster Item,,50893007,SPSI,Semen Analysis_Post Vasectomy,,Per Svc,343.00
Chargemaster Item,,50893205,SPSI,Semen Analysis Complete,,Per Svc,503.00
Chargemaster Item,,50992015,SPSI,CSF Cell Count And Differential,,Per Svc,288.00
Chargemaster Item,,50992064,SPSI,Automated Diff Count,,Per Svc,43.00
Chargemaster Item,,50992072,SPSI,Heparin Anti Xa Assay,,Per Svc,83.00
Chargemaster Item,,50992080,SPSI,Hep Induced Thrombocytopenia,,Per Svc,119.00
Chargemaster Item,,50992098,SPSI,Kleihauer - Betke,,Per Svc,50.00
Chargemaster Item,,50993013,SPSI,Malaria Agt Nos Assay W/Optic,,Per Svc,60.00
Chargemaster Item,,50993021,SPSI,Scan W/O Diff Count,,Per Svc,22.00
Chargemaster Item,,50993039,SPSI,Urine Microscopic Only,,Per Svc,20.00
Chargemaster Item,,51000016,SPSI,Crossmatch Electronic,,Per Svc,158.00
Chargemaster Item,,51000024,SPSI,Splitting Blood Or Products,,Per Svc,158.00
Chargemaster Item,,51000032,SPSI,Autologous Blood Process,,Per Svc,281.00
Chargemaster Item,,51364354,SPSI,Blood Typing Rh P/V,,Per Svc,215.00
Chargemaster Item,,51364362,SPSI,Blood Typing Abo P/V,,Per Svc,215.00
Chargemaster Item,,51860161,SPSI,Antibody Screen,,Per Svc,383.00
Chargemaster Item,,51860260,SPSI,Antibody ID,,Per Svc,944.00
Chargemaster Item,,51860310,SPSI,Direct Coombs,,Per Svc,223.00
Chargemaster Item,,51860328,SPSI,Transfusion Reaction,,Per Svc,742.00
Chargemaster Item,,51860336,SPSI,Antibody Titer..,,Per Svc,511.00
Chargemaster Item,,51860682,SPSI,Crossmatch,,Per Svc,762.00
Chargemaster Item,,51860732,SPSI,Ahg Crossmatch,,Per Svc,868.00
Chargemaster Item,,51860807,SPSI,Blood Typing Abo,,Per Svc,215.00
Chargemaster Item,,51860955,SPSI,Antigen Typing Unit..,,Per Svc,299.00
Chargemaster Item,,51860963,SPSI,Antigen Typing Patient RBC,,Per Svc,299.00
Chargemaster Item,,51861003,SPSI,Blood Typing Rh,,Per Svc,215.00
Chargemaster Item,,51861052,SPSI,RH Phenotype,,Per Svc,611.00
Chargemaster Item,,51861151,SPSI,Fetalscreen..,,Per Svc,218.00
Chargemaster Item,,51861367,SPSI,RBC Transfusion for Neonate,,Per Svc,421.00
Chargemaster Item,,51862027,SPSI,Pooling Of Blood Priduct,,Per Svc,2344.00
Chargemaster Item,,51862829,SPSI,Cold Agglutinin Titer,,Per Svc,379.00
Chargemaster Item,,51869956,SPSI,Intrauterine Trans Tech Asst,,Per Svc,577.00
Chargemaster Item,,51869980,SPSI,Fresh Frozen Plasma Prep,,Per Svc,240.00
Chargemaster Item,,51892057,SPSI,APT,,Per Svc,292.00
Chargemaster Item,,51900017,SPSI,Antigen Type Unit,,Per Svc,724.00
Chargemaster Item,,51900025,SPSI,Antibody Titer,,Per Svc,377.00
Chargemaster Item,,51900033,SPSI,Fetalscreen,,Per Svc,33.00
Chargemaster Item,,51900041,SPSI,Cold Agglutin Titer,,Per Svc,40.00
Chargemaster Item,,51900058,SPSI,Antigen Typing Unit,,Per Svc,668.00
Chargemaster Item,,52100047,SPSI,Urine Drugs Of Abuse POCT,,Per Svc,1018.00
Chargemaster Item,,52100062,SPSI,Beta 2 Microglobulin,,Per Svc,11.58
Chargemaster Item,,52100070,SPSI,T3 Uptake,,Per Svc,5.00
Chargemaster Item,,52100088,SPSI,T3 Free,,Per Svc,6.56
Chargemaster Item,,52100096,SPSI,Testosterone Total,,Per Svc,1039.00
Chargemaster Item,,52100104,SPSI,Progesterone by LS MS MS,,Per Svc,9.65
Chargemaster Item,,52100203,SPSI,Glucose Tolerance 2Hr Preg,,Per Svc,184.00
Chargemaster Item,,52100211,SPSI,Alpha-Fetoprotein Serum,,Per Svc,584.00
Chargemaster Item,,52100229,SPSI,Troponin I,,Per Svc,722.00
Chargemaster Item,,52100229Inactv,SPSI,Troponin I,,Per Svc,722.00
Chargemaster Item,,52100252,SPSI,LDL Cholesterol,,Per Svc,188.00
Chargemaster Item,,52100302,SPSI,Procalcitonin Lab Chem,,Per Svc,976.00
Chargemaster Item,,52100310,SPSI,Beta Hydroxybutyrate,,Per Svc,188.00
Chargemaster Item,,52100328,SPSI,Uric Acid (Other Source),,Per Svc,143.00
Chargemaster Item,,52800067,SPSI,Liver Panel,,Per Svc,1030.00
Chargemaster Item,,52800695,SPSI,Renal Function Panel,,Per Svc,1012.00
Chargemaster Item,,52800745,SPSI,Acute Hepatitis Panel,,Per Svc,986.00
Chargemaster Item,,52801040,SPSI,Electrolyte Panel,,Per Svc,853.00
Chargemaster Item,,52801123,SPSI,Comprehensive Metabolic Panel,,Per Svc,1096.00
Chargemaster Item,,52820032,SPSI,Acetaminophen,,Per Svc,934.00
Chargemaster Item,,52820107,SPSI,Acetone,,Per Svc,232.00
Chargemaster Item,,52820115,SPSI,Salicylate,,Per Svc,530.00
Chargemaster Item,,52820404,SPSI,Albumin,,Per Svc,399.00
Chargemaster Item,,52820438,SPSI,Urine Microalbumin 24HR,,Per Svc,648.00
Chargemaster Item,,52820446,SPSI,Urine Microalbumin Random,,Per Svc,705.00
Chargemaster Item,,52820552,SPSI,Ethanol,,Per Svc,667.00
Chargemaster Item,,52821402,SPSI,Ammonia,,Per Svc,815.00
Chargemaster Item,,52821451,SPSI,Amphetamine_ Urine,,Per Svc,325.00
Chargemaster Item,,52821501,SPSI,Amylase,,Per Svc,491.00
Chargemaster Item,,52821519,SPSI,Fluid Amylase,,Per Svc,491.00
Chargemaster Item,,52822053,SPSI,Phenobarbital,,Per Svc,712.00
Chargemaster Item,,52822509,SPSI,Bilirubin Total,,Per Svc,398.00
Chargemaster Item,,52822558,SPSI,Bilirubin Direct,,Per Svc,400.00
Chargemaster Item,,52823101,SPSI,Calcium,,Per Svc,398.00
Chargemaster Item,,52823309,SPSI,Ionized Calcium,,Per Svc,381.00
Chargemaster Item,,52823408,SPSI,Urine Calcium 24HR,,Per Svc,367.00
Chargemaster Item,,52823721,SPSI,Tegretol,,Per Svc,638.00
Chargemaster Item,,52823747,SPSI,CO2,,Per Svc,369.00
Chargemaster Item,,52824364,SPSI,Urine Chloride 24HR,,Per Svc,398.00
Chargemaster Item,,52824398,SPSI,Chloride,,Per Svc,398.00
Chargemaster Item,,52824653,SPSI,Cholesterol,,Per Svc,400.00
Chargemaster Item,,52825338,SPSI,Cortisol,,Per Svc,755.00
Chargemaster Item,,52825502,SPSI,CPK,,Per Svc,491.00
Chargemaster Item,,52825510,SPSI,Total CPK and CKMBI,,Per Svc,1296.00
Chargemaster Item,,52825536,SPSI,CPK MB By Immunoassay,,Per Svc,789.00
Chargemaster Item,,52825551,SPSI,Cardiac Troponin I,,Per Svc,722.00
Chargemaster Item,,52825650,SPSI,Creatinine_Serum,,Per Svc,369.00
Chargemaster Item,,52825676,SPSI,Urine Creatinine 24HR,,Per Svc,398.00
Chargemaster Item,,52825700,SPSI,Urine Creatinine Random,,Per Svc,398.00
Chargemaster Item,,52825759,SPSI,Urine Creatinine Clearance 24HR,,Per Svc,789.00
Chargemaster Item,,52826112,SPSI,Vitamin B12,,Per Svc,815.00
Chargemaster Item,,52826120,SPSI,Vitamin D 25 Hydroxy,,Per Svc,782.00
Chargemaster Item,,52826435,SPSI,Digoxin,,Per Svc,799.00
Chargemaster Item,,52826559,SPSI,Phentoin (Dilantin),,Per Svc,712.00
Chargemaster Item,,52826609,SPSI,Urine Drugs of Abuse Panel,,Per Svc,1018.00
Chargemaster Item,,52826625,SPSI,Gentamicin Random,,Per Svc,812.00
Chargemaster Item,,52826633,SPSI,Tobramycin Random,,Per Svc,812.00
Chargemaster Item,,52826641,SPSI,Amikacin Random,,Per Svc,747.00
Chargemaster Item,,52826658,SPSI,Valproic Acid,,Per Svc,655.00
Chargemaster Item,,52827284,SPSI,Ferritin,,Per Svc,712.00
Chargemaster Item,,52827466,SPSI,Folate,,Per Svc,698.00
Chargemaster Item,,52828001,SPSI,Blood PH,,Per Svc,502.00
Chargemaster Item,,52829454,SPSI,CSF Glucose,,Per Svc,398.00
Chargemaster Item,,52829470,SPSI,Glucose,,Per Svc,398.00
Chargemaster Item,,52829504,SPSI,Glucose Tolerance 1 Hour,,Per Svc,398.00
Chargemaster Item,,52829538,SPSI,Glucose Tolerance Gestationa,,Per Svc,1310.00
Chargemaster Item,,52829546,SPSI,Urine Glucose 24HR,,Per Svc,398.00
Chargemaster Item,,52829801,SPSI,GGT,,Per Svc,504.00
Chargemaster Item,,52829967,SPSI,Beta HCG Scr,,Per Svc,655.00
Chargemaster Item,,52829983,SPSI,HCG Quantitative,,Per Svc,934.00
Chargemaster Item,,52830015,SPSI,Follical Stimulating Hormone,,Per Svc,750.00
Chargemaster Item,,52830023,SPSI,LH,,Per Svc,742.00
Chargemaster Item,,52830106,SPSI,Haptoglobin,,Per Svc,8.44
Chargemaster Item,,52830361,SPSI,Hemoglobin A1C,,Per Svc,400.00
Chargemaster Item,,52835204,SPSI,Caffeine,,Per Svc,524.00
Chargemaster Item,,52835386,SPSI,T4 Free,,Per Svc,667.00
Chargemaster Item,,52835394,SPSI,T3 Total,,Per Svc,902.00
Chargemaster Item,,52835402,SPSI,Iron,,Per Svc,400.00
Chargemaster Item,,52835501,SPSI,Iron Binding Capacity,,Per Svc,400.00
Chargemaster Item,,52836053,SPSI,Lactic Acid,,Per Svc,552.00
Chargemaster Item,,52836152,SPSI,LDH,,Per Svc,398.00
Chargemaster Item,,52836905,SPSI,Lipase,,Per Svc,453.00
Chargemaster Item,,52837150,SPSI,Lipid Panel,,Per Svc,723.00
Chargemaster Item,,52837184,SPSI,HDL Cholesterol,,Per Svc,496.00
Chargemaster Item,,52837259,SPSI,Lithium,,Per Svc,440.00
Chargemaster Item,,52837358,SPSI,Magnesium,,Per Svc,398.00
Chargemaster Item,,52838802,SPSI,Brain Natriuretic Peptide,,Per Svc,701.00
Chargemaster Item,,52838810,SPSI,Brain Natriuretic Peptice (Bnp),,Per Svc,505.00
Chargemaster Item,,52839305,SPSI,Osmolality,,Per Svc,458.00
Chargemaster Item,,52839313,SPSI,Urine Osmolality,,Per Svc,458.00
Chargemaster Item,,52839701,SPSI,Pth Intact,,Per Svc,1669.00
Chargemaster Item,,52840667,SPSI,Prostate Specific Antigen,,Per Svc,595.00
Chargemaster Item,,52840675,SPSI,PSA Screen,,Per Svc,599.00
Chargemaster Item,,52840758,SPSI,Alkaline Phosphatase,,Per Svc,549.00
Chargemaster Item,,52841004,SPSI,Phosphorus,,Per Svc,400.00
Chargemaster Item,,52841327,SPSI,Potassium,,Per Svc,367.00
Chargemaster Item,,52841335,SPSI,Urine Potassium 24HR,,Per Svc,398.00
Chargemaster Item,,52841343,SPSI,Urine Potassium Random,,Per Svc,398.00
Chargemaster Item,,52841467,SPSI,Prolactin,,Per Svc,1050.00
Chargemaster Item,,52841558,SPSI,Total Protein,,Per Svc,400.00
Chargemaster Item,,52841756,SPSI,CSF Protein,,Per Svc,398.00
Chargemaster Item,,52841764,SPSI,Urine Protein 24HR,,Per Svc,398.00
Chargemaster Item,,52842952,SPSI,Sodium,,Per Svc,398.00
Chargemaster Item,,52842960,SPSI,Fluid Sodium,,Per Svc,398.00
Chargemaster Item,,52843000,SPSI,Urine Sodium 24HR,,Per Svc,367.00
Chargemaster Item,,52844206,SPSI,Theophylline,,Per Svc,619.00
Chargemaster Item,,52844438,SPSI,TSH,,Per Svc,924.00
Chargemaster Item,,52844503,SPSI,SGOT,,Per Svc,400.00
Chargemaster Item,,52844602,SPSI,SGPT,,Per Svc,400.00
Chargemaster Item,,52844669,SPSI,Transferrin,,Per Svc,799.00
Chargemaster Item,,52844750,SPSI,Triglycerides,,Per Svc,400.00
Chargemaster Item,,52844842,SPSI,Cardiac Troponin I POCT,,Per Svc,722.00
Chargemaster Item,,52845203,SPSI,BUN,,Per Svc,369.00
Chargemaster Item,,52845211,SPSI,Urine Urea Nitrogen Random,,Per Svc,398.00
Chargemaster Item,,52845229,SPSI,Bun Post Dialysis,,Per Svc,367.00
Chargemaster Item,,52845500,SPSI,Uric Acid,,Per Svc,400.00
Chargemaster Item,,52845609,SPSI,Urine Uric Acid 24HR,,Per Svc,398.00
Chargemaster Item,,52861408,SPSI,C Reactive Protein,,Per Svc,325.00
Chargemaster Item,,52861515,SPSI,CEA,,Per Svc,1029.00
Chargemaster Item,,52862869,SPSI,Hepatitis B Surface Antigen,,Per Svc,413.00
Chargemaster Item,,52862885,SPSI,Hepatitis B Surface Antibody,,Per Svc,288.00
Chargemaster Item,,52862893,SPSI,Hepatitis B Core Antibody IgM,,Per Svc,667.00
Chargemaster Item,,52862901,SPSI,Hepatitis A Antibody IgM,,Per Svc,712.00
Chargemaster Item,,52863164,SPSI,CA 125,,Per Svc,799.00
Chargemaster Item,,52863180,SPSI,Prealbumin,,Per Svc,562.00
Chargemaster Item,,52863263,SPSI,IGA,,Per Svc,5.00
Chargemaster Item,,52863289,SPSI,IGG,,Per Svc,5.00
Chargemaster Item,,52864311,SPSI,Rheumatoid Factor Quantitative,,Per Svc,196.00
Chargemaster Item,,52867033,SPSI,HIV 1 and HIV 2 Elisa,,Per Svc,576.00
Chargemaster Item,,52867629,SPSI,Rubella IgG,,Per Svc,307.00
Chargemaster Item,,52868031,SPSI,Hepatitis C Antibody,,Per Svc,461.00
Chargemaster Item,,52879970,SPSI,Vancomycin Random,,Per Svc,749.00
Chargemaster Item,,52900008,SPSI,Urine Creat Clearance 12HR,,Per Svc,789.00
Chargemaster Item,,52910007,SPSI,Fluid Urea Nitrogen,,Per Svc,398.00
Chargemaster Item,,52910049,SPSI,Amikacin Trough,,Per Svc,747.00
Chargemaster Item,,52910056,SPSI,Amikacin Peak,,Per Svc,747.00
Chargemaster Item,,52910064,SPSI,Urine Diastase 2HR,,Per Svc,491.00
Chargemaster Item,,52910072,SPSI,Postprandial Glucose 2HR,,Per Svc,398.00
Chargemaster Item,,52910080,SPSI,Gentamicin Trough,,Per Svc,812.00
Chargemaster Item,,52910098,SPSI,Gentamicin Peak,,Per Svc,812.00
Chargemaster Item,,52910106,SPSI,Fluid LDH,,Per Svc,398.00
Chargemaster Item,,52910114,SPSI,Fluid Total Protein,,Per Svc,398.00
Chargemaster Item,,52910122,SPSI,Fluid Albumin,,Per Svc,398.00
Chargemaster Item,,52910130,SPSI,Fluid Bilirubin,,Per Svc,398.00
Chargemaster Item,,52910148,SPSI,Fluid Chloride,,Per Svc,400.00
Chargemaster Item,,52910155,SPSI,Fluid Glucose,,Per Svc,398.00
Chargemaster Item,,52910163,SPSI,PH,,Per Svc,400.00
Chargemaster Item,,52910171,SPSI,Fluid Potassium,,Per Svc,398.00
Chargemaster Item,,52910189,SPSI,Reducing Substance_Urine,,Per Svc,401.00
Chargemaster Item,,52910197,SPSI,Tobramycin Trough,,Per Svc,812.00
Chargemaster Item,,52910205,SPSI,Tobramycin Peak,,Per Svc,812.00
Chargemaster Item,,52910213,SPSI,Urine Sodium Random,,Per Svc,398.00
Chargemaster Item,,52910221,SPSI,Urine Chloride Random,,Per Svc,398.00
Chargemaster Item,,52910239,SPSI,Urine Calcium Random,,Per Svc,367.00
Chargemaster Item,,52910247,SPSI,Urine Glucose Random,,Per Svc,398.00
Chargemaster Item,,52910254,SPSI,Urine Total Protein Random,,Per Svc,398.00
Chargemaster Item,,52910262,SPSI,Urine Urea Nitrogen 24HR,,Per Svc,398.00
Chargemaster Item,,52910270,SPSI,Urine Phosphorus Random,,Per Svc,398.00
Chargemaster Item,,52910288,SPSI,Urine Phosphorus 24HR,,Per Svc,398.00
Chargemaster Item,,52910296,SPSI,Urine Protein 12HR,,Per Svc,400.00
Chargemaster Item,,52910304,SPSI,Urine Magnesium Random,,Per Svc,367.00
Chargemaster Item,,52910312,SPSI,Urine Magnesium 24HR,,Per Svc,398.00
Chargemaster Item,,52910320,SPSI,Urine Uric Acid Random,,Per Svc,398.00
Chargemaster Item,,52910338,SPSI,Vancomycin Trough,,Per Svc,749.00
Chargemaster Item,,52910346,SPSI,Vancomycin Peak,,Per Svc,749.00
Chargemaster Item,,52910353,SPSI,Glucose 2 Hour,,Per Svc,398.00
Chargemaster Item,,52910379,SPSI,Glucose Fasting,,Per Svc,398.00
Chargemaster Item,,52910387,SPSI,TSH Reflex to FRT4 and Total T3,,Per Svc,924.00
Chargemaster Item,,52910395,SPSI,Fluid Creatinine,,Per Svc,398.00
Chargemaster Item,,52910403,SPSI,Basic Metabolic Panel,,Per Svc,976.00
Chargemaster Item,,52990181,SPSI,GTT Added Samples,,Per Svc,23.00
Chargemaster Item,,52992047,SPSI,COVID19 Antibody IGG (inhouse),,Per Svc,168.52
Chargemaster Item,,53000014,SPSI,Fungus Culture (Blood),,Per Svc,267.00
Chargemaster Item,,53000022,SPSI,AFB Blood Culture,,Per Svc,333.00
Chargemaster Item,,53000030,SPSI,Campy Assay EIA,,Per Svc,307.00
Chargemaster Item,,53000048,SPSI,Culture Typing Id Organism,,Per Svc,27.00
Chargemaster Item,,53000097,SPSI,Clo Test H. Pylori,,Per Svc,187.00
Chargemaster Item,,53000220,SPSI,Norovirus PCR,,Per Svc,632.00
Chargemaster Item,,53000303,SPSI,Verigene BC-GP 3,,Per Svc,117.00
Chargemaster Item,,53000311,SPSI,Verigene BC-GP 6,,Per Svc,117.00
Chargemaster Item,,53000329,SPSI,Verigene BC-GP 7,,Per Svc,117.00
Chargemaster Item,,53000337,SPSI,Verigene BC-GP 11,,Per Svc,117.00
Chargemaster Item,,53000345,SPSI,Verigene BC-GP,,Per Svc,117.00
Chargemaster Item,,53100095,SPSI,SARS COVID19 In House,,Per Svc,204.00
Chargemaster Item,,53100301,SPSI,C Difficile Toxin B DNA by PCR,,Per Svc,506.00
Chargemaster Item,,53100319,SPSI,Norovirus RNA QL RT PCR,,Per Svc,1656.00
Chargemaster Item,,53100327,SPSI,Sterility Culture,,Per Svc,559.00
Chargemaster Item,,53100418,SPSI,Resp Virus 12-25 Targets,,Per Svc,1667.12
Chargemaster Item,,53100426,SPSI,Chlamydia Pneum DNA Probe,,Per Svc,140.36
Chargemaster Item,,53100434,SPSI,M. Pneumon DNA Amp Probe,,Per Svc,140.36
Chargemaster Item,,53100442,SPSI,Respiratory Pathogen Panel 2,,Per Svc,2151.84
Chargemaster Item,,53110011,SPSI,Severe Acute Respiratory Syndrome,,Per Svc,1128.00
Chargemaster Item,,53200010,SPSI,Group B Streptococcus by PCR,,Per Svc,508.00
Chargemaster Item,,53200036,SPSI,Influenza A Pcr,,Per Svc,506.00
Chargemaster Item,,53200044,SPSI,2009 H1N1 Pcr,,Per Svc,506.00
Chargemaster Item,,53822706,SPSI,Stool Occult Blood,,Per Svc,103.00
Chargemaster Item,,53822730,SPSI,Occult Blood Gastric,,Per Svc,111.00
Chargemaster Item,,53822748,SPSI,C_Difficile Toxin EIA,,Per Svc,328.00
Chargemaster Item,,53822755,SPSI,Stool Clos. Diff Ag (Routine),,Per Svc,311.00
Chargemaster Item,,53860003,SPSI,Mono Test,,Per Svc,220.00
Chargemaster Item,,53860631,SPSI,ASO,,Per Svc,322.00
Chargemaster Item,,53865929,SPSI,RPR,,Per Svc,215.00
Chargemaster Item,,53870168,SPSI,Centrifuged Concentration,,Per Svc,315.00
Chargemaster Item,,53870184,SPSI,Additional Pathogens (Campy),,Per Svc,399.00
Chargemaster Item,,53870192,SPSI,Additional Pathogens (E Coli),,Per Svc,399.00
Chargemaster Item,,53870200,SPSI,Cytospin Concentration,,Per Svc,292.00
Chargemaster Item,,53870218,SPSI,ShigA Toxin I,,Per Svc,319.00
Chargemaster Item,,53870226,SPSI,ShigA Toxin II,,Per Svc,311.00
Chargemaster Item,,53870408,SPSI,Culture Blood,,Per Svc,658.00
Chargemaster Item,,53870457,SPSI,Salmonella/Shigella Prelim.,,Per Svc,520.00
Chargemaster Item,,53870556,SPSI,Stool Culture,,Per Svc,520.00
Chargemaster Item,,53870606,SPSI,Culture Throat,,Per Svc,559.00
Chargemaster Item,,53870705,SPSI,Culture Routine,,Per Svc,559.00
Chargemaster Item,,53870739,SPSI,Quant Aer Bact Culture,,Per Svc,448.00
Chargemaster Item,,53870762,SPSI,Anaerobic Culture,,Per Svc,487.00
Chargemaster Item,,53870812,SPSI,Culture Strep Screen,,Per Svc,256.00
Chargemaster Item,,53870820,SPSI,Group A Strep Screen Rapid,,Per Svc,315.00
Chargemaster Item,,53870838,SPSI,Culture Genital Rule Out Grp B Strep,,Per Svc,278.00
Chargemaster Item,,53870887,SPSI,Urine Culture With Colony Count,,Per Svc,401.00
Chargemaster Item,,53870945,SPSI,Presumptive Id'S, Multple Orgs,,Per Svc,298.00
Chargemaster Item,,53870994,SPSI,Culture Peritoneal Dialysis and Gram Stain,,Per Svc,448.00
Chargemaster Item,,53871018,SPSI,Fungus Cult-Skin, Hair, Nail,,Per Svc,249.00
Chargemaster Item,,53871026,SPSI,Culture Fungus,,Per Svc,405.00
Chargemaster Item,,53871059,SPSI,Genital Culture,,Per Svc,526.00
Chargemaster Item,,53871794,SPSI,Ova + Paraste Exam,,Per Svc,260.00
Chargemaster Item,,53871851,SPSI,KB Sensitivity,,Per Svc,329.00
Chargemaster Item,,53872016,SPSI,Etest, Ceftriaxone,,Per Svc,115.00
Chargemaster Item,,53872024,SPSI,Etest, Penicillin,,Per Svc,115.00
Chargemaster Item,,53872032,SPSI,Etest, Meropenem,,Per Svc,123.00
Chargemaster Item,,53872057,SPSI,Gram Stain of Specimen,,Per Svc,195.00
Chargemaster Item,,53872081,SPSI,Pinworm Exam,,Per Svc,175.00
Chargemaster Item,,53872115,SPSI,Etest, Metronidazole,,Per Svc,115.00
Chargemaster Item,,53872123,SPSI,Wet Mount for Trich and Yeast,,Per Svc,194.00
Chargemaster Item,,53872131,SPSI,KOH Prep,,Per Svc,203.00
Chargemaster Item,,53872164,SPSI,Etest, Daptomycin,,Per Svc,115.00
Chargemaster Item,,53872180,SPSI,Esbl Test Org No.1,,Per Svc,329.00
Chargemaster Item,,53872669,SPSI,Vre Pre Co-Hort,,Per Svc,278.00
Chargemaster Item,,53872677,SPSI,Vre Post Co-Hort,,Per Svc,278.00
Chargemaster Item,,53872685,SPSI,Mrsa Pre Co-Hort,,Per Svc,278.00
Chargemaster Item,,53872693,SPSI,Mrsa Post Co-Hort,,Per Svc,278.00
Chargemaster Item,,53872719,SPSI,Culture VRE Screen,,Per Svc,278.00
Chargemaster Item,,53874004,SPSI,Influenza A Eia,,Per Svc,353.00
Chargemaster Item,,53874012,SPSI,Influenza B Eia,,Per Svc,353.00
Chargemaster Item,,53874202,SPSI,Rsv Quick Test, Now,,Per Svc,328.00
Chargemaster Item,,53874251,SPSI,Stool Rotavirus Immunoassay,,Per Svc,296.00
Chargemaster Item,,53874277,SPSI,E Coli 0157 Immunoassay,,Per Svc,328.00
Chargemaster Item,,53874939,SPSI,PNA Fish,,Per Svc,617.00
Chargemaster Item,,53874947,SPSI,Glucose3 Hour GTT,,Per Svc,23.00
Chargemaster Item,,53875308,SPSI,Kirby Bauer Non_Ferm Susc,,Per Svc,304.00
Chargemaster Item,,53875316,SPSI,Kirby Bauer Non_Lact Ferm,,Per Svc,329.00
Chargemaster Item,,53875324,SPSI,Kirby Bauer Ps Aerug,,Per Svc,329.00
Chargemaster Item,,53875332,SPSI,Kirby Bauer Str Pneumo,,Per Svc,329.00
Chargemaster Item,,53875340,SPSI,Kirby Bauer Str Pneumo_Blood,,Per Svc,329.00
Chargemaster Item,,53875357,SPSI,Kirby Bauer Str Pneumo_CSF,,Per Svc,329.00
Chargemaster Item,,53875365,SPSI,Vitek Acineto,,Per Svc,413.00
Chargemaster Item,,53875373,SPSI,Vitek Add Abs,,Per Svc,115.00
Chargemaster Item,,53875381,SPSI,Vitek Beta Strep,,Per Svc,413.00
Chargemaster Item,,53875407,SPSI,Vitek Enterococcus Panel,,Per Svc,381.00
Chargemaster Item,,53875423,SPSI,VELNBL,,Per Svc,413.00
Chargemaster Item,,53875431,SPSI,Vitek Gram Pos Cocci Susc,,Per Svc,413.00
Chargemaster Item,,53875449,SPSI,Vitek Non Ferm,,Per Svc,413.00
Chargemaster Item,,53875456,SPSI,Vitek Pseudo,,Per Svc,413.00
Chargemaster Item,,53875464,SPSI,Vitek Strep Pneumo,,Per Svc,413.00
Chargemaster Item,,53875514,SPSI,RPR Titer,,Per Svc,31.00
Chargemaster Item,,53875522,SPSI,Trichrome Stain,,Per Svc,130.00
Chargemaster Item,,53875531,SPSI,Scabies Exam,,Per Svc,30.00
Chargemaster Item,,53875548,SPSI,C Difficile Toxin By PCR,,Per Svc,506.00
Chargemaster Item,,53875555,SPSI,Influenza RSV By PCR,,Per Svc,924.00
Chargemaster Item,,53879995,SPSI,Sterility Plate,,Per Svc,48.00
Chargemaster Item,,53890554,SPSI,Stool For WBCs,,Per Svc,243.00
Chargemaster Item,,53891255,SPSI,Stool Fat Qualitative,,Per Svc,182.00
Chargemaster Item,,53891263,SPSI,Stool Muscle Fiber,,Per Svc,220.00
Chargemaster Item,,53900015,SPSI,Culture Cath Tip Non Urinary,,Per Svc,559.00
Chargemaster Item,,53991279,SPSI,Stool Vegetable Fiber,,Per Svc,220.00
Chargemaster Item,,53991287,SPSI,APIE,,Per Svc,278.00
Chargemaster Item,,53991352,SPSI,Anaerobic Id, Org#1,,Per Svc,382.00
Chargemaster Item,,53991410,SPSI,YBC Card,,Per Svc,260.00
Chargemaster Item,,53991477,SPSI,Beta_Lactamase Induction,,Per Svc,134.00
Chargemaster Item,,53992079,SPSI,Culture GC,,Per Svc,382.00
Chargemaster Item,,53992186,SPSI,Cath Tip Culture,,Per Svc,382.00
Chargemaster Item,,53992202,SPSI,Culture, Tissue,,Per Svc,448.00
Chargemaster Item,,53992210,SPSI,Culture VRE Screen for Inpatients,,Per Svc,278.00
Chargemaster Item,,53992236,SPSI,Culture Typing PBP2,,Per Svc,35.00
Chargemaster Item,,53992251,SPSI,Influenza A/B,,Per Svc,2206.00
Chargemaster Item,,53992269,SPSI,H1N1 BY RNA PCR,,Per Svc,548.00
Chargemaster Item,,53992277,SPSI,Culture Typing Staph Latex,,Per Svc,35.00
Chargemaster Item,,53992301,SPSI,MRSA DHS Screen,,Per Svc,278.00
Chargemaster Item,,53992319,SPSI,MRSA Admit Screen,,Per Svc,278.00
Chargemaster Item,,53992327,SPSI,MRSA Discharge Screen,,Per Svc,278.00
Chargemaster Item,,53992335,SPSI,MRSA Outpatient Screen,,Per Svc,256.00
Chargemaster Item,,53992343,SPSI,ASO Titer,,Per Svc,52.00
Chargemaster Item,,53992350,SPSI,CRE Screen,,Per Svc,48.00
Chargemaster Item,,53992368,SPSI,Parasite ID,,Per Svc,30.00
Chargemaster Item,,53992376,SPSI,Fungal Stain,,Per Svc,30.00
Chargemaster Item,,53992384,SPSI,Shiga I and II Immunoassay,,Per Svc,66.00
Chargemaster Item,,53993101,SPSI,N. Gonorrhoeae (NG),,Per Svc,209.00
Chargemaster Item,,53993119,SPSI,Chlamydia C. Trachomatis (CT),,Per Svc,209.00
Chargemaster Item,,53993127,SPSI,RSV By PCR,,Per Svc,419.00
Chargemaster Item,,54000021,SPSI,Activated Clotting Time,,Per Svc,452.00
Chargemaster Item,,54000039,SPSI,Amnisure Analysis,,Per Svc,1697.00
Chargemaster Item,,54000104,SPSI,Urine Pregnancy Test,,Per Svc,323.00
Chargemaster Item,,54100003,SPSI,Glucose_Roche Glucometer,,Per Svc,398.00
Chargemaster Item,,54100227,SPSI,Hemoglobin (Potc),,Per Svc,96.00
Chargemaster Item,,54100243,SPSI,Influeza A W/Optic,,Per Svc,66.20
Chargemaster Item,,54100250,SPSI,Influenza B W/Optic,,Per Svc,66.20
Chargemaster Item,,54872619,SPSI,UA Dip Auto,,Per Svc,261.00
Chargemaster Item,,54872619Inactv,SPSI,UA Dip Auto,,Per Svc,261.00
Chargemaster Item,,56000011,SPSI,Path Consult Initial Site,,Per Svc,595.00
Chargemaster Item,,56000029,SPSI,Path Consult Addl Site,,Per Svc,296.00
Chargemaster Item,,56100217,SPSI,Fine Needle Aspiration,,Per Svc,560.00
Chargemaster Item,,56382203,SPSI,Bone Marrow Aspiration,,Per Svc,2507.00
Chargemaster Item,,56382211,SPSI,Bone Marrow Core Biopsy,,Per Svc,2520.00
Chargemaster Item,,56850977,SPSI,Bone Marrow Asp Interpretation,,Per Svc,1521.00
Chargemaster Item,,56851025,SPSI,Bone Marrow Biopsy,,Per Svc,601.00
Chargemaster Item,,56881048,SPSI,Cytology/Smears, Brush,,Per Svc,260.00
Chargemaster Item,,56881089,SPSI,Cytology,Sacco, Cytospin,,Per Svc,390.00
Chargemaster Item,,56881097,SPSI,Cytology/Sacco, Sytospin,,Per Svc,390.00
Chargemaster Item,,56881253,SPSI,Stool Fat Qualitative,,Per Svc,182.00
Chargemaster Item,,56881600,SPSI,Cytology/Smears-Other Source A,,Per Svc,217.00
Chargemaster Item,,56881618,SPSI,Cytology-Prep And Interp,,Per Svc,336.00
Chargemaster Item,,56881634,SPSI,Cytology/Smears-Other Source B,,Per Svc,217.00
Chargemaster Item,,56881725,SPSI,Fna/Immediate Interpretation,,Per Svc,306.00
Chargemaster Item,,56881733,SPSI,Fna/Interpretation,,Per Svc,674.00
Chargemaster Item,,56883002,SPSI,Surg Path Level I,,Per Svc,193.00
Chargemaster Item,,56883028,SPSI,Surg Path Level Ii,,Per Svc,307.00
Chargemaster Item,,56883044,SPSI,Surg Path Level Iii,,Per Svc,438.00
Chargemaster Item,,56883051,SPSI,Surg Path Level Iv,,Per Svc,731.00
Chargemaster Item,,56883077,SPSI,Surg Path Level V,,Per Svc,1010.00
Chargemaster Item,,56883093,SPSI,Surg Path Level Vi,,Per Svc,1202.00
Chargemaster Item,,56883119,SPSI,Decalcification,,Per Svc,156.00
Chargemaster Item,,56883127,SPSI,Special Stains Gp I, Ea(Org),,Per Svc,726.00
Chargemaster Item,,56883135,SPSI,Special Stains Gp Ii Ea(Muci,,Per Svc,689.00
Chargemaster Item,,56883234,SPSI,Path Conslt/Slide Prep/Rview,,Per Svc,1192.00
Chargemaster Item,,56883317,SPSI,Path Consult/Frozen Section,,Per Svc,467.00
Chargemaster Item,,56883325,SPSI,Path Consult/Additional Fs,,Per Svc,238.00
Chargemaster Item,,57000010,SPSI,Red Blood Cells Leuko Irr Divi,,Per Svc,225.00
Chargemaster Item,,57000028,SPSI,Red Blood Cells Leuko. Divided,,Per Svc,192.00
Chargemaster Item,,57000036,SPSI,Red Blood Cell Divided,,Per Svc,179.00
Chargemaster Item,,57000044,SPSI,Red Blood Cells Irradiated Div,,Per Svc,179.00
Chargemaster Item,,57000051,SPSI,Rbc Washed, Divided,,Per Svc,355.00
Chargemaster Item,,57000069,SPSI,Rbc Washed Lr Divided,,Per Svc,367.00
Chargemaster Item,,57000077,SPSI,Rbc Washed, Lr Irr. Divided,,Per Svc,367.00
Chargemaster Item,,57000085,SPSI,Rbc Deglycerized Lr Divided,,Per Svc,537.00
Chargemaster Item,,57000093,SPSI,Red Blood Cells Degly. Divided,,Per Svc,525.00
Chargemaster Item,,57000101,SPSI,Rbc Deglycerized Lr Irr. Divid,,Per Svc,537.00
Chargemaster Item,,57000119,SPSI,Whole Blood Divided,,Per Svc,269.00
Chargemaster Item,,57000127,SPSI,Red Blood Cells,,Per Svc,358.00
Chargemaster Item,,57000135,SPSI,Whole Blood Lr Divided,,Per Svc,282.00
Chargemaster Item,,57000143,SPSI,Fresh Frozen Plasma Transfusion,,Per Svc,62.00
Chargemaster Item,,57000150,SPSI,Leuko Reduced Red Cells,,Per Svc,383.00
Chargemaster Item,,57000168,SPSI,Fresh Frozen Plasma Divided,,Per Svc,31.00
Chargemaster Item,,57000176,SPSI,One Donor Ffp, Apheresis,,Per Svc,124.00
Chargemaster Item,,57000184,SPSI,Platelet Pheresis Divided,,Per Svc,347.00
Chargemaster Item,,57000192,SPSI,Plasma Frozen Within 24Hrs Div,,Per Svc,27.00
Chargemaster Item,,57000200,SPSI,Platelet Transfusion,,Per Svc,113.00
Chargemaster Item,,57000218,SPSI,Plasma Frozen Within 24 Hrs Ir,,Per Svc,27.00
Chargemaster Item,,57000226,SPSI,Cryoprecipitate,,Per Svc,62.00
Chargemaster Item,,57000234,SPSI,Plasma Frozen w/i 24 Hrs Ir Div,,Per Svc,27.00
Chargemaster Item,,57000242,SPSI,Plateletpheres wash LRIRR Div,,Per Svc,563.00
Chargemaster Item,,57000259,SPSI,Plateletpheresis washed LR Div,,Per Svc,563.00
Chargemaster Item,,57000267,SPSI,RBC Deglycerized, divided,,Per Svc,486.00
Chargemaster Item,,57000275,SPSI,Granulocytes pheresis divided,,Per Svc,1899.00
Chargemaster Item,,57000283,SPSI,Plasma cryo reduced divided,,Per Svc,27.00
Chargemaster Item,,57000291,SPSI,Granulocytes, pheresis irr div,,Per Svc,1899.00
Chargemaster Item,,57000309,SPSI,Irradiated L/R Red Blood Cells,,Per Svc,383.00
Chargemaster Item,,57000317,SPSI,Irradiated L/R Plateletpheres,,Per Svc,680.00
Chargemaster Item,,57000325,SPSI,RBC Deglycerized LR IRR. Div,,Per Svc,1899.00
Chargemaster Item,,57000333,SPSI,Red Blood Cell Divided..,,Per Svc,179.00
Chargemaster Item,,57000432,SPSI,Arc Abo Type,,Per Svc,19.00
Chargemaster Item,,57000440,SPSI,Arc Rh Type,,Per Svc,9.00
Chargemaster Item,,57000457,SPSI,Arc Phenotype Complete,,Per Svc,25.00
Chargemaster Item,,57000465,SPSI,Arc Patient Rbc Phenotype,,Per Svc,15.00
Chargemaster Item,,57000473,SPSI,Arc Dat Each Antisera,,Per Svc,10.00
Chargemaster Item,,57000499,SPSI,Arc Antibody Screen,,Per Svc,25.00
Chargemaster Item,,57000507,SPSI,Arc Pretreat of Rbc's w/Enzyme,,Per Svc,19.00
Chargemaster Item,,57000515,SPSI,Arc Antibody Id,,Per Svc,31.00
Chargemaster Item,,57000523,SPSI,Arc Elution,,Per Svc,63.00
Chargemaster Item,,57000531,SPSI,Arc Pretreat of Rbc's w/Chemicl,,Per Svc,31.00
Chargemaster Item,,57000549,SPSI,Platelet Pheresis,,Per Svc,680.00
Chargemaster Item,,57000556,SPSI,Platelet Pheresis Leukoreduced,,Per Svc,680.00
Chargemaster Item,,57000648,SPSI,Arc Reticulocyte Separation,,Per Svc,85.00
Chargemaster Item,,57000655,SPSI,Arc Dilution Of Serum,,Per Svc,37.00
Chargemaster Item,,57000663,SPSI,Arc Inhibition Of Serum,,Per Svc,37.00
Chargemaster Item,,57000671,SPSI,Arc Titration Each,,Per Svc,63.00
Chargemaster Item,,57000689,SPSI,Arc Thawing/Prep Of Rare Rbc'S,,Per Svc,63.00
Chargemaster Item,,57000697,SPSI,Arc Differential Adsorption,,Per Svc,37.00
Chargemaster Item,,57000705,SPSI,Arc Hemolysins + Agglutinins,,Per Svc,87.00
Chargemaster Item,,57000713,SPSI,Arc Pre Treatment Ser W/Drugs,,Per Svc,125.00
Chargemaster Item,,57000721,SPSI,Arc Monocyte Monolayer Assay,,Per Svc,624.00
Chargemaster Item,,57000754,SPSI,Arc Abo Discrepancy Resolution,,Per Svc,184.00
Chargemaster Item,,57000762,SPSI,Antigen Screen Of Unit W/Pt,,Per Svc,36.00
Chargemaster Item,,57000796,SPSI,Arc Antigen Screened-Each Ag,,Per Svc,56.00
Chargemaster Item,,57000812,SPSI,Arc High Incidence Ag Neg Unit,,Per Svc,326.00
Chargemaster Item,,57000820,SPSI,Arc Hgb S Test Per Unit,,Per Svc,31.00
Chargemaster Item,,57000838,SPSI,Arc Spec Recruitment Rbc Donor,,Per Svc,67.00
Chargemaster Item,,57000846,SPSI,Arc Spec Recruitment Plt Donor,,Per Svc,67.00
Chargemaster Item,,57000861,SPSI,Arc Plt Assoc Igg/Pla1 Typing,,Per Svc,114.00
Chargemaster Item,,57000879,SPSI,Arc Hla Typing A,B,C Serologic,,Per Svc,298.00
Chargemaster Item,,57000887,SPSI,Arc Hla Ab Id/Leukocyte Abs,,Per Svc,260.00
Chargemaster Item,,57000895,SPSI,Arc Hla-Matched Component,,Per Svc,326.00
Chargemaster Item,,57000903,SPSI,Arc Ag Neg Plt Component,,Per Svc,113.00
Chargemaster Item,,57001018,SPSI,Whole Blood,,Per Svc,538.00
Chargemaster Item,,57001042,SPSI,Irradiated Red Blood Cells,,Per Svc,358.00
Chargemaster Item,,57001075,SPSI,Autologous Administration Fee,,Per Svc,136.00
Chargemaster Item,,57001133,SPSI,Whole Blood Irradiated,,Per Svc,538.00
Chargemaster Item,,57001141,SPSI,Whole Blood Leukoreduced,,Per Svc,2320.00
Chargemaster Item,,57001158,SPSI,Whole Blood Leukoreduced Irr,,Per Svc,563.00
Chargemaster Item,,57001166,SPSI,Red Blood Cells Washed Irr.,,Per Svc,709.00
Chargemaster Item,,57001174,SPSI,Red Blood Cells Washed Leuko,,Per Svc,732.00
Chargemaster Item,,57001182,SPSI,Rbc Rejuvenated Deglycerized,,Per Svc,1335.00
Chargemaster Item,,57001190,SPSI,Rbc Leukoreduced Deglycerize,,Per Svc,1074.00
Chargemaster Item,,57001208,SPSI,Rbc Deglycerized Irradiated,,Per Svc,1050.00
Chargemaster Item,,57001216,SPSI,Rbc Rejuvenated Degly.Irr.,,Per Svc,1335.00
Chargemaster Item,,57001224,SPSI,Cryoprecipitate Irradiated,,Per Svc,62.00
Chargemaster Item,,57001232,SPSI,Platelets Irradiated,,Per Svc,113.00
Chargemaster Item,,57001240,SPSI,Platelet Pheresis Irradiated,,Per Svc,680.00
Chargemaster Item,,57001257,SPSI,Granulocytes Pheresis Irr.,,Per Svc,3255.00
Chargemaster Item,,57001265,SPSI,Plasma Frozen Within 24 Hrs,,Per Svc,54.00
Chargemaster Item,,57001273,SPSI,Plasma Frozen Within 24 Hrs Ir.,,Per Svc,54.00
Chargemaster Item,,57001281,SPSI,Red Blood Cells Leuko. Divided.,,Per Svc,192.00
Chargemaster Item,,57001299,SPSI,Red Blood Cells Irradiated Did,,Per Svc,179.00
Chargemaster Item,,57001307,SPSI,Red Blood Cells Leuko Irr Divi.,,Per Svc,225.00
Chargemaster Item,,57001315,SPSI,Red Blood Cells Degly. Divided.,,Per Svc,525.00
Chargemaster Item,,57001323,SPSI,Fresh Frozen Plasma Divided.,,Per Svc,31.00
Chargemaster Item,,57001331,SPSI,Platelet Pheresis Divided.,,Per Svc,341.00
Chargemaster Item,,57001349,SPSI,Fresh Frozen Plasma Irradiate,,Per Svc,31.00
Chargemaster Item,,57002040,SPSI,Rbc Washed, Divided..,,Per Svc,355.00
Chargemaster Item,,57002057,SPSI,Rbc Washed, Irr. Divided,,Per Svc,355.00
Chargemaster Item,,57002065,SPSI,Rbc Washed, Lr Divided,,Per Svc,367.00
Chargemaster Item,,57002073,SPSI,Rbc Washed, Lr Irr. Divided.,,Per Svc,367.00
Chargemaster Item,,57002081,SPSI,Rbc Washed, Lr Irradiated,,Per Svc,732.00
Chargemaster Item,,57002099,SPSI,Whole Blood Divided.,,Per Svc,269.00
Chargemaster Item,,57002107,SPSI,Whole Blood Lr. Divided,,Per Svc,282.00
Chargemaster Item,,57002115,SPSI,Whole Blood Irr. Divided,,Per Svc,269.00
Chargemaster Item,,57002123,SPSI,Whole Blood Lr Irr. Divided,,Per Svc,282.00
Chargemaster Item,,57002131,SPSI,Plateletpheresis Irr Divided,,Per Svc,341.00
Chargemaster Item,,57002149,SPSI,Plateletpheresis Lr Divided,,Per Svc,341.00
Chargemaster Item,,57002156,SPSI,Plateletpheresis Lr Irr. Divi,,Per Svc,373.00
Chargemaster Item,,57002164,SPSI,Platelets, Leukoreduced,,Per Svc,91.00
Chargemaster Item,,57002172,SPSI,Platelets, Leukoreduced Irr.,,Per Svc,137.00
Chargemaster Item,,57002180,SPSI,Rbc Deglycerized Lr Divided.,,Per Svc,537.00
Chargemaster Item,,57002198,SPSI,Rbc Deglycerized Rejuv. Divi,,Per Svc,667.00
Chargemaster Item,,57002206,SPSI,Rbc Deglycerized Irr. Divided,,Per Svc,525.00
Chargemaster Item,,57002214,SPSI,Rbc Deglycerized Lr Irr.,,Per Svc,1074.00
Chargemaster Item,,57002222,SPSI,Rbc Deglycerized Lr Irr Divid,,Per Svc,537.00
Chargemaster Item,,57002230,SPSI,Rbc Deglycerized Rejuv. Irr,,Per Svc,1335.00
Chargemaster Item,,57002271,SPSI,Plateletpheresis, Routine,,Per Svc,1663.00
Chargemaster Item,,57002313,SPSI,Plasma Frozen Within 24Hrs Div.,,Per Svc,27.00
Chargemaster Item,,57002321,SPSI,Plasma Frozen W/24Hrs Irr. Div,,Per Svc,27.00
Chargemaster Item,,57002339,SPSI,RBC Deglycerized Rej. LR Div,,Per Svc,495.00
Chargemaster Item,,57002347,SPSI,RBC Degly Rej LRR IRR Div,,Per Svc,495.00
Chargemaster Item,,57100000,SPSI,ARC HLA A Typing,,Per Svc,155.00
Chargemaster Item,,57110009,SPSI,ARC HLA B Typing,,Per Svc,155.00
Chargemaster Item,,57120008,SPSI,ARC HLA AB ID Class I,,Per Svc,260.00
Chargemaster Item,,57130007,SPSI,ARC PLA-1 Antigen Typing,,Per Svc,119.00
Chargemaster Item,,57860223,SPSI,ARC Platelet Antibody Screen,,Per Svc,233.00
Chargemaster Item,,57866709,SPSI,Washed Red Blood Cells,,Per Svc,709.00
Chargemaster Item,,57869208,SPSI,Prescreen W/Pat Serum Perunit,,Per Svc,37.00
Chargemaster Item,,57869216,SPSI,Arc Platelet Crossmatch,,Per Svc,233.00
Chargemaster Item,,57869323,SPSI,Rbc Deglycerized,,Per Svc,1050.00
Chargemaster Item,,57869976,SPSI,Irradiation, Red Cells,,Per Svc,43.00
Chargemaster Item,,57870016,SPSI,Platpher. Leukoredu Path Rdiv,,Per Svc,1562.00
Chargemaster Item,,57870024,SPSI,Platelets Leukoreduced Div,,Per Svc,228.00
Chargemaster Item,,57870032,SPSI,Platelets Lr Ir Div,,Per Svc,342.00
Chargemaster Item,,57870040,SPSI,Platelet Phere Washed Lr Ir,,Per Svc,2010.00
Chargemaster Item,,57870057,SPSI,Pletelet Phere Washed Lr,,Per Svc,2010.00
Chargemaster Item,,57870065,SPSI,Plasma Cryo Reduced,,Per Svc,95.00
Chargemaster Item,,57870073,SPSI,Granulocytes Pheresis,,Per Svc,6781.00
Chargemaster Item,,57870081,SPSI,Rbc Deglycerized Rejuv Lr,,Per Svc,1777.00
Chargemaster Item,,57870099,SPSI,Rbc Deglycerized Rejuv Lr Ir,,Per Svc,1777.00
Chargemaster Item,,57870115,SPSI,Platpher. Leuko Redu Path Red,,Per Svc,1562.00
Chargemaster Item,,57870123,SPSI,Platpher Leuko Redu Path Red,,Per Svc,2162.50
Chargemaster Item,,57870131,SPSI,Rbc Deglycerized Lr Ir,,Per Svc,1777.00
Chargemaster Item,,57870149,SPSI,RBC LR IR,,Per Svc,225.00
Chargemaster Item,,57870156,SPSI,PLT Pheresis LR IR,,Per Svc,347.00
Chargemaster Item,,58000019,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,58000027,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,58000035,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,58000043,SPSI,Pediatrics Unit,,Per Svc,7950.00
Chargemaster Item,,58000126,SPSI,Definitive Observation Unit 2,,Per Svc,11138.00
Chargemaster Item,,58000209,SPSI,Ldrp Unit,,Per Svc,7950.00
Chargemaster Item,,58000317,SPSI,Blood Transfusion,,Per Svc,1860.00
Chargemaster Item,,58000325,SPSI,Immuniz Admin,,Per Svc,301.00
Chargemaster Item,,58000333,SPSI,Immuniz Admin Ea Add Vac,,Per Svc,433.00
Chargemaster Item,,58000341,SPSI,IV Infusion Initial IVPB,,Per Svc,637.00
Chargemaster Item,,58000358,SPSI,Iv Infuse, Each Addl Hr,,Per Svc,611.00
Chargemaster Item,,58000366,SPSI,IV Hydration,,Every 60 Minutes,1227.00
Chargemaster Item,,58000374,SPSI,Iv Hydration Ea Add Hr,,Per Svc,611.00
Chargemaster Item,,58000382,SPSI,IV Push Single/Initial Drug,,Per Svc,454.00
Chargemaster Item,,58000390,SPSI,IV Push Sequential Ea New Med,,Per Svc,454.00
Chargemaster Item,,58000408,SPSI,IV Push Sequential Same Med Rpt Doses,,Per Svc,427.00
Chargemaster Item,,58000416,SPSI,Prolong Iv Inf Port Or Imp Pump,,Per Svc,1158.00
Chargemaster Item,,58000424,SPSI,Admin Influenza Virus Vaccine,,Per Svc,332.00
Chargemaster Item,,58000432,SPSI,Admin Pneumococcal Vaccine,,Per Svc,332.00
Chargemaster Item,,58000440,SPSI,IV Sequential Infusion Up to 1 Hr IVPB New Med,,Per Svc,1131.00
Chargemaster Item,,58000457,SPSI,IV Concurrent Infuse 2 IVPB at Same Time,,Per Svc,1227.00
Chargemaster Item,,58000465,SPSI,Inj Subcutenousc/Intramus,,Per Svc,234.00
Chargemaster Item,,58000481,SPSI,Unlisted Iv Inj Or Infuse Proc,,Per Svc,81.00
Chargemaster Item,,58000499,SPSI,Resuscitation CPR,,Per Svc,2386.00
Chargemaster Item,,58000507,SPSI,Temp Transcutaneous Pacing,,Per Svc,12442.00
Chargemaster Item,,58000515,SPSI,Cardioversion,,Per Svc,18029.00
Chargemaster Item,,58000523,SPSI,Cardioversion Elect Int,,Per Svc,11131.00
Chargemaster Item,,58000572,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,58000573,SPSI,Observation Continuation,,First 89 Minutes,331.00
Chargemaster Item,,58000580,SPSI,Observation High Per Hr,,Per Svc,213.00
Chargemaster Item,,58000598,SPSI,Direct Admit To Observation,,Per Svc,494.00
Chargemaster Item,,58000605,SPSI,Procedure in Observation Unit,,Per Svc,1914.00
Chargemaster Item,,58000614,SPSI,IV Infuse, up to 1hr,,Per Svc,1186.00
Chargemaster Item,,58000622,SPSI,IV Hydration, Up To 1Hr,,Per Svc,1097.00
Chargemaster Item,,58000639,SPSI,Moderate Sedation <5/Yrs Int,,Every 15 Minutes,305.00
Chargemaster Item,,58000647,SPSI,Moderate Sedation >5/Yrs Initial,,Every 15 Minutes,303.00
Chargemaster Item,,58000662,SPSI,Procedure in Trauma - Observ,,Per Svc,1914.00
Chargemaster Item,,58900002,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,59364158,SPSI,Venous Blood Collection,,Per Svc,59.00
Chargemaster Item,,59364166,SPSI,Capillary Blood Collection,,Per Svc,54.00
Chargemaster Item,,59364174,SPSI,Special Handling,,Per Svc,19.00
Chargemaster Item,,59800615,SPSI,Lipid Panel,,Per Svc,723.00
Chargemaster Item,,59810507,SPSI,Total Volume_3,,Per Svc,122.00
Chargemaster Item,,60000015,SPSI,ICD Remote Transmission Tech,,Per Svc,1727.00
Chargemaster Item,,60000023,SPSI,Cardiac Event Monitor Hook-up,,Per Svc,221.00
Chargemaster Item,,60000031,SPSI,ICD In Patient Express,,Per Svc,221.00
Chargemaster Item,,60000049,SPSI,Pacemaker In Patient Express,,Per Svc,221.00
Chargemaster Item,,60000056,SPSI,InPatient Loop Recordr Express,,Per Svc,221.00
Chargemaster Item,,60000064,SPSI,Echo Complete Adult with IEA,,Per Svc,4834.00
Chargemaster Item,,60000072,SPSI,Echo Limited Adult with IEA,,Per Svc,2733.00
Chargemaster Item,,60000080,SPSI,Echo Dobi Stress with IEA,,Per Svc,4788.00
Chargemaster Item,,60000098,SPSI,Duplicity Perf Lipid Micro Inj,11994-0011-01,Per Svc,0.01
Chargemaster Item,,60000106,SPSI,TEE with IEA,,Per Svc,8927.00
Chargemaster Item,,6009005,SPSI,Neonatal Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,60839867,SPSI,GI Reflux Study,,Per Svc,1709.00
Chargemaster Item,,60930005,SPSI,Ecg,,Per Svc,1343.00
Chargemaster Item,,60930013,SPSI,Arrhy Surv Recorder,,Per Svc,44.00
Chargemaster Item,,60930153,SPSI,Cv Stress Test,,Per Svc,2812.00
Chargemaster Item,,60930179,SPSI,Adend Thallium Stress,,Per Svc,2812.00
Chargemaster Item,,60930195,SPSI,Thallium Stress Test,,Per Svc,2812.00
Chargemaster Item,,60932266,SPSI,Holter Scan/Analysis,,Per Svc,3183.00
Chargemaster Item,,60932746,SPSI,Holter Recording,,Per Svc,1281.00
Chargemaster Item,,60932787,SPSI,Saecg,,Per Svc,1360.00
Chargemaster Item,,60933538,SPSI,Dobu Thallium Stress,,Per Svc,2812.00
Chargemaster Item,,60934007,SPSI,Pericardial Peds Tap,,Per Svc,2117.00
Chargemaster Item,,60934015,SPSI,Tee Adult,,Per Svc,6579.00
Chargemaster Item,,60934031,SPSI,Tee Icu,,Per Svc,6717.00
Chargemaster Item,,60934049,SPSI,Lmtd 2D No Color No Doppler,,Per Svc,2684.00
Chargemaster Item,,60934056,SPSI,3D w/Interp Req Postproces,,Per Svc,1045.00
Chargemaster Item,,60934064,SPSI,3D w/Interp Postproces Not Req,,Per Svc,1218.00
Chargemaster Item,,60937000,SPSI,Ppm Dual Interrogation,,Per Svc,422.00
Chargemaster Item,,60937018,SPSI,Ppm Single Interrogation,,Per Svc,361.00
Chargemaster Item,,60937315,SPSI,Ppm Dual Analysis/Eri,,Per Svc,820.00
Chargemaster Item,,60937349,SPSI,Ppm Single Analysis/Eri,,Per Svc,820.00
Chargemaster Item,,60937927,SPSI,Telepacer Analog Dual,,Per Svc,269.00
Chargemaster Item,,60937943,SPSI,Telepacer Analog Single,,Per Svc,269.00
Chargemaster Item,,60937950,SPSI,Lexiscan Stress Test,,Per Svc,2812.00
Chargemaster Item,,60938156,SPSI,Color Mapping,,Per Svc,1932.00
Chargemaster Item,,60938164,SPSI,Doppler Complete,,Per Svc,1950.00
Chargemaster Item,,60938172,SPSI,Doppler Limited,,Per Svc,1388.00
Chargemaster Item,,60938198,SPSI,Adult Echo Complete,,Per Svc,4570.00
Chargemaster Item,,60938206,SPSI,2D Lmtd,,Per Svc,2460.00
Chargemaster Item,,60938214,SPSI,Ped Echo Complete,,Per Svc,4218.00
Chargemaster Item,,60938222,SPSI,Ped Echo Limited,,Per Svc,2297.00
Chargemaster Item,,60938230,SPSI,Neo Echo Complete,,Per Svc,4218.00
Chargemaster Item,,60938248,SPSI,Neo Echo Limited,,Per Svc,2297.00
Chargemaster Item,,60938255,SPSI,Stress Echo With Meds,,Per Svc,4524.00
Chargemaster Item,,60938263,SPSI,Stress Echo No Meds,,Per Svc,4524.00
Chargemaster Item,,60938271,SPSI,Pericardial Tap Adult,,Per Svc,2469.00
Chargemaster Item,,60938933,SPSI,Bubble Study,,Per Svc,652.00
Chargemaster Item,,60941218,SPSI,Echo Adult Complete W/Bubble,,Per Svc,4834.00
Chargemaster Item,,60941234,SPSI,Echo Adult Ltd W/Bubble,,Per Svc,2733.00
Chargemaster Item,,60947710,SPSI,TTE F/U or LMTD,,Per Svc,1281.00
Chargemaster Item,,60947751,SPSI,Apnea Monitor Data Rec Dwnld,,Per Svc,332.00
Chargemaster Item,,60958063,SPSI,Apnea Monitor Hk-Up/Disconnect,,Per Svc,332.00
Chargemaster Item,,60958071,SPSI,ER OP Loop Recorder,,Per Svc,221.00
Chargemaster Item,,61000055,SPSI,Enrollment Fee/H@P,,Per Svc,185.00
Chargemaster Item,,61000063,SPSI,EKG,,Per Svc,50.00
Chargemaster Item,,61000071,SPSI,Lifestyle education class,,Per Svc,25.00
Chargemaster Item,,61000089,SPSI,Follow up Medical Visit,,Per Svc,40.00
Chargemaster Item,,61000097,SPSI,Dietician consultation,,Per Svc,45.00
Chargemaster Item,,61000105,SPSI,OptiFast food product,,Per Svc,4.25
Chargemaster Item,,61000147,SPSI,Lost or Damaged Equiptment,,Per Svc,393.00
Chargemaster Item,,61000253,SPSI,Monthly Program Fee,,Per Svc,150.00
Chargemaster Item,,61502126,SPSI,Clinic Visit Est Limited,,Per Svc,171.00
Chargemaster Item,,61502134,SPSI,Clinic Visit Est Low Complex,,Per Svc,186.00
Chargemaster Item,,61700019,SPSI,Poly-Reduced,,Per Svc,4342.00
Chargemaster Item,,61700027,SPSI,Poly-Cpap Reduced,,Per Svc,4784.00
Chargemaster Item,,61910048,SPSI,Home Sleep Test Type 3,,Per Svc,616.00
Chargemaster Item,,61946604,SPSI,Poly Cpap,,Per Svc,10358.00
Chargemaster Item,,61957817,SPSI,Poly<6yrs Reduced,,Per Svc,2141.00
Chargemaster Item,,61957825,SPSI,Polysom <6 yrs 4/ > Paramtrs,,Per Svc,4283.00
Chargemaster Item,,61957833,SPSI,Polysom <6yrs CPAP/Bilvl,,Per Svc,4283.00
Chargemaster Item,,61958039,SPSI,Actigraphy Watch,,Per Svc,254.00
Chargemaster Item,,61958054,SPSI,Mslt/Mwt W/Poly,,Per Svc,3103.00
Chargemaster Item,,61958286,SPSI,Polysomnogram,,Per Svc,8686.00
Chargemaster Item,,61992038,SPSI,Clinic Visit New Patient Low Complex,,Per Svc,228.00
Chargemaster Item,,61992111,SPSI,Clinic Visit Est Mod Complex,,Per Svc,238.00
Chargemaster Item,,61992129,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,61992137,SPSI,Clinic Visit New Patient High,,Per Svc,403.00
Chargemaster Item,,61992152,SPSI,Clinic Visit Est High,,Per Svc,305.00
Chargemaster Item,,61992418,SPSI,Clinic Visit New Patient Mod Complex,,Per Svc,271.00
Chargemaster Item,,61992426,SPSI,HP RTD Shake,,Per Svc,5.00
Chargemaster Item,,61992434,SPSI,Optifast Bundle #1,,Per Svc,178.50
Chargemaster Item,,61992442,SPSI,Optifast Bundle #2,,Per Svc,178.50
Chargemaster Item,,61992459,SPSI,Optifast Bundle #3,,Per Svc,181.50
Chargemaster Item,,61992475,SPSI,Teleheatlh Facility Fee,,Per Svc,106.60
Chargemaster Item,,62700042,SPSI,Moderate Sedation <5/Yrs Int,,Every 15 Minutes,305.00
Chargemaster Item,,62700059,SPSI,Moderate Sedation >5/Yrs Initial,,Every 15 Minutes,303.00
Chargemaster Item,,62700083,SPSI,Baer w Mod Sedation <5/Yrs Int,,Every 15 Minutes,75.00
Chargemaster Item,,62700091,SPSI,Baer w Mod Sedation >5/Yrs Int,,Every 15 Minutes,75.00
Chargemaster Item,,62700117,SPSI,EEG Cont Rec Tech Set Up,,Per Svc,1189.64
Chargemaster Item,,62700133,SPSI,EEG monit tech attended <12hrs,,Per Svc,3014.00
Chargemaster Item,,62700141,SPSI,Sep Upper & Lower Limbs,,Per Svc,1482.00
Chargemaster Item,,62700158,SPSI,Nerve Conduction 1-2 Studies,,Per Svc,347.00
Chargemaster Item,,62700166,SPSI,Nerve Conduction 3-4 Studies,,Per Svc,347.00
Chargemaster Item,,62700174,SPSI,Nerve Conduction 5-6 Studies,,Per Svc,347.00
Chargemaster Item,,62700182,SPSI,Nerve Conduction 7-8 Studies,,Per Svc,347.00
Chargemaster Item,,62700190,SPSI,Nerve Conduction 9-10 Studies,,Per Svc,641.00
Chargemaster Item,,62700208,SPSI,Nerve Conduction 11-12 Studies,,Per Svc,641.00
Chargemaster Item,,62700216,SPSI,NRV Conduction 13 or >Studies,,Per Svc,641.00
Chargemaster Item,,62700224,SPSI,IN OP RM 1:1 Monitoring 15 Min,,Every 15 Minutes,455.00
Chargemaster Item,,62700232,SPSI,EEG Monitor Tech Attended,,Per Svc,6027.00
Chargemaster Item,,62700240,SPSI,EEG 41-60 Minutes,,Per Svc,3199.00
Chargemaster Item,,62700257,SPSI,EEG over 1 hour,,Per Svc,3342.00
Chargemaster Item,,62702014,SPSI,VEEG 2-12 Hr Unmntr,,Per Svc,5887.70
Chargemaster Item,,62702022,SPSI,VEEG 12-26 Hr Unmntr,,Per Svc,11775.40
Chargemaster Item,,62702030,SPSI,EEG W/O Vid 02-12 Hr Unmntr,,Per Svc,1370.36
Chargemaster Item,,62702048,SPSI,EEG W/O Vid 12-26 Hr Unmntr,,Per Svc,3930.36
Chargemaster Item,,62922802,SPSI,Evoked Potential-Visual,,Per Svc,2838.00
Chargemaster Item,,62922810,SPSI,Re Screen Abr,,Per Svc,847.00
Chargemaster Item,,62925821,SPSI,Re Screen Oae,,Per Svc,1441.00
Chargemaster Item,,62925854,SPSI,Baer W/Eval,,Per Svc,3120.00
Chargemaster Item,,62925862,SPSI,Pediatric Baer W/Eval,,Per Svc,3120.00
Chargemaster Item,,62925870,SPSI,Initial Screen Abr,,Per Svc,847.00
Chargemaster Item,,62925888,SPSI,Initial Screen Oae,,Per Svc,1441.00
Chargemaster Item,,62958194,SPSI,Eeg Awake & Asleep,,Per Svc,3393.00
Chargemaster Item,,62958202,SPSI,Eeg Awake,,Per Svc,2906.00
Chargemaster Item,,62958228,SPSI,Eeg Sleep,,Per Svc,3393.00
Chargemaster Item,,62958236,SPSI,Pediatric EEG/Sleep,,Per Svc,3393.00
Chargemaster Item,,62958244,SPSI,Eeg Cereb Death,,Per Svc,3800.00
Chargemaster Item,,62959259,SPSI,Ser Upper Ext,,Per Svc,2992.00
Chargemaster Item,,62959267,SPSI,Ser Lower Ext,,Per Svc,2992.00
Chargemaster Item,,62959986,SPSI,Telemetry Eeg 24 Hours,,Per Svc,15263.00
Chargemaster Item,,62959994,SPSI,Intra Op Eeg,,Per Svc,8855.00
Chargemaster Item,,63000008,SPSI,Cognitive Training: init15 Min,,Per Svc,284.00
Chargemaster Item,,63000018,SPSI,Cognitive Training: addl15 Min,,Per Svc,266.00
Chargemaster Item,,63000050,SPSI,E visit 5-10 mins.,,Per Svc,131.00
Chargemaster Item,,63000051,SPSI,E visit 11-20 mins.,,Per Svc,231.00
Chargemaster Item,,63000052,SPSI,E visit 21 or more mins.,,Per Svc,361.00
Chargemaster Item,,63000057,SPSI,Half Year Membership,,Per Svc,300.00
Chargemaster Item,,63000065,SPSI,Half Year Membership Assoc,,Per Svc,250.00
Chargemaster Item,,63001056,SPSI,Manual Therapy Tech Ea 15 Min OT,,Every 15 Minutes,379.00
Chargemaster Item,,63001064,SPSI,Sensory Integrative Tech Ea 15 Min OT,,Every 15 Minutes,276.00
Chargemaster Item,,63001148,SPSI,Debridement First 20sq cm OT,,Per Svc,737.00
Chargemaster Item,,63001155,SPSI,Debridement Ea Add 20 sq cm OT,,Per Svc,320.00
Chargemaster Item,,63003344,SPSI,Medical Supply,,Per Svc,55.00
Chargemaster Item,,63010155,SPSI,Electrode-Ionto,,Per Svc,77.00
Chargemaster Item,,63010486,SPSI,Unna Boot,,Per Svc,607.00
Chargemaster Item,,63010601,SPSI,Muscle Re-Education Ea 15 Min,,Every 15 Minutes,441.00
Chargemaster Item,,63010635,SPSI,Orthotic Fitting/Training Ea 15 Min,,Every 15 Minutes,265.00
Chargemaster Item,,63010684,SPSI,Self Care Home Manage Training Ea 15 Min,,Every 15 Minutes,341.00
Chargemaster Item,,63010742,SPSI,Knee Strapping,,Per Svc,213.00
Chargemaster Item,,63010759,SPSI,Ankle/Foot Strapping,,Per Svc,212.00
Chargemaster Item,,63010767,SPSI,Toe(S) Strapping,,Per Svc,212.00
Chargemaster Item,,63010775,SPSI,Stapping/Lowback,,Per Svc,442.00
Chargemaster Item,,63010783,SPSI,Shoulder Strapping,,Per Svc,614.00
Chargemaster Item,,63010791,SPSI,Elbow/Wrist Strapping,,Per Svc,614.00
Chargemaster Item,,63010809,SPSI,Hand/Finger Strapping,,Per Svc,675.00
Chargemaster Item,,63010817,SPSI,Therapeutic Activities Ea 15 Min,,Every 15 Minutes,459.00
Chargemaster Item,,63010965,SPSI,Manual Therapy Tech Ea 15 Min,,Every 15 Minutes,375.00
Chargemaster Item,,63011294,SPSI,Biofeedback,,Per Svc,319.00
Chargemaster Item,,63011351,SPSI,Non-Selective Debridement,,Per Svc,346.00
Chargemaster Item,,63011369,SPSI,Sensory Integrative Tech Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,63011385,SPSI,Aquatic Therapy Each 15 Min,,Every 15 Minutes,331.00
Chargemaster Item,,63011393,SPSI,Contact Cast,,Per Svc,1557.00
Chargemaster Item,,63011583,SPSI,Electric Stim Unattended,,Per Svc,260.00
Chargemaster Item,,63011609,SPSI,Group Therapy Exercises,,Per Svc,316.00
Chargemaster Item,,63011617,SPSI,Debridement First 20sq cm,,Per Svc,737.00
Chargemaster Item,,63011625,SPSI,Debridement Ea Add 20 sq cm,,Per Svc,244.00
Chargemaster Item,,63011658,SPSI,Wound Vac<50,,Per Svc,730.00
Chargemaster Item,,63011666,SPSI,Wound Vac>50,,Per Svc,840.00
Chargemaster Item,,63011674,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,63011682,SPSI,Short Leg Splint,,Per Svc,357.00
Chargemaster Item,,63011690,SPSI,Orth/Prosth Use Checkout Each 15 Min,,Every 15 Minutes,190.00
Chargemaster Item,,63011724,SPSI,Canalith Repositioning Procedure,,Per Svc,232.00
Chargemaster Item,,63011730,SPSI,Sel debride and unna boot,,Per Svc,1343.00
Chargemaster Item,,63020015,SPSI,Self Care Home Manage Training Ea 15 Min OT,,Every 15 Minutes,343.00
Chargemaster Item,,63020023,SPSI,Therapeutic Activities Ea 15 Min OT,,Every 15 Minutes,459.00
Chargemaster Item,,63020056,SPSI,Muscle Re-Education Ea 15 Min OT,,Every 15 Minutes,443.00
Chargemaster Item,,63020098,SPSI,Orth/Prosth Use Checkout Each 15 Min,,Every 15 Minutes,190.00
Chargemaster Item,,63020106,SPSI,Therex Ea 15 Min OT,,Every 15 Minutes,324.00
Chargemaster Item,,63020114,SPSI,Orthotic Fitting/Training Ea 15 Min OT,,Every 15 Minutes,231.00
Chargemaster Item,,63020155,SPSI,Whirlpool OT,,Per Svc,258.00
Chargemaster Item,,63020163,SPSI,Ultrasound Each 15 Min OT,,Every 15 Minutes,195.00
Chargemaster Item,,63020189,SPSI,Elec Stim Unattended OT,,Per Svc,261.00
Chargemaster Item,,63020205,SPSI,Iontophoresis Each 15 Min OT,,Every 15 Minutes,284.00
Chargemaster Item,,63020221,SPSI,Hot Packs Cold Packs OT,,Per Svc,139.00
Chargemaster Item,,63020528,SPSI,Paraffin Bath OT,,Per Svc,136.00
Chargemaster Item,,63020585,SPSI,Vasopneumatic Device OT,,Per Svc,208.00
Chargemaster Item,,63021039,SPSI,Orthosis Custom Eo Free Motion,,Per Svc,2065.00
Chargemaster Item,,63021195,SPSI,Whfo Dyn Wst/Finger Driven,,Per Svc,3568.00
Chargemaster Item,,63021237,SPSI,Wrist Molded To Patient Model,,Per Svc,1172.00
Chargemaster Item,,63021633,SPSI,Shoulder Strapping,,Per Svc,614.00
Chargemaster Item,,63021641,SPSI,Hand/Finger Strapping,,Per Svc,675.00
Chargemaster Item,,63021658,SPSI,Electric Stim Attended OT,,Per Svc,250.00
Chargemaster Item,,63021674,SPSI,Elbow/Wrist Strapping,,Per Svc,614.00
Chargemaster Item,,63022367,SPSI,Electrode-Ionto,,Per Svc,77.00
Chargemaster Item,,63022409,SPSI,Non-Selective Debridement OT,,Per Svc,346.00
Chargemaster Item,,63024074,SPSI,Ewho Rigid W/O Joints Custom,,Per Svc,1745.00
Chargemaster Item,,63024082,SPSI,Ewho Nontorsion Jts, Custom,,Per Svc,2208.00
Chargemaster Item,,63024132,SPSI,Who Nontorsion Joints Custom,,Per Svc,2048.00
Chargemaster Item,,63024199,SPSI,Hfo W/O Joints Custom,,Per Svc,657.00
Chargemaster Item,,63024249,SPSI,Ho W/O Joints Custom,,Per Svc,647.00
Chargemaster Item,,63024348,SPSI,Fo W/O Joints Custom,,Per Svc,462.00
Chargemaster Item,,63024363,SPSI,Fo Nontorsion Joints Custom,,Per Svc,493.00
Chargemaster Item,,63024587,SPSI,Whfo Rigid W/O Jts Custom,,Per Svc,985.00
Chargemaster Item,,63025190,SPSI,Init eval: Low comp 30 mins,,Per Svc,733.00
Chargemaster Item,,63025200,SPSI,Init eval: Mod comp 45 mins,,Per Svc,733.00
Chargemaster Item,,63025210,SPSI,Init eval: High comp 60 mins,,Per Svc,733.00
Chargemaster Item,,63025220,SPSI,Re-Evaluation OT,,Per Svc,419.00
Chargemaster Item,,63051460,SPSI,Init eval: Low comp 20 mins,,Per Svc,716.00
Chargemaster Item,,63051470,SPSI,Init eval: Mod comp 30 mins,,Per Svc,716.00
Chargemaster Item,,63051480,SPSI,Init eval: High comp 45 mins,,Per Svc,716.00
Chargemaster Item,,63051490,SPSI,Re-Evaluation,,Per Svc,385.00
Chargemaster Item,,63212341,SPSI,Hip Strapping,,Per Svc,213.00
Chargemaster Item,,63514604,SPSI,Unna Boot and NSD,,Per Svc,953.00
Chargemaster Item,,63640620,SPSI,Biofeedback UI,,Per Svc,442.00
Chargemaster Item,,636C9363,SPSI,Drugs Rquiring Detail Coding C9363,,Per Svc,0.01
Chargemaster Item,,636C9363,SPSI,Drugs Rquiring Detail Coding C9363,,Per Svc,0.01
Chargemaster Item,,636C9363,SPSI,Drugs Rquiring Detail Coding C9363,,Per Svc,0.01
Chargemaster Item,,636C9363,SPSI,Drugs Rquiring Detail Coding C9363,,Per Svc,0.01
Chargemaster Item,,636Q4100,SPSI,Drugs Rquiring Detail Coding Q4100,,Per Svc,0.01
Chargemaster Item,,636Q4100,SPSI,Drugs Rquiring Detail Coding Q4100,,Per Svc,0.01
Chargemaster Item,,636Q4100,SPSI,Drugs Rquiring Detail Coding Q4100,,Per Svc,0.01
Chargemaster Item,,636Q4100,SPSI,Drugs Rquiring Detail Coding Q4100,,Per Svc,0.01
Chargemaster Item,,636Q4104,SPSI,Drugs Rquiring Detail Coding Q4104,,Per Svc,0.01
Chargemaster Item,,636Q4104,SPSI,Drugs Rquiring Detail Coding Q4104,,Per Svc,0.01
Chargemaster Item,,636Q4104,SPSI,Drugs Rquiring Detail Coding Q4104,,Per Svc,0.01
Chargemaster Item,,636Q4104,SPSI,Drugs Rquiring Detail Coding Q4104,,Per Svc,0.01
Chargemaster Item,,636Q4110,SPSI,Drugs Rquiring Detail Coding Q4110,,Per Svc,0.01
Chargemaster Item,,636Q4110,SPSI,Drugs Rquiring Detail Coding Q4110,,Per Svc,0.01
Chargemaster Item,,636Q4110,SPSI,Drugs Rquiring Detail Coding Q4110,,Per Svc,0.01
Chargemaster Item,,636Q4110,SPSI,Drugs Rquiring Detail Coding Q4110,,Per Svc,0.01
Chargemaster Item,,636Q4114,SPSI,Drugs Rquiring Detail Coding Q4114,,Per Svc,0.01
Chargemaster Item,,636Q4114,SPSI,Drugs Rquiring Detail Coding Q4114,,Per Svc,0.01
Chargemaster Item,,636Q4114,SPSI,Drugs Rquiring Detail Coding Q4114,,Per Svc,0.01
Chargemaster Item,,636Q4114,SPSI,Drugs Rquiring Detail Coding Q4114,,Per Svc,0.01
Chargemaster Item,,636Q4116,SPSI,Drugs Rquiring Detail Coding Q4116,,Per Svc,0.01
Chargemaster Item,,636Q4116,SPSI,Drugs Rquiring Detail Coding Q4116,,Per Svc,0.01
Chargemaster Item,,636Q4116,SPSI,Drugs Rquiring Detail Coding Q4116,,Per Svc,0.01
Chargemaster Item,,636Q4116,SPSI,Drugs Rquiring Detail Coding Q4116,,Per Svc,0.01
Chargemaster Item,,636Q4118,SPSI,Drugs Rquiring Detail Coding Q4118,,Per Svc,0.01
Chargemaster Item,,636Q4118,SPSI,Drugs Rquiring Detail Coding Q4118,,Per Svc,0.01
Chargemaster Item,,636Q4118,SPSI,Drugs Rquiring Detail Coding Q4118,,Per Svc,0.01
Chargemaster Item,,636Q4122,SPSI,Drugs Rquiring Detail Coding Q4122,,Per Svc,0.01
Chargemaster Item,,636Q4122,SPSI,Drugs Rquiring Detail Coding Q4122,,Per Svc,0.01
Chargemaster Item,,636Q4122,SPSI,Drugs Rquiring Detail Coding Q4122,,Per Svc,0.01
Chargemaster Item,,636Q4122,SPSI,Drugs Rquiring Detail Coding Q4122,,Per Svc,0.01
Chargemaster Item,,636Q4125,SPSI,Drugs Rquiring Detail Coding Q4125,,Per Svc,0.01
Chargemaster Item,,636Q4125,SPSI,Drugs Rquiring Detail Coding Q4125,,Per Svc,0.01
Chargemaster Item,,636Q4125,SPSI,Drugs Rquiring Detail Coding Q4125,,Per Svc,0.01
Chargemaster Item,,636Q4125,SPSI,Drugs Rquiring Detail Coding Q4125,,Per Svc,0.01
Chargemaster Item,,636Q4126,SPSI,Drugs Rquiring Detail Coding Q4126,,Per Svc,0.01
Chargemaster Item,,636Q4126,SPSI,Drugs Rquiring Detail Coding Q4126,,Per Svc,0.01
Chargemaster Item,,636Q4126,SPSI,Drugs Rquiring Detail Coding Q4126,,Per Svc,0.01
Chargemaster Item,,636Q4126,SPSI,Drugs Rquiring Detail Coding Q4126,,Per Svc,0.01
Chargemaster Item,,636Q4128,SPSI,Drugs Rquiring Detail Coding Q4128,,Per Svc,0.01
Chargemaster Item,,636Q4128,SPSI,Drugs Rquiring Detail Coding Q4128,,Per Svc,0.01
Chargemaster Item,,636Q4128,SPSI,Drugs Rquiring Detail Coding Q4128,,Per Svc,0.01
Chargemaster Item,,636Q4128,SPSI,Drugs Rquiring Detail Coding Q4128,,Per Svc,0.01
Chargemaster Item,,636Q4130,SPSI,Drugs Rquiring Detail Coding Q4130,,Per Svc,0.01
Chargemaster Item,,636Q4130,SPSI,Drugs Rquiring Detail Coding Q4130,,Per Svc,0.01
Chargemaster Item,,636Q4130,SPSI,Drugs Rquiring Detail Coding Q4130,,Per Svc,0.01
Chargemaster Item,,636Q4130,SPSI,Drugs Rquiring Detail Coding Q4130,,Per Svc,0.01
Chargemaster Item,,636Q4133,SPSI,Drugs Rquiring Detail Coding Q4133,,Per Svc,0.01
Chargemaster Item,,636Q4133,SPSI,Drugs Rquiring Detail Coding Q4133,,Per Svc,0.01
Chargemaster Item,,636Q4133,SPSI,Drugs Rquiring Detail Coding Q4133,,Per Svc,0.01
Chargemaster Item,,636Q4133,SPSI,Drugs Rquiring Detail Coding Q4133,,Per Svc,0.01
Chargemaster Item,,636Q4155,SPSI,Drugs Rquiring Detail Coding Q4155,,Per Svc,0.01
Chargemaster Item,,636Q4155,SPSI,Drugs Rquiring Detail Coding Q4155,,Per Svc,0.01
Chargemaster Item,,636Q4155,SPSI,Drugs Rquiring Detail Coding Q4155,,Per Svc,0.01
Chargemaster Item,,636Q4155,SPSI,Drugs Rquiring Detail Coding Q4155,,Per Svc,0.01
Chargemaster Item,,636Q4166,SPSI,Drugs Rquiring Detail Coding Q4166,,Per Svc,0.01
Chargemaster Item,,636Q4166,SPSI,Drugs Rquiring Detail Coding Q4166,,Per Svc,0.01
Chargemaster Item,,636Q4166,SPSI,Drugs Rquiring Detail Coding Q4166,,Per Svc,0.01
Chargemaster Item,,636Q9963,SPSI,Drugs Rquiring Detail Coding Q9963,,Per Svc,0.01
Chargemaster Item,,636Q9963,SPSI,Drugs Rquiring Detail Coding Q9963,,Per Svc,0.01
Chargemaster Item,,636Q9963,SPSI,Drugs Rquiring Detail Coding Q9963,,Per Svc,0.01
Chargemaster Item,,636Q9967,SPSI,Drugs Rquiring Detail Coding Q9967,,Per Svc,0.01
Chargemaster Item,,636Q9967,SPSI,Drugs Rquiring Detail Coding Q9967,,Per Svc,0.01
Chargemaster Item,,636Q9967,SPSI,Drugs Rquiring Detail Coding Q9967,,Per Svc,0.01
Chargemaster Item,,636Q9967,SPSI,Drugs Rquiring Detail Coding Q9967,,Per Svc,0.01
Chargemaster Item,,636XXXXX,SPSI,Drugs Rquiring Detail Coding,,Per Svc,0.01
Chargemaster Item,,636XXXXX,SPSI,Drugs Rquiring Detail Coding,,Per Svc,0.01
Chargemaster Item,,636XXXXX,SPSI,Drugs Rquiring Detail Coding,,Per Svc,0.01
Chargemaster Item,,636XXXXX,SPSI,Drugs Rquiring Detail Coding,,Per Svc,0.01
Chargemaster Item,,63707073,SPSI,Electric Stim Attended Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,63910024,SPSI,TENS,,Per Svc,103.00
Chargemaster Item,,63970101,SPSI,Hot Packs Cold Packs,,Per Svc,139.00
Chargemaster Item,,63970127,SPSI,Traction Mechanical,,Per Svc,235.00
Chargemaster Item,,63970169,SPSI,Vasopneumatic Device,,Per Svc,208.00
Chargemaster Item,,63970184,SPSI,Paraffin Bath,,Per Svc,171.00
Chargemaster Item,,63970226,SPSI,Whirlpool,,Per Svc,258.00
Chargemaster Item,,63970333,SPSI,Iontophoresis Each 15 Min,,Every 15 Minutes,283.00
Chargemaster Item,,63970358,SPSI,Ultrasound Each 15 Min,,Every 15 Minutes,195.00
Chargemaster Item,,63971109,SPSI,Therex Ea 15 Min,,Every 15 Minutes,320.00
Chargemaster Item,,63971166,SPSI,Gait Training Each 15 Mins,,Every 15 Minutes,412.00
Chargemaster Item,,63971285,SPSI,Annual Membership,,Per Svc,600.00
Chargemaster Item,,63975209,SPSI,Prosthetic Training Each 15 Min,,Every 15 Minutes,391.00
Chargemaster Item,,63977502,SPSI,Isokinetic Test Each 15 Min,,Every 15 Minutes,442.00
Chargemaster Item,,63990004,SPSI,Gym Fitness 4 visits,,Per Svc,30.00
Chargemaster Item,,63990012,SPSI,Gym Fitness 8 Visits,,Per Svc,60.00
Chargemaster Item,,63990022,SPSI,wheelchair manage ea 15 min,,Every 15 Minutes,251.00
Chargemaster Item,,63990772,SPSI,Annual Membership Associate Only,,Per Svc,500.00
Chargemaster Item,,63999142,SPSI,Aquatic Fitness 4 Visits,,Per Svc,30.00
Chargemaster Item,,63999191,SPSI,Aquatics Fitness 8 Visits,,Per Svc,60.00
Chargemaster Item,,64315005,SPSI,Endotracheal Intubation,,Per Svc,845.00
Chargemaster Item,,64316458,SPSI,Bronchoscopy,,Per Svc,5276.00
Chargemaster Item,,64317001,SPSI,HAST W/Report,,Per Svc,512.48
Chargemaster Item,,64317019,SPSI,HAST W/Oxygen and Report,,Per Svc,512.48
Chargemaster Item,,64364151,SPSI,Venous Blood Collection,,Per Svc,59.00
Chargemaster Item,,64364169,SPSI,Capillary Blood Collection,,Per Svc,54.00
Chargemaster Item,,64366008,SPSI,Arterial Puncture,,Per Svc,92.00
Chargemaster Item,,64823107,SPSI,Calcium Total,,Per Svc,389.00
Chargemaster Item,,64823750,SPSI,Carboxyhemoglobin (RT),,Per Svc,100.00
Chargemaster Item,,64824352,SPSI,Chloride:Blood,,Per Svc,389.00
Chargemaster Item,,64841323,SPSI,Potassium:Serum,,Per Svc,357.00
Chargemaster Item,,64842958,SPSI,Sodium:Serum,,Per Svc,389.00
Chargemaster Item,,64850183,SPSI,Hemoglobin,,Per Svc,100.00
Chargemaster Item,,64892201,SPSI,Sputum Induction,,Per Svc,485.00
Chargemaster Item,,64940026,SPSI,Initial Ventilator Day,,Per Svc,16045.00
Chargemaster Item,,64940034,SPSI,Ventilator Daily,,Per Svc,15489.00
Chargemaster Item,,64940604,SPSI,Complete Pulm Funct Test,,Per Svc,1636.00
Chargemaster Item,,64940703,SPSI,Broncho Challenge,,Per Svc,1900.00
Chargemaster Item,,64941008,SPSI,Pulmonary Spirometry,,Per Svc,765.00
Chargemaster Item,,64941503,SPSI,Vital Capacity Total,,Per Svc,288.00
Chargemaster Item,,64942402,SPSI,Frc Post Meds,,Per Svc,1012.00
Chargemaster Item,,64942410,SPSI,Frc Pre Meds,,Per Svc,1012.00
Chargemaster Item,,64946106,SPSI,Surfactant Administration,,Per Svc,357.00
Chargemaster Item,,64946205,SPSI,Pulmonary Stress Testng Simple,,Per Svc,407.00
Chargemaster Item,,64946213,SPSI,Pulmonary Stress Test Complex,,Per Svc,3090.00
Chargemaster Item,,64946270,SPSI,Mdi Spacer,,Per Svc,377.00
Chargemaster Item,,64946403,SPSI,Humidified Oxygen Set Up,,Per Svc,436.00
Chargemaster Item,,64946411,SPSI,Humidified Oxygen Daily,,Per Svc,3421.00
Chargemaster Item,,64946452,SPSI,Addition Hr Cont. Aerosol,,Per Svc,315.00
Chargemaster Item,,64946601,SPSI,Cpap Tx,,Per Svc,1663.00
Chargemaster Item,,64946619,SPSI,Bipap Therapy,,Per Svc,1663.00
Chargemaster Item,,64946627,SPSI,Neo Cpap/Bipap Ventilation,,Per Svc,1663.00
Chargemaster Item,,64946643,SPSI,Mdi,,Per Svc,485.00
Chargemaster Item,,64946676,SPSI,Percussinator Treatment,,Per Svc,485.00
Chargemaster Item,,64947021,SPSI,Hb02 Sat/Single,,Per Svc,230.00
Chargemaster Item,,64947203,SPSI,Dlco Only,,Per Svc,857.00
Chargemaster Item,,64947260,SPSI,Pft Plethysmography,,Per Svc,788.00
Chargemaster Item,,64947401,SPSI,Tcom Monitor,,Per Svc,3568.00
Chargemaster Item,,64947419,SPSI,Etco2 Monitor,,Per Svc,1355.00
Chargemaster Item,,64947609,SPSI,Pulse-Ox/Rest,,Per Svc,230.00
Chargemaster Item,,64947617,SPSI,Pulse-Ox/Exercise,,Per Svc,230.00
Chargemaster Item,,64947757,SPSI,Pneumogram Monitoring,,Per Svc,416.00
Chargemaster Item,,64947906,SPSI,Trach Tb Special Order,,Per Svc,403.00
Chargemaster Item,,64947914,SPSI,Peak Flow Meter,,Per Svc,181.00
Chargemaster Item,,64948219,SPSI,Maximum Breathing Capacity,,Per Svc,258.56
Chargemaster Item,,64958010,SPSI,Sleep Study Unattended w/Analy,,Per Svc,1498.00
Chargemaster Item,,64960008,SPSI,Resuscitation CPR,,Per Svc,2386.00
Chargemaster Item,,64960024,SPSI,Passy Muir Valve,,Per Svc,228.00
Chargemaster Item,,64963051,SPSI,Aerosol Neb Tx,,Per Svc,485.00
Chargemaster Item,,64963069,SPSI,Initial Aerosol Treatment,,Per Svc,740.00
Chargemaster Item,,64963218,SPSI,Oxygen Daily,,Per Svc,2397.00
Chargemaster Item,,64963341,SPSI,Pd & Percussion Treatment,,Per Svc,504.00
Chargemaster Item,,64963390,SPSI,Is Incentive Spirometry,,Per Svc,620.00
Chargemaster Item,,64964018,SPSI,Ippb Treatment,,Per Svc,446.00
Chargemaster Item,,64964216,SPSI,Nitric Oxide,,Per Svc,1030.00
Chargemaster Item,,64964505,SPSI,Rt Evaluation Assessment,,Per Svc,620.00
Chargemaster Item,,64980097,SPSI,Smoking Cessation Counseling,,Per Svc,127.00
Chargemaster Item,,64980659,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,64980667,SPSI,Lactic Acid,,Per Svc,552.00
Chargemaster Item,,64990237,SPSI,Arterial Blood Gas Analy,,Per Svc,1633.00
Chargemaster Item,,64999998,SPSI,Heli-Ox Hourly,,Per Svc,81.00
Chargemaster Item,,65000057,SPSI,Half Year Membership,,Per Svc,300.00
Chargemaster Item,,65000065,SPSI,Half Year Membership Assoc,,Per Svc,250.00
Chargemaster Item,,65930182,SPSI,EECP,,Per Svc,418.00
Chargemaster Item,,65937799,SPSI,DocFit Semi-Annual Membership,,Per Svc,60.00
Chargemaster Item,,65937807,SPSI,DocFit Annual Membership,,Per Svc,120.00
Chargemaster Item,,65937971,SPSI,Cardiac Rehab/Non-Monitored,,Per Svc,329.00
Chargemaster Item,,65971103,SPSI,Cardiac Rehab/Monitored,,Per Svc,275.00
Chargemaster Item,,65971111,SPSI,Cardiac Rehab Phase II,,Per Svc,47.00
Chargemaster Item,,65971285,SPSI,Annual Membership,,Per Svc,600.00
Chargemaster Item,,65978058,SPSI,Therapeutic Proc Ea 15 Min,,Every 15 Minutes,265.00
Chargemaster Item,,65978066,SPSI,Therapeutic Proc ea 15 Min Indv,,Every 15 Minutes,265.00
Chargemaster Item,,65978074,SPSI,Therapeutic Procedures,,Per Svc,265.00
Chargemaster Item,,65990004,SPSI,Gym Fitness 4 visits,,Per Svc,30.00
Chargemaster Item,,65990012,SPSI,Gym Fitness 8 Visits,,Per Svc,60.00
Chargemaster Item,,65990013,SPSI,PAD Rehab per session,,Per Svc,284.00
Chargemaster Item,,65990772,SPSI,Annual Membership Associate Only,,Per Svc,500.00
Chargemaster Item,,65990780,SPSI,Gym Fitness Per Visit,,Per Svc,7.50
Chargemaster Item,,66130303,SPSI,Carotid/Abi/Aorta Anerysm Scrn,,Per Svc,181.00
Chargemaster Item,,66130402,SPSI,Vasc Screen Intro Price,,Per Svc,73.00
Chargemaster Item,,66388026,SPSI,Carotid Duplex,,Per Svc,3717.00
Chargemaster Item,,66388208,SPSI,Lim/Fu Carotid Duplex,,Per Svc,2014.00
Chargemaster Item,,66388612,SPSI,Tcd Complete,,Per Svc,2999.00
Chargemaster Item,,66388802,SPSI,Tcd Limited,,Per Svc,1933.00
Chargemaster Item,,66389016,SPSI,Tcd Vasoreactive,,Per Svc,3781.00
Chargemaster Item,,66389206,SPSI,Tcd W/O Microbubble,,Per Svc,2101.00
Chargemaster Item,,66389305,SPSI,Tcd W/ Microbubble,,Per Svc,2351.00
Chargemaster Item,,66392259,SPSI,Abi/Plethy/Segment/Tcpo2 Ltd,,Per Svc,1391.00
Chargemaster Item,,66392374,SPSI,Abi/Plethy/Segment/Tcpo2,,Per Svc,2622.00
Chargemaster Item,,66392408,SPSI,Art Exam W/ Treadmill,,Per Svc,2937.00
Chargemaster Item,,66392531,SPSI,Lwrext Arterial Duplex Bilat,,Per Svc,2973.00
Chargemaster Item,,66392622,SPSI,Lext Arterial Duplex Left,,Per Svc,1617.00
Chargemaster Item,,66393026,SPSI,Upper Ext Arterial Duplex Scan,,Per Svc,2681.00
Chargemaster Item,,66393125,SPSI,Upper Ext Art Duplex Scan Left,,Per Svc,1624.00
Chargemaster Item,,66397068,SPSI,Duplex Scan Bilat Ext Veins,,Per Svc,3812.00
Chargemaster Item,,66397159,SPSI,Left Extremity Duplex Scan,,Per Svc,2692.00
Chargemaster Item,,66397548,SPSI,Us Visceral Duplex Scan,,Per Svc,2520.00
Chargemaster Item,,66397621,SPSI,Dup Art/Vein Abdomin/Renal Ltd,,Per Svc,2009.00
Chargemaster Item,,66397852,SPSI,Bypass Grafts Duplex Scan,,Per Svc,2678.00
Chargemaster Item,,66397928,SPSI,Lim Bypass Grafts Duplex Scan,,Per Svc,1350.00
Chargemaster Item,,66399015,SPSI,Dialysis Access Graft Eval,,Per Svc,2265.00
Chargemaster Item,,67000001,SPSI,Hemodialysis,,Per Svc,9077.00
Chargemaster Item,,67000002,SPSI,CRRT,,Per Svc,9077.00
Chargemaster Item,,67000003,SPSI,Peritoneal Dialysis,,Per Svc,9077.00
Chargemaster Item,,67000004,SPSI,Plasmapheresis,,Per Svc,11376.00
Chargemaster Item,,67000059,SPSI,Blood Transfusion,,Per Svc,1860.00
Chargemaster Item,,68000008,SPSI,Cognitive Training: init15 Min,,Per Svc,284.00
Chargemaster Item,,68000018,SPSI,Cognitive Training: addl15 Min,,Per Svc,266.00
Chargemaster Item,,68000050,SPSI,E visit 5-10 mins.,,Per Svc,131.00
Chargemaster Item,,68000051,SPSI,E visit 11-20 mins.,,Per Svc,231.00
Chargemaster Item,,68000052,SPSI,E visit 21 or more mins.,,Per Svc,361.00
Chargemaster Item,,68001056,SPSI,Manual Therapy Tech Ea 15 Min OT,,Every 15 Minutes,379.00
Chargemaster Item,,68001064,SPSI,Sensory Integrative Tech Ea 15 Min OT,,Every 15 Minutes,276.00
Chargemaster Item,,68001148,SPSI,Debridement First 20sq cm OT,,Per Svc,737.00
Chargemaster Item,,68001155,SPSI,Debridement Ea Add 20 sq cm OT,,Per Svc,320.00
Chargemaster Item,,68003344,SPSI,Medical Supply,,Per Svc,55.00
Chargemaster Item,,68020007,SPSI,Cognitive Training Ea 15 Min OT,,Every 15 Minutes,320.00
Chargemaster Item,,68020015,SPSI,Self Care Home Manage Training Ea 15 Min OT,,Every 15 Minutes,343.00
Chargemaster Item,,68020023,SPSI,Therapeutic Activities Ea 15 Min OT,,Every 15 Minutes,459.00
Chargemaster Item,,68020056,SPSI,Muscle Re-Education Ea 15 Min OT,,Every 15 Minutes,443.00
Chargemaster Item,,68020098,SPSI,Orth/Prosth Use Checkout Each 15 Min,,Every 15 Minutes,190.00
Chargemaster Item,,68020106,SPSI,Therex Ea 15 Min OT,,Every 15 Minutes,324.00
Chargemaster Item,,68020114,SPSI,Orthotic Fitting/Training Ea 15 Min OT,,Every 15 Minutes,231.00
Chargemaster Item,,68020155,SPSI,Whirlpool OT,,Per Svc,258.00
Chargemaster Item,,68020163,SPSI,Ultrasound Each 15 Min OT,,Every 15 Minutes,195.00
Chargemaster Item,,68020189,SPSI,Elec Stim Unattended OT,,Per Svc,261.00
Chargemaster Item,,68020197,SPSI,TENS,,Per Svc,103.00
Chargemaster Item,,68020205,SPSI,Iontophoresis Each 15 Min OT,,Every 15 Minutes,284.00
Chargemaster Item,,68020221,SPSI,Hot Packs Cold Packs OT,,Per Svc,139.00
Chargemaster Item,,68020528,SPSI,Paraffin Bath OT,,Per Svc,136.00
Chargemaster Item,,68020585,SPSI,Vasopneumatic Device OT,,Per Svc,208.00
Chargemaster Item,,68021039,SPSI,Orthosis Custom Eo Free Motion,,Per Svc,2065.00
Chargemaster Item,,68021195,SPSI,Whfo Dyn Wst/Finger Driven,,Per Svc,3568.00
Chargemaster Item,,68021237,SPSI,Wrist Molded To Patient Model,,Per Svc,1172.00
Chargemaster Item,,68021633,SPSI,Shoulder Strapping,,Per Svc,614.00
Chargemaster Item,,68021641,SPSI,Hand/Finger Strapping,,Per Svc,675.00
Chargemaster Item,,68021658,SPSI,Electric Stim Attended OT,,Per Svc,250.00
Chargemaster Item,,68021666,SPSI,PT Developmental Testing,Extended,,Per Svc,1438.00
Chargemaster Item,,68021674,SPSI,Elbow/Wrist Strapping,,Per Svc,614.00
Chargemaster Item,,68022367,SPSI,Electrode-Ionto,,Per Svc,77.00
Chargemaster Item,,68022409,SPSI,Non-Selective Debridement OT,,Per Svc,346.00
Chargemaster Item,,68022672,SPSI,Finger (Eg:Contracture),,Per Svc,614.00
Chargemaster Item,,68022680,SPSI,Finger Splint (Static),,Per Svc,1233.00
Chargemaster Item,,68022706,SPSI,Short Arm Splint,,Per Svc,1233.00
Chargemaster Item,,68024074,SPSI,Ewho Rigid W/O Joints Custom,,Per Svc,1745.00
Chargemaster Item,,68024082,SPSI,Ewho Nontorsion Jts, Custom,,Per Svc,2208.00
Chargemaster Item,,68024132,SPSI,Who Nontorsion Joints Custom,,Per Svc,2048.00
Chargemaster Item,,68024199,SPSI,Hfo W/O Joints Custom,,Per Svc,657.00
Chargemaster Item,,68024249,SPSI,Ho W/O Joints Custom,,Per Svc,647.00
Chargemaster Item,,68024348,SPSI,Fo W/O Joints Custom,,Per Svc,462.00
Chargemaster Item,,68024363,SPSI,Fo Nontorsion Joints Custom,,Per Svc,493.00
Chargemaster Item,,68024587,SPSI,Whfo Rigid W/O Jts Custom,,Per Svc,985.00
Chargemaster Item,,68025190,SPSI,Init eval: Low comp 30 mins,,Per Svc,733.00
Chargemaster Item,,68025200,SPSI,Init eval: Mod comp 45 mins,,Per Svc,733.00
Chargemaster Item,,68025210,SPSI,Init eval: High comp 60 mins,,Per Svc,733.00
Chargemaster Item,,68025220,SPSI,Re-Evaluation OT,,Per Svc,419.00
Chargemaster Item,,68970127,SPSI,Traction Mechanical,,Per Svc,235.00
Chargemaster Item,,68990022,SPSI,wheelchair manage ea 15 min,,Every 15 Minutes,251.00
Chargemaster Item,,69000016,SPSI,Epi Auto Trk, Arms Legs,,Per Svc,8555.00
Chargemaster Item,,69000024,SPSI,Epi Auto Trk, Arms Legs >100,,Per Svc,2137.00
Chargemaster Item,,69000028,SPSI,Biofeedback UI init 15 mins,,Per Svc,441.00
Chargemaster Item,,69000032,SPSI,Epi Auto Face, Scalp, Hands,,Per Svc,8555.00
Chargemaster Item,,69000038,SPSI,Biofeedback UI addl 15 mins,,Per Svc,321.00
Chargemaster Item,,69000040,SPSI,Epi Auto Face, Scalp, Hand >100,,Per Svc,2137.00
Chargemaster Item,,69000050,SPSI,E visit 5-10 mins,,Per Svc,131.00
Chargemaster Item,,69000051,SPSI,E visit 11-20 mins,,Per Svc,231.00
Chargemaster Item,,69000052,SPSI,E visit 21 or more mins,,Per Svc,361.00
Chargemaster Item,,69000057,SPSI,Half Year Membership,,Per Svc,300.00
Chargemaster Item,,69000065,SPSI,Half Year Membership Assoc,,Per Svc,250.00
Chargemaster Item,,69000081,SPSI,Massage 30 mins,,Every 30 Minutes,30.00
Chargemaster Item,,69001105,SPSI,Massage Patient,,First 30 Minutes,45.00
Chargemaster Item,,69003344,SPSI,Medical Supply,,Per Svc,55.00
Chargemaster Item,,69010155,SPSI,Electrode-Ionto,,Per Svc,77.00
Chargemaster Item,,69010197,SPSI,Hinged Knee Brace,,Per Svc,496.00
Chargemaster Item,,69010247,SPSI,Coban 3 Inch,,Per Svc,4.00
Chargemaster Item,,69010361,SPSI,Extension/Flexion 501,,Per Svc,151.00
Chargemaster Item,,69010411,SPSI,Arch Support-Metatarsal,,Per Svc,8.00
Chargemaster Item,,69010486,SPSI,Unna Boot,,Per Svc,607.00
Chargemaster Item,,69010601,SPSI,Muscle Re-Education Ea 15 Min,,Every 15 Minutes,441.00
Chargemaster Item,,69010635,SPSI,Orthotic Fitting/Training Ea 15 Min,,Every 15 Minutes,265.00
Chargemaster Item,,69010684,SPSI,Self Care Home Manage Training Ea 15 Min,,Every 15 Minutes,341.00
Chargemaster Item,,69010742,SPSI,Knee Strapping,,Per Svc,213.00
Chargemaster Item,,69010759,SPSI,Ankle/Foot Strapping,,Per Svc,212.00
Chargemaster Item,,69010767,SPSI,Toe(S) Strapping,,Per Svc,212.00
Chargemaster Item,,69010775,SPSI,Stapping/Lowback,,Per Svc,442.00
Chargemaster Item,,69010783,SPSI,Shoulder Strapping,,Per Svc,614.00
Chargemaster Item,,69010791,SPSI,Elbow/Wrist Strapping,,Per Svc,614.00
Chargemaster Item,,69010809,SPSI,Hand/Finger Strapping,,Per Svc,675.00
Chargemaster Item,,69010817,SPSI,Therapeutic Activities Ea 15 Min,,Every 15 Minutes,459.00
Chargemaster Item,,69010965,SPSI,Manual Therapy Tech Ea 15 Min,,Every 15 Minutes,375.00
Chargemaster Item,,69011013,SPSI,Unna Boot Supply,,Per Svc,60.00
Chargemaster Item,,69011294,SPSI,Biofeedback,,Per Svc,319.00
Chargemaster Item,,69011351,SPSI,Non-Selective Debridement,,Per Svc,346.00
Chargemaster Item,,69011369,SPSI,Sensory Integrative Tech Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,69011377,SPSI,Biofeedback UI,,Per Svc,442.00
Chargemaster Item,,69011385,SPSI,Aquatic Therapy Each 15 Min,,Every 15 Minutes,331.00
Chargemaster Item,,69011393,SPSI,Contact Cast,,Per Svc,1557.00
Chargemaster Item,,69011583,SPSI,Electric Stim Unattended,,Per Svc,260.00
Chargemaster Item,,69011609,SPSI,Group Therapy Exercises,,Per Svc,316.00
Chargemaster Item,,69011617,SPSI,Debridement First 20sq cm,,Per Svc,737.00
Chargemaster Item,,69011625,SPSI,Debridement Ea Add 20 sq cm,,Per Svc,244.00
Chargemaster Item,,69011633,SPSI,Collagen Dres<16Sqin,,Per Svc,179.00
Chargemaster Item,,69011658,SPSI,Wound Vac<50,,Per Svc,730.00
Chargemaster Item,,69011666,SPSI,Wound Vac>50,,Per Svc,840.00
Chargemaster Item,,69011674,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,69011682,SPSI,Short Leg Splint,,Per Svc,357.00
Chargemaster Item,,69011690,SPSI,Orth/Prosth Use Checkout Each 15 Min,,Every 15 Minutes,190.00
Chargemaster Item,,69011716,SPSI,PT Developmental Testing,Extended,,Per Svc,1438.00
Chargemaster Item,,69011724,SPSI,Canalith Repositioning Procedure,,Per Svc,232.00
Chargemaster Item,,69011730,SPSI,Sel debride and unna boot,,Per Svc,1343.00
Chargemaster Item,,69051460,SPSI,Init eval: Low comp 20 mins,,Per Svc,716.00
Chargemaster Item,,69051470,SPSI,Init eval: Mod comp 30 mins,,Per Svc,716.00
Chargemaster Item,,69051480,SPSI,Init eval: High comp 45 mins,,Per Svc,716.00
Chargemaster Item,,69051490,SPSI,Re-Evaluation,,Per Svc,385.00
Chargemaster Item,,69212341,SPSI,Hip Strapping,,Per Svc,213.00
Chargemaster Item,,69222008,SPSI,Clinic Visit New Patient Minimum,,Per Svc,162.00
Chargemaster Item,,69222016,SPSI,Clinic Visit New Patient Limited,,Per Svc,195.00
Chargemaster Item,,69222024,SPSI,Clinic Visit New Patient Low Complex,,Per Svc,228.00
Chargemaster Item,,69222032,SPSI,Clinic Visit New Patient Mod Complex,,Per Svc,271.00
Chargemaster Item,,69222040,SPSI,Clinic Visit New Patient High,,Per Svc,403.00
Chargemaster Item,,69222065,SPSI,Clinic Visit Est Limited,,Per Svc,171.00
Chargemaster Item,,69222073,SPSI,Clinic Visit Est Low Complex,,Per Svc,186.00
Chargemaster Item,,69222081,SPSI,Clinic Visit Est Mod Complex,,Per Svc,238.00
Chargemaster Item,,69222099,SPSI,Clinic Visit Est High,,Per Svc,305.00
Chargemaster Item,,69222222,SPSI,Wound Vac>50 A,,Per Svc,922.00
Chargemaster Item,,69222305,SPSI,Oasis Skin Subst Per Sq Cm,,Per Svc,32.00
Chargemaster Item,,69222321,SPSI,Skin Sub Grft T/A/L 25 Sq CM,,Per Svc,2271.00
Chargemaster Item,,69222339,SPSI,Skin Sub Graft T/A/L Add-On,,Per Svc,844.00
Chargemaster Item,,69222347,SPSI,Skin Sub Graft F/N/HF/G 25 Sq,,Per Svc,2271.00
Chargemaster Item,,69222354,SPSI,Skin Sub Graft F/N/Hf/G Add-On,,Per Svc,844.00
Chargemaster Item,,69222362,SPSI,Skin Sub Grft T/A/L CH > 100 Sq,,Per Svc,3470.00
Chargemaster Item,,69222370,SPSI,Skin Sub Graft T/A/L Child Add,,Per Svc,2271.00
Chargemaster Item,,69222388,SPSI,Skin Sub Grft F/N/HF/G CH 1st 100 Sq,,Per Svc,3470.00
Chargemaster Item,,69222396,SPSI,Skin Sub Graft F/N/HF/G Ch Add,,Per Svc,2271.00
Chargemaster Item,,69222404,SPSI,Wound Vac Disposable < 50,,Per Svc,912.00
Chargemaster Item,,69222412,SPSI,Wound Vac Disposable > 50,,Per Svc,912.00
Chargemaster Item,,69390601,SPSI,Massage Associate,,First 30 Minutes,43.00
Chargemaster Item,,69392201,SPSI,Any Test and Measure ea 15 Min,,Every 15 Minutes,407.00
Chargemaster Item,,69514604,SPSI,Unna Boot and NSD,,Per Svc,953.00
Chargemaster Item,,69640620,SPSI,Biofeedback UI,,Per Svc,442.00
Chargemaster Item,,69707073,SPSI,Electric Stim Attended Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,69900017,SPSI,Cardiac Rehab/Monitored,,Per Svc,275.00
Chargemaster Item,,69910024,SPSI,TENS,,Per Svc,103.00
Chargemaster Item,,69970101,SPSI,Hot Packs Cold Packs,,Per Svc,139.00
Chargemaster Item,,69970127,SPSI,Traction Mechanical,,Per Svc,235.00
Chargemaster Item,,69970143,SPSI,Elec Stim Unattended,,Per Svc,260.00
Chargemaster Item,,69970169,SPSI,Vasopneumatic Device,,Per Svc,208.00
Chargemaster Item,,69970184,SPSI,Paraffin Bath,,Per Svc,171.00
Chargemaster Item,,69970226,SPSI,Whirlpool,,Per Svc,258.00
Chargemaster Item,,69970333,SPSI,Iontophoresis Each 15 Min,,Every 15 Minutes,283.00
Chargemaster Item,,69970358,SPSI,Ultrasound Each 15 Min,,Every 15 Minutes,195.00
Chargemaster Item,,69971109,SPSI,Therex Ea 15 Min,,Every 15 Minutes,320.00
Chargemaster Item,,69971166,SPSI,Gait Training Each 15 Mins,,Every 15 Minutes,412.00
Chargemaster Item,,69971285,SPSI,Annual Membership,,Per Svc,600.00
Chargemaster Item,,69975209,SPSI,Prosthetic Training Each 15 Min,,Every 15 Minutes,391.00
Chargemaster Item,,69977502,SPSI,Isokinetic Test Each 15 Min,,Every 15 Minutes,442.00
Chargemaster Item,,69990004,SPSI,Gym Fitness 4 visits,,Per Svc,30.00
Chargemaster Item,,69990012,SPSI,Gym Fitness 8 Visits,,Per Svc,60.00
Chargemaster Item,,69990022,SPSI,wheelchair manage ea 15 min,,Every 15 Minutes,251.00
Chargemaster Item,,69990772,SPSI,Annual Membership Associate Only,,Per Svc,500.00
Chargemaster Item,,69999019,SPSI,Sports Physical,,Per Svc,31.00
Chargemaster Item,,69999100,SPSI,Golf Wellness One Hour,,Per Svc,90.00
Chargemaster Item,,69999134,SPSI,Aquatic Fitness Per Visit,,Per Svc,9.00
Chargemaster Item,,69999142,SPSI,Aquatic Fitness 4 Visits,,Per Svc,30.00
Chargemaster Item,,69999167,SPSI,Gym Fitness Per Visit,,Per Svc,7.50
Chargemaster Item,,69999191,SPSI,Aquatics Fitness 8 Visits,,Per Svc,60.00
Chargemaster Item,,69999225,SPSI,Epifix per sq cm,,Per Svc,641.00
Chargemaster Item,,69999985,SPSI,Golf Wellness Prog Eval,,Per Svc,158.00
Chargemaster Item,,70003344,SPSI,Medical Supply,,Per Svc,55.00
Chargemaster Item,,70899604,SPSI,SP Swallow Current Status,,Per Svc,0.01
Chargemaster Item,,70899703,SPSI,SP Swallow Goal Status,,Per Svc,0.01
Chargemaster Item,,70899802,SPSI,SP Swallow D/C Status,,Per Svc,0.01
Chargemaster Item,,70899901,SPSI,SP Motor Speech Current Status,,Per Svc,0.01
Chargemaster Item,,70915806,SPSI,SP Motor Speech D/C Status,,Per Svc,0.01
Chargemaster Item,,70915905,SPSI,SP Lang Comp Current Status,,Per Svc,0.01
Chargemaster Item,,70916002,SPSI,SP Lang Comp Goal Status,,Per Svc,0.01
Chargemaster Item,,70916101,SPSI,SP Lang Comp D/C Status,,Per Svc,0.01
Chargemaster Item,,70916200,SPSI,SP Lang Express Current Status,,Per Svc,0.01
Chargemaster Item,,70916309,SPSI,SP Lang Express Goal Status,,Per Svc,0.01
Chargemaster Item,,70916408,SPSI,SP Lang Express D/C Status,,Per Svc,0.01
Chargemaster Item,,70916507,SPSI,SP Atten Current Status,,Per Svc,0.01
Chargemaster Item,,70916606,SPSI,SP Atten Goal Status,,Per Svc,0.01
Chargemaster Item,,70916705,SPSI,SP Atten D/C Status,,Per Svc,0.01
Chargemaster Item,,70916804,SPSI,SP Memory Current Status,,Per Svc,0.01
Chargemaster Item,,70916903,SPSI,SP Memory Goal Status,,Per Svc,0.01
Chargemaster Item,,70917000,SPSI,SP Memory D/C Status,,Per Svc,0.01
Chargemaster Item,,70917109,SPSI,SP Voice Current Status,,Per Svc,0.01
Chargemaster Item,,70917208,SPSI,SP Voice Goal Status,,Per Svc,0.01
Chargemaster Item,,70917307,SPSI,SP Voice D/C Status,,Per Svc,0.01
Chargemaster Item,,70917406,SPSI,SP Speech Lang Current Status,,Per Svc,0.01
Chargemaster Item,,70917505,SPSI,SP Speech Lang Goal Status,,Per Svc,0.01
Chargemaster Item,,70917604,SPSI,SP Speech Lang D/C Status,,Per Svc,0.01
Chargemaster Item,,70918602,SPSI,SP Motor Speech Goal Status,,Per Svc,0.01
Chargemaster Item,,70925060,SPSI,Speech/Dysphagia Eval,,Per Svc,813.00
Chargemaster Item,,70925078,SPSI,Speech Therapy Treatment,,Per Svc,802.00
Chargemaster Item,,70925094,SPSI,Speech Evaluation,,Per Svc,761.00
Chargemaster Item,,70925177,SPSI,Treatment Of Swallow Dysfuncti,,Per Svc,782.00
Chargemaster Item,,70925185,SPSI,Laryngeal Function Studies,,Per Svc,1173.00
Chargemaster Item,,70925219,SPSI,Eval Of Swallow Dysfunction,,Per Svc,1437.00
Chargemaster Item,,70925227,SPSI,Eval Mbs Cine/Video,,Per Svc,1291.00
Chargemaster Item,,70925235,SPSI,Eval-Sgp Isthr,,Every 60 Minutes,1012.00
Chargemaster Item,,70925268,SPSI,Cognitive Training Ea 15 Min,,Every 15 Minutes,301.00
Chargemaster Item,,70925276,SPSI,Sensory Integrative Tech Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,70925284,SPSI,Sgd Train/Fit,,Per Svc,493.00
Chargemaster Item,,70925300,SPSI,Electric Stim Attended Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,70925326,SPSI,Therapeutic Activities Ea 15 Min,,Every 15 Minutes,459.00
Chargemaster Item,,70925334,SPSI,Cognitive Training_init15 Min,,Per Svc,284.00
Chargemaster Item,,70925342,SPSI,Cognitive Training_addl15 Min,,Per Svc,266.00
Chargemaster Item,,70925355,SPSI,E-visit 21 or more mins,,Per Svc,361.00
Chargemaster Item,,70925357,SPSI,E-visit 11-20 mins,,Per Svc,231.00
Chargemaster Item,,70925359,SPSI,E-visit 5-10 mins,,Per Svc,131.00
Chargemaster Item,,70971109,SPSI,Therex Ea 15 Min,,Every 15 Minutes,320.00
Chargemaster Item,,71000020,SPSI,Local Mac Anesthesia,,First 60 Minutes,982.00
Chargemaster Item,,71000046,SPSI,General/Spinal Anes,,First 60 Minutes,2842.00
Chargemaster Item,,71000061,SPSI,Egd With Eus Of Esophagus Only,,Per Svc,7454.00
Chargemaster Item,,71000079,SPSI,EGD and FNA of Esophagus Only,,Per Svc,7454.00
Chargemaster Item,,71000087,SPSI,Egd With Eus,,Per Svc,7454.00
Chargemaster Item,,71000095,SPSI,Egd With Eus And Fna,,Per Svc,7454.00
Chargemaster Item,,71000103,SPSI,Sigmoidoscopy With Eus,,Per Svc,6037.00
Chargemaster Item,,71000111,SPSI,Sigmoidoscopy With Eus & Fna,,Per Svc,6037.00
Chargemaster Item,,71000129,SPSI,Colonoscopy With Eus,,Per Svc,6037.00
Chargemaster Item,,71000137,SPSI,Colonoscopy With Eus And Fna,,Per Svc,6037.00
Chargemaster Item,,71000145,SPSI,Eus,,Per Svc,7454.00
Chargemaster Item,,71000152,SPSI,Eus With Fna,,Per Svc,7454.00
Chargemaster Item,,71000160,SPSI,Eus Needle,,Per Svc,1151.00
Chargemaster Item,,71000194,SPSI,Moderate Sedation <5/Yrs Int,,Every 15 Minutes,305.00
Chargemaster Item,,71000202,SPSI,Moderate Sedation >5/Yrs Initial,,Every 15 Minutes,303.00
Chargemaster Item,,71400006,SPSI,Gi Lab Cancelled,,Per Svc,2407.00
Chargemaster Item,,71400030,SPSI,Endoscopic Biopsy,,Per Svc,4811.00
Chargemaster Item,,71400048,SPSI,Endoscopic Cytology,,Per Svc,361.00
Chargemaster Item,,71400055,SPSI,Lower Polypectomy,,Per Svc,5783.00
Chargemaster Item,,71400063,SPSI,Foreign Body Removal,,Per Svc,3397.00
Chargemaster Item,,71400071,SPSI,Esoph Sclerosis,,Per Svc,4605.00
Chargemaster Item,,71400501,SPSI,Sensor Nellcor,,Per Svc,331.00
Chargemaster Item,,71401400,SPSI,Esophagduodnoscpy,,Per Svc,3150.00
Chargemaster Item,,71402002,SPSI,Colonoscopy,,Per Svc,4746.00
Chargemaster Item,,71402994,SPSI,Flex Sigmoidoscopy,,Per Svc,1426.00
Chargemaster Item,,71410484,SPSI,Ercp,,Per Svc,4558.00
Chargemaster Item,,71410492,SPSI,Recovery Room,,First 60 Minutes,1305.00
Chargemaster Item,,71430003,SPSI,Cath Inf No Dialysis,,Per Svc,0.01
Chargemaster Item,,71430045,SPSI,Cath Guide,,Per Svc,0.01
Chargemaster Item,,71432199,SPSI,Insertion Of Esophageal Stent,,Per Svc,2836.00
Chargemaster Item,,71432447,SPSI,Band Ligation,,Per Svc,7518.00
Chargemaster Item,,71432512,SPSI,Upper Polypectomy,,Per Svc,3666.00
Chargemaster Item,,71432587,SPSI,Ablation Therapy Ego,,Per Svc,5716.00
Chargemaster Item,,71432595,SPSI,Wallstent Biliary,,Per Svc,9629.00
Chargemaster Item,,71432611,SPSI,Ercp W/ Biopsy,,Per Svc,6732.00
Chargemaster Item,,71432629,SPSI,Sphincterotomy,,Per Svc,2996.00
Chargemaster Item,,71432645,SPSI,Stone Removal,,Per Svc,4625.00
Chargemaster Item,,71432652,SPSI,Lithotripsy Of Stone,,Per Svc,4392.00
Chargemaster Item,,71432686,SPSI,Stent Placement Bilia,,Per Svc,2930.00
Chargemaster Item,,71432694,SPSI,Ercp w/St Removal,,Per Svc,5102.00
Chargemaster Item,,71432710,SPSI,Balloon Dilation Of D,,Per Svc,3110.00
Chargemaster Item,,71432728,SPSI,Ablation Therapy Ercp,,Per Svc,5716.00
Chargemaster Item,,71434450,SPSI,Dilitation By Balloon,,Per Svc,3878.00
Chargemaster Item,,71434500,SPSI,Esophag Bouginage,,Per Svc,1041.00
Chargemaster Item,,71435507,SPSI,Gastrostomy,,Per Svc,6836.00
Chargemaster Item,,71436505,SPSI,Bicap - Upper,,Per Svc,3666.00
Chargemaster Item,,71437602,SPSI,Chg Of Gastrostomy/No Scope,,Per Svc,3110.00
Chargemaster Item,,71440010,SPSI,Bite Block,,Per Svc,46.00
Chargemaster Item,,71440028,SPSI,Snare,,Per Svc,264.00
Chargemaster Item,,71440036,SPSI,Forcep,,Per Svc,230.00
Chargemaster Item,,71440044,SPSI,Cannula,,Per Svc,620.00
Chargemaster Item,,71440051,SPSI,Guide Wire GI,,Per Svc,741.00
Chargemaster Item,,71440069,SPSI,Stonetome,,Per Svc,2988.00
Chargemaster Item,,71440085,SPSI,Peg Kit,,Per Svc,1463.00
Chargemaster Item,,71440093,SPSI,Peg Replacement,,Per Svc,148.00
Chargemaster Item,,71440101,SPSI,Ph Bravo Capsule,,Per Svc,1567.00
Chargemaster Item,,71440119,SPSI,Cre Balloon,,Per Svc,1892.00
Chargemaster Item,,71440150,SPSI,Flexima Stent,,Per Svc,559.00
Chargemaster Item,,71440168,SPSI,Cytology Catheter,,Per Svc,793.00
Chargemaster Item,,71440176,SPSI,Esophageal Stent,,Per Svc,9628.00
Chargemaster Item,,71440184,SPSI,Extractor Balloon,,Per Svc,1192.00
Chargemaster Item,,71440200,SPSI,Injection Gold Probe,,Per Svc,3783.00
Chargemaster Item,,71441000,SPSI,Sm Bowel Biop,,Per Svc,1724.00
Chargemaster Item,,71443733,SPSI,Conversion Peg to Pej,,Per Svc,3630.00
Chargemaster Item,,71453302,SPSI,Sigmodoscopy Biopsy,,Per Svc,1926.00
Chargemaster Item,,71453385,SPSI,Flex Sig Polypectomy,,Per Svc,2452.00
Chargemaster Item,,71453799,SPSI,Colon w/Fb Removal,,Per Svc,5038.00
Chargemaster Item,,71453807,SPSI,Colonoscopy Biopsy,,Per Svc,5217.00
Chargemaster Item,,71453823,SPSI,Bicap - Lower,,Per Svc,4816.00
Chargemaster Item,,71453831,SPSI,Ablation Therapy Colo,,Per Svc,6291.00
Chargemaster Item,,71453872,SPSI,Colon Stent Placement,,Per Svc,3686.00
Chargemaster Item,,71460026,SPSI,Stent Colon,,Per Svc,9580.00
Chargemaster Item,,71460034,SPSI,Jejunel Tube,,Per Svc,1549.00
Chargemaster Item,,71460059,SPSI,Gastro/Jejuno Tube, Std,,Per Svc,903.00
Chargemaster Item,,71480008,SPSI,Colonoscopy w/ Submucosal Inj,,Per Svc,7873.00
Chargemaster Item,,71480016,SPSI,Argon Plasma Coagulation Cath,,Per Svc,1112.00
Chargemaster Item,,71480024,SPSI,Egd w/ Control Of Bleeding,,Per Svc,6063.00
Chargemaster Item,,71480032,SPSI,Biliary Dilation Catheter,,Per Svc,1444.00
Chargemaster Item,,71480057,SPSI,Small Bowel Enteroscopy (SBE),,Per Svc,2836.00
Chargemaster Item,,71480065,SPSI,Mechanical Lithotripter,,Per Svc,3323.00
Chargemaster Item,,71480073,SPSI,Ercp + Stent Replacement,,Per Svc,4558.00
Chargemaster Item,,71480099,SPSI,Colonoscopy w/Control of Bleed,,Per Svc,7296.00
Chargemaster Item,,71500003,SPSI,Retrieval Net,,Per Svc,213.00
Chargemaster Item,,71500011,SPSI,Clip Device,,Per Svc,424.00
Chargemaster Item,,71500029,SPSI,Colonoscopy w/ Banding,,Per Svc,9288.00
Chargemaster Item,,71500037,SPSI,Retrieval Basket,,Per Svc,705.00
Chargemaster Item,,71500045,SPSI,Billiary Dilatation Balloon,,Per Svc,1131.00
Chargemaster Item,,71500052,SPSI,Polyflex Esophageal Stent,,Per Svc,8600.00
Chargemaster Item,,71600001,SPSI,Cath Balloon Non-Vasc,,Per Svc,0.01
Chargemaster Item,,71600019,SPSI,Miscellaneous Implant,,Per Svc,0.01
Chargemaster Item,,71600027,SPSI,Stent Coat W/Delvry,,Per Svc,0.01
Chargemaster Item,,71600035,SPSI,Stent Non W/Delvry,,Per Svc,0.01
Chargemaster Item,,71600043,SPSI,Stent Non W/O Delvry,,Per Svc,0.01
Chargemaster Item,,71600050,SPSI,Stent Tmp W/O Delvry,,Per Svc,0.01
Chargemaster Item,,71866776,SPSI,H-Pylori Test,,Per Svc,304.00
Chargemaster Item,,71911101,SPSI,Capsule Endoscopy,,Per Svc,4894.00
Chargemaster Item,,71987655,SPSI,Capsule Endoscopy Kit,,Per Svc,2475.00
Chargemaster Item,,71987663,SPSI,Miscellaneous Supply,,Per Svc,0.01
Chargemaster Item,,71992119,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,72000003,SPSI,Er Rm Chg Lv 1,,Per Svc,445.00
Chargemaster Item,,72000011,SPSI,Rabies Vaccine Im,,Per Svc,1691.00
Chargemaster Item,,72000334,SPSI,Moderate Sedation <5/Yrs Int,,Every 15 Minutes,305.00
Chargemaster Item,,72000342,SPSI,Moderate Sedation >5/Yrs Initial,,Every 15 Minutes,303.00
Chargemaster Item,,72001001,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,72001019,SPSI,Trauma Intensive Care Unit,,Per Svc,22266.00
Chargemaster Item,,72001027,SPSI,Trauma Intensive Care Unit MC,,Per Svc,22266.00
Chargemaster Item,,72001035,SPSI,Cardiac Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,72002567,SPSI,ER Medical Supply,,Per Svc,17.00
Chargemaster Item,,72003007,SPSI,Definitive Observation Unit 3,,Per Svc,11138.00
Chargemaster Item,,72003015,SPSI,Definitive Observation Unit 2,,Per Svc,11138.00
Chargemaster Item,,72005002,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,72006000,SPSI,Pediatrics Unit,,Per Svc,7950.00
Chargemaster Item,,72007008,SPSI,Ldrp Unit,,Per Svc,7950.00
Chargemaster Item,,72150006,SPSI,Er Rm Chg Lv 3,,Per Svc,1285.00
Chargemaster Item,,72150105,SPSI,Er Rm Chg Lv 4,,Per Svc,2471.00
Chargemaster Item,,72150113,SPSI,Er Triage,,Per Svc,246.00
Chargemaster Item,,72150121,SPSI,Er Rm Chg Lv 5,,Per Svc,3976.00
Chargemaster Item,,72150139,SPSI,Blood Transfusion,,Per Svc,1860.00
Chargemaster Item,,72150154,SPSI,Immuniz Admin,,Per Svc,301.00
Chargemaster Item,,72150162,SPSI,Immuniz Admin Ea Add Vac,,Per Svc,433.00
Chargemaster Item,,72150170,SPSI,Dermabond,,Per Svc,392.00
Chargemaster Item,,72150204,SPSI,Er Rm Chg Lv 2,,Per Svc,958.00
Chargemaster Item,,72150212,SPSI,Er Rm Chg W/Vent Lv 5,,Per Svc,17995.00
Chargemaster Item,,72150907,SPSI,Sepsis Catheter,,Per Svc,1259.00
Chargemaster Item,,72300007,SPSI,IV Infusion Initial IVPB,,Per Svc,637.00
Chargemaster Item,,72300015,SPSI,IV Hydration,,Every 60 Minutes,1227.00
Chargemaster Item,,72300023,SPSI,Iv Infuse, Each Addl Hr,,Per Svc,611.00
Chargemaster Item,,72300031,SPSI,Iv Hydration Ea Add Hr,,Per Svc,611.00
Chargemaster Item,,72300049,SPSI,IV Push Single/Initial Drug,,Per Svc,454.00
Chargemaster Item,,72300056,SPSI,IV Push Sequential Ea New Med,,Per Svc,454.00
Chargemaster Item,,72300080,SPSI,Prolong Iv Inf Port Or Imp Pump,,Per Svc,1158.00
Chargemaster Item,,72300098,SPSI,Urine Pregnancy,,Per Svc,378.00
Chargemaster Item,,72300106,SPSI,Urinalysis Without Micro,,Per Svc,267.00
Chargemaster Item,,72300114,SPSI,IV Push Sequential Same Med Rpt Doses,,Per Svc,427.00
Chargemaster Item,,72300155,SPSI,Catheterize For Urine Spec,,Per Svc,17.00
Chargemaster Item,,72315005,SPSI,Endotracheal Intubation,,Per Svc,845.00
Chargemaster Item,,72400005,SPSI,Procedure in Trauma,,Per Svc,1822.00
Chargemaster Item,,72400010,SPSI,Trauma Level One - Pre Notification,,Per Svc,18838.00
Chargemaster Item,,72400011,SPSI,Trauma Level Two - Pre Notification,,Per Svc,12951.00
Chargemaster Item,,72400012,SPSI,Trauma Level One - No Pre Notification,,Per Svc,18838.00
Chargemaster Item,,72400013,SPSI,Trauma Level Two - No Pre Notification,,Per Svc,12951.00
Chargemaster Item,,72400014,SPSI,Trauma Evaluation,,Per Svc,5887.00
Chargemaster Item,,72700032,SPSI,Bamlanivimab Infusion,,Per Svc,1238.40
Chargemaster Item,,72800006,SPSI,Procedure In ER,,Per Svc,1822.00
Chargemaster Item,,72800014,SPSI,ED Procedure,,Per Svc,1822.00
Chargemaster Item,,72901002,SPSI,Admin Influenza Virus Vaccine,,Per Svc,332.00
Chargemaster Item,,72901010,SPSI,Admin Pneumococcal Vaccine,,Per Svc,332.00
Chargemaster Item,,72907678,SPSI,IV Sequential Infusion Up to 1 Hr IVPB New Med,,Per Svc,1131.00
Chargemaster Item,,72907686,SPSI,IV Concurrent Infuse 2 IVPB at Same Time,,Per Svc,1227.00
Chargemaster Item,,72907728,SPSI,Inj Subcutenousc/Intramus,,Per Svc,234.00
Chargemaster Item,,72908007,SPSI,Pfizer Adm SARS COV2 Dose 1,,Per Svc,67.76
Chargemaster Item,,72908015,SPSI,Pfizer Adm SARS COV2 Dose 2,,Per Svc,113.56
Chargemaster Item,,72908023,SPSI,Moderna Adm SARS COV2 Dose 1,,Per Svc,67.76
Chargemaster Item,,72908031,SPSI,Moderna Adm SARS COV2 Dose 2,,Per Svc,113.56
Chargemaster Item,,72929508,SPSI,Resuscitation CPR,,Per Svc,2386.00
Chargemaster Item,,72929532,SPSI,Temp Transcutaneous Pacing,,Per Svc,12442.00
Chargemaster Item,,72929607,SPSI,Cardioversion,,Per Svc,18029.00
Chargemaster Item,,72929615,SPSI,Cardioversion Elect Int,,Per Svc,11131.00
Chargemaster Item,,72992191,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,72992192,SPSI,Observation Continuation,,First 89 Minutes,331.00
Chargemaster Item,,72992209,SPSI,Observation High Per Hr,,Per Svc,213.00
Chargemaster Item,,72992910,SPSI,Critical Care in ED,,Per Svc,4158.00
Chargemaster Item,,72992936,SPSI,Specimen Collection COVID-19,,Per Svc,91.92
Chargemaster Item,,72992993,SPSI,Direct Admit To Observation,,Per Svc,494.00
Chargemaster Item,,73000008,SPSI,Cognitive Training init15 Min,,Per Svc,308.00
Chargemaster Item,,73000018,SPSI,Cognitive Training addl15 Min,,Per Svc,289.00
Chargemaster Item,,73003344,SPSI,Medical Supply,,Per Svc,55.00
Chargemaster Item,,73010742,SPSI,Knee Strapping,,Per Svc,213.00
Chargemaster Item,,73010759,SPSI,Ankle/Foot Strapping,,Per Svc,212.00
Chargemaster Item,,73010767,SPSI,Toe(S) Strapping,,Per Svc,212.00
Chargemaster Item,,73010775,SPSI,Stapping/Lowback,,Per Svc,442.00
Chargemaster Item,,73010783,SPSI,Shoulder Strapping,,Per Svc,614.00
Chargemaster Item,,73010791,SPSI,Elbow/Wrist Strapping,,Per Svc,614.00
Chargemaster Item,,73010809,SPSI,Hand/Finger Strapping,,Per Svc,675.00
Chargemaster Item,,73020007,SPSI,Cognitive Training Ea 15 Min OT,,Every 15 Minutes,320.00
Chargemaster Item,,73025041,SPSI,Therex Ea 15 Min OT,,Every 15 Minutes,324.00
Chargemaster Item,,73025058,SPSI,Muscle Re-Education Ea 15 Min OT,,Every 15 Minutes,443.00
Chargemaster Item,,73025066,SPSI,Therapeutic Activities Ea 15 Min OT,,Every 15 Minutes,459.00
Chargemaster Item,,73025082,SPSI,Sensory Integrative Tech Ea 15 Min OT,,Every 15 Minutes,276.00
Chargemaster Item,,73025090,SPSI,Self Care Home Manage Training Ea 15 Min OT,,Every 15 Minutes,343.00
Chargemaster Item,,73025190,SPSI,Init eval: Low comp 30 mins,,Per Svc,733.00
Chargemaster Item,,73025200,SPSI,Init eval: Mod comp 45 mins,,Per Svc,733.00
Chargemaster Item,,73025210,SPSI,Init eval: High comp 60 mins,,Per Svc,733.00
Chargemaster Item,,73025220,SPSI,Re-Evaluation OT,,Per Svc,419.00
Chargemaster Item,,73026239,SPSI,PT Developmental Testing,Extended,,Per Svc,1438.00
Chargemaster Item,,73026247,SPSI,ST Developmental Testing,Extended,,Per Svc,1415.00
Chargemaster Item,,73026254,SPSI,OT Developmental Testing,Extended,,Per Svc,1415.00
Chargemaster Item,,73051047,SPSI,Elec Stim Unattended,,Per Svc,260.00
Chargemaster Item,,73051062,SPSI,Iontophoresis Each 15 Min,,Every 15 Minutes,283.00
Chargemaster Item,,73051070,SPSI,Paraffin Bath,,Per Svc,171.00
Chargemaster Item,,73051096,SPSI,TENS,,Per Svc,103.00
Chargemaster Item,,73051104,SPSI,Traction Mechanical,,Per Svc,235.00
Chargemaster Item,,73051120,SPSI,Whirlpool,,Per Svc,258.00
Chargemaster Item,,73051153,SPSI,Gait Training Each 15 Mins,,Every 15 Minutes,412.00
Chargemaster Item,,73051229,SPSI,Therex Ea 15 Min,,Every 15 Minutes,320.00
Chargemaster Item,,73051237,SPSI,Ultrasound Each 15 Min,,Every 15 Minutes,195.00
Chargemaster Item,,73051401,SPSI,Self Care Home Manage Training Ea 15 Min,,Every 15 Minutes,341.00
Chargemaster Item,,73051419,SPSI,Muscle Re-Education Ea 15 Min,,Every 15 Minutes,441.00
Chargemaster Item,,73051427,SPSI,Therapeutic Activities Ea 15 Min,,Every 15 Minutes,459.00
Chargemaster Item,,73051460,SPSI,Init eval: Low comp 20 mins,,Per Svc,716.00
Chargemaster Item,,73051470,SPSI,Init eval: Mod comp 30 mins,,Per Svc,716.00
Chargemaster Item,,73051480,SPSI,Init eval: High comp 45 mins,,Per Svc,716.00
Chargemaster Item,,73051490,SPSI,Re-Evaluation,,Per Svc,385.00
Chargemaster Item,,73051526,SPSI,Hot Packs Cold Packs,,Per Svc,139.00
Chargemaster Item,,73051641,SPSI,Unna Boot,,Per Svc,607.00
Chargemaster Item,,73051666,SPSI,Manual Therapy Tech Ea 15 Min,,Every 15 Minutes,375.00
Chargemaster Item,,73051674,SPSI,Biofeedback,,Per Svc,319.00
Chargemaster Item,,73051724,SPSI,Non-Selective Debridement,,Per Svc,346.00
Chargemaster Item,,73051955,SPSI,Debridement First 20sq cm,,Per Svc,737.00
Chargemaster Item,,73081168,SPSI,Coban 3 Inch,,Per Svc,4.00
Chargemaster Item,,73081408,SPSI,Unna Boot Supply,,Per Svc,60.00
Chargemaster Item,,73392003,SPSI,PT Developemental Testing,,Every 60 Minutes,1324.00
Chargemaster Item,,73412009,SPSI,ST Devel Testing, first hour,,Every 60 Minutes,1324.00
Chargemaster Item,,73412017,SPSI,OT Devel Testing, first hour,,Every 60 Minutes,1324.00
Chargemaster Item,,73930000,SPSI,Speech Evaluation,,Per Svc,761.00
Chargemaster Item,,73930018,SPSI,Speech Therapy Treatment,,Per Svc,802.00
Chargemaster Item,,74100108,SPSI,Access External Cath,,Per Svc,227.00
Chargemaster Item,,74100116,SPSI,Implant Access Catheter,,Per Svc,227.00
Chargemaster Item,,74100132,SPSI,Catheter Suppl,,Per Svc,227.00
Chargemaster Item,,74100470,SPSI,Thera Phlebotomy,,Per Svc,553.00
Chargemaster Item,,74100496,SPSI,Picc Insertion,,Per Svc,5817.00
Chargemaster Item,,74100512,SPSI,Admin Pneumococcal Vaccine,,Per Svc,332.00
Chargemaster Item,,74100652,SPSI,Blood Transfusion,,Per Svc,1860.00
Chargemaster Item,,74100694,SPSI,Admin Influenza Virus Vaccine,,Per Svc,332.00
Chargemaster Item,,74110032,SPSI,Chemo Infusion,,Per Svc,1437.00
Chargemaster Item,,74110040,SPSI,Chemo Iv Ea Addi Hr,,Per Svc,490.00
Chargemaster Item,,74300005,SPSI,IV Infusion Initial IVPB,,Per Svc,637.00
Chargemaster Item,,74300021,SPSI,Iv Infuse, Each Addl Hr,,Per Svc,611.00
Chargemaster Item,,74300047,SPSI,IV Push Single/Initial Drug,,Per Svc,454.00
Chargemaster Item,,74300054,SPSI,IV Push Sequential Ea New Med,,Per Svc,454.00
Chargemaster Item,,74300583,SPSI,IV Hydration,,Every 60 Minutes,1227.00
Chargemaster Item,,74410002,SPSI,Venous Blood Collection,,Per Svc,59.00
Chargemaster Item,,74410010,SPSI,Clinic Visit Est High,,Per Svc,305.00
Chargemaster Item,,74907726,SPSI,IV Sequential Infusion Up to 1 Hr IVPB New Med,,Per Svc,1131.00
Chargemaster Item,,74964164,SPSI,Chemo Prolong Infuse W Pump,,Per Svc,1437.00
Chargemaster Item,,74964172,SPSI,Each Additional Seq Infusion - Chemo Pump,,Per Svc,1258.00
Chargemaster Item,,74965237,SPSI,Irrigation For Drug Delivery,,Per Svc,589.00
Chargemaster Item,,74965427,SPSI,Chemotherapy Injection,,Per Svc,471.00
Chargemaster Item,,75000057,SPSI,Half Year Membership,,Per Svc,300.00
Chargemaster Item,,75000065,SPSI,Half Year Membership Assoc,,Per Svc,250.00
Chargemaster Item,,75003344,SPSI,Medical Supply,,Per Svc,55.00
Chargemaster Item,,75010155,SPSI,Electrode-Ionto,,Per Svc,77.00
Chargemaster Item,,75010197,SPSI,Hinged Knee Brace,,Per Svc,496.00
Chargemaster Item,,75010247,SPSI,Coban 3 Inch,,Per Svc,4.00
Chargemaster Item,,75010361,SPSI,Extension/Flexion 501,,Per Svc,151.00
Chargemaster Item,,75010486,SPSI,Unna Boot,,Per Svc,607.00
Chargemaster Item,,75010601,SPSI,Muscle Re-Education Ea 15 Min,,Every 15 Minutes,441.00
Chargemaster Item,,75010635,SPSI,Orthotic Fitting/Training Ea 15 Min,,Every 15 Minutes,265.00
Chargemaster Item,,75010684,SPSI,Self Care Home Manage Training Ea 15 Min,,Every 15 Minutes,341.00
Chargemaster Item,,75010742,SPSI,Knee Strapping,,Per Svc,213.00
Chargemaster Item,,75010759,SPSI,Ankle/Foot Strapping,,Per Svc,212.00
Chargemaster Item,,75010767,SPSI,Toe(S) Strapping,,Per Svc,212.00
Chargemaster Item,,75010775,SPSI,Stapping/Lowback,,Per Svc,442.00
Chargemaster Item,,75010783,SPSI,Shoulder Strapping,,Per Svc,614.00
Chargemaster Item,,75010791,SPSI,Elbow/Wrist Strapping,,Per Svc,614.00
Chargemaster Item,,75010809,SPSI,Hand/Finger Strapping,,Per Svc,675.00
Chargemaster Item,,75010817,SPSI,Therapeutic Activities Ea 15 Min,,Every 15 Minutes,459.00
Chargemaster Item,,75010965,SPSI,Manual Therapy Tech Ea 15 Min,,Every 15 Minutes,375.00
Chargemaster Item,,75011294,SPSI,Biofeedback,,Per Svc,319.00
Chargemaster Item,,75011351,SPSI,Non-Selective Debridement,,Per Svc,346.00
Chargemaster Item,,75011369,SPSI,Sensory Integrative Tech Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,75011385,SPSI,Aquatic Therapy Each 15 Min,,Every 15 Minutes,331.00
Chargemaster Item,,75011583,SPSI,Electric Stim Unattended,,Per Svc,260.00
Chargemaster Item,,75011609,SPSI,Group Therapy Exercises,,Per Svc,316.00
Chargemaster Item,,75011617,SPSI,Debridement First 20sq cm,,Per Svc,737.00
Chargemaster Item,,75011625,SPSI,Debridement Ea Add 20 sq cm,,Per Svc,244.00
Chargemaster Item,,75011633,SPSI,Collagen Dres<16Sqin,,Per Svc,179.00
Chargemaster Item,,75011674,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,75011682,SPSI,Short Leg Splint,,Per Svc,357.00
Chargemaster Item,,75011690,SPSI,Orth/Prosth Use Checkout Each 15 Min,,Every 15 Minutes,190.00
Chargemaster Item,,75011724,SPSI,Canalith Repositioning Procedure,,Per Svc,232.00
Chargemaster Item,,75011730,SPSI,Sel debride and unna boot,,Per Svc,1343.00
Chargemaster Item,,75051460,SPSI,Init eval: Low comp 20 mins,,Per Svc,716.00
Chargemaster Item,,75051470,SPSI,Init eval: Mod comp 30 mins,,Per Svc,716.00
Chargemaster Item,,75051480,SPSI,Init eval: High comp 45 mins,,Per Svc,716.00
Chargemaster Item,,75051490,SPSI,Re-Evaluation,,Per Svc,385.00
Chargemaster Item,,75212341,SPSI,Hip Strapping,,Per Svc,213.00
Chargemaster Item,,75392201,SPSI,Any Test and Measure ea 15 Min,,Every 15 Minutes,407.00
Chargemaster Item,,75514604,SPSI,Unna Boot and NSD,,Per Svc,953.00
Chargemaster Item,,75640620,SPSI,Biofeedback UI,,Per Svc,442.00
Chargemaster Item,,75707073,SPSI,Electric Stim Attended Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,75841429,SPSI,Unna Boot Supply,,Per Svc,60.00
Chargemaster Item,,75910024,SPSI,TENS,,Per Svc,103.00
Chargemaster Item,,75970101,SPSI,Hot Packs Cold Packs,,Per Svc,139.00
Chargemaster Item,,75970127,SPSI,Traction Mechanical,,Per Svc,235.00
Chargemaster Item,,75970169,SPSI,Vasopneumatic Device,,Per Svc,208.00
Chargemaster Item,,75970184,SPSI,Paraffin Bath,,Per Svc,171.00
Chargemaster Item,,75970226,SPSI,Whirlpool,,Per Svc,258.00
Chargemaster Item,,75970333,SPSI,Iontophoresis Each 15 Min,,Every 15 Minutes,283.00
Chargemaster Item,,75970358,SPSI,Ultrasound Each 15 Min,,Every 15 Minutes,195.00
Chargemaster Item,,75971109,SPSI,Therex Ea 15 Min,,Every 15 Minutes,320.00
Chargemaster Item,,75971166,SPSI,Gait Training Each 15 Mins,,Every 15 Minutes,412.00
Chargemaster Item,,75971285,SPSI,Annual Membership,,Per Svc,600.00
Chargemaster Item,,75975209,SPSI,Prosthetic Training Each 15 Min,,Every 15 Minutes,391.00
Chargemaster Item,,75977502,SPSI,Isokinetic Test Each 15 Min,,Every 15 Minutes,442.00
Chargemaster Item,,75990004,SPSI,Gym Fitness 4 visits,,Per Svc,30.00
Chargemaster Item,,75990012,SPSI,Gym Fitness 8 Visits,,Per Svc,60.00
Chargemaster Item,,75990022,SPSI,wheelchair manage ea 15 min,,Every 15 Minutes,251.00
Chargemaster Item,,75990772,SPSI,Annual Membership Associate Only,,Per Svc,500.00
Chargemaster Item,,75999134,SPSI,Aquatic Fitness Per Visit,,Per Svc,9.00
Chargemaster Item,,75999142,SPSI,Aquatic Fitness 4 Visits,,Per Svc,30.00
Chargemaster Item,,75999167,SPSI,Gym Fitness Per Visit,,Per Svc,7.50
Chargemaster Item,,75999191,SPSI,Aquatics Fitness 8 Visits,,Per Svc,60.00
Chargemaster Item,,76906205,SPSI,Nutritional Therapy Each 15,,Per Svc,150.00
Chargemaster Item,,76906411,SPSI,Nutri-Ante Grp30Min,,Per Svc,222.00
Chargemaster Item,,76992155,SPSI,Nutritional Follow-up Each 15 min,,Per Svc,150.00
Chargemaster Item,,77000016,SPSI,Mandible Limited,,Per Svc,1361.00
Chargemaster Item,,77000024,SPSI,Mandible Complete,,Per Svc,1361.00
Chargemaster Item,,77000032,SPSI,Mastoids Limited,,Per Svc,626.00
Chargemaster Item,,77000040,SPSI,Mastoids Complete,,Per Svc,868.00
Chargemaster Item,,77000057,SPSI,Lim Facial Bones,,Per Svc,1016.00
Chargemaster Item,,77000065,SPSI,Facial Bones,,Per Svc,1221.00
Chargemaster Item,,77000073,SPSI,Nasal Bones,,Per Svc,941.00
Chargemaster Item,,77000081,SPSI,Optic Foramina,,Per Svc,773.00
Chargemaster Item,,77000099,SPSI,Sinuses Limited,,Per Svc,966.00
Chargemaster Item,,77000107,SPSI,Sinuses Complete,,Per Svc,1399.00
Chargemaster Item,,77000115,SPSI,Sella Turcica,,Per Svc,701.00
Chargemaster Item,,77000123,SPSI,Skull 4 Views,,Per Svc,1554.00
Chargemaster Item,,77000131,SPSI,Skull 2 Views,,Per Svc,963.00
Chargemaster Item,,77000149,SPSI,Skull Complete,,Per Svc,1554.00
Chargemaster Item,,77000156,SPSI,Tm Joints Bilateral,,Per Svc,1617.00
Chargemaster Item,,77000164,SPSI,Neck Soft Tissue,,Per Svc,663.00
Chargemaster Item,,77000172,SPSI,Salivary Gland,,Per Svc,891.00
Chargemaster Item,,77000180,SPSI,Chest 1 View,,Per Svc,730.00
Chargemaster Item,,77000198,SPSI,Chest 2 View,,Per Svc,919.00
Chargemaster Item,,77000206,SPSI,Chest 3 Views,,Per Svc,1178.00
Chargemaster Item,,77000214,SPSI,Chest 4 Views,,Per Svc,1547.00
Chargemaster Item,,77000230,SPSI,Ribs W/ Pa Cxr Right,,Per Svc,1082.00
Chargemaster Item,,77000248,SPSI,Ribs W/ Pa Cxr Left,,Per Svc,1082.00
Chargemaster Item,,77000255,SPSI,Ribs Right,,Per Svc,949.00
Chargemaster Item,,77000263,SPSI,Ribs Left,,Per Svc,949.00
Chargemaster Item,,77000271,SPSI,Bilat Ribs,,Per Svc,1275.00
Chargemaster Item,,77000289,SPSI,Bilat Ribs W/ Pa Cxr,,Per Svc,1363.00
Chargemaster Item,,77000297,SPSI,Sternum,,Per Svc,779.00
Chargemaster Item,,77000305,SPSI,Sternoclavicular Joints,,Per Svc,803.00
Chargemaster Item,,77000321,SPSI,Spine 1 View,,Per Svc,752.00
Chargemaster Item,,77000339,SPSI,Cervical Spine 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,77000347,SPSI,Cervical Spine 4 or 5 Views,,Per Svc,1453.00
Chargemaster Item,,77000354,SPSI,Cerv Spine 6 Or More Views,,Per Svc,1865.00
Chargemaster Item,,77000362,SPSI,Cervical Spine 3 or Less Views,,Per Svc,799.00
Chargemaster Item,,77000370,SPSI,Thoracic Spine 4 Plus Views,,Per Svc,1414.00
Chargemaster Item,,77000388,SPSI,Thoracic Spine 2 Views,,Per Svc,1071.00
Chargemaster Item,,77000396,SPSI,Thoracolumbar min 2 Views,,Per Svc,944.00
Chargemaster Item,,77000412,SPSI,Lumbar Sp 2 Or 3 Views,,Per Svc,930.00
Chargemaster Item,,77000420,SPSI,Lumbar Spine 4 Views,,Per Svc,1112.00
Chargemaster Item,,77000438,SPSI,Ls Spine,,Per Svc,1112.00
Chargemaster Item,,77000438INACTV,SPSI,Lumbar Sp 4 Plus Views,,Per Svc,2537.00
Chargemaster Item,,77000446,SPSI,Ls Spine & Bending Views,,Per Svc,1979.00
Chargemaster Item,,77000453,SPSI,Ls Spine Only Bending Views,,Per Svc,1134.00
Chargemaster Item,,77000461,SPSI,Pelvis Ap,,Per Svc,941.00
Chargemaster Item,,77000479,SPSI,Pelvis 2 Views,,Per Svc,941.00
Chargemaster Item,,77000487,SPSI,Sacroiliac Joints,,Per Svc,843.00
Chargemaster Item,,77000495,SPSI,Sacrum & Coccyx,,Per Svc,794.00
Chargemaster Item,,77000503,SPSI,Metastatic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,77000511,SPSI,Metabolic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,77000529,SPSI,Clavicle Right,,Per Svc,710.00
Chargemaster Item,,77000537,SPSI,Clavicle Left,,Per Svc,710.00
Chargemaster Item,,77000545,SPSI,Scapula Right,,Per Svc,1030.00
Chargemaster Item,,77000552,SPSI,Scapula Left,,Per Svc,1030.00
Chargemaster Item,,77000560,SPSI,Shoulder 1 View Right,,Per Svc,869.00
Chargemaster Item,,77000578,SPSI,Shoulder 1 View Left,,Per Svc,869.00
Chargemaster Item,,77000586,SPSI,Shoulder 2 Views Right,,Per Svc,978.00
Chargemaster Item,,77000594,SPSI,Shoulder 2 Views Left,,Per Svc,978.00
Chargemaster Item,,77000602,SPSI,Acromioclavicular Joints,,Per Svc,903.00
Chargemaster Item,,77000610,SPSI,Humerus Right,,Per Svc,850.00
Chargemaster Item,,77000628,SPSI,Humerus Left,,Per Svc,850.00
Chargemaster Item,,77000636,SPSI,Elbow 2 Views Right,,Per Svc,886.00
Chargemaster Item,,77000644,SPSI,Elbow 2 Views Left,,Per Svc,886.00
Chargemaster Item,,77000651,SPSI,Elbow 4 Views Right,,Per Svc,1102.00
Chargemaster Item,,77000669,SPSI,Elbow 4 Views Left,,Per Svc,1102.00
Chargemaster Item,,77000677,SPSI,Forearm Right,,Per Svc,705.00
Chargemaster Item,,77000685,SPSI,Forearm Left,,Per Svc,705.00
Chargemaster Item,,77000693,SPSI,Uext Infant Left,,Per Svc,703.00
Chargemaster Item,,77000701,SPSI,Uext Infant Right,,Per Svc,703.00
Chargemaster Item,,77000719,SPSI,Wrist 2 View Right,,Per Svc,861.00
Chargemaster Item,,77000727,SPSI,Wrist 2 View Left,,Per Svc,861.00
Chargemaster Item,,77000735,SPSI,Wrist 4 View Right,,Per Svc,1022.00
Chargemaster Item,,77000743,SPSI,Wrist 4 View Left,,Per Svc,1022.00
Chargemaster Item,,77000750,SPSI,Hand 2 Views Right,,Per Svc,671.00
Chargemaster Item,,77000768,SPSI,Hand 2 Views Left,,Per Svc,671.00
Chargemaster Item,,77000776,SPSI,Pa Hands/Wrist,,Per Svc,671.00
Chargemaster Item,,77000784,SPSI,Hand 3 Views Right,,Per Svc,850.00
Chargemaster Item,,77000792,SPSI,Hand 3 Views Left,,Per Svc,850.00
Chargemaster Item,,77000800,SPSI,Finger(S) Right,,Per Svc,611.00
Chargemaster Item,,77000818,SPSI,Finger(S) Left,,Per Svc,611.00
Chargemaster Item,,77000826,SPSI,Hip 1 View Right,,Per Svc,703.00
Chargemaster Item,,77000834,SPSI,Hip 1 View Left,,Per Svc,703.00
Chargemaster Item,,77000909,SPSI,Femur Right,,Per Svc,850.00
Chargemaster Item,,77000917,SPSI,Femur Left,,Per Svc,783.00
Chargemaster Item,,77000925,SPSI,Knee 1 Or 2 Views Right,,Per Svc,743.00
Chargemaster Item,,77000933,SPSI,Knee 1 Or 2 Views Left,,Per Svc,743.00
Chargemaster Item,,77000941,SPSI,Ap Bil Knees Standing,,Per Svc,1274.00
Chargemaster Item,,77000958,SPSI,Knee 3 Views Left,,Per Svc,846.00
Chargemaster Item,,77000966,SPSI,Knee 3 Views Right,,Per Svc,846.00
Chargemaster Item,,77000974,SPSI,Patella Right,,Per Svc,846.00
Chargemaster Item,,77000982,SPSI,Patella Left,,Per Svc,846.00
Chargemaster Item,,77000990,SPSI,Tibia & Fibia Right,,Per Svc,795.00
Chargemaster Item,,77001006,SPSI,Tibia & Fibia Left,,Per Svc,795.00
Chargemaster Item,,77001014,SPSI,Lext Infant Left,,Per Svc,687.00
Chargemaster Item,,77001022,SPSI,Lext Infant Right,,Per Svc,687.00
Chargemaster Item,,77001030,SPSI,Ankle 2 Views Right,,Per Svc,817.00
Chargemaster Item,,77001048,SPSI,Ankle 2 Views Left,,Per Svc,817.00
Chargemaster Item,,77001055,SPSI,Ankle 4 Views Right,,Per Svc,1061.00
Chargemaster Item,,77001063,SPSI,Ankle 4 Views Left,,Per Svc,1061.00
Chargemaster Item,,77001071,SPSI,Foot 2 Views Right,,Per Svc,788.00
Chargemaster Item,,77001089,SPSI,Foot 2 Views Left,,Per Svc,788.00
Chargemaster Item,,77001097,SPSI,Foot 3 Views Right,,Per Svc,1011.00
Chargemaster Item,,77001105,SPSI,Foot 3 Views Left,,Per Svc,1011.00
Chargemaster Item,,77001113,SPSI,Os Calcis Right,,Per Svc,710.00
Chargemaster Item,,77001121,SPSI,Os Calcis Left,,Per Svc,710.00
Chargemaster Item,,77001139,SPSI,Toe/Toes Right,,Per Svc,622.00
Chargemaster Item,,77001147,SPSI,Toe/Toes Left,,Per Svc,622.00
Chargemaster Item,,77001154,SPSI,Abdomen 1 View,,Per Svc,1095.00
Chargemaster Item,,77001162,SPSI,Kub,,Per Svc,1095.00
Chargemaster Item,,77001170,SPSI,Abdomen 2 Views,,Per Svc,711.00
Chargemaster Item,,77001188,SPSI,Abd Series/Pa Chest,,Per Svc,1095.00
Chargemaster Item,,77001196,SPSI,Nose-Rectum Child Iv,,Per Svc,716.00
Chargemaster Item,,77001204,SPSI,Bone Age Studies,,Per Svc,1034.00
Chargemaster Item,,77001212,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,77001220,SPSI,Osseous Survey Complete,,Per Svc,4402.00
Chargemaster Item,,77001238,SPSI,Osseous Survey Limited,,Per Svc,2135.00
Chargemaster Item,,77001246,SPSI,Infant Osseous Survey,,Per Svc,1545.00
Chargemaster Item,,77001253,SPSI,Ap Standing Feet,,Per Svc,671.00
Chargemaster Item,,77001261,SPSI,Digital Screening Mammography,,Per Svc,633.00
Chargemaster Item,,77001600,SPSI,Upper Ext Art Duplex Scan Right,,Per Svc,1624.00
Chargemaster Item,,77001626,SPSI,Duplex Scan Bilat Ext Veins,,Per Svc,3812.00
Chargemaster Item,,77072081,SPSI,Entire Spine/Scoliosis 1 View,,Per Svc,1185.00
Chargemaster Item,,77072082,SPSI,Entire Spine/Scoliosis 2/3 Vws,,Per Svc,1383.00
Chargemaster Item,,77072083,SPSI,ENTIRE SPINE/SCOLIOSIS 4 OR 5 VWS,,Per Svc,1383.00
Chargemaster Item,,77072084,SPSI,ENTIRE SPINE/SCOLIOSIS 6 VWS,,Per Svc,1383.00
Chargemaster Item,,77073503,SPSI,LT Hip 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,77073504,SPSI,RT HIP 2 or 3 VIEWS,,Per Svc,941.00
Chargemaster Item,,77073526,SPSI,Bilat Hips w or wo Pelvis,,Per Svc,1647.00
Chargemaster Item,,77225522,SPSI,US Limited Chest,,Per Svc,1501.00
Chargemaster Item,,77763803,SPSI,CT Limited Abdomen,,Per Svc,2446.00
Chargemaster Item,,78000057,SPSI,Half Year Membership,,Per Svc,300.00
Chargemaster Item,,78000065,SPSI,Half Year Membership Assoc,,Per Svc,250.00
Chargemaster Item,,78003344,SPSI,Medical Supply,,Per Svc,55.00
Chargemaster Item,,78010155,SPSI,Electrode-Ionto,,Per Svc,77.00
Chargemaster Item,,78010197,SPSI,Hinged Knee Brace,,Per Svc,496.00
Chargemaster Item,,78010247,SPSI,Coban 3 Inch,,Per Svc,4.00
Chargemaster Item,,78010361,SPSI,Extension/Flexion 501,,Per Svc,151.00
Chargemaster Item,,78010486,SPSI,Unna Boot,,Per Svc,607.00
Chargemaster Item,,78010601,SPSI,Muscle Re-Education Ea 15 Min,,Every 15 Minutes,441.00
Chargemaster Item,,78010635,SPSI,Orthotic Fitting/Training Ea 15 Min,,Every 15 Minutes,265.00
Chargemaster Item,,78010684,SPSI,Self Care Home Manage Training Ea 15 Min,,Every 15 Minutes,341.00
Chargemaster Item,,78010742,SPSI,Knee Strapping,,Per Svc,213.00
Chargemaster Item,,78010759,SPSI,Ankle/Foot Strapping,,Per Svc,212.00
Chargemaster Item,,78010767,SPSI,Toe(S) Strapping,,Per Svc,212.00
Chargemaster Item,,78010775,SPSI,Stapping/Lowback,,Per Svc,442.00
Chargemaster Item,,78010783,SPSI,Shoulder Strapping,,Per Svc,614.00
Chargemaster Item,,78010791,SPSI,Elbow/Wrist Strapping,,Per Svc,614.00
Chargemaster Item,,78010809,SPSI,Hand/Finger Strapping,,Per Svc,675.00
Chargemaster Item,,78010817,SPSI,Therapeutic Activities Ea 15 Min,,Every 15 Minutes,459.00
Chargemaster Item,,78010965,SPSI,Manual Therapy Tech Ea 15 Min,,Every 15 Minutes,375.00
Chargemaster Item,,78011294,SPSI,Biofeedback,,Per Svc,319.00
Chargemaster Item,,78011351,SPSI,Non-Selective Debridement,,Per Svc,346.00
Chargemaster Item,,78011369,SPSI,Sensory Integrative Tech Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,78011583,SPSI,Electric Stim Unattended,,Per Svc,260.00
Chargemaster Item,,78011617,SPSI,Debridement First 20sq cm,,Per Svc,737.00
Chargemaster Item,,78011625,SPSI,Debridement Ea Add 20 sq cm,,Per Svc,244.00
Chargemaster Item,,78011633,SPSI,Collagen Dres<16Sqin,,Per Svc,179.00
Chargemaster Item,,78011674,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,78011682,SPSI,Short Leg Splint,,Per Svc,357.00
Chargemaster Item,,78011690,SPSI,Orth/Prosth Use Checkout Each 15 Min,,Every 15 Minutes,190.00
Chargemaster Item,,78011724,SPSI,Canalith Repositioning Procedure,,Per Svc,232.00
Chargemaster Item,,78011730,SPSI,Sel debride and unna boot,,Per Svc,1343.00
Chargemaster Item,,78051460,SPSI,Init eval: Low comp 20 mins,,Per Svc,716.00
Chargemaster Item,,78051470,SPSI,Init eval: Mod comp 30 mins,,Per Svc,716.00
Chargemaster Item,,78051480,SPSI,Init eval: High comp 45 mins,,Per Svc,716.00
Chargemaster Item,,78051490,SPSI,Re-Evaluation,,Per Svc,385.00
Chargemaster Item,,78212341,SPSI,Hip Strapping,,Per Svc,213.00
Chargemaster Item,,78392201,SPSI,Any Test and Measure ea 15 Min,,Every 15 Minutes,407.00
Chargemaster Item,,78514604,SPSI,Unna Boot and NSD,,Per Svc,953.00
Chargemaster Item,,78640620,SPSI,Biofeedback UI,,Per Svc,442.00
Chargemaster Item,,78641024,SPSI,Unna Boot Supply,,Per Svc,60.00
Chargemaster Item,,78707073,SPSI,Electric Stim Attended Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,78910024,SPSI,TENS,,Per Svc,103.00
Chargemaster Item,,78970101,SPSI,Hot Packs Cold Packs,,Per Svc,139.00
Chargemaster Item,,78970127,SPSI,Traction Mechanical,,Per Svc,235.00
Chargemaster Item,,78970169,SPSI,Vasopneumatic Device,,Per Svc,208.00
Chargemaster Item,,78970184,SPSI,Paraffin Bath,,Per Svc,171.00
Chargemaster Item,,78970226,SPSI,Whirlpool,,Per Svc,258.00
Chargemaster Item,,78970333,SPSI,Iontophoresis Each 15 Min,,Every 15 Minutes,283.00
Chargemaster Item,,78970358,SPSI,Ultrasound Each 15 Min,,Every 15 Minutes,195.00
Chargemaster Item,,78971109,SPSI,Therex Ea 15 Min,,Every 15 Minutes,320.00
Chargemaster Item,,78971166,SPSI,Gait Training Each 15 Mins,,Every 15 Minutes,412.00
Chargemaster Item,,78971285,SPSI,Annual Membership,,Per Svc,600.00
Chargemaster Item,,78975209,SPSI,Prosthetic Training Each 15 Min,,Every 15 Minutes,391.00
Chargemaster Item,,78977502,SPSI,Isokinetic Test Each 15 Min,,Every 15 Minutes,442.00
Chargemaster Item,,78990004,SPSI,Gym Fitness 4 visits,,Per Svc,30.00
Chargemaster Item,,78990012,SPSI,Gym Fitness 8 Visits,,Per Svc,60.00
Chargemaster Item,,78990022,SPSI,wheelchair manage ea 15 min,,Every 15 Minutes,251.00
Chargemaster Item,,78990772,SPSI,Annual Membership Associate Only,,Per Svc,500.00
Chargemaster Item,,78999167,SPSI,Gym Fitness Per Visit,,Per Svc,7.50
Chargemaster Item,,79000057,SPSI,Half Year Membership,,Per Svc,300.00
Chargemaster Item,,79000058,SPSI,Biofeedback UI init 15 mins,,Per Svc,441.00
Chargemaster Item,,79000065,SPSI,Half Year Membership Assoc,,Per Svc,250.00
Chargemaster Item,,79000068,SPSI,Biofeedback UI addl 15 mins,,Per Svc,321.00
Chargemaster Item,,79001105,SPSI,Massage Patient,,First 30 Minutes,45.00
Chargemaster Item,,79003344,SPSI,Medical Supply,,Per Svc,55.00
Chargemaster Item,,79010155,SPSI,Electrode-Ionto,,Per Svc,77.00
Chargemaster Item,,79010197,SPSI,Hinged Knee Brace,,Per Svc,496.00
Chargemaster Item,,79010247,SPSI,Coban 3 Inch,,Per Svc,4.00
Chargemaster Item,,79010361,SPSI,Extension/Flexion 501,,Per Svc,151.00
Chargemaster Item,,79010486,SPSI,Unna Boot,,Per Svc,607.00
Chargemaster Item,,79010601,SPSI,Muscle Re-Education Ea 15 Min,,Every 15 Minutes,441.00
Chargemaster Item,,79010635,SPSI,Orthotic Fitting/Training Ea 15 Min,,Every 15 Minutes,265.00
Chargemaster Item,,79010684,SPSI,Self Care Home Manage Training Ea 15 Min,,Every 15 Minutes,341.00
Chargemaster Item,,79010742,SPSI,Knee Strapping,,Per Svc,213.00
Chargemaster Item,,79010759,SPSI,Ankle/Foot Strapping,,Per Svc,212.00
Chargemaster Item,,79010767,SPSI,Toe(S) Strapping,,Per Svc,212.00
Chargemaster Item,,79010775,SPSI,Stapping/Lowback,,Per Svc,442.00
Chargemaster Item,,79010783,SPSI,Shoulder Strapping,,Per Svc,614.00
Chargemaster Item,,79010791,SPSI,Elbow/Wrist Strapping,,Per Svc,614.00
Chargemaster Item,,79010809,SPSI,Hand/Finger Strapping,,Per Svc,675.00
Chargemaster Item,,79010817,SPSI,Therapeutic Activities Ea 15 Min,,Every 15 Minutes,459.00
Chargemaster Item,,79010965,SPSI,Manual Therapy Tech Ea 15 Min,,Every 15 Minutes,375.00
Chargemaster Item,,79011294,SPSI,Biofeedback,,Per Svc,319.00
Chargemaster Item,,79011351,SPSI,Non-Selective Debridement,,Per Svc,346.00
Chargemaster Item,,79011369,SPSI,Sensory Integrative Tech Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,79011583,SPSI,Electric Stim Unattended,,Per Svc,260.00
Chargemaster Item,,79011617,SPSI,Debridement First 20sq cm,,Per Svc,737.00
Chargemaster Item,,79011625,SPSI,Debridement Ea Add 20 sq cm,,Per Svc,244.00
Chargemaster Item,,79011633,SPSI,Collagen Dres<16Sqin,,Per Svc,179.00
Chargemaster Item,,79011674,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Chargemaster Item,,79011682,SPSI,Short Leg Splint,,Per Svc,357.00
Chargemaster Item,,79011690,SPSI,Orth/Prosth Use Checkout Each 15 Min,,Every 15 Minutes,190.00
Chargemaster Item,,79011724,SPSI,Canalith Repositioning Procedure,,Per Svc,232.00
Chargemaster Item,,79011730,SPSI,Sel debride and unna boot,,Per Svc,1343.00
Chargemaster Item,,79051460,SPSI,Init eval: Low comp 20 mins,,Per Svc,716.00
Chargemaster Item,,79051470,SPSI,Init eval: Mod comp 30 mins,,Per Svc,716.00
Chargemaster Item,,79051480,SPSI,Init eval: High comp 45 mins,,Per Svc,716.00
Chargemaster Item,,79051490,SPSI,Re-Evaluation,,Per Svc,385.00
Chargemaster Item,,79212341,SPSI,Hip Strapping,,Per Svc,213.00
Chargemaster Item,,79390601,SPSI,Massage Associate,,First 30 Minutes,43.00
Chargemaster Item,,79392201,SPSI,Any Test and Measure ea 15 Min,,Every 15 Minutes,407.00
Chargemaster Item,,79514604,SPSI,Unna Boot and NSD,,Per Svc,953.00
Chargemaster Item,,79522090,SPSI,Pilates Instruction Per 1/2 Hour,,Every 30 Minutes,30.00
Chargemaster Item,,79541397,SPSI,Unna Boot Supply,,Per Svc,60.00
Chargemaster Item,,79640620,SPSI,Biofeedback UI,,Per Svc,442.00
Chargemaster Item,,79707073,SPSI,Electric Stim Attended Ea 15 Min,,Every 15 Minutes,251.00
Chargemaster Item,,79910024,SPSI,TENS,,Per Svc,103.00
Chargemaster Item,,79970101,SPSI,Hot Packs Cold Packs,,Per Svc,139.00
Chargemaster Item,,79970127,SPSI,Traction Mechanical,,Per Svc,235.00
Chargemaster Item,,79970143,SPSI,Elec Stim Unattended,,Per Svc,260.00
Chargemaster Item,,79970169,SPSI,Vasopneumatic Device,,Per Svc,208.00
Chargemaster Item,,79970184,SPSI,Paraffin Bath,,Per Svc,171.00
Chargemaster Item,,79970226,SPSI,Whirlpool,,Per Svc,258.00
Chargemaster Item,,79970333,SPSI,Iontophoresis Each 15 Min,,Every 15 Minutes,283.00
Chargemaster Item,,79970358,SPSI,Ultrasound Each 15 Min,,Every 15 Minutes,195.00
Chargemaster Item,,79971109,SPSI,Therex Ea 15 Min,,Every 15 Minutes,320.00
Chargemaster Item,,79971166,SPSI,Gait Training Each 15 Mins,,Every 15 Minutes,412.00
Chargemaster Item,,79971285,SPSI,Annual Membership,,Per Svc,600.00
Chargemaster Item,,79975209,SPSI,Prosthetic Training Each 15 Min,,Every 15 Minutes,391.00
Chargemaster Item,,79977502,SPSI,Isokinetic Test Each 15 Min,,Every 15 Minutes,442.00
Chargemaster Item,,79990004,SPSI,Gym Fitness 4 visits,,Per Svc,30.00
Chargemaster Item,,79990012,SPSI,Gym Fitness 8 Visits,,Per Svc,60.00
Chargemaster Item,,79990022,SPSI,wheelchair manage ea 15 min,,Every 15 Minutes,251.00
Chargemaster Item,,79990772,SPSI,Annual Membership Associate Only,,Per Svc,500.00
Chargemaster Item,,79999167,SPSI,Gym Fitness Per Visit,,Per Svc,7.50
Chargemaster Item,,8000002,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,8000010,SPSI,Observation Continuation,,First 89 Minutes,331.00
Chargemaster Item,,8003006,SPSI,Definitive Observation Unit 2,,Per Svc,11138.00
Chargemaster Item,,8003019,SPSI,Med Surg 5 Unit,,Per Svc,7950.00
Chargemaster Item,,8003028,SPSI,Intensive Care Unit,,Per Svc,20240.00
Chargemaster Item,,80700248,SPSI,Ct Head W Contrast,,Per Svc,8262.00
Chargemaster Item,,80700255,SPSI,Ct Head Wo Contrast,,Per Svc,7578.00
Chargemaster Item,,80700339,SPSI,Ct Orbit W Contrast,,Per Svc,8580.00
Chargemaster Item,,80700354,SPSI,Ct Head W/Wo Contrast,,Per Svc,11250.00
Chargemaster Item,,80700370,SPSI,Ct Orbit Wo Contrast,,Per Svc,7122.00
Chargemaster Item,,80704604,SPSI,Ct Temporal Bones W Con,,Per Svc,8580.00
Chargemaster Item,,80704802,SPSI,Ct Sinuses W Contrast,,Per Svc,9076.00
Chargemaster Item,,80704828,SPSI,Ct Orbit W/Wo Contrast,,Per Svc,10191.00
Chargemaster Item,,80704836,SPSI,Ct Temporal Bones Wo Con,,Per Svc,7410.00
Chargemaster Item,,80704869,SPSI,Ct Facial Bones Wo Con,,Per Svc,4815.00
Chargemaster Item,,80704877,SPSI,Ct Facial Bones W Con,,Per Svc,9444.00
Chargemaster Item,,80704893,SPSI,Ct Sinuses Wo Contrast,,Per Svc,4628.00
Chargemaster Item,,80704901,SPSI,Ct Neck Wo Contrast,,Per Svc,6131.00
Chargemaster Item,,80704919,SPSI,Ct Neck W Contrast,,Per Svc,7277.00
Chargemaster Item,,80704968,SPSI,Cta Head,,Per Svc,1846.00
Chargemaster Item,,80704984,SPSI,Cta Neck,,Per Svc,1788.00
Chargemaster Item,,80712508,SPSI,Ct Chest Wo Contrast,,Per Svc,7998.00
Chargemaster Item,,80712607,SPSI,Ct Thorax W Contrast,,Per Svc,9389.00
Chargemaster Item,,80712706,SPSI,Ct Thorax W/Wo Contrast,,Per Svc,10329.00
Chargemaster Item,,80712755,SPSI,Ct Chest Angio,,Per Svc,4716.00
Chargemaster Item,,80718596,SPSI,Ct Neck Wo/W Contrast,,Per Svc,9140.00
Chargemaster Item,,80718661,SPSI,Ct Lumbar Spine W/Wo Contrast,,Per Svc,12959.00
Chargemaster Item,,80718679,SPSI,Visipaque 320 Per Ml,,Per Svc,1.00
Chargemaster Item,,80718687,SPSI,Ultravist 300 Per Ml,,Per Svc,1.00
Chargemaster Item,,80718703,SPSI,Ultravist 370 Per Ml,,Per Svc,1.00
Chargemaster Item,,80718836,SPSI,Ct Cervical Spine W/Wo Contrst,,Per Svc,10989.00
Chargemaster Item,,80718844,SPSI,Ct Maxillofacial Wo/W Contrast,,Per Svc,9130.00
Chargemaster Item,,80718851,SPSI,Ct Abd & Pelvis Wo Contrast,,Per Svc,16615.00
Chargemaster Item,,80718869,SPSI,Ct Abd & Pelvis With Contrast,,Per Svc,19676.00
Chargemaster Item,,80718877,SPSI,Ct Abd/Pel Wo/W 1/Both Areas,,Per Svc,24929.00
Chargemaster Item,,80718963,SPSI,CT Angio Abdomen & Pelvis,,Per Svc,6788.00
Chargemaster Item,,80718971,SPSI,CT Chest Screening,,Per Svc,443.00
Chargemaster Item,,80720469,SPSI,Ct Thoracic Wo/W Contrast,,Per Svc,10839.00
Chargemaster Item,,80720642,SPSI,CT Thorax Screen w/o Contrast,,Per Svc,7998.00
Chargemaster Item,,80721251,SPSI,Ct Cervical Spine Wo Contrast,,Per Svc,9407.00
Chargemaster Item,,80721269,SPSI,Ct Cervical Spine W Contrast,,Per Svc,10195.00
Chargemaster Item,,80721285,SPSI,Ct Thoracic Spine Wo Contrast,,Per Svc,7113.00
Chargemaster Item,,80721293,SPSI,Ct Thoracic Spine W Contrast,,Per Svc,8644.00
Chargemaster Item,,80721319,SPSI,Ct Lumbar Spine Wo Contrast,,Per Svc,9034.00
Chargemaster Item,,80721327,SPSI,Ct Lumbar Spine W Contrast,,Per Svc,10416.00
Chargemaster Item,,80721913,SPSI,Ct Pelvis Angio,,Per Svc,3748.00
Chargemaster Item,,80721921,SPSI,Ct Pelvis Wo Contrast,,Per Svc,7585.00
Chargemaster Item,,80721939,SPSI,Ct Pelvis W Contrast,,Per Svc,8560.00
Chargemaster Item,,80721947,SPSI,Ct Pelvis W/Wo Contrast,,Per Svc,10794.00
Chargemaster Item,,80732001,SPSI,Ct Upper Ext Wo Contrast Right,,Per Svc,6913.00
Chargemaster Item,,80732019,SPSI,Ct Upper Ext W Contrast Right,,Per Svc,7349.00
Chargemaster Item,,80732027,SPSI,Ct Upper Ext W/Wo Contrast Right,,Per Svc,11762.00
Chargemaster Item,,80732035,SPSI,Ct Upper Ext Wo Contrast Left,,Per Svc,6913.00
Chargemaster Item,,80732043,SPSI,Ct Upper Ext W Contrast Left,,Per Svc,7349.00
Chargemaster Item,,80732068,SPSI,Cta Uext Right,,Per Svc,2427.00
Chargemaster Item,,80732076,SPSI,Cta Uext Left,,Per Svc,2427.00
Chargemaster Item,,80737000,SPSI,Ct Lower Ext Wo Contrast Right,,Per Svc,6845.00
Chargemaster Item,,80737018,SPSI,Ct Lower Ext W Contrast Right,,Per Svc,7750.00
Chargemaster Item,,80737026,SPSI,Ct Lower Ext W/Wo Cont Right,,Per Svc,11466.00
Chargemaster Item,,80737034,SPSI,Ct Lower Ext Wo Contrast Left,,Per Svc,6845.00
Chargemaster Item,,80737042,SPSI,Ct Lower Ext W Contrast Left,,Per Svc,7750.00
Chargemaster Item,,80737059,SPSI,Ct Lower Ext W/Wo Cont Left,,Per Svc,11466.00
Chargemaster Item,,80737067,SPSI,Cta Lower Ext Right,,Per Svc,2305.00
Chargemaster Item,,80737075,SPSI,Cta Lower Ext Left,,Per Svc,2305.00
Chargemaster Item,,80741507,SPSI,Ct Abdomen Wo Contrast,,Per Svc,7377.00
Chargemaster Item,,80741606,SPSI,Ct Abdomen W Contrast,,Per Svc,9193.00
Chargemaster Item,,80741705,SPSI,Ct Abdomen W/Wo Contrast,,Per Svc,11693.00
Chargemaster Item,,80741754,SPSI,Ct Abdomen Angio,,Per Svc,3038.00
Chargemaster Item,,80742612,SPSI,Ct Colonography Wo Contrast,,Per Svc,3251.00
Chargemaster Item,,80742620,SPSI,Ct Colonography W Contrast,,Per Svc,3533.00
Chargemaster Item,,80756356,SPSI,Cta Aorta-Ilio,,Per Svc,2936.00
Chargemaster Item,,80760408,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,80764970,SPSI,Ct Cardiac Scoring,,Per Svc,3408.00
Chargemaster Item,,80764988,SPSI,Omnipaque 350,,Per Svc,1.00
Chargemaster Item,,81125023,SPSI,Digital Lt Eklund Mamm,,Per Svc,764.00
Chargemaster Item,,81125031,SPSI,Digital Rt Eklund Mamm,,Per Svc,764.00
Chargemaster Item,,81125049,SPSI,Digital Right Mammogram,,Per Svc,764.00
Chargemaster Item,,81125056,SPSI,Digital Left Mammogram,,Per Svc,764.00
Chargemaster Item,,81125064,SPSI,Digital Eklund Mamm,,Per Svc,595.00
Chargemaster Item,,81125072,SPSI,Digital Screening Mammography,,Per Svc,633.00
Chargemaster Item,,81125094,SPSI,Digital Screen Mam Comb w/ CAD,,Per Svc,809.00
Chargemaster Item,,81125102,SPSI,Low Cost Screen Mam Comb w/ Cad,,Per Svc,75.00
Chargemaster Item,,81125110,SPSI,Digital Rt Eklund Mam Comb/Cad,,Per Svc,937.00
Chargemaster Item,,81125128,SPSI,Digital Lt Eklund Mam Comb/Cad,,Per Svc,937.00
Chargemaster Item,,81125136,SPSI,Digital Bilat Eklund Mam Cad,,Per Svc,998.00
Chargemaster Item,,81125148,SPSI,Eklund Screening Combo w/CAD,,Per Svc,809.00
Chargemaster Item,,81125155,SPSI,Lt Eklund Screen Combo w/CAD,,Per Svc,633.00
Chargemaster Item,,81125163,SPSI,Rt Eklund Screen Combo w/CAD,,Per Svc,633.00
Chargemaster Item,,81125171,SPSI,Screening Tomosynthesis,,Per Svc,178.00
Chargemaster Item,,81420416,SPSI,Left Ext Duplex Scan,,Per Svc,2921.00
Chargemaster Item,,81427106,SPSI,Right Ext Duplex Scan,,Per Svc,2921.00
Chargemaster Item,,81427155,SPSI,Duplex Scan Bilat Ext Veins,,Per Svc,3812.00
Chargemaster Item,,81760910INACTV,SPSI,Digital Bilateral Mammography,,Per Svc,826.00
Chargemaster Item,,82220476,SPSI,Us Screening Aaa,,Per Svc,1539.00
Chargemaster Item,,82220708,SPSI,Us Venous Bilat Lwrext Duplex,,Per Svc,3307.00
Chargemaster Item,,82220716,SPSI,Us Venous Lt Lwrext Duplex,,Per Svc,2692.00
Chargemaster Item,,82220724,SPSI,Us Venous Rt Lwrext Duplex,,Per Svc,2692.00
Chargemaster Item,,82225509,SPSI,Neo-Natal Cranial Sonogram,,Per Svc,1961.00
Chargemaster Item,,82225517,SPSI,Us Soft Tissue Head/Neck,,Per Svc,1957.00
Chargemaster Item,,82225525,SPSI,US Limited Chest,,Per Svc,1501.00
Chargemaster Item,,82225541,SPSI,US Breast Lt Complete,,Per Svc,1355.00
Chargemaster Item,,82225574,SPSI,Abdomen Sonogram,,Per Svc,2703.00
Chargemaster Item,,82225582,SPSI,Abd Sono Lim,,Per Svc,2045.00
Chargemaster Item,,82225590,SPSI,Gb/Ruq Sonogram,,Per Svc,2045.00
Chargemaster Item,,82225608,SPSI,Renal Sonogram,,Per Svc,2734.00
Chargemaster Item,,82225616,SPSI,Aorta Sonogram,,Per Svc,2734.00
Chargemaster Item,,82225624,SPSI,Retroperitoneal Us Lmt Right,,Per Svc,1694.00
Chargemaster Item,,82225632,SPSI,Retroperitoneal Us Lmt Left,,Per Svc,1694.00
Chargemaster Item,,82225640,SPSI,Us Spinal Canal,,Per Svc,2254.00
Chargemaster Item,,82225657,SPSI,Ob Us <14 Wks,,Per Svc,2906.00
Chargemaster Item,,82225665,SPSI,Ob <14Wks Ea Addl Gestation,,Per Svc,2185.00
Chargemaster Item,,82225673,SPSI,Ob Us 2Nd/3Rd Trimester,,Per Svc,2936.00
Chargemaster Item,,82225681,SPSI,Ob Us 2Nd/3Rd Trim Ea Add Gest,,Per Svc,2183.00
Chargemaster Item,,82225699,SPSI,Lim Ob Sono,,Per Svc,2685.00
Chargemaster Item,,82225707,SPSI,Plancenta Loc Sono,,Per Svc,2799.00
Chargemaster Item,,82225715,SPSI,Ob Follow-Up,,Per Svc,1325.00
Chargemaster Item,,82225723,SPSI,Ob Us Follow-Up Add Gest,,Per Svc,1325.00
Chargemaster Item,,82225731,SPSI,Pelvic Nonob Us,,Per Svc,2546.00
Chargemaster Item,,82225749,SPSI,Fu/Limited Pelvic Us,,Per Svc,1472.00
Chargemaster Item,,82225756,SPSI,Scrotal Sonogram,,Per Svc,2204.00
Chargemaster Item,,82225764,SPSI,Us Rt Extrmty Lim Nonvascular,,Per Svc,2080.00
Chargemaster Item,,82225772,SPSI,Us Lt Extrmty Lim Nonvascular,,Per Svc,2080.00
Chargemaster Item,,82225780,SPSI,Carotid Duplex,,Per Svc,3717.00
Chargemaster Item,,82225798,SPSI,Lim/Fu Carotid Duplex,,Per Svc,2014.00
Chargemaster Item,,82225806,SPSI,Lwrext Arterial Duplex Bilat,,Per Svc,2973.00
Chargemaster Item,,82225814,SPSI,Lext Arterial Duplex Left,,Per Svc,1617.00
Chargemaster Item,,82225822,SPSI,Lext Arterial Duplex Right,,Per Svc,1617.00
Chargemaster Item,,82225830,SPSI,Upper Ext Arterial Duplex Scan,,Per Svc,2681.00
Chargemaster Item,,82225855,SPSI,Upper Ext Art Duplex Scan Left,,Per Svc,1624.00
Chargemaster Item,,82225863,SPSI,Duplex Scan Bilat Ext Veins,,Per Svc,3812.00
Chargemaster Item,,82225871,SPSI,Right Extremity Duplex Scan,,Per Svc,3044.00
Chargemaster Item,,82225889,SPSI,Left Extremity Duplex Scan,,Per Svc,2692.00
Chargemaster Item,,82225889INACTV,SPSI,Right Ext Duplex Scan,,Per Svc,2921.00
Chargemaster Item,,82225897,SPSI,Bypass Grafts Duplex Scan,,Per Svc,2678.00
Chargemaster Item,,82225905,SPSI,Lim Bypass Grafts Duplex Scan,,Per Svc,1350.00
Chargemaster Item,,82225913,SPSI,Us Extremity Complete Nonvasc,,Per Svc,2080.00
Chargemaster Item,,82225947,SPSI,Us Visceral Duplex Scan,,Per Svc,2520.00
Chargemaster Item,,82226101,SPSI,Ob Us Transvaginal,,Per Svc,1178.00
Chargemaster Item,,82226119,SPSI,Us Nonob Transvaginal,,Per Svc,1878.00
Chargemaster Item,,82226143,SPSI,Us Renal Trnsplnt W/Doppler,,Per Svc,1784.00
Chargemaster Item,,82226150,SPSI,Retroperitoneal Us Limited,,Per Svc,1694.00
Chargemaster Item,,82226165,SPSI,US Visceral Limited Duplex Scan,,Per Svc,2180.00
Chargemaster Item,,82226176,SPSI,Us Venous Bilat Uprext Duplex,,Per Svc,3588.00
Chargemaster Item,,82226184,SPSI,Us Venous Lt Uprext Duplex,,Per Svc,2921.00
Chargemaster Item,,82226192,SPSI,US Venous Rt Uprext Duplex,,Per Svc,2921.00
Chargemaster Item,,83327015,SPSI,Mandible Limited,,Per Svc,1361.00
Chargemaster Item,,83327023,SPSI,Mandible Complete,,Per Svc,1361.00
Chargemaster Item,,83327031,SPSI,Mastoids Limited,,Per Svc,626.00
Chargemaster Item,,83327049,SPSI,Mastoids Complete,,Per Svc,868.00
Chargemaster Item,,83327056,SPSI,Lim Facial Bones,,Per Svc,1016.00
Chargemaster Item,,83327064,SPSI,Facial Bones,,Per Svc,1221.00
Chargemaster Item,,83327072,SPSI,Nasal Bones,,Per Svc,941.00
Chargemaster Item,,83327080,SPSI,Optic Foramina,,Per Svc,773.00
Chargemaster Item,,83327098,SPSI,Sinuses Limited,,Per Svc,966.00
Chargemaster Item,,83327106,SPSI,Sinuses Complete,,Per Svc,1399.00
Chargemaster Item,,83327114,SPSI,Sella Turcica,,Per Svc,701.00
Chargemaster Item,,83327122,SPSI,Skull 4 Views,,Per Svc,1554.00
Chargemaster Item,,83327130,SPSI,Skull 2 Views,,Per Svc,963.00
Chargemaster Item,,83327148,SPSI,Skull Complete,,Per Svc,1554.00
Chargemaster Item,,83327155,SPSI,Tm Joints Bilateral,,Per Svc,1617.00
Chargemaster Item,,83327163,SPSI,Neck Soft Tissue,,Per Svc,663.00
Chargemaster Item,,83327171,SPSI,Salivary Gland,,Per Svc,891.00
Chargemaster Item,,83327189,SPSI,Chest 1 View,,Per Svc,730.00
Chargemaster Item,,83327197,SPSI,Chest 2 View,,Per Svc,919.00
Chargemaster Item,,83327205,SPSI,Chest 3 Views,,Per Svc,1178.00
Chargemaster Item,,83327213,SPSI,Chest 4 Views,,Per Svc,1547.00
Chargemaster Item,,83327239,SPSI,Ribs W/ Pa Cxr Right,,Per Svc,1082.00
Chargemaster Item,,83327247,SPSI,Ribs W/ Pa Cxr Left,,Per Svc,1082.00
Chargemaster Item,,83327254,SPSI,Ribs Right,,Per Svc,949.00
Chargemaster Item,,83327262,SPSI,Ribs Left,,Per Svc,949.00
Chargemaster Item,,83327270,SPSI,Bilat Ribs,,Per Svc,1275.00
Chargemaster Item,,83327288,SPSI,Bilat Ribs W/ Pa Cxr,,Per Svc,1363.00
Chargemaster Item,,83327296,SPSI,Sternum,,Per Svc,779.00
Chargemaster Item,,83327304,SPSI,Sternoclavicular Joints,,Per Svc,803.00
Chargemaster Item,,83327320,SPSI,Spine 1 View,,Per Svc,752.00
Chargemaster Item,,83327338,SPSI,Cervical Spine 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,83327346,SPSI,Cervical Spine 4 or 5 Views,,Per Svc,1453.00
Chargemaster Item,,83327353,SPSI,Cerv Spine 6 Or More Views,,Per Svc,1865.00
Chargemaster Item,,83327361,SPSI,Cervical Spine 3 or Less Views,,Per Svc,799.00
Chargemaster Item,,83327379,SPSI,Thoracic Spine 4 Plus Views,,Per Svc,1414.00
Chargemaster Item,,83327387,SPSI,Thoracic Spine 2 Views,,Per Svc,1071.00
Chargemaster Item,,83327395,SPSI,Thoracolumbar min 2 Views,,Per Svc,944.00
Chargemaster Item,,83327411,SPSI,Lumbar Sp 2 Or 3 Views,,Per Svc,930.00
Chargemaster Item,,83327429,SPSI,Lumbar Spine 4 Views,,Per Svc,1112.00
Chargemaster Item,,83327437,SPSI,Ls Spine,,Per Svc,1112.00
Chargemaster Item,,83327437INACTV,SPSI,Lumbar Sp 4 Plus Views,,Per Svc,2537.00
Chargemaster Item,,83327445,SPSI,Ls Spine & Bending Views,,Per Svc,1979.00
Chargemaster Item,,83327452,SPSI,Ls Spine Only Bending Views,,Per Svc,1134.00
Chargemaster Item,,83327460,SPSI,Pelvis Ap,,Per Svc,941.00
Chargemaster Item,,83327478,SPSI,Pelvis 2 Views,,Per Svc,941.00
Chargemaster Item,,83327486,SPSI,Sacroiliac Joints,,Per Svc,843.00
Chargemaster Item,,83327494,SPSI,Sacrum & Coccyx,,Per Svc,794.00
Chargemaster Item,,83327502,SPSI,Metastatic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,83327510,SPSI,Metabolic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,83327528,SPSI,Clavicle Right,,Per Svc,710.00
Chargemaster Item,,83327536,SPSI,Clavicle Left,,Per Svc,710.00
Chargemaster Item,,83327544,SPSI,Scapula Right,,Per Svc,1030.00
Chargemaster Item,,83327551,SPSI,Scapula Left,,Per Svc,1030.00
Chargemaster Item,,83327569,SPSI,Shoulder 1 View Right,,Per Svc,869.00
Chargemaster Item,,83327577,SPSI,Shoulder 1 View Left,,Per Svc,869.00
Chargemaster Item,,83327585,SPSI,Shoulder 2 Views Right,,Per Svc,978.00
Chargemaster Item,,83327593,SPSI,Shoulder 2 Views Left,,Per Svc,978.00
Chargemaster Item,,83327601,SPSI,Acromioclavicular Joints,,Per Svc,903.00
Chargemaster Item,,83327619,SPSI,Humerus Right,,Per Svc,850.00
Chargemaster Item,,83327627,SPSI,Humerus Left,,Per Svc,850.00
Chargemaster Item,,83327635,SPSI,Elbow 2 Views Right,,Per Svc,886.00
Chargemaster Item,,83327643,SPSI,Elbow 2 Views Left,,Per Svc,886.00
Chargemaster Item,,83327650,SPSI,Elbow 4 Views Right,,Per Svc,1102.00
Chargemaster Item,,83327668,SPSI,Elbow 4 Views Left,,Per Svc,1102.00
Chargemaster Item,,83327676,SPSI,Forearm Right,,Per Svc,705.00
Chargemaster Item,,83327684,SPSI,Forearm Left,,Per Svc,705.00
Chargemaster Item,,83327692,SPSI,Uext Infant Left,,Per Svc,703.00
Chargemaster Item,,83327700,SPSI,Uext Infant Right,,Per Svc,703.00
Chargemaster Item,,83327718,SPSI,Wrist 2 View Right,,Per Svc,861.00
Chargemaster Item,,83327726,SPSI,Wrist 2 View Left,,Per Svc,861.00
Chargemaster Item,,83327734,SPSI,Wrist 4 View Right,,Per Svc,1022.00
Chargemaster Item,,83327742,SPSI,Wrist 4 View Left,,Per Svc,1022.00
Chargemaster Item,,83327759,SPSI,Hand 2 Views Right,,Per Svc,671.00
Chargemaster Item,,83327767,SPSI,Hand 2 Views Left,,Per Svc,671.00
Chargemaster Item,,83327775,SPSI,Pa Hands/Wrist,,Per Svc,671.00
Chargemaster Item,,83327783,SPSI,Hand 3 Views Right,,Per Svc,850.00
Chargemaster Item,,83327791,SPSI,Hand 3 Views Left,,Per Svc,850.00
Chargemaster Item,,83327809,SPSI,Finger(S) Right,,Per Svc,611.00
Chargemaster Item,,83327817,SPSI,Finger(S) Left,,Per Svc,611.00
Chargemaster Item,,83327825,SPSI,Hip 1 View Right,,Per Svc,703.00
Chargemaster Item,,83327833,SPSI,Hip 1 View Left,,Per Svc,703.00
Chargemaster Item,,83327908,SPSI,Femur Right,,Per Svc,850.00
Chargemaster Item,,83327916,SPSI,Femur Left,,Per Svc,783.00
Chargemaster Item,,83327924,SPSI,Knee 1 Or 2 Views Right,,Per Svc,743.00
Chargemaster Item,,83327932,SPSI,Knee 1 Or 2 Views Left,,Per Svc,743.00
Chargemaster Item,,83327940,SPSI,Ap Bil Knees Standing,,Per Svc,1274.00
Chargemaster Item,,83327957,SPSI,Knee 3 Views Left,,Per Svc,846.00
Chargemaster Item,,83327965,SPSI,Knee 3 Views Right,,Per Svc,846.00
Chargemaster Item,,83327973,SPSI,Patella Right,,Per Svc,846.00
Chargemaster Item,,83327981,SPSI,Patella Left,,Per Svc,846.00
Chargemaster Item,,83327999,SPSI,Tibia & Fibia Right,,Per Svc,795.00
Chargemaster Item,,83328005,SPSI,Tibia & Fibia Left,,Per Svc,795.00
Chargemaster Item,,83328013,SPSI,Lext Infant Left,,Per Svc,687.00
Chargemaster Item,,83328021,SPSI,Lext Infant Right,,Per Svc,687.00
Chargemaster Item,,83328039,SPSI,Ankle 2 Views Right,,Per Svc,817.00
Chargemaster Item,,83328047,SPSI,Ankle 2 Views Left,,Per Svc,817.00
Chargemaster Item,,83328054,SPSI,Ankle 4 Views Right,,Per Svc,1061.00
Chargemaster Item,,83328062,SPSI,Ankle 4 Views Left,,Per Svc,1061.00
Chargemaster Item,,83328070,SPSI,Foot 2 Views Right,,Per Svc,788.00
Chargemaster Item,,83328088,SPSI,Foot 2 Views Left,,Per Svc,788.00
Chargemaster Item,,83328096,SPSI,Foot 3 Views Right,,Per Svc,1011.00
Chargemaster Item,,83328104,SPSI,Foot 3 Views Left,,Per Svc,1011.00
Chargemaster Item,,83328112,SPSI,Os Calcis Right,,Per Svc,710.00
Chargemaster Item,,83328120,SPSI,Os Calcis Left,,Per Svc,710.00
Chargemaster Item,,83328138,SPSI,Toe/Toes Right,,Per Svc,622.00
Chargemaster Item,,83328146,SPSI,Toe/Toes Left,,Per Svc,622.00
Chargemaster Item,,83328153,SPSI,Abdomen 1 View,,Per Svc,1095.00
Chargemaster Item,,83328161,SPSI,Kub,,Per Svc,1095.00
Chargemaster Item,,83328179,SPSI,Abdomen 2 Views,,Per Svc,711.00
Chargemaster Item,,83328187,SPSI,Abd Series/Pa Chest,,Per Svc,1095.00
Chargemaster Item,,83328195,SPSI,Nose-Rectum Child Iv,,Per Svc,716.00
Chargemaster Item,,83328203,SPSI,Bone Age Studies,,Per Svc,1034.00
Chargemaster Item,,83328211,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,83328229,SPSI,Osseous Survey Complete,,Per Svc,4402.00
Chargemaster Item,,83328237,SPSI,Osseous Survey Limited,,Per Svc,2135.00
Chargemaster Item,,83328245,SPSI,Infant Osseous Survey,,Per Svc,1545.00
Chargemaster Item,,83328252,SPSI,Ap Standing Feet,,Per Svc,671.00
Chargemaster Item,,83372086,SPSI,Entire Spine/Scoliosis 1 View,,Per Svc,1185.00
Chargemaster Item,,83372087,SPSI,Entire Spine/Scoliosis 2/3 Vws,,Per Svc,1383.00
Chargemaster Item,,83372088,SPSI,ENTIRE SPINE/SCOLIOSIS 4 OR 5 VWS,,Per Svc,1383.00
Chargemaster Item,,83372089,SPSI,ENTIRE SPINE/SCOLIOSIS 6 VWS,,Per Svc,1383.00
Chargemaster Item,,83373501,SPSI,LT Hip 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,83373502,SPSI,RT HIP 2 or 3 VIEWS,,Per Svc,941.00
Chargemaster Item,,83373522,SPSI,Bilat Hips w or wo Pelvis,,Per Svc,1647.00
Chargemaster Item,,84429018,SPSI,Mandible Limited,,Per Svc,1361.00
Chargemaster Item,,84429026,SPSI,Mandible Complete,,Per Svc,1361.00
Chargemaster Item,,84429034,SPSI,Mastoids Limited,,Per Svc,626.00
Chargemaster Item,,84429042,SPSI,Mastoids Complete,,Per Svc,868.00
Chargemaster Item,,84429059,SPSI,Lim Facial Bones,,Per Svc,1016.00
Chargemaster Item,,84429067,SPSI,Facial Bones,,Per Svc,1221.00
Chargemaster Item,,84429075,SPSI,Nasal Bones,,Per Svc,941.00
Chargemaster Item,,84429083,SPSI,Optic Foramina,,Per Svc,773.00
Chargemaster Item,,84429091,SPSI,Sinuses Limited,,Per Svc,966.00
Chargemaster Item,,84429109,SPSI,Sinuses Complete,,Per Svc,1399.00
Chargemaster Item,,84429117,SPSI,Sella Turcica,,Per Svc,701.00
Chargemaster Item,,84429125,SPSI,Skull 4 Views,,Per Svc,1554.00
Chargemaster Item,,84429133,SPSI,Skull 2 Views,,Per Svc,963.00
Chargemaster Item,,84429141,SPSI,Skull Complete,,Per Svc,1554.00
Chargemaster Item,,84429158,SPSI,Tm Joints Bilateral,,Per Svc,1617.00
Chargemaster Item,,84429166,SPSI,Neck Soft Tissue,,Per Svc,663.00
Chargemaster Item,,84429174,SPSI,Salivary Gland,,Per Svc,891.00
Chargemaster Item,,84429182,SPSI,Chest 1 View,,Per Svc,730.00
Chargemaster Item,,84429190,SPSI,Chest 2 View,,Per Svc,919.00
Chargemaster Item,,84429208,SPSI,Chest 3 Views,,Per Svc,1178.00
Chargemaster Item,,84429216,SPSI,Chest 4 Views,,Per Svc,1547.00
Chargemaster Item,,84429232,SPSI,Ribs W/ Pa Cxr Right,,Per Svc,1082.00
Chargemaster Item,,84429240,SPSI,Ribs W/ Pa Cxr Left,,Per Svc,1082.00
Chargemaster Item,,84429257,SPSI,Ribs Right,,Per Svc,949.00
Chargemaster Item,,84429265,SPSI,Ribs Left,,Per Svc,949.00
Chargemaster Item,,84429273,SPSI,Bilat Ribs,,Per Svc,1275.00
Chargemaster Item,,84429281,SPSI,Bilat Ribs W/ Pa Cxr,,Per Svc,1363.00
Chargemaster Item,,84429299,SPSI,Sternum,,Per Svc,779.00
Chargemaster Item,,84429307,SPSI,Sternoclavicular Joints,,Per Svc,803.00
Chargemaster Item,,84429323,SPSI,Spine 1 View,,Per Svc,752.00
Chargemaster Item,,84429331,SPSI,Cervical Spine 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,84429349,SPSI,Cervical Spine 4 or 5 Views,,Per Svc,1453.00
Chargemaster Item,,84429356,SPSI,Cerv Spine 6 Or More Views,,Per Svc,1865.00
Chargemaster Item,,84429364,SPSI,Cervical Spine 3 or Less Views,,Per Svc,799.00
Chargemaster Item,,84429372,SPSI,Thoracic Spine 4 Plus Views,,Per Svc,1414.00
Chargemaster Item,,84429380,SPSI,Thoracic Spine 2 Views,,Per Svc,1071.00
Chargemaster Item,,84429398,SPSI,Thoracolumbar min 2 Views,,Per Svc,944.00
Chargemaster Item,,84429414,SPSI,Lumbar Sp 2 Or 3 Views,,Per Svc,930.00
Chargemaster Item,,84429422,SPSI,Lumbar Spine 4 Views,,Per Svc,1112.00
Chargemaster Item,,84429430,SPSI,Ls Spine,,Per Svc,1112.00
Chargemaster Item,,84429430INACTV,SPSI,Lumbar Sp 4 Plus Views,,Per Svc,2537.00
Chargemaster Item,,84429448,SPSI,Ls Spine & Bending Views,,Per Svc,1979.00
Chargemaster Item,,84429455,SPSI,Ls Spine Only Bending Views,,Per Svc,1134.00
Chargemaster Item,,84429463,SPSI,Pelvis Ap,,Per Svc,941.00
Chargemaster Item,,84429471,SPSI,Pelvis 2 Views,,Per Svc,941.00
Chargemaster Item,,84429489,SPSI,Sacroiliac Joints,,Per Svc,843.00
Chargemaster Item,,84429497,SPSI,Sacrum & Coccyx,,Per Svc,794.00
Chargemaster Item,,84429505,SPSI,Metastatic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,84429513,SPSI,Metabolic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,84429521,SPSI,Clavicle Right,,Per Svc,710.00
Chargemaster Item,,84429539,SPSI,Clavicle Left,,Per Svc,710.00
Chargemaster Item,,84429547,SPSI,Scapula Right,,Per Svc,1030.00
Chargemaster Item,,84429554,SPSI,Scapula Left,,Per Svc,1030.00
Chargemaster Item,,84429562,SPSI,Shoulder 1 View Right,,Per Svc,869.00
Chargemaster Item,,84429570,SPSI,Shoulder 1 View Left,,Per Svc,869.00
Chargemaster Item,,84429588,SPSI,Shoulder 2 Views Right,,Per Svc,978.00
Chargemaster Item,,84429596,SPSI,Shoulder 2 Views Left,,Per Svc,978.00
Chargemaster Item,,84429604,SPSI,Acromioclavicular Joints,,Per Svc,903.00
Chargemaster Item,,84429612,SPSI,Humerus Right,,Per Svc,850.00
Chargemaster Item,,84429620,SPSI,Humerus Left,,Per Svc,850.00
Chargemaster Item,,84429638,SPSI,Elbow 2 Views Right,,Per Svc,886.00
Chargemaster Item,,84429646,SPSI,Elbow 2 Views Left,,Per Svc,886.00
Chargemaster Item,,84429653,SPSI,Elbow 4 Views Right,,Per Svc,1102.00
Chargemaster Item,,84429661,SPSI,Elbow 4 Views Left,,Per Svc,1102.00
Chargemaster Item,,84429679,SPSI,Forearm Right,,Per Svc,705.00
Chargemaster Item,,84429687,SPSI,Forearm Left,,Per Svc,705.00
Chargemaster Item,,84429695,SPSI,Uext Infant Left,,Per Svc,703.00
Chargemaster Item,,84429703,SPSI,Uext Infant Right,,Per Svc,703.00
Chargemaster Item,,84429711,SPSI,Wrist 2 View Right,,Per Svc,861.00
Chargemaster Item,,84429729,SPSI,Wrist 2 View Left,,Per Svc,861.00
Chargemaster Item,,84429737,SPSI,Wrist 4 View Right,,Per Svc,1022.00
Chargemaster Item,,84429745,SPSI,Wrist 4 View Left,,Per Svc,1022.00
Chargemaster Item,,84429752,SPSI,Hand 2 Views Right,,Per Svc,671.00
Chargemaster Item,,84429760,SPSI,Hand 2 Views Left,,Per Svc,671.00
Chargemaster Item,,84429778,SPSI,Pa Hands/Wrist,,Per Svc,671.00
Chargemaster Item,,84429786,SPSI,Hand 3 Views Right,,Per Svc,850.00
Chargemaster Item,,84429794,SPSI,Hand 3 Views Left,,Per Svc,850.00
Chargemaster Item,,84429802,SPSI,Finger(S) Right,,Per Svc,611.00
Chargemaster Item,,84429810,SPSI,Finger(S) Left,,Per Svc,611.00
Chargemaster Item,,84429828,SPSI,Hip 1 View Right,,Per Svc,703.00
Chargemaster Item,,84429836,SPSI,Hip 1 View Left,,Per Svc,703.00
Chargemaster Item,,84429901,SPSI,Femur Right,,Per Svc,850.00
Chargemaster Item,,84429919,SPSI,Femur Left,,Per Svc,783.00
Chargemaster Item,,84429927,SPSI,Knee 1 Or 2 Views Right,,Per Svc,743.00
Chargemaster Item,,84429935,SPSI,Knee 1 Or 2 Views Left,,Per Svc,743.00
Chargemaster Item,,84429943,SPSI,Ap Bil Knees Standing,,Per Svc,1274.00
Chargemaster Item,,84429950,SPSI,Knee 3 Views Left,,Per Svc,846.00
Chargemaster Item,,84429968,SPSI,Knee 3 Views Right,,Per Svc,846.00
Chargemaster Item,,84429976,SPSI,Patella Right,,Per Svc,846.00
Chargemaster Item,,84429984,SPSI,Patella Left,,Per Svc,846.00
Chargemaster Item,,84429992,SPSI,Tibia & Fibia Right,,Per Svc,795.00
Chargemaster Item,,84430008,SPSI,Tibia & Fibia Left,,Per Svc,795.00
Chargemaster Item,,84430016,SPSI,Lext Infant Left,,Per Svc,687.00
Chargemaster Item,,84430024,SPSI,Lext Infant Right,,Per Svc,687.00
Chargemaster Item,,84430032,SPSI,Ankle 2 Views Right,,Per Svc,817.00
Chargemaster Item,,84430040,SPSI,Ankle 2 Views Left,,Per Svc,817.00
Chargemaster Item,,84430057,SPSI,Ankle 4 Views Right,,Per Svc,1061.00
Chargemaster Item,,84430065,SPSI,Ankle 4 Views Left,,Per Svc,1061.00
Chargemaster Item,,84430073,SPSI,Foot 2 Views Right,,Per Svc,788.00
Chargemaster Item,,84430081,SPSI,Foot 2 Views Left,,Per Svc,788.00
Chargemaster Item,,84430099,SPSI,Foot 3 Views Right,,Per Svc,1011.00
Chargemaster Item,,84430107,SPSI,Foot 3 Views Left,,Per Svc,1011.00
Chargemaster Item,,84430115,SPSI,Os Calcis Right,,Per Svc,710.00
Chargemaster Item,,84430123,SPSI,Os Calcis Left,,Per Svc,710.00
Chargemaster Item,,84430131,SPSI,Toe/Toes Right,,Per Svc,622.00
Chargemaster Item,,84430149,SPSI,Toe/Toes Left,,Per Svc,622.00
Chargemaster Item,,84430156,SPSI,Abdomen 1 View,,Per Svc,1095.00
Chargemaster Item,,84430164,SPSI,Kub,,Per Svc,1095.00
Chargemaster Item,,84430172,SPSI,Abdomen 2 Views,,Per Svc,711.00
Chargemaster Item,,84430180,SPSI,Abd Series/Pa Chest,,Per Svc,1095.00
Chargemaster Item,,84430198,SPSI,Nose-Rectum Child Iv,,Per Svc,716.00
Chargemaster Item,,84430206,SPSI,Bone Age Studies,,Per Svc,1034.00
Chargemaster Item,,84430214,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,84430222,SPSI,Osseous Survey Complete,,Per Svc,4402.00
Chargemaster Item,,84430230,SPSI,Osseous Survey Limited,,Per Svc,2135.00
Chargemaster Item,,84430248,SPSI,Infant Osseous Survey,,Per Svc,1545.00
Chargemaster Item,,84430255,SPSI,Ap Standing Feet,,Per Svc,671.00
Chargemaster Item,,84470814,SPSI,Dexa Bone Density Peripheral,,Per Svc,803.00
Chargemaster Item,,84470855,SPSI,Dxa Bone Density Axial w/Fx Ax,,Per Svc,803.00
Chargemaster Item,,84472083,SPSI,Entire Spine/Scoliosis 1 View,,Per Svc,1185.00
Chargemaster Item,,84472084,SPSI,Entire Spine/Scoliosis 2/3 Vws,,Per Svc,1383.00
Chargemaster Item,,84472085,SPSI,ENTIRE SPINE/SCOLIOSIS 4 OR 5 VWS,,Per Svc,1383.00
Chargemaster Item,,84472086,SPSI,ENTIRE SPINE/SCOLIOSIS 6 VWS,,Per Svc,1383.00
Chargemaster Item,,84473505,SPSI,LT Hip 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,84473506,SPSI,RT HIP 2 or 3 VIEWS,,Per Svc,941.00
Chargemaster Item,,84473529,SPSI,Bilat Hips w or wo Pelvis,,Per Svc,1647.00
Chargemaster Item,,84477082,SPSI,Dexa Bone Density Axial,,Per Svc,803.00
Chargemaster Item,,85000016,SPSI,Reflex HPV RNA HRE6/E7 TMA,,Per Svc,37.44
Chargemaster Item,,85000024,SPSI,Chlamydia GC RNA TMA,,Per Svc,48.25
Chargemaster Item,,85000032,SPSI,Cytology PAP & Rvw,,Per Svc,72.38
Chargemaster Item,,85100014,SPSI,Fetal Lung Maturity at UCI,,Per Svc,74.00
Chargemaster Item,,85100022,SPSI,FLM LS Ratio_UCI,,Per Svc,50.00
Chargemaster Item,,85100030,SPSI,FLM PG_UCI,,Per Svc,46.00
Chargemaster Item,,85100048,SPSI,PAP Smear Thin Prep (Quest),,Per Svc,35.00
Chargemaster Item,,85100055,SPSI,Pap Smear Conv (Quest),,Per Svc,14.00
Chargemaster Item,,85100063,SPSI,HPV HR Reflex,,Per Svc,40.00
Chargemaster Item,,85100097,SPSI,Mopath Procedure Level 1,,Per Svc,36.56
Chargemaster Item,,85100105,SPSI,Platelet Antibodies,,Per Svc,315.00
Chargemaster Item,,85800829,SPSI,Chlamydia,,Per Svc,140.00
Chargemaster Item,,85836625,SPSI,Lung Maturity Panel,,Per Svc,136.00
Chargemaster Item,,85840817,SPSI,PG_S,,Per Svc,20.27
Chargemaster Item,,85900041,SPSI,Antibody ID Platelet AN,,Per Svc,36.46
Chargemaster Item,,86855970,SPSI,Lupus Anticoagulant:Hexagonal,,Per Svc,38.50
Chargemaster Item,,87000014,SPSI,Pro Predict 6MP,,Per Svc,270.00
Chargemaster Item,,87000048,SPSI,Pro Predict Infliximab,,Per Svc,225.00
Chargemaster Item,,87000055,SPSI,Celiac Disease System,,Per Svc,290.00
Chargemaster Item,,87000063,SPSI,IBD Serology 7,,Per Svc,690.00
Chargemaster Item,,87000089,SPSI,Prometheus TPMT Enzymes,,Per Svc,220.00
Chargemaster Item,,89000012,SPSI,Rheumatoid Arthritis Panel,,Per Svc,151.50
Chargemaster Item,,89000020,SPSI,HLA DRB3 4 5 DNA Typing,,Per Svc,157.50
Chargemaster Item,,8900003,SPSI,Hospice Care Day,,Per Svc,978.00
Chargemaster Item,,89000038,SPSI,Fecal Globin By IHC,,Per Svc,18.34
Chargemaster Item,,89000046,SPSI,Stone Analysis (Quest),,Per Svc,11.58
Chargemaster Item,,89000053,SPSI,TPMT Genotype (Quest),,Per Svc,115.80
Chargemaster Item,,89000061,SPSI,Kappa Lambda Light Chain Ux,,Per Svc,61.76
Chargemaster Item,,89000079,SPSI,HIV 1/2 Antibody Differentiation,,Per Svc,25.00
Chargemaster Item,,89000095,SPSI,Cardiac Troponin I_Quest,,Per Svc,16.75
Chargemaster Item,,89000103,SPSI,CSF Amino Acids Quantitative,,Per Svc,262.00
Chargemaster Item,,89000111,SPSI,Aldosterone Renin Act Ratio,,Per Svc,23.16
Chargemaster Item,,89000129,SPSI,H Pylori Urea Breath Test,,Per Svc,50.00
Chargemaster Item,,89000137,SPSI,Protein S Free,,Per Svc,22.00
Chargemaster Item,,89000152,SPSI,T Pallidum Antibody by PA,,Per Svc,42.87
Chargemaster Item,,89000160,SPSI,D Lactate,,Per Svc,210.85
Chargemaster Item,,89000186,SPSI,Rufinamide,,Per Svc,133.00
Chargemaster Item,,89000194,SPSI,Urine BK Virus DNA Quantitative PCR,,Per Svc,85.00
Chargemaster Item,,89000202,SPSI,Single Stranded DNA Anitbody IgG,,Per Svc,62.84
Chargemaster Item,,89000210,SPSI,Allergy Respiratory Region XIII,,Per Svc,170.51
Chargemaster Item,,89000236,SPSI,JAK 2 Exons 12 and 13 Mutations,,Per Svc,175.00
Chargemaster Item,,89000244,SPSI,Iron 24 Hour Urine,,Per Svc,31.37
Chargemaster Item,,89000251,SPSI,Porphyrins Total Plasma,,Per Svc,39.00
Chargemaster Item,,89000269,SPSI,Human Metapneumovirus PCR,,Per Svc,349.00
Chargemaster Item,,89000277,SPSI,Cobalt (Blood),,Per Svc,62.00
Chargemaster Item,,89000285,SPSI,Chromium,,Per Svc,49.50
Chargemaster Item,,89000293,SPSI,Olanzapine,,Per Svc,71.41
Chargemaster Item,,89000301,SPSI,Peach,,Per Svc,10.00
Chargemaster Item,,89000319,SPSI,Ketone Panel,,Per Svc,98.00
Chargemaster Item,,89000327,SPSI,LP Pla2,,Per Svc,178.50
Chargemaster Item,,89000335,SPSI,Hepatitis C Virus Fibrosure,,Per Svc,288.75
Chargemaster Item,,89000343,SPSI,Leflunomide Metabolite,,Per Svc,171.00
Chargemaster Item,,89000350,SPSI,Mycoplasma Pneumoniae Cult,,Per Svc,20.36
Chargemaster Item,,89000368,SPSI,Legionella Pneumophila AG DFA,,Per Svc,47.48
Chargemaster Item,,89000376,SPSI,Legionella Culture,,Per Svc,33.78
Chargemaster Item,,89000384,SPSI,IGG Albumin Ratio (CSF),,Per Svc,18.00
Chargemaster Item,,89000392,SPSI,Antifungal Serum Itraconazole,,Per Svc,57.66
Chargemaster Item,,89000400,SPSI,Oxalic Acid Random Urine,,Per Svc,13.61
Chargemaster Item,,89000418,SPSI,Pregabalin Quant Urine,,Per Svc,100.00
Chargemaster Item,,89000434,SPSI,Steroid Panel,,Per Svc,1210.00
Chargemaster Item,,89000442,SPSI,Nuclear Matrix Proteins,,Per Svc,62.50
Chargemaster Item,,89000467,SPSI,Enterovirus Culture,,Per Svc,57.42
Chargemaster Item,,89000475,SPSI,JC Polyoma Virus AB,,Per Svc,1363.00
Chargemaster Item,,89000517,SPSI,Achondroplasia Mutation Analysis,,Per Svc,191.10
Chargemaster Item,,89000525,SPSI,Ethylene Glycol, Urine,,Per Svc,12.00
Chargemaster Item,,89000533,SPSI,HLA-B27 DNA Typing,,Per Svc,95.00
Chargemaster Item,,89000541,SPSI,Lyme Disease AB IGG IGM IFA CSF,,Per Svc,18.34
Chargemaster Item,,89000558,SPSI,Helicobacter Pylori AB IGA,,Per Svc,34.50
Chargemaster Item,,89000574,SPSI,Aspergillus Antigen,,Per Svc,100.66
Chargemaster Item,,89000590,SPSI,Fungus Culture Misc Source,,Per Svc,15.00
Chargemaster Item,,89000608,SPSI,Aerobic Bacteria ID,,Per Svc,22.50
Chargemaster Item,,89000616,SPSI,Bord Pert/Parapert DNA QL PCR,,Per Svc,74.88
Chargemaster Item,,89000632,SPSI,Herpes Simplex 1/2 DNA Rt Pcr,,Per Svc,96.50
Chargemaster Item,,89000657,SPSI,Herpes Simplex Virus Culture,,Per Svc,21.00
Chargemaster Item,,89000681,SPSI,M Avium Complex MIC Panel,,Per Svc,149.72
Chargemaster Item,,89000715,SPSI,MTB PCR, Non-Respiratory,,Per Svc,85.00
Chargemaster Item,,89000723,SPSI,Mycobacterium PCR, Respiratory,,Per Svc,85.00
Chargemaster Item,,89000731,SPSI,Norovirus RNA, RT-PCR,,Per Svc,86.85
Chargemaster Item,,89000749,SPSI,Pneumocystis Jiro Carinii DFA,,Per Svc,82.68
Chargemaster Item,,89000756,SPSI,Pneumocystis Jirovecii, Qualitative RT-PCR,,Per Svc,265.38
Chargemaster Item,,89000764,SPSI,S.Pneumoniae AG Detection LA,,Per Svc,43.43
Chargemaster Item,,89000806,SPSI,Pro BNP N Terminal,,Per Svc,40.00
Chargemaster Item,,89000830,SPSI,BRCA1 BRA2 Comprehensive,,Per Svc,2150.00
Chargemaster Item,,89000855,SPSI,Leptin,,Per Svc,73.45
Chargemaster Item,,89000863,SPSI,Donor HIV1/HCV/HBV w/Reflex,,Per Svc,357.54
Chargemaster Item,,89000897,SPSI,Porphyrins Frac Qnt (24hr UX),,Per Svc,42.00
Chargemaster Item,,89000905,SPSI,Herpes Sim Virus 2 IGG,,Per Svc,3.38
Chargemaster Item,,89000913,SPSI,PML/Rara T 15, 17 Quant RT-Pcr,,Per Svc,162.12
Chargemaster Item,,89000921,SPSI,Herpes Sim Virus 1 IGG,,Per Svc,3.38
Chargemaster Item,,89000939,SPSI,T3 Free,,Per Svc,6.56
Chargemaster Item,,89000947,SPSI,Lactate Dehydrogenase,,Per Svc,11.67
Chargemaster Item,,89000954,SPSI,IGA Subclasses or IGG,,Per Svc,64.94
Chargemaster Item,,89001010,SPSI,Liver Cytosol Autoantibodies,,Per Svc,138.00
Chargemaster Item,,89001028,SPSI,Alcohol Met w/Confirm UX,,Per Svc,57.90
Chargemaster Item,,89001036,SPSI,HIV1/2 AG,AB 4th Gen w/Reflex,,Per Svc,25.00
Chargemaster Item,,89001044,SPSI,Malaria Other Bld Parasites,,Per Svc,44.14
Chargemaster Item,,89001051,SPSI,Thrombopoietn Rec Mut Mpl W515,,Per Svc,350.00
Chargemaster Item,,89001077,SPSI,Von Willebrand Collagen Binding Assay,,Per Svc,60.00
Chargemaster Item,,89001093,SPSI,JAK2 V617F Quant Plasma,,Per Svc,250.00
Chargemaster Item,,89001101,SPSI,Alpha-Globin Common Mutation,,Per Svc,110.00
Chargemaster Item,,89001119,SPSI,Mycobact Avium Com DNA QL RTPC,,Per Svc,282.00
Chargemaster Item,,89001127,SPSI,HIV1 RNA Quant Rt PCR, CSF,,Per Svc,72.38
Chargemaster Item,,89001135,SPSI,Cardio IQ (R) HDL Cholesterol,,Per Svc,2.00
Chargemaster Item,,89001143,SPSI,Cardio IQ R Advanced Lipid Panel,,Per Svc,55.88
Chargemaster Item,,89001150,SPSI,ANA Screen IFA w/Reflex Titer,,Per Svc,4.85
Chargemaster Item,,89001168,SPSI,Cardio R Omega3,6 Fatty Acids,,Per Svc,175.50
Chargemaster Item,,89001176,SPSI,Plasminogen Activator AG,,Per Svc,53.08
Chargemaster Item,,89001184,SPSI,Bordetella Pertussis/Par Smear,,Per Svc,20.37
Chargemaster Item,,89001192,SPSI,Fish Multip Myel 13Q,17P,14Q32,,Per Svc,475.00
Chargemaster Item,,89001200,SPSI,Lacosamide,,Per Svc,82.03
Chargemaster Item,,89001218,SPSI,TTR DNA Sequencing Test,,Per Svc,1145.00
Chargemaster Item,,89001226,SPSI,Celiac Genetics,,Per Svc,215.00
Chargemaster Item,,89001234,SPSI,Mouse Urine Proteins IGE,,Per Svc,5.78
Chargemaster Item,,89001242,SPSI,Imported Fire Ant IGE,,Per Svc,5.78
Chargemaster Item,,89001259,SPSI,Allergy Insect Venom,,Per Svc,28.90
Chargemaster Item,,89001267,SPSI,Hepatitis B Core AB IGM,,Per Svc,8.00
Chargemaster Item,,89001275,SPSI,Lipoprotein Fractionation,,Per Svc,30.00
Chargemaster Item,,89001283,SPSI,Arbovirus AB Panel IFA,,Per Svc,132.00
Chargemaster Item,,89001291,SPSI,Selenium RBC,,Per Svc,64.66
Chargemaster Item,,89001309,SPSI,IA-2 Antibody,,Per Svc,48.25
Chargemaster Item,,89001317,SPSI,Cardio IQ Omega 3, 6 Fatty Acids,,Per Svc,50.00
Chargemaster Item,,89001333,SPSI,Urine Carnitine,,Per Svc,200.00
Chargemaster Item,,89001341,SPSI,Mixing Study,,Per Svc,35.00
Chargemaster Item,,89001358,SPSI,Hepatitis B Surface AB Qual,,Per Svc,4.00
Chargemaster Item,,89001366,SPSI,Bupropin and Metabolite,,Per Svc,99.00
Chargemaster Item,,89001374,SPSI,Hydrocodone and Metabolite UX,,Per Svc,70.00
Chargemaster Item,,89001382,SPSI,Hydrocodone Metabolite Bld,,Per Svc,114.00
Chargemaster Item,,89001390,SPSI,Immunofixation CSF,,Per Svc,55.11
Chargemaster Item,,89001408,SPSI,Benzodiazepine Confirmation UX,,Per Svc,21.23
Chargemaster Item,,89001416,SPSI,Respiratory Allergy Profile XI x25,,Per Svc,147.22
Chargemaster Item,,89001424,SPSI,Lyme Disease AB IGM,,Per Svc,75.27
Chargemaster Item,,89001432,SPSI,HLA B 5701 Typing,,Per Svc,173.70
Chargemaster Item,,89001440,SPSI,Thrombophilia Screen Inherited,,Per Svc,339.45
Chargemaster Item,,89001457,SPSI,Infliximab Act and Neut AB,,Per Svc,455.00
Chargemaster Item,,89001465,SPSI,Turkey Feathers IGE,,Per Svc,5.58
Chargemaster Item,,89001473,SPSI,Turkey Meat IGE,,Per Svc,5.58
Chargemaster Item,,89001481,SPSI,RBC Fragility,,Per Svc,25.81
Chargemaster Item,,89001499,SPSI,C4 Binding Protein Plasma,,Per Svc,19.30
Chargemaster Item,,89001507,SPSI,Vagninosis/Vaginitis Swab,,Per Svc,700.00
Chargemaster Item,,89001515,SPSI,Calreticulin Mutation Analysis,,Per Svc,445.55
Chargemaster Item,,89001523,SPSI,Lyme Disease AB IGG IGM CSF,,Per Svc,150.54
Chargemaster Item,,89001531,SPSI,Helicobacter Pylori Breath Ped,,Per Svc,50.00
Chargemaster Item,,89001549,SPSI,HLA Typing Celiac Disease,,Per Svc,96.50
Chargemaster Item,,89001556,SPSI,Allergy Panel 19 Seafood Group,,Per Svc,5.58
Chargemaster Item,,89001572,SPSI,Fentanyl and Norfentanyl,,Per Svc,58.87
Chargemaster Item,,89001580,SPSI,Hep B Virus Drug Res. Geno,,Per Svc,120.63
Chargemaster Item,,89001598,SPSI,Legionella Pneumophila AB IGM,,Per Svc,80.10
Chargemaster Item,,89001606,SPSI,Legionella Pneumophila AB IGG,,Per Svc,10.13
Chargemaster Item,,89001614,SPSI,Propoxyphene Quant,,Per Svc,96.45
Chargemaster Item,,89001630,SPSI,Musk Antibody Test,,Per Svc,1040.00
Chargemaster Item,,89001648,SPSI,Chromosone Microdeletion DNA,,Per Svc,282.61
Chargemaster Item,,89001655,SPSI,Progensa PCA3,,Per Svc,250.00
Chargemaster Item,,89001663,SPSI,Plasminogen Activator Inhib-1,,Per Svc,143.30
Chargemaster Item,,89001671,SPSI,Pain Management Profile W/Conf,,Per Svc,171.65
Chargemaster Item,,89001689,SPSI,Mdma/Mda Screen W/Conf Ux,,Per Svc,29.92
Chargemaster Item,,89001697,SPSI,Pain Management Fentanyl Ux,,Per Svc,38.60
Chargemaster Item,,89001705,SPSI,Nf1 Sequencing And Deletion,,Per Svc,440.00
Chargemaster Item,,89001713,SPSI,Respiratory Allergy Reg Xiv,,Per Svc,141.64
Chargemaster Item,,89001721,SPSI,Insulin Free (Bioactive),,Per Svc,27.99
Chargemaster Item,,89001747,SPSI,Alpha Fetoprotein Csf,,Per Svc,14.48
Chargemaster Item,,89001754,SPSI,Paraneoplastic Ab Eval Ref/Titre,,Per Svc,603.12
Chargemaster Item,,89001762,SPSI,Enterovirus/Parechovirus Pcr,,Per Svc,87.82
Chargemaster Item,,89001770,SPSI,Herpesvirus 6 Dna Qnt Rt Pcr,,Per Svc,265.38
Chargemaster Item,,89001788,SPSI,Cryptococcus Antibody,,Per Svc,24.13
Chargemaster Item,,89001796,SPSI,Fentanyl Qual (Urine),,Per Svc,68.74
Chargemaster Item,,89001804,SPSI,Anti-PM Scl-100 Ab,,Per Svc,93.00
Chargemaster Item,,89001812,SPSI,SMA Carrier Screen,,Per Svc,607.95
Chargemaster Item,,89001820,SPSI,Free Direct Dialysis T4 Total,,Per Svc,14.48
Chargemaster Item,,89001838,SPSI,Bact. Vaginosis DNA Qt Rt PCR,,Per Svc,92.64
Chargemaster Item,,89001846,SPSI,Infect Ag. Atopobium Vaginae,,Per Svc,92.64
Chargemaster Item,,89001853,SPSI,Infectious Ag. Megasphaera,,Per Svc,92.64
Chargemaster Item,,89001861,SPSI,Infect Ag. Gardnerella Vag.,,Per Svc,92.64
Chargemaster Item,,89001879,SPSI,Myositis Specific 11 Ab Panel,,Per Svc,86.53
Chargemaster Item,,89001887,SPSI,PL-7 Ab,,Per Svc,86.53
Chargemaster Item,,89001895,SPSI,PL-12 Ab,,Per Svc,86.53
Chargemaster Item,,89001903,SPSI,EJ Ab,,Per Svc,86.53
Chargemaster Item,,89001911,SPSI,OJ Ab,,Per Svc,86.53
Chargemaster Item,,89001929,SPSI,SRP Ab,,Per Svc,86.53
Chargemaster Item,,89001937,SPSI,Mi-2 Alpha Ab,,Per Svc,86.53
Chargemaster Item,,89001945,SPSI,Mi-2 Beta Ab,,Per Svc,86.53
Chargemaster Item,,89001952,SPSI,MDA-5 Ab,,Per Svc,86.53
Chargemaster Item,,89001960,SPSI,TIF-1Y Ab,,Per Svc,86.53
Chargemaster Item,,89001978,SPSI,NXP-2 Ab,,Per Svc,86.53
Chargemaster Item,,89001986,SPSI,Prenatal Carrier Screen,,Per Svc,262.16
Chargemaster Item,,89001994,SPSI,Fragile X PCR Screen,,Per Svc,96.50
Chargemaster Item,,89002000,SPSI,SMA,,Per Svc,262.16
Chargemaster Item,,89002018,SPSI,SARS COV2 RNA QUAL RT PCR,,Per Svc,100.00
Chargemaster Item,,89002265,SPSI,PCA1 A B LB,,Per Svc,161.25
Chargemaster Item,,89002273,SPSI,ANNA2 A B LB,,Per Svc,161.25
Chargemaster Item,,89010011,SPSI,Sodium, Feces,,Per Svc,31.62
Chargemaster Item,,89010029,SPSI,Potassium, Feces,,Per Svc,47.40
Chargemaster Item,,89010045,SPSI,Citrate, Urine,,Per Svc,69.20
Chargemaster Item,,89010052,SPSI,Creatinine, Urine,,Per Svc,17.30
Chargemaster Item,,89010110,SPSI,C1 Inhibitor Functional,,Per Svc,17.00
Chargemaster Item,,89010128,SPSI,Influenza Syndrome Profile CSF,,Per Svc,210.00
Chargemaster Item,,89010136,SPSI,Von Willebrand Factor Antigen,,Per Svc,28.00
Chargemaster Item,,89020010,SPSI,Aquaporin AB IGG Reflex Test,,Per Svc,528.00
Chargemaster Item,,89020028,SPSI,Paraneoplastic AB CBA Reflex,,Per Svc,400.00
Chargemaster Item,,89020036,SPSI,NMDAR1 AB,,Per Svc,400.00
Chargemaster Item,,89020044,SPSI,AMPAR1 AB,,Per Svc,400.00
Chargemaster Item,,89020051,SPSI,APARA2 AB,,Per Svc,400.00
Chargemaster Item,,89020069,SPSI,Neuronal Nuclear AB Reflex,,Per Svc,178.00
Chargemaster Item,,89020077,SPSI,Purkinje Cell AB Reflex,,Per Svc,786.19
Chargemaster Item,,89020085,SPSI,ANNA2 AB LB,,Per Svc,178.00
Chargemaster Item,,89020093,SPSI,PCA1 AB LB,,Per Svc,178.00
Chargemaster Item,,89020101,SPSI,CRMP5 AB LB,,Per Svc,178.00
Chargemaster Item,,89020119,SPSI,GD65 AB LB,,Per Svc,185.00
Chargemaster Item,,89020127,SPSI,Paraneoplastic ABLB REF CSF AN1,,Per Svc,161.25
Chargemaster Item,,89020135,SPSI,PCA TR AB LB,,Per Svc,161.25
Chargemaster Item,,89020143,SPSI,GAD65 AB LB,,Per Svc,161.25
Chargemaster Item,,89020150,SPSI,AGNA AB LB,,Per Svc,161.25
Chargemaster Item,,89020168,SPSI,Paraneoplastic AB CSF Reflex,,Per Svc,320.00
Chargemaster Item,,89020176,SPSI,AMPAR2 AB,,Per Svc,320.00
Chargemaster Item,,89020184,SPSI,GABABR AB,,Per Svc,320.00
Chargemaster Item,,89020192,SPSI,LGI1 AB,,Per Svc,320.00
Chargemaster Item,,89020200,SPSI,CASPR2 AB,,Per Svc,320.00
Chargemaster Item,,89020218,SPSI,Amphiphysin AB LB,,Per Svc,178.00
Chargemaster Item,,89020226,SPSI,Neuronal Nuclear A B Reflex,,Per Svc,786.19
Chargemaster Item,,89020234,SPSI,CRMP5 A B LB,,Per Svc,161.25
Chargemaster Item,,89020242,SPSI,Amphiphysin A B LB,,Per Svc,161.25
Chargemaster Item,,89020259,SPSI,AMPAR1 A B,,Per Svc,320.00
Chargemaster Item,,89020267,SPSI,Blastomyces AB Complement Fix,,Per Svc,28.95
Chargemaster Item,,89020275,SPSI,IGE Antibody Anti IGE IGG,,Per Svc,33.78
Chargemaster Item,,89020283,SPSI,Interleukin 2 Alpha Chain,,Per Svc,123.62
Chargemaster Item,,89020291,SPSI,Smooth Muscle AB W/Reflex Titer,,Per Svc,8.39
Chargemaster Item,,89020309,SPSI,Anti Synthentase Panel 1,,Per Svc,86.64
Chargemaster Item,,89020317,SPSI,JO-1 AB Pl-7 AB,,Per Svc,86.50
Chargemaster Item,,89020325,SPSI,PL-12 Antibody,,Per Svc,86.50
Chargemaster Item,,89020333,SPSI,EJ AB Antibody,,Per Svc,86.50
Chargemaster Item,,89020341,SPSI,OJ AB Antibody,,Per Svc,86.50
Chargemaster Item,,89020358,SPSI,Myelin Oligodenrocyte Gly AB,,Per Svc,264.00
Chargemaster Item,,89020366,SPSI,MOG AB CBA Titer,,Per Svc,264.00
Chargemaster Item,,89033922,SPSI,Pnh Flaer (High Sensitivity),,Per Svc,277.46
Chargemaster Item,,89033930,SPSI,Fungus Culture,,Per Svc,23.90
Chargemaster Item,,89033948,SPSI,Fungus Culture Blood,,Per Svc,37.50
Chargemaster Item,,89033955,SPSI,Bk Virus Quant Rt Pcr (Bld),,Per Svc,85.00
Chargemaster Item,,89039010,SPSI,Allergy Fusarium Moniliforme IgE,,Per Svc,10.00
Chargemaster Item,,89039051,SPSI,CSF Meningoencephalitis Panel,,Per Svc,483.94
Chargemaster Item,,89039085,SPSI,Urine - Comprehensive Drug Screen,,Per Svc,75.00
Chargemaster Item,,89039093,SPSI,Comprehensive Drug Screen,,Per Svc,35.00
Chargemaster Item,,89039101,SPSI,T4 Total,,Per Svc,3.86
Chargemaster Item,,89039119,SPSI,HBSAG Confirmation,,Per Svc,24.00
Chargemaster Item,,89039127,SPSI,Urine Orotic Acid,,Per Svc,162.54
Chargemaster Item,,89039135,SPSI,CSF Herpes Simplex Virus 1 and 2 Antibody Panel,,Per Svc,147.89
Chargemaster Item,,89039143,SPSI,C Trachomatis by DNA Probe,,Per Svc,6.00
Chargemaster Item,,89039150,SPSI,CSF Echovirus Antibody,,Per Svc,64.17
Chargemaster Item,,89039176,SPSI,Phospholipids,,Per Svc,10.00
Chargemaster Item,,89039184,SPSI,Antiphospholipid Antibody Panel,,Per Svc,79.03
Chargemaster Item,,89039192,SPSI,Adenovirus Antigen Detection Respiratory by DFA,,Per Svc,44.50
Chargemaster Item,,89039200,SPSI,Alpha 1 Antitrypsin Phenotype,,Per Svc,22.00
Chargemaster Item,,89039218,SPSI,Parvovirus B19 Qualitative by PCR,,Per Svc,82.03
Chargemaster Item,,89039226,SPSI,Parvovirus B19 Antibodies IgG_ IgM,,Per Svc,28.95
Chargemaster Item,,89039234,SPSI,Fish Bladder Cancer Washings,,Per Svc,225.00
Chargemaster Item,,89039259,SPSI,Filaria IgG4 Antibody by Elisa,,Per Svc,68.00
Chargemaster Item,,89039267,SPSI,Parainfluenza Viral Antigen Detection by DFA,,Per Svc,119.20
Chargemaster Item,,89039275,SPSI,Erythrocyte Protophorphyrin,,Per Svc,31.00
Chargemaster Item,,89039283,SPSI,Austr. Parrot/Parakeet Ige,,Per Svc,6.69
Chargemaster Item,,89039291,SPSI,Rast,Guinea Pig Epithelia Ige,,Per Svc,6.69
Chargemaster Item,,89039309,SPSI,C Trachomatis and N Gonorrhoeae RNA TMA,,Per Svc,48.25
Chargemaster Item,,89039317,SPSI,Paraldehyde And Metabolite,,Per Svc,79.00
Chargemaster Item,,89039341,SPSI,Allergy Food Panel,,Per Svc,69.36
Chargemaster Item,,89039358,SPSI,Allergy Basic Food Panel,,Per Svc,91.39
Chargemaster Item,,89039390,SPSI,Allergy California Panel,,Per Svc,140.00
Chargemaster Item,,89039408,SPSI,CLL Prognostic Panel Comprehensive,,Per Svc,1580.93
Chargemaster Item,,89039424,SPSI,Urine Dopamine,,Per Svc,62.50
Chargemaster Item,,89039432,SPSI,Urine Histoplasma Antigen,,Per Svc,109.00
Chargemaster Item,,89039440,SPSI,Rmsf Ab Titer Igg,,Per Svc,37.50
Chargemaster Item,,89039457,SPSI,Plasminogen Activity,,Per Svc,70.00
Chargemaster Item,,89039481,SPSI,CSF Cryptococcus Antibody,,Per Svc,38.60
Chargemaster Item,,89039499,SPSI,Echinococcus Antibody IgG,,Per Svc,37.50
Chargemaster Item,,89039507,SPSI,Mumps Virus Antibodies,,Per Svc,18.14
Chargemaster Item,,89039515,SPSI,Thyroid Antibody,,Per Svc,102.48
Chargemaster Item,,89039523,SPSI,Coccidioides Antibody With Reflex ID,,Per Svc,61.74
Chargemaster Item,,89039531,SPSI,Coccidioides Abs TP And F Ag,,Per Svc,45.36
Chargemaster Item,,89039572,SPSI,Genomic Alterations Postnatal,,Per Svc,2400.00
Chargemaster Item,,89039580,SPSI,Baclofen,,Per Svc,126.00
Chargemaster Item,,89039606,SPSI,Methadone_ Confirmation,,Per Svc,35.55
Chargemaster Item,,89039614,SPSI,Morphine Test,,Per Svc,35.55
Chargemaster Item,,89039630,SPSI,Xylose Fasting,,Per Svc,39.00
Chargemaster Item,,89039648,SPSI,Lactose Tolerance,,Per Svc,20.35
Chargemaster Item,,89039655,SPSI,Islet Ab Titer,,Per Svc,42.00
Chargemaster Item,,89039663,SPSI,Toxocara Antibody by Elisa,,Per Svc,35.46
Chargemaster Item,,89039671,SPSI,Glycomark,,Per Svc,35.00
Chargemaster Item,,89039689,SPSI,Bacterial Meningitidis Antigen Panel,,Per Svc,221.59
Chargemaster Item,,89039705,SPSI,Felbamate,,Per Svc,24.13
Chargemaster Item,,89039713,SPSI,Trofile CoReceptor Tropism,,Per Svc,1985.00
Chargemaster Item,,89039747,SPSI,CSF Synthesis Rate,,Per Svc,28.00
Chargemaster Item,,89039754,SPSI,Meperidine,,Per Svc,61.75
Chargemaster Item,,89039762,SPSI,Immune Cell Function,,Per Svc,120.63
Chargemaster Item,,89039770,SPSI,Epstein-Barr Nuclear Agab(Csf),,Per Svc,70.60
Chargemaster Item,,89039788,SPSI,Ontak Sensitivity (Cd25),,Per Svc,75.00
Chargemaster Item,,89039796,SPSI,Protein , Spinal Fluid 14-3-3,,Per Svc,136.50
Chargemaster Item,,89039812,SPSI,BCR ABL Rearrangement Quantitative by PCR,,Per Svc,150.00
Chargemaster Item,,89039838,SPSI,Voriconazole,,Per Svc,173.00
Chargemaster Item,,89039846,SPSI,Cystatin C,,Per Svc,54.00
Chargemaster Item,,89039853,SPSI,Allergy Pork IgE,,Per Svc,10.00
Chargemaster Item,,89039861,SPSI,Bartonella DNA Qualitative by RT PCR,,Per Svc,120.63
Chargemaster Item,,89039879,SPSI,Insulin Response,,Per Svc,51.00
Chargemaster Item,,89039887,SPSI,Atazanavir by HPLC,,Per Svc,96.40
Chargemaster Item,,89039895,SPSI,Von Willebrand Factor Activity,,Per Svc,60.00
Chargemaster Item,,89039903,SPSI,Sandostatin Octreotide,,Per Svc,200.00
Chargemaster Item,,89039911,SPSI,Listeria Antibody by CF,,Per Svc,47.10
Chargemaster Item,,89039937,SPSI,Lactoferrin Stool (Ibd-Check),,Per Svc,62.50
Chargemaster Item,,89039945,SPSI,Mycoplasma/Ureaplasma Cult Quest,,Per Svc,27.02
Chargemaster Item,,89040000,SPSI,Isohemagglutinin Titer,,Per Svc,112.45
Chargemaster Item,,89040018,SPSI,Adenovirus DNA QT RT PCR,,Per Svc,265.38
Chargemaster Item,,89040034,SPSI,Gaucher Disease DNA Mutation,,Per Svc,159.00
Chargemaster Item,,89040042,SPSI,Free Estradiol,,Per Svc,150.25
Chargemaster Item,,89040059,SPSI,HIV-1 Coreceptor Tropism,,Per Svc,860.00
Chargemaster Item,,89040067,SPSI,Listeria AB CF (CSF),,Per Svc,24.13
Chargemaster Item,,89040075,SPSI,Rett Syndrome Mutation,,Per Svc,110.00
Chargemaster Item,,89040083,SPSI,CEA Pleural Fluid,,Per Svc,9.00
Chargemaster Item,,89050009,SPSI,Influenza A H1 H3,,Per Svc,262.00
Chargemaster Item,,89050017,SPSI,Influenza B,,Per Svc,261.00
Chargemaster Item,,89050023,SPSI,Human Parainfluenza Vurus 1&2,,Per Svc,261.00
Chargemaster Item,,89050041,SPSI,Legionella Pneumonphila DNA,,Per Svc,40.13
Chargemaster Item,,89050058,SPSI,Legionella Species,,Per Svc,39.00
Chargemaster Item,,89050066,SPSI,BRCAvantage Comprehensive,,Per Svc,2074.75
Chargemaster Item,,89050082,SPSI,Ampicillin/Sulbactam,,Per Svc,28.06
Chargemaster Item,,89050090,SPSI,Clindamycin,,Per Svc,28.20
Chargemaster Item,,89050108,SPSI,Imipenem,,Per Svc,28.20
Chargemaster Item,,89050116,SPSI,Meropenem,,Per Svc,28.20
Chargemaster Item,,89050124,SPSI,Metronidazole,,Per Svc,28.20
Chargemaster Item,,89050132,SPSI,Penicillin,,Per Svc,28.20
Chargemaster Item,,89050140,SPSI,Blue Mussel IGE (F37),,Per Svc,5.58
Chargemaster Item,,89050157,SPSI,Oyster IGE (F290),,Per Svc,5.58
Chargemaster Item,,89050165,SPSI,Omega Check,,Per Svc,37.00
Chargemaster Item,,89050173,SPSI,Phosphatidylethanol,,Per Svc,89.00
Chargemaster Item,,89050181,SPSI,DNA DS AB IFA W/Reflex To Titer,,Per Svc,10.37
Chargemaster Item,,89050250,SPSI,Alpha LACTALB F76 IGE,,Per Svc,14.23
Chargemaster Item,,89050269,SPSI,Beta LACTOGLOB F77 IGE,,Per Svc,6.00
Chargemaster Item,,89050278,SPSI,Chocolate F93 IGE,,Per Svc,6.00
Chargemaster Item,,89050287,SPSI,Casein F78 IGE,,Per Svc,6.00
Chargemaster Item,,89050296,SPSI,Cheese Mold F82 IGE,,Per Svc,6.00
Chargemaster Item,,89050303,SPSI,Codfish F3 IGE,,Per Svc,6.00
Chargemaster Item,,89050312,SPSI,Egg White F1 IGE,,Per Svc,6.00
Chargemaster Item,,89050321,SPSI,Oat F7 IGE,,Per Svc,6.00
Chargemaster Item,,89050330,SPSI,Peanut F13 IGE,,Per Svc,6.00
Chargemaster Item,,89050349,SPSI,Rice F9 IGE,,Per Svc,6.00
Chargemaster Item,,89050358,SPSI,Soybean F14 IGE,,Per Svc,6.00
Chargemaster Item,,89050367,SPSI,Tuna F40 IGE,,Per Svc,6.00
Chargemaster Item,,89050376,SPSI,Wheat F4 IGE,,Per Svc,6.00
Chargemaster Item,,89051988,SPSI,NAFLD Fibrosis Score,,Per Svc,112.56
Chargemaster Item,,89052055,SPSI,Transferase,,Per Svc,112.56
Chargemaster Item,,89052144,SPSI,Alanine Amino Sgpt,,Per Svc,112.56
Chargemaster Item,,89052233,SPSI,Automated Platelet Count,,Per Svc,112.56
Chargemaster Item,,89052322,SPSI,Serum Albumin,,Per Svc,112.56
Chargemaster Item,,89120018,SPSI,Gonadotropin Releasing Hormone,,Per Svc,250.00
Chargemaster Item,,89120034,SPSI,Vitamin K,,Per Svc,107.00
Chargemaster Item,,89120042,SPSI,Islet Cell Antibody Titer,,Per Svc,42.00
Chargemaster Item,,89120059,SPSI,Dichloromethane,,Per Svc,80.00
Chargemaster Item,,89120067,SPSI,Alpha 2 Antiplasmin,,Per Svc,37.45
Chargemaster Item,,89120075,SPSI,Lyme Disease DNA Qualitative by PCR,,Per Svc,226.78
Chargemaster Item,,89120083,SPSI,Urine Carbohydrate Random,,Per Svc,112.38
Chargemaster Item,,89120091,SPSI,Cysticercus Ab Csf Elisa,,Per Svc,62.00
Chargemaster Item,,89120109,SPSI,Anca Screen W/Mpo Pr3 W/Reflex,,Per Svc,40.53
Chargemaster Item,,89120117,SPSI,Prot Electrophoresis IFX TP(U),,Per Svc,75.00
Chargemaster Item,,89120125,SPSI,Chlamy.Trac/Neiss/Gonorroeae,,Per Svc,16.00
Chargemaster Item,,89120133,SPSI,Osteocalcin N-Mid,,Per Svc,30.00
Chargemaster Item,,89120141,SPSI,Accutype Cyp2C19 Genotype,,Per Svc,168.88
Chargemaster Item,,89120158,SPSI,Giardia Ag Eia Stool,,Per Svc,9.65
Chargemaster Item,,89120166,SPSI,Cortisol (Saliva) LCMSMS,,Per Svc,25.00
Chargemaster Item,,89120174,SPSI,Cardiolipin Antibody IGA,,Per Svc,5.30
Chargemaster Item,,89120182,SPSI,Cardiolipin Antibody IGG,,Per Svc,5.30
Chargemaster Item,,89120190,SPSI,Cardiolipin Antibody IGM,,Per Svc,5.30
Chargemaster Item,,89120208,SPSI,Cardiolipin AB IGG, IGA, IGM,,Per Svc,83.00
Chargemaster Item,,89120216,SPSI,HSV 1/2 IGM Specific IGG,,Per Svc,6.76
Chargemaster Item,,89120232,SPSI,HSV 1 IGG Type Specific,,Per Svc,43.00
Chargemaster Item,,89120257,SPSI,Aspergillus DNA QL RT PCR,,Per Svc,159.00
Chargemaster Item,,89120265,SPSI,B-Cell Rec IGH Gene Rear Pct,,Per Svc,325.00
Chargemaster Item,,89121008,SPSI,DS DNA AB IFA Titer,,Per Svc,21.91
Chargemaster Item,,89121016,SPSI,Aripiprazole Quant,,Per Svc,109.05
Chargemaster Item,,89121024,SPSI,Bullous Pemphigoid BP230 AB,,Per Svc,51.15
Chargemaster Item,,89121032,SPSI,Neutrophil AB Flow Cytometry,,Per Svc,72.38
Chargemaster Item,,89121065,SPSI,HLA DR4 Flow Cytometry,,Per Svc,72.38
Chargemaster Item,,89131288,SPSI,Somatostin,,Per Svc,82.00
Chargemaster Item,,89131304,SPSI,Lymphocyte Subset Panel 5,,Per Svc,29.45
Chargemaster Item,,89131312,SPSI,CA 72 4,,Per Svc,60.00
Chargemaster Item,,89131320,SPSI,Babesia Microti Antibodies,,Per Svc,88.30
Chargemaster Item,,89131338,SPSI,Parvovirus B19 DNA Quantitative by PCR,,Per Svc,95.00
Chargemaster Item,,89131346,SPSI,Parvovirus B19 Antibody IgG,,Per Svc,28.95
Chargemaster Item,,89131353,SPSI,CSF Coccidioides Antibody ID,,Per Svc,58.00
Chargemaster Item,,89131379,SPSI,Allergen Gluten IgG,,Per Svc,37.04
Chargemaster Item,,89131387,SPSI,Galactose-1 Phosphate Ery,,Per Svc,307.23
Chargemaster Item,,89131395,SPSI,Lymphocyte Subset Panel 4,,Per Svc,45.36
Chargemaster Item,,89131403,SPSI,Tissue Transglutaminase Antibody IgA and IgG,,Per Svc,19.82
Chargemaster Item,,89131411,SPSI,Allergen Egg White IgG,,Per Svc,18.50
Chargemaster Item,,89131429,SPSI,Allergen Casein IgG,,Per Svc,18.50
Chargemaster Item,,89131437,SPSI,Allergen Egg Yolk IgG,,Per Svc,18.50
Chargemaster Item,,89131445,SPSI,Magnesium RBC,,Per Svc,34.42
Chargemaster Item,,89131452,SPSI,Zinc Whole Blood,,Per Svc,27.08
Chargemaster Item,,89131460,SPSI,Rocky Mountain Spotted Fever,,Per Svc,50.00
Chargemaster Item,,89131486,SPSI,Multiple Sclerosis Panel,,Per Svc,95.50
Chargemaster Item,,89131494,SPSI,Hydroxyproline Plasma by LC MS,,Per Svc,66.00
Chargemaster Item,,89131502,SPSI,C3 Nephritic Factor,,Per Svc,87.70
Chargemaster Item,,89131510,SPSI,Rabies Vaccine Response Titer,,Per Svc,62.00
Chargemaster Item,,89131528,SPSI,Soluble Liver Antigen Autoab,,Per Svc,33.00
Chargemaster Item,,89131544,SPSI,C3Pa Properdin Factor B,,Per Svc,33.00
Chargemaster Item,,89131551,SPSI,Antimicrobial Streptomycin Level,,Per Svc,83.36
Chargemaster Item,,89131577,SPSI,Anti-Striated Muscle Ab Titre,,Per Svc,42.00
Chargemaster Item,,89131585,SPSI,Thallium,,Per Svc,56.50
Chargemaster Item,,89131593,SPSI,Trimethoprim Sulfa Level by Bioassay,,Per Svc,87.40
Chargemaster Item,,89131601,SPSI,RNA Polymerase III Antibody,,Per Svc,75.00
Chargemaster Item,,89131619,SPSI,Coumadin,,Per Svc,17.37
Chargemaster Item,,89131643,SPSI,Fibrin Monomer,,Per Svc,40.50
Chargemaster Item,,89131759,SPSI,CFTR Intron 8 Poly-T Analysis,,Per Svc,142.50
Chargemaster Item,,89131817,SPSI,Procalcitonin,,Per Svc,245.00
Chargemaster Item,,89131833,SPSI,Osmolality, Feces,,Per Svc,14.87
Chargemaster Item,,89131841,SPSI,Hyaluronic Acid,,Per Svc,52.50
Chargemaster Item,,89131858,SPSI,Vibrio Cholerae w/Reflex Susc,,Per Svc,28.50
Chargemaster Item,,89131866,SPSI,Plasminogen Activator Inh-1,,Per Svc,143.30
Chargemaster Item,,89131874,SPSI,Chikungunya AB w/Reflex Titer,,Per Svc,91.68
Chargemaster Item,,89131882,SPSI,Varicela Z AB Total IGM CSF,,Per Svc,59.50
Chargemaster Item,,89131890,SPSI,Vitamin B3,,Per Svc,61.00
Chargemaster Item,,89131908,SPSI,Tryptophan,,Per Svc,75.00
Chargemaster Item,,89131916,SPSI,Mycobacterium Blood Culture,,Per Svc,16.00
Chargemaster Item,,89131957,SPSI,Silver (Serum),,Per Svc,98.65
Chargemaster Item,,89131981,SPSI,Hepatitis C Viral Rna Qual Tma,,Per Svc,56.94
Chargemaster Item,,89132005,SPSI,Chromosone Analy Mosaicism,,Per Svc,317.50
Chargemaster Item,,89134001,SPSI,Alpha Fetoprotein AFP L-3,,Per Svc,40.00
Chargemaster Item,,89134019,SPSI,Liver Fibrosis Panel,,Per Svc,133.50
Chargemaster Item,,89134027,SPSI,Helicobacter Pylori AG EIA Stool,,Per Svc,22.78
Chargemaster Item,,89134035,SPSI,Cardio IQ TM LP,,Per Svc,22.61
Chargemaster Item,,89134050,SPSI,Mycoplasma Pneum DNA QL RT PCR,,Per Svc,91.68
Chargemaster Item,,89134068,SPSI,Cryptococcal Ag Latex Screen,,Per Svc,9.65
Chargemaster Item,,89134076,SPSI,Cortisol Free Ux,,Per Svc,11.58
Chargemaster Item,,89134084,SPSI,IGG4 Food Panel VIII,,Per Svc,93.06
Chargemaster Item,,89300016,SPSI,Hereditary Comp Cancer Pan (B),,Per Svc,1188.00
Chargemaster Item,,89300024,SPSI,Genomic-Sequencing,,Per Svc,1188.00
Chargemaster Item,,89300032,SPSI,Hereditary Comp Cancer Pan (C),,Per Svc,1188.00
Chargemaster Item,,89300040,SPSI,Genomic Sequencing,,Per Svc,1188.00
Chargemaster Item,,89372163,SPSI,Bhl Ldl 7 Sub Classes,,Per Svc,58.50
Chargemaster Item,,89401004,SPSI,Somatic Mutation Prog,,Per Svc,1013.25
Chargemaster Item,,89401012,SPSI,Allergy IGE,,Per Svc,5.64
Chargemaster Item,,89401020,SPSI,Immunoglobulin,,Per Svc,5.64
Chargemaster Item,,89401053,SPSI,Gamma Globulin,,Per Svc,5.66
Chargemaster Item,,89401079,SPSI,Immunoglobulin E,,Per Svc,5.70
Chargemaster Item,,89401087,SPSI,Egg Component Panel,,Per Svc,5.58
Chargemaster Item,,89401095,SPSI,Alergy Specific IGE,,Per Svc,5.58
Chargemaster Item,,89402010,SPSI,Globulin IGE,,Per Svc,5.58
Chargemaster Item,,89402036,SPSI,Cortisone 24Hr Urine,,Per Svc,24.13
Chargemaster Item,,89402044,SPSI,Cortisone Serum,,Per Svc,110.98
Chargemaster Item,,89402069,SPSI,Cdiff Screen W/Ref Toxin B Rt,,Per Svc,36.67
Chargemaster Item,,89402077,SPSI,Oxidize LDL,,Per Svc,35.00
Chargemaster Item,,89402085,SPSI,Porphobilinogen 24Hr Urine,,Per Svc,24.13
Chargemaster Item,,89402093,SPSI,Neuron Specific Enolase CSF,,Per Svc,48.26
Chargemaster Item,,89402101,SPSI,MYD88 Mutation Analysis,,Per Svc,442.94
Chargemaster Item,,89800908,SPSI,Torch Panel Convalescent,,Per Svc,35.12
Chargemaster Item,,89801013,SPSI,Meconium Drug Screen 4,,Per Svc,69.96
Chargemaster Item,,89801054,SPSI,Psychotherapeutic Screen,,Per Svc,29.44
Chargemaster Item,,89801062,SPSI,MDMA And Metabolite,,Per Svc,31.00
Chargemaster Item,,89801070,SPSI,Urine Nicotine Qualitative,,Per Svc,25.00
Chargemaster Item,,89801526,SPSI,Amitriptyline Test,,Per Svc,21.73
Chargemaster Item,,89801559,SPSI,Clonazepam,,Per Svc,19.34
Chargemaster Item,,89801567,SPSI,Diazepam Panel,,Per Svc,97.74
Chargemaster Item,,89801583,SPSI,Cyclosporine by LC_MS_MS,,Per Svc,64.71
Chargemaster Item,,89801591,SPSI,Cyclosporine Trough by FPIA,,Per Svc,28.57
Chargemaster Item,,89801641,SPSI,Valproic Acid Free And Total,,Per Svc,41.05
Chargemaster Item,,89801682,SPSI,Zarontin,,Per Svc,17.10
Chargemaster Item,,89801765,SPSI,Lidocaine,,Per Svc,18.38
Chargemaster Item,,89801781,SPSI,Lithium_Quest,,Per Svc,4.83
Chargemaster Item,,89801872,SPSI,Phenytoin Free,,Per Svc,21.71
Chargemaster Item,,89801880,SPSI,Primidone Test,,Per Svc,37.76
Chargemaster Item,,89801922,SPSI,Procainamide,,Per Svc,70.00
Chargemaster Item,,89801948,SPSI,Quinidine,,Per Svc,25.00
Chargemaster Item,,89801971,SPSI,Tacrolimus by LC MS MS HS,,Per Svc,20.00
Chargemaster Item,,89802011,SPSI,Topiramate,,Per Svc,33.78
Chargemaster Item,,89802995,SPSI,Amiodarone and Metabolite,,Per Svc,13.37
Chargemaster Item,,89803001,SPSI,Methotrexate,,Per Svc,40.00
Chargemaster Item,,89803019,SPSI,Haloperidol,,Per Svc,56.50
Chargemaster Item,,89803027,SPSI,Mycophenolic Acid,,Per Svc,14.62
Chargemaster Item,,89803043,SPSI,Digitoxin,,Per Svc,62.00
Chargemaster Item,,89803050,SPSI,Flecainide,,Per Svc,16.71
Chargemaster Item,,89803068,SPSI,Fluoxetine,,Per Svc,40.00
Chargemaster Item,,89803084,SPSI,Lamotrigine,,Per Svc,9.17
Chargemaster Item,,89803092,SPSI,Disopyramide,,Per Svc,14.23
Chargemaster Item,,89803100,SPSI,Risperidone,,Per Svc,31.52
Chargemaster Item,,89803118,SPSI,Clomipramine,,Per Svc,26.00
Chargemaster Item,,89803126,SPSI,Trazodone by LC MS,,Per Svc,52.50
Chargemaster Item,,89803134,SPSI,Neopterin,,Per Svc,45.85
Chargemaster Item,,89803142,SPSI,Clozapine Panel,,Per Svc,26.00
Chargemaster Item,,89803167,SPSI,Quetiapine,,Per Svc,80.00
Chargemaster Item,,89803175,SPSI,Gabapentin Plasma,,Per Svc,25.00
Chargemaster Item,,89803191,SPSI,Oxcarbazepine SP,,Per Svc,35.71
Chargemaster Item,,89803209,SPSI,Sirolimus,,Per Svc,35.00
Chargemaster Item,,89803217,SPSI,Sotalol Serum or Plasma,,Per Svc,78.11
Chargemaster Item,,89803225,SPSI,Propafenone,,Per Svc,36.00
Chargemaster Item,,89803233,SPSI,Kaletra by HPLC,,Per Svc,105.00
Chargemaster Item,,89803241,SPSI,Zonisamide,,Per Svc,47.77
Chargemaster Item,,89803266,SPSI,Acetazolamide,,Per Svc,68.58
Chargemaster Item,,89803274,SPSI,Levodopa,,Per Svc,137.20
Chargemaster Item,,89803308,SPSI,Mexiletine,,Per Svc,39.62
Chargemaster Item,,89810063,SPSI,Indican,,Per Svc,12.25
Chargemaster Item,,89820104,SPSI,Beta Hydroxybutyrate,,Per Svc,188.00
Chargemaster Item,,89820179,SPSI,Acylcarnitine Plasma,,Per Svc,82.99
Chargemaster Item,,89820245,SPSI,ACTH Plasma,,Per Svc,9.65
Chargemaster Item,,89820302,SPSI,Urine Cyclic AMP,,Per Svc,81.50
Chargemaster Item,,89820716,SPSI,Copper Liver,,Per Svc,140.00
Chargemaster Item,,89820724,SPSI,Ethambutol by HPLC,,Per Svc,96.40
Chargemaster Item,,89820732,SPSI,Antimicrobial Pyrazinamide Level,,Per Svc,89.00
Chargemaster Item,,89820856,SPSI,Aldolase,,Per Svc,5.79
Chargemaster Item,,89820880,SPSI,Aldosterone,,Per Svc,11.58
Chargemaster Item,,89820898,SPSI,Urine Aldosterone,,Per Svc,44.46
Chargemaster Item,,89820906,SPSI,Congenital Adrenal Hyperplasia Panel 6,,Per Svc,265.00
Chargemaster Item,,89820914,SPSI,Congenital Adrenal Hyperplasia Profile 6B,,Per Svc,569.00
Chargemaster Item,,89821037,SPSI,Alpha 1 Antitrypsin,,Per Svc,12.79
Chargemaster Item,,89821052,SPSI,AFP as Tumor Marker,,Per Svc,11.23
Chargemaster Item,,89821086,SPSI,Aluminum Serum,,Per Svc,9.55
Chargemaster Item,,89821094,SPSI,Aluminum Whole Blood,,Per Svc,65.50
Chargemaster Item,,89821102,SPSI,Stool Alpha 1 Antitrypsin,,Per Svc,57.00
Chargemaster Item,,89821110,SPSI,Urine Aluminum 24HR,,Per Svc,46.50
Chargemaster Item,,89821300,SPSI,Amino Acids Quantitative Plasma,,Per Svc,7.38
Chargemaster Item,,89821318,SPSI,Homocysteine,,Per Svc,19.48
Chargemaster Item,,89821326,SPSI,Urine Cystine 24HR,,Per Svc,65.00
Chargemaster Item,,89821359,SPSI,Urine Delta Aminolevulinic Acid 24HR,,Per Svc,42.50
Chargemaster Item,,89821367,SPSI,Urine Delta Aminolevulinic Acid Random,,Per Svc,50.00
Chargemaster Item,,89821391,SPSI,Urine Amino Acids Quantitative,,Per Svc,72.38
Chargemaster Item,,89821508,SPSI,Amylase Isoenzymes,,Per Svc,29.00
Chargemaster Item,,89821573,SPSI,Androstenedione by LS MS MS,,Per Svc,21.92
Chargemaster Item,,89821649,SPSI,Angiotensin Converting Enzyme,,Per Svc,8.69
Chargemaster Item,,89821656,SPSI,CSF Angiotensin Converting Enzyme,,Per Svc,34.50
Chargemaster Item,,89821722,SPSI,Lipoprotein A,,Per Svc,12.00
Chargemaster Item,,89821730,SPSI,Apolipoprotein A1and B,,Per Svc,25.00
Chargemaster Item,,89821748,SPSI,Apolipoprotein B,,Per Svc,16.91
Chargemaster Item,,89821805,SPSI,Vitamin C,,Per Svc,13.51
Chargemaster Item,,89821912,SPSI,Stool Potassium,,Per Svc,14.95
Chargemaster Item,,89821920,SPSI,Stool Sodium,,Per Svc,13.00
Chargemaster Item,,89822068,SPSI,Pentobarbital,,Per Svc,25.00
Chargemaster Item,,89822324,SPSI,Beta 2 Microglobulin,,Per Svc,11.58
Chargemaster Item,,89822332,SPSI,Urine Beta 2 Microglobulin,,Per Svc,45.00
Chargemaster Item,,89822399,SPSI,Bile Acids,,Per Svc,27.26
Chargemaster Item,,89823009,SPSI,Cadmium,,Per Svc,54.50
Chargemaster Item,,89823017,SPSI,Urine Cadmium Random,,Per Svc,50.00
Chargemaster Item,,89823066,SPSI,Vitamin D 25 Hydroxy by LC MS MS,,Per Svc,9.00
Chargemaster Item,,89823082,SPSI,Calcitonin,,Per Svc,26.54
Chargemaster Item,,89823736,SPSI,Carbohydrate Deficient Transferrin,,Per Svc,62.50
Chargemaster Item,,89823751,SPSI,Carboxyhemoglobin, Bld,,Per Svc,24.37
Chargemaster Item,,89823785,SPSI,Fluid Cea,,Per Svc,42.00
Chargemaster Item,,89823801,SPSI,Carotene,,Per Svc,15.00
Chargemaster Item,,89823843,SPSI,Urine Catecholamines 24HR,,Per Svc,17.19
Chargemaster Item,,89823850,SPSI,Urine Catecholamines Random,,Per Svc,26.54
Chargemaster Item,,89823868,SPSI,Catecholamines Plasma,,Per Svc,75.00
Chargemaster Item,,89823876,SPSI,Epinephrine_Plasma,,Per Svc,29.75
Chargemaster Item,,89823884,SPSI,Norepinephrine Plasma,,Per Svc,43.80
Chargemaster Item,,89823900,SPSI,Ceruloplasmin,,Per Svc,6.76
Chargemaster Item,,89824387,SPSI,Stool Electrolytes,,Per Svc,14.95
Chargemaster Item,,89824809,SPSI,Cholinesterase,,Per Svc,30.00
Chargemaster Item,,89824932,SPSI,Bromide,,Per Svc,74.02
Chargemaster Item,,89824940,SPSI,Dehydrocholesterol_7,,Per Svc,175.00
Chargemaster Item,,89824957,SPSI,Dopamine Plasma,,Per Svc,75.00
Chargemaster Item,,89824973,SPSI,Coenzyme Q10,,Per Svc,120.00
Chargemaster Item,,89824981,SPSI,Porphyrins Fractionated Plasma,,Per Svc,88.78
Chargemaster Item,,89824999,SPSI,Sulfonyluria Hypoglycemics,,Per Svc,64.00
Chargemaster Item,,89825004,SPSI,Alpha 1 Antitrypsin Mutation,,Per Svc,223.64
Chargemaster Item,,89825079,SPSI,Urine Citric Acid with Creatinine 24HR,,Per Svc,23.88
Chargemaster Item,,89825210,SPSI,Cocaine Confirmation_Blood,,Per Svc,35.55
Chargemaster Item,,89825236,SPSI,N-Telopeptide Serum,,Per Svc,69.50
Chargemaster Item,,89825244,SPSI,Urine Collagen Cross Linked 24HR,,Per Svc,58.50
Chargemaster Item,,89825251,SPSI,Copper,,Per Svc,10.00
Chargemaster Item,,89825269,SPSI,Copper Plasma,,Per Svc,9.65
Chargemaster Item,,89825277,SPSI,Urine Copper 24HR,,Per Svc,17.37
Chargemaster Item,,89825285,SPSI,Urine Copper Random,,Per Svc,37.50
Chargemaster Item,,89825301,SPSI,Urine Cortisol Free 24HR,,Per Svc,12.00
Chargemaster Item,,89825319,SPSI,Cortisol Free And Total,,Per Svc,33.78
Chargemaster Item,,89825400,SPSI,Creatine 24HR Urine Quest,,Per Svc,5.79
Chargemaster Item,,89825426,SPSI,Cannabinoids Confirmation,,Per Svc,40.30
Chargemaster Item,,89825434,SPSI,Belladona Alkaloids,,Per Svc,138.00
Chargemaster Item,,89825442,SPSI,Fatty Acid Profile,,Per Svc,179.76
Chargemaster Item,,89825467,SPSI,Alpha-Fetoprotein Peritoneal,,Per Svc,42.00
Chargemaster Item,,89825475,SPSI,Hypertension Endocrine,,Per Svc,238.00
Chargemaster Item,,89825525,SPSI,CK Isoenzymes,,Per Svc,31.71
Chargemaster Item,,89825954,SPSI,Cryoglobulin Screen and Reflex,,Per Svc,25.34
Chargemaster Item,,89826002,SPSI,Cyanide,,Per Svc,44.87
Chargemaster Item,,89826085,SPSI,Vitamin B12 Binding Capacity Unsaturated,,Per Svc,31.48
Chargemaster Item,,89826267,SPSI,DHEA,,Per Svc,15.00
Chargemaster Item,,89826275,SPSI,DHEA Sulfate,,Per Svc,7.00
Chargemaster Item,,89826333,SPSI,Deoxycorticosterone,,Per Svc,77.00
Chargemaster Item,,89826341,SPSI,Deoxycortisol 11,,Per Svc,32.09
Chargemaster Item,,89826515,SPSI,Dihydrotestosterone,,Per Svc,102.66
Chargemaster Item,,89826523,SPSI,Vitamin D 1 25 Dihydroxy,,Per Svc,15.44
Chargemaster Item,,89826580,SPSI,Beta Galactosidase Leukocytes,,Per Svc,128.71
Chargemaster Item,,89826689,SPSI,Erythropoietin,,Per Svc,19.71
Chargemaster Item,,89826705,SPSI,Estradiol Ultra Sensitive,,Per Svc,17.85
Chargemaster Item,,89826713,SPSI,Estrogens Fractionated,,Per Svc,48.71
Chargemaster Item,,89826721,SPSI,Estrogens Total,,Per Svc,14.48
Chargemaster Item,,89826770,SPSI,Estriol,,Per Svc,21.73
Chargemaster Item,,89826796,SPSI,Estrone,,Per Svc,26.74
Chargemaster Item,,89826937,SPSI,Ethylene Glycol,,Per Svc,24.92
Chargemaster Item,,89827067,SPSI,Stool Fat Qualitative Quest,,Per Svc,23.00
Chargemaster Item,,89827109,SPSI,Fecal Lipids Total,,Per Svc,64.00
Chargemaster Item,,89827257,SPSI,Peroxisomal Panel,,Per Svc,111.18
Chargemaster Item,,89827471,SPSI,Folate RBC,,Per Svc,6.27
Chargemaster Item,,89827570,SPSI,Fructose,,Per Svc,68.75
Chargemaster Item,,89827604,SPSI,Galactose Quant,,Per Svc,88.75
Chargemaster Item,,89827844,SPSI,CSF IGG,,Per Svc,10.62
Chargemaster Item,,89827851,SPSI,Allergy Southwest Profile,,Per Svc,80.00
Chargemaster Item,,89827869,SPSI,IGD,,Per Svc,21.00
Chargemaster Item,,89827877,SPSI,IgG Subclasses,,Per Svc,40.72
Chargemaster Item,,89827885,SPSI,IgE,,Per Svc,7.72
Chargemaster Item,,89827893,SPSI,Infant_Toddler Food Panel,,Per Svc,57.94
Chargemaster Item,,89827901,SPSI,Immunoglobulins G_A_M_Serum,,Per Svc,14.48
Chargemaster Item,,89827919,SPSI,IGG,,Per Svc,5.00
Chargemaster Item,,89827927,SPSI,IGA,,Per Svc,5.00
Chargemaster Item,,89827935,SPSI,IgM,,Per Svc,5.00
Chargemaster Item,,89829410,SPSI,Gastrin,,Per Svc,12.00
Chargemaster Item,,89829436,SPSI,Glucagon,,Per Svc,53.00
Chargemaster Item,,89829550,SPSI,G6PD,,Per Svc,13.51
Chargemaster Item,,89829857,SPSI,Fructosamine,,Per Svc,5.79
Chargemaster Item,,89830020,SPSI,LH for Pediatrics,,Per Svc,42.00
Chargemaster Item,,89830038,SPSI,Growth Hormone,,Per Svc,12.06
Chargemaster Item,,89830103,SPSI,Haptoglobin,,Per Svc,8.44
Chargemaster Item,,89830152,SPSI,Heavy Metals,,Per Svc,33.85
Chargemaster Item,,89830160,SPSI,Urine Heavy Metals 24HR,,Per Svc,138.00
Chargemaster Item,,89830178,SPSI,Urine Heavy Metals 1 Random,,Per Svc,42.52
Chargemaster Item,,89830186,SPSI,Mercury,,Per Svc,14.25
Chargemaster Item,,89830194,SPSI,Antimony,,Per Svc,71.00
Chargemaster Item,,89830202,SPSI,Hemoglobinopathy Evaluation,,Per Svc,12.00
Chargemaster Item,,89830368,SPSI,Hemoglobin A1C_Quest,,Per Svc,23.50
Chargemaster Item,,89830517,SPSI,Hemoglobin Plasma,,Per Svc,25.00
Chargemaster Item,,89830707,SPSI,Urine Hemosiderin Qualitative,,Per Svc,41.90
Chargemaster Item,,89830806,SPSI,Hexosaminidase A and Total,,Per Svc,100.56
Chargemaster Item,,89831507,SPSI,Urine Homovanillic Acid Random,,Per Svc,33.00
Chargemaster Item,,89831515,SPSI,Urine Homovanillic Acid 24HR,,Per Svc,58.50
Chargemaster Item,,89834915,SPSI,Hydroxycorticosteroids 17,,Per Svc,36.75
Chargemaster Item,,89834923,SPSI,Rituxan Sensitivity,,Per Svc,75.00
Chargemaster Item,,89834956,SPSI,Sulfamethozazole, HPLC,,Per Svc,91.50
Chargemaster Item,,89834972,SPSI,Urine 5 HIAA 24HR,,Per Svc,7.20
Chargemaster Item,,89834980,SPSI,Urine 5 HIAA Random,,Per Svc,9.55
Chargemaster Item,,89834998,SPSI,Hydroxyprogesterone 17,,Per Svc,13.99
Chargemaster Item,,89835003,SPSI,Hydroxyproline Free & Total,,Per Svc,120.75
Chargemaster Item,,89835011,SPSI,Urine Hydroxyprogesterone 17 24HR,,Per Svc,200.00
Chargemaster Item,,89835151,SPSI,Lipoprotein Electrophoresis,,Per Svc,24.13
Chargemaster Item,,89835169,SPSI,Anti Mullerian Hormone,,Per Svc,51.00
Chargemaster Item,,89835185,SPSI,Cryptococcus Ag Screen Reflex Titer,,Per Svc,13.13
Chargemaster Item,,89835193,SPSI,Thyroid Peroxidase Antibody,,Per Svc,8.11
Chargemaster Item,,89835201,SPSI,Cyclic Citrullinated Peptide Antibody IgG,,Per Svc,7.00
Chargemaster Item,,89835219,SPSI,Cryptococcus Ag Serum,,Per Svc,13.75
Chargemaster Item,,89835227,SPSI,Myasthenia Gravis Panel 1,,Per Svc,34.81
Chargemaster Item,,89835235,SPSI,Lupus Anticoagulant Evaluation,,Per Svc,24.17
Chargemaster Item,,89835243,SPSI,IgF Binding Protein 3,,Per Svc,22.39
Chargemaster Item,,89835250,SPSI,Insulin,,Per Svc,6.76
Chargemaster Item,,89835268,SPSI,Glomerular Basement Membrane Antibody,,Per Svc,25.00
Chargemaster Item,,89835276,SPSI,Collagen Cross Linked N Telopeptides,,Per Svc,21.23
Chargemaster Item,,89835284,SPSI,Glutamic Acid Decarboxylase Antibody,,Per Svc,25.00
Chargemaster Item,,89835292,SPSI,Gliadin Antibody IgA_IgG,,Per Svc,20.54
Chargemaster Item,,89835318,SPSI,Allergy Animal Screen,,Per Svc,20.00
Chargemaster Item,,89835326,SPSI,Inhibin A,,Per Svc,19.30
Chargemaster Item,,89835334,SPSI,Acetylcholine Receptor Blocking Antibody,,Per Svc,46.32
Chargemaster Item,,89835342,SPSI,Dexamethasone,,Per Svc,63.60
Chargemaster Item,,89835375,SPSI,Neuron Specific Enolase,,Per Svc,40.05
Chargemaster Item,,89835383,SPSI,IgF Binding Protein 1,,Per Svc,36.25
Chargemaster Item,,89835391,SPSI,Alpha Subunit,,Per Svc,68.00
Chargemaster Item,,89835409,SPSI,Allergy Screen Seafood,,Per Svc,6.69
Chargemaster Item,,89835417,SPSI,Thyrotropin Binding Immunoglobulin,,Per Svc,19.30
Chargemaster Item,,89835425,SPSI,Trypsin,,Per Svc,37.50
Chargemaster Item,,89835433,SPSI,Celiac Disease Panel,,Per Svc,14.74
Chargemaster Item,,89835441,SPSI,Beta 2 Glycoprotein 1 Antibodies IgA IgG IgM,,Per Svc,30.00
Chargemaster Item,,89835458,SPSI,Histone Antibodies,,Per Svc,31.47
Chargemaster Item,,89835466,SPSI,Ribosomal P Protein Antibody,,Per Svc,4.78
Chargemaster Item,,89835474,SPSI,Type II Collagen Antibody,,Per Svc,105.00
Chargemaster Item,,89835490,SPSI,Interferon Alpha by EIA,,Per Svc,75.30
Chargemaster Item,,89835508,SPSI,Ganglioside Antibodies,,Per Svc,33.81
Chargemaster Item,,89835516,SPSI,Allergy Molds Screen,,Per Svc,20.00
Chargemaster Item,,89835524,SPSI,Myelin Associated Glycoprotein Antibody,,Per Svc,54.00
Chargemaster Item,,89835532,SPSI,IgF Binding Protein 2,,Per Svc,36.25
Chargemaster Item,,89835540,SPSI,Motor Sensory Neuro Panel,,Per Svc,188.74
Chargemaster Item,,89835557,SPSI,Pancreatic Polypeptide,,Per Svc,88.00
Chargemaster Item,,89835573,SPSI,Tumor Necrosis Highly Sensitive,,Per Svc,75.00
Chargemaster Item,,89835581,SPSI,Tryptase,,Per Svc,14.70
Chargemaster Item,,89835599,SPSI,Thyrotropin Releasing Hormone,,Per Svc,103.00
Chargemaster Item,,89835607,SPSI,Inhibin B,,Per Svc,120.63
Chargemaster Item,,89835615,SPSI,Serotonin Release Assay,,Per Svc,48.25
Chargemaster Item,,89835623,SPSI,Gliadin AntibodyIgA,,Per Svc,10.27
Chargemaster Item,,89835649,SPSI,Interleukin 6 Highly Sensitive,,Per Svc,95.54
Chargemaster Item,,89835656,SPSI,BP 180 Antibody,,Per Svc,55.00
Chargemaster Item,,89835862,SPSI,Urine Ketosteroids 17 24HR,,Per Svc,32.50
Chargemaster Item,,89835938,SPSI,Urine Ketosteroids 17 Fractionated 24HR,,Per Svc,98.00
Chargemaster Item,,89836050,SPSI,CSF Lactic Acid,,Per Svc,58.07
Chargemaster Item,,89836258,SPSI,LDH Isoenzymes,,Per Svc,16.76
Chargemaster Item,,89836555,SPSI,Lead,,Per Svc,4.83
Chargemaster Item,,89836563,SPSI,Urine Lead Random,,Per Svc,5.73
Chargemaster Item,,89836902,SPSI,Urine Lipase Random,,Per Svc,21.39
Chargemaster Item,,89837165,SPSI,VAP Cholesterol Test,,Per Svc,47.00
Chargemaster Item,,89837215,SPSI,LDL Cholesterol,,Per Svc,188.00
Chargemaster Item,,89837850,SPSI,Manganese,,Per Svc,40.00
Chargemaster Item,,89837892,SPSI,Bile Acids Fractionated,,Per Svc,65.00
Chargemaster Item,,89838353,SPSI,Urine Metanephrines 24HR,,Per Svc,17.00
Chargemaster Item,,89838361,SPSI,Urine Metanephrines Random,,Per Svc,28.65
Chargemaster Item,,89838379,SPSI,Metanephrines Plasma,,Per Svc,19.00
Chargemaster Item,,89838643,SPSI,Urine Glycosaminoglycans,,Per Svc,100.00
Chargemaster Item,,89838734,SPSI,Myelin Basic Protein,,Per Svc,18.34
Chargemaster Item,,89838742,SPSI,Myoglobin,,Per Svc,26.50
Chargemaster Item,,89838759,SPSI,Urine Myoglobulin,,Per Svc,14.48
Chargemaster Item,,89838833,SPSI,Kappa Lambda Light Chain,,Per Svc,24.00
Chargemaster Item,,89838841,SPSI,Urine Free Kappa Lambda Ratio,,Per Svc,64.00
Chargemaster Item,,89838916,SPSI,Hepatitis B Viral DNA Quantitative by PCR,,Per Svc,57.90
Chargemaster Item,,89838999,SPSI,Herpes Simplex DNA by PCR,,Per Svc,74.88
Chargemaster Item,,89839013,SPSI,HIV 1 RNA Quantitative by PCR,,Per Svc,72.38
Chargemaster Item,,89839062,SPSI,Factor II Mutation Analysis,,Per Svc,22.68
Chargemaster Item,,89839070,SPSI,Factor V Leiden Mutation Test,,Per Svc,38.60
Chargemaster Item,,89839088,SPSI,Cystic Fibrosis Carrier Screen,,Per Svc,82.03
Chargemaster Item,,89839120,SPSI,Hemochromatosis DNA,,Per Svc,72.38
Chargemaster Item,,89839153,SPSI,Nucleotidase 5,,Per Svc,48.89
Chargemaster Item,,89839161,SPSI,Oligoclonal Bands IgG,,Per Svc,16.89
Chargemaster Item,,89839179,SPSI,Urine Organic Acids Quantitative,,Per Svc,120.63
Chargemaster Item,,89839187,SPSI,Multiple Sclerosis Panel 1,,Per Svc,64.70
Chargemaster Item,,89839195,SPSI,Multiple Sclerosis Panel 2,,Per Svc,187.50
Chargemaster Item,,89839203,SPSI,Pernicious Anemia Panel,,Per Svc,180.00
Chargemaster Item,,89839211,SPSI,Methylmalonic Acid,,Per Svc,14.00
Chargemaster Item,,89839252,SPSI,Oxycodone,,Per Svc,67.00
Chargemaster Item,,89839401,SPSI,MTHFR Mutation DNA Analysis,,Per Svc,168.88
Chargemaster Item,,89839450,SPSI,Urine Oxalic Acid 24HR With Creatinine,,Per Svc,13.61
Chargemaster Item,,89839716,SPSI,Pth Intact Ref Lab,,Per Svc,18.09
Chargemaster Item,,89839732,SPSI,PTH Related Protein,,Per Svc,28.95
Chargemaster Item,,89840300,SPSI,Phenylalanine Plasma,,Per Svc,49.90
Chargemaster Item,,89840755,SPSI,Alkaline Phosphatase Bone,,Per Svc,13.00
Chargemaster Item,,89840805,SPSI,Alkaline Phosphatase Isoenzyme 2,,Per Svc,9.65
Chargemaster Item,,89841100,SPSI,Urine Porphobilinogen Random,,Per Svc,24.50
Chargemaster Item,,89841191,SPSI,Urine Porphyrins Fractionated Random,,Per Svc,16.41
Chargemaster Item,,89841209,SPSI,Acetylcholine Receptor Binding Antibody,,Per Svc,43.43
Chargemaster Item,,89841217,SPSI,Porphyrins Fractionated Quantitative,,Per Svc,70.00
Chargemaster Item,,89841225,SPSI,Coproporphyrin Isomers I and III,,Per Svc,76.61
Chargemaster Item,,89841233,SPSI,Porphyrins, Frac, 24Hr Urine,,Per Svc,16.41
Chargemaster Item,,89841340,SPSI,Fish Microdeletion Syndrome Panel_All Screens,,Per Svc,300.00
Chargemaster Item,,89841407,SPSI,Pregnenolone,,Per Svc,35.22
Chargemaster Item,,89841431,SPSI,Hydroxypregnenolone 17 Serum,,Per Svc,67.50
Chargemaster Item,,89841449,SPSI,Progesterone by LS MS MS,,Per Svc,9.65
Chargemaster Item,,89841548,SPSI,PSA Free,,Per Svc,30.49
Chargemaster Item,,89841555,SPSI,Urine Protein Electrophoresis Random,,Per Svc,75.00
Chargemaster Item,,89841563,SPSI,Urine Protein Electrophoresis 24HR With Immunofixation,,Per Svc,85.35
Chargemaster Item,,89841654,SPSI,Protein Electrophoresis,,Per Svc,39.57
Chargemaster Item,,89841662,SPSI,Serum Protein Immunoelectrophoresis,,Per Svc,29.00
Chargemaster Item,,89841811,SPSI,Heat Shock Protein 70 Antibody,,Per Svc,190.00
Chargemaster Item,,89841829,SPSI,Neuronal Nuclear Antibody RI by IFA,,Per Svc,45.68
Chargemaster Item,,89841852,SPSI,Hu Ab Csf, Wb, Titer,,Per Svc,27.00
Chargemaster Item,,89842025,SPSI,Zinc Protoporphyrin,,Per Svc,47.50
Chargemaster Item,,89842066,SPSI,Proinsulin,,Per Svc,38.60
Chargemaster Item,,89842074,SPSI,Vitamin B6 Plasma,,Per Svc,13.51
Chargemaster Item,,89842108,SPSI,Pyruvate,,Per Svc,15.00
Chargemaster Item,,89842389,SPSI,Lambert Eaton Syndrome Antibody Panel,,Per Svc,359.50
Chargemaster Item,,89842397,SPSI,Soluble Transferrin Receptor,,Per Svc,50.14
Chargemaster Item,,89842447,SPSI,Platelet Antibody Direct,,Per Svc,49.00
Chargemaster Item,,89842454,SPSI,Renin Activity Plasma by LC_MS_MS,,Per Svc,12.00
Chargemaster Item,,89842520,SPSI,Vitamin B2 Plasma,,Per Svc,53.08
Chargemaster Item,,89842553,SPSI,Selenium,,Per Svc,24.61
Chargemaster Item,,89842611,SPSI,Serotonin,,Per Svc,47.29
Chargemaster Item,,89842702,SPSI,Sex Hormone Binding Globulin,,Per Svc,14.96
Chargemaster Item,,89842751,SPSI,Lipid Associated Sialic Acid,,Per Svc,39.50
Chargemaster Item,,89843056,SPSI,IgF I,,Per Svc,18.34
Chargemaster Item,,89843114,SPSI,Carnitine,,Per Svc,29.92
Chargemaster Item,,89843122,SPSI,Adenosine Deaminase,,Per Svc,72.54
Chargemaster Item,,89843148,SPSI,Fluid Adenosine Deaminase,,Per Svc,150.00
Chargemaster Item,,89844013,SPSI,Testosterone Females and Peds by LC MS MS,,Per Svc,8.69
Chargemaster Item,,89844021,SPSI,Testosterone Free and Total by LC MS MS,,Per Svc,15.44
Chargemaster Item,,89844039,SPSI,Testosterone Total Males by ICMA,,Per Svc,9.55
Chargemaster Item,,89844047,SPSI,Testosterone Total and Free and Bioavailable,,Per Svc,28.47
Chargemaster Item,,89844252,SPSI,Vitamin B1 Plasma,,Per Svc,11.58
Chargemaster Item,,89844328,SPSI,Thyroglobulin Panel,,Per Svc,35.40
Chargemaster Item,,89844351,SPSI,T4 Free By Direct Dialysis,,Per Svc,14.33
Chargemaster Item,,89844427,SPSI,Thyroxine Binding Globulin,,Per Svc,25.00
Chargemaster Item,,89844450,SPSI,Thyroid Stimulating Immunoglobulin,,Per Svc,33.78
Chargemaster Item,,89844468,SPSI,Vitamin E,,Per Svc,13.51
Chargemaster Item,,89844799,SPSI,T3 Uptake,,Per Svc,5.00
Chargemaster Item,,89844815,SPSI,Thyroid Free T3 Panel,,Per Svc,15.55
Chargemaster Item,,89844823,SPSI,T3 Reverse,,Per Svc,14.23
Chargemaster Item,,89845101,SPSI,Tyrosine,,Per Svc,175.00
Chargemaster Item,,89845853,SPSI,Urine Vanillylmandelic Acid 24HR,,Per Svc,12.00
Chargemaster Item,,89845861,SPSI,Urine Vanillylmandelic Acid Random,,Per Svc,37.00
Chargemaster Item,,89845879,SPSI,Vasoactive Intestinal Polypeptide,,Per Svc,102.00
Chargemaster Item,,89845887,SPSI,Arginine Vasopressin,,Per Svc,38.10
Chargemaster Item,,89845903,SPSI,Vitamin A,,Per Svc,11.58
Chargemaster Item,,89846000,SPSI,Alcohol_Methyl B,,Per Svc,30.00
Chargemaster Item,,89846018,SPSI,Isopropanol,,Per Svc,28.00
Chargemaster Item,,89846307,SPSI,Zinc,,Per Svc,8.93
Chargemaster Item,,89846315,SPSI,Zinc Serum,,Per Svc,14.28
Chargemaster Item,,89846323,SPSI,Titanium,,Per Svc,93.00
Chargemaster Item,,89846349,SPSI,Francisella Tularensis Antibody,,Per Svc,63.00
Chargemaster Item,,89846356,SPSI,Yersinia Enterocolitica MAT,,Per Svc,55.00
Chargemaster Item,,89846364,SPSI,Inflammatory Bowel Disease Panel,,Per Svc,143.13
Chargemaster Item,,89846372,SPSI,Nicotine And Metabolite,,Per Svc,56.94
Chargemaster Item,,89846810,SPSI,C Peptide,,Per Svc,10.62
Chargemaster Item,,89847974,SPSI,CMV DNA Quantitative by PCR,,Per Svc,67.55
Chargemaster Item,,89849996,SPSI,Chromagranin A,,Per Svc,23.50
Chargemaster Item,,89850010,SPSI,Macroamylase,,Per Svc,68.00
Chargemaster Item,,89852107,SPSI,Factor II Activity,,Per Svc,37.44
Chargemaster Item,,89852206,SPSI,Factor V Activity Clotting,,Per Svc,47.29
Chargemaster Item,,89852305,SPSI,Factor VII Activity Clotting,,Per Svc,37.44
Chargemaster Item,,89852412,SPSI,Factor VIII Activity Clotting,,Per Svc,27.02
Chargemaster Item,,89852420,SPSI,Factor Viii Comp Panel 2,,Per Svc,127.00
Chargemaster Item,,89852453,SPSI,Ristocetin Cofactor,,Per Svc,28.00
Chargemaster Item,,89852479,SPSI,Von Willebrand Factor Antigen Multimeric,,Per Svc,43.93
Chargemaster Item,,89852487,SPSI,Von Willebr Activity W/Reflex,,Per Svc,212.30
Chargemaster Item,,89852503,SPSI,Factor IX Activity,,Per Svc,65.14
Chargemaster Item,,89852602,SPSI,Factor X Activity Clotting,,Per Svc,37.44
Chargemaster Item,,89852701,SPSI,Factor XI Activity Clotting Test,,Per Svc,37.44
Chargemaster Item,,89852800,SPSI,Factor XII Activity Test,,Per Svc,37.44
Chargemaster Item,,89852909,SPSI,Factor XIII Functional,,Per Svc,73.00
Chargemaster Item,,89853006,SPSI,Anti_Thrombin III Activity Test,,Per Svc,12.55
Chargemaster Item,,89853014,SPSI,Anti Thrombin III Antigen,,Per Svc,25.09
Chargemaster Item,,89853022,SPSI,Protein C Antigen,,Per Svc,21.23
Chargemaster Item,,89853030,SPSI,Anti Thrombin III Antigen Reflex,,Per Svc,13.00
Chargemaster Item,,89853048,SPSI,Protein C Activity,,Per Svc,32.09
Chargemaster Item,,89853055,SPSI,Protein S Antigen,,Per Svc,12.37
Chargemaster Item,,89853063,SPSI,Protein S Activity,,Per Svc,33.78
Chargemaster Item,,89853378,SPSI,Factor VIII Inhibitor Nijmegen,,Per Svc,144.00
Chargemaster Item,,89853386,SPSI,Factor IX Activity Inhibitor,,Per Svc,182.00
Chargemaster Item,,89853394,SPSI,Factor XI Inhibitor Panel,,Per Svc,65.00
Chargemaster Item,,89853402,SPSI,Factor XII Inhibitor Panel,,Per Svc,182.00
Chargemaster Item,,89853477,SPSI,PTT LA With Reflex,,Per Svc,7.64
Chargemaster Item,,89853600,SPSI,Euglobulin Clot Lysis Time,,Per Svc,36.00
Chargemaster Item,,89855209,SPSI,Heparin Anti Xa Low Molecular Weight Heparin,,Per Svc,73.82
Chargemaster Item,,89855498,SPSI,Lysozyme,,Per Svc,45.50
Chargemaster Item,,89855951,SPSI,Phospholipid Confirmation,,Per Svc,43.00
Chargemaster Item,,89855977,SPSI,Platelet Neutralization,,Per Svc,31.00
Chargemaster Item,,89855985,SPSI,Lupus Testing Reflex Fee,,Per Svc,43.00
Chargemaster Item,,89855993,SPSI,ANA Titer Fee,,Per Svc,11.00
Chargemaster Item,,89856132,SPSI,DRVVT Screen With Reflex,,Per Svc,13.05
Chargemaster Item,,89856157,SPSI,Iodine Level,,Per Svc,40.50
Chargemaster Item,,89856702,SPSI,Thrombin Clotting Time,,Per Svc,4.00
Chargemaster Item,,89857304,SPSI,Activated Protein C Resistance,,Per Svc,53.86
Chargemaster Item,,89858104,SPSI,Viscosity,,Per Svc,12.00
Chargemaster Item,,89858112,SPSI,Viscosity Whole Blood,,Per Svc,57.04
Chargemaster Item,,89860019,SPSI,Allergy Sunflower Seed IgG,,Per Svc,36.47
Chargemaster Item,,89860035,SPSI,Allergen - Individual,,Per Svc,6.69
Chargemaster Item,,89860043,SPSI,Allergen - Individual (R),,Per Svc,10.00
Chargemaster Item,,89860050,SPSI,Latex-Hevea Braziliensis Ige,,Per Svc,6.69
Chargemaster Item,,89860068,SPSI,Allergy Pine Pinon Nuts IgE,,Per Svc,40.21
Chargemaster Item,,89860084,SPSI,Allergy Green Pea IgE,,Per Svc,31.76
Chargemaster Item,,89860092,SPSI,Allergy Mold Profile IgE,,Per Svc,106.50
Chargemaster Item,,89860100,SPSI,Allergy Food Pediatric Profile,,Per Svc,60.00
Chargemaster Item,,89860118,SPSI,Dust Mite Profile Allergy,,Per Svc,20.00
Chargemaster Item,,89860126,SPSI,Allergy Meat Panel,,Per Svc,30.00
Chargemaster Item,,89860134,SPSI,Allergy Chicken IgE,,Per Svc,10.00
Chargemaster Item,,89860142,SPSI,Environmental Panel,,Per Svc,55.80
Chargemaster Item,,89860159,SPSI,Allergy Weed Panel 1,,Per Svc,50.00
Chargemaster Item,,89860167,SPSI,Allergy_Weeds,,Per Svc,70.00
Chargemaster Item,,89860175,SPSI,Allergy Shellfish Panel,,Per Svc,40.00
Chargemaster Item,,89860183,SPSI,Allergy Spinach IgE,,Per Svc,10.00
Chargemaster Item,,89860191,SPSI,Allergy Cucumber IgE,,Per Svc,10.00
Chargemaster Item,,89860209,SPSI,Allergy Trees and Grass Panel,,Per Svc,110.00
Chargemaster Item,,89860225,SPSI,Platelet Antibody Indirect IgG,,Per Svc,72.38
Chargemaster Item,,89860233,SPSI,Heparin Induced Platelet,,Per Svc,39.57
Chargemaster Item,,89860258,SPSI,Anca Reflex Titer,,Per Svc,31.25
Chargemaster Item,,89860266,SPSI,ANCA with Reflex Titer for MPO and PR3 Antibodies,,Per Svc,15.44
Chargemaster Item,,89860274,SPSI,Anca Titer Reflexed,,Per Svc,125.00
Chargemaster Item,,89860282,SPSI,Platelet Glycoprotein Antibody,,Per Svc,82.50
Chargemaster Item,,89860290,SPSI,Heparin Induced Thrombocytopenia,,Per Svc,87.82
Chargemaster Item,,89860399,SPSI,ANA and Rheumatoid Factor 2 with Reflex,,Per Svc,103.40
Chargemaster Item,,89860415,SPSI,ANA Choice Screen by IFA,,Per Svc,4.68
Chargemaster Item,,89861413,SPSI,Cardio CRP,,Per Svc,13.81
Chargemaster Item,,89861488,SPSI,Phosphatidylserine Antibodies IgA IgG IgM B,,Per Svc,77.50
Chargemaster Item,,89861504,SPSI,Phosphatidylserine Antibodies IgA IgG IgM A,,Per Svc,64.18
Chargemaster Item,,89861512,SPSI,Cardiolipin Reflex T,,Per Svc,80.00
Chargemaster Item,,89861603,SPSI,C1 Inhibitor Protein,,Per Svc,16.41
Chargemaster Item,,89861629,SPSI,Complement Total,,Per Svc,8.44
Chargemaster Item,,89861637,SPSI,C2 Complement,,Per Svc,45.00
Chargemaster Item,,89861645,SPSI,Angioedema Profile 2,,Per Svc,34.00
Chargemaster Item,,89861652,SPSI,C1q Complement,,Per Svc,43.50
Chargemaster Item,,89861660,SPSI,C5 Serum,,Per Svc,38.15
Chargemaster Item,,89861678,SPSI,C6 Serum,,Per Svc,51.00
Chargemaster Item,,89861686,SPSI,C7 Serum,,Per Svc,43.50
Chargemaster Item,,89861694,SPSI,C8 Serum,,Per Svc,48.50
Chargemaster Item,,89861702,SPSI,C9 Serum,,Per Svc,49.40
Chargemaster Item,,89861710,SPSI,C3 and C4 Complements,,Per Svc,13.51
Chargemaster Item,,89861728,SPSI,C4 Complement,,Per Svc,6.76
Chargemaster Item,,89861736,SPSI,C3 Complement,,Per Svc,6.76
Chargemaster Item,,89862155,SPSI,DNAse B Antibody,,Per Svc,16.00
Chargemaster Item,,89862262,SPSI,Anti-Dna Ab Ss,,Per Svc,7.53
Chargemaster Item,,89862270,SPSI,DNA Antibody Double Stranded,,Per Svc,7.80
Chargemaster Item,,89862353,SPSI,Sjogrens Antibodies SSA_SSB,,Per Svc,18.87
Chargemaster Item,,89862379,SPSI,EBV Nuclear Antigen and Antibody IgG,,Per Svc,9.36
Chargemaster Item,,89862387,SPSI,Jo 1 Antibodies,,Per Svc,26.41
Chargemaster Item,,89862395,SPSI,RNP Antibody,,Per Svc,20.00
Chargemaster Item,,89862403,SPSI,Sm Antibody,,Per Svc,8.45
Chargemaster Item,,89862411,SPSI,SCL 70 Antibody,,Per Svc,11.82
Chargemaster Item,,89862429,SPSI,ENA Antibodies Quantitative,,Per Svc,19.54
Chargemaster Item,,89862437,SPSI,Mi 2 Autoantibodies,,Per Svc,98.00
Chargemaster Item,,89862551,SPSI,Centromere B Antibody,,Per Svc,22.50
Chargemaster Item,,89862577,SPSI,ANCA Vasculitides,,Per Svc,25.09
Chargemaster Item,,89862593,SPSI,Lupus 12 Panel,,Per Svc,93.75
Chargemaster Item,,89862601,SPSI,Purkinje Cell Antibody Screen,,Per Svc,45.68
Chargemaster Item,,89862619,SPSI,Mitochondrial Antibody,,Per Svc,7.34
Chargemaster Item,,89862627,SPSI,Gastric Parietal Cells Antibody,,Per Svc,9.65
Chargemaster Item,,89862635,SPSI,Reticulin IgA With Reflex Titer,,Per Svc,14.04
Chargemaster Item,,89862643,SPSI,Actin Antibody,,Per Svc,8.69
Chargemaster Item,,89862650,SPSI,Striated Muscle Antibody,,Per Svc,11.58
Chargemaster Item,,89862668,SPSI,Hu Antibody Screen With Reflex,,Per Svc,125.00
Chargemaster Item,,89862676,SPSI,Tissue Transglutaminase Antibody IgA,,Per Svc,10.27
Chargemaster Item,,89862692,SPSI,Epidermal Antibodies,,Per Svc,45.00
Chargemaster Item,,89862700,SPSI,Intercellular Substance Titer,,Per Svc,27.00
Chargemaster Item,,89862718,SPSI,Basement Membrane Ab,,Per Svc,21.00
Chargemaster Item,,89862726,SPSI,Basement Membrane Titer,,Per Svc,27.00
Chargemaster Item,,89862734,SPSI,Mitochondrial Ab Titer,,Per Svc,22.50
Chargemaster Item,,89862742,SPSI,Reticulin Ab Titer,,Per Svc,25.00
Chargemaster Item,,89862759,SPSI,Striated Mus Ab Titer,,Per Svc,42.00
Chargemaster Item,,89862767,SPSI,Smooth Mus Ab Titer,,Per Svc,25.00
Chargemaster Item,,89862783,SPSI,CSF Hu Antibody Screen With Reflex,,Per Svc,95.54
Chargemaster Item,,89862791,SPSI,Parietal Cell Ab Titer,,Per Svc,26.00
Chargemaster Item,,89862874,SPSI,Hep B Surf Ag_Conf_Quest,,Per Svc,6.42
Chargemaster Item,,89862890,SPSI,Hepatitis B Core Antibody Total,,Per Svc,9.65
Chargemaster Item,,89862916,SPSI,Hepatitis B Surface Antibody Quantitative,,Per Svc,4.83
Chargemaster Item,,89862932,SPSI,Hepatitis Be Antigen,,Per Svc,7.72
Chargemaster Item,,89863005,SPSI,CA 15 3,,Per Svc,11.58
Chargemaster Item,,89863039,SPSI,Hepatitis C Antibody RIBA,,Per Svc,25.75
Chargemaster Item,,89863161,SPSI,CA 19 9,,Per Svc,10.62
Chargemaster Item,,89863187,SPSI,CA 27 29,,Per Svc,9.65
Chargemaster Item,,89863195,SPSI,Strongyloides Antibody by Elisa,,Per Svc,54.99
Chargemaster Item,,89863211,SPSI,Hantavirus Antibodies,,Per Svc,60.00
Chargemaster Item,,89863252,SPSI,Urine Protein Electrophoresis 24HR,,Per Svc,12.00
Chargemaster Item,,89863310,SPSI,Hypersen Pneumonitis Screen,,Per Svc,42.65
Chargemaster Item,,89863328,SPSI,Immune Complex C1q,,Per Svc,17.96
Chargemaster Item,,89863336,SPSI,Teichoic Acid Antibody Screen with Reflex to Titer,,Per Svc,32.00
Chargemaster Item,,89863344,SPSI,Immune Complex Panel 1,,Per Svc,118.50
Chargemaster Item,,89863351,SPSI,Urine Immunofixation,,Per Svc,12.55
Chargemaster Item,,89863369,SPSI,Immunofixation,,Per Svc,11.58
Chargemaster Item,,89863401,SPSI,Intrinsic Factor Blocking Antibody,,Per Svc,12.06
Chargemaster Item,,89863419,SPSI,Islet Cell Antibody Screen With Titer,,Per Svc,25.00
Chargemaster Item,,89863427,SPSI,Cryoglobulin Reflex T,,Per Svc,99.00
Chargemaster Item,,89863435,SPSI,Insulin Antibody,,Per Svc,19.30
Chargemaster Item,,89863443,SPSI,Insulin Ab Titer,,Per Svc,42.50
Chargemaster Item,,89863450,SPSI,Immune Complexes PEG IgG,,Per Svc,52.40
Chargemaster Item,,89863468,SPSI,Beta 2 Transferrin,,Per Svc,129.04
Chargemaster Item,,89863476,SPSI,C3D Circulating Immune Complex,,Per Svc,65.50
Chargemaster Item,,89863591,SPSI,Lymphocyte Subset Panel 3,,Per Svc,37.15
Chargemaster Item,,89863765,SPSI,Liver Kidney Microsome Antibody IgG,,Per Svc,15.28
Chargemaster Item,,89863823,SPSI,Interferon Beta IgG by Elisa,,Per Svc,637.75
Chargemaster Item,,89864060,SPSI,Cryptococcus Ag Titer Fee,,Per Svc,35.50
Chargemaster Item,,89864318,SPSI,Rheumatoid Factor_Quest,,Per Svc,22.50
Chargemaster Item,,89864326,SPSI,Fluid Rheumatoid Factor,,Per Svc,22.50
Chargemaster Item,,89864334,SPSI,Rheumatoid Factor Titer,,Per Svc,19.00
Chargemaster Item,,89864342,SPSI,Allergy Wormwood IgE,,Per Svc,10.00
Chargemaster Item,,89864359,SPSI,Allergy Johnson Grass IgE,,Per Svc,10.00
Chargemaster Item,,89864367,SPSI,Allergy Meadow Fescue IgE,,Per Svc,10.00
Chargemaster Item,,89864375,SPSI,Allergy Timothy Grass IgE,,Per Svc,10.00
Chargemaster Item,,89864383,SPSI,Allergy Mesquite IgE,,Per Svc,10.00
Chargemaster Item,,89864391,SPSI,Allergy Birch IgE,,Per Svc,10.00
Chargemaster Item,,89864409,SPSI,Allergy White Mulberry IgE,,Per Svc,6.69
Chargemaster Item,,89864417,SPSI,Allergy Cocklebur IgE,,Per Svc,10.00
Chargemaster Item,,89864425,SPSI,Allergy Sheep Epithelium IgE,,Per Svc,10.00
Chargemaster Item,,89864433,SPSI,Allergy Willow Tree IgE,,Per Svc,10.00
Chargemaster Item,,89864441,SPSI,Allergy White Ash IgE,,Per Svc,10.00
Chargemaster Item,,89864458,SPSI,Allergy White Pine IgE,,Per Svc,10.00
Chargemaster Item,,89864466,SPSI,Allergy Eucalyptus IgE,,Per Svc,10.00
Chargemaster Item,,89864474,SPSI,Allergy Acacia IgE,,Per Svc,10.00
Chargemaster Item,,89864482,SPSI,Allergy Lobster IgE,,Per Svc,6.69
Chargemaster Item,,89864490,SPSI,Allergy Bermuda Grass IgE,,Per Svc,10.00
Chargemaster Item,,89864508,SPSI,Allergy Derma Farinae IgE,,Per Svc,10.00
Chargemaster Item,,89864516,SPSI,Allergy Scale IgE,,Per Svc,10.00
Chargemaster Item,,89864524,SPSI,Allergy False Ragweed IgE,,Per Svc,10.00
Chargemaster Item,,89864532,SPSI,Allergy Mugwort IgE,,Per Svc,10.00
Chargemaster Item,,89864540,SPSI,Allergy English Plantain IgE,,Per Svc,10.00
Chargemaster Item,,89864557,SPSI,Allergy Shrimp IgE,,Per Svc,6.69
Chargemaster Item,,89864565,SPSI,Allergy ElmTree IgE,,Per Svc,10.00
Chargemaster Item,,89864573,SPSI,Allergy Lambs Quarter IgE,,Per Svc,10.00
Chargemaster Item,,89864581,SPSI,Allergy Russian Thistle IgE,,Per Svc,10.00
Chargemaster Item,,89864599,SPSI,Allergy Common Pigweed IgE,,Per Svc,10.00
Chargemaster Item,,89864607,SPSI,Allergy Orchard Grass IgE,,Per Svc,10.00
Chargemaster Item,,89864615,SPSI,Allergy Perennial Rye IgE,,Per Svc,10.00
Chargemaster Item,,89864623,SPSI,Allergy June Grass IgE,,Per Svc,10.00
Chargemaster Item,,89864631,SPSI,Allergy Red Top Grass IgE,,Per Svc,10.00
Chargemaster Item,,89864649,SPSI,Allergy Cladosporium Herbarum IgE,,Per Svc,10.00
Chargemaster Item,,89864656,SPSI,Allergy Cat Dander IgE,,Per Svc,6.69
Chargemaster Item,,89864664,SPSI,Allergy Dog Dander IgE,,Per Svc,10.00
Chargemaster Item,,89864672,SPSI,Allergy Wheat IgE,,Per Svc,6.69
Chargemaster Item,,89864680,SPSI,Allergy Cultivated Oat IgE,,Per Svc,10.00
Chargemaster Item,,89864698,SPSI,Allergy Alternaria Tenuis IgE,,Per Svc,10.00
Chargemaster Item,,89864706,SPSI,Allergy Walnut Tree IgE,,Per Svc,10.00
Chargemaster Item,,89864714,SPSI,Allergy Sycamore IgE,,Per Svc,10.00
Chargemaster Item,,89864722,SPSI,Allergy Cottonwood IgE,,Per Svc,10.00
Chargemaster Item,,89864730,SPSI,Allergy Alder IgE,,Per Svc,10.00
Chargemaster Item,,89864748,SPSI,Allergy Olive Tree IgE,,Per Svc,10.00
Chargemaster Item,,89864755,SPSI,Allergy Milk IgE,,Per Svc,5.58
Chargemaster Item,,89864763,SPSI,Allergy Crab IgE,,Per Svc,6.69
Chargemaster Item,,89864771,SPSI,Allergy Codfish IgE,,Per Svc,6.69
Chargemaster Item,,89864789,SPSI,Allergy Tuna IgE,,Per Svc,10.00
Chargemaster Item,,89864797,SPSI,Allergy Alpha Lactalbumin IgE,,Per Svc,10.00
Chargemaster Item,,89864805,SPSI,Allergy Casein IgE,,Per Svc,10.00
Chargemaster Item,,89864813,SPSI,Allergy Corn IgE,,Per Svc,10.00
Chargemaster Item,,89864821,SPSI,Allergy House Dust Greer IgE,,Per Svc,6.69
Chargemaster Item,,89864839,SPSI,Allergy Penicillium Notatum IgE,,Per Svc,10.00
Chargemaster Item,,89864847,SPSI,Allergy Aspergillus Fumigatus IgE,,Per Svc,6.69
Chargemaster Item,,89864854,SPSI,Allergy H Halodes IgE,,Per Svc,10.00
Chargemaster Item,,89864862,SPSI,Allergy D Pteronyssinus IgE,,Per Svc,6.69
Chargemaster Item,,89864870,SPSI,Allergy Dog Epithelia IgE,,Per Svc,6.69
Chargemaster Item,,89864888,SPSI,Allergy Goose Feathers IgE,,Per Svc,10.00
Chargemaster Item,,89864896,SPSI,Allergy Peanut IgE,,Per Svc,6.69
Chargemaster Item,,89864904,SPSI,Allergy Soybean IgE,,Per Svc,6.69
Chargemaster Item,,89864912,SPSI,Allergy Chicken Feathers IgE,,Per Svc,10.00
Chargemaster Item,,89864920,SPSI,Allergy Carrot IgE,,Per Svc,10.00
Chargemaster Item,,89864938,SPSI,Allergy Potato IgE,,Per Svc,10.00
Chargemaster Item,,89864946,SPSI,Allergy Horse Dander IgE,,Per Svc,10.00
Chargemaster Item,,89864953,SPSI,Allergy Cow Dander IgE,,Per Svc,10.00
Chargemaster Item,,89864961,SPSI,Allergy Pigeon Droppings IgE,,Per Svc,6.69
Chargemaster Item,,89864979,SPSI,Allergy Yellow Jacket IgE,,Per Svc,10.00
Chargemaster Item,,89864987,SPSI,Allergy Paper Wasp IgE,,Per Svc,10.00
Chargemaster Item,,89864995,SPSI,Allergy Peas IgE,,Per Svc,10.00
Chargemaster Item,,89865000,SPSI,Allergy White Bean IgE,,Per Svc,10.00
Chargemaster Item,,89865018,SPSI,Allergy Almond IgE,,Per Svc,10.00
Chargemaster Item,,89865026,SPSI,Allergy Coconut IgE,,Per Svc,10.00
Chargemaster Item,,89865034,SPSI,Allergy Pecan Nut IgE,,Per Svc,10.00
Chargemaster Item,,89865042,SPSI,Allergy Honeybee IgE,,Per Svc,10.00
Chargemaster Item,,89865059,SPSI,Allergy White Face Hornet IgE,,Per Svc,10.00
Chargemaster Item,,89865067,SPSI,Allergy Barley IgE,,Per Svc,10.00
Chargemaster Item,,89865075,SPSI,Allergy Rice IgE,,Per Svc,10.00
Chargemaster Item,,89865083,SPSI,Allergy Buckwheat IgE,,Per Svc,10.00
Chargemaster Item,,89865091,SPSI,Allergy Gluten IgE,,Per Svc,10.00
Chargemaster Item,,89865109,SPSI,Allergy Sesame Seed IgE,,Per Svc,10.00
Chargemaster Item,,89865117,SPSI,Allergy Orange IgE,,Per Svc,10.00
Chargemaster Item,,89865125,SPSI,Allergy Celery IgE,,Per Svc,10.00
Chargemaster Item,,89865133,SPSI,Allergy Parsley IgE,,Per Svc,10.00
Chargemaster Item,,89865141,SPSI,Allergy Lettuce IgE,,Per Svc,10.00
Chargemaster Item,,89865158,SPSI,Allergy Rye IgE,,Per Svc,10.00
Chargemaster Item,,89865166,SPSI,Allergy Candida Albicans IgE,,Per Svc,10.00
Chargemaster Item,,89865174,SPSI,Allergy Egg White IgE,,Per Svc,6.69
Chargemaster Item,,89865182,SPSI,Allergy Oat IgE,,Per Svc,10.00
Chargemaster Item,,89865190,SPSI,Allergy Tomato IgE,,Per Svc,10.00
Chargemaster Item,,89865208,SPSI,Allergy Beta Lactoglobulin IgE,,Per Svc,10.00
Chargemaster Item,,89865216,SPSI,Allergy Latex IgE,,Per Svc,5.58
Chargemaster Item,,89865224,SPSI,Allergy Firebush IgE,,Per Svc,10.00
Chargemaster Item,,89865232,SPSI,Allergy Western Ragweed IgE,,Per Svc,10.00
Chargemaster Item,,89865240,SPSI,Allergy Elder Marsh Rough IgE,,Per Svc,10.00
Chargemaster Item,,89865257,SPSI,Allergy Cotton Seed IgE,,Per Svc,10.00
Chargemaster Item,,89865265,SPSI,Allergy Cockroach IgE,,Per Svc,10.00
Chargemaster Item,,89865273,SPSI,Allergy Mixed Feather IgE,,Per Svc,20.00
Chargemaster Item,,89865281,SPSI,Allergy Mucor Racemosus IgE,,Per Svc,10.00
Chargemaster Item,,89865307,SPSI,Quanteferon Tb Gold,,Per Svc,43.43
Chargemaster Item,,89865315,SPSI,Adenovirus DNA Qualitative RT-PCR,,Per Svc,79.13
Chargemaster Item,,89865349,SPSI,Bord Pert/Parapert Cult DFA,,Per Svc,28.95
Chargemaster Item,,89865372,SPSI,Chlamydophila Pneumoniae Cult,,Per Svc,54.80
Chargemaster Item,,89865380,SPSI,Chlamydia Trachomatis Culture,,Per Svc,22.20
Chargemaster Item,,89865430,SPSI,Entamoeba Histolytica Antigen Detection,,Per Svc,34.00
Chargemaster Item,,89865448,SPSI,Enterovirus RNA, QL RT-PCR,,Per Svc,86.85
Chargemaster Item,,89865463,SPSI,Histoplasma Capsulatum DNA PCR,,Per Svc,223.50
Chargemaster Item,,89865489,SPSI,Influenza A/B Culture,,Per Svc,73.82
Chargemaster Item,,89865497,SPSI,Legionella DNA Ql, Rt-PCR,,Per Svc,82.00
Chargemaster Item,,89865513,SPSI,Legionella Pneumophila,,Per Svc,49.20
Chargemaster Item,,89865521,SPSI,Norovirus EIA Stool,,Per Svc,85.11
Chargemaster Item,,89865539,SPSI,Viral Respiratory Rapid Culture,,Per Svc,173.70
Chargemaster Item,,89865547,SPSI,Toxoplasma Gondii IGG/IGM CSF,,Per Svc,40.00
Chargemaster Item,,89865554,SPSI,Varicella Zoster DNA, Qualitative RT-PCR,,Per Svc,96.50
Chargemaster Item,,89865927,SPSI,CSF VDRL,,Per Svc,4.83
Chargemaster Item,,89866032,SPSI,Adenovirus Antibody,,Per Svc,13.08
Chargemaster Item,,89866065,SPSI,Aspergillus Antibody Profile,,Per Svc,17.86
Chargemaster Item,,89866073,SPSI,Fungus Panel,,Per Svc,269.11
Chargemaster Item,,89866099,SPSI,Pneumococcal IgG Serotypes,,Per Svc,75.00
Chargemaster Item,,89866107,SPSI,Pneumococcal Antibody IgG,,Per Svc,52.50
Chargemaster Item,,89866115,SPSI,Bartonella Species Antibody,,Per Svc,24.13
Chargemaster Item,,89866123,SPSI,Blastomyces Antibody by Immunodiffusion Serum,,Per Svc,18.67
Chargemaster Item,,89866131,SPSI,B Henselae Antibiodies IgG and IgM,,Per Svc,33.00
Chargemaster Item,,89866149,SPSI,Bartonella Henselae Igg Titer,,Per Svc,37.00
Chargemaster Item,,89866156,SPSI,Bartonella Henselae Igm Titer,,Per Svc,37.00
Chargemaster Item,,89866164,SPSI,B Pertussis Antibodies IgG and IgA,,Per Svc,56.28
Chargemaster Item,,89866172,SPSI,B Burgdorferi Antibody with Reflex,,Per Svc,8.69
Chargemaster Item,,89866206,SPSI,CSF B_Burgdorferi DNA by PCR,,Per Svc,37.10
Chargemaster Item,,89866214,SPSI,Toxic Shock Syndrome Antibody,,Per Svc,135.20
Chargemaster Item,,89866222,SPSI,Brucella Antibodies IgG and IgM,,Per Svc,18.44
Chargemaster Item,,89866230,SPSI,N Gonorrhoeae Antibody,,Per Svc,52.50
Chargemaster Item,,89866289,SPSI,Candida Albicans Antibody,,Per Svc,30.50
Chargemaster Item,,89866321,SPSI,C Trachomatis Antibodies IgG IgA IgM,,Per Svc,41.45
Chargemaster Item,,89866339,SPSI,C Pneumoniae Antibodies IgG IgA IgM by IF,,Per Svc,26.89
Chargemaster Item,,89866347,SPSI,Chlamydia Species Antibodies IgM,,Per Svc,52.50
Chargemaster Item,,89866354,SPSI,Coccidioides Antibody ID,,Per Svc,46.32
Chargemaster Item,,89866370,SPSI,CSF Coccidioides Antibody by CF,,Per Svc,21.71
Chargemaster Item,,89866388,SPSI,Q Fever Antibodies IgG_IgM,,Per Svc,47.32
Chargemaster Item,,89866396,SPSI,C Psittaci Antibodies IgG IgA IgM,,Per Svc,26.89
Chargemaster Item,,89866412,SPSI,Q Fever Igg Titer,,Per Svc,45.00
Chargemaster Item,,89866420,SPSI,Coccidioides Antibody by CF,,Per Svc,40.26
Chargemaster Item,,89866446,SPSI,CMV IgG Antibody,,Per Svc,5.73
Chargemaster Item,,89866453,SPSI,CMV Antibodies IgG and IgM,,Per Svc,18.34
Chargemaster Item,,89866461,SPSI,CMV IgM Antibody,,Per Svc,10.62
Chargemaster Item,,89866487,SPSI,Diphtheria Antibody,,Per Svc,20.00
Chargemaster Item,,89866495,SPSI,Torch Panel IgG and IgM,,Per Svc,58.92
Chargemaster Item,,89866511,SPSI,Arbovirus Antibody IgG by IFA,,Per Svc,62.12
Chargemaster Item,,89866586,SPSI,Coxsackie A Abs_ Serum,,Per Svc,61.36
Chargemaster Item,,89866594,SPSI,Coxsackie A Ab (4,16),,Per Svc,46.00
Chargemaster Item,,89866602,SPSI,Coxsackie B1 B6 Antibodies,,Per Svc,34.86
Chargemaster Item,,89866610,SPSI,Echovirus Antibody Panels by CF,,Per Svc,50.00
Chargemaster Item,,89866636,SPSI,EBV Ea D Ab IgG,,Per Svc,6.76
Chargemaster Item,,89866644,SPSI,Polio Antibody Neutralization,,Per Svc,105.50
Chargemaster Item,,89866651,SPSI,Epstein Barr 3 Test Panel,,Per Svc,27.84
Chargemaster Item,,89866669,SPSI,EBV Virus Antibody VCA IgG,,Per Svc,9.36
Chargemaster Item,,89866677,SPSI,EBV Virus Antibody VCA IgM,,Per Svc,9.12
Chargemaster Item,,89866685,SPSI,Ehrlichia Antibody Panel,,Per Svc,55.49
Chargemaster Item,,89866701,SPSI,Myocarditis Panel,,Per Svc,89.00
Chargemaster Item,,89866719,SPSI,S Cerevisiae Antibodies,,Per Svc,102.60
Chargemaster Item,,89866743,SPSI,Giardia Lamblia Antibody,,Per Svc,58.00
Chargemaster Item,,89866776,SPSI,H Pylori Antibody IgG,,Per Svc,9.65
Chargemaster Item,,89866784,SPSI,H Pylori Antibody IgM,,Per Svc,13.51
Chargemaster Item,,89866826,SPSI,Cysticercus Antibody by Elisa,,Per Svc,54.04
Chargemaster Item,,89866859,SPSI,Haemophilus Influenza B Vaccine Response,,Per Svc,42.68
Chargemaster Item,,89866867,SPSI,Schistosoma Antibody IgG,,Per Svc,40.53
Chargemaster Item,,89866875,SPSI,HTLV I and II Antibody Qualitative by EIA,,Per Svc,16.00
Chargemaster Item,,89866925,SPSI,Hepatitis Delta Antibody,,Per Svc,25.00
Chargemaster Item,,89866933,SPSI,Hepatitis D Virus,,Per Svc,38.55
Chargemaster Item,,89866941,SPSI,Herpes Simplex Virus 1 and 2 IgG Herpeselect,,Per Svc,6.76
Chargemaster Item,,89866958,SPSI,Herpes Simplex Virus IgM Antibody With Reflex Titer,,Per Svc,40.33
Chargemaster Item,,89866966,SPSI,Hsv Igm Ab Titer Fee,,Per Svc,37.50
Chargemaster Item,,89866982,SPSI,Histoplasma Antibody by CF,,Per Svc,39.08
Chargemaster Item,,89866990,SPSI,Histoplasma Antibody Panel,,Per Svc,31.00
Chargemaster Item,,89867071,SPSI,Hepatitis Be Antibody,,Per Svc,7.72
Chargemaster Item,,89867089,SPSI,Hepatitis A Ab_Total_Quest,,Per Svc,8.44
Chargemaster Item,,89867105,SPSI,Influenza Virus Antibodies,,Per Svc,29.61
Chargemaster Item,,89867113,SPSI,Influenza A IgG and IgM,,Per Svc,36.00
Chargemaster Item,,89867121,SPSI,Influenza B IgG IgM,,Per Svc,36.00
Chargemaster Item,,89867147,SPSI,Legionella Antibody Panel,,Per Svc,49.20
Chargemaster Item,,89867154,SPSI,L Pneumophila IgG and IgM 1 6,,Per Svc,55.00
Chargemaster Item,,89867170,SPSI,Leishmania Antibody by IFA,,Per Svc,94.69
Chargemaster Item,,89867204,SPSI,Leptospira Antibody,,Per Svc,17.72
Chargemaster Item,,89867279,SPSI,Encephalitis Ab Panel Csf,,Per Svc,162.95
Chargemaster Item,,89867287,SPSI,Lymphocytic Choriomeningitis,,Per Svc,46.50
Chargemaster Item,,89867295,SPSI,Lymphogranuloma Venereum Differentiation,,Per Svc,77.70
Chargemaster Item,,89867352,SPSI,Mumps Virus Antibody IgM,,Per Svc,16.65
Chargemaster Item,,89867360,SPSI,Mumps Virus Antibody IgG,,Per Svc,8.42
Chargemaster Item,,89867386,SPSI,M Pneumoniae Antibody IgG by EIA,,Per Svc,14.48
Chargemaster Item,,89867394,SPSI,M Pneumoniae Antibody IgM by EIA,,Per Svc,14.48
Chargemaster Item,,89867535,SPSI,E Histolytica IgG by Elisa,,Per Svc,19.00
Chargemaster Item,,89867543,SPSI,Trypanosoma Cruzi Antibody IgG by IFA,,Per Svc,45.37
Chargemaster Item,,89867576,SPSI,Typhus Fever Antibodies IgG IgM,,Per Svc,26.41
Chargemaster Item,,89867584,SPSI,Typhus (Murine) Ab Igg Titer,,Per Svc,37.50
Chargemaster Item,,89867592,SPSI,Typhus (Murine) Ab Igm Titer,,Per Svc,42.50
Chargemaster Item,,89867600,SPSI,Rickettsial Disease Antibody,,Per Svc,48.25
Chargemaster Item,,89867618,SPSI,Rmsf Ab Igm,,Per Svc,42.50
Chargemaster Item,,89867626,SPSI,Rubella Antibody IgG,,Per Svc,8.20
Chargemaster Item,,89867634,SPSI,Rubella IgM,,Per Svc,5.73
Chargemaster Item,,89867642,SPSI,Typhus Ab Igg,,Per Svc,37.50
Chargemaster Item,,89867659,SPSI,Measles Antibody IgM by IF,,Per Svc,13.75
Chargemaster Item,,89867675,SPSI,Measles Antibody IgG by EIA,,Per Svc,3.14
Chargemaster Item,,89867683,SPSI,Typhus Ab Igm,,Per Svc,42.50
Chargemaster Item,,89867691,SPSI,Rmsf Ab Igg,,Per Svc,37.50
Chargemaster Item,,89867709,SPSI,Salmonella Total Antibody by EIA,,Per Svc,34.98
Chargemaster Item,,89867741,SPSI,Tetanus Antitoxoid Antibody,,Per Svc,18.72
Chargemaster Item,,89867774,SPSI,Toxoplasma Antibody IgG,,Per Svc,11.62
Chargemaster Item,,89867782,SPSI,Toxoplasma Igm Ab,,Per Svc,5.73
Chargemaster Item,,89867790,SPSI,Torch Panel Acute,,Per Svc,50.15
Chargemaster Item,,89867816,SPSI,FTA Anitbodies,,Per Svc,5.79
Chargemaster Item,,89867824,SPSI,Toxoplasma Antibody IgM,,Per Svc,22.55
Chargemaster Item,,89867857,SPSI,T Pallidum Antibodies IgG_IgM,,Per Svc,46.70
Chargemaster Item,,89867873,SPSI,Varicella Zoster Antibody IgG by EIA,,Per Svc,3.86
Chargemaster Item,,89867881,SPSI,Varicella Zoster Antibody IgM by EIA,,Per Svc,9.89
Chargemaster Item,,89867907,SPSI,Parainfluenza Virus Antibodies,,Per Svc,17.72
Chargemaster Item,,89867915,SPSI,Hepatitis E Antibody IgG,,Per Svc,13.99
Chargemaster Item,,89867923,SPSI,Hepatitis E Antibody IgM,,Per Svc,47.00
Chargemaster Item,,89867931,SPSI,Dengue Fever Antibody Panel,,Per Svc,72.38
Chargemaster Item,,89867949,SPSI,Herpes Virus 6 IgG_IgM,,Per Svc,28.41
Chargemaster Item,,89867956,SPSI,CSF West Nile Virus Antibodies IgG IgM by Elisa,,Per Svc,58.87
Chargemaster Item,,89867964,SPSI,West Nile Virus Antibodies IgG IgM by Elisa,,Per Svc,33.78
Chargemaster Item,,89867972,SPSI,CSF HTLV I and II Antibody,,Per Svc,59.00
Chargemaster Item,,89867980,SPSI,Herpesvirus 8 IgG Antibody by IFA,,Per Svc,43.91
Chargemaster Item,,89868004,SPSI,Thyroglobulin Antibodies ATA TPO,,Per Svc,16.08
Chargemaster Item,,89868038,SPSI,Hepatitis C Ab Quest,,Per Svc,6.00
Chargemaster Item,,89868129,SPSI,Thyroglobulin Antibody Test,,Per Svc,7.41
Chargemaster Item,,89868145,SPSI,HLA B27,,Per Svc,15.44
Chargemaster Item,,89868152,SPSI,HLA Class I A_B_C DNA Typing,,Per Svc,340.00
Chargemaster Item,,89868178,SPSI,HLA DRB DQB1 Typing,,Per Svc,275.00
Chargemaster Item,,89868202,SPSI,Immunoglobulin Immunofixation Profile,,Per Svc,94.35
Chargemaster Item,,89868210,SPSI,Arsenic Serum Or Plasma,,Per Svc,74.00
Chargemaster Item,,89868228,SPSI,Endomysial Antibody,,Per Svc,10.27
Chargemaster Item,,89868236,SPSI,Stool Chymotrypsin,,Per Svc,51.00
Chargemaster Item,,89868244,SPSI,Pancreatic Elastase 1,,Per Svc,112.00
Chargemaster Item,,89868251,SPSI,Herpes Virus 6 DNA by PCR,,Per Svc,149.00
Chargemaster Item,,89868269,SPSI,Childhood Allergy Prof With IgE,,Per Svc,109.90
Chargemaster Item,,89868277,SPSI,Allergy Resp Region XII with IgE,,Per Svc,156.73
Chargemaster Item,,89868285,SPSI,Allergy Maple Boxelder IgE,,Per Svc,10.00
Chargemaster Item,,89868293,SPSI,Allergy Sheep Sorrel IgE,,Per Svc,10.00
Chargemaster Item,,89868301,SPSI,Cyclospora and Isospora Exam,,Per Svc,37.50
Chargemaster Item,,89868319,SPSI,Von Willebrand Comprehensive Panel,,Per Svc,136.07
Chargemaster Item,,89868327,SPSI,Collagen Type I,,Per Svc,30.00
Chargemaster Item,,89869416,SPSI,Sucrose Hemolysis Test,,Per Svc,12.00
Chargemaster Item,,89870000,SPSI,Barbiturates, Confirmation,,Per Svc,29.90
Chargemaster Item,,89870018,SPSI,HTLV I/II Confirmation Assay,,Per Svc,21.93
Chargemaster Item,,89870026,SPSI,Neuronal Nuclear AB WB CSF,,Per Svc,115.80
Chargemaster Item,,89870034,SPSI,Neuronal Nuclear AB Titer,,Per Svc,43.43
Chargemaster Item,,89870042,SPSI,Neuronal Nuclear AB WB Serum,,Per Svc,96.50
Chargemaster Item,,89870059,SPSI,Myasthenia Gravis Panel 3,,Per Svc,39.58
Chargemaster Item,,89870067,SPSI,Acetylcholine Rec Blocking AB,,Per Svc,39.56
Chargemaster Item,,89870075,SPSI,Anti-Striated Muscle AB Screen,,Per Svc,39.56
Chargemaster Item,,89870083,SPSI,Ricksettsia (RMSF) ABTiter IgM,,Per Svc,22.00
Chargemaster Item,,89870091,SPSI,Ricksettsia Typhus ABTiter IgG,,Per Svc,24.61
Chargemaster Item,,89870109,SPSI,Ricksettsia Typhus ABTiter IgM,,Per Svc,22.20
Chargemaster Item,,89870117,SPSI,Cryptococcal AG Latex Titer,,Per Svc,71.00
Chargemaster Item,,89870125,SPSI,Cytochrome P450 2D6 Genotype,,Per Svc,199.76
Chargemaster Item,,89870141,SPSI,Allergy Brazil Nut,,Per Svc,5.45
Chargemaster Item,,89870158,SPSI,Allergy Cashew Nut,,Per Svc,5.45
Chargemaster Item,,89870166,SPSI,Allergy Hazelnut,,Per Svc,5.45
Chargemaster Item,,89870174,SPSI,Allergy Macadamia Nut,,Per Svc,5.45
Chargemaster Item,,89870182,SPSI,Allergy Pistachio Nut,,Per Svc,5.45
Chargemaster Item,,89870190,SPSI,Brazil Nut Component,,Per Svc,5.45
Chargemaster Item,,89870208,SPSI,Cashew Nut Component,,Per Svc,5.45
Chargemaster Item,,89870216,SPSI,Walnut Component,,Per Svc,5.45
Chargemaster Item,,89870224,SPSI,Hazelnut Component,,Per Svc,21.78
Chargemaster Item,,89870232,SPSI,Peanut Component,,Per Svc,27.90
Chargemaster Item,,89870240,SPSI,Proteinase 3 Antibody,,Per Svc,14.48
Chargemaster Item,,89871107,SPSI,Acetylcholine Rec Mod AB,,Per Svc,56.94
Chargemaster Item,,89871123,SPSI,Beta HCG CSF,,Per Svc,11.58
Chargemaster Item,,89871131,SPSI,Modified AF Stain For Noc/Aer Ac,,Per Svc,4.83
Chargemaster Item,,89871149,SPSI,MTB Comp. Rifampin PCR Sputum,,Per Svc,360.00
Chargemaster Item,,89871156,SPSI,JAK2 V617F Cascading Reflex,,Per Svc,210.38
Chargemaster Item,,89871164,SPSI,GALR Exon 9 Mutation,,Per Svc,210.00
Chargemaster Item,,89871172,SPSI,JAK2 Exon 12 Mutation,,Per Svc,210.00
Chargemaster Item,,89871180,SPSI,MPL Exon 10 Mutation,,Per Svc,210.00
Chargemaster Item,,89871198,SPSI,CSF3R Exon 14/17 Mutation Gene,,Per Svc,210.00
Chargemaster Item,,89871776,SPSI,Ova_Parasite_Quest,,Per Svc,37.91
Chargemaster Item,,89872303,SPSI,Clostridium Difficile Neutral,,Per Svc,63.95
Chargemaster Item,,89872758,SPSI,Influenza Type B Antibody,,Per Svc,14.81
Chargemaster Item,,89873855,SPSI,Histoplasma Antigen Quantitative by EIA,,Per Svc,47.29
Chargemaster Item,,89874499,SPSI,Histoplasma Ag Random Urine,,Per Svc,105.00
Chargemaster Item,,89874929,SPSI,Chlamydia and N Gonorrheae Gen Probe,,Per Svc,12.00
Chargemaster Item,,89874960,SPSI,CMV DNA Qualitative by RT PCR,,Per Svc,75.00
Chargemaster Item,,89874978,SPSI,CSF CMV Antibodies IgG and IgM,,Per Svc,28.95
Chargemaster Item,,89875173,SPSI,HBV DNA_Qual PCR,,Per Svc,47.75
Chargemaster Item,,89875223,SPSI,Hepatitis C RNA Quantitative by PCR,,Per Svc,57.90
Chargemaster Item,,89875249,SPSI,Hepatitis C RNA Quantitative bDNA,,Per Svc,85.00
Chargemaster Item,,89875355,SPSI,HIV 1 DNA Qualitative by PCR,,Per Svc,120.63
Chargemaster Item,,89875397,SPSI,HIV 1 RNA by PCR With Reflex Genotype,,Per Svc,72.38
Chargemaster Item,,89875405,SPSI,HIV 1 RNA Quantitative bDNA 3.0,,Per Svc,85.00
Chargemaster Item,,89875421,SPSI,HIV 2 DNA and RNA Qualitative by PCR,,Per Svc,195.00
Chargemaster Item,,89875918,SPSI,Neisseria Gonorrhoeae DNA,SDA,,Per Svc,27.50
Chargemaster Item,,89875926,SPSI,Chlamydia and N Gonorrheae,,Per Svc,50.00
Chargemaster Item,,89875975,SPSI,Neuromyelitis Optica IGG AB,,Per Svc,407.20
Chargemaster Item,,89875983,SPSI,Calprotectin, Stool,,Per Svc,62.73
Chargemaster Item,,89878011,SPSI,EBV DNA Quantitative by PCR,,Per Svc,91.68
Chargemaster Item,,89878029,SPSI,West Nile Virus_RNA_PCR,,Per Svc,85.11
Chargemaster Item,,89878037,SPSI,EBV DNA Qualitative by PCR,,Per Svc,91.68
Chargemaster Item,,89879019,SPSI,HIV 1 Genotype,,Per Svc,241.25
Chargemaster Item,,89879027,SPSI,Hepatitis C Viral RNA Genotype LiPA,,Per Svc,120.63
Chargemaster Item,,89879035,SPSI,HIV 1 Virtual Phenotype,,Per Svc,250.00
Chargemaster Item,,89881809,SPSI,Leukemia Lymphoma Evaluation,,Per Svc,155.43
Chargemaster Item,,89881833,SPSI,Lymphocyte Subset Panel 1,,Per Svc,100.00
Chargemaster Item,,89881841,SPSI,Lymphocyte Subset Panel 2,,Per Svc,76.50
Chargemaster Item,,89881874,SPSI,Natural Killer Cells,,Per Svc,77.00
Chargemaster Item,,89881890,SPSI,Chronic Granulomatis Disease,,Per Svc,59.93
Chargemaster Item,,89881916,SPSI,Fetal Hemoglobin Whole Blood,,Per Svc,5.00
Chargemaster Item,,89881932,SPSI,Zap 70 Test,,Per Svc,230.00
Chargemaster Item,,89881957,SPSI,Fungitell (1-3) BD Glucan,,Per Svc,106.15
Chargemaster Item,,89881965,SPSI,Pepsinogen II,,Per Svc,250.00
Chargemaster Item,,89881973,SPSI,Respiratory Virus Panel IV PCR,,Per Svc,894.63
Chargemaster Item,,89882302,SPSI,Chromosome Analysis Blood,,Per Svc,241.25
Chargemaster Item,,89882310,SPSI,Fish DiGeorge VCFS,,Per Svc,360.00
Chargemaster Item,,89882336,SPSI,Chromosome Analysis Tissue,,Per Svc,375.00
Chargemaster Item,,89882351,SPSI,Chromosomes_Amniotic Fluid,,Per Svc,362.00
Chargemaster Item,,89882377,SPSI,Chromosome Analysis Hematologic,,Per Svc,207.86
Chargemaster Item,,89882393,SPSI,Chromosome Analysis Solid Tumor,,Per Svc,451.50
Chargemaster Item,,89882401,SPSI,Fish CML_ALL and bcr_abl Translocation,,Per Svc,312.66
Chargemaster Item,,89882518,SPSI,JAK2 V617F Mutation Analysis,,Per Svc,96.50
Chargemaster Item,,89882526,SPSI,Flucytosine_5,,Per Svc,79.65
Chargemaster Item,,89882534,SPSI,Kappa Lambda Light Chains Free,,Per Svc,29.05
Chargemaster Item,,89882542,SPSI,Urine Methylmalonic Acid,,Per Svc,21.53
Chargemaster Item,,89882559,SPSI,Urine Legionella Antigen,,Per Svc,11.58
Chargemaster Item,,89882567,SPSI,Urorisk Diagnostic Profile,,Per Svc,149.00
Chargemaster Item,,89882625,SPSI,Chromosome, Setup,,Per Svc,85.00
Chargemaster Item,,89882641,SPSI,Bone Marrow Scr Fee,,Per Svc,150.00
Chargemaster Item,,89882732,SPSI,Fish Subtelomere Screen,,Per Svc,1100.00
Chargemaster Item,,89882757,SPSI,Fish Prader Willi,,Per Svc,300.00
Chargemaster Item,,89882765,SPSI,Urine Fish Vysis Urovysion,,Per Svc,225.00
Chargemaster Item,,89882781,SPSI,Fish AML M3 and PML RARA T15_17,,Per Svc,180.00
Chargemaster Item,,89882898,SPSI,Chromosome Analysis High Resolution,,Per Svc,337.75
Chargemaster Item,,89882922,SPSI,JC Polyoma Virus QL RT PCR,,Per Svc,152.47
Chargemaster Item,,89882930,SPSI,Fungus Culture Skin,Hair,Nails,,Per Svc,31.27
Chargemaster Item,,89883664,SPSI,HPV Typing In Situ,,Per Svc,123.50
Chargemaster Item,,89883714,SPSI,Iodine Random Urine,,Per Svc,67.08
Chargemaster Item,,89883722,SPSI,P190 BCR-ABL1,,Per Svc,114.64
Chargemaster Item,,89883730,SPSI,P210 BCR-ABL1,,Per Svc,114.64
Chargemaster Item,,89884019,SPSI,Notch3 (Cadasil) Sequencing,,Per Svc,2850.00
Chargemaster Item,,89884027,SPSI,Cardio Iq( R) Lpa Aspirin Geno,,Per Svc,176.31
Chargemaster Item,,89884035,SPSI,Immunoglobulin G Subclass 4,,Per Svc,8.62
Chargemaster Item,,89884050,SPSI,Adenovirus,,Per Svc,36.23
Chargemaster Item,,89884068,SPSI,Influenza A,,Per Svc,32.00
Chargemaster Item,,89884084,SPSI,Parainfluenza 1,,Per Svc,32.00
Chargemaster Item,,89884092,SPSI,Parainfluenza 2,,Per Svc,32.00
Chargemaster Item,,89884115,SPSI,Cow-Dander Ige,,Per Svc,19.53
Chargemaster Item,,89885008,SPSI,Parainfluenza 3,,Per Svc,32.00
Chargemaster Item,,89885016,SPSI,RSV,,Per Svc,32.00
Chargemaster Item,,89885024,SPSI,Aspergillus Ag Eia Bal,,Per Svc,100.66
Chargemaster Item,,89885032,SPSI,Galectin 3,,Per Svc,75.00
Chargemaster Item,,89885040,SPSI,Penicilloyl & V Profile,,Per Svc,11.16
Chargemaster Item,,89885057,SPSI,Gad65 Neurological Synd Ab,,Per Svc,365.00
Chargemaster Item,,89885065,SPSI,Leukovantage Myel Syndrome,,Per Svc,2550.00
Chargemaster Item,,89885081,SPSI,Inhibin-B,,Per Svc,120.63
Chargemaster Item,,89885099,SPSI,Influenza-B,,Per Svc,32.00
Chargemaster Item,,89885107,SPSI,Cat-Dander Ige,,Per Svc,19.53
Chargemaster Item,,89885123,SPSI,Dog-Dander,,Per Svc,19.53
Chargemaster Item,,89885131,SPSI,Horse-Dander Ige,,Per Svc,19.53
Chargemaster Item,,89893259,SPSI,Sperm Antibodies IgA_ IgG,,Per Svc,58.00
Chargemaster Item,,89893319,SPSI,RSV RNA Qual PCR,,Per Svc,79.13
Chargemaster Item,,89893626,SPSI,Methaqualone GCMS Urine,,Per Svc,42.85
Chargemaster Item,,89893735,SPSI,NMDA Receptor Antibody (BLD),,Per Svc,500.00
Chargemaster Item,,89893844,SPSI,NMDA Receptor Antibody (CSF),,Per Svc,500.00
Chargemaster Item,,89893861,SPSI,NMDAR1 AB CBA,,Per Svc,145.83
Chargemaster Item,,89893879,SPSI,AMPAR1 AB CBA,,Per Svc,145.83
Chargemaster Item,,89893887,SPSI,AMPAR2 AB CBA,,Per Svc,145.83
Chargemaster Item,,89893895,SPSI,GABABR AB CBA,,Per Svc,145.83
Chargemaster Item,,89893903,SPSI,LGI 1 AB CBA,,Per Svc,145.83
Chargemaster Item,,89893911,SPSI,Gamma Hydroxybutyric Acid,,Per Svc,495.00
Chargemaster Item,,89893929,SPSI,Drug Abuse Screen 7,,Per Svc,56.94
Chargemaster Item,,89893937,SPSI,Cardio Iq 9P21 Genotype,,Per Svc,335.24
Chargemaster Item,,89893945,SPSI,Glutathione Total,,Per Svc,61.00
Chargemaster Item,,89893952,SPSI,IBS Detex,,Per Svc,170.00
Chargemaster Item,,89893960,SPSI,Paraneoplastic Ab Eval W/Ref,,Per Svc,896.20
Chargemaster Item,,89893978,SPSI,Aquaporin 4 Ab Igg,,Per Svc,528.00
Chargemaster Item,,89893986,SPSI,NMDA Receptor Ab (Csf),,Per Svc,500.00
Chargemaster Item,,89893994,SPSI,NMDA Receptor Ab (Bld),,Per Svc,500.00
Chargemaster Item,,89894018,SPSI,Muscle Fibers Fecal,,Per Svc,79.03
Chargemaster Item,,89894026,SPSI,Methqualone Bt Gcms (Ur),,Per Svc,42.85
Chargemaster Item,,89894034,SPSI,TPMT Activity,,Per Svc,275.00
Chargemaster Item,,89894216,SPSI,CASPR2 AB CBA,,Per Svc,145.83
Chargemaster Item,,89894224,SPSI,Chlorpromazine,,Per Svc,80.00
Chargemaster Item,,89899512,SPSI,Urine Comprehensive Drug Sceen,,Per Svc,75.00
Chargemaster Item,,89899520,SPSI,Caffeine (Quest),,Per Svc,19.30
Chargemaster Item,,89899534,SPSI,Interleukin-1 Beta,,Per Svc,193.00
Chargemaster Item,,89899546,SPSI,Adiponectin,,Per Svc,172.25
Chargemaster Item,,89899554,SPSI,Chromatin Necleosomal AB,,Per Svc,19.30
Chargemaster Item,,89899561,SPSI,Mumps Virus DNA Qual RT PCR,,Per Svc,130.28
Chargemaster Item,,89899579,SPSI,Respiratory Virus Screen,,Per Svc,31.36
Chargemaster Item,,89899587,SPSI,Theophylline (Quest),,Per Svc,13.58
Chargemaster Item,,89899595,SPSI,Fragile X DNA W/Chromosome Bld,,Per Svc,100.00
Chargemaster Item,,89899611,SPSI,Voltage Gated Calcium N AB,,Per Svc,73.88
Chargemaster Item,,89899629,SPSI,Lysomal Acid Lipase Act,,Per Svc,0.01
Chargemaster Item,,89899637,SPSI,Qnatal Advanced,,Per Svc,650.00
Chargemaster Item,,89899645,SPSI,Desmoglein Antibodies 1&3,,Per Svc,62.73
Chargemaster Item,,89899652,SPSI,Vascular Endothelial GR Elisa,,Per Svc,162.84
Chargemaster Item,,89899660,SPSI,Levetiracetam,,Per Svc,14.72
Chargemaster Item,,89899926,SPSI,Lupus Panel 2,,Per Svc,8.49
Chargemaster Item,,89899934,SPSI,Scleroderma Antibodies SCL 70,,Per Svc,8.46
Chargemaster Item,,89899942,SPSI,Sjogren's Antibodies SSA SSB,,Per Svc,8.46
Chargemaster Item,,89899959,SPSI,Sm and Sm/RNP Antibodies,,Per Svc,8.18
Chargemaster Item,,89899967,SPSI,Ribonuclear Antibody,,Per Svc,8.18
Chargemaster Item,,89899975,SPSI,Varicella ZOS Virus Rapid Cult,,Per Svc,33.78
Chargemaster Item,,89899983,SPSI,TSH Receptor Binding Antibody,,Per Svc,19.30
Chargemaster Item,,89899991,SPSI,Lyme Dis DNA Qual Rt PCR Fluid,,Per Svc,130.28
Chargemaster Item,,89900013,SPSI,Eta Protein 14.3.3,,Per Svc,104.22
Chargemaster Item,,89990022,SPSI,Tramadol And Metabolite Ur,,Per Svc,161.16
Chargemaster Item,,89990030,SPSI,Chromatin Ab,,Per Svc,19.30
Chargemaster Item,,89990048,SPSI,Prometheus Tpmt Genetics,,Per Svc,395.00
Chargemaster Item,,89990055,SPSI,Helicobacter Pylori,,Per Svc,27.78
Chargemaster Item,,89990066,SPSI,Voltage Gated Potassium,,Per Svc,73.88
Chargemaster Item,,89990220,SPSI,Codfish IGE,,Per Svc,5.50
Chargemaster Item,,89990238,SPSI,Crab IGE,,Per Svc,5.50
Chargemaster Item,,89990246,SPSI,Halibut IGE,,Per Svc,5.50
Chargemaster Item,,89990253,SPSI,Lobster IGE,,Per Svc,5.50
Chargemaster Item,,89990261,SPSI,Salmon IGE,,Per Svc,5.50
Chargemaster Item,,89990279,SPSI,Shrimp IGE,,Per Svc,5.50
Chargemaster Item,,89990287,SPSI,Tuna IGE,,Per Svc,6.06
Chargemaster Item,,89990295,SPSI,Copeptin,,Per Svc,151.46
Chargemaster Item,,89990303,SPSI,Trichomonas Sure Swab,,Per Svc,108.88
Chargemaster Item,,89990311,SPSI,Vedolizumab Qtabs,,Per Svc,290.80
Chargemaster Item,,89990321,SPSI,Syn Glucocorticoid Screen,,Per Svc,169.60
Chargemaster Item,,89990337,SPSI,Viracor IBT,,Per Svc,98.00
Chargemaster Item,,89990402,SPSI,Prothrombin 1.2,,Per Svc,67.55
Chargemaster Item,,89990501,SPSI,PSA Prostatectomy,,Per Svc,19.30
Chargemaster Item,,89990600,SPSI,Cryoglobulin Qualitative,,Per Svc,17.00
Chargemaster Item,,89990709,SPSI,Estrone Sulfate,,Per Svc,154.59
Chargemaster Item,,89990808,SPSI,RSV PCR Panel I,,Per Svc,329.55
Chargemaster Item,,89999015,SPSI,Zinc Transporter 8 AB,,Per Svc,64.92
Chargemaster Item,,89999023,SPSI,Albumin CSF,,Per Svc,6.76
Chargemaster Item,,89999049,SPSI,Almond IGE,,Per Svc,5.50
Chargemaster Item,,89999056,SPSI,Brazil Nut IGE,,Per Svc,5.50
Chargemaster Item,,89999064,SPSI,Cashew Nut IGE,,Per Svc,5.50
Chargemaster Item,,89999072,SPSI,Coconut IGE,,Per Svc,5.50
Chargemaster Item,,89999080,SPSI,Hazelnut IGE,,Per Svc,5.50
Chargemaster Item,,89999098,SPSI,Pecan Nut IGE,,Per Svc,5.50
Chargemaster Item,,89999106,SPSI,Walnut IGE,,Per Svc,6.04
Chargemaster Item,,89999122,SPSI,Prader Willi/Angelman Syndrome,,Per Svc,343.06
Chargemaster Item,,89999131,SPSI,Prader Willi Syndrome By Fish,,Per Svc,121.25
Chargemaster Item,,89999145,SPSI,Chromosome Specific,,Per Svc,120.00
Chargemaster Item,,89999155,SPSI,Opiates Confirmation,,Per Svc,112.47
Chargemaster Item,,89999163,SPSI,Definitive Drugs,,Per Svc,112.47
Chargemaster Item,,89999171,SPSI,Opiates Serum,,Per Svc,26.20
Chargemaster Item,,89999189,SPSI,Drug Abuse Screen 9 W/Conf,,Per Svc,33.78
Chargemaster Item,,89999197,SPSI,HLA B15:02 Scr W/Ref High Res,,Per Svc,125.00
Chargemaster Item,,89999205,SPSI,HLA B High Resolution Reflex,,Per Svc,140.00
Chargemaster Item,,89999213,SPSI,Sureswab Mycoplasma/Urea PCR,,Per Svc,82.89
Chargemaster Item,,89999221,SPSI,Infectious Agent Disease,,Per Svc,80.00
Chargemaster Item,,89999239,SPSI,Prostatic Acid Phosphatase,,Per Svc,9.41
Chargemaster Item,,89999247,SPSI,Collagen Type I C-Telopeptide,,Per Svc,28.98
Chargemaster Item,,89999254,SPSI,Ganglioside Gq1B AB,,Per Svc,72.38
Chargemaster Item,,89999262,SPSI,He4 Ovarian Cancer Monitoring,,Per Svc,96.50
Chargemaster Item,,89999270,SPSI,Wheat IGG,,Per Svc,10.60
Chargemaster Item,,89999288,SPSI,Ca 19-9 Peritoneal Fluid,,Per Svc,34.66
Chargemaster Item,,89999296,SPSI,Echinococcus AB IGG WB,,Per Svc,163.20
Chargemaster Item,,89999304,SPSI,DRVVT Confirm,,Per Svc,40.05
Chargemaster Item,,89999312,SPSI,DRVVT 1:1 Mix,,Per Svc,28.95
Chargemaster Item,,89999320,SPSI,Fragile X Methylation Analysis,,Per Svc,25.65
Chargemaster Item,,89999338,SPSI,Neurology AB_CBA_IFA,,Per Svc,146.00
Chargemaster Item,,89999346,SPSI,Antobody Receptor Type,,Per Svc,145.80
Chargemaster Item,,89999353,SPSI,Antibody N Methyl D Asparate,,Per Svc,145.80
Chargemaster Item,,89999361,SPSI,Antibody Contactin Assoc Pro,,Per Svc,145.80
Chargemaster Item,,89999379,SPSI,Antibody Gamma Aminobutyric,,Per Svc,145.80
Chargemaster Item,,89999387,SPSI,Glutamate Receptor Type,,Per Svc,145.80
Chargemaster Item,,89999395,SPSI,Thyroid Cancer Thyro Mon.,,Per Svc,21.41
Chargemaster Item,,89999403,SPSI,Thyroglobulin Lc/Ms/Ms,,Per Svc,8.89
Chargemaster Item,,89999411,SPSI,Thyroglobulin Reflex,,Per Svc,33.59
Chargemaster Item,,89999429,SPSI,Thyroglobulin Lcmsms Reflex,,Per Svc,160.00
Chargemaster Item,,89999437,SPSI,Bordetella Pert Toxin Ab Igg,,Per Svc,28.14
Chargemaster Item,,89999445,SPSI,Milk Cow IGG 4,,Per Svc,15.51
Chargemaster Item,,89999452,SPSI,Drug Mon. Alcohol Met UX,,Per Svc,38.60
Chargemaster Item,,89999460,SPSI,Definitive-Drugs,,Per Svc,25.50
Chargemaster Item,,89999478,SPSI,Definitive_Drugs,,Per Svc,25.50
Chargemaster Item,,89999486,SPSI,Allergen Tilapia IGE,,Per Svc,39.51
Chargemaster Item,,89999494,SPSI,Allergen Halibut IGG,,Per Svc,37.04
Chargemaster Item,,89999502,SPSI,Tomato IGG,,Per Svc,37.04
Chargemaster Item,,89999510,SPSI,Tuna IGG,,Per Svc,35.74
Chargemaster Item,,89999528,SPSI,Human Platelet Antigen 1 Geno,,Per Svc,123.04
Chargemaster Item,,89999536,SPSI,Procollagen Type I N Term,,Per Svc,77.20
Chargemaster Item,,89999544,SPSI,C Kit Mutation Analysis,,Per Svc,334.66
Chargemaster Item,,89999551,SPSI,JC Polyoma Virus Qnt Dna Rt PCR,,Per Svc,265.38
Chargemaster Item,,89999569,SPSI,Thyroglobulin Quant W/Out AB,,Per Svc,27.99
Chargemaster Item,,89999585,SPSI,Lactate Dehydrogenase CSF,,Per Svc,13.51
Chargemaster Item,,89999593,SPSI,Gadolinium 24Hr Urine,,Per Svc,121.59
Chargemaster Item,,89999601,SPSI,Rapid Respiratory Virus Reflex,,Per Svc,32.30
Chargemaster Item,,89999619,SPSI,Virus Indentified,,Per Svc,30.00
Chargemaster Item,,89999627,SPSI,SARS COVID19 Antibody IGG Quest,,Per Svc,65.00
Chargemaster Item,,89999635,SPSI,SMA Carrier Scrn,,Per Svc,607.95
Chargemaster Item,,89999643,SPSI,Saccharomyces AB IGA,,Per Svc,51.30
Chargemaster Item,,89999650,SPSI,Histamine Plasma,,Per Svc,64.17
Chargemaster Item,,89999668,SPSI,Fluconazole,,Per Svc,55.64
Chargemaster Item,,89999675,SPSI,Thiopurine Metabolites,,Per Svc,88.59
Chargemaster Item,,89999684,SPSI,Anaplasma PHAG AB IGG IGM,,Per Svc,31.36
Chargemaster Item,,89999701,SPSI,Amphiphysin AB,,Per Svc,696.25
Chargemaster Item,,89999718,SPSI,GAD65 Antibody,,Per Svc,696.25
Chargemaster Item,,89999726,SPSI,MATA AutoAntibody,,Per Svc,696.25
Chargemaster Item,,89999738,SPSI,CV2 Antibody,,Per Svc,696.25
Chargemaster Item,,89999742,SPSI,HU AutoAntibody,,Per Svc,696.25
Chargemaster Item,,89999756,SPSI,RI AutoAntibody,,Per Svc,696.25
Chargemaster Item,,89999767,SPSI,YO AutoAntibody,,Per Svc,696.25
Chargemaster Item,,89999770,SPSI,ZIC4 Antibody,,Per Svc,696.25
Chargemaster Item,,89999783,SPSI,Ibuprofen,,Per Svc,26.06
Chargemaster Item,,89999791,SPSI,Cardio IQ Direct LDL,,Per Svc,13.51
Chargemaster Item,,89999809,SPSI,Oxalate Acid,,Per Svc,82.00
Chargemaster Item,,9000001,SPSI,Observation Service Per Hour,,First 89 Minutes,331.00
Chargemaster Item,,9005000,SPSI,Med Surg 3 Unit,,Per Svc,7950.00
Chargemaster Item,,90882309,SPSI,Chromosome Analysis Routine Banding,,Per Svc,435.00
Chargemaster Item,,90882317,SPSI,Chromosome Analysis High Resolution Genesis,,Per Svc,535.00
Chargemaster Item,,90882333,SPSI,Chromosome Analysis Solid Tissue Genesis,,Per Svc,560.00
Chargemaster Item,,90882382,SPSI,Chromosome Analysis Blood Leukemic,,Per Svc,680.00
Chargemaster Item,,90882754,SPSI,Chromosome Analysis Fish Aneu Vyson,,Per Svc,460.00
Chargemaster Item,,90882762,SPSI,Chromosome Analysis Fish Single Probe,,Per Svc,310.00
Chargemaster Item,,91000059,SPSI,Cryptosporidiu/Giardia Dir Dfa,,Per Svc,92.25
Chargemaster Item,,91000109,SPSI,Toxoplasma Gondii DNA Quant PC,,Per Svc,120.63
Chargemaster Item,,91000117,SPSI,Cryptosporidium Ag,,Per Svc,65.25
Chargemaster Item,,91000125,SPSI,Isospora Detection, Fm,,Per Svc,84.75
Chargemaster Item,,91000158,SPSI,Respitratory Vir PCR W/h1n1,,Per Svc,894.00
Chargemaster Item,,91000166,SPSI,Cryofibrinogen,,Per Svc,17.99
Chargemaster Item,,91000174,SPSI,Coxiella Burnetii DNA PCR Qual,,Per Svc,223.50
Chargemaster Item,,91671107,SPSI,Streptococcus Group B Ag Lat,,Per Svc,63.75
Chargemaster Item,,91671156,SPSI,Streptococcus MIC Panel,,Per Svc,61.50
Chargemaster Item,,91671164,SPSI,Steno Maltophilia MIC Panel,,Per Svc,201.75
Chargemaster Item,,91671172,SPSI,Mycobacterium Slow Grower Panel,,Per Svc,117.00
Chargemaster Item,,91671180,SPSI,Susc Fungal, 4 Drug Panel,,Per Svc,462.00
Chargemaster Item,,91671198,SPSI,Varicella Zoster Direct Detection by DFA,,Per Svc,84.75
Chargemaster Item,,91671206,SPSI,Culture Respiratory Virus Rapid,,Per Svc,199.50
Chargemaster Item,,91671214,SPSI,CSF T_Pallidum Antibody by IFA,,Per Svc,58.50
Chargemaster Item,,91671222,SPSI,Gram Neg Bacilli Susc Panel,,Per Svc,63.00
Chargemaster Item,,91671230,SPSI,Strep Pneumo_MIC Panel,,Per Svc,126.00
Chargemaster Item,,91671248,SPSI,Mic Susc.Neisseria Gonorrhoeae,,Per Svc,166.50
Chargemaster Item,,91671255,SPSI,Fastidious GNB MIC Panel,,Per Svc,171.75
Chargemaster Item,,91671263,SPSI,Influenza A B RNA PCR,,Per Svc,223.50
Chargemaster Item,,91671271,SPSI,CSF Toxoplasma Gondii at Focus,,Per Svc,53.00
Chargemaster Item,,91671289,SPSI,Afb Id,Tch Susceptibility,,Per Svc,92.00
Chargemaster Item,,91671297,SPSI,C Difficile Toxin B Cell Culture,,Per Svc,67.50
Chargemaster Item,,91671313,SPSI,Norovirus RNA by RT PCR,,Per Svc,223.50
Chargemaster Item,,91671339,SPSI,AFB ID MTB/MAC DNA Probe,,Per Svc,66.75
Chargemaster Item,,91676148,SPSI,Itraconazole,,Per Svc,78.50
Chargemaster Item,,91676155,SPSI,Rotavirus Antigen by EIA,,Per Svc,68.25
Chargemaster Item,,91676163,SPSI,Fungal Smear and India Ink Prep,,Per Svc,39.75
Chargemaster Item,,91676213,SPSI,Respiratory Virus PCR Panel I,,Per Svc,329.55
Chargemaster Item,,91835223,SPSI,Legionella Urinary Ag_Focus,,Per Svc,51.50
Chargemaster Item,,91860122,SPSI,N. Meningitidis Sero. Sa,,Per Svc,80.25
Chargemaster Item,,91860130,SPSI,Yeast MIC 8 Panel,,Per Svc,528.00
Chargemaster Item,,91860148,SPSI,C_Difficile A_B Toxin_Focus,,Per Svc,67.50
Chargemaster Item,,91864033,SPSI,S Pneumococcus Antigen Detection,,Per Svc,43.00
Chargemaster Item,,91866905,SPSI,Neiss. Meningitidis Sero.Sa,,Per Svc,80.25
Chargemaster Item,,91866954,SPSI,Meningoencephalitis Panel,,Per Svc,512.00
Chargemaster Item,,91867234,SPSI,CSF Listeria Antibodies,,Per Svc,91.50
Chargemaster Item,,91867507,SPSI,Malaria Antibodies IgG by IFA,,Per Svc,108.75
Chargemaster Item,,91870709,SPSI,Aerobic Culture_Special,,Per Svc,104.25
Chargemaster Item,,91870717,SPSI,Pertuss/Para Pertus C,,Per Svc,88.00
Chargemaster Item,,91870725,SPSI,Staphylococcus_MIC Panel,,Per Svc,60.54
Chargemaster Item,,91870766,SPSI,Anaerobic Id,,Per Svc,63.44
Chargemaster Item,,91870816,SPSI,Culture Trichomonas,,Per Svc,43.68
Chargemaster Item,,91871038,SPSI,Fungus Blood Culture,,Per Svc,28.08
Chargemaster Item,,91871061,SPSI,B_Pertussis_Parapertussis Culture,,Per Svc,47.25
Chargemaster Item,,91871079,SPSI,Fungus Culture_Focus,,Per Svc,41.00
Chargemaster Item,,91871095,SPSI,Culture Mycoplasma Pneumoniae,,Per Svc,80.25
Chargemaster Item,,91871103,SPSI,Mucoplasma Cult, Genital,,Per Svc,85.50
Chargemaster Item,,91871129,SPSI,Culture Mycoplasma Fastidious Pathogen,,Per Svc,198.00
Chargemaster Item,,91871145,SPSI,Culture Chlamydia Trachomatis and Psittaci,,Per Svc,35.00
Chargemaster Item,,91871186,SPSI,Conventional Afb Id,,Per Svc,45.00
Chargemaster Item,,91871194,SPSI,Hplc-Fl Afb Id,,Per Svc,79.50
Chargemaster Item,,91871392,SPSI,B Pertussis and Parapertussis by DFA,,Per Svc,96.35
Chargemaster Item,,91871400,SPSI,Culture B Pertussis and DFA,,Per Svc,41.60
Chargemaster Item,,91871475,SPSI,Haemophilus Typing,,Per Svc,63.00
Chargemaster Item,,91871632,SPSI,Culture Herpes Simplex Virus Rapid 48 HR,,Per Svc,33.84
Chargemaster Item,,91871640,SPSI,Chlamydia Pneumoniae Culture,,Per Svc,108.50
Chargemaster Item,,91871665,SPSI,Bacterial Id,Aerobic,,Per Svc,50.00
Chargemaster Item,,91871731,SPSI,C_Difficile Toxin And Culture,,Per Svc,93.65
Chargemaster Item,,91871772,SPSI,Microsporidia Detection by LM,,Per Svc,76.50
Chargemaster Item,,91871798,SPSI,M Tuberculosis by PCR,,Per Svc,100.00
Chargemaster Item,,91871814,SPSI,Vancomycin Etest,,Per Svc,21.00
Chargemaster Item,,91871848,SPSI,Esbl Confirmation,,Per Svc,67.50
Chargemaster Item,,91871855,SPSI,Mic Single Antibiotic,,Per Svc,56.16
Chargemaster Item,,91871863,SPSI,Mic-Mbc Per Drug,,Per Svc,274.50
Chargemaster Item,,91871871,SPSI,Amphotericib B Susceptibility,,Per Svc,47.00
Chargemaster Item,,91871913,SPSI,Primary Susc Panel Afb,,Per Svc,35.00
Chargemaster Item,,91871921,SPSI,Susc Fungal, Per Drug,,Per Svc,41.60
Chargemaster Item,,91871939,SPSI,Afb Secondary Panel,,Per Svc,114.00
Chargemaster Item,,91871947,SPSI,MAIC 8 Drug Panel,,Per Svc,55.59
Chargemaster Item,,91871954,SPSI,Rapid Grower Panel Afb,,Per Svc,88.92
Chargemaster Item,,91871962,SPSI,Afb Primary Panel,,Per Svc,108.00
Chargemaster Item,,91871970,SPSI,Anaerobic Susceptibility,,Per Svc,79.50
Chargemaster Item,,91872028,SPSI,ADB Single Drug MIC,,Per Svc,87.00
Chargemaster Item,,91872044,SPSI,Nocardia_Actino_MIC Panel,,Per Svc,113.25
Chargemaster Item,,91872051,SPSI,Mic 2 Antibiotics,,Per Svc,111.00
Chargemaster Item,,91872077,SPSI,Cyclospora Detection by FM,,Per Svc,80.25
Chargemaster Item,,91872085,SPSI,AFB Smear_ Culture,,Per Svc,45.00
Chargemaster Item,,91872093,SPSI,Pneumocystis by DFA,,Per Svc,48.00
Chargemaster Item,,91872119,SPSI,AFB Smear Direct,,Per Svc,37.00
Chargemaster Item,,91872127,SPSI,Haemophilus MIC Panel,,Per Svc,60.06
Chargemaster Item,,91872135,SPSI,Antimicrobial Susc, Fas Strep,,Per Svc,148.50
Chargemaster Item,,91872168,SPSI,Antimicrobal Susc, Anaerobic,,Per Svc,79.50
Chargemaster Item,,91872176,SPSI,Gram Pos Rod, Mic Panel,,Per Svc,57.75
Chargemaster Item,,91872184,SPSI,Fungal India Ink Focus,,Per Svc,38.25
Chargemaster Item,,91872200,SPSI,Fungal Smear Koh Prep, Lm,,Per Svc,29.25
Chargemaster Item,,91872218,SPSI,Antimicrob Susc, Neiss,,Per Svc,148.50
Chargemaster Item,,91872226,SPSI,Antimicrobial Susc High Level,,Per Svc,82.00
Chargemaster Item,,91872234,SPSI,Gram Pos Bacilli Susc Panel,,Per Svc,64.30
Chargemaster Item,,91872242,SPSI,Enterococcus_MIC Panel,,Per Svc,150.00
Chargemaster Item,,91872259,SPSI,Antimicrob Susc, Afb 5 Drug,,Per Svc,303.00
Chargemaster Item,,91872267,SPSI,Antifungal Mic 7 Drugs,,Per Svc,448.50
Chargemaster Item,,91872440,SPSI,Antifungal Mic Panel,,Per Svc,285.48
Chargemaster Item,,91872507,SPSI,Culture Virus,,Per Svc,81.00
Chargemaster Item,,91872515,SPSI,Culture Enterovirus Rapid,,Per Svc,199.50
Chargemaster Item,,91872556,SPSI,Culture Varicella Zoster Rapid,,Per Svc,81.75
Chargemaster Item,,91872705,SPSI,Chlamydia Trachomatis by DFA,,Per Svc,63.00
Chargemaster Item,,91872770,SPSI,Influenza A_B_DFA_Focus,,Per Svc,80.25
Chargemaster Item,,91873018,SPSI,Stool Adenovirus Ag Detection EIA,,Per Svc,21.71
Chargemaster Item,,91874271,SPSI,E.Coli, Enterohemorrhagic,,Per Svc,96.00
Chargemaster Item,,91874495,SPSI,Helicobacter Pylori Ag EIA,,Per Svc,59.00
Chargemaster Item,,91874867,SPSI,C Pneumoniae DNA PCR,,Per Svc,223.50
Chargemaster Item,,91875005,SPSI,Norovirus by EIA,,Per Svc,70.50
Chargemaster Item,,91875013,SPSI,Parainfluenza Virus Direct by DFA,,Per Svc,108.75
Chargemaster Item,,91875294,SPSI,HSV 1 and 2 PCR_Focus,,Per Svc,160.00
Chargemaster Item,,91875419,SPSI,Legionella DNA by PCR Focus,,Per Svc,223.50
Chargemaster Item,,91875500,SPSI,Afb Gene Probe Mtb/Mai,,Per Svc,66.75
Chargemaster Item,,91875559,SPSI,Mtub, Maic Gene Probe,,Per Svc,28.80
Chargemaster Item,,91877977,SPSI,Gene Probe, Afb,,Per Svc,29.20
Chargemaster Item,,91877993,SPSI,B Pertussis and Parapertussis by PCR,,Per Svc,223.50
Chargemaster Item,,91878058,SPSI,Sars Coronavirus Rna, Rt-Pcr,,Per Svc,298.00
Chargemaster Item,,91878066,SPSI,Ehrlichia Chaffeensis DNA by PCR,,Per Svc,298.00
Chargemaster Item,,91878074,SPSI,Histoplasma Capsulatum by PCR,,Per Svc,223.50
Chargemaster Item,,91878991,SPSI,Cryptococcal Ag-Csf,,Per Svc,20.00
Chargemaster Item,,91879007,SPSI,Cryptococcus Ag, Serum,,Per Svc,20.80
Chargemaster Item,,91879924,SPSI,Cryptospora And Isospora Detection,,Per Svc,44.72
Chargemaster Item,,91879940,SPSI,Culture Cytomegalovirus Rapid,,Per Svc,40.00
Chargemaster Item,,91879999,SPSI,Legionella DFA And Culture,,Per Svc,108.75
Chargemaster Item,,91881789,SPSI,Helicobacter Pylori Culture,,Per Svc,159.00
Chargemaster Item,,91881847,SPSI,Adenovirus DNA Qualitative by PCR,,Per Svc,223.50
Chargemaster Item,,91881854,SPSI,Step. Pneumoniae Serotyping,,Per Svc,114.00
Chargemaster Item,,91883454,SPSI,Mycoplasma Pneumoniae_DNA_PCR Test,,Per Svc,135.00
Chargemaster Item,,91883462,SPSI,Legionella Pneumophila_DFA,,Per Svc,69.75
Chargemaster Item,,91888883,SPSI,Cryptococcus Ag Detection_LA,,Per Svc,27.00
Chargemaster Item,,91950014,SPSI,Yeast Identification,,Per Svc,24.61
Chargemaster Item,,92100072,SPSI,Kleihauer Betke,,Per Svc,85.50
Chargemaster Item,,92200328,SPSI,Gen Fish,2 Probes,2 Hypbid Ana,,Per Svc,300.00
Chargemaster Item,,92200336,SPSI,EWSR1 (Ewings Sarcoma),,Per Svc,250.00
Chargemaster Item,,92200435,SPSI,Microdisection,Manual,,Per Svc,275.00
Chargemaster Item,,92210079,SPSI,HER2 (IHC),,Per Svc,100.00
Chargemaster Item,,92210087,SPSI,Gen ISH-Tech Component,,Per Svc,180.00
Chargemaster Item,,92300094,SPSI,Flow Cytometry_Bone Marrow,,Per Svc,395.00
Chargemaster Item,,92300243,SPSI,Chromosone Analysis (Gen),,Per Svc,400.00
Chargemaster Item,,92300268,SPSI,HER 2 Neu Fish (Gen),,Per Svc,400.00
Chargemaster Item,,92400134,SPSI,Flow Cyt Cell Surf 1St Marker,,Per Svc,62.00
Chargemaster Item,,92400142,SPSI,Flow Cyt Cell Ea Addl Marker,,Per Svc,12.00
Chargemaster Item,,92400159,SPSI,Flow Cyt Interp 2-8 Markers,,Per Svc,55.82
Chargemaster Item,,92400183,SPSI,Immunohistochem Stain,,Per Svc,45.00
Chargemaster Item,,92400191,SPSI,In Situ Hydridiztion (M),,Per Svc,175.00
Chargemaster Item,,92400209,SPSI,Centromere E. Probe (M),,Per Svc,175.00
Chargemaster Item,,92400217,SPSI,In Situ Hydridization (C),,Per Svc,175.00
Chargemaster Item,,92400225,SPSI,Centromere E. Probe (C),,Per Svc,175.00
Chargemaster Item,,92400233,SPSI,Tiss Cult Neo Disorder Bm Bld,,Per Svc,176.47
Chargemaster Item,,92400241,SPSI,Chromosone Anlys Analyze 20-25,,Per Svc,174.14
Chargemaster Item,,92400258,SPSI,Chromosone Anlys Add Kryo,Ea,,Per Svc,35.07
Chargemaster Item,,92400274,SPSI,Chr Anlys,15-20Cell Kryotp Wb,,Per Svc,174.14
Chargemaster Item,,92400282,SPSI,Chr Anlys,5Cells 1Kryo Wb,,Per Svc,246.93
Chargemaster Item,,92400290,SPSI,Chr Anlys,Add Cells Ea Study,,Per Svc,26.54
Chargemaster Item,,92400308,SPSI,Special Stains Group 1,,Per Svc,72.37
Chargemaster Item,,92400316,SPSI,Special Stains Group Ii,,Per Svc,60.65
Chargemaster Item,,92400324,SPSI,Kras By PCR,,Per Svc,327.16
Chargemaster Item,,92400332,SPSI,Braf,,Per Svc,78.16
Chargemaster Item,,92400340,SPSI,EGFR Mutation By PCR,,Per Svc,443.00
Chargemaster Item,,92400357,SPSI,EGFR VIII By PCR,,Per Svc,85.38
Chargemaster Item,,92400365,SPSI,MSI PCR (Tumor & Normal),,Per Svc,275.52
Chargemaster Item,,92400373,SPSI,Her2 By Pcr,,Per Svc,111.32
Chargemaster Item,,92400381,SPSI,Pi3k By PCR,,Per Svc,359.92
Chargemaster Item,,92400399,SPSI,B-Cell Clonality HC IGH,,Per Svc,137.76
Chargemaster Item,,92400407,SPSI,T-Cell Clonality Beta By PCR,,Per Svc,568.52
Chargemaster Item,,92400415,SPSI,T-Cell Clonality Gamma By PCR,,Per Svc,137.76
Chargemaster Item,,92400423,SPSI,BCR/ABL Major By PCR Qt,,Per Svc,95.72
Chargemaster Item,,92400431,SPSI,BCR/ABL Minor By PCR,,Per Svc,95.72
Chargemaster Item,,92400449,SPSI,Jak2 PCR,,Per Svc,78.16
Chargemaster Item,,92400456,SPSI,PML/Raralpha Rt-PCR,,Per Svc,88.50
Chargemaster Item,,92400472,SPSI,NRAS Mutations Analysis Ex 2&3,,Per Svc,340.00
Chargemaster Item,,92400480,SPSI,Clarient Consult,,Per Svc,73.34
Chargemaster Item,,92400498,SPSI,Clarient Consult TC,,Per Svc,56.86
Chargemaster Item,,92400514,SPSI,Immunohisto Antibody Slide,,Per Svc,45.00
Chargemaster Item,,92400522,SPSI,Immunofluorescent TC,,Per Svc,58.80
Chargemaster Item,,92400530,SPSI,Fish Auto Global Multiplex,,Per Svc,461.04
Chargemaster Item,,92400548,SPSI,Tiss Culture Bone Marrow/Blood,,Per Svc,195.00
Chargemaster Item,,92400555,SPSI,Androgen Recepter Mutation Ana,,Per Svc,320.00
Chargemaster Item,,92400563,SPSI,Tissue Stain,,Per Svc,56.00
Chargemaster Item,,92400571,SPSI,Prostate Triple Stain,,Per Svc,135.00
Chargemaster Item,,92410000,SPSI,Morphometric Scope Ia Ihc Man,,Per Svc,45.00
Chargemaster Item,,92410018,SPSI,Morphometric Scope Ia Ihc Ca,,Per Svc,45.00
Chargemaster Item,,92410026,SPSI,Ihc Immunoperoxidase Qual,,Per Svc,45.00
Chargemaster Item,,92443001,SPSI,Neotype Lung Tumor Profile,,Per Svc,1249.00
Chargemaster Item,,92443019,SPSI,Fish Manual Global Multiplex,,Per Svc,401.84
Chargemaster Item,,92443027,SPSI,Ntrk Ngs Fusion Profile,,Per Svc,800.00
Chargemaster Item,,92443035,SPSI,Neotype Gastric Profile,,Per Svc,1340.00
Chargemaster Item,,92443043,SPSI,Neotype Mds/Cmml Profile,,Per Svc,2400.00
Chargemaster Item,,92443050,SPSI,Lung Fish Manual Pc Multi,,Per Svc,111.24
Chargemaster Item,,92443068,SPSI,Fish Manual Tc Multiplex,,Per Svc,290.60
Chargemaster Item,,92443076,SPSI,Neotype Next Gen Disc. Lung,,Per Svc,5000.00
Chargemaster Item,,92443084,SPSI,Bcr-Abl1 Standard Maj/Min,,Per Svc,450.00
Chargemaster Item,,92488147,SPSI,Pap Smear Thin Prep (Cdc),,Per Svc,21.00
Chargemaster Item,,92488154,SPSI,Pap Smear, Gyn (Cdc),,Per Svc,13.00
Chargemaster Item,,92591026,SPSI,Level IV Surg Path Gross Micro,,Per Svc,80.00
Chargemaster Item,,92591038,SPSI,Group II Other Stains,,Per Svc,83.09
Chargemaster Item,,92591046,SPSI,Immunofluorescent Study,,Per Svc,111.83
Chargemaster Item,,92591053,SPSI,Electron Microscopy,,Per Svc,412.58
Chargemaster Item,,92591061,SPSI,Immunofluorescent Study Addl,,Per Svc,86.77
Chargemaster Item,,92591087,SPSI,Level III Surg Path Gross Micro,,Per Svc,39.97
Chargemaster Item,,92840313,SPSI,Newborn Screen,,Per Svc,176.25
Chargemaster Item,,92840321,SPSI,Newborn Screening,,Per Svc,176.25
Chargemaster Item,,93150001,SPSI,Eklund Screening Combo w/CAD,,Per Svc,809.00
Chargemaster Item,,93150019,SPSI,Digital Screen Mam Comb w/ CAD,,Per Svc,809.00
Chargemaster Item,,93150035,SPSI,Low Cost Screen Mam Comb w/ Cad,,Per Svc,75.00
Chargemaster Item,,93150043,SPSI,Screening Tomosynthesis,,Per Svc,178.00
Chargemaster Item,,93251007,SPSI,Eye Foreign Body,,Per Svc,799.00
Chargemaster Item,,93251015,SPSI,Mandible Limited,,Per Svc,1361.00
Chargemaster Item,,93251023,SPSI,Mandible Complete,,Per Svc,1361.00
Chargemaster Item,,93251031,SPSI,Mastoids Limited,,Per Svc,626.00
Chargemaster Item,,93251049,SPSI,Mastoids Complete,,Per Svc,868.00
Chargemaster Item,,93251056,SPSI,Lim Facial Bones,,Per Svc,1016.00
Chargemaster Item,,93251064,SPSI,Facial Bones,,Per Svc,1221.00
Chargemaster Item,,93251072,SPSI,Nasal Bones,,Per Svc,941.00
Chargemaster Item,,93251080,SPSI,Optic Foramina,,Per Svc,773.00
Chargemaster Item,,93251098,SPSI,Sinuses Limited,,Per Svc,966.00
Chargemaster Item,,93251106,SPSI,Sinuses Complete,,Per Svc,1399.00
Chargemaster Item,,93251114,SPSI,Sella Turcica,,Per Svc,701.00
Chargemaster Item,,93251122,SPSI,Skull 4 Views,,Per Svc,1554.00
Chargemaster Item,,93251130,SPSI,Skull 2 Views,,Per Svc,963.00
Chargemaster Item,,93251148,SPSI,Skull Complete,,Per Svc,1554.00
Chargemaster Item,,93251155,SPSI,Tm Joints Bilateral,,Per Svc,1617.00
Chargemaster Item,,93251163,SPSI,Neck Soft Tissue,,Per Svc,663.00
Chargemaster Item,,93251171,SPSI,Salivary Gland,,Per Svc,891.00
Chargemaster Item,,93251189,SPSI,Chest 1 View,,Per Svc,730.00
Chargemaster Item,,93251197,SPSI,Chest 2 View,,Per Svc,919.00
Chargemaster Item,,93251205,SPSI,Chest 3 Views,,Per Svc,1178.00
Chargemaster Item,,93251213,SPSI,Chest 4 Views,,Per Svc,1547.00
Chargemaster Item,,93251221,SPSI,Ribs W/ Pa Cxr Right,,Per Svc,1082.00
Chargemaster Item,,93251239,SPSI,Ribs W/ Pa Cxr Left,,Per Svc,1082.00
Chargemaster Item,,93251247,SPSI,Ribs Right,,Per Svc,949.00
Chargemaster Item,,93251254,SPSI,Ribs Left,,Per Svc,949.00
Chargemaster Item,,93251262,SPSI,Bilat Ribs,,Per Svc,1275.00
Chargemaster Item,,93251270,SPSI,Bilat Ribs W/ Pa Cxr,,Per Svc,1363.00
Chargemaster Item,,93251288,SPSI,Sternum,,Per Svc,779.00
Chargemaster Item,,93251296,SPSI,Sternoclavicular Joints,,Per Svc,803.00
Chargemaster Item,,93251304,SPSI,Spine 1 View,,Per Svc,752.00
Chargemaster Item,,93251312,SPSI,Cervical Spine 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,93251320,SPSI,Cervical Spine 4 or 5 Views,,Per Svc,1453.00
Chargemaster Item,,93251338,SPSI,Cerv Spine 6 Or More Views,,Per Svc,1865.00
Chargemaster Item,,93251346,SPSI,Thoracic Spine 4 Plus Views,,Per Svc,1414.00
Chargemaster Item,,93251353,SPSI,Thoracic Spine 2 Views,,Per Svc,1071.00
Chargemaster Item,,93251361,SPSI,Thoracolumbar min 2 Views,,Per Svc,944.00
Chargemaster Item,,93251379,SPSI,Lumbar Sp 2 Or 3 Views,,Per Svc,930.00
Chargemaster Item,,93251387,SPSI,Lumbar Spine 4 Views,,Per Svc,1112.00
Chargemaster Item,,93251395,SPSI,Ls Spine,,Per Svc,1112.00
Chargemaster Item,,93251403,SPSI,Ls Spine & Bending Views,,Per Svc,1979.00
Chargemaster Item,,93251411,SPSI,Ls Spine Only Bending Views,,Per Svc,1134.00
Chargemaster Item,,93251429,SPSI,Pelvis Ap,,Per Svc,941.00
Chargemaster Item,,93251437,SPSI,Pelvis 2 Views,,Per Svc,941.00
Chargemaster Item,,93251445,SPSI,Sacroiliac Joints,,Per Svc,843.00
Chargemaster Item,,93251452,SPSI,Sacrum & Coccyx,,Per Svc,794.00
Chargemaster Item,,93251460,SPSI,Metastatic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,93251478,SPSI,Metabolic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,93251486,SPSI,Clavicle Right,,Per Svc,710.00
Chargemaster Item,,93251494,SPSI,Clavicle Left,,Per Svc,710.00
Chargemaster Item,,93251502,SPSI,Scapula Right,,Per Svc,1030.00
Chargemaster Item,,93251510,SPSI,Scapula Left,,Per Svc,1030.00
Chargemaster Item,,93251528,SPSI,Shoulder 1 View Right,,Per Svc,869.00
Chargemaster Item,,93251536,SPSI,Shoulder 1 View Left,,Per Svc,869.00
Chargemaster Item,,93251544,SPSI,Shoulder 2 Views Right,,Per Svc,978.00
Chargemaster Item,,93251551,SPSI,Shoulder 2 Views Left,,Per Svc,978.00
Chargemaster Item,,93251569,SPSI,Acromioclavicular Joints,,Per Svc,903.00
Chargemaster Item,,93251577,SPSI,Humerus Right,,Per Svc,850.00
Chargemaster Item,,93251585,SPSI,Humerus Left,,Per Svc,850.00
Chargemaster Item,,93251593,SPSI,Elbow 2 Views Right,,Per Svc,886.00
Chargemaster Item,,93251601,SPSI,Elbow 2 Views Left,,Per Svc,886.00
Chargemaster Item,,93251619,SPSI,Elbow 4 Views Right,,Per Svc,1102.00
Chargemaster Item,,93251627,SPSI,Elbow 4 Views Left,,Per Svc,1102.00
Chargemaster Item,,93251635,SPSI,Forearm Right,,Per Svc,705.00
Chargemaster Item,,93251643,SPSI,Forearm Left,,Per Svc,705.00
Chargemaster Item,,93251650,SPSI,Uext Infant Left,,Per Svc,703.00
Chargemaster Item,,93251668,SPSI,Uext Infant Right,,Per Svc,703.00
Chargemaster Item,,93251676,SPSI,Wrist 2 View Right,,Per Svc,861.00
Chargemaster Item,,93251684,SPSI,Wrist 2 View Left,,Per Svc,861.00
Chargemaster Item,,93251692,SPSI,Wrist 4 View Right,,Per Svc,1022.00
Chargemaster Item,,93251700,SPSI,Wrist 4 View Left,,Per Svc,1022.00
Chargemaster Item,,93251718,SPSI,Hand 2 Views Right,,Per Svc,671.00
Chargemaster Item,,93251726,SPSI,Hand 2 Views Left,,Per Svc,671.00
Chargemaster Item,,93251734,SPSI,Pa Hands/Wrist,,Per Svc,671.00
Chargemaster Item,,93251742,SPSI,Hand 3 Views Right,,Per Svc,850.00
Chargemaster Item,,93251759,SPSI,Hand 3 Views Left,,Per Svc,850.00
Chargemaster Item,,93251767,SPSI,Finger(S) Right,,Per Svc,611.00
Chargemaster Item,,93251775,SPSI,Finger(S) Left,,Per Svc,611.00
Chargemaster Item,,93251783,SPSI,Hip 1 View Right,,Per Svc,703.00
Chargemaster Item,,93251791,SPSI,Hip 1 View Left,,Per Svc,703.00
Chargemaster Item,,93251809,SPSI,Femur Right,,Per Svc,850.00
Chargemaster Item,,93251817,SPSI,Femur Left,,Per Svc,783.00
Chargemaster Item,,93251825,SPSI,Knee 1 Or 2 Views Right,,Per Svc,743.00
Chargemaster Item,,93251833,SPSI,Knee 1 Or 2 Views Left,,Per Svc,743.00
Chargemaster Item,,93251841,SPSI,Ap Bil Knees Standing,,Per Svc,1274.00
Chargemaster Item,,93251858,SPSI,Knee 3 Views Left,,Per Svc,846.00
Chargemaster Item,,93251866,SPSI,Knee 3 Views Right,,Per Svc,846.00
Chargemaster Item,,93251874,SPSI,Patella Right,,Per Svc,846.00
Chargemaster Item,,93251882,SPSI,Patella Left,,Per Svc,846.00
Chargemaster Item,,93251890,SPSI,Tibia & Fibia Right,,Per Svc,795.00
Chargemaster Item,,93251908,SPSI,Tibia & Fibia Left,,Per Svc,795.00
Chargemaster Item,,93251916,SPSI,Lext Infant Left,,Per Svc,687.00
Chargemaster Item,,93251924,SPSI,Lext Infant Right,,Per Svc,687.00
Chargemaster Item,,93251932,SPSI,Ankle 2 Views Right,,Per Svc,817.00
Chargemaster Item,,93251940,SPSI,Ankle 2 Views Left,,Per Svc,817.00
Chargemaster Item,,93251957,SPSI,Ankle 4 Views Right,,Per Svc,1061.00
Chargemaster Item,,93251965,SPSI,Ankle 4 Views Left,,Per Svc,1061.00
Chargemaster Item,,93251973,SPSI,Foot 2 Views Right,,Per Svc,788.00
Chargemaster Item,,93251981,SPSI,Foot 2 Views Left,,Per Svc,788.00
Chargemaster Item,,93251999,SPSI,Foot 3 Views Right,,Per Svc,1011.00
Chargemaster Item,,93252005,SPSI,Foot 3 Views Left,,Per Svc,1011.00
Chargemaster Item,,93252013,SPSI,Os Calcis Right,,Per Svc,710.00
Chargemaster Item,,93252021,SPSI,Os Calcis Left,,Per Svc,710.00
Chargemaster Item,,93252039,SPSI,Toe/Toes Right,,Per Svc,622.00
Chargemaster Item,,93252047,SPSI,Toe/Toes Left,,Per Svc,622.00
Chargemaster Item,,93252054,SPSI,Abdomen 1 View,,Per Svc,1095.00
Chargemaster Item,,93252062,SPSI,Kub,,Per Svc,1095.00
Chargemaster Item,,93252070,SPSI,Abdomen 2 Views,,Per Svc,711.00
Chargemaster Item,,93252088,SPSI,Abd Series/Pa Chest,,Per Svc,1095.00
Chargemaster Item,,93252096,SPSI,Nose-Rectum Child Iv,,Per Svc,716.00
Chargemaster Item,,93252104,SPSI,Bone Age Studies,,Per Svc,1034.00
Chargemaster Item,,93252112,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,93252120,SPSI,Osseous Survey Complete,,Per Svc,4402.00
Chargemaster Item,,93252138,SPSI,Osseous Survey Limited,,Per Svc,2135.00
Chargemaster Item,,93252146,SPSI,Infant Osseous Survey,,Per Svc,1545.00
Chargemaster Item,,93252153,SPSI,Ap Standing Feet,,Per Svc,671.00
Chargemaster Item,,93252187,SPSI,Entire Spine/Scoliosis 1 View,,Per Svc,1185.00
Chargemaster Item,,93252195,SPSI,Entire Spine/Scoliosis 2/3 Vws,,Per Svc,1383.00
Chargemaster Item,,93252203,SPSI,ENTIRE SPINE/SCOLIOSIS 4 OR 5 VWS,,Per Svc,1383.00
Chargemaster Item,,93252211,SPSI,ENTIRE SPINE/SCOLIOSIS 6 VWS,,Per Svc,1383.00
Chargemaster Item,,93252229,SPSI,LT Hip 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,93252237,SPSI,RT HIP 2 or 3 VIEWS,,Per Svc,941.00
Chargemaster Item,,93252245,SPSI,Bilat Hips w or wo Pelvis,,Per Svc,1647.00
Chargemaster Item,,93354009,SPSI,Mra Chest Wo Contrast,,Per Svc,1911.00
Chargemaster Item,,93354017,SPSI,Mra Chest W/Wo Contrast,,Per Svc,2509.00
Chargemaster Item,,93354025,SPSI,Mra Pelvis Wo/W Contrast,,Per Svc,2841.00
Chargemaster Item,,93354033,SPSI,Mri Rt Shoulder W Contrast,,Per Svc,6192.00
Chargemaster Item,,93354041,SPSI,Mri Lt Shoulder W Contrast,,Per Svc,6192.00
Chargemaster Item,,93354058,SPSI,Mri Rt Shoulder W/Wo Contrast,,Per Svc,9267.00
Chargemaster Item,,93354066,SPSI,Mri Lt Shoulder W/Wo Contrast,,Per Svc,9267.00
Chargemaster Item,,93354074,SPSI,Mri Rt Elbow W Contrast,,Per Svc,6192.00
Chargemaster Item,,93354082,SPSI,Mri Lt Elbow W Contrast,,Per Svc,6192.00
Chargemaster Item,,93354090,SPSI,Mri Rt Elbow W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,93354108,SPSI,Mri Lt Elbow W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,93354116,SPSI,Mri Rt Wrist W Contrast,,Per Svc,6192.00
Chargemaster Item,,93354124,SPSI,Mri Lt Wrist W Contrast,,Per Svc,6192.00
Chargemaster Item,,93354132,SPSI,Mri Rt Wrist W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,93354140,SPSI,Mri Lt Wrist W/Wo Contrast,,Per Svc,9288.00
Chargemaster Item,,93354157,SPSI,Mra Bil Lext W/Contrast,,Per Svc,5203.00
Chargemaster Item,,93354165,SPSI,Mra Bil Lext Wo Contrast,,Per Svc,2722.00
Chargemaster Item,,93354173,SPSI,Mra Bil Lext Wo/W Contrast,,Per Svc,6120.00
Chargemaster Item,,93354181,SPSI,Mri Rt Knee W Contrast,,Per Svc,6335.00
Chargemaster Item,,93354199,SPSI,Mri Lt Knee W Contrast,,Per Svc,6349.00
Chargemaster Item,,93354207,SPSI,Mri Rt Knee W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,93354215,SPSI,Mri Lt Knee W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,93354223,SPSI,Mri Lext W Contrast,,Per Svc,6335.00
Chargemaster Item,,93354231,SPSI,Mri Lext W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,93354249,SPSI,Mri Rt Ankle W Contrast,,Per Svc,6349.00
Chargemaster Item,,93354256,SPSI,Mri Lt Ankle W Contrast,,Per Svc,6349.00
Chargemaster Item,,93354264,SPSI,Mri Rt Ankle W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,93354272,SPSI,Mri Lt Ankle W/Wo Contrast,,Per Svc,8462.00
Chargemaster Item,,93354280,SPSI,Mra Rt Lext Wo Contrast,,Per Svc,2722.00
Chargemaster Item,,93354298,SPSI,Mra Lt Lext Wo Contrast,,Per Svc,2722.00
Chargemaster Item,,93354306,SPSI,Mra Rt Lext W/Wo Contrast,,Per Svc,6120.00
Chargemaster Item,,93354314,SPSI,Mra Lt Lext W/Wo Contrast,,Per Svc,6120.00
Chargemaster Item,,93354322,SPSI,Mra Abdomen Wo Contrast,,Per Svc,2280.00
Chargemaster Item,,93354330,SPSI,Mra Abdomen W W/O Contrast,,Per Svc,5953.00
Chargemaster Item,,93354348,SPSI,Mra Rt Uext W Contrast B,,Per Svc,6693.00
Chargemaster Item,,93354355,SPSI,Mra Rt Uext W Contrast A,,Per Svc,6693.00
Chargemaster Item,,93354363,SPSI,Mra Rt Uext Wo/W Contrast,,Per Svc,6707.00
Chargemaster Item,,93354371,SPSI,Mra Lt Uext Wo W/ Contrast,,Per Svc,6693.00
Chargemaster Item,,93354389,SPSI,Eovist Per Ml,,Per Svc,120.00
Chargemaster Item,,93354397,SPSI,Mra Pelvis W Contrast,,Per Svc,2919.00
Chargemaster Item,,93354405,SPSI,Mri Spectroscopy,,Per Svc,2560.00
Chargemaster Item,,93354413,SPSI,Mri Tmj'S,,Per Svc,4843.00
Chargemaster Item,,93354421,SPSI,Mri Orbt-Face-Neck Wo Contrast,,Per Svc,9601.00
Chargemaster Item,,93354447,SPSI,Mri Brain Wo Contrast,,Per Svc,10549.00
Chargemaster Item,,93354454,SPSI,Mri Brain Wo/W Contrast,,Per Svc,14319.00
Chargemaster Item,,93354462,SPSI,Mri Chest,,Per Svc,10194.00
Chargemaster Item,,93354470,SPSI,MRI Lim Cervical,,Per Svc,10501.00
Chargemaster Item,,93354488,SPSI,Mri Cervical Wo Contrast,,Per Svc,10501.00
Chargemaster Item,,93354496,SPSI,Mri Spinal Cord,,Per Svc,10501.00
Chargemaster Item,,93354504,SPSI,Mri Thoracic Wo Contrast,,Per Svc,8853.00
Chargemaster Item,,93354512,SPSI,MRI Lim Lumbar,,Per Svc,9897.00
Chargemaster Item,,93354520,SPSI,Mri Lumbar Wo Contrast,,Per Svc,9897.00
Chargemaster Item,,93354538,SPSI,Mri Cerv Wo/W Contrast,,Per Svc,11857.00
Chargemaster Item,,93354546,SPSI,MRI Lim Thoracic,,Per Svc,10735.00
Chargemaster Item,,93354553,SPSI,Mri Thoracic Wo/W Contrast,,Per Svc,10735.00
Chargemaster Item,,93354561,SPSI,Mri Lumbar Wo/W Contrast,,Per Svc,11707.00
Chargemaster Item,,93354579,SPSI,Mri Pelvis Wo Contrast,,Per Svc,9639.00
Chargemaster Item,,93354587,SPSI,Mri Right Shoulder Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,93354595,SPSI,Mri Left Shoulder Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,93354603,SPSI,Mri Lt Elbow Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,93354611,SPSI,Mri Right Wrist Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,93354629,SPSI,Mri Left Wrist Wo Contrast,,Per Svc,6936.00
Chargemaster Item,,93354637,SPSI,Mri Rt Elbow,,Per Svc,6921.00
Chargemaster Item,,93354645,SPSI,Mri Rt Ankle Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,93354652,SPSI,Mri Lext Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,93354660,SPSI,Mri Lt Ankle Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,93354678,SPSI,Mri Rt Knee Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,93354686,SPSI,Mri Lt Knee Wo Contrast,,Per Svc,5579.00
Chargemaster Item,,93354694,SPSI,Mri Abd Wo Contrast,,Per Svc,10194.00
Chargemaster Item,,93354702,SPSI,Mri Lim Brain,,Per Svc,10549.00
Chargemaster Item,,93354710,SPSI,Mri Upr Ext W/Wo Contrast Right,,Per Svc,9779.00
Chargemaster Item,,93354728,SPSI,Mri Upr Ext W/Wo Contrast Left,,Per Svc,9779.00
Chargemaster Item,,93354736,SPSI,Mri Lext (Not Joint) Right,,Per Svc,12230.00
Chargemaster Item,,93354744,SPSI,Mri Lext (Not Joint) Left,,Per Svc,12230.00
Chargemaster Item,,93354751,SPSI,Mri Uext Wo Contrast Right,,Per Svc,7982.00
Chargemaster Item,,93354769,SPSI,Mri Uext Wo Contrast Left,,Per Svc,7982.00
Chargemaster Item,,93354777,SPSI,Mri Lext (Not Joint) Wo Cont Right,,Per Svc,8900.00
Chargemaster Item,,93354785,SPSI,Mri Lext (Not Joint) Wo Cont Left,,Per Svc,8900.00
Chargemaster Item,,93354793,SPSI,Mri Pelvis With Contrast,,Per Svc,9639.00
Chargemaster Item,,93354801,SPSI,Multihance Gadobenate Per Ml,,Per Svc,24.00
Chargemaster Item,,93354819,SPSI,Mra Head Wo,,Per Svc,8003.00
Chargemaster Item,,93354827,SPSI,Mra Neck Wo,,Per Svc,8850.00
Chargemaster Item,,93354835,SPSI,Mri Orbt/Face/Neck W Contrast,,Per Svc,10987.00
Chargemaster Item,,93354843,SPSI,Mri Orb/Face/Neck W/Wo,,Per Svc,11013.00
Chargemaster Item,,93354850,SPSI,Mra Head W Contrast,,Per Svc,9077.00
Chargemaster Item,,93354868,SPSI,Mra Head Wo/W Contrast,,Per Svc,11728.00
Chargemaster Item,,93354876,SPSI,Mra Neck W Contrast,,Per Svc,4878.00
Chargemaster Item,,93354884,SPSI,Mra Neck Wo/W Contrast,,Per Svc,12934.00
Chargemaster Item,,93354892,SPSI,Mri Chest Wo/W Contrast,,Per Svc,12276.00
Chargemaster Item,,93354900,SPSI,Mri Pelvis Wo/W Contrast,,Per Svc,12459.00
Chargemaster Item,,93354918,SPSI,Mri Abdomen Wo/W Contrast,,Per Svc,12459.00
Chargemaster Item,,93354926,SPSI,Gadolinium Per Cc,,Per Svc,5.00
Chargemaster Item,,93354934,SPSI,Mri Brain W Contrast,,Per Svc,13143.00
Chargemaster Item,,93354942,SPSI,Mri Cervical W Contrast,,Per Svc,3235.00
Chargemaster Item,,93354959,SPSI,Mri Thoracic W Contrast,,Per Svc,9833.00
Chargemaster Item,,93354967,SPSI,Mri Lumbar W Contrast,,Per Svc,10653.00
Chargemaster Item,,93354975,SPSI,Gadavist Per Cc,50419-325-02,Per Svc,14.00
Chargemaster Item,,93457000,SPSI,CT Angio Abdomen & Pelvis,,Per Svc,6788.00
Chargemaster Item,,93457018,SPSI,CT Chest Screening,,Per Svc,443.00
Chargemaster Item,,93457026,SPSI,CT Thorax Screen w/o Contrast,,Per Svc,7998.00
Chargemaster Item,,93457034,SPSI,Ct Heart Cacs Wo Contrast,,Per Svc,9316.00
Chargemaster Item,,93457042,SPSI,Ct Heart Structure W Contrast,,Per Svc,11547.00
Chargemaster Item,,93457067,SPSI,Ultravist 370 Per Ml,,Per Svc,1.00
Chargemaster Item,,93457075,SPSI,Ct Head W Contrast,,Per Svc,8262.00
Chargemaster Item,,93457083,SPSI,Ct Head Wo Contrast,,Per Svc,7578.00
Chargemaster Item,,93457109,SPSI,Ct Orbits W Contrast,,Per Svc,8740.00
Chargemaster Item,,93457117,SPSI,Ct Head W/Wo Contrast,,Per Svc,11250.00
Chargemaster Item,,93457125,SPSI,Ct Orbit Wo Contrast,,Per Svc,7122.00
Chargemaster Item,,93457133,SPSI,Ct Temporal Bones W Contrast,,Per Svc,8740.00
Chargemaster Item,,93457141,SPSI,Ct Sinuses W Contrast,,Per Svc,9076.00
Chargemaster Item,,93457158,SPSI,Ct Orbit W/Wo Contrast,,Per Svc,10191.00
Chargemaster Item,,93457166,SPSI,Ct Temporal Bones Wo Contrast,,Per Svc,7548.00
Chargemaster Item,,93457174,SPSI,Ct Facial Bones Wo Contrast,,Per Svc,4628.00
Chargemaster Item,,93457182,SPSI,Ct Facial Bones W Contrast,,Per Svc,9076.00
Chargemaster Item,,93457190,SPSI,Ct Sinuses Wo Contrast,,Per Svc,4628.00
Chargemaster Item,,93457208,SPSI,Ct Neck Wo Contrast,,Per Svc,6131.00
Chargemaster Item,,93457216,SPSI,Ct Neck W Contrast,,Per Svc,7277.00
Chargemaster Item,,93457224,SPSI,Ct Neck Wo/W Contrast,,Per Svc,9140.00
Chargemaster Item,,93457232,SPSI,Cta Neck,,Per Svc,1788.00
Chargemaster Item,,93457240,SPSI,Ct Chest Wo Contrast,,Per Svc,7998.00
Chargemaster Item,,93457257,SPSI,Ct Thorax W Contrast,,Per Svc,9389.00
Chargemaster Item,,93457265,SPSI,Ct Thorax W/Wo Contrast,,Per Svc,10329.00
Chargemaster Item,,93457273,SPSI,Ct Chest Angio,,Per Svc,4716.00
Chargemaster Item,,93457281,SPSI,Cta Head,,Per Svc,1846.00
Chargemaster Item,,93457299,SPSI,Ct Cervical Spine Wo Contrast,,Per Svc,9407.00
Chargemaster Item,,93457307,SPSI,Ct Cervical Spine W Contrast,,Per Svc,10195.00
Chargemaster Item,,93457315,SPSI,Ct Thoracic Spine Wo Contrast,,Per Svc,7113.00
Chargemaster Item,,93457323,SPSI,Ct Thoracic Spine W Contrast,,Per Svc,8644.00
Chargemaster Item,,93457331,SPSI,Ct Lumbar Spine Wo Contrast,,Per Svc,9034.00
Chargemaster Item,,93457349,SPSI,Ct Lumbar Spine W Contrast,,Per Svc,10416.00
Chargemaster Item,,93457356,SPSI,Ct Lumbar Spine W/Wo Contrast,,Per Svc,12959.00
Chargemaster Item,,93457364,SPSI,Ct Pelvis Angio,,Per Svc,3748.00
Chargemaster Item,,93457372,SPSI,Ct Pelvis Wo Contrast,,Per Svc,7585.00
Chargemaster Item,,93457380,SPSI,Ct Pelvis W Contrast,,Per Svc,8560.00
Chargemaster Item,,93457398,SPSI,Ct Pelvis W/Wo Contrast,,Per Svc,10794.00
Chargemaster Item,,93457406,SPSI,Ct Upper Ext Wo Contrast Right,,Per Svc,6913.00
Chargemaster Item,,93457414,SPSI,Ct Rt Upper Ext W Contrast,,Per Svc,7488.00
Chargemaster Item,,93457422,SPSI,Ct Upper Ext Wo Contrast Left,,Per Svc,6913.00
Chargemaster Item,,93457430,SPSI,Ct Lt Upper Ext W Contrast,,Per Svc,7488.00
Chargemaster Item,,93457448,SPSI,Ct Rt Shoulder Arthrogram,,Per Svc,7063.00
Chargemaster Item,,93457455,SPSI,Ct Lt Shoulder Arthrogram,,Per Svc,7063.00
Chargemaster Item,,93457463,SPSI,Cta Uext Right,,Per Svc,2427.00
Chargemaster Item,,93457471,SPSI,Cta Uext Left,,Per Svc,2427.00
Chargemaster Item,,93457489,SPSI,Ct Lower Ext Wo Contrast Right,,Per Svc,6845.00
Chargemaster Item,,93457497,SPSI,Ct Lower Ext W Contrast Right,,Per Svc,7750.00
Chargemaster Item,,93457505,SPSI,Ct Lower Ext Wo Contrast Left,,Per Svc,6845.00
Chargemaster Item,,93457513,SPSI,Ct Lower Ext W Contrast Left,,Per Svc,7750.00
Chargemaster Item,,93457521,SPSI,Cta Lower Ext Right,,Per Svc,2305.00
Chargemaster Item,,93457539,SPSI,Cta Lower Ext Left,,Per Svc,2305.00
Chargemaster Item,,93457547,SPSI,Ct Abdomen Wo Contrast,,Per Svc,7377.00
Chargemaster Item,,93457554,SPSI,Ct Abdomen W Contrast,,Per Svc,9193.00
Chargemaster Item,,93457562,SPSI,Ct Abdomen W/Wo Contrast,,Per Svc,11693.00
Chargemaster Item,,93457570,SPSI,Ct Abdomen Angio,,Per Svc,3038.00
Chargemaster Item,,93457588,SPSI,Cta Aorta-Ilio,,Per Svc,2936.00
Chargemaster Item,,93457596,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,93457612,SPSI,Visipaque 320 Per Ml,,Per Svc,1.00
Chargemaster Item,,93457620,SPSI,Ct Thoracic Wo/W Contrast,,Per Svc,10839.00
Chargemaster Item,,93457638,SPSI,Ultravist 300 Per Ml,,Per Svc,1.00
Chargemaster Item,,93457646,SPSI,Cta Heart Complete,,Per Svc,5157.00
Chargemaster Item,,93457653,SPSI,Ct Cervical Spine W/Wo Contrst,,Per Svc,10989.00
Chargemaster Item,,93457661,SPSI,Ct Maxillofacial Wo/W Contrast,,Per Svc,9130.00
Chargemaster Item,,93457679,SPSI,Ct Upper Ext W/Wo Contrast Left,,Per Svc,12467.00
Chargemaster Item,,93457687,SPSI,Ct Abd & Pelvis Wo Contrast,,Per Svc,16615.00
Chargemaster Item,,93457695,SPSI,Ct Abd/Pel Wo/W 1/Both Areas,,Per Svc,24929.00
Chargemaster Item,,93457703,SPSI,Ct Abd & Pelvis With Contrast,,Per Svc,19676.00
Chargemaster Item,,93457711,SPSI,Omnipaque 350,,Per Svc,1.00
Chargemaster Item,,93559003,SPSI,Neo-Natal Cranial Sonogram,,Per Svc,1961.00
Chargemaster Item,,93559011,SPSI,Us Soft Tissue Head/Neck,,Per Svc,1957.00
Chargemaster Item,,93559029,SPSI,US Limited Chest,,Per Svc,1501.00
Chargemaster Item,,93559037,SPSI,Abdomen Sonogram,,Per Svc,2703.00
Chargemaster Item,,93559045,SPSI,Abd Sono Lim,,Per Svc,2045.00
Chargemaster Item,,93559052,SPSI,Gb/Ruq Sonogram,,Per Svc,2045.00
Chargemaster Item,,93559060,SPSI,Renal Sonogram,,Per Svc,2734.00
Chargemaster Item,,93559078,SPSI,Aorta Sonogram,,Per Svc,2734.00
Chargemaster Item,,93559086,SPSI,Rt Renal Lim Sono,,Per Svc,1654.00
Chargemaster Item,,93559094,SPSI,Lt Renal Lim Sono,,Per Svc,1654.00
Chargemaster Item,,93559102,SPSI,Us Spinal Canal,,Per Svc,2254.00
Chargemaster Item,,93559110,SPSI,Ob <14Wks Ea Addl Gestation,,Per Svc,2185.00
Chargemaster Item,,93559128,SPSI,Ob Us <14 Wks,,Per Svc,2906.00
Chargemaster Item,,93559136,SPSI,Ob Us 2Nd/3Rd Trim Ea Add Gest,,Per Svc,2183.00
Chargemaster Item,,93559144,SPSI,Ob Us 2Nd/3Rd Trimester,,Per Svc,2936.00
Chargemaster Item,,93559151,SPSI,Lim Ob Sono,,Per Svc,2685.00
Chargemaster Item,,93559169,SPSI,Ob Follow-Up,,Per Svc,1325.00
Chargemaster Item,,93559177,SPSI,Ob Us Follow-Up Add Gest,,Per Svc,1325.00
Chargemaster Item,,93559185,SPSI,Plcenta Loc Sono,,Per Svc,2685.00
Chargemaster Item,,93559193,SPSI,Pelvic Nonob Us,,Per Svc,2546.00
Chargemaster Item,,93559201,SPSI,Fu/Limited Pelvic Us,,Per Svc,1472.00
Chargemaster Item,,93559219,SPSI,Scrotal Sonogram,,Per Svc,2204.00
Chargemaster Item,,93559227,SPSI,Us Rt Extrmty Lim Nonvascular,,Per Svc,2080.00
Chargemaster Item,,93559235,SPSI,Us Lt Extrmty Lim Nonvascular,,Per Svc,2080.00
Chargemaster Item,,93559243,SPSI,Carotid Duplex,,Per Svc,3717.00
Chargemaster Item,,93559250,SPSI,Lim/Fu Carotid Duplex,,Per Svc,2014.00
Chargemaster Item,,93559268,SPSI,Lwrext Arterial Duplex Bilat,,Per Svc,2973.00
Chargemaster Item,,93559276,SPSI,Lext Arterial Duplex Left,,Per Svc,1617.00
Chargemaster Item,,93559284,SPSI,Lext Arterial Duplex Right,,Per Svc,1617.00
Chargemaster Item,,93559292,SPSI,Upper Ext Arterial Duplex Scan,,Per Svc,2681.00
Chargemaster Item,,93559300,SPSI,Upper Ext Art Duplex Scan Right,,Per Svc,1624.00
Chargemaster Item,,93559318,SPSI,Upper Ext Art Duplex Scan Left,,Per Svc,1624.00
Chargemaster Item,,93559326,SPSI,Duplex Scan Bilat Ext Veins,,Per Svc,3812.00
Chargemaster Item,,93559334,SPSI,Right Ext Duplex Scan,,Per Svc,2921.00
Chargemaster Item,,93559342,SPSI,Left Ext Duplex Scan,,Per Svc,2921.00
Chargemaster Item,,93559359,SPSI,Bypass Grafts Duplex Scan,,Per Svc,2678.00
Chargemaster Item,,93559367,SPSI,Lim Bypass Grafts Duplex Scan,,Per Svc,1350.00
Chargemaster Item,,93559375,SPSI,Us Visceral Duplex Scan,,Per Svc,2520.00
Chargemaster Item,,93559383,SPSI,Us Renal Trnsplnt W/Doppler,,Per Svc,1784.00
Chargemaster Item,,93559391,SPSI,Us Renal Trnsplnt W/O Doppler,,Per Svc,1654.00
Chargemaster Item,,93559409,SPSI,Us Renal Transplant W/Doppler,,Per Svc,1743.00
Chargemaster Item,,93559417,SPSI,Us Venous Bilat Uprext Duplex,,Per Svc,3588.00
Chargemaster Item,,93559425,SPSI,Us Venous Lt Uprext Duplex,,Per Svc,2921.00
Chargemaster Item,,93559433,SPSI,US Venous Rt Uprext Duplex,,Per Svc,2921.00
Chargemaster Item,,93559441,SPSI,Us Venous Bilat Lwrext Duplex,,Per Svc,3307.00
Chargemaster Item,,93559458,SPSI,Us Venous Lt Lwrext Duplex,,Per Svc,2692.00
Chargemaster Item,,93559466,SPSI,Us Venous Rt Lwrext Duplex,,Per Svc,2692.00
Chargemaster Item,,93559474,SPSI,Us Renal Transplant Wo Doppler,,Per Svc,1654.00
Chargemaster Item,,93559482,SPSI,US Visceral Limited Duplex Scan,,Per Svc,2180.00
Chargemaster Item,,93559490,SPSI,Ob Us Transvaginal,,Per Svc,1178.00
Chargemaster Item,,93559508,SPSI,Us Nonob Transvaginal,,Per Svc,1878.00
Chargemaster Item,,93559516,SPSI,Us Extremity Complete Nonvasc,,Per Svc,2080.00
Chargemaster Item,,94000018,SPSI,Cognitive Training init15 Min,,Per Svc,308.00
Chargemaster Item,,94000028,SPSI,Cognitive Training addl15 Min,,Per Svc,289.00
Chargemaster Item,,94003344,SPSI,Medical Supply,,Per Svc,55.00
Chargemaster Item,,94010742,SPSI,Knee Strapping,,Per Svc,213.00
Chargemaster Item,,94010759,SPSI,Ankle/Foot Strapping,,Per Svc,212.00
Chargemaster Item,,94010767,SPSI,Toe(S) Strapping,,Per Svc,212.00
Chargemaster Item,,94010775,SPSI,Stapping/Lowback,,Per Svc,442.00
Chargemaster Item,,94010783,SPSI,Shoulder Strapping,,Per Svc,614.00
Chargemaster Item,,94010791,SPSI,Elbow/Wrist Strapping,,Per Svc,614.00
Chargemaster Item,,94010809,SPSI,Hand/Finger Strapping,,Per Svc,675.00
Chargemaster Item,,94020007,SPSI,Cognitive Training Ea 15 Min OT,,Every 15 Minutes,320.00
Chargemaster Item,,94025041,SPSI,Therex Ea 15 Min OT,,Every 15 Minutes,324.00
Chargemaster Item,,94025058,SPSI,Muscle Re-Education Ea 15 Min OT,,Every 15 Minutes,443.00
Chargemaster Item,,94025066,SPSI,Therapeutic Activities Ea 15 Min OT,,Every 15 Minutes,459.00
Chargemaster Item,,94025082,SPSI,Sensory Integrative Tech Ea 15 Min OT,,Every 15 Minutes,276.00
Chargemaster Item,,94025090,SPSI,Self Care Home Manage Training Ea 15 Min OT,,Every 15 Minutes,343.00
Chargemaster Item,,94025190,SPSI,Init eval: Low comp 30 mins,,Per Svc,733.00
Chargemaster Item,,94025200,SPSI,Init eval: Mod comp 45 mins,,Per Svc,733.00
Chargemaster Item,,94025210,SPSI,Init eval: High comp 60 mins,,Per Svc,733.00
Chargemaster Item,,94025220,SPSI,Re-Evaluation OT,,Per Svc,419.00
Chargemaster Item,,94026239,SPSI,PT Developmental Testing,Extended,,Per Svc,1438.00
Chargemaster Item,,94026247,SPSI,ST Developmental Testing,Extended,,Per Svc,1415.00
Chargemaster Item,,94026254,SPSI,OT Developmental Testing,Extended,,Per Svc,1415.00
Chargemaster Item,,94051229,SPSI,Therex Ea 15 Min,,Every 15 Minutes,320.00
Chargemaster Item,,94051401,SPSI,Self Care Home Manage Training Ea 15 Min,,Every 15 Minutes,341.00
Chargemaster Item,,94051419,SPSI,Muscle Re-Education Ea 15 Min,,Every 15 Minutes,441.00
Chargemaster Item,,94051427,SPSI,Therapeutic Activities Ea 15 Min,,Every 15 Minutes,459.00
Chargemaster Item,,94051460,SPSI,Init eval: Low comp 20 mins,,Per Svc,716.00
Chargemaster Item,,94051470,SPSI,Init eval: Mod comp 30 mins,,Per Svc,716.00
Chargemaster Item,,94051480,SPSI,Init eval: High comp 45 mins,,Per Svc,716.00
Chargemaster Item,,94051490,SPSI,Re-Evaluation,,Per Svc,385.00
Chargemaster Item,,94051666,SPSI,Manual Therapy Tech Ea 15 Min,,Every 15 Minutes,375.00
Chargemaster Item,,94930000,SPSI,Speech Evaluation,,Per Svc,761.00
Chargemaster Item,,94930018,SPSI,Speech Therapy Treatment,,Per Svc,802.00
Chargemaster Item,,95000089,SPSI,HLA ABC Tissue Typing,,Per Svc,200.00
Chargemaster Item,,95000105,SPSI,Complement Fixation,,Per Svc,42.00
Chargemaster Item,,95000113,SPSI,Immunodiffusion,,Per Svc,34.00
Chargemaster Item,,95000147,SPSI,PathfinderTG Aspirate,,Per Svc,3100.73
Chargemaster Item,,95000154,SPSI,Bact Det PCR Univ Washington,,Per Svc,275.96
Chargemaster Item,,95000162,SPSI,Fungal Det PCR Univ Wash,,Per Svc,450.28
Chargemaster Item,,95000170,SPSI,Non TB Mycobac PCR Univ Wash,,Per Svc,305.89
Chargemaster Item,,95000188,SPSI,MTB Complex PCT Univ Wash,,Per Svc,202.65
Chargemaster Item,,95000196,SPSI,Bile Acids Total (ARUP),,Per Svc,19.50
Chargemaster Item,,95000204,SPSI,Microbiology Procedure,,Per Svc,500.00
Chargemaster Item,,95000212,SPSI,MNGS Pathogen DX UCSF,,Per Svc,2529.00
Chargemaster Item,,95000220,SPSI,Interpretation UCSF,,Per Svc,166.00
Chargemaster Item,,95000238,SPSI,Protein14-3-3 TAU, CSF (ARUP),,Per Svc,50.00
Chargemaster Item,,95000246,SPSI,Protein Western Blot,,Per Svc,50.00
Chargemaster Item,,95000253,SPSI,Neuro CSF Prion Protein QL,,Per Svc,531.87
Chargemaster Item,,95100012,SPSI,Stone Analysis,,Per Svc,25.99
Chargemaster Item,,95100038,SPSI,Additional Hematuria Analysis,,Per Svc,130.22
Chargemaster Item,,95100061,SPSI,Pancreatitis Panel CFTR (Arup),,Per Svc,940.00
Chargemaster Item,,95100079,SPSI,PRSS 1 Sequencing,,Per Svc,940.00
Chargemaster Item,,95100087,SPSI,Spink1 Sequencing,,Per Svc,940.00
Chargemaster Item,,95200010,SPSI,LEMS Antibody 475,,Per Svc,215.00
Chargemaster Item,,95200028,SPSI,Musk Antibody,,Per Svc,585.00
Chargemaster Item,,95210019,SPSI,Sample Ascertainment,,Per Svc,30.00
Chargemaster Item,,95210076,SPSI,Pap Smear (Sach),,Per Svc,25.00
Chargemaster Item,,95210100,SPSI,Gfap Immunostain (Mayo),,Per Svc,144.00
Chargemaster Item,,95210118,SPSI,Idh1 Mutation R132h Im,,Per Svc,144.00
Chargemaster Item,,95210126,SPSI,Cd68 Kp1 Immunostain (Mayo),,Per Svc,144.00
Chargemaster Item,,95210134,SPSI,Patho Consult (Mayo),,Per Svc,415.70
Chargemaster Item,,95210159,SPSI,UPD-14 (Mayo),,Per Svc,367.30
Chargemaster Item,,95210167,SPSI,CDKMS (MAYO),,Per Svc,900.00
Chargemaster Item,,95210175,SPSI,H19 BWSRS (MAYO),,Per Svc,1577.50
Chargemaster Item,,95210183,SPSI,IGF2 (MAYO),,Per Svc,194.90
Chargemaster Item,,95210191,SPSI,KCNQ1 (MAYO),,Per Svc,5155.00
Chargemaster Item,,95210209,SPSI,NMDA Receptor AB CBA (Mayo),,Per Svc,445.32
Chargemaster Item,,95210324,SPSI,Iron Tissue (Mayo),,Per Svc,252.60
Chargemaster Item,,95300026,SPSI,BRCA I and BRCA II,,Per Svc,2580.00
Chargemaster Item,,95700027,SPSI,Coccidioidomycosis Ser(Davis),,Per Svc,40.00
Chargemaster Item,,95800017,SPSI,MecA Gene by PCR,,Per Svc,182.72
Chargemaster Item,,95800033,SPSI,SARS COVID 19 (Kaiser),,Per Svc,100.00
Chargemaster Item,,95800041,SPSI,SARS COVID 19 (West Pac Labs),,Per Svc,70.00
Chargemaster Item,,95800058,SPSI,Neuronal Cell ABS CSF ARUP,,Per Svc,74.77
Chargemaster Item,,95800066,SPSI,COV19 Fulgent Lab,,Per Svc,65.00
Chargemaster Item,,95800082,SPSI,Biopsy - UCLA,,Per Svc,44.00
Chargemaster Item,,95800090,SPSI,IF Stains,,Per Svc,105.00
Chargemaster Item,,95810008,SPSI,Special Stains,,Per Svc,87.00
Chargemaster Item,,95810016,SPSI,Electron Microscopy - UCLA,,Per Svc,404.00
Chargemaster Item,,95810024,SPSI,IF Stain Ea Addl Stain Global,,Per Svc,69.00
Chargemaster Item,,95810032,SPSI,Immunohistochemistry Ea Addl,,Per Svc,92.00
Chargemaster Item,,96020003,SPSI,Cervical Myelogram S&I,,Per Svc,2185.00
Chargemaster Item,,96020011,SPSI,Thoracic Myelogram S&I,,Per Svc,2724.00
Chargemaster Item,,96020029,SPSI,Lumbar Myelogram S&I,,Per Svc,2120.00
Chargemaster Item,,96020037,SPSI,Combined Myelogram S&I,,Per Svc,4970.00
Chargemaster Item,,96020045,SPSI,Hysterosalpingogram S&I,,Per Svc,1790.00
Chargemaster Item,,96020052,SPSI,Inj Sonohystero/Hystero,,Per Svc,373.00
Chargemaster Item,,96020060,SPSI,UGI Single Contrast,,Per Svc,2097.00
Chargemaster Item,,96020078,SPSI,UGI Double Contrast,,Per Svc,2178.00
Chargemaster Item,,96020086,SPSI,Esophogram,,Per Svc,1522.00
Chargemaster Item,,96020094,SPSI,Ba Enema W/Wo Kub,,Per Svc,2251.00
Chargemaster Item,,96020102,SPSI,Air Contrast Enema,,Per Svc,2933.00
Chargemaster Item,,96020110,SPSI,Small Bowel Series,,Per Svc,1316.00
Chargemaster Item,,96020128,SPSI,Abscess-Fistula-Sinus Tract,,Per Svc,1442.00
Chargemaster Item,,96020136,SPSI,Flur Guide Ndl Plcmnt Spine,,Per Svc,1939.00
Chargemaster Item,,96020144,SPSI,Hocm 350 - 399Mg/Ml,,Per Svc,208.00
Chargemaster Item,,96020151,SPSI,Locm 100 - 199Mg/Ml,,Per Svc,1.00
Chargemaster Item,,96020169,SPSI,Locm 300 - 399Mg/Ml,,Per Svc,1.00
Chargemaster Item,,96020177,SPSI,Inj Fistula/Sinus Tract,,Per Svc,246.00
Chargemaster Item,,96020185,SPSI,Colon Ca Scrn/Colonscopy Be,,Per Svc,2282.00
Chargemaster Item,,96020193,SPSI,Sm Bowel Flw Through,,Per Svc,1213.00
Chargemaster Item,,96020201,SPSI,Myelogram Tray,,Per Svc,168.00
Chargemaster Item,,96020219,SPSI,Postop Cholangio Complete,,Per Svc,1076.00
Chargemaster Item,,96020227,SPSI,Retrograde Urethrogram S&I,,Per Svc,1329.00
Chargemaster Item,,96020235,SPSI,RT Nephrogram Exist Access Comp,,Per Svc,5244.00
Chargemaster Item,,96020243,SPSI,LT Nephromgram Exist Access Comp,,Per Svc,5244.00
Chargemaster Item,,96030507,SPSI,Eye Foreign Body,,Per Svc,799.00
Chargemaster Item,,96030515,SPSI,Mandible Limited,,Per Svc,1361.00
Chargemaster Item,,96030523,SPSI,Mandible Complete,,Per Svc,1361.00
Chargemaster Item,,96030531,SPSI,Mastoids Limited,,Per Svc,626.00
Chargemaster Item,,96030549,SPSI,Mastoids Complete,,Per Svc,868.00
Chargemaster Item,,96030556,SPSI,Lim Facial Bones,,Per Svc,1016.00
Chargemaster Item,,96030564,SPSI,Facial Bones,,Per Svc,1221.00
Chargemaster Item,,96030572,SPSI,Nasal Bones,,Per Svc,941.00
Chargemaster Item,,96030580,SPSI,Optic Foramina,,Per Svc,773.00
Chargemaster Item,,96030598,SPSI,Sinuses Limited,,Per Svc,966.00
Chargemaster Item,,96030606,SPSI,Sinuses Complete,,Per Svc,1399.00
Chargemaster Item,,96030614,SPSI,Sella Turcica,,Per Svc,701.00
Chargemaster Item,,96030622,SPSI,Skull 4 Views,,Per Svc,1554.00
Chargemaster Item,,96030630,SPSI,Skull 2 Views,,Per Svc,963.00
Chargemaster Item,,96030648,SPSI,Skull Complete,,Per Svc,1554.00
Chargemaster Item,,96030655,SPSI,Tm Joints Bilateral,,Per Svc,1617.00
Chargemaster Item,,96030663,SPSI,Neck Soft Tissue,,Per Svc,663.00
Chargemaster Item,,96030671,SPSI,Salivary Gland,,Per Svc,891.00
Chargemaster Item,,96030689,SPSI,Chest 1 View,,Per Svc,730.00
Chargemaster Item,,96030697,SPSI,Chest 2 View,,Per Svc,919.00
Chargemaster Item,,96030705,SPSI,Chest 3 Views,,Per Svc,1178.00
Chargemaster Item,,96030713,SPSI,Chest 4 Views,,Per Svc,1547.00
Chargemaster Item,,96030739,SPSI,Ribs W/ Pa Cxr Right,,Per Svc,1082.00
Chargemaster Item,,96030747,SPSI,Ribs W/ Pa Cxr Left,,Per Svc,1082.00
Chargemaster Item,,96030754,SPSI,Ribs Right,,Per Svc,949.00
Chargemaster Item,,96030762,SPSI,Ribs Left,,Per Svc,949.00
Chargemaster Item,,96030770,SPSI,Bilat Ribs,,Per Svc,1275.00
Chargemaster Item,,96030788,SPSI,Bilat Ribs W/ Pa Cxr,,Per Svc,1363.00
Chargemaster Item,,96030796,SPSI,Sternum,,Per Svc,779.00
Chargemaster Item,,96030804,SPSI,Sternoclavicular Joints,,Per Svc,803.00
Chargemaster Item,,96030820,SPSI,Spine 1 View,,Per Svc,752.00
Chargemaster Item,,96030838,SPSI,Cervical Spine 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,96030846,SPSI,Cervical Spine 4 or 5 Views,,Per Svc,1453.00
Chargemaster Item,,96030853,SPSI,Cerv Spine 6 Or More Views,,Per Svc,1865.00
Chargemaster Item,,96030861,SPSI,Cervical Spine 3 or Less Views,,Per Svc,799.00
Chargemaster Item,,96030879,SPSI,Thoracic Spine 4 Plus Views,,Per Svc,1414.00
Chargemaster Item,,96030887,SPSI,Thoracic Spine 2 Views,,Per Svc,1071.00
Chargemaster Item,,96030895,SPSI,Thoracolumbar min 2 Views,,Per Svc,944.00
Chargemaster Item,,96030911,SPSI,Lumbar Sp 2 Or 3 Views,,Per Svc,930.00
Chargemaster Item,,96030929,SPSI,Lumbar Spine 4 Views,,Per Svc,1112.00
Chargemaster Item,,96030937,SPSI,Ls Spine,,Per Svc,1112.00
Chargemaster Item,,96030937INACTV,SPSI,Lumbar Sp 4 Plus Views,,Per Svc,2537.00
Chargemaster Item,,96030945,SPSI,Ls Spine & Bending Views,,Per Svc,1979.00
Chargemaster Item,,96030952,SPSI,Ls Spine Only Bending Views,,Per Svc,1134.00
Chargemaster Item,,96030960,SPSI,Pelvis Ap,,Per Svc,941.00
Chargemaster Item,,96030978,SPSI,Pelvis 2 Views,,Per Svc,941.00
Chargemaster Item,,96030986,SPSI,Sacroiliac Joints,,Per Svc,843.00
Chargemaster Item,,96030994,SPSI,Sacrum & Coccyx,,Per Svc,794.00
Chargemaster Item,,96031000,SPSI,Metastatic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,96031018,SPSI,Metabolic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,96031026,SPSI,Clavicle Right,,Per Svc,710.00
Chargemaster Item,,96031034,SPSI,Clavicle Left,,Per Svc,710.00
Chargemaster Item,,96031042,SPSI,Scapula Right,,Per Svc,1030.00
Chargemaster Item,,96031059,SPSI,Scapula Left,,Per Svc,1030.00
Chargemaster Item,,96031067,SPSI,Shoulder 1 View Right,,Per Svc,869.00
Chargemaster Item,,96031075,SPSI,Shoulder 1 View Left,,Per Svc,869.00
Chargemaster Item,,96031083,SPSI,Shoulder 2 Views Right,,Per Svc,978.00
Chargemaster Item,,96031091,SPSI,Shoulder 2 Views Left,,Per Svc,978.00
Chargemaster Item,,96031109,SPSI,Acromioclavicular Joints,,Per Svc,903.00
Chargemaster Item,,96031117,SPSI,Humerus Right,,Per Svc,850.00
Chargemaster Item,,96031125,SPSI,Humerus Left,,Per Svc,850.00
Chargemaster Item,,96031133,SPSI,Elbow 2 Views Right,,Per Svc,886.00
Chargemaster Item,,96031141,SPSI,Elbow 2 Views Left,,Per Svc,886.00
Chargemaster Item,,96031158,SPSI,Elbow 4 Views Right,,Per Svc,1102.00
Chargemaster Item,,96031166,SPSI,Elbow 4 Views Left,,Per Svc,1102.00
Chargemaster Item,,96031174,SPSI,Forearm Right,,Per Svc,705.00
Chargemaster Item,,96031182,SPSI,Forearm Left,,Per Svc,705.00
Chargemaster Item,,96031190,SPSI,Uext Infant Left,,Per Svc,703.00
Chargemaster Item,,96031208,SPSI,Uext Infant Right,,Per Svc,703.00
Chargemaster Item,,96031216,SPSI,Wrist 2 View Right,,Per Svc,861.00
Chargemaster Item,,96031224,SPSI,Wrist 2 View Left,,Per Svc,861.00
Chargemaster Item,,96031232,SPSI,Wrist 4 View Right,,Per Svc,1022.00
Chargemaster Item,,96031240,SPSI,Wrist 4 View Left,,Per Svc,1022.00
Chargemaster Item,,96031257,SPSI,Hand 2 Views Right,,Per Svc,671.00
Chargemaster Item,,96031265,SPSI,Hand 2 Views Left,,Per Svc,671.00
Chargemaster Item,,96031273,SPSI,Pa Hands/Wrist,,Per Svc,671.00
Chargemaster Item,,96031281,SPSI,Hand 3 Views Right,,Per Svc,850.00
Chargemaster Item,,96031299,SPSI,Hand 3 Views Left,,Per Svc,850.00
Chargemaster Item,,96031307,SPSI,Finger(S) Right,,Per Svc,611.00
Chargemaster Item,,96031315,SPSI,Finger(S) Left,,Per Svc,611.00
Chargemaster Item,,96031323,SPSI,Hip 1 View Right,,Per Svc,703.00
Chargemaster Item,,96031331,SPSI,Hip 1 View Left,,Per Svc,703.00
Chargemaster Item,,96031406,SPSI,Femur Right,,Per Svc,850.00
Chargemaster Item,,96031414,SPSI,Femur Left,,Per Svc,783.00
Chargemaster Item,,96031422,SPSI,Knee 1 Or 2 Views Right,,Per Svc,743.00
Chargemaster Item,,96031430,SPSI,Knee 1 Or 2 Views Left,,Per Svc,743.00
Chargemaster Item,,96031448,SPSI,Ap Bil Knees Standing,,Per Svc,1274.00
Chargemaster Item,,96031455,SPSI,Knee 3 Views Left,,Per Svc,846.00
Chargemaster Item,,96031463,SPSI,Knee 3 Views Right,,Per Svc,846.00
Chargemaster Item,,96031471,SPSI,Patella Right,,Per Svc,846.00
Chargemaster Item,,96031489,SPSI,Patella Left,,Per Svc,846.00
Chargemaster Item,,96031497,SPSI,Tibia & Fibia Right,,Per Svc,795.00
Chargemaster Item,,96031505,SPSI,Tibia & Fibia Left,,Per Svc,795.00
Chargemaster Item,,96031513,SPSI,Lext Infant Left,,Per Svc,687.00
Chargemaster Item,,96031521,SPSI,Lext Infant Right,,Per Svc,687.00
Chargemaster Item,,96031539,SPSI,Ankle 2 Views Right,,Per Svc,817.00
Chargemaster Item,,96031547,SPSI,Ankle 2 Views Left,,Per Svc,817.00
Chargemaster Item,,96031554,SPSI,Ankle 4 Views Right,,Per Svc,1061.00
Chargemaster Item,,96031562,SPSI,Ankle 4 Views Left,,Per Svc,1061.00
Chargemaster Item,,96031570,SPSI,Foot 2 Views Right,,Per Svc,788.00
Chargemaster Item,,96031588,SPSI,Foot 2 Views Left,,Per Svc,788.00
Chargemaster Item,,96031596,SPSI,Foot 3 Views Right,,Per Svc,1011.00
Chargemaster Item,,96031604,SPSI,Foot 3 Views Left,,Per Svc,1011.00
Chargemaster Item,,96031612,SPSI,Os Calcis Right,,Per Svc,710.00
Chargemaster Item,,96031620,SPSI,Os Calcis Left,,Per Svc,710.00
Chargemaster Item,,96031638,SPSI,Toe/Toes Right,,Per Svc,622.00
Chargemaster Item,,96031646,SPSI,Toe/Toes Left,,Per Svc,622.00
Chargemaster Item,,96031653,SPSI,Abdomen 1 View,,Per Svc,1095.00
Chargemaster Item,,96031661,SPSI,Kub,,Per Svc,1095.00
Chargemaster Item,,96031679,SPSI,Abdomen 2 Views,,Per Svc,711.00
Chargemaster Item,,96031687,SPSI,Abd Series/Pa Chest,,Per Svc,1095.00
Chargemaster Item,,96031695,SPSI,Nose-Rectum Child Iv,,Per Svc,716.00
Chargemaster Item,,96031703,SPSI,Bone Age Studies,,Per Svc,1034.00
Chargemaster Item,,96031711,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,96031729,SPSI,Osseous Survey Complete,,Per Svc,4402.00
Chargemaster Item,,96031737,SPSI,Osseous Survey Limited,,Per Svc,2135.00
Chargemaster Item,,96031745,SPSI,Infant Osseous Survey,,Per Svc,1545.00
Chargemaster Item,,96031752,SPSI,Ap Standing Feet,,Per Svc,671.00
Chargemaster Item,,96031760,SPSI,Bone Density Periphal Dxa,,Per Svc,741.00
Chargemaster Item,,96031778,SPSI,Bone Density Axial Dxa,,Per Svc,741.00
Chargemaster Item,,96031786,SPSI,Lumbar Dxa Scan,,Per Svc,741.00
Chargemaster Item,,96072081,SPSI,ENTIRE SPINE/SCOLIOSIS 6 VWS,,Per Svc,1383.00
Chargemaster Item,,96072087,SPSI,Entire Spine/Scoliosis 1 View,,Per Svc,1185.00
Chargemaster Item,,96072088,SPSI,Entire Spine/Scoliosis 2/3 Vws,,Per Svc,1383.00
Chargemaster Item,,96072089,SPSI,ENTIRE SPINE/SCOLIOSIS 4 OR 5 VWS,,Per Svc,1383.00
Chargemaster Item,,96073501,SPSI,RT HIP 2 or 3 VIEWS,,Per Svc,941.00
Chargemaster Item,,96073509,SPSI,LT Hip 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,96073523,SPSI,Bilat Hips w or wo Pelvis,,Per Svc,1647.00
Chargemaster Item,,97037014,SPSI,Mandible Limited,,Per Svc,1361.00
Chargemaster Item,,97037022,SPSI,Mandible Complete,,Per Svc,1361.00
Chargemaster Item,,97037030,SPSI,Mastoids Limited,,Per Svc,626.00
Chargemaster Item,,97037048,SPSI,Mastoids Complete,,Per Svc,868.00
Chargemaster Item,,97037055,SPSI,Lim Facial Bones,,Per Svc,1016.00
Chargemaster Item,,97037063,SPSI,Facial Bones,,Per Svc,1221.00
Chargemaster Item,,97037071,SPSI,Nasal Bones,,Per Svc,941.00
Chargemaster Item,,97037089,SPSI,Optic Foramina,,Per Svc,773.00
Chargemaster Item,,97037097,SPSI,Sinuses Limited,,Per Svc,966.00
Chargemaster Item,,97037105,SPSI,Sinuses Complete,,Per Svc,1399.00
Chargemaster Item,,97037113,SPSI,Sella Turcica,,Per Svc,701.00
Chargemaster Item,,97037121,SPSI,Skull 4 Views,,Per Svc,1554.00
Chargemaster Item,,97037139,SPSI,Skull 2 Views,,Per Svc,963.00
Chargemaster Item,,97037147,SPSI,Skull Complete,,Per Svc,1554.00
Chargemaster Item,,97037154,SPSI,Tm Joints Bilateral,,Per Svc,1617.00
Chargemaster Item,,97037162,SPSI,Neck Soft Tissue,,Per Svc,663.00
Chargemaster Item,,97037170,SPSI,Salivary Gland,,Per Svc,891.00
Chargemaster Item,,97037188,SPSI,Chest 1 View,,Per Svc,730.00
Chargemaster Item,,97037196,SPSI,Chest 2 View,,Per Svc,919.00
Chargemaster Item,,97037204,SPSI,Chest 3 Views,,Per Svc,1178.00
Chargemaster Item,,97037212,SPSI,Chest 4 Views,,Per Svc,1547.00
Chargemaster Item,,97037238,SPSI,Ribs W/ Pa Cxr Right,,Per Svc,1082.00
Chargemaster Item,,97037246,SPSI,Ribs W/ Pa Cxr Left,,Per Svc,1082.00
Chargemaster Item,,97037253,SPSI,Ribs Right,,Per Svc,949.00
Chargemaster Item,,97037261,SPSI,Ribs Left,,Per Svc,949.00
Chargemaster Item,,97037279,SPSI,Bilat Ribs,,Per Svc,1275.00
Chargemaster Item,,97037287,SPSI,Bilat Ribs W/ Pa Cxr,,Per Svc,1363.00
Chargemaster Item,,97037295,SPSI,Sternum,,Per Svc,779.00
Chargemaster Item,,97037303,SPSI,Sternoclavicular Joints,,Per Svc,803.00
Chargemaster Item,,97037329,SPSI,Spine 1 View,,Per Svc,752.00
Chargemaster Item,,97037337,SPSI,Cervical Spine 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,97037345,SPSI,Cervical Spine 4 or 5 Views,,Per Svc,1453.00
Chargemaster Item,,97037352,SPSI,Cerv Spine 6 Or More Views,,Per Svc,1865.00
Chargemaster Item,,97037360,SPSI,Cervical Spine 3 or Less Views,,Per Svc,799.00
Chargemaster Item,,97037378,SPSI,Thoracic Spine 4 Plus Views,,Per Svc,1414.00
Chargemaster Item,,97037386,SPSI,Thoracic Spine 2 Views,,Per Svc,1071.00
Chargemaster Item,,97037394,SPSI,Thoracolumbar min 2 Views,,Per Svc,944.00
Chargemaster Item,,97037410,SPSI,Lumbar Sp 2 Or 3 Views,,Per Svc,930.00
Chargemaster Item,,97037428,SPSI,Lumbar Spine 4 Views,,Per Svc,1112.00
Chargemaster Item,,97037436,SPSI,Ls Spine,,Per Svc,1112.00
Chargemaster Item,,97037436INACTV,SPSI,Lumbar Sp 4 Plus Views,,Per Svc,2537.00
Chargemaster Item,,97037444,SPSI,Ls Spine & Bending Views,,Per Svc,1979.00
Chargemaster Item,,97037451,SPSI,Ls Spine Only Bending Views,,Per Svc,1134.00
Chargemaster Item,,97037469,SPSI,Pelvis Ap,,Per Svc,941.00
Chargemaster Item,,97037477,SPSI,Pelvis 2 Views,,Per Svc,941.00
Chargemaster Item,,97037485,SPSI,Sacroiliac Joints,,Per Svc,843.00
Chargemaster Item,,97037493,SPSI,Sacrum & Coccyx,,Per Svc,794.00
Chargemaster Item,,97037501,SPSI,Metastatic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,97037519,SPSI,Metabolic Bone Survey,,Per Svc,2135.00
Chargemaster Item,,97037527,SPSI,Clavicle Right,,Per Svc,710.00
Chargemaster Item,,97037535,SPSI,Clavicle Left,,Per Svc,710.00
Chargemaster Item,,97037543,SPSI,Scapula Right,,Per Svc,1030.00
Chargemaster Item,,97037550,SPSI,Scapula Left,,Per Svc,1030.00
Chargemaster Item,,97037568,SPSI,Shoulder 1 View Right,,Per Svc,869.00
Chargemaster Item,,97037576,SPSI,Shoulder 1 View Left,,Per Svc,869.00
Chargemaster Item,,97037584,SPSI,Shoulder 2 Views Right,,Per Svc,978.00
Chargemaster Item,,97037592,SPSI,Shoulder 2 Views Left,,Per Svc,978.00
Chargemaster Item,,97037600,SPSI,Acromioclavicular Joints,,Per Svc,903.00
Chargemaster Item,,97037618,SPSI,Humerus Right,,Per Svc,850.00
Chargemaster Item,,97037626,SPSI,Humerus Left,,Per Svc,850.00
Chargemaster Item,,97037634,SPSI,Elbow 2 Views Right,,Per Svc,886.00
Chargemaster Item,,97037642,SPSI,Elbow 2 Views Left,,Per Svc,886.00
Chargemaster Item,,97037659,SPSI,Elbow 4 Views Right,,Per Svc,1102.00
Chargemaster Item,,97037667,SPSI,Elbow 4 Views Left,,Per Svc,1102.00
Chargemaster Item,,97037675,SPSI,Forearm Right,,Per Svc,705.00
Chargemaster Item,,97037683,SPSI,Forearm Left,,Per Svc,705.00
Chargemaster Item,,97037691,SPSI,Uext Infant Left,,Per Svc,703.00
Chargemaster Item,,97037709,SPSI,Uext Infant Right,,Per Svc,703.00
Chargemaster Item,,97037717,SPSI,Wrist 2 View Right,,Per Svc,861.00
Chargemaster Item,,97037725,SPSI,Wrist 2 View Left,,Per Svc,861.00
Chargemaster Item,,97037733,SPSI,Wrist 4 View Right,,Per Svc,1022.00
Chargemaster Item,,97037741,SPSI,Wrist 4 View Left,,Per Svc,1022.00
Chargemaster Item,,97037758,SPSI,Hand 2 Views Right,,Per Svc,671.00
Chargemaster Item,,97037766,SPSI,Hand 2 Views Left,,Per Svc,671.00
Chargemaster Item,,97037774,SPSI,Pa Hands/Wrist,,Per Svc,671.00
Chargemaster Item,,97037782,SPSI,Hand 3 Views Right,,Per Svc,850.00
Chargemaster Item,,97037790,SPSI,Hand 3 Views Left,,Per Svc,850.00
Chargemaster Item,,97037808,SPSI,Finger(S) Right,,Per Svc,611.00
Chargemaster Item,,97037816,SPSI,Finger(S) Left,,Per Svc,611.00
Chargemaster Item,,97037824,SPSI,Hip 1 View Right,,Per Svc,703.00
Chargemaster Item,,97037832,SPSI,Hip 1 View Left,,Per Svc,703.00
Chargemaster Item,,97037907,SPSI,Femur Right,,Per Svc,850.00
Chargemaster Item,,97037915,SPSI,Femur Left,,Per Svc,783.00
Chargemaster Item,,97037923,SPSI,Knee 1 Or 2 Views Right,,Per Svc,743.00
Chargemaster Item,,97037931,SPSI,Knee 1 Or 2 Views Left,,Per Svc,743.00
Chargemaster Item,,97037949,SPSI,Ap Bil Knees Standing,,Per Svc,1274.00
Chargemaster Item,,97037956,SPSI,Knee 3 Views Left,,Per Svc,846.00
Chargemaster Item,,97037964,SPSI,Knee 3 Views Right,,Per Svc,846.00
Chargemaster Item,,97037972,SPSI,Patella Right,,Per Svc,846.00
Chargemaster Item,,97037980,SPSI,Patella Left,,Per Svc,846.00
Chargemaster Item,,97037998,SPSI,Tibia & Fibia Right,,Per Svc,795.00
Chargemaster Item,,97038004,SPSI,Tibia & Fibia Left,,Per Svc,795.00
Chargemaster Item,,97038012,SPSI,Lext Infant Left,,Per Svc,687.00
Chargemaster Item,,97038020,SPSI,Lext Infant Right,,Per Svc,687.00
Chargemaster Item,,97038038,SPSI,Ankle 2 Views Right,,Per Svc,817.00
Chargemaster Item,,97038046,SPSI,Ankle 2 Views Left,,Per Svc,817.00
Chargemaster Item,,97038053,SPSI,Ankle 4 Views Right,,Per Svc,1061.00
Chargemaster Item,,97038061,SPSI,Ankle 4 Views Left,,Per Svc,1061.00
Chargemaster Item,,97038079,SPSI,Foot 2 Views Right,,Per Svc,788.00
Chargemaster Item,,97038087,SPSI,Foot 2 Views Left,,Per Svc,788.00
Chargemaster Item,,97038095,SPSI,Foot 3 Views Right,,Per Svc,1011.00
Chargemaster Item,,97038103,SPSI,Foot 3 Views Left,,Per Svc,1011.00
Chargemaster Item,,97038111,SPSI,Os Calcis Right,,Per Svc,710.00
Chargemaster Item,,97038129,SPSI,Os Calcis Left,,Per Svc,710.00
Chargemaster Item,,97038137,SPSI,Toe/Toes Right,,Per Svc,622.00
Chargemaster Item,,97038145,SPSI,Toe/Toes Left,,Per Svc,622.00
Chargemaster Item,,97038152,SPSI,Abdomen 1 View,,Per Svc,1095.00
Chargemaster Item,,97038160,SPSI,Kub,,Per Svc,1095.00
Chargemaster Item,,97038178,SPSI,Abdomen 2 Views,,Per Svc,711.00
Chargemaster Item,,97038186,SPSI,Abd Series/Pa Chest,,Per Svc,1095.00
Chargemaster Item,,97038194,SPSI,Nose-Rectum Child Iv,,Per Svc,716.00
Chargemaster Item,,97038202,SPSI,Bone Age Studies,,Per Svc,1034.00
Chargemaster Item,,97038210,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,97038228,SPSI,Osseous Survey Complete,,Per Svc,4402.00
Chargemaster Item,,97038236,SPSI,Osseous Survey Limited,,Per Svc,2135.00
Chargemaster Item,,97038244,SPSI,Infant Osseous Survey,,Per Svc,1545.00
Chargemaster Item,,97038251,SPSI,Ap Standing Feet,,Per Svc,671.00
Chargemaster Item,,97072086,SPSI,Entire Spine/Scoliosis 1 View,,Per Svc,1185.00
Chargemaster Item,,97072087,SPSI,Entire Spine/Scoliosis 2/3 Vws,,Per Svc,1383.00
Chargemaster Item,,97072088,SPSI,ENTIRE SPINE/SCOLIOSIS 4 OR 5 VWS,,Per Svc,1383.00
Chargemaster Item,,97072089,SPSI,ENTIRE SPINE/SCOLIOSIS 6 VWS,,Per Svc,1383.00
Chargemaster Item,,97073508,SPSI,LT Hip 2 or 3 Views,,Per Svc,941.00
Chargemaster Item,,97073509,SPSI,RT HIP 2 or 3 VIEWS,,Per Svc,941.00
Chargemaster Item,,97073522,SPSI,Bilat Hips w or wo Pelvis,,Per Svc,1647.00
Chargemaster Item,,98218985,SPSI,CT Angio Abdomen & Pelvis,,Per Svc,6788.00
Chargemaster Item,,98218993,SPSI,CT Chest Screening,,Per Svc,443.00
Chargemaster Item,,98232994,SPSI,CT Thorax Screen w/o Contrast,,Per Svc,7998.00
Chargemaster Item,,98233000,SPSI,Ct Heart Cacs Wo Contrast,,Per Svc,9316.00
Chargemaster Item,,98233018,SPSI,Ct Heart Structure W Contrast,,Per Svc,11547.00
Chargemaster Item,,98233083,SPSI,Hocm Per 1Ml Cystoconray Ii,,Per Svc,1.00
Chargemaster Item,,98233091,SPSI,Ultravist 370 Per Ml,,Per Svc,1.00
Chargemaster Item,,98233109,SPSI,Ct Head W Contrast,,Per Svc,8262.00
Chargemaster Item,,98233117,SPSI,Ct Head Wo Contrast,,Per Svc,7578.00
Chargemaster Item,,98233133,SPSI,Ct Orbits W Contrast,,Per Svc,8740.00
Chargemaster Item,,98233141,SPSI,Ct Head W/Wo Contrast,,Per Svc,11250.00
Chargemaster Item,,98233158,SPSI,Ct Orbit Wo Contrast,,Per Svc,7122.00
Chargemaster Item,,98233166,SPSI,Ct Temporal Bones W Contrast,,Per Svc,8740.00
Chargemaster Item,,98233166INACTV,SPSI,Ct Orbit W Contrast,,Per Svc,8580.00
Chargemaster Item,,98233174,SPSI,Ct Sinuses W Contrast,,Per Svc,9076.00
Chargemaster Item,,98233182,SPSI,Ct Orbit W/Wo Contrast,,Per Svc,10191.00
Chargemaster Item,,98233190,SPSI,Ct Temporal Bones Wo Contrast,,Per Svc,7548.00
Chargemaster Item,,98233208,SPSI,Ct Facial Bones Wo Contrast,,Per Svc,4628.00
Chargemaster Item,,98233216,SPSI,Ct Facial Bones W Contrast,,Per Svc,9076.00
Chargemaster Item,,98233224,SPSI,Ct Sinuses Wo Contrast,,Per Svc,4628.00
Chargemaster Item,,98233232,SPSI,Ct Neck Wo Contrast,,Per Svc,6131.00
Chargemaster Item,,98233240,SPSI,Ct Neck W Contrast,,Per Svc,7277.00
Chargemaster Item,,98233257,SPSI,Ct Neck Wo/W Contrast,,Per Svc,9140.00
Chargemaster Item,,98233265,SPSI,Cta Neck,,Per Svc,1788.00
Chargemaster Item,,98233273,SPSI,Ct Chest Wo Contrast,,Per Svc,7998.00
Chargemaster Item,,98233281,SPSI,Ct Thorax W Contrast,,Per Svc,9389.00
Chargemaster Item,,98233299,SPSI,Ct Thorax W/Wo Contrast,,Per Svc,10329.00
Chargemaster Item,,98233307,SPSI,Ct Chest Angio,,Per Svc,4716.00
Chargemaster Item,,98233315,SPSI,Cta Head,,Per Svc,1846.00
Chargemaster Item,,98233323,SPSI,Ct Cervical Spine Wo Contrast,,Per Svc,9407.00
Chargemaster Item,,98233331,SPSI,Ct Cervical Spine W Contrast,,Per Svc,10195.00
Chargemaster Item,,98233349,SPSI,Ct Thoracic Spine Wo Contrast,,Per Svc,7113.00
Chargemaster Item,,98233356,SPSI,Ct Thoracic Spine W Contrast,,Per Svc,8644.00
Chargemaster Item,,98233364,SPSI,Ct Lumbar Spine Wo Contrast,,Per Svc,9034.00
Chargemaster Item,,98233372,SPSI,Ct Lumbar Spine W Contrast,,Per Svc,10416.00
Chargemaster Item,,98233380,SPSI,Ct Lumbar Spine W/Wo Contrast,,Per Svc,12959.00
Chargemaster Item,,98233398,SPSI,Ct Pelvis Angio,,Per Svc,3748.00
Chargemaster Item,,98233406,SPSI,Ct Pelvis Wo Contrast,,Per Svc,7585.00
Chargemaster Item,,98233414,SPSI,Ct Pelvis W Contrast,,Per Svc,8560.00
Chargemaster Item,,98233422,SPSI,Ct Pelvis W/Wo Contrast,,Per Svc,10794.00
Chargemaster Item,,98233430,SPSI,Ct Upper Ext Wo Contrast Right,,Per Svc,6913.00
Chargemaster Item,,98233448,SPSI,Ct Rt Upper Ext W Contrast,,Per Svc,7488.00
Chargemaster Item,,98233455,SPSI,Ct Upper Ext Wo Contrast Left,,Per Svc,6913.00
Chargemaster Item,,98233463,SPSI,Ct Lt Upper Ext W Contrast,,Per Svc,7488.00
Chargemaster Item,,98233471,SPSI,Ct Rt Shoulder Arthrogram,,Per Svc,7063.00
Chargemaster Item,,98233471INACTV,SPSI,Ct Upper Ext W Contrast Right,,Per Svc,7349.00
Chargemaster Item,,98233489,SPSI,Ct Lt Shoulder Arthrogram,,Per Svc,7063.00
Chargemaster Item,,98233489INACTV,SPSI,Ct Upper Ext W Contrast Left,,Per Svc,7349.00
Chargemaster Item,,98233497,SPSI,Cta Uext Right,,Per Svc,2427.00
Chargemaster Item,,98233505,SPSI,Cta Uext Left,,Per Svc,2427.00
Chargemaster Item,,98233513,SPSI,Ct Lower Ext Wo Contrast Right,,Per Svc,6845.00
Chargemaster Item,,98233521,SPSI,Ct Lower Ext W Contrast Right,,Per Svc,7750.00
Chargemaster Item,,98233539,SPSI,Ct Lower Ext Wo Contrast Left,,Per Svc,6845.00
Chargemaster Item,,98233547,SPSI,Ct Lower Ext W Contrast Left,,Per Svc,7750.00
Chargemaster Item,,98233554,SPSI,Cta Lower Ext Right,,Per Svc,2305.00
Chargemaster Item,,98233562,SPSI,Cta Lower Ext Left,,Per Svc,2305.00
Chargemaster Item,,98233570,SPSI,Ct Abdomen Wo Contrast,,Per Svc,7377.00
Chargemaster Item,,98233596,SPSI,Ct Abdomen W Contrast,,Per Svc,9193.00
Chargemaster Item,,98233604,SPSI,Ct Abdomen W/Wo Contrast,,Per Svc,11693.00
Chargemaster Item,,98233612,SPSI,Ct Abdomen Angio,,Per Svc,3038.00
Chargemaster Item,,98233620,SPSI,Cta Aorta-Ilio,,Per Svc,2936.00
Chargemaster Item,,98233638,SPSI,Bone Length Studies,,Per Svc,1346.00
Chargemaster Item,,98233653,SPSI,Visipaque 320 Per Ml,,Per Svc,1.00
Chargemaster Item,,98233661,SPSI,Ct Thoracic Wo/W Contrast,,Per Svc,10839.00
Chargemaster Item,,98233679,SPSI,Ultravist 300 Per Ml,,Per Svc,1.00
Chargemaster Item,,98233687,SPSI,Cta Heart Complete,,Per Svc,5157.00
Chargemaster Item,,98233695,SPSI,Ct Cervical Spine W/Wo Contrst,,Per Svc,10989.00
Chargemaster Item,,98233703,SPSI,Ct Maxillofacial Wo/W Contrast,,Per Svc,9130.00
Chargemaster Item,,98233711,SPSI,Ct Upper Ext W/Wo Contrast Left,,Per Svc,12467.00
Chargemaster Item,,98233729,SPSI,Ct Abd & Pelvis Wo Contrast,,Per Svc,16615.00
Chargemaster Item,,98233737,SPSI,Ct Abd & Pelvis With Contrast,,Per Svc,19676.00
Chargemaster Item,,98233745,SPSI,Ct Abd/Pel Wo/W 1/Both Areas,,Per Svc,24929.00
Chargemaster Item,,98233752,SPSI,Omnipaque 350,,Per Svc,1.00
Chargemaster Item,,99130023,SPSI,Digital Lt Eklund Mamm,,Per Svc,764.00
Chargemaster Item,,99130031,SPSI,Digital Rt Eklund Mamm,,Per Svc,764.00
Chargemaster Item,,99130049,SPSI,Digital Right Mammogram,,Per Svc,764.00
Chargemaster Item,,99130056,SPSI,Digital Left Mammogram,,Per Svc,764.00
Chargemaster Item,,99130064,SPSI,Digital Bilateral Mammography,,Per Svc,826.00
Chargemaster Item,,99130072,SPSI,Digital Screening Mammography,,Per Svc,633.00
Chargemaster Item,,99130403,SPSI,Eklund Screening Combo w/CAD,,Per Svc,809.00
Chargemaster Item,,99130411,SPSI,Lt Eklund Screen Combo w/CAD,,Per Svc,633.00
Chargemaster Item,,99130429,SPSI,Rt Eklund Screen Combo w/CAD,,Per Svc,633.00
Chargemaster Item,,99133806,SPSI,Digital Screen Mam Comb w/ CAD,,Per Svc,809.00
Chargemaster Item,,99133814,SPSI,Low Cost Screen Mam Comb w/ Cad,,Per Svc,75.00
Chargemaster Item,,99133822,SPSI,Digital Rt Eklund Mam Comb/Cad,,Per Svc,937.00
Chargemaster Item,,99133830,SPSI,Digital Lt Eklund Mam Comb/Cad,,Per Svc,937.00
Chargemaster Item,,99133848,SPSI,Digital Bilat Eklund Mam Cad,,Per Svc,998.00
Chargemaster Item,,99133852,SPSI,Screening Tomosynthesis,,Per Svc,178.00
Chargemaster Item,,z71400006,SPSI,Gi Lab Cancelled,,Per Svc,2407.00
Chargemaster Item,,z71400030,SPSI,Endoscopic Biopsy,,Per Svc,4811.00
Chargemaster Item,,z71400048,SPSI,Endoscopic Cytology,,Per Svc,361.00
Chargemaster Item,,z71400055,SPSI,Lower Polypectomy,,Per Svc,5783.00
Chargemaster Item,,z71400063,SPSI,Foreign Body Removal,,Per Svc,3397.00
Chargemaster Item,,z71400071,SPSI,Esoph Sclerosis,,Per Svc,4605.00
Chargemaster Item,,z71401400,SPSI,Esophagduodnoscpy,,Per Svc,3150.00
Chargemaster Item,,z71402002,SPSI,Colonoscopy,,Per Svc,4746.00
Chargemaster Item,,z71402994,SPSI,Flex Sigmoidoscopy,,Per Svc,1426.00
Chargemaster Item,,z71410484,SPSI,Ercp,,Per Svc,4558.00
Chargemaster Item,,z71410492,SPSI,Recovery Room,,First 60 Minutes,1305.00
Chargemaster Item,,z71432199,SPSI,Insertion Of Esophageal Stent,,Per Svc,2836.00
Chargemaster Item,,z71432447,SPSI,Band Ligation,,Per Svc,7518.00
Chargemaster Item,,z71432512,SPSI,Upper Polypectomy,,Per Svc,3666.00
Chargemaster Item,,z71432587,SPSI,Ablation Therapy Ego,,Per Svc,5716.00
Chargemaster Item,,z71432611,SPSI,Ercp W/ Biopsy,,Per Svc,6732.00
Chargemaster Item,,z71432629,SPSI,Sphincterotomy,,Per Svc,2996.00
Chargemaster Item,,z71432645,SPSI,Stone Removal,,Per Svc,4625.00
Chargemaster Item,,z71432652,SPSI,Lithotripsy Of Stone,,Per Svc,4392.00
Chargemaster Item,,z71432686,SPSI,Stent Placement Bilia,,Per Svc,2930.00
Chargemaster Item,,z71432694,SPSI,Ercp w/St Removal,,Per Svc,5102.00
Chargemaster Item,,z71432710,SPSI,Balloon Dilation Of D,,Per Svc,3110.00
Chargemaster Item,,z71432728,SPSI,Ablation Therapy Ercp,,Per Svc,5716.00
Chargemaster Item,,z71434450,SPSI,Dilitation By Balloon,,Per Svc,3878.00
Chargemaster Item,,z71434500,SPSI,Esophag Bouginage,,Per Svc,1041.00
Chargemaster Item,,z71435507,SPSI,Gastrostomy,,Per Svc,6836.00
Chargemaster Item,,z71436505,SPSI,Bicap - Upper,,Per Svc,3666.00
Chargemaster Item,,z71437602,SPSI,Chg Of Gastrostomy/No Scope,,Per Svc,3110.00
Chargemaster Item,,z71440010,SPSI,Bite Block,,Per Svc,46.00
Chargemaster Item,,z71440028,SPSI,Snare,,Per Svc,264.00
Chargemaster Item,,z71440036,SPSI,Forcep,,Per Svc,230.00
Chargemaster Item,,z71440044,SPSI,Cannula,,Per Svc,620.00
Chargemaster Item,,z71440069,SPSI,Stonetome,,Per Svc,2988.00
Chargemaster Item,,z71440085,SPSI,Peg Kit,,Per Svc,1463.00
Chargemaster Item,,z71440119,SPSI,Cre Balloon,,Per Svc,1892.00
Chargemaster Item,,z71440168,SPSI,Cytology Catheter,,Per Svc,793.00
Chargemaster Item,,z71440184,SPSI,Extractor Balloon,,Per Svc,1192.00
Chargemaster Item,,z71440200,SPSI,Injection Gold Probe,,Per Svc,3783.00
Chargemaster Item,,z71441000,SPSI,Sm Bowel Biop,,Per Svc,1724.00
Chargemaster Item,,z71443733,SPSI,Conversion Peg to Pej,,Per Svc,3630.00
Chargemaster Item,,z71453302,SPSI,Sigmodoscopy Biopsy,,Per Svc,1926.00
Chargemaster Item,,z71453385,SPSI,Flex Sig Polypectomy,,Per Svc,2452.00
Chargemaster Item,,z71453799,SPSI,Colon w/Fb Removal,,Per Svc,5038.00
Chargemaster Item,,z71453807,SPSI,Colonoscopy Biopsy,,Per Svc,5217.00
Chargemaster Item,,z71453823,SPSI,Bicap - Lower,,Per Svc,4816.00
Chargemaster Item,,z71453831,SPSI,Ablation Therapy Colo,,Per Svc,6291.00
Chargemaster Item,,z71460034,SPSI,Jejunel Tube,,Per Svc,1549.00
Chargemaster Item,,z71480008,SPSI,Colonoscopy w/ Submucosal Inj,,Per Svc,7873.00
Chargemaster Item,,z71480016,SPSI,Argon Plasma Coagulation Cath,,Per Svc,1112.00
Chargemaster Item,,z71480024,SPSI,Egd w/ Control Of Bleeding,,Per Svc,6063.00
Chargemaster Item,,z71480032,SPSI,Biliary Dilation Catheter,,Per Svc,1444.00
Chargemaster Item,,z71480057,SPSI,Small Bowel Enteroscopy (SBE),,Per Svc,2836.00
Chargemaster Item,,z71480073,SPSI,Ercp + Stent Replacement,,Per Svc,4558.00
Chargemaster Item,,z71480099,SPSI,Colonoscopy w/Control of Bleed,,Per Svc,7296.00
Chargemaster Item,,z71500003,SPSI,Retrieval Net,,Per Svc,213.00
Chargemaster Item,,z71500011,SPSI,Clip Device,,Per Svc,424.00
Chargemaster Item,,z71500029,SPSI,Colonoscopy w/ Banding,,Per Svc,9288.00
Chargemaster Item,,z71500037,SPSI,Retrieval Basket,,Per Svc,705.00
Chargemaster Item,,z71500045,SPSI,Billiary Dilatation Balloon,,Per Svc,1131.00
Chargemaster Item,,z71866776,SPSI,H-Pylori Test,,Per Svc,304.00
Chargemaster Item,,z71911101,SPSI,Capsule Endoscopy,,Per Svc,4894.00
Chargemaster Item,,z71987655,SPSI,Capsule Endoscopy Kit,,Per Svc,2475.00
Chargemaster Item,,z71992119,SPSI,Clinic Visit Est Minimum,,Per Svc,153.00
Cigna,HMO,0042T,CPT4/HCPCS,Ct Head Perfusion Analysis,,% of Charges,6500.00
Cigna,HMO,0390T,CPT4/HCPCS,Peri-Proc Eval/Prog. post Proc,,% of Charges,7966.00
Cigna,HMO,1,DRG,Heart transplant or implant of heart assist system w MCC,,Case Rate,738612.60
Cigna,HMO,10,DRG,Pancreas transplant,,Case Rate,92251.35
Cigna,HMO,100,DRG,Seizures w MCC,,Case Rate,47776.80
Cigna,HMO,10004,CPT4/HCPCS,Fine needle aspiration biopsy, without imaging guidance; each additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,10005,CPT4/HCPCS,Fine needle aspiration biopsy, including ultrasound guidance first lesion,,Case Rate,3000.00
Cigna,HMO,10006,CPT4/HCPCS,Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,10007,CPT4/HCPCS,Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion ,,Case Rate,3000.00
Cigna,HMO,10008,CPT4/HCPCS,Fine needle aspiration biopsy, including fluoroscopic guidance; each additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,10009,CPT4/HCPCS,Fine needle aspiration biopsy, including CT guidance; first lesion ,,Case Rate,3000.00
Cigna,HMO,10010,CPT4/HCPCS,Fine needle aspiration biopsy, including CT guidance; each additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,10011,CPT4/HCPCS,Fine needle aspiration biopsy, including MR guidance; first lesion ,,Case Rate,3000.00
Cigna,HMO,10012,CPT4/HCPCS,Fine needle aspiration biopsy, including MR guidance; each additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,10021,CPT4/HCPCS,FINE NEEDLE ASPIRATION WITHOUT IMAGING GUIDANCE ,,Case Rate,400.00
Cigna,HMO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Case Rate,400.00
Cigna,HMO,10035,CPT4/HCPCS,PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEEDLE, RADIOACTIVE SEEDS), PERCUTANEOUS, INCLUDING IMAGING GUIDANCE; FIRST LESION,,Case Rate,3000.00
Cigna,HMO,10036,CPT4/HCPCS,PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEEDLE, RADIOACTIVE SEEDS), PERCUTANEOUS, INCLUDING IMAGING GUIDANCE; EACH ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,10060,CPT4/HCPCS,Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single,,Case Rate,400.00
Cigna,HMO,10061,CPT4/HCPCS,Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple,,Case Rate,3000.00
Cigna,HMO,10080,CPT4/HCPCS,Incision and drainage of pilonidal cyst; simple,,Case Rate,400.00
Cigna,HMO,10081,CPT4/HCPCS,Incision and drainage of pilonidal cyst; complicated,,Case Rate,400.00
Cigna,HMO,101,DRG,Seizures w/o MCC,,Case Rate,22618.50
Cigna,HMO,10120,CPT4/HCPCS,Incision and removal of foreign body, subcutaneous tissues; simple,,Case Rate,400.00
Cigna,HMO,10121,CPT4/HCPCS,Remove foreign body,,Case Rate,3000.00
Cigna,HMO,10140,CPT4/HCPCS,Incision and drainage of hematoma, seroma or fluid collection,,Case Rate,400.00
Cigna,HMO,10160,CPT4/HCPCS,PUNCTURE ASPIRATION OF ABSCESS HEMATOMA BULLA OR CYST ,,Case Rate,400.00
Cigna,HMO,10180,CPT4/HCPCS,Complex drainage, wound,,Case Rate,3000.00
Cigna,HMO,102,DRG,Headaches w MCC,,Case Rate,29368.35
Cigna,HMO,103,DRG,Headaches w/o MCC,,Case Rate,21119.10
Cigna,HMO,11,DRG,Tracheostomy for face,mouth & neck diagnoses w MCC,,Case Rate,127918.20
Cigna,HMO,11000,CPT4/HCPCS,Debridement of extensive eczematous or infected skin; up to 10% of body surface,,Case Rate,400.00
Cigna,HMO,11001,CPT4/HCPCS,Debridement of extensive eczematous or infected skin; each additional 10% of the body surface (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,11010,CPT4/HCPCS,Debride skin, fx,,Case Rate,3000.00
Cigna,HMO,11011,CPT4/HCPCS,Debride skin/muscle, fx,,Case Rate,3000.00
Cigna,HMO,11012,CPT4/HCPCS,Debride skin/muscle/bone, fx,,Case Rate,3000.00
Cigna,HMO,11042,CPT4/HCPCS,Debride skin/tissue,,Case Rate,3000.00
Cigna,HMO,11043,CPT4/HCPCS,Debride tissue/muscle,,Case Rate,3000.00
Cigna,HMO,11044,CPT4/HCPCS,Debride tissue/muscle/bone,,Case Rate,3000.00
Cigna,HMO,11045,CPT4/HCPCS,DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,11046,CPT4/HCPCS,DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,11047,CPT4/HCPCS,DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,11055,CPT4/HCPCS,PARING OR CUTTING OF BENIGN HYPERKERATOIC LESION (EG. CORN OR CALLUS); SINGLE LESION ,,Case Rate,400.00
Cigna,HMO,11056,CPT4/HCPCS,PARING OR CUTING OF BENIGN HYPERKERATOIC LESION (EG. CORN OR CALOUS); TWO OR FOUR LESIONS ,,Case Rate,400.00
Cigna,HMO,11057,CPT4/HCPCS,PARING OR CUTTING OF BENIGN HYPERKERATOIC LESION (EG. CORN OR CALLUS); MORE THAN 4 LESIONS ,,Case Rate,400.00
Cigna,HMO,11102,CPT4/HCPCS,Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion ,,Case Rate,400.00
Cigna,HMO,11103,CPT4/HCPCS,Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,11104,CPT4/HCPCS,Punch biopsy of skin (including simple closure, when performed); single lesion ,,Case Rate,400.00
Cigna,HMO,11105,CPT4/HCPCS,Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,11106,CPT4/HCPCS,Incisional biopsy of skin (eg, wedge) (including simple closure, when performed) single lesion ,,Case Rate,3000.00
Cigna,HMO,11107,CPT4/HCPCS,Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,11200,CPT4/HCPCS,Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions,,Case Rate,400.00
Cigna,HMO,113,DRG,Orbital procedures w CC/MCC,,Case Rate,55890.90
Cigna,HMO,114,DRG,Orbital procedures w/o CC/MCC,,Case Rate,36860.25
Cigna,HMO,11400,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,HMO,11401,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,HMO,11402,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,HMO,11403,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm,,Case Rate,3000.00
Cigna,HMO,11404,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11406,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11420,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,HMO,11421,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,HMO,11422,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,HMO,11423,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm,,Case Rate,3000.00
Cigna,HMO,11424,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11426,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11440,CPT4/HCPCS,Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,HMO,11441,CPT4/HCPCS,Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,HMO,11442,CPT4/HCPCS,Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,HMO,11443,CPT4/HCPCS,Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm,,Case Rate,3000.00
Cigna,HMO,11444,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11446,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11450,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,HMO,11451,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,HMO,11462,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,HMO,11463,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,HMO,11470,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,HMO,11471,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,HMO,115,DRG,Extraocular procedures except orbit,,Case Rate,37059.15
Cigna,HMO,116,DRG,Intraocular procedures w CC/MCC,,Case Rate,47868.60
Cigna,HMO,11600,CPT4/HCPCS,Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,HMO,11601,CPT4/HCPCS,Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,HMO,11602,CPT4/HCPCS,Excision, malignant lesion, trunk, arms, or legs; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,HMO,11603,CPT4/HCPCS,Excision, malignant lesion, trunk, arms, or legs; lesion diameter 2.1 to 3.0 cm,,Case Rate,3000.00
Cigna,HMO,11604,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11606,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11620,CPT4/HCPCS,Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,HMO,11621,CPT4/HCPCS,Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,HMO,11622,CPT4/HCPCS,Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,HMO,11623,CPT4/HCPCS,Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm,,Case Rate,400.00
Cigna,HMO,11624,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11626,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11640,CPT4/HCPCS,Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,HMO,11641,CPT4/HCPCS,Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,HMO,11642,CPT4/HCPCS,Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,HMO,11643,CPT4/HCPCS,Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 2.1 to 3.0 cm,,Case Rate,3000.00
Cigna,HMO,11644,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,11646,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,HMO,117,DRG,Intraocular procedures w/o CC/MCC,,Case Rate,26491.95
Cigna,HMO,11720,CPT4/HCPCS,DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE OF FIVE ,,Case Rate,3000.00
Cigna,HMO,11721,CPT4/HCPCS,DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MORE ,,Case Rate,3000.00
Cigna,HMO,11730,CPT4/HCPCS,AVULSION OF NAIL PLATE PAR OR COM SIMPL SINGL (CON AS TOS 04) ,,Case Rate,3000.00
Cigna,HMO,11732,CPT4/HCPCS,AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,11740,CPT4/HCPCS,EVACUATION OF SUBUNGUAL HEMATOMA ,,Case Rate,3000.00
Cigna,HMO,11750,CPT4/HCPCS,Excision of nail and nail matrix, partial or complete, (eg, ingrown or deformed nail) for permanent removal,,Case Rate,3000.00
Cigna,HMO,11755,CPT4/HCPCS,BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PROXIMAL AND LATERAL NAIL FOLDS) (SEPARATE PROCEDURE),,Case Rate,3000.00
Cigna,HMO,11760,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED; SIMPLE,,Case Rate,400.00
Cigna,HMO,11762,CPT4/HCPCS,Reconstruction of nail bed with graft,,Case Rate,400.00
Cigna,HMO,11765,CPT4/HCPCS,WEDGE EXCISION OF SKIN OF NAIL FOLD (EG FOR INGROWN TOENAIL) ,,Case Rate,3000.00
Cigna,HMO,11770,CPT4/HCPCS,Removal of pilonidal lesion,,Case Rate,4000.00
Cigna,HMO,11771,CPT4/HCPCS,Removal of pilonidal lesion,,Case Rate,4000.00
Cigna,HMO,11772,CPT4/HCPCS,Removal of pilonidal lesion,,Case Rate,4000.00
Cigna,HMO,11900,CPT4/HCPCS,Injection, intralesional; up to and including seven lesions,,Case Rate,400.00
Cigna,HMO,11901,CPT4/HCPCS,Injection, intralesional; more than seven lesions,,Case Rate,400.00
Cigna,HMO,11920,CPT4/HCPCS,Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less,,Case Rate,400.00
Cigna,HMO,11921,CPT4/HCPCS,Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm,,Case Rate,400.00
Cigna,HMO,11922,CPT4/HCPCS,Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,11960,CPT4/HCPCS,Insert tissue expander(s),,Case Rate,3000.00
Cigna,HMO,11970,CPT4/HCPCS,Replace tissue expander,,Case Rate,4000.00
Cigna,HMO,11971,CPT4/HCPCS,Remove tissue expander(s),,Case Rate,3000.00
Cigna,HMO,11976,CPT4/HCPCS,REMOVAL WITHOUT REINSERTION IMPLANTABLE CONTRACEPTIVE CAPSULES ,,Case Rate,3000.00
Cigna,HMO,11980,CPT4/HCPCS,SUBCUTANEOUS HORMONE PELLET IMPLANTATION (IMPLANTATION OF ESTRADIOL AND/OR TESTOSTERONE PELLETS BENEATH THE SKIN),,Case Rate,400.00
Cigna,HMO,11981,CPT4/HCPCS,INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT ,,Case Rate,3000.00
Cigna,HMO,11982,CPT4/HCPCS,REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT ,,Case Rate,3000.00
Cigna,HMO,11983,CPT4/HCPCS,REMOVAL WITH REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT ,,Case Rate,3000.00
Cigna,HMO,12,DRG,Tracheostomy for face,mouth & neck diagnoses w CC,,Case Rate,97713.45
Cigna,HMO,12001,CPT4/HCPCS,Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less,,Case Rate,400.00
Cigna,HMO,12004,CPT4/HCPCS,Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm,,Case Rate,400.00
Cigna,HMO,12005,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,HMO,12006,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,HMO,12007,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,HMO,12014,CPT4/HCPCS,Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm,,Case Rate,400.00
Cigna,HMO,12015,CPT4/HCPCS,Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm,,Case Rate,400.00
Cigna,HMO,12016,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,HMO,12017,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,HMO,12018,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,HMO,12020,CPT4/HCPCS,Closure of split wound,,Case Rate,3000.00
Cigna,HMO,12021,CPT4/HCPCS,Closure of split wound,,Case Rate,3000.00
Cigna,HMO,12031,CPT4/HCPCS,Layer closure of wounds of scalp, axillae, trunk and/or extremities (excld. hands and feet); 2.5 cm or less,,Case Rate,400.00
Cigna,HMO,12032,CPT4/HCPCS,Layer closure of wounds of scalp, axillae, trunk and/or extremities (excld. hands and feet); 2.6 cm to 7.5 cm,,Case Rate,400.00
Cigna,HMO,12034,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12035,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12036,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12037,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12041,CPT4/HCPCS,Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less,,Case Rate,400.00
Cigna,HMO,12042,CPT4/HCPCS,Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm,,Case Rate,400.00
Cigna,HMO,12044,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12045,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12046,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12047,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12051,CPT4/HCPCS,Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less,,Case Rate,400.00
Cigna,HMO,12052,CPT4/HCPCS,Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm,,Case Rate,400.00
Cigna,HMO,12053,CPT4/HCPCS,Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm,,Case Rate,400.00
Cigna,HMO,12054,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12055,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12056,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,12057,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,HMO,121,DRG,Acute major eye infections w CC/MCC,,Case Rate,30311.85
Cigna,HMO,122,DRG,Acute major eye infections w/o CC/MCC,,Case Rate,16416.90
Cigna,HMO,123,DRG,Neurological eye disorders,,Case Rate,19515.15
Cigna,HMO,124,DRG,Other disorders of the eye w MCC,,Case Rate,35669.40
Cigna,HMO,125,DRG,Other disorders of the eye w/o MCC,,Case Rate,21302.70
Cigna,HMO,13,DRG,Tracheostomy for face,mouth & neck diagnoses w/o CC/MCC,,Case Rate,69372.75
Cigna,HMO,13100,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,3000.00
Cigna,HMO,13101,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,4000.00
Cigna,HMO,13102,CPT4/HCPCS,REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS,,Case Rate,3000.00
Cigna,HMO,13120,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,3000.00
Cigna,HMO,13121,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,4000.00
Cigna,HMO,13122,CPT4/HCPCS,REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS.,,Case Rate,3000.00
Cigna,HMO,13131,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,3000.00
Cigna,HMO,13132,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,4000.00
Cigna,HMO,13133,CPT4/HCPCS,REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE GENITALIA, HANDS AND/OR FEET; EACH ADDITIONAL 5CM OR LESS.,,Case Rate,3000.00
Cigna,HMO,13151,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,4000.00
Cigna,HMO,13152,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,4000.00
Cigna,HMO,13153,CPT4/HCPCS,REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; EACH ADDITIONAL 5 CM OR LESS.,,Case Rate,3000.00
Cigna,HMO,13160,CPT4/HCPCS,Late closure of wound,,Case Rate,3000.00
Cigna,HMO,135,DRG,Sinus & mastoid procedures w CC/MCC,,Case Rate,54585.30
Cigna,HMO,136,DRG,Sinus & mastoid procedures w/o CC/MCC,,Case Rate,32015.25
Cigna,HMO,137,DRG,Mouth procedures w CC/MCC,,Case Rate,37449.30
Cigna,HMO,138,DRG,Mouth procedures w/o CC/MCC,,Case Rate,21499.05
Cigna,HMO,139,DRG,Salivary gland procedures,,Case Rate,31283.40
Cigna,HMO,14,DRG,Allogeneic bone marrow transplant,,Case Rate,325859.40
Cigna,HMO,140,DRG,MAJOR HEAD AND NECK PROCEDURES WITH MCC,,Case Rate,101505.30
Cigna,HMO,14000,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,3000.00
Cigna,HMO,14001,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,HMO,14020,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,HMO,14021,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,HMO,14040,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,3000.00
Cigna,HMO,14041,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,HMO,14060,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,HMO,14061,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,HMO,141,DRG,MAJOR HEAD AND NECK PROCEDURES WITH CC,,Case Rate,56291.25
Cigna,HMO,142,DRG,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,,Case Rate,41024.40
Cigna,HMO,143,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC,,Case Rate,75576.90
Cigna,HMO,14301,CPT4/HCPCS,ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM ,,Case Rate,3000.00
Cigna,HMO,14302,CPT4/HCPCS,ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITI ONAL 30.0 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,14350,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,HMO,144,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC,,Case Rate,44637.75
Cigna,HMO,145,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,,Case Rate,30944.25
Cigna,HMO,146,DRG,Ear, nose, mouth & throat malignancy w MCC,,Case Rate,51844.05
Cigna,HMO,147,DRG,Ear, nose, mouth & throat malignancy w CC,,Case Rate,33178.05
Cigna,HMO,148,DRG,Ear, nose, mouth & throat malignancy w/o CC/MCC,,Case Rate,20050.65
Cigna,HMO,149,DRG,Dysequilibrium,,Case Rate,18755.25
Cigna,HMO,150,DRG,Epistaxis w MCC,,Case Rate,33779.85
Cigna,HMO,15002,CPT4/HCPCS,Wnd prep, ch/inf, trk/arm/lg,,Case Rate,3000.00
Cigna,HMO,15003,CPT4/HCPCS,Wnd prep, ch/inf addl 100 cm,,Case Rate,3000.00
Cigna,HMO,15004,CPT4/HCPCS,Wnd prep ch/inf, f/n/hf/g,,Case Rate,3000.00
Cigna,HMO,15005,CPT4/HCPCS,Wnd prep, f/n/hf/g, addl cm,,Case Rate,3000.00
Cigna,HMO,15040,CPT4/HCPCS,Harvest cultured skin graft,,Case Rate,3000.00
Cigna,HMO,15050,CPT4/HCPCS,Skin pinch graft,,Case Rate,3000.00
Cigna,HMO,151,DRG,Epistaxis w/o MCC,,Case Rate,18793.50
Cigna,HMO,15100,CPT4/HCPCS,Skin split graft,,Case Rate,3000.00
Cigna,HMO,15101,CPT4/HCPCS,Skin split graft add-on,,Case Rate,3000.00
Cigna,HMO,15110,CPT4/HCPCS,Epidrm autogrft trnk/arm/leg,,Case Rate,3000.00
Cigna,HMO,15111,CPT4/HCPCS,Epidrm autogrft t/a/l add-on,,Case Rate,3000.00
Cigna,HMO,15115,CPT4/HCPCS,Epidrm a-grft face/nck/hf/g,,Case Rate,3000.00
Cigna,HMO,15116,CPT4/HCPCS,Epidrm a-grft f/n/hf/g addl,,Case Rate,3000.00
Cigna,HMO,15120,CPT4/HCPCS,Skin split graft,,Case Rate,3000.00
Cigna,HMO,15121,CPT4/HCPCS,Skin split graft add-on,,Case Rate,3000.00
Cigna,HMO,15130,CPT4/HCPCS,Derm autograft, trnk/arm/leg,,Case Rate,3000.00
Cigna,HMO,15131,CPT4/HCPCS,Derm autograft t/a/l add-on,,Case Rate,3000.00
Cigna,HMO,15135,CPT4/HCPCS,Derm autograft face/nck/hf/g,,Case Rate,3000.00
Cigna,HMO,15136,CPT4/HCPCS,Derm autograft, f/n/hf/g add,,Case Rate,3000.00
Cigna,HMO,15150,CPT4/HCPCS,Cult epiderm grft t/arm/leg,,Case Rate,3000.00
Cigna,HMO,15151,CPT4/HCPCS,Cult epiderm grft t/a/l addl,,Case Rate,3000.00
Cigna,HMO,15152,CPT4/HCPCS,Cult epiderm graft t/a/l +%,,Case Rate,3000.00
Cigna,HMO,15155,CPT4/HCPCS,Cult epiderm graft, f/n/hf/g,,Case Rate,3000.00
Cigna,HMO,15156,CPT4/HCPCS,Cult epidrm grft f/n/hfg add,,Case Rate,3000.00
Cigna,HMO,15157,CPT4/HCPCS,Cult epiderm grft f/n/hfg +%,,Case Rate,3000.00
Cigna,HMO,152,DRG,Otitis media & URI w MCC,,Case Rate,27460.95
Cigna,HMO,15200,CPT4/HCPCS,Skin full graft,,Case Rate,4000.00
Cigna,HMO,15201,CPT4/HCPCS,Skin full graft add-on,,Case Rate,3000.00
Cigna,HMO,15220,CPT4/HCPCS,Skin full graft,,Case Rate,3000.00
Cigna,HMO,15221,CPT4/HCPCS,Skin full graft add-on,,Case Rate,3000.00
Cigna,HMO,15240,CPT4/HCPCS,Skin full graft,,Case Rate,4000.00
Cigna,HMO,15241,CPT4/HCPCS,Skin full graft add-on,,Case Rate,3000.00
Cigna,HMO,15260,CPT4/HCPCS,Skin full graft,,Case Rate,3000.00
Cigna,HMO,15261,CPT4/HCPCS,Skin full graft add-on,,Case Rate,3000.00
Cigna,HMO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Case Rate,3000.00
Cigna,HMO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Case Rate,3000.00
Cigna,HMO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Case Rate,3000.00
Cigna,HMO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Case Rate,3000.00
Cigna,HMO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Case Rate,3000.00
Cigna,HMO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Case Rate,3000.00
Cigna,HMO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Case Rate,3000.00
Cigna,HMO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Case Rate,3000.00
Cigna,HMO,153,DRG,Otitis media & URI w/o MCC,,Case Rate,18120.30
Cigna,HMO,154,DRG,Nasal trauma & deformity w MCC,,Case Rate,39333.75
Cigna,HMO,155,DRG,Nasal trauma & deformity w CC,,Case Rate,23123.40
Cigna,HMO,15570,CPT4/HCPCS,Form skin pedicle flap,,Case Rate,4000.00
Cigna,HMO,15572,CPT4/HCPCS,Form skin pedicle flap,,Case Rate,4000.00
Cigna,HMO,15574,CPT4/HCPCS,Form skin pedicle flap,,Case Rate,4000.00
Cigna,HMO,15576,CPT4/HCPCS,Form skin pedicle flap,,Case Rate,4000.00
Cigna,HMO,156,DRG,Nasal trauma & deformity w/o CC/MCC,,Case Rate,16768.80
Cigna,HMO,15600,CPT4/HCPCS,Skin graft,,Case Rate,4000.00
Cigna,HMO,15610,CPT4/HCPCS,Skin graft,,Case Rate,4000.00
Cigna,HMO,15620,CPT4/HCPCS,Skin graft,,Case Rate,4000.00
Cigna,HMO,15630,CPT4/HCPCS,Skin graft,,Case Rate,4000.00
Cigna,HMO,15650,CPT4/HCPCS,Transfer skin pedicle flap,,Case Rate,5000.00
Cigna,HMO,157,DRG,Dental & Oral Diseases w MCC,,Case Rate,40096.20
Cigna,HMO,15730,CPT4/HCPCS,Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s),,Case Rate,3000.00
Cigna,HMO,15731,CPT4/HCPCS,Forehead flap w/vasc pedicle,,Case Rate,4000.00
Cigna,HMO,15733,CPT4/HCPCS,Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae),,Case Rate,3000.00
Cigna,HMO,15734,CPT4/HCPCS,Muscle-skin graft, trunk,,Case Rate,4000.00
Cigna,HMO,15736,CPT4/HCPCS,Muscle-skin graft, arm,,Case Rate,4000.00
Cigna,HMO,15738,CPT4/HCPCS,Muscle-skin graft, leg,,Case Rate,4000.00
Cigna,HMO,15740,CPT4/HCPCS,Island pedicle flap graft,,Case Rate,3000.00
Cigna,HMO,15750,CPT4/HCPCS,Neurovascular pedicle graft,,Case Rate,3000.00
Cigna,HMO,15756,CPT4/HCPCS,Free muscle flap with or without skin with microvascular anastomosis,,Case Rate,3000.00
Cigna,HMO,15757,CPT4/HCPCS,Free skin flap with microvascular anastomosis,,Case Rate,3000.00
Cigna,HMO,15758,CPT4/HCPCS,Free fascial flap with microvascular anastomosis,,Case Rate,3000.00
Cigna,HMO,15760,CPT4/HCPCS,Composite skin graft,,Case Rate,3000.00
Cigna,HMO,15769,CPT4/HCPCS,Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia),,Case Rate,3000.00
Cigna,HMO,15770,CPT4/HCPCS,Derma-fat-fascia graft,,Case Rate,4000.00
Cigna,HMO,15771,CPT4/HCPCS,Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs 50 cc or less injectate,,Case Rate,3000.00
Cigna,HMO,15772,CPT4/HCPCS,Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part there of (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,15773,CPT4/HCPCS,Grafting of autologous fat harvested by liposuction technique to face, eyelids ,mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate,,Case Rate,3000.00
Cigna,HMO,15774,CPT4/HCPCS,Grafting of autologous fat harvested by liposuction technique to face, eyelids ,mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part there of (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,15775,CPT4/HCPCS,Hair transplant punch grafts,,Case Rate,4000.00
Cigna,HMO,15776,CPT4/HCPCS,Hair transplant punch grafts,,Case Rate,4000.00
Cigna,HMO,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,Case Rate,3000.00
Cigna,HMO,158,DRG,Dental & Oral Diseases w CC,,Case Rate,22672.05
Cigna,HMO,15819,CPT4/HCPCS,Cervicoplasty,,Case Rate,3000.00
Cigna,HMO,15820,CPT4/HCPCS,Revision of lower eyelid,,Case Rate,4000.00
Cigna,HMO,15821,CPT4/HCPCS,Revision of lower eyelid,,Case Rate,4000.00
Cigna,HMO,15822,CPT4/HCPCS,Revision of upper eyelid,,Case Rate,4000.00
Cigna,HMO,15823,CPT4/HCPCS,Revision of upper eyelid,,Case Rate,5000.00
Cigna,HMO,15824,CPT4/HCPCS,Removal of forehead wrinkles,,Case Rate,4000.00
Cigna,HMO,15825,CPT4/HCPCS,Removal of neck wrinkles,,Case Rate,4000.00
Cigna,HMO,15826,CPT4/HCPCS,Removal of brow wrinkles,,Case Rate,4000.00
Cigna,HMO,15828,CPT4/HCPCS,Removal of face wrinkles,,Case Rate,4000.00
Cigna,HMO,15829,CPT4/HCPCS,Removal of skin wrinkles,,Case Rate,5000.00
Cigna,HMO,15830,CPT4/HCPCS,Exc skin abd,,Case Rate,4000.00
Cigna,HMO,15832,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,HMO,15833,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,HMO,15834,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,HMO,15835,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,HMO,15836,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,HMO,15837,CPT4/HCPCS,Excision, excessive skin and subcutaneous tissue (including lipectomy); forearm or hand,,Case Rate,3000.00
Cigna,HMO,15838,CPT4/HCPCS,Excision, excessive skin and subcutaneous tissue (including lipectomy); submental fat pad,,Case Rate,3000.00
Cigna,HMO,15839,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,HMO,15840,CPT4/HCPCS,Graft for face nerve palsy,,Case Rate,4000.00
Cigna,HMO,15841,CPT4/HCPCS,Graft for face nerve palsy,,Case Rate,4000.00
Cigna,HMO,15842,CPT4/HCPCS,Flap for face nerve palsy,,Case Rate,4000.00
Cigna,HMO,15845,CPT4/HCPCS,Skin and muscle repair, face,,Case Rate,4000.00
Cigna,HMO,15847,CPT4/HCPCS,Exc skin abd add-on,,Case Rate,3000.00
Cigna,HMO,15850,CPT4/HCPCS,Removal of sutures under anesthesia (other than local), same surgeon,,Case Rate,3000.00
Cigna,HMO,15851,CPT4/HCPCS,Removal of sutures under anesthesia (other than local), other surgeon,,Case Rate,3000.00
Cigna,HMO,15852,CPT4/HCPCS,Dressing change (for other than burns) under anesthesia (other than local),,Case Rate,400.00
Cigna,HMO,15860,CPT4/HCPCS,Intravenous injection of agent (eg, fluorescein) to test blood flow in flap or graft,,Case Rate,400.00
Cigna,HMO,15876,CPT4/HCPCS,Suction assisted lipectomy,,Case Rate,4000.00
Cigna,HMO,15877,CPT4/HCPCS,Suction assisted lipectomy,,Case Rate,4000.00
Cigna,HMO,15878,CPT4/HCPCS,Suction assisted lipectomy,,Case Rate,4000.00
Cigna,HMO,15879,CPT4/HCPCS,Suction assisted lipectomy,,Case Rate,4000.00
Cigna,HMO,159,DRG,Dental & Oral Diseases w/o CC/MCC,,Case Rate,16722.90
Cigna,HMO,15920,CPT4/HCPCS,Removal of tail bone ulcer,,Case Rate,4000.00
Cigna,HMO,15922,CPT4/HCPCS,Removal of tail bone ulcer,,Case Rate,4000.00
Cigna,HMO,15931,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,HMO,15933,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,HMO,15934,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,HMO,15935,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,HMO,15936,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,HMO,15937,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,HMO,15940,CPT4/HCPCS,Remove hip pressure sore,,Case Rate,4000.00
Cigna,HMO,15941,CPT4/HCPCS,Remove hip pressure sore,,Case Rate,4000.00
Cigna,HMO,15944,CPT4/HCPCS,Remove hip pressure sore,,Case Rate,4000.00
Cigna,HMO,15945,CPT4/HCPCS,Remove hip pressure sore,,Case Rate,4000.00
Cigna,HMO,15946,CPT4/HCPCS,Remove hip pressure sore,,Case Rate,4000.00
Cigna,HMO,15950,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,HMO,15951,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,HMO,15952,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,HMO,15953,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,HMO,15956,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,HMO,15958,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,HMO,16,DRG,Autologous bone marrow transplant w CC/MCC,,Case Rate,171518.10
Cigna,HMO,16020,CPT4/HCPCS,Dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small,,Case Rate,3000.00
Cigna,HMO,16025,CPT4/HCPCS,Dress/debrid p-thick burn, m,,Case Rate,3000.00
Cigna,HMO,16030,CPT4/HCPCS,Treatment of burn(s),,Case Rate,3000.00
Cigna,HMO,16035,CPT4/HCPCS,Incision of burn scab, initi,,Case Rate,3000.00
Cigna,HMO,163,DRG,Major chest procedures w MCC,,Case Rate,126469.80
Cigna,HMO,164,DRG,Major chest procedures w CC,,Case Rate,67212.90
Cigna,HMO,165,DRG,Major chest procedures w/o CC/MCC,,Case Rate,48669.30
Cigna,HMO,166,DRG,Other resp system O.R. procedures w MCC,,Case Rate,96637.35
Cigna,HMO,167,DRG,Other resp system O.R. procedures w CC,,Case Rate,47455.50
Cigna,HMO,168,DRG,Other resp system O.R. procedures w/o CC/MCC,,Case Rate,34919.70
Cigna,HMO,17,DRG,Autologous bone marrow transplant w/o CC/MCC,,Case Rate,123170.10
Cigna,HMO,17000,CPT4/HCPCS,Destruction by any method, including laser, with or without surgical curettement, all benign or premalignant lesions (eg, actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions, including local anesthesia; first lesion,,Case Rate,400.00
Cigna,HMO,17003,CPT4/HCPCS,DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), ALL BENIGN OR PREMALIGNANT LESIONS (EG. ACTINIC KERATOSES) OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; SECOND THROUGH 14 LESIONS, EACH,,Case Rate,3000.00
Cigna,HMO,17004,CPT4/HCPCS,DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, ,,Case Rate,3000.00
Cigna,HMO,17106,CPT4/HCPCS,Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm,,Case Rate,3000.00
Cigna,HMO,17107,CPT4/HCPCS,Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 - 50.0 sq cm,,Case Rate,3000.00
Cigna,HMO,17108,CPT4/HCPCS,Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm,,Case Rate,3000.00
Cigna,HMO,17110,CPT4/HCPCS,Destruction by any method of flat warts, molluscum contagiosum, or milia; up to 14 lesions,,Case Rate,400.00
Cigna,HMO,17111,CPT4/HCPCS,DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF FLAT WARTS, MOLLISCUM CONTAGIOSUM, OR MILIA;15 OR MORE LESIONS ,,Case Rate,3000.00
Cigna,HMO,17250,CPT4/HCPCS,CHEMICAL CAUTERIZATION OF GRANULATION TISSUE ( PROUD FLESH, SINUS OR FISTULA) ,,Case Rate,3000.00
Cigna,HMO,17260,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM OR LESS ,,Case Rate,3000.00
Cigna,HMO,17261,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), TRUNK, ARMS OR LEGS; LESION DIAMETER 0.6 TO 1.0 CM ,,Case Rate,3000.00
Cigna,HMO,17262,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), TRUNK, ARMS OR LEGS; LESION DIAMETER 1.1 TO 2.0 CM ,,Case Rate,3000.00
Cigna,HMO,17263,CPT4/HCPCS,Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 2.1 to 3.0 cm,,Case Rate,400.00
Cigna,HMO,17264,CPT4/HCPCS,Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 3.1 to 4.0 cm,,Case Rate,400.00
Cigna,HMO,17266,CPT4/HCPCS,Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter over 4.0 cm,,Case Rate,3000.00
Cigna,HMO,17270,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.5 CM OR LESS ,,Case Rate,3000.00
Cigna,HMO,17271,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM ,,Case Rate,3000.00
Cigna,HMO,17272,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 1.1 TO 2.0 CM ,,Case Rate,3000.00
Cigna,HMO,17273,CPT4/HCPCS,Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm,,Case Rate,400.00
Cigna,HMO,17274,CPT4/HCPCS,Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm,,Case Rate,3000.00
Cigna,HMO,17276,CPT4/HCPCS,Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm,,Case Rate,3000.00
Cigna,HMO,17280,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.5 CM OR LESS ,,Case Rate,3000.00
Cigna,HMO,17281,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM ,,Case Rate,3000.00
Cigna,HMO,17282,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), FACE, EARS, EYELIDS, NOSE,.0 CMLIPS, MUCOUS MEMBRANE; LESION DIAMETER 1.1 TO 2.0 CM ,,Case Rate,3000.00
Cigna,HMO,17283,CPT4/HCPCS,Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm,,Case Rate,400.00
Cigna,HMO,17284,CPT4/HCPCS,Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm,,Case Rate,3000.00
Cigna,HMO,17286,CPT4/HCPCS,Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm,,Case Rate,400.00
Cigna,HMO,17311,CPT4/HCPCS,"Mohs, 1 stage, h/n/hf/g",,Case Rate,3000.00
Cigna,HMO,17312,CPT4/HCPCS,Mohs addl stage,,Case Rate,3000.00
Cigna,HMO,17313,CPT4/HCPCS,"Mohs, 1 stage, t/a/l",,Case Rate,3000.00
Cigna,HMO,17314,CPT4/HCPCS,"Mohs, addl stage, t/a/l",,Case Rate,3000.00
Cigna,HMO,17315,CPT4/HCPCS,"Mohs surg, addl block",,Case Rate,3000.00
Cigna,HMO,175,DRG,Pulmonary embolism w MCC,,Case Rate,39377.10
Cigna,HMO,176,DRG,Pulmonary embolism w/o MCC,,Case Rate,22610.85
Cigna,HMO,177,DRG,Respiratory infections & inflammations w MCC,,Case Rate,47055.15
Cigna,HMO,178,DRG,Respiratory infections & inflammations w CC,,Case Rate,30750.45
Cigna,HMO,179,DRG,Respiratory infections & inflammations w/o CC/MCC,,Case Rate,22213.05
Cigna,HMO,17999,CPT4/HCPCS,UNLISTED PROCEDURE, SKIN, MUCOUS MEM/SUBC TISSUE ,,Case Rate,3000.00
Cigna,HMO,18,DRG,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY,,Case Rate,951889.50
Cigna,HMO,180,DRG,Respiratory neoplasms w MCC,,Case Rate,44313.90
Cigna,HMO,181,DRG,Respiratory neoplasms w CC,,Case Rate,28582.95
Cigna,HMO,182,DRG,Respiratory neoplasms w/o CC/MCC,,Case Rate,20081.25
Cigna,HMO,183,DRG,Major chest trauma w MCC,,Case Rate,39667.80
Cigna,HMO,184,DRG,Major chest trauma w CC,,Case Rate,26504.70
Cigna,HMO,185,DRG,Major chest trauma w/o CC/MCC,,Case Rate,19726.80
Cigna,HMO,186,DRG,Pleural effusion w MCC,,Case Rate,39351.60
Cigna,HMO,187,DRG,Pleural effusion w CC,,Case Rate,26321.10
Cigna,HMO,188,DRG,Pleural effusion w/o CC/MCC,,Case Rate,18566.55
Cigna,HMO,189,DRG,Pulmonary edema & respiratory failure,,Case Rate,31232.40
Cigna,HMO,19,DRG,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,,Case Rate,169878.45
Cigna,HMO,190,DRG,Chronic obstructive pulmonary disease w MCC,,Case Rate,28659.45
Cigna,HMO,19000,CPT4/HCPCS,Puncture aspiration of cyst of breast;,,Case Rate,3000.00
Cigna,HMO,19001,CPT4/HCPCS,PUNCTURE ASPIRATION OF CYST; EACH ADDITIONAL CYST (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,19020,CPT4/HCPCS,Incision of breast lesion,,Case Rate,3000.00
Cigna,HMO,19030,CPT4/HCPCS,Injection procedure only for mammary ductogram or galactogram,,Case Rate,3000.00
Cigna,HMO,19081,CPT4/HCPCS,BX BREAST 1ST LESION STRTCTC,,Case Rate,4000.00
Cigna,HMO,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,Case Rate,3000.00
Cigna,HMO,19083,CPT4/HCPCS,BX BREAST 1ST LESION US IMAG,,Case Rate,4000.00
Cigna,HMO,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,Case Rate,3000.00
Cigna,HMO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Case Rate,4000.00
Cigna,HMO,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,Case Rate,3000.00
Cigna,HMO,191,DRG,Chronic obstructive pulmonary disease w CC,,Case Rate,22519.05
Cigna,HMO,19100,CPT4/HCPCS,Bx breast percut w/o image,,Case Rate,3000.00
Cigna,HMO,19101,CPT4/HCPCS,Biopsy of breast, open,,Case Rate,3000.00
Cigna,HMO,19105,CPT4/HCPCS,"Cryosurg ablate fa, each",,Case Rate,8300.00
Cigna,HMO,19110,CPT4/HCPCS,Nipple exploration,,Case Rate,3000.00
Cigna,HMO,19112,CPT4/HCPCS,Excise breast duct fistula,,Case Rate,4000.00
Cigna,HMO,19120,CPT4/HCPCS,Removal of breast lesion,,Case Rate,4000.00
Cigna,HMO,19125,CPT4/HCPCS,Excision, breast lesion,,Case Rate,4000.00
Cigna,HMO,19126,CPT4/HCPCS,Excision, addl breast lesion,,Case Rate,3000.00
Cigna,HMO,192,DRG,Chronic obstructive pulmonary disease w/o CC/MCC,,Case Rate,17719.95
Cigna,HMO,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,Case Rate,3000.00
Cigna,HMO,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,Case Rate,3000.00
Cigna,HMO,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,Case Rate,3000.00
Cigna,HMO,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,Case Rate,3000.00
Cigna,HMO,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,Case Rate,3000.00
Cigna,HMO,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,Case Rate,3000.00
Cigna,HMO,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,Case Rate,3000.00
Cigna,HMO,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,Case Rate,3000.00
Cigna,HMO,19294,CPT4/HCPCS,Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Case Rate,8300.00
Cigna,HMO,19297,CPT4/HCPCS,Placement Of Radiotherapy Afterloading Balloon Catheter Into The Breast For Interstitial Radioelement Application Following Partial Mastectomy, Includes Imaging Guidance; Concurrent With Partial Mastectomy (List Separately In Addition To Code For Primary,,Case Rate,3000.00
Cigna,HMO,19298,CPT4/HCPCS,Place breast rad tube/caths,,Case Rate,8300.00
Cigna,HMO,193,DRG,Simple pneumonia & pleurisy w MCC,,Case Rate,33422.85
Cigna,HMO,19300,CPT4/HCPCS,Removal of breast tissue,,Case Rate,4000.00
Cigna,HMO,19301,CPT4/HCPCS,Partical mastectomy,,Case Rate,4000.00
Cigna,HMO,19302,CPT4/HCPCS,P-mastectomy w/ln removal,,Case Rate,6000.00
Cigna,HMO,19303,CPT4/HCPCS,Mast, simple, complete,,Case Rate,4000.00
Cigna,HMO,19307,CPT4/HCPCS,"Mast, mod rad",,Case Rate,8300.00
Cigna,HMO,19316,CPT4/HCPCS,Suspension of breast,,Case Rate,4000.00
Cigna,HMO,19318,CPT4/HCPCS,Reduction of large breast,,Case Rate,4000.00
Cigna,HMO,19324,CPT4/HCPCS,Enlarge breast,,Case Rate,4000.00
Cigna,HMO,19325,CPT4/HCPCS,Enlarge breast with implant,,Case Rate,8300.00
Cigna,HMO,19328,CPT4/HCPCS,Removal of breast implant,,Case Rate,3000.00
Cigna,HMO,19330,CPT4/HCPCS,Removal of implant material,,Case Rate,3000.00
Cigna,HMO,19340,CPT4/HCPCS,Immediate breast prosthesis,,Case Rate,3000.00
Cigna,HMO,19342,CPT4/HCPCS,Delayed breast prosthesis,,Case Rate,4000.00
Cigna,HMO,19350,CPT4/HCPCS,Breast reconstruction,,Case Rate,4000.00
Cigna,HMO,19355,CPT4/HCPCS,Correct inverted nipple(s),,Case Rate,4000.00
Cigna,HMO,19357,CPT4/HCPCS,Breast reconstruction,,Case Rate,5000.00
Cigna,HMO,19364,CPT4/HCPCS,Breast reconstruction,,Case Rate,3000.00
Cigna,HMO,19366,CPT4/HCPCS,Breast reconstruction,,Case Rate,5000.00
Cigna,HMO,19370,CPT4/HCPCS,Surgery of breast capsule,,Case Rate,4000.00
Cigna,HMO,19371,CPT4/HCPCS,Removal of breast capsule,,Case Rate,4000.00
Cigna,HMO,19380,CPT4/HCPCS,Revise breast reconstruction,,Case Rate,5000.00
Cigna,HMO,19396,CPT4/HCPCS,PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT ,,Case Rate,3000.00
Cigna,HMO,194,DRG,Simple pneumonia & pleurisy w CC,,Case Rate,22006.50
Cigna,HMO,19499,CPT4/HCPCS,UNLISTED PROCEDURE, BREAST ,,Case Rate,3000.00
Cigna,HMO,195,DRG,Simple pneumonia & pleurisy w/o CC/MCC,,Case Rate,16957.50
Cigna,HMO,196,DRG,Interstitial lung disease w MCC,,Case Rate,44270.55
Cigna,HMO,197,DRG,Interstitial lung disease w CC,,Case Rate,25642.80
Cigna,HMO,198,DRG,Interstitial lung disease w/o CC/MCC,,Case Rate,18928.65
Cigna,HMO,199,DRG,Pneumothorax w MCC,,Case Rate,45583.80
Cigna,HMO,2,DRG,Heart transplant or implant of heart assist system w/o MCC,,Case Rate,406240.50
Cigna,HMO,20,DRG,Intracranial vascular procedures w PDX hemorrhage w MCC,,Case Rate,263162.55
Cigna,HMO,200,DRG,Pneumothorax w CC,,Case Rate,27412.50
Cigna,HMO,201,DRG,Pneumothorax w/o CC/MCC,,Case Rate,18092.25
Cigna,HMO,20103,CPT4/HCPCS,Exploration of penetrating wound (separate procedure); extremity,,Case Rate,3000.00
Cigna,HMO,202,DRG,Bronchitis & asthma w CC/MCC,,Case Rate,24622.80
Cigna,HMO,20200,CPT4/HCPCS,Muscle biopsy,,Case Rate,3000.00
Cigna,HMO,20205,CPT4/HCPCS,Deep muscle biopsy,,Case Rate,4000.00
Cigna,HMO,20206,CPT4/HCPCS,Needle biopsy, muscle,,Case Rate,3000.00
Cigna,HMO,20220,CPT4/HCPCS,Bone biopsy, trocar/needle,,Case Rate,3000.00
Cigna,HMO,20225,CPT4/HCPCS,Bone biopsy, trocar/needle,,Case Rate,3000.00
Cigna,HMO,20240,CPT4/HCPCS,Bone biopsy, excisional,,Case Rate,3000.00
Cigna,HMO,20245,CPT4/HCPCS,Bone biopsy, excisional,,Case Rate,4000.00
Cigna,HMO,20250,CPT4/HCPCS,Open bone biopsy,,Case Rate,4000.00
Cigna,HMO,20251,CPT4/HCPCS,Open bone biopsy,,Case Rate,4000.00
Cigna,HMO,203,DRG,Bronchitis & asthma w/o CC/MCC,,Case Rate,17990.25
Cigna,HMO,204,DRG,Respiratory signs & symptoms,,Case Rate,20208.75
Cigna,HMO,205,DRG,Other respiratory system diagnoses w MCC,,Case Rate,42898.65
Cigna,HMO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT; THERAPEUTIC (SEP PROC) (CON TOS 04) ,,Case Rate,3000.00
Cigna,HMO,20501,CPT4/HCPCS,Injection of sinus tract; diagnostic (sinogram),,Case Rate,3000.00
Cigna,HMO,20520,CPT4/HCPCS,Removal of foreign body in muscle or tendon sheath; simple,,Case Rate,3000.00
Cigna,HMO,20525,CPT4/HCPCS,Removal of foreign body,,Case Rate,4000.00
Cigna,HMO,20526,CPT4/HCPCS,INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC; CORTICOSTEROID), CARPAL TUNNEL ,,Case Rate,3000.00
Cigna,HMO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Case Rate,400.00
Cigna,HMO,20550,CPT4/HCPCS,INJECTION(S); SINGLE TENDON SHEATH, OR LIAGAMENT, APONEUROSIS (EG. PLANTAR "FASCIA") ,,Case Rate,3000.00
Cigna,HMO,20551,CPT4/HCPCS,INJECTION(S); SINGLE TENDON ,,Case Rate,3000.00
Cigna,HMO,20552,CPT4/HCPCS,INJECTION SINGLE OR MULTIPLE TRIGGER POINTS, ONE OR TWO MUSCLE(S) ,,Case Rate,3000.00
Cigna,HMO,20553,CPT4/HCPCS,INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), THREE OR MORE MUSCLE(S) ,,Case Rate,3000.00
Cigna,HMO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Case Rate,8300.00
Cigna,HMO,20560,CPT4/HCPCS,Needle insertion(s) without injection(s); 1 or 2 muscle(s),,Case Rate,3000.00
Cigna,HMO,20561,CPT4/HCPCS,Needle insertion(s) without injection(s); 3 or more muscles,,Case Rate,3000.00
Cigna,HMO,206,DRG,Other respiratory system diagnoses w/o MCC,,Case Rate,22547.10
Cigna,HMO,20600,CPT4/HCPCS,ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL JOINT OR BURSA (EG, FINGERS, TOES) ,,Case Rate,3000.00
Cigna,HMO,20604,CPT4/HCPCS, ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); WITH ULTRASOUND, WITH PERMANENT RECORDING AND REPORTING,,Case Rate,400.00
Cigna,HMO,20605,CPT4/HCPCS,Arthrocentesis, aspiration and/or injection; intermediate joint, bursa or ganglion cyst (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa),,Case Rate,3000.00
Cigna,HMO,20606,CPT4/HCPCS, ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA); WITH ULTRASOUND GUIDANCE, WITH PERMANENT RECORDING AND REPORTING,,Case Rate,400.00
Cigna,HMO,20610,CPT4/HCPCS,Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa),,Case Rate,3000.00
Cigna,HMO,20611,CPT4/HCPCS, ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITH ULTRASOUND GUIDANCE, WITH PERMANENT RECORDING AND REPORTING,,Case Rate,400.00
Cigna,HMO,20612,CPT4/HCPCS,ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION ,,Case Rate,3000.00
Cigna,HMO,20615,CPT4/HCPCS,Aspiration and injection for treatment of bone cyst,,Case Rate,400.00
Cigna,HMO,20650,CPT4/HCPCS,Insert and remove bone pin,,Case Rate,4000.00
Cigna,HMO,20660,CPT4/HCPCS,Apply, remove fixation device,,Case Rate,3000.00
Cigna,HMO,20661,CPT4/HCPCS,Application of head brace,,Case Rate,3000.00
Cigna,HMO,20662,CPT4/HCPCS,Application of pelvis brace,,Case Rate,4000.00
Cigna,HMO,20663,CPT4/HCPCS,Application of thigh brace,,Case Rate,4000.00
Cigna,HMO,20665,CPT4/HCPCS,Removal of fixation device,,Case Rate,400.00
Cigna,HMO,20670,CPT4/HCPCS,Removal of support implant,,Case Rate,3000.00
Cigna,HMO,20680,CPT4/HCPCS,Removal of support implant,,Case Rate,4000.00
Cigna,HMO,20690,CPT4/HCPCS,Apply bone fixation device,,Case Rate,3000.00
Cigna,HMO,20692,CPT4/HCPCS,Apply bone fixation device,,Case Rate,4000.00
Cigna,HMO,20693,CPT4/HCPCS,Adjust bone fixation device,,Case Rate,4000.00
Cigna,HMO,20694,CPT4/HCPCS,Remove bone fixation device,,Case Rate,3000.00
Cigna,HMO,20696,CPT4/HCPCS,APPLICATION OF MULTIPLANE (PINS OR WIRES IN MORE THAN ONE PLANE), UNILATERAL, EXTERNAL FIXATION WITH STEREOTACTIC COMPUTER-ASSISTED ADJUSTMENT (EG, SPATIAL FRAME), INCLUDING IMAGING; INITIAL AND SUBSEQUENT ALIGNMENT(S), ASSESSMENT(S), AND COMPUTATION(S) O,,Case Rate,8300.00
Cigna,HMO,20697,CPT4/HCPCS,APPLICATION OF MULTIPLANE (PINS OR WIRES IN MORE THAN ONE PLANE), UNILATERAL, EXTERNAL FIXATION WITH STEREOTACTIC COMPUTER-ASSISTED ADJUSTMENT (EG, SPATIAL FRAME), INCLUDING IMAGING; EXCHANGE (IE, REMOVAL AND REPLACEMENT) OF STRUT, EACH,,Case Rate,6000.00
Cigna,HMO,207,DRG,Respiratory system diagnosis w ventilator support 96+ hours,,Case Rate,146023.20
Cigna,HMO,20700,CPT4/HCPCS,Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,20701,CPT4/HCPCS,Removal of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,20702,CPT4/HCPCS,Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,20703,CPT4/HCPCS,Removal of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,20704,CPT4/HCPCS,Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,20705,CPT4/HCPCS,Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,208,DRG,Respiratory system diagnosis w ventilator support <96 hours,,Case Rate,64828.65
Cigna,HMO,20900,CPT4/HCPCS,Removal of bone for graft,,Case Rate,4000.00
Cigna,HMO,20902,CPT4/HCPCS,Removal of bone for graft,,Case Rate,4000.00
Cigna,HMO,20910,CPT4/HCPCS,Remove cartilage for graft,,Case Rate,4000.00
Cigna,HMO,20912,CPT4/HCPCS,Remove cartilage for graft,,Case Rate,4000.00
Cigna,HMO,20920,CPT4/HCPCS,Removal of fascia for graft,,Case Rate,4000.00
Cigna,HMO,20922,CPT4/HCPCS,Removal of fascia for graft,,Case Rate,4000.00
Cigna,HMO,20924,CPT4/HCPCS,Removal of tendon for graft,,Case Rate,4000.00
Cigna,HMO,20930,CPT4/HCPCS,ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,20931,CPT4/HCPCS,ALLOGRAFT, STRUCTURAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,20932,CPT4/HCPCS,Allograft, includes templating, cutting, placement and internal fixation, when performed; osteoarticular, including articular surface and contiguous bone (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,20933,CPT4/HCPCS,Allograft, includes templating, cutting, placement and internal fixation, when performed; hemicortical intercalary, partial (ie, hemicylindrical) (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,20934,CPT4/HCPCS,Allograft, includes templating, cutting, placement and internal fixation, when performed; intercalary, complete (ie, cylindrical) (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,20936,CPT4/HCPCS,Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) ,,Case Rate,3000.00
Cigna,HMO,20937,CPT4/HCPCS,Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure) ,,Case Rate,3000.00
Cigna,HMO,20938,CPT4/HCPCS,Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure) ,,Case Rate,3000.00
Cigna,HMO,20939,CPT4/HCPCS,Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,20950,CPT4/HCPCS,MONIT INTER FLUID PRES (INC INS DEV EG WICK CATH ETC) DET OF MUSC COMPAR SYNDR ,,Case Rate,3000.00
Cigna,HMO,20955,CPT4/HCPCS,Fibula bone graft, microvasc,,Case Rate,3000.00
Cigna,HMO,20962,CPT4/HCPCS,Other bone graft, microvasc,,Case Rate,3000.00
Cigna,HMO,20969,CPT4/HCPCS,Bone/skin graft, microvasc,,Case Rate,3000.00
Cigna,HMO,20970,CPT4/HCPCS,Bone/skin graft, iliac crest,,Case Rate,3000.00
Cigna,HMO,20972,CPT4/HCPCS,Bone/skin graft, metatarsal,,Case Rate,4000.00
Cigna,HMO,20973,CPT4/HCPCS,Bone/skin graft, great toe,,Case Rate,4000.00
Cigna,HMO,20975,CPT4/HCPCS,Electrical bone stimulation,,Case Rate,3000.00
Cigna,HMO,20982,CPT4/HCPCS,Ablation, bone tumor(s) (eg, osteoid osteoma, metastasis) radiofrequency, percutaneous, including computed tomographic guidance,,Case Rate,3000.00
Cigna,HMO,20983,CPT4/HCPCS, ABLATION THERAPY FOR REDUCTION OR ERADICATION OF 1 OR MORE BONE TUMORS (EG, METASTASIS) INCLUDING ADJACENT SOFT TISSUE WHEN INVOLVED BY TUMOR EXTENSION, PERCUTANEOUS, INCLUDING IMAGING GUIDANCE WHEN PERFORMED; CRYOABLATION,,Case Rate,3000.00
Cigna,HMO,20985,CPT4/HCPCS,CPTR-ASST DIR MS PX,,Case Rate,3000.00
Cigna,HMO,20999,CPT4/HCPCS,UNLISTED PROCEDURE, MUSCULOSKELETAL SYSTEM, GENERAL ,,Case Rate,3000.00
Cigna,HMO,21,DRG,Intracranial vascular procedures w PDX hemorrhage w CC,,Case Rate,192055.80
Cigna,HMO,21010,CPT4/HCPCS,Incision of jaw joint,,Case Rate,3000.00
Cigna,HMO,21011,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM,,Case Rate,400.00
Cigna,HMO,21012,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 C M OR GREATER ,,Case Rate,3000.00
Cigna,HMO,21013,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); LESS THAN 2 CM,,Case Rate,3000.00
Cigna,HMO,21014,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); 2 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,21015,CPT4/HCPCS,Resection of facial tumor,,Case Rate,4000.00
Cigna,HMO,21016,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FACE OR SCALP; 2 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,21025,CPT4/HCPCS,Excision of bone, lower jaw,,Case Rate,3000.00
Cigna,HMO,21026,CPT4/HCPCS,Excision of facial bone(s),,Case Rate,3000.00
Cigna,HMO,21029,CPT4/HCPCS,Contour of face bone lesion,,Case Rate,3000.00
Cigna,HMO,21030,CPT4/HCPCS,Excision of benign tumor or cyst of facial bone other than mandible,,Case Rate,3000.00
Cigna,HMO,21031,CPT4/HCPCS,Excision of torus mandibularis,,Case Rate,3000.00
Cigna,HMO,21032,CPT4/HCPCS,Excision of maxillary torus palatinus,,Case Rate,3000.00
Cigna,HMO,21034,CPT4/HCPCS,Removal of face bone lesion,,Case Rate,4000.00
Cigna,HMO,21040,CPT4/HCPCS,Removal of jaw bone lesion,,Case Rate,3000.00
Cigna,HMO,21044,CPT4/HCPCS,Removal of jaw bone lesion,,Case Rate,3000.00
Cigna,HMO,21046,CPT4/HCPCS,Excision, benign tumor, mandible,,Case Rate,3000.00
Cigna,HMO,21047,CPT4/HCPCS,Excision, benign tumor, mandible,,Case Rate,3000.00
Cigna,HMO,21048,CPT4/HCPCS,Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion (s),,Case Rate,4000.00
Cigna,HMO,21049,CPT4/HCPCS,Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive or destructive lesion (s),,Case Rate,4000.00
Cigna,HMO,21050,CPT4/HCPCS,Removal of jaw joint,,Case Rate,4000.00
Cigna,HMO,21060,CPT4/HCPCS,Remove jaw joint cartilage,,Case Rate,3000.00
Cigna,HMO,21070,CPT4/HCPCS,Remove coronoid process,,Case Rate,4000.00
Cigna,HMO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Case Rate,400.00
Cigna,HMO,21100,CPT4/HCPCS,Maxillofacial fixation,,Case Rate,3000.00
Cigna,HMO,21110,CPT4/HCPCS,APPLICA INTERDENTAL FIXA DEVICE FOR CONDI OTH THN FRAC/DISLOC INCL REMOVAL ,,Case Rate,3000.00
Cigna,HMO,21116,CPT4/HCPCS,Injection procedure for temporomandibular joint arthrography,,Case Rate,3000.00
Cigna,HMO,21120,CPT4/HCPCS,Reconstruction of chin,,Case Rate,6000.00
Cigna,HMO,21121,CPT4/HCPCS,Reconstruction of chin,,Case Rate,6000.00
Cigna,HMO,21122,CPT4/HCPCS,Reconstruction of chin,,Case Rate,6000.00
Cigna,HMO,21123,CPT4/HCPCS,Reconstruction of chin,,Case Rate,6000.00
Cigna,HMO,21125,CPT4/HCPCS,Augmentation, lower jaw bone,,Case Rate,6000.00
Cigna,HMO,21127,CPT4/HCPCS,Augmentation, lower jaw bone,,Case Rate,8300.00
Cigna,HMO,21137,CPT4/HCPCS,Reduction forehead; contouring only,,Case Rate,3000.00
Cigna,HMO,21138,CPT4/HCPCS,Reduction forehead; contouring and application of prosthetic material or bone graft (incld. obtaining autograft),,Case Rate,3000.00
Cigna,HMO,21141,CPT4/HCPCS,Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft,,Case Rate,3000.00
Cigna,HMO,21142,CPT4/HCPCS,Reconstruction midface, LeFort I; two pieces, segment movement in any direction, without bone graft,,Case Rate,3000.00
Cigna,HMO,21146,CPT4/HCPCS,Reconstruction midface, LeFort I; two pieces, segment movement in any direction, requiring bone grafts (incld. obtaining autografts) (eg, ungrafted unilateral alveolar cleft),,Case Rate,3000.00
Cigna,HMO,21172,CPT4/HCPCS,REC SUP-LAT ORB RIM AND LOWER FORHD, ADV/ALT W/WO GRFTS (INCL OBT AUTOGRFTS) ,,Case Rate,3000.00
Cigna,HMO,21175,CPT4/HCPCS,RECON BIFRON SUP-LAT ORB RIM/LOW FORHD ADVANC/ALT (EGPLAG,TRI,BRACH)W/WO GRE(IN ,,Case Rate,3000.00
Cigna,HMO,21181,CPT4/HCPCS,Contour cranial bone lesion,,Case Rate,6000.00
Cigna,HMO,21193,CPT4/HCPCS,RECONSTRUCT OF MANDIBULAR RAMI, HORIZ, VERT, "C", OR "L" OSTEOTOMY;W/O GRAFT ,,Case Rate,3000.00
Cigna,HMO,21195,CPT4/HCPCS,RECONSTRUCT OF MANDIBULAR RAMI A/O BODY SAGITTAL SPLT; W/O INTERNAL RIGID FIX ,,Case Rate,3000.00
Cigna,HMO,21198,CPT4/HCPCS,OSTEOTOMY, MANDIBLE, SEGMENTAL; ,,Case Rate,3000.00
Cigna,HMO,21199,CPT4/HCPCS,Osteotomy, mandible, segmental; with genioglossus advancement,,Case Rate,3000.00
Cigna,HMO,21206,CPT4/HCPCS,Reconstruct upper jaw bone,,Case Rate,5000.00
Cigna,HMO,21208,CPT4/HCPCS,Augmentation of facial bones,,Case Rate,6000.00
Cigna,HMO,21209,CPT4/HCPCS,Reduction of facial bones,,Case Rate,5000.00
Cigna,HMO,21210,CPT4/HCPCS,Face bone graft,,Case Rate,6000.00
Cigna,HMO,21215,CPT4/HCPCS,Lower jaw bone graft,,Case Rate,6000.00
Cigna,HMO,21230,CPT4/HCPCS,Rib cartilage graft,,Case Rate,6000.00
Cigna,HMO,21235,CPT4/HCPCS,Ear cartilage graft,,Case Rate,6000.00
Cigna,HMO,21240,CPT4/HCPCS,Reconstruction of jaw joint,,Case Rate,4000.00
Cigna,HMO,21242,CPT4/HCPCS,Reconstruction of jaw joint,,Case Rate,5000.00
Cigna,HMO,21243,CPT4/HCPCS,Reconstruction of jaw joint,,Case Rate,5000.00
Cigna,HMO,21244,CPT4/HCPCS,Reconstruction of lower jaw,,Case Rate,6000.00
Cigna,HMO,21245,CPT4/HCPCS,Reconstruction of jaw,,Case Rate,6000.00
Cigna,HMO,21246,CPT4/HCPCS,Reconstruction of jaw,,Case Rate,6000.00
Cigna,HMO,21248,CPT4/HCPCS,Reconstruction of jaw,,Case Rate,6000.00
Cigna,HMO,21249,CPT4/HCPCS,Reconstruction of jaw,,Case Rate,6000.00
Cigna,HMO,21267,CPT4/HCPCS,Revise eye sockets,,Case Rate,6000.00
Cigna,HMO,21270,CPT4/HCPCS,Augmentation, cheek bone,,Case Rate,5000.00
Cigna,HMO,21275,CPT4/HCPCS,Revision, orbitofacial bones,,Case Rate,6000.00
Cigna,HMO,21280,CPT4/HCPCS,Revision of eyelid,,Case Rate,5000.00
Cigna,HMO,21282,CPT4/HCPCS,Revision of eyelid,,Case Rate,5000.00
Cigna,HMO,21295,CPT4/HCPCS,Reconst lwr jaw w/o fixation,,Case Rate,3000.00
Cigna,HMO,21296,CPT4/HCPCS,Reconst lwr jaw w/fixation,,Case Rate,3000.00
Cigna,HMO,21310,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,3000.00
Cigna,HMO,21315,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,3000.00
Cigna,HMO,21320,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,3000.00
Cigna,HMO,21325,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,4000.00
Cigna,HMO,21330,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,5000.00
Cigna,HMO,21335,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,6000.00
Cigna,HMO,21336,CPT4/HCPCS,Treat nasal septal fracture,,Case Rate,4000.00
Cigna,HMO,21337,CPT4/HCPCS,Treat nasal septal fracture,,Case Rate,3000.00
Cigna,HMO,21338,CPT4/HCPCS,Treat nasoethmoid fracture,,Case Rate,4000.00
Cigna,HMO,21339,CPT4/HCPCS,Treat nasoethmoid fracture,,Case Rate,5000.00
Cigna,HMO,21340,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,4000.00
Cigna,HMO,21343,CPT4/HCPCS,Treatment of sinus fracture,,Case Rate,3000.00
Cigna,HMO,21344,CPT4/HCPCS,OPEN TREATMENT OF COMPLICATED (EG, COMMUNITED OR INVOLVING POSTERIOR WALL) FRONTAL SINUS FRACTURE, VIA CORNAL OR MULTIPLE APPROACHES,,Case Rate,3000.00
Cigna,HMO,21345,CPT4/HCPCS,Treat nose/jaw fracture,,Case Rate,6000.00
Cigna,HMO,21346,CPT4/HCPCS,OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); WITH WIRING AND/OR LOCAL FIXATION,,Case Rate,3000.00
Cigna,HMO,21347,CPT4/HCPCS,OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); REQUIRING MULTIPLE OPEN APPROACHES,,Case Rate,3000.00
Cigna,HMO,21348,CPT4/HCPCS,OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LE FORT II TYPE); WITH BONE GRAFTING (INCLUDES OBTAINING GRAFT),,Case Rate,3000.00
Cigna,HMO,21355,CPT4/HCPCS,Treat cheek bone fracture,,Case Rate,4000.00
Cigna,HMO,21356,CPT4/HCPCS,OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FRACTURE (EG, GILLES APPROACH),,Case Rate,4000.00
Cigna,HMO,21360,CPT4/HCPCS,Treat cheek bone fracture,,Case Rate,6000.00
Cigna,HMO,21365,CPT4/HCPCS,Treat cheek bone fracture CMS CORRECTION 5/30/03,,Case Rate,6000.00
Cigna,HMO,21366,CPT4/HCPCS,OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING CRANIAL NERVE FORAMINA) FRACTURE(S) OF MALAR AREA, INCLUDING ZYGOMATIC ARCH AND MALAR TRIPOD; WITH INTERNAL FIXATION AND MULTIPLE SURGICAL APPROACHES WITH BONE GRAFTING (INCLUDES OBTAINING GRAFT,,Case Rate,3000.00
Cigna,HMO,21385,CPT4/HCPCS,Open treatment of orbital floor blowout fracture; transantral approach (Caldwell-Luc type operation),,Case Rate,8300.00
Cigna,HMO,21386,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,3000.00
Cigna,HMO,21387,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,3000.00
Cigna,HMO,21390,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,6000.00
Cigna,HMO,21395,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,3000.00
Cigna,HMO,21400,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,3000.00
Cigna,HMO,21401,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,4000.00
Cigna,HMO,21406,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,4000.00
Cigna,HMO,21407,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,5000.00
Cigna,HMO,21421,CPT4/HCPCS,Treat mouth roof fracture,,Case Rate,4000.00
Cigna,HMO,21422,CPT4/HCPCS,Treat mouth roof fracture,,Case Rate,3000.00
Cigna,HMO,21440,CPT4/HCPCS,REPAIR DENTAL RIDGE FRACTURE,,Case Rate,4000.00
Cigna,HMO,21445,CPT4/HCPCS,Treat dental ridge fracture,,Case Rate,4000.00
Cigna,HMO,21450,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,4000.00
Cigna,HMO,21451,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,4000.00
Cigna,HMO,21452,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,3000.00
Cigna,HMO,21453,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,4000.00
Cigna,HMO,21454,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,5000.00
Cigna,HMO,21461,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,4000.00
Cigna,HMO,21462,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,5000.00
Cigna,HMO,21465,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,4000.00
Cigna,HMO,21470,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,5000.00
Cigna,HMO,21480,CPT4/HCPCS,Reset dislocated jaw,,Case Rate,3000.00
Cigna,HMO,21485,CPT4/HCPCS,Reset dislocated jaw,,Case Rate,3000.00
Cigna,HMO,21490,CPT4/HCPCS,Repair dislocated jaw,,Case Rate,4000.00
Cigna,HMO,21497,CPT4/HCPCS,Interdental wiring,,Case Rate,3000.00
Cigna,HMO,215,DRG,Other heart assist system implant,,Case Rate,284526.45
Cigna,HMO,21501,CPT4/HCPCS,Drain neck/chest lesion,,Case Rate,3000.00
Cigna,HMO,21502,CPT4/HCPCS,Drain chest lesion,,Case Rate,3000.00
Cigna,HMO,21510,CPT4/HCPCS,Drainage of bone lesion,,Case Rate,3000.00
Cigna,HMO,21550,CPT4/HCPCS,Biopsy of neck/chest,,Case Rate,3000.00
Cigna,HMO,21552,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTA NEOUS; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,21554,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASC IAL (EG, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,21555,CPT4/HCPCS,Remove lesion, neck/chest,,Case Rate,3000.00
Cigna,HMO,21556,CPT4/HCPCS,Remove lesion, neck/chest,,Case Rate,3000.00
Cigna,HMO,21557,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF NECK OR ANTERIOR THORAX; LESS THAN 5 CM ,,Case Rate,3000.00
Cigna,HMO,21558,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,8300.00
Cigna,HMO,21600,CPT4/HCPCS,Partial removal of rib,,Case Rate,3000.00
Cigna,HMO,21601,CPT4/HCPCS,Excision of chest wall tumor including rib(s),,Case Rate,3000.00
Cigna,HMO,21610,CPT4/HCPCS,Partial removal of rib,,Case Rate,3000.00
Cigna,HMO,21620,CPT4/HCPCS,Partial removal of sternum,,Case Rate,3000.00
Cigna,HMO,21685,CPT4/HCPCS,Hyoid myotomy and suspension,,Case Rate,3000.00
Cigna,HMO,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,8300.00
Cigna,HMO,21700,CPT4/HCPCS,Revision of neck muscle,,Case Rate,3000.00
Cigna,HMO,21720,CPT4/HCPCS,Revision of neck muscle,,Case Rate,4000.00
Cigna,HMO,21725,CPT4/HCPCS,Revision of neck muscle,,Case Rate,4000.00
Cigna,HMO,21740,CPT4/HCPCS,Reconstructive repair of pectus excavatum or carinatum,,Case Rate,3000.00
Cigna,HMO,21742,CPT4/HCPCS,Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure) without thoracoscopy,,Case Rate,4000.00
Cigna,HMO,21743,CPT4/HCPCS,Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure) with thoracoscopy,,Case Rate,4000.00
Cigna,HMO,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,8300.00
Cigna,HMO,21811,CPT4/HCPCS, OPEN TREATMENT OF RIB FRACTURE(S) WITH INTERNAL FIXATION, INCLUDES THORACOSCOPIC VISUALIZATION WHEN PERFORMED, UNILATERAL; 1-3 RIBS,,Case Rate,8300.00
Cigna,HMO,21812,CPT4/HCPCS, OPEN TREATMENT OF RIB FRACTURE(S) WITH INTERNAL FIXATION, INCLUDES THORACOSCOPIC VISUALIZATION WHEN PERFORMED, UNILATERAL; 4-6 RIBS,,Case Rate,8300.00
Cigna,HMO,21813,CPT4/HCPCS, OPEN TREATMENT OF RIB FRACTURE(S) WITH INTERNAL FIXATION, INCLUDES THORACOSCOPIC VISUALIZATION WHEN PERFORMED, UNILATERAL; 7 OR MORE RIBS,,Case Rate,8300.00
Cigna,HMO,21820,CPT4/HCPCS,Treat sternum fracture,,Case Rate,3000.00
Cigna,HMO,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,8300.00
Cigna,HMO,21920,CPT4/HCPCS,Biopsy soft tissue of back,,Case Rate,3000.00
Cigna,HMO,21925,CPT4/HCPCS,Biopsy soft tissue of back,,Case Rate,3000.00
Cigna,HMO,21930,CPT4/HCPCS,Remove lesion, back or flank,,Case Rate,3000.00
Cigna,HMO,21931,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 C M OR GREATER ,,Case Rate,3000.00
Cigna,HMO,21932,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, I NTRAMUSCULAR); LESS THAN 5 CM ,,Case Rate,3000.00
Cigna,HMO,21933,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, I NTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,21935,CPT4/HCPCS,Remove tumor, back,,Case Rate,4000.00
Cigna,HMO,21936,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,22,DRG,Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC,,Case Rate,123919.80
Cigna,HMO,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,8300.00
Cigna,HMO,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,8300.00
Cigna,HMO,22100,CPT4/HCPCS,Remove part of neck vertebra,,Case Rate,8300.00
Cigna,HMO,22101,CPT4/HCPCS,Remove part, thorax vertebra,,Case Rate,8300.00
Cigna,HMO,22102,CPT4/HCPCS,Remove part, lumbar vertebra,,Case Rate,8300.00
Cigna,HMO,22103,CPT4/HCPCS,Remove extra spine segment,,Case Rate,8300.00
Cigna,HMO,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,8300.00
Cigna,HMO,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,8300.00
Cigna,HMO,22310,CPT4/HCPCS,Treat spine fracture,,Case Rate,3000.00
Cigna,HMO,22315,CPT4/HCPCS,Treat spine fracture,,Case Rate,3000.00
Cigna,HMO,22318,CPT4/HCPCS,OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S) (INCLUDING OS ODONTOIDEUM), ANTERIOR APPROACH, INCLUDING PLACEMENT OF INTERNAL FIXATION;WITHOUT GRAFTING.,,Case Rate,3000.00
Cigna,HMO,22319,CPT4/HCPCS,OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S) (INCLUDING OS ODONTOIDEUM), ANTERIOR APPROACH, INCLUDING PLACEMENT OF INTERNAL FIXATION; WITH GRAFTING,,Case Rate,3000.00
Cigna,HMO,22325,CPT4/HCPCS,Treat spine fracture,,Case Rate,3000.00
Cigna,HMO,22326,CPT4/HCPCS,Treat neck spine fracture,,Case Rate,3000.00
Cigna,HMO,22327,CPT4/HCPCS,Treat thorax spine fracture,,Case Rate,3000.00
Cigna,HMO,22328,CPT4/HCPCS,Treat each add spine fx,,Case Rate,3000.00
Cigna,HMO,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,8300.00
Cigna,HMO,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,8300.00
Cigna,HMO,22505,CPT4/HCPCS,Manipulation of spine,,Case Rate,3000.00
Cigna,HMO,22510,CPT4/HCPCS, PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; CERVICOTHORACIC,,Case Rate,8300.00
Cigna,HMO,22511,CPT4/HCPCS, PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBOSACRAL,,Case Rate,8300.00
Cigna,HMO,22512,CPT4/HCPCS, PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL CERVICOTHORACIC OR LUMBOSACRAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE ,,Case Rate,8300.00
Cigna,HMO,22513,CPT4/HCPCS, PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANC,,Case Rate,3000.00
Cigna,HMO,22514,CPT4/HCPCS, PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANC,,Case Rate,3000.00
Cigna,HMO,22515,CPT4/HCPCS, PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANC,,Case Rate,3000.00
Cigna,HMO,22526,CPT4/HCPCS,"Idet, single level",,Case Rate,8300.00
Cigna,HMO,22527,CPT4/HCPCS,"Idet, 1 or more levels",,Case Rate,8300.00
Cigna,HMO,22551,CPT4/HCPCS,ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATIO N, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AN D/OR NERVE ROOTS; CERVICAL BELOW C2 ,,Case Rate,3000.00
Cigna,HMO,22552,CPT4/HCPCS,Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure) ,,Case Rate,3000.00
Cigna,HMO,22554,CPT4/HCPCS,ARTHRODESIS, ANTERIOR INTERBODY TECH, INCL MIN DISKECTOMY; CERVICAL BELOW C2 ,,Case Rate,3000.00
Cigna,HMO,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,8300.00
Cigna,HMO,22612,CPT4/HCPCS,ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL ; LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE, WHEN PERFORMED) ,,Case Rate,3000.00
Cigna,HMO,22614,CPT4/HCPCS,SPINE FUSION, EXTRA SEGMENT ,,Case Rate,3000.00
Cigna,HMO,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,8300.00
Cigna,HMO,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,8300.00
Cigna,HMO,22840,CPT4/HCPCS,Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary proced,,Case Rate,3000.00
Cigna,HMO,22842,CPT4/HCPCS,Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) ,,Case Rate,3000.00
Cigna,HMO,22845,CPT4/HCPCS,Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) ,,Case Rate,3000.00
Cigna,HMO,22853,CPT4/HCPCS,Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each inter,,Case Rate,3000.00
Cigna,HMO,22854,CPT4/HCPCS,Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) ,,Case Rate,3000.00
Cigna,HMO,22856,CPT4/HCPCS,TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION), SINGLE INTERSPACE, CERVICAL ,,Case Rate,3000.00
Cigna,HMO,22858,CPT4/HCPCS, TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SECOND LEVEL, CERVICAL (LIST SEPARATELY IN ADDITION ,,Case Rate,3000.00
Cigna,HMO,22859,CPT4/HCPCS,Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary,,Case Rate,3000.00
Cigna,HMO,22867,CPT4/HCPCS,Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level,,Case Rate,3000.00
Cigna,HMO,22868,CPT4/HCPCS,Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,22869,CPT4/HCPCS,Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level,,Case Rate,3000.00
Cigna,HMO,22870,CPT4/HCPCS,Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,22899,CPT4/HCPCS,UNLISTED PROCEDURE, SPINE ,,Case Rate,3000.00
Cigna,HMO,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,8300.00
Cigna,HMO,22900,CPT4/HCPCS,Remove abdominal wall lesion,,Case Rate,4000.00
Cigna,HMO,22901,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,22902,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; LE SS THAN 3 CM ,,Case Rate,3000.00
Cigna,HMO,22903,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,22904,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF ABDOMINAL WALL; LESS THAN 5 CM ,,Case Rate,3000.00
Cigna,HMO,22905,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF ABDOMINAL WALL; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,22999,CPT4/HCPCS,UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM ,,Case Rate,3000.00
Cigna,HMO,23,DRG,Cranio w major dev impl/acute complex CNS PDX w MCC or chemo implant,,Case Rate,144388.65
Cigna,HMO,230,DRG,Other cardiothoracic procedures w/o CC/MCC,,Case Rate,8300.00
Cigna,HMO,23000,CPT4/HCPCS,Removal of calcium deposits,,Case Rate,3000.00
Cigna,HMO,23020,CPT4/HCPCS,Release shoulder joint,,Case Rate,3000.00
Cigna,HMO,23030,CPT4/HCPCS,Drain shoulder lesion,,Case Rate,3000.00
Cigna,HMO,23031,CPT4/HCPCS,Drain shoulder bursa,,Case Rate,4000.00
Cigna,HMO,23035,CPT4/HCPCS,Drain shoulder bone lesion,,Case Rate,4000.00
Cigna,HMO,23040,CPT4/HCPCS,Exploratory shoulder surgery,,Case Rate,4000.00
Cigna,HMO,23044,CPT4/HCPCS,Exploratory shoulder surgery,,Case Rate,4000.00
Cigna,HMO,23065,CPT4/HCPCS,Biopsy shoulder tissues,,Case Rate,3000.00
Cigna,HMO,23066,CPT4/HCPCS,Biopsy shoulder tissues,,Case Rate,3000.00
Cigna,HMO,23071,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 C M OR GREATER ,,Case Rate,3000.00
Cigna,HMO,23073,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, I NTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,23075,CPT4/HCPCS,Removal of shoulder lesion,,Case Rate,3000.00
Cigna,HMO,23076,CPT4/HCPCS,Removal of shoulder lesion,,Case Rate,3000.00
Cigna,HMO,23077,CPT4/HCPCS,Remove tumor of shoulder,,Case Rate,4000.00
Cigna,HMO,23078,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF SHOULDER AREA; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,8300.00
Cigna,HMO,23100,CPT4/HCPCS,Biopsy of shoulder joint,,Case Rate,3000.00
Cigna,HMO,23101,CPT4/HCPCS,Shoulder joint surgery,,Case Rate,6000.00
Cigna,HMO,23105,CPT4/HCPCS,Remove shoulder joint lining,,Case Rate,4000.00
Cigna,HMO,23106,CPT4/HCPCS,Incision of collarbone joint,,Case Rate,4000.00
Cigna,HMO,23107,CPT4/HCPCS,Explore treat shoulder joint,,Case Rate,4000.00
Cigna,HMO,23120,CPT4/HCPCS,Partial removal, collar bone,,Case Rate,5000.00
Cigna,HMO,23125,CPT4/HCPCS,Removal of collar bone,,Case Rate,5000.00
Cigna,HMO,23130,CPT4/HCPCS,Remove shoulder bone, part,,Case Rate,5000.00
Cigna,HMO,23140,CPT4/HCPCS,Removal of bone lesion,,Case Rate,4000.00
Cigna,HMO,23145,CPT4/HCPCS,Removal of bone lesion,,Case Rate,5000.00
Cigna,HMO,23146,CPT4/HCPCS,Removal of bone lesion,,Case Rate,5000.00
Cigna,HMO,23150,CPT4/HCPCS,Removal of humerus lesion,,Case Rate,4000.00
Cigna,HMO,23155,CPT4/HCPCS,Removal of humerus lesion,,Case Rate,5000.00
Cigna,HMO,23156,CPT4/HCPCS,Removal of humerus lesion,,Case Rate,5000.00
Cigna,HMO,23170,CPT4/HCPCS,Remove collar bone lesion,,Case Rate,3000.00
Cigna,HMO,23172,CPT4/HCPCS,Remove shoulder blade lesion,,Case Rate,3000.00
Cigna,HMO,23174,CPT4/HCPCS,Remove humerus lesion,,Case Rate,3000.00
Cigna,HMO,23180,CPT4/HCPCS,Remove collar bone lesion,,Case Rate,4000.00
Cigna,HMO,23182,CPT4/HCPCS,Remove shoulder blade lesion,,Case Rate,4000.00
Cigna,HMO,23184,CPT4/HCPCS,Remove humerus lesion,,Case Rate,4000.00
Cigna,HMO,23190,CPT4/HCPCS,Partial removal of scapula,,Case Rate,4000.00
Cigna,HMO,23195,CPT4/HCPCS,Removal of head of humerus,,Case Rate,5000.00
Cigna,HMO,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,8300.00
Cigna,HMO,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,8300.00
Cigna,HMO,23330,CPT4/HCPCS,Remove shoulder foreign body,,Case Rate,3000.00
Cigna,HMO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Case Rate,4000.00
Cigna,HMO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Case Rate,8300.00
Cigna,HMO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Case Rate,3000.00
Cigna,HMO,23350,CPT4/HCPCS,Injection procedure for shoulder arthrography or enhanced ct/mri shoulder athrography,,Case Rate,3000.00
Cigna,HMO,23395,CPT4/HCPCS,Muscle transfer,shoulder/arm,,Case Rate,5000.00
Cigna,HMO,23397,CPT4/HCPCS,Muscle transfers,,Case Rate,6000.00
Cigna,HMO,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,8300.00
Cigna,HMO,23400,CPT4/HCPCS,Fixation of shoulder blade,,Case Rate,6000.00
Cigna,HMO,23405,CPT4/HCPCS,Incision of tendon & muscle,,Case Rate,3000.00
Cigna,HMO,23406,CPT4/HCPCS,Incise tendon(s) & muscle(s),,Case Rate,3000.00
Cigna,HMO,23410,CPT4/HCPCS,Repair of tendon(s),,Case Rate,5000.00
Cigna,HMO,23412,CPT4/HCPCS,Repair of tendon(s),,Case Rate,6000.00
Cigna,HMO,23415,CPT4/HCPCS,Release of shoulder ligament,,Case Rate,5000.00
Cigna,HMO,23420,CPT4/HCPCS,Repair of shoulder,,Case Rate,6000.00
Cigna,HMO,23430,CPT4/HCPCS,Repair biceps tendon,,Case Rate,4000.00
Cigna,HMO,23440,CPT4/HCPCS,Remove/transplant tendon,,Case Rate,4000.00
Cigna,HMO,23450,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,5000.00
Cigna,HMO,23455,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,6000.00
Cigna,HMO,23460,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,5000.00
Cigna,HMO,23462,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,6000.00
Cigna,HMO,23465,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,5000.00
Cigna,HMO,23466,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,6000.00
Cigna,HMO,23470,CPT4/HCPCS,ARTHROPLASTY, GLENOHUMERAL JOINT; HENIARTHOPLASTY ,,Case Rate,3000.00
Cigna,HMO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Case Rate,3000.00
Cigna,HMO,23480,CPT4/HCPCS,Revision of collar bone,,Case Rate,4000.00
Cigna,HMO,23485,CPT4/HCPCS,Revision of collar bone,,Case Rate,6000.00
Cigna,HMO,23490,CPT4/HCPCS,Reinforce clavicle,,Case Rate,4000.00
Cigna,HMO,23491,CPT4/HCPCS,Reinforce shoulder bones,,Case Rate,4000.00
Cigna,HMO,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,8300.00
Cigna,HMO,23500,CPT4/HCPCS,Treat clavicle fracture,,Case Rate,3000.00
Cigna,HMO,23505,CPT4/HCPCS,Treat clavicle fracture,,Case Rate,3000.00
Cigna,HMO,23515,CPT4/HCPCS,Treat clavicle fracture,,Case Rate,4000.00
Cigna,HMO,23520,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,3000.00
Cigna,HMO,23525,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,3000.00
Cigna,HMO,23530,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,4000.00
Cigna,HMO,23532,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,4000.00
Cigna,HMO,23540,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,3000.00
Cigna,HMO,23545,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,3000.00
Cigna,HMO,23550,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,4000.00
Cigna,HMO,23552,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,4000.00
Cigna,HMO,23570,CPT4/HCPCS,Treat shoulder blade fx,,Case Rate,3000.00
Cigna,HMO,23575,CPT4/HCPCS,Treat shoulder blade fx,,Case Rate,3000.00
Cigna,HMO,23585,CPT4/HCPCS,Treat scapula fracture,,Case Rate,4000.00
Cigna,HMO,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,8300.00
Cigna,HMO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Case Rate,3000.00
Cigna,HMO,23605,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,23615,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,HMO,23616,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,HMO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Case Rate,3000.00
Cigna,HMO,23625,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,23630,CPT4/HCPCS,Treat humerus fracture,,Case Rate,5000.00
Cigna,HMO,23650,CPT4/HCPCS,Treat shoulder dislocation,,Case Rate,3000.00
Cigna,HMO,23655,CPT4/HCPCS,Treat shoulder dislocation,,Case Rate,3000.00
Cigna,HMO,23660,CPT4/HCPCS,Treat shoulder dislocation,,Case Rate,4000.00
Cigna,HMO,23665,CPT4/HCPCS,Treat dislocation/fracture,,Case Rate,3000.00
Cigna,HMO,23670,CPT4/HCPCS,Treat dislocation/fracture,,Case Rate,4000.00
Cigna,HMO,23675,CPT4/HCPCS,Treat dislocation/fracture,,Case Rate,3000.00
Cigna,HMO,23680,CPT4/HCPCS,Treat dislocation/fracture,,Case Rate,4000.00
Cigna,HMO,237,DRG,Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair,,Case Rate,8300.00
Cigna,HMO,23700,CPT4/HCPCS,Fixation of shoulder,,Case Rate,3000.00
Cigna,HMO,238,DRG,Major cardiovasc procedures w/o MCC,,Case Rate,8300.00
Cigna,HMO,23800,CPT4/HCPCS,Fusion of shoulder joint,,Case Rate,4000.00
Cigna,HMO,23802,CPT4/HCPCS,Fusion of shoulder joint,,Case Rate,6000.00
Cigna,HMO,239,DRG,Amputation for circ sys disorders exc upper limb & toe w MCC,,Case Rate,122621.85
Cigna,HMO,23921,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,HMO,23929,CPT4/HCPCS,Unlisted procedure, shoulder,,Case Rate,3000.00
Cigna,HMO,23930,CPT4/HCPCS,Drainage of arm lesion,,Case Rate,3000.00
Cigna,HMO,23931,CPT4/HCPCS,Drainage of arm bursa,,Case Rate,3000.00
Cigna,HMO,23935,CPT4/HCPCS,Drain arm/elbow bone lesion,,Case Rate,3000.00
Cigna,HMO,24,DRG,Cranio w major dev impl/acute complex CNS PDX w/o MCC,,Case Rate,100278.75
Cigna,HMO,240,DRG,Amputation for circ sys disorders exc upper limb & toe w CC,,Case Rate,71145.00
Cigna,HMO,24000,CPT4/HCPCS,Exploratory elbow surgery,,Case Rate,4000.00
Cigna,HMO,24006,CPT4/HCPCS,Release elbow joint,,Case Rate,4000.00
Cigna,HMO,24065,CPT4/HCPCS,Biopsy arm/elbow soft tissue,,Case Rate,3000.00
Cigna,HMO,24066,CPT4/HCPCS,Biopsy arm/elbow soft tissue,,Case Rate,3000.00
Cigna,HMO,24071,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTA NEOUS; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,24073,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASC IAL (EG, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,24075,CPT4/HCPCS,Remove arm/elbow lesion,,Case Rate,3000.00
Cigna,HMO,24076,CPT4/HCPCS,Remove arm/elbow lesion,,Case Rate,3000.00
Cigna,HMO,24077,CPT4/HCPCS,Remove tumor of arm/elbow,,Case Rate,4000.00
Cigna,HMO,24079,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF UPPER ARM OR ELBOW AREA; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,241,DRG,Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC,,Case Rate,40580.70
Cigna,HMO,24100,CPT4/HCPCS,Biopsy elbow joint lining,,Case Rate,3000.00
Cigna,HMO,24101,CPT4/HCPCS,Explore/treat elbow joint,,Case Rate,4000.00
Cigna,HMO,24102,CPT4/HCPCS,Remove elbow joint lining,,Case Rate,4000.00
Cigna,HMO,24105,CPT4/HCPCS,Removal of elbow bursa,,Case Rate,4000.00
Cigna,HMO,24110,CPT4/HCPCS,Remove humerus lesion,,Case Rate,3000.00
Cigna,HMO,24115,CPT4/HCPCS,Remove/graft bone lesion,,Case Rate,4000.00
Cigna,HMO,24116,CPT4/HCPCS,Remove/graft bone lesion,,Case Rate,4000.00
Cigna,HMO,24120,CPT4/HCPCS,Remove elbow lesion,,Case Rate,4000.00
Cigna,HMO,24125,CPT4/HCPCS,Remove/graft bone lesion,,Case Rate,4000.00
Cigna,HMO,24126,CPT4/HCPCS,Remove/graft bone lesion,,Case Rate,4000.00
Cigna,HMO,24130,CPT4/HCPCS,Removal of head of radius,,Case Rate,4000.00
Cigna,HMO,24134,CPT4/HCPCS,Removal of arm bone lesion,,Case Rate,3000.00
Cigna,HMO,24136,CPT4/HCPCS,Remove radius bone lesion,,Case Rate,3000.00
Cigna,HMO,24138,CPT4/HCPCS,Remove elbow bone lesion,,Case Rate,3000.00
Cigna,HMO,24140,CPT4/HCPCS,Partial removal of arm bone,,Case Rate,4000.00
Cigna,HMO,24145,CPT4/HCPCS,Partial removal of radius,,Case Rate,4000.00
Cigna,HMO,24147,CPT4/HCPCS,Partial removal of elbow,,Case Rate,3000.00
Cigna,HMO,24149,CPT4/HCPCS,RADICAL RESECTION OF CAPSULE, SOFT TISSUE, AND HETEROTOPIC BONE, ELBOW, WITH CONTRACTURE RELEASE (SEPARATE PROCEDURE) . (FOR CAPSULAR AND SOFT TISSUE RELEASE ONLY, USE 24006) ,,Case Rate,3000.00
Cigna,HMO,24150,CPT4/HCPCS,Extensive humerus surgery,,Case Rate,4000.00
Cigna,HMO,24152,CPT4/HCPCS,Extensive radius surgery,,Case Rate,4000.00
Cigna,HMO,24155,CPT4/HCPCS,Removal of elbow joint,,Case Rate,4000.00
Cigna,HMO,24160,CPT4/HCPCS,Remove elbow joint implant,,Case Rate,3000.00
Cigna,HMO,24164,CPT4/HCPCS,Remove radius head implant,,Case Rate,4000.00
Cigna,HMO,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,8300.00
Cigna,HMO,24201,CPT4/HCPCS,Removal of arm foreign body,,Case Rate,3000.00
Cigna,HMO,24220,CPT4/HCPCS,Injection procedure for elbow arthrography,,Case Rate,3000.00
Cigna,HMO,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,8300.00
Cigna,HMO,24300,CPT4/HCPCS,MANIPULATION, ELBOW, UNDER ANESTHESIA,,Case Rate,4000.00
Cigna,HMO,24301,CPT4/HCPCS,Muscle/tendon transfer,,Case Rate,4000.00
Cigna,HMO,24305,CPT4/HCPCS,Arm tendon lengthening,,Case Rate,4000.00
Cigna,HMO,24310,CPT4/HCPCS,Revision of arm tendon,,Case Rate,4000.00
Cigna,HMO,24320,CPT4/HCPCS,Repair of arm tendon,,Case Rate,4000.00
Cigna,HMO,24330,CPT4/HCPCS,Revision of arm muscles,,Case Rate,4000.00
Cigna,HMO,24331,CPT4/HCPCS,Revision of arm muscles,,Case Rate,4000.00
Cigna,HMO,24332,CPT4/HCPCS,TENOLYSIS, TRICEPS,,Case Rate,4000.00
Cigna,HMO,24340,CPT4/HCPCS,Repair of biceps tendon,,Case Rate,4000.00
Cigna,HMO,24341,CPT4/HCPCS,Repair arm tendon/muscle,,Case Rate,4000.00
Cigna,HMO,24342,CPT4/HCPCS,Repair of ruptured tendon,,Case Rate,4000.00
Cigna,HMO,24343,CPT4/HCPCS,REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW WITH LOCAL TISSUE,,Case Rate,4000.00
Cigna,HMO,24344,CPT4/HCPCS,Reconstruction lateral collateral ligament,elbow with tendon graft [includes harvesting of graft,,Case Rate,4000.00
Cigna,HMO,24345,CPT4/HCPCS,Repr elbw med ligmnt w/tissu,,Case Rate,3000.00
Cigna,HMO,24346,CPT4/HCPCS,Reconstruction medial collateral ligament,elbow with tendon graft [includes harvesting of graft,,Case Rate,4000.00
Cigna,HMO,24357,CPT4/HCPCS,REPAIR ELBOW, PERC,,Case Rate,8300.00
Cigna,HMO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB, OPEN,,Case Rate,8300.00
Cigna,HMO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Case Rate,8300.00
Cigna,HMO,24360,CPT4/HCPCS,Reconstruct elbow joint,,Case Rate,5000.00
Cigna,HMO,24361,CPT4/HCPCS,Reconstruct elbow joint,,Case Rate,3000.00
Cigna,HMO,24362,CPT4/HCPCS,Reconstruct elbow joint,,Case Rate,5000.00
Cigna,HMO,24363,CPT4/HCPCS,Replace elbow joint,,Case Rate,3000.00
Cigna,HMO,24365,CPT4/HCPCS,Reconstruct head of radius,,Case Rate,5000.00
Cigna,HMO,24366,CPT4/HCPCS,Reconstruct head of radius,,Case Rate,3000.00
Cigna,HMO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Case Rate,3000.00
Cigna,HMO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Case Rate,3000.00
Cigna,HMO,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,8300.00
Cigna,HMO,24400,CPT4/HCPCS,Revision of humerus,,Case Rate,4000.00
Cigna,HMO,24410,CPT4/HCPCS,Revision of humerus,,Case Rate,4000.00
Cigna,HMO,24420,CPT4/HCPCS,Revision of humerus,,Case Rate,4000.00
Cigna,HMO,24430,CPT4/HCPCS,Repair of humerus,,Case Rate,4000.00
Cigna,HMO,24435,CPT4/HCPCS,Repair humerus with graft,,Case Rate,4000.00
Cigna,HMO,24470,CPT4/HCPCS,Revision of elbow joint,,Case Rate,4000.00
Cigna,HMO,24495,CPT4/HCPCS,Decompression of forearm,,Case Rate,3000.00
Cigna,HMO,24498,CPT4/HCPCS,Reinforce humerus,,Case Rate,4000.00
Cigna,HMO,245,DRG,AICD lead & generator procedures,,Case Rate,138057.00
Cigna,HMO,24500,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24505,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24515,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,HMO,24516,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,HMO,24530,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24535,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24538,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24545,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,HMO,24546,CPT4/HCPCS,Treat humerus fracture,,Case Rate,5000.00
Cigna,HMO,24560,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24565,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24566,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24575,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,HMO,24576,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24577,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24579,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,HMO,24582,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,HMO,24586,CPT4/HCPCS,Treat elbow fracture,,Case Rate,4000.00
Cigna,HMO,24587,CPT4/HCPCS,Treat elbow fracture,,Case Rate,5000.00
Cigna,HMO,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,8300.00
Cigna,HMO,24600,CPT4/HCPCS,Treat elbow dislocation,,Case Rate,3000.00
Cigna,HMO,24605,CPT4/HCPCS,Treat elbow dislocation,,Case Rate,3000.00
Cigna,HMO,24615,CPT4/HCPCS,Treat elbow dislocation,,Case Rate,4000.00
Cigna,HMO,24620,CPT4/HCPCS,Treat elbow fracture,,Case Rate,3000.00
Cigna,HMO,24635,CPT4/HCPCS,Treat elbow fracture,,Case Rate,4000.00
Cigna,HMO,24650,CPT4/HCPCS,Closed treatment of radial head or neck fracture; without manipulation,,Case Rate,400.00
Cigna,HMO,24655,CPT4/HCPCS,Treat radius fracture,,Case Rate,3000.00
Cigna,HMO,24665,CPT4/HCPCS,Treat radius fracture,,Case Rate,4000.00
Cigna,HMO,24666,CPT4/HCPCS,Treat radius fracture,,Case Rate,4000.00
Cigna,HMO,24670,CPT4/HCPCS,Treat ulnar fracture,,Case Rate,3000.00
Cigna,HMO,24675,CPT4/HCPCS,Treat ulnar fracture,,Case Rate,3000.00
Cigna,HMO,24685,CPT4/HCPCS,Treat ulnar fracture,,Case Rate,4000.00
Cigna,HMO,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,8300.00
Cigna,HMO,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,8300.00
Cigna,HMO,24800,CPT4/HCPCS,Fusion of elbow joint,,Case Rate,4000.00
Cigna,HMO,24802,CPT4/HCPCS,Fusion/graft of elbow joint,,Case Rate,5000.00
Cigna,HMO,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,8300.00
Cigna,HMO,24925,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,HMO,24999,CPT4/HCPCS,UNLISTED PROCEDURE, HUMERUS OR ELBOW ,,Case Rate,3000.00
Cigna,HMO,25,DRG,Craniotomy & endovascular intracranial procedures w MCC,,Case Rate,114538.35
Cigna,HMO,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,8300.00
Cigna,HMO,25000,CPT4/HCPCS,Incision of tendon sheath,,Case Rate,4000.00
Cigna,HMO,25001,CPT4/HCPCS,INCISION, FLEXOR TENDON SHEATH, WRIST (EG, FLEXOR CARPI radials,,Case Rate,4000.00
Cigna,HMO,25020,CPT4/HCPCS,Decompress forearm 1 space,,Case Rate,4000.00
Cigna,HMO,25023,CPT4/HCPCS,Decompress forearm 1 space,,Case Rate,4000.00
Cigna,HMO,25024,CPT4/HCPCS,Decompress forearm 2 spaces,,Case Rate,4000.00
Cigna,HMO,25025,CPT4/HCPCS,Decompress forarm 2 spaces,,Case Rate,4000.00
Cigna,HMO,25028,CPT4/HCPCS,Drainage of forearm lesion,,Case Rate,3000.00
Cigna,HMO,25031,CPT4/HCPCS,Drainage of forearm bursa,,Case Rate,3000.00
Cigna,HMO,25035,CPT4/HCPCS,Treat forearm bone lesion,,Case Rate,3000.00
Cigna,HMO,25040,CPT4/HCPCS,Explore/treat wrist joint,,Case Rate,5000.00
Cigna,HMO,25065,CPT4/HCPCS,Biopsy forearm soft tissues,,Case Rate,3000.00
Cigna,HMO,25066,CPT4/HCPCS,Biopsy forearm soft tissues,,Case Rate,3000.00
Cigna,HMO,25071,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCU TANEOUS; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,25073,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBFA SCIAL (EG, INTRAMUSCULAR); 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,25075,CPT4/HCPCS,Remove forearm lesion subcut,,Case Rate,3000.00
Cigna,HMO,25076,CPT4/HCPCS,Remove forearm lesion deep,,Case Rate,4000.00
Cigna,HMO,25077,CPT4/HCPCS,Remove tumor, forearm/wrist,,Case Rate,4000.00
Cigna,HMO,25078,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FOREARM AND/OR WRIST AREA; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,25085,CPT4/HCPCS,Incision of wrist capsule,,Case Rate,4000.00
Cigna,HMO,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,8300.00
Cigna,HMO,25100,CPT4/HCPCS,Biopsy of wrist joint,,Case Rate,3000.00
Cigna,HMO,25101,CPT4/HCPCS,Explore/treat wrist joint,,Case Rate,4000.00
Cigna,HMO,25105,CPT4/HCPCS,Remove wrist joint lining,,Case Rate,4000.00
Cigna,HMO,25107,CPT4/HCPCS,Remove wrist joint cartilage,,Case Rate,4000.00
Cigna,HMO,25109,CPT4/HCPCS,Excise tendon forearm/wrist,,Case Rate,4000.00
Cigna,HMO,25110,CPT4/HCPCS,Remove wrist tendon lesion,,Case Rate,4000.00
Cigna,HMO,25111,CPT4/HCPCS,Remove wrist tendon lesion,,Case Rate,4000.00
Cigna,HMO,25112,CPT4/HCPCS,Reremove wrist tendon lesion,,Case Rate,4000.00
Cigna,HMO,25115,CPT4/HCPCS,Remove wrist/forearm lesion,,Case Rate,4000.00
Cigna,HMO,25116,CPT4/HCPCS,Remove wrist/forearm lesion,,Case Rate,4000.00
Cigna,HMO,25118,CPT4/HCPCS,Excise wrist tendon sheath,,Case Rate,3000.00
Cigna,HMO,25119,CPT4/HCPCS,Partial removal of ulna,,Case Rate,4000.00
Cigna,HMO,25120,CPT4/HCPCS,Removal of forearm lesion,,Case Rate,4000.00
Cigna,HMO,25125,CPT4/HCPCS,Remove/graft forearm lesion,,Case Rate,4000.00
Cigna,HMO,25126,CPT4/HCPCS,Remove/graft forearm lesion,,Case Rate,4000.00
Cigna,HMO,25130,CPT4/HCPCS,Removal of wrist lesion,,Case Rate,4000.00
Cigna,HMO,25135,CPT4/HCPCS,Remove & graft wrist lesion,,Case Rate,4000.00
Cigna,HMO,25136,CPT4/HCPCS,Remove & graft wrist lesion,,Case Rate,4000.00
Cigna,HMO,25145,CPT4/HCPCS,Remove forearm bone lesion,,Case Rate,3000.00
Cigna,HMO,25150,CPT4/HCPCS,Partial removal of ulna,,Case Rate,3000.00
Cigna,HMO,25151,CPT4/HCPCS,Partial removal of radius,,Case Rate,3000.00
Cigna,HMO,25170,CPT4/HCPCS,Extensive forearm surgery,,Case Rate,4000.00
Cigna,HMO,252,DRG,Other vascular procedures w MCC,,Case Rate,84677.85
Cigna,HMO,25210,CPT4/HCPCS,Removal of wrist bone,,Case Rate,4000.00
Cigna,HMO,25215,CPT4/HCPCS,Removal of wrist bones,,Case Rate,4000.00
Cigna,HMO,25230,CPT4/HCPCS,Partial removal of radius,,Case Rate,4000.00
Cigna,HMO,25240,CPT4/HCPCS,Partial removal of ulna,,Case Rate,4000.00
Cigna,HMO,25246,CPT4/HCPCS,Injection procedure for wrist arthrography,,Case Rate,3000.00
Cigna,HMO,25248,CPT4/HCPCS,Remove forearm foreign body,,Case Rate,3000.00
Cigna,HMO,25250,CPT4/HCPCS,Removal of wrist prosthesis,,Case Rate,3000.00
Cigna,HMO,25251,CPT4/HCPCS,Removal of wrist prosthesis,,Case Rate,3000.00
Cigna,HMO,25259,CPT4/HCPCS,MANIPULATION, WRIST, UNDER ANESTHESIA,,Case Rate,4000.00
Cigna,HMO,25260,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,4000.00
Cigna,HMO,25263,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,3000.00
Cigna,HMO,25265,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,4000.00
Cigna,HMO,25270,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,4000.00
Cigna,HMO,25272,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,4000.00
Cigna,HMO,25274,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,4000.00
Cigna,HMO,25275,CPT4/HCPCS,Repair forearm tendon sheath,,Case Rate,4000.00
Cigna,HMO,25280,CPT4/HCPCS,Revise wrist/forearm tendon,,Case Rate,4000.00
Cigna,HMO,25290,CPT4/HCPCS,Incise wrist/forearm tendon,,Case Rate,4000.00
Cigna,HMO,25295,CPT4/HCPCS,Release wrist/forearm tendon,,Case Rate,4000.00
Cigna,HMO,253,DRG,Other vascular procedures w CC,,Case Rate,67669.35
Cigna,HMO,25300,CPT4/HCPCS,Fusion of tendons at wrist,,Case Rate,4000.00
Cigna,HMO,25301,CPT4/HCPCS,Fusion of tendons at wrist,,Case Rate,4000.00
Cigna,HMO,25310,CPT4/HCPCS,Transplant forearm tendon,,Case Rate,4000.00
Cigna,HMO,25312,CPT4/HCPCS,Transplant forearm tendon,,Case Rate,4000.00
Cigna,HMO,25315,CPT4/HCPCS,Revise palsy hand tendon(s),,Case Rate,4000.00
Cigna,HMO,25316,CPT4/HCPCS,Revise palsy hand tendon(s),,Case Rate,4000.00
Cigna,HMO,25320,CPT4/HCPCS,Repair/revise wrist joint,,Case Rate,4000.00
Cigna,HMO,25332,CPT4/HCPCS,Revise wrist joint,,Case Rate,5000.00
Cigna,HMO,25335,CPT4/HCPCS,Realignment of hand,,Case Rate,4000.00
Cigna,HMO,25337,CPT4/HCPCS,Reconstruct ulna/radioulnar,,Case Rate,5000.00
Cigna,HMO,25350,CPT4/HCPCS,Revision of radius,,Case Rate,4000.00
Cigna,HMO,25355,CPT4/HCPCS,Revision of radius,,Case Rate,4000.00
Cigna,HMO,25360,CPT4/HCPCS,Revision of ulna,,Case Rate,4000.00
Cigna,HMO,25365,CPT4/HCPCS,Revise radius & ulna,,Case Rate,4000.00
Cigna,HMO,25370,CPT4/HCPCS,Revise radius or ulna,,Case Rate,4000.00
Cigna,HMO,25375,CPT4/HCPCS,Revise radius & ulna,,Case Rate,4000.00
Cigna,HMO,25390,CPT4/HCPCS,Shorten radius or ulna,,Case Rate,4000.00
Cigna,HMO,25391,CPT4/HCPCS,Lengthen radius or ulna,,Case Rate,4000.00
Cigna,HMO,25392,CPT4/HCPCS,Shorten radius & ulna,,Case Rate,4000.00
Cigna,HMO,25393,CPT4/HCPCS,Lengthen radius & ulna,,Case Rate,4000.00
Cigna,HMO,25394,CPT4/HCPCS,OSTEOPLASTY, CARPAL BONE, SHORTENING,,Case Rate,4000.00
Cigna,HMO,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,46142.25
Cigna,HMO,25400,CPT4/HCPCS,Repair radius or ulna,,Case Rate,4000.00
Cigna,HMO,25405,CPT4/HCPCS,Repair/graft radius or ulna,,Case Rate,4000.00
Cigna,HMO,25415,CPT4/HCPCS,Repair radius & ulna,,Case Rate,4000.00
Cigna,HMO,25420,CPT4/HCPCS,Repair/graft radius & ulna,,Case Rate,4000.00
Cigna,HMO,25425,CPT4/HCPCS,Repair/graft radius or ulna,,Case Rate,4000.00
Cigna,HMO,25426,CPT4/HCPCS,Repair/graft radius & ulna,,Case Rate,4000.00
Cigna,HMO,25430,CPT4/HCPCS,INSERTION OF VASCULAR PEDICLE INTO CARPAL BONE (EG, HARII PROCEDURE),,Case Rate,4000.00
Cigna,HMO,25431,CPT4/HCPCS,REPAIR OF NONUNION OF CARPAL BONE (EXCLUDING CARPAL SCAPHOID (NAVICULAR))(INCLUDES OBTAINING GRAFT AND NECESSARY FIXATION), EACH BONE,,Case Rate,4000.00
Cigna,HMO,25440,CPT4/HCPCS,Repair/graft wrist bone,,Case Rate,4000.00
Cigna,HMO,25441,CPT4/HCPCS,Reconstruct wrist joint,,Case Rate,3000.00
Cigna,HMO,25442,CPT4/HCPCS,Reconstruct wrist joint,,Case Rate,3000.00
Cigna,HMO,25443,CPT4/HCPCS,Reconstruct wrist joint,,Case Rate,5000.00
Cigna,HMO,25444,CPT4/HCPCS,Reconstruct wrist joint,,Case Rate,5000.00
Cigna,HMO,25445,CPT4/HCPCS,Reconstruct wrist joint,,Case Rate,5000.00
Cigna,HMO,25446,CPT4/HCPCS,Wrist replacement,,Case Rate,3000.00
Cigna,HMO,25447,CPT4/HCPCS,Repair wrist joint(s),,Case Rate,5000.00
Cigna,HMO,25449,CPT4/HCPCS,Remove wrist joint implant,,Case Rate,5000.00
Cigna,HMO,25450,CPT4/HCPCS,Revision of wrist joint,,Case Rate,4000.00
Cigna,HMO,25455,CPT4/HCPCS,Revision of wrist joint,,Case Rate,4000.00
Cigna,HMO,25490,CPT4/HCPCS,Reinforce radius,,Case Rate,4000.00
Cigna,HMO,25491,CPT4/HCPCS,Reinforce ulna,,Case Rate,4000.00
Cigna,HMO,25492,CPT4/HCPCS,Reinforce radius and ulna,,Case Rate,4000.00
Cigna,HMO,255,DRG,Upper limb & toe amputation for circ system disorders w MCC,,Case Rate,64846.50
Cigna,HMO,25500,CPT4/HCPCS,Closed treatment of radial shaft fracture; without manipulation,,Case Rate,400.00
Cigna,HMO,25505,CPT4/HCPCS,Treat fracture of radius,,Case Rate,3000.00
Cigna,HMO,25515,CPT4/HCPCS,Treat fracture of radius,,Case Rate,4000.00
Cigna,HMO,25520,CPT4/HCPCS,Treat fracture of radius,,Case Rate,3000.00
Cigna,HMO,25525,CPT4/HCPCS,Treat fracture of radius,,Case Rate,4000.00
Cigna,HMO,25526,CPT4/HCPCS,Treat fracture of radius,,Case Rate,5000.00
Cigna,HMO,25530,CPT4/HCPCS,Closed treatment of ulnar shaft fracture; without manipulation,,Case Rate,400.00
Cigna,HMO,25535,CPT4/HCPCS,Treat fracture of ulna,,Case Rate,3000.00
Cigna,HMO,25545,CPT4/HCPCS,Treat fracture of ulna,,Case Rate,4000.00
Cigna,HMO,25560,CPT4/HCPCS,Closed treatment of radial and ulnar shaft fractures; without manipulation,,Case Rate,400.00
Cigna,HMO,25565,CPT4/HCPCS,Treat fracture radius & ulna,,Case Rate,3000.00
Cigna,HMO,25574,CPT4/HCPCS,Treat fracture radius & ulna,,Case Rate,4000.00
Cigna,HMO,25575,CPT4/HCPCS,Treat fracture radius/ulna,,Case Rate,4000.00
Cigna,HMO,256,DRG,Upper limb & toe amputation for circ system disorders w CC,,Case Rate,41899.05
Cigna,HMO,25600,CPT4/HCPCS,Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, with or without fracture of ulnar styloid; without manipulation,,Case Rate,400.00
Cigna,HMO,25605,CPT4/HCPCS,Treat fracture radius/ulna,,Case Rate,4000.00
Cigna,HMO,25606,CPT4/HCPCS,Treat fx distal radial,,Case Rate,4000.00
Cigna,HMO,25607,CPT4/HCPCS,Treat fx rad extra-articul,,Case Rate,5000.00
Cigna,HMO,25608,CPT4/HCPCS,Treat fx rad intra-articul,,Case Rate,5000.00
Cigna,HMO,25609,CPT4/HCPCS,Treat fx radial 3+ frag,,Case Rate,5000.00
Cigna,HMO,25624,CPT4/HCPCS,Treat wrist bone fracture,,Case Rate,3000.00
Cigna,HMO,25628,CPT4/HCPCS,Treat wrist bone fracture,,Case Rate,4000.00
Cigna,HMO,25630,CPT4/HCPCS,Closed treatment of carpal bone fracture (excld. carpal scaphoid (navicular)); without manipulation, each bone,,Case Rate,400.00
Cigna,HMO,25635,CPT4/HCPCS,Treat wrist bone fracture,,Case Rate,3000.00
Cigna,HMO,25645,CPT4/HCPCS,Treat wrist bone fracture,,Case Rate,4000.00
Cigna,HMO,25651,CPT4/HCPCS,PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE,,Case Rate,4000.00
Cigna,HMO,25652,CPT4/HCPCS,OPEN TREATMENT OF ULNAR STYLOID FRACTURE,,Case Rate,4000.00
Cigna,HMO,25660,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,3000.00
Cigna,HMO,25670,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,4000.00
Cigna,HMO,25671,CPT4/HCPCS,Pin radioulnar dislocation,,Case Rate,3000.00
Cigna,HMO,25675,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,3000.00
Cigna,HMO,25676,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,3000.00
Cigna,HMO,25680,CPT4/HCPCS,Treat wrist fracture,,Case Rate,3000.00
Cigna,HMO,25685,CPT4/HCPCS,Treat wrist fracture,,Case Rate,4000.00
Cigna,HMO,25690,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,3000.00
Cigna,HMO,25695,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,3000.00
Cigna,HMO,257,DRG,Upper limb & toe amputation for circ system disorders w/o CC/MCC,,Case Rate,29605.50
Cigna,HMO,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,8300.00
Cigna,HMO,25800,CPT4/HCPCS,Fusion of wrist joint,,Case Rate,4000.00
Cigna,HMO,25805,CPT4/HCPCS,Fusion/graft of wrist joint,,Case Rate,5000.00
Cigna,HMO,25810,CPT4/HCPCS,Fusion/graft of wrist joint,,Case Rate,5000.00
Cigna,HMO,25820,CPT4/HCPCS,Fusion of hand bones,,Case Rate,4000.00
Cigna,HMO,25825,CPT4/HCPCS,Fuse hand bones with graft,,Case Rate,5000.00
Cigna,HMO,25830,CPT4/HCPCS,Fusion, radioulnar jnt/ulna,,Case Rate,5000.00
Cigna,HMO,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,8300.00
Cigna,HMO,25907,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,HMO,25909,CPT4/HCPCS,AMPUTATION FOREARM,THRU RADIUS ANPULNA,REAMPUTATION ,,Case Rate,3000.00
Cigna,HMO,25922,CPT4/HCPCS,Amputate hand at wrist,,Case Rate,4000.00
Cigna,HMO,25929,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,HMO,25999,CPT4/HCPCS,UNLISTED PROCEDURE, FOREARM OR WRIST ,,Case Rate,3000.00
Cigna,HMO,26,DRG,Craniotomy & endovascular intracranial procedures w CC,,Case Rate,77979.00
Cigna,HMO,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,8300.00
Cigna,HMO,26011,CPT4/HCPCS,Drainage of finger abscess,,Case Rate,3000.00
Cigna,HMO,26020,CPT4/HCPCS,Drain hand tendon sheath,,Case Rate,3000.00
Cigna,HMO,26025,CPT4/HCPCS,Drainage of palm bursa,,Case Rate,3000.00
Cigna,HMO,26030,CPT4/HCPCS,Drainage of palm bursa(s),,Case Rate,3000.00
Cigna,HMO,26034,CPT4/HCPCS,Treat hand bone lesion,,Case Rate,3000.00
Cigna,HMO,26035,CPT4/HCPCS,Decompress fingers/hand,,Case Rate,4000.00
Cigna,HMO,26037,CPT4/HCPCS,Decompress fingers/hand,,Case Rate,4000.00
Cigna,HMO,26040,CPT4/HCPCS,Release palm contracture,,Case Rate,4000.00
Cigna,HMO,26045,CPT4/HCPCS,Release palm contracture,,Case Rate,4000.00
Cigna,HMO,26055,CPT4/HCPCS,Incise finger tendon sheath,,Case Rate,3000.00
Cigna,HMO,26060,CPT4/HCPCS,Incision of finger tendon,,Case Rate,3000.00
Cigna,HMO,26070,CPT4/HCPCS,Explore/treat hand joint,,Case Rate,3000.00
Cigna,HMO,26075,CPT4/HCPCS,Explore/treat finger joint,,Case Rate,4000.00
Cigna,HMO,26080,CPT4/HCPCS,Explore/treat finger joint,,Case Rate,4000.00
Cigna,HMO,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,8300.00
Cigna,HMO,26100,CPT4/HCPCS,Biopsy hand joint lining,,Case Rate,3000.00
Cigna,HMO,26105,CPT4/HCPCS,Biopsy finger joint lining,,Case Rate,3000.00
Cigna,HMO,26110,CPT4/HCPCS,Biopsy finger joint lining,,Case Rate,3000.00
Cigna,HMO,26111,CPT4/HCPCS,EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; 1.5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,26113,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFASCIAL (EG, INTRAMUSCULAR); 1.5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,26115,CPT4/HCPCS,Remove hand lesion subcut,,Case Rate,3000.00
Cigna,HMO,26116,CPT4/HCPCS,Remove hand lesion, deep,,Case Rate,3000.00
Cigna,HMO,26117,CPT4/HCPCS,Remove tumor, hand/finger,,Case Rate,4000.00
Cigna,HMO,26118,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF HAND OR FINGER; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,26121,CPT4/HCPCS,Release palm contracture,,Case Rate,4000.00
Cigna,HMO,26123,CPT4/HCPCS,Release palm contracture,,Case Rate,4000.00
Cigna,HMO,26125,CPT4/HCPCS,Release palm contracture,,Case Rate,3000.00
Cigna,HMO,26130,CPT4/HCPCS,Remove wrist joint lining,,Case Rate,4000.00
Cigna,HMO,26135,CPT4/HCPCS,Revise finger joint, each,,Case Rate,4000.00
Cigna,HMO,26140,CPT4/HCPCS,Revise finger joint, each,,Case Rate,3000.00
Cigna,HMO,26145,CPT4/HCPCS,Tendon excision, palm/finger,,Case Rate,4000.00
Cigna,HMO,26160,CPT4/HCPCS,Remove tendon sheath lesion,,Case Rate,4000.00
Cigna,HMO,26170,CPT4/HCPCS,Removal of palm tendon, each,,Case Rate,4000.00
Cigna,HMO,26180,CPT4/HCPCS,Removal of finger tendon,,Case Rate,4000.00
Cigna,HMO,26185,CPT4/HCPCS,Remove finger bone,,Case Rate,4000.00
Cigna,HMO,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,8300.00
Cigna,HMO,26200,CPT4/HCPCS,Remove hand bone lesion,,Case Rate,3000.00
Cigna,HMO,26205,CPT4/HCPCS,Remove/graft bone lesion,,Case Rate,4000.00
Cigna,HMO,26210,CPT4/HCPCS,Removal of finger lesion,,Case Rate,3000.00
Cigna,HMO,26215,CPT4/HCPCS,Remove/graft finger lesion,,Case Rate,4000.00
Cigna,HMO,26230,CPT4/HCPCS,Partial removal of hand bone,,Case Rate,6000.00
Cigna,HMO,26235,CPT4/HCPCS,Partial removal, finger bone,,Case Rate,4000.00
Cigna,HMO,26236,CPT4/HCPCS,Partial removal, finger bone,,Case Rate,4000.00
Cigna,HMO,26250,CPT4/HCPCS,Extensive hand surgery,,Case Rate,4000.00
Cigna,HMO,26260,CPT4/HCPCS,Extensive finger surgery,,Case Rate,4000.00
Cigna,HMO,26262,CPT4/HCPCS,Partial removal of finger,,Case Rate,3000.00
Cigna,HMO,263,DRG,Vein ligation & stripping,,Case Rate,58785.15
Cigna,HMO,26320,CPT4/HCPCS,Removal of implant from hand,,Case Rate,3000.00
Cigna,HMO,26340,CPT4/HCPCS,MANIPULATION, FINGER JOINT, UNDER ANESTHESIA, EACH JOINT,,Case Rate,3000.00
Cigna,HMO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Case Rate,3000.00
Cigna,HMO,26350,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,3000.00
Cigna,HMO,26352,CPT4/HCPCS,Repair/graft hand tendon,,Case Rate,4000.00
Cigna,HMO,26356,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,4000.00
Cigna,HMO,26357,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,4000.00
Cigna,HMO,26358,CPT4/HCPCS,Repair/graft hand tendon,,Case Rate,4000.00
Cigna,HMO,26370,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,4000.00
Cigna,HMO,26372,CPT4/HCPCS,Repair/graft hand tendon,,Case Rate,4000.00
Cigna,HMO,26373,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,4000.00
Cigna,HMO,26390,CPT4/HCPCS,Revise hand/finger tendon,,Case Rate,4000.00
Cigna,HMO,26392,CPT4/HCPCS,Repair/graft hand tendon,,Case Rate,4000.00
Cigna,HMO,264,DRG,Other circulatory system O.R. procedures,,Case Rate,82818.90
Cigna,HMO,26410,CPT4/HCPCS,Repair hand tendon,,Case Rate,4000.00
Cigna,HMO,26412,CPT4/HCPCS,Repair/graft hand tendon,,Case Rate,4000.00
Cigna,HMO,26415,CPT4/HCPCS,Excision, hand/finger tendon,,Case Rate,4000.00
Cigna,HMO,26416,CPT4/HCPCS,Graft hand or finger tendon,,Case Rate,4000.00
Cigna,HMO,26418,CPT4/HCPCS,Repair finger tendon,,Case Rate,4000.00
Cigna,HMO,26420,CPT4/HCPCS,Repair/graft finger tendon,,Case Rate,4000.00
Cigna,HMO,26426,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,4000.00
Cigna,HMO,26428,CPT4/HCPCS,Repair/graft finger tendon,,Case Rate,4000.00
Cigna,HMO,26432,CPT4/HCPCS,Repair finger tendon,,Case Rate,4000.00
Cigna,HMO,26433,CPT4/HCPCS,Repair finger tendon,,Case Rate,4000.00
Cigna,HMO,26434,CPT4/HCPCS,Repair/graft finger tendon,,Case Rate,4000.00
Cigna,HMO,26437,CPT4/HCPCS,Realignment of tendons,,Case Rate,4000.00
Cigna,HMO,26440,CPT4/HCPCS,Release palm/finger tendon,,Case Rate,4000.00
Cigna,HMO,26442,CPT4/HCPCS,Release palm & finger tendon,,Case Rate,4000.00
Cigna,HMO,26445,CPT4/HCPCS,Release hand/finger tendon,,Case Rate,4000.00
Cigna,HMO,26449,CPT4/HCPCS,Release forearm/hand tendon,,Case Rate,4000.00
Cigna,HMO,26450,CPT4/HCPCS,Incision of palm tendon,,Case Rate,4000.00
Cigna,HMO,26455,CPT4/HCPCS,Incision of finger tendon,,Case Rate,4000.00
Cigna,HMO,26460,CPT4/HCPCS,Incise hand/finger tendon,,Case Rate,4000.00
Cigna,HMO,26471,CPT4/HCPCS,Fusion of finger tendons,,Case Rate,3000.00
Cigna,HMO,26474,CPT4/HCPCS,Fusion of finger tendons,,Case Rate,3000.00
Cigna,HMO,26476,CPT4/HCPCS,Tendon lengthening,,Case Rate,3000.00
Cigna,HMO,26477,CPT4/HCPCS,Tendon shortening,,Case Rate,3000.00
Cigna,HMO,26478,CPT4/HCPCS,Lengthening of hand tendon,,Case Rate,3000.00
Cigna,HMO,26479,CPT4/HCPCS,Shortening of hand tendon,,Case Rate,3000.00
Cigna,HMO,26480,CPT4/HCPCS,Transplant hand tendon,,Case Rate,4000.00
Cigna,HMO,26483,CPT4/HCPCS,Transplant/graft hand tendon,,Case Rate,4000.00
Cigna,HMO,26485,CPT4/HCPCS,Transplant palm tendon,,Case Rate,3000.00
Cigna,HMO,26489,CPT4/HCPCS,Transplant/graft palm tendon,,Case Rate,4000.00
Cigna,HMO,26490,CPT4/HCPCS,Revise thumb tendon,,Case Rate,4000.00
Cigna,HMO,26492,CPT4/HCPCS,Tendon transfer with graft,,Case Rate,4000.00
Cigna,HMO,26494,CPT4/HCPCS,Hand tendon/muscle transfer,,Case Rate,4000.00
Cigna,HMO,26496,CPT4/HCPCS,Revise thumb tendon,,Case Rate,4000.00
Cigna,HMO,26497,CPT4/HCPCS,Finger tendon transfer,,Case Rate,4000.00
Cigna,HMO,26498,CPT4/HCPCS,Finger tendon transfer,,Case Rate,4000.00
Cigna,HMO,26499,CPT4/HCPCS,Revision of finger,,Case Rate,4000.00
Cigna,HMO,265,DRG,AICD lead procedures,,Case Rate,85748.85
Cigna,HMO,26500,CPT4/HCPCS,Hand tendon reconstruction,,Case Rate,4000.00
Cigna,HMO,26502,CPT4/HCPCS,Hand tendon reconstruction,,Case Rate,4000.00
Cigna,HMO,26508,CPT4/HCPCS,Release thumb contracture,,Case Rate,4000.00
Cigna,HMO,26510,CPT4/HCPCS,Thumb tendon transfer,,Case Rate,4000.00
Cigna,HMO,26516,CPT4/HCPCS,Fusion of knuckle joint,,Case Rate,3000.00
Cigna,HMO,26517,CPT4/HCPCS,Fusion of knuckle joints,,Case Rate,4000.00
Cigna,HMO,26518,CPT4/HCPCS,Fusion of knuckle joints,,Case Rate,4000.00
Cigna,HMO,26520,CPT4/HCPCS,Release knuckle contracture,,Case Rate,4000.00
Cigna,HMO,26525,CPT4/HCPCS,Release finger contracture,,Case Rate,4000.00
Cigna,HMO,26530,CPT4/HCPCS,Revise knuckle joint,,Case Rate,4000.00
Cigna,HMO,26531,CPT4/HCPCS,Revise knuckle with implant,,Case Rate,6000.00
Cigna,HMO,26535,CPT4/HCPCS,Revise finger joint,,Case Rate,5000.00
Cigna,HMO,26536,CPT4/HCPCS,Revise/implant finger joint,,Case Rate,5000.00
Cigna,HMO,26540,CPT4/HCPCS,Repair hand joint,,Case Rate,4000.00
Cigna,HMO,26541,CPT4/HCPCS,Repair hand joint with graft,,Case Rate,6000.00
Cigna,HMO,26542,CPT4/HCPCS,Repair hand joint with graft,,Case Rate,4000.00
Cigna,HMO,26545,CPT4/HCPCS,Reconstruct finger joint,,Case Rate,4000.00
Cigna,HMO,26546,CPT4/HCPCS,Repair nonunion hand,,Case Rate,4000.00
Cigna,HMO,26548,CPT4/HCPCS,Reconstruct finger joint,,Case Rate,4000.00
Cigna,HMO,26550,CPT4/HCPCS,Construct thumb replacement,,Case Rate,3000.00
Cigna,HMO,26551,CPT4/HCPCS,Great toe-hand transfer,,Case Rate,3000.00
Cigna,HMO,26553,CPT4/HCPCS,Single transfer, toe-hand,,Case Rate,3000.00
Cigna,HMO,26554,CPT4/HCPCS,Double transfer, toe-hand,,Case Rate,3000.00
Cigna,HMO,26555,CPT4/HCPCS,Positional change of finger,,Case Rate,4000.00
Cigna,HMO,26560,CPT4/HCPCS,Repair of web finger,,Case Rate,3000.00
Cigna,HMO,26561,CPT4/HCPCS,Repair of web finger,,Case Rate,4000.00
Cigna,HMO,26562,CPT4/HCPCS,Repair of web finger,,Case Rate,4000.00
Cigna,HMO,26565,CPT4/HCPCS,Correct metacarpal flaw,,Case Rate,5000.00
Cigna,HMO,26567,CPT4/HCPCS,Correct finger deformity,,Case Rate,5000.00
Cigna,HMO,26568,CPT4/HCPCS,Lengthen metacarpal/finger,,Case Rate,4000.00
Cigna,HMO,26580,CPT4/HCPCS,Repair hand deformity,,Case Rate,5000.00
Cigna,HMO,26587,CPT4/HCPCS,Reconstruct extra finger,,Case Rate,5000.00
Cigna,HMO,26590,CPT4/HCPCS,Repair finger deformity,,Case Rate,5000.00
Cigna,HMO,26591,CPT4/HCPCS,Repair muscles of hand,,Case Rate,4000.00
Cigna,HMO,26593,CPT4/HCPCS,Release muscles of hand,,Case Rate,4000.00
Cigna,HMO,26596,CPT4/HCPCS,Excision constricting tissue,,Case Rate,3000.00
Cigna,HMO,266,DRG,Endovascular Cardiac Valve Replacement w MCC,,Case Rate,180978.60
Cigna,HMO,26605,CPT4/HCPCS,Treat metacarpal fracture,,Case Rate,3000.00
Cigna,HMO,26607,CPT4/HCPCS,Treat metacarpal fracture,,Case Rate,3000.00
Cigna,HMO,26608,CPT4/HCPCS,Treat metacarpal fracture,,Case Rate,4000.00
Cigna,HMO,26615,CPT4/HCPCS,Treat metacarpal fracture,,Case Rate,4000.00
Cigna,HMO,26645,CPT4/HCPCS,Treat thumb fracture,,Case Rate,3000.00
Cigna,HMO,26650,CPT4/HCPCS,Treat thumb fracture,,Case Rate,3000.00
Cigna,HMO,26665,CPT4/HCPCS,Treat thumb fracture,,Case Rate,4000.00
Cigna,HMO,26675,CPT4/HCPCS,Treat hand dislocation,,Case Rate,3000.00
Cigna,HMO,26676,CPT4/HCPCS,Pin hand dislocation,,Case Rate,3000.00
Cigna,HMO,26685,CPT4/HCPCS,Treat hand dislocation,,Case Rate,4000.00
Cigna,HMO,26686,CPT4/HCPCS,Treat hand dislocation,,Case Rate,4000.00
Cigna,HMO,267,DRG,Endovascular Cardiac Valve Replacement w/o MCC,,Case Rate,142822.95
Cigna,HMO,26705,CPT4/HCPCS,Treat knuckle dislocation,,Case Rate,3000.00
Cigna,HMO,26706,CPT4/HCPCS,Pin knuckle dislocation,,Case Rate,3000.00
Cigna,HMO,26715,CPT4/HCPCS,Treat knuckle dislocation,,Case Rate,4000.00
Cigna,HMO,26720,CPT4/HCPCS,Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each,,Case Rate,400.00
Cigna,HMO,26725,CPT4/HCPCS,Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each,,Case Rate,400.00
Cigna,HMO,26727,CPT4/HCPCS,Treat finger fracture, each,,Case Rate,6000.00
Cigna,HMO,26735,CPT4/HCPCS,Treat finger fracture, each,,Case Rate,4000.00
Cigna,HMO,26740,CPT4/HCPCS,Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each,,Case Rate,400.00
Cigna,HMO,26742,CPT4/HCPCS,Treat finger fracture, each,,Case Rate,3000.00
Cigna,HMO,26746,CPT4/HCPCS,Treat finger fracture, each,,Case Rate,5000.00
Cigna,HMO,26756,CPT4/HCPCS,Pin finger fracture, each,,Case Rate,3000.00
Cigna,HMO,26765,CPT4/HCPCS,Treat finger fracture, each,,Case Rate,4000.00
Cigna,HMO,26776,CPT4/HCPCS,Pin finger dislocation,,Case Rate,3000.00
Cigna,HMO,26785,CPT4/HCPCS,Treat finger dislocation,,Case Rate,3000.00
Cigna,HMO,268,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w MCC,,Case Rate,177342.30
Cigna,HMO,26820,CPT4/HCPCS,Thumb fusion with graft,,Case Rate,5000.00
Cigna,HMO,26841,CPT4/HCPCS,Fusion of thumb,,Case Rate,4000.00
Cigna,HMO,26842,CPT4/HCPCS,Thumb fusion with graft,,Case Rate,4000.00
Cigna,HMO,26843,CPT4/HCPCS,Fusion of hand joint,,Case Rate,4000.00
Cigna,HMO,26844,CPT4/HCPCS,Fusion/graft of hand joint,,Case Rate,4000.00
Cigna,HMO,26850,CPT4/HCPCS,Fusion of knuckle,,Case Rate,4000.00
Cigna,HMO,26852,CPT4/HCPCS,Fusion of knuckle with graft,,Case Rate,4000.00
Cigna,HMO,26860,CPT4/HCPCS,Fusion of finger joint,,Case Rate,4000.00
Cigna,HMO,26861,CPT4/HCPCS,Fusion of finger jnt, add-on,,Case Rate,3000.00
Cigna,HMO,26862,CPT4/HCPCS,Fusion/graft of finger joint,,Case Rate,4000.00
Cigna,HMO,26863,CPT4/HCPCS,Fuse/graft added joint,,Case Rate,3000.00
Cigna,HMO,269,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w/o MCC,,Case Rate,110022.30
Cigna,HMO,26910,CPT4/HCPCS,Amputate metacarpal bone,,Case Rate,4000.00
Cigna,HMO,26951,CPT4/HCPCS,Amputation of finger/thumb,,Case Rate,3000.00
Cigna,HMO,26952,CPT4/HCPCS,Amputation of finger/thumb,,Case Rate,4000.00
Cigna,HMO,26989,CPT4/HCPCS,UNLISTED PROCEDURE, HANDS OR FINGERS ,,Case Rate,3000.00
Cigna,HMO,26990,CPT4/HCPCS,Drainage of pelvis lesion,,Case Rate,3000.00
Cigna,HMO,26991,CPT4/HCPCS,Drainage of pelvis bursa,,Case Rate,3000.00
Cigna,HMO,26992,CPT4/HCPCS,Drainage of bone lesion,,Case Rate,3000.00
Cigna,HMO,27,DRG,Craniotomy & endovascular intracranial procedures w/o CC/MCC,,Case Rate,64050.90
Cigna,HMO,270,DRG,Other Major Cardiovascular Procedures w MCC,,Case Rate,132130.80
Cigna,HMO,27000,CPT4/HCPCS,Incision of hip tendon,,Case Rate,3000.00
Cigna,HMO,27001,CPT4/HCPCS,Incision of hip tendon,,Case Rate,4000.00
Cigna,HMO,27003,CPT4/HCPCS,Incision of hip tendon,,Case Rate,4000.00
Cigna,HMO,27006,CPT4/HCPCS,TENOTOMY, ABDUCTORS AND/OR EXTENSOR(S) OF HIP, OPEN (SEPARATE PROCEDURE ,,Case Rate,3000.00
Cigna,HMO,27027,CPT4/HCPCS,DECOMPRESSION FASCIOTOMY(IES), PELVIC (BUTTOCK) COMPARTMENT(S) (EG, GLUTEUS MEDIUS-MINIMUS, GLUTEUS MAXIMUS, ILIOPSOAS, AND/OR TENSOR FASCIA LATA MUSCLE), UNILATERAL,,Case Rate,8300.00
Cigna,HMO,27030,CPT4/HCPCS,Drainage of hip joint,,Case Rate,3000.00
Cigna,HMO,27033,CPT4/HCPCS,Exploration of hip joint,,Case Rate,4000.00
Cigna,HMO,27035,CPT4/HCPCS,Denervation of hip joint,,Case Rate,4000.00
Cigna,HMO,27040,CPT4/HCPCS,Biopsy of soft tissues,,Case Rate,3000.00
Cigna,HMO,27041,CPT4/HCPCS,Biopsy of soft tissues,,Case Rate,3000.00
Cigna,HMO,27043,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOU S; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,27045,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,27047,CPT4/HCPCS,Remove hip/pelvis lesion,,Case Rate,3000.00
Cigna,HMO,27048,CPT4/HCPCS,Remove hip/pelvis lesion,,Case Rate,4000.00
Cigna,HMO,27049,CPT4/HCPCS,Remove tumor, hip/pelvis,,Case Rate,4000.00
Cigna,HMO,27050,CPT4/HCPCS,Biopsy of sacroiliac joint,,Case Rate,4000.00
Cigna,HMO,27052,CPT4/HCPCS,Biopsy of hip joint,,Case Rate,4000.00
Cigna,HMO,27057,CPT4/HCPCS,DECOMPRESSION FASCIOTOMY(IES), PELVIC (BUTTOCK) COMPARTMENT(S) (EG, GLUTEUS MEDIUS-MINIMUS, GLUTEUS MAXIMUS, ILIOPSOAS, AND/OR TENSOR FASCIA LATA MUSCLE) WITH DEBRIDEMENT OF NONVIABLE MUSCLE, UNILATERAL,,Case Rate,8300.00
Cigna,HMO,27059,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF PELVIS AND HIP AREA; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,27060,CPT4/HCPCS,Removal of ischial bursa,,Case Rate,5000.00
Cigna,HMO,27062,CPT4/HCPCS,Remove femur lesion/bursa,,Case Rate,5000.00
Cigna,HMO,27065,CPT4/HCPCS,Removal of hip bone lesion,,Case Rate,5000.00
Cigna,HMO,27066,CPT4/HCPCS,Removal of hip bone lesion,,Case Rate,5000.00
Cigna,HMO,27067,CPT4/HCPCS,Remove/graft hip bone lesion,,Case Rate,5000.00
Cigna,HMO,27080,CPT4/HCPCS,Removal of tail bone,,Case Rate,3000.00
Cigna,HMO,27086,CPT4/HCPCS,Remove hip foreign body,,Case Rate,3000.00
Cigna,HMO,27087,CPT4/HCPCS,Remove hip foreign body,,Case Rate,4000.00
Cigna,HMO,27093,CPT4/HCPCS,Injection procedure for hip arthrography; without anesthesia,,Case Rate,3000.00
Cigna,HMO,27095,CPT4/HCPCS,Injection procedure for hip arthrography; with anesthesia,,Case Rate,3000.00
Cigna,HMO,27096,CPT4/HCPCS,INJECTION PROCEDURE FOR SACROILIAC JOINT, ANESTHETIC/STEROID, WI TH IMAGE GUIDANCE (FLUOROSCOPY OR CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED ,,Case Rate,3000.00
Cigna,HMO,27097,CPT4/HCPCS,Revision of hip tendon,,Case Rate,4000.00
Cigna,HMO,27098,CPT4/HCPCS,Transfer tendon to pelvis,,Case Rate,4000.00
Cigna,HMO,271,DRG,Other Major Cardiovascular Procedures w CC,,Case Rate,90897.30
Cigna,HMO,27100,CPT4/HCPCS,Transfer of abdominal muscle,,Case Rate,4000.00
Cigna,HMO,27105,CPT4/HCPCS,Transfer of spinal muscle,,Case Rate,4000.00
Cigna,HMO,27110,CPT4/HCPCS,Transfer of iliopsoas muscle,,Case Rate,4000.00
Cigna,HMO,27111,CPT4/HCPCS,Transfer of iliopsoas muscle,,Case Rate,4000.00
Cigna,HMO,27197,CPT4/HCPCS,Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/in,,Case Rate,3000.00
Cigna,HMO,27198,CPT4/HCPCS,Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/in,,Case Rate,3000.00
Cigna,HMO,272,DRG,Other Major Cardiovascular Procedures w/o CC/MCC,,Case Rate,68564.40
Cigna,HMO,27200,CPT4/HCPCS,CLOSED TREATMENT OF COCCYGEAL FRACTURE ,,Case Rate,3000.00
Cigna,HMO,27202,CPT4/HCPCS,Treat tail bone fracture,,Case Rate,3000.00
Cigna,HMO,27230,CPT4/HCPCS,Treat thigh fracture,,Case Rate,3000.00
Cigna,HMO,27235,CPT4/HCPCS,PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMAL END, NECK ,,Case Rate,3000.00
Cigna,HMO,27238,CPT4/HCPCS,Treat thigh fracture,,Case Rate,3000.00
Cigna,HMO,27246,CPT4/HCPCS,Treat thigh fracture,,Case Rate,3000.00
Cigna,HMO,27250,CPT4/HCPCS,Treat hip dislocation,,Case Rate,3000.00
Cigna,HMO,27252,CPT4/HCPCS,Treat hip dislocation,,Case Rate,3000.00
Cigna,HMO,27256,CPT4/HCPCS,TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLOGICAL), BY ABDUCTION, SPLINT, OR TRACTION; WITHOUT ANESTHESIA, WITHOUT MANIPULATION ,,Case Rate,3000.00
Cigna,HMO,27257,CPT4/HCPCS,Treat hip dislocation,,Case Rate,4000.00
Cigna,HMO,27265,CPT4/HCPCS,Treat hip dislocation,,Case Rate,3000.00
Cigna,HMO,27266,CPT4/HCPCS,Treat hip dislocation,,Case Rate,3000.00
Cigna,HMO,27267,CPT4/HCPCS,CLTX THIGH FX,,Case Rate,3000.00
Cigna,HMO,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,Case Rate,3000.00
Cigna,HMO,27275,CPT4/HCPCS,Manipulation of hip joint,,Case Rate,3000.00
Cigna,HMO,27279,CPT4/HCPCS, ARTHRODESIS, SACROILIAC JOINT, PERCUTANEOUS OR MINIMALLY INVASIVE (INDIRECT VISUALIZATION), WITH IMAGE GUIDANCE, INCLUDES OBTAINING BONE GRAFT WHEN PERFORMED, AND PLACEMENT OF TRANSFIXING DEVICE,,Case Rate,3000.00
Cigna,HMO,27299,CPT4/HCPCS,UNLISTED PROCEDURE, PELVIS OR HIP JOINT ,,Case Rate,3000.00
Cigna,HMO,273,DRG,Percutaneous Intracardiac Procedures w MCC,,Case Rate,97848.60
Cigna,HMO,27301,CPT4/HCPCS,Drain thigh/knee lesion,,Case Rate,4000.00
Cigna,HMO,27303,CPT4/HCPCS,Drainage of bone lesion,,Case Rate,3000.00
Cigna,HMO,27305,CPT4/HCPCS,Incise thigh tendon & fascia,,Case Rate,3000.00
Cigna,HMO,27306,CPT4/HCPCS,Incision of thigh tendon,,Case Rate,4000.00
Cigna,HMO,27307,CPT4/HCPCS,Incision of thigh tendons,,Case Rate,4000.00
Cigna,HMO,27310,CPT4/HCPCS,Exploration of knee joint,,Case Rate,4000.00
Cigna,HMO,27323,CPT4/HCPCS,Biopsy, thigh soft tissues,,Case Rate,3000.00
Cigna,HMO,27324,CPT4/HCPCS,Biopsy, thigh soft tissues,,Case Rate,3000.00
Cigna,HMO,27325,CPT4/HCPCS,Neurectomy, hamstring,,Case Rate,3000.00
Cigna,HMO,27326,CPT4/HCPCS,Neurectomy, popliteal,,Case Rate,3000.00
Cigna,HMO,27327,CPT4/HCPCS,Removal of thigh lesion,,Case Rate,3000.00
Cigna,HMO,27328,CPT4/HCPCS,Removal of thigh lesion,,Case Rate,4000.00
Cigna,HMO,27329,CPT4/HCPCS,Remove tumor, thigh/knee,,Case Rate,4000.00
Cigna,HMO,27330,CPT4/HCPCS,Biopsy, knee joint lining,,Case Rate,4000.00
Cigna,HMO,27331,CPT4/HCPCS,Explore/treat knee joint,,Case Rate,4000.00
Cigna,HMO,27332,CPT4/HCPCS,Removal of knee cartilage,,Case Rate,4000.00
Cigna,HMO,27333,CPT4/HCPCS,Removal of knee cartilage,,Case Rate,4000.00
Cigna,HMO,27334,CPT4/HCPCS,Remove knee joint lining,,Case Rate,4000.00
Cigna,HMO,27335,CPT4/HCPCS,Remove knee joint lining,,Case Rate,4000.00
Cigna,HMO,27337,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS ; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,27339,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL ( EG, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,27340,CPT4/HCPCS,Removal of kneecap bursa,,Case Rate,4000.00
Cigna,HMO,27345,CPT4/HCPCS,Removal of knee cyst,,Case Rate,4000.00
Cigna,HMO,27347,CPT4/HCPCS,Remove knee cyst,,Case Rate,4000.00
Cigna,HMO,27350,CPT4/HCPCS,Removal of kneecap,,Case Rate,4000.00
Cigna,HMO,27355,CPT4/HCPCS,Remove femur lesion,,Case Rate,4000.00
Cigna,HMO,27356,CPT4/HCPCS,Remove femur lesion/graft,,Case Rate,4000.00
Cigna,HMO,27357,CPT4/HCPCS,Remove femur lesion/graft,,Case Rate,5000.00
Cigna,HMO,27358,CPT4/HCPCS,Remove femur lesion/fixation,,Case Rate,3000.00
Cigna,HMO,27360,CPT4/HCPCS,Partial removal, leg bone(s),,Case Rate,5000.00
Cigna,HMO,27364,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF THIGH OR KNEE AREA; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,27369,CPT4/HCPCS,Injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography ,,Case Rate,3000.00
Cigna,HMO,27372,CPT4/HCPCS,Removal of foreign body,,Case Rate,6000.00
Cigna,HMO,27380,CPT4/HCPCS,Repair of kneecap tendon,,Case Rate,3000.00
Cigna,HMO,27381,CPT4/HCPCS,Repair/graft kneecap tendon,,Case Rate,4000.00
Cigna,HMO,27385,CPT4/HCPCS,Repair of thigh muscle,,Case Rate,4000.00
Cigna,HMO,27386,CPT4/HCPCS,Repair/graft of thigh muscle,,Case Rate,4000.00
Cigna,HMO,27390,CPT4/HCPCS,Incision of thigh tendon,,Case Rate,3000.00
Cigna,HMO,27391,CPT4/HCPCS,Incision of thigh tendons,,Case Rate,3000.00
Cigna,HMO,27392,CPT4/HCPCS,Incision of thigh tendons,,Case Rate,4000.00
Cigna,HMO,27393,CPT4/HCPCS,Lengthening of thigh tendon,,Case Rate,3000.00
Cigna,HMO,27394,CPT4/HCPCS,Lengthening of thigh tendons,,Case Rate,4000.00
Cigna,HMO,27395,CPT4/HCPCS,Lengthening of thigh tendons,,Case Rate,4000.00
Cigna,HMO,27396,CPT4/HCPCS,Transplant of thigh tendon,,Case Rate,4000.00
Cigna,HMO,27397,CPT4/HCPCS,Transplants of thigh tendons,,Case Rate,4000.00
Cigna,HMO,274,DRG,Percutaneous Intracardiac Procedures w/o MCC,,Case Rate,83777.70
Cigna,HMO,27400,CPT4/HCPCS,Revise thigh muscles/tendons,,Case Rate,4000.00
Cigna,HMO,27403,CPT4/HCPCS,Repair of knee cartilage,,Case Rate,4000.00
Cigna,HMO,27405,CPT4/HCPCS,Repair of knee ligament,,Case Rate,4000.00
Cigna,HMO,27407,CPT4/HCPCS,Repair of knee ligament,,Case Rate,4000.00
Cigna,HMO,27409,CPT4/HCPCS,Repair of knee ligaments,,Case Rate,4000.00
Cigna,HMO,27412,CPT4/HCPCS,Autologous Chondrocyte Implantation, Knee,,Case Rate,3000.00
Cigna,HMO,27415,CPT4/HCPCS,Osteochondral Allograft, Knee, Open,,Case Rate,3000.00
Cigna,HMO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Case Rate,8300.00
Cigna,HMO,27418,CPT4/HCPCS,Repair degenerated kneecap,,Case Rate,4000.00
Cigna,HMO,27420,CPT4/HCPCS,Revision of unstable kneecap,,Case Rate,4000.00
Cigna,HMO,27422,CPT4/HCPCS,Revision of unstable kneecap,,Case Rate,6000.00
Cigna,HMO,27424,CPT4/HCPCS,Revision/removal of kneecap,,Case Rate,4000.00
Cigna,HMO,27425,CPT4/HCPCS,Lateral retinacular release,,Case Rate,6000.00
Cigna,HMO,27427,CPT4/HCPCS,Reconstruction, knee,,Case Rate,4000.00
Cigna,HMO,27428,CPT4/HCPCS,Reconstruction, knee,,Case Rate,4000.00
Cigna,HMO,27429,CPT4/HCPCS,Reconstruction, knee,,Case Rate,4000.00
Cigna,HMO,27430,CPT4/HCPCS,Revision of thigh muscles,,Case Rate,4000.00
Cigna,HMO,27435,CPT4/HCPCS,Incision of knee joint,,Case Rate,4000.00
Cigna,HMO,27437,CPT4/HCPCS,Revise kneecap,,Case Rate,4000.00
Cigna,HMO,27438,CPT4/HCPCS,Revise kneecap with implant,,Case Rate,5000.00
Cigna,HMO,27440,CPT4/HCPCS,Revision of knee joint,,Case Rate,5000.00
Cigna,HMO,27441,CPT4/HCPCS,Revision of knee joint,,Case Rate,5000.00
Cigna,HMO,27442,CPT4/HCPCS,Revision of knee joint,,Case Rate,5000.00
Cigna,HMO,27443,CPT4/HCPCS,Revision of knee joint,,Case Rate,5000.00
Cigna,HMO,27446,CPT4/HCPCS,ARTHROPLASTY KNEE CONDYLE AND PLATEAU MEDIAL OR LATERAL COMPARTMENT (SSO) ,,Case Rate,3000.00
Cigna,HMO,27447,CPT4/HCPCS,ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY),,Case Rate,3000.00
Cigna,HMO,27475,CPT4/HCPCS,ARREST, EPIPHYSEAL, ANY METHOD, (EPIPHYDIODESIS); DISTAL FEMUR ,,Case Rate,3000.00
Cigna,HMO,27477,CPT4/HCPCS,Arrest, epiphyseal, any method (eg, epiphysiodesis); tibia and fibula, proximal ,,Case Rate,3000.00
Cigna,HMO,27479,CPT4/HCPCS,ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYDIODESIS); CMBINED DISTAL FEMUR PROX ,,Case Rate,3000.00
Cigna,HMO,27485,CPT4/HCPCS,Arrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg, genu varus or valgus),,Case Rate,3000.00
Cigna,HMO,27496,CPT4/HCPCS,Decompression of thigh/knee,,Case Rate,5000.00
Cigna,HMO,27497,CPT4/HCPCS,Decompression of thigh/knee,,Case Rate,4000.00
Cigna,HMO,27498,CPT4/HCPCS,Decompression of thigh/knee,,Case Rate,4000.00
Cigna,HMO,27499,CPT4/HCPCS,Decompression of thigh/knee,,Case Rate,4000.00
Cigna,HMO,27500,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,HMO,27501,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,HMO,27502,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,HMO,27503,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,4000.00
Cigna,HMO,27507,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,HMO,27508,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,HMO,27509,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,4000.00
Cigna,HMO,27510,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,HMO,27511,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,HMO,27513,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,HMO,27516,CPT4/HCPCS,Treat thigh fx growth plate,,Case Rate,3000.00
Cigna,HMO,27517,CPT4/HCPCS,Treat thigh fx growth plate,,Case Rate,3000.00
Cigna,HMO,27520,CPT4/HCPCS,Treat kneecap fracture,,Case Rate,3000.00
Cigna,HMO,27524,CPT4/HCPCS,Treat kneecap fracture,,Case Rate,4000.00
Cigna,HMO,27530,CPT4/HCPCS,Treat knee fracture,,Case Rate,3000.00
Cigna,HMO,27532,CPT4/HCPCS,Treat knee fracture,,Case Rate,3000.00
Cigna,HMO,27535,CPT4/HCPCS,Treat knee fracture,,Case Rate,3000.00
Cigna,HMO,27538,CPT4/HCPCS,Treat knee fracture(s),,Case Rate,3000.00
Cigna,HMO,27550,CPT4/HCPCS,Treat knee dislocation,,Case Rate,3000.00
Cigna,HMO,27552,CPT4/HCPCS,Treat knee dislocation,,Case Rate,3000.00
Cigna,HMO,27560,CPT4/HCPCS,Treat kneecap dislocation,,Case Rate,3000.00
Cigna,HMO,27562,CPT4/HCPCS,Treat kneecap dislocation,,Case Rate,3000.00
Cigna,HMO,27566,CPT4/HCPCS,Treat kneecap dislocation,,Case Rate,3000.00
Cigna,HMO,27570,CPT4/HCPCS,Fixation of knee joint,,Case Rate,3000.00
Cigna,HMO,27594,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,HMO,27599,CPT4/HCPCS,UNLISTED PROCEDURE, FEMUR OR KNEE ,,Case Rate,3000.00
Cigna,HMO,27600,CPT4/HCPCS,Decompression of lower leg,,Case Rate,4000.00
Cigna,HMO,27601,CPT4/HCPCS,Decompression of lower leg,,Case Rate,4000.00
Cigna,HMO,27602,CPT4/HCPCS,Decompression of lower leg,,Case Rate,4000.00
Cigna,HMO,27603,CPT4/HCPCS,Drain lower leg lesion,,Case Rate,3000.00
Cigna,HMO,27604,CPT4/HCPCS,Drain lower leg bursa,,Case Rate,3000.00
Cigna,HMO,27605,CPT4/HCPCS,Incision of achilles tendon,,Case Rate,3000.00
Cigna,HMO,27606,CPT4/HCPCS,Incision of achilles tendon,,Case Rate,3000.00
Cigna,HMO,27607,CPT4/HCPCS,Treat lower leg bone lesion,,Case Rate,3000.00
Cigna,HMO,27610,CPT4/HCPCS,Explore/treat ankle joint,,Case Rate,3000.00
Cigna,HMO,27612,CPT4/HCPCS,Exploration of ankle joint,,Case Rate,4000.00
Cigna,HMO,27613,CPT4/HCPCS,Biopsy lower leg soft tissue,,Case Rate,3000.00
Cigna,HMO,27614,CPT4/HCPCS,Biopsy lower leg soft tissue,,Case Rate,3000.00
Cigna,HMO,27615,CPT4/HCPCS,Remove tumor, lower leg,,Case Rate,4000.00
Cigna,HMO,27616,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF LEG OR ANKLE AREA; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,27618,CPT4/HCPCS,Remove lower leg lesion,,Case Rate,3000.00
Cigna,HMO,27619,CPT4/HCPCS,Remove lower leg lesion,,Case Rate,4000.00
Cigna,HMO,27620,CPT4/HCPCS,Explore/treat ankle joint,,Case Rate,4000.00
Cigna,HMO,27625,CPT4/HCPCS,Remove ankle joint lining,,Case Rate,4000.00
Cigna,HMO,27626,CPT4/HCPCS,Remove ankle joint lining,,Case Rate,4000.00
Cigna,HMO,27630,CPT4/HCPCS,Removal of tendon lesion,,Case Rate,4000.00
Cigna,HMO,27632,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,27634,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (E G, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,27635,CPT4/HCPCS,Remove lower leg bone lesion,,Case Rate,4000.00
Cigna,HMO,27637,CPT4/HCPCS,Remove/graft leg bone lesion,,Case Rate,4000.00
Cigna,HMO,27638,CPT4/HCPCS,Remove/graft leg bone lesion,,Case Rate,4000.00
Cigna,HMO,27640,CPT4/HCPCS,Partial removal of tibia,,Case Rate,3000.00
Cigna,HMO,27641,CPT4/HCPCS,Partial removal of fibula,,Case Rate,3000.00
Cigna,HMO,27647,CPT4/HCPCS,Extensive ankle/heel surgery,,Case Rate,4000.00
Cigna,HMO,27648,CPT4/HCPCS,Injection procedure for ankle arthrography,,Case Rate,3000.00
Cigna,HMO,27650,CPT4/HCPCS,Repair achilles tendon,,Case Rate,4000.00
Cigna,HMO,27652,CPT4/HCPCS,Repair/graft achilles tendon,,Case Rate,4000.00
Cigna,HMO,27654,CPT4/HCPCS,Repair of achilles tendon,,Case Rate,4000.00
Cigna,HMO,27656,CPT4/HCPCS,Repair leg fascia defect,,Case Rate,3000.00
Cigna,HMO,27658,CPT4/HCPCS,Repair of leg tendon, each,,Case Rate,3000.00
Cigna,HMO,27659,CPT4/HCPCS,Repair of leg tendon, each,,Case Rate,3000.00
Cigna,HMO,27664,CPT4/HCPCS,Repair of leg tendon, each,,Case Rate,3000.00
Cigna,HMO,27665,CPT4/HCPCS,Repair of leg tendon, each,,Case Rate,3000.00
Cigna,HMO,27675,CPT4/HCPCS,Repair lower leg tendons,,Case Rate,3000.00
Cigna,HMO,27676,CPT4/HCPCS,Repair lower leg tendons,,Case Rate,4000.00
Cigna,HMO,27680,CPT4/HCPCS,Release of lower leg tendon,,Case Rate,4000.00
Cigna,HMO,27681,CPT4/HCPCS,Release of lower leg tendons,,Case Rate,3000.00
Cigna,HMO,27685,CPT4/HCPCS,Revision of lower leg tendon,,Case Rate,4000.00
Cigna,HMO,27686,CPT4/HCPCS,Revise lower leg tendons,,Case Rate,4000.00
Cigna,HMO,27687,CPT4/HCPCS,Revision of calf tendon,,Case Rate,4000.00
Cigna,HMO,27690,CPT4/HCPCS,Revise lower leg tendon,,Case Rate,4000.00
Cigna,HMO,27691,CPT4/HCPCS,Revise lower leg tendon,,Case Rate,4000.00
Cigna,HMO,27692,CPT4/HCPCS,Revise additional leg tendon,,Case Rate,3000.00
Cigna,HMO,27695,CPT4/HCPCS,Repair of ankle ligament,,Case Rate,3000.00
Cigna,HMO,27696,CPT4/HCPCS,Repair of ankle ligaments,,Case Rate,3000.00
Cigna,HMO,27698,CPT4/HCPCS,Repair of ankle ligament,,Case Rate,3000.00
Cigna,HMO,27700,CPT4/HCPCS,Revision of ankle joint,,Case Rate,5000.00
Cigna,HMO,27704,CPT4/HCPCS,Removal of ankle implant,,Case Rate,3000.00
Cigna,HMO,27705,CPT4/HCPCS,Incision of tibia,,Case Rate,3000.00
Cigna,HMO,27707,CPT4/HCPCS,Incision of fibula,,Case Rate,3000.00
Cigna,HMO,27709,CPT4/HCPCS,Incision of tibia & fibula,,Case Rate,3000.00
Cigna,HMO,27715,CPT4/HCPCS,Revision of lower leg,,Case Rate,3000.00
Cigna,HMO,27720,CPT4/HCPCS,REPAIR OF NONUNION OR MALUNION, TIBIA, WITHOUT GRAFT, ,,Case Rate,3000.00
Cigna,HMO,27722,CPT4/HCPCS,REPAIR OF NONUNION OR MALUNION, TIBIA; WITH SLIDING GRAFT ,,Case Rate,3000.00
Cigna,HMO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Case Rate,8300.00
Cigna,HMO,27730,CPT4/HCPCS,Repair of tibia epiphysis,,Case Rate,3000.00
Cigna,HMO,27732,CPT4/HCPCS,Repair of fibula epiphysis,,Case Rate,3000.00
Cigna,HMO,27734,CPT4/HCPCS,Repair lower leg epiphyses,,Case Rate,3000.00
Cigna,HMO,27740,CPT4/HCPCS,Repair of leg epiphyses,,Case Rate,3000.00
Cigna,HMO,27742,CPT4/HCPCS,Repair of leg epiphyses,,Case Rate,3000.00
Cigna,HMO,27745,CPT4/HCPCS,Reinforce tibia,,Case Rate,4000.00
Cigna,HMO,27750,CPT4/HCPCS,Treatment of tibia fracture,,Case Rate,3000.00
Cigna,HMO,27752,CPT4/HCPCS,Treatment of tibia fracture,,Case Rate,3000.00
Cigna,HMO,27756,CPT4/HCPCS,Treatment of tibia fracture,,Case Rate,4000.00
Cigna,HMO,27758,CPT4/HCPCS,Treatment of tibia fracture,,Case Rate,4000.00
Cigna,HMO,27759,CPT4/HCPCS,Treatment of tibia fracture,,Case Rate,4000.00
Cigna,HMO,27760,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,HMO,27762,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,HMO,27766,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,4000.00
Cigna,HMO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Case Rate,3000.00
Cigna,HMO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Case Rate,3000.00
Cigna,HMO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Case Rate,8300.00
Cigna,HMO,27780,CPT4/HCPCS,Treatment of fibula fracture,,Case Rate,3000.00
Cigna,HMO,27781,CPT4/HCPCS,Treatment of fibula fracture,,Case Rate,3000.00
Cigna,HMO,27784,CPT4/HCPCS,Treatment of fibula fracture,,Case Rate,4000.00
Cigna,HMO,27786,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,HMO,27788,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,HMO,27792,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,4000.00
Cigna,HMO,27808,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,HMO,27810,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,HMO,27814,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,4000.00
Cigna,HMO,27816,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,HMO,27818,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,HMO,27822,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,4000.00
Cigna,HMO,27823,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,4000.00
Cigna,HMO,27824,CPT4/HCPCS,Treat lower leg fracture,,Case Rate,3000.00
Cigna,HMO,27825,CPT4/HCPCS,Treat lower leg fracture,,Case Rate,3000.00
Cigna,HMO,27826,CPT4/HCPCS,Treat lower leg fracture,,Case Rate,4000.00
Cigna,HMO,27827,CPT4/HCPCS,Treat lower leg fracture,,Case Rate,4000.00
Cigna,HMO,27828,CPT4/HCPCS,Treat lower leg fracture,,Case Rate,4000.00
Cigna,HMO,27829,CPT4/HCPCS,Treat lower leg joint,,Case Rate,3000.00
Cigna,HMO,27830,CPT4/HCPCS,Treat lower leg dislocation,,Case Rate,3000.00
Cigna,HMO,27831,CPT4/HCPCS,Treat lower leg dislocation,,Case Rate,3000.00
Cigna,HMO,27832,CPT4/HCPCS,Treat lower leg dislocation,,Case Rate,3000.00
Cigna,HMO,27840,CPT4/HCPCS,Treat ankle dislocation,,Case Rate,3000.00
Cigna,HMO,27842,CPT4/HCPCS,Treat ankle dislocation,,Case Rate,3000.00
Cigna,HMO,27846,CPT4/HCPCS,Treat ankle dislocation,,Case Rate,4000.00
Cigna,HMO,27848,CPT4/HCPCS,Treat ankle dislocation,,Case Rate,4000.00
Cigna,HMO,27860,CPT4/HCPCS,Fixation of ankle joint,,Case Rate,3000.00
Cigna,HMO,27870,CPT4/HCPCS,Fusion of ankle joint,,Case Rate,4000.00
Cigna,HMO,27871,CPT4/HCPCS,Fusion of tibiofibular joint,,Case Rate,4000.00
Cigna,HMO,27884,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,HMO,27889,CPT4/HCPCS,Amputation of foot at ankle,,Case Rate,4000.00
Cigna,HMO,27892,CPT4/HCPCS,Decompression of leg,,Case Rate,4000.00
Cigna,HMO,27893,CPT4/HCPCS,Decompression of leg,,Case Rate,4000.00
Cigna,HMO,27894,CPT4/HCPCS,Decompression of leg,,Case Rate,4000.00
Cigna,HMO,27899,CPT4/HCPCS,UNLISTED PROCEDURE, LEG OR ANKLE ,,Case Rate,3000.00
Cigna,HMO,28,DRG,Spinal procedures w MCC,,Case Rate,25500.00
Cigna,HMO,280,DRG,Acute myocardial infarction, discharged alive w MCC,,Case Rate,41468.10
Cigna,HMO,28001,CPT4/HCPCS,Incision and drainage, bursa, foot,,Case Rate,3000.00
Cigna,HMO,28002,CPT4/HCPCS,Treatment of foot infection,,Case Rate,4000.00
Cigna,HMO,28003,CPT4/HCPCS,Treatment of foot infection,,Case Rate,4000.00
Cigna,HMO,28005,CPT4/HCPCS,Treat foot bone lesion,,Case Rate,4000.00
Cigna,HMO,28008,CPT4/HCPCS,Incision of foot fascia,,Case Rate,4000.00
Cigna,HMO,28010,CPT4/HCPCS,Tenotomy, percutaneous, toe; single tendon,,Case Rate,3000.00
Cigna,HMO,28011,CPT4/HCPCS,Incision of toe tendons,,Case Rate,4000.00
Cigna,HMO,28020,CPT4/HCPCS,Exploration of foot joint,,Case Rate,3000.00
Cigna,HMO,28022,CPT4/HCPCS,Exploration of foot joint,,Case Rate,3000.00
Cigna,HMO,28024,CPT4/HCPCS,Exploration of toe joint,,Case Rate,3000.00
Cigna,HMO,28035,CPT4/HCPCS,Decompression of tibia nerve,,Case Rate,4000.00
Cigna,HMO,28039,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; 1.5 CM OR GREATER,,Case Rate,3000.00
Cigna,HMO,28041,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL (EG, INT RAMUSCULAR); 1.5 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,28043,CPT4/HCPCS,Excision of foot lesion,,Case Rate,3000.00
Cigna,HMO,28045,CPT4/HCPCS,Excision of foot lesion,,Case Rate,4000.00
Cigna,HMO,28046,CPT4/HCPCS,Resection of tumor, foot,,Case Rate,4000.00
Cigna,HMO,28047,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FOOT OR TOE; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,HMO,28050,CPT4/HCPCS,Biopsy of foot joint lining,,Case Rate,3000.00
Cigna,HMO,28052,CPT4/HCPCS,Biopsy of foot joint lining,,Case Rate,3000.00
Cigna,HMO,28054,CPT4/HCPCS,Biopsy of toe joint lining,,Case Rate,3000.00
Cigna,HMO,28055,CPT4/HCPCS,Neurectomy, foot,,Case Rate,4000.00
Cigna,HMO,28060,CPT4/HCPCS,Partial removal, foot fascia,,Case Rate,3000.00
Cigna,HMO,28062,CPT4/HCPCS,Removal of foot fascia,,Case Rate,4000.00
Cigna,HMO,28070,CPT4/HCPCS,Removal of foot joint lining,,Case Rate,4000.00
Cigna,HMO,28072,CPT4/HCPCS,Removal of foot joint lining,,Case Rate,4000.00
Cigna,HMO,28080,CPT4/HCPCS,Removal of foot lesion,,Case Rate,4000.00
Cigna,HMO,28086,CPT4/HCPCS,Excise foot tendon sheath,,Case Rate,3000.00
Cigna,HMO,28088,CPT4/HCPCS,Excise foot tendon sheath,,Case Rate,3000.00
Cigna,HMO,28090,CPT4/HCPCS,Removal of foot lesion,,Case Rate,4000.00
Cigna,HMO,28092,CPT4/HCPCS,Removal of toe lesions,,Case Rate,4000.00
Cigna,HMO,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,8300.00
Cigna,HMO,28100,CPT4/HCPCS,Removal of ankle/heel lesion,,Case Rate,3000.00
Cigna,HMO,28102,CPT4/HCPCS,Remove/graft foot lesion,,Case Rate,4000.00
Cigna,HMO,28103,CPT4/HCPCS,Remove/graft foot lesion,,Case Rate,4000.00
Cigna,HMO,28104,CPT4/HCPCS,Removal of foot lesion,,Case Rate,3000.00
Cigna,HMO,28106,CPT4/HCPCS,Remove/graft foot lesion,,Case Rate,4000.00
Cigna,HMO,28107,CPT4/HCPCS,Remove/graft foot lesion,,Case Rate,4000.00
Cigna,HMO,28108,CPT4/HCPCS,Removal of toe lesions,,Case Rate,3000.00
Cigna,HMO,28110,CPT4/HCPCS,Part removal of metatarsal,,Case Rate,4000.00
Cigna,HMO,28111,CPT4/HCPCS,Part removal of metatarsal,,Case Rate,4000.00
Cigna,HMO,28112,CPT4/HCPCS,Part removal of metatarsal,,Case Rate,4000.00
Cigna,HMO,28113,CPT4/HCPCS,Part removal of metatarsal,,Case Rate,4000.00
Cigna,HMO,28114,CPT4/HCPCS,Removal of metatarsal heads,,Case Rate,4000.00
Cigna,HMO,28116,CPT4/HCPCS,Revision of foot,,Case Rate,4000.00
Cigna,HMO,28118,CPT4/HCPCS,Removal of heel bone,,Case Rate,4000.00
Cigna,HMO,28119,CPT4/HCPCS,Removal of heel spur,,Case Rate,4000.00
Cigna,HMO,28120,CPT4/HCPCS,Part removal of ankle/heel,,Case Rate,6000.00
Cigna,HMO,28122,CPT4/HCPCS,Partial removal of foot bone,,Case Rate,4000.00
Cigna,HMO,28124,CPT4/HCPCS,Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe,,Case Rate,4000.00
Cigna,HMO,28126,CPT4/HCPCS,Partial removal of toe,,Case Rate,4000.00
Cigna,HMO,28130,CPT4/HCPCS,Removal of ankle bone,,Case Rate,4000.00
Cigna,HMO,28140,CPT4/HCPCS,Removal of metatarsal,,Case Rate,4000.00
Cigna,HMO,28150,CPT4/HCPCS,Removal of toe,,Case Rate,4000.00
Cigna,HMO,28153,CPT4/HCPCS,Partial removal of toe,,Case Rate,4000.00
Cigna,HMO,28160,CPT4/HCPCS,Partial removal of toe,,Case Rate,4000.00
Cigna,HMO,28171,CPT4/HCPCS,Extensive foot surgery,,Case Rate,4000.00
Cigna,HMO,28173,CPT4/HCPCS,Extensive foot surgery,,Case Rate,4000.00
Cigna,HMO,28175,CPT4/HCPCS,Extensive foot surgery,,Case Rate,4000.00
Cigna,HMO,28190,CPT4/HCPCS,Removal of foreign body, foot; subcutaneous,,Case Rate,3000.00
Cigna,HMO,28192,CPT4/HCPCS,Removal of foot foreign body,,Case Rate,3000.00
Cigna,HMO,28193,CPT4/HCPCS,Removal of foot foreign body,,Case Rate,4000.00
Cigna,HMO,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,8300.00
Cigna,HMO,28200,CPT4/HCPCS,Repair of foot tendon,,Case Rate,4000.00
Cigna,HMO,28202,CPT4/HCPCS,Repair/graft of foot tendon,,Case Rate,4000.00
Cigna,HMO,28208,CPT4/HCPCS,Repair of foot tendon,,Case Rate,4000.00
Cigna,HMO,28210,CPT4/HCPCS,Repair/graft of foot tendon,,Case Rate,4000.00
Cigna,HMO,28220,CPT4/HCPCS,Tenolysis, flexor, foot; single tendon,,Case Rate,3000.00
Cigna,HMO,28222,CPT4/HCPCS,Release of foot tendons,,Case Rate,3000.00
Cigna,HMO,28225,CPT4/HCPCS,Release of foot tendon,,Case Rate,3000.00
Cigna,HMO,28226,CPT4/HCPCS,Release of foot tendons,,Case Rate,3000.00
Cigna,HMO,28230,CPT4/HCPCS,Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure),,Case Rate,3000.00
Cigna,HMO,28232,CPT4/HCPCS,Tenotomy, open, tendon flexor; toe, single tendon (separate procedure),,Case Rate,3000.00
Cigna,HMO,28234,CPT4/HCPCS,Incision of foot tendon,,Case Rate,3000.00
Cigna,HMO,28238,CPT4/HCPCS,Revision of foot tendon,,Case Rate,4000.00
Cigna,HMO,28240,CPT4/HCPCS,Release of big toe,,Case Rate,3000.00
Cigna,HMO,28250,CPT4/HCPCS,Revision of foot fascia,,Case Rate,4000.00
Cigna,HMO,28260,CPT4/HCPCS,Release of midfoot joint,,Case Rate,4000.00
Cigna,HMO,28261,CPT4/HCPCS,Revision of foot tendon,,Case Rate,4000.00
Cigna,HMO,28262,CPT4/HCPCS,Revision of foot and ankle,,Case Rate,4000.00
Cigna,HMO,28264,CPT4/HCPCS,Release of midfoot joint,,Case Rate,3000.00
Cigna,HMO,28270,CPT4/HCPCS,Release of foot contracture,,Case Rate,4000.00
Cigna,HMO,28272,CPT4/HCPCS,Capsulotomy; interphalangeal joint, each joint (separate procedure),,Case Rate,3000.00
Cigna,HMO,28280,CPT4/HCPCS,Fusion of toes,,Case Rate,3000.00
Cigna,HMO,28285,CPT4/HCPCS,Repair of hammertoe,,Case Rate,4000.00
Cigna,HMO,28286,CPT4/HCPCS,Repair of hammertoe,,Case Rate,4000.00
Cigna,HMO,28288,CPT4/HCPCS,Partial removal of foot bone,,Case Rate,4000.00
Cigna,HMO,28289,CPT4/HCPCS,Repair hallux rigidus,,Case Rate,4000.00
Cigna,HMO,28291,CPT4/HCPCS,Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant,,Case Rate,3000.00
Cigna,HMO,28292,CPT4/HCPCS,Correction of bunion,,Case Rate,3000.00
Cigna,HMO,28295,CPT4/HCPCS,Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method,,Case Rate,4000.00
Cigna,HMO,28296,CPT4/HCPCS,Correction of bunion,,Case Rate,4000.00
Cigna,HMO,28297,CPT4/HCPCS,Correction of bunion,,Case Rate,4000.00
Cigna,HMO,28298,CPT4/HCPCS,Correction of bunion,,Case Rate,4000.00
Cigna,HMO,28299,CPT4/HCPCS,Correction of bunion,,Case Rate,5000.00
Cigna,HMO,283,DRG,Acute myocardial infarction, expired w MCC,,Case Rate,47547.30
Cigna,HMO,28300,CPT4/HCPCS,Incision of heel bone,,Case Rate,3000.00
Cigna,HMO,28302,CPT4/HCPCS,Incision of ankle bone,,Case Rate,3000.00
Cigna,HMO,28304,CPT4/HCPCS,Incision of midfoot bones,,Case Rate,3000.00
Cigna,HMO,28305,CPT4/HCPCS,Incise/graft midfoot bones,,Case Rate,4000.00
Cigna,HMO,28306,CPT4/HCPCS,Incision of metatarsal,,Case Rate,4000.00
Cigna,HMO,28307,CPT4/HCPCS,Incision of metatarsal,,Case Rate,4000.00
Cigna,HMO,28308,CPT4/HCPCS,Incision of metatarsal,,Case Rate,3000.00
Cigna,HMO,28309,CPT4/HCPCS,Incision of metatarsals,,Case Rate,4000.00
Cigna,HMO,28310,CPT4/HCPCS,Revision of big toe,,Case Rate,4000.00
Cigna,HMO,28312,CPT4/HCPCS,Revision of toe,,Case Rate,4000.00
Cigna,HMO,28313,CPT4/HCPCS,Repair deformity of toe,,Case Rate,3000.00
Cigna,HMO,28315,CPT4/HCPCS,Removal of sesamoid bone,,Case Rate,4000.00
Cigna,HMO,28320,CPT4/HCPCS,Repair of foot bones,,Case Rate,4000.00
Cigna,HMO,28322,CPT4/HCPCS,Repair of metatarsals,,Case Rate,4000.00
Cigna,HMO,28340,CPT4/HCPCS,Resect enlarged toe tissue,,Case Rate,4000.00
Cigna,HMO,28341,CPT4/HCPCS,Resect enlarged toe,,Case Rate,4000.00
Cigna,HMO,28344,CPT4/HCPCS,Repair extra toe(s),,Case Rate,4000.00
Cigna,HMO,28345,CPT4/HCPCS,Repair webbed toe(s),,Case Rate,4000.00
Cigna,HMO,284,DRG,Acute myocardial infarction, expired w CC,,Case Rate,18722.10
Cigna,HMO,28400,CPT4/HCPCS,Treatment of heel fracture,,Case Rate,3000.00
Cigna,HMO,28405,CPT4/HCPCS,Treatment of heel fracture,,Case Rate,3000.00
Cigna,HMO,28406,CPT4/HCPCS,Treatment of heel fracture,,Case Rate,3000.00
Cigna,HMO,28415,CPT4/HCPCS,Treat heel fracture,,Case Rate,4000.00
Cigna,HMO,28420,CPT4/HCPCS,Treat/graft heel fracture,,Case Rate,4000.00
Cigna,HMO,28430,CPT4/HCPCS,Closed treatment of talus fracture; without manipulation,,Case Rate,400.00
Cigna,HMO,28435,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,HMO,28436,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,HMO,28445,CPT4/HCPCS,Treat ankle fracture,,Case Rate,4000.00
Cigna,HMO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Case Rate,8300.00
Cigna,HMO,28450,CPT4/HCPCS,Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each,,Case Rate,400.00
Cigna,HMO,28455,CPT4/HCPCS,Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each,,Case Rate,400.00
Cigna,HMO,28456,CPT4/HCPCS,Treat midfoot fracture,,Case Rate,3000.00
Cigna,HMO,28465,CPT4/HCPCS,Treat midfoot fracture, each,,Case Rate,4000.00
Cigna,HMO,28470,CPT4/HCPCS,Closed treatment of metatarsal fracture; without manipulation, each,,Case Rate,400.00
Cigna,HMO,28475,CPT4/HCPCS,Closed treatment of metatarsal fracture; with manipulation, each,,Case Rate,400.00
Cigna,HMO,28476,CPT4/HCPCS,Treat metatarsal fracture,,Case Rate,3000.00
Cigna,HMO,28485,CPT4/HCPCS,Treat metatarsal fracture,,Case Rate,4000.00
Cigna,HMO,28490,CPT4/HCPCS,Closed treatment of fracture great toe, phalanx or phalanges; without manipulation,,Case Rate,400.00
Cigna,HMO,28495,CPT4/HCPCS,Closed treatment of fracture great toe, phalanx or phalanges; with manipulation,,Case Rate,400.00
Cigna,HMO,28496,CPT4/HCPCS,Treat big toe fracture,,Case Rate,3000.00
Cigna,HMO,285,DRG,Acute myocardial infarction, expired w/o CC/MCC,,Case Rate,12658.20
Cigna,HMO,28505,CPT4/HCPCS,Treat big toe fracture,,Case Rate,4000.00
Cigna,HMO,28510,CPT4/HCPCS,Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each,,Case Rate,400.00
Cigna,HMO,28515,CPT4/HCPCS,Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each,,Case Rate,400.00
Cigna,HMO,28525,CPT4/HCPCS,Treat toe fracture,,Case Rate,4000.00
Cigna,HMO,28530,CPT4/HCPCS,Closed treatment of sesamoid fracture,,Case Rate,400.00
Cigna,HMO,28531,CPT4/HCPCS,Treat sesamoid bone fracture,,Case Rate,4000.00
Cigna,HMO,28540,CPT4/HCPCS,Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia,,Case Rate,400.00
Cigna,HMO,28545,CPT4/HCPCS,Treat foot dislocation,,Case Rate,3000.00
Cigna,HMO,28546,CPT4/HCPCS,Treat foot dislocation,,Case Rate,3000.00
Cigna,HMO,28555,CPT4/HCPCS,Repair foot dislocation,,Case Rate,3000.00
Cigna,HMO,28570,CPT4/HCPCS,Closed treatment of talotarsal joint dislocation; without anesthesia,,Case Rate,400.00
Cigna,HMO,28575,CPT4/HCPCS,Treat foot dislocation,,Case Rate,3000.00
Cigna,HMO,28576,CPT4/HCPCS,Treat foot dislocation,,Case Rate,4000.00
Cigna,HMO,28585,CPT4/HCPCS,Repair foot dislocation,,Case Rate,4000.00
Cigna,HMO,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,8300.00
Cigna,HMO,28600,CPT4/HCPCS,Closed treatment of tarsometatarsal joint dislocation; without anesthesia,,Case Rate,400.00
Cigna,HMO,28605,CPT4/HCPCS,Treat foot dislocation,,Case Rate,3000.00
Cigna,HMO,28606,CPT4/HCPCS,Treat foot dislocation,,Case Rate,3000.00
Cigna,HMO,28615,CPT4/HCPCS,Repair foot dislocation,,Case Rate,4000.00
Cigna,HMO,28630,CPT4/HCPCS,Closed treatment of metatarsophalangeal joint dislocation; without anesthesia,,Case Rate,400.00
Cigna,HMO,28635,CPT4/HCPCS,Treat toe dislocation,,Case Rate,3000.00
Cigna,HMO,28636,CPT4/HCPCS,Treat toe dislocation,,Case Rate,4000.00
Cigna,HMO,28645,CPT4/HCPCS,Repair toe dislocation,,Case Rate,4000.00
Cigna,HMO,28660,CPT4/HCPCS,Closed treatment of interphalangeal joint dislocation; without anesthesia,,Case Rate,400.00
Cigna,HMO,28665,CPT4/HCPCS,Treat toe dislocation,,Case Rate,3000.00
Cigna,HMO,28666,CPT4/HCPCS,Treat toe dislocation,,Case Rate,4000.00
Cigna,HMO,28675,CPT4/HCPCS,Repair of toe dislocation,,Case Rate,4000.00
Cigna,HMO,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,8300.00
Cigna,HMO,28705,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,HMO,28715,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,HMO,28725,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,HMO,28730,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,HMO,28735,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,HMO,28737,CPT4/HCPCS,Revision of foot bones,,Case Rate,5000.00
Cigna,HMO,28740,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,HMO,28750,CPT4/HCPCS,Fusion of big toe joint,,Case Rate,4000.00
Cigna,HMO,28755,CPT4/HCPCS,Fusion of big toe joint,,Case Rate,4000.00
Cigna,HMO,28760,CPT4/HCPCS,Fusion of big toe joint,,Case Rate,4000.00
Cigna,HMO,288,DRG,Acute & subacute endocarditis w MCC,,Case Rate,68365.50
Cigna,HMO,28805,CPT4/HCPCS,Amputation, foot; transmetatarsal,,Case Rate,3000.00
Cigna,HMO,28810,CPT4/HCPCS,Amputation toe & metatarsal,,Case Rate,3000.00
Cigna,HMO,28820,CPT4/HCPCS,Amputation of toe,,Case Rate,3000.00
Cigna,HMO,28825,CPT4/HCPCS,Partial amputation of toe,,Case Rate,3000.00
Cigna,HMO,28890,CPT4/HCPCS,Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia,,Case Rate,3000.00
Cigna,HMO,28899,CPT4/HCPCS,UNLISTED PROCEDURE, FOOT OR TOES ,,Case Rate,3000.00
Cigna,HMO,289,DRG,Acute & subacute endocarditis w CC,,Case Rate,41886.30
Cigna,HMO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,Case Rate,25500.00
Cigna,HMO,290,DRG,Acute & subacute endocarditis w/o CC/MCC,,Case Rate,26101.80
Cigna,HMO,29086,CPT4/HCPCS,APPLY FINGER CAST,,% of Charges,399.10
Cigna,HMO,291,DRG,Heart failure & shock w MCC,,Case Rate,34192.95
Cigna,HMO,29125,CPT4/HCPCS,Short Arm Splint,,% of Charges,801.45
Cigna,HMO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,% of Charges,801.45
Cigna,HMO,292,DRG,Heart failure & shock w CC,,Case Rate,22825.05
Cigna,HMO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,% of Charges,399.10
Cigna,HMO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,% of Charges,399.10
Cigna,HMO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,% of Charges,438.75
Cigna,HMO,293,DRG,Heart failure & shock w/o CC/MCC,,Case Rate,16641.30
Cigna,HMO,29305,CPT4/HCPCS,Application of hip spica cast; one leg,,Case Rate,400.00
Cigna,HMO,29325,CPT4/HCPCS,APPLICATION OF HIP SPICA CAST; ONE AND ONE-HALF SPICA OR BOTH LEGS,,Case Rate,400.00
Cigna,HMO,29345,CPT4/HCPCS,Application of long leg cast (thigh to toes);,,Case Rate,400.00
Cigna,HMO,294,DRG,Deep vein thrombophlebitis w CC/MCC,,Case Rate,32693.55
Cigna,HMO,29405,CPT4/HCPCS,Short Leg Cast,,% of Charges,702.00
Cigna,HMO,29445,CPT4/HCPCS,Contact Cast,,% of Charges,1012.05
Cigna,HMO,295,DRG,Deep vein thrombophlebitis w/o CC/MCC,,Case Rate,25023.15
Cigna,HMO,29515,CPT4/HCPCS,Short Leg Splint,,% of Charges,232.05
Cigna,HMO,29520,CPT4/HCPCS,Hip Strapping,,% of Charges,138.45
Cigna,HMO,29530,CPT4/HCPCS,Knee Strapping,,% of Charges,138.45
Cigna,HMO,29540,CPT4/HCPCS,Ankle/Foot Strapping,,% of Charges,137.80
Cigna,HMO,29550,CPT4/HCPCS,Toe(S) Strapping,,% of Charges,137.80
Cigna,HMO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,% of Charges,619.45
Cigna,HMO,296,DRG,Cardiac arrest, unexplained w MCC,,Case Rate,40667.40
Cigna,HMO,297,DRG,Cardiac arrest, unexplained w CC,,Case Rate,17967.30
Cigna,HMO,29799,CPT4/HCPCS,Stapping/Lowback,,% of Charges,287.30
Cigna,HMO,298,DRG,Cardiac arrest, unexplained w/o CC/MCC,,Case Rate,12449.10
Cigna,HMO,29800,CPT4/HCPCS,Jaw arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29804,CPT4/HCPCS,Jaw arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29805,CPT4/HCPCS,Shoulder arthroscopy, dx,,Case Rate,4000.00
Cigna,HMO,29806,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29807,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29819,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29820,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29821,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29822,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29823,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29824,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,5000.00
Cigna,HMO,29825,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29826,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29827,CPT4/HCPCS,Arthroscop rotator cuff repr,,Case Rate,5000.00
Cigna,HMO,29828,CPT4/HCPCS,ARTHROSCOPY BICEPS TENODESIS,,Case Rate,8300.00
Cigna,HMO,29830,CPT4/HCPCS,Elbow arthroscopy,,Case Rate,4000.00
Cigna,HMO,29834,CPT4/HCPCS,Elbow arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29835,CPT4/HCPCS,Elbow arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29836,CPT4/HCPCS,Elbow arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29837,CPT4/HCPCS,Elbow arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29838,CPT4/HCPCS,Elbow arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29840,CPT4/HCPCS,Wrist arthroscopy,,Case Rate,4000.00
Cigna,HMO,29843,CPT4/HCPCS,Wrist arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29844,CPT4/HCPCS,Wrist arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29845,CPT4/HCPCS,Wrist arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29846,CPT4/HCPCS,Wrist arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29847,CPT4/HCPCS,Wrist arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29848,CPT4/HCPCS,Wrist endoscopy/surgery,,Case Rate,8300.00
Cigna,HMO,29850,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29851,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29855,CPT4/HCPCS,Tibial arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29856,CPT4/HCPCS,Tibial arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29860,CPT4/HCPCS,Hip arthroscopy, dx,,Case Rate,4000.00
Cigna,HMO,29861,CPT4/HCPCS,Hip arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29862,CPT4/HCPCS,Hip arthroscopy/surgery,,Case Rate,8300.00
Cigna,HMO,29863,CPT4/HCPCS,Hip arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29866,CPT4/HCPCS,Arthroscopy, Knee, Surgical; Osteochondral Autograft(S) (Eg, Mosaicplasty) (Includes Harvesting Of The Autograft),,Case Rate,3000.00
Cigna,HMO,29867,CPT4/HCPCS,Arthroscopy, Knee, Surgical; Osteochondral Allograft (Eg, Mosaicplasty),,Case Rate,3000.00
Cigna,HMO,29868,CPT4/HCPCS,Arthroscopy, Knee, Surgical; Meniscal Transplantation (Includes Arthrotomy For Meniscal Insertion), Medial Or Lateral,,Case Rate,3000.00
Cigna,HMO,29870,CPT4/HCPCS,Knee arthroscopy, dx,,Case Rate,4000.00
Cigna,HMO,29871,CPT4/HCPCS,Knee arthroscopy/drainage,,Case Rate,4000.00
Cigna,HMO,29873,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29874,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29875,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29876,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29877,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29879,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29880,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29881,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29882,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29883,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29884,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29885,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29886,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29887,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29888,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29889,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29891,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29892,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29893,CPT4/HCPCS,Scope, plantar fasciotomy,,Case Rate,8300.00
Cigna,HMO,29894,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29895,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29897,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29898,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,29899,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,HMO,299,DRG,Peripheral vascular disorders w MCC,,Case Rate,39050.70
Cigna,HMO,29900,CPT4/HCPCS,Mcp joint arthroscopy, dx,,Case Rate,4000.00
Cigna,HMO,29901,CPT4/HCPCS,Mcp joint arthroscopy, surg,,Case Rate,4000.00
Cigna,HMO,29902,CPT4/HCPCS,Mcp joint arthroscopy, surg,,Case Rate,4000.00
Cigna,HMO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Case Rate,8300.00
Cigna,HMO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Case Rate,8300.00
Cigna,HMO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Case Rate,8300.00
Cigna,HMO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Case Rate,8300.00
Cigna,HMO,29914,CPT4/HCPCS,ARTHROSCOPY, HIP, SURGICAL; WITH FEMOROPLASTY (IE, TREATMENT OF CAM LESION),,Case Rate,8300.00
Cigna,HMO,29915,CPT4/HCPCS,ARTHROSCOPY, HIP, SURGICAL; WITH ACETABULOPLASTY (IE, TREATMENT OF PINCER LESION),,Case Rate,8300.00
Cigna,HMO,29916,CPT4/HCPCS,ARTHROSCOPY, HIP, SURGICAL; WITH LABRAL REPAIR,,Case Rate,8300.00
Cigna,HMO,29999,CPT4/HCPCS,UNLISTED PROCEDURE, ARTHROSCOPY ,,Case Rate,3000.00
Cigna,HMO,3,DRG,ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R.,,Case Rate,484275.60
Cigna,HMO,30,DRG,Spinal procedures w/o CC/MCC,,Case Rate,25500.00
Cigna,HMO,300,DRG,Peripheral vascular disorders w CC,,Case Rate,26576.10
Cigna,HMO,30000,CPT4/HCPCS,Drainage abscess or hematoma, nasal, internal approach,,Case Rate,400.00
Cigna,HMO,30020,CPT4/HCPCS,Drainage abscess or hematoma, nasal septum,,Case Rate,400.00
Cigna,HMO,301,DRG,Peripheral vascular disorders w/o CC/MCC,,Case Rate,18933.75
Cigna,HMO,30100,CPT4/HCPCS,Biopsy, intranasal,,Case Rate,3000.00
Cigna,HMO,30110,CPT4/HCPCS,Excision, nasal polyp(s), simple,,Case Rate,3000.00
Cigna,HMO,30115,CPT4/HCPCS,Removal of nose polyp(s),,Case Rate,3000.00
Cigna,HMO,30117,CPT4/HCPCS,Removal of intranasal lesion,,Case Rate,4000.00
Cigna,HMO,30118,CPT4/HCPCS,Removal of intranasal lesion,,Case Rate,4000.00
Cigna,HMO,30120,CPT4/HCPCS,Revision of nose,,Case Rate,3000.00
Cigna,HMO,30124,CPT4/HCPCS,Removal of nose lesion,,Case Rate,3000.00
Cigna,HMO,30125,CPT4/HCPCS,Removal of nose lesion,,Case Rate,3000.00
Cigna,HMO,30130,CPT4/HCPCS,Removal of turbinate bones,,Case Rate,4000.00
Cigna,HMO,30140,CPT4/HCPCS,Removal of turbinate bones,,Case Rate,3000.00
Cigna,HMO,30150,CPT4/HCPCS,Partial removal of nose,,Case Rate,4000.00
Cigna,HMO,30160,CPT4/HCPCS,Removal of nose,,Case Rate,4000.00
Cigna,HMO,302,DRG,Atherosclerosis w MCC,,Case Rate,27884.25
Cigna,HMO,30220,CPT4/HCPCS,Insert nasal septal button,,Case Rate,4000.00
Cigna,HMO,303,DRG,Atherosclerosis w/o MCC,,Case Rate,17248.20
Cigna,HMO,30310,CPT4/HCPCS,Remove nasal foreign body,,Case Rate,3000.00
Cigna,HMO,30320,CPT4/HCPCS,Remove nasal foreign body,,Case Rate,3000.00
Cigna,HMO,304,DRG,Hypertension w MCC,,Case Rate,27937.80
Cigna,HMO,30400,CPT4/HCPCS,Reconstruction of nose,,Case Rate,4000.00
Cigna,HMO,30410,CPT4/HCPCS,Reconstruction of nose,,Case Rate,5000.00
Cigna,HMO,30420,CPT4/HCPCS,Reconstruction of nose,,Case Rate,5000.00
Cigna,HMO,30430,CPT4/HCPCS,Revision of nose,,Case Rate,4000.00
Cigna,HMO,30435,CPT4/HCPCS,Revision of nose,,Case Rate,5000.00
Cigna,HMO,30450,CPT4/HCPCS,Revision of nose,,Case Rate,6000.00
Cigna,HMO,30460,CPT4/HCPCS,Revision of nose,,Case Rate,6000.00
Cigna,HMO,30462,CPT4/HCPCS,Revision of nose,,Case Rate,8300.00
Cigna,HMO,30465,CPT4/HCPCS,Repair nasal stenosis,,Case Rate,8300.00
Cigna,HMO,305,DRG,Hypertension w/o MCC,,Case Rate,18831.75
Cigna,HMO,30520,CPT4/HCPCS,Repair of nasal septum,,Case Rate,4000.00
Cigna,HMO,30540,CPT4/HCPCS,Repair nasal defect,,Case Rate,5000.00
Cigna,HMO,30545,CPT4/HCPCS,Repair nasal defect,,Case Rate,5000.00
Cigna,HMO,30560,CPT4/HCPCS,Release of nasal adhesions,,Case Rate,3000.00
Cigna,HMO,30580,CPT4/HCPCS,Repair upper jaw fistula,,Case Rate,4000.00
Cigna,HMO,306,DRG,Cardiac congenital & valvular disorders w MCC,,Case Rate,38344.35
Cigna,HMO,30600,CPT4/HCPCS,Repair mouth/nose fistula,,Case Rate,4000.00
Cigna,HMO,30620,CPT4/HCPCS,Intranasal reconstruction,,Case Rate,6000.00
Cigna,HMO,30630,CPT4/HCPCS,Repair nasal septum defect,,Case Rate,6000.00
Cigna,HMO,307,DRG,Cardiac congenital & valvular disorders w/o MCC,,Case Rate,22144.20
Cigna,HMO,308,DRG,Cardiac arrhythmia & conduction disorders w MCC,,Case Rate,30582.15
Cigna,HMO,30801,CPT4/HCPCS,Cauterization, inner nose,,Case Rate,3000.00
Cigna,HMO,30802,CPT4/HCPCS,Cauterization, inner nose,,Case Rate,3000.00
Cigna,HMO,309,DRG,Cardiac arrhythmia & conduction disorders w CC,,Case Rate,19109.70
Cigna,HMO,30901,CPT4/HCPCS,Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method,,Case Rate,400.00
Cigna,HMO,30903,CPT4/HCPCS,Control of nosebleed,,Case Rate,3000.00
Cigna,HMO,30905,CPT4/HCPCS,Control of nosebleed,,Case Rate,3000.00
Cigna,HMO,30906,CPT4/HCPCS,Repeat control of nosebleed,,Case Rate,3000.00
Cigna,HMO,30915,CPT4/HCPCS,Ligation, nasal sinus artery,,Case Rate,3000.00
Cigna,HMO,30920,CPT4/HCPCS,Ligation, upper jaw artery,,Case Rate,4000.00
Cigna,HMO,30930,CPT4/HCPCS,Therapy, fracture of nose,,Case Rate,4000.00
Cigna,HMO,30999,CPT4/HCPCS,UNLISTED PROCEDURE, NOSE ,,Case Rate,3000.00
Cigna,HMO,31,DRG,Ventricular shunt procedures w MCC,,Case Rate,111335.55
Cigna,HMO,310,DRG,Cardiac arrhythmia & conduction disorders w/o CC/MCC,,Case Rate,14239.20
Cigna,HMO,31000,CPT4/HCPCS,Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium),,Case Rate,400.00
Cigna,HMO,31002,CPT4/HCPCS,Lavage by cannulation; sphenoid sinus,,Case Rate,3000.00
Cigna,HMO,31020,CPT4/HCPCS,Exploration, maxillary sinus,,Case Rate,3000.00
Cigna,HMO,31030,CPT4/HCPCS,Exploration, maxillary sinus,,Case Rate,4000.00
Cigna,HMO,31032,CPT4/HCPCS,Explore sinus,remove polyps,,Case Rate,4000.00
Cigna,HMO,31050,CPT4/HCPCS,Exploration, sphenoid sinus,,Case Rate,3000.00
Cigna,HMO,31051,CPT4/HCPCS,Sphenoid sinus surgery,,Case Rate,4000.00
Cigna,HMO,31070,CPT4/HCPCS,Exploration of frontal sinus,,Case Rate,3000.00
Cigna,HMO,31075,CPT4/HCPCS,Exploration of frontal sinus,,Case Rate,4000.00
Cigna,HMO,31080,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,HMO,31081,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,HMO,31084,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,HMO,31085,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,HMO,31086,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,HMO,31087,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,HMO,31090,CPT4/HCPCS,Exploration of sinuses,,Case Rate,5000.00
Cigna,HMO,311,DRG,Angina pectoris,,Case Rate,17773.50
Cigna,HMO,312,DRG,Syncope & collapse,,Case Rate,21348.60
Cigna,HMO,31200,CPT4/HCPCS,Removal of ethmoid sinus,,Case Rate,3000.00
Cigna,HMO,31201,CPT4/HCPCS,Removal of ethmoid sinus,,Case Rate,5000.00
Cigna,HMO,31205,CPT4/HCPCS,Removal of ethmoid sinus,,Case Rate,4000.00
Cigna,HMO,31231,CPT4/HCPCS,Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure),,Case Rate,400.00
Cigna,HMO,31233,CPT4/HCPCS,Nasal/sinus endoscopy, dx,,Case Rate,3000.00
Cigna,HMO,31235,CPT4/HCPCS,Nasal/sinus endoscopy, dx,,Case Rate,3000.00
Cigna,HMO,31237,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,3000.00
Cigna,HMO,31238,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,3000.00
Cigna,HMO,31239,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,4000.00
Cigna,HMO,31240,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,3000.00
Cigna,HMO,31241,CPT4/HCPCS,Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery,,Case Rate,3000.00
Cigna,HMO,31253,CPT4/HCPCS,Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed,,Case Rate,3000.00
Cigna,HMO,31254,CPT4/HCPCS,Revision of ethmoid sinus,,Case Rate,4000.00
Cigna,HMO,31255,CPT4/HCPCS,Removal of ethmoid sinus,,Case Rate,5000.00
Cigna,HMO,31256,CPT4/HCPCS,Exploration maxillary sinus,,Case Rate,4000.00
Cigna,HMO,31257,CPT4/HCPCS,Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy,,Case Rate,3000.00
Cigna,HMO,31259,CPT4/HCPCS,Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus,,Case Rate,3000.00
Cigna,HMO,31267,CPT4/HCPCS,Endoscopy, maxillary sinus,,Case Rate,4000.00
Cigna,HMO,31276,CPT4/HCPCS,Sinus endoscopy, surgical,,Case Rate,4000.00
Cigna,HMO,31287,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,4000.00
Cigna,HMO,31288,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,4000.00
Cigna,HMO,31290,CPT4/HCPCS,Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; ethmoid region,,Case Rate,3000.00
Cigna,HMO,31291,CPT4/HCPCS,Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; sphenoid region,,Case Rate,3000.00
Cigna,HMO,31292,CPT4/HCPCS,Nasal/sinus endoscopy, surgical; with medial or inferior orbital wall decompression,,Case Rate,3000.00
Cigna,HMO,31293,CPT4/HCPCS,Nasal/sinus endoscopy, surgical; with medial orbital wall and inferior orbital wall decompression,,Case Rate,3000.00
Cigna,HMO,31294,CPT4/HCPCS,Nasal/sinus endoscopy, surgical; with optic nerve decompression,,Case Rate,3000.00
Cigna,HMO,31295,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF MAXILLARY SINUS OSTIUM (EG, BALLOON DILATION), TRANSNASAL OR VIA CANINE FOSSA,,Case Rate,8300.00
Cigna,HMO,31296,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF FRONTAL SINUS OSTIUM (EG, BALLOON DILATION),,Case Rate,8300.00
Cigna,HMO,31297,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF SPHENOID SINUS OSTIUM (EG, BALLOON DILATION),,Case Rate,8300.00
Cigna,HMO,31298,CPT4/HCPCS,Nasal/sinus endoscopy, surgical; with dilation of frontal and sphenoid sinus ostia (eg, balloon dilation),,Case Rate,3000.00
Cigna,HMO,313,DRG,Chest pain,,Case Rate,18380.40
Cigna,HMO,31300,CPT4/HCPCS,Removal of larynx lesion,,Case Rate,5000.00
Cigna,HMO,314,DRG,Other circulatory system diagnoses w MCC,,Case Rate,53126.70
Cigna,HMO,31400,CPT4/HCPCS,Revision of larynx,,Case Rate,3000.00
Cigna,HMO,31420,CPT4/HCPCS,Removal of epiglottis,,Case Rate,3000.00
Cigna,HMO,315,DRG,Other circulatory system diagnoses w CC,,Case Rate,24867.60
Cigna,HMO,31500,CPT4/HCPCS,INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE ,,Case Rate,3000.00
Cigna,HMO,31502,CPT4/HCPCS,TRACH TUBE CHANGE PRIOR TO ESTAB FISTULATRACT (CONSIDER AS TOS 04) ,,Case Rate,3000.00
Cigna,HMO,31510,CPT4/HCPCS,Laryngoscopy with biopsy,,Case Rate,3000.00
Cigna,HMO,31511,CPT4/HCPCS,Remove foreign body, larynx,,Case Rate,3000.00
Cigna,HMO,31512,CPT4/HCPCS,Removal of larynx lesion,,Case Rate,3000.00
Cigna,HMO,31513,CPT4/HCPCS,Injection into vocal cord,,Case Rate,3000.00
Cigna,HMO,31515,CPT4/HCPCS,Laryngoscopy for aspiration,,Case Rate,3000.00
Cigna,HMO,31520,CPT4/HCPCS,LARYNGOSCOPY DIRECT; DIAGNOSTIC, NEWBORN ,,Case Rate,3000.00
Cigna,HMO,31525,CPT4/HCPCS,Diagnostic laryngoscopy,,Case Rate,3000.00
Cigna,HMO,31526,CPT4/HCPCS,Diagnostic laryngoscopy,,Case Rate,3000.00
Cigna,HMO,31527,CPT4/HCPCS,Laryngoscopy for treatment,,Case Rate,3000.00
Cigna,HMO,31528,CPT4/HCPCS,Laryngoscopy and dilation,,Case Rate,3000.00
Cigna,HMO,31529,CPT4/HCPCS,Laryngoscopy and dilation,,Case Rate,3000.00
Cigna,HMO,31530,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,3000.00
Cigna,HMO,31531,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,4000.00
Cigna,HMO,31535,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,3000.00
Cigna,HMO,31536,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,4000.00
Cigna,HMO,31540,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,4000.00
Cigna,HMO,31541,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,4000.00
Cigna,HMO,31545,CPT4/HCPCS,Remove vc lesion w/scope,,Case Rate,4000.00
Cigna,HMO,31546,CPT4/HCPCS,Remove vc lesion scope/graft,,Case Rate,4000.00
Cigna,HMO,31551,CPT4/HCPCS,Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of age,,Case Rate,3000.00
Cigna,HMO,31552,CPT4/HCPCS,Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older,,Case Rate,3000.00
Cigna,HMO,31553,CPT4/HCPCS,Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of age,,Case Rate,3000.00
Cigna,HMO,31554,CPT4/HCPCS,Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older,,Case Rate,3000.00
Cigna,HMO,31560,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,5000.00
Cigna,HMO,31561,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,5000.00
Cigna,HMO,31570,CPT4/HCPCS,Laryngoscopy with injection,,Case Rate,3000.00
Cigna,HMO,31571,CPT4/HCPCS,Laryngoscopy with injection,,Case Rate,3000.00
Cigna,HMO,31572,CPT4/HCPCS,Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral,,Case Rate,6000.00
Cigna,HMO,31573,CPT4/HCPCS,Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral,,Case Rate,6000.00
Cigna,HMO,31574,CPT4/HCPCS,Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral,,Case Rate,6000.00
Cigna,HMO,31575,CPT4/HCPCS,Laryngoscopy, flexible fiberoptic; diagnostic,,Case Rate,400.00
Cigna,HMO,31576,CPT4/HCPCS,Laryngoscopy with biopsy,,Case Rate,3000.00
Cigna,HMO,31577,CPT4/HCPCS,Remove foreign body, larynx,,Case Rate,3000.00
Cigna,HMO,31578,CPT4/HCPCS,Removal of larynx lesion,,Case Rate,3000.00
Cigna,HMO,31579,CPT4/HCPCS,Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy,,Case Rate,3000.00
Cigna,HMO,31580,CPT4/HCPCS,Revision of larynx,,Case Rate,5000.00
Cigna,HMO,31584,CPT4/HCPCS,Treat larynx fracture,,Case Rate,3000.00
Cigna,HMO,31587,CPT4/HCPCS,Laryngoplasty, cricoid split, without graft placement,,Case Rate,3000.00
Cigna,HMO,31590,CPT4/HCPCS,Reinnervate larynx,,Case Rate,5000.00
Cigna,HMO,31591,CPT4/HCPCS,Laryngoplasty, medialization, unilateral,,Case Rate,3000.00
Cigna,HMO,31592,CPT4/HCPCS,Cricotracheal resection,,Case Rate,3000.00
Cigna,HMO,31599,CPT4/HCPCS,UNLISTED PROCEDURE, LARYNX ,,Case Rate,3000.00
Cigna,HMO,316,DRG,Other circulatory system diagnoses w/o CC/MCC,,Case Rate,19112.25
Cigna,HMO,31600,CPT4/HCPCS,Incision of windpipe,,Case Rate,3000.00
Cigna,HMO,31603,CPT4/HCPCS,Incision of windpipe,,Case Rate,3000.00
Cigna,HMO,31605,CPT4/HCPCS,TRACHEOSTOMY EMERGENCY PROCEDURE CRICOTHYROID MEMBRANE ,,Case Rate,3000.00
Cigna,HMO,31611,CPT4/HCPCS,Surgery/speech prosthesis,,Case Rate,4000.00
Cigna,HMO,31612,CPT4/HCPCS,Puncture/clear windpipe,,Case Rate,3000.00
Cigna,HMO,31613,CPT4/HCPCS,Repair windpipe opening,,Case Rate,3000.00
Cigna,HMO,31614,CPT4/HCPCS,Repair windpipe opening,,Case Rate,3000.00
Cigna,HMO,31615,CPT4/HCPCS,Visualization of windpipe,,Case Rate,3000.00
Cigna,HMO,31622,CPT4/HCPCS,Dx bronchoscope/wash,,Case Rate,3000.00
Cigna,HMO,31623,CPT4/HCPCS,Dx bronchoscope/brush,,Case Rate,3000.00
Cigna,HMO,31624,CPT4/HCPCS,Dx bronchoscope/lavage,,Case Rate,3000.00
Cigna,HMO,31625,CPT4/HCPCS,Bronchoscopy with biopsy,,Case Rate,3000.00
Cigna,HMO,31626,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE , WHEN PERFORMED; WITH PLACEMENT OF FIDUCIAL MARKERS, SINGLE OR MU LTIPLE ,,Case Rate,3000.00
Cigna,HMO,31627,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH COMPUTER-ASSISTED, IMAGE-GUIDED NAVIGATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE[S]),,Case Rate,3000.00
Cigna,HMO,31628,CPT4/HCPCS,Bronchoscopy with biopsy,,Case Rate,3000.00
Cigna,HMO,31629,CPT4/HCPCS,Bronchoscopy with biopsy,,Case Rate,3000.00
Cigna,HMO,31630,CPT4/HCPCS,Bronchoscopy with repair,,Case Rate,3000.00
Cigna,HMO,31631,CPT4/HCPCS,Bronchoscopy with dilation,,Case Rate,3000.00
Cigna,HMO,31632,CPT4/HCPCS,Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,31633,CPT4/HCPCS,Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,31634,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BALLOON OCCLUSION, WITH ASSESSMENT OF AIR LEAK, WITH ADMINISTRATION OF OCCLUSIVE SUBSTANCE (EG, FIBRIN GLUE), IF PERFORMED,,Case Rate,4000.00
Cigna,HMO,31635,CPT4/HCPCS,Remove foreign body, airway,,Case Rate,3000.00
Cigna,HMO,31636,CPT4/HCPCS,Bronchoscopy, bronch stents,,Case Rate,3000.00
Cigna,HMO,31637,CPT4/HCPCS,Bronchoscopy, stent add-on,,Case Rate,3000.00
Cigna,HMO,31638,CPT4/HCPCS,Bronchoscopy, revise stent,,Case Rate,3000.00
Cigna,HMO,31640,CPT4/HCPCS,Bronchoscopy & remove lesion,,Case Rate,3000.00
Cigna,HMO,31641,CPT4/HCPCS,Bronchoscopy, treat blockage,,Case Rate,3000.00
Cigna,HMO,31643,CPT4/HCPCS,Diag bronchoscope/catheter,,Case Rate,3000.00
Cigna,HMO,31645,CPT4/HCPCS,Bronchoscopy, clear airways,,Case Rate,3000.00
Cigna,HMO,31646,CPT4/HCPCS,Bronchoscopy, reclear airway,,Case Rate,3000.00
Cigna,HMO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Case Rate,6000.00
Cigna,HMO,31648,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,Case Rate,6000.00
Cigna,HMO,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Case Rate,4000.00
Cigna,HMO,31651,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,Case Rate,6000.00
Cigna,HMO,31652,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), ONE OR TWO MEDIASTINAL AND/OR HILAR LYMPH NODE STAT,,Case Rate,8300.00
Cigna,HMO,31653,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), 3 OR MORE MEDIASTINAL AND/OR HILAR LYMPH NODE STATI,,Case Rate,8300.00
Cigna,HMO,31654,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSENDOSCOPIC ENDOBRONCHIAL ULTRASOUND (EBUS) DURING BRONCHOSCOPIC DIAGNOSTIC OR THERAPEUTIC INTERVENTION(S) FOR PERIPHERAL LESION(S) (LIST SEPARATELY IN ADDITION TO ,,Case Rate,3000.00
Cigna,HMO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Case Rate,8300.00
Cigna,HMO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Case Rate,8300.00
Cigna,HMO,31717,CPT4/HCPCS,Bronchial brush biopsy,,Case Rate,3000.00
Cigna,HMO,31720,CPT4/HCPCS,Clearance of airways,,Case Rate,3000.00
Cigna,HMO,31725,CPT4/HCPCS,Catheter aspiration (separate procedure); tracheobronchial with fiberscope, bedside,,Case Rate,3000.00
Cigna,HMO,31730,CPT4/HCPCS,Intro, windpipe wire/tube,,Case Rate,3000.00
Cigna,HMO,31750,CPT4/HCPCS,Repair of windpipe,,Case Rate,5000.00
Cigna,HMO,31755,CPT4/HCPCS,Repair of windpipe,,Case Rate,3000.00
Cigna,HMO,31785,CPT4/HCPCS,Remove windpipe lesion,,Case Rate,4000.00
Cigna,HMO,31800,CPT4/HCPCS,Repair of windpipe injury,,Case Rate,3000.00
Cigna,HMO,31820,CPT4/HCPCS,Closure of windpipe lesion,,Case Rate,3000.00
Cigna,HMO,31825,CPT4/HCPCS,Repair of windpipe defect,,Case Rate,3000.00
Cigna,HMO,31830,CPT4/HCPCS,Revise windpipe scar,,Case Rate,3000.00
Cigna,HMO,31899,CPT4/HCPCS,Unlisted procedure, trachea, bronchi,,Case Rate,3000.00
Cigna,HMO,319,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W MCC,,Case Rate,110052.90
Cigna,HMO,32,DRG,Ventricular shunt procedures w CC,,Case Rate,56411.10
Cigna,HMO,320,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W/O MCC,,Case Rate,62314.35
Cigna,HMO,32400,CPT4/HCPCS,Needle biopsy chest lining,,Case Rate,3000.00
Cigna,HMO,32405,CPT4/HCPCS,Biopsy, lung or mediastinum,,Case Rate,3000.00
Cigna,HMO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Case Rate,8300.00
Cigna,HMO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Case Rate,3000.00
Cigna,HMO,32552,CPT4/HCPCS,REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF,,Case Rate,400.00
Cigna,HMO,32553,CPT4/HCPCS,Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple,,Case Rate,3000.00
Cigna,HMO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Case Rate,3000.00
Cigna,HMO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Case Rate,3000.00
Cigna,HMO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Case Rate,3000.00
Cigna,HMO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Case Rate,3000.00
Cigna,HMO,32560,CPT4/HCPCS,TREAT LUNG LINING CHEMICALLY,,Case Rate,3000.00
Cigna,HMO,32561,CPT4/HCPCS,INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF MULTILOCULATED EFFUSION); INITIAL DAY,,Case Rate,3000.00
Cigna,HMO,32562,CPT4/HCPCS,INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF MULTILOCULATED EFFUSION); SUBSEQUENT DAY,,Case Rate,3000.00
Cigna,HMO,326,DRG,Stomach, esophageal & duodenal proc w MCC,,Case Rate,137131.35
Cigna,HMO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Case Rate,3000.00
Cigna,HMO,32604,CPT4/HCPCS,THORACOSCOPY, DIAGNOSTIC,,Case Rate,3000.00
Cigna,HMO,32606,CPT4/HCPCS,THORACOSCOPY, DIAGNOSTIC,,Case Rate,3000.00
Cigna,HMO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Case Rate,8300.00
Cigna,HMO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Case Rate,8300.00
Cigna,HMO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Case Rate,8300.00
Cigna,HMO,32664,CPT4/HCPCS,Thoracoscopy, surgical; with thoracic sympathectomy,,Case Rate,3000.00
Cigna,HMO,327,DRG,Stomach, esophageal & duodenal proc w CC,,Case Rate,66544.80
Cigna,HMO,328,DRG,Stomach, esophageal & duodenal proc w/o CC/MCC,,Case Rate,42470.25
Cigna,HMO,329,DRG,Major small & large bowel procedures w MCC,,Case Rate,123682.65
Cigna,HMO,32994,CPT4/HCPCS,Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; cryoablation,,Case Rate,3000.00
Cigna,HMO,32998,CPT4/HCPCS,"Perq rf ablate tx, pul tumor",,Case Rate,8300.00
Cigna,HMO,33,DRG,Ventricular shunt procedures w/o CC/MCC,,Case Rate,43877.85
Cigna,HMO,330,DRG,Major small & large bowel procedures w CC,,Case Rate,64744.50
Cigna,HMO,33016,CPT4/HCPCS,Periocardiocentesis, including imaging guidance, when performed,,Case Rate,3000.00
Cigna,HMO,331,DRG,Major small & large bowel procedures w/o CC/MCC,,Case Rate,43607.55
Cigna,HMO,332,DRG,Rectal resection w MCC,,Case Rate,106072.35
Cigna,HMO,33206,CPT4/HCPCS,INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL ,,Case Rate,3000.00
Cigna,HMO,33207,CPT4/HCPCS,INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); VENTRICULAR ,,Case Rate,3000.00
Cigna,HMO,33208,CPT4/HCPCS,INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL AND VENTRICULAR ,,Case Rate,3000.00
Cigna,HMO,33210,CPT4/HCPCS,INSERT O REPLAC TEMP TRNSVENOUS SNGL CHAMBR CARD ELECTRD O PACEMKR CATH(SEP PR ,,Case Rate,3000.00
Cigna,HMO,33211,CPT4/HCPCS,INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING ELECTRODES (SEPARATE PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,33212,CPT4/HCPCS,Insertion of pulse generator,,Case Rate,4000.00
Cigna,HMO,33213,CPT4/HCPCS,Insertion of pulse generator,,Case Rate,4000.00
Cigna,HMO,33214,CPT4/HCPCS,UPGRADE OF IMPLANTED PACEMAKER SYSTEM, CONVERSION OF SINGLE CHAMBER SYSTEM TO DUAL CHAMBER SYSTEM (INCLUDES REMOVAL OF PREVIOUSLY PLACED PULSE GENERATOR, TESTING OF EXISTING LEAD, INSERTION OF NEW LEAD, INSERTION OF NEW PULSE GENERATOR) ,,Case Rate,3000.00
Cigna,HMO,33215,CPT4/HCPCS,Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator (right atrial or right ventricular) electrode,,Case Rate,3000.00
Cigna,HMO,33216,CPT4/HCPCS,INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR CARDIOVERTER-DEFIBRILLATOR ,,Case Rate,3000.00
Cigna,HMO,33217,CPT4/HCPCS,INSERTION OF 2 TRANSVENOUS ELECTRODES, PERMANENT PACEMAKER OR CA RDIOVERTER-DEFIBRILLATOR ,,Case Rate,3000.00
Cigna,HMO,33218,CPT4/HCPCS,REPAIR OF SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR PACING CARDIOVERTER-DEFIBRILLATOR ,,Case Rate,3000.00
Cigna,HMO,33220,CPT4/HCPCS,REPAIR OF 2 TRANSVENOUS ELECTRODES FOR PERMANENT PACEMAKER OR PACING CARDIOVERTER-DEFIBRILLATOR ,,Case Rate,3000.00
Cigna,HMO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Case Rate,3000.00
Cigna,HMO,33222,CPT4/HCPCS,Revise pocket, pacemaker,,Case Rate,3000.00
Cigna,HMO,33223,CPT4/HCPCS,Revise pocket, pacing-defib,,Case Rate,3000.00
Cigna,HMO,33224,CPT4/HCPCS,Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter-defibrillator pulse generator (including revision of pocket, removal, insertion and/or replacement of,,Case Rate,3000.00
Cigna,HMO,33225,CPT4/HCPCS,Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system)) (List separately in addition to code for,,Case Rate,3000.00
Cigna,HMO,33226,CPT4/HCPCS,Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of generator),,Case Rate,3000.00
Cigna,HMO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Case Rate,3000.00
Cigna,HMO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Case Rate,3000.00
Cigna,HMO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Case Rate,3000.00
Cigna,HMO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Case Rate,3000.00
Cigna,HMO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Case Rate,3000.00
Cigna,HMO,33233,CPT4/HCPCS,Removal of pacemaker system,,Case Rate,3000.00
Cigna,HMO,33234,CPT4/HCPCS,REMOVAL OF PERMANENT PACEMAKER ELECTRODE(S), SINGLE LEAD SYSTEM, ATRIAL OR VENTRICULAR ,,Case Rate,3000.00
Cigna,HMO,33235,CPT4/HCPCS,REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); DUAL LEAD SYSTEM ,,Case Rate,3000.00
Cigna,HMO,33240,CPT4/HCPCS,INSERTION OF PACING CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR ONLY; WITH EXISTING SINGLE LEAD ,,Case Rate,3000.00
Cigna,HMO,33241,CPT4/HCPCS,REMOVAL OF PACING CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR ONLY ,,Case Rate,3000.00
Cigna,HMO,33244,CPT4/HCPCS,REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR ELECTRODE(S); BY TRANSVENOUS EXTRACTION ,,Case Rate,3000.00
Cigna,HMO,33249,CPT4/HCPCS,INSERTION OR REPLACEMENT OF PERMANENT PACING CARDIOVERTER- DEFIBRILLATOR SYSTEM WITH TRANSVENOUS LEAD(S), SINGLE OR DUAL CHAMBER ,,Case Rate,3000.00
Cigna,HMO,33262,CPT4/HCPCS,REMV&REPLC CVD GEN SING LEAD,,Case Rate,3000.00
Cigna,HMO,33263,CPT4/HCPCS,REMV&REPLC CVD GEN DUAL LEAD,,Case Rate,3000.00
Cigna,HMO,33264,CPT4/HCPCS,REMV&REPLC CVD GEN MULT LEAD,,Case Rate,3000.00
Cigna,HMO,33270,CPT4/HCPCS, INSERTION OR REPLACEMENT OF PERMANENT SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR SYSTEM, WITH SUBCUTANEOUS ELECTRODE, INCLUDING DEFIBRILLATION THRESHOLD EVALUATION, INDUCTION OF ARRHYTHMIA, EVALUATION OF SENSING FOR ARRHYTHMIA TERMINATION, AND PROGRAMMING OR,,Case Rate,3000.00
Cigna,HMO,33271,CPT4/HCPCS, INSERTION OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE,,Case Rate,3000.00
Cigna,HMO,33272,CPT4/HCPCS, REMOVAL OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE,,Case Rate,3000.00
Cigna,HMO,33273,CPT4/HCPCS, REPOSITIONING OF PREVIOUSLY IMPLANTED SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE,,Case Rate,8300.00
Cigna,HMO,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,Case Rate,3000.00
Cigna,HMO,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,Case Rate,8300.00
Cigna,HMO,33285,CPT4/HCPCS,Insertion, subcutaneous cardiac rhythm monitor, including programming ,,Case Rate,3000.00
Cigna,HMO,33286,CPT4/HCPCS,Removal, subcutaneous cardiac rhythm monitor,,Case Rate,3000.00
Cigna,HMO,33289,CPT4/HCPCS,Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision an,,Case Rate,3000.00
Cigna,HMO,333,DRG,Rectal resection w CC,,Case Rate,54595.50
Cigna,HMO,334,DRG,Rectal resection w/o CC/MCC,,Case Rate,41034.60
Cigna,HMO,335,DRG,Peritoneal adhesiolysis w MCC,,Case Rate,99205.20
Cigna,HMO,336,DRG,Peritoneal adhesiolysis w CC,,Case Rate,58213.95
Cigna,HMO,337,DRG,Peritoneal adhesiolysis w/o CC/MCC,,Case Rate,41631.30
Cigna,HMO,338,DRG,Appendectomy w complicated principal diag w MCC,,Case Rate,71369.40
Cigna,HMO,339,DRG,Appendectomy w complicated principal diag w CC,,Case Rate,43222.50
Cigna,HMO,33968,CPT4/HCPCS,REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS.,,Case Rate,3000.00
Cigna,HMO,34,DRG,Carotid artery stent procedure w MCC,,Case Rate,101352.30
Cigna,HMO,340,DRG,Appendectomy w complicated principal diag w/o CC/MCC,,Case Rate,31324.20
Cigna,HMO,341,DRG,Appendectomy w/o complicated principal diag w MCC,,Case Rate,59063.10
Cigna,HMO,34101,CPT4/HCPCS,Removal of artery clot,,Case Rate,4000.00
Cigna,HMO,342,DRG,Appendectomy w/o complicated principal diag w CC,,Case Rate,36544.05
Cigna,HMO,343,DRG,Appendectomy w/o complicated principal diag w/o CC/MCC,,Case Rate,28289.70
Cigna,HMO,344,DRG,Minor small & large bowel procedures w MCC,,Case Rate,71422.95
Cigna,HMO,345,DRG,Minor small & large bowel procedures w CC,,Case Rate,40231.35
Cigna,HMO,346,DRG,Minor small & large bowel procedures w/o CC/MCC,,Case Rate,32512.50
Cigna,HMO,347,DRG,Anal & stomal procedures w MCC,,Case Rate,62770.80
Cigna,HMO,34701,CPT4/HCPCS,Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft ext,,Case Rate,3000.00
Cigna,HMO,34702,CPT4/HCPCS,Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft ext,,Case Rate,3000.00
Cigna,HMO,34703,CPT4/HCPCS,Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpreta,,Case Rate,3000.00
Cigna,HMO,34704,CPT4/HCPCS,Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpreta,,Case Rate,3000.00
Cigna,HMO,34705,CPT4/HCPCS,Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretat,,Case Rate,3000.00
Cigna,HMO,34706,CPT4/HCPCS,Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretat,,Case Rate,3000.00
Cigna,HMO,34707,CPT4/HCPCS,Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft exten,,Case Rate,3000.00
Cigna,HMO,34708,CPT4/HCPCS,Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft exten,,Case Rate,3000.00
Cigna,HMO,34709,CPT4/HCPCS,Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, penetrating ulcer, including pre-proced,,Case Rate,3000.00
Cigna,HMO,34710,CPT4/HCPCS,Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all n,,Case Rate,3000.00
Cigna,HMO,34711,CPT4/HCPCS,Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all n,,Case Rate,3000.00
Cigna,HMO,34712,CPT4/HCPCS,Transcatheter delivery of enhanced fixation device(s) to the endograft (eg, anchor, screw, tack) and all associated radiological supervision and interpretation,,Case Rate,3000.00
Cigna,HMO,34713,CPT4/HCPCS,Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,34714,CPT4/HCPCS,Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,34715,CPT4/HCPCS,Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,34716,CPT4/HCPCS,Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for p,,Case Rate,3000.00
Cigna,HMO,348,DRG,Anal & stomal procedures w CC,,Case Rate,34231.20
Cigna,HMO,34833,CPT4/HCPCS,Open iliac artery exposure with creation of conduit for delivery of infrarenal aortic or iliac endovascular prosthesis, by abdominal or retroperitoneal incision, unilateral,,Case Rate,3000.00
Cigna,HMO,34834,CPT4/HCPCS,Open brachial artery exposure to assist in the deployment of infrarenal aortic or iliac endovascular prosthesis by arm incision, unilateral,,Case Rate,3000.00
Cigna,HMO,349,DRG,Anal & stomal procedures w/o CC/MCC,,Case Rate,24972.15
Cigna,HMO,35,DRG,Carotid artery stent procedure w CC,,Case Rate,59596.05
Cigna,HMO,350,DRG,Inguinal & femoral hernia procedures w MCC,,Case Rate,62536.20
Cigna,HMO,351,DRG,Inguinal & femoral hernia procedures w CC,,Case Rate,38005.20
Cigna,HMO,35188,CPT4/HCPCS,Repair blood vessel lesion,,Case Rate,4000.00
Cigna,HMO,352,DRG,Inguinal & femoral hernia procedures w/o CC/MCC,,Case Rate,28126.50
Cigna,HMO,35201,CPT4/HCPCS,Repair blood vessel, direct; neck ,,Case Rate,3000.00
Cigna,HMO,35206,CPT4/HCPCS,Repair blood vessel, direct; upper extremity ,,Case Rate,3000.00
Cigna,HMO,35207,CPT4/HCPCS,Repair blood vessel lesion,,Case Rate,4000.00
Cigna,HMO,35226,CPT4/HCPCS,Repair blood vessel, direct; lower extremity ,,Case Rate,3000.00
Cigna,HMO,35231,CPT4/HCPCS,Repair blood vessel with vein graft; neck ,,Case Rate,3000.00
Cigna,HMO,35236,CPT4/HCPCS,Repair blood vessel with vein graft; upper extremity ,,Case Rate,3000.00
Cigna,HMO,35256,CPT4/HCPCS,Repair blood vessel with vein graft; lower extremity ,,Case Rate,3000.00
Cigna,HMO,35261,CPT4/HCPCS,Repair blood vessel with graft other than vein; neck ,,Case Rate,3000.00
Cigna,HMO,35266,CPT4/HCPCS,Repair blood vessel with graft other than vein; upper extremity ,,Case Rate,3000.00
Cigna,HMO,35286,CPT4/HCPCS,Repair blood vessel with graft other than vein; lower extremity ,,Case Rate,3000.00
Cigna,HMO,353,DRG,Hernia procedures except inguinal & femoral w MCC,,Case Rate,76711.65
Cigna,HMO,354,DRG,Hernia procedures except inguinal & femoral w CC,,Case Rate,45466.50
Cigna,HMO,355,DRG,Hernia procedures except inguinal & femoral w/o CC/MCC,,Case Rate,34659.60
Cigna,HMO,356,DRG,Other digestive system O.R. procedures w MCC,,Case Rate,109430.70
Cigna,HMO,357,DRG,Other digestive system O.R. procedures w CC,,Case Rate,57469.35
Cigna,HMO,35702,CPT4/HCPCS,Exploration not followed by surgical repair, artery; upper extremity (eg, axillary, brachial, radial, ulnar),,Case Rate,3000.00
Cigna,HMO,35703,CPT4/HCPCS,Exploration not followed by surgical repair, artery; lower extremity (eg, common femoral, deep femoral, superficial femoral, popliteal, tibial, peroneal,,Case Rate,3000.00
Cigna,HMO,358,DRG,Other digestive system O.R. procedures w/o CC/MCC,,Case Rate,34144.50
Cigna,HMO,35875,CPT4/HCPCS,Removal of clot in graft,,Case Rate,8300.00
Cigna,HMO,35876,CPT4/HCPCS,Removal of clot in graft,,Case Rate,8300.00
Cigna,HMO,35883,CPT4/HCPCS,Revise graft w/nonauto graft,,Case Rate,8300.00
Cigna,HMO,35884,CPT4/HCPCS,Revise graft w/vein,,Case Rate,8300.00
Cigna,HMO,36,DRG,Carotid artery stent procedure w/o CC/MCC,,Case Rate,47205.60
Cigna,HMO,36002,CPT4/HCPCS,INJECTION PROCEDURES (EG, THROMBIN) FOR PERCUTANEOUS TREATMENT OF EXTREMITY PSEUDOANEURYSM,,Case Rate,3000.00
Cigna,HMO,36005,CPT4/HCPCS,Injection procedure for contrast venography (including introduction of needle or intracatheter),,Case Rate,3000.00
Cigna,HMO,36010,CPT4/HCPCS,Introduction of catheter, superior or inferior vena cava,,Case Rate,3000.00
Cigna,HMO,36011,CPT4/HCPCS,Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein),,Case Rate,3000.00
Cigna,HMO,36012,CPT4/HCPCS,Selective catheter placement, venous system; second order, or more selective, branch (eg, left adrenal vein, petrosal sinus),,Case Rate,3000.00
Cigna,HMO,36013,CPT4/HCPCS,Introduction of catheter, right heart or main pulmonary artery,,Case Rate,3000.00
Cigna,HMO,36014,CPT4/HCPCS,Selective catheter placement, left or right pulmonary artery,,Case Rate,3000.00
Cigna,HMO,36015,CPT4/HCPCS,Selective catheter placement, segmental or subsegmental pulmonary artery,,Case Rate,3000.00
Cigna,HMO,36100,CPT4/HCPCS,Introduction of needle or intracatheter, carotid or vertebral artery,,Case Rate,3000.00
Cigna,HMO,36140,CPT4/HCPCS,Introduction of needle or intracatheter; extremity artery,,Case Rate,3000.00
Cigna,HMO,36160,CPT4/HCPCS,Introduction of needle or intracatheter, aortic, translumbar,,Case Rate,3000.00
Cigna,HMO,36200,CPT4/HCPCS,Introduction of catheter, aorta,,Case Rate,3000.00
Cigna,HMO,36215,CPT4/HCPCS,Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family,,Case Rate,3000.00
Cigna,HMO,36216,CPT4/HCPCS,Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family,,Case Rate,3000.00
Cigna,HMO,36217,CPT4/HCPCS,Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family,,Case Rate,3000.00
Cigna,HMO,36218,CPT4/HCPCS,Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate),,Case Rate,3000.00
Cigna,HMO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Case Rate,3000.00
Cigna,HMO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Case Rate,3000.00
Cigna,HMO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Case Rate,3000.00
Cigna,HMO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Case Rate,3000.00
Cigna,HMO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Case Rate,3000.00
Cigna,HMO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Case Rate,3000.00
Cigna,HMO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Case Rate,3000.00
Cigna,HMO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Case Rate,3000.00
Cigna,HMO,36245,CPT4/HCPCS,Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family,,Case Rate,3000.00
Cigna,HMO,36246,CPT4/HCPCS,Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family,,Case Rate,3000.00
Cigna,HMO,36247,CPT4/HCPCS,Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family,,Case Rate,3000.00
Cigna,HMO,36248,CPT4/HCPCS,Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriat,,Case Rate,3000.00
Cigna,HMO,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,Case Rate,3000.00
Cigna,HMO,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,Case Rate,3000.00
Cigna,HMO,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,Case Rate,3000.00
Cigna,HMO,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,Case Rate,3000.00
Cigna,HMO,36260,CPT4/HCPCS,Insertion of infusion pump,,Case Rate,4000.00
Cigna,HMO,36261,CPT4/HCPCS,Revision of infusion pump,,Case Rate,3000.00
Cigna,HMO,36262,CPT4/HCPCS,Removal of infusion pump,,Case Rate,3000.00
Cigna,HMO,36420,CPT4/HCPCS,Venipuncture, cutdown; under age 1 year,,Case Rate,400.00
Cigna,HMO,36425,CPT4/HCPCS,Venipuncture, cutdown; age 1 or over,,Case Rate,400.00
Cigna,HMO,36430,CPT4/HCPCS,TRANSFUSION, BLOOD OR BLOOD COMPONENTS, INDIRECT ,,Case Rate,3000.00
Cigna,HMO,36440,CPT4/HCPCS,PUSH TRANSFUSION, BLOOD, 2 YEARS OR UNDER ,,Case Rate,3000.00
Cigna,HMO,36450,CPT4/HCPCS,EXCHANGE TRANSFUSION, BLOOD, NEWBORN ,,Case Rate,3000.00
Cigna,HMO,36455,CPT4/HCPCS,EXCHANGE TRANSFUSION, BLOOD; OTHER THAN NEWBORN ,,Case Rate,3000.00
Cigna,HMO,36456,CPT4/HCPCS,Partial exchange transfusion, blood, plasma or crystalloid necessitating the skill of a physician or other qualified health care professional, newborn,,Case Rate,3000.00
Cigna,HMO,36460,CPT4/HCPCS,Transfusion, intrauterine, fetal,,Case Rate,3000.00
Cigna,HMO,36465,CPT4/HCPCS,Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphen,,Case Rate,3000.00
Cigna,HMO,36466,CPT4/HCPCS,Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vei,,Case Rate,3000.00
Cigna,HMO,36468,CPT4/HCPCS,S/MLT INJ SCLROS SOLUT;LMB/TRNK(TOS 03/TOS 04)(POTENT COS)(TOS 03 SPEC PH ONLY) ,,Case Rate,3000.00
Cigna,HMO,36470,CPT4/HCPCS,INJCT SCLEROS SOLUT;SINGL VEIN(TOS 03/TOS 04)(POTENT COS)(TOS 03 SPECIF PH ONLY ,,Case Rate,3000.00
Cigna,HMO,36471,CPT4/HCPCS,INJ SCLEROS SOLUT;MLTI VNS SAME LEG(TOS 03 TOS 04)(POTNT COS)(TOS 03 SPCIF PH O ,,Case Rate,3000.00
Cigna,HMO,36473,CPT4/HCPCS,Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated,,Case Rate,400.00
Cigna,HMO,36474,CPT4/HCPCS,Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition ,,Case Rate,3000.00
Cigna,HMO,36475,CPT4/HCPCS,Endovenous rf, 1st vein,,Case Rate,8300.00
Cigna,HMO,36476,CPT4/HCPCS,Endovenous rf, vein add-on,,Case Rate,3000.00
Cigna,HMO,36478,CPT4/HCPCS,Endovenous laser, 1st vein,,Case Rate,8300.00
Cigna,HMO,36479,CPT4/HCPCS,Endovenous laser vein addon,,Case Rate,3000.00
Cigna,HMO,36481,CPT4/HCPCS,Percutaneous portal vein catheterization by any method,,Case Rate,3000.00
Cigna,HMO,36482,CPT4/HCPCS,Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated,,Case Rate,3000.00
Cigna,HMO,36483,CPT4/HCPCS,Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a s,,Case Rate,3000.00
Cigna,HMO,36500,CPT4/HCPCS,Venous catheterization for selective organ blood sampling,,Case Rate,3000.00
Cigna,HMO,36511,CPT4/HCPCS,Therapeutic apheresis; for white blood cells,,Case Rate,3000.00
Cigna,HMO,36512,CPT4/HCPCS,Therapeutic apheresis; for red blood cells,,Case Rate,3000.00
Cigna,HMO,36513,CPT4/HCPCS,Therapeutic apheresis; for platelets,,Case Rate,3000.00
Cigna,HMO,36514,CPT4/HCPCS,Therapeutic apheresis; for plasma pheresis,,Case Rate,3000.00
Cigna,HMO,36516,CPT4/HCPCS,Therapeutic apheresis; with extracorporeal selective adsorption or selective filtration andplasma reinfusion,,Case Rate,3000.00
Cigna,HMO,36522,CPT4/HCPCS,PHOTOPHERESIS, EXTRACORPOREAL,,Case Rate,3000.00
Cigna,HMO,36555,CPT4/HCPCS,INSRT NON-TUNNL CNTRL CVC; <,,Case Rate,3000.00
Cigna,HMO,36556,CPT4/HCPCS,INSRT NON-TUNNL CNTRL CVC; 5,,Case Rate,3000.00
Cigna,HMO,36557,CPT4/HCPCS,INSRT TUNNL CVC NO PORT/PUMP,,Case Rate,3000.00
Cigna,HMO,36558,CPT4/HCPCS,INSRT TUNNL CVC NO PORT/PUMP,,Case Rate,3000.00
Cigna,HMO,36560,CPT4/HCPCS,INSRT TUNNL CNTRL CVAD PORT;,,Case Rate,4000.00
Cigna,HMO,36561,CPT4/HCPCS,INSRT TUNNL CNTRL CVAD PORT;,,Case Rate,4000.00
Cigna,HMO,36563,CPT4/HCPCS,INSRT TUNNL CNTRL CVAD W/SUB,,Case Rate,4000.00
Cigna,HMO,36565,CPT4/HCPCS,INSRT TUNL CVAD 2 CATH-SITE;,,Case Rate,4000.00
Cigna,HMO,36566,CPT4/HCPCS,INSRT TUNNL CVAD 2 CATH-2 SI,,Case Rate,6000.00
Cigna,HMO,36568,CPT4/HCPCS,INSERT PICC W/O PORT/PUMP; <,,Case Rate,3000.00
Cigna,HMO,36569,CPT4/HCPCS,INSERT PICC W/O PORT/PUMP; 5,,Case Rate,3000.00
Cigna,HMO,36570,CPT4/HCPCS,INSRT PERIPH INSRT CVAD W/PO,,Case Rate,4000.00
Cigna,HMO,36571,CPT4/HCPCS,INSRT PERIPH INSRT CVAD PORT,,Case Rate,4000.00
Cigna,HMO,36572,CPT4/HCPCS,Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; yo,,Case Rate,3000.00
Cigna,HMO,36573,CPT4/HCPCS,Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; ag,,Case Rate,3000.00
Cigna,HMO,36575,CPT4/HCPCS,REP CV ACSS CATH W/O PORT/PU,,Case Rate,3000.00
Cigna,HMO,36576,CPT4/HCPCS,REP CVAD W/PORT/PUMP CNTRL/P,,Case Rate,3000.00
Cigna,HMO,36578,CPT4/HCPCS,REPL CATH ONLY CVAD SUBQ POR,,Case Rate,3000.00
Cigna,HMO,36580,CPT4/HCPCS,REPL NON-TUNNLD CVC W/O PORT,,Case Rate,3000.00
Cigna,HMO,36581,CPT4/HCPCS,REPL TUNNLD CNTRL CVC W/O PO,,Case Rate,3000.00
Cigna,HMO,36582,CPT4/HCPCS,REPL TUNNLD CNTRL CVAD W/SUB,,Case Rate,4000.00
Cigna,HMO,36583,CPT4/HCPCS,REPL TUNNLD CNTRL CVAD W/SUB,,Case Rate,4000.00
Cigna,HMO,36584,CPT4/HCPCS,REPL PICC W/O PORT/PUMP SAME,,Case Rate,3000.00
Cigna,HMO,36585,CPT4/HCPCS,REPL PERIPH INSRT CVAD W/SUB,,Case Rate,4000.00
Cigna,HMO,36589,CPT4/HCPCS,REMV TUNNLD CVC W/O SUBQ POR,,Case Rate,3000.00
Cigna,HMO,36590,CPT4/HCPCS,REMV TUNNLD CVAD W/SUBQ PORT,,Case Rate,3000.00
Cigna,HMO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Case Rate,400.00
Cigna,HMO,36595,CPT4/HCPCS,Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access ,,Case Rate,3000.00
Cigna,HMO,36596,CPT4/HCPCS,Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen ,,Case Rate,3000.00
Cigna,HMO,36597,CPT4/HCPCS,Repositioning of previously placed central venous catheter under fluoroscopic guidance,,Case Rate,3000.00
Cigna,HMO,36598,CPT4/HCPCS,Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report,,Case Rate,3000.00
Cigna,HMO,36600,CPT4/HCPCS,Arterial Puncture,,% of Charges,59.80
Cigna,HMO,36620,CPT4/HCPCS,Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous,,Case Rate,3000.00
Cigna,HMO,36640,CPT4/HCPCS,Insertion catheter, artery,,Case Rate,3000.00
Cigna,HMO,36680,CPT4/HCPCS,Placement of needle for intraosseous infusion,,Case Rate,400.00
Cigna,HMO,368,DRG,Major esophageal disorders w MCC,,Case Rate,49528.65
Cigna,HMO,36800,CPT4/HCPCS,Insertion of cannula,,Case Rate,4000.00
Cigna,HMO,36810,CPT4/HCPCS,Insertion of cannula,,Case Rate,4000.00
Cigna,HMO,36815,CPT4/HCPCS,Insertion of cannula,,Case Rate,4000.00
Cigna,HMO,36818,CPT4/HCPCS,Arteriovenous Anastomosis, Open; By Upper Arm Cephalic Vein Transposition,,Case Rate,4000.00
Cigna,HMO,36819,CPT4/HCPCS,Av fusion/uppr arm vein,,Case Rate,4000.00
Cigna,HMO,36820,CPT4/HCPCS,Av fusion/forearm vein,,Case Rate,4000.00
Cigna,HMO,36821,CPT4/HCPCS,Av fusion direct any site,,Case Rate,4000.00
Cigna,HMO,36825,CPT4/HCPCS,Artery-vein graft,,Case Rate,4000.00
Cigna,HMO,36830,CPT4/HCPCS,Artery-vein graft,,Case Rate,4000.00
Cigna,HMO,36831,CPT4/HCPCS,Open thrombect av fistula,,Case Rate,8300.00
Cigna,HMO,36832,CPT4/HCPCS,Av fistula revision, open,,Case Rate,4000.00
Cigna,HMO,36833,CPT4/HCPCS,Av fistula revision,,Case Rate,4000.00
Cigna,HMO,36835,CPT4/HCPCS,Artery to vein shunt,,Case Rate,4000.00
Cigna,HMO,36838,CPT4/HCPCS,Distal revascularization and interval ligation (DRIL), upper extremity hemodialysis access (steal syndrome),,Case Rate,3000.00
Cigna,HMO,36860,CPT4/HCPCS,External cannula declotting,,Case Rate,3000.00
Cigna,HMO,36861,CPT4/HCPCS,Cannula declotting,,Case Rate,4000.00
Cigna,HMO,369,DRG,Major esophageal disorders w CC,,Case Rate,27458.40
Cigna,HMO,36901,CPT4/HCPCS,Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis ,,Case Rate,400.00
Cigna,HMO,36902,CPT4/HCPCS,Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis ,,Case Rate,3000.00
Cigna,HMO,36903,CPT4/HCPCS,Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis ,,Case Rate,3000.00
Cigna,HMO,36904,CPT4/HCPCS,Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), ,,Case Rate,3000.00
Cigna,HMO,36905,CPT4/HCPCS,Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), ,,Case Rate,3000.00
Cigna,HMO,36906,CPT4/HCPCS,Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), ,,Case Rate,3000.00
Cigna,HMO,36907,CPT4/HCPCS,Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary proc,,Case Rate,3000.00
Cigna,HMO,36908,CPT4/HCPCS,Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysi,,Case Rate,3000.00
Cigna,HMO,36909,CPT4/HCPCS,Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in a,,Case Rate,3000.00
Cigna,HMO,37,DRG,Extracranial procedures w MCC,,Case Rate,83504.85
Cigna,HMO,370,DRG,Major esophageal disorders w/o CC/MCC,,Case Rate,19063.80
Cigna,HMO,371,DRG,Major gastrointestinal disorders & peritoneal infections w MCC,,Case Rate,44071.65
Cigna,HMO,37183,CPT4/HCPCS,REVISION OF TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC SHUNT(S) (TIPS) (INCLUDES VENOUS ACCESS, HEPATIC AND PORTAL VEIN CATHETERIZATION, PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, INTRAHEPATIC TRACT RECANULIZATION/DILATATION, STENT PLACEMENT AND ALL ASSOCIATED,,Case Rate,3000.00
Cigna,HMO,37184,CPT4/HCPCS,Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel,,Case Rate,8300.00
Cigna,HMO,37185,CPT4/HCPCS,Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same v,,Case Rate,3000.00
Cigna,HMO,37186,CPT4/HCPCS,SECONDARY PERCUTANEOUS TRANSLUMINAL THROMBECTOMY (EG, NONPRIMARY MECHANICAL, SNARE BASKET, SUCTION TECHNIQUE), NONCORONARY, ARTERIAL OR ARTERIAL BYPASS GRAFT, INCLUDING FLUOROSCOPIC GUIDANCE AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTIONS, PR,,Case Rate,3000.00
Cigna,HMO,37187,CPT4/HCPCS,Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance,,Case Rate,8300.00
Cigna,HMO,37188,CPT4/HCPCS,Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy,,Case Rate,8300.00
Cigna,HMO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Case Rate,3000.00
Cigna,HMO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Case Rate,3000.00
Cigna,HMO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Case Rate,3000.00
Cigna,HMO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Case Rate,8300.00
Cigna,HMO,372,DRG,Major gastrointestinal disorders & peritoneal infections w CC,,Case Rate,26203.80
Cigna,HMO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY ,,Case Rate,3000.00
Cigna,HMO,37211,CPT4/HCPCS,TRANSCATHETER THERAPY, ARTERIAL INFUSION FOR THROMBOLYSIS OTHER THAN CORONARY, ANY METHOD, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION, INITIAL TREATMENT DAY ,,Case Rate,3000.00
Cigna,HMO,37212,CPT4/HCPCS,TRANSCATHETER THERAPY, VENOUS INFUSION FOR THROMBOLYSIS, ANY METHOD, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION, INITIAL TREATMENT DAY ,,Case Rate,3000.00
Cigna,HMO,37213,CPT4/HCPCS,TRANSCATHETER THERAPY, ARTERIAL OR VENOUS INFUSION FOR THROMBOLYSIS OTHER THAN CORONARY, ANY METHOD, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION, CONTINUED TREATMENT ON SUBSEQUENT DAY DURING COURSE OF THROMBOLYTIC THERAPY, INCLUDING FOLLOW-UP C,,Case Rate,3000.00
Cigna,HMO,37214,CPT4/HCPCS,TRANSCATHETER THERAPY, ARTERIAL OR VENOUS INFUSION FOR THROMBOLYSIS OTHER THAN CORONARY, ANY METHOD, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION, CONTINUED TREATMENT ON SUBSEQUENT DAY DURING COURSE OF THROMBOLYTIC THERAPY, INCLUDING FOLLOW-UP C,,Case Rate,3000.00
Cigna,HMO,37215,CPT4/HCPCS,Transcatheter Placement Of Intravascular Stent(S), Cervical Carotid Artery, Percutaneous; With Distal Embolic Protection,,Case Rate,3000.00
Cigna,HMO,37216,CPT4/HCPCS,Transcatheter Placement Of Intravascular Stent(S), Cervical Carotid Artery, Percutaneous; Without Distal Embolic Protection,,Case Rate,3000.00
Cigna,HMO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Case Rate,3000.00
Cigna,HMO,37218,CPT4/HCPCS, TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), INTRATHORACIC COMMON CAROTID ARTERY OR INNOMINATE ARTERY, OPEN OR PERCUTANEOUS ANTEGRADE APPROACH, INCLUDING ANGIOPLASTY, WHEN PERFORMED, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION,,Case Rate,3000.00
Cigna,HMO,37220,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY,,Case Rate,3000.00
Cigna,HMO,37221,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,HMO,37222,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, EACH ADDITIONAL IPSILATERAL ILIAC VESSEL; WITH TRANSLUMINAL ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,37223,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, EACH ADDITIONAL IPSILATERAL ILIAC VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMA,,Case Rate,3000.00
Cigna,HMO,37224,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL ANGIOPLASTY,,Case Rate,3000.00
Cigna,HMO,37225,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,HMO,37226,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,HMO,37227,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL STENT PLACEMENT(S) AND ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,HMO,37228,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY,,Case Rate,3000.00
Cigna,HMO,37229,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,HMO,37230,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,HMO,37231,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S) AND ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,HMO,37232,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,37233,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,37234,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR P,,Case Rate,3000.00
Cigna,HMO,37235,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S) AND ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED (LIST SEPARATELY IN ADDITI,,Case Rate,3000.00
Cigna,HMO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Case Rate,3000.00
Cigna,HMO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Case Rate,3000.00
Cigna,HMO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Case Rate,3000.00
Cigna,HMO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Case Rate,3000.00
Cigna,HMO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Case Rate,3000.00
Cigna,HMO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Case Rate,3000.00
Cigna,HMO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Case Rate,3000.00
Cigna,HMO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Case Rate,3000.00
Cigna,HMO,37246,CPT4/HCPCS,Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to p,,Case Rate,3000.00
Cigna,HMO,37247,CPT4/HCPCS,Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to p,,Case Rate,3000.00
Cigna,HMO,37248,CPT4/HCPCS,Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein,,Case Rate,3000.00
Cigna,HMO,37249,CPT4/HCPCS,Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in add,,Case Rate,3000.00
Cigna,HMO,37252,CPT4/HCPCS,INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; INITIAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,37253,CPT4/HCPCS,INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; EACH ADDITIONAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDUR,,Case Rate,3000.00
Cigna,HMO,373,DRG,Major gastrointestinal disorders & peritoneal infections w/o CC/MCC,,Case Rate,18959.25
Cigna,HMO,374,DRG,Digestive malignancy w MCC,,Case Rate,52731.45
Cigna,HMO,375,DRG,Digestive malignancy w CC,,Case Rate,30724.95
Cigna,HMO,37500,CPT4/HCPCS,Endoscopy ligate perf veins,,Case Rate,4000.00
Cigna,HMO,376,DRG,Digestive malignancy w/o CC/MCC,,Case Rate,22827.60
Cigna,HMO,37607,CPT4/HCPCS,Ligation of a-v fistula,,Case Rate,4000.00
Cigna,HMO,37609,CPT4/HCPCS,Temporal artery procedure,,Case Rate,3000.00
Cigna,HMO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Case Rate,3000.00
Cigna,HMO,37650,CPT4/HCPCS,Revision of major vein,,Case Rate,3000.00
Cigna,HMO,377,DRG,G.I. hemorrhage w MCC,,Case Rate,45871.95
Cigna,HMO,37700,CPT4/HCPCS,Revise leg vein,,Case Rate,3000.00
Cigna,HMO,37718,CPT4/HCPCS,Ligate/strip short leg vein,,Case Rate,4000.00
Cigna,HMO,37722,CPT4/HCPCS,Ligate/strip long leg vein,,Case Rate,4000.00
Cigna,HMO,37735,CPT4/HCPCS,Removal of leg veins/lesion,,Case Rate,4000.00
Cigna,HMO,37760,CPT4/HCPCS,Revision of leg veins,,Case Rate,4000.00
Cigna,HMO,37761,CPT4/HCPCS,Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg ,,Case Rate,3000.00
Cigna,HMO,37765,CPT4/HCPCS,Stab phlebectomy of varicose veins, one extremity; 10-20 stab incisions,,Case Rate,4000.00
Cigna,HMO,37766,CPT4/HCPCS,Stab phlebectomy of varicose veins, one extremity; more than 20 incisions,,Case Rate,4000.00
Cigna,HMO,37780,CPT4/HCPCS,Revision of leg vein,,Case Rate,4000.00
Cigna,HMO,37785,CPT4/HCPCS,Revise secondary varicosity,,Case Rate,4000.00
Cigna,HMO,37790,CPT4/HCPCS,Penile venous occlusion,,Case Rate,4000.00
Cigna,HMO,37799,CPT4/HCPCS,Unlisted procedure, vascular surgery,,Case Rate,3000.00
Cigna,HMO,378,DRG,G.I. hemorrhage w CC,,Case Rate,25326.60
Cigna,HMO,379,DRG,G.I. hemorrhage w/o CC/MCC,,Case Rate,16246.05
Cigna,HMO,38,DRG,Extracranial procedures w CC,,Case Rate,42261.15
Cigna,HMO,380,DRG,Complicated peptic ulcer w MCC,,Case Rate,48019.05
Cigna,HMO,381,DRG,Complicated peptic ulcer w CC,,Case Rate,27022.35
Cigna,HMO,38120,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, SPLENECTOMY,,Case Rate,5000.00
Cigna,HMO,38129,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN,,Case Rate,3000.00
Cigna,HMO,382,DRG,Complicated peptic ulcer w/o CC/MCC,,Case Rate,19591.65
Cigna,HMO,38200,CPT4/HCPCS,INJECTION PROCEDURE FOR SPLENOPORTOGRAPHY ,,Case Rate,3000.00
Cigna,HMO,38220,CPT4/HCPCS,BONE MARROW ASPIRATION,,Case Rate,3000.00
Cigna,HMO,38221,CPT4/HCPCS,BONE MARROW BIOPSY, NEEDLE OR TROCAR,,Case Rate,3000.00
Cigna,HMO,38222,CPT4/HCPCS,Diagnostic bone marrow; biopsy(ies) and aspiration(s),,Case Rate,3000.00
Cigna,HMO,38230,CPT4/HCPCS,BONE MARROW HARVESTING FOR TRANSPLANTATION; ALLOGENIC ,,Case Rate,3000.00
Cigna,HMO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Case Rate,8300.00
Cigna,HMO,38240,CPT4/HCPCS,HEMATOPOIETIC PROGENITOR CELL (HPC); ALLOGENEIC TRANSPLANTATION PER DONOR ,,Case Rate,3000.00
Cigna,HMO,38241,CPT4/HCPCS,HEMATOPOIETIC PROGENITOR CELL (HPC); AUTOLOGOUS TRANSPLANTATION ,,Case Rate,3000.00
Cigna,HMO,38243,CPT4/HCPCS,HEMATOPOIETIC PROGENITOR CELL (HPC); HPC BOOST ,,Case Rate,3000.00
Cigna,HMO,383,DRG,Uncomplicated peptic ulcer w MCC,,Case Rate,33427.95
Cigna,HMO,38300,CPT4/HCPCS,Drainage, lymph node lesion,,Case Rate,3000.00
Cigna,HMO,38305,CPT4/HCPCS,Drainage, lymph node lesion,,Case Rate,3000.00
Cigna,HMO,38308,CPT4/HCPCS,Incision of lymph channels,,Case Rate,3000.00
Cigna,HMO,384,DRG,Uncomplicated peptic ulcer w/o MCC,,Case Rate,22756.20
Cigna,HMO,385,DRG,Inflammatory bowel disease w MCC,,Case Rate,41287.05
Cigna,HMO,38500,CPT4/HCPCS,Biopsy/removal, lymph nodes,,Case Rate,3000.00
Cigna,HMO,38505,CPT4/HCPCS,Needle biopsy, lymph nodes,,Case Rate,3000.00
Cigna,HMO,38510,CPT4/HCPCS,Biopsy/removal, lymph nodes,,Case Rate,3000.00
Cigna,HMO,38520,CPT4/HCPCS,Biopsy/removal, lymph nodes,,Case Rate,3000.00
Cigna,HMO,38525,CPT4/HCPCS,Biopsy/removal, lymph nodes,,Case Rate,3000.00
Cigna,HMO,38530,CPT4/HCPCS,Biopsy/removal, lymph nodes,,Case Rate,3000.00
Cigna,HMO,38531,CPT4/HCPCS,Biopsy or excision of lymph node(s); open, inguinofemoral node(s,,Case Rate,3000.00
Cigna,HMO,38542,CPT4/HCPCS,Explore deep node(s), neck,,Case Rate,3000.00
Cigna,HMO,38550,CPT4/HCPCS,Removal, neck/armpit lesion,,Case Rate,4000.00
Cigna,HMO,38555,CPT4/HCPCS,Removal, neck/armpit lesion,,Case Rate,4000.00
Cigna,HMO,38570,CPT4/HCPCS,Laparoscopy, lymph node biop,,Case Rate,8300.00
Cigna,HMO,38571,CPT4/HCPCS,Laparoscopy, lymphadenectomy,,Case Rate,8300.00
Cigna,HMO,38572,CPT4/HCPCS,Laparoscopy, lymphadenectomy,,Case Rate,8300.00
Cigna,HMO,38573,CPT4/HCPCS,Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omentectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when perfo,,Case Rate,3000.00
Cigna,HMO,38589,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, LYMPHATIC SYSTEM,,Case Rate,3000.00
Cigna,HMO,386,DRG,Inflammatory bowel disease w CC,,Case Rate,25334.25
Cigna,HMO,387,DRG,Inflammatory bowel disease w/o CC/MCC,,Case Rate,18194.25
Cigna,HMO,38700,CPT4/HCPCS,Removal of lymph nodes, neck,,Case Rate,3000.00
Cigna,HMO,38720,CPT4/HCPCS,Cervical lymphadenectomy (complete),,Case Rate,3000.00
Cigna,HMO,38724,CPT4/HCPCS,Cervical lymphadenectomy (modified radical neck dissection),,Case Rate,3000.00
Cigna,HMO,38740,CPT4/HCPCS,Remove armpit lymph nodes,,Case Rate,3000.00
Cigna,HMO,38745,CPT4/HCPCS,Remove armpit lymph nodes,,Case Rate,4000.00
Cigna,HMO,38760,CPT4/HCPCS,Remove groin lymph nodes,,Case Rate,3000.00
Cigna,HMO,38790,CPT4/HCPCS,Inject for lymphatic x-ray,,Case Rate,3000.00
Cigna,HMO,38792,CPT4/HCPCS,Injection procedure; radioactive tracer for identification of sentinel node,,Case Rate,3000.00
Cigna,HMO,388,DRG,G.I. obstruction w MCC,,Case Rate,38550.90
Cigna,HMO,389,DRG,G.I. obstruction w CC,,Case Rate,20955.90
Cigna,HMO,38900,CPT4/HCPCS,INTRAOPERATIVE IDENTIFICATION (EG, MAPPING) OF SENTINEL LYMPH NODE(S) INCLUDES INJECTION OF NON-RADIOACTIVE DYE, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,38999,CPT4/HCPCS,UNLISTED PROCEDURE HEMIC OR LYMPHATIC SYSTEMS ,,Case Rate,3000.00
Cigna,HMO,39,DRG,Extracranial procedures w/o CC/MCC,,Case Rate,29044.50
Cigna,HMO,390,DRG,G.I. obstruction w/o CC/MCC,,Case Rate,14856.30
Cigna,HMO,391,DRG,Esophagitis, gastroent & misc digest disorders w MCC,,Case Rate,31732.20
Cigna,HMO,392,DRG,Esophagitis, gastroent & misc digest disorders w/o MCC,,Case Rate,19492.20
Cigna,HMO,393,DRG,Other digestive system diagnoses w MCC,,Case Rate,42166.80
Cigna,HMO,394,DRG,Other digestive system diagnoses w CC,,Case Rate,23934.30
Cigna,HMO,39401,CPT4/HCPCS,MEDIASTINOSCOPY; INCLUDES BIOPSY(IES) OF MEDIASTINAL MASS (EG, LYMPHOMA), WHEN PERFORMED,,Case Rate,3000.00
Cigna,HMO,39402,CPT4/HCPCS,MEDIASTINOSCOPY; WITH LYMPH NODE BIOPSY(IES) (EG, LUNG CANCER STAGING),,Case Rate,3000.00
Cigna,HMO,395,DRG,Other digestive system diagnoses w/o CC/MCC,,Case Rate,16567.35
Cigna,HMO,4,DRG,Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R.,,Case Rate,302481.00
Cigna,HMO,40,DRG,Periph/cranial nerve & other nerv syst proc w MCC,,Case Rate,100923.90
Cigna,HMO,405,DRG,Pancreas, liver & shunt procedures w MCC,,Case Rate,146127.75
Cigna,HMO,40500,CPT4/HCPCS,Partial excision of lip,,Case Rate,3000.00
Cigna,HMO,40510,CPT4/HCPCS,Partial excision of lip,,Case Rate,3000.00
Cigna,HMO,40520,CPT4/HCPCS,Partial excision of lip,,Case Rate,3000.00
Cigna,HMO,40525,CPT4/HCPCS,Reconstruct lip with flap,,Case Rate,3000.00
Cigna,HMO,40527,CPT4/HCPCS,Reconstruct lip with flap,,Case Rate,3000.00
Cigna,HMO,40530,CPT4/HCPCS,Partial removal of lip,,Case Rate,3000.00
Cigna,HMO,406,DRG,Pancreas, liver & shunt procedures w CC,,Case Rate,73363.50
Cigna,HMO,40650,CPT4/HCPCS,Repair lip,,Case Rate,4000.00
Cigna,HMO,40652,CPT4/HCPCS,Repair lip,,Case Rate,4000.00
Cigna,HMO,40654,CPT4/HCPCS,Repair lip,,Case Rate,4000.00
Cigna,HMO,407,DRG,Pancreas, liver & shunt procedures w/o CC/MCC,,Case Rate,53958.00
Cigna,HMO,40700,CPT4/HCPCS,Repair cleft lip/nasal,,Case Rate,6000.00
Cigna,HMO,40701,CPT4/HCPCS,Repair cleft lip/nasal,,Case Rate,6000.00
Cigna,HMO,40702,CPT4/HCPCS,Plastic repair of cleft lip/nasal deformity; primary bilateral, one of two stages,,Case Rate,3000.00
Cigna,HMO,40720,CPT4/HCPCS,Repair cleft lip/nasal,,Case Rate,6000.00
Cigna,HMO,40761,CPT4/HCPCS,Repair cleft lip/nasal,,Case Rate,4000.00
Cigna,HMO,408,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC,,Case Rate,95612.25
Cigna,HMO,40801,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,40805,CPT4/HCPCS,Removal, foreign body, mouth,,Case Rate,3000.00
Cigna,HMO,40806,CPT4/HCPCS,Incision of lip fold,,Case Rate,400.00
Cigna,HMO,40808,CPT4/HCPCS,Biopsy, vestibule of mouth,,Case Rate,400.00
Cigna,HMO,40810,CPT4/HCPCS,Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair,,Case Rate,3000.00
Cigna,HMO,40812,CPT4/HCPCS,Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair,,Case Rate,3000.00
Cigna,HMO,40814,CPT4/HCPCS,Excise/repair mouth lesion,,Case Rate,3000.00
Cigna,HMO,40816,CPT4/HCPCS,Excision of mouth lesion,,Case Rate,3000.00
Cigna,HMO,40818,CPT4/HCPCS,Excise oral mucosa for graft,,Case Rate,3000.00
Cigna,HMO,40819,CPT4/HCPCS,Excise lip or cheek fold,,Case Rate,3000.00
Cigna,HMO,40820,CPT4/HCPCS,Treatment of mouth lesion,,Case Rate,3000.00
Cigna,HMO,40831,CPT4/HCPCS,Repair mouth laceration,,Case Rate,3000.00
Cigna,HMO,40840,CPT4/HCPCS,Reconstruction of mouth,,Case Rate,3000.00
Cigna,HMO,40842,CPT4/HCPCS,Reconstruction of mouth,,Case Rate,4000.00
Cigna,HMO,40843,CPT4/HCPCS,Reconstruction of mouth,,Case Rate,4000.00
Cigna,HMO,40844,CPT4/HCPCS,Reconstruction of mouth,,Case Rate,5000.00
Cigna,HMO,40845,CPT4/HCPCS,Reconstruction of mouth,,Case Rate,5000.00
Cigna,HMO,40899,CPT4/HCPCS,Unlisted procedure, vestibule of mouth,,Case Rate,3000.00
Cigna,HMO,409,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w CC,,Case Rate,53914.65
Cigna,HMO,41,DRG,Periph/cranial nerve & other nerv syst proc w CC or periph neurostim,,Case Rate,59945.40
Cigna,HMO,410,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC,,Case Rate,39925.35
Cigna,HMO,41000,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41005,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41006,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41007,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41008,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41009,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41010,CPT4/HCPCS,Incision of tongue fold,,Case Rate,3000.00
Cigna,HMO,41015,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41016,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41017,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41018,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Case Rate,6000.00
Cigna,HMO,411,DRG,Cholecystectomy w c.d.e. w MCC,,Case Rate,95686.20
Cigna,HMO,41100,CPT4/HCPCS,Biopsy of tongue; anterior two-thirds,,Case Rate,3000.00
Cigna,HMO,41105,CPT4/HCPCS,Biopsy of tongue,,Case Rate,3000.00
Cigna,HMO,41108,CPT4/HCPCS,Biopsy of floor of mouth,,Case Rate,3000.00
Cigna,HMO,41110,CPT4/HCPCS,Excision of tongue lesion,,Case Rate,3000.00
Cigna,HMO,41112,CPT4/HCPCS,Excision of tongue lesion,,Case Rate,3000.00
Cigna,HMO,41113,CPT4/HCPCS,Excision of tongue lesion,,Case Rate,3000.00
Cigna,HMO,41114,CPT4/HCPCS,Excision of tongue lesion,,Case Rate,3000.00
Cigna,HMO,41115,CPT4/HCPCS,Excision of tongue fold,,Case Rate,3000.00
Cigna,HMO,41116,CPT4/HCPCS,Excision of mouth lesion,,Case Rate,3000.00
Cigna,HMO,41120,CPT4/HCPCS,Partial removal of tongue,,Case Rate,5000.00
Cigna,HMO,412,DRG,Cholecystectomy w c.d.e. w CC,,Case Rate,58030.35
Cigna,HMO,41250,CPT4/HCPCS,Repair tongue laceration,,Case Rate,3000.00
Cigna,HMO,41251,CPT4/HCPCS,Repair tongue laceration,,Case Rate,3000.00
Cigna,HMO,41252,CPT4/HCPCS,Repair tongue laceration,,Case Rate,3000.00
Cigna,HMO,413,DRG,Cholecystectomy w c.d.e. w/o CC/MCC,,Case Rate,44150.70
Cigna,HMO,414,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w MCC,,Case Rate,92450.25
Cigna,HMO,415,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w CC,,Case Rate,51813.45
Cigna,HMO,41510,CPT4/HCPCS,Tongue to lip surgery,,Case Rate,3000.00
Cigna,HMO,41512,CPT4/HCPCS,TONGUE BASE SUSPENSION, PERMANENT SUTURE TECHNIQUE,,Case Rate,4000.00
Cigna,HMO,41520,CPT4/HCPCS,Reconstruction, tongue fold,,Case Rate,3000.00
Cigna,HMO,41530,CPT4/HCPCS,SUBMUCOSAL ABLATION OF THE TONGUE BASE, RADIOFREQUENCY, ONE OR MORE SITES, PER SESSION,,Case Rate,6000.00
Cigna,HMO,416,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC,,Case Rate,36266.10
Cigna,HMO,417,DRG,Laparoscopic cholecystectomy w/o c.d.e. w MCC,,Case Rate,61799.25
Cigna,HMO,418,DRG,Laparoscopic cholecystectomy w/o c.d.e. w CC,,Case Rate,43046.55
Cigna,HMO,41800,CPT4/HCPCS,Drainage of gum lesion,,Case Rate,3000.00
Cigna,HMO,41805,CPT4/HCPCS,Removal foreign body, gum,,Case Rate,3000.00
Cigna,HMO,41806,CPT4/HCPCS,Removal foreign body, jawbone,,Case Rate,3000.00
Cigna,HMO,41820,CPT4/HCPCS,GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT ,,Case Rate,3000.00
Cigna,HMO,41821,CPT4/HCPCS,OPERCULECTOMY, EXCISION PERICORONAL TISSUES ,,Case Rate,3000.00
Cigna,HMO,41822,CPT4/HCPCS,EXCISION OF FIBROUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES ,,Case Rate,3000.00
Cigna,HMO,41823,CPT4/HCPCS,EXCISION OF OSSEOUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES ,,Case Rate,3000.00
Cigna,HMO,41825,CPT4/HCPCS,EXCIS OF LESION/TUMOR DENTOALVEOLAR STUCTURES; WITHOUT REPAIR ,,Case Rate,3000.00
Cigna,HMO,41826,CPT4/HCPCS,EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WITH SIMPLE REPAIR ,,Case Rate,3000.00
Cigna,HMO,41827,CPT4/HCPCS,Excision of gum lesion,,Case Rate,3000.00
Cigna,HMO,41828,CPT4/HCPCS,EXCISION OF HYPERPLASTIC ALVEOLAR MUCOSA, EACH SEXTANT OR QUADRANT (SPECIFY) ,,Case Rate,3000.00
Cigna,HMO,41830,CPT4/HCPCS,ALVEOLECTOMY, INCLUDING CURETTAGE OF OSTEITIS OR SEQUESTRECTOMY ,,Case Rate,3000.00
Cigna,HMO,41850,CPT4/HCPCS,DESTRUC OF LESION (EXCEPT EXC) DENTOALVEOLAR STRUCTURES ,,Case Rate,3000.00
Cigna,HMO,41870,CPT4/HCPCS,PERIODONTAL MUCOSAL GRAFTING ,,Case Rate,3000.00
Cigna,HMO,41874,CPT4/HCPCS,ALVEOLOPLASTY, EACH QUADRANT (SPECIFY) ,,Case Rate,3000.00
Cigna,HMO,41899,CPT4/HCPCS,Unlisted procedure, dentoalveolar structures,,Case Rate,3000.00
Cigna,HMO,419,DRG,Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC,,Case Rate,33537.60
Cigna,HMO,42,DRG,Periph/cranial nerve & other nerv syst proc w/o CC/MCC,,Case Rate,48064.95
Cigna,HMO,420,DRG,Hepatobiliary diagnostic procedures w MCC,,Case Rate,89609.55
Cigna,HMO,42000,CPT4/HCPCS,Drainage mouth roof lesion,,Case Rate,3000.00
Cigna,HMO,421,DRG,Hepatobiliary diagnostic procedures w CC,,Case Rate,48676.95
Cigna,HMO,42100,CPT4/HCPCS,Biopsy of palate, uvula,,Case Rate,3000.00
Cigna,HMO,42104,CPT4/HCPCS,Excision lesion, mouth roof,,Case Rate,3000.00
Cigna,HMO,42106,CPT4/HCPCS,Excision lesion, mouth roof,,Case Rate,3000.00
Cigna,HMO,42107,CPT4/HCPCS,Excision lesion, mouth roof,,Case Rate,3000.00
Cigna,HMO,42120,CPT4/HCPCS,Remove palate/lesion,,Case Rate,4000.00
Cigna,HMO,42140,CPT4/HCPCS,Excision of uvula,,Case Rate,3000.00
Cigna,HMO,42145,CPT4/HCPCS,Repair palate, pharynx/uvula,,Case Rate,5000.00
Cigna,HMO,42160,CPT4/HCPCS,Treatment mouth roof lesion,,Case Rate,3000.00
Cigna,HMO,42180,CPT4/HCPCS,Repair palate,,Case Rate,3000.00
Cigna,HMO,42182,CPT4/HCPCS,Repair palate,,Case Rate,3000.00
Cigna,HMO,422,DRG,Hepatobiliary diagnostic procedures w/o CC/MCC,,Case Rate,37010.70
Cigna,HMO,42200,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,5000.00
Cigna,HMO,42205,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,5000.00
Cigna,HMO,42210,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,5000.00
Cigna,HMO,42215,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,6000.00
Cigna,HMO,42220,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,5000.00
Cigna,HMO,42225,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,5000.00
Cigna,HMO,42226,CPT4/HCPCS,Lengthening of palate,,Case Rate,5000.00
Cigna,HMO,42235,CPT4/HCPCS,Repair palate,,Case Rate,5000.00
Cigna,HMO,42260,CPT4/HCPCS,Repair nose to lip fistula,,Case Rate,4000.00
Cigna,HMO,42280,CPT4/HCPCS,Maxillary impression for palatal prosthesis,,Case Rate,400.00
Cigna,HMO,42281,CPT4/HCPCS,Insertion, palate prosthesis,,Case Rate,4000.00
Cigna,HMO,423,DRG,Other hepatobiliary or pancreas O.R. procedures w MCC,,Case Rate,106564.50
Cigna,HMO,42300,CPT4/HCPCS,Drainage of salivary gland,,Case Rate,3000.00
Cigna,HMO,42305,CPT4/HCPCS,Drainage of salivary gland,,Case Rate,3000.00
Cigna,HMO,42310,CPT4/HCPCS,Drainage of salivary gland,,Case Rate,3000.00
Cigna,HMO,42320,CPT4/HCPCS,Drainage of salivary gland,,Case Rate,3000.00
Cigna,HMO,42330,CPT4/HCPCS,Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral,,Case Rate,3000.00
Cigna,HMO,42335,CPT4/HCPCS,Removal of salivary stone,,Case Rate,4000.00
Cigna,HMO,42340,CPT4/HCPCS,Removal of salivary stone,,Case Rate,3000.00
Cigna,HMO,424,DRG,Other hepatobiliary or pancreas O.R. procedures w CC,,Case Rate,58180.80
Cigna,HMO,42400,CPT4/HCPCS,Biopsy of salivary gland; needle,,Case Rate,3000.00
Cigna,HMO,42405,CPT4/HCPCS,Biopsy of salivary gland,,Case Rate,3000.00
Cigna,HMO,42408,CPT4/HCPCS,Excision of salivary cyst,,Case Rate,4000.00
Cigna,HMO,42409,CPT4/HCPCS,Drainage of salivary cyst,,Case Rate,4000.00
Cigna,HMO,42410,CPT4/HCPCS,Excise parotid gland/lesion,,Case Rate,4000.00
Cigna,HMO,42415,CPT4/HCPCS,Excise parotid gland/lesion,,Case Rate,6000.00
Cigna,HMO,42420,CPT4/HCPCS,Excise parotid gland/lesion,,Case Rate,6000.00
Cigna,HMO,42425,CPT4/HCPCS,Excise parotid gland/lesion,,Case Rate,6000.00
Cigna,HMO,42440,CPT4/HCPCS,Excise submaxillary gland,,Case Rate,4000.00
Cigna,HMO,42450,CPT4/HCPCS,Excise sublingual gland,,Case Rate,3000.00
Cigna,HMO,425,DRG,Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC,,Case Rate,39354.15
Cigna,HMO,42500,CPT4/HCPCS,Repair salivary duct,,Case Rate,4000.00
Cigna,HMO,42505,CPT4/HCPCS,Repair salivary duct,,Case Rate,4000.00
Cigna,HMO,42507,CPT4/HCPCS,Parotid duct diversion,,Case Rate,4000.00
Cigna,HMO,42509,CPT4/HCPCS,Parotid duct diversion,,Case Rate,4000.00
Cigna,HMO,42510,CPT4/HCPCS,Parotid duct diversion,,Case Rate,4000.00
Cigna,HMO,42550,CPT4/HCPCS,Injection procedure for sialography,,Case Rate,3000.00
Cigna,HMO,42600,CPT4/HCPCS,Closure of salivary fistula,,Case Rate,3000.00
Cigna,HMO,42650,CPT4/HCPCS,Dilation salivary duct,,Case Rate,3000.00
Cigna,HMO,42660,CPT4/HCPCS,Dilation and catheterization of salivary duct, with or without injection,,Case Rate,400.00
Cigna,HMO,42665,CPT4/HCPCS,Ligation of salivary duct,,Case Rate,6000.00
Cigna,HMO,42699,CPT4/HCPCS,UNLISTED PROCEDURE, SALIVARY GLANDS OR DUCTS ,,Case Rate,3000.00
Cigna,HMO,42700,CPT4/HCPCS,Drainage of tonsil abscess,,Case Rate,3000.00
Cigna,HMO,42720,CPT4/HCPCS,Drainage of throat abscess,,Case Rate,3000.00
Cigna,HMO,42725,CPT4/HCPCS,Drainage of throat abscess,,Case Rate,3000.00
Cigna,HMO,42800,CPT4/HCPCS,Biopsy; oropharynx,,Case Rate,3000.00
Cigna,HMO,42804,CPT4/HCPCS,Biopsy of upper nose/throat,,Case Rate,3000.00
Cigna,HMO,42806,CPT4/HCPCS,Biopsy of upper nose/throat,,Case Rate,3000.00
Cigna,HMO,42808,CPT4/HCPCS,Excise pharynx lesion,,Case Rate,3000.00
Cigna,HMO,42809,CPT4/HCPCS,Removal of foreign body from pharynx,,Case Rate,3000.00
Cigna,HMO,42810,CPT4/HCPCS,Excision of neck cyst,,Case Rate,4000.00
Cigna,HMO,42815,CPT4/HCPCS,Excision of neck cyst,,Case Rate,5000.00
Cigna,HMO,42820,CPT4/HCPCS,Remove tonsils and adenoids,,Case Rate,4000.00
Cigna,HMO,42821,CPT4/HCPCS,Remove tonsils and adenoids,,Case Rate,5000.00
Cigna,HMO,42825,CPT4/HCPCS,Removal of tonsils,,Case Rate,4000.00
Cigna,HMO,42826,CPT4/HCPCS,Removal of tonsils,,Case Rate,4000.00
Cigna,HMO,42830,CPT4/HCPCS,Removal of adenoids,,Case Rate,4000.00
Cigna,HMO,42831,CPT4/HCPCS,Removal of adenoids,,Case Rate,4000.00
Cigna,HMO,42835,CPT4/HCPCS,Removal of adenoids,,Case Rate,4000.00
Cigna,HMO,42836,CPT4/HCPCS,Removal of adenoids,,Case Rate,4000.00
Cigna,HMO,42860,CPT4/HCPCS,Excision of tonsil tags,,Case Rate,4000.00
Cigna,HMO,42870,CPT4/HCPCS,Excision of lingual tonsil,,Case Rate,4000.00
Cigna,HMO,42890,CPT4/HCPCS,Partial removal of pharynx,,Case Rate,6000.00
Cigna,HMO,42892,CPT4/HCPCS,Revision of pharyngeal walls,,Case Rate,6000.00
Cigna,HMO,42900,CPT4/HCPCS,Repair throat wound,,Case Rate,3000.00
Cigna,HMO,42950,CPT4/HCPCS,Reconstruction of throat,,Case Rate,3000.00
Cigna,HMO,42955,CPT4/HCPCS,Surgical opening of throat,,Case Rate,3000.00
Cigna,HMO,42960,CPT4/HCPCS,Control throat bleeding,,Case Rate,3000.00
Cigna,HMO,42962,CPT4/HCPCS,Control throat bleeding,,Case Rate,3000.00
Cigna,HMO,42970,CPT4/HCPCS,Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy);simple, with posterior nasal packs, with or without anterior packs and/or cauterization,,Case Rate,400.00
Cigna,HMO,42972,CPT4/HCPCS,Control nose/throat bleeding,,Case Rate,4000.00
Cigna,HMO,42999,CPT4/HCPCS,UNLISTED PROCEDURE, PHARYNX, ADENOIDS OR TONSILS ,,Case Rate,3000.00
Cigna,HMO,43130,CPT4/HCPCS,Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach,,Case Rate,3000.00
Cigna,HMO,43180,CPT4/HCPCS, ESOPHAGOSCOPY, RIGID, TRANSORAL WITH DIVERTICULECTOMY OF HYPOPHARYNX OR CERVICAL ESOPHAGUS (EG, ZENKER'S DIVERTICULUM), WITH CRICOPHARYNGEAL MYOTOMY, INCLUDES USE OF TELESCOPE OR OPERATING MICROSCOPE AND REPAIR, WHEN PERFORMED,,Case Rate,8300.00
Cigna,HMO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Case Rate,4000.00
Cigna,HMO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Case Rate,5000.00
Cigna,HMO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Case Rate,5000.00
Cigna,HMO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Case Rate,5000.00
Cigna,HMO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Case Rate,5000.00
Cigna,HMO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Case Rate,5000.00
Cigna,HMO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Case Rate,4000.00
Cigna,HMO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Case Rate,4000.00
Cigna,HMO,432,DRG,Cirrhosis & alcoholic hepatitis w MCC,,Case Rate,47993.55
Cigna,HMO,43200,CPT4/HCPCS,Esophagus endoscopy,,Case Rate,3000.00
Cigna,HMO,43201,CPT4/HCPCS,Esoph scope w/submucous inj,,Case Rate,3000.00
Cigna,HMO,43202,CPT4/HCPCS,Esophagus endoscopy, biopsy,,Case Rate,3000.00
Cigna,HMO,43204,CPT4/HCPCS,Esophagus endoscopy & inject,,Case Rate,3000.00
Cigna,HMO,43205,CPT4/HCPCS,Esophagus endoscopy/ligation,,Case Rate,3000.00
Cigna,HMO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Case Rate,5000.00
Cigna,HMO,43210,CPT4/HCPCS,ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ESOPHAGOGASTRIC FUNDOPLASTY, PARTIAL OR COMPLETE, INCLUDES DUODENOSCOPY WHEN PERFORMED,,Case Rate,8300.00
Cigna,HMO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Case Rate,4000.00
Cigna,HMO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Case Rate,8300.00
Cigna,HMO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Case Rate,5000.00
Cigna,HMO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Case Rate,5000.00
Cigna,HMO,43215,CPT4/HCPCS,Esophagus endoscopy,,Case Rate,3000.00
Cigna,HMO,43216,CPT4/HCPCS,Esophagus endoscopy/lesion,,Case Rate,3000.00
Cigna,HMO,43217,CPT4/HCPCS,Esophagus endoscopy,,Case Rate,3000.00
Cigna,HMO,43220,CPT4/HCPCS,Esoph endoscopy, dilation,,Case Rate,3000.00
Cigna,HMO,43226,CPT4/HCPCS,Esoph endoscopy, dilation,,Case Rate,3000.00
Cigna,HMO,43227,CPT4/HCPCS,Esoph endoscopy, repair,,Case Rate,3000.00
Cigna,HMO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Case Rate,8300.00
Cigna,HMO,43231,CPT4/HCPCS,Esoph endoscopy w/us exam,,Case Rate,3000.00
Cigna,HMO,43232,CPT4/HCPCS,Esoph endoscopy w/us fn bx,,Case Rate,3000.00
Cigna,HMO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Case Rate,5000.00
Cigna,HMO,43235,CPT4/HCPCS,Uppr gi endoscopy, diagnosis,,Case Rate,3000.00
Cigna,HMO,43236,CPT4/HCPCS,Uppr gi scope w/submuc inj,,Case Rate,3000.00
Cigna,HMO,43237,CPT4/HCPCS,Endoscopic us exam, esoph,,Case Rate,3000.00
Cigna,HMO,43238,CPT4/HCPCS,Uppr gi endoscopy w/us fn bx,,Case Rate,3000.00
Cigna,HMO,43239,CPT4/HCPCS,Upper GI endoscopy, biopsy,,Case Rate,3000.00
Cigna,HMO,43240,CPT4/HCPCS,Esoph endoscope w/drain cyst,,Case Rate,3000.00
Cigna,HMO,43241,CPT4/HCPCS,Upper GI endoscopy with tube,,Case Rate,3000.00
Cigna,HMO,43242,CPT4/HCPCS,Uppr gi endoscopy w/us fn bx,,Case Rate,3000.00
Cigna,HMO,43243,CPT4/HCPCS,Upper gi endoscopy & inject,,Case Rate,3000.00
Cigna,HMO,43244,CPT4/HCPCS,Upper GI endoscopy/ligation,,Case Rate,3000.00
Cigna,HMO,43245,CPT4/HCPCS,Operative upper GI endoscopy,,Case Rate,3000.00
Cigna,HMO,43246,CPT4/HCPCS,Place gastrostomy tube,,Case Rate,3000.00
Cigna,HMO,43247,CPT4/HCPCS,Operative upper GI endoscopy,,Case Rate,3000.00
Cigna,HMO,43248,CPT4/HCPCS,Uppr gi endoscopy/guide wire,,Case Rate,3000.00
Cigna,HMO,43249,CPT4/HCPCS,Esoph endoscopy, dilation,,Case Rate,3000.00
Cigna,HMO,43250,CPT4/HCPCS,Upper GI endoscopy/tumor,,Case Rate,3000.00
Cigna,HMO,43251,CPT4/HCPCS,Operative upper GI endoscopy,,Case Rate,3000.00
Cigna,HMO,43252,CPT4/HCPCS,UPPR GI OPTICL ENDOMICRSCOPY,,Case Rate,5000.00
Cigna,HMO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Case Rate,5000.00
Cigna,HMO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Case Rate,4000.00
Cigna,HMO,43255,CPT4/HCPCS,Operative upper GI endoscopy,,Case Rate,3000.00
Cigna,HMO,43257,CPT4/HCPCS,Upper Gastrointestinal Endoscopy Including Esophagus, Stomach, And Either The Duodenum And/Or Jejunum As Appropriate; With Delivery Of Thermal Energy To The Muscle Of Lower Esophageal Sphincter And/Or Gastric Cardia, For Treatment Of Gastroesophageal Refl,,Case Rate,4000.00
Cigna,HMO,43259,CPT4/HCPCS,Endoscopic ultrasound exam,,Case Rate,4000.00
Cigna,HMO,43260,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,HMO,43261,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,HMO,43262,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,HMO,43263,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,HMO,43264,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,HMO,43265,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,HMO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Case Rate,8300.00
Cigna,HMO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Case Rate,5000.00
Cigna,HMO,43273,CPT4/HCPCS,ENDOSCOPIC CANNULATION OF PAPILLA WITH DIRECT VISUALIZATION OF COMMON BILE DUCT(S) AND/OR PANCREATIC DUCT(S) (LIST SEPARATELY IN ADDITION TO CODE(S) FOR PRIMARY PROCEDURE),,Case Rate,8300.00
Cigna,HMO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Case Rate,8300.00
Cigna,HMO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Case Rate,8300.00
Cigna,HMO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Case Rate,8300.00
Cigna,HMO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Case Rate,8300.00
Cigna,HMO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Case Rate,8300.00
Cigna,HMO,43280,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES),,Case Rate,5000.00
Cigna,HMO,43281,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITHOUT IMPLANTATION OF MESH,,Case Rate,3000.00
Cigna,HMO,43282,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH IMPLANTATION OF MESH ,,Case Rate,3000.00
Cigna,HMO,43284,CPT4/HCPCS,Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed,,Case Rate,3000.00
Cigna,HMO,43285,CPT4/HCPCS,Removal of esophageal sphincter augmentation device,,Case Rate,3000.00
Cigna,HMO,43289,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, ESOPHAGUS,,Case Rate,3000.00
Cigna,HMO,433,DRG,Cirrhosis & alcoholic hepatitis w CC,,Case Rate,26226.75
Cigna,HMO,434,DRG,Cirrhosis & alcoholic hepatitis w/o CC/MCC,,Case Rate,15799.80
Cigna,HMO,43420,CPT4/HCPCS,CLOSURE ESOPHAGOSTOMY OR FISTULA, CERVICAL ,,Case Rate,3000.00
Cigna,HMO,43450,CPT4/HCPCS,Dilate esophagus,,Case Rate,3000.00
Cigna,HMO,43453,CPT4/HCPCS,Dilate esophagus,,Case Rate,3000.00
Cigna,HMO,43499,CPT4/HCPCS,UNLISTED PROCEDURE, ESOPHAGUS ,,Case Rate,3000.00
Cigna,HMO,435,DRG,Malignancy of hepatobiliary system or pancreas w MCC,,Case Rate,44696.40
Cigna,HMO,436,DRG,Malignancy of hepatobiliary system or pancreas w CC,,Case Rate,28565.10
Cigna,HMO,43647,CPT4/HCPCS,"Lap impl electrode, antrum",,Case Rate,8300.00
Cigna,HMO,43648,CPT4/HCPCS,Lap revise/remv eltrd antrum,,Case Rate,8300.00
Cigna,HMO,43651,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, TRUNCAL,,Case Rate,5000.00
Cigna,HMO,43652,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, SELECTIVE OR HIGHLY SELECTIVE,,Case Rate,5000.00
Cigna,HMO,43653,CPT4/HCPCS,Laparoscopy, gastrostomy,,Case Rate,8300.00
Cigna,HMO,43659,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, STOMACH,,Case Rate,3000.00
Cigna,HMO,437,DRG,Malignancy of hepatobiliary system or pancreas w/o CC/MCC,,Case Rate,22809.75
Cigna,HMO,43752,CPT4/HCPCS,Naso- or oro-gastric tube placement, necessitating physician's skill,,Case Rate,400.00
Cigna,HMO,43753,CPT4/HCPCS,GASTRIC INTUBATION AND ASPIRATION(S) THERAPEUTIC, NECESSITATING PHYSICIAN'S SKILL (EG, FOR GASTROINTESTINAL HEMORRHAGE), INCLUDING LAVAGE IF PERFORMED,,Case Rate,3000.00
Cigna,HMO,43754,CPT4/HCPCS,GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC; SINGLE SPECIMEN (EG, ACID ANALYSIS),,Case Rate,3000.00
Cigna,HMO,43755,CPT4/HCPCS,GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC; COLLECTION OF MULTIPLE FRACTIONAL SPECIMENS WITH GASTRIC STIMULATION, SINGLE OR DOUBLE LUMEN TUBE (GASTRIC SECRETORY STUDY) (EG, HISTAMINE, INSULIN, PENTAGASTRIN, CALCIUM, SECRETIN), INCLUDES DRUG ADMINISTRAT,,Case Rate,3000.00
Cigna,HMO,43756,CPT4/HCPCS,DUODENAL INTUBATION AND ASPIRATION, DIAGNOSTIC, INCLUDES IMAGE GUIDANCE; SINGLE SPECIMEN (EG, BILE STUDY FOR CRYSTALS OR AFFERENT LOOP CULTURE),,Case Rate,3000.00
Cigna,HMO,43757,CPT4/HCPCS,DUODENAL INTUBATION AND ASPIRATION, DIAGNOSTIC, INCLUDES IMAGE GUIDANCE; COLLECTION OF MULTIPLE FRACTIONAL SPECIMENS WITH PANCREATIC OR GALLBLADDER STIMULATION, SINGLE OR DOUBLE LUMEN TUBE, INCLUDES DRUG ADMINISTRATION,,Case Rate,3000.00
Cigna,HMO,43761,CPT4/HCPCS,Repositioning of the gastric feeding tube through the duodenum for enteric nutrition,,Case Rate,3000.00
Cigna,HMO,43762,CPT4/HCPCS,Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract ,,Case Rate,3000.00
Cigna,HMO,43763,CPT4/HCPCS,Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract ,,Case Rate,3000.00
Cigna,HMO,43770,CPT4/HCPCS,Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components),,Case Rate,3000.00
Cigna,HMO,43771,CPT4/HCPCS,Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only,,Case Rate,3000.00
Cigna,HMO,43772,CPT4/HCPCS,Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band component only,,Case Rate,3000.00
Cigna,HMO,43773,CPT4/HCPCS,Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only,,Case Rate,3000.00
Cigna,HMO,43774,CPT4/HCPCS,Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components,,Case Rate,3000.00
Cigna,HMO,438,DRG,Disorders of pancreas except malignancy w MCC,,Case Rate,40705.65
Cigna,HMO,43870,CPT4/HCPCS,Repair stomach opening,,Case Rate,3000.00
Cigna,HMO,43886,CPT4/HCPCS,Gastric restrictive procedure, open; revision of subcutaneous port component only,,Case Rate,3000.00
Cigna,HMO,43887,CPT4/HCPCS,Gastric restrictive procedure, open; removal of subcutaneous port component only,,Case Rate,3000.00
Cigna,HMO,43888,CPT4/HCPCS,Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only,,Case Rate,3000.00
Cigna,HMO,439,DRG,Disorders of pancreas except malignancy w CC,,Case Rate,21532.20
Cigna,HMO,43999,CPT4/HCPCS,UNLISTED PROCEDURE, STOMACH ,,Case Rate,3000.00
Cigna,HMO,440,DRG,Disorders of pancreas except malignancy w/o CC/MCC,,Case Rate,15450.45
Cigna,HMO,44005,CPT4/HCPCS,ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) FOR ACUTE BOWEL OBSTRUCTION (SEPARATE PROCEDURE),,Case Rate,3000.00
Cigna,HMO,44010,CPT4/HCPCS,DUODENOTOMY, FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY REMOVAL.,,Case Rate,3000.00
Cigna,HMO,44020,CPT4/HCPCS,ENTEROTOMY, SMALL INTESTINE, OTHER THAN DUODENUM; FOR EXPLORATION , BIOPSY(S),OR FOREIGN BODY REMOVAL,,Case Rate,3000.00
Cigna,HMO,44025,CPT4/HCPCS,COLOTOMY, FOR EXPLORATION, BIPSY(S), OR FOREIGN BODY REMOVAL,,Case Rate,3000.00
Cigna,HMO,44050,CPT4/HCPCS,REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL HERNIA, BY LAPAROTOMY,,Case Rate,3000.00
Cigna,HMO,44055,CPT4/HCPCS,CORRECTION OF MALROTATION BY LYSIS OF DUODENAL BANDS AND/OR REDUCTION OF MIDGUT VOLVULUS (EG, LADD PROCEDURE),,Case Rate,3000.00
Cigna,HMO,441,DRG,Disorders of liver except malig,cirr,alc hepa w MCC,,Case Rate,48034.35
Cigna,HMO,44100,CPT4/HCPCS,Biopsy of bowel,,Case Rate,3000.00
Cigna,HMO,44180,CPT4/HCPCS,Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure),,Case Rate,5000.00
Cigna,HMO,44186,CPT4/HCPCS,Laparoscopy, surgical; jejunostomy (eg, for decompression or feeding),,Case Rate,5000.00
Cigna,HMO,44187,CPT4/HCPCS,Laparoscopy, surgical; ileostomy or jejunostomy, non-tube,,Case Rate,3000.00
Cigna,HMO,44188,CPT4/HCPCS,Laparoscopy, surgical, colostomy or skin level cecostomy,,Case Rate,3000.00
Cigna,HMO,442,DRG,Disorders of liver except malig,cirr,alc hepa w CC,,Case Rate,23755.80
Cigna,HMO,44202,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; INTESTINAL RESECTION, WITH ANASTOMOSIS (INTRA OR EXTRACORPOREAL),,Case Rate,3000.00
Cigna,HMO,44213,CPT4/HCPCS,Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure),,Case Rate,3000.00
Cigna,HMO,44227,CPT4/HCPCS,Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomosis,,Case Rate,3000.00
Cigna,HMO,443,DRG,Disorders of liver except malig,cirr,alc hepa w/o CC/MCC,,Case Rate,16901.40
Cigna,HMO,44312,CPT4/HCPCS,Revision of ileostomy,,Case Rate,3000.00
Cigna,HMO,44340,CPT4/HCPCS,Revision of colostomy,,Case Rate,4000.00
Cigna,HMO,44345,CPT4/HCPCS,Revision of colostomy,,Case Rate,3000.00
Cigna,HMO,44346,CPT4/HCPCS,Revision of colostomy,,Case Rate,3000.00
Cigna,HMO,44360,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44361,CPT4/HCPCS,Small bowel endoscopy/biopsy,,Case Rate,3000.00
Cigna,HMO,44363,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44364,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44365,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44366,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44369,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44370,CPT4/HCPCS,Small bowel endoscopy/stent,,Case Rate,8300.00
Cigna,HMO,44372,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44373,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44376,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44377,CPT4/HCPCS,Small bowel endoscopy/biopsy,,Case Rate,3000.00
Cigna,HMO,44378,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44379,CPT4/HCPCS,S bowel endoscope w/stent,,Case Rate,8300.00
Cigna,HMO,44380,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44381,CPT4/HCPCS, ILEOSCOPY, THROUGH STOMA; WITH TRANSENDOSCOPIC BALLOON DILATION,,Case Rate,4000.00
Cigna,HMO,44382,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,HMO,44384,CPT4/HCPCS, ILEOSCOPY, THROUGH STOMA; WITH PLACEMENT OF ENDOSCOPIC STENT (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,HMO,44385,CPT4/HCPCS,Endoscopy of bowel pouch,,Case Rate,3000.00
Cigna,HMO,44386,CPT4/HCPCS,Endoscopy, bowel pouch/biop,,Case Rate,3000.00
Cigna,HMO,44388,CPT4/HCPCS,Colon endoscopy,,Case Rate,3000.00
Cigna,HMO,44389,CPT4/HCPCS,Colonoscopy with biopsy,,Case Rate,3000.00
Cigna,HMO,44390,CPT4/HCPCS,Colonoscopy for foreign body,,Case Rate,3000.00
Cigna,HMO,44391,CPT4/HCPCS,Colonoscopy for bleeding,,Case Rate,3000.00
Cigna,HMO,44392,CPT4/HCPCS,Colonoscopy & polypectomy,,Case Rate,3000.00
Cigna,HMO,44394,CPT4/HCPCS,Colonoscopy w/snare,,Case Rate,3000.00
Cigna,HMO,444,DRG,Disorders of the biliary tract w MCC,,Case Rate,42554.40
Cigna,HMO,44401,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE-AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,HMO,44402,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH ENDOSCOPIC STENT PLACEMENT (INCLUDING PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,HMO,44403,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH ENDOSCOPIC MUCOSAL RESECTION,,Case Rate,4000.00
Cigna,HMO,44404,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE,,Case Rate,4000.00
Cigna,HMO,44405,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH TRANSENDOSCOPIC BALLOON DILATION,,Case Rate,4000.00
Cigna,HMO,44406,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH ENDOSCOPIC ULTRASOUND EXAMINATION, LIMITED TO THE SIGMOID, DESCENDING, TRANSVERSE, OR ASCENDING COLON AND CECUM AND ADJACENT STRUCTURES,,Case Rate,4000.00
Cigna,HMO,44407,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S), INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE SIGMOID, DESCENDING, TRANSVERSE, OR ASCENDING COLON AND CECUM AND ADJAC,,Case Rate,4000.00
Cigna,HMO,44408,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOLVULUS, MEGACOLON), INCLUDING PLACEMENT OF DECOMPRESSION TUBE, WHEN PERFORMED,,Case Rate,4000.00
Cigna,HMO,445,DRG,Disorders of the biliary tract w CC,,Case Rate,27458.40
Cigna,HMO,446,DRG,Disorders of the biliary tract w/o CC/MCC,,Case Rate,20813.10
Cigna,HMO,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Case Rate,3000.00
Cigna,HMO,44799,CPT4/HCPCS,UNLISTED PROCEDURE, INTESTINE ,,Case Rate,3000.00
Cigna,HMO,44950,CPT4/HCPCS,Appendectomy;,,Case Rate,3000.00
Cigna,HMO,44970,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, APPENDECTOMY,,Case Rate,4000.00
Cigna,HMO,44979,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX,,Case Rate,3000.00
Cigna,HMO,45000,CPT4/HCPCS,Drainage of pelvic abscess,,Case Rate,3000.00
Cigna,HMO,45005,CPT4/HCPCS,Drainage of rectal abscess,,Case Rate,3000.00
Cigna,HMO,45020,CPT4/HCPCS,Drainage of rectal abscess,,Case Rate,3000.00
Cigna,HMO,45100,CPT4/HCPCS,Biopsy of rectum,,Case Rate,3000.00
Cigna,HMO,45108,CPT4/HCPCS,Removal of anorectal lesion,,Case Rate,3000.00
Cigna,HMO,45150,CPT4/HCPCS,Excision of rectal stricture,,Case Rate,3000.00
Cigna,HMO,45160,CPT4/HCPCS,Excision of rectal lesion,,Case Rate,3000.00
Cigna,HMO,45171,CPT4/HCPCS,EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; NOT INCLUDING MUSC ULARIS PROPRIA (IE, PARTIAL THICKNESS) ,,Case Rate,3000.00
Cigna,HMO,45172,CPT4/HCPCS,EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; INCLUDING MUSCULAR IS PROPRIA (IE, FULL THICKNESS) ,,Case Rate,3000.00
Cigna,HMO,45190,CPT4/HCPCS,Destruction, rectal tumor,,Case Rate,8300.00
Cigna,HMO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,Case Rate,25500.00
Cigna,HMO,45300,CPT4/HCPCS,Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure),,Case Rate,3000.00
Cigna,HMO,45303,CPT4/HCPCS,Proctosigmoidoscopy, rigid; with dilation, any method,,Case Rate,3000.00
Cigna,HMO,45305,CPT4/HCPCS,Protosigmoidoscopy w/bx,,Case Rate,3000.00
Cigna,HMO,45307,CPT4/HCPCS,Protosigmoidoscopy fb,,Case Rate,3000.00
Cigna,HMO,45308,CPT4/HCPCS,Protosigmoidoscopy removal,,Case Rate,3000.00
Cigna,HMO,45309,CPT4/HCPCS,Protosigmoidoscopy removal,,Case Rate,3000.00
Cigna,HMO,45315,CPT4/HCPCS,Protosigmoidoscopy removal,,Case Rate,3000.00
Cigna,HMO,45317,CPT4/HCPCS,Protosigmoidoscopy bleed,,Case Rate,3000.00
Cigna,HMO,45320,CPT4/HCPCS,Protosigmoidoscopy ablate,,Case Rate,3000.00
Cigna,HMO,45321,CPT4/HCPCS,Protosigmoidoscopy volvul,,Case Rate,3000.00
Cigna,HMO,45327,CPT4/HCPCS,Proctosigmoidoscopy w/stent,,Case Rate,3000.00
Cigna,HMO,45330,CPT4/HCPCS,Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure),,Case Rate,3000.00
Cigna,HMO,45331,CPT4/HCPCS,Sigmoidoscopy and biopsy,,Case Rate,3000.00
Cigna,HMO,45332,CPT4/HCPCS,Sigmoidoscopy w/fb removal,,Case Rate,3000.00
Cigna,HMO,45333,CPT4/HCPCS,Sigmoidoscopy & polypectomy,,Case Rate,3000.00
Cigna,HMO,45334,CPT4/HCPCS,Sigmoidoscopy for bleeding,,Case Rate,3000.00
Cigna,HMO,45335,CPT4/HCPCS,Sigmoidoscope w/submub inj,,Case Rate,3000.00
Cigna,HMO,45337,CPT4/HCPCS,Sigmoidoscopy & decompress,,Case Rate,3000.00
Cigna,HMO,45338,CPT4/HCPCS,Sigmoidoscpy w/tumr remove,,Case Rate,3000.00
Cigna,HMO,45340,CPT4/HCPCS,Sig w/balloon dilation,,Case Rate,3000.00
Cigna,HMO,45341,CPT4/HCPCS,Sigmoidoscopy w/ultrasound,,Case Rate,3000.00
Cigna,HMO,45342,CPT4/HCPCS,Sigmoidoscopy w/us guide,,Case Rate,3000.00
Cigna,HMO,45346,CPT4/HCPCS, SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,HMO,45347,CPT4/HCPCS, SIGMOIDOSCOPY, FLEXIBLE; WITH PLACEMENT OF ENDOSCOPIC STENT (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,HMO,45349,CPT4/HCPCS, SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION,,Case Rate,4000.00
Cigna,HMO,45350,CPT4/HCPCS, SIGMOIDOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS),,Case Rate,4000.00
Cigna,HMO,45378,CPT4/HCPCS,Diagnostic colonoscopy,,Case Rate,3000.00
Cigna,HMO,45379,CPT4/HCPCS,Colonoscopy w/fb removal,,Case Rate,3000.00
Cigna,HMO,45380,CPT4/HCPCS,Colonoscopy and biopsy,,Case Rate,3000.00
Cigna,HMO,45381,CPT4/HCPCS,Colonoscope, submucous inj,,Case Rate,3000.00
Cigna,HMO,45382,CPT4/HCPCS,Colonoscopy/control bleeding,,Case Rate,3000.00
Cigna,HMO,45384,CPT4/HCPCS,Lesion remove colonoscopy,,Case Rate,3000.00
Cigna,HMO,45385,CPT4/HCPCS,Lesion removal colonoscopy,,Case Rate,3000.00
Cigna,HMO,45386,CPT4/HCPCS,Colonoscope dilate stricture,,Case Rate,3000.00
Cigna,HMO,45388,CPT4/HCPCS, COLONOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,HMO,45389,CPT4/HCPCS, COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC STENT PLACEMENT (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,HMO,45390,CPT4/HCPCS, COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION,,Case Rate,4000.00
Cigna,HMO,45391,CPT4/HCPCS,Colonoscopy w/endoscope,,Case Rate,3000.00
Cigna,HMO,45392,CPT4/HCPCS,Colonoscopy w/endoscopic,,Case Rate,3000.00
Cigna,HMO,45393,CPT4/HCPCS, COLONOSCOPY, FLEXIBLE; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOLVULUS, MEGACOLON), INCLUDING PLACEMENT OF DECOMPRESSION TUBE, WHEN PERFORMED,,Case Rate,4000.00
Cigna,HMO,45395,CPT4/HCPCS,Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy,,Case Rate,3000.00
Cigna,HMO,45397,CPT4/HCPCS,Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy, when performed,,Case Rate,3000.00
Cigna,HMO,45398,CPT4/HCPCS, COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS),,Case Rate,4000.00
Cigna,HMO,45399,CPT4/HCPCS, UNLISTED PROCEDURE, COLON,,Case Rate,5000.00
Cigna,HMO,454,DRG,Combined anterior/posterior spinal fusion w CC,,Case Rate,25500.00
Cigna,HMO,45400,CPT4/HCPCS,Laparoscopy, surgical; proctopexy (for prolapse),,Case Rate,3000.00
Cigna,HMO,45402,CPT4/HCPCS,Laparoscopy, surgical; proctopexy (for prolapse), with sigmoid resection,,Case Rate,3000.00
Cigna,HMO,45499,CPT4/HCPCS,Unlisted laparoscopy procedure, rectum,,Case Rate,3000.00
Cigna,HMO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,Case Rate,25500.00
Cigna,HMO,45500,CPT4/HCPCS,Repair of rectum,,Case Rate,3000.00
Cigna,HMO,45505,CPT4/HCPCS,Repair of rectum,,Case Rate,3000.00
Cigna,HMO,45520,CPT4/HCPCS,PERIRECTAL INJECTION OF SCLEROSING SOLUTION FOR PROLAPSE, ,,Case Rate,3000.00
Cigna,HMO,45541,CPT4/HCPCS,PROCTOPEXY FOR PROLAPSE PERINEAL APPROACH ,,Case Rate,3000.00
Cigna,HMO,45560,CPT4/HCPCS,Repair of rectocele,,Case Rate,3000.00
Cigna,HMO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,Case Rate,25500.00
Cigna,HMO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,Case Rate,25500.00
Cigna,HMO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,Case Rate,25500.00
Cigna,HMO,459,DRG,Spinal fusion except cervical w MCC,,Case Rate,25500.00
Cigna,HMO,45900,CPT4/HCPCS,Reduction of rectal prolapse,,Case Rate,3000.00
Cigna,HMO,45905,CPT4/HCPCS,Dilation of anal sphincter,,Case Rate,3000.00
Cigna,HMO,45910,CPT4/HCPCS,Dilation of rectal narrowing,,Case Rate,3000.00
Cigna,HMO,45915,CPT4/HCPCS,Remove rectal obstruction,,Case Rate,3000.00
Cigna,HMO,45990,CPT4/HCPCS,Surg dx exam, anorectal,,Case Rate,3000.00
Cigna,HMO,460,DRG,Spinal fusion except cervical w/o MCC,,Case Rate,25500.00
Cigna,HMO,46020,CPT4/HCPCS,Placement of seton,,Case Rate,4000.00
Cigna,HMO,46030,CPT4/HCPCS,Removal of rectal marker,,Case Rate,3000.00
Cigna,HMO,46040,CPT4/HCPCS,Incision of rectal abscess,,Case Rate,4000.00
Cigna,HMO,46045,CPT4/HCPCS,Incision of rectal abscess,,Case Rate,3000.00
Cigna,HMO,46050,CPT4/HCPCS,Incision of anal abscess,,Case Rate,3000.00
Cigna,HMO,46060,CPT4/HCPCS,Incision of rectal abscess,,Case Rate,3000.00
Cigna,HMO,46070,CPT4/HCPCS,Incision, anal septum (infant),,Case Rate,3000.00
Cigna,HMO,46080,CPT4/HCPCS,Incision of anal sphincter,,Case Rate,4000.00
Cigna,HMO,46083,CPT4/HCPCS,Incision of thrombosed hemorrhoid, external ,,Case Rate,3000.00
Cigna,HMO,461,DRG,Bilateral or multiple major joint procs of lower extremity w MCC,,Case Rate,154943.10
Cigna,HMO,462,DRG,Bilateral or multiple major joint procs of lower extremity w/o MCC,,Case Rate,80177.10
Cigna,HMO,46200,CPT4/HCPCS,Removal of anal fissure,,Case Rate,3000.00
Cigna,HMO,46220,CPT4/HCPCS,Removal of anal tab,,Case Rate,3000.00
Cigna,HMO,46221,CPT4/HCPCS,Hemorrhoidectomy, by simple ligature (eg, rubber band),,Case Rate,3000.00
Cigna,HMO,46230,CPT4/HCPCS,Removal of anal tags,,Case Rate,3000.00
Cigna,HMO,46250,CPT4/HCPCS,Hemorrhoidectomy,,Case Rate,4000.00
Cigna,HMO,46255,CPT4/HCPCS,Hemorrhoidectomy,,Case Rate,4000.00
Cigna,HMO,46257,CPT4/HCPCS,Remove hemorrhoids & fissure,,Case Rate,4000.00
Cigna,HMO,46258,CPT4/HCPCS,Remove hemorrhoids & fistula,,Case Rate,4000.00
Cigna,HMO,46260,CPT4/HCPCS,Hemorrhoidectomy,,Case Rate,4000.00
Cigna,HMO,46261,CPT4/HCPCS,Remove hemorrhoids & fissure,,Case Rate,4000.00
Cigna,HMO,46262,CPT4/HCPCS,Remove hemorrhoids & fistula,,Case Rate,4000.00
Cigna,HMO,46270,CPT4/HCPCS,Removal of anal fistula,,Case Rate,4000.00
Cigna,HMO,46275,CPT4/HCPCS,Removal of anal fistula,,Case Rate,4000.00
Cigna,HMO,46280,CPT4/HCPCS,Removal of anal fistula,,Case Rate,4000.00
Cigna,HMO,46285,CPT4/HCPCS,Removal of anal fistula,,Case Rate,3000.00
Cigna,HMO,46288,CPT4/HCPCS,Repair anal fistula,,Case Rate,4000.00
Cigna,HMO,463,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC,,Case Rate,136817.70
Cigna,HMO,46320,CPT4/HCPCS,EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL ,,Case Rate,3000.00
Cigna,HMO,464,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC,,Case Rate,75849.75
Cigna,HMO,465,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC,,Case Rate,47011.80
Cigna,HMO,46505,CPT4/HCPCS,Chemodenervation of internal anal sphincter,,Case Rate,3000.00
Cigna,HMO,466,DRG,Revision of hip or knee replacement w MCC,,Case Rate,136297.50
Cigna,HMO,46600,CPT4/HCPCS,ANOSCOPY; DIAGNOSTIC (SEPARATE PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,46601,CPT4/HCPCS, ANOSCOPY; DIAGNOSTIC, WITH HIGH-RESOLUTION MAGNIFICATION (HRA) (EG, COLPOSCOPE, OPERATING MICROSCOPE) AND CHEMICAL AGENT ENHANCEMENT, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED,,Case Rate,3000.00
Cigna,HMO,46604,CPT4/HCPCS,ANOSCOPY; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE) ,,Case Rate,3000.00
Cigna,HMO,46606,CPT4/HCPCS,ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE,,Case Rate,3000.00
Cigna,HMO,46607,CPT4/HCPCS, ANOSCOPY; WITH HIGH-RESOLUTION MAGNIFICATION (HRA) (EG, COLPOSCOPE, OPERATING MICROSCOPE) AND CHEMICAL AGENT ENHANCEMENT, WITH BIOPSY, SINGLE OR MULTIPLE,,Case Rate,4000.00
Cigna,HMO,46608,CPT4/HCPCS,Anoscopy/ remove for body,,Case Rate,3000.00
Cigna,HMO,46610,CPT4/HCPCS,Anoscopy/remove lesion,,Case Rate,3000.00
Cigna,HMO,46611,CPT4/HCPCS,Anoscopy,,Case Rate,3000.00
Cigna,HMO,46612,CPT4/HCPCS,Anoscopy/ remove lesions,,Case Rate,3000.00
Cigna,HMO,46614,CPT4/HCPCS,ANOSCOPY; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR),,Case Rate,3000.00
Cigna,HMO,46615,CPT4/HCPCS,Anoscopy,,Case Rate,3000.00
Cigna,HMO,467,DRG,Revision of hip or knee replacement w CC,,Case Rate,91193.10
Cigna,HMO,46700,CPT4/HCPCS,Repair of anal stricture,,Case Rate,4000.00
Cigna,HMO,46706,CPT4/HCPCS,Repr of anal fistula w/glue,,Case Rate,3000.00
Cigna,HMO,46710,CPT4/HCPCS,Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; transperineal approach,,Case Rate,3000.00
Cigna,HMO,46712,CPT4/HCPCS,Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; combined transperineal and transabdominal approach,,Case Rate,3000.00
Cigna,HMO,46750,CPT4/HCPCS,Repair of anal sphincter,,Case Rate,4000.00
Cigna,HMO,46753,CPT4/HCPCS,Reconstruction of anus,,Case Rate,4000.00
Cigna,HMO,46754,CPT4/HCPCS,Removal of suture from anus,,Case Rate,3000.00
Cigna,HMO,46760,CPT4/HCPCS,Repair of anal sphincter,,Case Rate,3000.00
Cigna,HMO,46761,CPT4/HCPCS,Repair of anal sphincter,,Case Rate,4000.00
Cigna,HMO,468,DRG,Revision of hip or knee replacement w/o CC/MCC,,Case Rate,71502.00
Cigna,HMO,469,DRG,Major joint replacement or reattachment of lower extremity w MCC,,Case Rate,78652.20
Cigna,HMO,46900,CPT4/HCPCS,DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CHEMICAL,,Case Rate,3000.00
Cigna,HMO,46910,CPT4/HCPCS,DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION,,Case Rate,3000.00
Cigna,HMO,46916,CPT4/HCPCS,DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CRYOSURGERY,,Case Rate,400.00
Cigna,HMO,46917,CPT4/HCPCS,Laser surgery, anal lesions,,Case Rate,3000.00
Cigna,HMO,46922,CPT4/HCPCS,Excision of anal lesion(s),,Case Rate,3000.00
Cigna,HMO,46924,CPT4/HCPCS,Destruction, anal lesion(s),,Case Rate,3000.00
Cigna,HMO,46930,CPT4/HCPCS,DESTRUCTION OF INTERNAL HEMORRHOID(S) BY THERMAL ENERGY (EG, INFRARED COAGULATION, CAUTERY, RADIOFREQUENCY),,Case Rate,5000.00
Cigna,HMO,46940,CPT4/HCPCS,Curettage or cauterization of anal fissure, including dilation of anal sphincter (separate procedure); initial,,Case Rate,3000.00
Cigna,HMO,46942,CPT4/HCPCS,Curettage or cauterization of anal fissure, including dilation of anal sphincter (separate procedure); subsequent,,Case Rate,3000.00
Cigna,HMO,46945,CPT4/HCPCS,Ligation of internal hemorrhoids; single procedure,,Case Rate,3000.00
Cigna,HMO,46946,CPT4/HCPCS,Ligation of internal hemorrhoids; multiple procedures,,Case Rate,3000.00
Cigna,HMO,46947,CPT4/HCPCS,Hemorrhoidopexy by stapling,,Case Rate,6000.00
Cigna,HMO,46948,CPT4/HCPCS,Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed,,Case Rate,3000.00
Cigna,HMO,46999,CPT4/HCPCS,UNLISTED PROCEDURE, ANUS ,,Case Rate,3000.00
Cigna,HMO,470,DRG,Major joint replacement or reattachment of lower extremity w/o MCC,,Case Rate,48447.45
Cigna,HMO,47000,CPT4/HCPCS,Needle biopsy of liver,,Case Rate,3000.00
Cigna,HMO,47001,CPT4/HCPCS,BIOPSY OF LIVER, NEEDLE; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,471,DRG,Cervical spinal fusion w MCC,,Case Rate,25500.00
Cigna,HMO,472,DRG,Cervical spinal fusion w CC,,Case Rate,25500.00
Cigna,HMO,473,DRG,Cervical spinal fusion w/o CC/MCC,,Case Rate,25500.00
Cigna,HMO,47370,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, ABLATION OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY,,Case Rate,3000.00
Cigna,HMO,47371,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, ABLATION OF ONE OF MORE LIVER TUMOR(S); CRYOSURGICAL,,Case Rate,3000.00
Cigna,HMO,47379,CPT4/HCPCS,Unlisted laparoscopic procedure, liver,,Case Rate,3000.00
Cigna,HMO,47380,CPT4/HCPCS,ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY,,Case Rate,3000.00
Cigna,HMO,47381,CPT4/HCPCS,ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); CRYOSURGICAL,,Case Rate,3000.00
Cigna,HMO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Case Rate,3000.00
Cigna,HMO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Case Rate,8300.00
Cigna,HMO,474,DRG,Amputation for musculoskeletal sys & conn tissue dis w MCC,,Case Rate,103856.40
Cigna,HMO,475,DRG,Amputation for musculoskeletal sys & conn tissue dis w CC,,Case Rate,55936.80
Cigna,HMO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Case Rate,3000.00
Cigna,HMO,47532,CPT4/HCPCS,INJECTION PROCEDURE FOR CHOLANGIOGRAPHY, PERCUTANEOUS, COMPLETE DIAGNOSTIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; NEW ACCESS (EG, PERCUTANEOUS TRANSHEPATIC C,,Case Rate,8300.00
Cigna,HMO,47533,CPT4/HCPCS,PLACEMENT OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; EXTERNAL,,Case Rate,8300.00
Cigna,HMO,47534,CPT4/HCPCS,PLACEMENT OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; INTERNAL-EXTERNAL,,Case Rate,8300.00
Cigna,HMO,47535,CPT4/HCPCS,CONVERSION OF EXTERNAL BILIARY DRAINAGE CATHETER TO INTERNAL-EXTERNAL BILIARY DRAINAGE CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPR,,Case Rate,8300.00
Cigna,HMO,47536,CPT4/HCPCS,EXCHANGE OF BILIARY DRAINAGE CATHETER (EG, EXTERNAL, INTERNAL-EXTERNAL, OR CONVERSION OF INTERNAL-EXTERNAL TO EXTERNAL ONLY), PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLO,,Case Rate,8300.00
Cigna,HMO,47537,CPT4/HCPCS,REMOVAL OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURRENT INDWELLING BILIARY STENTS), INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL S,,Case Rate,3000.00
Cigna,HMO,47538,CPT4/HCPCS,PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY, IMAGING GUIDANCE (EG, FLUOROSCOPY AND/OR ULTRASOUND), BALLOON DILATION, CATHETER EXCHANGE(S) AND CATHETER REMOVAL(S) WHEN PERFORMED, AND ALL ASSOCIATED RADIOLOGICA,,Case Rate,8300.00
Cigna,HMO,47539,CPT4/HCPCS,PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY, IMAGING GUIDANCE (EG, FLUOROSCOPY AND/OR ULTRASOUND), BALLOON DILATION, CATHETER EXCHANGE(S) AND CATHETER REMOVAL(S) WHEN PERFORMED, AND ALL ASSOCIATED RADIOLOGICA,,Case Rate,8300.00
Cigna,HMO,47540,CPT4/HCPCS,PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY, IMAGING GUIDANCE (EG, FLUOROSCOPY AND/OR ULTRASOUND), BALLOON DILATION, CATHETER EXCHANGE(S) AND CATHETER REMOVAL(S) WHEN PERFORMED, AND ALL ASSOCIATED RADIOLOGICA,,Case Rate,8300.00
Cigna,HMO,47541,CPT4/HCPCS,PLACEMENT OF ACCESS THROUGH THE BILIARY TREE AND INTO SMALL BOWEL TO ASSIST WITH AN ENDOSCOPIC BILIARY PROCEDURE (EG, RENDEZVOUS PROCEDURE), PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROS,,Case Rate,8300.00
Cigna,HMO,47542,CPT4/HCPCS,BALLOON DILATION OF BILIARY DUCT(S) OR OF AMPULLA (SPHINCTEROPLASTY), PERCUTANEOUS, INCLUDING IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, EACH DUCT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PR,,Case Rate,3000.00
Cigna,HMO,47543,CPT4/HCPCS,ENDOLUMINAL BIOPSY(IES) OF BILIARY TREE, PERCUTANEOUS, ANY METHOD(S) (EG, BRUSH, FORCEPS, AND/OR NEEDLE), INCLUDING IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, SINGLE OR MULTIPLE (LIST SEPARATELY IN ,,Case Rate,3000.00
Cigna,HMO,47544,CPT4/HCPCS,REMOVAL OF CALCULI/DEBRIS FROM BILIARY DUCT(S) AND/OR GALLBLADDER, PERCUTANEOUS, INCLUDING DESTRUCTION OF CALCULI BY ANY METHOD (EG, MECHANICAL, ELECTROHYDRAULIC, LITHOTRIPSY) WHEN PERFORMED, IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOG,,Case Rate,3000.00
Cigna,HMO,47552,CPT4/HCPCS,Biliary endoscopy thru skin,,Case Rate,3000.00
Cigna,HMO,47553,CPT4/HCPCS,Biliary endoscopy thru skin,,Case Rate,4000.00
Cigna,HMO,47554,CPT4/HCPCS,Biliary endoscopy thru skin,,Case Rate,4000.00
Cigna,HMO,47555,CPT4/HCPCS,Biliary endoscopy thru skin,,Case Rate,4000.00
Cigna,HMO,47556,CPT4/HCPCS,Biliary endoscopy thru skin,,Case Rate,8300.00
Cigna,HMO,47562,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY,,Case Rate,8300.00
Cigna,HMO,47563,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY,,Case Rate,8300.00
Cigna,HMO,47564,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT,,Case Rate,8300.00
Cigna,HMO,47570,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; CHOLECYSTOENTEROSTOMY,,Case Rate,3000.00
Cigna,HMO,47579,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT,,Case Rate,3000.00
Cigna,HMO,476,DRG,Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC,,Case Rate,29574.90
Cigna,HMO,47600,CPT4/HCPCS,Cholecystectomy;,,Case Rate,3000.00
Cigna,HMO,47605,CPT4/HCPCS,CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY,,Case Rate,3000.00
Cigna,HMO,47610,CPT4/HCPCS,CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT;,,Case Rate,3000.00
Cigna,HMO,47612,CPT4/HCPCS,CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH CHOLEDOCHOENTEROSTOMY,,Case Rate,3000.00
Cigna,HMO,47620,CPT4/HCPCS,CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH TRANSDUODENAL SPHINCTEROTOMY OR SPHINCTEROPLASTY, WITH OR WITHOUT CHOLANGIOGRAPHY,,Case Rate,3000.00
Cigna,HMO,477,DRG,Biopsies of musculoskeletal system & connective tissue w MCC,,Case Rate,85600.95
Cigna,HMO,478,DRG,Biopsies of musculoskeletal system & connective tissue w CC,,Case Rate,60100.95
Cigna,HMO,479,DRG,Biopsies of musculoskeletal system & connective tissue w/o CC/MCC,,Case Rate,46137.15
Cigna,HMO,480,DRG,Hip & femur procedures except major joint w MCC,,Case Rate,77124.75
Cigna,HMO,481,DRG,Hip & femur procedures except major joint w CC,,Case Rate,53435.25
Cigna,HMO,48102,CPT4/HCPCS,Needle biopsy, pancreas,,Case Rate,3000.00
Cigna,HMO,482,DRG,Hip & femur procedures except major joint w/o CC/MCC,,Case Rate,41993.40
Cigna,HMO,483,DRG,Major joint & limb reattachment proc of upper extremity w CC/MCC,,Case Rate,60850.65
Cigna,HMO,485,DRG,Knee procedures w pdx of infection w MCC,,Case Rate,86893.80
Cigna,HMO,486,DRG,Knee procedures w pdx of infection w CC,,Case Rate,54784.20
Cigna,HMO,487,DRG,Knee procedures w pdx of infection w/o CC/MCC,,Case Rate,41827.65
Cigna,HMO,488,DRG,Knee procedures w/o pdx of infection w CC/MCC,,Case Rate,50352.30
Cigna,HMO,489,DRG,Knee procedures w/o pdx of infection w/o CC/MCC,,Case Rate,33104.10
Cigna,HMO,49000,CPT4/HCPCS,Exploration of abdomen,,Case Rate,3000.00
Cigna,HMO,49010,CPT4/HCPCS,Exploration, retroperitoneal area with or without biopsy(s) (separate procedure),,Case Rate,3000.00
Cigna,HMO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Case Rate,3000.00
Cigna,HMO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Case Rate,3000.00
Cigna,HMO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Case Rate,3000.00
Cigna,HMO,49180,CPT4/HCPCS,Biopsy, abdominal mass,,Case Rate,3000.00
Cigna,HMO,49185,CPT4/HCPCS,SCLEROTHERAPY OF A FLUID COLLECTION (EG, LYMPHOCELE, CYST, OR SEROMA), PERCUTANEOUS, INCLUDING CONTRAST INJECTION(S), SCLEROSANT INJECTION(S), DIAGNOSTIC STUDY, IMAGING GUIDANCE (EG, ULTRASOUND, FLUOROSCOPY) AND RADIOLOGICAL SUPERVISION AND INTERPRETATION,,Case Rate,6000.00
Cigna,HMO,492,DRG,Lower extrem & humer proc except hip,foot,femur w MCC,,Case Rate,88439.10
Cigna,HMO,49250,CPT4/HCPCS,Excision of umbilicus,,Case Rate,4000.00
Cigna,HMO,493,DRG,Lower extrem & humer proc except hip,foot,femur w CC,,Case Rate,59292.60
Cigna,HMO,49320,CPT4/HCPCS,Diag laparo separate proc,,Case Rate,4000.00
Cigna,HMO,49321,CPT4/HCPCS,Laparoscopy, biopsy,,Case Rate,4000.00
Cigna,HMO,49322,CPT4/HCPCS,Laparoscopy, aspiration,,Case Rate,4000.00
Cigna,HMO,49323,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND OMENTUM; WITH DRAINAGE OF LYMPHOCELE TO PERITONEAL CAVITY,,Case Rate,4000.00
Cigna,HMO,49324,CPT4/HCPCS,Lap insertion perm ip cath,,Case Rate,8300.00
Cigna,HMO,49325,CPT4/HCPCS,Lap revision perm ip cath,,Case Rate,8300.00
Cigna,HMO,49326,CPT4/HCPCS,Lap w/omentopexy add-on,,Case Rate,8300.00
Cigna,HMO,49327,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; WITH PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), INTRA-ABDOMINAL, INTRAPELVIC, AND/OR RETROPERITONEUM, INCLUDING IMAGING GUIDANCE, IF PERFORMED, SINGLE OR MULTIPLE (LIST SEPA,,Case Rate,8300.00
Cigna,HMO,49329,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM ,,Case Rate,3000.00
Cigna,HMO,494,DRG,Lower extrem & humer proc except hip,foot,femur w/o CC/MCC,,Case Rate,47223.45
Cigna,HMO,49400,CPT4/HCPCS,Air injection into abdomen,,Case Rate,3000.00
Cigna,HMO,49402,CPT4/HCPCS,Remove foreign body, adbomen,,Case Rate,3000.00
Cigna,HMO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Case Rate,8300.00
Cigna,HMO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Case Rate,8300.00
Cigna,HMO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Case Rate,4000.00
Cigna,HMO,49411,CPT4/HCPCS,PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PERCUTANEOUS, INTRA-ABDOMINAL, INTRA-PELVIC (EXCEPT PROSTATE), AND/OR RETROPERITONEUM, SINGLE OR MULTIPLE,,Case Rate,3000.00
Cigna,HMO,49418,CPT4/HCPCS,INSERTION OF TUNNELED INTRAPERITONEAL CATHETER (EG, DIALYSIS, INTRAPERITONEAL CHEMOTHERAPY INSTILLATION, MANAGEMENT OF ASCITES), COMPLETE PROCEDURE, INCLUDING IMAGING GUIDANCE, CATHETER PLACEMENT, CONTRAST INJECTION WHEN PERFORMED, AND RADIOLOGICAL SUPERV,,Case Rate,8300.00
Cigna,HMO,49419,CPT4/HCPCS,INSERTION OF TUNNELED INTRAPERITONEAL CATHETER, WITH SUBCUTANEOUS PORT (IE, TOTALLY IMPLANTABLE),,Case Rate,3000.00
Cigna,HMO,49421,CPT4/HCPCS,INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN,,Case Rate,3000.00
Cigna,HMO,49422,CPT4/HCPCS,Remove perm cannula/catheter,,Case Rate,3000.00
Cigna,HMO,49423,CPT4/HCPCS,EXCHANGE OF PREVIOUSLY PLACED ABSCESS OR CYST DRAINAGE CATHETER UNDER RADIOLOGICAL GUIDANCE (SEPARATE PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,49424,CPT4/HCPCS,CONTRAST INJECTION FOR ASSESSMENT OF ABSCESS OR CYST VIA PREVIOUSLY PLACED DRAINAGE CATHETER OR TUBE (SEPARATE PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,49425,CPT4/HCPCS,Insert abdomen-venous drain,,Case Rate,3000.00
Cigna,HMO,49426,CPT4/HCPCS,Revise abdomen-venous shunt,,Case Rate,3000.00
Cigna,HMO,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,Case Rate,3000.00
Cigna,HMO,49429,CPT4/HCPCS,REMOVAL OF PERITONEAL-VENOUS SHUNT ,,Case Rate,3000.00
Cigna,HMO,49435,CPT4/HCPCS,Insert subq exten to ip cath,,Case Rate,3000.00
Cigna,HMO,49436,CPT4/HCPCS,Embedded ip cath exit-site,,Case Rate,4000.00
Cigna,HMO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Case Rate,3000.00
Cigna,HMO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Case Rate,3000.00
Cigna,HMO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Case Rate,5000.00
Cigna,HMO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Case Rate,3000.00
Cigna,HMO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Case Rate,3000.00
Cigna,HMO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Case Rate,3000.00
Cigna,HMO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Case Rate,3000.00
Cigna,HMO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Case Rate,3000.00
Cigna,HMO,49465,CPT4/HCPCS,CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI ,,Case Rate,3000.00
Cigna,HMO,49491,CPT4/HCPCS,REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT BIRTH), PERFORMED FROM BIRTH UP TO 50 WEEKS POST-CONCEPTUAL AGE, WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE,,Case Rate,3000.00
Cigna,HMO,49492,CPT4/HCPCS,REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT BIRTH), PERFORMED FROM BIRTH UP TO 50 WEEKS POST-CONCEPTUAL AGE, WITH OR WITHOUT HYDROCELECTOMY; INCARCERATED OR STRANGULATED,,Case Rate,3000.00
Cigna,HMO,49495,CPT4/HCPCS,Rpr ing hernia baby, reduc,,Case Rate,4000.00
Cigna,HMO,49496,CPT4/HCPCS,Rpr ing hernia baby, blocked,,Case Rate,4000.00
Cigna,HMO,495,DRG,Local excision & removal int fix devices exc hip & femur w MCC,,Case Rate,92672.10
Cigna,HMO,49500,CPT4/HCPCS,Rpr ing hernia, init, reduce,,Case Rate,4000.00
Cigna,HMO,49501,CPT4/HCPCS,Rpr ing hernia, init blocked,,Case Rate,8300.00
Cigna,HMO,49505,CPT4/HCPCS,Rpr i/hern init reduc>5 yr,,Case Rate,4000.00
Cigna,HMO,49507,CPT4/HCPCS,Rpr i/hern init block>5 yr,,Case Rate,8300.00
Cigna,HMO,49520,CPT4/HCPCS,Rerepair ing hernia, reduce,,Case Rate,6000.00
Cigna,HMO,49521,CPT4/HCPCS,Rerepair ing hernia, blocked,,Case Rate,8300.00
Cigna,HMO,49525,CPT4/HCPCS,Repair ing hernia, sliding,,Case Rate,4000.00
Cigna,HMO,49540,CPT4/HCPCS,Repair lumbar hernia,,Case Rate,3000.00
Cigna,HMO,49550,CPT4/HCPCS,Rpr fem hernia, init, reduce,,Case Rate,5000.00
Cigna,HMO,49553,CPT4/HCPCS,Rpr fem hernia, init blocked,,Case Rate,8300.00
Cigna,HMO,49555,CPT4/HCPCS,Rerepair fem hernia, reduce,,Case Rate,5000.00
Cigna,HMO,49557,CPT4/HCPCS,Rerepair fem hernia, blocked,,Case Rate,8300.00
Cigna,HMO,49560,CPT4/HCPCS,Rpr ventral hern init, reduc,,Case Rate,4000.00
Cigna,HMO,49561,CPT4/HCPCS,Rpr ventral hern init, block,,Case Rate,8300.00
Cigna,HMO,49565,CPT4/HCPCS,Rerepair ventrl hern, reduce,,Case Rate,4000.00
Cigna,HMO,49566,CPT4/HCPCS,Rerepair ventrl hern, block,,Case Rate,8300.00
Cigna,HMO,49568,CPT4/HCPCS,Hernia repair w/mesh,,Case Rate,3000.00
Cigna,HMO,49570,CPT4/HCPCS,Rpr epigastric hern, reduce,,Case Rate,4000.00
Cigna,HMO,49572,CPT4/HCPCS,Rpr epigastric hern, blocked,,Case Rate,8300.00
Cigna,HMO,49580,CPT4/HCPCS,Rpr umbil hern, reduc <5 yr,,Case Rate,4000.00
Cigna,HMO,49582,CPT4/HCPCS,Rpr umbil hern, block < 5 yr,,Case Rate,8300.00
Cigna,HMO,49585,CPT4/HCPCS,Rpr umbil hern, reduc > 5 yr,,Case Rate,4000.00
Cigna,HMO,49587,CPT4/HCPCS,Rpr umbil hern, block > 5 yr,,Case Rate,8300.00
Cigna,HMO,49590,CPT4/HCPCS,Repair spigelian hernia,,Case Rate,4000.00
Cigna,HMO,496,DRG,Local excision & removal int fix devices exc hip & femur w CC,,Case Rate,50632.80
Cigna,HMO,49600,CPT4/HCPCS,Repair umbilical lesion,,Case Rate,4000.00
Cigna,HMO,49605,CPT4/HCPCS,Repair of large omphalocele or gastroschisis; with or without prosthesis,,Case Rate,3000.00
Cigna,HMO,49650,CPT4/HCPCS,Laparo hernia repair initial,,Case Rate,4000.00
Cigna,HMO,49651,CPT4/HCPCS,Laparo hernia repair recur,,Case Rate,6000.00
Cigna,HMO,49652,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); REDUCIBLE,,Case Rate,8300.00
Cigna,HMO,49653,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED,,Case Rate,8300.00
Cigna,HMO,49654,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); REDUCIBLE,,Case Rate,8300.00
Cigna,HMO,49655,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED,,Case Rate,8300.00
Cigna,HMO,49656,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, RECURRENT INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); REDUCIBLE,,Case Rate,8300.00
Cigna,HMO,49657,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, RECURRENT INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED,,Case Rate,8300.00
Cigna,HMO,49659,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY,,Case Rate,3000.00
Cigna,HMO,497,DRG,Local excision & removal int fix devices exc hip & femur w/o CC/MCC,,Case Rate,37196.85
Cigna,HMO,498,DRG,Local excision & removal int fix devices of hip & femur w CC/MCC,,Case Rate,65899.65
Cigna,HMO,499,DRG,Local excision & removal int fix devices of hip & femur w/o CC/MCC,,Case Rate,30566.85
Cigna,HMO,49999,CPT4/HCPCS,UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM ,,Case Rate,3000.00
Cigna,HMO,5,DRG,Liver transplant w MCC or intestinal transplant,,Case Rate,260694.15
Cigna,HMO,500,DRG,Soft tissue procedures w MCC,,Case Rate,80424.45
Cigna,HMO,50020,CPT4/HCPCS,Renal abscess, open drain,,Case Rate,3000.00
Cigna,HMO,50040,CPT4/HCPCS,Drainage of kidney,,Case Rate,3000.00
Cigna,HMO,50080,CPT4/HCPCS,PERC NEPHROS/PYLOS W/WO DILA, ENDO,LITHO,STENT/BASK EXTR UP TO 2 CM ,,Case Rate,3000.00
Cigna,HMO,50081,CPT4/HCPCS,PERC NEPHRO/PYLOS W/WO DILA,ENDO,LITHO,STENT/BASK EXTRA OVER 2 CM ,,Case Rate,3000.00
Cigna,HMO,501,DRG,Soft tissue procedures w CC,,Case Rate,44497.50
Cigna,HMO,502,DRG,Soft tissue procedures w/o CC/MCC,,Case Rate,33935.40
Cigna,HMO,50200,CPT4/HCPCS,Biopsy of kidney,,Case Rate,3000.00
Cigna,HMO,50250,CPT4/HCPCS,Ablation, open, one or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound, if performed,,Case Rate,3000.00
Cigna,HMO,503,DRG,Foot procedures w MCC,,Case Rate,67031.85
Cigna,HMO,50382,CPT4/HCPCS,Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation,,Case Rate,3000.00
Cigna,HMO,50384,CPT4/HCPCS,Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation,,Case Rate,3000.00
Cigna,HMO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Case Rate,5000.00
Cigna,HMO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Case Rate,3000.00
Cigna,HMO,50387,CPT4/HCPCS,Removal and replacement of externally accessible transnephric ureteral stent (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation,,Case Rate,3000.00
Cigna,HMO,50389,CPT4/HCPCS,Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent),,Case Rate,3000.00
Cigna,HMO,50390,CPT4/HCPCS,Drainage of kidney lesion,,Case Rate,3000.00
Cigna,HMO,50391,CPT4/HCPCS,Instillation(S) Of Therapeutic Agent Into Renal Pelvis And/Or Ureter Through Established Nephrostomy, Pyelostomy Or Ureterostomy Tube (Eg, Anticarcinogenic Or Antifungal Agent),,Case Rate,3000.00
Cigna,HMO,50396,CPT4/HCPCS,Measure kidney pressure,,Case Rate,3000.00
Cigna,HMO,504,DRG,Foot procedures w CC,,Case Rate,45234.45
Cigna,HMO,50430,CPT4/HCPCS,INJECTION PROCEDURE FOR ANTEGRADE NEPHROSTOGRAM AND/OR URETEROGRAM, COMPLETE DIAGNOSTIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; NEW ACCESS,,Case Rate,4000.00
Cigna,HMO,50431,CPT4/HCPCS,INJECTION PROCEDURE FOR ANTEGRADE NEPHROSTOGRAM AND/OR URETEROGRAM, COMPLETE DIAGNOSTIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; EXISTING ACCESS,,Case Rate,4000.00
Cigna,HMO,50432,CPT4/HCPCS,PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION,,Case Rate,6000.00
Cigna,HMO,50433,CPT4/HCPCS,PLACEMENT OF NEPHROURETERAL CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, NEW ACCESS,,Case Rate,6000.00
Cigna,HMO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER TO NEPHROURETERAL CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATIO,,Case Rate,4000.00
Cigna,HMO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION,,Case Rate,4000.00
Cigna,HMO,50436,CPT4/HCPCS,Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed ,,Case Rate,3000.00
Cigna,HMO,50437,CPT4/HCPCS,Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed; inclu,,Case Rate,3000.00
Cigna,HMO,505,DRG,Foot procedures w/o CC/MCC,,Case Rate,45234.45
Cigna,HMO,50520,CPT4/HCPCS,Close kidney-skin fistula,,Case Rate,3000.00
Cigna,HMO,50541,CPT4/HCPCS,LAPAROSCOPY, SURGICAL;ABLATION OF RENAL CYSTS,,Case Rate,5000.00
Cigna,HMO,50542,CPT4/HCPCS,Laparoscopy, surgical; ablation or renal mass lesion(s),,Case Rate,3000.00
Cigna,HMO,50543,CPT4/HCPCS,Laparoscopy, surgical; partial nephrectomy,,Case Rate,3000.00
Cigna,HMO,50544,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; PYELOPLASTY,,Case Rate,5000.00
Cigna,HMO,50546,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; NEPHRECTOMY,,Case Rate,3000.00
Cigna,HMO,50547,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; DONOR NEPHRECTOMY FROM LIVING DONOR (EXCLUDING PREPARATION AND MAINTENANCE OF ALLOGRAFT),,Case Rate,3000.00
Cigna,HMO,50548,CPT4/HCPCS,LAPAROSCOPICALLY ASSISTED NEPHROURETERECTOMY,,Case Rate,3000.00
Cigna,HMO,50549,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, RENAL,,Case Rate,3000.00
Cigna,HMO,50551,CPT4/HCPCS,Kidney endoscopy,,Case Rate,3000.00
Cigna,HMO,50553,CPT4/HCPCS,Kidney endoscopy,,Case Rate,3000.00
Cigna,HMO,50555,CPT4/HCPCS,Kidney endoscopy & biopsy,,Case Rate,3000.00
Cigna,HMO,50557,CPT4/HCPCS,Kidney endoscopy & treatment,,Case Rate,3000.00
Cigna,HMO,50561,CPT4/HCPCS,Kidney endoscopy & treatment,,Case Rate,3000.00
Cigna,HMO,50562,CPT4/HCPCS,Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive or radiologic service; with resection of tumor,,Case Rate,3000.00
Cigna,HMO,50570,CPT4/HCPCS,Kidney endoscopy,,Case Rate,3000.00
Cigna,HMO,50572,CPT4/HCPCS,Kidney endoscopy,,Case Rate,3000.00
Cigna,HMO,50574,CPT4/HCPCS,Kidney endoscopy & biopsy,,Case Rate,3000.00
Cigna,HMO,50576,CPT4/HCPCS,Kidney endoscopy & treatment,,Case Rate,3000.00
Cigna,HMO,50580,CPT4/HCPCS,Kidney endoscopy & treatment,,Case Rate,3000.00
Cigna,HMO,50590,CPT4/HCPCS,Lithotripsy, extracorporeal shock wave,,Case Rate,8300.00
Cigna,HMO,50592,CPT4/HCPCS,Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency,,Case Rate,3000.00
Cigna,HMO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Case Rate,8300.00
Cigna,HMO,506,DRG,Major thumb or joint procedures,,Case Rate,37630.35
Cigna,HMO,50600,CPT4/HCPCS,URETEROTOMY WITH EXPLORATION OR DRAINAGE (SEPARATE PROCEDURE),,Case Rate,3000.00
Cigna,HMO,50605,CPT4/HCPCS,URETEROTOMY FOR INSERTION OF INDWELLING STENT, ALL TYPES,,Case Rate,3000.00
Cigna,HMO,50606,CPT4/HCPCS,ENDOLUMINAL BIOPSY OF URETER AND/OR RENAL PELVIS, NON-ENDOSCOPIC, INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,50610,CPT4/HCPCS,URETEROLITHOTOMY; UPPER ONE-THIRD OF URETER,,Case Rate,3000.00
Cigna,HMO,50620,CPT4/HCPCS,URETEROLITHOTOMY; MIDDLE ONE-THIRD OF URETER,,Case Rate,3000.00
Cigna,HMO,50630,CPT4/HCPCS,URETEROLITHOTOMY; LOWER ONE-THIRD OF URETER,,Case Rate,3000.00
Cigna,HMO,50650,CPT4/HCPCS,URETERECTOMY, WITH BLADDER CUFF (SEPARATE PROCEDURE),,Case Rate,3000.00
Cigna,HMO,50660,CPT4/HCPCS,URETERECTOMY, TOTAL, ECTOPIC URETER, COMBINATION ABDOMINAL, VAGINAL AND/OR PERINEAL APPROACH,,Case Rate,3000.00
Cigna,HMO,50684,CPT4/HCPCS,Injection for ureter x-ray,,Case Rate,3000.00
Cigna,HMO,50688,CPT4/HCPCS,CHANGE OF URETEROSTOMY TUBE OR EXTERNALLY ACCESSIBLE URETERAL STENT VIA ILEAL CONDUIT,,Case Rate,3000.00
Cigna,HMO,50690,CPT4/HCPCS,Injection for ureter x-ray,,Case Rate,3000.00
Cigna,HMO,50693,CPT4/HCPCS,PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; PRE-EXISTING NEPHROSTOMY,,Case Rate,8300.00
Cigna,HMO,50694,CPT4/HCPCS,PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; NEW ACCESS, WITHOUT SEPA,,Case Rate,8300.00
Cigna,HMO,50695,CPT4/HCPCS,PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; NEW ACCESS, WITH SEPARAT,,Case Rate,8300.00
Cigna,HMO,507,DRG,Major shoulder or elbow joint procedures w CC/MCC,,Case Rate,51568.65
Cigna,HMO,50705,CPT4/HCPCS,URETERAL EMBOLIZATION OR OCCLUSION, INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,50706,CPT4/HCPCS,BALLOON DILATION, URETERAL STRICTURE, INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,508,DRG,Major shoulder or elbow joint procedures w/o CC/MCC,,Case Rate,36057.00
Cigna,HMO,509,DRG,Arthroscopy,,Case Rate,42681.90
Cigna,HMO,50945,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, URETEROLITHOTOMY,,Case Rate,5000.00
Cigna,HMO,50947,CPT4/HCPCS,Laparo new ureter/bladder,,Case Rate,8300.00
Cigna,HMO,50948,CPT4/HCPCS,Laparo new ureter/bladder,,Case Rate,8300.00
Cigna,HMO,50949,CPT4/HCPCS,Unlisted laparoscopic procedure, ureter,,Case Rate,3000.00
Cigna,HMO,50951,CPT4/HCPCS,Endoscopy of ureter,,Case Rate,3000.00
Cigna,HMO,50953,CPT4/HCPCS,Endoscopy of ureter,,Case Rate,3000.00
Cigna,HMO,50955,CPT4/HCPCS,Ureter endoscopy & biopsy,,Case Rate,3000.00
Cigna,HMO,50957,CPT4/HCPCS,Ureter endoscopy & treatment,,Case Rate,3000.00
Cigna,HMO,50961,CPT4/HCPCS,Ureter endoscopy & treatment,,Case Rate,3000.00
Cigna,HMO,50970,CPT4/HCPCS,Ureter endoscopy,,Case Rate,3000.00
Cigna,HMO,50972,CPT4/HCPCS,Ureter endoscopy & catheter,,Case Rate,3000.00
Cigna,HMO,50974,CPT4/HCPCS,Ureter endoscopy & biopsy,,Case Rate,3000.00
Cigna,HMO,50976,CPT4/HCPCS,Ureter endoscopy & treatment,,Case Rate,3000.00
Cigna,HMO,50980,CPT4/HCPCS,Ureter endoscopy & treatment,,Case Rate,3000.00
Cigna,HMO,510,DRG,Shoulder,elbow or forearm proc,exc major joint proc w MCC,,Case Rate,69632.85
Cigna,HMO,51020,CPT4/HCPCS,Incise & treat bladder,,Case Rate,4000.00
Cigna,HMO,51030,CPT4/HCPCS,Incise & treat bladder,,Case Rate,4000.00
Cigna,HMO,51040,CPT4/HCPCS,Incise & drain bladder,,Case Rate,4000.00
Cigna,HMO,51045,CPT4/HCPCS,Incise bladder/drain ureter,,Case Rate,4000.00
Cigna,HMO,51050,CPT4/HCPCS,Removal of bladder stone,,Case Rate,4000.00
Cigna,HMO,51065,CPT4/HCPCS,Remove ureter calculus,,Case Rate,4000.00
Cigna,HMO,51080,CPT4/HCPCS,Drainage of bladder abscess,,Case Rate,3000.00
Cigna,HMO,511,DRG,Shoulder,elbow or forearm proc,exc major joint proc w CC,,Case Rate,50196.75
Cigna,HMO,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,Case Rate,400.00
Cigna,HMO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Case Rate,400.00
Cigna,HMO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Case Rate,3000.00
Cigna,HMO,512,DRG,Shoulder,elbow or forearm proc,exc major joint proc w/o CC/MCC,,Case Rate,39683.10
Cigna,HMO,513,DRG,Hand or wrist proc, except major thumb or joint proc w CC/MCC,,Case Rate,39754.50
Cigna,HMO,514,DRG,Hand or wrist proc, except major thumb or joint proc w/o CC/MCC,,Case Rate,25352.10
Cigna,HMO,515,DRG,Other musculoskelet sys & conn tiss O.R. proc w MCC,,Case Rate,79993.50
Cigna,HMO,51500,CPT4/HCPCS,Removal of bladder cyst,,Case Rate,4000.00
Cigna,HMO,51520,CPT4/HCPCS,Removal of bladder lesion,,Case Rate,4000.00
Cigna,HMO,516,DRG,Other musculoskelet sys & conn tiss O.R. proc w CC,,Case Rate,50008.05
Cigna,HMO,517,DRG,Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC,,Case Rate,35615.85
Cigna,HMO,51700,CPT4/HCPCS,BLADDER IRRIGATION, SIMPLE LAVAGE AND/OR INSTILLATION (CONSIDER AS TOS 04) ,,Case Rate,3000.00
Cigna,HMO,51701,CPT4/HCPCS,Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine),,Case Rate,400.00
Cigna,HMO,51702,CPT4/HCPCS,Insertion of temporary indwelling bladder catheter; simple (eg, Foley),,Case Rate,400.00
Cigna,HMO,51703,CPT4/HCPCS,Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon),,Case Rate,3000.00
Cigna,HMO,51705,CPT4/HCPCS,CHANGE OF CYSTOSTOMY TUBE; SIMPLE ,,Case Rate,3000.00
Cigna,HMO,51710,CPT4/HCPCS,CHANGE OF CYSTOSTOMY TUBE; COMPLICATED,,Case Rate,3000.00
Cigna,HMO,51715,CPT4/HCPCS,Endoscopic injection/implant,,Case Rate,4000.00
Cigna,HMO,51725,CPT4/HCPCS,Simple cystometrogram,,Case Rate,3000.00
Cigna,HMO,51726,CPT4/HCPCS,Complex cystometrogram,,Case Rate,3000.00
Cigna,HMO,51727,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE,,Case Rate,400.00
Cigna,HMO,51728,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE), ANY TECHNIQUE,,Case Rate,400.00
Cigna,HMO,51729,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE) AND URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE,,Case Rate,400.00
Cigna,HMO,51785,CPT4/HCPCS,Anal/urinary muscle study,,Case Rate,3000.00
Cigna,HMO,51797,CPT4/HCPCS,VOIDING PRESSURE STUDIES, INTRA-ABDOMINAL (IE, RECTAL, GASTRIC, INTRAPERITONEAL) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,Case Rate,25500.00
Cigna,HMO,51800,CPT4/HCPCS,Cystoplasty or cystourethroplasty, plastic operation on bladder and/or vesical neck (anterior Y-plasty, vesical fundus resection), any procedure, with or without wedge resection of posterior vesical neck,,Case Rate,3000.00
Cigna,HMO,51820,CPT4/HCPCS,Cystourethroplasty with unilateral or bilateral ureteroneocystostomy,,Case Rate,3000.00
Cigna,HMO,51840,CPT4/HCPCS,Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); simple,,Case Rate,3000.00
Cigna,HMO,51841,CPT4/HCPCS,Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); complicated (eg, secondary repair),,Case Rate,3000.00
Cigna,HMO,51845,CPT4/HCPCS,Abdomino-vaginal vesical neck suspension, with or without endoscopic control (eg, Stamey, Raz, modified Pereyra),,Case Rate,3000.00
Cigna,HMO,51860,CPT4/HCPCS,CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE, ,,Case Rate,3000.00
Cigna,HMO,51865,CPT4/HCPCS,Repair of bladder wound,,Case Rate,3000.00
Cigna,HMO,51880,CPT4/HCPCS,Repair of bladder opening,,Case Rate,3000.00
Cigna,HMO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,Case Rate,25500.00
Cigna,HMO,51900,CPT4/HCPCS,Repair bladder/vagina lesion,,Case Rate,3000.00
Cigna,HMO,51920,CPT4/HCPCS,Close bladder-uterus fistula,,Case Rate,3000.00
Cigna,HMO,51990,CPT4/HCPCS,LAPAROSCOPY, SURGICAL;URETHRAL SUSPENSION FOR STRESS INCONTINENCE,,Case Rate,5000.00
Cigna,HMO,51992,CPT4/HCPCS,Laparo sling operation,,Case Rate,5000.00
Cigna,HMO,51999,CPT4/HCPCS,Unlisted laparoscopy procedure, bladder,,Case Rate,3000.00
Cigna,HMO,52,DRG,Spinal disorders & injuries w CC/MCC,,Case Rate,47050.05
Cigna,HMO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,Case Rate,25500.00
Cigna,HMO,52000,CPT4/HCPCS,Cystoscopy,,Case Rate,3000.00
Cigna,HMO,52001,CPT4/HCPCS,Cystoscopy, removal of clots,,Case Rate,3000.00
Cigna,HMO,52005,CPT4/HCPCS,Cystoscopy & ureter catheter,,Case Rate,3000.00
Cigna,HMO,52007,CPT4/HCPCS,Cystoscopy and biopsy,,Case Rate,3000.00
Cigna,HMO,52010,CPT4/HCPCS,Cystoscopy & duct catheter,,Case Rate,3000.00
Cigna,HMO,521,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,,Case Rate,78116.70
Cigna,HMO,522,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,,Case Rate,55822.05
Cigna,HMO,52204,CPT4/HCPCS,Cystoscopy,,Case Rate,3000.00
Cigna,HMO,52214,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52224,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52234,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52235,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,4000.00
Cigna,HMO,52240,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,4000.00
Cigna,HMO,52250,CPT4/HCPCS,Cystoscopy and radiotracer,,Case Rate,4000.00
Cigna,HMO,52260,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52265,CPT4/HCPCS,Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia,,Case Rate,3000.00
Cigna,HMO,52270,CPT4/HCPCS,Cystoscopy & revise urethra,,Case Rate,3000.00
Cigna,HMO,52275,CPT4/HCPCS,Cystoscopy & revise urethra,,Case Rate,3000.00
Cigna,HMO,52276,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,4000.00
Cigna,HMO,52277,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52281,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52282,CPT4/HCPCS,Cystoscopy, implant stent,,Case Rate,8300.00
Cigna,HMO,52283,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52285,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Case Rate,5000.00
Cigna,HMO,52290,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52300,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52301,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,4000.00
Cigna,HMO,52305,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52310,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52315,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52317,CPT4/HCPCS,Remove bladder stone,,Case Rate,3000.00
Cigna,HMO,52318,CPT4/HCPCS,Remove bladder stone,,Case Rate,3000.00
Cigna,HMO,52320,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,5000.00
Cigna,HMO,52325,CPT4/HCPCS,Cystoscopy, stone removal,,Case Rate,4000.00
Cigna,HMO,52327,CPT4/HCPCS,Cystoscopy, inject material,,Case Rate,3000.00
Cigna,HMO,52330,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52332,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,HMO,52334,CPT4/HCPCS,Create passage to kidney,,Case Rate,4000.00
Cigna,HMO,52341,CPT4/HCPCS,Cysto w/ureter stricture tx,,Case Rate,4000.00
Cigna,HMO,52342,CPT4/HCPCS,Cysto w/up stricture tx,,Case Rate,4000.00
Cigna,HMO,52343,CPT4/HCPCS,Cysto w/renal stricture tx,,Case Rate,4000.00
Cigna,HMO,52344,CPT4/HCPCS,Cysto/uretero, stone remove,,Case Rate,4000.00
Cigna,HMO,52345,CPT4/HCPCS,Cysto/uretero w/up stricture,,Case Rate,4000.00
Cigna,HMO,52346,CPT4/HCPCS,Cystouretero w/renal strict,,Case Rate,4000.00
Cigna,HMO,52351,CPT4/HCPCS,Cystouretro & or pyeloscope,,Case Rate,4000.00
Cigna,HMO,52352,CPT4/HCPCS,Cystouretro w/stone remove,,Case Rate,4000.00
Cigna,HMO,52353,CPT4/HCPCS,Cystouretero w/lithotripsy,,Case Rate,4000.00
Cigna,HMO,52354,CPT4/HCPCS,Cystouretero w/biopsy,,Case Rate,4000.00
Cigna,HMO,52355,CPT4/HCPCS,Cystouretero w/excise tumor,,Case Rate,4000.00
Cigna,HMO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Case Rate,8300.00
Cigna,HMO,52400,CPT4/HCPCS,Cystouretero w/congen repr,,Case Rate,4000.00
Cigna,HMO,52402,CPT4/HCPCS,Cystourethro cut ejacul duct,,Case Rate,4000.00
Cigna,HMO,52441,CPT4/HCPCS, CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT ADJUSTABLE TRANSPROSTATIC IMPLANT; SINGLE IMPLANT,,Case Rate,3000.00
Cigna,HMO,52442,CPT4/HCPCS,CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT ADJUSTABLE TRANSPROSTATIC IMPLANT; EACH ADDITIONAL PERMANENT ADJUSTABLE TRANSPROSTATIC IMPLANT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,52450,CPT4/HCPCS,Incision of prostate,,Case Rate,4000.00
Cigna,HMO,52500,CPT4/HCPCS,Revision of bladder neck,,Case Rate,4000.00
Cigna,HMO,52601,CPT4/HCPCS,Prostatectomy (TURP),,Case Rate,4000.00
Cigna,HMO,52630,CPT4/HCPCS,Remove prostate regrowth,,Case Rate,3000.00
Cigna,HMO,52640,CPT4/HCPCS,Relieve bladder contracture,,Case Rate,3000.00
Cigna,HMO,52647,CPT4/HCPCS,Laser surgery of prostate,,Case Rate,8300.00
Cigna,HMO,52648,CPT4/HCPCS,Laser surgery of prostate,,Case Rate,8300.00
Cigna,HMO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Case Rate,8300.00
Cigna,HMO,52700,CPT4/HCPCS,Drainage of prostate abscess,,Case Rate,3000.00
Cigna,HMO,53,DRG,Spinal disorders & injuries w/o CC/MCC,,Case Rate,28970.55
Cigna,HMO,53000,CPT4/HCPCS,Incision of urethra,,Case Rate,3000.00
Cigna,HMO,53010,CPT4/HCPCS,Incision of urethra,,Case Rate,3000.00
Cigna,HMO,53020,CPT4/HCPCS,Incision of urethra,,Case Rate,3000.00
Cigna,HMO,53025,CPT4/HCPCS,Meatotomy, cutting of meatus (separate procedure); infant,,Case Rate,3000.00
Cigna,HMO,53040,CPT4/HCPCS,Drainage of urethra abscess,,Case Rate,3000.00
Cigna,HMO,53060,CPT4/HCPCS,Drainage of Skenes gland abscess or cyst,,Case Rate,3000.00
Cigna,HMO,53080,CPT4/HCPCS,Drainage of urinary leakage,,Case Rate,4000.00
Cigna,HMO,53200,CPT4/HCPCS,Biopsy of urethra,,Case Rate,3000.00
Cigna,HMO,53210,CPT4/HCPCS,Removal of urethra,,Case Rate,5000.00
Cigna,HMO,53215,CPT4/HCPCS,Removal of urethra,,Case Rate,5000.00
Cigna,HMO,53220,CPT4/HCPCS,Treatment of urethra lesion,,Case Rate,3000.00
Cigna,HMO,53230,CPT4/HCPCS,Removal of urethra lesion,,Case Rate,3000.00
Cigna,HMO,53235,CPT4/HCPCS,Removal of urethra lesion,,Case Rate,4000.00
Cigna,HMO,53240,CPT4/HCPCS,Surgery for urethra pouch,,Case Rate,3000.00
Cigna,HMO,53250,CPT4/HCPCS,Removal of urethra gland,,Case Rate,3000.00
Cigna,HMO,53260,CPT4/HCPCS,Treatment of urethra lesion,,Case Rate,3000.00
Cigna,HMO,53265,CPT4/HCPCS,Treatment of urethra lesion,,Case Rate,3000.00
Cigna,HMO,53270,CPT4/HCPCS,Removal of urethra gland,,Case Rate,3000.00
Cigna,HMO,53275,CPT4/HCPCS,Repair of urethra defect,,Case Rate,3000.00
Cigna,HMO,533,DRG,Fractures of femur w MCC,,Case Rate,36021.30
Cigna,HMO,534,DRG,Fractures of femur w/o MCC,,Case Rate,20109.30
Cigna,HMO,53400,CPT4/HCPCS,Revise urethra, stage 1,,Case Rate,4000.00
Cigna,HMO,53405,CPT4/HCPCS,Revise urethra, stage 2,,Case Rate,3000.00
Cigna,HMO,53410,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,3000.00
Cigna,HMO,53420,CPT4/HCPCS,Reconstruct urethra, stage 1,,Case Rate,4000.00
Cigna,HMO,53425,CPT4/HCPCS,Reconstruct urethra, stage 2,,Case Rate,3000.00
Cigna,HMO,53430,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,3000.00
Cigna,HMO,53431,CPT4/HCPCS,Reconstruct urethra/bladder,,Case Rate,3000.00
Cigna,HMO,53440,CPT4/HCPCS,Correct bladder function,,Case Rate,3000.00
Cigna,HMO,53442,CPT4/HCPCS,Remove perineal prosthesis,,Case Rate,3000.00
Cigna,HMO,53444,CPT4/HCPCS,Insert tandem cuff,,Case Rate,3000.00
Cigna,HMO,53445,CPT4/HCPCS,Insert uro/ves nck sphincter,,Case Rate,3000.00
Cigna,HMO,53446,CPT4/HCPCS,Remove uro sphincter,,Case Rate,3000.00
Cigna,HMO,53447,CPT4/HCPCS,Remove/replace ur sphincter,,Case Rate,3000.00
Cigna,HMO,53449,CPT4/HCPCS,Repair uro sphincter,,Case Rate,3000.00
Cigna,HMO,53450,CPT4/HCPCS,Revision of urethra,,Case Rate,3000.00
Cigna,HMO,53460,CPT4/HCPCS,Revision of urethra,,Case Rate,3000.00
Cigna,HMO,535,DRG,Fractures of hip & pelvis w MCC,,Case Rate,31461.90
Cigna,HMO,53500,CPT4/HCPCS,Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring),,Case Rate,3000.00
Cigna,HMO,53502,CPT4/HCPCS,Repair of urethra injury,,Case Rate,3000.00
Cigna,HMO,53505,CPT4/HCPCS,Repair of urethra injury,,Case Rate,3000.00
Cigna,HMO,53510,CPT4/HCPCS,Repair of urethra injury,,Case Rate,3000.00
Cigna,HMO,53515,CPT4/HCPCS,Repair of urethra injury,,Case Rate,3000.00
Cigna,HMO,53520,CPT4/HCPCS,Repair of urethra defect,,Case Rate,3000.00
Cigna,HMO,536,DRG,Fractures of hip & pelvis w/o MCC,,Case Rate,19675.80
Cigna,HMO,53600,CPT4/HCPCS,Dilation of urethral stricture by passage of sound or urethral dilator, male; initial,,Case Rate,3000.00
Cigna,HMO,53601,CPT4/HCPCS,Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent,,Case Rate,3000.00
Cigna,HMO,53605,CPT4/HCPCS,Dilate urethra stricture,,Case Rate,3000.00
Cigna,HMO,53620,CPT4/HCPCS,Dilation of urethral stricture by passage of filiform and follower, male; initial,,Case Rate,3000.00
Cigna,HMO,53621,CPT4/HCPCS,Dilation of urethral stricture by passage of filiform and follower, male; subsequent,,Case Rate,3000.00
Cigna,HMO,53660,CPT4/HCPCS,Dilation of female urethra including suppository and/or instillation; initial,,Case Rate,400.00
Cigna,HMO,53665,CPT4/HCPCS,Dilation of urethra,,Case Rate,3000.00
Cigna,HMO,537,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC,,Case Rate,23796.60
Cigna,HMO,538,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC,,Case Rate,18395.70
Cigna,HMO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Case Rate,3000.00
Cigna,HMO,53852,CPT4/HCPCS,TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY.,,Case Rate,3000.00
Cigna,HMO,53854,CPT4/HCPCS,Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy ,,Case Rate,8300.00
Cigna,HMO,53855,CPT4/HCPCS,INSERTION OF A TEMPORARY PROSTATIC URETHRAL STENT, INCLUDING URETHRAL MEASUREMENT,,Case Rate,400.00
Cigna,HMO,53860,CPT4/HCPCS,TRANSURETHRAL RADIOFREQUENCY MICRO-REMODELING OF THE FEMALE BLADDER NECK AND PROXIMAL URETHRA FOR STRESS URINARY INCONTINENCE,,Case Rate,6000.00
Cigna,HMO,53899,CPT4/HCPCS,Unlisted procedure, urinary system,,Case Rate,3000.00
Cigna,HMO,539,DRG,Osteomyelitis w MCC,,Case Rate,49500.60
Cigna,HMO,54,DRG,Nervous system neoplasms w MCC,,Case Rate,34827.90
Cigna,HMO,540,DRG,Osteomyelitis w CC,,Case Rate,33030.15
Cigna,HMO,54000,CPT4/HCPCS,Slitting of prepuce,,Case Rate,3000.00
Cigna,HMO,54001,CPT4/HCPCS,Slitting of prepuce,,Case Rate,3000.00
Cigna,HMO,54015,CPT4/HCPCS,Drain penis lesion,,Case Rate,4000.00
Cigna,HMO,54057,CPT4/HCPCS,Laser surg, penis lesion(s),,Case Rate,3000.00
Cigna,HMO,54060,CPT4/HCPCS,Excision of penis lesion(s),,Case Rate,3000.00
Cigna,HMO,54065,CPT4/HCPCS,Destruction, penis lesion(s),,Case Rate,3000.00
Cigna,HMO,541,DRG,Osteomyelitis w/o CC/MCC,,Case Rate,21435.30
Cigna,HMO,54100,CPT4/HCPCS,Biopsy of penis,,Case Rate,3000.00
Cigna,HMO,54105,CPT4/HCPCS,Biopsy of penis,,Case Rate,3000.00
Cigna,HMO,54110,CPT4/HCPCS,Treatment of penis lesion,,Case Rate,3000.00
Cigna,HMO,54111,CPT4/HCPCS,Treat penis lesion, graft,,Case Rate,3000.00
Cigna,HMO,54112,CPT4/HCPCS,Treat penis lesion, graft,,Case Rate,3000.00
Cigna,HMO,54115,CPT4/HCPCS,Treatment of penis lesion,,Case Rate,3000.00
Cigna,HMO,54120,CPT4/HCPCS,Partial removal of penis,,Case Rate,3000.00
Cigna,HMO,54125,CPT4/HCPCS,Removal of penis,,Case Rate,3000.00
Cigna,HMO,54150,CPT4/HCPCS,Circumcision,,Case Rate,3000.00
Cigna,HMO,54160,CPT4/HCPCS,Circumcision,,Case Rate,3000.00
Cigna,HMO,54161,CPT4/HCPCS,Circumcision,,Case Rate,3000.00
Cigna,HMO,54162,CPT4/HCPCS,Lysis penil circumcis lesion,,Case Rate,3000.00
Cigna,HMO,54163,CPT4/HCPCS,Repair of circumcision,,Case Rate,3000.00
Cigna,HMO,54164,CPT4/HCPCS,Frenulotomy of penis,,Case Rate,3000.00
Cigna,HMO,542,DRG,Pathological fractures & musculoskelet & conn tiss malig w MCC,,Case Rate,46035.15
Cigna,HMO,54205,CPT4/HCPCS,Treatment of penis lesion,,Case Rate,4000.00
Cigna,HMO,54220,CPT4/HCPCS,Treatment of penis lesion,,Case Rate,3000.00
Cigna,HMO,54230,CPT4/HCPCS,Injection procedure for corpora cavernosography,,Case Rate,3000.00
Cigna,HMO,54240,CPT4/HCPCS,Penile plethysmography,,Case Rate,400.00
Cigna,HMO,54250,CPT4/HCPCS,Nocturnal penile tumescence and/or rigidity test,,Case Rate,400.00
Cigna,HMO,543,DRG,Pathological fractures & musculoskelet & conn tiss malig w CC,,Case Rate,26604.15
Cigna,HMO,54300,CPT4/HCPCS,Revision of penis,,Case Rate,4000.00
Cigna,HMO,54304,CPT4/HCPCS,Revision of penis,,Case Rate,4000.00
Cigna,HMO,54308,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,HMO,54312,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,HMO,54316,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,HMO,54318,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,HMO,54322,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,HMO,54324,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,HMO,54326,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,HMO,54328,CPT4/HCPCS,Revise penis/urethra,,Case Rate,4000.00
Cigna,HMO,54332,CPT4/HCPCS,One stage proximal penile or penoscrotal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap,,Case Rate,3000.00
Cigna,HMO,54336,CPT4/HCPCS,One stage perineal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap,,Case Rate,3000.00
Cigna,HMO,54340,CPT4/HCPCS,Secondary urethral surgery,,Case Rate,4000.00
Cigna,HMO,54344,CPT4/HCPCS,Secondary urethral surgery,,Case Rate,4000.00
Cigna,HMO,54348,CPT4/HCPCS,Secondary urethral surgery,,Case Rate,4000.00
Cigna,HMO,54352,CPT4/HCPCS,Reconstruct urethra/penis,,Case Rate,4000.00
Cigna,HMO,54360,CPT4/HCPCS,Penis plastic surgery,,Case Rate,4000.00
Cigna,HMO,54380,CPT4/HCPCS,Repair penis,,Case Rate,4000.00
Cigna,HMO,54385,CPT4/HCPCS,Repair penis,,Case Rate,4000.00
Cigna,HMO,544,DRG,Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC,,Case Rate,19793.10
Cigna,HMO,54400,CPT4/HCPCS,Insert semi-rigid prosthesis,,Case Rate,4000.00
Cigna,HMO,54401,CPT4/HCPCS,Insert self-contd prosthesis,,Case Rate,4000.00
Cigna,HMO,54405,CPT4/HCPCS,Insert multi-comp penis pros,,Case Rate,4000.00
Cigna,HMO,54406,CPT4/HCPCS,Remove multi-comp penis pros,,Case Rate,4000.00
Cigna,HMO,54408,CPT4/HCPCS,Repair multi-comp penis pros,,Case Rate,4000.00
Cigna,HMO,54410,CPT4/HCPCS,Remove/replace penis prosth,,Case Rate,4000.00
Cigna,HMO,54411,CPT4/HCPCS,REMOVAL AND REPLACEMENT OF ALL COMPONENTS OF A MULTI-COMPONENT INFLATABLE PENILE PROSTHESIS THROUGH AN INFECTED FIELD AT THE SAME OPERATIVE SESSION, INCLUDING IRRIGATION AND DEBRIDEMENT OF INFECTED TISSUE,,Case Rate,3000.00
Cigna,HMO,54415,CPT4/HCPCS,Remove self-contd penis pros,,Case Rate,4000.00
Cigna,HMO,54416,CPT4/HCPCS,Remv/repl penis contain pros,,Case Rate,4000.00
Cigna,HMO,54417,CPT4/HCPCS,REMOVAL AND REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR NFLATABLE (SELF-CONTAINED) PENILE PROTHESIS THROUGH AN INFECTED FIELD AT THE SAME OPERATIVE SESSION, INCLUDING IRRIGATION AND DEBRIDEMENT OF INFECTED TISSUE,,Case Rate,3000.00
Cigna,HMO,54420,CPT4/HCPCS,Revision of penis,,Case Rate,4000.00
Cigna,HMO,54435,CPT4/HCPCS,Revision of penis,,Case Rate,4000.00
Cigna,HMO,54437,CPT4/HCPCS,REPAIR OF TRAUMATIC CORPOREAL TEAR(S),,Case Rate,3000.00
Cigna,HMO,54440,CPT4/HCPCS,Repair of penis,,Case Rate,4000.00
Cigna,HMO,54450,CPT4/HCPCS,Preputial stretching,,Case Rate,3000.00
Cigna,HMO,545,DRG,Connective tissue disorders w MCC,,Case Rate,63737.25
Cigna,HMO,54500,CPT4/HCPCS,Biopsy of testis,,Case Rate,3000.00
Cigna,HMO,54505,CPT4/HCPCS,Biopsy of testis,,Case Rate,3000.00
Cigna,HMO,54512,CPT4/HCPCS,Excise lesion testis,,Case Rate,3000.00
Cigna,HMO,54520,CPT4/HCPCS,Removal of testis,,Case Rate,4000.00
Cigna,HMO,54522,CPT4/HCPCS,Orchiectomy, partial,,Case Rate,4000.00
Cigna,HMO,54530,CPT4/HCPCS,Removal of testis,,Case Rate,4000.00
Cigna,HMO,54550,CPT4/HCPCS,Exploration for testis,,Case Rate,4000.00
Cigna,HMO,54560,CPT4/HCPCS,Exploration for undescended testis with abdominal exploration,,Case Rate,3000.00
Cigna,HMO,546,DRG,Connective tissue disorders w CC,,Case Rate,30768.30
Cigna,HMO,54600,CPT4/HCPCS,Reduce testis torsion,,Case Rate,4000.00
Cigna,HMO,54620,CPT4/HCPCS,Suspension of testis,,Case Rate,4000.00
Cigna,HMO,54640,CPT4/HCPCS,Suspension of testis,,Case Rate,4000.00
Cigna,HMO,54650,CPT4/HCPCS,Orchiopexy, abdominal approach, for intra-abdominal testis (eg, Fowler-Stephens),,Case Rate,3000.00
Cigna,HMO,54660,CPT4/HCPCS,Revision of testis,,Case Rate,3000.00
Cigna,HMO,54670,CPT4/HCPCS,Repair testis injury,,Case Rate,4000.00
Cigna,HMO,54680,CPT4/HCPCS,Relocation of testis(es),,Case Rate,4000.00
Cigna,HMO,54690,CPT4/HCPCS,Laparoscopy, orchiectomy,,Case Rate,8300.00
Cigna,HMO,54692,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; ORCHIOPEXY FOR INTRA-ABDOMINAL TESTIS,,Case Rate,5000.00
Cigna,HMO,54699,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, TESTIS,,Case Rate,3000.00
Cigna,HMO,547,DRG,Connective tissue disorders w/o CC/MCC,,Case Rate,21241.50
Cigna,HMO,54700,CPT4/HCPCS,Drainage of scrotum,,Case Rate,3000.00
Cigna,HMO,548,DRG,Septic arthritis w MCC,,Case Rate,51754.80
Cigna,HMO,54800,CPT4/HCPCS,Biopsy of epididymis,,Case Rate,3000.00
Cigna,HMO,54830,CPT4/HCPCS,Remove epididymis lesion,,Case Rate,4000.00
Cigna,HMO,54840,CPT4/HCPCS,Remove epididymis lesion,,Case Rate,4000.00
Cigna,HMO,54860,CPT4/HCPCS,Removal of epididymis,,Case Rate,4000.00
Cigna,HMO,54861,CPT4/HCPCS,Removal of epididymis,,Case Rate,4000.00
Cigna,HMO,54865,CPT4/HCPCS,Explore epididymis,,Case Rate,3000.00
Cigna,HMO,549,DRG,Septic arthritis w CC,,Case Rate,31795.95
Cigna,HMO,54900,CPT4/HCPCS,Fusion of spermatic ducts,,Case Rate,4000.00
Cigna,HMO,54901,CPT4/HCPCS,Fusion of spermatic ducts,,Case Rate,4000.00
Cigna,HMO,55,DRG,Nervous system neoplasms w/o MCC,,Case Rate,26606.70
Cigna,HMO,550,DRG,Septic arthritis w/o CC/MCC,,Case Rate,22508.85
Cigna,HMO,55040,CPT4/HCPCS,Removal of hydrocele,,Case Rate,4000.00
Cigna,HMO,55041,CPT4/HCPCS,Removal of hydroceles,,Case Rate,5000.00
Cigna,HMO,55060,CPT4/HCPCS,Repair of hydrocele,,Case Rate,4000.00
Cigna,HMO,551,DRG,Medical back problems w MCC,,Case Rate,41389.05
Cigna,HMO,55100,CPT4/HCPCS,Drainage of scrotum abscess,,Case Rate,3000.00
Cigna,HMO,55110,CPT4/HCPCS,Explore scrotum,,Case Rate,3000.00
Cigna,HMO,55120,CPT4/HCPCS,Removal of scrotum lesion,,Case Rate,3000.00
Cigna,HMO,55150,CPT4/HCPCS,Removal of scrotum,,Case Rate,3000.00
Cigna,HMO,55175,CPT4/HCPCS,Revision of scrotum,,Case Rate,3000.00
Cigna,HMO,55180,CPT4/HCPCS,Revision of scrotum,,Case Rate,3000.00
Cigna,HMO,552,DRG,Medical back problems w/o MCC,,Case Rate,24021.00
Cigna,HMO,55200,CPT4/HCPCS,Incision of sperm duct,,Case Rate,3000.00
Cigna,HMO,55250,CPT4/HCPCS,Removal of sperm duct(s),,Case Rate,3000.00
Cigna,HMO,553,DRG,Bone diseases & arthropathies w MCC,,Case Rate,32341.65
Cigna,HMO,55300,CPT4/HCPCS,Vasotomy for vasograms, seminal vesiculograms, or epididymograms, unilateral or bilateral,,Case Rate,3000.00
Cigna,HMO,554,DRG,Bone diseases & arthropathies w/o MCC,,Case Rate,20155.20
Cigna,HMO,55400,CPT4/HCPCS,Repair of sperm duct,,Case Rate,3000.00
Cigna,HMO,555,DRG,Signs & symptoms of musculoskeletal system & conn tissue w MCC,,Case Rate,34751.40
Cigna,HMO,55500,CPT4/HCPCS,Removal of hydrocele,,Case Rate,4000.00
Cigna,HMO,55520,CPT4/HCPCS,Removal of sperm cord lesion,,Case Rate,4000.00
Cigna,HMO,55530,CPT4/HCPCS,Revise spermatic cord veins,,Case Rate,4000.00
Cigna,HMO,55535,CPT4/HCPCS,Revise spermatic cord veins,,Case Rate,4000.00
Cigna,HMO,55540,CPT4/HCPCS,Revise hernia & sperm veins,,Case Rate,5000.00
Cigna,HMO,55550,CPT4/HCPCS,Laparo ligate spermatic vein,,Case Rate,8300.00
Cigna,HMO,55559,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD,,Case Rate,3000.00
Cigna,HMO,556,DRG,Signs & symptoms of musculoskeletal system & conn tissue w/o MCC,,Case Rate,20560.65
Cigna,HMO,55600,CPT4/HCPCS,Incise sperm duct pouch,,Case Rate,3000.00
Cigna,HMO,55605,CPT4/HCPCS,Incise sperm duct pouch,,Case Rate,3000.00
Cigna,HMO,55650,CPT4/HCPCS,Remove sperm duct pouch,,Case Rate,3000.00
Cigna,HMO,55680,CPT4/HCPCS,Remove sperm pouch lesion,,Case Rate,3000.00
Cigna,HMO,557,DRG,Tendonitis, myositis & bursitis w MCC,,Case Rate,35544.45
Cigna,HMO,55700,CPT4/HCPCS,Biopsy of prostate,,Case Rate,3000.00
Cigna,HMO,55705,CPT4/HCPCS,Biopsy of prostate,,Case Rate,3000.00
Cigna,HMO,55706,CPT4/HCPCS,BIOPSIES, PROSTATE, NEEDLE, TRANSPERINEAL, STEREOTACTIC TEMPLATE GUIDED SATURATION SAMPLING, INCLUDING IMAGING GUIDANCE,,Case Rate,4000.00
Cigna,HMO,55720,CPT4/HCPCS,Drainage of prostate abscess,,Case Rate,3000.00
Cigna,HMO,55725,CPT4/HCPCS,Drainage of prostate abscess,,Case Rate,3000.00
Cigna,HMO,558,DRG,Tendonitis, myositis & bursitis w/o MCC,,Case Rate,21886.65
Cigna,HMO,55845,CPT4/HCPCS,Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes,,Case Rate,3000.00
Cigna,HMO,55860,CPT4/HCPCS,Exposure of prostate, any approach, for insertion of radioactive substance;,,Case Rate,3000.00
Cigna,HMO,55866,CPT4/HCPCS,LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED ,,Case Rate,3000.00
Cigna,HMO,55870,CPT4/HCPCS,Electroejaculation,,Case Rate,3000.00
Cigna,HMO,55873,CPT4/HCPCS,Cryosurgical ablation of the prostate (includes ultrasonic guidance for interstitial cryosurgical probe placement),,Case Rate,8300.00
Cigna,HMO,55874,CPT4/HCPCS,Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed,,Case Rate,3000.00
Cigna,HMO,55875,CPT4/HCPCS,Transperi needle place, pros,,Case Rate,8300.00
Cigna,HMO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Case Rate,3000.00
Cigna,HMO,55899,CPT4/HCPCS,Unlisted procedure, male genital system,,Case Rate,3000.00
Cigna,HMO,559,DRG,Aftercare, musculoskeletal system & connective tissue w MCC,,Case Rate,47631.45
Cigna,HMO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Case Rate,8300.00
Cigna,HMO,56,DRG,Degenerative nervous system disorders w MCC,,Case Rate,55776.15
Cigna,HMO,560,DRG,Aftercare, musculoskeletal system & connective tissue w CC,,Case Rate,27448.20
Cigna,HMO,561,DRG,Aftercare, musculoskeletal system & connective tissue w/o CC/MCC,,Case Rate,20173.05
Cigna,HMO,562,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC,,Case Rate,35904.00
Cigna,HMO,563,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC,,Case Rate,22205.40
Cigna,HMO,564,DRG,Other musculoskeletal sys & connective tissue diagnoses w MCC,,Case Rate,38601.90
Cigna,HMO,56405,CPT4/HCPCS,I & D of vulva/perineum,,Case Rate,3000.00
Cigna,HMO,56420,CPT4/HCPCS,Incision and drainage of Bartholins gland abscess,,Case Rate,3000.00
Cigna,HMO,56440,CPT4/HCPCS,Surgery for vulva lesion,,Case Rate,3000.00
Cigna,HMO,56441,CPT4/HCPCS,Lysis of labial lesion(s),,Case Rate,3000.00
Cigna,HMO,56442,CPT4/HCPCS,Hymenotomy,,Case Rate,3000.00
Cigna,HMO,565,DRG,Other musculoskeletal sys & connective tissue diagnoses w CC,,Case Rate,25660.65
Cigna,HMO,56501,CPT4/HCPCS,Destruction of lesion(s), vulva; simple, any method,,Case Rate,3000.00
Cigna,HMO,56515,CPT4/HCPCS,Destroy vulva lesion/s compl,,Case Rate,4000.00
Cigna,HMO,566,DRG,Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC,,Case Rate,19163.25
Cigna,HMO,56605,CPT4/HCPCS,Biopsy of vulva/perineum,,Case Rate,3000.00
Cigna,HMO,56606,CPT4/HCPCS,Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,56620,CPT4/HCPCS,Partial removal of vulva,,Case Rate,5000.00
Cigna,HMO,56625,CPT4/HCPCS,Complete removal of vulva,,Case Rate,6000.00
Cigna,HMO,56700,CPT4/HCPCS,Partial removal of hymen,,Case Rate,3000.00
Cigna,HMO,56740,CPT4/HCPCS,Remove vagina gland lesion,,Case Rate,4000.00
Cigna,HMO,56800,CPT4/HCPCS,Repair of vagina,,Case Rate,4000.00
Cigna,HMO,56810,CPT4/HCPCS,Repair of perineum,,Case Rate,5000.00
Cigna,HMO,56820,CPT4/HCPCS,Colposcopy of the vulva;,,Case Rate,400.00
Cigna,HMO,56821,CPT4/HCPCS,Colposcopy of the vulva; with biopsy,,Case Rate,3000.00
Cigna,HMO,57,DRG,Degenerative nervous system disorders w/o MCC,,Case Rate,32237.10
Cigna,HMO,570,DRG,Skin debridement w MCC,,Case Rate,72325.65
Cigna,HMO,57000,CPT4/HCPCS,Exploration of vagina,,Case Rate,3000.00
Cigna,HMO,57010,CPT4/HCPCS,Drainage of pelvic abscess,,Case Rate,3000.00
Cigna,HMO,57020,CPT4/HCPCS,Drainage of pelvic fluid,,Case Rate,3000.00
Cigna,HMO,57022,CPT4/HCPCS,Incision and drainage of vaginal hemaome; post-obstetrical,,Case Rate,3000.00
Cigna,HMO,57023,CPT4/HCPCS,I & d vag hematoma, non-ob,,Case Rate,3000.00
Cigna,HMO,57061,CPT4/HCPCS,Destruction of vaginal lesion(s); simple, any method,,Case Rate,3000.00
Cigna,HMO,57065,CPT4/HCPCS,Destroy vag lesions, complex,,Case Rate,3000.00
Cigna,HMO,571,DRG,Skin debridement w CC,,Case Rate,41636.40
Cigna,HMO,57100,CPT4/HCPCS,Biopsy of vaginal mucosa; simple (separate procedure),,Case Rate,3000.00
Cigna,HMO,57105,CPT4/HCPCS,Biopsy of vagina,,Case Rate,3000.00
Cigna,HMO,57106,CPT4/HCPCS,Vaginectomy, partial removal of vaginal wall;,,Case Rate,3000.00
Cigna,HMO,57107,CPT4/HCPCS,Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy),,Case Rate,3000.00
Cigna,HMO,57109,CPT4/HCPCS,Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy),,Case Rate,3000.00
Cigna,HMO,57110,CPT4/HCPCS,Vaginectomy, complete removal of vaginal wall;,,Case Rate,3000.00
Cigna,HMO,57111,CPT4/HCPCS,Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy),,Case Rate,3000.00
Cigna,HMO,57112,CPT4/HCPCS,Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy),,Case Rate,3000.00
Cigna,HMO,57120,CPT4/HCPCS,Colpocleisis (Le Fort type) ,,Case Rate,3000.00
Cigna,HMO,57130,CPT4/HCPCS,Remove vagina lesion,,Case Rate,3000.00
Cigna,HMO,57135,CPT4/HCPCS,Remove vagina lesion,,Case Rate,3000.00
Cigna,HMO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Case Rate,3000.00
Cigna,HMO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Case Rate,3000.00
Cigna,HMO,572,DRG,Skin debridement w/o CC/MCC,,Case Rate,28116.30
Cigna,HMO,57200,CPT4/HCPCS,Repair of vagina,,Case Rate,3000.00
Cigna,HMO,57210,CPT4/HCPCS,Repair vagina/perineum,,Case Rate,3000.00
Cigna,HMO,57220,CPT4/HCPCS,Revision of urethra,,Case Rate,4000.00
Cigna,HMO,57230,CPT4/HCPCS,Repair of urethral lesion,,Case Rate,4000.00
Cigna,HMO,57240,CPT4/HCPCS,Repair bladder & vagina,,Case Rate,5000.00
Cigna,HMO,57250,CPT4/HCPCS,Repair rectum & vagina,,Case Rate,5000.00
Cigna,HMO,57260,CPT4/HCPCS,Repair of vagina,,Case Rate,5000.00
Cigna,HMO,57265,CPT4/HCPCS,Extensive repair of vagina,,Case Rate,6000.00
Cigna,HMO,57267,CPT4/HCPCS,Insertion Of Mesh Or Other Prosthesis For Repair Of Pelvic Floor Defect, Each Site (Anterior, Posterior Compartment), Vaginal Approach (List Separately In Addition To Code For Primary Procedure),,Case Rate,3000.00
Cigna,HMO,57268,CPT4/HCPCS,Repair of bowel bulge,,Case Rate,4000.00
Cigna,HMO,57280,CPT4/HCPCS,Colpopexy, abdominal approach,,Case Rate,3000.00
Cigna,HMO,57282,CPT4/HCPCS,Sacrospinous ligament fixation for prolapse of vagina,,Case Rate,3000.00
Cigna,HMO,57283,CPT4/HCPCS,COLPOPEXY, VAGINAL; INTRA-PERITONEAL APPROACH (UTEROSACRAL, LEVATOR MYORRHAPHY) ,,Case Rate,3000.00
Cigna,HMO,57284,CPT4/HCPCS,Paravaginal defect repair (including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse),,Case Rate,3000.00
Cigna,HMO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT, VAG,,Case Rate,8300.00
Cigna,HMO,57287,CPT4/HCPCS,Removal or revision of sling for stress incontinence (eg, fascia or synthetic),,Case Rate,3000.00
Cigna,HMO,57288,CPT4/HCPCS,Repair bladder defect,,Case Rate,5000.00
Cigna,HMO,57289,CPT4/HCPCS,Repair bladder & vagina,,Case Rate,5000.00
Cigna,HMO,57291,CPT4/HCPCS,Construction of vagina,,Case Rate,5000.00
Cigna,HMO,57292,CPT4/HCPCS,CONSTRUCTION OF ARTIFICIAL VAGINA WITH GRAFT ,,Case Rate,3000.00
Cigna,HMO,57295,CPT4/HCPCS,Revision (including removal) of prosthetic vaginal graft, vaginal approach,,Case Rate,4000.00
Cigna,HMO,573,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w MCC,,Case Rate,141201.15
Cigna,HMO,57300,CPT4/HCPCS,Repair rectum-vagina fistula,,Case Rate,4000.00
Cigna,HMO,57305,CPT4/HCPCS,Closure of rectovaginal fistula; abdominal approach,,Case Rate,3000.00
Cigna,HMO,57310,CPT4/HCPCS,Repair urethrovaginal lesion,,Case Rate,4000.00
Cigna,HMO,57311,CPT4/HCPCS,Repair urethrovaginal lesion,,Case Rate,3000.00
Cigna,HMO,57320,CPT4/HCPCS,Repair bladder-vagina lesion,,Case Rate,4000.00
Cigna,HMO,57335,CPT4/HCPCS,Vaginoplasty for intersex state,,Case Rate,3000.00
Cigna,HMO,574,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w CC,,Case Rate,82831.65
Cigna,HMO,57400,CPT4/HCPCS,Dilation of vagina,,Case Rate,3000.00
Cigna,HMO,57410,CPT4/HCPCS,PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL),,Case Rate,3000.00
Cigna,HMO,57415,CPT4/HCPCS,Remove vaginal foreign body,,Case Rate,3000.00
Cigna,HMO,57420,CPT4/HCPCS,Colposcopy of the entire vagina, with cervix if present;,,Case Rate,3000.00
Cigna,HMO,57421,CPT4/HCPCS,Colposcopy of the entire vagina, with cervix if present; with biopsy(s),,Case Rate,3000.00
Cigna,HMO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT, LAP,,Case Rate,8300.00
Cigna,HMO,57425,CPT4/HCPCS,Laparoscopy, surgical, colpopexy (suspension of vaginal apex),,Case Rate,3000.00
Cigna,HMO,57426,CPT4/HCPCS,Revision (including removal) of prosthetic vaginal graft, laparoscopic approach ,,Case Rate,3000.00
Cigna,HMO,57452,CPT4/HCPCS,Colposcopy (vaginoscopy); (separate procedure),,Case Rate,3000.00
Cigna,HMO,57454,CPT4/HCPCS,Colposcopy (vaginoscopy); with biopsy(s) of the cervix and/or endocervical curettage,,Case Rate,3000.00
Cigna,HMO,57455,CPT4/HCPCS,Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix,,Case Rate,3000.00
Cigna,HMO,57456,CPT4/HCPCS,Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage,,Case Rate,3000.00
Cigna,HMO,57460,CPT4/HCPCS,Colposcopy (vaginoscopy); with loop electrode excision procedure of the cervix,,Case Rate,3000.00
Cigna,HMO,57461,CPT4/HCPCS,Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix,,Case Rate,3000.00
Cigna,HMO,575,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/MCC,,Case Rate,44918.25
Cigna,HMO,57500,CPT4/HCPCS,Biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure),,Case Rate,3000.00
Cigna,HMO,57505,CPT4/HCPCS,Endocervical curettage (not done as part of a dilation and curettage),,Case Rate,3000.00
Cigna,HMO,57510,CPT4/HCPCS,Cauterization of cervix; electro or thermal,,Case Rate,3000.00
Cigna,HMO,57511,CPT4/HCPCS,Cauterization of cervix; cryocautery, initial or repeat,,Case Rate,3000.00
Cigna,HMO,57513,CPT4/HCPCS,Laser surgery of cervix,,Case Rate,3000.00
Cigna,HMO,57520,CPT4/HCPCS,Conization of cervix,,Case Rate,3000.00
Cigna,HMO,57522,CPT4/HCPCS,Conization of cervix,,Case Rate,3000.00
Cigna,HMO,57530,CPT4/HCPCS,Removal of cervix,,Case Rate,4000.00
Cigna,HMO,57550,CPT4/HCPCS,Removal of residual cervix,,Case Rate,4000.00
Cigna,HMO,57556,CPT4/HCPCS,Remove cervix, repair bowel,,Case Rate,5000.00
Cigna,HMO,57558,CPT4/HCPCS,D&c of cervical stump,,Case Rate,4000.00
Cigna,HMO,576,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC,,Case Rate,128797.95
Cigna,HMO,577,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w CC,,Case Rate,65121.90
Cigna,HMO,57700,CPT4/HCPCS,Revision of cervix,,Case Rate,3000.00
Cigna,HMO,57720,CPT4/HCPCS,Revision of cervix,,Case Rate,4000.00
Cigna,HMO,578,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC,,Case Rate,41582.85
Cigna,HMO,57800,CPT4/HCPCS,Dilation of cervical canal,,Case Rate,3000.00
Cigna,HMO,579,DRG,Other skin, subcut tiss & breast proc w MCC,,Case Rate,74658.90
Cigna,HMO,58,DRG,Multiple sclerosis & cerebellar ataxia w MCC,,Case Rate,44285.85
Cigna,HMO,580,DRG,Other skin, subcut tiss & breast proc w CC,,Case Rate,40807.65
Cigna,HMO,581,DRG,Other skin, subcut tiss & breast proc w/o CC/MCC,,Case Rate,31928.55
Cigna,HMO,58100,CPT4/HCPCS,Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure),,Case Rate,400.00
Cigna,HMO,58110,CPT4/HCPCS,ENDOMETRIAL SAMPLING (BIOPSY) PERFORMED IN CONJUNCTION WITH COLPOSCOPY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,58120,CPT4/HCPCS,Dilation and curettage,,Case Rate,3000.00
Cigna,HMO,58140,CPT4/HCPCS,Myomectomy, excision of fibroid tumor of uterus, single or multiple (separate procedure); abdominal approach,,Case Rate,3000.00
Cigna,HMO,58145,CPT4/HCPCS,Removal of uterus lesion,,Case Rate,5000.00
Cigna,HMO,58150,CPT4/HCPCS,Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);,,Case Rate,3000.00
Cigna,HMO,58152,CPT4/HCPCS,Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch),,Case Rate,3000.00
Cigna,HMO,58180,CPT4/HCPCS,Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s),,Case Rate,3000.00
Cigna,HMO,582,DRG,Mastectomy for malignancy w CC/MCC,,Case Rate,41712.90
Cigna,HMO,58200,CPT4/HCPCS,Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s),,Case Rate,3000.00
Cigna,HMO,58210,CPT4/HCPCS,Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s),,Case Rate,3000.00
Cigna,HMO,58260,CPT4/HCPCS,Vaginal hysterectomy;,,Case Rate,8300.00
Cigna,HMO,58262,CPT4/HCPCS,Vaginal hysterectomy; with removal of tube(s), and/or ovary(s),,Case Rate,8300.00
Cigna,HMO,58263,CPT4/HCPCS,VAGINAL HYSTERECTOMY; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S), WITH REPAIR OF ENTEROCELE ,,Case Rate,3000.00
Cigna,HMO,58270,CPT4/HCPCS,VAG HYST W/WO REM TURE(S) W/WO REM OVARY(S) W RPR OF ENTEROCELE (SSO) ,,Case Rate,3000.00
Cigna,HMO,58290,CPT4/HCPCS,VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; ,,Case Rate,3000.00
Cigna,HMO,58291,CPT4/HCPCS,VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S) ,,Case Rate,3000.00
Cigna,HMO,58292,CPT4/HCPCS,VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S), WITH REPAIR OF ENTEROCELE ,,Case Rate,3000.00
Cigna,HMO,58294,CPT4/HCPCS,VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REPAIR OF ENTEROCELE ,,Case Rate,3000.00
Cigna,HMO,583,DRG,Mastectomy for malignancy w/o CC/MCC,,Case Rate,39216.45
Cigna,HMO,58300,CPT4/HCPCS,Insertion of intrauterine device (IUD),,Case Rate,400.00
Cigna,HMO,58301,CPT4/HCPCS,Removal of intrauterine device (IUD),,Case Rate,3000.00
Cigna,HMO,58340,CPT4/HCPCS,Catheterization and introduction of saline or contrast material for hysterosonography or hysterosalpingography,,Case Rate,3000.00
Cigna,HMO,58345,CPT4/HCPCS,Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography,,Case Rate,3000.00
Cigna,HMO,58346,CPT4/HCPCS,Insert heyman uteri capsule,,Case Rate,3000.00
Cigna,HMO,58350,CPT4/HCPCS,Reopen fallopian tube,,Case Rate,4000.00
Cigna,HMO,58353,CPT4/HCPCS,Endometr ablate, thermal,,Case Rate,6000.00
Cigna,HMO,58356,CPT4/HCPCS,Endometrial Cryoablation With Ultrasonic Guidance, Including Endometrial Curettage, When Performed,,Case Rate,3000.00
Cigna,HMO,584,DRG,Breast biopsy, local excision & other breast procedures w CC/MCC,,Case Rate,46519.65
Cigna,HMO,58400,CPT4/HCPCS,Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; (separate procedure),,Case Rate,3000.00
Cigna,HMO,585,DRG,Breast biopsy, local excision & other breast procedures w/o CC/MCC,,Case Rate,44283.30
Cigna,HMO,58520,CPT4/HCPCS,Hysterorrhaphy, repair of ruptured uterus (nonobstetrical),,Case Rate,3000.00
Cigna,HMO,58540,CPT4/HCPCS,Hysteroplasty, repair of uterine anomaly (Strassman type),,Case Rate,3000.00
Cigna,HMO,58541,CPT4/HCPCS,"Lsh, uterus 250 g or less",,Case Rate,8300.00
Cigna,HMO,58542,CPT4/HCPCS,Lsh w/t/o ut 250 g or less,,Case Rate,8300.00
Cigna,HMO,58543,CPT4/HCPCS,Lsh uterus above 250 g,,Case Rate,8300.00
Cigna,HMO,58544,CPT4/HCPCS,Lsh w/t/o uterus above 250 g,,Case Rate,8300.00
Cigna,HMO,58545,CPT4/HCPCS,Laparoscopic myomectomy,,Case Rate,8300.00
Cigna,HMO,58546,CPT4/HCPCS,Laparo-myomectomy, complex,,Case Rate,8300.00
Cigna,HMO,58550,CPT4/HCPCS,Laparo-asst vag hysterectomy,,Case Rate,8300.00
Cigna,HMO,58552,CPT4/HCPCS,Laparoscopy surgical, with vaginal hysterectomy, for uterus 250 grams or less; with removal of tube(s) and/or ovary(s),,Case Rate,5000.00
Cigna,HMO,58553,CPT4/HCPCS,Laparoscopy , surgical , with vaginal hysterectomy, for uterus greater than 250 grams;,,Case Rate,5000.00
Cigna,HMO,58554,CPT4/HCPCS,Laparoscopy , surgical , with vaginal hysterectomy, for uterus greater than 250 grams; with removal of tube(s) and/or ovary(s),,Case Rate,5000.00
Cigna,HMO,58555,CPT4/HCPCS,Hysteroscopy, dx, sep proc,,Case Rate,3000.00
Cigna,HMO,58558,CPT4/HCPCS,Hysteroscopy, biopsy,,Case Rate,4000.00
Cigna,HMO,58559,CPT4/HCPCS,Hysteroscopy, lysis,,Case Rate,3000.00
Cigna,HMO,58560,CPT4/HCPCS,Hysteroscopy, resect septum,,Case Rate,4000.00
Cigna,HMO,58561,CPT4/HCPCS,Hysteroscopy, remove myoma,,Case Rate,4000.00
Cigna,HMO,58562,CPT4/HCPCS,Hysteroscopy, remove fb,,Case Rate,4000.00
Cigna,HMO,58563,CPT4/HCPCS,Hysteroscopy, ablation,,Case Rate,8300.00
Cigna,HMO,58565,CPT4/HCPCS,Hysteroscopy, sterilization,,Case Rate,8300.00
Cigna,HMO,58570,CPT4/HCPCS,TLH, UTERUS 250 G OR LESS,,Case Rate,8300.00
Cigna,HMO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Case Rate,8300.00
Cigna,HMO,58572,CPT4/HCPCS,TLH, UTERUS OVER 250 G,,Case Rate,8300.00
Cigna,HMO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Case Rate,8300.00
Cigna,HMO,58578,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, UTERUS,,Case Rate,3000.00
Cigna,HMO,58579,CPT4/HCPCS,UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS,,Case Rate,3000.00
Cigna,HMO,58600,CPT4/HCPCS,Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral,,Case Rate,5000.00
Cigna,HMO,58605,CPT4/HCPCS,Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure),,Case Rate,3000.00
Cigna,HMO,58611,CPT4/HCPCS,Ligation or transection of fallopian tube(s) when done at the time of cesarean section or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,58615,CPT4/HCPCS,Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach,,Case Rate,3000.00
Cigna,HMO,58660,CPT4/HCPCS,Laparoscopy, lysis,,Case Rate,5000.00
Cigna,HMO,58661,CPT4/HCPCS,Laparoscopy, remove adnexa,,Case Rate,5000.00
Cigna,HMO,58662,CPT4/HCPCS,Laparoscopy, excise lesions,,Case Rate,5000.00
Cigna,HMO,58670,CPT4/HCPCS,Laparoscopy, tubal cautery,,Case Rate,4000.00
Cigna,HMO,58671,CPT4/HCPCS,Laparoscopy, tubal block,,Case Rate,4000.00
Cigna,HMO,58672,CPT4/HCPCS,Laparoscopy, fimbrioplasty,,Case Rate,5000.00
Cigna,HMO,58673,CPT4/HCPCS,Laparoscopy, salpingostomy,,Case Rate,5000.00
Cigna,HMO,58674,CPT4/HCPCS,Laparoscopy, surgical, ablation of uterine fibroid(s) including intraoperative ultrasound guidance and monitoring, radiofrequency,,Case Rate,3000.00
Cigna,HMO,58679,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY,,Case Rate,3000.00
Cigna,HMO,58700,CPT4/HCPCS,Salpingectomy, complete or partial, unilateral or bilateral (separate procedure),,Case Rate,3000.00
Cigna,HMO,58720,CPT4/HCPCS,Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure),,Case Rate,3000.00
Cigna,HMO,58740,CPT4/HCPCS,Lysis of adhesions (salpingolysis, ovariolysis),,Case Rate,3000.00
Cigna,HMO,58750,CPT4/HCPCS,Tubotubal anastomosis,,Case Rate,3000.00
Cigna,HMO,58752,CPT4/HCPCS,Tubouterine implantation,,Case Rate,3000.00
Cigna,HMO,58760,CPT4/HCPCS,Fimbrioplasty,,Case Rate,3000.00
Cigna,HMO,58770,CPT4/HCPCS,Salpingostomy (salpingoneostomy),,Case Rate,3000.00
Cigna,HMO,58800,CPT4/HCPCS,Drainage of ovarian cyst(s),,Case Rate,4000.00
Cigna,HMO,58805,CPT4/HCPCS,Drainage of ovarian cyst(s), unilateral or bilateral, (separate procedure); abdominal approach,,Case Rate,3000.00
Cigna,HMO,58820,CPT4/HCPCS,Drain ovary abscess, open,,Case Rate,4000.00
Cigna,HMO,58822,CPT4/HCPCS,Drainage of ovarian abscess; abdominal approach,,Case Rate,3000.00
Cigna,HMO,58825,CPT4/HCPCS,Transposition, ovary(s),,Case Rate,3000.00
Cigna,HMO,58900,CPT4/HCPCS,Biopsy of ovary(s),,Case Rate,4000.00
Cigna,HMO,58920,CPT4/HCPCS,Wedge resection or bisection of ovary, unilateral or bilateral,,Case Rate,3000.00
Cigna,HMO,58925,CPT4/HCPCS,Ovarian cystectomy, unilateral or bilateral,,Case Rate,3000.00
Cigna,HMO,58940,CPT4/HCPCS,Oophorectomy, partial or total, unilateral or bilateral;,,Case Rate,3000.00
Cigna,HMO,58960,CPT4/HCPCS,Laparotomy, for staging or restaging of ovarian malignancy (second look), with or without omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment with pelvic and limited para-aortic lymphadenectomy,,Case Rate,3000.00
Cigna,HMO,58970,CPT4/HCPCS,Retrieval of oocyte,,Case Rate,3000.00
Cigna,HMO,58974,CPT4/HCPCS,Transfer of embryo,,Case Rate,3000.00
Cigna,HMO,58976,CPT4/HCPCS,Transfer of embryo,,Case Rate,3000.00
Cigna,HMO,58999,CPT4/HCPCS,UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM NONOBSTETRICAL ,,Case Rate,3000.00
Cigna,HMO,59,DRG,Multiple sclerosis & cerebellar ataxia w CC,,Case Rate,28725.75
Cigna,HMO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Case Rate,3000.00
Cigna,HMO,59001,CPT4/HCPCS,AMNIOCENTESIS; THERAPEUTIC AMNIOTIC FLUID REDUCTION (INCLUDES ULTRASOUND GUIDANCE),,Case Rate,3000.00
Cigna,HMO,59025,CPT4/HCPCS,Fetal Non Series Test,,% of Charges,6500.00
Cigna,HMO,59070,CPT4/HCPCS,Transabdominal amnioinfusion, including ultrasound guidance,,Case Rate,3000.00
Cigna,HMO,59072,CPT4/HCPCS,Fetal umbilical cord occlusion, including ultrasound guidance,,Case Rate,3000.00
Cigna,HMO,59074,CPT4/HCPCS,Fetal fluid drainage (eg, vesicocentesis, thoracocentesis, paracentesis), including ultrasound guidance,,Case Rate,3000.00
Cigna,HMO,59076,CPT4/HCPCS,Fetal shunt placement, including ultrasound guidance,,Case Rate,3000.00
Cigna,HMO,59120,CPT4/HCPCS,Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach,,Case Rate,3000.00
Cigna,HMO,59121,CPT4/HCPCS,Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy,,Case Rate,3000.00
Cigna,HMO,59150,CPT4/HCPCS,Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or oophorectomy,,Case Rate,3000.00
Cigna,HMO,59151,CPT4/HCPCS,Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy,,Case Rate,3000.00
Cigna,HMO,59160,CPT4/HCPCS,D & c after delivery,,Case Rate,4000.00
Cigna,HMO,592,DRG,Skin ulcers w MCC,,Case Rate,43010.85
Cigna,HMO,59200,CPT4/HCPCS,Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure),,Case Rate,3000.00
Cigna,HMO,593,DRG,Skin ulcers w CC,,Case Rate,28988.40
Cigna,HMO,59300,CPT4/HCPCS,Episiotomy or vaginal repair, by other than attending physician,,Case Rate,3000.00
Cigna,HMO,59320,CPT4/HCPCS,Revision of cervix,,Case Rate,3000.00
Cigna,HMO,59325,CPT4/HCPCS,Cerclage of cervix, during pregnancy; abdominal,,Case Rate,3000.00
Cigna,HMO,594,DRG,Skin ulcers w/o CC/MCC,,Case Rate,20876.85
Cigna,HMO,59409,CPT4/HCPCS,Vaginal delivery only (with or without episiotomy and/or forceps);,,Case Rate,3000.00
Cigna,HMO,59410,CPT4/HCPCS,Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care,,Case Rate,3000.00
Cigna,HMO,59430,CPT4/HCPCS,Postpartum care only (separate procedure),,Case Rate,6500.00
Cigna,HMO,595,DRG,Major skin disorders w MCC,,Case Rate,51308.55
Cigna,HMO,59515,CPT4/HCPCS,Cesarean delivery only; including postpartum care,,Case Rate,3000.00
Cigna,HMO,596,DRG,Major skin disorders w/o MCC,,Case Rate,25224.60
Cigna,HMO,59612,CPT4/HCPCS,Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps);,,Case Rate,3000.00
Cigna,HMO,597,DRG,Malignant breast disorders w MCC,,Case Rate,41735.85
Cigna,HMO,598,DRG,Malignant breast disorders w CC,,Case Rate,28335.60
Cigna,HMO,59812,CPT4/HCPCS,Treatment of miscarriage,,Case Rate,5000.00
Cigna,HMO,59820,CPT4/HCPCS,Care of miscarriage,,Case Rate,5000.00
Cigna,HMO,59821,CPT4/HCPCS,Treatment of miscarriage,,Case Rate,5000.00
Cigna,HMO,59830,CPT4/HCPCS,Treatment of septic abortion, completed surgically,,Case Rate,3000.00
Cigna,HMO,59840,CPT4/HCPCS,Abortion,,Case Rate,5000.00
Cigna,HMO,59841,CPT4/HCPCS,Abortion,,Case Rate,5000.00
Cigna,HMO,59850,CPT4/HCPCS,Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;,,Case Rate,3000.00
Cigna,HMO,59851,CPT4/HCPCS,Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation,,Case Rate,3000.00
Cigna,HMO,59852,CPT4/HCPCS,Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed intra-amniotic injection),,Case Rate,3000.00
Cigna,HMO,59856,CPT4/HCPCS,Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation,,Case Rate,3000.00
Cigna,HMO,59857,CPT4/HCPCS,Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed medical evacuation),,Case Rate,3000.00
Cigna,HMO,59870,CPT4/HCPCS,Evacuate mole of uterus,,Case Rate,5000.00
Cigna,HMO,59871,CPT4/HCPCS,Remove cerclage suture,,Case Rate,5000.00
Cigna,HMO,59897,CPT4/HCPCS,Unlisted fetal invasive procedure, including ultrasound guidance,,Case Rate,3000.00
Cigna,HMO,59898,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, MATERNITY CARE AND DELIVERY,,Case Rate,3000.00
Cigna,HMO,59899,CPT4/HCPCS,Unlisted procedure, maternity care and delivery,,Case Rate,3000.00
Cigna,HMO,599,DRG,Malignant breast disorders w/o CC/MCC,,Case Rate,17115.60
Cigna,HMO,6,DRG,Liver transplant w/o MCC,,Case Rate,119638.35
Cigna,HMO,60,DRG,Multiple sclerosis & cerebellar ataxia w/o CC/MCC,,Case Rate,23347.80
Cigna,HMO,600,DRG,Non-malignant breast disorders w CC/MCC,,Case Rate,25390.35
Cigna,HMO,60000,CPT4/HCPCS,Drain thyroid/tongue cyst,,Case Rate,3000.00
Cigna,HMO,601,DRG,Non-malignant breast disorders w/o CC/MCC,,Case Rate,17533.80
Cigna,HMO,60100,CPT4/HCPCS,Biopsy thyroid, percutaneous core needle,,Case Rate,3000.00
Cigna,HMO,602,DRG,Cellulitis w MCC,,Case Rate,36633.30
Cigna,HMO,60200,CPT4/HCPCS,Remove thyroid lesion,,Case Rate,3000.00
Cigna,HMO,60210,CPT4/HCPCS,Partial thyroid lobectomy, unilateral; with or without isthmusectomy,,Case Rate,3000.00
Cigna,HMO,60212,CPT4/HCPCS,Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy,,Case Rate,3000.00
Cigna,HMO,60220,CPT4/HCPCS,Partial removal of thyroid,,Case Rate,3000.00
Cigna,HMO,60225,CPT4/HCPCS,Partial removal of thyroid,,Case Rate,4000.00
Cigna,HMO,60240,CPT4/HCPCS,Thyroidectomy, total or complete,,Case Rate,3000.00
Cigna,HMO,60252,CPT4/HCPCS,Thyroidectomy, total or subtotal for malignancy; with limited neck dissection,,Case Rate,3000.00
Cigna,HMO,60254,CPT4/HCPCS,Thyroidectomy, total or subtotal for malignancy; with radical neck dissection,,Case Rate,3000.00
Cigna,HMO,60260,CPT4/HCPCS,Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid,,Case Rate,3000.00
Cigna,HMO,60271,CPT4/HCPCS,THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID GLAND; CERVICAL APPROACH ,,Case Rate,3000.00
Cigna,HMO,60280,CPT4/HCPCS,Remove thyroid duct lesion,,Case Rate,4000.00
Cigna,HMO,60281,CPT4/HCPCS,Remove thyroid duct lesion,,Case Rate,4000.00
Cigna,HMO,603,DRG,Cellulitis w/o MCC,,Case Rate,21542.40
Cigna,HMO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Case Rate,400.00
Cigna,HMO,604,DRG,Trauma to the skin, subcut tiss & breast w MCC,,Case Rate,38028.15
Cigna,HMO,605,DRG,Trauma to the skin, subcut tiss & breast w/o MCC,,Case Rate,23184.60
Cigna,HMO,60500,CPT4/HCPCS,Parathyroidectomy or exploration of parathyroid(s);,,Case Rate,3000.00
Cigna,HMO,60502,CPT4/HCPCS,Parathyroidectomy or exploration of parathyroid(s); re-exploration,,Case Rate,8300.00
Cigna,HMO,60512,CPT4/HCPCS,Parathyroid autotransplantation (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,60520,CPT4/HCPCS,Thymectomy, partial or total; transcervical approach (separate procedure),,Case Rate,3000.00
Cigna,HMO,60540,CPT4/HCPCS,Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure);,,Case Rate,3000.00
Cigna,HMO,606,DRG,Minor skin disorders w MCC,,Case Rate,38530.50
Cigna,HMO,60650,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, WITH ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR WITHOUT BIOPSY, TRANSABDOMINAL, LUMBAR OR DORSAL,,Case Rate,3000.00
Cigna,HMO,60659,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, ENDOCRINE SYSTEM,,Case Rate,3000.00
Cigna,HMO,60699,CPT4/HCPCS,UNLISTED PROCEDURE, ENDOCRINE SYSTEM ,,Case Rate,3000.00
Cigna,HMO,607,DRG,Minor skin disorders w/o MCC,,Case Rate,21052.80
Cigna,HMO,61,DRG,Acute ischemic stroke w use of thrombolytic agent w MCC,,Case Rate,73649.10
Cigna,HMO,61000,CPT4/HCPCS,Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial,,Case Rate,3000.00
Cigna,HMO,61001,CPT4/HCPCS,Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps,,Case Rate,3000.00
Cigna,HMO,61020,CPT4/HCPCS,Remove brain cavity fluid,,Case Rate,3000.00
Cigna,HMO,61026,CPT4/HCPCS,Injection into brain canal,,Case Rate,3000.00
Cigna,HMO,61050,CPT4/HCPCS,Remove brain canal fluid,,Case Rate,3000.00
Cigna,HMO,61055,CPT4/HCPCS,Injection into brain canal,,Case Rate,3000.00
Cigna,HMO,61070,CPT4/HCPCS,Brain canal shunt procedure,,Case Rate,3000.00
Cigna,HMO,61215,CPT4/HCPCS,Insert brain-fluid device,,Case Rate,4000.00
Cigna,HMO,61316,CPT4/HCPCS,Incision and subcutaneous placement of cranial bone graft (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,614,DRG,Adrenal & pituitary procedures w CC/MCC,,Case Rate,60863.40
Cigna,HMO,615,DRG,Adrenal & pituitary procedures w/o CC/MCC,,Case Rate,40139.55
Cigna,HMO,61500,CPT4/HCPCS,Craniectomy; with excision of tumor or other bone lesion of skull,,Case Rate,3000.00
Cigna,HMO,616,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w MCC,,Case Rate,101714.40
Cigna,HMO,61623,CPT4/HCPCS,Endovascular temporary balloon arterial occlusion, head or neck (extracranial/intracranial) including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic s,,Case Rate,3000.00
Cigna,HMO,61626,CPT4/HCPCS,TRANSCATHETER OCCULUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION, TO ACHIEVE HEMOSTASIS, TO OCCLUDE A VASCULAR MALFORMATION), PERCUTANEOUS, ANY METHOD; NON-CENTRAL NERVOUS SYSTEM, HEAD OR NECK (EXTRACRANIAL, BRACHIOCEPHALIC B ,,Case Rate,3000.00
Cigna,HMO,61645,CPT4/HCPCS,PERCUTANEOUS ARTERIAL TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, INTRACRANIAL, ANY METHOD, INCLUDING DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT, AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(,,Case Rate,3000.00
Cigna,HMO,617,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w CC,,Case Rate,51869.55
Cigna,HMO,61781,CPT4/HCPCS,STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL, INTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,61782,CPT4/HCPCS,STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL, EXTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,61783,CPT4/HCPCS,STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; SPINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,61790,CPT4/HCPCS,Treat trigeminal nerve,,Case Rate,4000.00
Cigna,HMO,61791,CPT4/HCPCS,Treat trigeminal tract,,Case Rate,4000.00
Cigna,HMO,618,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w/o CC/MCC,,Case Rate,33226.50
Cigna,HMO,61800,CPT4/HCPCS,APPLICATION OF STEREOTACTIC HEADFRAME FOR STEREOTACTIC RADIOSURGERY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,61885,CPT4/HCPCS,Implant neurostim one array,,Case Rate,3000.00
Cigna,HMO,61886,CPT4/HCPCS,Implant neurostim arrays,,Case Rate,4000.00
Cigna,HMO,61888,CPT4/HCPCS,REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,,Case Rate,3000.00
Cigna,HMO,619,DRG,O.R. procedures for obesity w MCC,,Case Rate,78058.05
Cigna,HMO,62,DRG,Acute ischemic stroke w use of thrombolytic agent w CC,,Case Rate,50673.60
Cigna,HMO,620,DRG,O.R. procedures for obesity w CC,,Case Rate,44908.05
Cigna,HMO,621,DRG,O.R. procedures for obesity w/o CC/MCC,,Case Rate,40708.20
Cigna,HMO,62160,CPT4/HCPCS,Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or exteran ldrainage (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,62194,CPT4/HCPCS,Replace/irrigate catheter,,Case Rate,3000.00
Cigna,HMO,622,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC,,Case Rate,92126.40
Cigna,HMO,62225,CPT4/HCPCS,Replace/irrigate catheter,,Case Rate,3000.00
Cigna,HMO,62230,CPT4/HCPCS,Replace/revise brain shunt,,Case Rate,3000.00
Cigna,HMO,62256,CPT4/HCPCS,Remove brain cavity shunt,,Case Rate,3000.00
Cigna,HMO,62263,CPT4/HCPCS,Lysis epidural adhesions,,Case Rate,3000.00
Cigna,HMO,62264,CPT4/HCPCS,Epidural lysis on single day,,Case Rate,3000.00
Cigna,HMO,62267,CPT4/HCPCS,PERCUTANEOUS ASPIRATION WITHIN THE NUCLEUS PULPOSUS, INTERVERTEBRAL DISC, OR PARAVERTEBRAL TISSUE FOR DIAGNOSTIC PURPOSES,,Case Rate,3000.00
Cigna,HMO,62268,CPT4/HCPCS,Drain spinal cord cyst,,Case Rate,3000.00
Cigna,HMO,62269,CPT4/HCPCS,Needle biopsy, spinal cord,,Case Rate,3000.00
Cigna,HMO,62270,CPT4/HCPCS,Spinal fluid tap, diagnostic,,Case Rate,3000.00
Cigna,HMO,62272,CPT4/HCPCS,Drain cerebro spinal fluid,,Case Rate,3000.00
Cigna,HMO,62273,CPT4/HCPCS,Treat epidural spine lesion,,Case Rate,3000.00
Cigna,HMO,62280,CPT4/HCPCS,Treat spinal cord lesion,,Case Rate,3000.00
Cigna,HMO,62281,CPT4/HCPCS,Treat spinal cord lesion,,Case Rate,3000.00
Cigna,HMO,62282,CPT4/HCPCS,Treat spinal canal lesion,,Case Rate,3000.00
Cigna,HMO,62284,CPT4/HCPCS,Injection procedure for myelography and/or computerized axial tomography, spinal (other than C1-C2 and posterior fossa),,Case Rate,3000.00
Cigna,HMO,62287,CPT4/HCPCS,Percutaneous diskectomy,,Case Rate,8300.00
Cigna,HMO,62290,CPT4/HCPCS,Injection procedure for diskography, each level; lumbar,,Case Rate,3000.00
Cigna,HMO,62291,CPT4/HCPCS,Injection procedure for diskography, each level; cervical,,Case Rate,3000.00
Cigna,HMO,62292,CPT4/HCPCS,Injection procedure for chemonucleolysis, including diskography, intervertebral disk, single or multiple levels, lumbar,,Case Rate,3000.00
Cigna,HMO,62294,CPT4/HCPCS,Injection into spinal artery,,Case Rate,4000.00
Cigna,HMO,623,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w CC,,Case Rate,47758.95
Cigna,HMO,62302,CPT4/HCPCS, MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; CERVICAL,,Case Rate,4000.00
Cigna,HMO,62303,CPT4/HCPCS, MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; THORACIC,,Case Rate,4000.00
Cigna,HMO,62304,CPT4/HCPCS, MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; LUMBOSACRAL,,Case Rate,4000.00
Cigna,HMO,62305,CPT4/HCPCS,MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; 2 OR MORE REGIONS (EG, LUMBAR/THORACIC, CERVICAL/THORACIC, LUMBAR/CERVICAL, LUMBAR/THORACIC/CERVICAL),,Case Rate,3000.00
Cigna,HMO,62320,CPT4/HCPCS,Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thora,,Case Rate,3000.00
Cigna,HMO,62321,CPT4/HCPCS,Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thora,,Case Rate,3000.00
Cigna,HMO,62322,CPT4/HCPCS,Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral ,,Case Rate,3000.00
Cigna,HMO,62323,CPT4/HCPCS,Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral ,,Case Rate,3000.00
Cigna,HMO,62324,CPT4/HCPCS,Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar,,Case Rate,3000.00
Cigna,HMO,62325,CPT4/HCPCS,Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar,,Case Rate,3000.00
Cigna,HMO,62326,CPT4/HCPCS,Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar,,Case Rate,3000.00
Cigna,HMO,62327,CPT4/HCPCS,Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar,,Case Rate,3000.00
Cigna,HMO,62328,CPT4/HCPCS,Spinal puncture, lumbar diagnostic; with fluoroscopic or CT guidance,,Case Rate,3000.00
Cigna,HMO,62329,CPT4/HCPCS,Spinal puncture, therapeutic, for drainage of cerebrospinal; with fluoroscopic or CT guidance,,Case Rate,3000.00
Cigna,HMO,62350,CPT4/HCPCS,Implant spinal canal cath,,Case Rate,3000.00
Cigna,HMO,62351,CPT4/HCPCS,Implant spinal canal cath,,Case Rate,8300.00
Cigna,HMO,62355,CPT4/HCPCS,Remove spinal canal catheter,,Case Rate,3000.00
Cigna,HMO,62360,CPT4/HCPCS,Insert spine infusion device,,Case Rate,3000.00
Cigna,HMO,62361,CPT4/HCPCS,Implant spine infusion pump,,Case Rate,3000.00
Cigna,HMO,62362,CPT4/HCPCS,Implant spine infusion pump,,Case Rate,3000.00
Cigna,HMO,62365,CPT4/HCPCS,Remove spine infusion device,,Case Rate,3000.00
Cigna,HMO,62367,CPT4/HCPCS,Analyze spine infusion pump,,Case Rate,3000.00
Cigna,HMO,62368,CPT4/HCPCS,Analyze spine infusion pump,,Case Rate,3000.00
Cigna,HMO,62370,CPT4/HCPCS,ANALYZE SPINE INFUSION PUMP W/ MED REPRG & FIL,,Case Rate,400.00
Cigna,HMO,62380,CPT4/HCPCS,Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar,,Case Rate,3000.00
Cigna,HMO,624,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC,,Case Rate,27904.65
Cigna,HMO,625,DRG,Thyroid, parathyroid & thyroglossal procedures w MCC,,Case Rate,72450.60
Cigna,HMO,626,DRG,Thyroid, parathyroid & thyroglossal procedures w CC,,Case Rate,42133.65
Cigna,HMO,627,DRG,Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC,,Case Rate,30135.90
Cigna,HMO,628,DRG,Other endocrine, nutrit & metab O.R. proc w MCC,,Case Rate,94301.55
Cigna,HMO,629,DRG,Other endocrine, nutrit & metab O.R. proc w CC,,Case Rate,59843.40
Cigna,HMO,63,DRG,Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC,,Case Rate,43602.45
Cigna,HMO,630,DRG,Other endocrine, nutrit & metab O.R. proc w/o CC/MCC,,Case Rate,35875.95
Cigna,HMO,63001,CPT4/HCPCS,LAM W/EX A/O DE SP CO A/O CAU EQ WO FA, FO/DIS (EG SP ST) 1 OR 2 V SE CE (SSO) ,,Case Rate,3000.00
Cigna,HMO,63003,CPT4/HCPCS,LAM W/EX A/O DE SP CO A/O CA EQ WO FA, FO/DIS (EG SP ST) 1 OR 2 V SE TH (SSO) ,,Case Rate,3000.00
Cigna,HMO,63005,CPT4/HCPCS,Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), one or two vertebral segments; lumbar, except for spondylolisthesis,,Case Rate,8300.00
Cigna,HMO,63011,CPT4/HCPCS,Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), one or two vertebral segments; sacral,,Case Rate,8300.00
Cigna,HMO,63012,CPT4/HCPCS,Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure),,Case Rate,8300.00
Cigna,HMO,63015,CPT4/HCPCS,LA W/EX A/O DE SP CO A/O CA EQ W/O FA, FO/DIS (EG SP ST) M T 2 V SE CE (SSO) ,,Case Rate,3000.00
Cigna,HMO,63016,CPT4/HCPCS,LAM W/EX A/O DE SP CO A/O CA EQ, WO FA, FO/DI (EG SP ST) M T 2 V SE TH (SSO) ,,Case Rate,3000.00
Cigna,HMO,63017,CPT4/HCPCS,Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), more than 2 vertebral segments; lumbar,,Case Rate,8300.00
Cigna,HMO,63020,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, cervical,,Case Rate,8300.00
Cigna,HMO,63030,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar,,Case Rate,8300.00
Cigna,HMO,63035,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; each additional interspace, cervical or lumbar (List separately in addition to code for primar,,Case Rate,8300.00
Cigna,HMO,63040,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration; cervical,,Case Rate,8300.00
Cigna,HMO,63042,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration; lumbar,,Case Rate,8300.00
Cigna,HMO,63043,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional cervical interspace (List separately in addi,,Case Rate,3000.00
Cigna,HMO,63044,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar,,Case Rate,3000.00
Cigna,HMO,63045,CPT4/HCPCS,Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; cervical,,Case Rate,8300.00
Cigna,HMO,63046,CPT4/HCPCS,Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; thoracic,,Case Rate,8300.00
Cigna,HMO,63047,CPT4/HCPCS,Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; lumbar,,Case Rate,8300.00
Cigna,HMO,63048,CPT4/HCPCS,Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; each additional segment, cervical, thoracic, .....,,Case Rate,8300.00
Cigna,HMO,63055,CPT4/HCPCS,Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disk), single segment; thoracic,,Case Rate,8300.00
Cigna,HMO,63056,CPT4/HCPCS,TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATED INTERVERTEBRAL DISK) SINGLE SEGMENT; LUMBAR (INCLUDING TRANSFACET, OR LATERAL EXTRAFORAMINAL APPROACH)(EG, FAR LATERAL HERNIATED INTERVERTE ,,Case Rate,3000.00
Cigna,HMO,63057,CPT4/HCPCS,TRANSPEDICULAR APPROACH FOR DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATED INTERVERTEBRAL DISK); EACH ADDITIONAL SEGMENT, THORACIC OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,63075,CPT4/HCPCS,Diskectomy, anterior, with decompression of spinal cord and/ or nerve root(s), including osteophytectomy; cervical, single interspace,,Case Rate,3000.00
Cigna,HMO,63076,CPT4/HCPCS,Diskectomy, anterior, with decompression of spinal cord and/ or nerve root(s), including osteophytectomy; cervical, each additional interspace (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,63265,CPT4/HCPCS,Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; cervical,,Case Rate,8300.00
Cigna,HMO,63600,CPT4/HCPCS,Remove spinal cord lesion,,Case Rate,4000.00
Cigna,HMO,63610,CPT4/HCPCS,Stimulation of spinal cord,,Case Rate,4000.00
Cigna,HMO,63650,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,8300.00
Cigna,HMO,63655,CPT4/HCPCS,LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL ,,Case Rate,3000.00
Cigna,HMO,63661,CPT4/HCPCS,REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED,,Case Rate,6000.00
Cigna,HMO,63662,CPT4/HCPCS,REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED,,Case Rate,6000.00
Cigna,HMO,63663,CPT4/HCPCS,REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED,,Case Rate,6000.00
Cigna,HMO,63664,CPT4/HCPCS,REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED,,Case Rate,6000.00
Cigna,HMO,63685,CPT4/HCPCS,Implant neuroreceiver,,Case Rate,3000.00
Cigna,HMO,63688,CPT4/HCPCS,Revise/remove neuroreceiver,,Case Rate,3000.00
Cigna,HMO,637,DRG,Diabetes w MCC,,Case Rate,35054.85
Cigna,HMO,63741,CPT4/HCPCS,Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy,,Case Rate,3000.00
Cigna,HMO,63744,CPT4/HCPCS,Revision of spinal shunt,,Case Rate,4000.00
Cigna,HMO,63746,CPT4/HCPCS,Removal of spinal shunt,,Case Rate,3000.00
Cigna,HMO,638,DRG,Diabetes w CC,,Case Rate,22424.70
Cigna,HMO,639,DRG,Diabetes w/o CC/MCC,,Case Rate,15537.15
Cigna,HMO,64,DRG,Intracranial hemorrhage or cerebral infarction w MCC,,Case Rate,48781.50
Cigna,HMO,640,DRG,Nutritional & misc metabolic disorders w MCC,,Case Rate,31308.90
Cigna,HMO,641,DRG,Nutritional & misc metabolic disorders w/o MCC,,Case Rate,19201.50
Cigna,HMO,642,DRG,Inborn errors of metabolism,,Case Rate,32831.25
Cigna,HMO,643,DRG,Endocrine disorders w MCC,,Case Rate,42414.15
Cigna,HMO,644,DRG,Endocrine disorders w CC,,Case Rate,25966.65
Cigna,HMO,64400,CPT4/HCPCS,Injection, anesthetic agent; trigeminal nerve, any division or branch,,Case Rate,3000.00
Cigna,HMO,64405,CPT4/HCPCS,Injection, anesthetic agent; greater occipital nerve,,Case Rate,3000.00
Cigna,HMO,64408,CPT4/HCPCS,Injection, anesthetic agent; vagus nerve,,Case Rate,3000.00
Cigna,HMO,64415,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,HMO,64416,CPT4/HCPCS,Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement) ,,Case Rate,3000.00
Cigna,HMO,64417,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,HMO,64418,CPT4/HCPCS,Injection, anesthetic agent; suprascapular nerve,,Case Rate,3000.00
Cigna,HMO,64420,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,HMO,64421,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,HMO,64425,CPT4/HCPCS,Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves,,Case Rate,3000.00
Cigna,HMO,64430,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,HMO,64435,CPT4/HCPCS,Injection, anesthetic agent; paracervical (uterine) nerve,,Case Rate,3000.00
Cigna,HMO,64445,CPT4/HCPCS,Injection, anesthetic agent; sciatic nerve,,Case Rate,3000.00
Cigna,HMO,64449,CPT4/HCPCS,Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration,,Case Rate,3000.00
Cigna,HMO,64450,CPT4/HCPCS,Injection, anesthetic agent; other peripheral nerve or branch,,Case Rate,3000.00
Cigna,HMO,64451,CPT4/HCPCS,Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography) ,,Case Rate,3000.00
Cigna,HMO,64454,CPT4/HCPCS,Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed,,Case Rate,3000.00
Cigna,HMO,64455,CPT4/HCPCS,INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, PLANTAR COMMON DIGITAL NERVE(S) (EG, MORTON'S NEUROMA),,Case Rate,400.00
Cigna,HMO,64461,CPT4/HCPCS,PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SINGLE INJECTION SITE (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,400.00
Cigna,HMO,64462,CPT4/HCPCS,PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SECOND AND ANY ADDITIONAL INJECTION SITE(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,64463,CPT4/HCPCS,PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; CONTINUOUS INFUSION BY CATHETER (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,400.00
Cigna,HMO,64479,CPT4/HCPCS,Inj foramen epidural c/t,,Case Rate,3000.00
Cigna,HMO,64480,CPT4/HCPCS,Inj foramen epidural add-on,,Case Rate,3000.00
Cigna,HMO,64483,CPT4/HCPCS,Inj foramen epidural l/s,,Case Rate,3000.00
Cigna,HMO,64484,CPT4/HCPCS,Inj foramen epidural add-on,,Case Rate,3000.00
Cigna,HMO,64486,CPT4/HCPCS,TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) UNILATERAL; BY INJECTION(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,3000.00
Cigna,HMO,64487,CPT4/HCPCS,TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) UNILATERAL; BY CONTINUOUS INFUSION(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,3000.00
Cigna,HMO,64488,CPT4/HCPCS,TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) BILATERAL; BY INJECTIONS (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,3000.00
Cigna,HMO,64489,CPT4/HCPCS,TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) BILATERAL; BY CONTINUOUS INFUSIONS (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,3000.00
Cigna,HMO,64490,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL,,Case Rate,3000.00
Cigna,HMO,64491,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCED,,Case Rate,3000.00
Cigna,HMO,64492,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CO,,Case Rate,3000.00
Cigna,HMO,64493,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL,,Case Rate,3000.00
Cigna,HMO,64494,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,HMO,64495,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE F,,Case Rate,3000.00
Cigna,HMO,645,DRG,Endocrine disorders w/o CC/MCC,,Case Rate,19578.90
Cigna,HMO,64505,CPT4/HCPCS,Injection, anesthetic agent; sphenopalatine ganglion,,Case Rate,3000.00
Cigna,HMO,64510,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,HMO,64517,CPT4/HCPCS,N block inj, hypogastric plexus,,Case Rate,3000.00
Cigna,HMO,64520,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,HMO,64530,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,HMO,64550,CPT4/HCPCS,TENS,,% of Charges,66.95
Cigna,HMO,64553,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,3000.00
Cigna,HMO,64555,CPT4/HCPCS,Percutaneous implantation of neurostimulator electrodes; peripheral nerve,,Case Rate,3000.00
Cigna,HMO,64561,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,4000.00
Cigna,HMO,64566,CPT4/HCPCS,POSTERIOR TIBIAL NEUROSTIMULATION, PERCUTANEOUS NEEDLE ELECTRODE, SINGLE TREATMENT, INCLUDES PROGRAMMING,,Case Rate,3000.00
Cigna,HMO,64568,CPT4/HCPCS,INCISION FOR IMPLANTATION OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY AND PULSE GENERATOR,,Case Rate,3000.00
Cigna,HMO,64569,CPT4/HCPCS,REVISION OR REPLACEMENT OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY, INCLUDING CONNECTION TO EXISTING PULSE GENERATOR,,Case Rate,6000.00
Cigna,HMO,64570,CPT4/HCPCS,REMOVAL OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY AND PULSE GENERATOR,,Case Rate,8300.00
Cigna,HMO,64575,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,3000.00
Cigna,HMO,64580,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,3000.00
Cigna,HMO,64581,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,4000.00
Cigna,HMO,64585,CPT4/HCPCS,Revise/remove neuroelectrode,,Case Rate,3000.00
Cigna,HMO,64590,CPT4/HCPCS,Implant neuroreceiver,,Case Rate,3000.00
Cigna,HMO,64595,CPT4/HCPCS,Revise/remove neuroreceiver,,Case Rate,3000.00
Cigna,HMO,64600,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,HMO,64605,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,HMO,64610,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,HMO,64611,CPT4/HCPCS,CHEMODENERVATION OF PAROTID AND SUBMANDIBULAR SALIVARY GLANDS, BILATERAL,,Case Rate,400.00
Cigna,HMO,64612,CPT4/HCPCS,Destruction by neurolytic agent (chemodenervation of muscle endplate); muscles enervated by facial nerve (eg, for blepharospasm, hemifacial spasm),,Case Rate,3000.00
Cigna,HMO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Case Rate,400.00
Cigna,HMO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Case Rate,400.00
Cigna,HMO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Case Rate,400.00
Cigna,HMO,64620,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,HMO,64624,CPT4/HCPCS,Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed,,Case Rate,3000.00
Cigna,HMO,64625,CPT4/HCPCS,Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography),,Case Rate,3000.00
Cigna,HMO,64630,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,HMO,64632,CPT4/HCPCS,DESTRUCTION BY NEUROLYTIC AGENT; PLANTAR COMMON DIGITAL NERVE,,Case Rate,400.00
Cigna,HMO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Case Rate,3000.00
Cigna,HMO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,Case Rate,3000.00
Cigna,HMO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Case Rate,5000.00
Cigna,HMO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,Case Rate,3000.00
Cigna,HMO,64640,CPT4/HCPCS,Destruction by neurolytic agent; other peripheral nerve or branch,,Case Rate,3000.00
Cigna,HMO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Case Rate,400.00
Cigna,HMO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,Case Rate,3000.00
Cigna,HMO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Case Rate,400.00
Cigna,HMO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,Case Rate,3000.00
Cigna,HMO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Case Rate,400.00
Cigna,HMO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Case Rate,400.00
Cigna,HMO,64650,CPT4/HCPCS,Chemodenervation of eccrine glands; both axillae,,Case Rate,3000.00
Cigna,HMO,64653,CPT4/HCPCS,Chemodenervation of eccrine glands; other area(s) (eg, scalp, face, neck), per day,,Case Rate,3000.00
Cigna,HMO,64680,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,HMO,64681,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,HMO,64702,CPT4/HCPCS,Revise finger/toe nerve,,Case Rate,3000.00
Cigna,HMO,64704,CPT4/HCPCS,Revise hand/foot nerve,,Case Rate,3000.00
Cigna,HMO,64708,CPT4/HCPCS,Revise arm/leg nerve,,Case Rate,3000.00
Cigna,HMO,64712,CPT4/HCPCS,Revision of sciatic nerve,,Case Rate,3000.00
Cigna,HMO,64713,CPT4/HCPCS,Revision of arm nerve(s),,Case Rate,3000.00
Cigna,HMO,64714,CPT4/HCPCS,Revise low back nerve(s),,Case Rate,3000.00
Cigna,HMO,64716,CPT4/HCPCS,Revision of cranial nerve,,Case Rate,4000.00
Cigna,HMO,64718,CPT4/HCPCS,Revise ulnar nerve at elbow,,Case Rate,3000.00
Cigna,HMO,64719,CPT4/HCPCS,Revise ulnar nerve at wrist,,Case Rate,3000.00
Cigna,HMO,64721,CPT4/HCPCS,Carpal tunnel surgery,,Case Rate,3000.00
Cigna,HMO,64722,CPT4/HCPCS,Relieve pressure on nerve(s),,Case Rate,3000.00
Cigna,HMO,64726,CPT4/HCPCS,Release foot/toe nerve,,Case Rate,3000.00
Cigna,HMO,64727,CPT4/HCPCS,Internal nerve revision,,Case Rate,3000.00
Cigna,HMO,64732,CPT4/HCPCS,Incision of brow nerve,,Case Rate,3000.00
Cigna,HMO,64734,CPT4/HCPCS,Incision of cheek nerve,,Case Rate,3000.00
Cigna,HMO,64736,CPT4/HCPCS,Incision of chin nerve,,Case Rate,3000.00
Cigna,HMO,64738,CPT4/HCPCS,Incision of jaw nerve,,Case Rate,3000.00
Cigna,HMO,64740,CPT4/HCPCS,Incision of tongue nerve,,Case Rate,3000.00
Cigna,HMO,64742,CPT4/HCPCS,Incision of facial nerve,,Case Rate,3000.00
Cigna,HMO,64744,CPT4/HCPCS,Incise nerve, back of head,,Case Rate,3000.00
Cigna,HMO,64746,CPT4/HCPCS,Incise diaphragm nerve,,Case Rate,3000.00
Cigna,HMO,64771,CPT4/HCPCS,Sever cranial nerve,,Case Rate,3000.00
Cigna,HMO,64772,CPT4/HCPCS,Incision of spinal nerve,,Case Rate,3000.00
Cigna,HMO,64774,CPT4/HCPCS,Remove skin nerve lesion,,Case Rate,3000.00
Cigna,HMO,64776,CPT4/HCPCS,Remove digit nerve lesion,,Case Rate,4000.00
Cigna,HMO,64778,CPT4/HCPCS,Digit nerve surgery add-on,,Case Rate,3000.00
Cigna,HMO,64782,CPT4/HCPCS,Remove limb nerve lesion,,Case Rate,4000.00
Cigna,HMO,64783,CPT4/HCPCS,Limb nerve surgery add-on,,Case Rate,3000.00
Cigna,HMO,64784,CPT4/HCPCS,Remove nerve lesion,,Case Rate,4000.00
Cigna,HMO,64786,CPT4/HCPCS,Remove sciatic nerve lesion,,Case Rate,4000.00
Cigna,HMO,64787,CPT4/HCPCS,Implant nerve end,,Case Rate,3000.00
Cigna,HMO,64788,CPT4/HCPCS,Remove skin nerve lesion,,Case Rate,4000.00
Cigna,HMO,64790,CPT4/HCPCS,Removal of nerve lesion,,Case Rate,4000.00
Cigna,HMO,64792,CPT4/HCPCS,Removal of nerve lesion,,Case Rate,4000.00
Cigna,HMO,64795,CPT4/HCPCS,Biopsy of nerve,,Case Rate,3000.00
Cigna,HMO,64802,CPT4/HCPCS,Remove sympathetic nerves,,Case Rate,3000.00
Cigna,HMO,64821,CPT4/HCPCS,Remove sympathetic nerves,,Case Rate,4000.00
Cigna,HMO,64822,CPT4/HCPCS,SYMPATHECTOMY; ULNAR ARTERY,,Case Rate,4000.00
Cigna,HMO,64823,CPT4/HCPCS,SYMPATHECTOMY; SUPERFICIAL PALMAR ARCH,,Case Rate,3000.00
Cigna,HMO,64831,CPT4/HCPCS,Repair of digit nerve,,Case Rate,4000.00
Cigna,HMO,64832,CPT4/HCPCS,Repair nerve add-on,,Case Rate,3000.00
Cigna,HMO,64834,CPT4/HCPCS,Repair of hand or foot nerve,,Case Rate,3000.00
Cigna,HMO,64835,CPT4/HCPCS,Repair of hand or foot nerve,,Case Rate,4000.00
Cigna,HMO,64836,CPT4/HCPCS,Repair of hand or foot nerve,,Case Rate,4000.00
Cigna,HMO,64837,CPT4/HCPCS,Repair nerve add-on,,Case Rate,3000.00
Cigna,HMO,64840,CPT4/HCPCS,Repair of leg nerve,,Case Rate,3000.00
Cigna,HMO,64856,CPT4/HCPCS,Repair/transpose nerve,,Case Rate,3000.00
Cigna,HMO,64857,CPT4/HCPCS,Repair arm/leg nerve,,Case Rate,3000.00
Cigna,HMO,64858,CPT4/HCPCS,Repair sciatic nerve,,Case Rate,3000.00
Cigna,HMO,64859,CPT4/HCPCS,Nerve surgery,,Case Rate,3000.00
Cigna,HMO,64861,CPT4/HCPCS,Repair of arm nerves,,Case Rate,4000.00
Cigna,HMO,64862,CPT4/HCPCS,Repair of low back nerves,,Case Rate,4000.00
Cigna,HMO,64864,CPT4/HCPCS,Repair of facial nerve,,Case Rate,4000.00
Cigna,HMO,64865,CPT4/HCPCS,Repair of facial nerve,,Case Rate,4000.00
Cigna,HMO,64872,CPT4/HCPCS,Subsequent repair of nerve,,Case Rate,3000.00
Cigna,HMO,64874,CPT4/HCPCS,Repair & revise nerve add-on,,Case Rate,3000.00
Cigna,HMO,64876,CPT4/HCPCS,Repair nerve/shorten bone,,Case Rate,3000.00
Cigna,HMO,64885,CPT4/HCPCS,Nerve graft, head or neck,,Case Rate,3000.00
Cigna,HMO,64886,CPT4/HCPCS,Nerve graft, head or neck,,Case Rate,3000.00
Cigna,HMO,64890,CPT4/HCPCS,Nerve graft, hand or foot,,Case Rate,3000.00
Cigna,HMO,64891,CPT4/HCPCS,Nerve graft, hand or foot,,Case Rate,3000.00
Cigna,HMO,64892,CPT4/HCPCS,Nerve graft, arm or leg,,Case Rate,3000.00
Cigna,HMO,64893,CPT4/HCPCS,Nerve graft, arm or leg,,Case Rate,3000.00
Cigna,HMO,64895,CPT4/HCPCS,Nerve graft, hand or foot,,Case Rate,4000.00
Cigna,HMO,64896,CPT4/HCPCS,Nerve graft, hand or foot,,Case Rate,4000.00
Cigna,HMO,64897,CPT4/HCPCS,Nerve graft, arm or leg,,Case Rate,4000.00
Cigna,HMO,64898,CPT4/HCPCS,Nerve graft, arm or leg,,Case Rate,4000.00
Cigna,HMO,64901,CPT4/HCPCS,Nerve graft add-on,,Case Rate,3000.00
Cigna,HMO,64902,CPT4/HCPCS,Nerve graft add-on,,Case Rate,3000.00
Cigna,HMO,64905,CPT4/HCPCS,Nerve pedicle transfer,,Case Rate,3000.00
Cigna,HMO,64907,CPT4/HCPCS,Nerve pedicle transfer,,Case Rate,3000.00
Cigna,HMO,64910,CPT4/HCPCS,Nerve repair w/allograft,,Case Rate,5000.00
Cigna,HMO,64911,CPT4/HCPCS,Neurorraphy w/vein autograft,,Case Rate,5000.00
Cigna,HMO,64912,CPT4/HCPCS,Nerve repair; with nerve allograft, each nerve, first strand (cable),,Case Rate,3000.00
Cigna,HMO,64913,CPT4/HCPCS,Nerve repair; with nerve allograft, each additional strand (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,HMO,64999,CPT4/HCPCS,UNLISTED PROCEDURE NERVOUS SYSTEM ,,Case Rate,3000.00
Cigna,HMO,65,DRG,Intracranial hemorrhage or cerebral infarction w CC,,Case Rate,25964.10
Cigna,HMO,650,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,,Case Rate,115084.05
Cigna,HMO,65091,CPT4/HCPCS,Revise eye,,Case Rate,4000.00
Cigna,HMO,65093,CPT4/HCPCS,Revise eye with implant,,Case Rate,4000.00
Cigna,HMO,651,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,,Case Rate,94186.80
Cigna,HMO,65101,CPT4/HCPCS,Removal of eye,,Case Rate,4000.00
Cigna,HMO,65103,CPT4/HCPCS,Remove eye/insert implant,,Case Rate,4000.00
Cigna,HMO,65105,CPT4/HCPCS,Remove eye/attach implant,,Case Rate,4000.00
Cigna,HMO,65110,CPT4/HCPCS,Removal of eye,,Case Rate,5000.00
Cigna,HMO,65112,CPT4/HCPCS,Remove eye/revise socket,,Case Rate,6000.00
Cigna,HMO,65114,CPT4/HCPCS,Remove eye/revise socket,,Case Rate,6000.00
Cigna,HMO,65130,CPT4/HCPCS,Insert ocular implant,,Case Rate,4000.00
Cigna,HMO,65135,CPT4/HCPCS,Insert ocular implant,,Case Rate,3000.00
Cigna,HMO,65140,CPT4/HCPCS,Attach ocular implant,,Case Rate,4000.00
Cigna,HMO,65150,CPT4/HCPCS,Revise ocular implant,,Case Rate,3000.00
Cigna,HMO,65155,CPT4/HCPCS,Reinsert ocular implant,,Case Rate,4000.00
Cigna,HMO,65175,CPT4/HCPCS,Removal of ocular implant,,Case Rate,3000.00
Cigna,HMO,652,DRG,Kidney transplant,,Case Rate,81138.45
Cigna,HMO,65235,CPT4/HCPCS,Remove foreign body from eye,,Case Rate,3000.00
Cigna,HMO,65260,CPT4/HCPCS,Remove foreign body from eye,,Case Rate,4000.00
Cigna,HMO,65265,CPT4/HCPCS,Remove foreign body from eye,,Case Rate,4000.00
Cigna,HMO,65270,CPT4/HCPCS,Repair of eye wound,,Case Rate,3000.00
Cigna,HMO,65272,CPT4/HCPCS,Repair of eye wound,,Case Rate,3000.00
Cigna,HMO,65273,CPT4/HCPCS,Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization,,Case Rate,3000.00
Cigna,HMO,65275,CPT4/HCPCS,Repair of eye wound,,Case Rate,4000.00
Cigna,HMO,65280,CPT4/HCPCS,Repair of eye wound,,Case Rate,4000.00
Cigna,HMO,65285,CPT4/HCPCS,Repair of eye wound,,Case Rate,4000.00
Cigna,HMO,65286,CPT4/HCPCS,Repair of laceration; application of tissue glue, wounds of cornea and/or sclera,,Case Rate,3000.00
Cigna,HMO,65290,CPT4/HCPCS,Repair of eye socket wound,,Case Rate,4000.00
Cigna,HMO,653,DRG,Major bladder procedures w MCC,,Case Rate,138954.60
Cigna,HMO,654,DRG,Major bladder procedures w CC,,Case Rate,73955.10
Cigna,HMO,65400,CPT4/HCPCS,Removal of eye lesion,,Case Rate,3000.00
Cigna,HMO,65410,CPT4/HCPCS,Biopsy of cornea,,Case Rate,3000.00
Cigna,HMO,65420,CPT4/HCPCS,Removal of eye lesion,,Case Rate,3000.00
Cigna,HMO,65426,CPT4/HCPCS,Removal of eye lesion,,Case Rate,5000.00
Cigna,HMO,65435,CPT4/HCPCS,Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage) ,,Case Rate,3000.00
Cigna,HMO,65436,CPT4/HCPCS,Removal of corneal epithelium; with application of chelating agent (eg, EDTA),,Case Rate,400.00
Cigna,HMO,65450,CPT4/HCPCS,Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization,,Case Rate,400.00
Cigna,HMO,655,DRG,Major bladder procedures w/o CC/MCC,,Case Rate,53042.55
Cigna,HMO,656,DRG,Kidney & ureter procedures for neoplasm w MCC,,Case Rate,83683.35
Cigna,HMO,65600,CPT4/HCPCS,Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo),,Case Rate,3000.00
Cigna,HMO,657,DRG,Kidney & ureter procedures for neoplasm w CC,,Case Rate,49319.55
Cigna,HMO,65710,CPT4/HCPCS,Corneal transplant,,Case Rate,6000.00
Cigna,HMO,65730,CPT4/HCPCS,Corneal transplant,,Case Rate,6000.00
Cigna,HMO,65750,CPT4/HCPCS,Corneal transplant,,Case Rate,6000.00
Cigna,HMO,65755,CPT4/HCPCS,Corneal transplant,,Case Rate,6000.00
Cigna,HMO,65756,CPT4/HCPCS,KERATOPLASTY (CORNEAL TRANSPLANT); ENDOTHELIAL,,Case Rate,8300.00
Cigna,HMO,65760,CPT4/HCPCS,Keratomileusis,,Case Rate,400.00
Cigna,HMO,65765,CPT4/HCPCS,Keratophakia,,Case Rate,400.00
Cigna,HMO,65767,CPT4/HCPCS,Epikeratoplasty,,Case Rate,400.00
Cigna,HMO,65770,CPT4/HCPCS,Revise cornea with implant,,Case Rate,3000.00
Cigna,HMO,65771,CPT4/HCPCS,Radial keratotomy,,Case Rate,400.00
Cigna,HMO,65772,CPT4/HCPCS,Correction of astigmatism,,Case Rate,4000.00
Cigna,HMO,65775,CPT4/HCPCS,Correction of astigmatism,,Case Rate,4000.00
Cigna,HMO,65778,CPT4/HCPCS,PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE FOR WOUND HEALING; SELF-RETAINING,,Case Rate,3000.00
Cigna,HMO,65779,CPT4/HCPCS,PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE FOR WOUND HEALING; SINGLE LAYER, SUTURED,,Case Rate,3000.00
Cigna,HMO,65780,CPT4/HCPCS,Ocular reconst, transplant,,Case Rate,5000.00
Cigna,HMO,65781,CPT4/HCPCS,Ocular reconst, transplant,,Case Rate,5000.00
Cigna,HMO,65782,CPT4/HCPCS,Ocular reconst, transplant,,Case Rate,5000.00
Cigna,HMO,65785,CPT4/HCPCS,IMPLANTATION OF INTRASTROMAL CORNEAL RING SEGMENTS,,Case Rate,3000.00
Cigna,HMO,658,DRG,Kidney & ureter procedures for neoplasm w/o CC/MCC,,Case Rate,40267.05
Cigna,HMO,65800,CPT4/HCPCS,Drainage of eye,,Case Rate,3000.00
Cigna,HMO,65810,CPT4/HCPCS,Drainage of eye,,Case Rate,4000.00
Cigna,HMO,65815,CPT4/HCPCS,Drainage of eye,,Case Rate,3000.00
Cigna,HMO,65820,CPT4/HCPCS,Relieve inner eye pressure,,Case Rate,3000.00
Cigna,HMO,65850,CPT4/HCPCS,Incision of eye,,Case Rate,4000.00
Cigna,HMO,65855,CPT4/HCPCS,Trabeculoplasty by laser surgery, one or more sessions (defined treatment series),,Case Rate,3000.00
Cigna,HMO,65860,CPT4/HCPCS,Severing adhesions of anterior segment, laser technique (separate procedure),,Case Rate,3000.00
Cigna,HMO,65865,CPT4/HCPCS,Incise inner eye adhesions,,Case Rate,3000.00
Cigna,HMO,65870,CPT4/HCPCS,Incise inner eye adhesions,,Case Rate,4000.00
Cigna,HMO,65875,CPT4/HCPCS,Incise inner eye adhesions,,Case Rate,4000.00
Cigna,HMO,65880,CPT4/HCPCS,Incise inner eye adhesions,,Case Rate,4000.00
Cigna,HMO,659,DRG,Kidney & ureter procedures for non-neoplasm w MCC,,Case Rate,67952.40
Cigna,HMO,65900,CPT4/HCPCS,Remove eye lesion,,Case Rate,5000.00
Cigna,HMO,65920,CPT4/HCPCS,Remove implant of eye,,Case Rate,6000.00
Cigna,HMO,65930,CPT4/HCPCS,Remove blood clot from eye,,Case Rate,5000.00
Cigna,HMO,66,DRG,Intracranial hemorrhage or cerebral infarction w/o CC/MCC,,Case Rate,18127.95
Cigna,HMO,660,DRG,Kidney & ureter procedures for non-neoplasm w CC,,Case Rate,36806.70
Cigna,HMO,66020,CPT4/HCPCS,Injection treatment of eye,,Case Rate,3000.00
Cigna,HMO,66030,CPT4/HCPCS,Injection treatment of eye,,Case Rate,3000.00
Cigna,HMO,661,DRG,Kidney & ureter procedures for non-neoplasm w/o CC/MCC,,Case Rate,27142.20
Cigna,HMO,66130,CPT4/HCPCS,Remove eye lesion,,Case Rate,6000.00
Cigna,HMO,66150,CPT4/HCPCS,Glaucoma surgery,,Case Rate,4000.00
Cigna,HMO,66155,CPT4/HCPCS,Glaucoma surgery,,Case Rate,4000.00
Cigna,HMO,66160,CPT4/HCPCS,Glaucoma surgery,,Case Rate,3000.00
Cigna,HMO,66170,CPT4/HCPCS,Glaucoma surgery,,Case Rate,4000.00
Cigna,HMO,66172,CPT4/HCPCS,Incision of eye,,Case Rate,4000.00
Cigna,HMO,66174,CPT4/HCPCS,TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL; WITHOUT RETENTION OF DEVICE OR STENT,,Case Rate,5000.00
Cigna,HMO,66175,CPT4/HCPCS,TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL; WITH RETENTION OF DEVICE OR STENT,,Case Rate,5000.00
Cigna,HMO,66179,CPT4/HCPCS, AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR, EXTERNAL APPROACH; WITHOUT GRAFT,,Case Rate,8300.00
Cigna,HMO,66180,CPT4/HCPCS,Implant eye shunt,,Case Rate,5000.00
Cigna,HMO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Case Rate,8300.00
Cigna,HMO,66184,CPT4/HCPCS, REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR; WITHOUT GRAFT,,Case Rate,8300.00
Cigna,HMO,66185,CPT4/HCPCS,Revise eye shunt,,Case Rate,3000.00
Cigna,HMO,662,DRG,Minor bladder procedures w MCC,,Case Rate,74709.90
Cigna,HMO,66225,CPT4/HCPCS,Repair/graft eye lesion,,Case Rate,4000.00
Cigna,HMO,66250,CPT4/HCPCS,Follow-up surgery of eye,,Case Rate,3000.00
Cigna,HMO,663,DRG,Minor bladder procedures w CC,,Case Rate,40669.95
Cigna,HMO,664,DRG,Minor bladder procedures w/o CC/MCC,,Case Rate,30197.10
Cigna,HMO,665,DRG,Prostatectomy w MCC,,Case Rate,77435.85
Cigna,HMO,66500,CPT4/HCPCS,Incision of iris,,Case Rate,3000.00
Cigna,HMO,66505,CPT4/HCPCS,Incision of iris,,Case Rate,3000.00
Cigna,HMO,666,DRG,Prostatectomy w CC,,Case Rate,44224.65
Cigna,HMO,66600,CPT4/HCPCS,Remove iris and lesion,,Case Rate,4000.00
Cigna,HMO,66605,CPT4/HCPCS,Removal of iris,,Case Rate,4000.00
Cigna,HMO,66625,CPT4/HCPCS,Removal of iris,,Case Rate,4000.00
Cigna,HMO,66630,CPT4/HCPCS,Removal of iris,,Case Rate,4000.00
Cigna,HMO,66635,CPT4/HCPCS,Removal of iris,,Case Rate,4000.00
Cigna,HMO,66680,CPT4/HCPCS,Repair iris & ciliary body,,Case Rate,4000.00
Cigna,HMO,66682,CPT4/HCPCS,Repair iris & ciliary body,,Case Rate,3000.00
Cigna,HMO,667,DRG,Prostatectomy w/o CC/MCC,,Case Rate,25369.95
Cigna,HMO,66700,CPT4/HCPCS,Destruction, ciliary body,,Case Rate,3000.00
Cigna,HMO,66710,CPT4/HCPCS,Destruction, ciliary body,,Case Rate,3000.00
Cigna,HMO,66711,CPT4/HCPCS,Ciliary endoscopic ablation,,Case Rate,3000.00
Cigna,HMO,66720,CPT4/HCPCS,Destruction, ciliary body,,Case Rate,3000.00
Cigna,HMO,66740,CPT4/HCPCS,Destruction, ciliary body,,Case Rate,3000.00
Cigna,HMO,66761,CPT4/HCPCS,Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (one or more sessions),,Case Rate,3000.00
Cigna,HMO,66762,CPT4/HCPCS,Iridoplasty by photocoagulation (one or more sessions) (eg, for improvement of vision, for widening of anterior chamber angle),,Case Rate,3000.00
Cigna,HMO,66770,CPT4/HCPCS,Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure),,Case Rate,3000.00
Cigna,HMO,668,DRG,Transurethral procedures w MCC,,Case Rate,70255.05
Cigna,HMO,66820,CPT4/HCPCS,Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique (Ziegler or Wheeler knife),,Case Rate,3000.00
Cigna,HMO,66821,CPT4/HCPCS,After cataract laser surgery,,Case Rate,3000.00
Cigna,HMO,66825,CPT4/HCPCS,Reposition intraocular lens,,Case Rate,4000.00
Cigna,HMO,66830,CPT4/HCPCS,Removal of lens lesion,,Case Rate,4000.00
Cigna,HMO,66840,CPT4/HCPCS,Removal of lens material,,Case Rate,4000.00
Cigna,HMO,66850,CPT4/HCPCS,Removal of lens material,,Case Rate,6000.00
Cigna,HMO,66852,CPT4/HCPCS,Removal of lens material,,Case Rate,4000.00
Cigna,HMO,669,DRG,Transurethral procedures w CC,,Case Rate,39063.45
Cigna,HMO,66920,CPT4/HCPCS,Extraction of lens,,Case Rate,4000.00
Cigna,HMO,66930,CPT4/HCPCS,Extraction of lens,,Case Rate,5000.00
Cigna,HMO,66940,CPT4/HCPCS,Extraction of lens,,Case Rate,5000.00
Cigna,HMO,66982,CPT4/HCPCS,Cataract surgery, complex,,Case Rate,6000.00
Cigna,HMO,66983,CPT4/HCPCS,Cataract surg w/iol, 1 stage,,Case Rate,6000.00
Cigna,HMO,66984,CPT4/HCPCS,Cataract surg w/iol, i stage,,Case Rate,6000.00
Cigna,HMO,66985,CPT4/HCPCS,Insert lens prosthesis,,Case Rate,5000.00
Cigna,HMO,66986,CPT4/HCPCS,Exchange lens prosthesis,,Case Rate,5000.00
Cigna,HMO,66987,CPT4/HCPCS,Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure) manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine ,,Case Rate,3000.00
Cigna,HMO,66988,CPT4/HCPCS,Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure) manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), with endoscopic cyclophotocoagulation,,Case Rate,3000.00
Cigna,HMO,66990,CPT4/HCPCS,Use of ophthalmic endoscope (List separately in additon ot code for primary procedure),,Case Rate,3000.00
Cigna,HMO,66999,CPT4/HCPCS,UNLISTED PROCEDURE, ANTERIOR SEGMENT OF EYE ,,Case Rate,3000.00
Cigna,HMO,67,DRG,Nonspecific cva & precerebral occlusion w/o infarct w MCC,,Case Rate,36327.30
Cigna,HMO,670,DRG,Transurethral procedures w/o CC/MCC,,Case Rate,24900.75
Cigna,HMO,67005,CPT4/HCPCS,Partial removal of eye fluid,,Case Rate,4000.00
Cigna,HMO,67010,CPT4/HCPCS,Partial removal of eye fluid,,Case Rate,4000.00
Cigna,HMO,67015,CPT4/HCPCS,Release of eye fluid,,Case Rate,3000.00
Cigna,HMO,67025,CPT4/HCPCS,Replace eye fluid,,Case Rate,3000.00
Cigna,HMO,67027,CPT4/HCPCS,Implant eye drug system,,Case Rate,4000.00
Cigna,HMO,67028,CPT4/HCPCS,Intravitreal injection of a pharmacologic agent (separate procedure),,Case Rate,3000.00
Cigna,HMO,67030,CPT4/HCPCS,Incise inner eye strands,,Case Rate,3000.00
Cigna,HMO,67031,CPT4/HCPCS,Laser surgery, eye strands,,Case Rate,3000.00
Cigna,HMO,67036,CPT4/HCPCS,Removal of inner eye fluid,,Case Rate,4000.00
Cigna,HMO,67039,CPT4/HCPCS,Laser treatment of retina,,Case Rate,6000.00
Cigna,HMO,67040,CPT4/HCPCS,Laser treatment of retina,,Case Rate,6000.00
Cigna,HMO,67041,CPT4/HCPCS,Vitrectomy pars plana remove preretinal membrane,,Case Rate,8300.00
Cigna,HMO,67042,CPT4/HCPCS,Vitrectomy pars plana remove int memb retina,,Case Rate,8300.00
Cigna,HMO,67043,CPT4/HCPCS,Vitrectomy pars plana remove subretinal membrane,,Case Rate,8300.00
Cigna,HMO,671,DRG,Urethral procedures w CC/MCC,,Case Rate,45305.85
Cigna,HMO,67101,CPT4/HCPCS,Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage of subretinal fluid,,Case Rate,3000.00
Cigna,HMO,67105,CPT4/HCPCS,Repair of retinal detachment, one or more sessions; photocoagulation, with or without drainage of subretinal fluid,,Case Rate,3000.00
Cigna,HMO,67107,CPT4/HCPCS,Repair detached retina,,Case Rate,5000.00
Cigna,HMO,67108,CPT4/HCPCS,Repair detached retina,,Case Rate,6000.00
Cigna,HMO,67113,CPT4/HCPCS,Repair retinal detach, cplx,,Case Rate,8300.00
Cigna,HMO,67115,CPT4/HCPCS,Release encircling material,,Case Rate,3000.00
Cigna,HMO,67120,CPT4/HCPCS,Remove eye implant material,,Case Rate,3000.00
Cigna,HMO,67121,CPT4/HCPCS,Remove eye implant material,,Case Rate,3000.00
Cigna,HMO,67141,CPT4/HCPCS,Treatment of retina,,Case Rate,3000.00
Cigna,HMO,67145,CPT4/HCPCS,Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, one or more sessions; photocoagulation (laser or xenon arc),,Case Rate,3000.00
Cigna,HMO,672,DRG,Urethral procedures w/o CC/MCC,,Case Rate,29347.95
Cigna,HMO,67208,CPT4/HCPCS,Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; cryotherapy, diathermy,,Case Rate,3000.00
Cigna,HMO,67210,CPT4/HCPCS,Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; photocoagulation,,Case Rate,3000.00
Cigna,HMO,67218,CPT4/HCPCS,Treatment of retinal lesion,,Case Rate,5000.00
Cigna,HMO,67220,CPT4/HCPCS,Destruction of localized lesion of choroid (eg, choroidal neovascularization), one or more session, photocoagulation (laser),,Case Rate,3000.00
Cigna,HMO,67221,CPT4/HCPCS,Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion),,Case Rate,3000.00
Cigna,HMO,67225,CPT4/HCPCS,DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION); PHOTODYNAMIC THERAPY, SECOND EYE, AT SINGLE SESSION,,Case Rate,3000.00
Cigna,HMO,67227,CPT4/HCPCS,Treatment of retinal lesion,,Case Rate,3000.00
Cigna,HMO,67228,CPT4/HCPCS,Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), one or more sessions; photocoagulation (laser or xenon arc),,Case Rate,3000.00
Cigna,HMO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Case Rate,400.00
Cigna,HMO,67250,CPT4/HCPCS,Reinforce eye wall,,Case Rate,4000.00
Cigna,HMO,67255,CPT4/HCPCS,Reinforce/graft eye wall,,Case Rate,4000.00
Cigna,HMO,673,DRG,Other kidney & urinary tract procedures w MCC,,Case Rate,88309.05
Cigna,HMO,67311,CPT4/HCPCS,Revise eye muscle,,Case Rate,4000.00
Cigna,HMO,67312,CPT4/HCPCS,Revise two eye muscles,,Case Rate,4000.00
Cigna,HMO,67314,CPT4/HCPCS,Revise eye muscle,,Case Rate,4000.00
Cigna,HMO,67316,CPT4/HCPCS,Revise two eye muscles,,Case Rate,4000.00
Cigna,HMO,67318,CPT4/HCPCS,Revise eye muscle(s),,Case Rate,4000.00
Cigna,HMO,67320,CPT4/HCPCS,Revise eye muscle(s) add-on,,Case Rate,3000.00
Cigna,HMO,67331,CPT4/HCPCS,Eye surgery follow-up add-on,,Case Rate,3000.00
Cigna,HMO,67332,CPT4/HCPCS,Rerevise eye muscles add-on,,Case Rate,3000.00
Cigna,HMO,67334,CPT4/HCPCS,Revise eye muscle w/suture,,Case Rate,3000.00
Cigna,HMO,67335,CPT4/HCPCS,Eye suture during surgery,,Case Rate,3000.00
Cigna,HMO,67340,CPT4/HCPCS,Revise eye muscle add-on,,Case Rate,3000.00
Cigna,HMO,67343,CPT4/HCPCS,Release eye tissue,,Case Rate,6000.00
Cigna,HMO,67345,CPT4/HCPCS,Chemodenervation of extraocular muscle,,Case Rate,3000.00
Cigna,HMO,67346,CPT4/HCPCS,Biopsy, eye muscle,,Case Rate,3000.00
Cigna,HMO,674,DRG,Other kidney & urinary tract procedures w CC,,Case Rate,60700.20
Cigna,HMO,67400,CPT4/HCPCS,Explore/biopsy eye socket,,Case Rate,4000.00
Cigna,HMO,67405,CPT4/HCPCS,Explore/drain eye socket,,Case Rate,4000.00
Cigna,HMO,67412,CPT4/HCPCS,Explore/treat eye socket,,Case Rate,5000.00
Cigna,HMO,67413,CPT4/HCPCS,Explore/treat eye socket,,Case Rate,5000.00
Cigna,HMO,67414,CPT4/HCPCS,Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of bone for decompression,,Case Rate,3000.00
Cigna,HMO,67415,CPT4/HCPCS,Aspiration, orbital contents,,Case Rate,3000.00
Cigna,HMO,67420,CPT4/HCPCS,Explore/treat eye socket,,Case Rate,5000.00
Cigna,HMO,67430,CPT4/HCPCS,Explore/treat eye socket,,Case Rate,5000.00
Cigna,HMO,67440,CPT4/HCPCS,Explore/drain eye socket,,Case Rate,5000.00
Cigna,HMO,67445,CPT4/HCPCS,Explr/decompress eye socket,,Case Rate,5000.00
Cigna,HMO,67450,CPT4/HCPCS,Explore/biopsy eye socket,,Case Rate,5000.00
Cigna,HMO,675,DRG,Other kidney & urinary tract procedures w/o CC/MCC,,Case Rate,44676.00
Cigna,HMO,67505,CPT4/HCPCS,Retrobulbar injection; alcohol,,Case Rate,3000.00
Cigna,HMO,67515,CPT4/HCPCS,Injection of therapeutic agent into Tenons capsule,,Case Rate,3000.00
Cigna,HMO,67550,CPT4/HCPCS,Insert eye socket implant,,Case Rate,4000.00
Cigna,HMO,67560,CPT4/HCPCS,Revise eye socket implant,,Case Rate,3000.00
Cigna,HMO,67570,CPT4/HCPCS,Decompress optic nerve,,Case Rate,4000.00
Cigna,HMO,67700,CPT4/HCPCS,Blepharotomy, drainage of abscess, eyelid,,Case Rate,3000.00
Cigna,HMO,67710,CPT4/HCPCS,Severing of tarsorrhaphy,,Case Rate,3000.00
Cigna,HMO,67715,CPT4/HCPCS,Incision of eyelid fold,,Case Rate,3000.00
Cigna,HMO,67800,CPT4/HCPCS,Excision of chalazion; single,,Case Rate,3000.00
Cigna,HMO,67801,CPT4/HCPCS,Excision of chalazion; multiple, same lid,,Case Rate,3000.00
Cigna,HMO,67805,CPT4/HCPCS,Excision of chalazion; multiple, different lids,,Case Rate,3000.00
Cigna,HMO,67808,CPT4/HCPCS,Remove eyelid lesion(s),,Case Rate,3000.00
Cigna,HMO,67810,CPT4/HCPCS,Biopsy of eyelid,,Case Rate,3000.00
Cigna,HMO,67830,CPT4/HCPCS,Revise eyelashes,,Case Rate,3000.00
Cigna,HMO,67835,CPT4/HCPCS,Revise eyelashes,,Case Rate,3000.00
Cigna,HMO,67840,CPT4/HCPCS,Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure,,Case Rate,3000.00
Cigna,HMO,67850,CPT4/HCPCS,Destruction of lesion of lid margin (up to 1 cm),,Case Rate,3000.00
Cigna,HMO,67875,CPT4/HCPCS,Temporary closure of eyelids by suture (eg, Frost suture),,Case Rate,3000.00
Cigna,HMO,67880,CPT4/HCPCS,Revision of eyelid,,Case Rate,4000.00
Cigna,HMO,67882,CPT4/HCPCS,Revision of eyelid,,Case Rate,4000.00
Cigna,HMO,67900,CPT4/HCPCS,Repair brow defect,,Case Rate,4000.00
Cigna,HMO,67901,CPT4/HCPCS,Repair eyelid defect,,Case Rate,5000.00
Cigna,HMO,67902,CPT4/HCPCS,Repair eyelid defect,,Case Rate,5000.00
Cigna,HMO,67903,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,HMO,67904,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,HMO,67906,CPT4/HCPCS,Repair eyelid defect,,Case Rate,5000.00
Cigna,HMO,67908,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,HMO,67909,CPT4/HCPCS,Revise eyelid defect,,Case Rate,4000.00
Cigna,HMO,67911,CPT4/HCPCS,Revise eyelid defect,,Case Rate,4000.00
Cigna,HMO,67912,CPT4/HCPCS,Correction eyelid w/implant,,Case Rate,4000.00
Cigna,HMO,67914,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,HMO,67915,CPT4/HCPCS,Repair of ectropion; thermocauterization,,Case Rate,3000.00
Cigna,HMO,67916,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,HMO,67917,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,HMO,67921,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,HMO,67922,CPT4/HCPCS,Repair of entropion; thermocauterization,,Case Rate,3000.00
Cigna,HMO,67923,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,HMO,67924,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,HMO,67930,CPT4/HCPCS,Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; partial thickness,,Case Rate,5000.00
Cigna,HMO,67935,CPT4/HCPCS,Repair eyelid wound,,Case Rate,3000.00
Cigna,HMO,67938,CPT4/HCPCS,Removal of embedded foreign body, eyelid,,Case Rate,400.00
Cigna,HMO,67950,CPT4/HCPCS,Revision of eyelid,,Case Rate,3000.00
Cigna,HMO,67961,CPT4/HCPCS,Revision of eyelid,,Case Rate,4000.00
Cigna,HMO,67966,CPT4/HCPCS,Revision of eyelid,,Case Rate,4000.00
Cigna,HMO,67971,CPT4/HCPCS,Reconstruction of eyelid,,Case Rate,4000.00
Cigna,HMO,67973,CPT4/HCPCS,Reconstruction of eyelid,,Case Rate,4000.00
Cigna,HMO,67974,CPT4/HCPCS,Reconstruction of eyelid,,Case Rate,4000.00
Cigna,HMO,67975,CPT4/HCPCS,Reconstruction of eyelid,,Case Rate,4000.00
Cigna,HMO,68,DRG,Nonspecific cva & precerebral occlusion w/o infarct w/o MCC,,Case Rate,22659.30
Cigna,HMO,68020,CPT4/HCPCS,Incision of conjunctiva, drainage of cyst,,Case Rate,3000.00
Cigna,HMO,68100,CPT4/HCPCS,Biopsy of conjunctiva,,Case Rate,4000.00
Cigna,HMO,68110,CPT4/HCPCS,Excision of lesion, conjunctiva; up to 1 cm,,Case Rate,3000.00
Cigna,HMO,68115,CPT4/HCPCS,Remove eyelid lining lesion,,Case Rate,3000.00
Cigna,HMO,68130,CPT4/HCPCS,Remove eyelid lining lesion,,Case Rate,3000.00
Cigna,HMO,68135,CPT4/HCPCS,Destruction of lesion, conjunctiva,,Case Rate,3000.00
Cigna,HMO,682,DRG,Renal failure w MCC,,Case Rate,37490.10
Cigna,HMO,683,DRG,Renal failure w CC,,Case Rate,22391.55
Cigna,HMO,68320,CPT4/HCPCS,Revise/graft eyelid lining,,Case Rate,4000.00
Cigna,HMO,68325,CPT4/HCPCS,Revise/graft eyelid lining,,Case Rate,4000.00
Cigna,HMO,68326,CPT4/HCPCS,Revise/graft eyelid lining,,Case Rate,4000.00
Cigna,HMO,68328,CPT4/HCPCS,Revise/graft eyelid lining,,Case Rate,4000.00
Cigna,HMO,68330,CPT4/HCPCS,Revise eyelid lining,,Case Rate,4000.00
Cigna,HMO,68335,CPT4/HCPCS,Revise/graft eyelid lining,,Case Rate,4000.00
Cigna,HMO,68340,CPT4/HCPCS,Separate eyelid adhesions,,Case Rate,4000.00
Cigna,HMO,68360,CPT4/HCPCS,Revise eyelid lining,,Case Rate,3000.00
Cigna,HMO,68362,CPT4/HCPCS,Revise eyelid lining,,Case Rate,3000.00
Cigna,HMO,68371,CPT4/HCPCS,Harvest eye tissue, alograft,,Case Rate,3000.00
Cigna,HMO,684,DRG,Renal failure w/o CC/MCC,,Case Rate,15491.25
Cigna,HMO,68400,CPT4/HCPCS,Incision, drainage of lacrimal gland,,Case Rate,3000.00
Cigna,HMO,68420,CPT4/HCPCS,Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy),,Case Rate,5000.00
Cigna,HMO,68440,CPT4/HCPCS,Snip incision of lacrimal punctum ,,Case Rate,3000.00
Cigna,HMO,68500,CPT4/HCPCS,Removal of tear gland,,Case Rate,4000.00
Cigna,HMO,68505,CPT4/HCPCS,Partial removal, tear gland,,Case Rate,4000.00
Cigna,HMO,68510,CPT4/HCPCS,Biopsy of tear gland,,Case Rate,3000.00
Cigna,HMO,68520,CPT4/HCPCS,Removal of tear sac,,Case Rate,4000.00
Cigna,HMO,68525,CPT4/HCPCS,Biopsy of tear sac,,Case Rate,3000.00
Cigna,HMO,68530,CPT4/HCPCS,Removal of foreign body or dacryolith, lacrimal passages,,Case Rate,400.00
Cigna,HMO,68540,CPT4/HCPCS,Remove tear gland lesion,,Case Rate,4000.00
Cigna,HMO,68550,CPT4/HCPCS,Remove tear gland lesion,,Case Rate,4000.00
Cigna,HMO,686,DRG,Kidney & urinary tract neoplasms w MCC,,Case Rate,47766.60
Cigna,HMO,687,DRG,Kidney & urinary tract neoplasms w CC,,Case Rate,26718.90
Cigna,HMO,68700,CPT4/HCPCS,Repair tear ducts,,Case Rate,3000.00
Cigna,HMO,68705,CPT4/HCPCS,Correction of everted punctum, cautery,,Case Rate,3000.00
Cigna,HMO,68720,CPT4/HCPCS,Create tear sac drain,,Case Rate,4000.00
Cigna,HMO,68745,CPT4/HCPCS,Create tear duct drain,,Case Rate,4000.00
Cigna,HMO,68750,CPT4/HCPCS,Create tear duct drain,,Case Rate,4000.00
Cigna,HMO,68760,CPT4/HCPCS,Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery,,Case Rate,400.00
Cigna,HMO,68761,CPT4/HCPCS,Closure of the lacrimal punctum; by plug, each,,Case Rate,400.00
Cigna,HMO,68770,CPT4/HCPCS,Close tear system fistula,,Case Rate,4000.00
Cigna,HMO,688,DRG,Kidney & urinary tract neoplasms w/o CC/MCC,,Case Rate,17475.15
Cigna,HMO,68810,CPT4/HCPCS,Probe nasolacrimal duct,,Case Rate,3000.00
Cigna,HMO,68811,CPT4/HCPCS,Probe nasolacrimal duct,,Case Rate,3000.00
Cigna,HMO,68815,CPT4/HCPCS,Probe nasolacrimal duct,,Case Rate,3000.00
Cigna,HMO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Case Rate,5000.00
Cigna,HMO,68840,CPT4/HCPCS,Probing of lacrimal canaliculi, with or without irrigation,,Case Rate,400.00
Cigna,HMO,68850,CPT4/HCPCS,Injection of contrast medium for dacryocystography,,Case Rate,3000.00
Cigna,HMO,689,DRG,Kidney & urinary tract infections w MCC,,Case Rate,28338.15
Cigna,HMO,69,DRG,Transient ischemia,,Case Rate,20045.55
Cigna,HMO,690,DRG,Kidney & urinary tract infections w/o MCC,,Case Rate,20201.10
Cigna,HMO,69000,CPT4/HCPCS,Drainage external ear, abscess or hematoma; simple,,Case Rate,400.00
Cigna,HMO,69005,CPT4/HCPCS,Drainage external ear, abscess or hematoma; complicated,,Case Rate,3000.00
Cigna,HMO,69020,CPT4/HCPCS,Drainage external auditory canal, abscess,,Case Rate,400.00
Cigna,HMO,69110,CPT4/HCPCS,Remove external ear, partial,,Case Rate,3000.00
Cigna,HMO,69120,CPT4/HCPCS,Removal of external ear,,Case Rate,3000.00
Cigna,HMO,69140,CPT4/HCPCS,Remove ear canal lesion(s),,Case Rate,3000.00
Cigna,HMO,69145,CPT4/HCPCS,Remove ear canal lesion(s),,Case Rate,3000.00
Cigna,HMO,69150,CPT4/HCPCS,Extensive ear canal surgery,,Case Rate,4000.00
Cigna,HMO,69205,CPT4/HCPCS,Clear outer ear canal,,Case Rate,3000.00
Cigna,HMO,69209,CPT4/HCPCS,REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL,,Case Rate,400.00
Cigna,HMO,69210,CPT4/HCPCS,Removal impacted cerumen (separate procedure), one or both ears,,Case Rate,400.00
Cigna,HMO,69222,CPT4/HCPCS,Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than routine cleaning),,Case Rate,3000.00
Cigna,HMO,693,DRG,Urinary stones w/o esw lithotripsy w MCC,,Case Rate,32354.40
Cigna,HMO,69300,CPT4/HCPCS,Revise external ear,,Case Rate,4000.00
Cigna,HMO,69310,CPT4/HCPCS,Rebuild outer ear canal,,Case Rate,4000.00
Cigna,HMO,69320,CPT4/HCPCS,Rebuild outer ear canal,,Case Rate,6000.00
Cigna,HMO,694,DRG,Urinary stones w/o esw lithotripsy w/o MCC,,Case Rate,18597.15
Cigna,HMO,69420,CPT4/HCPCS,Myringotomy including aspiration and/or eustachian tube inflation,,Case Rate,3000.00
Cigna,HMO,69421,CPT4/HCPCS,Incision of eardrum,,Case Rate,4000.00
Cigna,HMO,69424,CPT4/HCPCS,Remove ventilating tube,,Case Rate,3000.00
Cigna,HMO,69433,CPT4/HCPCS,Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia,,Case Rate,3000.00
Cigna,HMO,69436,CPT4/HCPCS,Create eardrum opening,,Case Rate,4000.00
Cigna,HMO,69440,CPT4/HCPCS,Exploration of middle ear,,Case Rate,4000.00
Cigna,HMO,69450,CPT4/HCPCS,Eardrum revision,,Case Rate,3000.00
Cigna,HMO,695,DRG,Kidney & urinary tract signs & symptoms w MCC,,Case Rate,28975.65
Cigna,HMO,69501,CPT4/HCPCS,Mastoidectomy,,Case Rate,6000.00
Cigna,HMO,69502,CPT4/HCPCS,Mastoidectomy,,Case Rate,6000.00
Cigna,HMO,69505,CPT4/HCPCS,Remove mastoid structures,,Case Rate,6000.00
Cigna,HMO,69511,CPT4/HCPCS,Extensive mastoid surgery,,Case Rate,6000.00
Cigna,HMO,69530,CPT4/HCPCS,Extensive mastoid surgery,,Case Rate,6000.00
Cigna,HMO,69540,CPT4/HCPCS,Excision aural polyp,,Case Rate,3000.00
Cigna,HMO,69550,CPT4/HCPCS,Remove ear lesion,,Case Rate,5000.00
Cigna,HMO,69552,CPT4/HCPCS,Remove ear lesion,,Case Rate,6000.00
Cigna,HMO,696,DRG,Kidney & urinary tract signs & symptoms w/o MCC,,Case Rate,17587.35
Cigna,HMO,69601,CPT4/HCPCS,Mastoid surgery revision,,Case Rate,6000.00
Cigna,HMO,69602,CPT4/HCPCS,Mastoid surgery revision,,Case Rate,6000.00
Cigna,HMO,69603,CPT4/HCPCS,Mastoid surgery revision,,Case Rate,6000.00
Cigna,HMO,69604,CPT4/HCPCS,Mastoid surgery revision,,Case Rate,6000.00
Cigna,HMO,69605,CPT4/HCPCS,Mastoid surgery revision,,Case Rate,6000.00
Cigna,HMO,69610,CPT4/HCPCS,Tympanic membrane repair, with or without site preparation or perforation for closure, with or without patch,,Case Rate,3000.00
Cigna,HMO,69620,CPT4/HCPCS,Repair of eardrum,,Case Rate,3000.00
Cigna,HMO,69631,CPT4/HCPCS,Repair eardrum structures,,Case Rate,5000.00
Cigna,HMO,69632,CPT4/HCPCS,Rebuild eardrum structures,,Case Rate,5000.00
Cigna,HMO,69633,CPT4/HCPCS,Rebuild eardrum structures,,Case Rate,5000.00
Cigna,HMO,69635,CPT4/HCPCS,Repair eardrum structures,,Case Rate,6000.00
Cigna,HMO,69636,CPT4/HCPCS,Rebuild eardrum structures,,Case Rate,6000.00
Cigna,HMO,69637,CPT4/HCPCS,Rebuild eardrum structures,,Case Rate,6000.00
Cigna,HMO,69641,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,HMO,69642,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,HMO,69643,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,HMO,69644,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,HMO,69645,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,HMO,69646,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,HMO,69650,CPT4/HCPCS,Release middle ear bone,,Case Rate,6000.00
Cigna,HMO,69660,CPT4/HCPCS,Revise middle ear bone,,Case Rate,5000.00
Cigna,HMO,69661,CPT4/HCPCS,Revise middle ear bone,,Case Rate,5000.00
Cigna,HMO,69662,CPT4/HCPCS,Revise middle ear bone,,Case Rate,5000.00
Cigna,HMO,69666,CPT4/HCPCS,Repair middle ear structures,,Case Rate,4000.00
Cigna,HMO,69667,CPT4/HCPCS,Repair middle ear structures,,Case Rate,4000.00
Cigna,HMO,69670,CPT4/HCPCS,Remove mastoid air cells,,Case Rate,4000.00
Cigna,HMO,69676,CPT4/HCPCS,Remove middle ear nerve,,Case Rate,4000.00
Cigna,HMO,697,DRG,Urethral stricture,,Case Rate,25423.50
Cigna,HMO,69700,CPT4/HCPCS,Close mastoid fistula,,Case Rate,4000.00
Cigna,HMO,69710,CPT4/HCPCS,Implant/replace hearing aid,,Case Rate,4000.00
Cigna,HMO,69711,CPT4/HCPCS,Remove/repair hearing aid,,Case Rate,3000.00
Cigna,HMO,69714,CPT4/HCPCS,Implant temple bone w/stimul,,Case Rate,3000.00
Cigna,HMO,69715,CPT4/HCPCS,Temple bne implnt w/stimulat,,Case Rate,3000.00
Cigna,HMO,69717,CPT4/HCPCS,Temple bone implant revision,,Case Rate,3000.00
Cigna,HMO,69718,CPT4/HCPCS,Revise temple bone implant,,Case Rate,3000.00
Cigna,HMO,69720,CPT4/HCPCS,Release facial nerve,,Case Rate,5000.00
Cigna,HMO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Case Rate,3000.00
Cigna,HMO,69740,CPT4/HCPCS,Repair facial nerve,,Case Rate,5000.00
Cigna,HMO,69745,CPT4/HCPCS,Repair facial nerve,,Case Rate,5000.00
Cigna,HMO,69799,CPT4/HCPCS,UNLISTED PROCEDURE ON MIDDLE EAR ,,Case Rate,3000.00
Cigna,HMO,698,DRG,Other kidney & urinary tract diagnoses w MCC,,Case Rate,40970.85
Cigna,HMO,69801,CPT4/HCPCS,Incise inner ear,,Case Rate,5000.00
Cigna,HMO,69805,CPT4/HCPCS,Explore inner ear,,Case Rate,6000.00
Cigna,HMO,69806,CPT4/HCPCS,Explore inner ear,,Case Rate,6000.00
Cigna,HMO,699,DRG,Other kidney & urinary tract diagnoses w CC,,Case Rate,26142.60
Cigna,HMO,69905,CPT4/HCPCS,Remove inner ear,,Case Rate,6000.00
Cigna,HMO,69910,CPT4/HCPCS,Remove inner ear & mastoid,,Case Rate,6000.00
Cigna,HMO,69915,CPT4/HCPCS,Incise inner ear nerve,,Case Rate,6000.00
Cigna,HMO,69930,CPT4/HCPCS,Implant cochlear device,,Case Rate,6000.00
Cigna,HMO,69949,CPT4/HCPCS,UNLISTED PROCEDURE INNER EAR ,,Case Rate,3000.00
Cigna,HMO,69955,CPT4/HCPCS,TOTAL FACIAL NERVE DECOMPRESSION AND/OR REPAIR (MAY INCLUDE GRAFT) ,,Case Rate,3000.00
Cigna,HMO,69970,CPT4/HCPCS,REMOVAL OF TUMOR, TEMPORAL BONE ,,Case Rate,3000.00
Cigna,HMO,69979,CPT4/HCPCS,UNLISTED PROCEDURE, TEMPORAL BONE, MIDDLE FOSSA APPROACH ,,Case Rate,3000.00
Cigna,HMO,69990,CPT4/HCPCS,MICROSURGICAL TECHNIQUES,REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,HMO,7,DRG,Lung transplant,,Case Rate,295144.65
Cigna,HMO,70,DRG,Nonspecific cerebrovascular disorders w MCC,,Case Rate,42748.20
Cigna,HMO,700,DRG,Other kidney & urinary tract diagnoses w/o CC/MCC,,Case Rate,18992.40
Cigna,HMO,70015,CPT4/HCPCS,Cisterno S&I,,% of Charges,4045.45
Cigna,HMO,70030,CPT4/HCPCS,Eye Foreign Body,,% of Charges,364.35
Cigna,HMO,70100,CPT4/HCPCS,Mandible Limited,,% of Charges,364.35
Cigna,HMO,70110,CPT4/HCPCS,Mandible Complete,,% of Charges,657.95
Cigna,HMO,70120,CPT4/HCPCS,Mastoids Limited,,% of Charges,657.95
Cigna,HMO,70130,CPT4/HCPCS,Mastoids Complete,,% of Charges,657.95
Cigna,HMO,70140,CPT4/HCPCS,Lim Facial Bones,,% of Charges,364.35
Cigna,HMO,70150,CPT4/HCPCS,Facial Bones,,% of Charges,657.95
Cigna,HMO,70160,CPT4/HCPCS,Nasal Bones,,% of Charges,364.35
Cigna,HMO,70190,CPT4/HCPCS,Optic Foramina,,% of Charges,364.35
Cigna,HMO,70210,CPT4/HCPCS,Sinuses Limited,,% of Charges,364.35
Cigna,HMO,70220,CPT4/HCPCS,Sinuses Complete,,% of Charges,364.35
Cigna,HMO,70240,CPT4/HCPCS,Sella Turcica,,% of Charges,364.35
Cigna,HMO,70250,CPT4/HCPCS,Skull 2 Views,,% of Charges,657.95
Cigna,HMO,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,% of Charges,657.95
Cigna,HMO,70330,CPT4/HCPCS,Tm Joints Bilateral,,% of Charges,364.35
Cigna,HMO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,% of Charges,6500.00
Cigna,HMO,70360,CPT4/HCPCS,Neck Soft Tissue,,% of Charges,364.35
Cigna,HMO,70380,CPT4/HCPCS,Salivary Gland,,% of Charges,364.35
Cigna,HMO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,% of Charges,6500.00
Cigna,HMO,70460,CPT4/HCPCS,Ct Head W Contrast,,% of Charges,6500.00
Cigna,HMO,70470,CPT4/HCPCS,Ct Head W/Wo Contrast,,% of Charges,6500.00
Cigna,HMO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,% of Charges,6500.00
Cigna,HMO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,% of Charges,6500.00
Cigna,HMO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,% of Charges,6500.00
Cigna,HMO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,% of Charges,6500.00
Cigna,HMO,70488,CPT4/HCPCS,Ct Maxillofacial Wo/W Contrast,,% of Charges,6500.00
Cigna,HMO,70490,CPT4/HCPCS,Ct Neck Wo Contrast,,% of Charges,6500.00
Cigna,HMO,70491,CPT4/HCPCS,Ct Neck W Contrast,,% of Charges,6500.00
Cigna,HMO,70492,CPT4/HCPCS,Ct Neck Wo/W Contrast,,% of Charges,6500.00
Cigna,HMO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,% of Charges,6500.00
Cigna,HMO,70498,CPT4/HCPCS,Cta Neck,,% of Charges,6500.00
Cigna,HMO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,% of Charges,6500.00
Cigna,HMO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,% of Charges,6500.00
Cigna,HMO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,% of Charges,6500.00
Cigna,HMO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,% of Charges,6500.00
Cigna,HMO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,% of Charges,6500.00
Cigna,HMO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,% of Charges,6500.00
Cigna,HMO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,% of Charges,6500.00
Cigna,HMO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,% of Charges,6500.00
Cigna,HMO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,% of Charges,6500.00
Cigna,HMO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,% of Charges,6500.00
Cigna,HMO,707,DRG,Major male pelvic procedures w CC/MCC,,Case Rate,48975.30
Cigna,HMO,708,DRG,Major male pelvic procedures w/o CC/MCC,,Case Rate,38030.70
Cigna,HMO,709,DRG,Penis procedures w CC/MCC,,Case Rate,58953.45
Cigna,HMO,71,DRG,Nonspecific cerebrovascular disorders w CC,,Case Rate,25775.40
Cigna,HMO,710,DRG,Penis procedures w/o CC/MCC,,Case Rate,40797.45
Cigna,HMO,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,% of Charges,364.35
Cigna,HMO,71046,CPT4/HCPCS,Chest 2 View,,% of Charges,364.35
Cigna,HMO,71047,CPT4/HCPCS,Chest 3 Views,,% of Charges,364.35
Cigna,HMO,71048,CPT4/HCPCS,Chest 4 Views,,% of Charges,657.95
Cigna,HMO,711,DRG,Testes procedures w CC/MCC,,Case Rate,54322.65
Cigna,HMO,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,% of Charges,364.35
Cigna,HMO,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,% of Charges,657.95
Cigna,HMO,71110,CPT4/HCPCS,Bilat Ribs,,% of Charges,657.95
Cigna,HMO,71111,CPT4/HCPCS,Bilat Ribs W/ Pa Cxr,,% of Charges,657.95
Cigna,HMO,71120,CPT4/HCPCS,Sternum,,% of Charges,364.35
Cigna,HMO,71130,CPT4/HCPCS,Sternoclavicular Joints,,% of Charges,364.35
Cigna,HMO,712,DRG,Testes procedures w/o CC/MCC,,Case Rate,26966.25
Cigna,HMO,71250,CPT4/HCPCS,CT THORAX DX C-,,% of Charges,6500.00
Cigna,HMO,71260,CPT4/HCPCS,Ct Thorax W Contrast,,% of Charges,6500.00
Cigna,HMO,71270,CPT4/HCPCS,Ct Thorax W/Wo Contrast,,% of Charges,6500.00
Cigna,HMO,71275,CPT4/HCPCS,Ct Chest Angio,,% of Charges,6500.00
Cigna,HMO,713,DRG,Transurethral prostatectomy w CC/MCC,,Case Rate,38035.80
Cigna,HMO,714,DRG,Transurethral prostatectomy w/o CC/MCC,,Case Rate,23676.75
Cigna,HMO,715,DRG,Other male reproductive system O.R. proc for malignancy w CC/MCC,,Case Rate,51481.95
Cigna,HMO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,% of Charges,6500.00
Cigna,HMO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,% of Charges,6500.00
Cigna,HMO,716,DRG,Other male reproductive system O.R. proc for malignancy w/o CC/MCC,,Case Rate,32550.75
Cigna,HMO,717,DRG,Other male reproductive system O.R. proc exc malignancy w CC/MCC,,Case Rate,45861.75
Cigna,HMO,718,DRG,Other male reproductive system O.R. proc exc malignancy w/o CC/MCC,,Case Rate,31523.10
Cigna,HMO,72,DRG,Nonspecific cerebrovascular disorders w/o CC/MCC,,Case Rate,19665.60
Cigna,HMO,72020,CPT4/HCPCS,Spine 1 View,,% of Charges,364.35
Cigna,HMO,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,% of Charges,364.35
Cigna,HMO,72050,CPT4/HCPCS,Cervical Spine 4 or 5 Views,,% of Charges,657.95
Cigna,HMO,72052,CPT4/HCPCS,Cerv Spine 6 Or More Views,,% of Charges,657.95
Cigna,HMO,72070,CPT4/HCPCS,Thoracic Spine 2 Views,,% of Charges,657.95
Cigna,HMO,72074,CPT4/HCPCS,Thoracic Spine 4 Plus Views,,% of Charges,657.95
Cigna,HMO,72080,CPT4/HCPCS,Thoracolumbar min 2 Views,,% of Charges,364.35
Cigna,HMO,72081,CPT4/HCPCS,Entire Spine/Scoliosis 1 View,,% of Charges,364.35
Cigna,HMO,72082,CPT4/HCPCS,Entire Spine/Scoliosis 2/3 Vws,,% of Charges,657.95
Cigna,HMO,72083,CPT4/HCPCS,ENTIRE SPINE/SCOLIOSIS 4 OR 5 VWS,,% of Charges,657.95
Cigna,HMO,72084,CPT4/HCPCS,ENTIRE SPINE/SCOLIOSIS 6 VWS,,% of Charges,657.95
Cigna,HMO,72100,CPT4/HCPCS,Lumbar Sp 2 Or 3 Views,,% of Charges,657.95
Cigna,HMO,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,% of Charges,657.95
Cigna,HMO,72114,CPT4/HCPCS,Ls Spine & Bending Views,,% of Charges,657.95
Cigna,HMO,72120,CPT4/HCPCS,Ls Spine Only Bending Views,,% of Charges,657.95
Cigna,HMO,72125,CPT4/HCPCS,Ct Cervical Spine Wo Contrast,,% of Charges,6500.00
Cigna,HMO,72126,CPT4/HCPCS,Ct Cervical Spine W Contrast,,% of Charges,6500.00
Cigna,HMO,72127,CPT4/HCPCS,Ct Cervical Spine W/Wo Contrst,,% of Charges,6500.00
Cigna,HMO,72128,CPT4/HCPCS,Ct Thoracic Spine Wo Contrast,,% of Charges,6500.00
Cigna,HMO,72129,CPT4/HCPCS,Ct Thoracic Spine W Contrast,,% of Charges,6500.00
Cigna,HMO,72130,CPT4/HCPCS,Ct Thoracic Wo/W Contrast,,% of Charges,6500.00
Cigna,HMO,72131,CPT4/HCPCS,Ct Lumbar Spine Wo Contrast,,% of Charges,6500.00
Cigna,HMO,72132,CPT4/HCPCS,Ct Lumbar Spine W Contrast,,% of Charges,6500.00
Cigna,HMO,72133,CPT4/HCPCS,Ct Lumbar Spine W/Wo Contrast,,% of Charges,6500.00
Cigna,HMO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,% of Charges,6500.00
Cigna,HMO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,% of Charges,6500.00
Cigna,HMO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,% of Charges,6500.00
Cigna,HMO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,% of Charges,6500.00
Cigna,HMO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,% of Charges,6500.00
Cigna,HMO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,% of Charges,6500.00
Cigna,HMO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,% of Charges,6500.00
Cigna,HMO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,% of Charges,6500.00
Cigna,HMO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,% of Charges,6500.00
Cigna,HMO,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,% of Charges,657.95
Cigna,HMO,72190,CPT4/HCPCS,Pelvis Judet Views,,% of Charges,657.95
Cigna,HMO,72191,CPT4/HCPCS,Ct Pelvis Angio,,% of Charges,6500.00
Cigna,HMO,72192,CPT4/HCPCS,Ct Pelvis Wo Contrast,,% of Charges,6500.00
Cigna,HMO,72193,CPT4/HCPCS,Ct Pelvis W Contrast,,% of Charges,6500.00
Cigna,HMO,72194,CPT4/HCPCS,Ct Pelvis W/Wo Contrast,,% of Charges,6500.00
Cigna,HMO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,% of Charges,6500.00
Cigna,HMO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,% of Charges,6500.00
Cigna,HMO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,% of Charges,6500.00
Cigna,HMO,722,DRG,Malignancy, male reproductive system w MCC,,Case Rate,43579.50
Cigna,HMO,72202,CPT4/HCPCS,Sacroiliac Joints,,% of Charges,657.95
Cigna,HMO,72220,CPT4/HCPCS,Sacrum & Coccyx,,% of Charges,364.35
Cigna,HMO,72240,CPT4/HCPCS,Cervical Myelogram S&I,,% of Charges,4045.45
Cigna,HMO,72255,CPT4/HCPCS,Thoracic Myelogram S&I,,% of Charges,4045.45
Cigna,HMO,72265,CPT4/HCPCS,Lumbar Myelogram S&I,,% of Charges,4045.45
Cigna,HMO,72270,CPT4/HCPCS,Combined Myelogram S&I,,% of Charges,4045.45
Cigna,HMO,72285,CPT4/HCPCS,Cerv/Thor Diskography S&I,,% of Charges,9541.05
Cigna,HMO,72295,CPT4/HCPCS,Lumbar Diskography S&I,,% of Charges,9541.05
Cigna,HMO,723,DRG,Malignancy, male reproductive system w CC,,Case Rate,27772.05
Cigna,HMO,724,DRG,Malignancy, male reproductive system w/o CC/MCC,,Case Rate,16559.70
Cigna,HMO,725,DRG,Benign prostatic hypertrophy w MCC,,Case Rate,32688.45
Cigna,HMO,726,DRG,Benign prostatic hypertrophy w/o MCC,,Case Rate,18954.15
Cigna,HMO,727,DRG,Inflammation of the male reproductive system w MCC,,Case Rate,36161.55
Cigna,HMO,728,DRG,Inflammation of the male reproductive system w/o MCC,,Case Rate,20489.25
Cigna,HMO,729,DRG,Other male reproductive system diagnoses w CC/MCC,,Case Rate,25622.40
Cigna,HMO,73,DRG,Cranial & peripheral nerve disorders w MCC,,Case Rate,36959.70
Cigna,HMO,730,DRG,Other male reproductive system diagnoses w/o CC/MCC,,Case Rate,14425.35
Cigna,HMO,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,% of Charges,364.35
Cigna,HMO,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,% of Charges,657.95
Cigna,HMO,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,% of Charges,364.35
Cigna,HMO,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,% of Charges,364.35
Cigna,HMO,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,% of Charges,2256.65
Cigna,HMO,73050,CPT4/HCPCS,Acromioclavicular Joints,,% of Charges,364.35
Cigna,HMO,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,% of Charges,364.35
Cigna,HMO,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,% of Charges,364.35
Cigna,HMO,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,% of Charges,364.35
Cigna,HMO,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,% of Charges,2256.65
Cigna,HMO,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,% of Charges,364.35
Cigna,HMO,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,% of Charges,657.95
Cigna,HMO,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,% of Charges,364.35
Cigna,HMO,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,% of Charges,364.35
Cigna,HMO,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,% of Charges,2256.65
Cigna,HMO,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,% of Charges,657.95
Cigna,HMO,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,% of Charges,364.35
Cigna,HMO,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,% of Charges,364.35
Cigna,HMO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,% of Charges,6500.00
Cigna,HMO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,% of Charges,6500.00
Cigna,HMO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,% of Charges,6500.00
Cigna,HMO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,% of Charges,6500.00
Cigna,HMO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,% of Charges,6500.00
Cigna,HMO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,734,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC,,Case Rate,56681.40
Cigna,HMO,735,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC,,Case Rate,36044.25
Cigna,HMO,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,% of Charges,364.35
Cigna,HMO,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,% of Charges,364.35
Cigna,HMO,73521,CPT4/HCPCS,Bilat Hips w or wo Pelvis,,% of Charges,657.95
Cigna,HMO,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,% of Charges,2256.65
Cigna,HMO,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,% of Charges,364.35
Cigna,HMO,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,% of Charges,364.35
Cigna,HMO,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,% of Charges,364.35
Cigna,HMO,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,% of Charges,657.95
Cigna,HMO,73565,CPT4/HCPCS,Ap Bil Knees Standing,,% of Charges,364.35
Cigna,HMO,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,% of Charges,2256.65
Cigna,HMO,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,% of Charges,364.35
Cigna,HMO,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,% of Charges,364.35
Cigna,HMO,736,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w MCC,,Case Rate,108584.10
Cigna,HMO,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,% of Charges,364.35
Cigna,HMO,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,% of Charges,364.35
Cigna,HMO,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,% of Charges,2256.65
Cigna,HMO,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,% of Charges,364.35
Cigna,HMO,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,% of Charges,364.35
Cigna,HMO,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,% of Charges,364.35
Cigna,HMO,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,% of Charges,364.35
Cigna,HMO,737,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w CC,,Case Rate,52484.10
Cigna,HMO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,% of Charges,6500.00
Cigna,HMO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,% of Charges,6500.00
Cigna,HMO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,% of Charges,6500.00
Cigna,HMO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,% of Charges,6500.00
Cigna,HMO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,% of Charges,6500.00
Cigna,HMO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,% of Charges,6500.00
Cigna,HMO,738,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC,,Case Rate,37653.30
Cigna,HMO,739,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w MCC,,Case Rate,97453.35
Cigna,HMO,74,DRG,Cranial & peripheral nerve disorders w/o MCC,,Case Rate,25969.20
Cigna,HMO,740,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w CC,,Case Rate,45900.00
Cigna,HMO,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,% of Charges,364.35
Cigna,HMO,74019,CPT4/HCPCS,Abdomen 2 Views,,% of Charges,657.95
Cigna,HMO,74022,CPT4/HCPCS,Abd Series/Pa Chest,,% of Charges,657.95
Cigna,HMO,741,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC,,Case Rate,32627.25
Cigna,HMO,74150,CPT4/HCPCS,Ct Abdomen Wo Contrast,,% of Charges,6500.00
Cigna,HMO,74160,CPT4/HCPCS,Ct Abdomen W Contrast,,% of Charges,6500.00
Cigna,HMO,74170,CPT4/HCPCS,Ct Abdomen W/Wo Contrast,,% of Charges,6500.00
Cigna,HMO,74174,CPT4/HCPCS,CT Angio Abdomen & Pelvis,,% of Charges,6500.00
Cigna,HMO,74175,CPT4/HCPCS,Ct Abdomen Angio,,% of Charges,6500.00
Cigna,HMO,74176,CPT4/HCPCS,Ct Abd & Pelvis Wo Contrast,,% of Charges,6500.00
Cigna,HMO,74177,CPT4/HCPCS,Ct Abd & Pelvis With Contrast,,% of Charges,6500.00
Cigna,HMO,74178,CPT4/HCPCS,Ct Abd/Pel Wo/W 1/Both Areas,,% of Charges,6500.00
Cigna,HMO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,% of Charges,6500.00
Cigna,HMO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,% of Charges,6500.00
Cigna,HMO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,% of Charges,6500.00
Cigna,HMO,74190,CPT4/HCPCS,Peritoneogram S&I,,% of Charges,2909.35
Cigna,HMO,742,DRG,Uterine & adnexa proc for non-malignancy w CC/MCC,,Case Rate,43783.50
Cigna,HMO,74220,CPT4/HCPCS,Esophogram,,% of Charges,1179.80
Cigna,HMO,74230,CPT4/HCPCS,Modfd Ba Swallow/Video,,% of Charges,657.95
Cigna,HMO,74235,CPT4/HCPCS,Removal Fb Esoph W/Bal S&I,,% of Charges,6500.00
Cigna,HMO,74240,CPT4/HCPCS,UGI Single Contrast,,% of Charges,1179.80
Cigna,HMO,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,% of Charges,1179.80
Cigna,HMO,74248,CPT4/HCPCS,X-RAY SM INT F-THRU STD,,% of Charges,6500.00
Cigna,HMO,74250,CPT4/HCPCS,Small Bowel Series,,% of Charges,657.95
Cigna,HMO,74261,CPT4/HCPCS,Ct Colonography Wo Contrast,,% of Charges,6500.00
Cigna,HMO,74262,CPT4/HCPCS,Ct Colonography W Contrast,,% of Charges,6500.00
Cigna,HMO,74270,CPT4/HCPCS,Ba Enema W/Wo Kub,,% of Charges,1179.80
Cigna,HMO,74280,CPT4/HCPCS,Air Contrast Enema,,% of Charges,1179.80
Cigna,HMO,74283,CPT4/HCPCS,Therapeutic Ba Enema,,% of Charges,1179.80
Cigna,HMO,743,DRG,Uterine & adnexa proc for non-malignancy w/o CC/MCC,,Case Rate,28873.65
Cigna,HMO,74300,CPT4/HCPCS,Surg Cholangiogram S&I,,% of Charges,6500.00
Cigna,HMO,74330,CPT4/HCPCS,Ercp S&I,,% of Charges,6500.00
Cigna,HMO,74340,CPT4/HCPCS,Intro Long Gi W/Flouro,,% of Charges,6500.00
Cigna,HMO,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,% of Charges,6500.00
Cigna,HMO,744,DRG,D&C, conization, laparascopy & tubal interruption w CC/MCC,,Case Rate,45747.00
Cigna,HMO,74400,CPT4/HCPCS,Ivp W/Wo Lams,,% of Charges,1179.80
Cigna,HMO,74415,CPT4/HCPCS,Nephrotomogram,,% of Charges,1179.80
Cigna,HMO,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,% of Charges,2256.65
Cigna,HMO,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,% of Charges,2256.65
Cigna,HMO,74430,CPT4/HCPCS,Cystogram S&I,,% of Charges,2256.65
Cigna,HMO,74450,CPT4/HCPCS,Retrograde Urethrogram S&I,,% of Charges,1348.35
Cigna,HMO,74455,CPT4/HCPCS,Voiding Cystogram S&I,,% of Charges,1348.35
Cigna,HMO,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,% of Charges,2909.35
Cigna,HMO,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,% of Charges,10174.25
Cigna,HMO,745,DRG,D&C, conization, laparascopy & tubal interruption w/o CC/MCC,,Case Rate,29847.75
Cigna,HMO,746,DRG,Vagina, cervix & vulva procedures w CC/MCC,,Case Rate,41039.70
Cigna,HMO,747,DRG,Vagina, cervix & vulva procedures w/o CC/MCC,,Case Rate,23919.00
Cigna,HMO,74740,CPT4/HCPCS,Hysterosalpingogram S&I,,% of Charges,1348.35
Cigna,HMO,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,% of Charges,6500.00
Cigna,HMO,748,DRG,Female reproductive system reconstructive procedures,,Case Rate,34381.65
Cigna,HMO,749,DRG,Other female reproductive system O.R. procedures w CC/MCC,,Case Rate,69038.70
Cigna,HMO,75,DRG,Viral meningitis w CC/MCC,,Case Rate,41463.00
Cigna,HMO,750,DRG,Other female reproductive system O.R. procedures w/o CC/MCC,,Case Rate,37380.45
Cigna,HMO,754,DRG,Malignancy, female reproductive system w MCC,,Case Rate,46435.50
Cigna,HMO,755,DRG,Malignancy, female reproductive system w CC,,Case Rate,28753.80
Cigna,HMO,75571,CPT4/HCPCS,Ct Heart Cacs Wo Contrast,,% of Charges,6500.00
Cigna,HMO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,% of Charges,6500.00
Cigna,HMO,75574,CPT4/HCPCS,Cta Heart Complete,,% of Charges,6500.00
Cigna,HMO,756,DRG,Malignancy, female reproductive system w/o CC/MCC,,Case Rate,23360.55
Cigna,HMO,75605,CPT4/HCPCS,Thoracic Aortogram S&I,,% of Charges,25594.35
Cigna,HMO,75625,CPT4/HCPCS,Abd Aortogram S&I,,% of Charges,15447.85
Cigna,HMO,75630,CPT4/HCPCS,Abd Aortogram W/Runoffs S&I,,% of Charges,15447.85
Cigna,HMO,75635,CPT4/HCPCS,Cta Aorta-Ilio,,% of Charges,6500.00
Cigna,HMO,757,DRG,Infections, female reproductive system w MCC,,Case Rate,38813.55
Cigna,HMO,75705,CPT4/HCPCS,IR Spinal Select,,% of Charges,25594.35
Cigna,HMO,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,% of Charges,15447.85
Cigna,HMO,75716,CPT4/HCPCS,Ext Angio S&I Bilateral,,% of Charges,15447.85
Cigna,HMO,75726,CPT4/HCPCS,Visceral Angio Sel/Supr/Se S&I,,% of Charges,25594.35
Cigna,HMO,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,% of Charges,25594.35
Cigna,HMO,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,% of Charges,15447.85
Cigna,HMO,75743,CPT4/HCPCS,Pulmonary Angio Sel Bil S&I,,% of Charges,15447.85
Cigna,HMO,75746,CPT4/HCPCS,Pulm Angio Non-Sel S&I,,% of Charges,6395.65
Cigna,HMO,75756,CPT4/HCPCS,IR Internal Mammary S + I,,% of Charges,15447.85
Cigna,HMO,75774,CPT4/HCPCS,Angio Add S&I,,% of Charges,6500.00
Cigna,HMO,75791,CPT4/HCPCS,Alternate Access Av Shunt Right,,% of Charges,6500.00
Cigna,HMO,758,DRG,Infections, female reproductive system w CC,,Case Rate,24658.50
Cigna,HMO,75809,CPT4/HCPCS,Shuntogram S&I,,% of Charges,657.95
Cigna,HMO,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,% of Charges,3625.90
Cigna,HMO,75822,CPT4/HCPCS,Ext Venogram S&I Bilateral,,% of Charges,6395.65
Cigna,HMO,75825,CPT4/HCPCS,Inferior Venacavagram S&I,,% of Charges,15447.85
Cigna,HMO,75827,CPT4/HCPCS,Superior Venacavagram S&I,,% of Charges,3625.90
Cigna,HMO,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,% of Charges,15447.85
Cigna,HMO,75833,CPT4/HCPCS,Renal Venogram S&I Bilateral,,% of Charges,15447.85
Cigna,HMO,75860,CPT4/HCPCS,VEIN X-RAY NECK,,% of Charges,15447.85
Cigna,HMO,75872,CPT4/HCPCS,Epidural Venogram,,% of Charges,3625.90
Cigna,HMO,75885,CPT4/HCPCS,Perchepporto W Hemo Eva S&I,,% of Charges,15447.85
Cigna,HMO,75889,CPT4/HCPCS,Hepatic Veno Hemodyn Ev S&I,,% of Charges,15447.85
Cigna,HMO,75893,CPT4/HCPCS,Venous Sampling S&I,,% of Charges,25594.35
Cigna,HMO,75894,CPT4/HCPCS,Us Guide Emboliz S&I,,% of Charges,6500.00
Cigna,HMO,75898,CPT4/HCPCS,Angio F/U S&I,,% of Charges,6395.65
Cigna,HMO,759,DRG,Infections, female reproductive system w/o CC/MCC,,Case Rate,17421.60
Cigna,HMO,75901,CPT4/HCPCS,Removal Fibrinsheath Obstr S&I,,% of Charges,6500.00
Cigna,HMO,75902,CPT4/HCPCS,Removal Ic Obstruction S&I,,% of Charges,6500.00
Cigna,HMO,75952,CPT4/HCPCS,ENDOVASC REPAIR ABDOM AORTA,,% of Charges,6500.00
Cigna,HMO,75953,CPT4/HCPCS,ABDOM ANEURYSM ENDOVAS RPR,,% of Charges,6500.00
Cigna,HMO,75954,CPT4/HCPCS,IR Iliac Aneurysm Endo Rpr S+I - Inactive,,% of Charges,6500.00
Cigna,HMO,75962,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,% of Charges,6500.00
Cigna,HMO,75964,CPT4/HCPCS,Pta Other Addl Peripheral S&I,,% of Charges,6500.00
Cigna,HMO,75966,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,% of Charges,6500.00
Cigna,HMO,75968,CPT4/HCPCS,Pta Addl Visceral Ves S&I,,% of Charges,6500.00
Cigna,HMO,75978,CPT4/HCPCS,Pta Venous S&I Right,,% of Charges,6500.00
Cigna,HMO,75984,CPT4/HCPCS,Chng Perc/Cath S&I,,% of Charges,6500.00
Cigna,HMO,75989,CPT4/HCPCS,Ct Drain/Speci Coll S&I,,% of Charges,6500.00
Cigna,HMO,76,DRG,Viral meningitis w/o CC/MCC,,Case Rate,25012.95
Cigna,HMO,760,DRG,Menstrual & other female reproductive system disorders w CC/MCC,,Case Rate,23526.30
Cigna,HMO,76000,CPT4/HCPCS,Fluoroscopy Up To 1Hr,,% of Charges,1348.35
Cigna,HMO,76010,CPT4/HCPCS,Nose-Rectum Child Iv,,% of Charges,364.35
Cigna,HMO,76080,CPT4/HCPCS,Abscess-Fistula-Sinus Tract,,% of Charges,2909.35
Cigna,HMO,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,% of Charges,2909.35
Cigna,HMO,761,DRG,Menstrual & other female reproductive system disorders w/o CC/MCC,,Case Rate,15045.00
Cigna,HMO,76100,CPT4/HCPCS,Lams/Tomography,,% of Charges,657.95
Cigna,HMO,76120,CPT4/HCPCS,Cine/Videoradiography,,% of Charges,657.95
Cigna,HMO,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,% of Charges,6500.00
Cigna,HMO,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,% of Charges,6500.00
Cigna,HMO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,% of Charges,6500.00
Cigna,HMO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,% of Charges,6500.00
Cigna,HMO,76497,CPT4/HCPCS,CT PROCEDURE,,% of Charges,6500.00
Cigna,HMO,76499,CPT4/HCPCS,Cs Venogram W/O Implant,,% of Charges,364.35
Cigna,HMO,765,DRG,Cesarean section w CC/MCC,,Case Rate,5500.00
Cigna,HMO,76506,CPT4/HCPCS,Neo-Natal Cranial Sonogram,,% of Charges,657.95
Cigna,HMO,76536,CPT4/HCPCS,Us Soft Tissue Head/Neck,,% of Charges,657.95
Cigna,HMO,766,DRG,Cesarean section w/o CC/MCC,,Case Rate,5500.00
Cigna,HMO,76604,CPT4/HCPCS,US Limited Chest,,% of Charges,657.95
Cigna,HMO,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,% of Charges,657.95
Cigna,HMO,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,% of Charges,364.35
Cigna,HMO,767,DRG,Vaginal delivery w sterilization &/or D&C,,Case Rate,5500.00
Cigna,HMO,76700,CPT4/HCPCS,Abdomen Sonogram,,% of Charges,657.95
Cigna,HMO,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,% of Charges,657.95
Cigna,HMO,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,% of Charges,657.95
Cigna,HMO,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,% of Charges,657.95
Cigna,HMO,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,% of Charges,657.95
Cigna,HMO,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,Case Rate,5500.00
Cigna,HMO,76800,CPT4/HCPCS,Us Spinal Canal,,% of Charges,657.95
Cigna,HMO,76801,CPT4/HCPCS,Ob Us <14 Wks,,% of Charges,657.95
Cigna,HMO,76802,CPT4/HCPCS,Ob <14Wks Ea Addl Gestation,,% of Charges,6500.00
Cigna,HMO,76805,CPT4/HCPCS,Ob Us 2Nd/3Rd Trimester,,% of Charges,657.95
Cigna,HMO,76810,CPT4/HCPCS,Ob Us 2Nd/3Rd Trim Ea Add Gest,,% of Charges,6500.00
Cigna,HMO,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,% of Charges,657.95
Cigna,HMO,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,% of Charges,657.95
Cigna,HMO,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,% of Charges,657.95
Cigna,HMO,76818,CPT4/HCPCS,Bpp With Nst,,% of Charges,657.95
Cigna,HMO,76819,CPT4/HCPCS,Bpp W/O Nst,,% of Charges,657.95
Cigna,HMO,76830,CPT4/HCPCS,Us Nonob Transvaginal,,% of Charges,657.95
Cigna,HMO,76831,CPT4/HCPCS,Hysterosonography,,% of Charges,1348.35
Cigna,HMO,76856,CPT4/HCPCS,Pelvic Nonob Us,,% of Charges,657.95
Cigna,HMO,76857,CPT4/HCPCS,Fu/Limited Pelvic Us,,% of Charges,657.95
Cigna,HMO,76870,CPT4/HCPCS,Scrotal Sonogram,,% of Charges,657.95
Cigna,HMO,76872,CPT4/HCPCS,Us Transrectal,,% of Charges,657.95
Cigna,HMO,76881,CPT4/HCPCS,Us Extremity Complete Nonvasc,,% of Charges,657.95
Cigna,HMO,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,% of Charges,657.95
Cigna,HMO,76885,CPT4/HCPCS,Us Infant Hips W/Radiologist,,% of Charges,364.35
Cigna,HMO,76886,CPT4/HCPCS,Us Infant Hips No Radiologist,,% of Charges,364.35
Cigna,HMO,769,DRG,Postpartum & post abortion diagnoses w O.R. procedure,,Case Rate,41320.20
Cigna,HMO,76936,CPT4/HCPCS,Us Guide Compression Repair,,% of Charges,1475.55
Cigna,HMO,76937,CPT4/HCPCS,CVA US Guidance,,% of Charges,6500.00
Cigna,HMO,76940,CPT4/HCPCS,US Ablation Guidance,,% of Charges,6500.00
Cigna,HMO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,% of Charges,1623.05
Cigna,HMO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,% of Charges,669.50
Cigna,HMO,76981,CPT4/HCPCS,US Elastography Organ,,% of Charges,657.95
Cigna,HMO,76982,CPT4/HCPCS,US Elastography Tissue Lesion,,% of Charges,657.95
Cigna,HMO,76983,CPT4/HCPCS,US Ea Addl Elastography Lesion,,% of Charges,6500.00
Cigna,HMO,76998,CPT4/HCPCS,Us Guide Intraoperative S&I,,% of Charges,6500.00
Cigna,HMO,76999,CPT4/HCPCS,US Surg Specimen,,% of Charges,364.35
Cigna,HMO,77,DRG,Hypertensive encephalopathy w MCC,,Case Rate,39063.45
Cigna,HMO,770,DRG,Abortion w D&C, aspiration curettage or hysterotomy,,Case Rate,22646.55
Cigna,HMO,77001,CPT4/HCPCS,Cva Fluoro Guidance,,% of Charges,6500.00
Cigna,HMO,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,% of Charges,6500.00
Cigna,HMO,77003,CPT4/HCPCS,Flur Guide Ndl Plcmnt Spine,,% of Charges,6500.00
Cigna,HMO,77011,CPT4/HCPCS,Ct Guide Stereotactic Loc,,% of Charges,6500.00
Cigna,HMO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,% of Charges,6500.00
Cigna,HMO,77013,CPT4/HCPCS,CT Ablation Guidance,,% of Charges,6500.00
Cigna,HMO,77014,CPT4/HCPCS,Ct Guide Plcmnt Rad Tx Fields,,% of Charges,6500.00
Cigna,HMO,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,% of Charges,6500.00
Cigna,HMO,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,% of Charges,6500.00
Cigna,HMO,77051,CPT4/HCPCS,Cad Diagnostic Mammography-Inactive,,% of Charges,533.55
Cigna,HMO,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,% of Charges,1348.35
Cigna,HMO,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,% of Charges,1348.35
Cigna,HMO,77063,CPT4/HCPCS,Screening Tomosynthesis,,% of Charges,135.45
Cigna,HMO,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,% of Charges,504.55
Cigna,HMO,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,% of Charges,645.80
Cigna,HMO,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,% of Charges,533.55
Cigna,HMO,77071,CPT4/HCPCS,Stress Views Any Joint,,% of Charges,364.35
Cigna,HMO,77072,CPT4/HCPCS,Bone Age Studies,,% of Charges,657.95
Cigna,HMO,77073,CPT4/HCPCS,Bone Length Studies,,% of Charges,657.95
Cigna,HMO,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,% of Charges,657.95
Cigna,HMO,77075,CPT4/HCPCS,Osseous Survey Complete,,% of Charges,657.95
Cigna,HMO,77076,CPT4/HCPCS,Infant Osseous Survey,,% of Charges,657.95
Cigna,HMO,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,% of Charges,657.95
Cigna,HMO,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,% of Charges,657.95
Cigna,HMO,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,% of Charges,364.35
Cigna,HMO,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,% of Charges,657.95
Cigna,HMO,77280,CPT4/HCPCS,Simulation Aided Simple,,% of Charges,1369.55
Cigna,HMO,77285,CPT4/HCPCS,Simulation Aided Intermediate,,% of Charges,2829.45
Cigna,HMO,77290,CPT4/HCPCS,Simulation Aided Complex,,% of Charges,3642.60
Cigna,HMO,77293,CPT4/HCPCS,4D Resp Motion Management,,% of Charges,2126.15
Cigna,HMO,77295,CPT4/HCPCS,3D SBRT SRS Planning,,% of Charges,16040.05
Cigna,HMO,77300,CPT4/HCPCS,3D/IMRT/ Basic Dosimetry,,% of Charges,1015.30
Cigna,HMO,77301,CPT4/HCPCS,IMRT Planning,,% of Charges,17206.15
Cigna,HMO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,% of Charges,4446.65
Cigna,HMO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,% of Charges,7172.10
Cigna,HMO,77316,CPT4/HCPCS,Brachytherapy Isodose-Simp,,% of Charges,2797.60
Cigna,HMO,77317,CPT4/HCPCS,Brachytherapy Isodose Plan-I,,% of Charges,3622.45
Cigna,HMO,77318,CPT4/HCPCS,Brachytherapy Isodose-Comp,,% of Charges,4841.85
Cigna,HMO,77321,CPT4/HCPCS,Special Teletherapy Beam Plan,,% of Charges,2842.45
Cigna,HMO,77331,CPT4/HCPCS,Spec Dosim TLD/Micro,,% of Charges,486.20
Cigna,HMO,77332,CPT4/HCPCS,Treatment Devices Simple,,% of Charges,1014.00
Cigna,HMO,77333,CPT4/HCPCS,Treatment Devices Intermediate,,% of Charges,1448.20
Cigna,HMO,77334,CPT4/HCPCS,Treatment Devices Complex,,% of Charges,2557.10
Cigna,HMO,77336,CPT4/HCPCS,Contd Med Physics Per 5 Tx,,% of Charges,1593.80
Cigna,HMO,77338,CPT4/HCPCS,Devices MLC,,% of Charges,12726.35
Cigna,HMO,77370,CPT4/HCPCS,Special Med Rad Physics,,% of Charges,1861.60
Cigna,HMO,77372,CPT4/HCPCS,SRS Cranial 1 Tx,,% of Charges,27390.35
Cigna,HMO,77373,CPT4/HCPCS,SRT Body 1-5 Tx,,% of Charges,11764.35
Cigna,HMO,77385,CPT4/HCPCS,IMRT TX Breast & Prostate-Simp,,% of Charges,11173.50
Cigna,HMO,77386,CPT4/HCPCS,IMRT TX All Other-Comp,,% of Charges,13037.05
Cigna,HMO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,% of Charges,656.50
Cigna,HMO,774,DRG,Vaginal delivery w complicating diagnoses,,Case Rate,5500.00
Cigna,HMO,77402,CPT4/HCPCS,Radiation TX - Simple,,% of Charges,1123.85
Cigna,HMO,77407,CPT4/HCPCS,Radiation TX-Interm,,% of Charges,1530.10
Cigna,HMO,77412,CPT4/HCPCS,Radiation TX-Comp & Electron,,% of Charges,1686.75
Cigna,HMO,77417,CPT4/HCPCS,Port Films Weekly,,% of Charges,351.65
Cigna,HMO,77470,CPT4/HCPCS,Special Trt Procedure,,% of Charges,5604.30
Cigna,HMO,775,DRG,Vaginal delivery w/o complicating diagnoses,,Case Rate,5500.00
Cigna,HMO,776,DRG,Postpartum & post abortion diagnoses w/o O.R. procedure,,Case Rate,19604.40
Cigna,HMO,77750,CPT4/HCPCS,Infusion Radioelement,,% of Charges,881.40
Cigna,HMO,77770,CPT4/HCPCS,HDR 1 Channel,,% of Charges,10288.85
Cigna,HMO,77771,CPT4/HCPCS,HDR 2-12 Channels,,% of Charges,10288.85
Cigna,HMO,77772,CPT4/HCPCS,HDR >12 Channels,,% of Charges,10288.85
Cigna,HMO,77778,CPT4/HCPCS,Interstit Implant-C,,% of Charges,2313.35
Cigna,HMO,77789,CPT4/HCPCS,Surface Appl Radioelement,,% of Charges,183.95
Cigna,HMO,77790,CPT4/HCPCS,Supervision/Handle/Loading Rad Mat,,% of Charges,198.25
Cigna,HMO,779,DRG,Abortion w/o D&C,,Case Rate,26530.20
Cigna,HMO,78,DRG,Hypertensive encephalopathy w CC,,Case Rate,24199.50
Cigna,HMO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,5500.00
Cigna,HMO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,5500.00
Cigna,HMO,78459,CPT4/HCPCS,PET MYOCARD VIABILITY,,% of Charges,6500.00
Cigna,HMO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,5500.00
Cigna,HMO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,5500.00
Cigna,HMO,78608,CPT4/HCPCS,Pet Brain Metabolic,,% of Charges,6500.00
Cigna,HMO,78609,CPT4/HCPCS,Pet Brain Perfusion,,% of Charges,6500.00
Cigna,HMO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,5500.00
Cigna,HMO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,5500.00
Cigna,HMO,78814,CPT4/HCPCS,Pet/Ct Tumorimag Limited Area,,% of Charges,6500.00
Cigna,HMO,78815,CPT4/HCPCS,Pet/Ct Limited Skull - Thigh,,% of Charges,6500.00
Cigna,HMO,78816,CPT4/HCPCS,Pet/Ct Limited Whole Body,,% of Charges,6500.00
Cigna,HMO,789,DRG,Neonates, died or transferred to another acute care facility,,Case Rate,43821.75
Cigna,HMO,79,DRG,Hypertensive encephalopathy w/o CC/MCC,,Case Rate,18533.40
Cigna,HMO,790,DRG,Extreme immaturity or respiratory distress syndrome, neonate,,Case Rate,144511.05
Cigna,HMO,791,DRG,Prematurity w major problems,,Case Rate,98695.20
Cigna,HMO,79101,CPT4/HCPCS,IV Radiopharm Therapy,,% of Charges,2503.15
Cigna,HMO,792,DRG,Prematurity w/o major problems,,Case Rate,59550.15
Cigna,HMO,793,DRG,Full term neonate w major problems,,Case Rate,101380.35
Cigna,HMO,794,DRG,Neonate w other significant problems,,Case Rate,35883.60
Cigna,HMO,795,DRG,Normal newborn,,Case Rate,4857.75
Cigna,HMO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,5500.00
Cigna,HMO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,5500.00
Cigna,HMO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,5500.00
Cigna,HMO,799,DRG,Splenectomy w MCC,,Case Rate,131169.45
Cigna,HMO,8,DRG,Simultaneous pancreas/kidney transplant,,Case Rate,138383.40
Cigna,HMO,80,DRG,Nontraumatic stupor & coma w MCC,,Case Rate,53346.00
Cigna,HMO,800,DRG,Splenectomy w CC,,Case Rate,75260.70
Cigna,HMO,801,DRG,Splenectomy w/o CC/MCC,,Case Rate,42929.25
Cigna,HMO,802,DRG,Other O.R. proc of the blood & blood forming organs w MCC,,Case Rate,94571.85
Cigna,HMO,803,DRG,Other O.R. proc of the blood & blood forming organs w CC,,Case Rate,48062.40
Cigna,HMO,804,DRG,Other O.R. proc of the blood & blood forming organs w/o CC/MCC,,Case Rate,34787.10
Cigna,HMO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,5500.00
Cigna,HMO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,5500.00
Cigna,HMO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,5500.00
Cigna,HMO,808,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w MCC,,Case Rate,55536.45
Cigna,HMO,809,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w CC,,Case Rate,31153.35
Cigna,HMO,81,DRG,Nontraumatic stupor & coma w/o MCC,,Case Rate,19686.00
Cigna,HMO,810,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC,,Case Rate,24497.85
Cigna,HMO,811,DRG,Red blood cell disorders w MCC,,Case Rate,35128.80
Cigna,HMO,812,DRG,Red blood cell disorders w/o MCC,,Case Rate,22432.35
Cigna,HMO,813,DRG,Coagulation disorders,,Case Rate,39389.85
Cigna,HMO,814,DRG,Reticuloendothelial & immunity disorders w MCC,,Case Rate,48215.40
Cigna,HMO,815,DRG,Reticuloendothelial & immunity disorders w CC,,Case Rate,25308.75
Cigna,HMO,816,DRG,Reticuloendothelial & immunity disorders w/o CC/MCC,,Case Rate,16852.95
Cigna,HMO,817,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC,,Case Rate,58695.90
Cigna,HMO,818,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC,,Case Rate,33570.75
Cigna,HMO,819,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC,,Case Rate,25446.45
Cigna,HMO,82,DRG,Traumatic stupor & coma, coma >1 hr w MCC,,Case Rate,57581.55
Cigna,HMO,820,DRG,Lymphoma & leukemia w major O.R. procedure w MCC,,Case Rate,145026.15
Cigna,HMO,821,DRG,Lymphoma & leukemia w major O.R. procedure w CC,,Case Rate,54955.05
Cigna,HMO,822,DRG,Lymphoma & leukemia w major O.R. procedure w/o CC/MCC,,Case Rate,31915.80
Cigna,HMO,823,DRG,Lymphoma & non-acute leukemia w other O.R. proc w MCC,,Case Rate,114676.05
Cigna,HMO,824,DRG,Lymphoma & non-acute leukemia w other O.R. proc w CC,,Case Rate,60248.85
Cigna,HMO,825,DRG,Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC,,Case Rate,35717.85
Cigna,HMO,826,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC,,Case Rate,128438.40
Cigna,HMO,827,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC,,Case Rate,63688.80
Cigna,HMO,828,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o CC/MCC,,Case Rate,42781.35
Cigna,HMO,829,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC,,Case Rate,81745.35
Cigna,HMO,83,DRG,Traumatic stupor & coma, coma >1 hr w CC,,Case Rate,34213.35
Cigna,HMO,830,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w/o CC/MCC,,Case Rate,37650.75
Cigna,HMO,831,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC,,Case Rate,28588.05
Cigna,HMO,832,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC,,Case Rate,19884.90
Cigna,HMO,833,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC,,Case Rate,13668.00
Cigna,HMO,834,DRG,Acute leukemia w/o major O.R. procedure w MCC,,Case Rate,154277.55
Cigna,HMO,835,DRG,Acute leukemia w/o major O.R. procedure w CC,,Case Rate,53899.35
Cigna,HMO,836,DRG,Acute leukemia w/o major O.R. procedure w/o CC/MCC,,Case Rate,29824.80
Cigna,HMO,837,DRG,Chemo w acute leukemia as sdx or w high dose chemo agent w MCC,,Case Rate,145329.60
Cigna,HMO,838,DRG,Chemo w acute leukemia as sdx w CC or high dose chemo agent,,Case Rate,57599.40
Cigna,HMO,839,DRG,Chemo w acute leukemia as sdx w/o CC/MCC,,Case Rate,37900.65
Cigna,HMO,84,DRG,Traumatic stupor & coma, coma >1 hr w/o CC/MCC,,Case Rate,23057.10
Cigna,HMO,840,DRG,Lymphoma & non-acute leukemia w MCC,,Case Rate,82000.35
Cigna,HMO,841,DRG,Lymphoma & non-acute leukemia w CC,,Case Rate,41330.40
Cigna,HMO,842,DRG,Lymphoma & non-acute leukemia w/o CC/MCC,,Case Rate,27930.15
Cigna,HMO,843,DRG,Other myeloprolif dis or poorly diff neopl diag w MCC,,Case Rate,48523.95
Cigna,HMO,844,DRG,Other myeloprolif dis or poorly diff neopl diag w CC,,Case Rate,30102.75
Cigna,HMO,845,DRG,Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC,,Case Rate,21608.70
Cigna,HMO,846,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w MCC,,Case Rate,68082.45
Cigna,HMO,847,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w CC,,Case Rate,34047.60
Cigna,HMO,848,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC,,Case Rate,26239.50
Cigna,HMO,849,DRG,Radiotherapy,,Case Rate,63431.25
Cigna,HMO,85,DRG,Traumatic stupor & coma, coma <1 hr w MCC,,Case Rate,58813.20
Cigna,HMO,853,DRG,Infectious & parasitic diseases w O.R. procedure w MCC,,Case Rate,126087.30
Cigna,HMO,854,DRG,Infectious & parasitic diseases w O.R. procedure w CC,,Case Rate,53407.20
Cigna,HMO,855,DRG,Infectious & parasitic diseases w O.R. procedure w/o CC/MCC,,Case Rate,38122.50
Cigna,HMO,856,DRG,Postoperative or post-traumatic infections w O.R. proc w MCC,,Case Rate,115915.35
Cigna,HMO,857,DRG,Postoperative or post-traumatic infections w O.R. proc w CC,,Case Rate,51884.85
Cigna,HMO,858,DRG,Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC,,Case Rate,34384.20
Cigna,HMO,86,DRG,Traumatic stupor & coma, coma <1 hr w CC,,Case Rate,32458.95
Cigna,HMO,862,DRG,Postoperative & post-traumatic infections w MCC,,Case Rate,47909.40
Cigna,HMO,863,DRG,Postoperative & post-traumatic infections w/o MCC,,Case Rate,24923.70
Cigna,HMO,864,DRG,Fever of unknown origin,,Case Rate,22312.50
Cigna,HMO,865,DRG,Viral illness w MCC,,Case Rate,37711.95
Cigna,HMO,866,DRG,Viral illness w/o MCC,,Case Rate,21348.60
Cigna,HMO,867,DRG,Other infectious & parasitic diseases diagnoses w MCC,,Case Rate,56852.25
Cigna,HMO,868,DRG,Other infectious & parasitic diseases diagnoses w CC,,Case Rate,26989.20
Cigna,HMO,869,DRG,Other infectious & parasitic diseases diagnoses w/o CC/MCC,,Case Rate,18513.00
Cigna,HMO,87,DRG,Traumatic stupor & coma, coma <1 hr w/o CC/MCC,,Case Rate,21996.30
Cigna,HMO,870,DRG,Septicemia w MV 96+ hours,,Case Rate,163832.40
Cigna,HMO,871,DRG,Septicemia w/o MV 96+ hours w MCC,,Case Rate,47639.10
Cigna,HMO,872,DRG,Septicemia w/o MV 96+ hours w/o MCC,,Case Rate,26050.80
Cigna,HMO,876,DRG,O.R. procedure w principal diagnoses of mental illness,,Case Rate,83163.15
Cigna,HMO,88,DRG,Concussion w MCC,,Case Rate,37212.15
Cigna,HMO,880,DRG,Acute adjustment reaction & psychosocial dysfunction,,Case Rate,22021.80
Cigna,HMO,881,DRG,Depressive neuroses,,Case Rate,20435.70
Cigna,HMO,882,DRG,Neuroses except depressive,,Case Rate,20986.50
Cigna,HMO,883,DRG,Disorders of personality & impulse control,,Case Rate,40246.65
Cigna,HMO,884,DRG,Organic disturbances & mental retardation,,Case Rate,36816.90
Cigna,HMO,885,DRG,Psychoses,,Case Rate,31546.05
Cigna,HMO,886,DRG,Behavioral & developmental disorders,,Case Rate,31148.25
Cigna,HMO,887,DRG,Other mental disorder diagnoses,,Case Rate,27506.85
Cigna,HMO,89,DRG,Concussion w CC,,Case Rate,27060.60
Cigna,HMO,89220,CPT4/HCPCS,Sputum Induction,,% of Charges,315.25
Cigna,HMO,894,DRG,Alcohol/drug abuse or dependence, left ama,,Case Rate,13961.25
Cigna,HMO,895,DRG,Alcohol/drug abuse or dependence w rehabilitation therapy,,Case Rate,40596.00
Cigna,HMO,896,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC,,Case Rate,45313.50
Cigna,HMO,897,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC,,Case Rate,21050.25
Cigna,HMO,90,DRG,Concussion w/o CC/MCC,,Case Rate,21797.40
Cigna,HMO,901,DRG,Wound debridements for injuries w MCC,,Case Rate,108686.10
Cigna,HMO,902,DRG,Wound debridements for injuries w CC,,Case Rate,50041.20
Cigna,HMO,903,DRG,Wound debridements for injuries w/o CC/MCC,,Case Rate,28927.20
Cigna,HMO,904,DRG,Skin grafts for injuries w CC/MCC,,Case Rate,94895.70
Cigna,HMO,905,DRG,Skin grafts for injuries w/o CC/MCC,,Case Rate,41868.45
Cigna,HMO,906,DRG,Hand procedures for injuries,,Case Rate,45741.90
Cigna,HMO,907,DRG,Other O.R. procedures for injuries w MCC,,Case Rate,100906.05
Cigna,HMO,908,DRG,Other O.R. procedures for injuries w CC,,Case Rate,52030.20
Cigna,HMO,909,DRG,Other O.R. procedures for injuries w/o CC/MCC,,Case Rate,35059.95
Cigna,HMO,90901,CPT4/HCPCS,Biofeedback,,% of Charges,207.35
Cigna,HMO,90911,CPT4/HCPCS,Biofeedback UI,,% of Charges,287.30
Cigna,HMO,90912,CPT4/HCPCS,Biofeedback UI init 15 mins,,% of Charges,286.65
Cigna,HMO,90913,CPT4/HCPCS,Biofeedback UI addl 15 mins,,% of Charges,208.65
Cigna,HMO,91,DRG,Other disorders of nervous system w MCC,,Case Rate,42046.95
Cigna,HMO,913,DRG,Traumatic injury w MCC,,Case Rate,41728.20
Cigna,HMO,914,DRG,Traumatic injury w/o MCC,,Case Rate,22659.30
Cigna,HMO,915,DRG,Allergic reactions w MCC,,Case Rate,43288.80
Cigna,HMO,916,DRG,Allergic reactions w/o MCC,,Case Rate,16761.15
Cigna,HMO,917,DRG,Poisoning & toxic effects of drugs w MCC,,Case Rate,37676.25
Cigna,HMO,918,DRG,Poisoning & toxic effects of drugs w/o MCC,,Case Rate,20173.05
Cigna,HMO,919,DRG,Complications of treatment w MCC,,Case Rate,46777.20
Cigna,HMO,92,DRG,Other disorders of nervous system w CC,,Case Rate,25145.55
Cigna,HMO,920,DRG,Complications of treatment w CC,,Case Rate,26196.15
Cigna,HMO,921,DRG,Complications of treatment w/o CC/MCC,,Case Rate,17630.70
Cigna,HMO,922,DRG,Other injury, poisoning & toxic effect diag w MCC,,Case Rate,40483.80
Cigna,HMO,923,DRG,Other injury, poisoning & toxic effect diag w/o MCC,,Case Rate,23725.20
Cigna,HMO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,% of Charges,521.30
Cigna,HMO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,% of Charges,762.45
Cigna,HMO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,% of Charges,528.45
Cigna,HMO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,% of Charges,508.30
Cigna,HMO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,% of Charges,657.80
Cigna,HMO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,% of Charges,320.45
Cigna,HMO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,% of Charges,934.05
Cigna,HMO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,% of Charges,839.15
Cigna,HMO,927,DRG,Extensive burns or full thickness burns w MV 96+ hrs w skin graft,,Case Rate,536287.95
Cigna,HMO,928,DRG,Full thickness burn w skin graft or inhal inj w CC/MCC,,Case Rate,166237.05
Cigna,HMO,929,DRG,Full thickness burn w skin graft or inhal inj w/o CC/MCC,,Case Rate,76726.95
Cigna,HMO,92938,CPT4/HCPCS,Add Vessel W/Bare Metal Grafts,,% of Charges,7966.00
Cigna,HMO,93,DRG,Other disorders of nervous system w/o CC/MCC,,Case Rate,19923.15
Cigna,HMO,933,DRG,Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft,,Case Rate,57568.80
Cigna,HMO,93355,CPT4/HCPCS,TEE Intraoperative LAA implant,,% of Charges,7966.00
Cigna,HMO,934,DRG,Full thickness burn w/o skin grft or inhal inj,,Case Rate,49401.15
Cigna,HMO,93456,CPT4/HCPCS,Cath Plcmnt RHC, Coro Angio,,% of Charges,7966.00
Cigna,HMO,935,DRG,Non-extensive burns,,Case Rate,49299.15
Cigna,HMO,93580,CPT4/HCPCS,PFO Closure with Implant,,% of Charges,7966.00
Cigna,HMO,93724,CPT4/HCPCS,Non-Invasive Prog Stim Via PPM,,% of Charges,7966.00
Cigna,HMO,93799,CPT4/HCPCS,CARDIOVASCULAR PROCEDURE,,% of Charges,7966.00
Cigna,HMO,939,DRG,O.R. proc w diagnoses of other contact w health services w MCC,,Case Rate,86348.10
Cigna,HMO,94,DRG,Bacterial & tuberculous infections of nervous system w MCC,,Case Rate,92644.05
Cigna,HMO,940,DRG,O.R. proc w diagnoses of other contact w health services w CC,,Case Rate,56548.80
Cigna,HMO,94002,CPT4/HCPCS,Initial Ventilator Day,,% of Charges,10429.25
Cigna,HMO,94003,CPT4/HCPCS,Ventilator Daily,,% of Charges,10067.85
Cigna,HMO,941,DRG,O.R. proc w diagnoses of other contact w health services w/o CC/MCC,,Case Rate,49079.85
Cigna,HMO,945,DRG,Rehabilitation w CC/MCC,,Case Rate,37859.85
Cigna,HMO,946,DRG,Rehabilitation w/o CC/MCC,,Case Rate,28743.60
Cigna,HMO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,% of Charges,315.25
Cigna,HMO,94645,CPT4/HCPCS,Addition Hr Cont. Aerosol,,% of Charges,204.75
Cigna,HMO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,% of Charges,1080.95
Cigna,HMO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,% of Charges,481.00
Cigna,HMO,94667,CPT4/HCPCS,Pd & Percussion Treatment,,% of Charges,327.60
Cigna,HMO,947,DRG,Signs & symptoms w MCC,,Case Rate,30347.55
Cigna,HMO,948,DRG,Signs & symptoms w/o MCC,,Case Rate,20032.80
Cigna,HMO,949,DRG,Aftercare w CC/MCC,,Case Rate,28231.05
Cigna,HMO,95,DRG,Bacterial & tuberculous infections of nervous system w CC,,Case Rate,63954.00
Cigna,HMO,950,DRG,Aftercare w/o CC/MCC,,Case Rate,18841.95
Cigna,HMO,951,DRG,Other factors influencing health status,,Case Rate,14234.10
Cigna,HMO,955,DRG,Craniotomy for multiple significant trauma,,Case Rate,160344.00
Cigna,HMO,956,DRG,Limb reattachment, hip & femur proc for multiple significant trauma,,Case Rate,98144.40
Cigna,HMO,957,DRG,Other O.R. procedures for multiple significant trauma w MCC,,Case Rate,189230.40
Cigna,HMO,958,DRG,Other O.R. procedures for multiple significant trauma w CC,,Case Rate,107237.70
Cigna,HMO,959,DRG,Other O.R. procedures for multiple significant trauma w/o CC/MCC,,Case Rate,69722.10
Cigna,HMO,95992,CPT4/HCPCS,Canalith Repositioning Procedure,,% of Charges,150.80
Cigna,HMO,96,DRG,Bacterial & tuberculous infections of nervous system w/o CC/MCC,,Case Rate,59453.25
Cigna,HMO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,% of Charges,934.70
Cigna,HMO,963,DRG,Other multiple significant trauma w MCC,,Case Rate,69467.10
Cigna,HMO,964,DRG,Other multiple significant trauma w CC,,Case Rate,37954.20
Cigna,HMO,96401,CPT4/HCPCS,Chemo Anti Neopl SQ IM,,% of Charges,190.45
Cigna,HMO,96402,CPT4/HCPCS,Chemo Hormon Antineopl SQ IM,,% of Charges,190.45
Cigna,HMO,96409,CPT4/HCPCS,Chemo IV Push Single Drug,,% of Charges,776.10
Cigna,HMO,96411,CPT4/HCPCS,Chemo IV Push Addl Drug,,% of Charges,414.70
Cigna,HMO,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,% of Charges,1043.25
Cigna,HMO,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,% of Charges,356.85
Cigna,HMO,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,% of Charges,1043.25
Cigna,HMO,96417,CPT4/HCPCS,Each Additional Seq Infusion - Chemo Pump,,% of Charges,817.70
Cigna,HMO,96450,CPT4/HCPCS,Intrathecal Chemo Admin,,% of Charges,1607.45
Cigna,HMO,965,DRG,Other multiple significant trauma w/o CC/MCC,,Case Rate,23278.95
Cigna,HMO,96521,CPT4/HCPCS,Refill/Maint Portable Pump,,% of Charges,776.10
Cigna,HMO,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,% of Charges,403.00
Cigna,HMO,969,DRG,HIV w extensive O.R. procedure w MCC,,Case Rate,147578.70
Cigna,HMO,97,DRG,Non-bacterial infect of nervous sys exc viral meningitis w MCC,,Case Rate,95691.30
Cigna,HMO,970,DRG,HIV w extensive O.R. procedure w/o MCC,,Case Rate,75100.05
Cigna,HMO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,% of Charges,90.35
Cigna,HMO,97012,CPT4/HCPCS,Traction Mechanical,,% of Charges,152.75
Cigna,HMO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,% of Charges,135.20
Cigna,HMO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,% of Charges,111.15
Cigna,HMO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,% of Charges,167.70
Cigna,HMO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,% of Charges,163.15
Cigna,HMO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,% of Charges,184.60
Cigna,HMO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,% of Charges,126.75
Cigna,HMO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,% of Charges,210.60
Cigna,HMO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,% of Charges,287.95
Cigna,HMO,97113,CPT4/HCPCS,Aquatic Therapy Each 15 Min,,% of Charges,215.15
Cigna,HMO,97116,CPT4/HCPCS,Gait Training Each 15 Mins,,% of Charges,267.80
Cigna,HMO,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,% of Charges,200.20
Cigna,HMO,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,% of Charges,187.85
Cigna,HMO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,% of Charges,246.35
Cigna,HMO,97150,CPT4/HCPCS,Group Therapy Exercises,,% of Charges,205.40
Cigna,HMO,97161,CPT4/HCPCS,Init eval: Low comp 20 mins,,% of Charges,465.40
Cigna,HMO,97162,CPT4/HCPCS,Init eval: Mod comp 30 mins,,% of Charges,465.40
Cigna,HMO,97163,CPT4/HCPCS,Init eval: High comp 45 mins,,% of Charges,465.40
Cigna,HMO,97164,CPT4/HCPCS,Re-Evaluation,,% of Charges,250.25
Cigna,HMO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,% of Charges,476.45
Cigna,HMO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,% of Charges,476.45
Cigna,HMO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,% of Charges,476.45
Cigna,HMO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,% of Charges,272.35
Cigna,HMO,974,DRG,HIV w major related condition w MCC,,Case Rate,68485.35
Cigna,HMO,975,DRG,HIV w major related condition w CC,,Case Rate,32617.05
Cigna,HMO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,% of Charges,298.35
Cigna,HMO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,% of Charges,179.40
Cigna,HMO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,% of Charges,222.95
Cigna,HMO,97542,CPT4/HCPCS,wheelchair manage ea 15 min,,% of Charges,163.15
Cigna,HMO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,% of Charges,872.95
Cigna,HMO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,% of Charges,208.00
Cigna,HMO,976,DRG,HIV w major related condition w/o CC/MCC,,Case Rate,24202.05
Cigna,HMO,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,% of Charges,224.90
Cigna,HMO,97605,CPT4/HCPCS,Wound Vac<50,,% of Charges,474.50
Cigna,HMO,97606,CPT4/HCPCS,Wound Vac>50,,% of Charges,546.00
Cigna,HMO,977,DRG,HIV w or w/o other related condition,,Case Rate,33680.40
Cigna,HMO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,% of Charges,287.30
Cigna,HMO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,% of Charges,172.25
Cigna,HMO,97761,CPT4/HCPCS,Prosthetic Training Each 15 Min,,% of Charges,254.15
Cigna,HMO,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,% of Charges,123.50
Cigna,HMO,98,DRG,Non-bacterial infect of nervous sys exc viral meningitis w CC,,Case Rate,53827.95
Cigna,HMO,981,DRG,Extensive O.R. procedure unrelated to principal diagnosis w MCC,,Case Rate,117498.90
Cigna,HMO,982,DRG,Extensive O.R. procedure unrelated to principal diagnosis w CC,,Case Rate,64805.70
Cigna,HMO,983,DRG,Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC,,Case Rate,42197.40
Cigna,HMO,987,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w MCC,,Case Rate,83183.55
Cigna,HMO,988,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w CC,,Case Rate,42857.85
Cigna,HMO,989,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC,,Case Rate,28455.45
Cigna,HMO,99,DRG,Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC,,Case Rate,35631.15
Cigna,HMO,C8900,CPT4/HCPCS,MRA w/cont, abd,,% of Charges,6500.00
Cigna,HMO,C8901,CPT4/HCPCS,MRA w/o cont, abd,,% of Charges,6500.00
Cigna,HMO,C8902,CPT4/HCPCS,MRA w/o fol w/cont, abd,,% of Charges,6500.00
Cigna,HMO,C8903,CPT4/HCPCS,MRI w/cont, breast, uni,,% of Charges,6500.00
Cigna,HMO,C8904,CPT4/HCPCS,Mri w/o cont, breast, uni,,% of Charges,6500.00
Cigna,HMO,C8905,CPT4/HCPCS,MRI w/o fol w/cont, brst, un,,% of Charges,6500.00
Cigna,HMO,C8906,CPT4/HCPCS,MRI w/cont, breast, bi,,% of Charges,6500.00
Cigna,HMO,C8908,CPT4/HCPCS,MRI w/o fol w/cont, breast,,,% of Charges,6500.00
Cigna,HMO,C8909,CPT4/HCPCS,MRA w/cont, chest,,% of Charges,6500.00
Cigna,HMO,C8910,CPT4/HCPCS,MRA w/o cont, chest,,% of Charges,6500.00
Cigna,HMO,C8911,CPT4/HCPCS,MRA w/o fol w/cont, chest,,% of Charges,6500.00
Cigna,HMO,C8912,CPT4/HCPCS,MRA w/cont, lwr ext,,% of Charges,6500.00
Cigna,HMO,C8913,CPT4/HCPCS,MRA w/o cont, lwr ext,,% of Charges,6500.00
Cigna,HMO,C8914,CPT4/HCPCS,MRA w/o fol w/cont, lwr ext,,% of Charges,6500.00
Cigna,HMO,C8918,CPT4/HCPCS,MRA w/cont, pelvis,,% of Charges,6500.00
Cigna,HMO,C8919,CPT4/HCPCS,MRA w/o cont, pelvis,,% of Charges,6500.00
Cigna,HMO,C8920,CPT4/HCPCS,MRA w/o fol w/cont, pelvis,,% of Charges,6500.00
Cigna,HMO,C8934,CPT4/HCPCS,MRA, w/dye, upper extremity,,% of Charges,6500.00
Cigna,HMO,C8935,CPT4/HCPCS,MRA, w/o dye, upper extr,,% of Charges,6500.00
Cigna,HMO,C8936,CPT4/HCPCS,MRA, w/o&w/dye, upper extr,,% of Charges,6500.00
Cigna,HMO,C9725,CPT4/HCPCS,Place endorectal app,,% of Charges,5413.20
Cigna,HMO,G0120,CPT4/HCPCS,Colon Ca Scrn/Colonscopy Be,,% of Charges,6500.00
Cigna,HMO,G0173,CPT4/HCPCS,Srs 1 Tx &1St Sbrt Tx Delivery,,% of Charges,22311.90
Cigna,HMO,G0237,CPT4/HCPCS,Therapeutic Proc Ea 15 Min,,% of Charges,172.25
Cigna,HMO,G0238,CPT4/HCPCS,Therapeutic Proc ea 15 Min Indv,,% of Charges,172.25
Cigna,HMO,G0239,CPT4/HCPCS,Therapeutic Procedures,,% of Charges,172.25
Cigna,HMO,G0251,CPT4/HCPCS,Sts 2-5 Tx Delivery,,% of Charges,9210.50
Cigna,HMO,G0257,CPT4/HCPCS,Hemodialysis,,% of charges,5900.00
Cigna,HMO,G0279,CPT4/HCPCS,Tomosynthesis, mammo,,% of Charges,6500.00
Cigna,HMO,G0283,CPT4/HCPCS,Elec stim other than wound,,% of Charges,169.65
Cigna,HMO,G0389,CPT4/HCPCS,Ultrasound exam aaa screen,,% of Charges,6500.00
Cigna,HMO,G0515,CPT4/HCPCS,Cognitive skills development,,% of Charges,208.00
Cigna,HMO,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,% of Charges,85.15
Cigna,HMO,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,% of Charges,150.15
Cigna,HMO,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,% of Charges,234.65
Cigna,HMO,G8996,CPT4/HCPCS,SP Swallow Current Status,,% of Charges,6.5e-03
Cigna,HMO,G8997,CPT4/HCPCS,SP Swallow Goal Status,,% of Charges,6.5e-03
Cigna,HMO,G8998,CPT4/HCPCS,SP Swallow D/C Status,,% of Charges,6.5e-03
Cigna,HMO,G8999,CPT4/HCPCS,SP Motor Speech Current Status,,% of Charges,6.5e-03
Cigna,HMO,G9158,CPT4/HCPCS,SP Motor Speech D/C Status,,% of Charges,6.5e-03
Cigna,HMO,G9159,CPT4/HCPCS,SP Lang Comp Current Status,,% of Charges,6.5e-03
Cigna,HMO,G9160,CPT4/HCPCS,SP Lang Comp Goal Status,,% of Charges,6.5e-03
Cigna,HMO,G9161,CPT4/HCPCS,SP Lang Comp D/C Status,,% of Charges,6.5e-03
Cigna,HMO,G9162,CPT4/HCPCS,SP Lang Express Current Status,,% of Charges,6.5e-03
Cigna,HMO,G9163,CPT4/HCPCS,SP Lang Express Goal Status,,% of Charges,6.5e-03
Cigna,HMO,G9164,CPT4/HCPCS,SP Lang Express D/C Status,,% of Charges,6.5e-03
Cigna,HMO,G9165,CPT4/HCPCS,SP Atten Current Status,,% of Charges,6.5e-03
Cigna,HMO,G9166,CPT4/HCPCS,SP Atten Goal Status,,% of Charges,6.5e-03
Cigna,HMO,G9167,CPT4/HCPCS,SP Atten D/C Status,,% of Charges,6.5e-03
Cigna,HMO,G9168,CPT4/HCPCS,SP Memory Current Status,,% of Charges,6.5e-03
Cigna,HMO,G9169,CPT4/HCPCS,SP Memory Goal Status,,% of Charges,6.5e-03
Cigna,HMO,G9170,CPT4/HCPCS,SP Memory D/C Status,,% of Charges,6.5e-03
Cigna,HMO,G9171,CPT4/HCPCS,SP Voice Current Status,,% of Charges,6.5e-03
Cigna,HMO,G9172,CPT4/HCPCS,SP Voice Goal Status,,% of Charges,6.5e-03
Cigna,HMO,G9173,CPT4/HCPCS,SP Voice D/C Status,,% of Charges,6.5e-03
Cigna,HMO,G9174,CPT4/HCPCS,SP Speech Lang Current Status,,% of Charges,6.5e-03
Cigna,HMO,G9175,CPT4/HCPCS,SP Speech Lang Goal Status,,% of Charges,6.5e-03
Cigna,HMO,G9176,CPT4/HCPCS,SP Speech Lang D/C Status,,% of Charges,6.5e-03
Cigna,HMO,G9186,CPT4/HCPCS,SP Motor Speech Goal Status,,% of Charges,6.5e-03
Cigna,HMO,Q3014,CPT4/HCPCS,Teleheatlh Facility Fee,,% of charges,6500.00
Cigna,HMO,,,NICU/Newborn - Level I,,Per Diem,1500.00
Cigna,HMO,,,ICU,,Per Diem,6500.00
Cigna,HMO,,,CCU,,Per Diem,6500.00
Cigna,HMO,,,Telemetry,,Per Diem,6500.00
Cigna,HMO,,,Medical Surgical,,Per Diem,6500.00
Cigna,HMO,,,Observation,,Per Visit,6500.00
Cigna,HMO,,,NICU/Newborn - Level II,,Per Diem,7100.00
Cigna,HMO,,,NICU/Newborn - Level III,,Per Diem,7100.00
Cigna,HMO,,,NICU/Newborn - Level IV,,Per Diem,7100.00
Cigna,PPO,0042T,CPT4/HCPCS,Ct Head Perfusion Analysis,,% of Charges,6500.00
Cigna,PPO,0390T,CPT4/HCPCS,Peri-Proc Eval/Prog. post Proc,,% of Charges,7966.00
Cigna,PPO,1,DRG,Heart transplant or implant of heart assist system w MCC,,Case Rate,738612.60
Cigna,PPO,10,DRG,Pancreas transplant,,Case Rate,92251.35
Cigna,PPO,100,DRG,Seizures w MCC,,Case Rate,47776.80
Cigna,PPO,10004,CPT4/HCPCS,Fine needle aspiration biopsy, without imaging guidance; each additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,10005,CPT4/HCPCS,Fine needle aspiration biopsy, including ultrasound guidance first lesion,,Case Rate,3000.00
Cigna,PPO,10006,CPT4/HCPCS,Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,10007,CPT4/HCPCS,Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion ,,Case Rate,3000.00
Cigna,PPO,10008,CPT4/HCPCS,Fine needle aspiration biopsy, including fluoroscopic guidance; each additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,10009,CPT4/HCPCS,Fine needle aspiration biopsy, including CT guidance; first lesion ,,Case Rate,3000.00
Cigna,PPO,10010,CPT4/HCPCS,Fine needle aspiration biopsy, including CT guidance; each additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,10011,CPT4/HCPCS,Fine needle aspiration biopsy, including MR guidance; first lesion ,,Case Rate,3000.00
Cigna,PPO,10012,CPT4/HCPCS,Fine needle aspiration biopsy, including MR guidance; each additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,10021,CPT4/HCPCS,FINE NEEDLE ASPIRATION WITHOUT IMAGING GUIDANCE ,,Case Rate,400.00
Cigna,PPO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Case Rate,400.00
Cigna,PPO,10035,CPT4/HCPCS,PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEEDLE, RADIOACTIVE SEEDS), PERCUTANEOUS, INCLUDING IMAGING GUIDANCE; FIRST LESION,,Case Rate,3000.00
Cigna,PPO,10036,CPT4/HCPCS,PLACEMENT OF SOFT TISSUE LOCALIZATION DEVICE(S) (EG, CLIP, METALLIC PELLET, WIRE/NEEDLE, RADIOACTIVE SEEDS), PERCUTANEOUS, INCLUDING IMAGING GUIDANCE; EACH ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,10060,CPT4/HCPCS,Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single,,Case Rate,400.00
Cigna,PPO,10061,CPT4/HCPCS,Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple,,Case Rate,3000.00
Cigna,PPO,10080,CPT4/HCPCS,Incision and drainage of pilonidal cyst; simple,,Case Rate,400.00
Cigna,PPO,10081,CPT4/HCPCS,Incision and drainage of pilonidal cyst; complicated,,Case Rate,400.00
Cigna,PPO,101,DRG,Seizures w/o MCC,,Case Rate,22618.50
Cigna,PPO,10120,CPT4/HCPCS,Incision and removal of foreign body, subcutaneous tissues; simple,,Case Rate,400.00
Cigna,PPO,10121,CPT4/HCPCS,Remove foreign body,,Case Rate,3000.00
Cigna,PPO,10140,CPT4/HCPCS,Incision and drainage of hematoma, seroma or fluid collection,,Case Rate,400.00
Cigna,PPO,10160,CPT4/HCPCS,PUNCTURE ASPIRATION OF ABSCESS HEMATOMA BULLA OR CYST ,,Case Rate,400.00
Cigna,PPO,10180,CPT4/HCPCS,Complex drainage, wound,,Case Rate,3000.00
Cigna,PPO,102,DRG,Headaches w MCC,,Case Rate,29368.35
Cigna,PPO,103,DRG,Headaches w/o MCC,,Case Rate,21119.10
Cigna,PPO,11,DRG,Tracheostomy for face,mouth & neck diagnoses w MCC,,Case Rate,127918.20
Cigna,PPO,11000,CPT4/HCPCS,Debridement of extensive eczematous or infected skin; up to 10% of body surface,,Case Rate,400.00
Cigna,PPO,11001,CPT4/HCPCS,Debridement of extensive eczematous or infected skin; each additional 10% of the body surface (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,11010,CPT4/HCPCS,Debride skin, fx,,Case Rate,3000.00
Cigna,PPO,11011,CPT4/HCPCS,Debride skin/muscle, fx,,Case Rate,3000.00
Cigna,PPO,11012,CPT4/HCPCS,Debride skin/muscle/bone, fx,,Case Rate,3000.00
Cigna,PPO,11042,CPT4/HCPCS,Debride skin/tissue,,Case Rate,3000.00
Cigna,PPO,11043,CPT4/HCPCS,Debride tissue/muscle,,Case Rate,3000.00
Cigna,PPO,11044,CPT4/HCPCS,Debride tissue/muscle/bone,,Case Rate,3000.00
Cigna,PPO,11045,CPT4/HCPCS,DEBRIDEMENT, SUBCUTANEOUS TISSUE (INCLUDES EPIDERMIS AND DERMIS, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,11046,CPT4/HCPCS,DEBRIDEMENT, MUSCLE AND/OR FASCIA (INCLUDES EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,11047,CPT4/HCPCS,DEBRIDEMENT, BONE (INCLUDES EPIDERMIS, DERMIS, SUBCUTANEOUS TISSUE, MUSCLE AND/OR FASCIA, IF PERFORMED); EACH ADDITIONAL 20 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,11055,CPT4/HCPCS,PARING OR CUTTING OF BENIGN HYPERKERATOIC LESION (EG. CORN OR CALLUS); SINGLE LESION ,,Case Rate,400.00
Cigna,PPO,11056,CPT4/HCPCS,PARING OR CUTING OF BENIGN HYPERKERATOIC LESION (EG. CORN OR CALOUS); TWO OR FOUR LESIONS ,,Case Rate,400.00
Cigna,PPO,11057,CPT4/HCPCS,PARING OR CUTTING OF BENIGN HYPERKERATOIC LESION (EG. CORN OR CALLUS); MORE THAN 4 LESIONS ,,Case Rate,400.00
Cigna,PPO,11102,CPT4/HCPCS,Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion ,,Case Rate,400.00
Cigna,PPO,11103,CPT4/HCPCS,Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,11104,CPT4/HCPCS,Punch biopsy of skin (including simple closure, when performed); single lesion ,,Case Rate,400.00
Cigna,PPO,11105,CPT4/HCPCS,Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,11106,CPT4/HCPCS,Incisional biopsy of skin (eg, wedge) (including simple closure, when performed) single lesion ,,Case Rate,3000.00
Cigna,PPO,11107,CPT4/HCPCS,Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,11200,CPT4/HCPCS,Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions,,Case Rate,400.00
Cigna,PPO,113,DRG,Orbital procedures w CC/MCC,,Case Rate,55890.90
Cigna,PPO,114,DRG,Orbital procedures w/o CC/MCC,,Case Rate,36860.25
Cigna,PPO,11400,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,PPO,11401,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,PPO,11402,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,PPO,11403,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or legs; lesion diameter 2.1 to 3.0 cm,,Case Rate,3000.00
Cigna,PPO,11404,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11406,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11420,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,PPO,11421,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,PPO,11422,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,PPO,11423,CPT4/HCPCS,Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm,,Case Rate,3000.00
Cigna,PPO,11424,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11426,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11440,CPT4/HCPCS,Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,PPO,11441,CPT4/HCPCS,Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,PPO,11442,CPT4/HCPCS,Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,PPO,11443,CPT4/HCPCS,Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm,,Case Rate,3000.00
Cigna,PPO,11444,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11446,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11450,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,PPO,11451,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,PPO,11462,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,PPO,11463,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,PPO,11470,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,PPO,11471,CPT4/HCPCS,Removal, sweat gland lesion,,Case Rate,3000.00
Cigna,PPO,115,DRG,Extraocular procedures except orbit,,Case Rate,37059.15
Cigna,PPO,116,DRG,Intraocular procedures w CC/MCC,,Case Rate,47868.60
Cigna,PPO,11600,CPT4/HCPCS,Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,PPO,11601,CPT4/HCPCS,Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,PPO,11602,CPT4/HCPCS,Excision, malignant lesion, trunk, arms, or legs; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,PPO,11603,CPT4/HCPCS,Excision, malignant lesion, trunk, arms, or legs; lesion diameter 2.1 to 3.0 cm,,Case Rate,3000.00
Cigna,PPO,11604,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11606,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11620,CPT4/HCPCS,Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,PPO,11621,CPT4/HCPCS,Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,PPO,11622,CPT4/HCPCS,Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,PPO,11623,CPT4/HCPCS,Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm,,Case Rate,400.00
Cigna,PPO,11624,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11626,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11640,CPT4/HCPCS,Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.5 cm or less,,Case Rate,3000.00
Cigna,PPO,11641,CPT4/HCPCS,Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.6 to 1.0 cm,,Case Rate,3000.00
Cigna,PPO,11642,CPT4/HCPCS,Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 1.1 to 2.0 cm,,Case Rate,3000.00
Cigna,PPO,11643,CPT4/HCPCS,Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 2.1 to 3.0 cm,,Case Rate,3000.00
Cigna,PPO,11644,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,11646,CPT4/HCPCS,Removal of skin lesion,,Case Rate,3000.00
Cigna,PPO,117,DRG,Intraocular procedures w/o CC/MCC,,Case Rate,26491.95
Cigna,PPO,11720,CPT4/HCPCS,DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE OF FIVE ,,Case Rate,3000.00
Cigna,PPO,11721,CPT4/HCPCS,DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MORE ,,Case Rate,3000.00
Cigna,PPO,11730,CPT4/HCPCS,AVULSION OF NAIL PLATE PAR OR COM SIMPL SINGL (CON AS TOS 04) ,,Case Rate,3000.00
Cigna,PPO,11732,CPT4/HCPCS,AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACH ADDITIONAL NAIL PLATE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,11740,CPT4/HCPCS,EVACUATION OF SUBUNGUAL HEMATOMA ,,Case Rate,3000.00
Cigna,PPO,11750,CPT4/HCPCS,Excision of nail and nail matrix, partial or complete, (eg, ingrown or deformed nail) for permanent removal,,Case Rate,3000.00
Cigna,PPO,11755,CPT4/HCPCS,BIOPSY OF NAIL UNIT (EG, PLATE, BED, MATRIX, HYPONYCHIUM, PROXIMAL AND LATERAL NAIL FOLDS) (SEPARATE PROCEDURE),,Case Rate,3000.00
Cigna,PPO,11760,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED; SIMPLE,,Case Rate,400.00
Cigna,PPO,11762,CPT4/HCPCS,Reconstruction of nail bed with graft,,Case Rate,400.00
Cigna,PPO,11765,CPT4/HCPCS,WEDGE EXCISION OF SKIN OF NAIL FOLD (EG FOR INGROWN TOENAIL) ,,Case Rate,3000.00
Cigna,PPO,11770,CPT4/HCPCS,Removal of pilonidal lesion,,Case Rate,4000.00
Cigna,PPO,11771,CPT4/HCPCS,Removal of pilonidal lesion,,Case Rate,4000.00
Cigna,PPO,11772,CPT4/HCPCS,Removal of pilonidal lesion,,Case Rate,4000.00
Cigna,PPO,11900,CPT4/HCPCS,Injection, intralesional; up to and including seven lesions,,Case Rate,400.00
Cigna,PPO,11901,CPT4/HCPCS,Injection, intralesional; more than seven lesions,,Case Rate,400.00
Cigna,PPO,11920,CPT4/HCPCS,Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less,,Case Rate,400.00
Cigna,PPO,11921,CPT4/HCPCS,Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cm,,Case Rate,400.00
Cigna,PPO,11922,CPT4/HCPCS,Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,11960,CPT4/HCPCS,Insert tissue expander(s),,Case Rate,3000.00
Cigna,PPO,11970,CPT4/HCPCS,Replace tissue expander,,Case Rate,4000.00
Cigna,PPO,11971,CPT4/HCPCS,Remove tissue expander(s),,Case Rate,3000.00
Cigna,PPO,11976,CPT4/HCPCS,REMOVAL WITHOUT REINSERTION IMPLANTABLE CONTRACEPTIVE CAPSULES ,,Case Rate,3000.00
Cigna,PPO,11980,CPT4/HCPCS,SUBCUTANEOUS HORMONE PELLET IMPLANTATION (IMPLANTATION OF ESTRADIOL AND/OR TESTOSTERONE PELLETS BENEATH THE SKIN),,Case Rate,400.00
Cigna,PPO,11981,CPT4/HCPCS,INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT ,,Case Rate,3000.00
Cigna,PPO,11982,CPT4/HCPCS,REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT ,,Case Rate,3000.00
Cigna,PPO,11983,CPT4/HCPCS,REMOVAL WITH REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT ,,Case Rate,3000.00
Cigna,PPO,12,DRG,Tracheostomy for face,mouth & neck diagnoses w CC,,Case Rate,97713.45
Cigna,PPO,12001,CPT4/HCPCS,Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less,,Case Rate,400.00
Cigna,PPO,12004,CPT4/HCPCS,Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm,,Case Rate,400.00
Cigna,PPO,12005,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,PPO,12006,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,PPO,12007,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,PPO,12014,CPT4/HCPCS,Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm,,Case Rate,400.00
Cigna,PPO,12015,CPT4/HCPCS,Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm,,Case Rate,400.00
Cigna,PPO,12016,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,PPO,12017,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,PPO,12018,CPT4/HCPCS,Repair superficial wound(s),,Case Rate,3000.00
Cigna,PPO,12020,CPT4/HCPCS,Closure of split wound,,Case Rate,3000.00
Cigna,PPO,12021,CPT4/HCPCS,Closure of split wound,,Case Rate,3000.00
Cigna,PPO,12031,CPT4/HCPCS,Layer closure of wounds of scalp, axillae, trunk and/or extremities (excld. hands and feet); 2.5 cm or less,,Case Rate,400.00
Cigna,PPO,12032,CPT4/HCPCS,Layer closure of wounds of scalp, axillae, trunk and/or extremities (excld. hands and feet); 2.6 cm to 7.5 cm,,Case Rate,400.00
Cigna,PPO,12034,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12035,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12036,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12037,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12041,CPT4/HCPCS,Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less,,Case Rate,400.00
Cigna,PPO,12042,CPT4/HCPCS,Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm,,Case Rate,400.00
Cigna,PPO,12044,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12045,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12046,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12047,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12051,CPT4/HCPCS,Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less,,Case Rate,400.00
Cigna,PPO,12052,CPT4/HCPCS,Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm,,Case Rate,400.00
Cigna,PPO,12053,CPT4/HCPCS,Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm,,Case Rate,400.00
Cigna,PPO,12054,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12055,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12056,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,12057,CPT4/HCPCS,Layer closure of wound(s),,Case Rate,3000.00
Cigna,PPO,121,DRG,Acute major eye infections w CC/MCC,,Case Rate,30311.85
Cigna,PPO,122,DRG,Acute major eye infections w/o CC/MCC,,Case Rate,16416.90
Cigna,PPO,123,DRG,Neurological eye disorders,,Case Rate,19515.15
Cigna,PPO,124,DRG,Other disorders of the eye w MCC,,Case Rate,35669.40
Cigna,PPO,125,DRG,Other disorders of the eye w/o MCC,,Case Rate,21302.70
Cigna,PPO,13,DRG,Tracheostomy for face,mouth & neck diagnoses w/o CC/MCC,,Case Rate,69372.75
Cigna,PPO,13100,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,3000.00
Cigna,PPO,13101,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,4000.00
Cigna,PPO,13102,CPT4/HCPCS,REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS,,Case Rate,3000.00
Cigna,PPO,13120,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,3000.00
Cigna,PPO,13121,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,4000.00
Cigna,PPO,13122,CPT4/HCPCS,REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; EACH ADDITIONAL 5 CM OR LESS.,,Case Rate,3000.00
Cigna,PPO,13131,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,3000.00
Cigna,PPO,13132,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,4000.00
Cigna,PPO,13133,CPT4/HCPCS,REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE GENITALIA, HANDS AND/OR FEET; EACH ADDITIONAL 5CM OR LESS.,,Case Rate,3000.00
Cigna,PPO,13151,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,4000.00
Cigna,PPO,13152,CPT4/HCPCS,Repair of wound or lesion,,Case Rate,4000.00
Cigna,PPO,13153,CPT4/HCPCS,REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; EACH ADDITIONAL 5 CM OR LESS.,,Case Rate,3000.00
Cigna,PPO,13160,CPT4/HCPCS,Late closure of wound,,Case Rate,3000.00
Cigna,PPO,135,DRG,Sinus & mastoid procedures w CC/MCC,,Case Rate,54585.30
Cigna,PPO,136,DRG,Sinus & mastoid procedures w/o CC/MCC,,Case Rate,32015.25
Cigna,PPO,137,DRG,Mouth procedures w CC/MCC,,Case Rate,37449.30
Cigna,PPO,138,DRG,Mouth procedures w/o CC/MCC,,Case Rate,21499.05
Cigna,PPO,139,DRG,Salivary gland procedures,,Case Rate,31283.40
Cigna,PPO,14,DRG,Allogeneic bone marrow transplant,,Case Rate,325859.40
Cigna,PPO,140,DRG,MAJOR HEAD AND NECK PROCEDURES WITH MCC,,Case Rate,101505.30
Cigna,PPO,14000,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,3000.00
Cigna,PPO,14001,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,PPO,14020,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,PPO,14021,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,PPO,14040,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,3000.00
Cigna,PPO,14041,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,PPO,14060,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,PPO,14061,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,PPO,141,DRG,MAJOR HEAD AND NECK PROCEDURES WITH CC,,Case Rate,56291.25
Cigna,PPO,142,DRG,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,,Case Rate,41024.40
Cigna,PPO,143,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC,,Case Rate,75576.90
Cigna,PPO,14301,CPT4/HCPCS,ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM ,,Case Rate,3000.00
Cigna,PPO,14302,CPT4/HCPCS,ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITI ONAL 30.0 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,14350,CPT4/HCPCS,Skin tissue rearrangement,,Case Rate,4000.00
Cigna,PPO,144,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC,,Case Rate,44637.75
Cigna,PPO,145,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,,Case Rate,30944.25
Cigna,PPO,146,DRG,Ear, nose, mouth & throat malignancy w MCC,,Case Rate,51844.05
Cigna,PPO,147,DRG,Ear, nose, mouth & throat malignancy w CC,,Case Rate,33178.05
Cigna,PPO,148,DRG,Ear, nose, mouth & throat malignancy w/o CC/MCC,,Case Rate,20050.65
Cigna,PPO,149,DRG,Dysequilibrium,,Case Rate,18755.25
Cigna,PPO,150,DRG,Epistaxis w MCC,,Case Rate,33779.85
Cigna,PPO,15002,CPT4/HCPCS,Wnd prep, ch/inf, trk/arm/lg,,Case Rate,3000.00
Cigna,PPO,15003,CPT4/HCPCS,Wnd prep, ch/inf addl 100 cm,,Case Rate,3000.00
Cigna,PPO,15004,CPT4/HCPCS,Wnd prep ch/inf, f/n/hf/g,,Case Rate,3000.00
Cigna,PPO,15005,CPT4/HCPCS,Wnd prep, f/n/hf/g, addl cm,,Case Rate,3000.00
Cigna,PPO,15040,CPT4/HCPCS,Harvest cultured skin graft,,Case Rate,3000.00
Cigna,PPO,15050,CPT4/HCPCS,Skin pinch graft,,Case Rate,3000.00
Cigna,PPO,151,DRG,Epistaxis w/o MCC,,Case Rate,18793.50
Cigna,PPO,15100,CPT4/HCPCS,Skin split graft,,Case Rate,3000.00
Cigna,PPO,15101,CPT4/HCPCS,Skin split graft add-on,,Case Rate,3000.00
Cigna,PPO,15110,CPT4/HCPCS,Epidrm autogrft trnk/arm/leg,,Case Rate,3000.00
Cigna,PPO,15111,CPT4/HCPCS,Epidrm autogrft t/a/l add-on,,Case Rate,3000.00
Cigna,PPO,15115,CPT4/HCPCS,Epidrm a-grft face/nck/hf/g,,Case Rate,3000.00
Cigna,PPO,15116,CPT4/HCPCS,Epidrm a-grft f/n/hf/g addl,,Case Rate,3000.00
Cigna,PPO,15120,CPT4/HCPCS,Skin split graft,,Case Rate,3000.00
Cigna,PPO,15121,CPT4/HCPCS,Skin split graft add-on,,Case Rate,3000.00
Cigna,PPO,15130,CPT4/HCPCS,Derm autograft, trnk/arm/leg,,Case Rate,3000.00
Cigna,PPO,15131,CPT4/HCPCS,Derm autograft t/a/l add-on,,Case Rate,3000.00
Cigna,PPO,15135,CPT4/HCPCS,Derm autograft face/nck/hf/g,,Case Rate,3000.00
Cigna,PPO,15136,CPT4/HCPCS,Derm autograft, f/n/hf/g add,,Case Rate,3000.00
Cigna,PPO,15150,CPT4/HCPCS,Cult epiderm grft t/arm/leg,,Case Rate,3000.00
Cigna,PPO,15151,CPT4/HCPCS,Cult epiderm grft t/a/l addl,,Case Rate,3000.00
Cigna,PPO,15152,CPT4/HCPCS,Cult epiderm graft t/a/l +%,,Case Rate,3000.00
Cigna,PPO,15155,CPT4/HCPCS,Cult epiderm graft, f/n/hf/g,,Case Rate,3000.00
Cigna,PPO,15156,CPT4/HCPCS,Cult epidrm grft f/n/hfg add,,Case Rate,3000.00
Cigna,PPO,15157,CPT4/HCPCS,Cult epiderm grft f/n/hfg +%,,Case Rate,3000.00
Cigna,PPO,152,DRG,Otitis media & URI w MCC,,Case Rate,27460.95
Cigna,PPO,15200,CPT4/HCPCS,Skin full graft,,Case Rate,4000.00
Cigna,PPO,15201,CPT4/HCPCS,Skin full graft add-on,,Case Rate,3000.00
Cigna,PPO,15220,CPT4/HCPCS,Skin full graft,,Case Rate,3000.00
Cigna,PPO,15221,CPT4/HCPCS,Skin full graft add-on,,Case Rate,3000.00
Cigna,PPO,15240,CPT4/HCPCS,Skin full graft,,Case Rate,4000.00
Cigna,PPO,15241,CPT4/HCPCS,Skin full graft add-on,,Case Rate,3000.00
Cigna,PPO,15260,CPT4/HCPCS,Skin full graft,,Case Rate,3000.00
Cigna,PPO,15261,CPT4/HCPCS,Skin full graft add-on,,Case Rate,3000.00
Cigna,PPO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Case Rate,3000.00
Cigna,PPO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Case Rate,3000.00
Cigna,PPO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Case Rate,3000.00
Cigna,PPO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Case Rate,3000.00
Cigna,PPO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Case Rate,3000.00
Cigna,PPO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Case Rate,3000.00
Cigna,PPO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Case Rate,3000.00
Cigna,PPO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Case Rate,3000.00
Cigna,PPO,153,DRG,Otitis media & URI w/o MCC,,Case Rate,18120.30
Cigna,PPO,154,DRG,Nasal trauma & deformity w MCC,,Case Rate,39333.75
Cigna,PPO,155,DRG,Nasal trauma & deformity w CC,,Case Rate,23123.40
Cigna,PPO,15570,CPT4/HCPCS,Form skin pedicle flap,,Case Rate,4000.00
Cigna,PPO,15572,CPT4/HCPCS,Form skin pedicle flap,,Case Rate,4000.00
Cigna,PPO,15574,CPT4/HCPCS,Form skin pedicle flap,,Case Rate,4000.00
Cigna,PPO,15576,CPT4/HCPCS,Form skin pedicle flap,,Case Rate,4000.00
Cigna,PPO,156,DRG,Nasal trauma & deformity w/o CC/MCC,,Case Rate,16768.80
Cigna,PPO,15600,CPT4/HCPCS,Skin graft,,Case Rate,4000.00
Cigna,PPO,15610,CPT4/HCPCS,Skin graft,,Case Rate,4000.00
Cigna,PPO,15620,CPT4/HCPCS,Skin graft,,Case Rate,4000.00
Cigna,PPO,15630,CPT4/HCPCS,Skin graft,,Case Rate,4000.00
Cigna,PPO,15650,CPT4/HCPCS,Transfer skin pedicle flap,,Case Rate,5000.00
Cigna,PPO,157,DRG,Dental & Oral Diseases w MCC,,Case Rate,40096.20
Cigna,PPO,15730,CPT4/HCPCS,Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s),,Case Rate,3000.00
Cigna,PPO,15731,CPT4/HCPCS,Forehead flap w/vasc pedicle,,Case Rate,4000.00
Cigna,PPO,15733,CPT4/HCPCS,Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae),,Case Rate,3000.00
Cigna,PPO,15734,CPT4/HCPCS,Muscle-skin graft, trunk,,Case Rate,4000.00
Cigna,PPO,15736,CPT4/HCPCS,Muscle-skin graft, arm,,Case Rate,4000.00
Cigna,PPO,15738,CPT4/HCPCS,Muscle-skin graft, leg,,Case Rate,4000.00
Cigna,PPO,15740,CPT4/HCPCS,Island pedicle flap graft,,Case Rate,3000.00
Cigna,PPO,15750,CPT4/HCPCS,Neurovascular pedicle graft,,Case Rate,3000.00
Cigna,PPO,15756,CPT4/HCPCS,Free muscle flap with or without skin with microvascular anastomosis,,Case Rate,3000.00
Cigna,PPO,15757,CPT4/HCPCS,Free skin flap with microvascular anastomosis,,Case Rate,3000.00
Cigna,PPO,15758,CPT4/HCPCS,Free fascial flap with microvascular anastomosis,,Case Rate,3000.00
Cigna,PPO,15760,CPT4/HCPCS,Composite skin graft,,Case Rate,3000.00
Cigna,PPO,15769,CPT4/HCPCS,Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia),,Case Rate,3000.00
Cigna,PPO,15770,CPT4/HCPCS,Derma-fat-fascia graft,,Case Rate,4000.00
Cigna,PPO,15771,CPT4/HCPCS,Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs 50 cc or less injectate,,Case Rate,3000.00
Cigna,PPO,15772,CPT4/HCPCS,Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part there of (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,15773,CPT4/HCPCS,Grafting of autologous fat harvested by liposuction technique to face, eyelids ,mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate,,Case Rate,3000.00
Cigna,PPO,15774,CPT4/HCPCS,Grafting of autologous fat harvested by liposuction technique to face, eyelids ,mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part there of (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,15775,CPT4/HCPCS,Hair transplant punch grafts,,Case Rate,4000.00
Cigna,PPO,15776,CPT4/HCPCS,Hair transplant punch grafts,,Case Rate,4000.00
Cigna,PPO,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,Case Rate,3000.00
Cigna,PPO,158,DRG,Dental & Oral Diseases w CC,,Case Rate,22672.05
Cigna,PPO,15819,CPT4/HCPCS,Cervicoplasty,,Case Rate,3000.00
Cigna,PPO,15820,CPT4/HCPCS,Revision of lower eyelid,,Case Rate,4000.00
Cigna,PPO,15821,CPT4/HCPCS,Revision of lower eyelid,,Case Rate,4000.00
Cigna,PPO,15822,CPT4/HCPCS,Revision of upper eyelid,,Case Rate,4000.00
Cigna,PPO,15823,CPT4/HCPCS,Revision of upper eyelid,,Case Rate,5000.00
Cigna,PPO,15824,CPT4/HCPCS,Removal of forehead wrinkles,,Case Rate,4000.00
Cigna,PPO,15825,CPT4/HCPCS,Removal of neck wrinkles,,Case Rate,4000.00
Cigna,PPO,15826,CPT4/HCPCS,Removal of brow wrinkles,,Case Rate,4000.00
Cigna,PPO,15828,CPT4/HCPCS,Removal of face wrinkles,,Case Rate,4000.00
Cigna,PPO,15829,CPT4/HCPCS,Removal of skin wrinkles,,Case Rate,5000.00
Cigna,PPO,15830,CPT4/HCPCS,Exc skin abd,,Case Rate,4000.00
Cigna,PPO,15832,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,PPO,15833,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,PPO,15834,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,PPO,15835,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,PPO,15836,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,PPO,15837,CPT4/HCPCS,Excision, excessive skin and subcutaneous tissue (including lipectomy); forearm or hand,,Case Rate,3000.00
Cigna,PPO,15838,CPT4/HCPCS,Excision, excessive skin and subcutaneous tissue (including lipectomy); submental fat pad,,Case Rate,3000.00
Cigna,PPO,15839,CPT4/HCPCS,Excise excessive skin tissue,,Case Rate,4000.00
Cigna,PPO,15840,CPT4/HCPCS,Graft for face nerve palsy,,Case Rate,4000.00
Cigna,PPO,15841,CPT4/HCPCS,Graft for face nerve palsy,,Case Rate,4000.00
Cigna,PPO,15842,CPT4/HCPCS,Flap for face nerve palsy,,Case Rate,4000.00
Cigna,PPO,15845,CPT4/HCPCS,Skin and muscle repair, face,,Case Rate,4000.00
Cigna,PPO,15847,CPT4/HCPCS,Exc skin abd add-on,,Case Rate,3000.00
Cigna,PPO,15850,CPT4/HCPCS,Removal of sutures under anesthesia (other than local), same surgeon,,Case Rate,3000.00
Cigna,PPO,15851,CPT4/HCPCS,Removal of sutures under anesthesia (other than local), other surgeon,,Case Rate,3000.00
Cigna,PPO,15852,CPT4/HCPCS,Dressing change (for other than burns) under anesthesia (other than local),,Case Rate,400.00
Cigna,PPO,15860,CPT4/HCPCS,Intravenous injection of agent (eg, fluorescein) to test blood flow in flap or graft,,Case Rate,400.00
Cigna,PPO,15876,CPT4/HCPCS,Suction assisted lipectomy,,Case Rate,4000.00
Cigna,PPO,15877,CPT4/HCPCS,Suction assisted lipectomy,,Case Rate,4000.00
Cigna,PPO,15878,CPT4/HCPCS,Suction assisted lipectomy,,Case Rate,4000.00
Cigna,PPO,15879,CPT4/HCPCS,Suction assisted lipectomy,,Case Rate,4000.00
Cigna,PPO,159,DRG,Dental & Oral Diseases w/o CC/MCC,,Case Rate,16722.90
Cigna,PPO,15920,CPT4/HCPCS,Removal of tail bone ulcer,,Case Rate,4000.00
Cigna,PPO,15922,CPT4/HCPCS,Removal of tail bone ulcer,,Case Rate,4000.00
Cigna,PPO,15931,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,PPO,15933,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,PPO,15934,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,PPO,15935,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,PPO,15936,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,PPO,15937,CPT4/HCPCS,Remove sacrum pressure sore,,Case Rate,4000.00
Cigna,PPO,15940,CPT4/HCPCS,Remove hip pressure sore,,Case Rate,4000.00
Cigna,PPO,15941,CPT4/HCPCS,Remove hip pressure sore,,Case Rate,4000.00
Cigna,PPO,15944,CPT4/HCPCS,Remove hip pressure sore,,Case Rate,4000.00
Cigna,PPO,15945,CPT4/HCPCS,Remove hip pressure sore,,Case Rate,4000.00
Cigna,PPO,15946,CPT4/HCPCS,Remove hip pressure sore,,Case Rate,4000.00
Cigna,PPO,15950,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,PPO,15951,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,PPO,15952,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,PPO,15953,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,PPO,15956,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,PPO,15958,CPT4/HCPCS,Remove thigh pressure sore,,Case Rate,4000.00
Cigna,PPO,16,DRG,Autologous bone marrow transplant w CC/MCC,,Case Rate,171518.10
Cigna,PPO,16020,CPT4/HCPCS,Dressings and/or debridement, initial or subsequent; without anesthesia, office or hospital, small,,Case Rate,3000.00
Cigna,PPO,16025,CPT4/HCPCS,Dress/debrid p-thick burn, m,,Case Rate,3000.00
Cigna,PPO,16030,CPT4/HCPCS,Treatment of burn(s),,Case Rate,3000.00
Cigna,PPO,16035,CPT4/HCPCS,Incision of burn scab, initi,,Case Rate,3000.00
Cigna,PPO,163,DRG,Major chest procedures w MCC,,Case Rate,126469.80
Cigna,PPO,164,DRG,Major chest procedures w CC,,Case Rate,67212.90
Cigna,PPO,165,DRG,Major chest procedures w/o CC/MCC,,Case Rate,48669.30
Cigna,PPO,166,DRG,Other resp system O.R. procedures w MCC,,Case Rate,96637.35
Cigna,PPO,167,DRG,Other resp system O.R. procedures w CC,,Case Rate,47455.50
Cigna,PPO,168,DRG,Other resp system O.R. procedures w/o CC/MCC,,Case Rate,34919.70
Cigna,PPO,17,DRG,Autologous bone marrow transplant w/o CC/MCC,,Case Rate,123170.10
Cigna,PPO,17000,CPT4/HCPCS,Destruction by any method, including laser, with or without surgical curettement, all benign or premalignant lesions (eg, actinic keratoses) other than skin tags or cutaneous vascular proliferative lesions, including local anesthesia; first lesion,,Case Rate,400.00
Cigna,PPO,17003,CPT4/HCPCS,DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), ALL BENIGN OR PREMALIGNANT LESIONS (EG. ACTINIC KERATOSES) OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; SECOND THROUGH 14 LESIONS, EACH,,Case Rate,3000.00
Cigna,PPO,17004,CPT4/HCPCS,DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, ,,Case Rate,3000.00
Cigna,PPO,17106,CPT4/HCPCS,Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm,,Case Rate,3000.00
Cigna,PPO,17107,CPT4/HCPCS,Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 - 50.0 sq cm,,Case Rate,3000.00
Cigna,PPO,17108,CPT4/HCPCS,Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm,,Case Rate,3000.00
Cigna,PPO,17110,CPT4/HCPCS,Destruction by any method of flat warts, molluscum contagiosum, or milia; up to 14 lesions,,Case Rate,400.00
Cigna,PPO,17111,CPT4/HCPCS,DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF FLAT WARTS, MOLLISCUM CONTAGIOSUM, OR MILIA;15 OR MORE LESIONS ,,Case Rate,3000.00
Cigna,PPO,17250,CPT4/HCPCS,CHEMICAL CAUTERIZATION OF GRANULATION TISSUE ( PROUD FLESH, SINUS OR FISTULA) ,,Case Rate,3000.00
Cigna,PPO,17260,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM OR LESS ,,Case Rate,3000.00
Cigna,PPO,17261,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), TRUNK, ARMS OR LEGS; LESION DIAMETER 0.6 TO 1.0 CM ,,Case Rate,3000.00
Cigna,PPO,17262,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), TRUNK, ARMS OR LEGS; LESION DIAMETER 1.1 TO 2.0 CM ,,Case Rate,3000.00
Cigna,PPO,17263,CPT4/HCPCS,Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 2.1 to 3.0 cm,,Case Rate,400.00
Cigna,PPO,17264,CPT4/HCPCS,Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 3.1 to 4.0 cm,,Case Rate,400.00
Cigna,PPO,17266,CPT4/HCPCS,Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter over 4.0 cm,,Case Rate,3000.00
Cigna,PPO,17270,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.5 CM OR LESS ,,Case Rate,3000.00
Cigna,PPO,17271,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM ,,Case Rate,3000.00
Cigna,PPO,17272,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 1.1 TO 2.0 CM ,,Case Rate,3000.00
Cigna,PPO,17273,CPT4/HCPCS,Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm,,Case Rate,400.00
Cigna,PPO,17274,CPT4/HCPCS,Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm,,Case Rate,3000.00
Cigna,PPO,17276,CPT4/HCPCS,Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cm,,Case Rate,3000.00
Cigna,PPO,17280,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.5 CM OR LESS ,,Case Rate,3000.00
Cigna,PPO,17281,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM ,,Case Rate,3000.00
Cigna,PPO,17282,CPT4/HCPCS,DESTRUCTION,MALIGNANT LESION (EG, LASER SURGERY,ELECTROSURGERY, CRYOSURGERY,CHEMOSURGERY,SURGICAL CURETTEMENT), FACE, EARS, EYELIDS, NOSE,.0 CMLIPS, MUCOUS MEMBRANE; LESION DIAMETER 1.1 TO 2.0 CM ,,Case Rate,3000.00
Cigna,PPO,17283,CPT4/HCPCS,Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cm,,Case Rate,400.00
Cigna,PPO,17284,CPT4/HCPCS,Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cm,,Case Rate,3000.00
Cigna,PPO,17286,CPT4/HCPCS,Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cm,,Case Rate,400.00
Cigna,PPO,17311,CPT4/HCPCS,"Mohs, 1 stage, h/n/hf/g",,Case Rate,3000.00
Cigna,PPO,17312,CPT4/HCPCS,Mohs addl stage,,Case Rate,3000.00
Cigna,PPO,17313,CPT4/HCPCS,"Mohs, 1 stage, t/a/l",,Case Rate,3000.00
Cigna,PPO,17314,CPT4/HCPCS,"Mohs, addl stage, t/a/l",,Case Rate,3000.00
Cigna,PPO,17315,CPT4/HCPCS,"Mohs surg, addl block",,Case Rate,3000.00
Cigna,PPO,175,DRG,Pulmonary embolism w MCC,,Case Rate,39377.10
Cigna,PPO,176,DRG,Pulmonary embolism w/o MCC,,Case Rate,22610.85
Cigna,PPO,177,DRG,Respiratory infections & inflammations w MCC,,Case Rate,47055.15
Cigna,PPO,178,DRG,Respiratory infections & inflammations w CC,,Case Rate,30750.45
Cigna,PPO,179,DRG,Respiratory infections & inflammations w/o CC/MCC,,Case Rate,22213.05
Cigna,PPO,17999,CPT4/HCPCS,UNLISTED PROCEDURE, SKIN, MUCOUS MEM/SUBC TISSUE ,,Case Rate,3000.00
Cigna,PPO,18,DRG,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY,,Case Rate,951889.50
Cigna,PPO,180,DRG,Respiratory neoplasms w MCC,,Case Rate,44313.90
Cigna,PPO,181,DRG,Respiratory neoplasms w CC,,Case Rate,28582.95
Cigna,PPO,182,DRG,Respiratory neoplasms w/o CC/MCC,,Case Rate,20081.25
Cigna,PPO,183,DRG,Major chest trauma w MCC,,Case Rate,39667.80
Cigna,PPO,184,DRG,Major chest trauma w CC,,Case Rate,26504.70
Cigna,PPO,185,DRG,Major chest trauma w/o CC/MCC,,Case Rate,19726.80
Cigna,PPO,186,DRG,Pleural effusion w MCC,,Case Rate,39351.60
Cigna,PPO,187,DRG,Pleural effusion w CC,,Case Rate,26321.10
Cigna,PPO,188,DRG,Pleural effusion w/o CC/MCC,,Case Rate,18566.55
Cigna,PPO,189,DRG,Pulmonary edema & respiratory failure,,Case Rate,31232.40
Cigna,PPO,19,DRG,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,,Case Rate,169878.45
Cigna,PPO,190,DRG,Chronic obstructive pulmonary disease w MCC,,Case Rate,28659.45
Cigna,PPO,19000,CPT4/HCPCS,Puncture aspiration of cyst of breast;,,Case Rate,3000.00
Cigna,PPO,19001,CPT4/HCPCS,PUNCTURE ASPIRATION OF CYST; EACH ADDITIONAL CYST (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,19020,CPT4/HCPCS,Incision of breast lesion,,Case Rate,3000.00
Cigna,PPO,19030,CPT4/HCPCS,Injection procedure only for mammary ductogram or galactogram,,Case Rate,3000.00
Cigna,PPO,19081,CPT4/HCPCS,BX BREAST 1ST LESION STRTCTC,,Case Rate,4000.00
Cigna,PPO,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,Case Rate,3000.00
Cigna,PPO,19083,CPT4/HCPCS,BX BREAST 1ST LESION US IMAG,,Case Rate,4000.00
Cigna,PPO,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,Case Rate,3000.00
Cigna,PPO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Case Rate,4000.00
Cigna,PPO,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,Case Rate,3000.00
Cigna,PPO,191,DRG,Chronic obstructive pulmonary disease w CC,,Case Rate,22519.05
Cigna,PPO,19100,CPT4/HCPCS,Bx breast percut w/o image,,Case Rate,3000.00
Cigna,PPO,19101,CPT4/HCPCS,Biopsy of breast, open,,Case Rate,3000.00
Cigna,PPO,19105,CPT4/HCPCS,"Cryosurg ablate fa, each",,Case Rate,8300.00
Cigna,PPO,19110,CPT4/HCPCS,Nipple exploration,,Case Rate,3000.00
Cigna,PPO,19112,CPT4/HCPCS,Excise breast duct fistula,,Case Rate,4000.00
Cigna,PPO,19120,CPT4/HCPCS,Removal of breast lesion,,Case Rate,4000.00
Cigna,PPO,19125,CPT4/HCPCS,Excision, breast lesion,,Case Rate,4000.00
Cigna,PPO,19126,CPT4/HCPCS,Excision, addl breast lesion,,Case Rate,3000.00
Cigna,PPO,192,DRG,Chronic obstructive pulmonary disease w/o CC/MCC,,Case Rate,17719.95
Cigna,PPO,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,Case Rate,3000.00
Cigna,PPO,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,Case Rate,3000.00
Cigna,PPO,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,Case Rate,3000.00
Cigna,PPO,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,Case Rate,3000.00
Cigna,PPO,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,Case Rate,3000.00
Cigna,PPO,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,Case Rate,3000.00
Cigna,PPO,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,Case Rate,3000.00
Cigna,PPO,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,Case Rate,3000.00
Cigna,PPO,19294,CPT4/HCPCS,Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Case Rate,8300.00
Cigna,PPO,19297,CPT4/HCPCS,Placement Of Radiotherapy Afterloading Balloon Catheter Into The Breast For Interstitial Radioelement Application Following Partial Mastectomy, Includes Imaging Guidance; Concurrent With Partial Mastectomy (List Separately In Addition To Code For Primary,,Case Rate,3000.00
Cigna,PPO,19298,CPT4/HCPCS,Place breast rad tube/caths,,Case Rate,8300.00
Cigna,PPO,193,DRG,Simple pneumonia & pleurisy w MCC,,Case Rate,33422.85
Cigna,PPO,19300,CPT4/HCPCS,Removal of breast tissue,,Case Rate,4000.00
Cigna,PPO,19301,CPT4/HCPCS,Partical mastectomy,,Case Rate,4000.00
Cigna,PPO,19302,CPT4/HCPCS,P-mastectomy w/ln removal,,Case Rate,6000.00
Cigna,PPO,19303,CPT4/HCPCS,Mast, simple, complete,,Case Rate,4000.00
Cigna,PPO,19307,CPT4/HCPCS,"Mast, mod rad",,Case Rate,8300.00
Cigna,PPO,19316,CPT4/HCPCS,Suspension of breast,,Case Rate,4000.00
Cigna,PPO,19318,CPT4/HCPCS,Reduction of large breast,,Case Rate,4000.00
Cigna,PPO,19324,CPT4/HCPCS,Enlarge breast,,Case Rate,4000.00
Cigna,PPO,19325,CPT4/HCPCS,Enlarge breast with implant,,Case Rate,8300.00
Cigna,PPO,19328,CPT4/HCPCS,Removal of breast implant,,Case Rate,3000.00
Cigna,PPO,19330,CPT4/HCPCS,Removal of implant material,,Case Rate,3000.00
Cigna,PPO,19340,CPT4/HCPCS,Immediate breast prosthesis,,Case Rate,3000.00
Cigna,PPO,19342,CPT4/HCPCS,Delayed breast prosthesis,,Case Rate,4000.00
Cigna,PPO,19350,CPT4/HCPCS,Breast reconstruction,,Case Rate,4000.00
Cigna,PPO,19355,CPT4/HCPCS,Correct inverted nipple(s),,Case Rate,4000.00
Cigna,PPO,19357,CPT4/HCPCS,Breast reconstruction,,Case Rate,5000.00
Cigna,PPO,19364,CPT4/HCPCS,Breast reconstruction,,Case Rate,3000.00
Cigna,PPO,19366,CPT4/HCPCS,Breast reconstruction,,Case Rate,5000.00
Cigna,PPO,19370,CPT4/HCPCS,Surgery of breast capsule,,Case Rate,4000.00
Cigna,PPO,19371,CPT4/HCPCS,Removal of breast capsule,,Case Rate,4000.00
Cigna,PPO,19380,CPT4/HCPCS,Revise breast reconstruction,,Case Rate,5000.00
Cigna,PPO,19396,CPT4/HCPCS,PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT ,,Case Rate,3000.00
Cigna,PPO,194,DRG,Simple pneumonia & pleurisy w CC,,Case Rate,22006.50
Cigna,PPO,19499,CPT4/HCPCS,UNLISTED PROCEDURE, BREAST ,,Case Rate,3000.00
Cigna,PPO,195,DRG,Simple pneumonia & pleurisy w/o CC/MCC,,Case Rate,16957.50
Cigna,PPO,196,DRG,Interstitial lung disease w MCC,,Case Rate,44270.55
Cigna,PPO,197,DRG,Interstitial lung disease w CC,,Case Rate,25642.80
Cigna,PPO,198,DRG,Interstitial lung disease w/o CC/MCC,,Case Rate,18928.65
Cigna,PPO,199,DRG,Pneumothorax w MCC,,Case Rate,45583.80
Cigna,PPO,2,DRG,Heart transplant or implant of heart assist system w/o MCC,,Case Rate,406240.50
Cigna,PPO,20,DRG,Intracranial vascular procedures w PDX hemorrhage w MCC,,Case Rate,263162.55
Cigna,PPO,200,DRG,Pneumothorax w CC,,Case Rate,27412.50
Cigna,PPO,201,DRG,Pneumothorax w/o CC/MCC,,Case Rate,18092.25
Cigna,PPO,20103,CPT4/HCPCS,Exploration of penetrating wound (separate procedure); extremity,,Case Rate,3000.00
Cigna,PPO,202,DRG,Bronchitis & asthma w CC/MCC,,Case Rate,24622.80
Cigna,PPO,20200,CPT4/HCPCS,Muscle biopsy,,Case Rate,3000.00
Cigna,PPO,20205,CPT4/HCPCS,Deep muscle biopsy,,Case Rate,4000.00
Cigna,PPO,20206,CPT4/HCPCS,Needle biopsy, muscle,,Case Rate,3000.00
Cigna,PPO,20220,CPT4/HCPCS,Bone biopsy, trocar/needle,,Case Rate,3000.00
Cigna,PPO,20225,CPT4/HCPCS,Bone biopsy, trocar/needle,,Case Rate,3000.00
Cigna,PPO,20240,CPT4/HCPCS,Bone biopsy, excisional,,Case Rate,3000.00
Cigna,PPO,20245,CPT4/HCPCS,Bone biopsy, excisional,,Case Rate,4000.00
Cigna,PPO,20250,CPT4/HCPCS,Open bone biopsy,,Case Rate,4000.00
Cigna,PPO,20251,CPT4/HCPCS,Open bone biopsy,,Case Rate,4000.00
Cigna,PPO,203,DRG,Bronchitis & asthma w/o CC/MCC,,Case Rate,17990.25
Cigna,PPO,204,DRG,Respiratory signs & symptoms,,Case Rate,20208.75
Cigna,PPO,205,DRG,Other respiratory system diagnoses w MCC,,Case Rate,42898.65
Cigna,PPO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT; THERAPEUTIC (SEP PROC) (CON TOS 04) ,,Case Rate,3000.00
Cigna,PPO,20501,CPT4/HCPCS,Injection of sinus tract; diagnostic (sinogram),,Case Rate,3000.00
Cigna,PPO,20520,CPT4/HCPCS,Removal of foreign body in muscle or tendon sheath; simple,,Case Rate,3000.00
Cigna,PPO,20525,CPT4/HCPCS,Removal of foreign body,,Case Rate,4000.00
Cigna,PPO,20526,CPT4/HCPCS,INJECTION, THERAPEUTIC (EG, LOCAL ANESTHETIC; CORTICOSTEROID), CARPAL TUNNEL ,,Case Rate,3000.00
Cigna,PPO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Case Rate,400.00
Cigna,PPO,20550,CPT4/HCPCS,INJECTION(S); SINGLE TENDON SHEATH, OR LIAGAMENT, APONEUROSIS (EG. PLANTAR "FASCIA") ,,Case Rate,3000.00
Cigna,PPO,20551,CPT4/HCPCS,INJECTION(S); SINGLE TENDON ,,Case Rate,3000.00
Cigna,PPO,20552,CPT4/HCPCS,INJECTION SINGLE OR MULTIPLE TRIGGER POINTS, ONE OR TWO MUSCLE(S) ,,Case Rate,3000.00
Cigna,PPO,20553,CPT4/HCPCS,INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S), THREE OR MORE MUSCLE(S) ,,Case Rate,3000.00
Cigna,PPO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Case Rate,8300.00
Cigna,PPO,20560,CPT4/HCPCS,Needle insertion(s) without injection(s); 1 or 2 muscle(s),,Case Rate,3000.00
Cigna,PPO,20561,CPT4/HCPCS,Needle insertion(s) without injection(s); 3 or more muscles,,Case Rate,3000.00
Cigna,PPO,206,DRG,Other respiratory system diagnoses w/o MCC,,Case Rate,22547.10
Cigna,PPO,20600,CPT4/HCPCS,ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL JOINT OR BURSA (EG, FINGERS, TOES) ,,Case Rate,3000.00
Cigna,PPO,20604,CPT4/HCPCS, ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, SMALL JOINT OR BURSA (EG, FINGERS, TOES); WITH ULTRASOUND, WITH PERMANENT RECORDING AND REPORTING,,Case Rate,400.00
Cigna,PPO,20605,CPT4/HCPCS,Arthrocentesis, aspiration and/or injection; intermediate joint, bursa or ganglion cyst (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa),,Case Rate,3000.00
Cigna,PPO,20606,CPT4/HCPCS, ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, INTERMEDIATE JOINT OR BURSA (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA); WITH ULTRASOUND GUIDANCE, WITH PERMANENT RECORDING AND REPORTING,,Case Rate,400.00
Cigna,PPO,20610,CPT4/HCPCS,Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip, knee joint, subacromial bursa),,Case Rate,3000.00
Cigna,PPO,20611,CPT4/HCPCS, ARTHROCENTESIS, ASPIRATION AND/OR INJECTION, MAJOR JOINT OR BURSA (EG, SHOULDER, HIP, KNEE, SUBACROMIAL BURSA); WITH ULTRASOUND GUIDANCE, WITH PERMANENT RECORDING AND REPORTING,,Case Rate,400.00
Cigna,PPO,20612,CPT4/HCPCS,ASPIRATION AND/OR INJECTION OF GANGLION CYST(S) ANY LOCATION ,,Case Rate,3000.00
Cigna,PPO,20615,CPT4/HCPCS,Aspiration and injection for treatment of bone cyst,,Case Rate,400.00
Cigna,PPO,20650,CPT4/HCPCS,Insert and remove bone pin,,Case Rate,4000.00
Cigna,PPO,20660,CPT4/HCPCS,Apply, remove fixation device,,Case Rate,3000.00
Cigna,PPO,20661,CPT4/HCPCS,Application of head brace,,Case Rate,3000.00
Cigna,PPO,20662,CPT4/HCPCS,Application of pelvis brace,,Case Rate,4000.00
Cigna,PPO,20663,CPT4/HCPCS,Application of thigh brace,,Case Rate,4000.00
Cigna,PPO,20665,CPT4/HCPCS,Removal of fixation device,,Case Rate,400.00
Cigna,PPO,20670,CPT4/HCPCS,Removal of support implant,,Case Rate,3000.00
Cigna,PPO,20680,CPT4/HCPCS,Removal of support implant,,Case Rate,4000.00
Cigna,PPO,20690,CPT4/HCPCS,Apply bone fixation device,,Case Rate,3000.00
Cigna,PPO,20692,CPT4/HCPCS,Apply bone fixation device,,Case Rate,4000.00
Cigna,PPO,20693,CPT4/HCPCS,Adjust bone fixation device,,Case Rate,4000.00
Cigna,PPO,20694,CPT4/HCPCS,Remove bone fixation device,,Case Rate,3000.00
Cigna,PPO,20696,CPT4/HCPCS,APPLICATION OF MULTIPLANE (PINS OR WIRES IN MORE THAN ONE PLANE), UNILATERAL, EXTERNAL FIXATION WITH STEREOTACTIC COMPUTER-ASSISTED ADJUSTMENT (EG, SPATIAL FRAME), INCLUDING IMAGING; INITIAL AND SUBSEQUENT ALIGNMENT(S), ASSESSMENT(S), AND COMPUTATION(S) O,,Case Rate,8300.00
Cigna,PPO,20697,CPT4/HCPCS,APPLICATION OF MULTIPLANE (PINS OR WIRES IN MORE THAN ONE PLANE), UNILATERAL, EXTERNAL FIXATION WITH STEREOTACTIC COMPUTER-ASSISTED ADJUSTMENT (EG, SPATIAL FRAME), INCLUDING IMAGING; EXCHANGE (IE, REMOVAL AND REPLACEMENT) OF STRUT, EACH,,Case Rate,6000.00
Cigna,PPO,207,DRG,Respiratory system diagnosis w ventilator support 96+ hours,,Case Rate,146023.20
Cigna,PPO,20700,CPT4/HCPCS,Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,20701,CPT4/HCPCS,Removal of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,20702,CPT4/HCPCS,Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,20703,CPT4/HCPCS,Removal of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,20704,CPT4/HCPCS,Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,20705,CPT4/HCPCS,Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,208,DRG,Respiratory system diagnosis w ventilator support <96 hours,,Case Rate,64828.65
Cigna,PPO,20900,CPT4/HCPCS,Removal of bone for graft,,Case Rate,4000.00
Cigna,PPO,20902,CPT4/HCPCS,Removal of bone for graft,,Case Rate,4000.00
Cigna,PPO,20910,CPT4/HCPCS,Remove cartilage for graft,,Case Rate,4000.00
Cigna,PPO,20912,CPT4/HCPCS,Remove cartilage for graft,,Case Rate,4000.00
Cigna,PPO,20920,CPT4/HCPCS,Removal of fascia for graft,,Case Rate,4000.00
Cigna,PPO,20922,CPT4/HCPCS,Removal of fascia for graft,,Case Rate,4000.00
Cigna,PPO,20924,CPT4/HCPCS,Removal of tendon for graft,,Case Rate,4000.00
Cigna,PPO,20930,CPT4/HCPCS,ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,20931,CPT4/HCPCS,ALLOGRAFT, STRUCTURAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,20932,CPT4/HCPCS,Allograft, includes templating, cutting, placement and internal fixation, when performed; osteoarticular, including articular surface and contiguous bone (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,20933,CPT4/HCPCS,Allograft, includes templating, cutting, placement and internal fixation, when performed; hemicortical intercalary, partial (ie, hemicylindrical) (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,20934,CPT4/HCPCS,Allograft, includes templating, cutting, placement and internal fixation, when performed; intercalary, complete (ie, cylindrical) (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,20936,CPT4/HCPCS,Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure) ,,Case Rate,3000.00
Cigna,PPO,20937,CPT4/HCPCS,Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure) ,,Case Rate,3000.00
Cigna,PPO,20938,CPT4/HCPCS,Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure) ,,Case Rate,3000.00
Cigna,PPO,20939,CPT4/HCPCS,Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,20950,CPT4/HCPCS,MONIT INTER FLUID PRES (INC INS DEV EG WICK CATH ETC) DET OF MUSC COMPAR SYNDR ,,Case Rate,3000.00
Cigna,PPO,20955,CPT4/HCPCS,Fibula bone graft, microvasc,,Case Rate,3000.00
Cigna,PPO,20962,CPT4/HCPCS,Other bone graft, microvasc,,Case Rate,3000.00
Cigna,PPO,20969,CPT4/HCPCS,Bone/skin graft, microvasc,,Case Rate,3000.00
Cigna,PPO,20970,CPT4/HCPCS,Bone/skin graft, iliac crest,,Case Rate,3000.00
Cigna,PPO,20972,CPT4/HCPCS,Bone/skin graft, metatarsal,,Case Rate,4000.00
Cigna,PPO,20973,CPT4/HCPCS,Bone/skin graft, great toe,,Case Rate,4000.00
Cigna,PPO,20975,CPT4/HCPCS,Electrical bone stimulation,,Case Rate,3000.00
Cigna,PPO,20982,CPT4/HCPCS,Ablation, bone tumor(s) (eg, osteoid osteoma, metastasis) radiofrequency, percutaneous, including computed tomographic guidance,,Case Rate,3000.00
Cigna,PPO,20983,CPT4/HCPCS, ABLATION THERAPY FOR REDUCTION OR ERADICATION OF 1 OR MORE BONE TUMORS (EG, METASTASIS) INCLUDING ADJACENT SOFT TISSUE WHEN INVOLVED BY TUMOR EXTENSION, PERCUTANEOUS, INCLUDING IMAGING GUIDANCE WHEN PERFORMED; CRYOABLATION,,Case Rate,3000.00
Cigna,PPO,20985,CPT4/HCPCS,CPTR-ASST DIR MS PX,,Case Rate,3000.00
Cigna,PPO,20999,CPT4/HCPCS,UNLISTED PROCEDURE, MUSCULOSKELETAL SYSTEM, GENERAL ,,Case Rate,3000.00
Cigna,PPO,21,DRG,Intracranial vascular procedures w PDX hemorrhage w CC,,Case Rate,192055.80
Cigna,PPO,21010,CPT4/HCPCS,Incision of jaw joint,,Case Rate,3000.00
Cigna,PPO,21011,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM,,Case Rate,400.00
Cigna,PPO,21012,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 C M OR GREATER ,,Case Rate,3000.00
Cigna,PPO,21013,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); LESS THAN 2 CM,,Case Rate,3000.00
Cigna,PPO,21014,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); 2 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,21015,CPT4/HCPCS,Resection of facial tumor,,Case Rate,4000.00
Cigna,PPO,21016,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FACE OR SCALP; 2 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,21025,CPT4/HCPCS,Excision of bone, lower jaw,,Case Rate,3000.00
Cigna,PPO,21026,CPT4/HCPCS,Excision of facial bone(s),,Case Rate,3000.00
Cigna,PPO,21029,CPT4/HCPCS,Contour of face bone lesion,,Case Rate,3000.00
Cigna,PPO,21030,CPT4/HCPCS,Excision of benign tumor or cyst of facial bone other than mandible,,Case Rate,3000.00
Cigna,PPO,21031,CPT4/HCPCS,Excision of torus mandibularis,,Case Rate,3000.00
Cigna,PPO,21032,CPT4/HCPCS,Excision of maxillary torus palatinus,,Case Rate,3000.00
Cigna,PPO,21034,CPT4/HCPCS,Removal of face bone lesion,,Case Rate,4000.00
Cigna,PPO,21040,CPT4/HCPCS,Removal of jaw bone lesion,,Case Rate,3000.00
Cigna,PPO,21044,CPT4/HCPCS,Removal of jaw bone lesion,,Case Rate,3000.00
Cigna,PPO,21046,CPT4/HCPCS,Excision, benign tumor, mandible,,Case Rate,3000.00
Cigna,PPO,21047,CPT4/HCPCS,Excision, benign tumor, mandible,,Case Rate,3000.00
Cigna,PPO,21048,CPT4/HCPCS,Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion (s),,Case Rate,4000.00
Cigna,PPO,21049,CPT4/HCPCS,Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive or destructive lesion (s),,Case Rate,4000.00
Cigna,PPO,21050,CPT4/HCPCS,Removal of jaw joint,,Case Rate,4000.00
Cigna,PPO,21060,CPT4/HCPCS,Remove jaw joint cartilage,,Case Rate,3000.00
Cigna,PPO,21070,CPT4/HCPCS,Remove coronoid process,,Case Rate,4000.00
Cigna,PPO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Case Rate,400.00
Cigna,PPO,21100,CPT4/HCPCS,Maxillofacial fixation,,Case Rate,3000.00
Cigna,PPO,21110,CPT4/HCPCS,APPLICA INTERDENTAL FIXA DEVICE FOR CONDI OTH THN FRAC/DISLOC INCL REMOVAL ,,Case Rate,3000.00
Cigna,PPO,21116,CPT4/HCPCS,Injection procedure for temporomandibular joint arthrography,,Case Rate,3000.00
Cigna,PPO,21120,CPT4/HCPCS,Reconstruction of chin,,Case Rate,6000.00
Cigna,PPO,21121,CPT4/HCPCS,Reconstruction of chin,,Case Rate,6000.00
Cigna,PPO,21122,CPT4/HCPCS,Reconstruction of chin,,Case Rate,6000.00
Cigna,PPO,21123,CPT4/HCPCS,Reconstruction of chin,,Case Rate,6000.00
Cigna,PPO,21125,CPT4/HCPCS,Augmentation, lower jaw bone,,Case Rate,6000.00
Cigna,PPO,21127,CPT4/HCPCS,Augmentation, lower jaw bone,,Case Rate,8300.00
Cigna,PPO,21137,CPT4/HCPCS,Reduction forehead; contouring only,,Case Rate,3000.00
Cigna,PPO,21138,CPT4/HCPCS,Reduction forehead; contouring and application of prosthetic material or bone graft (incld. obtaining autograft),,Case Rate,3000.00
Cigna,PPO,21141,CPT4/HCPCS,Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft,,Case Rate,3000.00
Cigna,PPO,21142,CPT4/HCPCS,Reconstruction midface, LeFort I; two pieces, segment movement in any direction, without bone graft,,Case Rate,3000.00
Cigna,PPO,21146,CPT4/HCPCS,Reconstruction midface, LeFort I; two pieces, segment movement in any direction, requiring bone grafts (incld. obtaining autografts) (eg, ungrafted unilateral alveolar cleft),,Case Rate,3000.00
Cigna,PPO,21172,CPT4/HCPCS,REC SUP-LAT ORB RIM AND LOWER FORHD, ADV/ALT W/WO GRFTS (INCL OBT AUTOGRFTS) ,,Case Rate,3000.00
Cigna,PPO,21175,CPT4/HCPCS,RECON BIFRON SUP-LAT ORB RIM/LOW FORHD ADVANC/ALT (EGPLAG,TRI,BRACH)W/WO GRE(IN ,,Case Rate,3000.00
Cigna,PPO,21181,CPT4/HCPCS,Contour cranial bone lesion,,Case Rate,6000.00
Cigna,PPO,21193,CPT4/HCPCS,RECONSTRUCT OF MANDIBULAR RAMI, HORIZ, VERT, "C", OR "L" OSTEOTOMY;W/O GRAFT ,,Case Rate,3000.00
Cigna,PPO,21195,CPT4/HCPCS,RECONSTRUCT OF MANDIBULAR RAMI A/O BODY SAGITTAL SPLT; W/O INTERNAL RIGID FIX ,,Case Rate,3000.00
Cigna,PPO,21198,CPT4/HCPCS,OSTEOTOMY, MANDIBLE, SEGMENTAL; ,,Case Rate,3000.00
Cigna,PPO,21199,CPT4/HCPCS,Osteotomy, mandible, segmental; with genioglossus advancement,,Case Rate,3000.00
Cigna,PPO,21206,CPT4/HCPCS,Reconstruct upper jaw bone,,Case Rate,5000.00
Cigna,PPO,21208,CPT4/HCPCS,Augmentation of facial bones,,Case Rate,6000.00
Cigna,PPO,21209,CPT4/HCPCS,Reduction of facial bones,,Case Rate,5000.00
Cigna,PPO,21210,CPT4/HCPCS,Face bone graft,,Case Rate,6000.00
Cigna,PPO,21215,CPT4/HCPCS,Lower jaw bone graft,,Case Rate,6000.00
Cigna,PPO,21230,CPT4/HCPCS,Rib cartilage graft,,Case Rate,6000.00
Cigna,PPO,21235,CPT4/HCPCS,Ear cartilage graft,,Case Rate,6000.00
Cigna,PPO,21240,CPT4/HCPCS,Reconstruction of jaw joint,,Case Rate,4000.00
Cigna,PPO,21242,CPT4/HCPCS,Reconstruction of jaw joint,,Case Rate,5000.00
Cigna,PPO,21243,CPT4/HCPCS,Reconstruction of jaw joint,,Case Rate,5000.00
Cigna,PPO,21244,CPT4/HCPCS,Reconstruction of lower jaw,,Case Rate,6000.00
Cigna,PPO,21245,CPT4/HCPCS,Reconstruction of jaw,,Case Rate,6000.00
Cigna,PPO,21246,CPT4/HCPCS,Reconstruction of jaw,,Case Rate,6000.00
Cigna,PPO,21248,CPT4/HCPCS,Reconstruction of jaw,,Case Rate,6000.00
Cigna,PPO,21249,CPT4/HCPCS,Reconstruction of jaw,,Case Rate,6000.00
Cigna,PPO,21267,CPT4/HCPCS,Revise eye sockets,,Case Rate,6000.00
Cigna,PPO,21270,CPT4/HCPCS,Augmentation, cheek bone,,Case Rate,5000.00
Cigna,PPO,21275,CPT4/HCPCS,Revision, orbitofacial bones,,Case Rate,6000.00
Cigna,PPO,21280,CPT4/HCPCS,Revision of eyelid,,Case Rate,5000.00
Cigna,PPO,21282,CPT4/HCPCS,Revision of eyelid,,Case Rate,5000.00
Cigna,PPO,21295,CPT4/HCPCS,Reconst lwr jaw w/o fixation,,Case Rate,3000.00
Cigna,PPO,21296,CPT4/HCPCS,Reconst lwr jaw w/fixation,,Case Rate,3000.00
Cigna,PPO,21310,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,3000.00
Cigna,PPO,21315,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,3000.00
Cigna,PPO,21320,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,3000.00
Cigna,PPO,21325,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,4000.00
Cigna,PPO,21330,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,5000.00
Cigna,PPO,21335,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,6000.00
Cigna,PPO,21336,CPT4/HCPCS,Treat nasal septal fracture,,Case Rate,4000.00
Cigna,PPO,21337,CPT4/HCPCS,Treat nasal septal fracture,,Case Rate,3000.00
Cigna,PPO,21338,CPT4/HCPCS,Treat nasoethmoid fracture,,Case Rate,4000.00
Cigna,PPO,21339,CPT4/HCPCS,Treat nasoethmoid fracture,,Case Rate,5000.00
Cigna,PPO,21340,CPT4/HCPCS,Treatment of nose fracture,,Case Rate,4000.00
Cigna,PPO,21343,CPT4/HCPCS,Treatment of sinus fracture,,Case Rate,3000.00
Cigna,PPO,21344,CPT4/HCPCS,OPEN TREATMENT OF COMPLICATED (EG, COMMUNITED OR INVOLVING POSTERIOR WALL) FRONTAL SINUS FRACTURE, VIA CORNAL OR MULTIPLE APPROACHES,,Case Rate,3000.00
Cigna,PPO,21345,CPT4/HCPCS,Treat nose/jaw fracture,,Case Rate,6000.00
Cigna,PPO,21346,CPT4/HCPCS,OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); WITH WIRING AND/OR LOCAL FIXATION,,Case Rate,3000.00
Cigna,PPO,21347,CPT4/HCPCS,OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); REQUIRING MULTIPLE OPEN APPROACHES,,Case Rate,3000.00
Cigna,PPO,21348,CPT4/HCPCS,OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LE FORT II TYPE); WITH BONE GRAFTING (INCLUDES OBTAINING GRAFT),,Case Rate,3000.00
Cigna,PPO,21355,CPT4/HCPCS,Treat cheek bone fracture,,Case Rate,4000.00
Cigna,PPO,21356,CPT4/HCPCS,OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FRACTURE (EG, GILLES APPROACH),,Case Rate,4000.00
Cigna,PPO,21360,CPT4/HCPCS,Treat cheek bone fracture,,Case Rate,6000.00
Cigna,PPO,21365,CPT4/HCPCS,Treat cheek bone fracture CMS CORRECTION 5/30/03,,Case Rate,6000.00
Cigna,PPO,21366,CPT4/HCPCS,OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVING CRANIAL NERVE FORAMINA) FRACTURE(S) OF MALAR AREA, INCLUDING ZYGOMATIC ARCH AND MALAR TRIPOD; WITH INTERNAL FIXATION AND MULTIPLE SURGICAL APPROACHES WITH BONE GRAFTING (INCLUDES OBTAINING GRAFT,,Case Rate,3000.00
Cigna,PPO,21385,CPT4/HCPCS,Open treatment of orbital floor blowout fracture; transantral approach (Caldwell-Luc type operation),,Case Rate,8300.00
Cigna,PPO,21386,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,3000.00
Cigna,PPO,21387,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,3000.00
Cigna,PPO,21390,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,6000.00
Cigna,PPO,21395,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,3000.00
Cigna,PPO,21400,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,3000.00
Cigna,PPO,21401,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,4000.00
Cigna,PPO,21406,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,4000.00
Cigna,PPO,21407,CPT4/HCPCS,Treat eye socket fracture,,Case Rate,5000.00
Cigna,PPO,21421,CPT4/HCPCS,Treat mouth roof fracture,,Case Rate,4000.00
Cigna,PPO,21422,CPT4/HCPCS,Treat mouth roof fracture,,Case Rate,3000.00
Cigna,PPO,21440,CPT4/HCPCS,REPAIR DENTAL RIDGE FRACTURE,,Case Rate,4000.00
Cigna,PPO,21445,CPT4/HCPCS,Treat dental ridge fracture,,Case Rate,4000.00
Cigna,PPO,21450,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,4000.00
Cigna,PPO,21451,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,4000.00
Cigna,PPO,21452,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,3000.00
Cigna,PPO,21453,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,4000.00
Cigna,PPO,21454,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,5000.00
Cigna,PPO,21461,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,4000.00
Cigna,PPO,21462,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,5000.00
Cigna,PPO,21465,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,4000.00
Cigna,PPO,21470,CPT4/HCPCS,Treat lower jaw fracture,,Case Rate,5000.00
Cigna,PPO,21480,CPT4/HCPCS,Reset dislocated jaw,,Case Rate,3000.00
Cigna,PPO,21485,CPT4/HCPCS,Reset dislocated jaw,,Case Rate,3000.00
Cigna,PPO,21490,CPT4/HCPCS,Repair dislocated jaw,,Case Rate,4000.00
Cigna,PPO,21497,CPT4/HCPCS,Interdental wiring,,Case Rate,3000.00
Cigna,PPO,215,DRG,Other heart assist system implant,,Case Rate,284526.45
Cigna,PPO,21501,CPT4/HCPCS,Drain neck/chest lesion,,Case Rate,3000.00
Cigna,PPO,21502,CPT4/HCPCS,Drain chest lesion,,Case Rate,3000.00
Cigna,PPO,21510,CPT4/HCPCS,Drainage of bone lesion,,Case Rate,3000.00
Cigna,PPO,21550,CPT4/HCPCS,Biopsy of neck/chest,,Case Rate,3000.00
Cigna,PPO,21552,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTA NEOUS; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,21554,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASC IAL (EG, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,21555,CPT4/HCPCS,Remove lesion, neck/chest,,Case Rate,3000.00
Cigna,PPO,21556,CPT4/HCPCS,Remove lesion, neck/chest,,Case Rate,3000.00
Cigna,PPO,21557,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF NECK OR ANTERIOR THORAX; LESS THAN 5 CM ,,Case Rate,3000.00
Cigna,PPO,21558,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,8300.00
Cigna,PPO,21600,CPT4/HCPCS,Partial removal of rib,,Case Rate,3000.00
Cigna,PPO,21601,CPT4/HCPCS,Excision of chest wall tumor including rib(s),,Case Rate,3000.00
Cigna,PPO,21610,CPT4/HCPCS,Partial removal of rib,,Case Rate,3000.00
Cigna,PPO,21620,CPT4/HCPCS,Partial removal of sternum,,Case Rate,3000.00
Cigna,PPO,21685,CPT4/HCPCS,Hyoid myotomy and suspension,,Case Rate,3000.00
Cigna,PPO,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,8300.00
Cigna,PPO,21700,CPT4/HCPCS,Revision of neck muscle,,Case Rate,3000.00
Cigna,PPO,21720,CPT4/HCPCS,Revision of neck muscle,,Case Rate,4000.00
Cigna,PPO,21725,CPT4/HCPCS,Revision of neck muscle,,Case Rate,4000.00
Cigna,PPO,21740,CPT4/HCPCS,Reconstructive repair of pectus excavatum or carinatum,,Case Rate,3000.00
Cigna,PPO,21742,CPT4/HCPCS,Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure) without thoracoscopy,,Case Rate,4000.00
Cigna,PPO,21743,CPT4/HCPCS,Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure) with thoracoscopy,,Case Rate,4000.00
Cigna,PPO,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,8300.00
Cigna,PPO,21811,CPT4/HCPCS, OPEN TREATMENT OF RIB FRACTURE(S) WITH INTERNAL FIXATION, INCLUDES THORACOSCOPIC VISUALIZATION WHEN PERFORMED, UNILATERAL; 1-3 RIBS,,Case Rate,8300.00
Cigna,PPO,21812,CPT4/HCPCS, OPEN TREATMENT OF RIB FRACTURE(S) WITH INTERNAL FIXATION, INCLUDES THORACOSCOPIC VISUALIZATION WHEN PERFORMED, UNILATERAL; 4-6 RIBS,,Case Rate,8300.00
Cigna,PPO,21813,CPT4/HCPCS, OPEN TREATMENT OF RIB FRACTURE(S) WITH INTERNAL FIXATION, INCLUDES THORACOSCOPIC VISUALIZATION WHEN PERFORMED, UNILATERAL; 7 OR MORE RIBS,,Case Rate,8300.00
Cigna,PPO,21820,CPT4/HCPCS,Treat sternum fracture,,Case Rate,3000.00
Cigna,PPO,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,8300.00
Cigna,PPO,21920,CPT4/HCPCS,Biopsy soft tissue of back,,Case Rate,3000.00
Cigna,PPO,21925,CPT4/HCPCS,Biopsy soft tissue of back,,Case Rate,3000.00
Cigna,PPO,21930,CPT4/HCPCS,Remove lesion, back or flank,,Case Rate,3000.00
Cigna,PPO,21931,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 C M OR GREATER ,,Case Rate,3000.00
Cigna,PPO,21932,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, I NTRAMUSCULAR); LESS THAN 5 CM ,,Case Rate,3000.00
Cigna,PPO,21933,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, I NTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,21935,CPT4/HCPCS,Remove tumor, back,,Case Rate,4000.00
Cigna,PPO,21936,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,22,DRG,Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC,,Case Rate,123919.80
Cigna,PPO,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,8300.00
Cigna,PPO,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,8300.00
Cigna,PPO,22100,CPT4/HCPCS,Remove part of neck vertebra,,Case Rate,8300.00
Cigna,PPO,22101,CPT4/HCPCS,Remove part, thorax vertebra,,Case Rate,8300.00
Cigna,PPO,22102,CPT4/HCPCS,Remove part, lumbar vertebra,,Case Rate,8300.00
Cigna,PPO,22103,CPT4/HCPCS,Remove extra spine segment,,Case Rate,8300.00
Cigna,PPO,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,8300.00
Cigna,PPO,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,8300.00
Cigna,PPO,22310,CPT4/HCPCS,Treat spine fracture,,Case Rate,3000.00
Cigna,PPO,22315,CPT4/HCPCS,Treat spine fracture,,Case Rate,3000.00
Cigna,PPO,22318,CPT4/HCPCS,OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S) (INCLUDING OS ODONTOIDEUM), ANTERIOR APPROACH, INCLUDING PLACEMENT OF INTERNAL FIXATION;WITHOUT GRAFTING.,,Case Rate,3000.00
Cigna,PPO,22319,CPT4/HCPCS,OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S) (INCLUDING OS ODONTOIDEUM), ANTERIOR APPROACH, INCLUDING PLACEMENT OF INTERNAL FIXATION; WITH GRAFTING,,Case Rate,3000.00
Cigna,PPO,22325,CPT4/HCPCS,Treat spine fracture,,Case Rate,3000.00
Cigna,PPO,22326,CPT4/HCPCS,Treat neck spine fracture,,Case Rate,3000.00
Cigna,PPO,22327,CPT4/HCPCS,Treat thorax spine fracture,,Case Rate,3000.00
Cigna,PPO,22328,CPT4/HCPCS,Treat each add spine fx,,Case Rate,3000.00
Cigna,PPO,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,8300.00
Cigna,PPO,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,8300.00
Cigna,PPO,22505,CPT4/HCPCS,Manipulation of spine,,Case Rate,3000.00
Cigna,PPO,22510,CPT4/HCPCS, PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; CERVICOTHORACIC,,Case Rate,8300.00
Cigna,PPO,22511,CPT4/HCPCS, PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBOSACRAL,,Case Rate,8300.00
Cigna,PPO,22512,CPT4/HCPCS, PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL CERVICOTHORACIC OR LUMBOSACRAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE ,,Case Rate,8300.00
Cigna,PPO,22513,CPT4/HCPCS, PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANC,,Case Rate,3000.00
Cigna,PPO,22514,CPT4/HCPCS, PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANC,,Case Rate,3000.00
Cigna,PPO,22515,CPT4/HCPCS, PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANC,,Case Rate,3000.00
Cigna,PPO,22526,CPT4/HCPCS,"Idet, single level",,Case Rate,8300.00
Cigna,PPO,22527,CPT4/HCPCS,"Idet, 1 or more levels",,Case Rate,8300.00
Cigna,PPO,22551,CPT4/HCPCS,ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATIO N, DISCECTOMY, OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AN D/OR NERVE ROOTS; CERVICAL BELOW C2 ,,Case Rate,3000.00
Cigna,PPO,22552,CPT4/HCPCS,Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure) ,,Case Rate,3000.00
Cigna,PPO,22554,CPT4/HCPCS,ARTHRODESIS, ANTERIOR INTERBODY TECH, INCL MIN DISKECTOMY; CERVICAL BELOW C2 ,,Case Rate,3000.00
Cigna,PPO,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,8300.00
Cigna,PPO,22612,CPT4/HCPCS,ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL ; LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE, WHEN PERFORMED) ,,Case Rate,3000.00
Cigna,PPO,22614,CPT4/HCPCS,SPINE FUSION, EXTRA SEGMENT ,,Case Rate,3000.00
Cigna,PPO,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,8300.00
Cigna,PPO,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,8300.00
Cigna,PPO,22840,CPT4/HCPCS,Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary proced,,Case Rate,3000.00
Cigna,PPO,22842,CPT4/HCPCS,Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) ,,Case Rate,3000.00
Cigna,PPO,22845,CPT4/HCPCS,Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) ,,Case Rate,3000.00
Cigna,PPO,22853,CPT4/HCPCS,Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each inter,,Case Rate,3000.00
Cigna,PPO,22854,CPT4/HCPCS,Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) ,,Case Rate,3000.00
Cigna,PPO,22856,CPT4/HCPCS,TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION), SINGLE INTERSPACE, CERVICAL ,,Case Rate,3000.00
Cigna,PPO,22858,CPT4/HCPCS, TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SECOND LEVEL, CERVICAL (LIST SEPARATELY IN ADDITION ,,Case Rate,3000.00
Cigna,PPO,22859,CPT4/HCPCS,Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary,,Case Rate,3000.00
Cigna,PPO,22867,CPT4/HCPCS,Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level,,Case Rate,3000.00
Cigna,PPO,22868,CPT4/HCPCS,Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,22869,CPT4/HCPCS,Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level,,Case Rate,3000.00
Cigna,PPO,22870,CPT4/HCPCS,Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,22899,CPT4/HCPCS,UNLISTED PROCEDURE, SPINE ,,Case Rate,3000.00
Cigna,PPO,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,8300.00
Cigna,PPO,22900,CPT4/HCPCS,Remove abdominal wall lesion,,Case Rate,4000.00
Cigna,PPO,22901,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,22902,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; LE SS THAN 3 CM ,,Case Rate,3000.00
Cigna,PPO,22903,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,22904,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF ABDOMINAL WALL; LESS THAN 5 CM ,,Case Rate,3000.00
Cigna,PPO,22905,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF ABDOMINAL WALL; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,22999,CPT4/HCPCS,UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM ,,Case Rate,3000.00
Cigna,PPO,23,DRG,Cranio w major dev impl/acute complex CNS PDX w MCC or chemo implant,,Case Rate,144388.65
Cigna,PPO,230,DRG,Other cardiothoracic procedures w/o CC/MCC,,Case Rate,8300.00
Cigna,PPO,23000,CPT4/HCPCS,Removal of calcium deposits,,Case Rate,3000.00
Cigna,PPO,23020,CPT4/HCPCS,Release shoulder joint,,Case Rate,3000.00
Cigna,PPO,23030,CPT4/HCPCS,Drain shoulder lesion,,Case Rate,3000.00
Cigna,PPO,23031,CPT4/HCPCS,Drain shoulder bursa,,Case Rate,4000.00
Cigna,PPO,23035,CPT4/HCPCS,Drain shoulder bone lesion,,Case Rate,4000.00
Cigna,PPO,23040,CPT4/HCPCS,Exploratory shoulder surgery,,Case Rate,4000.00
Cigna,PPO,23044,CPT4/HCPCS,Exploratory shoulder surgery,,Case Rate,4000.00
Cigna,PPO,23065,CPT4/HCPCS,Biopsy shoulder tissues,,Case Rate,3000.00
Cigna,PPO,23066,CPT4/HCPCS,Biopsy shoulder tissues,,Case Rate,3000.00
Cigna,PPO,23071,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 C M OR GREATER ,,Case Rate,3000.00
Cigna,PPO,23073,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, I NTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,23075,CPT4/HCPCS,Removal of shoulder lesion,,Case Rate,3000.00
Cigna,PPO,23076,CPT4/HCPCS,Removal of shoulder lesion,,Case Rate,3000.00
Cigna,PPO,23077,CPT4/HCPCS,Remove tumor of shoulder,,Case Rate,4000.00
Cigna,PPO,23078,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF SHOULDER AREA; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,8300.00
Cigna,PPO,23100,CPT4/HCPCS,Biopsy of shoulder joint,,Case Rate,3000.00
Cigna,PPO,23101,CPT4/HCPCS,Shoulder joint surgery,,Case Rate,6000.00
Cigna,PPO,23105,CPT4/HCPCS,Remove shoulder joint lining,,Case Rate,4000.00
Cigna,PPO,23106,CPT4/HCPCS,Incision of collarbone joint,,Case Rate,4000.00
Cigna,PPO,23107,CPT4/HCPCS,Explore treat shoulder joint,,Case Rate,4000.00
Cigna,PPO,23120,CPT4/HCPCS,Partial removal, collar bone,,Case Rate,5000.00
Cigna,PPO,23125,CPT4/HCPCS,Removal of collar bone,,Case Rate,5000.00
Cigna,PPO,23130,CPT4/HCPCS,Remove shoulder bone, part,,Case Rate,5000.00
Cigna,PPO,23140,CPT4/HCPCS,Removal of bone lesion,,Case Rate,4000.00
Cigna,PPO,23145,CPT4/HCPCS,Removal of bone lesion,,Case Rate,5000.00
Cigna,PPO,23146,CPT4/HCPCS,Removal of bone lesion,,Case Rate,5000.00
Cigna,PPO,23150,CPT4/HCPCS,Removal of humerus lesion,,Case Rate,4000.00
Cigna,PPO,23155,CPT4/HCPCS,Removal of humerus lesion,,Case Rate,5000.00
Cigna,PPO,23156,CPT4/HCPCS,Removal of humerus lesion,,Case Rate,5000.00
Cigna,PPO,23170,CPT4/HCPCS,Remove collar bone lesion,,Case Rate,3000.00
Cigna,PPO,23172,CPT4/HCPCS,Remove shoulder blade lesion,,Case Rate,3000.00
Cigna,PPO,23174,CPT4/HCPCS,Remove humerus lesion,,Case Rate,3000.00
Cigna,PPO,23180,CPT4/HCPCS,Remove collar bone lesion,,Case Rate,4000.00
Cigna,PPO,23182,CPT4/HCPCS,Remove shoulder blade lesion,,Case Rate,4000.00
Cigna,PPO,23184,CPT4/HCPCS,Remove humerus lesion,,Case Rate,4000.00
Cigna,PPO,23190,CPT4/HCPCS,Partial removal of scapula,,Case Rate,4000.00
Cigna,PPO,23195,CPT4/HCPCS,Removal of head of humerus,,Case Rate,5000.00
Cigna,PPO,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,8300.00
Cigna,PPO,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,8300.00
Cigna,PPO,23330,CPT4/HCPCS,Remove shoulder foreign body,,Case Rate,3000.00
Cigna,PPO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Case Rate,4000.00
Cigna,PPO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Case Rate,8300.00
Cigna,PPO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Case Rate,3000.00
Cigna,PPO,23350,CPT4/HCPCS,Injection procedure for shoulder arthrography or enhanced ct/mri shoulder athrography,,Case Rate,3000.00
Cigna,PPO,23395,CPT4/HCPCS,Muscle transfer,shoulder/arm,,Case Rate,5000.00
Cigna,PPO,23397,CPT4/HCPCS,Muscle transfers,,Case Rate,6000.00
Cigna,PPO,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,8300.00
Cigna,PPO,23400,CPT4/HCPCS,Fixation of shoulder blade,,Case Rate,6000.00
Cigna,PPO,23405,CPT4/HCPCS,Incision of tendon & muscle,,Case Rate,3000.00
Cigna,PPO,23406,CPT4/HCPCS,Incise tendon(s) & muscle(s),,Case Rate,3000.00
Cigna,PPO,23410,CPT4/HCPCS,Repair of tendon(s),,Case Rate,5000.00
Cigna,PPO,23412,CPT4/HCPCS,Repair of tendon(s),,Case Rate,6000.00
Cigna,PPO,23415,CPT4/HCPCS,Release of shoulder ligament,,Case Rate,5000.00
Cigna,PPO,23420,CPT4/HCPCS,Repair of shoulder,,Case Rate,6000.00
Cigna,PPO,23430,CPT4/HCPCS,Repair biceps tendon,,Case Rate,4000.00
Cigna,PPO,23440,CPT4/HCPCS,Remove/transplant tendon,,Case Rate,4000.00
Cigna,PPO,23450,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,5000.00
Cigna,PPO,23455,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,6000.00
Cigna,PPO,23460,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,5000.00
Cigna,PPO,23462,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,6000.00
Cigna,PPO,23465,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,5000.00
Cigna,PPO,23466,CPT4/HCPCS,Repair shoulder capsule,,Case Rate,6000.00
Cigna,PPO,23470,CPT4/HCPCS,ARTHROPLASTY, GLENOHUMERAL JOINT; HENIARTHOPLASTY ,,Case Rate,3000.00
Cigna,PPO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Case Rate,3000.00
Cigna,PPO,23480,CPT4/HCPCS,Revision of collar bone,,Case Rate,4000.00
Cigna,PPO,23485,CPT4/HCPCS,Revision of collar bone,,Case Rate,6000.00
Cigna,PPO,23490,CPT4/HCPCS,Reinforce clavicle,,Case Rate,4000.00
Cigna,PPO,23491,CPT4/HCPCS,Reinforce shoulder bones,,Case Rate,4000.00
Cigna,PPO,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,8300.00
Cigna,PPO,23500,CPT4/HCPCS,Treat clavicle fracture,,Case Rate,3000.00
Cigna,PPO,23505,CPT4/HCPCS,Treat clavicle fracture,,Case Rate,3000.00
Cigna,PPO,23515,CPT4/HCPCS,Treat clavicle fracture,,Case Rate,4000.00
Cigna,PPO,23520,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,3000.00
Cigna,PPO,23525,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,3000.00
Cigna,PPO,23530,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,4000.00
Cigna,PPO,23532,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,4000.00
Cigna,PPO,23540,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,3000.00
Cigna,PPO,23545,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,3000.00
Cigna,PPO,23550,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,4000.00
Cigna,PPO,23552,CPT4/HCPCS,Treat clavicle dislocation,,Case Rate,4000.00
Cigna,PPO,23570,CPT4/HCPCS,Treat shoulder blade fx,,Case Rate,3000.00
Cigna,PPO,23575,CPT4/HCPCS,Treat shoulder blade fx,,Case Rate,3000.00
Cigna,PPO,23585,CPT4/HCPCS,Treat scapula fracture,,Case Rate,4000.00
Cigna,PPO,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,8300.00
Cigna,PPO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Case Rate,3000.00
Cigna,PPO,23605,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,23615,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,PPO,23616,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,PPO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Case Rate,3000.00
Cigna,PPO,23625,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,23630,CPT4/HCPCS,Treat humerus fracture,,Case Rate,5000.00
Cigna,PPO,23650,CPT4/HCPCS,Treat shoulder dislocation,,Case Rate,3000.00
Cigna,PPO,23655,CPT4/HCPCS,Treat shoulder dislocation,,Case Rate,3000.00
Cigna,PPO,23660,CPT4/HCPCS,Treat shoulder dislocation,,Case Rate,4000.00
Cigna,PPO,23665,CPT4/HCPCS,Treat dislocation/fracture,,Case Rate,3000.00
Cigna,PPO,23670,CPT4/HCPCS,Treat dislocation/fracture,,Case Rate,4000.00
Cigna,PPO,23675,CPT4/HCPCS,Treat dislocation/fracture,,Case Rate,3000.00
Cigna,PPO,23680,CPT4/HCPCS,Treat dislocation/fracture,,Case Rate,4000.00
Cigna,PPO,237,DRG,Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair,,Case Rate,8300.00
Cigna,PPO,23700,CPT4/HCPCS,Fixation of shoulder,,Case Rate,3000.00
Cigna,PPO,238,DRG,Major cardiovasc procedures w/o MCC,,Case Rate,8300.00
Cigna,PPO,23800,CPT4/HCPCS,Fusion of shoulder joint,,Case Rate,4000.00
Cigna,PPO,23802,CPT4/HCPCS,Fusion of shoulder joint,,Case Rate,6000.00
Cigna,PPO,239,DRG,Amputation for circ sys disorders exc upper limb & toe w MCC,,Case Rate,122621.85
Cigna,PPO,23921,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,PPO,23929,CPT4/HCPCS,Unlisted procedure, shoulder,,Case Rate,3000.00
Cigna,PPO,23930,CPT4/HCPCS,Drainage of arm lesion,,Case Rate,3000.00
Cigna,PPO,23931,CPT4/HCPCS,Drainage of arm bursa,,Case Rate,3000.00
Cigna,PPO,23935,CPT4/HCPCS,Drain arm/elbow bone lesion,,Case Rate,3000.00
Cigna,PPO,24,DRG,Cranio w major dev impl/acute complex CNS PDX w/o MCC,,Case Rate,100278.75
Cigna,PPO,240,DRG,Amputation for circ sys disorders exc upper limb & toe w CC,,Case Rate,71145.00
Cigna,PPO,24000,CPT4/HCPCS,Exploratory elbow surgery,,Case Rate,4000.00
Cigna,PPO,24006,CPT4/HCPCS,Release elbow joint,,Case Rate,4000.00
Cigna,PPO,24065,CPT4/HCPCS,Biopsy arm/elbow soft tissue,,Case Rate,3000.00
Cigna,PPO,24066,CPT4/HCPCS,Biopsy arm/elbow soft tissue,,Case Rate,3000.00
Cigna,PPO,24071,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBCUTA NEOUS; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,24073,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOW AREA, SUBFASC IAL (EG, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,24075,CPT4/HCPCS,Remove arm/elbow lesion,,Case Rate,3000.00
Cigna,PPO,24076,CPT4/HCPCS,Remove arm/elbow lesion,,Case Rate,3000.00
Cigna,PPO,24077,CPT4/HCPCS,Remove tumor of arm/elbow,,Case Rate,4000.00
Cigna,PPO,24079,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF UPPER ARM OR ELBOW AREA; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,241,DRG,Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC,,Case Rate,40580.70
Cigna,PPO,24100,CPT4/HCPCS,Biopsy elbow joint lining,,Case Rate,3000.00
Cigna,PPO,24101,CPT4/HCPCS,Explore/treat elbow joint,,Case Rate,4000.00
Cigna,PPO,24102,CPT4/HCPCS,Remove elbow joint lining,,Case Rate,4000.00
Cigna,PPO,24105,CPT4/HCPCS,Removal of elbow bursa,,Case Rate,4000.00
Cigna,PPO,24110,CPT4/HCPCS,Remove humerus lesion,,Case Rate,3000.00
Cigna,PPO,24115,CPT4/HCPCS,Remove/graft bone lesion,,Case Rate,4000.00
Cigna,PPO,24116,CPT4/HCPCS,Remove/graft bone lesion,,Case Rate,4000.00
Cigna,PPO,24120,CPT4/HCPCS,Remove elbow lesion,,Case Rate,4000.00
Cigna,PPO,24125,CPT4/HCPCS,Remove/graft bone lesion,,Case Rate,4000.00
Cigna,PPO,24126,CPT4/HCPCS,Remove/graft bone lesion,,Case Rate,4000.00
Cigna,PPO,24130,CPT4/HCPCS,Removal of head of radius,,Case Rate,4000.00
Cigna,PPO,24134,CPT4/HCPCS,Removal of arm bone lesion,,Case Rate,3000.00
Cigna,PPO,24136,CPT4/HCPCS,Remove radius bone lesion,,Case Rate,3000.00
Cigna,PPO,24138,CPT4/HCPCS,Remove elbow bone lesion,,Case Rate,3000.00
Cigna,PPO,24140,CPT4/HCPCS,Partial removal of arm bone,,Case Rate,4000.00
Cigna,PPO,24145,CPT4/HCPCS,Partial removal of radius,,Case Rate,4000.00
Cigna,PPO,24147,CPT4/HCPCS,Partial removal of elbow,,Case Rate,3000.00
Cigna,PPO,24149,CPT4/HCPCS,RADICAL RESECTION OF CAPSULE, SOFT TISSUE, AND HETEROTOPIC BONE, ELBOW, WITH CONTRACTURE RELEASE (SEPARATE PROCEDURE) . (FOR CAPSULAR AND SOFT TISSUE RELEASE ONLY, USE 24006) ,,Case Rate,3000.00
Cigna,PPO,24150,CPT4/HCPCS,Extensive humerus surgery,,Case Rate,4000.00
Cigna,PPO,24152,CPT4/HCPCS,Extensive radius surgery,,Case Rate,4000.00
Cigna,PPO,24155,CPT4/HCPCS,Removal of elbow joint,,Case Rate,4000.00
Cigna,PPO,24160,CPT4/HCPCS,Remove elbow joint implant,,Case Rate,3000.00
Cigna,PPO,24164,CPT4/HCPCS,Remove radius head implant,,Case Rate,4000.00
Cigna,PPO,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,8300.00
Cigna,PPO,24201,CPT4/HCPCS,Removal of arm foreign body,,Case Rate,3000.00
Cigna,PPO,24220,CPT4/HCPCS,Injection procedure for elbow arthrography,,Case Rate,3000.00
Cigna,PPO,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,8300.00
Cigna,PPO,24300,CPT4/HCPCS,MANIPULATION, ELBOW, UNDER ANESTHESIA,,Case Rate,4000.00
Cigna,PPO,24301,CPT4/HCPCS,Muscle/tendon transfer,,Case Rate,4000.00
Cigna,PPO,24305,CPT4/HCPCS,Arm tendon lengthening,,Case Rate,4000.00
Cigna,PPO,24310,CPT4/HCPCS,Revision of arm tendon,,Case Rate,4000.00
Cigna,PPO,24320,CPT4/HCPCS,Repair of arm tendon,,Case Rate,4000.00
Cigna,PPO,24330,CPT4/HCPCS,Revision of arm muscles,,Case Rate,4000.00
Cigna,PPO,24331,CPT4/HCPCS,Revision of arm muscles,,Case Rate,4000.00
Cigna,PPO,24332,CPT4/HCPCS,TENOLYSIS, TRICEPS,,Case Rate,4000.00
Cigna,PPO,24340,CPT4/HCPCS,Repair of biceps tendon,,Case Rate,4000.00
Cigna,PPO,24341,CPT4/HCPCS,Repair arm tendon/muscle,,Case Rate,4000.00
Cigna,PPO,24342,CPT4/HCPCS,Repair of ruptured tendon,,Case Rate,4000.00
Cigna,PPO,24343,CPT4/HCPCS,REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW WITH LOCAL TISSUE,,Case Rate,4000.00
Cigna,PPO,24344,CPT4/HCPCS,Reconstruction lateral collateral ligament,elbow with tendon graft [includes harvesting of graft,,Case Rate,4000.00
Cigna,PPO,24345,CPT4/HCPCS,Repr elbw med ligmnt w/tissu,,Case Rate,3000.00
Cigna,PPO,24346,CPT4/HCPCS,Reconstruction medial collateral ligament,elbow with tendon graft [includes harvesting of graft,,Case Rate,4000.00
Cigna,PPO,24357,CPT4/HCPCS,REPAIR ELBOW, PERC,,Case Rate,8300.00
Cigna,PPO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB, OPEN,,Case Rate,8300.00
Cigna,PPO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Case Rate,8300.00
Cigna,PPO,24360,CPT4/HCPCS,Reconstruct elbow joint,,Case Rate,5000.00
Cigna,PPO,24361,CPT4/HCPCS,Reconstruct elbow joint,,Case Rate,3000.00
Cigna,PPO,24362,CPT4/HCPCS,Reconstruct elbow joint,,Case Rate,5000.00
Cigna,PPO,24363,CPT4/HCPCS,Replace elbow joint,,Case Rate,3000.00
Cigna,PPO,24365,CPT4/HCPCS,Reconstruct head of radius,,Case Rate,5000.00
Cigna,PPO,24366,CPT4/HCPCS,Reconstruct head of radius,,Case Rate,3000.00
Cigna,PPO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Case Rate,3000.00
Cigna,PPO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Case Rate,3000.00
Cigna,PPO,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,8300.00
Cigna,PPO,24400,CPT4/HCPCS,Revision of humerus,,Case Rate,4000.00
Cigna,PPO,24410,CPT4/HCPCS,Revision of humerus,,Case Rate,4000.00
Cigna,PPO,24420,CPT4/HCPCS,Revision of humerus,,Case Rate,4000.00
Cigna,PPO,24430,CPT4/HCPCS,Repair of humerus,,Case Rate,4000.00
Cigna,PPO,24435,CPT4/HCPCS,Repair humerus with graft,,Case Rate,4000.00
Cigna,PPO,24470,CPT4/HCPCS,Revision of elbow joint,,Case Rate,4000.00
Cigna,PPO,24495,CPT4/HCPCS,Decompression of forearm,,Case Rate,3000.00
Cigna,PPO,24498,CPT4/HCPCS,Reinforce humerus,,Case Rate,4000.00
Cigna,PPO,245,DRG,AICD lead & generator procedures,,Case Rate,138057.00
Cigna,PPO,24500,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24505,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24515,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,PPO,24516,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,PPO,24530,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24535,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24538,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24545,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,PPO,24546,CPT4/HCPCS,Treat humerus fracture,,Case Rate,5000.00
Cigna,PPO,24560,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24565,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24566,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24575,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,PPO,24576,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24577,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24579,CPT4/HCPCS,Treat humerus fracture,,Case Rate,4000.00
Cigna,PPO,24582,CPT4/HCPCS,Treat humerus fracture,,Case Rate,3000.00
Cigna,PPO,24586,CPT4/HCPCS,Treat elbow fracture,,Case Rate,4000.00
Cigna,PPO,24587,CPT4/HCPCS,Treat elbow fracture,,Case Rate,5000.00
Cigna,PPO,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,8300.00
Cigna,PPO,24600,CPT4/HCPCS,Treat elbow dislocation,,Case Rate,3000.00
Cigna,PPO,24605,CPT4/HCPCS,Treat elbow dislocation,,Case Rate,3000.00
Cigna,PPO,24615,CPT4/HCPCS,Treat elbow dislocation,,Case Rate,4000.00
Cigna,PPO,24620,CPT4/HCPCS,Treat elbow fracture,,Case Rate,3000.00
Cigna,PPO,24635,CPT4/HCPCS,Treat elbow fracture,,Case Rate,4000.00
Cigna,PPO,24650,CPT4/HCPCS,Closed treatment of radial head or neck fracture; without manipulation,,Case Rate,400.00
Cigna,PPO,24655,CPT4/HCPCS,Treat radius fracture,,Case Rate,3000.00
Cigna,PPO,24665,CPT4/HCPCS,Treat radius fracture,,Case Rate,4000.00
Cigna,PPO,24666,CPT4/HCPCS,Treat radius fracture,,Case Rate,4000.00
Cigna,PPO,24670,CPT4/HCPCS,Treat ulnar fracture,,Case Rate,3000.00
Cigna,PPO,24675,CPT4/HCPCS,Treat ulnar fracture,,Case Rate,3000.00
Cigna,PPO,24685,CPT4/HCPCS,Treat ulnar fracture,,Case Rate,4000.00
Cigna,PPO,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,8300.00
Cigna,PPO,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,8300.00
Cigna,PPO,24800,CPT4/HCPCS,Fusion of elbow joint,,Case Rate,4000.00
Cigna,PPO,24802,CPT4/HCPCS,Fusion/graft of elbow joint,,Case Rate,5000.00
Cigna,PPO,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,8300.00
Cigna,PPO,24925,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,PPO,24999,CPT4/HCPCS,UNLISTED PROCEDURE, HUMERUS OR ELBOW ,,Case Rate,3000.00
Cigna,PPO,25,DRG,Craniotomy & endovascular intracranial procedures w MCC,,Case Rate,114538.35
Cigna,PPO,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,8300.00
Cigna,PPO,25000,CPT4/HCPCS,Incision of tendon sheath,,Case Rate,4000.00
Cigna,PPO,25001,CPT4/HCPCS,INCISION, FLEXOR TENDON SHEATH, WRIST (EG, FLEXOR CARPI radials,,Case Rate,4000.00
Cigna,PPO,25020,CPT4/HCPCS,Decompress forearm 1 space,,Case Rate,4000.00
Cigna,PPO,25023,CPT4/HCPCS,Decompress forearm 1 space,,Case Rate,4000.00
Cigna,PPO,25024,CPT4/HCPCS,Decompress forearm 2 spaces,,Case Rate,4000.00
Cigna,PPO,25025,CPT4/HCPCS,Decompress forarm 2 spaces,,Case Rate,4000.00
Cigna,PPO,25028,CPT4/HCPCS,Drainage of forearm lesion,,Case Rate,3000.00
Cigna,PPO,25031,CPT4/HCPCS,Drainage of forearm bursa,,Case Rate,3000.00
Cigna,PPO,25035,CPT4/HCPCS,Treat forearm bone lesion,,Case Rate,3000.00
Cigna,PPO,25040,CPT4/HCPCS,Explore/treat wrist joint,,Case Rate,5000.00
Cigna,PPO,25065,CPT4/HCPCS,Biopsy forearm soft tissues,,Case Rate,3000.00
Cigna,PPO,25066,CPT4/HCPCS,Biopsy forearm soft tissues,,Case Rate,3000.00
Cigna,PPO,25071,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCU TANEOUS; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,25073,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBFA SCIAL (EG, INTRAMUSCULAR); 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,25075,CPT4/HCPCS,Remove forearm lesion subcut,,Case Rate,3000.00
Cigna,PPO,25076,CPT4/HCPCS,Remove forearm lesion deep,,Case Rate,4000.00
Cigna,PPO,25077,CPT4/HCPCS,Remove tumor, forearm/wrist,,Case Rate,4000.00
Cigna,PPO,25078,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FOREARM AND/OR WRIST AREA; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,25085,CPT4/HCPCS,Incision of wrist capsule,,Case Rate,4000.00
Cigna,PPO,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,8300.00
Cigna,PPO,25100,CPT4/HCPCS,Biopsy of wrist joint,,Case Rate,3000.00
Cigna,PPO,25101,CPT4/HCPCS,Explore/treat wrist joint,,Case Rate,4000.00
Cigna,PPO,25105,CPT4/HCPCS,Remove wrist joint lining,,Case Rate,4000.00
Cigna,PPO,25107,CPT4/HCPCS,Remove wrist joint cartilage,,Case Rate,4000.00
Cigna,PPO,25109,CPT4/HCPCS,Excise tendon forearm/wrist,,Case Rate,4000.00
Cigna,PPO,25110,CPT4/HCPCS,Remove wrist tendon lesion,,Case Rate,4000.00
Cigna,PPO,25111,CPT4/HCPCS,Remove wrist tendon lesion,,Case Rate,4000.00
Cigna,PPO,25112,CPT4/HCPCS,Reremove wrist tendon lesion,,Case Rate,4000.00
Cigna,PPO,25115,CPT4/HCPCS,Remove wrist/forearm lesion,,Case Rate,4000.00
Cigna,PPO,25116,CPT4/HCPCS,Remove wrist/forearm lesion,,Case Rate,4000.00
Cigna,PPO,25118,CPT4/HCPCS,Excise wrist tendon sheath,,Case Rate,3000.00
Cigna,PPO,25119,CPT4/HCPCS,Partial removal of ulna,,Case Rate,4000.00
Cigna,PPO,25120,CPT4/HCPCS,Removal of forearm lesion,,Case Rate,4000.00
Cigna,PPO,25125,CPT4/HCPCS,Remove/graft forearm lesion,,Case Rate,4000.00
Cigna,PPO,25126,CPT4/HCPCS,Remove/graft forearm lesion,,Case Rate,4000.00
Cigna,PPO,25130,CPT4/HCPCS,Removal of wrist lesion,,Case Rate,4000.00
Cigna,PPO,25135,CPT4/HCPCS,Remove & graft wrist lesion,,Case Rate,4000.00
Cigna,PPO,25136,CPT4/HCPCS,Remove & graft wrist lesion,,Case Rate,4000.00
Cigna,PPO,25145,CPT4/HCPCS,Remove forearm bone lesion,,Case Rate,3000.00
Cigna,PPO,25150,CPT4/HCPCS,Partial removal of ulna,,Case Rate,3000.00
Cigna,PPO,25151,CPT4/HCPCS,Partial removal of radius,,Case Rate,3000.00
Cigna,PPO,25170,CPT4/HCPCS,Extensive forearm surgery,,Case Rate,4000.00
Cigna,PPO,252,DRG,Other vascular procedures w MCC,,Case Rate,84677.85
Cigna,PPO,25210,CPT4/HCPCS,Removal of wrist bone,,Case Rate,4000.00
Cigna,PPO,25215,CPT4/HCPCS,Removal of wrist bones,,Case Rate,4000.00
Cigna,PPO,25230,CPT4/HCPCS,Partial removal of radius,,Case Rate,4000.00
Cigna,PPO,25240,CPT4/HCPCS,Partial removal of ulna,,Case Rate,4000.00
Cigna,PPO,25246,CPT4/HCPCS,Injection procedure for wrist arthrography,,Case Rate,3000.00
Cigna,PPO,25248,CPT4/HCPCS,Remove forearm foreign body,,Case Rate,3000.00
Cigna,PPO,25250,CPT4/HCPCS,Removal of wrist prosthesis,,Case Rate,3000.00
Cigna,PPO,25251,CPT4/HCPCS,Removal of wrist prosthesis,,Case Rate,3000.00
Cigna,PPO,25259,CPT4/HCPCS,MANIPULATION, WRIST, UNDER ANESTHESIA,,Case Rate,4000.00
Cigna,PPO,25260,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,4000.00
Cigna,PPO,25263,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,3000.00
Cigna,PPO,25265,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,4000.00
Cigna,PPO,25270,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,4000.00
Cigna,PPO,25272,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,4000.00
Cigna,PPO,25274,CPT4/HCPCS,Repair forearm tendon/muscle,,Case Rate,4000.00
Cigna,PPO,25275,CPT4/HCPCS,Repair forearm tendon sheath,,Case Rate,4000.00
Cigna,PPO,25280,CPT4/HCPCS,Revise wrist/forearm tendon,,Case Rate,4000.00
Cigna,PPO,25290,CPT4/HCPCS,Incise wrist/forearm tendon,,Case Rate,4000.00
Cigna,PPO,25295,CPT4/HCPCS,Release wrist/forearm tendon,,Case Rate,4000.00
Cigna,PPO,253,DRG,Other vascular procedures w CC,,Case Rate,67669.35
Cigna,PPO,25300,CPT4/HCPCS,Fusion of tendons at wrist,,Case Rate,4000.00
Cigna,PPO,25301,CPT4/HCPCS,Fusion of tendons at wrist,,Case Rate,4000.00
Cigna,PPO,25310,CPT4/HCPCS,Transplant forearm tendon,,Case Rate,4000.00
Cigna,PPO,25312,CPT4/HCPCS,Transplant forearm tendon,,Case Rate,4000.00
Cigna,PPO,25315,CPT4/HCPCS,Revise palsy hand tendon(s),,Case Rate,4000.00
Cigna,PPO,25316,CPT4/HCPCS,Revise palsy hand tendon(s),,Case Rate,4000.00
Cigna,PPO,25320,CPT4/HCPCS,Repair/revise wrist joint,,Case Rate,4000.00
Cigna,PPO,25332,CPT4/HCPCS,Revise wrist joint,,Case Rate,5000.00
Cigna,PPO,25335,CPT4/HCPCS,Realignment of hand,,Case Rate,4000.00
Cigna,PPO,25337,CPT4/HCPCS,Reconstruct ulna/radioulnar,,Case Rate,5000.00
Cigna,PPO,25350,CPT4/HCPCS,Revision of radius,,Case Rate,4000.00
Cigna,PPO,25355,CPT4/HCPCS,Revision of radius,,Case Rate,4000.00
Cigna,PPO,25360,CPT4/HCPCS,Revision of ulna,,Case Rate,4000.00
Cigna,PPO,25365,CPT4/HCPCS,Revise radius & ulna,,Case Rate,4000.00
Cigna,PPO,25370,CPT4/HCPCS,Revise radius or ulna,,Case Rate,4000.00
Cigna,PPO,25375,CPT4/HCPCS,Revise radius & ulna,,Case Rate,4000.00
Cigna,PPO,25390,CPT4/HCPCS,Shorten radius or ulna,,Case Rate,4000.00
Cigna,PPO,25391,CPT4/HCPCS,Lengthen radius or ulna,,Case Rate,4000.00
Cigna,PPO,25392,CPT4/HCPCS,Shorten radius & ulna,,Case Rate,4000.00
Cigna,PPO,25393,CPT4/HCPCS,Lengthen radius & ulna,,Case Rate,4000.00
Cigna,PPO,25394,CPT4/HCPCS,OSTEOPLASTY, CARPAL BONE, SHORTENING,,Case Rate,4000.00
Cigna,PPO,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,46142.25
Cigna,PPO,25400,CPT4/HCPCS,Repair radius or ulna,,Case Rate,4000.00
Cigna,PPO,25405,CPT4/HCPCS,Repair/graft radius or ulna,,Case Rate,4000.00
Cigna,PPO,25415,CPT4/HCPCS,Repair radius & ulna,,Case Rate,4000.00
Cigna,PPO,25420,CPT4/HCPCS,Repair/graft radius & ulna,,Case Rate,4000.00
Cigna,PPO,25425,CPT4/HCPCS,Repair/graft radius or ulna,,Case Rate,4000.00
Cigna,PPO,25426,CPT4/HCPCS,Repair/graft radius & ulna,,Case Rate,4000.00
Cigna,PPO,25430,CPT4/HCPCS,INSERTION OF VASCULAR PEDICLE INTO CARPAL BONE (EG, HARII PROCEDURE),,Case Rate,4000.00
Cigna,PPO,25431,CPT4/HCPCS,REPAIR OF NONUNION OF CARPAL BONE (EXCLUDING CARPAL SCAPHOID (NAVICULAR))(INCLUDES OBTAINING GRAFT AND NECESSARY FIXATION), EACH BONE,,Case Rate,4000.00
Cigna,PPO,25440,CPT4/HCPCS,Repair/graft wrist bone,,Case Rate,4000.00
Cigna,PPO,25441,CPT4/HCPCS,Reconstruct wrist joint,,Case Rate,3000.00
Cigna,PPO,25442,CPT4/HCPCS,Reconstruct wrist joint,,Case Rate,3000.00
Cigna,PPO,25443,CPT4/HCPCS,Reconstruct wrist joint,,Case Rate,5000.00
Cigna,PPO,25444,CPT4/HCPCS,Reconstruct wrist joint,,Case Rate,5000.00
Cigna,PPO,25445,CPT4/HCPCS,Reconstruct wrist joint,,Case Rate,5000.00
Cigna,PPO,25446,CPT4/HCPCS,Wrist replacement,,Case Rate,3000.00
Cigna,PPO,25447,CPT4/HCPCS,Repair wrist joint(s),,Case Rate,5000.00
Cigna,PPO,25449,CPT4/HCPCS,Remove wrist joint implant,,Case Rate,5000.00
Cigna,PPO,25450,CPT4/HCPCS,Revision of wrist joint,,Case Rate,4000.00
Cigna,PPO,25455,CPT4/HCPCS,Revision of wrist joint,,Case Rate,4000.00
Cigna,PPO,25490,CPT4/HCPCS,Reinforce radius,,Case Rate,4000.00
Cigna,PPO,25491,CPT4/HCPCS,Reinforce ulna,,Case Rate,4000.00
Cigna,PPO,25492,CPT4/HCPCS,Reinforce radius and ulna,,Case Rate,4000.00
Cigna,PPO,255,DRG,Upper limb & toe amputation for circ system disorders w MCC,,Case Rate,64846.50
Cigna,PPO,25500,CPT4/HCPCS,Closed treatment of radial shaft fracture; without manipulation,,Case Rate,400.00
Cigna,PPO,25505,CPT4/HCPCS,Treat fracture of radius,,Case Rate,3000.00
Cigna,PPO,25515,CPT4/HCPCS,Treat fracture of radius,,Case Rate,4000.00
Cigna,PPO,25520,CPT4/HCPCS,Treat fracture of radius,,Case Rate,3000.00
Cigna,PPO,25525,CPT4/HCPCS,Treat fracture of radius,,Case Rate,4000.00
Cigna,PPO,25526,CPT4/HCPCS,Treat fracture of radius,,Case Rate,5000.00
Cigna,PPO,25530,CPT4/HCPCS,Closed treatment of ulnar shaft fracture; without manipulation,,Case Rate,400.00
Cigna,PPO,25535,CPT4/HCPCS,Treat fracture of ulna,,Case Rate,3000.00
Cigna,PPO,25545,CPT4/HCPCS,Treat fracture of ulna,,Case Rate,4000.00
Cigna,PPO,25560,CPT4/HCPCS,Closed treatment of radial and ulnar shaft fractures; without manipulation,,Case Rate,400.00
Cigna,PPO,25565,CPT4/HCPCS,Treat fracture radius & ulna,,Case Rate,3000.00
Cigna,PPO,25574,CPT4/HCPCS,Treat fracture radius & ulna,,Case Rate,4000.00
Cigna,PPO,25575,CPT4/HCPCS,Treat fracture radius/ulna,,Case Rate,4000.00
Cigna,PPO,256,DRG,Upper limb & toe amputation for circ system disorders w CC,,Case Rate,41899.05
Cigna,PPO,25600,CPT4/HCPCS,Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, with or without fracture of ulnar styloid; without manipulation,,Case Rate,400.00
Cigna,PPO,25605,CPT4/HCPCS,Treat fracture radius/ulna,,Case Rate,4000.00
Cigna,PPO,25606,CPT4/HCPCS,Treat fx distal radial,,Case Rate,4000.00
Cigna,PPO,25607,CPT4/HCPCS,Treat fx rad extra-articul,,Case Rate,5000.00
Cigna,PPO,25608,CPT4/HCPCS,Treat fx rad intra-articul,,Case Rate,5000.00
Cigna,PPO,25609,CPT4/HCPCS,Treat fx radial 3+ frag,,Case Rate,5000.00
Cigna,PPO,25624,CPT4/HCPCS,Treat wrist bone fracture,,Case Rate,3000.00
Cigna,PPO,25628,CPT4/HCPCS,Treat wrist bone fracture,,Case Rate,4000.00
Cigna,PPO,25630,CPT4/HCPCS,Closed treatment of carpal bone fracture (excld. carpal scaphoid (navicular)); without manipulation, each bone,,Case Rate,400.00
Cigna,PPO,25635,CPT4/HCPCS,Treat wrist bone fracture,,Case Rate,3000.00
Cigna,PPO,25645,CPT4/HCPCS,Treat wrist bone fracture,,Case Rate,4000.00
Cigna,PPO,25651,CPT4/HCPCS,PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE,,Case Rate,4000.00
Cigna,PPO,25652,CPT4/HCPCS,OPEN TREATMENT OF ULNAR STYLOID FRACTURE,,Case Rate,4000.00
Cigna,PPO,25660,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,3000.00
Cigna,PPO,25670,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,4000.00
Cigna,PPO,25671,CPT4/HCPCS,Pin radioulnar dislocation,,Case Rate,3000.00
Cigna,PPO,25675,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,3000.00
Cigna,PPO,25676,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,3000.00
Cigna,PPO,25680,CPT4/HCPCS,Treat wrist fracture,,Case Rate,3000.00
Cigna,PPO,25685,CPT4/HCPCS,Treat wrist fracture,,Case Rate,4000.00
Cigna,PPO,25690,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,3000.00
Cigna,PPO,25695,CPT4/HCPCS,Treat wrist dislocation,,Case Rate,3000.00
Cigna,PPO,257,DRG,Upper limb & toe amputation for circ system disorders w/o CC/MCC,,Case Rate,29605.50
Cigna,PPO,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,8300.00
Cigna,PPO,25800,CPT4/HCPCS,Fusion of wrist joint,,Case Rate,4000.00
Cigna,PPO,25805,CPT4/HCPCS,Fusion/graft of wrist joint,,Case Rate,5000.00
Cigna,PPO,25810,CPT4/HCPCS,Fusion/graft of wrist joint,,Case Rate,5000.00
Cigna,PPO,25820,CPT4/HCPCS,Fusion of hand bones,,Case Rate,4000.00
Cigna,PPO,25825,CPT4/HCPCS,Fuse hand bones with graft,,Case Rate,5000.00
Cigna,PPO,25830,CPT4/HCPCS,Fusion, radioulnar jnt/ulna,,Case Rate,5000.00
Cigna,PPO,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,8300.00
Cigna,PPO,25907,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,PPO,25909,CPT4/HCPCS,AMPUTATION FOREARM,THRU RADIUS ANPULNA,REAMPUTATION ,,Case Rate,3000.00
Cigna,PPO,25922,CPT4/HCPCS,Amputate hand at wrist,,Case Rate,4000.00
Cigna,PPO,25929,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,PPO,25999,CPT4/HCPCS,UNLISTED PROCEDURE, FOREARM OR WRIST ,,Case Rate,3000.00
Cigna,PPO,26,DRG,Craniotomy & endovascular intracranial procedures w CC,,Case Rate,77979.00
Cigna,PPO,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,8300.00
Cigna,PPO,26011,CPT4/HCPCS,Drainage of finger abscess,,Case Rate,3000.00
Cigna,PPO,26020,CPT4/HCPCS,Drain hand tendon sheath,,Case Rate,3000.00
Cigna,PPO,26025,CPT4/HCPCS,Drainage of palm bursa,,Case Rate,3000.00
Cigna,PPO,26030,CPT4/HCPCS,Drainage of palm bursa(s),,Case Rate,3000.00
Cigna,PPO,26034,CPT4/HCPCS,Treat hand bone lesion,,Case Rate,3000.00
Cigna,PPO,26035,CPT4/HCPCS,Decompress fingers/hand,,Case Rate,4000.00
Cigna,PPO,26037,CPT4/HCPCS,Decompress fingers/hand,,Case Rate,4000.00
Cigna,PPO,26040,CPT4/HCPCS,Release palm contracture,,Case Rate,4000.00
Cigna,PPO,26045,CPT4/HCPCS,Release palm contracture,,Case Rate,4000.00
Cigna,PPO,26055,CPT4/HCPCS,Incise finger tendon sheath,,Case Rate,3000.00
Cigna,PPO,26060,CPT4/HCPCS,Incision of finger tendon,,Case Rate,3000.00
Cigna,PPO,26070,CPT4/HCPCS,Explore/treat hand joint,,Case Rate,3000.00
Cigna,PPO,26075,CPT4/HCPCS,Explore/treat finger joint,,Case Rate,4000.00
Cigna,PPO,26080,CPT4/HCPCS,Explore/treat finger joint,,Case Rate,4000.00
Cigna,PPO,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,8300.00
Cigna,PPO,26100,CPT4/HCPCS,Biopsy hand joint lining,,Case Rate,3000.00
Cigna,PPO,26105,CPT4/HCPCS,Biopsy finger joint lining,,Case Rate,3000.00
Cigna,PPO,26110,CPT4/HCPCS,Biopsy finger joint lining,,Case Rate,3000.00
Cigna,PPO,26111,CPT4/HCPCS,EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; 1.5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,26113,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFASCIAL (EG, INTRAMUSCULAR); 1.5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,26115,CPT4/HCPCS,Remove hand lesion subcut,,Case Rate,3000.00
Cigna,PPO,26116,CPT4/HCPCS,Remove hand lesion, deep,,Case Rate,3000.00
Cigna,PPO,26117,CPT4/HCPCS,Remove tumor, hand/finger,,Case Rate,4000.00
Cigna,PPO,26118,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF HAND OR FINGER; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,26121,CPT4/HCPCS,Release palm contracture,,Case Rate,4000.00
Cigna,PPO,26123,CPT4/HCPCS,Release palm contracture,,Case Rate,4000.00
Cigna,PPO,26125,CPT4/HCPCS,Release palm contracture,,Case Rate,3000.00
Cigna,PPO,26130,CPT4/HCPCS,Remove wrist joint lining,,Case Rate,4000.00
Cigna,PPO,26135,CPT4/HCPCS,Revise finger joint, each,,Case Rate,4000.00
Cigna,PPO,26140,CPT4/HCPCS,Revise finger joint, each,,Case Rate,3000.00
Cigna,PPO,26145,CPT4/HCPCS,Tendon excision, palm/finger,,Case Rate,4000.00
Cigna,PPO,26160,CPT4/HCPCS,Remove tendon sheath lesion,,Case Rate,4000.00
Cigna,PPO,26170,CPT4/HCPCS,Removal of palm tendon, each,,Case Rate,4000.00
Cigna,PPO,26180,CPT4/HCPCS,Removal of finger tendon,,Case Rate,4000.00
Cigna,PPO,26185,CPT4/HCPCS,Remove finger bone,,Case Rate,4000.00
Cigna,PPO,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,8300.00
Cigna,PPO,26200,CPT4/HCPCS,Remove hand bone lesion,,Case Rate,3000.00
Cigna,PPO,26205,CPT4/HCPCS,Remove/graft bone lesion,,Case Rate,4000.00
Cigna,PPO,26210,CPT4/HCPCS,Removal of finger lesion,,Case Rate,3000.00
Cigna,PPO,26215,CPT4/HCPCS,Remove/graft finger lesion,,Case Rate,4000.00
Cigna,PPO,26230,CPT4/HCPCS,Partial removal of hand bone,,Case Rate,6000.00
Cigna,PPO,26235,CPT4/HCPCS,Partial removal, finger bone,,Case Rate,4000.00
Cigna,PPO,26236,CPT4/HCPCS,Partial removal, finger bone,,Case Rate,4000.00
Cigna,PPO,26250,CPT4/HCPCS,Extensive hand surgery,,Case Rate,4000.00
Cigna,PPO,26260,CPT4/HCPCS,Extensive finger surgery,,Case Rate,4000.00
Cigna,PPO,26262,CPT4/HCPCS,Partial removal of finger,,Case Rate,3000.00
Cigna,PPO,263,DRG,Vein ligation & stripping,,Case Rate,58785.15
Cigna,PPO,26320,CPT4/HCPCS,Removal of implant from hand,,Case Rate,3000.00
Cigna,PPO,26340,CPT4/HCPCS,MANIPULATION, FINGER JOINT, UNDER ANESTHESIA, EACH JOINT,,Case Rate,3000.00
Cigna,PPO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Case Rate,3000.00
Cigna,PPO,26350,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,3000.00
Cigna,PPO,26352,CPT4/HCPCS,Repair/graft hand tendon,,Case Rate,4000.00
Cigna,PPO,26356,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,4000.00
Cigna,PPO,26357,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,4000.00
Cigna,PPO,26358,CPT4/HCPCS,Repair/graft hand tendon,,Case Rate,4000.00
Cigna,PPO,26370,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,4000.00
Cigna,PPO,26372,CPT4/HCPCS,Repair/graft hand tendon,,Case Rate,4000.00
Cigna,PPO,26373,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,4000.00
Cigna,PPO,26390,CPT4/HCPCS,Revise hand/finger tendon,,Case Rate,4000.00
Cigna,PPO,26392,CPT4/HCPCS,Repair/graft hand tendon,,Case Rate,4000.00
Cigna,PPO,264,DRG,Other circulatory system O.R. procedures,,Case Rate,82818.90
Cigna,PPO,26410,CPT4/HCPCS,Repair hand tendon,,Case Rate,4000.00
Cigna,PPO,26412,CPT4/HCPCS,Repair/graft hand tendon,,Case Rate,4000.00
Cigna,PPO,26415,CPT4/HCPCS,Excision, hand/finger tendon,,Case Rate,4000.00
Cigna,PPO,26416,CPT4/HCPCS,Graft hand or finger tendon,,Case Rate,4000.00
Cigna,PPO,26418,CPT4/HCPCS,Repair finger tendon,,Case Rate,4000.00
Cigna,PPO,26420,CPT4/HCPCS,Repair/graft finger tendon,,Case Rate,4000.00
Cigna,PPO,26426,CPT4/HCPCS,Repair finger/hand tendon,,Case Rate,4000.00
Cigna,PPO,26428,CPT4/HCPCS,Repair/graft finger tendon,,Case Rate,4000.00
Cigna,PPO,26432,CPT4/HCPCS,Repair finger tendon,,Case Rate,4000.00
Cigna,PPO,26433,CPT4/HCPCS,Repair finger tendon,,Case Rate,4000.00
Cigna,PPO,26434,CPT4/HCPCS,Repair/graft finger tendon,,Case Rate,4000.00
Cigna,PPO,26437,CPT4/HCPCS,Realignment of tendons,,Case Rate,4000.00
Cigna,PPO,26440,CPT4/HCPCS,Release palm/finger tendon,,Case Rate,4000.00
Cigna,PPO,26442,CPT4/HCPCS,Release palm & finger tendon,,Case Rate,4000.00
Cigna,PPO,26445,CPT4/HCPCS,Release hand/finger tendon,,Case Rate,4000.00
Cigna,PPO,26449,CPT4/HCPCS,Release forearm/hand tendon,,Case Rate,4000.00
Cigna,PPO,26450,CPT4/HCPCS,Incision of palm tendon,,Case Rate,4000.00
Cigna,PPO,26455,CPT4/HCPCS,Incision of finger tendon,,Case Rate,4000.00
Cigna,PPO,26460,CPT4/HCPCS,Incise hand/finger tendon,,Case Rate,4000.00
Cigna,PPO,26471,CPT4/HCPCS,Fusion of finger tendons,,Case Rate,3000.00
Cigna,PPO,26474,CPT4/HCPCS,Fusion of finger tendons,,Case Rate,3000.00
Cigna,PPO,26476,CPT4/HCPCS,Tendon lengthening,,Case Rate,3000.00
Cigna,PPO,26477,CPT4/HCPCS,Tendon shortening,,Case Rate,3000.00
Cigna,PPO,26478,CPT4/HCPCS,Lengthening of hand tendon,,Case Rate,3000.00
Cigna,PPO,26479,CPT4/HCPCS,Shortening of hand tendon,,Case Rate,3000.00
Cigna,PPO,26480,CPT4/HCPCS,Transplant hand tendon,,Case Rate,4000.00
Cigna,PPO,26483,CPT4/HCPCS,Transplant/graft hand tendon,,Case Rate,4000.00
Cigna,PPO,26485,CPT4/HCPCS,Transplant palm tendon,,Case Rate,3000.00
Cigna,PPO,26489,CPT4/HCPCS,Transplant/graft palm tendon,,Case Rate,4000.00
Cigna,PPO,26490,CPT4/HCPCS,Revise thumb tendon,,Case Rate,4000.00
Cigna,PPO,26492,CPT4/HCPCS,Tendon transfer with graft,,Case Rate,4000.00
Cigna,PPO,26494,CPT4/HCPCS,Hand tendon/muscle transfer,,Case Rate,4000.00
Cigna,PPO,26496,CPT4/HCPCS,Revise thumb tendon,,Case Rate,4000.00
Cigna,PPO,26497,CPT4/HCPCS,Finger tendon transfer,,Case Rate,4000.00
Cigna,PPO,26498,CPT4/HCPCS,Finger tendon transfer,,Case Rate,4000.00
Cigna,PPO,26499,CPT4/HCPCS,Revision of finger,,Case Rate,4000.00
Cigna,PPO,265,DRG,AICD lead procedures,,Case Rate,85748.85
Cigna,PPO,26500,CPT4/HCPCS,Hand tendon reconstruction,,Case Rate,4000.00
Cigna,PPO,26502,CPT4/HCPCS,Hand tendon reconstruction,,Case Rate,4000.00
Cigna,PPO,26508,CPT4/HCPCS,Release thumb contracture,,Case Rate,4000.00
Cigna,PPO,26510,CPT4/HCPCS,Thumb tendon transfer,,Case Rate,4000.00
Cigna,PPO,26516,CPT4/HCPCS,Fusion of knuckle joint,,Case Rate,3000.00
Cigna,PPO,26517,CPT4/HCPCS,Fusion of knuckle joints,,Case Rate,4000.00
Cigna,PPO,26518,CPT4/HCPCS,Fusion of knuckle joints,,Case Rate,4000.00
Cigna,PPO,26520,CPT4/HCPCS,Release knuckle contracture,,Case Rate,4000.00
Cigna,PPO,26525,CPT4/HCPCS,Release finger contracture,,Case Rate,4000.00
Cigna,PPO,26530,CPT4/HCPCS,Revise knuckle joint,,Case Rate,4000.00
Cigna,PPO,26531,CPT4/HCPCS,Revise knuckle with implant,,Case Rate,6000.00
Cigna,PPO,26535,CPT4/HCPCS,Revise finger joint,,Case Rate,5000.00
Cigna,PPO,26536,CPT4/HCPCS,Revise/implant finger joint,,Case Rate,5000.00
Cigna,PPO,26540,CPT4/HCPCS,Repair hand joint,,Case Rate,4000.00
Cigna,PPO,26541,CPT4/HCPCS,Repair hand joint with graft,,Case Rate,6000.00
Cigna,PPO,26542,CPT4/HCPCS,Repair hand joint with graft,,Case Rate,4000.00
Cigna,PPO,26545,CPT4/HCPCS,Reconstruct finger joint,,Case Rate,4000.00
Cigna,PPO,26546,CPT4/HCPCS,Repair nonunion hand,,Case Rate,4000.00
Cigna,PPO,26548,CPT4/HCPCS,Reconstruct finger joint,,Case Rate,4000.00
Cigna,PPO,26550,CPT4/HCPCS,Construct thumb replacement,,Case Rate,3000.00
Cigna,PPO,26551,CPT4/HCPCS,Great toe-hand transfer,,Case Rate,3000.00
Cigna,PPO,26553,CPT4/HCPCS,Single transfer, toe-hand,,Case Rate,3000.00
Cigna,PPO,26554,CPT4/HCPCS,Double transfer, toe-hand,,Case Rate,3000.00
Cigna,PPO,26555,CPT4/HCPCS,Positional change of finger,,Case Rate,4000.00
Cigna,PPO,26560,CPT4/HCPCS,Repair of web finger,,Case Rate,3000.00
Cigna,PPO,26561,CPT4/HCPCS,Repair of web finger,,Case Rate,4000.00
Cigna,PPO,26562,CPT4/HCPCS,Repair of web finger,,Case Rate,4000.00
Cigna,PPO,26565,CPT4/HCPCS,Correct metacarpal flaw,,Case Rate,5000.00
Cigna,PPO,26567,CPT4/HCPCS,Correct finger deformity,,Case Rate,5000.00
Cigna,PPO,26568,CPT4/HCPCS,Lengthen metacarpal/finger,,Case Rate,4000.00
Cigna,PPO,26580,CPT4/HCPCS,Repair hand deformity,,Case Rate,5000.00
Cigna,PPO,26587,CPT4/HCPCS,Reconstruct extra finger,,Case Rate,5000.00
Cigna,PPO,26590,CPT4/HCPCS,Repair finger deformity,,Case Rate,5000.00
Cigna,PPO,26591,CPT4/HCPCS,Repair muscles of hand,,Case Rate,4000.00
Cigna,PPO,26593,CPT4/HCPCS,Release muscles of hand,,Case Rate,4000.00
Cigna,PPO,26596,CPT4/HCPCS,Excision constricting tissue,,Case Rate,3000.00
Cigna,PPO,266,DRG,Endovascular Cardiac Valve Replacement w MCC,,Case Rate,180978.60
Cigna,PPO,26605,CPT4/HCPCS,Treat metacarpal fracture,,Case Rate,3000.00
Cigna,PPO,26607,CPT4/HCPCS,Treat metacarpal fracture,,Case Rate,3000.00
Cigna,PPO,26608,CPT4/HCPCS,Treat metacarpal fracture,,Case Rate,4000.00
Cigna,PPO,26615,CPT4/HCPCS,Treat metacarpal fracture,,Case Rate,4000.00
Cigna,PPO,26645,CPT4/HCPCS,Treat thumb fracture,,Case Rate,3000.00
Cigna,PPO,26650,CPT4/HCPCS,Treat thumb fracture,,Case Rate,3000.00
Cigna,PPO,26665,CPT4/HCPCS,Treat thumb fracture,,Case Rate,4000.00
Cigna,PPO,26675,CPT4/HCPCS,Treat hand dislocation,,Case Rate,3000.00
Cigna,PPO,26676,CPT4/HCPCS,Pin hand dislocation,,Case Rate,3000.00
Cigna,PPO,26685,CPT4/HCPCS,Treat hand dislocation,,Case Rate,4000.00
Cigna,PPO,26686,CPT4/HCPCS,Treat hand dislocation,,Case Rate,4000.00
Cigna,PPO,267,DRG,Endovascular Cardiac Valve Replacement w/o MCC,,Case Rate,142822.95
Cigna,PPO,26705,CPT4/HCPCS,Treat knuckle dislocation,,Case Rate,3000.00
Cigna,PPO,26706,CPT4/HCPCS,Pin knuckle dislocation,,Case Rate,3000.00
Cigna,PPO,26715,CPT4/HCPCS,Treat knuckle dislocation,,Case Rate,4000.00
Cigna,PPO,26720,CPT4/HCPCS,Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each,,Case Rate,400.00
Cigna,PPO,26725,CPT4/HCPCS,Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each,,Case Rate,400.00
Cigna,PPO,26727,CPT4/HCPCS,Treat finger fracture, each,,Case Rate,6000.00
Cigna,PPO,26735,CPT4/HCPCS,Treat finger fracture, each,,Case Rate,4000.00
Cigna,PPO,26740,CPT4/HCPCS,Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each,,Case Rate,400.00
Cigna,PPO,26742,CPT4/HCPCS,Treat finger fracture, each,,Case Rate,3000.00
Cigna,PPO,26746,CPT4/HCPCS,Treat finger fracture, each,,Case Rate,5000.00
Cigna,PPO,26756,CPT4/HCPCS,Pin finger fracture, each,,Case Rate,3000.00
Cigna,PPO,26765,CPT4/HCPCS,Treat finger fracture, each,,Case Rate,4000.00
Cigna,PPO,26776,CPT4/HCPCS,Pin finger dislocation,,Case Rate,3000.00
Cigna,PPO,26785,CPT4/HCPCS,Treat finger dislocation,,Case Rate,3000.00
Cigna,PPO,268,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w MCC,,Case Rate,177342.30
Cigna,PPO,26820,CPT4/HCPCS,Thumb fusion with graft,,Case Rate,5000.00
Cigna,PPO,26841,CPT4/HCPCS,Fusion of thumb,,Case Rate,4000.00
Cigna,PPO,26842,CPT4/HCPCS,Thumb fusion with graft,,Case Rate,4000.00
Cigna,PPO,26843,CPT4/HCPCS,Fusion of hand joint,,Case Rate,4000.00
Cigna,PPO,26844,CPT4/HCPCS,Fusion/graft of hand joint,,Case Rate,4000.00
Cigna,PPO,26850,CPT4/HCPCS,Fusion of knuckle,,Case Rate,4000.00
Cigna,PPO,26852,CPT4/HCPCS,Fusion of knuckle with graft,,Case Rate,4000.00
Cigna,PPO,26860,CPT4/HCPCS,Fusion of finger joint,,Case Rate,4000.00
Cigna,PPO,26861,CPT4/HCPCS,Fusion of finger jnt, add-on,,Case Rate,3000.00
Cigna,PPO,26862,CPT4/HCPCS,Fusion/graft of finger joint,,Case Rate,4000.00
Cigna,PPO,26863,CPT4/HCPCS,Fuse/graft added joint,,Case Rate,3000.00
Cigna,PPO,269,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w/o MCC,,Case Rate,110022.30
Cigna,PPO,26910,CPT4/HCPCS,Amputate metacarpal bone,,Case Rate,4000.00
Cigna,PPO,26951,CPT4/HCPCS,Amputation of finger/thumb,,Case Rate,3000.00
Cigna,PPO,26952,CPT4/HCPCS,Amputation of finger/thumb,,Case Rate,4000.00
Cigna,PPO,26989,CPT4/HCPCS,UNLISTED PROCEDURE, HANDS OR FINGERS ,,Case Rate,3000.00
Cigna,PPO,26990,CPT4/HCPCS,Drainage of pelvis lesion,,Case Rate,3000.00
Cigna,PPO,26991,CPT4/HCPCS,Drainage of pelvis bursa,,Case Rate,3000.00
Cigna,PPO,26992,CPT4/HCPCS,Drainage of bone lesion,,Case Rate,3000.00
Cigna,PPO,27,DRG,Craniotomy & endovascular intracranial procedures w/o CC/MCC,,Case Rate,64050.90
Cigna,PPO,270,DRG,Other Major Cardiovascular Procedures w MCC,,Case Rate,132130.80
Cigna,PPO,27000,CPT4/HCPCS,Incision of hip tendon,,Case Rate,3000.00
Cigna,PPO,27001,CPT4/HCPCS,Incision of hip tendon,,Case Rate,4000.00
Cigna,PPO,27003,CPT4/HCPCS,Incision of hip tendon,,Case Rate,4000.00
Cigna,PPO,27006,CPT4/HCPCS,TENOTOMY, ABDUCTORS AND/OR EXTENSOR(S) OF HIP, OPEN (SEPARATE PROCEDURE ,,Case Rate,3000.00
Cigna,PPO,27027,CPT4/HCPCS,DECOMPRESSION FASCIOTOMY(IES), PELVIC (BUTTOCK) COMPARTMENT(S) (EG, GLUTEUS MEDIUS-MINIMUS, GLUTEUS MAXIMUS, ILIOPSOAS, AND/OR TENSOR FASCIA LATA MUSCLE), UNILATERAL,,Case Rate,8300.00
Cigna,PPO,27030,CPT4/HCPCS,Drainage of hip joint,,Case Rate,3000.00
Cigna,PPO,27033,CPT4/HCPCS,Exploration of hip joint,,Case Rate,4000.00
Cigna,PPO,27035,CPT4/HCPCS,Denervation of hip joint,,Case Rate,4000.00
Cigna,PPO,27040,CPT4/HCPCS,Biopsy of soft tissues,,Case Rate,3000.00
Cigna,PPO,27041,CPT4/HCPCS,Biopsy of soft tissues,,Case Rate,3000.00
Cigna,PPO,27043,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOU S; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,27045,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,27047,CPT4/HCPCS,Remove hip/pelvis lesion,,Case Rate,3000.00
Cigna,PPO,27048,CPT4/HCPCS,Remove hip/pelvis lesion,,Case Rate,4000.00
Cigna,PPO,27049,CPT4/HCPCS,Remove tumor, hip/pelvis,,Case Rate,4000.00
Cigna,PPO,27050,CPT4/HCPCS,Biopsy of sacroiliac joint,,Case Rate,4000.00
Cigna,PPO,27052,CPT4/HCPCS,Biopsy of hip joint,,Case Rate,4000.00
Cigna,PPO,27057,CPT4/HCPCS,DECOMPRESSION FASCIOTOMY(IES), PELVIC (BUTTOCK) COMPARTMENT(S) (EG, GLUTEUS MEDIUS-MINIMUS, GLUTEUS MAXIMUS, ILIOPSOAS, AND/OR TENSOR FASCIA LATA MUSCLE) WITH DEBRIDEMENT OF NONVIABLE MUSCLE, UNILATERAL,,Case Rate,8300.00
Cigna,PPO,27059,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF PELVIS AND HIP AREA; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,27060,CPT4/HCPCS,Removal of ischial bursa,,Case Rate,5000.00
Cigna,PPO,27062,CPT4/HCPCS,Remove femur lesion/bursa,,Case Rate,5000.00
Cigna,PPO,27065,CPT4/HCPCS,Removal of hip bone lesion,,Case Rate,5000.00
Cigna,PPO,27066,CPT4/HCPCS,Removal of hip bone lesion,,Case Rate,5000.00
Cigna,PPO,27067,CPT4/HCPCS,Remove/graft hip bone lesion,,Case Rate,5000.00
Cigna,PPO,27080,CPT4/HCPCS,Removal of tail bone,,Case Rate,3000.00
Cigna,PPO,27086,CPT4/HCPCS,Remove hip foreign body,,Case Rate,3000.00
Cigna,PPO,27087,CPT4/HCPCS,Remove hip foreign body,,Case Rate,4000.00
Cigna,PPO,27093,CPT4/HCPCS,Injection procedure for hip arthrography; without anesthesia,,Case Rate,3000.00
Cigna,PPO,27095,CPT4/HCPCS,Injection procedure for hip arthrography; with anesthesia,,Case Rate,3000.00
Cigna,PPO,27096,CPT4/HCPCS,INJECTION PROCEDURE FOR SACROILIAC JOINT, ANESTHETIC/STEROID, WI TH IMAGE GUIDANCE (FLUOROSCOPY OR CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED ,,Case Rate,3000.00
Cigna,PPO,27097,CPT4/HCPCS,Revision of hip tendon,,Case Rate,4000.00
Cigna,PPO,27098,CPT4/HCPCS,Transfer tendon to pelvis,,Case Rate,4000.00
Cigna,PPO,271,DRG,Other Major Cardiovascular Procedures w CC,,Case Rate,90897.30
Cigna,PPO,27100,CPT4/HCPCS,Transfer of abdominal muscle,,Case Rate,4000.00
Cigna,PPO,27105,CPT4/HCPCS,Transfer of spinal muscle,,Case Rate,4000.00
Cigna,PPO,27110,CPT4/HCPCS,Transfer of iliopsoas muscle,,Case Rate,4000.00
Cigna,PPO,27111,CPT4/HCPCS,Transfer of iliopsoas muscle,,Case Rate,4000.00
Cigna,PPO,27197,CPT4/HCPCS,Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/in,,Case Rate,3000.00
Cigna,PPO,27198,CPT4/HCPCS,Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/in,,Case Rate,3000.00
Cigna,PPO,272,DRG,Other Major Cardiovascular Procedures w/o CC/MCC,,Case Rate,68564.40
Cigna,PPO,27200,CPT4/HCPCS,CLOSED TREATMENT OF COCCYGEAL FRACTURE ,,Case Rate,3000.00
Cigna,PPO,27202,CPT4/HCPCS,Treat tail bone fracture,,Case Rate,3000.00
Cigna,PPO,27230,CPT4/HCPCS,Treat thigh fracture,,Case Rate,3000.00
Cigna,PPO,27235,CPT4/HCPCS,PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMAL END, NECK ,,Case Rate,3000.00
Cigna,PPO,27238,CPT4/HCPCS,Treat thigh fracture,,Case Rate,3000.00
Cigna,PPO,27246,CPT4/HCPCS,Treat thigh fracture,,Case Rate,3000.00
Cigna,PPO,27250,CPT4/HCPCS,Treat hip dislocation,,Case Rate,3000.00
Cigna,PPO,27252,CPT4/HCPCS,Treat hip dislocation,,Case Rate,3000.00
Cigna,PPO,27256,CPT4/HCPCS,TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLOGICAL), BY ABDUCTION, SPLINT, OR TRACTION; WITHOUT ANESTHESIA, WITHOUT MANIPULATION ,,Case Rate,3000.00
Cigna,PPO,27257,CPT4/HCPCS,Treat hip dislocation,,Case Rate,4000.00
Cigna,PPO,27265,CPT4/HCPCS,Treat hip dislocation,,Case Rate,3000.00
Cigna,PPO,27266,CPT4/HCPCS,Treat hip dislocation,,Case Rate,3000.00
Cigna,PPO,27267,CPT4/HCPCS,CLTX THIGH FX,,Case Rate,3000.00
Cigna,PPO,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,Case Rate,3000.00
Cigna,PPO,27275,CPT4/HCPCS,Manipulation of hip joint,,Case Rate,3000.00
Cigna,PPO,27279,CPT4/HCPCS, ARTHRODESIS, SACROILIAC JOINT, PERCUTANEOUS OR MINIMALLY INVASIVE (INDIRECT VISUALIZATION), WITH IMAGE GUIDANCE, INCLUDES OBTAINING BONE GRAFT WHEN PERFORMED, AND PLACEMENT OF TRANSFIXING DEVICE,,Case Rate,3000.00
Cigna,PPO,27299,CPT4/HCPCS,UNLISTED PROCEDURE, PELVIS OR HIP JOINT ,,Case Rate,3000.00
Cigna,PPO,273,DRG,Percutaneous Intracardiac Procedures w MCC,,Case Rate,97848.60
Cigna,PPO,27301,CPT4/HCPCS,Drain thigh/knee lesion,,Case Rate,4000.00
Cigna,PPO,27303,CPT4/HCPCS,Drainage of bone lesion,,Case Rate,3000.00
Cigna,PPO,27305,CPT4/HCPCS,Incise thigh tendon & fascia,,Case Rate,3000.00
Cigna,PPO,27306,CPT4/HCPCS,Incision of thigh tendon,,Case Rate,4000.00
Cigna,PPO,27307,CPT4/HCPCS,Incision of thigh tendons,,Case Rate,4000.00
Cigna,PPO,27310,CPT4/HCPCS,Exploration of knee joint,,Case Rate,4000.00
Cigna,PPO,27323,CPT4/HCPCS,Biopsy, thigh soft tissues,,Case Rate,3000.00
Cigna,PPO,27324,CPT4/HCPCS,Biopsy, thigh soft tissues,,Case Rate,3000.00
Cigna,PPO,27325,CPT4/HCPCS,Neurectomy, hamstring,,Case Rate,3000.00
Cigna,PPO,27326,CPT4/HCPCS,Neurectomy, popliteal,,Case Rate,3000.00
Cigna,PPO,27327,CPT4/HCPCS,Removal of thigh lesion,,Case Rate,3000.00
Cigna,PPO,27328,CPT4/HCPCS,Removal of thigh lesion,,Case Rate,4000.00
Cigna,PPO,27329,CPT4/HCPCS,Remove tumor, thigh/knee,,Case Rate,4000.00
Cigna,PPO,27330,CPT4/HCPCS,Biopsy, knee joint lining,,Case Rate,4000.00
Cigna,PPO,27331,CPT4/HCPCS,Explore/treat knee joint,,Case Rate,4000.00
Cigna,PPO,27332,CPT4/HCPCS,Removal of knee cartilage,,Case Rate,4000.00
Cigna,PPO,27333,CPT4/HCPCS,Removal of knee cartilage,,Case Rate,4000.00
Cigna,PPO,27334,CPT4/HCPCS,Remove knee joint lining,,Case Rate,4000.00
Cigna,PPO,27335,CPT4/HCPCS,Remove knee joint lining,,Case Rate,4000.00
Cigna,PPO,27337,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS ; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,27339,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL ( EG, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,27340,CPT4/HCPCS,Removal of kneecap bursa,,Case Rate,4000.00
Cigna,PPO,27345,CPT4/HCPCS,Removal of knee cyst,,Case Rate,4000.00
Cigna,PPO,27347,CPT4/HCPCS,Remove knee cyst,,Case Rate,4000.00
Cigna,PPO,27350,CPT4/HCPCS,Removal of kneecap,,Case Rate,4000.00
Cigna,PPO,27355,CPT4/HCPCS,Remove femur lesion,,Case Rate,4000.00
Cigna,PPO,27356,CPT4/HCPCS,Remove femur lesion/graft,,Case Rate,4000.00
Cigna,PPO,27357,CPT4/HCPCS,Remove femur lesion/graft,,Case Rate,5000.00
Cigna,PPO,27358,CPT4/HCPCS,Remove femur lesion/fixation,,Case Rate,3000.00
Cigna,PPO,27360,CPT4/HCPCS,Partial removal, leg bone(s),,Case Rate,5000.00
Cigna,PPO,27364,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF THIGH OR KNEE AREA; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,27369,CPT4/HCPCS,Injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrography ,,Case Rate,3000.00
Cigna,PPO,27372,CPT4/HCPCS,Removal of foreign body,,Case Rate,6000.00
Cigna,PPO,27380,CPT4/HCPCS,Repair of kneecap tendon,,Case Rate,3000.00
Cigna,PPO,27381,CPT4/HCPCS,Repair/graft kneecap tendon,,Case Rate,4000.00
Cigna,PPO,27385,CPT4/HCPCS,Repair of thigh muscle,,Case Rate,4000.00
Cigna,PPO,27386,CPT4/HCPCS,Repair/graft of thigh muscle,,Case Rate,4000.00
Cigna,PPO,27390,CPT4/HCPCS,Incision of thigh tendon,,Case Rate,3000.00
Cigna,PPO,27391,CPT4/HCPCS,Incision of thigh tendons,,Case Rate,3000.00
Cigna,PPO,27392,CPT4/HCPCS,Incision of thigh tendons,,Case Rate,4000.00
Cigna,PPO,27393,CPT4/HCPCS,Lengthening of thigh tendon,,Case Rate,3000.00
Cigna,PPO,27394,CPT4/HCPCS,Lengthening of thigh tendons,,Case Rate,4000.00
Cigna,PPO,27395,CPT4/HCPCS,Lengthening of thigh tendons,,Case Rate,4000.00
Cigna,PPO,27396,CPT4/HCPCS,Transplant of thigh tendon,,Case Rate,4000.00
Cigna,PPO,27397,CPT4/HCPCS,Transplants of thigh tendons,,Case Rate,4000.00
Cigna,PPO,274,DRG,Percutaneous Intracardiac Procedures w/o MCC,,Case Rate,83777.70
Cigna,PPO,27400,CPT4/HCPCS,Revise thigh muscles/tendons,,Case Rate,4000.00
Cigna,PPO,27403,CPT4/HCPCS,Repair of knee cartilage,,Case Rate,4000.00
Cigna,PPO,27405,CPT4/HCPCS,Repair of knee ligament,,Case Rate,4000.00
Cigna,PPO,27407,CPT4/HCPCS,Repair of knee ligament,,Case Rate,4000.00
Cigna,PPO,27409,CPT4/HCPCS,Repair of knee ligaments,,Case Rate,4000.00
Cigna,PPO,27412,CPT4/HCPCS,Autologous Chondrocyte Implantation, Knee,,Case Rate,3000.00
Cigna,PPO,27415,CPT4/HCPCS,Osteochondral Allograft, Knee, Open,,Case Rate,3000.00
Cigna,PPO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Case Rate,8300.00
Cigna,PPO,27418,CPT4/HCPCS,Repair degenerated kneecap,,Case Rate,4000.00
Cigna,PPO,27420,CPT4/HCPCS,Revision of unstable kneecap,,Case Rate,4000.00
Cigna,PPO,27422,CPT4/HCPCS,Revision of unstable kneecap,,Case Rate,6000.00
Cigna,PPO,27424,CPT4/HCPCS,Revision/removal of kneecap,,Case Rate,4000.00
Cigna,PPO,27425,CPT4/HCPCS,Lateral retinacular release,,Case Rate,6000.00
Cigna,PPO,27427,CPT4/HCPCS,Reconstruction, knee,,Case Rate,4000.00
Cigna,PPO,27428,CPT4/HCPCS,Reconstruction, knee,,Case Rate,4000.00
Cigna,PPO,27429,CPT4/HCPCS,Reconstruction, knee,,Case Rate,4000.00
Cigna,PPO,27430,CPT4/HCPCS,Revision of thigh muscles,,Case Rate,4000.00
Cigna,PPO,27435,CPT4/HCPCS,Incision of knee joint,,Case Rate,4000.00
Cigna,PPO,27437,CPT4/HCPCS,Revise kneecap,,Case Rate,4000.00
Cigna,PPO,27438,CPT4/HCPCS,Revise kneecap with implant,,Case Rate,5000.00
Cigna,PPO,27440,CPT4/HCPCS,Revision of knee joint,,Case Rate,5000.00
Cigna,PPO,27441,CPT4/HCPCS,Revision of knee joint,,Case Rate,5000.00
Cigna,PPO,27442,CPT4/HCPCS,Revision of knee joint,,Case Rate,5000.00
Cigna,PPO,27443,CPT4/HCPCS,Revision of knee joint,,Case Rate,5000.00
Cigna,PPO,27446,CPT4/HCPCS,ARTHROPLASTY KNEE CONDYLE AND PLATEAU MEDIAL OR LATERAL COMPARTMENT (SSO) ,,Case Rate,3000.00
Cigna,PPO,27447,CPT4/HCPCS,ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY),,Case Rate,3000.00
Cigna,PPO,27475,CPT4/HCPCS,ARREST, EPIPHYSEAL, ANY METHOD, (EPIPHYDIODESIS); DISTAL FEMUR ,,Case Rate,3000.00
Cigna,PPO,27477,CPT4/HCPCS,Arrest, epiphyseal, any method (eg, epiphysiodesis); tibia and fibula, proximal ,,Case Rate,3000.00
Cigna,PPO,27479,CPT4/HCPCS,ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYDIODESIS); CMBINED DISTAL FEMUR PROX ,,Case Rate,3000.00
Cigna,PPO,27485,CPT4/HCPCS,Arrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg, genu varus or valgus),,Case Rate,3000.00
Cigna,PPO,27496,CPT4/HCPCS,Decompression of thigh/knee,,Case Rate,5000.00
Cigna,PPO,27497,CPT4/HCPCS,Decompression of thigh/knee,,Case Rate,4000.00
Cigna,PPO,27498,CPT4/HCPCS,Decompression of thigh/knee,,Case Rate,4000.00
Cigna,PPO,27499,CPT4/HCPCS,Decompression of thigh/knee,,Case Rate,4000.00
Cigna,PPO,27500,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,PPO,27501,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,PPO,27502,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,PPO,27503,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,4000.00
Cigna,PPO,27507,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,PPO,27508,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,PPO,27509,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,4000.00
Cigna,PPO,27510,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,PPO,27511,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,PPO,27513,CPT4/HCPCS,Treatment of thigh fracture,,Case Rate,3000.00
Cigna,PPO,27516,CPT4/HCPCS,Treat thigh fx growth plate,,Case Rate,3000.00
Cigna,PPO,27517,CPT4/HCPCS,Treat thigh fx growth plate,,Case Rate,3000.00
Cigna,PPO,27520,CPT4/HCPCS,Treat kneecap fracture,,Case Rate,3000.00
Cigna,PPO,27524,CPT4/HCPCS,Treat kneecap fracture,,Case Rate,4000.00
Cigna,PPO,27530,CPT4/HCPCS,Treat knee fracture,,Case Rate,3000.00
Cigna,PPO,27532,CPT4/HCPCS,Treat knee fracture,,Case Rate,3000.00
Cigna,PPO,27535,CPT4/HCPCS,Treat knee fracture,,Case Rate,3000.00
Cigna,PPO,27538,CPT4/HCPCS,Treat knee fracture(s),,Case Rate,3000.00
Cigna,PPO,27550,CPT4/HCPCS,Treat knee dislocation,,Case Rate,3000.00
Cigna,PPO,27552,CPT4/HCPCS,Treat knee dislocation,,Case Rate,3000.00
Cigna,PPO,27560,CPT4/HCPCS,Treat kneecap dislocation,,Case Rate,3000.00
Cigna,PPO,27562,CPT4/HCPCS,Treat kneecap dislocation,,Case Rate,3000.00
Cigna,PPO,27566,CPT4/HCPCS,Treat kneecap dislocation,,Case Rate,3000.00
Cigna,PPO,27570,CPT4/HCPCS,Fixation of knee joint,,Case Rate,3000.00
Cigna,PPO,27594,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,PPO,27599,CPT4/HCPCS,UNLISTED PROCEDURE, FEMUR OR KNEE ,,Case Rate,3000.00
Cigna,PPO,27600,CPT4/HCPCS,Decompression of lower leg,,Case Rate,4000.00
Cigna,PPO,27601,CPT4/HCPCS,Decompression of lower leg,,Case Rate,4000.00
Cigna,PPO,27602,CPT4/HCPCS,Decompression of lower leg,,Case Rate,4000.00
Cigna,PPO,27603,CPT4/HCPCS,Drain lower leg lesion,,Case Rate,3000.00
Cigna,PPO,27604,CPT4/HCPCS,Drain lower leg bursa,,Case Rate,3000.00
Cigna,PPO,27605,CPT4/HCPCS,Incision of achilles tendon,,Case Rate,3000.00
Cigna,PPO,27606,CPT4/HCPCS,Incision of achilles tendon,,Case Rate,3000.00
Cigna,PPO,27607,CPT4/HCPCS,Treat lower leg bone lesion,,Case Rate,3000.00
Cigna,PPO,27610,CPT4/HCPCS,Explore/treat ankle joint,,Case Rate,3000.00
Cigna,PPO,27612,CPT4/HCPCS,Exploration of ankle joint,,Case Rate,4000.00
Cigna,PPO,27613,CPT4/HCPCS,Biopsy lower leg soft tissue,,Case Rate,3000.00
Cigna,PPO,27614,CPT4/HCPCS,Biopsy lower leg soft tissue,,Case Rate,3000.00
Cigna,PPO,27615,CPT4/HCPCS,Remove tumor, lower leg,,Case Rate,4000.00
Cigna,PPO,27616,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF LEG OR ANKLE AREA; 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,27618,CPT4/HCPCS,Remove lower leg lesion,,Case Rate,3000.00
Cigna,PPO,27619,CPT4/HCPCS,Remove lower leg lesion,,Case Rate,4000.00
Cigna,PPO,27620,CPT4/HCPCS,Explore/treat ankle joint,,Case Rate,4000.00
Cigna,PPO,27625,CPT4/HCPCS,Remove ankle joint lining,,Case Rate,4000.00
Cigna,PPO,27626,CPT4/HCPCS,Remove ankle joint lining,,Case Rate,4000.00
Cigna,PPO,27630,CPT4/HCPCS,Removal of tendon lesion,,Case Rate,4000.00
Cigna,PPO,27632,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBCUTANEOUS; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,27634,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA, SUBFASCIAL (E G, INTRAMUSCULAR); 5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,27635,CPT4/HCPCS,Remove lower leg bone lesion,,Case Rate,4000.00
Cigna,PPO,27637,CPT4/HCPCS,Remove/graft leg bone lesion,,Case Rate,4000.00
Cigna,PPO,27638,CPT4/HCPCS,Remove/graft leg bone lesion,,Case Rate,4000.00
Cigna,PPO,27640,CPT4/HCPCS,Partial removal of tibia,,Case Rate,3000.00
Cigna,PPO,27641,CPT4/HCPCS,Partial removal of fibula,,Case Rate,3000.00
Cigna,PPO,27647,CPT4/HCPCS,Extensive ankle/heel surgery,,Case Rate,4000.00
Cigna,PPO,27648,CPT4/HCPCS,Injection procedure for ankle arthrography,,Case Rate,3000.00
Cigna,PPO,27650,CPT4/HCPCS,Repair achilles tendon,,Case Rate,4000.00
Cigna,PPO,27652,CPT4/HCPCS,Repair/graft achilles tendon,,Case Rate,4000.00
Cigna,PPO,27654,CPT4/HCPCS,Repair of achilles tendon,,Case Rate,4000.00
Cigna,PPO,27656,CPT4/HCPCS,Repair leg fascia defect,,Case Rate,3000.00
Cigna,PPO,27658,CPT4/HCPCS,Repair of leg tendon, each,,Case Rate,3000.00
Cigna,PPO,27659,CPT4/HCPCS,Repair of leg tendon, each,,Case Rate,3000.00
Cigna,PPO,27664,CPT4/HCPCS,Repair of leg tendon, each,,Case Rate,3000.00
Cigna,PPO,27665,CPT4/HCPCS,Repair of leg tendon, each,,Case Rate,3000.00
Cigna,PPO,27675,CPT4/HCPCS,Repair lower leg tendons,,Case Rate,3000.00
Cigna,PPO,27676,CPT4/HCPCS,Repair lower leg tendons,,Case Rate,4000.00
Cigna,PPO,27680,CPT4/HCPCS,Release of lower leg tendon,,Case Rate,4000.00
Cigna,PPO,27681,CPT4/HCPCS,Release of lower leg tendons,,Case Rate,3000.00
Cigna,PPO,27685,CPT4/HCPCS,Revision of lower leg tendon,,Case Rate,4000.00
Cigna,PPO,27686,CPT4/HCPCS,Revise lower leg tendons,,Case Rate,4000.00
Cigna,PPO,27687,CPT4/HCPCS,Revision of calf tendon,,Case Rate,4000.00
Cigna,PPO,27690,CPT4/HCPCS,Revise lower leg tendon,,Case Rate,4000.00
Cigna,PPO,27691,CPT4/HCPCS,Revise lower leg tendon,,Case Rate,4000.00
Cigna,PPO,27692,CPT4/HCPCS,Revise additional leg tendon,,Case Rate,3000.00
Cigna,PPO,27695,CPT4/HCPCS,Repair of ankle ligament,,Case Rate,3000.00
Cigna,PPO,27696,CPT4/HCPCS,Repair of ankle ligaments,,Case Rate,3000.00
Cigna,PPO,27698,CPT4/HCPCS,Repair of ankle ligament,,Case Rate,3000.00
Cigna,PPO,27700,CPT4/HCPCS,Revision of ankle joint,,Case Rate,5000.00
Cigna,PPO,27704,CPT4/HCPCS,Removal of ankle implant,,Case Rate,3000.00
Cigna,PPO,27705,CPT4/HCPCS,Incision of tibia,,Case Rate,3000.00
Cigna,PPO,27707,CPT4/HCPCS,Incision of fibula,,Case Rate,3000.00
Cigna,PPO,27709,CPT4/HCPCS,Incision of tibia & fibula,,Case Rate,3000.00
Cigna,PPO,27715,CPT4/HCPCS,Revision of lower leg,,Case Rate,3000.00
Cigna,PPO,27720,CPT4/HCPCS,REPAIR OF NONUNION OR MALUNION, TIBIA, WITHOUT GRAFT, ,,Case Rate,3000.00
Cigna,PPO,27722,CPT4/HCPCS,REPAIR OF NONUNION OR MALUNION, TIBIA; WITH SLIDING GRAFT ,,Case Rate,3000.00
Cigna,PPO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Case Rate,8300.00
Cigna,PPO,27730,CPT4/HCPCS,Repair of tibia epiphysis,,Case Rate,3000.00
Cigna,PPO,27732,CPT4/HCPCS,Repair of fibula epiphysis,,Case Rate,3000.00
Cigna,PPO,27734,CPT4/HCPCS,Repair lower leg epiphyses,,Case Rate,3000.00
Cigna,PPO,27740,CPT4/HCPCS,Repair of leg epiphyses,,Case Rate,3000.00
Cigna,PPO,27742,CPT4/HCPCS,Repair of leg epiphyses,,Case Rate,3000.00
Cigna,PPO,27745,CPT4/HCPCS,Reinforce tibia,,Case Rate,4000.00
Cigna,PPO,27750,CPT4/HCPCS,Treatment of tibia fracture,,Case Rate,3000.00
Cigna,PPO,27752,CPT4/HCPCS,Treatment of tibia fracture,,Case Rate,3000.00
Cigna,PPO,27756,CPT4/HCPCS,Treatment of tibia fracture,,Case Rate,4000.00
Cigna,PPO,27758,CPT4/HCPCS,Treatment of tibia fracture,,Case Rate,4000.00
Cigna,PPO,27759,CPT4/HCPCS,Treatment of tibia fracture,,Case Rate,4000.00
Cigna,PPO,27760,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,PPO,27762,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,PPO,27766,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,4000.00
Cigna,PPO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Case Rate,3000.00
Cigna,PPO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Case Rate,3000.00
Cigna,PPO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Case Rate,8300.00
Cigna,PPO,27780,CPT4/HCPCS,Treatment of fibula fracture,,Case Rate,3000.00
Cigna,PPO,27781,CPT4/HCPCS,Treatment of fibula fracture,,Case Rate,3000.00
Cigna,PPO,27784,CPT4/HCPCS,Treatment of fibula fracture,,Case Rate,4000.00
Cigna,PPO,27786,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,PPO,27788,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,PPO,27792,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,4000.00
Cigna,PPO,27808,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,PPO,27810,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,PPO,27814,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,4000.00
Cigna,PPO,27816,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,PPO,27818,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,PPO,27822,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,4000.00
Cigna,PPO,27823,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,4000.00
Cigna,PPO,27824,CPT4/HCPCS,Treat lower leg fracture,,Case Rate,3000.00
Cigna,PPO,27825,CPT4/HCPCS,Treat lower leg fracture,,Case Rate,3000.00
Cigna,PPO,27826,CPT4/HCPCS,Treat lower leg fracture,,Case Rate,4000.00
Cigna,PPO,27827,CPT4/HCPCS,Treat lower leg fracture,,Case Rate,4000.00
Cigna,PPO,27828,CPT4/HCPCS,Treat lower leg fracture,,Case Rate,4000.00
Cigna,PPO,27829,CPT4/HCPCS,Treat lower leg joint,,Case Rate,3000.00
Cigna,PPO,27830,CPT4/HCPCS,Treat lower leg dislocation,,Case Rate,3000.00
Cigna,PPO,27831,CPT4/HCPCS,Treat lower leg dislocation,,Case Rate,3000.00
Cigna,PPO,27832,CPT4/HCPCS,Treat lower leg dislocation,,Case Rate,3000.00
Cigna,PPO,27840,CPT4/HCPCS,Treat ankle dislocation,,Case Rate,3000.00
Cigna,PPO,27842,CPT4/HCPCS,Treat ankle dislocation,,Case Rate,3000.00
Cigna,PPO,27846,CPT4/HCPCS,Treat ankle dislocation,,Case Rate,4000.00
Cigna,PPO,27848,CPT4/HCPCS,Treat ankle dislocation,,Case Rate,4000.00
Cigna,PPO,27860,CPT4/HCPCS,Fixation of ankle joint,,Case Rate,3000.00
Cigna,PPO,27870,CPT4/HCPCS,Fusion of ankle joint,,Case Rate,4000.00
Cigna,PPO,27871,CPT4/HCPCS,Fusion of tibiofibular joint,,Case Rate,4000.00
Cigna,PPO,27884,CPT4/HCPCS,Amputation follow-up surgery,,Case Rate,4000.00
Cigna,PPO,27889,CPT4/HCPCS,Amputation of foot at ankle,,Case Rate,4000.00
Cigna,PPO,27892,CPT4/HCPCS,Decompression of leg,,Case Rate,4000.00
Cigna,PPO,27893,CPT4/HCPCS,Decompression of leg,,Case Rate,4000.00
Cigna,PPO,27894,CPT4/HCPCS,Decompression of leg,,Case Rate,4000.00
Cigna,PPO,27899,CPT4/HCPCS,UNLISTED PROCEDURE, LEG OR ANKLE ,,Case Rate,3000.00
Cigna,PPO,28,DRG,Spinal procedures w MCC,,Case Rate,25500.00
Cigna,PPO,280,DRG,Acute myocardial infarction, discharged alive w MCC,,Case Rate,41468.10
Cigna,PPO,28001,CPT4/HCPCS,Incision and drainage, bursa, foot,,Case Rate,3000.00
Cigna,PPO,28002,CPT4/HCPCS,Treatment of foot infection,,Case Rate,4000.00
Cigna,PPO,28003,CPT4/HCPCS,Treatment of foot infection,,Case Rate,4000.00
Cigna,PPO,28005,CPT4/HCPCS,Treat foot bone lesion,,Case Rate,4000.00
Cigna,PPO,28008,CPT4/HCPCS,Incision of foot fascia,,Case Rate,4000.00
Cigna,PPO,28010,CPT4/HCPCS,Tenotomy, percutaneous, toe; single tendon,,Case Rate,3000.00
Cigna,PPO,28011,CPT4/HCPCS,Incision of toe tendons,,Case Rate,4000.00
Cigna,PPO,28020,CPT4/HCPCS,Exploration of foot joint,,Case Rate,3000.00
Cigna,PPO,28022,CPT4/HCPCS,Exploration of foot joint,,Case Rate,3000.00
Cigna,PPO,28024,CPT4/HCPCS,Exploration of toe joint,,Case Rate,3000.00
Cigna,PPO,28035,CPT4/HCPCS,Decompression of tibia nerve,,Case Rate,4000.00
Cigna,PPO,28039,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; 1.5 CM OR GREATER,,Case Rate,3000.00
Cigna,PPO,28041,CPT4/HCPCS,EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL (EG, INT RAMUSCULAR); 1.5 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,28043,CPT4/HCPCS,Excision of foot lesion,,Case Rate,3000.00
Cigna,PPO,28045,CPT4/HCPCS,Excision of foot lesion,,Case Rate,4000.00
Cigna,PPO,28046,CPT4/HCPCS,Resection of tumor, foot,,Case Rate,4000.00
Cigna,PPO,28047,CPT4/HCPCS,RADICAL RESECTION OF TUMOR (EG, SARCOMA), SOFT TISSUE OF FOOT OR TOE; 3 CM OR GREATER ,,Case Rate,3000.00
Cigna,PPO,28050,CPT4/HCPCS,Biopsy of foot joint lining,,Case Rate,3000.00
Cigna,PPO,28052,CPT4/HCPCS,Biopsy of foot joint lining,,Case Rate,3000.00
Cigna,PPO,28054,CPT4/HCPCS,Biopsy of toe joint lining,,Case Rate,3000.00
Cigna,PPO,28055,CPT4/HCPCS,Neurectomy, foot,,Case Rate,4000.00
Cigna,PPO,28060,CPT4/HCPCS,Partial removal, foot fascia,,Case Rate,3000.00
Cigna,PPO,28062,CPT4/HCPCS,Removal of foot fascia,,Case Rate,4000.00
Cigna,PPO,28070,CPT4/HCPCS,Removal of foot joint lining,,Case Rate,4000.00
Cigna,PPO,28072,CPT4/HCPCS,Removal of foot joint lining,,Case Rate,4000.00
Cigna,PPO,28080,CPT4/HCPCS,Removal of foot lesion,,Case Rate,4000.00
Cigna,PPO,28086,CPT4/HCPCS,Excise foot tendon sheath,,Case Rate,3000.00
Cigna,PPO,28088,CPT4/HCPCS,Excise foot tendon sheath,,Case Rate,3000.00
Cigna,PPO,28090,CPT4/HCPCS,Removal of foot lesion,,Case Rate,4000.00
Cigna,PPO,28092,CPT4/HCPCS,Removal of toe lesions,,Case Rate,4000.00
Cigna,PPO,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,8300.00
Cigna,PPO,28100,CPT4/HCPCS,Removal of ankle/heel lesion,,Case Rate,3000.00
Cigna,PPO,28102,CPT4/HCPCS,Remove/graft foot lesion,,Case Rate,4000.00
Cigna,PPO,28103,CPT4/HCPCS,Remove/graft foot lesion,,Case Rate,4000.00
Cigna,PPO,28104,CPT4/HCPCS,Removal of foot lesion,,Case Rate,3000.00
Cigna,PPO,28106,CPT4/HCPCS,Remove/graft foot lesion,,Case Rate,4000.00
Cigna,PPO,28107,CPT4/HCPCS,Remove/graft foot lesion,,Case Rate,4000.00
Cigna,PPO,28108,CPT4/HCPCS,Removal of toe lesions,,Case Rate,3000.00
Cigna,PPO,28110,CPT4/HCPCS,Part removal of metatarsal,,Case Rate,4000.00
Cigna,PPO,28111,CPT4/HCPCS,Part removal of metatarsal,,Case Rate,4000.00
Cigna,PPO,28112,CPT4/HCPCS,Part removal of metatarsal,,Case Rate,4000.00
Cigna,PPO,28113,CPT4/HCPCS,Part removal of metatarsal,,Case Rate,4000.00
Cigna,PPO,28114,CPT4/HCPCS,Removal of metatarsal heads,,Case Rate,4000.00
Cigna,PPO,28116,CPT4/HCPCS,Revision of foot,,Case Rate,4000.00
Cigna,PPO,28118,CPT4/HCPCS,Removal of heel bone,,Case Rate,4000.00
Cigna,PPO,28119,CPT4/HCPCS,Removal of heel spur,,Case Rate,4000.00
Cigna,PPO,28120,CPT4/HCPCS,Part removal of ankle/heel,,Case Rate,6000.00
Cigna,PPO,28122,CPT4/HCPCS,Partial removal of foot bone,,Case Rate,4000.00
Cigna,PPO,28124,CPT4/HCPCS,Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe,,Case Rate,4000.00
Cigna,PPO,28126,CPT4/HCPCS,Partial removal of toe,,Case Rate,4000.00
Cigna,PPO,28130,CPT4/HCPCS,Removal of ankle bone,,Case Rate,4000.00
Cigna,PPO,28140,CPT4/HCPCS,Removal of metatarsal,,Case Rate,4000.00
Cigna,PPO,28150,CPT4/HCPCS,Removal of toe,,Case Rate,4000.00
Cigna,PPO,28153,CPT4/HCPCS,Partial removal of toe,,Case Rate,4000.00
Cigna,PPO,28160,CPT4/HCPCS,Partial removal of toe,,Case Rate,4000.00
Cigna,PPO,28171,CPT4/HCPCS,Extensive foot surgery,,Case Rate,4000.00
Cigna,PPO,28173,CPT4/HCPCS,Extensive foot surgery,,Case Rate,4000.00
Cigna,PPO,28175,CPT4/HCPCS,Extensive foot surgery,,Case Rate,4000.00
Cigna,PPO,28190,CPT4/HCPCS,Removal of foreign body, foot; subcutaneous,,Case Rate,3000.00
Cigna,PPO,28192,CPT4/HCPCS,Removal of foot foreign body,,Case Rate,3000.00
Cigna,PPO,28193,CPT4/HCPCS,Removal of foot foreign body,,Case Rate,4000.00
Cigna,PPO,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,8300.00
Cigna,PPO,28200,CPT4/HCPCS,Repair of foot tendon,,Case Rate,4000.00
Cigna,PPO,28202,CPT4/HCPCS,Repair/graft of foot tendon,,Case Rate,4000.00
Cigna,PPO,28208,CPT4/HCPCS,Repair of foot tendon,,Case Rate,4000.00
Cigna,PPO,28210,CPT4/HCPCS,Repair/graft of foot tendon,,Case Rate,4000.00
Cigna,PPO,28220,CPT4/HCPCS,Tenolysis, flexor, foot; single tendon,,Case Rate,3000.00
Cigna,PPO,28222,CPT4/HCPCS,Release of foot tendons,,Case Rate,3000.00
Cigna,PPO,28225,CPT4/HCPCS,Release of foot tendon,,Case Rate,3000.00
Cigna,PPO,28226,CPT4/HCPCS,Release of foot tendons,,Case Rate,3000.00
Cigna,PPO,28230,CPT4/HCPCS,Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure),,Case Rate,3000.00
Cigna,PPO,28232,CPT4/HCPCS,Tenotomy, open, tendon flexor; toe, single tendon (separate procedure),,Case Rate,3000.00
Cigna,PPO,28234,CPT4/HCPCS,Incision of foot tendon,,Case Rate,3000.00
Cigna,PPO,28238,CPT4/HCPCS,Revision of foot tendon,,Case Rate,4000.00
Cigna,PPO,28240,CPT4/HCPCS,Release of big toe,,Case Rate,3000.00
Cigna,PPO,28250,CPT4/HCPCS,Revision of foot fascia,,Case Rate,4000.00
Cigna,PPO,28260,CPT4/HCPCS,Release of midfoot joint,,Case Rate,4000.00
Cigna,PPO,28261,CPT4/HCPCS,Revision of foot tendon,,Case Rate,4000.00
Cigna,PPO,28262,CPT4/HCPCS,Revision of foot and ankle,,Case Rate,4000.00
Cigna,PPO,28264,CPT4/HCPCS,Release of midfoot joint,,Case Rate,3000.00
Cigna,PPO,28270,CPT4/HCPCS,Release of foot contracture,,Case Rate,4000.00
Cigna,PPO,28272,CPT4/HCPCS,Capsulotomy; interphalangeal joint, each joint (separate procedure),,Case Rate,3000.00
Cigna,PPO,28280,CPT4/HCPCS,Fusion of toes,,Case Rate,3000.00
Cigna,PPO,28285,CPT4/HCPCS,Repair of hammertoe,,Case Rate,4000.00
Cigna,PPO,28286,CPT4/HCPCS,Repair of hammertoe,,Case Rate,4000.00
Cigna,PPO,28288,CPT4/HCPCS,Partial removal of foot bone,,Case Rate,4000.00
Cigna,PPO,28289,CPT4/HCPCS,Repair hallux rigidus,,Case Rate,4000.00
Cigna,PPO,28291,CPT4/HCPCS,Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant,,Case Rate,3000.00
Cigna,PPO,28292,CPT4/HCPCS,Correction of bunion,,Case Rate,3000.00
Cigna,PPO,28295,CPT4/HCPCS,Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method,,Case Rate,4000.00
Cigna,PPO,28296,CPT4/HCPCS,Correction of bunion,,Case Rate,4000.00
Cigna,PPO,28297,CPT4/HCPCS,Correction of bunion,,Case Rate,4000.00
Cigna,PPO,28298,CPT4/HCPCS,Correction of bunion,,Case Rate,4000.00
Cigna,PPO,28299,CPT4/HCPCS,Correction of bunion,,Case Rate,5000.00
Cigna,PPO,283,DRG,Acute myocardial infarction, expired w MCC,,Case Rate,47547.30
Cigna,PPO,28300,CPT4/HCPCS,Incision of heel bone,,Case Rate,3000.00
Cigna,PPO,28302,CPT4/HCPCS,Incision of ankle bone,,Case Rate,3000.00
Cigna,PPO,28304,CPT4/HCPCS,Incision of midfoot bones,,Case Rate,3000.00
Cigna,PPO,28305,CPT4/HCPCS,Incise/graft midfoot bones,,Case Rate,4000.00
Cigna,PPO,28306,CPT4/HCPCS,Incision of metatarsal,,Case Rate,4000.00
Cigna,PPO,28307,CPT4/HCPCS,Incision of metatarsal,,Case Rate,4000.00
Cigna,PPO,28308,CPT4/HCPCS,Incision of metatarsal,,Case Rate,3000.00
Cigna,PPO,28309,CPT4/HCPCS,Incision of metatarsals,,Case Rate,4000.00
Cigna,PPO,28310,CPT4/HCPCS,Revision of big toe,,Case Rate,4000.00
Cigna,PPO,28312,CPT4/HCPCS,Revision of toe,,Case Rate,4000.00
Cigna,PPO,28313,CPT4/HCPCS,Repair deformity of toe,,Case Rate,3000.00
Cigna,PPO,28315,CPT4/HCPCS,Removal of sesamoid bone,,Case Rate,4000.00
Cigna,PPO,28320,CPT4/HCPCS,Repair of foot bones,,Case Rate,4000.00
Cigna,PPO,28322,CPT4/HCPCS,Repair of metatarsals,,Case Rate,4000.00
Cigna,PPO,28340,CPT4/HCPCS,Resect enlarged toe tissue,,Case Rate,4000.00
Cigna,PPO,28341,CPT4/HCPCS,Resect enlarged toe,,Case Rate,4000.00
Cigna,PPO,28344,CPT4/HCPCS,Repair extra toe(s),,Case Rate,4000.00
Cigna,PPO,28345,CPT4/HCPCS,Repair webbed toe(s),,Case Rate,4000.00
Cigna,PPO,284,DRG,Acute myocardial infarction, expired w CC,,Case Rate,18722.10
Cigna,PPO,28400,CPT4/HCPCS,Treatment of heel fracture,,Case Rate,3000.00
Cigna,PPO,28405,CPT4/HCPCS,Treatment of heel fracture,,Case Rate,3000.00
Cigna,PPO,28406,CPT4/HCPCS,Treatment of heel fracture,,Case Rate,3000.00
Cigna,PPO,28415,CPT4/HCPCS,Treat heel fracture,,Case Rate,4000.00
Cigna,PPO,28420,CPT4/HCPCS,Treat/graft heel fracture,,Case Rate,4000.00
Cigna,PPO,28430,CPT4/HCPCS,Closed treatment of talus fracture; without manipulation,,Case Rate,400.00
Cigna,PPO,28435,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,PPO,28436,CPT4/HCPCS,Treatment of ankle fracture,,Case Rate,3000.00
Cigna,PPO,28445,CPT4/HCPCS,Treat ankle fracture,,Case Rate,4000.00
Cigna,PPO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Case Rate,8300.00
Cigna,PPO,28450,CPT4/HCPCS,Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each,,Case Rate,400.00
Cigna,PPO,28455,CPT4/HCPCS,Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each,,Case Rate,400.00
Cigna,PPO,28456,CPT4/HCPCS,Treat midfoot fracture,,Case Rate,3000.00
Cigna,PPO,28465,CPT4/HCPCS,Treat midfoot fracture, each,,Case Rate,4000.00
Cigna,PPO,28470,CPT4/HCPCS,Closed treatment of metatarsal fracture; without manipulation, each,,Case Rate,400.00
Cigna,PPO,28475,CPT4/HCPCS,Closed treatment of metatarsal fracture; with manipulation, each,,Case Rate,400.00
Cigna,PPO,28476,CPT4/HCPCS,Treat metatarsal fracture,,Case Rate,3000.00
Cigna,PPO,28485,CPT4/HCPCS,Treat metatarsal fracture,,Case Rate,4000.00
Cigna,PPO,28490,CPT4/HCPCS,Closed treatment of fracture great toe, phalanx or phalanges; without manipulation,,Case Rate,400.00
Cigna,PPO,28495,CPT4/HCPCS,Closed treatment of fracture great toe, phalanx or phalanges; with manipulation,,Case Rate,400.00
Cigna,PPO,28496,CPT4/HCPCS,Treat big toe fracture,,Case Rate,3000.00
Cigna,PPO,285,DRG,Acute myocardial infarction, expired w/o CC/MCC,,Case Rate,12658.20
Cigna,PPO,28505,CPT4/HCPCS,Treat big toe fracture,,Case Rate,4000.00
Cigna,PPO,28510,CPT4/HCPCS,Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each,,Case Rate,400.00
Cigna,PPO,28515,CPT4/HCPCS,Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each,,Case Rate,400.00
Cigna,PPO,28525,CPT4/HCPCS,Treat toe fracture,,Case Rate,4000.00
Cigna,PPO,28530,CPT4/HCPCS,Closed treatment of sesamoid fracture,,Case Rate,400.00
Cigna,PPO,28531,CPT4/HCPCS,Treat sesamoid bone fracture,,Case Rate,4000.00
Cigna,PPO,28540,CPT4/HCPCS,Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia,,Case Rate,400.00
Cigna,PPO,28545,CPT4/HCPCS,Treat foot dislocation,,Case Rate,3000.00
Cigna,PPO,28546,CPT4/HCPCS,Treat foot dislocation,,Case Rate,3000.00
Cigna,PPO,28555,CPT4/HCPCS,Repair foot dislocation,,Case Rate,3000.00
Cigna,PPO,28570,CPT4/HCPCS,Closed treatment of talotarsal joint dislocation; without anesthesia,,Case Rate,400.00
Cigna,PPO,28575,CPT4/HCPCS,Treat foot dislocation,,Case Rate,3000.00
Cigna,PPO,28576,CPT4/HCPCS,Treat foot dislocation,,Case Rate,4000.00
Cigna,PPO,28585,CPT4/HCPCS,Repair foot dislocation,,Case Rate,4000.00
Cigna,PPO,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,8300.00
Cigna,PPO,28600,CPT4/HCPCS,Closed treatment of tarsometatarsal joint dislocation; without anesthesia,,Case Rate,400.00
Cigna,PPO,28605,CPT4/HCPCS,Treat foot dislocation,,Case Rate,3000.00
Cigna,PPO,28606,CPT4/HCPCS,Treat foot dislocation,,Case Rate,3000.00
Cigna,PPO,28615,CPT4/HCPCS,Repair foot dislocation,,Case Rate,4000.00
Cigna,PPO,28630,CPT4/HCPCS,Closed treatment of metatarsophalangeal joint dislocation; without anesthesia,,Case Rate,400.00
Cigna,PPO,28635,CPT4/HCPCS,Treat toe dislocation,,Case Rate,3000.00
Cigna,PPO,28636,CPT4/HCPCS,Treat toe dislocation,,Case Rate,4000.00
Cigna,PPO,28645,CPT4/HCPCS,Repair toe dislocation,,Case Rate,4000.00
Cigna,PPO,28660,CPT4/HCPCS,Closed treatment of interphalangeal joint dislocation; without anesthesia,,Case Rate,400.00
Cigna,PPO,28665,CPT4/HCPCS,Treat toe dislocation,,Case Rate,3000.00
Cigna,PPO,28666,CPT4/HCPCS,Treat toe dislocation,,Case Rate,4000.00
Cigna,PPO,28675,CPT4/HCPCS,Repair of toe dislocation,,Case Rate,4000.00
Cigna,PPO,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,8300.00
Cigna,PPO,28705,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,PPO,28715,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,PPO,28725,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,PPO,28730,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,PPO,28735,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,PPO,28737,CPT4/HCPCS,Revision of foot bones,,Case Rate,5000.00
Cigna,PPO,28740,CPT4/HCPCS,Fusion of foot bones,,Case Rate,4000.00
Cigna,PPO,28750,CPT4/HCPCS,Fusion of big toe joint,,Case Rate,4000.00
Cigna,PPO,28755,CPT4/HCPCS,Fusion of big toe joint,,Case Rate,4000.00
Cigna,PPO,28760,CPT4/HCPCS,Fusion of big toe joint,,Case Rate,4000.00
Cigna,PPO,288,DRG,Acute & subacute endocarditis w MCC,,Case Rate,68365.50
Cigna,PPO,28805,CPT4/HCPCS,Amputation, foot; transmetatarsal,,Case Rate,3000.00
Cigna,PPO,28810,CPT4/HCPCS,Amputation toe & metatarsal,,Case Rate,3000.00
Cigna,PPO,28820,CPT4/HCPCS,Amputation of toe,,Case Rate,3000.00
Cigna,PPO,28825,CPT4/HCPCS,Partial amputation of toe,,Case Rate,3000.00
Cigna,PPO,28890,CPT4/HCPCS,Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia,,Case Rate,3000.00
Cigna,PPO,28899,CPT4/HCPCS,UNLISTED PROCEDURE, FOOT OR TOES ,,Case Rate,3000.00
Cigna,PPO,289,DRG,Acute & subacute endocarditis w CC,,Case Rate,41886.30
Cigna,PPO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,Case Rate,25500.00
Cigna,PPO,290,DRG,Acute & subacute endocarditis w/o CC/MCC,,Case Rate,26101.80
Cigna,PPO,29086,CPT4/HCPCS,APPLY FINGER CAST,,% of Charges,399.10
Cigna,PPO,291,DRG,Heart failure & shock w MCC,,Case Rate,34192.95
Cigna,PPO,29125,CPT4/HCPCS,Short Arm Splint,,% of Charges,801.45
Cigna,PPO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,% of Charges,801.45
Cigna,PPO,292,DRG,Heart failure & shock w CC,,Case Rate,22825.05
Cigna,PPO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,% of Charges,399.10
Cigna,PPO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,% of Charges,399.10
Cigna,PPO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,% of Charges,438.75
Cigna,PPO,293,DRG,Heart failure & shock w/o CC/MCC,,Case Rate,16641.30
Cigna,PPO,29305,CPT4/HCPCS,Application of hip spica cast; one leg,,Case Rate,400.00
Cigna,PPO,29325,CPT4/HCPCS,APPLICATION OF HIP SPICA CAST; ONE AND ONE-HALF SPICA OR BOTH LEGS,,Case Rate,400.00
Cigna,PPO,29345,CPT4/HCPCS,Application of long leg cast (thigh to toes);,,Case Rate,400.00
Cigna,PPO,294,DRG,Deep vein thrombophlebitis w CC/MCC,,Case Rate,32693.55
Cigna,PPO,29405,CPT4/HCPCS,Short Leg Cast,,% of Charges,702.00
Cigna,PPO,29445,CPT4/HCPCS,Contact Cast,,% of Charges,1012.05
Cigna,PPO,295,DRG,Deep vein thrombophlebitis w/o CC/MCC,,Case Rate,25023.15
Cigna,PPO,29515,CPT4/HCPCS,Short Leg Splint,,% of Charges,232.05
Cigna,PPO,29520,CPT4/HCPCS,Hip Strapping,,% of Charges,138.45
Cigna,PPO,29530,CPT4/HCPCS,Knee Strapping,,% of Charges,138.45
Cigna,PPO,29540,CPT4/HCPCS,Ankle/Foot Strapping,,% of Charges,137.80
Cigna,PPO,29550,CPT4/HCPCS,Toe(S) Strapping,,% of Charges,137.80
Cigna,PPO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,% of Charges,619.45
Cigna,PPO,296,DRG,Cardiac arrest, unexplained w MCC,,Case Rate,40667.40
Cigna,PPO,297,DRG,Cardiac arrest, unexplained w CC,,Case Rate,17967.30
Cigna,PPO,29799,CPT4/HCPCS,Stapping/Lowback,,% of Charges,287.30
Cigna,PPO,298,DRG,Cardiac arrest, unexplained w/o CC/MCC,,Case Rate,12449.10
Cigna,PPO,29800,CPT4/HCPCS,Jaw arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29804,CPT4/HCPCS,Jaw arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29805,CPT4/HCPCS,Shoulder arthroscopy, dx,,Case Rate,4000.00
Cigna,PPO,29806,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29807,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29819,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29820,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29821,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29822,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29823,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29824,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,5000.00
Cigna,PPO,29825,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29826,CPT4/HCPCS,Shoulder arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29827,CPT4/HCPCS,Arthroscop rotator cuff repr,,Case Rate,5000.00
Cigna,PPO,29828,CPT4/HCPCS,ARTHROSCOPY BICEPS TENODESIS,,Case Rate,8300.00
Cigna,PPO,29830,CPT4/HCPCS,Elbow arthroscopy,,Case Rate,4000.00
Cigna,PPO,29834,CPT4/HCPCS,Elbow arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29835,CPT4/HCPCS,Elbow arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29836,CPT4/HCPCS,Elbow arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29837,CPT4/HCPCS,Elbow arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29838,CPT4/HCPCS,Elbow arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29840,CPT4/HCPCS,Wrist arthroscopy,,Case Rate,4000.00
Cigna,PPO,29843,CPT4/HCPCS,Wrist arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29844,CPT4/HCPCS,Wrist arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29845,CPT4/HCPCS,Wrist arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29846,CPT4/HCPCS,Wrist arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29847,CPT4/HCPCS,Wrist arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29848,CPT4/HCPCS,Wrist endoscopy/surgery,,Case Rate,8300.00
Cigna,PPO,29850,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29851,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29855,CPT4/HCPCS,Tibial arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29856,CPT4/HCPCS,Tibial arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29860,CPT4/HCPCS,Hip arthroscopy, dx,,Case Rate,4000.00
Cigna,PPO,29861,CPT4/HCPCS,Hip arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29862,CPT4/HCPCS,Hip arthroscopy/surgery,,Case Rate,8300.00
Cigna,PPO,29863,CPT4/HCPCS,Hip arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29866,CPT4/HCPCS,Arthroscopy, Knee, Surgical; Osteochondral Autograft(S) (Eg, Mosaicplasty) (Includes Harvesting Of The Autograft),,Case Rate,3000.00
Cigna,PPO,29867,CPT4/HCPCS,Arthroscopy, Knee, Surgical; Osteochondral Allograft (Eg, Mosaicplasty),,Case Rate,3000.00
Cigna,PPO,29868,CPT4/HCPCS,Arthroscopy, Knee, Surgical; Meniscal Transplantation (Includes Arthrotomy For Meniscal Insertion), Medial Or Lateral,,Case Rate,3000.00
Cigna,PPO,29870,CPT4/HCPCS,Knee arthroscopy, dx,,Case Rate,4000.00
Cigna,PPO,29871,CPT4/HCPCS,Knee arthroscopy/drainage,,Case Rate,4000.00
Cigna,PPO,29873,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29874,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29875,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29876,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29877,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29879,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29880,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29881,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29882,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29883,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29884,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29885,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29886,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29887,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29888,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29889,CPT4/HCPCS,Knee arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29891,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29892,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29893,CPT4/HCPCS,Scope, plantar fasciotomy,,Case Rate,8300.00
Cigna,PPO,29894,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29895,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29897,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29898,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,29899,CPT4/HCPCS,Ankle arthroscopy/surgery,,Case Rate,4000.00
Cigna,PPO,299,DRG,Peripheral vascular disorders w MCC,,Case Rate,39050.70
Cigna,PPO,29900,CPT4/HCPCS,Mcp joint arthroscopy, dx,,Case Rate,4000.00
Cigna,PPO,29901,CPT4/HCPCS,Mcp joint arthroscopy, surg,,Case Rate,4000.00
Cigna,PPO,29902,CPT4/HCPCS,Mcp joint arthroscopy, surg,,Case Rate,4000.00
Cigna,PPO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Case Rate,8300.00
Cigna,PPO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Case Rate,8300.00
Cigna,PPO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Case Rate,8300.00
Cigna,PPO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Case Rate,8300.00
Cigna,PPO,29914,CPT4/HCPCS,ARTHROSCOPY, HIP, SURGICAL; WITH FEMOROPLASTY (IE, TREATMENT OF CAM LESION),,Case Rate,8300.00
Cigna,PPO,29915,CPT4/HCPCS,ARTHROSCOPY, HIP, SURGICAL; WITH ACETABULOPLASTY (IE, TREATMENT OF PINCER LESION),,Case Rate,8300.00
Cigna,PPO,29916,CPT4/HCPCS,ARTHROSCOPY, HIP, SURGICAL; WITH LABRAL REPAIR,,Case Rate,8300.00
Cigna,PPO,29999,CPT4/HCPCS,UNLISTED PROCEDURE, ARTHROSCOPY ,,Case Rate,3000.00
Cigna,PPO,3,DRG,ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R.,,Case Rate,484275.60
Cigna,PPO,30,DRG,Spinal procedures w/o CC/MCC,,Case Rate,25500.00
Cigna,PPO,300,DRG,Peripheral vascular disorders w CC,,Case Rate,26576.10
Cigna,PPO,30000,CPT4/HCPCS,Drainage abscess or hematoma, nasal, internal approach,,Case Rate,400.00
Cigna,PPO,30020,CPT4/HCPCS,Drainage abscess or hematoma, nasal septum,,Case Rate,400.00
Cigna,PPO,301,DRG,Peripheral vascular disorders w/o CC/MCC,,Case Rate,18933.75
Cigna,PPO,30100,CPT4/HCPCS,Biopsy, intranasal,,Case Rate,3000.00
Cigna,PPO,30110,CPT4/HCPCS,Excision, nasal polyp(s), simple,,Case Rate,3000.00
Cigna,PPO,30115,CPT4/HCPCS,Removal of nose polyp(s),,Case Rate,3000.00
Cigna,PPO,30117,CPT4/HCPCS,Removal of intranasal lesion,,Case Rate,4000.00
Cigna,PPO,30118,CPT4/HCPCS,Removal of intranasal lesion,,Case Rate,4000.00
Cigna,PPO,30120,CPT4/HCPCS,Revision of nose,,Case Rate,3000.00
Cigna,PPO,30124,CPT4/HCPCS,Removal of nose lesion,,Case Rate,3000.00
Cigna,PPO,30125,CPT4/HCPCS,Removal of nose lesion,,Case Rate,3000.00
Cigna,PPO,30130,CPT4/HCPCS,Removal of turbinate bones,,Case Rate,4000.00
Cigna,PPO,30140,CPT4/HCPCS,Removal of turbinate bones,,Case Rate,3000.00
Cigna,PPO,30150,CPT4/HCPCS,Partial removal of nose,,Case Rate,4000.00
Cigna,PPO,30160,CPT4/HCPCS,Removal of nose,,Case Rate,4000.00
Cigna,PPO,302,DRG,Atherosclerosis w MCC,,Case Rate,27884.25
Cigna,PPO,30220,CPT4/HCPCS,Insert nasal septal button,,Case Rate,4000.00
Cigna,PPO,303,DRG,Atherosclerosis w/o MCC,,Case Rate,17248.20
Cigna,PPO,30310,CPT4/HCPCS,Remove nasal foreign body,,Case Rate,3000.00
Cigna,PPO,30320,CPT4/HCPCS,Remove nasal foreign body,,Case Rate,3000.00
Cigna,PPO,304,DRG,Hypertension w MCC,,Case Rate,27937.80
Cigna,PPO,30400,CPT4/HCPCS,Reconstruction of nose,,Case Rate,4000.00
Cigna,PPO,30410,CPT4/HCPCS,Reconstruction of nose,,Case Rate,5000.00
Cigna,PPO,30420,CPT4/HCPCS,Reconstruction of nose,,Case Rate,5000.00
Cigna,PPO,30430,CPT4/HCPCS,Revision of nose,,Case Rate,4000.00
Cigna,PPO,30435,CPT4/HCPCS,Revision of nose,,Case Rate,5000.00
Cigna,PPO,30450,CPT4/HCPCS,Revision of nose,,Case Rate,6000.00
Cigna,PPO,30460,CPT4/HCPCS,Revision of nose,,Case Rate,6000.00
Cigna,PPO,30462,CPT4/HCPCS,Revision of nose,,Case Rate,8300.00
Cigna,PPO,30465,CPT4/HCPCS,Repair nasal stenosis,,Case Rate,8300.00
Cigna,PPO,305,DRG,Hypertension w/o MCC,,Case Rate,18831.75
Cigna,PPO,30520,CPT4/HCPCS,Repair of nasal septum,,Case Rate,4000.00
Cigna,PPO,30540,CPT4/HCPCS,Repair nasal defect,,Case Rate,5000.00
Cigna,PPO,30545,CPT4/HCPCS,Repair nasal defect,,Case Rate,5000.00
Cigna,PPO,30560,CPT4/HCPCS,Release of nasal adhesions,,Case Rate,3000.00
Cigna,PPO,30580,CPT4/HCPCS,Repair upper jaw fistula,,Case Rate,4000.00
Cigna,PPO,306,DRG,Cardiac congenital & valvular disorders w MCC,,Case Rate,38344.35
Cigna,PPO,30600,CPT4/HCPCS,Repair mouth/nose fistula,,Case Rate,4000.00
Cigna,PPO,30620,CPT4/HCPCS,Intranasal reconstruction,,Case Rate,6000.00
Cigna,PPO,30630,CPT4/HCPCS,Repair nasal septum defect,,Case Rate,6000.00
Cigna,PPO,307,DRG,Cardiac congenital & valvular disorders w/o MCC,,Case Rate,22144.20
Cigna,PPO,308,DRG,Cardiac arrhythmia & conduction disorders w MCC,,Case Rate,30582.15
Cigna,PPO,30801,CPT4/HCPCS,Cauterization, inner nose,,Case Rate,3000.00
Cigna,PPO,30802,CPT4/HCPCS,Cauterization, inner nose,,Case Rate,3000.00
Cigna,PPO,309,DRG,Cardiac arrhythmia & conduction disorders w CC,,Case Rate,19109.70
Cigna,PPO,30901,CPT4/HCPCS,Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method,,Case Rate,400.00
Cigna,PPO,30903,CPT4/HCPCS,Control of nosebleed,,Case Rate,3000.00
Cigna,PPO,30905,CPT4/HCPCS,Control of nosebleed,,Case Rate,3000.00
Cigna,PPO,30906,CPT4/HCPCS,Repeat control of nosebleed,,Case Rate,3000.00
Cigna,PPO,30915,CPT4/HCPCS,Ligation, nasal sinus artery,,Case Rate,3000.00
Cigna,PPO,30920,CPT4/HCPCS,Ligation, upper jaw artery,,Case Rate,4000.00
Cigna,PPO,30930,CPT4/HCPCS,Therapy, fracture of nose,,Case Rate,4000.00
Cigna,PPO,30999,CPT4/HCPCS,UNLISTED PROCEDURE, NOSE ,,Case Rate,3000.00
Cigna,PPO,31,DRG,Ventricular shunt procedures w MCC,,Case Rate,111335.55
Cigna,PPO,310,DRG,Cardiac arrhythmia & conduction disorders w/o CC/MCC,,Case Rate,14239.20
Cigna,PPO,31000,CPT4/HCPCS,Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium),,Case Rate,400.00
Cigna,PPO,31002,CPT4/HCPCS,Lavage by cannulation; sphenoid sinus,,Case Rate,3000.00
Cigna,PPO,31020,CPT4/HCPCS,Exploration, maxillary sinus,,Case Rate,3000.00
Cigna,PPO,31030,CPT4/HCPCS,Exploration, maxillary sinus,,Case Rate,4000.00
Cigna,PPO,31032,CPT4/HCPCS,Explore sinus,remove polyps,,Case Rate,4000.00
Cigna,PPO,31050,CPT4/HCPCS,Exploration, sphenoid sinus,,Case Rate,3000.00
Cigna,PPO,31051,CPT4/HCPCS,Sphenoid sinus surgery,,Case Rate,4000.00
Cigna,PPO,31070,CPT4/HCPCS,Exploration of frontal sinus,,Case Rate,3000.00
Cigna,PPO,31075,CPT4/HCPCS,Exploration of frontal sinus,,Case Rate,4000.00
Cigna,PPO,31080,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,PPO,31081,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,PPO,31084,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,PPO,31085,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,PPO,31086,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,PPO,31087,CPT4/HCPCS,Removal of frontal sinus,,Case Rate,4000.00
Cigna,PPO,31090,CPT4/HCPCS,Exploration of sinuses,,Case Rate,5000.00
Cigna,PPO,311,DRG,Angina pectoris,,Case Rate,17773.50
Cigna,PPO,312,DRG,Syncope & collapse,,Case Rate,21348.60
Cigna,PPO,31200,CPT4/HCPCS,Removal of ethmoid sinus,,Case Rate,3000.00
Cigna,PPO,31201,CPT4/HCPCS,Removal of ethmoid sinus,,Case Rate,5000.00
Cigna,PPO,31205,CPT4/HCPCS,Removal of ethmoid sinus,,Case Rate,4000.00
Cigna,PPO,31231,CPT4/HCPCS,Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure),,Case Rate,400.00
Cigna,PPO,31233,CPT4/HCPCS,Nasal/sinus endoscopy, dx,,Case Rate,3000.00
Cigna,PPO,31235,CPT4/HCPCS,Nasal/sinus endoscopy, dx,,Case Rate,3000.00
Cigna,PPO,31237,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,3000.00
Cigna,PPO,31238,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,3000.00
Cigna,PPO,31239,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,4000.00
Cigna,PPO,31240,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,3000.00
Cigna,PPO,31241,CPT4/HCPCS,Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery,,Case Rate,3000.00
Cigna,PPO,31253,CPT4/HCPCS,Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed,,Case Rate,3000.00
Cigna,PPO,31254,CPT4/HCPCS,Revision of ethmoid sinus,,Case Rate,4000.00
Cigna,PPO,31255,CPT4/HCPCS,Removal of ethmoid sinus,,Case Rate,5000.00
Cigna,PPO,31256,CPT4/HCPCS,Exploration maxillary sinus,,Case Rate,4000.00
Cigna,PPO,31257,CPT4/HCPCS,Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy,,Case Rate,3000.00
Cigna,PPO,31259,CPT4/HCPCS,Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus,,Case Rate,3000.00
Cigna,PPO,31267,CPT4/HCPCS,Endoscopy, maxillary sinus,,Case Rate,4000.00
Cigna,PPO,31276,CPT4/HCPCS,Sinus endoscopy, surgical,,Case Rate,4000.00
Cigna,PPO,31287,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,4000.00
Cigna,PPO,31288,CPT4/HCPCS,Nasal/sinus endoscopy, surg,,Case Rate,4000.00
Cigna,PPO,31290,CPT4/HCPCS,Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; ethmoid region,,Case Rate,3000.00
Cigna,PPO,31291,CPT4/HCPCS,Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; sphenoid region,,Case Rate,3000.00
Cigna,PPO,31292,CPT4/HCPCS,Nasal/sinus endoscopy, surgical; with medial or inferior orbital wall decompression,,Case Rate,3000.00
Cigna,PPO,31293,CPT4/HCPCS,Nasal/sinus endoscopy, surgical; with medial orbital wall and inferior orbital wall decompression,,Case Rate,3000.00
Cigna,PPO,31294,CPT4/HCPCS,Nasal/sinus endoscopy, surgical; with optic nerve decompression,,Case Rate,3000.00
Cigna,PPO,31295,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF MAXILLARY SINUS OSTIUM (EG, BALLOON DILATION), TRANSNASAL OR VIA CANINE FOSSA,,Case Rate,8300.00
Cigna,PPO,31296,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF FRONTAL SINUS OSTIUM (EG, BALLOON DILATION),,Case Rate,8300.00
Cigna,PPO,31297,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DILATION OF SPHENOID SINUS OSTIUM (EG, BALLOON DILATION),,Case Rate,8300.00
Cigna,PPO,31298,CPT4/HCPCS,Nasal/sinus endoscopy, surgical; with dilation of frontal and sphenoid sinus ostia (eg, balloon dilation),,Case Rate,3000.00
Cigna,PPO,313,DRG,Chest pain,,Case Rate,18380.40
Cigna,PPO,31300,CPT4/HCPCS,Removal of larynx lesion,,Case Rate,5000.00
Cigna,PPO,314,DRG,Other circulatory system diagnoses w MCC,,Case Rate,53126.70
Cigna,PPO,31400,CPT4/HCPCS,Revision of larynx,,Case Rate,3000.00
Cigna,PPO,31420,CPT4/HCPCS,Removal of epiglottis,,Case Rate,3000.00
Cigna,PPO,315,DRG,Other circulatory system diagnoses w CC,,Case Rate,24867.60
Cigna,PPO,31500,CPT4/HCPCS,INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE ,,Case Rate,3000.00
Cigna,PPO,31502,CPT4/HCPCS,TRACH TUBE CHANGE PRIOR TO ESTAB FISTULATRACT (CONSIDER AS TOS 04) ,,Case Rate,3000.00
Cigna,PPO,31510,CPT4/HCPCS,Laryngoscopy with biopsy,,Case Rate,3000.00
Cigna,PPO,31511,CPT4/HCPCS,Remove foreign body, larynx,,Case Rate,3000.00
Cigna,PPO,31512,CPT4/HCPCS,Removal of larynx lesion,,Case Rate,3000.00
Cigna,PPO,31513,CPT4/HCPCS,Injection into vocal cord,,Case Rate,3000.00
Cigna,PPO,31515,CPT4/HCPCS,Laryngoscopy for aspiration,,Case Rate,3000.00
Cigna,PPO,31520,CPT4/HCPCS,LARYNGOSCOPY DIRECT; DIAGNOSTIC, NEWBORN ,,Case Rate,3000.00
Cigna,PPO,31525,CPT4/HCPCS,Diagnostic laryngoscopy,,Case Rate,3000.00
Cigna,PPO,31526,CPT4/HCPCS,Diagnostic laryngoscopy,,Case Rate,3000.00
Cigna,PPO,31527,CPT4/HCPCS,Laryngoscopy for treatment,,Case Rate,3000.00
Cigna,PPO,31528,CPT4/HCPCS,Laryngoscopy and dilation,,Case Rate,3000.00
Cigna,PPO,31529,CPT4/HCPCS,Laryngoscopy and dilation,,Case Rate,3000.00
Cigna,PPO,31530,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,3000.00
Cigna,PPO,31531,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,4000.00
Cigna,PPO,31535,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,3000.00
Cigna,PPO,31536,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,4000.00
Cigna,PPO,31540,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,4000.00
Cigna,PPO,31541,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,4000.00
Cigna,PPO,31545,CPT4/HCPCS,Remove vc lesion w/scope,,Case Rate,4000.00
Cigna,PPO,31546,CPT4/HCPCS,Remove vc lesion scope/graft,,Case Rate,4000.00
Cigna,PPO,31551,CPT4/HCPCS,Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of age,,Case Rate,3000.00
Cigna,PPO,31552,CPT4/HCPCS,Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or older,,Case Rate,3000.00
Cigna,PPO,31553,CPT4/HCPCS,Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of age,,Case Rate,3000.00
Cigna,PPO,31554,CPT4/HCPCS,Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or older,,Case Rate,3000.00
Cigna,PPO,31560,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,5000.00
Cigna,PPO,31561,CPT4/HCPCS,Operative laryngoscopy,,Case Rate,5000.00
Cigna,PPO,31570,CPT4/HCPCS,Laryngoscopy with injection,,Case Rate,3000.00
Cigna,PPO,31571,CPT4/HCPCS,Laryngoscopy with injection,,Case Rate,3000.00
Cigna,PPO,31572,CPT4/HCPCS,Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateral,,Case Rate,6000.00
Cigna,PPO,31573,CPT4/HCPCS,Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral,,Case Rate,6000.00
Cigna,PPO,31574,CPT4/HCPCS,Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateral,,Case Rate,6000.00
Cigna,PPO,31575,CPT4/HCPCS,Laryngoscopy, flexible fiberoptic; diagnostic,,Case Rate,400.00
Cigna,PPO,31576,CPT4/HCPCS,Laryngoscopy with biopsy,,Case Rate,3000.00
Cigna,PPO,31577,CPT4/HCPCS,Remove foreign body, larynx,,Case Rate,3000.00
Cigna,PPO,31578,CPT4/HCPCS,Removal of larynx lesion,,Case Rate,3000.00
Cigna,PPO,31579,CPT4/HCPCS,Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy,,Case Rate,3000.00
Cigna,PPO,31580,CPT4/HCPCS,Revision of larynx,,Case Rate,5000.00
Cigna,PPO,31584,CPT4/HCPCS,Treat larynx fracture,,Case Rate,3000.00
Cigna,PPO,31587,CPT4/HCPCS,Laryngoplasty, cricoid split, without graft placement,,Case Rate,3000.00
Cigna,PPO,31590,CPT4/HCPCS,Reinnervate larynx,,Case Rate,5000.00
Cigna,PPO,31591,CPT4/HCPCS,Laryngoplasty, medialization, unilateral,,Case Rate,3000.00
Cigna,PPO,31592,CPT4/HCPCS,Cricotracheal resection,,Case Rate,3000.00
Cigna,PPO,31599,CPT4/HCPCS,UNLISTED PROCEDURE, LARYNX ,,Case Rate,3000.00
Cigna,PPO,316,DRG,Other circulatory system diagnoses w/o CC/MCC,,Case Rate,19112.25
Cigna,PPO,31600,CPT4/HCPCS,Incision of windpipe,,Case Rate,3000.00
Cigna,PPO,31603,CPT4/HCPCS,Incision of windpipe,,Case Rate,3000.00
Cigna,PPO,31605,CPT4/HCPCS,TRACHEOSTOMY EMERGENCY PROCEDURE CRICOTHYROID MEMBRANE ,,Case Rate,3000.00
Cigna,PPO,31611,CPT4/HCPCS,Surgery/speech prosthesis,,Case Rate,4000.00
Cigna,PPO,31612,CPT4/HCPCS,Puncture/clear windpipe,,Case Rate,3000.00
Cigna,PPO,31613,CPT4/HCPCS,Repair windpipe opening,,Case Rate,3000.00
Cigna,PPO,31614,CPT4/HCPCS,Repair windpipe opening,,Case Rate,3000.00
Cigna,PPO,31615,CPT4/HCPCS,Visualization of windpipe,,Case Rate,3000.00
Cigna,PPO,31622,CPT4/HCPCS,Dx bronchoscope/wash,,Case Rate,3000.00
Cigna,PPO,31623,CPT4/HCPCS,Dx bronchoscope/brush,,Case Rate,3000.00
Cigna,PPO,31624,CPT4/HCPCS,Dx bronchoscope/lavage,,Case Rate,3000.00
Cigna,PPO,31625,CPT4/HCPCS,Bronchoscopy with biopsy,,Case Rate,3000.00
Cigna,PPO,31626,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE , WHEN PERFORMED; WITH PLACEMENT OF FIDUCIAL MARKERS, SINGLE OR MU LTIPLE ,,Case Rate,3000.00
Cigna,PPO,31627,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH COMPUTER-ASSISTED, IMAGE-GUIDED NAVIGATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE[S]),,Case Rate,3000.00
Cigna,PPO,31628,CPT4/HCPCS,Bronchoscopy with biopsy,,Case Rate,3000.00
Cigna,PPO,31629,CPT4/HCPCS,Bronchoscopy with biopsy,,Case Rate,3000.00
Cigna,PPO,31630,CPT4/HCPCS,Bronchoscopy with repair,,Case Rate,3000.00
Cigna,PPO,31631,CPT4/HCPCS,Bronchoscopy with dilation,,Case Rate,3000.00
Cigna,PPO,31632,CPT4/HCPCS,Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,31633,CPT4/HCPCS,Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,31634,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BALLOON OCCLUSION, WITH ASSESSMENT OF AIR LEAK, WITH ADMINISTRATION OF OCCLUSIVE SUBSTANCE (EG, FIBRIN GLUE), IF PERFORMED,,Case Rate,4000.00
Cigna,PPO,31635,CPT4/HCPCS,Remove foreign body, airway,,Case Rate,3000.00
Cigna,PPO,31636,CPT4/HCPCS,Bronchoscopy, bronch stents,,Case Rate,3000.00
Cigna,PPO,31637,CPT4/HCPCS,Bronchoscopy, stent add-on,,Case Rate,3000.00
Cigna,PPO,31638,CPT4/HCPCS,Bronchoscopy, revise stent,,Case Rate,3000.00
Cigna,PPO,31640,CPT4/HCPCS,Bronchoscopy & remove lesion,,Case Rate,3000.00
Cigna,PPO,31641,CPT4/HCPCS,Bronchoscopy, treat blockage,,Case Rate,3000.00
Cigna,PPO,31643,CPT4/HCPCS,Diag bronchoscope/catheter,,Case Rate,3000.00
Cigna,PPO,31645,CPT4/HCPCS,Bronchoscopy, clear airways,,Case Rate,3000.00
Cigna,PPO,31646,CPT4/HCPCS,Bronchoscopy, reclear airway,,Case Rate,3000.00
Cigna,PPO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Case Rate,6000.00
Cigna,PPO,31648,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,Case Rate,6000.00
Cigna,PPO,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Case Rate,4000.00
Cigna,PPO,31651,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,Case Rate,6000.00
Cigna,PPO,31652,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), ONE OR TWO MEDIASTINAL AND/OR HILAR LYMPH NODE STAT,,Case Rate,8300.00
Cigna,PPO,31653,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH ENDOBRONCHIAL ULTRASOUND (EBUS) GUIDED TRANSTRACHEAL AND/OR TRANSBRONCHIAL SAMPLING (EG, ASPIRATION[S]/BIOPSY[IES]), 3 OR MORE MEDIASTINAL AND/OR HILAR LYMPH NODE STATI,,Case Rate,8300.00
Cigna,PPO,31654,CPT4/HCPCS,BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSENDOSCOPIC ENDOBRONCHIAL ULTRASOUND (EBUS) DURING BRONCHOSCOPIC DIAGNOSTIC OR THERAPEUTIC INTERVENTION(S) FOR PERIPHERAL LESION(S) (LIST SEPARATELY IN ADDITION TO ,,Case Rate,3000.00
Cigna,PPO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Case Rate,8300.00
Cigna,PPO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Case Rate,8300.00
Cigna,PPO,31717,CPT4/HCPCS,Bronchial brush biopsy,,Case Rate,3000.00
Cigna,PPO,31720,CPT4/HCPCS,Clearance of airways,,Case Rate,3000.00
Cigna,PPO,31725,CPT4/HCPCS,Catheter aspiration (separate procedure); tracheobronchial with fiberscope, bedside,,Case Rate,3000.00
Cigna,PPO,31730,CPT4/HCPCS,Intro, windpipe wire/tube,,Case Rate,3000.00
Cigna,PPO,31750,CPT4/HCPCS,Repair of windpipe,,Case Rate,5000.00
Cigna,PPO,31755,CPT4/HCPCS,Repair of windpipe,,Case Rate,3000.00
Cigna,PPO,31785,CPT4/HCPCS,Remove windpipe lesion,,Case Rate,4000.00
Cigna,PPO,31800,CPT4/HCPCS,Repair of windpipe injury,,Case Rate,3000.00
Cigna,PPO,31820,CPT4/HCPCS,Closure of windpipe lesion,,Case Rate,3000.00
Cigna,PPO,31825,CPT4/HCPCS,Repair of windpipe defect,,Case Rate,3000.00
Cigna,PPO,31830,CPT4/HCPCS,Revise windpipe scar,,Case Rate,3000.00
Cigna,PPO,31899,CPT4/HCPCS,Unlisted procedure, trachea, bronchi,,Case Rate,3000.00
Cigna,PPO,319,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W MCC,,Case Rate,110052.90
Cigna,PPO,32,DRG,Ventricular shunt procedures w CC,,Case Rate,56411.10
Cigna,PPO,320,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W/O MCC,,Case Rate,62314.35
Cigna,PPO,32400,CPT4/HCPCS,Needle biopsy chest lining,,Case Rate,3000.00
Cigna,PPO,32405,CPT4/HCPCS,Biopsy, lung or mediastinum,,Case Rate,3000.00
Cigna,PPO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Case Rate,8300.00
Cigna,PPO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Case Rate,3000.00
Cigna,PPO,32552,CPT4/HCPCS,REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF,,Case Rate,400.00
Cigna,PPO,32553,CPT4/HCPCS,Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), percutaneous, intra-thoracic, single or multiple,,Case Rate,3000.00
Cigna,PPO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Case Rate,3000.00
Cigna,PPO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Case Rate,3000.00
Cigna,PPO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Case Rate,3000.00
Cigna,PPO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Case Rate,3000.00
Cigna,PPO,32560,CPT4/HCPCS,TREAT LUNG LINING CHEMICALLY,,Case Rate,3000.00
Cigna,PPO,32561,CPT4/HCPCS,INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF MULTILOCULATED EFFUSION); INITIAL DAY,,Case Rate,3000.00
Cigna,PPO,32562,CPT4/HCPCS,INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF MULTILOCULATED EFFUSION); SUBSEQUENT DAY,,Case Rate,3000.00
Cigna,PPO,326,DRG,Stomach, esophageal & duodenal proc w MCC,,Case Rate,137131.35
Cigna,PPO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Case Rate,3000.00
Cigna,PPO,32604,CPT4/HCPCS,THORACOSCOPY, DIAGNOSTIC,,Case Rate,3000.00
Cigna,PPO,32606,CPT4/HCPCS,THORACOSCOPY, DIAGNOSTIC,,Case Rate,3000.00
Cigna,PPO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Case Rate,8300.00
Cigna,PPO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Case Rate,8300.00
Cigna,PPO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Case Rate,8300.00
Cigna,PPO,32664,CPT4/HCPCS,Thoracoscopy, surgical; with thoracic sympathectomy,,Case Rate,3000.00
Cigna,PPO,327,DRG,Stomach, esophageal & duodenal proc w CC,,Case Rate,66544.80
Cigna,PPO,328,DRG,Stomach, esophageal & duodenal proc w/o CC/MCC,,Case Rate,42470.25
Cigna,PPO,329,DRG,Major small & large bowel procedures w MCC,,Case Rate,123682.65
Cigna,PPO,32994,CPT4/HCPCS,Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; cryoablation,,Case Rate,3000.00
Cigna,PPO,32998,CPT4/HCPCS,"Perq rf ablate tx, pul tumor",,Case Rate,8300.00
Cigna,PPO,33,DRG,Ventricular shunt procedures w/o CC/MCC,,Case Rate,43877.85
Cigna,PPO,330,DRG,Major small & large bowel procedures w CC,,Case Rate,64744.50
Cigna,PPO,33016,CPT4/HCPCS,Periocardiocentesis, including imaging guidance, when performed,,Case Rate,3000.00
Cigna,PPO,331,DRG,Major small & large bowel procedures w/o CC/MCC,,Case Rate,43607.55
Cigna,PPO,332,DRG,Rectal resection w MCC,,Case Rate,106072.35
Cigna,PPO,33206,CPT4/HCPCS,INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL ,,Case Rate,3000.00
Cigna,PPO,33207,CPT4/HCPCS,INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); VENTRICULAR ,,Case Rate,3000.00
Cigna,PPO,33208,CPT4/HCPCS,INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL AND VENTRICULAR ,,Case Rate,3000.00
Cigna,PPO,33210,CPT4/HCPCS,INSERT O REPLAC TEMP TRNSVENOUS SNGL CHAMBR CARD ELECTRD O PACEMKR CATH(SEP PR ,,Case Rate,3000.00
Cigna,PPO,33211,CPT4/HCPCS,INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS DUAL CHAMBER PACING ELECTRODES (SEPARATE PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,33212,CPT4/HCPCS,Insertion of pulse generator,,Case Rate,4000.00
Cigna,PPO,33213,CPT4/HCPCS,Insertion of pulse generator,,Case Rate,4000.00
Cigna,PPO,33214,CPT4/HCPCS,UPGRADE OF IMPLANTED PACEMAKER SYSTEM, CONVERSION OF SINGLE CHAMBER SYSTEM TO DUAL CHAMBER SYSTEM (INCLUDES REMOVAL OF PREVIOUSLY PLACED PULSE GENERATOR, TESTING OF EXISTING LEAD, INSERTION OF NEW LEAD, INSERTION OF NEW PULSE GENERATOR) ,,Case Rate,3000.00
Cigna,PPO,33215,CPT4/HCPCS,Repositioning of previously implanted transvenous pacemaker or pacing cardioverter-defibrillator (right atrial or right ventricular) electrode,,Case Rate,3000.00
Cigna,PPO,33216,CPT4/HCPCS,INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR CARDIOVERTER-DEFIBRILLATOR ,,Case Rate,3000.00
Cigna,PPO,33217,CPT4/HCPCS,INSERTION OF 2 TRANSVENOUS ELECTRODES, PERMANENT PACEMAKER OR CA RDIOVERTER-DEFIBRILLATOR ,,Case Rate,3000.00
Cigna,PPO,33218,CPT4/HCPCS,REPAIR OF SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR PACING CARDIOVERTER-DEFIBRILLATOR ,,Case Rate,3000.00
Cigna,PPO,33220,CPT4/HCPCS,REPAIR OF 2 TRANSVENOUS ELECTRODES FOR PERMANENT PACEMAKER OR PACING CARDIOVERTER-DEFIBRILLATOR ,,Case Rate,3000.00
Cigna,PPO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Case Rate,3000.00
Cigna,PPO,33222,CPT4/HCPCS,Revise pocket, pacemaker,,Case Rate,3000.00
Cigna,PPO,33223,CPT4/HCPCS,Revise pocket, pacing-defib,,Case Rate,3000.00
Cigna,PPO,33224,CPT4/HCPCS,Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to previously placed pacemaker or pacing cardioverter-defibrillator pulse generator (including revision of pocket, removal, insertion and/or replacement of,,Case Rate,3000.00
Cigna,PPO,33225,CPT4/HCPCS,Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system)) (List separately in addition to code for,,Case Rate,3000.00
Cigna,PPO,33226,CPT4/HCPCS,Repositioning of previously implanted cardiac venous system (left ventricular) electrode (including removal, insertion and/or replacement of generator),,Case Rate,3000.00
Cigna,PPO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Case Rate,3000.00
Cigna,PPO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Case Rate,3000.00
Cigna,PPO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Case Rate,3000.00
Cigna,PPO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Case Rate,3000.00
Cigna,PPO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Case Rate,3000.00
Cigna,PPO,33233,CPT4/HCPCS,Removal of pacemaker system,,Case Rate,3000.00
Cigna,PPO,33234,CPT4/HCPCS,REMOVAL OF PERMANENT PACEMAKER ELECTRODE(S), SINGLE LEAD SYSTEM, ATRIAL OR VENTRICULAR ,,Case Rate,3000.00
Cigna,PPO,33235,CPT4/HCPCS,REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); DUAL LEAD SYSTEM ,,Case Rate,3000.00
Cigna,PPO,33240,CPT4/HCPCS,INSERTION OF PACING CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR ONLY; WITH EXISTING SINGLE LEAD ,,Case Rate,3000.00
Cigna,PPO,33241,CPT4/HCPCS,REMOVAL OF PACING CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR ONLY ,,Case Rate,3000.00
Cigna,PPO,33244,CPT4/HCPCS,REMOVAL OF SINGLE OR DUAL CHAMBER PACING CARDIOVERTER-DEFIBRILLATOR ELECTRODE(S); BY TRANSVENOUS EXTRACTION ,,Case Rate,3000.00
Cigna,PPO,33249,CPT4/HCPCS,INSERTION OR REPLACEMENT OF PERMANENT PACING CARDIOVERTER- DEFIBRILLATOR SYSTEM WITH TRANSVENOUS LEAD(S), SINGLE OR DUAL CHAMBER ,,Case Rate,3000.00
Cigna,PPO,33262,CPT4/HCPCS,REMV&REPLC CVD GEN SING LEAD,,Case Rate,3000.00
Cigna,PPO,33263,CPT4/HCPCS,REMV&REPLC CVD GEN DUAL LEAD,,Case Rate,3000.00
Cigna,PPO,33264,CPT4/HCPCS,REMV&REPLC CVD GEN MULT LEAD,,Case Rate,3000.00
Cigna,PPO,33270,CPT4/HCPCS, INSERTION OR REPLACEMENT OF PERMANENT SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR SYSTEM, WITH SUBCUTANEOUS ELECTRODE, INCLUDING DEFIBRILLATION THRESHOLD EVALUATION, INDUCTION OF ARRHYTHMIA, EVALUATION OF SENSING FOR ARRHYTHMIA TERMINATION, AND PROGRAMMING OR,,Case Rate,3000.00
Cigna,PPO,33271,CPT4/HCPCS, INSERTION OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE,,Case Rate,3000.00
Cigna,PPO,33272,CPT4/HCPCS, REMOVAL OF SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE,,Case Rate,3000.00
Cigna,PPO,33273,CPT4/HCPCS, REPOSITIONING OF PREVIOUSLY IMPLANTED SUBCUTANEOUS IMPLANTABLE DEFIBRILLATOR ELECTRODE,,Case Rate,8300.00
Cigna,PPO,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,Case Rate,3000.00
Cigna,PPO,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,Case Rate,8300.00
Cigna,PPO,33285,CPT4/HCPCS,Insertion, subcutaneous cardiac rhythm monitor, including programming ,,Case Rate,3000.00
Cigna,PPO,33286,CPT4/HCPCS,Removal, subcutaneous cardiac rhythm monitor,,Case Rate,3000.00
Cigna,PPO,33289,CPT4/HCPCS,Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision an,,Case Rate,3000.00
Cigna,PPO,333,DRG,Rectal resection w CC,,Case Rate,54595.50
Cigna,PPO,334,DRG,Rectal resection w/o CC/MCC,,Case Rate,41034.60
Cigna,PPO,335,DRG,Peritoneal adhesiolysis w MCC,,Case Rate,99205.20
Cigna,PPO,336,DRG,Peritoneal adhesiolysis w CC,,Case Rate,58213.95
Cigna,PPO,337,DRG,Peritoneal adhesiolysis w/o CC/MCC,,Case Rate,41631.30
Cigna,PPO,338,DRG,Appendectomy w complicated principal diag w MCC,,Case Rate,71369.40
Cigna,PPO,339,DRG,Appendectomy w complicated principal diag w CC,,Case Rate,43222.50
Cigna,PPO,33968,CPT4/HCPCS,REMOVAL OF INTRA-AORTIC BALLOON ASSIST DEVICE, PERCUTANEOUS.,,Case Rate,3000.00
Cigna,PPO,34,DRG,Carotid artery stent procedure w MCC,,Case Rate,101352.30
Cigna,PPO,340,DRG,Appendectomy w complicated principal diag w/o CC/MCC,,Case Rate,31324.20
Cigna,PPO,341,DRG,Appendectomy w/o complicated principal diag w MCC,,Case Rate,59063.10
Cigna,PPO,34101,CPT4/HCPCS,Removal of artery clot,,Case Rate,4000.00
Cigna,PPO,342,DRG,Appendectomy w/o complicated principal diag w CC,,Case Rate,36544.05
Cigna,PPO,343,DRG,Appendectomy w/o complicated principal diag w/o CC/MCC,,Case Rate,28289.70
Cigna,PPO,344,DRG,Minor small & large bowel procedures w MCC,,Case Rate,71422.95
Cigna,PPO,345,DRG,Minor small & large bowel procedures w CC,,Case Rate,40231.35
Cigna,PPO,346,DRG,Minor small & large bowel procedures w/o CC/MCC,,Case Rate,32512.50
Cigna,PPO,347,DRG,Anal & stomal procedures w MCC,,Case Rate,62770.80
Cigna,PPO,34701,CPT4/HCPCS,Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft ext,,Case Rate,3000.00
Cigna,PPO,34702,CPT4/HCPCS,Endovascular repair of infrarenal aorta by deployment of an aorto-aortic tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, all endograft ext,,Case Rate,3000.00
Cigna,PPO,34703,CPT4/HCPCS,Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpreta,,Case Rate,3000.00
Cigna,PPO,34704,CPT4/HCPCS,Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-uni-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpreta,,Case Rate,3000.00
Cigna,PPO,34705,CPT4/HCPCS,Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretat,,Case Rate,3000.00
Cigna,PPO,34706,CPT4/HCPCS,Endovascular repair of infrarenal aorta and/or iliac artery(ies) by deployment of an aorto-bi-iliac endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretat,,Case Rate,3000.00
Cigna,PPO,34707,CPT4/HCPCS,Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft exten,,Case Rate,3000.00
Cigna,PPO,34708,CPT4/HCPCS,Endovascular repair of iliac artery by deployment of an ilio-iliac tube endograft including pre-procedure sizing and device selection, all nonselective catheterization(s), all associated radiological supervision and interpretation, and all endograft exten,,Case Rate,3000.00
Cigna,PPO,34709,CPT4/HCPCS,Placement of extension prosthesis(es) distal to the common iliac artery(ies) or proximal to the renal artery(ies) for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, penetrating ulcer, including pre-proced,,Case Rate,3000.00
Cigna,PPO,34710,CPT4/HCPCS,Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all n,,Case Rate,3000.00
Cigna,PPO,34711,CPT4/HCPCS,Delayed placement of distal or proximal extension prosthesis for endovascular repair of infrarenal abdominal aortic or iliac aneurysm, false aneurysm, dissection, endoleak, or endograft migration, including pre-procedure sizing and device selection, all n,,Case Rate,3000.00
Cigna,PPO,34712,CPT4/HCPCS,Transcatheter delivery of enhanced fixation device(s) to the endograft (eg, anchor, screw, tack) and all associated radiological supervision and interpretation,,Case Rate,3000.00
Cigna,PPO,34713,CPT4/HCPCS,Percutaneous access and closure of femoral artery for delivery of endograft through a large sheath (12 French or larger), including ultrasound guidance, when performed, unilateral (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,34714,CPT4/HCPCS,Open femoral artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by groin incision, unilateral (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,34715,CPT4/HCPCS,Open axillary/subclavian artery exposure for delivery of endovascular prosthesis by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,34716,CPT4/HCPCS,Open axillary/subclavian artery exposure with creation of conduit for delivery of endovascular prosthesis or for establishment of cardiopulmonary bypass, by infraclavicular or supraclavicular incision, unilateral (List separately in addition to code for p,,Case Rate,3000.00
Cigna,PPO,348,DRG,Anal & stomal procedures w CC,,Case Rate,34231.20
Cigna,PPO,34833,CPT4/HCPCS,Open iliac artery exposure with creation of conduit for delivery of infrarenal aortic or iliac endovascular prosthesis, by abdominal or retroperitoneal incision, unilateral,,Case Rate,3000.00
Cigna,PPO,34834,CPT4/HCPCS,Open brachial artery exposure to assist in the deployment of infrarenal aortic or iliac endovascular prosthesis by arm incision, unilateral,,Case Rate,3000.00
Cigna,PPO,349,DRG,Anal & stomal procedures w/o CC/MCC,,Case Rate,24972.15
Cigna,PPO,35,DRG,Carotid artery stent procedure w CC,,Case Rate,59596.05
Cigna,PPO,350,DRG,Inguinal & femoral hernia procedures w MCC,,Case Rate,62536.20
Cigna,PPO,351,DRG,Inguinal & femoral hernia procedures w CC,,Case Rate,38005.20
Cigna,PPO,35188,CPT4/HCPCS,Repair blood vessel lesion,,Case Rate,4000.00
Cigna,PPO,352,DRG,Inguinal & femoral hernia procedures w/o CC/MCC,,Case Rate,28126.50
Cigna,PPO,35201,CPT4/HCPCS,Repair blood vessel, direct; neck ,,Case Rate,3000.00
Cigna,PPO,35206,CPT4/HCPCS,Repair blood vessel, direct; upper extremity ,,Case Rate,3000.00
Cigna,PPO,35207,CPT4/HCPCS,Repair blood vessel lesion,,Case Rate,4000.00
Cigna,PPO,35226,CPT4/HCPCS,Repair blood vessel, direct; lower extremity ,,Case Rate,3000.00
Cigna,PPO,35231,CPT4/HCPCS,Repair blood vessel with vein graft; neck ,,Case Rate,3000.00
Cigna,PPO,35236,CPT4/HCPCS,Repair blood vessel with vein graft; upper extremity ,,Case Rate,3000.00
Cigna,PPO,35256,CPT4/HCPCS,Repair blood vessel with vein graft; lower extremity ,,Case Rate,3000.00
Cigna,PPO,35261,CPT4/HCPCS,Repair blood vessel with graft other than vein; neck ,,Case Rate,3000.00
Cigna,PPO,35266,CPT4/HCPCS,Repair blood vessel with graft other than vein; upper extremity ,,Case Rate,3000.00
Cigna,PPO,35286,CPT4/HCPCS,Repair blood vessel with graft other than vein; lower extremity ,,Case Rate,3000.00
Cigna,PPO,353,DRG,Hernia procedures except inguinal & femoral w MCC,,Case Rate,76711.65
Cigna,PPO,354,DRG,Hernia procedures except inguinal & femoral w CC,,Case Rate,45466.50
Cigna,PPO,355,DRG,Hernia procedures except inguinal & femoral w/o CC/MCC,,Case Rate,34659.60
Cigna,PPO,356,DRG,Other digestive system O.R. procedures w MCC,,Case Rate,109430.70
Cigna,PPO,357,DRG,Other digestive system O.R. procedures w CC,,Case Rate,57469.35
Cigna,PPO,35702,CPT4/HCPCS,Exploration not followed by surgical repair, artery; upper extremity (eg, axillary, brachial, radial, ulnar),,Case Rate,3000.00
Cigna,PPO,35703,CPT4/HCPCS,Exploration not followed by surgical repair, artery; lower extremity (eg, common femoral, deep femoral, superficial femoral, popliteal, tibial, peroneal,,Case Rate,3000.00
Cigna,PPO,358,DRG,Other digestive system O.R. procedures w/o CC/MCC,,Case Rate,34144.50
Cigna,PPO,35875,CPT4/HCPCS,Removal of clot in graft,,Case Rate,8300.00
Cigna,PPO,35876,CPT4/HCPCS,Removal of clot in graft,,Case Rate,8300.00
Cigna,PPO,35883,CPT4/HCPCS,Revise graft w/nonauto graft,,Case Rate,8300.00
Cigna,PPO,35884,CPT4/HCPCS,Revise graft w/vein,,Case Rate,8300.00
Cigna,PPO,36,DRG,Carotid artery stent procedure w/o CC/MCC,,Case Rate,47205.60
Cigna,PPO,36002,CPT4/HCPCS,INJECTION PROCEDURES (EG, THROMBIN) FOR PERCUTANEOUS TREATMENT OF EXTREMITY PSEUDOANEURYSM,,Case Rate,3000.00
Cigna,PPO,36005,CPT4/HCPCS,Injection procedure for contrast venography (including introduction of needle or intracatheter),,Case Rate,3000.00
Cigna,PPO,36010,CPT4/HCPCS,Introduction of catheter, superior or inferior vena cava,,Case Rate,3000.00
Cigna,PPO,36011,CPT4/HCPCS,Selective catheter placement, venous system; first order branch (eg, renal vein, jugular vein),,Case Rate,3000.00
Cigna,PPO,36012,CPT4/HCPCS,Selective catheter placement, venous system; second order, or more selective, branch (eg, left adrenal vein, petrosal sinus),,Case Rate,3000.00
Cigna,PPO,36013,CPT4/HCPCS,Introduction of catheter, right heart or main pulmonary artery,,Case Rate,3000.00
Cigna,PPO,36014,CPT4/HCPCS,Selective catheter placement, left or right pulmonary artery,,Case Rate,3000.00
Cigna,PPO,36015,CPT4/HCPCS,Selective catheter placement, segmental or subsegmental pulmonary artery,,Case Rate,3000.00
Cigna,PPO,36100,CPT4/HCPCS,Introduction of needle or intracatheter, carotid or vertebral artery,,Case Rate,3000.00
Cigna,PPO,36140,CPT4/HCPCS,Introduction of needle or intracatheter; extremity artery,,Case Rate,3000.00
Cigna,PPO,36160,CPT4/HCPCS,Introduction of needle or intracatheter, aortic, translumbar,,Case Rate,3000.00
Cigna,PPO,36200,CPT4/HCPCS,Introduction of catheter, aorta,,Case Rate,3000.00
Cigna,PPO,36215,CPT4/HCPCS,Selective catheter placement, arterial system; each first order thoracic or brachiocephalic branch, within a vascular family,,Case Rate,3000.00
Cigna,PPO,36216,CPT4/HCPCS,Selective catheter placement, arterial system; initial second order thoracic or brachiocephalic branch, within a vascular family,,Case Rate,3000.00
Cigna,PPO,36217,CPT4/HCPCS,Selective catheter placement, arterial system; initial third order or more selective thoracic or brachiocephalic branch, within a vascular family,,Case Rate,3000.00
Cigna,PPO,36218,CPT4/HCPCS,Selective catheter placement, arterial system; additional second order, third order, and beyond, thoracic or brachiocephalic branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriate),,Case Rate,3000.00
Cigna,PPO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Case Rate,3000.00
Cigna,PPO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Case Rate,3000.00
Cigna,PPO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Case Rate,3000.00
Cigna,PPO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Case Rate,3000.00
Cigna,PPO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Case Rate,3000.00
Cigna,PPO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Case Rate,3000.00
Cigna,PPO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Case Rate,3000.00
Cigna,PPO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Case Rate,3000.00
Cigna,PPO,36245,CPT4/HCPCS,Selective catheter placement, arterial system; each first order abdominal, pelvic, or lower extremity artery branch, within a vascular family,,Case Rate,3000.00
Cigna,PPO,36246,CPT4/HCPCS,Selective catheter placement, arterial system; initial second order abdominal, pelvic, or lower extremity artery branch, within a vascular family,,Case Rate,3000.00
Cigna,PPO,36247,CPT4/HCPCS,Selective catheter placement, arterial system; initial third order or more selective abdominal, pelvic, or lower extremity artery branch, within a vascular family,,Case Rate,3000.00
Cigna,PPO,36248,CPT4/HCPCS,Selective catheter placement, arterial system; additional second order, third order, and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular family (List in addition to code for initial second or third order vessel as appropriat,,Case Rate,3000.00
Cigna,PPO,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,Case Rate,3000.00
Cigna,PPO,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,Case Rate,3000.00
Cigna,PPO,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,Case Rate,3000.00
Cigna,PPO,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,Case Rate,3000.00
Cigna,PPO,36260,CPT4/HCPCS,Insertion of infusion pump,,Case Rate,4000.00
Cigna,PPO,36261,CPT4/HCPCS,Revision of infusion pump,,Case Rate,3000.00
Cigna,PPO,36262,CPT4/HCPCS,Removal of infusion pump,,Case Rate,3000.00
Cigna,PPO,36420,CPT4/HCPCS,Venipuncture, cutdown; under age 1 year,,Case Rate,400.00
Cigna,PPO,36425,CPT4/HCPCS,Venipuncture, cutdown; age 1 or over,,Case Rate,400.00
Cigna,PPO,36430,CPT4/HCPCS,TRANSFUSION, BLOOD OR BLOOD COMPONENTS, INDIRECT ,,Case Rate,3000.00
Cigna,PPO,36440,CPT4/HCPCS,PUSH TRANSFUSION, BLOOD, 2 YEARS OR UNDER ,,Case Rate,3000.00
Cigna,PPO,36450,CPT4/HCPCS,EXCHANGE TRANSFUSION, BLOOD, NEWBORN ,,Case Rate,3000.00
Cigna,PPO,36455,CPT4/HCPCS,EXCHANGE TRANSFUSION, BLOOD; OTHER THAN NEWBORN ,,Case Rate,3000.00
Cigna,PPO,36456,CPT4/HCPCS,Partial exchange transfusion, blood, plasma or crystalloid necessitating the skill of a physician or other qualified health care professional, newborn,,Case Rate,3000.00
Cigna,PPO,36460,CPT4/HCPCS,Transfusion, intrauterine, fetal,,Case Rate,3000.00
Cigna,PPO,36465,CPT4/HCPCS,Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphen,,Case Rate,3000.00
Cigna,PPO,36466,CPT4/HCPCS,Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vei,,Case Rate,3000.00
Cigna,PPO,36468,CPT4/HCPCS,S/MLT INJ SCLROS SOLUT;LMB/TRNK(TOS 03/TOS 04)(POTENT COS)(TOS 03 SPEC PH ONLY) ,,Case Rate,3000.00
Cigna,PPO,36470,CPT4/HCPCS,INJCT SCLEROS SOLUT;SINGL VEIN(TOS 03/TOS 04)(POTENT COS)(TOS 03 SPECIF PH ONLY ,,Case Rate,3000.00
Cigna,PPO,36471,CPT4/HCPCS,INJ SCLEROS SOLUT;MLTI VNS SAME LEG(TOS 03 TOS 04)(POTNT COS)(TOS 03 SPCIF PH O ,,Case Rate,3000.00
Cigna,PPO,36473,CPT4/HCPCS,Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; first vein treated,,Case Rate,400.00
Cigna,PPO,36474,CPT4/HCPCS,Endovenous ablation therapy of incompetent vein, extremity, inclusive of all imaging guidance and monitoring, percutaneous, mechanochemical; subsequent vein(s) treated in a single extremity, each through separate access sites (List separately in addition ,,Case Rate,3000.00
Cigna,PPO,36475,CPT4/HCPCS,Endovenous rf, 1st vein,,Case Rate,8300.00
Cigna,PPO,36476,CPT4/HCPCS,Endovenous rf, vein add-on,,Case Rate,3000.00
Cigna,PPO,36478,CPT4/HCPCS,Endovenous laser, 1st vein,,Case Rate,8300.00
Cigna,PPO,36479,CPT4/HCPCS,Endovenous laser vein addon,,Case Rate,3000.00
Cigna,PPO,36481,CPT4/HCPCS,Percutaneous portal vein catheterization by any method,,Case Rate,3000.00
Cigna,PPO,36482,CPT4/HCPCS,Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; first vein treated,,Case Rate,3000.00
Cigna,PPO,36483,CPT4/HCPCS,Endovenous ablation therapy of incompetent vein, extremity, by transcatheter delivery of a chemical adhesive (eg, cyanoacrylate) remote from the access site, inclusive of all imaging guidance and monitoring, percutaneous; subsequent vein(s) treated in a s,,Case Rate,3000.00
Cigna,PPO,36500,CPT4/HCPCS,Venous catheterization for selective organ blood sampling,,Case Rate,3000.00
Cigna,PPO,36511,CPT4/HCPCS,Therapeutic apheresis; for white blood cells,,Case Rate,3000.00
Cigna,PPO,36512,CPT4/HCPCS,Therapeutic apheresis; for red blood cells,,Case Rate,3000.00
Cigna,PPO,36513,CPT4/HCPCS,Therapeutic apheresis; for platelets,,Case Rate,3000.00
Cigna,PPO,36514,CPT4/HCPCS,Therapeutic apheresis; for plasma pheresis,,Case Rate,3000.00
Cigna,PPO,36516,CPT4/HCPCS,Therapeutic apheresis; with extracorporeal selective adsorption or selective filtration andplasma reinfusion,,Case Rate,3000.00
Cigna,PPO,36522,CPT4/HCPCS,PHOTOPHERESIS, EXTRACORPOREAL,,Case Rate,3000.00
Cigna,PPO,36555,CPT4/HCPCS,INSRT NON-TUNNL CNTRL CVC; <,,Case Rate,3000.00
Cigna,PPO,36556,CPT4/HCPCS,INSRT NON-TUNNL CNTRL CVC; 5,,Case Rate,3000.00
Cigna,PPO,36557,CPT4/HCPCS,INSRT TUNNL CVC NO PORT/PUMP,,Case Rate,3000.00
Cigna,PPO,36558,CPT4/HCPCS,INSRT TUNNL CVC NO PORT/PUMP,,Case Rate,3000.00
Cigna,PPO,36560,CPT4/HCPCS,INSRT TUNNL CNTRL CVAD PORT;,,Case Rate,4000.00
Cigna,PPO,36561,CPT4/HCPCS,INSRT TUNNL CNTRL CVAD PORT;,,Case Rate,4000.00
Cigna,PPO,36563,CPT4/HCPCS,INSRT TUNNL CNTRL CVAD W/SUB,,Case Rate,4000.00
Cigna,PPO,36565,CPT4/HCPCS,INSRT TUNL CVAD 2 CATH-SITE;,,Case Rate,4000.00
Cigna,PPO,36566,CPT4/HCPCS,INSRT TUNNL CVAD 2 CATH-2 SI,,Case Rate,6000.00
Cigna,PPO,36568,CPT4/HCPCS,INSERT PICC W/O PORT/PUMP; <,,Case Rate,3000.00
Cigna,PPO,36569,CPT4/HCPCS,INSERT PICC W/O PORT/PUMP; 5,,Case Rate,3000.00
Cigna,PPO,36570,CPT4/HCPCS,INSRT PERIPH INSRT CVAD W/PO,,Case Rate,4000.00
Cigna,PPO,36571,CPT4/HCPCS,INSRT PERIPH INSRT CVAD PORT,,Case Rate,4000.00
Cigna,PPO,36572,CPT4/HCPCS,Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; yo,,Case Rate,3000.00
Cigna,PPO,36573,CPT4/HCPCS,Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, including all imaging guidance, image documentation, and all associated radiological supervision and interpretation required to perform the insertion; ag,,Case Rate,3000.00
Cigna,PPO,36575,CPT4/HCPCS,REP CV ACSS CATH W/O PORT/PU,,Case Rate,3000.00
Cigna,PPO,36576,CPT4/HCPCS,REP CVAD W/PORT/PUMP CNTRL/P,,Case Rate,3000.00
Cigna,PPO,36578,CPT4/HCPCS,REPL CATH ONLY CVAD SUBQ POR,,Case Rate,3000.00
Cigna,PPO,36580,CPT4/HCPCS,REPL NON-TUNNLD CVC W/O PORT,,Case Rate,3000.00
Cigna,PPO,36581,CPT4/HCPCS,REPL TUNNLD CNTRL CVC W/O PO,,Case Rate,3000.00
Cigna,PPO,36582,CPT4/HCPCS,REPL TUNNLD CNTRL CVAD W/SUB,,Case Rate,4000.00
Cigna,PPO,36583,CPT4/HCPCS,REPL TUNNLD CNTRL CVAD W/SUB,,Case Rate,4000.00
Cigna,PPO,36584,CPT4/HCPCS,REPL PICC W/O PORT/PUMP SAME,,Case Rate,3000.00
Cigna,PPO,36585,CPT4/HCPCS,REPL PERIPH INSRT CVAD W/SUB,,Case Rate,4000.00
Cigna,PPO,36589,CPT4/HCPCS,REMV TUNNLD CVC W/O SUBQ POR,,Case Rate,3000.00
Cigna,PPO,36590,CPT4/HCPCS,REMV TUNNLD CVAD W/SUBQ PORT,,Case Rate,3000.00
Cigna,PPO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Case Rate,400.00
Cigna,PPO,36595,CPT4/HCPCS,Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access ,,Case Rate,3000.00
Cigna,PPO,36596,CPT4/HCPCS,Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen ,,Case Rate,3000.00
Cigna,PPO,36597,CPT4/HCPCS,Repositioning of previously placed central venous catheter under fluoroscopic guidance,,Case Rate,3000.00
Cigna,PPO,36598,CPT4/HCPCS,Contrast injection(s) for radiologic evaluation of existing central venous access device, including fluoroscopy, image documentation and report,,Case Rate,3000.00
Cigna,PPO,36600,CPT4/HCPCS,Arterial Puncture,,% of Charges,59.80
Cigna,PPO,36620,CPT4/HCPCS,Arterial catheterization or cannulation for sampling, monitoring or transfusion (separate procedure); percutaneous,,Case Rate,3000.00
Cigna,PPO,36640,CPT4/HCPCS,Insertion catheter, artery,,Case Rate,3000.00
Cigna,PPO,36680,CPT4/HCPCS,Placement of needle for intraosseous infusion,,Case Rate,400.00
Cigna,PPO,368,DRG,Major esophageal disorders w MCC,,Case Rate,49528.65
Cigna,PPO,36800,CPT4/HCPCS,Insertion of cannula,,Case Rate,4000.00
Cigna,PPO,36810,CPT4/HCPCS,Insertion of cannula,,Case Rate,4000.00
Cigna,PPO,36815,CPT4/HCPCS,Insertion of cannula,,Case Rate,4000.00
Cigna,PPO,36818,CPT4/HCPCS,Arteriovenous Anastomosis, Open; By Upper Arm Cephalic Vein Transposition,,Case Rate,4000.00
Cigna,PPO,36819,CPT4/HCPCS,Av fusion/uppr arm vein,,Case Rate,4000.00
Cigna,PPO,36820,CPT4/HCPCS,Av fusion/forearm vein,,Case Rate,4000.00
Cigna,PPO,36821,CPT4/HCPCS,Av fusion direct any site,,Case Rate,4000.00
Cigna,PPO,36825,CPT4/HCPCS,Artery-vein graft,,Case Rate,4000.00
Cigna,PPO,36830,CPT4/HCPCS,Artery-vein graft,,Case Rate,4000.00
Cigna,PPO,36831,CPT4/HCPCS,Open thrombect av fistula,,Case Rate,8300.00
Cigna,PPO,36832,CPT4/HCPCS,Av fistula revision, open,,Case Rate,4000.00
Cigna,PPO,36833,CPT4/HCPCS,Av fistula revision,,Case Rate,4000.00
Cigna,PPO,36835,CPT4/HCPCS,Artery to vein shunt,,Case Rate,4000.00
Cigna,PPO,36838,CPT4/HCPCS,Distal revascularization and interval ligation (DRIL), upper extremity hemodialysis access (steal syndrome),,Case Rate,3000.00
Cigna,PPO,36860,CPT4/HCPCS,External cannula declotting,,Case Rate,3000.00
Cigna,PPO,36861,CPT4/HCPCS,Cannula declotting,,Case Rate,4000.00
Cigna,PPO,369,DRG,Major esophageal disorders w CC,,Case Rate,27458.40
Cigna,PPO,36901,CPT4/HCPCS,Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis ,,Case Rate,400.00
Cigna,PPO,36902,CPT4/HCPCS,Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis ,,Case Rate,3000.00
Cigna,PPO,36903,CPT4/HCPCS,Introduction of needle(s) and/or catheter(s), dialysis circuit, with diagnostic angiography of the dialysis circuit, including all direct puncture(s) and catheter placement(s), injection(s) of contrast, all necessary imaging from the arterial anastomosis ,,Case Rate,3000.00
Cigna,PPO,36904,CPT4/HCPCS,Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), ,,Case Rate,3000.00
Cigna,PPO,36905,CPT4/HCPCS,Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), ,,Case Rate,3000.00
Cigna,PPO,36906,CPT4/HCPCS,Percutaneous transluminal mechanical thrombectomy and/or infusion for thrombolysis, dialysis circuit, any method, including all imaging and radiological supervision and interpretation, diagnostic angiography, fluoroscopic guidance, catheter placement(s), ,,Case Rate,3000.00
Cigna,PPO,36907,CPT4/HCPCS,Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in addition to code for primary proc,,Case Rate,3000.00
Cigna,PPO,36908,CPT4/HCPCS,Transcatheter placement of intravascular stent(s), central dialysis segment, performed through dialysis circuit, including all imaging radiological supervision and interpretation required to perform the stenting, and all angioplasty in the central dialysi,,Case Rate,3000.00
Cigna,PPO,36909,CPT4/HCPCS,Dialysis circuit permanent vascular embolization or occlusion (including main circuit or any accessory veins), endovascular, including all imaging and radiological supervision and interpretation necessary to complete the intervention (List separately in a,,Case Rate,3000.00
Cigna,PPO,37,DRG,Extracranial procedures w MCC,,Case Rate,83504.85
Cigna,PPO,370,DRG,Major esophageal disorders w/o CC/MCC,,Case Rate,19063.80
Cigna,PPO,371,DRG,Major gastrointestinal disorders & peritoneal infections w MCC,,Case Rate,44071.65
Cigna,PPO,37183,CPT4/HCPCS,REVISION OF TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC SHUNT(S) (TIPS) (INCLUDES VENOUS ACCESS, HEPATIC AND PORTAL VEIN CATHETERIZATION, PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, INTRAHEPATIC TRACT RECANULIZATION/DILATATION, STENT PLACEMENT AND ALL ASSOCIATED,,Case Rate,3000.00
Cigna,PPO,37184,CPT4/HCPCS,Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); initial vessel,,Case Rate,8300.00
Cigna,PPO,37185,CPT4/HCPCS,Primary percutaneous transluminal mechanical thrombectomy, noncoronary, arterial or arterial bypass graft, including fluoroscopic guidance and intraprocedural pharmacological thrombolytic injection(s); second and all subsequent vessel(s) within the same v,,Case Rate,3000.00
Cigna,PPO,37186,CPT4/HCPCS,SECONDARY PERCUTANEOUS TRANSLUMINAL THROMBECTOMY (EG, NONPRIMARY MECHANICAL, SNARE BASKET, SUCTION TECHNIQUE), NONCORONARY, ARTERIAL OR ARTERIAL BYPASS GRAFT, INCLUDING FLUOROSCOPIC GUIDANCE AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTIONS, PR,,Case Rate,3000.00
Cigna,PPO,37187,CPT4/HCPCS,Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance,,Case Rate,8300.00
Cigna,PPO,37188,CPT4/HCPCS,Percutaneous transluminal mechanical thrombectomy, vein(s), including intraprocedural pharmacological thrombolytic injections and fluoroscopic guidance, repeat treatment on subsequent day during course of thrombolytic therapy,,Case Rate,8300.00
Cigna,PPO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Case Rate,3000.00
Cigna,PPO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Case Rate,3000.00
Cigna,PPO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Case Rate,3000.00
Cigna,PPO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Case Rate,8300.00
Cigna,PPO,372,DRG,Major gastrointestinal disorders & peritoneal infections w CC,,Case Rate,26203.80
Cigna,PPO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY ,,Case Rate,3000.00
Cigna,PPO,37211,CPT4/HCPCS,TRANSCATHETER THERAPY, ARTERIAL INFUSION FOR THROMBOLYSIS OTHER THAN CORONARY, ANY METHOD, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION, INITIAL TREATMENT DAY ,,Case Rate,3000.00
Cigna,PPO,37212,CPT4/HCPCS,TRANSCATHETER THERAPY, VENOUS INFUSION FOR THROMBOLYSIS, ANY METHOD, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION, INITIAL TREATMENT DAY ,,Case Rate,3000.00
Cigna,PPO,37213,CPT4/HCPCS,TRANSCATHETER THERAPY, ARTERIAL OR VENOUS INFUSION FOR THROMBOLYSIS OTHER THAN CORONARY, ANY METHOD, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION, CONTINUED TREATMENT ON SUBSEQUENT DAY DURING COURSE OF THROMBOLYTIC THERAPY, INCLUDING FOLLOW-UP C,,Case Rate,3000.00
Cigna,PPO,37214,CPT4/HCPCS,TRANSCATHETER THERAPY, ARTERIAL OR VENOUS INFUSION FOR THROMBOLYSIS OTHER THAN CORONARY, ANY METHOD, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION, CONTINUED TREATMENT ON SUBSEQUENT DAY DURING COURSE OF THROMBOLYTIC THERAPY, INCLUDING FOLLOW-UP C,,Case Rate,3000.00
Cigna,PPO,37215,CPT4/HCPCS,Transcatheter Placement Of Intravascular Stent(S), Cervical Carotid Artery, Percutaneous; With Distal Embolic Protection,,Case Rate,3000.00
Cigna,PPO,37216,CPT4/HCPCS,Transcatheter Placement Of Intravascular Stent(S), Cervical Carotid Artery, Percutaneous; Without Distal Embolic Protection,,Case Rate,3000.00
Cigna,PPO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Case Rate,3000.00
Cigna,PPO,37218,CPT4/HCPCS, TRANSCATHETER PLACEMENT OF INTRAVASCULAR STENT(S), INTRATHORACIC COMMON CAROTID ARTERY OR INNOMINATE ARTERY, OPEN OR PERCUTANEOUS ANTEGRADE APPROACH, INCLUDING ANGIOPLASTY, WHEN PERFORMED, AND RADIOLOGICAL SUPERVISION AND INTERPRETATION,,Case Rate,3000.00
Cigna,PPO,37220,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY,,Case Rate,3000.00
Cigna,PPO,37221,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,PPO,37222,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, EACH ADDITIONAL IPSILATERAL ILIAC VESSEL; WITH TRANSLUMINAL ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,37223,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, ILIAC ARTERY, EACH ADDITIONAL IPSILATERAL ILIAC VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMA,,Case Rate,3000.00
Cigna,PPO,37224,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL ANGIOPLASTY,,Case Rate,3000.00
Cigna,PPO,37225,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,PPO,37226,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,PPO,37227,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, FEMORAL, POPLITEAL ARTERY(S), UNILATERAL; WITH TRANSLUMINAL STENT PLACEMENT(S) AND ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,PPO,37228,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY,,Case Rate,3000.00
Cigna,PPO,37229,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,PPO,37230,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,PPO,37231,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL, PERONEAL ARTERY, UNILATERAL, INITIAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S) AND ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED,,Case Rate,3000.00
Cigna,PPO,37232,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH TRANSLUMINAL ANGIOPLASTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,37233,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,37234,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S), INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR P,,Case Rate,3000.00
Cigna,PPO,37235,CPT4/HCPCS,REVASCULARIZATION, ENDOVASCULAR, OPEN OR PERCUTANEOUS, TIBIAL/PERONEAL ARTERY, UNILATERAL, EACH ADDITIONAL VESSEL; WITH TRANSLUMINAL STENT PLACEMENT(S) AND ATHERECTOMY, INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL, WHEN PERFORMED (LIST SEPARATELY IN ADDITI,,Case Rate,3000.00
Cigna,PPO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Case Rate,3000.00
Cigna,PPO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Case Rate,3000.00
Cigna,PPO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Case Rate,3000.00
Cigna,PPO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Case Rate,3000.00
Cigna,PPO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Case Rate,3000.00
Cigna,PPO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Case Rate,3000.00
Cigna,PPO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Case Rate,3000.00
Cigna,PPO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Case Rate,3000.00
Cigna,PPO,37246,CPT4/HCPCS,Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to p,,Case Rate,3000.00
Cigna,PPO,37247,CPT4/HCPCS,Transluminal balloon angioplasty (except lower extremity artery(ies) for occlusive disease, intracranial, coronary, pulmonary, or dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to p,,Case Rate,3000.00
Cigna,PPO,37248,CPT4/HCPCS,Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein,,Case Rate,3000.00
Cigna,PPO,37249,CPT4/HCPCS,Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; each additional vein (List separately in add,,Case Rate,3000.00
Cigna,PPO,37252,CPT4/HCPCS,INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; INITIAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,37253,CPT4/HCPCS,INTRAVASCULAR ULTRASOUND (NONCORONARY VESSEL) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; EACH ADDITIONAL NONCORONARY VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDUR,,Case Rate,3000.00
Cigna,PPO,373,DRG,Major gastrointestinal disorders & peritoneal infections w/o CC/MCC,,Case Rate,18959.25
Cigna,PPO,374,DRG,Digestive malignancy w MCC,,Case Rate,52731.45
Cigna,PPO,375,DRG,Digestive malignancy w CC,,Case Rate,30724.95
Cigna,PPO,37500,CPT4/HCPCS,Endoscopy ligate perf veins,,Case Rate,4000.00
Cigna,PPO,376,DRG,Digestive malignancy w/o CC/MCC,,Case Rate,22827.60
Cigna,PPO,37607,CPT4/HCPCS,Ligation of a-v fistula,,Case Rate,4000.00
Cigna,PPO,37609,CPT4/HCPCS,Temporal artery procedure,,Case Rate,3000.00
Cigna,PPO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Case Rate,3000.00
Cigna,PPO,37650,CPT4/HCPCS,Revision of major vein,,Case Rate,3000.00
Cigna,PPO,377,DRG,G.I. hemorrhage w MCC,,Case Rate,45871.95
Cigna,PPO,37700,CPT4/HCPCS,Revise leg vein,,Case Rate,3000.00
Cigna,PPO,37718,CPT4/HCPCS,Ligate/strip short leg vein,,Case Rate,4000.00
Cigna,PPO,37722,CPT4/HCPCS,Ligate/strip long leg vein,,Case Rate,4000.00
Cigna,PPO,37735,CPT4/HCPCS,Removal of leg veins/lesion,,Case Rate,4000.00
Cigna,PPO,37760,CPT4/HCPCS,Revision of leg veins,,Case Rate,4000.00
Cigna,PPO,37761,CPT4/HCPCS,Ligation of perforator vein(s), subfascial, open, including ultrasound guidance, when performed, 1 leg ,,Case Rate,3000.00
Cigna,PPO,37765,CPT4/HCPCS,Stab phlebectomy of varicose veins, one extremity; 10-20 stab incisions,,Case Rate,4000.00
Cigna,PPO,37766,CPT4/HCPCS,Stab phlebectomy of varicose veins, one extremity; more than 20 incisions,,Case Rate,4000.00
Cigna,PPO,37780,CPT4/HCPCS,Revision of leg vein,,Case Rate,4000.00
Cigna,PPO,37785,CPT4/HCPCS,Revise secondary varicosity,,Case Rate,4000.00
Cigna,PPO,37790,CPT4/HCPCS,Penile venous occlusion,,Case Rate,4000.00
Cigna,PPO,37799,CPT4/HCPCS,Unlisted procedure, vascular surgery,,Case Rate,3000.00
Cigna,PPO,378,DRG,G.I. hemorrhage w CC,,Case Rate,25326.60
Cigna,PPO,379,DRG,G.I. hemorrhage w/o CC/MCC,,Case Rate,16246.05
Cigna,PPO,38,DRG,Extracranial procedures w CC,,Case Rate,42261.15
Cigna,PPO,380,DRG,Complicated peptic ulcer w MCC,,Case Rate,48019.05
Cigna,PPO,381,DRG,Complicated peptic ulcer w CC,,Case Rate,27022.35
Cigna,PPO,38120,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, SPLENECTOMY,,Case Rate,5000.00
Cigna,PPO,38129,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN,,Case Rate,3000.00
Cigna,PPO,382,DRG,Complicated peptic ulcer w/o CC/MCC,,Case Rate,19591.65
Cigna,PPO,38200,CPT4/HCPCS,INJECTION PROCEDURE FOR SPLENOPORTOGRAPHY ,,Case Rate,3000.00
Cigna,PPO,38220,CPT4/HCPCS,BONE MARROW ASPIRATION,,Case Rate,3000.00
Cigna,PPO,38221,CPT4/HCPCS,BONE MARROW BIOPSY, NEEDLE OR TROCAR,,Case Rate,3000.00
Cigna,PPO,38222,CPT4/HCPCS,Diagnostic bone marrow; biopsy(ies) and aspiration(s),,Case Rate,3000.00
Cigna,PPO,38230,CPT4/HCPCS,BONE MARROW HARVESTING FOR TRANSPLANTATION; ALLOGENIC ,,Case Rate,3000.00
Cigna,PPO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Case Rate,8300.00
Cigna,PPO,38240,CPT4/HCPCS,HEMATOPOIETIC PROGENITOR CELL (HPC); ALLOGENEIC TRANSPLANTATION PER DONOR ,,Case Rate,3000.00
Cigna,PPO,38241,CPT4/HCPCS,HEMATOPOIETIC PROGENITOR CELL (HPC); AUTOLOGOUS TRANSPLANTATION ,,Case Rate,3000.00
Cigna,PPO,38243,CPT4/HCPCS,HEMATOPOIETIC PROGENITOR CELL (HPC); HPC BOOST ,,Case Rate,3000.00
Cigna,PPO,383,DRG,Uncomplicated peptic ulcer w MCC,,Case Rate,33427.95
Cigna,PPO,38300,CPT4/HCPCS,Drainage, lymph node lesion,,Case Rate,3000.00
Cigna,PPO,38305,CPT4/HCPCS,Drainage, lymph node lesion,,Case Rate,3000.00
Cigna,PPO,38308,CPT4/HCPCS,Incision of lymph channels,,Case Rate,3000.00
Cigna,PPO,384,DRG,Uncomplicated peptic ulcer w/o MCC,,Case Rate,22756.20
Cigna,PPO,385,DRG,Inflammatory bowel disease w MCC,,Case Rate,41287.05
Cigna,PPO,38500,CPT4/HCPCS,Biopsy/removal, lymph nodes,,Case Rate,3000.00
Cigna,PPO,38505,CPT4/HCPCS,Needle biopsy, lymph nodes,,Case Rate,3000.00
Cigna,PPO,38510,CPT4/HCPCS,Biopsy/removal, lymph nodes,,Case Rate,3000.00
Cigna,PPO,38520,CPT4/HCPCS,Biopsy/removal, lymph nodes,,Case Rate,3000.00
Cigna,PPO,38525,CPT4/HCPCS,Biopsy/removal, lymph nodes,,Case Rate,3000.00
Cigna,PPO,38530,CPT4/HCPCS,Biopsy/removal, lymph nodes,,Case Rate,3000.00
Cigna,PPO,38531,CPT4/HCPCS,Biopsy or excision of lymph node(s); open, inguinofemoral node(s,,Case Rate,3000.00
Cigna,PPO,38542,CPT4/HCPCS,Explore deep node(s), neck,,Case Rate,3000.00
Cigna,PPO,38550,CPT4/HCPCS,Removal, neck/armpit lesion,,Case Rate,4000.00
Cigna,PPO,38555,CPT4/HCPCS,Removal, neck/armpit lesion,,Case Rate,4000.00
Cigna,PPO,38570,CPT4/HCPCS,Laparoscopy, lymph node biop,,Case Rate,8300.00
Cigna,PPO,38571,CPT4/HCPCS,Laparoscopy, lymphadenectomy,,Case Rate,8300.00
Cigna,PPO,38572,CPT4/HCPCS,Laparoscopy, lymphadenectomy,,Case Rate,8300.00
Cigna,PPO,38573,CPT4/HCPCS,Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omentectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when perfo,,Case Rate,3000.00
Cigna,PPO,38589,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, LYMPHATIC SYSTEM,,Case Rate,3000.00
Cigna,PPO,386,DRG,Inflammatory bowel disease w CC,,Case Rate,25334.25
Cigna,PPO,387,DRG,Inflammatory bowel disease w/o CC/MCC,,Case Rate,18194.25
Cigna,PPO,38700,CPT4/HCPCS,Removal of lymph nodes, neck,,Case Rate,3000.00
Cigna,PPO,38720,CPT4/HCPCS,Cervical lymphadenectomy (complete),,Case Rate,3000.00
Cigna,PPO,38724,CPT4/HCPCS,Cervical lymphadenectomy (modified radical neck dissection),,Case Rate,3000.00
Cigna,PPO,38740,CPT4/HCPCS,Remove armpit lymph nodes,,Case Rate,3000.00
Cigna,PPO,38745,CPT4/HCPCS,Remove armpit lymph nodes,,Case Rate,4000.00
Cigna,PPO,38760,CPT4/HCPCS,Remove groin lymph nodes,,Case Rate,3000.00
Cigna,PPO,38790,CPT4/HCPCS,Inject for lymphatic x-ray,,Case Rate,3000.00
Cigna,PPO,38792,CPT4/HCPCS,Injection procedure; radioactive tracer for identification of sentinel node,,Case Rate,3000.00
Cigna,PPO,388,DRG,G.I. obstruction w MCC,,Case Rate,38550.90
Cigna,PPO,389,DRG,G.I. obstruction w CC,,Case Rate,20955.90
Cigna,PPO,38900,CPT4/HCPCS,INTRAOPERATIVE IDENTIFICATION (EG, MAPPING) OF SENTINEL LYMPH NODE(S) INCLUDES INJECTION OF NON-RADIOACTIVE DYE, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,38999,CPT4/HCPCS,UNLISTED PROCEDURE HEMIC OR LYMPHATIC SYSTEMS ,,Case Rate,3000.00
Cigna,PPO,39,DRG,Extracranial procedures w/o CC/MCC,,Case Rate,29044.50
Cigna,PPO,390,DRG,G.I. obstruction w/o CC/MCC,,Case Rate,14856.30
Cigna,PPO,391,DRG,Esophagitis, gastroent & misc digest disorders w MCC,,Case Rate,31732.20
Cigna,PPO,392,DRG,Esophagitis, gastroent & misc digest disorders w/o MCC,,Case Rate,19492.20
Cigna,PPO,393,DRG,Other digestive system diagnoses w MCC,,Case Rate,42166.80
Cigna,PPO,394,DRG,Other digestive system diagnoses w CC,,Case Rate,23934.30
Cigna,PPO,39401,CPT4/HCPCS,MEDIASTINOSCOPY; INCLUDES BIOPSY(IES) OF MEDIASTINAL MASS (EG, LYMPHOMA), WHEN PERFORMED,,Case Rate,3000.00
Cigna,PPO,39402,CPT4/HCPCS,MEDIASTINOSCOPY; WITH LYMPH NODE BIOPSY(IES) (EG, LUNG CANCER STAGING),,Case Rate,3000.00
Cigna,PPO,395,DRG,Other digestive system diagnoses w/o CC/MCC,,Case Rate,16567.35
Cigna,PPO,4,DRG,Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R.,,Case Rate,302481.00
Cigna,PPO,40,DRG,Periph/cranial nerve & other nerv syst proc w MCC,,Case Rate,100923.90
Cigna,PPO,405,DRG,Pancreas, liver & shunt procedures w MCC,,Case Rate,146127.75
Cigna,PPO,40500,CPT4/HCPCS,Partial excision of lip,,Case Rate,3000.00
Cigna,PPO,40510,CPT4/HCPCS,Partial excision of lip,,Case Rate,3000.00
Cigna,PPO,40520,CPT4/HCPCS,Partial excision of lip,,Case Rate,3000.00
Cigna,PPO,40525,CPT4/HCPCS,Reconstruct lip with flap,,Case Rate,3000.00
Cigna,PPO,40527,CPT4/HCPCS,Reconstruct lip with flap,,Case Rate,3000.00
Cigna,PPO,40530,CPT4/HCPCS,Partial removal of lip,,Case Rate,3000.00
Cigna,PPO,406,DRG,Pancreas, liver & shunt procedures w CC,,Case Rate,73363.50
Cigna,PPO,40650,CPT4/HCPCS,Repair lip,,Case Rate,4000.00
Cigna,PPO,40652,CPT4/HCPCS,Repair lip,,Case Rate,4000.00
Cigna,PPO,40654,CPT4/HCPCS,Repair lip,,Case Rate,4000.00
Cigna,PPO,407,DRG,Pancreas, liver & shunt procedures w/o CC/MCC,,Case Rate,53958.00
Cigna,PPO,40700,CPT4/HCPCS,Repair cleft lip/nasal,,Case Rate,6000.00
Cigna,PPO,40701,CPT4/HCPCS,Repair cleft lip/nasal,,Case Rate,6000.00
Cigna,PPO,40702,CPT4/HCPCS,Plastic repair of cleft lip/nasal deformity; primary bilateral, one of two stages,,Case Rate,3000.00
Cigna,PPO,40720,CPT4/HCPCS,Repair cleft lip/nasal,,Case Rate,6000.00
Cigna,PPO,40761,CPT4/HCPCS,Repair cleft lip/nasal,,Case Rate,4000.00
Cigna,PPO,408,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC,,Case Rate,95612.25
Cigna,PPO,40801,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,40805,CPT4/HCPCS,Removal, foreign body, mouth,,Case Rate,3000.00
Cigna,PPO,40806,CPT4/HCPCS,Incision of lip fold,,Case Rate,400.00
Cigna,PPO,40808,CPT4/HCPCS,Biopsy, vestibule of mouth,,Case Rate,400.00
Cigna,PPO,40810,CPT4/HCPCS,Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair,,Case Rate,3000.00
Cigna,PPO,40812,CPT4/HCPCS,Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair,,Case Rate,3000.00
Cigna,PPO,40814,CPT4/HCPCS,Excise/repair mouth lesion,,Case Rate,3000.00
Cigna,PPO,40816,CPT4/HCPCS,Excision of mouth lesion,,Case Rate,3000.00
Cigna,PPO,40818,CPT4/HCPCS,Excise oral mucosa for graft,,Case Rate,3000.00
Cigna,PPO,40819,CPT4/HCPCS,Excise lip or cheek fold,,Case Rate,3000.00
Cigna,PPO,40820,CPT4/HCPCS,Treatment of mouth lesion,,Case Rate,3000.00
Cigna,PPO,40831,CPT4/HCPCS,Repair mouth laceration,,Case Rate,3000.00
Cigna,PPO,40840,CPT4/HCPCS,Reconstruction of mouth,,Case Rate,3000.00
Cigna,PPO,40842,CPT4/HCPCS,Reconstruction of mouth,,Case Rate,4000.00
Cigna,PPO,40843,CPT4/HCPCS,Reconstruction of mouth,,Case Rate,4000.00
Cigna,PPO,40844,CPT4/HCPCS,Reconstruction of mouth,,Case Rate,5000.00
Cigna,PPO,40845,CPT4/HCPCS,Reconstruction of mouth,,Case Rate,5000.00
Cigna,PPO,40899,CPT4/HCPCS,Unlisted procedure, vestibule of mouth,,Case Rate,3000.00
Cigna,PPO,409,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w CC,,Case Rate,53914.65
Cigna,PPO,41,DRG,Periph/cranial nerve & other nerv syst proc w CC or periph neurostim,,Case Rate,59945.40
Cigna,PPO,410,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC,,Case Rate,39925.35
Cigna,PPO,41000,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41005,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41006,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41007,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41008,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41009,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41010,CPT4/HCPCS,Incision of tongue fold,,Case Rate,3000.00
Cigna,PPO,41015,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41016,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41017,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41018,CPT4/HCPCS,Drainage of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Case Rate,6000.00
Cigna,PPO,411,DRG,Cholecystectomy w c.d.e. w MCC,,Case Rate,95686.20
Cigna,PPO,41100,CPT4/HCPCS,Biopsy of tongue; anterior two-thirds,,Case Rate,3000.00
Cigna,PPO,41105,CPT4/HCPCS,Biopsy of tongue,,Case Rate,3000.00
Cigna,PPO,41108,CPT4/HCPCS,Biopsy of floor of mouth,,Case Rate,3000.00
Cigna,PPO,41110,CPT4/HCPCS,Excision of tongue lesion,,Case Rate,3000.00
Cigna,PPO,41112,CPT4/HCPCS,Excision of tongue lesion,,Case Rate,3000.00
Cigna,PPO,41113,CPT4/HCPCS,Excision of tongue lesion,,Case Rate,3000.00
Cigna,PPO,41114,CPT4/HCPCS,Excision of tongue lesion,,Case Rate,3000.00
Cigna,PPO,41115,CPT4/HCPCS,Excision of tongue fold,,Case Rate,3000.00
Cigna,PPO,41116,CPT4/HCPCS,Excision of mouth lesion,,Case Rate,3000.00
Cigna,PPO,41120,CPT4/HCPCS,Partial removal of tongue,,Case Rate,5000.00
Cigna,PPO,412,DRG,Cholecystectomy w c.d.e. w CC,,Case Rate,58030.35
Cigna,PPO,41250,CPT4/HCPCS,Repair tongue laceration,,Case Rate,3000.00
Cigna,PPO,41251,CPT4/HCPCS,Repair tongue laceration,,Case Rate,3000.00
Cigna,PPO,41252,CPT4/HCPCS,Repair tongue laceration,,Case Rate,3000.00
Cigna,PPO,413,DRG,Cholecystectomy w c.d.e. w/o CC/MCC,,Case Rate,44150.70
Cigna,PPO,414,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w MCC,,Case Rate,92450.25
Cigna,PPO,415,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w CC,,Case Rate,51813.45
Cigna,PPO,41510,CPT4/HCPCS,Tongue to lip surgery,,Case Rate,3000.00
Cigna,PPO,41512,CPT4/HCPCS,TONGUE BASE SUSPENSION, PERMANENT SUTURE TECHNIQUE,,Case Rate,4000.00
Cigna,PPO,41520,CPT4/HCPCS,Reconstruction, tongue fold,,Case Rate,3000.00
Cigna,PPO,41530,CPT4/HCPCS,SUBMUCOSAL ABLATION OF THE TONGUE BASE, RADIOFREQUENCY, ONE OR MORE SITES, PER SESSION,,Case Rate,6000.00
Cigna,PPO,416,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC,,Case Rate,36266.10
Cigna,PPO,417,DRG,Laparoscopic cholecystectomy w/o c.d.e. w MCC,,Case Rate,61799.25
Cigna,PPO,418,DRG,Laparoscopic cholecystectomy w/o c.d.e. w CC,,Case Rate,43046.55
Cigna,PPO,41800,CPT4/HCPCS,Drainage of gum lesion,,Case Rate,3000.00
Cigna,PPO,41805,CPT4/HCPCS,Removal foreign body, gum,,Case Rate,3000.00
Cigna,PPO,41806,CPT4/HCPCS,Removal foreign body, jawbone,,Case Rate,3000.00
Cigna,PPO,41820,CPT4/HCPCS,GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT ,,Case Rate,3000.00
Cigna,PPO,41821,CPT4/HCPCS,OPERCULECTOMY, EXCISION PERICORONAL TISSUES ,,Case Rate,3000.00
Cigna,PPO,41822,CPT4/HCPCS,EXCISION OF FIBROUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES ,,Case Rate,3000.00
Cigna,PPO,41823,CPT4/HCPCS,EXCISION OF OSSEOUS TUBEROSITIES, DENTOALVEOLAR STRUCTURES ,,Case Rate,3000.00
Cigna,PPO,41825,CPT4/HCPCS,EXCIS OF LESION/TUMOR DENTOALVEOLAR STUCTURES; WITHOUT REPAIR ,,Case Rate,3000.00
Cigna,PPO,41826,CPT4/HCPCS,EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE), DENTOALVEOLAR STRUCTURES; WITH SIMPLE REPAIR ,,Case Rate,3000.00
Cigna,PPO,41827,CPT4/HCPCS,Excision of gum lesion,,Case Rate,3000.00
Cigna,PPO,41828,CPT4/HCPCS,EXCISION OF HYPERPLASTIC ALVEOLAR MUCOSA, EACH SEXTANT OR QUADRANT (SPECIFY) ,,Case Rate,3000.00
Cigna,PPO,41830,CPT4/HCPCS,ALVEOLECTOMY, INCLUDING CURETTAGE OF OSTEITIS OR SEQUESTRECTOMY ,,Case Rate,3000.00
Cigna,PPO,41850,CPT4/HCPCS,DESTRUC OF LESION (EXCEPT EXC) DENTOALVEOLAR STRUCTURES ,,Case Rate,3000.00
Cigna,PPO,41870,CPT4/HCPCS,PERIODONTAL MUCOSAL GRAFTING ,,Case Rate,3000.00
Cigna,PPO,41874,CPT4/HCPCS,ALVEOLOPLASTY, EACH QUADRANT (SPECIFY) ,,Case Rate,3000.00
Cigna,PPO,41899,CPT4/HCPCS,Unlisted procedure, dentoalveolar structures,,Case Rate,3000.00
Cigna,PPO,419,DRG,Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC,,Case Rate,33537.60
Cigna,PPO,42,DRG,Periph/cranial nerve & other nerv syst proc w/o CC/MCC,,Case Rate,48064.95
Cigna,PPO,420,DRG,Hepatobiliary diagnostic procedures w MCC,,Case Rate,89609.55
Cigna,PPO,42000,CPT4/HCPCS,Drainage mouth roof lesion,,Case Rate,3000.00
Cigna,PPO,421,DRG,Hepatobiliary diagnostic procedures w CC,,Case Rate,48676.95
Cigna,PPO,42100,CPT4/HCPCS,Biopsy of palate, uvula,,Case Rate,3000.00
Cigna,PPO,42104,CPT4/HCPCS,Excision lesion, mouth roof,,Case Rate,3000.00
Cigna,PPO,42106,CPT4/HCPCS,Excision lesion, mouth roof,,Case Rate,3000.00
Cigna,PPO,42107,CPT4/HCPCS,Excision lesion, mouth roof,,Case Rate,3000.00
Cigna,PPO,42120,CPT4/HCPCS,Remove palate/lesion,,Case Rate,4000.00
Cigna,PPO,42140,CPT4/HCPCS,Excision of uvula,,Case Rate,3000.00
Cigna,PPO,42145,CPT4/HCPCS,Repair palate, pharynx/uvula,,Case Rate,5000.00
Cigna,PPO,42160,CPT4/HCPCS,Treatment mouth roof lesion,,Case Rate,3000.00
Cigna,PPO,42180,CPT4/HCPCS,Repair palate,,Case Rate,3000.00
Cigna,PPO,42182,CPT4/HCPCS,Repair palate,,Case Rate,3000.00
Cigna,PPO,422,DRG,Hepatobiliary diagnostic procedures w/o CC/MCC,,Case Rate,37010.70
Cigna,PPO,42200,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,5000.00
Cigna,PPO,42205,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,5000.00
Cigna,PPO,42210,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,5000.00
Cigna,PPO,42215,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,6000.00
Cigna,PPO,42220,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,5000.00
Cigna,PPO,42225,CPT4/HCPCS,Reconstruct cleft palate,,Case Rate,5000.00
Cigna,PPO,42226,CPT4/HCPCS,Lengthening of palate,,Case Rate,5000.00
Cigna,PPO,42235,CPT4/HCPCS,Repair palate,,Case Rate,5000.00
Cigna,PPO,42260,CPT4/HCPCS,Repair nose to lip fistula,,Case Rate,4000.00
Cigna,PPO,42280,CPT4/HCPCS,Maxillary impression for palatal prosthesis,,Case Rate,400.00
Cigna,PPO,42281,CPT4/HCPCS,Insertion, palate prosthesis,,Case Rate,4000.00
Cigna,PPO,423,DRG,Other hepatobiliary or pancreas O.R. procedures w MCC,,Case Rate,106564.50
Cigna,PPO,42300,CPT4/HCPCS,Drainage of salivary gland,,Case Rate,3000.00
Cigna,PPO,42305,CPT4/HCPCS,Drainage of salivary gland,,Case Rate,3000.00
Cigna,PPO,42310,CPT4/HCPCS,Drainage of salivary gland,,Case Rate,3000.00
Cigna,PPO,42320,CPT4/HCPCS,Drainage of salivary gland,,Case Rate,3000.00
Cigna,PPO,42330,CPT4/HCPCS,Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral,,Case Rate,3000.00
Cigna,PPO,42335,CPT4/HCPCS,Removal of salivary stone,,Case Rate,4000.00
Cigna,PPO,42340,CPT4/HCPCS,Removal of salivary stone,,Case Rate,3000.00
Cigna,PPO,424,DRG,Other hepatobiliary or pancreas O.R. procedures w CC,,Case Rate,58180.80
Cigna,PPO,42400,CPT4/HCPCS,Biopsy of salivary gland; needle,,Case Rate,3000.00
Cigna,PPO,42405,CPT4/HCPCS,Biopsy of salivary gland,,Case Rate,3000.00
Cigna,PPO,42408,CPT4/HCPCS,Excision of salivary cyst,,Case Rate,4000.00
Cigna,PPO,42409,CPT4/HCPCS,Drainage of salivary cyst,,Case Rate,4000.00
Cigna,PPO,42410,CPT4/HCPCS,Excise parotid gland/lesion,,Case Rate,4000.00
Cigna,PPO,42415,CPT4/HCPCS,Excise parotid gland/lesion,,Case Rate,6000.00
Cigna,PPO,42420,CPT4/HCPCS,Excise parotid gland/lesion,,Case Rate,6000.00
Cigna,PPO,42425,CPT4/HCPCS,Excise parotid gland/lesion,,Case Rate,6000.00
Cigna,PPO,42440,CPT4/HCPCS,Excise submaxillary gland,,Case Rate,4000.00
Cigna,PPO,42450,CPT4/HCPCS,Excise sublingual gland,,Case Rate,3000.00
Cigna,PPO,425,DRG,Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC,,Case Rate,39354.15
Cigna,PPO,42500,CPT4/HCPCS,Repair salivary duct,,Case Rate,4000.00
Cigna,PPO,42505,CPT4/HCPCS,Repair salivary duct,,Case Rate,4000.00
Cigna,PPO,42507,CPT4/HCPCS,Parotid duct diversion,,Case Rate,4000.00
Cigna,PPO,42509,CPT4/HCPCS,Parotid duct diversion,,Case Rate,4000.00
Cigna,PPO,42510,CPT4/HCPCS,Parotid duct diversion,,Case Rate,4000.00
Cigna,PPO,42550,CPT4/HCPCS,Injection procedure for sialography,,Case Rate,3000.00
Cigna,PPO,42600,CPT4/HCPCS,Closure of salivary fistula,,Case Rate,3000.00
Cigna,PPO,42650,CPT4/HCPCS,Dilation salivary duct,,Case Rate,3000.00
Cigna,PPO,42660,CPT4/HCPCS,Dilation and catheterization of salivary duct, with or without injection,,Case Rate,400.00
Cigna,PPO,42665,CPT4/HCPCS,Ligation of salivary duct,,Case Rate,6000.00
Cigna,PPO,42699,CPT4/HCPCS,UNLISTED PROCEDURE, SALIVARY GLANDS OR DUCTS ,,Case Rate,3000.00
Cigna,PPO,42700,CPT4/HCPCS,Drainage of tonsil abscess,,Case Rate,3000.00
Cigna,PPO,42720,CPT4/HCPCS,Drainage of throat abscess,,Case Rate,3000.00
Cigna,PPO,42725,CPT4/HCPCS,Drainage of throat abscess,,Case Rate,3000.00
Cigna,PPO,42800,CPT4/HCPCS,Biopsy; oropharynx,,Case Rate,3000.00
Cigna,PPO,42804,CPT4/HCPCS,Biopsy of upper nose/throat,,Case Rate,3000.00
Cigna,PPO,42806,CPT4/HCPCS,Biopsy of upper nose/throat,,Case Rate,3000.00
Cigna,PPO,42808,CPT4/HCPCS,Excise pharynx lesion,,Case Rate,3000.00
Cigna,PPO,42809,CPT4/HCPCS,Removal of foreign body from pharynx,,Case Rate,3000.00
Cigna,PPO,42810,CPT4/HCPCS,Excision of neck cyst,,Case Rate,4000.00
Cigna,PPO,42815,CPT4/HCPCS,Excision of neck cyst,,Case Rate,5000.00
Cigna,PPO,42820,CPT4/HCPCS,Remove tonsils and adenoids,,Case Rate,4000.00
Cigna,PPO,42821,CPT4/HCPCS,Remove tonsils and adenoids,,Case Rate,5000.00
Cigna,PPO,42825,CPT4/HCPCS,Removal of tonsils,,Case Rate,4000.00
Cigna,PPO,42826,CPT4/HCPCS,Removal of tonsils,,Case Rate,4000.00
Cigna,PPO,42830,CPT4/HCPCS,Removal of adenoids,,Case Rate,4000.00
Cigna,PPO,42831,CPT4/HCPCS,Removal of adenoids,,Case Rate,4000.00
Cigna,PPO,42835,CPT4/HCPCS,Removal of adenoids,,Case Rate,4000.00
Cigna,PPO,42836,CPT4/HCPCS,Removal of adenoids,,Case Rate,4000.00
Cigna,PPO,42860,CPT4/HCPCS,Excision of tonsil tags,,Case Rate,4000.00
Cigna,PPO,42870,CPT4/HCPCS,Excision of lingual tonsil,,Case Rate,4000.00
Cigna,PPO,42890,CPT4/HCPCS,Partial removal of pharynx,,Case Rate,6000.00
Cigna,PPO,42892,CPT4/HCPCS,Revision of pharyngeal walls,,Case Rate,6000.00
Cigna,PPO,42900,CPT4/HCPCS,Repair throat wound,,Case Rate,3000.00
Cigna,PPO,42950,CPT4/HCPCS,Reconstruction of throat,,Case Rate,3000.00
Cigna,PPO,42955,CPT4/HCPCS,Surgical opening of throat,,Case Rate,3000.00
Cigna,PPO,42960,CPT4/HCPCS,Control throat bleeding,,Case Rate,3000.00
Cigna,PPO,42962,CPT4/HCPCS,Control throat bleeding,,Case Rate,3000.00
Cigna,PPO,42970,CPT4/HCPCS,Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy);simple, with posterior nasal packs, with or without anterior packs and/or cauterization,,Case Rate,400.00
Cigna,PPO,42972,CPT4/HCPCS,Control nose/throat bleeding,,Case Rate,4000.00
Cigna,PPO,42999,CPT4/HCPCS,UNLISTED PROCEDURE, PHARYNX, ADENOIDS OR TONSILS ,,Case Rate,3000.00
Cigna,PPO,43130,CPT4/HCPCS,Diverticulectomy of hypopharynx or esophagus, with or without myotomy; cervical approach,,Case Rate,3000.00
Cigna,PPO,43180,CPT4/HCPCS, ESOPHAGOSCOPY, RIGID, TRANSORAL WITH DIVERTICULECTOMY OF HYPOPHARYNX OR CERVICAL ESOPHAGUS (EG, ZENKER'S DIVERTICULUM), WITH CRICOPHARYNGEAL MYOTOMY, INCLUDES USE OF TELESCOPE OR OPERATING MICROSCOPE AND REPAIR, WHEN PERFORMED,,Case Rate,8300.00
Cigna,PPO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Case Rate,4000.00
Cigna,PPO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Case Rate,5000.00
Cigna,PPO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Case Rate,5000.00
Cigna,PPO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Case Rate,5000.00
Cigna,PPO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Case Rate,5000.00
Cigna,PPO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Case Rate,5000.00
Cigna,PPO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Case Rate,4000.00
Cigna,PPO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Case Rate,4000.00
Cigna,PPO,432,DRG,Cirrhosis & alcoholic hepatitis w MCC,,Case Rate,47993.55
Cigna,PPO,43200,CPT4/HCPCS,Esophagus endoscopy,,Case Rate,3000.00
Cigna,PPO,43201,CPT4/HCPCS,Esoph scope w/submucous inj,,Case Rate,3000.00
Cigna,PPO,43202,CPT4/HCPCS,Esophagus endoscopy, biopsy,,Case Rate,3000.00
Cigna,PPO,43204,CPT4/HCPCS,Esophagus endoscopy & inject,,Case Rate,3000.00
Cigna,PPO,43205,CPT4/HCPCS,Esophagus endoscopy/ligation,,Case Rate,3000.00
Cigna,PPO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Case Rate,5000.00
Cigna,PPO,43210,CPT4/HCPCS,ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ESOPHAGOGASTRIC FUNDOPLASTY, PARTIAL OR COMPLETE, INCLUDES DUODENOSCOPY WHEN PERFORMED,,Case Rate,8300.00
Cigna,PPO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Case Rate,4000.00
Cigna,PPO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Case Rate,8300.00
Cigna,PPO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Case Rate,5000.00
Cigna,PPO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Case Rate,5000.00
Cigna,PPO,43215,CPT4/HCPCS,Esophagus endoscopy,,Case Rate,3000.00
Cigna,PPO,43216,CPT4/HCPCS,Esophagus endoscopy/lesion,,Case Rate,3000.00
Cigna,PPO,43217,CPT4/HCPCS,Esophagus endoscopy,,Case Rate,3000.00
Cigna,PPO,43220,CPT4/HCPCS,Esoph endoscopy, dilation,,Case Rate,3000.00
Cigna,PPO,43226,CPT4/HCPCS,Esoph endoscopy, dilation,,Case Rate,3000.00
Cigna,PPO,43227,CPT4/HCPCS,Esoph endoscopy, repair,,Case Rate,3000.00
Cigna,PPO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Case Rate,8300.00
Cigna,PPO,43231,CPT4/HCPCS,Esoph endoscopy w/us exam,,Case Rate,3000.00
Cigna,PPO,43232,CPT4/HCPCS,Esoph endoscopy w/us fn bx,,Case Rate,3000.00
Cigna,PPO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Case Rate,5000.00
Cigna,PPO,43235,CPT4/HCPCS,Uppr gi endoscopy, diagnosis,,Case Rate,3000.00
Cigna,PPO,43236,CPT4/HCPCS,Uppr gi scope w/submuc inj,,Case Rate,3000.00
Cigna,PPO,43237,CPT4/HCPCS,Endoscopic us exam, esoph,,Case Rate,3000.00
Cigna,PPO,43238,CPT4/HCPCS,Uppr gi endoscopy w/us fn bx,,Case Rate,3000.00
Cigna,PPO,43239,CPT4/HCPCS,Upper GI endoscopy, biopsy,,Case Rate,3000.00
Cigna,PPO,43240,CPT4/HCPCS,Esoph endoscope w/drain cyst,,Case Rate,3000.00
Cigna,PPO,43241,CPT4/HCPCS,Upper GI endoscopy with tube,,Case Rate,3000.00
Cigna,PPO,43242,CPT4/HCPCS,Uppr gi endoscopy w/us fn bx,,Case Rate,3000.00
Cigna,PPO,43243,CPT4/HCPCS,Upper gi endoscopy & inject,,Case Rate,3000.00
Cigna,PPO,43244,CPT4/HCPCS,Upper GI endoscopy/ligation,,Case Rate,3000.00
Cigna,PPO,43245,CPT4/HCPCS,Operative upper GI endoscopy,,Case Rate,3000.00
Cigna,PPO,43246,CPT4/HCPCS,Place gastrostomy tube,,Case Rate,3000.00
Cigna,PPO,43247,CPT4/HCPCS,Operative upper GI endoscopy,,Case Rate,3000.00
Cigna,PPO,43248,CPT4/HCPCS,Uppr gi endoscopy/guide wire,,Case Rate,3000.00
Cigna,PPO,43249,CPT4/HCPCS,Esoph endoscopy, dilation,,Case Rate,3000.00
Cigna,PPO,43250,CPT4/HCPCS,Upper GI endoscopy/tumor,,Case Rate,3000.00
Cigna,PPO,43251,CPT4/HCPCS,Operative upper GI endoscopy,,Case Rate,3000.00
Cigna,PPO,43252,CPT4/HCPCS,UPPR GI OPTICL ENDOMICRSCOPY,,Case Rate,5000.00
Cigna,PPO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Case Rate,5000.00
Cigna,PPO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Case Rate,4000.00
Cigna,PPO,43255,CPT4/HCPCS,Operative upper GI endoscopy,,Case Rate,3000.00
Cigna,PPO,43257,CPT4/HCPCS,Upper Gastrointestinal Endoscopy Including Esophagus, Stomach, And Either The Duodenum And/Or Jejunum As Appropriate; With Delivery Of Thermal Energy To The Muscle Of Lower Esophageal Sphincter And/Or Gastric Cardia, For Treatment Of Gastroesophageal Refl,,Case Rate,4000.00
Cigna,PPO,43259,CPT4/HCPCS,Endoscopic ultrasound exam,,Case Rate,4000.00
Cigna,PPO,43260,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,PPO,43261,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,PPO,43262,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,PPO,43263,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,PPO,43264,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,PPO,43265,CPT4/HCPCS,Endo cholangiopancreatograph,,Case Rate,3000.00
Cigna,PPO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Case Rate,8300.00
Cigna,PPO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Case Rate,5000.00
Cigna,PPO,43273,CPT4/HCPCS,ENDOSCOPIC CANNULATION OF PAPILLA WITH DIRECT VISUALIZATION OF COMMON BILE DUCT(S) AND/OR PANCREATIC DUCT(S) (LIST SEPARATELY IN ADDITION TO CODE(S) FOR PRIMARY PROCEDURE),,Case Rate,8300.00
Cigna,PPO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Case Rate,8300.00
Cigna,PPO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Case Rate,8300.00
Cigna,PPO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Case Rate,8300.00
Cigna,PPO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Case Rate,8300.00
Cigna,PPO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Case Rate,8300.00
Cigna,PPO,43280,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY (EG, NISSEN, TOUPET PROCEDURES),,Case Rate,5000.00
Cigna,PPO,43281,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITHOUT IMPLANTATION OF MESH,,Case Rate,3000.00
Cigna,PPO,43282,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH IMPLANTATION OF MESH ,,Case Rate,3000.00
Cigna,PPO,43284,CPT4/HCPCS,Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed,,Case Rate,3000.00
Cigna,PPO,43285,CPT4/HCPCS,Removal of esophageal sphincter augmentation device,,Case Rate,3000.00
Cigna,PPO,43289,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, ESOPHAGUS,,Case Rate,3000.00
Cigna,PPO,433,DRG,Cirrhosis & alcoholic hepatitis w CC,,Case Rate,26226.75
Cigna,PPO,434,DRG,Cirrhosis & alcoholic hepatitis w/o CC/MCC,,Case Rate,15799.80
Cigna,PPO,43420,CPT4/HCPCS,CLOSURE ESOPHAGOSTOMY OR FISTULA, CERVICAL ,,Case Rate,3000.00
Cigna,PPO,43450,CPT4/HCPCS,Dilate esophagus,,Case Rate,3000.00
Cigna,PPO,43453,CPT4/HCPCS,Dilate esophagus,,Case Rate,3000.00
Cigna,PPO,43499,CPT4/HCPCS,UNLISTED PROCEDURE, ESOPHAGUS ,,Case Rate,3000.00
Cigna,PPO,435,DRG,Malignancy of hepatobiliary system or pancreas w MCC,,Case Rate,44696.40
Cigna,PPO,436,DRG,Malignancy of hepatobiliary system or pancreas w CC,,Case Rate,28565.10
Cigna,PPO,43647,CPT4/HCPCS,"Lap impl electrode, antrum",,Case Rate,8300.00
Cigna,PPO,43648,CPT4/HCPCS,Lap revise/remv eltrd antrum,,Case Rate,8300.00
Cigna,PPO,43651,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, TRUNCAL,,Case Rate,5000.00
Cigna,PPO,43652,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; TRANSECTION OF VAGUS NERVES, SELECTIVE OR HIGHLY SELECTIVE,,Case Rate,5000.00
Cigna,PPO,43653,CPT4/HCPCS,Laparoscopy, gastrostomy,,Case Rate,8300.00
Cigna,PPO,43659,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, STOMACH,,Case Rate,3000.00
Cigna,PPO,437,DRG,Malignancy of hepatobiliary system or pancreas w/o CC/MCC,,Case Rate,22809.75
Cigna,PPO,43752,CPT4/HCPCS,Naso- or oro-gastric tube placement, necessitating physician's skill,,Case Rate,400.00
Cigna,PPO,43753,CPT4/HCPCS,GASTRIC INTUBATION AND ASPIRATION(S) THERAPEUTIC, NECESSITATING PHYSICIAN'S SKILL (EG, FOR GASTROINTESTINAL HEMORRHAGE), INCLUDING LAVAGE IF PERFORMED,,Case Rate,3000.00
Cigna,PPO,43754,CPT4/HCPCS,GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC; SINGLE SPECIMEN (EG, ACID ANALYSIS),,Case Rate,3000.00
Cigna,PPO,43755,CPT4/HCPCS,GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC; COLLECTION OF MULTIPLE FRACTIONAL SPECIMENS WITH GASTRIC STIMULATION, SINGLE OR DOUBLE LUMEN TUBE (GASTRIC SECRETORY STUDY) (EG, HISTAMINE, INSULIN, PENTAGASTRIN, CALCIUM, SECRETIN), INCLUDES DRUG ADMINISTRAT,,Case Rate,3000.00
Cigna,PPO,43756,CPT4/HCPCS,DUODENAL INTUBATION AND ASPIRATION, DIAGNOSTIC, INCLUDES IMAGE GUIDANCE; SINGLE SPECIMEN (EG, BILE STUDY FOR CRYSTALS OR AFFERENT LOOP CULTURE),,Case Rate,3000.00
Cigna,PPO,43757,CPT4/HCPCS,DUODENAL INTUBATION AND ASPIRATION, DIAGNOSTIC, INCLUDES IMAGE GUIDANCE; COLLECTION OF MULTIPLE FRACTIONAL SPECIMENS WITH PANCREATIC OR GALLBLADDER STIMULATION, SINGLE OR DOUBLE LUMEN TUBE, INCLUDES DRUG ADMINISTRATION,,Case Rate,3000.00
Cigna,PPO,43761,CPT4/HCPCS,Repositioning of the gastric feeding tube through the duodenum for enteric nutrition,,Case Rate,3000.00
Cigna,PPO,43762,CPT4/HCPCS,Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract ,,Case Rate,3000.00
Cigna,PPO,43763,CPT4/HCPCS,Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract ,,Case Rate,3000.00
Cigna,PPO,43770,CPT4/HCPCS,Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric band (gastric band and subcutaneous port components),,Case Rate,3000.00
Cigna,PPO,43771,CPT4/HCPCS,Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric band component only,,Case Rate,3000.00
Cigna,PPO,43772,CPT4/HCPCS,Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band component only,,Case Rate,3000.00
Cigna,PPO,43773,CPT4/HCPCS,Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric band component only,,Case Rate,3000.00
Cigna,PPO,43774,CPT4/HCPCS,Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric band and subcutaneous port components,,Case Rate,3000.00
Cigna,PPO,438,DRG,Disorders of pancreas except malignancy w MCC,,Case Rate,40705.65
Cigna,PPO,43870,CPT4/HCPCS,Repair stomach opening,,Case Rate,3000.00
Cigna,PPO,43886,CPT4/HCPCS,Gastric restrictive procedure, open; revision of subcutaneous port component only,,Case Rate,3000.00
Cigna,PPO,43887,CPT4/HCPCS,Gastric restrictive procedure, open; removal of subcutaneous port component only,,Case Rate,3000.00
Cigna,PPO,43888,CPT4/HCPCS,Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only,,Case Rate,3000.00
Cigna,PPO,439,DRG,Disorders of pancreas except malignancy w CC,,Case Rate,21532.20
Cigna,PPO,43999,CPT4/HCPCS,UNLISTED PROCEDURE, STOMACH ,,Case Rate,3000.00
Cigna,PPO,440,DRG,Disorders of pancreas except malignancy w/o CC/MCC,,Case Rate,15450.45
Cigna,PPO,44005,CPT4/HCPCS,ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) FOR ACUTE BOWEL OBSTRUCTION (SEPARATE PROCEDURE),,Case Rate,3000.00
Cigna,PPO,44010,CPT4/HCPCS,DUODENOTOMY, FOR EXPLORATION, BIOPSY(S), OR FOREIGN BODY REMOVAL.,,Case Rate,3000.00
Cigna,PPO,44020,CPT4/HCPCS,ENTEROTOMY, SMALL INTESTINE, OTHER THAN DUODENUM; FOR EXPLORATION , BIOPSY(S),OR FOREIGN BODY REMOVAL,,Case Rate,3000.00
Cigna,PPO,44025,CPT4/HCPCS,COLOTOMY, FOR EXPLORATION, BIPSY(S), OR FOREIGN BODY REMOVAL,,Case Rate,3000.00
Cigna,PPO,44050,CPT4/HCPCS,REDUCTION OF VOLVULUS, INTUSSUSCEPTION, INTERNAL HERNIA, BY LAPAROTOMY,,Case Rate,3000.00
Cigna,PPO,44055,CPT4/HCPCS,CORRECTION OF MALROTATION BY LYSIS OF DUODENAL BANDS AND/OR REDUCTION OF MIDGUT VOLVULUS (EG, LADD PROCEDURE),,Case Rate,3000.00
Cigna,PPO,441,DRG,Disorders of liver except malig,cirr,alc hepa w MCC,,Case Rate,48034.35
Cigna,PPO,44100,CPT4/HCPCS,Biopsy of bowel,,Case Rate,3000.00
Cigna,PPO,44180,CPT4/HCPCS,Laparoscopy, surgical, enterolysis (freeing of intestinal adhesion) (separate procedure),,Case Rate,5000.00
Cigna,PPO,44186,CPT4/HCPCS,Laparoscopy, surgical; jejunostomy (eg, for decompression or feeding),,Case Rate,5000.00
Cigna,PPO,44187,CPT4/HCPCS,Laparoscopy, surgical; ileostomy or jejunostomy, non-tube,,Case Rate,3000.00
Cigna,PPO,44188,CPT4/HCPCS,Laparoscopy, surgical, colostomy or skin level cecostomy,,Case Rate,3000.00
Cigna,PPO,442,DRG,Disorders of liver except malig,cirr,alc hepa w CC,,Case Rate,23755.80
Cigna,PPO,44202,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; INTESTINAL RESECTION, WITH ANASTOMOSIS (INTRA OR EXTRACORPOREAL),,Case Rate,3000.00
Cigna,PPO,44213,CPT4/HCPCS,Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure),,Case Rate,3000.00
Cigna,PPO,44227,CPT4/HCPCS,Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomosis,,Case Rate,3000.00
Cigna,PPO,443,DRG,Disorders of liver except malig,cirr,alc hepa w/o CC/MCC,,Case Rate,16901.40
Cigna,PPO,44312,CPT4/HCPCS,Revision of ileostomy,,Case Rate,3000.00
Cigna,PPO,44340,CPT4/HCPCS,Revision of colostomy,,Case Rate,4000.00
Cigna,PPO,44345,CPT4/HCPCS,Revision of colostomy,,Case Rate,3000.00
Cigna,PPO,44346,CPT4/HCPCS,Revision of colostomy,,Case Rate,3000.00
Cigna,PPO,44360,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44361,CPT4/HCPCS,Small bowel endoscopy/biopsy,,Case Rate,3000.00
Cigna,PPO,44363,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44364,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44365,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44366,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44369,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44370,CPT4/HCPCS,Small bowel endoscopy/stent,,Case Rate,8300.00
Cigna,PPO,44372,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44373,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44376,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44377,CPT4/HCPCS,Small bowel endoscopy/biopsy,,Case Rate,3000.00
Cigna,PPO,44378,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44379,CPT4/HCPCS,S bowel endoscope w/stent,,Case Rate,8300.00
Cigna,PPO,44380,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44381,CPT4/HCPCS, ILEOSCOPY, THROUGH STOMA; WITH TRANSENDOSCOPIC BALLOON DILATION,,Case Rate,4000.00
Cigna,PPO,44382,CPT4/HCPCS,Small bowel endoscopy,,Case Rate,3000.00
Cigna,PPO,44384,CPT4/HCPCS, ILEOSCOPY, THROUGH STOMA; WITH PLACEMENT OF ENDOSCOPIC STENT (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,PPO,44385,CPT4/HCPCS,Endoscopy of bowel pouch,,Case Rate,3000.00
Cigna,PPO,44386,CPT4/HCPCS,Endoscopy, bowel pouch/biop,,Case Rate,3000.00
Cigna,PPO,44388,CPT4/HCPCS,Colon endoscopy,,Case Rate,3000.00
Cigna,PPO,44389,CPT4/HCPCS,Colonoscopy with biopsy,,Case Rate,3000.00
Cigna,PPO,44390,CPT4/HCPCS,Colonoscopy for foreign body,,Case Rate,3000.00
Cigna,PPO,44391,CPT4/HCPCS,Colonoscopy for bleeding,,Case Rate,3000.00
Cigna,PPO,44392,CPT4/HCPCS,Colonoscopy & polypectomy,,Case Rate,3000.00
Cigna,PPO,44394,CPT4/HCPCS,Colonoscopy w/snare,,Case Rate,3000.00
Cigna,PPO,444,DRG,Disorders of the biliary tract w MCC,,Case Rate,42554.40
Cigna,PPO,44401,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE-AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,PPO,44402,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH ENDOSCOPIC STENT PLACEMENT (INCLUDING PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,PPO,44403,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH ENDOSCOPIC MUCOSAL RESECTION,,Case Rate,4000.00
Cigna,PPO,44404,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE,,Case Rate,4000.00
Cigna,PPO,44405,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH TRANSENDOSCOPIC BALLOON DILATION,,Case Rate,4000.00
Cigna,PPO,44406,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH ENDOSCOPIC ULTRASOUND EXAMINATION, LIMITED TO THE SIGMOID, DESCENDING, TRANSVERSE, OR ASCENDING COLON AND CECUM AND ADJACENT STRUCTURES,,Case Rate,4000.00
Cigna,PPO,44407,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S), INCLUDES ENDOSCOPIC ULTRASOUND EXAMINATION LIMITED TO THE SIGMOID, DESCENDING, TRANSVERSE, OR ASCENDING COLON AND CECUM AND ADJAC,,Case Rate,4000.00
Cigna,PPO,44408,CPT4/HCPCS, COLONOSCOPY THROUGH STOMA; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOLVULUS, MEGACOLON), INCLUDING PLACEMENT OF DECOMPRESSION TUBE, WHEN PERFORMED,,Case Rate,4000.00
Cigna,PPO,445,DRG,Disorders of the biliary tract w CC,,Case Rate,27458.40
Cigna,PPO,446,DRG,Disorders of the biliary tract w/o CC/MCC,,Case Rate,20813.10
Cigna,PPO,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,Case Rate,3000.00
Cigna,PPO,44799,CPT4/HCPCS,UNLISTED PROCEDURE, INTESTINE ,,Case Rate,3000.00
Cigna,PPO,44950,CPT4/HCPCS,Appendectomy;,,Case Rate,3000.00
Cigna,PPO,44970,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, APPENDECTOMY,,Case Rate,4000.00
Cigna,PPO,44979,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX,,Case Rate,3000.00
Cigna,PPO,45000,CPT4/HCPCS,Drainage of pelvic abscess,,Case Rate,3000.00
Cigna,PPO,45005,CPT4/HCPCS,Drainage of rectal abscess,,Case Rate,3000.00
Cigna,PPO,45020,CPT4/HCPCS,Drainage of rectal abscess,,Case Rate,3000.00
Cigna,PPO,45100,CPT4/HCPCS,Biopsy of rectum,,Case Rate,3000.00
Cigna,PPO,45108,CPT4/HCPCS,Removal of anorectal lesion,,Case Rate,3000.00
Cigna,PPO,45150,CPT4/HCPCS,Excision of rectal stricture,,Case Rate,3000.00
Cigna,PPO,45160,CPT4/HCPCS,Excision of rectal lesion,,Case Rate,3000.00
Cigna,PPO,45171,CPT4/HCPCS,EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; NOT INCLUDING MUSC ULARIS PROPRIA (IE, PARTIAL THICKNESS) ,,Case Rate,3000.00
Cigna,PPO,45172,CPT4/HCPCS,EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; INCLUDING MUSCULAR IS PROPRIA (IE, FULL THICKNESS) ,,Case Rate,3000.00
Cigna,PPO,45190,CPT4/HCPCS,Destruction, rectal tumor,,Case Rate,8300.00
Cigna,PPO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,Case Rate,25500.00
Cigna,PPO,45300,CPT4/HCPCS,Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure),,Case Rate,3000.00
Cigna,PPO,45303,CPT4/HCPCS,Proctosigmoidoscopy, rigid; with dilation, any method,,Case Rate,3000.00
Cigna,PPO,45305,CPT4/HCPCS,Protosigmoidoscopy w/bx,,Case Rate,3000.00
Cigna,PPO,45307,CPT4/HCPCS,Protosigmoidoscopy fb,,Case Rate,3000.00
Cigna,PPO,45308,CPT4/HCPCS,Protosigmoidoscopy removal,,Case Rate,3000.00
Cigna,PPO,45309,CPT4/HCPCS,Protosigmoidoscopy removal,,Case Rate,3000.00
Cigna,PPO,45315,CPT4/HCPCS,Protosigmoidoscopy removal,,Case Rate,3000.00
Cigna,PPO,45317,CPT4/HCPCS,Protosigmoidoscopy bleed,,Case Rate,3000.00
Cigna,PPO,45320,CPT4/HCPCS,Protosigmoidoscopy ablate,,Case Rate,3000.00
Cigna,PPO,45321,CPT4/HCPCS,Protosigmoidoscopy volvul,,Case Rate,3000.00
Cigna,PPO,45327,CPT4/HCPCS,Proctosigmoidoscopy w/stent,,Case Rate,3000.00
Cigna,PPO,45330,CPT4/HCPCS,Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure),,Case Rate,3000.00
Cigna,PPO,45331,CPT4/HCPCS,Sigmoidoscopy and biopsy,,Case Rate,3000.00
Cigna,PPO,45332,CPT4/HCPCS,Sigmoidoscopy w/fb removal,,Case Rate,3000.00
Cigna,PPO,45333,CPT4/HCPCS,Sigmoidoscopy & polypectomy,,Case Rate,3000.00
Cigna,PPO,45334,CPT4/HCPCS,Sigmoidoscopy for bleeding,,Case Rate,3000.00
Cigna,PPO,45335,CPT4/HCPCS,Sigmoidoscope w/submub inj,,Case Rate,3000.00
Cigna,PPO,45337,CPT4/HCPCS,Sigmoidoscopy & decompress,,Case Rate,3000.00
Cigna,PPO,45338,CPT4/HCPCS,Sigmoidoscpy w/tumr remove,,Case Rate,3000.00
Cigna,PPO,45340,CPT4/HCPCS,Sig w/balloon dilation,,Case Rate,3000.00
Cigna,PPO,45341,CPT4/HCPCS,Sigmoidoscopy w/ultrasound,,Case Rate,3000.00
Cigna,PPO,45342,CPT4/HCPCS,Sigmoidoscopy w/us guide,,Case Rate,3000.00
Cigna,PPO,45346,CPT4/HCPCS, SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,PPO,45347,CPT4/HCPCS, SIGMOIDOSCOPY, FLEXIBLE; WITH PLACEMENT OF ENDOSCOPIC STENT (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,PPO,45349,CPT4/HCPCS, SIGMOIDOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION,,Case Rate,4000.00
Cigna,PPO,45350,CPT4/HCPCS, SIGMOIDOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS),,Case Rate,4000.00
Cigna,PPO,45378,CPT4/HCPCS,Diagnostic colonoscopy,,Case Rate,3000.00
Cigna,PPO,45379,CPT4/HCPCS,Colonoscopy w/fb removal,,Case Rate,3000.00
Cigna,PPO,45380,CPT4/HCPCS,Colonoscopy and biopsy,,Case Rate,3000.00
Cigna,PPO,45381,CPT4/HCPCS,Colonoscope, submucous inj,,Case Rate,3000.00
Cigna,PPO,45382,CPT4/HCPCS,Colonoscopy/control bleeding,,Case Rate,3000.00
Cigna,PPO,45384,CPT4/HCPCS,Lesion remove colonoscopy,,Case Rate,3000.00
Cigna,PPO,45385,CPT4/HCPCS,Lesion removal colonoscopy,,Case Rate,3000.00
Cigna,PPO,45386,CPT4/HCPCS,Colonoscope dilate stricture,,Case Rate,3000.00
Cigna,PPO,45388,CPT4/HCPCS, COLONOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,PPO,45389,CPT4/HCPCS, COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC STENT PLACEMENT (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED),,Case Rate,4000.00
Cigna,PPO,45390,CPT4/HCPCS, COLONOSCOPY, FLEXIBLE; WITH ENDOSCOPIC MUCOSAL RESECTION,,Case Rate,4000.00
Cigna,PPO,45391,CPT4/HCPCS,Colonoscopy w/endoscope,,Case Rate,3000.00
Cigna,PPO,45392,CPT4/HCPCS,Colonoscopy w/endoscopic,,Case Rate,3000.00
Cigna,PPO,45393,CPT4/HCPCS, COLONOSCOPY, FLEXIBLE; WITH DECOMPRESSION (FOR PATHOLOGIC DISTENTION) (EG, VOLVULUS, MEGACOLON), INCLUDING PLACEMENT OF DECOMPRESSION TUBE, WHEN PERFORMED,,Case Rate,4000.00
Cigna,PPO,45395,CPT4/HCPCS,Laparoscopy, surgical; proctectomy, complete, combined abdominoperineal, with colostomy,,Case Rate,3000.00
Cigna,PPO,45397,CPT4/HCPCS,Laparoscopy, surgical; proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal anastomosis), with creation of colonic reservoir (eg, J-pouch), with diverting enterostomy, when performed,,Case Rate,3000.00
Cigna,PPO,45398,CPT4/HCPCS, COLONOSCOPY, FLEXIBLE; WITH BAND LIGATION(S) (EG, HEMORRHOIDS),,Case Rate,4000.00
Cigna,PPO,45399,CPT4/HCPCS, UNLISTED PROCEDURE, COLON,,Case Rate,5000.00
Cigna,PPO,454,DRG,Combined anterior/posterior spinal fusion w CC,,Case Rate,25500.00
Cigna,PPO,45400,CPT4/HCPCS,Laparoscopy, surgical; proctopexy (for prolapse),,Case Rate,3000.00
Cigna,PPO,45402,CPT4/HCPCS,Laparoscopy, surgical; proctopexy (for prolapse), with sigmoid resection,,Case Rate,3000.00
Cigna,PPO,45499,CPT4/HCPCS,Unlisted laparoscopy procedure, rectum,,Case Rate,3000.00
Cigna,PPO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,Case Rate,25500.00
Cigna,PPO,45500,CPT4/HCPCS,Repair of rectum,,Case Rate,3000.00
Cigna,PPO,45505,CPT4/HCPCS,Repair of rectum,,Case Rate,3000.00
Cigna,PPO,45520,CPT4/HCPCS,PERIRECTAL INJECTION OF SCLEROSING SOLUTION FOR PROLAPSE, ,,Case Rate,3000.00
Cigna,PPO,45541,CPT4/HCPCS,PROCTOPEXY FOR PROLAPSE PERINEAL APPROACH ,,Case Rate,3000.00
Cigna,PPO,45560,CPT4/HCPCS,Repair of rectocele,,Case Rate,3000.00
Cigna,PPO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,Case Rate,25500.00
Cigna,PPO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,Case Rate,25500.00
Cigna,PPO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,Case Rate,25500.00
Cigna,PPO,459,DRG,Spinal fusion except cervical w MCC,,Case Rate,25500.00
Cigna,PPO,45900,CPT4/HCPCS,Reduction of rectal prolapse,,Case Rate,3000.00
Cigna,PPO,45905,CPT4/HCPCS,Dilation of anal sphincter,,Case Rate,3000.00
Cigna,PPO,45910,CPT4/HCPCS,Dilation of rectal narrowing,,Case Rate,3000.00
Cigna,PPO,45915,CPT4/HCPCS,Remove rectal obstruction,,Case Rate,3000.00
Cigna,PPO,45990,CPT4/HCPCS,Surg dx exam, anorectal,,Case Rate,3000.00
Cigna,PPO,460,DRG,Spinal fusion except cervical w/o MCC,,Case Rate,25500.00
Cigna,PPO,46020,CPT4/HCPCS,Placement of seton,,Case Rate,4000.00
Cigna,PPO,46030,CPT4/HCPCS,Removal of rectal marker,,Case Rate,3000.00
Cigna,PPO,46040,CPT4/HCPCS,Incision of rectal abscess,,Case Rate,4000.00
Cigna,PPO,46045,CPT4/HCPCS,Incision of rectal abscess,,Case Rate,3000.00
Cigna,PPO,46050,CPT4/HCPCS,Incision of anal abscess,,Case Rate,3000.00
Cigna,PPO,46060,CPT4/HCPCS,Incision of rectal abscess,,Case Rate,3000.00
Cigna,PPO,46070,CPT4/HCPCS,Incision, anal septum (infant),,Case Rate,3000.00
Cigna,PPO,46080,CPT4/HCPCS,Incision of anal sphincter,,Case Rate,4000.00
Cigna,PPO,46083,CPT4/HCPCS,Incision of thrombosed hemorrhoid, external ,,Case Rate,3000.00
Cigna,PPO,461,DRG,Bilateral or multiple major joint procs of lower extremity w MCC,,Case Rate,154943.10
Cigna,PPO,462,DRG,Bilateral or multiple major joint procs of lower extremity w/o MCC,,Case Rate,80177.10
Cigna,PPO,46200,CPT4/HCPCS,Removal of anal fissure,,Case Rate,3000.00
Cigna,PPO,46220,CPT4/HCPCS,Removal of anal tab,,Case Rate,3000.00
Cigna,PPO,46221,CPT4/HCPCS,Hemorrhoidectomy, by simple ligature (eg, rubber band),,Case Rate,3000.00
Cigna,PPO,46230,CPT4/HCPCS,Removal of anal tags,,Case Rate,3000.00
Cigna,PPO,46250,CPT4/HCPCS,Hemorrhoidectomy,,Case Rate,4000.00
Cigna,PPO,46255,CPT4/HCPCS,Hemorrhoidectomy,,Case Rate,4000.00
Cigna,PPO,46257,CPT4/HCPCS,Remove hemorrhoids & fissure,,Case Rate,4000.00
Cigna,PPO,46258,CPT4/HCPCS,Remove hemorrhoids & fistula,,Case Rate,4000.00
Cigna,PPO,46260,CPT4/HCPCS,Hemorrhoidectomy,,Case Rate,4000.00
Cigna,PPO,46261,CPT4/HCPCS,Remove hemorrhoids & fissure,,Case Rate,4000.00
Cigna,PPO,46262,CPT4/HCPCS,Remove hemorrhoids & fistula,,Case Rate,4000.00
Cigna,PPO,46270,CPT4/HCPCS,Removal of anal fistula,,Case Rate,4000.00
Cigna,PPO,46275,CPT4/HCPCS,Removal of anal fistula,,Case Rate,4000.00
Cigna,PPO,46280,CPT4/HCPCS,Removal of anal fistula,,Case Rate,4000.00
Cigna,PPO,46285,CPT4/HCPCS,Removal of anal fistula,,Case Rate,3000.00
Cigna,PPO,46288,CPT4/HCPCS,Repair anal fistula,,Case Rate,4000.00
Cigna,PPO,463,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC,,Case Rate,136817.70
Cigna,PPO,46320,CPT4/HCPCS,EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL ,,Case Rate,3000.00
Cigna,PPO,464,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC,,Case Rate,75849.75
Cigna,PPO,465,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC,,Case Rate,47011.80
Cigna,PPO,46505,CPT4/HCPCS,Chemodenervation of internal anal sphincter,,Case Rate,3000.00
Cigna,PPO,466,DRG,Revision of hip or knee replacement w MCC,,Case Rate,136297.50
Cigna,PPO,46600,CPT4/HCPCS,ANOSCOPY; DIAGNOSTIC (SEPARATE PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,46601,CPT4/HCPCS, ANOSCOPY; DIAGNOSTIC, WITH HIGH-RESOLUTION MAGNIFICATION (HRA) (EG, COLPOSCOPE, OPERATING MICROSCOPE) AND CHEMICAL AGENT ENHANCEMENT, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED,,Case Rate,3000.00
Cigna,PPO,46604,CPT4/HCPCS,ANOSCOPY; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE) ,,Case Rate,3000.00
Cigna,PPO,46606,CPT4/HCPCS,ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE,,Case Rate,3000.00
Cigna,PPO,46607,CPT4/HCPCS, ANOSCOPY; WITH HIGH-RESOLUTION MAGNIFICATION (HRA) (EG, COLPOSCOPE, OPERATING MICROSCOPE) AND CHEMICAL AGENT ENHANCEMENT, WITH BIOPSY, SINGLE OR MULTIPLE,,Case Rate,4000.00
Cigna,PPO,46608,CPT4/HCPCS,Anoscopy/ remove for body,,Case Rate,3000.00
Cigna,PPO,46610,CPT4/HCPCS,Anoscopy/remove lesion,,Case Rate,3000.00
Cigna,PPO,46611,CPT4/HCPCS,Anoscopy,,Case Rate,3000.00
Cigna,PPO,46612,CPT4/HCPCS,Anoscopy/ remove lesions,,Case Rate,3000.00
Cigna,PPO,46614,CPT4/HCPCS,ANOSCOPY; WITH CONTROL OF BLEEDING (EG, INJECTION, BIPOLAR CAUTERY, UNIPOLAR CAUTERY, LASER, HEATER PROBE, STAPLER, PLASMA COAGULATOR),,Case Rate,3000.00
Cigna,PPO,46615,CPT4/HCPCS,Anoscopy,,Case Rate,3000.00
Cigna,PPO,467,DRG,Revision of hip or knee replacement w CC,,Case Rate,91193.10
Cigna,PPO,46700,CPT4/HCPCS,Repair of anal stricture,,Case Rate,4000.00
Cigna,PPO,46706,CPT4/HCPCS,Repr of anal fistula w/glue,,Case Rate,3000.00
Cigna,PPO,46710,CPT4/HCPCS,Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; transperineal approach,,Case Rate,3000.00
Cigna,PPO,46712,CPT4/HCPCS,Repair of ileoanal pouch fistula/sinus (eg, perineal or vaginal), pouch advancement; combined transperineal and transabdominal approach,,Case Rate,3000.00
Cigna,PPO,46750,CPT4/HCPCS,Repair of anal sphincter,,Case Rate,4000.00
Cigna,PPO,46753,CPT4/HCPCS,Reconstruction of anus,,Case Rate,4000.00
Cigna,PPO,46754,CPT4/HCPCS,Removal of suture from anus,,Case Rate,3000.00
Cigna,PPO,46760,CPT4/HCPCS,Repair of anal sphincter,,Case Rate,3000.00
Cigna,PPO,46761,CPT4/HCPCS,Repair of anal sphincter,,Case Rate,4000.00
Cigna,PPO,468,DRG,Revision of hip or knee replacement w/o CC/MCC,,Case Rate,71502.00
Cigna,PPO,469,DRG,Major joint replacement or reattachment of lower extremity w MCC,,Case Rate,78652.20
Cigna,PPO,46900,CPT4/HCPCS,DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CHEMICAL,,Case Rate,3000.00
Cigna,PPO,46910,CPT4/HCPCS,DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION,,Case Rate,3000.00
Cigna,PPO,46916,CPT4/HCPCS,DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CRYOSURGERY,,Case Rate,400.00
Cigna,PPO,46917,CPT4/HCPCS,Laser surgery, anal lesions,,Case Rate,3000.00
Cigna,PPO,46922,CPT4/HCPCS,Excision of anal lesion(s),,Case Rate,3000.00
Cigna,PPO,46924,CPT4/HCPCS,Destruction, anal lesion(s),,Case Rate,3000.00
Cigna,PPO,46930,CPT4/HCPCS,DESTRUCTION OF INTERNAL HEMORRHOID(S) BY THERMAL ENERGY (EG, INFRARED COAGULATION, CAUTERY, RADIOFREQUENCY),,Case Rate,5000.00
Cigna,PPO,46940,CPT4/HCPCS,Curettage or cauterization of anal fissure, including dilation of anal sphincter (separate procedure); initial,,Case Rate,3000.00
Cigna,PPO,46942,CPT4/HCPCS,Curettage or cauterization of anal fissure, including dilation of anal sphincter (separate procedure); subsequent,,Case Rate,3000.00
Cigna,PPO,46945,CPT4/HCPCS,Ligation of internal hemorrhoids; single procedure,,Case Rate,3000.00
Cigna,PPO,46946,CPT4/HCPCS,Ligation of internal hemorrhoids; multiple procedures,,Case Rate,3000.00
Cigna,PPO,46947,CPT4/HCPCS,Hemorrhoidopexy by stapling,,Case Rate,6000.00
Cigna,PPO,46948,CPT4/HCPCS,Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed,,Case Rate,3000.00
Cigna,PPO,46999,CPT4/HCPCS,UNLISTED PROCEDURE, ANUS ,,Case Rate,3000.00
Cigna,PPO,470,DRG,Major joint replacement or reattachment of lower extremity w/o MCC,,Case Rate,48447.45
Cigna,PPO,47000,CPT4/HCPCS,Needle biopsy of liver,,Case Rate,3000.00
Cigna,PPO,47001,CPT4/HCPCS,BIOPSY OF LIVER, NEEDLE; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,471,DRG,Cervical spinal fusion w MCC,,Case Rate,25500.00
Cigna,PPO,472,DRG,Cervical spinal fusion w CC,,Case Rate,25500.00
Cigna,PPO,473,DRG,Cervical spinal fusion w/o CC/MCC,,Case Rate,25500.00
Cigna,PPO,47370,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, ABLATION OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY,,Case Rate,3000.00
Cigna,PPO,47371,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, ABLATION OF ONE OF MORE LIVER TUMOR(S); CRYOSURGICAL,,Case Rate,3000.00
Cigna,PPO,47379,CPT4/HCPCS,Unlisted laparoscopic procedure, liver,,Case Rate,3000.00
Cigna,PPO,47380,CPT4/HCPCS,ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); RADIOFREQUENCY,,Case Rate,3000.00
Cigna,PPO,47381,CPT4/HCPCS,ABLATION, OPEN, OF ONE OR MORE LIVER TUMOR(S); CRYOSURGICAL,,Case Rate,3000.00
Cigna,PPO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Case Rate,3000.00
Cigna,PPO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Case Rate,8300.00
Cigna,PPO,474,DRG,Amputation for musculoskeletal sys & conn tissue dis w MCC,,Case Rate,103856.40
Cigna,PPO,475,DRG,Amputation for musculoskeletal sys & conn tissue dis w CC,,Case Rate,55936.80
Cigna,PPO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Case Rate,3000.00
Cigna,PPO,47532,CPT4/HCPCS,INJECTION PROCEDURE FOR CHOLANGIOGRAPHY, PERCUTANEOUS, COMPLETE DIAGNOSTIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; NEW ACCESS (EG, PERCUTANEOUS TRANSHEPATIC C,,Case Rate,8300.00
Cigna,PPO,47533,CPT4/HCPCS,PLACEMENT OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; EXTERNAL,,Case Rate,8300.00
Cigna,PPO,47534,CPT4/HCPCS,PLACEMENT OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; INTERNAL-EXTERNAL,,Case Rate,8300.00
Cigna,PPO,47535,CPT4/HCPCS,CONVERSION OF EXTERNAL BILIARY DRAINAGE CATHETER TO INTERNAL-EXTERNAL BILIARY DRAINAGE CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPR,,Case Rate,8300.00
Cigna,PPO,47536,CPT4/HCPCS,EXCHANGE OF BILIARY DRAINAGE CATHETER (EG, EXTERNAL, INTERNAL-EXTERNAL, OR CONVERSION OF INTERNAL-EXTERNAL TO EXTERNAL ONLY), PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLO,,Case Rate,8300.00
Cigna,PPO,47537,CPT4/HCPCS,REMOVAL OF BILIARY DRAINAGE CATHETER, PERCUTANEOUS, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURRENT INDWELLING BILIARY STENTS), INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL S,,Case Rate,3000.00
Cigna,PPO,47538,CPT4/HCPCS,PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY, IMAGING GUIDANCE (EG, FLUOROSCOPY AND/OR ULTRASOUND), BALLOON DILATION, CATHETER EXCHANGE(S) AND CATHETER REMOVAL(S) WHEN PERFORMED, AND ALL ASSOCIATED RADIOLOGICA,,Case Rate,8300.00
Cigna,PPO,47539,CPT4/HCPCS,PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY, IMAGING GUIDANCE (EG, FLUOROSCOPY AND/OR ULTRASOUND), BALLOON DILATION, CATHETER EXCHANGE(S) AND CATHETER REMOVAL(S) WHEN PERFORMED, AND ALL ASSOCIATED RADIOLOGICA,,Case Rate,8300.00
Cigna,PPO,47540,CPT4/HCPCS,PLACEMENT OF STENT(S) INTO A BILE DUCT, PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY, IMAGING GUIDANCE (EG, FLUOROSCOPY AND/OR ULTRASOUND), BALLOON DILATION, CATHETER EXCHANGE(S) AND CATHETER REMOVAL(S) WHEN PERFORMED, AND ALL ASSOCIATED RADIOLOGICA,,Case Rate,8300.00
Cigna,PPO,47541,CPT4/HCPCS,PLACEMENT OF ACCESS THROUGH THE BILIARY TREE AND INTO SMALL BOWEL TO ASSIST WITH AN ENDOSCOPIC BILIARY PROCEDURE (EG, RENDEZVOUS PROCEDURE), PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROS,,Case Rate,8300.00
Cigna,PPO,47542,CPT4/HCPCS,BALLOON DILATION OF BILIARY DUCT(S) OR OF AMPULLA (SPHINCTEROPLASTY), PERCUTANEOUS, INCLUDING IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, EACH DUCT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PR,,Case Rate,3000.00
Cigna,PPO,47543,CPT4/HCPCS,ENDOLUMINAL BIOPSY(IES) OF BILIARY TREE, PERCUTANEOUS, ANY METHOD(S) (EG, BRUSH, FORCEPS, AND/OR NEEDLE), INCLUDING IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, SINGLE OR MULTIPLE (LIST SEPARATELY IN ,,Case Rate,3000.00
Cigna,PPO,47544,CPT4/HCPCS,REMOVAL OF CALCULI/DEBRIS FROM BILIARY DUCT(S) AND/OR GALLBLADDER, PERCUTANEOUS, INCLUDING DESTRUCTION OF CALCULI BY ANY METHOD (EG, MECHANICAL, ELECTROHYDRAULIC, LITHOTRIPSY) WHEN PERFORMED, IMAGING GUIDANCE (EG, FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOG,,Case Rate,3000.00
Cigna,PPO,47552,CPT4/HCPCS,Biliary endoscopy thru skin,,Case Rate,3000.00
Cigna,PPO,47553,CPT4/HCPCS,Biliary endoscopy thru skin,,Case Rate,4000.00
Cigna,PPO,47554,CPT4/HCPCS,Biliary endoscopy thru skin,,Case Rate,4000.00
Cigna,PPO,47555,CPT4/HCPCS,Biliary endoscopy thru skin,,Case Rate,4000.00
Cigna,PPO,47556,CPT4/HCPCS,Biliary endoscopy thru skin,,Case Rate,8300.00
Cigna,PPO,47562,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY,,Case Rate,8300.00
Cigna,PPO,47563,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY,,Case Rate,8300.00
Cigna,PPO,47564,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT,,Case Rate,8300.00
Cigna,PPO,47570,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; CHOLECYSTOENTEROSTOMY,,Case Rate,3000.00
Cigna,PPO,47579,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT,,Case Rate,3000.00
Cigna,PPO,476,DRG,Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC,,Case Rate,29574.90
Cigna,PPO,47600,CPT4/HCPCS,Cholecystectomy;,,Case Rate,3000.00
Cigna,PPO,47605,CPT4/HCPCS,CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY,,Case Rate,3000.00
Cigna,PPO,47610,CPT4/HCPCS,CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT;,,Case Rate,3000.00
Cigna,PPO,47612,CPT4/HCPCS,CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH CHOLEDOCHOENTEROSTOMY,,Case Rate,3000.00
Cigna,PPO,47620,CPT4/HCPCS,CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; WITH TRANSDUODENAL SPHINCTEROTOMY OR SPHINCTEROPLASTY, WITH OR WITHOUT CHOLANGIOGRAPHY,,Case Rate,3000.00
Cigna,PPO,477,DRG,Biopsies of musculoskeletal system & connective tissue w MCC,,Case Rate,85600.95
Cigna,PPO,478,DRG,Biopsies of musculoskeletal system & connective tissue w CC,,Case Rate,60100.95
Cigna,PPO,479,DRG,Biopsies of musculoskeletal system & connective tissue w/o CC/MCC,,Case Rate,46137.15
Cigna,PPO,480,DRG,Hip & femur procedures except major joint w MCC,,Case Rate,77124.75
Cigna,PPO,481,DRG,Hip & femur procedures except major joint w CC,,Case Rate,53435.25
Cigna,PPO,48102,CPT4/HCPCS,Needle biopsy, pancreas,,Case Rate,3000.00
Cigna,PPO,482,DRG,Hip & femur procedures except major joint w/o CC/MCC,,Case Rate,41993.40
Cigna,PPO,483,DRG,Major joint & limb reattachment proc of upper extremity w CC/MCC,,Case Rate,60850.65
Cigna,PPO,485,DRG,Knee procedures w pdx of infection w MCC,,Case Rate,86893.80
Cigna,PPO,486,DRG,Knee procedures w pdx of infection w CC,,Case Rate,54784.20
Cigna,PPO,487,DRG,Knee procedures w pdx of infection w/o CC/MCC,,Case Rate,41827.65
Cigna,PPO,488,DRG,Knee procedures w/o pdx of infection w CC/MCC,,Case Rate,50352.30
Cigna,PPO,489,DRG,Knee procedures w/o pdx of infection w/o CC/MCC,,Case Rate,33104.10
Cigna,PPO,49000,CPT4/HCPCS,Exploration of abdomen,,Case Rate,3000.00
Cigna,PPO,49010,CPT4/HCPCS,Exploration, retroperitoneal area with or without biopsy(s) (separate procedure),,Case Rate,3000.00
Cigna,PPO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Case Rate,3000.00
Cigna,PPO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Case Rate,3000.00
Cigna,PPO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Case Rate,3000.00
Cigna,PPO,49180,CPT4/HCPCS,Biopsy, abdominal mass,,Case Rate,3000.00
Cigna,PPO,49185,CPT4/HCPCS,SCLEROTHERAPY OF A FLUID COLLECTION (EG, LYMPHOCELE, CYST, OR SEROMA), PERCUTANEOUS, INCLUDING CONTRAST INJECTION(S), SCLEROSANT INJECTION(S), DIAGNOSTIC STUDY, IMAGING GUIDANCE (EG, ULTRASOUND, FLUOROSCOPY) AND RADIOLOGICAL SUPERVISION AND INTERPRETATION,,Case Rate,6000.00
Cigna,PPO,492,DRG,Lower extrem & humer proc except hip,foot,femur w MCC,,Case Rate,88439.10
Cigna,PPO,49250,CPT4/HCPCS,Excision of umbilicus,,Case Rate,4000.00
Cigna,PPO,493,DRG,Lower extrem & humer proc except hip,foot,femur w CC,,Case Rate,59292.60
Cigna,PPO,49320,CPT4/HCPCS,Diag laparo separate proc,,Case Rate,4000.00
Cigna,PPO,49321,CPT4/HCPCS,Laparoscopy, biopsy,,Case Rate,4000.00
Cigna,PPO,49322,CPT4/HCPCS,Laparoscopy, aspiration,,Case Rate,4000.00
Cigna,PPO,49323,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND OMENTUM; WITH DRAINAGE OF LYMPHOCELE TO PERITONEAL CAVITY,,Case Rate,4000.00
Cigna,PPO,49324,CPT4/HCPCS,Lap insertion perm ip cath,,Case Rate,8300.00
Cigna,PPO,49325,CPT4/HCPCS,Lap revision perm ip cath,,Case Rate,8300.00
Cigna,PPO,49326,CPT4/HCPCS,Lap w/omentopexy add-on,,Case Rate,8300.00
Cigna,PPO,49327,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; WITH PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), INTRA-ABDOMINAL, INTRAPELVIC, AND/OR RETROPERITONEUM, INCLUDING IMAGING GUIDANCE, IF PERFORMED, SINGLE OR MULTIPLE (LIST SEPA,,Case Rate,8300.00
Cigna,PPO,49329,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM ,,Case Rate,3000.00
Cigna,PPO,494,DRG,Lower extrem & humer proc except hip,foot,femur w/o CC/MCC,,Case Rate,47223.45
Cigna,PPO,49400,CPT4/HCPCS,Air injection into abdomen,,Case Rate,3000.00
Cigna,PPO,49402,CPT4/HCPCS,Remove foreign body, adbomen,,Case Rate,3000.00
Cigna,PPO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Case Rate,8300.00
Cigna,PPO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Case Rate,8300.00
Cigna,PPO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Case Rate,4000.00
Cigna,PPO,49411,CPT4/HCPCS,PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PERCUTANEOUS, INTRA-ABDOMINAL, INTRA-PELVIC (EXCEPT PROSTATE), AND/OR RETROPERITONEUM, SINGLE OR MULTIPLE,,Case Rate,3000.00
Cigna,PPO,49418,CPT4/HCPCS,INSERTION OF TUNNELED INTRAPERITONEAL CATHETER (EG, DIALYSIS, INTRAPERITONEAL CHEMOTHERAPY INSTILLATION, MANAGEMENT OF ASCITES), COMPLETE PROCEDURE, INCLUDING IMAGING GUIDANCE, CATHETER PLACEMENT, CONTRAST INJECTION WHEN PERFORMED, AND RADIOLOGICAL SUPERV,,Case Rate,8300.00
Cigna,PPO,49419,CPT4/HCPCS,INSERTION OF TUNNELED INTRAPERITONEAL CATHETER, WITH SUBCUTANEOUS PORT (IE, TOTALLY IMPLANTABLE),,Case Rate,3000.00
Cigna,PPO,49421,CPT4/HCPCS,INSERTION OF TUNNELED INTRAPERITONEAL CATHETER FOR DIALYSIS, OPEN,,Case Rate,3000.00
Cigna,PPO,49422,CPT4/HCPCS,Remove perm cannula/catheter,,Case Rate,3000.00
Cigna,PPO,49423,CPT4/HCPCS,EXCHANGE OF PREVIOUSLY PLACED ABSCESS OR CYST DRAINAGE CATHETER UNDER RADIOLOGICAL GUIDANCE (SEPARATE PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,49424,CPT4/HCPCS,CONTRAST INJECTION FOR ASSESSMENT OF ABSCESS OR CYST VIA PREVIOUSLY PLACED DRAINAGE CATHETER OR TUBE (SEPARATE PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,49425,CPT4/HCPCS,Insert abdomen-venous drain,,Case Rate,3000.00
Cigna,PPO,49426,CPT4/HCPCS,Revise abdomen-venous shunt,,Case Rate,3000.00
Cigna,PPO,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,Case Rate,3000.00
Cigna,PPO,49429,CPT4/HCPCS,REMOVAL OF PERITONEAL-VENOUS SHUNT ,,Case Rate,3000.00
Cigna,PPO,49435,CPT4/HCPCS,Insert subq exten to ip cath,,Case Rate,3000.00
Cigna,PPO,49436,CPT4/HCPCS,Embedded ip cath exit-site,,Case Rate,4000.00
Cigna,PPO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Case Rate,3000.00
Cigna,PPO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Case Rate,3000.00
Cigna,PPO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Case Rate,5000.00
Cigna,PPO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Case Rate,3000.00
Cigna,PPO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Case Rate,3000.00
Cigna,PPO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Case Rate,3000.00
Cigna,PPO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Case Rate,3000.00
Cigna,PPO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Case Rate,3000.00
Cigna,PPO,49465,CPT4/HCPCS,CONTRAST INJECTION PERQ RADIOLOGIC EVAL GI ,,Case Rate,3000.00
Cigna,PPO,49491,CPT4/HCPCS,REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT BIRTH), PERFORMED FROM BIRTH UP TO 50 WEEKS POST-CONCEPTUAL AGE, WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE,,Case Rate,3000.00
Cigna,PPO,49492,CPT4/HCPCS,REPAIR, INITIAL INGUINAL HERNIA, PRETERM INFANT (LESS THAN 37 WEEKS GESTATION AT BIRTH), PERFORMED FROM BIRTH UP TO 50 WEEKS POST-CONCEPTUAL AGE, WITH OR WITHOUT HYDROCELECTOMY; INCARCERATED OR STRANGULATED,,Case Rate,3000.00
Cigna,PPO,49495,CPT4/HCPCS,Rpr ing hernia baby, reduc,,Case Rate,4000.00
Cigna,PPO,49496,CPT4/HCPCS,Rpr ing hernia baby, blocked,,Case Rate,4000.00
Cigna,PPO,495,DRG,Local excision & removal int fix devices exc hip & femur w MCC,,Case Rate,92672.10
Cigna,PPO,49500,CPT4/HCPCS,Rpr ing hernia, init, reduce,,Case Rate,4000.00
Cigna,PPO,49501,CPT4/HCPCS,Rpr ing hernia, init blocked,,Case Rate,8300.00
Cigna,PPO,49505,CPT4/HCPCS,Rpr i/hern init reduc>5 yr,,Case Rate,4000.00
Cigna,PPO,49507,CPT4/HCPCS,Rpr i/hern init block>5 yr,,Case Rate,8300.00
Cigna,PPO,49520,CPT4/HCPCS,Rerepair ing hernia, reduce,,Case Rate,6000.00
Cigna,PPO,49521,CPT4/HCPCS,Rerepair ing hernia, blocked,,Case Rate,8300.00
Cigna,PPO,49525,CPT4/HCPCS,Repair ing hernia, sliding,,Case Rate,4000.00
Cigna,PPO,49540,CPT4/HCPCS,Repair lumbar hernia,,Case Rate,3000.00
Cigna,PPO,49550,CPT4/HCPCS,Rpr fem hernia, init, reduce,,Case Rate,5000.00
Cigna,PPO,49553,CPT4/HCPCS,Rpr fem hernia, init blocked,,Case Rate,8300.00
Cigna,PPO,49555,CPT4/HCPCS,Rerepair fem hernia, reduce,,Case Rate,5000.00
Cigna,PPO,49557,CPT4/HCPCS,Rerepair fem hernia, blocked,,Case Rate,8300.00
Cigna,PPO,49560,CPT4/HCPCS,Rpr ventral hern init, reduc,,Case Rate,4000.00
Cigna,PPO,49561,CPT4/HCPCS,Rpr ventral hern init, block,,Case Rate,8300.00
Cigna,PPO,49565,CPT4/HCPCS,Rerepair ventrl hern, reduce,,Case Rate,4000.00
Cigna,PPO,49566,CPT4/HCPCS,Rerepair ventrl hern, block,,Case Rate,8300.00
Cigna,PPO,49568,CPT4/HCPCS,Hernia repair w/mesh,,Case Rate,3000.00
Cigna,PPO,49570,CPT4/HCPCS,Rpr epigastric hern, reduce,,Case Rate,4000.00
Cigna,PPO,49572,CPT4/HCPCS,Rpr epigastric hern, blocked,,Case Rate,8300.00
Cigna,PPO,49580,CPT4/HCPCS,Rpr umbil hern, reduc <5 yr,,Case Rate,4000.00
Cigna,PPO,49582,CPT4/HCPCS,Rpr umbil hern, block < 5 yr,,Case Rate,8300.00
Cigna,PPO,49585,CPT4/HCPCS,Rpr umbil hern, reduc > 5 yr,,Case Rate,4000.00
Cigna,PPO,49587,CPT4/HCPCS,Rpr umbil hern, block > 5 yr,,Case Rate,8300.00
Cigna,PPO,49590,CPT4/HCPCS,Repair spigelian hernia,,Case Rate,4000.00
Cigna,PPO,496,DRG,Local excision & removal int fix devices exc hip & femur w CC,,Case Rate,50632.80
Cigna,PPO,49600,CPT4/HCPCS,Repair umbilical lesion,,Case Rate,4000.00
Cigna,PPO,49605,CPT4/HCPCS,Repair of large omphalocele or gastroschisis; with or without prosthesis,,Case Rate,3000.00
Cigna,PPO,49650,CPT4/HCPCS,Laparo hernia repair initial,,Case Rate,4000.00
Cigna,PPO,49651,CPT4/HCPCS,Laparo hernia repair recur,,Case Rate,6000.00
Cigna,PPO,49652,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); REDUCIBLE,,Case Rate,8300.00
Cigna,PPO,49653,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, VENTRAL, UMBILICAL, SPIGELIAN OR EPIGASTRIC HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED,,Case Rate,8300.00
Cigna,PPO,49654,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); REDUCIBLE,,Case Rate,8300.00
Cigna,PPO,49655,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED,,Case Rate,8300.00
Cigna,PPO,49656,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, RECURRENT INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); REDUCIBLE,,Case Rate,8300.00
Cigna,PPO,49657,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, REPAIR, RECURRENT INCISIONAL HERNIA (INCLUDES MESH INSERTION, WHEN PERFORMED); INCARCERATED OR STRANGULATED,,Case Rate,8300.00
Cigna,PPO,49659,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY,,Case Rate,3000.00
Cigna,PPO,497,DRG,Local excision & removal int fix devices exc hip & femur w/o CC/MCC,,Case Rate,37196.85
Cigna,PPO,498,DRG,Local excision & removal int fix devices of hip & femur w CC/MCC,,Case Rate,65899.65
Cigna,PPO,499,DRG,Local excision & removal int fix devices of hip & femur w/o CC/MCC,,Case Rate,30566.85
Cigna,PPO,49999,CPT4/HCPCS,UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM ,,Case Rate,3000.00
Cigna,PPO,5,DRG,Liver transplant w MCC or intestinal transplant,,Case Rate,260694.15
Cigna,PPO,500,DRG,Soft tissue procedures w MCC,,Case Rate,80424.45
Cigna,PPO,50020,CPT4/HCPCS,Renal abscess, open drain,,Case Rate,3000.00
Cigna,PPO,50040,CPT4/HCPCS,Drainage of kidney,,Case Rate,3000.00
Cigna,PPO,50080,CPT4/HCPCS,PERC NEPHROS/PYLOS W/WO DILA, ENDO,LITHO,STENT/BASK EXTR UP TO 2 CM ,,Case Rate,3000.00
Cigna,PPO,50081,CPT4/HCPCS,PERC NEPHRO/PYLOS W/WO DILA,ENDO,LITHO,STENT/BASK EXTRA OVER 2 CM ,,Case Rate,3000.00
Cigna,PPO,501,DRG,Soft tissue procedures w CC,,Case Rate,44497.50
Cigna,PPO,502,DRG,Soft tissue procedures w/o CC/MCC,,Case Rate,33935.40
Cigna,PPO,50200,CPT4/HCPCS,Biopsy of kidney,,Case Rate,3000.00
Cigna,PPO,50250,CPT4/HCPCS,Ablation, open, one or more renal mass lesion(s), cryosurgical, including intraoperative ultrasound, if performed,,Case Rate,3000.00
Cigna,PPO,503,DRG,Foot procedures w MCC,,Case Rate,67031.85
Cigna,PPO,50382,CPT4/HCPCS,Removal (via snare/capture) and replacement of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation,,Case Rate,3000.00
Cigna,PPO,50384,CPT4/HCPCS,Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, including radiological supervision and interpretation,,Case Rate,3000.00
Cigna,PPO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Case Rate,5000.00
Cigna,PPO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Case Rate,3000.00
Cigna,PPO,50387,CPT4/HCPCS,Removal and replacement of externally accessible transnephric ureteral stent (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation,,Case Rate,3000.00
Cigna,PPO,50389,CPT4/HCPCS,Removal of nephrostomy tube, requiring fluoroscopic guidance (eg, with concurrent indwelling ureteral stent),,Case Rate,3000.00
Cigna,PPO,50390,CPT4/HCPCS,Drainage of kidney lesion,,Case Rate,3000.00
Cigna,PPO,50391,CPT4/HCPCS,Instillation(S) Of Therapeutic Agent Into Renal Pelvis And/Or Ureter Through Established Nephrostomy, Pyelostomy Or Ureterostomy Tube (Eg, Anticarcinogenic Or Antifungal Agent),,Case Rate,3000.00
Cigna,PPO,50396,CPT4/HCPCS,Measure kidney pressure,,Case Rate,3000.00
Cigna,PPO,504,DRG,Foot procedures w CC,,Case Rate,45234.45
Cigna,PPO,50430,CPT4/HCPCS,INJECTION PROCEDURE FOR ANTEGRADE NEPHROSTOGRAM AND/OR URETEROGRAM, COMPLETE DIAGNOSTIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; NEW ACCESS,,Case Rate,4000.00
Cigna,PPO,50431,CPT4/HCPCS,INJECTION PROCEDURE FOR ANTEGRADE NEPHROSTOGRAM AND/OR URETEROGRAM, COMPLETE DIAGNOSTIC PROCEDURE INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; EXISTING ACCESS,,Case Rate,4000.00
Cigna,PPO,50432,CPT4/HCPCS,PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION,,Case Rate,6000.00
Cigna,PPO,50433,CPT4/HCPCS,PLACEMENT OF NEPHROURETERAL CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, NEW ACCESS,,Case Rate,6000.00
Cigna,PPO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER TO NEPHROURETERAL CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATIO,,Case Rate,4000.00
Cigna,PPO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION,,Case Rate,4000.00
Cigna,PPO,50436,CPT4/HCPCS,Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed ,,Case Rate,3000.00
Cigna,PPO,50437,CPT4/HCPCS,Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation, with postprocedure tube placement, when performed; inclu,,Case Rate,3000.00
Cigna,PPO,505,DRG,Foot procedures w/o CC/MCC,,Case Rate,45234.45
Cigna,PPO,50520,CPT4/HCPCS,Close kidney-skin fistula,,Case Rate,3000.00
Cigna,PPO,50541,CPT4/HCPCS,LAPAROSCOPY, SURGICAL;ABLATION OF RENAL CYSTS,,Case Rate,5000.00
Cigna,PPO,50542,CPT4/HCPCS,Laparoscopy, surgical; ablation or renal mass lesion(s),,Case Rate,3000.00
Cigna,PPO,50543,CPT4/HCPCS,Laparoscopy, surgical; partial nephrectomy,,Case Rate,3000.00
Cigna,PPO,50544,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; PYELOPLASTY,,Case Rate,5000.00
Cigna,PPO,50546,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; NEPHRECTOMY,,Case Rate,3000.00
Cigna,PPO,50547,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; DONOR NEPHRECTOMY FROM LIVING DONOR (EXCLUDING PREPARATION AND MAINTENANCE OF ALLOGRAFT),,Case Rate,3000.00
Cigna,PPO,50548,CPT4/HCPCS,LAPAROSCOPICALLY ASSISTED NEPHROURETERECTOMY,,Case Rate,3000.00
Cigna,PPO,50549,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, RENAL,,Case Rate,3000.00
Cigna,PPO,50551,CPT4/HCPCS,Kidney endoscopy,,Case Rate,3000.00
Cigna,PPO,50553,CPT4/HCPCS,Kidney endoscopy,,Case Rate,3000.00
Cigna,PPO,50555,CPT4/HCPCS,Kidney endoscopy & biopsy,,Case Rate,3000.00
Cigna,PPO,50557,CPT4/HCPCS,Kidney endoscopy & treatment,,Case Rate,3000.00
Cigna,PPO,50561,CPT4/HCPCS,Kidney endoscopy & treatment,,Case Rate,3000.00
Cigna,PPO,50562,CPT4/HCPCS,Renal endoscopy through established nephrostomy or pyelostomy, with or without irrigation, instillation, or ureteropyelography, exclusive or radiologic service; with resection of tumor,,Case Rate,3000.00
Cigna,PPO,50570,CPT4/HCPCS,Kidney endoscopy,,Case Rate,3000.00
Cigna,PPO,50572,CPT4/HCPCS,Kidney endoscopy,,Case Rate,3000.00
Cigna,PPO,50574,CPT4/HCPCS,Kidney endoscopy & biopsy,,Case Rate,3000.00
Cigna,PPO,50576,CPT4/HCPCS,Kidney endoscopy & treatment,,Case Rate,3000.00
Cigna,PPO,50580,CPT4/HCPCS,Kidney endoscopy & treatment,,Case Rate,3000.00
Cigna,PPO,50590,CPT4/HCPCS,Lithotripsy, extracorporeal shock wave,,Case Rate,8300.00
Cigna,PPO,50592,CPT4/HCPCS,Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency,,Case Rate,3000.00
Cigna,PPO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Case Rate,8300.00
Cigna,PPO,506,DRG,Major thumb or joint procedures,,Case Rate,37630.35
Cigna,PPO,50600,CPT4/HCPCS,URETEROTOMY WITH EXPLORATION OR DRAINAGE (SEPARATE PROCEDURE),,Case Rate,3000.00
Cigna,PPO,50605,CPT4/HCPCS,URETEROTOMY FOR INSERTION OF INDWELLING STENT, ALL TYPES,,Case Rate,3000.00
Cigna,PPO,50606,CPT4/HCPCS,ENDOLUMINAL BIOPSY OF URETER AND/OR RENAL PELVIS, NON-ENDOSCOPIC, INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,50610,CPT4/HCPCS,URETEROLITHOTOMY; UPPER ONE-THIRD OF URETER,,Case Rate,3000.00
Cigna,PPO,50620,CPT4/HCPCS,URETEROLITHOTOMY; MIDDLE ONE-THIRD OF URETER,,Case Rate,3000.00
Cigna,PPO,50630,CPT4/HCPCS,URETEROLITHOTOMY; LOWER ONE-THIRD OF URETER,,Case Rate,3000.00
Cigna,PPO,50650,CPT4/HCPCS,URETERECTOMY, WITH BLADDER CUFF (SEPARATE PROCEDURE),,Case Rate,3000.00
Cigna,PPO,50660,CPT4/HCPCS,URETERECTOMY, TOTAL, ECTOPIC URETER, COMBINATION ABDOMINAL, VAGINAL AND/OR PERINEAL APPROACH,,Case Rate,3000.00
Cigna,PPO,50684,CPT4/HCPCS,Injection for ureter x-ray,,Case Rate,3000.00
Cigna,PPO,50688,CPT4/HCPCS,CHANGE OF URETEROSTOMY TUBE OR EXTERNALLY ACCESSIBLE URETERAL STENT VIA ILEAL CONDUIT,,Case Rate,3000.00
Cigna,PPO,50690,CPT4/HCPCS,Injection for ureter x-ray,,Case Rate,3000.00
Cigna,PPO,50693,CPT4/HCPCS,PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; PRE-EXISTING NEPHROSTOMY,,Case Rate,8300.00
Cigna,PPO,50694,CPT4/HCPCS,PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; NEW ACCESS, WITHOUT SEPA,,Case Rate,8300.00
Cigna,PPO,50695,CPT4/HCPCS,PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; NEW ACCESS, WITH SEPARAT,,Case Rate,8300.00
Cigna,PPO,507,DRG,Major shoulder or elbow joint procedures w CC/MCC,,Case Rate,51568.65
Cigna,PPO,50705,CPT4/HCPCS,URETERAL EMBOLIZATION OR OCCLUSION, INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,50706,CPT4/HCPCS,BALLOON DILATION, URETERAL STRICTURE, INCLUDING IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,508,DRG,Major shoulder or elbow joint procedures w/o CC/MCC,,Case Rate,36057.00
Cigna,PPO,509,DRG,Arthroscopy,,Case Rate,42681.90
Cigna,PPO,50945,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, URETEROLITHOTOMY,,Case Rate,5000.00
Cigna,PPO,50947,CPT4/HCPCS,Laparo new ureter/bladder,,Case Rate,8300.00
Cigna,PPO,50948,CPT4/HCPCS,Laparo new ureter/bladder,,Case Rate,8300.00
Cigna,PPO,50949,CPT4/HCPCS,Unlisted laparoscopic procedure, ureter,,Case Rate,3000.00
Cigna,PPO,50951,CPT4/HCPCS,Endoscopy of ureter,,Case Rate,3000.00
Cigna,PPO,50953,CPT4/HCPCS,Endoscopy of ureter,,Case Rate,3000.00
Cigna,PPO,50955,CPT4/HCPCS,Ureter endoscopy & biopsy,,Case Rate,3000.00
Cigna,PPO,50957,CPT4/HCPCS,Ureter endoscopy & treatment,,Case Rate,3000.00
Cigna,PPO,50961,CPT4/HCPCS,Ureter endoscopy & treatment,,Case Rate,3000.00
Cigna,PPO,50970,CPT4/HCPCS,Ureter endoscopy,,Case Rate,3000.00
Cigna,PPO,50972,CPT4/HCPCS,Ureter endoscopy & catheter,,Case Rate,3000.00
Cigna,PPO,50974,CPT4/HCPCS,Ureter endoscopy & biopsy,,Case Rate,3000.00
Cigna,PPO,50976,CPT4/HCPCS,Ureter endoscopy & treatment,,Case Rate,3000.00
Cigna,PPO,50980,CPT4/HCPCS,Ureter endoscopy & treatment,,Case Rate,3000.00
Cigna,PPO,510,DRG,Shoulder,elbow or forearm proc,exc major joint proc w MCC,,Case Rate,69632.85
Cigna,PPO,51020,CPT4/HCPCS,Incise & treat bladder,,Case Rate,4000.00
Cigna,PPO,51030,CPT4/HCPCS,Incise & treat bladder,,Case Rate,4000.00
Cigna,PPO,51040,CPT4/HCPCS,Incise & drain bladder,,Case Rate,4000.00
Cigna,PPO,51045,CPT4/HCPCS,Incise bladder/drain ureter,,Case Rate,4000.00
Cigna,PPO,51050,CPT4/HCPCS,Removal of bladder stone,,Case Rate,4000.00
Cigna,PPO,51065,CPT4/HCPCS,Remove ureter calculus,,Case Rate,4000.00
Cigna,PPO,51080,CPT4/HCPCS,Drainage of bladder abscess,,Case Rate,3000.00
Cigna,PPO,511,DRG,Shoulder,elbow or forearm proc,exc major joint proc w CC,,Case Rate,50196.75
Cigna,PPO,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,Case Rate,400.00
Cigna,PPO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Case Rate,400.00
Cigna,PPO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Case Rate,3000.00
Cigna,PPO,512,DRG,Shoulder,elbow or forearm proc,exc major joint proc w/o CC/MCC,,Case Rate,39683.10
Cigna,PPO,513,DRG,Hand or wrist proc, except major thumb or joint proc w CC/MCC,,Case Rate,39754.50
Cigna,PPO,514,DRG,Hand or wrist proc, except major thumb or joint proc w/o CC/MCC,,Case Rate,25352.10
Cigna,PPO,515,DRG,Other musculoskelet sys & conn tiss O.R. proc w MCC,,Case Rate,79993.50
Cigna,PPO,51500,CPT4/HCPCS,Removal of bladder cyst,,Case Rate,4000.00
Cigna,PPO,51520,CPT4/HCPCS,Removal of bladder lesion,,Case Rate,4000.00
Cigna,PPO,516,DRG,Other musculoskelet sys & conn tiss O.R. proc w CC,,Case Rate,50008.05
Cigna,PPO,517,DRG,Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC,,Case Rate,35615.85
Cigna,PPO,51700,CPT4/HCPCS,BLADDER IRRIGATION, SIMPLE LAVAGE AND/OR INSTILLATION (CONSIDER AS TOS 04) ,,Case Rate,3000.00
Cigna,PPO,51701,CPT4/HCPCS,Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine),,Case Rate,400.00
Cigna,PPO,51702,CPT4/HCPCS,Insertion of temporary indwelling bladder catheter; simple (eg, Foley),,Case Rate,400.00
Cigna,PPO,51703,CPT4/HCPCS,Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon),,Case Rate,3000.00
Cigna,PPO,51705,CPT4/HCPCS,CHANGE OF CYSTOSTOMY TUBE; SIMPLE ,,Case Rate,3000.00
Cigna,PPO,51710,CPT4/HCPCS,CHANGE OF CYSTOSTOMY TUBE; COMPLICATED,,Case Rate,3000.00
Cigna,PPO,51715,CPT4/HCPCS,Endoscopic injection/implant,,Case Rate,4000.00
Cigna,PPO,51725,CPT4/HCPCS,Simple cystometrogram,,Case Rate,3000.00
Cigna,PPO,51726,CPT4/HCPCS,Complex cystometrogram,,Case Rate,3000.00
Cigna,PPO,51727,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE,,Case Rate,400.00
Cigna,PPO,51728,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE), ANY TECHNIQUE,,Case Rate,400.00
Cigna,PPO,51729,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE) AND URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE,,Case Rate,400.00
Cigna,PPO,51785,CPT4/HCPCS,Anal/urinary muscle study,,Case Rate,3000.00
Cigna,PPO,51797,CPT4/HCPCS,VOIDING PRESSURE STUDIES, INTRA-ABDOMINAL (IE, RECTAL, GASTRIC, INTRAPERITONEAL) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,Case Rate,25500.00
Cigna,PPO,51800,CPT4/HCPCS,Cystoplasty or cystourethroplasty, plastic operation on bladder and/or vesical neck (anterior Y-plasty, vesical fundus resection), any procedure, with or without wedge resection of posterior vesical neck,,Case Rate,3000.00
Cigna,PPO,51820,CPT4/HCPCS,Cystourethroplasty with unilateral or bilateral ureteroneocystostomy,,Case Rate,3000.00
Cigna,PPO,51840,CPT4/HCPCS,Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); simple,,Case Rate,3000.00
Cigna,PPO,51841,CPT4/HCPCS,Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz, Burch); complicated (eg, secondary repair),,Case Rate,3000.00
Cigna,PPO,51845,CPT4/HCPCS,Abdomino-vaginal vesical neck suspension, with or without endoscopic control (eg, Stamey, Raz, modified Pereyra),,Case Rate,3000.00
Cigna,PPO,51860,CPT4/HCPCS,CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE, ,,Case Rate,3000.00
Cigna,PPO,51865,CPT4/HCPCS,Repair of bladder wound,,Case Rate,3000.00
Cigna,PPO,51880,CPT4/HCPCS,Repair of bladder opening,,Case Rate,3000.00
Cigna,PPO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,Case Rate,25500.00
Cigna,PPO,51900,CPT4/HCPCS,Repair bladder/vagina lesion,,Case Rate,3000.00
Cigna,PPO,51920,CPT4/HCPCS,Close bladder-uterus fistula,,Case Rate,3000.00
Cigna,PPO,51990,CPT4/HCPCS,LAPAROSCOPY, SURGICAL;URETHRAL SUSPENSION FOR STRESS INCONTINENCE,,Case Rate,5000.00
Cigna,PPO,51992,CPT4/HCPCS,Laparo sling operation,,Case Rate,5000.00
Cigna,PPO,51999,CPT4/HCPCS,Unlisted laparoscopy procedure, bladder,,Case Rate,3000.00
Cigna,PPO,52,DRG,Spinal disorders & injuries w CC/MCC,,Case Rate,47050.05
Cigna,PPO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,Case Rate,25500.00
Cigna,PPO,52000,CPT4/HCPCS,Cystoscopy,,Case Rate,3000.00
Cigna,PPO,52001,CPT4/HCPCS,Cystoscopy, removal of clots,,Case Rate,3000.00
Cigna,PPO,52005,CPT4/HCPCS,Cystoscopy & ureter catheter,,Case Rate,3000.00
Cigna,PPO,52007,CPT4/HCPCS,Cystoscopy and biopsy,,Case Rate,3000.00
Cigna,PPO,52010,CPT4/HCPCS,Cystoscopy & duct catheter,,Case Rate,3000.00
Cigna,PPO,521,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,,Case Rate,78116.70
Cigna,PPO,522,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,,Case Rate,55822.05
Cigna,PPO,52204,CPT4/HCPCS,Cystoscopy,,Case Rate,3000.00
Cigna,PPO,52214,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52224,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52234,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52235,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,4000.00
Cigna,PPO,52240,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,4000.00
Cigna,PPO,52250,CPT4/HCPCS,Cystoscopy and radiotracer,,Case Rate,4000.00
Cigna,PPO,52260,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52265,CPT4/HCPCS,Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia,,Case Rate,3000.00
Cigna,PPO,52270,CPT4/HCPCS,Cystoscopy & revise urethra,,Case Rate,3000.00
Cigna,PPO,52275,CPT4/HCPCS,Cystoscopy & revise urethra,,Case Rate,3000.00
Cigna,PPO,52276,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,4000.00
Cigna,PPO,52277,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52281,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52282,CPT4/HCPCS,Cystoscopy, implant stent,,Case Rate,8300.00
Cigna,PPO,52283,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52285,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Case Rate,5000.00
Cigna,PPO,52290,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52300,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52301,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,4000.00
Cigna,PPO,52305,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52310,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52315,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52317,CPT4/HCPCS,Remove bladder stone,,Case Rate,3000.00
Cigna,PPO,52318,CPT4/HCPCS,Remove bladder stone,,Case Rate,3000.00
Cigna,PPO,52320,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,5000.00
Cigna,PPO,52325,CPT4/HCPCS,Cystoscopy, stone removal,,Case Rate,4000.00
Cigna,PPO,52327,CPT4/HCPCS,Cystoscopy, inject material,,Case Rate,3000.00
Cigna,PPO,52330,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52332,CPT4/HCPCS,Cystoscopy and treatment,,Case Rate,3000.00
Cigna,PPO,52334,CPT4/HCPCS,Create passage to kidney,,Case Rate,4000.00
Cigna,PPO,52341,CPT4/HCPCS,Cysto w/ureter stricture tx,,Case Rate,4000.00
Cigna,PPO,52342,CPT4/HCPCS,Cysto w/up stricture tx,,Case Rate,4000.00
Cigna,PPO,52343,CPT4/HCPCS,Cysto w/renal stricture tx,,Case Rate,4000.00
Cigna,PPO,52344,CPT4/HCPCS,Cysto/uretero, stone remove,,Case Rate,4000.00
Cigna,PPO,52345,CPT4/HCPCS,Cysto/uretero w/up stricture,,Case Rate,4000.00
Cigna,PPO,52346,CPT4/HCPCS,Cystouretero w/renal strict,,Case Rate,4000.00
Cigna,PPO,52351,CPT4/HCPCS,Cystouretro & or pyeloscope,,Case Rate,4000.00
Cigna,PPO,52352,CPT4/HCPCS,Cystouretro w/stone remove,,Case Rate,4000.00
Cigna,PPO,52353,CPT4/HCPCS,Cystouretero w/lithotripsy,,Case Rate,4000.00
Cigna,PPO,52354,CPT4/HCPCS,Cystouretero w/biopsy,,Case Rate,4000.00
Cigna,PPO,52355,CPT4/HCPCS,Cystouretero w/excise tumor,,Case Rate,4000.00
Cigna,PPO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Case Rate,8300.00
Cigna,PPO,52400,CPT4/HCPCS,Cystouretero w/congen repr,,Case Rate,4000.00
Cigna,PPO,52402,CPT4/HCPCS,Cystourethro cut ejacul duct,,Case Rate,4000.00
Cigna,PPO,52441,CPT4/HCPCS, CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT ADJUSTABLE TRANSPROSTATIC IMPLANT; SINGLE IMPLANT,,Case Rate,3000.00
Cigna,PPO,52442,CPT4/HCPCS,CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT ADJUSTABLE TRANSPROSTATIC IMPLANT; EACH ADDITIONAL PERMANENT ADJUSTABLE TRANSPROSTATIC IMPLANT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,52450,CPT4/HCPCS,Incision of prostate,,Case Rate,4000.00
Cigna,PPO,52500,CPT4/HCPCS,Revision of bladder neck,,Case Rate,4000.00
Cigna,PPO,52601,CPT4/HCPCS,Prostatectomy (TURP),,Case Rate,4000.00
Cigna,PPO,52630,CPT4/HCPCS,Remove prostate regrowth,,Case Rate,3000.00
Cigna,PPO,52640,CPT4/HCPCS,Relieve bladder contracture,,Case Rate,3000.00
Cigna,PPO,52647,CPT4/HCPCS,Laser surgery of prostate,,Case Rate,8300.00
Cigna,PPO,52648,CPT4/HCPCS,Laser surgery of prostate,,Case Rate,8300.00
Cigna,PPO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Case Rate,8300.00
Cigna,PPO,52700,CPT4/HCPCS,Drainage of prostate abscess,,Case Rate,3000.00
Cigna,PPO,53,DRG,Spinal disorders & injuries w/o CC/MCC,,Case Rate,28970.55
Cigna,PPO,53000,CPT4/HCPCS,Incision of urethra,,Case Rate,3000.00
Cigna,PPO,53010,CPT4/HCPCS,Incision of urethra,,Case Rate,3000.00
Cigna,PPO,53020,CPT4/HCPCS,Incision of urethra,,Case Rate,3000.00
Cigna,PPO,53025,CPT4/HCPCS,Meatotomy, cutting of meatus (separate procedure); infant,,Case Rate,3000.00
Cigna,PPO,53040,CPT4/HCPCS,Drainage of urethra abscess,,Case Rate,3000.00
Cigna,PPO,53060,CPT4/HCPCS,Drainage of Skenes gland abscess or cyst,,Case Rate,3000.00
Cigna,PPO,53080,CPT4/HCPCS,Drainage of urinary leakage,,Case Rate,4000.00
Cigna,PPO,53200,CPT4/HCPCS,Biopsy of urethra,,Case Rate,3000.00
Cigna,PPO,53210,CPT4/HCPCS,Removal of urethra,,Case Rate,5000.00
Cigna,PPO,53215,CPT4/HCPCS,Removal of urethra,,Case Rate,5000.00
Cigna,PPO,53220,CPT4/HCPCS,Treatment of urethra lesion,,Case Rate,3000.00
Cigna,PPO,53230,CPT4/HCPCS,Removal of urethra lesion,,Case Rate,3000.00
Cigna,PPO,53235,CPT4/HCPCS,Removal of urethra lesion,,Case Rate,4000.00
Cigna,PPO,53240,CPT4/HCPCS,Surgery for urethra pouch,,Case Rate,3000.00
Cigna,PPO,53250,CPT4/HCPCS,Removal of urethra gland,,Case Rate,3000.00
Cigna,PPO,53260,CPT4/HCPCS,Treatment of urethra lesion,,Case Rate,3000.00
Cigna,PPO,53265,CPT4/HCPCS,Treatment of urethra lesion,,Case Rate,3000.00
Cigna,PPO,53270,CPT4/HCPCS,Removal of urethra gland,,Case Rate,3000.00
Cigna,PPO,53275,CPT4/HCPCS,Repair of urethra defect,,Case Rate,3000.00
Cigna,PPO,533,DRG,Fractures of femur w MCC,,Case Rate,36021.30
Cigna,PPO,534,DRG,Fractures of femur w/o MCC,,Case Rate,20109.30
Cigna,PPO,53400,CPT4/HCPCS,Revise urethra, stage 1,,Case Rate,4000.00
Cigna,PPO,53405,CPT4/HCPCS,Revise urethra, stage 2,,Case Rate,3000.00
Cigna,PPO,53410,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,3000.00
Cigna,PPO,53420,CPT4/HCPCS,Reconstruct urethra, stage 1,,Case Rate,4000.00
Cigna,PPO,53425,CPT4/HCPCS,Reconstruct urethra, stage 2,,Case Rate,3000.00
Cigna,PPO,53430,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,3000.00
Cigna,PPO,53431,CPT4/HCPCS,Reconstruct urethra/bladder,,Case Rate,3000.00
Cigna,PPO,53440,CPT4/HCPCS,Correct bladder function,,Case Rate,3000.00
Cigna,PPO,53442,CPT4/HCPCS,Remove perineal prosthesis,,Case Rate,3000.00
Cigna,PPO,53444,CPT4/HCPCS,Insert tandem cuff,,Case Rate,3000.00
Cigna,PPO,53445,CPT4/HCPCS,Insert uro/ves nck sphincter,,Case Rate,3000.00
Cigna,PPO,53446,CPT4/HCPCS,Remove uro sphincter,,Case Rate,3000.00
Cigna,PPO,53447,CPT4/HCPCS,Remove/replace ur sphincter,,Case Rate,3000.00
Cigna,PPO,53449,CPT4/HCPCS,Repair uro sphincter,,Case Rate,3000.00
Cigna,PPO,53450,CPT4/HCPCS,Revision of urethra,,Case Rate,3000.00
Cigna,PPO,53460,CPT4/HCPCS,Revision of urethra,,Case Rate,3000.00
Cigna,PPO,535,DRG,Fractures of hip & pelvis w MCC,,Case Rate,31461.90
Cigna,PPO,53500,CPT4/HCPCS,Urethrolysis, transvaginal, secondary, open, including cystourethroscopy (eg, postsurgical obstruction, scarring),,Case Rate,3000.00
Cigna,PPO,53502,CPT4/HCPCS,Repair of urethra injury,,Case Rate,3000.00
Cigna,PPO,53505,CPT4/HCPCS,Repair of urethra injury,,Case Rate,3000.00
Cigna,PPO,53510,CPT4/HCPCS,Repair of urethra injury,,Case Rate,3000.00
Cigna,PPO,53515,CPT4/HCPCS,Repair of urethra injury,,Case Rate,3000.00
Cigna,PPO,53520,CPT4/HCPCS,Repair of urethra defect,,Case Rate,3000.00
Cigna,PPO,536,DRG,Fractures of hip & pelvis w/o MCC,,Case Rate,19675.80
Cigna,PPO,53600,CPT4/HCPCS,Dilation of urethral stricture by passage of sound or urethral dilator, male; initial,,Case Rate,3000.00
Cigna,PPO,53601,CPT4/HCPCS,Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent,,Case Rate,3000.00
Cigna,PPO,53605,CPT4/HCPCS,Dilate urethra stricture,,Case Rate,3000.00
Cigna,PPO,53620,CPT4/HCPCS,Dilation of urethral stricture by passage of filiform and follower, male; initial,,Case Rate,3000.00
Cigna,PPO,53621,CPT4/HCPCS,Dilation of urethral stricture by passage of filiform and follower, male; subsequent,,Case Rate,3000.00
Cigna,PPO,53660,CPT4/HCPCS,Dilation of female urethra including suppository and/or instillation; initial,,Case Rate,400.00
Cigna,PPO,53665,CPT4/HCPCS,Dilation of urethra,,Case Rate,3000.00
Cigna,PPO,537,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC,,Case Rate,23796.60
Cigna,PPO,538,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC,,Case Rate,18395.70
Cigna,PPO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Case Rate,3000.00
Cigna,PPO,53852,CPT4/HCPCS,TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY.,,Case Rate,3000.00
Cigna,PPO,53854,CPT4/HCPCS,Transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy ,,Case Rate,8300.00
Cigna,PPO,53855,CPT4/HCPCS,INSERTION OF A TEMPORARY PROSTATIC URETHRAL STENT, INCLUDING URETHRAL MEASUREMENT,,Case Rate,400.00
Cigna,PPO,53860,CPT4/HCPCS,TRANSURETHRAL RADIOFREQUENCY MICRO-REMODELING OF THE FEMALE BLADDER NECK AND PROXIMAL URETHRA FOR STRESS URINARY INCONTINENCE,,Case Rate,6000.00
Cigna,PPO,53899,CPT4/HCPCS,Unlisted procedure, urinary system,,Case Rate,3000.00
Cigna,PPO,539,DRG,Osteomyelitis w MCC,,Case Rate,49500.60
Cigna,PPO,54,DRG,Nervous system neoplasms w MCC,,Case Rate,34827.90
Cigna,PPO,540,DRG,Osteomyelitis w CC,,Case Rate,33030.15
Cigna,PPO,54000,CPT4/HCPCS,Slitting of prepuce,,Case Rate,3000.00
Cigna,PPO,54001,CPT4/HCPCS,Slitting of prepuce,,Case Rate,3000.00
Cigna,PPO,54015,CPT4/HCPCS,Drain penis lesion,,Case Rate,4000.00
Cigna,PPO,54057,CPT4/HCPCS,Laser surg, penis lesion(s),,Case Rate,3000.00
Cigna,PPO,54060,CPT4/HCPCS,Excision of penis lesion(s),,Case Rate,3000.00
Cigna,PPO,54065,CPT4/HCPCS,Destruction, penis lesion(s),,Case Rate,3000.00
Cigna,PPO,541,DRG,Osteomyelitis w/o CC/MCC,,Case Rate,21435.30
Cigna,PPO,54100,CPT4/HCPCS,Biopsy of penis,,Case Rate,3000.00
Cigna,PPO,54105,CPT4/HCPCS,Biopsy of penis,,Case Rate,3000.00
Cigna,PPO,54110,CPT4/HCPCS,Treatment of penis lesion,,Case Rate,3000.00
Cigna,PPO,54111,CPT4/HCPCS,Treat penis lesion, graft,,Case Rate,3000.00
Cigna,PPO,54112,CPT4/HCPCS,Treat penis lesion, graft,,Case Rate,3000.00
Cigna,PPO,54115,CPT4/HCPCS,Treatment of penis lesion,,Case Rate,3000.00
Cigna,PPO,54120,CPT4/HCPCS,Partial removal of penis,,Case Rate,3000.00
Cigna,PPO,54125,CPT4/HCPCS,Removal of penis,,Case Rate,3000.00
Cigna,PPO,54150,CPT4/HCPCS,Circumcision,,Case Rate,3000.00
Cigna,PPO,54160,CPT4/HCPCS,Circumcision,,Case Rate,3000.00
Cigna,PPO,54161,CPT4/HCPCS,Circumcision,,Case Rate,3000.00
Cigna,PPO,54162,CPT4/HCPCS,Lysis penil circumcis lesion,,Case Rate,3000.00
Cigna,PPO,54163,CPT4/HCPCS,Repair of circumcision,,Case Rate,3000.00
Cigna,PPO,54164,CPT4/HCPCS,Frenulotomy of penis,,Case Rate,3000.00
Cigna,PPO,542,DRG,Pathological fractures & musculoskelet & conn tiss malig w MCC,,Case Rate,46035.15
Cigna,PPO,54205,CPT4/HCPCS,Treatment of penis lesion,,Case Rate,4000.00
Cigna,PPO,54220,CPT4/HCPCS,Treatment of penis lesion,,Case Rate,3000.00
Cigna,PPO,54230,CPT4/HCPCS,Injection procedure for corpora cavernosography,,Case Rate,3000.00
Cigna,PPO,54240,CPT4/HCPCS,Penile plethysmography,,Case Rate,400.00
Cigna,PPO,54250,CPT4/HCPCS,Nocturnal penile tumescence and/or rigidity test,,Case Rate,400.00
Cigna,PPO,543,DRG,Pathological fractures & musculoskelet & conn tiss malig w CC,,Case Rate,26604.15
Cigna,PPO,54300,CPT4/HCPCS,Revision of penis,,Case Rate,4000.00
Cigna,PPO,54304,CPT4/HCPCS,Revision of penis,,Case Rate,4000.00
Cigna,PPO,54308,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,PPO,54312,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,PPO,54316,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,PPO,54318,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,PPO,54322,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,PPO,54324,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,PPO,54326,CPT4/HCPCS,Reconstruction of urethra,,Case Rate,4000.00
Cigna,PPO,54328,CPT4/HCPCS,Revise penis/urethra,,Case Rate,4000.00
Cigna,PPO,54332,CPT4/HCPCS,One stage proximal penile or penoscrotal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap,,Case Rate,3000.00
Cigna,PPO,54336,CPT4/HCPCS,One stage perineal hypospadias repair requiring extensive dissection to correct chordee and urethroplasty by use of skin graft tube and/or island flap,,Case Rate,3000.00
Cigna,PPO,54340,CPT4/HCPCS,Secondary urethral surgery,,Case Rate,4000.00
Cigna,PPO,54344,CPT4/HCPCS,Secondary urethral surgery,,Case Rate,4000.00
Cigna,PPO,54348,CPT4/HCPCS,Secondary urethral surgery,,Case Rate,4000.00
Cigna,PPO,54352,CPT4/HCPCS,Reconstruct urethra/penis,,Case Rate,4000.00
Cigna,PPO,54360,CPT4/HCPCS,Penis plastic surgery,,Case Rate,4000.00
Cigna,PPO,54380,CPT4/HCPCS,Repair penis,,Case Rate,4000.00
Cigna,PPO,54385,CPT4/HCPCS,Repair penis,,Case Rate,4000.00
Cigna,PPO,544,DRG,Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC,,Case Rate,19793.10
Cigna,PPO,54400,CPT4/HCPCS,Insert semi-rigid prosthesis,,Case Rate,4000.00
Cigna,PPO,54401,CPT4/HCPCS,Insert self-contd prosthesis,,Case Rate,4000.00
Cigna,PPO,54405,CPT4/HCPCS,Insert multi-comp penis pros,,Case Rate,4000.00
Cigna,PPO,54406,CPT4/HCPCS,Remove multi-comp penis pros,,Case Rate,4000.00
Cigna,PPO,54408,CPT4/HCPCS,Repair multi-comp penis pros,,Case Rate,4000.00
Cigna,PPO,54410,CPT4/HCPCS,Remove/replace penis prosth,,Case Rate,4000.00
Cigna,PPO,54411,CPT4/HCPCS,REMOVAL AND REPLACEMENT OF ALL COMPONENTS OF A MULTI-COMPONENT INFLATABLE PENILE PROSTHESIS THROUGH AN INFECTED FIELD AT THE SAME OPERATIVE SESSION, INCLUDING IRRIGATION AND DEBRIDEMENT OF INFECTED TISSUE,,Case Rate,3000.00
Cigna,PPO,54415,CPT4/HCPCS,Remove self-contd penis pros,,Case Rate,4000.00
Cigna,PPO,54416,CPT4/HCPCS,Remv/repl penis contain pros,,Case Rate,4000.00
Cigna,PPO,54417,CPT4/HCPCS,REMOVAL AND REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR NFLATABLE (SELF-CONTAINED) PENILE PROTHESIS THROUGH AN INFECTED FIELD AT THE SAME OPERATIVE SESSION, INCLUDING IRRIGATION AND DEBRIDEMENT OF INFECTED TISSUE,,Case Rate,3000.00
Cigna,PPO,54420,CPT4/HCPCS,Revision of penis,,Case Rate,4000.00
Cigna,PPO,54435,CPT4/HCPCS,Revision of penis,,Case Rate,4000.00
Cigna,PPO,54437,CPT4/HCPCS,REPAIR OF TRAUMATIC CORPOREAL TEAR(S),,Case Rate,3000.00
Cigna,PPO,54440,CPT4/HCPCS,Repair of penis,,Case Rate,4000.00
Cigna,PPO,54450,CPT4/HCPCS,Preputial stretching,,Case Rate,3000.00
Cigna,PPO,545,DRG,Connective tissue disorders w MCC,,Case Rate,63737.25
Cigna,PPO,54500,CPT4/HCPCS,Biopsy of testis,,Case Rate,3000.00
Cigna,PPO,54505,CPT4/HCPCS,Biopsy of testis,,Case Rate,3000.00
Cigna,PPO,54512,CPT4/HCPCS,Excise lesion testis,,Case Rate,3000.00
Cigna,PPO,54520,CPT4/HCPCS,Removal of testis,,Case Rate,4000.00
Cigna,PPO,54522,CPT4/HCPCS,Orchiectomy, partial,,Case Rate,4000.00
Cigna,PPO,54530,CPT4/HCPCS,Removal of testis,,Case Rate,4000.00
Cigna,PPO,54550,CPT4/HCPCS,Exploration for testis,,Case Rate,4000.00
Cigna,PPO,54560,CPT4/HCPCS,Exploration for undescended testis with abdominal exploration,,Case Rate,3000.00
Cigna,PPO,546,DRG,Connective tissue disorders w CC,,Case Rate,30768.30
Cigna,PPO,54600,CPT4/HCPCS,Reduce testis torsion,,Case Rate,4000.00
Cigna,PPO,54620,CPT4/HCPCS,Suspension of testis,,Case Rate,4000.00
Cigna,PPO,54640,CPT4/HCPCS,Suspension of testis,,Case Rate,4000.00
Cigna,PPO,54650,CPT4/HCPCS,Orchiopexy, abdominal approach, for intra-abdominal testis (eg, Fowler-Stephens),,Case Rate,3000.00
Cigna,PPO,54660,CPT4/HCPCS,Revision of testis,,Case Rate,3000.00
Cigna,PPO,54670,CPT4/HCPCS,Repair testis injury,,Case Rate,4000.00
Cigna,PPO,54680,CPT4/HCPCS,Relocation of testis(es),,Case Rate,4000.00
Cigna,PPO,54690,CPT4/HCPCS,Laparoscopy, orchiectomy,,Case Rate,8300.00
Cigna,PPO,54692,CPT4/HCPCS,LAPAROSCOPY, SURGICAL; ORCHIOPEXY FOR INTRA-ABDOMINAL TESTIS,,Case Rate,5000.00
Cigna,PPO,54699,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, TESTIS,,Case Rate,3000.00
Cigna,PPO,547,DRG,Connective tissue disorders w/o CC/MCC,,Case Rate,21241.50
Cigna,PPO,54700,CPT4/HCPCS,Drainage of scrotum,,Case Rate,3000.00
Cigna,PPO,548,DRG,Septic arthritis w MCC,,Case Rate,51754.80
Cigna,PPO,54800,CPT4/HCPCS,Biopsy of epididymis,,Case Rate,3000.00
Cigna,PPO,54830,CPT4/HCPCS,Remove epididymis lesion,,Case Rate,4000.00
Cigna,PPO,54840,CPT4/HCPCS,Remove epididymis lesion,,Case Rate,4000.00
Cigna,PPO,54860,CPT4/HCPCS,Removal of epididymis,,Case Rate,4000.00
Cigna,PPO,54861,CPT4/HCPCS,Removal of epididymis,,Case Rate,4000.00
Cigna,PPO,54865,CPT4/HCPCS,Explore epididymis,,Case Rate,3000.00
Cigna,PPO,549,DRG,Septic arthritis w CC,,Case Rate,31795.95
Cigna,PPO,54900,CPT4/HCPCS,Fusion of spermatic ducts,,Case Rate,4000.00
Cigna,PPO,54901,CPT4/HCPCS,Fusion of spermatic ducts,,Case Rate,4000.00
Cigna,PPO,55,DRG,Nervous system neoplasms w/o MCC,,Case Rate,26606.70
Cigna,PPO,550,DRG,Septic arthritis w/o CC/MCC,,Case Rate,22508.85
Cigna,PPO,55040,CPT4/HCPCS,Removal of hydrocele,,Case Rate,4000.00
Cigna,PPO,55041,CPT4/HCPCS,Removal of hydroceles,,Case Rate,5000.00
Cigna,PPO,55060,CPT4/HCPCS,Repair of hydrocele,,Case Rate,4000.00
Cigna,PPO,551,DRG,Medical back problems w MCC,,Case Rate,41389.05
Cigna,PPO,55100,CPT4/HCPCS,Drainage of scrotum abscess,,Case Rate,3000.00
Cigna,PPO,55110,CPT4/HCPCS,Explore scrotum,,Case Rate,3000.00
Cigna,PPO,55120,CPT4/HCPCS,Removal of scrotum lesion,,Case Rate,3000.00
Cigna,PPO,55150,CPT4/HCPCS,Removal of scrotum,,Case Rate,3000.00
Cigna,PPO,55175,CPT4/HCPCS,Revision of scrotum,,Case Rate,3000.00
Cigna,PPO,55180,CPT4/HCPCS,Revision of scrotum,,Case Rate,3000.00
Cigna,PPO,552,DRG,Medical back problems w/o MCC,,Case Rate,24021.00
Cigna,PPO,55200,CPT4/HCPCS,Incision of sperm duct,,Case Rate,3000.00
Cigna,PPO,55250,CPT4/HCPCS,Removal of sperm duct(s),,Case Rate,3000.00
Cigna,PPO,553,DRG,Bone diseases & arthropathies w MCC,,Case Rate,32341.65
Cigna,PPO,55300,CPT4/HCPCS,Vasotomy for vasograms, seminal vesiculograms, or epididymograms, unilateral or bilateral,,Case Rate,3000.00
Cigna,PPO,554,DRG,Bone diseases & arthropathies w/o MCC,,Case Rate,20155.20
Cigna,PPO,55400,CPT4/HCPCS,Repair of sperm duct,,Case Rate,3000.00
Cigna,PPO,555,DRG,Signs & symptoms of musculoskeletal system & conn tissue w MCC,,Case Rate,34751.40
Cigna,PPO,55500,CPT4/HCPCS,Removal of hydrocele,,Case Rate,4000.00
Cigna,PPO,55520,CPT4/HCPCS,Removal of sperm cord lesion,,Case Rate,4000.00
Cigna,PPO,55530,CPT4/HCPCS,Revise spermatic cord veins,,Case Rate,4000.00
Cigna,PPO,55535,CPT4/HCPCS,Revise spermatic cord veins,,Case Rate,4000.00
Cigna,PPO,55540,CPT4/HCPCS,Revise hernia & sperm veins,,Case Rate,5000.00
Cigna,PPO,55550,CPT4/HCPCS,Laparo ligate spermatic vein,,Case Rate,8300.00
Cigna,PPO,55559,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD,,Case Rate,3000.00
Cigna,PPO,556,DRG,Signs & symptoms of musculoskeletal system & conn tissue w/o MCC,,Case Rate,20560.65
Cigna,PPO,55600,CPT4/HCPCS,Incise sperm duct pouch,,Case Rate,3000.00
Cigna,PPO,55605,CPT4/HCPCS,Incise sperm duct pouch,,Case Rate,3000.00
Cigna,PPO,55650,CPT4/HCPCS,Remove sperm duct pouch,,Case Rate,3000.00
Cigna,PPO,55680,CPT4/HCPCS,Remove sperm pouch lesion,,Case Rate,3000.00
Cigna,PPO,557,DRG,Tendonitis, myositis & bursitis w MCC,,Case Rate,35544.45
Cigna,PPO,55700,CPT4/HCPCS,Biopsy of prostate,,Case Rate,3000.00
Cigna,PPO,55705,CPT4/HCPCS,Biopsy of prostate,,Case Rate,3000.00
Cigna,PPO,55706,CPT4/HCPCS,BIOPSIES, PROSTATE, NEEDLE, TRANSPERINEAL, STEREOTACTIC TEMPLATE GUIDED SATURATION SAMPLING, INCLUDING IMAGING GUIDANCE,,Case Rate,4000.00
Cigna,PPO,55720,CPT4/HCPCS,Drainage of prostate abscess,,Case Rate,3000.00
Cigna,PPO,55725,CPT4/HCPCS,Drainage of prostate abscess,,Case Rate,3000.00
Cigna,PPO,558,DRG,Tendonitis, myositis & bursitis w/o MCC,,Case Rate,21886.65
Cigna,PPO,55845,CPT4/HCPCS,Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes,,Case Rate,3000.00
Cigna,PPO,55860,CPT4/HCPCS,Exposure of prostate, any approach, for insertion of radioactive substance;,,Case Rate,3000.00
Cigna,PPO,55866,CPT4/HCPCS,LAPAROSCOPY, SURGICAL PROSTATECTOMY, RETROPUBIC RADICAL, INCLUDING NERVE SPARING, INCLUDES ROBOTIC ASSISTANCE, WHEN PERFORMED ,,Case Rate,3000.00
Cigna,PPO,55870,CPT4/HCPCS,Electroejaculation,,Case Rate,3000.00
Cigna,PPO,55873,CPT4/HCPCS,Cryosurgical ablation of the prostate (includes ultrasonic guidance for interstitial cryosurgical probe placement),,Case Rate,8300.00
Cigna,PPO,55874,CPT4/HCPCS,Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed,,Case Rate,3000.00
Cigna,PPO,55875,CPT4/HCPCS,Transperi needle place, pros,,Case Rate,8300.00
Cigna,PPO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Case Rate,3000.00
Cigna,PPO,55899,CPT4/HCPCS,Unlisted procedure, male genital system,,Case Rate,3000.00
Cigna,PPO,559,DRG,Aftercare, musculoskeletal system & connective tissue w MCC,,Case Rate,47631.45
Cigna,PPO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Case Rate,8300.00
Cigna,PPO,56,DRG,Degenerative nervous system disorders w MCC,,Case Rate,55776.15
Cigna,PPO,560,DRG,Aftercare, musculoskeletal system & connective tissue w CC,,Case Rate,27448.20
Cigna,PPO,561,DRG,Aftercare, musculoskeletal system & connective tissue w/o CC/MCC,,Case Rate,20173.05
Cigna,PPO,562,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC,,Case Rate,35904.00
Cigna,PPO,563,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC,,Case Rate,22205.40
Cigna,PPO,564,DRG,Other musculoskeletal sys & connective tissue diagnoses w MCC,,Case Rate,38601.90
Cigna,PPO,56405,CPT4/HCPCS,I & D of vulva/perineum,,Case Rate,3000.00
Cigna,PPO,56420,CPT4/HCPCS,Incision and drainage of Bartholins gland abscess,,Case Rate,3000.00
Cigna,PPO,56440,CPT4/HCPCS,Surgery for vulva lesion,,Case Rate,3000.00
Cigna,PPO,56441,CPT4/HCPCS,Lysis of labial lesion(s),,Case Rate,3000.00
Cigna,PPO,56442,CPT4/HCPCS,Hymenotomy,,Case Rate,3000.00
Cigna,PPO,565,DRG,Other musculoskeletal sys & connective tissue diagnoses w CC,,Case Rate,25660.65
Cigna,PPO,56501,CPT4/HCPCS,Destruction of lesion(s), vulva; simple, any method,,Case Rate,3000.00
Cigna,PPO,56515,CPT4/HCPCS,Destroy vulva lesion/s compl,,Case Rate,4000.00
Cigna,PPO,566,DRG,Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC,,Case Rate,19163.25
Cigna,PPO,56605,CPT4/HCPCS,Biopsy of vulva/perineum,,Case Rate,3000.00
Cigna,PPO,56606,CPT4/HCPCS,Biopsy of vulva or perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,56620,CPT4/HCPCS,Partial removal of vulva,,Case Rate,5000.00
Cigna,PPO,56625,CPT4/HCPCS,Complete removal of vulva,,Case Rate,6000.00
Cigna,PPO,56700,CPT4/HCPCS,Partial removal of hymen,,Case Rate,3000.00
Cigna,PPO,56740,CPT4/HCPCS,Remove vagina gland lesion,,Case Rate,4000.00
Cigna,PPO,56800,CPT4/HCPCS,Repair of vagina,,Case Rate,4000.00
Cigna,PPO,56810,CPT4/HCPCS,Repair of perineum,,Case Rate,5000.00
Cigna,PPO,56820,CPT4/HCPCS,Colposcopy of the vulva;,,Case Rate,400.00
Cigna,PPO,56821,CPT4/HCPCS,Colposcopy of the vulva; with biopsy,,Case Rate,3000.00
Cigna,PPO,57,DRG,Degenerative nervous system disorders w/o MCC,,Case Rate,32237.10
Cigna,PPO,570,DRG,Skin debridement w MCC,,Case Rate,72325.65
Cigna,PPO,57000,CPT4/HCPCS,Exploration of vagina,,Case Rate,3000.00
Cigna,PPO,57010,CPT4/HCPCS,Drainage of pelvic abscess,,Case Rate,3000.00
Cigna,PPO,57020,CPT4/HCPCS,Drainage of pelvic fluid,,Case Rate,3000.00
Cigna,PPO,57022,CPT4/HCPCS,Incision and drainage of vaginal hemaome; post-obstetrical,,Case Rate,3000.00
Cigna,PPO,57023,CPT4/HCPCS,I & d vag hematoma, non-ob,,Case Rate,3000.00
Cigna,PPO,57061,CPT4/HCPCS,Destruction of vaginal lesion(s); simple, any method,,Case Rate,3000.00
Cigna,PPO,57065,CPT4/HCPCS,Destroy vag lesions, complex,,Case Rate,3000.00
Cigna,PPO,571,DRG,Skin debridement w CC,,Case Rate,41636.40
Cigna,PPO,57100,CPT4/HCPCS,Biopsy of vaginal mucosa; simple (separate procedure),,Case Rate,3000.00
Cigna,PPO,57105,CPT4/HCPCS,Biopsy of vagina,,Case Rate,3000.00
Cigna,PPO,57106,CPT4/HCPCS,Vaginectomy, partial removal of vaginal wall;,,Case Rate,3000.00
Cigna,PPO,57107,CPT4/HCPCS,Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy),,Case Rate,3000.00
Cigna,PPO,57109,CPT4/HCPCS,Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy),,Case Rate,3000.00
Cigna,PPO,57110,CPT4/HCPCS,Vaginectomy, complete removal of vaginal wall;,,Case Rate,3000.00
Cigna,PPO,57111,CPT4/HCPCS,Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy),,Case Rate,3000.00
Cigna,PPO,57112,CPT4/HCPCS,Vaginectomy, complete removal of vaginal wall; with removal of paravaginal tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy),,Case Rate,3000.00
Cigna,PPO,57120,CPT4/HCPCS,Colpocleisis (Le Fort type) ,,Case Rate,3000.00
Cigna,PPO,57130,CPT4/HCPCS,Remove vagina lesion,,Case Rate,3000.00
Cigna,PPO,57135,CPT4/HCPCS,Remove vagina lesion,,Case Rate,3000.00
Cigna,PPO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Case Rate,3000.00
Cigna,PPO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Case Rate,3000.00
Cigna,PPO,572,DRG,Skin debridement w/o CC/MCC,,Case Rate,28116.30
Cigna,PPO,57200,CPT4/HCPCS,Repair of vagina,,Case Rate,3000.00
Cigna,PPO,57210,CPT4/HCPCS,Repair vagina/perineum,,Case Rate,3000.00
Cigna,PPO,57220,CPT4/HCPCS,Revision of urethra,,Case Rate,4000.00
Cigna,PPO,57230,CPT4/HCPCS,Repair of urethral lesion,,Case Rate,4000.00
Cigna,PPO,57240,CPT4/HCPCS,Repair bladder & vagina,,Case Rate,5000.00
Cigna,PPO,57250,CPT4/HCPCS,Repair rectum & vagina,,Case Rate,5000.00
Cigna,PPO,57260,CPT4/HCPCS,Repair of vagina,,Case Rate,5000.00
Cigna,PPO,57265,CPT4/HCPCS,Extensive repair of vagina,,Case Rate,6000.00
Cigna,PPO,57267,CPT4/HCPCS,Insertion Of Mesh Or Other Prosthesis For Repair Of Pelvic Floor Defect, Each Site (Anterior, Posterior Compartment), Vaginal Approach (List Separately In Addition To Code For Primary Procedure),,Case Rate,3000.00
Cigna,PPO,57268,CPT4/HCPCS,Repair of bowel bulge,,Case Rate,4000.00
Cigna,PPO,57280,CPT4/HCPCS,Colpopexy, abdominal approach,,Case Rate,3000.00
Cigna,PPO,57282,CPT4/HCPCS,Sacrospinous ligament fixation for prolapse of vagina,,Case Rate,3000.00
Cigna,PPO,57283,CPT4/HCPCS,COLPOPEXY, VAGINAL; INTRA-PERITONEAL APPROACH (UTEROSACRAL, LEVATOR MYORRHAPHY) ,,Case Rate,3000.00
Cigna,PPO,57284,CPT4/HCPCS,Paravaginal defect repair (including repair of cystocele, stress urinary incontinence, and/or incomplete vaginal prolapse),,Case Rate,3000.00
Cigna,PPO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT, VAG,,Case Rate,8300.00
Cigna,PPO,57287,CPT4/HCPCS,Removal or revision of sling for stress incontinence (eg, fascia or synthetic),,Case Rate,3000.00
Cigna,PPO,57288,CPT4/HCPCS,Repair bladder defect,,Case Rate,5000.00
Cigna,PPO,57289,CPT4/HCPCS,Repair bladder & vagina,,Case Rate,5000.00
Cigna,PPO,57291,CPT4/HCPCS,Construction of vagina,,Case Rate,5000.00
Cigna,PPO,57292,CPT4/HCPCS,CONSTRUCTION OF ARTIFICIAL VAGINA WITH GRAFT ,,Case Rate,3000.00
Cigna,PPO,57295,CPT4/HCPCS,Revision (including removal) of prosthetic vaginal graft, vaginal approach,,Case Rate,4000.00
Cigna,PPO,573,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w MCC,,Case Rate,141201.15
Cigna,PPO,57300,CPT4/HCPCS,Repair rectum-vagina fistula,,Case Rate,4000.00
Cigna,PPO,57305,CPT4/HCPCS,Closure of rectovaginal fistula; abdominal approach,,Case Rate,3000.00
Cigna,PPO,57310,CPT4/HCPCS,Repair urethrovaginal lesion,,Case Rate,4000.00
Cigna,PPO,57311,CPT4/HCPCS,Repair urethrovaginal lesion,,Case Rate,3000.00
Cigna,PPO,57320,CPT4/HCPCS,Repair bladder-vagina lesion,,Case Rate,4000.00
Cigna,PPO,57335,CPT4/HCPCS,Vaginoplasty for intersex state,,Case Rate,3000.00
Cigna,PPO,574,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w CC,,Case Rate,82831.65
Cigna,PPO,57400,CPT4/HCPCS,Dilation of vagina,,Case Rate,3000.00
Cigna,PPO,57410,CPT4/HCPCS,PELVIC EXAMINATION UNDER ANESTHESIA (OTHER THAN LOCAL),,Case Rate,3000.00
Cigna,PPO,57415,CPT4/HCPCS,Remove vaginal foreign body,,Case Rate,3000.00
Cigna,PPO,57420,CPT4/HCPCS,Colposcopy of the entire vagina, with cervix if present;,,Case Rate,3000.00
Cigna,PPO,57421,CPT4/HCPCS,Colposcopy of the entire vagina, with cervix if present; with biopsy(s),,Case Rate,3000.00
Cigna,PPO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT, LAP,,Case Rate,8300.00
Cigna,PPO,57425,CPT4/HCPCS,Laparoscopy, surgical, colpopexy (suspension of vaginal apex),,Case Rate,3000.00
Cigna,PPO,57426,CPT4/HCPCS,Revision (including removal) of prosthetic vaginal graft, laparoscopic approach ,,Case Rate,3000.00
Cigna,PPO,57452,CPT4/HCPCS,Colposcopy (vaginoscopy); (separate procedure),,Case Rate,3000.00
Cigna,PPO,57454,CPT4/HCPCS,Colposcopy (vaginoscopy); with biopsy(s) of the cervix and/or endocervical curettage,,Case Rate,3000.00
Cigna,PPO,57455,CPT4/HCPCS,Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix,,Case Rate,3000.00
Cigna,PPO,57456,CPT4/HCPCS,Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage,,Case Rate,3000.00
Cigna,PPO,57460,CPT4/HCPCS,Colposcopy (vaginoscopy); with loop electrode excision procedure of the cervix,,Case Rate,3000.00
Cigna,PPO,57461,CPT4/HCPCS,Colposcopy of the cervix including upper/adjacent vagina; with loop electrode conization of the cervix,,Case Rate,3000.00
Cigna,PPO,575,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/MCC,,Case Rate,44918.25
Cigna,PPO,57500,CPT4/HCPCS,Biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure),,Case Rate,3000.00
Cigna,PPO,57505,CPT4/HCPCS,Endocervical curettage (not done as part of a dilation and curettage),,Case Rate,3000.00
Cigna,PPO,57510,CPT4/HCPCS,Cauterization of cervix; electro or thermal,,Case Rate,3000.00
Cigna,PPO,57511,CPT4/HCPCS,Cauterization of cervix; cryocautery, initial or repeat,,Case Rate,3000.00
Cigna,PPO,57513,CPT4/HCPCS,Laser surgery of cervix,,Case Rate,3000.00
Cigna,PPO,57520,CPT4/HCPCS,Conization of cervix,,Case Rate,3000.00
Cigna,PPO,57522,CPT4/HCPCS,Conization of cervix,,Case Rate,3000.00
Cigna,PPO,57530,CPT4/HCPCS,Removal of cervix,,Case Rate,4000.00
Cigna,PPO,57550,CPT4/HCPCS,Removal of residual cervix,,Case Rate,4000.00
Cigna,PPO,57556,CPT4/HCPCS,Remove cervix, repair bowel,,Case Rate,5000.00
Cigna,PPO,57558,CPT4/HCPCS,D&c of cervical stump,,Case Rate,4000.00
Cigna,PPO,576,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC,,Case Rate,128797.95
Cigna,PPO,577,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w CC,,Case Rate,65121.90
Cigna,PPO,57700,CPT4/HCPCS,Revision of cervix,,Case Rate,3000.00
Cigna,PPO,57720,CPT4/HCPCS,Revision of cervix,,Case Rate,4000.00
Cigna,PPO,578,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC,,Case Rate,41582.85
Cigna,PPO,57800,CPT4/HCPCS,Dilation of cervical canal,,Case Rate,3000.00
Cigna,PPO,579,DRG,Other skin, subcut tiss & breast proc w MCC,,Case Rate,74658.90
Cigna,PPO,58,DRG,Multiple sclerosis & cerebellar ataxia w MCC,,Case Rate,44285.85
Cigna,PPO,580,DRG,Other skin, subcut tiss & breast proc w CC,,Case Rate,40807.65
Cigna,PPO,581,DRG,Other skin, subcut tiss & breast proc w/o CC/MCC,,Case Rate,31928.55
Cigna,PPO,58100,CPT4/HCPCS,Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure),,Case Rate,400.00
Cigna,PPO,58110,CPT4/HCPCS,ENDOMETRIAL SAMPLING (BIOPSY) PERFORMED IN CONJUNCTION WITH COLPOSCOPY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,58120,CPT4/HCPCS,Dilation and curettage,,Case Rate,3000.00
Cigna,PPO,58140,CPT4/HCPCS,Myomectomy, excision of fibroid tumor of uterus, single or multiple (separate procedure); abdominal approach,,Case Rate,3000.00
Cigna,PPO,58145,CPT4/HCPCS,Removal of uterus lesion,,Case Rate,5000.00
Cigna,PPO,58150,CPT4/HCPCS,Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s);,,Case Rate,3000.00
Cigna,PPO,58152,CPT4/HCPCS,Total abdominal hysterectomy (corpus and cervix), with or without removal of tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg, Marshall-Marchetti-Krantz, Burch),,Case Rate,3000.00
Cigna,PPO,58180,CPT4/HCPCS,Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without removal of tube(s), with or without removal of ovary(s),,Case Rate,3000.00
Cigna,PPO,582,DRG,Mastectomy for malignancy w CC/MCC,,Case Rate,41712.90
Cigna,PPO,58200,CPT4/HCPCS,Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and pelvic lymph node sampling, with or without removal of tube(s), with or without removal of ovary(s),,Case Rate,3000.00
Cigna,PPO,58210,CPT4/HCPCS,Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with or without removal of ovary(s),,Case Rate,3000.00
Cigna,PPO,58260,CPT4/HCPCS,Vaginal hysterectomy;,,Case Rate,8300.00
Cigna,PPO,58262,CPT4/HCPCS,Vaginal hysterectomy; with removal of tube(s), and/or ovary(s),,Case Rate,8300.00
Cigna,PPO,58263,CPT4/HCPCS,VAGINAL HYSTERECTOMY; WITH REMOVAL OF TUBE(S), AND/OR OVARY(S), WITH REPAIR OF ENTEROCELE ,,Case Rate,3000.00
Cigna,PPO,58270,CPT4/HCPCS,VAG HYST W/WO REM TURE(S) W/WO REM OVARY(S) W RPR OF ENTEROCELE (SSO) ,,Case Rate,3000.00
Cigna,PPO,58290,CPT4/HCPCS,VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; ,,Case Rate,3000.00
Cigna,PPO,58291,CPT4/HCPCS,VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S) ,,Case Rate,3000.00
Cigna,PPO,58292,CPT4/HCPCS,VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S), WITH REPAIR OF ENTEROCELE ,,Case Rate,3000.00
Cigna,PPO,58294,CPT4/HCPCS,VAGINAL HYSTERECTOMY, FOR UTERUS GREATER THAN 250 GRAMS; WITH REPAIR OF ENTEROCELE ,,Case Rate,3000.00
Cigna,PPO,583,DRG,Mastectomy for malignancy w/o CC/MCC,,Case Rate,39216.45
Cigna,PPO,58300,CPT4/HCPCS,Insertion of intrauterine device (IUD),,Case Rate,400.00
Cigna,PPO,58301,CPT4/HCPCS,Removal of intrauterine device (IUD),,Case Rate,3000.00
Cigna,PPO,58340,CPT4/HCPCS,Catheterization and introduction of saline or contrast material for hysterosonography or hysterosalpingography,,Case Rate,3000.00
Cigna,PPO,58345,CPT4/HCPCS,Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography,,Case Rate,3000.00
Cigna,PPO,58346,CPT4/HCPCS,Insert heyman uteri capsule,,Case Rate,3000.00
Cigna,PPO,58350,CPT4/HCPCS,Reopen fallopian tube,,Case Rate,4000.00
Cigna,PPO,58353,CPT4/HCPCS,Endometr ablate, thermal,,Case Rate,6000.00
Cigna,PPO,58356,CPT4/HCPCS,Endometrial Cryoablation With Ultrasonic Guidance, Including Endometrial Curettage, When Performed,,Case Rate,3000.00
Cigna,PPO,584,DRG,Breast biopsy, local excision & other breast procedures w CC/MCC,,Case Rate,46519.65
Cigna,PPO,58400,CPT4/HCPCS,Uterine suspension, with or without shortening of round ligaments, with or without shortening of sacrouterine ligaments; (separate procedure),,Case Rate,3000.00
Cigna,PPO,585,DRG,Breast biopsy, local excision & other breast procedures w/o CC/MCC,,Case Rate,44283.30
Cigna,PPO,58520,CPT4/HCPCS,Hysterorrhaphy, repair of ruptured uterus (nonobstetrical),,Case Rate,3000.00
Cigna,PPO,58540,CPT4/HCPCS,Hysteroplasty, repair of uterine anomaly (Strassman type),,Case Rate,3000.00
Cigna,PPO,58541,CPT4/HCPCS,"Lsh, uterus 250 g or less",,Case Rate,8300.00
Cigna,PPO,58542,CPT4/HCPCS,Lsh w/t/o ut 250 g or less,,Case Rate,8300.00
Cigna,PPO,58543,CPT4/HCPCS,Lsh uterus above 250 g,,Case Rate,8300.00
Cigna,PPO,58544,CPT4/HCPCS,Lsh w/t/o uterus above 250 g,,Case Rate,8300.00
Cigna,PPO,58545,CPT4/HCPCS,Laparoscopic myomectomy,,Case Rate,8300.00
Cigna,PPO,58546,CPT4/HCPCS,Laparo-myomectomy, complex,,Case Rate,8300.00
Cigna,PPO,58550,CPT4/HCPCS,Laparo-asst vag hysterectomy,,Case Rate,8300.00
Cigna,PPO,58552,CPT4/HCPCS,Laparoscopy surgical, with vaginal hysterectomy, for uterus 250 grams or less; with removal of tube(s) and/or ovary(s),,Case Rate,5000.00
Cigna,PPO,58553,CPT4/HCPCS,Laparoscopy , surgical , with vaginal hysterectomy, for uterus greater than 250 grams;,,Case Rate,5000.00
Cigna,PPO,58554,CPT4/HCPCS,Laparoscopy , surgical , with vaginal hysterectomy, for uterus greater than 250 grams; with removal of tube(s) and/or ovary(s),,Case Rate,5000.00
Cigna,PPO,58555,CPT4/HCPCS,Hysteroscopy, dx, sep proc,,Case Rate,3000.00
Cigna,PPO,58558,CPT4/HCPCS,Hysteroscopy, biopsy,,Case Rate,4000.00
Cigna,PPO,58559,CPT4/HCPCS,Hysteroscopy, lysis,,Case Rate,3000.00
Cigna,PPO,58560,CPT4/HCPCS,Hysteroscopy, resect septum,,Case Rate,4000.00
Cigna,PPO,58561,CPT4/HCPCS,Hysteroscopy, remove myoma,,Case Rate,4000.00
Cigna,PPO,58562,CPT4/HCPCS,Hysteroscopy, remove fb,,Case Rate,4000.00
Cigna,PPO,58563,CPT4/HCPCS,Hysteroscopy, ablation,,Case Rate,8300.00
Cigna,PPO,58565,CPT4/HCPCS,Hysteroscopy, sterilization,,Case Rate,8300.00
Cigna,PPO,58570,CPT4/HCPCS,TLH, UTERUS 250 G OR LESS,,Case Rate,8300.00
Cigna,PPO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Case Rate,8300.00
Cigna,PPO,58572,CPT4/HCPCS,TLH, UTERUS OVER 250 G,,Case Rate,8300.00
Cigna,PPO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Case Rate,8300.00
Cigna,PPO,58578,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, UTERUS,,Case Rate,3000.00
Cigna,PPO,58579,CPT4/HCPCS,UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS,,Case Rate,3000.00
Cigna,PPO,58600,CPT4/HCPCS,Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral,,Case Rate,5000.00
Cigna,PPO,58605,CPT4/HCPCS,Ligation or transection of fallopian tube(s), abdominal or vaginal approach, postpartum, unilateral or bilateral, during same hospitalization (separate procedure),,Case Rate,3000.00
Cigna,PPO,58611,CPT4/HCPCS,Ligation or transection of fallopian tube(s) when done at the time of cesarean section or intra-abdominal surgery (not a separate procedure) (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,58615,CPT4/HCPCS,Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or suprapubic approach,,Case Rate,3000.00
Cigna,PPO,58660,CPT4/HCPCS,Laparoscopy, lysis,,Case Rate,5000.00
Cigna,PPO,58661,CPT4/HCPCS,Laparoscopy, remove adnexa,,Case Rate,5000.00
Cigna,PPO,58662,CPT4/HCPCS,Laparoscopy, excise lesions,,Case Rate,5000.00
Cigna,PPO,58670,CPT4/HCPCS,Laparoscopy, tubal cautery,,Case Rate,4000.00
Cigna,PPO,58671,CPT4/HCPCS,Laparoscopy, tubal block,,Case Rate,4000.00
Cigna,PPO,58672,CPT4/HCPCS,Laparoscopy, fimbrioplasty,,Case Rate,5000.00
Cigna,PPO,58673,CPT4/HCPCS,Laparoscopy, salpingostomy,,Case Rate,5000.00
Cigna,PPO,58674,CPT4/HCPCS,Laparoscopy, surgical, ablation of uterine fibroid(s) including intraoperative ultrasound guidance and monitoring, radiofrequency,,Case Rate,3000.00
Cigna,PPO,58679,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY,,Case Rate,3000.00
Cigna,PPO,58700,CPT4/HCPCS,Salpingectomy, complete or partial, unilateral or bilateral (separate procedure),,Case Rate,3000.00
Cigna,PPO,58720,CPT4/HCPCS,Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate procedure),,Case Rate,3000.00
Cigna,PPO,58740,CPT4/HCPCS,Lysis of adhesions (salpingolysis, ovariolysis),,Case Rate,3000.00
Cigna,PPO,58750,CPT4/HCPCS,Tubotubal anastomosis,,Case Rate,3000.00
Cigna,PPO,58752,CPT4/HCPCS,Tubouterine implantation,,Case Rate,3000.00
Cigna,PPO,58760,CPT4/HCPCS,Fimbrioplasty,,Case Rate,3000.00
Cigna,PPO,58770,CPT4/HCPCS,Salpingostomy (salpingoneostomy),,Case Rate,3000.00
Cigna,PPO,58800,CPT4/HCPCS,Drainage of ovarian cyst(s),,Case Rate,4000.00
Cigna,PPO,58805,CPT4/HCPCS,Drainage of ovarian cyst(s), unilateral or bilateral, (separate procedure); abdominal approach,,Case Rate,3000.00
Cigna,PPO,58820,CPT4/HCPCS,Drain ovary abscess, open,,Case Rate,4000.00
Cigna,PPO,58822,CPT4/HCPCS,Drainage of ovarian abscess; abdominal approach,,Case Rate,3000.00
Cigna,PPO,58825,CPT4/HCPCS,Transposition, ovary(s),,Case Rate,3000.00
Cigna,PPO,58900,CPT4/HCPCS,Biopsy of ovary(s),,Case Rate,4000.00
Cigna,PPO,58920,CPT4/HCPCS,Wedge resection or bisection of ovary, unilateral or bilateral,,Case Rate,3000.00
Cigna,PPO,58925,CPT4/HCPCS,Ovarian cystectomy, unilateral or bilateral,,Case Rate,3000.00
Cigna,PPO,58940,CPT4/HCPCS,Oophorectomy, partial or total, unilateral or bilateral;,,Case Rate,3000.00
Cigna,PPO,58960,CPT4/HCPCS,Laparotomy, for staging or restaging of ovarian malignancy (second look), with or without omentectomy, peritoneal washing, biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment with pelvic and limited para-aortic lymphadenectomy,,Case Rate,3000.00
Cigna,PPO,58970,CPT4/HCPCS,Retrieval of oocyte,,Case Rate,3000.00
Cigna,PPO,58974,CPT4/HCPCS,Transfer of embryo,,Case Rate,3000.00
Cigna,PPO,58976,CPT4/HCPCS,Transfer of embryo,,Case Rate,3000.00
Cigna,PPO,58999,CPT4/HCPCS,UNLISTED PROCEDURE, FEMALE GENITAL SYSTEM NONOBSTETRICAL ,,Case Rate,3000.00
Cigna,PPO,59,DRG,Multiple sclerosis & cerebellar ataxia w CC,,Case Rate,28725.75
Cigna,PPO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Case Rate,3000.00
Cigna,PPO,59001,CPT4/HCPCS,AMNIOCENTESIS; THERAPEUTIC AMNIOTIC FLUID REDUCTION (INCLUDES ULTRASOUND GUIDANCE),,Case Rate,3000.00
Cigna,PPO,59025,CPT4/HCPCS,Fetal Non Series Test,,% of Charges,6500.00
Cigna,PPO,59070,CPT4/HCPCS,Transabdominal amnioinfusion, including ultrasound guidance,,Case Rate,3000.00
Cigna,PPO,59072,CPT4/HCPCS,Fetal umbilical cord occlusion, including ultrasound guidance,,Case Rate,3000.00
Cigna,PPO,59074,CPT4/HCPCS,Fetal fluid drainage (eg, vesicocentesis, thoracocentesis, paracentesis), including ultrasound guidance,,Case Rate,3000.00
Cigna,PPO,59076,CPT4/HCPCS,Fetal shunt placement, including ultrasound guidance,,Case Rate,3000.00
Cigna,PPO,59120,CPT4/HCPCS,Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach,,Case Rate,3000.00
Cigna,PPO,59121,CPT4/HCPCS,Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy and/or oophorectomy,,Case Rate,3000.00
Cigna,PPO,59150,CPT4/HCPCS,Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or oophorectomy,,Case Rate,3000.00
Cigna,PPO,59151,CPT4/HCPCS,Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or oophorectomy,,Case Rate,3000.00
Cigna,PPO,59160,CPT4/HCPCS,D & c after delivery,,Case Rate,4000.00
Cigna,PPO,592,DRG,Skin ulcers w MCC,,Case Rate,43010.85
Cigna,PPO,59200,CPT4/HCPCS,Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure),,Case Rate,3000.00
Cigna,PPO,593,DRG,Skin ulcers w CC,,Case Rate,28988.40
Cigna,PPO,59300,CPT4/HCPCS,Episiotomy or vaginal repair, by other than attending physician,,Case Rate,3000.00
Cigna,PPO,59320,CPT4/HCPCS,Revision of cervix,,Case Rate,3000.00
Cigna,PPO,59325,CPT4/HCPCS,Cerclage of cervix, during pregnancy; abdominal,,Case Rate,3000.00
Cigna,PPO,594,DRG,Skin ulcers w/o CC/MCC,,Case Rate,20876.85
Cigna,PPO,59409,CPT4/HCPCS,Vaginal delivery only (with or without episiotomy and/or forceps);,,Case Rate,3000.00
Cigna,PPO,59410,CPT4/HCPCS,Vaginal delivery only (with or without episiotomy and/or forceps); including postpartum care,,Case Rate,3000.00
Cigna,PPO,59430,CPT4/HCPCS,Postpartum care only (separate procedure),,Case Rate,6500.00
Cigna,PPO,595,DRG,Major skin disorders w MCC,,Case Rate,51308.55
Cigna,PPO,59515,CPT4/HCPCS,Cesarean delivery only; including postpartum care,,Case Rate,3000.00
Cigna,PPO,596,DRG,Major skin disorders w/o MCC,,Case Rate,25224.60
Cigna,PPO,59612,CPT4/HCPCS,Vaginal delivery only, after previous cesarean delivery (with or without episiotomy and/or forceps);,,Case Rate,3000.00
Cigna,PPO,597,DRG,Malignant breast disorders w MCC,,Case Rate,41735.85
Cigna,PPO,598,DRG,Malignant breast disorders w CC,,Case Rate,28335.60
Cigna,PPO,59812,CPT4/HCPCS,Treatment of miscarriage,,Case Rate,5000.00
Cigna,PPO,59820,CPT4/HCPCS,Care of miscarriage,,Case Rate,5000.00
Cigna,PPO,59821,CPT4/HCPCS,Treatment of miscarriage,,Case Rate,5000.00
Cigna,PPO,59830,CPT4/HCPCS,Treatment of septic abortion, completed surgically,,Case Rate,3000.00
Cigna,PPO,59840,CPT4/HCPCS,Abortion,,Case Rate,5000.00
Cigna,PPO,59841,CPT4/HCPCS,Abortion,,Case Rate,5000.00
Cigna,PPO,59850,CPT4/HCPCS,Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines;,,Case Rate,3000.00
Cigna,PPO,59851,CPT4/HCPCS,Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation,,Case Rate,3000.00
Cigna,PPO,59852,CPT4/HCPCS,Induced abortion, by one or more intra-amniotic injections (amniocentesis-injections), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed intra-amniotic injection),,Case Rate,3000.00
Cigna,PPO,59856,CPT4/HCPCS,Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with dilation and curettage and/or evacuation,,Case Rate,3000.00
Cigna,PPO,59857,CPT4/HCPCS,Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or without cervical dilation (eg, laminaria), including hospital admission and visits, delivery of fetus and secundines; with hysterotomy (failed medical evacuation),,Case Rate,3000.00
Cigna,PPO,59870,CPT4/HCPCS,Evacuate mole of uterus,,Case Rate,5000.00
Cigna,PPO,59871,CPT4/HCPCS,Remove cerclage suture,,Case Rate,5000.00
Cigna,PPO,59897,CPT4/HCPCS,Unlisted fetal invasive procedure, including ultrasound guidance,,Case Rate,3000.00
Cigna,PPO,59898,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, MATERNITY CARE AND DELIVERY,,Case Rate,3000.00
Cigna,PPO,59899,CPT4/HCPCS,Unlisted procedure, maternity care and delivery,,Case Rate,3000.00
Cigna,PPO,599,DRG,Malignant breast disorders w/o CC/MCC,,Case Rate,17115.60
Cigna,PPO,6,DRG,Liver transplant w/o MCC,,Case Rate,119638.35
Cigna,PPO,60,DRG,Multiple sclerosis & cerebellar ataxia w/o CC/MCC,,Case Rate,23347.80
Cigna,PPO,600,DRG,Non-malignant breast disorders w CC/MCC,,Case Rate,25390.35
Cigna,PPO,60000,CPT4/HCPCS,Drain thyroid/tongue cyst,,Case Rate,3000.00
Cigna,PPO,601,DRG,Non-malignant breast disorders w/o CC/MCC,,Case Rate,17533.80
Cigna,PPO,60100,CPT4/HCPCS,Biopsy thyroid, percutaneous core needle,,Case Rate,3000.00
Cigna,PPO,602,DRG,Cellulitis w MCC,,Case Rate,36633.30
Cigna,PPO,60200,CPT4/HCPCS,Remove thyroid lesion,,Case Rate,3000.00
Cigna,PPO,60210,CPT4/HCPCS,Partial thyroid lobectomy, unilateral; with or without isthmusectomy,,Case Rate,3000.00
Cigna,PPO,60212,CPT4/HCPCS,Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy,,Case Rate,3000.00
Cigna,PPO,60220,CPT4/HCPCS,Partial removal of thyroid,,Case Rate,3000.00
Cigna,PPO,60225,CPT4/HCPCS,Partial removal of thyroid,,Case Rate,4000.00
Cigna,PPO,60240,CPT4/HCPCS,Thyroidectomy, total or complete,,Case Rate,3000.00
Cigna,PPO,60252,CPT4/HCPCS,Thyroidectomy, total or subtotal for malignancy; with limited neck dissection,,Case Rate,3000.00
Cigna,PPO,60254,CPT4/HCPCS,Thyroidectomy, total or subtotal for malignancy; with radical neck dissection,,Case Rate,3000.00
Cigna,PPO,60260,CPT4/HCPCS,Thyroidectomy, removal of all remaining thyroid tissue following previous removal of a portion of thyroid,,Case Rate,3000.00
Cigna,PPO,60271,CPT4/HCPCS,THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID GLAND; CERVICAL APPROACH ,,Case Rate,3000.00
Cigna,PPO,60280,CPT4/HCPCS,Remove thyroid duct lesion,,Case Rate,4000.00
Cigna,PPO,60281,CPT4/HCPCS,Remove thyroid duct lesion,,Case Rate,4000.00
Cigna,PPO,603,DRG,Cellulitis w/o MCC,,Case Rate,21542.40
Cigna,PPO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Case Rate,400.00
Cigna,PPO,604,DRG,Trauma to the skin, subcut tiss & breast w MCC,,Case Rate,38028.15
Cigna,PPO,605,DRG,Trauma to the skin, subcut tiss & breast w/o MCC,,Case Rate,23184.60
Cigna,PPO,60500,CPT4/HCPCS,Parathyroidectomy or exploration of parathyroid(s);,,Case Rate,3000.00
Cigna,PPO,60502,CPT4/HCPCS,Parathyroidectomy or exploration of parathyroid(s); re-exploration,,Case Rate,8300.00
Cigna,PPO,60512,CPT4/HCPCS,Parathyroid autotransplantation (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,60520,CPT4/HCPCS,Thymectomy, partial or total; transcervical approach (separate procedure),,Case Rate,3000.00
Cigna,PPO,60540,CPT4/HCPCS,Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure);,,Case Rate,3000.00
Cigna,PPO,606,DRG,Minor skin disorders w MCC,,Case Rate,38530.50
Cigna,PPO,60650,CPT4/HCPCS,LAPAROSCOPY, SURGICAL, WITH ADRENALECTOMY, PARTIAL OR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR WITHOUT BIOPSY, TRANSABDOMINAL, LUMBAR OR DORSAL,,Case Rate,3000.00
Cigna,PPO,60659,CPT4/HCPCS,UNLISTED LAPAROSCOPY PROCEDURE, ENDOCRINE SYSTEM,,Case Rate,3000.00
Cigna,PPO,60699,CPT4/HCPCS,UNLISTED PROCEDURE, ENDOCRINE SYSTEM ,,Case Rate,3000.00
Cigna,PPO,607,DRG,Minor skin disorders w/o MCC,,Case Rate,21052.80
Cigna,PPO,61,DRG,Acute ischemic stroke w use of thrombolytic agent w MCC,,Case Rate,73649.10
Cigna,PPO,61000,CPT4/HCPCS,Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial,,Case Rate,3000.00
Cigna,PPO,61001,CPT4/HCPCS,Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent taps,,Case Rate,3000.00
Cigna,PPO,61020,CPT4/HCPCS,Remove brain cavity fluid,,Case Rate,3000.00
Cigna,PPO,61026,CPT4/HCPCS,Injection into brain canal,,Case Rate,3000.00
Cigna,PPO,61050,CPT4/HCPCS,Remove brain canal fluid,,Case Rate,3000.00
Cigna,PPO,61055,CPT4/HCPCS,Injection into brain canal,,Case Rate,3000.00
Cigna,PPO,61070,CPT4/HCPCS,Brain canal shunt procedure,,Case Rate,3000.00
Cigna,PPO,61215,CPT4/HCPCS,Insert brain-fluid device,,Case Rate,4000.00
Cigna,PPO,61316,CPT4/HCPCS,Incision and subcutaneous placement of cranial bone graft (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,614,DRG,Adrenal & pituitary procedures w CC/MCC,,Case Rate,60863.40
Cigna,PPO,615,DRG,Adrenal & pituitary procedures w/o CC/MCC,,Case Rate,40139.55
Cigna,PPO,61500,CPT4/HCPCS,Craniectomy; with excision of tumor or other bone lesion of skull,,Case Rate,3000.00
Cigna,PPO,616,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w MCC,,Case Rate,101714.40
Cigna,PPO,61623,CPT4/HCPCS,Endovascular temporary balloon arterial occlusion, head or neck (extracranial/intracranial) including selective catheterization of vessel to be occluded, positioning and inflation of occlusion balloon, concomitant neurological monitoring, and radiologic s,,Case Rate,3000.00
Cigna,PPO,61626,CPT4/HCPCS,TRANSCATHETER OCCULUSION OR EMBOLIZATION (EG, FOR TUMOR DESTRUCTION, TO ACHIEVE HEMOSTASIS, TO OCCLUDE A VASCULAR MALFORMATION), PERCUTANEOUS, ANY METHOD; NON-CENTRAL NERVOUS SYSTEM, HEAD OR NECK (EXTRACRANIAL, BRACHIOCEPHALIC B ,,Case Rate,3000.00
Cigna,PPO,61645,CPT4/HCPCS,PERCUTANEOUS ARTERIAL TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, INTRACRANIAL, ANY METHOD, INCLUDING DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT, AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(,,Case Rate,3000.00
Cigna,PPO,617,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w CC,,Case Rate,51869.55
Cigna,PPO,61781,CPT4/HCPCS,STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL, INTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,61782,CPT4/HCPCS,STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; CRANIAL, EXTRADURAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,61783,CPT4/HCPCS,STEREOTACTIC COMPUTER-ASSISTED (NAVIGATIONAL) PROCEDURE; SPINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,61790,CPT4/HCPCS,Treat trigeminal nerve,,Case Rate,4000.00
Cigna,PPO,61791,CPT4/HCPCS,Treat trigeminal tract,,Case Rate,4000.00
Cigna,PPO,618,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w/o CC/MCC,,Case Rate,33226.50
Cigna,PPO,61800,CPT4/HCPCS,APPLICATION OF STEREOTACTIC HEADFRAME FOR STEREOTACTIC RADIOSURGERY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,61885,CPT4/HCPCS,Implant neurostim one array,,Case Rate,3000.00
Cigna,PPO,61886,CPT4/HCPCS,Implant neurostim arrays,,Case Rate,4000.00
Cigna,PPO,61888,CPT4/HCPCS,REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,,Case Rate,3000.00
Cigna,PPO,619,DRG,O.R. procedures for obesity w MCC,,Case Rate,78058.05
Cigna,PPO,62,DRG,Acute ischemic stroke w use of thrombolytic agent w CC,,Case Rate,50673.60
Cigna,PPO,620,DRG,O.R. procedures for obesity w CC,,Case Rate,44908.05
Cigna,PPO,621,DRG,O.R. procedures for obesity w/o CC/MCC,,Case Rate,40708.20
Cigna,PPO,62160,CPT4/HCPCS,Neuroendoscopy, intracranial, for placement or replacement of ventricular catheter and attachment to shunt system or exteran ldrainage (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,62194,CPT4/HCPCS,Replace/irrigate catheter,,Case Rate,3000.00
Cigna,PPO,622,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC,,Case Rate,92126.40
Cigna,PPO,62225,CPT4/HCPCS,Replace/irrigate catheter,,Case Rate,3000.00
Cigna,PPO,62230,CPT4/HCPCS,Replace/revise brain shunt,,Case Rate,3000.00
Cigna,PPO,62256,CPT4/HCPCS,Remove brain cavity shunt,,Case Rate,3000.00
Cigna,PPO,62263,CPT4/HCPCS,Lysis epidural adhesions,,Case Rate,3000.00
Cigna,PPO,62264,CPT4/HCPCS,Epidural lysis on single day,,Case Rate,3000.00
Cigna,PPO,62267,CPT4/HCPCS,PERCUTANEOUS ASPIRATION WITHIN THE NUCLEUS PULPOSUS, INTERVERTEBRAL DISC, OR PARAVERTEBRAL TISSUE FOR DIAGNOSTIC PURPOSES,,Case Rate,3000.00
Cigna,PPO,62268,CPT4/HCPCS,Drain spinal cord cyst,,Case Rate,3000.00
Cigna,PPO,62269,CPT4/HCPCS,Needle biopsy, spinal cord,,Case Rate,3000.00
Cigna,PPO,62270,CPT4/HCPCS,Spinal fluid tap, diagnostic,,Case Rate,3000.00
Cigna,PPO,62272,CPT4/HCPCS,Drain cerebro spinal fluid,,Case Rate,3000.00
Cigna,PPO,62273,CPT4/HCPCS,Treat epidural spine lesion,,Case Rate,3000.00
Cigna,PPO,62280,CPT4/HCPCS,Treat spinal cord lesion,,Case Rate,3000.00
Cigna,PPO,62281,CPT4/HCPCS,Treat spinal cord lesion,,Case Rate,3000.00
Cigna,PPO,62282,CPT4/HCPCS,Treat spinal canal lesion,,Case Rate,3000.00
Cigna,PPO,62284,CPT4/HCPCS,Injection procedure for myelography and/or computerized axial tomography, spinal (other than C1-C2 and posterior fossa),,Case Rate,3000.00
Cigna,PPO,62287,CPT4/HCPCS,Percutaneous diskectomy,,Case Rate,8300.00
Cigna,PPO,62290,CPT4/HCPCS,Injection procedure for diskography, each level; lumbar,,Case Rate,3000.00
Cigna,PPO,62291,CPT4/HCPCS,Injection procedure for diskography, each level; cervical,,Case Rate,3000.00
Cigna,PPO,62292,CPT4/HCPCS,Injection procedure for chemonucleolysis, including diskography, intervertebral disk, single or multiple levels, lumbar,,Case Rate,3000.00
Cigna,PPO,62294,CPT4/HCPCS,Injection into spinal artery,,Case Rate,4000.00
Cigna,PPO,623,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w CC,,Case Rate,47758.95
Cigna,PPO,62302,CPT4/HCPCS, MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; CERVICAL,,Case Rate,4000.00
Cigna,PPO,62303,CPT4/HCPCS, MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; THORACIC,,Case Rate,4000.00
Cigna,PPO,62304,CPT4/HCPCS, MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; LUMBOSACRAL,,Case Rate,4000.00
Cigna,PPO,62305,CPT4/HCPCS,MYELOGRAPHY VIA LUMBAR INJECTION, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION; 2 OR MORE REGIONS (EG, LUMBAR/THORACIC, CERVICAL/THORACIC, LUMBAR/CERVICAL, LUMBAR/THORACIC/CERVICAL),,Case Rate,3000.00
Cigna,PPO,62320,CPT4/HCPCS,Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thora,,Case Rate,3000.00
Cigna,PPO,62321,CPT4/HCPCS,Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thora,,Case Rate,3000.00
Cigna,PPO,62322,CPT4/HCPCS,Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral ,,Case Rate,3000.00
Cigna,PPO,62323,CPT4/HCPCS,Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral ,,Case Rate,3000.00
Cigna,PPO,62324,CPT4/HCPCS,Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar,,Case Rate,3000.00
Cigna,PPO,62325,CPT4/HCPCS,Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar,,Case Rate,3000.00
Cigna,PPO,62326,CPT4/HCPCS,Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar,,Case Rate,3000.00
Cigna,PPO,62327,CPT4/HCPCS,Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar,,Case Rate,3000.00
Cigna,PPO,62328,CPT4/HCPCS,Spinal puncture, lumbar diagnostic; with fluoroscopic or CT guidance,,Case Rate,3000.00
Cigna,PPO,62329,CPT4/HCPCS,Spinal puncture, therapeutic, for drainage of cerebrospinal; with fluoroscopic or CT guidance,,Case Rate,3000.00
Cigna,PPO,62350,CPT4/HCPCS,Implant spinal canal cath,,Case Rate,3000.00
Cigna,PPO,62351,CPT4/HCPCS,Implant spinal canal cath,,Case Rate,8300.00
Cigna,PPO,62355,CPT4/HCPCS,Remove spinal canal catheter,,Case Rate,3000.00
Cigna,PPO,62360,CPT4/HCPCS,Insert spine infusion device,,Case Rate,3000.00
Cigna,PPO,62361,CPT4/HCPCS,Implant spine infusion pump,,Case Rate,3000.00
Cigna,PPO,62362,CPT4/HCPCS,Implant spine infusion pump,,Case Rate,3000.00
Cigna,PPO,62365,CPT4/HCPCS,Remove spine infusion device,,Case Rate,3000.00
Cigna,PPO,62367,CPT4/HCPCS,Analyze spine infusion pump,,Case Rate,3000.00
Cigna,PPO,62368,CPT4/HCPCS,Analyze spine infusion pump,,Case Rate,3000.00
Cigna,PPO,62370,CPT4/HCPCS,ANALYZE SPINE INFUSION PUMP W/ MED REPRG & FIL,,Case Rate,400.00
Cigna,PPO,62380,CPT4/HCPCS,Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar,,Case Rate,3000.00
Cigna,PPO,624,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC,,Case Rate,27904.65
Cigna,PPO,625,DRG,Thyroid, parathyroid & thyroglossal procedures w MCC,,Case Rate,72450.60
Cigna,PPO,626,DRG,Thyroid, parathyroid & thyroglossal procedures w CC,,Case Rate,42133.65
Cigna,PPO,627,DRG,Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC,,Case Rate,30135.90
Cigna,PPO,628,DRG,Other endocrine, nutrit & metab O.R. proc w MCC,,Case Rate,94301.55
Cigna,PPO,629,DRG,Other endocrine, nutrit & metab O.R. proc w CC,,Case Rate,59843.40
Cigna,PPO,63,DRG,Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC,,Case Rate,43602.45
Cigna,PPO,630,DRG,Other endocrine, nutrit & metab O.R. proc w/o CC/MCC,,Case Rate,35875.95
Cigna,PPO,63001,CPT4/HCPCS,LAM W/EX A/O DE SP CO A/O CAU EQ WO FA, FO/DIS (EG SP ST) 1 OR 2 V SE CE (SSO) ,,Case Rate,3000.00
Cigna,PPO,63003,CPT4/HCPCS,LAM W/EX A/O DE SP CO A/O CA EQ WO FA, FO/DIS (EG SP ST) 1 OR 2 V SE TH (SSO) ,,Case Rate,3000.00
Cigna,PPO,63005,CPT4/HCPCS,Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), one or two vertebral segments; lumbar, except for spondylolisthesis,,Case Rate,8300.00
Cigna,PPO,63011,CPT4/HCPCS,Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), one or two vertebral segments; sacral,,Case Rate,8300.00
Cigna,PPO,63012,CPT4/HCPCS,Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure),,Case Rate,8300.00
Cigna,PPO,63015,CPT4/HCPCS,LA W/EX A/O DE SP CO A/O CA EQ W/O FA, FO/DIS (EG SP ST) M T 2 V SE CE (SSO) ,,Case Rate,3000.00
Cigna,PPO,63016,CPT4/HCPCS,LAM W/EX A/O DE SP CO A/O CA EQ, WO FA, FO/DI (EG SP ST) M T 2 V SE TH (SSO) ,,Case Rate,3000.00
Cigna,PPO,63017,CPT4/HCPCS,Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis), more than 2 vertebral segments; lumbar,,Case Rate,8300.00
Cigna,PPO,63020,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, cervical,,Case Rate,8300.00
Cigna,PPO,63030,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; one interspace, lumbar,,Case Rate,8300.00
Cigna,PPO,63035,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk; each additional interspace, cervical or lumbar (List separately in addition to code for primar,,Case Rate,8300.00
Cigna,PPO,63040,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration; cervical,,Case Rate,8300.00
Cigna,PPO,63042,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk, reexploration; lumbar,,Case Rate,8300.00
Cigna,PPO,63043,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional cervical interspace (List separately in addi,,Case Rate,3000.00
Cigna,PPO,63044,CPT4/HCPCS,Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar,,Case Rate,3000.00
Cigna,PPO,63045,CPT4/HCPCS,Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; cervical,,Case Rate,8300.00
Cigna,PPO,63046,CPT4/HCPCS,Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; thoracic,,Case Rate,8300.00
Cigna,PPO,63047,CPT4/HCPCS,Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; lumbar,,Case Rate,8300.00
Cigna,PPO,63048,CPT4/HCPCS,Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or lateral recess stenosis)), single vertebral segment; each additional segment, cervical, thoracic, .....,,Case Rate,8300.00
Cigna,PPO,63055,CPT4/HCPCS,Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disk), single segment; thoracic,,Case Rate,8300.00
Cigna,PPO,63056,CPT4/HCPCS,TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATED INTERVERTEBRAL DISK) SINGLE SEGMENT; LUMBAR (INCLUDING TRANSFACET, OR LATERAL EXTRAFORAMINAL APPROACH)(EG, FAR LATERAL HERNIATED INTERVERTE ,,Case Rate,3000.00
Cigna,PPO,63057,CPT4/HCPCS,TRANSPEDICULAR APPROACH FOR DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATED INTERVERTEBRAL DISK); EACH ADDITIONAL SEGMENT, THORACIC OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,63075,CPT4/HCPCS,Diskectomy, anterior, with decompression of spinal cord and/ or nerve root(s), including osteophytectomy; cervical, single interspace,,Case Rate,3000.00
Cigna,PPO,63076,CPT4/HCPCS,Diskectomy, anterior, with decompression of spinal cord and/ or nerve root(s), including osteophytectomy; cervical, each additional interspace (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,63265,CPT4/HCPCS,Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm, extradural; cervical,,Case Rate,8300.00
Cigna,PPO,63600,CPT4/HCPCS,Remove spinal cord lesion,,Case Rate,4000.00
Cigna,PPO,63610,CPT4/HCPCS,Stimulation of spinal cord,,Case Rate,4000.00
Cigna,PPO,63650,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,8300.00
Cigna,PPO,63655,CPT4/HCPCS,LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL ,,Case Rate,3000.00
Cigna,PPO,63661,CPT4/HCPCS,REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED,,Case Rate,6000.00
Cigna,PPO,63662,CPT4/HCPCS,REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED,,Case Rate,6000.00
Cigna,PPO,63663,CPT4/HCPCS,REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED,,Case Rate,6000.00
Cigna,PPO,63664,CPT4/HCPCS,REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED,,Case Rate,6000.00
Cigna,PPO,63685,CPT4/HCPCS,Implant neuroreceiver,,Case Rate,3000.00
Cigna,PPO,63688,CPT4/HCPCS,Revise/remove neuroreceiver,,Case Rate,3000.00
Cigna,PPO,637,DRG,Diabetes w MCC,,Case Rate,35054.85
Cigna,PPO,63741,CPT4/HCPCS,Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; percutaneous, not requiring laminectomy,,Case Rate,3000.00
Cigna,PPO,63744,CPT4/HCPCS,Revision of spinal shunt,,Case Rate,4000.00
Cigna,PPO,63746,CPT4/HCPCS,Removal of spinal shunt,,Case Rate,3000.00
Cigna,PPO,638,DRG,Diabetes w CC,,Case Rate,22424.70
Cigna,PPO,639,DRG,Diabetes w/o CC/MCC,,Case Rate,15537.15
Cigna,PPO,64,DRG,Intracranial hemorrhage or cerebral infarction w MCC,,Case Rate,48781.50
Cigna,PPO,640,DRG,Nutritional & misc metabolic disorders w MCC,,Case Rate,31308.90
Cigna,PPO,641,DRG,Nutritional & misc metabolic disorders w/o MCC,,Case Rate,19201.50
Cigna,PPO,642,DRG,Inborn errors of metabolism,,Case Rate,32831.25
Cigna,PPO,643,DRG,Endocrine disorders w MCC,,Case Rate,42414.15
Cigna,PPO,644,DRG,Endocrine disorders w CC,,Case Rate,25966.65
Cigna,PPO,64400,CPT4/HCPCS,Injection, anesthetic agent; trigeminal nerve, any division or branch,,Case Rate,3000.00
Cigna,PPO,64405,CPT4/HCPCS,Injection, anesthetic agent; greater occipital nerve,,Case Rate,3000.00
Cigna,PPO,64408,CPT4/HCPCS,Injection, anesthetic agent; vagus nerve,,Case Rate,3000.00
Cigna,PPO,64415,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,PPO,64416,CPT4/HCPCS,Injection, anesthetic agent; brachial plexus, continuous infusion by catheter (including catheter placement) ,,Case Rate,3000.00
Cigna,PPO,64417,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,PPO,64418,CPT4/HCPCS,Injection, anesthetic agent; suprascapular nerve,,Case Rate,3000.00
Cigna,PPO,64420,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,PPO,64421,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,PPO,64425,CPT4/HCPCS,Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves,,Case Rate,3000.00
Cigna,PPO,64430,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,PPO,64435,CPT4/HCPCS,Injection, anesthetic agent; paracervical (uterine) nerve,,Case Rate,3000.00
Cigna,PPO,64445,CPT4/HCPCS,Injection, anesthetic agent; sciatic nerve,,Case Rate,3000.00
Cigna,PPO,64449,CPT4/HCPCS,Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) including daily management for anesthetic agent administration,,Case Rate,3000.00
Cigna,PPO,64450,CPT4/HCPCS,Injection, anesthetic agent; other peripheral nerve or branch,,Case Rate,3000.00
Cigna,PPO,64451,CPT4/HCPCS,Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography) ,,Case Rate,3000.00
Cigna,PPO,64454,CPT4/HCPCS,Injection(s), anesthetic agent(s) and/or steroid; genicular nerve branches, including imaging guidance, when performed,,Case Rate,3000.00
Cigna,PPO,64455,CPT4/HCPCS,INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, PLANTAR COMMON DIGITAL NERVE(S) (EG, MORTON'S NEUROMA),,Case Rate,400.00
Cigna,PPO,64461,CPT4/HCPCS,PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SINGLE INJECTION SITE (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,400.00
Cigna,PPO,64462,CPT4/HCPCS,PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; SECOND AND ANY ADDITIONAL INJECTION SITE(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,64463,CPT4/HCPCS,PARAVERTEBRAL BLOCK (PVB) (PARASPINOUS BLOCK), THORACIC; CONTINUOUS INFUSION BY CATHETER (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,400.00
Cigna,PPO,64479,CPT4/HCPCS,Inj foramen epidural c/t,,Case Rate,3000.00
Cigna,PPO,64480,CPT4/HCPCS,Inj foramen epidural add-on,,Case Rate,3000.00
Cigna,PPO,64483,CPT4/HCPCS,Inj foramen epidural l/s,,Case Rate,3000.00
Cigna,PPO,64484,CPT4/HCPCS,Inj foramen epidural add-on,,Case Rate,3000.00
Cigna,PPO,64486,CPT4/HCPCS,TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) UNILATERAL; BY INJECTION(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,3000.00
Cigna,PPO,64487,CPT4/HCPCS,TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) UNILATERAL; BY CONTINUOUS INFUSION(S) (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,3000.00
Cigna,PPO,64488,CPT4/HCPCS,TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) BILATERAL; BY INJECTIONS (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,3000.00
Cigna,PPO,64489,CPT4/HCPCS,TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK (ABDOMINAL PLANE BLOCK, RECTUS SHEATH BLOCK) BILATERAL; BY CONTINUOUS INFUSIONS (INCLUDES IMAGING GUIDANCE, WHEN PERFORMED),,Case Rate,3000.00
Cigna,PPO,64490,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL,,Case Rate,3000.00
Cigna,PPO,64491,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCED,,Case Rate,3000.00
Cigna,PPO,64492,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CO,,Case Rate,3000.00
Cigna,PPO,64493,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL,,Case Rate,3000.00
Cigna,PPO,64494,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE),,Case Rate,3000.00
Cigna,PPO,64495,CPT4/HCPCS,INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE F,,Case Rate,3000.00
Cigna,PPO,645,DRG,Endocrine disorders w/o CC/MCC,,Case Rate,19578.90
Cigna,PPO,64505,CPT4/HCPCS,Injection, anesthetic agent; sphenopalatine ganglion,,Case Rate,3000.00
Cigna,PPO,64510,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,PPO,64517,CPT4/HCPCS,N block inj, hypogastric plexus,,Case Rate,3000.00
Cigna,PPO,64520,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,PPO,64530,CPT4/HCPCS,Injection for nerve block,,Case Rate,3000.00
Cigna,PPO,64550,CPT4/HCPCS,TENS,,% of Charges,66.95
Cigna,PPO,64553,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,3000.00
Cigna,PPO,64555,CPT4/HCPCS,Percutaneous implantation of neurostimulator electrodes; peripheral nerve,,Case Rate,3000.00
Cigna,PPO,64561,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,4000.00
Cigna,PPO,64566,CPT4/HCPCS,POSTERIOR TIBIAL NEUROSTIMULATION, PERCUTANEOUS NEEDLE ELECTRODE, SINGLE TREATMENT, INCLUDES PROGRAMMING,,Case Rate,3000.00
Cigna,PPO,64568,CPT4/HCPCS,INCISION FOR IMPLANTATION OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY AND PULSE GENERATOR,,Case Rate,3000.00
Cigna,PPO,64569,CPT4/HCPCS,REVISION OR REPLACEMENT OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY, INCLUDING CONNECTION TO EXISTING PULSE GENERATOR,,Case Rate,6000.00
Cigna,PPO,64570,CPT4/HCPCS,REMOVAL OF CRANIAL NERVE (EG, VAGUS NERVE) NEUROSTIMULATOR ELECTRODE ARRAY AND PULSE GENERATOR,,Case Rate,8300.00
Cigna,PPO,64575,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,3000.00
Cigna,PPO,64580,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,3000.00
Cigna,PPO,64581,CPT4/HCPCS,Implant neuroelectrodes,,Case Rate,4000.00
Cigna,PPO,64585,CPT4/HCPCS,Revise/remove neuroelectrode,,Case Rate,3000.00
Cigna,PPO,64590,CPT4/HCPCS,Implant neuroreceiver,,Case Rate,3000.00
Cigna,PPO,64595,CPT4/HCPCS,Revise/remove neuroreceiver,,Case Rate,3000.00
Cigna,PPO,64600,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,PPO,64605,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,PPO,64610,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,PPO,64611,CPT4/HCPCS,CHEMODENERVATION OF PAROTID AND SUBMANDIBULAR SALIVARY GLANDS, BILATERAL,,Case Rate,400.00
Cigna,PPO,64612,CPT4/HCPCS,Destruction by neurolytic agent (chemodenervation of muscle endplate); muscles enervated by facial nerve (eg, for blepharospasm, hemifacial spasm),,Case Rate,3000.00
Cigna,PPO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Case Rate,400.00
Cigna,PPO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Case Rate,400.00
Cigna,PPO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Case Rate,400.00
Cigna,PPO,64620,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,PPO,64624,CPT4/HCPCS,Destruction by neurolytic agent, genicular nerve branches including imaging guidance, when performed,,Case Rate,3000.00
Cigna,PPO,64625,CPT4/HCPCS,Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography),,Case Rate,3000.00
Cigna,PPO,64630,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,PPO,64632,CPT4/HCPCS,DESTRUCTION BY NEUROLYTIC AGENT; PLANTAR COMMON DIGITAL NERVE,,Case Rate,400.00
Cigna,PPO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Case Rate,3000.00
Cigna,PPO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,Case Rate,3000.00
Cigna,PPO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Case Rate,5000.00
Cigna,PPO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,Case Rate,3000.00
Cigna,PPO,64640,CPT4/HCPCS,Destruction by neurolytic agent; other peripheral nerve or branch,,Case Rate,3000.00
Cigna,PPO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Case Rate,400.00
Cigna,PPO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,Case Rate,3000.00
Cigna,PPO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Case Rate,400.00
Cigna,PPO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,Case Rate,3000.00
Cigna,PPO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Case Rate,400.00
Cigna,PPO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Case Rate,400.00
Cigna,PPO,64650,CPT4/HCPCS,Chemodenervation of eccrine glands; both axillae,,Case Rate,3000.00
Cigna,PPO,64653,CPT4/HCPCS,Chemodenervation of eccrine glands; other area(s) (eg, scalp, face, neck), per day,,Case Rate,3000.00
Cigna,PPO,64680,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,PPO,64681,CPT4/HCPCS,Injection treatment of nerve,,Case Rate,3000.00
Cigna,PPO,64702,CPT4/HCPCS,Revise finger/toe nerve,,Case Rate,3000.00
Cigna,PPO,64704,CPT4/HCPCS,Revise hand/foot nerve,,Case Rate,3000.00
Cigna,PPO,64708,CPT4/HCPCS,Revise arm/leg nerve,,Case Rate,3000.00
Cigna,PPO,64712,CPT4/HCPCS,Revision of sciatic nerve,,Case Rate,3000.00
Cigna,PPO,64713,CPT4/HCPCS,Revision of arm nerve(s),,Case Rate,3000.00
Cigna,PPO,64714,CPT4/HCPCS,Revise low back nerve(s),,Case Rate,3000.00
Cigna,PPO,64716,CPT4/HCPCS,Revision of cranial nerve,,Case Rate,4000.00
Cigna,PPO,64718,CPT4/HCPCS,Revise ulnar nerve at elbow,,Case Rate,3000.00
Cigna,PPO,64719,CPT4/HCPCS,Revise ulnar nerve at wrist,,Case Rate,3000.00
Cigna,PPO,64721,CPT4/HCPCS,Carpal tunnel surgery,,Case Rate,3000.00
Cigna,PPO,64722,CPT4/HCPCS,Relieve pressure on nerve(s),,Case Rate,3000.00
Cigna,PPO,64726,CPT4/HCPCS,Release foot/toe nerve,,Case Rate,3000.00
Cigna,PPO,64727,CPT4/HCPCS,Internal nerve revision,,Case Rate,3000.00
Cigna,PPO,64732,CPT4/HCPCS,Incision of brow nerve,,Case Rate,3000.00
Cigna,PPO,64734,CPT4/HCPCS,Incision of cheek nerve,,Case Rate,3000.00
Cigna,PPO,64736,CPT4/HCPCS,Incision of chin nerve,,Case Rate,3000.00
Cigna,PPO,64738,CPT4/HCPCS,Incision of jaw nerve,,Case Rate,3000.00
Cigna,PPO,64740,CPT4/HCPCS,Incision of tongue nerve,,Case Rate,3000.00
Cigna,PPO,64742,CPT4/HCPCS,Incision of facial nerve,,Case Rate,3000.00
Cigna,PPO,64744,CPT4/HCPCS,Incise nerve, back of head,,Case Rate,3000.00
Cigna,PPO,64746,CPT4/HCPCS,Incise diaphragm nerve,,Case Rate,3000.00
Cigna,PPO,64771,CPT4/HCPCS,Sever cranial nerve,,Case Rate,3000.00
Cigna,PPO,64772,CPT4/HCPCS,Incision of spinal nerve,,Case Rate,3000.00
Cigna,PPO,64774,CPT4/HCPCS,Remove skin nerve lesion,,Case Rate,3000.00
Cigna,PPO,64776,CPT4/HCPCS,Remove digit nerve lesion,,Case Rate,4000.00
Cigna,PPO,64778,CPT4/HCPCS,Digit nerve surgery add-on,,Case Rate,3000.00
Cigna,PPO,64782,CPT4/HCPCS,Remove limb nerve lesion,,Case Rate,4000.00
Cigna,PPO,64783,CPT4/HCPCS,Limb nerve surgery add-on,,Case Rate,3000.00
Cigna,PPO,64784,CPT4/HCPCS,Remove nerve lesion,,Case Rate,4000.00
Cigna,PPO,64786,CPT4/HCPCS,Remove sciatic nerve lesion,,Case Rate,4000.00
Cigna,PPO,64787,CPT4/HCPCS,Implant nerve end,,Case Rate,3000.00
Cigna,PPO,64788,CPT4/HCPCS,Remove skin nerve lesion,,Case Rate,4000.00
Cigna,PPO,64790,CPT4/HCPCS,Removal of nerve lesion,,Case Rate,4000.00
Cigna,PPO,64792,CPT4/HCPCS,Removal of nerve lesion,,Case Rate,4000.00
Cigna,PPO,64795,CPT4/HCPCS,Biopsy of nerve,,Case Rate,3000.00
Cigna,PPO,64802,CPT4/HCPCS,Remove sympathetic nerves,,Case Rate,3000.00
Cigna,PPO,64821,CPT4/HCPCS,Remove sympathetic nerves,,Case Rate,4000.00
Cigna,PPO,64822,CPT4/HCPCS,SYMPATHECTOMY; ULNAR ARTERY,,Case Rate,4000.00
Cigna,PPO,64823,CPT4/HCPCS,SYMPATHECTOMY; SUPERFICIAL PALMAR ARCH,,Case Rate,3000.00
Cigna,PPO,64831,CPT4/HCPCS,Repair of digit nerve,,Case Rate,4000.00
Cigna,PPO,64832,CPT4/HCPCS,Repair nerve add-on,,Case Rate,3000.00
Cigna,PPO,64834,CPT4/HCPCS,Repair of hand or foot nerve,,Case Rate,3000.00
Cigna,PPO,64835,CPT4/HCPCS,Repair of hand or foot nerve,,Case Rate,4000.00
Cigna,PPO,64836,CPT4/HCPCS,Repair of hand or foot nerve,,Case Rate,4000.00
Cigna,PPO,64837,CPT4/HCPCS,Repair nerve add-on,,Case Rate,3000.00
Cigna,PPO,64840,CPT4/HCPCS,Repair of leg nerve,,Case Rate,3000.00
Cigna,PPO,64856,CPT4/HCPCS,Repair/transpose nerve,,Case Rate,3000.00
Cigna,PPO,64857,CPT4/HCPCS,Repair arm/leg nerve,,Case Rate,3000.00
Cigna,PPO,64858,CPT4/HCPCS,Repair sciatic nerve,,Case Rate,3000.00
Cigna,PPO,64859,CPT4/HCPCS,Nerve surgery,,Case Rate,3000.00
Cigna,PPO,64861,CPT4/HCPCS,Repair of arm nerves,,Case Rate,4000.00
Cigna,PPO,64862,CPT4/HCPCS,Repair of low back nerves,,Case Rate,4000.00
Cigna,PPO,64864,CPT4/HCPCS,Repair of facial nerve,,Case Rate,4000.00
Cigna,PPO,64865,CPT4/HCPCS,Repair of facial nerve,,Case Rate,4000.00
Cigna,PPO,64872,CPT4/HCPCS,Subsequent repair of nerve,,Case Rate,3000.00
Cigna,PPO,64874,CPT4/HCPCS,Repair & revise nerve add-on,,Case Rate,3000.00
Cigna,PPO,64876,CPT4/HCPCS,Repair nerve/shorten bone,,Case Rate,3000.00
Cigna,PPO,64885,CPT4/HCPCS,Nerve graft, head or neck,,Case Rate,3000.00
Cigna,PPO,64886,CPT4/HCPCS,Nerve graft, head or neck,,Case Rate,3000.00
Cigna,PPO,64890,CPT4/HCPCS,Nerve graft, hand or foot,,Case Rate,3000.00
Cigna,PPO,64891,CPT4/HCPCS,Nerve graft, hand or foot,,Case Rate,3000.00
Cigna,PPO,64892,CPT4/HCPCS,Nerve graft, arm or leg,,Case Rate,3000.00
Cigna,PPO,64893,CPT4/HCPCS,Nerve graft, arm or leg,,Case Rate,3000.00
Cigna,PPO,64895,CPT4/HCPCS,Nerve graft, hand or foot,,Case Rate,4000.00
Cigna,PPO,64896,CPT4/HCPCS,Nerve graft, hand or foot,,Case Rate,4000.00
Cigna,PPO,64897,CPT4/HCPCS,Nerve graft, arm or leg,,Case Rate,4000.00
Cigna,PPO,64898,CPT4/HCPCS,Nerve graft, arm or leg,,Case Rate,4000.00
Cigna,PPO,64901,CPT4/HCPCS,Nerve graft add-on,,Case Rate,3000.00
Cigna,PPO,64902,CPT4/HCPCS,Nerve graft add-on,,Case Rate,3000.00
Cigna,PPO,64905,CPT4/HCPCS,Nerve pedicle transfer,,Case Rate,3000.00
Cigna,PPO,64907,CPT4/HCPCS,Nerve pedicle transfer,,Case Rate,3000.00
Cigna,PPO,64910,CPT4/HCPCS,Nerve repair w/allograft,,Case Rate,5000.00
Cigna,PPO,64911,CPT4/HCPCS,Neurorraphy w/vein autograft,,Case Rate,5000.00
Cigna,PPO,64912,CPT4/HCPCS,Nerve repair; with nerve allograft, each nerve, first strand (cable),,Case Rate,3000.00
Cigna,PPO,64913,CPT4/HCPCS,Nerve repair; with nerve allograft, each additional strand (List separately in addition to code for primary procedure),,Case Rate,3000.00
Cigna,PPO,64999,CPT4/HCPCS,UNLISTED PROCEDURE NERVOUS SYSTEM ,,Case Rate,3000.00
Cigna,PPO,65,DRG,Intracranial hemorrhage or cerebral infarction w CC,,Case Rate,25964.10
Cigna,PPO,650,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,,Case Rate,115084.05
Cigna,PPO,65091,CPT4/HCPCS,Revise eye,,Case Rate,4000.00
Cigna,PPO,65093,CPT4/HCPCS,Revise eye with implant,,Case Rate,4000.00
Cigna,PPO,651,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,,Case Rate,94186.80
Cigna,PPO,65101,CPT4/HCPCS,Removal of eye,,Case Rate,4000.00
Cigna,PPO,65103,CPT4/HCPCS,Remove eye/insert implant,,Case Rate,4000.00
Cigna,PPO,65105,CPT4/HCPCS,Remove eye/attach implant,,Case Rate,4000.00
Cigna,PPO,65110,CPT4/HCPCS,Removal of eye,,Case Rate,5000.00
Cigna,PPO,65112,CPT4/HCPCS,Remove eye/revise socket,,Case Rate,6000.00
Cigna,PPO,65114,CPT4/HCPCS,Remove eye/revise socket,,Case Rate,6000.00
Cigna,PPO,65130,CPT4/HCPCS,Insert ocular implant,,Case Rate,4000.00
Cigna,PPO,65135,CPT4/HCPCS,Insert ocular implant,,Case Rate,3000.00
Cigna,PPO,65140,CPT4/HCPCS,Attach ocular implant,,Case Rate,4000.00
Cigna,PPO,65150,CPT4/HCPCS,Revise ocular implant,,Case Rate,3000.00
Cigna,PPO,65155,CPT4/HCPCS,Reinsert ocular implant,,Case Rate,4000.00
Cigna,PPO,65175,CPT4/HCPCS,Removal of ocular implant,,Case Rate,3000.00
Cigna,PPO,652,DRG,Kidney transplant,,Case Rate,81138.45
Cigna,PPO,65235,CPT4/HCPCS,Remove foreign body from eye,,Case Rate,3000.00
Cigna,PPO,65260,CPT4/HCPCS,Remove foreign body from eye,,Case Rate,4000.00
Cigna,PPO,65265,CPT4/HCPCS,Remove foreign body from eye,,Case Rate,4000.00
Cigna,PPO,65270,CPT4/HCPCS,Repair of eye wound,,Case Rate,3000.00
Cigna,PPO,65272,CPT4/HCPCS,Repair of eye wound,,Case Rate,3000.00
Cigna,PPO,65273,CPT4/HCPCS,Repair of laceration; conjunctiva, by mobilization and rearrangement, with hospitalization,,Case Rate,3000.00
Cigna,PPO,65275,CPT4/HCPCS,Repair of eye wound,,Case Rate,4000.00
Cigna,PPO,65280,CPT4/HCPCS,Repair of eye wound,,Case Rate,4000.00
Cigna,PPO,65285,CPT4/HCPCS,Repair of eye wound,,Case Rate,4000.00
Cigna,PPO,65286,CPT4/HCPCS,Repair of laceration; application of tissue glue, wounds of cornea and/or sclera,,Case Rate,3000.00
Cigna,PPO,65290,CPT4/HCPCS,Repair of eye socket wound,,Case Rate,4000.00
Cigna,PPO,653,DRG,Major bladder procedures w MCC,,Case Rate,138954.60
Cigna,PPO,654,DRG,Major bladder procedures w CC,,Case Rate,73955.10
Cigna,PPO,65400,CPT4/HCPCS,Removal of eye lesion,,Case Rate,3000.00
Cigna,PPO,65410,CPT4/HCPCS,Biopsy of cornea,,Case Rate,3000.00
Cigna,PPO,65420,CPT4/HCPCS,Removal of eye lesion,,Case Rate,3000.00
Cigna,PPO,65426,CPT4/HCPCS,Removal of eye lesion,,Case Rate,5000.00
Cigna,PPO,65435,CPT4/HCPCS,Removal of corneal epithelium; with or without chemocauterization (abrasion, curettage) ,,Case Rate,3000.00
Cigna,PPO,65436,CPT4/HCPCS,Removal of corneal epithelium; with application of chelating agent (eg, EDTA),,Case Rate,400.00
Cigna,PPO,65450,CPT4/HCPCS,Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization,,Case Rate,400.00
Cigna,PPO,655,DRG,Major bladder procedures w/o CC/MCC,,Case Rate,53042.55
Cigna,PPO,656,DRG,Kidney & ureter procedures for neoplasm w MCC,,Case Rate,83683.35
Cigna,PPO,65600,CPT4/HCPCS,Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo),,Case Rate,3000.00
Cigna,PPO,657,DRG,Kidney & ureter procedures for neoplasm w CC,,Case Rate,49319.55
Cigna,PPO,65710,CPT4/HCPCS,Corneal transplant,,Case Rate,6000.00
Cigna,PPO,65730,CPT4/HCPCS,Corneal transplant,,Case Rate,6000.00
Cigna,PPO,65750,CPT4/HCPCS,Corneal transplant,,Case Rate,6000.00
Cigna,PPO,65755,CPT4/HCPCS,Corneal transplant,,Case Rate,6000.00
Cigna,PPO,65756,CPT4/HCPCS,KERATOPLASTY (CORNEAL TRANSPLANT); ENDOTHELIAL,,Case Rate,8300.00
Cigna,PPO,65760,CPT4/HCPCS,Keratomileusis,,Case Rate,400.00
Cigna,PPO,65765,CPT4/HCPCS,Keratophakia,,Case Rate,400.00
Cigna,PPO,65767,CPT4/HCPCS,Epikeratoplasty,,Case Rate,400.00
Cigna,PPO,65770,CPT4/HCPCS,Revise cornea with implant,,Case Rate,3000.00
Cigna,PPO,65771,CPT4/HCPCS,Radial keratotomy,,Case Rate,400.00
Cigna,PPO,65772,CPT4/HCPCS,Correction of astigmatism,,Case Rate,4000.00
Cigna,PPO,65775,CPT4/HCPCS,Correction of astigmatism,,Case Rate,4000.00
Cigna,PPO,65778,CPT4/HCPCS,PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE FOR WOUND HEALING; SELF-RETAINING,,Case Rate,3000.00
Cigna,PPO,65779,CPT4/HCPCS,PLACEMENT OF AMNIOTIC MEMBRANE ON THE OCULAR SURFACE FOR WOUND HEALING; SINGLE LAYER, SUTURED,,Case Rate,3000.00
Cigna,PPO,65780,CPT4/HCPCS,Ocular reconst, transplant,,Case Rate,5000.00
Cigna,PPO,65781,CPT4/HCPCS,Ocular reconst, transplant,,Case Rate,5000.00
Cigna,PPO,65782,CPT4/HCPCS,Ocular reconst, transplant,,Case Rate,5000.00
Cigna,PPO,65785,CPT4/HCPCS,IMPLANTATION OF INTRASTROMAL CORNEAL RING SEGMENTS,,Case Rate,3000.00
Cigna,PPO,658,DRG,Kidney & ureter procedures for neoplasm w/o CC/MCC,,Case Rate,40267.05
Cigna,PPO,65800,CPT4/HCPCS,Drainage of eye,,Case Rate,3000.00
Cigna,PPO,65810,CPT4/HCPCS,Drainage of eye,,Case Rate,4000.00
Cigna,PPO,65815,CPT4/HCPCS,Drainage of eye,,Case Rate,3000.00
Cigna,PPO,65820,CPT4/HCPCS,Relieve inner eye pressure,,Case Rate,3000.00
Cigna,PPO,65850,CPT4/HCPCS,Incision of eye,,Case Rate,4000.00
Cigna,PPO,65855,CPT4/HCPCS,Trabeculoplasty by laser surgery, one or more sessions (defined treatment series),,Case Rate,3000.00
Cigna,PPO,65860,CPT4/HCPCS,Severing adhesions of anterior segment, laser technique (separate procedure),,Case Rate,3000.00
Cigna,PPO,65865,CPT4/HCPCS,Incise inner eye adhesions,,Case Rate,3000.00
Cigna,PPO,65870,CPT4/HCPCS,Incise inner eye adhesions,,Case Rate,4000.00
Cigna,PPO,65875,CPT4/HCPCS,Incise inner eye adhesions,,Case Rate,4000.00
Cigna,PPO,65880,CPT4/HCPCS,Incise inner eye adhesions,,Case Rate,4000.00
Cigna,PPO,659,DRG,Kidney & ureter procedures for non-neoplasm w MCC,,Case Rate,67952.40
Cigna,PPO,65900,CPT4/HCPCS,Remove eye lesion,,Case Rate,5000.00
Cigna,PPO,65920,CPT4/HCPCS,Remove implant of eye,,Case Rate,6000.00
Cigna,PPO,65930,CPT4/HCPCS,Remove blood clot from eye,,Case Rate,5000.00
Cigna,PPO,66,DRG,Intracranial hemorrhage or cerebral infarction w/o CC/MCC,,Case Rate,18127.95
Cigna,PPO,660,DRG,Kidney & ureter procedures for non-neoplasm w CC,,Case Rate,36806.70
Cigna,PPO,66020,CPT4/HCPCS,Injection treatment of eye,,Case Rate,3000.00
Cigna,PPO,66030,CPT4/HCPCS,Injection treatment of eye,,Case Rate,3000.00
Cigna,PPO,661,DRG,Kidney & ureter procedures for non-neoplasm w/o CC/MCC,,Case Rate,27142.20
Cigna,PPO,66130,CPT4/HCPCS,Remove eye lesion,,Case Rate,6000.00
Cigna,PPO,66150,CPT4/HCPCS,Glaucoma surgery,,Case Rate,4000.00
Cigna,PPO,66155,CPT4/HCPCS,Glaucoma surgery,,Case Rate,4000.00
Cigna,PPO,66160,CPT4/HCPCS,Glaucoma surgery,,Case Rate,3000.00
Cigna,PPO,66170,CPT4/HCPCS,Glaucoma surgery,,Case Rate,4000.00
Cigna,PPO,66172,CPT4/HCPCS,Incision of eye,,Case Rate,4000.00
Cigna,PPO,66174,CPT4/HCPCS,TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL; WITHOUT RETENTION OF DEVICE OR STENT,,Case Rate,5000.00
Cigna,PPO,66175,CPT4/HCPCS,TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL; WITH RETENTION OF DEVICE OR STENT,,Case Rate,5000.00
Cigna,PPO,66179,CPT4/HCPCS, AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR, EXTERNAL APPROACH; WITHOUT GRAFT,,Case Rate,8300.00
Cigna,PPO,66180,CPT4/HCPCS,Implant eye shunt,,Case Rate,5000.00
Cigna,PPO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Case Rate,8300.00
Cigna,PPO,66184,CPT4/HCPCS, REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR EQUATORIAL PLATE RESERVOIR; WITHOUT GRAFT,,Case Rate,8300.00
Cigna,PPO,66185,CPT4/HCPCS,Revise eye shunt,,Case Rate,3000.00
Cigna,PPO,662,DRG,Minor bladder procedures w MCC,,Case Rate,74709.90
Cigna,PPO,66225,CPT4/HCPCS,Repair/graft eye lesion,,Case Rate,4000.00
Cigna,PPO,66250,CPT4/HCPCS,Follow-up surgery of eye,,Case Rate,3000.00
Cigna,PPO,663,DRG,Minor bladder procedures w CC,,Case Rate,40669.95
Cigna,PPO,664,DRG,Minor bladder procedures w/o CC/MCC,,Case Rate,30197.10
Cigna,PPO,665,DRG,Prostatectomy w MCC,,Case Rate,77435.85
Cigna,PPO,66500,CPT4/HCPCS,Incision of iris,,Case Rate,3000.00
Cigna,PPO,66505,CPT4/HCPCS,Incision of iris,,Case Rate,3000.00
Cigna,PPO,666,DRG,Prostatectomy w CC,,Case Rate,44224.65
Cigna,PPO,66600,CPT4/HCPCS,Remove iris and lesion,,Case Rate,4000.00
Cigna,PPO,66605,CPT4/HCPCS,Removal of iris,,Case Rate,4000.00
Cigna,PPO,66625,CPT4/HCPCS,Removal of iris,,Case Rate,4000.00
Cigna,PPO,66630,CPT4/HCPCS,Removal of iris,,Case Rate,4000.00
Cigna,PPO,66635,CPT4/HCPCS,Removal of iris,,Case Rate,4000.00
Cigna,PPO,66680,CPT4/HCPCS,Repair iris & ciliary body,,Case Rate,4000.00
Cigna,PPO,66682,CPT4/HCPCS,Repair iris & ciliary body,,Case Rate,3000.00
Cigna,PPO,667,DRG,Prostatectomy w/o CC/MCC,,Case Rate,25369.95
Cigna,PPO,66700,CPT4/HCPCS,Destruction, ciliary body,,Case Rate,3000.00
Cigna,PPO,66710,CPT4/HCPCS,Destruction, ciliary body,,Case Rate,3000.00
Cigna,PPO,66711,CPT4/HCPCS,Ciliary endoscopic ablation,,Case Rate,3000.00
Cigna,PPO,66720,CPT4/HCPCS,Destruction, ciliary body,,Case Rate,3000.00
Cigna,PPO,66740,CPT4/HCPCS,Destruction, ciliary body,,Case Rate,3000.00
Cigna,PPO,66761,CPT4/HCPCS,Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (one or more sessions),,Case Rate,3000.00
Cigna,PPO,66762,CPT4/HCPCS,Iridoplasty by photocoagulation (one or more sessions) (eg, for improvement of vision, for widening of anterior chamber angle),,Case Rate,3000.00
Cigna,PPO,66770,CPT4/HCPCS,Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure),,Case Rate,3000.00
Cigna,PPO,668,DRG,Transurethral procedures w MCC,,Case Rate,70255.05
Cigna,PPO,66820,CPT4/HCPCS,Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); stab incision technique (Ziegler or Wheeler knife),,Case Rate,3000.00
Cigna,PPO,66821,CPT4/HCPCS,After cataract laser surgery,,Case Rate,3000.00
Cigna,PPO,66825,CPT4/HCPCS,Reposition intraocular lens,,Case Rate,4000.00
Cigna,PPO,66830,CPT4/HCPCS,Removal of lens lesion,,Case Rate,4000.00
Cigna,PPO,66840,CPT4/HCPCS,Removal of lens material,,Case Rate,4000.00
Cigna,PPO,66850,CPT4/HCPCS,Removal of lens material,,Case Rate,6000.00
Cigna,PPO,66852,CPT4/HCPCS,Removal of lens material,,Case Rate,4000.00
Cigna,PPO,669,DRG,Transurethral procedures w CC,,Case Rate,39063.45
Cigna,PPO,66920,CPT4/HCPCS,Extraction of lens,,Case Rate,4000.00
Cigna,PPO,66930,CPT4/HCPCS,Extraction of lens,,Case Rate,5000.00
Cigna,PPO,66940,CPT4/HCPCS,Extraction of lens,,Case Rate,5000.00
Cigna,PPO,66982,CPT4/HCPCS,Cataract surgery, complex,,Case Rate,6000.00
Cigna,PPO,66983,CPT4/HCPCS,Cataract surg w/iol, 1 stage,,Case Rate,6000.00
Cigna,PPO,66984,CPT4/HCPCS,Cataract surg w/iol, i stage,,Case Rate,6000.00
Cigna,PPO,66985,CPT4/HCPCS,Insert lens prosthesis,,Case Rate,5000.00
Cigna,PPO,66986,CPT4/HCPCS,Exchange lens prosthesis,,Case Rate,5000.00
Cigna,PPO,66987,CPT4/HCPCS,Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure) manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine ,,Case Rate,3000.00
Cigna,PPO,66988,CPT4/HCPCS,Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure) manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), with endoscopic cyclophotocoagulation,,Case Rate,3000.00
Cigna,PPO,66990,CPT4/HCPCS,Use of ophthalmic endoscope (List separately in additon ot code for primary procedure),,Case Rate,3000.00
Cigna,PPO,66999,CPT4/HCPCS,UNLISTED PROCEDURE, ANTERIOR SEGMENT OF EYE ,,Case Rate,3000.00
Cigna,PPO,67,DRG,Nonspecific cva & precerebral occlusion w/o infarct w MCC,,Case Rate,36327.30
Cigna,PPO,670,DRG,Transurethral procedures w/o CC/MCC,,Case Rate,24900.75
Cigna,PPO,67005,CPT4/HCPCS,Partial removal of eye fluid,,Case Rate,4000.00
Cigna,PPO,67010,CPT4/HCPCS,Partial removal of eye fluid,,Case Rate,4000.00
Cigna,PPO,67015,CPT4/HCPCS,Release of eye fluid,,Case Rate,3000.00
Cigna,PPO,67025,CPT4/HCPCS,Replace eye fluid,,Case Rate,3000.00
Cigna,PPO,67027,CPT4/HCPCS,Implant eye drug system,,Case Rate,4000.00
Cigna,PPO,67028,CPT4/HCPCS,Intravitreal injection of a pharmacologic agent (separate procedure),,Case Rate,3000.00
Cigna,PPO,67030,CPT4/HCPCS,Incise inner eye strands,,Case Rate,3000.00
Cigna,PPO,67031,CPT4/HCPCS,Laser surgery, eye strands,,Case Rate,3000.00
Cigna,PPO,67036,CPT4/HCPCS,Removal of inner eye fluid,,Case Rate,4000.00
Cigna,PPO,67039,CPT4/HCPCS,Laser treatment of retina,,Case Rate,6000.00
Cigna,PPO,67040,CPT4/HCPCS,Laser treatment of retina,,Case Rate,6000.00
Cigna,PPO,67041,CPT4/HCPCS,Vitrectomy pars plana remove preretinal membrane,,Case Rate,8300.00
Cigna,PPO,67042,CPT4/HCPCS,Vitrectomy pars plana remove int memb retina,,Case Rate,8300.00
Cigna,PPO,67043,CPT4/HCPCS,Vitrectomy pars plana remove subretinal membrane,,Case Rate,8300.00
Cigna,PPO,671,DRG,Urethral procedures w CC/MCC,,Case Rate,45305.85
Cigna,PPO,67101,CPT4/HCPCS,Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage of subretinal fluid,,Case Rate,3000.00
Cigna,PPO,67105,CPT4/HCPCS,Repair of retinal detachment, one or more sessions; photocoagulation, with or without drainage of subretinal fluid,,Case Rate,3000.00
Cigna,PPO,67107,CPT4/HCPCS,Repair detached retina,,Case Rate,5000.00
Cigna,PPO,67108,CPT4/HCPCS,Repair detached retina,,Case Rate,6000.00
Cigna,PPO,67113,CPT4/HCPCS,Repair retinal detach, cplx,,Case Rate,8300.00
Cigna,PPO,67115,CPT4/HCPCS,Release encircling material,,Case Rate,3000.00
Cigna,PPO,67120,CPT4/HCPCS,Remove eye implant material,,Case Rate,3000.00
Cigna,PPO,67121,CPT4/HCPCS,Remove eye implant material,,Case Rate,3000.00
Cigna,PPO,67141,CPT4/HCPCS,Treatment of retina,,Case Rate,3000.00
Cigna,PPO,67145,CPT4/HCPCS,Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, one or more sessions; photocoagulation (laser or xenon arc),,Case Rate,3000.00
Cigna,PPO,672,DRG,Urethral procedures w/o CC/MCC,,Case Rate,29347.95
Cigna,PPO,67208,CPT4/HCPCS,Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; cryotherapy, diathermy,,Case Rate,3000.00
Cigna,PPO,67210,CPT4/HCPCS,Destruction of localized lesion of retina (eg, macular edema, tumors), one or more sessions; photocoagulation,,Case Rate,3000.00
Cigna,PPO,67218,CPT4/HCPCS,Treatment of retinal lesion,,Case Rate,5000.00
Cigna,PPO,67220,CPT4/HCPCS,Destruction of localized lesion of choroid (eg, choroidal neovascularization), one or more session, photocoagulation (laser),,Case Rate,3000.00
Cigna,PPO,67221,CPT4/HCPCS,Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion),,Case Rate,3000.00
Cigna,PPO,67225,CPT4/HCPCS,DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDAL NEOVASCULARIZATION); PHOTODYNAMIC THERAPY, SECOND EYE, AT SINGLE SESSION,,Case Rate,3000.00
Cigna,PPO,67227,CPT4/HCPCS,Treatment of retinal lesion,,Case Rate,3000.00
Cigna,PPO,67228,CPT4/HCPCS,Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), one or more sessions; photocoagulation (laser or xenon arc),,Case Rate,3000.00
Cigna,PPO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Case Rate,400.00
Cigna,PPO,67250,CPT4/HCPCS,Reinforce eye wall,,Case Rate,4000.00
Cigna,PPO,67255,CPT4/HCPCS,Reinforce/graft eye wall,,Case Rate,4000.00
Cigna,PPO,673,DRG,Other kidney & urinary tract procedures w MCC,,Case Rate,88309.05
Cigna,PPO,67311,CPT4/HCPCS,Revise eye muscle,,Case Rate,4000.00
Cigna,PPO,67312,CPT4/HCPCS,Revise two eye muscles,,Case Rate,4000.00
Cigna,PPO,67314,CPT4/HCPCS,Revise eye muscle,,Case Rate,4000.00
Cigna,PPO,67316,CPT4/HCPCS,Revise two eye muscles,,Case Rate,4000.00
Cigna,PPO,67318,CPT4/HCPCS,Revise eye muscle(s),,Case Rate,4000.00
Cigna,PPO,67320,CPT4/HCPCS,Revise eye muscle(s) add-on,,Case Rate,3000.00
Cigna,PPO,67331,CPT4/HCPCS,Eye surgery follow-up add-on,,Case Rate,3000.00
Cigna,PPO,67332,CPT4/HCPCS,Rerevise eye muscles add-on,,Case Rate,3000.00
Cigna,PPO,67334,CPT4/HCPCS,Revise eye muscle w/suture,,Case Rate,3000.00
Cigna,PPO,67335,CPT4/HCPCS,Eye suture during surgery,,Case Rate,3000.00
Cigna,PPO,67340,CPT4/HCPCS,Revise eye muscle add-on,,Case Rate,3000.00
Cigna,PPO,67343,CPT4/HCPCS,Release eye tissue,,Case Rate,6000.00
Cigna,PPO,67345,CPT4/HCPCS,Chemodenervation of extraocular muscle,,Case Rate,3000.00
Cigna,PPO,67346,CPT4/HCPCS,Biopsy, eye muscle,,Case Rate,3000.00
Cigna,PPO,674,DRG,Other kidney & urinary tract procedures w CC,,Case Rate,60700.20
Cigna,PPO,67400,CPT4/HCPCS,Explore/biopsy eye socket,,Case Rate,4000.00
Cigna,PPO,67405,CPT4/HCPCS,Explore/drain eye socket,,Case Rate,4000.00
Cigna,PPO,67412,CPT4/HCPCS,Explore/treat eye socket,,Case Rate,5000.00
Cigna,PPO,67413,CPT4/HCPCS,Explore/treat eye socket,,Case Rate,5000.00
Cigna,PPO,67414,CPT4/HCPCS,Orbitotomy without bone flap (frontal or transconjunctival approach); with removal of bone for decompression,,Case Rate,3000.00
Cigna,PPO,67415,CPT4/HCPCS,Aspiration, orbital contents,,Case Rate,3000.00
Cigna,PPO,67420,CPT4/HCPCS,Explore/treat eye socket,,Case Rate,5000.00
Cigna,PPO,67430,CPT4/HCPCS,Explore/treat eye socket,,Case Rate,5000.00
Cigna,PPO,67440,CPT4/HCPCS,Explore/drain eye socket,,Case Rate,5000.00
Cigna,PPO,67445,CPT4/HCPCS,Explr/decompress eye socket,,Case Rate,5000.00
Cigna,PPO,67450,CPT4/HCPCS,Explore/biopsy eye socket,,Case Rate,5000.00
Cigna,PPO,675,DRG,Other kidney & urinary tract procedures w/o CC/MCC,,Case Rate,44676.00
Cigna,PPO,67505,CPT4/HCPCS,Retrobulbar injection; alcohol,,Case Rate,3000.00
Cigna,PPO,67515,CPT4/HCPCS,Injection of therapeutic agent into Tenons capsule,,Case Rate,3000.00
Cigna,PPO,67550,CPT4/HCPCS,Insert eye socket implant,,Case Rate,4000.00
Cigna,PPO,67560,CPT4/HCPCS,Revise eye socket implant,,Case Rate,3000.00
Cigna,PPO,67570,CPT4/HCPCS,Decompress optic nerve,,Case Rate,4000.00
Cigna,PPO,67700,CPT4/HCPCS,Blepharotomy, drainage of abscess, eyelid,,Case Rate,3000.00
Cigna,PPO,67710,CPT4/HCPCS,Severing of tarsorrhaphy,,Case Rate,3000.00
Cigna,PPO,67715,CPT4/HCPCS,Incision of eyelid fold,,Case Rate,3000.00
Cigna,PPO,67800,CPT4/HCPCS,Excision of chalazion; single,,Case Rate,3000.00
Cigna,PPO,67801,CPT4/HCPCS,Excision of chalazion; multiple, same lid,,Case Rate,3000.00
Cigna,PPO,67805,CPT4/HCPCS,Excision of chalazion; multiple, different lids,,Case Rate,3000.00
Cigna,PPO,67808,CPT4/HCPCS,Remove eyelid lesion(s),,Case Rate,3000.00
Cigna,PPO,67810,CPT4/HCPCS,Biopsy of eyelid,,Case Rate,3000.00
Cigna,PPO,67830,CPT4/HCPCS,Revise eyelashes,,Case Rate,3000.00
Cigna,PPO,67835,CPT4/HCPCS,Revise eyelashes,,Case Rate,3000.00
Cigna,PPO,67840,CPT4/HCPCS,Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure,,Case Rate,3000.00
Cigna,PPO,67850,CPT4/HCPCS,Destruction of lesion of lid margin (up to 1 cm),,Case Rate,3000.00
Cigna,PPO,67875,CPT4/HCPCS,Temporary closure of eyelids by suture (eg, Frost suture),,Case Rate,3000.00
Cigna,PPO,67880,CPT4/HCPCS,Revision of eyelid,,Case Rate,4000.00
Cigna,PPO,67882,CPT4/HCPCS,Revision of eyelid,,Case Rate,4000.00
Cigna,PPO,67900,CPT4/HCPCS,Repair brow defect,,Case Rate,4000.00
Cigna,PPO,67901,CPT4/HCPCS,Repair eyelid defect,,Case Rate,5000.00
Cigna,PPO,67902,CPT4/HCPCS,Repair eyelid defect,,Case Rate,5000.00
Cigna,PPO,67903,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,PPO,67904,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,PPO,67906,CPT4/HCPCS,Repair eyelid defect,,Case Rate,5000.00
Cigna,PPO,67908,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,PPO,67909,CPT4/HCPCS,Revise eyelid defect,,Case Rate,4000.00
Cigna,PPO,67911,CPT4/HCPCS,Revise eyelid defect,,Case Rate,4000.00
Cigna,PPO,67912,CPT4/HCPCS,Correction eyelid w/implant,,Case Rate,4000.00
Cigna,PPO,67914,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,PPO,67915,CPT4/HCPCS,Repair of ectropion; thermocauterization,,Case Rate,3000.00
Cigna,PPO,67916,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,PPO,67917,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,PPO,67921,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,PPO,67922,CPT4/HCPCS,Repair of entropion; thermocauterization,,Case Rate,3000.00
Cigna,PPO,67923,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,PPO,67924,CPT4/HCPCS,Repair eyelid defect,,Case Rate,4000.00
Cigna,PPO,67930,CPT4/HCPCS,Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct closure; partial thickness,,Case Rate,5000.00
Cigna,PPO,67935,CPT4/HCPCS,Repair eyelid wound,,Case Rate,3000.00
Cigna,PPO,67938,CPT4/HCPCS,Removal of embedded foreign body, eyelid,,Case Rate,400.00
Cigna,PPO,67950,CPT4/HCPCS,Revision of eyelid,,Case Rate,3000.00
Cigna,PPO,67961,CPT4/HCPCS,Revision of eyelid,,Case Rate,4000.00
Cigna,PPO,67966,CPT4/HCPCS,Revision of eyelid,,Case Rate,4000.00
Cigna,PPO,67971,CPT4/HCPCS,Reconstruction of eyelid,,Case Rate,4000.00
Cigna,PPO,67973,CPT4/HCPCS,Reconstruction of eyelid,,Case Rate,4000.00
Cigna,PPO,67974,CPT4/HCPCS,Reconstruction of eyelid,,Case Rate,4000.00
Cigna,PPO,67975,CPT4/HCPCS,Reconstruction of eyelid,,Case Rate,4000.00
Cigna,PPO,68,DRG,Nonspecific cva & precerebral occlusion w/o infarct w/o MCC,,Case Rate,22659.30
Cigna,PPO,68020,CPT4/HCPCS,Incision of conjunctiva, drainage of cyst,,Case Rate,3000.00
Cigna,PPO,68100,CPT4/HCPCS,Biopsy of conjunctiva,,Case Rate,4000.00
Cigna,PPO,68110,CPT4/HCPCS,Excision of lesion, conjunctiva; up to 1 cm,,Case Rate,3000.00
Cigna,PPO,68115,CPT4/HCPCS,Remove eyelid lining lesion,,Case Rate,3000.00
Cigna,PPO,68130,CPT4/HCPCS,Remove eyelid lining lesion,,Case Rate,3000.00
Cigna,PPO,68135,CPT4/HCPCS,Destruction of lesion, conjunctiva,,Case Rate,3000.00
Cigna,PPO,682,DRG,Renal failure w MCC,,Case Rate,37490.10
Cigna,PPO,683,DRG,Renal failure w CC,,Case Rate,22391.55
Cigna,PPO,68320,CPT4/HCPCS,Revise/graft eyelid lining,,Case Rate,4000.00
Cigna,PPO,68325,CPT4/HCPCS,Revise/graft eyelid lining,,Case Rate,4000.00
Cigna,PPO,68326,CPT4/HCPCS,Revise/graft eyelid lining,,Case Rate,4000.00
Cigna,PPO,68328,CPT4/HCPCS,Revise/graft eyelid lining,,Case Rate,4000.00
Cigna,PPO,68330,CPT4/HCPCS,Revise eyelid lining,,Case Rate,4000.00
Cigna,PPO,68335,CPT4/HCPCS,Revise/graft eyelid lining,,Case Rate,4000.00
Cigna,PPO,68340,CPT4/HCPCS,Separate eyelid adhesions,,Case Rate,4000.00
Cigna,PPO,68360,CPT4/HCPCS,Revise eyelid lining,,Case Rate,3000.00
Cigna,PPO,68362,CPT4/HCPCS,Revise eyelid lining,,Case Rate,3000.00
Cigna,PPO,68371,CPT4/HCPCS,Harvest eye tissue, alograft,,Case Rate,3000.00
Cigna,PPO,684,DRG,Renal failure w/o CC/MCC,,Case Rate,15491.25
Cigna,PPO,68400,CPT4/HCPCS,Incision, drainage of lacrimal gland,,Case Rate,3000.00
Cigna,PPO,68420,CPT4/HCPCS,Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy),,Case Rate,5000.00
Cigna,PPO,68440,CPT4/HCPCS,Snip incision of lacrimal punctum ,,Case Rate,3000.00
Cigna,PPO,68500,CPT4/HCPCS,Removal of tear gland,,Case Rate,4000.00
Cigna,PPO,68505,CPT4/HCPCS,Partial removal, tear gland,,Case Rate,4000.00
Cigna,PPO,68510,CPT4/HCPCS,Biopsy of tear gland,,Case Rate,3000.00
Cigna,PPO,68520,CPT4/HCPCS,Removal of tear sac,,Case Rate,4000.00
Cigna,PPO,68525,CPT4/HCPCS,Biopsy of tear sac,,Case Rate,3000.00
Cigna,PPO,68530,CPT4/HCPCS,Removal of foreign body or dacryolith, lacrimal passages,,Case Rate,400.00
Cigna,PPO,68540,CPT4/HCPCS,Remove tear gland lesion,,Case Rate,4000.00
Cigna,PPO,68550,CPT4/HCPCS,Remove tear gland lesion,,Case Rate,4000.00
Cigna,PPO,686,DRG,Kidney & urinary tract neoplasms w MCC,,Case Rate,47766.60
Cigna,PPO,687,DRG,Kidney & urinary tract neoplasms w CC,,Case Rate,26718.90
Cigna,PPO,68700,CPT4/HCPCS,Repair tear ducts,,Case Rate,3000.00
Cigna,PPO,68705,CPT4/HCPCS,Correction of everted punctum, cautery,,Case Rate,3000.00
Cigna,PPO,68720,CPT4/HCPCS,Create tear sac drain,,Case Rate,4000.00
Cigna,PPO,68745,CPT4/HCPCS,Create tear duct drain,,Case Rate,4000.00
Cigna,PPO,68750,CPT4/HCPCS,Create tear duct drain,,Case Rate,4000.00
Cigna,PPO,68760,CPT4/HCPCS,Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery,,Case Rate,400.00
Cigna,PPO,68761,CPT4/HCPCS,Closure of the lacrimal punctum; by plug, each,,Case Rate,400.00
Cigna,PPO,68770,CPT4/HCPCS,Close tear system fistula,,Case Rate,4000.00
Cigna,PPO,688,DRG,Kidney & urinary tract neoplasms w/o CC/MCC,,Case Rate,17475.15
Cigna,PPO,68810,CPT4/HCPCS,Probe nasolacrimal duct,,Case Rate,3000.00
Cigna,PPO,68811,CPT4/HCPCS,Probe nasolacrimal duct,,Case Rate,3000.00
Cigna,PPO,68815,CPT4/HCPCS,Probe nasolacrimal duct,,Case Rate,3000.00
Cigna,PPO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Case Rate,5000.00
Cigna,PPO,68840,CPT4/HCPCS,Probing of lacrimal canaliculi, with or without irrigation,,Case Rate,400.00
Cigna,PPO,68850,CPT4/HCPCS,Injection of contrast medium for dacryocystography,,Case Rate,3000.00
Cigna,PPO,689,DRG,Kidney & urinary tract infections w MCC,,Case Rate,28338.15
Cigna,PPO,69,DRG,Transient ischemia,,Case Rate,20045.55
Cigna,PPO,690,DRG,Kidney & urinary tract infections w/o MCC,,Case Rate,20201.10
Cigna,PPO,69000,CPT4/HCPCS,Drainage external ear, abscess or hematoma; simple,,Case Rate,400.00
Cigna,PPO,69005,CPT4/HCPCS,Drainage external ear, abscess or hematoma; complicated,,Case Rate,3000.00
Cigna,PPO,69020,CPT4/HCPCS,Drainage external auditory canal, abscess,,Case Rate,400.00
Cigna,PPO,69110,CPT4/HCPCS,Remove external ear, partial,,Case Rate,3000.00
Cigna,PPO,69120,CPT4/HCPCS,Removal of external ear,,Case Rate,3000.00
Cigna,PPO,69140,CPT4/HCPCS,Remove ear canal lesion(s),,Case Rate,3000.00
Cigna,PPO,69145,CPT4/HCPCS,Remove ear canal lesion(s),,Case Rate,3000.00
Cigna,PPO,69150,CPT4/HCPCS,Extensive ear canal surgery,,Case Rate,4000.00
Cigna,PPO,69205,CPT4/HCPCS,Clear outer ear canal,,Case Rate,3000.00
Cigna,PPO,69209,CPT4/HCPCS,REMOVAL IMPACTED CERUMEN USING IRRIGATION/LAVAGE, UNILATERAL,,Case Rate,400.00
Cigna,PPO,69210,CPT4/HCPCS,Removal impacted cerumen (separate procedure), one or both ears,,Case Rate,400.00
Cigna,PPO,69222,CPT4/HCPCS,Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than routine cleaning),,Case Rate,3000.00
Cigna,PPO,693,DRG,Urinary stones w/o esw lithotripsy w MCC,,Case Rate,32354.40
Cigna,PPO,69300,CPT4/HCPCS,Revise external ear,,Case Rate,4000.00
Cigna,PPO,69310,CPT4/HCPCS,Rebuild outer ear canal,,Case Rate,4000.00
Cigna,PPO,69320,CPT4/HCPCS,Rebuild outer ear canal,,Case Rate,6000.00
Cigna,PPO,694,DRG,Urinary stones w/o esw lithotripsy w/o MCC,,Case Rate,18597.15
Cigna,PPO,69420,CPT4/HCPCS,Myringotomy including aspiration and/or eustachian tube inflation,,Case Rate,3000.00
Cigna,PPO,69421,CPT4/HCPCS,Incision of eardrum,,Case Rate,4000.00
Cigna,PPO,69424,CPT4/HCPCS,Remove ventilating tube,,Case Rate,3000.00
Cigna,PPO,69433,CPT4/HCPCS,Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia,,Case Rate,3000.00
Cigna,PPO,69436,CPT4/HCPCS,Create eardrum opening,,Case Rate,4000.00
Cigna,PPO,69440,CPT4/HCPCS,Exploration of middle ear,,Case Rate,4000.00
Cigna,PPO,69450,CPT4/HCPCS,Eardrum revision,,Case Rate,3000.00
Cigna,PPO,695,DRG,Kidney & urinary tract signs & symptoms w MCC,,Case Rate,28975.65
Cigna,PPO,69501,CPT4/HCPCS,Mastoidectomy,,Case Rate,6000.00
Cigna,PPO,69502,CPT4/HCPCS,Mastoidectomy,,Case Rate,6000.00
Cigna,PPO,69505,CPT4/HCPCS,Remove mastoid structures,,Case Rate,6000.00
Cigna,PPO,69511,CPT4/HCPCS,Extensive mastoid surgery,,Case Rate,6000.00
Cigna,PPO,69530,CPT4/HCPCS,Extensive mastoid surgery,,Case Rate,6000.00
Cigna,PPO,69540,CPT4/HCPCS,Excision aural polyp,,Case Rate,3000.00
Cigna,PPO,69550,CPT4/HCPCS,Remove ear lesion,,Case Rate,5000.00
Cigna,PPO,69552,CPT4/HCPCS,Remove ear lesion,,Case Rate,6000.00
Cigna,PPO,696,DRG,Kidney & urinary tract signs & symptoms w/o MCC,,Case Rate,17587.35
Cigna,PPO,69601,CPT4/HCPCS,Mastoid surgery revision,,Case Rate,6000.00
Cigna,PPO,69602,CPT4/HCPCS,Mastoid surgery revision,,Case Rate,6000.00
Cigna,PPO,69603,CPT4/HCPCS,Mastoid surgery revision,,Case Rate,6000.00
Cigna,PPO,69604,CPT4/HCPCS,Mastoid surgery revision,,Case Rate,6000.00
Cigna,PPO,69605,CPT4/HCPCS,Mastoid surgery revision,,Case Rate,6000.00
Cigna,PPO,69610,CPT4/HCPCS,Tympanic membrane repair, with or without site preparation or perforation for closure, with or without patch,,Case Rate,3000.00
Cigna,PPO,69620,CPT4/HCPCS,Repair of eardrum,,Case Rate,3000.00
Cigna,PPO,69631,CPT4/HCPCS,Repair eardrum structures,,Case Rate,5000.00
Cigna,PPO,69632,CPT4/HCPCS,Rebuild eardrum structures,,Case Rate,5000.00
Cigna,PPO,69633,CPT4/HCPCS,Rebuild eardrum structures,,Case Rate,5000.00
Cigna,PPO,69635,CPT4/HCPCS,Repair eardrum structures,,Case Rate,6000.00
Cigna,PPO,69636,CPT4/HCPCS,Rebuild eardrum structures,,Case Rate,6000.00
Cigna,PPO,69637,CPT4/HCPCS,Rebuild eardrum structures,,Case Rate,6000.00
Cigna,PPO,69641,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,PPO,69642,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,PPO,69643,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,PPO,69644,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,PPO,69645,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,PPO,69646,CPT4/HCPCS,Revise middle ear & mastoid,,Case Rate,6000.00
Cigna,PPO,69650,CPT4/HCPCS,Release middle ear bone,,Case Rate,6000.00
Cigna,PPO,69660,CPT4/HCPCS,Revise middle ear bone,,Case Rate,5000.00
Cigna,PPO,69661,CPT4/HCPCS,Revise middle ear bone,,Case Rate,5000.00
Cigna,PPO,69662,CPT4/HCPCS,Revise middle ear bone,,Case Rate,5000.00
Cigna,PPO,69666,CPT4/HCPCS,Repair middle ear structures,,Case Rate,4000.00
Cigna,PPO,69667,CPT4/HCPCS,Repair middle ear structures,,Case Rate,4000.00
Cigna,PPO,69670,CPT4/HCPCS,Remove mastoid air cells,,Case Rate,4000.00
Cigna,PPO,69676,CPT4/HCPCS,Remove middle ear nerve,,Case Rate,4000.00
Cigna,PPO,697,DRG,Urethral stricture,,Case Rate,25423.50
Cigna,PPO,69700,CPT4/HCPCS,Close mastoid fistula,,Case Rate,4000.00
Cigna,PPO,69710,CPT4/HCPCS,Implant/replace hearing aid,,Case Rate,4000.00
Cigna,PPO,69711,CPT4/HCPCS,Remove/repair hearing aid,,Case Rate,3000.00
Cigna,PPO,69714,CPT4/HCPCS,Implant temple bone w/stimul,,Case Rate,3000.00
Cigna,PPO,69715,CPT4/HCPCS,Temple bne implnt w/stimulat,,Case Rate,3000.00
Cigna,PPO,69717,CPT4/HCPCS,Temple bone implant revision,,Case Rate,3000.00
Cigna,PPO,69718,CPT4/HCPCS,Revise temple bone implant,,Case Rate,3000.00
Cigna,PPO,69720,CPT4/HCPCS,Release facial nerve,,Case Rate,5000.00
Cigna,PPO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Case Rate,3000.00
Cigna,PPO,69740,CPT4/HCPCS,Repair facial nerve,,Case Rate,5000.00
Cigna,PPO,69745,CPT4/HCPCS,Repair facial nerve,,Case Rate,5000.00
Cigna,PPO,69799,CPT4/HCPCS,UNLISTED PROCEDURE ON MIDDLE EAR ,,Case Rate,3000.00
Cigna,PPO,698,DRG,Other kidney & urinary tract diagnoses w MCC,,Case Rate,40970.85
Cigna,PPO,69801,CPT4/HCPCS,Incise inner ear,,Case Rate,5000.00
Cigna,PPO,69805,CPT4/HCPCS,Explore inner ear,,Case Rate,6000.00
Cigna,PPO,69806,CPT4/HCPCS,Explore inner ear,,Case Rate,6000.00
Cigna,PPO,699,DRG,Other kidney & urinary tract diagnoses w CC,,Case Rate,26142.60
Cigna,PPO,69905,CPT4/HCPCS,Remove inner ear,,Case Rate,6000.00
Cigna,PPO,69910,CPT4/HCPCS,Remove inner ear & mastoid,,Case Rate,6000.00
Cigna,PPO,69915,CPT4/HCPCS,Incise inner ear nerve,,Case Rate,6000.00
Cigna,PPO,69930,CPT4/HCPCS,Implant cochlear device,,Case Rate,6000.00
Cigna,PPO,69949,CPT4/HCPCS,UNLISTED PROCEDURE INNER EAR ,,Case Rate,3000.00
Cigna,PPO,69955,CPT4/HCPCS,TOTAL FACIAL NERVE DECOMPRESSION AND/OR REPAIR (MAY INCLUDE GRAFT) ,,Case Rate,3000.00
Cigna,PPO,69970,CPT4/HCPCS,REMOVAL OF TUMOR, TEMPORAL BONE ,,Case Rate,3000.00
Cigna,PPO,69979,CPT4/HCPCS,UNLISTED PROCEDURE, TEMPORAL BONE, MIDDLE FOSSA APPROACH ,,Case Rate,3000.00
Cigna,PPO,69990,CPT4/HCPCS,MICROSURGICAL TECHNIQUES,REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ,,Case Rate,3000.00
Cigna,PPO,7,DRG,Lung transplant,,Case Rate,295144.65
Cigna,PPO,70,DRG,Nonspecific cerebrovascular disorders w MCC,,Case Rate,42748.20
Cigna,PPO,700,DRG,Other kidney & urinary tract diagnoses w/o CC/MCC,,Case Rate,18992.40
Cigna,PPO,70015,CPT4/HCPCS,Cisterno S&I,,% of Charges,4045.45
Cigna,PPO,70030,CPT4/HCPCS,Eye Foreign Body,,% of Charges,364.35
Cigna,PPO,70100,CPT4/HCPCS,Mandible Limited,,% of Charges,364.35
Cigna,PPO,70110,CPT4/HCPCS,Mandible Complete,,% of Charges,657.95
Cigna,PPO,70120,CPT4/HCPCS,Mastoids Limited,,% of Charges,657.95
Cigna,PPO,70130,CPT4/HCPCS,Mastoids Complete,,% of Charges,657.95
Cigna,PPO,70140,CPT4/HCPCS,Lim Facial Bones,,% of Charges,364.35
Cigna,PPO,70150,CPT4/HCPCS,Facial Bones,,% of Charges,657.95
Cigna,PPO,70160,CPT4/HCPCS,Nasal Bones,,% of Charges,364.35
Cigna,PPO,70190,CPT4/HCPCS,Optic Foramina,,% of Charges,364.35
Cigna,PPO,70210,CPT4/HCPCS,Sinuses Limited,,% of Charges,364.35
Cigna,PPO,70220,CPT4/HCPCS,Sinuses Complete,,% of Charges,364.35
Cigna,PPO,70240,CPT4/HCPCS,Sella Turcica,,% of Charges,364.35
Cigna,PPO,70250,CPT4/HCPCS,Skull 2 Views,,% of Charges,657.95
Cigna,PPO,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,% of Charges,657.95
Cigna,PPO,70330,CPT4/HCPCS,Tm Joints Bilateral,,% of Charges,364.35
Cigna,PPO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,% of Charges,6500.00
Cigna,PPO,70360,CPT4/HCPCS,Neck Soft Tissue,,% of Charges,364.35
Cigna,PPO,70380,CPT4/HCPCS,Salivary Gland,,% of Charges,364.35
Cigna,PPO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,% of Charges,6500.00
Cigna,PPO,70460,CPT4/HCPCS,Ct Head W Contrast,,% of Charges,6500.00
Cigna,PPO,70470,CPT4/HCPCS,Ct Head W/Wo Contrast,,% of Charges,6500.00
Cigna,PPO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,% of Charges,6500.00
Cigna,PPO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,% of Charges,6500.00
Cigna,PPO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,% of Charges,6500.00
Cigna,PPO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,% of Charges,6500.00
Cigna,PPO,70488,CPT4/HCPCS,Ct Maxillofacial Wo/W Contrast,,% of Charges,6500.00
Cigna,PPO,70490,CPT4/HCPCS,Ct Neck Wo Contrast,,% of Charges,6500.00
Cigna,PPO,70491,CPT4/HCPCS,Ct Neck W Contrast,,% of Charges,6500.00
Cigna,PPO,70492,CPT4/HCPCS,Ct Neck Wo/W Contrast,,% of Charges,6500.00
Cigna,PPO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,% of Charges,6500.00
Cigna,PPO,70498,CPT4/HCPCS,Cta Neck,,% of Charges,6500.00
Cigna,PPO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,% of Charges,6500.00
Cigna,PPO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,% of Charges,6500.00
Cigna,PPO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,% of Charges,6500.00
Cigna,PPO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,% of Charges,6500.00
Cigna,PPO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,% of Charges,6500.00
Cigna,PPO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,% of Charges,6500.00
Cigna,PPO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,% of Charges,6500.00
Cigna,PPO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,% of Charges,6500.00
Cigna,PPO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,% of Charges,6500.00
Cigna,PPO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,% of Charges,6500.00
Cigna,PPO,707,DRG,Major male pelvic procedures w CC/MCC,,Case Rate,48975.30
Cigna,PPO,708,DRG,Major male pelvic procedures w/o CC/MCC,,Case Rate,38030.70
Cigna,PPO,709,DRG,Penis procedures w CC/MCC,,Case Rate,58953.45
Cigna,PPO,71,DRG,Nonspecific cerebrovascular disorders w CC,,Case Rate,25775.40
Cigna,PPO,710,DRG,Penis procedures w/o CC/MCC,,Case Rate,40797.45
Cigna,PPO,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,% of Charges,364.35
Cigna,PPO,71046,CPT4/HCPCS,Chest 2 View,,% of Charges,364.35
Cigna,PPO,71047,CPT4/HCPCS,Chest 3 Views,,% of Charges,364.35
Cigna,PPO,71048,CPT4/HCPCS,Chest 4 Views,,% of Charges,657.95
Cigna,PPO,711,DRG,Testes procedures w CC/MCC,,Case Rate,54322.65
Cigna,PPO,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,% of Charges,364.35
Cigna,PPO,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,% of Charges,657.95
Cigna,PPO,71110,CPT4/HCPCS,Bilat Ribs,,% of Charges,657.95
Cigna,PPO,71111,CPT4/HCPCS,Bilat Ribs W/ Pa Cxr,,% of Charges,657.95
Cigna,PPO,71120,CPT4/HCPCS,Sternum,,% of Charges,364.35
Cigna,PPO,71130,CPT4/HCPCS,Sternoclavicular Joints,,% of Charges,364.35
Cigna,PPO,712,DRG,Testes procedures w/o CC/MCC,,Case Rate,26966.25
Cigna,PPO,71250,CPT4/HCPCS,CT THORAX DX C-,,% of Charges,6500.00
Cigna,PPO,71260,CPT4/HCPCS,Ct Thorax W Contrast,,% of Charges,6500.00
Cigna,PPO,71270,CPT4/HCPCS,Ct Thorax W/Wo Contrast,,% of Charges,6500.00
Cigna,PPO,71275,CPT4/HCPCS,Ct Chest Angio,,% of Charges,6500.00
Cigna,PPO,713,DRG,Transurethral prostatectomy w CC/MCC,,Case Rate,38035.80
Cigna,PPO,714,DRG,Transurethral prostatectomy w/o CC/MCC,,Case Rate,23676.75
Cigna,PPO,715,DRG,Other male reproductive system O.R. proc for malignancy w CC/MCC,,Case Rate,51481.95
Cigna,PPO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,% of Charges,6500.00
Cigna,PPO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,% of Charges,6500.00
Cigna,PPO,716,DRG,Other male reproductive system O.R. proc for malignancy w/o CC/MCC,,Case Rate,32550.75
Cigna,PPO,717,DRG,Other male reproductive system O.R. proc exc malignancy w CC/MCC,,Case Rate,45861.75
Cigna,PPO,718,DRG,Other male reproductive system O.R. proc exc malignancy w/o CC/MCC,,Case Rate,31523.10
Cigna,PPO,72,DRG,Nonspecific cerebrovascular disorders w/o CC/MCC,,Case Rate,19665.60
Cigna,PPO,72020,CPT4/HCPCS,Spine 1 View,,% of Charges,364.35
Cigna,PPO,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,% of Charges,364.35
Cigna,PPO,72050,CPT4/HCPCS,Cervical Spine 4 or 5 Views,,% of Charges,657.95
Cigna,PPO,72052,CPT4/HCPCS,Cerv Spine 6 Or More Views,,% of Charges,657.95
Cigna,PPO,72070,CPT4/HCPCS,Thoracic Spine 2 Views,,% of Charges,657.95
Cigna,PPO,72074,CPT4/HCPCS,Thoracic Spine 4 Plus Views,,% of Charges,657.95
Cigna,PPO,72080,CPT4/HCPCS,Thoracolumbar min 2 Views,,% of Charges,364.35
Cigna,PPO,72081,CPT4/HCPCS,Entire Spine/Scoliosis 1 View,,% of Charges,364.35
Cigna,PPO,72082,CPT4/HCPCS,Entire Spine/Scoliosis 2/3 Vws,,% of Charges,657.95
Cigna,PPO,72083,CPT4/HCPCS,ENTIRE SPINE/SCOLIOSIS 4 OR 5 VWS,,% of Charges,657.95
Cigna,PPO,72084,CPT4/HCPCS,ENTIRE SPINE/SCOLIOSIS 6 VWS,,% of Charges,657.95
Cigna,PPO,72100,CPT4/HCPCS,Lumbar Sp 2 Or 3 Views,,% of Charges,657.95
Cigna,PPO,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,% of Charges,657.95
Cigna,PPO,72114,CPT4/HCPCS,Ls Spine & Bending Views,,% of Charges,657.95
Cigna,PPO,72120,CPT4/HCPCS,Ls Spine Only Bending Views,,% of Charges,657.95
Cigna,PPO,72125,CPT4/HCPCS,Ct Cervical Spine Wo Contrast,,% of Charges,6500.00
Cigna,PPO,72126,CPT4/HCPCS,Ct Cervical Spine W Contrast,,% of Charges,6500.00
Cigna,PPO,72127,CPT4/HCPCS,Ct Cervical Spine W/Wo Contrst,,% of Charges,6500.00
Cigna,PPO,72128,CPT4/HCPCS,Ct Thoracic Spine Wo Contrast,,% of Charges,6500.00
Cigna,PPO,72129,CPT4/HCPCS,Ct Thoracic Spine W Contrast,,% of Charges,6500.00
Cigna,PPO,72130,CPT4/HCPCS,Ct Thoracic Wo/W Contrast,,% of Charges,6500.00
Cigna,PPO,72131,CPT4/HCPCS,Ct Lumbar Spine Wo Contrast,,% of Charges,6500.00
Cigna,PPO,72132,CPT4/HCPCS,Ct Lumbar Spine W Contrast,,% of Charges,6500.00
Cigna,PPO,72133,CPT4/HCPCS,Ct Lumbar Spine W/Wo Contrast,,% of Charges,6500.00
Cigna,PPO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,% of Charges,6500.00
Cigna,PPO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,% of Charges,6500.00
Cigna,PPO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,% of Charges,6500.00
Cigna,PPO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,% of Charges,6500.00
Cigna,PPO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,% of Charges,6500.00
Cigna,PPO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,% of Charges,6500.00
Cigna,PPO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,% of Charges,6500.00
Cigna,PPO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,% of Charges,6500.00
Cigna,PPO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,% of Charges,6500.00
Cigna,PPO,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,% of Charges,657.95
Cigna,PPO,72190,CPT4/HCPCS,Pelvis Judet Views,,% of Charges,657.95
Cigna,PPO,72191,CPT4/HCPCS,Ct Pelvis Angio,,% of Charges,6500.00
Cigna,PPO,72192,CPT4/HCPCS,Ct Pelvis Wo Contrast,,% of Charges,6500.00
Cigna,PPO,72193,CPT4/HCPCS,Ct Pelvis W Contrast,,% of Charges,6500.00
Cigna,PPO,72194,CPT4/HCPCS,Ct Pelvis W/Wo Contrast,,% of Charges,6500.00
Cigna,PPO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,% of Charges,6500.00
Cigna,PPO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,% of Charges,6500.00
Cigna,PPO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,% of Charges,6500.00
Cigna,PPO,722,DRG,Malignancy, male reproductive system w MCC,,Case Rate,43579.50
Cigna,PPO,72202,CPT4/HCPCS,Sacroiliac Joints,,% of Charges,657.95
Cigna,PPO,72220,CPT4/HCPCS,Sacrum & Coccyx,,% of Charges,364.35
Cigna,PPO,72240,CPT4/HCPCS,Cervical Myelogram S&I,,% of Charges,4045.45
Cigna,PPO,72255,CPT4/HCPCS,Thoracic Myelogram S&I,,% of Charges,4045.45
Cigna,PPO,72265,CPT4/HCPCS,Lumbar Myelogram S&I,,% of Charges,4045.45
Cigna,PPO,72270,CPT4/HCPCS,Combined Myelogram S&I,,% of Charges,4045.45
Cigna,PPO,72285,CPT4/HCPCS,Cerv/Thor Diskography S&I,,% of Charges,9541.05
Cigna,PPO,72295,CPT4/HCPCS,Lumbar Diskography S&I,,% of Charges,9541.05
Cigna,PPO,723,DRG,Malignancy, male reproductive system w CC,,Case Rate,27772.05
Cigna,PPO,724,DRG,Malignancy, male reproductive system w/o CC/MCC,,Case Rate,16559.70
Cigna,PPO,725,DRG,Benign prostatic hypertrophy w MCC,,Case Rate,32688.45
Cigna,PPO,726,DRG,Benign prostatic hypertrophy w/o MCC,,Case Rate,18954.15
Cigna,PPO,727,DRG,Inflammation of the male reproductive system w MCC,,Case Rate,36161.55
Cigna,PPO,728,DRG,Inflammation of the male reproductive system w/o MCC,,Case Rate,20489.25
Cigna,PPO,729,DRG,Other male reproductive system diagnoses w CC/MCC,,Case Rate,25622.40
Cigna,PPO,73,DRG,Cranial & peripheral nerve disorders w MCC,,Case Rate,36959.70
Cigna,PPO,730,DRG,Other male reproductive system diagnoses w/o CC/MCC,,Case Rate,14425.35
Cigna,PPO,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,% of Charges,364.35
Cigna,PPO,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,% of Charges,657.95
Cigna,PPO,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,% of Charges,364.35
Cigna,PPO,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,% of Charges,364.35
Cigna,PPO,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,% of Charges,2256.65
Cigna,PPO,73050,CPT4/HCPCS,Acromioclavicular Joints,,% of Charges,364.35
Cigna,PPO,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,% of Charges,364.35
Cigna,PPO,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,% of Charges,364.35
Cigna,PPO,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,% of Charges,364.35
Cigna,PPO,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,% of Charges,2256.65
Cigna,PPO,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,% of Charges,364.35
Cigna,PPO,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,% of Charges,657.95
Cigna,PPO,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,% of Charges,364.35
Cigna,PPO,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,% of Charges,364.35
Cigna,PPO,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,% of Charges,2256.65
Cigna,PPO,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,% of Charges,657.95
Cigna,PPO,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,% of Charges,364.35
Cigna,PPO,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,% of Charges,364.35
Cigna,PPO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,% of Charges,6500.00
Cigna,PPO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,% of Charges,6500.00
Cigna,PPO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,% of Charges,6500.00
Cigna,PPO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,% of Charges,6500.00
Cigna,PPO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,% of Charges,6500.00
Cigna,PPO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,734,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC,,Case Rate,56681.40
Cigna,PPO,735,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC,,Case Rate,36044.25
Cigna,PPO,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,% of Charges,364.35
Cigna,PPO,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,% of Charges,364.35
Cigna,PPO,73521,CPT4/HCPCS,Bilat Hips w or wo Pelvis,,% of Charges,657.95
Cigna,PPO,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,% of Charges,2256.65
Cigna,PPO,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,% of Charges,364.35
Cigna,PPO,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,% of Charges,364.35
Cigna,PPO,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,% of Charges,364.35
Cigna,PPO,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,% of Charges,657.95
Cigna,PPO,73565,CPT4/HCPCS,Ap Bil Knees Standing,,% of Charges,364.35
Cigna,PPO,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,% of Charges,2256.65
Cigna,PPO,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,% of Charges,364.35
Cigna,PPO,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,% of Charges,364.35
Cigna,PPO,736,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w MCC,,Case Rate,108584.10
Cigna,PPO,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,% of Charges,364.35
Cigna,PPO,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,% of Charges,364.35
Cigna,PPO,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,% of Charges,2256.65
Cigna,PPO,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,% of Charges,364.35
Cigna,PPO,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,% of Charges,364.35
Cigna,PPO,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,% of Charges,364.35
Cigna,PPO,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,% of Charges,364.35
Cigna,PPO,737,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w CC,,Case Rate,52484.10
Cigna,PPO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,% of Charges,6500.00
Cigna,PPO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,% of Charges,6500.00
Cigna,PPO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,% of Charges,6500.00
Cigna,PPO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,% of Charges,6500.00
Cigna,PPO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,% of Charges,6500.00
Cigna,PPO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,% of Charges,6500.00
Cigna,PPO,738,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC,,Case Rate,37653.30
Cigna,PPO,739,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w MCC,,Case Rate,97453.35
Cigna,PPO,74,DRG,Cranial & peripheral nerve disorders w/o MCC,,Case Rate,25969.20
Cigna,PPO,740,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w CC,,Case Rate,45900.00
Cigna,PPO,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,% of Charges,364.35
Cigna,PPO,74019,CPT4/HCPCS,Abdomen 2 Views,,% of Charges,657.95
Cigna,PPO,74022,CPT4/HCPCS,Abd Series/Pa Chest,,% of Charges,657.95
Cigna,PPO,741,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC,,Case Rate,32627.25
Cigna,PPO,74150,CPT4/HCPCS,Ct Abdomen Wo Contrast,,% of Charges,6500.00
Cigna,PPO,74160,CPT4/HCPCS,Ct Abdomen W Contrast,,% of Charges,6500.00
Cigna,PPO,74170,CPT4/HCPCS,Ct Abdomen W/Wo Contrast,,% of Charges,6500.00
Cigna,PPO,74174,CPT4/HCPCS,CT Angio Abdomen & Pelvis,,% of Charges,6500.00
Cigna,PPO,74175,CPT4/HCPCS,Ct Abdomen Angio,,% of Charges,6500.00
Cigna,PPO,74176,CPT4/HCPCS,Ct Abd & Pelvis Wo Contrast,,% of Charges,6500.00
Cigna,PPO,74177,CPT4/HCPCS,Ct Abd & Pelvis With Contrast,,% of Charges,6500.00
Cigna,PPO,74178,CPT4/HCPCS,Ct Abd/Pel Wo/W 1/Both Areas,,% of Charges,6500.00
Cigna,PPO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,% of Charges,6500.00
Cigna,PPO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,% of Charges,6500.00
Cigna,PPO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,% of Charges,6500.00
Cigna,PPO,74190,CPT4/HCPCS,Peritoneogram S&I,,% of Charges,2909.35
Cigna,PPO,742,DRG,Uterine & adnexa proc for non-malignancy w CC/MCC,,Case Rate,43783.50
Cigna,PPO,74220,CPT4/HCPCS,Esophogram,,% of Charges,1179.80
Cigna,PPO,74230,CPT4/HCPCS,Modfd Ba Swallow/Video,,% of Charges,657.95
Cigna,PPO,74235,CPT4/HCPCS,Removal Fb Esoph W/Bal S&I,,% of Charges,6500.00
Cigna,PPO,74240,CPT4/HCPCS,UGI Single Contrast,,% of Charges,1179.80
Cigna,PPO,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,% of Charges,1179.80
Cigna,PPO,74248,CPT4/HCPCS,X-RAY SM INT F-THRU STD,,% of Charges,6500.00
Cigna,PPO,74250,CPT4/HCPCS,Small Bowel Series,,% of Charges,657.95
Cigna,PPO,74261,CPT4/HCPCS,Ct Colonography Wo Contrast,,% of Charges,6500.00
Cigna,PPO,74262,CPT4/HCPCS,Ct Colonography W Contrast,,% of Charges,6500.00
Cigna,PPO,74270,CPT4/HCPCS,Ba Enema W/Wo Kub,,% of Charges,1179.80
Cigna,PPO,74280,CPT4/HCPCS,Air Contrast Enema,,% of Charges,1179.80
Cigna,PPO,74283,CPT4/HCPCS,Therapeutic Ba Enema,,% of Charges,1179.80
Cigna,PPO,743,DRG,Uterine & adnexa proc for non-malignancy w/o CC/MCC,,Case Rate,28873.65
Cigna,PPO,74300,CPT4/HCPCS,Surg Cholangiogram S&I,,% of Charges,6500.00
Cigna,PPO,74330,CPT4/HCPCS,Ercp S&I,,% of Charges,6500.00
Cigna,PPO,74340,CPT4/HCPCS,Intro Long Gi W/Flouro,,% of Charges,6500.00
Cigna,PPO,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,% of Charges,6500.00
Cigna,PPO,744,DRG,D&C, conization, laparascopy & tubal interruption w CC/MCC,,Case Rate,45747.00
Cigna,PPO,74400,CPT4/HCPCS,Ivp W/Wo Lams,,% of Charges,1179.80
Cigna,PPO,74415,CPT4/HCPCS,Nephrotomogram,,% of Charges,1179.80
Cigna,PPO,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,% of Charges,2256.65
Cigna,PPO,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,% of Charges,2256.65
Cigna,PPO,74430,CPT4/HCPCS,Cystogram S&I,,% of Charges,2256.65
Cigna,PPO,74450,CPT4/HCPCS,Retrograde Urethrogram S&I,,% of Charges,1348.35
Cigna,PPO,74455,CPT4/HCPCS,Voiding Cystogram S&I,,% of Charges,1348.35
Cigna,PPO,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,% of Charges,2909.35
Cigna,PPO,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,% of Charges,10174.25
Cigna,PPO,745,DRG,D&C, conization, laparascopy & tubal interruption w/o CC/MCC,,Case Rate,29847.75
Cigna,PPO,746,DRG,Vagina, cervix & vulva procedures w CC/MCC,,Case Rate,41039.70
Cigna,PPO,747,DRG,Vagina, cervix & vulva procedures w/o CC/MCC,,Case Rate,23919.00
Cigna,PPO,74740,CPT4/HCPCS,Hysterosalpingogram S&I,,% of Charges,1348.35
Cigna,PPO,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,% of Charges,6500.00
Cigna,PPO,748,DRG,Female reproductive system reconstructive procedures,,Case Rate,34381.65
Cigna,PPO,749,DRG,Other female reproductive system O.R. procedures w CC/MCC,,Case Rate,69038.70
Cigna,PPO,75,DRG,Viral meningitis w CC/MCC,,Case Rate,41463.00
Cigna,PPO,750,DRG,Other female reproductive system O.R. procedures w/o CC/MCC,,Case Rate,37380.45
Cigna,PPO,754,DRG,Malignancy, female reproductive system w MCC,,Case Rate,46435.50
Cigna,PPO,755,DRG,Malignancy, female reproductive system w CC,,Case Rate,28753.80
Cigna,PPO,75571,CPT4/HCPCS,Ct Heart Cacs Wo Contrast,,% of Charges,6500.00
Cigna,PPO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,% of Charges,6500.00
Cigna,PPO,75574,CPT4/HCPCS,Cta Heart Complete,,% of Charges,6500.00
Cigna,PPO,756,DRG,Malignancy, female reproductive system w/o CC/MCC,,Case Rate,23360.55
Cigna,PPO,75605,CPT4/HCPCS,Thoracic Aortogram S&I,,% of Charges,25594.35
Cigna,PPO,75625,CPT4/HCPCS,Abd Aortogram S&I,,% of Charges,15447.85
Cigna,PPO,75630,CPT4/HCPCS,Abd Aortogram W/Runoffs S&I,,% of Charges,15447.85
Cigna,PPO,75635,CPT4/HCPCS,Cta Aorta-Ilio,,% of Charges,6500.00
Cigna,PPO,757,DRG,Infections, female reproductive system w MCC,,Case Rate,38813.55
Cigna,PPO,75705,CPT4/HCPCS,IR Spinal Select,,% of Charges,25594.35
Cigna,PPO,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,% of Charges,15447.85
Cigna,PPO,75716,CPT4/HCPCS,Ext Angio S&I Bilateral,,% of Charges,15447.85
Cigna,PPO,75726,CPT4/HCPCS,Visceral Angio Sel/Supr/Se S&I,,% of Charges,25594.35
Cigna,PPO,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,% of Charges,25594.35
Cigna,PPO,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,% of Charges,15447.85
Cigna,PPO,75743,CPT4/HCPCS,Pulmonary Angio Sel Bil S&I,,% of Charges,15447.85
Cigna,PPO,75746,CPT4/HCPCS,Pulm Angio Non-Sel S&I,,% of Charges,6395.65
Cigna,PPO,75756,CPT4/HCPCS,IR Internal Mammary S + I,,% of Charges,15447.85
Cigna,PPO,75774,CPT4/HCPCS,Angio Add S&I,,% of Charges,6500.00
Cigna,PPO,75791,CPT4/HCPCS,Alternate Access Av Shunt Right,,% of Charges,6500.00
Cigna,PPO,758,DRG,Infections, female reproductive system w CC,,Case Rate,24658.50
Cigna,PPO,75809,CPT4/HCPCS,Shuntogram S&I,,% of Charges,657.95
Cigna,PPO,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,% of Charges,3625.90
Cigna,PPO,75822,CPT4/HCPCS,Ext Venogram S&I Bilateral,,% of Charges,6395.65
Cigna,PPO,75825,CPT4/HCPCS,Inferior Venacavagram S&I,,% of Charges,15447.85
Cigna,PPO,75827,CPT4/HCPCS,Superior Venacavagram S&I,,% of Charges,3625.90
Cigna,PPO,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,% of Charges,15447.85
Cigna,PPO,75833,CPT4/HCPCS,Renal Venogram S&I Bilateral,,% of Charges,15447.85
Cigna,PPO,75860,CPT4/HCPCS,VEIN X-RAY NECK,,% of Charges,15447.85
Cigna,PPO,75872,CPT4/HCPCS,Epidural Venogram,,% of Charges,3625.90
Cigna,PPO,75885,CPT4/HCPCS,Perchepporto W Hemo Eva S&I,,% of Charges,15447.85
Cigna,PPO,75889,CPT4/HCPCS,Hepatic Veno Hemodyn Ev S&I,,% of Charges,15447.85
Cigna,PPO,75893,CPT4/HCPCS,Venous Sampling S&I,,% of Charges,25594.35
Cigna,PPO,75894,CPT4/HCPCS,Us Guide Emboliz S&I,,% of Charges,6500.00
Cigna,PPO,75898,CPT4/HCPCS,Angio F/U S&I,,% of Charges,6395.65
Cigna,PPO,759,DRG,Infections, female reproductive system w/o CC/MCC,,Case Rate,17421.60
Cigna,PPO,75901,CPT4/HCPCS,Removal Fibrinsheath Obstr S&I,,% of Charges,6500.00
Cigna,PPO,75902,CPT4/HCPCS,Removal Ic Obstruction S&I,,% of Charges,6500.00
Cigna,PPO,75952,CPT4/HCPCS,ENDOVASC REPAIR ABDOM AORTA,,% of Charges,6500.00
Cigna,PPO,75953,CPT4/HCPCS,ABDOM ANEURYSM ENDOVAS RPR,,% of Charges,6500.00
Cigna,PPO,75954,CPT4/HCPCS,IR Iliac Aneurysm Endo Rpr S+I - Inactive,,% of Charges,6500.00
Cigna,PPO,75962,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,% of Charges,6500.00
Cigna,PPO,75964,CPT4/HCPCS,Pta Other Addl Peripheral S&I,,% of Charges,6500.00
Cigna,PPO,75966,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,% of Charges,6500.00
Cigna,PPO,75968,CPT4/HCPCS,Pta Addl Visceral Ves S&I,,% of Charges,6500.00
Cigna,PPO,75978,CPT4/HCPCS,Pta Venous S&I Right,,% of Charges,6500.00
Cigna,PPO,75984,CPT4/HCPCS,Chng Perc/Cath S&I,,% of Charges,6500.00
Cigna,PPO,75989,CPT4/HCPCS,Ct Drain/Speci Coll S&I,,% of Charges,6500.00
Cigna,PPO,76,DRG,Viral meningitis w/o CC/MCC,,Case Rate,25012.95
Cigna,PPO,760,DRG,Menstrual & other female reproductive system disorders w CC/MCC,,Case Rate,23526.30
Cigna,PPO,76000,CPT4/HCPCS,Fluoroscopy Up To 1Hr,,% of Charges,1348.35
Cigna,PPO,76010,CPT4/HCPCS,Nose-Rectum Child Iv,,% of Charges,364.35
Cigna,PPO,76080,CPT4/HCPCS,Abscess-Fistula-Sinus Tract,,% of Charges,2909.35
Cigna,PPO,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,% of Charges,2909.35
Cigna,PPO,761,DRG,Menstrual & other female reproductive system disorders w/o CC/MCC,,Case Rate,15045.00
Cigna,PPO,76100,CPT4/HCPCS,Lams/Tomography,,% of Charges,657.95
Cigna,PPO,76120,CPT4/HCPCS,Cine/Videoradiography,,% of Charges,657.95
Cigna,PPO,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,% of Charges,6500.00
Cigna,PPO,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,% of Charges,6500.00
Cigna,PPO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,% of Charges,6500.00
Cigna,PPO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,% of Charges,6500.00
Cigna,PPO,76497,CPT4/HCPCS,CT PROCEDURE,,% of Charges,6500.00
Cigna,PPO,76499,CPT4/HCPCS,Cs Venogram W/O Implant,,% of Charges,364.35
Cigna,PPO,765,DRG,Cesarean section w CC/MCC,,Case Rate,5500.00
Cigna,PPO,76506,CPT4/HCPCS,Neo-Natal Cranial Sonogram,,% of Charges,657.95
Cigna,PPO,76536,CPT4/HCPCS,Us Soft Tissue Head/Neck,,% of Charges,657.95
Cigna,PPO,766,DRG,Cesarean section w/o CC/MCC,,Case Rate,5500.00
Cigna,PPO,76604,CPT4/HCPCS,US Limited Chest,,% of Charges,657.95
Cigna,PPO,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,% of Charges,657.95
Cigna,PPO,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,% of Charges,364.35
Cigna,PPO,767,DRG,Vaginal delivery w sterilization &/or D&C,,Case Rate,5500.00
Cigna,PPO,76700,CPT4/HCPCS,Abdomen Sonogram,,% of Charges,657.95
Cigna,PPO,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,% of Charges,657.95
Cigna,PPO,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,% of Charges,657.95
Cigna,PPO,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,% of Charges,657.95
Cigna,PPO,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,% of Charges,657.95
Cigna,PPO,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,Case Rate,5500.00
Cigna,PPO,76800,CPT4/HCPCS,Us Spinal Canal,,% of Charges,657.95
Cigna,PPO,76801,CPT4/HCPCS,Ob Us <14 Wks,,% of Charges,657.95
Cigna,PPO,76802,CPT4/HCPCS,Ob <14Wks Ea Addl Gestation,,% of Charges,6500.00
Cigna,PPO,76805,CPT4/HCPCS,Ob Us 2Nd/3Rd Trimester,,% of Charges,657.95
Cigna,PPO,76810,CPT4/HCPCS,Ob Us 2Nd/3Rd Trim Ea Add Gest,,% of Charges,6500.00
Cigna,PPO,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,% of Charges,657.95
Cigna,PPO,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,% of Charges,657.95
Cigna,PPO,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,% of Charges,657.95
Cigna,PPO,76818,CPT4/HCPCS,Bpp With Nst,,% of Charges,657.95
Cigna,PPO,76819,CPT4/HCPCS,Bpp W/O Nst,,% of Charges,657.95
Cigna,PPO,76830,CPT4/HCPCS,Us Nonob Transvaginal,,% of Charges,657.95
Cigna,PPO,76831,CPT4/HCPCS,Hysterosonography,,% of Charges,1348.35
Cigna,PPO,76856,CPT4/HCPCS,Pelvic Nonob Us,,% of Charges,657.95
Cigna,PPO,76857,CPT4/HCPCS,Fu/Limited Pelvic Us,,% of Charges,657.95
Cigna,PPO,76870,CPT4/HCPCS,Scrotal Sonogram,,% of Charges,657.95
Cigna,PPO,76872,CPT4/HCPCS,Us Transrectal,,% of Charges,657.95
Cigna,PPO,76881,CPT4/HCPCS,Us Extremity Complete Nonvasc,,% of Charges,657.95
Cigna,PPO,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,% of Charges,657.95
Cigna,PPO,76885,CPT4/HCPCS,Us Infant Hips W/Radiologist,,% of Charges,364.35
Cigna,PPO,76886,CPT4/HCPCS,Us Infant Hips No Radiologist,,% of Charges,364.35
Cigna,PPO,769,DRG,Postpartum & post abortion diagnoses w O.R. procedure,,Case Rate,41320.20
Cigna,PPO,76936,CPT4/HCPCS,Us Guide Compression Repair,,% of Charges,1475.55
Cigna,PPO,76937,CPT4/HCPCS,CVA US Guidance,,% of Charges,6500.00
Cigna,PPO,76940,CPT4/HCPCS,US Ablation Guidance,,% of Charges,6500.00
Cigna,PPO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,% of Charges,1623.05
Cigna,PPO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,% of Charges,669.50
Cigna,PPO,76981,CPT4/HCPCS,US Elastography Organ,,% of Charges,657.95
Cigna,PPO,76982,CPT4/HCPCS,US Elastography Tissue Lesion,,% of Charges,657.95
Cigna,PPO,76983,CPT4/HCPCS,US Ea Addl Elastography Lesion,,% of Charges,6500.00
Cigna,PPO,76998,CPT4/HCPCS,Us Guide Intraoperative S&I,,% of Charges,6500.00
Cigna,PPO,76999,CPT4/HCPCS,US Surg Specimen,,% of Charges,364.35
Cigna,PPO,77,DRG,Hypertensive encephalopathy w MCC,,Case Rate,39063.45
Cigna,PPO,770,DRG,Abortion w D&C, aspiration curettage or hysterotomy,,Case Rate,22646.55
Cigna,PPO,77001,CPT4/HCPCS,Cva Fluoro Guidance,,% of Charges,6500.00
Cigna,PPO,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,% of Charges,6500.00
Cigna,PPO,77003,CPT4/HCPCS,Flur Guide Ndl Plcmnt Spine,,% of Charges,6500.00
Cigna,PPO,77011,CPT4/HCPCS,Ct Guide Stereotactic Loc,,% of Charges,6500.00
Cigna,PPO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,% of Charges,6500.00
Cigna,PPO,77013,CPT4/HCPCS,CT Ablation Guidance,,% of Charges,6500.00
Cigna,PPO,77014,CPT4/HCPCS,Ct Guide Plcmnt Rad Tx Fields,,% of Charges,6500.00
Cigna,PPO,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,% of Charges,6500.00
Cigna,PPO,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,% of Charges,6500.00
Cigna,PPO,77051,CPT4/HCPCS,Cad Diagnostic Mammography-Inactive,,% of Charges,533.55
Cigna,PPO,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,% of Charges,1348.35
Cigna,PPO,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,% of Charges,1348.35
Cigna,PPO,77063,CPT4/HCPCS,Screening Tomosynthesis,,% of Charges,135.45
Cigna,PPO,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,% of Charges,504.55
Cigna,PPO,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,% of Charges,645.80
Cigna,PPO,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,% of Charges,533.55
Cigna,PPO,77071,CPT4/HCPCS,Stress Views Any Joint,,% of Charges,364.35
Cigna,PPO,77072,CPT4/HCPCS,Bone Age Studies,,% of Charges,657.95
Cigna,PPO,77073,CPT4/HCPCS,Bone Length Studies,,% of Charges,657.95
Cigna,PPO,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,% of Charges,657.95
Cigna,PPO,77075,CPT4/HCPCS,Osseous Survey Complete,,% of Charges,657.95
Cigna,PPO,77076,CPT4/HCPCS,Infant Osseous Survey,,% of Charges,657.95
Cigna,PPO,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,% of Charges,657.95
Cigna,PPO,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,% of Charges,657.95
Cigna,PPO,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,% of Charges,364.35
Cigna,PPO,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,% of Charges,657.95
Cigna,PPO,77280,CPT4/HCPCS,Simulation Aided Simple,,% of Charges,1369.55
Cigna,PPO,77285,CPT4/HCPCS,Simulation Aided Intermediate,,% of Charges,2829.45
Cigna,PPO,77290,CPT4/HCPCS,Simulation Aided Complex,,% of Charges,3642.60
Cigna,PPO,77293,CPT4/HCPCS,4D Resp Motion Management,,% of Charges,2126.15
Cigna,PPO,77295,CPT4/HCPCS,3D SBRT SRS Planning,,% of Charges,16040.05
Cigna,PPO,77300,CPT4/HCPCS,3D/IMRT/ Basic Dosimetry,,% of Charges,1015.30
Cigna,PPO,77301,CPT4/HCPCS,IMRT Planning,,% of Charges,17206.15
Cigna,PPO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,% of Charges,4446.65
Cigna,PPO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,% of Charges,7172.10
Cigna,PPO,77316,CPT4/HCPCS,Brachytherapy Isodose-Simp,,% of Charges,2797.60
Cigna,PPO,77317,CPT4/HCPCS,Brachytherapy Isodose Plan-I,,% of Charges,3622.45
Cigna,PPO,77318,CPT4/HCPCS,Brachytherapy Isodose-Comp,,% of Charges,4841.85
Cigna,PPO,77321,CPT4/HCPCS,Special Teletherapy Beam Plan,,% of Charges,2842.45
Cigna,PPO,77331,CPT4/HCPCS,Spec Dosim TLD/Micro,,% of Charges,486.20
Cigna,PPO,77332,CPT4/HCPCS,Treatment Devices Simple,,% of Charges,1014.00
Cigna,PPO,77333,CPT4/HCPCS,Treatment Devices Intermediate,,% of Charges,1448.20
Cigna,PPO,77334,CPT4/HCPCS,Treatment Devices Complex,,% of Charges,2557.10
Cigna,PPO,77336,CPT4/HCPCS,Contd Med Physics Per 5 Tx,,% of Charges,1593.80
Cigna,PPO,77338,CPT4/HCPCS,Devices MLC,,% of Charges,12726.35
Cigna,PPO,77370,CPT4/HCPCS,Special Med Rad Physics,,% of Charges,1861.60
Cigna,PPO,77372,CPT4/HCPCS,SRS Cranial 1 Tx,,% of Charges,27390.35
Cigna,PPO,77373,CPT4/HCPCS,SRT Body 1-5 Tx,,% of Charges,11764.35
Cigna,PPO,77385,CPT4/HCPCS,IMRT TX Breast & Prostate-Simp,,% of Charges,11173.50
Cigna,PPO,77386,CPT4/HCPCS,IMRT TX All Other-Comp,,% of Charges,13037.05
Cigna,PPO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,% of Charges,656.50
Cigna,PPO,774,DRG,Vaginal delivery w complicating diagnoses,,Case Rate,5500.00
Cigna,PPO,77402,CPT4/HCPCS,Radiation TX - Simple,,% of Charges,1123.85
Cigna,PPO,77407,CPT4/HCPCS,Radiation TX-Interm,,% of Charges,1530.10
Cigna,PPO,77412,CPT4/HCPCS,Radiation TX-Comp & Electron,,% of Charges,1686.75
Cigna,PPO,77417,CPT4/HCPCS,Port Films Weekly,,% of Charges,351.65
Cigna,PPO,77470,CPT4/HCPCS,Special Trt Procedure,,% of Charges,5604.30
Cigna,PPO,775,DRG,Vaginal delivery w/o complicating diagnoses,,Case Rate,5500.00
Cigna,PPO,776,DRG,Postpartum & post abortion diagnoses w/o O.R. procedure,,Case Rate,19604.40
Cigna,PPO,77750,CPT4/HCPCS,Infusion Radioelement,,% of Charges,881.40
Cigna,PPO,77770,CPT4/HCPCS,HDR 1 Channel,,% of Charges,10288.85
Cigna,PPO,77771,CPT4/HCPCS,HDR 2-12 Channels,,% of Charges,10288.85
Cigna,PPO,77772,CPT4/HCPCS,HDR >12 Channels,,% of Charges,10288.85
Cigna,PPO,77778,CPT4/HCPCS,Interstit Implant-C,,% of Charges,2313.35
Cigna,PPO,77789,CPT4/HCPCS,Surface Appl Radioelement,,% of Charges,183.95
Cigna,PPO,77790,CPT4/HCPCS,Supervision/Handle/Loading Rad Mat,,% of Charges,198.25
Cigna,PPO,779,DRG,Abortion w/o D&C,,Case Rate,26530.20
Cigna,PPO,78,DRG,Hypertensive encephalopathy w CC,,Case Rate,24199.50
Cigna,PPO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,5500.00
Cigna,PPO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,5500.00
Cigna,PPO,78459,CPT4/HCPCS,PET MYOCARD VIABILITY,,% of Charges,6500.00
Cigna,PPO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,5500.00
Cigna,PPO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,5500.00
Cigna,PPO,78608,CPT4/HCPCS,Pet Brain Metabolic,,% of Charges,6500.00
Cigna,PPO,78609,CPT4/HCPCS,Pet Brain Perfusion,,% of Charges,6500.00
Cigna,PPO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,5500.00
Cigna,PPO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,5500.00
Cigna,PPO,78814,CPT4/HCPCS,Pet/Ct Tumorimag Limited Area,,% of Charges,6500.00
Cigna,PPO,78815,CPT4/HCPCS,Pet/Ct Limited Skull - Thigh,,% of Charges,6500.00
Cigna,PPO,78816,CPT4/HCPCS,Pet/Ct Limited Whole Body,,% of Charges,6500.00
Cigna,PPO,789,DRG,Neonates, died or transferred to another acute care facility,,Case Rate,43821.75
Cigna,PPO,79,DRG,Hypertensive encephalopathy w/o CC/MCC,,Case Rate,18533.40
Cigna,PPO,790,DRG,Extreme immaturity or respiratory distress syndrome, neonate,,Case Rate,144511.05
Cigna,PPO,791,DRG,Prematurity w major problems,,Case Rate,98695.20
Cigna,PPO,79101,CPT4/HCPCS,IV Radiopharm Therapy,,% of Charges,2503.15
Cigna,PPO,792,DRG,Prematurity w/o major problems,,Case Rate,59550.15
Cigna,PPO,793,DRG,Full term neonate w major problems,,Case Rate,101380.35
Cigna,PPO,794,DRG,Neonate w other significant problems,,Case Rate,35883.60
Cigna,PPO,795,DRG,Normal newborn,,Case Rate,4857.75
Cigna,PPO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,5500.00
Cigna,PPO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,5500.00
Cigna,PPO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,5500.00
Cigna,PPO,799,DRG,Splenectomy w MCC,,Case Rate,131169.45
Cigna,PPO,8,DRG,Simultaneous pancreas/kidney transplant,,Case Rate,138383.40
Cigna,PPO,80,DRG,Nontraumatic stupor & coma w MCC,,Case Rate,53346.00
Cigna,PPO,800,DRG,Splenectomy w CC,,Case Rate,75260.70
Cigna,PPO,801,DRG,Splenectomy w/o CC/MCC,,Case Rate,42929.25
Cigna,PPO,802,DRG,Other O.R. proc of the blood & blood forming organs w MCC,,Case Rate,94571.85
Cigna,PPO,803,DRG,Other O.R. proc of the blood & blood forming organs w CC,,Case Rate,48062.40
Cigna,PPO,804,DRG,Other O.R. proc of the blood & blood forming organs w/o CC/MCC,,Case Rate,34787.10
Cigna,PPO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,5500.00
Cigna,PPO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,5500.00
Cigna,PPO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,5500.00
Cigna,PPO,808,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w MCC,,Case Rate,55536.45
Cigna,PPO,809,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w CC,,Case Rate,31153.35
Cigna,PPO,81,DRG,Nontraumatic stupor & coma w/o MCC,,Case Rate,19686.00
Cigna,PPO,810,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC,,Case Rate,24497.85
Cigna,PPO,811,DRG,Red blood cell disorders w MCC,,Case Rate,35128.80
Cigna,PPO,812,DRG,Red blood cell disorders w/o MCC,,Case Rate,22432.35
Cigna,PPO,813,DRG,Coagulation disorders,,Case Rate,39389.85
Cigna,PPO,814,DRG,Reticuloendothelial & immunity disorders w MCC,,Case Rate,48215.40
Cigna,PPO,815,DRG,Reticuloendothelial & immunity disorders w CC,,Case Rate,25308.75
Cigna,PPO,816,DRG,Reticuloendothelial & immunity disorders w/o CC/MCC,,Case Rate,16852.95
Cigna,PPO,817,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC,,Case Rate,58695.90
Cigna,PPO,818,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC,,Case Rate,33570.75
Cigna,PPO,819,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC,,Case Rate,25446.45
Cigna,PPO,82,DRG,Traumatic stupor & coma, coma >1 hr w MCC,,Case Rate,57581.55
Cigna,PPO,820,DRG,Lymphoma & leukemia w major O.R. procedure w MCC,,Case Rate,145026.15
Cigna,PPO,821,DRG,Lymphoma & leukemia w major O.R. procedure w CC,,Case Rate,54955.05
Cigna,PPO,822,DRG,Lymphoma & leukemia w major O.R. procedure w/o CC/MCC,,Case Rate,31915.80
Cigna,PPO,823,DRG,Lymphoma & non-acute leukemia w other O.R. proc w MCC,,Case Rate,114676.05
Cigna,PPO,824,DRG,Lymphoma & non-acute leukemia w other O.R. proc w CC,,Case Rate,60248.85
Cigna,PPO,825,DRG,Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC,,Case Rate,35717.85
Cigna,PPO,826,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC,,Case Rate,128438.40
Cigna,PPO,827,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC,,Case Rate,63688.80
Cigna,PPO,828,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o CC/MCC,,Case Rate,42781.35
Cigna,PPO,829,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC,,Case Rate,81745.35
Cigna,PPO,83,DRG,Traumatic stupor & coma, coma >1 hr w CC,,Case Rate,34213.35
Cigna,PPO,830,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w/o CC/MCC,,Case Rate,37650.75
Cigna,PPO,831,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC,,Case Rate,28588.05
Cigna,PPO,832,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC,,Case Rate,19884.90
Cigna,PPO,833,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC,,Case Rate,13668.00
Cigna,PPO,834,DRG,Acute leukemia w/o major O.R. procedure w MCC,,Case Rate,154277.55
Cigna,PPO,835,DRG,Acute leukemia w/o major O.R. procedure w CC,,Case Rate,53899.35
Cigna,PPO,836,DRG,Acute leukemia w/o major O.R. procedure w/o CC/MCC,,Case Rate,29824.80
Cigna,PPO,837,DRG,Chemo w acute leukemia as sdx or w high dose chemo agent w MCC,,Case Rate,145329.60
Cigna,PPO,838,DRG,Chemo w acute leukemia as sdx w CC or high dose chemo agent,,Case Rate,57599.40
Cigna,PPO,839,DRG,Chemo w acute leukemia as sdx w/o CC/MCC,,Case Rate,37900.65
Cigna,PPO,84,DRG,Traumatic stupor & coma, coma >1 hr w/o CC/MCC,,Case Rate,23057.10
Cigna,PPO,840,DRG,Lymphoma & non-acute leukemia w MCC,,Case Rate,82000.35
Cigna,PPO,841,DRG,Lymphoma & non-acute leukemia w CC,,Case Rate,41330.40
Cigna,PPO,842,DRG,Lymphoma & non-acute leukemia w/o CC/MCC,,Case Rate,27930.15
Cigna,PPO,843,DRG,Other myeloprolif dis or poorly diff neopl diag w MCC,,Case Rate,48523.95
Cigna,PPO,844,DRG,Other myeloprolif dis or poorly diff neopl diag w CC,,Case Rate,30102.75
Cigna,PPO,845,DRG,Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC,,Case Rate,21608.70
Cigna,PPO,846,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w MCC,,Case Rate,68082.45
Cigna,PPO,847,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w CC,,Case Rate,34047.60
Cigna,PPO,848,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC,,Case Rate,26239.50
Cigna,PPO,849,DRG,Radiotherapy,,Case Rate,63431.25
Cigna,PPO,85,DRG,Traumatic stupor & coma, coma <1 hr w MCC,,Case Rate,58813.20
Cigna,PPO,853,DRG,Infectious & parasitic diseases w O.R. procedure w MCC,,Case Rate,126087.30
Cigna,PPO,854,DRG,Infectious & parasitic diseases w O.R. procedure w CC,,Case Rate,53407.20
Cigna,PPO,855,DRG,Infectious & parasitic diseases w O.R. procedure w/o CC/MCC,,Case Rate,38122.50
Cigna,PPO,856,DRG,Postoperative or post-traumatic infections w O.R. proc w MCC,,Case Rate,115915.35
Cigna,PPO,857,DRG,Postoperative or post-traumatic infections w O.R. proc w CC,,Case Rate,51884.85
Cigna,PPO,858,DRG,Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC,,Case Rate,34384.20
Cigna,PPO,86,DRG,Traumatic stupor & coma, coma <1 hr w CC,,Case Rate,32458.95
Cigna,PPO,862,DRG,Postoperative & post-traumatic infections w MCC,,Case Rate,47909.40
Cigna,PPO,863,DRG,Postoperative & post-traumatic infections w/o MCC,,Case Rate,24923.70
Cigna,PPO,864,DRG,Fever of unknown origin,,Case Rate,22312.50
Cigna,PPO,865,DRG,Viral illness w MCC,,Case Rate,37711.95
Cigna,PPO,866,DRG,Viral illness w/o MCC,,Case Rate,21348.60
Cigna,PPO,867,DRG,Other infectious & parasitic diseases diagnoses w MCC,,Case Rate,56852.25
Cigna,PPO,868,DRG,Other infectious & parasitic diseases diagnoses w CC,,Case Rate,26989.20
Cigna,PPO,869,DRG,Other infectious & parasitic diseases diagnoses w/o CC/MCC,,Case Rate,18513.00
Cigna,PPO,87,DRG,Traumatic stupor & coma, coma <1 hr w/o CC/MCC,,Case Rate,21996.30
Cigna,PPO,870,DRG,Septicemia w MV 96+ hours,,Case Rate,163832.40
Cigna,PPO,871,DRG,Septicemia w/o MV 96+ hours w MCC,,Case Rate,47639.10
Cigna,PPO,872,DRG,Septicemia w/o MV 96+ hours w/o MCC,,Case Rate,26050.80
Cigna,PPO,876,DRG,O.R. procedure w principal diagnoses of mental illness,,Case Rate,83163.15
Cigna,PPO,88,DRG,Concussion w MCC,,Case Rate,37212.15
Cigna,PPO,880,DRG,Acute adjustment reaction & psychosocial dysfunction,,Case Rate,22021.80
Cigna,PPO,881,DRG,Depressive neuroses,,Case Rate,20435.70
Cigna,PPO,882,DRG,Neuroses except depressive,,Case Rate,20986.50
Cigna,PPO,883,DRG,Disorders of personality & impulse control,,Case Rate,40246.65
Cigna,PPO,884,DRG,Organic disturbances & mental retardation,,Case Rate,36816.90
Cigna,PPO,885,DRG,Psychoses,,Case Rate,31546.05
Cigna,PPO,886,DRG,Behavioral & developmental disorders,,Case Rate,31148.25
Cigna,PPO,887,DRG,Other mental disorder diagnoses,,Case Rate,27506.85
Cigna,PPO,89,DRG,Concussion w CC,,Case Rate,27060.60
Cigna,PPO,89220,CPT4/HCPCS,Sputum Induction,,% of Charges,315.25
Cigna,PPO,894,DRG,Alcohol/drug abuse or dependence, left ama,,Case Rate,13961.25
Cigna,PPO,895,DRG,Alcohol/drug abuse or dependence w rehabilitation therapy,,Case Rate,40596.00
Cigna,PPO,896,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC,,Case Rate,45313.50
Cigna,PPO,897,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC,,Case Rate,21050.25
Cigna,PPO,90,DRG,Concussion w/o CC/MCC,,Case Rate,21797.40
Cigna,PPO,901,DRG,Wound debridements for injuries w MCC,,Case Rate,108686.10
Cigna,PPO,902,DRG,Wound debridements for injuries w CC,,Case Rate,50041.20
Cigna,PPO,903,DRG,Wound debridements for injuries w/o CC/MCC,,Case Rate,28927.20
Cigna,PPO,904,DRG,Skin grafts for injuries w CC/MCC,,Case Rate,94895.70
Cigna,PPO,905,DRG,Skin grafts for injuries w/o CC/MCC,,Case Rate,41868.45
Cigna,PPO,906,DRG,Hand procedures for injuries,,Case Rate,45741.90
Cigna,PPO,907,DRG,Other O.R. procedures for injuries w MCC,,Case Rate,100906.05
Cigna,PPO,908,DRG,Other O.R. procedures for injuries w CC,,Case Rate,52030.20
Cigna,PPO,909,DRG,Other O.R. procedures for injuries w/o CC/MCC,,Case Rate,35059.95
Cigna,PPO,90901,CPT4/HCPCS,Biofeedback,,% of Charges,207.35
Cigna,PPO,90911,CPT4/HCPCS,Biofeedback UI,,% of Charges,287.30
Cigna,PPO,90912,CPT4/HCPCS,Biofeedback UI init 15 mins,,% of Charges,286.65
Cigna,PPO,90913,CPT4/HCPCS,Biofeedback UI addl 15 mins,,% of Charges,208.65
Cigna,PPO,91,DRG,Other disorders of nervous system w MCC,,Case Rate,42046.95
Cigna,PPO,913,DRG,Traumatic injury w MCC,,Case Rate,41728.20
Cigna,PPO,914,DRG,Traumatic injury w/o MCC,,Case Rate,22659.30
Cigna,PPO,915,DRG,Allergic reactions w MCC,,Case Rate,43288.80
Cigna,PPO,916,DRG,Allergic reactions w/o MCC,,Case Rate,16761.15
Cigna,PPO,917,DRG,Poisoning & toxic effects of drugs w MCC,,Case Rate,37676.25
Cigna,PPO,918,DRG,Poisoning & toxic effects of drugs w/o MCC,,Case Rate,20173.05
Cigna,PPO,919,DRG,Complications of treatment w MCC,,Case Rate,46777.20
Cigna,PPO,92,DRG,Other disorders of nervous system w CC,,Case Rate,25145.55
Cigna,PPO,920,DRG,Complications of treatment w CC,,Case Rate,26196.15
Cigna,PPO,921,DRG,Complications of treatment w/o CC/MCC,,Case Rate,17630.70
Cigna,PPO,922,DRG,Other injury, poisoning & toxic effect diag w MCC,,Case Rate,40483.80
Cigna,PPO,923,DRG,Other injury, poisoning & toxic effect diag w/o MCC,,Case Rate,23725.20
Cigna,PPO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,% of Charges,521.30
Cigna,PPO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,% of Charges,762.45
Cigna,PPO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,% of Charges,528.45
Cigna,PPO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,% of Charges,508.30
Cigna,PPO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,% of Charges,657.80
Cigna,PPO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,% of Charges,320.45
Cigna,PPO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,% of Charges,934.05
Cigna,PPO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,% of Charges,839.15
Cigna,PPO,927,DRG,Extensive burns or full thickness burns w MV 96+ hrs w skin graft,,Case Rate,536287.95
Cigna,PPO,928,DRG,Full thickness burn w skin graft or inhal inj w CC/MCC,,Case Rate,166237.05
Cigna,PPO,929,DRG,Full thickness burn w skin graft or inhal inj w/o CC/MCC,,Case Rate,76726.95
Cigna,PPO,92938,CPT4/HCPCS,Add Vessel W/Bare Metal Grafts,,% of Charges,7966.00
Cigna,PPO,93,DRG,Other disorders of nervous system w/o CC/MCC,,Case Rate,19923.15
Cigna,PPO,933,DRG,Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft,,Case Rate,57568.80
Cigna,PPO,93355,CPT4/HCPCS,TEE Intraoperative LAA implant,,% of Charges,7966.00
Cigna,PPO,934,DRG,Full thickness burn w/o skin grft or inhal inj,,Case Rate,49401.15
Cigna,PPO,93456,CPT4/HCPCS,Cath Plcmnt RHC, Coro Angio,,% of Charges,7966.00
Cigna,PPO,935,DRG,Non-extensive burns,,Case Rate,49299.15
Cigna,PPO,93580,CPT4/HCPCS,PFO Closure with Implant,,% of Charges,7966.00
Cigna,PPO,93724,CPT4/HCPCS,Non-Invasive Prog Stim Via PPM,,% of Charges,7966.00
Cigna,PPO,93799,CPT4/HCPCS,CARDIOVASCULAR PROCEDURE,,% of Charges,7966.00
Cigna,PPO,939,DRG,O.R. proc w diagnoses of other contact w health services w MCC,,Case Rate,86348.10
Cigna,PPO,94,DRG,Bacterial & tuberculous infections of nervous system w MCC,,Case Rate,92644.05
Cigna,PPO,940,DRG,O.R. proc w diagnoses of other contact w health services w CC,,Case Rate,56548.80
Cigna,PPO,94002,CPT4/HCPCS,Initial Ventilator Day,,% of Charges,10429.25
Cigna,PPO,94003,CPT4/HCPCS,Ventilator Daily,,% of Charges,10067.85
Cigna,PPO,941,DRG,O.R. proc w diagnoses of other contact w health services w/o CC/MCC,,Case Rate,49079.85
Cigna,PPO,945,DRG,Rehabilitation w CC/MCC,,Case Rate,37859.85
Cigna,PPO,946,DRG,Rehabilitation w/o CC/MCC,,Case Rate,28743.60
Cigna,PPO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,% of Charges,315.25
Cigna,PPO,94645,CPT4/HCPCS,Addition Hr Cont. Aerosol,,% of Charges,204.75
Cigna,PPO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,% of Charges,1080.95
Cigna,PPO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,% of Charges,481.00
Cigna,PPO,94667,CPT4/HCPCS,Pd & Percussion Treatment,,% of Charges,327.60
Cigna,PPO,947,DRG,Signs & symptoms w MCC,,Case Rate,30347.55
Cigna,PPO,948,DRG,Signs & symptoms w/o MCC,,Case Rate,20032.80
Cigna,PPO,949,DRG,Aftercare w CC/MCC,,Case Rate,28231.05
Cigna,PPO,95,DRG,Bacterial & tuberculous infections of nervous system w CC,,Case Rate,63954.00
Cigna,PPO,950,DRG,Aftercare w/o CC/MCC,,Case Rate,18841.95
Cigna,PPO,951,DRG,Other factors influencing health status,,Case Rate,14234.10
Cigna,PPO,955,DRG,Craniotomy for multiple significant trauma,,Case Rate,160344.00
Cigna,PPO,956,DRG,Limb reattachment, hip & femur proc for multiple significant trauma,,Case Rate,98144.40
Cigna,PPO,957,DRG,Other O.R. procedures for multiple significant trauma w MCC,,Case Rate,189230.40
Cigna,PPO,958,DRG,Other O.R. procedures for multiple significant trauma w CC,,Case Rate,107237.70
Cigna,PPO,959,DRG,Other O.R. procedures for multiple significant trauma w/o CC/MCC,,Case Rate,69722.10
Cigna,PPO,95992,CPT4/HCPCS,Canalith Repositioning Procedure,,% of Charges,150.80
Cigna,PPO,96,DRG,Bacterial & tuberculous infections of nervous system w/o CC/MCC,,Case Rate,59453.25
Cigna,PPO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,% of Charges,934.70
Cigna,PPO,963,DRG,Other multiple significant trauma w MCC,,Case Rate,69467.10
Cigna,PPO,964,DRG,Other multiple significant trauma w CC,,Case Rate,37954.20
Cigna,PPO,96401,CPT4/HCPCS,Chemo Anti Neopl SQ IM,,% of Charges,190.45
Cigna,PPO,96402,CPT4/HCPCS,Chemo Hormon Antineopl SQ IM,,% of Charges,190.45
Cigna,PPO,96409,CPT4/HCPCS,Chemo IV Push Single Drug,,% of Charges,776.10
Cigna,PPO,96411,CPT4/HCPCS,Chemo IV Push Addl Drug,,% of Charges,414.70
Cigna,PPO,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,% of Charges,1043.25
Cigna,PPO,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,% of Charges,356.85
Cigna,PPO,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,% of Charges,1043.25
Cigna,PPO,96417,CPT4/HCPCS,Each Additional Seq Infusion - Chemo Pump,,% of Charges,817.70
Cigna,PPO,96450,CPT4/HCPCS,Intrathecal Chemo Admin,,% of Charges,1607.45
Cigna,PPO,965,DRG,Other multiple significant trauma w/o CC/MCC,,Case Rate,23278.95
Cigna,PPO,96521,CPT4/HCPCS,Refill/Maint Portable Pump,,% of Charges,776.10
Cigna,PPO,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,% of Charges,403.00
Cigna,PPO,969,DRG,HIV w extensive O.R. procedure w MCC,,Case Rate,147578.70
Cigna,PPO,97,DRG,Non-bacterial infect of nervous sys exc viral meningitis w MCC,,Case Rate,95691.30
Cigna,PPO,970,DRG,HIV w extensive O.R. procedure w/o MCC,,Case Rate,75100.05
Cigna,PPO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,% of Charges,90.35
Cigna,PPO,97012,CPT4/HCPCS,Traction Mechanical,,% of Charges,152.75
Cigna,PPO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,% of Charges,135.20
Cigna,PPO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,% of Charges,111.15
Cigna,PPO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,% of Charges,167.70
Cigna,PPO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,% of Charges,163.15
Cigna,PPO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,% of Charges,184.60
Cigna,PPO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,% of Charges,126.75
Cigna,PPO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,% of Charges,210.60
Cigna,PPO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,% of Charges,287.95
Cigna,PPO,97113,CPT4/HCPCS,Aquatic Therapy Each 15 Min,,% of Charges,215.15
Cigna,PPO,97116,CPT4/HCPCS,Gait Training Each 15 Mins,,% of Charges,267.80
Cigna,PPO,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,% of Charges,200.20
Cigna,PPO,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,% of Charges,187.85
Cigna,PPO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,% of Charges,246.35
Cigna,PPO,97150,CPT4/HCPCS,Group Therapy Exercises,,% of Charges,205.40
Cigna,PPO,97161,CPT4/HCPCS,Init eval: Low comp 20 mins,,% of Charges,465.40
Cigna,PPO,97162,CPT4/HCPCS,Init eval: Mod comp 30 mins,,% of Charges,465.40
Cigna,PPO,97163,CPT4/HCPCS,Init eval: High comp 45 mins,,% of Charges,465.40
Cigna,PPO,97164,CPT4/HCPCS,Re-Evaluation,,% of Charges,250.25
Cigna,PPO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,% of Charges,476.45
Cigna,PPO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,% of Charges,476.45
Cigna,PPO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,% of Charges,476.45
Cigna,PPO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,% of Charges,272.35
Cigna,PPO,974,DRG,HIV w major related condition w MCC,,Case Rate,68485.35
Cigna,PPO,975,DRG,HIV w major related condition w CC,,Case Rate,32617.05
Cigna,PPO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,% of Charges,298.35
Cigna,PPO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,% of Charges,179.40
Cigna,PPO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,% of Charges,222.95
Cigna,PPO,97542,CPT4/HCPCS,wheelchair manage ea 15 min,,% of Charges,163.15
Cigna,PPO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,% of Charges,872.95
Cigna,PPO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,% of Charges,208.00
Cigna,PPO,976,DRG,HIV w major related condition w/o CC/MCC,,Case Rate,24202.05
Cigna,PPO,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,% of Charges,224.90
Cigna,PPO,97605,CPT4/HCPCS,Wound Vac<50,,% of Charges,474.50
Cigna,PPO,97606,CPT4/HCPCS,Wound Vac>50,,% of Charges,546.00
Cigna,PPO,977,DRG,HIV w or w/o other related condition,,Case Rate,33680.40
Cigna,PPO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,% of Charges,287.30
Cigna,PPO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,% of Charges,172.25
Cigna,PPO,97761,CPT4/HCPCS,Prosthetic Training Each 15 Min,,% of Charges,254.15
Cigna,PPO,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,% of Charges,123.50
Cigna,PPO,98,DRG,Non-bacterial infect of nervous sys exc viral meningitis w CC,,Case Rate,53827.95
Cigna,PPO,981,DRG,Extensive O.R. procedure unrelated to principal diagnosis w MCC,,Case Rate,117498.90
Cigna,PPO,982,DRG,Extensive O.R. procedure unrelated to principal diagnosis w CC,,Case Rate,64805.70
Cigna,PPO,983,DRG,Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC,,Case Rate,42197.40
Cigna,PPO,987,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w MCC,,Case Rate,83183.55
Cigna,PPO,988,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w CC,,Case Rate,42857.85
Cigna,PPO,989,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC,,Case Rate,28455.45
Cigna,PPO,99,DRG,Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC,,Case Rate,35631.15
Cigna,PPO,C8900,CPT4/HCPCS,MRA w/cont, abd,,% of Charges,6500.00
Cigna,PPO,C8901,CPT4/HCPCS,MRA w/o cont, abd,,% of Charges,6500.00
Cigna,PPO,C8902,CPT4/HCPCS,MRA w/o fol w/cont, abd,,% of Charges,6500.00
Cigna,PPO,C8903,CPT4/HCPCS,MRI w/cont, breast, uni,,% of Charges,6500.00
Cigna,PPO,C8904,CPT4/HCPCS,Mri w/o cont, breast, uni,,% of Charges,6500.00
Cigna,PPO,C8905,CPT4/HCPCS,MRI w/o fol w/cont, brst, un,,% of Charges,6500.00
Cigna,PPO,C8906,CPT4/HCPCS,MRI w/cont, breast, bi,,% of Charges,6500.00
Cigna,PPO,C8908,CPT4/HCPCS,MRI w/o fol w/cont, breast,,,% of Charges,6500.00
Cigna,PPO,C8909,CPT4/HCPCS,MRA w/cont, chest,,% of Charges,6500.00
Cigna,PPO,C8910,CPT4/HCPCS,MRA w/o cont, chest,,% of Charges,6500.00
Cigna,PPO,C8911,CPT4/HCPCS,MRA w/o fol w/cont, chest,,% of Charges,6500.00
Cigna,PPO,C8912,CPT4/HCPCS,MRA w/cont, lwr ext,,% of Charges,6500.00
Cigna,PPO,C8913,CPT4/HCPCS,MRA w/o cont, lwr ext,,% of Charges,6500.00
Cigna,PPO,C8914,CPT4/HCPCS,MRA w/o fol w/cont, lwr ext,,% of Charges,6500.00
Cigna,PPO,C8918,CPT4/HCPCS,MRA w/cont, pelvis,,% of Charges,6500.00
Cigna,PPO,C8919,CPT4/HCPCS,MRA w/o cont, pelvis,,% of Charges,6500.00
Cigna,PPO,C8920,CPT4/HCPCS,MRA w/o fol w/cont, pelvis,,% of Charges,6500.00
Cigna,PPO,C8934,CPT4/HCPCS,MRA, w/dye, upper extremity,,% of Charges,6500.00
Cigna,PPO,C8935,CPT4/HCPCS,MRA, w/o dye, upper extr,,% of Charges,6500.00
Cigna,PPO,C8936,CPT4/HCPCS,MRA, w/o&w/dye, upper extr,,% of Charges,6500.00
Cigna,PPO,C9725,CPT4/HCPCS,Place endorectal app,,% of Charges,5413.20
Cigna,PPO,G0120,CPT4/HCPCS,Colon Ca Scrn/Colonscopy Be,,% of Charges,6500.00
Cigna,PPO,G0173,CPT4/HCPCS,Srs 1 Tx &1St Sbrt Tx Delivery,,% of Charges,22311.90
Cigna,PPO,G0237,CPT4/HCPCS,Therapeutic Proc Ea 15 Min,,% of Charges,172.25
Cigna,PPO,G0238,CPT4/HCPCS,Therapeutic Proc ea 15 Min Indv,,% of Charges,172.25
Cigna,PPO,G0239,CPT4/HCPCS,Therapeutic Procedures,,% of Charges,172.25
Cigna,PPO,G0251,CPT4/HCPCS,Sts 2-5 Tx Delivery,,% of Charges,9210.50
Cigna,PPO,G0257,CPT4/HCPCS,Hemodialysis,,% of charges,5900.00
Cigna,PPO,G0279,CPT4/HCPCS,Tomosynthesis, mammo,,% of Charges,6500.00
Cigna,PPO,G0283,CPT4/HCPCS,Elec stim other than wound,,% of Charges,169.00
Cigna,PPO,G0389,CPT4/HCPCS,Ultrasound exam aaa screen,,% of Charges,6500.00
Cigna,PPO,G0515,CPT4/HCPCS,Cognitive skills development,,% of Charges,208.00
Cigna,PPO,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,% of Charges,85.15
Cigna,PPO,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,% of Charges,150.15
Cigna,PPO,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,% of Charges,234.65
Cigna,PPO,G8996,CPT4/HCPCS,SP Swallow Current Status,,% of Charges,6.5e-03
Cigna,PPO,G8997,CPT4/HCPCS,SP Swallow Goal Status,,% of Charges,6.5e-03
Cigna,PPO,G8998,CPT4/HCPCS,SP Swallow D/C Status,,% of Charges,6.5e-03
Cigna,PPO,G8999,CPT4/HCPCS,SP Motor Speech Current Status,,% of Charges,6.5e-03
Cigna,PPO,G9158,CPT4/HCPCS,SP Motor Speech D/C Status,,% of Charges,6.5e-03
Cigna,PPO,G9159,CPT4/HCPCS,SP Lang Comp Current Status,,% of Charges,6.5e-03
Cigna,PPO,G9160,CPT4/HCPCS,SP Lang Comp Goal Status,,% of Charges,6.5e-03
Cigna,PPO,G9161,CPT4/HCPCS,SP Lang Comp D/C Status,,% of Charges,6.5e-03
Cigna,PPO,G9162,CPT4/HCPCS,SP Lang Express Current Status,,% of Charges,6.5e-03
Cigna,PPO,G9163,CPT4/HCPCS,SP Lang Express Goal Status,,% of Charges,6.5e-03
Cigna,PPO,G9164,CPT4/HCPCS,SP Lang Express D/C Status,,% of Charges,6.5e-03
Cigna,PPO,G9165,CPT4/HCPCS,SP Atten Current Status,,% of Charges,6.5e-03
Cigna,PPO,G9166,CPT4/HCPCS,SP Atten Goal Status,,% of Charges,6.5e-03
Cigna,PPO,G9167,CPT4/HCPCS,SP Atten D/C Status,,% of Charges,6.5e-03
Cigna,PPO,G9168,CPT4/HCPCS,SP Memory Current Status,,% of Charges,6.5e-03
Cigna,PPO,G9169,CPT4/HCPCS,SP Memory Goal Status,,% of Charges,6.5e-03
Cigna,PPO,G9170,CPT4/HCPCS,SP Memory D/C Status,,% of Charges,6.5e-03
Cigna,PPO,G9171,CPT4/HCPCS,SP Voice Current Status,,% of Charges,6.5e-03
Cigna,PPO,G9172,CPT4/HCPCS,SP Voice Goal Status,,% of Charges,6.5e-03
Cigna,PPO,G9173,CPT4/HCPCS,SP Voice D/C Status,,% of Charges,6.5e-03
Cigna,PPO,G9174,CPT4/HCPCS,SP Speech Lang Current Status,,% of Charges,6.5e-03
Cigna,PPO,G9175,CPT4/HCPCS,SP Speech Lang Goal Status,,% of Charges,6.5e-03
Cigna,PPO,G9176,CPT4/HCPCS,SP Speech Lang D/C Status,,% of Charges,6.5e-03
Cigna,PPO,G9186,CPT4/HCPCS,SP Motor Speech Goal Status,,% of Charges,6.5e-03
Cigna,PPO,Q3014,CPT4/HCPCS,Teleheatlh Facility Fee,,% of charges,6500.00
Cigna,PPO,,,NICU/Newborn - Level I,,Per Diem,1500.00
Cigna,PPO,,,ICU,,Per Diem,6500.00
Cigna,PPO,,,CCU,,Per Diem,6500.00
Cigna,PPO,,,Telemetry,,Per Diem,6500.00
Cigna,PPO,,,Medical Surgical,,Per Diem,6500.00
Cigna,PPO,,,NICU/Newborn - Level II,,Per Diem,7100.00
Cigna,PPO,,,NICU/Newborn - Level III,,Per Diem,7100.00
Cigna,PPO,,,NICU/Newborn - Level IV,,Per Diem,7100.00
Health Net,EPO,0042T,CPT4/HCPCS,CT PERFUSION W/CONTRAST CBF,,% of Charges Not to Exceed,6766.00
Health Net,EPO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,% of Charges Not to Exceed,7894.00
Health Net,EPO,215,DRG,Other heart assist system implant,,Case Rate,54537.00
Health Net,EPO,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,54537.00
Health Net,EPO,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,54537.00
Health Net,EPO,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,54537.00
Health Net,EPO,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,54537.00
Health Net,EPO,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,54537.00
Health Net,EPO,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,54537.00
Health Net,EPO,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,31908.00
Health Net,EPO,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,31908.00
Health Net,EPO,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,31908.00
Health Net,EPO,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,31908.00
Health Net,EPO,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,31908.00
Health Net,EPO,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,31908.00
Health Net,EPO,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,54537.00
Health Net,EPO,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,54537.00
Health Net,EPO,230,DRG,Other cardiothoracic procedures w/o CC/MCC,,Case Rate,54537.00
Health Net,EPO,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,54537.00
Health Net,EPO,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,54537.00
Health Net,EPO,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,54537.00
Health Net,EPO,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,54537.00
Health Net,EPO,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,54537.00
Health Net,EPO,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,54537.00
Health Net,EPO,237,DRG,Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair,,Case Rate,54537.00
Health Net,EPO,238,DRG,Major cardiovasc procedures w/o MCC,,Case Rate,54537.00
Health Net,EPO,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,13874.00
Health Net,EPO,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,13874.00
Health Net,EPO,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,13874.00
Health Net,EPO,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,13748.00
Health Net,EPO,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,13748.00
Health Net,EPO,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,13748.00
Health Net,EPO,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,13748.00
Health Net,EPO,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,13748.00
Health Net,EPO,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,13748.00
Health Net,EPO,252,DRG,Other vascular procedures w MCC,,Case Rate,54537.00
Health Net,EPO,253,DRG,Other vascular procedures w CC,,Case Rate,54537.00
Health Net,EPO,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,54537.00
Health Net,EPO,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,13874.00
Health Net,EPO,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,13874.00
Health Net,EPO,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,13874.00
Health Net,EPO,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,13874.00
Health Net,EPO,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,13874.00
Health Net,EPO,28,DRG,Spinal procedures w MCC,,100% of Medicare Allowable,50104.38
Health Net,EPO,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,11074.00
Health Net,EPO,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,11074.00
Health Net,EPO,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,11074.00
Health Net,EPO,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,11074.00
Health Net,EPO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,100% of Medicare Allowable,28366.65
Health Net,EPO,29086,CPT4/HCPCS,APPLY FINGER CAST,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29520,CPT4/HCPCS,STRAPPING OF HIP,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29550,CPT4/HCPCS,STRAPPING OF TOES,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,% of Charges Not to Exceed,6766.00
Health Net,EPO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,30,DRG,Spinal procedures w/o CC/MCC,,100% of Medicare Allowable,20292.27
Health Net,EPO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Per Visit,21405.00
Health Net,EPO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Per Visit,21405.00
Health Net,EPO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Per Visit,21405.00
Health Net,EPO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Per Visit,21405.00
Health Net,EPO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Per Visit,21405.00
Health Net,EPO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Per Visit,21405.00
Health Net,EPO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Per Visit,21405.00
Health Net,EPO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Per Visit,21405.00
Health Net,EPO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Per Visit,21405.00
Health Net,EPO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Per Visit,21405.00
Health Net,EPO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Per Visit,21405.00
Health Net,EPO,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,% of Charges Not to Exceed,6766.00
Health Net,EPO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,100% of Medicare Allowable,79147.70
Health Net,EPO,454,DRG,Combined anterior/posterior spinal fusion w CC,,100% of Medicare Allowable,52498.54
Health Net,EPO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,100% of Medicare Allowable,41245.71
Health Net,EPO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,100% of Medicare Allowable,74021.04
Health Net,EPO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,100% of Medicare Allowable,55975.71
Health Net,EPO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,100% of Medicare Allowable,43194.79
Health Net,EPO,459,DRG,Spinal fusion except cervical w MCC,,100% of Medicare Allowable,57954.06
Health Net,EPO,460,DRG,Spinal fusion except cervical w/o MCC,,100% of Medicare Allowable,33856.61
Health Net,EPO,471,DRG,Cervical spinal fusion w MCC,,100% of Medicare Allowable,43189.63
Health Net,EPO,472,DRG,Cervical spinal fusion w CC,,100% of Medicare Allowable,26284.99
Health Net,EPO,473,DRG,Cervical spinal fusion w/o CC/MCC,,100% of Medicare Allowable,21868.58
Health Net,EPO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,% of Charges Not to Exceed,6766.00
Health Net,EPO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,% of Charges Not to Exceed,6766.00
Health Net,EPO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,100% of Medicare Allowable,30857.23
Health Net,EPO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,100% of Medicare Allowable,16853.83
Health Net,EPO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,100% of Medicare Allowable,12202.39
Health Net,EPO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,% of Charges Not to Exceed,7894.00
Health Net,EPO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,% of Charges Not to Exceed,7894.00
Health Net,EPO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,% of Charges Not to Exceed,7894.00
Health Net,EPO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61618,CPT4/HCPCS,REPAIR DURA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61619,CPT4/HCPCS,REPAIR DURA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61783,CPT4/HCPCS,SCAN PROC SPINAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,% of Charges Not to Exceed,5310.00
Health Net,EPO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63295,CPT4/HCPCS,REPAIR LAMINECTOMY DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63620,CPT4/HCPCS,SRS SPINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,% of Charges Not to Exceed,6766.00
Health Net,EPO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,% of Charges Not to Exceed,5310.00
Health Net,EPO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,% of Charges Not to Exceed,5310.00
Health Net,EPO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,% of Charges Not to Exceed,5310.00
Health Net,EPO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64787,CPT4/HCPCS,IMPLANT NERVE END,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64859,CPT4/HCPCS,NERVE SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,% of Charges Not to Exceed,5310.00
Health Net,EPO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65091,CPT4/HCPCS,REVISE EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65101,CPT4/HCPCS,REMOVAL OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65110,CPT4/HCPCS,REMOVAL OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65430,CPT4/HCPCS,CORNEAL SMEAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65600,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65760,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65765,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65850,CPT4/HCPCS,INCISION OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65900,CPT4/HCPCS,REMOVE EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66130,CPT4/HCPCS,REMOVE EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66172,CPT4/HCPCS,INCISION OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66500,CPT4/HCPCS,INCISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66505,CPT4/HCPCS,INCISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66761,CPT4/HCPCS,REVISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66762,CPT4/HCPCS,REVISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,% of Charges Not to Exceed,5310.00
Health Net,EPO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67710,CPT4/HCPCS,INCISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,% of Charges Not to Exceed,5310.00
Health Net,EPO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67820,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67825,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67830,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67835,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67850,CPT4/HCPCS,TREAT EYELID LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67880,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67882,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67950,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67961,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67966,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68330,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68360,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68362,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69090,CPT4/HCPCS,PIERCE EARLOBES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,% of Charges Not to Exceed,5310.00
Health Net,EPO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,% of Charges Not to Exceed,5310.00
Health Net,EPO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69450,CPT4/HCPCS,EARDRUM REVISION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69501,CPT4/HCPCS,MASTOIDECTOMY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69502,CPT4/HCPCS,MASTOIDECTOMY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69540,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69550,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69552,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69554,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69801,CPT4/HCPCS,INCISE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69905,CPT4/HCPCS,REMOVE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,EPO,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,EPO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,71250,CPT4/HCPCS,CT THORAX DX C-,,% of Charges Not to Exceed,6766.00
Health Net,EPO,71260,CPT4/HCPCS,CT THORAX DX C+,,% of Charges Not to Exceed,6766.00
Health Net,EPO,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,% of Charges Not to Exceed,6766.00
Health Net,EPO,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,% of Charges Not to Exceed,6766.00
Health Net,EPO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72193,CPT4/HCPCS,CT PELVIS W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,% of Charges Not to Exceed,6766.00
Health Net,EPO,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,% of Charges Not to Exceed,6766.00
Health Net,EPO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,% of Charges Not to Exceed,6766.00
Health Net,EPO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,76497,CPT4/HCPCS,CT PROCEDURE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,Case Rate,4921.00
Health Net,EPO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,% of Charges Not to Exceed,7894.00
Health Net,EPO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,% of Charges Not to Exceed,6766.00
Health Net,EPO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,% of Charges Not to Exceed,6766.00
Health Net,EPO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,% of Charges Not to Exceed,6766.00
Health Net,EPO,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,% of Charges Not to Exceed,6766.00
Health Net,EPO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,7894.00
Health Net,EPO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,7894.00
Health Net,EPO,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,7894.00
Health Net,EPO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77372,CPT4/HCPCS,SRS LINEAR BASED,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77373,CPT4/HCPCS,SBRT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,% of Charges Not to Exceed,7894.00
Health Net,EPO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,% of Charges Not to Exceed,7894.00
Health Net,EPO,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Per Visit,13685.00
Health Net,EPO,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Per Visit,13685.00
Health Net,EPO,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Per Visit,13685.00
Health Net,EPO,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Per Visit,13685.00
Health Net,EPO,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Per Visit,13685.00
Health Net,EPO,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Per Visit,13685.00
Health Net,EPO,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,13685.00
Health Net,EPO,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,13685.00
Health Net,EPO,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,13685.00
Health Net,EPO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Per Visit,13685.00
Health Net,EPO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Per Visit,13685.00
Health Net,EPO,77790,CPT4/HCPCS,RADIATION HANDLING,,Per Visit,13685.00
Health Net,EPO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,12830.00
Health Net,EPO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,12830.00
Health Net,EPO,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,12830.00
Health Net,EPO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,12830.00
Health Net,EPO,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,% of Charges Not to Exceed,6766.00
Health Net,EPO,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,% of Charges Not to Exceed,6766.00
Health Net,EPO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,12830.00
Health Net,EPO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,12830.00
Health Net,EPO,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,% of Charges Not to Exceed,6766.00
Health Net,EPO,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,% of Charges Not to Exceed,6766.00
Health Net,EPO,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,% of Charges Not to Exceed,7894.00
Health Net,EPO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,4921.00
Health Net,EPO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,4921.00
Health Net,EPO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,4921.00
Health Net,EPO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,4921.00
Health Net,EPO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,4921.00
Health Net,EPO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,4921.00
Health Net,EPO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,% of Charges Not to Exceed,6766.00
Health Net,EPO,90901,CPT4/HCPCS,BIOFEEDBACK TRAIN ANY METH,,% of Charges Not to Exceed,6766.00
Health Net,EPO,90911,CPT4/HCPCS,BIOFEEDBACK PERI/URO/RECTAL,,% of Charges Not to Exceed,6766.00
Health Net,EPO,90912,CPT4/HCPCS,BFB TRAINING 1ST 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,90913,CPT4/HCPCS,BFB TRAINING EA ADDL 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,% of Charges Not to Exceed,6766.00
Health Net,EPO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,% of Charges Not to Exceed,6766.00
Health Net,EPO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,% of Charges Not to Exceed,6766.00
Health Net,EPO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,% of Charges Not to Exceed,6766.00
Health Net,EPO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Per Visit,8970.00
Health Net,EPO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Per Visit,8970.00
Health Net,EPO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Per Visit,8970.00
Health Net,EPO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Per Visit,8970.00
Health Net,EPO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Per Visit,8970.00
Health Net,EPO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Per Visit,8970.00
Health Net,EPO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Per Visit,8970.00
Health Net,EPO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Per Visit,8970.00
Health Net,EPO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Per Visit,8970.00
Health Net,EPO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Per Visit,8970.00
Health Net,EPO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Per Visit,8970.00
Health Net,EPO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Per Visit,8970.00
Health Net,EPO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Per Visit,8970.00
Health Net,EPO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Per Visit,4613.00
Health Net,EPO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Per Visit,4613.00
Health Net,EPO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Per Visit,4613.00
Health Net,EPO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Per Visit,4613.00
Health Net,EPO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Per Visit,4613.00
Health Net,EPO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Per Visit,4613.00
Health Net,EPO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Per Visit,4613.00
Health Net,EPO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Per Visit,4613.00
Health Net,EPO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Per Visit,4613.00
Health Net,EPO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Per Visit,4613.00
Health Net,EPO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Per Visit,4613.00
Health Net,EPO,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Per Visit,4613.00
Health Net,EPO,93463,CPT4/HCPCS,DRUG ADMIN & HEMODYNMIC MEAS,,Per Visit,4613.00
Health Net,EPO,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Per Visit,4613.00
Health Net,EPO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Per Visit,4613.00
Health Net,EPO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Per Visit,4613.00
Health Net,EPO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,EPO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,EPO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,EPO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,EPO,93561,CPT4/HCPCS,CARDIAC OUTPUT MEASUREMENT,,Per Visit,4613.00
Health Net,EPO,93562,CPT4/HCPCS,CARD OUTPUT MEASURE SUBSQ,,Per Visit,4613.00
Health Net,EPO,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,Per Visit,4613.00
Health Net,EPO,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,Per Visit,4613.00
Health Net,EPO,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,Per Visit,4613.00
Health Net,EPO,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,Per Visit,4613.00
Health Net,EPO,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,Per Visit,4613.00
Health Net,EPO,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,Per Visit,4613.00
Health Net,EPO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Per Visit,7530.00
Health Net,EPO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Per Visit,7530.00
Health Net,EPO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Per Visit,7530.00
Health Net,EPO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Per Visit,7530.00
Health Net,EPO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Per Visit,7530.00
Health Net,EPO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Per Visit,7530.00
Health Net,EPO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Per Visit,7530.00
Health Net,EPO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Per Visit,7530.00
Health Net,EPO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Per Visit,7530.00
Health Net,EPO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Per Visit,7530.00
Health Net,EPO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,EPO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,EPO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,EPO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,EPO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Per Visit,7530.00
Health Net,EPO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Per Visit,7530.00
Health Net,EPO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Per Visit,7530.00
Health Net,EPO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Per Visit,7530.00
Health Net,EPO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,EPO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,EPO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Per Visit,8885.00
Health Net,EPO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Per Visit,8885.00
Health Net,EPO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Per Visit,8885.00
Health Net,EPO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Per Visit,8885.00
Health Net,EPO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Per Visit,8885.00
Health Net,EPO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Per Visit,8885.00
Health Net,EPO,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,% of Charges Not to Exceed,6766.00
Health Net,EPO,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,% of Charges Not to Exceed,6766.00
Health Net,EPO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,% of Charges Not to Exceed,6766.00
Health Net,EPO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,% of Charges Not to Exceed,6766.00
Health Net,EPO,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,% of Charges Not to Exceed,6766.00
Health Net,EPO,95992,CPT4/HCPCS,CANALITH REPOSITIONING PROC,,% of Charges Not to Exceed,6766.00
Health Net,EPO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,% of Charges Not to Exceed,6766.00
Health Net,EPO,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8900,CPT4/HCPCS,MRA w/cont, abd,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8901,CPT4/HCPCS,MRA w/o cont, abd,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8902,CPT4/HCPCS,MRA w/o fol w/cont, abd,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8903,CPT4/HCPCS,MRI w/cont, breast, uni,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8904,CPT4/HCPCS,Mri w/o cont, breast, uni,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8905,CPT4/HCPCS,MRI w/o fol w/cont, brst, un,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8906,CPT4/HCPCS,MRI w/cont, breast, bi,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8908,CPT4/HCPCS,MRI w/o fol w/cont, breast,,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8909,CPT4/HCPCS,MRA w/cont, chest,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8910,CPT4/HCPCS,MRA w/o cont, chest,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8911,CPT4/HCPCS,MRA w/o fol w/cont, chest,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8912,CPT4/HCPCS,MRA w/cont, lwr ext,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8913,CPT4/HCPCS,MRA w/o cont, lwr ext,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8914,CPT4/HCPCS,MRA w/o fol w/cont, lwr ext,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8918,CPT4/HCPCS,MRA w/cont, pelvis,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8919,CPT4/HCPCS,MRA w/o cont, pelvis,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8920,CPT4/HCPCS,MRA w/o fol w/cont, pelvis,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8934,CPT4/HCPCS,MRA, w/dye, upper extremity,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8935,CPT4/HCPCS,MRA, w/o dye, upper extr,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C8936,CPT4/HCPCS,MRA, w/o&w/dye, upper extr,,% of Charges Not to Exceed,6766.00
Health Net,EPO,C9725,CPT4/HCPCS,Place endorectal app,,% of Charges Not to Exceed,7894.00
Health Net,EPO,G0173,CPT4/HCPCS,Linear acc stereo radsur com,,% of Charges Not to Exceed,7894.00
Health Net,EPO,G0237,CPT4/HCPCS,Therapeutic procd strg endur,,% of Charges Not to Exceed,6766.00
Health Net,EPO,G0238,CPT4/HCPCS,Oth resp proc, indiv,,% of Charges Not to Exceed,6766.00
Health Net,EPO,G0239,CPT4/HCPCS,Oth resp proc, group,,% of Charges Not to Exceed,6766.00
Health Net,EPO,G0251,CPT4/HCPCS,Linear acc based stero radio,,% of Charges Not to Exceed,7894.00
Health Net,EPO,G0283,CPT4/HCPCS,Elec stim other than wound,,% of Charges Not to Exceed,6766.00
Health Net,EPO,G0297,CPT4/HCPCS,Ldct for lung ca screen,,Per Visit,21405.00
Health Net,EPO,G0300,CPT4/HCPCS,Hhs/hospice of lpn ea 15 min,,Per Visit,21405.00
Health Net,EPO,G0515,CPT4/HCPCS,Cognitive skills development,,% of Charges Not to Exceed,6766.00
Health Net,EPO,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,% of Charges Not to Exceed,6766.00
Health Net,EPO,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,% of Charges Not to Exceed,6766.00
Health Net,EPO,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,% of Charges Not to Exceed,6766.00
Health Net,EPO,,,NICU/Newborn - Level I,,Per Diem,1138.00
Health Net,EPO,,,Medical Surgical,,Per Diem,3489.00
Health Net,EPO,,,CCU,,Per Diem,5510.00
Health Net,EPO,,,ICU,,Per Diem,5510.00
Health Net,EPO,,,NICU/Newborn - Level II,,Per Diem,5510.00
Health Net,EPO,,,NICU/Newborn - Level III,,Per Diem,5510.00
Health Net,Exchange,0042T,CPT4/HCPCS,CT PERFUSION W/CONTRAST CBF,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,215,DRG,Other heart assist system implant,,Case Rate,46358.00
Health Net,Exchange,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,46358.00
Health Net,Exchange,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,46358.00
Health Net,Exchange,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,46358.00
Health Net,Exchange,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,46358.00
Health Net,Exchange,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,46358.00
Health Net,Exchange,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,46358.00
Health Net,Exchange,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,27124.00
Health Net,Exchange,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,27124.00
Health Net,Exchange,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,27124.00
Health Net,Exchange,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,27124.00
Health Net,Exchange,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,27124.00
Health Net,Exchange,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,27124.00
Health Net,Exchange,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,46358.00
Health Net,Exchange,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,46358.00
Health Net,Exchange,230,DRG,Other cardiothoracic procedures w/o CC/MCC,,Case Rate,46358.00
Health Net,Exchange,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,46358.00
Health Net,Exchange,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,46358.00
Health Net,Exchange,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,46358.00
Health Net,Exchange,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,46358.00
Health Net,Exchange,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,46358.00
Health Net,Exchange,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,46358.00
Health Net,Exchange,237,DRG,Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair,,Case Rate,46358.00
Health Net,Exchange,238,DRG,Major cardiovasc procedures w/o MCC,,Case Rate,46358.00
Health Net,Exchange,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,11793.00
Health Net,Exchange,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,11793.00
Health Net,Exchange,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,11793.00
Health Net,Exchange,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,11686.00
Health Net,Exchange,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,11686.00
Health Net,Exchange,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,11686.00
Health Net,Exchange,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,11686.00
Health Net,Exchange,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,11686.00
Health Net,Exchange,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,11686.00
Health Net,Exchange,252,DRG,Other vascular procedures w MCC,,Case Rate,46358.00
Health Net,Exchange,253,DRG,Other vascular procedures w CC,,Case Rate,46358.00
Health Net,Exchange,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,46358.00
Health Net,Exchange,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,11793.00
Health Net,Exchange,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,11793.00
Health Net,Exchange,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,11793.00
Health Net,Exchange,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,11793.00
Health Net,Exchange,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,11793.00
Health Net,Exchange,28,DRG,Spinal procedures w MCC,,100% of Medicare Allowable,50104.38
Health Net,Exchange,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,9413.00
Health Net,Exchange,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,9413.00
Health Net,Exchange,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,9413.00
Health Net,Exchange,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,9413.00
Health Net,Exchange,29,DRG,Spinal procedures w CC or spinal neurostimulators,,100% of Medicare Allowable,28366.65
Health Net,Exchange,29086,CPT4/HCPCS,APPLY FINGER CAST,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29520,CPT4/HCPCS,STRAPPING OF HIP,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29530,CPT4/HCPCS,STRAPPING OF KNEE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29550,CPT4/HCPCS,STRAPPING OF TOES,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,30,DRG,Spinal procedures w/o CC/MCC,,100% of Medicare Allowable,20292.27
Health Net,Exchange,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Per Visit,13913.00
Health Net,Exchange,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Per Visit,13913.00
Health Net,Exchange,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Per Visit,13913.00
Health Net,Exchange,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Per Visit,13913.00
Health Net,Exchange,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Per Visit,13913.00
Health Net,Exchange,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Per Visit,13913.00
Health Net,Exchange,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Per Visit,13913.00
Health Net,Exchange,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Per Visit,13913.00
Health Net,Exchange,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Per Visit,13913.00
Health Net,Exchange,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Per Visit,13913.00
Health Net,Exchange,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Per Visit,13913.00
Health Net,Exchange,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,453,DRG,Combined anterior/posterior spinal fusion w MCC,,100% of Medicare Allowable,79147.70
Health Net,Exchange,454,DRG,Combined anterior/posterior spinal fusion w CC,,100% of Medicare Allowable,52498.54
Health Net,Exchange,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,100% of Medicare Allowable,41245.71
Health Net,Exchange,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,100% of Medicare Allowable,74021.04
Health Net,Exchange,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,100% of Medicare Allowable,55975.71
Health Net,Exchange,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,100% of Medicare Allowable,43194.79
Health Net,Exchange,459,DRG,Spinal fusion except cervical w MCC,,100% of Medicare Allowable,57954.06
Health Net,Exchange,460,DRG,Spinal fusion except cervical w/o MCC,,100% of Medicare Allowable,33856.61
Health Net,Exchange,471,DRG,Cervical spinal fusion w MCC,,100% of Medicare Allowable,43189.63
Health Net,Exchange,472,DRG,Cervical spinal fusion w CC,,100% of Medicare Allowable,26284.99
Health Net,Exchange,473,DRG,Cervical spinal fusion w/o CC/MCC,,100% of Medicare Allowable,21868.58
Health Net,Exchange,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,100% of Medicare Allowable,30857.23
Health Net,Exchange,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,100% of Medicare Allowable,16853.83
Health Net,Exchange,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,100% of Medicare Allowable,12202.39
Health Net,Exchange,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61618,CPT4/HCPCS,REPAIR DURA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61619,CPT4/HCPCS,REPAIR DURA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61783,CPT4/HCPCS,SCAN PROC SPINAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63295,CPT4/HCPCS,REPAIR LAMINECTOMY DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63620,CPT4/HCPCS,SRS SPINAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64784,CPT4/HCPCS,REMOVE NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64787,CPT4/HCPCS,IMPLANT NERVE END,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64795,CPT4/HCPCS,BIOPSY OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64859,CPT4/HCPCS,NERVE SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65091,CPT4/HCPCS,REVISE EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65101,CPT4/HCPCS,REMOVAL OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65110,CPT4/HCPCS,REMOVAL OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65430,CPT4/HCPCS,CORNEAL SMEAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65600,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65760,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65765,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65800,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65810,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65815,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65850,CPT4/HCPCS,INCISION OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65900,CPT4/HCPCS,REMOVE EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66130,CPT4/HCPCS,REMOVE EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66172,CPT4/HCPCS,INCISION OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66500,CPT4/HCPCS,INCISION OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66505,CPT4/HCPCS,INCISION OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66605,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66625,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66630,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66635,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66761,CPT4/HCPCS,REVISION OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66762,CPT4/HCPCS,REVISION OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66920,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66930,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66940,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67025,CPT4/HCPCS,REPLACE EYE FLUID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67028,CPT4/HCPCS,INJECTION EYE DRUG,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67141,CPT4/HCPCS,TREATMENT OF RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67145,CPT4/HCPCS,TREATMENT OF RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67250,CPT4/HCPCS,REINFORCE EYE WALL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67710,CPT4/HCPCS,INCISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67800,CPT4/HCPCS,REMOVE EYELID LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67820,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67825,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67830,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67835,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67840,CPT4/HCPCS,REMOVE EYELID LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67850,CPT4/HCPCS,TREAT EYELID LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67880,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67882,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67950,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67961,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67966,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68330,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68360,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68362,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69090,CPT4/HCPCS,PIERCE EARLOBES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69420,CPT4/HCPCS,INCISION OF EARDRUM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69421,CPT4/HCPCS,INCISION OF EARDRUM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69450,CPT4/HCPCS,EARDRUM REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69501,CPT4/HCPCS,MASTOIDECTOMY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69502,CPT4/HCPCS,MASTOIDECTOMY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69540,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69550,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69552,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69554,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69801,CPT4/HCPCS,INCISE INNER EAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69805,CPT4/HCPCS,EXPLORE INNER EAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69806,CPT4/HCPCS,EXPLORE INNER EAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69905,CPT4/HCPCS,REMOVE INNER EAR,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Exchange,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,71250,CPT4/HCPCS,CT THORAX DX C-,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,71260,CPT4/HCPCS,CT THORAX DX C+,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72193,CPT4/HCPCS,CT PELVIS W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,76390,CPT4/HCPCS,MR SPECTROSCOPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,76497,CPT4/HCPCS,CT PROCEDURE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,Case Rate,4183.00
Health Net,Exchange,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77372,CPT4/HCPCS,SRS LINEAR BASED,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77373,CPT4/HCPCS,SBRT DELIVERY,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Per Visit,8895.00
Health Net,Exchange,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Per Visit,8895.00
Health Net,Exchange,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Per Visit,8895.00
Health Net,Exchange,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Per Visit,8895.00
Health Net,Exchange,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Per Visit,8895.00
Health Net,Exchange,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Per Visit,8895.00
Health Net,Exchange,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,8895.00
Health Net,Exchange,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,8895.00
Health Net,Exchange,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,8895.00
Health Net,Exchange,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Per Visit,8895.00
Health Net,Exchange,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Per Visit,8895.00
Health Net,Exchange,77790,CPT4/HCPCS,RADIATION HANDLING,,Per Visit,8895.00
Health Net,Exchange,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,10906.00
Health Net,Exchange,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,10906.00
Health Net,Exchange,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,10906.00
Health Net,Exchange,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,10906.00
Health Net,Exchange,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,% of Charges Not to Exceed,4399.00
Health Net,Exchange,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,% of Charges Not to Exceed,4399.00
Health Net,Exchange,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,10906.00
Health Net,Exchange,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,10906.00
Health Net,Exchange,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,4183.00
Health Net,Exchange,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,4183.00
Health Net,Exchange,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,4183.00
Health Net,Exchange,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,4183.00
Health Net,Exchange,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,4183.00
Health Net,Exchange,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,4183.00
Health Net,Exchange,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,90901,CPT4/HCPCS,BIOFEEDBACK TRAIN ANY METH,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,90911,CPT4/HCPCS,BIOFEEDBACK PERI/URO/RECTAL,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,90912,CPT4/HCPCS,BFB TRAINING 1ST 15 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,90913,CPT4/HCPCS,BFB TRAINING EA ADDL 15 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Per Visit,5831.00
Health Net,Exchange,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Per Visit,5831.00
Health Net,Exchange,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Per Visit,5831.00
Health Net,Exchange,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Per Visit,5831.00
Health Net,Exchange,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Per Visit,5831.00
Health Net,Exchange,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Per Visit,5831.00
Health Net,Exchange,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Per Visit,5831.00
Health Net,Exchange,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Per Visit,5831.00
Health Net,Exchange,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Per Visit,5831.00
Health Net,Exchange,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Per Visit,5831.00
Health Net,Exchange,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Per Visit,5831.00
Health Net,Exchange,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Per Visit,5831.00
Health Net,Exchange,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Per Visit,5831.00
Health Net,Exchange,93451,CPT4/HCPCS,RIGHT HEART CATH,,Per Visit,2998.00
Health Net,Exchange,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Per Visit,2998.00
Health Net,Exchange,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Per Visit,2998.00
Health Net,Exchange,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Per Visit,2998.00
Health Net,Exchange,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Per Visit,2998.00
Health Net,Exchange,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Per Visit,2998.00
Health Net,Exchange,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Per Visit,2998.00
Health Net,Exchange,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Per Visit,2998.00
Health Net,Exchange,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Per Visit,2998.00
Health Net,Exchange,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Per Visit,2998.00
Health Net,Exchange,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Per Visit,2998.00
Health Net,Exchange,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Per Visit,2998.00
Health Net,Exchange,93463,CPT4/HCPCS,DRUG ADMIN & HEMODYNMIC MEAS,,Per Visit,2998.00
Health Net,Exchange,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Per Visit,2998.00
Health Net,Exchange,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Per Visit,2998.00
Health Net,Exchange,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Per Visit,2998.00
Health Net,Exchange,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Per Visit,2998.00
Health Net,Exchange,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,2998.00
Health Net,Exchange,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,2998.00
Health Net,Exchange,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,2998.00
Health Net,Exchange,93561,CPT4/HCPCS,CARDIAC OUTPUT MEASUREMENT,,Per Visit,2998.00
Health Net,Exchange,93562,CPT4/HCPCS,CARD OUTPUT MEASURE SUBSQ,,Per Visit,2998.00
Health Net,Exchange,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,Per Visit,2998.00
Health Net,Exchange,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,Per Visit,2998.00
Health Net,Exchange,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,Per Visit,2998.00
Health Net,Exchange,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,Per Visit,2998.00
Health Net,Exchange,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,Per Visit,2998.00
Health Net,Exchange,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,Per Visit,2998.00
Health Net,Exchange,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Per Visit,4895.00
Health Net,Exchange,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Per Visit,4895.00
Health Net,Exchange,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Per Visit,4895.00
Health Net,Exchange,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Per Visit,4895.00
Health Net,Exchange,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Per Visit,4895.00
Health Net,Exchange,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Per Visit,4895.00
Health Net,Exchange,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Per Visit,4895.00
Health Net,Exchange,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Per Visit,4895.00
Health Net,Exchange,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Per Visit,4895.00
Health Net,Exchange,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Per Visit,4895.00
Health Net,Exchange,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Exchange,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Exchange,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Exchange,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Exchange,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Per Visit,4895.00
Health Net,Exchange,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Per Visit,4895.00
Health Net,Exchange,93631,CPT4/HCPCS,HEART PACING MAPPING,,Per Visit,4895.00
Health Net,Exchange,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Per Visit,4895.00
Health Net,Exchange,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Exchange,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Exchange,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Per Visit,5575.00
Health Net,Exchange,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Per Visit,5575.00
Health Net,Exchange,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Per Visit,5575.00
Health Net,Exchange,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Per Visit,5575.00
Health Net,Exchange,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Per Visit,5575.00
Health Net,Exchange,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Per Visit,5575.00
Health Net,Exchange,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,95992,CPT4/HCPCS,CANALITH REPOSITIONING PROC,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97533,CPT4/HCPCS,SENSORY INTEGRATION,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8900,CPT4/HCPCS,MRA w/cont, abd,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8901,CPT4/HCPCS,MRA w/o cont, abd,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8902,CPT4/HCPCS,MRA w/o fol w/cont, abd,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8903,CPT4/HCPCS,MRI w/cont, breast, uni,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8904,CPT4/HCPCS,Mri w/o cont, breast, uni,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8905,CPT4/HCPCS,MRI w/o fol w/cont, brst, un,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8906,CPT4/HCPCS,MRI w/cont, breast, bi,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8908,CPT4/HCPCS,MRI w/o fol w/cont, breast,,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8909,CPT4/HCPCS,MRA w/cont, chest,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8910,CPT4/HCPCS,MRA w/o cont, chest,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8911,CPT4/HCPCS,MRA w/o fol w/cont, chest,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8912,CPT4/HCPCS,MRA w/cont, lwr ext,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8913,CPT4/HCPCS,MRA w/o cont, lwr ext,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8914,CPT4/HCPCS,MRA w/o fol w/cont, lwr ext,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8918,CPT4/HCPCS,MRA w/cont, pelvis,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8919,CPT4/HCPCS,MRA w/o cont, pelvis,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8920,CPT4/HCPCS,MRA w/o fol w/cont, pelvis,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8934,CPT4/HCPCS,MRA, w/dye, upper extremity,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8935,CPT4/HCPCS,MRA, w/o dye, upper extr,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C8936,CPT4/HCPCS,MRA, w/o&w/dye, upper extr,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,C9725,CPT4/HCPCS,Place endorectal app,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,G0173,CPT4/HCPCS,Linear acc stereo radsur com,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,G0237,CPT4/HCPCS,Therapeutic procd strg endur,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,G0238,CPT4/HCPCS,Oth resp proc, indiv,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,G0239,CPT4/HCPCS,Oth resp proc, group,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,G0251,CPT4/HCPCS,Linear acc based stero radio,,% of Charges Not to Exceed,5131.00
Health Net,Exchange,G0283,CPT4/HCPCS,Elec stim other than wound,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,G0297,CPT4/HCPCS,Ldct for lung ca screen,,Per Visit,13913.00
Health Net,Exchange,G0300,CPT4/HCPCS,Hhs/hospice of lpn ea 15 min,,Per Visit,13913.00
Health Net,Exchange,G0515,CPT4/HCPCS,Cognitive skills development,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,% of Charges Not to Exceed,4399.00
Health Net,Exchange,,,NICU/Newborn - Level I,,Per Diem,967.00
Health Net,Exchange,,,Medical Surgical,,Per Diem,2965.00
Health Net,Exchange,,,CCU,,Per Diem,4684.00
Health Net,Exchange,,,ICU,,Per Diem,4684.00
Health Net,Exchange,,,NICU/Newborn - Level II,,Per Diem,4684.00
Health Net,Exchange,,,NICU/Newborn - Level III,,Per Diem,4684.00
Health Net,Exchange,,,NICU/Newborn - Level IV,,Per Diem,4684.00
Health Net,HMO,0042T,CPT4/HCPCS,CT PERFUSION W/CONTRAST CBF,,% of Charges Not to Exceed,6766.00
Health Net,HMO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,% of Charges Not to Exceed,7894.00
Health Net,HMO,215,DRG,Other heart assist system implant,,Case Rate,54537.00
Health Net,HMO,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,54537.00
Health Net,HMO,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,54537.00
Health Net,HMO,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,54537.00
Health Net,HMO,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,54537.00
Health Net,HMO,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,54537.00
Health Net,HMO,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,54537.00
Health Net,HMO,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,31908.00
Health Net,HMO,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,31908.00
Health Net,HMO,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,31908.00
Health Net,HMO,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,31908.00
Health Net,HMO,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,31908.00
Health Net,HMO,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,31908.00
Health Net,HMO,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,54537.00
Health Net,HMO,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,54537.00
Health Net,HMO,230,DRG,Other cardiothoracic procedures w/o CC/MCC,,Case Rate,54537.00
Health Net,HMO,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,54537.00
Health Net,HMO,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,54537.00
Health Net,HMO,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,54537.00
Health Net,HMO,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,54537.00
Health Net,HMO,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,54537.00
Health Net,HMO,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,54537.00
Health Net,HMO,237,DRG,Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair,,Case Rate,54537.00
Health Net,HMO,238,DRG,Major cardiovasc procedures w/o MCC,,Case Rate,54537.00
Health Net,HMO,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,13874.00
Health Net,HMO,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,13874.00
Health Net,HMO,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,13874.00
Health Net,HMO,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,13748.00
Health Net,HMO,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,13748.00
Health Net,HMO,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,13748.00
Health Net,HMO,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,13748.00
Health Net,HMO,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,13748.00
Health Net,HMO,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,13748.00
Health Net,HMO,252,DRG,Other vascular procedures w MCC,,Case Rate,54537.00
Health Net,HMO,253,DRG,Other vascular procedures w CC,,Case Rate,54537.00
Health Net,HMO,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,54537.00
Health Net,HMO,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,13874.00
Health Net,HMO,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,13874.00
Health Net,HMO,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,13874.00
Health Net,HMO,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,13874.00
Health Net,HMO,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,13874.00
Health Net,HMO,28,DRG,Spinal procedures w MCC,,100% of Medicare Allowable,50104.38
Health Net,HMO,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,11074.00
Health Net,HMO,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,11074.00
Health Net,HMO,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,11074.00
Health Net,HMO,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,11074.00
Health Net,HMO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,100% of Medicare Allowable,28366.65
Health Net,HMO,29086,CPT4/HCPCS,APPLY FINGER CAST,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29520,CPT4/HCPCS,STRAPPING OF HIP,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29550,CPT4/HCPCS,STRAPPING OF TOES,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,% of Charges Not to Exceed,6766.00
Health Net,HMO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,30,DRG,Spinal procedures w/o CC/MCC,,100% of Medicare Allowable,20292.27
Health Net,HMO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Per Visit,21405.00
Health Net,HMO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Per Visit,21405.00
Health Net,HMO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Per Visit,21405.00
Health Net,HMO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Per Visit,21405.00
Health Net,HMO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Per Visit,21405.00
Health Net,HMO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Per Visit,21405.00
Health Net,HMO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Per Visit,21405.00
Health Net,HMO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Per Visit,21405.00
Health Net,HMO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Per Visit,21405.00
Health Net,HMO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Per Visit,21405.00
Health Net,HMO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Per Visit,21405.00
Health Net,HMO,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,% of Charges Not to Exceed,6766.00
Health Net,HMO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,100% of Medicare Allowable,79147.70
Health Net,HMO,454,DRG,Combined anterior/posterior spinal fusion w CC,,100% of Medicare Allowable,52498.54
Health Net,HMO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,100% of Medicare Allowable,41245.71
Health Net,HMO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,100% of Medicare Allowable,74021.04
Health Net,HMO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,100% of Medicare Allowable,55975.71
Health Net,HMO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,100% of Medicare Allowable,43194.79
Health Net,HMO,459,DRG,Spinal fusion except cervical w MCC,,100% of Medicare Allowable,57954.06
Health Net,HMO,460,DRG,Spinal fusion except cervical w/o MCC,,100% of Medicare Allowable,33856.61
Health Net,HMO,471,DRG,Cervical spinal fusion w MCC,,100% of Medicare Allowable,43189.63
Health Net,HMO,472,DRG,Cervical spinal fusion w CC,,100% of Medicare Allowable,26284.99
Health Net,HMO,473,DRG,Cervical spinal fusion w/o CC/MCC,,100% of Medicare Allowable,21868.58
Health Net,HMO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,% of Charges Not to Exceed,6766.00
Health Net,HMO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,% of Charges Not to Exceed,6766.00
Health Net,HMO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,100% of Medicare Allowable,30857.23
Health Net,HMO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,100% of Medicare Allowable,16853.83
Health Net,HMO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,100% of Medicare Allowable,12202.39
Health Net,HMO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,% of Charges Not to Exceed,7894.00
Health Net,HMO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,% of Charges Not to Exceed,7894.00
Health Net,HMO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,% of Charges Not to Exceed,7894.00
Health Net,HMO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61618,CPT4/HCPCS,REPAIR DURA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61619,CPT4/HCPCS,REPAIR DURA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61783,CPT4/HCPCS,SCAN PROC SPINAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,% of Charges Not to Exceed,5310.00
Health Net,HMO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63295,CPT4/HCPCS,REPAIR LAMINECTOMY DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63620,CPT4/HCPCS,SRS SPINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,% of Charges Not to Exceed,6766.00
Health Net,HMO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,% of Charges Not to Exceed,5310.00
Health Net,HMO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,% of Charges Not to Exceed,5310.00
Health Net,HMO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,% of Charges Not to Exceed,5310.00
Health Net,HMO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64787,CPT4/HCPCS,IMPLANT NERVE END,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64859,CPT4/HCPCS,NERVE SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,% of Charges Not to Exceed,5310.00
Health Net,HMO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65091,CPT4/HCPCS,REVISE EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65101,CPT4/HCPCS,REMOVAL OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65110,CPT4/HCPCS,REMOVAL OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65430,CPT4/HCPCS,CORNEAL SMEAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65600,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65760,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65765,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65850,CPT4/HCPCS,INCISION OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65900,CPT4/HCPCS,REMOVE EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66130,CPT4/HCPCS,REMOVE EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66172,CPT4/HCPCS,INCISION OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66500,CPT4/HCPCS,INCISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66505,CPT4/HCPCS,INCISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66761,CPT4/HCPCS,REVISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66762,CPT4/HCPCS,REVISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,% of Charges Not to Exceed,5310.00
Health Net,HMO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67710,CPT4/HCPCS,INCISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,% of Charges Not to Exceed,5310.00
Health Net,HMO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67820,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67825,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67830,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67835,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67850,CPT4/HCPCS,TREAT EYELID LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67880,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67882,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67950,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67961,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67966,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68330,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68360,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68362,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69090,CPT4/HCPCS,PIERCE EARLOBES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,% of Charges Not to Exceed,5310.00
Health Net,HMO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,% of Charges Not to Exceed,5310.00
Health Net,HMO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69450,CPT4/HCPCS,EARDRUM REVISION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69501,CPT4/HCPCS,MASTOIDECTOMY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69502,CPT4/HCPCS,MASTOIDECTOMY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69540,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69550,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69552,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69554,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69801,CPT4/HCPCS,INCISE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69905,CPT4/HCPCS,REMOVE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,HMO,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,HMO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,71250,CPT4/HCPCS,CT THORAX DX C-,,% of Charges Not to Exceed,6766.00
Health Net,HMO,71260,CPT4/HCPCS,CT THORAX DX C+,,% of Charges Not to Exceed,6766.00
Health Net,HMO,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,% of Charges Not to Exceed,6766.00
Health Net,HMO,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,% of Charges Not to Exceed,6766.00
Health Net,HMO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72193,CPT4/HCPCS,CT PELVIS W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,% of Charges Not to Exceed,6766.00
Health Net,HMO,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,% of Charges Not to Exceed,6766.00
Health Net,HMO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,% of Charges Not to Exceed,6766.00
Health Net,HMO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,76497,CPT4/HCPCS,CT PROCEDURE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,Case Rate,4921.00
Health Net,HMO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,% of Charges Not to Exceed,7894.00
Health Net,HMO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,% of Charges Not to Exceed,6766.00
Health Net,HMO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,% of Charges Not to Exceed,6766.00
Health Net,HMO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,% of Charges Not to Exceed,6766.00
Health Net,HMO,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,% of Charges Not to Exceed,6766.00
Health Net,HMO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,7894.00
Health Net,HMO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,7894.00
Health Net,HMO,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,7894.00
Health Net,HMO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77372,CPT4/HCPCS,SRS LINEAR BASED,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77373,CPT4/HCPCS,SBRT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,% of Charges Not to Exceed,7894.00
Health Net,HMO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,% of Charges Not to Exceed,7894.00
Health Net,HMO,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Per Visit,13685.00
Health Net,HMO,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Per Visit,13685.00
Health Net,HMO,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Per Visit,13685.00
Health Net,HMO,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Per Visit,13685.00
Health Net,HMO,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Per Visit,13685.00
Health Net,HMO,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Per Visit,13685.00
Health Net,HMO,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,13685.00
Health Net,HMO,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,13685.00
Health Net,HMO,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,13685.00
Health Net,HMO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Per Visit,13685.00
Health Net,HMO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Per Visit,13685.00
Health Net,HMO,77790,CPT4/HCPCS,RADIATION HANDLING,,Per Visit,13685.00
Health Net,HMO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,12830.00
Health Net,HMO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,12830.00
Health Net,HMO,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,12830.00
Health Net,HMO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,12830.00
Health Net,HMO,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,% of Charges Not to Exceed,6766.00
Health Net,HMO,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,% of Charges Not to Exceed,6766.00
Health Net,HMO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,12830.00
Health Net,HMO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,12830.00
Health Net,HMO,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,% of Charges Not to Exceed,6766.00
Health Net,HMO,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,% of Charges Not to Exceed,6766.00
Health Net,HMO,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,% of Charges Not to Exceed,7894.00
Health Net,HMO,796,DRG,#N/A,,Case Rate,4921.00
Health Net,HMO,797,DRG,#N/A,,Case Rate,4921.00
Health Net,HMO,798,DRG,#N/A,,Case Rate,4921.00
Health Net,HMO,805,DRG,#N/A,,Case Rate,4921.00
Health Net,HMO,806,DRG,#N/A,,Case Rate,4921.00
Health Net,HMO,807,DRG,#N/A,,Case Rate,4921.00
Health Net,HMO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,% of Charges Not to Exceed,6766.00
Health Net,HMO,90901,CPT4/HCPCS,BIOFEEDBACK TRAIN ANY METH,,% of Charges Not to Exceed,6766.00
Health Net,HMO,90911,CPT4/HCPCS,BIOFEEDBACK PERI/URO/RECTAL,,% of Charges Not to Exceed,6766.00
Health Net,HMO,90912,CPT4/HCPCS,BFB TRAINING 1ST 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,90913,CPT4/HCPCS,BFB TRAINING EA ADDL 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,% of Charges Not to Exceed,6766.00
Health Net,HMO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,% of Charges Not to Exceed,6766.00
Health Net,HMO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,% of Charges Not to Exceed,6766.00
Health Net,HMO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,% of Charges Not to Exceed,6766.00
Health Net,HMO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Per Visit,8970.00
Health Net,HMO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Per Visit,8970.00
Health Net,HMO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Per Visit,8970.00
Health Net,HMO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Per Visit,8970.00
Health Net,HMO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Per Visit,8970.00
Health Net,HMO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Per Visit,8970.00
Health Net,HMO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Per Visit,8970.00
Health Net,HMO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Per Visit,8970.00
Health Net,HMO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Per Visit,8970.00
Health Net,HMO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Per Visit,8970.00
Health Net,HMO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Per Visit,8970.00
Health Net,HMO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Per Visit,8970.00
Health Net,HMO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Per Visit,8970.00
Health Net,HMO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Per Visit,4613.00
Health Net,HMO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Per Visit,4613.00
Health Net,HMO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Per Visit,4613.00
Health Net,HMO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Per Visit,4613.00
Health Net,HMO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Per Visit,4613.00
Health Net,HMO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Per Visit,4613.00
Health Net,HMO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Per Visit,4613.00
Health Net,HMO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Per Visit,4613.00
Health Net,HMO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Per Visit,4613.00
Health Net,HMO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Per Visit,4613.00
Health Net,HMO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Per Visit,4613.00
Health Net,HMO,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Per Visit,4613.00
Health Net,HMO,93463,CPT4/HCPCS,DRUG ADMIN & HEMODYNMIC MEAS,,Per Visit,4613.00
Health Net,HMO,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Per Visit,4613.00
Health Net,HMO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Per Visit,4613.00
Health Net,HMO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Per Visit,4613.00
Health Net,HMO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,HMO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,HMO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,HMO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,HMO,93561,CPT4/HCPCS,CARDIAC OUTPUT MEASUREMENT,,Per Visit,4613.00
Health Net,HMO,93562,CPT4/HCPCS,CARD OUTPUT MEASURE SUBSQ,,Per Visit,4613.00
Health Net,HMO,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,Per Visit,4613.00
Health Net,HMO,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,Per Visit,4613.00
Health Net,HMO,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,Per Visit,4613.00
Health Net,HMO,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,Per Visit,4613.00
Health Net,HMO,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,Per Visit,4613.00
Health Net,HMO,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,Per Visit,4613.00
Health Net,HMO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Per Visit,7530.00
Health Net,HMO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Per Visit,7530.00
Health Net,HMO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Per Visit,7530.00
Health Net,HMO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Per Visit,7530.00
Health Net,HMO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Per Visit,7530.00
Health Net,HMO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Per Visit,7530.00
Health Net,HMO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Per Visit,7530.00
Health Net,HMO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Per Visit,7530.00
Health Net,HMO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Per Visit,7530.00
Health Net,HMO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Per Visit,7530.00
Health Net,HMO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,HMO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,HMO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,HMO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,HMO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Per Visit,7530.00
Health Net,HMO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Per Visit,7530.00
Health Net,HMO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Per Visit,7530.00
Health Net,HMO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Per Visit,7530.00
Health Net,HMO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,HMO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,HMO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Per Visit,8885.00
Health Net,HMO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Per Visit,8885.00
Health Net,HMO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Per Visit,8885.00
Health Net,HMO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Per Visit,8885.00
Health Net,HMO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Per Visit,8885.00
Health Net,HMO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Per Visit,8885.00
Health Net,HMO,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,% of Charges Not to Exceed,6766.00
Health Net,HMO,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,% of Charges Not to Exceed,6766.00
Health Net,HMO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,% of Charges Not to Exceed,6766.00
Health Net,HMO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,% of Charges Not to Exceed,6766.00
Health Net,HMO,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,% of Charges Not to Exceed,6766.00
Health Net,HMO,95992,CPT4/HCPCS,CANALITH REPOSITIONING PROC,,% of Charges Not to Exceed,6766.00
Health Net,HMO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,% of Charges Not to Exceed,6766.00
Health Net,HMO,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8900,CPT4/HCPCS,MRA w/cont, abd,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8901,CPT4/HCPCS,MRA w/o cont, abd,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8902,CPT4/HCPCS,MRA w/o fol w/cont, abd,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8903,CPT4/HCPCS,MRI w/cont, breast, uni,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8904,CPT4/HCPCS,Mri w/o cont, breast, uni,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8905,CPT4/HCPCS,MRI w/o fol w/cont, brst, un,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8906,CPT4/HCPCS,MRI w/cont, breast, bi,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8908,CPT4/HCPCS,MRI w/o fol w/cont, breast,,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8909,CPT4/HCPCS,MRA w/cont, chest,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8910,CPT4/HCPCS,MRA w/o cont, chest,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8911,CPT4/HCPCS,MRA w/o fol w/cont, chest,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8912,CPT4/HCPCS,MRA w/cont, lwr ext,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8913,CPT4/HCPCS,MRA w/o cont, lwr ext,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8914,CPT4/HCPCS,MRA w/o fol w/cont, lwr ext,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8918,CPT4/HCPCS,MRA w/cont, pelvis,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8919,CPT4/HCPCS,MRA w/o cont, pelvis,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8920,CPT4/HCPCS,MRA w/o fol w/cont, pelvis,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8934,CPT4/HCPCS,MRA, w/dye, upper extremity,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8935,CPT4/HCPCS,MRA, w/o dye, upper extr,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C8936,CPT4/HCPCS,MRA, w/o&w/dye, upper extr,,% of Charges Not to Exceed,6766.00
Health Net,HMO,C9725,CPT4/HCPCS,Place endorectal app,,% of Charges Not to Exceed,7894.00
Health Net,HMO,G0173,CPT4/HCPCS,Linear acc stereo radsur com,,% of Charges Not to Exceed,7894.00
Health Net,HMO,G0237,CPT4/HCPCS,Therapeutic procd strg endur,,% of Charges Not to Exceed,6766.00
Health Net,HMO,G0238,CPT4/HCPCS,Oth resp proc, indiv,,% of Charges Not to Exceed,6766.00
Health Net,HMO,G0239,CPT4/HCPCS,Oth resp proc, group,,% of Charges Not to Exceed,6766.00
Health Net,HMO,G0251,CPT4/HCPCS,Linear acc based stero radio,,% of Charges Not to Exceed,7894.00
Health Net,HMO,G0283,CPT4/HCPCS,Elec stim other than wound,,% of Charges Not to Exceed,6766.00
Health Net,HMO,G0297,CPT4/HCPCS,Ldct for lung ca screen,,Per Visit,21405.00
Health Net,HMO,G0300,CPT4/HCPCS,Hhs/hospice of lpn ea 15 min,,Per Visit,21405.00
Health Net,HMO,G0515,CPT4/HCPCS,Cognitive skills development,,% of Charges Not to Exceed,6766.00
Health Net,HMO,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,% of Charges Not to Exceed,6766.00
Health Net,HMO,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,% of Charges Not to Exceed,6766.00
Health Net,HMO,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,% of Charges Not to Exceed,6766.00
Health Net,HMO,,,NICU/Newborn - Level I,,Per Diem,1138.00
Health Net,HMO,,,Medical Surgical,,Per Diem,3489.00
Health Net,HMO,,,CCU,,Per Diem,5510.00
Health Net,HMO,,,ICU,,Per Diem,5510.00
Health Net,HMO,,,NICU/Newborn - Level II,,Per Diem,5510.00
Health Net,HMO,,,NICU/Newborn - Level III,,Per Diem,5510.00
Health Net,PPO,0042T,CPT4/HCPCS,CT PERFUSION W/CONTRAST CBF,,% of Charges Not to Exceed,6766.00
Health Net,PPO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,% of Charges Not to Exceed,7894.00
Health Net,PPO,215,DRG,Other heart assist system implant,,Case Rate,54537.00
Health Net,PPO,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,54537.00
Health Net,PPO,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,54537.00
Health Net,PPO,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,54537.00
Health Net,PPO,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,54537.00
Health Net,PPO,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,54537.00
Health Net,PPO,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,54537.00
Health Net,PPO,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,31908.00
Health Net,PPO,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,31908.00
Health Net,PPO,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,31908.00
Health Net,PPO,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,31908.00
Health Net,PPO,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,31908.00
Health Net,PPO,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,31908.00
Health Net,PPO,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,54537.00
Health Net,PPO,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,54537.00
Health Net,PPO,230,DRG,Other cardiothoracic procedures w/o CC/MCC,,Case Rate,54537.00
Health Net,PPO,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,54537.00
Health Net,PPO,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,54537.00
Health Net,PPO,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,54537.00
Health Net,PPO,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,54537.00
Health Net,PPO,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,54537.00
Health Net,PPO,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,54537.00
Health Net,PPO,237,DRG,Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair,,Case Rate,54537.00
Health Net,PPO,238,DRG,Major cardiovasc procedures w/o MCC,,Case Rate,54537.00
Health Net,PPO,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,13874.00
Health Net,PPO,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,13874.00
Health Net,PPO,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,13874.00
Health Net,PPO,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,13748.00
Health Net,PPO,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,13748.00
Health Net,PPO,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,13748.00
Health Net,PPO,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,13748.00
Health Net,PPO,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,13748.00
Health Net,PPO,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,13748.00
Health Net,PPO,252,DRG,Other vascular procedures w MCC,,Case Rate,54537.00
Health Net,PPO,253,DRG,Other vascular procedures w CC,,Case Rate,54537.00
Health Net,PPO,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,54537.00
Health Net,PPO,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,13874.00
Health Net,PPO,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,13874.00
Health Net,PPO,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,13874.00
Health Net,PPO,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,13874.00
Health Net,PPO,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,13874.00
Health Net,PPO,28,DRG,Spinal procedures w MCC,,100% of Medicare Allowable,50104.38
Health Net,PPO,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,11074.00
Health Net,PPO,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,11074.00
Health Net,PPO,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,11074.00
Health Net,PPO,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,11074.00
Health Net,PPO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,100% of Medicare Allowable,28366.65
Health Net,PPO,29086,CPT4/HCPCS,APPLY FINGER CAST,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29520,CPT4/HCPCS,STRAPPING OF HIP,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29550,CPT4/HCPCS,STRAPPING OF TOES,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,% of Charges Not to Exceed,6766.00
Health Net,PPO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,30,DRG,Spinal procedures w/o CC/MCC,,100% of Medicare Allowable,20292.27
Health Net,PPO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Per Visit,21405.00
Health Net,PPO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Per Visit,21405.00
Health Net,PPO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Per Visit,21405.00
Health Net,PPO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Per Visit,21405.00
Health Net,PPO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Per Visit,21405.00
Health Net,PPO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Per Visit,21405.00
Health Net,PPO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Per Visit,21405.00
Health Net,PPO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Per Visit,21405.00
Health Net,PPO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Per Visit,21405.00
Health Net,PPO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Per Visit,21405.00
Health Net,PPO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Per Visit,21405.00
Health Net,PPO,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,% of Charges Not to Exceed,6766.00
Health Net,PPO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,100% of Medicare Allowable,79147.70
Health Net,PPO,454,DRG,Combined anterior/posterior spinal fusion w CC,,100% of Medicare Allowable,52498.54
Health Net,PPO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,100% of Medicare Allowable,41245.71
Health Net,PPO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,100% of Medicare Allowable,74021.04
Health Net,PPO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,100% of Medicare Allowable,55975.71
Health Net,PPO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,100% of Medicare Allowable,43194.79
Health Net,PPO,459,DRG,Spinal fusion except cervical w MCC,,100% of Medicare Allowable,57954.06
Health Net,PPO,460,DRG,Spinal fusion except cervical w/o MCC,,100% of Medicare Allowable,33856.61
Health Net,PPO,471,DRG,Cervical spinal fusion w MCC,,100% of Medicare Allowable,43189.63
Health Net,PPO,472,DRG,Cervical spinal fusion w CC,,100% of Medicare Allowable,26284.99
Health Net,PPO,473,DRG,Cervical spinal fusion w/o CC/MCC,,100% of Medicare Allowable,21868.58
Health Net,PPO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,% of Charges Not to Exceed,6766.00
Health Net,PPO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,% of Charges Not to Exceed,6766.00
Health Net,PPO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,100% of Medicare Allowable,30857.23
Health Net,PPO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,100% of Medicare Allowable,16853.83
Health Net,PPO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,100% of Medicare Allowable,12202.39
Health Net,PPO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,% of Charges Not to Exceed,7894.00
Health Net,PPO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,% of Charges Not to Exceed,7894.00
Health Net,PPO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,% of Charges Not to Exceed,7894.00
Health Net,PPO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61618,CPT4/HCPCS,REPAIR DURA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61619,CPT4/HCPCS,REPAIR DURA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61783,CPT4/HCPCS,SCAN PROC SPINAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,% of Charges Not to Exceed,5310.00
Health Net,PPO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63295,CPT4/HCPCS,REPAIR LAMINECTOMY DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63620,CPT4/HCPCS,SRS SPINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,% of Charges Not to Exceed,6766.00
Health Net,PPO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,% of Charges Not to Exceed,5310.00
Health Net,PPO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,% of Charges Not to Exceed,5310.00
Health Net,PPO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,% of Charges Not to Exceed,5310.00
Health Net,PPO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64787,CPT4/HCPCS,IMPLANT NERVE END,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64859,CPT4/HCPCS,NERVE SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,% of Charges Not to Exceed,5310.00
Health Net,PPO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65091,CPT4/HCPCS,REVISE EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65101,CPT4/HCPCS,REMOVAL OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65110,CPT4/HCPCS,REMOVAL OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65430,CPT4/HCPCS,CORNEAL SMEAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65600,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65760,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65765,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65850,CPT4/HCPCS,INCISION OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65900,CPT4/HCPCS,REMOVE EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66130,CPT4/HCPCS,REMOVE EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66172,CPT4/HCPCS,INCISION OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66500,CPT4/HCPCS,INCISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66505,CPT4/HCPCS,INCISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66761,CPT4/HCPCS,REVISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66762,CPT4/HCPCS,REVISION OF IRIS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,% of Charges Not to Exceed,5310.00
Health Net,PPO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67710,CPT4/HCPCS,INCISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,% of Charges Not to Exceed,5310.00
Health Net,PPO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67820,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67825,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67830,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67835,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67850,CPT4/HCPCS,TREAT EYELID LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67880,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67882,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67950,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67961,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67966,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68330,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68360,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68362,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69090,CPT4/HCPCS,PIERCE EARLOBES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,% of Charges Not to Exceed,5310.00
Health Net,PPO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,% of Charges Not to Exceed,5310.00
Health Net,PPO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69450,CPT4/HCPCS,EARDRUM REVISION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69501,CPT4/HCPCS,MASTOIDECTOMY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69502,CPT4/HCPCS,MASTOIDECTOMY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69540,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69550,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69552,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69554,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69801,CPT4/HCPCS,INCISE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69905,CPT4/HCPCS,REMOVE INNER EAR,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,% of Charges Not to Exceed,5310.00
Health Net,PPO,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,% of Charges Not to Exceed,5310.00
Health Net,PPO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,71250,CPT4/HCPCS,CT THORAX DX C-,,% of Charges Not to Exceed,6766.00
Health Net,PPO,71260,CPT4/HCPCS,CT THORAX DX C+,,% of Charges Not to Exceed,6766.00
Health Net,PPO,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,% of Charges Not to Exceed,6766.00
Health Net,PPO,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,% of Charges Not to Exceed,6766.00
Health Net,PPO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72193,CPT4/HCPCS,CT PELVIS W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,% of Charges Not to Exceed,6766.00
Health Net,PPO,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,% of Charges Not to Exceed,6766.00
Health Net,PPO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,% of Charges Not to Exceed,6766.00
Health Net,PPO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,76497,CPT4/HCPCS,CT PROCEDURE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,Case Rate,4921.00
Health Net,PPO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,% of Charges Not to Exceed,7894.00
Health Net,PPO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,% of Charges Not to Exceed,6766.00
Health Net,PPO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,% of Charges Not to Exceed,6766.00
Health Net,PPO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,% of Charges Not to Exceed,6766.00
Health Net,PPO,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,% of Charges Not to Exceed,6766.00
Health Net,PPO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,7894.00
Health Net,PPO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,7894.00
Health Net,PPO,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,7894.00
Health Net,PPO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77372,CPT4/HCPCS,SRS LINEAR BASED,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77373,CPT4/HCPCS,SBRT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,% of Charges Not to Exceed,7894.00
Health Net,PPO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,% of Charges Not to Exceed,7894.00
Health Net,PPO,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Per Visit,13685.00
Health Net,PPO,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Per Visit,13685.00
Health Net,PPO,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Per Visit,13685.00
Health Net,PPO,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Per Visit,13685.00
Health Net,PPO,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Per Visit,13685.00
Health Net,PPO,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Per Visit,13685.00
Health Net,PPO,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,13685.00
Health Net,PPO,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,13685.00
Health Net,PPO,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,13685.00
Health Net,PPO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Per Visit,13685.00
Health Net,PPO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Per Visit,13685.00
Health Net,PPO,77790,CPT4/HCPCS,RADIATION HANDLING,,Per Visit,13685.00
Health Net,PPO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,12830.00
Health Net,PPO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,12830.00
Health Net,PPO,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,12830.00
Health Net,PPO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,12830.00
Health Net,PPO,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,% of Charges Not to Exceed,6766.00
Health Net,PPO,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,% of Charges Not to Exceed,6766.00
Health Net,PPO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,12830.00
Health Net,PPO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,12830.00
Health Net,PPO,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,% of Charges Not to Exceed,6766.00
Health Net,PPO,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,% of Charges Not to Exceed,6766.00
Health Net,PPO,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,% of Charges Not to Exceed,7894.00
Health Net,PPO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,4921.00
Health Net,PPO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,4921.00
Health Net,PPO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,4921.00
Health Net,PPO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,4921.00
Health Net,PPO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,4921.00
Health Net,PPO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,4921.00
Health Net,PPO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,% of Charges Not to Exceed,6766.00
Health Net,PPO,90901,CPT4/HCPCS,BIOFEEDBACK TRAIN ANY METH,,% of Charges Not to Exceed,6766.00
Health Net,PPO,90911,CPT4/HCPCS,BIOFEEDBACK PERI/URO/RECTAL,,% of Charges Not to Exceed,6766.00
Health Net,PPO,90912,CPT4/HCPCS,BFB TRAINING 1ST 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,90913,CPT4/HCPCS,BFB TRAINING EA ADDL 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,% of Charges Not to Exceed,6766.00
Health Net,PPO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,% of Charges Not to Exceed,6766.00
Health Net,PPO,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,% of Charges Not to Exceed,6766.00
Health Net,PPO,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,% of Charges Not to Exceed,6766.00
Health Net,PPO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Per Visit,8970.00
Health Net,PPO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Per Visit,8970.00
Health Net,PPO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Per Visit,8970.00
Health Net,PPO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Per Visit,8970.00
Health Net,PPO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Per Visit,8970.00
Health Net,PPO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Per Visit,8970.00
Health Net,PPO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Per Visit,8970.00
Health Net,PPO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Per Visit,8970.00
Health Net,PPO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Per Visit,8970.00
Health Net,PPO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Per Visit,8970.00
Health Net,PPO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Per Visit,8970.00
Health Net,PPO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Per Visit,8970.00
Health Net,PPO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Per Visit,8970.00
Health Net,PPO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Per Visit,4613.00
Health Net,PPO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Per Visit,4613.00
Health Net,PPO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Per Visit,4613.00
Health Net,PPO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Per Visit,4613.00
Health Net,PPO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Per Visit,4613.00
Health Net,PPO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Per Visit,4613.00
Health Net,PPO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Per Visit,4613.00
Health Net,PPO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Per Visit,4613.00
Health Net,PPO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Per Visit,4613.00
Health Net,PPO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Per Visit,4613.00
Health Net,PPO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Per Visit,4613.00
Health Net,PPO,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Per Visit,4613.00
Health Net,PPO,93463,CPT4/HCPCS,DRUG ADMIN & HEMODYNMIC MEAS,,Per Visit,4613.00
Health Net,PPO,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Per Visit,4613.00
Health Net,PPO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Per Visit,4613.00
Health Net,PPO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Per Visit,4613.00
Health Net,PPO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,PPO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,PPO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,PPO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,4613.00
Health Net,PPO,93561,CPT4/HCPCS,CARDIAC OUTPUT MEASUREMENT,,Per Visit,4613.00
Health Net,PPO,93562,CPT4/HCPCS,CARD OUTPUT MEASURE SUBSQ,,Per Visit,4613.00
Health Net,PPO,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,Per Visit,4613.00
Health Net,PPO,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,Per Visit,4613.00
Health Net,PPO,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,Per Visit,4613.00
Health Net,PPO,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,Per Visit,4613.00
Health Net,PPO,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,Per Visit,4613.00
Health Net,PPO,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,Per Visit,4613.00
Health Net,PPO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Per Visit,7530.00
Health Net,PPO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Per Visit,7530.00
Health Net,PPO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Per Visit,7530.00
Health Net,PPO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Per Visit,7530.00
Health Net,PPO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Per Visit,7530.00
Health Net,PPO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Per Visit,7530.00
Health Net,PPO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Per Visit,7530.00
Health Net,PPO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Per Visit,7530.00
Health Net,PPO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Per Visit,7530.00
Health Net,PPO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Per Visit,7530.00
Health Net,PPO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,PPO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,PPO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,PPO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,PPO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Per Visit,7530.00
Health Net,PPO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Per Visit,7530.00
Health Net,PPO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Per Visit,7530.00
Health Net,PPO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Per Visit,7530.00
Health Net,PPO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,PPO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,7530.00
Health Net,PPO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Per Visit,8885.00
Health Net,PPO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Per Visit,8885.00
Health Net,PPO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Per Visit,8885.00
Health Net,PPO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Per Visit,8885.00
Health Net,PPO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Per Visit,8885.00
Health Net,PPO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Per Visit,8885.00
Health Net,PPO,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,% of Charges Not to Exceed,6766.00
Health Net,PPO,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,% of Charges Not to Exceed,6766.00
Health Net,PPO,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,% of Charges Not to Exceed,6766.00
Health Net,PPO,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,% of Charges Not to Exceed,6766.00
Health Net,PPO,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,% of Charges Not to Exceed,6766.00
Health Net,PPO,95992,CPT4/HCPCS,CANALITH REPOSITIONING PROC,,% of Charges Not to Exceed,6766.00
Health Net,PPO,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,% of Charges Not to Exceed,6766.00
Health Net,PPO,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8900,CPT4/HCPCS,MRA w/cont, abd,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8901,CPT4/HCPCS,MRA w/o cont, abd,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8902,CPT4/HCPCS,MRA w/o fol w/cont, abd,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8903,CPT4/HCPCS,MRI w/cont, breast, uni,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8904,CPT4/HCPCS,Mri w/o cont, breast, uni,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8905,CPT4/HCPCS,MRI w/o fol w/cont, brst, un,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8906,CPT4/HCPCS,MRI w/cont, breast, bi,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8908,CPT4/HCPCS,MRI w/o fol w/cont, breast,,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8909,CPT4/HCPCS,MRA w/cont, chest,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8910,CPT4/HCPCS,MRA w/o cont, chest,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8911,CPT4/HCPCS,MRA w/o fol w/cont, chest,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8912,CPT4/HCPCS,MRA w/cont, lwr ext,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8913,CPT4/HCPCS,MRA w/o cont, lwr ext,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8914,CPT4/HCPCS,MRA w/o fol w/cont, lwr ext,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8918,CPT4/HCPCS,MRA w/cont, pelvis,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8919,CPT4/HCPCS,MRA w/o cont, pelvis,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8920,CPT4/HCPCS,MRA w/o fol w/cont, pelvis,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8934,CPT4/HCPCS,MRA, w/dye, upper extremity,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8935,CPT4/HCPCS,MRA, w/o dye, upper extr,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C8936,CPT4/HCPCS,MRA, w/o&w/dye, upper extr,,% of Charges Not to Exceed,6766.00
Health Net,PPO,C9725,CPT4/HCPCS,Place endorectal app,,% of Charges Not to Exceed,7894.00
Health Net,PPO,G0173,CPT4/HCPCS,Linear acc stereo radsur com,,% of Charges Not to Exceed,7894.00
Health Net,PPO,G0237,CPT4/HCPCS,Therapeutic procd strg endur,,% of Charges Not to Exceed,6766.00
Health Net,PPO,G0238,CPT4/HCPCS,Oth resp proc, indiv,,% of Charges Not to Exceed,6766.00
Health Net,PPO,G0239,CPT4/HCPCS,Oth resp proc, group,,% of Charges Not to Exceed,6766.00
Health Net,PPO,G0251,CPT4/HCPCS,Linear acc based stero radio,,% of Charges Not to Exceed,7894.00
Health Net,PPO,G0283,CPT4/HCPCS,Elec stim other than wound,,% of Charges Not to Exceed,6766.00
Health Net,PPO,G0297,CPT4/HCPCS,Ldct for lung ca screen,,Per Visit,21405.00
Health Net,PPO,G0300,CPT4/HCPCS,Hhs/hospice of lpn ea 15 min,,Per Visit,21405.00
Health Net,PPO,G0515,CPT4/HCPCS,Cognitive skills development,,% of Charges Not to Exceed,6766.00
Health Net,PPO,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,% of Charges Not to Exceed,6766.00
Health Net,PPO,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,% of Charges Not to Exceed,6766.00
Health Net,PPO,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,% of Charges Not to Exceed,6766.00
Health Net,PPO,,,NICU/Newborn - Level I,,Per Diem,1138.00
Health Net,PPO,,,Medical Surgical,,Per Diem,3489.00
Health Net,PPO,,,CCU,,Per Diem,5510.00
Health Net,PPO,,,ICU,,Per Diem,5510.00
Health Net,PPO,,,NICU/Newborn - Level II,,Per Diem,5510.00
Health Net,PPO,,,NICU/Newborn - Level III,,Per Diem,5510.00
Health Net,Salud,0042T,CPT4/HCPCS,CT PERFUSION W/CONTRAST CBF,,% of Charges Not to Exceed,4399.00
Health Net,Salud,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,% of Charges Not to Exceed,5131.00
Health Net,Salud,215,DRG,Other heart assist system implant,,Case Rate,46358.00
Health Net,Salud,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,46358.00
Health Net,Salud,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,46358.00
Health Net,Salud,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,46358.00
Health Net,Salud,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,46358.00
Health Net,Salud,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,46358.00
Health Net,Salud,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,46358.00
Health Net,Salud,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,27124.00
Health Net,Salud,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,27124.00
Health Net,Salud,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,27124.00
Health Net,Salud,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,27124.00
Health Net,Salud,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,27124.00
Health Net,Salud,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,27124.00
Health Net,Salud,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,46358.00
Health Net,Salud,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,46358.00
Health Net,Salud,230,DRG,Other cardiothoracic procedures w/o CC/MCC,,Case Rate,46358.00
Health Net,Salud,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,46358.00
Health Net,Salud,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,46358.00
Health Net,Salud,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,46358.00
Health Net,Salud,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,46358.00
Health Net,Salud,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,46358.00
Health Net,Salud,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,46358.00
Health Net,Salud,237,DRG,Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair,,Case Rate,46358.00
Health Net,Salud,238,DRG,Major cardiovasc procedures w/o MCC,,Case Rate,46358.00
Health Net,Salud,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,11793.00
Health Net,Salud,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,11793.00
Health Net,Salud,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,11793.00
Health Net,Salud,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,11686.00
Health Net,Salud,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,11686.00
Health Net,Salud,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,11686.00
Health Net,Salud,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,11686.00
Health Net,Salud,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,11686.00
Health Net,Salud,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,11686.00
Health Net,Salud,252,DRG,Other vascular procedures w MCC,,Case Rate,46358.00
Health Net,Salud,253,DRG,Other vascular procedures w CC,,Case Rate,46358.00
Health Net,Salud,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,46358.00
Health Net,Salud,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,11793.00
Health Net,Salud,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,11793.00
Health Net,Salud,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,11793.00
Health Net,Salud,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,11793.00
Health Net,Salud,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,11793.00
Health Net,Salud,28,DRG,Spinal procedures w MCC,,100% of Medicare Allowable,50104.38
Health Net,Salud,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,9413.00
Health Net,Salud,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,9413.00
Health Net,Salud,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,9413.00
Health Net,Salud,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,9413.00
Health Net,Salud,29,DRG,Spinal procedures w CC or spinal neurostimulators,,100% of Medicare Allowable,28366.65
Health Net,Salud,29086,CPT4/HCPCS,APPLY FINGER CAST,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29520,CPT4/HCPCS,STRAPPING OF HIP,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29530,CPT4/HCPCS,STRAPPING OF KNEE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29550,CPT4/HCPCS,STRAPPING OF TOES,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,% of Charges Not to Exceed,4399.00
Health Net,Salud,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,30,DRG,Spinal procedures w/o CC/MCC,,100% of Medicare Allowable,20292.27
Health Net,Salud,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Per Visit,13913.00
Health Net,Salud,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Per Visit,13913.00
Health Net,Salud,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Per Visit,13913.00
Health Net,Salud,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Per Visit,13913.00
Health Net,Salud,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Per Visit,13913.00
Health Net,Salud,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Per Visit,13913.00
Health Net,Salud,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Per Visit,13913.00
Health Net,Salud,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Per Visit,13913.00
Health Net,Salud,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Per Visit,13913.00
Health Net,Salud,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Per Visit,13913.00
Health Net,Salud,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Per Visit,13913.00
Health Net,Salud,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,% of Charges Not to Exceed,4399.00
Health Net,Salud,453,DRG,Combined anterior/posterior spinal fusion w MCC,,100% of Medicare Allowable,79147.70
Health Net,Salud,454,DRG,Combined anterior/posterior spinal fusion w CC,,100% of Medicare Allowable,52498.54
Health Net,Salud,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,100% of Medicare Allowable,41245.71
Health Net,Salud,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,100% of Medicare Allowable,74021.04
Health Net,Salud,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,100% of Medicare Allowable,55975.71
Health Net,Salud,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,100% of Medicare Allowable,43194.79
Health Net,Salud,459,DRG,Spinal fusion except cervical w MCC,,100% of Medicare Allowable,57954.06
Health Net,Salud,460,DRG,Spinal fusion except cervical w/o MCC,,100% of Medicare Allowable,33856.61
Health Net,Salud,471,DRG,Cervical spinal fusion w MCC,,100% of Medicare Allowable,43189.63
Health Net,Salud,472,DRG,Cervical spinal fusion w CC,,100% of Medicare Allowable,26284.99
Health Net,Salud,473,DRG,Cervical spinal fusion w/o CC/MCC,,100% of Medicare Allowable,21868.58
Health Net,Salud,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,% of Charges Not to Exceed,4399.00
Health Net,Salud,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,% of Charges Not to Exceed,4399.00
Health Net,Salud,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,100% of Medicare Allowable,30857.23
Health Net,Salud,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,100% of Medicare Allowable,16853.83
Health Net,Salud,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,100% of Medicare Allowable,12202.39
Health Net,Salud,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,% of Charges Not to Exceed,5131.00
Health Net,Salud,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,% of Charges Not to Exceed,5131.00
Health Net,Salud,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,% of Charges Not to Exceed,5131.00
Health Net,Salud,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61618,CPT4/HCPCS,REPAIR DURA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61619,CPT4/HCPCS,REPAIR DURA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61783,CPT4/HCPCS,SCAN PROC SPINAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,% of Charges Not to Exceed,3452.00
Health Net,Salud,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63295,CPT4/HCPCS,REPAIR LAMINECTOMY DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63620,CPT4/HCPCS,SRS SPINAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,% of Charges Not to Exceed,4399.00
Health Net,Salud,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,% of Charges Not to Exceed,3452.00
Health Net,Salud,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,% of Charges Not to Exceed,3452.00
Health Net,Salud,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,% of Charges Not to Exceed,3452.00
Health Net,Salud,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64784,CPT4/HCPCS,REMOVE NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64787,CPT4/HCPCS,IMPLANT NERVE END,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64795,CPT4/HCPCS,BIOPSY OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64859,CPT4/HCPCS,NERVE SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,% of Charges Not to Exceed,3452.00
Health Net,Salud,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65091,CPT4/HCPCS,REVISE EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65101,CPT4/HCPCS,REMOVAL OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65110,CPT4/HCPCS,REMOVAL OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65430,CPT4/HCPCS,CORNEAL SMEAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65600,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65760,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65765,CPT4/HCPCS,REVISION OF CORNEA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65800,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65810,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65815,CPT4/HCPCS,DRAINAGE OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65850,CPT4/HCPCS,INCISION OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65900,CPT4/HCPCS,REMOVE EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66130,CPT4/HCPCS,REMOVE EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66172,CPT4/HCPCS,INCISION OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66500,CPT4/HCPCS,INCISION OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66505,CPT4/HCPCS,INCISION OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66605,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66625,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66630,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66635,CPT4/HCPCS,REMOVAL OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66761,CPT4/HCPCS,REVISION OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66762,CPT4/HCPCS,REVISION OF IRIS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66920,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66930,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66940,CPT4/HCPCS,EXTRACTION OF LENS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67025,CPT4/HCPCS,REPLACE EYE FLUID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67028,CPT4/HCPCS,INJECTION EYE DRUG,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67141,CPT4/HCPCS,TREATMENT OF RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67145,CPT4/HCPCS,TREATMENT OF RETINA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67250,CPT4/HCPCS,REINFORCE EYE WALL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,% of Charges Not to Exceed,3452.00
Health Net,Salud,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67710,CPT4/HCPCS,INCISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67800,CPT4/HCPCS,REMOVE EYELID LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,% of Charges Not to Exceed,3452.00
Health Net,Salud,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67820,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67825,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67830,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67835,CPT4/HCPCS,REVISE EYELASHES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67840,CPT4/HCPCS,REMOVE EYELID LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67850,CPT4/HCPCS,TREAT EYELID LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67880,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67882,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67950,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67961,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67966,CPT4/HCPCS,REVISION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68330,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68360,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68362,CPT4/HCPCS,REVISE EYELID LINING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69090,CPT4/HCPCS,PIERCE EARLOBES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,% of Charges Not to Exceed,3452.00
Health Net,Salud,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,% of Charges Not to Exceed,3452.00
Health Net,Salud,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69420,CPT4/HCPCS,INCISION OF EARDRUM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69421,CPT4/HCPCS,INCISION OF EARDRUM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69450,CPT4/HCPCS,EARDRUM REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69501,CPT4/HCPCS,MASTOIDECTOMY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69502,CPT4/HCPCS,MASTOIDECTOMY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69540,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69550,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69552,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69554,CPT4/HCPCS,REMOVE EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69801,CPT4/HCPCS,INCISE INNER EAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69805,CPT4/HCPCS,EXPLORE INNER EAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69806,CPT4/HCPCS,EXPLORE INNER EAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69905,CPT4/HCPCS,REMOVE INNER EAR,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,% of Charges Not to Exceed,3452.00
Health Net,Salud,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,% of Charges Not to Exceed,3452.00
Health Net,Salud,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,71250,CPT4/HCPCS,CT THORAX DX C-,,% of Charges Not to Exceed,4399.00
Health Net,Salud,71260,CPT4/HCPCS,CT THORAX DX C+,,% of Charges Not to Exceed,4399.00
Health Net,Salud,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,% of Charges Not to Exceed,4399.00
Health Net,Salud,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,% of Charges Not to Exceed,4399.00
Health Net,Salud,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72193,CPT4/HCPCS,CT PELVIS W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,% of Charges Not to Exceed,4399.00
Health Net,Salud,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,% of Charges Not to Exceed,4399.00
Health Net,Salud,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,% of Charges Not to Exceed,4399.00
Health Net,Salud,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,76390,CPT4/HCPCS,MR SPECTROSCOPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,76497,CPT4/HCPCS,CT PROCEDURE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,Case Rate,4183.00
Health Net,Salud,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,% of Charges Not to Exceed,5131.00
Health Net,Salud,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,% of Charges Not to Exceed,4399.00
Health Net,Salud,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,% of Charges Not to Exceed,4399.00
Health Net,Salud,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,% of Charges Not to Exceed,4399.00
Health Net,Salud,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,% of Charges Not to Exceed,4399.00
Health Net,Salud,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,5131.00
Health Net,Salud,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,5131.00
Health Net,Salud,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,% of Charges Not to Exceed,5131.00
Health Net,Salud,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77372,CPT4/HCPCS,SRS LINEAR BASED,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77373,CPT4/HCPCS,SBRT DELIVERY,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,% of Charges Not to Exceed,5131.00
Health Net,Salud,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,% of Charges Not to Exceed,5131.00
Health Net,Salud,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Per Visit,8895.00
Health Net,Salud,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Per Visit,8895.00
Health Net,Salud,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Per Visit,8895.00
Health Net,Salud,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Per Visit,8895.00
Health Net,Salud,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Per Visit,8895.00
Health Net,Salud,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Per Visit,8895.00
Health Net,Salud,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,8895.00
Health Net,Salud,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,8895.00
Health Net,Salud,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Per Visit,8895.00
Health Net,Salud,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Per Visit,8895.00
Health Net,Salud,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Per Visit,8895.00
Health Net,Salud,77790,CPT4/HCPCS,RADIATION HANDLING,,Per Visit,8895.00
Health Net,Salud,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,10906.00
Health Net,Salud,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,10906.00
Health Net,Salud,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,10906.00
Health Net,Salud,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,10906.00
Health Net,Salud,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,% of Charges Not to Exceed,4399.00
Health Net,Salud,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,% of Charges Not to Exceed,4399.00
Health Net,Salud,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,10906.00
Health Net,Salud,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,10906.00
Health Net,Salud,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,% of Charges Not to Exceed,4399.00
Health Net,Salud,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,% of Charges Not to Exceed,4399.00
Health Net,Salud,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,% of Charges Not to Exceed,5131.00
Health Net,Salud,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,4183.00
Health Net,Salud,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,4183.00
Health Net,Salud,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,4183.00
Health Net,Salud,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,4183.00
Health Net,Salud,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,4183.00
Health Net,Salud,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,4183.00
Health Net,Salud,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,% of Charges Not to Exceed,4399.00
Health Net,Salud,90901,CPT4/HCPCS,BIOFEEDBACK TRAIN ANY METH,,% of Charges Not to Exceed,4399.00
Health Net,Salud,90911,CPT4/HCPCS,BIOFEEDBACK PERI/URO/RECTAL,,% of Charges Not to Exceed,4399.00
Health Net,Salud,90912,CPT4/HCPCS,BFB TRAINING 1ST 15 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,90913,CPT4/HCPCS,BFB TRAINING EA ADDL 15 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,% of Charges Not to Exceed,4399.00
Health Net,Salud,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,% of Charges Not to Exceed,4399.00
Health Net,Salud,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,% of Charges Not to Exceed,4399.00
Health Net,Salud,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,% of Charges Not to Exceed,4399.00
Health Net,Salud,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Per Visit,5831.00
Health Net,Salud,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Per Visit,5831.00
Health Net,Salud,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Per Visit,5831.00
Health Net,Salud,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Per Visit,5831.00
Health Net,Salud,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Per Visit,5831.00
Health Net,Salud,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Per Visit,5831.00
Health Net,Salud,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Per Visit,5831.00
Health Net,Salud,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Per Visit,5831.00
Health Net,Salud,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Per Visit,5831.00
Health Net,Salud,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Per Visit,5831.00
Health Net,Salud,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Per Visit,5831.00
Health Net,Salud,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Per Visit,5831.00
Health Net,Salud,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Per Visit,5831.00
Health Net,Salud,93451,CPT4/HCPCS,RIGHT HEART CATH,,Per Visit,2998.00
Health Net,Salud,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Per Visit,2998.00
Health Net,Salud,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Per Visit,2998.00
Health Net,Salud,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Per Visit,2998.00
Health Net,Salud,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Per Visit,2998.00
Health Net,Salud,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Per Visit,2998.00
Health Net,Salud,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Per Visit,2998.00
Health Net,Salud,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Per Visit,2998.00
Health Net,Salud,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Per Visit,2998.00
Health Net,Salud,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Per Visit,2998.00
Health Net,Salud,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Per Visit,2998.00
Health Net,Salud,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Per Visit,2998.00
Health Net,Salud,93463,CPT4/HCPCS,DRUG ADMIN & HEMODYNMIC MEAS,,Per Visit,2998.00
Health Net,Salud,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Per Visit,2998.00
Health Net,Salud,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Per Visit,2998.00
Health Net,Salud,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Per Visit,2998.00
Health Net,Salud,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Per Visit,2998.00
Health Net,Salud,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,2998.00
Health Net,Salud,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,2998.00
Health Net,Salud,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Per Visit,2998.00
Health Net,Salud,93561,CPT4/HCPCS,CARDIAC OUTPUT MEASUREMENT,,Per Visit,2998.00
Health Net,Salud,93562,CPT4/HCPCS,CARD OUTPUT MEASURE SUBSQ,,Per Visit,2998.00
Health Net,Salud,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,Per Visit,2998.00
Health Net,Salud,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,Per Visit,2998.00
Health Net,Salud,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,Per Visit,2998.00
Health Net,Salud,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,Per Visit,2998.00
Health Net,Salud,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,Per Visit,2998.00
Health Net,Salud,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,Per Visit,2998.00
Health Net,Salud,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Per Visit,4895.00
Health Net,Salud,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Per Visit,4895.00
Health Net,Salud,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Per Visit,4895.00
Health Net,Salud,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Per Visit,4895.00
Health Net,Salud,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Per Visit,4895.00
Health Net,Salud,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Per Visit,4895.00
Health Net,Salud,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Per Visit,4895.00
Health Net,Salud,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Per Visit,4895.00
Health Net,Salud,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Per Visit,4895.00
Health Net,Salud,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Per Visit,4895.00
Health Net,Salud,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Salud,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Salud,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Salud,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Salud,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Per Visit,4895.00
Health Net,Salud,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Per Visit,4895.00
Health Net,Salud,93631,CPT4/HCPCS,HEART PACING MAPPING,,Per Visit,4895.00
Health Net,Salud,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Per Visit,4895.00
Health Net,Salud,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Salud,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Per Visit,4895.00
Health Net,Salud,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Per Visit,5575.00
Health Net,Salud,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Per Visit,5575.00
Health Net,Salud,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Per Visit,5575.00
Health Net,Salud,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Per Visit,5575.00
Health Net,Salud,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Per Visit,5575.00
Health Net,Salud,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Per Visit,5575.00
Health Net,Salud,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,% of Charges Not to Exceed,4399.00
Health Net,Salud,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,% of Charges Not to Exceed,4399.00
Health Net,Salud,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,% of Charges Not to Exceed,4399.00
Health Net,Salud,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,% of Charges Not to Exceed,4399.00
Health Net,Salud,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,% of Charges Not to Exceed,4399.00
Health Net,Salud,95992,CPT4/HCPCS,CANALITH REPOSITIONING PROC,,% of Charges Not to Exceed,4399.00
Health Net,Salud,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97533,CPT4/HCPCS,SENSORY INTEGRATION,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,% of Charges Not to Exceed,4399.00
Health Net,Salud,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8900,CPT4/HCPCS,MRA w/cont, abd,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8901,CPT4/HCPCS,MRA w/o cont, abd,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8902,CPT4/HCPCS,MRA w/o fol w/cont, abd,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8903,CPT4/HCPCS,MRI w/cont, breast, uni,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8904,CPT4/HCPCS,Mri w/o cont, breast, uni,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8905,CPT4/HCPCS,MRI w/o fol w/cont, brst, un,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8906,CPT4/HCPCS,MRI w/cont, breast, bi,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8908,CPT4/HCPCS,MRI w/o fol w/cont, breast,,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8909,CPT4/HCPCS,MRA w/cont, chest,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8910,CPT4/HCPCS,MRA w/o cont, chest,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8911,CPT4/HCPCS,MRA w/o fol w/cont, chest,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8912,CPT4/HCPCS,MRA w/cont, lwr ext,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8913,CPT4/HCPCS,MRA w/o cont, lwr ext,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8914,CPT4/HCPCS,MRA w/o fol w/cont, lwr ext,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8918,CPT4/HCPCS,MRA w/cont, pelvis,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8919,CPT4/HCPCS,MRA w/o cont, pelvis,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8920,CPT4/HCPCS,MRA w/o fol w/cont, pelvis,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8934,CPT4/HCPCS,MRA, w/dye, upper extremity,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8935,CPT4/HCPCS,MRA, w/o dye, upper extr,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C8936,CPT4/HCPCS,MRA, w/o&w/dye, upper extr,,% of Charges Not to Exceed,4399.00
Health Net,Salud,C9725,CPT4/HCPCS,Place endorectal app,,% of Charges Not to Exceed,5131.00
Health Net,Salud,G0173,CPT4/HCPCS,Linear acc stereo radsur com,,% of Charges Not to Exceed,5131.00
Health Net,Salud,G0237,CPT4/HCPCS,Therapeutic procd strg endur,,% of Charges Not to Exceed,4399.00
Health Net,Salud,G0238,CPT4/HCPCS,Oth resp proc, indiv,,% of Charges Not to Exceed,4399.00
Health Net,Salud,G0239,CPT4/HCPCS,Oth resp proc, group,,% of Charges Not to Exceed,4399.00
Health Net,Salud,G0251,CPT4/HCPCS,Linear acc based stero radio,,% of Charges Not to Exceed,5131.00
Health Net,Salud,G0283,CPT4/HCPCS,Elec stim other than wound,,% of Charges Not to Exceed,4399.00
Health Net,Salud,G0297,CPT4/HCPCS,Ldct for lung ca screen,,Per Visit,13913.00
Health Net,Salud,G0300,CPT4/HCPCS,Hhs/hospice of lpn ea 15 min,,Per Visit,13913.00
Health Net,Salud,G0515,CPT4/HCPCS,Cognitive skills development,,% of Charges Not to Exceed,4399.00
Health Net,Salud,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,% of Charges Not to Exceed,4399.00
Health Net,Salud,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,% of Charges Not to Exceed,4399.00
Health Net,Salud,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,% of Charges Not to Exceed,4399.00
Health Net,Salud,,,NICU/Newborn - Level I,,Per Diem,967.00
Health Net,Salud,,,Medical Surgical,,Per Diem,2965.00
Health Net,Salud,,,CCU,,Per Diem,4684.00
Health Net,Salud,,,ICU,,Per Diem,4684.00
Health Net,Salud,,,NICU/Newborn - Level II,,Per Diem,4684.00
Health Net,Salud,,,NICU/Newborn - Level III,,Per Diem,4684.00
Health Net,Salud,,,NICU/Newborn - Level IV,,Per Diem,4684.00
United HealthCare,HMO,0054T,CPT4/HCPCS,BONE SRGRY CMPTR FLUOR IMAGE,,Case Rate,985.00
United HealthCare,HMO,0055T,CPT4/HCPCS,BONE SRGRY CMPTR CT/MRI IMAG,,Case Rate,985.00
United HealthCare,HMO,0071T,CPT4/HCPCS,US LEIOMYOMATA ABLATE <200,,Grouper Rate,3965.00
United HealthCare,HMO,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,Grouper Rate,3965.00
United HealthCare,HMO,0075T,CPT4/HCPCS,PERQ STENT/CHEST VERT ART,,Grouper Rate,1291.00
United HealthCare,HMO,0076T,CPT4/HCPCS,S&I STENT/CHEST VERT ART,,Grouper Rate,1291.00
United HealthCare,HMO,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Grouper Rate,22812.00
United HealthCare,HMO,0101T,CPT4/HCPCS,EXTRACORP SHOCKWV TX HI ENRG,,Grouper Rate,4847.00
United HealthCare,HMO,0102T,CPT4/HCPCS,EXTRACORP SHOCKWV TX ANESTH,,Grouper Rate,4847.00
United HealthCare,HMO,0163T,CPT4/HCPCS,LUMB ARTIF DISKECTOMY ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,0164T,CPT4/HCPCS,REMOVE LUMB ARTIF DISC ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,0165T,CPT4/HCPCS,REVISE LUMB ARTIF DISC ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Grouper Rate,4847.00
United HealthCare,HMO,0191T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,5730.00
United HealthCare,HMO,0200T,CPT4/HCPCS,PERQ SACRAL AUGMT UNILAT INJ,,Grouper Rate,4847.00
United HealthCare,HMO,0201T,CPT4/HCPCS,PERQ SACRAL AUGMT BILAT INJ,,Grouper Rate,4847.00
United HealthCare,HMO,0202T,CPT4/HCPCS,POST VERT ARTHRPLST 1 LUMBAR,,Grouper Rate,1291.00
United HealthCare,HMO,0207T,CPT4/HCPCS,CLEAR EYELID GLAND W/HEAT,,Grouper Rate,1145.00
United HealthCare,HMO,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1235.00
United HealthCare,HMO,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1145.00
United HealthCare,HMO,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1145.00
United HealthCare,HMO,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1235.00
United HealthCare,HMO,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1145.00
United HealthCare,HMO,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1145.00
United HealthCare,HMO,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,Grouper Rate,1291.00
United HealthCare,HMO,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,Grouper Rate,1291.00
United HealthCare,HMO,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Grouper Rate,4847.00
United HealthCare,HMO,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,1235.00
United HealthCare,HMO,0229T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,1145.00
United HealthCare,HMO,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,1235.00
United HealthCare,HMO,0231T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,1145.00
United HealthCare,HMO,0232T,CPT4/HCPCS,NJX PLATELET PLASMA,,Grouper Rate,1145.00
United HealthCare,HMO,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Grouper Rate,9547.00
United HealthCare,HMO,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,Grouper Rate,1291.00
United HealthCare,HMO,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Grouper Rate,9547.00
United HealthCare,HMO,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Grouper Rate,9547.00
United HealthCare,HMO,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,Grouper Rate,9547.00
United HealthCare,HMO,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,Grouper Rate,5730.00
United HealthCare,HMO,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,Grouper Rate,5730.00
United HealthCare,HMO,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,Grouper Rate,5730.00
United HealthCare,HMO,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,Grouper Rate,5730.00
United HealthCare,HMO,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,Grouper Rate,13506.00
United HealthCare,HMO,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,Grouper Rate,4847.00
United HealthCare,HMO,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,Grouper Rate,13506.00
United HealthCare,HMO,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,Grouper Rate,6612.00
United HealthCare,HMO,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,Grouper Rate,4847.00
United HealthCare,HMO,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,Grouper Rate,4847.00
United HealthCare,HMO,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,Grouper Rate,6612.00
United HealthCare,HMO,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,Grouper Rate,6612.00
United HealthCare,HMO,0278T,CPT4/HCPCS,TEMPR,,Grouper Rate,1145.00
United HealthCare,HMO,0290T,CPT4/HCPCS,LASER INC FOR PKP/LKP RECIP,,Grouper Rate,1145.00
United HealthCare,HMO,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Grouper Rate,13506.00
United HealthCare,HMO,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Grouper Rate,13506.00
United HealthCare,HMO,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Grouper Rate,4847.00
United HealthCare,HMO,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Grouper Rate,4847.00
United HealthCare,HMO,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Grouper Rate,4847.00
United HealthCare,HMO,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Grouper Rate,13506.00
United HealthCare,HMO,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,Grouper Rate,1145.00
United HealthCare,HMO,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Grouper Rate,3965.00
United HealthCare,HMO,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,Grouper Rate,4847.00
United HealthCare,HMO,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,Grouper Rate,4847.00
United HealthCare,HMO,0342T,CPT4/HCPCS,THXP APHERESIS W/HDL DELIP,,Grouper Rate,5730.00
United HealthCare,HMO,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,1291.00
United HealthCare,HMO,0347T,CPT4/HCPCS,INS BONE DEVICE FOR RSA,,Grouper Rate,1145.00
United HealthCare,HMO,0355T,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,0356T,CPT4/HCPCS,INSRT DRUG DEVICE FOR IOP,,Grouper Rate,1145.00
United HealthCare,HMO,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,1145.00
United HealthCare,HMO,0396T,CPT4/HCPCS,INTRAOP KINETIC BALNCE SENSR,,Grouper Rate,1145.00
United HealthCare,HMO,0397T,CPT4/HCPCS,ERCP W/OPTICAL ENDOMICROSCPY,,Grouper Rate,1145.00
United HealthCare,HMO,0398T,CPT4/HCPCS,MRGFUS STRTCTC LES ABLTJ,,Grouper Rate,9547.00
United HealthCare,HMO,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Grouper Rate,3965.00
United HealthCare,HMO,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Grouper Rate,5730.00
United HealthCare,HMO,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Grouper Rate,22812.00
United HealthCare,HMO,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Grouper Rate,22812.00
United HealthCare,HMO,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Grouper Rate,9547.00
United HealthCare,HMO,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Grouper Rate,9547.00
United HealthCare,HMO,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Grouper Rate,4847.00
United HealthCare,HMO,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Grouper Rate,4847.00
United HealthCare,HMO,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Grouper Rate,22812.00
United HealthCare,HMO,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Grouper Rate,1235.00
United HealthCare,HMO,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Grouper Rate,1291.00
United HealthCare,HMO,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,1145.00
United HealthCare,HMO,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,1145.00
United HealthCare,HMO,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Grouper Rate,5730.00
United HealthCare,HMO,0424T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA COMPL,,Grouper Rate,22812.00
United HealthCare,HMO,0425T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA SEN LD,,Grouper Rate,6612.00
United HealthCare,HMO,0426T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA STM LD,,Grouper Rate,13506.00
United HealthCare,HMO,0427T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA PLS GN,,Grouper Rate,13506.00
United HealthCare,HMO,0428T,CPT4/HCPCS,RMVL NSTIM APNEA PLS GEN,,Grouper Rate,4847.00
United HealthCare,HMO,0429T,CPT4/HCPCS,RMVL NSTIM APNEA SEN LD,,Grouper Rate,4847.00
United HealthCare,HMO,0430T,CPT4/HCPCS,RMVL NSTIM APNEA STIMJ LD,,Grouper Rate,4847.00
United HealthCare,HMO,0431T,CPT4/HCPCS,RMVL/RPLC NSTIM APNEA PLS GN,,Grouper Rate,13506.00
United HealthCare,HMO,0432T,CPT4/HCPCS,REPOS NSTIM APNEA STIMJ LD,,Grouper Rate,4847.00
United HealthCare,HMO,0433T,CPT4/HCPCS,REPOS NSTIM APNEA SENSING LD,,Grouper Rate,4847.00
United HealthCare,HMO,0437T,CPT4/HCPCS,IMPLTJ SYNTH RNFCMT ABDL WAL,,Grouper Rate,1145.00
United HealthCare,HMO,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Grouper Rate,5730.00
United HealthCare,HMO,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Grouper Rate,5730.00
United HealthCare,HMO,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Grouper Rate,5730.00
United HealthCare,HMO,0443T,CPT4/HCPCS,R-T SPCTRL ALYS PRST8 TISS,,Grouper Rate,1145.00
United HealthCare,HMO,0444T,CPT4/HCPCS,1ST PLMT DRUG ELUT OC INS,,Grouper Rate,1145.00
United HealthCare,HMO,0445T,CPT4/HCPCS,SBSQT PLMT DRUG ELUT OC INS,,Grouper Rate,1145.00
United HealthCare,HMO,0446T,CPT4/HCPCS,INSJ IMPLTBL GLUCOSE SENSOR,,Grouper Rate,1145.00
United HealthCare,HMO,0447T,CPT4/HCPCS,RMVL IMPLTBL GLUCOSE SENSOR,,Grouper Rate,1145.00
United HealthCare,HMO,0448T,CPT4/HCPCS,REMVL INSJ IMPLTBL GLUC SENS,,Grouper Rate,1145.00
United HealthCare,HMO,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Grouper Rate,5730.00
United HealthCare,HMO,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Grouper Rate,1145.00
United HealthCare,HMO,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,Grouper Rate,1291.00
United HealthCare,HMO,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,Grouper Rate,1291.00
United HealthCare,HMO,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Grouper Rate,6612.00
United HealthCare,HMO,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Grouper Rate,6612.00
United HealthCare,HMO,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,Grouper Rate,1291.00
United HealthCare,HMO,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,Grouper Rate,1291.00
United HealthCare,HMO,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Grouper Rate,4847.00
United HealthCare,HMO,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Grouper Rate,4847.00
United HealthCare,HMO,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,Grouper Rate,1291.00
United HealthCare,HMO,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Grouper Rate,4847.00
United HealthCare,HMO,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,Grouper Rate,1291.00
United HealthCare,HMO,0462T,CPT4/HCPCS,PRGRMG EVAL AORTIC VENTR SYS,,Grouper Rate,1145.00
United HealthCare,HMO,0463T,CPT4/HCPCS,INTERROG AORTIC VENTR SYS,,Grouper Rate,1145.00
United HealthCare,HMO,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,Grouper Rate,1145.00
United HealthCare,HMO,0466T,CPT4/HCPCS,INSJ CH WAL RESPIR ELTRD/RA,,Grouper Rate,1145.00
United HealthCare,HMO,0467T,CPT4/HCPCS,REVJ/RPLMNT CH RESPIR ELTRD,,Grouper Rate,4847.00
United HealthCare,HMO,0468T,CPT4/HCPCS,RMVL CH WAL RESPIR ELTRD/RA,,Grouper Rate,4847.00
United HealthCare,HMO,0474T,CPT4/HCPCS,INSJ AQUEOUS DRG DEV IO RSVR,,Grouper Rate,5730.00
United HealthCare,HMO,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Grouper Rate,1145.00
United HealthCare,HMO,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Grouper Rate,1145.00
United HealthCare,HMO,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Grouper Rate,1145.00
United HealthCare,HMO,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,Grouper Rate,1291.00
United HealthCare,HMO,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,Grouper Rate,1291.00
United HealthCare,HMO,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Grouper Rate,1291.00
United HealthCare,HMO,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Grouper Rate,1291.00
United HealthCare,HMO,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Grouper Rate,1145.00
United HealthCare,HMO,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Grouper Rate,1145.00
United HealthCare,HMO,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,Grouper Rate,1291.00
United HealthCare,HMO,0495T,CPT4/HCPCS,MNTR CDVR DON LNG 1ST 2 HRS,,Grouper Rate,1291.00
United HealthCare,HMO,0496T,CPT4/HCPCS,MNTR CDVR DON LNG EA ADDL HR,,Grouper Rate,1291.00
United HealthCare,HMO,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Grouper Rate,3965.00
United HealthCare,HMO,0505T,CPT4/HCPCS,EV FEMPOP ARTL REVSC,,Grouper Rate,9547.00
United HealthCare,HMO,0510T,CPT4/HCPCS,RMVL SINUS TARSI IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,0511T,CPT4/HCPCS,RMVL&RINSJ SINUS TARSI IMPLT,,Grouper Rate,3965.00
United HealthCare,HMO,0512T,CPT4/HCPCS,ESW INTEG WND HLG 1ST WND,,Grouper Rate,1145.00
United HealthCare,HMO,0513T,CPT4/HCPCS,ESW INTEG WND HLG EA ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,0514T,CPT4/HCPCS,INTRAOP VIS AXIS ID PT FIXJ,,Grouper Rate,1145.00
United HealthCare,HMO,0515T,CPT4/HCPCS,INSJ WCS LV COMPL SYS,,Grouper Rate,22812.00
United HealthCare,HMO,0516T,CPT4/HCPCS,INSJ WCS LV ELTRD ONLY,,Grouper Rate,9547.00
United HealthCare,HMO,0517T,CPT4/HCPCS,INSJ WCS LV PG COMPNT,,Grouper Rate,9547.00
United HealthCare,HMO,0518T,CPT4/HCPCS,RMVL PG COMPNT WCS,,Grouper Rate,4847.00
United HealthCare,HMO,0519T,CPT4/HCPCS,RMVL & RPLCMT PG COMPNT WCS,,Grouper Rate,4847.00
United HealthCare,HMO,0520T,CPT4/HCPCS,RMVL&RPLCMT PG WCS NEW ELTRD,,Grouper Rate,22812.00
United HealthCare,HMO,0523T,CPT4/HCPCS,NTRAPX C FFR W/3D FUNCJL MAP,,Grouper Rate,1145.00
United HealthCare,HMO,0524T,CPT4/HCPCS,EV CATH DIR CHEM ABLTJ W/IMG,,Grouper Rate,4847.00
United HealthCare,HMO,0525T,CPT4/HCPCS,INSJ/RPLCMT COMPL IIMS,,Grouper Rate,9547.00
United HealthCare,HMO,0526T,CPT4/HCPCS,INSJ/RPLCMT IIMS ELTRD ONLY,,Grouper Rate,9547.00
United HealthCare,HMO,0527T,CPT4/HCPCS,INSJ/RPLCMT IIMS IMPLT MNTR,,Grouper Rate,9547.00
United HealthCare,HMO,0530T,CPT4/HCPCS,REMOVAL COMPLETE IIMS,,Grouper Rate,4847.00
United HealthCare,HMO,0531T,CPT4/HCPCS,REMOVAL IIMS ELECTRODE ONLY,,Grouper Rate,4847.00
United HealthCare,HMO,0532T,CPT4/HCPCS,REMOVAL IIMS IMPLT MNTR ONLY,,Grouper Rate,4847.00
United HealthCare,HMO,0543T,CPT4/HCPCS,TA MV RPR W/ARTIF CHORD TEND,,Grouper Rate,1291.00
United HealthCare,HMO,0544T,CPT4/HCPCS,TCAT MV ANNULUS RCNSTJ,,Grouper Rate,1291.00
United HealthCare,HMO,0545T,CPT4/HCPCS,TCAT TV ANNULUS RCNSTJ,,Grouper Rate,1291.00
United HealthCare,HMO,0548T,CPT4/HCPCS,TPRNL BALO CNTNC DEV BI,,Grouper Rate,10164.00
United HealthCare,HMO,0549T,CPT4/HCPCS,TPRNL BALO CNTNC DEV UNI,,Grouper Rate,4847.00
United HealthCare,HMO,0550T,CPT4/HCPCS,TPRNL BALO CNTNC DEV RMVL EA,,Grouper Rate,3965.00
United HealthCare,HMO,0551T,CPT4/HCPCS,TPRNL BALO CNTNC DEV ADJMT,,Grouper Rate,1145.00
United HealthCare,HMO,0553T,CPT4/HCPCS,PERQ TCAT ILIAC ANAST IMPLT,,Grouper Rate,1291.00
United HealthCare,HMO,0563T,CPT4/HCPCS,EVAC MEIBOMIAN GLND HEAT BI,,Grouper Rate,1145.00
United HealthCare,HMO,0565T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS HRVG,,Grouper Rate,1145.00
United HealthCare,HMO,0566T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS NJX,,Grouper Rate,1145.00
United HealthCare,HMO,0567T,CPT4/HCPCS,PERM FLP TUBE OCCLS W/IMPLT,,Grouper Rate,1291.00
United HealthCare,HMO,0568T,CPT4/HCPCS,INTRO MIX SALINE&AIR F/SSG,,Grouper Rate,1291.00
United HealthCare,HMO,0569T,CPT4/HCPCS,TTVR PERQ APPR 1ST PROSTH,,Grouper Rate,1291.00
United HealthCare,HMO,0570T,CPT4/HCPCS,TTVR PERQ EA ADDL PROSTH,,Grouper Rate,1291.00
United HealthCare,HMO,0571T,CPT4/HCPCS,INSJ/RPLCMT ICDS SS ELTRD,,Grouper Rate,1291.00
United HealthCare,HMO,0572T,CPT4/HCPCS,INSERTION SS DFB ELECTRODE,,Grouper Rate,1291.00
United HealthCare,HMO,0573T,CPT4/HCPCS,REMOVAL SS DFB ELECTRODE,,Grouper Rate,1291.00
United HealthCare,HMO,0574T,CPT4/HCPCS,REPOS PREV SS IMPL DFB ELTRD,,Grouper Rate,1291.00
United HealthCare,HMO,0575T,CPT4/HCPCS,PRGRMG DEV EVAL ICDS SS IP,,Grouper Rate,1291.00
United HealthCare,HMO,0576T,CPT4/HCPCS,INTERROG DEV EVAL ICDS SS IP,,Grouper Rate,1291.00
United HealthCare,HMO,0578T,CPT4/HCPCS,REM INTERROG DEV ICDS PHYS,,Grouper Rate,1291.00
United HealthCare,HMO,0579T,CPT4/HCPCS,REM INTERROG DEV ICDS TECH,,Grouper Rate,1291.00
United HealthCare,HMO,0580T,CPT4/HCPCS,RMVL SS IMPL DFB PG ONLY,,Grouper Rate,1291.00
United HealthCare,HMO,0581T,CPT4/HCPCS,ABLTJ MAL BRST TUM PERQ CRTX,,Grouper Rate,1291.00
United HealthCare,HMO,0582T,CPT4/HCPCS,TRURL ABLTJ MAL PRST8 TISS,,Grouper Rate,1291.00
United HealthCare,HMO,0583T,CPT4/HCPCS,TMPST AUTO TUBE DLVR SYS,,Grouper Rate,1291.00
United HealthCare,HMO,0584T,CPT4/HCPCS,PERQ ISLET CELL TRANSPLANT,,Grouper Rate,1291.00
United HealthCare,HMO,0585T,CPT4/HCPCS,LAPS ISLET CELL TRANSPLANT,,Grouper Rate,1291.00
United HealthCare,HMO,0586T,CPT4/HCPCS,OPEN ISLET CELL TRANSPLANT,,Grouper Rate,1291.00
United HealthCare,HMO,0587T,CPT4/HCPCS,PERQ IMPLTJ/RPLCMT ISDNS PTN,,Grouper Rate,1235.00
United HealthCare,HMO,0588T,CPT4/HCPCS,REVISION/REMOVAL ISDNS PTN,,Grouper Rate,1145.00
United HealthCare,HMO,10004,CPT4/HCPCS,FNA BX W/O IMG GDN EA ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,10005,CPT4/HCPCS,FNA BX W/US GDN 1ST LES,,Grouper Rate,1235.00
United HealthCare,HMO,10006,CPT4/HCPCS,FNA BX W/US GDN EA ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,10007,CPT4/HCPCS,FNA BX W/FLUOR GDN 1ST LES,,Grouper Rate,1235.00
United HealthCare,HMO,10008,CPT4/HCPCS,FNA BX W/FLUOR GDN EA ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,10009,CPT4/HCPCS,FNA BX W/CT GDN 1ST LES,,Grouper Rate,1235.00
United HealthCare,HMO,10010,CPT4/HCPCS,FNA BX W/CT GDN EA ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,10011,CPT4/HCPCS,FNA BX W/MR GDN 1ST LES,,Grouper Rate,1235.00
United HealthCare,HMO,10012,CPT4/HCPCS,FNA BX W/MR GDN EA ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Grouper Rate,1145.00
United HealthCare,HMO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Grouper Rate,1235.00
United HealthCare,HMO,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Grouper Rate,1235.00
United HealthCare,HMO,10036,CPT4/HCPCS,PERQ DEV SOFT TISS ADD IMAG,,Grouper Rate,1145.00
United HealthCare,HMO,10040,CPT4/HCPCS,ACNE SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,1145.00
United HealthCare,HMO,10061,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,1145.00
United HealthCare,HMO,10080,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,1235.00
United HealthCare,HMO,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,1235.00
United HealthCare,HMO,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,1145.00
United HealthCare,HMO,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,1291.00
United HealthCare,HMO,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Grouper Rate,1291.00
United HealthCare,HMO,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Grouper Rate,1145.00
United HealthCare,HMO,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Grouper Rate,3965.00
United HealthCare,HMO,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Grouper Rate,1145.00
United HealthCare,HMO,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,Grouper Rate,1291.00
United HealthCare,HMO,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,Grouper Rate,1291.00
United HealthCare,HMO,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,Grouper Rate,1291.00
United HealthCare,HMO,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,Grouper Rate,4847.00
United HealthCare,HMO,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Grouper Rate,1235.00
United HealthCare,HMO,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Grouper Rate,1235.00
United HealthCare,HMO,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Grouper Rate,1235.00
United HealthCare,HMO,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Grouper Rate,1235.00
United HealthCare,HMO,11045,CPT4/HCPCS,DEB SUBQ TISSUE ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,11046,CPT4/HCPCS,DEB MUSC/FASCIA ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,11047,CPT4/HCPCS,DEB BONE ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,11055,CPT4/HCPCS,TRIM SKIN LESION,,Grouper Rate,1145.00
United HealthCare,HMO,11056,CPT4/HCPCS,TRIM SKIN LESIONS 2 TO 4,,Grouper Rate,1145.00
United HealthCare,HMO,11057,CPT4/HCPCS,TRIM SKIN LESIONS OVER 4,,Grouper Rate,1145.00
United HealthCare,HMO,11102,CPT4/HCPCS,TANGNTL BX SKIN SINGLE LES,,Grouper Rate,1145.00
United HealthCare,HMO,11103,CPT4/HCPCS,TANGNTL BX SKIN EA SEP/ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,11104,CPT4/HCPCS,PUNCH BX SKIN SINGLE LESION,,Grouper Rate,1145.00
United HealthCare,HMO,11105,CPT4/HCPCS,PUNCH BX SKIN EA SEP/ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,11106,CPT4/HCPCS,INCAL BX SKN SINGLE LES,,Grouper Rate,1145.00
United HealthCare,HMO,11107,CPT4/HCPCS,INCAL BX SKN EA SEP/ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,11200,CPT4/HCPCS,REMOVAL OF SKIN TAGS 2.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,11305,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,11306,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,11307,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,11308,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,11310,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,11311,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,11312,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,11313,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,Grouper Rate,1235.00
United HealthCare,HMO,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,Grouper Rate,1145.00
United HealthCare,HMO,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,Grouper Rate,1235.00
United HealthCare,HMO,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,Grouper Rate,1235.00
United HealthCare,HMO,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,Grouper Rate,1291.00
United HealthCare,HMO,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,Grouper Rate,1291.00
United HealthCare,HMO,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Grouper Rate,1235.00
United HealthCare,HMO,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Grouper Rate,1235.00
United HealthCare,HMO,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Grouper Rate,1235.00
United HealthCare,HMO,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Grouper Rate,1291.00
United HealthCare,HMO,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Grouper Rate,1291.00
United HealthCare,HMO,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Grouper Rate,3965.00
United HealthCare,HMO,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Grouper Rate,1235.00
United HealthCare,HMO,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Grouper Rate,1235.00
United HealthCare,HMO,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Grouper Rate,1235.00
United HealthCare,HMO,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Grouper Rate,1235.00
United HealthCare,HMO,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Grouper Rate,1235.00
United HealthCare,HMO,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Grouper Rate,3965.00
United HealthCare,HMO,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3965.00
United HealthCare,HMO,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3965.00
United HealthCare,HMO,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3965.00
United HealthCare,HMO,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3965.00
United HealthCare,HMO,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3965.00
United HealthCare,HMO,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,3965.00
United HealthCare,HMO,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Grouper Rate,1235.00
United HealthCare,HMO,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Grouper Rate,1235.00
United HealthCare,HMO,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Grouper Rate,1145.00
United HealthCare,HMO,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Grouper Rate,1235.00
United HealthCare,HMO,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Grouper Rate,1235.00
United HealthCare,HMO,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Grouper Rate,1291.00
United HealthCare,HMO,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Grouper Rate,1235.00
United HealthCare,HMO,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Grouper Rate,1235.00
United HealthCare,HMO,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Grouper Rate,1235.00
United HealthCare,HMO,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Grouper Rate,1235.00
United HealthCare,HMO,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Grouper Rate,1291.00
United HealthCare,HMO,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Grouper Rate,3965.00
United HealthCare,HMO,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Grouper Rate,1235.00
United HealthCare,HMO,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Grouper Rate,1235.00
United HealthCare,HMO,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Grouper Rate,1235.00
United HealthCare,HMO,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Grouper Rate,1235.00
United HealthCare,HMO,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Grouper Rate,1291.00
United HealthCare,HMO,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Grouper Rate,3965.00
United HealthCare,HMO,11719,CPT4/HCPCS,TRIM NAIL(S) ANY NUMBER,,Grouper Rate,1145.00
United HealthCare,HMO,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Grouper Rate,1145.00
United HealthCare,HMO,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Grouper Rate,1145.00
United HealthCare,HMO,11730,CPT4/HCPCS,REMOVAL OF NAIL PLATE,,Grouper Rate,1145.00
United HealthCare,HMO,11732,CPT4/HCPCS,REMOVE NAIL PLATE ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,11740,CPT4/HCPCS,DRAIN BLOOD FROM UNDER NAIL,,Grouper Rate,1145.00
United HealthCare,HMO,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Grouper Rate,1145.00
United HealthCare,HMO,11755,CPT4/HCPCS,BIOPSY NAIL UNIT,,Grouper Rate,1235.00
United HealthCare,HMO,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Grouper Rate,1145.00
United HealthCare,HMO,11762,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED,,Grouper Rate,1291.00
United HealthCare,HMO,11765,CPT4/HCPCS,EXCISION OF NAIL FOLD TOE,,Grouper Rate,1145.00
United HealthCare,HMO,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Grouper Rate,3965.00
United HealthCare,HMO,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Grouper Rate,3965.00
United HealthCare,HMO,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Grouper Rate,3965.00
United HealthCare,HMO,11900,CPT4/HCPCS,INJECT SKIN LESIONS 7,,Grouper Rate,1145.00
United HealthCare,HMO,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Grouper Rate,1145.00
United HealthCare,HMO,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Grouper Rate,1145.00
United HealthCare,HMO,11950,CPT4/HCPCS,TX CONTOUR DEFECTS 1 CC/<,,Grouper Rate,1145.00
United HealthCare,HMO,11951,CPT4/HCPCS,TX CONTOUR DEFECTS 1.1-5.0CC,,Grouper Rate,1145.00
United HealthCare,HMO,11952,CPT4/HCPCS,TX CONTOUR DEFECTS 5.1-10CC,,Grouper Rate,1145.00
United HealthCare,HMO,11954,CPT4/HCPCS,TX CONTOUR DEFECTS >10.0 CC,,Grouper Rate,1145.00
United HealthCare,HMO,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Grouper Rate,4847.00
United HealthCare,HMO,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Grouper Rate,5730.00
United HealthCare,HMO,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Grouper Rate,3965.00
United HealthCare,HMO,11976,CPT4/HCPCS,REMOVE CONTRACEPTIVE CAPSULE,,Grouper Rate,1235.00
United HealthCare,HMO,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Grouper Rate,1145.00
United HealthCare,HMO,11981,CPT4/HCPCS,INSERT DRUG IMPLANT DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,11982,CPT4/HCPCS,REMOVE DRUG IMPLANT DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,11983,CPT4/HCPCS,REMOVE/INSERT DRUG IMPLANT,,Grouper Rate,1145.00
United HealthCare,HMO,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,Grouper Rate,1145.00
United HealthCare,HMO,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Grouper Rate,1145.00
United HealthCare,HMO,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Grouper Rate,1145.00
United HealthCare,HMO,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Grouper Rate,1145.00
United HealthCare,HMO,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Grouper Rate,1145.00
United HealthCare,HMO,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Grouper Rate,1145.00
United HealthCare,HMO,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,1145.00
United HealthCare,HMO,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,1145.00
United HealthCare,HMO,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Grouper Rate,1145.00
United HealthCare,HMO,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Grouper Rate,1145.00
United HealthCare,HMO,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Grouper Rate,1145.00
United HealthCare,HMO,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Grouper Rate,1145.00
United HealthCare,HMO,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Grouper Rate,1291.00
United HealthCare,HMO,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Grouper Rate,1145.00
United HealthCare,HMO,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Grouper Rate,1145.00
United HealthCare,HMO,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Grouper Rate,1145.00
United HealthCare,HMO,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Grouper Rate,1145.00
United HealthCare,HMO,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Grouper Rate,1291.00
United HealthCare,HMO,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Grouper Rate,1145.00
United HealthCare,HMO,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Grouper Rate,1145.00
United HealthCare,HMO,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Grouper Rate,1145.00
United HealthCare,HMO,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Grouper Rate,1145.00
United HealthCare,HMO,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Grouper Rate,1145.00
United HealthCare,HMO,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Grouper Rate,1145.00
United HealthCare,HMO,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Grouper Rate,1145.00
United HealthCare,HMO,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Grouper Rate,1145.00
United HealthCare,HMO,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Grouper Rate,1145.00
United HealthCare,HMO,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Grouper Rate,1145.00
United HealthCare,HMO,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1145.00
United HealthCare,HMO,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1145.00
United HealthCare,HMO,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1145.00
United HealthCare,HMO,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Grouper Rate,1145.00
United HealthCare,HMO,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Grouper Rate,1145.00
United HealthCare,HMO,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Grouper Rate,1291.00
United HealthCare,HMO,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Grouper Rate,1291.00
United HealthCare,HMO,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Grouper Rate,1291.00
United HealthCare,HMO,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Grouper Rate,1291.00
United HealthCare,HMO,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,1291.00
United HealthCare,HMO,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,1291.00
United HealthCare,HMO,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Grouper Rate,1291.00
United HealthCare,HMO,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Grouper Rate,1291.00
United HealthCare,HMO,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Grouper Rate,4847.00
United HealthCare,HMO,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Grouper Rate,1145.00
United HealthCare,HMO,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Grouper Rate,1291.00
United HealthCare,HMO,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Grouper Rate,1291.00
United HealthCare,HMO,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Grouper Rate,1145.00
United HealthCare,HMO,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Grouper Rate,1145.00
United HealthCare,HMO,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Grouper Rate,1145.00
United HealthCare,HMO,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Grouper Rate,1145.00
United HealthCare,HMO,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Grouper Rate,1291.00
United HealthCare,HMO,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Grouper Rate,1291.00
United HealthCare,HMO,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Grouper Rate,1291.00
United HealthCare,HMO,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Grouper Rate,4847.00
United HealthCare,HMO,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Grouper Rate,1145.00
United HealthCare,HMO,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Grouper Rate,3965.00
United HealthCare,HMO,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Grouper Rate,4847.00
United HealthCare,HMO,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Grouper Rate,1145.00
United HealthCare,HMO,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Grouper Rate,1291.00
United HealthCare,HMO,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Grouper Rate,1145.00
United HealthCare,HMO,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Grouper Rate,4847.00
United HealthCare,HMO,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Grouper Rate,1145.00
United HealthCare,HMO,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Grouper Rate,1145.00
United HealthCare,HMO,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Grouper Rate,3965.00
United HealthCare,HMO,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Grouper Rate,1291.00
United HealthCare,HMO,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Grouper Rate,1291.00
United HealthCare,HMO,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Grouper Rate,1291.00
United HealthCare,HMO,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Grouper Rate,1291.00
United HealthCare,HMO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Grouper Rate,4847.00
United HealthCare,HMO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Grouper Rate,1145.00
United HealthCare,HMO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Grouper Rate,1291.00
United HealthCare,HMO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Grouper Rate,1291.00
United HealthCare,HMO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Grouper Rate,1145.00
United HealthCare,HMO,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Grouper Rate,1291.00
United HealthCare,HMO,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Grouper Rate,4847.00
United HealthCare,HMO,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Grouper Rate,1291.00
United HealthCare,HMO,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Grouper Rate,1291.00
United HealthCare,HMO,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Grouper Rate,4847.00
United HealthCare,HMO,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Grouper Rate,3965.00
United HealthCare,HMO,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Grouper Rate,1291.00
United HealthCare,HMO,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Grouper Rate,1291.00
United HealthCare,HMO,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Grouper Rate,1291.00
United HealthCare,HMO,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Grouper Rate,4847.00
United HealthCare,HMO,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Grouper Rate,4847.00
United HealthCare,HMO,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Grouper Rate,4847.00
United HealthCare,HMO,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Grouper Rate,4847.00
United HealthCare,HMO,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Grouper Rate,1291.00
United HealthCare,HMO,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Grouper Rate,4847.00
United HealthCare,HMO,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Grouper Rate,4847.00
United HealthCare,HMO,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Grouper Rate,3965.00
United HealthCare,HMO,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Grouper Rate,3965.00
United HealthCare,HMO,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Grouper Rate,3965.00
United HealthCare,HMO,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,15769,CPT4/HCPCS,GRFG AUTOL SOFT TISS DIR EXC,,Grouper Rate,4847.00
United HealthCare,HMO,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,15771,CPT4/HCPCS,GRFG AUTOL FAT LIPO 50 CC/<,,Grouper Rate,4847.00
United HealthCare,HMO,15772,CPT4/HCPCS,GRFG AUTOL FAT LIPO EA ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,15773,CPT4/HCPCS,GRFG AUTOL FAT LIPO 25 CC/<,,Grouper Rate,1291.00
United HealthCare,HMO,15774,CPT4/HCPCS,GFRG AUTOL FAT LIPO EA ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,15775,CPT4/HCPCS,HAIR TRNSPL 1-15 PUNCH GRFTS,,Grouper Rate,1145.00
United HealthCare,HMO,15776,CPT4/HCPCS,HAIR TRNSPL >15 PUNCH GRAFTS,,Grouper Rate,1145.00
United HealthCare,HMO,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,Grouper Rate,1145.00
United HealthCare,HMO,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,Grouper Rate,3965.00
United HealthCare,HMO,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,Grouper Rate,1235.00
United HealthCare,HMO,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,Grouper Rate,1235.00
United HealthCare,HMO,15783,CPT4/HCPCS,DERMABRASION SUPRFL ANY SITE,,Grouper Rate,1145.00
United HealthCare,HMO,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,Grouper Rate,1145.00
United HealthCare,HMO,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,15788,CPT4/HCPCS,CHEMICAL PEEL FACE EPIDERM,,Grouper Rate,1145.00
United HealthCare,HMO,15789,CPT4/HCPCS,CHEMICAL PEEL FACE DERMAL,,Grouper Rate,1145.00
United HealthCare,HMO,15792,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Grouper Rate,1145.00
United HealthCare,HMO,15793,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Grouper Rate,1145.00
United HealthCare,HMO,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Grouper Rate,1291.00
United HealthCare,HMO,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,1291.00
United HealthCare,HMO,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,1291.00
United HealthCare,HMO,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,1291.00
United HealthCare,HMO,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,1291.00
United HealthCare,HMO,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Grouper Rate,1291.00
United HealthCare,HMO,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Grouper Rate,4847.00
United HealthCare,HMO,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Grouper Rate,4847.00
United HealthCare,HMO,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Grouper Rate,4847.00
United HealthCare,HMO,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Grouper Rate,4847.00
United HealthCare,HMO,15830,CPT4/HCPCS,EXC SKIN ABD,,Grouper Rate,5730.00
United HealthCare,HMO,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Grouper Rate,3965.00
United HealthCare,HMO,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Grouper Rate,3965.00
United HealthCare,HMO,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Grouper Rate,3965.00
United HealthCare,HMO,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Grouper Rate,3965.00
United HealthCare,HMO,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Grouper Rate,1291.00
United HealthCare,HMO,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Grouper Rate,1291.00
United HealthCare,HMO,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Grouper Rate,1291.00
United HealthCare,HMO,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Grouper Rate,4847.00
United HealthCare,HMO,15847,CPT4/HCPCS,EXC SKIN ABD ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Grouper Rate,1145.00
United HealthCare,HMO,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Grouper Rate,1291.00
United HealthCare,HMO,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Grouper Rate,1145.00
United HealthCare,HMO,15860,CPT4/HCPCS,TEST FOR BLOOD FLOW IN GRAFT,,Grouper Rate,1145.00
United HealthCare,HMO,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Grouper Rate,4847.00
United HealthCare,HMO,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Grouper Rate,4847.00
United HealthCare,HMO,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Grouper Rate,1291.00
United HealthCare,HMO,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Grouper Rate,4847.00
United HealthCare,HMO,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,1291.00
United HealthCare,HMO,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,4847.00
United HealthCare,HMO,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3965.00
United HealthCare,HMO,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,3965.00
United HealthCare,HMO,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,4847.00
United HealthCare,HMO,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,4847.00
United HealthCare,HMO,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,1291.00
United HealthCare,HMO,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,1291.00
United HealthCare,HMO,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,3965.00
United HealthCare,HMO,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,3965.00
United HealthCare,HMO,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,4847.00
United HealthCare,HMO,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,1291.00
United HealthCare,HMO,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,3965.00
United HealthCare,HMO,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3965.00
United HealthCare,HMO,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3965.00
United HealthCare,HMO,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,3965.00
United HealthCare,HMO,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,4847.00
United HealthCare,HMO,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,1291.00
United HealthCare,HMO,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,4847.00
United HealthCare,HMO,15999,CPT4/HCPCS,REMOVAL OF PRESSURE SORE,,Grouper Rate,1235.00
United HealthCare,HMO,16000,CPT4/HCPCS,INITIAL TREATMENT OF BURN(S),,Grouper Rate,1145.00
United HealthCare,HMO,16020,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN S,,Grouper Rate,1145.00
United HealthCare,HMO,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Grouper Rate,1145.00
United HealthCare,HMO,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Grouper Rate,1145.00
United HealthCare,HMO,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Grouper Rate,1145.00
United HealthCare,HMO,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,Grouper Rate,1291.00
United HealthCare,HMO,17000,CPT4/HCPCS,DESTRUCT PREMALG LESION,,Grouper Rate,1145.00
United HealthCare,HMO,17003,CPT4/HCPCS,DESTRUCT PREMALG LES 2-14,,Grouper Rate,1145.00
United HealthCare,HMO,17004,CPT4/HCPCS,DESTROY PREMAL LESIONS 15/>,,Grouper Rate,1145.00
United HealthCare,HMO,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1291.00
United HealthCare,HMO,17110,CPT4/HCPCS,DESTRUCT B9 LESION 1-14,,Grouper Rate,1145.00
United HealthCare,HMO,17111,CPT4/HCPCS,DESTRUCT LESION 15 OR MORE,,Grouper Rate,1145.00
United HealthCare,HMO,17250,CPT4/HCPCS,CHEM CAUT OF GRANLTJ TISSUE,,Grouper Rate,1145.00
United HealthCare,HMO,17260,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17261,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17262,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17263,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17264,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17266,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17270,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17271,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17272,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17273,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17274,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17276,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17280,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17281,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17282,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17283,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17284,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17286,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,17311,CPT4/HCPCS,MOHS 1 STAGE H/N/HF/G,,Grouper Rate,1145.00
United HealthCare,HMO,17312,CPT4/HCPCS,MOHS ADDL STAGE,,Grouper Rate,1145.00
United HealthCare,HMO,17313,CPT4/HCPCS,MOHS 1 STAGE T/A/L,,Grouper Rate,1145.00
United HealthCare,HMO,17314,CPT4/HCPCS,MOHS ADDL STAGE T/A/L,,Grouper Rate,1145.00
United HealthCare,HMO,17315,CPT4/HCPCS,MOHS SURG ADDL BLOCK,,Grouper Rate,1145.00
United HealthCare,HMO,17340,CPT4/HCPCS,CRYOTHERAPY OF SKIN,,Grouper Rate,1145.00
United HealthCare,HMO,17360,CPT4/HCPCS,SKIN PEEL THERAPY,,Grouper Rate,1145.00
United HealthCare,HMO,17380,CPT4/HCPCS,HAIR REMOVAL BY ELECTROLYSIS,,Grouper Rate,1145.00
United HealthCare,HMO,17999,CPT4/HCPCS,SKIN TISSUE PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Grouper Rate,1235.00
United HealthCare,HMO,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Grouper Rate,3965.00
United HealthCare,HMO,19030,CPT4/HCPCS,INJECTION FOR BREAST X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Grouper Rate,1291.00
United HealthCare,HMO,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,Grouper Rate,1145.00
United HealthCare,HMO,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Grouper Rate,1291.00
United HealthCare,HMO,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,Grouper Rate,1145.00
United HealthCare,HMO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Grouper Rate,1291.00
United HealthCare,HMO,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,Grouper Rate,1145.00
United HealthCare,HMO,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Grouper Rate,1291.00
United HealthCare,HMO,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Grouper Rate,3965.00
United HealthCare,HMO,19105,CPT4/HCPCS,CRYOSURG ABLATE FA EACH,,Grouper Rate,4847.00
United HealthCare,HMO,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Grouper Rate,3965.00
United HealthCare,HMO,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Grouper Rate,3965.00
United HealthCare,HMO,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Grouper Rate,3965.00
United HealthCare,HMO,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Grouper Rate,3965.00
United HealthCare,HMO,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Grouper Rate,1145.00
United HealthCare,HMO,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,Grouper Rate,1235.00
United HealthCare,HMO,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,Grouper Rate,1145.00
United HealthCare,HMO,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,Grouper Rate,1235.00
United HealthCare,HMO,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,Grouper Rate,1145.00
United HealthCare,HMO,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,Grouper Rate,1235.00
United HealthCare,HMO,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,Grouper Rate,1145.00
United HealthCare,HMO,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,Grouper Rate,1235.00
United HealthCare,HMO,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,Grouper Rate,1145.00
United HealthCare,HMO,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Grouper Rate,1145.00
United HealthCare,HMO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Grouper Rate,6612.00
United HealthCare,HMO,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Grouper Rate,6612.00
United HealthCare,HMO,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Grouper Rate,6612.00
United HealthCare,HMO,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Grouper Rate,3965.00
United HealthCare,HMO,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Grouper Rate,3965.00
United HealthCare,HMO,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Grouper Rate,5730.00
United HealthCare,HMO,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Grouper Rate,4847.00
United HealthCare,HMO,19305,CPT4/HCPCS,MAST RADICAL,,Grouper Rate,1291.00
United HealthCare,HMO,19306,CPT4/HCPCS,MAST RAD URBAN TYPE,,Grouper Rate,1291.00
United HealthCare,HMO,19307,CPT4/HCPCS,MAST MOD RAD,,Grouper Rate,5730.00
United HealthCare,HMO,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Grouper Rate,4847.00
United HealthCare,HMO,19318,CPT4/HCPCS,BREAST REDUCTION,,Grouper Rate,5730.00
United HealthCare,HMO,19324,CPT4/HCPCS,ENLARGE BREAST,,Grouper Rate,5730.00
United HealthCare,HMO,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Grouper Rate,6612.00
United HealthCare,HMO,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Grouper Rate,5730.00
United HealthCare,HMO,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Grouper Rate,6612.00
United HealthCare,HMO,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,3965.00
United HealthCare,HMO,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Grouper Rate,4847.00
United HealthCare,HMO,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Grouper Rate,6612.00
United HealthCare,HMO,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,Grouper Rate,1291.00
United HealthCare,HMO,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Grouper Rate,5730.00
United HealthCare,HMO,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,4847.00
United HealthCare,HMO,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,Grouper Rate,5730.00
United HealthCare,HMO,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,Grouper Rate,5730.00
United HealthCare,HMO,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,Grouper Rate,5730.00
United HealthCare,HMO,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Grouper Rate,4847.00
United HealthCare,HMO,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Grouper Rate,4847.00
United HealthCare,HMO,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Grouper Rate,5730.00
United HealthCare,HMO,19396,CPT4/HCPCS,DESIGN CUSTOM BREAST IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,19499,CPT4/HCPCS,BREAST SURGERY PROCEDURE,,Grouper Rate,3965.00
United HealthCare,HMO,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,Grouper Rate,1145.00
United HealthCare,HMO,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,Grouper Rate,1291.00
United HealthCare,HMO,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,Grouper Rate,1291.00
United HealthCare,HMO,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Grouper Rate,1235.00
United HealthCare,HMO,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,Grouper Rate,5730.00
United HealthCare,HMO,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Grouper Rate,1291.00
United HealthCare,HMO,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,1235.00
United HealthCare,HMO,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,1291.00
United HealthCare,HMO,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Grouper Rate,3965.00
United HealthCare,HMO,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Grouper Rate,3965.00
United HealthCare,HMO,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,4847.00
United HealthCare,HMO,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,4847.00
United HealthCare,HMO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Grouper Rate,1291.00
United HealthCare,HMO,20501,CPT4/HCPCS,INJECT SINUS TRACT FOR X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,1235.00
United HealthCare,HMO,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,3965.00
United HealthCare,HMO,20526,CPT4/HCPCS,THER INJECTION CARP TUNNEL,,Grouper Rate,1145.00
United HealthCare,HMO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Grouper Rate,1145.00
United HealthCare,HMO,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Grouper Rate,1145.00
United HealthCare,HMO,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Grouper Rate,1145.00
United HealthCare,HMO,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Grouper Rate,1145.00
United HealthCare,HMO,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Grouper Rate,1145.00
United HealthCare,HMO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Grouper Rate,3965.00
United HealthCare,HMO,20560,CPT4/HCPCS,NDL INSJ W/O NJX 1 OR 2 MUSC,,Grouper Rate,1291.00
United HealthCare,HMO,20561,CPT4/HCPCS,NDL INSJ W/O NJX 3+ MUSC,,Grouper Rate,1291.00
United HealthCare,HMO,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1145.00
United HealthCare,HMO,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1145.00
United HealthCare,HMO,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1145.00
United HealthCare,HMO,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1235.00
United HealthCare,HMO,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1145.00
United HealthCare,HMO,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1145.00
United HealthCare,HMO,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Grouper Rate,1145.00
United HealthCare,HMO,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Grouper Rate,1235.00
United HealthCare,HMO,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Grouper Rate,4847.00
United HealthCare,HMO,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Grouper Rate,3965.00
United HealthCare,HMO,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Grouper Rate,3965.00
United HealthCare,HMO,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Grouper Rate,4847.00
United HealthCare,HMO,20664,CPT4/HCPCS,APPLICATION OF HALO,,Grouper Rate,3965.00
United HealthCare,HMO,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,1291.00
United HealthCare,HMO,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,3965.00
United HealthCare,HMO,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,4847.00
United HealthCare,HMO,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,4847.00
United HealthCare,HMO,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Grouper Rate,4847.00
United HealthCare,HMO,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Grouper Rate,4847.00
United HealthCare,HMO,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Grouper Rate,1235.00
United HealthCare,HMO,20700,CPT4/HCPCS,MNL PREP&INSJ DP RX DLVR DEV,,Grouper Rate,1145.00
United HealthCare,HMO,20701,CPT4/HCPCS,RMVL DEEP RX DELIVERY DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,20702,CPT4/HCPCS,MNL PREP&INSJ IMED RX DEV,,Grouper Rate,1145.00
United HealthCare,HMO,20703,CPT4/HCPCS,RMVL IMED RX DELIVERY DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,20704,CPT4/HCPCS,MNL PREP&INSJ I-ARTIC RX DEV,,Grouper Rate,1145.00
United HealthCare,HMO,20705,CPT4/HCPCS,RMVL I-ARTIC RX DELIVERY DEV,,Grouper Rate,1145.00
United HealthCare,HMO,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,Grouper Rate,1291.00
United HealthCare,HMO,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,Grouper Rate,1291.00
United HealthCare,HMO,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,Grouper Rate,1291.00
United HealthCare,HMO,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Grouper Rate,1291.00
United HealthCare,HMO,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Grouper Rate,3965.00
United HealthCare,HMO,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Grouper Rate,1291.00
United HealthCare,HMO,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Grouper Rate,1291.00
United HealthCare,HMO,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,Grouper Rate,1291.00
United HealthCare,HMO,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,1145.00
United HealthCare,HMO,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,3965.00
United HealthCare,HMO,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,20932,CPT4/HCPCS,OSTEOART ALGRFT W/SURF & B1,,Grouper Rate,1145.00
United HealthCare,HMO,20933,CPT4/HCPCS,HEMICRT INTRCLRY ALGRFT PRTL,,Grouper Rate,1145.00
United HealthCare,HMO,20934,CPT4/HCPCS,INTERCALARY ALGRFT COMPL,,Grouper Rate,1145.00
United HealthCare,HMO,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Grouper Rate,4847.00
United HealthCare,HMO,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Grouper Rate,4847.00
United HealthCare,HMO,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Grouper Rate,4847.00
United HealthCare,HMO,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Grouper Rate,1145.00
United HealthCare,HMO,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Grouper Rate,1235.00
United HealthCare,HMO,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Grouper Rate,4847.00
United HealthCare,HMO,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,Grouper Rate,1291.00
United HealthCare,HMO,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,Grouper Rate,1291.00
United HealthCare,HMO,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Grouper Rate,4847.00
United HealthCare,HMO,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Grouper Rate,4847.00
United HealthCare,HMO,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Grouper Rate,4847.00
United HealthCare,HMO,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Grouper Rate,6612.00
United HealthCare,HMO,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Grouper Rate,6612.00
United HealthCare,HMO,20974,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Grouper Rate,1145.00
United HealthCare,HMO,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Grouper Rate,1145.00
United HealthCare,HMO,20979,CPT4/HCPCS,US BONE STIMULATION,,Grouper Rate,1145.00
United HealthCare,HMO,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,5730.00
United HealthCare,HMO,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,6612.00
United HealthCare,HMO,20985,CPT4/HCPCS,CPTR-ASST DIR MS PX,,Grouper Rate,1145.00
United HealthCare,HMO,20999,CPT4/HCPCS,MUSCULOSKELETAL SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Grouper Rate,1235.00
United HealthCare,HMO,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Grouper Rate,1235.00
United HealthCare,HMO,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Grouper Rate,1235.00
United HealthCare,HMO,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Grouper Rate,1235.00
United HealthCare,HMO,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Grouper Rate,1291.00
United HealthCare,HMO,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Grouper Rate,5730.00
United HealthCare,HMO,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Grouper Rate,3965.00
United HealthCare,HMO,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Grouper Rate,3965.00
United HealthCare,HMO,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Grouper Rate,3965.00
United HealthCare,HMO,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Grouper Rate,3965.00
United HealthCare,HMO,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Grouper Rate,5730.00
United HealthCare,HMO,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Grouper Rate,5730.00
United HealthCare,HMO,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Grouper Rate,5730.00
United HealthCare,HMO,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Grouper Rate,5730.00
United HealthCare,HMO,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Grouper Rate,5730.00
United HealthCare,HMO,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Grouper Rate,5730.00
United HealthCare,HMO,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Grouper Rate,5730.00
United HealthCare,HMO,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Grouper Rate,5730.00
United HealthCare,HMO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Grouper Rate,1291.00
United HealthCare,HMO,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1291.00
United HealthCare,HMO,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,5730.00
United HealthCare,HMO,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,5730.00
United HealthCare,HMO,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,5730.00
United HealthCare,HMO,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,5730.00
United HealthCare,HMO,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,5730.00
United HealthCare,HMO,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,5730.00
United HealthCare,HMO,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,5730.00
United HealthCare,HMO,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1145.00
United HealthCare,HMO,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,5730.00
United HealthCare,HMO,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,5730.00
United HealthCare,HMO,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,5730.00
United HealthCare,HMO,21089,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1145.00
United HealthCare,HMO,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Grouper Rate,5730.00
United HealthCare,HMO,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Grouper Rate,1291.00
United HealthCare,HMO,21116,CPT4/HCPCS,INJECTION JAW JOINT X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,3965.00
United HealthCare,HMO,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,3965.00
United HealthCare,HMO,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,3965.00
United HealthCare,HMO,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,3965.00
United HealthCare,HMO,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,3965.00
United HealthCare,HMO,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,5730.00
United HealthCare,HMO,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,3965.00
United HealthCare,HMO,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5730.00
United HealthCare,HMO,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,5730.00
United HealthCare,HMO,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,Grouper Rate,5730.00
United HealthCare,HMO,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,Grouper Rate,1291.00
United HealthCare,HMO,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,Grouper Rate,1291.00
United HealthCare,HMO,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,Grouper Rate,1291.00
United HealthCare,HMO,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,Grouper Rate,1291.00
United HealthCare,HMO,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,Grouper Rate,1291.00
United HealthCare,HMO,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,5730.00
United HealthCare,HMO,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,5730.00
United HealthCare,HMO,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Grouper Rate,1291.00
United HealthCare,HMO,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Grouper Rate,1291.00
United HealthCare,HMO,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,1291.00
United HealthCare,HMO,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,1291.00
United HealthCare,HMO,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,1291.00
United HealthCare,HMO,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,Grouper Rate,1291.00
United HealthCare,HMO,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Grouper Rate,5730.00
United HealthCare,HMO,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,Grouper Rate,5730.00
United HealthCare,HMO,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Grouper Rate,3965.00
United HealthCare,HMO,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Grouper Rate,5730.00
United HealthCare,HMO,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Grouper Rate,5730.00
United HealthCare,HMO,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Grouper Rate,5730.00
United HealthCare,HMO,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Grouper Rate,5730.00
United HealthCare,HMO,21210,CPT4/HCPCS,FACE BONE GRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Grouper Rate,5730.00
United HealthCare,HMO,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,5730.00
United HealthCare,HMO,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,5730.00
United HealthCare,HMO,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Grouper Rate,1291.00
United HealthCare,HMO,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,5730.00
United HealthCare,HMO,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,5730.00
United HealthCare,HMO,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Grouper Rate,1291.00
United HealthCare,HMO,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,Grouper Rate,5730.00
United HealthCare,HMO,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5730.00
United HealthCare,HMO,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5730.00
United HealthCare,HMO,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5730.00
United HealthCare,HMO,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,5730.00
United HealthCare,HMO,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,1291.00
United HealthCare,HMO,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Grouper Rate,5730.00
United HealthCare,HMO,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Grouper Rate,5730.00
United HealthCare,HMO,21280,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,5730.00
United HealthCare,HMO,21282,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,1291.00
United HealthCare,HMO,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,1291.00
United HealthCare,HMO,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,3965.00
United HealthCare,HMO,21299,CPT4/HCPCS,CRANIO/MAXILLOFACIAL SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Grouper Rate,1145.00
United HealthCare,HMO,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Grouper Rate,1291.00
United HealthCare,HMO,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Grouper Rate,1291.00
United HealthCare,HMO,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Grouper Rate,3965.00
United HealthCare,HMO,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Grouper Rate,3965.00
United HealthCare,HMO,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Grouper Rate,3965.00
United HealthCare,HMO,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Grouper Rate,3965.00
United HealthCare,HMO,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Grouper Rate,1291.00
United HealthCare,HMO,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Grouper Rate,3965.00
United HealthCare,HMO,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Grouper Rate,3965.00
United HealthCare,HMO,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Grouper Rate,5730.00
United HealthCare,HMO,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Grouper Rate,5730.00
United HealthCare,HMO,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Grouper Rate,1291.00
United HealthCare,HMO,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Grouper Rate,1291.00
United HealthCare,HMO,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Grouper Rate,3965.00
United HealthCare,HMO,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Grouper Rate,1291.00
United HealthCare,HMO,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Grouper Rate,3965.00
United HealthCare,HMO,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Grouper Rate,5730.00
United HealthCare,HMO,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Grouper Rate,4847.00
United HealthCare,HMO,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Grouper Rate,5730.00
United HealthCare,HMO,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Grouper Rate,5730.00
United HealthCare,HMO,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Grouper Rate,5730.00
United HealthCare,HMO,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Grouper Rate,5730.00
United HealthCare,HMO,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Grouper Rate,5730.00
United HealthCare,HMO,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Grouper Rate,1145.00
United HealthCare,HMO,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Grouper Rate,1291.00
United HealthCare,HMO,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Grouper Rate,5730.00
United HealthCare,HMO,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Grouper Rate,5730.00
United HealthCare,HMO,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,Grouper Rate,5730.00
United HealthCare,HMO,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,1145.00
United HealthCare,HMO,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,1291.00
United HealthCare,HMO,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Grouper Rate,5730.00
United HealthCare,HMO,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Grouper Rate,1291.00
United HealthCare,HMO,21499,CPT4/HCPCS,HEAD SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Grouper Rate,3965.00
United HealthCare,HMO,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Grouper Rate,3965.00
United HealthCare,HMO,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Grouper Rate,1291.00
United HealthCare,HMO,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Grouper Rate,3965.00
United HealthCare,HMO,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Grouper Rate,1291.00
United HealthCare,HMO,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,92827.00
United HealthCare,HMO,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,4847.00
United HealthCare,HMO,21601,CPT4/HCPCS,EXC CHEST WALL TUMOR W/RIBS,,Grouper Rate,3965.00
United HealthCare,HMO,21602,CPT4/HCPCS,EXC CH WAL TUM W/O LYMPHADEC,,Grouper Rate,1291.00
United HealthCare,HMO,21603,CPT4/HCPCS,EXC CH WAL TUM W/LYMPHADEC,,Grouper Rate,1291.00
United HealthCare,HMO,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,4847.00
United HealthCare,HMO,21615,CPT4/HCPCS,REMOVAL OF RIB,,Grouper Rate,1291.00
United HealthCare,HMO,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,Grouper Rate,1291.00
United HealthCare,HMO,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Grouper Rate,1291.00
United HealthCare,HMO,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,Grouper Rate,1291.00
United HealthCare,HMO,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Grouper Rate,3965.00
United HealthCare,HMO,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,157890.00
United HealthCare,HMO,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,3965.00
United HealthCare,HMO,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,Grouper Rate,1291.00
United HealthCare,HMO,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,3965.00
United HealthCare,HMO,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,1235.00
United HealthCare,HMO,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Grouper Rate,1291.00
United HealthCare,HMO,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Grouper Rate,5730.00
United HealthCare,HMO,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Grouper Rate,5730.00
United HealthCare,HMO,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,Grouper Rate,1291.00
United HealthCare,HMO,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,95223.00
United HealthCare,HMO,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Grouper Rate,3965.00
United HealthCare,HMO,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,21899,CPT4/HCPCS,NECK/CHEST SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,88100.00
United HealthCare,HMO,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,1235.00
United HealthCare,HMO,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,3965.00
United HealthCare,HMO,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,70018.00
United HealthCare,HMO,22010,CPT4/HCPCS,I&D P-SPINE C/T/CERV-THOR,,Grouper Rate,1291.00
United HealthCare,HMO,22015,CPT4/HCPCS,I&D ABSCESS P-SPINE L/S/LS,,Grouper Rate,1291.00
United HealthCare,HMO,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,72827.00
United HealthCare,HMO,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,6612.00
United HealthCare,HMO,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,6612.00
United HealthCare,HMO,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,6612.00
United HealthCare,HMO,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,1145.00
United HealthCare,HMO,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,1291.00
United HealthCare,HMO,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,1291.00
United HealthCare,HMO,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,1291.00
United HealthCare,HMO,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,1291.00
United HealthCare,HMO,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,80051.00
United HealthCare,HMO,22206,CPT4/HCPCS,INCIS SPINE 3 COLUMN THORAC,,Grouper Rate,1291.00
United HealthCare,HMO,22207,CPT4/HCPCS,INCIS SPINE 3 COLUMN LUMBAR,,Grouper Rate,1291.00
United HealthCare,HMO,22208,CPT4/HCPCS,INCIS SPINE 3 COLUMN ADL SEG,,Grouper Rate,1291.00
United HealthCare,HMO,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,Grouper Rate,1291.00
United HealthCare,HMO,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,Grouper Rate,1291.00
United HealthCare,HMO,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,Grouper Rate,1291.00
United HealthCare,HMO,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,Grouper Rate,1291.00
United HealthCare,HMO,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,Grouper Rate,1291.00
United HealthCare,HMO,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,Grouper Rate,1291.00
United HealthCare,HMO,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,Grouper Rate,1291.00
United HealthCare,HMO,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,Grouper Rate,1291.00
United HealthCare,HMO,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,68653.00
United HealthCare,HMO,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Grouper Rate,1145.00
United HealthCare,HMO,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Grouper Rate,1291.00
United HealthCare,HMO,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Grouper Rate,3965.00
United HealthCare,HMO,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Grouper Rate,3965.00
United HealthCare,HMO,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Grouper Rate,3965.00
United HealthCare,HMO,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,73011.00
United HealthCare,HMO,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,62811.00
United HealthCare,HMO,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Grouper Rate,1291.00
United HealthCare,HMO,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Grouper Rate,4847.00
United HealthCare,HMO,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Grouper Rate,4847.00
United HealthCare,HMO,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Grouper Rate,1145.00
United HealthCare,HMO,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,6612.00
United HealthCare,HMO,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,6612.00
United HealthCare,HMO,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1145.00
United HealthCare,HMO,22526,CPT4/HCPCS,IDET SINGLE LEVEL,,Grouper Rate,4847.00
United HealthCare,HMO,22527,CPT4/HCPCS,IDET 1 OR MORE LEVELS,,Grouper Rate,4847.00
United HealthCare,HMO,22532,CPT4/HCPCS,LAT THORAX SPINE FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,22533,CPT4/HCPCS,LAT LUMBAR SPINE FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,22534,CPT4/HCPCS,LAT THOR/LUMB ADDL SEG,,Grouper Rate,1291.00
United HealthCare,HMO,22548,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,6612.00
United HealthCare,HMO,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Grouper Rate,6612.00
United HealthCare,HMO,22552,CPT4/HCPCS,ADDL NECK SPINE FUSION,,Grouper Rate,5730.00
United HealthCare,HMO,22554,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,6612.00
United HealthCare,HMO,22556,CPT4/HCPCS,THORAX SPINE FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,22558,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,Grouper Rate,6612.00
United HealthCare,HMO,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,Grouper Rate,1291.00
United HealthCare,HMO,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,22595,CPT4/HCPCS,NECK SPINAL FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,123132.00
United HealthCare,HMO,22600,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,22610,CPT4/HCPCS,THORAX SPINE FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,6612.00
United HealthCare,HMO,22614,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,1145.00
United HealthCare,HMO,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,1291.00
United HealthCare,HMO,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,Grouper Rate,10164.00
United HealthCare,HMO,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,1145.00
United HealthCare,HMO,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,104989.00
United HealthCare,HMO,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,53856.00
United HealthCare,HMO,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,Grouper Rate,1291.00
United HealthCare,HMO,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,Grouper Rate,1291.00
United HealthCare,HMO,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,Grouper Rate,1291.00
United HealthCare,HMO,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,Grouper Rate,1291.00
United HealthCare,HMO,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,Grouper Rate,1291.00
United HealthCare,HMO,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,Grouper Rate,1291.00
United HealthCare,HMO,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,Grouper Rate,1291.00
United HealthCare,HMO,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,Grouper Rate,1291.00
United HealthCare,HMO,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,6612.00
United HealthCare,HMO,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,6612.00
United HealthCare,HMO,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,6612.00
United HealthCare,HMO,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,Grouper Rate,1291.00
United HealthCare,HMO,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,22853,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,22854,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,22856,CPT4/HCPCS,CERV ARTIFIC DISKECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,22857,CPT4/HCPCS,LUMBAR ARTIF DISKECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Grouper Rate,1145.00
United HealthCare,HMO,22859,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,22861,CPT4/HCPCS,REVISE CERV ARTIFIC DISC,,Grouper Rate,1291.00
United HealthCare,HMO,22862,CPT4/HCPCS,REVISE LUMBAR ARTIF DISC,,Grouper Rate,1291.00
United HealthCare,HMO,22864,CPT4/HCPCS,REMOVE CERV ARTIF DISC,,Grouper Rate,1291.00
United HealthCare,HMO,22865,CPT4/HCPCS,REMOVE LUMB ARTIF DISC,,Grouper Rate,1291.00
United HealthCare,HMO,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,6612.00
United HealthCare,HMO,22868,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,1145.00
United HealthCare,HMO,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,6612.00
United HealthCare,HMO,22870,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,1145.00
United HealthCare,HMO,22899,CPT4/HCPCS,SPINE SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,42502.00
United HealthCare,HMO,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Grouper Rate,3965.00
United HealthCare,HMO,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Grouper Rate,1291.00
United HealthCare,HMO,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,22999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Grouper Rate,1291.00
United HealthCare,HMO,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Grouper Rate,3965.00
United HealthCare,HMO,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Grouper Rate,3965.00
United HealthCare,HMO,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,1235.00
United HealthCare,HMO,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,3965.00
United HealthCare,HMO,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,66116.00
United HealthCare,HMO,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Grouper Rate,4847.00
United HealthCare,HMO,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Grouper Rate,4847.00
United HealthCare,HMO,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Grouper Rate,4847.00
United HealthCare,HMO,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Grouper Rate,5730.00
United HealthCare,HMO,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,4847.00
United HealthCare,HMO,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Grouper Rate,4847.00
United HealthCare,HMO,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Grouper Rate,4847.00
United HealthCare,HMO,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,56110.00
United HealthCare,HMO,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,134322.00
United HealthCare,HMO,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,1235.00
United HealthCare,HMO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Grouper Rate,1235.00
United HealthCare,HMO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,3965.00
United HealthCare,HMO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,23350,CPT4/HCPCS,INJECTION FOR SHOULDER X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Grouper Rate,5730.00
United HealthCare,HMO,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Grouper Rate,5730.00
United HealthCare,HMO,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,102498.00
United HealthCare,HMO,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Grouper Rate,4847.00
United HealthCare,HMO,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Grouper Rate,4847.00
United HealthCare,HMO,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Grouper Rate,5730.00
United HealthCare,HMO,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Grouper Rate,5730.00
United HealthCare,HMO,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Grouper Rate,5730.00
United HealthCare,HMO,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Grouper Rate,5730.00
United HealthCare,HMO,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Grouper Rate,5730.00
United HealthCare,HMO,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6612.00
United HealthCare,HMO,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6612.00
United HealthCare,HMO,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6612.00
United HealthCare,HMO,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5730.00
United HealthCare,HMO,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5730.00
United HealthCare,HMO,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,5730.00
United HealthCare,HMO,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,5730.00
United HealthCare,HMO,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,6612.00
United HealthCare,HMO,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Grouper Rate,6612.00
United HealthCare,HMO,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Grouper Rate,6612.00
United HealthCare,HMO,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,62810.00
United HealthCare,HMO,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,1235.00
United HealthCare,HMO,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,1145.00
United HealthCare,HMO,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,1145.00
United HealthCare,HMO,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,77691.00
United HealthCare,HMO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,1235.00
United HealthCare,HMO,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Grouper Rate,1291.00
United HealthCare,HMO,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,Grouper Rate,1291.00
United HealthCare,HMO,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,23929,CPT4/HCPCS,SHOULDER SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Grouper Rate,3965.00
United HealthCare,HMO,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Grouper Rate,1291.00
United HealthCare,HMO,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Grouper Rate,3965.00
United HealthCare,HMO,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Grouper Rate,4847.00
United HealthCare,HMO,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Grouper Rate,3965.00
United HealthCare,HMO,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,3965.00
United HealthCare,HMO,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Grouper Rate,3965.00
United HealthCare,HMO,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Grouper Rate,4847.00
United HealthCare,HMO,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Grouper Rate,4847.00
United HealthCare,HMO,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,4847.00
United HealthCare,HMO,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Grouper Rate,4847.00
United HealthCare,HMO,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Grouper Rate,4847.00
United HealthCare,HMO,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Grouper Rate,5730.00
United HealthCare,HMO,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Grouper Rate,5730.00
United HealthCare,HMO,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,22829.00
United HealthCare,HMO,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,1235.00
United HealthCare,HMO,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,1291.00
United HealthCare,HMO,24220,CPT4/HCPCS,INJECTION FOR ELBOW X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,35377.00
United HealthCare,HMO,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Grouper Rate,1291.00
United HealthCare,HMO,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Grouper Rate,4847.00
United HealthCare,HMO,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Grouper Rate,4847.00
United HealthCare,HMO,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,6612.00
United HealthCare,HMO,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,5730.00
United HealthCare,HMO,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Grouper Rate,4847.00
United HealthCare,HMO,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Grouper Rate,5730.00
United HealthCare,HMO,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Grouper Rate,5730.00
United HealthCare,HMO,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Grouper Rate,5730.00
United HealthCare,HMO,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Grouper Rate,4847.00
United HealthCare,HMO,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Grouper Rate,5730.00
United HealthCare,HMO,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Grouper Rate,4847.00
United HealthCare,HMO,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Grouper Rate,5730.00
United HealthCare,HMO,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Grouper Rate,3965.00
United HealthCare,HMO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Grouper Rate,4847.00
United HealthCare,HMO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Grouper Rate,4847.00
United HealthCare,HMO,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,5730.00
United HealthCare,HMO,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,9547.00
United HealthCare,HMO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,14968.00
United HealthCare,HMO,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5730.00
United HealthCare,HMO,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5730.00
United HealthCare,HMO,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,5730.00
United HealthCare,HMO,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Grouper Rate,6612.00
United HealthCare,HMO,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Grouper Rate,6612.00
United HealthCare,HMO,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Grouper Rate,4847.00
United HealthCare,HMO,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Grouper Rate,6612.00
United HealthCare,HMO,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,30561.00
United HealthCare,HMO,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,29508.00
United HealthCare,HMO,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,17470.00
United HealthCare,HMO,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,25164.00
United HealthCare,HMO,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Grouper Rate,1291.00
United HealthCare,HMO,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Grouper Rate,1291.00
United HealthCare,HMO,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,Grouper Rate,1291.00
United HealthCare,HMO,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,Grouper Rate,6612.00
United HealthCare,HMO,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,Grouper Rate,1291.00
United HealthCare,HMO,24999,CPT4/HCPCS,UPPER ARM/ELBOW SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,26338.00
United HealthCare,HMO,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Grouper Rate,3965.00
United HealthCare,HMO,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Grouper Rate,3965.00
United HealthCare,HMO,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,4847.00
United HealthCare,HMO,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,4847.00
United HealthCare,HMO,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,4847.00
United HealthCare,HMO,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,3965.00
United HealthCare,HMO,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Grouper Rate,3965.00
United HealthCare,HMO,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Grouper Rate,3965.00
United HealthCare,HMO,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,1235.00
United HealthCare,HMO,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,3965.00
United HealthCare,HMO,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Grouper Rate,1291.00
United HealthCare,HMO,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Grouper Rate,3965.00
United HealthCare,HMO,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Grouper Rate,3965.00
United HealthCare,HMO,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,24268.00
United HealthCare,HMO,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,4847.00
United HealthCare,HMO,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Grouper Rate,4847.00
United HealthCare,HMO,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Grouper Rate,3965.00
United HealthCare,HMO,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,3965.00
United HealthCare,HMO,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,3965.00
United HealthCare,HMO,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Grouper Rate,3965.00
United HealthCare,HMO,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,3965.00
United HealthCare,HMO,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,3965.00
United HealthCare,HMO,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Grouper Rate,3965.00
United HealthCare,HMO,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,4847.00
United HealthCare,HMO,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Grouper Rate,4847.00
United HealthCare,HMO,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,3965.00
United HealthCare,HMO,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,4847.00
United HealthCare,HMO,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Grouper Rate,4847.00
United HealthCare,HMO,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,4847.00
United HealthCare,HMO,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,4847.00
United HealthCare,HMO,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,4847.00
United HealthCare,HMO,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,4847.00
United HealthCare,HMO,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Grouper Rate,4847.00
United HealthCare,HMO,252,DRG,Other vascular procedures w MCC,,Case Rate,25163.00
United HealthCare,HMO,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Grouper Rate,4847.00
United HealthCare,HMO,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Grouper Rate,4847.00
United HealthCare,HMO,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,4847.00
United HealthCare,HMO,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,4847.00
United HealthCare,HMO,25246,CPT4/HCPCS,INJECTION FOR WRIST X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Grouper Rate,3965.00
United HealthCare,HMO,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,1291.00
United HealthCare,HMO,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,4847.00
United HealthCare,HMO,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Grouper Rate,1291.00
United HealthCare,HMO,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Grouper Rate,4847.00
United HealthCare,HMO,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,253,DRG,Other vascular procedures w CC,,Case Rate,20573.00
United HealthCare,HMO,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,4847.00
United HealthCare,HMO,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,4847.00
United HealthCare,HMO,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,5730.00
United HealthCare,HMO,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,4847.00
United HealthCare,HMO,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,6612.00
United HealthCare,HMO,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Grouper Rate,5730.00
United HealthCare,HMO,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Grouper Rate,5730.00
United HealthCare,HMO,25350,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,5730.00
United HealthCare,HMO,25355,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,5730.00
United HealthCare,HMO,25360,CPT4/HCPCS,REVISION OF ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Grouper Rate,4847.00
United HealthCare,HMO,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Grouper Rate,5730.00
United HealthCare,HMO,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,23300.00
United HealthCare,HMO,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,6612.00
United HealthCare,HMO,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Grouper Rate,6612.00
United HealthCare,HMO,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,6612.00
United HealthCare,HMO,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Grouper Rate,5730.00
United HealthCare,HMO,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Grouper Rate,5730.00
United HealthCare,HMO,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Grouper Rate,5730.00
United HealthCare,HMO,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Grouper Rate,9547.00
United HealthCare,HMO,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Grouper Rate,5730.00
United HealthCare,HMO,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Grouper Rate,5730.00
United HealthCare,HMO,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,25490,CPT4/HCPCS,REINFORCE RADIUS,,Grouper Rate,5730.00
United HealthCare,HMO,25491,CPT4/HCPCS,REINFORCE ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1145.00
United HealthCare,HMO,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1235.00
United HealthCare,HMO,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,6612.00
United HealthCare,HMO,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1145.00
United HealthCare,HMO,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,6612.00
United HealthCare,HMO,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,6612.00
United HealthCare,HMO,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,1145.00
United HealthCare,HMO,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,1145.00
United HealthCare,HMO,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,6612.00
United HealthCare,HMO,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,1145.00
United HealthCare,HMO,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,1145.00
United HealthCare,HMO,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,6612.00
United HealthCare,HMO,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,6612.00
United HealthCare,HMO,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,1145.00
United HealthCare,HMO,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,1235.00
United HealthCare,HMO,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Grouper Rate,3965.00
United HealthCare,HMO,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Grouper Rate,6612.00
United HealthCare,HMO,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Grouper Rate,6612.00
United HealthCare,HMO,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Grouper Rate,6612.00
United HealthCare,HMO,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1235.00
United HealthCare,HMO,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Grouper Rate,6612.00
United HealthCare,HMO,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,4035.00
United HealthCare,HMO,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Grouper Rate,5730.00
United HealthCare,HMO,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Grouper Rate,6612.00
United HealthCare,HMO,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Grouper Rate,5730.00
United HealthCare,HMO,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,2914.00
United HealthCare,HMO,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,1291.00
United HealthCare,HMO,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,1291.00
United HealthCare,HMO,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,1291.00
United HealthCare,HMO,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,1291.00
United HealthCare,HMO,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,3965.00
United HealthCare,HMO,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,25927,CPT4/HCPCS,AMPUTATION OF HAND,,Grouper Rate,1291.00
United HealthCare,HMO,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,25999,CPT4/HCPCS,FOREARM OR WRIST SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,13830.00
United HealthCare,HMO,26010,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Grouper Rate,1145.00
United HealthCare,HMO,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Grouper Rate,1291.00
United HealthCare,HMO,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Grouper Rate,1291.00
United HealthCare,HMO,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Grouper Rate,1291.00
United HealthCare,HMO,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,1291.00
United HealthCare,HMO,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,1291.00
United HealthCare,HMO,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,4847.00
United HealthCare,HMO,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Grouper Rate,1291.00
United HealthCare,HMO,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,18344.00
United HealthCare,HMO,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Grouper Rate,1291.00
United HealthCare,HMO,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,1291.00
United HealthCare,HMO,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,1291.00
United HealthCare,HMO,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,4847.00
United HealthCare,HMO,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,4847.00
United HealthCare,HMO,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,1291.00
United HealthCare,HMO,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,4847.00
United HealthCare,HMO,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,1291.00
United HealthCare,HMO,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Grouper Rate,1291.00
United HealthCare,HMO,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Grouper Rate,1291.00
United HealthCare,HMO,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Grouper Rate,1291.00
United HealthCare,HMO,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,7188.00
United HealthCare,HMO,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Grouper Rate,1291.00
United HealthCare,HMO,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Grouper Rate,1291.00
United HealthCare,HMO,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Grouper Rate,1291.00
United HealthCare,HMO,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,1291.00
United HealthCare,HMO,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,1291.00
United HealthCare,HMO,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Grouper Rate,1291.00
United HealthCare,HMO,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Grouper Rate,1145.00
United HealthCare,HMO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Grouper Rate,1145.00
United HealthCare,HMO,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Grouper Rate,1291.00
United HealthCare,HMO,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,1291.00
United HealthCare,HMO,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,1291.00
United HealthCare,HMO,26476,CPT4/HCPCS,TENDON LENGTHENING,,Grouper Rate,1291.00
United HealthCare,HMO,26477,CPT4/HCPCS,TENDON SHORTENING,,Grouper Rate,1291.00
United HealthCare,HMO,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Grouper Rate,4847.00
United HealthCare,HMO,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,4847.00
United HealthCare,HMO,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,4847.00
United HealthCare,HMO,26499,CPT4/HCPCS,REVISION OF FINGER,,Grouper Rate,3965.00
United HealthCare,HMO,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,1291.00
United HealthCare,HMO,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,4847.00
United HealthCare,HMO,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Grouper Rate,4847.00
United HealthCare,HMO,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,4847.00
United HealthCare,HMO,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,4847.00
United HealthCare,HMO,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Grouper Rate,5730.00
United HealthCare,HMO,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Grouper Rate,4847.00
United HealthCare,HMO,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Grouper Rate,4847.00
United HealthCare,HMO,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Grouper Rate,4847.00
United HealthCare,HMO,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Grouper Rate,1291.00
United HealthCare,HMO,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Grouper Rate,1291.00
United HealthCare,HMO,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Grouper Rate,4847.00
United HealthCare,HMO,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,Grouper Rate,1291.00
United HealthCare,HMO,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,1291.00
United HealthCare,HMO,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,4847.00
United HealthCare,HMO,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,4847.00
United HealthCare,HMO,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Grouper Rate,4847.00
United HealthCare,HMO,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Grouper Rate,4847.00
United HealthCare,HMO,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Grouper Rate,4847.00
United HealthCare,HMO,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Grouper Rate,1291.00
United HealthCare,HMO,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Grouper Rate,1291.00
United HealthCare,HMO,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Grouper Rate,1291.00
United HealthCare,HMO,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Grouper Rate,3965.00
United HealthCare,HMO,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Grouper Rate,1291.00
United HealthCare,HMO,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,266,DRG,Endovascular Cardiac Valve Replacement w MCC,,Case Rate,138457.00
United HealthCare,HMO,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,267,DRG,Endovascular Cardiac Valve Replacement w/o MCC,,Case Rate,103962.00
United HealthCare,HMO,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1145.00
United HealthCare,HMO,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1145.00
United HealthCare,HMO,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,3965.00
United HealthCare,HMO,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,3965.00
United HealthCare,HMO,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1145.00
United HealthCare,HMO,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1145.00
United HealthCare,HMO,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,3965.00
United HealthCare,HMO,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1145.00
United HealthCare,HMO,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1145.00
United HealthCare,HMO,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Grouper Rate,3965.00
United HealthCare,HMO,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,3965.00
United HealthCare,HMO,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,268,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w MCC,,Case Rate,98437.00
United HealthCare,HMO,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,26841,CPT4/HCPCS,FUSION OF THUMB,,Grouper Rate,4847.00
United HealthCare,HMO,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Grouper Rate,4847.00
United HealthCare,HMO,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Grouper Rate,1145.00
United HealthCare,HMO,269,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w/o MCC,,Case Rate,61188.00
United HealthCare,HMO,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Grouper Rate,4847.00
United HealthCare,HMO,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,1291.00
United HealthCare,HMO,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,1291.00
United HealthCare,HMO,26989,CPT4/HCPCS,HAND/FINGER SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Grouper Rate,3965.00
United HealthCare,HMO,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Grouper Rate,3965.00
United HealthCare,HMO,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,270,DRG,Other Major Cardiovascular Procedures w MCC,,Case Rate,74210.00
United HealthCare,HMO,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,1291.00
United HealthCare,HMO,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Grouper Rate,4847.00
United HealthCare,HMO,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,Grouper Rate,1291.00
United HealthCare,HMO,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Grouper Rate,4847.00
United HealthCare,HMO,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,1235.00
United HealthCare,HMO,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,1235.00
United HealthCare,HMO,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,Grouper Rate,1291.00
United HealthCare,HMO,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Grouper Rate,3965.00
United HealthCare,HMO,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Grouper Rate,3965.00
United HealthCare,HMO,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Grouper Rate,3965.00
United HealthCare,HMO,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Grouper Rate,3965.00
United HealthCare,HMO,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Grouper Rate,4847.00
United HealthCare,HMO,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,Grouper Rate,1291.00
United HealthCare,HMO,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,Grouper Rate,6612.00
United HealthCare,HMO,27075,CPT4/HCPCS,RESECT HIP TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,Grouper Rate,1291.00
United HealthCare,HMO,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,Grouper Rate,1291.00
United HealthCare,HMO,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,Grouper Rate,1291.00
United HealthCare,HMO,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Grouper Rate,4847.00
United HealthCare,HMO,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,1291.00
United HealthCare,HMO,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,3965.00
United HealthCare,HMO,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Grouper Rate,1291.00
United HealthCare,HMO,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Grouper Rate,1291.00
United HealthCare,HMO,27093,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,27095,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Grouper Rate,1145.00
United HealthCare,HMO,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Grouper Rate,3965.00
United HealthCare,HMO,271,DRG,Other Major Cardiovascular Procedures w CC,,Case Rate,49254.00
United HealthCare,HMO,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Grouper Rate,5730.00
United HealthCare,HMO,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Grouper Rate,5730.00
United HealthCare,HMO,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,5730.00
United HealthCare,HMO,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,5730.00
United HealthCare,HMO,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Grouper Rate,1291.00
United HealthCare,HMO,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Grouper Rate,1291.00
United HealthCare,HMO,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,Grouper Rate,1291.00
United HealthCare,HMO,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Grouper Rate,9547.00
United HealthCare,HMO,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Grouper Rate,9547.00
United HealthCare,HMO,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,9547.00
United HealthCare,HMO,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,9547.00
United HealthCare,HMO,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,9547.00
United HealthCare,HMO,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,Grouper Rate,1291.00
United HealthCare,HMO,27146,CPT4/HCPCS,INCISION OF HIP BONE,,Grouper Rate,1291.00
United HealthCare,HMO,27147,CPT4/HCPCS,REVISION OF HIP BONE,,Grouper Rate,1291.00
United HealthCare,HMO,27151,CPT4/HCPCS,INCISION OF HIP BONES,,Grouper Rate,1291.00
United HealthCare,HMO,27156,CPT4/HCPCS,REVISION OF HIP BONES,,Grouper Rate,1291.00
United HealthCare,HMO,27158,CPT4/HCPCS,REVISION OF PELVIS,,Grouper Rate,1291.00
United HealthCare,HMO,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,Grouper Rate,1291.00
United HealthCare,HMO,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,Grouper Rate,1291.00
United HealthCare,HMO,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,Grouper Rate,1291.00
United HealthCare,HMO,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,1291.00
United HealthCare,HMO,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,6612.00
United HealthCare,HMO,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,1291.00
United HealthCare,HMO,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,6612.00
United HealthCare,HMO,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,Grouper Rate,6612.00
United HealthCare,HMO,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,1291.00
United HealthCare,HMO,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,Grouper Rate,1291.00
United HealthCare,HMO,27187,CPT4/HCPCS,REINFORCE HIP BONES,,Grouper Rate,1291.00
United HealthCare,HMO,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,1145.00
United HealthCare,HMO,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,1145.00
United HealthCare,HMO,272,DRG,Other Major Cardiovascular Procedures w/o CC/MCC,,Case Rate,35277.00
United HealthCare,HMO,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,Grouper Rate,1235.00
United HealthCare,HMO,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,4847.00
United HealthCare,HMO,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Grouper Rate,3965.00
United HealthCare,HMO,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Grouper Rate,3965.00
United HealthCare,HMO,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,4847.00
United HealthCare,HMO,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1235.00
United HealthCare,HMO,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1235.00
United HealthCare,HMO,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,27267,CPT4/HCPCS,CLTX THIGH FX,,Grouper Rate,1291.00
United HealthCare,HMO,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,Grouper Rate,1291.00
United HealthCare,HMO,27269,CPT4/HCPCS,OPTX THIGH FX,,Grouper Rate,1291.00
United HealthCare,HMO,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,Grouper Rate,1291.00
United HealthCare,HMO,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Grouper Rate,1291.00
United HealthCare,HMO,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Grouper Rate,1291.00
United HealthCare,HMO,27299,CPT4/HCPCS,PELVIS/HIP JOINT SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,273,DRG,Percutaneous Intracardiac Procedures w MCC,,Case Rate,37635.00
United HealthCare,HMO,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Grouper Rate,3965.00
United HealthCare,HMO,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,4847.00
United HealthCare,HMO,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,1235.00
United HealthCare,HMO,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,3965.00
United HealthCare,HMO,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Grouper Rate,1291.00
United HealthCare,HMO,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Grouper Rate,1291.00
United HealthCare,HMO,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Grouper Rate,3965.00
United HealthCare,HMO,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Grouper Rate,1291.00
United HealthCare,HMO,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Grouper Rate,4847.00
United HealthCare,HMO,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,4847.00
United HealthCare,HMO,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,4847.00
United HealthCare,HMO,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,4847.00
United HealthCare,HMO,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,4847.00
United HealthCare,HMO,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Grouper Rate,3965.00
United HealthCare,HMO,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Grouper Rate,3965.00
United HealthCare,HMO,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Grouper Rate,3965.00
United HealthCare,HMO,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Grouper Rate,4847.00
United HealthCare,HMO,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Grouper Rate,4847.00
United HealthCare,HMO,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Grouper Rate,1145.00
United HealthCare,HMO,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Grouper Rate,4847.00
United HealthCare,HMO,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,27369,CPT4/HCPCS,NJX CNTRST KNE ARTHG/CT/MRI,,Grouper Rate,1145.00
United HealthCare,HMO,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,3965.00
United HealthCare,HMO,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,3965.00
United HealthCare,HMO,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,4847.00
United HealthCare,HMO,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,4847.00
United HealthCare,HMO,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,5730.00
United HealthCare,HMO,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Grouper Rate,5730.00
United HealthCare,HMO,274,DRG,Percutaneous Intracardiac Procedures w/o MCC,,Case Rate,25652.00
United HealthCare,HMO,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Grouper Rate,5730.00
United HealthCare,HMO,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Grouper Rate,4847.00
United HealthCare,HMO,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,5730.00
United HealthCare,HMO,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,6612.00
United HealthCare,HMO,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Grouper Rate,5730.00
United HealthCare,HMO,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Grouper Rate,6612.00
United HealthCare,HMO,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Grouper Rate,6612.00
United HealthCare,HMO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Grouper Rate,5730.00
United HealthCare,HMO,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,5730.00
United HealthCare,HMO,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,5730.00
United HealthCare,HMO,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Grouper Rate,5730.00
United HealthCare,HMO,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Grouper Rate,4847.00
United HealthCare,HMO,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,6612.00
United HealthCare,HMO,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,6612.00
United HealthCare,HMO,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,6612.00
United HealthCare,HMO,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Grouper Rate,5730.00
United HealthCare,HMO,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,27437,CPT4/HCPCS,REVISE KNEECAP,,Grouper Rate,5730.00
United HealthCare,HMO,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Grouper Rate,6612.00
United HealthCare,HMO,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Grouper Rate,9547.00
United HealthCare,HMO,27448,CPT4/HCPCS,INCISION OF THIGH,,Grouper Rate,1291.00
United HealthCare,HMO,27450,CPT4/HCPCS,INCISION OF THIGH,,Grouper Rate,1291.00
United HealthCare,HMO,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,Grouper Rate,1291.00
United HealthCare,HMO,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,Grouper Rate,1291.00
United HealthCare,HMO,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,Grouper Rate,5730.00
United HealthCare,HMO,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,Grouper Rate,1291.00
United HealthCare,HMO,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,Grouper Rate,1291.00
United HealthCare,HMO,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,Grouper Rate,1291.00
United HealthCare,HMO,27470,CPT4/HCPCS,REPAIR OF THIGH,,Grouper Rate,1291.00
United HealthCare,HMO,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,Grouper Rate,1291.00
United HealthCare,HMO,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,4847.00
United HealthCare,HMO,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,4847.00
United HealthCare,HMO,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,4847.00
United HealthCare,HMO,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,4847.00
United HealthCare,HMO,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Grouper Rate,9547.00
United HealthCare,HMO,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,Grouper Rate,1291.00
United HealthCare,HMO,27495,CPT4/HCPCS,REINFORCE THIGH,,Grouper Rate,1291.00
United HealthCare,HMO,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,4847.00
United HealthCare,HMO,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,3965.00
United HealthCare,HMO,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,4847.00
United HealthCare,HMO,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,4847.00
United HealthCare,HMO,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,4847.00
United HealthCare,HMO,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,4847.00
United HealthCare,HMO,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1145.00
United HealthCare,HMO,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1145.00
United HealthCare,HMO,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1291.00
United HealthCare,HMO,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,4847.00
United HealthCare,HMO,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Grouper Rate,1145.00
United HealthCare,HMO,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,4847.00
United HealthCare,HMO,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,5730.00
United HealthCare,HMO,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,4847.00
United HealthCare,HMO,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,27580,CPT4/HCPCS,FUSION OF KNEE,,Grouper Rate,1291.00
United HealthCare,HMO,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,1291.00
United HealthCare,HMO,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,1291.00
United HealthCare,HMO,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,1291.00
United HealthCare,HMO,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,Grouper Rate,1291.00
United HealthCare,HMO,27599,CPT4/HCPCS,LEG SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,3965.00
United HealthCare,HMO,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,3965.00
United HealthCare,HMO,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,4847.00
United HealthCare,HMO,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Grouper Rate,3965.00
United HealthCare,HMO,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Grouper Rate,3965.00
United HealthCare,HMO,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,1235.00
United HealthCare,HMO,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,3965.00
United HealthCare,HMO,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,4847.00
United HealthCare,HMO,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,4847.00
United HealthCare,HMO,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,4847.00
United HealthCare,HMO,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Grouper Rate,3965.00
United HealthCare,HMO,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,4847.00
United HealthCare,HMO,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Grouper Rate,4847.00
United HealthCare,HMO,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Grouper Rate,4847.00
United HealthCare,HMO,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Grouper Rate,4847.00
United HealthCare,HMO,27648,CPT4/HCPCS,INJECTION FOR ANKLE X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Grouper Rate,5730.00
United HealthCare,HMO,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Grouper Rate,5730.00
United HealthCare,HMO,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Grouper Rate,5730.00
United HealthCare,HMO,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,3965.00
United HealthCare,HMO,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,3965.00
United HealthCare,HMO,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,4847.00
United HealthCare,HMO,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,4847.00
United HealthCare,HMO,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,3965.00
United HealthCare,HMO,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,4847.00
United HealthCare,HMO,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Grouper Rate,4847.00
United HealthCare,HMO,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Grouper Rate,4847.00
United HealthCare,HMO,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Grouper Rate,4847.00
United HealthCare,HMO,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,5730.00
United HealthCare,HMO,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,5730.00
United HealthCare,HMO,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Grouper Rate,1145.00
United HealthCare,HMO,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,4847.00
United HealthCare,HMO,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Grouper Rate,4847.00
United HealthCare,HMO,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,4847.00
United HealthCare,HMO,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Grouper Rate,5730.00
United HealthCare,HMO,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,27705,CPT4/HCPCS,INCISION OF TIBIA,,Grouper Rate,5730.00
United HealthCare,HMO,27707,CPT4/HCPCS,INCISION OF FIBULA,,Grouper Rate,4847.00
United HealthCare,HMO,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Grouper Rate,4847.00
United HealthCare,HMO,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,Grouper Rate,1291.00
United HealthCare,HMO,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Grouper Rate,4847.00
United HealthCare,HMO,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Grouper Rate,6612.00
United HealthCare,HMO,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,6612.00
United HealthCare,HMO,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,1291.00
United HealthCare,HMO,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,Grouper Rate,1291.00
United HealthCare,HMO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Grouper Rate,6612.00
United HealthCare,HMO,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,Grouper Rate,1291.00
United HealthCare,HMO,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Grouper Rate,4847.00
United HealthCare,HMO,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Grouper Rate,4847.00
United HealthCare,HMO,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Grouper Rate,4847.00
United HealthCare,HMO,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,4847.00
United HealthCare,HMO,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,5730.00
United HealthCare,HMO,27745,CPT4/HCPCS,REINFORCE TIBIA,,Grouper Rate,6612.00
United HealthCare,HMO,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Grouper Rate,1145.00
United HealthCare,HMO,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Grouper Rate,1291.00
United HealthCare,HMO,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Grouper Rate,6612.00
United HealthCare,HMO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Grouper Rate,1145.00
United HealthCare,HMO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Grouper Rate,1145.00
United HealthCare,HMO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Grouper Rate,6612.00
United HealthCare,HMO,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,1235.00
United HealthCare,HMO,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1235.00
United HealthCare,HMO,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1235.00
United HealthCare,HMO,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1235.00
United HealthCare,HMO,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Grouper Rate,1291.00
United HealthCare,HMO,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Grouper Rate,6612.00
United HealthCare,HMO,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,1291.00
United HealthCare,HMO,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,1291.00
United HealthCare,HMO,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,1291.00
United HealthCare,HMO,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,1291.00
United HealthCare,HMO,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,4847.00
United HealthCare,HMO,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,4847.00
United HealthCare,HMO,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,4847.00
United HealthCare,HMO,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,4847.00
United HealthCare,HMO,27899,CPT4/HCPCS,LEG/ANKLE SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,28,DRG,Spinal procedures w MCC,,Case Rate,44203.00
United HealthCare,HMO,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Grouper Rate,1291.00
United HealthCare,HMO,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,3965.00
United HealthCare,HMO,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,3965.00
United HealthCare,HMO,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Grouper Rate,3965.00
United HealthCare,HMO,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Grouper Rate,3965.00
United HealthCare,HMO,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Grouper Rate,1291.00
United HealthCare,HMO,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Grouper Rate,1291.00
United HealthCare,HMO,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Grouper Rate,1291.00
United HealthCare,HMO,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Grouper Rate,3965.00
United HealthCare,HMO,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,3965.00
United HealthCare,HMO,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,3965.00
United HealthCare,HMO,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Grouper Rate,3965.00
United HealthCare,HMO,28055,CPT4/HCPCS,NEURECTOMY FOOT,,Grouper Rate,3965.00
United HealthCare,HMO,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Grouper Rate,3965.00
United HealthCare,HMO,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Grouper Rate,3965.00
United HealthCare,HMO,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,3965.00
United HealthCare,HMO,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,3965.00
United HealthCare,HMO,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3965.00
United HealthCare,HMO,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,3965.00
United HealthCare,HMO,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,3965.00
United HealthCare,HMO,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3965.00
United HealthCare,HMO,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,3965.00
United HealthCare,HMO,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,18221.00
United HealthCare,HMO,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Grouper Rate,3965.00
United HealthCare,HMO,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,6612.00
United HealthCare,HMO,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,6612.00
United HealthCare,HMO,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,3965.00
United HealthCare,HMO,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,6612.00
United HealthCare,HMO,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,6612.00
United HealthCare,HMO,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,3965.00
United HealthCare,HMO,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3965.00
United HealthCare,HMO,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3965.00
United HealthCare,HMO,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3965.00
United HealthCare,HMO,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,3965.00
United HealthCare,HMO,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Grouper Rate,3965.00
United HealthCare,HMO,28116,CPT4/HCPCS,REVISION OF FOOT,,Grouper Rate,3965.00
United HealthCare,HMO,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Grouper Rate,3965.00
United HealthCare,HMO,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Grouper Rate,3965.00
United HealthCare,HMO,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Grouper Rate,3965.00
United HealthCare,HMO,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,3965.00
United HealthCare,HMO,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Grouper Rate,3965.00
United HealthCare,HMO,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Grouper Rate,3965.00
United HealthCare,HMO,28150,CPT4/HCPCS,REMOVAL OF TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Grouper Rate,3965.00
United HealthCare,HMO,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Grouper Rate,3965.00
United HealthCare,HMO,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Grouper Rate,3965.00
United HealthCare,HMO,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1235.00
United HealthCare,HMO,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1291.00
United HealthCare,HMO,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1235.00
United HealthCare,HMO,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,14740.00
United HealthCare,HMO,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,6612.00
United HealthCare,HMO,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,3965.00
United HealthCare,HMO,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,3965.00
United HealthCare,HMO,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Grouper Rate,3965.00
United HealthCare,HMO,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,6612.00
United HealthCare,HMO,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Grouper Rate,3965.00
United HealthCare,HMO,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,3965.00
United HealthCare,HMO,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Grouper Rate,3965.00
United HealthCare,HMO,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Grouper Rate,3965.00
United HealthCare,HMO,28280,CPT4/HCPCS,FUSION OF TOES,,Grouper Rate,3965.00
United HealthCare,HMO,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,3965.00
United HealthCare,HMO,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,3965.00
United HealthCare,HMO,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,3965.00
United HealthCare,HMO,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Grouper Rate,3965.00
United HealthCare,HMO,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Grouper Rate,6612.00
United HealthCare,HMO,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,4847.00
United HealthCare,HMO,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,4847.00
United HealthCare,HMO,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,4847.00
United HealthCare,HMO,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,4847.00
United HealthCare,HMO,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,4847.00
United HealthCare,HMO,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,4847.00
United HealthCare,HMO,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Grouper Rate,6612.00
United HealthCare,HMO,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Grouper Rate,3965.00
United HealthCare,HMO,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Grouper Rate,6612.00
United HealthCare,HMO,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Grouper Rate,6612.00
United HealthCare,HMO,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,3965.00
United HealthCare,HMO,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,3965.00
United HealthCare,HMO,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,3965.00
United HealthCare,HMO,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Grouper Rate,6612.00
United HealthCare,HMO,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28312,CPT4/HCPCS,REVISION OF TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Grouper Rate,3965.00
United HealthCare,HMO,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Grouper Rate,6612.00
United HealthCare,HMO,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Grouper Rate,3965.00
United HealthCare,HMO,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Grouper Rate,3965.00
United HealthCare,HMO,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Grouper Rate,3965.00
United HealthCare,HMO,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Grouper Rate,3965.00
United HealthCare,HMO,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,Grouper Rate,6612.00
United HealthCare,HMO,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Grouper Rate,6612.00
United HealthCare,HMO,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,1145.00
United HealthCare,HMO,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,1145.00
United HealthCare,HMO,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,6612.00
United HealthCare,HMO,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,6612.00
United HealthCare,HMO,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,1145.00
United HealthCare,HMO,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,16923.00
United HealthCare,HMO,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,6612.00
United HealthCare,HMO,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1145.00
United HealthCare,HMO,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Grouper Rate,3965.00
United HealthCare,HMO,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,15845.00
United HealthCare,HMO,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6612.00
United HealthCare,HMO,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6612.00
United HealthCare,HMO,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6612.00
United HealthCare,HMO,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6612.00
United HealthCare,HMO,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6612.00
United HealthCare,HMO,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Grouper Rate,6612.00
United HealthCare,HMO,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,6612.00
United HealthCare,HMO,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,3965.00
United HealthCare,HMO,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,6612.00
United HealthCare,HMO,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,Grouper Rate,1291.00
United HealthCare,HMO,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Grouper Rate,3965.00
United HealthCare,HMO,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Grouper Rate,3965.00
United HealthCare,HMO,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Grouper Rate,3965.00
United HealthCare,HMO,28890,CPT4/HCPCS,HI ENRGY ESWT PLANTAR FASCIA,,Grouper Rate,4847.00
United HealthCare,HMO,28899,CPT4/HCPCS,FOOT/TOES SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,Case Rate,39371.00
United HealthCare,HMO,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,Grouper Rate,1145.00
United HealthCare,HMO,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29065,CPT4/HCPCS,APPLICATION OF LONG ARM CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29075,CPT4/HCPCS,APPLICATION OF FOREARM CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29085,CPT4/HCPCS,APPLY HAND/WRIST CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29086,CPT4/HCPCS,APPLY FINGER CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29105,CPT4/HCPCS,APPLY LONG ARM SPLINT,,Grouper Rate,1145.00
United HealthCare,HMO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Grouper Rate,1145.00
United HealthCare,HMO,29126,CPT4/HCPCS,APPLY FOREARM SPLINT,,Grouper Rate,1145.00
United HealthCare,HMO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Grouper Rate,1145.00
United HealthCare,HMO,29131,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Grouper Rate,1145.00
United HealthCare,HMO,29200,CPT4/HCPCS,STRAPPING OF CHEST,,Grouper Rate,1145.00
United HealthCare,HMO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Grouper Rate,1145.00
United HealthCare,HMO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Grouper Rate,1145.00
United HealthCare,HMO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Grouper Rate,1145.00
United HealthCare,HMO,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Grouper Rate,1145.00
United HealthCare,HMO,29345,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29355,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29358,CPT4/HCPCS,APPLY LONG LEG CAST BRACE,,Grouper Rate,1145.00
United HealthCare,HMO,29365,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29425,CPT4/HCPCS,APPLY SHORT LEG CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29435,CPT4/HCPCS,APPLY SHORT LEG CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29450,CPT4/HCPCS,APPLICATION OF LEG CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29505,CPT4/HCPCS,APPLICATION LONG LEG SPLINT,,Grouper Rate,1145.00
United HealthCare,HMO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Grouper Rate,1145.00
United HealthCare,HMO,29520,CPT4/HCPCS,STRAPPING OF HIP,,Grouper Rate,1145.00
United HealthCare,HMO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,Grouper Rate,1145.00
United HealthCare,HMO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,Grouper Rate,1145.00
United HealthCare,HMO,29550,CPT4/HCPCS,STRAPPING OF TOES,,Grouper Rate,1145.00
United HealthCare,HMO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Grouper Rate,1145.00
United HealthCare,HMO,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,Grouper Rate,1145.00
United HealthCare,HMO,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,Grouper Rate,1145.00
United HealthCare,HMO,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29710,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29730,CPT4/HCPCS,WINDOWING OF CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29740,CPT4/HCPCS,WEDGING OF CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29750,CPT4/HCPCS,WEDGING OF CLUBFOOT CAST,,Grouper Rate,1145.00
United HealthCare,HMO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Grouper Rate,4847.00
United HealthCare,HMO,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Grouper Rate,6612.00
United HealthCare,HMO,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Grouper Rate,6612.00
United HealthCare,HMO,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Grouper Rate,6612.00
United HealthCare,HMO,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Grouper Rate,6612.00
United HealthCare,HMO,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Grouper Rate,6612.00
United HealthCare,HMO,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Grouper Rate,4847.00
United HealthCare,HMO,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Grouper Rate,6612.00
United HealthCare,HMO,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Grouper Rate,6612.00
United HealthCare,HMO,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Grouper Rate,6612.00
United HealthCare,HMO,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Grouper Rate,1145.00
United HealthCare,HMO,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Grouper Rate,6612.00
United HealthCare,HMO,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Grouper Rate,6612.00
United HealthCare,HMO,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Grouper Rate,6612.00
United HealthCare,HMO,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Grouper Rate,4847.00
United HealthCare,HMO,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Grouper Rate,6612.00
United HealthCare,HMO,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Grouper Rate,6612.00
United HealthCare,HMO,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Grouper Rate,6612.00
United HealthCare,HMO,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,6612.00
United HealthCare,HMO,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,6612.00
United HealthCare,HMO,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Grouper Rate,6612.00
United HealthCare,HMO,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Grouper Rate,4847.00
United HealthCare,HMO,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Grouper Rate,4847.00
United HealthCare,HMO,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5730.00
United HealthCare,HMO,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Grouper Rate,3965.00
United HealthCare,HMO,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Grouper Rate,4847.00
United HealthCare,HMO,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,6612.00
United HealthCare,HMO,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,4847.00
United HealthCare,HMO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Grouper Rate,4847.00
United HealthCare,HMO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Grouper Rate,4847.00
United HealthCare,HMO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Grouper Rate,4847.00
United HealthCare,HMO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Grouper Rate,6612.00
United HealthCare,HMO,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Grouper Rate,6612.00
United HealthCare,HMO,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Grouper Rate,6612.00
United HealthCare,HMO,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Grouper Rate,6612.00
United HealthCare,HMO,29999,CPT4/HCPCS,ARTHROSCOPY OF JOINT,,Grouper Rate,1145.00
United HealthCare,HMO,30,DRG,Spinal procedures w/o CC/MCC,,Case Rate,24460.00
United HealthCare,HMO,30000,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Grouper Rate,1145.00
United HealthCare,HMO,30020,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Grouper Rate,1145.00
United HealthCare,HMO,30100,CPT4/HCPCS,INTRANASAL BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,1291.00
United HealthCare,HMO,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,3965.00
United HealthCare,HMO,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,3965.00
United HealthCare,HMO,30120,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,3965.00
United HealthCare,HMO,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,5730.00
United HealthCare,HMO,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Grouper Rate,3965.00
United HealthCare,HMO,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Grouper Rate,3965.00
United HealthCare,HMO,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Grouper Rate,5730.00
United HealthCare,HMO,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Grouper Rate,5730.00
United HealthCare,HMO,30200,CPT4/HCPCS,INJECTION TREATMENT OF NOSE,,Grouper Rate,1145.00
United HealthCare,HMO,30210,CPT4/HCPCS,NASAL SINUS THERAPY,,Grouper Rate,1291.00
United HealthCare,HMO,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Grouper Rate,1291.00
United HealthCare,HMO,30300,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1145.00
United HealthCare,HMO,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1291.00
United HealthCare,HMO,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1291.00
United HealthCare,HMO,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,3965.00
United HealthCare,HMO,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5730.00
United HealthCare,HMO,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,5730.00
United HealthCare,HMO,30430,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,3965.00
United HealthCare,HMO,30435,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5730.00
United HealthCare,HMO,30450,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5730.00
United HealthCare,HMO,30460,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5730.00
United HealthCare,HMO,30462,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,5730.00
United HealthCare,HMO,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Grouper Rate,5730.00
United HealthCare,HMO,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Grouper Rate,3965.00
United HealthCare,HMO,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,5730.00
United HealthCare,HMO,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,5730.00
United HealthCare,HMO,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Grouper Rate,5730.00
United HealthCare,HMO,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Grouper Rate,5730.00
United HealthCare,HMO,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Grouper Rate,5730.00
United HealthCare,HMO,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Grouper Rate,1291.00
United HealthCare,HMO,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Grouper Rate,1291.00
United HealthCare,HMO,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1145.00
United HealthCare,HMO,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1145.00
United HealthCare,HMO,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1145.00
United HealthCare,HMO,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Grouper Rate,1145.00
United HealthCare,HMO,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Grouper Rate,4847.00
United HealthCare,HMO,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Grouper Rate,4847.00
United HealthCare,HMO,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Grouper Rate,3965.00
United HealthCare,HMO,30999,CPT4/HCPCS,NASAL SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Grouper Rate,1145.00
United HealthCare,HMO,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Grouper Rate,1291.00
United HealthCare,HMO,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,3965.00
United HealthCare,HMO,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,5730.00
United HealthCare,HMO,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Grouper Rate,5730.00
United HealthCare,HMO,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,Grouper Rate,3965.00
United HealthCare,HMO,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Grouper Rate,5730.00
United HealthCare,HMO,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Grouper Rate,5730.00
United HealthCare,HMO,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,3965.00
United HealthCare,HMO,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,5730.00
United HealthCare,HMO,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5730.00
United HealthCare,HMO,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5730.00
United HealthCare,HMO,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5730.00
United HealthCare,HMO,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5730.00
United HealthCare,HMO,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5730.00
United HealthCare,HMO,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,5730.00
United HealthCare,HMO,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Grouper Rate,5730.00
United HealthCare,HMO,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,5730.00
United HealthCare,HMO,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,1291.00
United HealthCare,HMO,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,3965.00
United HealthCare,HMO,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Grouper Rate,1291.00
United HealthCare,HMO,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Grouper Rate,1291.00
United HealthCare,HMO,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Grouper Rate,1145.00
United HealthCare,HMO,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Grouper Rate,1145.00
United HealthCare,HMO,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Grouper Rate,1291.00
United HealthCare,HMO,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1291.00
United HealthCare,HMO,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1291.00
United HealthCare,HMO,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3965.00
United HealthCare,HMO,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,3965.00
United HealthCare,HMO,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Grouper Rate,3965.00
United HealthCare,HMO,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Grouper Rate,4847.00
United HealthCare,HMO,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Grouper Rate,3965.00
United HealthCare,HMO,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Grouper Rate,4847.00
United HealthCare,HMO,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,3965.00
United HealthCare,HMO,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Grouper Rate,4847.00
United HealthCare,HMO,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Grouper Rate,4847.00
United HealthCare,HMO,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Grouper Rate,3965.00
United HealthCare,HMO,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Grouper Rate,4847.00
United HealthCare,HMO,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,4847.00
United HealthCare,HMO,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,4847.00
United HealthCare,HMO,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1291.00
United HealthCare,HMO,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1291.00
United HealthCare,HMO,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Grouper Rate,4847.00
United HealthCare,HMO,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Grouper Rate,4847.00
United HealthCare,HMO,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Grouper Rate,4847.00
United HealthCare,HMO,31295,CPT4/HCPCS,NSL/SINS NDSC SURG MAX SINS,,Grouper Rate,4847.00
United HealthCare,HMO,31296,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT SINS,,Grouper Rate,4847.00
United HealthCare,HMO,31297,CPT4/HCPCS,NSL/SINS NDSC SURG SPHN SINS,,Grouper Rate,3965.00
United HealthCare,HMO,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Grouper Rate,4847.00
United HealthCare,HMO,31299,CPT4/HCPCS,SINUS SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,3965.00
United HealthCare,HMO,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,Grouper Rate,1291.00
United HealthCare,HMO,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,Grouper Rate,1291.00
United HealthCare,HMO,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1291.00
United HealthCare,HMO,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1291.00
United HealthCare,HMO,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1291.00
United HealthCare,HMO,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1291.00
United HealthCare,HMO,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1291.00
United HealthCare,HMO,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1291.00
United HealthCare,HMO,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,Grouper Rate,1291.00
United HealthCare,HMO,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,Grouper Rate,1291.00
United HealthCare,HMO,31400,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,5730.00
United HealthCare,HMO,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Grouper Rate,5730.00
United HealthCare,HMO,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Grouper Rate,1145.00
United HealthCare,HMO,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Grouper Rate,1145.00
United HealthCare,HMO,31505,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Grouper Rate,1145.00
United HealthCare,HMO,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Grouper Rate,1145.00
United HealthCare,HMO,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,3965.00
United HealthCare,HMO,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Grouper Rate,1145.00
United HealthCare,HMO,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Grouper Rate,1145.00
United HealthCare,HMO,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Grouper Rate,1145.00
United HealthCare,HMO,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Grouper Rate,1291.00
United HealthCare,HMO,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Grouper Rate,1291.00
United HealthCare,HMO,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,3965.00
United HealthCare,HMO,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,3965.00
United HealthCare,HMO,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Grouper Rate,1291.00
United HealthCare,HMO,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Grouper Rate,3965.00
United HealthCare,HMO,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Grouper Rate,3965.00
United HealthCare,HMO,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Grouper Rate,3965.00
United HealthCare,HMO,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Grouper Rate,3965.00
United HealthCare,HMO,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Grouper Rate,3965.00
United HealthCare,HMO,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5730.00
United HealthCare,HMO,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5730.00
United HealthCare,HMO,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5730.00
United HealthCare,HMO,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,5730.00
United HealthCare,HMO,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Grouper Rate,4847.00
United HealthCare,HMO,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Grouper Rate,3965.00
United HealthCare,HMO,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Grouper Rate,1291.00
United HealthCare,HMO,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Grouper Rate,3965.00
United HealthCare,HMO,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Grouper Rate,3965.00
United HealthCare,HMO,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Grouper Rate,1291.00
United HealthCare,HMO,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Grouper Rate,1291.00
United HealthCare,HMO,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Grouper Rate,1145.00
United HealthCare,HMO,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Grouper Rate,1145.00
United HealthCare,HMO,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Grouper Rate,1145.00
United HealthCare,HMO,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Grouper Rate,5730.00
United HealthCare,HMO,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Grouper Rate,4847.00
United HealthCare,HMO,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Grouper Rate,5730.00
United HealthCare,HMO,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Grouper Rate,5730.00
United HealthCare,HMO,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Grouper Rate,5730.00
United HealthCare,HMO,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Grouper Rate,5730.00
United HealthCare,HMO,31599,CPT4/HCPCS,LARYNX SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,3965.00
United HealthCare,HMO,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,3965.00
United HealthCare,HMO,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1291.00
United HealthCare,HMO,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1145.00
United HealthCare,HMO,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,3965.00
United HealthCare,HMO,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Grouper Rate,3965.00
United HealthCare,HMO,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Grouper Rate,3965.00
United HealthCare,HMO,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,3965.00
United HealthCare,HMO,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,5730.00
United HealthCare,HMO,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Grouper Rate,1145.00
United HealthCare,HMO,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Grouper Rate,1291.00
United HealthCare,HMO,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Grouper Rate,1291.00
United HealthCare,HMO,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Grouper Rate,1291.00
United HealthCare,HMO,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Grouper Rate,1291.00
United HealthCare,HMO,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Grouper Rate,4847.00
United HealthCare,HMO,31627,CPT4/HCPCS,NAVIGATIONAL BRONCHOSCOPY,,Grouper Rate,1145.00
United HealthCare,HMO,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Grouper Rate,1291.00
United HealthCare,HMO,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Grouper Rate,4847.00
United HealthCare,HMO,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Grouper Rate,4847.00
United HealthCare,HMO,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Grouper Rate,4847.00
United HealthCare,HMO,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Grouper Rate,4847.00
United HealthCare,HMO,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Grouper Rate,4847.00
United HealthCare,HMO,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Grouper Rate,4847.00
United HealthCare,HMO,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Grouper Rate,4847.00
United HealthCare,HMO,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Grouper Rate,4847.00
United HealthCare,HMO,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Grouper Rate,1291.00
United HealthCare,HMO,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Grouper Rate,1291.00
United HealthCare,HMO,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Grouper Rate,1145.00
United HealthCare,HMO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Grouper Rate,4847.00
United HealthCare,HMO,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Grouper Rate,4847.00
United HealthCare,HMO,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,31651,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,Grouper Rate,1145.00
United HealthCare,HMO,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Grouper Rate,3965.00
United HealthCare,HMO,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Grouper Rate,3965.00
United HealthCare,HMO,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Grouper Rate,1145.00
United HealthCare,HMO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Grouper Rate,4847.00
United HealthCare,HMO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Grouper Rate,4847.00
United HealthCare,HMO,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Grouper Rate,1145.00
United HealthCare,HMO,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,1145.00
United HealthCare,HMO,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,1291.00
United HealthCare,HMO,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Grouper Rate,1291.00
United HealthCare,HMO,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,5730.00
United HealthCare,HMO,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,5730.00
United HealthCare,HMO,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,1291.00
United HealthCare,HMO,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,Grouper Rate,1291.00
United HealthCare,HMO,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,Grouper Rate,1291.00
United HealthCare,HMO,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,Grouper Rate,1291.00
United HealthCare,HMO,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Grouper Rate,1291.00
United HealthCare,HMO,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Grouper Rate,1291.00
United HealthCare,HMO,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,1291.00
United HealthCare,HMO,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,1291.00
United HealthCare,HMO,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Grouper Rate,3965.00
United HealthCare,HMO,31899,CPT4/HCPCS,AIRWAYS SURGICAL PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,Grouper Rate,1291.00
United HealthCare,HMO,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,Grouper Rate,1291.00
United HealthCare,HMO,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,Grouper Rate,1291.00
United HealthCare,HMO,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,Grouper Rate,1291.00
United HealthCare,HMO,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,1291.00
United HealthCare,HMO,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,Grouper Rate,1291.00
United HealthCare,HMO,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,Grouper Rate,1291.00
United HealthCare,HMO,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,Grouper Rate,1291.00
United HealthCare,HMO,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Grouper Rate,1291.00
United HealthCare,HMO,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,Grouper Rate,1291.00
United HealthCare,HMO,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Grouper Rate,1291.00
United HealthCare,HMO,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,Grouper Rate,1291.00
United HealthCare,HMO,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,Grouper Rate,1291.00
United HealthCare,HMO,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,Grouper Rate,1291.00
United HealthCare,HMO,32215,CPT4/HCPCS,TREAT CHEST LINING,,Grouper Rate,1291.00
United HealthCare,HMO,32220,CPT4/HCPCS,RELEASE OF LUNG,,Grouper Rate,1291.00
United HealthCare,HMO,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,Grouper Rate,1291.00
United HealthCare,HMO,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,Grouper Rate,1291.00
United HealthCare,HMO,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,Grouper Rate,1291.00
United HealthCare,HMO,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Grouper Rate,1291.00
United HealthCare,HMO,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Grouper Rate,1291.00
United HealthCare,HMO,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,Grouper Rate,1291.00
United HealthCare,HMO,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,Grouper Rate,1291.00
United HealthCare,HMO,32482,CPT4/HCPCS,BILOBECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,32484,CPT4/HCPCS,SEGMENTECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,32488,CPT4/HCPCS,COMPLETION PNEUMONECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,Grouper Rate,1291.00
United HealthCare,HMO,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,32503,CPT4/HCPCS,RESECT APICAL LUNG TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,32504,CPT4/HCPCS,RESECT APICAL LUNG TUM/CHEST,,Grouper Rate,1291.00
United HealthCare,HMO,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,Grouper Rate,1291.00
United HealthCare,HMO,32506,CPT4/HCPCS,WEDGE RESECT OF LUNG ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,32507,CPT4/HCPCS,WEDGE RESECT OF LUNG DIAG,,Grouper Rate,1291.00
United HealthCare,HMO,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,Grouper Rate,1291.00
United HealthCare,HMO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Grouper Rate,4847.00
United HealthCare,HMO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Grouper Rate,1235.00
United HealthCare,HMO,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Grouper Rate,1235.00
United HealthCare,HMO,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Grouper Rate,1291.00
United HealthCare,HMO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Grouper Rate,1235.00
United HealthCare,HMO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Grouper Rate,1235.00
United HealthCare,HMO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Grouper Rate,1291.00
United HealthCare,HMO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Grouper Rate,1235.00
United HealthCare,HMO,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Grouper Rate,1235.00
United HealthCare,HMO,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Grouper Rate,1235.00
United HealthCare,HMO,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Grouper Rate,1235.00
United HealthCare,HMO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Grouper Rate,5730.00
United HealthCare,HMO,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Grouper Rate,5730.00
United HealthCare,HMO,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Grouper Rate,5730.00
United HealthCare,HMO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Grouper Rate,5730.00
United HealthCare,HMO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Grouper Rate,5730.00
United HealthCare,HMO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Grouper Rate,5730.00
United HealthCare,HMO,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,Grouper Rate,9547.00
United HealthCare,HMO,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,Grouper Rate,9547.00
United HealthCare,HMO,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,Grouper Rate,9547.00
United HealthCare,HMO,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,Grouper Rate,6612.00
United HealthCare,HMO,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,Grouper Rate,1291.00
United HealthCare,HMO,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,Grouper Rate,9547.00
United HealthCare,HMO,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,Grouper Rate,9547.00
United HealthCare,HMO,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,Grouper Rate,1291.00
United HealthCare,HMO,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,Grouper Rate,1291.00
United HealthCare,HMO,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,Grouper Rate,1291.00
United HealthCare,HMO,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Grouper Rate,4847.00
United HealthCare,HMO,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,Grouper Rate,1291.00
United HealthCare,HMO,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,Grouper Rate,1291.00
United HealthCare,HMO,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,Grouper Rate,1291.00
United HealthCare,HMO,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,Grouper Rate,1291.00
United HealthCare,HMO,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,Grouper Rate,1291.00
United HealthCare,HMO,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,Grouper Rate,1291.00
United HealthCare,HMO,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,Grouper Rate,1291.00
United HealthCare,HMO,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,Grouper Rate,1291.00
United HealthCare,HMO,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,Grouper Rate,1291.00
United HealthCare,HMO,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,Grouper Rate,1291.00
United HealthCare,HMO,32852,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Grouper Rate,1291.00
United HealthCare,HMO,32853,CPT4/HCPCS,LUNG TRANSPLANT DOUBLE,,Grouper Rate,1291.00
United HealthCare,HMO,32854,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Grouper Rate,1291.00
United HealthCare,HMO,32855,CPT4/HCPCS,PREPARE DONOR LUNG SINGLE,,Grouper Rate,1291.00
United HealthCare,HMO,32856,CPT4/HCPCS,PREPARE DONOR LUNG DOUBLE,,Grouper Rate,1291.00
United HealthCare,HMO,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,Grouper Rate,1291.00
United HealthCare,HMO,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Grouper Rate,1291.00
United HealthCare,HMO,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Grouper Rate,1291.00
United HealthCare,HMO,32940,CPT4/HCPCS,REVISION OF LUNG,,Grouper Rate,1291.00
United HealthCare,HMO,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,Grouper Rate,1235.00
United HealthCare,HMO,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Grouper Rate,6612.00
United HealthCare,HMO,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,Grouper Rate,1291.00
United HealthCare,HMO,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Grouper Rate,6612.00
United HealthCare,HMO,32999,CPT4/HCPCS,CHEST SURGERY PROCEDURE,,Grouper Rate,1235.00
United HealthCare,HMO,33016,CPT4/HCPCS,PERICARDIOCENTESIS W/IMAGING,,Grouper Rate,1235.00
United HealthCare,HMO,33017,CPT4/HCPCS,PRCRD DRG 6YR+ W/O CGEN CAR,,Grouper Rate,1291.00
United HealthCare,HMO,33018,CPT4/HCPCS,PRCRD DRG 0-5YR OR W/ANOMLY,,Grouper Rate,1291.00
United HealthCare,HMO,33019,CPT4/HCPCS,PERQ PRCRD DRG INSJ CATH CT,,Grouper Rate,1291.00
United HealthCare,HMO,33020,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,1291.00
United HealthCare,HMO,33025,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,1291.00
United HealthCare,HMO,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Grouper Rate,1291.00
United HealthCare,HMO,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Grouper Rate,1291.00
United HealthCare,HMO,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,Grouper Rate,1291.00
United HealthCare,HMO,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,1291.00
United HealthCare,HMO,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,1291.00
United HealthCare,HMO,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,Grouper Rate,1291.00
United HealthCare,HMO,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,33202,CPT4/HCPCS,INSERT EPICARD ELTRD OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,33203,CPT4/HCPCS,INSERT EPICARD ELTRD ENDO,,Grouper Rate,1291.00
United HealthCare,HMO,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Case Rate,10164.00
United HealthCare,HMO,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Case Rate,10164.00
United HealthCare,HMO,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Case Rate,10164.00
United HealthCare,HMO,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Grouper Rate,6612.00
United HealthCare,HMO,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Grouper Rate,6612.00
United HealthCare,HMO,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Case Rate,10164.00
United HealthCare,HMO,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Case Rate,10164.00
United HealthCare,HMO,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Case Rate,10164.00
United HealthCare,HMO,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Grouper Rate,4847.00
United HealthCare,HMO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Grouper Rate,6612.00
United HealthCare,HMO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Grouper Rate,6612.00
United HealthCare,HMO,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Grouper Rate,4847.00
United HealthCare,HMO,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Grouper Rate,4847.00
United HealthCare,HMO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Case Rate,10164.00
United HealthCare,HMO,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Grouper Rate,1291.00
United HealthCare,HMO,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Grouper Rate,1291.00
United HealthCare,HMO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Case Rate,10164.00
United HealthCare,HMO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Case Rate,10164.00
United HealthCare,HMO,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Grouper Rate,4847.00
United HealthCare,HMO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Case Rate,10164.00
United HealthCare,HMO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Case Rate,10164.00
United HealthCare,HMO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Case Rate,10164.00
United HealthCare,HMO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Case Rate,22812.00
United HealthCare,HMO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Case Rate,22812.00
United HealthCare,HMO,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Grouper Rate,4847.00
United HealthCare,HMO,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Grouper Rate,4847.00
United HealthCare,HMO,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Grouper Rate,4847.00
United HealthCare,HMO,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Case Rate,22812.00
United HealthCare,HMO,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Grouper Rate,4847.00
United HealthCare,HMO,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,Grouper Rate,5730.00
United HealthCare,HMO,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Grouper Rate,4847.00
United HealthCare,HMO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Case Rate,22812.00
United HealthCare,HMO,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,1291.00
United HealthCare,HMO,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,1291.00
United HealthCare,HMO,33254,CPT4/HCPCS,ABLATE ATRIA LMTD,,Grouper Rate,1291.00
United HealthCare,HMO,33255,CPT4/HCPCS,ABLATE ATRIA W/O BYPASS EXT,,Grouper Rate,1291.00
United HealthCare,HMO,33256,CPT4/HCPCS,ABLATE ATRIA W/BYPASS EXTEN,,Grouper Rate,1291.00
United HealthCare,HMO,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,1291.00
United HealthCare,HMO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Case Rate,22812.00
United HealthCare,HMO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Case Rate,22812.00
United HealthCare,HMO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Case Rate,22812.00
United HealthCare,HMO,33265,CPT4/HCPCS,ABLATE ATRIA LMTD ENDO,,Grouper Rate,1291.00
United HealthCare,HMO,33266,CPT4/HCPCS,ABLATE ATRIA X10SV ENDO,,Grouper Rate,1291.00
United HealthCare,HMO,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Case Rate,22812.00
United HealthCare,HMO,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Case Rate,22812.00
United HealthCare,HMO,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Case Rate,22812.00
United HealthCare,HMO,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Grouper Rate,4847.00
United HealthCare,HMO,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,Grouper Rate,13506.00
United HealthCare,HMO,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,Grouper Rate,4847.00
United HealthCare,HMO,33285,CPT4/HCPCS,INSJ SUBQ CAR RHYTHM MNTR,,Grouper Rate,9547.00
United HealthCare,HMO,33286,CPT4/HCPCS,RMVL SUBQ CAR RHYTHM MNTR,,Grouper Rate,1235.00
United HealthCare,HMO,33289,CPT4/HCPCS,TCAT IMPL WRLS P-ART PRS SNR,,Grouper Rate,22812.00
United HealthCare,HMO,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Grouper Rate,1291.00
United HealthCare,HMO,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,Grouper Rate,1291.00
United HealthCare,HMO,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Grouper Rate,1291.00
United HealthCare,HMO,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,Grouper Rate,1291.00
United HealthCare,HMO,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,Grouper Rate,1291.00
United HealthCare,HMO,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,1291.00
United HealthCare,HMO,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,1291.00
United HealthCare,HMO,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,1291.00
United HealthCare,HMO,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,Grouper Rate,1291.00
United HealthCare,HMO,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,1291.00
United HealthCare,HMO,33406,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,1291.00
United HealthCare,HMO,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,1291.00
United HealthCare,HMO,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33413,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33414,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,Grouper Rate,1291.00
United HealthCare,HMO,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Grouper Rate,1145.00
United HealthCare,HMO,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33440,CPT4/HCPCS,RPLCMT A-VALVE TLCJ AUTOL PV,,Grouper Rate,1291.00
United HealthCare,HMO,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33463,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Grouper Rate,1291.00
United HealthCare,HMO,33464,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Grouper Rate,1291.00
United HealthCare,HMO,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33475,CPT4/HCPCS,REPLACEMENT PULMONARY VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1291.00
United HealthCare,HMO,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,Grouper Rate,1291.00
United HealthCare,HMO,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1291.00
United HealthCare,HMO,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,Grouper Rate,1291.00
United HealthCare,HMO,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,Grouper Rate,1291.00
United HealthCare,HMO,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,33505,CPT4/HCPCS,REPAIR ARTERY W/TUNNEL,,Grouper Rate,1291.00
United HealthCare,HMO,33506,CPT4/HCPCS,REPAIR ARTERY TRANSLOCATION,,Grouper Rate,1291.00
United HealthCare,HMO,33507,CPT4/HCPCS,REPAIR ART INTRAMURAL,,Grouper Rate,1291.00
United HealthCare,HMO,33508,CPT4/HCPCS,ENDOSCOPIC VEIN HARVEST,,Grouper Rate,1145.00
United HealthCare,HMO,33510,CPT4/HCPCS,CABG VEIN SINGLE,,Grouper Rate,1291.00
United HealthCare,HMO,33511,CPT4/HCPCS,CABG VEIN TWO,,Grouper Rate,1291.00
United HealthCare,HMO,33512,CPT4/HCPCS,CABG VEIN THREE,,Grouper Rate,1291.00
United HealthCare,HMO,33513,CPT4/HCPCS,CABG VEIN FOUR,,Grouper Rate,1291.00
United HealthCare,HMO,33514,CPT4/HCPCS,CABG VEIN FIVE,,Grouper Rate,1291.00
United HealthCare,HMO,33516,CPT4/HCPCS,CABG VEIN SIX OR MORE,,Grouper Rate,1291.00
United HealthCare,HMO,33517,CPT4/HCPCS,CABG ARTERY-VEIN SINGLE,,Grouper Rate,1291.00
United HealthCare,HMO,33518,CPT4/HCPCS,CABG ARTERY-VEIN TWO,,Grouper Rate,1291.00
United HealthCare,HMO,33519,CPT4/HCPCS,CABG ARTERY-VEIN THREE,,Grouper Rate,1291.00
United HealthCare,HMO,33521,CPT4/HCPCS,CABG ARTERY-VEIN FOUR,,Grouper Rate,1291.00
United HealthCare,HMO,33522,CPT4/HCPCS,CABG ARTERY-VEIN FIVE,,Grouper Rate,1291.00
United HealthCare,HMO,33523,CPT4/HCPCS,CABG ART-VEIN SIX OR MORE,,Grouper Rate,1291.00
United HealthCare,HMO,33530,CPT4/HCPCS,CORONARY ARTERY BYPASS/REOP,,Grouper Rate,1291.00
United HealthCare,HMO,33533,CPT4/HCPCS,CABG ARTERIAL SINGLE,,Grouper Rate,1291.00
United HealthCare,HMO,33534,CPT4/HCPCS,CABG ARTERIAL TWO,,Grouper Rate,1291.00
United HealthCare,HMO,33535,CPT4/HCPCS,CABG ARTERIAL THREE,,Grouper Rate,1291.00
United HealthCare,HMO,33536,CPT4/HCPCS,CABG ARTERIAL FOUR OR MORE,,Grouper Rate,1291.00
United HealthCare,HMO,33542,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,1291.00
United HealthCare,HMO,33545,CPT4/HCPCS,REPAIR OF HEART DAMAGE,,Grouper Rate,1291.00
United HealthCare,HMO,33548,CPT4/HCPCS,RESTORE/REMODEL VENTRICLE,,Grouper Rate,1291.00
United HealthCare,HMO,33572,CPT4/HCPCS,OPEN CORONARY ENDARTERECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,33600,CPT4/HCPCS,CLOSURE OF VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33602,CPT4/HCPCS,CLOSURE OF VALVE,,Grouper Rate,1291.00
United HealthCare,HMO,33606,CPT4/HCPCS,ANASTOMOSIS/ARTERY-AORTA,,Grouper Rate,1291.00
United HealthCare,HMO,33608,CPT4/HCPCS,REPAIR ANOMALY W/CONDUIT,,Grouper Rate,1291.00
United HealthCare,HMO,33610,CPT4/HCPCS,REPAIR BY ENLARGEMENT,,Grouper Rate,1291.00
United HealthCare,HMO,33611,CPT4/HCPCS,REPAIR DOUBLE VENTRICLE,,Grouper Rate,1291.00
United HealthCare,HMO,33612,CPT4/HCPCS,REPAIR DOUBLE VENTRICLE,,Grouper Rate,1291.00
United HealthCare,HMO,33615,CPT4/HCPCS,REPAIR MODIFIED FONTAN,,Grouper Rate,1291.00
United HealthCare,HMO,33617,CPT4/HCPCS,REPAIR SINGLE VENTRICLE,,Grouper Rate,1291.00
United HealthCare,HMO,33619,CPT4/HCPCS,REPAIR SINGLE VENTRICLE,,Grouper Rate,1291.00
United HealthCare,HMO,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,Grouper Rate,1291.00
United HealthCare,HMO,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,Grouper Rate,1291.00
United HealthCare,HMO,33622,CPT4/HCPCS,REDO COMPL CARDIAC ANOMALY,,Grouper Rate,1291.00
United HealthCare,HMO,33641,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33645,CPT4/HCPCS,REVISION OF HEART VEINS,,Grouper Rate,1291.00
United HealthCare,HMO,33647,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECTS,,Grouper Rate,1291.00
United HealthCare,HMO,33660,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1291.00
United HealthCare,HMO,33665,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1291.00
United HealthCare,HMO,33670,CPT4/HCPCS,REPAIR OF HEART CHAMBERS,,Grouper Rate,1291.00
United HealthCare,HMO,33675,CPT4/HCPCS,CLOSE MULT VSD,,Grouper Rate,1291.00
United HealthCare,HMO,33676,CPT4/HCPCS,CLOSE MULT VSD W/RESECTION,,Grouper Rate,1291.00
United HealthCare,HMO,33677,CPT4/HCPCS,CL MULT VSD W/REM PUL BAND,,Grouper Rate,1291.00
United HealthCare,HMO,33681,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33684,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33688,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33690,CPT4/HCPCS,REINFORCE PULMONARY ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,33692,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1291.00
United HealthCare,HMO,33694,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1291.00
United HealthCare,HMO,33697,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1291.00
United HealthCare,HMO,33702,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1291.00
United HealthCare,HMO,33710,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1291.00
United HealthCare,HMO,33720,CPT4/HCPCS,REPAIR OF HEART DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33722,CPT4/HCPCS,REPAIR OF HEART DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33724,CPT4/HCPCS,REPAIR VENOUS ANOMALY,,Grouper Rate,1291.00
United HealthCare,HMO,33726,CPT4/HCPCS,REPAIR PUL VENOUS STENOSIS,,Grouper Rate,1291.00
United HealthCare,HMO,33730,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT(S),,Grouper Rate,1291.00
United HealthCare,HMO,33732,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33735,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1291.00
United HealthCare,HMO,33736,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1291.00
United HealthCare,HMO,33737,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1291.00
United HealthCare,HMO,33750,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,33755,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,33762,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,33764,CPT4/HCPCS,MAJOR VESSEL SHUNT & GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,33766,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,33767,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,33768,CPT4/HCPCS,CAVOPULMONARY SHUNTING,,Grouper Rate,1291.00
United HealthCare,HMO,33770,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33771,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33774,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33775,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33776,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33777,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33778,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33779,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33780,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33781,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33782,CPT4/HCPCS,NIKAIDOH PROC,,Grouper Rate,1291.00
United HealthCare,HMO,33783,CPT4/HCPCS,NIKAIDOH PROC W/OSTIA IMPLT,,Grouper Rate,1291.00
United HealthCare,HMO,33786,CPT4/HCPCS,REPAIR ARTERIAL TRUNK,,Grouper Rate,1291.00
United HealthCare,HMO,33788,CPT4/HCPCS,REVISION OF PULMONARY ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,33800,CPT4/HCPCS,AORTIC SUSPENSION,,Grouper Rate,1291.00
United HealthCare,HMO,33802,CPT4/HCPCS,REPAIR VESSEL DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33803,CPT4/HCPCS,REPAIR VESSEL DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33813,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33814,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33820,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,10164.00
United HealthCare,HMO,33822,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,9547.00
United HealthCare,HMO,33824,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,10164.00
United HealthCare,HMO,33840,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,1291.00
United HealthCare,HMO,33845,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,1291.00
United HealthCare,HMO,33851,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,1291.00
United HealthCare,HMO,33852,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33853,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,33858,CPT4/HCPCS,AS-AORT GRF F/AORTIC DSJ,,Grouper Rate,1291.00
United HealthCare,HMO,33859,CPT4/HCPCS,AS-AORT GRF F/DS OTH/THN DSJ,,Grouper Rate,1291.00
United HealthCare,HMO,33863,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,33864,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,33866,CPT4/HCPCS,AORTIC HEMIARCH GRAFT,,Grouper Rate,1145.00
United HealthCare,HMO,33871,CPT4/HCPCS,TRANSVRS A-ARCH GRF HYPTHRM,,Grouper Rate,1291.00
United HealthCare,HMO,33875,CPT4/HCPCS,THORACIC AORTIC GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,33877,CPT4/HCPCS,THORACOABDOMINAL GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,33880,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,Grouper Rate,1291.00
United HealthCare,HMO,33881,CPT4/HCPCS,ENDOVASC TAA REPR W/O SUBCL,,Grouper Rate,1291.00
United HealthCare,HMO,33883,CPT4/HCPCS,INSERT ENDOVASC PROSTH TAA,,Grouper Rate,1291.00
United HealthCare,HMO,33884,CPT4/HCPCS,ENDOVASC PROSTH TAA ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,33886,CPT4/HCPCS,ENDOVASC PROSTH DELAYED,,Grouper Rate,1291.00
United HealthCare,HMO,33889,CPT4/HCPCS,ARTERY TRANSPOSE/ENDOVAS TAA,,Grouper Rate,1291.00
United HealthCare,HMO,33891,CPT4/HCPCS,CAR-CAR BP GRFT/ENDOVAS TAA,,Grouper Rate,1291.00
United HealthCare,HMO,33910,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,Grouper Rate,1291.00
United HealthCare,HMO,33915,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,Grouper Rate,1291.00
United HealthCare,HMO,33916,CPT4/HCPCS,SURGERY OF GREAT VESSEL,,Grouper Rate,1291.00
United HealthCare,HMO,33917,CPT4/HCPCS,REPAIR PULMONARY ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,33920,CPT4/HCPCS,REPAIR PULMONARY ATRESIA,,Grouper Rate,1291.00
United HealthCare,HMO,33922,CPT4/HCPCS,TRANSECT PULMONARY ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,33924,CPT4/HCPCS,REMOVE PULMONARY SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,33925,CPT4/HCPCS,RPR PUL ART UNIFOCAL W/O CPB,,Grouper Rate,1291.00
United HealthCare,HMO,33926,CPT4/HCPCS,REPR PUL ART UNIFOCAL W/CPB,,Grouper Rate,1291.00
United HealthCare,HMO,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,Grouper Rate,1291.00
United HealthCare,HMO,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,Grouper Rate,1291.00
United HealthCare,HMO,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,Grouper Rate,1291.00
United HealthCare,HMO,33930,CPT4/HCPCS,REMOVAL OF DONOR HEART/LUNG,,Grouper Rate,1291.00
United HealthCare,HMO,33933,CPT4/HCPCS,PREPARE DONOR HEART/LUNG,,Grouper Rate,1291.00
United HealthCare,HMO,33935,CPT4/HCPCS,TRANSPLANTATION HEART/LUNG,,Grouper Rate,1291.00
United HealthCare,HMO,33940,CPT4/HCPCS,REMOVAL OF DONOR HEART,,Grouper Rate,1291.00
United HealthCare,HMO,33944,CPT4/HCPCS,PREPARE DONOR HEART,,Grouper Rate,1291.00
United HealthCare,HMO,33945,CPT4/HCPCS,TRANSPLANTATION OF HEART,,Grouper Rate,1291.00
United HealthCare,HMO,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,Grouper Rate,1291.00
United HealthCare,HMO,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,Grouper Rate,1291.00
United HealthCare,HMO,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33967,CPT4/HCPCS,INSERT I-AORT PERCUT DEVICE,,Grouper Rate,13506.00
United HealthCare,HMO,33968,CPT4/HCPCS,REMOVE AORTIC ASSIST DEVICE,,Grouper Rate,13506.00
United HealthCare,HMO,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33970,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,Grouper Rate,1291.00
United HealthCare,HMO,33971,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,Grouper Rate,1291.00
United HealthCare,HMO,33973,CPT4/HCPCS,INSERT BALLOON DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,33974,CPT4/HCPCS,REMOVE INTRA-AORTIC BALLOON,,Grouper Rate,1291.00
United HealthCare,HMO,33975,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,33976,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,33977,CPT4/HCPCS,REMOVE VENTRICULAR DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,33978,CPT4/HCPCS,REMOVE VENTRICULAR DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,33979,CPT4/HCPCS,INSERT INTRACORPOREAL DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,33980,CPT4/HCPCS,REMOVE INTRACORPOREAL DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,33981,CPT4/HCPCS,REPLACE VAD PUMP EXT,,Grouper Rate,1291.00
United HealthCare,HMO,33982,CPT4/HCPCS,REPLACE VAD INTRA W/O BP,,Grouper Rate,1291.00
United HealthCare,HMO,33983,CPT4/HCPCS,REPLACE VAD INTRA W/BP,,Grouper Rate,1291.00
United HealthCare,HMO,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Grouper Rate,1291.00
United HealthCare,HMO,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,Grouper Rate,1291.00
United HealthCare,HMO,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,Grouper Rate,1291.00
United HealthCare,HMO,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,Grouper Rate,1291.00
United HealthCare,HMO,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,Grouper Rate,1291.00
United HealthCare,HMO,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,Grouper Rate,1291.00
United HealthCare,HMO,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,Grouper Rate,1291.00
United HealthCare,HMO,33999,CPT4/HCPCS,CARDIAC SURGERY PROCEDURE,,Grouper Rate,1235.00
United HealthCare,HMO,34001,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,1291.00
United HealthCare,HMO,34051,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,1291.00
United HealthCare,HMO,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,6612.00
United HealthCare,HMO,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,Grouper Rate,6612.00
United HealthCare,HMO,34151,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,1291.00
United HealthCare,HMO,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,6612.00
United HealthCare,HMO,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,Grouper Rate,6612.00
United HealthCare,HMO,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,1291.00
United HealthCare,HMO,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,4847.00
United HealthCare,HMO,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,1291.00
United HealthCare,HMO,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,1235.00
United HealthCare,HMO,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,4847.00
United HealthCare,HMO,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,Grouper Rate,6612.00
United HealthCare,HMO,34502,CPT4/HCPCS,RECONSTRUCT VENA CAVA,,Grouper Rate,1291.00
United HealthCare,HMO,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,Grouper Rate,6612.00
United HealthCare,HMO,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,Grouper Rate,6612.00
United HealthCare,HMO,34530,CPT4/HCPCS,LEG VEIN FUSION,,Grouper Rate,4847.00
United HealthCare,HMO,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Grouper Rate,1291.00
United HealthCare,HMO,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Grouper Rate,1291.00
United HealthCare,HMO,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Grouper Rate,1291.00
United HealthCare,HMO,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Grouper Rate,1291.00
United HealthCare,HMO,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Grouper Rate,1291.00
United HealthCare,HMO,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Grouper Rate,1291.00
United HealthCare,HMO,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Grouper Rate,1291.00
United HealthCare,HMO,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Grouper Rate,1291.00
United HealthCare,HMO,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Grouper Rate,1291.00
United HealthCare,HMO,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Grouper Rate,1291.00
United HealthCare,HMO,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Grouper Rate,1291.00
United HealthCare,HMO,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Grouper Rate,1145.00
United HealthCare,HMO,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Grouper Rate,1145.00
United HealthCare,HMO,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Grouper Rate,1145.00
United HealthCare,HMO,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Grouper Rate,1145.00
United HealthCare,HMO,34717,CPT4/HCPCS,EVASC RPR A-ILIAC NDGFT,,Grouper Rate,1291.00
United HealthCare,HMO,34718,CPT4/HCPCS,EVASC RPR N/A A-ILIAC NDGFT,,Grouper Rate,1291.00
United HealthCare,HMO,34808,CPT4/HCPCS,ENDOVAS ILIAC A DEVICE ADDON,,Grouper Rate,1291.00
United HealthCare,HMO,34812,CPT4/HCPCS,OPN FEM ART EXPOS,,Grouper Rate,1291.00
United HealthCare,HMO,34813,CPT4/HCPCS,FEMORAL ENDOVAS GRAFT ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,34820,CPT4/HCPCS,OPN ILIAC ART EXPOS,,Grouper Rate,1291.00
United HealthCare,HMO,34830,CPT4/HCPCS,OPEN AORTIC TUBE PROSTH REPR,,Grouper Rate,1291.00
United HealthCare,HMO,34831,CPT4/HCPCS,OPEN AORTOILIAC PROSTH REPR,,Grouper Rate,1291.00
United HealthCare,HMO,34832,CPT4/HCPCS,OPEN AORTOFEMOR PROSTH REPR,,Grouper Rate,1291.00
United HealthCare,HMO,34833,CPT4/HCPCS,OPN ILAC ART EXPOS CNDT CRTJ,,Grouper Rate,1291.00
United HealthCare,HMO,34834,CPT4/HCPCS,OPN BRACH ART EXPOS,,Grouper Rate,1291.00
United HealthCare,HMO,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,Grouper Rate,1291.00
United HealthCare,HMO,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,Grouper Rate,1291.00
United HealthCare,HMO,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,Grouper Rate,1291.00
United HealthCare,HMO,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,Grouper Rate,1291.00
United HealthCare,HMO,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,Grouper Rate,1291.00
United HealthCare,HMO,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,6612.00
United HealthCare,HMO,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,Grouper Rate,1291.00
United HealthCare,HMO,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,Grouper Rate,1291.00
United HealthCare,HMO,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,Grouper Rate,6612.00
United HealthCare,HMO,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,1291.00
United HealthCare,HMO,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,1291.00
United HealthCare,HMO,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,1291.00
United HealthCare,HMO,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,Grouper Rate,1291.00
United HealthCare,HMO,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,Grouper Rate,1291.00
United HealthCare,HMO,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,Grouper Rate,1291.00
United HealthCare,HMO,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,Grouper Rate,1291.00
United HealthCare,HMO,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,Grouper Rate,1291.00
United HealthCare,HMO,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1235.00
United HealthCare,HMO,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,4847.00
United HealthCare,HMO,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6612.00
United HealthCare,HMO,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6612.00
United HealthCare,HMO,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6612.00
United HealthCare,HMO,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,4847.00
United HealthCare,HMO,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,4847.00
United HealthCare,HMO,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1235.00
United HealthCare,HMO,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,4847.00
United HealthCare,HMO,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6612.00
United HealthCare,HMO,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6612.00
United HealthCare,HMO,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,4847.00
United HealthCare,HMO,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6612.00
United HealthCare,HMO,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,6612.00
United HealthCare,HMO,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35302,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35303,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35304,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35305,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35306,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,6612.00
United HealthCare,HMO,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35371,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,35390,CPT4/HCPCS,REOPERATION CAROTID ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,35400,CPT4/HCPCS,ANGIOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,Grouper Rate,1145.00
United HealthCare,HMO,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,Grouper Rate,1291.00
United HealthCare,HMO,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,Grouper Rate,1291.00
United HealthCare,HMO,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,Grouper Rate,1291.00
United HealthCare,HMO,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,Grouper Rate,1291.00
United HealthCare,HMO,35510,CPT4/HCPCS,ART BYP GRFT CAROTID-BRCHIAL,,Grouper Rate,1291.00
United HealthCare,HMO,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,Grouper Rate,1291.00
United HealthCare,HMO,35512,CPT4/HCPCS,ART BYP GRFT SUBCLAV-BRCHIAL,,Grouper Rate,1291.00
United HealthCare,HMO,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,Grouper Rate,1291.00
United HealthCare,HMO,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,Grouper Rate,1291.00
United HealthCare,HMO,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,Grouper Rate,1291.00
United HealthCare,HMO,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35522,CPT4/HCPCS,ART BYP GRFT AXILL-BRACHIAL,,Grouper Rate,1291.00
United HealthCare,HMO,35523,CPT4/HCPCS,ART BYP GRFT BRCHL-ULNR-RDL,,Grouper Rate,1291.00
United HealthCare,HMO,35525,CPT4/HCPCS,ART BYP GRFT BRACHIAL-BRCHL,,Grouper Rate,1291.00
United HealthCare,HMO,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,Grouper Rate,1291.00
United HealthCare,HMO,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,Grouper Rate,1291.00
United HealthCare,HMO,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,Grouper Rate,1291.00
United HealthCare,HMO,35535,CPT4/HCPCS,ART BYP GRFT HEPATORENAL,,Grouper Rate,1291.00
United HealthCare,HMO,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,Grouper Rate,1291.00
United HealthCare,HMO,35537,CPT4/HCPCS,ART BYP GRFT AORTOILIAC,,Grouper Rate,1291.00
United HealthCare,HMO,35538,CPT4/HCPCS,ART BYP GRFT AORTOBI-ILIAC,,Grouper Rate,1291.00
United HealthCare,HMO,35539,CPT4/HCPCS,ART BYP GRFT AORTOFEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35540,CPT4/HCPCS,ART BYP GRFT AORTBIFEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,Grouper Rate,1291.00
United HealthCare,HMO,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,Grouper Rate,1291.00
United HealthCare,HMO,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,Grouper Rate,1291.00
United HealthCare,HMO,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Grouper Rate,1291.00
United HealthCare,HMO,35570,CPT4/HCPCS,ART BYP TIBIAL-TIB/PERONEAL,,Grouper Rate,1291.00
United HealthCare,HMO,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Grouper Rate,1291.00
United HealthCare,HMO,35572,CPT4/HCPCS,HARVEST FEMOROPOPLITEAL VEIN,,Grouper Rate,1145.00
United HealthCare,HMO,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,Grouper Rate,1291.00
United HealthCare,HMO,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,Grouper Rate,1291.00
United HealthCare,HMO,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,Grouper Rate,1291.00
United HealthCare,HMO,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,Grouper Rate,1291.00
United HealthCare,HMO,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,Grouper Rate,1291.00
United HealthCare,HMO,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,Grouper Rate,1291.00
United HealthCare,HMO,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,Grouper Rate,1291.00
United HealthCare,HMO,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35623,CPT4/HCPCS,ART BYP AXILLARY-POP-TIBIAL,,Grouper Rate,1291.00
United HealthCare,HMO,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,Grouper Rate,1291.00
United HealthCare,HMO,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,Grouper Rate,1291.00
United HealthCare,HMO,35632,CPT4/HCPCS,ART BYP ILIO-CELIAC,,Grouper Rate,1291.00
United HealthCare,HMO,35633,CPT4/HCPCS,ART BYP ILIO-MESENTERIC,,Grouper Rate,1291.00
United HealthCare,HMO,35634,CPT4/HCPCS,ART BYP ILIORENAL,,Grouper Rate,1291.00
United HealthCare,HMO,35636,CPT4/HCPCS,ART BYP SPENORENAL,,Grouper Rate,1291.00
United HealthCare,HMO,35637,CPT4/HCPCS,ART BYP AORTOILIAC,,Grouper Rate,1291.00
United HealthCare,HMO,35638,CPT4/HCPCS,ART BYP AORTOBI-ILIAC,,Grouper Rate,1291.00
United HealthCare,HMO,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,Grouper Rate,1291.00
United HealthCare,HMO,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,Grouper Rate,1291.00
United HealthCare,HMO,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,Grouper Rate,1291.00
United HealthCare,HMO,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,Grouper Rate,1291.00
United HealthCare,HMO,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,Grouper Rate,1291.00
United HealthCare,HMO,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,Grouper Rate,1291.00
United HealthCare,HMO,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Grouper Rate,1291.00
United HealthCare,HMO,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Grouper Rate,1291.00
United HealthCare,HMO,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,Grouper Rate,1291.00
United HealthCare,HMO,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,Grouper Rate,1291.00
United HealthCare,HMO,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,Grouper Rate,1291.00
United HealthCare,HMO,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,Grouper Rate,1145.00
United HealthCare,HMO,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,Grouper Rate,1145.00
United HealthCare,HMO,35691,CPT4/HCPCS,ART TRNSPOSJ VERTBRL CAROTID,,Grouper Rate,1291.00
United HealthCare,HMO,35693,CPT4/HCPCS,ART TRNSPOSJ SUBCLAVIAN,,Grouper Rate,1291.00
United HealthCare,HMO,35694,CPT4/HCPCS,ART TRNSPOSJ SUBCLAV CAROTID,,Grouper Rate,1291.00
United HealthCare,HMO,35695,CPT4/HCPCS,ART TRNSPOSJ CAROTID SUBCLAV,,Grouper Rate,1291.00
United HealthCare,HMO,35697,CPT4/HCPCS,REIMPLANT ARTERY EACH,,Grouper Rate,1291.00
United HealthCare,HMO,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,Grouper Rate,1291.00
United HealthCare,HMO,35702,CPT4/HCPCS,EXPL N/FLWD SURG UXTR ART,,Grouper Rate,1291.00
United HealthCare,HMO,35703,CPT4/HCPCS,EXPL N/FLWD SURG LXTR ART,,Grouper Rate,1291.00
United HealthCare,HMO,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,Grouper Rate,1291.00
United HealthCare,HMO,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,Grouper Rate,1291.00
United HealthCare,HMO,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,Grouper Rate,1291.00
United HealthCare,HMO,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,Grouper Rate,4847.00
United HealthCare,HMO,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,6612.00
United HealthCare,HMO,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,6612.00
United HealthCare,HMO,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,6612.00
United HealthCare,HMO,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,6612.00
United HealthCare,HMO,35883,CPT4/HCPCS,REVISE GRAFT W/NONAUTO GRAFT,,Grouper Rate,6612.00
United HealthCare,HMO,35884,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,6612.00
United HealthCare,HMO,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,Grouper Rate,1291.00
United HealthCare,HMO,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,Grouper Rate,4847.00
United HealthCare,HMO,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,Grouper Rate,1291.00
United HealthCare,HMO,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,Grouper Rate,1291.00
United HealthCare,HMO,36000,CPT4/HCPCS,PLACE NEEDLE IN VEIN,,Grouper Rate,1145.00
United HealthCare,HMO,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Grouper Rate,1235.00
United HealthCare,HMO,36005,CPT4/HCPCS,INJECTION EXT VENOGRAPHY,,Grouper Rate,1145.00
United HealthCare,HMO,36010,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1145.00
United HealthCare,HMO,36011,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1145.00
United HealthCare,HMO,36012,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1145.00
United HealthCare,HMO,36013,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1145.00
United HealthCare,HMO,36014,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1145.00
United HealthCare,HMO,36015,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1145.00
United HealthCare,HMO,36100,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,Grouper Rate,1145.00
United HealthCare,HMO,36140,CPT4/HCPCS,INTRO NDL ICATH UPR/LXTR ART,,Grouper Rate,1145.00
United HealthCare,HMO,36160,CPT4/HCPCS,ESTABLISH ACCESS TO AORTA,,Grouper Rate,1145.00
United HealthCare,HMO,36200,CPT4/HCPCS,PLACE CATHETER IN AORTA,,Grouper Rate,1145.00
United HealthCare,HMO,36215,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1145.00
United HealthCare,HMO,36216,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1145.00
United HealthCare,HMO,36217,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1145.00
United HealthCare,HMO,36218,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1145.00
United HealthCare,HMO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Grouper Rate,4847.00
United HealthCare,HMO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,4847.00
United HealthCare,HMO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,6612.00
United HealthCare,HMO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Grouper Rate,6612.00
United HealthCare,HMO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Grouper Rate,4847.00
United HealthCare,HMO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Grouper Rate,6612.00
United HealthCare,HMO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Grouper Rate,1145.00
United HealthCare,HMO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Grouper Rate,1145.00
United HealthCare,HMO,36245,CPT4/HCPCS,INS CATH ABD/L-EXT ART 1ST,,Grouper Rate,1145.00
United HealthCare,HMO,36246,CPT4/HCPCS,INS CATH ABD/L-EXT ART 2ND,,Grouper Rate,1145.00
United HealthCare,HMO,36247,CPT4/HCPCS,INS CATH ABD/L-EXT ART 3RD,,Grouper Rate,1145.00
United HealthCare,HMO,36248,CPT4/HCPCS,INS CATH ABD/L-EXT ART ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,Grouper Rate,4847.00
United HealthCare,HMO,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,Grouper Rate,4847.00
United HealthCare,HMO,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,Grouper Rate,6612.00
United HealthCare,HMO,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,Grouper Rate,4847.00
United HealthCare,HMO,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Grouper Rate,6612.00
United HealthCare,HMO,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Grouper Rate,4847.00
United HealthCare,HMO,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Grouper Rate,4847.00
United HealthCare,HMO,36299,CPT4/HCPCS,VESSEL INJECTION PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Grouper Rate,1145.00
United HealthCare,HMO,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Grouper Rate,1145.00
United HealthCare,HMO,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Grouper Rate,1145.00
United HealthCare,HMO,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Grouper Rate,1145.00
United HealthCare,HMO,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Grouper Rate,1145.00
United HealthCare,HMO,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Grouper Rate,1145.00
United HealthCare,HMO,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Grouper Rate,1145.00
United HealthCare,HMO,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Grouper Rate,1145.00
United HealthCare,HMO,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Grouper Rate,1291.00
United HealthCare,HMO,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Grouper Rate,1291.00
United HealthCare,HMO,36468,CPT4/HCPCS,NJX SCLRSNT SPIDER VEINS,,Grouper Rate,1145.00
United HealthCare,HMO,36470,CPT4/HCPCS,NJX SCLRSNT 1 INCMPTNT VEIN,,Grouper Rate,1145.00
United HealthCare,HMO,36471,CPT4/HCPCS,NJX SCLRSNT MLT INCMPTNT VN,,Grouper Rate,1145.00
United HealthCare,HMO,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Grouper Rate,4847.00
United HealthCare,HMO,36474,CPT4/HCPCS,ENDOVENOUS MCHNCHEM ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Grouper Rate,4847.00
United HealthCare,HMO,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Grouper Rate,4847.00
United HealthCare,HMO,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Grouper Rate,1145.00
United HealthCare,HMO,36481,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1145.00
United HealthCare,HMO,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Grouper Rate,6612.00
United HealthCare,HMO,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Grouper Rate,1145.00
United HealthCare,HMO,36500,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1145.00
United HealthCare,HMO,36510,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1145.00
United HealthCare,HMO,36511,CPT4/HCPCS,APHERESIS WBC,,Grouper Rate,1291.00
United HealthCare,HMO,36512,CPT4/HCPCS,APHERESIS RBC,,Grouper Rate,1291.00
United HealthCare,HMO,36513,CPT4/HCPCS,APHERESIS PLATELETS,,Grouper Rate,1145.00
United HealthCare,HMO,36514,CPT4/HCPCS,APHERESIS PLASMA,,Grouper Rate,1291.00
United HealthCare,HMO,36516,CPT4/HCPCS,APHERESIS IMMUNOADS SLCTV,,Grouper Rate,5730.00
United HealthCare,HMO,36522,CPT4/HCPCS,PHOTOPHERESIS,,Grouper Rate,5730.00
United HealthCare,HMO,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,1235.00
United HealthCare,HMO,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,1235.00
United HealthCare,HMO,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,6612.00
United HealthCare,HMO,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,6612.00
United HealthCare,HMO,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,6612.00
United HealthCare,HMO,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Grouper Rate,1235.00
United HealthCare,HMO,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Grouper Rate,1235.00
United HealthCare,HMO,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36572,CPT4/HCPCS,INSJ PICC RS&I <5 YR,,Grouper Rate,1235.00
United HealthCare,HMO,36573,CPT4/HCPCS,INSJ PICC RS&I 5 YR+,,Grouper Rate,1291.00
United HealthCare,HMO,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,1235.00
United HealthCare,HMO,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,1235.00
United HealthCare,HMO,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Grouper Rate,1235.00
United HealthCare,HMO,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,6612.00
United HealthCare,HMO,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Grouper Rate,1235.00
United HealthCare,HMO,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,1235.00
United HealthCare,HMO,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,1235.00
United HealthCare,HMO,36591,CPT4/HCPCS,DRAW BLOOD OFF VENOUS DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,36592,CPT4/HCPCS,COLLECT BLOOD FROM PICC,,Grouper Rate,1145.00
United HealthCare,HMO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,4847.00
United HealthCare,HMO,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,1235.00
United HealthCare,HMO,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Grouper Rate,1235.00
United HealthCare,HMO,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,Grouper Rate,1145.00
United HealthCare,HMO,36620,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1145.00
United HealthCare,HMO,36625,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1145.00
United HealthCare,HMO,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,4847.00
United HealthCare,HMO,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Grouper Rate,1145.00
United HealthCare,HMO,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,6612.00
United HealthCare,HMO,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,4847.00
United HealthCare,HMO,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,6612.00
United HealthCare,HMO,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Grouper Rate,6612.00
United HealthCare,HMO,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Grouper Rate,6612.00
United HealthCare,HMO,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Grouper Rate,6612.00
United HealthCare,HMO,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Grouper Rate,4847.00
United HealthCare,HMO,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,Grouper Rate,3965.00
United HealthCare,HMO,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Grouper Rate,6612.00
United HealthCare,HMO,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Grouper Rate,6612.00
United HealthCare,HMO,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Grouper Rate,6612.00
United HealthCare,HMO,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Grouper Rate,6612.00
United HealthCare,HMO,36833,CPT4/HCPCS,AV FISTULA REVISION,,Grouper Rate,6612.00
United HealthCare,HMO,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Grouper Rate,4847.00
United HealthCare,HMO,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Grouper Rate,6612.00
United HealthCare,HMO,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Grouper Rate,1235.00
United HealthCare,HMO,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Grouper Rate,6612.00
United HealthCare,HMO,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,1291.00
United HealthCare,HMO,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,6612.00
United HealthCare,HMO,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,9547.00
United HealthCare,HMO,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,6612.00
United HealthCare,HMO,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,9547.00
United HealthCare,HMO,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,13506.00
United HealthCare,HMO,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Grouper Rate,1145.00
United HealthCare,HMO,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Grouper Rate,1145.00
United HealthCare,HMO,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Grouper Rate,1145.00
United HealthCare,HMO,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,1291.00
United HealthCare,HMO,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,1291.00
United HealthCare,HMO,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,1291.00
United HealthCare,HMO,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,1291.00
United HealthCare,HMO,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,Grouper Rate,1291.00
United HealthCare,HMO,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,Grouper Rate,1291.00
United HealthCare,HMO,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Grouper Rate,9547.00
United HealthCare,HMO,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Grouper Rate,6612.00
United HealthCare,HMO,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Grouper Rate,1145.00
United HealthCare,HMO,37186,CPT4/HCPCS,SEC ART THROMBECTOMY ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Grouper Rate,4847.00
United HealthCare,HMO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Grouper Rate,6612.00
United HealthCare,HMO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Grouper Rate,4847.00
United HealthCare,HMO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Grouper Rate,4847.00
United HealthCare,HMO,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,Grouper Rate,1145.00
United HealthCare,HMO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Grouper Rate,4847.00
United HealthCare,HMO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Grouper Rate,6612.00
United HealthCare,HMO,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Grouper Rate,6612.00
United HealthCare,HMO,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Grouper Rate,4847.00
United HealthCare,HMO,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Grouper Rate,1235.00
United HealthCare,HMO,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Grouper Rate,1235.00
United HealthCare,HMO,37215,CPT4/HCPCS,TRANSCATH STENT CCA W/EPS,,Grouper Rate,1291.00
United HealthCare,HMO,37216,CPT4/HCPCS,TRANSCATH STENT CCA W/O EPS,,Grouper Rate,1291.00
United HealthCare,HMO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Grouper Rate,1291.00
United HealthCare,HMO,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Grouper Rate,1291.00
United HealthCare,HMO,37220,CPT4/HCPCS,ILIAC REVASC,,Grouper Rate,6612.00
United HealthCare,HMO,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Grouper Rate,9547.00
United HealthCare,HMO,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Grouper Rate,6612.00
United HealthCare,HMO,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Grouper Rate,6612.00
United HealthCare,HMO,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Grouper Rate,6612.00
United HealthCare,HMO,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Grouper Rate,9547.00
United HealthCare,HMO,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Grouper Rate,9547.00
United HealthCare,HMO,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Grouper Rate,13506.00
United HealthCare,HMO,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Grouper Rate,6612.00
United HealthCare,HMO,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Grouper Rate,9547.00
United HealthCare,HMO,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Grouper Rate,9547.00
United HealthCare,HMO,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Grouper Rate,13506.00
United HealthCare,HMO,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Grouper Rate,6612.00
United HealthCare,HMO,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Grouper Rate,9547.00
United HealthCare,HMO,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Grouper Rate,6612.00
United HealthCare,HMO,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Grouper Rate,6612.00
United HealthCare,HMO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Grouper Rate,9547.00
United HealthCare,HMO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,6612.00
United HealthCare,HMO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Grouper Rate,9547.00
United HealthCare,HMO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,6612.00
United HealthCare,HMO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Grouper Rate,9547.00
United HealthCare,HMO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Grouper Rate,9547.00
United HealthCare,HMO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Grouper Rate,9547.00
United HealthCare,HMO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Grouper Rate,9547.00
United HealthCare,HMO,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Grouper Rate,6612.00
United HealthCare,HMO,37247,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL ART,,Grouper Rate,1145.00
United HealthCare,HMO,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Grouper Rate,6612.00
United HealthCare,HMO,37249,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL VEIN,,Grouper Rate,1145.00
United HealthCare,HMO,37252,CPT4/HCPCS,INTRVASC US NONCORONARY 1ST,,Grouper Rate,1145.00
United HealthCare,HMO,37253,CPT4/HCPCS,INTRVASC US NONCORONARY ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Grouper Rate,6612.00
United HealthCare,HMO,37501,CPT4/HCPCS,VASCULAR ENDOSCOPY PROCEDURE,,Grouper Rate,1235.00
United HealthCare,HMO,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,Grouper Rate,1235.00
United HealthCare,HMO,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,4847.00
United HealthCare,HMO,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,4847.00
United HealthCare,HMO,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,4847.00
United HealthCare,HMO,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Grouper Rate,4847.00
United HealthCare,HMO,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,1235.00
United HealthCare,HMO,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Grouper Rate,6612.00
United HealthCare,HMO,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,4847.00
United HealthCare,HMO,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,1291.00
United HealthCare,HMO,37700,CPT4/HCPCS,REVISE LEG VEIN,,Grouper Rate,4847.00
United HealthCare,HMO,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Grouper Rate,4847.00
United HealthCare,HMO,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Grouper Rate,4847.00
United HealthCare,HMO,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Grouper Rate,4847.00
United HealthCare,HMO,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Grouper Rate,4847.00
United HealthCare,HMO,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Grouper Rate,1235.00
United HealthCare,HMO,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Grouper Rate,4847.00
United HealthCare,HMO,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Grouper Rate,4847.00
United HealthCare,HMO,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Grouper Rate,1235.00
United HealthCare,HMO,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Grouper Rate,4847.00
United HealthCare,HMO,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,Grouper Rate,1291.00
United HealthCare,HMO,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Grouper Rate,4847.00
United HealthCare,HMO,37799,CPT4/HCPCS,VASCULAR SURGERY PROCEDURE,,Grouper Rate,1235.00
United HealthCare,HMO,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Grouper Rate,1291.00
United HealthCare,HMO,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,Grouper Rate,1291.00
United HealthCare,HMO,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Grouper Rate,1291.00
United HealthCare,HMO,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,Grouper Rate,1291.00
United HealthCare,HMO,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,38129,CPT4/HCPCS,LAPAROSCOPE PROC SPLEEN,,Grouper Rate,5730.00
United HealthCare,HMO,38200,CPT4/HCPCS,INJECTION FOR SPLEEN X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,Grouper Rate,1145.00
United HealthCare,HMO,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,Grouper Rate,1291.00
United HealthCare,HMO,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,Grouper Rate,1145.00
United HealthCare,HMO,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,Grouper Rate,1145.00
United HealthCare,HMO,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,Grouper Rate,1145.00
United HealthCare,HMO,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,Grouper Rate,1145.00
United HealthCare,HMO,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,Grouper Rate,1145.00
United HealthCare,HMO,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,Grouper Rate,1145.00
United HealthCare,HMO,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,Grouper Rate,1145.00
United HealthCare,HMO,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,Grouper Rate,1145.00
United HealthCare,HMO,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,Grouper Rate,1145.00
United HealthCare,HMO,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Grouper Rate,1235.00
United HealthCare,HMO,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Grouper Rate,1235.00
United HealthCare,HMO,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Grouper Rate,1291.00
United HealthCare,HMO,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Grouper Rate,1291.00
United HealthCare,HMO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Grouper Rate,5730.00
United HealthCare,HMO,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Grouper Rate,5730.00
United HealthCare,HMO,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Grouper Rate,1291.00
United HealthCare,HMO,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,Grouper Rate,1291.00
United HealthCare,HMO,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Grouper Rate,1291.00
United HealthCare,HMO,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Grouper Rate,3965.00
United HealthCare,HMO,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3965.00
United HealthCare,HMO,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Grouper Rate,1291.00
United HealthCare,HMO,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3965.00
United HealthCare,HMO,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3965.00
United HealthCare,HMO,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3965.00
United HealthCare,HMO,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,3965.00
United HealthCare,HMO,38531,CPT4/HCPCS,OPEN BX/EXC INGUINOFEM NODES,,Grouper Rate,4847.00
United HealthCare,HMO,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Grouper Rate,6612.00
United HealthCare,HMO,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,3965.00
United HealthCare,HMO,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,3965.00
United HealthCare,HMO,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,Grouper Rate,1291.00
United HealthCare,HMO,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,Grouper Rate,1291.00
United HealthCare,HMO,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Grouper Rate,6612.00
United HealthCare,HMO,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Grouper Rate,6612.00
United HealthCare,HMO,38589,CPT4/HCPCS,LAPAROSCOPE PROC LYMPHATIC,,Grouper Rate,5730.00
United HealthCare,HMO,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,3965.00
United HealthCare,HMO,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,3965.00
United HealthCare,HMO,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,3965.00
United HealthCare,HMO,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,6612.00
United HealthCare,HMO,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,6612.00
United HealthCare,HMO,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,Grouper Rate,1291.00
United HealthCare,HMO,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,Grouper Rate,1291.00
United HealthCare,HMO,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,3965.00
United HealthCare,HMO,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,1291.00
United HealthCare,HMO,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,Grouper Rate,1291.00
United HealthCare,HMO,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,Grouper Rate,1291.00
United HealthCare,HMO,38790,CPT4/HCPCS,INJECT FOR LYMPHATIC X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,38792,CPT4/HCPCS,RA TRACER ID OF SENTINL NODE,,Grouper Rate,1145.00
United HealthCare,HMO,38794,CPT4/HCPCS,ACCESS THORACIC LYMPH DUCT,,Grouper Rate,1145.00
United HealthCare,HMO,38900,CPT4/HCPCS,IO MAP OF SENT LYMPH NODE,,Grouper Rate,1145.00
United HealthCare,HMO,38999,CPT4/HCPCS,BLOOD/LYMPH SYSTEM PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,1291.00
United HealthCare,HMO,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,1291.00
United HealthCare,HMO,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,Grouper Rate,1291.00
United HealthCare,HMO,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Grouper Rate,5730.00
United HealthCare,HMO,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Grouper Rate,5730.00
United HealthCare,HMO,39499,CPT4/HCPCS,CHEST PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,Grouper Rate,1291.00
United HealthCare,HMO,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,1291.00
United HealthCare,HMO,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,1291.00
United HealthCare,HMO,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,1291.00
United HealthCare,HMO,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,Grouper Rate,1291.00
United HealthCare,HMO,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,Grouper Rate,1291.00
United HealthCare,HMO,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,Grouper Rate,1291.00
United HealthCare,HMO,39599,CPT4/HCPCS,DIAPHRAGM SURGERY PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,40490,CPT4/HCPCS,BIOPSY OF LIP,,Grouper Rate,1145.00
United HealthCare,HMO,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1291.00
United HealthCare,HMO,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,3965.00
United HealthCare,HMO,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1291.00
United HealthCare,HMO,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,3965.00
United HealthCare,HMO,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,3965.00
United HealthCare,HMO,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Grouper Rate,3965.00
United HealthCare,HMO,40650,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,1145.00
United HealthCare,HMO,40652,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,1145.00
United HealthCare,HMO,40654,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,1291.00
United HealthCare,HMO,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5730.00
United HealthCare,HMO,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5730.00
United HealthCare,HMO,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5730.00
United HealthCare,HMO,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5730.00
United HealthCare,HMO,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,5730.00
United HealthCare,HMO,40799,CPT4/HCPCS,LIP SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1235.00
United HealthCare,HMO,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1145.00
United HealthCare,HMO,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,1291.00
United HealthCare,HMO,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,1145.00
United HealthCare,HMO,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Grouper Rate,1145.00
United HealthCare,HMO,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Grouper Rate,1145.00
United HealthCare,HMO,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,3965.00
United HealthCare,HMO,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,3965.00
United HealthCare,HMO,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Grouper Rate,1145.00
United HealthCare,HMO,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Grouper Rate,1291.00
United HealthCare,HMO,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,1145.00
United HealthCare,HMO,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,1145.00
United HealthCare,HMO,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,3965.00
United HealthCare,HMO,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,3965.00
United HealthCare,HMO,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,3965.00
United HealthCare,HMO,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5730.00
United HealthCare,HMO,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,5730.00
United HealthCare,HMO,40899,CPT4/HCPCS,MOUTH SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1145.00
United HealthCare,HMO,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1145.00
United HealthCare,HMO,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1145.00
United HealthCare,HMO,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Grouper Rate,1291.00
United HealthCare,HMO,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1145.00
United HealthCare,HMO,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,3965.00
United HealthCare,HMO,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Grouper Rate,3965.00
United HealthCare,HMO,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,1145.00
United HealthCare,HMO,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,1291.00
United HealthCare,HMO,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Grouper Rate,1235.00
United HealthCare,HMO,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Grouper Rate,1291.00
United HealthCare,HMO,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,3965.00
United HealthCare,HMO,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,5730.00
United HealthCare,HMO,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,1291.00
United HealthCare,HMO,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,Grouper Rate,1291.00
United HealthCare,HMO,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1145.00
United HealthCare,HMO,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1145.00
United HealthCare,HMO,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1145.00
United HealthCare,HMO,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Grouper Rate,5730.00
United HealthCare,HMO,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Grouper Rate,5730.00
United HealthCare,HMO,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Grouper Rate,3965.00
United HealthCare,HMO,41599,CPT4/HCPCS,TONGUE AND MOUTH SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Grouper Rate,1145.00
United HealthCare,HMO,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Grouper Rate,1291.00
United HealthCare,HMO,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Grouper Rate,1291.00
United HealthCare,HMO,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Grouper Rate,3965.00
United HealthCare,HMO,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Grouper Rate,1291.00
United HealthCare,HMO,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,3965.00
United HealthCare,HMO,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,3965.00
United HealthCare,HMO,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,5730.00
United HealthCare,HMO,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Grouper Rate,3965.00
United HealthCare,HMO,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Grouper Rate,1291.00
United HealthCare,HMO,41870,CPT4/HCPCS,GUM GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,41872,CPT4/HCPCS,REPAIR GUM,,Grouper Rate,5730.00
United HealthCare,HMO,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Grouper Rate,1291.00
United HealthCare,HMO,41899,CPT4/HCPCS,DENTAL SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Grouper Rate,1145.00
United HealthCare,HMO,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Grouper Rate,1291.00
United HealthCare,HMO,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1291.00
United HealthCare,HMO,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1291.00
United HealthCare,HMO,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,3965.00
United HealthCare,HMO,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Grouper Rate,3965.00
United HealthCare,HMO,42140,CPT4/HCPCS,EXCISION OF UVULA,,Grouper Rate,1291.00
United HealthCare,HMO,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Grouper Rate,3965.00
United HealthCare,HMO,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Grouper Rate,1291.00
United HealthCare,HMO,42180,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,1145.00
United HealthCare,HMO,42182,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,3965.00
United HealthCare,HMO,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5730.00
United HealthCare,HMO,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5730.00
United HealthCare,HMO,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5730.00
United HealthCare,HMO,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5730.00
United HealthCare,HMO,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5730.00
United HealthCare,HMO,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,5730.00
United HealthCare,HMO,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,5730.00
United HealthCare,HMO,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,5730.00
United HealthCare,HMO,42235,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,5730.00
United HealthCare,HMO,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Grouper Rate,3965.00
United HealthCare,HMO,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Grouper Rate,1145.00
United HealthCare,HMO,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Grouper Rate,1291.00
United HealthCare,HMO,42299,CPT4/HCPCS,PALATE/UVULA SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1291.00
United HealthCare,HMO,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,3965.00
United HealthCare,HMO,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1145.00
United HealthCare,HMO,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1145.00
United HealthCare,HMO,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,1291.00
United HealthCare,HMO,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,3965.00
United HealthCare,HMO,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,1291.00
United HealthCare,HMO,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,1235.00
United HealthCare,HMO,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,1291.00
United HealthCare,HMO,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Grouper Rate,3965.00
United HealthCare,HMO,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Grouper Rate,3965.00
United HealthCare,HMO,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5730.00
United HealthCare,HMO,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5730.00
United HealthCare,HMO,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5730.00
United HealthCare,HMO,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,5730.00
United HealthCare,HMO,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,3965.00
United HealthCare,HMO,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Grouper Rate,5730.00
United HealthCare,HMO,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Grouper Rate,3965.00
United HealthCare,HMO,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,3965.00
United HealthCare,HMO,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,5730.00
United HealthCare,HMO,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5730.00
United HealthCare,HMO,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5730.00
United HealthCare,HMO,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,5730.00
United HealthCare,HMO,42550,CPT4/HCPCS,INJECTION FOR SALIVARY X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,42650,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Grouper Rate,1291.00
United HealthCare,HMO,42660,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Grouper Rate,1145.00
United HealthCare,HMO,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Grouper Rate,3965.00
United HealthCare,HMO,42699,CPT4/HCPCS,SALIVARY SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Grouper Rate,1145.00
United HealthCare,HMO,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,5730.00
United HealthCare,HMO,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Grouper Rate,1235.00
United HealthCare,HMO,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,1291.00
United HealthCare,HMO,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,3965.00
United HealthCare,HMO,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Grouper Rate,3965.00
United HealthCare,HMO,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Grouper Rate,1145.00
United HealthCare,HMO,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,3965.00
United HealthCare,HMO,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,5730.00
United HealthCare,HMO,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,3965.00
United HealthCare,HMO,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,3965.00
United HealthCare,HMO,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,3965.00
United HealthCare,HMO,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,3965.00
United HealthCare,HMO,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3965.00
United HealthCare,HMO,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3965.00
United HealthCare,HMO,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3965.00
United HealthCare,HMO,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,3965.00
United HealthCare,HMO,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,3965.00
United HealthCare,HMO,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,5730.00
United HealthCare,HMO,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,1291.00
United HealthCare,HMO,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Grouper Rate,3965.00
United HealthCare,HMO,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Grouper Rate,3965.00
United HealthCare,HMO,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Grouper Rate,5730.00
United HealthCare,HMO,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,5730.00
United HealthCare,HMO,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,1291.00
United HealthCare,HMO,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Grouper Rate,3965.00
United HealthCare,HMO,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Grouper Rate,1291.00
United HealthCare,HMO,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1145.00
United HealthCare,HMO,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1291.00
United HealthCare,HMO,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,3965.00
United HealthCare,HMO,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1145.00
United HealthCare,HMO,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1291.00
United HealthCare,HMO,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1291.00
United HealthCare,HMO,42999,CPT4/HCPCS,THROAT SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,Grouper Rate,5730.00
United HealthCare,HMO,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Grouper Rate,1291.00
United HealthCare,HMO,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Grouper Rate,1291.00
United HealthCare,HMO,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,Grouper Rate,1291.00
United HealthCare,HMO,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,5730.00
United HealthCare,HMO,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,1291.00
United HealthCare,HMO,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Grouper Rate,3965.00
United HealthCare,HMO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Grouper Rate,1291.00
United HealthCare,HMO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Grouper Rate,1291.00
United HealthCare,HMO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Grouper Rate,1291.00
United HealthCare,HMO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Grouper Rate,1291.00
United HealthCare,HMO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Grouper Rate,1291.00
United HealthCare,HMO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Grouper Rate,1291.00
United HealthCare,HMO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Grouper Rate,1291.00
United HealthCare,HMO,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Grouper Rate,1291.00
United HealthCare,HMO,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Grouper Rate,1291.00
United HealthCare,HMO,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Grouper Rate,1291.00
United HealthCare,HMO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Grouper Rate,4847.00
United HealthCare,HMO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Grouper Rate,1291.00
United HealthCare,HMO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Grouper Rate,4847.00
United HealthCare,HMO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Grouper Rate,1291.00
United HealthCare,HMO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Grouper Rate,1291.00
United HealthCare,HMO,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Grouper Rate,1291.00
United HealthCare,HMO,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Grouper Rate,3965.00
United HealthCare,HMO,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Grouper Rate,1291.00
United HealthCare,HMO,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Grouper Rate,1291.00
United HealthCare,HMO,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Grouper Rate,1291.00
United HealthCare,HMO,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Grouper Rate,1291.00
United HealthCare,HMO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Grouper Rate,3965.00
United HealthCare,HMO,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Grouper Rate,1291.00
United HealthCare,HMO,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Grouper Rate,1291.00
United HealthCare,HMO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Grouper Rate,1291.00
United HealthCare,HMO,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Grouper Rate,1291.00
United HealthCare,HMO,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Grouper Rate,1291.00
United HealthCare,HMO,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Grouper Rate,1291.00
United HealthCare,HMO,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,1291.00
United HealthCare,HMO,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Grouper Rate,1291.00
United HealthCare,HMO,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Grouper Rate,3965.00
United HealthCare,HMO,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Grouper Rate,1291.00
United HealthCare,HMO,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,1291.00
United HealthCare,HMO,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Grouper Rate,1291.00
United HealthCare,HMO,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Grouper Rate,1291.00
United HealthCare,HMO,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Grouper Rate,1291.00
United HealthCare,HMO,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Grouper Rate,1291.00
United HealthCare,HMO,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Grouper Rate,1291.00
United HealthCare,HMO,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Grouper Rate,1291.00
United HealthCare,HMO,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Grouper Rate,1291.00
United HealthCare,HMO,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Grouper Rate,1291.00
United HealthCare,HMO,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Grouper Rate,1291.00
United HealthCare,HMO,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Grouper Rate,1291.00
United HealthCare,HMO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Grouper Rate,1291.00
United HealthCare,HMO,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Grouper Rate,1291.00
United HealthCare,HMO,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Grouper Rate,3965.00
United HealthCare,HMO,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Grouper Rate,1291.00
United HealthCare,HMO,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Grouper Rate,3965.00
United HealthCare,HMO,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,3965.00
United HealthCare,HMO,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,3965.00
United HealthCare,HMO,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Grouper Rate,3965.00
United HealthCare,HMO,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Grouper Rate,3965.00
United HealthCare,HMO,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Grouper Rate,3965.00
United HealthCare,HMO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Grouper Rate,4847.00
United HealthCare,HMO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Grouper Rate,1291.00
United HealthCare,HMO,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Grouper Rate,1145.00
United HealthCare,HMO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Grouper Rate,3965.00
United HealthCare,HMO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Grouper Rate,3965.00
United HealthCare,HMO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Grouper Rate,3965.00
United HealthCare,HMO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Grouper Rate,3965.00
United HealthCare,HMO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Grouper Rate,3965.00
United HealthCare,HMO,43279,CPT4/HCPCS,LAP MYOTOMY HELLER,,Grouper Rate,6612.00
United HealthCare,HMO,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Grouper Rate,6612.00
United HealthCare,HMO,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Grouper Rate,6612.00
United HealthCare,HMO,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Grouper Rate,6612.00
United HealthCare,HMO,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,Grouper Rate,1291.00
United HealthCare,HMO,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Grouper Rate,6612.00
United HealthCare,HMO,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Grouper Rate,6612.00
United HealthCare,HMO,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,Grouper Rate,1291.00
United HealthCare,HMO,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,Grouper Rate,1291.00
United HealthCare,HMO,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,Grouper Rate,1291.00
United HealthCare,HMO,43289,CPT4/HCPCS,LAPAROSCOPE PROC ESOPH,,Grouper Rate,5730.00
United HealthCare,HMO,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,Grouper Rate,1291.00
United HealthCare,HMO,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,Grouper Rate,1291.00
United HealthCare,HMO,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,Grouper Rate,1291.00
United HealthCare,HMO,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,Grouper Rate,1291.00
United HealthCare,HMO,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,Grouper Rate,1291.00
United HealthCare,HMO,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,Grouper Rate,1291.00
United HealthCare,HMO,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,Grouper Rate,1291.00
United HealthCare,HMO,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,Grouper Rate,1291.00
United HealthCare,HMO,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Grouper Rate,1291.00
United HealthCare,HMO,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Grouper Rate,1291.00
United HealthCare,HMO,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Grouper Rate,1291.00
United HealthCare,HMO,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Grouper Rate,1291.00
United HealthCare,HMO,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Grouper Rate,1291.00
United HealthCare,HMO,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Grouper Rate,1291.00
United HealthCare,HMO,43338,CPT4/HCPCS,ESOPH LENGTHENING,,Grouper Rate,1291.00
United HealthCare,HMO,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Grouper Rate,1291.00
United HealthCare,HMO,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Grouper Rate,1291.00
United HealthCare,HMO,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,Grouper Rate,6612.00
United HealthCare,HMO,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,3965.00
United HealthCare,HMO,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,1291.00
United HealthCare,HMO,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Grouper Rate,1291.00
United HealthCare,HMO,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,Grouper Rate,1291.00
United HealthCare,HMO,43496,CPT4/HCPCS,FREE JEJUNUM FLAP MICROVASC,,Grouper Rate,1291.00
United HealthCare,HMO,43499,CPT4/HCPCS,ESOPHAGUS SURGERY PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Grouper Rate,1291.00
United HealthCare,HMO,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Grouper Rate,1291.00
United HealthCare,HMO,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Grouper Rate,1291.00
United HealthCare,HMO,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Grouper Rate,1291.00
United HealthCare,HMO,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,Grouper Rate,1291.00
United HealthCare,HMO,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,Grouper Rate,3965.00
United HealthCare,HMO,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,1291.00
United HealthCare,HMO,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,1291.00
United HealthCare,HMO,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,1291.00
United HealthCare,HMO,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,1291.00
United HealthCare,HMO,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,1291.00
United HealthCare,HMO,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,1291.00
United HealthCare,HMO,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,1291.00
United HealthCare,HMO,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,1291.00
United HealthCare,HMO,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Grouper Rate,1291.00
United HealthCare,HMO,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Grouper Rate,1291.00
United HealthCare,HMO,43644,CPT4/HCPCS,LAP GASTRIC BYPASS/ROUX-EN-Y,,Grouper Rate,6612.00
United HealthCare,HMO,43645,CPT4/HCPCS,LAP GASTR BYPASS INCL SMLL I,,Grouper Rate,6612.00
United HealthCare,HMO,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Grouper Rate,9547.00
United HealthCare,HMO,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Grouper Rate,5730.00
United HealthCare,HMO,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,6612.00
United HealthCare,HMO,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,6612.00
United HealthCare,HMO,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,43659,CPT4/HCPCS,LAPAROSCOPE PROC STOM,,Grouper Rate,5730.00
United HealthCare,HMO,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Grouper Rate,1145.00
United HealthCare,HMO,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Grouper Rate,1145.00
United HealthCare,HMO,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Grouper Rate,1145.00
United HealthCare,HMO,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Grouper Rate,1145.00
United HealthCare,HMO,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Grouper Rate,1291.00
United HealthCare,HMO,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Grouper Rate,1291.00
United HealthCare,HMO,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Grouper Rate,1145.00
United HealthCare,HMO,43762,CPT4/HCPCS,RPLC GTUBE NO REVJ TRC,,Grouper Rate,1145.00
United HealthCare,HMO,43763,CPT4/HCPCS,RPLC GTUBE REVJ GSTRST TRC,,Grouper Rate,1145.00
United HealthCare,HMO,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Grouper Rate,6612.00
United HealthCare,HMO,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Grouper Rate,4847.00
United HealthCare,HMO,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Grouper Rate,4847.00
United HealthCare,HMO,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Grouper Rate,5730.00
United HealthCare,HMO,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Grouper Rate,9547.00
United HealthCare,HMO,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,Grouper Rate,1291.00
United HealthCare,HMO,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,3965.00
United HealthCare,HMO,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,1291.00
United HealthCare,HMO,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,1291.00
United HealthCare,HMO,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,Grouper Rate,1291.00
United HealthCare,HMO,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,Grouper Rate,1291.00
United HealthCare,HMO,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,Grouper Rate,5730.00
United HealthCare,HMO,43845,CPT4/HCPCS,GASTROPLASTY DUODENAL SWITCH,,Grouper Rate,1291.00
United HealthCare,HMO,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,Grouper Rate,1291.00
United HealthCare,HMO,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,Grouper Rate,1291.00
United HealthCare,HMO,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,Grouper Rate,1291.00
United HealthCare,HMO,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Grouper Rate,3965.00
United HealthCare,HMO,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,43881,CPT4/HCPCS,IMPL/REDO ELECTRD ANTRUM,,Grouper Rate,1291.00
United HealthCare,HMO,43882,CPT4/HCPCS,REVISE/REMOVE ELECTRD ANTRUM,,Grouper Rate,1291.00
United HealthCare,HMO,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Grouper Rate,4847.00
United HealthCare,HMO,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Grouper Rate,4847.00
United HealthCare,HMO,43999,CPT4/HCPCS,STOMACH SURGERY PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Grouper Rate,1291.00
United HealthCare,HMO,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Grouper Rate,1291.00
United HealthCare,HMO,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,Grouper Rate,1291.00
United HealthCare,HMO,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,Grouper Rate,1291.00
United HealthCare,HMO,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,Grouper Rate,1291.00
United HealthCare,HMO,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,Grouper Rate,1291.00
United HealthCare,HMO,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,Grouper Rate,1291.00
United HealthCare,HMO,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,Grouper Rate,1291.00
United HealthCare,HMO,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,Grouper Rate,1291.00
United HealthCare,HMO,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,Grouper Rate,1291.00
United HealthCare,HMO,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,Grouper Rate,1291.00
United HealthCare,HMO,44137,CPT4/HCPCS,REMOVE INTESTINAL ALLOGRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,Grouper Rate,1291.00
United HealthCare,HMO,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1291.00
United HealthCare,HMO,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1291.00
United HealthCare,HMO,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1291.00
United HealthCare,HMO,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1291.00
United HealthCare,HMO,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1291.00
United HealthCare,HMO,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1291.00
United HealthCare,HMO,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1291.00
United HealthCare,HMO,44150,CPT4/HCPCS,REMOVAL OF COLON,,Grouper Rate,1291.00
United HealthCare,HMO,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44157,CPT4/HCPCS,COLECTOMY W/ILEOANAL ANAST,,Grouper Rate,1291.00
United HealthCare,HMO,44158,CPT4/HCPCS,COLECTOMY W/NEO-RECTUM POUCH,,Grouper Rate,1291.00
United HealthCare,HMO,44160,CPT4/HCPCS,REMOVAL OF COLON,,Grouper Rate,1291.00
United HealthCare,HMO,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Grouper Rate,6612.00
United HealthCare,HMO,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44188,CPT4/HCPCS,LAP COLOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Grouper Rate,5730.00
United HealthCare,HMO,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,Grouper Rate,5730.00
United HealthCare,HMO,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,Grouper Rate,5730.00
United HealthCare,HMO,44205,CPT4/HCPCS,LAP COLECTOMY PART W/ILEUM,,Grouper Rate,1291.00
United HealthCare,HMO,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,Grouper Rate,1291.00
United HealthCare,HMO,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44238,CPT4/HCPCS,LAPAROSCOPE PROC INTESTINE,,Grouper Rate,5730.00
United HealthCare,HMO,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,Grouper Rate,1291.00
United HealthCare,HMO,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,4847.00
United HealthCare,HMO,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,Grouper Rate,1291.00
United HealthCare,HMO,44320,CPT4/HCPCS,COLOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,Grouper Rate,1291.00
United HealthCare,HMO,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,4847.00
United HealthCare,HMO,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,4847.00
United HealthCare,HMO,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,4847.00
United HealthCare,HMO,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Grouper Rate,4847.00
United HealthCare,HMO,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Grouper Rate,4847.00
United HealthCare,HMO,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,1291.00
United HealthCare,HMO,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,1291.00
United HealthCare,HMO,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Grouper Rate,1291.00
United HealthCare,HMO,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Grouper Rate,1291.00
United HealthCare,HMO,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Grouper Rate,1291.00
United HealthCare,HMO,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Grouper Rate,1291.00
United HealthCare,HMO,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Grouper Rate,1291.00
United HealthCare,HMO,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Grouper Rate,1291.00
United HealthCare,HMO,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Grouper Rate,1291.00
United HealthCare,HMO,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,1291.00
United HealthCare,HMO,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,1291.00
United HealthCare,HMO,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Grouper Rate,1291.00
United HealthCare,HMO,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Grouper Rate,1291.00
United HealthCare,HMO,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Grouper Rate,1291.00
United HealthCare,HMO,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Grouper Rate,1291.00
United HealthCare,HMO,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,1291.00
United HealthCare,HMO,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,Grouper Rate,1291.00
United HealthCare,HMO,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,Grouper Rate,1291.00
United HealthCare,HMO,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,1291.00
United HealthCare,HMO,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,1291.00
United HealthCare,HMO,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,1291.00
United HealthCare,HMO,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,Grouper Rate,1291.00
United HealthCare,HMO,44701,CPT4/HCPCS,INTRAOP COLON LAVAGE ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,44715,CPT4/HCPCS,PREPARE DONOR INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,44720,CPT4/HCPCS,PREP DONOR INTESTINE/VENOUS,,Grouper Rate,1291.00
United HealthCare,HMO,44721,CPT4/HCPCS,PREP DONOR INTESTINE/ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,44799,CPT4/HCPCS,UNLISTED PX SMALL INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,44800,CPT4/HCPCS,EXCISION OF BOWEL POUCH,,Grouper Rate,1291.00
United HealthCare,HMO,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,Grouper Rate,1291.00
United HealthCare,HMO,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,Grouper Rate,1291.00
United HealthCare,HMO,44899,CPT4/HCPCS,BOWEL SURGERY PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,44950,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,4847.00
United HealthCare,HMO,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,44960,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,44979,CPT4/HCPCS,LAPAROSCOPE PROC APP,,Grouper Rate,5730.00
United HealthCare,HMO,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Grouper Rate,1291.00
United HealthCare,HMO,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Grouper Rate,3965.00
United HealthCare,HMO,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,1291.00
United HealthCare,HMO,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,1291.00
United HealthCare,HMO,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,1291.00
United HealthCare,HMO,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,1291.00
United HealthCare,HMO,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,1291.00
United HealthCare,HMO,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,Grouper Rate,1291.00
United HealthCare,HMO,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,1291.00
United HealthCare,HMO,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,Grouper Rate,1291.00
United HealthCare,HMO,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,45126,CPT4/HCPCS,PELVIC EXENTERATION,,Grouper Rate,1291.00
United HealthCare,HMO,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Grouper Rate,1291.00
United HealthCare,HMO,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Grouper Rate,1291.00
United HealthCare,HMO,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,Grouper Rate,1291.00
United HealthCare,HMO,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Grouper Rate,1291.00
United HealthCare,HMO,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Grouper Rate,3965.00
United HealthCare,HMO,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Grouper Rate,3965.00
United HealthCare,HMO,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Grouper Rate,4847.00
United HealthCare,HMO,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Grouper Rate,3965.00
United HealthCare,HMO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,Case Rate,98531.00
United HealthCare,HMO,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Grouper Rate,1235.00
United HealthCare,HMO,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Grouper Rate,1291.00
United HealthCare,HMO,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Grouper Rate,1291.00
United HealthCare,HMO,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Grouper Rate,3965.00
United HealthCare,HMO,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Grouper Rate,1291.00
United HealthCare,HMO,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Grouper Rate,3965.00
United HealthCare,HMO,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Grouper Rate,3965.00
United HealthCare,HMO,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Grouper Rate,4847.00
United HealthCare,HMO,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Grouper Rate,1235.00
United HealthCare,HMO,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Grouper Rate,1235.00
United HealthCare,HMO,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Grouper Rate,1235.00
United HealthCare,HMO,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Grouper Rate,1291.00
United HealthCare,HMO,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Grouper Rate,1235.00
United HealthCare,HMO,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Grouper Rate,1291.00
United HealthCare,HMO,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Grouper Rate,1291.00
United HealthCare,HMO,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Grouper Rate,1291.00
United HealthCare,HMO,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Grouper Rate,1291.00
United HealthCare,HMO,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Grouper Rate,1291.00
United HealthCare,HMO,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Grouper Rate,1291.00
United HealthCare,HMO,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Grouper Rate,1291.00
United HealthCare,HMO,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Grouper Rate,1291.00
United HealthCare,HMO,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Grouper Rate,1291.00
United HealthCare,HMO,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Grouper Rate,1291.00
United HealthCare,HMO,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Grouper Rate,1291.00
United HealthCare,HMO,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Grouper Rate,1291.00
United HealthCare,HMO,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Grouper Rate,1291.00
United HealthCare,HMO,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,1291.00
United HealthCare,HMO,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,1291.00
United HealthCare,HMO,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Grouper Rate,1291.00
United HealthCare,HMO,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Grouper Rate,1291.00
United HealthCare,HMO,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,1291.00
United HealthCare,HMO,45395,CPT4/HCPCS,LAP REMOVAL OF RECTUM,,Grouper Rate,1291.00
United HealthCare,HMO,45397,CPT4/HCPCS,LAP REMOVE RECTUM W/POUCH,,Grouper Rate,1291.00
United HealthCare,HMO,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Grouper Rate,1291.00
United HealthCare,HMO,45399,CPT4/HCPCS,UNLISTED PROCEDURE COLON,,Grouper Rate,1291.00
United HealthCare,HMO,454,DRG,Combined anterior/posterior spinal fusion w CC,,Case Rate,76904.00
United HealthCare,HMO,45400,CPT4/HCPCS,LAPAROSCOPIC PROC,,Grouper Rate,1291.00
United HealthCare,HMO,45402,CPT4/HCPCS,LAP PROCTOPEXY W/SIG RESECT,,Grouper Rate,1291.00
United HealthCare,HMO,45499,CPT4/HCPCS,LAPAROSCOPE PROC RECTUM,,Grouper Rate,5730.00
United HealthCare,HMO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,Case Rate,66640.00
United HealthCare,HMO,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,3965.00
United HealthCare,HMO,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,4847.00
United HealthCare,HMO,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Grouper Rate,1235.00
United HealthCare,HMO,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,1291.00
United HealthCare,HMO,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,4847.00
United HealthCare,HMO,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,Grouper Rate,1291.00
United HealthCare,HMO,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Grouper Rate,4847.00
United HealthCare,HMO,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Grouper Rate,1291.00
United HealthCare,HMO,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Grouper Rate,1291.00
United HealthCare,HMO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,Case Rate,66901.00
United HealthCare,HMO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,Case Rate,75875.00
United HealthCare,HMO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,Case Rate,48879.00
United HealthCare,HMO,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,459,DRG,Spinal fusion except cervical w MCC,,Case Rate,62569.00
United HealthCare,HMO,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Grouper Rate,1235.00
United HealthCare,HMO,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Grouper Rate,1291.00
United HealthCare,HMO,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Grouper Rate,1291.00
United HealthCare,HMO,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Grouper Rate,1291.00
United HealthCare,HMO,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Grouper Rate,1291.00
United HealthCare,HMO,45999,CPT4/HCPCS,RECTUM SURGERY PROCEDURE,,Grouper Rate,1235.00
United HealthCare,HMO,460,DRG,Spinal fusion except cervical w/o MCC,,Case Rate,48417.00
United HealthCare,HMO,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Grouper Rate,3965.00
United HealthCare,HMO,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Grouper Rate,1291.00
United HealthCare,HMO,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,3965.00
United HealthCare,HMO,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Grouper Rate,1235.00
United HealthCare,HMO,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Grouper Rate,1291.00
United HealthCare,HMO,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Grouper Rate,1291.00
United HealthCare,HMO,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Grouper Rate,1145.00
United HealthCare,HMO,461,DRG,Bilateral or multiple major joint procs of lower extremity w MCC,,Case Rate,38472.00
United HealthCare,HMO,462,DRG,Bilateral or multiple major joint procs of lower extremity w/o MCC,,Case Rate,31097.00
United HealthCare,HMO,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Grouper Rate,3965.00
United HealthCare,HMO,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Grouper Rate,1291.00
United HealthCare,HMO,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Grouper Rate,1235.00
United HealthCare,HMO,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Grouper Rate,1291.00
United HealthCare,HMO,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Grouper Rate,3965.00
United HealthCare,HMO,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Grouper Rate,3965.00
United HealthCare,HMO,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Grouper Rate,3965.00
United HealthCare,HMO,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Grouper Rate,3965.00
United HealthCare,HMO,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Grouper Rate,3965.00
United HealthCare,HMO,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Grouper Rate,3965.00
United HealthCare,HMO,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Grouper Rate,3965.00
United HealthCare,HMO,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Grouper Rate,3965.00
United HealthCare,HMO,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Grouper Rate,3965.00
United HealthCare,HMO,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Grouper Rate,3965.00
United HealthCare,HMO,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Grouper Rate,3965.00
United HealthCare,HMO,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Grouper Rate,4847.00
United HealthCare,HMO,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Grouper Rate,1291.00
United HealthCare,HMO,46500,CPT4/HCPCS,INJECTION INTO HEMORRHOID(S),,Grouper Rate,1235.00
United HealthCare,HMO,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Grouper Rate,1291.00
United HealthCare,HMO,466,DRG,Revision of hip or knee replacement w MCC,,Case Rate,27988.00
United HealthCare,HMO,46600,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY SPX,,Grouper Rate,1145.00
United HealthCare,HMO,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Grouper Rate,1145.00
United HealthCare,HMO,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Grouper Rate,1291.00
United HealthCare,HMO,46606,CPT4/HCPCS,ANOSCOPY AND BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Grouper Rate,1291.00
United HealthCare,HMO,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,46611,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Grouper Rate,3965.00
United HealthCare,HMO,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Grouper Rate,1291.00
United HealthCare,HMO,46615,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,3965.00
United HealthCare,HMO,467,DRG,Revision of hip or knee replacement w CC,,Case Rate,21757.00
United HealthCare,HMO,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,3965.00
United HealthCare,HMO,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,1291.00
United HealthCare,HMO,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Grouper Rate,3965.00
United HealthCare,HMO,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,Grouper Rate,4847.00
United HealthCare,HMO,46710,CPT4/HCPCS,REPR PER/VAG POUCH SNGL PROC,,Grouper Rate,1291.00
United HealthCare,HMO,46712,CPT4/HCPCS,REPR PER/VAG POUCH DBL PROC,,Grouper Rate,1291.00
United HealthCare,HMO,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,Grouper Rate,1291.00
United HealthCare,HMO,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,Grouper Rate,1291.00
United HealthCare,HMO,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,1291.00
United HealthCare,HMO,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,1291.00
United HealthCare,HMO,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,1291.00
United HealthCare,HMO,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,Grouper Rate,1291.00
United HealthCare,HMO,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1291.00
United HealthCare,HMO,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1291.00
United HealthCare,HMO,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1291.00
United HealthCare,HMO,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,4847.00
United HealthCare,HMO,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,1291.00
United HealthCare,HMO,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Grouper Rate,3965.00
United HealthCare,HMO,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Grouper Rate,1291.00
United HealthCare,HMO,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,4847.00
United HealthCare,HMO,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,4847.00
United HealthCare,HMO,468,DRG,Revision of hip or knee replacement w/o CC/MCC,,Case Rate,19398.00
United HealthCare,HMO,469,DRG,Major joint replacement or reattachment of lower extremity w MCC,,Case Rate,25000.00
United HealthCare,HMO,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1145.00
United HealthCare,HMO,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1291.00
United HealthCare,HMO,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Grouper Rate,1145.00
United HealthCare,HMO,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Grouper Rate,3965.00
United HealthCare,HMO,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Grouper Rate,3965.00
United HealthCare,HMO,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,3965.00
United HealthCare,HMO,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Grouper Rate,1235.00
United HealthCare,HMO,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,1291.00
United HealthCare,HMO,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,1235.00
United HealthCare,HMO,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Grouper Rate,3965.00
United HealthCare,HMO,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Grouper Rate,3965.00
United HealthCare,HMO,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Grouper Rate,4847.00
United HealthCare,HMO,46948,CPT4/HCPCS,INT HRHC TRANAL DARTLZJ 2+,,Grouper Rate,3965.00
United HealthCare,HMO,46999,CPT4/HCPCS,ANUS SURGERY PROCEDURE,,Grouper Rate,1235.00
United HealthCare,HMO,470,DRG,Major joint replacement or reattachment of lower extremity w/o MCC,,Case Rate,27589.00
United HealthCare,HMO,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47001,CPT4/HCPCS,NEEDLE BIOPSY LIVER ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,Grouper Rate,1291.00
United HealthCare,HMO,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,Grouper Rate,1291.00
United HealthCare,HMO,471,DRG,Cervical spinal fusion w MCC,,Case Rate,25116.00
United HealthCare,HMO,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,1291.00
United HealthCare,HMO,47143,CPT4/HCPCS,PREP DONOR LIVER WHOLE,,Grouper Rate,1291.00
United HealthCare,HMO,47144,CPT4/HCPCS,PREP DONOR LIVER 3-SEGMENT,,Grouper Rate,1291.00
United HealthCare,HMO,47145,CPT4/HCPCS,PREP DONOR LIVER LOBE SPLIT,,Grouper Rate,1291.00
United HealthCare,HMO,47146,CPT4/HCPCS,PREP DONOR LIVER/VENOUS,,Grouper Rate,1291.00
United HealthCare,HMO,47147,CPT4/HCPCS,PREP DONOR LIVER/ARTERIAL,,Grouper Rate,1291.00
United HealthCare,HMO,472,DRG,Cervical spinal fusion w CC,,Case Rate,17956.00
United HealthCare,HMO,473,DRG,Cervical spinal fusion w/o CC/MCC,,Case Rate,26998.00
United HealthCare,HMO,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,Grouper Rate,1291.00
United HealthCare,HMO,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Grouper Rate,9547.00
United HealthCare,HMO,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Grouper Rate,9547.00
United HealthCare,HMO,47379,CPT4/HCPCS,LAPAROSCOPE PROCEDURE LIVER,,Grouper Rate,5730.00
United HealthCare,HMO,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Grouper Rate,1291.00
United HealthCare,HMO,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Grouper Rate,1291.00
United HealthCare,HMO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Grouper Rate,6612.00
United HealthCare,HMO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Grouper Rate,6612.00
United HealthCare,HMO,47399,CPT4/HCPCS,LIVER SURGERY PROCEDURE,,Grouper Rate,1235.00
United HealthCare,HMO,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,Grouper Rate,1291.00
United HealthCare,HMO,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,Grouper Rate,1291.00
United HealthCare,HMO,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,Grouper Rate,1291.00
United HealthCare,HMO,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,Grouper Rate,1291.00
United HealthCare,HMO,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,Grouper Rate,4847.00
United HealthCare,HMO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,4847.00
United HealthCare,HMO,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,4847.00
United HealthCare,HMO,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,4847.00
United HealthCare,HMO,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,4847.00
United HealthCare,HMO,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Grouper Rate,4847.00
United HealthCare,HMO,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Grouper Rate,4847.00
United HealthCare,HMO,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Grouper Rate,1291.00
United HealthCare,HMO,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,6612.00
United HealthCare,HMO,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,6612.00
United HealthCare,HMO,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,6612.00
United HealthCare,HMO,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Grouper Rate,4847.00
United HealthCare,HMO,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Grouper Rate,1145.00
United HealthCare,HMO,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Grouper Rate,1145.00
United HealthCare,HMO,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Grouper Rate,1145.00
United HealthCare,HMO,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,Grouper Rate,1235.00
United HealthCare,HMO,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Grouper Rate,4847.00
United HealthCare,HMO,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,6612.00
United HealthCare,HMO,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,6612.00
United HealthCare,HMO,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,4847.00
United HealthCare,HMO,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,6612.00
United HealthCare,HMO,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Grouper Rate,6612.00
United HealthCare,HMO,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Grouper Rate,6612.00
United HealthCare,HMO,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,47579,CPT4/HCPCS,LAPAROSCOPE PROC BILIARY,,Grouper Rate,5730.00
United HealthCare,HMO,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,Grouper Rate,1291.00
United HealthCare,HMO,47701,CPT4/HCPCS,BILE DUCT REVISION,,Grouper Rate,1291.00
United HealthCare,HMO,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,Grouper Rate,1291.00
United HealthCare,HMO,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,Grouper Rate,1291.00
United HealthCare,HMO,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,Grouper Rate,1291.00
United HealthCare,HMO,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,Grouper Rate,1291.00
United HealthCare,HMO,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,Grouper Rate,1291.00
United HealthCare,HMO,47999,CPT4/HCPCS,BILE TRACT SURGERY PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,Grouper Rate,1291.00
United HealthCare,HMO,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,Grouper Rate,1291.00
United HealthCare,HMO,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,Grouper Rate,1291.00
United HealthCare,HMO,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Grouper Rate,1291.00
United HealthCare,HMO,48105,CPT4/HCPCS,RESECT/DEBRIDE PANCREAS,,Grouper Rate,1291.00
United HealthCare,HMO,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,Grouper Rate,1291.00
United HealthCare,HMO,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,1291.00
United HealthCare,HMO,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,1291.00
United HealthCare,HMO,48146,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,Grouper Rate,1291.00
United HealthCare,HMO,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,1291.00
United HealthCare,HMO,48152,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,48153,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,48154,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,Grouper Rate,1291.00
United HealthCare,HMO,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,Grouper Rate,1291.00
United HealthCare,HMO,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,Grouper Rate,1291.00
United HealthCare,HMO,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Grouper Rate,1291.00
United HealthCare,HMO,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,48545,CPT4/HCPCS,PANCREATORRHAPHY,,Grouper Rate,1291.00
United HealthCare,HMO,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,Grouper Rate,1291.00
United HealthCare,HMO,48548,CPT4/HCPCS,FUSE PANCREAS AND BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,48999,CPT4/HCPCS,PANCREAS SURGERY PROCEDURE,,Grouper Rate,1235.00
United HealthCare,HMO,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,4847.00
United HealthCare,HMO,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,Grouper Rate,1291.00
United HealthCare,HMO,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Grouper Rate,1291.00
United HealthCare,HMO,49013,CPT4/HCPCS,PRPERTL PEL PACK HEMRRG TRMA,,Grouper Rate,1291.00
United HealthCare,HMO,49014,CPT4/HCPCS,REEXPLORATION PELVIC WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,Grouper Rate,1291.00
United HealthCare,HMO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Grouper Rate,1291.00
United HealthCare,HMO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Grouper Rate,1291.00
United HealthCare,HMO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Grouper Rate,1291.00
United HealthCare,HMO,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Grouper Rate,1291.00
United HealthCare,HMO,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Grouper Rate,1235.00
United HealthCare,HMO,492,DRG,Lower extrem & humer proc except hip,foot,femur w MCC,,Case Rate,22292.00
United HealthCare,HMO,49203,CPT4/HCPCS,EXC ABD TUM 5 CM OR LESS,,Grouper Rate,3965.00
United HealthCare,HMO,49204,CPT4/HCPCS,EXC ABD TUM OVER 5 CM,,Grouper Rate,6612.00
United HealthCare,HMO,49205,CPT4/HCPCS,EXC ABD TUM OVER 10 CM,,Grouper Rate,6612.00
United HealthCare,HMO,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,Grouper Rate,1291.00
United HealthCare,HMO,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Grouper Rate,4847.00
United HealthCare,HMO,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,Grouper Rate,1291.00
United HealthCare,HMO,493,DRG,Lower extrem & humer proc except hip,foot,femur w CC,,Case Rate,17095.00
United HealthCare,HMO,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Grouper Rate,5730.00
United HealthCare,HMO,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Grouper Rate,5730.00
United HealthCare,HMO,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Grouper Rate,5730.00
United HealthCare,HMO,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Grouper Rate,5730.00
United HealthCare,HMO,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Grouper Rate,5730.00
United HealthCare,HMO,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Grouper Rate,5730.00
United HealthCare,HMO,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,49327,CPT4/HCPCS,LAP INS DEVICE FOR RT,,Grouper Rate,1145.00
United HealthCare,HMO,49329,CPT4/HCPCS,LAPARO PROC ABDM/PER/OMENT,,Grouper Rate,5730.00
United HealthCare,HMO,494,DRG,Lower extrem & humer proc except hip,foot,femur w/o CC/MCC,,Case Rate,17705.00
United HealthCare,HMO,49400,CPT4/HCPCS,AIR INJECTION INTO ABDOMEN,,Grouper Rate,1145.00
United HealthCare,HMO,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Grouper Rate,4847.00
United HealthCare,HMO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Grouper Rate,1291.00
United HealthCare,HMO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Grouper Rate,1291.00
United HealthCare,HMO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Grouper Rate,1291.00
United HealthCare,HMO,49411,CPT4/HCPCS,INS MARK ABD/PEL FOR RT PERQ,,Grouper Rate,1291.00
United HealthCare,HMO,49412,CPT4/HCPCS,INS DEVICE FOR RT GUIDE OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Grouper Rate,4847.00
United HealthCare,HMO,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Grouper Rate,6612.00
United HealthCare,HMO,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Grouper Rate,4847.00
United HealthCare,HMO,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Grouper Rate,4847.00
United HealthCare,HMO,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Grouper Rate,1291.00
United HealthCare,HMO,49424,CPT4/HCPCS,ASSESS CYST CONTRAST INJECT,,Grouper Rate,1145.00
United HealthCare,HMO,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Grouper Rate,1291.00
United HealthCare,HMO,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Grouper Rate,4847.00
United HealthCare,HMO,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,Grouper Rate,1145.00
United HealthCare,HMO,49428,CPT4/HCPCS,LIGATION OF SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Grouper Rate,4847.00
United HealthCare,HMO,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Grouper Rate,1291.00
United HealthCare,HMO,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Grouper Rate,1291.00
United HealthCare,HMO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Grouper Rate,1291.00
United HealthCare,HMO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Grouper Rate,1291.00
United HealthCare,HMO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Grouper Rate,1291.00
United HealthCare,HMO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Grouper Rate,1291.00
United HealthCare,HMO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Grouper Rate,1291.00
United HealthCare,HMO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Grouper Rate,1291.00
United HealthCare,HMO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Grouper Rate,1291.00
United HealthCare,HMO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Grouper Rate,1145.00
United HealthCare,HMO,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Grouper Rate,4847.00
United HealthCare,HMO,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Grouper Rate,4847.00
United HealthCare,HMO,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Grouper Rate,4847.00
United HealthCare,HMO,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Grouper Rate,4847.00
United HealthCare,HMO,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Grouper Rate,4847.00
United HealthCare,HMO,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Grouper Rate,4847.00
United HealthCare,HMO,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Grouper Rate,4847.00
United HealthCare,HMO,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Grouper Rate,4847.00
United HealthCare,HMO,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Grouper Rate,4847.00
United HealthCare,HMO,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Grouper Rate,4847.00
United HealthCare,HMO,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Grouper Rate,4847.00
United HealthCare,HMO,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Grouper Rate,4847.00
United HealthCare,HMO,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Grouper Rate,4847.00
United HealthCare,HMO,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Grouper Rate,4847.00
United HealthCare,HMO,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Grouper Rate,4847.00
United HealthCare,HMO,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Grouper Rate,4847.00
United HealthCare,HMO,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Grouper Rate,4847.00
United HealthCare,HMO,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Grouper Rate,4847.00
United HealthCare,HMO,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Grouper Rate,4847.00
United HealthCare,HMO,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Grouper Rate,4847.00
United HealthCare,HMO,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Grouper Rate,1145.00
United HealthCare,HMO,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Grouper Rate,4847.00
United HealthCare,HMO,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Grouper Rate,4847.00
United HealthCare,HMO,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Grouper Rate,4847.00
United HealthCare,HMO,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Grouper Rate,4847.00
United HealthCare,HMO,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Grouper Rate,4847.00
United HealthCare,HMO,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Grouper Rate,4847.00
United HealthCare,HMO,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Grouper Rate,4847.00
United HealthCare,HMO,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,4847.00
United HealthCare,HMO,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Grouper Rate,6612.00
United HealthCare,HMO,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Grouper Rate,6612.00
United HealthCare,HMO,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Grouper Rate,6612.00
United HealthCare,HMO,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Grouper Rate,6612.00
United HealthCare,HMO,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Grouper Rate,6612.00
United HealthCare,HMO,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Grouper Rate,6612.00
United HealthCare,HMO,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Grouper Rate,6612.00
United HealthCare,HMO,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Grouper Rate,6612.00
United HealthCare,HMO,49659,CPT4/HCPCS,LAPARO PROC HERNIA REPAIR,,Grouper Rate,5730.00
United HealthCare,HMO,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,Grouper Rate,1291.00
United HealthCare,HMO,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,Grouper Rate,1291.00
United HealthCare,HMO,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,Grouper Rate,1291.00
United HealthCare,HMO,49906,CPT4/HCPCS,FREE OMENTAL FLAP MICROVASC,,Grouper Rate,1291.00
United HealthCare,HMO,49999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Grouper Rate,3965.00
United HealthCare,HMO,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Grouper Rate,3965.00
United HealthCare,HMO,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,1291.00
United HealthCare,HMO,50065,CPT4/HCPCS,INCISION OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50070,CPT4/HCPCS,INCISION OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,1291.00
United HealthCare,HMO,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,5730.00
United HealthCare,HMO,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,5730.00
United HealthCare,HMO,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,Grouper Rate,1291.00
United HealthCare,HMO,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,1291.00
United HealthCare,HMO,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Grouper Rate,1291.00
United HealthCare,HMO,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,50220,CPT4/HCPCS,REMOVE KIDNEY OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,Grouper Rate,1291.00
United HealthCare,HMO,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,Grouper Rate,1291.00
United HealthCare,HMO,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50250,CPT4/HCPCS,CRYOABLATE RENAL MASS OPEN,,Grouper Rate,1291.00
United HealthCare,HMO,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Grouper Rate,1291.00
United HealthCare,HMO,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Grouper Rate,1291.00
United HealthCare,HMO,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,Grouper Rate,1291.00
United HealthCare,HMO,50323,CPT4/HCPCS,PREP CADAVER RENAL ALLOGRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,50325,CPT4/HCPCS,PREP DONOR RENAL GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,50327,CPT4/HCPCS,PREP RENAL GRAFT/VENOUS,,Grouper Rate,1291.00
United HealthCare,HMO,50328,CPT4/HCPCS,PREP RENAL GRAFT/ARTERIAL,,Grouper Rate,1291.00
United HealthCare,HMO,50329,CPT4/HCPCS,PREP RENAL GRAFT/URETERAL,,Grouper Rate,1291.00
United HealthCare,HMO,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Grouper Rate,3965.00
United HealthCare,HMO,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Grouper Rate,3965.00
United HealthCare,HMO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Grouper Rate,3965.00
United HealthCare,HMO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Grouper Rate,3965.00
United HealthCare,HMO,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Grouper Rate,1291.00
United HealthCare,HMO,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Grouper Rate,1235.00
United HealthCare,HMO,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Grouper Rate,1235.00
United HealthCare,HMO,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Grouper Rate,1145.00
United HealthCare,HMO,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Grouper Rate,1235.00
United HealthCare,HMO,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,1235.00
United HealthCare,HMO,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,1235.00
United HealthCare,HMO,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Grouper Rate,3965.00
United HealthCare,HMO,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Grouper Rate,3965.00
United HealthCare,HMO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Grouper Rate,1235.00
United HealthCare,HMO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Grouper Rate,1235.00
United HealthCare,HMO,50436,CPT4/HCPCS,DILAT XST TRC NDURLGC PX,,Grouper Rate,3965.00
United HealthCare,HMO,50437,CPT4/HCPCS,DILAT XST TRC NEW ACCESS RCS,,Grouper Rate,4847.00
United HealthCare,HMO,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Grouper Rate,1235.00
United HealthCare,HMO,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Grouper Rate,5730.00
United HealthCare,HMO,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Grouper Rate,9547.00
United HealthCare,HMO,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Grouper Rate,6612.00
United HealthCare,HMO,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,50546,CPT4/HCPCS,LAPAROSCOPIC NEPHRECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50549,CPT4/HCPCS,LAPAROSCOPE PROC RENAL,,Grouper Rate,5730.00
United HealthCare,HMO,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,3965.00
United HealthCare,HMO,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Grouper Rate,1235.00
United HealthCare,HMO,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1235.00
United HealthCare,HMO,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1235.00
United HealthCare,HMO,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,1235.00
United HealthCare,HMO,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,5730.00
United HealthCare,HMO,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1291.00
United HealthCare,HMO,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1291.00
United HealthCare,HMO,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Grouper Rate,6612.00
United HealthCare,HMO,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Grouper Rate,6612.00
United HealthCare,HMO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Grouper Rate,6612.00
United HealthCare,HMO,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Grouper Rate,1291.00
United HealthCare,HMO,50606,CPT4/HCPCS,ENDOLUMINAL BX URTR RNL PLVS,,Grouper Rate,1145.00
United HealthCare,HMO,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,1291.00
United HealthCare,HMO,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,1291.00
United HealthCare,HMO,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,1291.00
United HealthCare,HMO,50650,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50660,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50684,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,Grouper Rate,1145.00
United HealthCare,HMO,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Grouper Rate,1291.00
United HealthCare,HMO,50690,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,4847.00
United HealthCare,HMO,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,4847.00
United HealthCare,HMO,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,4847.00
United HealthCare,HMO,50700,CPT4/HCPCS,REVISION OF URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50705,CPT4/HCPCS,URETERAL EMBOLIZATION/OCCL,,Grouper Rate,1145.00
United HealthCare,HMO,50706,CPT4/HCPCS,BALLOON DILATE URTRL STRIX,,Grouper Rate,1145.00
United HealthCare,HMO,50715,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50722,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50727,CPT4/HCPCS,REVISE URETER,,Grouper Rate,3965.00
United HealthCare,HMO,50728,CPT4/HCPCS,REVISE URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Grouper Rate,1291.00
United HealthCare,HMO,50760,CPT4/HCPCS,FUSION OF URETERS,,Grouper Rate,1291.00
United HealthCare,HMO,50770,CPT4/HCPCS,SPLICING OF URETERS,,Grouper Rate,1291.00
United HealthCare,HMO,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,50782,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,50783,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,Grouper Rate,1291.00
United HealthCare,HMO,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,50830,CPT4/HCPCS,REVISE URINE FLOW,,Grouper Rate,1291.00
United HealthCare,HMO,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,Grouper Rate,1291.00
United HealthCare,HMO,50900,CPT4/HCPCS,REPAIR OF URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,50940,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,6612.00
United HealthCare,HMO,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,6612.00
United HealthCare,HMO,50949,CPT4/HCPCS,LAPAROSCOPE PROC URETER,,Grouper Rate,5730.00
United HealthCare,HMO,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,1235.00
United HealthCare,HMO,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,1291.00
United HealthCare,HMO,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,3965.00
United HealthCare,HMO,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Grouper Rate,1235.00
United HealthCare,HMO,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Grouper Rate,1235.00
United HealthCare,HMO,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1291.00
United HealthCare,HMO,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,3965.00
United HealthCare,HMO,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,3965.00
United HealthCare,HMO,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Grouper Rate,3965.00
United HealthCare,HMO,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Grouper Rate,1235.00
United HealthCare,HMO,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Grouper Rate,3965.00
United HealthCare,HMO,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,5730.00
United HealthCare,HMO,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Grouper Rate,3965.00
United HealthCare,HMO,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,Grouper Rate,1145.00
United HealthCare,HMO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Grouper Rate,1291.00
United HealthCare,HMO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Grouper Rate,3965.00
United HealthCare,HMO,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Grouper Rate,4847.00
United HealthCare,HMO,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,3965.00
United HealthCare,HMO,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,4847.00
United HealthCare,HMO,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,4847.00
United HealthCare,HMO,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,Grouper Rate,3965.00
United HealthCare,HMO,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,Grouper Rate,1291.00
United HealthCare,HMO,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,Grouper Rate,1291.00
United HealthCare,HMO,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Grouper Rate,1291.00
United HealthCare,HMO,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,1291.00
United HealthCare,HMO,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Grouper Rate,1291.00
United HealthCare,HMO,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,1291.00
United HealthCare,HMO,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,1291.00
United HealthCare,HMO,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,Grouper Rate,1291.00
United HealthCare,HMO,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,Grouper Rate,1291.00
United HealthCare,HMO,51600,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,51605,CPT4/HCPCS,PREPARATION FOR BLADDER XRAY,,Grouper Rate,1145.00
United HealthCare,HMO,51610,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,51700,CPT4/HCPCS,IRRIGATION OF BLADDER,,Grouper Rate,1145.00
United HealthCare,HMO,51701,CPT4/HCPCS,INSERT BLADDER CATHETER,,Grouper Rate,1145.00
United HealthCare,HMO,51702,CPT4/HCPCS,INSERT TEMP BLADDER CATH,,Grouper Rate,1145.00
United HealthCare,HMO,51703,CPT4/HCPCS,INSERT BLADDER CATH COMPLEX,,Grouper Rate,1145.00
United HealthCare,HMO,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,1145.00
United HealthCare,HMO,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,1235.00
United HealthCare,HMO,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Grouper Rate,1145.00
United HealthCare,HMO,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Grouper Rate,1145.00
United HealthCare,HMO,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Grouper Rate,1145.00
United HealthCare,HMO,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Grouper Rate,1235.00
United HealthCare,HMO,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Grouper Rate,1235.00
United HealthCare,HMO,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Grouper Rate,1235.00
United HealthCare,HMO,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,Grouper Rate,1145.00
United HealthCare,HMO,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,Grouper Rate,1145.00
United HealthCare,HMO,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,1145.00
United HealthCare,HMO,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,1145.00
United HealthCare,HMO,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,Grouper Rate,1145.00
United HealthCare,HMO,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Grouper Rate,1145.00
United HealthCare,HMO,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,Grouper Rate,1145.00
United HealthCare,HMO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,Case Rate,20701.00
United HealthCare,HMO,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Grouper Rate,1291.00
United HealthCare,HMO,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Grouper Rate,1291.00
United HealthCare,HMO,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Grouper Rate,5730.00
United HealthCare,HMO,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,3965.00
United HealthCare,HMO,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,4847.00
United HealthCare,HMO,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Grouper Rate,3965.00
United HealthCare,HMO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,Case Rate,20701.00
United HealthCare,HMO,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Grouper Rate,4847.00
United HealthCare,HMO,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Grouper Rate,3965.00
United HealthCare,HMO,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,Grouper Rate,1291.00
United HealthCare,HMO,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,Grouper Rate,1291.00
United HealthCare,HMO,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,Grouper Rate,3965.00
United HealthCare,HMO,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Grouper Rate,6612.00
United HealthCare,HMO,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Grouper Rate,6612.00
United HealthCare,HMO,51999,CPT4/HCPCS,LAPAROSCOPE PROC BLA,,Grouper Rate,5730.00
United HealthCare,HMO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,Case Rate,7353.00
United HealthCare,HMO,52000,CPT4/HCPCS,CYSTOSCOPY,,Grouper Rate,1235.00
United HealthCare,HMO,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Grouper Rate,1291.00
United HealthCare,HMO,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Grouper Rate,3965.00
United HealthCare,HMO,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Grouper Rate,3965.00
United HealthCare,HMO,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Grouper Rate,1235.00
United HealthCare,HMO,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Grouper Rate,3965.00
United HealthCare,HMO,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Grouper Rate,3965.00
United HealthCare,HMO,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1291.00
United HealthCare,HMO,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1235.00
United HealthCare,HMO,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,1291.00
United HealthCare,HMO,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1291.00
United HealthCare,HMO,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Grouper Rate,3965.00
United HealthCare,HMO,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1291.00
United HealthCare,HMO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Grouper Rate,1291.00
United HealthCare,HMO,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1291.00
United HealthCare,HMO,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,3965.00
United HealthCare,HMO,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,3965.00
United HealthCare,HMO,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Grouper Rate,3965.00
United HealthCare,HMO,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Grouper Rate,5730.00
United HealthCare,HMO,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Grouper Rate,3965.00
United HealthCare,HMO,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Grouper Rate,3965.00
United HealthCare,HMO,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Grouper Rate,3965.00
United HealthCare,HMO,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Grouper Rate,3965.00
United HealthCare,HMO,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Grouper Rate,3965.00
United HealthCare,HMO,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Grouper Rate,3965.00
United HealthCare,HMO,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Grouper Rate,3965.00
United HealthCare,HMO,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Grouper Rate,3965.00
United HealthCare,HMO,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Grouper Rate,3965.00
United HealthCare,HMO,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Grouper Rate,5730.00
United HealthCare,HMO,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Grouper Rate,3965.00
United HealthCare,HMO,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Grouper Rate,3965.00
United HealthCare,HMO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Grouper Rate,5730.00
United HealthCare,HMO,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Grouper Rate,3965.00
United HealthCare,HMO,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Grouper Rate,3965.00
United HealthCare,HMO,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Grouper Rate,1145.00
United HealthCare,HMO,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Grouper Rate,1145.00
United HealthCare,HMO,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Grouper Rate,3965.00
United HealthCare,HMO,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Grouper Rate,3965.00
United HealthCare,HMO,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Grouper Rate,5730.00
United HealthCare,HMO,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Grouper Rate,5730.00
United HealthCare,HMO,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Grouper Rate,3965.00
United HealthCare,HMO,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,5730.00
United HealthCare,HMO,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,5730.00
United HealthCare,HMO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Grouper Rate,5730.00
United HealthCare,HMO,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,3965.00
United HealthCare,HMO,53000,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,53010,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,53020,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,53025,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,3965.00
United HealthCare,HMO,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,3965.00
United HealthCare,HMO,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,3965.00
United HealthCare,HMO,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,3965.00
United HealthCare,HMO,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,4847.00
United HealthCare,HMO,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,4847.00
United HealthCare,HMO,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,3965.00
United HealthCare,HMO,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Grouper Rate,4847.00
United HealthCare,HMO,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,3965.00
United HealthCare,HMO,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,3965.00
United HealthCare,HMO,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,3965.00
United HealthCare,HMO,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,3965.00
United HealthCare,HMO,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Grouper Rate,4847.00
United HealthCare,HMO,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Grouper Rate,4847.00
United HealthCare,HMO,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5730.00
United HealthCare,HMO,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Grouper Rate,4847.00
United HealthCare,HMO,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Grouper Rate,4847.00
United HealthCare,HMO,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Grouper Rate,4847.00
United HealthCare,HMO,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Grouper Rate,9547.00
United HealthCare,HMO,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Grouper Rate,4847.00
United HealthCare,HMO,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Grouper Rate,9547.00
United HealthCare,HMO,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Grouper Rate,10164.00
United HealthCare,HMO,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Grouper Rate,6612.00
United HealthCare,HMO,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Grouper Rate,10164.00
United HealthCare,HMO,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,Grouper Rate,1235.00
United HealthCare,HMO,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Grouper Rate,4847.00
United HealthCare,HMO,53450,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,53460,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Grouper Rate,4847.00
United HealthCare,HMO,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,3965.00
United HealthCare,HMO,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,4847.00
United HealthCare,HMO,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,3965.00
United HealthCare,HMO,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,4847.00
United HealthCare,HMO,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,4847.00
United HealthCare,HMO,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1145.00
United HealthCare,HMO,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1145.00
United HealthCare,HMO,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1291.00
United HealthCare,HMO,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1235.00
United HealthCare,HMO,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1145.00
United HealthCare,HMO,53660,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,1145.00
United HealthCare,HMO,53661,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,1145.00
United HealthCare,HMO,53665,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,3965.00
United HealthCare,HMO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Grouper Rate,1291.00
United HealthCare,HMO,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Grouper Rate,5730.00
United HealthCare,HMO,53854,CPT4/HCPCS,TRURL DSTRJ PRST8 TISS RF WV,,Grouper Rate,3965.00
United HealthCare,HMO,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Grouper Rate,1235.00
United HealthCare,HMO,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Grouper Rate,1291.00
United HealthCare,HMO,53899,CPT4/HCPCS,UROLOGY SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,3965.00
United HealthCare,HMO,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,3965.00
United HealthCare,HMO,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Grouper Rate,1291.00
United HealthCare,HMO,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1145.00
United HealthCare,HMO,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1291.00
United HealthCare,HMO,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,Grouper Rate,1145.00
United HealthCare,HMO,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Grouper Rate,1291.00
United HealthCare,HMO,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Grouper Rate,1291.00
United HealthCare,HMO,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1291.00
United HealthCare,HMO,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,1291.00
United HealthCare,HMO,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,3965.00
United HealthCare,HMO,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,5730.00
United HealthCare,HMO,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,3965.00
United HealthCare,HMO,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Grouper Rate,4847.00
United HealthCare,HMO,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Grouper Rate,1291.00
United HealthCare,HMO,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,Grouper Rate,1291.00
United HealthCare,HMO,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,Grouper Rate,1291.00
United HealthCare,HMO,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Grouper Rate,3965.00
United HealthCare,HMO,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Grouper Rate,3965.00
United HealthCare,HMO,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Grouper Rate,3965.00
United HealthCare,HMO,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Grouper Rate,3965.00
United HealthCare,HMO,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Grouper Rate,3965.00
United HealthCare,HMO,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Grouper Rate,3965.00
United HealthCare,HMO,54200,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1145.00
United HealthCare,HMO,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,4847.00
United HealthCare,HMO,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1145.00
United HealthCare,HMO,54230,CPT4/HCPCS,PREPARE PENIS STUDY,,Grouper Rate,1145.00
United HealthCare,HMO,54231,CPT4/HCPCS,DYNAMIC CAVERNOSOMETRY,,Grouper Rate,1291.00
United HealthCare,HMO,54235,CPT4/HCPCS,PENILE INJECTION,,Grouper Rate,1145.00
United HealthCare,HMO,54240,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,1145.00
United HealthCare,HMO,54250,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,1145.00
United HealthCare,HMO,54300,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5730.00
United HealthCare,HMO,54304,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5730.00
United HealthCare,HMO,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5730.00
United HealthCare,HMO,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5730.00
United HealthCare,HMO,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5730.00
United HealthCare,HMO,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,4847.00
United HealthCare,HMO,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Grouper Rate,5730.00
United HealthCare,HMO,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Grouper Rate,5730.00
United HealthCare,HMO,54380,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,4847.00
United HealthCare,HMO,54385,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,4847.00
United HealthCare,HMO,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,Grouper Rate,5730.00
United HealthCare,HMO,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Grouper Rate,9547.00
United HealthCare,HMO,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Grouper Rate,10164.00
United HealthCare,HMO,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Grouper Rate,10164.00
United HealthCare,HMO,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Grouper Rate,4847.00
United HealthCare,HMO,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Grouper Rate,5730.00
United HealthCare,HMO,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Grouper Rate,10164.00
United HealthCare,HMO,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Grouper Rate,1145.00
United HealthCare,HMO,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Grouper Rate,4847.00
United HealthCare,HMO,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Grouper Rate,10164.00
United HealthCare,HMO,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Grouper Rate,1235.00
United HealthCare,HMO,54420,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,4847.00
United HealthCare,HMO,54430,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,1291.00
United HealthCare,HMO,54435,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,4847.00
United HealthCare,HMO,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Grouper Rate,3965.00
United HealthCare,HMO,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,Grouper Rate,1291.00
United HealthCare,HMO,54440,CPT4/HCPCS,REPAIR OF PENIS,,Grouper Rate,4847.00
United HealthCare,HMO,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Grouper Rate,1145.00
United HealthCare,HMO,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,1291.00
United HealthCare,HMO,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,3965.00
United HealthCare,HMO,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Grouper Rate,3965.00
United HealthCare,HMO,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,4847.00
United HealthCare,HMO,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Grouper Rate,3965.00
United HealthCare,HMO,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,4847.00
United HealthCare,HMO,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,Grouper Rate,4847.00
United HealthCare,HMO,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,4847.00
United HealthCare,HMO,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,3965.00
United HealthCare,HMO,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Grouper Rate,3965.00
United HealthCare,HMO,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Grouper Rate,3965.00
United HealthCare,HMO,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Grouper Rate,4847.00
United HealthCare,HMO,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Grouper Rate,4847.00
United HealthCare,HMO,54660,CPT4/HCPCS,REVISION OF TESTIS,,Grouper Rate,3965.00
United HealthCare,HMO,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Grouper Rate,3965.00
United HealthCare,HMO,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Grouper Rate,3965.00
United HealthCare,HMO,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Grouper Rate,6612.00
United HealthCare,HMO,54699,CPT4/HCPCS,LAPAROSCOPE PROC TESTIS,,Grouper Rate,5730.00
United HealthCare,HMO,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Grouper Rate,3965.00
United HealthCare,HMO,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Grouper Rate,1235.00
United HealthCare,HMO,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,3965.00
United HealthCare,HMO,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,3965.00
United HealthCare,HMO,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,3965.00
United HealthCare,HMO,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,3965.00
United HealthCare,HMO,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Grouper Rate,3965.00
United HealthCare,HMO,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,3965.00
United HealthCare,HMO,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,3965.00
United HealthCare,HMO,55000,CPT4/HCPCS,DRAINAGE OF HYDROCELE,,Grouper Rate,1235.00
United HealthCare,HMO,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,4847.00
United HealthCare,HMO,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Grouper Rate,4847.00
United HealthCare,HMO,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Grouper Rate,3965.00
United HealthCare,HMO,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Grouper Rate,3965.00
United HealthCare,HMO,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Grouper Rate,3965.00
United HealthCare,HMO,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Grouper Rate,3965.00
United HealthCare,HMO,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,5730.00
United HealthCare,HMO,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,3965.00
United HealthCare,HMO,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Grouper Rate,3965.00
United HealthCare,HMO,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Grouper Rate,3965.00
United HealthCare,HMO,55300,CPT4/HCPCS,PREPARE SPERM DUCT X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Grouper Rate,3965.00
United HealthCare,HMO,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,4847.00
United HealthCare,HMO,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Grouper Rate,3965.00
United HealthCare,HMO,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,3965.00
United HealthCare,HMO,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,4847.00
United HealthCare,HMO,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Grouper Rate,4847.00
United HealthCare,HMO,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Grouper Rate,6612.00
United HealthCare,HMO,55559,CPT4/HCPCS,LAPARO PROC SPERMATIC CORD,,Grouper Rate,5730.00
United HealthCare,HMO,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,3965.00
United HealthCare,HMO,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,1235.00
United HealthCare,HMO,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Grouper Rate,1235.00
United HealthCare,HMO,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Grouper Rate,3965.00
United HealthCare,HMO,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,1291.00
United HealthCare,HMO,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,1291.00
United HealthCare,HMO,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Grouper Rate,1291.00
United HealthCare,HMO,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,3965.00
United HealthCare,HMO,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,3965.00
United HealthCare,HMO,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,1291.00
United HealthCare,HMO,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,1291.00
United HealthCare,HMO,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,1291.00
United HealthCare,HMO,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Grouper Rate,3965.00
United HealthCare,HMO,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Grouper Rate,9547.00
United HealthCare,HMO,55870,CPT4/HCPCS,ELECTROEJACULATION,,Grouper Rate,1235.00
United HealthCare,HMO,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Grouper Rate,9547.00
United HealthCare,HMO,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Grouper Rate,6612.00
United HealthCare,HMO,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Case Rate,4847.00
United HealthCare,HMO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Grouper Rate,1291.00
United HealthCare,HMO,55899,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Grouper Rate,4847.00
United HealthCare,HMO,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Grouper Rate,1145.00
United HealthCare,HMO,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Grouper Rate,1145.00
United HealthCare,HMO,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Grouper Rate,3965.00
United HealthCare,HMO,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Grouper Rate,3965.00
United HealthCare,HMO,56442,CPT4/HCPCS,HYMENOTOMY,,Grouper Rate,3965.00
United HealthCare,HMO,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Grouper Rate,1291.00
United HealthCare,HMO,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Grouper Rate,1291.00
United HealthCare,HMO,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,1235.00
United HealthCare,HMO,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,1145.00
United HealthCare,HMO,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Grouper Rate,3965.00
United HealthCare,HMO,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Grouper Rate,3965.00
United HealthCare,HMO,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,9547.00
United HealthCare,HMO,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,9547.00
United HealthCare,HMO,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,9547.00
United HealthCare,HMO,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,9547.00
United HealthCare,HMO,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,9547.00
United HealthCare,HMO,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Grouper Rate,3965.00
United HealthCare,HMO,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Grouper Rate,3965.00
United HealthCare,HMO,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,3965.00
United HealthCare,HMO,56805,CPT4/HCPCS,REPAIR CLITORIS,,Grouper Rate,3965.00
United HealthCare,HMO,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Grouper Rate,3965.00
United HealthCare,HMO,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Grouper Rate,1145.00
United HealthCare,HMO,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Grouper Rate,1145.00
United HealthCare,HMO,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Grouper Rate,3965.00
United HealthCare,HMO,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,3965.00
United HealthCare,HMO,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Grouper Rate,3965.00
United HealthCare,HMO,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Grouper Rate,1291.00
United HealthCare,HMO,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Grouper Rate,3965.00
United HealthCare,HMO,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Grouper Rate,3965.00
United HealthCare,HMO,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Grouper Rate,3965.00
United HealthCare,HMO,57100,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,1235.00
United HealthCare,HMO,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,3965.00
United HealthCare,HMO,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Grouper Rate,3965.00
United HealthCare,HMO,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Grouper Rate,3965.00
United HealthCare,HMO,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Grouper Rate,3965.00
United HealthCare,HMO,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Grouper Rate,1291.00
United HealthCare,HMO,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Grouper Rate,4847.00
United HealthCare,HMO,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Grouper Rate,1291.00
United HealthCare,HMO,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Grouper Rate,4847.00
United HealthCare,HMO,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,3965.00
United HealthCare,HMO,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,3965.00
United HealthCare,HMO,57150,CPT4/HCPCS,TREAT VAGINA INFECTION,,Grouper Rate,1145.00
United HealthCare,HMO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Grouper Rate,1235.00
United HealthCare,HMO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,57160,CPT4/HCPCS,INSERT PESSARY/OTHER DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,57170,CPT4/HCPCS,FITTING OF DIAPHRAGM/CAP,,Grouper Rate,1145.00
United HealthCare,HMO,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,Grouper Rate,1145.00
United HealthCare,HMO,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,3965.00
United HealthCare,HMO,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Grouper Rate,3965.00
United HealthCare,HMO,57220,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,5730.00
United HealthCare,HMO,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Grouper Rate,3965.00
United HealthCare,HMO,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Grouper Rate,4847.00
United HealthCare,HMO,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Grouper Rate,4847.00
United HealthCare,HMO,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Grouper Rate,4847.00
United HealthCare,HMO,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Grouper Rate,5730.00
United HealthCare,HMO,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Grouper Rate,1145.00
United HealthCare,HMO,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Grouper Rate,3965.00
United HealthCare,HMO,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,Grouper Rate,3965.00
United HealthCare,HMO,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Grouper Rate,3965.00
United HealthCare,HMO,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Grouper Rate,5730.00
United HealthCare,HMO,57283,CPT4/HCPCS,COLPOPEXY INTRAPERITONEAL,,Grouper Rate,5730.00
United HealthCare,HMO,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Grouper Rate,5730.00
United HealthCare,HMO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Grouper Rate,5730.00
United HealthCare,HMO,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Grouper Rate,4847.00
United HealthCare,HMO,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Grouper Rate,5730.00
United HealthCare,HMO,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Grouper Rate,4847.00
United HealthCare,HMO,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Grouper Rate,3965.00
United HealthCare,HMO,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Grouper Rate,4847.00
United HealthCare,HMO,57295,CPT4/HCPCS,REVISE VAG GRAFT VIA VAGINA,,Grouper Rate,3965.00
United HealthCare,HMO,57296,CPT4/HCPCS,REVISE VAG GRAFT OPEN ABD,,Grouper Rate,1291.00
United HealthCare,HMO,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,3965.00
United HealthCare,HMO,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,Grouper Rate,3965.00
United HealthCare,HMO,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,5730.00
United HealthCare,HMO,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,4847.00
United HealthCare,HMO,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,4847.00
United HealthCare,HMO,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,4847.00
United HealthCare,HMO,57335,CPT4/HCPCS,REPAIR VAGINA,,Grouper Rate,3965.00
United HealthCare,HMO,57400,CPT4/HCPCS,DILATION OF VAGINA,,Grouper Rate,3965.00
United HealthCare,HMO,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Grouper Rate,3965.00
United HealthCare,HMO,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Grouper Rate,3965.00
United HealthCare,HMO,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Grouper Rate,1145.00
United HealthCare,HMO,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Grouper Rate,1235.00
United HealthCare,HMO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Grouper Rate,6612.00
United HealthCare,HMO,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Grouper Rate,6612.00
United HealthCare,HMO,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Grouper Rate,4847.00
United HealthCare,HMO,57452,CPT4/HCPCS,EXAM OF CERVIX W/SCOPE,,Grouper Rate,1145.00
United HealthCare,HMO,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Grouper Rate,1145.00
United HealthCare,HMO,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Grouper Rate,1145.00
United HealthCare,HMO,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Grouper Rate,1145.00
United HealthCare,HMO,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Grouper Rate,3965.00
United HealthCare,HMO,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Grouper Rate,3965.00
United HealthCare,HMO,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Grouper Rate,1235.00
United HealthCare,HMO,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Grouper Rate,1235.00
United HealthCare,HMO,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Grouper Rate,3965.00
United HealthCare,HMO,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Grouper Rate,1145.00
United HealthCare,HMO,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Grouper Rate,3965.00
United HealthCare,HMO,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,3965.00
United HealthCare,HMO,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,3965.00
United HealthCare,HMO,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Grouper Rate,3965.00
United HealthCare,HMO,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,Grouper Rate,1291.00
United HealthCare,HMO,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,1291.00
United HealthCare,HMO,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,Grouper Rate,1291.00
United HealthCare,HMO,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,3965.00
United HealthCare,HMO,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,Grouper Rate,4847.00
United HealthCare,HMO,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Grouper Rate,5730.00
United HealthCare,HMO,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Grouper Rate,3965.00
United HealthCare,HMO,57700,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3965.00
United HealthCare,HMO,57720,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3965.00
United HealthCare,HMO,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Grouper Rate,3965.00
United HealthCare,HMO,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Grouper Rate,1145.00
United HealthCare,HMO,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Grouper Rate,3965.00
United HealthCare,HMO,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Grouper Rate,4847.00
United HealthCare,HMO,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Grouper Rate,3965.00
United HealthCare,HMO,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,Grouper Rate,4847.00
United HealthCare,HMO,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,Grouper Rate,1291.00
United HealthCare,HMO,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Grouper Rate,4847.00
United HealthCare,HMO,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Grouper Rate,4847.00
United HealthCare,HMO,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Grouper Rate,4847.00
United HealthCare,HMO,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,Grouper Rate,4847.00
United HealthCare,HMO,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Grouper Rate,4847.00
United HealthCare,HMO,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Grouper Rate,4847.00
United HealthCare,HMO,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Grouper Rate,4847.00
United HealthCare,HMO,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Grouper Rate,5730.00
United HealthCare,HMO,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Grouper Rate,5730.00
United HealthCare,HMO,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Grouper Rate,5730.00
United HealthCare,HMO,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,Grouper Rate,4847.00
United HealthCare,HMO,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Grouper Rate,5730.00
United HealthCare,HMO,58300,CPT4/HCPCS,INSERT INTRAUTERINE DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,58301,CPT4/HCPCS,REMOVE INTRAUTERINE DEVICE,,Grouper Rate,1145.00
United HealthCare,HMO,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Grouper Rate,1145.00
United HealthCare,HMO,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Grouper Rate,1145.00
United HealthCare,HMO,58323,CPT4/HCPCS,SPERM WASHING,,Grouper Rate,1145.00
United HealthCare,HMO,58340,CPT4/HCPCS,CATHETER FOR HYSTEROGRAPHY,,Grouper Rate,1145.00
United HealthCare,HMO,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,3965.00
United HealthCare,HMO,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Grouper Rate,3965.00
United HealthCare,HMO,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,4847.00
United HealthCare,HMO,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Grouper Rate,4847.00
United HealthCare,HMO,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Grouper Rate,5730.00
United HealthCare,HMO,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,1291.00
United HealthCare,HMO,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,1291.00
United HealthCare,HMO,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Grouper Rate,1291.00
United HealthCare,HMO,58540,CPT4/HCPCS,REVISION OF UTERUS,,Grouper Rate,1291.00
United HealthCare,HMO,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Grouper Rate,6612.00
United HealthCare,HMO,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Grouper Rate,6612.00
United HealthCare,HMO,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Grouper Rate,6612.00
United HealthCare,HMO,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Grouper Rate,6612.00
United HealthCare,HMO,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Grouper Rate,5730.00
United HealthCare,HMO,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Grouper Rate,6612.00
United HealthCare,HMO,58548,CPT4/HCPCS,LAP RADICAL HYST,,Grouper Rate,5730.00
United HealthCare,HMO,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Grouper Rate,6612.00
United HealthCare,HMO,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Grouper Rate,6612.00
United HealthCare,HMO,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Grouper Rate,6612.00
United HealthCare,HMO,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Grouper Rate,3965.00
United HealthCare,HMO,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Grouper Rate,3965.00
United HealthCare,HMO,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Grouper Rate,3965.00
United HealthCare,HMO,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Grouper Rate,4847.00
United HealthCare,HMO,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Grouper Rate,4847.00
United HealthCare,HMO,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Grouper Rate,3965.00
United HealthCare,HMO,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Grouper Rate,4847.00
United HealthCare,HMO,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Grouper Rate,5730.00
United HealthCare,HMO,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Grouper Rate,6612.00
United HealthCare,HMO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Grouper Rate,6612.00
United HealthCare,HMO,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Grouper Rate,6612.00
United HealthCare,HMO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Grouper Rate,6612.00
United HealthCare,HMO,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,Grouper Rate,1291.00
United HealthCare,HMO,58578,CPT4/HCPCS,LAPARO PROC UTERUS,,Grouper Rate,5730.00
United HealthCare,HMO,58579,CPT4/HCPCS,HYSTEROSCOPE PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,3965.00
United HealthCare,HMO,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,1291.00
United HealthCare,HMO,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Grouper Rate,3965.00
United HealthCare,HMO,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Grouper Rate,6612.00
United HealthCare,HMO,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Grouper Rate,6612.00
United HealthCare,HMO,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Grouper Rate,6612.00
United HealthCare,HMO,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Grouper Rate,6612.00
United HealthCare,HMO,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Grouper Rate,6612.00
United HealthCare,HMO,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Grouper Rate,6612.00
United HealthCare,HMO,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Grouper Rate,6612.00
United HealthCare,HMO,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Grouper Rate,6612.00
United HealthCare,HMO,58679,CPT4/HCPCS,LAPARO PROC OVIDUCT-OVARY,,Grouper Rate,5730.00
United HealthCare,HMO,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Grouper Rate,4847.00
United HealthCare,HMO,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Grouper Rate,5730.00
United HealthCare,HMO,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Grouper Rate,3965.00
United HealthCare,HMO,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Grouper Rate,4847.00
United HealthCare,HMO,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Grouper Rate,4847.00
United HealthCare,HMO,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Grouper Rate,4847.00
United HealthCare,HMO,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Grouper Rate,3965.00
United HealthCare,HMO,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,3965.00
United HealthCare,HMO,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,3965.00
United HealthCare,HMO,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Grouper Rate,3965.00
United HealthCare,HMO,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Grouper Rate,4847.00
United HealthCare,HMO,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Grouper Rate,4847.00
United HealthCare,HMO,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Grouper Rate,3965.00
United HealthCare,HMO,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Grouper Rate,4847.00
United HealthCare,HMO,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Grouper Rate,4847.00
United HealthCare,HMO,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,4847.00
United HealthCare,HMO,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,4847.00
United HealthCare,HMO,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,4847.00
United HealthCare,HMO,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,1291.00
United HealthCare,HMO,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,1291.00
United HealthCare,HMO,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,Grouper Rate,1291.00
United HealthCare,HMO,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,Grouper Rate,1291.00
United HealthCare,HMO,58956,CPT4/HCPCS,BSO OMENTECTOMY W/TAH,,Grouper Rate,1291.00
United HealthCare,HMO,58957,CPT4/HCPCS,RESECT RECURRENT GYN MAL,,Grouper Rate,1291.00
United HealthCare,HMO,58958,CPT4/HCPCS,RESECT RECUR GYN MAL W/LYM,,Grouper Rate,1291.00
United HealthCare,HMO,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,6612.00
United HealthCare,HMO,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Grouper Rate,1235.00
United HealthCare,HMO,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,1235.00
United HealthCare,HMO,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,1145.00
United HealthCare,HMO,58999,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Grouper Rate,1235.00
United HealthCare,HMO,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Grouper Rate,1145.00
United HealthCare,HMO,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,Grouper Rate,1145.00
United HealthCare,HMO,59015,CPT4/HCPCS,CHORION BIOPSY,,Grouper Rate,1235.00
United HealthCare,HMO,59020,CPT4/HCPCS,FETAL CONTRACT STRESS TEST,,Grouper Rate,1145.00
United HealthCare,HMO,59025,CPT4/HCPCS,FETAL NON-STRESS TEST,,Grouper Rate,1145.00
United HealthCare,HMO,59030,CPT4/HCPCS,FETAL SCALP BLOOD SAMPLE,,Grouper Rate,1145.00
United HealthCare,HMO,59050,CPT4/HCPCS,FETAL MONITOR W/REPORT,,Grouper Rate,1145.00
United HealthCare,HMO,59051,CPT4/HCPCS,FETAL MONITOR/INTERPRET ONLY,,Grouper Rate,1291.00
United HealthCare,HMO,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Grouper Rate,1145.00
United HealthCare,HMO,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Grouper Rate,1145.00
United HealthCare,HMO,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Grouper Rate,1145.00
United HealthCare,HMO,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Grouper Rate,1145.00
United HealthCare,HMO,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,Grouper Rate,3965.00
United HealthCare,HMO,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,4847.00
United HealthCare,HMO,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,4847.00
United HealthCare,HMO,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1291.00
United HealthCare,HMO,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1291.00
United HealthCare,HMO,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1291.00
United HealthCare,HMO,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1291.00
United HealthCare,HMO,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6612.00
United HealthCare,HMO,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,6612.00
United HealthCare,HMO,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Grouper Rate,3965.00
United HealthCare,HMO,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Grouper Rate,1145.00
United HealthCare,HMO,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Grouper Rate,3965.00
United HealthCare,HMO,59320,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,3965.00
United HealthCare,HMO,59325,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,1291.00
United HealthCare,HMO,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Grouper Rate,3965.00
United HealthCare,HMO,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,Grouper Rate,3965.00
United HealthCare,HMO,59414,CPT4/HCPCS,DELIVER PLACENTA,,Grouper Rate,3965.00
United HealthCare,HMO,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Grouper Rate,3965.00
United HealthCare,HMO,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,3965.00
United HealthCare,HMO,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Grouper Rate,3965.00
United HealthCare,HMO,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,3965.00
United HealthCare,HMO,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Grouper Rate,1291.00
United HealthCare,HMO,59840,CPT4/HCPCS,ABORTION,,Grouper Rate,3965.00
United HealthCare,HMO,59841,CPT4/HCPCS,ABORTION,,Grouper Rate,3965.00
United HealthCare,HMO,59850,CPT4/HCPCS,ABORTION,,Grouper Rate,1291.00
United HealthCare,HMO,59851,CPT4/HCPCS,ABORTION,,Grouper Rate,1291.00
United HealthCare,HMO,59852,CPT4/HCPCS,ABORTION,,Grouper Rate,1291.00
United HealthCare,HMO,59855,CPT4/HCPCS,ABORTION,,Grouper Rate,1291.00
United HealthCare,HMO,59856,CPT4/HCPCS,ABORTION,,Grouper Rate,1291.00
United HealthCare,HMO,59857,CPT4/HCPCS,ABORTION,,Grouper Rate,1291.00
United HealthCare,HMO,59866,CPT4/HCPCS,ABORTION (MPR),,Grouper Rate,1145.00
United HealthCare,HMO,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Grouper Rate,3965.00
United HealthCare,HMO,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Grouper Rate,4847.00
United HealthCare,HMO,59897,CPT4/HCPCS,FETAL INVAS PX W/US,,Grouper Rate,1145.00
United HealthCare,HMO,59898,CPT4/HCPCS,LAPARO PROC OB CARE/DELIVER,,Grouper Rate,5730.00
United HealthCare,HMO,59899,CPT4/HCPCS,MATERNITY CARE PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Grouper Rate,1291.00
United HealthCare,HMO,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Grouper Rate,1235.00
United HealthCare,HMO,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Grouper Rate,6612.00
United HealthCare,HMO,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,6612.00
United HealthCare,HMO,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,6612.00
United HealthCare,HMO,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,6612.00
United HealthCare,HMO,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,6612.00
United HealthCare,HMO,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,6612.00
United HealthCare,HMO,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,5730.00
United HealthCare,HMO,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Grouper Rate,5730.00
United HealthCare,HMO,60270,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,1291.00
United HealthCare,HMO,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,5730.00
United HealthCare,HMO,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,6612.00
United HealthCare,HMO,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,6612.00
United HealthCare,HMO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Grouper Rate,1235.00
United HealthCare,HMO,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,5730.00
United HealthCare,HMO,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Grouper Rate,5730.00
United HealthCare,HMO,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,1291.00
United HealthCare,HMO,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Grouper Rate,1145.00
United HealthCare,HMO,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,5730.00
United HealthCare,HMO,60521,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,1291.00
United HealthCare,HMO,60522,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,1291.00
United HealthCare,HMO,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,1291.00
United HealthCare,HMO,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,1291.00
United HealthCare,HMO,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Grouper Rate,1291.00
United HealthCare,HMO,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Grouper Rate,1291.00
United HealthCare,HMO,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Grouper Rate,5730.00
United HealthCare,HMO,60659,CPT4/HCPCS,LAPARO PROC ENDOCRINE,,Grouper Rate,5730.00
United HealthCare,HMO,60699,CPT4/HCPCS,ENDOCRINE SURGERY PROCEDURE,,Grouper Rate,6612.00
United HealthCare,HMO,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,1235.00
United HealthCare,HMO,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,1235.00
United HealthCare,HMO,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Grouper Rate,1235.00
United HealthCare,HMO,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,1235.00
United HealthCare,HMO,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Grouper Rate,1145.00
United HealthCare,HMO,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,1145.00
United HealthCare,HMO,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Grouper Rate,1235.00
United HealthCare,HMO,61105,CPT4/HCPCS,TWIST DRILL HOLE,,Grouper Rate,1291.00
United HealthCare,HMO,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,Grouper Rate,1291.00
United HealthCare,HMO,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,Grouper Rate,1291.00
United HealthCare,HMO,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,Grouper Rate,1291.00
United HealthCare,HMO,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,Grouper Rate,1291.00
United HealthCare,HMO,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Grouper Rate,5730.00
United HealthCare,HMO,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Grouper Rate,1291.00
United HealthCare,HMO,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Grouper Rate,1291.00
United HealthCare,HMO,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Grouper Rate,1291.00
United HealthCare,HMO,61305,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Grouper Rate,1291.00
United HealthCare,HMO,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,61314,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,61315,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Grouper Rate,1291.00
United HealthCare,HMO,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,61321,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1291.00
United HealthCare,HMO,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,Grouper Rate,1291.00
United HealthCare,HMO,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,Grouper Rate,5730.00
United HealthCare,HMO,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,Grouper Rate,1291.00
United HealthCare,HMO,61343,CPT4/HCPCS,INCISE SKULL (PRESS RELIEF),,Grouper Rate,1291.00
United HealthCare,HMO,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,Grouper Rate,1291.00
United HealthCare,HMO,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Grouper Rate,6612.00
United HealthCare,HMO,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,Grouper Rate,1291.00
United HealthCare,HMO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Grouper Rate,1291.00
United HealthCare,HMO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,1291.00
United HealthCare,HMO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,1291.00
United HealthCare,HMO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,Grouper Rate,1291.00
United HealthCare,HMO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Grouper Rate,1291.00
United HealthCare,HMO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Grouper Rate,1291.00
United HealthCare,HMO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Grouper Rate,1291.00
United HealthCare,HMO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Grouper Rate,1291.00
United HealthCare,HMO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,Grouper Rate,1291.00
United HealthCare,HMO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,Grouper Rate,1291.00
United HealthCare,HMO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Grouper Rate,1291.00
United HealthCare,HMO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Grouper Rate,1291.00
United HealthCare,HMO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Grouper Rate,1291.00
United HealthCare,HMO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Grouper Rate,1291.00
United HealthCare,HMO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,Grouper Rate,1291.00
United HealthCare,HMO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1291.00
United HealthCare,HMO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,1291.00
United HealthCare,HMO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,Grouper Rate,1291.00
United HealthCare,HMO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,61618,CPT4/HCPCS,REPAIR DURA,,Grouper Rate,1291.00
United HealthCare,HMO,61619,CPT4/HCPCS,REPAIR DURA,,Grouper Rate,1291.00
United HealthCare,HMO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Grouper Rate,9547.00
United HealthCare,HMO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,Grouper Rate,1291.00
United HealthCare,HMO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Grouper Rate,9547.00
United HealthCare,HMO,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,Grouper Rate,1291.00
United HealthCare,HMO,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,Grouper Rate,1291.00
United HealthCare,HMO,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,Grouper Rate,1291.00
United HealthCare,HMO,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,Grouper Rate,1291.00
United HealthCare,HMO,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,Grouper Rate,1291.00
United HealthCare,HMO,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,Grouper Rate,1291.00
United HealthCare,HMO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,Grouper Rate,1291.00
United HealthCare,HMO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,Grouper Rate,1291.00
United HealthCare,HMO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Grouper Rate,1291.00
United HealthCare,HMO,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Grouper Rate,1291.00
United HealthCare,HMO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,Grouper Rate,1291.00
United HealthCare,HMO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,Grouper Rate,1291.00
United HealthCare,HMO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,1291.00
United HealthCare,HMO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,1291.00
United HealthCare,HMO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,1291.00
United HealthCare,HMO,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,Grouper Rate,1291.00
United HealthCare,HMO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Grouper Rate,5730.00
United HealthCare,HMO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,Grouper Rate,1291.00
United HealthCare,HMO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,Grouper Rate,1291.00
United HealthCare,HMO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,1291.00
United HealthCare,HMO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,Grouper Rate,5730.00
United HealthCare,HMO,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,Grouper Rate,1145.00
United HealthCare,HMO,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,Grouper Rate,1145.00
United HealthCare,HMO,61783,CPT4/HCPCS,SCAN PROC SPINAL,,Grouper Rate,1145.00
United HealthCare,HMO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Grouper Rate,3965.00
United HealthCare,HMO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,Grouper Rate,6612.00
United HealthCare,HMO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,Grouper Rate,6612.00
United HealthCare,HMO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1291.00
United HealthCare,HMO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1291.00
United HealthCare,HMO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Grouper Rate,1291.00
United HealthCare,HMO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Grouper Rate,1291.00
United HealthCare,HMO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1291.00
United HealthCare,HMO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,4847.00
United HealthCare,HMO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Grouper Rate,13506.00
United HealthCare,HMO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Grouper Rate,22812.00
United HealthCare,HMO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,4847.00
United HealthCare,HMO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,Grouper Rate,5730.00
United HealthCare,HMO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,Grouper Rate,1291.00
United HealthCare,HMO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,Grouper Rate,1291.00
United HealthCare,HMO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,Grouper Rate,1291.00
United HealthCare,HMO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,Grouper Rate,1291.00
United HealthCare,HMO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,Grouper Rate,1291.00
United HealthCare,HMO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,Grouper Rate,1291.00
United HealthCare,HMO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,Grouper Rate,1291.00
United HealthCare,HMO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,Grouper Rate,1291.00
United HealthCare,HMO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Grouper Rate,1291.00
United HealthCare,HMO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,Grouper Rate,1291.00
United HealthCare,HMO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,Grouper Rate,1291.00
United HealthCare,HMO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,Grouper Rate,1291.00
United HealthCare,HMO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,Grouper Rate,1291.00
United HealthCare,HMO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,Grouper Rate,1291.00
United HealthCare,HMO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,Grouper Rate,1291.00
United HealthCare,HMO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,3965.00
United HealthCare,HMO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,Grouper Rate,1291.00
United HealthCare,HMO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,1291.00
United HealthCare,HMO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Grouper Rate,5730.00
United HealthCare,HMO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,Grouper Rate,1145.00
United HealthCare,HMO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Grouper Rate,1235.00
United HealthCare,HMO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Grouper Rate,1235.00
United HealthCare,HMO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Grouper Rate,1235.00
United HealthCare,HMO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Grouper Rate,1235.00
United HealthCare,HMO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Grouper Rate,1291.00
United HealthCare,HMO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Grouper Rate,1235.00
United HealthCare,HMO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Grouper Rate,1235.00
United HealthCare,HMO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Grouper Rate,1235.00
United HealthCare,HMO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,1235.00
United HealthCare,HMO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,1235.00
United HealthCare,HMO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Grouper Rate,1235.00
United HealthCare,HMO,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,Grouper Rate,1145.00
United HealthCare,HMO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Grouper Rate,4847.00
United HealthCare,HMO,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,Grouper Rate,1145.00
United HealthCare,HMO,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,Grouper Rate,1145.00
United HealthCare,HMO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Grouper Rate,3965.00
United HealthCare,HMO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Grouper Rate,1235.00
United HealthCare,HMO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1235.00
United HealthCare,HMO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1235.00
United HealthCare,HMO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1235.00
United HealthCare,HMO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1235.00
United HealthCare,HMO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1235.00
United HealthCare,HMO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1235.00
United HealthCare,HMO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1235.00
United HealthCare,HMO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1235.00
United HealthCare,HMO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1235.00
United HealthCare,HMO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1235.00
United HealthCare,HMO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1235.00
United HealthCare,HMO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1235.00
United HealthCare,HMO,62328,CPT4/HCPCS,DX LMBR SPI PNXR W/FLUOR/CT,,Grouper Rate,1235.00
United HealthCare,HMO,62329,CPT4/HCPCS,THER SPI PNXR CSF FLUOR/CT,,Grouper Rate,1235.00
United HealthCare,HMO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,5730.00
United HealthCare,HMO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,6612.00
United HealthCare,HMO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Grouper Rate,3965.00
United HealthCare,HMO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Grouper Rate,5730.00
United HealthCare,HMO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,13506.00
United HealthCare,HMO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,13506.00
United HealthCare,HMO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Grouper Rate,6612.00
United HealthCare,HMO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Grouper Rate,1145.00
United HealthCare,HMO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Grouper Rate,1145.00
United HealthCare,HMO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,Grouper Rate,1145.00
United HealthCare,HMO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Grouper Rate,1145.00
United HealthCare,HMO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Grouper Rate,6612.00
United HealthCare,HMO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Grouper Rate,6612.00
United HealthCare,HMO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Grouper Rate,6612.00
United HealthCare,HMO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Grouper Rate,6612.00
United HealthCare,HMO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Grouper Rate,6612.00
United HealthCare,HMO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Grouper Rate,6612.00
United HealthCare,HMO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Grouper Rate,6612.00
United HealthCare,HMO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Grouper Rate,6612.00
United HealthCare,HMO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Grouper Rate,6612.00
United HealthCare,HMO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Grouper Rate,6612.00
United HealthCare,HMO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Grouper Rate,6612.00
United HealthCare,HMO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Grouper Rate,4847.00
United HealthCare,HMO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Grouper Rate,4847.00
United HealthCare,HMO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Grouper Rate,6612.00
United HealthCare,HMO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Grouper Rate,6612.00
United HealthCare,HMO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Grouper Rate,6612.00
United HealthCare,HMO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,Grouper Rate,1291.00
United HealthCare,HMO,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,Grouper Rate,1291.00
United HealthCare,HMO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,6612.00
United HealthCare,HMO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Grouper Rate,6612.00
United HealthCare,HMO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,6612.00
United HealthCare,HMO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,6612.00
United HealthCare,HMO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Grouper Rate,1291.00
United HealthCare,HMO,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Grouper Rate,1291.00
United HealthCare,HMO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,Grouper Rate,6612.00
United HealthCare,HMO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,Grouper Rate,1291.00
United HealthCare,HMO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Grouper Rate,1291.00
United HealthCare,HMO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Grouper Rate,1291.00
United HealthCare,HMO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,Grouper Rate,1291.00
United HealthCare,HMO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Grouper Rate,1291.00
United HealthCare,HMO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Grouper Rate,1291.00
United HealthCare,HMO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Grouper Rate,1291.00
United HealthCare,HMO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Grouper Rate,1291.00
United HealthCare,HMO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,Grouper Rate,9547.00
United HealthCare,HMO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,Grouper Rate,9547.00
United HealthCare,HMO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,Grouper Rate,9547.00
United HealthCare,HMO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,Grouper Rate,1291.00
United HealthCare,HMO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,Grouper Rate,1291.00
United HealthCare,HMO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,Grouper Rate,1291.00
United HealthCare,HMO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,Grouper Rate,1291.00
United HealthCare,HMO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,Grouper Rate,9547.00
United HealthCare,HMO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,Grouper Rate,1291.00
United HealthCare,HMO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,Grouper Rate,9547.00
United HealthCare,HMO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Grouper Rate,6612.00
United HealthCare,HMO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Grouper Rate,6612.00
United HealthCare,HMO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Grouper Rate,3965.00
United HealthCare,HMO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Grouper Rate,6612.00
United HealthCare,HMO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,Grouper Rate,1291.00
United HealthCare,HMO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Grouper Rate,9547.00
United HealthCare,HMO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Grouper Rate,1291.00
United HealthCare,HMO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,Grouper Rate,1291.00
United HealthCare,HMO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,Grouper Rate,9547.00
United HealthCare,HMO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,Grouper Rate,1291.00
United HealthCare,HMO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,Grouper Rate,1291.00
United HealthCare,HMO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,Grouper Rate,9547.00
United HealthCare,HMO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,Grouper Rate,1291.00
United HealthCare,HMO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,Grouper Rate,1291.00
United HealthCare,HMO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,Grouper Rate,9547.00
United HealthCare,HMO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,Grouper Rate,9547.00
United HealthCare,HMO,63295,CPT4/HCPCS,REPAIR LAMINECTOMY DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,Grouper Rate,1291.00
United HealthCare,HMO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,Grouper Rate,1291.00
United HealthCare,HMO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,Grouper Rate,1291.00
United HealthCare,HMO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,Grouper Rate,1291.00
United HealthCare,HMO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,Grouper Rate,1291.00
United HealthCare,HMO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,Grouper Rate,1291.00
United HealthCare,HMO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,Grouper Rate,1291.00
United HealthCare,HMO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1291.00
United HealthCare,HMO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Grouper Rate,3965.00
United HealthCare,HMO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Grouper Rate,1291.00
United HealthCare,HMO,63620,CPT4/HCPCS,SRS SPINAL LESION,,Grouper Rate,6612.00
United HealthCare,HMO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,Grouper Rate,1291.00
United HealthCare,HMO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,6612.00
United HealthCare,HMO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,9547.00
United HealthCare,HMO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Grouper Rate,3965.00
United HealthCare,HMO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Grouper Rate,4847.00
United HealthCare,HMO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Grouper Rate,6612.00
United HealthCare,HMO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Grouper Rate,6612.00
United HealthCare,HMO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Grouper Rate,13506.00
United HealthCare,HMO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,4847.00
United HealthCare,HMO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,1291.00
United HealthCare,HMO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,1291.00
United HealthCare,HMO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,1291.00
United HealthCare,HMO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,1291.00
United HealthCare,HMO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Grouper Rate,1291.00
United HealthCare,HMO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Grouper Rate,1291.00
United HealthCare,HMO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,Grouper Rate,1291.00
United HealthCare,HMO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,1291.00
United HealthCare,HMO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,5730.00
United HealthCare,HMO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Grouper Rate,5730.00
United HealthCare,HMO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Grouper Rate,3965.00
United HealthCare,HMO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Grouper Rate,1145.00
United HealthCare,HMO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Grouper Rate,1145.00
United HealthCare,HMO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Grouper Rate,1145.00
United HealthCare,HMO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Grouper Rate,1235.00
United HealthCare,HMO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Grouper Rate,1235.00
United HealthCare,HMO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Grouper Rate,1235.00
United HealthCare,HMO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Grouper Rate,1235.00
United HealthCare,HMO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Grouper Rate,1235.00
United HealthCare,HMO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Grouper Rate,1235.00
United HealthCare,HMO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Grouper Rate,1235.00
United HealthCare,HMO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Grouper Rate,1235.00
United HealthCare,HMO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Grouper Rate,1235.00
United HealthCare,HMO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Grouper Rate,1235.00
United HealthCare,HMO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,Grouper Rate,1235.00
United HealthCare,HMO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,Grouper Rate,1235.00
United HealthCare,HMO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,Grouper Rate,1235.00
United HealthCare,HMO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Grouper Rate,1235.00
United HealthCare,HMO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Grouper Rate,1235.00
United HealthCare,HMO,64451,CPT4/HCPCS,NJX AA&/STRD NRV NRVTG SI JT,,Grouper Rate,1235.00
United HealthCare,HMO,64454,CPT4/HCPCS,NJX AA&/STRD GNCLR NRV BRNCH,,Grouper Rate,1235.00
United HealthCare,HMO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Grouper Rate,1145.00
United HealthCare,HMO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Grouper Rate,1235.00
United HealthCare,HMO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Grouper Rate,1145.00
United HealthCare,HMO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Grouper Rate,1235.00
United HealthCare,HMO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Grouper Rate,1235.00
United HealthCare,HMO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Grouper Rate,1145.00
United HealthCare,HMO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Grouper Rate,1235.00
United HealthCare,HMO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Grouper Rate,1145.00
United HealthCare,HMO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Grouper Rate,1145.00
United HealthCare,HMO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Grouper Rate,1145.00
United HealthCare,HMO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Grouper Rate,1145.00
United HealthCare,HMO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Grouper Rate,1145.00
United HealthCare,HMO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Grouper Rate,1235.00
United HealthCare,HMO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Grouper Rate,1145.00
United HealthCare,HMO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Grouper Rate,1145.00
United HealthCare,HMO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Grouper Rate,1235.00
United HealthCare,HMO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Grouper Rate,1145.00
United HealthCare,HMO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Grouper Rate,1145.00
United HealthCare,HMO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Grouper Rate,1145.00
United HealthCare,HMO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Grouper Rate,1235.00
United HealthCare,HMO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Grouper Rate,1235.00
United HealthCare,HMO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Grouper Rate,1235.00
United HealthCare,HMO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Grouper Rate,1235.00
United HealthCare,HMO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,6612.00
United HealthCare,HMO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,6612.00
United HealthCare,HMO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,6612.00
United HealthCare,HMO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Grouper Rate,1145.00
United HealthCare,HMO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Grouper Rate,22812.00
United HealthCare,HMO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Grouper Rate,6612.00
United HealthCare,HMO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Grouper Rate,6612.00
United HealthCare,HMO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,9547.00
United HealthCare,HMO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,9547.00
United HealthCare,HMO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,9547.00
United HealthCare,HMO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,4847.00
United HealthCare,HMO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Grouper Rate,13506.00
United HealthCare,HMO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Grouper Rate,4847.00
United HealthCare,HMO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1235.00
United HealthCare,HMO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Grouper Rate,1145.00
United HealthCare,HMO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Grouper Rate,1145.00
United HealthCare,HMO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Grouper Rate,1145.00
United HealthCare,HMO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Grouper Rate,1145.00
United HealthCare,HMO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Grouper Rate,1145.00
United HealthCare,HMO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1235.00
United HealthCare,HMO,64624,CPT4/HCPCS,DSTRJ NULYT AGT GNCLR NRV,,Grouper Rate,3965.00
United HealthCare,HMO,64625,CPT4/HCPCS,RF ABLTJ NRV NRVTG SI JT,,Grouper Rate,3965.00
United HealthCare,HMO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1235.00
United HealthCare,HMO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Grouper Rate,1145.00
United HealthCare,HMO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Grouper Rate,3965.00
United HealthCare,HMO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Grouper Rate,3965.00
United HealthCare,HMO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1235.00
United HealthCare,HMO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Grouper Rate,1235.00
United HealthCare,HMO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,Grouper Rate,1145.00
United HealthCare,HMO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Grouper Rate,1235.00
United HealthCare,HMO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,Grouper Rate,1145.00
United HealthCare,HMO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Grouper Rate,1235.00
United HealthCare,HMO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Grouper Rate,1235.00
United HealthCare,HMO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,1145.00
United HealthCare,HMO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,1145.00
United HealthCare,HMO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1235.00
United HealthCare,HMO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1235.00
United HealthCare,HMO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Grouper Rate,3965.00
United HealthCare,HMO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Grouper Rate,3965.00
United HealthCare,HMO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Grouper Rate,3965.00
United HealthCare,HMO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Grouper Rate,3965.00
United HealthCare,HMO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Grouper Rate,3965.00
United HealthCare,HMO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Grouper Rate,1145.00
United HealthCare,HMO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Grouper Rate,1291.00
United HealthCare,HMO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Grouper Rate,1291.00
United HealthCare,HMO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Grouper Rate,1291.00
United HealthCare,HMO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Grouper Rate,1291.00
United HealthCare,HMO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Grouper Rate,3965.00
United HealthCare,HMO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Grouper Rate,1291.00
United HealthCare,HMO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,Grouper Rate,1291.00
United HealthCare,HMO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Grouper Rate,1291.00
United HealthCare,HMO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Grouper Rate,1291.00
United HealthCare,HMO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Grouper Rate,4847.00
United HealthCare,HMO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Grouper Rate,5730.00
United HealthCare,HMO,64787,CPT4/HCPCS,IMPLANT NERVE END,,Grouper Rate,1145.00
United HealthCare,HMO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,5730.00
United HealthCare,HMO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Grouper Rate,1291.00
United HealthCare,HMO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,1291.00
United HealthCare,HMO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,1291.00
United HealthCare,HMO,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,1291.00
United HealthCare,HMO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,Grouper Rate,3965.00
United HealthCare,HMO,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,4847.00
United HealthCare,HMO,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,4847.00
United HealthCare,HMO,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,Grouper Rate,4847.00
United HealthCare,HMO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Grouper Rate,4847.00
United HealthCare,HMO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Grouper Rate,4847.00
United HealthCare,HMO,64859,CPT4/HCPCS,NERVE SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Grouper Rate,4847.00
United HealthCare,HMO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Grouper Rate,5730.00
United HealthCare,HMO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,1291.00
United HealthCare,HMO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,1291.00
United HealthCare,HMO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Grouper Rate,1145.00
United HealthCare,HMO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Grouper Rate,1145.00
United HealthCare,HMO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Grouper Rate,5730.00
United HealthCare,HMO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Grouper Rate,5730.00
United HealthCare,HMO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,5730.00
United HealthCare,HMO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,5730.00
United HealthCare,HMO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Grouper Rate,5730.00
United HealthCare,HMO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,5730.00
United HealthCare,HMO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,5730.00
United HealthCare,HMO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,5730.00
United HealthCare,HMO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Grouper Rate,5730.00
United HealthCare,HMO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,5730.00
United HealthCare,HMO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,5730.00
United HealthCare,HMO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,5730.00
United HealthCare,HMO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Grouper Rate,5730.00
United HealthCare,HMO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Grouper Rate,1145.00
United HealthCare,HMO,64999,CPT4/HCPCS,NERVOUS SYSTEM SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,65091,CPT4/HCPCS,REVISE EYE,,Grouper Rate,4847.00
United HealthCare,HMO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65101,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,4847.00
United HealthCare,HMO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65110,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,4847.00
United HealthCare,HMO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,4847.00
United HealthCare,HMO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,4847.00
United HealthCare,HMO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,3965.00
United HealthCare,HMO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1145.00
United HealthCare,HMO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1145.00
United HealthCare,HMO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1145.00
United HealthCare,HMO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1145.00
United HealthCare,HMO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,3965.00
United HealthCare,HMO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1145.00
United HealthCare,HMO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,3965.00
United HealthCare,HMO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3965.00
United HealthCare,HMO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3965.00
United HealthCare,HMO,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,4847.00
United HealthCare,HMO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3965.00
United HealthCare,HMO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,3965.00
United HealthCare,HMO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1291.00
United HealthCare,HMO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Grouper Rate,4847.00
United HealthCare,HMO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,1291.00
United HealthCare,HMO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Grouper Rate,1235.00
United HealthCare,HMO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,65430,CPT4/HCPCS,CORNEAL SMEAR,,Grouper Rate,1145.00
United HealthCare,HMO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,1291.00
United HealthCare,HMO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,3965.00
United HealthCare,HMO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Grouper Rate,1145.00
United HealthCare,HMO,65600,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,3965.00
United HealthCare,HMO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,5730.00
United HealthCare,HMO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,5730.00
United HealthCare,HMO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,5730.00
United HealthCare,HMO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,5730.00
United HealthCare,HMO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Grouper Rate,5730.00
United HealthCare,HMO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,Grouper Rate,1145.00
United HealthCare,HMO,65760,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,3965.00
United HealthCare,HMO,65765,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,3965.00
United HealthCare,HMO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Grouper Rate,3965.00
United HealthCare,HMO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Grouper Rate,6612.00
United HealthCare,HMO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Grouper Rate,3965.00
United HealthCare,HMO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,1291.00
United HealthCare,HMO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,3965.00
United HealthCare,HMO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Grouper Rate,1291.00
United HealthCare,HMO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Grouper Rate,4847.00
United HealthCare,HMO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5730.00
United HealthCare,HMO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Grouper Rate,5730.00
United HealthCare,HMO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1145.00
United HealthCare,HMO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,3965.00
United HealthCare,HMO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,3965.00
United HealthCare,HMO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Grouper Rate,3965.00
United HealthCare,HMO,65850,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,3965.00
United HealthCare,HMO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Grouper Rate,1235.00
United HealthCare,HMO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,1235.00
United HealthCare,HMO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,3965.00
United HealthCare,HMO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,3965.00
United HealthCare,HMO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,3965.00
United HealthCare,HMO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,3965.00
United HealthCare,HMO,65900,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Grouper Rate,3965.00
United HealthCare,HMO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Grouper Rate,3965.00
United HealthCare,HMO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,1291.00
United HealthCare,HMO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,1291.00
United HealthCare,HMO,66130,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,66172,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,3965.00
United HealthCare,HMO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Grouper Rate,5730.00
United HealthCare,HMO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Grouper Rate,5730.00
United HealthCare,HMO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Grouper Rate,5730.00
United HealthCare,HMO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Grouper Rate,5730.00
United HealthCare,HMO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Grouper Rate,3965.00
United HealthCare,HMO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Grouper Rate,3965.00
United HealthCare,HMO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Grouper Rate,3965.00
United HealthCare,HMO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Grouper Rate,3965.00
United HealthCare,HMO,66500,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,1145.00
United HealthCare,HMO,66505,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,1291.00
United HealthCare,HMO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Grouper Rate,3965.00
United HealthCare,HMO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,5730.00
United HealthCare,HMO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,1291.00
United HealthCare,HMO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,1291.00
United HealthCare,HMO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,3965.00
United HealthCare,HMO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,3965.00
United HealthCare,HMO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,3965.00
United HealthCare,HMO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1291.00
United HealthCare,HMO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Grouper Rate,3965.00
United HealthCare,HMO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Grouper Rate,3965.00
United HealthCare,HMO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,3965.00
United HealthCare,HMO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,3965.00
United HealthCare,HMO,66761,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,1235.00
United HealthCare,HMO,66762,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,1235.00
United HealthCare,HMO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Grouper Rate,1235.00
United HealthCare,HMO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Grouper Rate,1145.00
United HealthCare,HMO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Grouper Rate,1235.00
United HealthCare,HMO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Grouper Rate,3965.00
United HealthCare,HMO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Grouper Rate,3965.00
United HealthCare,HMO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,3965.00
United HealthCare,HMO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,3965.00
United HealthCare,HMO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,5730.00
United HealthCare,HMO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,3965.00
United HealthCare,HMO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,3965.00
United HealthCare,HMO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,1291.00
United HealthCare,HMO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Grouper Rate,3965.00
United HealthCare,HMO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Grouper Rate,3965.00
United HealthCare,HMO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Grouper Rate,3965.00
United HealthCare,HMO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Grouper Rate,3965.00
United HealthCare,HMO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Grouper Rate,3965.00
United HealthCare,HMO,66987,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX W/ECP,,Grouper Rate,5730.00
United HealthCare,HMO,66988,CPT4/HCPCS,XCAPSL CTRC RMVL W/ECP,,Grouper Rate,5730.00
United HealthCare,HMO,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,66999,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,3965.00
United HealthCare,HMO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,3965.00
United HealthCare,HMO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Grouper Rate,3965.00
United HealthCare,HMO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Grouper Rate,3965.00
United HealthCare,HMO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Grouper Rate,5730.00
United HealthCare,HMO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Grouper Rate,1145.00
United HealthCare,HMO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Grouper Rate,3965.00
United HealthCare,HMO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Grouper Rate,1235.00
United HealthCare,HMO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Grouper Rate,5730.00
United HealthCare,HMO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,5730.00
United HealthCare,HMO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,5730.00
United HealthCare,HMO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Grouper Rate,5730.00
United HealthCare,HMO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Grouper Rate,5730.00
United HealthCare,HMO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Grouper Rate,5730.00
United HealthCare,HMO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Grouper Rate,3965.00
United HealthCare,HMO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Grouper Rate,1235.00
United HealthCare,HMO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,5730.00
United HealthCare,HMO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,5730.00
United HealthCare,HMO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,3965.00
United HealthCare,HMO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Grouper Rate,5730.00
United HealthCare,HMO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Grouper Rate,3965.00
United HealthCare,HMO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,3965.00
United HealthCare,HMO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,5730.00
United HealthCare,HMO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,1145.00
United HealthCare,HMO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,1235.00
United HealthCare,HMO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,1145.00
United HealthCare,HMO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,1235.00
United HealthCare,HMO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,4847.00
United HealthCare,HMO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Grouper Rate,1235.00
United HealthCare,HMO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Grouper Rate,1235.00
United HealthCare,HMO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Grouper Rate,4847.00
United HealthCare,HMO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Grouper Rate,1235.00
United HealthCare,HMO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Grouper Rate,1235.00
United HealthCare,HMO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Grouper Rate,3965.00
United HealthCare,HMO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Grouper Rate,3965.00
United HealthCare,HMO,67299,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Grouper Rate,1291.00
United HealthCare,HMO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,3965.00
United HealthCare,HMO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,4847.00
United HealthCare,HMO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,3965.00
United HealthCare,HMO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,3965.00
United HealthCare,HMO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Grouper Rate,3965.00
United HealthCare,HMO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Grouper Rate,1145.00
United HealthCare,HMO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Grouper Rate,3965.00
United HealthCare,HMO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Grouper Rate,1145.00
United HealthCare,HMO,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,Grouper Rate,4847.00
United HealthCare,HMO,67399,CPT4/HCPCS,UNLISTED PX EXTRAOCULAR MUSC,,Grouper Rate,1145.00
United HealthCare,HMO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,4847.00
United HealthCare,HMO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,3965.00
United HealthCare,HMO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,3965.00
United HealthCare,HMO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,3965.00
United HealthCare,HMO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,4847.00
United HealthCare,HMO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Grouper Rate,3965.00
United HealthCare,HMO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,4847.00
United HealthCare,HMO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,4847.00
United HealthCare,HMO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,4847.00
United HealthCare,HMO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,4847.00
United HealthCare,HMO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,4847.00
United HealthCare,HMO,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,1145.00
United HealthCare,HMO,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,1145.00
United HealthCare,HMO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,1145.00
United HealthCare,HMO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Grouper Rate,4847.00
United HealthCare,HMO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Grouper Rate,4847.00
United HealthCare,HMO,67599,CPT4/HCPCS,ORBIT SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Grouper Rate,1145.00
United HealthCare,HMO,67710,CPT4/HCPCS,INCISION OF EYELID,,Grouper Rate,1291.00
United HealthCare,HMO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Grouper Rate,3965.00
United HealthCare,HMO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,1145.00
United HealthCare,HMO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,1291.00
United HealthCare,HMO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Grouper Rate,3965.00
United HealthCare,HMO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Grouper Rate,1145.00
United HealthCare,HMO,67820,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1145.00
United HealthCare,HMO,67825,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1145.00
United HealthCare,HMO,67830,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1291.00
United HealthCare,HMO,67835,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,3965.00
United HealthCare,HMO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,1291.00
United HealthCare,HMO,67850,CPT4/HCPCS,TREAT EYELID LESION,,Grouper Rate,1291.00
United HealthCare,HMO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Grouper Rate,1291.00
United HealthCare,HMO,67880,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3965.00
United HealthCare,HMO,67882,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3965.00
United HealthCare,HMO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4847.00
United HealthCare,HMO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4847.00
United HealthCare,HMO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Grouper Rate,3965.00
United HealthCare,HMO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,3965.00
United HealthCare,HMO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,3965.00
United HealthCare,HMO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,3965.00
United HealthCare,HMO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Grouper Rate,1145.00
United HealthCare,HMO,67950,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3965.00
United HealthCare,HMO,67961,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3965.00
United HealthCare,HMO,67966,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,3965.00
United HealthCare,HMO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3965.00
United HealthCare,HMO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3965.00
United HealthCare,HMO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,4847.00
United HealthCare,HMO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,3965.00
United HealthCare,HMO,67999,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,1145.00
United HealthCare,HMO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Grouper Rate,1291.00
United HealthCare,HMO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,Grouper Rate,1145.00
United HealthCare,HMO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Grouper Rate,1235.00
United HealthCare,HMO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,3965.00
United HealthCare,HMO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,3965.00
United HealthCare,HMO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,3965.00
United HealthCare,HMO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,3965.00
United HealthCare,HMO,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,Grouper Rate,1145.00
United HealthCare,HMO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,3965.00
United HealthCare,HMO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,4847.00
United HealthCare,HMO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,4847.00
United HealthCare,HMO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,3965.00
United HealthCare,HMO,68330,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,3965.00
United HealthCare,HMO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,4847.00
United HealthCare,HMO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Grouper Rate,3965.00
United HealthCare,HMO,68360,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,4847.00
United HealthCare,HMO,68362,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,3965.00
United HealthCare,HMO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Grouper Rate,3965.00
United HealthCare,HMO,68399,CPT4/HCPCS,EYELID LINING SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Grouper Rate,1291.00
United HealthCare,HMO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Grouper Rate,1235.00
United HealthCare,HMO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Grouper Rate,1145.00
United HealthCare,HMO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Grouper Rate,4847.00
United HealthCare,HMO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Grouper Rate,4847.00
United HealthCare,HMO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Grouper Rate,3965.00
United HealthCare,HMO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Grouper Rate,4847.00
United HealthCare,HMO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Grouper Rate,3965.00
United HealthCare,HMO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Grouper Rate,1145.00
United HealthCare,HMO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,3965.00
United HealthCare,HMO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,4847.00
United HealthCare,HMO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Grouper Rate,3965.00
United HealthCare,HMO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Grouper Rate,1145.00
United HealthCare,HMO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Grouper Rate,4847.00
United HealthCare,HMO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,4847.00
United HealthCare,HMO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,4847.00
United HealthCare,HMO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,1145.00
United HealthCare,HMO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,1145.00
United HealthCare,HMO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Grouper Rate,1235.00
United HealthCare,HMO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,Grouper Rate,1145.00
United HealthCare,HMO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1145.00
United HealthCare,HMO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,3965.00
United HealthCare,HMO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,3965.00
United HealthCare,HMO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Grouper Rate,3965.00
United HealthCare,HMO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Grouper Rate,1145.00
United HealthCare,HMO,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,Grouper Rate,1145.00
United HealthCare,HMO,68899,CPT4/HCPCS,TEAR DUCT SYSTEM SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,1235.00
United HealthCare,HMO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,1291.00
United HealthCare,HMO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Grouper Rate,1235.00
United HealthCare,HMO,69090,CPT4/HCPCS,PIERCE EARLOBES,,Grouper Rate,1291.00
United HealthCare,HMO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,Grouper Rate,1145.00
United HealthCare,HMO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,Grouper Rate,1291.00
United HealthCare,HMO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Grouper Rate,1291.00
United HealthCare,HMO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Grouper Rate,3965.00
United HealthCare,HMO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,3965.00
United HealthCare,HMO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,1291.00
United HealthCare,HMO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Grouper Rate,3965.00
United HealthCare,HMO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,Grouper Rate,1291.00
United HealthCare,HMO,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Grouper Rate,1145.00
United HealthCare,HMO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Grouper Rate,1291.00
United HealthCare,HMO,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Grouper Rate,1145.00
United HealthCare,HMO,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Grouper Rate,1145.00
United HealthCare,HMO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,1145.00
United HealthCare,HMO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,1145.00
United HealthCare,HMO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Grouper Rate,3965.00
United HealthCare,HMO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,5730.00
United HealthCare,HMO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,5730.00
United HealthCare,HMO,69399,CPT4/HCPCS,OUTER EAR SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,1145.00
United HealthCare,HMO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,1291.00
United HealthCare,HMO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Grouper Rate,4847.00
United HealthCare,HMO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,1145.00
United HealthCare,HMO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,1291.00
United HealthCare,HMO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Grouper Rate,3965.00
United HealthCare,HMO,69450,CPT4/HCPCS,EARDRUM REVISION,,Grouper Rate,5730.00
United HealthCare,HMO,69501,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,5730.00
United HealthCare,HMO,69502,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,3965.00
United HealthCare,HMO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Grouper Rate,5730.00
United HealthCare,HMO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,5730.00
United HealthCare,HMO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,5730.00
United HealthCare,HMO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,Grouper Rate,1291.00
United HealthCare,HMO,69540,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,1291.00
United HealthCare,HMO,69550,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,5730.00
United HealthCare,HMO,69552,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,5730.00
United HealthCare,HMO,69554,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,1291.00
United HealthCare,HMO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,5730.00
United HealthCare,HMO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,5730.00
United HealthCare,HMO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,5730.00
United HealthCare,HMO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,5730.00
United HealthCare,HMO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,5730.00
United HealthCare,HMO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,3965.00
United HealthCare,HMO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,3965.00
United HealthCare,HMO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,5730.00
United HealthCare,HMO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,5730.00
United HealthCare,HMO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,5730.00
United HealthCare,HMO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,5730.00
United HealthCare,HMO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,5730.00
United HealthCare,HMO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,5730.00
United HealthCare,HMO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,5730.00
United HealthCare,HMO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,5730.00
United HealthCare,HMO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,5730.00
United HealthCare,HMO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,5730.00
United HealthCare,HMO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,5730.00
United HealthCare,HMO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,5730.00
United HealthCare,HMO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Grouper Rate,3965.00
United HealthCare,HMO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5730.00
United HealthCare,HMO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5730.00
United HealthCare,HMO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,5730.00
United HealthCare,HMO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,3965.00
United HealthCare,HMO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,3965.00
United HealthCare,HMO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Grouper Rate,5730.00
United HealthCare,HMO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Grouper Rate,3965.00
United HealthCare,HMO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Grouper Rate,1291.00
United HealthCare,HMO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Grouper Rate,5730.00
United HealthCare,HMO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Grouper Rate,5730.00
United HealthCare,HMO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Grouper Rate,9547.00
United HealthCare,HMO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Grouper Rate,9547.00
United HealthCare,HMO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Grouper Rate,5730.00
United HealthCare,HMO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Grouper Rate,9547.00
United HealthCare,HMO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,69799,CPT4/HCPCS,MIDDLE EAR SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,69801,CPT4/HCPCS,INCISE INNER EAR,,Grouper Rate,1291.00
United HealthCare,HMO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,5730.00
United HealthCare,HMO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,5730.00
United HealthCare,HMO,69905,CPT4/HCPCS,REMOVE INNER EAR,,Grouper Rate,5730.00
United HealthCare,HMO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Grouper Rate,5730.00
United HealthCare,HMO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Grouper Rate,22812.00
United HealthCare,HMO,69949,CPT4/HCPCS,INNER EAR SURGERY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,1291.00
United HealthCare,HMO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,5730.00
United HealthCare,HMO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,Grouper Rate,5730.00
United HealthCare,HMO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Grouper Rate,5730.00
United HealthCare,HMO,69979,CPT4/HCPCS,TEMPORAL BONE SURGERY,,Grouper Rate,1145.00
United HealthCare,HMO,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,70010,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Per Unit,142.00
United HealthCare,HMO,70015,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Per Unit,142.00
United HealthCare,HMO,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,Per Unit,142.00
United HealthCare,HMO,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,Per Unit,142.00
United HealthCare,HMO,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,Per Unit,142.00
United HealthCare,HMO,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Per Unit,142.00
United HealthCare,HMO,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Per Unit,142.00
United HealthCare,HMO,70134,CPT4/HCPCS,X-RAY EXAM OF MIDDLE EAR,,Per Unit,142.00
United HealthCare,HMO,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Per Unit,142.00
United HealthCare,HMO,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Per Unit,142.00
United HealthCare,HMO,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,Per Unit,142.00
United HealthCare,HMO,70170,CPT4/HCPCS,X-RAY EXAM OF TEAR DUCT,,Per Unit,142.00
United HealthCare,HMO,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Per Unit,142.00
United HealthCare,HMO,70200,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Per Unit,142.00
United HealthCare,HMO,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Per Unit,142.00
United HealthCare,HMO,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Per Unit,142.00
United HealthCare,HMO,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,Per Unit,142.00
United HealthCare,HMO,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Per Unit,142.00
United HealthCare,HMO,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Per Unit,142.00
United HealthCare,HMO,70300,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Per Unit,142.00
United HealthCare,HMO,70310,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Per Unit,142.00
United HealthCare,HMO,70320,CPT4/HCPCS,FULL MOUTH X-RAY OF TEETH,,Per Unit,142.00
United HealthCare,HMO,70328,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Per Unit,142.00
United HealthCare,HMO,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,Per Unit,142.00
United HealthCare,HMO,70332,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Per Unit,142.00
United HealthCare,HMO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,Case Rate,1147.00
United HealthCare,HMO,70350,CPT4/HCPCS,X-RAY HEAD FOR ORTHODONTIA,,Per Unit,142.00
United HealthCare,HMO,70355,CPT4/HCPCS,PANORAMIC X-RAY OF JAWS,,Per Unit,142.00
United HealthCare,HMO,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,Per Unit,142.00
United HealthCare,HMO,70370,CPT4/HCPCS,THROAT X-RAY & FLUOROSCOPY,,Per Unit,142.00
United HealthCare,HMO,70371,CPT4/HCPCS,SPEECH EVALUATION COMPLEX,,Per Unit,142.00
United HealthCare,HMO,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,Per Unit,142.00
United HealthCare,HMO,70390,CPT4/HCPCS,X-RAY EXAM OF SALIVARY DUCT,,Per Unit,142.00
United HealthCare,HMO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,Case Rate,985.00
United HealthCare,HMO,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,Per Unit,142.00
United HealthCare,HMO,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,Per Unit,142.00
United HealthCare,HMO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,Case Rate,985.00
United HealthCare,HMO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,Per Unit,142.00
United HealthCare,HMO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,Per Unit,142.00
United HealthCare,HMO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,Case Rate,985.00
United HealthCare,HMO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,Per Unit,142.00
United HealthCare,HMO,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,Per Unit,142.00
United HealthCare,HMO,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,Case Rate,985.00
United HealthCare,HMO,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,Per Unit,142.00
United HealthCare,HMO,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,Per Unit,142.00
United HealthCare,HMO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,Case Rate,985.00
United HealthCare,HMO,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,Case Rate,985.00
United HealthCare,HMO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,Case Rate,1147.00
United HealthCare,HMO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,Case Rate,1147.00
United HealthCare,HMO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,Case Rate,1147.00
United HealthCare,HMO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,Case Rate,1147.00
United HealthCare,HMO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,Case Rate,1147.00
United HealthCare,HMO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,Case Rate,1147.00
United HealthCare,HMO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,Case Rate,1147.00
United HealthCare,HMO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,Case Rate,1147.00
United HealthCare,HMO,70554,CPT4/HCPCS,FMRI BRAIN BY TECH,,Case Rate,1147.00
United HealthCare,HMO,70555,CPT4/HCPCS,FMRI BRAIN BY PHYS/PSYCH,,Case Rate,1147.00
United HealthCare,HMO,70557,CPT4/HCPCS,MRI BRAIN W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,70558,CPT4/HCPCS,MRI BRAIN W/DYE,,Case Rate,1147.00
United HealthCare,HMO,70559,CPT4/HCPCS,MRI BRAIN W/O & W/DYE,,Case Rate,1147.00
United HealthCare,HMO,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,Per Unit,142.00
United HealthCare,HMO,71046,CPT4/HCPCS,X-RAY EXAM CHEST 2 VIEWS,,Per Unit,142.00
United HealthCare,HMO,71047,CPT4/HCPCS,X-RAY EXAM CHEST 3 VIEWS,,Per Unit,142.00
United HealthCare,HMO,71048,CPT4/HCPCS,X-RAY EXAM CHEST 4+ VIEWS,,Per Unit,142.00
United HealthCare,HMO,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,Per Unit,142.00
United HealthCare,HMO,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,Per Unit,142.00
United HealthCare,HMO,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,Per Unit,142.00
United HealthCare,HMO,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,Per Unit,142.00
United HealthCare,HMO,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,Per Unit,142.00
United HealthCare,HMO,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,Per Unit,142.00
United HealthCare,HMO,71250,CPT4/HCPCS,CT THORAX DX C-,,Case Rate,985.00
United HealthCare,HMO,71260,CPT4/HCPCS,CT THORAX DX C+,,Per Unit,142.00
United HealthCare,HMO,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,Per Unit,142.00
United HealthCare,HMO,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,Per Unit,142.00
United HealthCare,HMO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,71551,CPT4/HCPCS,MRI CHEST W/DYE,,Case Rate,1147.00
United HealthCare,HMO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,Case Rate,1147.00
United HealthCare,HMO,71555,CPT4/HCPCS,MRI ANGIO CHEST W OR W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,Per Unit,142.00
United HealthCare,HMO,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,Per Unit,142.00
United HealthCare,HMO,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,Per Unit,142.00
United HealthCare,HMO,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,Per Unit,142.00
United HealthCare,HMO,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,Per Unit,142.00
United HealthCare,HMO,72072,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 3VWS,,Per Unit,142.00
United HealthCare,HMO,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,Per Unit,142.00
United HealthCare,HMO,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,Per Unit,142.00
United HealthCare,HMO,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,Per Unit,142.00
United HealthCare,HMO,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,Per Unit,142.00
United HealthCare,HMO,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,Per Unit,142.00
United HealthCare,HMO,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,Per Unit,142.00
United HealthCare,HMO,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,Per Unit,142.00
United HealthCare,HMO,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,Per Unit,142.00
United HealthCare,HMO,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,Per Unit,142.00
United HealthCare,HMO,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,Per Unit,142.00
United HealthCare,HMO,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,Case Rate,985.00
United HealthCare,HMO,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,Per Unit,142.00
United HealthCare,HMO,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,Per Unit,142.00
United HealthCare,HMO,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,Case Rate,985.00
United HealthCare,HMO,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,Per Unit,142.00
United HealthCare,HMO,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,Per Unit,142.00
United HealthCare,HMO,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,Case Rate,985.00
United HealthCare,HMO,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,Per Unit,142.00
United HealthCare,HMO,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,Per Unit,142.00
United HealthCare,HMO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,Case Rate,1147.00
United HealthCare,HMO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,Case Rate,1147.00
United HealthCare,HMO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,Case Rate,1147.00
United HealthCare,HMO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,Case Rate,1147.00
United HealthCare,HMO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,Case Rate,1147.00
United HealthCare,HMO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,Case Rate,1147.00
United HealthCare,HMO,72159,CPT4/HCPCS,MR ANGIO SPINE W/O&W/DYE,,Case Rate,1147.00
United HealthCare,HMO,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Per Unit,142.00
United HealthCare,HMO,72190,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Per Unit,142.00
United HealthCare,HMO,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,Case Rate,985.00
United HealthCare,HMO,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,Case Rate,985.00
United HealthCare,HMO,72193,CPT4/HCPCS,CT PELVIS W/DYE,,Per Unit,142.00
United HealthCare,HMO,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,Per Unit,142.00
United HealthCare,HMO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,Case Rate,1147.00
United HealthCare,HMO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,Case Rate,1147.00
United HealthCare,HMO,72198,CPT4/HCPCS,MR ANGIO PELVIS W/O & W/DYE,,Case Rate,1147.00
United HealthCare,HMO,72200,CPT4/HCPCS,X-RAY EXAM SI JOINTS,,Per Unit,142.00
United HealthCare,HMO,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,Per Unit,142.00
United HealthCare,HMO,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,Per Unit,142.00
United HealthCare,HMO,72240,CPT4/HCPCS,MYELOGRAPHY NECK SPINE,,Per Unit,142.00
United HealthCare,HMO,72255,CPT4/HCPCS,MYELOGRAPHY THORACIC SPINE,,Per Unit,142.00
United HealthCare,HMO,72265,CPT4/HCPCS,MYELOGRAPHY L-S SPINE,,Per Unit,142.00
United HealthCare,HMO,72270,CPT4/HCPCS,MYELOGPHY 2/> SPINE REGIONS,,Per Unit,142.00
United HealthCare,HMO,72275,CPT4/HCPCS,EPIDUROGRAPHY,,Per Unit,142.00
United HealthCare,HMO,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,Per Unit,142.00
United HealthCare,HMO,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,Per Unit,142.00
United HealthCare,HMO,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,Per Unit,142.00
United HealthCare,HMO,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,Per Unit,142.00
United HealthCare,HMO,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Per Unit,142.00
United HealthCare,HMO,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Per Unit,142.00
United HealthCare,HMO,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,Per Unit,142.00
United HealthCare,HMO,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,Per Unit,142.00
United HealthCare,HMO,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,Per Unit,142.00
United HealthCare,HMO,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Per Unit,142.00
United HealthCare,HMO,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Per Unit,142.00
United HealthCare,HMO,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,Per Unit,142.00
United HealthCare,HMO,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,Per Unit,142.00
United HealthCare,HMO,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,Per Unit,142.00
United HealthCare,HMO,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Per Unit,142.00
United HealthCare,HMO,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Per Unit,142.00
United HealthCare,HMO,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,Per Unit,142.00
United HealthCare,HMO,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,Per Unit,142.00
United HealthCare,HMO,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,Per Unit,142.00
United HealthCare,HMO,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,Per Unit,142.00
United HealthCare,HMO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,Case Rate,985.00
United HealthCare,HMO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,Per Unit,142.00
United HealthCare,HMO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,Per Unit,142.00
United HealthCare,HMO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,Case Rate,985.00
United HealthCare,HMO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,73219,CPT4/HCPCS,MRI UPPER EXTREMITY W/DYE,,Case Rate,1147.00
United HealthCare,HMO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,Case Rate,1147.00
United HealthCare,HMO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,Case Rate,1147.00
United HealthCare,HMO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,Case Rate,1147.00
United HealthCare,HMO,73225,CPT4/HCPCS,MR ANGIO UPR EXTR W/O&W/DYE,,Case Rate,1147.00
United HealthCare,HMO,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,Per Unit,142.00
United HealthCare,HMO,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,Per Unit,142.00
United HealthCare,HMO,73503,CPT4/HCPCS,X-RAY EXAM HIP UNI 4/> VIEWS,,Per Unit,142.00
United HealthCare,HMO,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,Per Unit,142.00
United HealthCare,HMO,73522,CPT4/HCPCS,X-RAY EXAM HIPS BI 3-4 VIEWS,,Per Unit,142.00
United HealthCare,HMO,73523,CPT4/HCPCS,X-RAY EXAM HIPS BI 5/> VIEWS,,Per Unit,142.00
United HealthCare,HMO,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,Per Unit,142.00
United HealthCare,HMO,73551,CPT4/HCPCS,X-RAY EXAM OF FEMUR 1,,Per Unit,142.00
United HealthCare,HMO,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,Per Unit,142.00
United HealthCare,HMO,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,Per Unit,142.00
United HealthCare,HMO,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,Per Unit,142.00
United HealthCare,HMO,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,Per Unit,142.00
United HealthCare,HMO,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,Per Unit,142.00
United HealthCare,HMO,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,Per Unit,142.00
United HealthCare,HMO,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,Per Unit,142.00
United HealthCare,HMO,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,Per Unit,142.00
United HealthCare,HMO,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Per Unit,142.00
United HealthCare,HMO,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Per Unit,142.00
United HealthCare,HMO,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,Per Unit,142.00
United HealthCare,HMO,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Per Unit,142.00
United HealthCare,HMO,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Per Unit,142.00
United HealthCare,HMO,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,Per Unit,142.00
United HealthCare,HMO,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,Per Unit,142.00
United HealthCare,HMO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,Case Rate,985.00
United HealthCare,HMO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,Per Unit,142.00
United HealthCare,HMO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,Per Unit,142.00
United HealthCare,HMO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,Case Rate,985.00
United HealthCare,HMO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,73719,CPT4/HCPCS,MRI LOWER EXTREMITY W/DYE,,Case Rate,1147.00
United HealthCare,HMO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,Case Rate,1147.00
United HealthCare,HMO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,Case Rate,1147.00
United HealthCare,HMO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,Case Rate,1147.00
United HealthCare,HMO,73725,CPT4/HCPCS,MR ANG LWR EXT W OR W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,Per Unit,142.00
United HealthCare,HMO,74019,CPT4/HCPCS,X-RAY EXAM ABDOMEN 2 VIEWS,,Per Unit,142.00
United HealthCare,HMO,74021,CPT4/HCPCS,X-RAY EXAM ABDOMEN 3+ VIEWS,,Per Unit,142.00
United HealthCare,HMO,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,Per Unit,142.00
United HealthCare,HMO,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,Case Rate,985.00
United HealthCare,HMO,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,Per Unit,142.00
United HealthCare,HMO,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,Per Unit,142.00
United HealthCare,HMO,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,Case Rate,985.00
United HealthCare,HMO,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,Case Rate,985.00
United HealthCare,HMO,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,Case Rate,985.00
United HealthCare,HMO,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,Case Rate,985.00
United HealthCare,HMO,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,Case Rate,985.00
United HealthCare,HMO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,Case Rate,1147.00
United HealthCare,HMO,74182,CPT4/HCPCS,MRI ABDOMEN W/DYE,,Case Rate,1147.00
United HealthCare,HMO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,Case Rate,1147.00
United HealthCare,HMO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,Case Rate,1147.00
United HealthCare,HMO,74190,CPT4/HCPCS,X-RAY EXAM OF PERITONEUM,,Per Unit,142.00
United HealthCare,HMO,74210,CPT4/HCPCS,X-RAY XM PHRNX&/CRV ESOPH C+,,Per Unit,142.00
United HealthCare,HMO,74220,CPT4/HCPCS,X-RAY XM ESOPHAGUS 1CNTRST,,Per Unit,142.00
United HealthCare,HMO,74230,CPT4/HCPCS,X-RAY XM SWLNG FUNCJ C+,,Per Unit,142.00
United HealthCare,HMO,74235,CPT4/HCPCS,REMOVE ESOPHAGUS OBSTRUCTION,,Per Unit,142.00
United HealthCare,HMO,74240,CPT4/HCPCS,X-RAY XM UPR GI TRC 1CNTRST,,Per Unit,142.00
United HealthCare,HMO,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,Per Unit,142.00
United HealthCare,HMO,74250,CPT4/HCPCS,X-RAY XM SM INT 1CNTRST STD,,Per Unit,142.00
United HealthCare,HMO,74251,CPT4/HCPCS,X-RAY XM SM INT 2CNTRST STD,,Per Unit,142.00
United HealthCare,HMO,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,Case Rate,985.00
United HealthCare,HMO,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,Case Rate,985.00
United HealthCare,HMO,74263,CPT4/HCPCS,CT COLONOGRAPHY SCREENING,,Case Rate,985.00
United HealthCare,HMO,74270,CPT4/HCPCS,X-RAY XM COLON 1CNTRST STD,,Per Unit,142.00
United HealthCare,HMO,74280,CPT4/HCPCS,X-RAY XM COLON 2CNTRST STD,,Per Unit,142.00
United HealthCare,HMO,74283,CPT4/HCPCS,THER NMA RDCTJ INTUS/OBSTRCJ,,Per Unit,142.00
United HealthCare,HMO,74290,CPT4/HCPCS,CONTRAST X-RAY GALLBLADDER,,Per Unit,142.00
United HealthCare,HMO,74300,CPT4/HCPCS,X-RAY BILE DUCTS/PANCREAS,,Per Unit,142.00
United HealthCare,HMO,74301,CPT4/HCPCS,X-RAYS AT SURGERY ADD-ON,,Per Unit,142.00
United HealthCare,HMO,74328,CPT4/HCPCS,X-RAY BILE DUCT ENDOSCOPY,,Per Unit,142.00
United HealthCare,HMO,74329,CPT4/HCPCS,X-RAY FOR PANCREAS ENDOSCOPY,,Per Unit,142.00
United HealthCare,HMO,74330,CPT4/HCPCS,X-RAY BILE/PANC ENDOSCOPY,,Per Unit,142.00
United HealthCare,HMO,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,Per Unit,142.00
United HealthCare,HMO,74355,CPT4/HCPCS,X-RAY GUIDE INTESTINAL TUBE,,Per Unit,142.00
United HealthCare,HMO,74360,CPT4/HCPCS,X-RAY GUIDE GI DILATION,,Per Unit,142.00
United HealthCare,HMO,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,Per Unit,142.00
United HealthCare,HMO,74400,CPT4/HCPCS,UROGRAPHY IV +-KUB TOMOG,,Per Unit,142.00
United HealthCare,HMO,74410,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BOLUS,,Per Unit,142.00
United HealthCare,HMO,74415,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BLS W/NF,,Per Unit,142.00
United HealthCare,HMO,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,Per Unit,142.00
United HealthCare,HMO,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,Per Unit,142.00
United HealthCare,HMO,74430,CPT4/HCPCS,CONTRAST X-RAY BLADDER,,Per Unit,142.00
United HealthCare,HMO,74440,CPT4/HCPCS,X-RAY MALE GENITAL TRACT,,Per Unit,142.00
United HealthCare,HMO,74445,CPT4/HCPCS,X-RAY EXAM OF PENIS,,Per Unit,142.00
United HealthCare,HMO,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Per Unit,142.00
United HealthCare,HMO,74455,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Per Unit,142.00
United HealthCare,HMO,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,Per Unit,142.00
United HealthCare,HMO,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,Per Unit,142.00
United HealthCare,HMO,74710,CPT4/HCPCS,X-RAY MEASUREMENT OF PELVIS,,Per Unit,142.00
United HealthCare,HMO,74712,CPT4/HCPCS,MRI FETAL SNGL/1ST GESTATION,,Case Rate,1147.00
United HealthCare,HMO,74713,CPT4/HCPCS,MRI FETAL EA ADDL GESTATION,,Case Rate,1147.00
United HealthCare,HMO,74740,CPT4/HCPCS,X-RAY FEMALE GENITAL TRACT,,Per Unit,142.00
United HealthCare,HMO,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,Per Unit,142.00
United HealthCare,HMO,74775,CPT4/HCPCS,X-RAY EXAM OF PERINEUM,,Per Unit,142.00
United HealthCare,HMO,75557,CPT4/HCPCS,CARDIAC MRI FOR MORPH,,Per Unit,142.00
United HealthCare,HMO,75559,CPT4/HCPCS,CARDIAC MRI W/STRESS IMG,,Per Unit,142.00
United HealthCare,HMO,75561,CPT4/HCPCS,CARDIAC MRI FOR MORPH W/DYE,,Per Unit,142.00
United HealthCare,HMO,75563,CPT4/HCPCS,CARD MRI W/STRESS IMG & DYE,,Per Unit,142.00
United HealthCare,HMO,75565,CPT4/HCPCS,CARD MRI VELOC FLOW MAPPING,,Per Unit,142.00
United HealthCare,HMO,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,Case Rate,985.00
United HealthCare,HMO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,Case Rate,985.00
United HealthCare,HMO,75573,CPT4/HCPCS,CT HRT W/3D IMAGE CONGEN,,Case Rate,985.00
United HealthCare,HMO,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,Case Rate,985.00
United HealthCare,HMO,75600,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Per Unit,142.00
United HealthCare,HMO,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Per Unit,142.00
United HealthCare,HMO,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,Per Unit,142.00
United HealthCare,HMO,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,Per Unit,142.00
United HealthCare,HMO,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,Case Rate,985.00
United HealthCare,HMO,75705,CPT4/HCPCS,ARTERY X-RAYS SPINE,,Per Unit,142.00
United HealthCare,HMO,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,Per Unit,142.00
United HealthCare,HMO,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,Per Unit,142.00
United HealthCare,HMO,75726,CPT4/HCPCS,ARTERY X-RAYS ABDOMEN,,Per Unit,142.00
United HealthCare,HMO,75731,CPT4/HCPCS,ARTERY X-RAYS ADRENAL GLAND,,Per Unit,142.00
United HealthCare,HMO,75733,CPT4/HCPCS,ARTERY X-RAYS ADRENALS,,Per Unit,142.00
United HealthCare,HMO,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,Per Unit,142.00
United HealthCare,HMO,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Per Unit,142.00
United HealthCare,HMO,75743,CPT4/HCPCS,ARTERY X-RAYS LUNGS,,Per Unit,142.00
United HealthCare,HMO,75746,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Per Unit,142.00
United HealthCare,HMO,75756,CPT4/HCPCS,ARTERY X-RAYS CHEST,,Per Unit,142.00
United HealthCare,HMO,75774,CPT4/HCPCS,ARTERY X-RAY EACH VESSEL,,Per Unit,142.00
United HealthCare,HMO,75801,CPT4/HCPCS,LYMPH VESSEL X-RAY ARM/LEG,,Per Unit,142.00
United HealthCare,HMO,75803,CPT4/HCPCS,LYMPH VESSEL X-RAY ARMS/LEGS,,Per Unit,142.00
United HealthCare,HMO,75805,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Per Unit,142.00
United HealthCare,HMO,75807,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Per Unit,142.00
United HealthCare,HMO,75809,CPT4/HCPCS,NONVASCULAR SHUNT X-RAY,,Per Unit,142.00
United HealthCare,HMO,75810,CPT4/HCPCS,VEIN X-RAY SPLEEN/LIVER,,Per Unit,142.00
United HealthCare,HMO,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,Per Unit,142.00
United HealthCare,HMO,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,Per Unit,142.00
United HealthCare,HMO,75825,CPT4/HCPCS,VEIN X-RAY TRUNK,,Per Unit,142.00
United HealthCare,HMO,75827,CPT4/HCPCS,VEIN X-RAY CHEST,,Per Unit,142.00
United HealthCare,HMO,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,Per Unit,142.00
United HealthCare,HMO,75833,CPT4/HCPCS,VEIN X-RAY KIDNEYS,,Per Unit,142.00
United HealthCare,HMO,75840,CPT4/HCPCS,VEIN X-RAY ADRENAL GLAND,,Per Unit,142.00
United HealthCare,HMO,75842,CPT4/HCPCS,VEIN X-RAY ADRENAL GLANDS,,Per Unit,142.00
United HealthCare,HMO,75860,CPT4/HCPCS,VEIN X-RAY NECK,,Per Unit,142.00
United HealthCare,HMO,75870,CPT4/HCPCS,VEIN X-RAY SKULL,,Per Unit,142.00
United HealthCare,HMO,75872,CPT4/HCPCS,VEIN X-RAY SKULL EPIDURAL,,Per Unit,142.00
United HealthCare,HMO,75880,CPT4/HCPCS,VEIN X-RAY EYE SOCKET,,Per Unit,142.00
United HealthCare,HMO,75885,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Per Unit,142.00
United HealthCare,HMO,75887,CPT4/HCPCS,VEIN X-RAY LIVER W/O HEMODYN,,Per Unit,142.00
United HealthCare,HMO,75889,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Per Unit,142.00
United HealthCare,HMO,75891,CPT4/HCPCS,VEIN X-RAY LIVER,,Per Unit,142.00
United HealthCare,HMO,75893,CPT4/HCPCS,VENOUS SAMPLING BY CATHETER,,Per Unit,142.00
United HealthCare,HMO,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,Per Unit,142.00
United HealthCare,HMO,75898,CPT4/HCPCS,FOLLOW-UP ANGIOGRAPHY,,Per Unit,142.00
United HealthCare,HMO,75901,CPT4/HCPCS,REMOVE CVA DEVICE OBSTRUCT,,Per Unit,142.00
United HealthCare,HMO,75902,CPT4/HCPCS,REMOVE CVA LUMEN OBSTRUCT,,Per Unit,142.00
United HealthCare,HMO,75956,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,Per Unit,142.00
United HealthCare,HMO,75957,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,Per Unit,142.00
United HealthCare,HMO,75958,CPT4/HCPCS,XRAY PLACE PROX EXT THOR AO,,Per Unit,142.00
United HealthCare,HMO,75959,CPT4/HCPCS,XRAY PLACE DIST EXT THOR AO,,Per Unit,142.00
United HealthCare,HMO,75970,CPT4/HCPCS,VASCULAR BIOPSY,,Per Unit,142.00
United HealthCare,HMO,75984,CPT4/HCPCS,XRAY CONTROL CATHETER CHANGE,,Per Unit,142.00
United HealthCare,HMO,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,Per Unit,142.00
United HealthCare,HMO,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,Per Unit,142.00
United HealthCare,HMO,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,Per Unit,142.00
United HealthCare,HMO,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,Per Unit,142.00
United HealthCare,HMO,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,Per Unit,142.00
United HealthCare,HMO,76100,CPT4/HCPCS,X-RAY EXAM OF BODY SECTION,,Per Unit,142.00
United HealthCare,HMO,76101,CPT4/HCPCS,COMPLEX BODY SECTION X-RAY,,Per Unit,142.00
United HealthCare,HMO,76102,CPT4/HCPCS,COMPLEX BODY SECTION X-RAYS,,Per Unit,142.00
United HealthCare,HMO,76120,CPT4/HCPCS,CINE/VIDEO X-RAYS,,Per Unit,142.00
United HealthCare,HMO,76125,CPT4/HCPCS,CINE/VIDEO X-RAYS ADD-ON,,Per Unit,142.00
United HealthCare,HMO,76140,CPT4/HCPCS,X-RAY CONSULTATION,,Per Unit,142.00
United HealthCare,HMO,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Per Unit,142.00
United HealthCare,HMO,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Per Unit,142.00
United HealthCare,HMO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,Case Rate,985.00
United HealthCare,HMO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,Per Unit,142.00
United HealthCare,HMO,76391,CPT4/HCPCS,MR ELASTOGRAPHY,,Per Unit,142.00
United HealthCare,HMO,76496,CPT4/HCPCS,FLUOROSCOPIC PROCEDURE,,Per Unit,142.00
United HealthCare,HMO,76497,CPT4/HCPCS,CT PROCEDURE,,Per Unit,142.00
United HealthCare,HMO,76498,CPT4/HCPCS,MRI PROCEDURE,,Case Rate,1147.00
United HealthCare,HMO,76499,CPT4/HCPCS,RADIOGRAPHIC PROCEDURE,,Per Unit,142.00
United HealthCare,HMO,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,Case Rate,553.00
United HealthCare,HMO,76510,CPT4/HCPCS,OPH US DX B-SCAN&QUAN A-SCAN,,Case Rate,553.00
United HealthCare,HMO,76511,CPT4/HCPCS,OPH US DX QUAN A-SCAN ONLY,,Case Rate,553.00
United HealthCare,HMO,76512,CPT4/HCPCS,OPH US DX B-SCAN,,Case Rate,553.00
United HealthCare,HMO,76513,CPT4/HCPCS,OPH US DX ANT SGM US UNI/BI,,Case Rate,553.00
United HealthCare,HMO,76514,CPT4/HCPCS,ECHO EXAM OF EYE THICKNESS,,Case Rate,553.00
United HealthCare,HMO,76516,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,553.00
United HealthCare,HMO,76519,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,553.00
United HealthCare,HMO,76529,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,553.00
United HealthCare,HMO,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,Case Rate,553.00
United HealthCare,HMO,76604,CPT4/HCPCS,US EXAM CHEST,,Case Rate,553.00
United HealthCare,HMO,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,Case Rate,553.00
United HealthCare,HMO,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,Case Rate,553.00
United HealthCare,HMO,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,Case Rate,553.00
United HealthCare,HMO,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,Case Rate,553.00
United HealthCare,HMO,76706,CPT4/HCPCS,US ABDL AORTA SCREEN AAA,,Case Rate,553.00
United HealthCare,HMO,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,Case Rate,553.00
United HealthCare,HMO,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,Case Rate,553.00
United HealthCare,HMO,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,Case Rate,553.00
United HealthCare,HMO,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,Case Rate,553.00
United HealthCare,HMO,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,Case Rate,553.00
United HealthCare,HMO,76802,CPT4/HCPCS,OB US < 14 WKS ADDL FETUS,,Case Rate,553.00
United HealthCare,HMO,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,Case Rate,553.00
United HealthCare,HMO,76810,CPT4/HCPCS,OB US >= 14 WKS ADDL FETUS,,Case Rate,553.00
United HealthCare,HMO,76811,CPT4/HCPCS,OB US DETAILED SNGL FETUS,,Case Rate,553.00
United HealthCare,HMO,76812,CPT4/HCPCS,OB US DETAILED ADDL FETUS,,Case Rate,553.00
United HealthCare,HMO,76813,CPT4/HCPCS,OB US NUCHAL MEAS 1 GEST,,Case Rate,553.00
United HealthCare,HMO,76814,CPT4/HCPCS,OB US NUCHAL MEAS ADD-ON,,Case Rate,553.00
United HealthCare,HMO,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,Case Rate,553.00
United HealthCare,HMO,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,Case Rate,553.00
United HealthCare,HMO,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,Case Rate,553.00
United HealthCare,HMO,76818,CPT4/HCPCS,FETAL BIOPHYS PROFILE W/NST,,Case Rate,553.00
United HealthCare,HMO,76819,CPT4/HCPCS,FETAL BIOPHYS PROFIL W/O NST,,Case Rate,553.00
United HealthCare,HMO,76820,CPT4/HCPCS,UMBILICAL ARTERY ECHO,,Case Rate,553.00
United HealthCare,HMO,76821,CPT4/HCPCS,MIDDLE CEREBRAL ARTERY ECHO,,Case Rate,553.00
United HealthCare,HMO,76825,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,553.00
United HealthCare,HMO,76826,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,553.00
United HealthCare,HMO,76827,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,553.00
United HealthCare,HMO,76828,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,553.00
United HealthCare,HMO,76830,CPT4/HCPCS,TRANSVAGINAL US NON-OB,,Case Rate,553.00
United HealthCare,HMO,76831,CPT4/HCPCS,ECHO EXAM UTERUS,,Case Rate,553.00
United HealthCare,HMO,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,Case Rate,553.00
United HealthCare,HMO,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,Case Rate,553.00
United HealthCare,HMO,76870,CPT4/HCPCS,US EXAM SCROTUM,,Case Rate,553.00
United HealthCare,HMO,76872,CPT4/HCPCS,US TRANSRECTAL,,Case Rate,553.00
United HealthCare,HMO,76873,CPT4/HCPCS,ECHOGRAP TRANS R PROS STUDY,,Case Rate,553.00
United HealthCare,HMO,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,Case Rate,553.00
United HealthCare,HMO,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,Case Rate,553.00
United HealthCare,HMO,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,Case Rate,553.00
United HealthCare,HMO,76886,CPT4/HCPCS,US EXAM INFANT HIPS STATIC,,Case Rate,553.00
United HealthCare,HMO,76932,CPT4/HCPCS,ECHO GUIDE FOR HEART BIOPSY,,Case Rate,553.00
United HealthCare,HMO,76936,CPT4/HCPCS,ECHO GUIDE FOR ARTERY REPAIR,,Case Rate,553.00
United HealthCare,HMO,76937,CPT4/HCPCS,US GUIDE VASCULAR ACCESS,,Case Rate,553.00
United HealthCare,HMO,76940,CPT4/HCPCS,US GUIDE TISSUE ABLATION,,Case Rate,553.00
United HealthCare,HMO,76941,CPT4/HCPCS,ECHO GUIDE FOR TRANSFUSION,,Case Rate,553.00
United HealthCare,HMO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,Case Rate,553.00
United HealthCare,HMO,76945,CPT4/HCPCS,ECHO GUIDE VILLUS SAMPLING,,Case Rate,553.00
United HealthCare,HMO,76946,CPT4/HCPCS,ECHO GUIDE FOR AMNIOCENTESIS,,Case Rate,553.00
United HealthCare,HMO,76948,CPT4/HCPCS,ECHO GUIDE OVA ASPIRATION,,Case Rate,553.00
United HealthCare,HMO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,Case Rate,553.00
United HealthCare,HMO,76970,CPT4/HCPCS,ULTRASOUND EXAM FOLLOW-UP,,Case Rate,553.00
United HealthCare,HMO,76975,CPT4/HCPCS,GI ENDOSCOPIC ULTRASOUND,,Case Rate,553.00
United HealthCare,HMO,76977,CPT4/HCPCS,US BONE DENSITY MEASURE,,Case Rate,553.00
United HealthCare,HMO,76978,CPT4/HCPCS,US TRGT DYN MBUBB 1ST LES,,Case Rate,553.00
United HealthCare,HMO,76979,CPT4/HCPCS,US TRGT DYN MBUBB EA ADDL,,Case Rate,553.00
United HealthCare,HMO,76981,CPT4/HCPCS,USE PARENCHYMA,,Case Rate,553.00
United HealthCare,HMO,76982,CPT4/HCPCS,USE 1ST TARGET LESION,,Case Rate,553.00
United HealthCare,HMO,76983,CPT4/HCPCS,USE EA ADDL TARGET LESION,,Case Rate,553.00
United HealthCare,HMO,76998,CPT4/HCPCS,US GUIDE INTRAOP,,Case Rate,553.00
United HealthCare,HMO,77001,CPT4/HCPCS,FLUOROGUIDE FOR VEIN DEVICE,,Per Unit,142.00
United HealthCare,HMO,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,Per Unit,142.00
United HealthCare,HMO,77003,CPT4/HCPCS,FLUOROGUIDE FOR SPINE INJECT,,Per Unit,142.00
United HealthCare,HMO,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,Case Rate,985.00
United HealthCare,HMO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,Case Rate,985.00
United HealthCare,HMO,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,Case Rate,985.00
United HealthCare,HMO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Case Rate,985.00
United HealthCare,HMO,77021,CPT4/HCPCS,MRI GUIDANCE NDL PLMT RS&I,,Case Rate,1147.00
United HealthCare,HMO,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,Case Rate,1147.00
United HealthCare,HMO,77046,CPT4/HCPCS,MRI BREAST C- UNILATERAL,,Case Rate,1147.00
United HealthCare,HMO,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,Case Rate,1147.00
United HealthCare,HMO,77048,CPT4/HCPCS,MRI BREAST C-+ W/CAD UNI,,Case Rate,1147.00
United HealthCare,HMO,77049,CPT4/HCPCS,MRI BREAST C-+ W/CAD BI,,Case Rate,1147.00
United HealthCare,HMO,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,Case Rate,348.00
United HealthCare,HMO,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,Case Rate,348.00
United HealthCare,HMO,77061,CPT4/HCPCS,BREAST TOMOSYNTHESIS UNI,,Case Rate,348.00
United HealthCare,HMO,77062,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Case Rate,348.00
United HealthCare,HMO,77063,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Case Rate,348.00
United HealthCare,HMO,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,Case Rate,348.00
United HealthCare,HMO,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,Case Rate,348.00
United HealthCare,HMO,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,Case Rate,348.00
United HealthCare,HMO,77071,CPT4/HCPCS,X-RAY STRESS VIEW,,Per Unit,142.00
United HealthCare,HMO,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,Per Unit,142.00
United HealthCare,HMO,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,Per Unit,142.00
United HealthCare,HMO,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,Per Unit,142.00
United HealthCare,HMO,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,Per Unit,142.00
United HealthCare,HMO,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,Per Unit,142.00
United HealthCare,HMO,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,Per Unit,142.00
United HealthCare,HMO,77078,CPT4/HCPCS,CT BONE DENSITY AXIAL,,Case Rate,985.00
United HealthCare,HMO,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,Per Unit,142.00
United HealthCare,HMO,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,Per Unit,142.00
United HealthCare,HMO,77084,CPT4/HCPCS,MAGNETIC IMAGE BONE MARROW,,Case Rate,1147.00
United HealthCare,HMO,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,Per Unit,142.00
United HealthCare,HMO,77086,CPT4/HCPCS,FRACTURE ASSESSMENT VIA DXA,,Per Unit,142.00
United HealthCare,HMO,77261,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Per Unit,142.00
United HealthCare,HMO,77262,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Per Unit,142.00
United HealthCare,HMO,77263,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Per Unit,142.00
United HealthCare,HMO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,2422.00
United HealthCare,HMO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,2422.00
United HealthCare,HMO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,2422.00
United HealthCare,HMO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,Case Rate,2422.00
United HealthCare,HMO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,Case Rate,2422.00
United HealthCare,HMO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,Case Rate,2422.00
United HealthCare,HMO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,Case Rate,2422.00
United HealthCare,HMO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,Case Rate,2422.00
United HealthCare,HMO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,Case Rate,2422.00
United HealthCare,HMO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,Case Rate,2422.00
United HealthCare,HMO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,Case Rate,2422.00
United HealthCare,HMO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,Case Rate,2422.00
United HealthCare,HMO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,Case Rate,2422.00
United HealthCare,HMO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,Case Rate,2422.00
United HealthCare,HMO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,2422.00
United HealthCare,HMO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,2422.00
United HealthCare,HMO,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,2422.00
United HealthCare,HMO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,2422.00
United HealthCare,HMO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,Case Rate,2422.00
United HealthCare,HMO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,2422.00
United HealthCare,HMO,77371,CPT4/HCPCS,SRS MULTISOURCE,,Case Rate,2422.00
United HealthCare,HMO,77372,CPT4/HCPCS,SRS LINEAR BASED,,Case Rate,2422.00
United HealthCare,HMO,77373,CPT4/HCPCS,SBRT DELIVERY,,Case Rate,2422.00
United HealthCare,HMO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,Case Rate,2422.00
United HealthCare,HMO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,Case Rate,2422.00
United HealthCare,HMO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,Case Rate,2422.00
United HealthCare,HMO,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,2422.00
United HealthCare,HMO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,2422.00
United HealthCare,HMO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,2422.00
United HealthCare,HMO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,2422.00
United HealthCare,HMO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,Case Rate,2422.00
United HealthCare,HMO,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,Case Rate,2422.00
United HealthCare,HMO,77424,CPT4/HCPCS,IO RAD TX DELIVERY BY X-RAY,,Case Rate,2422.00
United HealthCare,HMO,77425,CPT4/HCPCS,IO RAD TX DELIVER BY ELCTRNS,,Case Rate,2422.00
United HealthCare,HMO,77427,CPT4/HCPCS,RADIATION TX MANAGEMENT X5,,Case Rate,2422.00
United HealthCare,HMO,77431,CPT4/HCPCS,RADIATION THERAPY MANAGEMENT,,Case Rate,2422.00
United HealthCare,HMO,77432,CPT4/HCPCS,STEREOTACTIC RADIATION TRMT,,Case Rate,2422.00
United HealthCare,HMO,77435,CPT4/HCPCS,SBRT MANAGEMENT,,Case Rate,2422.00
United HealthCare,HMO,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,Case Rate,2422.00
United HealthCare,HMO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,Case Rate,2422.00
United HealthCare,HMO,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,Case Rate,2422.00
United HealthCare,HMO,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,Case Rate,2422.00
United HealthCare,HMO,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,Case Rate,2422.00
United HealthCare,HMO,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,Case Rate,2422.00
United HealthCare,HMO,77600,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2422.00
United HealthCare,HMO,77605,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2422.00
United HealthCare,HMO,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2422.00
United HealthCare,HMO,77615,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2422.00
United HealthCare,HMO,77620,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2422.00
United HealthCare,HMO,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Case Rate,2422.00
United HealthCare,HMO,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Case Rate,2422.00
United HealthCare,HMO,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Case Rate,2422.00
United HealthCare,HMO,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Case Rate,2422.00
United HealthCare,HMO,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,2422.00
United HealthCare,HMO,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,2422.00
United HealthCare,HMO,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,2422.00
United HealthCare,HMO,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,2422.00
United HealthCare,HMO,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,2422.00
United HealthCare,HMO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Case Rate,2422.00
United HealthCare,HMO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Case Rate,2422.00
United HealthCare,HMO,77790,CPT4/HCPCS,RADIATION HANDLING,,Case Rate,2422.00
United HealthCare,HMO,78012,CPT4/HCPCS,THYROID UPTAKE MEASUREMENT,,Per Unit,142.00
United HealthCare,HMO,78013,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Per Unit,142.00
United HealthCare,HMO,78014,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Per Unit,142.00
United HealthCare,HMO,78015,CPT4/HCPCS,THYROID MET IMAGING,,Per Unit,142.00
United HealthCare,HMO,78016,CPT4/HCPCS,THYROID MET IMAGING/STUDIES,,Per Unit,142.00
United HealthCare,HMO,78018,CPT4/HCPCS,THYROID MET IMAGING BODY,,Per Unit,142.00
United HealthCare,HMO,78020,CPT4/HCPCS,THYROID MET UPTAKE,,Per Unit,142.00
United HealthCare,HMO,78070,CPT4/HCPCS,PARATHYROID PLANAR IMAGING,,Per Unit,142.00
United HealthCare,HMO,78071,CPT4/HCPCS,PARATHYRD PLANAR W/WO SUBTRJ,,Per Unit,142.00
United HealthCare,HMO,78072,CPT4/HCPCS,PARATHYRD PLANAR W/SPECT&CT,,Per Unit,142.00
United HealthCare,HMO,78075,CPT4/HCPCS,ADRENAL CORTEX & MEDULLA IMG,,Per Unit,142.00
United HealthCare,HMO,78102,CPT4/HCPCS,BONE MARROW IMAGING LTD,,Per Unit,142.00
United HealthCare,HMO,78103,CPT4/HCPCS,BONE MARROW IMAGING MULT,,Per Unit,142.00
United HealthCare,HMO,78104,CPT4/HCPCS,BONE MARROW IMAGING BODY,,Per Unit,142.00
United HealthCare,HMO,78110,CPT4/HCPCS,PLASMA VOLUME SINGLE,,Per Unit,142.00
United HealthCare,HMO,78111,CPT4/HCPCS,PLASMA VOLUME MULTIPLE,,Per Unit,142.00
United HealthCare,HMO,78120,CPT4/HCPCS,RED CELL MASS SINGLE,,Per Unit,142.00
United HealthCare,HMO,78121,CPT4/HCPCS,RED CELL MASS MULTIPLE,,Per Unit,142.00
United HealthCare,HMO,78122,CPT4/HCPCS,BLOOD VOLUME,,Per Unit,142.00
United HealthCare,HMO,78130,CPT4/HCPCS,RED CELL SURVIVAL STUDY,,Per Unit,142.00
United HealthCare,HMO,78135,CPT4/HCPCS,RED CELL SURVIVAL KINETICS,,Per Unit,142.00
United HealthCare,HMO,78140,CPT4/HCPCS,RED CELL SEQUESTRATION,,Per Unit,142.00
United HealthCare,HMO,78185,CPT4/HCPCS,SPLEEN IMAGING,,Per Unit,142.00
United HealthCare,HMO,78191,CPT4/HCPCS,PLATELET SURVIVAL,,Per Unit,142.00
United HealthCare,HMO,78195,CPT4/HCPCS,LYMPH SYSTEM IMAGING,,Per Unit,142.00
United HealthCare,HMO,78201,CPT4/HCPCS,LIVER IMAGING,,Per Unit,142.00
United HealthCare,HMO,78202,CPT4/HCPCS,LIVER IMAGING WITH FLOW,,Per Unit,142.00
United HealthCare,HMO,78215,CPT4/HCPCS,LIVER AND SPLEEN IMAGING,,Per Unit,142.00
United HealthCare,HMO,78216,CPT4/HCPCS,LIVER & SPLEEN IMAGE/FLOW,,Per Unit,142.00
United HealthCare,HMO,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Per Unit,142.00
United HealthCare,HMO,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Per Unit,142.00
United HealthCare,HMO,78230,CPT4/HCPCS,SALIVARY GLAND IMAGING,,Per Unit,142.00
United HealthCare,HMO,78231,CPT4/HCPCS,SERIAL SALIVARY IMAGING,,Per Unit,142.00
United HealthCare,HMO,78232,CPT4/HCPCS,SALIVARY GLAND FUNCTION EXAM,,Per Unit,142.00
United HealthCare,HMO,78258,CPT4/HCPCS,ESOPHAGEAL MOTILITY STUDY,,Per Unit,142.00
United HealthCare,HMO,78261,CPT4/HCPCS,GASTRIC MUCOSA IMAGING,,Per Unit,142.00
United HealthCare,HMO,78262,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX EXAM,,Per Unit,142.00
United HealthCare,HMO,78264,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Per Unit,142.00
United HealthCare,HMO,78265,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Per Unit,142.00
United HealthCare,HMO,78266,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Per Unit,142.00
United HealthCare,HMO,78267,CPT4/HCPCS,BREATH TST ATTAIN/ANAL C-14,,Per Unit,142.00
United HealthCare,HMO,78268,CPT4/HCPCS,BREATH TEST ANALYSIS C-14,,Per Unit,142.00
United HealthCare,HMO,78278,CPT4/HCPCS,ACUTE GI BLOOD LOSS IMAGING,,Per Unit,142.00
United HealthCare,HMO,78282,CPT4/HCPCS,GI PROTEIN LOSS EXAM,,Per Unit,142.00
United HealthCare,HMO,78290,CPT4/HCPCS,MECKELS DIVERT EXAM,,Per Unit,142.00
United HealthCare,HMO,78291,CPT4/HCPCS,LEVEEN/SHUNT PATENCY EXAM,,Per Unit,142.00
United HealthCare,HMO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,10242.00
United HealthCare,HMO,78300,CPT4/HCPCS,BONE IMAGING LIMITED AREA,,Per Unit,142.00
United HealthCare,HMO,78305,CPT4/HCPCS,BONE IMAGING MULTIPLE AREAS,,Per Unit,142.00
United HealthCare,HMO,78306,CPT4/HCPCS,BONE IMAGING WHOLE BODY,,Per Unit,142.00
United HealthCare,HMO,78315,CPT4/HCPCS,BONE IMAGING 3 PHASE,,Per Unit,142.00
United HealthCare,HMO,78350,CPT4/HCPCS,BONE MINERAL SINGLE PHOTON,,Per Unit,142.00
United HealthCare,HMO,78351,CPT4/HCPCS,BONE MINERAL DUAL PHOTON,,Per Unit,142.00
United HealthCare,HMO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,10242.00
United HealthCare,HMO,78414,CPT4/HCPCS,NON-IMAGING HEART FUNCTION,,Per Unit,142.00
United HealthCare,HMO,78428,CPT4/HCPCS,CARDIAC SHUNT IMAGING,,Per Unit,142.00
United HealthCare,HMO,78445,CPT4/HCPCS,VASCULAR FLOW IMAGING,,Per Unit,142.00
United HealthCare,HMO,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,Per Unit,142.00
United HealthCare,HMO,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,Per Unit,142.00
United HealthCare,HMO,78453,CPT4/HCPCS,HT MUSCLE IMAGE PLANAR SING,,Per Unit,142.00
United HealthCare,HMO,78454,CPT4/HCPCS,HT MUSC IMAGE PLANAR MULT,,Per Unit,142.00
United HealthCare,HMO,78456,CPT4/HCPCS,ACUTE VENOUS THROMBUS IMAGE,,Per Unit,142.00
United HealthCare,HMO,78457,CPT4/HCPCS,VENOUS THROMBOSIS IMAGING,,Per Unit,142.00
United HealthCare,HMO,78458,CPT4/HCPCS,VEN THROMBOSIS IMAGES BILAT,,Per Unit,142.00
United HealthCare,HMO,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,Per Unit,142.00
United HealthCare,HMO,78466,CPT4/HCPCS,HEART INFARCT IMAGE,,Per Unit,142.00
United HealthCare,HMO,78468,CPT4/HCPCS,HEART INFARCT IMAGE (EF),,Per Unit,142.00
United HealthCare,HMO,78469,CPT4/HCPCS,HEART INFARCT IMAGE (3D),,Per Unit,142.00
United HealthCare,HMO,78472,CPT4/HCPCS,GATED HEART PLANAR SINGLE,,Per Unit,142.00
United HealthCare,HMO,78473,CPT4/HCPCS,GATED HEART MULTIPLE,,Per Unit,142.00
United HealthCare,HMO,78481,CPT4/HCPCS,HEART FIRST PASS SINGLE,,Per Unit,142.00
United HealthCare,HMO,78483,CPT4/HCPCS,HEART FIRST PASS MULTIPLE,,Per Unit,142.00
United HealthCare,HMO,78491,CPT4/HCPCS,MYOCRD IMG PET 1STD RST/STRS,,Per Unit,142.00
United HealthCare,HMO,78492,CPT4/HCPCS,MYOCRD IMG PET MLT RST&STRS,,Per Unit,142.00
United HealthCare,HMO,78494,CPT4/HCPCS,HEART IMAGE SPECT,,Per Unit,142.00
United HealthCare,HMO,78496,CPT4/HCPCS,HEART FIRST PASS ADD-ON,,Per Unit,142.00
United HealthCare,HMO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,10242.00
United HealthCare,HMO,78579,CPT4/HCPCS,LUNG VENTILATION IMAGING,,Per Unit,142.00
United HealthCare,HMO,78580,CPT4/HCPCS,LUNG PERFUSION IMAGING,,Per Unit,142.00
United HealthCare,HMO,78582,CPT4/HCPCS,LUNG VENTILAT&PERFUS IMAGING,,Per Unit,142.00
United HealthCare,HMO,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Per Unit,142.00
United HealthCare,HMO,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Per Unit,142.00
United HealthCare,HMO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,10242.00
United HealthCare,HMO,78600,CPT4/HCPCS,BRAIN IMAGE < 4 VIEWS,,Per Unit,142.00
United HealthCare,HMO,78601,CPT4/HCPCS,BRAIN IMAGE W/FLOW < 4 VIEWS,,Per Unit,142.00
United HealthCare,HMO,78605,CPT4/HCPCS,BRAIN IMAGE 4+ VIEWS,,Per Unit,142.00
United HealthCare,HMO,78606,CPT4/HCPCS,BRAIN IMAGE W/FLOW 4 + VIEWS,,Per Unit,142.00
United HealthCare,HMO,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,Per Unit,142.00
United HealthCare,HMO,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,Per Unit,142.00
United HealthCare,HMO,78610,CPT4/HCPCS,BRAIN FLOW IMAGING ONLY,,Per Unit,142.00
United HealthCare,HMO,78630,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Per Unit,142.00
United HealthCare,HMO,78635,CPT4/HCPCS,CSF VENTRICULOGRAPHY,,Per Unit,142.00
United HealthCare,HMO,78645,CPT4/HCPCS,CSF SHUNT EVALUATION,,Per Unit,142.00
United HealthCare,HMO,78650,CPT4/HCPCS,CSF LEAKAGE IMAGING,,Per Unit,142.00
United HealthCare,HMO,78660,CPT4/HCPCS,NUCLEAR EXAM OF TEAR FLOW,,Per Unit,142.00
United HealthCare,HMO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,10242.00
United HealthCare,HMO,78700,CPT4/HCPCS,KIDNEY IMAGING MORPHOL,,Per Unit,142.00
United HealthCare,HMO,78701,CPT4/HCPCS,KIDNEY IMAGING WITH FLOW,,Per Unit,142.00
United HealthCare,HMO,78707,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/O DRUG,,Per Unit,142.00
United HealthCare,HMO,78708,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/DRUG,,Per Unit,142.00
United HealthCare,HMO,78709,CPT4/HCPCS,K FLOW/FUNCT IMAGE MULTIPLE,,Per Unit,142.00
United HealthCare,HMO,78725,CPT4/HCPCS,KIDNEY FUNCTION STUDY,,Per Unit,142.00
United HealthCare,HMO,78730,CPT4/HCPCS,URINARY BLADDER RETENTION,,Per Unit,142.00
United HealthCare,HMO,78740,CPT4/HCPCS,URETERAL REFLUX STUDY,,Per Unit,142.00
United HealthCare,HMO,78761,CPT4/HCPCS,TESTICULAR IMAGING W/FLOW,,Per Unit,142.00
United HealthCare,HMO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,10242.00
United HealthCare,HMO,78800,CPT4/HCPCS,RP LOCLZJ TUM 1 AREA 1 D IMG,,Per Unit,142.00
United HealthCare,HMO,78801,CPT4/HCPCS,RP LOCLZJ TUM 2+AREA 1+D IMG,,Per Unit,142.00
United HealthCare,HMO,78802,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 1 D IMG,,Per Unit,142.00
United HealthCare,HMO,78803,CPT4/HCPCS,RP LOCLZJ TUM SPECT 1 AREA,,Per Unit,142.00
United HealthCare,HMO,78804,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 2+D IMG,,Per Unit,142.00
United HealthCare,HMO,78808,CPT4/HCPCS,IV INJ RA DRUG DX STUDY,,Per Unit,142.00
United HealthCare,HMO,78811,CPT4/HCPCS,PET IMAGE LTD AREA,,Per Unit,142.00
United HealthCare,HMO,78812,CPT4/HCPCS,PET IMAGE SKULL-THIGH,,Per Unit,142.00
United HealthCare,HMO,78813,CPT4/HCPCS,PET IMAGE FULL BODY,,Per Unit,142.00
United HealthCare,HMO,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,Per Unit,142.00
United HealthCare,HMO,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,Per Unit,142.00
United HealthCare,HMO,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,Per Unit,142.00
United HealthCare,HMO,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Per Unit,142.00
United HealthCare,HMO,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,Per Unit,142.00
United HealthCare,HMO,79200,CPT4/HCPCS,NUCLEAR RX INTRACAV ADMIN,,Per Unit,142.00
United HealthCare,HMO,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Per Unit,142.00
United HealthCare,HMO,79403,CPT4/HCPCS,HEMATOPOIETIC NUCLEAR TX,,Per Unit,142.00
United HealthCare,HMO,79440,CPT4/HCPCS,NUCLEAR RX INTRA-ARTICULAR,,Per Unit,142.00
United HealthCare,HMO,79445,CPT4/HCPCS,NUCLEAR RX INTRA-ARTERIAL,,Per Unit,142.00
United HealthCare,HMO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,4461.00
United HealthCare,HMO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,4461.00
United HealthCare,HMO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,4461.00
United HealthCare,HMO,80047,CPT4/HCPCS,METABOLIC PANEL IONIZED CA,,Per Unit,96.00
United HealthCare,HMO,80048,CPT4/HCPCS,METABOLIC PANEL TOTAL CA,,Per Unit,96.00
United HealthCare,HMO,80050,CPT4/HCPCS,GENERAL HEALTH PANEL,,Per Unit,96.00
United HealthCare,HMO,80051,CPT4/HCPCS,ELECTROLYTE PANEL,,Per Unit,96.00
United HealthCare,HMO,80053,CPT4/HCPCS,COMPREHEN METABOLIC PANEL,,Per Unit,96.00
United HealthCare,HMO,80055,CPT4/HCPCS,OBSTETRIC PANEL,,Per Unit,96.00
United HealthCare,HMO,80061,CPT4/HCPCS,LIPID PANEL,,Per Unit,96.00
United HealthCare,HMO,80069,CPT4/HCPCS,RENAL FUNCTION PANEL,,Per Unit,96.00
United HealthCare,HMO,80074,CPT4/HCPCS,ACUTE HEPATITIS PANEL,,Per Unit,96.00
United HealthCare,HMO,80076,CPT4/HCPCS,HEPATIC FUNCTION PANEL,,Per Unit,96.00
United HealthCare,HMO,80081,CPT4/HCPCS,OBSTETRIC PANEL,,Per Unit,96.00
United HealthCare,HMO,80150,CPT4/HCPCS,ASSAY OF AMIKACIN,,Per Unit,96.00
United HealthCare,HMO,80155,CPT4/HCPCS,DRUG ASSAY CAFFEINE,,Per Unit,96.00
United HealthCare,HMO,80156,CPT4/HCPCS,ASSAY CARBAMAZEPINE TOTAL,,Per Unit,96.00
United HealthCare,HMO,80157,CPT4/HCPCS,ASSAY CARBAMAZEPINE FREE,,Per Unit,96.00
United HealthCare,HMO,80158,CPT4/HCPCS,DRUG ASSAY CYCLOSPORINE,,Per Unit,96.00
United HealthCare,HMO,80159,CPT4/HCPCS,DRUG ASSAY CLOZAPINE,,Per Unit,96.00
United HealthCare,HMO,80162,CPT4/HCPCS,ASSAY OF DIGOXIN TOTAL,,Per Unit,96.00
United HealthCare,HMO,80163,CPT4/HCPCS,ASSAY OF DIGOXIN FREE,,Per Unit,96.00
United HealthCare,HMO,80164,CPT4/HCPCS,ASSAY DIPROPYLACETIC ACD TOT,,Per Unit,96.00
United HealthCare,HMO,80165,CPT4/HCPCS,DIPROPYLACETIC ACID FREE,,Per Unit,96.00
United HealthCare,HMO,80168,CPT4/HCPCS,ASSAY OF ETHOSUXIMIDE,,Per Unit,96.00
United HealthCare,HMO,80169,CPT4/HCPCS,DRUG ASSAY EVEROLIMUS,,Per Unit,96.00
United HealthCare,HMO,80170,CPT4/HCPCS,ASSAY OF GENTAMICIN,,Per Unit,96.00
United HealthCare,HMO,80171,CPT4/HCPCS,DRUG SCREEN QUANT GABAPENTIN,,Per Unit,96.00
United HealthCare,HMO,80173,CPT4/HCPCS,ASSAY OF HALOPERIDOL,,Per Unit,96.00
United HealthCare,HMO,80175,CPT4/HCPCS,DRUG SCREEN QUAN LAMOTRIGINE,,Per Unit,96.00
United HealthCare,HMO,80176,CPT4/HCPCS,ASSAY OF LIDOCAINE,,Per Unit,96.00
United HealthCare,HMO,80177,CPT4/HCPCS,DRUG SCRN QUAN LEVETIRACETAM,,Per Unit,96.00
United HealthCare,HMO,80178,CPT4/HCPCS,ASSAY OF LITHIUM,,Per Unit,96.00
United HealthCare,HMO,80180,CPT4/HCPCS,DRUG SCRN QUAN MYCOPHENOLATE,,Per Unit,96.00
United HealthCare,HMO,80183,CPT4/HCPCS,DRUG SCRN QUANT OXCARBAZEPIN,,Per Unit,96.00
United HealthCare,HMO,80184,CPT4/HCPCS,ASSAY OF PHENOBARBITAL,,Per Unit,96.00
United HealthCare,HMO,80185,CPT4/HCPCS,ASSAY OF PHENYTOIN TOTAL,,Per Unit,96.00
United HealthCare,HMO,80186,CPT4/HCPCS,ASSAY OF PHENYTOIN FREE,,Per Unit,96.00
United HealthCare,HMO,80188,CPT4/HCPCS,ASSAY OF PRIMIDONE,,Per Unit,96.00
United HealthCare,HMO,80190,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,Per Unit,96.00
United HealthCare,HMO,80192,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,Per Unit,96.00
United HealthCare,HMO,80194,CPT4/HCPCS,ASSAY OF QUINIDINE,,Per Unit,96.00
United HealthCare,HMO,80195,CPT4/HCPCS,ASSAY OF SIROLIMUS,,Per Unit,96.00
United HealthCare,HMO,80197,CPT4/HCPCS,ASSAY OF TACROLIMUS,,Per Unit,96.00
United HealthCare,HMO,80198,CPT4/HCPCS,ASSAY OF THEOPHYLLINE,,Per Unit,96.00
United HealthCare,HMO,80199,CPT4/HCPCS,DRUG SCREEN QUANT TIAGABINE,,Per Unit,96.00
United HealthCare,HMO,80200,CPT4/HCPCS,ASSAY OF TOBRAMYCIN,,Per Unit,96.00
United HealthCare,HMO,80201,CPT4/HCPCS,ASSAY OF TOPIRAMATE,,Per Unit,96.00
United HealthCare,HMO,80202,CPT4/HCPCS,ASSAY OF VANCOMYCIN,,Per Unit,96.00
United HealthCare,HMO,80203,CPT4/HCPCS,DRUG SCREEN QUANT ZONISAMIDE,,Per Unit,96.00
United HealthCare,HMO,80299,CPT4/HCPCS,QUANTITATIVE ASSAY DRUG,,Per Unit,96.00
United HealthCare,HMO,80305,CPT4/HCPCS,DRUG TEST PRSMV DIR OPT OBS,,Per Unit,96.00
United HealthCare,HMO,80306,CPT4/HCPCS,DRUG TEST PRSMV INSTRMNT,,Per Unit,96.00
United HealthCare,HMO,80307,CPT4/HCPCS,DRUG TEST PRSMV CHEM ANLYZR,,Per Unit,96.00
United HealthCare,HMO,80320,CPT4/HCPCS,DRUG SCREEN QUANTALCOHOLS,,Per Unit,96.00
United HealthCare,HMO,80321,CPT4/HCPCS,ALCOHOLS BIOMARKERS 1OR 2,,Per Unit,96.00
United HealthCare,HMO,80322,CPT4/HCPCS,ALCOHOLS BIOMARKERS 3/MORE,,Per Unit,96.00
United HealthCare,HMO,80323,CPT4/HCPCS,ALKALOIDS NOS,,Per Unit,96.00
United HealthCare,HMO,80324,CPT4/HCPCS,DRUG SCREEN AMPHETAMINES 1/2,,Per Unit,96.00
United HealthCare,HMO,80325,CPT4/HCPCS,AMPHETAMINES 3OR 4,,Per Unit,96.00
United HealthCare,HMO,80326,CPT4/HCPCS,AMPHETAMINES 5 OR MORE,,Per Unit,96.00
United HealthCare,HMO,80327,CPT4/HCPCS,ANABOLIC STEROID 1 OR 2,,Per Unit,96.00
United HealthCare,HMO,80328,CPT4/HCPCS,ANABOLIC STEROID 3 OR MORE,,Per Unit,96.00
United HealthCare,HMO,80329,CPT4/HCPCS,ANALGESICS NON-OPIOID 1 OR 2,,Per Unit,96.00
United HealthCare,HMO,80330,CPT4/HCPCS,ANALGESICS NON-OPIOID 3-5,,Per Unit,96.00
United HealthCare,HMO,80331,CPT4/HCPCS,ANALGESICS NON-OPIOID 6/MORE,,Per Unit,96.00
United HealthCare,HMO,80332,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 1 OR 2,,Per Unit,96.00
United HealthCare,HMO,80333,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 3-5,,Per Unit,96.00
United HealthCare,HMO,80334,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 6/MORE,,Per Unit,96.00
United HealthCare,HMO,80335,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 1/2,,Per Unit,96.00
United HealthCare,HMO,80336,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 3-5,,Per Unit,96.00
United HealthCare,HMO,80337,CPT4/HCPCS,TRICYCLIC & CYCLICALS 6/MORE,,Per Unit,96.00
United HealthCare,HMO,80338,CPT4/HCPCS,ANTIDEPRESSANT NOT SPECIFIED,,Per Unit,96.00
United HealthCare,HMO,80339,CPT4/HCPCS,ANTIEPILEPTICS NOS 1-3,,Per Unit,96.00
United HealthCare,HMO,80340,CPT4/HCPCS,ANTIEPILEPTICS NOS 4-6,,Per Unit,96.00
United HealthCare,HMO,80341,CPT4/HCPCS,ANTIEPILEPTICS NOS 7/MORE,,Per Unit,96.00
United HealthCare,HMO,80342,CPT4/HCPCS,ANTIPSYCHOTICS NOS 1-3,,Per Unit,96.00
United HealthCare,HMO,80343,CPT4/HCPCS,ANTIPSYCHOTICS NOS 4-6,,Per Unit,96.00
United HealthCare,HMO,80344,CPT4/HCPCS,ANTIPSYCHOTICS NOS 7/MORE,,Per Unit,96.00
United HealthCare,HMO,80345,CPT4/HCPCS,DRUG SCREENING BARBITURATES,,Per Unit,96.00
United HealthCare,HMO,80346,CPT4/HCPCS,BENZODIAZEPINES1-12,,Per Unit,96.00
United HealthCare,HMO,80347,CPT4/HCPCS,BENZODIAZEPINES 13 OR MORE,,Per Unit,96.00
United HealthCare,HMO,80348,CPT4/HCPCS,DRUG SCREENING BUPRENORPHINE,,Per Unit,96.00
United HealthCare,HMO,80349,CPT4/HCPCS,CANNABINOIDS NATURAL,,Per Unit,96.00
United HealthCare,HMO,80350,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 1-3,,Per Unit,96.00
United HealthCare,HMO,80351,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 4-6,,Per Unit,96.00
United HealthCare,HMO,80352,CPT4/HCPCS,CANNABINOID SYNTHETIC 7/MORE,,Per Unit,96.00
United HealthCare,HMO,80353,CPT4/HCPCS,DRUG SCREENING COCAINE,,Per Unit,96.00
United HealthCare,HMO,80354,CPT4/HCPCS,DRUG SCREENING FENTANYL,,Per Unit,96.00
United HealthCare,HMO,80355,CPT4/HCPCS,GABAPENTIN NON-BLOOD,,Per Unit,96.00
United HealthCare,HMO,80356,CPT4/HCPCS,HEROIN METABOLITE,,Per Unit,96.00
United HealthCare,HMO,80357,CPT4/HCPCS,KETAMINE AND NORKETAMINE,,Per Unit,96.00
United HealthCare,HMO,80358,CPT4/HCPCS,DRUG SCREENING METHADONE,,Per Unit,96.00
United HealthCare,HMO,80359,CPT4/HCPCS,METHYLENEDIOXYAMPHETAMINES,,Per Unit,96.00
United HealthCare,HMO,80360,CPT4/HCPCS,METHYLPHENIDATE,,Per Unit,96.00
United HealthCare,HMO,80361,CPT4/HCPCS,OPIATES 1 OR MORE,,Per Unit,96.00
United HealthCare,HMO,80362,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 1/2,,Per Unit,96.00
United HealthCare,HMO,80363,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 3/4,,Per Unit,96.00
United HealthCare,HMO,80364,CPT4/HCPCS,OPIOID &OPIATE ANALOG 5/MORE,,Per Unit,96.00
United HealthCare,HMO,80365,CPT4/HCPCS,DRUG SCREENING OXYCODONE,,Per Unit,96.00
United HealthCare,HMO,80366,CPT4/HCPCS,DRUG SCREENING PREGABALIN,,Per Unit,96.00
United HealthCare,HMO,80367,CPT4/HCPCS,DRUG SCREENING PROPOXYPHENE,,Per Unit,96.00
United HealthCare,HMO,80368,CPT4/HCPCS,SEDATIVE HYPNOTICS,,Per Unit,96.00
United HealthCare,HMO,80369,CPT4/HCPCS,SKELETAL MUSCLE RELAXANT 1/2,,Per Unit,96.00
United HealthCare,HMO,80370,CPT4/HCPCS,SKEL MUSC RELAXANT 3 OR MORE,,Per Unit,96.00
United HealthCare,HMO,80371,CPT4/HCPCS,STIMULANTS SYNTHETIC,,Per Unit,96.00
United HealthCare,HMO,80372,CPT4/HCPCS,DRUG SCREENING TAPENTADOL,,Per Unit,96.00
United HealthCare,HMO,80373,CPT4/HCPCS,DRUG SCREENING TRAMADOL,,Per Unit,96.00
United HealthCare,HMO,80374,CPT4/HCPCS,STEREOISOMER ANALYSIS,,Per Unit,96.00
United HealthCare,HMO,80375,CPT4/HCPCS,DRUG/SUBSTANCE NOS 1-3,,Per Unit,96.00
United HealthCare,HMO,80376,CPT4/HCPCS,DRUG/SUBSTANCE NOS 4-6,,Per Unit,96.00
United HealthCare,HMO,80377,CPT4/HCPCS,DRUG/SUBSTANCE NOS 7/MORE,,Per Unit,96.00
United HealthCare,HMO,80400,CPT4/HCPCS,ACTH STIMULATION PANEL,,Per Unit,96.00
United HealthCare,HMO,80402,CPT4/HCPCS,ACTH STIMULATION PANEL,,Per Unit,96.00
United HealthCare,HMO,80406,CPT4/HCPCS,ACTH STIMULATION PANEL,,Per Unit,96.00
United HealthCare,HMO,80408,CPT4/HCPCS,ALDOSTERONE SUPPRESSION EVAL,,Per Unit,96.00
United HealthCare,HMO,80410,CPT4/HCPCS,CALCITONIN STIMUL PANEL,,Per Unit,96.00
United HealthCare,HMO,80412,CPT4/HCPCS,CRH STIMULATION PANEL,,Per Unit,96.00
United HealthCare,HMO,80414,CPT4/HCPCS,TESTOSTERONE RESPONSE PANEL,,Per Unit,96.00
United HealthCare,HMO,80415,CPT4/HCPCS,TOT ESTRADIOL RESPONSE PANEL,,Per Unit,96.00
United HealthCare,HMO,80416,CPT4/HCPCS,RENIN STIMULATION PANEL,,Per Unit,96.00
United HealthCare,HMO,80417,CPT4/HCPCS,RENIN STIMULATION PANEL,,Per Unit,96.00
United HealthCare,HMO,80418,CPT4/HCPCS,PITUITARY EVALUATION PANEL,,Per Unit,96.00
United HealthCare,HMO,80420,CPT4/HCPCS,DEXAMETHASONE PANEL,,Per Unit,96.00
United HealthCare,HMO,80422,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,Per Unit,96.00
United HealthCare,HMO,80424,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,Per Unit,96.00
United HealthCare,HMO,80426,CPT4/HCPCS,GONADOTROPIN HORMONE PANEL,,Per Unit,96.00
United HealthCare,HMO,80428,CPT4/HCPCS,GROWTH HORMONE PANEL,,Per Unit,96.00
United HealthCare,HMO,80430,CPT4/HCPCS,GROWTH HORMONE PANEL,,Per Unit,96.00
United HealthCare,HMO,80432,CPT4/HCPCS,INSULIN SUPPRESSION PANEL,,Per Unit,96.00
United HealthCare,HMO,80434,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,Per Unit,96.00
United HealthCare,HMO,80435,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,Per Unit,96.00
United HealthCare,HMO,80436,CPT4/HCPCS,METYRAPONE PANEL,,Per Unit,96.00
United HealthCare,HMO,80438,CPT4/HCPCS,TRH STIMULATION PANEL,,Per Unit,96.00
United HealthCare,HMO,80439,CPT4/HCPCS,TRH STIMULATION PANEL,,Per Unit,96.00
United HealthCare,HMO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,4461.00
United HealthCare,HMO,80500,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,Per Unit,96.00
United HealthCare,HMO,80502,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,Per Unit,96.00
United HealthCare,HMO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,4461.00
United HealthCare,HMO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,4461.00
United HealthCare,HMO,81000,CPT4/HCPCS,URINALYSIS NONAUTO W/SCOPE,,Per Unit,96.00
United HealthCare,HMO,81001,CPT4/HCPCS,URINALYSIS AUTO W/SCOPE,,Per Unit,96.00
United HealthCare,HMO,81002,CPT4/HCPCS,URINALYSIS NONAUTO W/O SCOPE,,Per Unit,96.00
United HealthCare,HMO,81003,CPT4/HCPCS,URINALYSIS AUTO W/O SCOPE,,Per Unit,96.00
United HealthCare,HMO,81005,CPT4/HCPCS,URINALYSIS,,Per Unit,96.00
United HealthCare,HMO,81007,CPT4/HCPCS,URINE SCREEN FOR BACTERIA,,Per Unit,96.00
United HealthCare,HMO,81015,CPT4/HCPCS,MICROSCOPIC EXAM OF URINE,,Per Unit,96.00
United HealthCare,HMO,81020,CPT4/HCPCS,URINALYSIS GLASS TEST,,Per Unit,96.00
United HealthCare,HMO,81025,CPT4/HCPCS,URINE PREGNANCY TEST,,Per Unit,96.00
United HealthCare,HMO,81050,CPT4/HCPCS,URINALYSIS VOLUME MEASURE,,Per Unit,96.00
United HealthCare,HMO,81105,CPT4/HCPCS,HPA-1 GENOTYPING,,Per Unit,150.00
United HealthCare,HMO,81106,CPT4/HCPCS,HPA-2 GENOTYPING,,Per Unit,150.00
United HealthCare,HMO,81107,CPT4/HCPCS,HPA-3 GENOTYPING,,Per Unit,150.00
United HealthCare,HMO,81108,CPT4/HCPCS,HPA-4 GENOTYPING,,Per Unit,150.00
United HealthCare,HMO,81109,CPT4/HCPCS,HPA-5 GENOTYPING,,Per Unit,150.00
United HealthCare,HMO,81110,CPT4/HCPCS,HPA-6 GENOTYPING,,Per Unit,150.00
United HealthCare,HMO,81111,CPT4/HCPCS,HPA-9 GENOTYPING,,Per Unit,150.00
United HealthCare,HMO,81112,CPT4/HCPCS,HPA-15 GENOTYPING,,Per Unit,150.00
United HealthCare,HMO,81120,CPT4/HCPCS,IDH1 COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81121,CPT4/HCPCS,IDH2 COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81161,CPT4/HCPCS,DMD DUP/DELET ANALYSIS,,Per Unit,150.00
United HealthCare,HMO,81162,CPT4/HCPCS,BRCA1&2 GEN FULL SEQ DUP/DEL,,Per Unit,150.00
United HealthCare,HMO,81163,CPT4/HCPCS,BRCA1&2 GENE FULL SEQ ALYS,,Per Unit,150.00
United HealthCare,HMO,81164,CPT4/HCPCS,BRCA1&2 GEN FUL DUP/DEL ALYS,,Per Unit,150.00
United HealthCare,HMO,81165,CPT4/HCPCS,BRCA1 GENE FULL SEQ ALYS,,Per Unit,150.00
United HealthCare,HMO,81166,CPT4/HCPCS,BRCA1 GENE FULL DUP/DEL ALYS,,Per Unit,150.00
United HealthCare,HMO,81167,CPT4/HCPCS,BRCA2 GENE FULL DUP/DEL ALYS,,Per Unit,150.00
United HealthCare,HMO,81170,CPT4/HCPCS,ABL1 GENE,,Per Unit,150.00
United HealthCare,HMO,81171,CPT4/HCPCS,AFF2 GENE DETC ABNOR ALLELES,,Per Unit,150.00
United HealthCare,HMO,81172,CPT4/HCPCS,AFF2 GENE CHARAC ALLELES,,Per Unit,150.00
United HealthCare,HMO,81173,CPT4/HCPCS,AR GENE FULL GENE SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81174,CPT4/HCPCS,AR GENE KNOWN FAMIL VARIANT,,Per Unit,150.00
United HealthCare,HMO,81175,CPT4/HCPCS,ASXL1 FULL GENE SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81176,CPT4/HCPCS,ASXL1 GENE TARGET SEQ ALYS,,Per Unit,150.00
United HealthCare,HMO,81177,CPT4/HCPCS,ATN1 GENE DETC ABNOR ALLELES,,Per Unit,150.00
United HealthCare,HMO,81178,CPT4/HCPCS,ATXN1 GENE DETC ABNOR ALLELE,,Per Unit,150.00
United HealthCare,HMO,81179,CPT4/HCPCS,ATXN2 GENE DETC ABNOR ALLELE,,Per Unit,150.00
United HealthCare,HMO,81180,CPT4/HCPCS,ATXN3 GENE DETC ABNOR ALLELE,,Per Unit,150.00
United HealthCare,HMO,81181,CPT4/HCPCS,ATXN7 GENE DETC ABNOR ALLELE,,Per Unit,150.00
United HealthCare,HMO,81182,CPT4/HCPCS,ATXN8OS GEN DETC ABNOR ALLEL,,Per Unit,150.00
United HealthCare,HMO,81183,CPT4/HCPCS,ATXN10 GENE DETC ABNOR ALLEL,,Per Unit,150.00
United HealthCare,HMO,81184,CPT4/HCPCS,CACNA1A GEN DETC ABNOR ALLEL,,Per Unit,150.00
United HealthCare,HMO,81185,CPT4/HCPCS,CACNA1A GENE FULL GENE SEQ,,Per Unit,150.00
United HealthCare,HMO,81186,CPT4/HCPCS,CACNA1A GEN KNOWN FAMIL VRNT,,Per Unit,150.00
United HealthCare,HMO,81187,CPT4/HCPCS,CNBP GENE DETC ABNOR ALLELE,,Per Unit,150.00
United HealthCare,HMO,81188,CPT4/HCPCS,CSTB GENE DETC ABNOR ALLELE,,Per Unit,150.00
United HealthCare,HMO,81189,CPT4/HCPCS,CSTB GENE FULL GENE SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81190,CPT4/HCPCS,CSTB GENE KNOWN FAMIL VRNT,,Per Unit,150.00
United HealthCare,HMO,81200,CPT4/HCPCS,ASPA GENE,,Per Unit,150.00
United HealthCare,HMO,81201,CPT4/HCPCS,APC GENE FULL SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81202,CPT4/HCPCS,APC GENE KNOWN FAM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81203,CPT4/HCPCS,APC GENE DUP/DELET VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81204,CPT4/HCPCS,AR GENE CHARAC ALLELES,,Per Unit,150.00
United HealthCare,HMO,81205,CPT4/HCPCS,BCKDHB GENE,,Per Unit,150.00
United HealthCare,HMO,81206,CPT4/HCPCS,BCR/ABL1 GENE MAJOR BP,,Per Unit,150.00
United HealthCare,HMO,81207,CPT4/HCPCS,BCR/ABL1 GENE MINOR BP,,Per Unit,150.00
United HealthCare,HMO,81208,CPT4/HCPCS,BCR/ABL1 GENE OTHER BP,,Per Unit,150.00
United HealthCare,HMO,81209,CPT4/HCPCS,BLM GENE,,Per Unit,150.00
United HealthCare,HMO,81210,CPT4/HCPCS,BRAF GENE,,Per Unit,150.00
United HealthCare,HMO,81212,CPT4/HCPCS,BRCA1&2 185&5385&6174 VRNT,,Per Unit,150.00
United HealthCare,HMO,81215,CPT4/HCPCS,BRCA1 GENE KNOWN FAMIL VRNT,,Per Unit,150.00
United HealthCare,HMO,81216,CPT4/HCPCS,BRCA2 GENE FULL SEQ ALYS,,Per Unit,150.00
United HealthCare,HMO,81217,CPT4/HCPCS,BRCA2 GENE KNOWN FAMIL VRNT,,Per Unit,150.00
United HealthCare,HMO,81218,CPT4/HCPCS,CEBPA GENE FULL SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81219,CPT4/HCPCS,CALR GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81220,CPT4/HCPCS,CFTR GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81221,CPT4/HCPCS,CFTR GENE KNOWN FAM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81222,CPT4/HCPCS,CFTR GENE DUP/DELET VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81223,CPT4/HCPCS,CFTR GENE FULL SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81224,CPT4/HCPCS,CFTR GENE INTRON POLY T,,Per Unit,150.00
United HealthCare,HMO,81225,CPT4/HCPCS,CYP2C19 GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81226,CPT4/HCPCS,CYP2D6 GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81227,CPT4/HCPCS,CYP2C9 GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81228,CPT4/HCPCS,CYTOGEN MICRARRAY COPY NMBR,,Per Unit,150.00
United HealthCare,HMO,81229,CPT4/HCPCS,CYTOGEN M ARRAY COPY NO&SNP,,Per Unit,150.00
United HealthCare,HMO,81230,CPT4/HCPCS,CYP3A4 GENE COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81231,CPT4/HCPCS,CYP3A5 GENE COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81232,CPT4/HCPCS,DPYD GENE COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81233,CPT4/HCPCS,BTK GENE COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81234,CPT4/HCPCS,DMPK GENE DETC ABNOR ALLELE,,Per Unit,150.00
United HealthCare,HMO,81235,CPT4/HCPCS,EGFR GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81236,CPT4/HCPCS,EZH2 GENE FULL GENE SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81237,CPT4/HCPCS,EZH2 GENE COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81238,CPT4/HCPCS,F9 FULL GENE SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81239,CPT4/HCPCS,DMPK GENE CHARAC ALLELES,,Per Unit,150.00
United HealthCare,HMO,81240,CPT4/HCPCS,F2 GENE,,Per Unit,150.00
United HealthCare,HMO,81241,CPT4/HCPCS,F5 GENE,,Per Unit,150.00
United HealthCare,HMO,81242,CPT4/HCPCS,FANCC GENE,,Per Unit,150.00
United HealthCare,HMO,81243,CPT4/HCPCS,FMR1 GENE DETECTION,,Per Unit,150.00
United HealthCare,HMO,81244,CPT4/HCPCS,FMR1 GENE CHARAC ALLELES,,Per Unit,150.00
United HealthCare,HMO,81245,CPT4/HCPCS,FLT3 GENE,,Per Unit,150.00
United HealthCare,HMO,81246,CPT4/HCPCS,FLT3 GENE ANALYSIS,,Per Unit,150.00
United HealthCare,HMO,81247,CPT4/HCPCS,G6PD GENE ALYS CMN VARIANT,,Per Unit,150.00
United HealthCare,HMO,81248,CPT4/HCPCS,G6PD KNOWN FAMILIAL VARIANT,,Per Unit,150.00
United HealthCare,HMO,81249,CPT4/HCPCS,G6PD FULL GENE SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81250,CPT4/HCPCS,G6PC GENE,,Per Unit,150.00
United HealthCare,HMO,81251,CPT4/HCPCS,GBA GENE,,Per Unit,150.00
United HealthCare,HMO,81252,CPT4/HCPCS,GJB2 GENE FULL SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81253,CPT4/HCPCS,GJB2 GENE KNOWN FAM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81254,CPT4/HCPCS,GJB6 GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81255,CPT4/HCPCS,HEXA GENE,,Per Unit,150.00
United HealthCare,HMO,81256,CPT4/HCPCS,HFE GENE,,Per Unit,150.00
United HealthCare,HMO,81257,CPT4/HCPCS,HBA1/HBA2 GENE,,Per Unit,150.00
United HealthCare,HMO,81258,CPT4/HCPCS,HBA1/HBA2 GENE FAM VRNT,,Per Unit,150.00
United HealthCare,HMO,81259,CPT4/HCPCS,HBA1/HBA2 FULL GENE SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81260,CPT4/HCPCS,IKBKAP GENE,,Per Unit,150.00
United HealthCare,HMO,81261,CPT4/HCPCS,IGH GENE REARRANGE AMP METH,,Per Unit,150.00
United HealthCare,HMO,81262,CPT4/HCPCS,IGH GENE REARRANG DIR PROBE,,Per Unit,150.00
United HealthCare,HMO,81263,CPT4/HCPCS,IGH VARI REGIONAL MUTATION,,Per Unit,150.00
United HealthCare,HMO,81264,CPT4/HCPCS,IGK REARRANGEABN CLONAL POP,,Per Unit,150.00
United HealthCare,HMO,81265,CPT4/HCPCS,STR MARKERS SPECIMEN ANAL,,Per Unit,150.00
United HealthCare,HMO,81266,CPT4/HCPCS,STR MARKERS SPEC ANAL ADDL,,Per Unit,150.00
United HealthCare,HMO,81267,CPT4/HCPCS,CHIMERISM ANAL NO CELL SELEC,,Per Unit,150.00
United HealthCare,HMO,81268,CPT4/HCPCS,CHIMERISM ANAL W/CELL SELECT,,Per Unit,150.00
United HealthCare,HMO,81269,CPT4/HCPCS,HBA1/HBA2 GENE DUP/DEL VRNTS,,Per Unit,150.00
United HealthCare,HMO,81270,CPT4/HCPCS,JAK2 GENE,,Per Unit,150.00
United HealthCare,HMO,81271,CPT4/HCPCS,HTT GENE DETC ABNOR ALLELES,,Per Unit,150.00
United HealthCare,HMO,81272,CPT4/HCPCS,KIT GENE TARGETED SEQ ANALYS,,Per Unit,150.00
United HealthCare,HMO,81273,CPT4/HCPCS,KIT GENE ANALYS D816 VARIANT,,Per Unit,150.00
United HealthCare,HMO,81274,CPT4/HCPCS,HTT GENE CHARAC ALLELES,,Per Unit,150.00
United HealthCare,HMO,81275,CPT4/HCPCS,KRAS GENE VARIANTS EXON 2,,Per Unit,150.00
United HealthCare,HMO,81276,CPT4/HCPCS,KRAS GENE ADDL VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81283,CPT4/HCPCS,IFNL3 GENE,,Per Unit,150.00
United HealthCare,HMO,81284,CPT4/HCPCS,FXN GENE DETC ABNOR ALLELES,,Per Unit,150.00
United HealthCare,HMO,81285,CPT4/HCPCS,FXN GENE CHARAC ALLELES,,Per Unit,150.00
United HealthCare,HMO,81286,CPT4/HCPCS,FXN GENE FULL GENE SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81287,CPT4/HCPCS,MGMT GENE PRMTR MTHYLTN ALYS,,Per Unit,150.00
United HealthCare,HMO,81288,CPT4/HCPCS,MLH1 GENE,,Per Unit,150.00
United HealthCare,HMO,81289,CPT4/HCPCS,FXN GENE KNOWN FAMIL VARIANT,,Per Unit,150.00
United HealthCare,HMO,81290,CPT4/HCPCS,MCOLN1 GENE,,Per Unit,150.00
United HealthCare,HMO,81291,CPT4/HCPCS,MTHFR GENE,,Per Unit,150.00
United HealthCare,HMO,81292,CPT4/HCPCS,MLH1 GENE FULL SEQ,,Per Unit,150.00
United HealthCare,HMO,81293,CPT4/HCPCS,MLH1 GENE KNOWN VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81294,CPT4/HCPCS,MLH1 GENE DUP/DELETE VARIANT,,Per Unit,150.00
United HealthCare,HMO,81295,CPT4/HCPCS,MSH2 GENE FULL SEQ,,Per Unit,150.00
United HealthCare,HMO,81296,CPT4/HCPCS,MSH2 GENE KNOWN VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81297,CPT4/HCPCS,MSH2 GENE DUP/DELETE VARIANT,,Per Unit,150.00
United HealthCare,HMO,81298,CPT4/HCPCS,MSH6 GENE FULL SEQ,,Per Unit,150.00
United HealthCare,HMO,81299,CPT4/HCPCS,MSH6 GENE KNOWN VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81300,CPT4/HCPCS,MSH6 GENE DUP/DELETE VARIANT,,Per Unit,150.00
United HealthCare,HMO,81301,CPT4/HCPCS,MICROSATELLITE INSTABILITY,,Per Unit,150.00
United HealthCare,HMO,81302,CPT4/HCPCS,MECP2 GENE FULL SEQ,,Per Unit,150.00
United HealthCare,HMO,81303,CPT4/HCPCS,MECP2 GENE KNOWN VARIANT,,Per Unit,150.00
United HealthCare,HMO,81304,CPT4/HCPCS,MECP2 GENE DUP/DELET VARIANT,,Per Unit,150.00
United HealthCare,HMO,81305,CPT4/HCPCS,MYD88 GENE P.LEU265PRO VRNT,,Per Unit,150.00
United HealthCare,HMO,81306,CPT4/HCPCS,NUDT15 GENE COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81310,CPT4/HCPCS,NPM1 GENE,,Per Unit,150.00
United HealthCare,HMO,81311,CPT4/HCPCS,NRAS GENE VARIANTS EXON 2&3,,Per Unit,150.00
United HealthCare,HMO,81312,CPT4/HCPCS,PABPN1 GENE DETC ABNOR ALLEL,,Per Unit,150.00
United HealthCare,HMO,81313,CPT4/HCPCS,PCA3/KLK3 ANTIGEN,,Per Unit,150.00
United HealthCare,HMO,81314,CPT4/HCPCS,PDGFRA GENE,,Per Unit,150.00
United HealthCare,HMO,81315,CPT4/HCPCS,PML/RARALPHA COM BREAKPOINTS,,Per Unit,150.00
United HealthCare,HMO,81316,CPT4/HCPCS,PML/RARALPHA 1 BREAKPOINT,,Per Unit,150.00
United HealthCare,HMO,81317,CPT4/HCPCS,PMS2 GENE FULL SEQ ANALYSIS,,Per Unit,150.00
United HealthCare,HMO,81318,CPT4/HCPCS,PMS2 KNOWN FAMILIAL VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81319,CPT4/HCPCS,PMS2 GENE DUP/DELET VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81320,CPT4/HCPCS,PLCG2 GENE COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81321,CPT4/HCPCS,PTEN GENE FULL SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81322,CPT4/HCPCS,PTEN GENE KNOWN FAM VARIANT,,Per Unit,150.00
United HealthCare,HMO,81323,CPT4/HCPCS,PTEN GENE DUP/DELET VARIANT,,Per Unit,150.00
United HealthCare,HMO,81324,CPT4/HCPCS,PMP22 GENE DUP/DELET,,Per Unit,150.00
United HealthCare,HMO,81325,CPT4/HCPCS,PMP22 GENE FULL SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81326,CPT4/HCPCS,PMP22 GENE KNOWN FAM VARIANT,,Per Unit,150.00
United HealthCare,HMO,81327,CPT4/HCPCS,SEPT9 GEN PRMTR MTHYLTN ALYS,,Per Unit,150.00
United HealthCare,HMO,81328,CPT4/HCPCS,SLCO1B1 GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81329,CPT4/HCPCS,SMN1 GENE DOS/DELETION ALYS,,Per Unit,150.00
United HealthCare,HMO,81330,CPT4/HCPCS,SMPD1 GENE COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81331,CPT4/HCPCS,SNRPN/UBE3A GENE,,Per Unit,150.00
United HealthCare,HMO,81332,CPT4/HCPCS,SERPINA1 GENE,,Per Unit,150.00
United HealthCare,HMO,81333,CPT4/HCPCS,TGFBI GENE COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81334,CPT4/HCPCS,RUNX1 GENE TARGETED SEQ ALYS,,Per Unit,150.00
United HealthCare,HMO,81335,CPT4/HCPCS,TPMT GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81336,CPT4/HCPCS,SMN1 GENE FULL GENE SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81337,CPT4/HCPCS,SMN1 GEN NOWN FAMIL SEQ VRNT,,Per Unit,150.00
United HealthCare,HMO,81340,CPT4/HCPCS,TRB@ GENE REARRANGE AMPLIFY,,Per Unit,150.00
United HealthCare,HMO,81341,CPT4/HCPCS,TRB@ GENE REARRANGE DIRPROBE,,Per Unit,150.00
United HealthCare,HMO,81342,CPT4/HCPCS,TRG GENE REARRANGEMENT ANAL,,Per Unit,150.00
United HealthCare,HMO,81343,CPT4/HCPCS,PPP2R2B GEN DETC ABNOR ALLEL,,Per Unit,150.00
United HealthCare,HMO,81344,CPT4/HCPCS,TBP GENE DETC ABNOR ALLELES,,Per Unit,150.00
United HealthCare,HMO,81345,CPT4/HCPCS,TERT GENE TARGETED SEQ ALYS,,Per Unit,150.00
United HealthCare,HMO,81346,CPT4/HCPCS,TYMS GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81350,CPT4/HCPCS,UGT1A1 GENE COMMON VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81355,CPT4/HCPCS,VKORC1 GENE,,Per Unit,150.00
United HealthCare,HMO,81361,CPT4/HCPCS,HBB GENE COM VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81362,CPT4/HCPCS,HBB GENE KNOWN FAM VARIANT,,Per Unit,150.00
United HealthCare,HMO,81363,CPT4/HCPCS,HBB GENE DUP/DEL VARIANTS,,Per Unit,150.00
United HealthCare,HMO,81364,CPT4/HCPCS,HBB FULL GENE SEQUENCE,,Per Unit,150.00
United HealthCare,HMO,81370,CPT4/HCPCS,HLA I & II TYPING LR,,Per Unit,150.00
United HealthCare,HMO,81371,CPT4/HCPCS,HLA I & II TYPE VERIFY LR,,Per Unit,150.00
United HealthCare,HMO,81372,CPT4/HCPCS,HLA I TYPING COMPLETE LR,,Per Unit,150.00
United HealthCare,HMO,81373,CPT4/HCPCS,HLA I TYPING 1 LOCUS LR,,Per Unit,150.00
United HealthCare,HMO,81374,CPT4/HCPCS,HLA I TYPING 1 ANTIGEN LR,,Per Unit,150.00
United HealthCare,HMO,81375,CPT4/HCPCS,HLA II TYPING AG EQUIV LR,,Per Unit,150.00
United HealthCare,HMO,81376,CPT4/HCPCS,HLA II TYPING 1 LOCUS LR,,Per Unit,150.00
United HealthCare,HMO,81377,CPT4/HCPCS,HLA II TYPE 1 AG EQUIV LR,,Per Unit,150.00
United HealthCare,HMO,81378,CPT4/HCPCS,HLA I & II TYPING HR,,Per Unit,150.00
United HealthCare,HMO,81379,CPT4/HCPCS,HLA I TYPING COMPLETE HR,,Per Unit,150.00
United HealthCare,HMO,81380,CPT4/HCPCS,HLA I TYPING 1 LOCUS HR,,Per Unit,150.00
United HealthCare,HMO,81381,CPT4/HCPCS,HLA I TYPING 1 ALLELE HR,,Per Unit,150.00
United HealthCare,HMO,81382,CPT4/HCPCS,HLA II TYPING 1 LOC HR,,Per Unit,150.00
United HealthCare,HMO,81383,CPT4/HCPCS,HLA II TYPING 1 ALLELE HR,,Per Unit,150.00
United HealthCare,HMO,81400,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 1,,Per Unit,150.00
United HealthCare,HMO,81401,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 2,,Per Unit,150.00
United HealthCare,HMO,81402,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 3,,Per Unit,150.00
United HealthCare,HMO,81403,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 4,,Per Unit,150.00
United HealthCare,HMO,81404,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 5,,Per Unit,150.00
United HealthCare,HMO,81405,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 6,,Per Unit,150.00
United HealthCare,HMO,81406,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 7,,Per Unit,150.00
United HealthCare,HMO,81407,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 8,,Per Unit,150.00
United HealthCare,HMO,81408,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 9,,Per Unit,150.00
United HealthCare,HMO,81410,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,Per Unit,96.00
United HealthCare,HMO,81411,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,Per Unit,96.00
United HealthCare,HMO,81412,CPT4/HCPCS,ASHKENAZI JEWISH ASSOC DIS,,Per Unit,96.00
United HealthCare,HMO,81413,CPT4/HCPCS,CAR ION CHNNLPATH INC 10 GNS,,Per Unit,96.00
United HealthCare,HMO,81414,CPT4/HCPCS,CAR ION CHNNLPATH INC 2 GNS,,Per Unit,96.00
United HealthCare,HMO,81415,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,Per Unit,96.00
United HealthCare,HMO,81416,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,Per Unit,96.00
United HealthCare,HMO,81417,CPT4/HCPCS,EXOME RE-EVALUATION,,Per Unit,96.00
United HealthCare,HMO,81420,CPT4/HCPCS,FETAL CHRMOML ANEUPLOIDY,,Per Unit,96.00
United HealthCare,HMO,81422,CPT4/HCPCS,FETAL CHRMOML MICRODELTJ,,Per Unit,96.00
United HealthCare,HMO,81425,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,Per Unit,96.00
United HealthCare,HMO,81426,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,Per Unit,96.00
United HealthCare,HMO,81427,CPT4/HCPCS,GENOME RE-EVALUATION,,Per Unit,96.00
United HealthCare,HMO,81430,CPT4/HCPCS,HEARING LOSS SEQUENCE ANALYS,,Per Unit,96.00
United HealthCare,HMO,81431,CPT4/HCPCS,HEARING LOSS DUP/DEL ANALYS,,Per Unit,96.00
United HealthCare,HMO,81432,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,Per Unit,96.00
United HealthCare,HMO,81433,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,Per Unit,96.00
United HealthCare,HMO,81434,CPT4/HCPCS,HEREDITARY RETINAL DISORDERS,,Per Unit,96.00
United HealthCare,HMO,81435,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,Per Unit,96.00
United HealthCare,HMO,81436,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,Per Unit,96.00
United HealthCare,HMO,81437,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,Per Unit,96.00
United HealthCare,HMO,81438,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,Per Unit,96.00
United HealthCare,HMO,81439,CPT4/HCPCS,HRDTRY CARDMYPY GENE PANEL,,Per Unit,96.00
United HealthCare,HMO,81440,CPT4/HCPCS,MITOCHONDRIAL GENE,,Per Unit,96.00
United HealthCare,HMO,81442,CPT4/HCPCS,NOONAN SPECTRUM DISORDERS,,Per Unit,96.00
United HealthCare,HMO,81443,CPT4/HCPCS,GENETIC TSTG SEVERE INH COND,,Per Unit,96.00
United HealthCare,HMO,81445,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Per Unit,96.00
United HealthCare,HMO,81448,CPT4/HCPCS,HRDTRY PERPH NEURPHY PANEL,,Per Unit,96.00
United HealthCare,HMO,81450,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Per Unit,96.00
United HealthCare,HMO,81455,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Per Unit,96.00
United HealthCare,HMO,81460,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,Per Unit,96.00
United HealthCare,HMO,81465,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,Per Unit,96.00
United HealthCare,HMO,81470,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,Per Unit,96.00
United HealthCare,HMO,81471,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,Per Unit,96.00
United HealthCare,HMO,81479,CPT4/HCPCS,UNLISTED MOLECULAR PATHOLOGY,,Per Unit,96.00
United HealthCare,HMO,81490,CPT4/HCPCS,AUTOIMMUNE RHEUMATOID ARTHR,,Per Unit,96.00
United HealthCare,HMO,81493,CPT4/HCPCS,COR ARTERY DISEASE MRNA,,Per Unit,96.00
United HealthCare,HMO,81500,CPT4/HCPCS,ONCO (OVAR) TWO PROTEINS,,Per Unit,96.00
United HealthCare,HMO,81503,CPT4/HCPCS,ONCO (OVAR) FIVE PROTEINS,,Per Unit,96.00
United HealthCare,HMO,81504,CPT4/HCPCS,ONCOLOGY TISSUE OF ORIGIN,,Per Unit,96.00
United HealthCare,HMO,81506,CPT4/HCPCS,ENDO ASSAY SEVEN ANAL,,Per Unit,96.00
United HealthCare,HMO,81507,CPT4/HCPCS,FETAL ANEUPLOIDY TRISOM RISK,,Per Unit,96.00
United HealthCare,HMO,81508,CPT4/HCPCS,FTL CGEN ABNOR TWO PROTEINS,,Per Unit,96.00
United HealthCare,HMO,81509,CPT4/HCPCS,FTL CGEN ABNOR 3 PROTEINS,,Per Unit,96.00
United HealthCare,HMO,81510,CPT4/HCPCS,FTL CGEN ABNOR THREE ANAL,,Per Unit,96.00
United HealthCare,HMO,81511,CPT4/HCPCS,FTL CGEN ABNOR FOUR ANAL,,Per Unit,96.00
United HealthCare,HMO,81512,CPT4/HCPCS,FTL CGEN ABNOR FIVE ANAL,,Per Unit,96.00
United HealthCare,HMO,81518,CPT4/HCPCS,ONC BRST MRNA 11 GENES,,Per Unit,96.00
United HealthCare,HMO,81519,CPT4/HCPCS,ONCOLOGY BREAST MRNA,,Per Unit,96.00
United HealthCare,HMO,81520,CPT4/HCPCS,ONC BREAST MRNA 58 GENES,,Per Unit,96.00
United HealthCare,HMO,81521,CPT4/HCPCS,ONC BREAST MRNA 70 GENES,,Per Unit,96.00
United HealthCare,HMO,81525,CPT4/HCPCS,ONCOLOGY COLON MRNA,,Per Unit,96.00
United HealthCare,HMO,81528,CPT4/HCPCS,ONCOLOGY COLORECTAL SCR,,Per Unit,96.00
United HealthCare,HMO,81535,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,Per Unit,96.00
United HealthCare,HMO,81536,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,Per Unit,96.00
United HealthCare,HMO,81538,CPT4/HCPCS,ONCOLOGY LUNG,,Per Unit,96.00
United HealthCare,HMO,81539,CPT4/HCPCS,ONCOLOGY PROSTATE PROB SCORE,,Per Unit,96.00
United HealthCare,HMO,81540,CPT4/HCPCS,ONCOLOGY TUM UNKNOWN ORIGIN,,Per Unit,96.00
United HealthCare,HMO,81541,CPT4/HCPCS,ONC PROSTATE MRNA 46 GENES,,Per Unit,96.00
United HealthCare,HMO,81545,CPT4/HCPCS,ONCOLOGY THYROID,,Per Unit,96.00
United HealthCare,HMO,81551,CPT4/HCPCS,ONC PROSTATE 3 GENES,,Per Unit,96.00
United HealthCare,HMO,81595,CPT4/HCPCS,CARDIOLOGY HRT TRNSPL MRNA,,Per Unit,96.00
United HealthCare,HMO,81596,CPT4/HCPCS,NFCT DS CHRNC HCV 6 ASSAYS,,Per Unit,96.00
United HealthCare,HMO,82009,CPT4/HCPCS,TEST FOR ACETONE/KETONES,,Per Unit,96.00
United HealthCare,HMO,82010,CPT4/HCPCS,ACETONE ASSAY,,Per Unit,96.00
United HealthCare,HMO,82013,CPT4/HCPCS,ACETYLCHOLINESTERASE ASSAY,,Per Unit,96.00
United HealthCare,HMO,82016,CPT4/HCPCS,ACYLCARNITINES QUAL,,Per Unit,96.00
United HealthCare,HMO,82017,CPT4/HCPCS,ACYLCARNITINES QUANT,,Per Unit,96.00
United HealthCare,HMO,82024,CPT4/HCPCS,ASSAY OF ACTH,,Per Unit,96.00
United HealthCare,HMO,82030,CPT4/HCPCS,ASSAY OF ADP & AMP,,Per Unit,96.00
United HealthCare,HMO,82040,CPT4/HCPCS,ASSAY OF SERUM ALBUMIN,,Per Unit,96.00
United HealthCare,HMO,82042,CPT4/HCPCS,OTHER SOURCE ALBUMIN QUAN EA,,Per Unit,96.00
United HealthCare,HMO,82043,CPT4/HCPCS,UR ALBUMIN QUANTITATIVE,,Per Unit,96.00
United HealthCare,HMO,82044,CPT4/HCPCS,UR ALBUMIN SEMIQUANTITATIVE,,Per Unit,96.00
United HealthCare,HMO,82045,CPT4/HCPCS,ALBUMIN ISCHEMIA MODIFIED,,Per Unit,96.00
United HealthCare,HMO,82075,CPT4/HCPCS,ASSAY OF BREATH ETHANOL,,Per Unit,96.00
United HealthCare,HMO,82085,CPT4/HCPCS,ASSAY OF ALDOLASE,,Per Unit,96.00
United HealthCare,HMO,82088,CPT4/HCPCS,ASSAY OF ALDOSTERONE,,Per Unit,96.00
United HealthCare,HMO,82103,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN TOTAL,,Per Unit,96.00
United HealthCare,HMO,82104,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN PHENO,,Per Unit,96.00
United HealthCare,HMO,82105,CPT4/HCPCS,ALPHA-FETOPROTEIN SERUM,,Per Unit,96.00
United HealthCare,HMO,82106,CPT4/HCPCS,ALPHA-FETOPROTEIN AMNIOTIC,,Per Unit,96.00
United HealthCare,HMO,82107,CPT4/HCPCS,ALPHA-FETOPROTEIN L3,,Per Unit,96.00
United HealthCare,HMO,82108,CPT4/HCPCS,ASSAY OF ALUMINUM,,Per Unit,96.00
United HealthCare,HMO,82120,CPT4/HCPCS,AMINES VAGINAL FLUID QUAL,,Per Unit,96.00
United HealthCare,HMO,82127,CPT4/HCPCS,AMINO ACID SINGLE QUAL,,Per Unit,96.00
United HealthCare,HMO,82128,CPT4/HCPCS,AMINO ACIDS MULT QUAL,,Per Unit,96.00
United HealthCare,HMO,82131,CPT4/HCPCS,AMINO ACIDS SINGLE QUANT,,Per Unit,96.00
United HealthCare,HMO,82135,CPT4/HCPCS,ASSAY AMINOLEVULINIC ACID,,Per Unit,96.00
United HealthCare,HMO,82136,CPT4/HCPCS,AMINO ACIDS QUANT 2-5,,Per Unit,96.00
United HealthCare,HMO,82139,CPT4/HCPCS,AMINO ACIDS QUAN 6 OR MORE,,Per Unit,96.00
United HealthCare,HMO,82140,CPT4/HCPCS,ASSAY OF AMMONIA,,Per Unit,96.00
United HealthCare,HMO,82143,CPT4/HCPCS,AMNIOTIC FLUID SCAN,,Per Unit,96.00
United HealthCare,HMO,82150,CPT4/HCPCS,ASSAY OF AMYLASE,,Per Unit,96.00
United HealthCare,HMO,82154,CPT4/HCPCS,ANDROSTANEDIOL GLUCURONIDE,,Per Unit,96.00
United HealthCare,HMO,82157,CPT4/HCPCS,ASSAY OF ANDROSTENEDIONE,,Per Unit,96.00
United HealthCare,HMO,82160,CPT4/HCPCS,ASSAY OF ANDROSTERONE,,Per Unit,96.00
United HealthCare,HMO,82163,CPT4/HCPCS,ASSAY OF ANGIOTENSIN II,,Per Unit,96.00
United HealthCare,HMO,82164,CPT4/HCPCS,ANGIOTENSIN I ENZYME TEST,,Per Unit,96.00
United HealthCare,HMO,82172,CPT4/HCPCS,ASSAY OF APOLIPOPROTEIN,,Per Unit,96.00
United HealthCare,HMO,82175,CPT4/HCPCS,ASSAY OF ARSENIC,,Per Unit,96.00
United HealthCare,HMO,82180,CPT4/HCPCS,ASSAY OF ASCORBIC ACID,,Per Unit,96.00
United HealthCare,HMO,82190,CPT4/HCPCS,ATOMIC ABSORPTION,,Per Unit,96.00
United HealthCare,HMO,82232,CPT4/HCPCS,ASSAY OF BETA-2 PROTEIN,,Per Unit,96.00
United HealthCare,HMO,82239,CPT4/HCPCS,BILE ACIDS TOTAL,,Per Unit,96.00
United HealthCare,HMO,82240,CPT4/HCPCS,BILE ACIDS CHOLYLGLYCINE,,Per Unit,96.00
United HealthCare,HMO,82247,CPT4/HCPCS,BILIRUBIN TOTAL,,Per Unit,96.00
United HealthCare,HMO,82248,CPT4/HCPCS,BILIRUBIN DIRECT,,Per Unit,96.00
United HealthCare,HMO,82252,CPT4/HCPCS,FECAL BILIRUBIN TEST,,Per Unit,96.00
United HealthCare,HMO,82261,CPT4/HCPCS,ASSAY OF BIOTINIDASE,,Per Unit,96.00
United HealthCare,HMO,82270,CPT4/HCPCS,OCCULT BLOOD FECES,,Per Unit,96.00
United HealthCare,HMO,82271,CPT4/HCPCS,OCCULT BLOOD OTHER SOURCES,,Per Unit,96.00
United HealthCare,HMO,82272,CPT4/HCPCS,OCCULT BLD FECES 1-3 TESTS,,Per Unit,96.00
United HealthCare,HMO,82274,CPT4/HCPCS,ASSAY TEST FOR BLOOD FECAL,,Per Unit,96.00
United HealthCare,HMO,82286,CPT4/HCPCS,ASSAY OF BRADYKININ,,Per Unit,96.00
United HealthCare,HMO,82300,CPT4/HCPCS,ASSAY OF CADMIUM,,Per Unit,96.00
United HealthCare,HMO,82306,CPT4/HCPCS,VITAMIN D 25 HYDROXY,,Per Unit,96.00
United HealthCare,HMO,82308,CPT4/HCPCS,ASSAY OF CALCITONIN,,Per Unit,96.00
United HealthCare,HMO,82310,CPT4/HCPCS,ASSAY OF CALCIUM,,Per Unit,96.00
United HealthCare,HMO,82330,CPT4/HCPCS,ASSAY OF CALCIUM,,Per Unit,96.00
United HealthCare,HMO,82331,CPT4/HCPCS,CALCIUM INFUSION TEST,,Per Unit,96.00
United HealthCare,HMO,82340,CPT4/HCPCS,ASSAY OF CALCIUM IN URINE,,Per Unit,96.00
United HealthCare,HMO,82355,CPT4/HCPCS,CALCULUS ANALYSIS QUAL,,Per Unit,96.00
United HealthCare,HMO,82360,CPT4/HCPCS,CALCULUS ASSAY QUANT,,Per Unit,96.00
United HealthCare,HMO,82365,CPT4/HCPCS,CALCULUS SPECTROSCOPY,,Per Unit,96.00
United HealthCare,HMO,82370,CPT4/HCPCS,X-RAY ASSAY CALCULUS,,Per Unit,96.00
United HealthCare,HMO,82373,CPT4/HCPCS,ASSAY C-D TRANSFER MEASURE,,Per Unit,96.00
United HealthCare,HMO,82374,CPT4/HCPCS,ASSAY BLOOD CARBON DIOXIDE,,Per Unit,96.00
United HealthCare,HMO,82375,CPT4/HCPCS,ASSAY CARBOXYHB QUANT,,Per Unit,96.00
United HealthCare,HMO,82376,CPT4/HCPCS,ASSAY CARBOXYHB QUAL,,Per Unit,96.00
United HealthCare,HMO,82378,CPT4/HCPCS,CARCINOEMBRYONIC ANTIGEN,,Per Unit,96.00
United HealthCare,HMO,82379,CPT4/HCPCS,ASSAY OF CARNITINE,,Per Unit,96.00
United HealthCare,HMO,82380,CPT4/HCPCS,ASSAY OF CAROTENE,,Per Unit,96.00
United HealthCare,HMO,82382,CPT4/HCPCS,ASSAY URINE CATECHOLAMINES,,Per Unit,96.00
United HealthCare,HMO,82383,CPT4/HCPCS,ASSAY BLOOD CATECHOLAMINES,,Per Unit,96.00
United HealthCare,HMO,82384,CPT4/HCPCS,ASSAY THREE CATECHOLAMINES,,Per Unit,96.00
United HealthCare,HMO,82387,CPT4/HCPCS,ASSAY OF CATHEPSIN-D,,Per Unit,96.00
United HealthCare,HMO,82390,CPT4/HCPCS,ASSAY OF CERULOPLASMIN,,Per Unit,96.00
United HealthCare,HMO,82397,CPT4/HCPCS,CHEMILUMINESCENT ASSAY,,Per Unit,96.00
United HealthCare,HMO,82415,CPT4/HCPCS,ASSAY OF CHLORAMPHENICOL,,Per Unit,96.00
United HealthCare,HMO,82435,CPT4/HCPCS,ASSAY OF BLOOD CHLORIDE,,Per Unit,96.00
United HealthCare,HMO,82436,CPT4/HCPCS,ASSAY OF URINE CHLORIDE,,Per Unit,96.00
United HealthCare,HMO,82438,CPT4/HCPCS,ASSAY OTHER FLUID CHLORIDES,,Per Unit,96.00
United HealthCare,HMO,82441,CPT4/HCPCS,TEST FOR CHLOROHYDROCARBONS,,Per Unit,96.00
United HealthCare,HMO,82465,CPT4/HCPCS,ASSAY BLD/SERUM CHOLESTEROL,,Per Unit,96.00
United HealthCare,HMO,82480,CPT4/HCPCS,ASSAY SERUM CHOLINESTERASE,,Per Unit,96.00
United HealthCare,HMO,82482,CPT4/HCPCS,ASSAY RBC CHOLINESTERASE,,Per Unit,96.00
United HealthCare,HMO,82485,CPT4/HCPCS,ASSAY CHONDROITIN SULFATE,,Per Unit,96.00
United HealthCare,HMO,82495,CPT4/HCPCS,ASSAY OF CHROMIUM,,Per Unit,96.00
United HealthCare,HMO,82507,CPT4/HCPCS,ASSAY OF CITRATE,,Per Unit,96.00
United HealthCare,HMO,82523,CPT4/HCPCS,COLLAGEN CROSSLINKS,,Per Unit,96.00
United HealthCare,HMO,82525,CPT4/HCPCS,ASSAY OF COPPER,,Per Unit,96.00
United HealthCare,HMO,82528,CPT4/HCPCS,ASSAY OF CORTICOSTERONE,,Per Unit,96.00
United HealthCare,HMO,82530,CPT4/HCPCS,CORTISOL FREE,,Per Unit,96.00
United HealthCare,HMO,82533,CPT4/HCPCS,TOTAL CORTISOL,,Per Unit,96.00
United HealthCare,HMO,82540,CPT4/HCPCS,ASSAY OF CREATINE,,Per Unit,96.00
United HealthCare,HMO,82542,CPT4/HCPCS,COL CHROMOTOGRAPHY QUAL/QUAN,,Per Unit,96.00
United HealthCare,HMO,82550,CPT4/HCPCS,ASSAY OF CK (CPK),,Per Unit,96.00
United HealthCare,HMO,82552,CPT4/HCPCS,ASSAY OF CPK IN BLOOD,,Per Unit,96.00
United HealthCare,HMO,82553,CPT4/HCPCS,CREATINE MB FRACTION,,Per Unit,96.00
United HealthCare,HMO,82554,CPT4/HCPCS,CREATINE ISOFORMS,,Per Unit,96.00
United HealthCare,HMO,82565,CPT4/HCPCS,ASSAY OF CREATININE,,Per Unit,96.00
United HealthCare,HMO,82570,CPT4/HCPCS,ASSAY OF URINE CREATININE,,Per Unit,96.00
United HealthCare,HMO,82575,CPT4/HCPCS,CREATININE CLEARANCE TEST,,Per Unit,96.00
United HealthCare,HMO,82585,CPT4/HCPCS,ASSAY OF CRYOFIBRINOGEN,,Per Unit,96.00
United HealthCare,HMO,82595,CPT4/HCPCS,ASSAY OF CRYOGLOBULIN,,Per Unit,96.00
United HealthCare,HMO,82600,CPT4/HCPCS,ASSAY OF CYANIDE,,Per Unit,96.00
United HealthCare,HMO,82607,CPT4/HCPCS,VITAMIN B-12,,Per Unit,96.00
United HealthCare,HMO,82608,CPT4/HCPCS,B-12 BINDING CAPACITY,,Per Unit,96.00
United HealthCare,HMO,82610,CPT4/HCPCS,CYSTATIN C,,Per Unit,96.00
United HealthCare,HMO,82615,CPT4/HCPCS,TEST FOR URINE CYSTINES,,Per Unit,96.00
United HealthCare,HMO,82626,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,Per Unit,96.00
United HealthCare,HMO,82627,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,Per Unit,96.00
United HealthCare,HMO,82633,CPT4/HCPCS,DESOXYCORTICOSTERONE,,Per Unit,96.00
United HealthCare,HMO,82634,CPT4/HCPCS,DEOXYCORTISOL,,Per Unit,96.00
United HealthCare,HMO,82638,CPT4/HCPCS,ASSAY OF DIBUCAINE NUMBER,,Per Unit,96.00
United HealthCare,HMO,82652,CPT4/HCPCS,VIT D 1 25-DIHYDROXY,,Per Unit,96.00
United HealthCare,HMO,82656,CPT4/HCPCS,PANCREATIC ELASTASE FECAL,,Per Unit,96.00
United HealthCare,HMO,82657,CPT4/HCPCS,ENZYME CELL ACTIVITY,,Per Unit,96.00
United HealthCare,HMO,82658,CPT4/HCPCS,ENZYME CELL ACTIVITY RA,,Per Unit,96.00
United HealthCare,HMO,82664,CPT4/HCPCS,ELECTROPHORETIC TEST,,Per Unit,96.00
United HealthCare,HMO,82668,CPT4/HCPCS,ASSAY OF ERYTHROPOIETIN,,Per Unit,96.00
United HealthCare,HMO,82670,CPT4/HCPCS,ASSAY OF TOTAL ESTRADIOL,,Per Unit,96.00
United HealthCare,HMO,82671,CPT4/HCPCS,ASSAY OF ESTROGENS,,Per Unit,96.00
United HealthCare,HMO,82672,CPT4/HCPCS,ASSAY OF ESTROGEN,,Per Unit,96.00
United HealthCare,HMO,82677,CPT4/HCPCS,ASSAY OF ESTRIOL,,Per Unit,96.00
United HealthCare,HMO,82679,CPT4/HCPCS,ASSAY OF ESTRONE,,Per Unit,96.00
United HealthCare,HMO,82693,CPT4/HCPCS,ASSAY OF ETHYLENE GLYCOL,,Per Unit,96.00
United HealthCare,HMO,82696,CPT4/HCPCS,ASSAY OF ETIOCHOLANOLONE,,Per Unit,96.00
United HealthCare,HMO,82705,CPT4/HCPCS,FATS/LIPIDS FECES QUAL,,Per Unit,96.00
United HealthCare,HMO,82710,CPT4/HCPCS,FATS/LIPIDS FECES QUANT,,Per Unit,96.00
United HealthCare,HMO,82715,CPT4/HCPCS,ASSAY OF FECAL FAT,,Per Unit,96.00
United HealthCare,HMO,82725,CPT4/HCPCS,ASSAY OF BLOOD FATTY ACIDS,,Per Unit,96.00
United HealthCare,HMO,82726,CPT4/HCPCS,LONG CHAIN FATTY ACIDS,,Per Unit,96.00
United HealthCare,HMO,82728,CPT4/HCPCS,ASSAY OF FERRITIN,,Per Unit,96.00
United HealthCare,HMO,82731,CPT4/HCPCS,ASSAY OF FETAL FIBRONECTIN,,Per Unit,96.00
United HealthCare,HMO,82735,CPT4/HCPCS,ASSAY OF FLUORIDE,,Per Unit,96.00
United HealthCare,HMO,82746,CPT4/HCPCS,ASSAY OF FOLIC ACID SERUM,,Per Unit,96.00
United HealthCare,HMO,82747,CPT4/HCPCS,ASSAY OF FOLIC ACID RBC,,Per Unit,96.00
United HealthCare,HMO,82757,CPT4/HCPCS,ASSAY OF SEMEN FRUCTOSE,,Per Unit,96.00
United HealthCare,HMO,82759,CPT4/HCPCS,ASSAY OF RBC GALACTOKINASE,,Per Unit,96.00
United HealthCare,HMO,82760,CPT4/HCPCS,ASSAY OF GALACTOSE,,Per Unit,96.00
United HealthCare,HMO,82775,CPT4/HCPCS,ASSAY GALACTOSE TRANSFERASE,,Per Unit,96.00
United HealthCare,HMO,82776,CPT4/HCPCS,GALACTOSE TRANSFERASE TEST,,Per Unit,96.00
United HealthCare,HMO,82777,CPT4/HCPCS,GALECTIN-3,,Per Unit,96.00
United HealthCare,HMO,82784,CPT4/HCPCS,ASSAY IGA/IGD/IGG/IGM EACH,,Per Unit,96.00
United HealthCare,HMO,82785,CPT4/HCPCS,ASSAY OF IGE,,Per Unit,96.00
United HealthCare,HMO,82787,CPT4/HCPCS,IGG 1 2 3 OR 4 EACH,,Per Unit,96.00
United HealthCare,HMO,82800,CPT4/HCPCS,BLOOD PH,,Per Unit,96.00
United HealthCare,HMO,82803,CPT4/HCPCS,BLOOD GASES ANY COMBINATION,,Per Unit,96.00
United HealthCare,HMO,82805,CPT4/HCPCS,BLOOD GASES W/O2 SATURATION,,Per Unit,96.00
United HealthCare,HMO,82810,CPT4/HCPCS,BLOOD GASES O2 SAT ONLY,,Per Unit,96.00
United HealthCare,HMO,82820,CPT4/HCPCS,HEMOGLOBIN-OXYGEN AFFINITY,,Per Unit,96.00
United HealthCare,HMO,82930,CPT4/HCPCS,GASTRIC ANALY W/PH EA SPEC,,Per Unit,96.00
United HealthCare,HMO,82938,CPT4/HCPCS,GASTRIN TEST,,Per Unit,96.00
United HealthCare,HMO,82941,CPT4/HCPCS,ASSAY OF GASTRIN,,Per Unit,96.00
United HealthCare,HMO,82943,CPT4/HCPCS,ASSAY OF GLUCAGON,,Per Unit,96.00
United HealthCare,HMO,82945,CPT4/HCPCS,GLUCOSE OTHER FLUID,,Per Unit,96.00
United HealthCare,HMO,82946,CPT4/HCPCS,GLUCAGON TOLERANCE TEST,,Per Unit,96.00
United HealthCare,HMO,82947,CPT4/HCPCS,ASSAY GLUCOSE BLOOD QUANT,,Per Unit,96.00
United HealthCare,HMO,82948,CPT4/HCPCS,REAGENT STRIP/BLOOD GLUCOSE,,Per Unit,96.00
United HealthCare,HMO,82950,CPT4/HCPCS,GLUCOSE TEST,,Per Unit,96.00
United HealthCare,HMO,82951,CPT4/HCPCS,GLUCOSE TOLERANCE TEST (GTT),,Per Unit,96.00
United HealthCare,HMO,82952,CPT4/HCPCS,GTT-ADDED SAMPLES,,Per Unit,96.00
United HealthCare,HMO,82955,CPT4/HCPCS,ASSAY OF G6PD ENZYME,,Per Unit,96.00
United HealthCare,HMO,82960,CPT4/HCPCS,TEST FOR G6PD ENZYME,,Per Unit,96.00
United HealthCare,HMO,82962,CPT4/HCPCS,GLUCOSE BLOOD TEST,,Per Unit,96.00
United HealthCare,HMO,82963,CPT4/HCPCS,ASSAY OF GLUCOSIDASE,,Per Unit,96.00
United HealthCare,HMO,82965,CPT4/HCPCS,ASSAY OF GDH ENZYME,,Per Unit,96.00
United HealthCare,HMO,82977,CPT4/HCPCS,ASSAY OF GGT,,Per Unit,96.00
United HealthCare,HMO,82978,CPT4/HCPCS,ASSAY OF GLUTATHIONE,,Per Unit,96.00
United HealthCare,HMO,82979,CPT4/HCPCS,ASSAY RBC GLUTATHIONE,,Per Unit,96.00
United HealthCare,HMO,82985,CPT4/HCPCS,ASSAY OF GLYCATED PROTEIN,,Per Unit,96.00
United HealthCare,HMO,83001,CPT4/HCPCS,ASSAY OF GONADOTROPIN (FSH),,Per Unit,96.00
United HealthCare,HMO,83002,CPT4/HCPCS,ASSAY OF GONADOTROPIN (LH),,Per Unit,96.00
United HealthCare,HMO,83003,CPT4/HCPCS,ASSAY GROWTH HORMONE (HGH),,Per Unit,96.00
United HealthCare,HMO,83006,CPT4/HCPCS,GROWTH STIMULATION GENE 2,,Per Unit,96.00
United HealthCare,HMO,83009,CPT4/HCPCS,H PYLORI (C-13) BLOOD,,Per Unit,96.00
United HealthCare,HMO,83010,CPT4/HCPCS,ASSAY OF HAPTOGLOBIN QUANT,,Per Unit,96.00
United HealthCare,HMO,83012,CPT4/HCPCS,ASSAY OF HAPTOGLOBINS,,Per Unit,96.00
United HealthCare,HMO,83013,CPT4/HCPCS,H PYLORI (C-13) BREATH,,Per Unit,96.00
United HealthCare,HMO,83014,CPT4/HCPCS,H PYLORI DRUG ADMIN,,Per Unit,96.00
United HealthCare,HMO,83015,CPT4/HCPCS,HEAVY METAL QUAL ANY ANAL,,Per Unit,96.00
United HealthCare,HMO,83018,CPT4/HCPCS,HEAVY METAL QUANT EACH NES,,Per Unit,96.00
United HealthCare,HMO,83020,CPT4/HCPCS,HEMOGLOBIN ELECTROPHORESIS,,Per Unit,96.00
United HealthCare,HMO,83021,CPT4/HCPCS,HEMOGLOBIN CHROMOTOGRAPHY,,Per Unit,96.00
United HealthCare,HMO,83026,CPT4/HCPCS,HEMOGLOBIN COPPER SULFATE,,Per Unit,96.00
United HealthCare,HMO,83030,CPT4/HCPCS,FETAL HEMOGLOBIN CHEMICAL,,Per Unit,96.00
United HealthCare,HMO,83033,CPT4/HCPCS,FETAL HEMOGLOBIN ASSAY QUAL,,Per Unit,96.00
United HealthCare,HMO,83036,CPT4/HCPCS,GLYCOSYLATED HEMOGLOBIN TEST,,Per Unit,96.00
United HealthCare,HMO,83037,CPT4/HCPCS,GLYCOSYLATED HB HOME DEVICE,,Per Unit,96.00
United HealthCare,HMO,83045,CPT4/HCPCS,BLOOD METHEMOGLOBIN TEST,,Per Unit,96.00
United HealthCare,HMO,83050,CPT4/HCPCS,BLOOD METHEMOGLOBIN ASSAY,,Per Unit,96.00
United HealthCare,HMO,83051,CPT4/HCPCS,ASSAY OF PLASMA HEMOGLOBIN,,Per Unit,96.00
United HealthCare,HMO,83060,CPT4/HCPCS,BLOOD SULFHEMOGLOBIN ASSAY,,Per Unit,96.00
United HealthCare,HMO,83065,CPT4/HCPCS,ASSAY OF HEMOGLOBIN HEAT,,Per Unit,96.00
United HealthCare,HMO,83068,CPT4/HCPCS,HEMOGLOBIN STABILITY SCREEN,,Per Unit,96.00
United HealthCare,HMO,83069,CPT4/HCPCS,ASSAY OF URINE HEMOGLOBIN,,Per Unit,96.00
United HealthCare,HMO,83070,CPT4/HCPCS,ASSAY OF HEMOSIDERIN QUAL,,Per Unit,96.00
United HealthCare,HMO,83080,CPT4/HCPCS,ASSAY OF B HEXOSAMINIDASE,,Per Unit,96.00
United HealthCare,HMO,83088,CPT4/HCPCS,ASSAY OF HISTAMINE,,Per Unit,96.00
United HealthCare,HMO,83090,CPT4/HCPCS,ASSAY OF HOMOCYSTINE,,Per Unit,96.00
United HealthCare,HMO,83150,CPT4/HCPCS,ASSAY OF HOMOVANILLIC ACID,,Per Unit,96.00
United HealthCare,HMO,83491,CPT4/HCPCS,ASSAY OF CORTICOSTEROIDS 17,,Per Unit,96.00
United HealthCare,HMO,83497,CPT4/HCPCS,ASSAY OF 5-HIAA,,Per Unit,96.00
United HealthCare,HMO,83498,CPT4/HCPCS,ASSAY OF PROGESTERONE 17-D,,Per Unit,96.00
United HealthCare,HMO,83500,CPT4/HCPCS,ASSAY FREE HYDROXYPROLINE,,Per Unit,96.00
United HealthCare,HMO,83505,CPT4/HCPCS,ASSAY TOTAL HYDROXYPROLINE,,Per Unit,96.00
United HealthCare,HMO,83516,CPT4/HCPCS,IMMUNOASSAY NONANTIBODY,,Per Unit,96.00
United HealthCare,HMO,83518,CPT4/HCPCS,IMMUNOASSAY DIPSTICK,,Per Unit,96.00
United HealthCare,HMO,83519,CPT4/HCPCS,RIA NONANTIBODY,,Per Unit,96.00
United HealthCare,HMO,83520,CPT4/HCPCS,IMMUNOASSAY QUANT NOS NONAB,,Per Unit,96.00
United HealthCare,HMO,83525,CPT4/HCPCS,ASSAY OF INSULIN,,Per Unit,96.00
United HealthCare,HMO,83527,CPT4/HCPCS,ASSAY OF INSULIN,,Per Unit,96.00
United HealthCare,HMO,83528,CPT4/HCPCS,ASSAY OF INTRINSIC FACTOR,,Per Unit,96.00
United HealthCare,HMO,83540,CPT4/HCPCS,ASSAY OF IRON,,Per Unit,96.00
United HealthCare,HMO,83550,CPT4/HCPCS,IRON BINDING TEST,,Per Unit,96.00
United HealthCare,HMO,83570,CPT4/HCPCS,ASSAY OF IDH ENZYME,,Per Unit,96.00
United HealthCare,HMO,83582,CPT4/HCPCS,ASSAY OF KETOGENIC STEROIDS,,Per Unit,96.00
United HealthCare,HMO,83586,CPT4/HCPCS,ASSAY 17- KETOSTEROIDS,,Per Unit,96.00
United HealthCare,HMO,83593,CPT4/HCPCS,FRACTIONATION KETOSTEROIDS,,Per Unit,96.00
United HealthCare,HMO,83605,CPT4/HCPCS,ASSAY OF LACTIC ACID,,Per Unit,96.00
United HealthCare,HMO,83615,CPT4/HCPCS,LACTATE (LD) (LDH) ENZYME,,Per Unit,96.00
United HealthCare,HMO,83625,CPT4/HCPCS,ASSAY OF LDH ENZYMES,,Per Unit,96.00
United HealthCare,HMO,83630,CPT4/HCPCS,LACTOFERRIN FECAL (QUAL),,Per Unit,96.00
United HealthCare,HMO,83631,CPT4/HCPCS,LACTOFERRIN FECAL (QUANT),,Per Unit,96.00
United HealthCare,HMO,83632,CPT4/HCPCS,PLACENTAL LACTOGEN,,Per Unit,96.00
United HealthCare,HMO,83633,CPT4/HCPCS,TEST URINE FOR LACTOSE,,Per Unit,96.00
United HealthCare,HMO,83655,CPT4/HCPCS,ASSAY OF LEAD,,Per Unit,96.00
United HealthCare,HMO,83661,CPT4/HCPCS,L/S RATIO FETAL LUNG,,Per Unit,96.00
United HealthCare,HMO,83662,CPT4/HCPCS,FOAM STABILITY FETAL LUNG,,Per Unit,96.00
United HealthCare,HMO,83663,CPT4/HCPCS,FLUORO POLARIZE FETAL LUNG,,Per Unit,96.00
United HealthCare,HMO,83664,CPT4/HCPCS,LAMELLAR BDY FETAL LUNG,,Per Unit,96.00
United HealthCare,HMO,83670,CPT4/HCPCS,ASSAY OF LAP ENZYME,,Per Unit,96.00
United HealthCare,HMO,83690,CPT4/HCPCS,ASSAY OF LIPASE,,Per Unit,96.00
United HealthCare,HMO,83695,CPT4/HCPCS,ASSAY OF LIPOPROTEIN(A),,Per Unit,96.00
United HealthCare,HMO,83698,CPT4/HCPCS,ASSAY LIPOPROTEIN PLA2,,Per Unit,96.00
United HealthCare,HMO,83700,CPT4/HCPCS,LIPOPRO BLD ELECTROPHORETIC,,Per Unit,96.00
United HealthCare,HMO,83701,CPT4/HCPCS,LIPOPROTEIN BLD HR FRACTION,,Per Unit,96.00
United HealthCare,HMO,83704,CPT4/HCPCS,LIPOPROTEIN BLD QUAN PART,,Per Unit,96.00
United HealthCare,HMO,83718,CPT4/HCPCS,ASSAY OF LIPOPROTEIN,,Per Unit,96.00
United HealthCare,HMO,83719,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,Per Unit,96.00
United HealthCare,HMO,83721,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,Per Unit,96.00
United HealthCare,HMO,83722,CPT4/HCPCS,LIPOPRTN DIR MEAS SD LDL CHL,,Per Unit,96.00
United HealthCare,HMO,83727,CPT4/HCPCS,ASSAY OF LRH HORMONE,,Per Unit,96.00
United HealthCare,HMO,83735,CPT4/HCPCS,ASSAY OF MAGNESIUM,,Per Unit,96.00
United HealthCare,HMO,83775,CPT4/HCPCS,ASSAY MALATE DEHYDROGENASE,,Per Unit,96.00
United HealthCare,HMO,83785,CPT4/HCPCS,ASSAY OF MANGANESE,,Per Unit,96.00
United HealthCare,HMO,83789,CPT4/HCPCS,MASS SPECTROMETRY QUAL/QUAN,,Per Unit,96.00
United HealthCare,HMO,83825,CPT4/HCPCS,ASSAY OF MERCURY,,Per Unit,96.00
United HealthCare,HMO,83835,CPT4/HCPCS,ASSAY OF METANEPHRINES,,Per Unit,96.00
United HealthCare,HMO,83857,CPT4/HCPCS,ASSAY OF METHEMALBUMIN,,Per Unit,96.00
United HealthCare,HMO,83861,CPT4/HCPCS,MICROFLUID ANALY TEARS,,Per Unit,96.00
United HealthCare,HMO,83864,CPT4/HCPCS,MUCOPOLYSACCHARIDES,,Per Unit,96.00
United HealthCare,HMO,83872,CPT4/HCPCS,ASSAY SYNOVIAL FLUID MUCIN,,Per Unit,96.00
United HealthCare,HMO,83873,CPT4/HCPCS,ASSAY OF CSF PROTEIN,,Per Unit,96.00
United HealthCare,HMO,83874,CPT4/HCPCS,ASSAY OF MYOGLOBIN,,Per Unit,96.00
United HealthCare,HMO,83876,CPT4/HCPCS,ASSAY MYELOPEROXIDASE,,Per Unit,96.00
United HealthCare,HMO,83880,CPT4/HCPCS,ASSAY OF NATRIURETIC PEPTIDE,,Per Unit,96.00
United HealthCare,HMO,83883,CPT4/HCPCS,ASSAY NEPHELOMETRY NOT SPEC,,Per Unit,96.00
United HealthCare,HMO,83885,CPT4/HCPCS,ASSAY OF NICKEL,,Per Unit,96.00
United HealthCare,HMO,83915,CPT4/HCPCS,ASSAY OF NUCLEOTIDASE,,Per Unit,96.00
United HealthCare,HMO,83916,CPT4/HCPCS,OLIGOCLONAL BANDS,,Per Unit,96.00
United HealthCare,HMO,83918,CPT4/HCPCS,ORGANIC ACIDS TOTAL QUANT,,Per Unit,96.00
United HealthCare,HMO,83919,CPT4/HCPCS,ORGANIC ACIDS QUAL EACH,,Per Unit,96.00
United HealthCare,HMO,83921,CPT4/HCPCS,ORGANIC ACID SINGLE QUANT,,Per Unit,96.00
United HealthCare,HMO,83930,CPT4/HCPCS,ASSAY OF BLOOD OSMOLALITY,,Per Unit,96.00
United HealthCare,HMO,83935,CPT4/HCPCS,ASSAY OF URINE OSMOLALITY,,Per Unit,96.00
United HealthCare,HMO,83937,CPT4/HCPCS,ASSAY OF OSTEOCALCIN,,Per Unit,96.00
United HealthCare,HMO,83945,CPT4/HCPCS,ASSAY OF OXALATE,,Per Unit,96.00
United HealthCare,HMO,83950,CPT4/HCPCS,ONCOPROTEIN HER-2/NEU,,Per Unit,96.00
United HealthCare,HMO,83951,CPT4/HCPCS,ONCOPROTEIN DCP,,Per Unit,96.00
United HealthCare,HMO,83970,CPT4/HCPCS,ASSAY OF PARATHORMONE,,Per Unit,96.00
United HealthCare,HMO,83986,CPT4/HCPCS,ASSAY PH BODY FLUID NOS,,Per Unit,96.00
United HealthCare,HMO,83987,CPT4/HCPCS,EXHALED BREATH CONDENSATE,,Per Unit,96.00
United HealthCare,HMO,83992,CPT4/HCPCS,ASSAY FOR PHENCYCLIDINE,,Per Unit,96.00
United HealthCare,HMO,83993,CPT4/HCPCS,ASSAY FOR CALPROTECTIN FECAL,,Per Unit,96.00
United HealthCare,HMO,84030,CPT4/HCPCS,ASSAY OF BLOOD PKU,,Per Unit,96.00
United HealthCare,HMO,84035,CPT4/HCPCS,ASSAY OF PHENYLKETONES,,Per Unit,96.00
United HealthCare,HMO,84060,CPT4/HCPCS,ASSAY ACID PHOSPHATASE,,Per Unit,96.00
United HealthCare,HMO,84066,CPT4/HCPCS,ASSAY PROSTATE PHOSPHATASE,,Per Unit,96.00
United HealthCare,HMO,84075,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,Per Unit,96.00
United HealthCare,HMO,84078,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,Per Unit,96.00
United HealthCare,HMO,84080,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASES,,Per Unit,96.00
United HealthCare,HMO,84081,CPT4/HCPCS,ASSAY PHOSPHATIDYLGLYCEROL,,Per Unit,96.00
United HealthCare,HMO,84085,CPT4/HCPCS,ASSAY OF RBC PG6D ENZYME,,Per Unit,96.00
United HealthCare,HMO,84087,CPT4/HCPCS,ASSAY PHOSPHOHEXOSE ENZYMES,,Per Unit,96.00
United HealthCare,HMO,84100,CPT4/HCPCS,ASSAY OF PHOSPHORUS,,Per Unit,96.00
United HealthCare,HMO,84105,CPT4/HCPCS,ASSAY OF URINE PHOSPHORUS,,Per Unit,96.00
United HealthCare,HMO,84106,CPT4/HCPCS,TEST FOR PORPHOBILINOGEN,,Per Unit,96.00
United HealthCare,HMO,84110,CPT4/HCPCS,ASSAY OF PORPHOBILINOGEN,,Per Unit,96.00
United HealthCare,HMO,84112,CPT4/HCPCS,EVAL AMNIOTIC FLUID PROTEIN,,Per Unit,96.00
United HealthCare,HMO,84119,CPT4/HCPCS,TEST URINE FOR PORPHYRINS,,Per Unit,96.00
United HealthCare,HMO,84120,CPT4/HCPCS,ASSAY OF URINE PORPHYRINS,,Per Unit,96.00
United HealthCare,HMO,84126,CPT4/HCPCS,ASSAY OF FECES PORPHYRINS,,Per Unit,96.00
United HealthCare,HMO,84132,CPT4/HCPCS,ASSAY OF SERUM POTASSIUM,,Per Unit,96.00
United HealthCare,HMO,84133,CPT4/HCPCS,ASSAY OF URINE POTASSIUM,,Per Unit,96.00
United HealthCare,HMO,84134,CPT4/HCPCS,ASSAY OF PREALBUMIN,,Per Unit,96.00
United HealthCare,HMO,84135,CPT4/HCPCS,ASSAY OF PREGNANEDIOL,,Per Unit,96.00
United HealthCare,HMO,84138,CPT4/HCPCS,ASSAY OF PREGNANETRIOL,,Per Unit,96.00
United HealthCare,HMO,84140,CPT4/HCPCS,ASSAY OF PREGNENOLONE,,Per Unit,96.00
United HealthCare,HMO,84143,CPT4/HCPCS,ASSAY OF 17-HYDROXYPREGNENO,,Per Unit,96.00
United HealthCare,HMO,84144,CPT4/HCPCS,ASSAY OF PROGESTERONE,,Per Unit,96.00
United HealthCare,HMO,84145,CPT4/HCPCS,PROCALCITONIN (PCT),,Per Unit,96.00
United HealthCare,HMO,84146,CPT4/HCPCS,ASSAY OF PROLACTIN,,Per Unit,96.00
United HealthCare,HMO,84150,CPT4/HCPCS,ASSAY OF PROSTAGLANDIN,,Per Unit,96.00
United HealthCare,HMO,84152,CPT4/HCPCS,ASSAY OF PSA COMPLEXED,,Per Unit,96.00
United HealthCare,HMO,84153,CPT4/HCPCS,ASSAY OF PSA TOTAL,,Per Unit,96.00
United HealthCare,HMO,84154,CPT4/HCPCS,ASSAY OF PSA FREE,,Per Unit,96.00
United HealthCare,HMO,84155,CPT4/HCPCS,ASSAY OF PROTEIN SERUM,,Per Unit,96.00
United HealthCare,HMO,84156,CPT4/HCPCS,ASSAY OF PROTEIN URINE,,Per Unit,96.00
United HealthCare,HMO,84157,CPT4/HCPCS,ASSAY OF PROTEIN OTHER,,Per Unit,96.00
United HealthCare,HMO,84160,CPT4/HCPCS,ASSAY OF PROTEIN ANY SOURCE,,Per Unit,96.00
United HealthCare,HMO,84163,CPT4/HCPCS,PAPPA SERUM,,Per Unit,96.00
United HealthCare,HMO,84165,CPT4/HCPCS,PROTEIN E-PHORESIS SERUM,,Per Unit,96.00
United HealthCare,HMO,84166,CPT4/HCPCS,PROTEIN E-PHORESIS/URINE/CSF,,Per Unit,96.00
United HealthCare,HMO,84181,CPT4/HCPCS,WESTERN BLOT TEST,,Per Unit,96.00
United HealthCare,HMO,84182,CPT4/HCPCS,PROTEIN WESTERN BLOT TEST,,Per Unit,96.00
United HealthCare,HMO,84202,CPT4/HCPCS,ASSAY RBC PROTOPORPHYRIN,,Per Unit,96.00
United HealthCare,HMO,84203,CPT4/HCPCS,TEST RBC PROTOPORPHYRIN,,Per Unit,96.00
United HealthCare,HMO,84206,CPT4/HCPCS,ASSAY OF PROINSULIN,,Per Unit,96.00
United HealthCare,HMO,84207,CPT4/HCPCS,ASSAY OF VITAMIN B-6,,Per Unit,96.00
United HealthCare,HMO,84210,CPT4/HCPCS,ASSAY OF PYRUVATE,,Per Unit,96.00
United HealthCare,HMO,84220,CPT4/HCPCS,ASSAY OF PYRUVATE KINASE,,Per Unit,96.00
United HealthCare,HMO,84228,CPT4/HCPCS,ASSAY OF QUININE,,Per Unit,96.00
United HealthCare,HMO,84233,CPT4/HCPCS,ASSAY OF ESTROGEN,,Per Unit,96.00
United HealthCare,HMO,84234,CPT4/HCPCS,ASSAY OF PROGESTERONE,,Per Unit,96.00
United HealthCare,HMO,84235,CPT4/HCPCS,ASSAY OF ENDOCRINE HORMONE,,Per Unit,96.00
United HealthCare,HMO,84238,CPT4/HCPCS,ASSAY NONENDOCRINE RECEPTOR,,Per Unit,96.00
United HealthCare,HMO,84244,CPT4/HCPCS,ASSAY OF RENIN,,Per Unit,96.00
United HealthCare,HMO,84252,CPT4/HCPCS,ASSAY OF VITAMIN B-2,,Per Unit,96.00
United HealthCare,HMO,84255,CPT4/HCPCS,ASSAY OF SELENIUM,,Per Unit,96.00
United HealthCare,HMO,84260,CPT4/HCPCS,ASSAY OF SEROTONIN,,Per Unit,96.00
United HealthCare,HMO,84270,CPT4/HCPCS,ASSAY OF SEX HORMONE GLOBUL,,Per Unit,96.00
United HealthCare,HMO,84275,CPT4/HCPCS,ASSAY OF SIALIC ACID,,Per Unit,96.00
United HealthCare,HMO,84285,CPT4/HCPCS,ASSAY OF SILICA,,Per Unit,96.00
United HealthCare,HMO,84295,CPT4/HCPCS,ASSAY OF SERUM SODIUM,,Per Unit,96.00
United HealthCare,HMO,84300,CPT4/HCPCS,ASSAY OF URINE SODIUM,,Per Unit,96.00
United HealthCare,HMO,84302,CPT4/HCPCS,ASSAY OF SWEAT SODIUM,,Per Unit,96.00
United HealthCare,HMO,84305,CPT4/HCPCS,ASSAY OF SOMATOMEDIN,,Per Unit,96.00
United HealthCare,HMO,84307,CPT4/HCPCS,ASSAY OF SOMATOSTATIN,,Per Unit,96.00
United HealthCare,HMO,84311,CPT4/HCPCS,SPECTROPHOTOMETRY,,Per Unit,96.00
United HealthCare,HMO,84315,CPT4/HCPCS,BODY FLUID SPECIFIC GRAVITY,,Per Unit,96.00
United HealthCare,HMO,84375,CPT4/HCPCS,CHROMATOGRAM ASSAY SUGARS,,Per Unit,96.00
United HealthCare,HMO,84376,CPT4/HCPCS,SUGARS SINGLE QUAL,,Per Unit,96.00
United HealthCare,HMO,84377,CPT4/HCPCS,SUGARS MULTIPLE QUAL,,Per Unit,96.00
United HealthCare,HMO,84378,CPT4/HCPCS,SUGARS SINGLE QUANT,,Per Unit,96.00
United HealthCare,HMO,84379,CPT4/HCPCS,SUGARS MULTIPLE QUANT,,Per Unit,96.00
United HealthCare,HMO,84392,CPT4/HCPCS,ASSAY OF URINE SULFATE,,Per Unit,96.00
United HealthCare,HMO,84402,CPT4/HCPCS,ASSAY OF FREE TESTOSTERONE,,Per Unit,96.00
United HealthCare,HMO,84403,CPT4/HCPCS,ASSAY OF TOTAL TESTOSTERONE,,Per Unit,96.00
United HealthCare,HMO,84410,CPT4/HCPCS,TESTOSTERONE BIOAVAILABLE,,Per Unit,96.00
United HealthCare,HMO,84425,CPT4/HCPCS,ASSAY OF VITAMIN B-1,,Per Unit,96.00
United HealthCare,HMO,84430,CPT4/HCPCS,ASSAY OF THIOCYANATE,,Per Unit,96.00
United HealthCare,HMO,84431,CPT4/HCPCS,THROMBOXANE URINE,,Per Unit,96.00
United HealthCare,HMO,84432,CPT4/HCPCS,ASSAY OF THYROGLOBULIN,,Per Unit,96.00
United HealthCare,HMO,84436,CPT4/HCPCS,ASSAY OF TOTAL THYROXINE,,Per Unit,96.00
United HealthCare,HMO,84437,CPT4/HCPCS,ASSAY OF NEONATAL THYROXINE,,Per Unit,96.00
United HealthCare,HMO,84439,CPT4/HCPCS,ASSAY OF FREE THYROXINE,,Per Unit,96.00
United HealthCare,HMO,84442,CPT4/HCPCS,ASSAY OF THYROID ACTIVITY,,Per Unit,96.00
United HealthCare,HMO,84443,CPT4/HCPCS,ASSAY THYROID STIM HORMONE,,Per Unit,96.00
United HealthCare,HMO,84445,CPT4/HCPCS,ASSAY OF TSI GLOBULIN,,Per Unit,96.00
United HealthCare,HMO,84446,CPT4/HCPCS,ASSAY OF VITAMIN E,,Per Unit,96.00
United HealthCare,HMO,84449,CPT4/HCPCS,ASSAY OF TRANSCORTIN,,Per Unit,96.00
United HealthCare,HMO,84450,CPT4/HCPCS,TRANSFERASE (AST) (SGOT),,Per Unit,96.00
United HealthCare,HMO,84460,CPT4/HCPCS,ALANINE AMINO (ALT) (SGPT),,Per Unit,96.00
United HealthCare,HMO,84466,CPT4/HCPCS,ASSAY OF TRANSFERRIN,,Per Unit,96.00
United HealthCare,HMO,84478,CPT4/HCPCS,ASSAY OF TRIGLYCERIDES,,Per Unit,96.00
United HealthCare,HMO,84479,CPT4/HCPCS,ASSAY OF THYROID (T3 OR T4),,Per Unit,96.00
United HealthCare,HMO,84480,CPT4/HCPCS,ASSAY TRIIODOTHYRONINE (T3),,Per Unit,96.00
United HealthCare,HMO,84481,CPT4/HCPCS,FREE ASSAY (FT-3),,Per Unit,96.00
United HealthCare,HMO,84482,CPT4/HCPCS,T3 REVERSE,,Per Unit,96.00
United HealthCare,HMO,84484,CPT4/HCPCS,ASSAY OF TROPONIN QUANT,,Per Unit,96.00
United HealthCare,HMO,84485,CPT4/HCPCS,ASSAY DUODENAL FLUID TRYPSIN,,Per Unit,96.00
United HealthCare,HMO,84488,CPT4/HCPCS,TEST FECES FOR TRYPSIN,,Per Unit,96.00
United HealthCare,HMO,84490,CPT4/HCPCS,ASSAY OF FECES FOR TRYPSIN,,Per Unit,96.00
United HealthCare,HMO,84510,CPT4/HCPCS,ASSAY OF TYROSINE,,Per Unit,96.00
United HealthCare,HMO,84512,CPT4/HCPCS,ASSAY OF TROPONIN QUAL,,Per Unit,96.00
United HealthCare,HMO,84520,CPT4/HCPCS,ASSAY OF UREA NITROGEN,,Per Unit,96.00
United HealthCare,HMO,84525,CPT4/HCPCS,UREA NITROGEN SEMI-QUANT,,Per Unit,96.00
United HealthCare,HMO,84540,CPT4/HCPCS,ASSAY OF URINE/UREA-N,,Per Unit,96.00
United HealthCare,HMO,84545,CPT4/HCPCS,UREA-N CLEARANCE TEST,,Per Unit,96.00
United HealthCare,HMO,84550,CPT4/HCPCS,ASSAY OF BLOOD/URIC ACID,,Per Unit,96.00
United HealthCare,HMO,84560,CPT4/HCPCS,ASSAY OF URINE/URIC ACID,,Per Unit,96.00
United HealthCare,HMO,84577,CPT4/HCPCS,ASSAY OF FECES/UROBILINOGEN,,Per Unit,96.00
United HealthCare,HMO,84578,CPT4/HCPCS,TEST URINE UROBILINOGEN,,Per Unit,96.00
United HealthCare,HMO,84580,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,Per Unit,96.00
United HealthCare,HMO,84583,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,Per Unit,96.00
United HealthCare,HMO,84585,CPT4/HCPCS,ASSAY OF URINE VMA,,Per Unit,96.00
United HealthCare,HMO,84586,CPT4/HCPCS,ASSAY OF VIP,,Per Unit,96.00
United HealthCare,HMO,84588,CPT4/HCPCS,ASSAY OF VASOPRESSIN,,Per Unit,96.00
United HealthCare,HMO,84590,CPT4/HCPCS,ASSAY OF VITAMIN A,,Per Unit,96.00
United HealthCare,HMO,84591,CPT4/HCPCS,ASSAY OF NOS VITAMIN,,Per Unit,96.00
United HealthCare,HMO,84597,CPT4/HCPCS,ASSAY OF VITAMIN K,,Per Unit,96.00
United HealthCare,HMO,84600,CPT4/HCPCS,ASSAY OF VOLATILES,,Per Unit,96.00
United HealthCare,HMO,84620,CPT4/HCPCS,XYLOSE TOLERANCE TEST,,Per Unit,96.00
United HealthCare,HMO,84630,CPT4/HCPCS,ASSAY OF ZINC,,Per Unit,96.00
United HealthCare,HMO,84681,CPT4/HCPCS,ASSAY OF C-PEPTIDE,,Per Unit,96.00
United HealthCare,HMO,84702,CPT4/HCPCS,CHORIONIC GONADOTROPIN TEST,,Per Unit,96.00
United HealthCare,HMO,84703,CPT4/HCPCS,CHORIONIC GONADOTROPIN ASSAY,,Per Unit,96.00
United HealthCare,HMO,84704,CPT4/HCPCS,HCG FREE BETACHAIN TEST,,Per Unit,96.00
United HealthCare,HMO,84830,CPT4/HCPCS,OVULATION TESTS,,Per Unit,96.00
United HealthCare,HMO,85002,CPT4/HCPCS,BLEEDING TIME TEST,,Per Unit,96.00
United HealthCare,HMO,85004,CPT4/HCPCS,AUTOMATED DIFF WBC COUNT,,Per Unit,96.00
United HealthCare,HMO,85007,CPT4/HCPCS,BL SMEAR W/DIFF WBC COUNT,,Per Unit,96.00
United HealthCare,HMO,85008,CPT4/HCPCS,BL SMEAR W/O DIFF WBC COUNT,,Per Unit,96.00
United HealthCare,HMO,85009,CPT4/HCPCS,MANUAL DIFF WBC COUNT B-COAT,,Per Unit,96.00
United HealthCare,HMO,85013,CPT4/HCPCS,SPUN MICROHEMATOCRIT,,Per Unit,96.00
United HealthCare,HMO,85014,CPT4/HCPCS,HEMATOCRIT,,Per Unit,96.00
United HealthCare,HMO,85018,CPT4/HCPCS,HEMOGLOBIN,,Per Unit,96.00
United HealthCare,HMO,85025,CPT4/HCPCS,COMPLETE CBC W/AUTO DIFF WBC,,Per Unit,96.00
United HealthCare,HMO,85027,CPT4/HCPCS,COMPLETE CBC AUTOMATED,,Per Unit,96.00
United HealthCare,HMO,85032,CPT4/HCPCS,MANUAL CELL COUNT EACH,,Per Unit,96.00
United HealthCare,HMO,85041,CPT4/HCPCS,AUTOMATED RBC COUNT,,Per Unit,96.00
United HealthCare,HMO,85044,CPT4/HCPCS,MANUAL RETICULOCYTE COUNT,,Per Unit,96.00
United HealthCare,HMO,85045,CPT4/HCPCS,AUTOMATED RETICULOCYTE COUNT,,Per Unit,96.00
United HealthCare,HMO,85046,CPT4/HCPCS,RETICYTE/HGB CONCENTRATE,,Per Unit,96.00
United HealthCare,HMO,85048,CPT4/HCPCS,AUTOMATED LEUKOCYTE COUNT,,Per Unit,96.00
United HealthCare,HMO,85049,CPT4/HCPCS,AUTOMATED PLATELET COUNT,,Per Unit,96.00
United HealthCare,HMO,85055,CPT4/HCPCS,RETICULATED PLATELET ASSAY,,Per Unit,96.00
United HealthCare,HMO,85060,CPT4/HCPCS,BLOOD SMEAR INTERPRETATION,,Per Unit,96.00
United HealthCare,HMO,85097,CPT4/HCPCS,BONE MARROW INTERPRETATION,,Per Unit,96.00
United HealthCare,HMO,85130,CPT4/HCPCS,CHROMOGENIC SUBSTRATE ASSAY,,Per Unit,96.00
United HealthCare,HMO,85170,CPT4/HCPCS,BLOOD CLOT RETRACTION,,Per Unit,96.00
United HealthCare,HMO,85175,CPT4/HCPCS,BLOOD CLOT LYSIS TIME,,Per Unit,96.00
United HealthCare,HMO,85210,CPT4/HCPCS,CLOT FACTOR II PROTHROM SPEC,,Per Unit,96.00
United HealthCare,HMO,85220,CPT4/HCPCS,BLOOC CLOT FACTOR V TEST,,Per Unit,96.00
United HealthCare,HMO,85230,CPT4/HCPCS,CLOT FACTOR VII PROCONVERTIN,,Per Unit,96.00
United HealthCare,HMO,85240,CPT4/HCPCS,CLOT FACTOR VIII AHG 1 STAGE,,Per Unit,96.00
United HealthCare,HMO,85244,CPT4/HCPCS,CLOT FACTOR VIII RELTD ANTGN,,Per Unit,96.00
United HealthCare,HMO,85245,CPT4/HCPCS,CLOT FACTOR VIII VW RISTOCTN,,Per Unit,96.00
United HealthCare,HMO,85246,CPT4/HCPCS,CLOT FACTOR VIII VW ANTIGEN,,Per Unit,96.00
United HealthCare,HMO,85247,CPT4/HCPCS,CLOT FACTOR VIII MULTIMETRIC,,Per Unit,96.00
United HealthCare,HMO,85250,CPT4/HCPCS,CLOT FACTOR IX PTC/CHRSTMAS,,Per Unit,96.00
United HealthCare,HMO,85260,CPT4/HCPCS,CLOT FACTOR X STUART-POWER,,Per Unit,96.00
United HealthCare,HMO,85270,CPT4/HCPCS,CLOT FACTOR XI PTA,,Per Unit,96.00
United HealthCare,HMO,85280,CPT4/HCPCS,CLOT FACTOR XII HAGEMAN,,Per Unit,96.00
United HealthCare,HMO,85290,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN STAB,,Per Unit,96.00
United HealthCare,HMO,85291,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN SCRN,,Per Unit,96.00
United HealthCare,HMO,85292,CPT4/HCPCS,CLOT FACTOR FLETCHER FACT,,Per Unit,96.00
United HealthCare,HMO,85293,CPT4/HCPCS,CLOT FACTOR WGHT KININOGEN,,Per Unit,96.00
United HealthCare,HMO,85300,CPT4/HCPCS,ANTITHROMBIN III ACTIVITY,,Per Unit,96.00
United HealthCare,HMO,85301,CPT4/HCPCS,ANTITHROMBIN III ANTIGEN,,Per Unit,96.00
United HealthCare,HMO,85302,CPT4/HCPCS,CLOT INHIBIT PROT C ANTIGEN,,Per Unit,96.00
United HealthCare,HMO,85303,CPT4/HCPCS,CLOT INHIBIT PROT C ACTIVITY,,Per Unit,96.00
United HealthCare,HMO,85305,CPT4/HCPCS,CLOT INHIBIT PROT S TOTAL,,Per Unit,96.00
United HealthCare,HMO,85306,CPT4/HCPCS,CLOT INHIBIT PROT S FREE,,Per Unit,96.00
United HealthCare,HMO,85307,CPT4/HCPCS,ASSAY ACTIVATED PROTEIN C,,Per Unit,96.00
United HealthCare,HMO,85335,CPT4/HCPCS,FACTOR INHIBITOR TEST,,Per Unit,96.00
United HealthCare,HMO,85337,CPT4/HCPCS,THROMBOMODULIN,,Per Unit,96.00
United HealthCare,HMO,85345,CPT4/HCPCS,COAGULATION TIME LEE & WHITE,,Per Unit,96.00
United HealthCare,HMO,85347,CPT4/HCPCS,COAGULATION TIME ACTIVATED,,Per Unit,96.00
United HealthCare,HMO,85348,CPT4/HCPCS,COAGULATION TIME OTR METHOD,,Per Unit,96.00
United HealthCare,HMO,85360,CPT4/HCPCS,EUGLOBULIN LYSIS,,Per Unit,96.00
United HealthCare,HMO,85362,CPT4/HCPCS,FIBRIN DEGRADATION PRODUCTS,,Per Unit,96.00
United HealthCare,HMO,85366,CPT4/HCPCS,FIBRINOGEN TEST,,Per Unit,96.00
United HealthCare,HMO,85370,CPT4/HCPCS,FIBRINOGEN TEST,,Per Unit,96.00
United HealthCare,HMO,85378,CPT4/HCPCS,FIBRIN DEGRADE SEMIQUANT,,Per Unit,96.00
United HealthCare,HMO,85379,CPT4/HCPCS,FIBRIN DEGRADATION QUANT,,Per Unit,96.00
United HealthCare,HMO,85380,CPT4/HCPCS,FIBRIN DEGRADJ D-DIMER,,Per Unit,96.00
United HealthCare,HMO,85384,CPT4/HCPCS,FIBRINOGEN ACTIVITY,,Per Unit,96.00
United HealthCare,HMO,85385,CPT4/HCPCS,FIBRINOGEN ANTIGEN,,Per Unit,96.00
United HealthCare,HMO,85390,CPT4/HCPCS,FIBRINOLYSINS SCREEN I&R,,Per Unit,96.00
United HealthCare,HMO,85396,CPT4/HCPCS,CLOTTING ASSAY WHOLE BLOOD,,Per Unit,96.00
United HealthCare,HMO,85397,CPT4/HCPCS,CLOTTING FUNCT ACTIVITY,,Per Unit,96.00
United HealthCare,HMO,85400,CPT4/HCPCS,FIBRINOLYTIC PLASMIN,,Per Unit,96.00
United HealthCare,HMO,85410,CPT4/HCPCS,FIBRINOLYTIC ANTIPLASMIN,,Per Unit,96.00
United HealthCare,HMO,85415,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Per Unit,96.00
United HealthCare,HMO,85420,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Per Unit,96.00
United HealthCare,HMO,85421,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Per Unit,96.00
United HealthCare,HMO,85441,CPT4/HCPCS,HEINZ BODIES DIRECT,,Per Unit,96.00
United HealthCare,HMO,85445,CPT4/HCPCS,HEINZ BODIES INDUCED,,Per Unit,96.00
United HealthCare,HMO,85460,CPT4/HCPCS,HEMOGLOBIN FETAL,,Per Unit,96.00
United HealthCare,HMO,85461,CPT4/HCPCS,HEMOGLOBIN FETAL,,Per Unit,96.00
United HealthCare,HMO,85475,CPT4/HCPCS,HEMOLYSIN ACID,,Per Unit,96.00
United HealthCare,HMO,85520,CPT4/HCPCS,HEPARIN ASSAY,,Per Unit,96.00
United HealthCare,HMO,85525,CPT4/HCPCS,HEPARIN NEUTRALIZATION,,Per Unit,96.00
United HealthCare,HMO,85530,CPT4/HCPCS,HEPARIN-PROTAMINE TOLERANCE,,Per Unit,96.00
United HealthCare,HMO,85536,CPT4/HCPCS,IRON STAIN PERIPHERAL BLOOD,,Per Unit,96.00
United HealthCare,HMO,85540,CPT4/HCPCS,WBC ALKALINE PHOSPHATASE,,Per Unit,96.00
United HealthCare,HMO,85547,CPT4/HCPCS,RBC MECHANICAL FRAGILITY,,Per Unit,96.00
United HealthCare,HMO,85549,CPT4/HCPCS,MURAMIDASE,,Per Unit,96.00
United HealthCare,HMO,85555,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,Per Unit,96.00
United HealthCare,HMO,85557,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,Per Unit,96.00
United HealthCare,HMO,85576,CPT4/HCPCS,BLOOD PLATELET AGGREGATION,,Per Unit,96.00
United HealthCare,HMO,85597,CPT4/HCPCS,PHOSPHOLIPID PLTLT NEUTRALIZ,,Per Unit,96.00
United HealthCare,HMO,85598,CPT4/HCPCS,HEXAGNAL PHOSPH PLTLT NEUTRL,,Per Unit,96.00
United HealthCare,HMO,85610,CPT4/HCPCS,PROTHROMBIN TIME,,Per Unit,96.00
United HealthCare,HMO,85611,CPT4/HCPCS,PROTHROMBIN TEST,,Per Unit,96.00
United HealthCare,HMO,85612,CPT4/HCPCS,VIPER VENOM PROTHROMBIN TIME,,Per Unit,96.00
United HealthCare,HMO,85613,CPT4/HCPCS,RUSSELL VIPER VENOM DILUTED,,Per Unit,96.00
United HealthCare,HMO,85635,CPT4/HCPCS,REPTILASE TEST,,Per Unit,96.00
United HealthCare,HMO,85651,CPT4/HCPCS,RBC SED RATE NONAUTOMATED,,Per Unit,96.00
United HealthCare,HMO,85652,CPT4/HCPCS,RBC SED RATE AUTOMATED,,Per Unit,96.00
United HealthCare,HMO,85660,CPT4/HCPCS,RBC SICKLE CELL TEST,,Per Unit,96.00
United HealthCare,HMO,85670,CPT4/HCPCS,THROMBIN TIME PLASMA,,Per Unit,96.00
United HealthCare,HMO,85675,CPT4/HCPCS,THROMBIN TIME TITER,,Per Unit,96.00
United HealthCare,HMO,85705,CPT4/HCPCS,THROMBOPLASTIN INHIBITION,,Per Unit,96.00
United HealthCare,HMO,85730,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,Per Unit,96.00
United HealthCare,HMO,85732,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,Per Unit,96.00
United HealthCare,HMO,85810,CPT4/HCPCS,BLOOD VISCOSITY EXAMINATION,,Per Unit,96.00
United HealthCare,HMO,86000,CPT4/HCPCS,AGGLUTININS FEBRILE ANTIGEN,,Per Unit,96.00
United HealthCare,HMO,86001,CPT4/HCPCS,ALLERGEN SPECIFIC IGG,,Per Unit,96.00
United HealthCare,HMO,86003,CPT4/HCPCS,ALLG SPEC IGE CRUDE XTRC EA,,Per Unit,96.00
United HealthCare,HMO,86005,CPT4/HCPCS,ALLG SPEC IGE MULTIALLG SCR,,Per Unit,96.00
United HealthCare,HMO,86008,CPT4/HCPCS,ALLG SPEC IGE RECOMB EA,,Per Unit,96.00
United HealthCare,HMO,86021,CPT4/HCPCS,WBC ANTIBODY IDENTIFICATION,,Per Unit,96.00
United HealthCare,HMO,86022,CPT4/HCPCS,PLATELET ANTIBODIES,,Per Unit,96.00
United HealthCare,HMO,86023,CPT4/HCPCS,IMMUNOGLOBULIN ASSAY,,Per Unit,96.00
United HealthCare,HMO,86038,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES,,Per Unit,96.00
United HealthCare,HMO,86039,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES (ANA),,Per Unit,96.00
United HealthCare,HMO,86060,CPT4/HCPCS,ANTISTREPTOLYSIN O TITER,,Per Unit,96.00
United HealthCare,HMO,86063,CPT4/HCPCS,ANTISTREPTOLYSIN O SCREEN,,Per Unit,96.00
United HealthCare,HMO,86077,CPT4/HCPCS,PHYS BLOOD BANK SERV XMATCH,,Per Unit,96.00
United HealthCare,HMO,86078,CPT4/HCPCS,PHYS BLOOD BANK SERV REACTJ,,Per Unit,96.00
United HealthCare,HMO,86079,CPT4/HCPCS,PHYS BLOOD BANK SERV AUTHRJ,,Per Unit,96.00
United HealthCare,HMO,86140,CPT4/HCPCS,C-REACTIVE PROTEIN,,Per Unit,96.00
United HealthCare,HMO,86141,CPT4/HCPCS,C-REACTIVE PROTEIN HS,,Per Unit,96.00
United HealthCare,HMO,86146,CPT4/HCPCS,BETA-2 GLYCOPROTEIN ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86147,CPT4/HCPCS,CARDIOLIPIN ANTIBODY EA IG,,Per Unit,96.00
United HealthCare,HMO,86148,CPT4/HCPCS,ANTI-PHOSPHOLIPID ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86152,CPT4/HCPCS,CELL ENUMERATION & ID,,Per Unit,96.00
United HealthCare,HMO,86153,CPT4/HCPCS,CELL ENUMERATION PHYS INTERP,,Per Unit,96.00
United HealthCare,HMO,86155,CPT4/HCPCS,CHEMOTAXIS ASSAY,,Per Unit,96.00
United HealthCare,HMO,86156,CPT4/HCPCS,COLD AGGLUTININ SCREEN,,Per Unit,96.00
United HealthCare,HMO,86157,CPT4/HCPCS,COLD AGGLUTININ TITER,,Per Unit,96.00
United HealthCare,HMO,86160,CPT4/HCPCS,COMPLEMENT ANTIGEN,,Per Unit,96.00
United HealthCare,HMO,86161,CPT4/HCPCS,COMPLEMENT/FUNCTION ACTIVITY,,Per Unit,96.00
United HealthCare,HMO,86162,CPT4/HCPCS,COMPLEMENT TOTAL (CH50),,Per Unit,96.00
United HealthCare,HMO,86171,CPT4/HCPCS,COMPLEMENT FIXATION EACH,,Per Unit,96.00
United HealthCare,HMO,86200,CPT4/HCPCS,CCP ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86215,CPT4/HCPCS,DEOXYRIBONUCLEASE ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86225,CPT4/HCPCS,DNA ANTIBODY NATIVE,,Per Unit,96.00
United HealthCare,HMO,86226,CPT4/HCPCS,DNA ANTIBODY SINGLE STRAND,,Per Unit,96.00
United HealthCare,HMO,86235,CPT4/HCPCS,NUCLEAR ANTIGEN ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86255,CPT4/HCPCS,FLUORESCENT ANTIBODY SCREEN,,Per Unit,96.00
United HealthCare,HMO,86256,CPT4/HCPCS,FLUORESCENT ANTIBODY TITER,,Per Unit,96.00
United HealthCare,HMO,86277,CPT4/HCPCS,GROWTH HORMONE ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86280,CPT4/HCPCS,HEMAGGLUTINATION INHIBITION,,Per Unit,96.00
United HealthCare,HMO,86294,CPT4/HCPCS,IMMUNOASSAY TUMOR QUAL,,Per Unit,96.00
United HealthCare,HMO,86300,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 15-3,,Per Unit,96.00
United HealthCare,HMO,86301,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 19-9,,Per Unit,96.00
United HealthCare,HMO,86304,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 125,,Per Unit,96.00
United HealthCare,HMO,86305,CPT4/HCPCS,HUMAN EPIDIDYMIS PROTEIN 4,,Per Unit,96.00
United HealthCare,HMO,86308,CPT4/HCPCS,HETEROPHILE ANTIBODY SCREEN,,Per Unit,96.00
United HealthCare,HMO,86309,CPT4/HCPCS,HETEROPHILE ANTIBODY TITER,,Per Unit,96.00
United HealthCare,HMO,86310,CPT4/HCPCS,HETEROPHILE ANTIBODY ABSRBJ,,Per Unit,96.00
United HealthCare,HMO,86316,CPT4/HCPCS,IMMUNOASSAY TUMOR OTHER,,Per Unit,96.00
United HealthCare,HMO,86317,CPT4/HCPCS,IMMUNOASSAY INFECTIOUS AGENT,,Per Unit,96.00
United HealthCare,HMO,86318,CPT4/HCPCS,IA INFECTIOUS AGENT ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86320,CPT4/HCPCS,SERUM IMMUNOELECTROPHORESIS,,Per Unit,96.00
United HealthCare,HMO,86325,CPT4/HCPCS,OTHER IMMUNOELECTROPHORESIS,,Per Unit,96.00
United HealthCare,HMO,86327,CPT4/HCPCS,IMMUNOELECTROPHORESIS ASSAY,,Per Unit,96.00
United HealthCare,HMO,86329,CPT4/HCPCS,IMMUNODIFFUSION NES,,Per Unit,96.00
United HealthCare,HMO,86331,CPT4/HCPCS,IMMUNODIFFUSION OUCHTERLONY,,Per Unit,96.00
United HealthCare,HMO,86332,CPT4/HCPCS,IMMUNE COMPLEX ASSAY,,Per Unit,96.00
United HealthCare,HMO,86334,CPT4/HCPCS,IMMUNOFIX E-PHORESIS SERUM,,Per Unit,96.00
United HealthCare,HMO,86335,CPT4/HCPCS,IMMUNFIX E-PHORSIS/URINE/CSF,,Per Unit,96.00
United HealthCare,HMO,86336,CPT4/HCPCS,INHIBIN A,,Per Unit,96.00
United HealthCare,HMO,86337,CPT4/HCPCS,INSULIN ANTIBODIES,,Per Unit,96.00
United HealthCare,HMO,86340,CPT4/HCPCS,INTRINSIC FACTOR ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86341,CPT4/HCPCS,ISLET CELL ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86343,CPT4/HCPCS,LEUKOCYTE HISTAMINE RELEASE,,Per Unit,96.00
United HealthCare,HMO,86344,CPT4/HCPCS,LEUKOCYTE PHAGOCYTOSIS,,Per Unit,96.00
United HealthCare,HMO,86352,CPT4/HCPCS,CELL FUNCTION ASSAY W/STIM,,Per Unit,96.00
United HealthCare,HMO,86353,CPT4/HCPCS,LYMPHOCYTE TRANSFORMATION,,Per Unit,96.00
United HealthCare,HMO,86355,CPT4/HCPCS,B CELLS TOTAL COUNT,,Per Unit,96.00
United HealthCare,HMO,86356,CPT4/HCPCS,MONONUCLEAR CELL ANTIGEN,,Per Unit,96.00
United HealthCare,HMO,86357,CPT4/HCPCS,NK CELLS TOTAL COUNT,,Per Unit,96.00
United HealthCare,HMO,86359,CPT4/HCPCS,T CELLS TOTAL COUNT,,Per Unit,96.00
United HealthCare,HMO,86360,CPT4/HCPCS,T CELL ABSOLUTE COUNT/RATIO,,Per Unit,96.00
United HealthCare,HMO,86361,CPT4/HCPCS,T CELL ABSOLUTE COUNT,,Per Unit,96.00
United HealthCare,HMO,86367,CPT4/HCPCS,STEM CELLS TOTAL COUNT,,Per Unit,96.00
United HealthCare,HMO,86376,CPT4/HCPCS,MICROSOMAL ANTIBODY EACH,,Per Unit,96.00
United HealthCare,HMO,86382,CPT4/HCPCS,NEUTRALIZATION TEST VIRAL,,Per Unit,96.00
United HealthCare,HMO,86384,CPT4/HCPCS,NITROBLUE TETRAZOLIUM DYE,,Per Unit,96.00
United HealthCare,HMO,86386,CPT4/HCPCS,NUCLEAR MATRIX PROTEIN 22,,Per Unit,96.00
United HealthCare,HMO,86403,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY SCRN,,Per Unit,96.00
United HealthCare,HMO,86406,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY TITR,,Per Unit,96.00
United HealthCare,HMO,86430,CPT4/HCPCS,RHEUMATOID FACTOR TEST QUAL,,Per Unit,96.00
United HealthCare,HMO,86431,CPT4/HCPCS,RHEUMATOID FACTOR QUANT,,Per Unit,96.00
United HealthCare,HMO,86480,CPT4/HCPCS,TB TEST CELL IMMUN MEASURE,,Per Unit,96.00
United HealthCare,HMO,86481,CPT4/HCPCS,TB AG RESPONSE T-CELL SUSP,,Per Unit,96.00
United HealthCare,HMO,86485,CPT4/HCPCS,SKIN TEST CANDIDA,,Per Unit,96.00
United HealthCare,HMO,86486,CPT4/HCPCS,SKIN TEST NOS ANTIGEN,,Per Unit,96.00
United HealthCare,HMO,86490,CPT4/HCPCS,COCCIDIOIDOMYCOSIS SKIN TEST,,Per Unit,96.00
United HealthCare,HMO,86510,CPT4/HCPCS,HISTOPLASMOSIS SKIN TEST,,Per Unit,96.00
United HealthCare,HMO,86580,CPT4/HCPCS,TB INTRADERMAL TEST,,Per Unit,96.00
United HealthCare,HMO,86590,CPT4/HCPCS,STREPTOKINASE ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86592,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUAL,,Per Unit,96.00
United HealthCare,HMO,86593,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUANT,,Per Unit,96.00
United HealthCare,HMO,86602,CPT4/HCPCS,ANTINOMYCES ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86603,CPT4/HCPCS,ADENOVIRUS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86606,CPT4/HCPCS,ASPERGILLUS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86609,CPT4/HCPCS,BACTERIUM ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86611,CPT4/HCPCS,BARTONELLA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86612,CPT4/HCPCS,BLASTOMYCES ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86615,CPT4/HCPCS,BORDETELLA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86617,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86618,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86619,CPT4/HCPCS,BORRELIA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86622,CPT4/HCPCS,BRUCELLA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86625,CPT4/HCPCS,CAMPYLOBACTER ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86628,CPT4/HCPCS,CANDIDA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86631,CPT4/HCPCS,CHLAMYDIA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86632,CPT4/HCPCS,CHLAMYDIA IGM ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86635,CPT4/HCPCS,COCCIDIOIDES ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86638,CPT4/HCPCS,Q FEVER ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86641,CPT4/HCPCS,CRYPTOCOCCUS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86644,CPT4/HCPCS,CMV ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86645,CPT4/HCPCS,CMV ANTIBODY IGM,,Per Unit,96.00
United HealthCare,HMO,86648,CPT4/HCPCS,DIPHTHERIA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86651,CPT4/HCPCS,ENCEPHALITIS CALIFORN ANTBDY,,Per Unit,96.00
United HealthCare,HMO,86652,CPT4/HCPCS,ENCEPHALTIS EAST EQNE ANBDY,,Per Unit,96.00
United HealthCare,HMO,86653,CPT4/HCPCS,ENCEPHALTIS ST LOUIS ANTBODY,,Per Unit,96.00
United HealthCare,HMO,86654,CPT4/HCPCS,ENCEPHALTIS WEST EQNE ANTBDY,,Per Unit,96.00
United HealthCare,HMO,86658,CPT4/HCPCS,ENTEROVIRUS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86663,CPT4/HCPCS,EPSTEIN-BARR ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86664,CPT4/HCPCS,EPSTEIN-BARR NUCLEAR ANTIGEN,,Per Unit,96.00
United HealthCare,HMO,86665,CPT4/HCPCS,EPSTEIN-BARR CAPSID VCA,,Per Unit,96.00
United HealthCare,HMO,86666,CPT4/HCPCS,EHRLICHIA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86668,CPT4/HCPCS,FRANCISELLA TULARENSIS,,Per Unit,96.00
United HealthCare,HMO,86671,CPT4/HCPCS,FUNGUS NES ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86674,CPT4/HCPCS,GIARDIA LAMBLIA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86677,CPT4/HCPCS,HELICOBACTER PYLORI ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86682,CPT4/HCPCS,HELMINTH ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86684,CPT4/HCPCS,HEMOPHILUS INFLUENZA ANTIBDY,,Per Unit,96.00
United HealthCare,HMO,86687,CPT4/HCPCS,HTLV-I ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86688,CPT4/HCPCS,HTLV-II ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86689,CPT4/HCPCS,HTLV/HIV CONFIRMJ ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86692,CPT4/HCPCS,HEPATITIS DELTA AGENT ANTBDY,,Per Unit,96.00
United HealthCare,HMO,86694,CPT4/HCPCS,HERPES SIMPLEX NES ANTBDY,,Per Unit,96.00
United HealthCare,HMO,86695,CPT4/HCPCS,HERPES SIMPLEX TYPE 1 TEST,,Per Unit,96.00
United HealthCare,HMO,86696,CPT4/HCPCS,HERPES SIMPLEX TYPE 2 TEST,,Per Unit,96.00
United HealthCare,HMO,86698,CPT4/HCPCS,HISTOPLASMA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86701,CPT4/HCPCS,HIV-1ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86702,CPT4/HCPCS,HIV-2 ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86703,CPT4/HCPCS,HIV-1/HIV-2 1 RESULT ANTBDY,,Per Unit,96.00
United HealthCare,HMO,86704,CPT4/HCPCS,HEP B CORE ANTIBODY TOTAL,,Per Unit,96.00
United HealthCare,HMO,86705,CPT4/HCPCS,HEP B CORE ANTIBODY IGM,,Per Unit,96.00
United HealthCare,HMO,86706,CPT4/HCPCS,HEP B SURFACE ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86707,CPT4/HCPCS,HEPATITIS BE ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86708,CPT4/HCPCS,HEPATITIS A ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86709,CPT4/HCPCS,HEPATITIS A IGM ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86710,CPT4/HCPCS,INFLUENZA VIRUS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86711,CPT4/HCPCS,JOHN CUNNINGHAM ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86713,CPT4/HCPCS,LEGIONELLA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86717,CPT4/HCPCS,LEISHMANIA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86720,CPT4/HCPCS,LEPTOSPIRA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86723,CPT4/HCPCS,LISTERIA MONOCYTOGENES,,Per Unit,96.00
United HealthCare,HMO,86727,CPT4/HCPCS,LYMPH CHORIOMENINGITIS AB,,Per Unit,96.00
United HealthCare,HMO,86732,CPT4/HCPCS,MUCORMYCOSIS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86735,CPT4/HCPCS,MUMPS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86738,CPT4/HCPCS,MYCOPLASMA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86741,CPT4/HCPCS,NEISSERIA MENINGITIDIS,,Per Unit,96.00
United HealthCare,HMO,86744,CPT4/HCPCS,NOCARDIA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86747,CPT4/HCPCS,PARVOVIRUS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86750,CPT4/HCPCS,MALARIA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86753,CPT4/HCPCS,PROTOZOA ANTIBODY NOS,,Per Unit,96.00
United HealthCare,HMO,86756,CPT4/HCPCS,RESPIRATORY VIRUS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86757,CPT4/HCPCS,RICKETTSIA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86759,CPT4/HCPCS,ROTAVIRUS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86762,CPT4/HCPCS,RUBELLA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86765,CPT4/HCPCS,RUBEOLA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86768,CPT4/HCPCS,SALMONELLA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86771,CPT4/HCPCS,SHIGELLA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86774,CPT4/HCPCS,TETANUS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86777,CPT4/HCPCS,TOXOPLASMA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86778,CPT4/HCPCS,TOXOPLASMA ANTIBODY IGM,,Per Unit,96.00
United HealthCare,HMO,86780,CPT4/HCPCS,TREPONEMA PALLIDUM,,Per Unit,96.00
United HealthCare,HMO,86784,CPT4/HCPCS,TRICHINELLA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86787,CPT4/HCPCS,VARICELLA-ZOSTER ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86788,CPT4/HCPCS,WEST NILE VIRUS AB IGM,,Per Unit,96.00
United HealthCare,HMO,86789,CPT4/HCPCS,WEST NILE VIRUS ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86790,CPT4/HCPCS,VIRUS ANTIBODY NOS,,Per Unit,96.00
United HealthCare,HMO,86793,CPT4/HCPCS,YERSINIA ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86794,CPT4/HCPCS,ZIKA VIRUS IGM ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86800,CPT4/HCPCS,THYROGLOBULIN ANTIBODY,,Per Unit,96.00
United HealthCare,HMO,86803,CPT4/HCPCS,HEPATITIS C AB TEST,,Per Unit,96.00
United HealthCare,HMO,86804,CPT4/HCPCS,HEP C AB TEST CONFIRM,,Per Unit,96.00
United HealthCare,HMO,86805,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,Per Unit,96.00
United HealthCare,HMO,86806,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,Per Unit,96.00
United HealthCare,HMO,86807,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,Per Unit,96.00
United HealthCare,HMO,86808,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,Per Unit,96.00
United HealthCare,HMO,86812,CPT4/HCPCS,HLA TYPING A B OR C,,Per Unit,96.00
United HealthCare,HMO,86813,CPT4/HCPCS,HLA TYPING A B OR C,,Per Unit,96.00
United HealthCare,HMO,86816,CPT4/HCPCS,HLA TYPING DR/DQ,,Per Unit,96.00
United HealthCare,HMO,86817,CPT4/HCPCS,HLA TYPING DR/DQ,,Per Unit,96.00
United HealthCare,HMO,86821,CPT4/HCPCS,LYMPHOCYTE CULTURE MIXED,,Per Unit,96.00
United HealthCare,HMO,86825,CPT4/HCPCS,HLA X-MATH NON-CYTOTOXIC,,Per Unit,96.00
United HealthCare,HMO,86826,CPT4/HCPCS,HLA X-MATCH NONCYTOTOXC ADDL,,Per Unit,96.00
United HealthCare,HMO,86828,CPT4/HCPCS,HLA CLASS I&II ANTIBODY QUAL,,Per Unit,96.00
United HealthCare,HMO,86829,CPT4/HCPCS,HLA CLASS I/II ANTIBODY QUAL,,Per Unit,96.00
United HealthCare,HMO,86830,CPT4/HCPCS,HLA CLASS I PHENOTYPE QUAL,,Per Unit,96.00
United HealthCare,HMO,86831,CPT4/HCPCS,HLA CLASS II PHENOTYPE QUAL,,Per Unit,96.00
United HealthCare,HMO,86832,CPT4/HCPCS,HLA CLASS I HIGH DEFIN QUAL,,Per Unit,96.00
United HealthCare,HMO,86833,CPT4/HCPCS,HLA CLASS II HIGH DEFIN QUAL,,Per Unit,96.00
United HealthCare,HMO,86834,CPT4/HCPCS,HLA CLASS I SEMIQUANT PANEL,,Per Unit,96.00
United HealthCare,HMO,86835,CPT4/HCPCS,HLA CLASS II SEMIQUANT PANEL,,Per Unit,96.00
United HealthCare,HMO,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,Per Unit,96.00
United HealthCare,HMO,86860,CPT4/HCPCS,RBC ANTIBODY ELUTION,,Per Unit,96.00
United HealthCare,HMO,86870,CPT4/HCPCS,RBC ANTIBODY IDENTIFICATION,,Per Unit,96.00
United HealthCare,HMO,86880,CPT4/HCPCS,COOMBS TEST DIRECT,,Per Unit,96.00
United HealthCare,HMO,86885,CPT4/HCPCS,COOMBS TEST INDIRECT QUAL,,Per Unit,96.00
United HealthCare,HMO,86886,CPT4/HCPCS,COOMBS TEST INDIRECT TITER,,Per Unit,96.00
United HealthCare,HMO,86890,CPT4/HCPCS,AUTOLOGOUS BLOOD PROCESS,,Per Unit,96.00
United HealthCare,HMO,86891,CPT4/HCPCS,AUTOLOGOUS BLOOD OP SALVAGE,,Per Unit,96.00
United HealthCare,HMO,86900,CPT4/HCPCS,BLOOD TYPING SEROLOGIC ABO,,Per Unit,96.00
United HealthCare,HMO,86901,CPT4/HCPCS,BLOOD TYPING SEROLOGIC RH(D),,Per Unit,96.00
United HealthCare,HMO,86902,CPT4/HCPCS,BLOOD TYPE ANTIGEN DONOR EA,,Per Unit,96.00
United HealthCare,HMO,86904,CPT4/HCPCS,BLOOD TYPING PATIENT SERUM,,Per Unit,96.00
United HealthCare,HMO,86905,CPT4/HCPCS,BLOOD TYPING RBC ANTIGENS,,Per Unit,96.00
United HealthCare,HMO,86906,CPT4/HCPCS,BLD TYPING SEROLOGIC RH PHNT,,Per Unit,96.00
United HealthCare,HMO,86910,CPT4/HCPCS,BLOOD TYPING PATERNITY TEST,,Per Unit,96.00
United HealthCare,HMO,86911,CPT4/HCPCS,BLOOD TYPING ANTIGEN SYSTEM,,Per Unit,96.00
United HealthCare,HMO,86920,CPT4/HCPCS,COMPATIBILITY TEST SPIN,,Per Unit,96.00
United HealthCare,HMO,86921,CPT4/HCPCS,COMPATIBILITY TEST INCUBATE,,Per Unit,96.00
United HealthCare,HMO,86922,CPT4/HCPCS,COMPATIBILITY TEST ANTIGLOB,,Per Unit,96.00
United HealthCare,HMO,86923,CPT4/HCPCS,COMPATIBILITY TEST ELECTRIC,,Per Unit,96.00
United HealthCare,HMO,86927,CPT4/HCPCS,PLASMA FRESH FROZEN,,Per Unit,96.00
United HealthCare,HMO,86930,CPT4/HCPCS,FROZEN BLOOD PREP,,Per Unit,96.00
United HealthCare,HMO,86931,CPT4/HCPCS,FROZEN BLOOD THAW,,Per Unit,96.00
United HealthCare,HMO,86932,CPT4/HCPCS,FROZEN BLOOD FREEZE/THAW,,Per Unit,96.00
United HealthCare,HMO,86940,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS AUTO,,Per Unit,96.00
United HealthCare,HMO,86941,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS,,Per Unit,96.00
United HealthCare,HMO,86945,CPT4/HCPCS,BLOOD PRODUCT/IRRADIATION,,Per Unit,96.00
United HealthCare,HMO,86950,CPT4/HCPCS,LEUKACYTE TRANSFUSION,,Per Unit,96.00
United HealthCare,HMO,86960,CPT4/HCPCS,VOL REDUCTION OF BLOOD/PROD,,Per Unit,96.00
United HealthCare,HMO,86965,CPT4/HCPCS,POOLING BLOOD PLATELETS,,Per Unit,96.00
United HealthCare,HMO,86970,CPT4/HCPCS,RBC PRETX INCUBATJ W/CHEMICL,,Per Unit,96.00
United HealthCare,HMO,86971,CPT4/HCPCS,RBC PRETX INCUBATJ W/ENZYMES,,Per Unit,96.00
United HealthCare,HMO,86972,CPT4/HCPCS,RBC PRETX INCUBATJ W/DENSITY,,Per Unit,96.00
United HealthCare,HMO,86975,CPT4/HCPCS,RBC SERUM PRETX INCUBJ DRUGS,,Per Unit,96.00
United HealthCare,HMO,86976,CPT4/HCPCS,RBC SERUM PRETX ID DILUTION,,Per Unit,96.00
United HealthCare,HMO,86977,CPT4/HCPCS,RBC SERUM PRETX INCUBJ/INHIB,,Per Unit,96.00
United HealthCare,HMO,86978,CPT4/HCPCS,RBC PRETREATMENT SERUM,,Per Unit,96.00
United HealthCare,HMO,86985,CPT4/HCPCS,SPLIT BLOOD OR PRODUCTS,,Per Unit,96.00
United HealthCare,HMO,87003,CPT4/HCPCS,SMALL ANIMAL INOCULATION,,Per Unit,96.00
United HealthCare,HMO,87015,CPT4/HCPCS,SPECIMEN INFECT AGNT CONCNTJ,,Per Unit,96.00
United HealthCare,HMO,87040,CPT4/HCPCS,BLOOD CULTURE FOR BACTERIA,,Per Unit,96.00
United HealthCare,HMO,87045,CPT4/HCPCS,FECES CULTURE AEROBIC BACT,,Per Unit,96.00
United HealthCare,HMO,87046,CPT4/HCPCS,STOOL CULTR AEROBIC BACT EA,,Per Unit,96.00
United HealthCare,HMO,87070,CPT4/HCPCS,CULTURE OTHR SPECIMN AEROBIC,,Per Unit,96.00
United HealthCare,HMO,87071,CPT4/HCPCS,CULTURE AEROBIC QUANT OTHER,,Per Unit,96.00
United HealthCare,HMO,87073,CPT4/HCPCS,CULTURE BACTERIA ANAEROBIC,,Per Unit,96.00
United HealthCare,HMO,87075,CPT4/HCPCS,CULTR BACTERIA EXCEPT BLOOD,,Per Unit,96.00
United HealthCare,HMO,87076,CPT4/HCPCS,CULTURE ANAEROBE IDENT EACH,,Per Unit,96.00
United HealthCare,HMO,87077,CPT4/HCPCS,CULTURE AEROBIC IDENTIFY,,Per Unit,96.00
United HealthCare,HMO,87081,CPT4/HCPCS,CULTURE SCREEN ONLY,,Per Unit,96.00
United HealthCare,HMO,87084,CPT4/HCPCS,CULTURE OF SPECIMEN BY KIT,,Per Unit,96.00
United HealthCare,HMO,87086,CPT4/HCPCS,URINE CULTURE/COLONY COUNT,,Per Unit,96.00
United HealthCare,HMO,87088,CPT4/HCPCS,URINE BACTERIA CULTURE,,Per Unit,96.00
United HealthCare,HMO,87101,CPT4/HCPCS,SKIN FUNGI CULTURE,,Per Unit,96.00
United HealthCare,HMO,87102,CPT4/HCPCS,FUNGUS ISOLATION CULTURE,,Per Unit,96.00
United HealthCare,HMO,87103,CPT4/HCPCS,BLOOD FUNGUS CULTURE,,Per Unit,96.00
United HealthCare,HMO,87106,CPT4/HCPCS,FUNGI IDENTIFICATION YEAST,,Per Unit,96.00
United HealthCare,HMO,87107,CPT4/HCPCS,FUNGI IDENTIFICATION MOLD,,Per Unit,96.00
United HealthCare,HMO,87109,CPT4/HCPCS,MYCOPLASMA,,Per Unit,96.00
United HealthCare,HMO,87110,CPT4/HCPCS,CHLAMYDIA CULTURE,,Per Unit,96.00
United HealthCare,HMO,87116,CPT4/HCPCS,MYCOBACTERIA CULTURE,,Per Unit,96.00
United HealthCare,HMO,87118,CPT4/HCPCS,MYCOBACTERIC IDENTIFICATION,,Per Unit,96.00
United HealthCare,HMO,87140,CPT4/HCPCS,CULTURE TYPE IMMUNOFLUORESC,,Per Unit,96.00
United HealthCare,HMO,87143,CPT4/HCPCS,CULTURE TYPING GLC/HPLC,,Per Unit,96.00
United HealthCare,HMO,87147,CPT4/HCPCS,CULTURE TYPE IMMUNOLOGIC,,Per Unit,96.00
United HealthCare,HMO,87149,CPT4/HCPCS,DNA/RNA DIRECT PROBE,,Per Unit,96.00
United HealthCare,HMO,87150,CPT4/HCPCS,DNA/RNA AMPLIFIED PROBE,,Per Unit,96.00
United HealthCare,HMO,87152,CPT4/HCPCS,CULTURE TYPE PULSE FIELD GEL,,Per Unit,96.00
United HealthCare,HMO,87153,CPT4/HCPCS,DNA/RNA SEQUENCING,,Per Unit,96.00
United HealthCare,HMO,87158,CPT4/HCPCS,CULTURE TYPING ADDED METHOD,,Per Unit,96.00
United HealthCare,HMO,87164,CPT4/HCPCS,DARK FIELD EXAMINATION,,Per Unit,96.00
United HealthCare,HMO,87166,CPT4/HCPCS,DARK FIELD EXAMINATION,,Per Unit,96.00
United HealthCare,HMO,87168,CPT4/HCPCS,MACROSCOPIC EXAM ARTHROPOD,,Per Unit,96.00
United HealthCare,HMO,87169,CPT4/HCPCS,MACROSCOPIC EXAM PARASITE,,Per Unit,96.00
United HealthCare,HMO,87172,CPT4/HCPCS,PINWORM EXAM,,Per Unit,96.00
United HealthCare,HMO,87176,CPT4/HCPCS,TISSUE HOMOGENIZATION CULTR,,Per Unit,96.00
United HealthCare,HMO,87177,CPT4/HCPCS,OVA AND PARASITES SMEARS,,Per Unit,96.00
United HealthCare,HMO,87181,CPT4/HCPCS,MICROBE SUSCEPTIBLE DIFFUSE,,Per Unit,96.00
United HealthCare,HMO,87184,CPT4/HCPCS,MICROBE SUSCEPTIBLE DISK,,Per Unit,96.00
United HealthCare,HMO,87185,CPT4/HCPCS,MICROBE SUSCEPTIBLE ENZYME,,Per Unit,96.00
United HealthCare,HMO,87186,CPT4/HCPCS,MICROBE SUSCEPTIBLE MIC,,Per Unit,96.00
United HealthCare,HMO,87187,CPT4/HCPCS,MICROBE SUSCEPTIBLE MLC,,Per Unit,96.00
United HealthCare,HMO,87188,CPT4/HCPCS,MICROBE SUSCEPT MACROBROTH,,Per Unit,96.00
United HealthCare,HMO,87190,CPT4/HCPCS,MICROBE SUSCEPT MYCOBACTERI,,Per Unit,96.00
United HealthCare,HMO,87197,CPT4/HCPCS,BACTERICIDAL LEVEL SERUM,,Per Unit,96.00
United HealthCare,HMO,87205,CPT4/HCPCS,SMEAR GRAM STAIN,,Per Unit,96.00
United HealthCare,HMO,87206,CPT4/HCPCS,SMEAR FLUORESCENT/ACID STAI,,Per Unit,96.00
United HealthCare,HMO,87207,CPT4/HCPCS,SMEAR SPECIAL STAIN,,Per Unit,96.00
United HealthCare,HMO,87209,CPT4/HCPCS,SMEAR COMPLEX STAIN,,Per Unit,96.00
United HealthCare,HMO,87210,CPT4/HCPCS,SMEAR WET MOUNT SALINE/INK,,Per Unit,96.00
United HealthCare,HMO,87220,CPT4/HCPCS,TISSUE EXAM FOR FUNGI,,Per Unit,96.00
United HealthCare,HMO,87230,CPT4/HCPCS,ASSAY TOXIN OR ANTITOXIN,,Per Unit,96.00
United HealthCare,HMO,87250,CPT4/HCPCS,VIRUS INOCULATE EGGS/ANIMAL,,Per Unit,96.00
United HealthCare,HMO,87252,CPT4/HCPCS,VIRUS INOCULATION TISSUE,,Per Unit,96.00
United HealthCare,HMO,87253,CPT4/HCPCS,VIRUS INOCULATE TISSUE ADDL,,Per Unit,96.00
United HealthCare,HMO,87254,CPT4/HCPCS,VIRUS INOCULATION SHELL VIA,,Per Unit,96.00
United HealthCare,HMO,87255,CPT4/HCPCS,GENET VIRUS ISOLATE HSV,,Per Unit,96.00
United HealthCare,HMO,87260,CPT4/HCPCS,ADENOVIRUS AG IF,,Per Unit,96.00
United HealthCare,HMO,87265,CPT4/HCPCS,PERTUSSIS AG IF,,Per Unit,96.00
United HealthCare,HMO,87267,CPT4/HCPCS,ENTEROVIRUS ANTIBODY DFA,,Per Unit,96.00
United HealthCare,HMO,87269,CPT4/HCPCS,GIARDIA AG IF,,Per Unit,96.00
United HealthCare,HMO,87270,CPT4/HCPCS,CHLAMYDIA TRACHOMATIS AG IF,,Per Unit,96.00
United HealthCare,HMO,87271,CPT4/HCPCS,CYTOMEGALOVIRUS DFA,,Per Unit,96.00
United HealthCare,HMO,87272,CPT4/HCPCS,CRYPTOSPORIDIUM AG IF,,Per Unit,96.00
United HealthCare,HMO,87273,CPT4/HCPCS,HERPES SIMPLEX 2 AG IF,,Per Unit,96.00
United HealthCare,HMO,87274,CPT4/HCPCS,HERPES SIMPLEX 1 AG IF,,Per Unit,96.00
United HealthCare,HMO,87275,CPT4/HCPCS,INFLUENZA B AG IF,,Per Unit,96.00
United HealthCare,HMO,87276,CPT4/HCPCS,INFLUENZA A AG IF,,Per Unit,96.00
United HealthCare,HMO,87278,CPT4/HCPCS,LEGION PNEUMOPHILIA AG IF,,Per Unit,96.00
United HealthCare,HMO,87279,CPT4/HCPCS,PARAINFLUENZA AG IF,,Per Unit,96.00
United HealthCare,HMO,87280,CPT4/HCPCS,RESPIRATORY SYNCYTIAL AG IF,,Per Unit,96.00
United HealthCare,HMO,87281,CPT4/HCPCS,PNEUMOCYSTIS CARINII AG IF,,Per Unit,96.00
United HealthCare,HMO,87283,CPT4/HCPCS,RUBEOLA AG IF,,Per Unit,96.00
United HealthCare,HMO,87285,CPT4/HCPCS,TREPONEMA PALLIDUM AG IF,,Per Unit,96.00
United HealthCare,HMO,87290,CPT4/HCPCS,VARICELLA ZOSTER AG IF,,Per Unit,96.00
United HealthCare,HMO,87299,CPT4/HCPCS,ANTIBODY DETECTION NOS IF,,Per Unit,96.00
United HealthCare,HMO,87300,CPT4/HCPCS,AG DETECTION POLYVAL IF,,Per Unit,96.00
United HealthCare,HMO,87301,CPT4/HCPCS,ADENOVIRUS AG IA,,Per Unit,96.00
United HealthCare,HMO,87305,CPT4/HCPCS,ASPERGILLUS AG IA,,Per Unit,96.00
United HealthCare,HMO,87320,CPT4/HCPCS,CHYLMD TRACH AG IA,,Per Unit,96.00
United HealthCare,HMO,87324,CPT4/HCPCS,CLOSTRIDIUM AG IA,,Per Unit,96.00
United HealthCare,HMO,87327,CPT4/HCPCS,CRYPTOCOCCUS NEOFORM AG IA,,Per Unit,96.00
United HealthCare,HMO,87328,CPT4/HCPCS,CRYPTOSPORIDIUM AG IA,,Per Unit,96.00
United HealthCare,HMO,87329,CPT4/HCPCS,GIARDIA AG IA,,Per Unit,96.00
United HealthCare,HMO,87332,CPT4/HCPCS,CYTOMEGALOVIRUS AG IA,,Per Unit,96.00
United HealthCare,HMO,87335,CPT4/HCPCS,E COLI 0157 AG IA,,Per Unit,96.00
United HealthCare,HMO,87336,CPT4/HCPCS,ENTAMOEB HIST DISPR AG IA,,Per Unit,96.00
United HealthCare,HMO,87337,CPT4/HCPCS,ENTAMOEB HIST GROUP AG IA,,Per Unit,96.00
United HealthCare,HMO,87338,CPT4/HCPCS,HPYLORI STOOL IA,,Per Unit,96.00
United HealthCare,HMO,87339,CPT4/HCPCS,H PYLORI AG IA,,Per Unit,96.00
United HealthCare,HMO,87340,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,Per Unit,96.00
United HealthCare,HMO,87341,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,Per Unit,96.00
United HealthCare,HMO,87350,CPT4/HCPCS,HEPATITIS BE AG IA,,Per Unit,96.00
United HealthCare,HMO,87380,CPT4/HCPCS,HEPATITIS DELTA AG IA,,Per Unit,96.00
United HealthCare,HMO,87385,CPT4/HCPCS,HISTOPLASMA CAPSUL AG IA,,Per Unit,96.00
United HealthCare,HMO,87389,CPT4/HCPCS,HIV-1 AG W/HIV-1 & HIV-2 AB,,Per Unit,96.00
United HealthCare,HMO,87390,CPT4/HCPCS,HIV-1 AG IA,,Per Unit,96.00
United HealthCare,HMO,87391,CPT4/HCPCS,HIV-2 AG IA,,Per Unit,96.00
United HealthCare,HMO,87400,CPT4/HCPCS,INFLUENZA A/B AG IA,,Per Unit,96.00
United HealthCare,HMO,87420,CPT4/HCPCS,RESP SYNCYTIAL AG IA,,Per Unit,96.00
United HealthCare,HMO,87425,CPT4/HCPCS,ROTAVIRUS AG IA,,Per Unit,96.00
United HealthCare,HMO,87427,CPT4/HCPCS,SHIGA-LIKE TOXIN AG IA,,Per Unit,96.00
United HealthCare,HMO,87430,CPT4/HCPCS,STREP A AG IA,,Per Unit,96.00
United HealthCare,HMO,87449,CPT4/HCPCS,AG DETECT NOS IA MULT,,Per Unit,96.00
United HealthCare,HMO,87450,CPT4/HCPCS,AG DETECT NOS IA SINGLE,,Per Unit,96.00
United HealthCare,HMO,87451,CPT4/HCPCS,AG DETECT POLYVAL IA MULT,,Per Unit,96.00
United HealthCare,HMO,87471,CPT4/HCPCS,BARTONELLA DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87472,CPT4/HCPCS,BARTONELLA DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87475,CPT4/HCPCS,LYME DIS DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87476,CPT4/HCPCS,LYME DIS DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87480,CPT4/HCPCS,CANDIDA DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87481,CPT4/HCPCS,CANDIDA DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87482,CPT4/HCPCS,CANDIDA DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87483,CPT4/HCPCS,CNS DNA AMP PROBE TYPE 12-25,,Per Unit,96.00
United HealthCare,HMO,87485,CPT4/HCPCS,CHYLMD PNEUM DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87486,CPT4/HCPCS,CHYLMD PNEUM DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87487,CPT4/HCPCS,CHYLMD PNEUM DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87490,CPT4/HCPCS,CHYLMD TRACH DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87491,CPT4/HCPCS,CHYLMD TRACH DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87492,CPT4/HCPCS,CHYLMD TRACH DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87493,CPT4/HCPCS,C DIFF AMPLIFIED PROBE,,Per Unit,96.00
United HealthCare,HMO,87495,CPT4/HCPCS,CYTOMEG DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87496,CPT4/HCPCS,CYTOMEG DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87497,CPT4/HCPCS,CYTOMEG DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87498,CPT4/HCPCS,ENTEROVIRUS PROBE&REVRS TRNS,,Per Unit,96.00
United HealthCare,HMO,87500,CPT4/HCPCS,VANOMYCIN DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87501,CPT4/HCPCS,INFLUENZA DNA AMP PROB 1+,,Per Unit,96.00
United HealthCare,HMO,87502,CPT4/HCPCS,INFLUENZA DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87503,CPT4/HCPCS,INFLUENZA DNA AMP PROB ADDL,,Per Unit,96.00
United HealthCare,HMO,87505,CPT4/HCPCS,NFCT AGENT DETECTION GI,,Per Unit,96.00
United HealthCare,HMO,87506,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 6-11,,Per Unit,96.00
United HealthCare,HMO,87507,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 12-25,,Per Unit,96.00
United HealthCare,HMO,87510,CPT4/HCPCS,GARDNER VAG DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87511,CPT4/HCPCS,GARDNER VAG DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87512,CPT4/HCPCS,GARDNER VAG DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87516,CPT4/HCPCS,HEPATITIS B DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87517,CPT4/HCPCS,HEPATITIS B DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87520,CPT4/HCPCS,HEPATITIS C RNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87521,CPT4/HCPCS,HEPATITIS C PROBE&RVRS TRNSC,,Per Unit,96.00
United HealthCare,HMO,87522,CPT4/HCPCS,HEPATITIS C REVRS TRNSCRPJ,,Per Unit,96.00
United HealthCare,HMO,87525,CPT4/HCPCS,HEPATITIS G DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87526,CPT4/HCPCS,HEPATITIS G DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87527,CPT4/HCPCS,HEPATITIS G DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87528,CPT4/HCPCS,HSV DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87529,CPT4/HCPCS,HSV DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87530,CPT4/HCPCS,HSV DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87531,CPT4/HCPCS,HHV-6 DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87532,CPT4/HCPCS,HHV-6 DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87533,CPT4/HCPCS,HHV-6 DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87534,CPT4/HCPCS,HIV-1 DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87535,CPT4/HCPCS,HIV-1 PROBE&REVERSE TRNSCRPJ,,Per Unit,96.00
United HealthCare,HMO,87536,CPT4/HCPCS,HIV-1 QUANT&REVRSE TRNSCRPJ,,Per Unit,96.00
United HealthCare,HMO,87537,CPT4/HCPCS,HIV-2 DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87538,CPT4/HCPCS,HIV-2 PROBE&REVRSE TRNSCRIPJ,,Per Unit,96.00
United HealthCare,HMO,87539,CPT4/HCPCS,HIV-2 QUANT&REVRSE TRNSCRIPJ,,Per Unit,96.00
United HealthCare,HMO,87540,CPT4/HCPCS,LEGION PNEUMO DNA DIR PROB,,Per Unit,96.00
United HealthCare,HMO,87541,CPT4/HCPCS,LEGION PNEUMO DNA AMP PROB,,Per Unit,96.00
United HealthCare,HMO,87542,CPT4/HCPCS,LEGION PNEUMO DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87550,CPT4/HCPCS,MYCOBACTERIA DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87551,CPT4/HCPCS,MYCOBACTERIA DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87552,CPT4/HCPCS,MYCOBACTERIA DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87555,CPT4/HCPCS,M.TUBERCULO DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87556,CPT4/HCPCS,M.TUBERCULO DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87557,CPT4/HCPCS,M.TUBERCULO DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87560,CPT4/HCPCS,M.AVIUM-INTRA DNA DIR PROB,,Per Unit,96.00
United HealthCare,HMO,87561,CPT4/HCPCS,M.AVIUM-INTRA DNA AMP PROB,,Per Unit,96.00
United HealthCare,HMO,87562,CPT4/HCPCS,M.AVIUM-INTRA DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87580,CPT4/HCPCS,M.PNEUMON DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87581,CPT4/HCPCS,M.PNEUMON DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87582,CPT4/HCPCS,M.PNEUMON DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87590,CPT4/HCPCS,N.GONORRHOEAE DNA DIR PROB,,Per Unit,96.00
United HealthCare,HMO,87591,CPT4/HCPCS,N.GONORRHOEAE DNA AMP PROB,,Per Unit,96.00
United HealthCare,HMO,87592,CPT4/HCPCS,N.GONORRHOEAE DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87623,CPT4/HCPCS,HPV LOW-RISK TYPES,,Per Unit,96.00
United HealthCare,HMO,87624,CPT4/HCPCS,HPV HIGH-RISK TYPES,,Per Unit,96.00
United HealthCare,HMO,87625,CPT4/HCPCS,HPV TYPES 16 & 18 ONLY,,Per Unit,96.00
United HealthCare,HMO,87631,CPT4/HCPCS,RESP VIRUS 3-5 TARGETS,,Per Unit,96.00
United HealthCare,HMO,87632,CPT4/HCPCS,RESP VIRUS 6-11 TARGETS,,Per Unit,96.00
United HealthCare,HMO,87633,CPT4/HCPCS,RESP VIRUS 12-25 TARGETS,,Per Unit,96.00
United HealthCare,HMO,87634,CPT4/HCPCS,RSV DNA/RNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87640,CPT4/HCPCS,STAPH A DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87641,CPT4/HCPCS,MR-STAPH DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87650,CPT4/HCPCS,STREP A DNA DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87651,CPT4/HCPCS,STREP A DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87652,CPT4/HCPCS,STREP A DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87653,CPT4/HCPCS,STREP B DNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87660,CPT4/HCPCS,TRICHOMONAS VAGIN DIR PROBE,,Per Unit,96.00
United HealthCare,HMO,87661,CPT4/HCPCS,TRICHOMONAS VAGINALIS AMPLIF,,Per Unit,96.00
United HealthCare,HMO,87662,CPT4/HCPCS,ZIKA VIRUS DNA/RNA AMP PROBE,,Per Unit,96.00
United HealthCare,HMO,87797,CPT4/HCPCS,DETECT AGENT NOS DNA DIR,,Per Unit,96.00
United HealthCare,HMO,87798,CPT4/HCPCS,DETECT AGENT NOS DNA AMP,,Per Unit,96.00
United HealthCare,HMO,87799,CPT4/HCPCS,DETECT AGENT NOS DNA QUANT,,Per Unit,96.00
United HealthCare,HMO,87800,CPT4/HCPCS,DETECT AGNT MULT DNA DIREC,,Per Unit,96.00
United HealthCare,HMO,87801,CPT4/HCPCS,DETECT AGNT MULT DNA AMPLI,,Per Unit,96.00
United HealthCare,HMO,87802,CPT4/HCPCS,STREP B ASSAY W/OPTIC,,Per Unit,96.00
United HealthCare,HMO,87803,CPT4/HCPCS,CLOSTRIDIUM TOXIN A W/OPTIC,,Per Unit,96.00
United HealthCare,HMO,87804,CPT4/HCPCS,INFLUENZA ASSAY W/OPTIC,,Per Unit,96.00
United HealthCare,HMO,87806,CPT4/HCPCS,HIV ANTIGEN W/HIV ANTIBODIES,,Per Unit,96.00
United HealthCare,HMO,87807,CPT4/HCPCS,RSV ASSAY W/OPTIC,,Per Unit,96.00
United HealthCare,HMO,87808,CPT4/HCPCS,TRICHOMONAS ASSAY W/OPTIC,,Per Unit,96.00
United HealthCare,HMO,87809,CPT4/HCPCS,ADENOVIRUS ASSAY W/OPTIC,,Per Unit,96.00
United HealthCare,HMO,87810,CPT4/HCPCS,CHYLMD TRACH ASSAY W/OPTIC,,Per Unit,96.00
United HealthCare,HMO,87850,CPT4/HCPCS,N. GONORRHOEAE ASSAY W/OPTIC,,Per Unit,96.00
United HealthCare,HMO,87880,CPT4/HCPCS,STREP A ASSAY W/OPTIC,,Per Unit,96.00
United HealthCare,HMO,87899,CPT4/HCPCS,AGENT NOS ASSAY W/OPTIC,,Per Unit,96.00
United HealthCare,HMO,87900,CPT4/HCPCS,PHENOTYPE INFECT AGENT DRUG,,Per Unit,96.00
United HealthCare,HMO,87901,CPT4/HCPCS,GENOTYPE DNA HIV REVERSE T,,Per Unit,96.00
United HealthCare,HMO,87902,CPT4/HCPCS,GENOTYPE DNA/RNA HEP C,,Per Unit,96.00
United HealthCare,HMO,87903,CPT4/HCPCS,PHENOTYPE DNA HIV W/CULTURE,,Per Unit,96.00
United HealthCare,HMO,87904,CPT4/HCPCS,PHENOTYPE DNA HIV W/CLT ADD,,Per Unit,96.00
United HealthCare,HMO,87905,CPT4/HCPCS,SIALIDASE ENZYME ASSAY,,Per Unit,96.00
United HealthCare,HMO,87906,CPT4/HCPCS,GENOTYPE DNA/RNA HIV,,Per Unit,96.00
United HealthCare,HMO,87910,CPT4/HCPCS,GENOTYPE CYTOMEGALOVIRUS,,Per Unit,96.00
United HealthCare,HMO,87912,CPT4/HCPCS,GENOTYPE DNA HEPATITIS B,,Per Unit,96.00
United HealthCare,HMO,88000,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,96.00
United HealthCare,HMO,88005,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,96.00
United HealthCare,HMO,88007,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,96.00
United HealthCare,HMO,88012,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,96.00
United HealthCare,HMO,88014,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,96.00
United HealthCare,HMO,88016,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,96.00
United HealthCare,HMO,88020,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Per Unit,96.00
United HealthCare,HMO,88025,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Per Unit,96.00
United HealthCare,HMO,88027,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Per Unit,96.00
United HealthCare,HMO,88028,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Per Unit,96.00
United HealthCare,HMO,88029,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Per Unit,96.00
United HealthCare,HMO,88036,CPT4/HCPCS,LIMITED AUTOPSY,,Per Unit,96.00
United HealthCare,HMO,88037,CPT4/HCPCS,LIMITED AUTOPSY,,Per Unit,96.00
United HealthCare,HMO,88040,CPT4/HCPCS,FORENSIC AUTOPSY (NECROPSY),,Per Unit,96.00
United HealthCare,HMO,88045,CPT4/HCPCS,CORONERS AUTOPSY (NECROPSY),,Per Unit,96.00
United HealthCare,HMO,88104,CPT4/HCPCS,CYTOPATH FL NONGYN SMEARS,,Per Unit,96.00
United HealthCare,HMO,88106,CPT4/HCPCS,CYTOPATH FL NONGYN FILTER,,Per Unit,96.00
United HealthCare,HMO,88108,CPT4/HCPCS,CYTOPATH CONCENTRATE TECH,,Per Unit,96.00
United HealthCare,HMO,88112,CPT4/HCPCS,CYTOPATH CELL ENHANCE TECH,,Per Unit,96.00
United HealthCare,HMO,88120,CPT4/HCPCS,CYTP URNE 3-5 PROBES EA SPEC,,Per Unit,96.00
United HealthCare,HMO,88121,CPT4/HCPCS,CYTP URINE 3-5 PROBES CMPTR,,Per Unit,96.00
United HealthCare,HMO,88125,CPT4/HCPCS,FORENSIC CYTOPATHOLOGY,,Per Unit,96.00
United HealthCare,HMO,88130,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,Per Unit,96.00
United HealthCare,HMO,88140,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,Per Unit,96.00
United HealthCare,HMO,88141,CPT4/HCPCS,CYTOPATH C/V INTERPRET,,Per Unit,96.00
United HealthCare,HMO,88142,CPT4/HCPCS,CYTOPATH C/V THIN LAYER,,Per Unit,96.00
United HealthCare,HMO,88143,CPT4/HCPCS,CYTOPATH C/V THIN LAYER REDO,,Per Unit,96.00
United HealthCare,HMO,88147,CPT4/HCPCS,CYTOPATH C/V AUTOMATED,,Per Unit,96.00
United HealthCare,HMO,88148,CPT4/HCPCS,CYTOPATH C/V AUTO RESCREEN,,Per Unit,96.00
United HealthCare,HMO,88150,CPT4/HCPCS,CYTOPATH C/V MANUAL,,Per Unit,96.00
United HealthCare,HMO,88152,CPT4/HCPCS,CYTOPATH C/V AUTO REDO,,Per Unit,96.00
United HealthCare,HMO,88153,CPT4/HCPCS,CYTOPATH C/V REDO,,Per Unit,96.00
United HealthCare,HMO,88155,CPT4/HCPCS,CYTOPATH C/V INDEX ADD-ON,,Per Unit,96.00
United HealthCare,HMO,88160,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Per Unit,96.00
United HealthCare,HMO,88161,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Per Unit,96.00
United HealthCare,HMO,88162,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Per Unit,96.00
United HealthCare,HMO,88164,CPT4/HCPCS,CYTOPATH TBS C/V MANUAL,,Per Unit,96.00
United HealthCare,HMO,88165,CPT4/HCPCS,CYTOPATH TBS C/V REDO,,Per Unit,96.00
United HealthCare,HMO,88166,CPT4/HCPCS,CYTOPATH TBS C/V AUTO REDO,,Per Unit,96.00
United HealthCare,HMO,88167,CPT4/HCPCS,CYTOPATH TBS C/V SELECT,,Per Unit,96.00
United HealthCare,HMO,88172,CPT4/HCPCS,CYTP DX EVAL FNA 1ST EA SITE,,Per Unit,96.00
United HealthCare,HMO,88173,CPT4/HCPCS,CYTOPATH EVAL FNA REPORT,,Per Unit,96.00
United HealthCare,HMO,88174,CPT4/HCPCS,CYTOPATH C/V AUTO IN FLUID,,Per Unit,96.00
United HealthCare,HMO,88175,CPT4/HCPCS,CYTOPATH C/V AUTO FLUID REDO,,Per Unit,96.00
United HealthCare,HMO,88177,CPT4/HCPCS,CYTP FNA EVAL EA ADDL,,Per Unit,96.00
United HealthCare,HMO,88182,CPT4/HCPCS,CELL MARKER STUDY,,Per Unit,96.00
United HealthCare,HMO,88184,CPT4/HCPCS,FLOWCYTOMETRY/ TC 1 MARKER,,Per Unit,96.00
United HealthCare,HMO,88185,CPT4/HCPCS,FLOWCYTOMETRY/TC ADD-ON,,Per Unit,96.00
United HealthCare,HMO,88187,CPT4/HCPCS,FLOWCYTOMETRY/READ 2-8,,Per Unit,96.00
United HealthCare,HMO,88188,CPT4/HCPCS,FLOWCYTOMETRY/READ 9-15,,Per Unit,96.00
United HealthCare,HMO,88189,CPT4/HCPCS,FLOWCYTOMETRY/READ 16 & >,,Per Unit,96.00
United HealthCare,HMO,88230,CPT4/HCPCS,TISSUE CULTURE LYMPHOCYTE,,Per Unit,96.00
United HealthCare,HMO,88233,CPT4/HCPCS,TISSUE CULTURE SKIN/BIOPSY,,Per Unit,96.00
United HealthCare,HMO,88235,CPT4/HCPCS,TISSUE CULTURE PLACENTA,,Per Unit,96.00
United HealthCare,HMO,88237,CPT4/HCPCS,TISSUE CULTURE BONE MARROW,,Per Unit,96.00
United HealthCare,HMO,88239,CPT4/HCPCS,TISSUE CULTURE TUMOR,,Per Unit,96.00
United HealthCare,HMO,88240,CPT4/HCPCS,CELL CRYOPRESERVE/STORAGE,,Per Unit,96.00
United HealthCare,HMO,88241,CPT4/HCPCS,FROZEN CELL PREPARATION,,Per Unit,96.00
United HealthCare,HMO,88245,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,Per Unit,96.00
United HealthCare,HMO,88248,CPT4/HCPCS,CHROMOSOME ANALYSIS 50-100,,Per Unit,96.00
United HealthCare,HMO,88249,CPT4/HCPCS,CHROMOSOME ANALYSIS 100,,Per Unit,96.00
United HealthCare,HMO,88261,CPT4/HCPCS,CHROMOSOME ANALYSIS 5,,Per Unit,96.00
United HealthCare,HMO,88262,CPT4/HCPCS,CHROMOSOME ANALYSIS 15-20,,Per Unit,96.00
United HealthCare,HMO,88263,CPT4/HCPCS,CHROMOSOME ANALYSIS 45,,Per Unit,96.00
United HealthCare,HMO,88264,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,Per Unit,96.00
United HealthCare,HMO,88267,CPT4/HCPCS,CHROMOSOME ANALYS PLACENTA,,Per Unit,96.00
United HealthCare,HMO,88269,CPT4/HCPCS,CHROMOSOME ANALYS AMNIOTIC,,Per Unit,96.00
United HealthCare,HMO,88271,CPT4/HCPCS,CYTOGENETICS DNA PROBE,,Per Unit,96.00
United HealthCare,HMO,88272,CPT4/HCPCS,CYTOGENETICS 3-5,,Per Unit,96.00
United HealthCare,HMO,88273,CPT4/HCPCS,CYTOGENETICS 10-30,,Per Unit,96.00
United HealthCare,HMO,88274,CPT4/HCPCS,CYTOGENETICS 25-99,,Per Unit,96.00
United HealthCare,HMO,88275,CPT4/HCPCS,CYTOGENETICS 100-300,,Per Unit,96.00
United HealthCare,HMO,88280,CPT4/HCPCS,CHROMOSOME KARYOTYPE STUDY,,Per Unit,96.00
United HealthCare,HMO,88283,CPT4/HCPCS,CHROMOSOME BANDING STUDY,,Per Unit,96.00
United HealthCare,HMO,88285,CPT4/HCPCS,CHROMOSOME COUNT ADDITIONAL,,Per Unit,96.00
United HealthCare,HMO,88289,CPT4/HCPCS,CHROMOSOME STUDY ADDITIONAL,,Per Unit,96.00
United HealthCare,HMO,88291,CPT4/HCPCS,CYTO/MOLECULAR REPORT,,Per Unit,96.00
United HealthCare,HMO,88300,CPT4/HCPCS,SURGICAL PATH GROSS,,Per Unit,96.00
United HealthCare,HMO,88302,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Per Unit,96.00
United HealthCare,HMO,88304,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Per Unit,96.00
United HealthCare,HMO,88305,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Per Unit,96.00
United HealthCare,HMO,88307,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Per Unit,96.00
United HealthCare,HMO,88309,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Per Unit,96.00
United HealthCare,HMO,88311,CPT4/HCPCS,DECALCIFY TISSUE,,Per Unit,96.00
United HealthCare,HMO,88312,CPT4/HCPCS,SPECIAL STAINS GROUP 1,,Per Unit,96.00
United HealthCare,HMO,88313,CPT4/HCPCS,SPECIAL STAINS GROUP 2,,Per Unit,96.00
United HealthCare,HMO,88314,CPT4/HCPCS,HISTOCHEMICAL STAINS ADD-ON,,Per Unit,96.00
United HealthCare,HMO,88319,CPT4/HCPCS,ENZYME HISTOCHEMISTRY,,Per Unit,96.00
United HealthCare,HMO,88321,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Per Unit,96.00
United HealthCare,HMO,88323,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Per Unit,96.00
United HealthCare,HMO,88325,CPT4/HCPCS,COMPREHENSIVE REVIEW OF DATA,,Per Unit,96.00
United HealthCare,HMO,88329,CPT4/HCPCS,PATH CONSULT INTROP,,Per Unit,96.00
United HealthCare,HMO,88331,CPT4/HCPCS,PATH CONSULT INTRAOP 1 BLOC,,Per Unit,96.00
United HealthCare,HMO,88332,CPT4/HCPCS,PATH CONSULT INTRAOP ADDL,,Per Unit,96.00
United HealthCare,HMO,88333,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 1,,Per Unit,96.00
United HealthCare,HMO,88334,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 2,,Per Unit,96.00
United HealthCare,HMO,88341,CPT4/HCPCS,IMMUNOHISTO ANTB ADDL SLIDE,,Per Unit,96.00
United HealthCare,HMO,88342,CPT4/HCPCS,IMMUNOHISTO ANTB 1ST STAIN,,Per Unit,96.00
United HealthCare,HMO,88344,CPT4/HCPCS,IMMUNOHISTO ANTIBODY SLIDE,,Per Unit,96.00
United HealthCare,HMO,88346,CPT4/HCPCS,IMMUNOFLUOR ANTB 1ST STAIN,,Per Unit,96.00
United HealthCare,HMO,88348,CPT4/HCPCS,ELECTRON MICROSCOPY,,Per Unit,96.00
United HealthCare,HMO,88350,CPT4/HCPCS,IMMUNOFLUOR ANTB ADDL STAIN,,Per Unit,96.00
United HealthCare,HMO,88355,CPT4/HCPCS,ANALYSIS SKELETAL MUSCLE,,Per Unit,96.00
United HealthCare,HMO,88356,CPT4/HCPCS,ANALYSIS NERVE,,Per Unit,96.00
United HealthCare,HMO,88358,CPT4/HCPCS,ANALYSIS TUMOR,,Per Unit,96.00
United HealthCare,HMO,88360,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/MANUAL,,Per Unit,96.00
United HealthCare,HMO,88361,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/COMPUT,,Per Unit,96.00
United HealthCare,HMO,88362,CPT4/HCPCS,NERVE TEASING PREPARATIONS,,Per Unit,96.00
United HealthCare,HMO,88363,CPT4/HCPCS,XM ARCHIVE TISSUE MOLEC ANAL,,Per Unit,96.00
United HealthCare,HMO,88364,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Per Unit,96.00
United HealthCare,HMO,88365,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Per Unit,96.00
United HealthCare,HMO,88366,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Per Unit,96.00
United HealthCare,HMO,88367,CPT4/HCPCS,INSITU HYBRIDIZATION AUTO,,Per Unit,96.00
United HealthCare,HMO,88368,CPT4/HCPCS,INSITU HYBRIDIZATION MANUAL,,Per Unit,96.00
United HealthCare,HMO,88369,CPT4/HCPCS,M/PHMTRC ALYSISHQUANT/SEMIQ,,Per Unit,96.00
United HealthCare,HMO,88371,CPT4/HCPCS,PROTEIN WESTERN BLOT TISSUE,,Per Unit,96.00
United HealthCare,HMO,88372,CPT4/HCPCS,PROTEIN ANALYSIS W/PROBE,,Per Unit,96.00
United HealthCare,HMO,88373,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Per Unit,96.00
United HealthCare,HMO,88374,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Per Unit,96.00
United HealthCare,HMO,88375,CPT4/HCPCS,OPTICAL ENDOMICROSCPY INTERP,,Per Unit,96.00
United HealthCare,HMO,88377,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Per Unit,96.00
United HealthCare,HMO,88380,CPT4/HCPCS,MICRODISSECTION LASER,,Per Unit,96.00
United HealthCare,HMO,88381,CPT4/HCPCS,MICRODISSECTION MANUAL,,Per Unit,96.00
United HealthCare,HMO,88387,CPT4/HCPCS,TISS EXAM MOLECULAR STUDY,,Per Unit,96.00
United HealthCare,HMO,88388,CPT4/HCPCS,TISS EX MOLECUL STUDY ADD-ON,,Per Unit,96.00
United HealthCare,HMO,88720,CPT4/HCPCS,BILIRUBIN TOTAL TRANSCUT,,Per Unit,96.00
United HealthCare,HMO,88738,CPT4/HCPCS,HGB QUANT TRANSCUTANEOUS,,Per Unit,96.00
United HealthCare,HMO,88740,CPT4/HCPCS,TRANSCUTANEOUS CARBOXYHB,,Per Unit,96.00
United HealthCare,HMO,88741,CPT4/HCPCS,TRANSCUTANEOUS METHB,,Per Unit,96.00
United HealthCare,HMO,89049,CPT4/HCPCS,CHCT FOR MAL HYPERTHERMIA,,Per Unit,96.00
United HealthCare,HMO,89050,CPT4/HCPCS,BODY FLUID CELL COUNT,,Per Unit,96.00
United HealthCare,HMO,89051,CPT4/HCPCS,BODY FLUID CELL COUNT,,Per Unit,96.00
United HealthCare,HMO,89055,CPT4/HCPCS,LEUKOCYTE ASSESSMENT FECAL,,Per Unit,96.00
United HealthCare,HMO,89060,CPT4/HCPCS,EXAM SYNOVIAL FLUID CRYSTALS,,Per Unit,96.00
United HealthCare,HMO,89125,CPT4/HCPCS,SPECIMEN FAT STAIN,,Per Unit,96.00
United HealthCare,HMO,89160,CPT4/HCPCS,EXAM FECES FOR MEAT FIBERS,,Per Unit,96.00
United HealthCare,HMO,89190,CPT4/HCPCS,NASAL SMEAR FOR EOSINOPHILS,,Per Unit,96.00
United HealthCare,HMO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Per Unit,96.00
United HealthCare,HMO,89230,CPT4/HCPCS,COLLECT SWEAT FOR TEST,,Per Unit,96.00
United HealthCare,HMO,89250,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Per Unit,96.00
United HealthCare,HMO,89251,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Per Unit,96.00
United HealthCare,HMO,89253,CPT4/HCPCS,EMBRYO HATCHING,,Per Unit,96.00
United HealthCare,HMO,89254,CPT4/HCPCS,OOCYTE IDENTIFICATION,,Per Unit,96.00
United HealthCare,HMO,89255,CPT4/HCPCS,PREPARE EMBRYO FOR TRANSFER,,Per Unit,96.00
United HealthCare,HMO,89257,CPT4/HCPCS,SPERM IDENTIFICATION,,Per Unit,96.00
United HealthCare,HMO,89258,CPT4/HCPCS,CRYOPRESERVATION EMBRYO(S),,Per Unit,96.00
United HealthCare,HMO,89259,CPT4/HCPCS,CRYOPRESERVATION SPERM,,Per Unit,96.00
United HealthCare,HMO,89260,CPT4/HCPCS,SPERM ISOLATION SIMPLE,,Per Unit,96.00
United HealthCare,HMO,89261,CPT4/HCPCS,SPERM ISOLATION COMPLEX,,Per Unit,96.00
United HealthCare,HMO,89264,CPT4/HCPCS,IDENTIFY SPERM TISSUE,,Per Unit,96.00
United HealthCare,HMO,89268,CPT4/HCPCS,INSEMINATION OF OOCYTES,,Per Unit,96.00
United HealthCare,HMO,89272,CPT4/HCPCS,EXTENDED CULTURE OF OOCYTES,,Per Unit,96.00
United HealthCare,HMO,89280,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,Per Unit,96.00
United HealthCare,HMO,89281,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,Per Unit,96.00
United HealthCare,HMO,89290,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,Per Unit,96.00
United HealthCare,HMO,89291,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,Per Unit,96.00
United HealthCare,HMO,89300,CPT4/HCPCS,SEMEN ANALYSIS W/HUHNER,,Per Unit,96.00
United HealthCare,HMO,89310,CPT4/HCPCS,SEMEN ANALYSIS W/COUNT,,Per Unit,96.00
United HealthCare,HMO,89320,CPT4/HCPCS,SEMEN ANAL VOL/COUNT/MOT,,Per Unit,96.00
United HealthCare,HMO,89321,CPT4/HCPCS,SEMEN ANAL SPERM DETECTION,,Per Unit,96.00
United HealthCare,HMO,89322,CPT4/HCPCS,SEMEN ANAL STRICT CRITERIA,,Per Unit,96.00
United HealthCare,HMO,89325,CPT4/HCPCS,SPERM ANTIBODY TEST,,Per Unit,96.00
United HealthCare,HMO,89329,CPT4/HCPCS,SPERM EVALUATION TEST,,Per Unit,96.00
United HealthCare,HMO,89330,CPT4/HCPCS,EVALUATION CERVICAL MUCUS,,Per Unit,96.00
United HealthCare,HMO,89331,CPT4/HCPCS,RETROGRADE EJACULATION ANAL,,Per Unit,96.00
United HealthCare,HMO,89335,CPT4/HCPCS,CRYOPRESERVE TESTICULAR TISS,,Per Unit,96.00
United HealthCare,HMO,89337,CPT4/HCPCS,CRYOPRESERVATION OOCYTE(S),,Per Unit,96.00
United HealthCare,HMO,89342,CPT4/HCPCS,STORAGE/YEAR EMBRYO(S),,Per Unit,96.00
United HealthCare,HMO,89343,CPT4/HCPCS,STORAGE/YEAR SPERM/SEMEN,,Per Unit,96.00
United HealthCare,HMO,89344,CPT4/HCPCS,STORAGE/YEAR REPROD TISSUE,,Per Unit,96.00
United HealthCare,HMO,89346,CPT4/HCPCS,STORAGE/YEAR OOCYTE(S),,Per Unit,96.00
United HealthCare,HMO,89352,CPT4/HCPCS,THAWING CRYOPRESRVED EMBRYO,,Per Unit,96.00
United HealthCare,HMO,89353,CPT4/HCPCS,THAWING CRYOPRESRVED SPERM,,Per Unit,96.00
United HealthCare,HMO,89354,CPT4/HCPCS,THAW CRYOPRSVRD REPROD TISS,,Per Unit,96.00
United HealthCare,HMO,89356,CPT4/HCPCS,THAWING CRYOPRESRVED OOCYTE,,Per Unit,96.00
United HealthCare,HMO,91010,CPT4/HCPCS,ESOPHAGUS MOTILITY STUDY,,Grouper Rate,1145.00
United HealthCare,HMO,91013,CPT4/HCPCS,ESOPHGL MOTIL W/STIM/PERFUS,,Grouper Rate,1145.00
United HealthCare,HMO,91020,CPT4/HCPCS,GASTRIC MOTILITY STUDIES,,Grouper Rate,1145.00
United HealthCare,HMO,91022,CPT4/HCPCS,DUODENAL MOTILITY STUDY,,Grouper Rate,1145.00
United HealthCare,HMO,91030,CPT4/HCPCS,ACID PERFUSION OF ESOPHAGUS,,Grouper Rate,1145.00
United HealthCare,HMO,91034,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX TEST,,Grouper Rate,1145.00
United HealthCare,HMO,91035,CPT4/HCPCS,G-ESOPH REFLX TST W/ELECTROD,,Grouper Rate,1145.00
United HealthCare,HMO,91037,CPT4/HCPCS,ESOPH IMPED FUNCTION TEST,,Grouper Rate,1145.00
United HealthCare,HMO,91038,CPT4/HCPCS,ESOPH IMPED FUNCT TEST > 1HR,,Grouper Rate,1145.00
United HealthCare,HMO,91040,CPT4/HCPCS,ESOPH BALLOON DISTENSION TST,,Grouper Rate,1145.00
United HealthCare,HMO,91065,CPT4/HCPCS,BREATH HYDROGEN/METHANE TEST,,Grouper Rate,1145.00
United HealthCare,HMO,91110,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,91111,CPT4/HCPCS,ESOPHAGEAL CAPSULE ENDOSCOPY,,Grouper Rate,1291.00
United HealthCare,HMO,91112,CPT4/HCPCS,GI WIRELESS CAPSULE MEASURE,,Grouper Rate,1291.00
United HealthCare,HMO,91117,CPT4/HCPCS,COLON MOTILITY 6 HR STUDY,,Grouper Rate,1145.00
United HealthCare,HMO,91120,CPT4/HCPCS,RECTAL SENSATION TEST,,Grouper Rate,1145.00
United HealthCare,HMO,91122,CPT4/HCPCS,ANAL PRESSURE RECORD,,Grouper Rate,1145.00
United HealthCare,HMO,91132,CPT4/HCPCS,ELECTROGASTROGRAPHY,,Grouper Rate,1145.00
United HealthCare,HMO,91133,CPT4/HCPCS,ELECTROGASTROGRAPHY W/TEST,,Grouper Rate,1145.00
United HealthCare,HMO,91299,CPT4/HCPCS,GASTROENTEROLOGY PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,Grouper Rate,3965.00
United HealthCare,HMO,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,Grouper Rate,1145.00
United HealthCare,HMO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,288.00
United HealthCare,HMO,92508,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,288.00
United HealthCare,HMO,92521,CPT4/HCPCS,EVALUATION OF SPEECH FLUENCY,,Case Rate,288.00
United HealthCare,HMO,92522,CPT4/HCPCS,EVALUATE SPEECH PRODUCTION,,Case Rate,288.00
United HealthCare,HMO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,Case Rate,288.00
United HealthCare,HMO,92524,CPT4/HCPCS,BEHAVRAL QUALIT ANALYS VOICE,,Case Rate,288.00
United HealthCare,HMO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Case Rate,6612.00
United HealthCare,HMO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Case Rate,6612.00
United HealthCare,HMO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Case Rate,6612.00
United HealthCare,HMO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Case Rate,6612.00
United HealthCare,HMO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Case Rate,9547.00
United HealthCare,HMO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Case Rate,9547.00
United HealthCare,HMO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Case Rate,9547.00
United HealthCare,HMO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Case Rate,9547.00
United HealthCare,HMO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Case Rate,9547.00
United HealthCare,HMO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Case Rate,9547.00
United HealthCare,HMO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Grouper Rate,6612.00
United HealthCare,HMO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Case Rate,9547.00
United HealthCare,HMO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Case Rate,9547.00
United HealthCare,HMO,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,Grouper Rate,1145.00
United HealthCare,HMO,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,Grouper Rate,1235.00
United HealthCare,HMO,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Grouper Rate,1235.00
United HealthCare,HMO,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,Grouper Rate,1235.00
United HealthCare,HMO,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,Grouper Rate,1291.00
United HealthCare,HMO,92971,CPT4/HCPCS,CARDIOASSIST EXTERNAL,,Grouper Rate,1291.00
United HealthCare,HMO,92973,CPT4/HCPCS,PRQ CORONARY MECH THROMBECT,,Grouper Rate,1145.00
United HealthCare,HMO,92974,CPT4/HCPCS,CATH PLACE CARDIO BRACHYTX,,Grouper Rate,1145.00
United HealthCare,HMO,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Grouper Rate,1291.00
United HealthCare,HMO,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Grouper Rate,1145.00
United HealthCare,HMO,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,Grouper Rate,1145.00
United HealthCare,HMO,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,Grouper Rate,1145.00
United HealthCare,HMO,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,Grouper Rate,6612.00
United HealthCare,HMO,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,6612.00
United HealthCare,HMO,92990,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,6612.00
United HealthCare,HMO,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1291.00
United HealthCare,HMO,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1291.00
United HealthCare,HMO,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Grouper Rate,6612.00
United HealthCare,HMO,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Grouper Rate,6612.00
United HealthCare,HMO,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,608.00
United HealthCare,HMO,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,608.00
United HealthCare,HMO,93306,CPT4/HCPCS,TTE W/DOPPLER COMPLETE,,Case Rate,608.00
United HealthCare,HMO,93307,CPT4/HCPCS,TTE W/O DOPPLER COMPLETE,,Case Rate,608.00
United HealthCare,HMO,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,Case Rate,608.00
United HealthCare,HMO,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,608.00
United HealthCare,HMO,93313,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,608.00
United HealthCare,HMO,93314,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,608.00
United HealthCare,HMO,93315,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,608.00
United HealthCare,HMO,93316,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,608.00
United HealthCare,HMO,93317,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,608.00
United HealthCare,HMO,93318,CPT4/HCPCS,ECHO TRANSESOPHAGEAL INTRAOP,,Case Rate,608.00
United HealthCare,HMO,93320,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,608.00
United HealthCare,HMO,93321,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,608.00
United HealthCare,HMO,93325,CPT4/HCPCS,DOPPLER COLOR FLOW ADD-ON,,Case Rate,608.00
United HealthCare,HMO,93350,CPT4/HCPCS,STRESS TTE ONLY,,Case Rate,608.00
United HealthCare,HMO,93351,CPT4/HCPCS,STRESS TTE COMPLETE,,Case Rate,608.00
United HealthCare,HMO,93352,CPT4/HCPCS,ADMIN ECG CONTRAST AGENT,,Case Rate,608.00
United HealthCare,HMO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Grouper Rate,5730.00
United HealthCare,HMO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Grouper Rate,5730.00
United HealthCare,HMO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Grouper Rate,5730.00
United HealthCare,HMO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Grouper Rate,5730.00
United HealthCare,HMO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Grouper Rate,5730.00
United HealthCare,HMO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Grouper Rate,5730.00
United HealthCare,HMO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Grouper Rate,5730.00
United HealthCare,HMO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Grouper Rate,5730.00
United HealthCare,HMO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Grouper Rate,5730.00
United HealthCare,HMO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,5730.00
United HealthCare,HMO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,5730.00
United HealthCare,HMO,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Grouper Rate,1145.00
United HealthCare,HMO,93463,CPT4/HCPCS,DRUG ADMIN & HEMODYNMIC MEAS,,Grouper Rate,1145.00
United HealthCare,HMO,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Grouper Rate,1145.00
United HealthCare,HMO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Grouper Rate,1235.00
United HealthCare,HMO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Grouper Rate,4847.00
United HealthCare,HMO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Grouper Rate,4847.00
United HealthCare,HMO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,4847.00
United HealthCare,HMO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,4847.00
United HealthCare,HMO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,4847.00
United HealthCare,HMO,93561,CPT4/HCPCS,CARDIAC OUTPUT MEASUREMENT,,Grouper Rate,1145.00
United HealthCare,HMO,93562,CPT4/HCPCS,CARD OUTPUT MEASURE SUBSQ,,Grouper Rate,1145.00
United HealthCare,HMO,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,Grouper Rate,1145.00
United HealthCare,HMO,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,Grouper Rate,1145.00
United HealthCare,HMO,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,Grouper Rate,1145.00
United HealthCare,HMO,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,Grouper Rate,1145.00
United HealthCare,HMO,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,Grouper Rate,1145.00
United HealthCare,HMO,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,Grouper Rate,1145.00
United HealthCare,HMO,93571,CPT4/HCPCS,HEART FLOW RESERVE MEASURE,,Grouper Rate,1145.00
United HealthCare,HMO,93572,CPT4/HCPCS,HEART FLOW RESERVE MEASURE,,Grouper Rate,1145.00
United HealthCare,HMO,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Grouper Rate,10164.00
United HealthCare,HMO,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Grouper Rate,10164.00
United HealthCare,HMO,93582,CPT4/HCPCS,PERQ TRANSCATH CLOSURE PDA,,Grouper Rate,10164.00
United HealthCare,HMO,93583,CPT4/HCPCS,PERQ TRANSCATH SEPTAL REDUXN,,Grouper Rate,1291.00
United HealthCare,HMO,93590,CPT4/HCPCS,PERQ TRANSCATH CLS MITRAL,,Grouper Rate,13506.00
United HealthCare,HMO,93591,CPT4/HCPCS,PERQ TRANSCATH CLS AORTIC,,Grouper Rate,13506.00
United HealthCare,HMO,93592,CPT4/HCPCS,PERQ TRANSCATH CLOSURE EACH,,Grouper Rate,1145.00
United HealthCare,HMO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Case Rate,4847.00
United HealthCare,HMO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Case Rate,4847.00
United HealthCare,HMO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Case Rate,4847.00
United HealthCare,HMO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Case Rate,4847.00
United HealthCare,HMO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Case Rate,4847.00
United HealthCare,HMO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Case Rate,4847.00
United HealthCare,HMO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Case Rate,4847.00
United HealthCare,HMO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,4847.00
United HealthCare,HMO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,4847.00
United HealthCare,HMO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Case Rate,4847.00
United HealthCare,HMO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,4847.00
United HealthCare,HMO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,4847.00
United HealthCare,HMO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,4847.00
United HealthCare,HMO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,4847.00
United HealthCare,HMO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Case Rate,4847.00
United HealthCare,HMO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Case Rate,4847.00
United HealthCare,HMO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Case Rate,4847.00
United HealthCare,HMO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Case Rate,4847.00
United HealthCare,HMO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,4847.00
United HealthCare,HMO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,4847.00
United HealthCare,HMO,93644,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,4847.00
United HealthCare,HMO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,6612.00
United HealthCare,HMO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Case Rate,6612.00
United HealthCare,HMO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Case Rate,6612.00
United HealthCare,HMO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Case Rate,6612.00
United HealthCare,HMO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Case Rate,6612.00
United HealthCare,HMO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Case Rate,6612.00
United HealthCare,HMO,93660,CPT4/HCPCS,TILT TABLE EVALUATION,,Grouper Rate,1145.00
United HealthCare,HMO,93662,CPT4/HCPCS,INTRACARDIAC ECG (ICE),,Grouper Rate,1145.00
United HealthCare,HMO,93745,CPT4/HCPCS,SET-UP CARDIOVERT-DEFIBRILL,,Grouper Rate,1145.00
United HealthCare,HMO,93750,CPT4/HCPCS,INTERROGATION VAD IN PERSON,,Grouper Rate,1145.00
United HealthCare,HMO,93799,CPT4/HCPCS,CARDIOVASCULAR PROCEDURE,,Grouper Rate,1145.00
United HealthCare,HMO,95800,CPT4/HCPCS,SLP STDY UNATTENDED,,Case Rate,3302.00
United HealthCare,HMO,95801,CPT4/HCPCS,SLP STDY UNATND W/ANAL,,Case Rate,3302.00
United HealthCare,HMO,95805,CPT4/HCPCS,MULTIPLE SLEEP LATENCY TEST,,Case Rate,3302.00
United HealthCare,HMO,95806,CPT4/HCPCS,SLEEP STUDY UNATT&RESP EFFT,,Case Rate,3302.00
United HealthCare,HMO,95807,CPT4/HCPCS,SLEEP STUDY ATTENDED,,Case Rate,3302.00
United HealthCare,HMO,95808,CPT4/HCPCS,POLYSOM ANY AGE 1-3> PARAM,,Case Rate,3302.00
United HealthCare,HMO,95810,CPT4/HCPCS,POLYSOM 6/> YRS 4/> PARAM,,Case Rate,3302.00
United HealthCare,HMO,95811,CPT4/HCPCS,POLYSOM 6/>YRS CPAP 4/> PARM,,Case Rate,3302.00
United HealthCare,HMO,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Grouper Rate,1145.00
United HealthCare,HMO,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Grouper Rate,1145.00
United HealthCare,HMO,96567,CPT4/HCPCS,PDT DSTR PRMLG LES SKN,,Grouper Rate,1145.00
United HealthCare,HMO,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,Grouper Rate,1145.00
United HealthCare,HMO,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,Grouper Rate,1145.00
United HealthCare,HMO,96573,CPT4/HCPCS,PDT DSTR PRMLG LES PHYS/QHP,,Grouper Rate,1145.00
United HealthCare,HMO,96574,CPT4/HCPCS,DBRDMT PRMLG LES W/PDT,,Grouper Rate,1145.00
United HealthCare,HMO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Case Rate,288.00
United HealthCare,HMO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Case Rate,288.00
United HealthCare,HMO,97014,CPT4/HCPCS,ELECTRIC STIMULATION THERAPY,,Case Rate,288.00
United HealthCare,HMO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Case Rate,288.00
United HealthCare,HMO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Case Rate,288.00
United HealthCare,HMO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Case Rate,288.00
United HealthCare,HMO,97024,CPT4/HCPCS,DIATHERMY EG MICROWAVE,,Case Rate,288.00
United HealthCare,HMO,97026,CPT4/HCPCS,INFRARED THERAPY,,Case Rate,288.00
United HealthCare,HMO,97028,CPT4/HCPCS,ULTRAVIOLET THERAPY,,Case Rate,288.00
United HealthCare,HMO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Case Rate,288.00
United HealthCare,HMO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Case Rate,288.00
United HealthCare,HMO,97034,CPT4/HCPCS,CONTRAST BATH THERAPY,,Case Rate,288.00
United HealthCare,HMO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Case Rate,288.00
United HealthCare,HMO,97036,CPT4/HCPCS,HYDROTHERAPY,,Case Rate,288.00
United HealthCare,HMO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Case Rate,288.00
United HealthCare,HMO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Case Rate,288.00
United HealthCare,HMO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Case Rate,288.00
United HealthCare,HMO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Case Rate,288.00
United HealthCare,HMO,97124,CPT4/HCPCS,MASSAGE THERAPY,,Case Rate,288.00
United HealthCare,HMO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Case Rate,288.00
United HealthCare,HMO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Case Rate,288.00
United HealthCare,HMO,97151,CPT4/HCPCS,BHV ID ASSMT BY PHYS/QHP,,Case Rate,288.00
United HealthCare,HMO,97152,CPT4/HCPCS,BHV ID SUPRT ASSMT BY 1 TECH,,Case Rate,288.00
United HealthCare,HMO,97153,CPT4/HCPCS,ADAPTIVE BEHAVIOR TX BY TECH,,Case Rate,288.00
United HealthCare,HMO,97154,CPT4/HCPCS,GRP ADAPT BHV TX BY TECH,,Case Rate,288.00
United HealthCare,HMO,97155,CPT4/HCPCS,ADAPT BEHAVIOR TX PHYS/QHP,,Case Rate,288.00
United HealthCare,HMO,97156,CPT4/HCPCS,FAM ADAPT BHV TX GDN PHY/QHP,,Case Rate,288.00
United HealthCare,HMO,97157,CPT4/HCPCS,MULT FAM ADAPT BHV TX GDN,,Case Rate,288.00
United HealthCare,HMO,97158,CPT4/HCPCS,GRP ADAPT BHV TX BY PHY/QHP,,Case Rate,288.00
United HealthCare,HMO,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,Case Rate,288.00
United HealthCare,HMO,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,Case Rate,288.00
United HealthCare,HMO,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,Case Rate,288.00
United HealthCare,HMO,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,Case Rate,288.00
United HealthCare,HMO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,Case Rate,288.00
United HealthCare,HMO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,Case Rate,288.00
United HealthCare,HMO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,Case Rate,288.00
United HealthCare,HMO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,Case Rate,288.00
United HealthCare,HMO,97169,CPT4/HCPCS,ATHLETIC TRN EVAL LOW CMPLX,,Case Rate,288.00
United HealthCare,HMO,97170,CPT4/HCPCS,ATHLETIC TRN EVAL MOD CMPLX,,Case Rate,288.00
United HealthCare,HMO,97171,CPT4/HCPCS,ATHLETIC TRN EVAL HIGH CMPLX,,Case Rate,288.00
United HealthCare,HMO,97172,CPT4/HCPCS,ATHLETIC TRN RE-EVAL PLAN CR,,Case Rate,288.00
United HealthCare,HMO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Case Rate,288.00
United HealthCare,HMO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Case Rate,288.00
United HealthCare,HMO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Case Rate,288.00
United HealthCare,HMO,97537,CPT4/HCPCS,COMMUNITY/WORK REINTEGRATION,,Case Rate,288.00
United HealthCare,HMO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Case Rate,288.00
United HealthCare,HMO,97545,CPT4/HCPCS,WORK HARDENING,,Case Rate,288.00
United HealthCare,HMO,97546,CPT4/HCPCS,WORK HARDENING ADD-ON,,Case Rate,288.00
United HealthCare,HMO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Grouper Rate,1145.00
United HealthCare,HMO,C5271,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1145.00
United HealthCare,HMO,C5272,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1145.00
United HealthCare,HMO,C5273,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1291.00
United HealthCare,HMO,C5274,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1145.00
United HealthCare,HMO,C5275,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1145.00
United HealthCare,HMO,C5276,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1145.00
United HealthCare,HMO,C5277,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1145.00
United HealthCare,HMO,C5278,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1145.00
United HealthCare,HMO,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Case Rate,9547.00
United HealthCare,HMO,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Case Rate,9547.00
United HealthCare,HMO,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Case Rate,9547.00
United HealthCare,HMO,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,Case Rate,9547.00
United HealthCare,HMO,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,Case Rate,9547.00
United HealthCare,HMO,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,Case Rate,9547.00
United HealthCare,HMO,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Case Rate,9547.00
United HealthCare,HMO,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Case Rate,9547.00
United HealthCare,HMO,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,Case Rate,9547.00
United HealthCare,HMO,C9725,CPT4/HCPCS,Place endorectal app,,Grouper Rate,1235.00
United HealthCare,HMO,C9726,CPT4/HCPCS,Rxt breast appl place/remov,,Grouper Rate,1145.00
United HealthCare,HMO,C9727,CPT4/HCPCS,Insert palate implants,,Grouper Rate,1291.00
United HealthCare,HMO,C9734,CPT4/HCPCS,U/S trtmt, not leiomyomata,,Grouper Rate,3965.00
United HealthCare,HMO,C9738,CPT4/HCPCS,Blue light cysto imag agent,,Grouper Rate,1145.00
United HealthCare,HMO,C9739,CPT4/HCPCS,Cystoscopy prostatic imp 1-3,,Grouper Rate,3965.00
United HealthCare,HMO,C9740,CPT4/HCPCS,Cysto impl 4 or more,,Grouper Rate,6612.00
United HealthCare,HMO,C9745,CPT4/HCPCS,Nasal endo eustachian tube,,Grouper Rate,5730.00
United HealthCare,HMO,C9747,CPT4/HCPCS,Ablation, hifu, prostate,,Grouper Rate,5730.00
United HealthCare,HMO,C9749,CPT4/HCPCS,Repair nasal stenosis w/imp,,Grouper Rate,3965.00
United HealthCare,HMO,C9751,CPT4/HCPCS,Microwave bronch, 3d, ebus,,Grouper Rate,9547.00
United HealthCare,HMO,C9752,CPT4/HCPCS,Intraosseous des lumb/sacrum,,Grouper Rate,4847.00
United HealthCare,HMO,C9753,CPT4/HCPCS,Intraosseous destruct add'l,,Grouper Rate,1145.00
United HealthCare,HMO,C9754,CPT4/HCPCS,Perc av fistula, direct,,Grouper Rate,9547.00
United HealthCare,HMO,C9755,CPT4/HCPCS,Rf magnetic-guide av fistula,,Grouper Rate,9547.00
United HealthCare,HMO,C9756,CPT4/HCPCS,Fluorescence lymph map w/icg,,Grouper Rate,1145.00
United HealthCare,HMO,C9757,CPT4/HCPCS,Spine/lumbar disk surgery,,Grouper Rate,6612.00
United HealthCare,HMO,C9758,CPT4/HCPCS,Blind interatrial shunt ide,,Grouper Rate,10164.00
United HealthCare,HMO,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Grouper Rate,1235.00
United HealthCare,HMO,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Grouper Rate,1235.00
United HealthCare,HMO,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Grouper Rate,1235.00
United HealthCare,HMO,G0127,CPT4/HCPCS,Trim nail(s),,Grouper Rate,1145.00
United HealthCare,HMO,G0168,CPT4/HCPCS,Wound closure by adhesive,,Grouper Rate,1145.00
United HealthCare,HMO,G0186,CPT4/HCPCS,Dstry eye lesn,fdr vssl tech,,Grouper Rate,1235.00
United HealthCare,HMO,G0259,CPT4/HCPCS,Inject for sacroiliac joint,,Grouper Rate,1145.00
United HealthCare,HMO,G0260,CPT4/HCPCS,Inj for sacroiliac jt anesth,,Grouper Rate,1235.00
United HealthCare,HMO,G0268,CPT4/HCPCS,Removal of impacted wax md,,Grouper Rate,1145.00
United HealthCare,HMO,G0269,CPT4/HCPCS,Occlusive device in vein art,,Grouper Rate,1145.00
United HealthCare,HMO,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,Grouper Rate,6612.00
United HealthCare,HMO,G0289,CPT4/HCPCS,Arthro, loose body + chondro,,Grouper Rate,1145.00
United HealthCare,HMO,G0339,CPT4/HCPCS,Robot lin-radsurg com, first,,Grouper Rate,5730.00
United HealthCare,HMO,G0340,CPT4/HCPCS,Robt lin-radsurg fractx 2-5,,Grouper Rate,4847.00
United HealthCare,HMO,G0398,CPT4/HCPCS,Home sleep test/type 2 Porta,,Case Rate,3302.00
United HealthCare,HMO,G0399,CPT4/HCPCS,Home sleep test/type 3 Porta,,Case Rate,3302.00
United HealthCare,HMO,G0400,CPT4/HCPCS,Home sleep test/type 4 Porta,,Case Rate,3302.00
United HealthCare,HMO,G0412,CPT4/HCPCS,Open tx iliac spine uni/bil,,Grouper Rate,1291.00
United HealthCare,HMO,G0413,CPT4/HCPCS,Pelvic ring fracture uni/bil,,Grouper Rate,4847.00
United HealthCare,HMO,G0414,CPT4/HCPCS,Pelvic ring fx treat int fix,,Grouper Rate,1291.00
United HealthCare,HMO,G0415,CPT4/HCPCS,Open tx post pelvic fxcture,,Grouper Rate,1291.00
United HealthCare,HMO,G0428,CPT4/HCPCS,Collagen meniscus implant,,Grouper Rate,1291.00
United HealthCare,HMO,G0448,CPT4/HCPCS,Place perm pacing cardiovert,,Grouper Rate,1291.00
United HealthCare,HMO,G0453,CPT4/HCPCS,Cont intraop neuro monitor,,Grouper Rate,1145.00
United HealthCare,HMO,G0516,CPT4/HCPCS,Insert drug del implant, >=4,,Grouper Rate,1145.00
United HealthCare,HMO,G0517,CPT4/HCPCS,Remove drug implant,,Grouper Rate,1145.00
United HealthCare,HMO,G0518,CPT4/HCPCS,Remove w insert drug implant,,Grouper Rate,1145.00
United HealthCare,HMO,,,NICU/Newborn - Level I,,Per Diem,1076.00
United HealthCare,HMO,,,Medical Surgical,,Per Diem,4415.00
United HealthCare,HMO,,,Telemetry,,Per Diem,5024.00
United HealthCare,HMO,,,Neo ICU,,Per Diem,5129.00
United HealthCare,HMO,,,Critical Care,,Per Diem,7458.00
United HealthCare,PPO,0054T,CPT4/HCPCS,BONE SRGRY CMPTR FLUOR IMAGE,,Case Rate,1042.00
United HealthCare,PPO,0055T,CPT4/HCPCS,BONE SRGRY CMPTR CT/MRI IMAG,,Case Rate,1042.00
United HealthCare,PPO,0071T,CPT4/HCPCS,US LEIOMYOMATA ABLATE <200,,Grouper Rate,4204.00
United HealthCare,PPO,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,Grouper Rate,4204.00
United HealthCare,PPO,0075T,CPT4/HCPCS,PERQ STENT/CHEST VERT ART,,Grouper Rate,1370.00
United HealthCare,PPO,0076T,CPT4/HCPCS,S&I STENT/CHEST VERT ART,,Grouper Rate,1370.00
United HealthCare,PPO,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,Grouper Rate,24180.00
United HealthCare,PPO,0101T,CPT4/HCPCS,EXTRACORP SHOCKWV TX HI ENRG,,Grouper Rate,5138.00
United HealthCare,PPO,0102T,CPT4/HCPCS,EXTRACORP SHOCKWV TX ANESTH,,Grouper Rate,5138.00
United HealthCare,PPO,0163T,CPT4/HCPCS,LUMB ARTIF DISKECTOMY ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,0164T,CPT4/HCPCS,REMOVE LUMB ARTIF DISC ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,0165T,CPT4/HCPCS,REVISE LUMB ARTIF DISC ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,Grouper Rate,5138.00
United HealthCare,PPO,0191T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,6075.00
United HealthCare,PPO,0200T,CPT4/HCPCS,PERQ SACRAL AUGMT UNILAT INJ,,Grouper Rate,5138.00
United HealthCare,PPO,0201T,CPT4/HCPCS,PERQ SACRAL AUGMT BILAT INJ,,Grouper Rate,5138.00
United HealthCare,PPO,0202T,CPT4/HCPCS,POST VERT ARTHRPLST 1 LUMBAR,,Grouper Rate,1370.00
United HealthCare,PPO,0207T,CPT4/HCPCS,CLEAR EYELID GLAND W/HEAT,,Grouper Rate,1214.00
United HealthCare,PPO,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1308.00
United HealthCare,PPO,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1214.00
United HealthCare,PPO,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,Grouper Rate,1214.00
United HealthCare,PPO,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1308.00
United HealthCare,PPO,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1214.00
United HealthCare,PPO,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,Grouper Rate,1214.00
United HealthCare,PPO,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,Grouper Rate,1370.00
United HealthCare,PPO,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,Grouper Rate,1370.00
United HealthCare,PPO,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,Grouper Rate,5138.00
United HealthCare,PPO,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,1308.00
United HealthCare,PPO,0229T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,Grouper Rate,1214.00
United HealthCare,PPO,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,1308.00
United HealthCare,PPO,0231T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,Grouper Rate,1214.00
United HealthCare,PPO,0232T,CPT4/HCPCS,NJX PLATELET PLASMA,,Grouper Rate,1214.00
United HealthCare,PPO,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,Grouper Rate,10119.00
United HealthCare,PPO,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,Grouper Rate,1370.00
United HealthCare,PPO,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,Grouper Rate,10119.00
United HealthCare,PPO,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,Grouper Rate,10119.00
United HealthCare,PPO,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,Grouper Rate,10119.00
United HealthCare,PPO,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,Grouper Rate,6075.00
United HealthCare,PPO,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,Grouper Rate,6075.00
United HealthCare,PPO,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,Grouper Rate,6075.00
United HealthCare,PPO,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,Grouper Rate,6075.00
United HealthCare,PPO,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,Grouper Rate,14317.00
United HealthCare,PPO,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,Grouper Rate,5138.00
United HealthCare,PPO,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,Grouper Rate,14317.00
United HealthCare,PPO,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,Grouper Rate,7007.00
United HealthCare,PPO,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,Grouper Rate,5138.00
United HealthCare,PPO,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,Grouper Rate,5138.00
United HealthCare,PPO,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,Grouper Rate,7007.00
United HealthCare,PPO,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,Grouper Rate,7007.00
United HealthCare,PPO,0278T,CPT4/HCPCS,TEMPR,,Grouper Rate,1214.00
United HealthCare,PPO,0290T,CPT4/HCPCS,LASER INC FOR PKP/LKP RECIP,,Grouper Rate,1214.00
United HealthCare,PPO,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,Grouper Rate,14317.00
United HealthCare,PPO,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,Grouper Rate,14317.00
United HealthCare,PPO,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,Grouper Rate,5138.00
United HealthCare,PPO,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,Grouper Rate,5138.00
United HealthCare,PPO,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,Grouper Rate,5138.00
United HealthCare,PPO,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,Grouper Rate,14317.00
United HealthCare,PPO,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,Grouper Rate,1214.00
United HealthCare,PPO,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,Grouper Rate,4204.00
United HealthCare,PPO,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,Grouper Rate,5138.00
United HealthCare,PPO,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,Grouper Rate,5138.00
United HealthCare,PPO,0342T,CPT4/HCPCS,THXP APHERESIS W/HDL DELIP,,Grouper Rate,6075.00
United HealthCare,PPO,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,Grouper Rate,1370.00
United HealthCare,PPO,0347T,CPT4/HCPCS,INS BONE DEVICE FOR RSA,,Grouper Rate,1214.00
United HealthCare,PPO,0355T,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,0356T,CPT4/HCPCS,INSRT DRUG DEVICE FOR IOP,,Grouper Rate,1214.00
United HealthCare,PPO,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,Grouper Rate,1214.00
United HealthCare,PPO,0396T,CPT4/HCPCS,INTRAOP KINETIC BALNCE SENSR,,Grouper Rate,1214.00
United HealthCare,PPO,0397T,CPT4/HCPCS,ERCP W/OPTICAL ENDOMICROSCPY,,Grouper Rate,1214.00
United HealthCare,PPO,0398T,CPT4/HCPCS,MRGFUS STRTCTC LES ABLTJ,,Grouper Rate,10119.00
United HealthCare,PPO,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,Grouper Rate,4204.00
United HealthCare,PPO,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,Grouper Rate,6075.00
United HealthCare,PPO,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,Grouper Rate,24180.00
United HealthCare,PPO,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,Grouper Rate,24180.00
United HealthCare,PPO,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,Grouper Rate,10119.00
United HealthCare,PPO,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,Grouper Rate,10119.00
United HealthCare,PPO,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,Grouper Rate,5138.00
United HealthCare,PPO,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,Grouper Rate,5138.00
United HealthCare,PPO,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,Grouper Rate,24180.00
United HealthCare,PPO,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,Grouper Rate,1308.00
United HealthCare,PPO,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,Grouper Rate,1370.00
United HealthCare,PPO,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,1214.00
United HealthCare,PPO,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,Grouper Rate,1214.00
United HealthCare,PPO,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,Grouper Rate,6075.00
United HealthCare,PPO,0424T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA COMPL,,Grouper Rate,24180.00
United HealthCare,PPO,0425T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA SEN LD,,Grouper Rate,7007.00
United HealthCare,PPO,0426T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA STM LD,,Grouper Rate,14317.00
United HealthCare,PPO,0427T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA PLS GN,,Grouper Rate,14317.00
United HealthCare,PPO,0428T,CPT4/HCPCS,RMVL NSTIM APNEA PLS GEN,,Grouper Rate,5138.00
United HealthCare,PPO,0429T,CPT4/HCPCS,RMVL NSTIM APNEA SEN LD,,Grouper Rate,5138.00
United HealthCare,PPO,0430T,CPT4/HCPCS,RMVL NSTIM APNEA STIMJ LD,,Grouper Rate,5138.00
United HealthCare,PPO,0431T,CPT4/HCPCS,RMVL/RPLC NSTIM APNEA PLS GN,,Grouper Rate,14317.00
United HealthCare,PPO,0432T,CPT4/HCPCS,REPOS NSTIM APNEA STIMJ LD,,Grouper Rate,5138.00
United HealthCare,PPO,0433T,CPT4/HCPCS,REPOS NSTIM APNEA SENSING LD,,Grouper Rate,5138.00
United HealthCare,PPO,0437T,CPT4/HCPCS,IMPLTJ SYNTH RNFCMT ABDL WAL,,Grouper Rate,1214.00
United HealthCare,PPO,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,Grouper Rate,6075.00
United HealthCare,PPO,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,Grouper Rate,6075.00
United HealthCare,PPO,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,Grouper Rate,6075.00
United HealthCare,PPO,0443T,CPT4/HCPCS,R-T SPCTRL ALYS PRST8 TISS,,Grouper Rate,1214.00
United HealthCare,PPO,0444T,CPT4/HCPCS,1ST PLMT DRUG ELUT OC INS,,Grouper Rate,1214.00
United HealthCare,PPO,0445T,CPT4/HCPCS,SBSQT PLMT DRUG ELUT OC INS,,Grouper Rate,1214.00
United HealthCare,PPO,0446T,CPT4/HCPCS,INSJ IMPLTBL GLUCOSE SENSOR,,Grouper Rate,1214.00
United HealthCare,PPO,0447T,CPT4/HCPCS,RMVL IMPLTBL GLUCOSE SENSOR,,Grouper Rate,1214.00
United HealthCare,PPO,0448T,CPT4/HCPCS,REMVL INSJ IMPLTBL GLUC SENS,,Grouper Rate,1214.00
United HealthCare,PPO,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,Grouper Rate,6075.00
United HealthCare,PPO,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,Grouper Rate,1214.00
United HealthCare,PPO,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,Grouper Rate,1370.00
United HealthCare,PPO,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,Grouper Rate,1370.00
United HealthCare,PPO,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,Grouper Rate,7007.00
United HealthCare,PPO,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,Grouper Rate,7007.00
United HealthCare,PPO,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,Grouper Rate,1370.00
United HealthCare,PPO,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,Grouper Rate,1370.00
United HealthCare,PPO,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,Grouper Rate,5138.00
United HealthCare,PPO,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,Grouper Rate,5138.00
United HealthCare,PPO,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,Grouper Rate,1370.00
United HealthCare,PPO,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,Grouper Rate,5138.00
United HealthCare,PPO,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,Grouper Rate,1370.00
United HealthCare,PPO,0462T,CPT4/HCPCS,PRGRMG EVAL AORTIC VENTR SYS,,Grouper Rate,1214.00
United HealthCare,PPO,0463T,CPT4/HCPCS,INTERROG AORTIC VENTR SYS,,Grouper Rate,1214.00
United HealthCare,PPO,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,Grouper Rate,1214.00
United HealthCare,PPO,0466T,CPT4/HCPCS,INSJ CH WAL RESPIR ELTRD/RA,,Grouper Rate,1214.00
United HealthCare,PPO,0467T,CPT4/HCPCS,REVJ/RPLMNT CH RESPIR ELTRD,,Grouper Rate,5138.00
United HealthCare,PPO,0468T,CPT4/HCPCS,RMVL CH WAL RESPIR ELTRD/RA,,Grouper Rate,5138.00
United HealthCare,PPO,0474T,CPT4/HCPCS,INSJ AQUEOUS DRG DEV IO RSVR,,Grouper Rate,6075.00
United HealthCare,PPO,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,Grouper Rate,1214.00
United HealthCare,PPO,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,Grouper Rate,1214.00
United HealthCare,PPO,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,Grouper Rate,1214.00
United HealthCare,PPO,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,Grouper Rate,1370.00
United HealthCare,PPO,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,Grouper Rate,1370.00
United HealthCare,PPO,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,Grouper Rate,1370.00
United HealthCare,PPO,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,Grouper Rate,1370.00
United HealthCare,PPO,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,Grouper Rate,1214.00
United HealthCare,PPO,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,Grouper Rate,1214.00
United HealthCare,PPO,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,Grouper Rate,1370.00
United HealthCare,PPO,0495T,CPT4/HCPCS,MNTR CDVR DON LNG 1ST 2 HRS,,Grouper Rate,1370.00
United HealthCare,PPO,0496T,CPT4/HCPCS,MNTR CDVR DON LNG EA ADDL HR,,Grouper Rate,1370.00
United HealthCare,PPO,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,Grouper Rate,4204.00
United HealthCare,PPO,0505T,CPT4/HCPCS,EV FEMPOP ARTL REVSC,,Grouper Rate,10119.00
United HealthCare,PPO,0510T,CPT4/HCPCS,RMVL SINUS TARSI IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,0511T,CPT4/HCPCS,RMVL&RINSJ SINUS TARSI IMPLT,,Grouper Rate,4204.00
United HealthCare,PPO,0512T,CPT4/HCPCS,ESW INTEG WND HLG 1ST WND,,Grouper Rate,1214.00
United HealthCare,PPO,0513T,CPT4/HCPCS,ESW INTEG WND HLG EA ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,0514T,CPT4/HCPCS,INTRAOP VIS AXIS ID PT FIXJ,,Grouper Rate,1214.00
United HealthCare,PPO,0515T,CPT4/HCPCS,INSJ WCS LV COMPL SYS,,Grouper Rate,24180.00
United HealthCare,PPO,0516T,CPT4/HCPCS,INSJ WCS LV ELTRD ONLY,,Grouper Rate,10119.00
United HealthCare,PPO,0517T,CPT4/HCPCS,INSJ WCS LV PG COMPNT,,Grouper Rate,10119.00
United HealthCare,PPO,0518T,CPT4/HCPCS,RMVL PG COMPNT WCS,,Grouper Rate,5138.00
United HealthCare,PPO,0519T,CPT4/HCPCS,RMVL & RPLCMT PG COMPNT WCS,,Grouper Rate,5138.00
United HealthCare,PPO,0520T,CPT4/HCPCS,RMVL&RPLCMT PG WCS NEW ELTRD,,Grouper Rate,24180.00
United HealthCare,PPO,0523T,CPT4/HCPCS,NTRAPX C FFR W/3D FUNCJL MAP,,Grouper Rate,1214.00
United HealthCare,PPO,0524T,CPT4/HCPCS,EV CATH DIR CHEM ABLTJ W/IMG,,Grouper Rate,5138.00
United HealthCare,PPO,0525T,CPT4/HCPCS,INSJ/RPLCMT COMPL IIMS,,Grouper Rate,10119.00
United HealthCare,PPO,0526T,CPT4/HCPCS,INSJ/RPLCMT IIMS ELTRD ONLY,,Grouper Rate,10119.00
United HealthCare,PPO,0527T,CPT4/HCPCS,INSJ/RPLCMT IIMS IMPLT MNTR,,Grouper Rate,10119.00
United HealthCare,PPO,0530T,CPT4/HCPCS,REMOVAL COMPLETE IIMS,,Grouper Rate,5138.00
United HealthCare,PPO,0531T,CPT4/HCPCS,REMOVAL IIMS ELECTRODE ONLY,,Grouper Rate,5138.00
United HealthCare,PPO,0532T,CPT4/HCPCS,REMOVAL IIMS IMPLT MNTR ONLY,,Grouper Rate,5138.00
United HealthCare,PPO,0543T,CPT4/HCPCS,TA MV RPR W/ARTIF CHORD TEND,,Grouper Rate,1370.00
United HealthCare,PPO,0544T,CPT4/HCPCS,TCAT MV ANNULUS RCNSTJ,,Grouper Rate,1370.00
United HealthCare,PPO,0545T,CPT4/HCPCS,TCAT TV ANNULUS RCNSTJ,,Grouper Rate,1370.00
United HealthCare,PPO,0548T,CPT4/HCPCS,TPRNL BALO CNTNC DEV BI,,Grouper Rate,10772.00
United HealthCare,PPO,0549T,CPT4/HCPCS,TPRNL BALO CNTNC DEV UNI,,Grouper Rate,5138.00
United HealthCare,PPO,0550T,CPT4/HCPCS,TPRNL BALO CNTNC DEV RMVL EA,,Grouper Rate,4204.00
United HealthCare,PPO,0551T,CPT4/HCPCS,TPRNL BALO CNTNC DEV ADJMT,,Grouper Rate,1214.00
United HealthCare,PPO,0553T,CPT4/HCPCS,PERQ TCAT ILIAC ANAST IMPLT,,Grouper Rate,1370.00
United HealthCare,PPO,0563T,CPT4/HCPCS,EVAC MEIBOMIAN GLND HEAT BI,,Grouper Rate,1214.00
United HealthCare,PPO,0565T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS HRVG,,Grouper Rate,1214.00
United HealthCare,PPO,0566T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS NJX,,Grouper Rate,1214.00
United HealthCare,PPO,0567T,CPT4/HCPCS,PERM FLP TUBE OCCLS W/IMPLT,,Grouper Rate,1370.00
United HealthCare,PPO,0568T,CPT4/HCPCS,INTRO MIX SALINE&AIR F/SSG,,Grouper Rate,1370.00
United HealthCare,PPO,0569T,CPT4/HCPCS,TTVR PERQ APPR 1ST PROSTH,,Grouper Rate,1370.00
United HealthCare,PPO,0570T,CPT4/HCPCS,TTVR PERQ EA ADDL PROSTH,,Grouper Rate,1370.00
United HealthCare,PPO,0571T,CPT4/HCPCS,INSJ/RPLCMT ICDS SS ELTRD,,Grouper Rate,1370.00
United HealthCare,PPO,0572T,CPT4/HCPCS,INSERTION SS DFB ELECTRODE,,Grouper Rate,1370.00
United HealthCare,PPO,0573T,CPT4/HCPCS,REMOVAL SS DFB ELECTRODE,,Grouper Rate,1370.00
United HealthCare,PPO,0574T,CPT4/HCPCS,REPOS PREV SS IMPL DFB ELTRD,,Grouper Rate,1370.00
United HealthCare,PPO,0575T,CPT4/HCPCS,PRGRMG DEV EVAL ICDS SS IP,,Grouper Rate,1370.00
United HealthCare,PPO,0576T,CPT4/HCPCS,INTERROG DEV EVAL ICDS SS IP,,Grouper Rate,1370.00
United HealthCare,PPO,0578T,CPT4/HCPCS,REM INTERROG DEV ICDS PHYS,,Grouper Rate,1370.00
United HealthCare,PPO,0579T,CPT4/HCPCS,REM INTERROG DEV ICDS TECH,,Grouper Rate,1370.00
United HealthCare,PPO,0580T,CPT4/HCPCS,RMVL SS IMPL DFB PG ONLY,,Grouper Rate,1370.00
United HealthCare,PPO,0581T,CPT4/HCPCS,ABLTJ MAL BRST TUM PERQ CRTX,,Grouper Rate,1370.00
United HealthCare,PPO,0582T,CPT4/HCPCS,TRURL ABLTJ MAL PRST8 TISS,,Grouper Rate,1370.00
United HealthCare,PPO,0583T,CPT4/HCPCS,TMPST AUTO TUBE DLVR SYS,,Grouper Rate,1370.00
United HealthCare,PPO,0584T,CPT4/HCPCS,PERQ ISLET CELL TRANSPLANT,,Grouper Rate,1370.00
United HealthCare,PPO,0585T,CPT4/HCPCS,LAPS ISLET CELL TRANSPLANT,,Grouper Rate,1370.00
United HealthCare,PPO,0586T,CPT4/HCPCS,OPEN ISLET CELL TRANSPLANT,,Grouper Rate,1370.00
United HealthCare,PPO,0587T,CPT4/HCPCS,PERQ IMPLTJ/RPLCMT ISDNS PTN,,Grouper Rate,1308.00
United HealthCare,PPO,0588T,CPT4/HCPCS,REVISION/REMOVAL ISDNS PTN,,Grouper Rate,1214.00
United HealthCare,PPO,10004,CPT4/HCPCS,FNA BX W/O IMG GDN EA ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,10005,CPT4/HCPCS,FNA BX W/US GDN 1ST LES,,Grouper Rate,1308.00
United HealthCare,PPO,10006,CPT4/HCPCS,FNA BX W/US GDN EA ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,10007,CPT4/HCPCS,FNA BX W/FLUOR GDN 1ST LES,,Grouper Rate,1308.00
United HealthCare,PPO,10008,CPT4/HCPCS,FNA BX W/FLUOR GDN EA ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,10009,CPT4/HCPCS,FNA BX W/CT GDN 1ST LES,,Grouper Rate,1308.00
United HealthCare,PPO,10010,CPT4/HCPCS,FNA BX W/CT GDN EA ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,10011,CPT4/HCPCS,FNA BX W/MR GDN 1ST LES,,Grouper Rate,1308.00
United HealthCare,PPO,10012,CPT4/HCPCS,FNA BX W/MR GDN EA ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,Grouper Rate,1214.00
United HealthCare,PPO,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,Grouper Rate,1308.00
United HealthCare,PPO,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,Grouper Rate,1308.00
United HealthCare,PPO,10036,CPT4/HCPCS,PERQ DEV SOFT TISS ADD IMAG,,Grouper Rate,1214.00
United HealthCare,PPO,10040,CPT4/HCPCS,ACNE SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,1214.00
United HealthCare,PPO,10061,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,Grouper Rate,1214.00
United HealthCare,PPO,10080,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,1308.00
United HealthCare,PPO,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,Grouper Rate,1308.00
United HealthCare,PPO,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,1214.00
United HealthCare,PPO,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,Grouper Rate,1370.00
United HealthCare,PPO,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,Grouper Rate,1370.00
United HealthCare,PPO,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,Grouper Rate,1214.00
United HealthCare,PPO,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,Grouper Rate,4204.00
United HealthCare,PPO,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,Grouper Rate,1214.00
United HealthCare,PPO,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,Grouper Rate,1370.00
United HealthCare,PPO,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,Grouper Rate,1370.00
United HealthCare,PPO,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,Grouper Rate,1370.00
United HealthCare,PPO,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,Grouper Rate,5138.00
United HealthCare,PPO,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,Grouper Rate,1308.00
United HealthCare,PPO,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,Grouper Rate,1308.00
United HealthCare,PPO,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,Grouper Rate,1308.00
United HealthCare,PPO,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,Grouper Rate,1308.00
United HealthCare,PPO,11045,CPT4/HCPCS,DEB SUBQ TISSUE ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,11046,CPT4/HCPCS,DEB MUSC/FASCIA ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,11047,CPT4/HCPCS,DEB BONE ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,11055,CPT4/HCPCS,TRIM SKIN LESION,,Grouper Rate,1214.00
United HealthCare,PPO,11056,CPT4/HCPCS,TRIM SKIN LESIONS 2 TO 4,,Grouper Rate,1214.00
United HealthCare,PPO,11057,CPT4/HCPCS,TRIM SKIN LESIONS OVER 4,,Grouper Rate,1214.00
United HealthCare,PPO,11102,CPT4/HCPCS,TANGNTL BX SKIN SINGLE LES,,Grouper Rate,1214.00
United HealthCare,PPO,11103,CPT4/HCPCS,TANGNTL BX SKIN EA SEP/ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,11104,CPT4/HCPCS,PUNCH BX SKIN SINGLE LESION,,Grouper Rate,1214.00
United HealthCare,PPO,11105,CPT4/HCPCS,PUNCH BX SKIN EA SEP/ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,11106,CPT4/HCPCS,INCAL BX SKN SINGLE LES,,Grouper Rate,1214.00
United HealthCare,PPO,11107,CPT4/HCPCS,INCAL BX SKN EA SEP/ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,11200,CPT4/HCPCS,REMOVAL OF SKIN TAGS 2.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,11305,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,11306,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,11307,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,11308,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,11310,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,11311,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,11312,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,11313,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,Grouper Rate,1308.00
United HealthCare,PPO,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,Grouper Rate,1214.00
United HealthCare,PPO,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,Grouper Rate,1308.00
United HealthCare,PPO,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,Grouper Rate,1308.00
United HealthCare,PPO,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,Grouper Rate,1370.00
United HealthCare,PPO,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,Grouper Rate,1370.00
United HealthCare,PPO,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,Grouper Rate,1308.00
United HealthCare,PPO,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,Grouper Rate,1308.00
United HealthCare,PPO,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,Grouper Rate,1308.00
United HealthCare,PPO,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,Grouper Rate,1370.00
United HealthCare,PPO,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,Grouper Rate,1370.00
United HealthCare,PPO,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,Grouper Rate,4204.00
United HealthCare,PPO,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,Grouper Rate,1308.00
United HealthCare,PPO,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,Grouper Rate,1308.00
United HealthCare,PPO,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,Grouper Rate,1308.00
United HealthCare,PPO,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,Grouper Rate,1308.00
United HealthCare,PPO,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,Grouper Rate,1308.00
United HealthCare,PPO,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,Grouper Rate,4204.00
United HealthCare,PPO,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,4204.00
United HealthCare,PPO,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,4204.00
United HealthCare,PPO,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,4204.00
United HealthCare,PPO,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,4204.00
United HealthCare,PPO,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,4204.00
United HealthCare,PPO,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,Grouper Rate,4204.00
United HealthCare,PPO,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,Grouper Rate,1308.00
United HealthCare,PPO,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,Grouper Rate,1308.00
United HealthCare,PPO,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,Grouper Rate,1214.00
United HealthCare,PPO,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,Grouper Rate,1308.00
United HealthCare,PPO,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,Grouper Rate,1308.00
United HealthCare,PPO,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,Grouper Rate,1370.00
United HealthCare,PPO,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,Grouper Rate,1308.00
United HealthCare,PPO,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,Grouper Rate,1308.00
United HealthCare,PPO,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,Grouper Rate,1308.00
United HealthCare,PPO,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,Grouper Rate,1308.00
United HealthCare,PPO,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,Grouper Rate,1370.00
United HealthCare,PPO,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,Grouper Rate,4204.00
United HealthCare,PPO,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,Grouper Rate,1308.00
United HealthCare,PPO,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,Grouper Rate,1308.00
United HealthCare,PPO,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,Grouper Rate,1308.00
United HealthCare,PPO,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,Grouper Rate,1308.00
United HealthCare,PPO,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,Grouper Rate,1370.00
United HealthCare,PPO,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,Grouper Rate,4204.00
United HealthCare,PPO,11719,CPT4/HCPCS,TRIM NAIL(S) ANY NUMBER,,Grouper Rate,1214.00
United HealthCare,PPO,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,Grouper Rate,1214.00
United HealthCare,PPO,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,Grouper Rate,1214.00
United HealthCare,PPO,11730,CPT4/HCPCS,REMOVAL OF NAIL PLATE,,Grouper Rate,1214.00
United HealthCare,PPO,11732,CPT4/HCPCS,REMOVE NAIL PLATE ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,11740,CPT4/HCPCS,DRAIN BLOOD FROM UNDER NAIL,,Grouper Rate,1214.00
United HealthCare,PPO,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,Grouper Rate,1214.00
United HealthCare,PPO,11755,CPT4/HCPCS,BIOPSY NAIL UNIT,,Grouper Rate,1308.00
United HealthCare,PPO,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,Grouper Rate,1214.00
United HealthCare,PPO,11762,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED,,Grouper Rate,1370.00
United HealthCare,PPO,11765,CPT4/HCPCS,EXCISION OF NAIL FOLD TOE,,Grouper Rate,1214.00
United HealthCare,PPO,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,Grouper Rate,4204.00
United HealthCare,PPO,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,Grouper Rate,4204.00
United HealthCare,PPO,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,Grouper Rate,4204.00
United HealthCare,PPO,11900,CPT4/HCPCS,INJECT SKIN LESIONS 7,,Grouper Rate,1214.00
United HealthCare,PPO,11920,CPT4/HCPCS,CORRECT SKIN COLOR 6.0 CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,Grouper Rate,1214.00
United HealthCare,PPO,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,Grouper Rate,1214.00
United HealthCare,PPO,11950,CPT4/HCPCS,TX CONTOUR DEFECTS 1 CC/<,,Grouper Rate,1214.00
United HealthCare,PPO,11951,CPT4/HCPCS,TX CONTOUR DEFECTS 1.1-5.0CC,,Grouper Rate,1214.00
United HealthCare,PPO,11952,CPT4/HCPCS,TX CONTOUR DEFECTS 5.1-10CC,,Grouper Rate,1214.00
United HealthCare,PPO,11954,CPT4/HCPCS,TX CONTOUR DEFECTS >10.0 CC,,Grouper Rate,1214.00
United HealthCare,PPO,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,Grouper Rate,5138.00
United HealthCare,PPO,11970,CPT4/HCPCS,RPLCMT TISS XPNDR PERM IMPLT,,Grouper Rate,6075.00
United HealthCare,PPO,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,Grouper Rate,4204.00
United HealthCare,PPO,11976,CPT4/HCPCS,REMOVE CONTRACEPTIVE CAPSULE,,Grouper Rate,1308.00
United HealthCare,PPO,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,Grouper Rate,1214.00
United HealthCare,PPO,11981,CPT4/HCPCS,INSERT DRUG IMPLANT DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,11982,CPT4/HCPCS,REMOVE DRUG IMPLANT DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,11983,CPT4/HCPCS,REMOVE/INSERT DRUG IMPLANT,,Grouper Rate,1214.00
United HealthCare,PPO,12001,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK 2.5CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,Grouper Rate,1214.00
United HealthCare,PPO,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,Grouper Rate,1214.00
United HealthCare,PPO,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,Grouper Rate,1214.00
United HealthCare,PPO,12006,CPT4/HCPCS,RPR S/N/A/GEN/TRK20.1-30.0CM,,Grouper Rate,1214.00
United HealthCare,PPO,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,Grouper Rate,1214.00
United HealthCare,PPO,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,Grouper Rate,1214.00
United HealthCare,PPO,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,12017,CPT4/HCPCS,RPR FE/E/EN/L/M 20.1-30.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,1214.00
United HealthCare,PPO,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,Grouper Rate,1214.00
United HealthCare,PPO,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,12032,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.6-7.5,,Grouper Rate,1214.00
United HealthCare,PPO,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,Grouper Rate,1214.00
United HealthCare,PPO,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,Grouper Rate,1214.00
United HealthCare,PPO,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,Grouper Rate,1214.00
United HealthCare,PPO,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,Grouper Rate,1370.00
United HealthCare,PPO,12041,CPT4/HCPCS,INTMD RPR N-HF/GENIT 2.5CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,Grouper Rate,1214.00
United HealthCare,PPO,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,Grouper Rate,1214.00
United HealthCare,PPO,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,Grouper Rate,1214.00
United HealthCare,PPO,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,Grouper Rate,1214.00
United HealthCare,PPO,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,Grouper Rate,1370.00
United HealthCare,PPO,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,Grouper Rate,1214.00
United HealthCare,PPO,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,Grouper Rate,1214.00
United HealthCare,PPO,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,Grouper Rate,1214.00
United HealthCare,PPO,12056,CPT4/HCPCS,INTMD RPR FACE/MM 20.1-30.0,,Grouper Rate,1214.00
United HealthCare,PPO,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,Grouper Rate,1214.00
United HealthCare,PPO,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,Grouper Rate,1214.00
United HealthCare,PPO,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,Grouper Rate,1214.00
United HealthCare,PPO,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,Grouper Rate,1214.00
United HealthCare,PPO,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,Grouper Rate,1214.00
United HealthCare,PPO,13122,CPT4/HCPCS,CMPLX RPR S/A/L ADDL 5 CM/>,,Grouper Rate,1214.00
United HealthCare,PPO,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1214.00
United HealthCare,PPO,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1214.00
United HealthCare,PPO,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,Grouper Rate,1214.00
United HealthCare,PPO,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,Grouper Rate,1214.00
United HealthCare,PPO,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,Grouper Rate,1214.00
United HealthCare,PPO,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,Grouper Rate,1370.00
United HealthCare,PPO,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,Grouper Rate,1370.00
United HealthCare,PPO,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,Grouper Rate,1370.00
United HealthCare,PPO,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,Grouper Rate,1370.00
United HealthCare,PPO,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,1370.00
United HealthCare,PPO,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,Grouper Rate,1370.00
United HealthCare,PPO,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,Grouper Rate,1370.00
United HealthCare,PPO,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,Grouper Rate,1370.00
United HealthCare,PPO,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,Grouper Rate,5138.00
United HealthCare,PPO,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,Grouper Rate,1214.00
United HealthCare,PPO,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,Grouper Rate,1370.00
United HealthCare,PPO,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,Grouper Rate,1370.00
United HealthCare,PPO,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,Grouper Rate,1214.00
United HealthCare,PPO,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,Grouper Rate,1214.00
United HealthCare,PPO,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,Grouper Rate,1214.00
United HealthCare,PPO,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,Grouper Rate,1214.00
United HealthCare,PPO,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,Grouper Rate,1370.00
United HealthCare,PPO,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,Grouper Rate,1370.00
United HealthCare,PPO,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,Grouper Rate,1370.00
United HealthCare,PPO,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,Grouper Rate,5138.00
United HealthCare,PPO,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,Grouper Rate,1214.00
United HealthCare,PPO,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,Grouper Rate,4204.00
United HealthCare,PPO,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,Grouper Rate,5138.00
United HealthCare,PPO,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,Grouper Rate,1214.00
United HealthCare,PPO,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,Grouper Rate,1370.00
United HealthCare,PPO,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,Grouper Rate,1214.00
United HealthCare,PPO,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,Grouper Rate,5138.00
United HealthCare,PPO,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,Grouper Rate,1214.00
United HealthCare,PPO,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,Grouper Rate,1214.00
United HealthCare,PPO,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,Grouper Rate,4204.00
United HealthCare,PPO,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,Grouper Rate,1370.00
United HealthCare,PPO,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,Grouper Rate,1370.00
United HealthCare,PPO,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,Grouper Rate,1370.00
United HealthCare,PPO,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,Grouper Rate,1370.00
United HealthCare,PPO,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,Grouper Rate,5138.00
United HealthCare,PPO,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,Grouper Rate,1214.00
United HealthCare,PPO,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,Grouper Rate,1370.00
United HealthCare,PPO,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,Grouper Rate,1370.00
United HealthCare,PPO,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,Grouper Rate,1214.00
United HealthCare,PPO,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,Grouper Rate,1370.00
United HealthCare,PPO,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,Grouper Rate,5138.00
United HealthCare,PPO,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,Grouper Rate,1370.00
United HealthCare,PPO,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,Grouper Rate,1370.00
United HealthCare,PPO,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,Grouper Rate,5138.00
United HealthCare,PPO,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,Grouper Rate,4204.00
United HealthCare,PPO,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,Grouper Rate,1370.00
United HealthCare,PPO,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,Grouper Rate,1370.00
United HealthCare,PPO,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,Grouper Rate,1370.00
United HealthCare,PPO,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,Grouper Rate,5138.00
United HealthCare,PPO,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,Grouper Rate,5138.00
United HealthCare,PPO,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,Grouper Rate,5138.00
United HealthCare,PPO,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,Grouper Rate,5138.00
United HealthCare,PPO,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,Grouper Rate,1370.00
United HealthCare,PPO,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,Grouper Rate,5138.00
United HealthCare,PPO,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,Grouper Rate,5138.00
United HealthCare,PPO,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,Grouper Rate,4204.00
United HealthCare,PPO,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,Grouper Rate,4204.00
United HealthCare,PPO,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,Grouper Rate,4204.00
United HealthCare,PPO,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,15769,CPT4/HCPCS,GRFG AUTOL SOFT TISS DIR EXC,,Grouper Rate,5138.00
United HealthCare,PPO,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,15771,CPT4/HCPCS,GRFG AUTOL FAT LIPO 50 CC/<,,Grouper Rate,5138.00
United HealthCare,PPO,15772,CPT4/HCPCS,GRFG AUTOL FAT LIPO EA ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,15773,CPT4/HCPCS,GRFG AUTOL FAT LIPO 25 CC/<,,Grouper Rate,1370.00
United HealthCare,PPO,15774,CPT4/HCPCS,GFRG AUTOL FAT LIPO EA ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,15775,CPT4/HCPCS,HAIR TRNSPL 1-15 PUNCH GRFTS,,Grouper Rate,1214.00
United HealthCare,PPO,15776,CPT4/HCPCS,HAIR TRNSPL >15 PUNCH GRAFTS,,Grouper Rate,1214.00
United HealthCare,PPO,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,Grouper Rate,1214.00
United HealthCare,PPO,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,Grouper Rate,4204.00
United HealthCare,PPO,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,Grouper Rate,1308.00
United HealthCare,PPO,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,Grouper Rate,1308.00
United HealthCare,PPO,15783,CPT4/HCPCS,DERMABRASION SUPRFL ANY SITE,,Grouper Rate,1214.00
United HealthCare,PPO,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,Grouper Rate,1214.00
United HealthCare,PPO,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,15788,CPT4/HCPCS,CHEMICAL PEEL FACE EPIDERM,,Grouper Rate,1214.00
United HealthCare,PPO,15789,CPT4/HCPCS,CHEMICAL PEEL FACE DERMAL,,Grouper Rate,1214.00
United HealthCare,PPO,15792,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Grouper Rate,1214.00
United HealthCare,PPO,15793,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,Grouper Rate,1214.00
United HealthCare,PPO,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,Grouper Rate,1370.00
United HealthCare,PPO,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,1370.00
United HealthCare,PPO,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,Grouper Rate,1370.00
United HealthCare,PPO,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,1370.00
United HealthCare,PPO,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,Grouper Rate,1370.00
United HealthCare,PPO,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,Grouper Rate,1370.00
United HealthCare,PPO,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,Grouper Rate,5138.00
United HealthCare,PPO,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,Grouper Rate,5138.00
United HealthCare,PPO,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,Grouper Rate,5138.00
United HealthCare,PPO,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,Grouper Rate,5138.00
United HealthCare,PPO,15830,CPT4/HCPCS,EXC SKIN ABD,,Grouper Rate,6075.00
United HealthCare,PPO,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,Grouper Rate,4204.00
United HealthCare,PPO,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,Grouper Rate,4204.00
United HealthCare,PPO,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,Grouper Rate,4204.00
United HealthCare,PPO,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,Grouper Rate,4204.00
United HealthCare,PPO,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,Grouper Rate,1370.00
United HealthCare,PPO,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,Grouper Rate,1370.00
United HealthCare,PPO,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,Grouper Rate,1370.00
United HealthCare,PPO,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,Grouper Rate,5138.00
United HealthCare,PPO,15847,CPT4/HCPCS,EXC SKIN ABD ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,Grouper Rate,1214.00
United HealthCare,PPO,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,Grouper Rate,1370.00
United HealthCare,PPO,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,Grouper Rate,1214.00
United HealthCare,PPO,15860,CPT4/HCPCS,TEST FOR BLOOD FLOW IN GRAFT,,Grouper Rate,1214.00
United HealthCare,PPO,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,Grouper Rate,5138.00
United HealthCare,PPO,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,Grouper Rate,5138.00
United HealthCare,PPO,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,Grouper Rate,1370.00
United HealthCare,PPO,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,Grouper Rate,5138.00
United HealthCare,PPO,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,1370.00
United HealthCare,PPO,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,Grouper Rate,5138.00
United HealthCare,PPO,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,4204.00
United HealthCare,PPO,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,4204.00
United HealthCare,PPO,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5138.00
United HealthCare,PPO,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,5138.00
United HealthCare,PPO,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,1370.00
United HealthCare,PPO,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,Grouper Rate,1370.00
United HealthCare,PPO,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,4204.00
United HealthCare,PPO,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,4204.00
United HealthCare,PPO,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,5138.00
United HealthCare,PPO,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,1370.00
United HealthCare,PPO,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,Grouper Rate,4204.00
United HealthCare,PPO,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,4204.00
United HealthCare,PPO,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,4204.00
United HealthCare,PPO,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,4204.00
United HealthCare,PPO,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5138.00
United HealthCare,PPO,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,1370.00
United HealthCare,PPO,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,Grouper Rate,5138.00
United HealthCare,PPO,15999,CPT4/HCPCS,REMOVAL OF PRESSURE SORE,,Grouper Rate,1308.00
United HealthCare,PPO,16000,CPT4/HCPCS,INITIAL TREATMENT OF BURN(S),,Grouper Rate,1214.00
United HealthCare,PPO,16020,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN S,,Grouper Rate,1214.00
United HealthCare,PPO,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,Grouper Rate,1214.00
United HealthCare,PPO,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,Grouper Rate,1214.00
United HealthCare,PPO,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,Grouper Rate,1214.00
United HealthCare,PPO,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,Grouper Rate,1370.00
United HealthCare,PPO,17000,CPT4/HCPCS,DESTRUCT PREMALG LESION,,Grouper Rate,1214.00
United HealthCare,PPO,17003,CPT4/HCPCS,DESTRUCT PREMALG LES 2-14,,Grouper Rate,1214.00
United HealthCare,PPO,17004,CPT4/HCPCS,DESTROY PREMAL LESIONS 15/>,,Grouper Rate,1214.00
United HealthCare,PPO,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1370.00
United HealthCare,PPO,17110,CPT4/HCPCS,DESTRUCT B9 LESION 1-14,,Grouper Rate,1214.00
United HealthCare,PPO,17111,CPT4/HCPCS,DESTRUCT LESION 15 OR MORE,,Grouper Rate,1214.00
United HealthCare,PPO,17250,CPT4/HCPCS,CHEM CAUT OF GRANLTJ TISSUE,,Grouper Rate,1214.00
United HealthCare,PPO,17260,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17261,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17262,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17263,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17264,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17266,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17270,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17271,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17272,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17273,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17274,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17276,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17280,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17281,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17282,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17283,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17284,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17286,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,17311,CPT4/HCPCS,MOHS 1 STAGE H/N/HF/G,,Grouper Rate,1214.00
United HealthCare,PPO,17312,CPT4/HCPCS,MOHS ADDL STAGE,,Grouper Rate,1214.00
United HealthCare,PPO,17313,CPT4/HCPCS,MOHS 1 STAGE T/A/L,,Grouper Rate,1214.00
United HealthCare,PPO,17314,CPT4/HCPCS,MOHS ADDL STAGE T/A/L,,Grouper Rate,1214.00
United HealthCare,PPO,17315,CPT4/HCPCS,MOHS SURG ADDL BLOCK,,Grouper Rate,1214.00
United HealthCare,PPO,17340,CPT4/HCPCS,CRYOTHERAPY OF SKIN,,Grouper Rate,1214.00
United HealthCare,PPO,17360,CPT4/HCPCS,SKIN PEEL THERAPY,,Grouper Rate,1214.00
United HealthCare,PPO,17380,CPT4/HCPCS,HAIR REMOVAL BY ELECTROLYSIS,,Grouper Rate,1214.00
United HealthCare,PPO,17999,CPT4/HCPCS,SKIN TISSUE PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,Grouper Rate,1308.00
United HealthCare,PPO,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,Grouper Rate,4204.00
United HealthCare,PPO,19030,CPT4/HCPCS,INJECTION FOR BREAST X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,Grouper Rate,1370.00
United HealthCare,PPO,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,Grouper Rate,1214.00
United HealthCare,PPO,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,Grouper Rate,1370.00
United HealthCare,PPO,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,Grouper Rate,1214.00
United HealthCare,PPO,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,Grouper Rate,1370.00
United HealthCare,PPO,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,Grouper Rate,1214.00
United HealthCare,PPO,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,Grouper Rate,1370.00
United HealthCare,PPO,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,Grouper Rate,4204.00
United HealthCare,PPO,19105,CPT4/HCPCS,CRYOSURG ABLATE FA EACH,,Grouper Rate,5138.00
United HealthCare,PPO,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,Grouper Rate,4204.00
United HealthCare,PPO,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,Grouper Rate,4204.00
United HealthCare,PPO,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,Grouper Rate,4204.00
United HealthCare,PPO,19125,CPT4/HCPCS,EXCISION BREAST LESION,,Grouper Rate,4204.00
United HealthCare,PPO,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,Grouper Rate,1214.00
United HealthCare,PPO,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,Grouper Rate,1308.00
United HealthCare,PPO,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,Grouper Rate,1214.00
United HealthCare,PPO,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,Grouper Rate,1308.00
United HealthCare,PPO,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,Grouper Rate,1214.00
United HealthCare,PPO,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,Grouper Rate,1308.00
United HealthCare,PPO,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,Grouper Rate,1214.00
United HealthCare,PPO,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,Grouper Rate,1308.00
United HealthCare,PPO,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,Grouper Rate,1214.00
United HealthCare,PPO,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,Grouper Rate,1214.00
United HealthCare,PPO,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,Grouper Rate,7007.00
United HealthCare,PPO,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,Grouper Rate,7007.00
United HealthCare,PPO,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,Grouper Rate,7007.00
United HealthCare,PPO,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,Grouper Rate,4204.00
United HealthCare,PPO,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,Grouper Rate,4204.00
United HealthCare,PPO,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,Grouper Rate,6075.00
United HealthCare,PPO,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,Grouper Rate,5138.00
United HealthCare,PPO,19305,CPT4/HCPCS,MAST RADICAL,,Grouper Rate,1370.00
United HealthCare,PPO,19306,CPT4/HCPCS,MAST RAD URBAN TYPE,,Grouper Rate,1370.00
United HealthCare,PPO,19307,CPT4/HCPCS,MAST MOD RAD,,Grouper Rate,6075.00
United HealthCare,PPO,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,Grouper Rate,5138.00
United HealthCare,PPO,19318,CPT4/HCPCS,BREAST REDUCTION,,Grouper Rate,6075.00
United HealthCare,PPO,19324,CPT4/HCPCS,ENLARGE BREAST,,Grouper Rate,6075.00
United HealthCare,PPO,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,Grouper Rate,7007.00
United HealthCare,PPO,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,Grouper Rate,6075.00
United HealthCare,PPO,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,Grouper Rate,7007.00
United HealthCare,PPO,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,4204.00
United HealthCare,PPO,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,Grouper Rate,5138.00
United HealthCare,PPO,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,Grouper Rate,7007.00
United HealthCare,PPO,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,Grouper Rate,1370.00
United HealthCare,PPO,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,Grouper Rate,6075.00
United HealthCare,PPO,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,Grouper Rate,5138.00
United HealthCare,PPO,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,Grouper Rate,6075.00
United HealthCare,PPO,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,Grouper Rate,6075.00
United HealthCare,PPO,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,Grouper Rate,6075.00
United HealthCare,PPO,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,Grouper Rate,5138.00
United HealthCare,PPO,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,Grouper Rate,5138.00
United HealthCare,PPO,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,Grouper Rate,6075.00
United HealthCare,PPO,19396,CPT4/HCPCS,DESIGN CUSTOM BREAST IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,19499,CPT4/HCPCS,BREAST SURGERY PROCEDURE,,Grouper Rate,4204.00
United HealthCare,PPO,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,Grouper Rate,1214.00
United HealthCare,PPO,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,Grouper Rate,1370.00
United HealthCare,PPO,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,Grouper Rate,1370.00
United HealthCare,PPO,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,Grouper Rate,1308.00
United HealthCare,PPO,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,Grouper Rate,6075.00
United HealthCare,PPO,20200,CPT4/HCPCS,MUSCLE BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,Grouper Rate,1370.00
United HealthCare,PPO,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,1308.00
United HealthCare,PPO,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,Grouper Rate,1370.00
United HealthCare,PPO,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,Grouper Rate,4204.00
United HealthCare,PPO,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,Grouper Rate,4204.00
United HealthCare,PPO,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,5138.00
United HealthCare,PPO,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,Grouper Rate,5138.00
United HealthCare,PPO,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,Grouper Rate,1370.00
United HealthCare,PPO,20501,CPT4/HCPCS,INJECT SINUS TRACT FOR X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,1308.00
United HealthCare,PPO,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,4204.00
United HealthCare,PPO,20526,CPT4/HCPCS,THER INJECTION CARP TUNNEL,,Grouper Rate,1214.00
United HealthCare,PPO,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,Grouper Rate,1214.00
United HealthCare,PPO,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,Grouper Rate,1214.00
United HealthCare,PPO,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,Grouper Rate,1214.00
United HealthCare,PPO,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,Grouper Rate,1214.00
United HealthCare,PPO,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,Grouper Rate,1214.00
United HealthCare,PPO,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,Grouper Rate,4204.00
United HealthCare,PPO,20560,CPT4/HCPCS,NDL INSJ W/O NJX 1 OR 2 MUSC,,Grouper Rate,1370.00
United HealthCare,PPO,20561,CPT4/HCPCS,NDL INSJ W/O NJX 3+ MUSC,,Grouper Rate,1370.00
United HealthCare,PPO,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1214.00
United HealthCare,PPO,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1214.00
United HealthCare,PPO,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1214.00
United HealthCare,PPO,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1308.00
United HealthCare,PPO,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,Grouper Rate,1214.00
United HealthCare,PPO,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,Grouper Rate,1214.00
United HealthCare,PPO,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,Grouper Rate,1214.00
United HealthCare,PPO,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,Grouper Rate,1308.00
United HealthCare,PPO,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,Grouper Rate,5138.00
United HealthCare,PPO,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,Grouper Rate,4204.00
United HealthCare,PPO,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,Grouper Rate,4204.00
United HealthCare,PPO,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,Grouper Rate,5138.00
United HealthCare,PPO,20664,CPT4/HCPCS,APPLICATION OF HALO,,Grouper Rate,4204.00
United HealthCare,PPO,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,1370.00
United HealthCare,PPO,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,Grouper Rate,4204.00
United HealthCare,PPO,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,5138.00
United HealthCare,PPO,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,Grouper Rate,5138.00
United HealthCare,PPO,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,Grouper Rate,5138.00
United HealthCare,PPO,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,Grouper Rate,5138.00
United HealthCare,PPO,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,Grouper Rate,1308.00
United HealthCare,PPO,20700,CPT4/HCPCS,MNL PREP&INSJ DP RX DLVR DEV,,Grouper Rate,1214.00
United HealthCare,PPO,20701,CPT4/HCPCS,RMVL DEEP RX DELIVERY DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,20702,CPT4/HCPCS,MNL PREP&INSJ IMED RX DEV,,Grouper Rate,1214.00
United HealthCare,PPO,20703,CPT4/HCPCS,RMVL IMED RX DELIVERY DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,20704,CPT4/HCPCS,MNL PREP&INSJ I-ARTIC RX DEV,,Grouper Rate,1214.00
United HealthCare,PPO,20705,CPT4/HCPCS,RMVL I-ARTIC RX DELIVERY DEV,,Grouper Rate,1214.00
United HealthCare,PPO,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,Grouper Rate,1370.00
United HealthCare,PPO,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,Grouper Rate,1370.00
United HealthCare,PPO,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,Grouper Rate,1370.00
United HealthCare,PPO,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Grouper Rate,1370.00
United HealthCare,PPO,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,Grouper Rate,4204.00
United HealthCare,PPO,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Grouper Rate,1370.00
United HealthCare,PPO,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,Grouper Rate,1370.00
United HealthCare,PPO,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,Grouper Rate,1370.00
United HealthCare,PPO,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,1214.00
United HealthCare,PPO,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,Grouper Rate,4204.00
United HealthCare,PPO,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,20932,CPT4/HCPCS,OSTEOART ALGRFT W/SURF & B1,,Grouper Rate,1214.00
United HealthCare,PPO,20933,CPT4/HCPCS,HEMICRT INTRCLRY ALGRFT PRTL,,Grouper Rate,1214.00
United HealthCare,PPO,20934,CPT4/HCPCS,INTERCALARY ALGRFT COMPL,,Grouper Rate,1214.00
United HealthCare,PPO,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,Grouper Rate,5138.00
United HealthCare,PPO,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,Grouper Rate,5138.00
United HealthCare,PPO,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,Grouper Rate,5138.00
United HealthCare,PPO,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,Grouper Rate,1214.00
United HealthCare,PPO,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,Grouper Rate,1308.00
United HealthCare,PPO,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,Grouper Rate,5138.00
United HealthCare,PPO,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,Grouper Rate,1370.00
United HealthCare,PPO,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,Grouper Rate,1370.00
United HealthCare,PPO,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,Grouper Rate,5138.00
United HealthCare,PPO,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,Grouper Rate,5138.00
United HealthCare,PPO,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,Grouper Rate,5138.00
United HealthCare,PPO,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,Grouper Rate,7007.00
United HealthCare,PPO,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,Grouper Rate,7007.00
United HealthCare,PPO,20974,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Grouper Rate,1214.00
United HealthCare,PPO,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,Grouper Rate,1214.00
United HealthCare,PPO,20979,CPT4/HCPCS,US BONE STIMULATION,,Grouper Rate,1214.00
United HealthCare,PPO,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,6075.00
United HealthCare,PPO,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,Grouper Rate,7007.00
United HealthCare,PPO,20985,CPT4/HCPCS,CPTR-ASST DIR MS PX,,Grouper Rate,1214.00
United HealthCare,PPO,20999,CPT4/HCPCS,MUSCULOSKELETAL SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,Grouper Rate,1308.00
United HealthCare,PPO,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,Grouper Rate,1308.00
United HealthCare,PPO,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,Grouper Rate,1308.00
United HealthCare,PPO,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,Grouper Rate,1308.00
United HealthCare,PPO,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,Grouper Rate,1370.00
United HealthCare,PPO,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,Grouper Rate,6075.00
United HealthCare,PPO,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,Grouper Rate,4204.00
United HealthCare,PPO,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,Grouper Rate,4204.00
United HealthCare,PPO,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,Grouper Rate,4204.00
United HealthCare,PPO,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,Grouper Rate,4204.00
United HealthCare,PPO,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,Grouper Rate,6075.00
United HealthCare,PPO,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,Grouper Rate,6075.00
United HealthCare,PPO,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,Grouper Rate,6075.00
United HealthCare,PPO,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,Grouper Rate,6075.00
United HealthCare,PPO,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,Grouper Rate,6075.00
United HealthCare,PPO,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,Grouper Rate,6075.00
United HealthCare,PPO,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,Grouper Rate,6075.00
United HealthCare,PPO,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,Grouper Rate,6075.00
United HealthCare,PPO,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,Grouper Rate,1370.00
United HealthCare,PPO,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1370.00
United HealthCare,PPO,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,6075.00
United HealthCare,PPO,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,6075.00
United HealthCare,PPO,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,6075.00
United HealthCare,PPO,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,6075.00
United HealthCare,PPO,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,6075.00
United HealthCare,PPO,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,6075.00
United HealthCare,PPO,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,6075.00
United HealthCare,PPO,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1214.00
United HealthCare,PPO,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,6075.00
United HealthCare,PPO,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,6075.00
United HealthCare,PPO,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,6075.00
United HealthCare,PPO,21089,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,Grouper Rate,1214.00
United HealthCare,PPO,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,Grouper Rate,6075.00
United HealthCare,PPO,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,Grouper Rate,1370.00
United HealthCare,PPO,21116,CPT4/HCPCS,INJECTION JAW JOINT X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,4204.00
United HealthCare,PPO,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,4204.00
United HealthCare,PPO,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,4204.00
United HealthCare,PPO,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,Grouper Rate,4204.00
United HealthCare,PPO,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,4204.00
United HealthCare,PPO,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,Grouper Rate,6075.00
United HealthCare,PPO,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,4204.00
United HealthCare,PPO,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,6075.00
United HealthCare,PPO,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,Grouper Rate,6075.00
United HealthCare,PPO,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,Grouper Rate,6075.00
United HealthCare,PPO,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,Grouper Rate,1370.00
United HealthCare,PPO,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,Grouper Rate,1370.00
United HealthCare,PPO,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,Grouper Rate,1370.00
United HealthCare,PPO,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,Grouper Rate,1370.00
United HealthCare,PPO,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,Grouper Rate,1370.00
United HealthCare,PPO,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,6075.00
United HealthCare,PPO,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,Grouper Rate,6075.00
United HealthCare,PPO,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Grouper Rate,1370.00
United HealthCare,PPO,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,Grouper Rate,1370.00
United HealthCare,PPO,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,1370.00
United HealthCare,PPO,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,1370.00
United HealthCare,PPO,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,Grouper Rate,1370.00
United HealthCare,PPO,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,Grouper Rate,1370.00
United HealthCare,PPO,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,Grouper Rate,6075.00
United HealthCare,PPO,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,Grouper Rate,6075.00
United HealthCare,PPO,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,Grouper Rate,4204.00
United HealthCare,PPO,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,Grouper Rate,6075.00
United HealthCare,PPO,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,Grouper Rate,6075.00
United HealthCare,PPO,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,Grouper Rate,6075.00
United HealthCare,PPO,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,Grouper Rate,6075.00
United HealthCare,PPO,21210,CPT4/HCPCS,FACE BONE GRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,Grouper Rate,6075.00
United HealthCare,PPO,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6075.00
United HealthCare,PPO,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6075.00
United HealthCare,PPO,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Grouper Rate,1370.00
United HealthCare,PPO,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6075.00
United HealthCare,PPO,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,Grouper Rate,6075.00
United HealthCare,PPO,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,Grouper Rate,1370.00
United HealthCare,PPO,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,Grouper Rate,6075.00
United HealthCare,PPO,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,6075.00
United HealthCare,PPO,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,6075.00
United HealthCare,PPO,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,6075.00
United HealthCare,PPO,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,6075.00
United HealthCare,PPO,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,Grouper Rate,1370.00
United HealthCare,PPO,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,Grouper Rate,6075.00
United HealthCare,PPO,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,Grouper Rate,6075.00
United HealthCare,PPO,21280,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,6075.00
United HealthCare,PPO,21282,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,1370.00
United HealthCare,PPO,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,1370.00
United HealthCare,PPO,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,Grouper Rate,4204.00
United HealthCare,PPO,21299,CPT4/HCPCS,CRANIO/MAXILLOFACIAL SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,Grouper Rate,1214.00
United HealthCare,PPO,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,Grouper Rate,1370.00
United HealthCare,PPO,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,Grouper Rate,1370.00
United HealthCare,PPO,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,Grouper Rate,4204.00
United HealthCare,PPO,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,Grouper Rate,4204.00
United HealthCare,PPO,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,Grouper Rate,4204.00
United HealthCare,PPO,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,Grouper Rate,4204.00
United HealthCare,PPO,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,Grouper Rate,1370.00
United HealthCare,PPO,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,Grouper Rate,4204.00
United HealthCare,PPO,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,Grouper Rate,4204.00
United HealthCare,PPO,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,Grouper Rate,6075.00
United HealthCare,PPO,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,Grouper Rate,6075.00
United HealthCare,PPO,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,Grouper Rate,1370.00
United HealthCare,PPO,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,Grouper Rate,1370.00
United HealthCare,PPO,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,Grouper Rate,4204.00
United HealthCare,PPO,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,Grouper Rate,1370.00
United HealthCare,PPO,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,Grouper Rate,4204.00
United HealthCare,PPO,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,Grouper Rate,6075.00
United HealthCare,PPO,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,Grouper Rate,5138.00
United HealthCare,PPO,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,Grouper Rate,6075.00
United HealthCare,PPO,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,Grouper Rate,6075.00
United HealthCare,PPO,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,Grouper Rate,6075.00
United HealthCare,PPO,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,Grouper Rate,6075.00
United HealthCare,PPO,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,Grouper Rate,6075.00
United HealthCare,PPO,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,Grouper Rate,1214.00
United HealthCare,PPO,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,Grouper Rate,1370.00
United HealthCare,PPO,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,Grouper Rate,6075.00
United HealthCare,PPO,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,Grouper Rate,6075.00
United HealthCare,PPO,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,Grouper Rate,6075.00
United HealthCare,PPO,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,1214.00
United HealthCare,PPO,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,Grouper Rate,1370.00
United HealthCare,PPO,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,Grouper Rate,6075.00
United HealthCare,PPO,21497,CPT4/HCPCS,INTERDENTAL WIRING,,Grouper Rate,1370.00
United HealthCare,PPO,21499,CPT4/HCPCS,HEAD SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,Grouper Rate,4204.00
United HealthCare,PPO,21502,CPT4/HCPCS,DRAIN CHEST LESION,,Grouper Rate,4204.00
United HealthCare,PPO,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,Grouper Rate,1370.00
United HealthCare,PPO,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,Grouper Rate,4204.00
United HealthCare,PPO,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,Grouper Rate,1370.00
United HealthCare,PPO,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,Case Rate,98396.00
United HealthCare,PPO,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,5138.00
United HealthCare,PPO,21601,CPT4/HCPCS,EXC CHEST WALL TUMOR W/RIBS,,Grouper Rate,4204.00
United HealthCare,PPO,21602,CPT4/HCPCS,EXC CH WAL TUM W/O LYMPHADEC,,Grouper Rate,1370.00
United HealthCare,PPO,21603,CPT4/HCPCS,EXC CH WAL TUM W/LYMPHADEC,,Grouper Rate,1370.00
United HealthCare,PPO,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,Grouper Rate,5138.00
United HealthCare,PPO,21615,CPT4/HCPCS,REMOVAL OF RIB,,Grouper Rate,1370.00
United HealthCare,PPO,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,Grouper Rate,1370.00
United HealthCare,PPO,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,Grouper Rate,1370.00
United HealthCare,PPO,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,Grouper Rate,1370.00
United HealthCare,PPO,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,Grouper Rate,4204.00
United HealthCare,PPO,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,Case Rate,167364.00
United HealthCare,PPO,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,4204.00
United HealthCare,PPO,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,Grouper Rate,1370.00
United HealthCare,PPO,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,4204.00
United HealthCare,PPO,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,Grouper Rate,1308.00
United HealthCare,PPO,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,Grouper Rate,1370.00
United HealthCare,PPO,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,Grouper Rate,6075.00
United HealthCare,PPO,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,Grouper Rate,6075.00
United HealthCare,PPO,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,Grouper Rate,1370.00
United HealthCare,PPO,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,Case Rate,100934.00
United HealthCare,PPO,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,Grouper Rate,4204.00
United HealthCare,PPO,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,21899,CPT4/HCPCS,NECK/CHEST SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,Case Rate,93387.00
United HealthCare,PPO,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,1308.00
United HealthCare,PPO,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,Grouper Rate,4204.00
United HealthCare,PPO,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,Case Rate,74220.00
United HealthCare,PPO,22010,CPT4/HCPCS,I&D P-SPINE C/T/CERV-THOR,,Grouper Rate,1370.00
United HealthCare,PPO,22015,CPT4/HCPCS,I&D ABSCESS P-SPINE L/S/LS,,Grouper Rate,1370.00
United HealthCare,PPO,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,Case Rate,77197.00
United HealthCare,PPO,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,7007.00
United HealthCare,PPO,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,7007.00
United HealthCare,PPO,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,7007.00
United HealthCare,PPO,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,1214.00
United HealthCare,PPO,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,Grouper Rate,1370.00
United HealthCare,PPO,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,Grouper Rate,1370.00
United HealthCare,PPO,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,Grouper Rate,1370.00
United HealthCare,PPO,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,Grouper Rate,1370.00
United HealthCare,PPO,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,Case Rate,84854.00
United HealthCare,PPO,22206,CPT4/HCPCS,INCIS SPINE 3 COLUMN THORAC,,Grouper Rate,1370.00
United HealthCare,PPO,22207,CPT4/HCPCS,INCIS SPINE 3 COLUMN LUMBAR,,Grouper Rate,1370.00
United HealthCare,PPO,22208,CPT4/HCPCS,INCIS SPINE 3 COLUMN ADL SEG,,Grouper Rate,1370.00
United HealthCare,PPO,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,Grouper Rate,1370.00
United HealthCare,PPO,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,Grouper Rate,1370.00
United HealthCare,PPO,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,Grouper Rate,1370.00
United HealthCare,PPO,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,Grouper Rate,1370.00
United HealthCare,PPO,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,Grouper Rate,1370.00
United HealthCare,PPO,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,Grouper Rate,1370.00
United HealthCare,PPO,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,Grouper Rate,1370.00
United HealthCare,PPO,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,Grouper Rate,1370.00
United HealthCare,PPO,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,Case Rate,72773.00
United HealthCare,PPO,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,Grouper Rate,1214.00
United HealthCare,PPO,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,Grouper Rate,1370.00
United HealthCare,PPO,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,Grouper Rate,4204.00
United HealthCare,PPO,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,Grouper Rate,4204.00
United HealthCare,PPO,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,Grouper Rate,4204.00
United HealthCare,PPO,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,Case Rate,77390.00
United HealthCare,PPO,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,Case Rate,66581.00
United HealthCare,PPO,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,Grouper Rate,1370.00
United HealthCare,PPO,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,Grouper Rate,5138.00
United HealthCare,PPO,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,Grouper Rate,5138.00
United HealthCare,PPO,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,Grouper Rate,1214.00
United HealthCare,PPO,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,7007.00
United HealthCare,PPO,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,7007.00
United HealthCare,PPO,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,Grouper Rate,1214.00
United HealthCare,PPO,22526,CPT4/HCPCS,IDET SINGLE LEVEL,,Grouper Rate,5138.00
United HealthCare,PPO,22527,CPT4/HCPCS,IDET 1 OR MORE LEVELS,,Grouper Rate,5138.00
United HealthCare,PPO,22532,CPT4/HCPCS,LAT THORAX SPINE FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,22533,CPT4/HCPCS,LAT LUMBAR SPINE FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,22534,CPT4/HCPCS,LAT THOR/LUMB ADDL SEG,,Grouper Rate,1370.00
United HealthCare,PPO,22548,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,7007.00
United HealthCare,PPO,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,Grouper Rate,7007.00
United HealthCare,PPO,22552,CPT4/HCPCS,ADDL NECK SPINE FUSION,,Grouper Rate,6075.00
United HealthCare,PPO,22554,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,7007.00
United HealthCare,PPO,22556,CPT4/HCPCS,THORAX SPINE FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,22558,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,Grouper Rate,7007.00
United HealthCare,PPO,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,Grouper Rate,1370.00
United HealthCare,PPO,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,22595,CPT4/HCPCS,NECK SPINAL FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,Case Rate,130522.00
United HealthCare,PPO,22600,CPT4/HCPCS,NECK SPINE FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,22610,CPT4/HCPCS,THORAX SPINE FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,7007.00
United HealthCare,PPO,22614,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,1214.00
United HealthCare,PPO,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,1370.00
United HealthCare,PPO,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,Grouper Rate,10772.00
United HealthCare,PPO,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,Grouper Rate,1214.00
United HealthCare,PPO,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,Case Rate,111289.00
United HealthCare,PPO,228,DRG,Other cardiothoracic procedures w MCC,,Case Rate,57085.00
United HealthCare,PPO,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,Grouper Rate,1370.00
United HealthCare,PPO,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,Grouper Rate,1370.00
United HealthCare,PPO,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,Grouper Rate,1370.00
United HealthCare,PPO,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,Grouper Rate,1370.00
United HealthCare,PPO,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,Grouper Rate,1370.00
United HealthCare,PPO,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,Grouper Rate,1370.00
United HealthCare,PPO,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,Grouper Rate,1370.00
United HealthCare,PPO,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,Grouper Rate,1370.00
United HealthCare,PPO,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,7007.00
United HealthCare,PPO,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,7007.00
United HealthCare,PPO,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,Grouper Rate,7007.00
United HealthCare,PPO,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,Grouper Rate,1370.00
United HealthCare,PPO,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,22853,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,22854,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,22856,CPT4/HCPCS,CERV ARTIFIC DISKECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,22857,CPT4/HCPCS,LUMBAR ARTIF DISKECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,Grouper Rate,1214.00
United HealthCare,PPO,22859,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,22861,CPT4/HCPCS,REVISE CERV ARTIFIC DISC,,Grouper Rate,1370.00
United HealthCare,PPO,22862,CPT4/HCPCS,REVISE LUMBAR ARTIF DISC,,Grouper Rate,1370.00
United HealthCare,PPO,22864,CPT4/HCPCS,REMOVE CERV ARTIF DISC,,Grouper Rate,1370.00
United HealthCare,PPO,22865,CPT4/HCPCS,REMOVE LUMB ARTIF DISC,,Grouper Rate,1370.00
United HealthCare,PPO,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,7007.00
United HealthCare,PPO,22868,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,Grouper Rate,1214.00
United HealthCare,PPO,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,7007.00
United HealthCare,PPO,22870,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,Grouper Rate,1214.00
United HealthCare,PPO,22899,CPT4/HCPCS,SPINE SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,229,DRG,Other cardiothoracic procedures w CC,,Case Rate,45053.00
United HealthCare,PPO,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,Grouper Rate,4204.00
United HealthCare,PPO,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,Grouper Rate,1370.00
United HealthCare,PPO,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,22999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,Grouper Rate,1370.00
United HealthCare,PPO,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,Grouper Rate,4204.00
United HealthCare,PPO,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,Grouper Rate,4204.00
United HealthCare,PPO,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,1308.00
United HealthCare,PPO,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,Grouper Rate,4204.00
United HealthCare,PPO,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,231,DRG,Coronary bypass w PTCA w MCC,,Case Rate,70084.00
United HealthCare,PPO,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,Grouper Rate,5138.00
United HealthCare,PPO,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,Grouper Rate,5138.00
United HealthCare,PPO,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,Grouper Rate,5138.00
United HealthCare,PPO,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,Grouper Rate,6075.00
United HealthCare,PPO,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,5138.00
United HealthCare,PPO,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,Grouper Rate,5138.00
United HealthCare,PPO,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,Grouper Rate,5138.00
United HealthCare,PPO,232,DRG,Coronary bypass w PTCA w/o MCC,,Case Rate,59478.00
United HealthCare,PPO,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,233,DRG,Coronary bypass w cardiac cath w MCC,,Case Rate,142385.00
United HealthCare,PPO,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,Grouper Rate,1308.00
United HealthCare,PPO,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,Grouper Rate,1308.00
United HealthCare,PPO,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,4204.00
United HealthCare,PPO,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,23350,CPT4/HCPCS,INJECTION FOR SHOULDER X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,Grouper Rate,6075.00
United HealthCare,PPO,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,Grouper Rate,6075.00
United HealthCare,PPO,234,DRG,Coronary bypass w cardiac cath w/o MCC,,Case Rate,108650.00
United HealthCare,PPO,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,Grouper Rate,5138.00
United HealthCare,PPO,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,Grouper Rate,5138.00
United HealthCare,PPO,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,Grouper Rate,6075.00
United HealthCare,PPO,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,Grouper Rate,6075.00
United HealthCare,PPO,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,Grouper Rate,6075.00
United HealthCare,PPO,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,Grouper Rate,6075.00
United HealthCare,PPO,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,Grouper Rate,6075.00
United HealthCare,PPO,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,7007.00
United HealthCare,PPO,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,7007.00
United HealthCare,PPO,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,7007.00
United HealthCare,PPO,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6075.00
United HealthCare,PPO,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6075.00
United HealthCare,PPO,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,Grouper Rate,6075.00
United HealthCare,PPO,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,6075.00
United HealthCare,PPO,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,Grouper Rate,7007.00
United HealthCare,PPO,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,Grouper Rate,7007.00
United HealthCare,PPO,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,Grouper Rate,7007.00
United HealthCare,PPO,235,DRG,Coronary bypass w/o cardiac cath w MCC,,Case Rate,66579.00
United HealthCare,PPO,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,1308.00
United HealthCare,PPO,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,1214.00
United HealthCare,PPO,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,Grouper Rate,1214.00
United HealthCare,PPO,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,Case Rate,82356.00
United HealthCare,PPO,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,1308.00
United HealthCare,PPO,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,Grouper Rate,1370.00
United HealthCare,PPO,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,Grouper Rate,1370.00
United HealthCare,PPO,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,23929,CPT4/HCPCS,SHOULDER SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,Grouper Rate,4204.00
United HealthCare,PPO,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,Grouper Rate,1370.00
United HealthCare,PPO,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,Grouper Rate,4204.00
United HealthCare,PPO,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,Grouper Rate,5138.00
United HealthCare,PPO,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,Grouper Rate,4204.00
United HealthCare,PPO,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,Grouper Rate,4204.00
United HealthCare,PPO,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,Grouper Rate,4204.00
United HealthCare,PPO,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,Grouper Rate,5138.00
United HealthCare,PPO,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,Grouper Rate,5138.00
United HealthCare,PPO,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,5138.00
United HealthCare,PPO,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,Grouper Rate,5138.00
United HealthCare,PPO,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,Grouper Rate,5138.00
United HealthCare,PPO,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,Grouper Rate,6075.00
United HealthCare,PPO,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,Grouper Rate,6075.00
United HealthCare,PPO,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,242,DRG,Permanent cardiac pacemaker implant w MCC,,Case Rate,24196.00
United HealthCare,PPO,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,1308.00
United HealthCare,PPO,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,Grouper Rate,1370.00
United HealthCare,PPO,24220,CPT4/HCPCS,INJECTION FOR ELBOW X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,243,DRG,Permanent cardiac pacemaker implant w CC,,Case Rate,37502.00
United HealthCare,PPO,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,Grouper Rate,1370.00
United HealthCare,PPO,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,Grouper Rate,5138.00
United HealthCare,PPO,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,Grouper Rate,5138.00
United HealthCare,PPO,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,7007.00
United HealthCare,PPO,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,Grouper Rate,6075.00
United HealthCare,PPO,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,Grouper Rate,5138.00
United HealthCare,PPO,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,Grouper Rate,6075.00
United HealthCare,PPO,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,Grouper Rate,6075.00
United HealthCare,PPO,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,Grouper Rate,6075.00
United HealthCare,PPO,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,Grouper Rate,5138.00
United HealthCare,PPO,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,Grouper Rate,6075.00
United HealthCare,PPO,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,Grouper Rate,5138.00
United HealthCare,PPO,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,Grouper Rate,6075.00
United HealthCare,PPO,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,Grouper Rate,4204.00
United HealthCare,PPO,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,Grouper Rate,5138.00
United HealthCare,PPO,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,Grouper Rate,5138.00
United HealthCare,PPO,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,6075.00
United HealthCare,PPO,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,Grouper Rate,10119.00
United HealthCare,PPO,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,Case Rate,15869.00
United HealthCare,PPO,24400,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,6075.00
United HealthCare,PPO,24410,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,6075.00
United HealthCare,PPO,24420,CPT4/HCPCS,REVISION OF HUMERUS,,Grouper Rate,6075.00
United HealthCare,PPO,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,Grouper Rate,7007.00
United HealthCare,PPO,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,Grouper Rate,7007.00
United HealthCare,PPO,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,Grouper Rate,5138.00
United HealthCare,PPO,24498,CPT4/HCPCS,REINFORCE HUMERUS,,Grouper Rate,7007.00
United HealthCare,PPO,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,Case Rate,32398.00
United HealthCare,PPO,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,Case Rate,31279.00
United HealthCare,PPO,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,Case Rate,18519.00
United HealthCare,PPO,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,Case Rate,26675.00
United HealthCare,PPO,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Grouper Rate,1370.00
United HealthCare,PPO,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,Grouper Rate,1370.00
United HealthCare,PPO,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,Grouper Rate,1370.00
United HealthCare,PPO,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,Grouper Rate,7007.00
United HealthCare,PPO,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,Grouper Rate,1370.00
United HealthCare,PPO,24999,CPT4/HCPCS,UPPER ARM/ELBOW SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,Case Rate,27917.00
United HealthCare,PPO,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,Grouper Rate,4204.00
United HealthCare,PPO,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,Grouper Rate,4204.00
United HealthCare,PPO,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,5138.00
United HealthCare,PPO,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,Grouper Rate,5138.00
United HealthCare,PPO,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,5138.00
United HealthCare,PPO,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,Grouper Rate,4204.00
United HealthCare,PPO,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,Grouper Rate,4204.00
United HealthCare,PPO,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,Grouper Rate,4204.00
United HealthCare,PPO,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,1308.00
United HealthCare,PPO,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,Grouper Rate,4204.00
United HealthCare,PPO,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,Grouper Rate,1370.00
United HealthCare,PPO,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,Grouper Rate,4204.00
United HealthCare,PPO,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,Grouper Rate,4204.00
United HealthCare,PPO,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,Case Rate,25725.00
United HealthCare,PPO,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,5138.00
United HealthCare,PPO,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,Grouper Rate,5138.00
United HealthCare,PPO,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,Grouper Rate,4204.00
United HealthCare,PPO,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,4204.00
United HealthCare,PPO,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,Grouper Rate,4204.00
United HealthCare,PPO,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,Grouper Rate,4204.00
United HealthCare,PPO,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,4204.00
United HealthCare,PPO,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,Grouper Rate,4204.00
United HealthCare,PPO,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,Grouper Rate,4204.00
United HealthCare,PPO,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,5138.00
United HealthCare,PPO,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,Grouper Rate,5138.00
United HealthCare,PPO,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,4204.00
United HealthCare,PPO,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,Grouper Rate,5138.00
United HealthCare,PPO,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,Grouper Rate,5138.00
United HealthCare,PPO,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,5138.00
United HealthCare,PPO,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,Grouper Rate,5138.00
United HealthCare,PPO,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,5138.00
United HealthCare,PPO,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,5138.00
United HealthCare,PPO,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,Grouper Rate,5138.00
United HealthCare,PPO,252,DRG,Other vascular procedures w MCC,,Case Rate,26674.00
United HealthCare,PPO,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,Grouper Rate,5138.00
United HealthCare,PPO,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,Grouper Rate,5138.00
United HealthCare,PPO,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,Grouper Rate,5138.00
United HealthCare,PPO,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,Grouper Rate,5138.00
United HealthCare,PPO,25246,CPT4/HCPCS,INJECTION FOR WRIST X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,Grouper Rate,4204.00
United HealthCare,PPO,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,1370.00
United HealthCare,PPO,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,Grouper Rate,5138.00
United HealthCare,PPO,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,Grouper Rate,1370.00
United HealthCare,PPO,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,Grouper Rate,5138.00
United HealthCare,PPO,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,253,DRG,Other vascular procedures w CC,,Case Rate,21806.00
United HealthCare,PPO,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,5138.00
United HealthCare,PPO,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,Grouper Rate,5138.00
United HealthCare,PPO,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,Grouper Rate,6075.00
United HealthCare,PPO,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,5138.00
United HealthCare,PPO,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,Grouper Rate,7007.00
United HealthCare,PPO,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,25332,CPT4/HCPCS,REVISE WRIST JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,Grouper Rate,6075.00
United HealthCare,PPO,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,Grouper Rate,6075.00
United HealthCare,PPO,25350,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,6075.00
United HealthCare,PPO,25355,CPT4/HCPCS,REVISION OF RADIUS,,Grouper Rate,6075.00
United HealthCare,PPO,25360,CPT4/HCPCS,REVISION OF ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,Grouper Rate,5138.00
United HealthCare,PPO,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,Grouper Rate,6075.00
United HealthCare,PPO,254,DRG,Other vascular procedures w/o CC/MCC,,Case Rate,24698.00
United HealthCare,PPO,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,7007.00
United HealthCare,PPO,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,Grouper Rate,7007.00
United HealthCare,PPO,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,7007.00
United HealthCare,PPO,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,Grouper Rate,6075.00
United HealthCare,PPO,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,Grouper Rate,6075.00
United HealthCare,PPO,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,Grouper Rate,6075.00
United HealthCare,PPO,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,25446,CPT4/HCPCS,WRIST REPLACEMENT,,Grouper Rate,10119.00
United HealthCare,PPO,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,Grouper Rate,6075.00
United HealthCare,PPO,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,Grouper Rate,6075.00
United HealthCare,PPO,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,25490,CPT4/HCPCS,REINFORCE RADIUS,,Grouper Rate,6075.00
United HealthCare,PPO,25491,CPT4/HCPCS,REINFORCE ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1214.00
United HealthCare,PPO,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1308.00
United HealthCare,PPO,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,7007.00
United HealthCare,PPO,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,1214.00
United HealthCare,PPO,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,7007.00
United HealthCare,PPO,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,Grouper Rate,7007.00
United HealthCare,PPO,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,1214.00
United HealthCare,PPO,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,1214.00
United HealthCare,PPO,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,Grouper Rate,7007.00
United HealthCare,PPO,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,1214.00
United HealthCare,PPO,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,1214.00
United HealthCare,PPO,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,Grouper Rate,7007.00
United HealthCare,PPO,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,7007.00
United HealthCare,PPO,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,1214.00
United HealthCare,PPO,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,Grouper Rate,1308.00
United HealthCare,PPO,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,Grouper Rate,4204.00
United HealthCare,PPO,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,Grouper Rate,7007.00
United HealthCare,PPO,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,Grouper Rate,7007.00
United HealthCare,PPO,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,Grouper Rate,7007.00
United HealthCare,PPO,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1308.00
United HealthCare,PPO,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,Grouper Rate,7007.00
United HealthCare,PPO,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,258,DRG,Cardiac pacemaker device replacement w MCC,,Case Rate,4279.00
United HealthCare,PPO,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,25820,CPT4/HCPCS,FUSION OF HAND BONES,,Grouper Rate,6075.00
United HealthCare,PPO,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,Grouper Rate,7007.00
United HealthCare,PPO,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,Grouper Rate,6075.00
United HealthCare,PPO,259,DRG,Cardiac pacemaker device replacement w/o MCC,,Case Rate,3086.00
United HealthCare,PPO,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,1370.00
United HealthCare,PPO,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,1370.00
United HealthCare,PPO,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,Grouper Rate,1370.00
United HealthCare,PPO,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,1370.00
United HealthCare,PPO,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,Grouper Rate,4204.00
United HealthCare,PPO,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,25927,CPT4/HCPCS,AMPUTATION OF HAND,,Grouper Rate,1370.00
United HealthCare,PPO,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,25999,CPT4/HCPCS,FOREARM OR WRIST SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,Case Rate,14660.00
United HealthCare,PPO,26010,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Grouper Rate,1214.00
United HealthCare,PPO,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,Grouper Rate,1370.00
United HealthCare,PPO,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,Grouper Rate,1370.00
United HealthCare,PPO,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,Grouper Rate,1370.00
United HealthCare,PPO,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,1370.00
United HealthCare,PPO,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,Grouper Rate,1370.00
United HealthCare,PPO,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5138.00
United HealthCare,PPO,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,Grouper Rate,1370.00
United HealthCare,PPO,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,261,DRG,Cardiac pacemaker revision except device replacement w CC,,Case Rate,19446.00
United HealthCare,PPO,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,Grouper Rate,1370.00
United HealthCare,PPO,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,1370.00
United HealthCare,PPO,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,Grouper Rate,1370.00
United HealthCare,PPO,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5138.00
United HealthCare,PPO,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,5138.00
United HealthCare,PPO,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,Grouper Rate,1370.00
United HealthCare,PPO,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,5138.00
United HealthCare,PPO,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,Grouper Rate,1370.00
United HealthCare,PPO,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,Grouper Rate,1370.00
United HealthCare,PPO,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,Grouper Rate,1370.00
United HealthCare,PPO,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26185,CPT4/HCPCS,REMOVE FINGER BONE,,Grouper Rate,1370.00
United HealthCare,PPO,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,Case Rate,7621.00
United HealthCare,PPO,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,Grouper Rate,1370.00
United HealthCare,PPO,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,Grouper Rate,1370.00
United HealthCare,PPO,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,Grouper Rate,1370.00
United HealthCare,PPO,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,1370.00
United HealthCare,PPO,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,Grouper Rate,1370.00
United HealthCare,PPO,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,Grouper Rate,1370.00
United HealthCare,PPO,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,Grouper Rate,1214.00
United HealthCare,PPO,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,Grouper Rate,1214.00
United HealthCare,PPO,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26410,CPT4/HCPCS,REPAIR HAND TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,Grouper Rate,1370.00
United HealthCare,PPO,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,1370.00
United HealthCare,PPO,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,Grouper Rate,1370.00
United HealthCare,PPO,26476,CPT4/HCPCS,TENDON LENGTHENING,,Grouper Rate,1370.00
United HealthCare,PPO,26477,CPT4/HCPCS,TENDON SHORTENING,,Grouper Rate,1370.00
United HealthCare,PPO,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26490,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,Grouper Rate,5138.00
United HealthCare,PPO,26496,CPT4/HCPCS,REVISE THUMB TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,5138.00
United HealthCare,PPO,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,Grouper Rate,5138.00
United HealthCare,PPO,26499,CPT4/HCPCS,REVISION OF FINGER,,Grouper Rate,4204.00
United HealthCare,PPO,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,1370.00
United HealthCare,PPO,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,Grouper Rate,5138.00
United HealthCare,PPO,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,Grouper Rate,5138.00
United HealthCare,PPO,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,5138.00
United HealthCare,PPO,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,Grouper Rate,5138.00
United HealthCare,PPO,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,Grouper Rate,6075.00
United HealthCare,PPO,26535,CPT4/HCPCS,REVISE FINGER JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,26540,CPT4/HCPCS,REPAIR HAND JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,Grouper Rate,5138.00
United HealthCare,PPO,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,Grouper Rate,5138.00
United HealthCare,PPO,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,Grouper Rate,5138.00
United HealthCare,PPO,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,Grouper Rate,1370.00
United HealthCare,PPO,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,Grouper Rate,1370.00
United HealthCare,PPO,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,Grouper Rate,5138.00
United HealthCare,PPO,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,Grouper Rate,1370.00
United HealthCare,PPO,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,1370.00
United HealthCare,PPO,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,5138.00
United HealthCare,PPO,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,Grouper Rate,5138.00
United HealthCare,PPO,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,Grouper Rate,5138.00
United HealthCare,PPO,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,Grouper Rate,5138.00
United HealthCare,PPO,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,Grouper Rate,5138.00
United HealthCare,PPO,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,Grouper Rate,1370.00
United HealthCare,PPO,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,Grouper Rate,1370.00
United HealthCare,PPO,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,Grouper Rate,1370.00
United HealthCare,PPO,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,Grouper Rate,4204.00
United HealthCare,PPO,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,Grouper Rate,1370.00
United HealthCare,PPO,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,266,DRG,Endovascular Cardiac Valve Replacement w MCC,,Case Rate,146765.00
United HealthCare,PPO,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,267,DRG,Endovascular Cardiac Valve Replacement w/o MCC,,Case Rate,110200.00
United HealthCare,PPO,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1214.00
United HealthCare,PPO,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1214.00
United HealthCare,PPO,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,4204.00
United HealthCare,PPO,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,4204.00
United HealthCare,PPO,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1214.00
United HealthCare,PPO,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1214.00
United HealthCare,PPO,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,4204.00
United HealthCare,PPO,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1214.00
United HealthCare,PPO,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,1214.00
United HealthCare,PPO,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,Grouper Rate,4204.00
United HealthCare,PPO,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,Grouper Rate,4204.00
United HealthCare,PPO,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,268,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w MCC,,Case Rate,104342.00
United HealthCare,PPO,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,26841,CPT4/HCPCS,FUSION OF THUMB,,Grouper Rate,5138.00
United HealthCare,PPO,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,Grouper Rate,5138.00
United HealthCare,PPO,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,Grouper Rate,1214.00
United HealthCare,PPO,269,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w/o MCC,,Case Rate,64858.00
United HealthCare,PPO,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,Grouper Rate,5138.00
United HealthCare,PPO,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,1370.00
United HealthCare,PPO,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,Grouper Rate,1370.00
United HealthCare,PPO,26989,CPT4/HCPCS,HAND/FINGER SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,Grouper Rate,4204.00
United HealthCare,PPO,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,Grouper Rate,4204.00
United HealthCare,PPO,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,270,DRG,Other Major Cardiovascular Procedures w MCC,,Case Rate,78662.00
United HealthCare,PPO,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,Grouper Rate,1370.00
United HealthCare,PPO,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,Grouper Rate,5138.00
United HealthCare,PPO,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,Grouper Rate,1370.00
United HealthCare,PPO,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,Grouper Rate,5138.00
United HealthCare,PPO,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,1308.00
United HealthCare,PPO,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,Grouper Rate,1308.00
United HealthCare,PPO,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,Grouper Rate,1370.00
United HealthCare,PPO,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,Grouper Rate,4204.00
United HealthCare,PPO,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,Grouper Rate,4204.00
United HealthCare,PPO,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,Grouper Rate,4204.00
United HealthCare,PPO,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,Grouper Rate,4204.00
United HealthCare,PPO,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,Grouper Rate,5138.00
United HealthCare,PPO,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,Grouper Rate,1370.00
United HealthCare,PPO,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,Grouper Rate,7007.00
United HealthCare,PPO,27075,CPT4/HCPCS,RESECT HIP TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,Grouper Rate,1370.00
United HealthCare,PPO,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,Grouper Rate,1370.00
United HealthCare,PPO,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,Grouper Rate,1370.00
United HealthCare,PPO,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,Grouper Rate,5138.00
United HealthCare,PPO,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,1370.00
United HealthCare,PPO,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,Grouper Rate,4204.00
United HealthCare,PPO,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Grouper Rate,1370.00
United HealthCare,PPO,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,Grouper Rate,1370.00
United HealthCare,PPO,27093,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,27095,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,Grouper Rate,1214.00
United HealthCare,PPO,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,Grouper Rate,4204.00
United HealthCare,PPO,271,DRG,Other Major Cardiovascular Procedures w CC,,Case Rate,52209.00
United HealthCare,PPO,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,Grouper Rate,6075.00
United HealthCare,PPO,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,Grouper Rate,6075.00
United HealthCare,PPO,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,6075.00
United HealthCare,PPO,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,Grouper Rate,6075.00
United HealthCare,PPO,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Grouper Rate,1370.00
United HealthCare,PPO,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,Grouper Rate,1370.00
United HealthCare,PPO,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,Grouper Rate,1370.00
United HealthCare,PPO,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Grouper Rate,10119.00
United HealthCare,PPO,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,Grouper Rate,10119.00
United HealthCare,PPO,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,10119.00
United HealthCare,PPO,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,10119.00
United HealthCare,PPO,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,Grouper Rate,10119.00
United HealthCare,PPO,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,Grouper Rate,1370.00
United HealthCare,PPO,27146,CPT4/HCPCS,INCISION OF HIP BONE,,Grouper Rate,1370.00
United HealthCare,PPO,27147,CPT4/HCPCS,REVISION OF HIP BONE,,Grouper Rate,1370.00
United HealthCare,PPO,27151,CPT4/HCPCS,INCISION OF HIP BONES,,Grouper Rate,1370.00
United HealthCare,PPO,27156,CPT4/HCPCS,REVISION OF HIP BONES,,Grouper Rate,1370.00
United HealthCare,PPO,27158,CPT4/HCPCS,REVISION OF PELVIS,,Grouper Rate,1370.00
United HealthCare,PPO,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,Grouper Rate,1370.00
United HealthCare,PPO,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,Grouper Rate,1370.00
United HealthCare,PPO,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,Grouper Rate,1370.00
United HealthCare,PPO,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,1370.00
United HealthCare,PPO,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,7007.00
United HealthCare,PPO,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,1370.00
United HealthCare,PPO,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,7007.00
United HealthCare,PPO,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,Grouper Rate,7007.00
United HealthCare,PPO,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,Grouper Rate,1370.00
United HealthCare,PPO,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,Grouper Rate,1370.00
United HealthCare,PPO,27187,CPT4/HCPCS,REINFORCE HIP BONES,,Grouper Rate,1370.00
United HealthCare,PPO,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,1214.00
United HealthCare,PPO,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,Grouper Rate,1214.00
United HealthCare,PPO,272,DRG,Other Major Cardiovascular Procedures w/o CC/MCC,,Case Rate,37392.00
United HealthCare,PPO,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,Grouper Rate,1308.00
United HealthCare,PPO,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,5138.00
United HealthCare,PPO,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Grouper Rate,4204.00
United HealthCare,PPO,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,Grouper Rate,4204.00
United HealthCare,PPO,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,5138.00
United HealthCare,PPO,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1308.00
United HealthCare,PPO,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1308.00
United HealthCare,PPO,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,27267,CPT4/HCPCS,CLTX THIGH FX,,Grouper Rate,1370.00
United HealthCare,PPO,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,Grouper Rate,1370.00
United HealthCare,PPO,27269,CPT4/HCPCS,OPTX THIGH FX,,Grouper Rate,1370.00
United HealthCare,PPO,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,Grouper Rate,1370.00
United HealthCare,PPO,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Grouper Rate,1370.00
United HealthCare,PPO,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,Grouper Rate,1370.00
United HealthCare,PPO,27299,CPT4/HCPCS,PELVIS/HIP JOINT SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,273,DRG,Percutaneous Intracardiac Procedures w MCC,,Case Rate,39894.00
United HealthCare,PPO,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,Grouper Rate,4204.00
United HealthCare,PPO,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,5138.00
United HealthCare,PPO,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,1308.00
United HealthCare,PPO,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,Grouper Rate,4204.00
United HealthCare,PPO,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,Grouper Rate,1370.00
United HealthCare,PPO,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,Grouper Rate,1370.00
United HealthCare,PPO,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,Grouper Rate,4204.00
United HealthCare,PPO,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,Grouper Rate,1370.00
United HealthCare,PPO,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,Grouper Rate,5138.00
United HealthCare,PPO,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,5138.00
United HealthCare,PPO,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,Grouper Rate,5138.00
United HealthCare,PPO,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,5138.00
United HealthCare,PPO,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,Grouper Rate,5138.00
United HealthCare,PPO,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,Grouper Rate,4204.00
United HealthCare,PPO,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,Grouper Rate,4204.00
United HealthCare,PPO,27347,CPT4/HCPCS,REMOVE KNEE CYST,,Grouper Rate,4204.00
United HealthCare,PPO,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,Grouper Rate,5138.00
United HealthCare,PPO,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,Grouper Rate,5138.00
United HealthCare,PPO,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,Grouper Rate,1214.00
United HealthCare,PPO,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,Grouper Rate,5138.00
United HealthCare,PPO,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,27369,CPT4/HCPCS,NJX CNTRST KNE ARTHG/CT/MRI,,Grouper Rate,1214.00
United HealthCare,PPO,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,Grouper Rate,4204.00
United HealthCare,PPO,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,4204.00
United HealthCare,PPO,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,Grouper Rate,5138.00
United HealthCare,PPO,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,5138.00
United HealthCare,PPO,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,Grouper Rate,6075.00
United HealthCare,PPO,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,Grouper Rate,6075.00
United HealthCare,PPO,274,DRG,Percutaneous Intracardiac Procedures w/o MCC,,Case Rate,27192.00
United HealthCare,PPO,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,Grouper Rate,6075.00
United HealthCare,PPO,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,Grouper Rate,5138.00
United HealthCare,PPO,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,6075.00
United HealthCare,PPO,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,Grouper Rate,7007.00
United HealthCare,PPO,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,Grouper Rate,6075.00
United HealthCare,PPO,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,Grouper Rate,7007.00
United HealthCare,PPO,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,Grouper Rate,7007.00
United HealthCare,PPO,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,Grouper Rate,6075.00
United HealthCare,PPO,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,6075.00
United HealthCare,PPO,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,Grouper Rate,6075.00
United HealthCare,PPO,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,Grouper Rate,6075.00
United HealthCare,PPO,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,Grouper Rate,5138.00
United HealthCare,PPO,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,7007.00
United HealthCare,PPO,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,7007.00
United HealthCare,PPO,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,Grouper Rate,7007.00
United HealthCare,PPO,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,Grouper Rate,6075.00
United HealthCare,PPO,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,27437,CPT4/HCPCS,REVISE KNEECAP,,Grouper Rate,6075.00
United HealthCare,PPO,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,Grouper Rate,7007.00
United HealthCare,PPO,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,Grouper Rate,10119.00
United HealthCare,PPO,27448,CPT4/HCPCS,INCISION OF THIGH,,Grouper Rate,1370.00
United HealthCare,PPO,27450,CPT4/HCPCS,INCISION OF THIGH,,Grouper Rate,1370.00
United HealthCare,PPO,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,Grouper Rate,1370.00
United HealthCare,PPO,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,Grouper Rate,1370.00
United HealthCare,PPO,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,Grouper Rate,6075.00
United HealthCare,PPO,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,Grouper Rate,1370.00
United HealthCare,PPO,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,Grouper Rate,1370.00
United HealthCare,PPO,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,Grouper Rate,1370.00
United HealthCare,PPO,27470,CPT4/HCPCS,REPAIR OF THIGH,,Grouper Rate,1370.00
United HealthCare,PPO,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,Grouper Rate,1370.00
United HealthCare,PPO,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,5138.00
United HealthCare,PPO,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,5138.00
United HealthCare,PPO,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,5138.00
United HealthCare,PPO,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,Grouper Rate,5138.00
United HealthCare,PPO,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,Grouper Rate,10119.00
United HealthCare,PPO,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,Grouper Rate,1370.00
United HealthCare,PPO,27495,CPT4/HCPCS,REINFORCE THIGH,,Grouper Rate,1370.00
United HealthCare,PPO,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,5138.00
United HealthCare,PPO,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,4204.00
United HealthCare,PPO,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,5138.00
United HealthCare,PPO,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,Grouper Rate,5138.00
United HealthCare,PPO,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5138.00
United HealthCare,PPO,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,5138.00
United HealthCare,PPO,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1214.00
United HealthCare,PPO,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1214.00
United HealthCare,PPO,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,Grouper Rate,1370.00
United HealthCare,PPO,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,5138.00
United HealthCare,PPO,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,Grouper Rate,1214.00
United HealthCare,PPO,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,5138.00
United HealthCare,PPO,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,6075.00
United HealthCare,PPO,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,Grouper Rate,5138.00
United HealthCare,PPO,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,27580,CPT4/HCPCS,FUSION OF KNEE,,Grouper Rate,1370.00
United HealthCare,PPO,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,1370.00
United HealthCare,PPO,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,1370.00
United HealthCare,PPO,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,Grouper Rate,1370.00
United HealthCare,PPO,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,Grouper Rate,1370.00
United HealthCare,PPO,27599,CPT4/HCPCS,LEG SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,4204.00
United HealthCare,PPO,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,4204.00
United HealthCare,PPO,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,Grouper Rate,5138.00
United HealthCare,PPO,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,Grouper Rate,4204.00
United HealthCare,PPO,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,Grouper Rate,4204.00
United HealthCare,PPO,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,1308.00
United HealthCare,PPO,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,Grouper Rate,4204.00
United HealthCare,PPO,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,Grouper Rate,5138.00
United HealthCare,PPO,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,5138.00
United HealthCare,PPO,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,Grouper Rate,5138.00
United HealthCare,PPO,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,Grouper Rate,4204.00
United HealthCare,PPO,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,Grouper Rate,5138.00
United HealthCare,PPO,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,Grouper Rate,5138.00
United HealthCare,PPO,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,Grouper Rate,5138.00
United HealthCare,PPO,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,Grouper Rate,5138.00
United HealthCare,PPO,27648,CPT4/HCPCS,INJECTION FOR ANKLE X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,Grouper Rate,6075.00
United HealthCare,PPO,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,Grouper Rate,6075.00
United HealthCare,PPO,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,Grouper Rate,6075.00
United HealthCare,PPO,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,4204.00
United HealthCare,PPO,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,4204.00
United HealthCare,PPO,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,5138.00
United HealthCare,PPO,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,Grouper Rate,5138.00
United HealthCare,PPO,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,4204.00
United HealthCare,PPO,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,Grouper Rate,5138.00
United HealthCare,PPO,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,Grouper Rate,5138.00
United HealthCare,PPO,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,Grouper Rate,5138.00
United HealthCare,PPO,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,Grouper Rate,5138.00
United HealthCare,PPO,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,6075.00
United HealthCare,PPO,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,Grouper Rate,6075.00
United HealthCare,PPO,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,Grouper Rate,1214.00
United HealthCare,PPO,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,5138.00
United HealthCare,PPO,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,Grouper Rate,5138.00
United HealthCare,PPO,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,Grouper Rate,5138.00
United HealthCare,PPO,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,Grouper Rate,6075.00
United HealthCare,PPO,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,27705,CPT4/HCPCS,INCISION OF TIBIA,,Grouper Rate,6075.00
United HealthCare,PPO,27707,CPT4/HCPCS,INCISION OF FIBULA,,Grouper Rate,5138.00
United HealthCare,PPO,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,Grouper Rate,5138.00
United HealthCare,PPO,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,Grouper Rate,1370.00
United HealthCare,PPO,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,Grouper Rate,5138.00
United HealthCare,PPO,27720,CPT4/HCPCS,REPAIR OF TIBIA,,Grouper Rate,7007.00
United HealthCare,PPO,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,7007.00
United HealthCare,PPO,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,Grouper Rate,1370.00
United HealthCare,PPO,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,Grouper Rate,1370.00
United HealthCare,PPO,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,Grouper Rate,7007.00
United HealthCare,PPO,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,Grouper Rate,1370.00
United HealthCare,PPO,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,Grouper Rate,5138.00
United HealthCare,PPO,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,Grouper Rate,5138.00
United HealthCare,PPO,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,Grouper Rate,5138.00
United HealthCare,PPO,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,5138.00
United HealthCare,PPO,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,Grouper Rate,6075.00
United HealthCare,PPO,27745,CPT4/HCPCS,REINFORCE TIBIA,,Grouper Rate,7007.00
United HealthCare,PPO,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,Grouper Rate,1214.00
United HealthCare,PPO,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,Grouper Rate,1370.00
United HealthCare,PPO,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,Grouper Rate,7007.00
United HealthCare,PPO,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,Grouper Rate,1214.00
United HealthCare,PPO,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,Grouper Rate,1214.00
United HealthCare,PPO,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,Grouper Rate,7007.00
United HealthCare,PPO,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,1308.00
United HealthCare,PPO,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1308.00
United HealthCare,PPO,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1308.00
United HealthCare,PPO,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,1308.00
United HealthCare,PPO,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,Grouper Rate,1370.00
United HealthCare,PPO,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,Grouper Rate,7007.00
United HealthCare,PPO,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,1370.00
United HealthCare,PPO,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,1370.00
United HealthCare,PPO,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,Grouper Rate,1370.00
United HealthCare,PPO,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,1370.00
United HealthCare,PPO,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,Grouper Rate,5138.00
United HealthCare,PPO,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,5138.00
United HealthCare,PPO,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,5138.00
United HealthCare,PPO,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,Grouper Rate,5138.00
United HealthCare,PPO,27899,CPT4/HCPCS,LEG/ANKLE SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,28,DRG,Spinal procedures w MCC,,Case Rate,46851.00
United HealthCare,PPO,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,Grouper Rate,1370.00
United HealthCare,PPO,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,4204.00
United HealthCare,PPO,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,Grouper Rate,4204.00
United HealthCare,PPO,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,Grouper Rate,4204.00
United HealthCare,PPO,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,Grouper Rate,4204.00
United HealthCare,PPO,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,Grouper Rate,1370.00
United HealthCare,PPO,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,Grouper Rate,1370.00
United HealthCare,PPO,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,Grouper Rate,1370.00
United HealthCare,PPO,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,Grouper Rate,4204.00
United HealthCare,PPO,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,4204.00
United HealthCare,PPO,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,Grouper Rate,4204.00
United HealthCare,PPO,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,Grouper Rate,4204.00
United HealthCare,PPO,28055,CPT4/HCPCS,NEURECTOMY FOOT,,Grouper Rate,4204.00
United HealthCare,PPO,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,Grouper Rate,4204.00
United HealthCare,PPO,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,Grouper Rate,4204.00
United HealthCare,PPO,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,4204.00
United HealthCare,PPO,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,Grouper Rate,4204.00
United HealthCare,PPO,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,4204.00
United HealthCare,PPO,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,4204.00
United HealthCare,PPO,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,Grouper Rate,4204.00
United HealthCare,PPO,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,4204.00
United HealthCare,PPO,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,4204.00
United HealthCare,PPO,281,DRG,Acute myocardial infarction, discharged alive w CC,,Case Rate,19316.00
United HealthCare,PPO,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,Grouper Rate,4204.00
United HealthCare,PPO,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,7007.00
United HealthCare,PPO,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,7007.00
United HealthCare,PPO,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,Grouper Rate,4204.00
United HealthCare,PPO,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,7007.00
United HealthCare,PPO,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,Grouper Rate,7007.00
United HealthCare,PPO,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,Grouper Rate,4204.00
United HealthCare,PPO,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,4204.00
United HealthCare,PPO,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,4204.00
United HealthCare,PPO,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,4204.00
United HealthCare,PPO,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,Grouper Rate,4204.00
United HealthCare,PPO,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,Grouper Rate,4204.00
United HealthCare,PPO,28116,CPT4/HCPCS,REVISION OF FOOT,,Grouper Rate,4204.00
United HealthCare,PPO,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,Grouper Rate,4204.00
United HealthCare,PPO,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,Grouper Rate,4204.00
United HealthCare,PPO,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,Grouper Rate,4204.00
United HealthCare,PPO,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,4204.00
United HealthCare,PPO,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,Grouper Rate,4204.00
United HealthCare,PPO,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,Grouper Rate,4204.00
United HealthCare,PPO,28150,CPT4/HCPCS,REMOVAL OF TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,Grouper Rate,4204.00
United HealthCare,PPO,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,Grouper Rate,4204.00
United HealthCare,PPO,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,Grouper Rate,4204.00
United HealthCare,PPO,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1308.00
United HealthCare,PPO,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1370.00
United HealthCare,PPO,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,Grouper Rate,1308.00
United HealthCare,PPO,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,Case Rate,15627.00
United HealthCare,PPO,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,Grouper Rate,7007.00
United HealthCare,PPO,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,4204.00
United HealthCare,PPO,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,Grouper Rate,4204.00
United HealthCare,PPO,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,Grouper Rate,4204.00
United HealthCare,PPO,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,7007.00
United HealthCare,PPO,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,Grouper Rate,4204.00
United HealthCare,PPO,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,Grouper Rate,4204.00
United HealthCare,PPO,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,Grouper Rate,4204.00
United HealthCare,PPO,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,Grouper Rate,4204.00
United HealthCare,PPO,28280,CPT4/HCPCS,FUSION OF TOES,,Grouper Rate,4204.00
United HealthCare,PPO,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,4204.00
United HealthCare,PPO,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,Grouper Rate,4204.00
United HealthCare,PPO,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,Grouper Rate,4204.00
United HealthCare,PPO,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,Grouper Rate,4204.00
United HealthCare,PPO,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,Grouper Rate,7007.00
United HealthCare,PPO,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5138.00
United HealthCare,PPO,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5138.00
United HealthCare,PPO,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5138.00
United HealthCare,PPO,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5138.00
United HealthCare,PPO,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5138.00
United HealthCare,PPO,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,Grouper Rate,5138.00
United HealthCare,PPO,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,Grouper Rate,7007.00
United HealthCare,PPO,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,Grouper Rate,4204.00
United HealthCare,PPO,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,Grouper Rate,7007.00
United HealthCare,PPO,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,Grouper Rate,7007.00
United HealthCare,PPO,28306,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,4204.00
United HealthCare,PPO,28307,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,4204.00
United HealthCare,PPO,28308,CPT4/HCPCS,INCISION OF METATARSAL,,Grouper Rate,4204.00
United HealthCare,PPO,28309,CPT4/HCPCS,INCISION OF METATARSALS,,Grouper Rate,7007.00
United HealthCare,PPO,28310,CPT4/HCPCS,REVISION OF BIG TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28312,CPT4/HCPCS,REVISION OF TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,Grouper Rate,4204.00
United HealthCare,PPO,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,Grouper Rate,7007.00
United HealthCare,PPO,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,Grouper Rate,4204.00
United HealthCare,PPO,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,Grouper Rate,4204.00
United HealthCare,PPO,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,Grouper Rate,4204.00
United HealthCare,PPO,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,Grouper Rate,4204.00
United HealthCare,PPO,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,Grouper Rate,7007.00
United HealthCare,PPO,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,Grouper Rate,7007.00
United HealthCare,PPO,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,1214.00
United HealthCare,PPO,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,1214.00
United HealthCare,PPO,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,Grouper Rate,7007.00
United HealthCare,PPO,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,Grouper Rate,7007.00
United HealthCare,PPO,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,1214.00
United HealthCare,PPO,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,Case Rate,17941.00
United HealthCare,PPO,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,Grouper Rate,7007.00
United HealthCare,PPO,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,1214.00
United HealthCare,PPO,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,Grouper Rate,4204.00
United HealthCare,PPO,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,Case Rate,16795.00
United HealthCare,PPO,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,7007.00
United HealthCare,PPO,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,7007.00
United HealthCare,PPO,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,7007.00
United HealthCare,PPO,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,7007.00
United HealthCare,PPO,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,7007.00
United HealthCare,PPO,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,Grouper Rate,7007.00
United HealthCare,PPO,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,Grouper Rate,7007.00
United HealthCare,PPO,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,4204.00
United HealthCare,PPO,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,Grouper Rate,7007.00
United HealthCare,PPO,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,Grouper Rate,1370.00
United HealthCare,PPO,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,Grouper Rate,4204.00
United HealthCare,PPO,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,Grouper Rate,4204.00
United HealthCare,PPO,28820,CPT4/HCPCS,AMPUTATION OF TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,Grouper Rate,4204.00
United HealthCare,PPO,28890,CPT4/HCPCS,HI ENRGY ESWT PLANTAR FASCIA,,Grouper Rate,5138.00
United HealthCare,PPO,28899,CPT4/HCPCS,FOOT/TOES SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,29,DRG,Spinal procedures w CC or spinal neurostimulators,,Case Rate,41731.00
United HealthCare,PPO,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,Grouper Rate,1214.00
United HealthCare,PPO,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29065,CPT4/HCPCS,APPLICATION OF LONG ARM CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29075,CPT4/HCPCS,APPLICATION OF FOREARM CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29085,CPT4/HCPCS,APPLY HAND/WRIST CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29086,CPT4/HCPCS,APPLY FINGER CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29105,CPT4/HCPCS,APPLY LONG ARM SPLINT,,Grouper Rate,1214.00
United HealthCare,PPO,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,Grouper Rate,1214.00
United HealthCare,PPO,29126,CPT4/HCPCS,APPLY FOREARM SPLINT,,Grouper Rate,1214.00
United HealthCare,PPO,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Grouper Rate,1214.00
United HealthCare,PPO,29131,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,Grouper Rate,1214.00
United HealthCare,PPO,29200,CPT4/HCPCS,STRAPPING OF CHEST,,Grouper Rate,1214.00
United HealthCare,PPO,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,Grouper Rate,1214.00
United HealthCare,PPO,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,Grouper Rate,1214.00
United HealthCare,PPO,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,Grouper Rate,1214.00
United HealthCare,PPO,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,Grouper Rate,1214.00
United HealthCare,PPO,29345,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29355,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29358,CPT4/HCPCS,APPLY LONG LEG CAST BRACE,,Grouper Rate,1214.00
United HealthCare,PPO,29365,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29425,CPT4/HCPCS,APPLY SHORT LEG CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29435,CPT4/HCPCS,APPLY SHORT LEG CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29450,CPT4/HCPCS,APPLICATION OF LEG CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29505,CPT4/HCPCS,APPLICATION LONG LEG SPLINT,,Grouper Rate,1214.00
United HealthCare,PPO,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,Grouper Rate,1214.00
United HealthCare,PPO,29520,CPT4/HCPCS,STRAPPING OF HIP,,Grouper Rate,1214.00
United HealthCare,PPO,29530,CPT4/HCPCS,STRAPPING OF KNEE,,Grouper Rate,1214.00
United HealthCare,PPO,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,Grouper Rate,1214.00
United HealthCare,PPO,29550,CPT4/HCPCS,STRAPPING OF TOES,,Grouper Rate,1214.00
United HealthCare,PPO,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,Grouper Rate,1214.00
United HealthCare,PPO,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,Grouper Rate,1214.00
United HealthCare,PPO,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,Grouper Rate,1214.00
United HealthCare,PPO,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29710,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29730,CPT4/HCPCS,WINDOWING OF CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29740,CPT4/HCPCS,WEDGING OF CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29750,CPT4/HCPCS,WEDGING OF CLUBFOOT CAST,,Grouper Rate,1214.00
United HealthCare,PPO,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,Grouper Rate,5138.00
United HealthCare,PPO,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,Grouper Rate,7007.00
United HealthCare,PPO,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,Grouper Rate,7007.00
United HealthCare,PPO,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,Grouper Rate,7007.00
United HealthCare,PPO,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,Grouper Rate,7007.00
United HealthCare,PPO,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,Grouper Rate,7007.00
United HealthCare,PPO,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,Grouper Rate,5138.00
United HealthCare,PPO,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,Grouper Rate,7007.00
United HealthCare,PPO,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,Grouper Rate,7007.00
United HealthCare,PPO,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,Grouper Rate,7007.00
United HealthCare,PPO,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,Grouper Rate,1214.00
United HealthCare,PPO,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,Grouper Rate,7007.00
United HealthCare,PPO,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,Grouper Rate,7007.00
United HealthCare,PPO,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,Grouper Rate,7007.00
United HealthCare,PPO,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,Grouper Rate,5138.00
United HealthCare,PPO,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,Grouper Rate,7007.00
United HealthCare,PPO,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,Grouper Rate,7007.00
United HealthCare,PPO,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,Grouper Rate,7007.00
United HealthCare,PPO,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,7007.00
United HealthCare,PPO,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,Grouper Rate,7007.00
United HealthCare,PPO,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,Grouper Rate,7007.00
United HealthCare,PPO,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,Grouper Rate,5138.00
United HealthCare,PPO,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,Grouper Rate,5138.00
United HealthCare,PPO,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,6075.00
United HealthCare,PPO,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,Grouper Rate,4204.00
United HealthCare,PPO,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,Grouper Rate,5138.00
United HealthCare,PPO,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,7007.00
United HealthCare,PPO,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,Grouper Rate,5138.00
United HealthCare,PPO,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,Grouper Rate,5138.00
United HealthCare,PPO,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,Grouper Rate,5138.00
United HealthCare,PPO,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,Grouper Rate,5138.00
United HealthCare,PPO,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,Grouper Rate,7007.00
United HealthCare,PPO,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,Grouper Rate,7007.00
United HealthCare,PPO,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,Grouper Rate,7007.00
United HealthCare,PPO,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,Grouper Rate,7007.00
United HealthCare,PPO,29999,CPT4/HCPCS,ARTHROSCOPY OF JOINT,,Grouper Rate,1214.00
United HealthCare,PPO,30,DRG,Spinal procedures w/o CC/MCC,,Case Rate,25930.00
United HealthCare,PPO,30000,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Grouper Rate,1214.00
United HealthCare,PPO,30020,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,Grouper Rate,1214.00
United HealthCare,PPO,30100,CPT4/HCPCS,INTRANASAL BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,1370.00
United HealthCare,PPO,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,Grouper Rate,4204.00
United HealthCare,PPO,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,Grouper Rate,4204.00
United HealthCare,PPO,30120,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,4204.00
United HealthCare,PPO,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,Grouper Rate,6075.00
United HealthCare,PPO,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,Grouper Rate,4204.00
United HealthCare,PPO,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,Grouper Rate,4204.00
United HealthCare,PPO,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,Grouper Rate,6075.00
United HealthCare,PPO,30160,CPT4/HCPCS,REMOVAL OF NOSE,,Grouper Rate,6075.00
United HealthCare,PPO,30200,CPT4/HCPCS,INJECTION TREATMENT OF NOSE,,Grouper Rate,1214.00
United HealthCare,PPO,30210,CPT4/HCPCS,NASAL SINUS THERAPY,,Grouper Rate,1370.00
United HealthCare,PPO,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,Grouper Rate,1370.00
United HealthCare,PPO,30300,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1214.00
United HealthCare,PPO,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1370.00
United HealthCare,PPO,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,Grouper Rate,1370.00
United HealthCare,PPO,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,4204.00
United HealthCare,PPO,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,6075.00
United HealthCare,PPO,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,Grouper Rate,6075.00
United HealthCare,PPO,30430,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,4204.00
United HealthCare,PPO,30435,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,6075.00
United HealthCare,PPO,30450,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,6075.00
United HealthCare,PPO,30460,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,6075.00
United HealthCare,PPO,30462,CPT4/HCPCS,REVISION OF NOSE,,Grouper Rate,6075.00
United HealthCare,PPO,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,Grouper Rate,6075.00
United HealthCare,PPO,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,Grouper Rate,4204.00
United HealthCare,PPO,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,6075.00
United HealthCare,PPO,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,Grouper Rate,6075.00
United HealthCare,PPO,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,Grouper Rate,6075.00
United HealthCare,PPO,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,Grouper Rate,6075.00
United HealthCare,PPO,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,Grouper Rate,6075.00
United HealthCare,PPO,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,Grouper Rate,1370.00
United HealthCare,PPO,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,Grouper Rate,1370.00
United HealthCare,PPO,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1214.00
United HealthCare,PPO,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1214.00
United HealthCare,PPO,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,Grouper Rate,1214.00
United HealthCare,PPO,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,Grouper Rate,1214.00
United HealthCare,PPO,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,Grouper Rate,5138.00
United HealthCare,PPO,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,Grouper Rate,5138.00
United HealthCare,PPO,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,Grouper Rate,4204.00
United HealthCare,PPO,30999,CPT4/HCPCS,NASAL SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,Grouper Rate,1214.00
United HealthCare,PPO,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,Grouper Rate,1370.00
United HealthCare,PPO,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,4204.00
United HealthCare,PPO,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,6075.00
United HealthCare,PPO,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,Grouper Rate,6075.00
United HealthCare,PPO,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,Grouper Rate,4204.00
United HealthCare,PPO,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,Grouper Rate,6075.00
United HealthCare,PPO,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,Grouper Rate,6075.00
United HealthCare,PPO,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,4204.00
United HealthCare,PPO,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,Grouper Rate,6075.00
United HealthCare,PPO,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6075.00
United HealthCare,PPO,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6075.00
United HealthCare,PPO,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6075.00
United HealthCare,PPO,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6075.00
United HealthCare,PPO,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6075.00
United HealthCare,PPO,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,Grouper Rate,6075.00
United HealthCare,PPO,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,Grouper Rate,6075.00
United HealthCare,PPO,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,6075.00
United HealthCare,PPO,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,1370.00
United HealthCare,PPO,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,Grouper Rate,4204.00
United HealthCare,PPO,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Grouper Rate,1370.00
United HealthCare,PPO,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,Grouper Rate,1370.00
United HealthCare,PPO,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,Grouper Rate,1214.00
United HealthCare,PPO,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,Grouper Rate,1214.00
United HealthCare,PPO,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,Grouper Rate,1370.00
United HealthCare,PPO,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1370.00
United HealthCare,PPO,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1370.00
United HealthCare,PPO,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,4204.00
United HealthCare,PPO,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,4204.00
United HealthCare,PPO,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,Grouper Rate,4204.00
United HealthCare,PPO,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,Grouper Rate,5138.00
United HealthCare,PPO,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,Grouper Rate,4204.00
United HealthCare,PPO,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,Grouper Rate,5138.00
United HealthCare,PPO,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,Grouper Rate,4204.00
United HealthCare,PPO,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,Grouper Rate,5138.00
United HealthCare,PPO,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,Grouper Rate,5138.00
United HealthCare,PPO,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,Grouper Rate,4204.00
United HealthCare,PPO,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,Grouper Rate,5138.00
United HealthCare,PPO,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5138.00
United HealthCare,PPO,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,5138.00
United HealthCare,PPO,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1370.00
United HealthCare,PPO,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,Grouper Rate,1370.00
United HealthCare,PPO,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,Grouper Rate,5138.00
United HealthCare,PPO,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,Grouper Rate,5138.00
United HealthCare,PPO,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,Grouper Rate,5138.00
United HealthCare,PPO,31295,CPT4/HCPCS,NSL/SINS NDSC SURG MAX SINS,,Grouper Rate,5138.00
United HealthCare,PPO,31296,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT SINS,,Grouper Rate,5138.00
United HealthCare,PPO,31297,CPT4/HCPCS,NSL/SINS NDSC SURG SPHN SINS,,Grouper Rate,4204.00
United HealthCare,PPO,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,Grouper Rate,5138.00
United HealthCare,PPO,31299,CPT4/HCPCS,SINUS SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,4204.00
United HealthCare,PPO,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,Grouper Rate,1370.00
United HealthCare,PPO,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,Grouper Rate,1370.00
United HealthCare,PPO,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1370.00
United HealthCare,PPO,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1370.00
United HealthCare,PPO,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1370.00
United HealthCare,PPO,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1370.00
United HealthCare,PPO,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1370.00
United HealthCare,PPO,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,Grouper Rate,1370.00
United HealthCare,PPO,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,Grouper Rate,1370.00
United HealthCare,PPO,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,Grouper Rate,1370.00
United HealthCare,PPO,31400,CPT4/HCPCS,REVISION OF LARYNX,,Grouper Rate,6075.00
United HealthCare,PPO,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,Grouper Rate,6075.00
United HealthCare,PPO,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,Grouper Rate,1214.00
United HealthCare,PPO,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,Grouper Rate,1214.00
United HealthCare,PPO,31505,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Grouper Rate,1214.00
United HealthCare,PPO,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,Grouper Rate,1214.00
United HealthCare,PPO,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,Grouper Rate,4204.00
United HealthCare,PPO,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,Grouper Rate,1214.00
United HealthCare,PPO,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,Grouper Rate,1214.00
United HealthCare,PPO,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,Grouper Rate,1214.00
United HealthCare,PPO,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,Grouper Rate,1370.00
United HealthCare,PPO,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,Grouper Rate,1370.00
United HealthCare,PPO,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,4204.00
United HealthCare,PPO,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,Grouper Rate,4204.00
United HealthCare,PPO,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,Grouper Rate,1370.00
United HealthCare,PPO,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,Grouper Rate,4204.00
United HealthCare,PPO,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,Grouper Rate,4204.00
United HealthCare,PPO,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,Grouper Rate,4204.00
United HealthCare,PPO,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,Grouper Rate,4204.00
United HealthCare,PPO,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,Grouper Rate,4204.00
United HealthCare,PPO,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6075.00
United HealthCare,PPO,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6075.00
United HealthCare,PPO,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6075.00
United HealthCare,PPO,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,Grouper Rate,6075.00
United HealthCare,PPO,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,Grouper Rate,5138.00
United HealthCare,PPO,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,Grouper Rate,4204.00
United HealthCare,PPO,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,Grouper Rate,1370.00
United HealthCare,PPO,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,Grouper Rate,4204.00
United HealthCare,PPO,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,Grouper Rate,4204.00
United HealthCare,PPO,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,Grouper Rate,1370.00
United HealthCare,PPO,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,Grouper Rate,1370.00
United HealthCare,PPO,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,Grouper Rate,1214.00
United HealthCare,PPO,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,Grouper Rate,1214.00
United HealthCare,PPO,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,Grouper Rate,1214.00
United HealthCare,PPO,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,Grouper Rate,6075.00
United HealthCare,PPO,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,Grouper Rate,5138.00
United HealthCare,PPO,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,Grouper Rate,6075.00
United HealthCare,PPO,31590,CPT4/HCPCS,REINNERVATE LARYNX,,Grouper Rate,6075.00
United HealthCare,PPO,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,Grouper Rate,6075.00
United HealthCare,PPO,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,Grouper Rate,6075.00
United HealthCare,PPO,31599,CPT4/HCPCS,LARYNX SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,4204.00
United HealthCare,PPO,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,4204.00
United HealthCare,PPO,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1370.00
United HealthCare,PPO,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,1214.00
United HealthCare,PPO,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,Grouper Rate,4204.00
United HealthCare,PPO,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,Grouper Rate,4204.00
United HealthCare,PPO,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,Grouper Rate,4204.00
United HealthCare,PPO,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,4204.00
United HealthCare,PPO,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,Grouper Rate,6075.00
United HealthCare,PPO,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,Grouper Rate,1214.00
United HealthCare,PPO,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,Grouper Rate,1370.00
United HealthCare,PPO,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,Grouper Rate,1370.00
United HealthCare,PPO,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,Grouper Rate,1370.00
United HealthCare,PPO,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,Grouper Rate,1370.00
United HealthCare,PPO,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,Grouper Rate,5138.00
United HealthCare,PPO,31627,CPT4/HCPCS,NAVIGATIONAL BRONCHOSCOPY,,Grouper Rate,1214.00
United HealthCare,PPO,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,Grouper Rate,1370.00
United HealthCare,PPO,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,Grouper Rate,5138.00
United HealthCare,PPO,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,Grouper Rate,5138.00
United HealthCare,PPO,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,Grouper Rate,5138.00
United HealthCare,PPO,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,Grouper Rate,5138.00
United HealthCare,PPO,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,Grouper Rate,5138.00
United HealthCare,PPO,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,Grouper Rate,5138.00
United HealthCare,PPO,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,Grouper Rate,5138.00
United HealthCare,PPO,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,Grouper Rate,5138.00
United HealthCare,PPO,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,Grouper Rate,1370.00
United HealthCare,PPO,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,Grouper Rate,1370.00
United HealthCare,PPO,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,Grouper Rate,1214.00
United HealthCare,PPO,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,Grouper Rate,5138.00
United HealthCare,PPO,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,Grouper Rate,5138.00
United HealthCare,PPO,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,31651,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,Grouper Rate,1214.00
United HealthCare,PPO,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,Grouper Rate,4204.00
United HealthCare,PPO,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,Grouper Rate,4204.00
United HealthCare,PPO,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,Grouper Rate,1214.00
United HealthCare,PPO,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,Grouper Rate,5138.00
United HealthCare,PPO,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,Grouper Rate,5138.00
United HealthCare,PPO,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,Grouper Rate,1214.00
United HealthCare,PPO,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,1214.00
United HealthCare,PPO,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,Grouper Rate,1370.00
United HealthCare,PPO,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,Grouper Rate,1370.00
United HealthCare,PPO,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,6075.00
United HealthCare,PPO,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,6075.00
United HealthCare,PPO,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,Grouper Rate,1370.00
United HealthCare,PPO,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,Grouper Rate,1370.00
United HealthCare,PPO,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,Grouper Rate,1370.00
United HealthCare,PPO,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,Grouper Rate,1370.00
United HealthCare,PPO,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Grouper Rate,1370.00
United HealthCare,PPO,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,Grouper Rate,1370.00
United HealthCare,PPO,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,1370.00
United HealthCare,PPO,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,Grouper Rate,1370.00
United HealthCare,PPO,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,Grouper Rate,4204.00
United HealthCare,PPO,31899,CPT4/HCPCS,AIRWAYS SURGICAL PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,Grouper Rate,1370.00
United HealthCare,PPO,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,Grouper Rate,1370.00
United HealthCare,PPO,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,Grouper Rate,1370.00
United HealthCare,PPO,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,Grouper Rate,1370.00
United HealthCare,PPO,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,1370.00
United HealthCare,PPO,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,Grouper Rate,1370.00
United HealthCare,PPO,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,Grouper Rate,1370.00
United HealthCare,PPO,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,Grouper Rate,1370.00
United HealthCare,PPO,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Grouper Rate,1370.00
United HealthCare,PPO,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,Grouper Rate,1370.00
United HealthCare,PPO,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,Grouper Rate,1370.00
United HealthCare,PPO,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,Grouper Rate,1370.00
United HealthCare,PPO,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,Grouper Rate,1370.00
United HealthCare,PPO,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,Grouper Rate,1370.00
United HealthCare,PPO,32215,CPT4/HCPCS,TREAT CHEST LINING,,Grouper Rate,1370.00
United HealthCare,PPO,32220,CPT4/HCPCS,RELEASE OF LUNG,,Grouper Rate,1370.00
United HealthCare,PPO,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,Grouper Rate,1370.00
United HealthCare,PPO,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,Grouper Rate,1370.00
United HealthCare,PPO,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,Grouper Rate,1370.00
United HealthCare,PPO,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,Grouper Rate,1370.00
United HealthCare,PPO,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,Grouper Rate,1370.00
United HealthCare,PPO,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,Grouper Rate,1370.00
United HealthCare,PPO,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,Grouper Rate,1370.00
United HealthCare,PPO,32482,CPT4/HCPCS,BILOBECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,32484,CPT4/HCPCS,SEGMENTECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,32488,CPT4/HCPCS,COMPLETION PNEUMONECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,Grouper Rate,1370.00
United HealthCare,PPO,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,32503,CPT4/HCPCS,RESECT APICAL LUNG TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,32504,CPT4/HCPCS,RESECT APICAL LUNG TUM/CHEST,,Grouper Rate,1370.00
United HealthCare,PPO,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,Grouper Rate,1370.00
United HealthCare,PPO,32506,CPT4/HCPCS,WEDGE RESECT OF LUNG ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,32507,CPT4/HCPCS,WEDGE RESECT OF LUNG DIAG,,Grouper Rate,1370.00
United HealthCare,PPO,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,Grouper Rate,1370.00
United HealthCare,PPO,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,Grouper Rate,5138.00
United HealthCare,PPO,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,Grouper Rate,1308.00
United HealthCare,PPO,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,Grouper Rate,1308.00
United HealthCare,PPO,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,Grouper Rate,1370.00
United HealthCare,PPO,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,Grouper Rate,1308.00
United HealthCare,PPO,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,Grouper Rate,1308.00
United HealthCare,PPO,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,Grouper Rate,1370.00
United HealthCare,PPO,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,Grouper Rate,1308.00
United HealthCare,PPO,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,Grouper Rate,1308.00
United HealthCare,PPO,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,Grouper Rate,1308.00
United HealthCare,PPO,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,Grouper Rate,1308.00
United HealthCare,PPO,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,Grouper Rate,6075.00
United HealthCare,PPO,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,Grouper Rate,6075.00
United HealthCare,PPO,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,Grouper Rate,6075.00
United HealthCare,PPO,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,Grouper Rate,6075.00
United HealthCare,PPO,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,Grouper Rate,6075.00
United HealthCare,PPO,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,Grouper Rate,6075.00
United HealthCare,PPO,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,Grouper Rate,10119.00
United HealthCare,PPO,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,Grouper Rate,10119.00
United HealthCare,PPO,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,Grouper Rate,10119.00
United HealthCare,PPO,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,Grouper Rate,7007.00
United HealthCare,PPO,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,Grouper Rate,1370.00
United HealthCare,PPO,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,Grouper Rate,10119.00
United HealthCare,PPO,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,Grouper Rate,10119.00
United HealthCare,PPO,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,Grouper Rate,1370.00
United HealthCare,PPO,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,Grouper Rate,1370.00
United HealthCare,PPO,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,Grouper Rate,1370.00
United HealthCare,PPO,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,Grouper Rate,5138.00
United HealthCare,PPO,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,Grouper Rate,1370.00
United HealthCare,PPO,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,Grouper Rate,1370.00
United HealthCare,PPO,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,Grouper Rate,1370.00
United HealthCare,PPO,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,Grouper Rate,1370.00
United HealthCare,PPO,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,Grouper Rate,1370.00
United HealthCare,PPO,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,Grouper Rate,1370.00
United HealthCare,PPO,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,Grouper Rate,1370.00
United HealthCare,PPO,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,Grouper Rate,1370.00
United HealthCare,PPO,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,Grouper Rate,1370.00
United HealthCare,PPO,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,Grouper Rate,1370.00
United HealthCare,PPO,32852,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Grouper Rate,1370.00
United HealthCare,PPO,32853,CPT4/HCPCS,LUNG TRANSPLANT DOUBLE,,Grouper Rate,1370.00
United HealthCare,PPO,32854,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,Grouper Rate,1370.00
United HealthCare,PPO,32855,CPT4/HCPCS,PREPARE DONOR LUNG SINGLE,,Grouper Rate,1370.00
United HealthCare,PPO,32856,CPT4/HCPCS,PREPARE DONOR LUNG DOUBLE,,Grouper Rate,1370.00
United HealthCare,PPO,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,Grouper Rate,1370.00
United HealthCare,PPO,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Grouper Rate,1370.00
United HealthCare,PPO,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,Grouper Rate,1370.00
United HealthCare,PPO,32940,CPT4/HCPCS,REVISION OF LUNG,,Grouper Rate,1370.00
United HealthCare,PPO,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,Grouper Rate,1308.00
United HealthCare,PPO,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,Grouper Rate,7007.00
United HealthCare,PPO,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,Grouper Rate,1370.00
United HealthCare,PPO,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,Grouper Rate,7007.00
United HealthCare,PPO,32999,CPT4/HCPCS,CHEST SURGERY PROCEDURE,,Grouper Rate,1308.00
United HealthCare,PPO,33016,CPT4/HCPCS,PERICARDIOCENTESIS W/IMAGING,,Grouper Rate,1308.00
United HealthCare,PPO,33017,CPT4/HCPCS,PRCRD DRG 6YR+ W/O CGEN CAR,,Grouper Rate,1370.00
United HealthCare,PPO,33018,CPT4/HCPCS,PRCRD DRG 0-5YR OR W/ANOMLY,,Grouper Rate,1370.00
United HealthCare,PPO,33019,CPT4/HCPCS,PERQ PRCRD DRG INSJ CATH CT,,Grouper Rate,1370.00
United HealthCare,PPO,33020,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,1370.00
United HealthCare,PPO,33025,CPT4/HCPCS,INCISION OF HEART SAC,,Grouper Rate,1370.00
United HealthCare,PPO,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Grouper Rate,1370.00
United HealthCare,PPO,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,Grouper Rate,1370.00
United HealthCare,PPO,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,Grouper Rate,1370.00
United HealthCare,PPO,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,1370.00
United HealthCare,PPO,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,1370.00
United HealthCare,PPO,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,Grouper Rate,1370.00
United HealthCare,PPO,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,33202,CPT4/HCPCS,INSERT EPICARD ELTRD OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,33203,CPT4/HCPCS,INSERT EPICARD ELTRD ENDO,,Grouper Rate,1370.00
United HealthCare,PPO,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,Case Rate,10772.00
United HealthCare,PPO,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,Case Rate,10772.00
United HealthCare,PPO,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,Case Rate,10772.00
United HealthCare,PPO,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,Grouper Rate,7007.00
United HealthCare,PPO,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,Grouper Rate,7007.00
United HealthCare,PPO,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,Case Rate,10772.00
United HealthCare,PPO,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,Case Rate,10772.00
United HealthCare,PPO,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,Case Rate,10772.00
United HealthCare,PPO,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,Grouper Rate,5138.00
United HealthCare,PPO,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,Grouper Rate,7007.00
United HealthCare,PPO,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,Grouper Rate,7007.00
United HealthCare,PPO,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,Grouper Rate,5138.00
United HealthCare,PPO,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,Grouper Rate,5138.00
United HealthCare,PPO,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,Case Rate,10772.00
United HealthCare,PPO,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,Grouper Rate,1370.00
United HealthCare,PPO,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,Grouper Rate,1370.00
United HealthCare,PPO,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,Case Rate,10772.00
United HealthCare,PPO,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,Case Rate,10772.00
United HealthCare,PPO,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,Grouper Rate,5138.00
United HealthCare,PPO,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,Case Rate,10772.00
United HealthCare,PPO,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,Case Rate,10772.00
United HealthCare,PPO,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,Case Rate,10772.00
United HealthCare,PPO,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,Case Rate,24180.00
United HealthCare,PPO,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,Case Rate,24180.00
United HealthCare,PPO,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,Grouper Rate,5138.00
United HealthCare,PPO,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,Grouper Rate,5138.00
United HealthCare,PPO,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,Grouper Rate,5138.00
United HealthCare,PPO,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,Case Rate,24180.00
United HealthCare,PPO,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,Grouper Rate,5138.00
United HealthCare,PPO,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,Grouper Rate,6075.00
United HealthCare,PPO,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,Grouper Rate,5138.00
United HealthCare,PPO,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,Case Rate,24180.00
United HealthCare,PPO,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,1370.00
United HealthCare,PPO,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,1370.00
United HealthCare,PPO,33254,CPT4/HCPCS,ABLATE ATRIA LMTD,,Grouper Rate,1370.00
United HealthCare,PPO,33255,CPT4/HCPCS,ABLATE ATRIA W/O BYPASS EXT,,Grouper Rate,1370.00
United HealthCare,PPO,33256,CPT4/HCPCS,ABLATE ATRIA W/BYPASS EXTEN,,Grouper Rate,1370.00
United HealthCare,PPO,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,1370.00
United HealthCare,PPO,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,Case Rate,24180.00
United HealthCare,PPO,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,Case Rate,24180.00
United HealthCare,PPO,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,Case Rate,24180.00
United HealthCare,PPO,33265,CPT4/HCPCS,ABLATE ATRIA LMTD ENDO,,Grouper Rate,1370.00
United HealthCare,PPO,33266,CPT4/HCPCS,ABLATE ATRIA X10SV ENDO,,Grouper Rate,1370.00
United HealthCare,PPO,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,Case Rate,24180.00
United HealthCare,PPO,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,Case Rate,24180.00
United HealthCare,PPO,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,Case Rate,24180.00
United HealthCare,PPO,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,Grouper Rate,5138.00
United HealthCare,PPO,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,Grouper Rate,14317.00
United HealthCare,PPO,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,Grouper Rate,5138.00
United HealthCare,PPO,33285,CPT4/HCPCS,INSJ SUBQ CAR RHYTHM MNTR,,Grouper Rate,10119.00
United HealthCare,PPO,33286,CPT4/HCPCS,RMVL SUBQ CAR RHYTHM MNTR,,Grouper Rate,1308.00
United HealthCare,PPO,33289,CPT4/HCPCS,TCAT IMPL WRLS P-ART PRS SNR,,Grouper Rate,24180.00
United HealthCare,PPO,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Grouper Rate,1370.00
United HealthCare,PPO,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,Grouper Rate,1370.00
United HealthCare,PPO,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,Grouper Rate,1370.00
United HealthCare,PPO,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,Grouper Rate,1370.00
United HealthCare,PPO,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,Grouper Rate,1370.00
United HealthCare,PPO,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,1370.00
United HealthCare,PPO,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,1370.00
United HealthCare,PPO,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,Grouper Rate,1370.00
United HealthCare,PPO,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,Grouper Rate,1370.00
United HealthCare,PPO,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,1370.00
United HealthCare,PPO,33406,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,1370.00
United HealthCare,PPO,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,Grouper Rate,1370.00
United HealthCare,PPO,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33413,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33414,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,Grouper Rate,1370.00
United HealthCare,PPO,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,Grouper Rate,1214.00
United HealthCare,PPO,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33440,CPT4/HCPCS,RPLCMT A-VALVE TLCJ AUTOL PV,,Grouper Rate,1370.00
United HealthCare,PPO,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33463,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Grouper Rate,1370.00
United HealthCare,PPO,33464,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,Grouper Rate,1370.00
United HealthCare,PPO,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33475,CPT4/HCPCS,REPLACEMENT PULMONARY VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1370.00
United HealthCare,PPO,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,Grouper Rate,1370.00
United HealthCare,PPO,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1370.00
United HealthCare,PPO,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,Grouper Rate,1370.00
United HealthCare,PPO,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,Grouper Rate,1370.00
United HealthCare,PPO,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,33505,CPT4/HCPCS,REPAIR ARTERY W/TUNNEL,,Grouper Rate,1370.00
United HealthCare,PPO,33506,CPT4/HCPCS,REPAIR ARTERY TRANSLOCATION,,Grouper Rate,1370.00
United HealthCare,PPO,33507,CPT4/HCPCS,REPAIR ART INTRAMURAL,,Grouper Rate,1370.00
United HealthCare,PPO,33508,CPT4/HCPCS,ENDOSCOPIC VEIN HARVEST,,Grouper Rate,1214.00
United HealthCare,PPO,33510,CPT4/HCPCS,CABG VEIN SINGLE,,Grouper Rate,1370.00
United HealthCare,PPO,33511,CPT4/HCPCS,CABG VEIN TWO,,Grouper Rate,1370.00
United HealthCare,PPO,33512,CPT4/HCPCS,CABG VEIN THREE,,Grouper Rate,1370.00
United HealthCare,PPO,33513,CPT4/HCPCS,CABG VEIN FOUR,,Grouper Rate,1370.00
United HealthCare,PPO,33514,CPT4/HCPCS,CABG VEIN FIVE,,Grouper Rate,1370.00
United HealthCare,PPO,33516,CPT4/HCPCS,CABG VEIN SIX OR MORE,,Grouper Rate,1370.00
United HealthCare,PPO,33517,CPT4/HCPCS,CABG ARTERY-VEIN SINGLE,,Grouper Rate,1370.00
United HealthCare,PPO,33518,CPT4/HCPCS,CABG ARTERY-VEIN TWO,,Grouper Rate,1370.00
United HealthCare,PPO,33519,CPT4/HCPCS,CABG ARTERY-VEIN THREE,,Grouper Rate,1370.00
United HealthCare,PPO,33521,CPT4/HCPCS,CABG ARTERY-VEIN FOUR,,Grouper Rate,1370.00
United HealthCare,PPO,33522,CPT4/HCPCS,CABG ARTERY-VEIN FIVE,,Grouper Rate,1370.00
United HealthCare,PPO,33523,CPT4/HCPCS,CABG ART-VEIN SIX OR MORE,,Grouper Rate,1370.00
United HealthCare,PPO,33530,CPT4/HCPCS,CORONARY ARTERY BYPASS/REOP,,Grouper Rate,1370.00
United HealthCare,PPO,33533,CPT4/HCPCS,CABG ARTERIAL SINGLE,,Grouper Rate,1370.00
United HealthCare,PPO,33534,CPT4/HCPCS,CABG ARTERIAL TWO,,Grouper Rate,1370.00
United HealthCare,PPO,33535,CPT4/HCPCS,CABG ARTERIAL THREE,,Grouper Rate,1370.00
United HealthCare,PPO,33536,CPT4/HCPCS,CABG ARTERIAL FOUR OR MORE,,Grouper Rate,1370.00
United HealthCare,PPO,33542,CPT4/HCPCS,REMOVAL OF HEART LESION,,Grouper Rate,1370.00
United HealthCare,PPO,33545,CPT4/HCPCS,REPAIR OF HEART DAMAGE,,Grouper Rate,1370.00
United HealthCare,PPO,33548,CPT4/HCPCS,RESTORE/REMODEL VENTRICLE,,Grouper Rate,1370.00
United HealthCare,PPO,33572,CPT4/HCPCS,OPEN CORONARY ENDARTERECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,33600,CPT4/HCPCS,CLOSURE OF VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33602,CPT4/HCPCS,CLOSURE OF VALVE,,Grouper Rate,1370.00
United HealthCare,PPO,33606,CPT4/HCPCS,ANASTOMOSIS/ARTERY-AORTA,,Grouper Rate,1370.00
United HealthCare,PPO,33608,CPT4/HCPCS,REPAIR ANOMALY W/CONDUIT,,Grouper Rate,1370.00
United HealthCare,PPO,33610,CPT4/HCPCS,REPAIR BY ENLARGEMENT,,Grouper Rate,1370.00
United HealthCare,PPO,33611,CPT4/HCPCS,REPAIR DOUBLE VENTRICLE,,Grouper Rate,1370.00
United HealthCare,PPO,33612,CPT4/HCPCS,REPAIR DOUBLE VENTRICLE,,Grouper Rate,1370.00
United HealthCare,PPO,33615,CPT4/HCPCS,REPAIR MODIFIED FONTAN,,Grouper Rate,1370.00
United HealthCare,PPO,33617,CPT4/HCPCS,REPAIR SINGLE VENTRICLE,,Grouper Rate,1370.00
United HealthCare,PPO,33619,CPT4/HCPCS,REPAIR SINGLE VENTRICLE,,Grouper Rate,1370.00
United HealthCare,PPO,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,Grouper Rate,1370.00
United HealthCare,PPO,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,Grouper Rate,1370.00
United HealthCare,PPO,33622,CPT4/HCPCS,REDO COMPL CARDIAC ANOMALY,,Grouper Rate,1370.00
United HealthCare,PPO,33641,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33645,CPT4/HCPCS,REVISION OF HEART VEINS,,Grouper Rate,1370.00
United HealthCare,PPO,33647,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECTS,,Grouper Rate,1370.00
United HealthCare,PPO,33660,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1370.00
United HealthCare,PPO,33665,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1370.00
United HealthCare,PPO,33670,CPT4/HCPCS,REPAIR OF HEART CHAMBERS,,Grouper Rate,1370.00
United HealthCare,PPO,33675,CPT4/HCPCS,CLOSE MULT VSD,,Grouper Rate,1370.00
United HealthCare,PPO,33676,CPT4/HCPCS,CLOSE MULT VSD W/RESECTION,,Grouper Rate,1370.00
United HealthCare,PPO,33677,CPT4/HCPCS,CL MULT VSD W/REM PUL BAND,,Grouper Rate,1370.00
United HealthCare,PPO,33681,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33684,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33688,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33690,CPT4/HCPCS,REINFORCE PULMONARY ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,33692,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1370.00
United HealthCare,PPO,33694,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1370.00
United HealthCare,PPO,33697,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1370.00
United HealthCare,PPO,33702,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1370.00
United HealthCare,PPO,33710,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,Grouper Rate,1370.00
United HealthCare,PPO,33720,CPT4/HCPCS,REPAIR OF HEART DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33722,CPT4/HCPCS,REPAIR OF HEART DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33724,CPT4/HCPCS,REPAIR VENOUS ANOMALY,,Grouper Rate,1370.00
United HealthCare,PPO,33726,CPT4/HCPCS,REPAIR PUL VENOUS STENOSIS,,Grouper Rate,1370.00
United HealthCare,PPO,33730,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT(S),,Grouper Rate,1370.00
United HealthCare,PPO,33732,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33735,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1370.00
United HealthCare,PPO,33736,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1370.00
United HealthCare,PPO,33737,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1370.00
United HealthCare,PPO,33750,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,33755,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,33762,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,33764,CPT4/HCPCS,MAJOR VESSEL SHUNT & GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,33766,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,33767,CPT4/HCPCS,MAJOR VESSEL SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,33768,CPT4/HCPCS,CAVOPULMONARY SHUNTING,,Grouper Rate,1370.00
United HealthCare,PPO,33770,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33771,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33774,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33775,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33776,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33777,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33778,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33779,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33780,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33781,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33782,CPT4/HCPCS,NIKAIDOH PROC,,Grouper Rate,1370.00
United HealthCare,PPO,33783,CPT4/HCPCS,NIKAIDOH PROC W/OSTIA IMPLT,,Grouper Rate,1370.00
United HealthCare,PPO,33786,CPT4/HCPCS,REPAIR ARTERIAL TRUNK,,Grouper Rate,1370.00
United HealthCare,PPO,33788,CPT4/HCPCS,REVISION OF PULMONARY ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,33800,CPT4/HCPCS,AORTIC SUSPENSION,,Grouper Rate,1370.00
United HealthCare,PPO,33802,CPT4/HCPCS,REPAIR VESSEL DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33803,CPT4/HCPCS,REPAIR VESSEL DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33813,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33814,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33820,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,10772.00
United HealthCare,PPO,33822,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,10119.00
United HealthCare,PPO,33824,CPT4/HCPCS,REVISE MAJOR VESSEL,,Grouper Rate,10772.00
United HealthCare,PPO,33840,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,1370.00
United HealthCare,PPO,33845,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,1370.00
United HealthCare,PPO,33851,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,Grouper Rate,1370.00
United HealthCare,PPO,33852,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33853,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,33858,CPT4/HCPCS,AS-AORT GRF F/AORTIC DSJ,,Grouper Rate,1370.00
United HealthCare,PPO,33859,CPT4/HCPCS,AS-AORT GRF F/DS OTH/THN DSJ,,Grouper Rate,1370.00
United HealthCare,PPO,33863,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,33864,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,33866,CPT4/HCPCS,AORTIC HEMIARCH GRAFT,,Grouper Rate,1214.00
United HealthCare,PPO,33871,CPT4/HCPCS,TRANSVRS A-ARCH GRF HYPTHRM,,Grouper Rate,1370.00
United HealthCare,PPO,33875,CPT4/HCPCS,THORACIC AORTIC GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,33877,CPT4/HCPCS,THORACOABDOMINAL GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,33880,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,Grouper Rate,1370.00
United HealthCare,PPO,33881,CPT4/HCPCS,ENDOVASC TAA REPR W/O SUBCL,,Grouper Rate,1370.00
United HealthCare,PPO,33883,CPT4/HCPCS,INSERT ENDOVASC PROSTH TAA,,Grouper Rate,1370.00
United HealthCare,PPO,33884,CPT4/HCPCS,ENDOVASC PROSTH TAA ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,33886,CPT4/HCPCS,ENDOVASC PROSTH DELAYED,,Grouper Rate,1370.00
United HealthCare,PPO,33889,CPT4/HCPCS,ARTERY TRANSPOSE/ENDOVAS TAA,,Grouper Rate,1370.00
United HealthCare,PPO,33891,CPT4/HCPCS,CAR-CAR BP GRFT/ENDOVAS TAA,,Grouper Rate,1370.00
United HealthCare,PPO,33910,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,Grouper Rate,1370.00
United HealthCare,PPO,33915,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,Grouper Rate,1370.00
United HealthCare,PPO,33916,CPT4/HCPCS,SURGERY OF GREAT VESSEL,,Grouper Rate,1370.00
United HealthCare,PPO,33917,CPT4/HCPCS,REPAIR PULMONARY ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,33920,CPT4/HCPCS,REPAIR PULMONARY ATRESIA,,Grouper Rate,1370.00
United HealthCare,PPO,33922,CPT4/HCPCS,TRANSECT PULMONARY ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,33924,CPT4/HCPCS,REMOVE PULMONARY SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,33925,CPT4/HCPCS,RPR PUL ART UNIFOCAL W/O CPB,,Grouper Rate,1370.00
United HealthCare,PPO,33926,CPT4/HCPCS,REPR PUL ART UNIFOCAL W/CPB,,Grouper Rate,1370.00
United HealthCare,PPO,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,Grouper Rate,1370.00
United HealthCare,PPO,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,Grouper Rate,1370.00
United HealthCare,PPO,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,Grouper Rate,1370.00
United HealthCare,PPO,33930,CPT4/HCPCS,REMOVAL OF DONOR HEART/LUNG,,Grouper Rate,1370.00
United HealthCare,PPO,33933,CPT4/HCPCS,PREPARE DONOR HEART/LUNG,,Grouper Rate,1370.00
United HealthCare,PPO,33935,CPT4/HCPCS,TRANSPLANTATION HEART/LUNG,,Grouper Rate,1370.00
United HealthCare,PPO,33940,CPT4/HCPCS,REMOVAL OF DONOR HEART,,Grouper Rate,1370.00
United HealthCare,PPO,33944,CPT4/HCPCS,PREPARE DONOR HEART,,Grouper Rate,1370.00
United HealthCare,PPO,33945,CPT4/HCPCS,TRANSPLANTATION OF HEART,,Grouper Rate,1370.00
United HealthCare,PPO,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,Grouper Rate,1370.00
United HealthCare,PPO,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,Grouper Rate,1370.00
United HealthCare,PPO,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33967,CPT4/HCPCS,INSERT I-AORT PERCUT DEVICE,,Grouper Rate,14317.00
United HealthCare,PPO,33968,CPT4/HCPCS,REMOVE AORTIC ASSIST DEVICE,,Grouper Rate,14317.00
United HealthCare,PPO,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33970,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,Grouper Rate,1370.00
United HealthCare,PPO,33971,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,Grouper Rate,1370.00
United HealthCare,PPO,33973,CPT4/HCPCS,INSERT BALLOON DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,33974,CPT4/HCPCS,REMOVE INTRA-AORTIC BALLOON,,Grouper Rate,1370.00
United HealthCare,PPO,33975,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,33976,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,33977,CPT4/HCPCS,REMOVE VENTRICULAR DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,33978,CPT4/HCPCS,REMOVE VENTRICULAR DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,33979,CPT4/HCPCS,INSERT INTRACORPOREAL DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,33980,CPT4/HCPCS,REMOVE INTRACORPOREAL DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,33981,CPT4/HCPCS,REPLACE VAD PUMP EXT,,Grouper Rate,1370.00
United HealthCare,PPO,33982,CPT4/HCPCS,REPLACE VAD INTRA W/O BP,,Grouper Rate,1370.00
United HealthCare,PPO,33983,CPT4/HCPCS,REPLACE VAD INTRA W/BP,,Grouper Rate,1370.00
United HealthCare,PPO,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,Grouper Rate,1370.00
United HealthCare,PPO,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,Grouper Rate,1370.00
United HealthCare,PPO,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,Grouper Rate,1370.00
United HealthCare,PPO,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,Grouper Rate,1370.00
United HealthCare,PPO,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,Grouper Rate,1370.00
United HealthCare,PPO,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,Grouper Rate,1370.00
United HealthCare,PPO,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,Grouper Rate,1370.00
United HealthCare,PPO,33999,CPT4/HCPCS,CARDIAC SURGERY PROCEDURE,,Grouper Rate,1308.00
United HealthCare,PPO,34001,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,1370.00
United HealthCare,PPO,34051,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,1370.00
United HealthCare,PPO,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,7007.00
United HealthCare,PPO,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,Grouper Rate,7007.00
United HealthCare,PPO,34151,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,1370.00
United HealthCare,PPO,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,Grouper Rate,7007.00
United HealthCare,PPO,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,Grouper Rate,7007.00
United HealthCare,PPO,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,1370.00
United HealthCare,PPO,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,5138.00
United HealthCare,PPO,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,1370.00
United HealthCare,PPO,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,1308.00
United HealthCare,PPO,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,Grouper Rate,5138.00
United HealthCare,PPO,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,Grouper Rate,7007.00
United HealthCare,PPO,34502,CPT4/HCPCS,RECONSTRUCT VENA CAVA,,Grouper Rate,1370.00
United HealthCare,PPO,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,Grouper Rate,7007.00
United HealthCare,PPO,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,Grouper Rate,7007.00
United HealthCare,PPO,34530,CPT4/HCPCS,LEG VEIN FUSION,,Grouper Rate,5138.00
United HealthCare,PPO,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,Grouper Rate,1370.00
United HealthCare,PPO,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,Grouper Rate,1370.00
United HealthCare,PPO,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,Grouper Rate,1370.00
United HealthCare,PPO,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,Grouper Rate,1370.00
United HealthCare,PPO,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,Grouper Rate,1370.00
United HealthCare,PPO,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,Grouper Rate,1370.00
United HealthCare,PPO,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,Grouper Rate,1370.00
United HealthCare,PPO,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,Grouper Rate,1370.00
United HealthCare,PPO,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,Grouper Rate,1370.00
United HealthCare,PPO,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,Grouper Rate,1370.00
United HealthCare,PPO,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,Grouper Rate,1370.00
United HealthCare,PPO,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,Grouper Rate,1214.00
United HealthCare,PPO,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,Grouper Rate,1214.00
United HealthCare,PPO,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,Grouper Rate,1214.00
United HealthCare,PPO,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,Grouper Rate,1214.00
United HealthCare,PPO,34717,CPT4/HCPCS,EVASC RPR A-ILIAC NDGFT,,Grouper Rate,1370.00
United HealthCare,PPO,34718,CPT4/HCPCS,EVASC RPR N/A A-ILIAC NDGFT,,Grouper Rate,1370.00
United HealthCare,PPO,34808,CPT4/HCPCS,ENDOVAS ILIAC A DEVICE ADDON,,Grouper Rate,1370.00
United HealthCare,PPO,34812,CPT4/HCPCS,OPN FEM ART EXPOS,,Grouper Rate,1370.00
United HealthCare,PPO,34813,CPT4/HCPCS,FEMORAL ENDOVAS GRAFT ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,34820,CPT4/HCPCS,OPN ILIAC ART EXPOS,,Grouper Rate,1370.00
United HealthCare,PPO,34830,CPT4/HCPCS,OPEN AORTIC TUBE PROSTH REPR,,Grouper Rate,1370.00
United HealthCare,PPO,34831,CPT4/HCPCS,OPEN AORTOILIAC PROSTH REPR,,Grouper Rate,1370.00
United HealthCare,PPO,34832,CPT4/HCPCS,OPEN AORTOFEMOR PROSTH REPR,,Grouper Rate,1370.00
United HealthCare,PPO,34833,CPT4/HCPCS,OPN ILAC ART EXPOS CNDT CRTJ,,Grouper Rate,1370.00
United HealthCare,PPO,34834,CPT4/HCPCS,OPN BRACH ART EXPOS,,Grouper Rate,1370.00
United HealthCare,PPO,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,Grouper Rate,1370.00
United HealthCare,PPO,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,Grouper Rate,1370.00
United HealthCare,PPO,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,Grouper Rate,1370.00
United HealthCare,PPO,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,Grouper Rate,1370.00
United HealthCare,PPO,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,Grouper Rate,1370.00
United HealthCare,PPO,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,7007.00
United HealthCare,PPO,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,Grouper Rate,1370.00
United HealthCare,PPO,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,Grouper Rate,1370.00
United HealthCare,PPO,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,Grouper Rate,7007.00
United HealthCare,PPO,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,1370.00
United HealthCare,PPO,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,1370.00
United HealthCare,PPO,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,Grouper Rate,1370.00
United HealthCare,PPO,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,Grouper Rate,1370.00
United HealthCare,PPO,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,Grouper Rate,1370.00
United HealthCare,PPO,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,Grouper Rate,1370.00
United HealthCare,PPO,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,Grouper Rate,1370.00
United HealthCare,PPO,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,Grouper Rate,1370.00
United HealthCare,PPO,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1308.00
United HealthCare,PPO,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5138.00
United HealthCare,PPO,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7007.00
United HealthCare,PPO,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7007.00
United HealthCare,PPO,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7007.00
United HealthCare,PPO,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5138.00
United HealthCare,PPO,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5138.00
United HealthCare,PPO,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1308.00
United HealthCare,PPO,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5138.00
United HealthCare,PPO,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7007.00
United HealthCare,PPO,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7007.00
United HealthCare,PPO,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,5138.00
United HealthCare,PPO,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7007.00
United HealthCare,PPO,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,Grouper Rate,7007.00
United HealthCare,PPO,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35302,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35303,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35304,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35305,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35306,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,7007.00
United HealthCare,PPO,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35371,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,35390,CPT4/HCPCS,REOPERATION CAROTID ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,35400,CPT4/HCPCS,ANGIOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,Grouper Rate,1214.00
United HealthCare,PPO,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,Grouper Rate,1370.00
United HealthCare,PPO,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,Grouper Rate,1370.00
United HealthCare,PPO,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,Grouper Rate,1370.00
United HealthCare,PPO,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,Grouper Rate,1370.00
United HealthCare,PPO,35510,CPT4/HCPCS,ART BYP GRFT CAROTID-BRCHIAL,,Grouper Rate,1370.00
United HealthCare,PPO,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,Grouper Rate,1370.00
United HealthCare,PPO,35512,CPT4/HCPCS,ART BYP GRFT SUBCLAV-BRCHIAL,,Grouper Rate,1370.00
United HealthCare,PPO,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,Grouper Rate,1370.00
United HealthCare,PPO,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,Grouper Rate,1370.00
United HealthCare,PPO,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,Grouper Rate,1370.00
United HealthCare,PPO,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35522,CPT4/HCPCS,ART BYP GRFT AXILL-BRACHIAL,,Grouper Rate,1370.00
United HealthCare,PPO,35523,CPT4/HCPCS,ART BYP GRFT BRCHL-ULNR-RDL,,Grouper Rate,1370.00
United HealthCare,PPO,35525,CPT4/HCPCS,ART BYP GRFT BRACHIAL-BRCHL,,Grouper Rate,1370.00
United HealthCare,PPO,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,Grouper Rate,1370.00
United HealthCare,PPO,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,Grouper Rate,1370.00
United HealthCare,PPO,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,Grouper Rate,1370.00
United HealthCare,PPO,35535,CPT4/HCPCS,ART BYP GRFT HEPATORENAL,,Grouper Rate,1370.00
United HealthCare,PPO,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,Grouper Rate,1370.00
United HealthCare,PPO,35537,CPT4/HCPCS,ART BYP GRFT AORTOILIAC,,Grouper Rate,1370.00
United HealthCare,PPO,35538,CPT4/HCPCS,ART BYP GRFT AORTOBI-ILIAC,,Grouper Rate,1370.00
United HealthCare,PPO,35539,CPT4/HCPCS,ART BYP GRFT AORTOFEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35540,CPT4/HCPCS,ART BYP GRFT AORTBIFEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,Grouper Rate,1370.00
United HealthCare,PPO,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,Grouper Rate,1370.00
United HealthCare,PPO,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,Grouper Rate,1370.00
United HealthCare,PPO,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Grouper Rate,1370.00
United HealthCare,PPO,35570,CPT4/HCPCS,ART BYP TIBIAL-TIB/PERONEAL,,Grouper Rate,1370.00
United HealthCare,PPO,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Grouper Rate,1370.00
United HealthCare,PPO,35572,CPT4/HCPCS,HARVEST FEMOROPOPLITEAL VEIN,,Grouper Rate,1214.00
United HealthCare,PPO,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,Grouper Rate,1370.00
United HealthCare,PPO,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,Grouper Rate,1370.00
United HealthCare,PPO,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,Grouper Rate,1370.00
United HealthCare,PPO,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,Grouper Rate,1370.00
United HealthCare,PPO,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,Grouper Rate,1370.00
United HealthCare,PPO,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,Grouper Rate,1370.00
United HealthCare,PPO,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,Grouper Rate,1370.00
United HealthCare,PPO,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35623,CPT4/HCPCS,ART BYP AXILLARY-POP-TIBIAL,,Grouper Rate,1370.00
United HealthCare,PPO,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,Grouper Rate,1370.00
United HealthCare,PPO,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,Grouper Rate,1370.00
United HealthCare,PPO,35632,CPT4/HCPCS,ART BYP ILIO-CELIAC,,Grouper Rate,1370.00
United HealthCare,PPO,35633,CPT4/HCPCS,ART BYP ILIO-MESENTERIC,,Grouper Rate,1370.00
United HealthCare,PPO,35634,CPT4/HCPCS,ART BYP ILIORENAL,,Grouper Rate,1370.00
United HealthCare,PPO,35636,CPT4/HCPCS,ART BYP SPENORENAL,,Grouper Rate,1370.00
United HealthCare,PPO,35637,CPT4/HCPCS,ART BYP AORTOILIAC,,Grouper Rate,1370.00
United HealthCare,PPO,35638,CPT4/HCPCS,ART BYP AORTOBI-ILIAC,,Grouper Rate,1370.00
United HealthCare,PPO,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,Grouper Rate,1370.00
United HealthCare,PPO,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,Grouper Rate,1370.00
United HealthCare,PPO,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,Grouper Rate,1370.00
United HealthCare,PPO,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,Grouper Rate,1370.00
United HealthCare,PPO,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,Grouper Rate,1370.00
United HealthCare,PPO,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,Grouper Rate,1370.00
United HealthCare,PPO,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,Grouper Rate,1370.00
United HealthCare,PPO,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,Grouper Rate,1370.00
United HealthCare,PPO,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,Grouper Rate,1370.00
United HealthCare,PPO,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,Grouper Rate,1370.00
United HealthCare,PPO,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,Grouper Rate,1370.00
United HealthCare,PPO,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,Grouper Rate,1214.00
United HealthCare,PPO,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,Grouper Rate,1214.00
United HealthCare,PPO,35691,CPT4/HCPCS,ART TRNSPOSJ VERTBRL CAROTID,,Grouper Rate,1370.00
United HealthCare,PPO,35693,CPT4/HCPCS,ART TRNSPOSJ SUBCLAVIAN,,Grouper Rate,1370.00
United HealthCare,PPO,35694,CPT4/HCPCS,ART TRNSPOSJ SUBCLAV CAROTID,,Grouper Rate,1370.00
United HealthCare,PPO,35695,CPT4/HCPCS,ART TRNSPOSJ CAROTID SUBCLAV,,Grouper Rate,1370.00
United HealthCare,PPO,35697,CPT4/HCPCS,REIMPLANT ARTERY EACH,,Grouper Rate,1370.00
United HealthCare,PPO,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,Grouper Rate,1370.00
United HealthCare,PPO,35702,CPT4/HCPCS,EXPL N/FLWD SURG UXTR ART,,Grouper Rate,1370.00
United HealthCare,PPO,35703,CPT4/HCPCS,EXPL N/FLWD SURG LXTR ART,,Grouper Rate,1370.00
United HealthCare,PPO,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,Grouper Rate,1370.00
United HealthCare,PPO,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,Grouper Rate,1370.00
United HealthCare,PPO,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,Grouper Rate,1370.00
United HealthCare,PPO,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,Grouper Rate,5138.00
United HealthCare,PPO,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,7007.00
United HealthCare,PPO,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,Grouper Rate,7007.00
United HealthCare,PPO,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,7007.00
United HealthCare,PPO,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,7007.00
United HealthCare,PPO,35883,CPT4/HCPCS,REVISE GRAFT W/NONAUTO GRAFT,,Grouper Rate,7007.00
United HealthCare,PPO,35884,CPT4/HCPCS,REVISE GRAFT W/VEIN,,Grouper Rate,7007.00
United HealthCare,PPO,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,Grouper Rate,1370.00
United HealthCare,PPO,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,Grouper Rate,5138.00
United HealthCare,PPO,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,Grouper Rate,1370.00
United HealthCare,PPO,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,Grouper Rate,1370.00
United HealthCare,PPO,36000,CPT4/HCPCS,PLACE NEEDLE IN VEIN,,Grouper Rate,1214.00
United HealthCare,PPO,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,Grouper Rate,1308.00
United HealthCare,PPO,36005,CPT4/HCPCS,INJECTION EXT VENOGRAPHY,,Grouper Rate,1214.00
United HealthCare,PPO,36010,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1214.00
United HealthCare,PPO,36011,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1214.00
United HealthCare,PPO,36012,CPT4/HCPCS,PLACE CATHETER IN VEIN,,Grouper Rate,1214.00
United HealthCare,PPO,36013,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1214.00
United HealthCare,PPO,36014,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1214.00
United HealthCare,PPO,36015,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1214.00
United HealthCare,PPO,36100,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,Grouper Rate,1214.00
United HealthCare,PPO,36140,CPT4/HCPCS,INTRO NDL ICATH UPR/LXTR ART,,Grouper Rate,1214.00
United HealthCare,PPO,36160,CPT4/HCPCS,ESTABLISH ACCESS TO AORTA,,Grouper Rate,1214.00
United HealthCare,PPO,36200,CPT4/HCPCS,PLACE CATHETER IN AORTA,,Grouper Rate,1214.00
United HealthCare,PPO,36215,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1214.00
United HealthCare,PPO,36216,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1214.00
United HealthCare,PPO,36217,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1214.00
United HealthCare,PPO,36218,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,Grouper Rate,1214.00
United HealthCare,PPO,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,Grouper Rate,5138.00
United HealthCare,PPO,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,5138.00
United HealthCare,PPO,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,Grouper Rate,7007.00
United HealthCare,PPO,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,Grouper Rate,7007.00
United HealthCare,PPO,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,Grouper Rate,5138.00
United HealthCare,PPO,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,Grouper Rate,7007.00
United HealthCare,PPO,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,Grouper Rate,1214.00
United HealthCare,PPO,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,Grouper Rate,1214.00
United HealthCare,PPO,36245,CPT4/HCPCS,INS CATH ABD/L-EXT ART 1ST,,Grouper Rate,1214.00
United HealthCare,PPO,36246,CPT4/HCPCS,INS CATH ABD/L-EXT ART 2ND,,Grouper Rate,1214.00
United HealthCare,PPO,36247,CPT4/HCPCS,INS CATH ABD/L-EXT ART 3RD,,Grouper Rate,1214.00
United HealthCare,PPO,36248,CPT4/HCPCS,INS CATH ABD/L-EXT ART ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,Grouper Rate,5138.00
United HealthCare,PPO,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,Grouper Rate,5138.00
United HealthCare,PPO,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,Grouper Rate,7007.00
United HealthCare,PPO,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,Grouper Rate,5138.00
United HealthCare,PPO,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,Grouper Rate,7007.00
United HealthCare,PPO,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,Grouper Rate,5138.00
United HealthCare,PPO,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,Grouper Rate,5138.00
United HealthCare,PPO,36299,CPT4/HCPCS,VESSEL INJECTION PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,Grouper Rate,1214.00
United HealthCare,PPO,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,Grouper Rate,1214.00
United HealthCare,PPO,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,Grouper Rate,1214.00
United HealthCare,PPO,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,Grouper Rate,1214.00
United HealthCare,PPO,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,Grouper Rate,1214.00
United HealthCare,PPO,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,Grouper Rate,1214.00
United HealthCare,PPO,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,Grouper Rate,1214.00
United HealthCare,PPO,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,Grouper Rate,1214.00
United HealthCare,PPO,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,Grouper Rate,1370.00
United HealthCare,PPO,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,Grouper Rate,1370.00
United HealthCare,PPO,36468,CPT4/HCPCS,NJX SCLRSNT SPIDER VEINS,,Grouper Rate,1214.00
United HealthCare,PPO,36470,CPT4/HCPCS,NJX SCLRSNT 1 INCMPTNT VEIN,,Grouper Rate,1214.00
United HealthCare,PPO,36471,CPT4/HCPCS,NJX SCLRSNT MLT INCMPTNT VN,,Grouper Rate,1214.00
United HealthCare,PPO,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,Grouper Rate,5138.00
United HealthCare,PPO,36474,CPT4/HCPCS,ENDOVENOUS MCHNCHEM ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,Grouper Rate,5138.00
United HealthCare,PPO,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,Grouper Rate,5138.00
United HealthCare,PPO,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,Grouper Rate,1214.00
United HealthCare,PPO,36481,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1214.00
United HealthCare,PPO,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,Grouper Rate,7007.00
United HealthCare,PPO,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,Grouper Rate,1214.00
United HealthCare,PPO,36500,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1214.00
United HealthCare,PPO,36510,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,Grouper Rate,1214.00
United HealthCare,PPO,36511,CPT4/HCPCS,APHERESIS WBC,,Grouper Rate,1370.00
United HealthCare,PPO,36512,CPT4/HCPCS,APHERESIS RBC,,Grouper Rate,1370.00
United HealthCare,PPO,36513,CPT4/HCPCS,APHERESIS PLATELETS,,Grouper Rate,1214.00
United HealthCare,PPO,36514,CPT4/HCPCS,APHERESIS PLASMA,,Grouper Rate,1370.00
United HealthCare,PPO,36516,CPT4/HCPCS,APHERESIS IMMUNOADS SLCTV,,Grouper Rate,6075.00
United HealthCare,PPO,36522,CPT4/HCPCS,PHOTOPHERESIS,,Grouper Rate,6075.00
United HealthCare,PPO,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,1308.00
United HealthCare,PPO,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,Grouper Rate,1308.00
United HealthCare,PPO,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,7007.00
United HealthCare,PPO,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,7007.00
United HealthCare,PPO,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,Grouper Rate,7007.00
United HealthCare,PPO,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,Grouper Rate,1308.00
United HealthCare,PPO,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,Grouper Rate,1308.00
United HealthCare,PPO,36570,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36571,CPT4/HCPCS,INSERT PICVAD CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36572,CPT4/HCPCS,INSJ PICC RS&I <5 YR,,Grouper Rate,1308.00
United HealthCare,PPO,36573,CPT4/HCPCS,INSJ PICC RS&I 5 YR+,,Grouper Rate,1370.00
United HealthCare,PPO,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,1308.00
United HealthCare,PPO,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,Grouper Rate,1308.00
United HealthCare,PPO,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36580,CPT4/HCPCS,REPLACE CVAD CATH,,Grouper Rate,1308.00
United HealthCare,PPO,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,Grouper Rate,7007.00
United HealthCare,PPO,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,Grouper Rate,1308.00
United HealthCare,PPO,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,1308.00
United HealthCare,PPO,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,Grouper Rate,1308.00
United HealthCare,PPO,36591,CPT4/HCPCS,DRAW BLOOD OFF VENOUS DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,36592,CPT4/HCPCS,COLLECT BLOOD FROM PICC,,Grouper Rate,1214.00
United HealthCare,PPO,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,5138.00
United HealthCare,PPO,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,Grouper Rate,1308.00
United HealthCare,PPO,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,Grouper Rate,1308.00
United HealthCare,PPO,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,Grouper Rate,1214.00
United HealthCare,PPO,36620,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1214.00
United HealthCare,PPO,36625,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1214.00
United HealthCare,PPO,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,5138.00
United HealthCare,PPO,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,Grouper Rate,1214.00
United HealthCare,PPO,36800,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,7007.00
United HealthCare,PPO,36810,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,5138.00
United HealthCare,PPO,36815,CPT4/HCPCS,INSERTION OF CANNULA,,Grouper Rate,7007.00
United HealthCare,PPO,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,Grouper Rate,7007.00
United HealthCare,PPO,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,Grouper Rate,7007.00
United HealthCare,PPO,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,Grouper Rate,7007.00
United HealthCare,PPO,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,Grouper Rate,5138.00
United HealthCare,PPO,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,Grouper Rate,4204.00
United HealthCare,PPO,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,Grouper Rate,7007.00
United HealthCare,PPO,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,Grouper Rate,7007.00
United HealthCare,PPO,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,Grouper Rate,7007.00
United HealthCare,PPO,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,Grouper Rate,7007.00
United HealthCare,PPO,36833,CPT4/HCPCS,AV FISTULA REVISION,,Grouper Rate,7007.00
United HealthCare,PPO,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,Grouper Rate,5138.00
United HealthCare,PPO,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,Grouper Rate,7007.00
United HealthCare,PPO,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,Grouper Rate,1308.00
United HealthCare,PPO,36861,CPT4/HCPCS,CANNULA DECLOTTING,,Grouper Rate,7007.00
United HealthCare,PPO,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,1370.00
United HealthCare,PPO,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,7007.00
United HealthCare,PPO,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,Grouper Rate,10119.00
United HealthCare,PPO,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,7007.00
United HealthCare,PPO,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,10119.00
United HealthCare,PPO,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,Grouper Rate,14317.00
United HealthCare,PPO,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,Grouper Rate,1214.00
United HealthCare,PPO,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,Grouper Rate,1214.00
United HealthCare,PPO,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,Grouper Rate,1214.00
United HealthCare,PPO,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,1370.00
United HealthCare,PPO,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,1370.00
United HealthCare,PPO,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,1370.00
United HealthCare,PPO,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,Grouper Rate,1370.00
United HealthCare,PPO,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,Grouper Rate,1370.00
United HealthCare,PPO,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,Grouper Rate,1370.00
United HealthCare,PPO,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,Grouper Rate,10119.00
United HealthCare,PPO,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,Grouper Rate,7007.00
United HealthCare,PPO,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,Grouper Rate,1214.00
United HealthCare,PPO,37186,CPT4/HCPCS,SEC ART THROMBECTOMY ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,Grouper Rate,5138.00
United HealthCare,PPO,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,Grouper Rate,7007.00
United HealthCare,PPO,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,Grouper Rate,5138.00
United HealthCare,PPO,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,Grouper Rate,5138.00
United HealthCare,PPO,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,Grouper Rate,1214.00
United HealthCare,PPO,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,Grouper Rate,5138.00
United HealthCare,PPO,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,Grouper Rate,7007.00
United HealthCare,PPO,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,Grouper Rate,7007.00
United HealthCare,PPO,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,Grouper Rate,5138.00
United HealthCare,PPO,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,Grouper Rate,1308.00
United HealthCare,PPO,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,Grouper Rate,1308.00
United HealthCare,PPO,37215,CPT4/HCPCS,TRANSCATH STENT CCA W/EPS,,Grouper Rate,1370.00
United HealthCare,PPO,37216,CPT4/HCPCS,TRANSCATH STENT CCA W/O EPS,,Grouper Rate,1370.00
United HealthCare,PPO,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,Grouper Rate,1370.00
United HealthCare,PPO,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,Grouper Rate,1370.00
United HealthCare,PPO,37220,CPT4/HCPCS,ILIAC REVASC,,Grouper Rate,7007.00
United HealthCare,PPO,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,Grouper Rate,10119.00
United HealthCare,PPO,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,Grouper Rate,7007.00
United HealthCare,PPO,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,Grouper Rate,7007.00
United HealthCare,PPO,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,Grouper Rate,7007.00
United HealthCare,PPO,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,Grouper Rate,10119.00
United HealthCare,PPO,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,Grouper Rate,10119.00
United HealthCare,PPO,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,Grouper Rate,14317.00
United HealthCare,PPO,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,Grouper Rate,7007.00
United HealthCare,PPO,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,Grouper Rate,10119.00
United HealthCare,PPO,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,Grouper Rate,10119.00
United HealthCare,PPO,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,Grouper Rate,14317.00
United HealthCare,PPO,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,Grouper Rate,7007.00
United HealthCare,PPO,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,Grouper Rate,10119.00
United HealthCare,PPO,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,Grouper Rate,7007.00
United HealthCare,PPO,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,Grouper Rate,7007.00
United HealthCare,PPO,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,Grouper Rate,10119.00
United HealthCare,PPO,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,7007.00
United HealthCare,PPO,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,Grouper Rate,10119.00
United HealthCare,PPO,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,Grouper Rate,7007.00
United HealthCare,PPO,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,Grouper Rate,10119.00
United HealthCare,PPO,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,Grouper Rate,10119.00
United HealthCare,PPO,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,Grouper Rate,10119.00
United HealthCare,PPO,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,Grouper Rate,10119.00
United HealthCare,PPO,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,Grouper Rate,7007.00
United HealthCare,PPO,37247,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL ART,,Grouper Rate,1214.00
United HealthCare,PPO,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,Grouper Rate,7007.00
United HealthCare,PPO,37249,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL VEIN,,Grouper Rate,1214.00
United HealthCare,PPO,37252,CPT4/HCPCS,INTRVASC US NONCORONARY 1ST,,Grouper Rate,1214.00
United HealthCare,PPO,37253,CPT4/HCPCS,INTRVASC US NONCORONARY ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,Grouper Rate,7007.00
United HealthCare,PPO,37501,CPT4/HCPCS,VASCULAR ENDOSCOPY PROCEDURE,,Grouper Rate,1308.00
United HealthCare,PPO,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,Grouper Rate,1308.00
United HealthCare,PPO,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,5138.00
United HealthCare,PPO,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,5138.00
United HealthCare,PPO,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,5138.00
United HealthCare,PPO,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,Grouper Rate,5138.00
United HealthCare,PPO,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,Grouper Rate,1308.00
United HealthCare,PPO,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,Grouper Rate,7007.00
United HealthCare,PPO,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,5138.00
United HealthCare,PPO,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,Grouper Rate,1370.00
United HealthCare,PPO,37700,CPT4/HCPCS,REVISE LEG VEIN,,Grouper Rate,5138.00
United HealthCare,PPO,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,Grouper Rate,5138.00
United HealthCare,PPO,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,Grouper Rate,5138.00
United HealthCare,PPO,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,Grouper Rate,5138.00
United HealthCare,PPO,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,Grouper Rate,5138.00
United HealthCare,PPO,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,Grouper Rate,1308.00
United HealthCare,PPO,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,Grouper Rate,5138.00
United HealthCare,PPO,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,Grouper Rate,5138.00
United HealthCare,PPO,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,Grouper Rate,1308.00
United HealthCare,PPO,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,Grouper Rate,5138.00
United HealthCare,PPO,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,Grouper Rate,1370.00
United HealthCare,PPO,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,Grouper Rate,5138.00
United HealthCare,PPO,37799,CPT4/HCPCS,VASCULAR SURGERY PROCEDURE,,Grouper Rate,1308.00
United HealthCare,PPO,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Grouper Rate,1370.00
United HealthCare,PPO,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,Grouper Rate,1370.00
United HealthCare,PPO,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,Grouper Rate,1370.00
United HealthCare,PPO,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,Grouper Rate,1370.00
United HealthCare,PPO,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,38129,CPT4/HCPCS,LAPAROSCOPE PROC SPLEEN,,Grouper Rate,6075.00
United HealthCare,PPO,38200,CPT4/HCPCS,INJECTION FOR SPLEEN X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,Grouper Rate,1214.00
United HealthCare,PPO,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,Grouper Rate,1370.00
United HealthCare,PPO,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,Grouper Rate,1214.00
United HealthCare,PPO,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,Grouper Rate,1214.00
United HealthCare,PPO,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,Grouper Rate,1214.00
United HealthCare,PPO,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,Grouper Rate,1214.00
United HealthCare,PPO,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,Grouper Rate,1214.00
United HealthCare,PPO,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,Grouper Rate,1214.00
United HealthCare,PPO,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,Grouper Rate,1214.00
United HealthCare,PPO,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,Grouper Rate,1214.00
United HealthCare,PPO,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,Grouper Rate,1214.00
United HealthCare,PPO,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,Grouper Rate,1308.00
United HealthCare,PPO,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,Grouper Rate,1308.00
United HealthCare,PPO,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,Grouper Rate,1370.00
United HealthCare,PPO,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,Grouper Rate,1370.00
United HealthCare,PPO,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,Grouper Rate,6075.00
United HealthCare,PPO,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,Grouper Rate,6075.00
United HealthCare,PPO,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,Grouper Rate,1370.00
United HealthCare,PPO,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,Grouper Rate,1370.00
United HealthCare,PPO,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,Grouper Rate,1370.00
United HealthCare,PPO,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,Grouper Rate,4204.00
United HealthCare,PPO,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,4204.00
United HealthCare,PPO,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,Grouper Rate,1370.00
United HealthCare,PPO,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,4204.00
United HealthCare,PPO,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,4204.00
United HealthCare,PPO,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,4204.00
United HealthCare,PPO,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,Grouper Rate,4204.00
United HealthCare,PPO,38531,CPT4/HCPCS,OPEN BX/EXC INGUINOFEM NODES,,Grouper Rate,5138.00
United HealthCare,PPO,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,Grouper Rate,7007.00
United HealthCare,PPO,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,4204.00
United HealthCare,PPO,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,Grouper Rate,4204.00
United HealthCare,PPO,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,Grouper Rate,1370.00
United HealthCare,PPO,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,Grouper Rate,1370.00
United HealthCare,PPO,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,Grouper Rate,7007.00
United HealthCare,PPO,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,Grouper Rate,7007.00
United HealthCare,PPO,38589,CPT4/HCPCS,LAPAROSCOPE PROC LYMPHATIC,,Grouper Rate,6075.00
United HealthCare,PPO,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,4204.00
United HealthCare,PPO,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,4204.00
United HealthCare,PPO,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,Grouper Rate,4204.00
United HealthCare,PPO,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,7007.00
United HealthCare,PPO,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,Grouper Rate,7007.00
United HealthCare,PPO,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,Grouper Rate,1370.00
United HealthCare,PPO,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,Grouper Rate,1370.00
United HealthCare,PPO,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,4204.00
United HealthCare,PPO,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,Grouper Rate,1370.00
United HealthCare,PPO,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,Grouper Rate,1370.00
United HealthCare,PPO,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,Grouper Rate,1370.00
United HealthCare,PPO,38790,CPT4/HCPCS,INJECT FOR LYMPHATIC X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,38792,CPT4/HCPCS,RA TRACER ID OF SENTINL NODE,,Grouper Rate,1214.00
United HealthCare,PPO,38794,CPT4/HCPCS,ACCESS THORACIC LYMPH DUCT,,Grouper Rate,1214.00
United HealthCare,PPO,38900,CPT4/HCPCS,IO MAP OF SENT LYMPH NODE,,Grouper Rate,1214.00
United HealthCare,PPO,38999,CPT4/HCPCS,BLOOD/LYMPH SYSTEM PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,1370.00
United HealthCare,PPO,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,Grouper Rate,1370.00
United HealthCare,PPO,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,Grouper Rate,1370.00
United HealthCare,PPO,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,Grouper Rate,6075.00
United HealthCare,PPO,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,Grouper Rate,6075.00
United HealthCare,PPO,39499,CPT4/HCPCS,CHEST PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,Grouper Rate,1370.00
United HealthCare,PPO,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,1370.00
United HealthCare,PPO,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,1370.00
United HealthCare,PPO,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,Grouper Rate,1370.00
United HealthCare,PPO,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,Grouper Rate,1370.00
United HealthCare,PPO,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,Grouper Rate,1370.00
United HealthCare,PPO,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,Grouper Rate,1370.00
United HealthCare,PPO,39599,CPT4/HCPCS,DIAPHRAGM SURGERY PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,40490,CPT4/HCPCS,BIOPSY OF LIP,,Grouper Rate,1214.00
United HealthCare,PPO,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1370.00
United HealthCare,PPO,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,4204.00
United HealthCare,PPO,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,Grouper Rate,1370.00
United HealthCare,PPO,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,4204.00
United HealthCare,PPO,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,Grouper Rate,4204.00
United HealthCare,PPO,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,Grouper Rate,4204.00
United HealthCare,PPO,40650,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,1214.00
United HealthCare,PPO,40652,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,1214.00
United HealthCare,PPO,40654,CPT4/HCPCS,REPAIR LIP,,Grouper Rate,1370.00
United HealthCare,PPO,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,6075.00
United HealthCare,PPO,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,6075.00
United HealthCare,PPO,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,6075.00
United HealthCare,PPO,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,6075.00
United HealthCare,PPO,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,Grouper Rate,6075.00
United HealthCare,PPO,40799,CPT4/HCPCS,LIP SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1308.00
United HealthCare,PPO,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1214.00
United HealthCare,PPO,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,1370.00
United HealthCare,PPO,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,Grouper Rate,1214.00
United HealthCare,PPO,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,Grouper Rate,1214.00
United HealthCare,PPO,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,Grouper Rate,1214.00
United HealthCare,PPO,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,Grouper Rate,4204.00
United HealthCare,PPO,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,4204.00
United HealthCare,PPO,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,Grouper Rate,1214.00
United HealthCare,PPO,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,Grouper Rate,1370.00
United HealthCare,PPO,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,1214.00
United HealthCare,PPO,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,Grouper Rate,1214.00
United HealthCare,PPO,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,4204.00
United HealthCare,PPO,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,4204.00
United HealthCare,PPO,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,4204.00
United HealthCare,PPO,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,6075.00
United HealthCare,PPO,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,Grouper Rate,6075.00
United HealthCare,PPO,40899,CPT4/HCPCS,MOUTH SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1214.00
United HealthCare,PPO,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1214.00
United HealthCare,PPO,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1214.00
United HealthCare,PPO,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,Grouper Rate,1370.00
United HealthCare,PPO,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1214.00
United HealthCare,PPO,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,4204.00
United HealthCare,PPO,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,Grouper Rate,4204.00
United HealthCare,PPO,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,1214.00
United HealthCare,PPO,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,Grouper Rate,1370.00
United HealthCare,PPO,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,Grouper Rate,1308.00
United HealthCare,PPO,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,Grouper Rate,1370.00
United HealthCare,PPO,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,Grouper Rate,4204.00
United HealthCare,PPO,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,6075.00
United HealthCare,PPO,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,Grouper Rate,1370.00
United HealthCare,PPO,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,Grouper Rate,1370.00
United HealthCare,PPO,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1214.00
United HealthCare,PPO,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1214.00
United HealthCare,PPO,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,Grouper Rate,1214.00
United HealthCare,PPO,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,41512,CPT4/HCPCS,TONGUE SUSPENSION,,Grouper Rate,6075.00
United HealthCare,PPO,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,Grouper Rate,6075.00
United HealthCare,PPO,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,Grouper Rate,4204.00
United HealthCare,PPO,41599,CPT4/HCPCS,TONGUE AND MOUTH SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,Grouper Rate,1214.00
United HealthCare,PPO,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,Grouper Rate,1370.00
United HealthCare,PPO,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,Grouper Rate,1370.00
United HealthCare,PPO,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,Grouper Rate,4204.00
United HealthCare,PPO,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,Grouper Rate,1370.00
United HealthCare,PPO,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,4204.00
United HealthCare,PPO,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,4204.00
United HealthCare,PPO,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,6075.00
United HealthCare,PPO,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,Grouper Rate,4204.00
United HealthCare,PPO,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,Grouper Rate,1370.00
United HealthCare,PPO,41870,CPT4/HCPCS,GUM GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,41872,CPT4/HCPCS,REPAIR GUM,,Grouper Rate,6075.00
United HealthCare,PPO,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,Grouper Rate,1370.00
United HealthCare,PPO,41899,CPT4/HCPCS,DENTAL SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,Grouper Rate,1214.00
United HealthCare,PPO,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,Grouper Rate,1370.00
United HealthCare,PPO,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1370.00
United HealthCare,PPO,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,1370.00
United HealthCare,PPO,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,Grouper Rate,4204.00
United HealthCare,PPO,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,Grouper Rate,4204.00
United HealthCare,PPO,42140,CPT4/HCPCS,EXCISION OF UVULA,,Grouper Rate,1370.00
United HealthCare,PPO,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,Grouper Rate,4204.00
United HealthCare,PPO,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,Grouper Rate,1370.00
United HealthCare,PPO,42180,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,1214.00
United HealthCare,PPO,42182,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,4204.00
United HealthCare,PPO,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6075.00
United HealthCare,PPO,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6075.00
United HealthCare,PPO,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6075.00
United HealthCare,PPO,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6075.00
United HealthCare,PPO,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6075.00
United HealthCare,PPO,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,Grouper Rate,6075.00
United HealthCare,PPO,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,6075.00
United HealthCare,PPO,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,Grouper Rate,6075.00
United HealthCare,PPO,42235,CPT4/HCPCS,REPAIR PALATE,,Grouper Rate,6075.00
United HealthCare,PPO,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,Grouper Rate,4204.00
United HealthCare,PPO,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,Grouper Rate,1214.00
United HealthCare,PPO,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,Grouper Rate,1370.00
United HealthCare,PPO,42299,CPT4/HCPCS,PALATE/UVULA SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1370.00
United HealthCare,PPO,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,4204.00
United HealthCare,PPO,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1214.00
United HealthCare,PPO,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,Grouper Rate,1214.00
United HealthCare,PPO,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,1370.00
United HealthCare,PPO,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,4204.00
United HealthCare,PPO,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,Grouper Rate,1370.00
United HealthCare,PPO,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,1308.00
United HealthCare,PPO,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,Grouper Rate,1370.00
United HealthCare,PPO,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,Grouper Rate,4204.00
United HealthCare,PPO,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,Grouper Rate,4204.00
United HealthCare,PPO,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,6075.00
United HealthCare,PPO,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,6075.00
United HealthCare,PPO,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,6075.00
United HealthCare,PPO,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,6075.00
United HealthCare,PPO,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,Grouper Rate,4204.00
United HealthCare,PPO,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,Grouper Rate,6075.00
United HealthCare,PPO,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,Grouper Rate,4204.00
United HealthCare,PPO,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,4204.00
United HealthCare,PPO,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,Grouper Rate,6075.00
United HealthCare,PPO,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,6075.00
United HealthCare,PPO,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,6075.00
United HealthCare,PPO,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,Grouper Rate,6075.00
United HealthCare,PPO,42550,CPT4/HCPCS,INJECTION FOR SALIVARY X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,42650,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Grouper Rate,1370.00
United HealthCare,PPO,42660,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,Grouper Rate,1214.00
United HealthCare,PPO,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,Grouper Rate,4204.00
United HealthCare,PPO,42699,CPT4/HCPCS,SALIVARY SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,Grouper Rate,1214.00
United HealthCare,PPO,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,Grouper Rate,6075.00
United HealthCare,PPO,42800,CPT4/HCPCS,BIOPSY OF THROAT,,Grouper Rate,1308.00
United HealthCare,PPO,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,1370.00
United HealthCare,PPO,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,Grouper Rate,4204.00
United HealthCare,PPO,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,Grouper Rate,4204.00
United HealthCare,PPO,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,Grouper Rate,1214.00
United HealthCare,PPO,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,4204.00
United HealthCare,PPO,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,Grouper Rate,6075.00
United HealthCare,PPO,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,4204.00
United HealthCare,PPO,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,Grouper Rate,4204.00
United HealthCare,PPO,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,4204.00
United HealthCare,PPO,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,Grouper Rate,4204.00
United HealthCare,PPO,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,4204.00
United HealthCare,PPO,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,4204.00
United HealthCare,PPO,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,4204.00
United HealthCare,PPO,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,Grouper Rate,4204.00
United HealthCare,PPO,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,4204.00
United HealthCare,PPO,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,6075.00
United HealthCare,PPO,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,Grouper Rate,1370.00
United HealthCare,PPO,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,Grouper Rate,4204.00
United HealthCare,PPO,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,Grouper Rate,4204.00
United HealthCare,PPO,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,Grouper Rate,6075.00
United HealthCare,PPO,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,6075.00
United HealthCare,PPO,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,Grouper Rate,1370.00
United HealthCare,PPO,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,Grouper Rate,4204.00
United HealthCare,PPO,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,Grouper Rate,1370.00
United HealthCare,PPO,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1214.00
United HealthCare,PPO,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,1370.00
United HealthCare,PPO,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,Grouper Rate,4204.00
United HealthCare,PPO,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1214.00
United HealthCare,PPO,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1370.00
United HealthCare,PPO,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,Grouper Rate,1370.00
United HealthCare,PPO,42999,CPT4/HCPCS,THROAT SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,Grouper Rate,6075.00
United HealthCare,PPO,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Grouper Rate,1370.00
United HealthCare,PPO,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,Grouper Rate,1370.00
United HealthCare,PPO,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,Grouper Rate,1370.00
United HealthCare,PPO,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,6075.00
United HealthCare,PPO,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,Grouper Rate,1370.00
United HealthCare,PPO,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,Grouper Rate,4204.00
United HealthCare,PPO,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,Grouper Rate,1370.00
United HealthCare,PPO,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,Grouper Rate,1370.00
United HealthCare,PPO,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,Grouper Rate,1370.00
United HealthCare,PPO,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,Grouper Rate,1370.00
United HealthCare,PPO,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,Grouper Rate,1370.00
United HealthCare,PPO,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,Grouper Rate,1370.00
United HealthCare,PPO,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,Grouper Rate,1370.00
United HealthCare,PPO,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,Grouper Rate,1370.00
United HealthCare,PPO,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,Grouper Rate,1370.00
United HealthCare,PPO,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,Grouper Rate,1370.00
United HealthCare,PPO,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,Grouper Rate,5138.00
United HealthCare,PPO,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,Grouper Rate,1370.00
United HealthCare,PPO,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,Grouper Rate,5138.00
United HealthCare,PPO,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,Grouper Rate,1370.00
United HealthCare,PPO,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,Grouper Rate,1370.00
United HealthCare,PPO,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,Grouper Rate,1370.00
United HealthCare,PPO,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,Grouper Rate,4204.00
United HealthCare,PPO,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,Grouper Rate,1370.00
United HealthCare,PPO,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,Grouper Rate,1370.00
United HealthCare,PPO,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,Grouper Rate,1370.00
United HealthCare,PPO,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,Grouper Rate,1370.00
United HealthCare,PPO,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,Grouper Rate,4204.00
United HealthCare,PPO,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,Grouper Rate,1370.00
United HealthCare,PPO,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,Grouper Rate,1370.00
United HealthCare,PPO,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,Grouper Rate,1370.00
United HealthCare,PPO,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,Grouper Rate,1370.00
United HealthCare,PPO,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,Grouper Rate,1370.00
United HealthCare,PPO,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,Grouper Rate,1370.00
United HealthCare,PPO,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,1370.00
United HealthCare,PPO,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,Grouper Rate,1370.00
United HealthCare,PPO,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,Grouper Rate,4204.00
United HealthCare,PPO,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,Grouper Rate,1370.00
United HealthCare,PPO,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,Grouper Rate,1370.00
United HealthCare,PPO,43243,CPT4/HCPCS,EGD INJECTION VARICES,,Grouper Rate,1370.00
United HealthCare,PPO,43244,CPT4/HCPCS,EGD VARICES LIGATION,,Grouper Rate,1370.00
United HealthCare,PPO,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,Grouper Rate,1370.00
United HealthCare,PPO,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,Grouper Rate,1370.00
United HealthCare,PPO,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,Grouper Rate,1370.00
United HealthCare,PPO,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,Grouper Rate,1370.00
United HealthCare,PPO,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,Grouper Rate,1370.00
United HealthCare,PPO,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,Grouper Rate,1370.00
United HealthCare,PPO,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,Grouper Rate,1370.00
United HealthCare,PPO,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,Grouper Rate,1370.00
United HealthCare,PPO,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,Grouper Rate,1370.00
United HealthCare,PPO,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,Grouper Rate,1370.00
United HealthCare,PPO,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,Grouper Rate,4204.00
United HealthCare,PPO,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,Grouper Rate,1370.00
United HealthCare,PPO,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,Grouper Rate,4204.00
United HealthCare,PPO,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,4204.00
United HealthCare,PPO,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,Grouper Rate,4204.00
United HealthCare,PPO,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,Grouper Rate,4204.00
United HealthCare,PPO,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,Grouper Rate,4204.00
United HealthCare,PPO,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,Grouper Rate,4204.00
United HealthCare,PPO,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,Grouper Rate,5138.00
United HealthCare,PPO,43270,CPT4/HCPCS,EGD LESION ABLATION,,Grouper Rate,1370.00
United HealthCare,PPO,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,Grouper Rate,1214.00
United HealthCare,PPO,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,Grouper Rate,4204.00
United HealthCare,PPO,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,Grouper Rate,4204.00
United HealthCare,PPO,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,Grouper Rate,4204.00
United HealthCare,PPO,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,Grouper Rate,4204.00
United HealthCare,PPO,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,Grouper Rate,4204.00
United HealthCare,PPO,43279,CPT4/HCPCS,LAP MYOTOMY HELLER,,Grouper Rate,7007.00
United HealthCare,PPO,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,Grouper Rate,7007.00
United HealthCare,PPO,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,Grouper Rate,7007.00
United HealthCare,PPO,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,Grouper Rate,7007.00
United HealthCare,PPO,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,Grouper Rate,1370.00
United HealthCare,PPO,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,Grouper Rate,7007.00
United HealthCare,PPO,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,Grouper Rate,7007.00
United HealthCare,PPO,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,Grouper Rate,1370.00
United HealthCare,PPO,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,Grouper Rate,1370.00
United HealthCare,PPO,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,Grouper Rate,1370.00
United HealthCare,PPO,43289,CPT4/HCPCS,LAPAROSCOPE PROC ESOPH,,Grouper Rate,6075.00
United HealthCare,PPO,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,Grouper Rate,1370.00
United HealthCare,PPO,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,Grouper Rate,1370.00
United HealthCare,PPO,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,Grouper Rate,1370.00
United HealthCare,PPO,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,Grouper Rate,1370.00
United HealthCare,PPO,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,Grouper Rate,1370.00
United HealthCare,PPO,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,Grouper Rate,1370.00
United HealthCare,PPO,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,Grouper Rate,1370.00
United HealthCare,PPO,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,Grouper Rate,1370.00
United HealthCare,PPO,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Grouper Rate,1370.00
United HealthCare,PPO,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,Grouper Rate,1370.00
United HealthCare,PPO,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Grouper Rate,1370.00
United HealthCare,PPO,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,Grouper Rate,1370.00
United HealthCare,PPO,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Grouper Rate,1370.00
United HealthCare,PPO,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,Grouper Rate,1370.00
United HealthCare,PPO,43338,CPT4/HCPCS,ESOPH LENGTHENING,,Grouper Rate,1370.00
United HealthCare,PPO,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Grouper Rate,1370.00
United HealthCare,PPO,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,Grouper Rate,1370.00
United HealthCare,PPO,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,Grouper Rate,7007.00
United HealthCare,PPO,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,4204.00
United HealthCare,PPO,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,Grouper Rate,1370.00
United HealthCare,PPO,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,Grouper Rate,1370.00
United HealthCare,PPO,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,Grouper Rate,1370.00
United HealthCare,PPO,43496,CPT4/HCPCS,FREE JEJUNUM FLAP MICROVASC,,Grouper Rate,1370.00
United HealthCare,PPO,43499,CPT4/HCPCS,ESOPHAGUS SURGERY PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Grouper Rate,1370.00
United HealthCare,PPO,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Grouper Rate,1370.00
United HealthCare,PPO,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,Grouper Rate,1370.00
United HealthCare,PPO,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,Grouper Rate,1370.00
United HealthCare,PPO,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,Grouper Rate,1370.00
United HealthCare,PPO,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,Grouper Rate,4204.00
United HealthCare,PPO,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,1370.00
United HealthCare,PPO,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,1370.00
United HealthCare,PPO,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,Grouper Rate,1370.00
United HealthCare,PPO,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,1370.00
United HealthCare,PPO,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,1370.00
United HealthCare,PPO,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,1370.00
United HealthCare,PPO,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,1370.00
United HealthCare,PPO,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,Grouper Rate,1370.00
United HealthCare,PPO,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Grouper Rate,1370.00
United HealthCare,PPO,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,Grouper Rate,1370.00
United HealthCare,PPO,43644,CPT4/HCPCS,LAP GASTRIC BYPASS/ROUX-EN-Y,,Grouper Rate,7007.00
United HealthCare,PPO,43645,CPT4/HCPCS,LAP GASTR BYPASS INCL SMLL I,,Grouper Rate,7007.00
United HealthCare,PPO,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,Grouper Rate,10119.00
United HealthCare,PPO,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,Grouper Rate,6075.00
United HealthCare,PPO,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,7007.00
United HealthCare,PPO,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,Grouper Rate,7007.00
United HealthCare,PPO,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,43659,CPT4/HCPCS,LAPAROSCOPE PROC STOM,,Grouper Rate,6075.00
United HealthCare,PPO,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,Grouper Rate,1214.00
United HealthCare,PPO,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,Grouper Rate,1214.00
United HealthCare,PPO,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,Grouper Rate,1214.00
United HealthCare,PPO,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,Grouper Rate,1214.00
United HealthCare,PPO,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,Grouper Rate,1370.00
United HealthCare,PPO,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,Grouper Rate,1370.00
United HealthCare,PPO,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,Grouper Rate,1214.00
United HealthCare,PPO,43762,CPT4/HCPCS,RPLC GTUBE NO REVJ TRC,,Grouper Rate,1214.00
United HealthCare,PPO,43763,CPT4/HCPCS,RPLC GTUBE REVJ GSTRST TRC,,Grouper Rate,1214.00
United HealthCare,PPO,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,Grouper Rate,7007.00
United HealthCare,PPO,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,Grouper Rate,5138.00
United HealthCare,PPO,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,Grouper Rate,5138.00
United HealthCare,PPO,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,Grouper Rate,6075.00
United HealthCare,PPO,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,Grouper Rate,10119.00
United HealthCare,PPO,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,Grouper Rate,1370.00
United HealthCare,PPO,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,4204.00
United HealthCare,PPO,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,1370.00
United HealthCare,PPO,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,Grouper Rate,1370.00
United HealthCare,PPO,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,Grouper Rate,1370.00
United HealthCare,PPO,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,Grouper Rate,1370.00
United HealthCare,PPO,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,Grouper Rate,6075.00
United HealthCare,PPO,43845,CPT4/HCPCS,GASTROPLASTY DUODENAL SWITCH,,Grouper Rate,1370.00
United HealthCare,PPO,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,Grouper Rate,1370.00
United HealthCare,PPO,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,Grouper Rate,1370.00
United HealthCare,PPO,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,Grouper Rate,1370.00
United HealthCare,PPO,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,Grouper Rate,4204.00
United HealthCare,PPO,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,43881,CPT4/HCPCS,IMPL/REDO ELECTRD ANTRUM,,Grouper Rate,1370.00
United HealthCare,PPO,43882,CPT4/HCPCS,REVISE/REMOVE ELECTRD ANTRUM,,Grouper Rate,1370.00
United HealthCare,PPO,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,Grouper Rate,5138.00
United HealthCare,PPO,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,Grouper Rate,5138.00
United HealthCare,PPO,43999,CPT4/HCPCS,STOMACH SURGERY PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,Grouper Rate,1370.00
United HealthCare,PPO,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,Grouper Rate,1370.00
United HealthCare,PPO,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,Grouper Rate,1370.00
United HealthCare,PPO,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,Grouper Rate,1370.00
United HealthCare,PPO,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,Grouper Rate,1370.00
United HealthCare,PPO,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,Grouper Rate,1370.00
United HealthCare,PPO,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,Grouper Rate,1370.00
United HealthCare,PPO,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,Grouper Rate,1370.00
United HealthCare,PPO,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,Grouper Rate,1370.00
United HealthCare,PPO,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,Grouper Rate,1370.00
United HealthCare,PPO,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,Grouper Rate,1370.00
United HealthCare,PPO,44137,CPT4/HCPCS,REMOVE INTESTINAL ALLOGRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,Grouper Rate,1370.00
United HealthCare,PPO,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1370.00
United HealthCare,PPO,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1370.00
United HealthCare,PPO,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1370.00
United HealthCare,PPO,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1370.00
United HealthCare,PPO,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1370.00
United HealthCare,PPO,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1370.00
United HealthCare,PPO,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,Grouper Rate,1370.00
United HealthCare,PPO,44150,CPT4/HCPCS,REMOVAL OF COLON,,Grouper Rate,1370.00
United HealthCare,PPO,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44157,CPT4/HCPCS,COLECTOMY W/ILEOANAL ANAST,,Grouper Rate,1370.00
United HealthCare,PPO,44158,CPT4/HCPCS,COLECTOMY W/NEO-RECTUM POUCH,,Grouper Rate,1370.00
United HealthCare,PPO,44160,CPT4/HCPCS,REMOVAL OF COLON,,Grouper Rate,1370.00
United HealthCare,PPO,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,Grouper Rate,7007.00
United HealthCare,PPO,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44188,CPT4/HCPCS,LAP COLOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44202,CPT4/HCPCS,LAP ENTERECTOMY,,Grouper Rate,6075.00
United HealthCare,PPO,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,Grouper Rate,6075.00
United HealthCare,PPO,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,Grouper Rate,6075.00
United HealthCare,PPO,44205,CPT4/HCPCS,LAP COLECTOMY PART W/ILEUM,,Grouper Rate,1370.00
United HealthCare,PPO,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,Grouper Rate,1370.00
United HealthCare,PPO,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44238,CPT4/HCPCS,LAPAROSCOPE PROC INTESTINE,,Grouper Rate,6075.00
United HealthCare,PPO,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,Grouper Rate,1370.00
United HealthCare,PPO,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,5138.00
United HealthCare,PPO,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,Grouper Rate,1370.00
United HealthCare,PPO,44320,CPT4/HCPCS,COLOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,Grouper Rate,1370.00
United HealthCare,PPO,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5138.00
United HealthCare,PPO,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5138.00
United HealthCare,PPO,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,Grouper Rate,5138.00
United HealthCare,PPO,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,Grouper Rate,5138.00
United HealthCare,PPO,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,Grouper Rate,5138.00
United HealthCare,PPO,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,1370.00
United HealthCare,PPO,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,Grouper Rate,1370.00
United HealthCare,PPO,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,Grouper Rate,1370.00
United HealthCare,PPO,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,Grouper Rate,1370.00
United HealthCare,PPO,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,Grouper Rate,1370.00
United HealthCare,PPO,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,Grouper Rate,1370.00
United HealthCare,PPO,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,Grouper Rate,1370.00
United HealthCare,PPO,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,Grouper Rate,1370.00
United HealthCare,PPO,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,Grouper Rate,1370.00
United HealthCare,PPO,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,1370.00
United HealthCare,PPO,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,1370.00
United HealthCare,PPO,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,Grouper Rate,1370.00
United HealthCare,PPO,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,Grouper Rate,1370.00
United HealthCare,PPO,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,Grouper Rate,1370.00
United HealthCare,PPO,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,Grouper Rate,1370.00
United HealthCare,PPO,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,1370.00
United HealthCare,PPO,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,Grouper Rate,1370.00
United HealthCare,PPO,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,Grouper Rate,1370.00
United HealthCare,PPO,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,1370.00
United HealthCare,PPO,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,1370.00
United HealthCare,PPO,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,Grouper Rate,1370.00
United HealthCare,PPO,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,Grouper Rate,1370.00
United HealthCare,PPO,44701,CPT4/HCPCS,INTRAOP COLON LAVAGE ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,44715,CPT4/HCPCS,PREPARE DONOR INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,44720,CPT4/HCPCS,PREP DONOR INTESTINE/VENOUS,,Grouper Rate,1370.00
United HealthCare,PPO,44721,CPT4/HCPCS,PREP DONOR INTESTINE/ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,44799,CPT4/HCPCS,UNLISTED PX SMALL INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,44800,CPT4/HCPCS,EXCISION OF BOWEL POUCH,,Grouper Rate,1370.00
United HealthCare,PPO,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,Grouper Rate,1370.00
United HealthCare,PPO,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,Grouper Rate,1370.00
United HealthCare,PPO,44899,CPT4/HCPCS,BOWEL SURGERY PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,44950,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,5138.00
United HealthCare,PPO,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,44960,CPT4/HCPCS,APPENDECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,44979,CPT4/HCPCS,LAPAROSCOPE PROC APP,,Grouper Rate,6075.00
United HealthCare,PPO,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,Grouper Rate,1370.00
United HealthCare,PPO,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,Grouper Rate,4204.00
United HealthCare,PPO,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,1370.00
United HealthCare,PPO,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,1370.00
United HealthCare,PPO,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,1370.00
United HealthCare,PPO,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,1370.00
United HealthCare,PPO,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,Grouper Rate,1370.00
United HealthCare,PPO,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,Grouper Rate,1370.00
United HealthCare,PPO,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,Grouper Rate,1370.00
United HealthCare,PPO,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,Grouper Rate,1370.00
United HealthCare,PPO,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,45126,CPT4/HCPCS,PELVIC EXENTERATION,,Grouper Rate,1370.00
United HealthCare,PPO,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Grouper Rate,1370.00
United HealthCare,PPO,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,Grouper Rate,1370.00
United HealthCare,PPO,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,Grouper Rate,1370.00
United HealthCare,PPO,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,Grouper Rate,1370.00
United HealthCare,PPO,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,Grouper Rate,4204.00
United HealthCare,PPO,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,Grouper Rate,4204.00
United HealthCare,PPO,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,Grouper Rate,5138.00
United HealthCare,PPO,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,Grouper Rate,4204.00
United HealthCare,PPO,453,DRG,Combined anterior/posterior spinal fusion w MCC,,Case Rate,104443.00
United HealthCare,PPO,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,Grouper Rate,1308.00
United HealthCare,PPO,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,Grouper Rate,1370.00
United HealthCare,PPO,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,Grouper Rate,1370.00
United HealthCare,PPO,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,Grouper Rate,4204.00
United HealthCare,PPO,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,Grouper Rate,1370.00
United HealthCare,PPO,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,Grouper Rate,4204.00
United HealthCare,PPO,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,Grouper Rate,4204.00
United HealthCare,PPO,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,Grouper Rate,5138.00
United HealthCare,PPO,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,Grouper Rate,1308.00
United HealthCare,PPO,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,Grouper Rate,1308.00
United HealthCare,PPO,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,Grouper Rate,1308.00
United HealthCare,PPO,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,Grouper Rate,1370.00
United HealthCare,PPO,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,Grouper Rate,1308.00
United HealthCare,PPO,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,Grouper Rate,1370.00
United HealthCare,PPO,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,Grouper Rate,1370.00
United HealthCare,PPO,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,Grouper Rate,1370.00
United HealthCare,PPO,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,Grouper Rate,1370.00
United HealthCare,PPO,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,Grouper Rate,1370.00
United HealthCare,PPO,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,Grouper Rate,1370.00
United HealthCare,PPO,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,Grouper Rate,1370.00
United HealthCare,PPO,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,Grouper Rate,1370.00
United HealthCare,PPO,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,Grouper Rate,1370.00
United HealthCare,PPO,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,Grouper Rate,1370.00
United HealthCare,PPO,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,Grouper Rate,1370.00
United HealthCare,PPO,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,Grouper Rate,1370.00
United HealthCare,PPO,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,Grouper Rate,1370.00
United HealthCare,PPO,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,Grouper Rate,1370.00
United HealthCare,PPO,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,Grouper Rate,1370.00
United HealthCare,PPO,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,Grouper Rate,1370.00
United HealthCare,PPO,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,Grouper Rate,1370.00
United HealthCare,PPO,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,Grouper Rate,1370.00
United HealthCare,PPO,45395,CPT4/HCPCS,LAP REMOVAL OF RECTUM,,Grouper Rate,1370.00
United HealthCare,PPO,45397,CPT4/HCPCS,LAP REMOVE RECTUM W/POUCH,,Grouper Rate,1370.00
United HealthCare,PPO,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,Grouper Rate,1370.00
United HealthCare,PPO,45399,CPT4/HCPCS,UNLISTED PROCEDURE COLON,,Grouper Rate,1370.00
United HealthCare,PPO,454,DRG,Combined anterior/posterior spinal fusion w CC,,Case Rate,81519.00
United HealthCare,PPO,45400,CPT4/HCPCS,LAPAROSCOPIC PROC,,Grouper Rate,1370.00
United HealthCare,PPO,45402,CPT4/HCPCS,LAP PROCTOPEXY W/SIG RESECT,,Grouper Rate,1370.00
United HealthCare,PPO,45499,CPT4/HCPCS,LAPAROSCOPE PROC RECTUM,,Grouper Rate,6075.00
United HealthCare,PPO,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,Case Rate,70637.00
United HealthCare,PPO,45500,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,4204.00
United HealthCare,PPO,45505,CPT4/HCPCS,REPAIR OF RECTUM,,Grouper Rate,5138.00
United HealthCare,PPO,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,Grouper Rate,1308.00
United HealthCare,PPO,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,1370.00
United HealthCare,PPO,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,Grouper Rate,5138.00
United HealthCare,PPO,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,Grouper Rate,1370.00
United HealthCare,PPO,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,Grouper Rate,5138.00
United HealthCare,PPO,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Grouper Rate,1370.00
United HealthCare,PPO,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,Grouper Rate,1370.00
United HealthCare,PPO,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,Case Rate,70917.00
United HealthCare,PPO,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,Case Rate,80428.00
United HealthCare,PPO,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,Case Rate,51812.00
United HealthCare,PPO,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,459,DRG,Spinal fusion except cervical w MCC,,Case Rate,66320.00
United HealthCare,PPO,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,Grouper Rate,1308.00
United HealthCare,PPO,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,Grouper Rate,1370.00
United HealthCare,PPO,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,Grouper Rate,1370.00
United HealthCare,PPO,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,Grouper Rate,1370.00
United HealthCare,PPO,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,Grouper Rate,1370.00
United HealthCare,PPO,45999,CPT4/HCPCS,RECTUM SURGERY PROCEDURE,,Grouper Rate,1308.00
United HealthCare,PPO,460,DRG,Spinal fusion except cervical w/o MCC,,Case Rate,51324.00
United HealthCare,PPO,46020,CPT4/HCPCS,PLACEMENT OF SETON,,Grouper Rate,4204.00
United HealthCare,PPO,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,Grouper Rate,1370.00
United HealthCare,PPO,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,4204.00
United HealthCare,PPO,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,Grouper Rate,1308.00
United HealthCare,PPO,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,Grouper Rate,1370.00
United HealthCare,PPO,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,Grouper Rate,1370.00
United HealthCare,PPO,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,Grouper Rate,1214.00
United HealthCare,PPO,461,DRG,Bilateral or multiple major joint procs of lower extremity w MCC,,Case Rate,40778.00
United HealthCare,PPO,462,DRG,Bilateral or multiple major joint procs of lower extremity w/o MCC,,Case Rate,32964.00
United HealthCare,PPO,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,Grouper Rate,4204.00
United HealthCare,PPO,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,Grouper Rate,1370.00
United HealthCare,PPO,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,Grouper Rate,1308.00
United HealthCare,PPO,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,Grouper Rate,1370.00
United HealthCare,PPO,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,Grouper Rate,4204.00
United HealthCare,PPO,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,Grouper Rate,4204.00
United HealthCare,PPO,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,Grouper Rate,4204.00
United HealthCare,PPO,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,Grouper Rate,4204.00
United HealthCare,PPO,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,Grouper Rate,4204.00
United HealthCare,PPO,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,Grouper Rate,4204.00
United HealthCare,PPO,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,Grouper Rate,4204.00
United HealthCare,PPO,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,Grouper Rate,4204.00
United HealthCare,PPO,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,Grouper Rate,4204.00
United HealthCare,PPO,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,Grouper Rate,4204.00
United HealthCare,PPO,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,Grouper Rate,4204.00
United HealthCare,PPO,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,Grouper Rate,5138.00
United HealthCare,PPO,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,Grouper Rate,1370.00
United HealthCare,PPO,46500,CPT4/HCPCS,INJECTION INTO HEMORRHOID(S),,Grouper Rate,1308.00
United HealthCare,PPO,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,Grouper Rate,1370.00
United HealthCare,PPO,466,DRG,Revision of hip or knee replacement w MCC,,Case Rate,29667.00
United HealthCare,PPO,46600,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY SPX,,Grouper Rate,1214.00
United HealthCare,PPO,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,Grouper Rate,1214.00
United HealthCare,PPO,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,Grouper Rate,1370.00
United HealthCare,PPO,46606,CPT4/HCPCS,ANOSCOPY AND BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,Grouper Rate,1370.00
United HealthCare,PPO,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,46611,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,Grouper Rate,4204.00
United HealthCare,PPO,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,Grouper Rate,1370.00
United HealthCare,PPO,46615,CPT4/HCPCS,ANOSCOPY,,Grouper Rate,4204.00
United HealthCare,PPO,467,DRG,Revision of hip or knee replacement w CC,,Case Rate,23062.00
United HealthCare,PPO,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,4204.00
United HealthCare,PPO,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,Grouper Rate,1370.00
United HealthCare,PPO,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,Grouper Rate,4204.00
United HealthCare,PPO,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,Grouper Rate,5138.00
United HealthCare,PPO,46710,CPT4/HCPCS,REPR PER/VAG POUCH SNGL PROC,,Grouper Rate,1370.00
United HealthCare,PPO,46712,CPT4/HCPCS,REPR PER/VAG POUCH DBL PROC,,Grouper Rate,1370.00
United HealthCare,PPO,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,Grouper Rate,1370.00
United HealthCare,PPO,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,Grouper Rate,1370.00
United HealthCare,PPO,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,1370.00
United HealthCare,PPO,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,1370.00
United HealthCare,PPO,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,Grouper Rate,1370.00
United HealthCare,PPO,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,Grouper Rate,1370.00
United HealthCare,PPO,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1370.00
United HealthCare,PPO,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1370.00
United HealthCare,PPO,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,Grouper Rate,1370.00
United HealthCare,PPO,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,5138.00
United HealthCare,PPO,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,1370.00
United HealthCare,PPO,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,Grouper Rate,4204.00
United HealthCare,PPO,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,Grouper Rate,1370.00
United HealthCare,PPO,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,5138.00
United HealthCare,PPO,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,Grouper Rate,5138.00
United HealthCare,PPO,468,DRG,Revision of hip or knee replacement w/o CC/MCC,,Case Rate,20562.00
United HealthCare,PPO,469,DRG,Major joint replacement or reattachment of lower extremity w MCC,,Case Rate,26499.00
United HealthCare,PPO,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1214.00
United HealthCare,PPO,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,1370.00
United HealthCare,PPO,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,Grouper Rate,1214.00
United HealthCare,PPO,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,Grouper Rate,4204.00
United HealthCare,PPO,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,Grouper Rate,4204.00
United HealthCare,PPO,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,Grouper Rate,4204.00
United HealthCare,PPO,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,Grouper Rate,1308.00
United HealthCare,PPO,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,1370.00
United HealthCare,PPO,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,Grouper Rate,1308.00
United HealthCare,PPO,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,Grouper Rate,4204.00
United HealthCare,PPO,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,Grouper Rate,4204.00
United HealthCare,PPO,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,Grouper Rate,5138.00
United HealthCare,PPO,46948,CPT4/HCPCS,INT HRHC TRANAL DARTLZJ 2+,,Grouper Rate,4204.00
United HealthCare,PPO,46999,CPT4/HCPCS,ANUS SURGERY PROCEDURE,,Grouper Rate,1308.00
United HealthCare,PPO,470,DRG,Major joint replacement or reattachment of lower extremity w/o MCC,,Case Rate,29247.00
United HealthCare,PPO,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47001,CPT4/HCPCS,NEEDLE BIOPSY LIVER ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,Grouper Rate,1370.00
United HealthCare,PPO,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,Grouper Rate,1370.00
United HealthCare,PPO,471,DRG,Cervical spinal fusion w MCC,,Case Rate,26623.00
United HealthCare,PPO,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,Grouper Rate,1370.00
United HealthCare,PPO,47143,CPT4/HCPCS,PREP DONOR LIVER WHOLE,,Grouper Rate,1370.00
United HealthCare,PPO,47144,CPT4/HCPCS,PREP DONOR LIVER 3-SEGMENT,,Grouper Rate,1370.00
United HealthCare,PPO,47145,CPT4/HCPCS,PREP DONOR LIVER LOBE SPLIT,,Grouper Rate,1370.00
United HealthCare,PPO,47146,CPT4/HCPCS,PREP DONOR LIVER/VENOUS,,Grouper Rate,1370.00
United HealthCare,PPO,47147,CPT4/HCPCS,PREP DONOR LIVER/ARTERIAL,,Grouper Rate,1370.00
United HealthCare,PPO,472,DRG,Cervical spinal fusion w CC,,Case Rate,19033.00
United HealthCare,PPO,473,DRG,Cervical spinal fusion w/o CC/MCC,,Case Rate,28617.00
United HealthCare,PPO,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,Grouper Rate,1370.00
United HealthCare,PPO,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,Grouper Rate,10119.00
United HealthCare,PPO,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,Grouper Rate,10119.00
United HealthCare,PPO,47379,CPT4/HCPCS,LAPAROSCOPE PROCEDURE LIVER,,Grouper Rate,6075.00
United HealthCare,PPO,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,Grouper Rate,1370.00
United HealthCare,PPO,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,Grouper Rate,1370.00
United HealthCare,PPO,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,Grouper Rate,7007.00
United HealthCare,PPO,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,Grouper Rate,7007.00
United HealthCare,PPO,47399,CPT4/HCPCS,LIVER SURGERY PROCEDURE,,Grouper Rate,1308.00
United HealthCare,PPO,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,Grouper Rate,1370.00
United HealthCare,PPO,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,Grouper Rate,1370.00
United HealthCare,PPO,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,Grouper Rate,1370.00
United HealthCare,PPO,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,Grouper Rate,1370.00
United HealthCare,PPO,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,Grouper Rate,5138.00
United HealthCare,PPO,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,5138.00
United HealthCare,PPO,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,Grouper Rate,5138.00
United HealthCare,PPO,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,5138.00
United HealthCare,PPO,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,Grouper Rate,5138.00
United HealthCare,PPO,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,Grouper Rate,5138.00
United HealthCare,PPO,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,Grouper Rate,5138.00
United HealthCare,PPO,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,Grouper Rate,1370.00
United HealthCare,PPO,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,7007.00
United HealthCare,PPO,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,7007.00
United HealthCare,PPO,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,Grouper Rate,7007.00
United HealthCare,PPO,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,Grouper Rate,5138.00
United HealthCare,PPO,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,Grouper Rate,1214.00
United HealthCare,PPO,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,Grouper Rate,1214.00
United HealthCare,PPO,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,Grouper Rate,1214.00
United HealthCare,PPO,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,Grouper Rate,1308.00
United HealthCare,PPO,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,Grouper Rate,5138.00
United HealthCare,PPO,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,7007.00
United HealthCare,PPO,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,7007.00
United HealthCare,PPO,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,5138.00
United HealthCare,PPO,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,Grouper Rate,7007.00
United HealthCare,PPO,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,Grouper Rate,7007.00
United HealthCare,PPO,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,Grouper Rate,7007.00
United HealthCare,PPO,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,47579,CPT4/HCPCS,LAPAROSCOPE PROC BILIARY,,Grouper Rate,6075.00
United HealthCare,PPO,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,Grouper Rate,1370.00
United HealthCare,PPO,47701,CPT4/HCPCS,BILE DUCT REVISION,,Grouper Rate,1370.00
United HealthCare,PPO,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,Grouper Rate,1370.00
United HealthCare,PPO,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,Grouper Rate,1370.00
United HealthCare,PPO,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,Grouper Rate,1370.00
United HealthCare,PPO,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,Grouper Rate,1370.00
United HealthCare,PPO,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,Grouper Rate,1370.00
United HealthCare,PPO,47999,CPT4/HCPCS,BILE TRACT SURGERY PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,Grouper Rate,1370.00
United HealthCare,PPO,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,Grouper Rate,1370.00
United HealthCare,PPO,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,Grouper Rate,1370.00
United HealthCare,PPO,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,Grouper Rate,1370.00
United HealthCare,PPO,48105,CPT4/HCPCS,RESECT/DEBRIDE PANCREAS,,Grouper Rate,1370.00
United HealthCare,PPO,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,Grouper Rate,1370.00
United HealthCare,PPO,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,1370.00
United HealthCare,PPO,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,1370.00
United HealthCare,PPO,48146,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,Grouper Rate,1370.00
United HealthCare,PPO,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,Grouper Rate,1370.00
United HealthCare,PPO,48152,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,48153,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,48154,CPT4/HCPCS,PANCREATECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,Grouper Rate,1370.00
United HealthCare,PPO,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,Grouper Rate,1370.00
United HealthCare,PPO,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,Grouper Rate,1370.00
United HealthCare,PPO,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,Grouper Rate,1370.00
United HealthCare,PPO,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,48545,CPT4/HCPCS,PANCREATORRHAPHY,,Grouper Rate,1370.00
United HealthCare,PPO,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,Grouper Rate,1370.00
United HealthCare,PPO,48548,CPT4/HCPCS,FUSE PANCREAS AND BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,48999,CPT4/HCPCS,PANCREAS SURGERY PROCEDURE,,Grouper Rate,1308.00
United HealthCare,PPO,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,5138.00
United HealthCare,PPO,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,Grouper Rate,1370.00
United HealthCare,PPO,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,Grouper Rate,1370.00
United HealthCare,PPO,49013,CPT4/HCPCS,PRPERTL PEL PACK HEMRRG TRMA,,Grouper Rate,1370.00
United HealthCare,PPO,49014,CPT4/HCPCS,REEXPLORATION PELVIC WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,Grouper Rate,1370.00
United HealthCare,PPO,49082,CPT4/HCPCS,ABD PARACENTESIS,,Grouper Rate,1370.00
United HealthCare,PPO,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,Grouper Rate,1370.00
United HealthCare,PPO,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,Grouper Rate,1370.00
United HealthCare,PPO,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,Grouper Rate,1370.00
United HealthCare,PPO,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,Grouper Rate,1308.00
United HealthCare,PPO,492,DRG,Lower extrem & humer proc except hip,foot,femur w MCC,,Case Rate,23631.00
United HealthCare,PPO,49203,CPT4/HCPCS,EXC ABD TUM 5 CM OR LESS,,Grouper Rate,4204.00
United HealthCare,PPO,49204,CPT4/HCPCS,EXC ABD TUM OVER 5 CM,,Grouper Rate,7007.00
United HealthCare,PPO,49205,CPT4/HCPCS,EXC ABD TUM OVER 10 CM,,Grouper Rate,7007.00
United HealthCare,PPO,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,Grouper Rate,1370.00
United HealthCare,PPO,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,Grouper Rate,5138.00
United HealthCare,PPO,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,Grouper Rate,1370.00
United HealthCare,PPO,493,DRG,Lower extrem & humer proc except hip,foot,femur w CC,,Case Rate,18121.00
United HealthCare,PPO,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,Grouper Rate,6075.00
United HealthCare,PPO,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,Grouper Rate,6075.00
United HealthCare,PPO,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,Grouper Rate,6075.00
United HealthCare,PPO,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,Grouper Rate,6075.00
United HealthCare,PPO,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,Grouper Rate,6075.00
United HealthCare,PPO,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,Grouper Rate,6075.00
United HealthCare,PPO,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,49327,CPT4/HCPCS,LAP INS DEVICE FOR RT,,Grouper Rate,1214.00
United HealthCare,PPO,49329,CPT4/HCPCS,LAPARO PROC ABDM/PER/OMENT,,Grouper Rate,6075.00
United HealthCare,PPO,494,DRG,Lower extrem & humer proc except hip,foot,femur w/o CC/MCC,,Case Rate,18766.00
United HealthCare,PPO,49400,CPT4/HCPCS,AIR INJECTION INTO ABDOMEN,,Grouper Rate,1214.00
United HealthCare,PPO,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,Grouper Rate,5138.00
United HealthCare,PPO,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,Grouper Rate,1370.00
United HealthCare,PPO,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,Grouper Rate,1370.00
United HealthCare,PPO,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,Grouper Rate,1370.00
United HealthCare,PPO,49411,CPT4/HCPCS,INS MARK ABD/PEL FOR RT PERQ,,Grouper Rate,1370.00
United HealthCare,PPO,49412,CPT4/HCPCS,INS DEVICE FOR RT GUIDE OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,Grouper Rate,5138.00
United HealthCare,PPO,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,Grouper Rate,7007.00
United HealthCare,PPO,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,Grouper Rate,5138.00
United HealthCare,PPO,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,Grouper Rate,5138.00
United HealthCare,PPO,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,Grouper Rate,1370.00
United HealthCare,PPO,49424,CPT4/HCPCS,ASSESS CYST CONTRAST INJECT,,Grouper Rate,1214.00
United HealthCare,PPO,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,Grouper Rate,1370.00
United HealthCare,PPO,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,Grouper Rate,5138.00
United HealthCare,PPO,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,Grouper Rate,1214.00
United HealthCare,PPO,49428,CPT4/HCPCS,LIGATION OF SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,Grouper Rate,5138.00
United HealthCare,PPO,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,Grouper Rate,1370.00
United HealthCare,PPO,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,Grouper Rate,1370.00
United HealthCare,PPO,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,Grouper Rate,1370.00
United HealthCare,PPO,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,Grouper Rate,1370.00
United HealthCare,PPO,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,Grouper Rate,1370.00
United HealthCare,PPO,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,Grouper Rate,1370.00
United HealthCare,PPO,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,Grouper Rate,1370.00
United HealthCare,PPO,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,Grouper Rate,1370.00
United HealthCare,PPO,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,Grouper Rate,1370.00
United HealthCare,PPO,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,Grouper Rate,1214.00
United HealthCare,PPO,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,Grouper Rate,5138.00
United HealthCare,PPO,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,Grouper Rate,5138.00
United HealthCare,PPO,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,Grouper Rate,5138.00
United HealthCare,PPO,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,Grouper Rate,5138.00
United HealthCare,PPO,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,Grouper Rate,5138.00
United HealthCare,PPO,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,Grouper Rate,5138.00
United HealthCare,PPO,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,Grouper Rate,5138.00
United HealthCare,PPO,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,Grouper Rate,5138.00
United HealthCare,PPO,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,Grouper Rate,5138.00
United HealthCare,PPO,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,Grouper Rate,5138.00
United HealthCare,PPO,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,Grouper Rate,5138.00
United HealthCare,PPO,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,Grouper Rate,5138.00
United HealthCare,PPO,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,Grouper Rate,5138.00
United HealthCare,PPO,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,Grouper Rate,5138.00
United HealthCare,PPO,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,Grouper Rate,5138.00
United HealthCare,PPO,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,Grouper Rate,5138.00
United HealthCare,PPO,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,Grouper Rate,5138.00
United HealthCare,PPO,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,Grouper Rate,5138.00
United HealthCare,PPO,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,Grouper Rate,5138.00
United HealthCare,PPO,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,Grouper Rate,5138.00
United HealthCare,PPO,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,Grouper Rate,1214.00
United HealthCare,PPO,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,Grouper Rate,5138.00
United HealthCare,PPO,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,Grouper Rate,5138.00
United HealthCare,PPO,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,Grouper Rate,5138.00
United HealthCare,PPO,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,Grouper Rate,5138.00
United HealthCare,PPO,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,Grouper Rate,5138.00
United HealthCare,PPO,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,Grouper Rate,5138.00
United HealthCare,PPO,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,Grouper Rate,5138.00
United HealthCare,PPO,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,5138.00
United HealthCare,PPO,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,Grouper Rate,7007.00
United HealthCare,PPO,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,Grouper Rate,7007.00
United HealthCare,PPO,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,Grouper Rate,7007.00
United HealthCare,PPO,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,Grouper Rate,7007.00
United HealthCare,PPO,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,Grouper Rate,7007.00
United HealthCare,PPO,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,Grouper Rate,7007.00
United HealthCare,PPO,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,Grouper Rate,7007.00
United HealthCare,PPO,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,Grouper Rate,7007.00
United HealthCare,PPO,49659,CPT4/HCPCS,LAPARO PROC HERNIA REPAIR,,Grouper Rate,6075.00
United HealthCare,PPO,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,Grouper Rate,1370.00
United HealthCare,PPO,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,Grouper Rate,1370.00
United HealthCare,PPO,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,Grouper Rate,1370.00
United HealthCare,PPO,49906,CPT4/HCPCS,FREE OMENTAL FLAP MICROVASC,,Grouper Rate,1370.00
United HealthCare,PPO,49999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,Grouper Rate,4204.00
United HealthCare,PPO,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,Grouper Rate,4204.00
United HealthCare,PPO,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,1370.00
United HealthCare,PPO,50065,CPT4/HCPCS,INCISION OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50070,CPT4/HCPCS,INCISION OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,1370.00
United HealthCare,PPO,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,6075.00
United HealthCare,PPO,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,6075.00
United HealthCare,PPO,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,Grouper Rate,1370.00
United HealthCare,PPO,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,Grouper Rate,1370.00
United HealthCare,PPO,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,Grouper Rate,1370.00
United HealthCare,PPO,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,50220,CPT4/HCPCS,REMOVE KIDNEY OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,Grouper Rate,1370.00
United HealthCare,PPO,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,Grouper Rate,1370.00
United HealthCare,PPO,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50250,CPT4/HCPCS,CRYOABLATE RENAL MASS OPEN,,Grouper Rate,1370.00
United HealthCare,PPO,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Grouper Rate,1370.00
United HealthCare,PPO,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,Grouper Rate,1370.00
United HealthCare,PPO,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,Grouper Rate,1370.00
United HealthCare,PPO,50323,CPT4/HCPCS,PREP CADAVER RENAL ALLOGRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,50325,CPT4/HCPCS,PREP DONOR RENAL GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,50327,CPT4/HCPCS,PREP RENAL GRAFT/VENOUS,,Grouper Rate,1370.00
United HealthCare,PPO,50328,CPT4/HCPCS,PREP RENAL GRAFT/ARTERIAL,,Grouper Rate,1370.00
United HealthCare,PPO,50329,CPT4/HCPCS,PREP RENAL GRAFT/URETERAL,,Grouper Rate,1370.00
United HealthCare,PPO,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,Grouper Rate,4204.00
United HealthCare,PPO,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,Grouper Rate,4204.00
United HealthCare,PPO,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,Grouper Rate,4204.00
United HealthCare,PPO,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,Grouper Rate,4204.00
United HealthCare,PPO,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,Grouper Rate,1370.00
United HealthCare,PPO,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,Grouper Rate,1308.00
United HealthCare,PPO,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,Grouper Rate,1308.00
United HealthCare,PPO,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,Grouper Rate,1214.00
United HealthCare,PPO,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,Grouper Rate,1308.00
United HealthCare,PPO,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,1308.00
United HealthCare,PPO,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,Grouper Rate,1308.00
United HealthCare,PPO,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,Grouper Rate,4204.00
United HealthCare,PPO,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,Grouper Rate,4204.00
United HealthCare,PPO,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,Grouper Rate,1308.00
United HealthCare,PPO,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,Grouper Rate,1308.00
United HealthCare,PPO,50436,CPT4/HCPCS,DILAT XST TRC NDURLGC PX,,Grouper Rate,4204.00
United HealthCare,PPO,50437,CPT4/HCPCS,DILAT XST TRC NEW ACCESS RCS,,Grouper Rate,5138.00
United HealthCare,PPO,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,Grouper Rate,1308.00
United HealthCare,PPO,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,Grouper Rate,6075.00
United HealthCare,PPO,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,Grouper Rate,10119.00
United HealthCare,PPO,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,Grouper Rate,7007.00
United HealthCare,PPO,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,50546,CPT4/HCPCS,LAPAROSCOPIC NEPHRECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50549,CPT4/HCPCS,LAPAROSCOPE PROC RENAL,,Grouper Rate,6075.00
United HealthCare,PPO,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,4204.00
United HealthCare,PPO,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,Grouper Rate,1308.00
United HealthCare,PPO,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1308.00
United HealthCare,PPO,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,1308.00
United HealthCare,PPO,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,Grouper Rate,1308.00
United HealthCare,PPO,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,Grouper Rate,6075.00
United HealthCare,PPO,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1370.00
United HealthCare,PPO,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,Grouper Rate,1370.00
United HealthCare,PPO,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,Grouper Rate,7007.00
United HealthCare,PPO,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,Grouper Rate,7007.00
United HealthCare,PPO,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,Grouper Rate,7007.00
United HealthCare,PPO,50600,CPT4/HCPCS,EXPLORATION OF URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,Grouper Rate,1370.00
United HealthCare,PPO,50606,CPT4/HCPCS,ENDOLUMINAL BX URTR RNL PLVS,,Grouper Rate,1214.00
United HealthCare,PPO,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,1370.00
United HealthCare,PPO,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,1370.00
United HealthCare,PPO,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,1370.00
United HealthCare,PPO,50650,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50660,CPT4/HCPCS,REMOVAL OF URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50684,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,Grouper Rate,1214.00
United HealthCare,PPO,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,Grouper Rate,1370.00
United HealthCare,PPO,50690,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,5138.00
United HealthCare,PPO,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,5138.00
United HealthCare,PPO,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,Grouper Rate,5138.00
United HealthCare,PPO,50700,CPT4/HCPCS,REVISION OF URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50705,CPT4/HCPCS,URETERAL EMBOLIZATION/OCCL,,Grouper Rate,1214.00
United HealthCare,PPO,50706,CPT4/HCPCS,BALLOON DILATE URTRL STRIX,,Grouper Rate,1214.00
United HealthCare,PPO,50715,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50722,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50727,CPT4/HCPCS,REVISE URETER,,Grouper Rate,4204.00
United HealthCare,PPO,50728,CPT4/HCPCS,REVISE URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,Grouper Rate,1370.00
United HealthCare,PPO,50760,CPT4/HCPCS,FUSION OF URETERS,,Grouper Rate,1370.00
United HealthCare,PPO,50770,CPT4/HCPCS,SPLICING OF URETERS,,Grouper Rate,1370.00
United HealthCare,PPO,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,50782,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,50783,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,Grouper Rate,1370.00
United HealthCare,PPO,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,50830,CPT4/HCPCS,REVISE URINE FLOW,,Grouper Rate,1370.00
United HealthCare,PPO,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,Grouper Rate,1370.00
United HealthCare,PPO,50900,CPT4/HCPCS,REPAIR OF URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,50940,CPT4/HCPCS,RELEASE OF URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,7007.00
United HealthCare,PPO,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,Grouper Rate,7007.00
United HealthCare,PPO,50949,CPT4/HCPCS,LAPAROSCOPE PROC URETER,,Grouper Rate,6075.00
United HealthCare,PPO,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,1308.00
United HealthCare,PPO,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,Grouper Rate,1370.00
United HealthCare,PPO,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,4204.00
United HealthCare,PPO,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,50970,CPT4/HCPCS,URETER ENDOSCOPY,,Grouper Rate,1308.00
United HealthCare,PPO,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,Grouper Rate,1308.00
United HealthCare,PPO,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,1370.00
United HealthCare,PPO,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,4204.00
United HealthCare,PPO,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,Grouper Rate,4204.00
United HealthCare,PPO,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,Grouper Rate,4204.00
United HealthCare,PPO,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,Grouper Rate,1308.00
United HealthCare,PPO,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,Grouper Rate,4204.00
United HealthCare,PPO,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,Grouper Rate,6075.00
United HealthCare,PPO,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,Grouper Rate,4204.00
United HealthCare,PPO,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,Grouper Rate,1214.00
United HealthCare,PPO,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,Grouper Rate,1370.00
United HealthCare,PPO,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,Grouper Rate,4204.00
United HealthCare,PPO,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,Grouper Rate,5138.00
United HealthCare,PPO,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,4204.00
United HealthCare,PPO,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5138.00
United HealthCare,PPO,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,Grouper Rate,5138.00
United HealthCare,PPO,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,Grouper Rate,4204.00
United HealthCare,PPO,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,Grouper Rate,1370.00
United HealthCare,PPO,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,Grouper Rate,1370.00
United HealthCare,PPO,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Grouper Rate,1370.00
United HealthCare,PPO,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,1370.00
United HealthCare,PPO,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,Grouper Rate,1370.00
United HealthCare,PPO,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,1370.00
United HealthCare,PPO,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,Grouper Rate,1370.00
United HealthCare,PPO,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,Grouper Rate,1370.00
United HealthCare,PPO,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,Grouper Rate,1370.00
United HealthCare,PPO,51600,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,51605,CPT4/HCPCS,PREPARATION FOR BLADDER XRAY,,Grouper Rate,1214.00
United HealthCare,PPO,51610,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,51700,CPT4/HCPCS,IRRIGATION OF BLADDER,,Grouper Rate,1214.00
United HealthCare,PPO,51701,CPT4/HCPCS,INSERT BLADDER CATHETER,,Grouper Rate,1214.00
United HealthCare,PPO,51702,CPT4/HCPCS,INSERT TEMP BLADDER CATH,,Grouper Rate,1214.00
United HealthCare,PPO,51703,CPT4/HCPCS,INSERT BLADDER CATH COMPLEX,,Grouper Rate,1214.00
United HealthCare,PPO,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,1214.00
United HealthCare,PPO,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,Grouper Rate,1308.00
United HealthCare,PPO,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,Grouper Rate,1214.00
United HealthCare,PPO,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,Grouper Rate,1214.00
United HealthCare,PPO,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,Grouper Rate,1214.00
United HealthCare,PPO,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,Grouper Rate,1308.00
United HealthCare,PPO,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,Grouper Rate,1308.00
United HealthCare,PPO,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,Grouper Rate,1308.00
United HealthCare,PPO,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,Grouper Rate,1214.00
United HealthCare,PPO,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,Grouper Rate,1214.00
United HealthCare,PPO,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,1214.00
United HealthCare,PPO,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,Grouper Rate,1214.00
United HealthCare,PPO,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,Grouper Rate,1214.00
United HealthCare,PPO,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,Grouper Rate,1214.00
United HealthCare,PPO,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,Grouper Rate,1214.00
United HealthCare,PPO,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,Case Rate,21940.00
United HealthCare,PPO,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,Grouper Rate,1370.00
United HealthCare,PPO,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,Grouper Rate,1370.00
United HealthCare,PPO,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,Grouper Rate,6075.00
United HealthCare,PPO,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,4204.00
United HealthCare,PPO,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,Grouper Rate,5138.00
United HealthCare,PPO,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,Grouper Rate,4204.00
United HealthCare,PPO,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,Case Rate,21940.00
United HealthCare,PPO,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,Grouper Rate,5138.00
United HealthCare,PPO,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,Grouper Rate,4204.00
United HealthCare,PPO,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,Grouper Rate,1370.00
United HealthCare,PPO,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,Grouper Rate,1370.00
United HealthCare,PPO,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,Grouper Rate,4204.00
United HealthCare,PPO,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,Grouper Rate,7007.00
United HealthCare,PPO,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,Grouper Rate,7007.00
United HealthCare,PPO,51999,CPT4/HCPCS,LAPAROSCOPE PROC BLA,,Grouper Rate,6075.00
United HealthCare,PPO,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,Case Rate,7793.00
United HealthCare,PPO,52000,CPT4/HCPCS,CYSTOSCOPY,,Grouper Rate,1308.00
United HealthCare,PPO,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,Grouper Rate,1370.00
United HealthCare,PPO,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,Grouper Rate,4204.00
United HealthCare,PPO,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,Grouper Rate,4204.00
United HealthCare,PPO,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,Grouper Rate,1308.00
United HealthCare,PPO,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,Grouper Rate,4204.00
United HealthCare,PPO,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,Grouper Rate,4204.00
United HealthCare,PPO,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1370.00
United HealthCare,PPO,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1308.00
United HealthCare,PPO,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,1370.00
United HealthCare,PPO,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1370.00
United HealthCare,PPO,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,Grouper Rate,4204.00
United HealthCare,PPO,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1370.00
United HealthCare,PPO,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,Grouper Rate,1370.00
United HealthCare,PPO,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,1370.00
United HealthCare,PPO,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,4204.00
United HealthCare,PPO,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,Grouper Rate,4204.00
United HealthCare,PPO,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,Grouper Rate,4204.00
United HealthCare,PPO,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,Grouper Rate,6075.00
United HealthCare,PPO,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,Grouper Rate,4204.00
United HealthCare,PPO,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,Grouper Rate,4204.00
United HealthCare,PPO,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,Grouper Rate,4204.00
United HealthCare,PPO,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,Grouper Rate,4204.00
United HealthCare,PPO,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,Grouper Rate,4204.00
United HealthCare,PPO,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,Grouper Rate,4204.00
United HealthCare,PPO,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,Grouper Rate,4204.00
United HealthCare,PPO,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,Grouper Rate,4204.00
United HealthCare,PPO,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,Grouper Rate,4204.00
United HealthCare,PPO,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,Grouper Rate,6075.00
United HealthCare,PPO,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,Grouper Rate,4204.00
United HealthCare,PPO,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,Grouper Rate,4204.00
United HealthCare,PPO,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,Grouper Rate,6075.00
United HealthCare,PPO,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,Grouper Rate,4204.00
United HealthCare,PPO,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,Grouper Rate,4204.00
United HealthCare,PPO,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,Grouper Rate,1214.00
United HealthCare,PPO,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,Grouper Rate,1214.00
United HealthCare,PPO,52450,CPT4/HCPCS,INCISION OF PROSTATE,,Grouper Rate,4204.00
United HealthCare,PPO,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,Grouper Rate,4204.00
United HealthCare,PPO,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,Grouper Rate,6075.00
United HealthCare,PPO,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,Grouper Rate,6075.00
United HealthCare,PPO,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,Grouper Rate,4204.00
United HealthCare,PPO,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,6075.00
United HealthCare,PPO,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,Grouper Rate,6075.00
United HealthCare,PPO,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,Grouper Rate,6075.00
United HealthCare,PPO,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,4204.00
United HealthCare,PPO,53000,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,53010,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,53020,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,53025,CPT4/HCPCS,INCISION OF URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,4204.00
United HealthCare,PPO,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,Grouper Rate,4204.00
United HealthCare,PPO,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,4204.00
United HealthCare,PPO,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,Grouper Rate,4204.00
United HealthCare,PPO,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,5138.00
United HealthCare,PPO,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,5138.00
United HealthCare,PPO,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,Grouper Rate,4204.00
United HealthCare,PPO,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,Grouper Rate,5138.00
United HealthCare,PPO,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,4204.00
United HealthCare,PPO,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,4204.00
United HealthCare,PPO,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,Grouper Rate,4204.00
United HealthCare,PPO,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,Grouper Rate,4204.00
United HealthCare,PPO,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,Grouper Rate,5138.00
United HealthCare,PPO,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,Grouper Rate,5138.00
United HealthCare,PPO,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,6075.00
United HealthCare,PPO,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,Grouper Rate,5138.00
United HealthCare,PPO,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,Grouper Rate,5138.00
United HealthCare,PPO,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,Grouper Rate,5138.00
United HealthCare,PPO,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,Grouper Rate,10119.00
United HealthCare,PPO,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,Grouper Rate,5138.00
United HealthCare,PPO,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,Grouper Rate,10119.00
United HealthCare,PPO,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,Grouper Rate,10772.00
United HealthCare,PPO,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,Grouper Rate,7007.00
United HealthCare,PPO,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,Grouper Rate,10772.00
United HealthCare,PPO,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,Grouper Rate,1308.00
United HealthCare,PPO,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,Grouper Rate,5138.00
United HealthCare,PPO,53450,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,53460,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,Grouper Rate,5138.00
United HealthCare,PPO,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,4204.00
United HealthCare,PPO,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,5138.00
United HealthCare,PPO,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,4204.00
United HealthCare,PPO,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,Grouper Rate,5138.00
United HealthCare,PPO,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,Grouper Rate,5138.00
United HealthCare,PPO,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1214.00
United HealthCare,PPO,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1214.00
United HealthCare,PPO,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1370.00
United HealthCare,PPO,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1308.00
United HealthCare,PPO,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,Grouper Rate,1214.00
United HealthCare,PPO,53660,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,1214.00
United HealthCare,PPO,53661,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,1214.00
United HealthCare,PPO,53665,CPT4/HCPCS,DILATION OF URETHRA,,Grouper Rate,4204.00
United HealthCare,PPO,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,Grouper Rate,1370.00
United HealthCare,PPO,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,Grouper Rate,6075.00
United HealthCare,PPO,53854,CPT4/HCPCS,TRURL DSTRJ PRST8 TISS RF WV,,Grouper Rate,4204.00
United HealthCare,PPO,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,Grouper Rate,1308.00
United HealthCare,PPO,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,Grouper Rate,1370.00
United HealthCare,PPO,53899,CPT4/HCPCS,UROLOGY SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,4204.00
United HealthCare,PPO,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,Grouper Rate,4204.00
United HealthCare,PPO,54015,CPT4/HCPCS,DRAIN PENIS LESION,,Grouper Rate,1370.00
United HealthCare,PPO,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1214.00
United HealthCare,PPO,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1370.00
United HealthCare,PPO,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,Grouper Rate,1214.00
United HealthCare,PPO,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,Grouper Rate,1370.00
United HealthCare,PPO,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,Grouper Rate,1370.00
United HealthCare,PPO,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,Grouper Rate,1370.00
United HealthCare,PPO,54100,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,1370.00
United HealthCare,PPO,54105,CPT4/HCPCS,BIOPSY OF PENIS,,Grouper Rate,4204.00
United HealthCare,PPO,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,6075.00
United HealthCare,PPO,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,4204.00
United HealthCare,PPO,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,Grouper Rate,5138.00
United HealthCare,PPO,54125,CPT4/HCPCS,REMOVAL OF PENIS,,Grouper Rate,1370.00
United HealthCare,PPO,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,Grouper Rate,1370.00
United HealthCare,PPO,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,Grouper Rate,1370.00
United HealthCare,PPO,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,Grouper Rate,4204.00
United HealthCare,PPO,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,Grouper Rate,4204.00
United HealthCare,PPO,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,Grouper Rate,4204.00
United HealthCare,PPO,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,Grouper Rate,4204.00
United HealthCare,PPO,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,Grouper Rate,4204.00
United HealthCare,PPO,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,Grouper Rate,4204.00
United HealthCare,PPO,54200,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1214.00
United HealthCare,PPO,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,5138.00
United HealthCare,PPO,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,Grouper Rate,1214.00
United HealthCare,PPO,54230,CPT4/HCPCS,PREPARE PENIS STUDY,,Grouper Rate,1214.00
United HealthCare,PPO,54231,CPT4/HCPCS,DYNAMIC CAVERNOSOMETRY,,Grouper Rate,1370.00
United HealthCare,PPO,54235,CPT4/HCPCS,PENILE INJECTION,,Grouper Rate,1214.00
United HealthCare,PPO,54240,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,1214.00
United HealthCare,PPO,54250,CPT4/HCPCS,PENIS STUDY,,Grouper Rate,1214.00
United HealthCare,PPO,54300,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,6075.00
United HealthCare,PPO,54304,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,6075.00
United HealthCare,PPO,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,6075.00
United HealthCare,PPO,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,6075.00
United HealthCare,PPO,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,6075.00
United HealthCare,PPO,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,Grouper Rate,5138.00
United HealthCare,PPO,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,Grouper Rate,6075.00
United HealthCare,PPO,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,Grouper Rate,6075.00
United HealthCare,PPO,54380,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5138.00
United HealthCare,PPO,54385,CPT4/HCPCS,REPAIR PENIS,,Grouper Rate,5138.00
United HealthCare,PPO,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,Grouper Rate,6075.00
United HealthCare,PPO,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,Grouper Rate,10119.00
United HealthCare,PPO,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,Grouper Rate,10772.00
United HealthCare,PPO,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,Grouper Rate,10772.00
United HealthCare,PPO,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,Grouper Rate,5138.00
United HealthCare,PPO,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,Grouper Rate,6075.00
United HealthCare,PPO,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,Grouper Rate,10772.00
United HealthCare,PPO,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,Grouper Rate,1214.00
United HealthCare,PPO,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,Grouper Rate,5138.00
United HealthCare,PPO,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,Grouper Rate,10772.00
United HealthCare,PPO,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,Grouper Rate,1308.00
United HealthCare,PPO,54420,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5138.00
United HealthCare,PPO,54430,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,1370.00
United HealthCare,PPO,54435,CPT4/HCPCS,REVISION OF PENIS,,Grouper Rate,5138.00
United HealthCare,PPO,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,Grouper Rate,4204.00
United HealthCare,PPO,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,Grouper Rate,1370.00
United HealthCare,PPO,54440,CPT4/HCPCS,REPAIR OF PENIS,,Grouper Rate,5138.00
United HealthCare,PPO,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,Grouper Rate,1214.00
United HealthCare,PPO,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,1370.00
United HealthCare,PPO,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,Grouper Rate,4204.00
United HealthCare,PPO,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,Grouper Rate,4204.00
United HealthCare,PPO,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,5138.00
United HealthCare,PPO,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,Grouper Rate,4204.00
United HealthCare,PPO,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,Grouper Rate,5138.00
United HealthCare,PPO,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,Grouper Rate,5138.00
United HealthCare,PPO,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,5138.00
United HealthCare,PPO,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,Grouper Rate,4204.00
United HealthCare,PPO,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,Grouper Rate,4204.00
United HealthCare,PPO,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,Grouper Rate,4204.00
United HealthCare,PPO,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,Grouper Rate,5138.00
United HealthCare,PPO,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,Grouper Rate,5138.00
United HealthCare,PPO,54660,CPT4/HCPCS,REVISION OF TESTIS,,Grouper Rate,4204.00
United HealthCare,PPO,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,Grouper Rate,4204.00
United HealthCare,PPO,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,Grouper Rate,4204.00
United HealthCare,PPO,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,Grouper Rate,7007.00
United HealthCare,PPO,54699,CPT4/HCPCS,LAPAROSCOPE PROC TESTIS,,Grouper Rate,6075.00
United HealthCare,PPO,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,Grouper Rate,4204.00
United HealthCare,PPO,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,Grouper Rate,1308.00
United HealthCare,PPO,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,4204.00
United HealthCare,PPO,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,Grouper Rate,4204.00
United HealthCare,PPO,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,4204.00
United HealthCare,PPO,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,Grouper Rate,4204.00
United HealthCare,PPO,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,Grouper Rate,4204.00
United HealthCare,PPO,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,4204.00
United HealthCare,PPO,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,Grouper Rate,4204.00
United HealthCare,PPO,55000,CPT4/HCPCS,DRAINAGE OF HYDROCELE,,Grouper Rate,1308.00
United HealthCare,PPO,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,5138.00
United HealthCare,PPO,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,Grouper Rate,5138.00
United HealthCare,PPO,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,Grouper Rate,4204.00
United HealthCare,PPO,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,55110,CPT4/HCPCS,EXPLORE SCROTUM,,Grouper Rate,4204.00
United HealthCare,PPO,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,Grouper Rate,4204.00
United HealthCare,PPO,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,Grouper Rate,4204.00
United HealthCare,PPO,55175,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,6075.00
United HealthCare,PPO,55180,CPT4/HCPCS,REVISION OF SCROTUM,,Grouper Rate,4204.00
United HealthCare,PPO,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,Grouper Rate,4204.00
United HealthCare,PPO,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,Grouper Rate,4204.00
United HealthCare,PPO,55300,CPT4/HCPCS,PREPARE SPERM DUCT X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,Grouper Rate,4204.00
United HealthCare,PPO,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,Grouper Rate,5138.00
United HealthCare,PPO,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,Grouper Rate,4204.00
United HealthCare,PPO,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,4204.00
United HealthCare,PPO,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,Grouper Rate,5138.00
United HealthCare,PPO,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,Grouper Rate,5138.00
United HealthCare,PPO,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,Grouper Rate,7007.00
United HealthCare,PPO,55559,CPT4/HCPCS,LAPARO PROC SPERMATIC CORD,,Grouper Rate,6075.00
United HealthCare,PPO,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,4204.00
United HealthCare,PPO,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,Grouper Rate,1308.00
United HealthCare,PPO,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,Grouper Rate,1308.00
United HealthCare,PPO,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,Grouper Rate,4204.00
United HealthCare,PPO,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,1370.00
United HealthCare,PPO,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,Grouper Rate,1370.00
United HealthCare,PPO,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,Grouper Rate,1370.00
United HealthCare,PPO,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,4204.00
United HealthCare,PPO,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,Grouper Rate,4204.00
United HealthCare,PPO,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,1370.00
United HealthCare,PPO,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,1370.00
United HealthCare,PPO,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,Grouper Rate,1370.00
United HealthCare,PPO,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,Grouper Rate,4204.00
United HealthCare,PPO,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,Grouper Rate,10119.00
United HealthCare,PPO,55870,CPT4/HCPCS,ELECTROEJACULATION,,Grouper Rate,1308.00
United HealthCare,PPO,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,Grouper Rate,10119.00
United HealthCare,PPO,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,Grouper Rate,7007.00
United HealthCare,PPO,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,Case Rate,5138.00
United HealthCare,PPO,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,Grouper Rate,1370.00
United HealthCare,PPO,55899,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,Grouper Rate,5138.00
United HealthCare,PPO,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,Grouper Rate,1214.00
United HealthCare,PPO,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,Grouper Rate,1214.00
United HealthCare,PPO,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,Grouper Rate,4204.00
United HealthCare,PPO,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,Grouper Rate,4204.00
United HealthCare,PPO,56442,CPT4/HCPCS,HYMENOTOMY,,Grouper Rate,4204.00
United HealthCare,PPO,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,Grouper Rate,1370.00
United HealthCare,PPO,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,Grouper Rate,1370.00
United HealthCare,PPO,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,1308.00
United HealthCare,PPO,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,Grouper Rate,1214.00
United HealthCare,PPO,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,Grouper Rate,4204.00
United HealthCare,PPO,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,Grouper Rate,4204.00
United HealthCare,PPO,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,10119.00
United HealthCare,PPO,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,10119.00
United HealthCare,PPO,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,10119.00
United HealthCare,PPO,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,10119.00
United HealthCare,PPO,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,10119.00
United HealthCare,PPO,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,Grouper Rate,4204.00
United HealthCare,PPO,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,Grouper Rate,4204.00
United HealthCare,PPO,56800,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,4204.00
United HealthCare,PPO,56805,CPT4/HCPCS,REPAIR CLITORIS,,Grouper Rate,4204.00
United HealthCare,PPO,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,Grouper Rate,4204.00
United HealthCare,PPO,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,Grouper Rate,1214.00
United HealthCare,PPO,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,Grouper Rate,1214.00
United HealthCare,PPO,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,Grouper Rate,4204.00
United HealthCare,PPO,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,Grouper Rate,4204.00
United HealthCare,PPO,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,Grouper Rate,4204.00
United HealthCare,PPO,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,Grouper Rate,1370.00
United HealthCare,PPO,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,Grouper Rate,4204.00
United HealthCare,PPO,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,Grouper Rate,4204.00
United HealthCare,PPO,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,Grouper Rate,4204.00
United HealthCare,PPO,57100,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,1308.00
United HealthCare,PPO,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,Grouper Rate,4204.00
United HealthCare,PPO,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,Grouper Rate,4204.00
United HealthCare,PPO,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,Grouper Rate,4204.00
United HealthCare,PPO,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,Grouper Rate,4204.00
United HealthCare,PPO,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,Grouper Rate,1370.00
United HealthCare,PPO,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,Grouper Rate,5138.00
United HealthCare,PPO,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,Grouper Rate,1370.00
United HealthCare,PPO,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,Grouper Rate,5138.00
United HealthCare,PPO,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,4204.00
United HealthCare,PPO,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,Grouper Rate,4204.00
United HealthCare,PPO,57150,CPT4/HCPCS,TREAT VAGINA INFECTION,,Grouper Rate,1214.00
United HealthCare,PPO,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,Grouper Rate,1308.00
United HealthCare,PPO,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,57160,CPT4/HCPCS,INSERT PESSARY/OTHER DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,57170,CPT4/HCPCS,FITTING OF DIAPHRAGM/CAP,,Grouper Rate,1214.00
United HealthCare,PPO,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,Grouper Rate,1214.00
United HealthCare,PPO,57200,CPT4/HCPCS,REPAIR OF VAGINA,,Grouper Rate,4204.00
United HealthCare,PPO,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,Grouper Rate,4204.00
United HealthCare,PPO,57220,CPT4/HCPCS,REVISION OF URETHRA,,Grouper Rate,6075.00
United HealthCare,PPO,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,Grouper Rate,4204.00
United HealthCare,PPO,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,Grouper Rate,5138.00
United HealthCare,PPO,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,Grouper Rate,5138.00
United HealthCare,PPO,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,Grouper Rate,5138.00
United HealthCare,PPO,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,Grouper Rate,6075.00
United HealthCare,PPO,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,Grouper Rate,1214.00
United HealthCare,PPO,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,Grouper Rate,4204.00
United HealthCare,PPO,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,Grouper Rate,4204.00
United HealthCare,PPO,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,Grouper Rate,4204.00
United HealthCare,PPO,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,Grouper Rate,6075.00
United HealthCare,PPO,57283,CPT4/HCPCS,COLPOPEXY INTRAPERITONEAL,,Grouper Rate,6075.00
United HealthCare,PPO,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,Grouper Rate,6075.00
United HealthCare,PPO,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,Grouper Rate,6075.00
United HealthCare,PPO,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,Grouper Rate,5138.00
United HealthCare,PPO,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,Grouper Rate,6075.00
United HealthCare,PPO,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,Grouper Rate,5138.00
United HealthCare,PPO,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,Grouper Rate,4204.00
United HealthCare,PPO,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,Grouper Rate,5138.00
United HealthCare,PPO,57295,CPT4/HCPCS,REVISE VAG GRAFT VIA VAGINA,,Grouper Rate,4204.00
United HealthCare,PPO,57296,CPT4/HCPCS,REVISE VAG GRAFT OPEN ABD,,Grouper Rate,1370.00
United HealthCare,PPO,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,4204.00
United HealthCare,PPO,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,Grouper Rate,4204.00
United HealthCare,PPO,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,6075.00
United HealthCare,PPO,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,Grouper Rate,5138.00
United HealthCare,PPO,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,5138.00
United HealthCare,PPO,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,Grouper Rate,5138.00
United HealthCare,PPO,57335,CPT4/HCPCS,REPAIR VAGINA,,Grouper Rate,4204.00
United HealthCare,PPO,57400,CPT4/HCPCS,DILATION OF VAGINA,,Grouper Rate,4204.00
United HealthCare,PPO,57410,CPT4/HCPCS,PELVIC EXAMINATION,,Grouper Rate,4204.00
United HealthCare,PPO,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,Grouper Rate,4204.00
United HealthCare,PPO,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,Grouper Rate,1214.00
United HealthCare,PPO,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,Grouper Rate,1308.00
United HealthCare,PPO,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,Grouper Rate,7007.00
United HealthCare,PPO,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,Grouper Rate,7007.00
United HealthCare,PPO,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,Grouper Rate,5138.00
United HealthCare,PPO,57452,CPT4/HCPCS,EXAM OF CERVIX W/SCOPE,,Grouper Rate,1214.00
United HealthCare,PPO,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,Grouper Rate,1214.00
United HealthCare,PPO,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,Grouper Rate,1214.00
United HealthCare,PPO,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,Grouper Rate,1214.00
United HealthCare,PPO,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,Grouper Rate,4204.00
United HealthCare,PPO,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,Grouper Rate,4204.00
United HealthCare,PPO,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,Grouper Rate,1308.00
United HealthCare,PPO,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,Grouper Rate,1308.00
United HealthCare,PPO,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,Grouper Rate,4204.00
United HealthCare,PPO,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,Grouper Rate,1214.00
United HealthCare,PPO,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,Grouper Rate,4204.00
United HealthCare,PPO,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,4204.00
United HealthCare,PPO,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,Grouper Rate,4204.00
United HealthCare,PPO,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,Grouper Rate,4204.00
United HealthCare,PPO,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,Grouper Rate,1370.00
United HealthCare,PPO,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,1370.00
United HealthCare,PPO,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,Grouper Rate,1370.00
United HealthCare,PPO,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,Grouper Rate,4204.00
United HealthCare,PPO,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,Grouper Rate,5138.00
United HealthCare,PPO,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,Grouper Rate,6075.00
United HealthCare,PPO,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,Grouper Rate,4204.00
United HealthCare,PPO,57700,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,4204.00
United HealthCare,PPO,57720,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,4204.00
United HealthCare,PPO,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,Grouper Rate,4204.00
United HealthCare,PPO,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,Grouper Rate,1214.00
United HealthCare,PPO,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,Grouper Rate,4204.00
United HealthCare,PPO,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,Grouper Rate,5138.00
United HealthCare,PPO,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,Grouper Rate,4204.00
United HealthCare,PPO,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,Grouper Rate,5138.00
United HealthCare,PPO,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,Grouper Rate,1370.00
United HealthCare,PPO,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,Grouper Rate,5138.00
United HealthCare,PPO,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,Grouper Rate,5138.00
United HealthCare,PPO,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,Grouper Rate,5138.00
United HealthCare,PPO,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,Grouper Rate,5138.00
United HealthCare,PPO,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,Grouper Rate,5138.00
United HealthCare,PPO,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Grouper Rate,5138.00
United HealthCare,PPO,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,Grouper Rate,5138.00
United HealthCare,PPO,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,58290,CPT4/HCPCS,VAG HYST COMPLEX,,Grouper Rate,6075.00
United HealthCare,PPO,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,Grouper Rate,6075.00
United HealthCare,PPO,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,Grouper Rate,6075.00
United HealthCare,PPO,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,Grouper Rate,5138.00
United HealthCare,PPO,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,Grouper Rate,6075.00
United HealthCare,PPO,58300,CPT4/HCPCS,INSERT INTRAUTERINE DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,58301,CPT4/HCPCS,REMOVE INTRAUTERINE DEVICE,,Grouper Rate,1214.00
United HealthCare,PPO,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Grouper Rate,1214.00
United HealthCare,PPO,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,Grouper Rate,1214.00
United HealthCare,PPO,58323,CPT4/HCPCS,SPERM WASHING,,Grouper Rate,1214.00
United HealthCare,PPO,58340,CPT4/HCPCS,CATHETER FOR HYSTEROGRAPHY,,Grouper Rate,1214.00
United HealthCare,PPO,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,4204.00
United HealthCare,PPO,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,Grouper Rate,4204.00
United HealthCare,PPO,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,Grouper Rate,5138.00
United HealthCare,PPO,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,Grouper Rate,5138.00
United HealthCare,PPO,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,Grouper Rate,6075.00
United HealthCare,PPO,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,1370.00
United HealthCare,PPO,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,Grouper Rate,1370.00
United HealthCare,PPO,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,Grouper Rate,1370.00
United HealthCare,PPO,58540,CPT4/HCPCS,REVISION OF UTERUS,,Grouper Rate,1370.00
United HealthCare,PPO,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,Grouper Rate,7007.00
United HealthCare,PPO,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,Grouper Rate,7007.00
United HealthCare,PPO,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,Grouper Rate,7007.00
United HealthCare,PPO,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,Grouper Rate,7007.00
United HealthCare,PPO,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,Grouper Rate,6075.00
United HealthCare,PPO,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,Grouper Rate,7007.00
United HealthCare,PPO,58548,CPT4/HCPCS,LAP RADICAL HYST,,Grouper Rate,6075.00
United HealthCare,PPO,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,Grouper Rate,7007.00
United HealthCare,PPO,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,Grouper Rate,7007.00
United HealthCare,PPO,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,Grouper Rate,7007.00
United HealthCare,PPO,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,Grouper Rate,4204.00
United HealthCare,PPO,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,Grouper Rate,4204.00
United HealthCare,PPO,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,Grouper Rate,4204.00
United HealthCare,PPO,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,Grouper Rate,5138.00
United HealthCare,PPO,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,Grouper Rate,5138.00
United HealthCare,PPO,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,Grouper Rate,4204.00
United HealthCare,PPO,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,Grouper Rate,5138.00
United HealthCare,PPO,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,Grouper Rate,6075.00
United HealthCare,PPO,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,Grouper Rate,7007.00
United HealthCare,PPO,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,Grouper Rate,7007.00
United HealthCare,PPO,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,Grouper Rate,7007.00
United HealthCare,PPO,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,Grouper Rate,7007.00
United HealthCare,PPO,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,Grouper Rate,1370.00
United HealthCare,PPO,58578,CPT4/HCPCS,LAPARO PROC UTERUS,,Grouper Rate,6075.00
United HealthCare,PPO,58579,CPT4/HCPCS,HYSTEROSCOPE PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,4204.00
United HealthCare,PPO,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,Grouper Rate,1370.00
United HealthCare,PPO,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,Grouper Rate,4204.00
United HealthCare,PPO,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,Grouper Rate,7007.00
United HealthCare,PPO,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,Grouper Rate,7007.00
United HealthCare,PPO,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,Grouper Rate,7007.00
United HealthCare,PPO,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,Grouper Rate,7007.00
United HealthCare,PPO,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,Grouper Rate,7007.00
United HealthCare,PPO,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,Grouper Rate,7007.00
United HealthCare,PPO,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,Grouper Rate,7007.00
United HealthCare,PPO,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,Grouper Rate,7007.00
United HealthCare,PPO,58679,CPT4/HCPCS,LAPARO PROC OVIDUCT-OVARY,,Grouper Rate,6075.00
United HealthCare,PPO,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,Grouper Rate,5138.00
United HealthCare,PPO,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,Grouper Rate,6075.00
United HealthCare,PPO,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,Grouper Rate,4204.00
United HealthCare,PPO,58750,CPT4/HCPCS,REPAIR OVIDUCT,,Grouper Rate,5138.00
United HealthCare,PPO,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,Grouper Rate,5138.00
United HealthCare,PPO,58760,CPT4/HCPCS,FIMBRIOPLASTY,,Grouper Rate,5138.00
United HealthCare,PPO,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,Grouper Rate,4204.00
United HealthCare,PPO,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,4204.00
United HealthCare,PPO,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,Grouper Rate,4204.00
United HealthCare,PPO,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,Grouper Rate,4204.00
United HealthCare,PPO,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,Grouper Rate,5138.00
United HealthCare,PPO,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,Grouper Rate,5138.00
United HealthCare,PPO,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,Grouper Rate,4204.00
United HealthCare,PPO,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,Grouper Rate,5138.00
United HealthCare,PPO,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,Grouper Rate,5138.00
United HealthCare,PPO,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,5138.00
United HealthCare,PPO,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,Grouper Rate,5138.00
United HealthCare,PPO,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,5138.00
United HealthCare,PPO,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,1370.00
United HealthCare,PPO,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,Grouper Rate,1370.00
United HealthCare,PPO,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,Grouper Rate,1370.00
United HealthCare,PPO,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,Grouper Rate,1370.00
United HealthCare,PPO,58956,CPT4/HCPCS,BSO OMENTECTOMY W/TAH,,Grouper Rate,1370.00
United HealthCare,PPO,58957,CPT4/HCPCS,RESECT RECURRENT GYN MAL,,Grouper Rate,1370.00
United HealthCare,PPO,58958,CPT4/HCPCS,RESECT RECUR GYN MAL W/LYM,,Grouper Rate,1370.00
United HealthCare,PPO,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,Grouper Rate,7007.00
United HealthCare,PPO,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,Grouper Rate,1308.00
United HealthCare,PPO,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,1308.00
United HealthCare,PPO,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,Grouper Rate,1214.00
United HealthCare,PPO,58999,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,Grouper Rate,1308.00
United HealthCare,PPO,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,Grouper Rate,1214.00
United HealthCare,PPO,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,Grouper Rate,1214.00
United HealthCare,PPO,59015,CPT4/HCPCS,CHORION BIOPSY,,Grouper Rate,1308.00
United HealthCare,PPO,59020,CPT4/HCPCS,FETAL CONTRACT STRESS TEST,,Grouper Rate,1214.00
United HealthCare,PPO,59025,CPT4/HCPCS,FETAL NON-STRESS TEST,,Grouper Rate,1214.00
United HealthCare,PPO,59030,CPT4/HCPCS,FETAL SCALP BLOOD SAMPLE,,Grouper Rate,1214.00
United HealthCare,PPO,59050,CPT4/HCPCS,FETAL MONITOR W/REPORT,,Grouper Rate,1214.00
United HealthCare,PPO,59051,CPT4/HCPCS,FETAL MONITOR/INTERPRET ONLY,,Grouper Rate,1370.00
United HealthCare,PPO,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,Grouper Rate,1214.00
United HealthCare,PPO,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,Grouper Rate,1214.00
United HealthCare,PPO,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,Grouper Rate,1214.00
United HealthCare,PPO,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,Grouper Rate,1214.00
United HealthCare,PPO,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,Grouper Rate,4204.00
United HealthCare,PPO,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5138.00
United HealthCare,PPO,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,5138.00
United HealthCare,PPO,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1370.00
United HealthCare,PPO,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1370.00
United HealthCare,PPO,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1370.00
United HealthCare,PPO,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,1370.00
United HealthCare,PPO,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,7007.00
United HealthCare,PPO,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,Grouper Rate,7007.00
United HealthCare,PPO,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,Grouper Rate,4204.00
United HealthCare,PPO,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,Grouper Rate,1214.00
United HealthCare,PPO,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,Grouper Rate,4204.00
United HealthCare,PPO,59320,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,4204.00
United HealthCare,PPO,59325,CPT4/HCPCS,REVISION OF CERVIX,,Grouper Rate,1370.00
United HealthCare,PPO,59409,CPT4/HCPCS,OBSTETRICAL CARE,,Grouper Rate,4204.00
United HealthCare,PPO,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,Grouper Rate,4204.00
United HealthCare,PPO,59414,CPT4/HCPCS,DELIVER PLACENTA,,Grouper Rate,4204.00
United HealthCare,PPO,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,Grouper Rate,4204.00
United HealthCare,PPO,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,4204.00
United HealthCare,PPO,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,Grouper Rate,4204.00
United HealthCare,PPO,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,Grouper Rate,4204.00
United HealthCare,PPO,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,Grouper Rate,1370.00
United HealthCare,PPO,59840,CPT4/HCPCS,ABORTION,,Grouper Rate,4204.00
United HealthCare,PPO,59841,CPT4/HCPCS,ABORTION,,Grouper Rate,4204.00
United HealthCare,PPO,59850,CPT4/HCPCS,ABORTION,,Grouper Rate,1370.00
United HealthCare,PPO,59851,CPT4/HCPCS,ABORTION,,Grouper Rate,1370.00
United HealthCare,PPO,59852,CPT4/HCPCS,ABORTION,,Grouper Rate,1370.00
United HealthCare,PPO,59855,CPT4/HCPCS,ABORTION,,Grouper Rate,1370.00
United HealthCare,PPO,59856,CPT4/HCPCS,ABORTION,,Grouper Rate,1370.00
United HealthCare,PPO,59857,CPT4/HCPCS,ABORTION,,Grouper Rate,1370.00
United HealthCare,PPO,59866,CPT4/HCPCS,ABORTION (MPR),,Grouper Rate,1214.00
United HealthCare,PPO,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,Grouper Rate,4204.00
United HealthCare,PPO,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,Grouper Rate,5138.00
United HealthCare,PPO,59897,CPT4/HCPCS,FETAL INVAS PX W/US,,Grouper Rate,1214.00
United HealthCare,PPO,59898,CPT4/HCPCS,LAPARO PROC OB CARE/DELIVER,,Grouper Rate,6075.00
United HealthCare,PPO,59899,CPT4/HCPCS,MATERNITY CARE PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,Grouper Rate,1370.00
United HealthCare,PPO,60100,CPT4/HCPCS,BIOPSY OF THYROID,,Grouper Rate,1308.00
United HealthCare,PPO,60200,CPT4/HCPCS,REMOVE THYROID LESION,,Grouper Rate,7007.00
United HealthCare,PPO,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,7007.00
United HealthCare,PPO,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,Grouper Rate,7007.00
United HealthCare,PPO,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,7007.00
United HealthCare,PPO,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,Grouper Rate,7007.00
United HealthCare,PPO,60240,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,7007.00
United HealthCare,PPO,60252,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,6075.00
United HealthCare,PPO,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,Grouper Rate,6075.00
United HealthCare,PPO,60270,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,1370.00
United HealthCare,PPO,60271,CPT4/HCPCS,REMOVAL OF THYROID,,Grouper Rate,6075.00
United HealthCare,PPO,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,7007.00
United HealthCare,PPO,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,Grouper Rate,7007.00
United HealthCare,PPO,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,Grouper Rate,1308.00
United HealthCare,PPO,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,6075.00
United HealthCare,PPO,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,Grouper Rate,6075.00
United HealthCare,PPO,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,Grouper Rate,1370.00
United HealthCare,PPO,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,Grouper Rate,1214.00
United HealthCare,PPO,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,6075.00
United HealthCare,PPO,60521,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,1370.00
United HealthCare,PPO,60522,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,Grouper Rate,1370.00
United HealthCare,PPO,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,1370.00
United HealthCare,PPO,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,Grouper Rate,1370.00
United HealthCare,PPO,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Grouper Rate,1370.00
United HealthCare,PPO,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,Grouper Rate,1370.00
United HealthCare,PPO,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,Grouper Rate,6075.00
United HealthCare,PPO,60659,CPT4/HCPCS,LAPARO PROC ENDOCRINE,,Grouper Rate,6075.00
United HealthCare,PPO,60699,CPT4/HCPCS,ENDOCRINE SURGERY PROCEDURE,,Grouper Rate,7007.00
United HealthCare,PPO,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,1308.00
United HealthCare,PPO,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,Grouper Rate,1308.00
United HealthCare,PPO,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,Grouper Rate,1308.00
United HealthCare,PPO,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,1308.00
United HealthCare,PPO,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,Grouper Rate,1214.00
United HealthCare,PPO,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,Grouper Rate,1214.00
United HealthCare,PPO,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,Grouper Rate,1308.00
United HealthCare,PPO,61105,CPT4/HCPCS,TWIST DRILL HOLE,,Grouper Rate,1370.00
United HealthCare,PPO,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,Grouper Rate,1370.00
United HealthCare,PPO,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,Grouper Rate,1370.00
United HealthCare,PPO,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,Grouper Rate,1370.00
United HealthCare,PPO,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,Grouper Rate,1370.00
United HealthCare,PPO,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,Grouper Rate,6075.00
United HealthCare,PPO,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Grouper Rate,1370.00
United HealthCare,PPO,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,Grouper Rate,1370.00
United HealthCare,PPO,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Grouper Rate,1370.00
United HealthCare,PPO,61305,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,Grouper Rate,1370.00
United HealthCare,PPO,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,61314,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,61315,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,Grouper Rate,1370.00
United HealthCare,PPO,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,61321,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,Grouper Rate,1370.00
United HealthCare,PPO,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,Grouper Rate,1370.00
United HealthCare,PPO,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,Grouper Rate,6075.00
United HealthCare,PPO,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,Grouper Rate,1370.00
United HealthCare,PPO,61343,CPT4/HCPCS,INCISE SKULL (PRESS RELIEF),,Grouper Rate,1370.00
United HealthCare,PPO,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,Grouper Rate,1370.00
United HealthCare,PPO,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,Grouper Rate,7007.00
United HealthCare,PPO,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,Grouper Rate,1370.00
United HealthCare,PPO,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,Grouper Rate,1370.00
United HealthCare,PPO,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,1370.00
United HealthCare,PPO,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,1370.00
United HealthCare,PPO,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,Grouper Rate,1370.00
United HealthCare,PPO,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Grouper Rate,1370.00
United HealthCare,PPO,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,Grouper Rate,1370.00
United HealthCare,PPO,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Grouper Rate,1370.00
United HealthCare,PPO,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,Grouper Rate,1370.00
United HealthCare,PPO,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,Grouper Rate,1370.00
United HealthCare,PPO,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,Grouper Rate,1370.00
United HealthCare,PPO,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Grouper Rate,1370.00
United HealthCare,PPO,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,Grouper Rate,1370.00
United HealthCare,PPO,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,Grouper Rate,1370.00
United HealthCare,PPO,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,Grouper Rate,1370.00
United HealthCare,PPO,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,Grouper Rate,1370.00
United HealthCare,PPO,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,Grouper Rate,1370.00
United HealthCare,PPO,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,Grouper Rate,1370.00
United HealthCare,PPO,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,Grouper Rate,1370.00
United HealthCare,PPO,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,61618,CPT4/HCPCS,REPAIR DURA,,Grouper Rate,1370.00
United HealthCare,PPO,61619,CPT4/HCPCS,REPAIR DURA,,Grouper Rate,1370.00
United HealthCare,PPO,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,Grouper Rate,10119.00
United HealthCare,PPO,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,Grouper Rate,1370.00
United HealthCare,PPO,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,Grouper Rate,10119.00
United HealthCare,PPO,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,Grouper Rate,1370.00
United HealthCare,PPO,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,Grouper Rate,1370.00
United HealthCare,PPO,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,Grouper Rate,1370.00
United HealthCare,PPO,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,Grouper Rate,1370.00
United HealthCare,PPO,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,Grouper Rate,1370.00
United HealthCare,PPO,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,Grouper Rate,1370.00
United HealthCare,PPO,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,Grouper Rate,1370.00
United HealthCare,PPO,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,Grouper Rate,1370.00
United HealthCare,PPO,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Grouper Rate,1370.00
United HealthCare,PPO,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,Grouper Rate,1370.00
United HealthCare,PPO,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,Grouper Rate,1370.00
United HealthCare,PPO,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,Grouper Rate,1370.00
United HealthCare,PPO,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,1370.00
United HealthCare,PPO,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,1370.00
United HealthCare,PPO,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,Grouper Rate,1370.00
United HealthCare,PPO,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,Grouper Rate,1370.00
United HealthCare,PPO,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Grouper Rate,6075.00
United HealthCare,PPO,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,Grouper Rate,1370.00
United HealthCare,PPO,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,Grouper Rate,1370.00
United HealthCare,PPO,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,Grouper Rate,1370.00
United HealthCare,PPO,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,Grouper Rate,6075.00
United HealthCare,PPO,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,Grouper Rate,1214.00
United HealthCare,PPO,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,Grouper Rate,1214.00
United HealthCare,PPO,61783,CPT4/HCPCS,SCAN PROC SPINAL,,Grouper Rate,1214.00
United HealthCare,PPO,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,Grouper Rate,4204.00
United HealthCare,PPO,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,Grouper Rate,7007.00
United HealthCare,PPO,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,Grouper Rate,7007.00
United HealthCare,PPO,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1370.00
United HealthCare,PPO,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1370.00
United HealthCare,PPO,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Grouper Rate,1370.00
United HealthCare,PPO,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,Grouper Rate,1370.00
United HealthCare,PPO,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,1370.00
United HealthCare,PPO,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,5138.00
United HealthCare,PPO,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,Grouper Rate,14317.00
United HealthCare,PPO,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,Grouper Rate,24180.00
United HealthCare,PPO,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,5138.00
United HealthCare,PPO,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,Grouper Rate,6075.00
United HealthCare,PPO,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,Grouper Rate,1370.00
United HealthCare,PPO,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,Grouper Rate,1370.00
United HealthCare,PPO,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,Grouper Rate,1370.00
United HealthCare,PPO,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,Grouper Rate,1370.00
United HealthCare,PPO,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,Grouper Rate,1370.00
United HealthCare,PPO,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,Grouper Rate,1370.00
United HealthCare,PPO,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,Grouper Rate,1370.00
United HealthCare,PPO,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,Grouper Rate,1370.00
United HealthCare,PPO,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,Grouper Rate,1370.00
United HealthCare,PPO,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,Grouper Rate,1370.00
United HealthCare,PPO,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,Grouper Rate,1370.00
United HealthCare,PPO,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,Grouper Rate,1370.00
United HealthCare,PPO,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,Grouper Rate,1370.00
United HealthCare,PPO,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,Grouper Rate,1370.00
United HealthCare,PPO,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,Grouper Rate,1370.00
United HealthCare,PPO,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,4204.00
United HealthCare,PPO,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,Grouper Rate,1370.00
United HealthCare,PPO,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,Grouper Rate,1370.00
United HealthCare,PPO,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,Grouper Rate,6075.00
United HealthCare,PPO,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,Grouper Rate,1214.00
United HealthCare,PPO,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,Grouper Rate,1308.00
United HealthCare,PPO,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,Grouper Rate,1308.00
United HealthCare,PPO,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,Grouper Rate,1308.00
United HealthCare,PPO,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,Grouper Rate,1308.00
United HealthCare,PPO,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,Grouper Rate,1370.00
United HealthCare,PPO,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,Grouper Rate,1308.00
United HealthCare,PPO,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,Grouper Rate,1308.00
United HealthCare,PPO,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,Grouper Rate,1308.00
United HealthCare,PPO,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,1308.00
United HealthCare,PPO,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,Grouper Rate,1308.00
United HealthCare,PPO,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,Grouper Rate,1308.00
United HealthCare,PPO,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,Grouper Rate,1214.00
United HealthCare,PPO,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,Grouper Rate,5138.00
United HealthCare,PPO,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,Grouper Rate,1214.00
United HealthCare,PPO,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,Grouper Rate,1214.00
United HealthCare,PPO,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,Grouper Rate,4204.00
United HealthCare,PPO,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,Grouper Rate,1308.00
United HealthCare,PPO,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1308.00
United HealthCare,PPO,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1308.00
United HealthCare,PPO,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1308.00
United HealthCare,PPO,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,Grouper Rate,1308.00
United HealthCare,PPO,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1308.00
United HealthCare,PPO,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1308.00
United HealthCare,PPO,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1308.00
United HealthCare,PPO,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1308.00
United HealthCare,PPO,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1308.00
United HealthCare,PPO,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,Grouper Rate,1308.00
United HealthCare,PPO,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1308.00
United HealthCare,PPO,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,Grouper Rate,1308.00
United HealthCare,PPO,62328,CPT4/HCPCS,DX LMBR SPI PNXR W/FLUOR/CT,,Grouper Rate,1308.00
United HealthCare,PPO,62329,CPT4/HCPCS,THER SPI PNXR CSF FLUOR/CT,,Grouper Rate,1308.00
United HealthCare,PPO,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,6075.00
United HealthCare,PPO,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,Grouper Rate,7007.00
United HealthCare,PPO,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,Grouper Rate,4204.00
United HealthCare,PPO,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,Grouper Rate,6075.00
United HealthCare,PPO,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,14317.00
United HealthCare,PPO,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,Grouper Rate,14317.00
United HealthCare,PPO,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,Grouper Rate,7007.00
United HealthCare,PPO,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,Grouper Rate,1214.00
United HealthCare,PPO,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,Grouper Rate,1214.00
United HealthCare,PPO,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,Grouper Rate,1214.00
United HealthCare,PPO,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,Grouper Rate,1214.00
United HealthCare,PPO,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,Grouper Rate,7007.00
United HealthCare,PPO,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,Grouper Rate,7007.00
United HealthCare,PPO,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,Grouper Rate,7007.00
United HealthCare,PPO,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,Grouper Rate,7007.00
United HealthCare,PPO,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,Grouper Rate,7007.00
United HealthCare,PPO,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,Grouper Rate,7007.00
United HealthCare,PPO,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,Grouper Rate,7007.00
United HealthCare,PPO,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,Grouper Rate,7007.00
United HealthCare,PPO,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,Grouper Rate,7007.00
United HealthCare,PPO,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,Grouper Rate,7007.00
United HealthCare,PPO,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,Grouper Rate,7007.00
United HealthCare,PPO,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,Grouper Rate,5138.00
United HealthCare,PPO,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,Grouper Rate,5138.00
United HealthCare,PPO,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,Grouper Rate,7007.00
United HealthCare,PPO,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,Grouper Rate,7007.00
United HealthCare,PPO,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,Grouper Rate,7007.00
United HealthCare,PPO,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,Grouper Rate,1370.00
United HealthCare,PPO,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,Grouper Rate,1370.00
United HealthCare,PPO,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,7007.00
United HealthCare,PPO,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,Grouper Rate,7007.00
United HealthCare,PPO,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,Grouper Rate,7007.00
United HealthCare,PPO,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,7007.00
United HealthCare,PPO,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Grouper Rate,1370.00
United HealthCare,PPO,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,Grouper Rate,1370.00
United HealthCare,PPO,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,Grouper Rate,7007.00
United HealthCare,PPO,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,Grouper Rate,1370.00
United HealthCare,PPO,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Grouper Rate,1370.00
United HealthCare,PPO,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,Grouper Rate,1370.00
United HealthCare,PPO,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,Grouper Rate,1370.00
United HealthCare,PPO,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Grouper Rate,1370.00
United HealthCare,PPO,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,Grouper Rate,1370.00
United HealthCare,PPO,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Grouper Rate,1370.00
United HealthCare,PPO,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,Grouper Rate,1370.00
United HealthCare,PPO,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,Grouper Rate,10119.00
United HealthCare,PPO,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,Grouper Rate,10119.00
United HealthCare,PPO,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,Grouper Rate,10119.00
United HealthCare,PPO,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,Grouper Rate,1370.00
United HealthCare,PPO,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,Grouper Rate,1370.00
United HealthCare,PPO,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,Grouper Rate,1370.00
United HealthCare,PPO,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,Grouper Rate,1370.00
United HealthCare,PPO,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,Grouper Rate,10119.00
United HealthCare,PPO,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,Grouper Rate,1370.00
United HealthCare,PPO,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,Grouper Rate,10119.00
United HealthCare,PPO,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,Grouper Rate,7007.00
United HealthCare,PPO,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Grouper Rate,7007.00
United HealthCare,PPO,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Grouper Rate,4204.00
United HealthCare,PPO,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Grouper Rate,7007.00
United HealthCare,PPO,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,Grouper Rate,1370.00
United HealthCare,PPO,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,Grouper Rate,10119.00
United HealthCare,PPO,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,Grouper Rate,1370.00
United HealthCare,PPO,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,Grouper Rate,1370.00
United HealthCare,PPO,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,Grouper Rate,10119.00
United HealthCare,PPO,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,Grouper Rate,1370.00
United HealthCare,PPO,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,Grouper Rate,1370.00
United HealthCare,PPO,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,Grouper Rate,10119.00
United HealthCare,PPO,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,Grouper Rate,1370.00
United HealthCare,PPO,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,Grouper Rate,1370.00
United HealthCare,PPO,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,Grouper Rate,10119.00
United HealthCare,PPO,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,Grouper Rate,10119.00
United HealthCare,PPO,63295,CPT4/HCPCS,REPAIR LAMINECTOMY DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,Grouper Rate,1370.00
United HealthCare,PPO,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,Grouper Rate,1370.00
United HealthCare,PPO,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,Grouper Rate,1370.00
United HealthCare,PPO,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,Grouper Rate,1370.00
United HealthCare,PPO,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,Grouper Rate,1370.00
United HealthCare,PPO,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,Grouper Rate,1370.00
United HealthCare,PPO,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,Grouper Rate,1370.00
United HealthCare,PPO,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,Grouper Rate,1370.00
United HealthCare,PPO,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,Grouper Rate,4204.00
United HealthCare,PPO,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,Grouper Rate,1370.00
United HealthCare,PPO,63620,CPT4/HCPCS,SRS SPINAL LESION,,Grouper Rate,7007.00
United HealthCare,PPO,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,Grouper Rate,1370.00
United HealthCare,PPO,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,7007.00
United HealthCare,PPO,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,10119.00
United HealthCare,PPO,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,Grouper Rate,4204.00
United HealthCare,PPO,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,Grouper Rate,5138.00
United HealthCare,PPO,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,Grouper Rate,7007.00
United HealthCare,PPO,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,Grouper Rate,7007.00
United HealthCare,PPO,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,Grouper Rate,14317.00
United HealthCare,PPO,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,Grouper Rate,5138.00
United HealthCare,PPO,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,1370.00
United HealthCare,PPO,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,1370.00
United HealthCare,PPO,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,1370.00
United HealthCare,PPO,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,Grouper Rate,1370.00
United HealthCare,PPO,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Grouper Rate,1370.00
United HealthCare,PPO,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,Grouper Rate,1370.00
United HealthCare,PPO,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,Grouper Rate,1370.00
United HealthCare,PPO,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,1370.00
United HealthCare,PPO,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,Grouper Rate,6075.00
United HealthCare,PPO,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,Grouper Rate,6075.00
United HealthCare,PPO,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,Grouper Rate,4204.00
United HealthCare,PPO,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,Grouper Rate,1214.00
United HealthCare,PPO,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,Grouper Rate,1214.00
United HealthCare,PPO,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,Grouper Rate,1214.00
United HealthCare,PPO,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,Grouper Rate,1308.00
United HealthCare,PPO,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,Grouper Rate,1308.00
United HealthCare,PPO,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,Grouper Rate,1308.00
United HealthCare,PPO,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,Grouper Rate,1308.00
United HealthCare,PPO,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,Grouper Rate,1308.00
United HealthCare,PPO,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,Grouper Rate,1308.00
United HealthCare,PPO,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,Grouper Rate,1308.00
United HealthCare,PPO,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,Grouper Rate,1308.00
United HealthCare,PPO,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,Grouper Rate,1308.00
United HealthCare,PPO,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,Grouper Rate,1308.00
United HealthCare,PPO,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,Grouper Rate,1308.00
United HealthCare,PPO,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,Grouper Rate,1308.00
United HealthCare,PPO,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,Grouper Rate,1308.00
United HealthCare,PPO,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,Grouper Rate,1308.00
United HealthCare,PPO,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,Grouper Rate,1308.00
United HealthCare,PPO,64451,CPT4/HCPCS,NJX AA&/STRD NRV NRVTG SI JT,,Grouper Rate,1308.00
United HealthCare,PPO,64454,CPT4/HCPCS,NJX AA&/STRD GNCLR NRV BRNCH,,Grouper Rate,1308.00
United HealthCare,PPO,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,Grouper Rate,1214.00
United HealthCare,PPO,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,Grouper Rate,1308.00
United HealthCare,PPO,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,Grouper Rate,1214.00
United HealthCare,PPO,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,Grouper Rate,1308.00
United HealthCare,PPO,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,Grouper Rate,1308.00
United HealthCare,PPO,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,Grouper Rate,1214.00
United HealthCare,PPO,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,Grouper Rate,1308.00
United HealthCare,PPO,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,Grouper Rate,1214.00
United HealthCare,PPO,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,Grouper Rate,1214.00
United HealthCare,PPO,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,Grouper Rate,1214.00
United HealthCare,PPO,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,Grouper Rate,1214.00
United HealthCare,PPO,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,Grouper Rate,1214.00
United HealthCare,PPO,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,Grouper Rate,1308.00
United HealthCare,PPO,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,Grouper Rate,1214.00
United HealthCare,PPO,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,Grouper Rate,1214.00
United HealthCare,PPO,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,Grouper Rate,1308.00
United HealthCare,PPO,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,Grouper Rate,1214.00
United HealthCare,PPO,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,Grouper Rate,1214.00
United HealthCare,PPO,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,Grouper Rate,1214.00
United HealthCare,PPO,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,Grouper Rate,1308.00
United HealthCare,PPO,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,Grouper Rate,1308.00
United HealthCare,PPO,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,Grouper Rate,1308.00
United HealthCare,PPO,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,Grouper Rate,1308.00
United HealthCare,PPO,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,7007.00
United HealthCare,PPO,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,7007.00
United HealthCare,PPO,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,7007.00
United HealthCare,PPO,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,Grouper Rate,1214.00
United HealthCare,PPO,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,Grouper Rate,24180.00
United HealthCare,PPO,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,Grouper Rate,7007.00
United HealthCare,PPO,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,Grouper Rate,7007.00
United HealthCare,PPO,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,10119.00
United HealthCare,PPO,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,10119.00
United HealthCare,PPO,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,Grouper Rate,10119.00
United HealthCare,PPO,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,Grouper Rate,5138.00
United HealthCare,PPO,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,Grouper Rate,14317.00
United HealthCare,PPO,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,Grouper Rate,5138.00
United HealthCare,PPO,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1308.00
United HealthCare,PPO,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,Grouper Rate,1214.00
United HealthCare,PPO,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,Grouper Rate,1214.00
United HealthCare,PPO,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,Grouper Rate,1214.00
United HealthCare,PPO,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,Grouper Rate,1214.00
United HealthCare,PPO,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,Grouper Rate,1214.00
United HealthCare,PPO,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1308.00
United HealthCare,PPO,64624,CPT4/HCPCS,DSTRJ NULYT AGT GNCLR NRV,,Grouper Rate,4204.00
United HealthCare,PPO,64625,CPT4/HCPCS,RF ABLTJ NRV NRVTG SI JT,,Grouper Rate,4204.00
United HealthCare,PPO,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1308.00
United HealthCare,PPO,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,Grouper Rate,1214.00
United HealthCare,PPO,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,Grouper Rate,4204.00
United HealthCare,PPO,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,Grouper Rate,4204.00
United HealthCare,PPO,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1308.00
United HealthCare,PPO,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,Grouper Rate,1308.00
United HealthCare,PPO,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,Grouper Rate,1214.00
United HealthCare,PPO,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,Grouper Rate,1308.00
United HealthCare,PPO,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,Grouper Rate,1214.00
United HealthCare,PPO,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,Grouper Rate,1308.00
United HealthCare,PPO,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,Grouper Rate,1308.00
United HealthCare,PPO,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,1214.00
United HealthCare,PPO,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,Grouper Rate,1214.00
United HealthCare,PPO,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1308.00
United HealthCare,PPO,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,Grouper Rate,1308.00
United HealthCare,PPO,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,Grouper Rate,4204.00
United HealthCare,PPO,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,Grouper Rate,4204.00
United HealthCare,PPO,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,Grouper Rate,4204.00
United HealthCare,PPO,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,Grouper Rate,4204.00
United HealthCare,PPO,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,Grouper Rate,4204.00
United HealthCare,PPO,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,Grouper Rate,1214.00
United HealthCare,PPO,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,Grouper Rate,1370.00
United HealthCare,PPO,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,Grouper Rate,1370.00
United HealthCare,PPO,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,Grouper Rate,1370.00
United HealthCare,PPO,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,Grouper Rate,1370.00
United HealthCare,PPO,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,Grouper Rate,4204.00
United HealthCare,PPO,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,Grouper Rate,1370.00
United HealthCare,PPO,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,Grouper Rate,1370.00
United HealthCare,PPO,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,Grouper Rate,1370.00
United HealthCare,PPO,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Grouper Rate,1370.00
United HealthCare,PPO,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,Grouper Rate,5138.00
United HealthCare,PPO,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,64784,CPT4/HCPCS,REMOVE NERVE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,Grouper Rate,6075.00
United HealthCare,PPO,64787,CPT4/HCPCS,IMPLANT NERVE END,,Grouper Rate,1214.00
United HealthCare,PPO,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,Grouper Rate,6075.00
United HealthCare,PPO,64795,CPT4/HCPCS,BIOPSY OF NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,Grouper Rate,1370.00
United HealthCare,PPO,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,1370.00
United HealthCare,PPO,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,1370.00
United HealthCare,PPO,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,1370.00
United HealthCare,PPO,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,Grouper Rate,4204.00
United HealthCare,PPO,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,5138.00
United HealthCare,PPO,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,Grouper Rate,5138.00
United HealthCare,PPO,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,Grouper Rate,5138.00
United HealthCare,PPO,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,Grouper Rate,5138.00
United HealthCare,PPO,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,Grouper Rate,5138.00
United HealthCare,PPO,64859,CPT4/HCPCS,NERVE SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,Grouper Rate,5138.00
United HealthCare,PPO,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,Grouper Rate,6075.00
United HealthCare,PPO,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,1370.00
United HealthCare,PPO,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,Grouper Rate,1370.00
United HealthCare,PPO,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,Grouper Rate,1214.00
United HealthCare,PPO,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,Grouper Rate,1214.00
United HealthCare,PPO,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,Grouper Rate,6075.00
United HealthCare,PPO,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,Grouper Rate,6075.00
United HealthCare,PPO,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,6075.00
United HealthCare,PPO,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,6075.00
United HealthCare,PPO,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,Grouper Rate,6075.00
United HealthCare,PPO,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,6075.00
United HealthCare,PPO,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,Grouper Rate,6075.00
United HealthCare,PPO,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,Grouper Rate,6075.00
United HealthCare,PPO,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,Grouper Rate,6075.00
United HealthCare,PPO,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,Grouper Rate,6075.00
United HealthCare,PPO,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,6075.00
United HealthCare,PPO,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,Grouper Rate,6075.00
United HealthCare,PPO,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,Grouper Rate,6075.00
United HealthCare,PPO,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,Grouper Rate,1214.00
United HealthCare,PPO,64999,CPT4/HCPCS,NERVOUS SYSTEM SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,65091,CPT4/HCPCS,REVISE EYE,,Grouper Rate,5138.00
United HealthCare,PPO,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65101,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,5138.00
United HealthCare,PPO,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65110,CPT4/HCPCS,REMOVAL OF EYE,,Grouper Rate,5138.00
United HealthCare,PPO,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,5138.00
United HealthCare,PPO,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,Grouper Rate,5138.00
United HealthCare,PPO,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,4204.00
United HealthCare,PPO,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1214.00
United HealthCare,PPO,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1214.00
United HealthCare,PPO,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1214.00
United HealthCare,PPO,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1214.00
United HealthCare,PPO,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,4204.00
United HealthCare,PPO,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,1214.00
United HealthCare,PPO,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,Grouper Rate,4204.00
United HealthCare,PPO,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,4204.00
United HealthCare,PPO,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,4204.00
United HealthCare,PPO,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,5138.00
United HealthCare,PPO,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,4204.00
United HealthCare,PPO,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,4204.00
United HealthCare,PPO,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,Grouper Rate,1370.00
United HealthCare,PPO,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,Grouper Rate,5138.00
United HealthCare,PPO,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,1370.00
United HealthCare,PPO,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,Grouper Rate,1308.00
United HealthCare,PPO,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,65430,CPT4/HCPCS,CORNEAL SMEAR,,Grouper Rate,1214.00
United HealthCare,PPO,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,1370.00
United HealthCare,PPO,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,Grouper Rate,4204.00
United HealthCare,PPO,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,Grouper Rate,1214.00
United HealthCare,PPO,65600,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,4204.00
United HealthCare,PPO,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6075.00
United HealthCare,PPO,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6075.00
United HealthCare,PPO,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6075.00
United HealthCare,PPO,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,Grouper Rate,6075.00
United HealthCare,PPO,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,Grouper Rate,6075.00
United HealthCare,PPO,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,Grouper Rate,1214.00
United HealthCare,PPO,65760,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,4204.00
United HealthCare,PPO,65765,CPT4/HCPCS,REVISION OF CORNEA,,Grouper Rate,4204.00
United HealthCare,PPO,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,Grouper Rate,4204.00
United HealthCare,PPO,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,Grouper Rate,7007.00
United HealthCare,PPO,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,Grouper Rate,4204.00
United HealthCare,PPO,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,1370.00
United HealthCare,PPO,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,Grouper Rate,4204.00
United HealthCare,PPO,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,Grouper Rate,1370.00
United HealthCare,PPO,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,Grouper Rate,5138.00
United HealthCare,PPO,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,6075.00
United HealthCare,PPO,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,Grouper Rate,6075.00
United HealthCare,PPO,65800,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,1214.00
United HealthCare,PPO,65810,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,4204.00
United HealthCare,PPO,65815,CPT4/HCPCS,DRAINAGE OF EYE,,Grouper Rate,4204.00
United HealthCare,PPO,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,Grouper Rate,4204.00
United HealthCare,PPO,65850,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,4204.00
United HealthCare,PPO,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,Grouper Rate,1308.00
United HealthCare,PPO,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,1308.00
United HealthCare,PPO,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,4204.00
United HealthCare,PPO,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,4204.00
United HealthCare,PPO,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,4204.00
United HealthCare,PPO,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,Grouper Rate,4204.00
United HealthCare,PPO,65900,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,Grouper Rate,4204.00
United HealthCare,PPO,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,Grouper Rate,4204.00
United HealthCare,PPO,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,1370.00
United HealthCare,PPO,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,Grouper Rate,1370.00
United HealthCare,PPO,66130,CPT4/HCPCS,REMOVE EYE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,66172,CPT4/HCPCS,INCISION OF EYE,,Grouper Rate,4204.00
United HealthCare,PPO,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,Grouper Rate,6075.00
United HealthCare,PPO,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,Grouper Rate,6075.00
United HealthCare,PPO,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,Grouper Rate,6075.00
United HealthCare,PPO,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,Grouper Rate,6075.00
United HealthCare,PPO,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,Grouper Rate,4204.00
United HealthCare,PPO,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,Grouper Rate,4204.00
United HealthCare,PPO,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,Grouper Rate,4204.00
United HealthCare,PPO,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,Grouper Rate,4204.00
United HealthCare,PPO,66500,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,1214.00
United HealthCare,PPO,66505,CPT4/HCPCS,INCISION OF IRIS,,Grouper Rate,1370.00
United HealthCare,PPO,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,Grouper Rate,4204.00
United HealthCare,PPO,66605,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,6075.00
United HealthCare,PPO,66625,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,1370.00
United HealthCare,PPO,66630,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,1370.00
United HealthCare,PPO,66635,CPT4/HCPCS,REMOVAL OF IRIS,,Grouper Rate,4204.00
United HealthCare,PPO,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,4204.00
United HealthCare,PPO,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,Grouper Rate,4204.00
United HealthCare,PPO,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,1370.00
United HealthCare,PPO,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,Grouper Rate,4204.00
United HealthCare,PPO,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,Grouper Rate,4204.00
United HealthCare,PPO,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,4204.00
United HealthCare,PPO,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,Grouper Rate,4204.00
United HealthCare,PPO,66761,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,1308.00
United HealthCare,PPO,66762,CPT4/HCPCS,REVISION OF IRIS,,Grouper Rate,1308.00
United HealthCare,PPO,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,Grouper Rate,1308.00
United HealthCare,PPO,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,Grouper Rate,1214.00
United HealthCare,PPO,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,Grouper Rate,1308.00
United HealthCare,PPO,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,Grouper Rate,4204.00
United HealthCare,PPO,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,Grouper Rate,4204.00
United HealthCare,PPO,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,4204.00
United HealthCare,PPO,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,4204.00
United HealthCare,PPO,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,Grouper Rate,6075.00
United HealthCare,PPO,66920,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,4204.00
United HealthCare,PPO,66930,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,4204.00
United HealthCare,PPO,66940,CPT4/HCPCS,EXTRACTION OF LENS,,Grouper Rate,1370.00
United HealthCare,PPO,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,Grouper Rate,4204.00
United HealthCare,PPO,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,Grouper Rate,4204.00
United HealthCare,PPO,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,Grouper Rate,4204.00
United HealthCare,PPO,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,Grouper Rate,4204.00
United HealthCare,PPO,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,Grouper Rate,4204.00
United HealthCare,PPO,66987,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX W/ECP,,Grouper Rate,6075.00
United HealthCare,PPO,66988,CPT4/HCPCS,XCAPSL CTRC RMVL W/ECP,,Grouper Rate,6075.00
United HealthCare,PPO,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,66999,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,4204.00
United HealthCare,PPO,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,Grouper Rate,4204.00
United HealthCare,PPO,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,Grouper Rate,4204.00
United HealthCare,PPO,67025,CPT4/HCPCS,REPLACE EYE FLUID,,Grouper Rate,4204.00
United HealthCare,PPO,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,Grouper Rate,6075.00
United HealthCare,PPO,67028,CPT4/HCPCS,INJECTION EYE DRUG,,Grouper Rate,1214.00
United HealthCare,PPO,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,Grouper Rate,4204.00
United HealthCare,PPO,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,Grouper Rate,1308.00
United HealthCare,PPO,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,Grouper Rate,6075.00
United HealthCare,PPO,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,6075.00
United HealthCare,PPO,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,Grouper Rate,6075.00
United HealthCare,PPO,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,Grouper Rate,6075.00
United HealthCare,PPO,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,Grouper Rate,6075.00
United HealthCare,PPO,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,Grouper Rate,6075.00
United HealthCare,PPO,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,Grouper Rate,4204.00
United HealthCare,PPO,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,Grouper Rate,1308.00
United HealthCare,PPO,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,6075.00
United HealthCare,PPO,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,6075.00
United HealthCare,PPO,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,Grouper Rate,4204.00
United HealthCare,PPO,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,Grouper Rate,6075.00
United HealthCare,PPO,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,Grouper Rate,4204.00
United HealthCare,PPO,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,4204.00
United HealthCare,PPO,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,Grouper Rate,6075.00
United HealthCare,PPO,67141,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,1214.00
United HealthCare,PPO,67145,CPT4/HCPCS,TREATMENT OF RETINA,,Grouper Rate,1308.00
United HealthCare,PPO,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,1214.00
United HealthCare,PPO,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,1308.00
United HealthCare,PPO,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,Grouper Rate,5138.00
United HealthCare,PPO,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,Grouper Rate,1308.00
United HealthCare,PPO,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,Grouper Rate,1308.00
United HealthCare,PPO,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,Grouper Rate,5138.00
United HealthCare,PPO,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,Grouper Rate,1308.00
United HealthCare,PPO,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,Grouper Rate,1308.00
United HealthCare,PPO,67250,CPT4/HCPCS,REINFORCE EYE WALL,,Grouper Rate,4204.00
United HealthCare,PPO,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,Grouper Rate,4204.00
United HealthCare,PPO,67299,CPT4/HCPCS,EYE SURGERY PROCEDURE,,Grouper Rate,1370.00
United HealthCare,PPO,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,4204.00
United HealthCare,PPO,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,5138.00
United HealthCare,PPO,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,Grouper Rate,4204.00
United HealthCare,PPO,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,Grouper Rate,4204.00
United HealthCare,PPO,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,Grouper Rate,4204.00
United HealthCare,PPO,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,Grouper Rate,1214.00
United HealthCare,PPO,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,Grouper Rate,4204.00
United HealthCare,PPO,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,Grouper Rate,1214.00
United HealthCare,PPO,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,Grouper Rate,5138.00
United HealthCare,PPO,67399,CPT4/HCPCS,UNLISTED PX EXTRAOCULAR MUSC,,Grouper Rate,1214.00
United HealthCare,PPO,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,5138.00
United HealthCare,PPO,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,4204.00
United HealthCare,PPO,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,4204.00
United HealthCare,PPO,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,4204.00
United HealthCare,PPO,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,5138.00
United HealthCare,PPO,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,Grouper Rate,4204.00
United HealthCare,PPO,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5138.00
United HealthCare,PPO,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,Grouper Rate,5138.00
United HealthCare,PPO,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,Grouper Rate,5138.00
United HealthCare,PPO,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,Grouper Rate,5138.00
United HealthCare,PPO,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,Grouper Rate,5138.00
United HealthCare,PPO,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,1214.00
United HealthCare,PPO,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,1214.00
United HealthCare,PPO,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,Grouper Rate,1214.00
United HealthCare,PPO,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,Grouper Rate,5138.00
United HealthCare,PPO,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,Grouper Rate,5138.00
United HealthCare,PPO,67599,CPT4/HCPCS,ORBIT SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,Grouper Rate,1214.00
United HealthCare,PPO,67710,CPT4/HCPCS,INCISION OF EYELID,,Grouper Rate,1370.00
United HealthCare,PPO,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,Grouper Rate,4204.00
United HealthCare,PPO,67800,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,1214.00
United HealthCare,PPO,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,1370.00
United HealthCare,PPO,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,Grouper Rate,4204.00
United HealthCare,PPO,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,Grouper Rate,1214.00
United HealthCare,PPO,67820,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1214.00
United HealthCare,PPO,67825,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1214.00
United HealthCare,PPO,67830,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,1370.00
United HealthCare,PPO,67835,CPT4/HCPCS,REVISE EYELASHES,,Grouper Rate,4204.00
United HealthCare,PPO,67840,CPT4/HCPCS,REMOVE EYELID LESION,,Grouper Rate,1370.00
United HealthCare,PPO,67850,CPT4/HCPCS,TREAT EYELID LESION,,Grouper Rate,1370.00
United HealthCare,PPO,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,Grouper Rate,1370.00
United HealthCare,PPO,67880,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,4204.00
United HealthCare,PPO,67882,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,4204.00
United HealthCare,PPO,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5138.00
United HealthCare,PPO,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,5138.00
United HealthCare,PPO,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,Grouper Rate,4204.00
United HealthCare,PPO,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,Grouper Rate,4204.00
United HealthCare,PPO,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,4204.00
United HealthCare,PPO,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,Grouper Rate,4204.00
United HealthCare,PPO,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,Grouper Rate,1214.00
United HealthCare,PPO,67950,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,4204.00
United HealthCare,PPO,67961,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,4204.00
United HealthCare,PPO,67966,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,4204.00
United HealthCare,PPO,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,4204.00
United HealthCare,PPO,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,4204.00
United HealthCare,PPO,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,5138.00
United HealthCare,PPO,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,Grouper Rate,4204.00
United HealthCare,PPO,67999,CPT4/HCPCS,REVISION OF EYELID,,Grouper Rate,1214.00
United HealthCare,PPO,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,Grouper Rate,1370.00
United HealthCare,PPO,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,Grouper Rate,1214.00
United HealthCare,PPO,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,Grouper Rate,1308.00
United HealthCare,PPO,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,4204.00
United HealthCare,PPO,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,4204.00
United HealthCare,PPO,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,4204.00
United HealthCare,PPO,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,Grouper Rate,4204.00
United HealthCare,PPO,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,Grouper Rate,1214.00
United HealthCare,PPO,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,4204.00
United HealthCare,PPO,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5138.00
United HealthCare,PPO,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5138.00
United HealthCare,PPO,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,4204.00
United HealthCare,PPO,68330,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,4204.00
United HealthCare,PPO,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,Grouper Rate,5138.00
United HealthCare,PPO,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,Grouper Rate,4204.00
United HealthCare,PPO,68360,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,5138.00
United HealthCare,PPO,68362,CPT4/HCPCS,REVISE EYELID LINING,,Grouper Rate,4204.00
United HealthCare,PPO,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,Grouper Rate,4204.00
United HealthCare,PPO,68399,CPT4/HCPCS,EYELID LINING SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,Grouper Rate,1370.00
United HealthCare,PPO,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,Grouper Rate,1308.00
United HealthCare,PPO,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,Grouper Rate,1214.00
United HealthCare,PPO,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,Grouper Rate,5138.00
United HealthCare,PPO,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,Grouper Rate,5138.00
United HealthCare,PPO,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,Grouper Rate,4204.00
United HealthCare,PPO,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,Grouper Rate,5138.00
United HealthCare,PPO,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,Grouper Rate,4204.00
United HealthCare,PPO,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,Grouper Rate,1214.00
United HealthCare,PPO,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,4204.00
United HealthCare,PPO,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,Grouper Rate,5138.00
United HealthCare,PPO,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,Grouper Rate,4204.00
United HealthCare,PPO,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,Grouper Rate,1214.00
United HealthCare,PPO,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,Grouper Rate,5138.00
United HealthCare,PPO,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,5138.00
United HealthCare,PPO,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,Grouper Rate,5138.00
United HealthCare,PPO,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,1214.00
United HealthCare,PPO,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,Grouper Rate,1214.00
United HealthCare,PPO,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,Grouper Rate,1308.00
United HealthCare,PPO,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,Grouper Rate,1214.00
United HealthCare,PPO,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,1214.00
United HealthCare,PPO,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,4204.00
United HealthCare,PPO,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,Grouper Rate,4204.00
United HealthCare,PPO,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,Grouper Rate,4204.00
United HealthCare,PPO,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,Grouper Rate,1214.00
United HealthCare,PPO,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,Grouper Rate,1214.00
United HealthCare,PPO,68899,CPT4/HCPCS,TEAR DUCT SYSTEM SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,1308.00
United HealthCare,PPO,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,Grouper Rate,1370.00
United HealthCare,PPO,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,Grouper Rate,1308.00
United HealthCare,PPO,69090,CPT4/HCPCS,PIERCE EARLOBES,,Grouper Rate,1370.00
United HealthCare,PPO,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,Grouper Rate,1214.00
United HealthCare,PPO,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,Grouper Rate,1370.00
United HealthCare,PPO,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,Grouper Rate,1370.00
United HealthCare,PPO,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,Grouper Rate,4204.00
United HealthCare,PPO,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,4204.00
United HealthCare,PPO,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,Grouper Rate,1370.00
United HealthCare,PPO,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,Grouper Rate,4204.00
United HealthCare,PPO,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,Grouper Rate,1370.00
United HealthCare,PPO,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Grouper Rate,1214.00
United HealthCare,PPO,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,Grouper Rate,1370.00
United HealthCare,PPO,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Grouper Rate,1214.00
United HealthCare,PPO,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,Grouper Rate,1214.00
United HealthCare,PPO,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,1214.00
United HealthCare,PPO,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,Grouper Rate,1214.00
United HealthCare,PPO,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,Grouper Rate,4204.00
United HealthCare,PPO,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,6075.00
United HealthCare,PPO,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,Grouper Rate,6075.00
United HealthCare,PPO,69399,CPT4/HCPCS,OUTER EAR SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,69420,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,1214.00
United HealthCare,PPO,69421,CPT4/HCPCS,INCISION OF EARDRUM,,Grouper Rate,1370.00
United HealthCare,PPO,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,Grouper Rate,5138.00
United HealthCare,PPO,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,1214.00
United HealthCare,PPO,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,Grouper Rate,1370.00
United HealthCare,PPO,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,Grouper Rate,4204.00
United HealthCare,PPO,69450,CPT4/HCPCS,EARDRUM REVISION,,Grouper Rate,6075.00
United HealthCare,PPO,69501,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,6075.00
United HealthCare,PPO,69502,CPT4/HCPCS,MASTOIDECTOMY,,Grouper Rate,4204.00
United HealthCare,PPO,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,Grouper Rate,6075.00
United HealthCare,PPO,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,6075.00
United HealthCare,PPO,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,Grouper Rate,6075.00
United HealthCare,PPO,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,Grouper Rate,1370.00
United HealthCare,PPO,69540,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,1370.00
United HealthCare,PPO,69550,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,6075.00
United HealthCare,PPO,69552,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,6075.00
United HealthCare,PPO,69554,CPT4/HCPCS,REMOVE EAR LESION,,Grouper Rate,1370.00
United HealthCare,PPO,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6075.00
United HealthCare,PPO,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6075.00
United HealthCare,PPO,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6075.00
United HealthCare,PPO,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6075.00
United HealthCare,PPO,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,Grouper Rate,6075.00
United HealthCare,PPO,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,4204.00
United HealthCare,PPO,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,Grouper Rate,4204.00
United HealthCare,PPO,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,6075.00
United HealthCare,PPO,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6075.00
United HealthCare,PPO,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6075.00
United HealthCare,PPO,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,Grouper Rate,6075.00
United HealthCare,PPO,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6075.00
United HealthCare,PPO,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,Grouper Rate,6075.00
United HealthCare,PPO,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6075.00
United HealthCare,PPO,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6075.00
United HealthCare,PPO,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6075.00
United HealthCare,PPO,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6075.00
United HealthCare,PPO,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6075.00
United HealthCare,PPO,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,Grouper Rate,6075.00
United HealthCare,PPO,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,Grouper Rate,4204.00
United HealthCare,PPO,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,6075.00
United HealthCare,PPO,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,6075.00
United HealthCare,PPO,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,Grouper Rate,6075.00
United HealthCare,PPO,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,4204.00
United HealthCare,PPO,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,Grouper Rate,4204.00
United HealthCare,PPO,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,Grouper Rate,6075.00
United HealthCare,PPO,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,Grouper Rate,4204.00
United HealthCare,PPO,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,Grouper Rate,1370.00
United HealthCare,PPO,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,Grouper Rate,6075.00
United HealthCare,PPO,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,Grouper Rate,6075.00
United HealthCare,PPO,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,Grouper Rate,10119.00
United HealthCare,PPO,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,Grouper Rate,10119.00
United HealthCare,PPO,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,Grouper Rate,6075.00
United HealthCare,PPO,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,Grouper Rate,10119.00
United HealthCare,PPO,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,69799,CPT4/HCPCS,MIDDLE EAR SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,69801,CPT4/HCPCS,INCISE INNER EAR,,Grouper Rate,1370.00
United HealthCare,PPO,69805,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,6075.00
United HealthCare,PPO,69806,CPT4/HCPCS,EXPLORE INNER EAR,,Grouper Rate,6075.00
United HealthCare,PPO,69905,CPT4/HCPCS,REMOVE INNER EAR,,Grouper Rate,6075.00
United HealthCare,PPO,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,Grouper Rate,6075.00
United HealthCare,PPO,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,Grouper Rate,24180.00
United HealthCare,PPO,69949,CPT4/HCPCS,INNER EAR SURGERY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,Grouper Rate,1370.00
United HealthCare,PPO,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,Grouper Rate,6075.00
United HealthCare,PPO,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,Grouper Rate,6075.00
United HealthCare,PPO,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,Grouper Rate,6075.00
United HealthCare,PPO,69979,CPT4/HCPCS,TEMPORAL BONE SURGERY,,Grouper Rate,1214.00
United HealthCare,PPO,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,70010,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Per Unit,150.00
United HealthCare,PPO,70015,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,Per Unit,150.00
United HealthCare,PPO,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,Per Unit,150.00
United HealthCare,PPO,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,Per Unit,150.00
United HealthCare,PPO,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,Per Unit,150.00
United HealthCare,PPO,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Per Unit,150.00
United HealthCare,PPO,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,Per Unit,150.00
United HealthCare,PPO,70134,CPT4/HCPCS,X-RAY EXAM OF MIDDLE EAR,,Per Unit,150.00
United HealthCare,PPO,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Per Unit,150.00
United HealthCare,PPO,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,Per Unit,150.00
United HealthCare,PPO,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,Per Unit,150.00
United HealthCare,PPO,70170,CPT4/HCPCS,X-RAY EXAM OF TEAR DUCT,,Per Unit,150.00
United HealthCare,PPO,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Per Unit,150.00
United HealthCare,PPO,70200,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,Per Unit,150.00
United HealthCare,PPO,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Per Unit,150.00
United HealthCare,PPO,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,Per Unit,150.00
United HealthCare,PPO,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,Per Unit,150.00
United HealthCare,PPO,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Per Unit,150.00
United HealthCare,PPO,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,Per Unit,150.00
United HealthCare,PPO,70300,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Per Unit,150.00
United HealthCare,PPO,70310,CPT4/HCPCS,X-RAY EXAM OF TEETH,,Per Unit,150.00
United HealthCare,PPO,70320,CPT4/HCPCS,FULL MOUTH X-RAY OF TEETH,,Per Unit,150.00
United HealthCare,PPO,70328,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Per Unit,150.00
United HealthCare,PPO,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,Per Unit,150.00
United HealthCare,PPO,70332,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,Per Unit,150.00
United HealthCare,PPO,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,Case Rate,1216.00
United HealthCare,PPO,70350,CPT4/HCPCS,X-RAY HEAD FOR ORTHODONTIA,,Per Unit,150.00
United HealthCare,PPO,70355,CPT4/HCPCS,PANORAMIC X-RAY OF JAWS,,Per Unit,150.00
United HealthCare,PPO,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,Per Unit,150.00
United HealthCare,PPO,70370,CPT4/HCPCS,THROAT X-RAY & FLUOROSCOPY,,Per Unit,150.00
United HealthCare,PPO,70371,CPT4/HCPCS,SPEECH EVALUATION COMPLEX,,Per Unit,150.00
United HealthCare,PPO,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,Per Unit,150.00
United HealthCare,PPO,70390,CPT4/HCPCS,X-RAY EXAM OF SALIVARY DUCT,,Per Unit,150.00
United HealthCare,PPO,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,Per Unit,150.00
United HealthCare,PPO,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,Per Unit,150.00
United HealthCare,PPO,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,Per Unit,150.00
United HealthCare,PPO,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,Per Unit,150.00
United HealthCare,PPO,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,Per Unit,150.00
United HealthCare,PPO,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,Per Unit,150.00
United HealthCare,PPO,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,Per Unit,150.00
United HealthCare,PPO,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,Per Unit,150.00
United HealthCare,PPO,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,Case Rate,1042.00
United HealthCare,PPO,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,Case Rate,1042.00
United HealthCare,PPO,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,Case Rate,1216.00
United HealthCare,PPO,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,Case Rate,1216.00
United HealthCare,PPO,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,Case Rate,1216.00
United HealthCare,PPO,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,Case Rate,1216.00
United HealthCare,PPO,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,Case Rate,1216.00
United HealthCare,PPO,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,Case Rate,1216.00
United HealthCare,PPO,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,Case Rate,1216.00
United HealthCare,PPO,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,Case Rate,1216.00
United HealthCare,PPO,70554,CPT4/HCPCS,FMRI BRAIN BY TECH,,Case Rate,1216.00
United HealthCare,PPO,70555,CPT4/HCPCS,FMRI BRAIN BY PHYS/PSYCH,,Case Rate,1216.00
United HealthCare,PPO,70557,CPT4/HCPCS,MRI BRAIN W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,70558,CPT4/HCPCS,MRI BRAIN W/DYE,,Case Rate,1216.00
United HealthCare,PPO,70559,CPT4/HCPCS,MRI BRAIN W/O & W/DYE,,Case Rate,1216.00
United HealthCare,PPO,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,Per Unit,150.00
United HealthCare,PPO,71046,CPT4/HCPCS,X-RAY EXAM CHEST 2 VIEWS,,Per Unit,150.00
United HealthCare,PPO,71047,CPT4/HCPCS,X-RAY EXAM CHEST 3 VIEWS,,Per Unit,150.00
United HealthCare,PPO,71048,CPT4/HCPCS,X-RAY EXAM CHEST 4+ VIEWS,,Per Unit,150.00
United HealthCare,PPO,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,Per Unit,150.00
United HealthCare,PPO,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,Per Unit,150.00
United HealthCare,PPO,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,Per Unit,150.00
United HealthCare,PPO,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,Per Unit,150.00
United HealthCare,PPO,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,Per Unit,150.00
United HealthCare,PPO,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,Per Unit,150.00
United HealthCare,PPO,71250,CPT4/HCPCS,CT THORAX DX C-,,Case Rate,1042.00
United HealthCare,PPO,71260,CPT4/HCPCS,CT THORAX DX C+,,Per Unit,150.00
United HealthCare,PPO,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,Per Unit,150.00
United HealthCare,PPO,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,Per Unit,150.00
United HealthCare,PPO,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,71551,CPT4/HCPCS,MRI CHEST W/DYE,,Case Rate,1216.00
United HealthCare,PPO,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,Case Rate,1216.00
United HealthCare,PPO,71555,CPT4/HCPCS,MRI ANGIO CHEST W OR W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,Per Unit,150.00
United HealthCare,PPO,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,Per Unit,150.00
United HealthCare,PPO,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,Per Unit,150.00
United HealthCare,PPO,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,Per Unit,150.00
United HealthCare,PPO,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,Per Unit,150.00
United HealthCare,PPO,72072,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 3VWS,,Per Unit,150.00
United HealthCare,PPO,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,Per Unit,150.00
United HealthCare,PPO,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,Per Unit,150.00
United HealthCare,PPO,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,Per Unit,150.00
United HealthCare,PPO,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,Per Unit,150.00
United HealthCare,PPO,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,Per Unit,150.00
United HealthCare,PPO,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,Per Unit,150.00
United HealthCare,PPO,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,Per Unit,150.00
United HealthCare,PPO,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,Per Unit,150.00
United HealthCare,PPO,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,Per Unit,150.00
United HealthCare,PPO,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,Per Unit,150.00
United HealthCare,PPO,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,Per Unit,150.00
United HealthCare,PPO,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,Per Unit,150.00
United HealthCare,PPO,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,Per Unit,150.00
United HealthCare,PPO,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,Per Unit,150.00
United HealthCare,PPO,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,Per Unit,150.00
United HealthCare,PPO,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,Per Unit,150.00
United HealthCare,PPO,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,Case Rate,1216.00
United HealthCare,PPO,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,Case Rate,1216.00
United HealthCare,PPO,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,Case Rate,1216.00
United HealthCare,PPO,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,Case Rate,1216.00
United HealthCare,PPO,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,Case Rate,1216.00
United HealthCare,PPO,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,Case Rate,1216.00
United HealthCare,PPO,72159,CPT4/HCPCS,MR ANGIO SPINE W/O&W/DYE,,Case Rate,1216.00
United HealthCare,PPO,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Per Unit,150.00
United HealthCare,PPO,72190,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,Per Unit,150.00
United HealthCare,PPO,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,Case Rate,1042.00
United HealthCare,PPO,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,72193,CPT4/HCPCS,CT PELVIS W/DYE,,Per Unit,150.00
United HealthCare,PPO,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,Per Unit,150.00
United HealthCare,PPO,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,Case Rate,1216.00
United HealthCare,PPO,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,Case Rate,1216.00
United HealthCare,PPO,72198,CPT4/HCPCS,MR ANGIO PELVIS W/O & W/DYE,,Case Rate,1216.00
United HealthCare,PPO,72200,CPT4/HCPCS,X-RAY EXAM SI JOINTS,,Per Unit,150.00
United HealthCare,PPO,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,Per Unit,150.00
United HealthCare,PPO,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,Per Unit,150.00
United HealthCare,PPO,72240,CPT4/HCPCS,MYELOGRAPHY NECK SPINE,,Per Unit,150.00
United HealthCare,PPO,72255,CPT4/HCPCS,MYELOGRAPHY THORACIC SPINE,,Per Unit,150.00
United HealthCare,PPO,72265,CPT4/HCPCS,MYELOGRAPHY L-S SPINE,,Per Unit,150.00
United HealthCare,PPO,72270,CPT4/HCPCS,MYELOGPHY 2/> SPINE REGIONS,,Per Unit,150.00
United HealthCare,PPO,72275,CPT4/HCPCS,EPIDUROGRAPHY,,Per Unit,150.00
United HealthCare,PPO,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,Per Unit,150.00
United HealthCare,PPO,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,Per Unit,150.00
United HealthCare,PPO,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,Per Unit,150.00
United HealthCare,PPO,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,Per Unit,150.00
United HealthCare,PPO,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Per Unit,150.00
United HealthCare,PPO,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,Per Unit,150.00
United HealthCare,PPO,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,Per Unit,150.00
United HealthCare,PPO,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,Per Unit,150.00
United HealthCare,PPO,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,Per Unit,150.00
United HealthCare,PPO,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Per Unit,150.00
United HealthCare,PPO,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,Per Unit,150.00
United HealthCare,PPO,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,Per Unit,150.00
United HealthCare,PPO,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,Per Unit,150.00
United HealthCare,PPO,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,Per Unit,150.00
United HealthCare,PPO,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Per Unit,150.00
United HealthCare,PPO,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,Per Unit,150.00
United HealthCare,PPO,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,Per Unit,150.00
United HealthCare,PPO,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,Per Unit,150.00
United HealthCare,PPO,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,Per Unit,150.00
United HealthCare,PPO,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,Per Unit,150.00
United HealthCare,PPO,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,Per Unit,150.00
United HealthCare,PPO,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,Per Unit,150.00
United HealthCare,PPO,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,Case Rate,1042.00
United HealthCare,PPO,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,73219,CPT4/HCPCS,MRI UPPER EXTREMITY W/DYE,,Case Rate,1216.00
United HealthCare,PPO,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,Case Rate,1216.00
United HealthCare,PPO,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,Case Rate,1216.00
United HealthCare,PPO,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,Case Rate,1216.00
United HealthCare,PPO,73225,CPT4/HCPCS,MR ANGIO UPR EXTR W/O&W/DYE,,Case Rate,1216.00
United HealthCare,PPO,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,Per Unit,150.00
United HealthCare,PPO,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,Per Unit,150.00
United HealthCare,PPO,73503,CPT4/HCPCS,X-RAY EXAM HIP UNI 4/> VIEWS,,Per Unit,150.00
United HealthCare,PPO,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,Per Unit,150.00
United HealthCare,PPO,73522,CPT4/HCPCS,X-RAY EXAM HIPS BI 3-4 VIEWS,,Per Unit,150.00
United HealthCare,PPO,73523,CPT4/HCPCS,X-RAY EXAM HIPS BI 5/> VIEWS,,Per Unit,150.00
United HealthCare,PPO,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,Per Unit,150.00
United HealthCare,PPO,73551,CPT4/HCPCS,X-RAY EXAM OF FEMUR 1,,Per Unit,150.00
United HealthCare,PPO,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,Per Unit,150.00
United HealthCare,PPO,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,Per Unit,150.00
United HealthCare,PPO,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,Per Unit,150.00
United HealthCare,PPO,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,Per Unit,150.00
United HealthCare,PPO,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,Per Unit,150.00
United HealthCare,PPO,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,Per Unit,150.00
United HealthCare,PPO,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,Per Unit,150.00
United HealthCare,PPO,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,Per Unit,150.00
United HealthCare,PPO,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Per Unit,150.00
United HealthCare,PPO,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,Per Unit,150.00
United HealthCare,PPO,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,Per Unit,150.00
United HealthCare,PPO,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Per Unit,150.00
United HealthCare,PPO,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,Per Unit,150.00
United HealthCare,PPO,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,Per Unit,150.00
United HealthCare,PPO,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,Per Unit,150.00
United HealthCare,PPO,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,Per Unit,150.00
United HealthCare,PPO,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,Per Unit,150.00
United HealthCare,PPO,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,Case Rate,1042.00
United HealthCare,PPO,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,73719,CPT4/HCPCS,MRI LOWER EXTREMITY W/DYE,,Case Rate,1216.00
United HealthCare,PPO,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,Case Rate,1216.00
United HealthCare,PPO,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,Case Rate,1216.00
United HealthCare,PPO,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,Case Rate,1216.00
United HealthCare,PPO,73725,CPT4/HCPCS,MR ANG LWR EXT W OR W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,Per Unit,150.00
United HealthCare,PPO,74019,CPT4/HCPCS,X-RAY EXAM ABDOMEN 2 VIEWS,,Per Unit,150.00
United HealthCare,PPO,74021,CPT4/HCPCS,X-RAY EXAM ABDOMEN 3+ VIEWS,,Per Unit,150.00
United HealthCare,PPO,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,Per Unit,150.00
United HealthCare,PPO,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,Case Rate,1042.00
United HealthCare,PPO,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,Per Unit,150.00
United HealthCare,PPO,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,Per Unit,150.00
United HealthCare,PPO,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,Case Rate,1042.00
United HealthCare,PPO,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,Case Rate,1042.00
United HealthCare,PPO,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,Case Rate,1042.00
United HealthCare,PPO,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,Case Rate,1042.00
United HealthCare,PPO,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,Case Rate,1042.00
United HealthCare,PPO,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,Case Rate,1216.00
United HealthCare,PPO,74182,CPT4/HCPCS,MRI ABDOMEN W/DYE,,Case Rate,1216.00
United HealthCare,PPO,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,Case Rate,1216.00
United HealthCare,PPO,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,Case Rate,1216.00
United HealthCare,PPO,74190,CPT4/HCPCS,X-RAY EXAM OF PERITONEUM,,Per Unit,150.00
United HealthCare,PPO,74210,CPT4/HCPCS,X-RAY XM PHRNX&/CRV ESOPH C+,,Per Unit,150.00
United HealthCare,PPO,74220,CPT4/HCPCS,X-RAY XM ESOPHAGUS 1CNTRST,,Per Unit,150.00
United HealthCare,PPO,74230,CPT4/HCPCS,X-RAY XM SWLNG FUNCJ C+,,Per Unit,150.00
United HealthCare,PPO,74235,CPT4/HCPCS,REMOVE ESOPHAGUS OBSTRUCTION,,Per Unit,150.00
United HealthCare,PPO,74240,CPT4/HCPCS,X-RAY XM UPR GI TRC 1CNTRST,,Per Unit,150.00
United HealthCare,PPO,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,Per Unit,150.00
United HealthCare,PPO,74250,CPT4/HCPCS,X-RAY XM SM INT 1CNTRST STD,,Per Unit,150.00
United HealthCare,PPO,74251,CPT4/HCPCS,X-RAY XM SM INT 2CNTRST STD,,Per Unit,150.00
United HealthCare,PPO,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,Case Rate,1042.00
United HealthCare,PPO,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,Case Rate,1042.00
United HealthCare,PPO,74263,CPT4/HCPCS,CT COLONOGRAPHY SCREENING,,Case Rate,1042.00
United HealthCare,PPO,74270,CPT4/HCPCS,X-RAY XM COLON 1CNTRST STD,,Per Unit,150.00
United HealthCare,PPO,74280,CPT4/HCPCS,X-RAY XM COLON 2CNTRST STD,,Per Unit,150.00
United HealthCare,PPO,74283,CPT4/HCPCS,THER NMA RDCTJ INTUS/OBSTRCJ,,Per Unit,150.00
United HealthCare,PPO,74290,CPT4/HCPCS,CONTRAST X-RAY GALLBLADDER,,Per Unit,150.00
United HealthCare,PPO,74300,CPT4/HCPCS,X-RAY BILE DUCTS/PANCREAS,,Per Unit,150.00
United HealthCare,PPO,74301,CPT4/HCPCS,X-RAYS AT SURGERY ADD-ON,,Per Unit,150.00
United HealthCare,PPO,74328,CPT4/HCPCS,X-RAY BILE DUCT ENDOSCOPY,,Per Unit,150.00
United HealthCare,PPO,74329,CPT4/HCPCS,X-RAY FOR PANCREAS ENDOSCOPY,,Per Unit,150.00
United HealthCare,PPO,74330,CPT4/HCPCS,X-RAY BILE/PANC ENDOSCOPY,,Per Unit,150.00
United HealthCare,PPO,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,Per Unit,150.00
United HealthCare,PPO,74355,CPT4/HCPCS,X-RAY GUIDE INTESTINAL TUBE,,Per Unit,150.00
United HealthCare,PPO,74360,CPT4/HCPCS,X-RAY GUIDE GI DILATION,,Per Unit,150.00
United HealthCare,PPO,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,Per Unit,150.00
United HealthCare,PPO,74400,CPT4/HCPCS,UROGRAPHY IV +-KUB TOMOG,,Per Unit,150.00
United HealthCare,PPO,74410,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BOLUS,,Per Unit,150.00
United HealthCare,PPO,74415,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BLS W/NF,,Per Unit,150.00
United HealthCare,PPO,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,Per Unit,150.00
United HealthCare,PPO,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,Per Unit,150.00
United HealthCare,PPO,74430,CPT4/HCPCS,CONTRAST X-RAY BLADDER,,Per Unit,150.00
United HealthCare,PPO,74440,CPT4/HCPCS,X-RAY MALE GENITAL TRACT,,Per Unit,150.00
United HealthCare,PPO,74445,CPT4/HCPCS,X-RAY EXAM OF PENIS,,Per Unit,150.00
United HealthCare,PPO,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Per Unit,150.00
United HealthCare,PPO,74455,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,Per Unit,150.00
United HealthCare,PPO,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,Per Unit,150.00
United HealthCare,PPO,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,Per Unit,150.00
United HealthCare,PPO,74710,CPT4/HCPCS,X-RAY MEASUREMENT OF PELVIS,,Per Unit,150.00
United HealthCare,PPO,74712,CPT4/HCPCS,MRI FETAL SNGL/1ST GESTATION,,Case Rate,1216.00
United HealthCare,PPO,74713,CPT4/HCPCS,MRI FETAL EA ADDL GESTATION,,Case Rate,1216.00
United HealthCare,PPO,74740,CPT4/HCPCS,X-RAY FEMALE GENITAL TRACT,,Per Unit,150.00
United HealthCare,PPO,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,Per Unit,150.00
United HealthCare,PPO,74775,CPT4/HCPCS,X-RAY EXAM OF PERINEUM,,Per Unit,150.00
United HealthCare,PPO,75557,CPT4/HCPCS,CARDIAC MRI FOR MORPH,,Per Unit,150.00
United HealthCare,PPO,75559,CPT4/HCPCS,CARDIAC MRI W/STRESS IMG,,Per Unit,150.00
United HealthCare,PPO,75561,CPT4/HCPCS,CARDIAC MRI FOR MORPH W/DYE,,Per Unit,150.00
United HealthCare,PPO,75563,CPT4/HCPCS,CARD MRI W/STRESS IMG & DYE,,Per Unit,150.00
United HealthCare,PPO,75565,CPT4/HCPCS,CARD MRI VELOC FLOW MAPPING,,Per Unit,150.00
United HealthCare,PPO,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,Case Rate,1042.00
United HealthCare,PPO,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,Case Rate,1042.00
United HealthCare,PPO,75573,CPT4/HCPCS,CT HRT W/3D IMAGE CONGEN,,Case Rate,1042.00
United HealthCare,PPO,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,Case Rate,1042.00
United HealthCare,PPO,75600,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Per Unit,150.00
United HealthCare,PPO,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,Per Unit,150.00
United HealthCare,PPO,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,Per Unit,150.00
United HealthCare,PPO,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,Per Unit,150.00
United HealthCare,PPO,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,Case Rate,1042.00
United HealthCare,PPO,75705,CPT4/HCPCS,ARTERY X-RAYS SPINE,,Per Unit,150.00
United HealthCare,PPO,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,Per Unit,150.00
United HealthCare,PPO,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,Per Unit,150.00
United HealthCare,PPO,75726,CPT4/HCPCS,ARTERY X-RAYS ABDOMEN,,Per Unit,150.00
United HealthCare,PPO,75731,CPT4/HCPCS,ARTERY X-RAYS ADRENAL GLAND,,Per Unit,150.00
United HealthCare,PPO,75733,CPT4/HCPCS,ARTERY X-RAYS ADRENALS,,Per Unit,150.00
United HealthCare,PPO,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,Per Unit,150.00
United HealthCare,PPO,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Per Unit,150.00
United HealthCare,PPO,75743,CPT4/HCPCS,ARTERY X-RAYS LUNGS,,Per Unit,150.00
United HealthCare,PPO,75746,CPT4/HCPCS,ARTERY X-RAYS LUNG,,Per Unit,150.00
United HealthCare,PPO,75756,CPT4/HCPCS,ARTERY X-RAYS CHEST,,Per Unit,150.00
United HealthCare,PPO,75774,CPT4/HCPCS,ARTERY X-RAY EACH VESSEL,,Per Unit,150.00
United HealthCare,PPO,75801,CPT4/HCPCS,LYMPH VESSEL X-RAY ARM/LEG,,Per Unit,150.00
United HealthCare,PPO,75803,CPT4/HCPCS,LYMPH VESSEL X-RAY ARMS/LEGS,,Per Unit,150.00
United HealthCare,PPO,75805,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Per Unit,150.00
United HealthCare,PPO,75807,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,Per Unit,150.00
United HealthCare,PPO,75809,CPT4/HCPCS,NONVASCULAR SHUNT X-RAY,,Per Unit,150.00
United HealthCare,PPO,75810,CPT4/HCPCS,VEIN X-RAY SPLEEN/LIVER,,Per Unit,150.00
United HealthCare,PPO,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,Per Unit,150.00
United HealthCare,PPO,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,Per Unit,150.00
United HealthCare,PPO,75825,CPT4/HCPCS,VEIN X-RAY TRUNK,,Per Unit,150.00
United HealthCare,PPO,75827,CPT4/HCPCS,VEIN X-RAY CHEST,,Per Unit,150.00
United HealthCare,PPO,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,Per Unit,150.00
United HealthCare,PPO,75833,CPT4/HCPCS,VEIN X-RAY KIDNEYS,,Per Unit,150.00
United HealthCare,PPO,75840,CPT4/HCPCS,VEIN X-RAY ADRENAL GLAND,,Per Unit,150.00
United HealthCare,PPO,75842,CPT4/HCPCS,VEIN X-RAY ADRENAL GLANDS,,Per Unit,150.00
United HealthCare,PPO,75860,CPT4/HCPCS,VEIN X-RAY NECK,,Per Unit,150.00
United HealthCare,PPO,75870,CPT4/HCPCS,VEIN X-RAY SKULL,,Per Unit,150.00
United HealthCare,PPO,75872,CPT4/HCPCS,VEIN X-RAY SKULL EPIDURAL,,Per Unit,150.00
United HealthCare,PPO,75880,CPT4/HCPCS,VEIN X-RAY EYE SOCKET,,Per Unit,150.00
United HealthCare,PPO,75885,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Per Unit,150.00
United HealthCare,PPO,75887,CPT4/HCPCS,VEIN X-RAY LIVER W/O HEMODYN,,Per Unit,150.00
United HealthCare,PPO,75889,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,Per Unit,150.00
United HealthCare,PPO,75891,CPT4/HCPCS,VEIN X-RAY LIVER,,Per Unit,150.00
United HealthCare,PPO,75893,CPT4/HCPCS,VENOUS SAMPLING BY CATHETER,,Per Unit,150.00
United HealthCare,PPO,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,Per Unit,150.00
United HealthCare,PPO,75898,CPT4/HCPCS,FOLLOW-UP ANGIOGRAPHY,,Per Unit,150.00
United HealthCare,PPO,75901,CPT4/HCPCS,REMOVE CVA DEVICE OBSTRUCT,,Per Unit,150.00
United HealthCare,PPO,75902,CPT4/HCPCS,REMOVE CVA LUMEN OBSTRUCT,,Per Unit,150.00
United HealthCare,PPO,75956,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,Per Unit,150.00
United HealthCare,PPO,75957,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,Per Unit,150.00
United HealthCare,PPO,75958,CPT4/HCPCS,XRAY PLACE PROX EXT THOR AO,,Per Unit,150.00
United HealthCare,PPO,75959,CPT4/HCPCS,XRAY PLACE DIST EXT THOR AO,,Per Unit,150.00
United HealthCare,PPO,75970,CPT4/HCPCS,VASCULAR BIOPSY,,Per Unit,150.00
United HealthCare,PPO,75984,CPT4/HCPCS,XRAY CONTROL CATHETER CHANGE,,Per Unit,150.00
United HealthCare,PPO,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,Per Unit,150.00
United HealthCare,PPO,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,Per Unit,150.00
United HealthCare,PPO,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,Per Unit,150.00
United HealthCare,PPO,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,Per Unit,150.00
United HealthCare,PPO,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,Per Unit,150.00
United HealthCare,PPO,76100,CPT4/HCPCS,X-RAY EXAM OF BODY SECTION,,Per Unit,150.00
United HealthCare,PPO,76101,CPT4/HCPCS,COMPLEX BODY SECTION X-RAY,,Per Unit,150.00
United HealthCare,PPO,76102,CPT4/HCPCS,COMPLEX BODY SECTION X-RAYS,,Per Unit,150.00
United HealthCare,PPO,76120,CPT4/HCPCS,CINE/VIDEO X-RAYS,,Per Unit,150.00
United HealthCare,PPO,76125,CPT4/HCPCS,CINE/VIDEO X-RAYS ADD-ON,,Per Unit,150.00
United HealthCare,PPO,76140,CPT4/HCPCS,X-RAY CONSULTATION,,Per Unit,150.00
United HealthCare,PPO,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Per Unit,150.00
United HealthCare,PPO,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,Per Unit,150.00
United HealthCare,PPO,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,Case Rate,1042.00
United HealthCare,PPO,76390,CPT4/HCPCS,MR SPECTROSCOPY,,Per Unit,150.00
United HealthCare,PPO,76391,CPT4/HCPCS,MR ELASTOGRAPHY,,Per Unit,150.00
United HealthCare,PPO,76496,CPT4/HCPCS,FLUOROSCOPIC PROCEDURE,,Per Unit,150.00
United HealthCare,PPO,76497,CPT4/HCPCS,CT PROCEDURE,,Per Unit,150.00
United HealthCare,PPO,76498,CPT4/HCPCS,MRI PROCEDURE,,Case Rate,1216.00
United HealthCare,PPO,76499,CPT4/HCPCS,RADIOGRAPHIC PROCEDURE,,Per Unit,150.00
United HealthCare,PPO,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,Case Rate,587.00
United HealthCare,PPO,76510,CPT4/HCPCS,OPH US DX B-SCAN&QUAN A-SCAN,,Case Rate,587.00
United HealthCare,PPO,76511,CPT4/HCPCS,OPH US DX QUAN A-SCAN ONLY,,Case Rate,587.00
United HealthCare,PPO,76512,CPT4/HCPCS,OPH US DX B-SCAN,,Case Rate,587.00
United HealthCare,PPO,76513,CPT4/HCPCS,OPH US DX ANT SGM US UNI/BI,,Case Rate,587.00
United HealthCare,PPO,76514,CPT4/HCPCS,ECHO EXAM OF EYE THICKNESS,,Case Rate,587.00
United HealthCare,PPO,76516,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,587.00
United HealthCare,PPO,76519,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,587.00
United HealthCare,PPO,76529,CPT4/HCPCS,ECHO EXAM OF EYE,,Case Rate,587.00
United HealthCare,PPO,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,Case Rate,587.00
United HealthCare,PPO,76604,CPT4/HCPCS,US EXAM CHEST,,Case Rate,587.00
United HealthCare,PPO,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,Case Rate,587.00
United HealthCare,PPO,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,Case Rate,587.00
United HealthCare,PPO,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,Case Rate,587.00
United HealthCare,PPO,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,Case Rate,587.00
United HealthCare,PPO,76706,CPT4/HCPCS,US ABDL AORTA SCREEN AAA,,Case Rate,587.00
United HealthCare,PPO,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,Case Rate,587.00
United HealthCare,PPO,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,Case Rate,587.00
United HealthCare,PPO,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,Case Rate,587.00
United HealthCare,PPO,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,Case Rate,587.00
United HealthCare,PPO,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,Case Rate,587.00
United HealthCare,PPO,76802,CPT4/HCPCS,OB US < 14 WKS ADDL FETUS,,Case Rate,587.00
United HealthCare,PPO,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,Case Rate,587.00
United HealthCare,PPO,76810,CPT4/HCPCS,OB US >= 14 WKS ADDL FETUS,,Case Rate,587.00
United HealthCare,PPO,76811,CPT4/HCPCS,OB US DETAILED SNGL FETUS,,Case Rate,587.00
United HealthCare,PPO,76812,CPT4/HCPCS,OB US DETAILED ADDL FETUS,,Case Rate,587.00
United HealthCare,PPO,76813,CPT4/HCPCS,OB US NUCHAL MEAS 1 GEST,,Case Rate,587.00
United HealthCare,PPO,76814,CPT4/HCPCS,OB US NUCHAL MEAS ADD-ON,,Case Rate,587.00
United HealthCare,PPO,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,Case Rate,587.00
United HealthCare,PPO,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,Case Rate,587.00
United HealthCare,PPO,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,Case Rate,587.00
United HealthCare,PPO,76818,CPT4/HCPCS,FETAL BIOPHYS PROFILE W/NST,,Case Rate,587.00
United HealthCare,PPO,76819,CPT4/HCPCS,FETAL BIOPHYS PROFIL W/O NST,,Case Rate,587.00
United HealthCare,PPO,76820,CPT4/HCPCS,UMBILICAL ARTERY ECHO,,Case Rate,587.00
United HealthCare,PPO,76821,CPT4/HCPCS,MIDDLE CEREBRAL ARTERY ECHO,,Case Rate,587.00
United HealthCare,PPO,76825,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,587.00
United HealthCare,PPO,76826,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,587.00
United HealthCare,PPO,76827,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,587.00
United HealthCare,PPO,76828,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,Case Rate,587.00
United HealthCare,PPO,76830,CPT4/HCPCS,TRANSVAGINAL US NON-OB,,Case Rate,587.00
United HealthCare,PPO,76831,CPT4/HCPCS,ECHO EXAM UTERUS,,Case Rate,587.00
United HealthCare,PPO,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,Case Rate,587.00
United HealthCare,PPO,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,Case Rate,587.00
United HealthCare,PPO,76870,CPT4/HCPCS,US EXAM SCROTUM,,Case Rate,587.00
United HealthCare,PPO,76872,CPT4/HCPCS,US TRANSRECTAL,,Case Rate,587.00
United HealthCare,PPO,76873,CPT4/HCPCS,ECHOGRAP TRANS R PROS STUDY,,Case Rate,587.00
United HealthCare,PPO,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,Case Rate,587.00
United HealthCare,PPO,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,Case Rate,587.00
United HealthCare,PPO,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,Case Rate,587.00
United HealthCare,PPO,76886,CPT4/HCPCS,US EXAM INFANT HIPS STATIC,,Case Rate,587.00
United HealthCare,PPO,76932,CPT4/HCPCS,ECHO GUIDE FOR HEART BIOPSY,,Case Rate,587.00
United HealthCare,PPO,76936,CPT4/HCPCS,ECHO GUIDE FOR ARTERY REPAIR,,Case Rate,587.00
United HealthCare,PPO,76937,CPT4/HCPCS,US GUIDE VASCULAR ACCESS,,Case Rate,587.00
United HealthCare,PPO,76940,CPT4/HCPCS,US GUIDE TISSUE ABLATION,,Case Rate,587.00
United HealthCare,PPO,76941,CPT4/HCPCS,ECHO GUIDE FOR TRANSFUSION,,Case Rate,587.00
United HealthCare,PPO,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,Case Rate,587.00
United HealthCare,PPO,76945,CPT4/HCPCS,ECHO GUIDE VILLUS SAMPLING,,Case Rate,587.00
United HealthCare,PPO,76946,CPT4/HCPCS,ECHO GUIDE FOR AMNIOCENTESIS,,Case Rate,587.00
United HealthCare,PPO,76948,CPT4/HCPCS,ECHO GUIDE OVA ASPIRATION,,Case Rate,587.00
United HealthCare,PPO,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,Case Rate,587.00
United HealthCare,PPO,76970,CPT4/HCPCS,ULTRASOUND EXAM FOLLOW-UP,,Case Rate,587.00
United HealthCare,PPO,76975,CPT4/HCPCS,GI ENDOSCOPIC ULTRASOUND,,Case Rate,587.00
United HealthCare,PPO,76977,CPT4/HCPCS,US BONE DENSITY MEASURE,,Case Rate,587.00
United HealthCare,PPO,76978,CPT4/HCPCS,US TRGT DYN MBUBB 1ST LES,,Case Rate,587.00
United HealthCare,PPO,76979,CPT4/HCPCS,US TRGT DYN MBUBB EA ADDL,,Case Rate,587.00
United HealthCare,PPO,76981,CPT4/HCPCS,USE PARENCHYMA,,Case Rate,587.00
United HealthCare,PPO,76982,CPT4/HCPCS,USE 1ST TARGET LESION,,Case Rate,587.00
United HealthCare,PPO,76983,CPT4/HCPCS,USE EA ADDL TARGET LESION,,Case Rate,587.00
United HealthCare,PPO,76998,CPT4/HCPCS,US GUIDE INTRAOP,,Case Rate,587.00
United HealthCare,PPO,77001,CPT4/HCPCS,FLUOROGUIDE FOR VEIN DEVICE,,Per Unit,150.00
United HealthCare,PPO,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,Per Unit,150.00
United HealthCare,PPO,77003,CPT4/HCPCS,FLUOROGUIDE FOR SPINE INJECT,,Per Unit,150.00
United HealthCare,PPO,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,Case Rate,1042.00
United HealthCare,PPO,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,Case Rate,1042.00
United HealthCare,PPO,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,Case Rate,1042.00
United HealthCare,PPO,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,Case Rate,1042.00
United HealthCare,PPO,77021,CPT4/HCPCS,MRI GUIDANCE NDL PLMT RS&I,,Case Rate,1216.00
United HealthCare,PPO,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,Case Rate,1216.00
United HealthCare,PPO,77046,CPT4/HCPCS,MRI BREAST C- UNILATERAL,,Case Rate,1216.00
United HealthCare,PPO,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,Case Rate,1216.00
United HealthCare,PPO,77048,CPT4/HCPCS,MRI BREAST C-+ W/CAD UNI,,Case Rate,1216.00
United HealthCare,PPO,77049,CPT4/HCPCS,MRI BREAST C-+ W/CAD BI,,Case Rate,1216.00
United HealthCare,PPO,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,Case Rate,366.00
United HealthCare,PPO,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,Case Rate,366.00
United HealthCare,PPO,77061,CPT4/HCPCS,BREAST TOMOSYNTHESIS UNI,,Case Rate,366.00
United HealthCare,PPO,77062,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Case Rate,366.00
United HealthCare,PPO,77063,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,Case Rate,366.00
United HealthCare,PPO,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,Case Rate,366.00
United HealthCare,PPO,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,Case Rate,366.00
United HealthCare,PPO,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,Case Rate,366.00
United HealthCare,PPO,77071,CPT4/HCPCS,X-RAY STRESS VIEW,,Per Unit,150.00
United HealthCare,PPO,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,Per Unit,150.00
United HealthCare,PPO,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,Per Unit,150.00
United HealthCare,PPO,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,Per Unit,150.00
United HealthCare,PPO,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,Per Unit,150.00
United HealthCare,PPO,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,Per Unit,150.00
United HealthCare,PPO,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,Per Unit,150.00
United HealthCare,PPO,77078,CPT4/HCPCS,CT BONE DENSITY AXIAL,,Case Rate,1042.00
United HealthCare,PPO,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,Per Unit,150.00
United HealthCare,PPO,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,Per Unit,150.00
United HealthCare,PPO,77084,CPT4/HCPCS,MAGNETIC IMAGE BONE MARROW,,Case Rate,1216.00
United HealthCare,PPO,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,Per Unit,150.00
United HealthCare,PPO,77086,CPT4/HCPCS,FRACTURE ASSESSMENT VIA DXA,,Per Unit,150.00
United HealthCare,PPO,77261,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Per Unit,150.00
United HealthCare,PPO,77262,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Per Unit,150.00
United HealthCare,PPO,77263,CPT4/HCPCS,RADIATION THERAPY PLANNING,,Per Unit,150.00
United HealthCare,PPO,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,2567.00
United HealthCare,PPO,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,2567.00
United HealthCare,PPO,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,Case Rate,2567.00
United HealthCare,PPO,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,Case Rate,2567.00
United HealthCare,PPO,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,Case Rate,2567.00
United HealthCare,PPO,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,Case Rate,2567.00
United HealthCare,PPO,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,Case Rate,2567.00
United HealthCare,PPO,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,Case Rate,2567.00
United HealthCare,PPO,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,Case Rate,2567.00
United HealthCare,PPO,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,Case Rate,2567.00
United HealthCare,PPO,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,Case Rate,2567.00
United HealthCare,PPO,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,Case Rate,2567.00
United HealthCare,PPO,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,Case Rate,2567.00
United HealthCare,PPO,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,Case Rate,2567.00
United HealthCare,PPO,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,2567.00
United HealthCare,PPO,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,2567.00
United HealthCare,PPO,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,Case Rate,2567.00
United HealthCare,PPO,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,2567.00
United HealthCare,PPO,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,Case Rate,2567.00
United HealthCare,PPO,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,Case Rate,2567.00
United HealthCare,PPO,77371,CPT4/HCPCS,SRS MULTISOURCE,,Case Rate,2567.00
United HealthCare,PPO,77372,CPT4/HCPCS,SRS LINEAR BASED,,Case Rate,2567.00
United HealthCare,PPO,77373,CPT4/HCPCS,SBRT DELIVERY,,Case Rate,2567.00
United HealthCare,PPO,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,Case Rate,2567.00
United HealthCare,PPO,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,Case Rate,2567.00
United HealthCare,PPO,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,Case Rate,2567.00
United HealthCare,PPO,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,2567.00
United HealthCare,PPO,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,2567.00
United HealthCare,PPO,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,2567.00
United HealthCare,PPO,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,Case Rate,2567.00
United HealthCare,PPO,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,Case Rate,2567.00
United HealthCare,PPO,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,Case Rate,2567.00
United HealthCare,PPO,77424,CPT4/HCPCS,IO RAD TX DELIVERY BY X-RAY,,Case Rate,2567.00
United HealthCare,PPO,77425,CPT4/HCPCS,IO RAD TX DELIVER BY ELCTRNS,,Case Rate,2567.00
United HealthCare,PPO,77427,CPT4/HCPCS,RADIATION TX MANAGEMENT X5,,Case Rate,2567.00
United HealthCare,PPO,77431,CPT4/HCPCS,RADIATION THERAPY MANAGEMENT,,Case Rate,2567.00
United HealthCare,PPO,77432,CPT4/HCPCS,STEREOTACTIC RADIATION TRMT,,Case Rate,2567.00
United HealthCare,PPO,77435,CPT4/HCPCS,SBRT MANAGEMENT,,Case Rate,2567.00
United HealthCare,PPO,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,Case Rate,2567.00
United HealthCare,PPO,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,Case Rate,2567.00
United HealthCare,PPO,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,Case Rate,2567.00
United HealthCare,PPO,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,Case Rate,2567.00
United HealthCare,PPO,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,Case Rate,2567.00
United HealthCare,PPO,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,Case Rate,2567.00
United HealthCare,PPO,77600,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2567.00
United HealthCare,PPO,77605,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2567.00
United HealthCare,PPO,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2567.00
United HealthCare,PPO,77615,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2567.00
United HealthCare,PPO,77620,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,Case Rate,2567.00
United HealthCare,PPO,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,Case Rate,2567.00
United HealthCare,PPO,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,Case Rate,2567.00
United HealthCare,PPO,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,Case Rate,2567.00
United HealthCare,PPO,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,Case Rate,2567.00
United HealthCare,PPO,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,2567.00
United HealthCare,PPO,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,Case Rate,2567.00
United HealthCare,PPO,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,2567.00
United HealthCare,PPO,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,2567.00
United HealthCare,PPO,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,Case Rate,2567.00
United HealthCare,PPO,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,Case Rate,2567.00
United HealthCare,PPO,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,Case Rate,2567.00
United HealthCare,PPO,77790,CPT4/HCPCS,RADIATION HANDLING,,Case Rate,2567.00
United HealthCare,PPO,78012,CPT4/HCPCS,THYROID UPTAKE MEASUREMENT,,Per Unit,150.00
United HealthCare,PPO,78013,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Per Unit,150.00
United HealthCare,PPO,78014,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,Per Unit,150.00
United HealthCare,PPO,78015,CPT4/HCPCS,THYROID MET IMAGING,,Per Unit,150.00
United HealthCare,PPO,78016,CPT4/HCPCS,THYROID MET IMAGING/STUDIES,,Per Unit,150.00
United HealthCare,PPO,78018,CPT4/HCPCS,THYROID MET IMAGING BODY,,Per Unit,150.00
United HealthCare,PPO,78020,CPT4/HCPCS,THYROID MET UPTAKE,,Per Unit,150.00
United HealthCare,PPO,78070,CPT4/HCPCS,PARATHYROID PLANAR IMAGING,,Per Unit,150.00
United HealthCare,PPO,78071,CPT4/HCPCS,PARATHYRD PLANAR W/WO SUBTRJ,,Per Unit,150.00
United HealthCare,PPO,78072,CPT4/HCPCS,PARATHYRD PLANAR W/SPECT&CT,,Per Unit,150.00
United HealthCare,PPO,78075,CPT4/HCPCS,ADRENAL CORTEX & MEDULLA IMG,,Per Unit,150.00
United HealthCare,PPO,78102,CPT4/HCPCS,BONE MARROW IMAGING LTD,,Per Unit,150.00
United HealthCare,PPO,78103,CPT4/HCPCS,BONE MARROW IMAGING MULT,,Per Unit,150.00
United HealthCare,PPO,78104,CPT4/HCPCS,BONE MARROW IMAGING BODY,,Per Unit,150.00
United HealthCare,PPO,78110,CPT4/HCPCS,PLASMA VOLUME SINGLE,,Per Unit,150.00
United HealthCare,PPO,78111,CPT4/HCPCS,PLASMA VOLUME MULTIPLE,,Per Unit,150.00
United HealthCare,PPO,78120,CPT4/HCPCS,RED CELL MASS SINGLE,,Per Unit,150.00
United HealthCare,PPO,78121,CPT4/HCPCS,RED CELL MASS MULTIPLE,,Per Unit,150.00
United HealthCare,PPO,78122,CPT4/HCPCS,BLOOD VOLUME,,Per Unit,150.00
United HealthCare,PPO,78130,CPT4/HCPCS,RED CELL SURVIVAL STUDY,,Per Unit,150.00
United HealthCare,PPO,78135,CPT4/HCPCS,RED CELL SURVIVAL KINETICS,,Per Unit,150.00
United HealthCare,PPO,78140,CPT4/HCPCS,RED CELL SEQUESTRATION,,Per Unit,150.00
United HealthCare,PPO,78185,CPT4/HCPCS,SPLEEN IMAGING,,Per Unit,150.00
United HealthCare,PPO,78191,CPT4/HCPCS,PLATELET SURVIVAL,,Per Unit,150.00
United HealthCare,PPO,78195,CPT4/HCPCS,LYMPH SYSTEM IMAGING,,Per Unit,150.00
United HealthCare,PPO,78201,CPT4/HCPCS,LIVER IMAGING,,Per Unit,150.00
United HealthCare,PPO,78202,CPT4/HCPCS,LIVER IMAGING WITH FLOW,,Per Unit,150.00
United HealthCare,PPO,78215,CPT4/HCPCS,LIVER AND SPLEEN IMAGING,,Per Unit,150.00
United HealthCare,PPO,78216,CPT4/HCPCS,LIVER & SPLEEN IMAGE/FLOW,,Per Unit,150.00
United HealthCare,PPO,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,Per Unit,150.00
United HealthCare,PPO,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,Per Unit,150.00
United HealthCare,PPO,78230,CPT4/HCPCS,SALIVARY GLAND IMAGING,,Per Unit,150.00
United HealthCare,PPO,78231,CPT4/HCPCS,SERIAL SALIVARY IMAGING,,Per Unit,150.00
United HealthCare,PPO,78232,CPT4/HCPCS,SALIVARY GLAND FUNCTION EXAM,,Per Unit,150.00
United HealthCare,PPO,78258,CPT4/HCPCS,ESOPHAGEAL MOTILITY STUDY,,Per Unit,150.00
United HealthCare,PPO,78261,CPT4/HCPCS,GASTRIC MUCOSA IMAGING,,Per Unit,150.00
United HealthCare,PPO,78262,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX EXAM,,Per Unit,150.00
United HealthCare,PPO,78264,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Per Unit,150.00
United HealthCare,PPO,78265,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Per Unit,150.00
United HealthCare,PPO,78266,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,Per Unit,150.00
United HealthCare,PPO,78267,CPT4/HCPCS,BREATH TST ATTAIN/ANAL C-14,,Per Unit,150.00
United HealthCare,PPO,78268,CPT4/HCPCS,BREATH TEST ANALYSIS C-14,,Per Unit,150.00
United HealthCare,PPO,78278,CPT4/HCPCS,ACUTE GI BLOOD LOSS IMAGING,,Per Unit,150.00
United HealthCare,PPO,78282,CPT4/HCPCS,GI PROTEIN LOSS EXAM,,Per Unit,150.00
United HealthCare,PPO,78290,CPT4/HCPCS,MECKELS DIVERT EXAM,,Per Unit,150.00
United HealthCare,PPO,78291,CPT4/HCPCS,LEVEEN/SHUNT PATENCY EXAM,,Per Unit,150.00
United HealthCare,PPO,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,Case Rate,11173.00
United HealthCare,PPO,78300,CPT4/HCPCS,BONE IMAGING LIMITED AREA,,Per Unit,150.00
United HealthCare,PPO,78305,CPT4/HCPCS,BONE IMAGING MULTIPLE AREAS,,Per Unit,150.00
United HealthCare,PPO,78306,CPT4/HCPCS,BONE IMAGING WHOLE BODY,,Per Unit,150.00
United HealthCare,PPO,78315,CPT4/HCPCS,BONE IMAGING 3 PHASE,,Per Unit,150.00
United HealthCare,PPO,78350,CPT4/HCPCS,BONE MINERAL SINGLE PHOTON,,Per Unit,150.00
United HealthCare,PPO,78351,CPT4/HCPCS,BONE MINERAL DUAL PHOTON,,Per Unit,150.00
United HealthCare,PPO,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,Case Rate,11173.00
United HealthCare,PPO,78414,CPT4/HCPCS,NON-IMAGING HEART FUNCTION,,Per Unit,150.00
United HealthCare,PPO,78428,CPT4/HCPCS,CARDIAC SHUNT IMAGING,,Per Unit,150.00
United HealthCare,PPO,78445,CPT4/HCPCS,VASCULAR FLOW IMAGING,,Per Unit,150.00
United HealthCare,PPO,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,Per Unit,150.00
United HealthCare,PPO,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,Per Unit,150.00
United HealthCare,PPO,78453,CPT4/HCPCS,HT MUSCLE IMAGE PLANAR SING,,Per Unit,150.00
United HealthCare,PPO,78454,CPT4/HCPCS,HT MUSC IMAGE PLANAR MULT,,Per Unit,150.00
United HealthCare,PPO,78456,CPT4/HCPCS,ACUTE VENOUS THROMBUS IMAGE,,Per Unit,150.00
United HealthCare,PPO,78457,CPT4/HCPCS,VENOUS THROMBOSIS IMAGING,,Per Unit,150.00
United HealthCare,PPO,78458,CPT4/HCPCS,VEN THROMBOSIS IMAGES BILAT,,Per Unit,150.00
United HealthCare,PPO,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,Per Unit,150.00
United HealthCare,PPO,78466,CPT4/HCPCS,HEART INFARCT IMAGE,,Per Unit,150.00
United HealthCare,PPO,78468,CPT4/HCPCS,HEART INFARCT IMAGE (EF),,Per Unit,150.00
United HealthCare,PPO,78469,CPT4/HCPCS,HEART INFARCT IMAGE (3D),,Per Unit,150.00
United HealthCare,PPO,78472,CPT4/HCPCS,GATED HEART PLANAR SINGLE,,Per Unit,150.00
United HealthCare,PPO,78473,CPT4/HCPCS,GATED HEART MULTIPLE,,Per Unit,150.00
United HealthCare,PPO,78481,CPT4/HCPCS,HEART FIRST PASS SINGLE,,Per Unit,150.00
United HealthCare,PPO,78483,CPT4/HCPCS,HEART FIRST PASS MULTIPLE,,Per Unit,150.00
United HealthCare,PPO,78491,CPT4/HCPCS,MYOCRD IMG PET 1STD RST/STRS,,Per Unit,150.00
United HealthCare,PPO,78492,CPT4/HCPCS,MYOCRD IMG PET MLT RST&STRS,,Per Unit,150.00
United HealthCare,PPO,78494,CPT4/HCPCS,HEART IMAGE SPECT,,Per Unit,150.00
United HealthCare,PPO,78496,CPT4/HCPCS,HEART FIRST PASS ADD-ON,,Per Unit,150.00
United HealthCare,PPO,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,Case Rate,11173.00
United HealthCare,PPO,78579,CPT4/HCPCS,LUNG VENTILATION IMAGING,,Per Unit,150.00
United HealthCare,PPO,78580,CPT4/HCPCS,LUNG PERFUSION IMAGING,,Per Unit,150.00
United HealthCare,PPO,78582,CPT4/HCPCS,LUNG VENTILAT&PERFUS IMAGING,,Per Unit,150.00
United HealthCare,PPO,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,Per Unit,150.00
United HealthCare,PPO,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,Per Unit,150.00
United HealthCare,PPO,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,Case Rate,11173.00
United HealthCare,PPO,78600,CPT4/HCPCS,BRAIN IMAGE < 4 VIEWS,,Per Unit,150.00
United HealthCare,PPO,78601,CPT4/HCPCS,BRAIN IMAGE W/FLOW < 4 VIEWS,,Per Unit,150.00
United HealthCare,PPO,78605,CPT4/HCPCS,BRAIN IMAGE 4+ VIEWS,,Per Unit,150.00
United HealthCare,PPO,78606,CPT4/HCPCS,BRAIN IMAGE W/FLOW 4 + VIEWS,,Per Unit,150.00
United HealthCare,PPO,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,Per Unit,150.00
United HealthCare,PPO,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,Per Unit,150.00
United HealthCare,PPO,78610,CPT4/HCPCS,BRAIN FLOW IMAGING ONLY,,Per Unit,150.00
United HealthCare,PPO,78630,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,Per Unit,150.00
United HealthCare,PPO,78635,CPT4/HCPCS,CSF VENTRICULOGRAPHY,,Per Unit,150.00
United HealthCare,PPO,78645,CPT4/HCPCS,CSF SHUNT EVALUATION,,Per Unit,150.00
United HealthCare,PPO,78650,CPT4/HCPCS,CSF LEAKAGE IMAGING,,Per Unit,150.00
United HealthCare,PPO,78660,CPT4/HCPCS,NUCLEAR EXAM OF TEAR FLOW,,Per Unit,150.00
United HealthCare,PPO,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,Case Rate,11173.00
United HealthCare,PPO,78700,CPT4/HCPCS,KIDNEY IMAGING MORPHOL,,Per Unit,150.00
United HealthCare,PPO,78701,CPT4/HCPCS,KIDNEY IMAGING WITH FLOW,,Per Unit,150.00
United HealthCare,PPO,78707,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/O DRUG,,Per Unit,150.00
United HealthCare,PPO,78708,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/DRUG,,Per Unit,150.00
United HealthCare,PPO,78709,CPT4/HCPCS,K FLOW/FUNCT IMAGE MULTIPLE,,Per Unit,150.00
United HealthCare,PPO,78725,CPT4/HCPCS,KIDNEY FUNCTION STUDY,,Per Unit,150.00
United HealthCare,PPO,78730,CPT4/HCPCS,URINARY BLADDER RETENTION,,Per Unit,150.00
United HealthCare,PPO,78740,CPT4/HCPCS,URETERAL REFLUX STUDY,,Per Unit,150.00
United HealthCare,PPO,78761,CPT4/HCPCS,TESTICULAR IMAGING W/FLOW,,Per Unit,150.00
United HealthCare,PPO,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,Case Rate,11173.00
United HealthCare,PPO,78800,CPT4/HCPCS,RP LOCLZJ TUM 1 AREA 1 D IMG,,Per Unit,150.00
United HealthCare,PPO,78801,CPT4/HCPCS,RP LOCLZJ TUM 2+AREA 1+D IMG,,Per Unit,150.00
United HealthCare,PPO,78802,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 1 D IMG,,Per Unit,150.00
United HealthCare,PPO,78803,CPT4/HCPCS,RP LOCLZJ TUM SPECT 1 AREA,,Per Unit,150.00
United HealthCare,PPO,78804,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 2+D IMG,,Per Unit,150.00
United HealthCare,PPO,78808,CPT4/HCPCS,IV INJ RA DRUG DX STUDY,,Per Unit,150.00
United HealthCare,PPO,78811,CPT4/HCPCS,PET IMAGE LTD AREA,,Per Unit,150.00
United HealthCare,PPO,78812,CPT4/HCPCS,PET IMAGE SKULL-THIGH,,Per Unit,150.00
United HealthCare,PPO,78813,CPT4/HCPCS,PET IMAGE FULL BODY,,Per Unit,150.00
United HealthCare,PPO,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,Per Unit,150.00
United HealthCare,PPO,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,Per Unit,150.00
United HealthCare,PPO,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,Per Unit,150.00
United HealthCare,PPO,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,Per Unit,150.00
United HealthCare,PPO,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,Per Unit,150.00
United HealthCare,PPO,79200,CPT4/HCPCS,NUCLEAR RX INTRACAV ADMIN,,Per Unit,150.00
United HealthCare,PPO,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,Per Unit,150.00
United HealthCare,PPO,79403,CPT4/HCPCS,HEMATOPOIETIC NUCLEAR TX,,Per Unit,150.00
United HealthCare,PPO,79440,CPT4/HCPCS,NUCLEAR RX INTRA-ARTICULAR,,Per Unit,150.00
United HealthCare,PPO,79445,CPT4/HCPCS,NUCLEAR RX INTRA-ARTERIAL,,Per Unit,150.00
United HealthCare,PPO,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,Case Rate,4868.00
United HealthCare,PPO,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,Case Rate,4868.00
United HealthCare,PPO,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,Case Rate,4868.00
United HealthCare,PPO,80047,CPT4/HCPCS,METABOLIC PANEL IONIZED CA,,Per Unit,102.00
United HealthCare,PPO,80048,CPT4/HCPCS,METABOLIC PANEL TOTAL CA,,Per Unit,102.00
United HealthCare,PPO,80050,CPT4/HCPCS,GENERAL HEALTH PANEL,,Per Unit,102.00
United HealthCare,PPO,80051,CPT4/HCPCS,ELECTROLYTE PANEL,,Per Unit,102.00
United HealthCare,PPO,80053,CPT4/HCPCS,COMPREHEN METABOLIC PANEL,,Per Unit,102.00
United HealthCare,PPO,80055,CPT4/HCPCS,OBSTETRIC PANEL,,Per Unit,102.00
United HealthCare,PPO,80061,CPT4/HCPCS,LIPID PANEL,,Per Unit,102.00
United HealthCare,PPO,80069,CPT4/HCPCS,RENAL FUNCTION PANEL,,Per Unit,102.00
United HealthCare,PPO,80074,CPT4/HCPCS,ACUTE HEPATITIS PANEL,,Per Unit,102.00
United HealthCare,PPO,80076,CPT4/HCPCS,HEPATIC FUNCTION PANEL,,Per Unit,102.00
United HealthCare,PPO,80081,CPT4/HCPCS,OBSTETRIC PANEL,,Per Unit,102.00
United HealthCare,PPO,80150,CPT4/HCPCS,ASSAY OF AMIKACIN,,Per Unit,102.00
United HealthCare,PPO,80155,CPT4/HCPCS,DRUG ASSAY CAFFEINE,,Per Unit,102.00
United HealthCare,PPO,80156,CPT4/HCPCS,ASSAY CARBAMAZEPINE TOTAL,,Per Unit,102.00
United HealthCare,PPO,80157,CPT4/HCPCS,ASSAY CARBAMAZEPINE FREE,,Per Unit,102.00
United HealthCare,PPO,80158,CPT4/HCPCS,DRUG ASSAY CYCLOSPORINE,,Per Unit,102.00
United HealthCare,PPO,80159,CPT4/HCPCS,DRUG ASSAY CLOZAPINE,,Per Unit,102.00
United HealthCare,PPO,80162,CPT4/HCPCS,ASSAY OF DIGOXIN TOTAL,,Per Unit,102.00
United HealthCare,PPO,80163,CPT4/HCPCS,ASSAY OF DIGOXIN FREE,,Per Unit,102.00
United HealthCare,PPO,80164,CPT4/HCPCS,ASSAY DIPROPYLACETIC ACD TOT,,Per Unit,102.00
United HealthCare,PPO,80165,CPT4/HCPCS,DIPROPYLACETIC ACID FREE,,Per Unit,102.00
United HealthCare,PPO,80168,CPT4/HCPCS,ASSAY OF ETHOSUXIMIDE,,Per Unit,102.00
United HealthCare,PPO,80169,CPT4/HCPCS,DRUG ASSAY EVEROLIMUS,,Per Unit,102.00
United HealthCare,PPO,80170,CPT4/HCPCS,ASSAY OF GENTAMICIN,,Per Unit,102.00
United HealthCare,PPO,80171,CPT4/HCPCS,DRUG SCREEN QUANT GABAPENTIN,,Per Unit,102.00
United HealthCare,PPO,80173,CPT4/HCPCS,ASSAY OF HALOPERIDOL,,Per Unit,102.00
United HealthCare,PPO,80175,CPT4/HCPCS,DRUG SCREEN QUAN LAMOTRIGINE,,Per Unit,102.00
United HealthCare,PPO,80176,CPT4/HCPCS,ASSAY OF LIDOCAINE,,Per Unit,102.00
United HealthCare,PPO,80177,CPT4/HCPCS,DRUG SCRN QUAN LEVETIRACETAM,,Per Unit,102.00
United HealthCare,PPO,80178,CPT4/HCPCS,ASSAY OF LITHIUM,,Per Unit,102.00
United HealthCare,PPO,80180,CPT4/HCPCS,DRUG SCRN QUAN MYCOPHENOLATE,,Per Unit,102.00
United HealthCare,PPO,80183,CPT4/HCPCS,DRUG SCRN QUANT OXCARBAZEPIN,,Per Unit,102.00
United HealthCare,PPO,80184,CPT4/HCPCS,ASSAY OF PHENOBARBITAL,,Per Unit,102.00
United HealthCare,PPO,80185,CPT4/HCPCS,ASSAY OF PHENYTOIN TOTAL,,Per Unit,102.00
United HealthCare,PPO,80186,CPT4/HCPCS,ASSAY OF PHENYTOIN FREE,,Per Unit,102.00
United HealthCare,PPO,80188,CPT4/HCPCS,ASSAY OF PRIMIDONE,,Per Unit,102.00
United HealthCare,PPO,80190,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,Per Unit,102.00
United HealthCare,PPO,80192,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,Per Unit,102.00
United HealthCare,PPO,80194,CPT4/HCPCS,ASSAY OF QUINIDINE,,Per Unit,102.00
United HealthCare,PPO,80195,CPT4/HCPCS,ASSAY OF SIROLIMUS,,Per Unit,102.00
United HealthCare,PPO,80197,CPT4/HCPCS,ASSAY OF TACROLIMUS,,Per Unit,102.00
United HealthCare,PPO,80198,CPT4/HCPCS,ASSAY OF THEOPHYLLINE,,Per Unit,102.00
United HealthCare,PPO,80199,CPT4/HCPCS,DRUG SCREEN QUANT TIAGABINE,,Per Unit,102.00
United HealthCare,PPO,80200,CPT4/HCPCS,ASSAY OF TOBRAMYCIN,,Per Unit,102.00
United HealthCare,PPO,80201,CPT4/HCPCS,ASSAY OF TOPIRAMATE,,Per Unit,102.00
United HealthCare,PPO,80202,CPT4/HCPCS,ASSAY OF VANCOMYCIN,,Per Unit,102.00
United HealthCare,PPO,80203,CPT4/HCPCS,DRUG SCREEN QUANT ZONISAMIDE,,Per Unit,102.00
United HealthCare,PPO,80299,CPT4/HCPCS,QUANTITATIVE ASSAY DRUG,,Per Unit,102.00
United HealthCare,PPO,80305,CPT4/HCPCS,DRUG TEST PRSMV DIR OPT OBS,,Per Unit,102.00
United HealthCare,PPO,80306,CPT4/HCPCS,DRUG TEST PRSMV INSTRMNT,,Per Unit,102.00
United HealthCare,PPO,80307,CPT4/HCPCS,DRUG TEST PRSMV CHEM ANLYZR,,Per Unit,102.00
United HealthCare,PPO,80320,CPT4/HCPCS,DRUG SCREEN QUANTALCOHOLS,,Per Unit,102.00
United HealthCare,PPO,80321,CPT4/HCPCS,ALCOHOLS BIOMARKERS 1OR 2,,Per Unit,102.00
United HealthCare,PPO,80322,CPT4/HCPCS,ALCOHOLS BIOMARKERS 3/MORE,,Per Unit,102.00
United HealthCare,PPO,80323,CPT4/HCPCS,ALKALOIDS NOS,,Per Unit,102.00
United HealthCare,PPO,80324,CPT4/HCPCS,DRUG SCREEN AMPHETAMINES 1/2,,Per Unit,102.00
United HealthCare,PPO,80325,CPT4/HCPCS,AMPHETAMINES 3OR 4,,Per Unit,102.00
United HealthCare,PPO,80326,CPT4/HCPCS,AMPHETAMINES 5 OR MORE,,Per Unit,102.00
United HealthCare,PPO,80327,CPT4/HCPCS,ANABOLIC STEROID 1 OR 2,,Per Unit,102.00
United HealthCare,PPO,80328,CPT4/HCPCS,ANABOLIC STEROID 3 OR MORE,,Per Unit,102.00
United HealthCare,PPO,80329,CPT4/HCPCS,ANALGESICS NON-OPIOID 1 OR 2,,Per Unit,102.00
United HealthCare,PPO,80330,CPT4/HCPCS,ANALGESICS NON-OPIOID 3-5,,Per Unit,102.00
United HealthCare,PPO,80331,CPT4/HCPCS,ANALGESICS NON-OPIOID 6/MORE,,Per Unit,102.00
United HealthCare,PPO,80332,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 1 OR 2,,Per Unit,102.00
United HealthCare,PPO,80333,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 3-5,,Per Unit,102.00
United HealthCare,PPO,80334,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 6/MORE,,Per Unit,102.00
United HealthCare,PPO,80335,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 1/2,,Per Unit,102.00
United HealthCare,PPO,80336,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 3-5,,Per Unit,102.00
United HealthCare,PPO,80337,CPT4/HCPCS,TRICYCLIC & CYCLICALS 6/MORE,,Per Unit,102.00
United HealthCare,PPO,80338,CPT4/HCPCS,ANTIDEPRESSANT NOT SPECIFIED,,Per Unit,102.00
United HealthCare,PPO,80339,CPT4/HCPCS,ANTIEPILEPTICS NOS 1-3,,Per Unit,102.00
United HealthCare,PPO,80340,CPT4/HCPCS,ANTIEPILEPTICS NOS 4-6,,Per Unit,102.00
United HealthCare,PPO,80341,CPT4/HCPCS,ANTIEPILEPTICS NOS 7/MORE,,Per Unit,102.00
United HealthCare,PPO,80342,CPT4/HCPCS,ANTIPSYCHOTICS NOS 1-3,,Per Unit,102.00
United HealthCare,PPO,80343,CPT4/HCPCS,ANTIPSYCHOTICS NOS 4-6,,Per Unit,102.00
United HealthCare,PPO,80344,CPT4/HCPCS,ANTIPSYCHOTICS NOS 7/MORE,,Per Unit,102.00
United HealthCare,PPO,80345,CPT4/HCPCS,DRUG SCREENING BARBITURATES,,Per Unit,102.00
United HealthCare,PPO,80346,CPT4/HCPCS,BENZODIAZEPINES1-12,,Per Unit,102.00
United HealthCare,PPO,80347,CPT4/HCPCS,BENZODIAZEPINES 13 OR MORE,,Per Unit,102.00
United HealthCare,PPO,80348,CPT4/HCPCS,DRUG SCREENING BUPRENORPHINE,,Per Unit,102.00
United HealthCare,PPO,80349,CPT4/HCPCS,CANNABINOIDS NATURAL,,Per Unit,102.00
United HealthCare,PPO,80350,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 1-3,,Per Unit,102.00
United HealthCare,PPO,80351,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 4-6,,Per Unit,102.00
United HealthCare,PPO,80352,CPT4/HCPCS,CANNABINOID SYNTHETIC 7/MORE,,Per Unit,102.00
United HealthCare,PPO,80353,CPT4/HCPCS,DRUG SCREENING COCAINE,,Per Unit,102.00
United HealthCare,PPO,80354,CPT4/HCPCS,DRUG SCREENING FENTANYL,,Per Unit,102.00
United HealthCare,PPO,80355,CPT4/HCPCS,GABAPENTIN NON-BLOOD,,Per Unit,102.00
United HealthCare,PPO,80356,CPT4/HCPCS,HEROIN METABOLITE,,Per Unit,102.00
United HealthCare,PPO,80357,CPT4/HCPCS,KETAMINE AND NORKETAMINE,,Per Unit,102.00
United HealthCare,PPO,80358,CPT4/HCPCS,DRUG SCREENING METHADONE,,Per Unit,102.00
United HealthCare,PPO,80359,CPT4/HCPCS,METHYLENEDIOXYAMPHETAMINES,,Per Unit,102.00
United HealthCare,PPO,80360,CPT4/HCPCS,METHYLPHENIDATE,,Per Unit,102.00
United HealthCare,PPO,80361,CPT4/HCPCS,OPIATES 1 OR MORE,,Per Unit,102.00
United HealthCare,PPO,80362,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 1/2,,Per Unit,102.00
United HealthCare,PPO,80363,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 3/4,,Per Unit,102.00
United HealthCare,PPO,80364,CPT4/HCPCS,OPIOID &OPIATE ANALOG 5/MORE,,Per Unit,102.00
United HealthCare,PPO,80365,CPT4/HCPCS,DRUG SCREENING OXYCODONE,,Per Unit,102.00
United HealthCare,PPO,80366,CPT4/HCPCS,DRUG SCREENING PREGABALIN,,Per Unit,102.00
United HealthCare,PPO,80367,CPT4/HCPCS,DRUG SCREENING PROPOXYPHENE,,Per Unit,102.00
United HealthCare,PPO,80368,CPT4/HCPCS,SEDATIVE HYPNOTICS,,Per Unit,102.00
United HealthCare,PPO,80369,CPT4/HCPCS,SKELETAL MUSCLE RELAXANT 1/2,,Per Unit,102.00
United HealthCare,PPO,80370,CPT4/HCPCS,SKEL MUSC RELAXANT 3 OR MORE,,Per Unit,102.00
United HealthCare,PPO,80371,CPT4/HCPCS,STIMULANTS SYNTHETIC,,Per Unit,102.00
United HealthCare,PPO,80372,CPT4/HCPCS,DRUG SCREENING TAPENTADOL,,Per Unit,102.00
United HealthCare,PPO,80373,CPT4/HCPCS,DRUG SCREENING TRAMADOL,,Per Unit,102.00
United HealthCare,PPO,80374,CPT4/HCPCS,STEREOISOMER ANALYSIS,,Per Unit,102.00
United HealthCare,PPO,80375,CPT4/HCPCS,DRUG/SUBSTANCE NOS 1-3,,Per Unit,102.00
United HealthCare,PPO,80376,CPT4/HCPCS,DRUG/SUBSTANCE NOS 4-6,,Per Unit,102.00
United HealthCare,PPO,80377,CPT4/HCPCS,DRUG/SUBSTANCE NOS 7/MORE,,Per Unit,102.00
United HealthCare,PPO,80400,CPT4/HCPCS,ACTH STIMULATION PANEL,,Per Unit,102.00
United HealthCare,PPO,80402,CPT4/HCPCS,ACTH STIMULATION PANEL,,Per Unit,102.00
United HealthCare,PPO,80406,CPT4/HCPCS,ACTH STIMULATION PANEL,,Per Unit,102.00
United HealthCare,PPO,80408,CPT4/HCPCS,ALDOSTERONE SUPPRESSION EVAL,,Per Unit,102.00
United HealthCare,PPO,80410,CPT4/HCPCS,CALCITONIN STIMUL PANEL,,Per Unit,102.00
United HealthCare,PPO,80412,CPT4/HCPCS,CRH STIMULATION PANEL,,Per Unit,102.00
United HealthCare,PPO,80414,CPT4/HCPCS,TESTOSTERONE RESPONSE PANEL,,Per Unit,102.00
United HealthCare,PPO,80415,CPT4/HCPCS,TOT ESTRADIOL RESPONSE PANEL,,Per Unit,102.00
United HealthCare,PPO,80416,CPT4/HCPCS,RENIN STIMULATION PANEL,,Per Unit,102.00
United HealthCare,PPO,80417,CPT4/HCPCS,RENIN STIMULATION PANEL,,Per Unit,102.00
United HealthCare,PPO,80418,CPT4/HCPCS,PITUITARY EVALUATION PANEL,,Per Unit,102.00
United HealthCare,PPO,80420,CPT4/HCPCS,DEXAMETHASONE PANEL,,Per Unit,102.00
United HealthCare,PPO,80422,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,Per Unit,102.00
United HealthCare,PPO,80424,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,Per Unit,102.00
United HealthCare,PPO,80426,CPT4/HCPCS,GONADOTROPIN HORMONE PANEL,,Per Unit,102.00
United HealthCare,PPO,80428,CPT4/HCPCS,GROWTH HORMONE PANEL,,Per Unit,102.00
United HealthCare,PPO,80430,CPT4/HCPCS,GROWTH HORMONE PANEL,,Per Unit,102.00
United HealthCare,PPO,80432,CPT4/HCPCS,INSULIN SUPPRESSION PANEL,,Per Unit,102.00
United HealthCare,PPO,80434,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,Per Unit,102.00
United HealthCare,PPO,80435,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,Per Unit,102.00
United HealthCare,PPO,80436,CPT4/HCPCS,METYRAPONE PANEL,,Per Unit,102.00
United HealthCare,PPO,80438,CPT4/HCPCS,TRH STIMULATION PANEL,,Per Unit,102.00
United HealthCare,PPO,80439,CPT4/HCPCS,TRH STIMULATION PANEL,,Per Unit,102.00
United HealthCare,PPO,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,Case Rate,4868.00
United HealthCare,PPO,80500,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,Per Unit,102.00
United HealthCare,PPO,80502,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,Per Unit,102.00
United HealthCare,PPO,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,Case Rate,4868.00
United HealthCare,PPO,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,Case Rate,4868.00
United HealthCare,PPO,81000,CPT4/HCPCS,URINALYSIS NONAUTO W/SCOPE,,Per Unit,102.00
United HealthCare,PPO,81001,CPT4/HCPCS,URINALYSIS AUTO W/SCOPE,,Per Unit,102.00
United HealthCare,PPO,81002,CPT4/HCPCS,URINALYSIS NONAUTO W/O SCOPE,,Per Unit,102.00
United HealthCare,PPO,81003,CPT4/HCPCS,URINALYSIS AUTO W/O SCOPE,,Per Unit,102.00
United HealthCare,PPO,81005,CPT4/HCPCS,URINALYSIS,,Per Unit,102.00
United HealthCare,PPO,81007,CPT4/HCPCS,URINE SCREEN FOR BACTERIA,,Per Unit,102.00
United HealthCare,PPO,81015,CPT4/HCPCS,MICROSCOPIC EXAM OF URINE,,Per Unit,102.00
United HealthCare,PPO,81020,CPT4/HCPCS,URINALYSIS GLASS TEST,,Per Unit,102.00
United HealthCare,PPO,81025,CPT4/HCPCS,URINE PREGNANCY TEST,,Per Unit,102.00
United HealthCare,PPO,81050,CPT4/HCPCS,URINALYSIS VOLUME MEASURE,,Per Unit,102.00
United HealthCare,PPO,81105,CPT4/HCPCS,HPA-1 GENOTYPING,,Per Unit,158.00
United HealthCare,PPO,81106,CPT4/HCPCS,HPA-2 GENOTYPING,,Per Unit,158.00
United HealthCare,PPO,81107,CPT4/HCPCS,HPA-3 GENOTYPING,,Per Unit,158.00
United HealthCare,PPO,81108,CPT4/HCPCS,HPA-4 GENOTYPING,,Per Unit,158.00
United HealthCare,PPO,81109,CPT4/HCPCS,HPA-5 GENOTYPING,,Per Unit,158.00
United HealthCare,PPO,81110,CPT4/HCPCS,HPA-6 GENOTYPING,,Per Unit,158.00
United HealthCare,PPO,81111,CPT4/HCPCS,HPA-9 GENOTYPING,,Per Unit,158.00
United HealthCare,PPO,81112,CPT4/HCPCS,HPA-15 GENOTYPING,,Per Unit,158.00
United HealthCare,PPO,81120,CPT4/HCPCS,IDH1 COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81121,CPT4/HCPCS,IDH2 COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81161,CPT4/HCPCS,DMD DUP/DELET ANALYSIS,,Per Unit,158.00
United HealthCare,PPO,81162,CPT4/HCPCS,BRCA1&2 GEN FULL SEQ DUP/DEL,,Per Unit,158.00
United HealthCare,PPO,81163,CPT4/HCPCS,BRCA1&2 GENE FULL SEQ ALYS,,Per Unit,158.00
United HealthCare,PPO,81164,CPT4/HCPCS,BRCA1&2 GEN FUL DUP/DEL ALYS,,Per Unit,158.00
United HealthCare,PPO,81165,CPT4/HCPCS,BRCA1 GENE FULL SEQ ALYS,,Per Unit,158.00
United HealthCare,PPO,81166,CPT4/HCPCS,BRCA1 GENE FULL DUP/DEL ALYS,,Per Unit,158.00
United HealthCare,PPO,81167,CPT4/HCPCS,BRCA2 GENE FULL DUP/DEL ALYS,,Per Unit,158.00
United HealthCare,PPO,81170,CPT4/HCPCS,ABL1 GENE,,Per Unit,158.00
United HealthCare,PPO,81171,CPT4/HCPCS,AFF2 GENE DETC ABNOR ALLELES,,Per Unit,158.00
United HealthCare,PPO,81172,CPT4/HCPCS,AFF2 GENE CHARAC ALLELES,,Per Unit,158.00
United HealthCare,PPO,81173,CPT4/HCPCS,AR GENE FULL GENE SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81174,CPT4/HCPCS,AR GENE KNOWN FAMIL VARIANT,,Per Unit,158.00
United HealthCare,PPO,81175,CPT4/HCPCS,ASXL1 FULL GENE SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81176,CPT4/HCPCS,ASXL1 GENE TARGET SEQ ALYS,,Per Unit,158.00
United HealthCare,PPO,81177,CPT4/HCPCS,ATN1 GENE DETC ABNOR ALLELES,,Per Unit,158.00
United HealthCare,PPO,81178,CPT4/HCPCS,ATXN1 GENE DETC ABNOR ALLELE,,Per Unit,158.00
United HealthCare,PPO,81179,CPT4/HCPCS,ATXN2 GENE DETC ABNOR ALLELE,,Per Unit,158.00
United HealthCare,PPO,81180,CPT4/HCPCS,ATXN3 GENE DETC ABNOR ALLELE,,Per Unit,158.00
United HealthCare,PPO,81181,CPT4/HCPCS,ATXN7 GENE DETC ABNOR ALLELE,,Per Unit,158.00
United HealthCare,PPO,81182,CPT4/HCPCS,ATXN8OS GEN DETC ABNOR ALLEL,,Per Unit,158.00
United HealthCare,PPO,81183,CPT4/HCPCS,ATXN10 GENE DETC ABNOR ALLEL,,Per Unit,158.00
United HealthCare,PPO,81184,CPT4/HCPCS,CACNA1A GEN DETC ABNOR ALLEL,,Per Unit,158.00
United HealthCare,PPO,81185,CPT4/HCPCS,CACNA1A GENE FULL GENE SEQ,,Per Unit,158.00
United HealthCare,PPO,81186,CPT4/HCPCS,CACNA1A GEN KNOWN FAMIL VRNT,,Per Unit,158.00
United HealthCare,PPO,81187,CPT4/HCPCS,CNBP GENE DETC ABNOR ALLELE,,Per Unit,158.00
United HealthCare,PPO,81188,CPT4/HCPCS,CSTB GENE DETC ABNOR ALLELE,,Per Unit,158.00
United HealthCare,PPO,81189,CPT4/HCPCS,CSTB GENE FULL GENE SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81190,CPT4/HCPCS,CSTB GENE KNOWN FAMIL VRNT,,Per Unit,158.00
United HealthCare,PPO,81200,CPT4/HCPCS,ASPA GENE,,Per Unit,158.00
United HealthCare,PPO,81201,CPT4/HCPCS,APC GENE FULL SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81202,CPT4/HCPCS,APC GENE KNOWN FAM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81203,CPT4/HCPCS,APC GENE DUP/DELET VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81204,CPT4/HCPCS,AR GENE CHARAC ALLELES,,Per Unit,158.00
United HealthCare,PPO,81205,CPT4/HCPCS,BCKDHB GENE,,Per Unit,158.00
United HealthCare,PPO,81206,CPT4/HCPCS,BCR/ABL1 GENE MAJOR BP,,Per Unit,158.00
United HealthCare,PPO,81207,CPT4/HCPCS,BCR/ABL1 GENE MINOR BP,,Per Unit,158.00
United HealthCare,PPO,81208,CPT4/HCPCS,BCR/ABL1 GENE OTHER BP,,Per Unit,158.00
United HealthCare,PPO,81209,CPT4/HCPCS,BLM GENE,,Per Unit,158.00
United HealthCare,PPO,81210,CPT4/HCPCS,BRAF GENE,,Per Unit,158.00
United HealthCare,PPO,81212,CPT4/HCPCS,BRCA1&2 185&5385&6174 VRNT,,Per Unit,158.00
United HealthCare,PPO,81215,CPT4/HCPCS,BRCA1 GENE KNOWN FAMIL VRNT,,Per Unit,158.00
United HealthCare,PPO,81216,CPT4/HCPCS,BRCA2 GENE FULL SEQ ALYS,,Per Unit,158.00
United HealthCare,PPO,81217,CPT4/HCPCS,BRCA2 GENE KNOWN FAMIL VRNT,,Per Unit,158.00
United HealthCare,PPO,81218,CPT4/HCPCS,CEBPA GENE FULL SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81219,CPT4/HCPCS,CALR GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81220,CPT4/HCPCS,CFTR GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81221,CPT4/HCPCS,CFTR GENE KNOWN FAM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81222,CPT4/HCPCS,CFTR GENE DUP/DELET VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81223,CPT4/HCPCS,CFTR GENE FULL SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81224,CPT4/HCPCS,CFTR GENE INTRON POLY T,,Per Unit,158.00
United HealthCare,PPO,81225,CPT4/HCPCS,CYP2C19 GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81226,CPT4/HCPCS,CYP2D6 GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81227,CPT4/HCPCS,CYP2C9 GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81228,CPT4/HCPCS,CYTOGEN MICRARRAY COPY NMBR,,Per Unit,158.00
United HealthCare,PPO,81229,CPT4/HCPCS,CYTOGEN M ARRAY COPY NO&SNP,,Per Unit,158.00
United HealthCare,PPO,81230,CPT4/HCPCS,CYP3A4 GENE COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81231,CPT4/HCPCS,CYP3A5 GENE COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81232,CPT4/HCPCS,DPYD GENE COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81233,CPT4/HCPCS,BTK GENE COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81234,CPT4/HCPCS,DMPK GENE DETC ABNOR ALLELE,,Per Unit,158.00
United HealthCare,PPO,81235,CPT4/HCPCS,EGFR GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81236,CPT4/HCPCS,EZH2 GENE FULL GENE SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81237,CPT4/HCPCS,EZH2 GENE COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81238,CPT4/HCPCS,F9 FULL GENE SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81239,CPT4/HCPCS,DMPK GENE CHARAC ALLELES,,Per Unit,158.00
United HealthCare,PPO,81240,CPT4/HCPCS,F2 GENE,,Per Unit,158.00
United HealthCare,PPO,81241,CPT4/HCPCS,F5 GENE,,Per Unit,158.00
United HealthCare,PPO,81242,CPT4/HCPCS,FANCC GENE,,Per Unit,158.00
United HealthCare,PPO,81243,CPT4/HCPCS,FMR1 GENE DETECTION,,Per Unit,158.00
United HealthCare,PPO,81244,CPT4/HCPCS,FMR1 GENE CHARAC ALLELES,,Per Unit,158.00
United HealthCare,PPO,81245,CPT4/HCPCS,FLT3 GENE,,Per Unit,158.00
United HealthCare,PPO,81246,CPT4/HCPCS,FLT3 GENE ANALYSIS,,Per Unit,158.00
United HealthCare,PPO,81247,CPT4/HCPCS,G6PD GENE ALYS CMN VARIANT,,Per Unit,158.00
United HealthCare,PPO,81248,CPT4/HCPCS,G6PD KNOWN FAMILIAL VARIANT,,Per Unit,158.00
United HealthCare,PPO,81249,CPT4/HCPCS,G6PD FULL GENE SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81250,CPT4/HCPCS,G6PC GENE,,Per Unit,158.00
United HealthCare,PPO,81251,CPT4/HCPCS,GBA GENE,,Per Unit,158.00
United HealthCare,PPO,81252,CPT4/HCPCS,GJB2 GENE FULL SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81253,CPT4/HCPCS,GJB2 GENE KNOWN FAM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81254,CPT4/HCPCS,GJB6 GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81255,CPT4/HCPCS,HEXA GENE,,Per Unit,158.00
United HealthCare,PPO,81256,CPT4/HCPCS,HFE GENE,,Per Unit,158.00
United HealthCare,PPO,81257,CPT4/HCPCS,HBA1/HBA2 GENE,,Per Unit,158.00
United HealthCare,PPO,81258,CPT4/HCPCS,HBA1/HBA2 GENE FAM VRNT,,Per Unit,158.00
United HealthCare,PPO,81259,CPT4/HCPCS,HBA1/HBA2 FULL GENE SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81260,CPT4/HCPCS,IKBKAP GENE,,Per Unit,158.00
United HealthCare,PPO,81261,CPT4/HCPCS,IGH GENE REARRANGE AMP METH,,Per Unit,158.00
United HealthCare,PPO,81262,CPT4/HCPCS,IGH GENE REARRANG DIR PROBE,,Per Unit,158.00
United HealthCare,PPO,81263,CPT4/HCPCS,IGH VARI REGIONAL MUTATION,,Per Unit,158.00
United HealthCare,PPO,81264,CPT4/HCPCS,IGK REARRANGEABN CLONAL POP,,Per Unit,158.00
United HealthCare,PPO,81265,CPT4/HCPCS,STR MARKERS SPECIMEN ANAL,,Per Unit,158.00
United HealthCare,PPO,81266,CPT4/HCPCS,STR MARKERS SPEC ANAL ADDL,,Per Unit,158.00
United HealthCare,PPO,81267,CPT4/HCPCS,CHIMERISM ANAL NO CELL SELEC,,Per Unit,158.00
United HealthCare,PPO,81268,CPT4/HCPCS,CHIMERISM ANAL W/CELL SELECT,,Per Unit,158.00
United HealthCare,PPO,81269,CPT4/HCPCS,HBA1/HBA2 GENE DUP/DEL VRNTS,,Per Unit,158.00
United HealthCare,PPO,81270,CPT4/HCPCS,JAK2 GENE,,Per Unit,158.00
United HealthCare,PPO,81271,CPT4/HCPCS,HTT GENE DETC ABNOR ALLELES,,Per Unit,158.00
United HealthCare,PPO,81272,CPT4/HCPCS,KIT GENE TARGETED SEQ ANALYS,,Per Unit,158.00
United HealthCare,PPO,81273,CPT4/HCPCS,KIT GENE ANALYS D816 VARIANT,,Per Unit,158.00
United HealthCare,PPO,81274,CPT4/HCPCS,HTT GENE CHARAC ALLELES,,Per Unit,158.00
United HealthCare,PPO,81275,CPT4/HCPCS,KRAS GENE VARIANTS EXON 2,,Per Unit,158.00
United HealthCare,PPO,81276,CPT4/HCPCS,KRAS GENE ADDL VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81283,CPT4/HCPCS,IFNL3 GENE,,Per Unit,158.00
United HealthCare,PPO,81284,CPT4/HCPCS,FXN GENE DETC ABNOR ALLELES,,Per Unit,158.00
United HealthCare,PPO,81285,CPT4/HCPCS,FXN GENE CHARAC ALLELES,,Per Unit,158.00
United HealthCare,PPO,81286,CPT4/HCPCS,FXN GENE FULL GENE SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81287,CPT4/HCPCS,MGMT GENE PRMTR MTHYLTN ALYS,,Per Unit,158.00
United HealthCare,PPO,81288,CPT4/HCPCS,MLH1 GENE,,Per Unit,158.00
United HealthCare,PPO,81289,CPT4/HCPCS,FXN GENE KNOWN FAMIL VARIANT,,Per Unit,158.00
United HealthCare,PPO,81290,CPT4/HCPCS,MCOLN1 GENE,,Per Unit,158.00
United HealthCare,PPO,81291,CPT4/HCPCS,MTHFR GENE,,Per Unit,158.00
United HealthCare,PPO,81292,CPT4/HCPCS,MLH1 GENE FULL SEQ,,Per Unit,158.00
United HealthCare,PPO,81293,CPT4/HCPCS,MLH1 GENE KNOWN VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81294,CPT4/HCPCS,MLH1 GENE DUP/DELETE VARIANT,,Per Unit,158.00
United HealthCare,PPO,81295,CPT4/HCPCS,MSH2 GENE FULL SEQ,,Per Unit,158.00
United HealthCare,PPO,81296,CPT4/HCPCS,MSH2 GENE KNOWN VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81297,CPT4/HCPCS,MSH2 GENE DUP/DELETE VARIANT,,Per Unit,158.00
United HealthCare,PPO,81298,CPT4/HCPCS,MSH6 GENE FULL SEQ,,Per Unit,158.00
United HealthCare,PPO,81299,CPT4/HCPCS,MSH6 GENE KNOWN VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81300,CPT4/HCPCS,MSH6 GENE DUP/DELETE VARIANT,,Per Unit,158.00
United HealthCare,PPO,81301,CPT4/HCPCS,MICROSATELLITE INSTABILITY,,Per Unit,158.00
United HealthCare,PPO,81302,CPT4/HCPCS,MECP2 GENE FULL SEQ,,Per Unit,158.00
United HealthCare,PPO,81303,CPT4/HCPCS,MECP2 GENE KNOWN VARIANT,,Per Unit,158.00
United HealthCare,PPO,81304,CPT4/HCPCS,MECP2 GENE DUP/DELET VARIANT,,Per Unit,158.00
United HealthCare,PPO,81305,CPT4/HCPCS,MYD88 GENE P.LEU265PRO VRNT,,Per Unit,158.00
United HealthCare,PPO,81306,CPT4/HCPCS,NUDT15 GENE COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81310,CPT4/HCPCS,NPM1 GENE,,Per Unit,158.00
United HealthCare,PPO,81311,CPT4/HCPCS,NRAS GENE VARIANTS EXON 2&3,,Per Unit,158.00
United HealthCare,PPO,81312,CPT4/HCPCS,PABPN1 GENE DETC ABNOR ALLEL,,Per Unit,158.00
United HealthCare,PPO,81313,CPT4/HCPCS,PCA3/KLK3 ANTIGEN,,Per Unit,158.00
United HealthCare,PPO,81314,CPT4/HCPCS,PDGFRA GENE,,Per Unit,158.00
United HealthCare,PPO,81315,CPT4/HCPCS,PML/RARALPHA COM BREAKPOINTS,,Per Unit,158.00
United HealthCare,PPO,81316,CPT4/HCPCS,PML/RARALPHA 1 BREAKPOINT,,Per Unit,158.00
United HealthCare,PPO,81317,CPT4/HCPCS,PMS2 GENE FULL SEQ ANALYSIS,,Per Unit,158.00
United HealthCare,PPO,81318,CPT4/HCPCS,PMS2 KNOWN FAMILIAL VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81319,CPT4/HCPCS,PMS2 GENE DUP/DELET VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81320,CPT4/HCPCS,PLCG2 GENE COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81321,CPT4/HCPCS,PTEN GENE FULL SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81322,CPT4/HCPCS,PTEN GENE KNOWN FAM VARIANT,,Per Unit,158.00
United HealthCare,PPO,81323,CPT4/HCPCS,PTEN GENE DUP/DELET VARIANT,,Per Unit,158.00
United HealthCare,PPO,81324,CPT4/HCPCS,PMP22 GENE DUP/DELET,,Per Unit,158.00
United HealthCare,PPO,81325,CPT4/HCPCS,PMP22 GENE FULL SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81326,CPT4/HCPCS,PMP22 GENE KNOWN FAM VARIANT,,Per Unit,158.00
United HealthCare,PPO,81327,CPT4/HCPCS,SEPT9 GEN PRMTR MTHYLTN ALYS,,Per Unit,158.00
United HealthCare,PPO,81328,CPT4/HCPCS,SLCO1B1 GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81329,CPT4/HCPCS,SMN1 GENE DOS/DELETION ALYS,,Per Unit,158.00
United HealthCare,PPO,81330,CPT4/HCPCS,SMPD1 GENE COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81331,CPT4/HCPCS,SNRPN/UBE3A GENE,,Per Unit,158.00
United HealthCare,PPO,81332,CPT4/HCPCS,SERPINA1 GENE,,Per Unit,158.00
United HealthCare,PPO,81333,CPT4/HCPCS,TGFBI GENE COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81334,CPT4/HCPCS,RUNX1 GENE TARGETED SEQ ALYS,,Per Unit,158.00
United HealthCare,PPO,81335,CPT4/HCPCS,TPMT GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81336,CPT4/HCPCS,SMN1 GENE FULL GENE SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81337,CPT4/HCPCS,SMN1 GEN NOWN FAMIL SEQ VRNT,,Per Unit,158.00
United HealthCare,PPO,81340,CPT4/HCPCS,TRB@ GENE REARRANGE AMPLIFY,,Per Unit,158.00
United HealthCare,PPO,81341,CPT4/HCPCS,TRB@ GENE REARRANGE DIRPROBE,,Per Unit,158.00
United HealthCare,PPO,81342,CPT4/HCPCS,TRG GENE REARRANGEMENT ANAL,,Per Unit,158.00
United HealthCare,PPO,81343,CPT4/HCPCS,PPP2R2B GEN DETC ABNOR ALLEL,,Per Unit,158.00
United HealthCare,PPO,81344,CPT4/HCPCS,TBP GENE DETC ABNOR ALLELES,,Per Unit,158.00
United HealthCare,PPO,81345,CPT4/HCPCS,TERT GENE TARGETED SEQ ALYS,,Per Unit,158.00
United HealthCare,PPO,81346,CPT4/HCPCS,TYMS GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81350,CPT4/HCPCS,UGT1A1 GENE COMMON VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81355,CPT4/HCPCS,VKORC1 GENE,,Per Unit,158.00
United HealthCare,PPO,81361,CPT4/HCPCS,HBB GENE COM VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81362,CPT4/HCPCS,HBB GENE KNOWN FAM VARIANT,,Per Unit,158.00
United HealthCare,PPO,81363,CPT4/HCPCS,HBB GENE DUP/DEL VARIANTS,,Per Unit,158.00
United HealthCare,PPO,81364,CPT4/HCPCS,HBB FULL GENE SEQUENCE,,Per Unit,158.00
United HealthCare,PPO,81370,CPT4/HCPCS,HLA I & II TYPING LR,,Per Unit,158.00
United HealthCare,PPO,81371,CPT4/HCPCS,HLA I & II TYPE VERIFY LR,,Per Unit,158.00
United HealthCare,PPO,81372,CPT4/HCPCS,HLA I TYPING COMPLETE LR,,Per Unit,158.00
United HealthCare,PPO,81373,CPT4/HCPCS,HLA I TYPING 1 LOCUS LR,,Per Unit,158.00
United HealthCare,PPO,81374,CPT4/HCPCS,HLA I TYPING 1 ANTIGEN LR,,Per Unit,158.00
United HealthCare,PPO,81375,CPT4/HCPCS,HLA II TYPING AG EQUIV LR,,Per Unit,158.00
United HealthCare,PPO,81376,CPT4/HCPCS,HLA II TYPING 1 LOCUS LR,,Per Unit,158.00
United HealthCare,PPO,81377,CPT4/HCPCS,HLA II TYPE 1 AG EQUIV LR,,Per Unit,158.00
United HealthCare,PPO,81378,CPT4/HCPCS,HLA I & II TYPING HR,,Per Unit,158.00
United HealthCare,PPO,81379,CPT4/HCPCS,HLA I TYPING COMPLETE HR,,Per Unit,158.00
United HealthCare,PPO,81380,CPT4/HCPCS,HLA I TYPING 1 LOCUS HR,,Per Unit,158.00
United HealthCare,PPO,81381,CPT4/HCPCS,HLA I TYPING 1 ALLELE HR,,Per Unit,158.00
United HealthCare,PPO,81382,CPT4/HCPCS,HLA II TYPING 1 LOC HR,,Per Unit,158.00
United HealthCare,PPO,81383,CPT4/HCPCS,HLA II TYPING 1 ALLELE HR,,Per Unit,158.00
United HealthCare,PPO,81400,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 1,,Per Unit,158.00
United HealthCare,PPO,81401,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 2,,Per Unit,158.00
United HealthCare,PPO,81402,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 3,,Per Unit,158.00
United HealthCare,PPO,81403,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 4,,Per Unit,158.00
United HealthCare,PPO,81404,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 5,,Per Unit,158.00
United HealthCare,PPO,81405,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 6,,Per Unit,158.00
United HealthCare,PPO,81406,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 7,,Per Unit,158.00
United HealthCare,PPO,81407,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 8,,Per Unit,158.00
United HealthCare,PPO,81408,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 9,,Per Unit,158.00
United HealthCare,PPO,81410,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,Per Unit,102.00
United HealthCare,PPO,81411,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,Per Unit,102.00
United HealthCare,PPO,81412,CPT4/HCPCS,ASHKENAZI JEWISH ASSOC DIS,,Per Unit,102.00
United HealthCare,PPO,81413,CPT4/HCPCS,CAR ION CHNNLPATH INC 10 GNS,,Per Unit,102.00
United HealthCare,PPO,81414,CPT4/HCPCS,CAR ION CHNNLPATH INC 2 GNS,,Per Unit,102.00
United HealthCare,PPO,81415,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,Per Unit,102.00
United HealthCare,PPO,81416,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,Per Unit,102.00
United HealthCare,PPO,81417,CPT4/HCPCS,EXOME RE-EVALUATION,,Per Unit,102.00
United HealthCare,PPO,81420,CPT4/HCPCS,FETAL CHRMOML ANEUPLOIDY,,Per Unit,102.00
United HealthCare,PPO,81422,CPT4/HCPCS,FETAL CHRMOML MICRODELTJ,,Per Unit,102.00
United HealthCare,PPO,81425,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,Per Unit,102.00
United HealthCare,PPO,81426,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,Per Unit,102.00
United HealthCare,PPO,81427,CPT4/HCPCS,GENOME RE-EVALUATION,,Per Unit,102.00
United HealthCare,PPO,81430,CPT4/HCPCS,HEARING LOSS SEQUENCE ANALYS,,Per Unit,102.00
United HealthCare,PPO,81431,CPT4/HCPCS,HEARING LOSS DUP/DEL ANALYS,,Per Unit,102.00
United HealthCare,PPO,81432,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,Per Unit,102.00
United HealthCare,PPO,81433,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,Per Unit,102.00
United HealthCare,PPO,81434,CPT4/HCPCS,HEREDITARY RETINAL DISORDERS,,Per Unit,102.00
United HealthCare,PPO,81435,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,Per Unit,102.00
United HealthCare,PPO,81436,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,Per Unit,102.00
United HealthCare,PPO,81437,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,Per Unit,102.00
United HealthCare,PPO,81438,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,Per Unit,102.00
United HealthCare,PPO,81439,CPT4/HCPCS,HRDTRY CARDMYPY GENE PANEL,,Per Unit,102.00
United HealthCare,PPO,81440,CPT4/HCPCS,MITOCHONDRIAL GENE,,Per Unit,102.00
United HealthCare,PPO,81442,CPT4/HCPCS,NOONAN SPECTRUM DISORDERS,,Per Unit,102.00
United HealthCare,PPO,81443,CPT4/HCPCS,GENETIC TSTG SEVERE INH COND,,Per Unit,102.00
United HealthCare,PPO,81445,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Per Unit,102.00
United HealthCare,PPO,81448,CPT4/HCPCS,HRDTRY PERPH NEURPHY PANEL,,Per Unit,102.00
United HealthCare,PPO,81450,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Per Unit,102.00
United HealthCare,PPO,81455,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,Per Unit,102.00
United HealthCare,PPO,81460,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,Per Unit,102.00
United HealthCare,PPO,81465,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,Per Unit,102.00
United HealthCare,PPO,81470,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,Per Unit,102.00
United HealthCare,PPO,81471,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,Per Unit,102.00
United HealthCare,PPO,81479,CPT4/HCPCS,UNLISTED MOLECULAR PATHOLOGY,,Per Unit,102.00
United HealthCare,PPO,81490,CPT4/HCPCS,AUTOIMMUNE RHEUMATOID ARTHR,,Per Unit,102.00
United HealthCare,PPO,81493,CPT4/HCPCS,COR ARTERY DISEASE MRNA,,Per Unit,102.00
United HealthCare,PPO,81500,CPT4/HCPCS,ONCO (OVAR) TWO PROTEINS,,Per Unit,102.00
United HealthCare,PPO,81503,CPT4/HCPCS,ONCO (OVAR) FIVE PROTEINS,,Per Unit,102.00
United HealthCare,PPO,81504,CPT4/HCPCS,ONCOLOGY TISSUE OF ORIGIN,,Per Unit,102.00
United HealthCare,PPO,81506,CPT4/HCPCS,ENDO ASSAY SEVEN ANAL,,Per Unit,102.00
United HealthCare,PPO,81507,CPT4/HCPCS,FETAL ANEUPLOIDY TRISOM RISK,,Per Unit,102.00
United HealthCare,PPO,81508,CPT4/HCPCS,FTL CGEN ABNOR TWO PROTEINS,,Per Unit,102.00
United HealthCare,PPO,81509,CPT4/HCPCS,FTL CGEN ABNOR 3 PROTEINS,,Per Unit,102.00
United HealthCare,PPO,81510,CPT4/HCPCS,FTL CGEN ABNOR THREE ANAL,,Per Unit,102.00
United HealthCare,PPO,81511,CPT4/HCPCS,FTL CGEN ABNOR FOUR ANAL,,Per Unit,102.00
United HealthCare,PPO,81512,CPT4/HCPCS,FTL CGEN ABNOR FIVE ANAL,,Per Unit,102.00
United HealthCare,PPO,81518,CPT4/HCPCS,ONC BRST MRNA 11 GENES,,Per Unit,102.00
United HealthCare,PPO,81519,CPT4/HCPCS,ONCOLOGY BREAST MRNA,,Per Unit,102.00
United HealthCare,PPO,81520,CPT4/HCPCS,ONC BREAST MRNA 58 GENES,,Per Unit,102.00
United HealthCare,PPO,81521,CPT4/HCPCS,ONC BREAST MRNA 70 GENES,,Per Unit,102.00
United HealthCare,PPO,81525,CPT4/HCPCS,ONCOLOGY COLON MRNA,,Per Unit,102.00
United HealthCare,PPO,81528,CPT4/HCPCS,ONCOLOGY COLORECTAL SCR,,Per Unit,102.00
United HealthCare,PPO,81535,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,Per Unit,102.00
United HealthCare,PPO,81536,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,Per Unit,102.00
United HealthCare,PPO,81538,CPT4/HCPCS,ONCOLOGY LUNG,,Per Unit,102.00
United HealthCare,PPO,81539,CPT4/HCPCS,ONCOLOGY PROSTATE PROB SCORE,,Per Unit,102.00
United HealthCare,PPO,81540,CPT4/HCPCS,ONCOLOGY TUM UNKNOWN ORIGIN,,Per Unit,102.00
United HealthCare,PPO,81541,CPT4/HCPCS,ONC PROSTATE MRNA 46 GENES,,Per Unit,102.00
United HealthCare,PPO,81545,CPT4/HCPCS,ONCOLOGY THYROID,,Per Unit,102.00
United HealthCare,PPO,81551,CPT4/HCPCS,ONC PROSTATE 3 GENES,,Per Unit,102.00
United HealthCare,PPO,81595,CPT4/HCPCS,CARDIOLOGY HRT TRNSPL MRNA,,Per Unit,102.00
United HealthCare,PPO,81596,CPT4/HCPCS,NFCT DS CHRNC HCV 6 ASSAYS,,Per Unit,102.00
United HealthCare,PPO,82009,CPT4/HCPCS,TEST FOR ACETONE/KETONES,,Per Unit,102.00
United HealthCare,PPO,82010,CPT4/HCPCS,ACETONE ASSAY,,Per Unit,102.00
United HealthCare,PPO,82013,CPT4/HCPCS,ACETYLCHOLINESTERASE ASSAY,,Per Unit,102.00
United HealthCare,PPO,82016,CPT4/HCPCS,ACYLCARNITINES QUAL,,Per Unit,102.00
United HealthCare,PPO,82017,CPT4/HCPCS,ACYLCARNITINES QUANT,,Per Unit,102.00
United HealthCare,PPO,82024,CPT4/HCPCS,ASSAY OF ACTH,,Per Unit,102.00
United HealthCare,PPO,82030,CPT4/HCPCS,ASSAY OF ADP & AMP,,Per Unit,102.00
United HealthCare,PPO,82040,CPT4/HCPCS,ASSAY OF SERUM ALBUMIN,,Per Unit,102.00
United HealthCare,PPO,82042,CPT4/HCPCS,OTHER SOURCE ALBUMIN QUAN EA,,Per Unit,102.00
United HealthCare,PPO,82043,CPT4/HCPCS,UR ALBUMIN QUANTITATIVE,,Per Unit,102.00
United HealthCare,PPO,82044,CPT4/HCPCS,UR ALBUMIN SEMIQUANTITATIVE,,Per Unit,102.00
United HealthCare,PPO,82045,CPT4/HCPCS,ALBUMIN ISCHEMIA MODIFIED,,Per Unit,102.00
United HealthCare,PPO,82075,CPT4/HCPCS,ASSAY OF BREATH ETHANOL,,Per Unit,102.00
United HealthCare,PPO,82085,CPT4/HCPCS,ASSAY OF ALDOLASE,,Per Unit,102.00
United HealthCare,PPO,82088,CPT4/HCPCS,ASSAY OF ALDOSTERONE,,Per Unit,102.00
United HealthCare,PPO,82103,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN TOTAL,,Per Unit,102.00
United HealthCare,PPO,82104,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN PHENO,,Per Unit,102.00
United HealthCare,PPO,82105,CPT4/HCPCS,ALPHA-FETOPROTEIN SERUM,,Per Unit,102.00
United HealthCare,PPO,82106,CPT4/HCPCS,ALPHA-FETOPROTEIN AMNIOTIC,,Per Unit,102.00
United HealthCare,PPO,82107,CPT4/HCPCS,ALPHA-FETOPROTEIN L3,,Per Unit,102.00
United HealthCare,PPO,82108,CPT4/HCPCS,ASSAY OF ALUMINUM,,Per Unit,102.00
United HealthCare,PPO,82120,CPT4/HCPCS,AMINES VAGINAL FLUID QUAL,,Per Unit,102.00
United HealthCare,PPO,82127,CPT4/HCPCS,AMINO ACID SINGLE QUAL,,Per Unit,102.00
United HealthCare,PPO,82128,CPT4/HCPCS,AMINO ACIDS MULT QUAL,,Per Unit,102.00
United HealthCare,PPO,82131,CPT4/HCPCS,AMINO ACIDS SINGLE QUANT,,Per Unit,102.00
United HealthCare,PPO,82135,CPT4/HCPCS,ASSAY AMINOLEVULINIC ACID,,Per Unit,102.00
United HealthCare,PPO,82136,CPT4/HCPCS,AMINO ACIDS QUANT 2-5,,Per Unit,102.00
United HealthCare,PPO,82139,CPT4/HCPCS,AMINO ACIDS QUAN 6 OR MORE,,Per Unit,102.00
United HealthCare,PPO,82140,CPT4/HCPCS,ASSAY OF AMMONIA,,Per Unit,102.00
United HealthCare,PPO,82143,CPT4/HCPCS,AMNIOTIC FLUID SCAN,,Per Unit,102.00
United HealthCare,PPO,82150,CPT4/HCPCS,ASSAY OF AMYLASE,,Per Unit,102.00
United HealthCare,PPO,82154,CPT4/HCPCS,ANDROSTANEDIOL GLUCURONIDE,,Per Unit,102.00
United HealthCare,PPO,82157,CPT4/HCPCS,ASSAY OF ANDROSTENEDIONE,,Per Unit,102.00
United HealthCare,PPO,82160,CPT4/HCPCS,ASSAY OF ANDROSTERONE,,Per Unit,102.00
United HealthCare,PPO,82163,CPT4/HCPCS,ASSAY OF ANGIOTENSIN II,,Per Unit,102.00
United HealthCare,PPO,82164,CPT4/HCPCS,ANGIOTENSIN I ENZYME TEST,,Per Unit,102.00
United HealthCare,PPO,82172,CPT4/HCPCS,ASSAY OF APOLIPOPROTEIN,,Per Unit,102.00
United HealthCare,PPO,82175,CPT4/HCPCS,ASSAY OF ARSENIC,,Per Unit,102.00
United HealthCare,PPO,82180,CPT4/HCPCS,ASSAY OF ASCORBIC ACID,,Per Unit,102.00
United HealthCare,PPO,82190,CPT4/HCPCS,ATOMIC ABSORPTION,,Per Unit,102.00
United HealthCare,PPO,82232,CPT4/HCPCS,ASSAY OF BETA-2 PROTEIN,,Per Unit,102.00
United HealthCare,PPO,82239,CPT4/HCPCS,BILE ACIDS TOTAL,,Per Unit,102.00
United HealthCare,PPO,82240,CPT4/HCPCS,BILE ACIDS CHOLYLGLYCINE,,Per Unit,102.00
United HealthCare,PPO,82247,CPT4/HCPCS,BILIRUBIN TOTAL,,Per Unit,102.00
United HealthCare,PPO,82248,CPT4/HCPCS,BILIRUBIN DIRECT,,Per Unit,102.00
United HealthCare,PPO,82252,CPT4/HCPCS,FECAL BILIRUBIN TEST,,Per Unit,102.00
United HealthCare,PPO,82261,CPT4/HCPCS,ASSAY OF BIOTINIDASE,,Per Unit,102.00
United HealthCare,PPO,82270,CPT4/HCPCS,OCCULT BLOOD FECES,,Per Unit,102.00
United HealthCare,PPO,82271,CPT4/HCPCS,OCCULT BLOOD OTHER SOURCES,,Per Unit,102.00
United HealthCare,PPO,82272,CPT4/HCPCS,OCCULT BLD FECES 1-3 TESTS,,Per Unit,102.00
United HealthCare,PPO,82274,CPT4/HCPCS,ASSAY TEST FOR BLOOD FECAL,,Per Unit,102.00
United HealthCare,PPO,82286,CPT4/HCPCS,ASSAY OF BRADYKININ,,Per Unit,102.00
United HealthCare,PPO,82300,CPT4/HCPCS,ASSAY OF CADMIUM,,Per Unit,102.00
United HealthCare,PPO,82306,CPT4/HCPCS,VITAMIN D 25 HYDROXY,,Per Unit,102.00
United HealthCare,PPO,82308,CPT4/HCPCS,ASSAY OF CALCITONIN,,Per Unit,102.00
United HealthCare,PPO,82310,CPT4/HCPCS,ASSAY OF CALCIUM,,Per Unit,102.00
United HealthCare,PPO,82330,CPT4/HCPCS,ASSAY OF CALCIUM,,Per Unit,102.00
United HealthCare,PPO,82331,CPT4/HCPCS,CALCIUM INFUSION TEST,,Per Unit,102.00
United HealthCare,PPO,82340,CPT4/HCPCS,ASSAY OF CALCIUM IN URINE,,Per Unit,102.00
United HealthCare,PPO,82355,CPT4/HCPCS,CALCULUS ANALYSIS QUAL,,Per Unit,102.00
United HealthCare,PPO,82360,CPT4/HCPCS,CALCULUS ASSAY QUANT,,Per Unit,102.00
United HealthCare,PPO,82365,CPT4/HCPCS,CALCULUS SPECTROSCOPY,,Per Unit,102.00
United HealthCare,PPO,82370,CPT4/HCPCS,X-RAY ASSAY CALCULUS,,Per Unit,102.00
United HealthCare,PPO,82373,CPT4/HCPCS,ASSAY C-D TRANSFER MEASURE,,Per Unit,102.00
United HealthCare,PPO,82374,CPT4/HCPCS,ASSAY BLOOD CARBON DIOXIDE,,Per Unit,102.00
United HealthCare,PPO,82375,CPT4/HCPCS,ASSAY CARBOXYHB QUANT,,Per Unit,102.00
United HealthCare,PPO,82376,CPT4/HCPCS,ASSAY CARBOXYHB QUAL,,Per Unit,102.00
United HealthCare,PPO,82378,CPT4/HCPCS,CARCINOEMBRYONIC ANTIGEN,,Per Unit,102.00
United HealthCare,PPO,82379,CPT4/HCPCS,ASSAY OF CARNITINE,,Per Unit,102.00
United HealthCare,PPO,82380,CPT4/HCPCS,ASSAY OF CAROTENE,,Per Unit,102.00
United HealthCare,PPO,82382,CPT4/HCPCS,ASSAY URINE CATECHOLAMINES,,Per Unit,102.00
United HealthCare,PPO,82383,CPT4/HCPCS,ASSAY BLOOD CATECHOLAMINES,,Per Unit,102.00
United HealthCare,PPO,82384,CPT4/HCPCS,ASSAY THREE CATECHOLAMINES,,Per Unit,102.00
United HealthCare,PPO,82387,CPT4/HCPCS,ASSAY OF CATHEPSIN-D,,Per Unit,102.00
United HealthCare,PPO,82390,CPT4/HCPCS,ASSAY OF CERULOPLASMIN,,Per Unit,102.00
United HealthCare,PPO,82397,CPT4/HCPCS,CHEMILUMINESCENT ASSAY,,Per Unit,102.00
United HealthCare,PPO,82415,CPT4/HCPCS,ASSAY OF CHLORAMPHENICOL,,Per Unit,102.00
United HealthCare,PPO,82435,CPT4/HCPCS,ASSAY OF BLOOD CHLORIDE,,Per Unit,102.00
United HealthCare,PPO,82436,CPT4/HCPCS,ASSAY OF URINE CHLORIDE,,Per Unit,102.00
United HealthCare,PPO,82438,CPT4/HCPCS,ASSAY OTHER FLUID CHLORIDES,,Per Unit,102.00
United HealthCare,PPO,82441,CPT4/HCPCS,TEST FOR CHLOROHYDROCARBONS,,Per Unit,102.00
United HealthCare,PPO,82465,CPT4/HCPCS,ASSAY BLD/SERUM CHOLESTEROL,,Per Unit,102.00
United HealthCare,PPO,82480,CPT4/HCPCS,ASSAY SERUM CHOLINESTERASE,,Per Unit,102.00
United HealthCare,PPO,82482,CPT4/HCPCS,ASSAY RBC CHOLINESTERASE,,Per Unit,102.00
United HealthCare,PPO,82485,CPT4/HCPCS,ASSAY CHONDROITIN SULFATE,,Per Unit,102.00
United HealthCare,PPO,82495,CPT4/HCPCS,ASSAY OF CHROMIUM,,Per Unit,102.00
United HealthCare,PPO,82507,CPT4/HCPCS,ASSAY OF CITRATE,,Per Unit,102.00
United HealthCare,PPO,82523,CPT4/HCPCS,COLLAGEN CROSSLINKS,,Per Unit,102.00
United HealthCare,PPO,82525,CPT4/HCPCS,ASSAY OF COPPER,,Per Unit,102.00
United HealthCare,PPO,82528,CPT4/HCPCS,ASSAY OF CORTICOSTERONE,,Per Unit,102.00
United HealthCare,PPO,82530,CPT4/HCPCS,CORTISOL FREE,,Per Unit,102.00
United HealthCare,PPO,82533,CPT4/HCPCS,TOTAL CORTISOL,,Per Unit,102.00
United HealthCare,PPO,82540,CPT4/HCPCS,ASSAY OF CREATINE,,Per Unit,102.00
United HealthCare,PPO,82542,CPT4/HCPCS,COL CHROMOTOGRAPHY QUAL/QUAN,,Per Unit,102.00
United HealthCare,PPO,82550,CPT4/HCPCS,ASSAY OF CK (CPK),,Per Unit,102.00
United HealthCare,PPO,82552,CPT4/HCPCS,ASSAY OF CPK IN BLOOD,,Per Unit,102.00
United HealthCare,PPO,82553,CPT4/HCPCS,CREATINE MB FRACTION,,Per Unit,102.00
United HealthCare,PPO,82554,CPT4/HCPCS,CREATINE ISOFORMS,,Per Unit,102.00
United HealthCare,PPO,82565,CPT4/HCPCS,ASSAY OF CREATININE,,Per Unit,102.00
United HealthCare,PPO,82570,CPT4/HCPCS,ASSAY OF URINE CREATININE,,Per Unit,102.00
United HealthCare,PPO,82575,CPT4/HCPCS,CREATININE CLEARANCE TEST,,Per Unit,102.00
United HealthCare,PPO,82585,CPT4/HCPCS,ASSAY OF CRYOFIBRINOGEN,,Per Unit,102.00
United HealthCare,PPO,82595,CPT4/HCPCS,ASSAY OF CRYOGLOBULIN,,Per Unit,102.00
United HealthCare,PPO,82600,CPT4/HCPCS,ASSAY OF CYANIDE,,Per Unit,102.00
United HealthCare,PPO,82607,CPT4/HCPCS,VITAMIN B-12,,Per Unit,102.00
United HealthCare,PPO,82608,CPT4/HCPCS,B-12 BINDING CAPACITY,,Per Unit,102.00
United HealthCare,PPO,82610,CPT4/HCPCS,CYSTATIN C,,Per Unit,102.00
United HealthCare,PPO,82615,CPT4/HCPCS,TEST FOR URINE CYSTINES,,Per Unit,102.00
United HealthCare,PPO,82626,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,Per Unit,102.00
United HealthCare,PPO,82627,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,Per Unit,102.00
United HealthCare,PPO,82633,CPT4/HCPCS,DESOXYCORTICOSTERONE,,Per Unit,102.00
United HealthCare,PPO,82634,CPT4/HCPCS,DEOXYCORTISOL,,Per Unit,102.00
United HealthCare,PPO,82638,CPT4/HCPCS,ASSAY OF DIBUCAINE NUMBER,,Per Unit,102.00
United HealthCare,PPO,82652,CPT4/HCPCS,VIT D 1 25-DIHYDROXY,,Per Unit,102.00
United HealthCare,PPO,82656,CPT4/HCPCS,PANCREATIC ELASTASE FECAL,,Per Unit,102.00
United HealthCare,PPO,82657,CPT4/HCPCS,ENZYME CELL ACTIVITY,,Per Unit,102.00
United HealthCare,PPO,82658,CPT4/HCPCS,ENZYME CELL ACTIVITY RA,,Per Unit,102.00
United HealthCare,PPO,82664,CPT4/HCPCS,ELECTROPHORETIC TEST,,Per Unit,102.00
United HealthCare,PPO,82668,CPT4/HCPCS,ASSAY OF ERYTHROPOIETIN,,Per Unit,102.00
United HealthCare,PPO,82670,CPT4/HCPCS,ASSAY OF TOTAL ESTRADIOL,,Per Unit,102.00
United HealthCare,PPO,82671,CPT4/HCPCS,ASSAY OF ESTROGENS,,Per Unit,102.00
United HealthCare,PPO,82672,CPT4/HCPCS,ASSAY OF ESTROGEN,,Per Unit,102.00
United HealthCare,PPO,82677,CPT4/HCPCS,ASSAY OF ESTRIOL,,Per Unit,102.00
United HealthCare,PPO,82679,CPT4/HCPCS,ASSAY OF ESTRONE,,Per Unit,102.00
United HealthCare,PPO,82693,CPT4/HCPCS,ASSAY OF ETHYLENE GLYCOL,,Per Unit,102.00
United HealthCare,PPO,82696,CPT4/HCPCS,ASSAY OF ETIOCHOLANOLONE,,Per Unit,102.00
United HealthCare,PPO,82705,CPT4/HCPCS,FATS/LIPIDS FECES QUAL,,Per Unit,102.00
United HealthCare,PPO,82710,CPT4/HCPCS,FATS/LIPIDS FECES QUANT,,Per Unit,102.00
United HealthCare,PPO,82715,CPT4/HCPCS,ASSAY OF FECAL FAT,,Per Unit,102.00
United HealthCare,PPO,82725,CPT4/HCPCS,ASSAY OF BLOOD FATTY ACIDS,,Per Unit,102.00
United HealthCare,PPO,82726,CPT4/HCPCS,LONG CHAIN FATTY ACIDS,,Per Unit,102.00
United HealthCare,PPO,82728,CPT4/HCPCS,ASSAY OF FERRITIN,,Per Unit,102.00
United HealthCare,PPO,82731,CPT4/HCPCS,ASSAY OF FETAL FIBRONECTIN,,Per Unit,102.00
United HealthCare,PPO,82735,CPT4/HCPCS,ASSAY OF FLUORIDE,,Per Unit,102.00
United HealthCare,PPO,82746,CPT4/HCPCS,ASSAY OF FOLIC ACID SERUM,,Per Unit,102.00
United HealthCare,PPO,82747,CPT4/HCPCS,ASSAY OF FOLIC ACID RBC,,Per Unit,102.00
United HealthCare,PPO,82757,CPT4/HCPCS,ASSAY OF SEMEN FRUCTOSE,,Per Unit,102.00
United HealthCare,PPO,82759,CPT4/HCPCS,ASSAY OF RBC GALACTOKINASE,,Per Unit,102.00
United HealthCare,PPO,82760,CPT4/HCPCS,ASSAY OF GALACTOSE,,Per Unit,102.00
United HealthCare,PPO,82775,CPT4/HCPCS,ASSAY GALACTOSE TRANSFERASE,,Per Unit,102.00
United HealthCare,PPO,82776,CPT4/HCPCS,GALACTOSE TRANSFERASE TEST,,Per Unit,102.00
United HealthCare,PPO,82777,CPT4/HCPCS,GALECTIN-3,,Per Unit,102.00
United HealthCare,PPO,82784,CPT4/HCPCS,ASSAY IGA/IGD/IGG/IGM EACH,,Per Unit,102.00
United HealthCare,PPO,82785,CPT4/HCPCS,ASSAY OF IGE,,Per Unit,102.00
United HealthCare,PPO,82787,CPT4/HCPCS,IGG 1 2 3 OR 4 EACH,,Per Unit,102.00
United HealthCare,PPO,82800,CPT4/HCPCS,BLOOD PH,,Per Unit,102.00
United HealthCare,PPO,82803,CPT4/HCPCS,BLOOD GASES ANY COMBINATION,,Per Unit,102.00
United HealthCare,PPO,82805,CPT4/HCPCS,BLOOD GASES W/O2 SATURATION,,Per Unit,102.00
United HealthCare,PPO,82810,CPT4/HCPCS,BLOOD GASES O2 SAT ONLY,,Per Unit,102.00
United HealthCare,PPO,82820,CPT4/HCPCS,HEMOGLOBIN-OXYGEN AFFINITY,,Per Unit,102.00
United HealthCare,PPO,82930,CPT4/HCPCS,GASTRIC ANALY W/PH EA SPEC,,Per Unit,102.00
United HealthCare,PPO,82938,CPT4/HCPCS,GASTRIN TEST,,Per Unit,102.00
United HealthCare,PPO,82941,CPT4/HCPCS,ASSAY OF GASTRIN,,Per Unit,102.00
United HealthCare,PPO,82943,CPT4/HCPCS,ASSAY OF GLUCAGON,,Per Unit,102.00
United HealthCare,PPO,82945,CPT4/HCPCS,GLUCOSE OTHER FLUID,,Per Unit,102.00
United HealthCare,PPO,82946,CPT4/HCPCS,GLUCAGON TOLERANCE TEST,,Per Unit,102.00
United HealthCare,PPO,82947,CPT4/HCPCS,ASSAY GLUCOSE BLOOD QUANT,,Per Unit,102.00
United HealthCare,PPO,82948,CPT4/HCPCS,REAGENT STRIP/BLOOD GLUCOSE,,Per Unit,102.00
United HealthCare,PPO,82950,CPT4/HCPCS,GLUCOSE TEST,,Per Unit,102.00
United HealthCare,PPO,82951,CPT4/HCPCS,GLUCOSE TOLERANCE TEST (GTT),,Per Unit,102.00
United HealthCare,PPO,82952,CPT4/HCPCS,GTT-ADDED SAMPLES,,Per Unit,102.00
United HealthCare,PPO,82955,CPT4/HCPCS,ASSAY OF G6PD ENZYME,,Per Unit,102.00
United HealthCare,PPO,82960,CPT4/HCPCS,TEST FOR G6PD ENZYME,,Per Unit,102.00
United HealthCare,PPO,82962,CPT4/HCPCS,GLUCOSE BLOOD TEST,,Per Unit,102.00
United HealthCare,PPO,82963,CPT4/HCPCS,ASSAY OF GLUCOSIDASE,,Per Unit,102.00
United HealthCare,PPO,82965,CPT4/HCPCS,ASSAY OF GDH ENZYME,,Per Unit,102.00
United HealthCare,PPO,82977,CPT4/HCPCS,ASSAY OF GGT,,Per Unit,102.00
United HealthCare,PPO,82978,CPT4/HCPCS,ASSAY OF GLUTATHIONE,,Per Unit,102.00
United HealthCare,PPO,82979,CPT4/HCPCS,ASSAY RBC GLUTATHIONE,,Per Unit,102.00
United HealthCare,PPO,82985,CPT4/HCPCS,ASSAY OF GLYCATED PROTEIN,,Per Unit,102.00
United HealthCare,PPO,83001,CPT4/HCPCS,ASSAY OF GONADOTROPIN (FSH),,Per Unit,102.00
United HealthCare,PPO,83002,CPT4/HCPCS,ASSAY OF GONADOTROPIN (LH),,Per Unit,102.00
United HealthCare,PPO,83003,CPT4/HCPCS,ASSAY GROWTH HORMONE (HGH),,Per Unit,102.00
United HealthCare,PPO,83006,CPT4/HCPCS,GROWTH STIMULATION GENE 2,,Per Unit,102.00
United HealthCare,PPO,83009,CPT4/HCPCS,H PYLORI (C-13) BLOOD,,Per Unit,102.00
United HealthCare,PPO,83010,CPT4/HCPCS,ASSAY OF HAPTOGLOBIN QUANT,,Per Unit,102.00
United HealthCare,PPO,83012,CPT4/HCPCS,ASSAY OF HAPTOGLOBINS,,Per Unit,102.00
United HealthCare,PPO,83013,CPT4/HCPCS,H PYLORI (C-13) BREATH,,Per Unit,102.00
United HealthCare,PPO,83014,CPT4/HCPCS,H PYLORI DRUG ADMIN,,Per Unit,102.00
United HealthCare,PPO,83015,CPT4/HCPCS,HEAVY METAL QUAL ANY ANAL,,Per Unit,102.00
United HealthCare,PPO,83018,CPT4/HCPCS,HEAVY METAL QUANT EACH NES,,Per Unit,102.00
United HealthCare,PPO,83020,CPT4/HCPCS,HEMOGLOBIN ELECTROPHORESIS,,Per Unit,102.00
United HealthCare,PPO,83021,CPT4/HCPCS,HEMOGLOBIN CHROMOTOGRAPHY,,Per Unit,102.00
United HealthCare,PPO,83026,CPT4/HCPCS,HEMOGLOBIN COPPER SULFATE,,Per Unit,102.00
United HealthCare,PPO,83030,CPT4/HCPCS,FETAL HEMOGLOBIN CHEMICAL,,Per Unit,102.00
United HealthCare,PPO,83033,CPT4/HCPCS,FETAL HEMOGLOBIN ASSAY QUAL,,Per Unit,102.00
United HealthCare,PPO,83036,CPT4/HCPCS,GLYCOSYLATED HEMOGLOBIN TEST,,Per Unit,102.00
United HealthCare,PPO,83037,CPT4/HCPCS,GLYCOSYLATED HB HOME DEVICE,,Per Unit,102.00
United HealthCare,PPO,83045,CPT4/HCPCS,BLOOD METHEMOGLOBIN TEST,,Per Unit,102.00
United HealthCare,PPO,83050,CPT4/HCPCS,BLOOD METHEMOGLOBIN ASSAY,,Per Unit,102.00
United HealthCare,PPO,83051,CPT4/HCPCS,ASSAY OF PLASMA HEMOGLOBIN,,Per Unit,102.00
United HealthCare,PPO,83060,CPT4/HCPCS,BLOOD SULFHEMOGLOBIN ASSAY,,Per Unit,102.00
United HealthCare,PPO,83065,CPT4/HCPCS,ASSAY OF HEMOGLOBIN HEAT,,Per Unit,102.00
United HealthCare,PPO,83068,CPT4/HCPCS,HEMOGLOBIN STABILITY SCREEN,,Per Unit,102.00
United HealthCare,PPO,83069,CPT4/HCPCS,ASSAY OF URINE HEMOGLOBIN,,Per Unit,102.00
United HealthCare,PPO,83070,CPT4/HCPCS,ASSAY OF HEMOSIDERIN QUAL,,Per Unit,102.00
United HealthCare,PPO,83080,CPT4/HCPCS,ASSAY OF B HEXOSAMINIDASE,,Per Unit,102.00
United HealthCare,PPO,83088,CPT4/HCPCS,ASSAY OF HISTAMINE,,Per Unit,102.00
United HealthCare,PPO,83090,CPT4/HCPCS,ASSAY OF HOMOCYSTINE,,Per Unit,102.00
United HealthCare,PPO,83150,CPT4/HCPCS,ASSAY OF HOMOVANILLIC ACID,,Per Unit,102.00
United HealthCare,PPO,83491,CPT4/HCPCS,ASSAY OF CORTICOSTEROIDS 17,,Per Unit,102.00
United HealthCare,PPO,83497,CPT4/HCPCS,ASSAY OF 5-HIAA,,Per Unit,102.00
United HealthCare,PPO,83498,CPT4/HCPCS,ASSAY OF PROGESTERONE 17-D,,Per Unit,102.00
United HealthCare,PPO,83500,CPT4/HCPCS,ASSAY FREE HYDROXYPROLINE,,Per Unit,102.00
United HealthCare,PPO,83505,CPT4/HCPCS,ASSAY TOTAL HYDROXYPROLINE,,Per Unit,102.00
United HealthCare,PPO,83516,CPT4/HCPCS,IMMUNOASSAY NONANTIBODY,,Per Unit,102.00
United HealthCare,PPO,83518,CPT4/HCPCS,IMMUNOASSAY DIPSTICK,,Per Unit,102.00
United HealthCare,PPO,83519,CPT4/HCPCS,RIA NONANTIBODY,,Per Unit,102.00
United HealthCare,PPO,83520,CPT4/HCPCS,IMMUNOASSAY QUANT NOS NONAB,,Per Unit,102.00
United HealthCare,PPO,83525,CPT4/HCPCS,ASSAY OF INSULIN,,Per Unit,102.00
United HealthCare,PPO,83527,CPT4/HCPCS,ASSAY OF INSULIN,,Per Unit,102.00
United HealthCare,PPO,83528,CPT4/HCPCS,ASSAY OF INTRINSIC FACTOR,,Per Unit,102.00
United HealthCare,PPO,83540,CPT4/HCPCS,ASSAY OF IRON,,Per Unit,102.00
United HealthCare,PPO,83550,CPT4/HCPCS,IRON BINDING TEST,,Per Unit,102.00
United HealthCare,PPO,83570,CPT4/HCPCS,ASSAY OF IDH ENZYME,,Per Unit,102.00
United HealthCare,PPO,83582,CPT4/HCPCS,ASSAY OF KETOGENIC STEROIDS,,Per Unit,102.00
United HealthCare,PPO,83586,CPT4/HCPCS,ASSAY 17- KETOSTEROIDS,,Per Unit,102.00
United HealthCare,PPO,83593,CPT4/HCPCS,FRACTIONATION KETOSTEROIDS,,Per Unit,102.00
United HealthCare,PPO,83605,CPT4/HCPCS,ASSAY OF LACTIC ACID,,Per Unit,102.00
United HealthCare,PPO,83615,CPT4/HCPCS,LACTATE (LD) (LDH) ENZYME,,Per Unit,102.00
United HealthCare,PPO,83625,CPT4/HCPCS,ASSAY OF LDH ENZYMES,,Per Unit,102.00
United HealthCare,PPO,83630,CPT4/HCPCS,LACTOFERRIN FECAL (QUAL),,Per Unit,102.00
United HealthCare,PPO,83631,CPT4/HCPCS,LACTOFERRIN FECAL (QUANT),,Per Unit,102.00
United HealthCare,PPO,83632,CPT4/HCPCS,PLACENTAL LACTOGEN,,Per Unit,102.00
United HealthCare,PPO,83633,CPT4/HCPCS,TEST URINE FOR LACTOSE,,Per Unit,102.00
United HealthCare,PPO,83655,CPT4/HCPCS,ASSAY OF LEAD,,Per Unit,102.00
United HealthCare,PPO,83661,CPT4/HCPCS,L/S RATIO FETAL LUNG,,Per Unit,102.00
United HealthCare,PPO,83662,CPT4/HCPCS,FOAM STABILITY FETAL LUNG,,Per Unit,102.00
United HealthCare,PPO,83663,CPT4/HCPCS,FLUORO POLARIZE FETAL LUNG,,Per Unit,102.00
United HealthCare,PPO,83664,CPT4/HCPCS,LAMELLAR BDY FETAL LUNG,,Per Unit,102.00
United HealthCare,PPO,83670,CPT4/HCPCS,ASSAY OF LAP ENZYME,,Per Unit,102.00
United HealthCare,PPO,83690,CPT4/HCPCS,ASSAY OF LIPASE,,Per Unit,102.00
United HealthCare,PPO,83695,CPT4/HCPCS,ASSAY OF LIPOPROTEIN(A),,Per Unit,102.00
United HealthCare,PPO,83698,CPT4/HCPCS,ASSAY LIPOPROTEIN PLA2,,Per Unit,102.00
United HealthCare,PPO,83700,CPT4/HCPCS,LIPOPRO BLD ELECTROPHORETIC,,Per Unit,102.00
United HealthCare,PPO,83701,CPT4/HCPCS,LIPOPROTEIN BLD HR FRACTION,,Per Unit,102.00
United HealthCare,PPO,83704,CPT4/HCPCS,LIPOPROTEIN BLD QUAN PART,,Per Unit,102.00
United HealthCare,PPO,83718,CPT4/HCPCS,ASSAY OF LIPOPROTEIN,,Per Unit,102.00
United HealthCare,PPO,83719,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,Per Unit,102.00
United HealthCare,PPO,83721,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,Per Unit,102.00
United HealthCare,PPO,83722,CPT4/HCPCS,LIPOPRTN DIR MEAS SD LDL CHL,,Per Unit,102.00
United HealthCare,PPO,83727,CPT4/HCPCS,ASSAY OF LRH HORMONE,,Per Unit,102.00
United HealthCare,PPO,83735,CPT4/HCPCS,ASSAY OF MAGNESIUM,,Per Unit,102.00
United HealthCare,PPO,83775,CPT4/HCPCS,ASSAY MALATE DEHYDROGENASE,,Per Unit,102.00
United HealthCare,PPO,83785,CPT4/HCPCS,ASSAY OF MANGANESE,,Per Unit,102.00
United HealthCare,PPO,83789,CPT4/HCPCS,MASS SPECTROMETRY QUAL/QUAN,,Per Unit,102.00
United HealthCare,PPO,83825,CPT4/HCPCS,ASSAY OF MERCURY,,Per Unit,102.00
United HealthCare,PPO,83835,CPT4/HCPCS,ASSAY OF METANEPHRINES,,Per Unit,102.00
United HealthCare,PPO,83857,CPT4/HCPCS,ASSAY OF METHEMALBUMIN,,Per Unit,102.00
United HealthCare,PPO,83861,CPT4/HCPCS,MICROFLUID ANALY TEARS,,Per Unit,102.00
United HealthCare,PPO,83864,CPT4/HCPCS,MUCOPOLYSACCHARIDES,,Per Unit,102.00
United HealthCare,PPO,83872,CPT4/HCPCS,ASSAY SYNOVIAL FLUID MUCIN,,Per Unit,102.00
United HealthCare,PPO,83873,CPT4/HCPCS,ASSAY OF CSF PROTEIN,,Per Unit,102.00
United HealthCare,PPO,83874,CPT4/HCPCS,ASSAY OF MYOGLOBIN,,Per Unit,102.00
United HealthCare,PPO,83876,CPT4/HCPCS,ASSAY MYELOPEROXIDASE,,Per Unit,102.00
United HealthCare,PPO,83880,CPT4/HCPCS,ASSAY OF NATRIURETIC PEPTIDE,,Per Unit,102.00
United HealthCare,PPO,83883,CPT4/HCPCS,ASSAY NEPHELOMETRY NOT SPEC,,Per Unit,102.00
United HealthCare,PPO,83885,CPT4/HCPCS,ASSAY OF NICKEL,,Per Unit,102.00
United HealthCare,PPO,83915,CPT4/HCPCS,ASSAY OF NUCLEOTIDASE,,Per Unit,102.00
United HealthCare,PPO,83916,CPT4/HCPCS,OLIGOCLONAL BANDS,,Per Unit,102.00
United HealthCare,PPO,83918,CPT4/HCPCS,ORGANIC ACIDS TOTAL QUANT,,Per Unit,102.00
United HealthCare,PPO,83919,CPT4/HCPCS,ORGANIC ACIDS QUAL EACH,,Per Unit,102.00
United HealthCare,PPO,83921,CPT4/HCPCS,ORGANIC ACID SINGLE QUANT,,Per Unit,102.00
United HealthCare,PPO,83930,CPT4/HCPCS,ASSAY OF BLOOD OSMOLALITY,,Per Unit,102.00
United HealthCare,PPO,83935,CPT4/HCPCS,ASSAY OF URINE OSMOLALITY,,Per Unit,102.00
United HealthCare,PPO,83937,CPT4/HCPCS,ASSAY OF OSTEOCALCIN,,Per Unit,102.00
United HealthCare,PPO,83945,CPT4/HCPCS,ASSAY OF OXALATE,,Per Unit,102.00
United HealthCare,PPO,83950,CPT4/HCPCS,ONCOPROTEIN HER-2/NEU,,Per Unit,102.00
United HealthCare,PPO,83951,CPT4/HCPCS,ONCOPROTEIN DCP,,Per Unit,102.00
United HealthCare,PPO,83970,CPT4/HCPCS,ASSAY OF PARATHORMONE,,Per Unit,102.00
United HealthCare,PPO,83986,CPT4/HCPCS,ASSAY PH BODY FLUID NOS,,Per Unit,102.00
United HealthCare,PPO,83987,CPT4/HCPCS,EXHALED BREATH CONDENSATE,,Per Unit,102.00
United HealthCare,PPO,83992,CPT4/HCPCS,ASSAY FOR PHENCYCLIDINE,,Per Unit,102.00
United HealthCare,PPO,83993,CPT4/HCPCS,ASSAY FOR CALPROTECTIN FECAL,,Per Unit,102.00
United HealthCare,PPO,84030,CPT4/HCPCS,ASSAY OF BLOOD PKU,,Per Unit,102.00
United HealthCare,PPO,84035,CPT4/HCPCS,ASSAY OF PHENYLKETONES,,Per Unit,102.00
United HealthCare,PPO,84060,CPT4/HCPCS,ASSAY ACID PHOSPHATASE,,Per Unit,102.00
United HealthCare,PPO,84066,CPT4/HCPCS,ASSAY PROSTATE PHOSPHATASE,,Per Unit,102.00
United HealthCare,PPO,84075,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,Per Unit,102.00
United HealthCare,PPO,84078,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,Per Unit,102.00
United HealthCare,PPO,84080,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASES,,Per Unit,102.00
United HealthCare,PPO,84081,CPT4/HCPCS,ASSAY PHOSPHATIDYLGLYCEROL,,Per Unit,102.00
United HealthCare,PPO,84085,CPT4/HCPCS,ASSAY OF RBC PG6D ENZYME,,Per Unit,102.00
United HealthCare,PPO,84087,CPT4/HCPCS,ASSAY PHOSPHOHEXOSE ENZYMES,,Per Unit,102.00
United HealthCare,PPO,84100,CPT4/HCPCS,ASSAY OF PHOSPHORUS,,Per Unit,102.00
United HealthCare,PPO,84105,CPT4/HCPCS,ASSAY OF URINE PHOSPHORUS,,Per Unit,102.00
United HealthCare,PPO,84106,CPT4/HCPCS,TEST FOR PORPHOBILINOGEN,,Per Unit,102.00
United HealthCare,PPO,84110,CPT4/HCPCS,ASSAY OF PORPHOBILINOGEN,,Per Unit,102.00
United HealthCare,PPO,84112,CPT4/HCPCS,EVAL AMNIOTIC FLUID PROTEIN,,Per Unit,102.00
United HealthCare,PPO,84119,CPT4/HCPCS,TEST URINE FOR PORPHYRINS,,Per Unit,102.00
United HealthCare,PPO,84120,CPT4/HCPCS,ASSAY OF URINE PORPHYRINS,,Per Unit,102.00
United HealthCare,PPO,84126,CPT4/HCPCS,ASSAY OF FECES PORPHYRINS,,Per Unit,102.00
United HealthCare,PPO,84132,CPT4/HCPCS,ASSAY OF SERUM POTASSIUM,,Per Unit,102.00
United HealthCare,PPO,84133,CPT4/HCPCS,ASSAY OF URINE POTASSIUM,,Per Unit,102.00
United HealthCare,PPO,84134,CPT4/HCPCS,ASSAY OF PREALBUMIN,,Per Unit,102.00
United HealthCare,PPO,84135,CPT4/HCPCS,ASSAY OF PREGNANEDIOL,,Per Unit,102.00
United HealthCare,PPO,84138,CPT4/HCPCS,ASSAY OF PREGNANETRIOL,,Per Unit,102.00
United HealthCare,PPO,84140,CPT4/HCPCS,ASSAY OF PREGNENOLONE,,Per Unit,102.00
United HealthCare,PPO,84143,CPT4/HCPCS,ASSAY OF 17-HYDROXYPREGNENO,,Per Unit,102.00
United HealthCare,PPO,84144,CPT4/HCPCS,ASSAY OF PROGESTERONE,,Per Unit,102.00
United HealthCare,PPO,84145,CPT4/HCPCS,PROCALCITONIN (PCT),,Per Unit,102.00
United HealthCare,PPO,84146,CPT4/HCPCS,ASSAY OF PROLACTIN,,Per Unit,102.00
United HealthCare,PPO,84150,CPT4/HCPCS,ASSAY OF PROSTAGLANDIN,,Per Unit,102.00
United HealthCare,PPO,84152,CPT4/HCPCS,ASSAY OF PSA COMPLEXED,,Per Unit,102.00
United HealthCare,PPO,84153,CPT4/HCPCS,ASSAY OF PSA TOTAL,,Per Unit,102.00
United HealthCare,PPO,84154,CPT4/HCPCS,ASSAY OF PSA FREE,,Per Unit,102.00
United HealthCare,PPO,84155,CPT4/HCPCS,ASSAY OF PROTEIN SERUM,,Per Unit,102.00
United HealthCare,PPO,84156,CPT4/HCPCS,ASSAY OF PROTEIN URINE,,Per Unit,102.00
United HealthCare,PPO,84157,CPT4/HCPCS,ASSAY OF PROTEIN OTHER,,Per Unit,102.00
United HealthCare,PPO,84160,CPT4/HCPCS,ASSAY OF PROTEIN ANY SOURCE,,Per Unit,102.00
United HealthCare,PPO,84163,CPT4/HCPCS,PAPPA SERUM,,Per Unit,102.00
United HealthCare,PPO,84165,CPT4/HCPCS,PROTEIN E-PHORESIS SERUM,,Per Unit,102.00
United HealthCare,PPO,84166,CPT4/HCPCS,PROTEIN E-PHORESIS/URINE/CSF,,Per Unit,102.00
United HealthCare,PPO,84181,CPT4/HCPCS,WESTERN BLOT TEST,,Per Unit,102.00
United HealthCare,PPO,84182,CPT4/HCPCS,PROTEIN WESTERN BLOT TEST,,Per Unit,102.00
United HealthCare,PPO,84202,CPT4/HCPCS,ASSAY RBC PROTOPORPHYRIN,,Per Unit,102.00
United HealthCare,PPO,84203,CPT4/HCPCS,TEST RBC PROTOPORPHYRIN,,Per Unit,102.00
United HealthCare,PPO,84206,CPT4/HCPCS,ASSAY OF PROINSULIN,,Per Unit,102.00
United HealthCare,PPO,84207,CPT4/HCPCS,ASSAY OF VITAMIN B-6,,Per Unit,102.00
United HealthCare,PPO,84210,CPT4/HCPCS,ASSAY OF PYRUVATE,,Per Unit,102.00
United HealthCare,PPO,84220,CPT4/HCPCS,ASSAY OF PYRUVATE KINASE,,Per Unit,102.00
United HealthCare,PPO,84228,CPT4/HCPCS,ASSAY OF QUININE,,Per Unit,102.00
United HealthCare,PPO,84233,CPT4/HCPCS,ASSAY OF ESTROGEN,,Per Unit,102.00
United HealthCare,PPO,84234,CPT4/HCPCS,ASSAY OF PROGESTERONE,,Per Unit,102.00
United HealthCare,PPO,84235,CPT4/HCPCS,ASSAY OF ENDOCRINE HORMONE,,Per Unit,102.00
United HealthCare,PPO,84238,CPT4/HCPCS,ASSAY NONENDOCRINE RECEPTOR,,Per Unit,102.00
United HealthCare,PPO,84244,CPT4/HCPCS,ASSAY OF RENIN,,Per Unit,102.00
United HealthCare,PPO,84252,CPT4/HCPCS,ASSAY OF VITAMIN B-2,,Per Unit,102.00
United HealthCare,PPO,84255,CPT4/HCPCS,ASSAY OF SELENIUM,,Per Unit,102.00
United HealthCare,PPO,84260,CPT4/HCPCS,ASSAY OF SEROTONIN,,Per Unit,102.00
United HealthCare,PPO,84270,CPT4/HCPCS,ASSAY OF SEX HORMONE GLOBUL,,Per Unit,102.00
United HealthCare,PPO,84275,CPT4/HCPCS,ASSAY OF SIALIC ACID,,Per Unit,102.00
United HealthCare,PPO,84285,CPT4/HCPCS,ASSAY OF SILICA,,Per Unit,102.00
United HealthCare,PPO,84295,CPT4/HCPCS,ASSAY OF SERUM SODIUM,,Per Unit,102.00
United HealthCare,PPO,84300,CPT4/HCPCS,ASSAY OF URINE SODIUM,,Per Unit,102.00
United HealthCare,PPO,84302,CPT4/HCPCS,ASSAY OF SWEAT SODIUM,,Per Unit,102.00
United HealthCare,PPO,84305,CPT4/HCPCS,ASSAY OF SOMATOMEDIN,,Per Unit,102.00
United HealthCare,PPO,84307,CPT4/HCPCS,ASSAY OF SOMATOSTATIN,,Per Unit,102.00
United HealthCare,PPO,84311,CPT4/HCPCS,SPECTROPHOTOMETRY,,Per Unit,102.00
United HealthCare,PPO,84315,CPT4/HCPCS,BODY FLUID SPECIFIC GRAVITY,,Per Unit,102.00
United HealthCare,PPO,84375,CPT4/HCPCS,CHROMATOGRAM ASSAY SUGARS,,Per Unit,102.00
United HealthCare,PPO,84376,CPT4/HCPCS,SUGARS SINGLE QUAL,,Per Unit,102.00
United HealthCare,PPO,84377,CPT4/HCPCS,SUGARS MULTIPLE QUAL,,Per Unit,102.00
United HealthCare,PPO,84378,CPT4/HCPCS,SUGARS SINGLE QUANT,,Per Unit,102.00
United HealthCare,PPO,84379,CPT4/HCPCS,SUGARS MULTIPLE QUANT,,Per Unit,102.00
United HealthCare,PPO,84392,CPT4/HCPCS,ASSAY OF URINE SULFATE,,Per Unit,102.00
United HealthCare,PPO,84402,CPT4/HCPCS,ASSAY OF FREE TESTOSTERONE,,Per Unit,102.00
United HealthCare,PPO,84403,CPT4/HCPCS,ASSAY OF TOTAL TESTOSTERONE,,Per Unit,102.00
United HealthCare,PPO,84410,CPT4/HCPCS,TESTOSTERONE BIOAVAILABLE,,Per Unit,102.00
United HealthCare,PPO,84425,CPT4/HCPCS,ASSAY OF VITAMIN B-1,,Per Unit,102.00
United HealthCare,PPO,84430,CPT4/HCPCS,ASSAY OF THIOCYANATE,,Per Unit,102.00
United HealthCare,PPO,84431,CPT4/HCPCS,THROMBOXANE URINE,,Per Unit,102.00
United HealthCare,PPO,84432,CPT4/HCPCS,ASSAY OF THYROGLOBULIN,,Per Unit,102.00
United HealthCare,PPO,84436,CPT4/HCPCS,ASSAY OF TOTAL THYROXINE,,Per Unit,102.00
United HealthCare,PPO,84437,CPT4/HCPCS,ASSAY OF NEONATAL THYROXINE,,Per Unit,102.00
United HealthCare,PPO,84439,CPT4/HCPCS,ASSAY OF FREE THYROXINE,,Per Unit,102.00
United HealthCare,PPO,84442,CPT4/HCPCS,ASSAY OF THYROID ACTIVITY,,Per Unit,102.00
United HealthCare,PPO,84443,CPT4/HCPCS,ASSAY THYROID STIM HORMONE,,Per Unit,102.00
United HealthCare,PPO,84445,CPT4/HCPCS,ASSAY OF TSI GLOBULIN,,Per Unit,102.00
United HealthCare,PPO,84446,CPT4/HCPCS,ASSAY OF VITAMIN E,,Per Unit,102.00
United HealthCare,PPO,84449,CPT4/HCPCS,ASSAY OF TRANSCORTIN,,Per Unit,102.00
United HealthCare,PPO,84450,CPT4/HCPCS,TRANSFERASE (AST) (SGOT),,Per Unit,102.00
United HealthCare,PPO,84460,CPT4/HCPCS,ALANINE AMINO (ALT) (SGPT),,Per Unit,102.00
United HealthCare,PPO,84466,CPT4/HCPCS,ASSAY OF TRANSFERRIN,,Per Unit,102.00
United HealthCare,PPO,84478,CPT4/HCPCS,ASSAY OF TRIGLYCERIDES,,Per Unit,102.00
United HealthCare,PPO,84479,CPT4/HCPCS,ASSAY OF THYROID (T3 OR T4),,Per Unit,102.00
United HealthCare,PPO,84480,CPT4/HCPCS,ASSAY TRIIODOTHYRONINE (T3),,Per Unit,102.00
United HealthCare,PPO,84481,CPT4/HCPCS,FREE ASSAY (FT-3),,Per Unit,102.00
United HealthCare,PPO,84482,CPT4/HCPCS,T3 REVERSE,,Per Unit,102.00
United HealthCare,PPO,84484,CPT4/HCPCS,ASSAY OF TROPONIN QUANT,,Per Unit,102.00
United HealthCare,PPO,84485,CPT4/HCPCS,ASSAY DUODENAL FLUID TRYPSIN,,Per Unit,102.00
United HealthCare,PPO,84488,CPT4/HCPCS,TEST FECES FOR TRYPSIN,,Per Unit,102.00
United HealthCare,PPO,84490,CPT4/HCPCS,ASSAY OF FECES FOR TRYPSIN,,Per Unit,102.00
United HealthCare,PPO,84510,CPT4/HCPCS,ASSAY OF TYROSINE,,Per Unit,102.00
United HealthCare,PPO,84512,CPT4/HCPCS,ASSAY OF TROPONIN QUAL,,Per Unit,102.00
United HealthCare,PPO,84520,CPT4/HCPCS,ASSAY OF UREA NITROGEN,,Per Unit,102.00
United HealthCare,PPO,84525,CPT4/HCPCS,UREA NITROGEN SEMI-QUANT,,Per Unit,102.00
United HealthCare,PPO,84540,CPT4/HCPCS,ASSAY OF URINE/UREA-N,,Per Unit,102.00
United HealthCare,PPO,84545,CPT4/HCPCS,UREA-N CLEARANCE TEST,,Per Unit,102.00
United HealthCare,PPO,84550,CPT4/HCPCS,ASSAY OF BLOOD/URIC ACID,,Per Unit,102.00
United HealthCare,PPO,84560,CPT4/HCPCS,ASSAY OF URINE/URIC ACID,,Per Unit,102.00
United HealthCare,PPO,84577,CPT4/HCPCS,ASSAY OF FECES/UROBILINOGEN,,Per Unit,102.00
United HealthCare,PPO,84578,CPT4/HCPCS,TEST URINE UROBILINOGEN,,Per Unit,102.00
United HealthCare,PPO,84580,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,Per Unit,102.00
United HealthCare,PPO,84583,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,Per Unit,102.00
United HealthCare,PPO,84585,CPT4/HCPCS,ASSAY OF URINE VMA,,Per Unit,102.00
United HealthCare,PPO,84586,CPT4/HCPCS,ASSAY OF VIP,,Per Unit,102.00
United HealthCare,PPO,84588,CPT4/HCPCS,ASSAY OF VASOPRESSIN,,Per Unit,102.00
United HealthCare,PPO,84590,CPT4/HCPCS,ASSAY OF VITAMIN A,,Per Unit,102.00
United HealthCare,PPO,84591,CPT4/HCPCS,ASSAY OF NOS VITAMIN,,Per Unit,102.00
United HealthCare,PPO,84597,CPT4/HCPCS,ASSAY OF VITAMIN K,,Per Unit,102.00
United HealthCare,PPO,84600,CPT4/HCPCS,ASSAY OF VOLATILES,,Per Unit,102.00
United HealthCare,PPO,84620,CPT4/HCPCS,XYLOSE TOLERANCE TEST,,Per Unit,102.00
United HealthCare,PPO,84630,CPT4/HCPCS,ASSAY OF ZINC,,Per Unit,102.00
United HealthCare,PPO,84681,CPT4/HCPCS,ASSAY OF C-PEPTIDE,,Per Unit,102.00
United HealthCare,PPO,84702,CPT4/HCPCS,CHORIONIC GONADOTROPIN TEST,,Per Unit,102.00
United HealthCare,PPO,84703,CPT4/HCPCS,CHORIONIC GONADOTROPIN ASSAY,,Per Unit,102.00
United HealthCare,PPO,84704,CPT4/HCPCS,HCG FREE BETACHAIN TEST,,Per Unit,102.00
United HealthCare,PPO,84830,CPT4/HCPCS,OVULATION TESTS,,Per Unit,102.00
United HealthCare,PPO,85002,CPT4/HCPCS,BLEEDING TIME TEST,,Per Unit,102.00
United HealthCare,PPO,85004,CPT4/HCPCS,AUTOMATED DIFF WBC COUNT,,Per Unit,102.00
United HealthCare,PPO,85007,CPT4/HCPCS,BL SMEAR W/DIFF WBC COUNT,,Per Unit,102.00
United HealthCare,PPO,85008,CPT4/HCPCS,BL SMEAR W/O DIFF WBC COUNT,,Per Unit,102.00
United HealthCare,PPO,85009,CPT4/HCPCS,MANUAL DIFF WBC COUNT B-COAT,,Per Unit,102.00
United HealthCare,PPO,85013,CPT4/HCPCS,SPUN MICROHEMATOCRIT,,Per Unit,102.00
United HealthCare,PPO,85014,CPT4/HCPCS,HEMATOCRIT,,Per Unit,102.00
United HealthCare,PPO,85018,CPT4/HCPCS,HEMOGLOBIN,,Per Unit,102.00
United HealthCare,PPO,85025,CPT4/HCPCS,COMPLETE CBC W/AUTO DIFF WBC,,Per Unit,102.00
United HealthCare,PPO,85027,CPT4/HCPCS,COMPLETE CBC AUTOMATED,,Per Unit,102.00
United HealthCare,PPO,85032,CPT4/HCPCS,MANUAL CELL COUNT EACH,,Per Unit,102.00
United HealthCare,PPO,85041,CPT4/HCPCS,AUTOMATED RBC COUNT,,Per Unit,102.00
United HealthCare,PPO,85044,CPT4/HCPCS,MANUAL RETICULOCYTE COUNT,,Per Unit,102.00
United HealthCare,PPO,85045,CPT4/HCPCS,AUTOMATED RETICULOCYTE COUNT,,Per Unit,102.00
United HealthCare,PPO,85046,CPT4/HCPCS,RETICYTE/HGB CONCENTRATE,,Per Unit,102.00
United HealthCare,PPO,85048,CPT4/HCPCS,AUTOMATED LEUKOCYTE COUNT,,Per Unit,102.00
United HealthCare,PPO,85049,CPT4/HCPCS,AUTOMATED PLATELET COUNT,,Per Unit,102.00
United HealthCare,PPO,85055,CPT4/HCPCS,RETICULATED PLATELET ASSAY,,Per Unit,102.00
United HealthCare,PPO,85060,CPT4/HCPCS,BLOOD SMEAR INTERPRETATION,,Per Unit,102.00
United HealthCare,PPO,85097,CPT4/HCPCS,BONE MARROW INTERPRETATION,,Per Unit,102.00
United HealthCare,PPO,85130,CPT4/HCPCS,CHROMOGENIC SUBSTRATE ASSAY,,Per Unit,102.00
United HealthCare,PPO,85170,CPT4/HCPCS,BLOOD CLOT RETRACTION,,Per Unit,102.00
United HealthCare,PPO,85175,CPT4/HCPCS,BLOOD CLOT LYSIS TIME,,Per Unit,102.00
United HealthCare,PPO,85210,CPT4/HCPCS,CLOT FACTOR II PROTHROM SPEC,,Per Unit,102.00
United HealthCare,PPO,85220,CPT4/HCPCS,BLOOC CLOT FACTOR V TEST,,Per Unit,102.00
United HealthCare,PPO,85230,CPT4/HCPCS,CLOT FACTOR VII PROCONVERTIN,,Per Unit,102.00
United HealthCare,PPO,85240,CPT4/HCPCS,CLOT FACTOR VIII AHG 1 STAGE,,Per Unit,102.00
United HealthCare,PPO,85244,CPT4/HCPCS,CLOT FACTOR VIII RELTD ANTGN,,Per Unit,102.00
United HealthCare,PPO,85245,CPT4/HCPCS,CLOT FACTOR VIII VW RISTOCTN,,Per Unit,102.00
United HealthCare,PPO,85246,CPT4/HCPCS,CLOT FACTOR VIII VW ANTIGEN,,Per Unit,102.00
United HealthCare,PPO,85247,CPT4/HCPCS,CLOT FACTOR VIII MULTIMETRIC,,Per Unit,102.00
United HealthCare,PPO,85250,CPT4/HCPCS,CLOT FACTOR IX PTC/CHRSTMAS,,Per Unit,102.00
United HealthCare,PPO,85260,CPT4/HCPCS,CLOT FACTOR X STUART-POWER,,Per Unit,102.00
United HealthCare,PPO,85270,CPT4/HCPCS,CLOT FACTOR XI PTA,,Per Unit,102.00
United HealthCare,PPO,85280,CPT4/HCPCS,CLOT FACTOR XII HAGEMAN,,Per Unit,102.00
United HealthCare,PPO,85290,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN STAB,,Per Unit,102.00
United HealthCare,PPO,85291,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN SCRN,,Per Unit,102.00
United HealthCare,PPO,85292,CPT4/HCPCS,CLOT FACTOR FLETCHER FACT,,Per Unit,102.00
United HealthCare,PPO,85293,CPT4/HCPCS,CLOT FACTOR WGHT KININOGEN,,Per Unit,102.00
United HealthCare,PPO,85300,CPT4/HCPCS,ANTITHROMBIN III ACTIVITY,,Per Unit,102.00
United HealthCare,PPO,85301,CPT4/HCPCS,ANTITHROMBIN III ANTIGEN,,Per Unit,102.00
United HealthCare,PPO,85302,CPT4/HCPCS,CLOT INHIBIT PROT C ANTIGEN,,Per Unit,102.00
United HealthCare,PPO,85303,CPT4/HCPCS,CLOT INHIBIT PROT C ACTIVITY,,Per Unit,102.00
United HealthCare,PPO,85305,CPT4/HCPCS,CLOT INHIBIT PROT S TOTAL,,Per Unit,102.00
United HealthCare,PPO,85306,CPT4/HCPCS,CLOT INHIBIT PROT S FREE,,Per Unit,102.00
United HealthCare,PPO,85307,CPT4/HCPCS,ASSAY ACTIVATED PROTEIN C,,Per Unit,102.00
United HealthCare,PPO,85335,CPT4/HCPCS,FACTOR INHIBITOR TEST,,Per Unit,102.00
United HealthCare,PPO,85337,CPT4/HCPCS,THROMBOMODULIN,,Per Unit,102.00
United HealthCare,PPO,85345,CPT4/HCPCS,COAGULATION TIME LEE & WHITE,,Per Unit,102.00
United HealthCare,PPO,85347,CPT4/HCPCS,COAGULATION TIME ACTIVATED,,Per Unit,102.00
United HealthCare,PPO,85348,CPT4/HCPCS,COAGULATION TIME OTR METHOD,,Per Unit,102.00
United HealthCare,PPO,85360,CPT4/HCPCS,EUGLOBULIN LYSIS,,Per Unit,102.00
United HealthCare,PPO,85362,CPT4/HCPCS,FIBRIN DEGRADATION PRODUCTS,,Per Unit,102.00
United HealthCare,PPO,85366,CPT4/HCPCS,FIBRINOGEN TEST,,Per Unit,102.00
United HealthCare,PPO,85370,CPT4/HCPCS,FIBRINOGEN TEST,,Per Unit,102.00
United HealthCare,PPO,85378,CPT4/HCPCS,FIBRIN DEGRADE SEMIQUANT,,Per Unit,102.00
United HealthCare,PPO,85379,CPT4/HCPCS,FIBRIN DEGRADATION QUANT,,Per Unit,102.00
United HealthCare,PPO,85380,CPT4/HCPCS,FIBRIN DEGRADJ D-DIMER,,Per Unit,102.00
United HealthCare,PPO,85384,CPT4/HCPCS,FIBRINOGEN ACTIVITY,,Per Unit,102.00
United HealthCare,PPO,85385,CPT4/HCPCS,FIBRINOGEN ANTIGEN,,Per Unit,102.00
United HealthCare,PPO,85390,CPT4/HCPCS,FIBRINOLYSINS SCREEN I&R,,Per Unit,102.00
United HealthCare,PPO,85396,CPT4/HCPCS,CLOTTING ASSAY WHOLE BLOOD,,Per Unit,102.00
United HealthCare,PPO,85397,CPT4/HCPCS,CLOTTING FUNCT ACTIVITY,,Per Unit,102.00
United HealthCare,PPO,85400,CPT4/HCPCS,FIBRINOLYTIC PLASMIN,,Per Unit,102.00
United HealthCare,PPO,85410,CPT4/HCPCS,FIBRINOLYTIC ANTIPLASMIN,,Per Unit,102.00
United HealthCare,PPO,85415,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Per Unit,102.00
United HealthCare,PPO,85420,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Per Unit,102.00
United HealthCare,PPO,85421,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,Per Unit,102.00
United HealthCare,PPO,85441,CPT4/HCPCS,HEINZ BODIES DIRECT,,Per Unit,102.00
United HealthCare,PPO,85445,CPT4/HCPCS,HEINZ BODIES INDUCED,,Per Unit,102.00
United HealthCare,PPO,85460,CPT4/HCPCS,HEMOGLOBIN FETAL,,Per Unit,102.00
United HealthCare,PPO,85461,CPT4/HCPCS,HEMOGLOBIN FETAL,,Per Unit,102.00
United HealthCare,PPO,85475,CPT4/HCPCS,HEMOLYSIN ACID,,Per Unit,102.00
United HealthCare,PPO,85520,CPT4/HCPCS,HEPARIN ASSAY,,Per Unit,102.00
United HealthCare,PPO,85525,CPT4/HCPCS,HEPARIN NEUTRALIZATION,,Per Unit,102.00
United HealthCare,PPO,85530,CPT4/HCPCS,HEPARIN-PROTAMINE TOLERANCE,,Per Unit,102.00
United HealthCare,PPO,85536,CPT4/HCPCS,IRON STAIN PERIPHERAL BLOOD,,Per Unit,102.00
United HealthCare,PPO,85540,CPT4/HCPCS,WBC ALKALINE PHOSPHATASE,,Per Unit,102.00
United HealthCare,PPO,85547,CPT4/HCPCS,RBC MECHANICAL FRAGILITY,,Per Unit,102.00
United HealthCare,PPO,85549,CPT4/HCPCS,MURAMIDASE,,Per Unit,102.00
United HealthCare,PPO,85555,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,Per Unit,102.00
United HealthCare,PPO,85557,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,Per Unit,102.00
United HealthCare,PPO,85576,CPT4/HCPCS,BLOOD PLATELET AGGREGATION,,Per Unit,102.00
United HealthCare,PPO,85597,CPT4/HCPCS,PHOSPHOLIPID PLTLT NEUTRALIZ,,Per Unit,102.00
United HealthCare,PPO,85598,CPT4/HCPCS,HEXAGNAL PHOSPH PLTLT NEUTRL,,Per Unit,102.00
United HealthCare,PPO,85610,CPT4/HCPCS,PROTHROMBIN TIME,,Per Unit,102.00
United HealthCare,PPO,85611,CPT4/HCPCS,PROTHROMBIN TEST,,Per Unit,102.00
United HealthCare,PPO,85612,CPT4/HCPCS,VIPER VENOM PROTHROMBIN TIME,,Per Unit,102.00
United HealthCare,PPO,85613,CPT4/HCPCS,RUSSELL VIPER VENOM DILUTED,,Per Unit,102.00
United HealthCare,PPO,85635,CPT4/HCPCS,REPTILASE TEST,,Per Unit,102.00
United HealthCare,PPO,85651,CPT4/HCPCS,RBC SED RATE NONAUTOMATED,,Per Unit,102.00
United HealthCare,PPO,85652,CPT4/HCPCS,RBC SED RATE AUTOMATED,,Per Unit,102.00
United HealthCare,PPO,85660,CPT4/HCPCS,RBC SICKLE CELL TEST,,Per Unit,102.00
United HealthCare,PPO,85670,CPT4/HCPCS,THROMBIN TIME PLASMA,,Per Unit,102.00
United HealthCare,PPO,85675,CPT4/HCPCS,THROMBIN TIME TITER,,Per Unit,102.00
United HealthCare,PPO,85705,CPT4/HCPCS,THROMBOPLASTIN INHIBITION,,Per Unit,102.00
United HealthCare,PPO,85730,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,Per Unit,102.00
United HealthCare,PPO,85732,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,Per Unit,102.00
United HealthCare,PPO,85810,CPT4/HCPCS,BLOOD VISCOSITY EXAMINATION,,Per Unit,102.00
United HealthCare,PPO,86000,CPT4/HCPCS,AGGLUTININS FEBRILE ANTIGEN,,Per Unit,102.00
United HealthCare,PPO,86001,CPT4/HCPCS,ALLERGEN SPECIFIC IGG,,Per Unit,102.00
United HealthCare,PPO,86003,CPT4/HCPCS,ALLG SPEC IGE CRUDE XTRC EA,,Per Unit,102.00
United HealthCare,PPO,86005,CPT4/HCPCS,ALLG SPEC IGE MULTIALLG SCR,,Per Unit,102.00
United HealthCare,PPO,86008,CPT4/HCPCS,ALLG SPEC IGE RECOMB EA,,Per Unit,102.00
United HealthCare,PPO,86021,CPT4/HCPCS,WBC ANTIBODY IDENTIFICATION,,Per Unit,102.00
United HealthCare,PPO,86022,CPT4/HCPCS,PLATELET ANTIBODIES,,Per Unit,102.00
United HealthCare,PPO,86023,CPT4/HCPCS,IMMUNOGLOBULIN ASSAY,,Per Unit,102.00
United HealthCare,PPO,86038,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES,,Per Unit,102.00
United HealthCare,PPO,86039,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES (ANA),,Per Unit,102.00
United HealthCare,PPO,86060,CPT4/HCPCS,ANTISTREPTOLYSIN O TITER,,Per Unit,102.00
United HealthCare,PPO,86063,CPT4/HCPCS,ANTISTREPTOLYSIN O SCREEN,,Per Unit,102.00
United HealthCare,PPO,86077,CPT4/HCPCS,PHYS BLOOD BANK SERV XMATCH,,Per Unit,102.00
United HealthCare,PPO,86078,CPT4/HCPCS,PHYS BLOOD BANK SERV REACTJ,,Per Unit,102.00
United HealthCare,PPO,86079,CPT4/HCPCS,PHYS BLOOD BANK SERV AUTHRJ,,Per Unit,102.00
United HealthCare,PPO,86140,CPT4/HCPCS,C-REACTIVE PROTEIN,,Per Unit,102.00
United HealthCare,PPO,86141,CPT4/HCPCS,C-REACTIVE PROTEIN HS,,Per Unit,102.00
United HealthCare,PPO,86146,CPT4/HCPCS,BETA-2 GLYCOPROTEIN ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86147,CPT4/HCPCS,CARDIOLIPIN ANTIBODY EA IG,,Per Unit,102.00
United HealthCare,PPO,86148,CPT4/HCPCS,ANTI-PHOSPHOLIPID ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86152,CPT4/HCPCS,CELL ENUMERATION & ID,,Per Unit,102.00
United HealthCare,PPO,86153,CPT4/HCPCS,CELL ENUMERATION PHYS INTERP,,Per Unit,102.00
United HealthCare,PPO,86155,CPT4/HCPCS,CHEMOTAXIS ASSAY,,Per Unit,102.00
United HealthCare,PPO,86156,CPT4/HCPCS,COLD AGGLUTININ SCREEN,,Per Unit,102.00
United HealthCare,PPO,86157,CPT4/HCPCS,COLD AGGLUTININ TITER,,Per Unit,102.00
United HealthCare,PPO,86160,CPT4/HCPCS,COMPLEMENT ANTIGEN,,Per Unit,102.00
United HealthCare,PPO,86161,CPT4/HCPCS,COMPLEMENT/FUNCTION ACTIVITY,,Per Unit,102.00
United HealthCare,PPO,86162,CPT4/HCPCS,COMPLEMENT TOTAL (CH50),,Per Unit,102.00
United HealthCare,PPO,86171,CPT4/HCPCS,COMPLEMENT FIXATION EACH,,Per Unit,102.00
United HealthCare,PPO,86200,CPT4/HCPCS,CCP ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86215,CPT4/HCPCS,DEOXYRIBONUCLEASE ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86225,CPT4/HCPCS,DNA ANTIBODY NATIVE,,Per Unit,102.00
United HealthCare,PPO,86226,CPT4/HCPCS,DNA ANTIBODY SINGLE STRAND,,Per Unit,102.00
United HealthCare,PPO,86235,CPT4/HCPCS,NUCLEAR ANTIGEN ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86255,CPT4/HCPCS,FLUORESCENT ANTIBODY SCREEN,,Per Unit,102.00
United HealthCare,PPO,86256,CPT4/HCPCS,FLUORESCENT ANTIBODY TITER,,Per Unit,102.00
United HealthCare,PPO,86277,CPT4/HCPCS,GROWTH HORMONE ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86280,CPT4/HCPCS,HEMAGGLUTINATION INHIBITION,,Per Unit,102.00
United HealthCare,PPO,86294,CPT4/HCPCS,IMMUNOASSAY TUMOR QUAL,,Per Unit,102.00
United HealthCare,PPO,86300,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 15-3,,Per Unit,102.00
United HealthCare,PPO,86301,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 19-9,,Per Unit,102.00
United HealthCare,PPO,86304,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 125,,Per Unit,102.00
United HealthCare,PPO,86305,CPT4/HCPCS,HUMAN EPIDIDYMIS PROTEIN 4,,Per Unit,102.00
United HealthCare,PPO,86308,CPT4/HCPCS,HETEROPHILE ANTIBODY SCREEN,,Per Unit,102.00
United HealthCare,PPO,86309,CPT4/HCPCS,HETEROPHILE ANTIBODY TITER,,Per Unit,102.00
United HealthCare,PPO,86310,CPT4/HCPCS,HETEROPHILE ANTIBODY ABSRBJ,,Per Unit,102.00
United HealthCare,PPO,86316,CPT4/HCPCS,IMMUNOASSAY TUMOR OTHER,,Per Unit,102.00
United HealthCare,PPO,86317,CPT4/HCPCS,IMMUNOASSAY INFECTIOUS AGENT,,Per Unit,102.00
United HealthCare,PPO,86318,CPT4/HCPCS,IA INFECTIOUS AGENT ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86320,CPT4/HCPCS,SERUM IMMUNOELECTROPHORESIS,,Per Unit,102.00
United HealthCare,PPO,86325,CPT4/HCPCS,OTHER IMMUNOELECTROPHORESIS,,Per Unit,102.00
United HealthCare,PPO,86327,CPT4/HCPCS,IMMUNOELECTROPHORESIS ASSAY,,Per Unit,102.00
United HealthCare,PPO,86329,CPT4/HCPCS,IMMUNODIFFUSION NES,,Per Unit,102.00
United HealthCare,PPO,86331,CPT4/HCPCS,IMMUNODIFFUSION OUCHTERLONY,,Per Unit,102.00
United HealthCare,PPO,86332,CPT4/HCPCS,IMMUNE COMPLEX ASSAY,,Per Unit,102.00
United HealthCare,PPO,86334,CPT4/HCPCS,IMMUNOFIX E-PHORESIS SERUM,,Per Unit,102.00
United HealthCare,PPO,86335,CPT4/HCPCS,IMMUNFIX E-PHORSIS/URINE/CSF,,Per Unit,102.00
United HealthCare,PPO,86336,CPT4/HCPCS,INHIBIN A,,Per Unit,102.00
United HealthCare,PPO,86337,CPT4/HCPCS,INSULIN ANTIBODIES,,Per Unit,102.00
United HealthCare,PPO,86340,CPT4/HCPCS,INTRINSIC FACTOR ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86341,CPT4/HCPCS,ISLET CELL ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86343,CPT4/HCPCS,LEUKOCYTE HISTAMINE RELEASE,,Per Unit,102.00
United HealthCare,PPO,86344,CPT4/HCPCS,LEUKOCYTE PHAGOCYTOSIS,,Per Unit,102.00
United HealthCare,PPO,86352,CPT4/HCPCS,CELL FUNCTION ASSAY W/STIM,,Per Unit,102.00
United HealthCare,PPO,86353,CPT4/HCPCS,LYMPHOCYTE TRANSFORMATION,,Per Unit,102.00
United HealthCare,PPO,86355,CPT4/HCPCS,B CELLS TOTAL COUNT,,Per Unit,102.00
United HealthCare,PPO,86356,CPT4/HCPCS,MONONUCLEAR CELL ANTIGEN,,Per Unit,102.00
United HealthCare,PPO,86357,CPT4/HCPCS,NK CELLS TOTAL COUNT,,Per Unit,102.00
United HealthCare,PPO,86359,CPT4/HCPCS,T CELLS TOTAL COUNT,,Per Unit,102.00
United HealthCare,PPO,86360,CPT4/HCPCS,T CELL ABSOLUTE COUNT/RATIO,,Per Unit,102.00
United HealthCare,PPO,86361,CPT4/HCPCS,T CELL ABSOLUTE COUNT,,Per Unit,102.00
United HealthCare,PPO,86367,CPT4/HCPCS,STEM CELLS TOTAL COUNT,,Per Unit,102.00
United HealthCare,PPO,86376,CPT4/HCPCS,MICROSOMAL ANTIBODY EACH,,Per Unit,102.00
United HealthCare,PPO,86382,CPT4/HCPCS,NEUTRALIZATION TEST VIRAL,,Per Unit,102.00
United HealthCare,PPO,86384,CPT4/HCPCS,NITROBLUE TETRAZOLIUM DYE,,Per Unit,102.00
United HealthCare,PPO,86386,CPT4/HCPCS,NUCLEAR MATRIX PROTEIN 22,,Per Unit,102.00
United HealthCare,PPO,86403,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY SCRN,,Per Unit,102.00
United HealthCare,PPO,86406,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY TITR,,Per Unit,102.00
United HealthCare,PPO,86430,CPT4/HCPCS,RHEUMATOID FACTOR TEST QUAL,,Per Unit,102.00
United HealthCare,PPO,86431,CPT4/HCPCS,RHEUMATOID FACTOR QUANT,,Per Unit,102.00
United HealthCare,PPO,86480,CPT4/HCPCS,TB TEST CELL IMMUN MEASURE,,Per Unit,102.00
United HealthCare,PPO,86481,CPT4/HCPCS,TB AG RESPONSE T-CELL SUSP,,Per Unit,102.00
United HealthCare,PPO,86485,CPT4/HCPCS,SKIN TEST CANDIDA,,Per Unit,102.00
United HealthCare,PPO,86486,CPT4/HCPCS,SKIN TEST NOS ANTIGEN,,Per Unit,102.00
United HealthCare,PPO,86490,CPT4/HCPCS,COCCIDIOIDOMYCOSIS SKIN TEST,,Per Unit,102.00
United HealthCare,PPO,86510,CPT4/HCPCS,HISTOPLASMOSIS SKIN TEST,,Per Unit,102.00
United HealthCare,PPO,86580,CPT4/HCPCS,TB INTRADERMAL TEST,,Per Unit,102.00
United HealthCare,PPO,86590,CPT4/HCPCS,STREPTOKINASE ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86592,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUAL,,Per Unit,102.00
United HealthCare,PPO,86593,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUANT,,Per Unit,102.00
United HealthCare,PPO,86602,CPT4/HCPCS,ANTINOMYCES ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86603,CPT4/HCPCS,ADENOVIRUS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86606,CPT4/HCPCS,ASPERGILLUS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86609,CPT4/HCPCS,BACTERIUM ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86611,CPT4/HCPCS,BARTONELLA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86612,CPT4/HCPCS,BLASTOMYCES ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86615,CPT4/HCPCS,BORDETELLA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86617,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86618,CPT4/HCPCS,LYME DISEASE ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86619,CPT4/HCPCS,BORRELIA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86622,CPT4/HCPCS,BRUCELLA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86625,CPT4/HCPCS,CAMPYLOBACTER ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86628,CPT4/HCPCS,CANDIDA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86631,CPT4/HCPCS,CHLAMYDIA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86632,CPT4/HCPCS,CHLAMYDIA IGM ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86635,CPT4/HCPCS,COCCIDIOIDES ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86638,CPT4/HCPCS,Q FEVER ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86641,CPT4/HCPCS,CRYPTOCOCCUS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86644,CPT4/HCPCS,CMV ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86645,CPT4/HCPCS,CMV ANTIBODY IGM,,Per Unit,102.00
United HealthCare,PPO,86648,CPT4/HCPCS,DIPHTHERIA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86651,CPT4/HCPCS,ENCEPHALITIS CALIFORN ANTBDY,,Per Unit,102.00
United HealthCare,PPO,86652,CPT4/HCPCS,ENCEPHALTIS EAST EQNE ANBDY,,Per Unit,102.00
United HealthCare,PPO,86653,CPT4/HCPCS,ENCEPHALTIS ST LOUIS ANTBODY,,Per Unit,102.00
United HealthCare,PPO,86654,CPT4/HCPCS,ENCEPHALTIS WEST EQNE ANTBDY,,Per Unit,102.00
United HealthCare,PPO,86658,CPT4/HCPCS,ENTEROVIRUS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86663,CPT4/HCPCS,EPSTEIN-BARR ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86664,CPT4/HCPCS,EPSTEIN-BARR NUCLEAR ANTIGEN,,Per Unit,102.00
United HealthCare,PPO,86665,CPT4/HCPCS,EPSTEIN-BARR CAPSID VCA,,Per Unit,102.00
United HealthCare,PPO,86666,CPT4/HCPCS,EHRLICHIA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86668,CPT4/HCPCS,FRANCISELLA TULARENSIS,,Per Unit,102.00
United HealthCare,PPO,86671,CPT4/HCPCS,FUNGUS NES ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86674,CPT4/HCPCS,GIARDIA LAMBLIA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86677,CPT4/HCPCS,HELICOBACTER PYLORI ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86682,CPT4/HCPCS,HELMINTH ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86684,CPT4/HCPCS,HEMOPHILUS INFLUENZA ANTIBDY,,Per Unit,102.00
United HealthCare,PPO,86687,CPT4/HCPCS,HTLV-I ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86688,CPT4/HCPCS,HTLV-II ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86689,CPT4/HCPCS,HTLV/HIV CONFIRMJ ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86692,CPT4/HCPCS,HEPATITIS DELTA AGENT ANTBDY,,Per Unit,102.00
United HealthCare,PPO,86694,CPT4/HCPCS,HERPES SIMPLEX NES ANTBDY,,Per Unit,102.00
United HealthCare,PPO,86695,CPT4/HCPCS,HERPES SIMPLEX TYPE 1 TEST,,Per Unit,102.00
United HealthCare,PPO,86696,CPT4/HCPCS,HERPES SIMPLEX TYPE 2 TEST,,Per Unit,102.00
United HealthCare,PPO,86698,CPT4/HCPCS,HISTOPLASMA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86701,CPT4/HCPCS,HIV-1ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86702,CPT4/HCPCS,HIV-2 ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86703,CPT4/HCPCS,HIV-1/HIV-2 1 RESULT ANTBDY,,Per Unit,102.00
United HealthCare,PPO,86704,CPT4/HCPCS,HEP B CORE ANTIBODY TOTAL,,Per Unit,102.00
United HealthCare,PPO,86705,CPT4/HCPCS,HEP B CORE ANTIBODY IGM,,Per Unit,102.00
United HealthCare,PPO,86706,CPT4/HCPCS,HEP B SURFACE ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86707,CPT4/HCPCS,HEPATITIS BE ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86708,CPT4/HCPCS,HEPATITIS A ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86709,CPT4/HCPCS,HEPATITIS A IGM ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86710,CPT4/HCPCS,INFLUENZA VIRUS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86711,CPT4/HCPCS,JOHN CUNNINGHAM ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86713,CPT4/HCPCS,LEGIONELLA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86717,CPT4/HCPCS,LEISHMANIA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86720,CPT4/HCPCS,LEPTOSPIRA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86723,CPT4/HCPCS,LISTERIA MONOCYTOGENES,,Per Unit,102.00
United HealthCare,PPO,86727,CPT4/HCPCS,LYMPH CHORIOMENINGITIS AB,,Per Unit,102.00
United HealthCare,PPO,86732,CPT4/HCPCS,MUCORMYCOSIS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86735,CPT4/HCPCS,MUMPS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86738,CPT4/HCPCS,MYCOPLASMA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86741,CPT4/HCPCS,NEISSERIA MENINGITIDIS,,Per Unit,102.00
United HealthCare,PPO,86744,CPT4/HCPCS,NOCARDIA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86747,CPT4/HCPCS,PARVOVIRUS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86750,CPT4/HCPCS,MALARIA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86753,CPT4/HCPCS,PROTOZOA ANTIBODY NOS,,Per Unit,102.00
United HealthCare,PPO,86756,CPT4/HCPCS,RESPIRATORY VIRUS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86757,CPT4/HCPCS,RICKETTSIA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86759,CPT4/HCPCS,ROTAVIRUS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86762,CPT4/HCPCS,RUBELLA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86765,CPT4/HCPCS,RUBEOLA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86768,CPT4/HCPCS,SALMONELLA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86771,CPT4/HCPCS,SHIGELLA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86774,CPT4/HCPCS,TETANUS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86777,CPT4/HCPCS,TOXOPLASMA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86778,CPT4/HCPCS,TOXOPLASMA ANTIBODY IGM,,Per Unit,102.00
United HealthCare,PPO,86780,CPT4/HCPCS,TREPONEMA PALLIDUM,,Per Unit,102.00
United HealthCare,PPO,86784,CPT4/HCPCS,TRICHINELLA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86787,CPT4/HCPCS,VARICELLA-ZOSTER ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86788,CPT4/HCPCS,WEST NILE VIRUS AB IGM,,Per Unit,102.00
United HealthCare,PPO,86789,CPT4/HCPCS,WEST NILE VIRUS ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86790,CPT4/HCPCS,VIRUS ANTIBODY NOS,,Per Unit,102.00
United HealthCare,PPO,86793,CPT4/HCPCS,YERSINIA ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86794,CPT4/HCPCS,ZIKA VIRUS IGM ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86800,CPT4/HCPCS,THYROGLOBULIN ANTIBODY,,Per Unit,102.00
United HealthCare,PPO,86803,CPT4/HCPCS,HEPATITIS C AB TEST,,Per Unit,102.00
United HealthCare,PPO,86804,CPT4/HCPCS,HEP C AB TEST CONFIRM,,Per Unit,102.00
United HealthCare,PPO,86805,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,Per Unit,102.00
United HealthCare,PPO,86806,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,Per Unit,102.00
United HealthCare,PPO,86807,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,Per Unit,102.00
United HealthCare,PPO,86808,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,Per Unit,102.00
United HealthCare,PPO,86812,CPT4/HCPCS,HLA TYPING A B OR C,,Per Unit,102.00
United HealthCare,PPO,86813,CPT4/HCPCS,HLA TYPING A B OR C,,Per Unit,102.00
United HealthCare,PPO,86816,CPT4/HCPCS,HLA TYPING DR/DQ,,Per Unit,102.00
United HealthCare,PPO,86817,CPT4/HCPCS,HLA TYPING DR/DQ,,Per Unit,102.00
United HealthCare,PPO,86821,CPT4/HCPCS,LYMPHOCYTE CULTURE MIXED,,Per Unit,102.00
United HealthCare,PPO,86825,CPT4/HCPCS,HLA X-MATH NON-CYTOTOXIC,,Per Unit,102.00
United HealthCare,PPO,86826,CPT4/HCPCS,HLA X-MATCH NONCYTOTOXC ADDL,,Per Unit,102.00
United HealthCare,PPO,86828,CPT4/HCPCS,HLA CLASS I&II ANTIBODY QUAL,,Per Unit,102.00
United HealthCare,PPO,86829,CPT4/HCPCS,HLA CLASS I/II ANTIBODY QUAL,,Per Unit,102.00
United HealthCare,PPO,86830,CPT4/HCPCS,HLA CLASS I PHENOTYPE QUAL,,Per Unit,102.00
United HealthCare,PPO,86831,CPT4/HCPCS,HLA CLASS II PHENOTYPE QUAL,,Per Unit,102.00
United HealthCare,PPO,86832,CPT4/HCPCS,HLA CLASS I HIGH DEFIN QUAL,,Per Unit,102.00
United HealthCare,PPO,86833,CPT4/HCPCS,HLA CLASS II HIGH DEFIN QUAL,,Per Unit,102.00
United HealthCare,PPO,86834,CPT4/HCPCS,HLA CLASS I SEMIQUANT PANEL,,Per Unit,102.00
United HealthCare,PPO,86835,CPT4/HCPCS,HLA CLASS II SEMIQUANT PANEL,,Per Unit,102.00
United HealthCare,PPO,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,Per Unit,102.00
United HealthCare,PPO,86860,CPT4/HCPCS,RBC ANTIBODY ELUTION,,Per Unit,102.00
United HealthCare,PPO,86870,CPT4/HCPCS,RBC ANTIBODY IDENTIFICATION,,Per Unit,102.00
United HealthCare,PPO,86880,CPT4/HCPCS,COOMBS TEST DIRECT,,Per Unit,102.00
United HealthCare,PPO,86885,CPT4/HCPCS,COOMBS TEST INDIRECT QUAL,,Per Unit,102.00
United HealthCare,PPO,86886,CPT4/HCPCS,COOMBS TEST INDIRECT TITER,,Per Unit,102.00
United HealthCare,PPO,86890,CPT4/HCPCS,AUTOLOGOUS BLOOD PROCESS,,Per Unit,102.00
United HealthCare,PPO,86891,CPT4/HCPCS,AUTOLOGOUS BLOOD OP SALVAGE,,Per Unit,102.00
United HealthCare,PPO,86900,CPT4/HCPCS,BLOOD TYPING SEROLOGIC ABO,,Per Unit,102.00
United HealthCare,PPO,86901,CPT4/HCPCS,BLOOD TYPING SEROLOGIC RH(D),,Per Unit,102.00
United HealthCare,PPO,86902,CPT4/HCPCS,BLOOD TYPE ANTIGEN DONOR EA,,Per Unit,102.00
United HealthCare,PPO,86904,CPT4/HCPCS,BLOOD TYPING PATIENT SERUM,,Per Unit,102.00
United HealthCare,PPO,86905,CPT4/HCPCS,BLOOD TYPING RBC ANTIGENS,,Per Unit,102.00
United HealthCare,PPO,86906,CPT4/HCPCS,BLD TYPING SEROLOGIC RH PHNT,,Per Unit,102.00
United HealthCare,PPO,86910,CPT4/HCPCS,BLOOD TYPING PATERNITY TEST,,Per Unit,102.00
United HealthCare,PPO,86911,CPT4/HCPCS,BLOOD TYPING ANTIGEN SYSTEM,,Per Unit,102.00
United HealthCare,PPO,86920,CPT4/HCPCS,COMPATIBILITY TEST SPIN,,Per Unit,102.00
United HealthCare,PPO,86921,CPT4/HCPCS,COMPATIBILITY TEST INCUBATE,,Per Unit,102.00
United HealthCare,PPO,86922,CPT4/HCPCS,COMPATIBILITY TEST ANTIGLOB,,Per Unit,102.00
United HealthCare,PPO,86923,CPT4/HCPCS,COMPATIBILITY TEST ELECTRIC,,Per Unit,102.00
United HealthCare,PPO,86927,CPT4/HCPCS,PLASMA FRESH FROZEN,,Per Unit,102.00
United HealthCare,PPO,86930,CPT4/HCPCS,FROZEN BLOOD PREP,,Per Unit,102.00
United HealthCare,PPO,86931,CPT4/HCPCS,FROZEN BLOOD THAW,,Per Unit,102.00
United HealthCare,PPO,86932,CPT4/HCPCS,FROZEN BLOOD FREEZE/THAW,,Per Unit,102.00
United HealthCare,PPO,86940,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS AUTO,,Per Unit,102.00
United HealthCare,PPO,86941,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS,,Per Unit,102.00
United HealthCare,PPO,86945,CPT4/HCPCS,BLOOD PRODUCT/IRRADIATION,,Per Unit,102.00
United HealthCare,PPO,86950,CPT4/HCPCS,LEUKACYTE TRANSFUSION,,Per Unit,102.00
United HealthCare,PPO,86960,CPT4/HCPCS,VOL REDUCTION OF BLOOD/PROD,,Per Unit,102.00
United HealthCare,PPO,86965,CPT4/HCPCS,POOLING BLOOD PLATELETS,,Per Unit,102.00
United HealthCare,PPO,86970,CPT4/HCPCS,RBC PRETX INCUBATJ W/CHEMICL,,Per Unit,102.00
United HealthCare,PPO,86971,CPT4/HCPCS,RBC PRETX INCUBATJ W/ENZYMES,,Per Unit,102.00
United HealthCare,PPO,86972,CPT4/HCPCS,RBC PRETX INCUBATJ W/DENSITY,,Per Unit,102.00
United HealthCare,PPO,86975,CPT4/HCPCS,RBC SERUM PRETX INCUBJ DRUGS,,Per Unit,102.00
United HealthCare,PPO,86976,CPT4/HCPCS,RBC SERUM PRETX ID DILUTION,,Per Unit,102.00
United HealthCare,PPO,86977,CPT4/HCPCS,RBC SERUM PRETX INCUBJ/INHIB,,Per Unit,102.00
United HealthCare,PPO,86978,CPT4/HCPCS,RBC PRETREATMENT SERUM,,Per Unit,102.00
United HealthCare,PPO,86985,CPT4/HCPCS,SPLIT BLOOD OR PRODUCTS,,Per Unit,102.00
United HealthCare,PPO,87003,CPT4/HCPCS,SMALL ANIMAL INOCULATION,,Per Unit,102.00
United HealthCare,PPO,87015,CPT4/HCPCS,SPECIMEN INFECT AGNT CONCNTJ,,Per Unit,102.00
United HealthCare,PPO,87040,CPT4/HCPCS,BLOOD CULTURE FOR BACTERIA,,Per Unit,102.00
United HealthCare,PPO,87045,CPT4/HCPCS,FECES CULTURE AEROBIC BACT,,Per Unit,102.00
United HealthCare,PPO,87046,CPT4/HCPCS,STOOL CULTR AEROBIC BACT EA,,Per Unit,102.00
United HealthCare,PPO,87070,CPT4/HCPCS,CULTURE OTHR SPECIMN AEROBIC,,Per Unit,102.00
United HealthCare,PPO,87071,CPT4/HCPCS,CULTURE AEROBIC QUANT OTHER,,Per Unit,102.00
United HealthCare,PPO,87073,CPT4/HCPCS,CULTURE BACTERIA ANAEROBIC,,Per Unit,102.00
United HealthCare,PPO,87075,CPT4/HCPCS,CULTR BACTERIA EXCEPT BLOOD,,Per Unit,102.00
United HealthCare,PPO,87076,CPT4/HCPCS,CULTURE ANAEROBE IDENT EACH,,Per Unit,102.00
United HealthCare,PPO,87077,CPT4/HCPCS,CULTURE AEROBIC IDENTIFY,,Per Unit,102.00
United HealthCare,PPO,87081,CPT4/HCPCS,CULTURE SCREEN ONLY,,Per Unit,102.00
United HealthCare,PPO,87084,CPT4/HCPCS,CULTURE OF SPECIMEN BY KIT,,Per Unit,102.00
United HealthCare,PPO,87086,CPT4/HCPCS,URINE CULTURE/COLONY COUNT,,Per Unit,102.00
United HealthCare,PPO,87088,CPT4/HCPCS,URINE BACTERIA CULTURE,,Per Unit,102.00
United HealthCare,PPO,87101,CPT4/HCPCS,SKIN FUNGI CULTURE,,Per Unit,102.00
United HealthCare,PPO,87102,CPT4/HCPCS,FUNGUS ISOLATION CULTURE,,Per Unit,102.00
United HealthCare,PPO,87103,CPT4/HCPCS,BLOOD FUNGUS CULTURE,,Per Unit,102.00
United HealthCare,PPO,87106,CPT4/HCPCS,FUNGI IDENTIFICATION YEAST,,Per Unit,102.00
United HealthCare,PPO,87107,CPT4/HCPCS,FUNGI IDENTIFICATION MOLD,,Per Unit,102.00
United HealthCare,PPO,87109,CPT4/HCPCS,MYCOPLASMA,,Per Unit,102.00
United HealthCare,PPO,87110,CPT4/HCPCS,CHLAMYDIA CULTURE,,Per Unit,102.00
United HealthCare,PPO,87116,CPT4/HCPCS,MYCOBACTERIA CULTURE,,Per Unit,102.00
United HealthCare,PPO,87118,CPT4/HCPCS,MYCOBACTERIC IDENTIFICATION,,Per Unit,102.00
United HealthCare,PPO,87140,CPT4/HCPCS,CULTURE TYPE IMMUNOFLUORESC,,Per Unit,102.00
United HealthCare,PPO,87143,CPT4/HCPCS,CULTURE TYPING GLC/HPLC,,Per Unit,102.00
United HealthCare,PPO,87147,CPT4/HCPCS,CULTURE TYPE IMMUNOLOGIC,,Per Unit,102.00
United HealthCare,PPO,87149,CPT4/HCPCS,DNA/RNA DIRECT PROBE,,Per Unit,102.00
United HealthCare,PPO,87150,CPT4/HCPCS,DNA/RNA AMPLIFIED PROBE,,Per Unit,102.00
United HealthCare,PPO,87152,CPT4/HCPCS,CULTURE TYPE PULSE FIELD GEL,,Per Unit,102.00
United HealthCare,PPO,87153,CPT4/HCPCS,DNA/RNA SEQUENCING,,Per Unit,102.00
United HealthCare,PPO,87158,CPT4/HCPCS,CULTURE TYPING ADDED METHOD,,Per Unit,102.00
United HealthCare,PPO,87164,CPT4/HCPCS,DARK FIELD EXAMINATION,,Per Unit,102.00
United HealthCare,PPO,87166,CPT4/HCPCS,DARK FIELD EXAMINATION,,Per Unit,102.00
United HealthCare,PPO,87168,CPT4/HCPCS,MACROSCOPIC EXAM ARTHROPOD,,Per Unit,102.00
United HealthCare,PPO,87169,CPT4/HCPCS,MACROSCOPIC EXAM PARASITE,,Per Unit,102.00
United HealthCare,PPO,87172,CPT4/HCPCS,PINWORM EXAM,,Per Unit,102.00
United HealthCare,PPO,87176,CPT4/HCPCS,TISSUE HOMOGENIZATION CULTR,,Per Unit,102.00
United HealthCare,PPO,87177,CPT4/HCPCS,OVA AND PARASITES SMEARS,,Per Unit,102.00
United HealthCare,PPO,87181,CPT4/HCPCS,MICROBE SUSCEPTIBLE DIFFUSE,,Per Unit,102.00
United HealthCare,PPO,87184,CPT4/HCPCS,MICROBE SUSCEPTIBLE DISK,,Per Unit,102.00
United HealthCare,PPO,87185,CPT4/HCPCS,MICROBE SUSCEPTIBLE ENZYME,,Per Unit,102.00
United HealthCare,PPO,87186,CPT4/HCPCS,MICROBE SUSCEPTIBLE MIC,,Per Unit,102.00
United HealthCare,PPO,87187,CPT4/HCPCS,MICROBE SUSCEPTIBLE MLC,,Per Unit,102.00
United HealthCare,PPO,87188,CPT4/HCPCS,MICROBE SUSCEPT MACROBROTH,,Per Unit,102.00
United HealthCare,PPO,87190,CPT4/HCPCS,MICROBE SUSCEPT MYCOBACTERI,,Per Unit,102.00
United HealthCare,PPO,87197,CPT4/HCPCS,BACTERICIDAL LEVEL SERUM,,Per Unit,102.00
United HealthCare,PPO,87205,CPT4/HCPCS,SMEAR GRAM STAIN,,Per Unit,102.00
United HealthCare,PPO,87206,CPT4/HCPCS,SMEAR FLUORESCENT/ACID STAI,,Per Unit,102.00
United HealthCare,PPO,87207,CPT4/HCPCS,SMEAR SPECIAL STAIN,,Per Unit,102.00
United HealthCare,PPO,87209,CPT4/HCPCS,SMEAR COMPLEX STAIN,,Per Unit,102.00
United HealthCare,PPO,87210,CPT4/HCPCS,SMEAR WET MOUNT SALINE/INK,,Per Unit,102.00
United HealthCare,PPO,87220,CPT4/HCPCS,TISSUE EXAM FOR FUNGI,,Per Unit,102.00
United HealthCare,PPO,87230,CPT4/HCPCS,ASSAY TOXIN OR ANTITOXIN,,Per Unit,102.00
United HealthCare,PPO,87250,CPT4/HCPCS,VIRUS INOCULATE EGGS/ANIMAL,,Per Unit,102.00
United HealthCare,PPO,87252,CPT4/HCPCS,VIRUS INOCULATION TISSUE,,Per Unit,102.00
United HealthCare,PPO,87253,CPT4/HCPCS,VIRUS INOCULATE TISSUE ADDL,,Per Unit,102.00
United HealthCare,PPO,87254,CPT4/HCPCS,VIRUS INOCULATION SHELL VIA,,Per Unit,102.00
United HealthCare,PPO,87255,CPT4/HCPCS,GENET VIRUS ISOLATE HSV,,Per Unit,102.00
United HealthCare,PPO,87260,CPT4/HCPCS,ADENOVIRUS AG IF,,Per Unit,102.00
United HealthCare,PPO,87265,CPT4/HCPCS,PERTUSSIS AG IF,,Per Unit,102.00
United HealthCare,PPO,87267,CPT4/HCPCS,ENTEROVIRUS ANTIBODY DFA,,Per Unit,102.00
United HealthCare,PPO,87269,CPT4/HCPCS,GIARDIA AG IF,,Per Unit,102.00
United HealthCare,PPO,87270,CPT4/HCPCS,CHLAMYDIA TRACHOMATIS AG IF,,Per Unit,102.00
United HealthCare,PPO,87271,CPT4/HCPCS,CYTOMEGALOVIRUS DFA,,Per Unit,102.00
United HealthCare,PPO,87272,CPT4/HCPCS,CRYPTOSPORIDIUM AG IF,,Per Unit,102.00
United HealthCare,PPO,87273,CPT4/HCPCS,HERPES SIMPLEX 2 AG IF,,Per Unit,102.00
United HealthCare,PPO,87274,CPT4/HCPCS,HERPES SIMPLEX 1 AG IF,,Per Unit,102.00
United HealthCare,PPO,87275,CPT4/HCPCS,INFLUENZA B AG IF,,Per Unit,102.00
United HealthCare,PPO,87276,CPT4/HCPCS,INFLUENZA A AG IF,,Per Unit,102.00
United HealthCare,PPO,87278,CPT4/HCPCS,LEGION PNEUMOPHILIA AG IF,,Per Unit,102.00
United HealthCare,PPO,87279,CPT4/HCPCS,PARAINFLUENZA AG IF,,Per Unit,102.00
United HealthCare,PPO,87280,CPT4/HCPCS,RESPIRATORY SYNCYTIAL AG IF,,Per Unit,102.00
United HealthCare,PPO,87281,CPT4/HCPCS,PNEUMOCYSTIS CARINII AG IF,,Per Unit,102.00
United HealthCare,PPO,87283,CPT4/HCPCS,RUBEOLA AG IF,,Per Unit,102.00
United HealthCare,PPO,87285,CPT4/HCPCS,TREPONEMA PALLIDUM AG IF,,Per Unit,102.00
United HealthCare,PPO,87290,CPT4/HCPCS,VARICELLA ZOSTER AG IF,,Per Unit,102.00
United HealthCare,PPO,87299,CPT4/HCPCS,ANTIBODY DETECTION NOS IF,,Per Unit,102.00
United HealthCare,PPO,87300,CPT4/HCPCS,AG DETECTION POLYVAL IF,,Per Unit,102.00
United HealthCare,PPO,87301,CPT4/HCPCS,ADENOVIRUS AG IA,,Per Unit,102.00
United HealthCare,PPO,87305,CPT4/HCPCS,ASPERGILLUS AG IA,,Per Unit,102.00
United HealthCare,PPO,87320,CPT4/HCPCS,CHYLMD TRACH AG IA,,Per Unit,102.00
United HealthCare,PPO,87324,CPT4/HCPCS,CLOSTRIDIUM AG IA,,Per Unit,102.00
United HealthCare,PPO,87327,CPT4/HCPCS,CRYPTOCOCCUS NEOFORM AG IA,,Per Unit,102.00
United HealthCare,PPO,87328,CPT4/HCPCS,CRYPTOSPORIDIUM AG IA,,Per Unit,102.00
United HealthCare,PPO,87329,CPT4/HCPCS,GIARDIA AG IA,,Per Unit,102.00
United HealthCare,PPO,87332,CPT4/HCPCS,CYTOMEGALOVIRUS AG IA,,Per Unit,102.00
United HealthCare,PPO,87335,CPT4/HCPCS,E COLI 0157 AG IA,,Per Unit,102.00
United HealthCare,PPO,87336,CPT4/HCPCS,ENTAMOEB HIST DISPR AG IA,,Per Unit,102.00
United HealthCare,PPO,87337,CPT4/HCPCS,ENTAMOEB HIST GROUP AG IA,,Per Unit,102.00
United HealthCare,PPO,87338,CPT4/HCPCS,HPYLORI STOOL IA,,Per Unit,102.00
United HealthCare,PPO,87339,CPT4/HCPCS,H PYLORI AG IA,,Per Unit,102.00
United HealthCare,PPO,87340,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,Per Unit,102.00
United HealthCare,PPO,87341,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,Per Unit,102.00
United HealthCare,PPO,87350,CPT4/HCPCS,HEPATITIS BE AG IA,,Per Unit,102.00
United HealthCare,PPO,87380,CPT4/HCPCS,HEPATITIS DELTA AG IA,,Per Unit,102.00
United HealthCare,PPO,87385,CPT4/HCPCS,HISTOPLASMA CAPSUL AG IA,,Per Unit,102.00
United HealthCare,PPO,87389,CPT4/HCPCS,HIV-1 AG W/HIV-1 & HIV-2 AB,,Per Unit,102.00
United HealthCare,PPO,87390,CPT4/HCPCS,HIV-1 AG IA,,Per Unit,102.00
United HealthCare,PPO,87391,CPT4/HCPCS,HIV-2 AG IA,,Per Unit,102.00
United HealthCare,PPO,87400,CPT4/HCPCS,INFLUENZA A/B AG IA,,Per Unit,102.00
United HealthCare,PPO,87420,CPT4/HCPCS,RESP SYNCYTIAL AG IA,,Per Unit,102.00
United HealthCare,PPO,87425,CPT4/HCPCS,ROTAVIRUS AG IA,,Per Unit,102.00
United HealthCare,PPO,87427,CPT4/HCPCS,SHIGA-LIKE TOXIN AG IA,,Per Unit,102.00
United HealthCare,PPO,87430,CPT4/HCPCS,STREP A AG IA,,Per Unit,102.00
United HealthCare,PPO,87449,CPT4/HCPCS,AG DETECT NOS IA MULT,,Per Unit,102.00
United HealthCare,PPO,87450,CPT4/HCPCS,AG DETECT NOS IA SINGLE,,Per Unit,102.00
United HealthCare,PPO,87451,CPT4/HCPCS,AG DETECT POLYVAL IA MULT,,Per Unit,102.00
United HealthCare,PPO,87471,CPT4/HCPCS,BARTONELLA DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87472,CPT4/HCPCS,BARTONELLA DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87475,CPT4/HCPCS,LYME DIS DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87476,CPT4/HCPCS,LYME DIS DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87480,CPT4/HCPCS,CANDIDA DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87481,CPT4/HCPCS,CANDIDA DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87482,CPT4/HCPCS,CANDIDA DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87483,CPT4/HCPCS,CNS DNA AMP PROBE TYPE 12-25,,Per Unit,102.00
United HealthCare,PPO,87485,CPT4/HCPCS,CHYLMD PNEUM DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87486,CPT4/HCPCS,CHYLMD PNEUM DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87487,CPT4/HCPCS,CHYLMD PNEUM DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87490,CPT4/HCPCS,CHYLMD TRACH DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87491,CPT4/HCPCS,CHYLMD TRACH DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87492,CPT4/HCPCS,CHYLMD TRACH DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87493,CPT4/HCPCS,C DIFF AMPLIFIED PROBE,,Per Unit,102.00
United HealthCare,PPO,87495,CPT4/HCPCS,CYTOMEG DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87496,CPT4/HCPCS,CYTOMEG DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87497,CPT4/HCPCS,CYTOMEG DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87498,CPT4/HCPCS,ENTEROVIRUS PROBE&REVRS TRNS,,Per Unit,102.00
United HealthCare,PPO,87500,CPT4/HCPCS,VANOMYCIN DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87501,CPT4/HCPCS,INFLUENZA DNA AMP PROB 1+,,Per Unit,102.00
United HealthCare,PPO,87502,CPT4/HCPCS,INFLUENZA DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87503,CPT4/HCPCS,INFLUENZA DNA AMP PROB ADDL,,Per Unit,102.00
United HealthCare,PPO,87505,CPT4/HCPCS,NFCT AGENT DETECTION GI,,Per Unit,102.00
United HealthCare,PPO,87506,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 6-11,,Per Unit,102.00
United HealthCare,PPO,87507,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 12-25,,Per Unit,102.00
United HealthCare,PPO,87510,CPT4/HCPCS,GARDNER VAG DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87511,CPT4/HCPCS,GARDNER VAG DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87512,CPT4/HCPCS,GARDNER VAG DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87516,CPT4/HCPCS,HEPATITIS B DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87517,CPT4/HCPCS,HEPATITIS B DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87520,CPT4/HCPCS,HEPATITIS C RNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87521,CPT4/HCPCS,HEPATITIS C PROBE&RVRS TRNSC,,Per Unit,102.00
United HealthCare,PPO,87522,CPT4/HCPCS,HEPATITIS C REVRS TRNSCRPJ,,Per Unit,102.00
United HealthCare,PPO,87525,CPT4/HCPCS,HEPATITIS G DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87526,CPT4/HCPCS,HEPATITIS G DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87527,CPT4/HCPCS,HEPATITIS G DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87528,CPT4/HCPCS,HSV DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87529,CPT4/HCPCS,HSV DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87530,CPT4/HCPCS,HSV DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87531,CPT4/HCPCS,HHV-6 DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87532,CPT4/HCPCS,HHV-6 DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87533,CPT4/HCPCS,HHV-6 DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87534,CPT4/HCPCS,HIV-1 DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87535,CPT4/HCPCS,HIV-1 PROBE&REVERSE TRNSCRPJ,,Per Unit,102.00
United HealthCare,PPO,87536,CPT4/HCPCS,HIV-1 QUANT&REVRSE TRNSCRPJ,,Per Unit,102.00
United HealthCare,PPO,87537,CPT4/HCPCS,HIV-2 DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87538,CPT4/HCPCS,HIV-2 PROBE&REVRSE TRNSCRIPJ,,Per Unit,102.00
United HealthCare,PPO,87539,CPT4/HCPCS,HIV-2 QUANT&REVRSE TRNSCRIPJ,,Per Unit,102.00
United HealthCare,PPO,87540,CPT4/HCPCS,LEGION PNEUMO DNA DIR PROB,,Per Unit,102.00
United HealthCare,PPO,87541,CPT4/HCPCS,LEGION PNEUMO DNA AMP PROB,,Per Unit,102.00
United HealthCare,PPO,87542,CPT4/HCPCS,LEGION PNEUMO DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87550,CPT4/HCPCS,MYCOBACTERIA DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87551,CPT4/HCPCS,MYCOBACTERIA DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87552,CPT4/HCPCS,MYCOBACTERIA DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87555,CPT4/HCPCS,M.TUBERCULO DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87556,CPT4/HCPCS,M.TUBERCULO DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87557,CPT4/HCPCS,M.TUBERCULO DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87560,CPT4/HCPCS,M.AVIUM-INTRA DNA DIR PROB,,Per Unit,102.00
United HealthCare,PPO,87561,CPT4/HCPCS,M.AVIUM-INTRA DNA AMP PROB,,Per Unit,102.00
United HealthCare,PPO,87562,CPT4/HCPCS,M.AVIUM-INTRA DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87580,CPT4/HCPCS,M.PNEUMON DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87581,CPT4/HCPCS,M.PNEUMON DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87582,CPT4/HCPCS,M.PNEUMON DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87590,CPT4/HCPCS,N.GONORRHOEAE DNA DIR PROB,,Per Unit,102.00
United HealthCare,PPO,87591,CPT4/HCPCS,N.GONORRHOEAE DNA AMP PROB,,Per Unit,102.00
United HealthCare,PPO,87592,CPT4/HCPCS,N.GONORRHOEAE DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87623,CPT4/HCPCS,HPV LOW-RISK TYPES,,Per Unit,102.00
United HealthCare,PPO,87624,CPT4/HCPCS,HPV HIGH-RISK TYPES,,Per Unit,102.00
United HealthCare,PPO,87625,CPT4/HCPCS,HPV TYPES 16 & 18 ONLY,,Per Unit,102.00
United HealthCare,PPO,87631,CPT4/HCPCS,RESP VIRUS 3-5 TARGETS,,Per Unit,102.00
United HealthCare,PPO,87632,CPT4/HCPCS,RESP VIRUS 6-11 TARGETS,,Per Unit,102.00
United HealthCare,PPO,87633,CPT4/HCPCS,RESP VIRUS 12-25 TARGETS,,Per Unit,102.00
United HealthCare,PPO,87634,CPT4/HCPCS,RSV DNA/RNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87640,CPT4/HCPCS,STAPH A DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87641,CPT4/HCPCS,MR-STAPH DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87650,CPT4/HCPCS,STREP A DNA DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87651,CPT4/HCPCS,STREP A DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87652,CPT4/HCPCS,STREP A DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87653,CPT4/HCPCS,STREP B DNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87660,CPT4/HCPCS,TRICHOMONAS VAGIN DIR PROBE,,Per Unit,102.00
United HealthCare,PPO,87661,CPT4/HCPCS,TRICHOMONAS VAGINALIS AMPLIF,,Per Unit,102.00
United HealthCare,PPO,87662,CPT4/HCPCS,ZIKA VIRUS DNA/RNA AMP PROBE,,Per Unit,102.00
United HealthCare,PPO,87797,CPT4/HCPCS,DETECT AGENT NOS DNA DIR,,Per Unit,102.00
United HealthCare,PPO,87798,CPT4/HCPCS,DETECT AGENT NOS DNA AMP,,Per Unit,102.00
United HealthCare,PPO,87799,CPT4/HCPCS,DETECT AGENT NOS DNA QUANT,,Per Unit,102.00
United HealthCare,PPO,87800,CPT4/HCPCS,DETECT AGNT MULT DNA DIREC,,Per Unit,102.00
United HealthCare,PPO,87801,CPT4/HCPCS,DETECT AGNT MULT DNA AMPLI,,Per Unit,102.00
United HealthCare,PPO,87802,CPT4/HCPCS,STREP B ASSAY W/OPTIC,,Per Unit,102.00
United HealthCare,PPO,87803,CPT4/HCPCS,CLOSTRIDIUM TOXIN A W/OPTIC,,Per Unit,102.00
United HealthCare,PPO,87804,CPT4/HCPCS,INFLUENZA ASSAY W/OPTIC,,Per Unit,102.00
United HealthCare,PPO,87806,CPT4/HCPCS,HIV ANTIGEN W/HIV ANTIBODIES,,Per Unit,102.00
United HealthCare,PPO,87807,CPT4/HCPCS,RSV ASSAY W/OPTIC,,Per Unit,102.00
United HealthCare,PPO,87808,CPT4/HCPCS,TRICHOMONAS ASSAY W/OPTIC,,Per Unit,102.00
United HealthCare,PPO,87809,CPT4/HCPCS,ADENOVIRUS ASSAY W/OPTIC,,Per Unit,102.00
United HealthCare,PPO,87810,CPT4/HCPCS,CHYLMD TRACH ASSAY W/OPTIC,,Per Unit,102.00
United HealthCare,PPO,87850,CPT4/HCPCS,N. GONORRHOEAE ASSAY W/OPTIC,,Per Unit,102.00
United HealthCare,PPO,87880,CPT4/HCPCS,STREP A ASSAY W/OPTIC,,Per Unit,102.00
United HealthCare,PPO,87899,CPT4/HCPCS,AGENT NOS ASSAY W/OPTIC,,Per Unit,102.00
United HealthCare,PPO,87900,CPT4/HCPCS,PHENOTYPE INFECT AGENT DRUG,,Per Unit,102.00
United HealthCare,PPO,87901,CPT4/HCPCS,GENOTYPE DNA HIV REVERSE T,,Per Unit,102.00
United HealthCare,PPO,87902,CPT4/HCPCS,GENOTYPE DNA/RNA HEP C,,Per Unit,102.00
United HealthCare,PPO,87903,CPT4/HCPCS,PHENOTYPE DNA HIV W/CULTURE,,Per Unit,102.00
United HealthCare,PPO,87904,CPT4/HCPCS,PHENOTYPE DNA HIV W/CLT ADD,,Per Unit,102.00
United HealthCare,PPO,87905,CPT4/HCPCS,SIALIDASE ENZYME ASSAY,,Per Unit,102.00
United HealthCare,PPO,87906,CPT4/HCPCS,GENOTYPE DNA/RNA HIV,,Per Unit,102.00
United HealthCare,PPO,87910,CPT4/HCPCS,GENOTYPE CYTOMEGALOVIRUS,,Per Unit,102.00
United HealthCare,PPO,87912,CPT4/HCPCS,GENOTYPE DNA HEPATITIS B,,Per Unit,102.00
United HealthCare,PPO,88000,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,102.00
United HealthCare,PPO,88005,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,102.00
United HealthCare,PPO,88007,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,102.00
United HealthCare,PPO,88012,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,102.00
United HealthCare,PPO,88014,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,102.00
United HealthCare,PPO,88016,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,Per Unit,102.00
United HealthCare,PPO,88020,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Per Unit,102.00
United HealthCare,PPO,88025,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Per Unit,102.00
United HealthCare,PPO,88027,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Per Unit,102.00
United HealthCare,PPO,88028,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Per Unit,102.00
United HealthCare,PPO,88029,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,Per Unit,102.00
United HealthCare,PPO,88036,CPT4/HCPCS,LIMITED AUTOPSY,,Per Unit,102.00
United HealthCare,PPO,88037,CPT4/HCPCS,LIMITED AUTOPSY,,Per Unit,102.00
United HealthCare,PPO,88040,CPT4/HCPCS,FORENSIC AUTOPSY (NECROPSY),,Per Unit,102.00
United HealthCare,PPO,88045,CPT4/HCPCS,CORONERS AUTOPSY (NECROPSY),,Per Unit,102.00
United HealthCare,PPO,88104,CPT4/HCPCS,CYTOPATH FL NONGYN SMEARS,,Per Unit,102.00
United HealthCare,PPO,88106,CPT4/HCPCS,CYTOPATH FL NONGYN FILTER,,Per Unit,102.00
United HealthCare,PPO,88108,CPT4/HCPCS,CYTOPATH CONCENTRATE TECH,,Per Unit,102.00
United HealthCare,PPO,88112,CPT4/HCPCS,CYTOPATH CELL ENHANCE TECH,,Per Unit,102.00
United HealthCare,PPO,88120,CPT4/HCPCS,CYTP URNE 3-5 PROBES EA SPEC,,Per Unit,102.00
United HealthCare,PPO,88121,CPT4/HCPCS,CYTP URINE 3-5 PROBES CMPTR,,Per Unit,102.00
United HealthCare,PPO,88125,CPT4/HCPCS,FORENSIC CYTOPATHOLOGY,,Per Unit,102.00
United HealthCare,PPO,88130,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,Per Unit,102.00
United HealthCare,PPO,88140,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,Per Unit,102.00
United HealthCare,PPO,88141,CPT4/HCPCS,CYTOPATH C/V INTERPRET,,Per Unit,102.00
United HealthCare,PPO,88142,CPT4/HCPCS,CYTOPATH C/V THIN LAYER,,Per Unit,102.00
United HealthCare,PPO,88143,CPT4/HCPCS,CYTOPATH C/V THIN LAYER REDO,,Per Unit,102.00
United HealthCare,PPO,88147,CPT4/HCPCS,CYTOPATH C/V AUTOMATED,,Per Unit,102.00
United HealthCare,PPO,88148,CPT4/HCPCS,CYTOPATH C/V AUTO RESCREEN,,Per Unit,102.00
United HealthCare,PPO,88150,CPT4/HCPCS,CYTOPATH C/V MANUAL,,Per Unit,102.00
United HealthCare,PPO,88152,CPT4/HCPCS,CYTOPATH C/V AUTO REDO,,Per Unit,102.00
United HealthCare,PPO,88153,CPT4/HCPCS,CYTOPATH C/V REDO,,Per Unit,102.00
United HealthCare,PPO,88155,CPT4/HCPCS,CYTOPATH C/V INDEX ADD-ON,,Per Unit,102.00
United HealthCare,PPO,88160,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Per Unit,102.00
United HealthCare,PPO,88161,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Per Unit,102.00
United HealthCare,PPO,88162,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,Per Unit,102.00
United HealthCare,PPO,88164,CPT4/HCPCS,CYTOPATH TBS C/V MANUAL,,Per Unit,102.00
United HealthCare,PPO,88165,CPT4/HCPCS,CYTOPATH TBS C/V REDO,,Per Unit,102.00
United HealthCare,PPO,88166,CPT4/HCPCS,CYTOPATH TBS C/V AUTO REDO,,Per Unit,102.00
United HealthCare,PPO,88167,CPT4/HCPCS,CYTOPATH TBS C/V SELECT,,Per Unit,102.00
United HealthCare,PPO,88172,CPT4/HCPCS,CYTP DX EVAL FNA 1ST EA SITE,,Per Unit,102.00
United HealthCare,PPO,88173,CPT4/HCPCS,CYTOPATH EVAL FNA REPORT,,Per Unit,102.00
United HealthCare,PPO,88174,CPT4/HCPCS,CYTOPATH C/V AUTO IN FLUID,,Per Unit,102.00
United HealthCare,PPO,88175,CPT4/HCPCS,CYTOPATH C/V AUTO FLUID REDO,,Per Unit,102.00
United HealthCare,PPO,88177,CPT4/HCPCS,CYTP FNA EVAL EA ADDL,,Per Unit,102.00
United HealthCare,PPO,88182,CPT4/HCPCS,CELL MARKER STUDY,,Per Unit,102.00
United HealthCare,PPO,88184,CPT4/HCPCS,FLOWCYTOMETRY/ TC 1 MARKER,,Per Unit,102.00
United HealthCare,PPO,88185,CPT4/HCPCS,FLOWCYTOMETRY/TC ADD-ON,,Per Unit,102.00
United HealthCare,PPO,88187,CPT4/HCPCS,FLOWCYTOMETRY/READ 2-8,,Per Unit,102.00
United HealthCare,PPO,88188,CPT4/HCPCS,FLOWCYTOMETRY/READ 9-15,,Per Unit,102.00
United HealthCare,PPO,88189,CPT4/HCPCS,FLOWCYTOMETRY/READ 16 & >,,Per Unit,102.00
United HealthCare,PPO,88230,CPT4/HCPCS,TISSUE CULTURE LYMPHOCYTE,,Per Unit,102.00
United HealthCare,PPO,88233,CPT4/HCPCS,TISSUE CULTURE SKIN/BIOPSY,,Per Unit,102.00
United HealthCare,PPO,88235,CPT4/HCPCS,TISSUE CULTURE PLACENTA,,Per Unit,102.00
United HealthCare,PPO,88237,CPT4/HCPCS,TISSUE CULTURE BONE MARROW,,Per Unit,102.00
United HealthCare,PPO,88239,CPT4/HCPCS,TISSUE CULTURE TUMOR,,Per Unit,102.00
United HealthCare,PPO,88240,CPT4/HCPCS,CELL CRYOPRESERVE/STORAGE,,Per Unit,102.00
United HealthCare,PPO,88241,CPT4/HCPCS,FROZEN CELL PREPARATION,,Per Unit,102.00
United HealthCare,PPO,88245,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,Per Unit,102.00
United HealthCare,PPO,88248,CPT4/HCPCS,CHROMOSOME ANALYSIS 50-100,,Per Unit,102.00
United HealthCare,PPO,88249,CPT4/HCPCS,CHROMOSOME ANALYSIS 100,,Per Unit,102.00
United HealthCare,PPO,88261,CPT4/HCPCS,CHROMOSOME ANALYSIS 5,,Per Unit,102.00
United HealthCare,PPO,88262,CPT4/HCPCS,CHROMOSOME ANALYSIS 15-20,,Per Unit,102.00
United HealthCare,PPO,88263,CPT4/HCPCS,CHROMOSOME ANALYSIS 45,,Per Unit,102.00
United HealthCare,PPO,88264,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,Per Unit,102.00
United HealthCare,PPO,88267,CPT4/HCPCS,CHROMOSOME ANALYS PLACENTA,,Per Unit,102.00
United HealthCare,PPO,88269,CPT4/HCPCS,CHROMOSOME ANALYS AMNIOTIC,,Per Unit,102.00
United HealthCare,PPO,88271,CPT4/HCPCS,CYTOGENETICS DNA PROBE,,Per Unit,102.00
United HealthCare,PPO,88272,CPT4/HCPCS,CYTOGENETICS 3-5,,Per Unit,102.00
United HealthCare,PPO,88273,CPT4/HCPCS,CYTOGENETICS 10-30,,Per Unit,102.00
United HealthCare,PPO,88274,CPT4/HCPCS,CYTOGENETICS 25-99,,Per Unit,102.00
United HealthCare,PPO,88275,CPT4/HCPCS,CYTOGENETICS 100-300,,Per Unit,102.00
United HealthCare,PPO,88280,CPT4/HCPCS,CHROMOSOME KARYOTYPE STUDY,,Per Unit,102.00
United HealthCare,PPO,88283,CPT4/HCPCS,CHROMOSOME BANDING STUDY,,Per Unit,102.00
United HealthCare,PPO,88285,CPT4/HCPCS,CHROMOSOME COUNT ADDITIONAL,,Per Unit,102.00
United HealthCare,PPO,88289,CPT4/HCPCS,CHROMOSOME STUDY ADDITIONAL,,Per Unit,102.00
United HealthCare,PPO,88291,CPT4/HCPCS,CYTO/MOLECULAR REPORT,,Per Unit,102.00
United HealthCare,PPO,88300,CPT4/HCPCS,SURGICAL PATH GROSS,,Per Unit,102.00
United HealthCare,PPO,88302,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Per Unit,102.00
United HealthCare,PPO,88304,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Per Unit,102.00
United HealthCare,PPO,88305,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Per Unit,102.00
United HealthCare,PPO,88307,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Per Unit,102.00
United HealthCare,PPO,88309,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,Per Unit,102.00
United HealthCare,PPO,88311,CPT4/HCPCS,DECALCIFY TISSUE,,Per Unit,102.00
United HealthCare,PPO,88312,CPT4/HCPCS,SPECIAL STAINS GROUP 1,,Per Unit,102.00
United HealthCare,PPO,88313,CPT4/HCPCS,SPECIAL STAINS GROUP 2,,Per Unit,102.00
United HealthCare,PPO,88314,CPT4/HCPCS,HISTOCHEMICAL STAINS ADD-ON,,Per Unit,102.00
United HealthCare,PPO,88319,CPT4/HCPCS,ENZYME HISTOCHEMISTRY,,Per Unit,102.00
United HealthCare,PPO,88321,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Per Unit,102.00
United HealthCare,PPO,88323,CPT4/HCPCS,MICROSLIDE CONSULTATION,,Per Unit,102.00
United HealthCare,PPO,88325,CPT4/HCPCS,COMPREHENSIVE REVIEW OF DATA,,Per Unit,102.00
United HealthCare,PPO,88329,CPT4/HCPCS,PATH CONSULT INTROP,,Per Unit,102.00
United HealthCare,PPO,88331,CPT4/HCPCS,PATH CONSULT INTRAOP 1 BLOC,,Per Unit,102.00
United HealthCare,PPO,88332,CPT4/HCPCS,PATH CONSULT INTRAOP ADDL,,Per Unit,102.00
United HealthCare,PPO,88333,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 1,,Per Unit,102.00
United HealthCare,PPO,88334,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 2,,Per Unit,102.00
United HealthCare,PPO,88341,CPT4/HCPCS,IMMUNOHISTO ANTB ADDL SLIDE,,Per Unit,102.00
United HealthCare,PPO,88342,CPT4/HCPCS,IMMUNOHISTO ANTB 1ST STAIN,,Per Unit,102.00
United HealthCare,PPO,88344,CPT4/HCPCS,IMMUNOHISTO ANTIBODY SLIDE,,Per Unit,102.00
United HealthCare,PPO,88346,CPT4/HCPCS,IMMUNOFLUOR ANTB 1ST STAIN,,Per Unit,102.00
United HealthCare,PPO,88348,CPT4/HCPCS,ELECTRON MICROSCOPY,,Per Unit,102.00
United HealthCare,PPO,88350,CPT4/HCPCS,IMMUNOFLUOR ANTB ADDL STAIN,,Per Unit,102.00
United HealthCare,PPO,88355,CPT4/HCPCS,ANALYSIS SKELETAL MUSCLE,,Per Unit,102.00
United HealthCare,PPO,88356,CPT4/HCPCS,ANALYSIS NERVE,,Per Unit,102.00
United HealthCare,PPO,88358,CPT4/HCPCS,ANALYSIS TUMOR,,Per Unit,102.00
United HealthCare,PPO,88360,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/MANUAL,,Per Unit,102.00
United HealthCare,PPO,88361,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/COMPUT,,Per Unit,102.00
United HealthCare,PPO,88362,CPT4/HCPCS,NERVE TEASING PREPARATIONS,,Per Unit,102.00
United HealthCare,PPO,88363,CPT4/HCPCS,XM ARCHIVE TISSUE MOLEC ANAL,,Per Unit,102.00
United HealthCare,PPO,88364,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Per Unit,102.00
United HealthCare,PPO,88365,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Per Unit,102.00
United HealthCare,PPO,88366,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,Per Unit,102.00
United HealthCare,PPO,88367,CPT4/HCPCS,INSITU HYBRIDIZATION AUTO,,Per Unit,102.00
United HealthCare,PPO,88368,CPT4/HCPCS,INSITU HYBRIDIZATION MANUAL,,Per Unit,102.00
United HealthCare,PPO,88369,CPT4/HCPCS,M/PHMTRC ALYSISHQUANT/SEMIQ,,Per Unit,102.00
United HealthCare,PPO,88371,CPT4/HCPCS,PROTEIN WESTERN BLOT TISSUE,,Per Unit,102.00
United HealthCare,PPO,88372,CPT4/HCPCS,PROTEIN ANALYSIS W/PROBE,,Per Unit,102.00
United HealthCare,PPO,88373,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Per Unit,102.00
United HealthCare,PPO,88374,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Per Unit,102.00
United HealthCare,PPO,88375,CPT4/HCPCS,OPTICAL ENDOMICROSCPY INTERP,,Per Unit,102.00
United HealthCare,PPO,88377,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,Per Unit,102.00
United HealthCare,PPO,88380,CPT4/HCPCS,MICRODISSECTION LASER,,Per Unit,102.00
United HealthCare,PPO,88381,CPT4/HCPCS,MICRODISSECTION MANUAL,,Per Unit,102.00
United HealthCare,PPO,88387,CPT4/HCPCS,TISS EXAM MOLECULAR STUDY,,Per Unit,102.00
United HealthCare,PPO,88388,CPT4/HCPCS,TISS EX MOLECUL STUDY ADD-ON,,Per Unit,102.00
United HealthCare,PPO,88720,CPT4/HCPCS,BILIRUBIN TOTAL TRANSCUT,,Per Unit,102.00
United HealthCare,PPO,88738,CPT4/HCPCS,HGB QUANT TRANSCUTANEOUS,,Per Unit,102.00
United HealthCare,PPO,88740,CPT4/HCPCS,TRANSCUTANEOUS CARBOXYHB,,Per Unit,102.00
United HealthCare,PPO,88741,CPT4/HCPCS,TRANSCUTANEOUS METHB,,Per Unit,102.00
United HealthCare,PPO,89049,CPT4/HCPCS,CHCT FOR MAL HYPERTHERMIA,,Per Unit,102.00
United HealthCare,PPO,89050,CPT4/HCPCS,BODY FLUID CELL COUNT,,Per Unit,102.00
United HealthCare,PPO,89051,CPT4/HCPCS,BODY FLUID CELL COUNT,,Per Unit,102.00
United HealthCare,PPO,89055,CPT4/HCPCS,LEUKOCYTE ASSESSMENT FECAL,,Per Unit,102.00
United HealthCare,PPO,89060,CPT4/HCPCS,EXAM SYNOVIAL FLUID CRYSTALS,,Per Unit,102.00
United HealthCare,PPO,89125,CPT4/HCPCS,SPECIMEN FAT STAIN,,Per Unit,102.00
United HealthCare,PPO,89160,CPT4/HCPCS,EXAM FECES FOR MEAT FIBERS,,Per Unit,102.00
United HealthCare,PPO,89190,CPT4/HCPCS,NASAL SMEAR FOR EOSINOPHILS,,Per Unit,102.00
United HealthCare,PPO,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,Per Unit,102.00
United HealthCare,PPO,89230,CPT4/HCPCS,COLLECT SWEAT FOR TEST,,Per Unit,102.00
United HealthCare,PPO,89250,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Per Unit,102.00
United HealthCare,PPO,89251,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,Per Unit,102.00
United HealthCare,PPO,89253,CPT4/HCPCS,EMBRYO HATCHING,,Per Unit,102.00
United HealthCare,PPO,89254,CPT4/HCPCS,OOCYTE IDENTIFICATION,,Per Unit,102.00
United HealthCare,PPO,89255,CPT4/HCPCS,PREPARE EMBRYO FOR TRANSFER,,Per Unit,102.00
United HealthCare,PPO,89257,CPT4/HCPCS,SPERM IDENTIFICATION,,Per Unit,102.00
United HealthCare,PPO,89258,CPT4/HCPCS,CRYOPRESERVATION EMBRYO(S),,Per Unit,102.00
United HealthCare,PPO,89259,CPT4/HCPCS,CRYOPRESERVATION SPERM,,Per Unit,102.00
United HealthCare,PPO,89260,CPT4/HCPCS,SPERM ISOLATION SIMPLE,,Per Unit,102.00
United HealthCare,PPO,89261,CPT4/HCPCS,SPERM ISOLATION COMPLEX,,Per Unit,102.00
United HealthCare,PPO,89264,CPT4/HCPCS,IDENTIFY SPERM TISSUE,,Per Unit,102.00
United HealthCare,PPO,89268,CPT4/HCPCS,INSEMINATION OF OOCYTES,,Per Unit,102.00
United HealthCare,PPO,89272,CPT4/HCPCS,EXTENDED CULTURE OF OOCYTES,,Per Unit,102.00
United HealthCare,PPO,89280,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,Per Unit,102.00
United HealthCare,PPO,89281,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,Per Unit,102.00
United HealthCare,PPO,89290,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,Per Unit,102.00
United HealthCare,PPO,89291,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,Per Unit,102.00
United HealthCare,PPO,89300,CPT4/HCPCS,SEMEN ANALYSIS W/HUHNER,,Per Unit,102.00
United HealthCare,PPO,89310,CPT4/HCPCS,SEMEN ANALYSIS W/COUNT,,Per Unit,102.00
United HealthCare,PPO,89320,CPT4/HCPCS,SEMEN ANAL VOL/COUNT/MOT,,Per Unit,102.00
United HealthCare,PPO,89321,CPT4/HCPCS,SEMEN ANAL SPERM DETECTION,,Per Unit,102.00
United HealthCare,PPO,89322,CPT4/HCPCS,SEMEN ANAL STRICT CRITERIA,,Per Unit,102.00
United HealthCare,PPO,89325,CPT4/HCPCS,SPERM ANTIBODY TEST,,Per Unit,102.00
United HealthCare,PPO,89329,CPT4/HCPCS,SPERM EVALUATION TEST,,Per Unit,102.00
United HealthCare,PPO,89330,CPT4/HCPCS,EVALUATION CERVICAL MUCUS,,Per Unit,102.00
United HealthCare,PPO,89331,CPT4/HCPCS,RETROGRADE EJACULATION ANAL,,Per Unit,102.00
United HealthCare,PPO,89335,CPT4/HCPCS,CRYOPRESERVE TESTICULAR TISS,,Per Unit,102.00
United HealthCare,PPO,89337,CPT4/HCPCS,CRYOPRESERVATION OOCYTE(S),,Per Unit,102.00
United HealthCare,PPO,89342,CPT4/HCPCS,STORAGE/YEAR EMBRYO(S),,Per Unit,102.00
United HealthCare,PPO,89343,CPT4/HCPCS,STORAGE/YEAR SPERM/SEMEN,,Per Unit,102.00
United HealthCare,PPO,89344,CPT4/HCPCS,STORAGE/YEAR REPROD TISSUE,,Per Unit,102.00
United HealthCare,PPO,89346,CPT4/HCPCS,STORAGE/YEAR OOCYTE(S),,Per Unit,102.00
United HealthCare,PPO,89352,CPT4/HCPCS,THAWING CRYOPRESRVED EMBRYO,,Per Unit,102.00
United HealthCare,PPO,89353,CPT4/HCPCS,THAWING CRYOPRESRVED SPERM,,Per Unit,102.00
United HealthCare,PPO,89354,CPT4/HCPCS,THAW CRYOPRSVRD REPROD TISS,,Per Unit,102.00
United HealthCare,PPO,89356,CPT4/HCPCS,THAWING CRYOPRESRVED OOCYTE,,Per Unit,102.00
United HealthCare,PPO,91010,CPT4/HCPCS,ESOPHAGUS MOTILITY STUDY,,Grouper Rate,1214.00
United HealthCare,PPO,91013,CPT4/HCPCS,ESOPHGL MOTIL W/STIM/PERFUS,,Grouper Rate,1214.00
United HealthCare,PPO,91020,CPT4/HCPCS,GASTRIC MOTILITY STUDIES,,Grouper Rate,1214.00
United HealthCare,PPO,91022,CPT4/HCPCS,DUODENAL MOTILITY STUDY,,Grouper Rate,1214.00
United HealthCare,PPO,91030,CPT4/HCPCS,ACID PERFUSION OF ESOPHAGUS,,Grouper Rate,1214.00
United HealthCare,PPO,91034,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX TEST,,Grouper Rate,1214.00
United HealthCare,PPO,91035,CPT4/HCPCS,G-ESOPH REFLX TST W/ELECTROD,,Grouper Rate,1214.00
United HealthCare,PPO,91037,CPT4/HCPCS,ESOPH IMPED FUNCTION TEST,,Grouper Rate,1214.00
United HealthCare,PPO,91038,CPT4/HCPCS,ESOPH IMPED FUNCT TEST > 1HR,,Grouper Rate,1214.00
United HealthCare,PPO,91040,CPT4/HCPCS,ESOPH BALLOON DISTENSION TST,,Grouper Rate,1214.00
United HealthCare,PPO,91065,CPT4/HCPCS,BREATH HYDROGEN/METHANE TEST,,Grouper Rate,1214.00
United HealthCare,PPO,91110,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,91111,CPT4/HCPCS,ESOPHAGEAL CAPSULE ENDOSCOPY,,Grouper Rate,1370.00
United HealthCare,PPO,91112,CPT4/HCPCS,GI WIRELESS CAPSULE MEASURE,,Grouper Rate,1370.00
United HealthCare,PPO,91117,CPT4/HCPCS,COLON MOTILITY 6 HR STUDY,,Grouper Rate,1214.00
United HealthCare,PPO,91120,CPT4/HCPCS,RECTAL SENSATION TEST,,Grouper Rate,1214.00
United HealthCare,PPO,91122,CPT4/HCPCS,ANAL PRESSURE RECORD,,Grouper Rate,1214.00
United HealthCare,PPO,91132,CPT4/HCPCS,ELECTROGASTROGRAPHY,,Grouper Rate,1214.00
United HealthCare,PPO,91133,CPT4/HCPCS,ELECTROGASTROGRAPHY W/TEST,,Grouper Rate,1214.00
United HealthCare,PPO,91299,CPT4/HCPCS,GASTROENTEROLOGY PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,Grouper Rate,4204.00
United HealthCare,PPO,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,Grouper Rate,1214.00
United HealthCare,PPO,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,305.00
United HealthCare,PPO,92508,CPT4/HCPCS,SPEECH/HEARING THERAPY,,Case Rate,305.00
United HealthCare,PPO,92521,CPT4/HCPCS,EVALUATION OF SPEECH FLUENCY,,Case Rate,305.00
United HealthCare,PPO,92522,CPT4/HCPCS,EVALUATE SPEECH PRODUCTION,,Case Rate,305.00
United HealthCare,PPO,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,Case Rate,305.00
United HealthCare,PPO,92524,CPT4/HCPCS,BEHAVRAL QUALIT ANALYS VOICE,,Case Rate,305.00
United HealthCare,PPO,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,Case Rate,7007.00
United HealthCare,PPO,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,Case Rate,7007.00
United HealthCare,PPO,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,Case Rate,7007.00
United HealthCare,PPO,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,Case Rate,7007.00
United HealthCare,PPO,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,Case Rate,10119.00
United HealthCare,PPO,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,Case Rate,10119.00
United HealthCare,PPO,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Case Rate,10119.00
United HealthCare,PPO,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,Case Rate,10119.00
United HealthCare,PPO,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,Case Rate,10119.00
United HealthCare,PPO,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,Case Rate,10119.00
United HealthCare,PPO,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,Grouper Rate,7007.00
United HealthCare,PPO,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,Case Rate,10119.00
United HealthCare,PPO,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,Case Rate,10119.00
United HealthCare,PPO,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,Grouper Rate,1214.00
United HealthCare,PPO,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,Grouper Rate,1308.00
United HealthCare,PPO,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,Grouper Rate,1308.00
United HealthCare,PPO,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,Grouper Rate,1308.00
United HealthCare,PPO,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,Grouper Rate,1370.00
United HealthCare,PPO,92971,CPT4/HCPCS,CARDIOASSIST EXTERNAL,,Grouper Rate,1370.00
United HealthCare,PPO,92973,CPT4/HCPCS,PRQ CORONARY MECH THROMBECT,,Grouper Rate,1214.00
United HealthCare,PPO,92974,CPT4/HCPCS,CATH PLACE CARDIO BRACHYTX,,Grouper Rate,1214.00
United HealthCare,PPO,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Grouper Rate,1370.00
United HealthCare,PPO,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,Grouper Rate,1214.00
United HealthCare,PPO,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,Grouper Rate,1214.00
United HealthCare,PPO,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,Grouper Rate,1214.00
United HealthCare,PPO,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,Grouper Rate,7007.00
United HealthCare,PPO,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,Grouper Rate,7007.00
United HealthCare,PPO,92990,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,Grouper Rate,7007.00
United HealthCare,PPO,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1370.00
United HealthCare,PPO,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,Grouper Rate,1370.00
United HealthCare,PPO,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Grouper Rate,7007.00
United HealthCare,PPO,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,Grouper Rate,7007.00
United HealthCare,PPO,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,643.00
United HealthCare,PPO,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,Case Rate,643.00
United HealthCare,PPO,93306,CPT4/HCPCS,TTE W/DOPPLER COMPLETE,,Case Rate,643.00
United HealthCare,PPO,93307,CPT4/HCPCS,TTE W/O DOPPLER COMPLETE,,Case Rate,643.00
United HealthCare,PPO,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,Case Rate,643.00
United HealthCare,PPO,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,643.00
United HealthCare,PPO,93313,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,643.00
United HealthCare,PPO,93314,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,643.00
United HealthCare,PPO,93315,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,643.00
United HealthCare,PPO,93316,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,643.00
United HealthCare,PPO,93317,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,Case Rate,643.00
United HealthCare,PPO,93318,CPT4/HCPCS,ECHO TRANSESOPHAGEAL INTRAOP,,Case Rate,643.00
United HealthCare,PPO,93320,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,643.00
United HealthCare,PPO,93321,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,Case Rate,643.00
United HealthCare,PPO,93325,CPT4/HCPCS,DOPPLER COLOR FLOW ADD-ON,,Case Rate,643.00
United HealthCare,PPO,93350,CPT4/HCPCS,STRESS TTE ONLY,,Case Rate,643.00
United HealthCare,PPO,93351,CPT4/HCPCS,STRESS TTE COMPLETE,,Case Rate,643.00
United HealthCare,PPO,93352,CPT4/HCPCS,ADMIN ECG CONTRAST AGENT,,Case Rate,643.00
United HealthCare,PPO,93451,CPT4/HCPCS,RIGHT HEART CATH,,Grouper Rate,6075.00
United HealthCare,PPO,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,Grouper Rate,6075.00
United HealthCare,PPO,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,Grouper Rate,6075.00
United HealthCare,PPO,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,Grouper Rate,6075.00
United HealthCare,PPO,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,Grouper Rate,6075.00
United HealthCare,PPO,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,Grouper Rate,6075.00
United HealthCare,PPO,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,Grouper Rate,6075.00
United HealthCare,PPO,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,Grouper Rate,6075.00
United HealthCare,PPO,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,Grouper Rate,6075.00
United HealthCare,PPO,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,6075.00
United HealthCare,PPO,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,Grouper Rate,6075.00
United HealthCare,PPO,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,Grouper Rate,1214.00
United HealthCare,PPO,93463,CPT4/HCPCS,DRUG ADMIN & HEMODYNMIC MEAS,,Grouper Rate,1214.00
United HealthCare,PPO,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,Grouper Rate,1214.00
United HealthCare,PPO,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,Grouper Rate,1308.00
United HealthCare,PPO,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,Grouper Rate,5138.00
United HealthCare,PPO,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,Grouper Rate,5138.00
United HealthCare,PPO,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,5138.00
United HealthCare,PPO,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,5138.00
United HealthCare,PPO,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,Grouper Rate,5138.00
United HealthCare,PPO,93561,CPT4/HCPCS,CARDIAC OUTPUT MEASUREMENT,,Grouper Rate,1214.00
United HealthCare,PPO,93562,CPT4/HCPCS,CARD OUTPUT MEASURE SUBSQ,,Grouper Rate,1214.00
United HealthCare,PPO,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,Grouper Rate,1214.00
United HealthCare,PPO,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,Grouper Rate,1214.00
United HealthCare,PPO,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,Grouper Rate,1214.00
United HealthCare,PPO,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,Grouper Rate,1214.00
United HealthCare,PPO,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,Grouper Rate,1214.00
United HealthCare,PPO,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,Grouper Rate,1214.00
United HealthCare,PPO,93571,CPT4/HCPCS,HEART FLOW RESERVE MEASURE,,Grouper Rate,1214.00
United HealthCare,PPO,93572,CPT4/HCPCS,HEART FLOW RESERVE MEASURE,,Grouper Rate,1214.00
United HealthCare,PPO,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,Grouper Rate,10772.00
United HealthCare,PPO,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,Grouper Rate,10772.00
United HealthCare,PPO,93582,CPT4/HCPCS,PERQ TRANSCATH CLOSURE PDA,,Grouper Rate,10772.00
United HealthCare,PPO,93583,CPT4/HCPCS,PERQ TRANSCATH SEPTAL REDUXN,,Grouper Rate,1370.00
United HealthCare,PPO,93590,CPT4/HCPCS,PERQ TRANSCATH CLS MITRAL,,Grouper Rate,14317.00
United HealthCare,PPO,93591,CPT4/HCPCS,PERQ TRANSCATH CLS AORTIC,,Grouper Rate,14317.00
United HealthCare,PPO,93592,CPT4/HCPCS,PERQ TRANSCATH CLOSURE EACH,,Grouper Rate,1214.00
United HealthCare,PPO,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,Case Rate,5138.00
United HealthCare,PPO,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,Case Rate,5138.00
United HealthCare,PPO,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,Case Rate,5138.00
United HealthCare,PPO,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,Case Rate,5138.00
United HealthCare,PPO,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,Case Rate,5138.00
United HealthCare,PPO,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,Case Rate,5138.00
United HealthCare,PPO,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,Case Rate,5138.00
United HealthCare,PPO,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,5138.00
United HealthCare,PPO,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,Case Rate,5138.00
United HealthCare,PPO,93618,CPT4/HCPCS,HEART RHYTHM PACING,,Case Rate,5138.00
United HealthCare,PPO,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,5138.00
United HealthCare,PPO,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,5138.00
United HealthCare,PPO,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,5138.00
United HealthCare,PPO,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,5138.00
United HealthCare,PPO,93623,CPT4/HCPCS,STIMULATION PACING HEART,,Case Rate,5138.00
United HealthCare,PPO,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,Case Rate,5138.00
United HealthCare,PPO,93631,CPT4/HCPCS,HEART PACING MAPPING,,Case Rate,5138.00
United HealthCare,PPO,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,Case Rate,5138.00
United HealthCare,PPO,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,5138.00
United HealthCare,PPO,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,5138.00
United HealthCare,PPO,93644,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,Case Rate,5138.00
United HealthCare,PPO,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,Grouper Rate,7007.00
United HealthCare,PPO,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,Case Rate,7007.00
United HealthCare,PPO,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,Case Rate,7007.00
United HealthCare,PPO,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,Case Rate,7007.00
United HealthCare,PPO,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,Case Rate,7007.00
United HealthCare,PPO,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,Case Rate,7007.00
United HealthCare,PPO,93660,CPT4/HCPCS,TILT TABLE EVALUATION,,Grouper Rate,1214.00
United HealthCare,PPO,93662,CPT4/HCPCS,INTRACARDIAC ECG (ICE),,Grouper Rate,1214.00
United HealthCare,PPO,93745,CPT4/HCPCS,SET-UP CARDIOVERT-DEFIBRILL,,Grouper Rate,1214.00
United HealthCare,PPO,93750,CPT4/HCPCS,INTERROGATION VAD IN PERSON,,Grouper Rate,1214.00
United HealthCare,PPO,93799,CPT4/HCPCS,CARDIOVASCULAR PROCEDURE,,Grouper Rate,1214.00
United HealthCare,PPO,95800,CPT4/HCPCS,SLP STDY UNATTENDED,,Case Rate,3498.00
United HealthCare,PPO,95801,CPT4/HCPCS,SLP STDY UNATND W/ANAL,,Case Rate,3498.00
United HealthCare,PPO,95805,CPT4/HCPCS,MULTIPLE SLEEP LATENCY TEST,,Case Rate,3498.00
United HealthCare,PPO,95806,CPT4/HCPCS,SLEEP STUDY UNATT&RESP EFFT,,Case Rate,3498.00
United HealthCare,PPO,95807,CPT4/HCPCS,SLEEP STUDY ATTENDED,,Case Rate,3498.00
United HealthCare,PPO,95808,CPT4/HCPCS,POLYSOM ANY AGE 1-3> PARAM,,Case Rate,3498.00
United HealthCare,PPO,95810,CPT4/HCPCS,POLYSOM 6/> YRS 4/> PARAM,,Case Rate,3498.00
United HealthCare,PPO,95811,CPT4/HCPCS,POLYSOM 6/>YRS CPAP 4/> PARM,,Case Rate,3498.00
United HealthCare,PPO,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Grouper Rate,1214.00
United HealthCare,PPO,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,Grouper Rate,1214.00
United HealthCare,PPO,96567,CPT4/HCPCS,PDT DSTR PRMLG LES SKN,,Grouper Rate,1214.00
United HealthCare,PPO,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,Grouper Rate,1214.00
United HealthCare,PPO,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,Grouper Rate,1214.00
United HealthCare,PPO,96573,CPT4/HCPCS,PDT DSTR PRMLG LES PHYS/QHP,,Grouper Rate,1214.00
United HealthCare,PPO,96574,CPT4/HCPCS,DBRDMT PRMLG LES W/PDT,,Grouper Rate,1214.00
United HealthCare,PPO,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,Case Rate,305.00
United HealthCare,PPO,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,Case Rate,305.00
United HealthCare,PPO,97014,CPT4/HCPCS,ELECTRIC STIMULATION THERAPY,,Case Rate,305.00
United HealthCare,PPO,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,Case Rate,305.00
United HealthCare,PPO,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,Case Rate,305.00
United HealthCare,PPO,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,Case Rate,305.00
United HealthCare,PPO,97024,CPT4/HCPCS,DIATHERMY EG MICROWAVE,,Case Rate,305.00
United HealthCare,PPO,97026,CPT4/HCPCS,INFRARED THERAPY,,Case Rate,305.00
United HealthCare,PPO,97028,CPT4/HCPCS,ULTRAVIOLET THERAPY,,Case Rate,305.00
United HealthCare,PPO,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,Case Rate,305.00
United HealthCare,PPO,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,Case Rate,305.00
United HealthCare,PPO,97034,CPT4/HCPCS,CONTRAST BATH THERAPY,,Case Rate,305.00
United HealthCare,PPO,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,Case Rate,305.00
United HealthCare,PPO,97036,CPT4/HCPCS,HYDROTHERAPY,,Case Rate,305.00
United HealthCare,PPO,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,Case Rate,305.00
United HealthCare,PPO,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,Case Rate,305.00
United HealthCare,PPO,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,Case Rate,305.00
United HealthCare,PPO,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,Case Rate,305.00
United HealthCare,PPO,97124,CPT4/HCPCS,MASSAGE THERAPY,,Case Rate,305.00
United HealthCare,PPO,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,Case Rate,305.00
United HealthCare,PPO,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,Case Rate,305.00
United HealthCare,PPO,97151,CPT4/HCPCS,BHV ID ASSMT BY PHYS/QHP,,Case Rate,305.00
United HealthCare,PPO,97152,CPT4/HCPCS,BHV ID SUPRT ASSMT BY 1 TECH,,Case Rate,305.00
United HealthCare,PPO,97153,CPT4/HCPCS,ADAPTIVE BEHAVIOR TX BY TECH,,Case Rate,305.00
United HealthCare,PPO,97154,CPT4/HCPCS,GRP ADAPT BHV TX BY TECH,,Case Rate,305.00
United HealthCare,PPO,97155,CPT4/HCPCS,ADAPT BEHAVIOR TX PHYS/QHP,,Case Rate,305.00
United HealthCare,PPO,97156,CPT4/HCPCS,FAM ADAPT BHV TX GDN PHY/QHP,,Case Rate,305.00
United HealthCare,PPO,97157,CPT4/HCPCS,MULT FAM ADAPT BHV TX GDN,,Case Rate,305.00
United HealthCare,PPO,97158,CPT4/HCPCS,GRP ADAPT BHV TX BY PHY/QHP,,Case Rate,305.00
United HealthCare,PPO,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,Case Rate,305.00
United HealthCare,PPO,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,Case Rate,305.00
United HealthCare,PPO,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,Case Rate,305.00
United HealthCare,PPO,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,Case Rate,305.00
United HealthCare,PPO,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,Case Rate,305.00
United HealthCare,PPO,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,Case Rate,305.00
United HealthCare,PPO,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,Case Rate,305.00
United HealthCare,PPO,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,Case Rate,305.00
United HealthCare,PPO,97169,CPT4/HCPCS,ATHLETIC TRN EVAL LOW CMPLX,,Case Rate,305.00
United HealthCare,PPO,97170,CPT4/HCPCS,ATHLETIC TRN EVAL MOD CMPLX,,Case Rate,305.00
United HealthCare,PPO,97171,CPT4/HCPCS,ATHLETIC TRN EVAL HIGH CMPLX,,Case Rate,305.00
United HealthCare,PPO,97172,CPT4/HCPCS,ATHLETIC TRN RE-EVAL PLAN CR,,Case Rate,305.00
United HealthCare,PPO,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,Case Rate,305.00
United HealthCare,PPO,97533,CPT4/HCPCS,SENSORY INTEGRATION,,Case Rate,305.00
United HealthCare,PPO,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,Case Rate,305.00
United HealthCare,PPO,97537,CPT4/HCPCS,COMMUNITY/WORK REINTEGRATION,,Case Rate,305.00
United HealthCare,PPO,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,Case Rate,305.00
United HealthCare,PPO,97545,CPT4/HCPCS,WORK HARDENING,,Case Rate,305.00
United HealthCare,PPO,97546,CPT4/HCPCS,WORK HARDENING ADD-ON,,Case Rate,305.00
United HealthCare,PPO,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,Grouper Rate,1214.00
United HealthCare,PPO,C5271,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1214.00
United HealthCare,PPO,C5272,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1214.00
United HealthCare,PPO,C5273,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1370.00
United HealthCare,PPO,C5274,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1214.00
United HealthCare,PPO,C5275,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1214.00
United HealthCare,PPO,C5276,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1214.00
United HealthCare,PPO,C5277,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1214.00
United HealthCare,PPO,C5278,CPT4/HCPCS,Low cost skin substitute app,,Grouper Rate,1214.00
United HealthCare,PPO,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,Case Rate,10119.00
United HealthCare,PPO,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,Case Rate,10119.00
United HealthCare,PPO,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,Case Rate,10119.00
United HealthCare,PPO,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,Case Rate,10119.00
United HealthCare,PPO,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,Case Rate,10119.00
United HealthCare,PPO,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,Case Rate,10119.00
United HealthCare,PPO,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,Case Rate,10119.00
United HealthCare,PPO,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,Case Rate,10119.00
United HealthCare,PPO,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,Case Rate,10119.00
United HealthCare,PPO,C9725,CPT4/HCPCS,Place endorectal app,,Grouper Rate,1308.00
United HealthCare,PPO,C9726,CPT4/HCPCS,Rxt breast appl place/remov,,Grouper Rate,1214.00
United HealthCare,PPO,C9727,CPT4/HCPCS,Insert palate implants,,Grouper Rate,1370.00
United HealthCare,PPO,C9734,CPT4/HCPCS,U/S trtmt, not leiomyomata,,Grouper Rate,4204.00
United HealthCare,PPO,C9738,CPT4/HCPCS,Blue light cysto imag agent,,Grouper Rate,1214.00
United HealthCare,PPO,C9739,CPT4/HCPCS,Cystoscopy prostatic imp 1-3,,Grouper Rate,4204.00
United HealthCare,PPO,C9740,CPT4/HCPCS,Cysto impl 4 or more,,Grouper Rate,7007.00
United HealthCare,PPO,C9745,CPT4/HCPCS,Nasal endo eustachian tube,,Grouper Rate,6075.00
United HealthCare,PPO,C9747,CPT4/HCPCS,Ablation, hifu, prostate,,Grouper Rate,6075.00
United HealthCare,PPO,C9749,CPT4/HCPCS,Repair nasal stenosis w/imp,,Grouper Rate,4204.00
United HealthCare,PPO,C9751,CPT4/HCPCS,Microwave bronch, 3d, ebus,,Grouper Rate,10119.00
United HealthCare,PPO,C9752,CPT4/HCPCS,Intraosseous des lumb/sacrum,,Grouper Rate,5138.00
United HealthCare,PPO,C9753,CPT4/HCPCS,Intraosseous destruct add'l,,Grouper Rate,1214.00
United HealthCare,PPO,C9754,CPT4/HCPCS,Perc av fistula, direct,,Grouper Rate,10119.00
United HealthCare,PPO,C9755,CPT4/HCPCS,Rf magnetic-guide av fistula,,Grouper Rate,10119.00
United HealthCare,PPO,C9756,CPT4/HCPCS,Fluorescence lymph map w/icg,,Grouper Rate,1214.00
United HealthCare,PPO,C9757,CPT4/HCPCS,Spine/lumbar disk surgery,,Grouper Rate,7007.00
United HealthCare,PPO,C9758,CPT4/HCPCS,Blind interatrial shunt ide,,Grouper Rate,10772.00
United HealthCare,PPO,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,Grouper Rate,1308.00
United HealthCare,PPO,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,Grouper Rate,1308.00
United HealthCare,PPO,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,Grouper Rate,1308.00
United HealthCare,PPO,G0127,CPT4/HCPCS,Trim nail(s),,Grouper Rate,1214.00
United HealthCare,PPO,G0168,CPT4/HCPCS,Wound closure by adhesive,,Grouper Rate,1214.00
United HealthCare,PPO,G0186,CPT4/HCPCS,Dstry eye lesn,fdr vssl tech,,Grouper Rate,1308.00
United HealthCare,PPO,G0259,CPT4/HCPCS,Inject for sacroiliac joint,,Grouper Rate,1214.00
United HealthCare,PPO,G0260,CPT4/HCPCS,Inj for sacroiliac jt anesth,,Grouper Rate,1308.00
United HealthCare,PPO,G0268,CPT4/HCPCS,Removal of impacted wax md,,Grouper Rate,1214.00
United HealthCare,PPO,G0269,CPT4/HCPCS,Occlusive device in vein art,,Grouper Rate,1214.00
United HealthCare,PPO,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,Grouper Rate,7007.00
United HealthCare,PPO,G0289,CPT4/HCPCS,Arthro, loose body + chondro,,Grouper Rate,1214.00
United HealthCare,PPO,G0339,CPT4/HCPCS,Robot lin-radsurg com, first,,Grouper Rate,6075.00
United HealthCare,PPO,G0340,CPT4/HCPCS,Robt lin-radsurg fractx 2-5,,Grouper Rate,5138.00
United HealthCare,PPO,G0398,CPT4/HCPCS,Home sleep test/type 2 Porta,,Case Rate,3498.00
United HealthCare,PPO,G0399,CPT4/HCPCS,Home sleep test/type 3 Porta,,Case Rate,3498.00
United HealthCare,PPO,G0400,CPT4/HCPCS,Home sleep test/type 4 Porta,,Case Rate,3498.00
United HealthCare,PPO,G0412,CPT4/HCPCS,Open tx iliac spine uni/bil,,Grouper Rate,1370.00
United HealthCare,PPO,G0413,CPT4/HCPCS,Pelvic ring fracture uni/bil,,Grouper Rate,5138.00
United HealthCare,PPO,G0414,CPT4/HCPCS,Pelvic ring fx treat int fix,,Grouper Rate,1370.00
United HealthCare,PPO,G0415,CPT4/HCPCS,Open tx post pelvic fxcture,,Grouper Rate,1370.00
United HealthCare,PPO,G0428,CPT4/HCPCS,Collagen meniscus implant,,Grouper Rate,1370.00
United HealthCare,PPO,G0448,CPT4/HCPCS,Place perm pacing cardiovert,,Grouper Rate,1370.00
United HealthCare,PPO,G0453,CPT4/HCPCS,Cont intraop neuro monitor,,Grouper Rate,1214.00
United HealthCare,PPO,G0516,CPT4/HCPCS,Insert drug del implant, >=4,,Grouper Rate,1214.00
United HealthCare,PPO,G0517,CPT4/HCPCS,Remove drug implant,,Grouper Rate,1214.00
United HealthCare,PPO,G0518,CPT4/HCPCS,Remove w insert drug implant,,Grouper Rate,1214.00
United HealthCare,PPO,,,NICU/Newborn - Level I,,Per Diem,1174.00
United HealthCare,PPO,,,Medical Surgical,,Per Diem,4817.00
United HealthCare,PPO,,,Telemetry,,Per Diem,5481.00
United HealthCare,PPO,,,Neo ICU,,Per Diem,5762.00
United HealthCare,PPO,,,Critical Care,,Per Diem,8135.00
Deidentified Minimum,,1,DRG,Heart transplant or implant of heart assist system w MCC,,,479084.40
Deidentified Minimum,,2,DRG,Heart transplant or implant of heart assist system w/o MCC,,,263498.74
Deidentified Minimum,,3,DRG,ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R.,,,314114.44
Deidentified Minimum,,4,DRG,Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R.,,,196197.48
Deidentified Minimum,,5,DRG,Liver transplant w MCC or intestinal transplant,,,169093.38
Deidentified Minimum,,6,DRG,Liver transplant w/o MCC,,,77600.71
Deidentified Minimum,,7,DRG,Lung transplant,,,191438.92
Deidentified Minimum,,8,DRG,Simultaneous pancreas/kidney transplant,,,89759.27
Deidentified Minimum,,10,DRG,Pancreas transplant,,,59836.75
Deidentified Minimum,,11,DRG,Tracheostomy for face,mouth & neck diagnoses w MCC,,,82971.25
Deidentified Minimum,,12,DRG,Tracheostomy for face,mouth & neck diagnoses w CC,,,63379.62
Deidentified Minimum,,13,DRG,Tracheostomy for face,mouth & neck diagnoses w/o CC/MCC,,,44997.07
Deidentified Minimum,,14,DRG,Allogeneic bone marrow transplant,,,211361.35
Deidentified Minimum,,16,DRG,Autologous bone marrow transplant w CC/MCC,,,111251.34
Deidentified Minimum,,17,DRG,Autologous bone marrow transplant w/o CC/MCC,,,79891.50
Deidentified Minimum,,18,DRG,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY,,,617421.66
Deidentified Minimum,,19,DRG,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,,,110187.82
Deidentified Minimum,,20,DRG,Intracranial vascular procedures w PDX hemorrhage w MCC,,,170694.45
Deidentified Minimum,,21,DRG,Intracranial vascular procedures w PDX hemorrhage w CC,,,124572.66
Deidentified Minimum,,22,DRG,Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC,,,80377.78
Deidentified Minimum,,23,DRG,Cranio w major dev impl/acute complex CNS PDX w MCC or chemo implant,,,93654.44
Deidentified Minimum,,24,DRG,Cranio w major dev impl/acute complex CNS PDX w/o MCC,,,65043.55
Deidentified Minimum,,25,DRG,Craniotomy & endovascular intracranial procedures w MCC,,,74292.71
Deidentified Minimum,,26,DRG,Craniotomy & endovascular intracranial procedures w CC,,,50579.32
Deidentified Minimum,,27,DRG,Craniotomy & endovascular intracranial procedures w/o CC/MCC,,,41545.17
Deidentified Minimum,,28,DRG,Spinal procedures w MCC,,,5769.00
Deidentified Minimum,,29,DRG,Spinal procedures w CC or spinal neurostimulators,,,5769.00
Deidentified Minimum,,30,DRG,Spinal procedures w/o CC/MCC,,,5769.00
Deidentified Minimum,,31,DRG,Ventricular shunt procedures w MCC,,,72215.29
Deidentified Minimum,,32,DRG,Ventricular shunt procedures w CC,,,36589.78
Deidentified Minimum,,33,DRG,Ventricular shunt procedures w/o CC/MCC,,,28460.37
Deidentified Minimum,,34,DRG,Carotid artery stent procedure w MCC,,,65739.88
Deidentified Minimum,,35,DRG,Carotid artery stent procedure w CC,,,38655.63
Deidentified Minimum,,36,DRG,Carotid artery stent procedure w/o CC/MCC,,,30618.84
Deidentified Minimum,,37,DRG,Extracranial procedures w MCC,,,54163.53
Deidentified Minimum,,38,DRG,Extracranial procedures w CC,,,27411.74
Deidentified Minimum,,39,DRG,Extracranial procedures w/o CC/MCC,,,18839.06
Deidentified Minimum,,40,DRG,Periph/cranial nerve & other nerv syst proc w MCC,,,65462.01
Deidentified Minimum,,41,DRG,Periph/cranial nerve & other nerv syst proc w CC or periph neurostim,,,38882.23
Deidentified Minimum,,42,DRG,Periph/cranial nerve & other nerv syst proc w/o CC/MCC,,,31176.24
Deidentified Minimum,,52,DRG,Spinal disorders & injuries w CC/MCC,,,30517.95
Deidentified Minimum,,53,DRG,Spinal disorders & injuries w/o CC/MCC,,,18791.09
Deidentified Minimum,,54,DRG,Nervous system neoplasms w MCC,,,22590.33
Deidentified Minimum,,55,DRG,Nervous system neoplasms w/o MCC,,,17257.83
Deidentified Minimum,,56,DRG,Degenerative nervous system disorders w MCC,,,36177.94
Deidentified Minimum,,57,DRG,Degenerative nervous system disorders w/o MCC,,,20909.86
Deidentified Minimum,,58,DRG,Multiple sclerosis & cerebellar ataxia w MCC,,,28725.01
Deidentified Minimum,,59,DRG,Multiple sclerosis & cerebellar ataxia w CC,,,18632.31
Deidentified Minimum,,60,DRG,Multiple sclerosis & cerebellar ataxia w/o CC/MCC,,,15144.02
Deidentified Minimum,,61,DRG,Acute ischemic stroke w use of thrombolytic agent w MCC,,,47770.82
Deidentified Minimum,,62,DRG,Acute ischemic stroke w use of thrombolytic agent w CC,,,32868.28
Deidentified Minimum,,63,DRG,Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC,,,28281.74
Deidentified Minimum,,64,DRG,Intracranial hemorrhage or cerebral infarction w MCC,,,31641.02
Deidentified Minimum,,65,DRG,Intracranial hemorrhage or cerebral infarction w CC,,,16841.02
Deidentified Minimum,,66,DRG,Intracranial hemorrhage or cerebral infarction w/o CC/MCC,,,11758.28
Deidentified Minimum,,67,DRG,Nonspecific cva & precerebral occlusion w/o infarct w MCC,,,23562.88
Deidentified Minimum,,68,DRG,Nonspecific cva & precerebral occlusion w/o infarct w/o MCC,,,14697.44
Deidentified Minimum,,69,DRG,Transient ischemia,,,13002.09
Deidentified Minimum,,70,DRG,Nonspecific cerebrovascular disorders w MCC,,,27727.65
Deidentified Minimum,,71,DRG,Nonspecific cerebrovascular disorders w CC,,,16718.63
Deidentified Minimum,,72,DRG,Nonspecific cerebrovascular disorders w/o CC/MCC,,,12755.64
Deidentified Minimum,,73,DRG,Cranial & peripheral nerve disorders w MCC,,,23973.07
Deidentified Minimum,,74,DRG,Cranial & peripheral nerve disorders w/o MCC,,,16844.33
Deidentified Minimum,,75,DRG,Viral meningitis w CC/MCC,,,26894.04
Deidentified Minimum,,76,DRG,Viral meningitis w/o CC/MCC,,,16224.08
Deidentified Minimum,,77,DRG,Hypertensive encephalopathy w MCC,,,25337.62
Deidentified Minimum,,78,DRG,Hypertensive encephalopathy w CC,,,15696.46
Deidentified Minimum,,79,DRG,Hypertensive encephalopathy w/o CC/MCC,,,12021.27
Deidentified Minimum,,80,DRG,Nontraumatic stupor & coma w MCC,,,34601.68
Deidentified Minimum,,81,DRG,Nontraumatic stupor & coma w/o MCC,,,12768.88
Deidentified Minimum,,82,DRG,Traumatic stupor & coma, coma >1 hr w MCC,,,37348.97
Deidentified Minimum,,83,DRG,Traumatic stupor & coma, coma >1 hr w CC,,,22191.71
Deidentified Minimum,,84,DRG,Traumatic stupor & coma, coma >1 hr w/o CC/MCC,,,14955.46
Deidentified Minimum,,85,DRG,Traumatic stupor & coma, coma <1 hr w MCC,,,38147.85
Deidentified Minimum,,86,DRG,Traumatic stupor & coma, coma <1 hr w CC,,,21053.76
Deidentified Minimum,,87,DRG,Traumatic stupor & coma, coma <1 hr w/o CC/MCC,,,14267.40
Deidentified Minimum,,88,DRG,Concussion w MCC,,,24136.82
Deidentified Minimum,,89,DRG,Concussion w CC,,,17552.24
Deidentified Minimum,,90,DRG,Concussion w/o CC/MCC,,,14138.39
Deidentified Minimum,,91,DRG,Other disorders of nervous system w MCC,,,27272.80
Deidentified Minimum,,92,DRG,Other disorders of nervous system w CC,,,16310.09
Deidentified Minimum,,93,DRG,Other disorders of nervous system w/o CC/MCC,,,12922.70
Deidentified Minimum,,94,DRG,Bacterial & tuberculous infections of nervous system w MCC,,,60091.47
Deidentified Minimum,,95,DRG,Bacterial & tuberculous infections of nervous system w CC,,,41482.32
Deidentified Minimum,,96,DRG,Bacterial & tuberculous infections of nervous system w/o CC/MCC,,,38563.01
Deidentified Minimum,,97,DRG,Non-bacterial infect of nervous sys exc viral meningitis w MCC,,,62068.00
Deidentified Minimum,,98,DRG,Non-bacterial infect of nervous sys exc viral meningitis w CC,,,34914.28
Deidentified Minimum,,99,DRG,Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC,,,23111.34
Deidentified Minimum,,100,DRG,Seizures w MCC,,,30989.34
Deidentified Minimum,,101,DRG,Seizures w/o MCC,,,14670.98
Deidentified Minimum,,102,DRG,Headaches w MCC,,,19049.11
Deidentified Minimum,,103,DRG,Headaches w/o MCC,,,13698.42
Deidentified Minimum,,113,DRG,Orbital procedures w CC/MCC,,,36252.37
Deidentified Minimum,,114,DRG,Orbital procedures w/o CC/MCC,,,23908.57
Deidentified Minimum,,115,DRG,Extraocular procedures except orbit,,,24037.58
Deidentified Minimum,,116,DRG,Intraocular procedures w CC/MCC,,,31048.88
Deidentified Minimum,,117,DRG,Intraocular procedures w/o CC/MCC,,,17183.40
Deidentified Minimum,,121,DRG,Acute major eye infections w CC/MCC,,,19661.09
Deidentified Minimum,,122,DRG,Acute major eye infections w/o CC/MCC,,,10648.45
Deidentified Minimum,,123,DRG,Neurological eye disorders,,,12658.06
Deidentified Minimum,,124,DRG,Other disorders of the eye w MCC,,,23136.15
Deidentified Minimum,,125,DRG,Other disorders of the eye w/o MCC,,,13817.51
Deidentified Minimum,,135,DRG,Sinus & mastoid procedures w CC/MCC,,,35405.52
Deidentified Minimum,,136,DRG,Sinus & mastoid procedures w/o CC/MCC,,,20765.97
Deidentified Minimum,,137,DRG,Mouth procedures w CC/MCC,,,24290.64
Deidentified Minimum,,138,DRG,Mouth procedures w/o CC/MCC,,,13944.87
Deidentified Minimum,,139,DRG,Salivary gland procedures,,,20291.27
Deidentified Minimum,,140,DRG,MAJOR HEAD AND NECK PROCEDURES WITH MCC,,,65839.12
Deidentified Minimum,,141,DRG,MAJOR HEAD AND NECK PROCEDURES WITH CC,,,36512.05
Deidentified Minimum,,142,DRG,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,,,26609.55
Deidentified Minimum,,143,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC,,,49021.25
Deidentified Minimum,,144,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC,,,28953.27
Deidentified Minimum,,145,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,,,20071.29
Deidentified Minimum,,146,DRG,Ear, nose, mouth & throat malignancy w MCC,,,33627.47
Deidentified Minimum,,147,DRG,Ear, nose, mouth & throat malignancy w CC,,,21520.19
Deidentified Minimum,,148,DRG,Ear, nose, mouth & throat malignancy w/o CC/MCC,,,13005.40
Deidentified Minimum,,149,DRG,Dysequilibrium,,,12165.17
Deidentified Minimum,,150,DRG,Epistaxis w MCC,,,21910.53
Deidentified Minimum,,151,DRG,Epistaxis w/o MCC,,,12189.98
Deidentified Minimum,,152,DRG,Otitis media & URI w MCC,,,17811.92
Deidentified Minimum,,153,DRG,Otitis media & URI w/o MCC,,,11753.32
Deidentified Minimum,,154,DRG,Nasal trauma & deformity w MCC,,,25512.95
Deidentified Minimum,,155,DRG,Nasal trauma & deformity w CC,,,14998.47
Deidentified Minimum,,156,DRG,Nasal trauma & deformity w/o CC/MCC,,,10876.70
Deidentified Minimum,,157,DRG,Dental & Oral Diseases w MCC,,,26007.49
Deidentified Minimum,,158,DRG,Dental & Oral Diseases w CC,,,14705.71
Deidentified Minimum,,159,DRG,Dental & Oral Diseases w/o CC/MCC,,,10846.93
Deidentified Minimum,,163,DRG,Major chest procedures w MCC,,,82031.78
Deidentified Minimum,,164,DRG,Major chest procedures w CC,,,43596.13
Deidentified Minimum,,165,DRG,Major chest procedures w/o CC/MCC,,,31568.24
Deidentified Minimum,,166,DRG,Other resp system O.R. procedures w MCC,,,62681.63
Deidentified Minimum,,167,DRG,Other resp system O.R. procedures w CC,,,30780.94
Deidentified Minimum,,168,DRG,Other resp system O.R. procedures w/o CC/MCC,,,22649.87
Deidentified Minimum,,175,DRG,Pulmonary embolism w MCC,,,25541.06
Deidentified Minimum,,176,DRG,Pulmonary embolism w/o MCC,,,14666.01
Deidentified Minimum,,177,DRG,Respiratory infections & inflammations w MCC,,,30521.26
Deidentified Minimum,,178,DRG,Respiratory infections & inflammations w CC,,,19945.58
Deidentified Minimum,,179,DRG,Respiratory infections & inflammations w/o CC/MCC,,,14407.99
Deidentified Minimum,,180,DRG,Respiratory neoplasms w MCC,,,28743.21
Deidentified Minimum,,181,DRG,Respiratory neoplasms w CC,,,18539.68
Deidentified Minimum,,182,DRG,Respiratory neoplasms w/o CC/MCC,,,13025.25
Deidentified Minimum,,183,DRG,Major chest trauma w MCC,,,25729.62
Deidentified Minimum,,184,DRG,Major chest trauma w CC,,,17191.67
Deidentified Minimum,,185,DRG,Major chest trauma w/o CC/MCC,,,12795.34
Deidentified Minimum,,186,DRG,Pleural effusion w MCC,,,25524.52
Deidentified Minimum,,187,DRG,Pleural effusion w CC,,,17072.58
Deidentified Minimum,,188,DRG,Pleural effusion w/o CC/MCC,,,12042.77
Deidentified Minimum,,189,DRG,Pulmonary edema & respiratory failure,,,20258.19
Deidentified Minimum,,190,DRG,Chronic obstructive pulmonary disease w MCC,,,18589.30
Deidentified Minimum,,191,DRG,Chronic obstructive pulmonary disease w CC,,,14606.47
Deidentified Minimum,,192,DRG,Chronic obstructive pulmonary disease w/o CC/MCC,,,11493.64
Deidentified Minimum,,193,DRG,Simple pneumonia & pleurisy w MCC,,,21678.97
Deidentified Minimum,,194,DRG,Simple pneumonia & pleurisy w CC,,,14274.02
Deidentified Minimum,,195,DRG,Simple pneumonia & pleurisy w/o CC/MCC,,,10999.10
Deidentified Minimum,,196,DRG,Interstitial lung disease w MCC,,,28715.09
Deidentified Minimum,,197,DRG,Interstitial lung disease w CC,,,16632.62
Deidentified Minimum,,198,DRG,Interstitial lung disease w/o CC/MCC,,,12277.64
Deidentified Minimum,,199,DRG,Pneumothorax w MCC,,,29566.90
Deidentified Minimum,,200,DRG,Pneumothorax w CC,,,17780.50
Deidentified Minimum,,201,DRG,Pneumothorax w/o CC/MCC,,,11735.13
Deidentified Minimum,,202,DRG,Bronchitis & asthma w CC/MCC,,,15971.02
Deidentified Minimum,,203,DRG,Bronchitis & asthma w/o CC/MCC,,,11668.97
Deidentified Minimum,,204,DRG,Respiratory signs & symptoms,,,13107.95
Deidentified Minimum,,205,DRG,Other respiratory system diagnoses w MCC,,,27825.24
Deidentified Minimum,,206,DRG,Other respiratory system diagnoses w/o MCC,,,14624.66
Deidentified Minimum,,207,DRG,Respiratory system diagnosis w ventilator support 96+ hours,,,94714.65
Deidentified Minimum,,208,DRG,Respiratory system diagnosis w ventilator support <96 hours,,,42049.64
Deidentified Minimum,,215,DRG,Other heart assist system implant,,,46358.00
Deidentified Minimum,,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,,8300.00
Deidentified Minimum,,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,,8300.00
Deidentified Minimum,,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,,8300.00
Deidentified Minimum,,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,,8300.00
Deidentified Minimum,,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,,8300.00
Deidentified Minimum,,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,,8300.00
Deidentified Minimum,,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,,8300.00
Deidentified Minimum,,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,,8300.00
Deidentified Minimum,,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,,8300.00
Deidentified Minimum,,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,,8300.00
Deidentified Minimum,,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,,8300.00
Deidentified Minimum,,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,,8300.00
Deidentified Minimum,,228,DRG,Other cardiothoracic procedures w MCC,,,8300.00
Deidentified Minimum,,229,DRG,Other cardiothoracic procedures w CC,,,8300.00
Deidentified Minimum,,230,DRG,Other cardiothoracic procedures w/o CC/MCC,,,8300.00
Deidentified Minimum,,231,DRG,Coronary bypass w PTCA w MCC,,,8300.00
Deidentified Minimum,,232,DRG,Coronary bypass w PTCA w/o MCC,,,8300.00
Deidentified Minimum,,233,DRG,Coronary bypass w cardiac cath w MCC,,,8300.00
Deidentified Minimum,,234,DRG,Coronary bypass w cardiac cath w/o MCC,,,8300.00
Deidentified Minimum,,235,DRG,Coronary bypass w/o cardiac cath w MCC,,,8300.00
Deidentified Minimum,,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,,8300.00
Deidentified Minimum,,237,DRG,Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair,,,8300.00
Deidentified Minimum,,238,DRG,Major cardiovasc procedures w/o MCC,,,8300.00
Deidentified Minimum,,239,DRG,Amputation for circ sys disorders exc upper limb & toe w MCC,,,79535.89
Deidentified Minimum,,240,DRG,Amputation for circ sys disorders exc upper limb & toe w CC,,,46146.60
Deidentified Minimum,,241,DRG,Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC,,,26321.75
Deidentified Minimum,,242,DRG,Permanent cardiac pacemaker implant w MCC,,,8300.00
Deidentified Minimum,,243,DRG,Permanent cardiac pacemaker implant w CC,,,8300.00
Deidentified Minimum,,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,,8300.00
Deidentified Minimum,,245,DRG,AICD lead & generator procedures,,,89547.56
Deidentified Minimum,,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,,8300.00
Deidentified Minimum,,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,,8300.00
Deidentified Minimum,,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,,8300.00
Deidentified Minimum,,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,,8300.00
Deidentified Minimum,,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,,8300.00
Deidentified Minimum,,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,,8300.00
Deidentified Minimum,,252,DRG,Other vascular procedures w MCC,,,25163.00
Deidentified Minimum,,253,DRG,Other vascular procedures w CC,,,20573.00
Deidentified Minimum,,254,DRG,Other vascular procedures w/o CC/MCC,,,23300.00
Deidentified Minimum,,255,DRG,Upper limb & toe amputation for circ system disorders w MCC,,,42061.22
Deidentified Minimum,,256,DRG,Upper limb & toe amputation for circ system disorders w CC,,,27176.87
Deidentified Minimum,,257,DRG,Upper limb & toe amputation for circ system disorders w/o CC/MCC,,,19202.94
Deidentified Minimum,,258,DRG,Cardiac pacemaker device replacement w MCC,,,4035.00
Deidentified Minimum,,259,DRG,Cardiac pacemaker device replacement w/o MCC,,,2914.00
Deidentified Minimum,,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,,8300.00
Deidentified Minimum,,261,DRG,Cardiac pacemaker revision except device replacement w CC,,,8300.00
Deidentified Minimum,,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,,7188.00
Deidentified Minimum,,263,DRG,Vein ligation & stripping,,,38129.66
Deidentified Minimum,,264,DRG,Other circulatory system O.R. procedures,,,53718.61
Deidentified Minimum,,265,DRG,AICD lead procedures,,,55619.05
Deidentified Minimum,,266,DRG,Endovascular Cardiac Valve Replacement w MCC,,,117387.68
Deidentified Minimum,,267,DRG,Endovascular Cardiac Valve Replacement w/o MCC,,,92638.88
Deidentified Minimum,,268,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w MCC,,,98437.00
Deidentified Minimum,,269,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w/o MCC,,,61188.00
Deidentified Minimum,,270,DRG,Other Major Cardiovascular Procedures w MCC,,,74210.00
Deidentified Minimum,,271,DRG,Other Major Cardiovascular Procedures w CC,,,49254.00
Deidentified Minimum,,272,DRG,Other Major Cardiovascular Procedures w/o CC/MCC,,,35277.00
Deidentified Minimum,,273,DRG,Percutaneous Intracardiac Procedures w MCC,,,37635.00
Deidentified Minimum,,274,DRG,Percutaneous Intracardiac Procedures w/o MCC,,,25652.00
Deidentified Minimum,,280,DRG,Acute myocardial infarction, discharged alive w MCC,,,26897.34
Deidentified Minimum,,281,DRG,Acute myocardial infarction, discharged alive w CC,,,8300.00
Deidentified Minimum,,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,,8300.00
Deidentified Minimum,,283,DRG,Acute myocardial infarction, expired w MCC,,,30840.48
Deidentified Minimum,,284,DRG,Acute myocardial infarction, expired w CC,,,12143.66
Deidentified Minimum,,285,DRG,Acute myocardial infarction, expired w/o CC/MCC,,,8210.45
Deidentified Minimum,,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,,8300.00
Deidentified Minimum,,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,,8300.00
Deidentified Minimum,,288,DRG,Acute & subacute endocarditis w MCC,,,44343.74
Deidentified Minimum,,289,DRG,Acute & subacute endocarditis w CC,,,27168.60
Deidentified Minimum,,290,DRG,Acute & subacute endocarditis w/o CC/MCC,,,16930.34
Deidentified Minimum,,291,DRG,Heart failure & shock w MCC,,,22178.48
Deidentified Minimum,,292,DRG,Heart failure & shock w CC,,,14804.95
Deidentified Minimum,,293,DRG,Heart failure & shock w/o CC/MCC,,,10794.00
Deidentified Minimum,,294,DRG,Deep vein thrombophlebitis w CC/MCC,,,21205.93
Deidentified Minimum,,295,DRG,Deep vein thrombophlebitis w/o CC/MCC,,,16230.70
Deidentified Minimum,,296,DRG,Cardiac arrest, unexplained w MCC,,,26377.99
Deidentified Minimum,,297,DRG,Cardiac arrest, unexplained w CC,,,11654.08
Deidentified Minimum,,298,DRG,Cardiac arrest, unexplained w/o CC/MCC,,,8074.82
Deidentified Minimum,,299,DRG,Peripheral vascular disorders w MCC,,,25329.35
Deidentified Minimum,,300,DRG,Peripheral vascular disorders w CC,,,17237.98
Deidentified Minimum,,301,DRG,Peripheral vascular disorders w/o CC/MCC,,,12280.95
Deidentified Minimum,,302,DRG,Atherosclerosis w MCC,,,18086.49
Deidentified Minimum,,303,DRG,Atherosclerosis w/o MCC,,,11187.65
Deidentified Minimum,,304,DRG,Hypertension w MCC,,,18121.22
Deidentified Minimum,,305,DRG,Hypertension w/o MCC,,,12214.79
Deidentified Minimum,,306,DRG,Cardiac congenital & valvular disorders w MCC,,,24871.19
Deidentified Minimum,,307,DRG,Cardiac congenital & valvular disorders w/o MCC,,,14363.33
Deidentified Minimum,,308,DRG,Cardiac arrhythmia & conduction disorders w MCC,,,19836.42
Deidentified Minimum,,309,DRG,Cardiac arrhythmia & conduction disorders w CC,,,12395.07
Deidentified Minimum,,310,DRG,Cardiac arrhythmia & conduction disorders w/o CC/MCC,,,9235.93
Deidentified Minimum,,311,DRG,Angina pectoris,,,11528.38
Deidentified Minimum,,312,DRG,Syncope & collapse,,,13847.28
Deidentified Minimum,,313,DRG,Chest pain,,,11922.03
Deidentified Minimum,,314,DRG,Other circulatory system diagnoses w MCC,,,34459.43
Deidentified Minimum,,315,DRG,Other circulatory system diagnoses w CC,,,16129.80
Deidentified Minimum,,316,DRG,Other circulatory system diagnoses w/o CC/MCC,,,12396.73
Deidentified Minimum,,319,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W MCC,,,71383.33
Deidentified Minimum,,320,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W/O MCC,,,40418.79
Deidentified Minimum,,326,DRG,Stomach, esophageal & duodenal proc w MCC,,,88947.15
Deidentified Minimum,,327,DRG,Stomach, esophageal & duodenal proc w CC,,,43162.78
Deidentified Minimum,,328,DRG,Stomach, esophageal & duodenal proc w/o CC/MCC,,,27547.37
Deidentified Minimum,,329,DRG,Major small & large bowel procedures w MCC,,,80223.96
Deidentified Minimum,,330,DRG,Major small & large bowel procedures w CC,,,41995.06
Deidentified Minimum,,331,DRG,Major small & large bowel procedures w/o CC/MCC,,,28285.05
Deidentified Minimum,,332,DRG,Rectal resection w MCC,,,68801.43
Deidentified Minimum,,333,DRG,Rectal resection w CC,,,35412.14
Deidentified Minimum,,334,DRG,Rectal resection w/o CC/MCC,,,26616.16
Deidentified Minimum,,335,DRG,Peritoneal adhesiolysis w MCC,,,64347.21
Deidentified Minimum,,336,DRG,Peritoneal adhesiolysis w CC,,,37759.16
Deidentified Minimum,,337,DRG,Peritoneal adhesiolysis w/o CC/MCC,,,27003.20
Deidentified Minimum,,338,DRG,Appendectomy w complicated principal diag w MCC,,,46292.15
Deidentified Minimum,,339,DRG,Appendectomy w complicated principal diag w CC,,,28035.30
Deidentified Minimum,,340,DRG,Appendectomy w complicated principal diag w/o CC/MCC,,,20317.73
Deidentified Minimum,,341,DRG,Appendectomy w/o complicated principal diag w MCC,,,38309.94
Deidentified Minimum,,342,DRG,Appendectomy w/o complicated principal diag w CC,,,23703.47
Deidentified Minimum,,343,DRG,Appendectomy w/o complicated principal diag w/o CC/MCC,,,18349.47
Deidentified Minimum,,344,DRG,Minor small & large bowel procedures w MCC,,,46326.88
Deidentified Minimum,,345,DRG,Minor small & large bowel procedures w CC,,,26095.15
Deidentified Minimum,,346,DRG,Minor small & large bowel procedures w/o CC/MCC,,,21088.50
Deidentified Minimum,,347,DRG,Anal & stomal procedures w MCC,,,40714.86
Deidentified Minimum,,348,DRG,Anal & stomal procedures w CC,,,22203.29
Deidentified Minimum,,349,DRG,Anal & stomal procedures w/o CC/MCC,,,16197.62
Deidentified Minimum,,350,DRG,Inguinal & femoral hernia procedures w MCC,,,40562.69
Deidentified Minimum,,351,DRG,Inguinal & femoral hernia procedures w CC,,,24651.21
Deidentified Minimum,,352,DRG,Inguinal & femoral hernia procedures w/o CC/MCC,,,18243.62
Deidentified Minimum,,353,DRG,Hernia procedures except inguinal & femoral w MCC,,,49757.28
Deidentified Minimum,,354,DRG,Hernia procedures except inguinal & femoral w CC,,,29490.82
Deidentified Minimum,,355,DRG,Hernia procedures except inguinal & femoral w/o CC/MCC,,,22481.16
Deidentified Minimum,,356,DRG,Other digestive system O.R. procedures w MCC,,,70979.75
Deidentified Minimum,,357,DRG,Other digestive system O.R. procedures w CC,,,37276.19
Deidentified Minimum,,358,DRG,Other digestive system O.R. procedures w/o CC/MCC,,,22147.06
Deidentified Minimum,,368,DRG,Major esophageal disorders w MCC,,,32125.64
Deidentified Minimum,,369,DRG,Major esophageal disorders w CC,,,17810.27
Deidentified Minimum,,370,DRG,Major esophageal disorders w/o CC/MCC,,,12365.30
Deidentified Minimum,,371,DRG,Major gastrointestinal disorders & peritoneal infections w MCC,,,28586.08
Deidentified Minimum,,372,DRG,Major gastrointestinal disorders & peritoneal infections w CC,,,16996.50
Deidentified Minimum,,373,DRG,Major gastrointestinal disorders & peritoneal infections w/o CC/MCC,,,12297.49
Deidentified Minimum,,374,DRG,Digestive malignancy w MCC,,,34203.06
Deidentified Minimum,,375,DRG,Digestive malignancy w CC,,,19929.04
Deidentified Minimum,,376,DRG,Digestive malignancy w/o CC/MCC,,,14806.60
Deidentified Minimum,,377,DRG,G.I. hemorrhage w MCC,,,29753.80
Deidentified Minimum,,378,DRG,G.I. hemorrhage w CC,,,16427.52
Deidentified Minimum,,379,DRG,G.I. hemorrhage w/o CC/MCC,,,10537.63
Deidentified Minimum,,380,DRG,Complicated peptic ulcer w MCC,,,31146.47
Deidentified Minimum,,381,DRG,Complicated peptic ulcer w CC,,,17527.43
Deidentified Minimum,,382,DRG,Complicated peptic ulcer w/o CC/MCC,,,12707.68
Deidentified Minimum,,383,DRG,Uncomplicated peptic ulcer w MCC,,,21682.28
Deidentified Minimum,,384,DRG,Uncomplicated peptic ulcer w/o MCC,,,14760.29
Deidentified Minimum,,385,DRG,Inflammatory bowel disease w MCC,,,26779.91
Deidentified Minimum,,386,DRG,Inflammatory bowel disease w CC,,,16432.49
Deidentified Minimum,,387,DRG,Inflammatory bowel disease w/o CC/MCC,,,11801.29
Deidentified Minimum,,388,DRG,G.I. obstruction w MCC,,,25005.17
Deidentified Minimum,,389,DRG,G.I. obstruction w CC,,,13592.57
Deidentified Minimum,,390,DRG,G.I. obstruction w/o CC/MCC,,,9636.20
Deidentified Minimum,,391,DRG,Esophagitis, gastroent & misc digest disorders w MCC,,,20582.37
Deidentified Minimum,,392,DRG,Esophagitis, gastroent & misc digest disorders w/o MCC,,,12643.17
Deidentified Minimum,,393,DRG,Other digestive system diagnoses w MCC,,,27350.54
Deidentified Minimum,,394,DRG,Other digestive system diagnoses w CC,,,15524.44
Deidentified Minimum,,395,DRG,Other digestive system diagnoses w/o CC/MCC,,,10746.03
Deidentified Minimum,,405,DRG,Pancreas, liver & shunt procedures w MCC,,,94782.47
Deidentified Minimum,,406,DRG,Pancreas, liver & shunt procedures w CC,,,47585.58
Deidentified Minimum,,407,DRG,Pancreas, liver & shunt procedures w/o CC/MCC,,,34998.64
Deidentified Minimum,,408,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC,,,62016.73
Deidentified Minimum,,409,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w CC,,,34970.52
Deidentified Minimum,,410,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC,,,25896.67
Deidentified Minimum,,411,DRG,Cholecystectomy w c.d.e. w MCC,,,62064.69
Deidentified Minimum,,412,DRG,Cholecystectomy w c.d.e. w CC,,,37640.07
Deidentified Minimum,,413,DRG,Cholecystectomy w c.d.e. w/o CC/MCC,,,28637.35
Deidentified Minimum,,414,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w MCC,,,59965.77
Deidentified Minimum,,415,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w CC,,,33607.62
Deidentified Minimum,,416,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC,,,23523.18
Deidentified Minimum,,417,DRG,Laparoscopic cholecystectomy w/o c.d.e. w MCC,,,40084.69
Deidentified Minimum,,418,DRG,Laparoscopic cholecystectomy w/o c.d.e. w CC,,,27921.17
Deidentified Minimum,,419,DRG,Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC,,,21753.40
Deidentified Minimum,,420,DRG,Hepatobiliary diagnostic procedures w MCC,,,58123.21
Deidentified Minimum,,421,DRG,Hepatobiliary diagnostic procedures w CC,,,31573.20
Deidentified Minimum,,422,DRG,Hepatobiliary diagnostic procedures w/o CC/MCC,,,24006.15
Deidentified Minimum,,423,DRG,Other hepatobiliary or pancreas O.R. procedures w MCC,,,69120.66
Deidentified Minimum,,424,DRG,Other hepatobiliary or pancreas O.R. procedures w CC,,,37737.66
Deidentified Minimum,,425,DRG,Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC,,,25526.18
Deidentified Minimum,,432,DRG,Cirrhosis & alcoholic hepatitis w MCC,,,31129.93
Deidentified Minimum,,433,DRG,Cirrhosis & alcoholic hepatitis w CC,,,17011.39
Deidentified Minimum,,434,DRG,Cirrhosis & alcoholic hepatitis w/o CC/MCC,,,10248.18
Deidentified Minimum,,435,DRG,Malignancy of hepatobiliary system or pancreas w MCC,,,28991.31
Deidentified Minimum,,436,DRG,Malignancy of hepatobiliary system or pancreas w CC,,,18528.10
Deidentified Minimum,,437,DRG,Malignancy of hepatobiliary system or pancreas w/o CC/MCC,,,14795.03
Deidentified Minimum,,438,DRG,Disorders of pancreas except malignancy w MCC,,,26402.80
Deidentified Minimum,,439,DRG,Disorders of pancreas except malignancy w CC,,,13966.37
Deidentified Minimum,,440,DRG,Disorders of pancreas except malignancy w/o CC/MCC,,,10021.58
Deidentified Minimum,,441,DRG,Disorders of liver except malig,cirr,alc hepa w MCC,,,31156.39
Deidentified Minimum,,442,DRG,Disorders of liver except malig,cirr,alc hepa w CC,,,15408.66
Deidentified Minimum,,443,DRG,Disorders of liver except malig,cirr,alc hepa w/o CC/MCC,,,10962.71
Deidentified Minimum,,444,DRG,Disorders of the biliary tract w MCC,,,27601.95
Deidentified Minimum,,445,DRG,Disorders of the biliary tract w CC,,,17810.27
Deidentified Minimum,,446,DRG,Disorders of the biliary tract w/o CC/MCC,,,13499.94
Deidentified Minimum,,453,DRG,Combined anterior/posterior spinal fusion w MCC,,,5769.00
Deidentified Minimum,,454,DRG,Combined anterior/posterior spinal fusion w CC,,,5769.00
Deidentified Minimum,,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,,5769.00
Deidentified Minimum,,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,,5769.00
Deidentified Minimum,,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,,5769.00
Deidentified Minimum,,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,,5769.00
Deidentified Minimum,,459,DRG,Spinal fusion except cervical w MCC,,,5769.00
Deidentified Minimum,,460,DRG,Spinal fusion except cervical w/o MCC,,,5769.00
Deidentified Minimum,,461,DRG,Bilateral or multiple major joint procs of lower extremity w MCC,,,38472.00
Deidentified Minimum,,462,DRG,Bilateral or multiple major joint procs of lower extremity w/o MCC,,,31097.00
Deidentified Minimum,,463,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC,,,88743.71
Deidentified Minimum,,464,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC,,,49198.23
Deidentified Minimum,,465,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC,,,30493.14
Deidentified Minimum,,466,DRG,Revision of hip or knee replacement w MCC,,,27988.00
Deidentified Minimum,,467,DRG,Revision of hip or knee replacement w CC,,,21757.00
Deidentified Minimum,,468,DRG,Revision of hip or knee replacement w/o CC/MCC,,,19398.00
Deidentified Minimum,,469,DRG,Major joint replacement or reattachment of lower extremity w MCC,,,25000.00
Deidentified Minimum,,470,DRG,Major joint replacement or reattachment of lower extremity w/o MCC,,,27589.00
Deidentified Minimum,,471,DRG,Cervical spinal fusion w MCC,,,5769.00
Deidentified Minimum,,472,DRG,Cervical spinal fusion w CC,,,5769.00
Deidentified Minimum,,473,DRG,Cervical spinal fusion w/o CC/MCC,,,5769.00
Deidentified Minimum,,474,DRG,Amputation for musculoskeletal sys & conn tissue dis w MCC,,,67364.11
Deidentified Minimum,,475,DRG,Amputation for musculoskeletal sys & conn tissue dis w CC,,,36282.14
Deidentified Minimum,,476,DRG,Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC,,,19183.09
Deidentified Minimum,,477,DRG,Biopsies of musculoskeletal system & connective tissue w MCC,,,55523.12
Deidentified Minimum,,478,DRG,Biopsies of musculoskeletal system & connective tissue w CC,,,38983.12
Deidentified Minimum,,479,DRG,Biopsies of musculoskeletal system & connective tissue w/o CC/MCC,,,29925.82
Deidentified Minimum,,480,DRG,Hip & femur procedures except major joint w MCC,,,50025.23
Deidentified Minimum,,481,DRG,Hip & femur procedures except major joint w CC,,,34659.57
Deidentified Minimum,,482,DRG,Hip & femur procedures except major joint w/o CC/MCC,,,27238.07
Deidentified Minimum,,483,DRG,Major joint & limb reattachment proc of upper extremity w CC/MCC,,,39469.40
Deidentified Minimum,,485,DRG,Knee procedures w pdx of infection w MCC,,,56361.70
Deidentified Minimum,,486,DRG,Knee procedures w pdx of infection w CC,,,35534.53
Deidentified Minimum,,487,DRG,Knee procedures w pdx of infection w/o CC/MCC,,,27130.56
Deidentified Minimum,,488,DRG,Knee procedures w/o pdx of infection w CC/MCC,,,32659.88
Deidentified Minimum,,489,DRG,Knee procedures w/o pdx of infection w/o CC/MCC,,,21472.22
Deidentified Minimum,,492,DRG,Lower extrem & humer proc except hip,foot,femur w MCC,,,22292.00
Deidentified Minimum,,493,DRG,Lower extrem & humer proc except hip,foot,femur w CC,,,17095.00
Deidentified Minimum,,494,DRG,Lower extrem & humer proc except hip,foot,femur w/o CC/MCC,,,17705.00
Deidentified Minimum,,495,DRG,Local excision & removal int fix devices exc hip & femur w MCC,,,60109.66
Deidentified Minimum,,496,DRG,Local excision & removal int fix devices exc hip & femur w CC,,,32841.82
Deidentified Minimum,,497,DRG,Local excision & removal int fix devices exc hip & femur w/o CC/MCC,,,24126.89
Deidentified Minimum,,498,DRG,Local excision & removal int fix devices of hip & femur w CC/MCC,,,42744.32
Deidentified Minimum,,499,DRG,Local excision & removal int fix devices of hip & femur w/o CC/MCC,,,19826.49
Deidentified Minimum,,500,DRG,Soft tissue procedures w MCC,,,52165.50
Deidentified Minimum,,501,DRG,Soft tissue procedures w CC,,,28862.30
Deidentified Minimum,,502,DRG,Soft tissue procedures w/o CC/MCC,,,22011.43
Deidentified Minimum,,503,DRG,Foot procedures w MCC,,,43478.69
Deidentified Minimum,,504,DRG,Foot procedures w CC,,,29340.30
Deidentified Minimum,,505,DRG,Foot procedures w/o CC/MCC,,,29340.30
Deidentified Minimum,,506,DRG,Major thumb or joint procedures,,,24408.07
Deidentified Minimum,,507,DRG,Major shoulder or elbow joint procedures w CC/MCC,,,33448.84
Deidentified Minimum,,508,DRG,Major shoulder or elbow joint procedures w/o CC/MCC,,,23387.56
Deidentified Minimum,,509,DRG,Arthroscopy,,,27684.65
Deidentified Minimum,,510,DRG,Shoulder,elbow or forearm proc,exc major joint proc w MCC,,,45165.77
Deidentified Minimum,,511,DRG,Shoulder,elbow or forearm proc,exc major joint proc w CC,,,32558.99
Deidentified Minimum,,512,DRG,Shoulder,elbow or forearm proc,exc major joint proc w/o CC/MCC,,,25739.54
Deidentified Minimum,,513,DRG,Hand or wrist proc, except major thumb or joint proc w CC/MCC,,,25785.86
Deidentified Minimum,,514,DRG,Hand or wrist proc, except major thumb or joint proc w/o CC/MCC,,,16444.06
Deidentified Minimum,,515,DRG,Other musculoskelet sys & conn tiss O.R. proc w MCC,,,51885.98
Deidentified Minimum,,516,DRG,Other musculoskelet sys & conn tiss O.R. proc w CC,,,32436.59
Deidentified Minimum,,517,DRG,Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC,,,23101.41
Deidentified Minimum,,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,,5769.00
Deidentified Minimum,,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,,5769.00
Deidentified Minimum,,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,,5769.00
Deidentified Minimum,,521,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,,,50668.63
Deidentified Minimum,,522,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,,,36207.71
Deidentified Minimum,,533,DRG,Fractures of femur w MCC,,,23364.40
Deidentified Minimum,,534,DRG,Fractures of femur w/o MCC,,,13043.44
Deidentified Minimum,,535,DRG,Fractures of hip & pelvis w MCC,,,20407.05
Deidentified Minimum,,536,DRG,Fractures of hip & pelvis w/o MCC,,,12762.26
Deidentified Minimum,,537,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC,,,15435.12
Deidentified Minimum,,538,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC,,,11931.95
Deidentified Minimum,,539,DRG,Osteomyelitis w MCC,,,32107.44
Deidentified Minimum,,540,DRG,Osteomyelitis w CC,,,21424.26
Deidentified Minimum,,541,DRG,Osteomyelitis w/o CC/MCC,,,13903.52
Deidentified Minimum,,542,DRG,Pathological fractures & musculoskelet & conn tiss malig w MCC,,,29859.66
Deidentified Minimum,,543,DRG,Pathological fractures & musculoskelet & conn tiss malig w CC,,,17256.18
Deidentified Minimum,,544,DRG,Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC,,,12838.34
Deidentified Minimum,,545,DRG,Connective tissue disorders w MCC,,,41341.73
Deidentified Minimum,,546,DRG,Connective tissue disorders w CC,,,19957.16
Deidentified Minimum,,547,DRG,Connective tissue disorders w/o CC/MCC,,,13777.82
Deidentified Minimum,,548,DRG,Septic arthritis w MCC,,,33569.58
Deidentified Minimum,,549,DRG,Septic arthritis w CC,,,20623.72
Deidentified Minimum,,550,DRG,Septic arthritis w/o CC/MCC,,,14599.85
Deidentified Minimum,,551,DRG,Medical back problems w MCC,,,26846.07
Deidentified Minimum,,552,DRG,Medical back problems w/o MCC,,,15580.68
Deidentified Minimum,,553,DRG,Bone diseases & arthropathies w MCC,,,20977.68
Deidentified Minimum,,554,DRG,Bone diseases & arthropathies w/o MCC,,,13073.21
Deidentified Minimum,,555,DRG,Signs & symptoms of musculoskeletal system & conn tissue w MCC,,,22540.71
Deidentified Minimum,,556,DRG,Signs & symptoms of musculoskeletal system & conn tissue w/o MCC,,,13336.20
Deidentified Minimum,,557,DRG,Tendonitis, myositis & bursitis w MCC,,,23055.10
Deidentified Minimum,,558,DRG,Tendonitis, myositis & bursitis w/o MCC,,,14196.28
Deidentified Minimum,,559,DRG,Aftercare, musculoskeletal system & connective tissue w MCC,,,30895.06
Deidentified Minimum,,560,DRG,Aftercare, musculoskeletal system & connective tissue w CC,,,17803.65
Deidentified Minimum,,561,DRG,Aftercare, musculoskeletal system & connective tissue w/o CC/MCC,,,13084.79
Deidentified Minimum,,562,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC,,,23288.32
Deidentified Minimum,,563,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC,,,14403.03
Deidentified Minimum,,564,DRG,Other musculoskeletal sys & connective tissue diagnoses w MCC,,,25038.25
Deidentified Minimum,,565,DRG,Other musculoskeletal sys & connective tissue diagnoses w CC,,,16644.20
Deidentified Minimum,,566,DRG,Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC,,,12429.81
Deidentified Minimum,,570,DRG,Skin debridement w MCC,,,46912.40
Deidentified Minimum,,571,DRG,Skin debridement w CC,,,27006.51
Deidentified Minimum,,572,DRG,Skin debridement w/o CC/MCC,,,18237.00
Deidentified Minimum,,573,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w MCC,,,91586.94
Deidentified Minimum,,574,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w CC,,,53726.88
Deidentified Minimum,,575,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/MCC,,,29135.21
Deidentified Minimum,,576,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC,,,83541.88
Deidentified Minimum,,577,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w CC,,,42239.85
Deidentified Minimum,,578,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC,,,26971.77
Deidentified Minimum,,579,DRG,Other skin, subcut tiss & breast proc w MCC,,,48425.81
Deidentified Minimum,,580,DRG,Other skin, subcut tiss & breast proc w CC,,,26468.96
Deidentified Minimum,,581,DRG,Other skin, subcut tiss & breast proc w/o CC/MCC,,,20709.73
Deidentified Minimum,,582,DRG,Mastectomy for malignancy w CC/MCC,,,27056.13
Deidentified Minimum,,583,DRG,Mastectomy for malignancy w/o CC/MCC,,,25436.86
Deidentified Minimum,,584,DRG,Breast biopsy, local excision & other breast procedures w CC/MCC,,,30173.92
Deidentified Minimum,,585,DRG,Breast biopsy, local excision & other breast procedures w/o CC/MCC,,,28723.36
Deidentified Minimum,,592,DRG,Skin ulcers w MCC,,,27898.01
Deidentified Minimum,,593,DRG,Skin ulcers w CC,,,18802.67
Deidentified Minimum,,594,DRG,Skin ulcers w/o CC/MCC,,,13541.29
Deidentified Minimum,,595,DRG,Major skin disorders w MCC,,,33280.13
Deidentified Minimum,,596,DRG,Major skin disorders w/o MCC,,,16361.36
Deidentified Minimum,,597,DRG,Malignant breast disorders w MCC,,,27071.01
Deidentified Minimum,,598,DRG,Malignant breast disorders w CC,,,18379.24
Deidentified Minimum,,599,DRG,Malignant breast disorders w/o CC/MCC,,,11101.64
Deidentified Minimum,,600,DRG,Non-malignant breast disorders w CC/MCC,,,16468.87
Deidentified Minimum,,601,DRG,Non-malignant breast disorders w/o CC/MCC,,,11372.90
Deidentified Minimum,,602,DRG,Cellulitis w MCC,,,23761.36
Deidentified Minimum,,603,DRG,Cellulitis w/o MCC,,,13972.99
Deidentified Minimum,,604,DRG,Trauma to the skin, subcut tiss & breast w MCC,,,24666.10
Deidentified Minimum,,605,DRG,Trauma to the skin, subcut tiss & breast w/o MCC,,,15038.16
Deidentified Minimum,,606,DRG,Minor skin disorders w MCC,,,24991.94
Deidentified Minimum,,607,DRG,Minor skin disorders w/o MCC,,,13655.42
Deidentified Minimum,,614,DRG,Adrenal & pituitary procedures w CC/MCC,,,39477.67
Deidentified Minimum,,615,DRG,Adrenal & pituitary procedures w/o CC/MCC,,,26035.61
Deidentified Minimum,,616,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w MCC,,,65974.75
Deidentified Minimum,,617,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w CC,,,33644.01
Deidentified Minimum,,618,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w/o CC/MCC,,,21551.62
Deidentified Minimum,,619,DRG,O.R. procedures for obesity w MCC,,,50630.59
Deidentified Minimum,,620,DRG,O.R. procedures for obesity w CC,,,29128.59
Deidentified Minimum,,621,DRG,O.R. procedures for obesity w/o CC/MCC,,,26404.45
Deidentified Minimum,,622,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC,,,59755.71
Deidentified Minimum,,623,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w CC,,,30977.76
Deidentified Minimum,,624,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC,,,18099.72
Deidentified Minimum,,625,DRG,Thyroid, parathyroid & thyroglossal procedures w MCC,,,46993.44
Deidentified Minimum,,626,DRG,Thyroid, parathyroid & thyroglossal procedures w CC,,,27329.04
Deidentified Minimum,,627,DRG,Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC,,,19546.97
Deidentified Minimum,,628,DRG,Other endocrine, nutrit & metab O.R. proc w MCC,,,61166.57
Deidentified Minimum,,629,DRG,Other endocrine, nutrit & metab O.R. proc w CC,,,38816.07
Deidentified Minimum,,630,DRG,Other endocrine, nutrit & metab O.R. proc w/o CC/MCC,,,23270.12
Deidentified Minimum,,637,DRG,Diabetes w MCC,,,22737.53
Deidentified Minimum,,638,DRG,Diabetes w CC,,,14545.27
Deidentified Minimum,,639,DRG,Diabetes w/o CC/MCC,,,10077.82
Deidentified Minimum,,640,DRG,Nutritional & misc metabolic disorders w MCC,,,20307.81
Deidentified Minimum,,641,DRG,Nutritional & misc metabolic disorders w/o MCC,,,12454.62
Deidentified Minimum,,642,DRG,Inborn errors of metabolism,,,21295.25
Deidentified Minimum,,643,DRG,Endocrine disorders w MCC,,,27510.98
Deidentified Minimum,,644,DRG,Endocrine disorders w CC,,,16842.68
Deidentified Minimum,,645,DRG,Endocrine disorders w/o CC/MCC,,,12699.41
Deidentified Minimum,,650,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,,,74646.67
Deidentified Minimum,,651,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,,,61092.14
Deidentified Minimum,,652,DRG,Kidney transplant,,,52628.62
Deidentified Minimum,,653,DRG,Major bladder procedures w MCC,,,90129.76
Deidentified Minimum,,654,DRG,Major bladder procedures w CC,,,47969.30
Deidentified Minimum,,655,DRG,Major bladder procedures w/o CC/MCC,,,34404.85
Deidentified Minimum,,656,DRG,Kidney & ureter procedures for neoplasm w MCC,,,54279.31
Deidentified Minimum,,657,DRG,Kidney & ureter procedures for neoplasm w CC,,,31990.01
Deidentified Minimum,,658,DRG,Kidney & ureter procedures for neoplasm w/o CC/MCC,,,26118.31
Deidentified Minimum,,659,DRG,Kidney & ureter procedures for non-neoplasm w MCC,,,44075.79
Deidentified Minimum,,660,DRG,Kidney & ureter procedures for non-neoplasm w CC,,,23873.83
Deidentified Minimum,,661,DRG,Kidney & ureter procedures for non-neoplasm w/o CC/MCC,,,17605.17
Deidentified Minimum,,662,DRG,Minor bladder procedures w MCC,,,48458.89
Deidentified Minimum,,663,DRG,Minor bladder procedures w CC,,,26379.64
Deidentified Minimum,,664,DRG,Minor bladder procedures w/o CC/MCC,,,19586.66
Deidentified Minimum,,665,DRG,Prostatectomy w MCC,,,50227.01
Deidentified Minimum,,666,DRG,Prostatectomy w CC,,,28685.32
Deidentified Minimum,,667,DRG,Prostatectomy w/o CC/MCC,,,16455.64
Deidentified Minimum,,668,DRG,Transurethral procedures w MCC,,,45569.35
Deidentified Minimum,,669,DRG,Transurethral procedures w CC,,,25337.62
Deidentified Minimum,,670,DRG,Transurethral procedures w/o CC/MCC,,,16151.31
Deidentified Minimum,,671,DRG,Urethral procedures w CC/MCC,,,29386.61
Deidentified Minimum,,672,DRG,Urethral procedures w/o CC/MCC,,,19035.88
Deidentified Minimum,,673,DRG,Other kidney & urinary tract procedures w MCC,,,57279.67
Deidentified Minimum,,674,DRG,Other kidney & urinary tract procedures w CC,,,39371.81
Deidentified Minimum,,675,DRG,Other kidney & urinary tract procedures w/o CC/MCC,,,28978.08
Deidentified Minimum,,682,DRG,Renal failure w MCC,,,24317.10
Deidentified Minimum,,683,DRG,Renal failure w CC,,,14523.77
Deidentified Minimum,,684,DRG,Renal failure w/o CC/MCC,,,10048.05
Deidentified Minimum,,686,DRG,Kidney & urinary tract neoplasms w MCC,,,30982.72
Deidentified Minimum,,687,DRG,Kidney & urinary tract neoplasms w CC,,,17330.61
Deidentified Minimum,,688,DRG,Kidney & urinary tract neoplasms w/o CC/MCC,,,11334.86
Deidentified Minimum,,689,DRG,Kidney & urinary tract infections w MCC,,,18380.90
Deidentified Minimum,,690,DRG,Kidney & urinary tract infections w/o MCC,,,13102.98
Deidentified Minimum,,693,DRG,Urinary stones w/o esw lithotripsy w MCC,,,20985.95
Deidentified Minimum,,694,DRG,Urinary stones w/o esw lithotripsy w/o MCC,,,12062.62
Deidentified Minimum,,695,DRG,Kidney & urinary tract signs & symptoms w MCC,,,18794.40
Deidentified Minimum,,696,DRG,Kidney & urinary tract signs & symptoms w/o MCC,,,11407.63
Deidentified Minimum,,697,DRG,Urethral stricture,,,16490.38
Deidentified Minimum,,698,DRG,Other kidney & urinary tract diagnoses w MCC,,,26574.81
Deidentified Minimum,,699,DRG,Other kidney & urinary tract diagnoses w CC,,,16956.80
Deidentified Minimum,,700,DRG,Other kidney & urinary tract diagnoses w/o CC/MCC,,,12318.99
Deidentified Minimum,,707,DRG,Major male pelvic procedures w CC/MCC,,,31766.72
Deidentified Minimum,,708,DRG,Major male pelvic procedures w/o CC/MCC,,,24667.75
Deidentified Minimum,,709,DRG,Penis procedures w CC/MCC,,,38238.82
Deidentified Minimum,,710,DRG,Penis procedures w/o CC/MCC,,,26462.34
Deidentified Minimum,,711,DRG,Testes procedures w CC/MCC,,,35235.16
Deidentified Minimum,,712,DRG,Testes procedures w/o CC/MCC,,,17491.05
Deidentified Minimum,,713,DRG,Transurethral prostatectomy w CC/MCC,,,24671.06
Deidentified Minimum,,714,DRG,Transurethral prostatectomy w/o CC/MCC,,,15357.39
Deidentified Minimum,,715,DRG,Other male reproductive system O.R. proc for malignancy w CC/MCC,,,33392.60
Deidentified Minimum,,716,DRG,Other male reproductive system O.R. proc for malignancy w/o CC/MCC,,,21113.31
Deidentified Minimum,,717,DRG,Other male reproductive system O.R. proc exc malignancy w CC/MCC,,,29747.19
Deidentified Minimum,,718,DRG,Other male reproductive system O.R. proc exc malignancy w/o CC/MCC,,,20446.74
Deidentified Minimum,,722,DRG,Malignancy, male reproductive system w MCC,,,28266.86
Deidentified Minimum,,723,DRG,Malignancy, male reproductive system w CC,,,18013.71
Deidentified Minimum,,724,DRG,Malignancy, male reproductive system w/o CC/MCC,,,10741.07
Deidentified Minimum,,725,DRG,Benign prostatic hypertrophy w MCC,,,21202.62
Deidentified Minimum,,726,DRG,Benign prostatic hypertrophy w/o MCC,,,12294.18
Deidentified Minimum,,727,DRG,Inflammation of the male reproductive system w MCC,,,23455.37
Deidentified Minimum,,728,DRG,Inflammation of the male reproductive system w/o MCC,,,13289.89
Deidentified Minimum,,729,DRG,Other male reproductive system diagnoses w CC/MCC,,,16619.39
Deidentified Minimum,,730,DRG,Other male reproductive system diagnoses w/o CC/MCC,,,9356.67
Deidentified Minimum,,734,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC,,,36765.11
Deidentified Minimum,,735,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC,,,23379.29
Deidentified Minimum,,736,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w MCC,,,70430.62
Deidentified Minimum,,737,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w CC,,,34042.62
Deidentified Minimum,,738,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC,,,24422.96
Deidentified Minimum,,739,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w MCC,,,63210.91
Deidentified Minimum,,740,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w CC,,,29772.00
Deidentified Minimum,,741,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC,,,21162.93
Deidentified Minimum,,742,DRG,Uterine & adnexa proc for non-malignancy w CC/MCC,,,28399.18
Deidentified Minimum,,743,DRG,Uterine & adnexa proc for non-malignancy w/o CC/MCC,,,18728.24
Deidentified Minimum,,744,DRG,D&C, conization, laparascopy & tubal interruption w CC/MCC,,,29672.76
Deidentified Minimum,,745,DRG,D&C, conization, laparascopy & tubal interruption w/o CC/MCC,,,19360.07
Deidentified Minimum,,746,DRG,Vagina, cervix & vulva procedures w CC/MCC,,,26619.47
Deidentified Minimum,,747,DRG,Vagina, cervix & vulva procedures w/o CC/MCC,,,15514.52
Deidentified Minimum,,748,DRG,Female reproductive system reconstructive procedures,,,22300.88
Deidentified Minimum,,749,DRG,Other female reproductive system O.R. procedures w CC/MCC,,,44780.39
Deidentified Minimum,,750,DRG,Other female reproductive system O.R. procedures w/o CC/MCC,,,24245.98
Deidentified Minimum,,754,DRG,Malignancy, female reproductive system w MCC,,,30119.34
Deidentified Minimum,,755,DRG,Malignancy, female reproductive system w CC,,,18650.50
Deidentified Minimum,,756,DRG,Malignancy, female reproductive system w/o CC/MCC,,,15152.29
Deidentified Minimum,,757,DRG,Infections, female reproductive system w MCC,,,25175.53
Deidentified Minimum,,758,DRG,Infections, female reproductive system w CC,,,15994.18
Deidentified Minimum,,759,DRG,Infections, female reproductive system w/o CC/MCC,,,11300.12
Deidentified Minimum,,760,DRG,Menstrual & other female reproductive system disorders w CC/MCC,,,15259.80
Deidentified Minimum,,761,DRG,Menstrual & other female reproductive system disorders w/o CC/MCC,,,9758.60
Deidentified Minimum,,765,DRG,Cesarean section w CC/MCC,,,5500.00
Deidentified Minimum,,766,DRG,Cesarean section w/o CC/MCC,,,5500.00
Deidentified Minimum,,767,DRG,Vaginal delivery w sterilization &/or D&C,,,5500.00
Deidentified Minimum,,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,,4183.00
Deidentified Minimum,,769,DRG,Postpartum & post abortion diagnoses w O.R. procedure,,,26801.41
Deidentified Minimum,,770,DRG,Abortion w D&C, aspiration curettage or hysterotomy,,,14689.17
Deidentified Minimum,,774,DRG,Vaginal delivery w complicating diagnoses,,,5500.00
Deidentified Minimum,,775,DRG,Vaginal delivery w/o complicating diagnoses,,,5500.00
Deidentified Minimum,,776,DRG,Postpartum & post abortion diagnoses w/o O.R. procedure,,,12715.95
Deidentified Minimum,,779,DRG,Abortion w/o D&C,,,17208.21
Deidentified Minimum,,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,,3937.00
Deidentified Minimum,,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,,3937.00
Deidentified Minimum,,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,,3937.00
Deidentified Minimum,,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,,3937.00
Deidentified Minimum,,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,,3937.00
Deidentified Minimum,,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,,3937.00
Deidentified Minimum,,789,DRG,Neonates, died or transferred to another acute care facility,,,28423.99
Deidentified Minimum,,790,DRG,Extreme immaturity or respiratory distress syndrome, neonate,,,93733.83
Deidentified Minimum,,791,DRG,Prematurity w major problems,,,64016.41
Deidentified Minimum,,792,DRG,Prematurity w/o major problems,,,38625.86
Deidentified Minimum,,793,DRG,Full term neonate w major problems,,,65758.07
Deidentified Minimum,,794,DRG,Neonate w other significant problems,,,23275.08
Deidentified Minimum,,795,DRG,Normal newborn,,,3150.87
Deidentified Minimum,,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,,3937.00
Deidentified Minimum,,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,,3937.00
Deidentified Minimum,,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,,3937.00
Deidentified Minimum,,799,DRG,Splenectomy w MCC,,,85080.10
Deidentified Minimum,,800,DRG,Splenectomy w CC,,,48816.15
Deidentified Minimum,,801,DRG,Splenectomy w/o CC/MCC,,,27845.09
Deidentified Minimum,,802,DRG,Other O.R. proc of the blood & blood forming organs w MCC,,,61341.89
Deidentified Minimum,,803,DRG,Other O.R. proc of the blood & blood forming organs w CC,,,31174.59
Deidentified Minimum,,804,DRG,Other O.R. proc of the blood & blood forming organs w/o CC/MCC,,,22563.86
Deidentified Minimum,,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,,3937.00
Deidentified Minimum,,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,,3937.00
Deidentified Minimum,,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,,3937.00
Deidentified Minimum,,808,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w MCC,,,36022.46
Deidentified Minimum,,809,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w CC,,,20206.91
Deidentified Minimum,,810,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC,,,15889.97
Deidentified Minimum,,811,DRG,Red blood cell disorders w MCC,,,22785.50
Deidentified Minimum,,812,DRG,Red blood cell disorders w/o MCC,,,14550.23
Deidentified Minimum,,813,DRG,Coagulation disorders,,,25549.33
Deidentified Minimum,,814,DRG,Reticuloendothelial & immunity disorders w MCC,,,31273.83
Deidentified Minimum,,815,DRG,Reticuloendothelial & immunity disorders w CC,,,16415.95
Deidentified Minimum,,816,DRG,Reticuloendothelial & immunity disorders w/o CC/MCC,,,10931.28
Deidentified Minimum,,817,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC,,,38071.77
Deidentified Minimum,,818,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC,,,21774.91
Deidentified Minimum,,819,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC,,,16505.26
Deidentified Minimum,,820,DRG,Lymphoma & leukemia w major O.R. procedure w MCC,,,94067.94
Deidentified Minimum,,821,DRG,Lymphoma & leukemia w major O.R. procedure w CC,,,35645.35
Deidentified Minimum,,822,DRG,Lymphoma & leukemia w major O.R. procedure w/o CC/MCC,,,20701.46
Deidentified Minimum,,823,DRG,Lymphoma & non-acute leukemia w other O.R. proc w MCC,,,74382.03
Deidentified Minimum,,824,DRG,Lymphoma & non-acute leukemia w other O.R. proc w CC,,,39079.05
Deidentified Minimum,,825,DRG,Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC,,,23167.57
Deidentified Minimum,,826,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC,,,83308.67
Deidentified Minimum,,827,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC,,,41310.30
Deidentified Minimum,,828,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o CC/MCC,,,27749.15
Deidentified Minimum,,829,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC,,,53022.27
Deidentified Minimum,,830,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w/o CC/MCC,,,24421.31
Deidentified Minimum,,831,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC,,,18542.99
Deidentified Minimum,,832,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC,,,12897.89
Deidentified Minimum,,833,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC,,,8865.44
Deidentified Minimum,,834,DRG,Acute leukemia w/o major O.R. procedure w MCC,,,100068.65
Deidentified Minimum,,835,DRG,Acute leukemia w/o major O.R. procedure w CC,,,34960.59
Deidentified Minimum,,836,DRG,Acute leukemia w/o major O.R. procedure w/o CC/MCC,,,19345.18
Deidentified Minimum,,837,DRG,Chemo w acute leukemia as sdx or w high dose chemo agent w MCC,,,94264.76
Deidentified Minimum,,838,DRG,Chemo w acute leukemia as sdx w CC or high dose chemo agent,,,37360.55
Deidentified Minimum,,839,DRG,Chemo w acute leukemia as sdx w/o CC/MCC,,,24583.40
Deidentified Minimum,,840,DRG,Lymphoma & non-acute leukemia w MCC,,,53187.67
Deidentified Minimum,,841,DRG,Lymphoma & non-acute leukemia w CC,,,26808.03
Deidentified Minimum,,842,DRG,Lymphoma & non-acute leukemia w/o CC/MCC,,,18116.26
Deidentified Minimum,,843,DRG,Other myeloprolif dis or poorly diff neopl diag w MCC,,,31473.96
Deidentified Minimum,,844,DRG,Other myeloprolif dis or poorly diff neopl diag w CC,,,19525.47
Deidentified Minimum,,845,DRG,Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC,,,14015.99
Deidentified Minimum,,846,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w MCC,,,44160.14
Deidentified Minimum,,847,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w CC,,,22084.20
Deidentified Minimum,,848,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC,,,17019.66
Deidentified Minimum,,849,DRG,Radiotherapy,,,41143.25
Deidentified Minimum,,853,DRG,Infectious & parasitic diseases w O.R. procedure w MCC,,,81783.68
Deidentified Minimum,,854,DRG,Infectious & parasitic diseases w O.R. procedure w CC,,,34641.37
Deidentified Minimum,,855,DRG,Infectious & parasitic diseases w O.R. procedure w/o CC/MCC,,,24727.30
Deidentified Minimum,,856,DRG,Postoperative or post-traumatic infections w O.R. proc w MCC,,,75185.87
Deidentified Minimum,,857,DRG,Postoperative or post-traumatic infections w O.R. proc w CC,,,33653.93
Deidentified Minimum,,858,DRG,Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC,,,22302.53
Deidentified Minimum,,862,DRG,Postoperative & post-traumatic infections w MCC,,,31075.35
Deidentified Minimum,,863,DRG,Postoperative & post-traumatic infections w/o MCC,,,16166.19
Deidentified Minimum,,864,DRG,Fever of unknown origin,,,14472.50
Deidentified Minimum,,865,DRG,Viral illness w MCC,,,24461.00
Deidentified Minimum,,866,DRG,Viral illness w/o MCC,,,13847.28
Deidentified Minimum,,867,DRG,Other infectious & parasitic diseases diagnoses w MCC,,,36875.93
Deidentified Minimum,,868,DRG,Other infectious & parasitic diseases diagnoses w CC,,,17505.93
Deidentified Minimum,,869,DRG,Other infectious & parasitic diseases diagnoses w/o CC/MCC,,,12008.04
Deidentified Minimum,,870,DRG,Septicemia w MV 96+ hours,,,106266.19
Deidentified Minimum,,871,DRG,Septicemia w/o MV 96+ hours w MCC,,,30900.02
Deidentified Minimum,,872,DRG,Septicemia w/o MV 96+ hours w/o MCC,,,16897.26
Deidentified Minimum,,876,DRG,O.R. procedure w principal diagnoses of mental illness,,,53941.90
Deidentified Minimum,,880,DRG,Acute adjustment reaction & psychosocial dysfunction,,,14283.94
Deidentified Minimum,,881,DRG,Depressive neuroses,,,13255.15
Deidentified Minimum,,882,DRG,Neuroses except depressive,,,13612.42
Deidentified Minimum,,883,DRG,Disorders of personality & impulse control,,,26105.08
Deidentified Minimum,,884,DRG,Organic disturbances & mental retardation,,,23880.45
Deidentified Minimum,,885,DRG,Psychoses,,,20461.63
Deidentified Minimum,,886,DRG,Behavioral & developmental disorders,,,20203.61
Deidentified Minimum,,887,DRG,Other mental disorder diagnoses,,,17841.69
Deidentified Minimum,,894,DRG,Alcohol/drug abuse or dependence, left ama,,,9055.65
Deidentified Minimum,,895,DRG,Alcohol/drug abuse or dependence w rehabilitation therapy,,,26331.68
Deidentified Minimum,,896,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC,,,29391.58
Deidentified Minimum,,897,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC,,,13653.77
Deidentified Minimum,,901,DRG,Wound debridements for injuries w MCC,,,70496.78
Deidentified Minimum,,902,DRG,Wound debridements for injuries w CC,,,32458.09
Deidentified Minimum,,903,DRG,Wound debridements for injuries w/o CC/MCC,,,18762.97
Deidentified Minimum,,904,DRG,Skin grafts for injuries w CC/MCC,,,61551.95
Deidentified Minimum,,905,DRG,Skin grafts for injuries w/o CC/MCC,,,27157.02
Deidentified Minimum,,906,DRG,Hand procedures for injuries,,,29669.45
Deidentified Minimum,,907,DRG,Other O.R. procedures for injuries w MCC,,,65450.43
Deidentified Minimum,,908,DRG,Other O.R. procedures for injuries w CC,,,33748.21
Deidentified Minimum,,909,DRG,Other O.R. procedures for injuries w/o CC/MCC,,,22740.84
Deidentified Minimum,,913,DRG,Traumatic injury w MCC,,,27066.05
Deidentified Minimum,,914,DRG,Traumatic injury w/o MCC,,,14697.44
Deidentified Minimum,,915,DRG,Allergic reactions w MCC,,,28078.30
Deidentified Minimum,,916,DRG,Allergic reactions w/o MCC,,,10871.74
Deidentified Minimum,,917,DRG,Poisoning & toxic effects of drugs w MCC,,,24437.85
Deidentified Minimum,,918,DRG,Poisoning & toxic effects of drugs w/o MCC,,,13084.79
Deidentified Minimum,,919,DRG,Complications of treatment w MCC,,,30340.97
Deidentified Minimum,,920,DRG,Complications of treatment w CC,,,16991.54
Deidentified Minimum,,921,DRG,Complications of treatment w/o CC/MCC,,,11435.75
Deidentified Minimum,,922,DRG,Other injury, poisoning & toxic effect diag w MCC,,,26258.90
Deidentified Minimum,,923,DRG,Other injury, poisoning & toxic effect diag w/o MCC,,,15388.81
Deidentified Minimum,,927,DRG,Extensive burns or full thickness burns w MV 96+ hrs w skin graft,,,347851.08
Deidentified Minimum,,928,DRG,Full thickness burn w skin graft or inhal inj w CC/MCC,,,107825.91
Deidentified Minimum,,929,DRG,Full thickness burn w skin graft or inhal inj w/o CC/MCC,,,49767.20
Deidentified Minimum,,933,DRG,Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft,,,37340.70
Deidentified Minimum,,934,DRG,Full thickness burn w/o skin grft or inhal inj,,,32042.94
Deidentified Minimum,,935,DRG,Non-extensive burns,,,31976.78
Deidentified Minimum,,939,DRG,O.R. proc w diagnoses of other contact w health services w MCC,,,56007.74
Deidentified Minimum,,940,DRG,O.R. proc w diagnoses of other contact w health services w CC,,,36679.10
Deidentified Minimum,,941,DRG,O.R. proc w diagnoses of other contact w health services w/o CC/MCC,,,31834.53
Deidentified Minimum,,945,DRG,Rehabilitation w CC/MCC,,,24556.93
Deidentified Minimum,,946,DRG,Rehabilitation w/o CC/MCC,,,18643.88
Deidentified Minimum,,947,DRG,Signs & symptoms w MCC,,,19684.25
Deidentified Minimum,,948,DRG,Signs & symptoms w/o MCC,,,12993.82
Deidentified Minimum,,949,DRG,Aftercare w CC/MCC,,,18311.43
Deidentified Minimum,,950,DRG,Aftercare w/o CC/MCC,,,12221.40
Deidentified Minimum,,951,DRG,Other factors influencing health status,,,9232.62
Deidentified Minimum,,955,DRG,Craniotomy for multiple significant trauma,,,104003.52
Deidentified Minimum,,956,DRG,Limb reattachment, hip & femur proc for multiple significant trauma,,,63659.15
Deidentified Minimum,,957,DRG,Other O.R. procedures for multiple significant trauma w MCC,,,122740.03
Deidentified Minimum,,958,DRG,Other O.R. procedures for multiple significant trauma w CC,,,69557.31
Deidentified Minimum,,959,DRG,Other O.R. procedures for multiple significant trauma w/o CC/MCC,,,45223.66
Deidentified Minimum,,963,DRG,Other multiple significant trauma w MCC,,,45058.26
Deidentified Minimum,,964,DRG,Other multiple significant trauma w CC,,,24618.13
Deidentified Minimum,,965,DRG,Other multiple significant trauma w/o CC/MCC,,,15099.36
Deidentified Minimum,,969,DRG,HIV w extensive O.R. procedure w MCC,,,95723.59
Deidentified Minimum,,970,DRG,HIV w extensive O.R. procedure w/o MCC,,,48711.95
Deidentified Minimum,,974,DRG,HIV w major related condition w MCC,,,44421.47
Deidentified Minimum,,975,DRG,HIV w major related condition w CC,,,21156.31
Deidentified Minimum,,976,DRG,HIV w major related condition w/o CC/MCC,,,15698.11
Deidentified Minimum,,977,DRG,HIV w or w/o other related condition,,,21846.03
Deidentified Minimum,,981,DRG,Extensive O.R. procedure unrelated to principal diagnosis w MCC,,,76213.01
Deidentified Minimum,,982,DRG,Extensive O.R. procedure unrelated to principal diagnosis w CC,,,42034.75
Deidentified Minimum,,983,DRG,Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC,,,27370.39
Deidentified Minimum,,987,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w MCC,,,53955.13
Deidentified Minimum,,988,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w CC,,,27798.77
Deidentified Minimum,,989,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC,,,18456.98
Deidentified Maximum,,1,DRG,Heart transplant or implant of heart assist system w MCC,,,738612.60
Deidentified Maximum,,2,DRG,Heart transplant or implant of heart assist system w/o MCC,,,406240.50
Deidentified Maximum,,3,DRG,ECMO or trach w MV 96+ hrs or PDX exc face, mouth & neck w maj O.R.,,,484275.60
Deidentified Maximum,,4,DRG,Trach w MV 96+ hrs or PDX exc face, mouth & neck w/o maj O.R.,,,302481.00
Deidentified Maximum,,5,DRG,Liver transplant w MCC or intestinal transplant,,,260694.15
Deidentified Maximum,,6,DRG,Liver transplant w/o MCC,,,119638.35
Deidentified Maximum,,7,DRG,Lung transplant,,,295144.65
Deidentified Maximum,,8,DRG,Simultaneous pancreas/kidney transplant,,,138383.40
Deidentified Maximum,,10,DRG,Pancreas transplant,,,92251.35
Deidentified Maximum,,11,DRG,Tracheostomy for face,mouth & neck diagnoses w MCC,,,127918.20
Deidentified Maximum,,12,DRG,Tracheostomy for face,mouth & neck diagnoses w CC,,,97713.45
Deidentified Maximum,,13,DRG,Tracheostomy for face,mouth & neck diagnoses w/o CC/MCC,,,69372.75
Deidentified Maximum,,14,DRG,Allogeneic bone marrow transplant,,,325859.40
Deidentified Maximum,,16,DRG,Autologous bone marrow transplant w CC/MCC,,,171518.10
Deidentified Maximum,,17,DRG,Autologous bone marrow transplant w/o CC/MCC,,,123170.10
Deidentified Maximum,,18,DRG,CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL IMMUNOTHERAPY,,,951889.50
Deidentified Maximum,,19,DRG,SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,,,169878.45
Deidentified Maximum,,20,DRG,Intracranial vascular procedures w PDX hemorrhage w MCC,,,263162.55
Deidentified Maximum,,21,DRG,Intracranial vascular procedures w PDX hemorrhage w CC,,,192055.80
Deidentified Maximum,,22,DRG,Intracranial vascular procedures w PDX hemorrhage w/o CC/MCC,,,123919.80
Deidentified Maximum,,23,DRG,Cranio w major dev impl/acute complex CNS PDX w MCC or chemo implant,,,144388.65
Deidentified Maximum,,24,DRG,Cranio w major dev impl/acute complex CNS PDX w/o MCC,,,100278.75
Deidentified Maximum,,25,DRG,Craniotomy & endovascular intracranial procedures w MCC,,,114538.35
Deidentified Maximum,,26,DRG,Craniotomy & endovascular intracranial procedures w CC,,,77979.00
Deidentified Maximum,,27,DRG,Craniotomy & endovascular intracranial procedures w/o CC/MCC,,,64050.90
Deidentified Maximum,,28,DRG,Spinal procedures w MCC,,,96262.80
Deidentified Maximum,,29,DRG,Spinal procedures w CC or spinal neurostimulators,,,54499.30
Deidentified Maximum,,30,DRG,Spinal procedures w/o CC/MCC,,,38986.43
Deidentified Maximum,,31,DRG,Ventricular shunt procedures w MCC,,,111335.55
Deidentified Maximum,,32,DRG,Ventricular shunt procedures w CC,,,56411.10
Deidentified Maximum,,33,DRG,Ventricular shunt procedures w/o CC/MCC,,,43877.85
Deidentified Maximum,,34,DRG,Carotid artery stent procedure w MCC,,,101352.30
Deidentified Maximum,,35,DRG,Carotid artery stent procedure w CC,,,59596.05
Deidentified Maximum,,36,DRG,Carotid artery stent procedure w/o CC/MCC,,,47205.60
Deidentified Maximum,,37,DRG,Extracranial procedures w MCC,,,83504.85
Deidentified Maximum,,38,DRG,Extracranial procedures w CC,,,42261.15
Deidentified Maximum,,39,DRG,Extracranial procedures w/o CC/MCC,,,29044.50
Deidentified Maximum,,40,DRG,Periph/cranial nerve & other nerv syst proc w MCC,,,100923.90
Deidentified Maximum,,41,DRG,Periph/cranial nerve & other nerv syst proc w CC or periph neurostim,,,59945.40
Deidentified Maximum,,42,DRG,Periph/cranial nerve & other nerv syst proc w/o CC/MCC,,,48064.95
Deidentified Maximum,,52,DRG,Spinal disorders & injuries w CC/MCC,,,47050.05
Deidentified Maximum,,53,DRG,Spinal disorders & injuries w/o CC/MCC,,,28970.55
Deidentified Maximum,,54,DRG,Nervous system neoplasms w MCC,,,34827.90
Deidentified Maximum,,55,DRG,Nervous system neoplasms w/o MCC,,,26606.70
Deidentified Maximum,,56,DRG,Degenerative nervous system disorders w MCC,,,55776.15
Deidentified Maximum,,57,DRG,Degenerative nervous system disorders w/o MCC,,,32237.10
Deidentified Maximum,,58,DRG,Multiple sclerosis & cerebellar ataxia w MCC,,,44285.85
Deidentified Maximum,,59,DRG,Multiple sclerosis & cerebellar ataxia w CC,,,28725.75
Deidentified Maximum,,60,DRG,Multiple sclerosis & cerebellar ataxia w/o CC/MCC,,,23347.80
Deidentified Maximum,,61,DRG,Acute ischemic stroke w use of thrombolytic agent w MCC,,,73649.10
Deidentified Maximum,,62,DRG,Acute ischemic stroke w use of thrombolytic agent w CC,,,50673.60
Deidentified Maximum,,63,DRG,Acute ischemic stroke w use of thrombolytic agent w/o CC/MCC,,,43602.45
Deidentified Maximum,,64,DRG,Intracranial hemorrhage or cerebral infarction w MCC,,,48781.50
Deidentified Maximum,,65,DRG,Intracranial hemorrhage or cerebral infarction w CC,,,25964.10
Deidentified Maximum,,66,DRG,Intracranial hemorrhage or cerebral infarction w/o CC/MCC,,,18127.95
Deidentified Maximum,,67,DRG,Nonspecific cva & precerebral occlusion w/o infarct w MCC,,,36327.30
Deidentified Maximum,,68,DRG,Nonspecific cva & precerebral occlusion w/o infarct w/o MCC,,,22659.30
Deidentified Maximum,,69,DRG,Transient ischemia,,,20045.55
Deidentified Maximum,,70,DRG,Nonspecific cerebrovascular disorders w MCC,,,42748.20
Deidentified Maximum,,71,DRG,Nonspecific cerebrovascular disorders w CC,,,25775.40
Deidentified Maximum,,72,DRG,Nonspecific cerebrovascular disorders w/o CC/MCC,,,19665.60
Deidentified Maximum,,73,DRG,Cranial & peripheral nerve disorders w MCC,,,36959.70
Deidentified Maximum,,74,DRG,Cranial & peripheral nerve disorders w/o MCC,,,25969.20
Deidentified Maximum,,75,DRG,Viral meningitis w CC/MCC,,,41463.00
Deidentified Maximum,,76,DRG,Viral meningitis w/o CC/MCC,,,25012.95
Deidentified Maximum,,77,DRG,Hypertensive encephalopathy w MCC,,,39063.45
Deidentified Maximum,,78,DRG,Hypertensive encephalopathy w CC,,,24199.50
Deidentified Maximum,,79,DRG,Hypertensive encephalopathy w/o CC/MCC,,,18533.40
Deidentified Maximum,,80,DRG,Nontraumatic stupor & coma w MCC,,,53346.00
Deidentified Maximum,,81,DRG,Nontraumatic stupor & coma w/o MCC,,,19686.00
Deidentified Maximum,,82,DRG,Traumatic stupor & coma, coma >1 hr w MCC,,,57581.55
Deidentified Maximum,,83,DRG,Traumatic stupor & coma, coma >1 hr w CC,,,34213.35
Deidentified Maximum,,84,DRG,Traumatic stupor & coma, coma >1 hr w/o CC/MCC,,,23057.10
Deidentified Maximum,,85,DRG,Traumatic stupor & coma, coma <1 hr w MCC,,,58813.20
Deidentified Maximum,,86,DRG,Traumatic stupor & coma, coma <1 hr w CC,,,32458.95
Deidentified Maximum,,87,DRG,Traumatic stupor & coma, coma <1 hr w/o CC/MCC,,,21996.30
Deidentified Maximum,,88,DRG,Concussion w MCC,,,37212.15
Deidentified Maximum,,89,DRG,Concussion w CC,,,27060.60
Deidentified Maximum,,90,DRG,Concussion w/o CC/MCC,,,21797.40
Deidentified Maximum,,91,DRG,Other disorders of nervous system w MCC,,,42046.95
Deidentified Maximum,,92,DRG,Other disorders of nervous system w CC,,,25145.55
Deidentified Maximum,,93,DRG,Other disorders of nervous system w/o CC/MCC,,,19923.15
Deidentified Maximum,,94,DRG,Bacterial & tuberculous infections of nervous system w MCC,,,92644.05
Deidentified Maximum,,95,DRG,Bacterial & tuberculous infections of nervous system w CC,,,63954.00
Deidentified Maximum,,96,DRG,Bacterial & tuberculous infections of nervous system w/o CC/MCC,,,59453.25
Deidentified Maximum,,97,DRG,Non-bacterial infect of nervous sys exc viral meningitis w MCC,,,95691.30
Deidentified Maximum,,98,DRG,Non-bacterial infect of nervous sys exc viral meningitis w CC,,,53827.95
Deidentified Maximum,,99,DRG,Non-bacterial infect of nervous sys exc viral meningitis w/o CC/MCC,,,35631.15
Deidentified Maximum,,100,DRG,Seizures w MCC,,,47776.80
Deidentified Maximum,,101,DRG,Seizures w/o MCC,,,22618.50
Deidentified Maximum,,102,DRG,Headaches w MCC,,,29368.35
Deidentified Maximum,,103,DRG,Headaches w/o MCC,,,21119.10
Deidentified Maximum,,113,DRG,Orbital procedures w CC/MCC,,,55890.90
Deidentified Maximum,,114,DRG,Orbital procedures w/o CC/MCC,,,36860.25
Deidentified Maximum,,115,DRG,Extraocular procedures except orbit,,,37059.15
Deidentified Maximum,,116,DRG,Intraocular procedures w CC/MCC,,,47868.60
Deidentified Maximum,,117,DRG,Intraocular procedures w/o CC/MCC,,,26491.95
Deidentified Maximum,,121,DRG,Acute major eye infections w CC/MCC,,,30311.85
Deidentified Maximum,,122,DRG,Acute major eye infections w/o CC/MCC,,,16416.90
Deidentified Maximum,,123,DRG,Neurological eye disorders,,,19515.15
Deidentified Maximum,,124,DRG,Other disorders of the eye w MCC,,,35669.40
Deidentified Maximum,,125,DRG,Other disorders of the eye w/o MCC,,,21302.70
Deidentified Maximum,,135,DRG,Sinus & mastoid procedures w CC/MCC,,,54585.30
Deidentified Maximum,,136,DRG,Sinus & mastoid procedures w/o CC/MCC,,,32015.25
Deidentified Maximum,,137,DRG,Mouth procedures w CC/MCC,,,37449.30
Deidentified Maximum,,138,DRG,Mouth procedures w/o CC/MCC,,,21499.05
Deidentified Maximum,,139,DRG,Salivary gland procedures,,,31283.40
Deidentified Maximum,,140,DRG,MAJOR HEAD AND NECK PROCEDURES WITH MCC,,,101505.30
Deidentified Maximum,,141,DRG,MAJOR HEAD AND NECK PROCEDURES WITH CC,,,56291.25
Deidentified Maximum,,142,DRG,MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,,,41024.40
Deidentified Maximum,,143,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC,,,75576.90
Deidentified Maximum,,144,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC,,,44637.75
Deidentified Maximum,,145,DRG,OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC,,,30944.25
Deidentified Maximum,,146,DRG,Ear, nose, mouth & throat malignancy w MCC,,,51844.05
Deidentified Maximum,,147,DRG,Ear, nose, mouth & throat malignancy w CC,,,33178.05
Deidentified Maximum,,148,DRG,Ear, nose, mouth & throat malignancy w/o CC/MCC,,,20050.65
Deidentified Maximum,,149,DRG,Dysequilibrium,,,18755.25
Deidentified Maximum,,150,DRG,Epistaxis w MCC,,,33779.85
Deidentified Maximum,,151,DRG,Epistaxis w/o MCC,,,18793.50
Deidentified Maximum,,152,DRG,Otitis media & URI w MCC,,,27460.95
Deidentified Maximum,,153,DRG,Otitis media & URI w/o MCC,,,18120.30
Deidentified Maximum,,154,DRG,Nasal trauma & deformity w MCC,,,39333.75
Deidentified Maximum,,155,DRG,Nasal trauma & deformity w CC,,,23123.40
Deidentified Maximum,,156,DRG,Nasal trauma & deformity w/o CC/MCC,,,16768.80
Deidentified Maximum,,157,DRG,Dental & Oral Diseases w MCC,,,40096.20
Deidentified Maximum,,158,DRG,Dental & Oral Diseases w CC,,,22672.05
Deidentified Maximum,,159,DRG,Dental & Oral Diseases w/o CC/MCC,,,16722.90
Deidentified Maximum,,163,DRG,Major chest procedures w MCC,,,126469.80
Deidentified Maximum,,164,DRG,Major chest procedures w CC,,,67212.90
Deidentified Maximum,,165,DRG,Major chest procedures w/o CC/MCC,,,48669.30
Deidentified Maximum,,166,DRG,Other resp system O.R. procedures w MCC,,,96637.35
Deidentified Maximum,,167,DRG,Other resp system O.R. procedures w CC,,,47455.50
Deidentified Maximum,,168,DRG,Other resp system O.R. procedures w/o CC/MCC,,,34919.70
Deidentified Maximum,,175,DRG,Pulmonary embolism w MCC,,,39377.10
Deidentified Maximum,,176,DRG,Pulmonary embolism w/o MCC,,,22610.85
Deidentified Maximum,,177,DRG,Respiratory infections & inflammations w MCC,,,47055.15
Deidentified Maximum,,178,DRG,Respiratory infections & inflammations w CC,,,30750.45
Deidentified Maximum,,179,DRG,Respiratory infections & inflammations w/o CC/MCC,,,22213.05
Deidentified Maximum,,180,DRG,Respiratory neoplasms w MCC,,,44313.90
Deidentified Maximum,,181,DRG,Respiratory neoplasms w CC,,,28582.95
Deidentified Maximum,,182,DRG,Respiratory neoplasms w/o CC/MCC,,,20081.25
Deidentified Maximum,,183,DRG,Major chest trauma w MCC,,,39667.80
Deidentified Maximum,,184,DRG,Major chest trauma w CC,,,26504.70
Deidentified Maximum,,185,DRG,Major chest trauma w/o CC/MCC,,,19726.80
Deidentified Maximum,,186,DRG,Pleural effusion w MCC,,,39351.60
Deidentified Maximum,,187,DRG,Pleural effusion w CC,,,26321.10
Deidentified Maximum,,188,DRG,Pleural effusion w/o CC/MCC,,,18566.55
Deidentified Maximum,,189,DRG,Pulmonary edema & respiratory failure,,,31232.40
Deidentified Maximum,,190,DRG,Chronic obstructive pulmonary disease w MCC,,,28659.45
Deidentified Maximum,,191,DRG,Chronic obstructive pulmonary disease w CC,,,22519.05
Deidentified Maximum,,192,DRG,Chronic obstructive pulmonary disease w/o CC/MCC,,,17719.95
Deidentified Maximum,,193,DRG,Simple pneumonia & pleurisy w MCC,,,33422.85
Deidentified Maximum,,194,DRG,Simple pneumonia & pleurisy w CC,,,22006.50
Deidentified Maximum,,195,DRG,Simple pneumonia & pleurisy w/o CC/MCC,,,16957.50
Deidentified Maximum,,196,DRG,Interstitial lung disease w MCC,,,44270.55
Deidentified Maximum,,197,DRG,Interstitial lung disease w CC,,,25642.80
Deidentified Maximum,,198,DRG,Interstitial lung disease w/o CC/MCC,,,18928.65
Deidentified Maximum,,199,DRG,Pneumothorax w MCC,,,45583.80
Deidentified Maximum,,200,DRG,Pneumothorax w CC,,,27412.50
Deidentified Maximum,,201,DRG,Pneumothorax w/o CC/MCC,,,18092.25
Deidentified Maximum,,202,DRG,Bronchitis & asthma w CC/MCC,,,24622.80
Deidentified Maximum,,203,DRG,Bronchitis & asthma w/o CC/MCC,,,17990.25
Deidentified Maximum,,204,DRG,Respiratory signs & symptoms,,,20208.75
Deidentified Maximum,,205,DRG,Other respiratory system diagnoses w MCC,,,42898.65
Deidentified Maximum,,206,DRG,Other respiratory system diagnoses w/o MCC,,,22547.10
Deidentified Maximum,,207,DRG,Respiratory system diagnosis w ventilator support 96+ hours,,,146023.20
Deidentified Maximum,,208,DRG,Respiratory system diagnosis w ventilator support <96 hours,,,64828.65
Deidentified Maximum,,215,DRG,Other heart assist system implant,,,284526.45
Deidentified Maximum,,216,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w MCC,,,172513.85
Deidentified Maximum,,217,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w CC,,,167364.00
Deidentified Maximum,,218,DRG,Cardiac valve & oth maj cardiothoracic proc w card cath w/o CC/MCC,,,100934.00
Deidentified Maximum,,219,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w MCC,,,133231.35
Deidentified Maximum,,220,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w CC,,,89314.34
Deidentified Maximum,,221,DRG,Cardiac valve & oth maj cardiothoracic proc w/o card cath w/o CC/MCC,,,77197.00
Deidentified Maximum,,222,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w MCC,,,139284.99
Deidentified Maximum,,223,DRG,Cardiac defib implant w cardiac cath w AMI/HF/shock w/o MCC,,,102748.13
Deidentified Maximum,,224,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w MCC,,,121770.78
Deidentified Maximum,,225,DRG,Cardiac defib implant w cardiac cath w/o AMI/HF/shock w/o MCC,,,93067.27
Deidentified Maximum,,226,DRG,Cardiac defibrillator implant w/o cardiac cath w MCC,,,130522.00
Deidentified Maximum,,227,DRG,Cardiac defibrillator implant w/o cardiac cath w/o MCC,,,111289.00
Deidentified Maximum,,228,DRG,Other cardiothoracic procedures w MCC,,,102801.06
Deidentified Maximum,,229,DRG,Other cardiothoracic procedures w CC,,,65961.52
Deidentified Maximum,,230,DRG,Other cardiothoracic procedures w/o CC/MCC,,,54537.00
Deidentified Maximum,,231,DRG,Coronary bypass w PTCA w MCC,,,140427.90
Deidentified Maximum,,232,DRG,Coronary bypass w PTCA w/o MCC,,,97557.88
Deidentified Maximum,,233,DRG,Coronary bypass w cardiac cath w MCC,,,142385.00
Deidentified Maximum,,234,DRG,Coronary bypass w cardiac cath w/o MCC,,,108650.00
Deidentified Maximum,,235,DRG,Coronary bypass w/o cardiac cath w MCC,,,99739.50
Deidentified Maximum,,236,DRG,Coronary bypass w/o cardiac cath w/o MCC,,,82356.00
Deidentified Maximum,,237,DRG,Major cardiovasc procedures w MCC or thoracic aortic anuerysm repair,,,54537.00
Deidentified Maximum,,238,DRG,Major cardiovasc procedures w/o MCC,,,54537.00
Deidentified Maximum,,239,DRG,Amputation for circ sys disorders exc upper limb & toe w MCC,,,122621.85
Deidentified Maximum,,240,DRG,Amputation for circ sys disorders exc upper limb & toe w CC,,,71145.00
Deidentified Maximum,,241,DRG,Amputation for circ sys disorders exc upper limb & toe w/o CC/MCC,,,40580.70
Deidentified Maximum,,242,DRG,Permanent cardiac pacemaker implant w MCC,,,61570.15
Deidentified Maximum,,243,DRG,Permanent cardiac pacemaker implant w CC,,,41889.20
Deidentified Maximum,,244,DRG,Permanent cardiac pacemaker implant w/o CC/MCC,,,34166.67
Deidentified Maximum,,245,DRG,AICD lead & generator procedures,,,138057.00
Deidentified Maximum,,246,DRG,Perc cardiovasc proc w drug-eluting stent w MCC or 4+ vessels/stents,,,51699.07
Deidentified Maximum,,247,DRG,Perc cardiovasc proc w drug-eluting stent w/o MCC,,,32884.82
Deidentified Maximum,,248,DRG,Perc cardiovasc proc w non-drug-eluting stent w MCC or 4+ ves/stents,,,52496.30
Deidentified Maximum,,249,DRG,Perc cardiovasc proc w non-drug-eluting stent w/o MCC,,,31083.62
Deidentified Maximum,,250,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w MCC,,,41727.11
Deidentified Maximum,,251,DRG,Perc cardiovasc proc w/o coronary artery stent or AMI w/o MCC,,,27453.09
Deidentified Maximum,,252,DRG,Other vascular procedures w MCC,,,84677.85
Deidentified Maximum,,253,DRG,Other vascular procedures w CC,,,67669.35
Deidentified Maximum,,254,DRG,Other vascular procedures w/o CC/MCC,,,54537.00
Deidentified Maximum,,255,DRG,Upper limb & toe amputation for circ system disorders w MCC,,,64846.50
Deidentified Maximum,,256,DRG,Upper limb & toe amputation for circ system disorders w CC,,,41899.05
Deidentified Maximum,,257,DRG,Upper limb & toe amputation for circ system disorders w/o CC/MCC,,,29605.50
Deidentified Maximum,,258,DRG,Cardiac pacemaker device replacement w MCC,,,52949.50
Deidentified Maximum,,259,DRG,Cardiac pacemaker device replacement w/o MCC,,,35068.10
Deidentified Maximum,,260,DRG,Cardiac pacemaker revision except device replacement w MCC,,,59282.66
Deidentified Maximum,,261,DRG,Cardiac pacemaker revision except device replacement w CC,,,32936.10
Deidentified Maximum,,262,DRG,Cardiac pacemaker revision except device replacement w/o CC/MCC,,,28251.97
Deidentified Maximum,,263,DRG,Vein ligation & stripping,,,58785.15
Deidentified Maximum,,264,DRG,Other circulatory system O.R. procedures,,,82818.90
Deidentified Maximum,,265,DRG,AICD lead procedures,,,85748.85
Deidentified Maximum,,266,DRG,Endovascular Cardiac Valve Replacement w MCC,,,180978.60
Deidentified Maximum,,267,DRG,Endovascular Cardiac Valve Replacement w/o MCC,,,142822.95
Deidentified Maximum,,268,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w MCC,,,177342.30
Deidentified Maximum,,269,DRG,Aortic And Heart Assist Procedures Except Pulsation Balloon w/o MCC,,,110022.30
Deidentified Maximum,,270,DRG,Other Major Cardiovascular Procedures w MCC,,,132130.80
Deidentified Maximum,,271,DRG,Other Major Cardiovascular Procedures w CC,,,90897.30
Deidentified Maximum,,272,DRG,Other Major Cardiovascular Procedures w/o CC/MCC,,,68564.40
Deidentified Maximum,,273,DRG,Percutaneous Intracardiac Procedures w MCC,,,97848.60
Deidentified Maximum,,274,DRG,Percutaneous Intracardiac Procedures w/o MCC,,,83777.70
Deidentified Maximum,,280,DRG,Acute myocardial infarction, discharged alive w MCC,,,41468.10
Deidentified Maximum,,281,DRG,Acute myocardial infarction, discharged alive w CC,,,19316.00
Deidentified Maximum,,282,DRG,Acute myocardia infarction, discharged alive w/o CC/MCC,,,15627.00
Deidentified Maximum,,283,DRG,Acute myocardial infarction, expired w MCC,,,47547.30
Deidentified Maximum,,284,DRG,Acute myocardial infarction, expired w CC,,,18722.10
Deidentified Maximum,,285,DRG,Acute myocardial infarction, expired w/o CC/MCC,,,12658.20
Deidentified Maximum,,286,DRG,Circulatory disorders except AMI, w card cath w MCC,,,36621.21
Deidentified Maximum,,287,DRG,Circulatory disorders except AMI, w card cath w/o MCC,,,19021.00
Deidentified Maximum,,288,DRG,Acute & subacute endocarditis w MCC,,,68365.50
Deidentified Maximum,,289,DRG,Acute & subacute endocarditis w CC,,,41886.30
Deidentified Maximum,,290,DRG,Acute & subacute endocarditis w/o CC/MCC,,,26101.80
Deidentified Maximum,,291,DRG,Heart failure & shock w MCC,,,34192.95
Deidentified Maximum,,292,DRG,Heart failure & shock w CC,,,22825.05
Deidentified Maximum,,293,DRG,Heart failure & shock w/o CC/MCC,,,16641.30
Deidentified Maximum,,294,DRG,Deep vein thrombophlebitis w CC/MCC,,,32693.55
Deidentified Maximum,,295,DRG,Deep vein thrombophlebitis w/o CC/MCC,,,25023.15
Deidentified Maximum,,296,DRG,Cardiac arrest, unexplained w MCC,,,40667.40
Deidentified Maximum,,297,DRG,Cardiac arrest, unexplained w CC,,,17967.30
Deidentified Maximum,,298,DRG,Cardiac arrest, unexplained w/o CC/MCC,,,12449.10
Deidentified Maximum,,299,DRG,Peripheral vascular disorders w MCC,,,39050.70
Deidentified Maximum,,300,DRG,Peripheral vascular disorders w CC,,,26576.10
Deidentified Maximum,,301,DRG,Peripheral vascular disorders w/o CC/MCC,,,18933.75
Deidentified Maximum,,302,DRG,Atherosclerosis w MCC,,,27884.25
Deidentified Maximum,,303,DRG,Atherosclerosis w/o MCC,,,17248.20
Deidentified Maximum,,304,DRG,Hypertension w MCC,,,27937.80
Deidentified Maximum,,305,DRG,Hypertension w/o MCC,,,18831.75
Deidentified Maximum,,306,DRG,Cardiac congenital & valvular disorders w MCC,,,38344.35
Deidentified Maximum,,307,DRG,Cardiac congenital & valvular disorders w/o MCC,,,22144.20
Deidentified Maximum,,308,DRG,Cardiac arrhythmia & conduction disorders w MCC,,,30582.15
Deidentified Maximum,,309,DRG,Cardiac arrhythmia & conduction disorders w CC,,,19109.70
Deidentified Maximum,,310,DRG,Cardiac arrhythmia & conduction disorders w/o CC/MCC,,,14239.20
Deidentified Maximum,,311,DRG,Angina pectoris,,,17773.50
Deidentified Maximum,,312,DRG,Syncope & collapse,,,21348.60
Deidentified Maximum,,313,DRG,Chest pain,,,18380.40
Deidentified Maximum,,314,DRG,Other circulatory system diagnoses w MCC,,,53126.70
Deidentified Maximum,,315,DRG,Other circulatory system diagnoses w CC,,,24867.60
Deidentified Maximum,,316,DRG,Other circulatory system diagnoses w/o CC/MCC,,,19112.25
Deidentified Maximum,,319,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W MCC,,,110052.90
Deidentified Maximum,,320,DRG,OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES W/O MCC,,,62314.35
Deidentified Maximum,,326,DRG,Stomach, esophageal & duodenal proc w MCC,,,137131.35
Deidentified Maximum,,327,DRG,Stomach, esophageal & duodenal proc w CC,,,66544.80
Deidentified Maximum,,328,DRG,Stomach, esophageal & duodenal proc w/o CC/MCC,,,42470.25
Deidentified Maximum,,329,DRG,Major small & large bowel procedures w MCC,,,123682.65
Deidentified Maximum,,330,DRG,Major small & large bowel procedures w CC,,,64744.50
Deidentified Maximum,,331,DRG,Major small & large bowel procedures w/o CC/MCC,,,43607.55
Deidentified Maximum,,332,DRG,Rectal resection w MCC,,,106072.35
Deidentified Maximum,,333,DRG,Rectal resection w CC,,,54595.50
Deidentified Maximum,,334,DRG,Rectal resection w/o CC/MCC,,,41034.60
Deidentified Maximum,,335,DRG,Peritoneal adhesiolysis w MCC,,,99205.20
Deidentified Maximum,,336,DRG,Peritoneal adhesiolysis w CC,,,58213.95
Deidentified Maximum,,337,DRG,Peritoneal adhesiolysis w/o CC/MCC,,,41631.30
Deidentified Maximum,,338,DRG,Appendectomy w complicated principal diag w MCC,,,71369.40
Deidentified Maximum,,339,DRG,Appendectomy w complicated principal diag w CC,,,43222.50
Deidentified Maximum,,340,DRG,Appendectomy w complicated principal diag w/o CC/MCC,,,31324.20
Deidentified Maximum,,341,DRG,Appendectomy w/o complicated principal diag w MCC,,,59063.10
Deidentified Maximum,,342,DRG,Appendectomy w/o complicated principal diag w CC,,,36544.05
Deidentified Maximum,,343,DRG,Appendectomy w/o complicated principal diag w/o CC/MCC,,,28289.70
Deidentified Maximum,,344,DRG,Minor small & large bowel procedures w MCC,,,71422.95
Deidentified Maximum,,345,DRG,Minor small & large bowel procedures w CC,,,40231.35
Deidentified Maximum,,346,DRG,Minor small & large bowel procedures w/o CC/MCC,,,32512.50
Deidentified Maximum,,347,DRG,Anal & stomal procedures w MCC,,,62770.80
Deidentified Maximum,,348,DRG,Anal & stomal procedures w CC,,,34231.20
Deidentified Maximum,,349,DRG,Anal & stomal procedures w/o CC/MCC,,,24972.15
Deidentified Maximum,,350,DRG,Inguinal & femoral hernia procedures w MCC,,,62536.20
Deidentified Maximum,,351,DRG,Inguinal & femoral hernia procedures w CC,,,38005.20
Deidentified Maximum,,352,DRG,Inguinal & femoral hernia procedures w/o CC/MCC,,,28126.50
Deidentified Maximum,,353,DRG,Hernia procedures except inguinal & femoral w MCC,,,76711.65
Deidentified Maximum,,354,DRG,Hernia procedures except inguinal & femoral w CC,,,45466.50
Deidentified Maximum,,355,DRG,Hernia procedures except inguinal & femoral w/o CC/MCC,,,34659.60
Deidentified Maximum,,356,DRG,Other digestive system O.R. procedures w MCC,,,109430.70
Deidentified Maximum,,357,DRG,Other digestive system O.R. procedures w CC,,,57469.35
Deidentified Maximum,,358,DRG,Other digestive system O.R. procedures w/o CC/MCC,,,34144.50
Deidentified Maximum,,368,DRG,Major esophageal disorders w MCC,,,49528.65
Deidentified Maximum,,369,DRG,Major esophageal disorders w CC,,,27458.40
Deidentified Maximum,,370,DRG,Major esophageal disorders w/o CC/MCC,,,19063.80
Deidentified Maximum,,371,DRG,Major gastrointestinal disorders & peritoneal infections w MCC,,,44071.65
Deidentified Maximum,,372,DRG,Major gastrointestinal disorders & peritoneal infections w CC,,,26203.80
Deidentified Maximum,,373,DRG,Major gastrointestinal disorders & peritoneal infections w/o CC/MCC,,,18959.25
Deidentified Maximum,,374,DRG,Digestive malignancy w MCC,,,52731.45
Deidentified Maximum,,375,DRG,Digestive malignancy w CC,,,30724.95
Deidentified Maximum,,376,DRG,Digestive malignancy w/o CC/MCC,,,22827.60
Deidentified Maximum,,377,DRG,G.I. hemorrhage w MCC,,,45871.95
Deidentified Maximum,,378,DRG,G.I. hemorrhage w CC,,,25326.60
Deidentified Maximum,,379,DRG,G.I. hemorrhage w/o CC/MCC,,,16246.05
Deidentified Maximum,,380,DRG,Complicated peptic ulcer w MCC,,,48019.05
Deidentified Maximum,,381,DRG,Complicated peptic ulcer w CC,,,27022.35
Deidentified Maximum,,382,DRG,Complicated peptic ulcer w/o CC/MCC,,,19591.65
Deidentified Maximum,,383,DRG,Uncomplicated peptic ulcer w MCC,,,33427.95
Deidentified Maximum,,384,DRG,Uncomplicated peptic ulcer w/o MCC,,,22756.20
Deidentified Maximum,,385,DRG,Inflammatory bowel disease w MCC,,,41287.05
Deidentified Maximum,,386,DRG,Inflammatory bowel disease w CC,,,25334.25
Deidentified Maximum,,387,DRG,Inflammatory bowel disease w/o CC/MCC,,,18194.25
Deidentified Maximum,,388,DRG,G.I. obstruction w MCC,,,38550.90
Deidentified Maximum,,389,DRG,G.I. obstruction w CC,,,20955.90
Deidentified Maximum,,390,DRG,G.I. obstruction w/o CC/MCC,,,14856.30
Deidentified Maximum,,391,DRG,Esophagitis, gastroent & misc digest disorders w MCC,,,31732.20
Deidentified Maximum,,392,DRG,Esophagitis, gastroent & misc digest disorders w/o MCC,,,19492.20
Deidentified Maximum,,393,DRG,Other digestive system diagnoses w MCC,,,42166.80
Deidentified Maximum,,394,DRG,Other digestive system diagnoses w CC,,,23934.30
Deidentified Maximum,,395,DRG,Other digestive system diagnoses w/o CC/MCC,,,16567.35
Deidentified Maximum,,405,DRG,Pancreas, liver & shunt procedures w MCC,,,146127.75
Deidentified Maximum,,406,DRG,Pancreas, liver & shunt procedures w CC,,,73363.50
Deidentified Maximum,,407,DRG,Pancreas, liver & shunt procedures w/o CC/MCC,,,53958.00
Deidentified Maximum,,408,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w MCC,,,95612.25
Deidentified Maximum,,409,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w CC,,,53914.65
Deidentified Maximum,,410,DRG,Biliary tract proc except only cholecyst w or w/o c.d.e. w/o CC/MCC,,,39925.35
Deidentified Maximum,,411,DRG,Cholecystectomy w c.d.e. w MCC,,,95686.20
Deidentified Maximum,,412,DRG,Cholecystectomy w c.d.e. w CC,,,58030.35
Deidentified Maximum,,413,DRG,Cholecystectomy w c.d.e. w/o CC/MCC,,,44150.70
Deidentified Maximum,,414,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w MCC,,,92450.25
Deidentified Maximum,,415,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w CC,,,51813.45
Deidentified Maximum,,416,DRG,Cholecystectomy except by laparoscope w/o c.d.e. w/o CC/MCC,,,36266.10
Deidentified Maximum,,417,DRG,Laparoscopic cholecystectomy w/o c.d.e. w MCC,,,61799.25
Deidentified Maximum,,418,DRG,Laparoscopic cholecystectomy w/o c.d.e. w CC,,,43046.55
Deidentified Maximum,,419,DRG,Laparoscopic cholecystectomy w/o c.d.e. w/o CC/MCC,,,33537.60
Deidentified Maximum,,420,DRG,Hepatobiliary diagnostic procedures w MCC,,,89609.55
Deidentified Maximum,,421,DRG,Hepatobiliary diagnostic procedures w CC,,,48676.95
Deidentified Maximum,,422,DRG,Hepatobiliary diagnostic procedures w/o CC/MCC,,,37010.70
Deidentified Maximum,,423,DRG,Other hepatobiliary or pancreas O.R. procedures w MCC,,,106564.50
Deidentified Maximum,,424,DRG,Other hepatobiliary or pancreas O.R. procedures w CC,,,58180.80
Deidentified Maximum,,425,DRG,Other hepatobiliary or pancreas O.R. procedures w/o CC/MCC,,,39354.15
Deidentified Maximum,,432,DRG,Cirrhosis & alcoholic hepatitis w MCC,,,47993.55
Deidentified Maximum,,433,DRG,Cirrhosis & alcoholic hepatitis w CC,,,26226.75
Deidentified Maximum,,434,DRG,Cirrhosis & alcoholic hepatitis w/o CC/MCC,,,15799.80
Deidentified Maximum,,435,DRG,Malignancy of hepatobiliary system or pancreas w MCC,,,44696.40
Deidentified Maximum,,436,DRG,Malignancy of hepatobiliary system or pancreas w CC,,,28565.10
Deidentified Maximum,,437,DRG,Malignancy of hepatobiliary system or pancreas w/o CC/MCC,,,22809.75
Deidentified Maximum,,438,DRG,Disorders of pancreas except malignancy w MCC,,,40705.65
Deidentified Maximum,,439,DRG,Disorders of pancreas except malignancy w CC,,,21532.20
Deidentified Maximum,,440,DRG,Disorders of pancreas except malignancy w/o CC/MCC,,,15450.45
Deidentified Maximum,,441,DRG,Disorders of liver except malig,cirr,alc hepa w MCC,,,48034.35
Deidentified Maximum,,442,DRG,Disorders of liver except malig,cirr,alc hepa w CC,,,23755.80
Deidentified Maximum,,443,DRG,Disorders of liver except malig,cirr,alc hepa w/o CC/MCC,,,16901.40
Deidentified Maximum,,444,DRG,Disorders of the biliary tract w MCC,,,42554.40
Deidentified Maximum,,445,DRG,Disorders of the biliary tract w CC,,,27458.40
Deidentified Maximum,,446,DRG,Disorders of the biliary tract w/o CC/MCC,,,20813.10
Deidentified Maximum,,453,DRG,Combined anterior/posterior spinal fusion w MCC,,,152062.14
Deidentified Maximum,,454,DRG,Combined anterior/posterior spinal fusion w CC,,,100862.57
Deidentified Maximum,,455,DRG,Combined anterior/posterior spinal fusion w/o CC/MCC,,,79243.14
Deidentified Maximum,,456,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w MCC,,,142212.57
Deidentified Maximum,,457,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w CC,,,107543.08
Deidentified Maximum,,458,DRG,Spinal fus exc cerv w spinal curv/malig/infec or 9+ fus w/o CC/MCC,,,82987.79
Deidentified Maximum,,459,DRG,Spinal fusion except cervical w MCC,,,111343.97
Deidentified Maximum,,460,DRG,Spinal fusion except cervical w/o MCC,,,65046.85
Deidentified Maximum,,461,DRG,Bilateral or multiple major joint procs of lower extremity w MCC,,,154943.10
Deidentified Maximum,,462,DRG,Bilateral or multiple major joint procs of lower extremity w/o MCC,,,80177.10
Deidentified Maximum,,463,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w MCC,,,136817.70
Deidentified Maximum,,464,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w CC,,,75849.75
Deidentified Maximum,,465,DRG,Wnd debrid & skn grft exc hand, for musculo-conn tiss dis w/o CC/MCC,,,47011.80
Deidentified Maximum,,466,DRG,Revision of hip or knee replacement w MCC,,,136297.50
Deidentified Maximum,,467,DRG,Revision of hip or knee replacement w CC,,,91193.10
Deidentified Maximum,,468,DRG,Revision of hip or knee replacement w/o CC/MCC,,,71502.00
Deidentified Maximum,,469,DRG,Major joint replacement or reattachment of lower extremity w MCC,,,78652.20
Deidentified Maximum,,470,DRG,Major joint replacement or reattachment of lower extremity w/o MCC,,,48447.45
Deidentified Maximum,,471,DRG,Cervical spinal fusion w MCC,,,82977.87
Deidentified Maximum,,472,DRG,Cervical spinal fusion w CC,,,50499.92
Deidentified Maximum,,473,DRG,Cervical spinal fusion w/o CC/MCC,,,42014.90
Deidentified Maximum,,474,DRG,Amputation for musculoskeletal sys & conn tissue dis w MCC,,,103856.40
Deidentified Maximum,,475,DRG,Amputation for musculoskeletal sys & conn tissue dis w CC,,,55936.80
Deidentified Maximum,,476,DRG,Amputation for musculoskeletal sys & conn tissue dis w/o CC/MCC,,,29574.90
Deidentified Maximum,,477,DRG,Biopsies of musculoskeletal system & connective tissue w MCC,,,85600.95
Deidentified Maximum,,478,DRG,Biopsies of musculoskeletal system & connective tissue w CC,,,60100.95
Deidentified Maximum,,479,DRG,Biopsies of musculoskeletal system & connective tissue w/o CC/MCC,,,46137.15
Deidentified Maximum,,480,DRG,Hip & femur procedures except major joint w MCC,,,77124.75
Deidentified Maximum,,481,DRG,Hip & femur procedures except major joint w CC,,,53435.25
Deidentified Maximum,,482,DRG,Hip & femur procedures except major joint w/o CC/MCC,,,41993.40
Deidentified Maximum,,483,DRG,Major joint & limb reattachment proc of upper extremity w CC/MCC,,,60850.65
Deidentified Maximum,,485,DRG,Knee procedures w pdx of infection w MCC,,,86893.80
Deidentified Maximum,,486,DRG,Knee procedures w pdx of infection w CC,,,54784.20
Deidentified Maximum,,487,DRG,Knee procedures w pdx of infection w/o CC/MCC,,,41827.65
Deidentified Maximum,,488,DRG,Knee procedures w/o pdx of infection w CC/MCC,,,50352.30
Deidentified Maximum,,489,DRG,Knee procedures w/o pdx of infection w/o CC/MCC,,,33104.10
Deidentified Maximum,,492,DRG,Lower extrem & humer proc except hip,foot,femur w MCC,,,88439.10
Deidentified Maximum,,493,DRG,Lower extrem & humer proc except hip,foot,femur w CC,,,59292.60
Deidentified Maximum,,494,DRG,Lower extrem & humer proc except hip,foot,femur w/o CC/MCC,,,47223.45
Deidentified Maximum,,495,DRG,Local excision & removal int fix devices exc hip & femur w MCC,,,92672.10
Deidentified Maximum,,496,DRG,Local excision & removal int fix devices exc hip & femur w CC,,,50632.80
Deidentified Maximum,,497,DRG,Local excision & removal int fix devices exc hip & femur w/o CC/MCC,,,37196.85
Deidentified Maximum,,498,DRG,Local excision & removal int fix devices of hip & femur w CC/MCC,,,65899.65
Deidentified Maximum,,499,DRG,Local excision & removal int fix devices of hip & femur w/o CC/MCC,,,30566.85
Deidentified Maximum,,500,DRG,Soft tissue procedures w MCC,,,80424.45
Deidentified Maximum,,501,DRG,Soft tissue procedures w CC,,,44497.50
Deidentified Maximum,,502,DRG,Soft tissue procedures w/o CC/MCC,,,33935.40
Deidentified Maximum,,503,DRG,Foot procedures w MCC,,,67031.85
Deidentified Maximum,,504,DRG,Foot procedures w CC,,,45234.45
Deidentified Maximum,,505,DRG,Foot procedures w/o CC/MCC,,,45234.45
Deidentified Maximum,,506,DRG,Major thumb or joint procedures,,,37630.35
Deidentified Maximum,,507,DRG,Major shoulder or elbow joint procedures w CC/MCC,,,51568.65
Deidentified Maximum,,508,DRG,Major shoulder or elbow joint procedures w/o CC/MCC,,,36057.00
Deidentified Maximum,,509,DRG,Arthroscopy,,,42681.90
Deidentified Maximum,,510,DRG,Shoulder,elbow or forearm proc,exc major joint proc w MCC,,,69632.85
Deidentified Maximum,,511,DRG,Shoulder,elbow or forearm proc,exc major joint proc w CC,,,50196.75
Deidentified Maximum,,512,DRG,Shoulder,elbow or forearm proc,exc major joint proc w/o CC/MCC,,,39683.10
Deidentified Maximum,,513,DRG,Hand or wrist proc, except major thumb or joint proc w CC/MCC,,,39754.50
Deidentified Maximum,,514,DRG,Hand or wrist proc, except major thumb or joint proc w/o CC/MCC,,,25352.10
Deidentified Maximum,,515,DRG,Other musculoskelet sys & conn tiss O.R. proc w MCC,,,79993.50
Deidentified Maximum,,516,DRG,Other musculoskelet sys & conn tiss O.R. proc w CC,,,50008.05
Deidentified Maximum,,517,DRG,Other musculoskelet sys & conn tiss O.R. proc w/o CC/MCC,,,35615.85
Deidentified Maximum,,518,DRG,Back & Neck Proc Exc Spinal Fusion w MCC Or Disc Device/Neurostim,,,59284.32
Deidentified Maximum,,519,DRG,Back & Neck Proc Exc Spinal Fusion w CC ,,,32380.35
Deidentified Maximum,,520,DRG,Back & Neck Proc Exc Spinal Fusion w/o CC/MCC,,,25500.00
Deidentified Maximum,,521,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,,,78116.70
Deidentified Maximum,,522,DRG,HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,,,55822.05
Deidentified Maximum,,533,DRG,Fractures of femur w MCC,,,36021.30
Deidentified Maximum,,534,DRG,Fractures of femur w/o MCC,,,20109.30
Deidentified Maximum,,535,DRG,Fractures of hip & pelvis w MCC,,,31461.90
Deidentified Maximum,,536,DRG,Fractures of hip & pelvis w/o MCC,,,19675.80
Deidentified Maximum,,537,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w CC/MCC,,,23796.60
Deidentified Maximum,,538,DRG,Sprains, strains, & dislocations of hip, pelvis & thigh w/o CC/MCC,,,18395.70
Deidentified Maximum,,539,DRG,Osteomyelitis w MCC,,,49500.60
Deidentified Maximum,,540,DRG,Osteomyelitis w CC,,,33030.15
Deidentified Maximum,,541,DRG,Osteomyelitis w/o CC/MCC,,,21435.30
Deidentified Maximum,,542,DRG,Pathological fractures & musculoskelet & conn tiss malig w MCC,,,46035.15
Deidentified Maximum,,543,DRG,Pathological fractures & musculoskelet & conn tiss malig w CC,,,26604.15
Deidentified Maximum,,544,DRG,Pathological fractures & musculoskelet & conn tiss malig w/o CC/MCC,,,19793.10
Deidentified Maximum,,545,DRG,Connective tissue disorders w MCC,,,63737.25
Deidentified Maximum,,546,DRG,Connective tissue disorders w CC,,,30768.30
Deidentified Maximum,,547,DRG,Connective tissue disorders w/o CC/MCC,,,21241.50
Deidentified Maximum,,548,DRG,Septic arthritis w MCC,,,51754.80
Deidentified Maximum,,549,DRG,Septic arthritis w CC,,,31795.95
Deidentified Maximum,,550,DRG,Septic arthritis w/o CC/MCC,,,22508.85
Deidentified Maximum,,551,DRG,Medical back problems w MCC,,,41389.05
Deidentified Maximum,,552,DRG,Medical back problems w/o MCC,,,24021.00
Deidentified Maximum,,553,DRG,Bone diseases & arthropathies w MCC,,,32341.65
Deidentified Maximum,,554,DRG,Bone diseases & arthropathies w/o MCC,,,20155.20
Deidentified Maximum,,555,DRG,Signs & symptoms of musculoskeletal system & conn tissue w MCC,,,34751.40
Deidentified Maximum,,556,DRG,Signs & symptoms of musculoskeletal system & conn tissue w/o MCC,,,20560.65
Deidentified Maximum,,557,DRG,Tendonitis, myositis & bursitis w MCC,,,35544.45
Deidentified Maximum,,558,DRG,Tendonitis, myositis & bursitis w/o MCC,,,21886.65
Deidentified Maximum,,559,DRG,Aftercare, musculoskeletal system & connective tissue w MCC,,,47631.45
Deidentified Maximum,,560,DRG,Aftercare, musculoskeletal system & connective tissue w CC,,,27448.20
Deidentified Maximum,,561,DRG,Aftercare, musculoskeletal system & connective tissue w/o CC/MCC,,,20173.05
Deidentified Maximum,,562,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w MCC,,,35904.00
Deidentified Maximum,,563,DRG,Fx, sprn, strn & disl except femur, hip, pelvis & thigh w/o MCC,,,22205.40
Deidentified Maximum,,564,DRG,Other musculoskeletal sys & connective tissue diagnoses w MCC,,,38601.90
Deidentified Maximum,,565,DRG,Other musculoskeletal sys & connective tissue diagnoses w CC,,,25660.65
Deidentified Maximum,,566,DRG,Other musculoskeletal sys & connective tissue diagnoses w/o CC/MCC,,,19163.25
Deidentified Maximum,,570,DRG,Skin debridement w MCC,,,72325.65
Deidentified Maximum,,571,DRG,Skin debridement w CC,,,41636.40
Deidentified Maximum,,572,DRG,Skin debridement w/o CC/MCC,,,28116.30
Deidentified Maximum,,573,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w MCC,,,141201.15
Deidentified Maximum,,574,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w CC,,,82831.65
Deidentified Maximum,,575,DRG,Skin graft &/or debrid for skn ulcer or cellulitis w/o CC/MCC,,,44918.25
Deidentified Maximum,,576,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w MCC,,,128797.95
Deidentified Maximum,,577,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w CC,,,65121.90
Deidentified Maximum,,578,DRG,Skin graft &/or debrid exc for skin ulcer or cellulitis w/o CC/MCC,,,41582.85
Deidentified Maximum,,579,DRG,Other skin, subcut tiss & breast proc w MCC,,,74658.90
Deidentified Maximum,,580,DRG,Other skin, subcut tiss & breast proc w CC,,,40807.65
Deidentified Maximum,,581,DRG,Other skin, subcut tiss & breast proc w/o CC/MCC,,,31928.55
Deidentified Maximum,,582,DRG,Mastectomy for malignancy w CC/MCC,,,41712.90
Deidentified Maximum,,583,DRG,Mastectomy for malignancy w/o CC/MCC,,,39216.45
Deidentified Maximum,,584,DRG,Breast biopsy, local excision & other breast procedures w CC/MCC,,,46519.65
Deidentified Maximum,,585,DRG,Breast biopsy, local excision & other breast procedures w/o CC/MCC,,,44283.30
Deidentified Maximum,,592,DRG,Skin ulcers w MCC,,,43010.85
Deidentified Maximum,,593,DRG,Skin ulcers w CC,,,28988.40
Deidentified Maximum,,594,DRG,Skin ulcers w/o CC/MCC,,,20876.85
Deidentified Maximum,,595,DRG,Major skin disorders w MCC,,,51308.55
Deidentified Maximum,,596,DRG,Major skin disorders w/o MCC,,,25224.60
Deidentified Maximum,,597,DRG,Malignant breast disorders w MCC,,,41735.85
Deidentified Maximum,,598,DRG,Malignant breast disorders w CC,,,28335.60
Deidentified Maximum,,599,DRG,Malignant breast disorders w/o CC/MCC,,,17115.60
Deidentified Maximum,,600,DRG,Non-malignant breast disorders w CC/MCC,,,25390.35
Deidentified Maximum,,601,DRG,Non-malignant breast disorders w/o CC/MCC,,,17533.80
Deidentified Maximum,,602,DRG,Cellulitis w MCC,,,36633.30
Deidentified Maximum,,603,DRG,Cellulitis w/o MCC,,,21542.40
Deidentified Maximum,,604,DRG,Trauma to the skin, subcut tiss & breast w MCC,,,38028.15
Deidentified Maximum,,605,DRG,Trauma to the skin, subcut tiss & breast w/o MCC,,,23184.60
Deidentified Maximum,,606,DRG,Minor skin disorders w MCC,,,38530.50
Deidentified Maximum,,607,DRG,Minor skin disorders w/o MCC,,,21052.80
Deidentified Maximum,,614,DRG,Adrenal & pituitary procedures w CC/MCC,,,60863.40
Deidentified Maximum,,615,DRG,Adrenal & pituitary procedures w/o CC/MCC,,,40139.55
Deidentified Maximum,,616,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w MCC,,,101714.40
Deidentified Maximum,,617,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w CC,,,51869.55
Deidentified Maximum,,618,DRG,Amputat of lower limb for endocrine,nutrit,& metabol dis w/o CC/MCC,,,33226.50
Deidentified Maximum,,619,DRG,O.R. procedures for obesity w MCC,,,78058.05
Deidentified Maximum,,620,DRG,O.R. procedures for obesity w CC,,,44908.05
Deidentified Maximum,,621,DRG,O.R. procedures for obesity w/o CC/MCC,,,40708.20
Deidentified Maximum,,622,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w MCC,,,92126.40
Deidentified Maximum,,623,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w CC,,,47758.95
Deidentified Maximum,,624,DRG,Skin grafts & wound debrid for endoc, nutrit & metab dis w/o CC/MCC,,,27904.65
Deidentified Maximum,,625,DRG,Thyroid, parathyroid & thyroglossal procedures w MCC,,,72450.60
Deidentified Maximum,,626,DRG,Thyroid, parathyroid & thyroglossal procedures w CC,,,42133.65
Deidentified Maximum,,627,DRG,Thyroid, parathyroid & thyroglossal procedures w/o CC/MCC,,,30135.90
Deidentified Maximum,,628,DRG,Other endocrine, nutrit & metab O.R. proc w MCC,,,94301.55
Deidentified Maximum,,629,DRG,Other endocrine, nutrit & metab O.R. proc w CC,,,59843.40
Deidentified Maximum,,630,DRG,Other endocrine, nutrit & metab O.R. proc w/o CC/MCC,,,35875.95
Deidentified Maximum,,637,DRG,Diabetes w MCC,,,35054.85
Deidentified Maximum,,638,DRG,Diabetes w CC,,,22424.70
Deidentified Maximum,,639,DRG,Diabetes w/o CC/MCC,,,15537.15
Deidentified Maximum,,640,DRG,Nutritional & misc metabolic disorders w MCC,,,31308.90
Deidentified Maximum,,641,DRG,Nutritional & misc metabolic disorders w/o MCC,,,19201.50
Deidentified Maximum,,642,DRG,Inborn errors of metabolism,,,32831.25
Deidentified Maximum,,643,DRG,Endocrine disorders w MCC,,,42414.15
Deidentified Maximum,,644,DRG,Endocrine disorders w CC,,,25966.65
Deidentified Maximum,,645,DRG,Endocrine disorders w/o CC/MCC,,,19578.90
Deidentified Maximum,,650,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,,,115084.05
Deidentified Maximum,,651,DRG,KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,,,94186.80
Deidentified Maximum,,652,DRG,Kidney transplant,,,81138.45
Deidentified Maximum,,653,DRG,Major bladder procedures w MCC,,,138954.60
Deidentified Maximum,,654,DRG,Major bladder procedures w CC,,,73955.10
Deidentified Maximum,,655,DRG,Major bladder procedures w/o CC/MCC,,,53042.55
Deidentified Maximum,,656,DRG,Kidney & ureter procedures for neoplasm w MCC,,,83683.35
Deidentified Maximum,,657,DRG,Kidney & ureter procedures for neoplasm w CC,,,49319.55
Deidentified Maximum,,658,DRG,Kidney & ureter procedures for neoplasm w/o CC/MCC,,,40267.05
Deidentified Maximum,,659,DRG,Kidney & ureter procedures for non-neoplasm w MCC,,,67952.40
Deidentified Maximum,,660,DRG,Kidney & ureter procedures for non-neoplasm w CC,,,36806.70
Deidentified Maximum,,661,DRG,Kidney & ureter procedures for non-neoplasm w/o CC/MCC,,,27142.20
Deidentified Maximum,,662,DRG,Minor bladder procedures w MCC,,,74709.90
Deidentified Maximum,,663,DRG,Minor bladder procedures w CC,,,40669.95
Deidentified Maximum,,664,DRG,Minor bladder procedures w/o CC/MCC,,,30197.10
Deidentified Maximum,,665,DRG,Prostatectomy w MCC,,,77435.85
Deidentified Maximum,,666,DRG,Prostatectomy w CC,,,44224.65
Deidentified Maximum,,667,DRG,Prostatectomy w/o CC/MCC,,,25369.95
Deidentified Maximum,,668,DRG,Transurethral procedures w MCC,,,70255.05
Deidentified Maximum,,669,DRG,Transurethral procedures w CC,,,39063.45
Deidentified Maximum,,670,DRG,Transurethral procedures w/o CC/MCC,,,24900.75
Deidentified Maximum,,671,DRG,Urethral procedures w CC/MCC,,,45305.85
Deidentified Maximum,,672,DRG,Urethral procedures w/o CC/MCC,,,29347.95
Deidentified Maximum,,673,DRG,Other kidney & urinary tract procedures w MCC,,,88309.05
Deidentified Maximum,,674,DRG,Other kidney & urinary tract procedures w CC,,,60700.20
Deidentified Maximum,,675,DRG,Other kidney & urinary tract procedures w/o CC/MCC,,,44676.00
Deidentified Maximum,,682,DRG,Renal failure w MCC,,,37490.10
Deidentified Maximum,,683,DRG,Renal failure w CC,,,22391.55
Deidentified Maximum,,684,DRG,Renal failure w/o CC/MCC,,,15491.25
Deidentified Maximum,,686,DRG,Kidney & urinary tract neoplasms w MCC,,,47766.60
Deidentified Maximum,,687,DRG,Kidney & urinary tract neoplasms w CC,,,26718.90
Deidentified Maximum,,688,DRG,Kidney & urinary tract neoplasms w/o CC/MCC,,,17475.15
Deidentified Maximum,,689,DRG,Kidney & urinary tract infections w MCC,,,28338.15
Deidentified Maximum,,690,DRG,Kidney & urinary tract infections w/o MCC,,,20201.10
Deidentified Maximum,,693,DRG,Urinary stones w/o esw lithotripsy w MCC,,,32354.40
Deidentified Maximum,,694,DRG,Urinary stones w/o esw lithotripsy w/o MCC,,,18597.15
Deidentified Maximum,,695,DRG,Kidney & urinary tract signs & symptoms w MCC,,,28975.65
Deidentified Maximum,,696,DRG,Kidney & urinary tract signs & symptoms w/o MCC,,,17587.35
Deidentified Maximum,,697,DRG,Urethral stricture,,,25423.50
Deidentified Maximum,,698,DRG,Other kidney & urinary tract diagnoses w MCC,,,40970.85
Deidentified Maximum,,699,DRG,Other kidney & urinary tract diagnoses w CC,,,26142.60
Deidentified Maximum,,700,DRG,Other kidney & urinary tract diagnoses w/o CC/MCC,,,18992.40
Deidentified Maximum,,707,DRG,Major male pelvic procedures w CC/MCC,,,48975.30
Deidentified Maximum,,708,DRG,Major male pelvic procedures w/o CC/MCC,,,38030.70
Deidentified Maximum,,709,DRG,Penis procedures w CC/MCC,,,58953.45
Deidentified Maximum,,710,DRG,Penis procedures w/o CC/MCC,,,40797.45
Deidentified Maximum,,711,DRG,Testes procedures w CC/MCC,,,54322.65
Deidentified Maximum,,712,DRG,Testes procedures w/o CC/MCC,,,26966.25
Deidentified Maximum,,713,DRG,Transurethral prostatectomy w CC/MCC,,,38035.80
Deidentified Maximum,,714,DRG,Transurethral prostatectomy w/o CC/MCC,,,23676.75
Deidentified Maximum,,715,DRG,Other male reproductive system O.R. proc for malignancy w CC/MCC,,,51481.95
Deidentified Maximum,,716,DRG,Other male reproductive system O.R. proc for malignancy w/o CC/MCC,,,32550.75
Deidentified Maximum,,717,DRG,Other male reproductive system O.R. proc exc malignancy w CC/MCC,,,45861.75
Deidentified Maximum,,718,DRG,Other male reproductive system O.R. proc exc malignancy w/o CC/MCC,,,31523.10
Deidentified Maximum,,722,DRG,Malignancy, male reproductive system w MCC,,,43579.50
Deidentified Maximum,,723,DRG,Malignancy, male reproductive system w CC,,,27772.05
Deidentified Maximum,,724,DRG,Malignancy, male reproductive system w/o CC/MCC,,,16559.70
Deidentified Maximum,,725,DRG,Benign prostatic hypertrophy w MCC,,,32688.45
Deidentified Maximum,,726,DRG,Benign prostatic hypertrophy w/o MCC,,,18954.15
Deidentified Maximum,,727,DRG,Inflammation of the male reproductive system w MCC,,,36161.55
Deidentified Maximum,,728,DRG,Inflammation of the male reproductive system w/o MCC,,,20489.25
Deidentified Maximum,,729,DRG,Other male reproductive system diagnoses w CC/MCC,,,25622.40
Deidentified Maximum,,730,DRG,Other male reproductive system diagnoses w/o CC/MCC,,,14425.35
Deidentified Maximum,,734,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w CC/MCC,,,56681.40
Deidentified Maximum,,735,DRG,Pelvic evisceration, rad hysterectomy & rad vulvectomy w/o CC/MCC,,,36044.25
Deidentified Maximum,,736,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w MCC,,,108584.10
Deidentified Maximum,,737,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w CC,,,52484.10
Deidentified Maximum,,738,DRG,Uterine & adnexa proc for ovarian or adnexal malignancy w/o CC/MCC,,,37653.30
Deidentified Maximum,,739,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w MCC,,,97453.35
Deidentified Maximum,,740,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w CC,,,45900.00
Deidentified Maximum,,741,DRG,Uterine,adnexa proc for non-ovarian/adnexal malig w/o CC/MCC,,,32627.25
Deidentified Maximum,,742,DRG,Uterine & adnexa proc for non-malignancy w CC/MCC,,,43783.50
Deidentified Maximum,,743,DRG,Uterine & adnexa proc for non-malignancy w/o CC/MCC,,,28873.65
Deidentified Maximum,,744,DRG,D&C, conization, laparascopy & tubal interruption w CC/MCC,,,45747.00
Deidentified Maximum,,745,DRG,D&C, conization, laparascopy & tubal interruption w/o CC/MCC,,,29847.75
Deidentified Maximum,,746,DRG,Vagina, cervix & vulva procedures w CC/MCC,,,41039.70
Deidentified Maximum,,747,DRG,Vagina, cervix & vulva procedures w/o CC/MCC,,,23919.00
Deidentified Maximum,,748,DRG,Female reproductive system reconstructive procedures,,,34381.65
Deidentified Maximum,,749,DRG,Other female reproductive system O.R. procedures w CC/MCC,,,69038.70
Deidentified Maximum,,750,DRG,Other female reproductive system O.R. procedures w/o CC/MCC,,,37380.45
Deidentified Maximum,,754,DRG,Malignancy, female reproductive system w MCC,,,46435.50
Deidentified Maximum,,755,DRG,Malignancy, female reproductive system w CC,,,28753.80
Deidentified Maximum,,756,DRG,Malignancy, female reproductive system w/o CC/MCC,,,23360.55
Deidentified Maximum,,757,DRG,Infections, female reproductive system w MCC,,,38813.55
Deidentified Maximum,,758,DRG,Infections, female reproductive system w CC,,,24658.50
Deidentified Maximum,,759,DRG,Infections, female reproductive system w/o CC/MCC,,,17421.60
Deidentified Maximum,,760,DRG,Menstrual & other female reproductive system disorders w CC/MCC,,,23526.30
Deidentified Maximum,,761,DRG,Menstrual & other female reproductive system disorders w/o CC/MCC,,,15045.00
Deidentified Maximum,,765,DRG,Cesarean section w CC/MCC,,,5500.00
Deidentified Maximum,,766,DRG,Cesarean section w/o CC/MCC,,,5500.00
Deidentified Maximum,,767,DRG,Vaginal delivery w sterilization &/or D&C,,,5500.00
Deidentified Maximum,,768,DRG,Vaginal delivery w O.R. proc except steril &/or D&C,,,19365.03
Deidentified Maximum,,769,DRG,Postpartum & post abortion diagnoses w O.R. procedure,,,41320.20
Deidentified Maximum,,770,DRG,Abortion w D&C, aspiration curettage or hysterotomy,,,22646.55
Deidentified Maximum,,774,DRG,Vaginal delivery w complicating diagnoses,,,5500.00
Deidentified Maximum,,775,DRG,Vaginal delivery w/o complicating diagnoses,,,5500.00
Deidentified Maximum,,776,DRG,Postpartum & post abortion diagnoses w/o O.R. procedure,,,19604.40
Deidentified Maximum,,779,DRG,Abortion w/o D&C,,,26530.20
Deidentified Maximum,,783,DRG,CESAREAN SECTION W STERILIZATION W MCC,,,30974.45
Deidentified Maximum,,784,DRG,CESAREAN SECTION W STERILIZATION W CC,,,18109.64
Deidentified Maximum,,785,DRG,CESAREAN SECTION W STERILIZATION W/O CC/MCC,,,15139.06
Deidentified Maximum,,786,DRG,CESAREAN SECTION W/O STERILIZATION W MCC,,,26316.79
Deidentified Maximum,,787,DRG,CESAREAN SECTION W/O STERILIZATION W CC,,,17577.05
Deidentified Maximum,,788,DRG,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,,,14672.63
Deidentified Maximum,,789,DRG,Neonates, died or transferred to another acute care facility,,,43821.75
Deidentified Maximum,,790,DRG,Extreme immaturity or respiratory distress syndrome, neonate,,,144511.05
Deidentified Maximum,,791,DRG,Prematurity w major problems,,,98695.20
Deidentified Maximum,,792,DRG,Prematurity w/o major problems,,,59550.15
Deidentified Maximum,,793,DRG,Full term neonate w major problems,,,101380.35
Deidentified Maximum,,794,DRG,Neonate w other significant problems,,,35883.60
Deidentified Maximum,,795,DRG,Normal newborn,,,4857.75
Deidentified Maximum,,796,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W MCC,,,17663.06
Deidentified Maximum,,797,DRG,VAGINAL DELIVERY W STERILIZATION/D&C W CC,,,15215.14
Deidentified Maximum,,798,DRG,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,,,13683.54
Deidentified Maximum,,799,DRG,Splenectomy w MCC,,,131169.45
Deidentified Maximum,,800,DRG,Splenectomy w CC,,,75260.70
Deidentified Maximum,,801,DRG,Splenectomy w/o CC/MCC,,,42929.25
Deidentified Maximum,,802,DRG,Other O.R. proc of the blood & blood forming organs w MCC,,,94571.85
Deidentified Maximum,,803,DRG,Other O.R. proc of the blood & blood forming organs w CC,,,48062.40
Deidentified Maximum,,804,DRG,Other O.R. proc of the blood & blood forming organs w/o CC/MCC,,,34787.10
Deidentified Maximum,,805,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,,,16983.27
Deidentified Maximum,,806,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,,,12138.70
Deidentified Maximum,,807,DRG,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,,,10603.79
Deidentified Maximum,,808,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w MCC,,,55536.45
Deidentified Maximum,,809,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w CC,,,31153.35
Deidentified Maximum,,810,DRG,Major hematol/immun diag exc sickle cell crisis & coagul w/o CC/MCC,,,24497.85
Deidentified Maximum,,811,DRG,Red blood cell disorders w MCC,,,35128.80
Deidentified Maximum,,812,DRG,Red blood cell disorders w/o MCC,,,22432.35
Deidentified Maximum,,813,DRG,Coagulation disorders,,,39389.85
Deidentified Maximum,,814,DRG,Reticuloendothelial & immunity disorders w MCC,,,48215.40
Deidentified Maximum,,815,DRG,Reticuloendothelial & immunity disorders w CC,,,25308.75
Deidentified Maximum,,816,DRG,Reticuloendothelial & immunity disorders w/o CC/MCC,,,16852.95
Deidentified Maximum,,817,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W MCC,,,58695.90
Deidentified Maximum,,818,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC,,,33570.75
Deidentified Maximum,,819,DRG,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W/O CC/MCC,,,25446.45
Deidentified Maximum,,820,DRG,Lymphoma & leukemia w major O.R. procedure w MCC,,,145026.15
Deidentified Maximum,,821,DRG,Lymphoma & leukemia w major O.R. procedure w CC,,,54955.05
Deidentified Maximum,,822,DRG,Lymphoma & leukemia w major O.R. procedure w/o CC/MCC,,,31915.80
Deidentified Maximum,,823,DRG,Lymphoma & non-acute leukemia w other O.R. proc w MCC,,,114676.05
Deidentified Maximum,,824,DRG,Lymphoma & non-acute leukemia w other O.R. proc w CC,,,60248.85
Deidentified Maximum,,825,DRG,Lymphoma & non-acute leukemia w other O.R. proc w/o CC/MCC,,,35717.85
Deidentified Maximum,,826,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w MCC,,,128438.40
Deidentified Maximum,,827,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w CC,,,63688.80
Deidentified Maximum,,828,DRG,Myeloprolif disord or poorly diff neopl w maj O.R. proc w/o CC/MCC,,,42781.35
Deidentified Maximum,,829,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w CC/MCC,,,81745.35
Deidentified Maximum,,830,DRG,Myeloprolif disord or poorly diff neopl w other O.R. proc w/o CC/MCC,,,37650.75
Deidentified Maximum,,831,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC,,,28588.05
Deidentified Maximum,,832,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC,,,19884.90
Deidentified Maximum,,833,DRG,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC,,,13668.00
Deidentified Maximum,,834,DRG,Acute leukemia w/o major O.R. procedure w MCC,,,154277.55
Deidentified Maximum,,835,DRG,Acute leukemia w/o major O.R. procedure w CC,,,53899.35
Deidentified Maximum,,836,DRG,Acute leukemia w/o major O.R. procedure w/o CC/MCC,,,29824.80
Deidentified Maximum,,837,DRG,Chemo w acute leukemia as sdx or w high dose chemo agent w MCC,,,145329.60
Deidentified Maximum,,838,DRG,Chemo w acute leukemia as sdx w CC or high dose chemo agent,,,57599.40
Deidentified Maximum,,839,DRG,Chemo w acute leukemia as sdx w/o CC/MCC,,,37900.65
Deidentified Maximum,,840,DRG,Lymphoma & non-acute leukemia w MCC,,,82000.35
Deidentified Maximum,,841,DRG,Lymphoma & non-acute leukemia w CC,,,41330.40
Deidentified Maximum,,842,DRG,Lymphoma & non-acute leukemia w/o CC/MCC,,,27930.15
Deidentified Maximum,,843,DRG,Other myeloprolif dis or poorly diff neopl diag w MCC,,,48523.95
Deidentified Maximum,,844,DRG,Other myeloprolif dis or poorly diff neopl diag w CC,,,30102.75
Deidentified Maximum,,845,DRG,Other myeloprolif dis or poorly diff neopl diag w/o CC/MCC,,,21608.70
Deidentified Maximum,,846,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w MCC,,,68082.45
Deidentified Maximum,,847,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w CC,,,34047.60
Deidentified Maximum,,848,DRG,Chemotherapy w/o acute leukemia as secondary diagnosis w/o CC/MCC,,,26239.50
Deidentified Maximum,,849,DRG,Radiotherapy,,,63431.25
Deidentified Maximum,,853,DRG,Infectious & parasitic diseases w O.R. procedure w MCC,,,126087.30
Deidentified Maximum,,854,DRG,Infectious & parasitic diseases w O.R. procedure w CC,,,53407.20
Deidentified Maximum,,855,DRG,Infectious & parasitic diseases w O.R. procedure w/o CC/MCC,,,38122.50
Deidentified Maximum,,856,DRG,Postoperative or post-traumatic infections w O.R. proc w MCC,,,115915.35
Deidentified Maximum,,857,DRG,Postoperative or post-traumatic infections w O.R. proc w CC,,,51884.85
Deidentified Maximum,,858,DRG,Postoperative or post-traumatic infections w O.R. proc w/o CC/MCC,,,34384.20
Deidentified Maximum,,862,DRG,Postoperative & post-traumatic infections w MCC,,,47909.40
Deidentified Maximum,,863,DRG,Postoperative & post-traumatic infections w/o MCC,,,24923.70
Deidentified Maximum,,864,DRG,Fever of unknown origin,,,22312.50
Deidentified Maximum,,865,DRG,Viral illness w MCC,,,37711.95
Deidentified Maximum,,866,DRG,Viral illness w/o MCC,,,21348.60
Deidentified Maximum,,867,DRG,Other infectious & parasitic diseases diagnoses w MCC,,,56852.25
Deidentified Maximum,,868,DRG,Other infectious & parasitic diseases diagnoses w CC,,,26989.20
Deidentified Maximum,,869,DRG,Other infectious & parasitic diseases diagnoses w/o CC/MCC,,,18513.00
Deidentified Maximum,,870,DRG,Septicemia w MV 96+ hours,,,163832.40
Deidentified Maximum,,871,DRG,Septicemia w/o MV 96+ hours w MCC,,,47639.10
Deidentified Maximum,,872,DRG,Septicemia w/o MV 96+ hours w/o MCC,,,26050.80
Deidentified Maximum,,876,DRG,O.R. procedure w principal diagnoses of mental illness,,,83163.15
Deidentified Maximum,,880,DRG,Acute adjustment reaction & psychosocial dysfunction,,,22021.80
Deidentified Maximum,,881,DRG,Depressive neuroses,,,20435.70
Deidentified Maximum,,882,DRG,Neuroses except depressive,,,20986.50
Deidentified Maximum,,883,DRG,Disorders of personality & impulse control,,,40246.65
Deidentified Maximum,,884,DRG,Organic disturbances & mental retardation,,,36816.90
Deidentified Maximum,,885,DRG,Psychoses,,,31546.05
Deidentified Maximum,,886,DRG,Behavioral & developmental disorders,,,31148.25
Deidentified Maximum,,887,DRG,Other mental disorder diagnoses,,,27506.85
Deidentified Maximum,,894,DRG,Alcohol/drug abuse or dependence, left ama,,,13961.25
Deidentified Maximum,,895,DRG,Alcohol/drug abuse or dependence w rehabilitation therapy,,,40596.00
Deidentified Maximum,,896,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w MCC,,,45313.50
Deidentified Maximum,,897,DRG,Alcohol/drug abuse or dependence w/o rehabilitation therapy w/o MCC,,,21050.25
Deidentified Maximum,,901,DRG,Wound debridements for injuries w MCC,,,108686.10
Deidentified Maximum,,902,DRG,Wound debridements for injuries w CC,,,50041.20
Deidentified Maximum,,903,DRG,Wound debridements for injuries w/o CC/MCC,,,28927.20
Deidentified Maximum,,904,DRG,Skin grafts for injuries w CC/MCC,,,94895.70
Deidentified Maximum,,905,DRG,Skin grafts for injuries w/o CC/MCC,,,41868.45
Deidentified Maximum,,906,DRG,Hand procedures for injuries,,,45741.90
Deidentified Maximum,,907,DRG,Other O.R. procedures for injuries w MCC,,,100906.05
Deidentified Maximum,,908,DRG,Other O.R. procedures for injuries w CC,,,52030.20
Deidentified Maximum,,909,DRG,Other O.R. procedures for injuries w/o CC/MCC,,,35059.95
Deidentified Maximum,,913,DRG,Traumatic injury w MCC,,,41728.20
Deidentified Maximum,,914,DRG,Traumatic injury w/o MCC,,,22659.30
Deidentified Maximum,,915,DRG,Allergic reactions w MCC,,,43288.80
Deidentified Maximum,,916,DRG,Allergic reactions w/o MCC,,,16761.15
Deidentified Maximum,,917,DRG,Poisoning & toxic effects of drugs w MCC,,,37676.25
Deidentified Maximum,,918,DRG,Poisoning & toxic effects of drugs w/o MCC,,,20173.05
Deidentified Maximum,,919,DRG,Complications of treatment w MCC,,,46777.20
Deidentified Maximum,,920,DRG,Complications of treatment w CC,,,26196.15
Deidentified Maximum,,921,DRG,Complications of treatment w/o CC/MCC,,,17630.70
Deidentified Maximum,,922,DRG,Other injury, poisoning & toxic effect diag w MCC,,,40483.80
Deidentified Maximum,,923,DRG,Other injury, poisoning & toxic effect diag w/o MCC,,,23725.20
Deidentified Maximum,,927,DRG,Extensive burns or full thickness burns w MV 96+ hrs w skin graft,,,536287.95
Deidentified Maximum,,928,DRG,Full thickness burn w skin graft or inhal inj w CC/MCC,,,166237.05
Deidentified Maximum,,929,DRG,Full thickness burn w skin graft or inhal inj w/o CC/MCC,,,76726.95
Deidentified Maximum,,933,DRG,Extensive burns or full thickness burns w MV 96+ hrs w/o skin graft,,,57568.80
Deidentified Maximum,,934,DRG,Full thickness burn w/o skin grft or inhal inj,,,49401.15
Deidentified Maximum,,935,DRG,Non-extensive burns,,,49299.15
Deidentified Maximum,,939,DRG,O.R. proc w diagnoses of other contact w health services w MCC,,,86348.10
Deidentified Maximum,,940,DRG,O.R. proc w diagnoses of other contact w health services w CC,,,56548.80
Deidentified Maximum,,941,DRG,O.R. proc w diagnoses of other contact w health services w/o CC/MCC,,,49079.85
Deidentified Maximum,,945,DRG,Rehabilitation w CC/MCC,,,37859.85
Deidentified Maximum,,946,DRG,Rehabilitation w/o CC/MCC,,,28743.60
Deidentified Maximum,,947,DRG,Signs & symptoms w MCC,,,30347.55
Deidentified Maximum,,948,DRG,Signs & symptoms w/o MCC,,,20032.80
Deidentified Maximum,,949,DRG,Aftercare w CC/MCC,,,28231.05
Deidentified Maximum,,950,DRG,Aftercare w/o CC/MCC,,,18841.95
Deidentified Maximum,,951,DRG,Other factors influencing health status,,,14234.10
Deidentified Maximum,,955,DRG,Craniotomy for multiple significant trauma,,,160344.00
Deidentified Maximum,,956,DRG,Limb reattachment, hip & femur proc for multiple significant trauma,,,98144.40
Deidentified Maximum,,957,DRG,Other O.R. procedures for multiple significant trauma w MCC,,,189230.40
Deidentified Maximum,,958,DRG,Other O.R. procedures for multiple significant trauma w CC,,,107237.70
Deidentified Maximum,,959,DRG,Other O.R. procedures for multiple significant trauma w/o CC/MCC,,,69722.10
Deidentified Maximum,,963,DRG,Other multiple significant trauma w MCC,,,69467.10
Deidentified Maximum,,964,DRG,Other multiple significant trauma w CC,,,37954.20
Deidentified Maximum,,965,DRG,Other multiple significant trauma w/o CC/MCC,,,23278.95
Deidentified Maximum,,969,DRG,HIV w extensive O.R. procedure w MCC,,,147578.70
Deidentified Maximum,,970,DRG,HIV w extensive O.R. procedure w/o MCC,,,75100.05
Deidentified Maximum,,974,DRG,HIV w major related condition w MCC,,,68485.35
Deidentified Maximum,,975,DRG,HIV w major related condition w CC,,,32617.05
Deidentified Maximum,,976,DRG,HIV w major related condition w/o CC/MCC,,,24202.05
Deidentified Maximum,,977,DRG,HIV w or w/o other related condition,,,33680.40
Deidentified Maximum,,981,DRG,Extensive O.R. procedure unrelated to principal diagnosis w MCC,,,117498.90
Deidentified Maximum,,982,DRG,Extensive O.R. procedure unrelated to principal diagnosis w CC,,,64805.70
Deidentified Maximum,,983,DRG,Extensive O.R. procedure unrelated to principal diagnosis w/o CC/MCC,,,42197.40
Deidentified Maximum,,987,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w MCC,,,83183.55
Deidentified Maximum,,988,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w CC,,,42857.85
Deidentified Maximum,,989,DRG,Non-extensive O.R. proc unrelated to principal diagnosis w/o CC/MCC,,,28455.45
Deindentified Minimum,,,,Boarder Baby,,,1245.00
Deindentified Minimum,,,,CCU,,,4250.00
Deindentified Minimum,,,,Clinic Visit,,,60.00
Deindentified Minimum,,,,ICU,,,4250.00
Deindentified Minimum,,,,Medical Surgical,,,2965.00
Deindentified Minimum,,,,Neo ICU,,,5129.00
Deindentified Minimum,,,,NICU/Newborn - Level I,,,946.00
Deindentified Minimum,,,,NICU/Newborn - Level II,,,4684.00
Deindentified Minimum,,,,NICU/Newborn - Level III,,,4684.00
Deindentified Minimum,,,,NICU/Newborn - Level IV,,,4684.00
Deindentified Minimum,,,,Pediatrics,,,4250.00
Deindentified Minimum,,,,Telemetry,,,5024.00
Deindentified Maximum,,,,Boarder Baby,,,1245.00
Deindentified Maximum,,,,CCU,,,6500.00
Deindentified Maximum,,,,Clinic Visit,,,60.00
Deindentified Maximum,,,,ICU,,,6500.00
Deindentified Maximum,,,,Medical Surgical,,,6500.00
Deindentified Maximum,,,,Neo ICU,,,5762.00
Deindentified Maximum,,,,NICU/Newborn - Level I,,,3973.00
Deindentified Maximum,,,,NICU/Newborn - Level II,,,7200.00
Deindentified Maximum,,,,NICU/Newborn - Level III,,,7200.00
Deindentified Maximum,,,,NICU/Newborn - Level IV,,,7200.00
Deindentified Maximum,,,,Pediatrics,,,5692.00
Deindentified Maximum,,,,Telemetry,,,6500.00
Deidentified Minimum,,0071T,CPT4/HCPCS,US LEIOMYOMATA ABLATE <200,,,1678.00
Deidentified Minimum,,0075T,CPT4/HCPCS,PERQ STENT/CHEST VERT ART,,,1291.00
Deidentified Minimum,,0124T,CPT4/HCPCS,CONJUNCTIVAL DRUG PLACEMENT,,,5029.00
Deidentified Minimum,,0202T,CPT4/HCPCS,POST VERT ARTHRPLST 1 LUMBAR,,,1291.00
Deidentified Minimum,,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,,987.78
Deidentified Minimum,,0249T,CPT4/HCPCS,LIGATION HEMORRHOID W/US,,,1678.88
Deidentified Minimum,,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,,1678.88
Deidentified Minimum,,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,,3544.00
Deidentified Minimum,,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,,3544.00
Deidentified Minimum,,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,,3544.00
Deidentified Minimum,,0272T,CPT4/HCPCS,INTERROGATE CRTD SNS DEV,,,987.78
Deidentified Minimum,,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,,1678.88
Deidentified Minimum,,0278T,CPT4/HCPCS,TEMPR,,,987.78
Deidentified Minimum,,0282T,CPT4/HCPCS,PERIPH FIELD STIMUL TRIAL,,,1678.88
Deidentified Minimum,,0294T,CPT4/HCPCS,INS LT ATRL MONT PRES LEAD,,,5281.00
Deidentified Minimum,,0307T,CPT4/HCPCS,RMVL ICAR ISCHM MNTRNG DVCE,,,3544.00
Deidentified Minimum,,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,,3656.00
Deidentified Minimum,,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,,5281.00
Deidentified Minimum,,0343T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,,8841.00
Deidentified Minimum,,0344T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,,8841.00
Deidentified Minimum,,0378T,CPT4/HCPCS,VISUAL FIELD ASSMNT REV/RPRT,,,6049.05
Deidentified Minimum,,0390T,CPT4/HCPCS,PERIPROC EVAL INPER LEDLS PM,,,7966.00
Deidentified Minimum,,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,,1678.00
Deidentified Minimum,,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,,1678.00
Deidentified Minimum,,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,,3198.57
Deidentified Minimum,,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,,987.78
Deidentified Minimum,,0424T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA COMPL,,,1678.88
Deidentified Minimum,,0426T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA STM LD,,,1678.00
Deidentified Minimum,,0431T,CPT4/HCPCS,RMVL/RPLC NSTIM APNEA PLS GN,,,1678.88
Deidentified Minimum,,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,,1678.00
Deidentified Minimum,,0444T,CPT4/HCPCS,1ST PLMT DRUG ELUT OC INS,,,1145.00
Deidentified Minimum,,0445T,CPT4/HCPCS,SBSQT PLMT DRUG ELUT OC INS,,,1145.00
Deidentified Minimum,,0446T,CPT4/HCPCS,INSJ IMPLTBL GLUCOSE SENSOR,,,1145.00
Deidentified Minimum,,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,,1145.00
Deidentified Minimum,,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,,987.78
Deidentified Minimum,,0527T,CPT4/HCPCS,INSJ/RPLCMT IIMS IMPLT MNTR,,,3544.00
Deidentified Minimum,,0530T,CPT4/HCPCS,REMOVAL COMPLETE IIMS,,,3544.00
Deidentified Minimum,,0537T,CPT4/HCPCS,BLD DRV T LYMPHCYT CAR-T CLL,,,1678.00
Deidentified Minimum,,0544T,CPT4/HCPCS,TCAT MV ANNULUS RCNSTJ,,,1291.00
Deidentified Minimum,,0569T,CPT4/HCPCS,TTVR PERQ APPR 1ST PROSTH,,,1291.00
Deidentified Minimum,,0588T,CPT4/HCPCS,REVISION/REMOVAL ISDNS PTN,,,1145.00
Deidentified Minimum,,10005,CPT4/HCPCS,FNA BX W/US GDN 1ST LES,,,1235.00
Deidentified Minimum,,10007,CPT4/HCPCS,FNA BX W/FLUOR GDN 1ST LES,,,1235.00
Deidentified Minimum,,10011,CPT4/HCPCS,FNA BX W/MR GDN 1ST LES,,,1235.00
Deidentified Minimum,,10022,CPT4/HCPCS,FNA W/IMAGE,,,1678.00
Deidentified Minimum,,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,,400.00
Deidentified Minimum,,10061,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,,1145.00
Deidentified Minimum,,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,,1291.00
Deidentified Minimum,,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,,987.78
Deidentified Minimum,,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,,1145.00
Deidentified Minimum,,11046,CPT4/HCPCS,DEB MUSC/FASCIA ADD-ON,,,1145.00
Deidentified Minimum,,11105,CPT4/HCPCS,PUNCH BX SKIN EA SEP/ADDL,,,1145.00
Deidentified Minimum,,11107,CPT4/HCPCS,INCAL BX SKN EA SEP/ADDL,,,1145.00
Deidentified Minimum,,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,,1291.00
Deidentified Minimum,,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,,1235.00
Deidentified Minimum,,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,1678.88
Deidentified Minimum,,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,1678.88
Deidentified Minimum,,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,1678.88
Deidentified Minimum,,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,,1235.00
Deidentified Minimum,,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,,1235.00
Deidentified Minimum,,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,,400.00
Deidentified Minimum,,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,,400.00
Deidentified Minimum,,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,,987.78
Deidentified Minimum,,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,,1145.00
Deidentified Minimum,,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,,987.78
Deidentified Minimum,,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,,400.00
Deidentified Minimum,,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,,1145.00
Deidentified Minimum,,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,,400.00
Deidentified Minimum,,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,,1145.00
Deidentified Minimum,,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,,1145.00
Deidentified Minimum,,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,,1145.00
Deidentified Minimum,,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,,1145.00
Deidentified Minimum,,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,,1291.00
Deidentified Minimum,,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,,1145.00
Deidentified Minimum,,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,,1678.88
Deidentified Minimum,,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,,1145.00
Deidentified Minimum,,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,,1678.88
Deidentified Minimum,,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,,1145.00
Deidentified Minimum,,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,,1145.00
Deidentified Minimum,,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,,1291.00
Deidentified Minimum,,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,,1145.00
Deidentified Minimum,,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,,1678.00
Deidentified Minimum,,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,,987.78
Deidentified Minimum,,15732,CPT4/HCPCS,MUSCLE-SKIN GRAFT HEAD/NECK,,,3544.00
Deidentified Minimum,,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,,3000.00
Deidentified Minimum,,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,,1291.00
Deidentified Minimum,,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,,3000.00
Deidentified Minimum,,15769,CPT4/HCPCS,GRFG AUTOL SOFT TISS DIR EXC,,,3000.00
Deidentified Minimum,,15773,CPT4/HCPCS,GRFG AUTOL FAT LIPO 25 CC/<,,,1291.00
Deidentified Minimum,,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,,1235.00
Deidentified Minimum,,15783,CPT4/HCPCS,DERMABRASION SUPRFL ANY SITE,,,987.78
Deidentified Minimum,,15792,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,,987.78
Deidentified Minimum,,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,,1678.88
Deidentified Minimum,,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,,1291.00
Deidentified Minimum,,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,3544.00
Deidentified Minimum,,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,4000.00
Deidentified Minimum,,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,3965.00
Deidentified Minimum,,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,4000.00
Deidentified Minimum,,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,,1145.00
Deidentified Minimum,,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,987.78
Deidentified Minimum,,17276,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17314,CPT4/HCPCS,MOHS ADDL STAGE T/A/L,,,1145.00
Deidentified Minimum,,17340,CPT4/HCPCS,CRYOTHERAPY OF SKIN,,,987.78
Deidentified Minimum,,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,,987.78
Deidentified Minimum,,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,,1291.00
Deidentified Minimum,,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,,1145.00
Deidentified Minimum,,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,,1145.00
Deidentified Minimum,,19318,CPT4/HCPCS,BREAST REDUCTION,,,4000.00
Deidentified Minimum,,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,,5029.00
Deidentified Minimum,,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,,5281.00
Deidentified Minimum,,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,,1291.00
Deidentified Minimum,,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,,987.78
Deidentified Minimum,,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,,400.00
Deidentified Minimum,,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,,2002.00
Deidentified Minimum,,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,,987.78
Deidentified Minimum,,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,,3198.57
Deidentified Minimum,,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,,1291.00
Deidentified Minimum,,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,,1291.00
Deidentified Minimum,,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,,1291.00
Deidentified Minimum,,20926,CPT4/HCPCS,REMOVAL OF TISSUE FOR GRAFT,,,5029.00
Deidentified Minimum,,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,,987.78
Deidentified Minimum,,20974,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,,987.78
Deidentified Minimum,,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,,1145.00
Deidentified Minimum,,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,,1678.88
Deidentified Minimum,,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,,1235.00
Deidentified Minimum,,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,,1678.88
Deidentified Minimum,,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,,3000.00
Deidentified Minimum,,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,,400.00
Deidentified Minimum,,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,,1291.00
Deidentified Minimum,,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,,1291.00
Deidentified Minimum,,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,,1291.00
Deidentified Minimum,,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,,1291.00
Deidentified Minimum,,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,,3000.00
Deidentified Minimum,,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,,5000.00
Deidentified Minimum,,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,,5730.00
Deidentified Minimum,,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,,5730.00
Deidentified Minimum,,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,,5730.00
Deidentified Minimum,,21282,CPT4/HCPCS,REVISION OF EYELID,,,1291.00
Deidentified Minimum,,21299,CPT4/HCPCS,CRANIO/MAXILLOFACIAL SURGERY,,,1145.00
Deidentified Minimum,,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,,1291.00
Deidentified Minimum,,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,,1291.00
Deidentified Minimum,,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,,3198.57
Deidentified Minimum,,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,,1291.00
Deidentified Minimum,,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,,5000.00
Deidentified Minimum,,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,,1291.00
Deidentified Minimum,,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,1291.00
Deidentified Minimum,,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,,1678.88
Deidentified Minimum,,21502,CPT4/HCPCS,DRAIN CHEST LESION,,,1678.88
Deidentified Minimum,,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,,1291.00
Deidentified Minimum,,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,,1678.88
Deidentified Minimum,,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,,3000.00
Deidentified Minimum,,21602,CPT4/HCPCS,EXC CH WAL TUM W/O LYMPHADEC,,,1291.00
Deidentified Minimum,,21615,CPT4/HCPCS,REMOVAL OF RIB,,,1291.00
Deidentified Minimum,,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,,1291.00
Deidentified Minimum,,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,,1291.00
Deidentified Minimum,,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,,1291.00
Deidentified Minimum,,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,,1291.00
Deidentified Minimum,,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,,3544.00
Deidentified Minimum,,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,,1291.00
Deidentified Minimum,,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,,1678.88
Deidentified Minimum,,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,,1291.00
Deidentified Minimum,,22207,CPT4/HCPCS,INCIS SPINE 3 COLUMN LUMBAR,,,1291.00
Deidentified Minimum,,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,,1291.00
Deidentified Minimum,,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,,1291.00
Deidentified Minimum,,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,,3000.00
Deidentified Minimum,,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,,1678.88
Deidentified Minimum,,22523,CPT4/HCPCS,PERCUT KYPHOPLASTY THOR,,,1678.88
Deidentified Minimum,,22524,CPT4/HCPCS,PERCUT KYPHOPLASTY LUMBAR,,,1678.88
Deidentified Minimum,,22533,CPT4/HCPCS,LAT LUMBAR SPINE FUSION,,,1291.00
Deidentified Minimum,,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,,3000.00
Deidentified Minimum,,22614,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,,1145.00
Deidentified Minimum,,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,,1291.00
Deidentified Minimum,,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,,1291.00
Deidentified Minimum,,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,2002.00
Deidentified Minimum,,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,,1291.00
Deidentified Minimum,,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,,1291.00
Deidentified Minimum,,22864,CPT4/HCPCS,REMOVE CERV ARTIF DISC,,,1291.00
Deidentified Minimum,,22865,CPT4/HCPCS,REMOVE LUMB ARTIF DISC,,,1291.00
Deidentified Minimum,,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,,3965.00
Deidentified Minimum,,22999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,,3544.00
Deidentified Minimum,,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,,1291.00
Deidentified Minimum,,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,,1678.88
Deidentified Minimum,,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,,4847.00
Deidentified Minimum,,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,,4000.00
Deidentified Minimum,,23331,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,,1678.00
Deidentified Minimum,,23332,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,,5029.00
Deidentified Minimum,,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,,3965.00
Deidentified Minimum,,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,,4847.00
Deidentified Minimum,,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,,5000.00
Deidentified Minimum,,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,,5730.00
Deidentified Minimum,,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,,4000.00
Deidentified Minimum,,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,6000.00
Deidentified Minimum,,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,5000.00
Deidentified Minimum,,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,5730.00
Deidentified Minimum,,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,,5281.00
Deidentified Minimum,,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,,3544.00
Deidentified Minimum,,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,,3544.00
Deidentified Minimum,,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,3544.00
Deidentified Minimum,,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4000.00
Deidentified Minimum,,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1145.00
Deidentified Minimum,,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,,1145.00
Deidentified Minimum,,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,,1145.00
Deidentified Minimum,,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,,3544.00
Deidentified Minimum,,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,,1678.00
Deidentified Minimum,,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,,3544.00
Deidentified Minimum,,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,,1291.00
Deidentified Minimum,,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,,1678.88
Deidentified Minimum,,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,,3000.00
Deidentified Minimum,,24220,CPT4/HCPCS,INJECTION FOR ELBOW X-RAY,,,1145.00
Deidentified Minimum,,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,,3544.00
Deidentified Minimum,,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,,3544.00
Deidentified Minimum,,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,,1678.88
Deidentified Minimum,,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,,1678.88
Deidentified Minimum,,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,,3000.00
Deidentified Minimum,,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,,3000.00
Deidentified Minimum,,24400,CPT4/HCPCS,REVISION OF HUMERUS,,,4000.00
Deidentified Minimum,,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,,3544.00
Deidentified Minimum,,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1678.88
Deidentified Minimum,,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,,3544.00
Deidentified Minimum,,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,,987.78
Deidentified Minimum,,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,1291.00
Deidentified Minimum,,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,,3544.00
Deidentified Minimum,,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,,3544.00
Deidentified Minimum,,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,,1235.00
Deidentified Minimum,,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,,3544.00
Deidentified Minimum,,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,,3544.00
Deidentified Minimum,,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,,3965.00
Deidentified Minimum,,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,,1678.88
Deidentified Minimum,,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,,3544.00
Deidentified Minimum,,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,,1678.00
Deidentified Minimum,,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,1678.88
Deidentified Minimum,,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,3544.00
Deidentified Minimum,,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,4000.00
Deidentified Minimum,,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,,3544.00
Deidentified Minimum,,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,,3544.00
Deidentified Minimum,,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,,3544.00
Deidentified Minimum,,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,,4000.00
Deidentified Minimum,,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,,5000.00
Deidentified Minimum,,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,3544.00
Deidentified Minimum,,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,4000.00
Deidentified Minimum,,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,5000.00
Deidentified Minimum,,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,987.78
Deidentified Minimum,,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,,5000.00
Deidentified Minimum,,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,,3544.00
Deidentified Minimum,,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,,1291.00
Deidentified Minimum,,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,3000.00
Deidentified Minimum,,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,,1291.00
Deidentified Minimum,,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,,1291.00
Deidentified Minimum,,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,,1678.88
Deidentified Minimum,,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,,1291.00
Deidentified Minimum,,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,,1291.00
Deidentified Minimum,,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,,1291.00
Deidentified Minimum,,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,,987.78
Deidentified Minimum,,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,,4000.00
Deidentified Minimum,,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,4000.00
Deidentified Minimum,,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,,3544.00
Deidentified Minimum,,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,,3544.00
Deidentified Minimum,,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,,1291.00
Deidentified Minimum,,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,,3544.00
Deidentified Minimum,,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,,1291.00
Deidentified Minimum,,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,,3544.00
Deidentified Minimum,,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,,3544.00
Deidentified Minimum,,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,,4847.00
Deidentified Minimum,,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,,3544.00
Deidentified Minimum,,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,,3000.00
Deidentified Minimum,,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,,1291.00
Deidentified Minimum,,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,,1291.00
Deidentified Minimum,,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,,1291.00
Deidentified Minimum,,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,,1145.00
Deidentified Minimum,,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,,1678.88
Deidentified Minimum,,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,,3544.00
Deidentified Minimum,,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,400.00
Deidentified Minimum,,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,3965.00
Deidentified Minimum,,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,1145.00
Deidentified Minimum,,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,987.78
Deidentified Minimum,,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,,3544.00
Deidentified Minimum,,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,,1678.00
Deidentified Minimum,,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,,1291.00
Deidentified Minimum,,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,,1291.00
Deidentified Minimum,,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,,1678.00
Deidentified Minimum,,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,,3544.00
Deidentified Minimum,,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,,1678.00
Deidentified Minimum,,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,,3965.00
Deidentified Minimum,,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,,3965.00
Deidentified Minimum,,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,,4847.00
Deidentified Minimum,,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,,4847.00
Deidentified Minimum,,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,,1291.00
Deidentified Minimum,,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,,1291.00
Deidentified Minimum,,27151,CPT4/HCPCS,INCISION OF HIP BONES,,,1291.00
Deidentified Minimum,,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,,3198.57
Deidentified Minimum,,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,,1291.00
Deidentified Minimum,,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,,1291.00
Deidentified Minimum,,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,,1291.00
Deidentified Minimum,,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,,1145.00
Deidentified Minimum,,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,,1291.00
Deidentified Minimum,,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,,1145.00
Deidentified Minimum,,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,,1235.00
Deidentified Minimum,,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,,1291.00
Deidentified Minimum,,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,,4000.00
Deidentified Minimum,,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,,1678.00
Deidentified Minimum,,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,,3544.00
Deidentified Minimum,,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,,4847.00
Deidentified Minimum,,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,,3544.00
Deidentified Minimum,,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,,3000.00
Deidentified Minimum,,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,,3544.00
Deidentified Minimum,,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,,4000.00
Deidentified Minimum,,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,,3000.00
Deidentified Minimum,,27470,CPT4/HCPCS,REPAIR OF THIGH,,,1291.00
Deidentified Minimum,,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,,1678.88
Deidentified Minimum,,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,1291.00
Deidentified Minimum,,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,,1291.00
Deidentified Minimum,,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,,1678.88
Deidentified Minimum,,27580,CPT4/HCPCS,FUSION OF KNEE,,,1291.00
Deidentified Minimum,,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,,1291.00
Deidentified Minimum,,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,,1291.00
Deidentified Minimum,,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,,1291.00
Deidentified Minimum,,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,,1291.00
Deidentified Minimum,,27648,CPT4/HCPCS,INJECTION FOR ANKLE X-RAY,,,1145.00
Deidentified Minimum,,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,,3544.00
Deidentified Minimum,,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,,3544.00
Deidentified Minimum,,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,,1678.88
Deidentified Minimum,,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,,1678.88
Deidentified Minimum,,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,,1678.88
Deidentified Minimum,,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,,1678.88
Deidentified Minimum,,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,,1291.00
Deidentified Minimum,,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,,1291.00
Deidentified Minimum,,27720,CPT4/HCPCS,REPAIR OF TIBIA,,,3000.00
Deidentified Minimum,,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,,4000.00
Deidentified Minimum,,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,,1291.00
Deidentified Minimum,,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,,3544.00
Deidentified Minimum,,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,1145.00
Deidentified Minimum,,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,,3544.00
Deidentified Minimum,,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,,1291.00
Deidentified Minimum,,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,,1678.88
Deidentified Minimum,,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,,3544.00
Deidentified Minimum,,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,,1678.88
Deidentified Minimum,,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,,3544.00
Deidentified Minimum,,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,,3544.00
Deidentified Minimum,,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,,3544.00
Deidentified Minimum,,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,,3544.00
Deidentified Minimum,,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,,3544.00
Deidentified Minimum,,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,,1235.00
Deidentified Minimum,,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,,3544.00
Deidentified Minimum,,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,,1678.00
Deidentified Minimum,,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,,3544.00
Deidentified Minimum,,28280,CPT4/HCPCS,FUSION OF TOES,,,1678.88
Deidentified Minimum,,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,,3544.00
Deidentified Minimum,,28290,CPT4/HCPCS,CORRECTION OF BUNION,,,1678.88
Deidentified Minimum,,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,3544.00
Deidentified Minimum,,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,,3544.00
Deidentified Minimum,,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,,400.00
Deidentified Minimum,,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,,400.00
Deidentified Minimum,,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,,1678.88
Deidentified Minimum,,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,,1678.88
Deidentified Minimum,,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,,3544.00
Deidentified Minimum,,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,,4000.00
Deidentified Minimum,,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,,4000.00
Deidentified Minimum,,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,,4000.00
Deidentified Minimum,,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,,5000.00
Deidentified Minimum,,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,,4000.00
Deidentified Minimum,,29020,CPT4/HCPCS,APPLICATION OF BODY CAST,,,1678.88
Deidentified Minimum,,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,,987.78
Deidentified Minimum,,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,,193.00
Deidentified Minimum,,29131,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,,987.78
Deidentified Minimum,,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,,193.00
Deidentified Minimum,,29450,CPT4/HCPCS,APPLICATION OF LEG CAST,,,987.78
Deidentified Minimum,,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,,4000.00
Deidentified Minimum,,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,,4000.00
Deidentified Minimum,,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,,3000.00
Deidentified Minimum,,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,78320,CPT4/HCPCS,BONE IMAGING (3D),,,2978.36
Deidentified Minimum,,78351,CPT4/HCPCS,BONE MINERAL DUAL PHOTON,,,81.31
Deidentified Minimum,,78428,CPT4/HCPCS,CARDIAC SHUNT IMAGING,,,142.00
Deidentified Minimum,,78445,CPT4/HCPCS,VASCULAR FLOW IMAGING,,,142.00
Deidentified Minimum,,78453,CPT4/HCPCS,HT MUSCLE IMAGE PLANAR SING,,,142.00
Deidentified Minimum,,78466,CPT4/HCPCS,HEART INFARCT IMAGE,,,142.00
Deidentified Minimum,,78468,CPT4/HCPCS,HEART INFARCT IMAGE (EF),,,142.00
Deidentified Minimum,,78469,CPT4/HCPCS,HEART INFARCT IMAGE (3D),,,142.00
Deidentified Minimum,,78472,CPT4/HCPCS,GATED HEART PLANAR SINGLE,,,142.00
Deidentified Minimum,,78473,CPT4/HCPCS,GATED HEART MULTIPLE,,,142.00
Deidentified Minimum,,78481,CPT4/HCPCS,HEART FIRST PASS SINGLE,,,142.00
Deidentified Minimum,,78492,CPT4/HCPCS,MYOCRD IMG PET MLT RST&STRS,,,142.00
Deidentified Minimum,,78496,CPT4/HCPCS,HEART FIRST PASS ADD-ON,,,142.00
Deidentified Minimum,,78579,CPT4/HCPCS,LUNG VENTILATION IMAGING,,,142.00
Deidentified Minimum,,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,,142.00
Deidentified Minimum,,78600,CPT4/HCPCS,BRAIN IMAGE < 4 VIEWS,,,142.00
Deidentified Minimum,,78601,CPT4/HCPCS,BRAIN IMAGE W/FLOW < 4 VIEWS,,,142.00
Deidentified Minimum,,78605,CPT4/HCPCS,BRAIN IMAGE 4+ VIEWS,,,142.00
Deidentified Minimum,,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,,142.00
Deidentified Minimum,,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,,142.00
Deidentified Minimum,,78645,CPT4/HCPCS,CSF SHUNT EVALUATION,,,142.00
Deidentified Minimum,,78701,CPT4/HCPCS,KIDNEY IMAGING WITH FLOW,,,142.00
Deidentified Minimum,,78709,CPT4/HCPCS,K FLOW/FUNCT IMAGE MULTIPLE,,,142.00
Deidentified Minimum,,78813,CPT4/HCPCS,PET IMAGE FULL BODY,,,142.00
Deidentified Minimum,,80150,CPT4/HCPCS,ASSAY OF AMIKACIN,,,96.00
Deidentified Minimum,,80158,CPT4/HCPCS,DRUG ASSAY CYCLOSPORINE,,,96.00
Deidentified Minimum,,80176,CPT4/HCPCS,ASSAY OF LIDOCAINE,,,96.00
Deidentified Minimum,,80197,CPT4/HCPCS,ASSAY OF TACROLIMUS,,,96.00
Deidentified Minimum,,80199,CPT4/HCPCS,DRUG SCREEN QUANT TIAGABINE,,,96.00
Deidentified Minimum,,80200,CPT4/HCPCS,ASSAY OF TOBRAMYCIN,,,96.00
Deidentified Minimum,,80336,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 3-5,,,0.08
Deidentified Minimum,,80344,CPT4/HCPCS,ANTIPSYCHOTICS NOS 7/MORE,,,0.08
Deidentified Minimum,,80345,CPT4/HCPCS,DRUG SCREENING BARBITURATES,,,0.08
Deidentified Minimum,,80355,CPT4/HCPCS,GABAPENTIN NON-BLOOD,,,0.08
Deidentified Minimum,,80374,CPT4/HCPCS,STEREOISOMER ANALYSIS,,,0.08
Deidentified Minimum,,80375,CPT4/HCPCS,DRUG/SUBSTANCE NOS 1-3,,,0.08
Deidentified Minimum,,80377,CPT4/HCPCS,DRUG/SUBSTANCE NOS 7/MORE,,,0.08
Deidentified Minimum,,80424,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,,96.00
Deidentified Minimum,,80428,CPT4/HCPCS,GROWTH HORMONE PANEL,,,96.00
Deidentified Minimum,,81001,CPT4/HCPCS,URINALYSIS AUTO W/SCOPE,,,31.75
Deidentified Minimum,,81002,CPT4/HCPCS,URINALYSIS NONAUTO W/O SCOPE,,,25.70
Deidentified Minimum,,81015,CPT4/HCPCS,MICROSCOPIC EXAM OF URINE,,,30.57
Deidentified Minimum,,81050,CPT4/HCPCS,URINALYSIS VOLUME MEASURE,,,30.15
Deidentified Minimum,,81105,CPT4/HCPCS,HPA-1 GENOTYPING,,,150.00
Deidentified Minimum,,81120,CPT4/HCPCS,IDH1 COMMON VARIANTS,,,150.00
Deidentified Minimum,,81121,CPT4/HCPCS,IDH2 COMMON VARIANTS,,,150.00
Deidentified Minimum,,81162,CPT4/HCPCS,BRCA1&2 GEN FULL SEQ DUP/DEL,,,150.00
Deidentified Minimum,,81164,CPT4/HCPCS,BRCA1&2 GEN FUL DUP/DEL ALYS,,,150.00
Deidentified Minimum,,81171,CPT4/HCPCS,AFF2 GENE DETC ABNOR ALLELES,,,150.00
Deidentified Minimum,,81202,CPT4/HCPCS,APC GENE KNOWN FAM VARIANTS,,,150.00
Deidentified Minimum,,81208,CPT4/HCPCS,BCR/ABL1 GENE OTHER BP,,,150.00
Deidentified Minimum,,81210,CPT4/HCPCS,BRAF GENE,,,150.00
Deidentified Minimum,,81215,CPT4/HCPCS,BRCA1 GENE KNOWN FAMIL VRNT,,,150.00
Deidentified Minimum,,81222,CPT4/HCPCS,CFTR GENE DUP/DELET VARIANTS,,,150.00
Deidentified Minimum,,81226,CPT4/HCPCS,CYP2D6 GENE COM VARIANTS,,,150.00
Deidentified Minimum,,81228,CPT4/HCPCS,CYTOGEN MICRARRAY COPY NMBR,,,150.00
Deidentified Minimum,,81232,CPT4/HCPCS,DPYD GENE COMMON VARIANTS,,,150.00
Deidentified Minimum,,81233,CPT4/HCPCS,BTK GENE COMMON VARIANTS,,,150.00
Deidentified Minimum,,81238,CPT4/HCPCS,F9 FULL GENE SEQUENCE,,,150.00
Deidentified Minimum,,81242,CPT4/HCPCS,FANCC GENE,,,150.00
Deidentified Minimum,,81244,CPT4/HCPCS,FMR1 GENE CHARAC ALLELES,,,141.70
Deidentified Minimum,,81263,CPT4/HCPCS,IGH VARI REGIONAL MUTATION,,,150.00
Deidentified Minimum,,81268,CPT4/HCPCS,CHIMERISM ANAL W/CELL SELECT,,,150.00
Deidentified Minimum,,81292,CPT4/HCPCS,MLH1 GENE FULL SEQ,,,150.00
Deidentified Minimum,,81300,CPT4/HCPCS,MSH6 GENE DUP/DELETE VARIANT,,,150.00
Deidentified Minimum,,81315,CPT4/HCPCS,PML/RARALPHA COM BREAKPOINTS,,,150.00
Deidentified Minimum,,81319,CPT4/HCPCS,PMS2 GENE DUP/DELET VARIANTS,,,150.00
Deidentified Minimum,,81322,CPT4/HCPCS,PTEN GENE KNOWN FAM VARIANT,,,150.00
Deidentified Minimum,,81330,CPT4/HCPCS,SMPD1 GENE COMMON VARIANTS,,,150.00
Deidentified Minimum,,81343,CPT4/HCPCS,PPP2R2B GEN DETC ABNOR ALLEL,,,150.00
Deidentified Minimum,,81375,CPT4/HCPCS,HLA II TYPING AG EQUIV LR,,,150.00
Deidentified Minimum,,81380,CPT4/HCPCS,HLA I TYPING 1 LOCUS HR,,,150.00
Deidentified Minimum,,81382,CPT4/HCPCS,HLA II TYPING 1 LOC HR,,,150.00
Deidentified Minimum,,81401,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 2,,,150.00
Deidentified Minimum,,81402,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 3,,,150.00
Deidentified Minimum,,81403,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 4,,,150.00
Deidentified Minimum,,81405,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 6,,,150.00
Deidentified Minimum,,81406,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 7,,,150.00
Deidentified Minimum,,81414,CPT4/HCPCS,CAR ION CHNNLPATH INC 2 GNS,,,96.00
Deidentified Minimum,,81422,CPT4/HCPCS,FETAL CHRMOML MICRODELTJ,,,96.00
Deidentified Minimum,,81425,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,,0.08
Deidentified Minimum,,81427,CPT4/HCPCS,GENOME RE-EVALUATION,,,0.08
Deidentified Minimum,,81442,CPT4/HCPCS,NOONAN SPECTRUM DISORDERS,,,96.00
Deidentified Minimum,,81448,CPT4/HCPCS,HRDTRY PERPH NEURPHY PANEL,,,96.00
Deidentified Minimum,,81493,CPT4/HCPCS,COR ARTERY DISEASE MRNA,,,96.00
Deidentified Minimum,,81503,CPT4/HCPCS,ONCO (OVAR) FIVE PROTEINS,,,96.00
Deidentified Minimum,,81507,CPT4/HCPCS,FETAL ANEUPLOIDY TRISOM RISK,,,96.00
Deidentified Minimum,,81510,CPT4/HCPCS,FTL CGEN ABNOR THREE ANAL,,,96.00
Deidentified Minimum,,81519,CPT4/HCPCS,ONCOLOGY BREAST MRNA,,,96.00
Deidentified Minimum,,81528,CPT4/HCPCS,ONCOLOGY COLORECTAL SCR,,,96.00
Deidentified Minimum,,81540,CPT4/HCPCS,ONCOLOGY TUM UNKNOWN ORIGIN,,,96.00
Deidentified Minimum,,81545,CPT4/HCPCS,ONCOLOGY THYROID,,,96.00
Deidentified Minimum,,81595,CPT4/HCPCS,CARDIOLOGY HRT TRNSPL MRNA,,,96.00
Deidentified Minimum,,81596,CPT4/HCPCS,NFCT DS CHRNC HCV 6 ASSAYS,,,96.00
Deidentified Minimum,,82030,CPT4/HCPCS,ASSAY OF ADP & AMP,,,96.00
Deidentified Minimum,,82042,CPT4/HCPCS,OTHER SOURCE ALBUMIN QUAN EA,,,32.92
Deidentified Minimum,,82127,CPT4/HCPCS,AMINO ACID SINGLE QUAL,,,96.00
Deidentified Minimum,,82131,CPT4/HCPCS,AMINO ACIDS SINGLE QUANT,,,96.00
Deidentified Minimum,,82139,CPT4/HCPCS,AMINO ACIDS QUAN 6 OR MORE,,,96.00
Deidentified Minimum,,82154,CPT4/HCPCS,ANDROSTANEDIOL GLUCURONIDE,,,96.00
Deidentified Minimum,,82190,CPT4/HCPCS,ATOMIC ABSORPTION,,,96.00
Deidentified Minimum,,82272,CPT4/HCPCS,OCCULT BLD FECES 1-3 TESTS,,,32.67
Deidentified Minimum,,82274,CPT4/HCPCS,ASSAY TEST FOR BLOOD FECAL,,,96.00
Deidentified Minimum,,82306,CPT4/HCPCS,VITAMIN D 25 HYDROXY,,,96.00
Deidentified Minimum,,82373,CPT4/HCPCS,ASSAY C-D TRANSFER MEASURE,,,96.00
Deidentified Minimum,,82374,CPT4/HCPCS,ASSAY BLOOD CARBON DIOXIDE,,,49.14
Deidentified Minimum,,82380,CPT4/HCPCS,ASSAY OF CAROTENE,,,92.65
Deidentified Minimum,,82387,CPT4/HCPCS,ASSAY OF CATHEPSIN-D,,,96.00
Deidentified Minimum,,82415,CPT4/HCPCS,ASSAY OF CHLORAMPHENICOL,,,96.00
Deidentified Minimum,,82441,CPT4/HCPCS,TEST FOR CHLOROHYDROCARBONS,,,60.31
Deidentified Minimum,,82485,CPT4/HCPCS,ASSAY CHONDROITIN SULFATE,,,96.00
Deidentified Minimum,,82523,CPT4/HCPCS,COLLAGEN CROSSLINKS,,,96.00
Deidentified Minimum,,82530,CPT4/HCPCS,CORTISOL FREE,,,96.00
Deidentified Minimum,,82533,CPT4/HCPCS,TOTAL CORTISOL,,,96.00
Deidentified Minimum,,82608,CPT4/HCPCS,B-12 BINDING CAPACITY,,,96.00
Deidentified Minimum,,82610,CPT4/HCPCS,CYSTATIN C,,,96.00
Deidentified Minimum,,82664,CPT4/HCPCS,ELECTROPHORETIC TEST,,,96.00
Deidentified Minimum,,82668,CPT4/HCPCS,ASSAY OF ERYTHROPOIETIN,,,96.00
Deidentified Minimum,,82693,CPT4/HCPCS,ASSAY OF ETHYLENE GLYCOL,,,96.00
Deidentified Minimum,,82728,CPT4/HCPCS,ASSAY OF FERRITIN,,,96.00
Deidentified Minimum,,83003,CPT4/HCPCS,ASSAY GROWTH HORMONE (HGH),,,96.00
Deidentified Minimum,,83009,CPT4/HCPCS,H PYLORI (C-13) BLOOD,,,96.00
Deidentified Minimum,,83014,CPT4/HCPCS,H PYLORI DRUG ADMIN,,,78.96
Deidentified Minimum,,83065,CPT4/HCPCS,ASSAY OF HEMOGLOBIN HEAT,,,69.21
Deidentified Minimum,,83090,CPT4/HCPCS,ASSAY OF HOMOCYSTINE,,,96.00
Deidentified Minimum,,83520,CPT4/HCPCS,IMMUNOASSAY QUANT NOS NONAB,,,96.00
Deidentified Minimum,,83528,CPT4/HCPCS,ASSAY OF INTRINSIC FACTOR,,,96.00
Deidentified Minimum,,83550,CPT4/HCPCS,IRON BINDING TEST,,,70.30
Deidentified Minimum,,83570,CPT4/HCPCS,ASSAY OF IDH ENZYME,,,88.87
Deidentified Minimum,,83655,CPT4/HCPCS,ASSAY OF LEAD,,,96.00
Deidentified Minimum,,83670,CPT4/HCPCS,ASSAY OF LAP ENZYME,,,92.14
Deidentified Minimum,,83700,CPT4/HCPCS,LIPOPRO BLD ELECTROPHORETIC,,,96.00
Deidentified Minimum,,83721,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,,95.84
Deidentified Minimum,,83735,CPT4/HCPCS,ASSAY OF MAGNESIUM,,,67.36
Deidentified Minimum,,83789,CPT4/HCPCS,MASS SPECTROMETRY QUAL/QUAN,,,96.00
Deidentified Minimum,,83861,CPT4/HCPCS,MICROFLUID ANALY TEARS,,,96.00
Deidentified Minimum,,83874,CPT4/HCPCS,ASSAY OF MYOGLOBIN,,,96.00
Deidentified Minimum,,83880,CPT4/HCPCS,ASSAY OF NATRIURETIC PEPTIDE,,,96.00
Deidentified Minimum,,83918,CPT4/HCPCS,ORGANIC ACIDS TOTAL QUANT,,,96.00
Deidentified Minimum,,83935,CPT4/HCPCS,ASSAY OF URINE OSMOLALITY,,,68.46
Deidentified Minimum,,83987,CPT4/HCPCS,EXHALED BREATH CONDENSATE,,,96.00
Deidentified Minimum,,83992,CPT4/HCPCS,ASSAY FOR PHENCYCLIDINE,,,0.08
Deidentified Minimum,,84085,CPT4/HCPCS,ASSAY OF RBC PG6D ENZYME,,,67.78
Deidentified Minimum,,84087,CPT4/HCPCS,ASSAY PHOSPHOHEXOSE ENZYMES,,,96.00
Deidentified Minimum,,84110,CPT4/HCPCS,ASSAY OF PORPHOBILINOGEN,,,84.84
Deidentified Minimum,,84112,CPT4/HCPCS,EVAL AMNIOTIC FLUID PROTEIN,,,96.00
Deidentified Minimum,,84143,CPT4/HCPCS,ASSAY OF 17-HYDROXYPREGNENO,,,96.00
Deidentified Minimum,,84144,CPT4/HCPCS,ASSAY OF PROGESTERONE,,,96.00
Deidentified Minimum,,84146,CPT4/HCPCS,ASSAY OF PROLACTIN,,,96.00
Deidentified Minimum,,84154,CPT4/HCPCS,ASSAY OF PSA FREE,,,96.00
Deidentified Minimum,,84165,CPT4/HCPCS,PROTEIN E-PHORESIS SERUM,,,96.00
Deidentified Minimum,,84182,CPT4/HCPCS,PROTEIN WESTERN BLOT TEST,,,96.00
Deidentified Minimum,,84233,CPT4/HCPCS,ASSAY OF ESTROGEN,,,96.00
Deidentified Minimum,,84275,CPT4/HCPCS,ASSAY OF SIALIC ACID,,,96.00
Deidentified Minimum,,84295,CPT4/HCPCS,ASSAY OF SERUM SODIUM,,,48.30
Deidentified Minimum,,84305,CPT4/HCPCS,ASSAY OF SOMATOMEDIN,,,96.00
Deidentified Minimum,,84392,CPT4/HCPCS,ASSAY OF URINE SULFATE,,,47.71
Deidentified Minimum,,84425,CPT4/HCPCS,ASSAY OF VITAMIN B-1,,,96.00
Deidentified Minimum,,84437,CPT4/HCPCS,ASSAY OF NEONATAL THYROXINE,,,65.01
Deidentified Minimum,,84439,CPT4/HCPCS,ASSAY OF FREE THYROXINE,,,90.63
Deidentified Minimum,,84449,CPT4/HCPCS,ASSAY OF TRANSCORTIN,,,96.00
Deidentified Minimum,,84478,CPT4/HCPCS,ASSAY OF TRIGLYCERIDES,,,57.87
Deidentified Minimum,,84479,CPT4/HCPCS,ASSAY OF THYROID (T3 OR T4),,,65.01
Deidentified Minimum,,84512,CPT4/HCPCS,ASSAY OF TROPONIN QUAL,,,77.36
Deidentified Minimum,,84577,CPT4/HCPCS,ASSAY OF FECES/UROBILINOGEN,,,96.00
Deidentified Minimum,,84585,CPT4/HCPCS,ASSAY OF URINE VMA,,,96.00
Deidentified Minimum,,84600,CPT4/HCPCS,ASSAY OF VOLATILES,,,96.00
Deidentified Minimum,,84620,CPT4/HCPCS,XYLOSE TOLERANCE TEST,,,96.00
Deidentified Minimum,,84703,CPT4/HCPCS,CHORIONIC GONADOTROPIN ASSAY,,,75.43
Deidentified Minimum,,85025,CPT4/HCPCS,COMPLETE CBC W/AUTO DIFF WBC,,,78.12
Deidentified Minimum,,85044,CPT4/HCPCS,MANUAL RETICULOCYTE COUNT,,,43.17
Deidentified Minimum,,85245,CPT4/HCPCS,CLOT FACTOR VIII VW RISTOCTN,,,96.00
Deidentified Minimum,,85246,CPT4/HCPCS,CLOT FACTOR VIII VW ANTIGEN,,,96.00
Deidentified Minimum,,85247,CPT4/HCPCS,CLOT FACTOR VIII MULTIMETRIC,,,96.00
Deidentified Minimum,,85270,CPT4/HCPCS,CLOT FACTOR XI PTA,,,96.00
Deidentified Minimum,,85303,CPT4/HCPCS,CLOT INHIBIT PROT C ACTIVITY,,,96.00
Deidentified Minimum,,85307,CPT4/HCPCS,ASSAY ACTIVATED PROTEIN C,,,96.00
Deidentified Minimum,,85378,CPT4/HCPCS,FIBRIN DEGRADE SEMIQUANT,,,71.65
Deidentified Minimum,,85380,CPT4/HCPCS,FIBRIN DEGRADJ D-DIMER,,,96.00
Deidentified Minimum,,85400,CPT4/HCPCS,FIBRINOLYTIC PLASMIN,,,88.87
Deidentified Minimum,,85441,CPT4/HCPCS,HEINZ BODIES DIRECT,,,42.25
Deidentified Minimum,,85460,CPT4/HCPCS,HEMOGLOBIN FETAL,,,77.78
Deidentified Minimum,,85461,CPT4/HCPCS,HEMOGLOBIN FETAL,,,66.69
Deidentified Minimum,,85536,CPT4/HCPCS,IRON STAIN PERIPHERAL BLOOD,,,65.01
Deidentified Minimum,,85540,CPT4/HCPCS,WBC ALKALINE PHOSPHATASE,,,86.43
Deidentified Minimum,,85549,CPT4/HCPCS,MURAMIDASE,,,96.00
Deidentified Minimum,,85597,CPT4/HCPCS,PHOSPHOLIPID PLTLT NEUTRALIZ,,,96.00
Deidentified Minimum,,85660,CPT4/HCPCS,RBC SICKLE CELL TEST,,,55.43
Deidentified Minimum,,86003,CPT4/HCPCS,ALLG SPEC IGE CRUDE XTRC EA,,,52.41
Deidentified Minimum,,86008,CPT4/HCPCS,ALLG SPEC IGE RECOMB EA,,,96.00
Deidentified Minimum,,86038,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES,,,96.00
Deidentified Minimum,,86152,CPT4/HCPCS,CELL ENUMERATION & ID,,,96.00
Deidentified Minimum,,86162,CPT4/HCPCS,COMPLEMENT TOTAL (CH50),,,96.00
Deidentified Minimum,,86171,CPT4/HCPCS,COMPLEMENT FIXATION EACH,,,96.00
Deidentified Minimum,,86225,CPT4/HCPCS,DNA ANTIBODY NATIVE,,,96.00
Deidentified Minimum,,86226,CPT4/HCPCS,DNA ANTIBODY SINGLE STRAND,,,96.00
Deidentified Minimum,,86336,CPT4/HCPCS,INHIBIN A,,,96.00
Deidentified Minimum,,86355,CPT4/HCPCS,B CELLS TOTAL COUNT,,,96.00
Deidentified Minimum,,86403,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY SCRN,,,96.00
Deidentified Minimum,,86485,CPT4/HCPCS,SKIN TEST CANDIDA,,,96.00
Deidentified Minimum,,86606,CPT4/HCPCS,ASPERGILLUS ANTIBODY,,,96.00
Deidentified Minimum,,86615,CPT4/HCPCS,BORDETELLA ANTIBODY,,,96.00
Deidentified Minimum,,86628,CPT4/HCPCS,CANDIDA ANTIBODY,,,96.00
Deidentified Minimum,,86632,CPT4/HCPCS,CHLAMYDIA IGM ANTIBODY,,,96.00
Deidentified Minimum,,86638,CPT4/HCPCS,Q FEVER ANTIBODY,,,96.00
Deidentified Minimum,,86648,CPT4/HCPCS,DIPHTHERIA ANTIBODY,,,96.00
Deidentified Minimum,,86671,CPT4/HCPCS,FUNGUS NES ANTIBODY,,,96.00
Deidentified Minimum,,86677,CPT4/HCPCS,HELICOBACTER PYLORI ANTIBODY,,,96.00
Deidentified Minimum,,86688,CPT4/HCPCS,HTLV-II ANTIBODY,,,96.00
Deidentified Minimum,,86696,CPT4/HCPCS,HERPES SIMPLEX TYPE 2 TEST,,,96.00
Deidentified Minimum,,86702,CPT4/HCPCS,HIV-2 ANTIBODY,,,96.00
Deidentified Minimum,,86704,CPT4/HCPCS,HEP B CORE ANTIBODY TOTAL,,,96.00
Deidentified Minimum,,86732,CPT4/HCPCS,MUCORMYCOSIS ANTIBODY,,,96.00
Deidentified Minimum,,86757,CPT4/HCPCS,RICKETTSIA ANTIBODY,,,96.00
Deidentified Minimum,,86778,CPT4/HCPCS,TOXOPLASMA ANTIBODY IGM,,,96.00
Deidentified Minimum,,86788,CPT4/HCPCS,WEST NILE VIRUS AB IGM,,,96.00
Deidentified Minimum,,86803,CPT4/HCPCS,HEPATITIS C AB TEST,,,96.00
Deidentified Minimum,,86806,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,,96.00
Deidentified Minimum,,86860,CPT4/HCPCS,RBC ANTIBODY ELUTION,,,96.00
Deidentified Minimum,,86880,CPT4/HCPCS,COOMBS TEST DIRECT,,,54.01
Deidentified Minimum,,86900,CPT4/HCPCS,BLOOD TYPING SEROLOGIC ABO,,,29.98
Deidentified Minimum,,86902,CPT4/HCPCS,BLOOD TYPE ANTIGEN DONOR EA,,,38.38
Deidentified Minimum,,86920,CPT4/HCPCS,COMPATIBILITY TEST SPIN,,,96.00
Deidentified Minimum,,86960,CPT4/HCPCS,VOL REDUCTION OF BLOOD/PROD,,,96.00
Deidentified Minimum,,86970,CPT4/HCPCS,RBC PRETX INCUBATJ W/CHEMICL,,,96.00
Deidentified Minimum,,86971,CPT4/HCPCS,RBC PRETX INCUBATJ W/ENZYMES,,,96.00
Deidentified Minimum,,87003,CPT4/HCPCS,SMALL ANIMAL INOCULATION,,,96.00
Deidentified Minimum,,87015,CPT4/HCPCS,SPECIMEN INFECT AGNT CONCNTJ,,,67.11
Deidentified Minimum,,87084,CPT4/HCPCS,CULTURE OF SPECIMEN BY KIT,,,86.52
Deidentified Minimum,,87140,CPT4/HCPCS,CULTURE TYPE IMMUNOFLUORESC,,,55.94
Deidentified Minimum,,87143,CPT4/HCPCS,CULTURE TYPING GLC/HPLC,,,96.00
Deidentified Minimum,,87158,CPT4/HCPCS,CULTURE TYPING ADDED METHOD,,,52.58
Deidentified Minimum,,87184,CPT4/HCPCS,MICROBE SUSCEPTIBLE DISK,,,69.29
Deidentified Minimum,,87206,CPT4/HCPCS,SMEAR FLUORESCENT/ACID STAI,,,54.01
Deidentified Minimum,,87253,CPT4/HCPCS,VIRUS INOCULATE TISSUE ADDL,,,96.00
Deidentified Minimum,,87260,CPT4/HCPCS,ADENOVIRUS AG IF,,,93.32
Deidentified Minimum,,87280,CPT4/HCPCS,RESPIRATORY SYNCYTIAL AG IF,,,93.32
Deidentified Minimum,,87281,CPT4/HCPCS,PNEUMOCYSTIS CARINII AG IF,,,93.32
Deidentified Minimum,,87285,CPT4/HCPCS,TREPONEMA PALLIDUM AG IF,,,93.32
Deidentified Minimum,,87336,CPT4/HCPCS,ENTAMOEB HIST DISPR AG IA,,,93.32
Deidentified Minimum,,87337,CPT4/HCPCS,ENTAMOEB HIST GROUP AG IA,,,93.32
Deidentified Minimum,,87340,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,,96.00
Deidentified Minimum,,87389,CPT4/HCPCS,HIV-1 AG W/HIV-1 & HIV-2 AB,,,96.00
Deidentified Minimum,,87400,CPT4/HCPCS,INFLUENZA A/B AG IA,,,93.32
Deidentified Minimum,,87425,CPT4/HCPCS,ROTAVIRUS AG IA,,,93.32
Deidentified Minimum,,87449,CPT4/HCPCS,AG DETECT NOS IA MULT,,,93.32
Deidentified Minimum,,87450,CPT4/HCPCS,AG DETECT NOS IA SINGLE,,,34.27
Deidentified Minimum,,87481,CPT4/HCPCS,CANDIDA DNA AMP PROBE,,,96.00
Deidentified Minimum,,87482,CPT4/HCPCS,CANDIDA DNA QUANT,,,96.00
Deidentified Minimum,,87487,CPT4/HCPCS,CHYLMD PNEUM DNA QUANT,,,96.00
Deidentified Minimum,,87495,CPT4/HCPCS,CYTOMEG DNA DIR PROBE,,,96.00
Deidentified Minimum,,87501,CPT4/HCPCS,INFLUENZA DNA AMP PROB 1+,,,96.00
Deidentified Minimum,,87534,CPT4/HCPCS,HIV-1 DNA DIR PROBE,,,96.00
Deidentified Minimum,,87539,CPT4/HCPCS,HIV-2 QUANT&REVRSE TRNSCRIPJ,,,96.00
Deidentified Minimum,,87550,CPT4/HCPCS,MYCOBACTERIA DNA DIR PROBE,,,96.00
Deidentified Minimum,,87592,CPT4/HCPCS,N.GONORRHOEAE DNA QUANT,,,96.00
Deidentified Minimum,,87633,CPT4/HCPCS,RESP VIRUS 12-25 TARGETS,,,96.00
Deidentified Minimum,,87634,CPT4/HCPCS,RSV DNA/RNA AMP PROBE,,,96.00
Deidentified Minimum,,87797,CPT4/HCPCS,DETECT AGENT NOS DNA DIR,,,96.00
Deidentified Minimum,,87798,CPT4/HCPCS,DETECT AGENT NOS DNA AMP,,,96.00
Deidentified Minimum,,87801,CPT4/HCPCS,DETECT AGNT MULT DNA AMPLI,,,96.00
Deidentified Minimum,,87899,CPT4/HCPCS,AGENT NOS ASSAY W/OPTIC,,,93.32
Deidentified Minimum,,87906,CPT4/HCPCS,GENOTYPE DNA/RNA HIV,,,96.00
Deidentified Minimum,,87910,CPT4/HCPCS,GENOTYPE CYTOMEGALOVIRUS,,,96.00
Deidentified Minimum,,88007,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,96.00
Deidentified Minimum,,88036,CPT4/HCPCS,LIMITED AUTOPSY,,,96.00
Deidentified Minimum,,88130,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,,96.00
Deidentified Minimum,,88143,CPT4/HCPCS,CYTOPATH C/V THIN LAYER REDO,,,96.00
Deidentified Minimum,,88162,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,,96.00
Deidentified Minimum,,88166,CPT4/HCPCS,CYTOPATH TBS C/V AUTO REDO,,,96.00
Deidentified Minimum,,88245,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,,96.00
Deidentified Minimum,,88269,CPT4/HCPCS,CHROMOSOME ANALYS AMNIOTIC,,,96.00
Deidentified Minimum,,88291,CPT4/HCPCS,CYTO/MOLECULAR REPORT,,,89.87
Deidentified Minimum,,88313,CPT4/HCPCS,SPECIAL STAINS GROUP 2,,,96.00
Deidentified Minimum,,88344,CPT4/HCPCS,IMMUNOHISTO ANTIBODY SLIDE,,,96.00
Deidentified Minimum,,88348,CPT4/HCPCS,ELECTRON MICROSCOPY,,,96.00
Deidentified Minimum,,88381,CPT4/HCPCS,MICRODISSECTION MANUAL,,,96.00
Deidentified Minimum,,88388,CPT4/HCPCS,TISS EX MOLECUL STUDY ADD-ON,,,37.29
Deidentified Minimum,,88738,CPT4/HCPCS,HGB QUANT TRANSCUTANEOUS,,,50.40
Deidentified Minimum,,88741,CPT4/HCPCS,TRANSCUTANEOUS METHB,,,50.40
Deidentified Minimum,,89253,CPT4/HCPCS,EMBRYO HATCHING,,,96.00
Deidentified Minimum,,89261,CPT4/HCPCS,SPERM ISOLATION COMPLEX,,,96.00
Deidentified Minimum,,89272,CPT4/HCPCS,EXTENDED CULTURE OF OOCYTES,,,96.00
Deidentified Minimum,,89300,CPT4/HCPCS,SEMEN ANALYSIS W/HUHNER,,,89.62
Deidentified Minimum,,89320,CPT4/HCPCS,SEMEN ANAL VOL/COUNT/MOT,,,96.00
Deidentified Minimum,,89322,CPT4/HCPCS,SEMEN ANAL STRICT CRITERIA,,,96.00
Deidentified Minimum,,89329,CPT4/HCPCS,SPERM EVALUATION TEST,,,96.00
Deidentified Minimum,,89331,CPT4/HCPCS,RETROGRADE EJACULATION ANAL,,,96.00
Deidentified Minimum,,90805,CPT4/HCPCS,PSYTX OFF 20-30 MIN W/E&M,,,127.58
Deidentified Minimum,,90809,CPT4/HCPCS,PSYTX OFF 75-80 W/E&M,,,283.25
Deidentified Minimum,,90814,CPT4/HCPCS,INTAC PSYTX OFF 75-80 MIN,,,274.41
Deidentified Minimum,,90822,CPT4/HCPCS,PSYTX HOSP 75-80 MIN W/E&M,,,340.22
Deidentified Minimum,,90829,CPT4/HCPCS,INTAC PSYTX HSP 75-80 W/E&M,,,345.81
Deidentified Minimum,,90862,CPT4/HCPCS,MEDICATION MANAGEMENT,,,137.97
Deidentified Minimum,,90875,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,,150.86
Deidentified Minimum,,90876,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,,231.88
Deidentified Minimum,,90880,CPT4/HCPCS,HYPNOTHERAPY,,,207.83
Deidentified Minimum,,90913,CPT4/HCPCS,BFB TRAINING EA ADDL 15 MIN,,,193.00
Deidentified Minimum,,91034,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX TEST,,,1145.00
Deidentified Minimum,,91112,CPT4/HCPCS,GI WIRELESS CAPSULE MEASURE,,,1291.00
Deidentified Minimum,,92004,CPT4/HCPCS,EYE EXAM NEW PATIENT,,,834.11
Deidentified Minimum,,92012,CPT4/HCPCS,EYE EXAM ESTABLISH PATIENT,,,503.67
Deidentified Minimum,,92015,CPT4/HCPCS,DETERMINE REFRACTIVE STATE,,,720.97
Deidentified Minimum,,92025,CPT4/HCPCS,CORNEAL TOPOGRAPHY,,,158.00
Deidentified Minimum,,92065,CPT4/HCPCS,ORTHOPTIC/PLEOPTIC TRAINING,,,191.69
Deidentified Minimum,,92226,CPT4/HCPCS,SPECIAL EYE EXAM SUBSEQUENT,,,105.08
Deidentified Minimum,,92250,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,,740.21
Deidentified Minimum,,92260,CPT4/HCPCS,OPHTHALMOSCOPY/DYNAMOMETRY,,,129.13
Deidentified Minimum,,92283,CPT4/HCPCS,COLOR VISION EXAMINATION,,,369.72
Deidentified Minimum,,92311,CPT4/HCPCS,CONTACT LENS FITTING,,,536.57
Deidentified Minimum,,92317,CPT4/HCPCS,RX CORNEOSCLERAL CNTACT LENS,,,456.32
Deidentified Minimum,,92342,CPT4/HCPCS,FIT SPECTACLES MULTIFOCAL,,,369.72
Deidentified Minimum,,92352,CPT4/HCPCS,FIT APHAKIA SPECTCL MONOFOCL,,,331.23
Deidentified Minimum,,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,,554.25
Deidentified Minimum,,92504,CPT4/HCPCS,EAR MICROSCOPY EXAMINATION,,,244.62
Deidentified Minimum,,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,,193.00
Deidentified Minimum,,92524,CPT4/HCPCS,BEHAVRAL QUALIT ANALYS VOICE,,,288.00
Deidentified Minimum,,92541,CPT4/HCPCS,SPONTANEOUS NYSTAGMUS TEST,,,383.38
Deidentified Minimum,,92542,CPT4/HCPCS,POSITIONAL NYSTAGMUS TEST,,,441.12
Deidentified Minimum,,92546,CPT4/HCPCS,SINUSOIDAL ROTATIONAL TEST,,,811.61
Deidentified Minimum,,92550,CPT4/HCPCS,TYMPANOMETRY & REFLEX THRESH,,,105.08
Deidentified Minimum,,92556,CPT4/HCPCS,SPEECH AUDIOMETRY COMPLETE,,,298.47
Deidentified Minimum,,92588,CPT4/HCPCS,EVOKED AUDITORY TST COMPLETE,,,759.75
Deidentified Minimum,,92608,CPT4/HCPCS,EX FOR SPEECH DEVICE RX ADDL,,,342.55
Deidentified Minimum,,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,,193.00
Deidentified Minimum,,92615,CPT4/HCPCS,LARYNGOSCOPIC SENSORY I&R,,,188.58
Deidentified Minimum,,92627,CPT4/HCPCS,EVAL AUD FUNCJ EA ADDL 15,,,272.70
Deidentified Minimum,,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,,5831.00
Deidentified Minimum,,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,,5831.00
Deidentified Minimum,,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,,5831.00
Deidentified Minimum,,92973,CPT4/HCPCS,PRQ CORONARY MECH THROMBECT,,,1145.00
Deidentified Minimum,,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,,1145.00
Deidentified Minimum,,92982,CPT4/HCPCS,CORONARY ARTERY DILATION,,,2491.09
Deidentified Minimum,,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,1291.00
Deidentified Minimum,,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,,5029.00
Deidentified Minimum,,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,,1678.88
Deidentified Minimum,,93260,CPT4/HCPCS,PRGRMG DEV EVAL IMPLTBL SYS,,,190.42
Deidentified Minimum,,93271,CPT4/HCPCS,ECG/MONITORING AND ANALYSIS,,,1867.82
Deidentified Minimum,,93278,CPT4/HCPCS,ECG/SIGNAL-AVERAGED,,,198.66
Deidentified Minimum,,93279,CPT4/HCPCS,PRGRMG DEV EVAL PM/LDLS PM,,,162.37
Deidentified Minimum,,93291,CPT4/HCPCS,INTERROG DEV EVAL SCRMS IP,,,138.09
Deidentified Minimum,,93295,CPT4/HCPCS,DEV INTERROG REMOTE 1/2/MLT,,,541.04
Deidentified Minimum,,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,,608.00
Deidentified Minimum,,93307,CPT4/HCPCS,TTE W/O DOPPLER COMPLETE,,,608.00
Deidentified Minimum,,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,608.00
Deidentified Minimum,,93313,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,125.25
Deidentified Minimum,,93315,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,522.27
Deidentified Minimum,,93321,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,,189.58
Deidentified Minimum,,93351,CPT4/HCPCS,STRESS TTE COMPLETE,,,608.00
Deidentified Minimum,,93355,CPT4/HCPCS,ECHO TRANSESOPHAGEAL (TEE),,,7966.00
Deidentified Minimum,,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,,2998.00
Deidentified Minimum,,93562,CPT4/HCPCS,CARD OUTPUT MEASURE SUBSQ,,,1145.00
Deidentified Minimum,,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,,1145.00
Deidentified Minimum,,93571,CPT4/HCPCS,HEART FLOW RESERVE MEASURE,,,1145.00
Deidentified Minimum,,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,,5222.42
Deidentified Minimum,,93590,CPT4/HCPCS,PERQ TRANSCATH CLS MITRAL,,,8797.00
Deidentified Minimum,,93592,CPT4/HCPCS,PERQ TRANSCATH CLOSURE EACH,,,1145.00
Deidentified Minimum,,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,,995.52
Deidentified Minimum,,93618,CPT4/HCPCS,HEART RHYTHM PACING,,,1678.00
Deidentified Minimum,,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,1999.75
Deidentified Minimum,,93652,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,3816.25
Deidentified Minimum,,93786,CPT4/HCPCS,AMBL BP MNTR W/SW REC ONLY,,,441.88
Deidentified Minimum,,93788,CPT4/HCPCS,AMBL BP MNTR W/SW A/R,,,249.43
Deidentified Minimum,,93790,CPT4/HCPCS,AMBL BP MNTR W/SW I&R,,,66.59
Deidentified Minimum,,93886,CPT4/HCPCS,INTRACRANIAL COMPLETE STUDY,,,1364.91
Deidentified Minimum,,93888,CPT4/HCPCS,INTRACRANIAL LIMITED STUDY,,,554.31
Deidentified Minimum,,93893,CPT4/HCPCS,TCD EMBOLI DETECT W/INJ,,,857.30
Deidentified Minimum,,93895,CPT4/HCPCS,CAROTID INTIMA ATHEROMA EVAL,,,627.14
Deidentified Minimum,,93965,CPT4/HCPCS,EXTREMITY STUDY,,,885.63
Deidentified Minimum,,93970,CPT4/HCPCS,EXTREMITY STUDY,,,1364.91
Deidentified Minimum,,93976,CPT4/HCPCS,VASCULAR STUDY,,,1361.89
Deidentified Minimum,,93982,CPT4/HCPCS,ANEURYSM PRESSURE SENS STUDY,,,388.95
Deidentified Minimum,,94150,CPT4/HCPCS,VITAL CAPACITY TEST,,,220.56
Deidentified Minimum,,94400,CPT4/HCPCS,CO2 BREATHING RESPONSE CURVE,,,370.63
Deidentified Minimum,,94610,CPT4/HCPCS,SURFACTANT ADMIN THRU TUBE,,,273.30
Deidentified Minimum,,94620,CPT4/HCPCS,PULMONARY STRESS TEST/SIMPLE,,,1108.52
Deidentified Minimum,,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,,3544.00
Deidentified Minimum,,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,,3544.00
Deidentified Minimum,,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,,3544.00
Deidentified Minimum,,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,,3965.00
Deidentified Minimum,,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,,3544.00
Deidentified Minimum,,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,,1678.88
Deidentified Minimum,,28309,CPT4/HCPCS,INCISION OF METATARSALS,,,4000.00
Deidentified Minimum,,28310,CPT4/HCPCS,REVISION OF BIG TOE,,,3544.00
Deidentified Minimum,,28312,CPT4/HCPCS,REVISION OF TOE,,,3544.00
Deidentified Minimum,,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,,1145.00
Deidentified Minimum,,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,,3544.00
Deidentified Minimum,,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,,3544.00
Deidentified Minimum,,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,,3544.00
Deidentified Minimum,,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,1145.00
Deidentified Minimum,,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,1678.88
Deidentified Minimum,,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,,3544.00
Deidentified Minimum,,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,,987.78
Deidentified Minimum,,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,,987.78
Deidentified Minimum,,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,,987.78
Deidentified Minimum,,29075,CPT4/HCPCS,APPLICATION OF FOREARM CAST,,,987.78
Deidentified Minimum,,29086,CPT4/HCPCS,APPLY FINGER CAST,,,399.10
Deidentified Minimum,,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,,193.00
Deidentified Minimum,,29425,CPT4/HCPCS,APPLY SHORT LEG CAST,,,987.78
Deidentified Minimum,,29530,CPT4/HCPCS,STRAPPING OF KNEE,,,138.45
Deidentified Minimum,,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,,1145.00
Deidentified Minimum,,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,,987.78
Deidentified Minimum,,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,,4000.00
Deidentified Minimum,,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,,3544.00
Deidentified Minimum,,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,,3544.00
Deidentified Minimum,,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,,5783.00
Deidentified Minimum,,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,,3544.00
Deidentified Minimum,,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,,3544.00
Deidentified Minimum,,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,,1678.88
Deidentified Minimum,,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,,1291.00
Deidentified Minimum,,30120,CPT4/HCPCS,REVISION OF NOSE,,,1678.00
Deidentified Minimum,,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,,1291.00
Deidentified Minimum,,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,,4000.00
Deidentified Minimum,,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,,3544.00
Deidentified Minimum,,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,,3000.00
Deidentified Minimum,,31296,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT SINS,,,3198.57
Deidentified Minimum,,31400,CPT4/HCPCS,REVISION OF LARYNX,,,3000.00
Deidentified Minimum,,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,,1145.00
Deidentified Minimum,,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,,3000.00
Deidentified Minimum,,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,,1145.00
Deidentified Minimum,,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,,3000.00
Deidentified Minimum,,31588,CPT4/HCPCS,REVISION OF LARYNX,,,5281.00
Deidentified Minimum,,31590,CPT4/HCPCS,REINNERVATE LARYNX,,,5000.00
Deidentified Minimum,,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,,1145.00
Deidentified Minimum,,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,,1678.88
Deidentified Minimum,,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,,1291.00
Deidentified Minimum,,31656,CPT4/HCPCS,BRONCHOSCOPY INJ FOR X-RAY,,,1678.00
Deidentified Minimum,,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,,1291.00
Deidentified Minimum,,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,,1291.00
Deidentified Minimum,,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,,1291.00
Deidentified Minimum,,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,,1291.00
Deidentified Minimum,,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,,1291.00
Deidentified Minimum,,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,,1291.00
Deidentified Minimum,,32488,CPT4/HCPCS,COMPLETION PNEUMONECTOMY,,,1291.00
Deidentified Minimum,,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,,1678.00
Deidentified Minimum,,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,,400.00
Deidentified Minimum,,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,,1235.00
Deidentified Minimum,,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,,3544.00
Deidentified Minimum,,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,,3544.00
Deidentified Minimum,,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,,1291.00
Deidentified Minimum,,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,,987.78
Deidentified Minimum,,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,,987.78
Deidentified Minimum,,32852,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,,1291.00
Deidentified Minimum,,32856,CPT4/HCPCS,PREPARE DONOR LUNG DOUBLE,,,1291.00
Deidentified Minimum,,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,,3000.00
Deidentified Minimum,,33025,CPT4/HCPCS,INCISION OF HEART SAC,,,1291.00
Deidentified Minimum,,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,,1291.00
Deidentified Minimum,,33203,CPT4/HCPCS,INSERT EPICARD ELTRD ENDO,,,1291.00
Deidentified Minimum,,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,,3000.00
Deidentified Minimum,,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,,1678.88
Deidentified Minimum,,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,,1291.00
Deidentified Minimum,,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,,987.78
Deidentified Minimum,,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,,3000.00
Deidentified Minimum,,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,,1291.00
Deidentified Minimum,,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,,1291.00
Deidentified Minimum,,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,,1291.00
Deidentified Minimum,,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,,1291.00
Deidentified Minimum,,33413,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,,1291.00
Deidentified Minimum,,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,,1291.00
Deidentified Minimum,,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,,1291.00
Deidentified Minimum,,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,,1291.00
Deidentified Minimum,,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,,1291.00
Deidentified Minimum,,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,,1291.00
Deidentified Minimum,,33530,CPT4/HCPCS,CORONARY ARTERY BYPASS/REOP,,,1291.00
Deidentified Minimum,,33536,CPT4/HCPCS,CABG ARTERIAL FOUR OR MORE,,,1291.00
Deidentified Minimum,,33606,CPT4/HCPCS,ANASTOMOSIS/ARTERY-AORTA,,,1291.00
Deidentified Minimum,,33619,CPT4/HCPCS,REPAIR SINGLE VENTRICLE,,,1291.00
Deidentified Minimum,,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,,1291.00
Deidentified Minimum,,33622,CPT4/HCPCS,REDO COMPL CARDIAC ANOMALY,,,1291.00
Deidentified Minimum,,33645,CPT4/HCPCS,REVISION OF HEART VEINS,,,1291.00
Deidentified Minimum,,33660,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,1291.00
Deidentified Minimum,,33724,CPT4/HCPCS,REPAIR VENOUS ANOMALY,,,1291.00
Deidentified Minimum,,33771,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1291.00
Deidentified Minimum,,33774,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1291.00
Deidentified Minimum,,33778,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1291.00
Deidentified Minimum,,33782,CPT4/HCPCS,NIKAIDOH PROC,,,1291.00
Deidentified Minimum,,33786,CPT4/HCPCS,REPAIR ARTERIAL TRUNK,,,1291.00
Deidentified Minimum,,33803,CPT4/HCPCS,REPAIR VESSEL DEFECT,,,1291.00
Deidentified Minimum,,33822,CPT4/HCPCS,REVISE MAJOR VESSEL,,,6588.00
Deidentified Minimum,,33840,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,,1291.00
Deidentified Minimum,,33845,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,,1291.00
Deidentified Minimum,,33870,CPT4/HCPCS,TRANSVERSE AORTIC ARCH GRAFT,,,8841.00
Deidentified Minimum,,33884,CPT4/HCPCS,ENDOVASC PROSTH TAA ADD-ON,,,1291.00
Deidentified Minimum,,33889,CPT4/HCPCS,ARTERY TRANSPOSE/ENDOVAS TAA,,,1291.00
Deidentified Minimum,,33916,CPT4/HCPCS,SURGERY OF GREAT VESSEL,,,1291.00
Deidentified Minimum,,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,,987.78
Deidentified Minimum,,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,,987.78
Deidentified Minimum,,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,987.78
Deidentified Minimum,,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,987.78
Deidentified Minimum,,33967,CPT4/HCPCS,INSERT I-AORT PERCUT DEVICE,,,5029.00
Deidentified Minimum,,33968,CPT4/HCPCS,REMOVE AORTIC ASSIST DEVICE,,,2002.00
Deidentified Minimum,,33974,CPT4/HCPCS,REMOVE INTRA-AORTIC BALLOON,,,1291.00
Deidentified Minimum,,33976,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,,1291.00
Deidentified Minimum,,33977,CPT4/HCPCS,REMOVE VENTRICULAR DEVICE,,,1291.00
Deidentified Minimum,,34151,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,,1291.00
Deidentified Minimum,,34502,CPT4/HCPCS,RECONSTRUCT VENA CAVA,,,1291.00
Deidentified Minimum,,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,,3544.00
Deidentified Minimum,,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,,1291.00
Deidentified Minimum,,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,,1291.00
Deidentified Minimum,,34717,CPT4/HCPCS,EVASC RPR A-ILIAC NDGFT,,,1291.00
Deidentified Minimum,,34718,CPT4/HCPCS,EVASC RPR N/A A-ILIAC NDGFT,,,1291.00
Deidentified Minimum,,34804,CPT4/HCPCS,ENDOVAS AAA REPR W/1-P PART,,,5783.00
Deidentified Minimum,,34806,CPT4/HCPCS,ANEURYSM PRESS SENSOR ADD-ON,,,1678.88
Deidentified Minimum,,34820,CPT4/HCPCS,OPN ILIAC ART EXPOS,,,1291.00
Deidentified Minimum,,34834,CPT4/HCPCS,OPN BRACH ART EXPOS,,,1291.00
Deidentified Minimum,,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,,987.78
Deidentified Minimum,,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,,987.78
Deidentified Minimum,,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,4000.00
Deidentified Minimum,,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,3000.00
Deidentified Minimum,,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,3000.00
Deidentified Minimum,,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1235.00
Deidentified Minimum,,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,3000.00
Deidentified Minimum,,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35450,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,3544.00
Deidentified Minimum,,35460,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,,3544.00
Deidentified Minimum,,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,,1291.00
Deidentified Minimum,,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,,1291.00
Deidentified Minimum,,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,,1291.00
Deidentified Minimum,,35623,CPT4/HCPCS,ART BYP AXILLARY-POP-TIBIAL,,,1291.00
Deidentified Minimum,,35637,CPT4/HCPCS,ART BYP AORTOILIAC,,,1291.00
Deidentified Minimum,,35638,CPT4/HCPCS,ART BYP AORTOBI-ILIAC,,,1291.00
Deidentified Minimum,,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,,1291.00
Deidentified Minimum,,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,,1291.00
Deidentified Minimum,,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,,1291.00
Deidentified Minimum,,35695,CPT4/HCPCS,ART TRNSPOSJ CAROTID SUBCLAV,,,1291.00
Deidentified Minimum,,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,,5029.00
Deidentified Minimum,,35884,CPT4/HCPCS,REVISE GRAFT W/VEIN,,,5029.00
Deidentified Minimum,,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,,1291.00
Deidentified Minimum,,36012,CPT4/HCPCS,PLACE CATHETER IN VEIN,,,1145.00
Deidentified Minimum,,36216,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,1145.00
Deidentified Minimum,,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,,3000.00
Deidentified Minimum,,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,,3000.00
Deidentified Minimum,,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,,3000.00
Deidentified Minimum,,36246,CPT4/HCPCS,INS CATH ABD/L-EXT ART 2ND,,,1145.00
Deidentified Minimum,,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,,3000.00
Deidentified Minimum,,36299,CPT4/HCPCS,VESSEL INJECTION PROCEDURE,,,1145.00
Deidentified Minimum,,36468,CPT4/HCPCS,NJX SCLRSNT SPIDER VEINS,,,1145.00
Deidentified Minimum,,36471,CPT4/HCPCS,NJX SCLRSNT MLT INCMPTNT VN,,,1145.00
Deidentified Minimum,,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,,1145.00
Deidentified Minimum,,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,,1235.00
Deidentified Minimum,,36570,CPT4/HCPCS,INSERT PICVAD CATH,,,3198.57
Deidentified Minimum,,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,,1678.00
Deidentified Minimum,,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,,1678.00
Deidentified Minimum,,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,,1235.00
Deidentified Minimum,,36800,CPT4/HCPCS,INSERTION OF CANNULA,,,3544.00
Deidentified Minimum,,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,,3000.00
Deidentified Minimum,,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,,1291.00
Deidentified Minimum,,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,,1291.00
Deidentified Minimum,,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,,1145.00
Deidentified Minimum,,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,,3000.00
Deidentified Minimum,,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,,1678.88
Deidentified Minimum,,37206,CPT4/HCPCS,TRANSCATH IV STENT/PERC ADDL,,,1678.88
Deidentified Minimum,,37209,CPT4/HCPCS,CHANGE IV CATH AT THROMB TX,,,1678.00
Deidentified Minimum,,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,,987.78
Deidentified Minimum,,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,,3000.00
Deidentified Minimum,,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,,3000.00
Deidentified Minimum,,37252,CPT4/HCPCS,INTRVASC US NONCORONARY 1ST,,,1145.00
Deidentified Minimum,,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,,4847.00
Deidentified Minimum,,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,,1291.00
Deidentified Minimum,,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,,1235.00
Deidentified Minimum,,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,,1291.00
Deidentified Minimum,,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,,1291.00
Deidentified Minimum,,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,,3544.00
Deidentified Minimum,,38129,CPT4/HCPCS,LAPAROSCOPE PROC SPLEEN,,,3000.00
Deidentified Minimum,,38204,CPT4/HCPCS,BL DONOR SEARCH MANAGEMENT,,,1678.00
Deidentified Minimum,,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,,1291.00
Deidentified Minimum,,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,,1291.00
Deidentified Minimum,,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,,1291.00
Deidentified Minimum,,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,,3544.00
Deidentified Minimum,,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,,3000.00
Deidentified Minimum,,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,,1678.88
Deidentified Minimum,,38999,CPT4/HCPCS,BLOOD/LYMPH SYSTEM PROCEDURE,,,1145.00
Deidentified Minimum,,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,,1291.00
Deidentified Minimum,,39599,CPT4/HCPCS,DIAPHRAGM SURGERY PROCEDURE,,,1291.00
Deidentified Minimum,,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,,1291.00
Deidentified Minimum,,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,,1678.88
Deidentified Minimum,,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,,5029.00
Deidentified Minimum,,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,987.78
Deidentified Minimum,,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1145.00
Deidentified Minimum,,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1291.00
Deidentified Minimum,,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1145.00
Deidentified Minimum,,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,,1678.00
Deidentified Minimum,,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,,1291.00
Deidentified Minimum,,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,,1291.00
Deidentified Minimum,,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,,1145.00
Deidentified Minimum,,41870,CPT4/HCPCS,GUM GRAFT,,,1291.00
Deidentified Minimum,,41899,CPT4/HCPCS,DENTAL SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,,1291.00
Deidentified Minimum,,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,,1145.00
Deidentified Minimum,,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,,5730.00
Deidentified Minimum,,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,,3965.00
Deidentified Minimum,,42660,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,,400.00
Deidentified Minimum,,42800,CPT4/HCPCS,BIOPSY OF THROAT,,,1235.00
Deidentified Minimum,,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,,5000.00
Deidentified Minimum,,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,,3965.00
Deidentified Minimum,,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,,3965.00
Deidentified Minimum,,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,,3965.00
Deidentified Minimum,,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,,3544.00
Deidentified Minimum,,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,,1678.88
Deidentified Minimum,,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,,1291.00
Deidentified Minimum,,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,,1291.00
Deidentified Minimum,,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,,1291.00
Deidentified Minimum,,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,,1291.00
Deidentified Minimum,,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,,1291.00
Deidentified Minimum,,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,,1678.88
Deidentified Minimum,,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,,1291.00
Deidentified Minimum,,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,,1291.00
Deidentified Minimum,,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,,1291.00
Deidentified Minimum,,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,,1291.00
Deidentified Minimum,,43243,CPT4/HCPCS,EGD INJECTION VARICES,,,1291.00
Deidentified Minimum,,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,,1291.00
Deidentified Minimum,,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,,5000.00
Deidentified Minimum,,43289,CPT4/HCPCS,LAPAROSCOPE PROC ESOPH,,,3000.00
Deidentified Minimum,,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,,1291.00
Deidentified Minimum,,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,,1291.00
Deidentified Minimum,,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,,1291.00
Deidentified Minimum,,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,,1291.00
Deidentified Minimum,,43458,CPT4/HCPCS,DILATE ESOPHAGUS,,,1678.88
Deidentified Minimum,,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,,1291.00
Deidentified Minimum,,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,,1291.00
Deidentified Minimum,,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,,1291.00
Deidentified Minimum,,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,,987.78
Deidentified Minimum,,43762,CPT4/HCPCS,RPLC GTUBE NO REVJ TRC,,,1145.00
Deidentified Minimum,,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,,1291.00
Deidentified Minimum,,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,,1291.00
Deidentified Minimum,,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,,1291.00
Deidentified Minimum,,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,,1678.00
Deidentified Minimum,,43999,CPT4/HCPCS,STOMACH SURGERY PROCEDURE,,,1291.00
Deidentified Minimum,,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,,1291.00
Deidentified Minimum,,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,,1291.00
Deidentified Minimum,,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,,1291.00
Deidentified Minimum,,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,,1291.00
Deidentified Minimum,,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,,1291.00
Deidentified Minimum,,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,1291.00
Deidentified Minimum,,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,,1291.00
Deidentified Minimum,,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,,1291.00
Deidentified Minimum,,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,,1291.00
Deidentified Minimum,,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,,3544.00
Deidentified Minimum,,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,,1291.00
Deidentified Minimum,,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,,1291.00
Deidentified Minimum,,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,,1291.00
Deidentified Minimum,,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,,1291.00
Deidentified Minimum,,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,,1291.00
Deidentified Minimum,,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,,1291.00
Deidentified Minimum,,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,,1291.00
Deidentified Minimum,,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,,2002.00
Deidentified Minimum,,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,,1291.00
Deidentified Minimum,,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,,1291.00
Deidentified Minimum,,44960,CPT4/HCPCS,APPENDECTOMY,,,1291.00
Deidentified Minimum,,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,,1291.00
Deidentified Minimum,,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,,1291.00
Deidentified Minimum,,45126,CPT4/HCPCS,PELVIC EXENTERATION,,,1291.00
Deidentified Minimum,,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,,1291.00
Deidentified Minimum,,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,,1678.88
Deidentified Minimum,,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,,2002.00
Deidentified Minimum,,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,,1291.00
Deidentified Minimum,,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,,1678.00
Deidentified Minimum,,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,,1235.00
Deidentified Minimum,,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,,1291.00
Deidentified Minimum,,45383,CPT4/HCPCS,LESION REMOVAL COLONOSCOPY,,,1678.00
Deidentified Minimum,,45387,CPT4/HCPCS,COLONOSCOPY W/STENT,,,1678.00
Deidentified Minimum,,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,,1291.00
Deidentified Minimum,,45400,CPT4/HCPCS,LAPAROSCOPIC PROC,,,1291.00
Deidentified Minimum,,45500,CPT4/HCPCS,REPAIR OF RECTUM,,,1678.88
Deidentified Minimum,,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,,1291.00
Deidentified Minimum,,45999,CPT4/HCPCS,RECTUM SURGERY PROCEDURE,,,1235.00
Deidentified Minimum,,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,,1291.00
Deidentified Minimum,,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,,1291.00
Deidentified Minimum,,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,,1291.00
Deidentified Minimum,,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,,3544.00
Deidentified Minimum,,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,,3544.00
Deidentified Minimum,,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,,3544.00
Deidentified Minimum,,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,,1291.00
Deidentified Minimum,,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,,1291.00
Deidentified Minimum,,46615,CPT4/HCPCS,ANOSCOPY,,,1678.00
Deidentified Minimum,,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,,3544.00
Deidentified Minimum,,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,,3544.00
Deidentified Minimum,,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,,1678.00
Deidentified Minimum,,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,,1291.00
Deidentified Minimum,,47001,CPT4/HCPCS,NEEDLE BIOPSY LIVER ADD-ON,,,1145.00
Deidentified Minimum,,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,,1291.00
Deidentified Minimum,,47143,CPT4/HCPCS,PREP DONOR LIVER WHOLE,,,1291.00
Deidentified Minimum,,47145,CPT4/HCPCS,PREP DONOR LIVER LOBE SPLIT,,,1291.00
Deidentified Minimum,,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,,1291.00
Deidentified Minimum,,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,,1678.00
Deidentified Minimum,,47510,CPT4/HCPCS,INSERT CATHETER BILE DUCT,,,1678.88
Deidentified Minimum,,47530,CPT4/HCPCS,REVISE/REINSERT BILE TUBE,,,1678.00
Deidentified Minimum,,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,,1678.00
Deidentified Minimum,,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,,1678.00
Deidentified Minimum,,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,,1678.00
Deidentified Minimum,,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,,1145.00
Deidentified Minimum,,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,,1145.00
Deidentified Minimum,,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,,3544.00
Deidentified Minimum,,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,,1291.00
Deidentified Minimum,,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,,1291.00
Deidentified Minimum,,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,,1291.00
Deidentified Minimum,,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,,1291.00
Deidentified Minimum,,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,,1291.00
Deidentified Minimum,,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,,1291.00
Deidentified Minimum,,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,,1291.00
Deidentified Minimum,,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,,1291.00
Deidentified Minimum,,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,,1291.00
Deidentified Minimum,,48154,CPT4/HCPCS,PANCREATECTOMY,,,1291.00
Deidentified Minimum,,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,,1291.00
Deidentified Minimum,,48545,CPT4/HCPCS,PANCREATORRHAPHY,,,1291.00
Deidentified Minimum,,48554,CPT4/HCPCS,TRANSPL ALLOGRAFT PANCREAS,,,3198.57
Deidentified Minimum,,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,,1291.00
Deidentified Minimum,,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,,1678.88
Deidentified Minimum,,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,,1291.00
Deidentified Minimum,,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,,1291.00
Deidentified Minimum,,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,,3000.00
Deidentified Minimum,,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,,4000.00
Deidentified Minimum,,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,,4847.00
Deidentified Minimum,,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,,5029.00
Deidentified Minimum,,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,,1678.88
Deidentified Minimum,,50065,CPT4/HCPCS,INCISION OF KIDNEY,,,1291.00
Deidentified Minimum,,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,,3000.00
Deidentified Minimum,,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,,1291.00
Deidentified Minimum,,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,,1291.00
Deidentified Minimum,,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,,1291.00
Deidentified Minimum,,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,,1291.00
Deidentified Minimum,,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,,1291.00
Deidentified Minimum,,50329,CPT4/HCPCS,PREP RENAL GRAFT/URETERAL,,,1291.00
Deidentified Minimum,,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,,1678.88
Deidentified Minimum,,50398,CPT4/HCPCS,CHANGE KIDNEY TUBE,,,1678.00
Deidentified Minimum,,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,,1235.00
Deidentified Minimum,,50437,CPT4/HCPCS,DILAT XST TRC NEW ACCESS RCS,,,1678.00
Deidentified Minimum,,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,,1291.00
Deidentified Minimum,,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,,1291.00
Deidentified Minimum,,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,,5000.00
Deidentified Minimum,,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,,5000.00
Deidentified Minimum,,50546,CPT4/HCPCS,LAPAROSCOPIC NEPHRECTOMY,,,1291.00
Deidentified Minimum,,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,,1291.00
Deidentified Minimum,,50549,CPT4/HCPCS,LAPAROSCOPE PROC RENAL,,,3000.00
Deidentified Minimum,,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,,1678.00
Deidentified Minimum,,50715,CPT4/HCPCS,RELEASE OF URETER,,,1291.00
Deidentified Minimum,,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,,1291.00
Deidentified Minimum,,50728,CPT4/HCPCS,REVISE URETER,,,1291.00
Deidentified Minimum,,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,,1291.00
Deidentified Minimum,,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,,1145.00
Deidentified Minimum,,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,,1678.00
Deidentified Minimum,,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,,5000.00
Deidentified Minimum,,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,,1678.88
Deidentified Minimum,,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,,1145.00
Deidentified Minimum,,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,,1291.00
Deidentified Minimum,,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,,3544.00
Deidentified Minimum,,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,,3965.00
Deidentified Minimum,,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,1291.00
Deidentified Minimum,,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,,1291.00
Deidentified Minimum,,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,,1145.00
Deidentified Minimum,,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,,1291.00
Deidentified Minimum,,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,,1678.88
Deidentified Minimum,,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,,3544.00
Deidentified Minimum,,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,,3965.00
Deidentified Minimum,,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,,1678.00
Deidentified Minimum,,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,,1291.00
Deidentified Minimum,,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,,3000.00
Deidentified Minimum,,31599,CPT4/HCPCS,LARYNX SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,,1291.00
Deidentified Minimum,,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,,1678.88
Deidentified Minimum,,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,,1291.00
Deidentified Minimum,,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,,1291.00
Deidentified Minimum,,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,,1678.88
Deidentified Minimum,,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,,1291.00
Deidentified Minimum,,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,,1678.88
Deidentified Minimum,,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,,1678.88
Deidentified Minimum,,31715,CPT4/HCPCS,INJECTION FOR BRONCHUS X-RAY,,,1678.00
Deidentified Minimum,,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,,1678.88
Deidentified Minimum,,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,,1291.00
Deidentified Minimum,,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,,1291.00
Deidentified Minimum,,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,,1291.00
Deidentified Minimum,,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,,1291.00
Deidentified Minimum,,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,,1291.00
Deidentified Minimum,,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,,1291.00
Deidentified Minimum,,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,,1291.00
Deidentified Minimum,,32421,CPT4/HCPCS,THORACENTESIS FOR ASPIRATION,,,1678.00
Deidentified Minimum,,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,,1291.00
Deidentified Minimum,,32484,CPT4/HCPCS,SEGMENTECTOMY,,,1291.00
Deidentified Minimum,,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,,1291.00
Deidentified Minimum,,32503,CPT4/HCPCS,RESECT APICAL LUNG TUMOR,,,1291.00
Deidentified Minimum,,32507,CPT4/HCPCS,WEDGE RESECT OF LUNG DIAG,,,1291.00
Deidentified Minimum,,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,,1235.00
Deidentified Minimum,,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,,3198.57
Deidentified Minimum,,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,,987.78
Deidentified Minimum,,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,,1291.00
Deidentified Minimum,,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,,1291.00
Deidentified Minimum,,32701,CPT4/HCPCS,THORAX STEREO RAD TARGETW/TX,,,1678.00
Deidentified Minimum,,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,,1291.00
Deidentified Minimum,,32854,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,,1291.00
Deidentified Minimum,,32855,CPT4/HCPCS,PREPARE DONOR LUNG SINGLE,,,1291.00
Deidentified Minimum,,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,,1291.00
Deidentified Minimum,,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,,1291.00
Deidentified Minimum,,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,,1291.00
Deidentified Minimum,,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,,1291.00
Deidentified Minimum,,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,,3000.00
Deidentified Minimum,,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,,1678.88
Deidentified Minimum,,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,,1678.88
Deidentified Minimum,,33255,CPT4/HCPCS,ABLATE ATRIA W/O BYPASS EXT,,,1291.00
Deidentified Minimum,,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,,1678.88
Deidentified Minimum,,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,,3000.00
Deidentified Minimum,,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,,1678.88
Deidentified Minimum,,33284,CPT4/HCPCS,REMOVE PAT-ACTIVE HT RECORD,,,1678.00
Deidentified Minimum,,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,,1291.00
Deidentified Minimum,,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,,1291.00
Deidentified Minimum,,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,,1291.00
Deidentified Minimum,,33400,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,,8841.00
Deidentified Minimum,,33414,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,,1291.00
Deidentified Minimum,,33464,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,,1291.00
Deidentified Minimum,,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,,1291.00
Deidentified Minimum,,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,,1291.00
Deidentified Minimum,,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,,1291.00
Deidentified Minimum,,33511,CPT4/HCPCS,CABG VEIN TWO,,,1291.00
Deidentified Minimum,,33518,CPT4/HCPCS,CABG ARTERY-VEIN TWO,,,1291.00
Deidentified Minimum,,33523,CPT4/HCPCS,CABG ART-VEIN SIX OR MORE,,,1291.00
Deidentified Minimum,,33600,CPT4/HCPCS,CLOSURE OF VALVE,,,1291.00
Deidentified Minimum,,33610,CPT4/HCPCS,REPAIR BY ENLARGEMENT,,,1291.00
Deidentified Minimum,,33641,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,,1291.00
Deidentified Minimum,,33665,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,1291.00
Deidentified Minimum,,33677,CPT4/HCPCS,CL MULT VSD W/REM PUL BAND,,,1291.00
Deidentified Minimum,,33726,CPT4/HCPCS,REPAIR PUL VENOUS STENOSIS,,,1291.00
Deidentified Minimum,,33762,CPT4/HCPCS,MAJOR VESSEL SHUNT,,,1291.00
Deidentified Minimum,,33768,CPT4/HCPCS,CAVOPULMONARY SHUNTING,,,1291.00
Deidentified Minimum,,33824,CPT4/HCPCS,REVISE MAJOR VESSEL,,,8012.00
Deidentified Minimum,,33853,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,,1291.00
Deidentified Minimum,,33863,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,,1291.00
Deidentified Minimum,,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,,1291.00
Deidentified Minimum,,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,,1291.00
Deidentified Minimum,,33935,CPT4/HCPCS,TRANSPLANTATION HEART/LUNG,,,1291.00
Deidentified Minimum,,33945,CPT4/HCPCS,TRANSPLANTATION OF HEART,,,1291.00
Deidentified Minimum,,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,,987.78
Deidentified Minimum,,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,,987.78
Deidentified Minimum,,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,,987.78
Deidentified Minimum,,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,,987.78
Deidentified Minimum,,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,987.78
Deidentified Minimum,,33970,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,,1291.00
Deidentified Minimum,,33973,CPT4/HCPCS,INSERT BALLOON DEVICE,,,1291.00
Deidentified Minimum,,33981,CPT4/HCPCS,REPLACE VAD PUMP EXT,,,1291.00
Deidentified Minimum,,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,,987.78
Deidentified Minimum,,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,,1291.00
Deidentified Minimum,,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,,1291.00
Deidentified Minimum,,34051,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,,1291.00
Deidentified Minimum,,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,,3544.00
Deidentified Minimum,,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,,1235.00
Deidentified Minimum,,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,,3544.00
Deidentified Minimum,,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,,5029.00
Deidentified Minimum,,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,,1291.00
Deidentified Minimum,,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,,1291.00
Deidentified Minimum,,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,,1291.00
Deidentified Minimum,,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,,1145.00
Deidentified Minimum,,34800,CPT4/HCPCS,ENDOVAS AAA REPR W/SM TUBE,,,5783.00
Deidentified Minimum,,34802,CPT4/HCPCS,ENDOVAS AAA REPR W/2-P PART,,,5783.00
Deidentified Minimum,,34805,CPT4/HCPCS,ENDOVAS AAA REPR W/LONG TUBE,,,5783.00
Deidentified Minimum,,34830,CPT4/HCPCS,OPEN AORTIC TUBE PROSTH REPR,,,1291.00
Deidentified Minimum,,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,,987.78
Deidentified Minimum,,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,,987.78
Deidentified Minimum,,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,,1291.00
Deidentified Minimum,,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,3544.00
Deidentified Minimum,,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,3000.00
Deidentified Minimum,,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,,1291.00
Deidentified Minimum,,35523,CPT4/HCPCS,ART BYP GRFT BRCHL-ULNR-RDL,,,1291.00
Deidentified Minimum,,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,,1291.00
Deidentified Minimum,,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,,1291.00
Deidentified Minimum,,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,,1291.00
Deidentified Minimum,,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,,1291.00
Deidentified Minimum,,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,,1291.00
Deidentified Minimum,,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,,1291.00
Deidentified Minimum,,36160,CPT4/HCPCS,ESTABLISH ACCESS TO AORTA,,,1145.00
Deidentified Minimum,,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,,3000.00
Deidentified Minimum,,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,,400.00
Deidentified Minimum,,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,,1145.00
Deidentified Minimum,,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,,3544.00
Deidentified Minimum,,36522,CPT4/HCPCS,PHOTOPHERESIS,,,1678.00
Deidentified Minimum,,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,1678.88
Deidentified Minimum,,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,1678.88
Deidentified Minimum,,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,1678.88
Deidentified Minimum,,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,,1235.00
Deidentified Minimum,,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,,1678.88
Deidentified Minimum,,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,,59.80
Deidentified Minimum,,36620,CPT4/HCPCS,INSERTION CATHETER ARTERY,,,1145.00
Deidentified Minimum,,36625,CPT4/HCPCS,INSERTION CATHETER ARTERY,,,1145.00
Deidentified Minimum,,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,,400.00
Deidentified Minimum,,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,,5029.00
Deidentified Minimum,,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,,4000.00
Deidentified Minimum,,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,,1235.00
Deidentified Minimum,,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,,1145.00
Deidentified Minimum,,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,,1291.00
Deidentified Minimum,,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,,3000.00
Deidentified Minimum,,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,,1678.88
Deidentified Minimum,,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,,3000.00
Deidentified Minimum,,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,,3544.00
Deidentified Minimum,,37208,CPT4/HCPCS,TRANSCATH IV STENT/OPEN ADDL,,,1678.88
Deidentified Minimum,,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,,1678.88
Deidentified Minimum,,37216,CPT4/HCPCS,TRANSCATH STENT CCA W/O EPS,,,1291.00
Deidentified Minimum,,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,,3000.00
Deidentified Minimum,,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,,1678.88
Deidentified Minimum,,37247,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL ART,,,1145.00
Deidentified Minimum,,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,,1291.00
Deidentified Minimum,,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,,3000.00
Deidentified Minimum,,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,,3544.00
Deidentified Minimum,,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,,1291.00
Deidentified Minimum,,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,,5000.00
Deidentified Minimum,,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,,1145.00
Deidentified Minimum,,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,,1145.00
Deidentified Minimum,,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,,1678.88
Deidentified Minimum,,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,,1291.00
Deidentified Minimum,,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,,1678.88
Deidentified Minimum,,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,,5281.00
Deidentified Minimum,,38589,CPT4/HCPCS,LAPAROSCOPE PROC LYMPHATIC,,,3000.00
Deidentified Minimum,,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,,1291.00
Deidentified Minimum,,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,,1291.00
Deidentified Minimum,,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,,3000.00
Deidentified Minimum,,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,,1678.88
Deidentified Minimum,,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,,1678.88
Deidentified Minimum,,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,,3544.00
Deidentified Minimum,,40799,CPT4/HCPCS,LIP SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,,987.78
Deidentified Minimum,,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,,1678.88
Deidentified Minimum,,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,,1291.00
Deidentified Minimum,,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,,1145.00
Deidentified Minimum,,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,,1678.88
Deidentified Minimum,,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,,1678.88
Deidentified Minimum,,40899,CPT4/HCPCS,MOUTH SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1291.00
Deidentified Minimum,,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,,1291.00
Deidentified Minimum,,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,,1145.00
Deidentified Minimum,,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,,1291.00
Deidentified Minimum,,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,,1678.00
Deidentified Minimum,,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,,1678.88
Deidentified Minimum,,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,,1291.00
Deidentified Minimum,,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,,3965.00
Deidentified Minimum,,42140,CPT4/HCPCS,EXCISION OF UVULA,,,1291.00
Deidentified Minimum,,42180,CPT4/HCPCS,REPAIR PALATE,,,1145.00
Deidentified Minimum,,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,5000.00
Deidentified Minimum,,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,,1145.00
Deidentified Minimum,,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,,1291.00
Deidentified Minimum,,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,,3544.00
Deidentified Minimum,,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,,1678.88
Deidentified Minimum,,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,,4000.00
Deidentified Minimum,,42650,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,,1291.00
Deidentified Minimum,,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,,1678.88
Deidentified Minimum,,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,,987.78
Deidentified Minimum,,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,,3544.00
Deidentified Minimum,,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,,1678.88
Deidentified Minimum,,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,,1291.00
Deidentified Minimum,,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,,1291.00
Deidentified Minimum,,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,,1291.00
Deidentified Minimum,,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,,3000.00
Deidentified Minimum,,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,,1291.00
Deidentified Minimum,,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,,1291.00
Deidentified Minimum,,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,,1678.00
Deidentified Minimum,,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,,1291.00
Deidentified Minimum,,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,,1291.00
Deidentified Minimum,,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,,1678.88
Deidentified Minimum,,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,,1678.88
Deidentified Minimum,,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,,1678.88
Deidentified Minimum,,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,,1678.88
Deidentified Minimum,,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,,3000.00
Deidentified Minimum,,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,,1291.00
Deidentified Minimum,,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,,1291.00
Deidentified Minimum,,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,,1291.00
Deidentified Minimum,,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,,1291.00
Deidentified Minimum,,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,,1291.00
Deidentified Minimum,,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,,1291.00
Deidentified Minimum,,43338,CPT4/HCPCS,ESOPH LENGTHENING,,,1291.00
Deidentified Minimum,,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,,1291.00
Deidentified Minimum,,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,,1291.00
Deidentified Minimum,,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,,1291.00
Deidentified Minimum,,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,,1291.00
Deidentified Minimum,,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,,1291.00
Deidentified Minimum,,43644,CPT4/HCPCS,LAP GASTRIC BYPASS/ROUX-EN-Y,,,6612.00
Deidentified Minimum,,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,,987.78
Deidentified Minimum,,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,,3000.00
Deidentified Minimum,,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,,3000.00
Deidentified Minimum,,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,,3000.00
Deidentified Minimum,,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,,1291.00
Deidentified Minimum,,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,,1291.00
Deidentified Minimum,,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,,1291.00
Deidentified Minimum,,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,,1291.00
Deidentified Minimum,,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,,3000.00
Deidentified Minimum,,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,,1291.00
Deidentified Minimum,,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,,1291.00
Deidentified Minimum,,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,,1291.00
Deidentified Minimum,,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,1291.00
Deidentified Minimum,,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,,1291.00
Deidentified Minimum,,44158,CPT4/HCPCS,COLECTOMY W/NEO-RECTUM POUCH,,,1291.00
Deidentified Minimum,,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,,1291.00
Deidentified Minimum,,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,,1678.88
Deidentified Minimum,,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,,1291.00
Deidentified Minimum,,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,,1291.00
Deidentified Minimum,,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,,1291.00
Deidentified Minimum,,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44383,CPT4/HCPCS,ILEOSCOPY W/STENT,,,1678.00
Deidentified Minimum,,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,,1291.00
Deidentified Minimum,,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,,1291.00
Deidentified Minimum,,44393,CPT4/HCPCS,COLONOSCOPY LESION REMOVAL,,,1678.00
Deidentified Minimum,,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,,1291.00
Deidentified Minimum,,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,,1291.00
Deidentified Minimum,,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,,1291.00
Deidentified Minimum,,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,,1291.00
Deidentified Minimum,,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,,1291.00
Deidentified Minimum,,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,,1291.00
Deidentified Minimum,,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,,1291.00
Deidentified Minimum,,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,,1291.00
Deidentified Minimum,,44721,CPT4/HCPCS,PREP DONOR INTESTINE/ARTERY,,,1291.00
Deidentified Minimum,,44800,CPT4/HCPCS,EXCISION OF BOWEL POUCH,,,1291.00
Deidentified Minimum,,44899,CPT4/HCPCS,BOWEL SURGERY PROCEDURE,,,1291.00
Deidentified Minimum,,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,,1145.00
Deidentified Minimum,,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,,1291.00
Deidentified Minimum,,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,,1678.88
Deidentified Minimum,,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,,1678.88
Deidentified Minimum,,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,,1235.00
Deidentified Minimum,,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,,1291.00
Deidentified Minimum,,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,,1235.00
Deidentified Minimum,,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,,1291.00
Deidentified Minimum,,45339,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATE TUMR,,,1678.00
Deidentified Minimum,,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,,1291.00
Deidentified Minimum,,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,,1291.00
Deidentified Minimum,,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,,1291.00
Deidentified Minimum,,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,,1291.00
Deidentified Minimum,,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,,1291.00
Deidentified Minimum,,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,,1235.00
Deidentified Minimum,,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,,3544.00
Deidentified Minimum,,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,,3544.00
Deidentified Minimum,,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,,3544.00
Deidentified Minimum,,46600,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY SPX,,,987.78
Deidentified Minimum,,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,,1291.00
Deidentified Minimum,,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,,1678.00
Deidentified Minimum,,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,,1678.00
Deidentified Minimum,,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,,1291.00
Deidentified Minimum,,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,,1291.00
Deidentified Minimum,,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,,1235.00
Deidentified Minimum,,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,,1678.00
Deidentified Minimum,,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,,1291.00
Deidentified Minimum,,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,,1291.00
Deidentified Minimum,,47144,CPT4/HCPCS,PREP DONOR LIVER 3-SEGMENT,,,1291.00
Deidentified Minimum,,47147,CPT4/HCPCS,PREP DONOR LIVER/ARTERIAL,,,1291.00
Deidentified Minimum,,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,,3000.00
Deidentified Minimum,,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,,1291.00
Deidentified Minimum,,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,,4399.00
Deidentified Minimum,,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,,1291.00
Deidentified Minimum,,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,,1291.00
Deidentified Minimum,,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,,1678.88
Deidentified Minimum,,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,,1291.00
Deidentified Minimum,,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,,1235.00
Deidentified Minimum,,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,,1678.88
Deidentified Minimum,,47560,CPT4/HCPCS,LAPAROSCOPY W/CHOLANGIO,,,3544.00
Deidentified Minimum,,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,,6612.00
Deidentified Minimum,,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,,1291.00
Deidentified Minimum,,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,,1291.00
Deidentified Minimum,,47701,CPT4/HCPCS,BILE DUCT REVISION,,,1291.00
Deidentified Minimum,,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,,1291.00
Deidentified Minimum,,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,,1291.00
Deidentified Minimum,,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,,1291.00
Deidentified Minimum,,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,,1291.00
Deidentified Minimum,,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,,1291.00
Deidentified Minimum,,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,,1291.00
Deidentified Minimum,,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,,1291.00
Deidentified Minimum,,48550,CPT4/HCPCS,DONOR PANCREATECTOMY,,,3198.57
Deidentified Minimum,,48999,CPT4/HCPCS,PANCREAS SURGERY PROCEDURE,,,1235.00
Deidentified Minimum,,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,,1291.00
Deidentified Minimum,,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,,1291.00
Deidentified Minimum,,49203,CPT4/HCPCS,EXC ABD TUM 5 CM OR LESS,,,3965.00
Deidentified Minimum,,49205,CPT4/HCPCS,EXC ABD TUM OVER 10 CM,,,6612.00
Deidentified Minimum,,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,,1291.00
Deidentified Minimum,,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,,1291.00
Deidentified Minimum,,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,,3544.00
Deidentified Minimum,,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,,4000.00
Deidentified Minimum,,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,,4000.00
Deidentified Minimum,,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,,1145.00
Deidentified Minimum,,49400,CPT4/HCPCS,AIR INJECTION INTO ABDOMEN,,,1145.00
Deidentified Minimum,,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,,1678.88
Deidentified Minimum,,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,,1291.00
Deidentified Minimum,,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,,1291.00
Deidentified Minimum,,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,,4000.00
Deidentified Minimum,,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,,4000.00
Deidentified Minimum,,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,,1678.88
Deidentified Minimum,,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,,4847.00
Deidentified Minimum,,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,,4000.00
Deidentified Minimum,,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,,4847.00
Deidentified Minimum,,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,,4000.00
Deidentified Minimum,,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,,4847.00
Deidentified Minimum,,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,,5029.00
Deidentified Minimum,,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,,1291.00
Deidentified Minimum,,49999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,,1291.00
Deidentified Minimum,,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,,1291.00
Deidentified Minimum,,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,,3000.00
Deidentified Minimum,,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,,1291.00
Deidentified Minimum,,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,,1291.00
Deidentified Minimum,,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,,1291.00
Deidentified Minimum,,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,,1291.00
Deidentified Minimum,,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,,1291.00
Deidentified Minimum,,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,,3000.00
Deidentified Minimum,,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,,1678.00
Deidentified Minimum,,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,,1678.00
Deidentified Minimum,,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,,1235.00
Deidentified Minimum,,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,,1291.00
Deidentified Minimum,,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,,3000.00
Deidentified Minimum,,50600,CPT4/HCPCS,EXPLORATION OF URETER,,,1291.00
Deidentified Minimum,,50650,CPT4/HCPCS,REMOVAL OF URETER,,,1291.00
Deidentified Minimum,,50684,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,,1145.00
Deidentified Minimum,,50706,CPT4/HCPCS,BALLOON DILATE URTRL STRIX,,,1145.00
Deidentified Minimum,,50727,CPT4/HCPCS,REVISE URETER,,,1678.88
Deidentified Minimum,,50782,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,,1291.00
Deidentified Minimum,,50830,CPT4/HCPCS,REVISE URINE FLOW,,,1291.00
Deidentified Minimum,,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,,1291.00
Deidentified Minimum,,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,,5281.00
Deidentified Minimum,,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,,1291.00
Deidentified Minimum,,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,,1678.00
Deidentified Minimum,,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,,1291.00
Deidentified Minimum,,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,,1291.00
Deidentified Minimum,,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,,987.78
Deidentified Minimum,,50690,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,,1145.00
Deidentified Minimum,,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,,1678.00
Deidentified Minimum,,50700,CPT4/HCPCS,REVISION OF URETER,,,1291.00
Deidentified Minimum,,50760,CPT4/HCPCS,FUSION OF URETERS,,,1291.00
Deidentified Minimum,,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,,1291.00
Deidentified Minimum,,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,,1235.00
Deidentified Minimum,,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,,1678.00
Deidentified Minimum,,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,,1235.00
Deidentified Minimum,,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,,3965.00
Deidentified Minimum,,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,,400.00
Deidentified Minimum,,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,,4000.00
Deidentified Minimum,,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,,3965.00
Deidentified Minimum,,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,,1291.00
Deidentified Minimum,,51610,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,,1145.00
Deidentified Minimum,,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,,1678.88
Deidentified Minimum,,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,,400.00
Deidentified Minimum,,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,,987.78
Deidentified Minimum,,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,,987.78
Deidentified Minimum,,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,,1291.00
Deidentified Minimum,,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,,1291.00
Deidentified Minimum,,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,,1678.88
Deidentified Minimum,,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1291.00
Deidentified Minimum,,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1291.00
Deidentified Minimum,,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,,1291.00
Deidentified Minimum,,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,,3544.00
Deidentified Minimum,,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,,1678.88
Deidentified Minimum,,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,,1678.00
Deidentified Minimum,,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,,1678.00
Deidentified Minimum,,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,,1678.88
Deidentified Minimum,,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,,1678.88
Deidentified Minimum,,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,3198.57
Deidentified Minimum,,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,,1678.88
Deidentified Minimum,,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,,3000.00
Deidentified Minimum,,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,,1235.00
Deidentified Minimum,,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,,1678.00
Deidentified Minimum,,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,,1291.00
Deidentified Minimum,,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,,1678.00
Deidentified Minimum,,54105,CPT4/HCPCS,BIOPSY OF PENIS,,,1678.00
Deidentified Minimum,,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,,1678.88
Deidentified Minimum,,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,,3000.00
Deidentified Minimum,,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,,4000.00
Deidentified Minimum,,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,,3544.00
Deidentified Minimum,,54385,CPT4/HCPCS,REPAIR PENIS,,,4000.00
Deidentified Minimum,,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,,4280.43
Deidentified Minimum,,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,,3544.00
Deidentified Minimum,,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,,1145.00
Deidentified Minimum,,54420,CPT4/HCPCS,REVISION OF PENIS,,,4000.00
Deidentified Minimum,,54435,CPT4/HCPCS,REVISION OF PENIS,,,4000.00
Deidentified Minimum,,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,,1678.00
Deidentified Minimum,,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,,3544.00
Deidentified Minimum,,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,,1678.88
Deidentified Minimum,,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,,1235.00
Deidentified Minimum,,55000,CPT4/HCPCS,DRAINAGE OF HYDROCELE,,,987.78
Deidentified Minimum,,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,,3965.00
Deidentified Minimum,,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,,1291.00
Deidentified Minimum,,55110,CPT4/HCPCS,EXPLORE SCROTUM,,,1678.88
Deidentified Minimum,,55180,CPT4/HCPCS,REVISION OF SCROTUM,,,1678.88
Deidentified Minimum,,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,,1291.00
Deidentified Minimum,,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,1291.00
Deidentified Minimum,,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,,1291.00
Deidentified Minimum,,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,1291.00
Deidentified Minimum,,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,,6588.00
Deidentified Minimum,,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,,1678.88
Deidentified Minimum,,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,4280.43
Deidentified Minimum,,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,3198.57
Deidentified Minimum,,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,1291.00
Deidentified Minimum,,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,,1291.00
Deidentified Minimum,,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,,1678.88
Deidentified Minimum,,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,,3965.00
Deidentified Minimum,,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,,4847.00
Deidentified Minimum,,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,,987.78
Deidentified Minimum,,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,,3000.00
Deidentified Minimum,,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,,1678.88
Deidentified Minimum,,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,,1235.00
Deidentified Minimum,,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,,4847.00
Deidentified Minimum,,57700,CPT4/HCPCS,REVISION OF CERVIX,,,1678.00
Deidentified Minimum,,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,,3000.00
Deidentified Minimum,,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,,1291.00
Deidentified Minimum,,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,,1291.00
Deidentified Minimum,,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,,1291.00
Deidentified Minimum,,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,,987.78
Deidentified Minimum,,58340,CPT4/HCPCS,CATHETER FOR HYSTEROGRAPHY,,,1145.00
Deidentified Minimum,,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,,3000.00
Deidentified Minimum,,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,,5281.00
Deidentified Minimum,,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,,4847.00
Deidentified Minimum,,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,,1291.00
Deidentified Minimum,,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,,3544.00
Deidentified Minimum,,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,,3544.00
Deidentified Minimum,,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,,5000.00
Deidentified Minimum,,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,,3000.00
Deidentified Minimum,,58958,CPT4/HCPCS,RESECT RECUR GYN MAL W/LYM,,,1291.00
Deidentified Minimum,,59020,CPT4/HCPCS,FETAL CONTRACT STRESS TEST,,,987.78
Deidentified Minimum,,59025,CPT4/HCPCS,FETAL NON-STRESS TEST,,,987.78
Deidentified Minimum,,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,1678.88
Deidentified Minimum,,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,3000.00
Deidentified Minimum,,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,3000.00
Deidentified Minimum,,59325,CPT4/HCPCS,REVISION OF CERVIX,,,1291.00
Deidentified Minimum,,59414,CPT4/HCPCS,DELIVER PLACENTA,,,1678.88
Deidentified Minimum,,59430,CPT4/HCPCS,CARE AFTER DELIVERY,,,987.78
Deidentified Minimum,,59514,CPT4/HCPCS,CESAREAN DELIVERY ONLY,,,4891.93
Deidentified Minimum,,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,,3000.00
Deidentified Minimum,,59857,CPT4/HCPCS,ABORTION,,,1291.00
Deidentified Minimum,,60100,CPT4/HCPCS,BIOPSY OF THYROID,,,987.78
Deidentified Minimum,,60240,CPT4/HCPCS,REMOVAL OF THYROID,,,3000.00
Deidentified Minimum,,60271,CPT4/HCPCS,REMOVAL OF THYROID,,,3000.00
Deidentified Minimum,,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,,3198.57
Deidentified Minimum,,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,,1291.00
Deidentified Minimum,,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,,1291.00
Deidentified Minimum,,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,,1235.00
Deidentified Minimum,,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,,1291.00
Deidentified Minimum,,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,,1291.00
Deidentified Minimum,,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,,1291.00
Deidentified Minimum,,61305,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,,1291.00
Deidentified Minimum,,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,,1291.00
Deidentified Minimum,,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,,1291.00
Deidentified Minimum,,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,,1291.00
Deidentified Minimum,,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,,1291.00
Deidentified Minimum,,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,,1291.00
Deidentified Minimum,,61480,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,,4891.93
Deidentified Minimum,,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,,1291.00
Deidentified Minimum,,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,,1291.00
Deidentified Minimum,,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,1291.00
Deidentified Minimum,,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,1291.00
Deidentified Minimum,,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,,1291.00
Deidentified Minimum,,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,,1291.00
Deidentified Minimum,,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,,1291.00
Deidentified Minimum,,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,,1291.00
Deidentified Minimum,,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,1291.00
Deidentified Minimum,,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,,3000.00
Deidentified Minimum,,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,,1291.00
Deidentified Minimum,,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,,1291.00
Deidentified Minimum,,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,,1291.00
Deidentified Minimum,,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,,1291.00
Deidentified Minimum,,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,,1291.00
Deidentified Minimum,,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,,1291.00
Deidentified Minimum,,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,,1291.00
Deidentified Minimum,,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,,1291.00
Deidentified Minimum,,62116,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,,5783.00
Deidentified Minimum,,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,,1291.00
Deidentified Minimum,,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,,1291.00
Deidentified Minimum,,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,1291.00
Deidentified Minimum,,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,,1235.00
Deidentified Minimum,,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,,1291.00
Deidentified Minimum,,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,,1235.00
Deidentified Minimum,,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,,1235.00
Deidentified Minimum,,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,,1235.00
Deidentified Minimum,,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,,1235.00
Deidentified Minimum,,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,,1235.00
Deidentified Minimum,,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,,987.78
Deidentified Minimum,,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,,3452.00
Deidentified Minimum,,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,,1291.00
Deidentified Minimum,,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,,3452.00
Deidentified Minimum,,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,,3000.00
Deidentified Minimum,,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,,1291.00
Deidentified Minimum,,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,,1291.00
Deidentified Minimum,,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,,1291.00
Deidentified Minimum,,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,,3452.00
Deidentified Minimum,,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,,3198.57
Deidentified Minimum,,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,,1291.00
Deidentified Minimum,,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,,1291.00
Deidentified Minimum,,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,,1291.00
Deidentified Minimum,,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,,1291.00
Deidentified Minimum,,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,,1678.88
Deidentified Minimum,,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,,1291.00
Deidentified Minimum,,63615,CPT4/HCPCS,REMOVE LESION OF SPINAL CORD,,,4280.43
Deidentified Minimum,,63620,CPT4/HCPCS,SRS SPINAL LESION,,,3452.00
Deidentified Minimum,,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,,1291.00
Deidentified Minimum,,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,,1235.00
Deidentified Minimum,,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,,400.00
Deidentified Minimum,,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,,400.00
Deidentified Minimum,,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,,1145.00
Deidentified Minimum,,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,,1235.00
Deidentified Minimum,,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,,1145.00
Deidentified Minimum,,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,,1235.00
Deidentified Minimum,,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1678.88
Deidentified Minimum,,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,1235.00
Deidentified Minimum,,64624,CPT4/HCPCS,DSTRJ NULYT AGT GNCLR NRV,,,1678.00
Deidentified Minimum,,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,,400.00
Deidentified Minimum,,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,,1145.00
Deidentified Minimum,,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,,1145.00
Deidentified Minimum,,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,,1678.88
Deidentified Minimum,,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,,1291.00
Deidentified Minimum,,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,,1678.88
Deidentified Minimum,,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,,1678.88
Deidentified Minimum,,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,,1145.00
Deidentified Minimum,,64784,CPT4/HCPCS,REMOVE NERVE LESION,,,3452.00
Deidentified Minimum,,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,,3452.00
Deidentified Minimum,,64795,CPT4/HCPCS,BIOPSY OF NERVE,,,1678.00
Deidentified Minimum,,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,,1291.00
Deidentified Minimum,,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,,3000.00
Deidentified Minimum,,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,,1145.00
Deidentified Minimum,,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,,1678.88
Deidentified Minimum,,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,,3452.00
Deidentified Minimum,,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,,1145.00
Deidentified Minimum,,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,,1678.88
Deidentified Minimum,,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,,3452.00
Deidentified Minimum,,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,,3452.00
Deidentified Minimum,,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,,3452.00
Deidentified Minimum,,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,,3452.00
Deidentified Minimum,,65110,CPT4/HCPCS,REMOVAL OF EYE,,,3452.00
Deidentified Minimum,,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,,1678.88
Deidentified Minimum,,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,,1678.00
Deidentified Minimum,,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,987.78
Deidentified Minimum,,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,1678.88
Deidentified Minimum,,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,,1678.88
Deidentified Minimum,,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,,3452.00
Deidentified Minimum,,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,,3452.00
Deidentified Minimum,,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,,3452.00
Deidentified Minimum,,66172,CPT4/HCPCS,INCISION OF EYE,,,3452.00
Deidentified Minimum,,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,,3452.00
Deidentified Minimum,,66500,CPT4/HCPCS,INCISION OF IRIS,,,1145.00
Deidentified Minimum,,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,,1678.88
Deidentified Minimum,,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,,1678.88
Deidentified Minimum,,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,,1145.00
Deidentified Minimum,,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,,3452.00
Deidentified Minimum,,66987,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX W/ECP,,,3000.00
Deidentified Minimum,,67025,CPT4/HCPCS,REPLACE EYE FLUID,,,1678.00
Deidentified Minimum,,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,,3452.00
Deidentified Minimum,,67145,CPT4/HCPCS,TREATMENT OF RETINA,,,1235.00
Deidentified Minimum,,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,,1235.00
Deidentified Minimum,,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,,1235.00
Deidentified Minimum,,67250,CPT4/HCPCS,REINFORCE EYE WALL,,,3452.00
Deidentified Minimum,,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,,3452.00
Deidentified Minimum,,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,,3000.00
Deidentified Minimum,,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,,3452.00
Deidentified Minimum,,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,,3452.00
Deidentified Minimum,,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,,3452.00
Deidentified Minimum,,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,,987.78
Deidentified Minimum,,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,,1678.00
Deidentified Minimum,,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,,1291.00
Deidentified Minimum,,67880,CPT4/HCPCS,REVISION OF EYELID,,,3452.00
Deidentified Minimum,,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,,3452.00
Deidentified Minimum,,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,,3198.57
Deidentified Minimum,,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67961,CPT4/HCPCS,REVISION OF EYELID,,,3452.00
Deidentified Minimum,,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,,1678.00
Deidentified Minimum,,68362,CPT4/HCPCS,REVISE EYELID LINING,,,1678.88
Deidentified Minimum,,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,,987.78
Deidentified Minimum,,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,,1678.00
Deidentified Minimum,,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,,1145.00
Deidentified Minimum,,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,,400.00
Deidentified Minimum,,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,,1678.88
Deidentified Minimum,,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,,1291.00
Deidentified Minimum,,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,,3452.00
Deidentified Minimum,,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,,3452.00
Deidentified Minimum,,69501,CPT4/HCPCS,MASTOIDECTOMY,,,3452.00
Deidentified Minimum,,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,,3452.00
Deidentified Minimum,,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,,3452.00
Deidentified Minimum,,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,,1678.88
Deidentified Minimum,,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,,3452.00
Deidentified Minimum,,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,,3452.00
Deidentified Minimum,,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,3452.00
Deidentified Minimum,,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,,3452.00
Deidentified Minimum,,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,,3452.00
Deidentified Minimum,,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,,3000.00
Deidentified Minimum,,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,,3452.00
Deidentified Minimum,,70015,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,,142.00
Deidentified Minimum,,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,,142.00
Deidentified Minimum,,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,,142.00
Deidentified Minimum,,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,,142.00
Deidentified Minimum,,70170,CPT4/HCPCS,X-RAY EXAM OF TEAR DUCT,,,142.00
Deidentified Minimum,,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,,142.00
Deidentified Minimum,,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,,142.00
Deidentified Minimum,,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,,142.00
Deidentified Minimum,,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,,142.00
Deidentified Minimum,,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,,142.00
Deidentified Minimum,,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,,142.00
Deidentified Minimum,,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,,1147.00
Deidentified Minimum,,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,,1147.00
Deidentified Minimum,,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,,1147.00
Deidentified Minimum,,70555,CPT4/HCPCS,FMRI BRAIN BY PHYS/PSYCH,,,1147.00
Deidentified Minimum,,71034,CPT4/HCPCS,CHEST X-RAY&FLUORO 4/> VIEWS,,,0.00
Deidentified Minimum,,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,,89.54
Deidentified Minimum,,71048,CPT4/HCPCS,X-RAY EXAM CHEST 4+ VIEWS,,,142.00
Deidentified Minimum,,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,,142.00
Deidentified Minimum,,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,,1147.00
Deidentified Minimum,,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,,1147.00
Deidentified Minimum,,71555,CPT4/HCPCS,MRI ANGIO CHEST W OR W/O DYE,,,1147.00
Deidentified Minimum,,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,,142.00
Deidentified Minimum,,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,,142.00
Deidentified Minimum,,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,,142.00
Deidentified Minimum,,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,,1147.00
Deidentified Minimum,,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,,1147.00
Deidentified Minimum,,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,,985.00
Deidentified Minimum,,72291,CPT4/HCPCS,PERQ VERTE/SACROPLSTY FLUOR,,,0.00
Deidentified Minimum,,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,,142.00
Deidentified Minimum,,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,,142.00
Deidentified Minimum,,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,,142.00
Deidentified Minimum,,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,,985.00
Deidentified Minimum,,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,,142.00
Deidentified Minimum,,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,,1147.00
Deidentified Minimum,,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,,1147.00
Deidentified Minimum,,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,,142.00
Deidentified Minimum,,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,,142.00
Deidentified Minimum,,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,,142.00
Deidentified Minimum,,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,,142.00
Deidentified Minimum,,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,,1147.00
Deidentified Minimum,,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,,1147.00
Deidentified Minimum,,74010,CPT4/HCPCS,X-RAY EXAM OF ABDOMEN,,,0.00
Deidentified Minimum,,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,,142.00
Deidentified Minimum,,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,,142.00
Deidentified Minimum,,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,,985.00
Deidentified Minimum,,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,,985.00
Deidentified Minimum,,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,,1147.00
Deidentified Minimum,,74241,CPT4/HCPCS,X-RAY UPPER GI DELAY W/KUB,,,749.21
Deidentified Minimum,,74290,CPT4/HCPCS,CONTRAST X-RAY GALLBLADDER,,,142.00
Deidentified Minimum,,74328,CPT4/HCPCS,X-RAY BILE DUCT ENDOSCOPY,,,142.00
Deidentified Minimum,,74330,CPT4/HCPCS,X-RAY BILE/PANC ENDOSCOPY,,,142.00
Deidentified Minimum,,74355,CPT4/HCPCS,X-RAY GUIDE INTESTINAL TUBE,,,142.00
Deidentified Minimum,,74360,CPT4/HCPCS,X-RAY GUIDE GI DILATION,,,142.00
Deidentified Minimum,,74410,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BOLUS,,,142.00
Deidentified Minimum,,74440,CPT4/HCPCS,X-RAY MALE GENITAL TRACT,,,142.00
Deidentified Minimum,,74712,CPT4/HCPCS,MRI FETAL SNGL/1ST GESTATION,,,1147.00
Deidentified Minimum,,74775,CPT4/HCPCS,X-RAY EXAM OF PERINEUM,,,142.00
Deidentified Minimum,,75557,CPT4/HCPCS,CARDIAC MRI FOR MORPH,,,142.00
Deidentified Minimum,,75559,CPT4/HCPCS,CARDIAC MRI W/STRESS IMG,,,142.00
Deidentified Minimum,,75600,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,,142.00
Deidentified Minimum,,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,,142.00
Deidentified Minimum,,75731,CPT4/HCPCS,ARTERY X-RAYS ADRENAL GLAND,,,142.00
Deidentified Minimum,,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,,142.00
Deidentified Minimum,,75743,CPT4/HCPCS,ARTERY X-RAYS LUNGS,,,142.00
Deidentified Minimum,,75825,CPT4/HCPCS,VEIN X-RAY TRUNK,,,142.00
Deidentified Minimum,,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,,142.00
Deidentified Minimum,,75833,CPT4/HCPCS,VEIN X-RAY KIDNEYS,,,142.00
Deidentified Minimum,,75860,CPT4/HCPCS,VEIN X-RAY NECK,,,142.00
Deidentified Minimum,,75887,CPT4/HCPCS,VEIN X-RAY LIVER W/O HEMODYN,,,142.00
Deidentified Minimum,,75889,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,,142.00
Deidentified Minimum,,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,,142.00
Deidentified Minimum,,75901,CPT4/HCPCS,REMOVE CVA DEVICE OBSTRUCT,,,142.00
Deidentified Minimum,,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,,142.00
Deidentified Minimum,,76125,CPT4/HCPCS,CINE/VIDEO X-RAYS ADD-ON,,,142.00
Deidentified Minimum,,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,,142.00
Deidentified Minimum,,76498,CPT4/HCPCS,MRI PROCEDURE,,,1147.00
Deidentified Minimum,,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,,553.00
Deidentified Minimum,,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,,364.35
Deidentified Minimum,,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,,553.00
Deidentified Minimum,,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,,553.00
Deidentified Minimum,,76814,CPT4/HCPCS,OB US NUCHAL MEAS ADD-ON,,,282.91
Deidentified Minimum,,76819,CPT4/HCPCS,FETAL BIOPHYS PROFIL W/O NST,,,469.39
Deidentified Minimum,,76826,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,,361.80
Deidentified Minimum,,76831,CPT4/HCPCS,ECHO EXAM UTERUS,,,553.00
Deidentified Minimum,,76870,CPT4/HCPCS,US EXAM SCROTUM,,,553.00
Deidentified Minimum,,76930,CPT4/HCPCS,ECHO GUIDE CARDIOCENTESIS,,,771.71
Deidentified Minimum,,76940,CPT4/HCPCS,US GUIDE TISSUE ABLATION,,,553.00
Deidentified Minimum,,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,,553.00
Deidentified Minimum,,76970,CPT4/HCPCS,ULTRASOUND EXAM FOLLOW-UP,,,534.24
Deidentified Minimum,,76977,CPT4/HCPCS,US BONE DENSITY MEASURE,,,66.86
Deidentified Minimum,,77057,CPT4/HCPCS,MAMMOGRAM SCREENING,,,0.00
Deidentified Minimum,,77084,CPT4/HCPCS,MAGNETIC IMAGE BONE MARROW,,,1147.00
Deidentified Minimum,,77086,CPT4/HCPCS,FRACTURE ASSESSMENT VIA DXA,,,142.00
Deidentified Minimum,,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,,1181.79
Deidentified Minimum,,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,,2422.00
Deidentified Minimum,,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,,546.43
Deidentified Minimum,,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,,961.27
Deidentified Minimum,,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,,280.71
Deidentified Minimum,,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,,661.52
Deidentified Minimum,,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,,220.75
Deidentified Minimum,,77424,CPT4/HCPCS,IO RAD TX DELIVERY BY X-RAY,,,2422.00
Deidentified Minimum,,77425,CPT4/HCPCS,IO RAD TX DELIVER BY ELCTRNS,,,737.20
Deidentified Minimum,,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,,1402.14
Deidentified Minimum,,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,,2258.02
Deidentified Minimum,,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,,1425.64
Deidentified Minimum,,77787,CPT4/HCPCS,HDR BRACHYTX OVER 12 CHAN,,,3544.00
Deidentified Minimum,,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,,81.09
Deidentified Minimum,,78012,CPT4/HCPCS,THYROID UPTAKE MEASUREMENT,,,142.00
Deidentified Minimum,,78015,CPT4/HCPCS,THYROID MET IMAGING,,,142.00
Deidentified Minimum,,78121,CPT4/HCPCS,RED CELL MASS MULTIPLE,,,142.00
Deidentified Minimum,,78300,CPT4/HCPCS,BONE IMAGING LIMITED AREA,,,142.00
Deidentified Minimum,,0033T,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,,3198.57
Deidentified Minimum,,0048T,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,,8012.00
Deidentified Minimum,,0051T,CPT4/HCPCS,IMPLANT TOTAL HEART SYSTEM,,,8841.00
Deidentified Minimum,,0054T,CPT4/HCPCS,BONE SRGRY CMPTR FLUOR IMAGE,,,985.00
Deidentified Minimum,,0092T,CPT4/HCPCS,ARTIFIC DISC ADDL CERVICAL,,,5783.00
Deidentified Minimum,,0095T,CPT4/HCPCS,RMVL ARTIFIC DISC ADDL CRVCL,,,3544.00
Deidentified Minimum,,0099T,CPT4/HCPCS,IMPLANT CORNEAL RING,,,1678.88
Deidentified Minimum,,0165T,CPT4/HCPCS,REVISE LUMB ARTIF DISC ADDL,,,1291.00
Deidentified Minimum,,0172T,CPT4/HCPCS,LUMBAR SPINE PROCESS ADDL,,,5281.00
Deidentified Minimum,,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,,1678.00
Deidentified Minimum,,0191T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,,5730.00
Deidentified Minimum,,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,,987.78
Deidentified Minimum,,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,,987.78
Deidentified Minimum,,0231T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,,1145.00
Deidentified Minimum,,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,,1291.00
Deidentified Minimum,,0245T,CPT4/HCPCS,OPEN TX RIB FX 1-2 RIBS,,,1678.88
Deidentified Minimum,,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,,3544.00
Deidentified Minimum,,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,,3544.00
Deidentified Minimum,,0276T,CPT4/HCPCS,BRONCH THERMOPLASTY 1 LOBE,,,1678.88
Deidentified Minimum,,0284T,CPT4/HCPCS,PERIPH FIELD STIMUL REVISE,,,1678.88
Deidentified Minimum,,0288T,CPT4/HCPCS,ANOSCOPY W/RF DELIVERY,,,1678.00
Deidentified Minimum,,0297T,CPT4/HCPCS,EXT ECG SCAN W/REPORT,,,987.78
Deidentified Minimum,,0298T,CPT4/HCPCS,EXT ECG REVIEW AND INTERP,,,987.78
Deidentified Minimum,,0302T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS COMPL,,,3544.00
Deidentified Minimum,,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,,4847.00
Deidentified Minimum,,0321T,CPT4/HCPCS,INSERT SUBQ DEFIB PLS GEN,,,6588.00
Deidentified Minimum,,0324T,CPT4/HCPCS,RMVL SUBQ DEFIB ELECTRODE,,,5029.00
Deidentified Minimum,,0336T,CPT4/HCPCS,LAP ABLAT UTERINE FIBROIDS,,,5029.00
Deidentified Minimum,,0375T,CPT4/HCPCS,TOTAL DISC ARTHRP ANT APPR,,,987.78
Deidentified Minimum,,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,,1145.00
Deidentified Minimum,,0377T,CPT4/HCPCS,ANOSCPY INJ AGENT FOR INCONT,,,1678.00
Deidentified Minimum,,0379T,CPT4/HCPCS,VIS FIELD ASSMNT TECH SUPPT,,,6049.05
Deidentified Minimum,,0394T,CPT4/HCPCS,HDR ELCTRNC SKN SURF BRCHYTX,,,12850.70
Deidentified Minimum,,0398T,CPT4/HCPCS,MRGFUS STRTCTC LES ABLTJ,,,1678.00
Deidentified Minimum,,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,,1678.88
Deidentified Minimum,,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,,1678.88
Deidentified Minimum,,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,,1291.00
Deidentified Minimum,,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,,987.78
Deidentified Minimum,,0428T,CPT4/HCPCS,RMVL NSTIM APNEA PLS GEN,,,1678.00
Deidentified Minimum,,0432T,CPT4/HCPCS,REPOS NSTIM APNEA STIMJ LD,,,1678.00
Deidentified Minimum,,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,,1678.00
Deidentified Minimum,,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,,987.78
Deidentified Minimum,,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,,987.78
Deidentified Minimum,,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,,987.78
Deidentified Minimum,,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,,1145.00
Deidentified Minimum,,0468T,CPT4/HCPCS,RMVL CH WAL RESPIR ELTRD/RA,,,1678.88
Deidentified Minimum,,0474T,CPT4/HCPCS,INSJ AQUEOUS DRG DEV IO RSVR,,,3198.57
Deidentified Minimum,,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,,1145.00
Deidentified Minimum,,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,,1291.00
Deidentified Minimum,,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,,1291.00
Deidentified Minimum,,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,,1145.00
Deidentified Minimum,,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,,1678.88
Deidentified Minimum,,0505T,CPT4/HCPCS,EV FEMPOP ARTL REVSC,,,5281.00
Deidentified Minimum,,0513T,CPT4/HCPCS,ESW INTEG WND HLG EA ADDL,,,1145.00
Deidentified Minimum,,0514T,CPT4/HCPCS,INTRAOP VIS AXIS ID PT FIXJ,,,1145.00
Deidentified Minimum,,0523T,CPT4/HCPCS,NTRAPX C FFR W/3D FUNCJL MAP,,,1145.00
Deidentified Minimum,,0524T,CPT4/HCPCS,EV CATH DIR CHEM ABLTJ W/IMG,,,3544.00
Deidentified Minimum,,0531T,CPT4/HCPCS,REMOVAL IIMS ELECTRODE ONLY,,,3544.00
Deidentified Minimum,,0540T,CPT4/HCPCS,CAR-T CLL ADMN AUTOLOGOUS,,,1678.88
Deidentified Minimum,,0543T,CPT4/HCPCS,TA MV RPR W/ARTIF CHORD TEND,,,1291.00
Deidentified Minimum,,0553T,CPT4/HCPCS,PERQ TCAT ILIAC ANAST IMPLT,,,1291.00
Deidentified Minimum,,0568T,CPT4/HCPCS,INTRO MIX SALINE&AIR F/SSG,,,1291.00
Deidentified Minimum,,0574T,CPT4/HCPCS,REPOS PREV SS IMPL DFB ELTRD,,,1291.00
Deidentified Minimum,,0586T,CPT4/HCPCS,OPEN ISLET CELL TRANSPLANT,,,1291.00
Deidentified Minimum,,10004,CPT4/HCPCS,FNA BX W/O IMG GDN EA ADDL,,,1145.00
Deidentified Minimum,,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,,1291.00
Deidentified Minimum,,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,,400.00
Deidentified Minimum,,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,,987.78
Deidentified Minimum,,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,,1235.00
Deidentified Minimum,,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,,1235.00
Deidentified Minimum,,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,,1235.00
Deidentified Minimum,,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,1678.88
Deidentified Minimum,,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,,1235.00
Deidentified Minimum,,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,,1235.00
Deidentified Minimum,,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,,1291.00
Deidentified Minimum,,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,,400.00
Deidentified Minimum,,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,,1235.00
Deidentified Minimum,,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,,1235.00
Deidentified Minimum,,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,,1145.00
Deidentified Minimum,,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,,1678.88
Deidentified Minimum,,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,,987.78
Deidentified Minimum,,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,,1145.00
Deidentified Minimum,,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,,400.00
Deidentified Minimum,,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,,400.00
Deidentified Minimum,,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,,1145.00
Deidentified Minimum,,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,,1291.00
Deidentified Minimum,,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,,1291.00
Deidentified Minimum,,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,,1291.00
Deidentified Minimum,,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,,1145.00
Deidentified Minimum,,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,,1145.00
Deidentified Minimum,,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,,1291.00
Deidentified Minimum,,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,,1291.00
Deidentified Minimum,,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,,1291.00
Deidentified Minimum,,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,,1291.00
Deidentified Minimum,,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,,3544.00
Deidentified Minimum,,15772,CPT4/HCPCS,GRFG AUTOL FAT LIPO EA ADDL,,,1145.00
Deidentified Minimum,,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,,1235.00
Deidentified Minimum,,15789,CPT4/HCPCS,CHEMICAL PEEL FACE DERMAL,,,987.78
Deidentified Minimum,,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,,1291.00
Deidentified Minimum,,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,,1678.88
Deidentified Minimum,,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,,4000.00
Deidentified Minimum,,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,,1291.00
Deidentified Minimum,,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,,3544.00
Deidentified Minimum,,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,,1678.88
Deidentified Minimum,,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,,4000.00
Deidentified Minimum,,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,1291.00
Deidentified Minimum,,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,,3965.00
Deidentified Minimum,,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,3544.00
Deidentified Minimum,,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,4000.00
Deidentified Minimum,,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,,1291.00
Deidentified Minimum,,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,987.78
Deidentified Minimum,,17110,CPT4/HCPCS,DESTRUCT B9 LESION 1-14,,,400.00
Deidentified Minimum,,17261,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17262,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17283,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,400.00
Deidentified Minimum,,17286,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,400.00
Deidentified Minimum,,17312,CPT4/HCPCS,MOHS ADDL STAGE,,,1145.00
Deidentified Minimum,,19030,CPT4/HCPCS,INJECTION FOR BREAST X-RAY,,,1145.00
Deidentified Minimum,,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,,1291.00
Deidentified Minimum,,19103,CPT4/HCPCS,BX BREAST PERCUT W/DEVICE,,,1678.00
Deidentified Minimum,,19125,CPT4/HCPCS,EXCISION BREAST LESION,,,3544.00
Deidentified Minimum,,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,,1145.00
Deidentified Minimum,,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,,1678.88
Deidentified Minimum,,19324,CPT4/HCPCS,ENLARGE BREAST,,,4000.00
Deidentified Minimum,,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,,1678.00
Deidentified Minimum,,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,,3965.00
Deidentified Minimum,,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,,1678.88
Deidentified Minimum,,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,,5000.00
Deidentified Minimum,,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,,1291.00
Deidentified Minimum,,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,,4000.00
Deidentified Minimum,,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,,1145.00
Deidentified Minimum,,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,,3544.00
Deidentified Minimum,,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,,3544.00
Deidentified Minimum,,20561,CPT4/HCPCS,NDL INSJ W/O NJX 3+ MUSC,,,1291.00
Deidentified Minimum,,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,,987.78
Deidentified Minimum,,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,,400.00
Deidentified Minimum,,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,,400.00
Deidentified Minimum,,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,,987.78
Deidentified Minimum,,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,,1291.00
Deidentified Minimum,,20704,CPT4/HCPCS,MNL PREP&INSJ I-ARTIC RX DEV,,,1145.00
Deidentified Minimum,,20705,CPT4/HCPCS,RMVL I-ARTIC RX DELIVERY DEV,,,1145.00
Deidentified Minimum,,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,,3965.00
Deidentified Minimum,,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,,3544.00
Deidentified Minimum,,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,,1145.00
Deidentified Minimum,,20932,CPT4/HCPCS,OSTEOART ALGRFT W/SURF & B1,,,1145.00
Deidentified Minimum,,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,,1678.00
Deidentified Minimum,,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,,3000.00
Deidentified Minimum,,20985,CPT4/HCPCS,CPTR-ASST DIR MS PX,,,1145.00
Deidentified Minimum,,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,,1678.88
Deidentified Minimum,,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,,1678.88
Deidentified Minimum,,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,,3544.00
Deidentified Minimum,,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,,1678.88
Deidentified Minimum,,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,,3544.00
Deidentified Minimum,,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,,5281.00
Deidentified Minimum,,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,,1291.00
Deidentified Minimum,,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,,3000.00
Deidentified Minimum,,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,,3544.00
Deidentified Minimum,,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,,3000.00
Deidentified Minimum,,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,,1291.00
Deidentified Minimum,,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,,5000.00
Deidentified Minimum,,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,,5730.00
Deidentified Minimum,,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,,1291.00
Deidentified Minimum,,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,,3000.00
Deidentified Minimum,,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,,3965.00
Deidentified Minimum,,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,,1291.00
Deidentified Minimum,,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,,3544.00
Deidentified Minimum,,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,1291.00
Deidentified Minimum,,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,5000.00
Deidentified Minimum,,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,,1291.00
Deidentified Minimum,,21495,CPT4/HCPCS,TREAT HYOID BONE FRACTURE,,,5029.00
Deidentified Minimum,,21499,CPT4/HCPCS,HEAD SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,21603,CPT4/HCPCS,EXC CH WAL TUM W/LYMPHADEC,,,1291.00
Deidentified Minimum,,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,,1291.00
Deidentified Minimum,,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,,4000.00
Deidentified Minimum,,21810,CPT4/HCPCS,TREATMENT OF RIB FRACTURE(S),,,1678.88
Deidentified Minimum,,21899,CPT4/HCPCS,NECK/CHEST SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,,3544.00
Deidentified Minimum,,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,,1145.00
Deidentified Minimum,,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,,1291.00
Deidentified Minimum,,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,,1291.00
Deidentified Minimum,,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,,1291.00
Deidentified Minimum,,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,,1678.88
Deidentified Minimum,,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,,1678.00
Deidentified Minimum,,22532,CPT4/HCPCS,LAT THORAX SPINE FUSION,,,1291.00
Deidentified Minimum,,22558,CPT4/HCPCS,LUMBAR SPINE FUSION,,,1291.00
Deidentified Minimum,,22610,CPT4/HCPCS,THORAX SPINE FUSION,,,1291.00
Deidentified Minimum,,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,,1291.00
Deidentified Minimum,,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,,1291.00
Deidentified Minimum,,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,,1291.00
Deidentified Minimum,,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,,1291.00
Deidentified Minimum,,22859,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,,1145.00
Deidentified Minimum,,22861,CPT4/HCPCS,REVISE CERV ARTIFIC DISC,,,1291.00
Deidentified Minimum,,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,,3000.00
Deidentified Minimum,,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,,1291.00
Deidentified Minimum,,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,,4000.00
Deidentified Minimum,,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,,4847.00
Deidentified Minimum,,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,,5000.00
Deidentified Minimum,,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,,4847.00
Deidentified Minimum,,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,,1678.88
Deidentified Minimum,,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,,1291.00
Deidentified Minimum,,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,,1235.00
Deidentified Minimum,,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,,987.78
Deidentified Minimum,,23350,CPT4/HCPCS,INJECTION FOR SHOULDER X-RAY,,,1145.00
Deidentified Minimum,,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,,5000.00
Deidentified Minimum,,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,,4000.00
Deidentified Minimum,,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,,3000.00
Deidentified Minimum,,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,1291.00
Deidentified Minimum,,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,,3544.00
Deidentified Minimum,,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1145.00
Deidentified Minimum,,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,,3544.00
Deidentified Minimum,,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,,3544.00
Deidentified Minimum,,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,,1291.00
Deidentified Minimum,,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,,1678.88
Deidentified Minimum,,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,,3000.00
Deidentified Minimum,,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,,1678.00
Deidentified Minimum,,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,,3544.00
Deidentified Minimum,,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,,3544.00
Deidentified Minimum,,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,,1678.88
Deidentified Minimum,,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,,3544.00
Deidentified Minimum,,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,,1291.00
Deidentified Minimum,,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,,3544.00
Deidentified Minimum,,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,,1678.88
Deidentified Minimum,,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,,3544.00
Deidentified Minimum,,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,,3544.00
Deidentified Minimum,,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,,5000.00
Deidentified Minimum,,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,,3000.00
Deidentified Minimum,,24498,CPT4/HCPCS,REINFORCE HUMERUS,,,3544.00
Deidentified Minimum,,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1145.00
Deidentified Minimum,,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1145.00
Deidentified Minimum,,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,,1291.00
Deidentified Minimum,,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,,4000.00
Deidentified Minimum,,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,,5000.00
Deidentified Minimum,,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,,1678.00
Deidentified Minimum,,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,,3544.00
Deidentified Minimum,,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,,1678.00
Deidentified Minimum,,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,,1678.88
Deidentified Minimum,,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,,1678.00
Deidentified Minimum,,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,,1291.00
Deidentified Minimum,,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,,3000.00
Deidentified Minimum,,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,,3544.00
Deidentified Minimum,,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,,1678.88
Deidentified Minimum,,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,,3544.00
Deidentified Minimum,,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,,3544.00
Deidentified Minimum,,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,,3544.00
Deidentified Minimum,,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,,1678.88
Deidentified Minimum,,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,,1678.88
Deidentified Minimum,,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,,1291.00
Deidentified Minimum,,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,3544.00
Deidentified Minimum,,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,,4000.00
Deidentified Minimum,,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,,3544.00
Deidentified Minimum,,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,,5000.00
Deidentified Minimum,,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,,3544.00
Deidentified Minimum,,25491,CPT4/HCPCS,REINFORCE ULNA,,,3544.00
Deidentified Minimum,,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,400.00
Deidentified Minimum,,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,,400.00
Deidentified Minimum,,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,1291.00
Deidentified Minimum,,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,,5000.00
Deidentified Minimum,,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,,5000.00
Deidentified Minimum,,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,,1291.00
Deidentified Minimum,,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,,1291.00
Deidentified Minimum,,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,,1291.00
Deidentified Minimum,,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,,1291.00
Deidentified Minimum,,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,,1291.00
Deidentified Minimum,,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,,1291.00
Deidentified Minimum,,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,,3000.00
Deidentified Minimum,,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,,1291.00
Deidentified Minimum,,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,,1291.00
Deidentified Minimum,,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,,4000.00
Deidentified Minimum,,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,,3544.00
Deidentified Minimum,,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,,3544.00
Deidentified Minimum,,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,,1291.00
Deidentified Minimum,,26496,CPT4/HCPCS,REVISE THUMB TENDON,,,3544.00
Deidentified Minimum,,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,,4000.00
Deidentified Minimum,,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,,3544.00
Deidentified Minimum,,26535,CPT4/HCPCS,REVISE FINGER JOINT,,,5000.00
Deidentified Minimum,,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,,4000.00
Deidentified Minimum,,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,,1291.00
Deidentified Minimum,,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,,3544.00
Deidentified Minimum,,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,,3544.00
Deidentified Minimum,,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,,4000.00
Deidentified Minimum,,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,,987.78
Deidentified Minimum,,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,,3965.00
Deidentified Minimum,,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,3965.00
Deidentified Minimum,,26841,CPT4/HCPCS,FUSION OF THUMB,,,4000.00
Deidentified Minimum,,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,,3544.00
Deidentified Minimum,,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,,1291.00
Deidentified Minimum,,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,,1291.00
Deidentified Minimum,,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,,3544.00
Deidentified Minimum,,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,,1678.88
Deidentified Minimum,,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,,3965.00
Deidentified Minimum,,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,,1291.00
Deidentified Minimum,,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,,3544.00
Deidentified Minimum,,27093,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,,1145.00
Deidentified Minimum,,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,,4000.00
Deidentified Minimum,,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,,5783.00
Deidentified Minimum,,27147,CPT4/HCPCS,REVISION OF HIP BONE,,,1291.00
Deidentified Minimum,,27156,CPT4/HCPCS,REVISION OF HIP BONES,,,1291.00
Deidentified Minimum,,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,,1291.00
Deidentified Minimum,,27194,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,,1678.88
Deidentified Minimum,,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,,1235.00
Deidentified Minimum,,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,,987.78
Deidentified Minimum,,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,,3965.00
Deidentified Minimum,,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,,1291.00
Deidentified Minimum,,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,,3544.00
Deidentified Minimum,,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,,1678.88
Deidentified Minimum,,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,,1291.00
Deidentified Minimum,,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,,4000.00
Deidentified Minimum,,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,,3544.00
Deidentified Minimum,,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,,3965.00
Deidentified Minimum,,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,,3544.00
Deidentified Minimum,,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,,3544.00
Deidentified Minimum,,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,,1678.88
Deidentified Minimum,,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,,3544.00
Deidentified Minimum,,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,,4000.00
Deidentified Minimum,,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,,3000.00
Deidentified Minimum,,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,,4000.00
Deidentified Minimum,,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,,4000.00
Deidentified Minimum,,27437,CPT4/HCPCS,REVISE KNEECAP,,,4000.00
Deidentified Minimum,,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,,5000.00
Deidentified Minimum,,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,,3000.00
Deidentified Minimum,,27448,CPT4/HCPCS,INCISION OF THIGH,,,1291.00
Deidentified Minimum,,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,,1291.00
Deidentified Minimum,,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,,1291.00
Deidentified Minimum,,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,,1291.00
Deidentified Minimum,,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,,1291.00
Deidentified Minimum,,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,,3000.00
Deidentified Minimum,,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,,3000.00
Deidentified Minimum,,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,1145.00
Deidentified Minimum,,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,3544.00
Deidentified Minimum,,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,,1291.00
Deidentified Minimum,,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,,1678.88
Deidentified Minimum,,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,,1291.00
Deidentified Minimum,,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,1291.00
Deidentified Minimum,,27599,CPT4/HCPCS,LEG SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,,1678.00
Deidentified Minimum,,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,,1235.00
Deidentified Minimum,,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,,4000.00
Deidentified Minimum,,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,,3544.00
Deidentified Minimum,,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,,1678.88
Deidentified Minimum,,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,,3544.00
Deidentified Minimum,,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,,1678.88
Deidentified Minimum,,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,,1678.88
Deidentified Minimum,,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,,4000.00
Deidentified Minimum,,27705,CPT4/HCPCS,INCISION OF TIBIA,,,1678.88
Deidentified Minimum,,27707,CPT4/HCPCS,INCISION OF FIBULA,,,1678.88
Deidentified Minimum,,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,,3000.00
Deidentified Minimum,,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,,1145.00
Deidentified Minimum,,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,,1235.00
Deidentified Minimum,,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,1235.00
Deidentified Minimum,,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,,1145.00
Deidentified Minimum,,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,,3544.00
Deidentified Minimum,,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,,1678.88
Deidentified Minimum,,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,,3544.00
Deidentified Minimum,,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,,4000.00
Deidentified Minimum,,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,,1291.00
Deidentified Minimum,,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,,3544.00
Deidentified Minimum,,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,,1678.88
Deidentified Minimum,,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,,1678.00
Deidentified Minimum,,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,,1678.88
Deidentified Minimum,,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,,3965.00
Deidentified Minimum,,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,,3000.00
Deidentified Minimum,,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,,1678.88
Deidentified Minimum,,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,,1678.88
Deidentified Minimum,,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,,1678.88
Deidentified Minimum,,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,,3544.00
Deidentified Minimum,,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,,1678.88
Deidentified Minimum,,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,,1678.88
Deidentified Minimum,,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,,3544.00
Deidentified Minimum,,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,,3544.00
Deidentified Minimum,,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,,1678.00
Deidentified Minimum,,28150,CPT4/HCPCS,REMOVAL OF TOE,,,1678.88
Deidentified Minimum,,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,,1291.00
Deidentified Minimum,,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,,3544.00
Deidentified Minimum,,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,,1678.00
Deidentified Minimum,,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,,1678.00
Deidentified Minimum,,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,3544.00
Deidentified Minimum,,94644,CPT4/HCPCS,CBT 1ST HOUR,,,450.74
Deidentified Minimum,,94772,CPT4/HCPCS,BREATH RECORDING INFANT,,,0.00
Deidentified Minimum,,95044,CPT4/HCPCS,ALLERGY PATCH TESTS,,,105.08
Deidentified Minimum,,95056,CPT4/HCPCS,PHOTOSENSITIVITY TESTS,,,90.64
Deidentified Minimum,,95822,CPT4/HCPCS,EEG COMA OR SLEEP ONLY,,,1928.98
Deidentified Minimum,,95830,CPT4/HCPCS,INSERT ELECTRODES FOR EEG,,,1632.21
Deidentified Minimum,,95833,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,,287.13
Deidentified Minimum,,95857,CPT4/HCPCS,CHOLINESTERASE CHALLENGE,,,296.76
Deidentified Minimum,,95866,CPT4/HCPCS,MUSCLE TEST HEMIDIAPHRAGM,,,406.02
Deidentified Minimum,,95869,CPT4/HCPCS,MUSCLE TEST THOR PARASPINAL,,,113.92
Deidentified Minimum,,95913,CPT4/HCPCS,MOTOR&SENS 13/> NRV CND TEST,,,0.00
Deidentified Minimum,,95925,CPT4/HCPCS,SOMATOSENSORY TESTING,,,462.06
Deidentified Minimum,,95926,CPT4/HCPCS,SOMATOSENSORY TESTING,,,462.06
Deidentified Minimum,,95950,CPT4/HCPCS,AMBULATORY EEG MONITORING,,,2016.32
Deidentified Minimum,,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,,726.70
Deidentified Minimum,,96101,CPT4/HCPCS,PSYCHO TESTING BY PSYCH/PHYS,,,178.96
Deidentified Minimum,,96102,CPT4/HCPCS,PSYCHO TESTING BY TECHNICIAN,,,47.34
Deidentified Minimum,,96119,CPT4/HCPCS,NEUROPSYCH TESTING BY TEC,,,120.73
Deidentified Minimum,,96125,CPT4/HCPCS,COGNITIVE TEST BY HC PRO,,,242.58
Deidentified Minimum,,96153,CPT4/HCPCS,INTERVENE HLTH/BEHAVE GROUP,,,13.66
Deidentified Minimum,,96154,CPT4/HCPCS,INTERV HLTH/BEHAV FAM W/PT,,,42.53
Deidentified Minimum,,96366,CPT4/HCPCS,THER/PROPH/DIAG IV INF ADDON,,,194.16
Deidentified Minimum,,96369,CPT4/HCPCS,SC THER INFUSION UP TO 1 HR,,,1881.49
Deidentified Minimum,,96372,CPT4/HCPCS,THER/PROPH/DIAG INJ SC/IM,,,210.93
Deidentified Minimum,,96373,CPT4/HCPCS,THER/PROPH/DIAG INJ IA,,,152.41
Deidentified Minimum,,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,,190.45
Deidentified Minimum,,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,,190.45
Deidentified Minimum,,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,,193.00
Deidentified Minimum,,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,,193.00
Deidentified Minimum,,96521,CPT4/HCPCS,REFILL/MAINT PORTABLE PUMP,,,776.10
Deidentified Minimum,,96523,CPT4/HCPCS,IRRIG DRUG DELIVERY DEVICE,,,244.77
Deidentified Minimum,,96574,CPT4/HCPCS,DBRDMT PRMLG LES W/PDT,,,1145.00
Deidentified Minimum,,96910,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-B,,,978.46
Deidentified Minimum,,96913,CPT4/HCPCS,PHOTOCHEMOTHERAPY UV-A OR B,,,1796.58
Deidentified Minimum,,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,,71.40
Deidentified Minimum,,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,,178.16
Deidentified Minimum,,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,,138.75
Deidentified Minimum,,97156,CPT4/HCPCS,FAM ADAPT BHV TX GDN PHY/QHP,,,206.64
Deidentified Minimum,,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,,193.00
Deidentified Minimum,,98960,CPT4/HCPCS,SELF-MGMT EDUC & TRAIN 1 PT,,,0.00
Deidentified Minimum,,99191,CPT4/HCPCS,SPECIAL PUMP SERVICES,,,5593.36
Deidentified Minimum,,A9503,CPT4/HCPCS,Tc99m medronate,,,108.78
Deidentified Minimum,,A9507,CPT4/HCPCS,In111 capromab,,,36778.72
Deidentified Minimum,,A9528,CPT4/HCPCS,Iodine I-131 iodide cap, dx,,,454.86
Deidentified Minimum,,A9550,CPT4/HCPCS,Tc99m gluceptate,,,161.36
Deidentified Minimum,,A9557,CPT4/HCPCS,Tc99m bicisate,,,3113.04
Deidentified Minimum,,A9571,CPT4/HCPCS,Indium IN-111 auto platelet,,,29920.38
Deidentified Minimum,,A9575,CPT4/HCPCS,Inj gadoterate meglumi 0.1ml,,,1.51
Deidentified Minimum,,A9581,CPT4/HCPCS,Gadoxetate disodium inj,,,125.07
Deidentified Minimum,,C8909,CPT4/HCPCS,MRA w/cont, chest,,,4399.00
Deidentified Minimum,,C8920,CPT4/HCPCS,MRA w/o fol w/cont, pelvis,,,4399.00
Deidentified Minimum,,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,,6876.92
Deidentified Minimum,,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,,6876.92
Deidentified Minimum,,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,,6876.92
Deidentified Minimum,,C9732,CPT4/HCPCS,Insert ocular telescope pros,,,3544.00
Deidentified Minimum,,C9740,CPT4/HCPCS,Cysto impl 4 or more,,,4280.43
Deidentified Minimum,,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,,1235.00
Deidentified Minimum,,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,,1235.00
Deidentified Minimum,,G0168,CPT4/HCPCS,Wound closure by adhesive,,,1145.00
Deidentified Minimum,,G0173,CPT4/HCPCS,Linear acc stereo radsur com,,,5131.00
Deidentified Minimum,,G0251,CPT4/HCPCS,Linear acc based stero radio,,,5131.00
Deidentified Minimum,,G0291,CPT4/HCPCS,Drug-eluting stents,each add,,,8012.00
Deidentified Minimum,,G0300,CPT4/HCPCS,Hhs/hospice of lpn ea 15 min,,,13913.00
Deidentified Minimum,,G0415,CPT4/HCPCS,Open tx post pelvic fxcture,,,1291.00
Deidentified Minimum,,G0428,CPT4/HCPCS,Collagen meniscus implant,,,1291.00
Deidentified Minimum,,G0453,CPT4/HCPCS,Cont intraop neuro monitor,,,1145.00
Deidentified Minimum,,G0455,CPT4/HCPCS,Fecal microbiota prep instil,,,2002.00
Deidentified Minimum,,G6001,CPT4/HCPCS,Echo guidance radiotherapy,,,159.34
Deidentified Minimum,,G6007,CPT4/HCPCS,Radiation treatment delivery,,,1902.52
Deidentified Minimum,,G6024,CPT4/HCPCS,Lesion removal colonoscopy,,,1678.00
Deidentified Minimum,,G6025,CPT4/HCPCS,Colonoscopy w/stent,,,1678.00
Deidentified Minimum,,G8979,CPT4/HCPCS,Mobility goal status,,,0.00
Deidentified Minimum,,G8980,CPT4/HCPCS,Mobility d/c status,,,0.00
Deidentified Minimum,,G8982,CPT4/HCPCS,Body pos goal status,,,0.00
Deidentified Minimum,,G8989,CPT4/HCPCS,Self care d/c status,,,0.00
Deidentified Minimum,,G8991,CPT4/HCPCS,Other pt/ot goal status,,,0.00
Deidentified Minimum,,G8992,CPT4/HCPCS,Other pt/ot d/c status,,,0.00
Deidentified Minimum,,G8995,CPT4/HCPCS,Sub pt/ot d/c status,,,0.00
Deidentified Minimum,,G8996,CPT4/HCPCS,Swallow current status,,,6.5e-03
Deidentified Minimum,,G8997,CPT4/HCPCS,Swallow goal status,,,6.5e-03
Deidentified Minimum,,G9158,CPT4/HCPCS,Motor speech d/c status,,,6.5e-03
Deidentified Minimum,,G9165,CPT4/HCPCS,Atten current status,,,6.5e-03
Deidentified Minimum,,G9186,CPT4/HCPCS,Motor speech goal status,,,6.5e-03
Deidentified Minimum,,J1447,CPT4/HCPCS,Inj tbo filgrastim 1 microg,,,4.53
Deidentified Minimum,,J8600,CPT4/HCPCS,Melphalan oral 2 MG,,,76.60
Deidentified Minimum,,J9015,CPT4/HCPCS,Aldesleukin injection,,,39184.90
Deidentified Minimum,,J9070,CPT4/HCPCS,Cyclophosphamide 100 MG inj,,,281.98
Deidentified Minimum,,J9151,CPT4/HCPCS,Daunorubicin citrate inj,,,1924.27
Deidentified Minimum,,J9160,CPT4/HCPCS,Denileukin diftitox inj,,,12993.03
Deidentified Minimum,,J9202,CPT4/HCPCS,Goserelin acetate implant,,,4275.76
Deidentified Minimum,,J9215,CPT4/HCPCS,Interferon alfa-n3 inj,,,252.00
Deidentified Minimum,,J9230,CPT4/HCPCS,Mechlorethamine hcl inj,,,2591.14
Deidentified Minimum,,J9262,CPT4/HCPCS,Inj, omacetaxine mep, 0.01mg,,,24.69
Deidentified Minimum,,J9263,CPT4/HCPCS,Oxaliplatin,,,1.26
Deidentified Minimum,,J9270,CPT4/HCPCS,Plicamycin (mithramycin) inj,,,688.38
Deidentified Minimum,,J9371,CPT4/HCPCS,Inj, vincristine sul lip 1mg,,,26095.35
Deidentified Minimum,,J9400,CPT4/HCPCS,Inj, ziv-aflibercept, 1mg,,,71.23
Deidentified Minimum,,P9612,CPT4/HCPCS,Catheterize for urine spec,,,2002.00
Deidentified Minimum,,Q0085,CPT4/HCPCS,Chemo by both infusion and o,,,1405.15
Deidentified Minimum,,Q2017,CPT4/HCPCS,Teniposide, 50 mg,,,20882.14
Deidentified Minimum,,Q9954,CPT4/HCPCS,Oral MR contrast, 100 ml,,,87.61
Deidentified Minimum,,Q9959,CPT4/HCPCS,HOCM 150-199mg/ml iodine,1ml,,,0.75
Deidentified Minimum,,Q9965,CPT4/HCPCS,LOCM 100-199mg/ml iodine,1ml,,,7.47
Deidentified Minimum,,S0108,CPT4/HCPCS,Mercaptopurine 50 mg,,,25.20
Deidentified Minimum,,S0183,CPT4/HCPCS,Prochlorperazine 5 mg,,,3.02
Deidentified Minimum,,S2400,CPT4/HCPCS,Fetal surg congen hernia,,,8012.00
Deidentified Minimum,,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,,1291.00
Deidentified Minimum,,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,,1291.00
Deidentified Minimum,,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,,1291.00
Deidentified Minimum,,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,,1291.00
Deidentified Minimum,,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,,1291.00
Deidentified Minimum,,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,,1291.00
Deidentified Minimum,,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,,1291.00
Deidentified Minimum,,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,,3000.00
Deidentified Minimum,,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,,1291.00
Deidentified Minimum,,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,,3000.00
Deidentified Minimum,,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,,1678.00
Deidentified Minimum,,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,,1678.00
Deidentified Minimum,,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,,6612.00
Deidentified Minimum,,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,,1291.00
Deidentified Minimum,,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,,1291.00
Deidentified Minimum,,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,,1291.00
Deidentified Minimum,,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,,1291.00
Deidentified Minimum,,48511,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,,1678.88
Deidentified Minimum,,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,,3000.00
Deidentified Minimum,,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,,1291.00
Deidentified Minimum,,49061,CPT4/HCPCS,DRAIN PERCUT RETROPER ABSC,,,1678.00
Deidentified Minimum,,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,,1291.00
Deidentified Minimum,,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,,3544.00
Deidentified Minimum,,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,,1291.00
Deidentified Minimum,,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,,1291.00
Deidentified Minimum,,49412,CPT4/HCPCS,INS DEVICE FOR RT GUIDE OPEN,,,1291.00
Deidentified Minimum,,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,,1678.88
Deidentified Minimum,,49424,CPT4/HCPCS,ASSESS CYST CONTRAST INJECT,,,1145.00
Deidentified Minimum,,49428,CPT4/HCPCS,LIGATION OF SHUNT,,,1291.00
Deidentified Minimum,,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,,1678.88
Deidentified Minimum,,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,,1291.00
Deidentified Minimum,,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,,1145.00
Deidentified Minimum,,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,,4847.00
Deidentified Minimum,,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,,4847.00
Deidentified Minimum,,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,,1291.00
Deidentified Minimum,,50021,CPT4/HCPCS,RENAL ABSCESS PERCUT DRAIN,,,1678.00
Deidentified Minimum,,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,,1291.00
Deidentified Minimum,,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,,1291.00
Deidentified Minimum,,50325,CPT4/HCPCS,PREP DONOR RENAL GRAFT,,,1291.00
Deidentified Minimum,,50328,CPT4/HCPCS,PREP RENAL GRAFT/ARTERIAL,,,1291.00
Deidentified Minimum,,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,,1678.88
Deidentified Minimum,,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,,987.78
Deidentified Minimum,,50392,CPT4/HCPCS,INSERT KIDNEY DRAIN,,,1678.00
Deidentified Minimum,,50393,CPT4/HCPCS,INSERT URETERAL TUBE,,,1678.00
Deidentified Minimum,,50394,CPT4/HCPCS,INJECTION FOR KIDNEY X-RAY,,,1678.00
Deidentified Minimum,,50395,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,,1678.00
Deidentified Minimum,,50436,CPT4/HCPCS,DILAT XST TRC NDURLGC PX,,,1678.00
Deidentified Minimum,,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,,1235.00
Deidentified Minimum,,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,,1235.00
Deidentified Minimum,,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,,1235.00
Deidentified Minimum,,50606,CPT4/HCPCS,ENDOLUMINAL BX URTR RNL PLVS,,,1145.00
Deidentified Minimum,,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,,1291.00
Deidentified Minimum,,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,,1678.00
Deidentified Minimum,,50705,CPT4/HCPCS,URETERAL EMBOLIZATION/OCCL,,,1145.00
Deidentified Minimum,,50722,CPT4/HCPCS,RELEASE OF URETER,,,1291.00
Deidentified Minimum,,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,,1291.00
Deidentified Minimum,,50900,CPT4/HCPCS,REPAIR OF URETER,,,1291.00
Deidentified Minimum,,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,,5281.00
Deidentified Minimum,,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,,1291.00
Deidentified Minimum,,50970,CPT4/HCPCS,URETER ENDOSCOPY,,,1235.00
Deidentified Minimum,,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,,1291.00
Deidentified Minimum,,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,,3198.57
Deidentified Minimum,,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,,1291.00
Deidentified Minimum,,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,,1291.00
Deidentified Minimum,,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,,1291.00
Deidentified Minimum,,51700,CPT4/HCPCS,IRRIGATION OF BLADDER,,,987.78
Deidentified Minimum,,51702,CPT4/HCPCS,INSERT TEMP BLADDER CATH,,,400.00
Deidentified Minimum,,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,,987.78
Deidentified Minimum,,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,,987.78
Deidentified Minimum,,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,,3000.00
Deidentified Minimum,,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,,1678.00
Deidentified Minimum,,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,,1678.88
Deidentified Minimum,,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,,3965.00
Deidentified Minimum,,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,,1678.88
Deidentified Minimum,,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,,1678.88
Deidentified Minimum,,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,,1678.88
Deidentified Minimum,,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,,1678.88
Deidentified Minimum,,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,,1678.88
Deidentified Minimum,,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,,1678.88
Deidentified Minimum,,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,,1678.88
Deidentified Minimum,,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,,1678.00
Deidentified Minimum,,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,,1678.88
Deidentified Minimum,,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,,1678.88
Deidentified Minimum,,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,,1145.00
Deidentified Minimum,,53665,CPT4/HCPCS,DILATION OF URETHRA,,,1678.00
Deidentified Minimum,,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,,3000.00
Deidentified Minimum,,53899,CPT4/HCPCS,UROLOGY SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,,1678.00
Deidentified Minimum,,54125,CPT4/HCPCS,REMOVAL OF PENIS,,,1291.00
Deidentified Minimum,,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,,1291.00
Deidentified Minimum,,54304,CPT4/HCPCS,REVISION OF PENIS,,,3544.00
Deidentified Minimum,,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,4000.00
Deidentified Minimum,,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,3544.00
Deidentified Minimum,,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,,4000.00
Deidentified Minimum,,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,,4000.00
Deidentified Minimum,,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,,3000.00
Deidentified Minimum,,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,,3000.00
Deidentified Minimum,,54699,CPT4/HCPCS,LAPAROSCOPE PROC TESTIS,,,3000.00
Deidentified Minimum,,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,,3965.00
Deidentified Minimum,,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,,1678.88
Deidentified Minimum,,55300,CPT4/HCPCS,PREPARE SPERM DUCT X-RAY,,,1145.00
Deidentified Minimum,,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,,3544.00
Deidentified Minimum,,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,,3965.00
Deidentified Minimum,,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,,4000.00
Deidentified Minimum,,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,,1678.00
Deidentified Minimum,,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,,1678.00
Deidentified Minimum,,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,1291.00
Deidentified Minimum,,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,1291.00
Deidentified Minimum,,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,,1678.00
Deidentified Minimum,,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,,3965.00
Deidentified Minimum,,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,,1678.00
Deidentified Minimum,,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,,1678.00
Deidentified Minimum,,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,,3000.00
Deidentified Minimum,,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,,3000.00
Deidentified Minimum,,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,,3000.00
Deidentified Minimum,,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,,987.78
Deidentified Minimum,,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,,3000.00
Deidentified Minimum,,57283,CPT4/HCPCS,COLPOPEXY INTRAPERITONEAL,,,3000.00
Deidentified Minimum,,57296,CPT4/HCPCS,REVISE VAG GRAFT OPEN ABD,,,1291.00
Deidentified Minimum,,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,,3544.00
Deidentified Minimum,,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,,1291.00
Deidentified Minimum,,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,,3544.00
Deidentified Minimum,,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,,1678.00
Deidentified Minimum,,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,,987.78
Deidentified Minimum,,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,,1145.00
Deidentified Minimum,,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,,1678.00
Deidentified Minimum,,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,,1145.00
Deidentified Minimum,,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,,1678.88
Deidentified Minimum,,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,,1678.88
Deidentified Minimum,,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,,1678.88
Deidentified Minimum,,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,,1678.00
Deidentified Minimum,,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,,1678.88
Deidentified Minimum,,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,,1291.00
Deidentified Minimum,,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,,3000.00
Deidentified Minimum,,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,,987.78
Deidentified Minimum,,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,,1678.00
Deidentified Minimum,,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,,1291.00
Deidentified Minimum,,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,,5029.00
Deidentified Minimum,,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,,5281.00
Deidentified Minimum,,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,,3544.00
Deidentified Minimum,,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,,3000.00
Deidentified Minimum,,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,,3544.00
Deidentified Minimum,,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,,3000.00
Deidentified Minimum,,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,,3198.57
Deidentified Minimum,,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,,1291.00
Deidentified Minimum,,59050,CPT4/HCPCS,FETAL MONITOR W/REPORT,,,987.78
Deidentified Minimum,,59051,CPT4/HCPCS,FETAL MONITOR/INTERPRET ONLY,,,987.78
Deidentified Minimum,,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,,3000.00
Deidentified Minimum,,59515,CPT4/HCPCS,CESAREAN DELIVERY,,,3000.00
Deidentified Minimum,,59525,CPT4/HCPCS,REMOVE UTERUS AFTER CESAREAN,,,3198.57
Deidentified Minimum,,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,,3544.00
Deidentified Minimum,,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,,1678.88
Deidentified Minimum,,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,,3544.00
Deidentified Minimum,,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,,4000.00
Deidentified Minimum,,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,,3000.00
Deidentified Minimum,,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,,1145.00
Deidentified Minimum,,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,,1291.00
Deidentified Minimum,,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,,5730.00
Deidentified Minimum,,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,,1291.00
Deidentified Minimum,,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,1291.00
Deidentified Minimum,,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,,1291.00
Deidentified Minimum,,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,,1291.00
Deidentified Minimum,,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,1291.00
Deidentified Minimum,,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,1291.00
Deidentified Minimum,,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,,1291.00
Deidentified Minimum,,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,,1291.00
Deidentified Minimum,,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,,1291.00
Deidentified Minimum,,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,1291.00
Deidentified Minimum,,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,1291.00
Deidentified Minimum,,61609,CPT4/HCPCS,TRANSECT ARTERY SINUS,,,6588.00
Deidentified Minimum,,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,,3000.00
Deidentified Minimum,,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,,1291.00
Deidentified Minimum,,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,,1291.00
Deidentified Minimum,,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,,1291.00
Deidentified Minimum,,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,,3198.57
Deidentified Minimum,,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,,1291.00
Deidentified Minimum,,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,,3452.00
Deidentified Minimum,,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,,1291.00
Deidentified Minimum,,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,,1291.00
Deidentified Minimum,,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,,1291.00
Deidentified Minimum,,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,,1291.00
Deidentified Minimum,,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,,1291.00
Deidentified Minimum,,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,,1291.00
Deidentified Minimum,,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,1291.00
Deidentified Minimum,,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,,1678.00
Deidentified Minimum,,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,1291.00
Deidentified Minimum,,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,1291.00
Deidentified Minimum,,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,,1291.00
Deidentified Minimum,,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,,1678.88
Deidentified Minimum,,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,,1145.00
Deidentified Minimum,,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,,1235.00
Deidentified Minimum,,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,,1235.00
Deidentified Minimum,,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,,1145.00
Deidentified Minimum,,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,,1235.00
Deidentified Minimum,,62318,CPT4/HCPCS,INJECT SPINE W/CATH CRV/THRC,,,1678.00
Deidentified Minimum,,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,,1235.00
Deidentified Minimum,,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,,1678.88
Deidentified Minimum,,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,,1678.88
Deidentified Minimum,,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,,1678.88
Deidentified Minimum,,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,,1145.00
Deidentified Minimum,,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,,400.00
Deidentified Minimum,,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,,3452.00
Deidentified Minimum,,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,,3000.00
Deidentified Minimum,,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,,3452.00
Deidentified Minimum,,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,,1145.00
Deidentified Minimum,,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,,3452.00
Deidentified Minimum,,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,,3452.00
Deidentified Minimum,,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,,3452.00
Deidentified Minimum,,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,1291.00
Deidentified Minimum,,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,,1291.00
Deidentified Minimum,,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,,1291.00
Deidentified Minimum,,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,,1291.00
Deidentified Minimum,,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,,1291.00
Deidentified Minimum,,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,,1291.00
Deidentified Minimum,,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,,1291.00
Deidentified Minimum,,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,,1291.00
Deidentified Minimum,,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,1291.00
Deidentified Minimum,,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1678.88
Deidentified Minimum,,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,,1678.88
Deidentified Minimum,,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,,1678.88
Deidentified Minimum,,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,,1678.00
Deidentified Minimum,,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,,1291.00
Deidentified Minimum,,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,,1291.00
Deidentified Minimum,,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,,1145.00
Deidentified Minimum,,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,,1235.00
Deidentified Minimum,,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,,1235.00
Deidentified Minimum,,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,,1235.00
Deidentified Minimum,,64451,CPT4/HCPCS,NJX AA&/STRD NRV NRVTG SI JT,,,1235.00
Deidentified Minimum,,64454,CPT4/HCPCS,NJX AA&/STRD GNCLR NRV BRNCH,,,1235.00
Deidentified Minimum,,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,,1235.00
Deidentified Minimum,,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,,1145.00
Deidentified Minimum,,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,,1145.00
Deidentified Minimum,,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,,1235.00
Deidentified Minimum,,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,,66.95
Deidentified Minimum,,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1678.00
Deidentified Minimum,,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,,3000.00
Deidentified Minimum,,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,,1678.00
Deidentified Minimum,,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,,400.00
Deidentified Minimum,,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,,400.00
Deidentified Minimum,,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,1235.00
Deidentified Minimum,,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,,1145.00
Deidentified Minimum,,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,,1145.00
Deidentified Minimum,,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,,400.00
Deidentified Minimum,,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,,400.00
Deidentified Minimum,,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,,987.78
Deidentified Minimum,,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,,1678.88
Deidentified Minimum,,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,,1678.88
Deidentified Minimum,,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,,3452.00
Deidentified Minimum,,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,,1678.00
Deidentified Minimum,,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,,1291.00
Deidentified Minimum,,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,,1678.88
Deidentified Minimum,,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,,1291.00
Deidentified Minimum,,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,,1678.88
Deidentified Minimum,,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,,1291.00
Deidentified Minimum,,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,,3452.00
Deidentified Minimum,,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,,1291.00
Deidentified Minimum,,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,,1145.00
Deidentified Minimum,,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,,1678.00
Deidentified Minimum,,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,,3452.00
Deidentified Minimum,,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,987.78
Deidentified Minimum,,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,987.78
Deidentified Minimum,,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,,1678.88
Deidentified Minimum,,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,,3452.00
Deidentified Minimum,,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,,1145.00
Deidentified Minimum,,65760,CPT4/HCPCS,REVISION OF CORNEA,,,400.00
Deidentified Minimum,,65765,CPT4/HCPCS,REVISION OF CORNEA,,,400.00
Deidentified Minimum,,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,,400.00
Deidentified Minimum,,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,,1678.88
Deidentified Minimum,,65850,CPT4/HCPCS,INCISION OF EYE,,,3452.00
Deidentified Minimum,,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,,1235.00
Deidentified Minimum,,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,,1678.88
Deidentified Minimum,,66130,CPT4/HCPCS,REMOVE EYE LESION,,,3452.00
Deidentified Minimum,,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,,3452.00
Deidentified Minimum,,66220,CPT4/HCPCS,REPAIR EYE LESION,,,3544.00
Deidentified Minimum,,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,,1678.88
Deidentified Minimum,,66605,CPT4/HCPCS,REMOVAL OF IRIS,,,3452.00
Deidentified Minimum,,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,,1678.88
Deidentified Minimum,,66920,CPT4/HCPCS,EXTRACTION OF LENS,,,3452.00
Deidentified Minimum,,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,,3452.00
Deidentified Minimum,,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,,3452.00
Deidentified Minimum,,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,,3452.00
Deidentified Minimum,,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,,3452.00
Deidentified Minimum,,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,,1145.00
Deidentified Minimum,,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,,3452.00
Deidentified Minimum,,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,,3452.00
Deidentified Minimum,,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,,3452.00
Deidentified Minimum,,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,,1145.00
Deidentified Minimum,,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,,2002.00
Deidentified Minimum,,67399,CPT4/HCPCS,UNLISTED PX EXTRAOCULAR MUSC,,,1145.00
Deidentified Minimum,,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,,3452.00
Deidentified Minimum,,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,,3452.00
Deidentified Minimum,,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,,3452.00
Deidentified Minimum,,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,,3452.00
Deidentified Minimum,,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,,987.78
Deidentified Minimum,,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,,1678.88
Deidentified Minimum,,67820,CPT4/HCPCS,REVISE EYELASHES,,,1145.00
Deidentified Minimum,,67950,CPT4/HCPCS,REVISION OF EYELID,,,1678.88
Deidentified Minimum,,67999,CPT4/HCPCS,REVISION OF EYELID,,,1145.00
Deidentified Minimum,,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,,3452.00
Deidentified Minimum,,68360,CPT4/HCPCS,REVISE EYELID LINING,,,1678.88
Deidentified Minimum,,68399,CPT4/HCPCS,EYELID LINING SURGERY,,,1145.00
Deidentified Minimum,,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,,1678.00
Deidentified Minimum,,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,,3452.00
Deidentified Minimum,,68899,CPT4/HCPCS,TEAR DUCT SYSTEM SURGERY,,,1145.00
Deidentified Minimum,,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,,1145.00
Deidentified Minimum,,69399,CPT4/HCPCS,OUTER EAR SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,69420,CPT4/HCPCS,INCISION OF EARDRUM,,,1145.00
Deidentified Minimum,,69502,CPT4/HCPCS,MASTOIDECTOMY,,,3452.00
Deidentified Minimum,,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,,3452.00
Deidentified Minimum,,69552,CPT4/HCPCS,REMOVE EAR LESION,,,3452.00
Deidentified Minimum,,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,,3452.00
Deidentified Minimum,,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,3452.00
Deidentified Minimum,,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,3452.00
Deidentified Minimum,,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,,3452.00
Deidentified Minimum,,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,,3452.00
Deidentified Minimum,,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,,3452.00
Deidentified Minimum,,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,,3452.00
Deidentified Minimum,,69801,CPT4/HCPCS,INCISE INNER EAR,,,1291.00
Deidentified Minimum,,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,,1291.00
Deidentified Minimum,,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,,142.00
Deidentified Minimum,,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,,142.00
Deidentified Minimum,,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,,142.00
Deidentified Minimum,,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,,1147.00
Deidentified Minimum,,70355,CPT4/HCPCS,PANORAMIC X-RAY OF JAWS,,,96.43
Deidentified Minimum,,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,,985.00
Deidentified Minimum,,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,,985.00
Deidentified Minimum,,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,,142.00
Deidentified Minimum,,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,,985.00
Deidentified Minimum,,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,,1147.00
Deidentified Minimum,,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,,1147.00
Deidentified Minimum,,70559,CPT4/HCPCS,MRI BRAIN W/O & W/DYE,,,1147.00
Deidentified Minimum,,71250,CPT4/HCPCS,CT THORAX DX C-,,,985.00
Deidentified Minimum,,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,,142.00
Deidentified Minimum,,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,,142.00
Deidentified Minimum,,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,,142.00
Deidentified Minimum,,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,,985.00
Deidentified Minimum,,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,,142.00
Deidentified Minimum,,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,,1147.00
Deidentified Minimum,,72190,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,,142.00
Deidentified Minimum,,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,,142.00
Deidentified Minimum,,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,,142.00
Deidentified Minimum,,72275,CPT4/HCPCS,EPIDUROGRAPHY,,,142.00
Deidentified Minimum,,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,,142.00
Deidentified Minimum,,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,,142.00
Deidentified Minimum,,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,,142.00
Deidentified Minimum,,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,,142.00
Deidentified Minimum,,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,,142.00
Deidentified Minimum,,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,,985.00
Deidentified Minimum,,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,,142.00
Deidentified Minimum,,73510,CPT4/HCPCS,X-RAY EXAM OF HIP,,,0.00
Deidentified Minimum,,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,,142.00
Deidentified Minimum,,74182,CPT4/HCPCS,MRI ABDOMEN W/DYE,,,1147.00
Deidentified Minimum,,74190,CPT4/HCPCS,X-RAY EXAM OF PERITONEUM,,,142.00
Deidentified Minimum,,74210,CPT4/HCPCS,X-RAY XM PHRNX&/CRV ESOPH C+,,,142.00
Deidentified Minimum,,74230,CPT4/HCPCS,X-RAY XM SWLNG FUNCJ C+,,,142.00
Deidentified Minimum,,74250,CPT4/HCPCS,X-RAY XM SM INT 1CNTRST STD,,,142.00
Deidentified Minimum,,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,,985.00
Deidentified Minimum,,74263,CPT4/HCPCS,CT COLONOGRAPHY SCREENING,,,985.00
Deidentified Minimum,,74270,CPT4/HCPCS,X-RAY XM COLON 1CNTRST STD,,,142.00
Deidentified Minimum,,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,,142.00
Deidentified Minimum,,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,,142.00
Deidentified Minimum,,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,,142.00
Deidentified Minimum,,74710,CPT4/HCPCS,X-RAY MEASUREMENT OF PELVIS,,,142.00
Deidentified Minimum,,75565,CPT4/HCPCS,CARD MRI VELOC FLOW MAPPING,,,142.00
Deidentified Minimum,,75573,CPT4/HCPCS,CT HRT W/3D IMAGE CONGEN,,,826.82
Deidentified Minimum,,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,,142.00
Deidentified Minimum,,75756,CPT4/HCPCS,ARTERY X-RAYS CHEST,,,142.00
Deidentified Minimum,,75774,CPT4/HCPCS,ARTERY X-RAY EACH VESSEL,,,142.00
Deidentified Minimum,,75842,CPT4/HCPCS,VEIN X-RAY ADRENAL GLANDS,,,142.00
Deidentified Minimum,,75885,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,,142.00
Deidentified Minimum,,75891,CPT4/HCPCS,VEIN X-RAY LIVER,,,142.00
Deidentified Minimum,,75902,CPT4/HCPCS,REMOVE CVA LUMEN OBSTRUCT,,,142.00
Deidentified Minimum,,75958,CPT4/HCPCS,XRAY PLACE PROX EXT THOR AO,,,142.00
Deidentified Minimum,,76979,CPT4/HCPCS,US TRGT DYN MBUBB EA ADDL,,,553.00
Deidentified Minimum,,76983,CPT4/HCPCS,USE EA ADDL TARGET LESION,,,287.69
Deidentified Minimum,,76998,CPT4/HCPCS,US GUIDE INTRAOP,,,487.11
Deidentified Minimum,,77003,CPT4/HCPCS,FLUOROGUIDE FOR SPINE INJECT,,,142.00
Deidentified Minimum,,77051,CPT4/HCPCS,COMPUTER DX MAMMOGRAM ADD-ON,,,533.54
Deidentified Minimum,,77055,CPT4/HCPCS,MAMMOGRAM ONE BREAST,,,0.00
Deidentified Minimum,,77058,CPT4/HCPCS,MRI ONE BREAST,,,10066.59
Deidentified Minimum,,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,,142.00
Deidentified Minimum,,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,,142.00
Deidentified Minimum,,77261,CPT4/HCPCS,RADIATION THERAPY PLANNING,,,142.00
Deidentified Minimum,,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,,2422.00
Deidentified Minimum,,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,,1000.91
Deidentified Minimum,,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,,1505.69
Deidentified Minimum,,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,,477.14
Deidentified Minimum,,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,,703.66
Deidentified Minimum,,78020,CPT4/HCPCS,THYROID MET UPTAKE,,,142.00
Deidentified Minimum,,78070,CPT4/HCPCS,PARATHYROID PLANAR IMAGING,,,142.00
Deidentified Minimum,,78072,CPT4/HCPCS,PARATHYRD PLANAR W/SPECT&CT,,,142.00
Deidentified Minimum,,78102,CPT4/HCPCS,BONE MARROW IMAGING LTD,,,142.00
Deidentified Minimum,,78104,CPT4/HCPCS,BONE MARROW IMAGING BODY,,,142.00
Deidentified Minimum,,78265,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,,142.00
Deidentified Minimum,,78291,CPT4/HCPCS,LEVEEN/SHUNT PATENCY EXAM,,,142.00
Deidentified Minimum,,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,,142.00
Deidentified Minimum,,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,,142.00
Deidentified Minimum,,78580,CPT4/HCPCS,LUNG PERFUSION IMAGING,,,142.00
Deidentified Minimum,,78610,CPT4/HCPCS,BRAIN FLOW IMAGING ONLY,,,142.00
Deidentified Minimum,,78635,CPT4/HCPCS,CSF VENTRICULOGRAPHY,,,142.00
Deidentified Minimum,,78708,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/DRUG,,,142.00
Deidentified Minimum,,78725,CPT4/HCPCS,KIDNEY FUNCTION STUDY,,,142.00
Deidentified Minimum,,78808,CPT4/HCPCS,IV INJ RA DRUG DX STUDY,,,142.00
Deidentified Minimum,,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,,142.00
Deidentified Minimum,,79445,CPT4/HCPCS,NUCLEAR RX INTRA-ARTERIAL,,,142.00
Deidentified Minimum,,80163,CPT4/HCPCS,ASSAY OF DIGOXIN FREE,,,96.00
Deidentified Minimum,,80178,CPT4/HCPCS,ASSAY OF LITHIUM,,,66.44
Deidentified Minimum,,80194,CPT4/HCPCS,ASSAY OF QUINIDINE,,,96.00
Deidentified Minimum,,80320,CPT4/HCPCS,DRUG SCREEN QUANTALCOHOLS,,,0.08
Deidentified Minimum,,80322,CPT4/HCPCS,ALCOHOLS BIOMARKERS 3/MORE,,,0.08
Deidentified Minimum,,80330,CPT4/HCPCS,ANALGESICS NON-OPIOID 3-5,,,0.08
Deidentified Minimum,,80331,CPT4/HCPCS,ANALGESICS NON-OPIOID 6/MORE,,,0.08
Deidentified Minimum,,80334,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 6/MORE,,,0.08
Deidentified Minimum,,80335,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 1/2,,,0.08
Deidentified Minimum,,80337,CPT4/HCPCS,TRICYCLIC & CYCLICALS 6/MORE,,,0.08
Deidentified Minimum,,80364,CPT4/HCPCS,OPIOID &OPIATE ANALOG 5/MORE,,,0.08
Deidentified Minimum,,80367,CPT4/HCPCS,DRUG SCREENING PROPOXYPHENE,,,0.08
Deidentified Minimum,,80376,CPT4/HCPCS,DRUG/SUBSTANCE NOS 4-6,,,0.08
Deidentified Minimum,,80400,CPT4/HCPCS,ACTH STIMULATION PANEL,,,96.00
Deidentified Minimum,,80415,CPT4/HCPCS,TOT ESTRADIOL RESPONSE PANEL,,,96.00
Deidentified Minimum,,80426,CPT4/HCPCS,GONADOTROPIN HORMONE PANEL,,,96.00
Deidentified Minimum,,80438,CPT4/HCPCS,TRH STIMULATION PANEL,,,96.00
Deidentified Minimum,,80500,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,,96.00
Deidentified Minimum,,81005,CPT4/HCPCS,URINALYSIS,,,21.75
Deidentified Minimum,,81020,CPT4/HCPCS,URINALYSIS GLASS TEST,,,37.04
Deidentified Minimum,,81110,CPT4/HCPCS,HPA-6 GENOTYPING,,,150.00
Deidentified Minimum,,81111,CPT4/HCPCS,HPA-9 GENOTYPING,,,150.00
Deidentified Minimum,,81182,CPT4/HCPCS,ATXN8OS GEN DETC ABNOR ALLEL,,,150.00
Deidentified Minimum,,81186,CPT4/HCPCS,CACNA1A GEN KNOWN FAMIL VRNT,,,150.00
Deidentified Minimum,,81190,CPT4/HCPCS,CSTB GENE KNOWN FAMIL VRNT,,,150.00
Deidentified Minimum,,81203,CPT4/HCPCS,APC GENE DUP/DELET VARIANTS,,,150.00
Deidentified Minimum,,81206,CPT4/HCPCS,BCR/ABL1 GENE MAJOR BP,,,150.00
Deidentified Minimum,,81207,CPT4/HCPCS,BCR/ABL1 GENE MINOR BP,,,150.00
Deidentified Minimum,,81216,CPT4/HCPCS,BRCA2 GENE FULL SEQ ALYS,,,150.00
Deidentified Minimum,,81220,CPT4/HCPCS,CFTR GENE COM VARIANTS,,,150.00
Deidentified Minimum,,81224,CPT4/HCPCS,CFTR GENE INTRON POLY T,,,150.00
Deidentified Minimum,,81227,CPT4/HCPCS,CYP2C9 GENE COM VARIANTS,,,150.00
Deidentified Minimum,,81231,CPT4/HCPCS,CYP3A5 GENE COMMON VARIANTS,,,150.00
Deidentified Minimum,,81241,CPT4/HCPCS,F5 GENE,,,150.00
Deidentified Minimum,,81250,CPT4/HCPCS,G6PC GENE,,,150.00
Deidentified Minimum,,81252,CPT4/HCPCS,GJB2 GENE FULL SEQUENCE,,,150.00
Deidentified Minimum,,81260,CPT4/HCPCS,IKBKAP GENE,,,150.00
Deidentified Minimum,,81269,CPT4/HCPCS,HBA1/HBA2 GENE DUP/DEL VRNTS,,,150.00
Deidentified Minimum,,81285,CPT4/HCPCS,FXN GENE CHARAC ALLELES,,,150.00
Deidentified Minimum,,81295,CPT4/HCPCS,MSH2 GENE FULL SEQ,,,150.00
Deidentified Minimum,,81301,CPT4/HCPCS,MICROSATELLITE INSTABILITY,,,150.00
Deidentified Minimum,,81306,CPT4/HCPCS,NUDT15 GENE COMMON VARIANTS,,,150.00
Deidentified Minimum,,81314,CPT4/HCPCS,PDGFRA GENE,,,150.00
Deidentified Minimum,,81335,CPT4/HCPCS,TPMT GENE COM VARIANTS,,,150.00
Deidentified Minimum,,81363,CPT4/HCPCS,HBB GENE DUP/DEL VARIANTS,,,150.00
Deidentified Minimum,,81374,CPT4/HCPCS,HLA I TYPING 1 ANTIGEN LR,,,150.00
Deidentified Minimum,,81408,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 9,,,150.00
Deidentified Minimum,,81413,CPT4/HCPCS,CAR ION CHNNLPATH INC 10 GNS,,,96.00
Deidentified Minimum,,81420,CPT4/HCPCS,FETAL CHRMOML ANEUPLOIDY,,,96.00
Deidentified Minimum,,81426,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,,0.08
Deidentified Minimum,,81435,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,,96.00
Deidentified Minimum,,81437,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,,96.00
Deidentified Minimum,,81470,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,,96.00
Deidentified Minimum,,81504,CPT4/HCPCS,ONCOLOGY TISSUE OF ORIGIN,,,96.00
Deidentified Minimum,,81511,CPT4/HCPCS,FTL CGEN ABNOR FOUR ANAL,,,96.00
Deidentified Minimum,,81538,CPT4/HCPCS,ONCOLOGY LUNG,,,96.00
Deidentified Minimum,,82075,CPT4/HCPCS,ASSAY OF BREATH ETHANOL,,,0.08
Deidentified Minimum,,82104,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN PHENO,,,96.00
Deidentified Minimum,,82108,CPT4/HCPCS,ASSAY OF ALUMINUM,,,96.00
Deidentified Minimum,,82143,CPT4/HCPCS,AMNIOTIC FLUID SCAN,,,69.04
Deidentified Minimum,,82157,CPT4/HCPCS,ASSAY OF ANDROSTENEDIONE,,,96.00
Deidentified Minimum,,82172,CPT4/HCPCS,ASSAY OF APOLIPOPROTEIN,,,96.00
Deidentified Minimum,,82232,CPT4/HCPCS,ASSAY OF BETA-2 PROTEIN,,,96.00
Deidentified Minimum,,82261,CPT4/HCPCS,ASSAY OF BIOTINIDASE,,,96.00
Deidentified Minimum,,82271,CPT4/HCPCS,OCCULT BLOOD OTHER SOURCES,,,32.67
Deidentified Minimum,,82310,CPT4/HCPCS,ASSAY OF CALCIUM,,,51.82
Deidentified Minimum,,82382,CPT4/HCPCS,ASSAY URINE CATECHOLAMINES,,,96.00
Deidentified Minimum,,82435,CPT4/HCPCS,ASSAY OF BLOOD CHLORIDE,,,46.20
Deidentified Minimum,,82465,CPT4/HCPCS,ASSAY BLD/SERUM CHOLESTEROL,,,43.76
Deidentified Minimum,,82542,CPT4/HCPCS,COL CHROMOTOGRAPHY QUAL/QUAN,,,96.00
Deidentified Minimum,,82550,CPT4/HCPCS,ASSAY OF CK (CPK),,,65.43
Deidentified Minimum,,82585,CPT4/HCPCS,ASSAY OF CRYOFIBRINOGEN,,,86.18
Deidentified Minimum,,82633,CPT4/HCPCS,DESOXYCORTICOSTERONE,,,96.00
Deidentified Minimum,,82652,CPT4/HCPCS,VIT D 1 25-DIHYDROXY,,,96.00
Deidentified Minimum,,82657,CPT4/HCPCS,ENZYME CELL ACTIVITY,,,96.00
Deidentified Minimum,,82677,CPT4/HCPCS,ASSAY OF ESTRIOL,,,96.00
Deidentified Minimum,,82705,CPT4/HCPCS,FATS/LIPIDS FECES QUAL,,,51.15
Deidentified Minimum,,82776,CPT4/HCPCS,GALACTOSE TRANSFERASE TEST,,,84.25
Deidentified Minimum,,82785,CPT4/HCPCS,ASSAY OF IGE,,,96.00
Deidentified Minimum,,82938,CPT4/HCPCS,GASTRIN TEST,,,96.00
Deidentified Minimum,,82950,CPT4/HCPCS,GLUCOSE TEST,,,47.71
Deidentified Minimum,,82965,CPT4/HCPCS,ASSAY OF GDH ENZYME,,,77.70
Deidentified Minimum,,82978,CPT4/HCPCS,ASSAY OF GLUTATHIONE,,,96.00
Deidentified Minimum,,83006,CPT4/HCPCS,GROWTH STIMULATION GENE 2,,,96.00
Deidentified Minimum,,83018,CPT4/HCPCS,HEAVY METAL QUANT EACH NES,,,96.00
Deidentified Minimum,,83021,CPT4/HCPCS,HEMOGLOBIN CHROMOTOGRAPHY,,,96.00
Deidentified Minimum,,83036,CPT4/HCPCS,GLYCOSYLATED HEMOGLOBIN TEST,,,96.00
Deidentified Minimum,,83500,CPT4/HCPCS,ASSAY FREE HYDROXYPROLINE,,,96.00
Deidentified Minimum,,83582,CPT4/HCPCS,ASSAY OF KETOGENIC STEROIDS,,,96.00
Deidentified Minimum,,83586,CPT4/HCPCS,ASSAY 17- KETOSTEROIDS,,,96.00
Deidentified Minimum,,83661,CPT4/HCPCS,L/S RATIO FETAL LUNG,,,96.00
Deidentified Minimum,,83698,CPT4/HCPCS,ASSAY LIPOPROTEIN PLA2,,,96.00
Deidentified Minimum,,83704,CPT4/HCPCS,LIPOPROTEIN BLD QUAN PART,,,96.00
Deidentified Minimum,,83775,CPT4/HCPCS,ASSAY MALATE DEHYDROGENASE,,,74.00
Deidentified Minimum,,83885,CPT4/HCPCS,ASSAY OF NICKEL,,,96.00
Deidentified Minimum,,83916,CPT4/HCPCS,OLIGOCLONAL BANDS,,,96.00
Deidentified Minimum,,84078,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,,65.85
Deidentified Minimum,,84081,CPT4/HCPCS,ASSAY PHOSPHATIDYLGLYCEROL,,,96.00
Deidentified Minimum,,84106,CPT4/HCPCS,TEST FOR PORPHOBILINOGEN,,,43.00
Deidentified Minimum,,84133,CPT4/HCPCS,ASSAY OF URINE POTASSIUM,,,43.17
Deidentified Minimum,,84155,CPT4/HCPCS,ASSAY OF PROTEIN SERUM,,,36.87
Deidentified Minimum,,84156,CPT4/HCPCS,ASSAY OF PROTEIN URINE,,,36.87
Deidentified Minimum,,84157,CPT4/HCPCS,ASSAY OF PROTEIN OTHER,,,36.87
Deidentified Minimum,,84234,CPT4/HCPCS,ASSAY OF PROGESTERONE,,,96.00
Deidentified Minimum,,84235,CPT4/HCPCS,ASSAY OF ENDOCRINE HORMONE,,,96.00
Deidentified Minimum,,84270,CPT4/HCPCS,ASSAY OF SEX HORMONE GLOBUL,,,96.00
Deidentified Minimum,,84300,CPT4/HCPCS,ASSAY OF URINE SODIUM,,,48.88
Deidentified Minimum,,84307,CPT4/HCPCS,ASSAY OF SOMATOSTATIN,,,96.00
Deidentified Minimum,,84315,CPT4/HCPCS,BODY FLUID SPECIFIC GRAVITY,,,25.20
Deidentified Minimum,,84376,CPT4/HCPCS,SUGARS SINGLE QUAL,,,55.27
Deidentified Minimum,,84431,CPT4/HCPCS,THROMBOXANE URINE,,,96.00
Deidentified Minimum,,84446,CPT4/HCPCS,ASSAY OF VITAMIN E,,,96.00
Deidentified Minimum,,84450,CPT4/HCPCS,TRANSFERASE (AST) (SGOT),,,51.99
Deidentified Minimum,,84466,CPT4/HCPCS,ASSAY OF TRANSFERRIN,,,96.00
Deidentified Minimum,,84480,CPT4/HCPCS,ASSAY TRIIODOTHYRONINE (T3),,,96.00
Deidentified Minimum,,84481,CPT4/HCPCS,FREE ASSAY (FT-3),,,96.00
Deidentified Minimum,,84482,CPT4/HCPCS,T3 REVERSE,,,96.00
Deidentified Minimum,,84510,CPT4/HCPCS,ASSAY OF TYROSINE,,,96.00
Deidentified Minimum,,84520,CPT4/HCPCS,ASSAY OF UREA NITROGEN,,,39.73
Deidentified Minimum,,84545,CPT4/HCPCS,UREA-N CLEARANCE TEST,,,66.35
Deidentified Minimum,,84560,CPT4/HCPCS,ASSAY OF URINE/URIC ACID,,,47.71
Deidentified Minimum,,84578,CPT4/HCPCS,TEST URINE UROBILINOGEN,,,32.59
Deidentified Minimum,,84590,CPT4/HCPCS,ASSAY OF VITAMIN A,,,96.00
Deidentified Minimum,,85049,CPT4/HCPCS,AUTOMATED PLATELET COUNT,,,44.93
Deidentified Minimum,,85170,CPT4/HCPCS,BLOOD CLOT RETRACTION,,,36.37
Deidentified Minimum,,85250,CPT4/HCPCS,CLOT FACTOR IX PTC/CHRSTMAS,,,96.00
Deidentified Minimum,,85290,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN STAB,,,96.00
Deidentified Minimum,,85370,CPT4/HCPCS,FIBRINOGEN TEST,,,96.00
Deidentified Minimum,,85576,CPT4/HCPCS,BLOOD PLATELET AGGREGATION,,,96.00
Deidentified Minimum,,85613,CPT4/HCPCS,RUSSELL VIPER VENOM DILUTED,,,96.00
Deidentified Minimum,,86005,CPT4/HCPCS,ALLG SPEC IGE MULTIALLG SCR,,,53.76
Deidentified Minimum,,86022,CPT4/HCPCS,PLATELET ANTIBODIES,,,96.00
Deidentified Minimum,,86023,CPT4/HCPCS,IMMUNOGLOBULIN ASSAY,,,96.00
Deidentified Minimum,,86079,CPT4/HCPCS,PHYS BLOOD BANK SERV AUTHRJ,,,96.00
Deidentified Minimum,,86140,CPT4/HCPCS,C-REACTIVE PROTEIN,,,51.99
Deidentified Minimum,,86141,CPT4/HCPCS,C-REACTIVE PROTEIN HS,,,96.00
Deidentified Minimum,,86153,CPT4/HCPCS,CELL ENUMERATION PHYS INTERP,,,96.00
Deidentified Minimum,,86156,CPT4/HCPCS,COLD AGGLUTININ SCREEN,,,67.36
Deidentified Minimum,,86160,CPT4/HCPCS,COMPLEMENT ANTIGEN,,,96.00
Deidentified Minimum,,86161,CPT4/HCPCS,COMPLEMENT/FUNCTION ACTIVITY,,,96.00
Deidentified Minimum,,86280,CPT4/HCPCS,HEMAGGLUTINATION INHIBITION,,,82.23
Deidentified Minimum,,86329,CPT4/HCPCS,IMMUNODIFFUSION NES,,,96.00
Deidentified Minimum,,86332,CPT4/HCPCS,IMMUNE COMPLEX ASSAY,,,96.00
Deidentified Minimum,,86334,CPT4/HCPCS,IMMUNOFIX E-PHORESIS SERUM,,,96.00
Deidentified Minimum,,86344,CPT4/HCPCS,LEUKOCYTE PHAGOCYTOSIS,,,80.22
Deidentified Minimum,,86360,CPT4/HCPCS,T CELL ABSOLUTE COUNT/RATIO,,,96.00
Deidentified Minimum,,86609,CPT4/HCPCS,BACTERIUM ANTIBODY,,,96.00
Deidentified Minimum,,86611,CPT4/HCPCS,BARTONELLA ANTIBODY,,,96.00
Deidentified Minimum,,86617,CPT4/HCPCS,LYME DISEASE ANTIBODY,,,96.00
Deidentified Minimum,,86618,CPT4/HCPCS,LYME DISEASE ANTIBODY,,,96.00
Deidentified Minimum,,86645,CPT4/HCPCS,CMV ANTIBODY IGM,,,96.00
Deidentified Minimum,,86651,CPT4/HCPCS,ENCEPHALITIS CALIFORN ANTBDY,,,96.00
Deidentified Minimum,,86658,CPT4/HCPCS,ENTEROVIRUS ANTIBODY,,,96.00
Deidentified Minimum,,86663,CPT4/HCPCS,EPSTEIN-BARR ANTIBODY,,,96.00
Deidentified Minimum,,86664,CPT4/HCPCS,EPSTEIN-BARR NUCLEAR ANTIGEN,,,96.00
Deidentified Minimum,,86682,CPT4/HCPCS,HELMINTH ANTIBODY,,,96.00
Deidentified Minimum,,86684,CPT4/HCPCS,HEMOPHILUS INFLUENZA ANTIBDY,,,96.00
Deidentified Minimum,,86687,CPT4/HCPCS,HTLV-I ANTIBODY,,,84.33
Deidentified Minimum,,86709,CPT4/HCPCS,HEPATITIS A IGM ANTIBODY,,,96.00
Deidentified Minimum,,86711,CPT4/HCPCS,JOHN CUNNINGHAM ANTIBODY,,,96.00
Deidentified Minimum,,86741,CPT4/HCPCS,NEISSERIA MENINGITIDIS,,,96.00
Deidentified Minimum,,86744,CPT4/HCPCS,NOCARDIA ANTIBODY,,,96.00
Deidentified Minimum,,86747,CPT4/HCPCS,PARVOVIRUS ANTIBODY,,,96.00
Deidentified Minimum,,86774,CPT4/HCPCS,TETANUS ANTIBODY,,,96.00
Deidentified Minimum,,86787,CPT4/HCPCS,VARICELLA-ZOSTER ANTIBODY,,,96.00
Deidentified Minimum,,86800,CPT4/HCPCS,THYROGLOBULIN ANTIBODY,,,96.00
Deidentified Minimum,,86804,CPT4/HCPCS,HEP C AB TEST CONFIRM,,,96.00
Deidentified Minimum,,86805,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,,96.00
Deidentified Minimum,,86833,CPT4/HCPCS,HLA CLASS II HIGH DEFIN QUAL,,,96.00
Deidentified Minimum,,86886,CPT4/HCPCS,COOMBS TEST INDIRECT TITER,,,51.99
Deidentified Minimum,,86905,CPT4/HCPCS,BLOOD TYPING RBC ANTIGENS,,,38.38
Deidentified Minimum,,86927,CPT4/HCPCS,PLASMA FRESH FROZEN,,,96.00
Deidentified Minimum,,86940,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS AUTO,,,82.40
Deidentified Minimum,,86950,CPT4/HCPCS,LEUKACYTE TRANSFUSION,,,96.00
Deidentified Minimum,,86976,CPT4/HCPCS,RBC SERUM PRETX ID DILUTION,,,91.42
Deidentified Minimum,,87101,CPT4/HCPCS,SKIN FUNGI CULTURE,,,77.53
Deidentified Minimum,,87116,CPT4/HCPCS,MYCOBACTERIA CULTURE,,,96.00
Deidentified Minimum,,87188,CPT4/HCPCS,MICROBE SUSCEPT MACROBROTH,,,66.69
Deidentified Minimum,,87267,CPT4/HCPCS,ENTEROVIRUS ANTIBODY DFA,,,93.32
Deidentified Minimum,,87276,CPT4/HCPCS,INFLUENZA A AG IF,,,93.32
Deidentified Minimum,,87278,CPT4/HCPCS,LEGION PNEUMOPHILIA AG IF,,,93.32
Deidentified Minimum,,87283,CPT4/HCPCS,RUBEOLA AG IF,,,93.32
Deidentified Minimum,,87290,CPT4/HCPCS,VARICELLA ZOSTER AG IF,,,93.32
Deidentified Minimum,,87339,CPT4/HCPCS,H PYLORI AG IA,,,93.32
Deidentified Minimum,,87350,CPT4/HCPCS,HEPATITIS BE AG IA,,,96.00
Deidentified Minimum,,87385,CPT4/HCPCS,HISTOPLASMA CAPSUL AG IA,,,93.32
Deidentified Minimum,,87391,CPT4/HCPCS,HIV-2 AG IA,,,96.00
Deidentified Minimum,,87420,CPT4/HCPCS,RESP SYNCYTIAL AG IA,,,93.32
Deidentified Minimum,,87472,CPT4/HCPCS,BARTONELLA DNA QUANT,,,96.00
Deidentified Minimum,,87480,CPT4/HCPCS,CANDIDA DNA DIR PROBE,,,96.00
Deidentified Minimum,,87483,CPT4/HCPCS,CNS DNA AMP PROBE TYPE 12-25,,,96.00
Deidentified Minimum,,87491,CPT4/HCPCS,CHYLMD TRACH DNA AMP PROBE,,,96.00
Deidentified Minimum,,87493,CPT4/HCPCS,C DIFF AMPLIFIED PROBE,,,96.00
Deidentified Minimum,,87497,CPT4/HCPCS,CYTOMEG DNA QUANT,,,96.00
Deidentified Minimum,,87498,CPT4/HCPCS,ENTEROVIRUS PROBE&REVRS TRNS,,,96.00
Deidentified Minimum,,87507,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 12-25,,,96.00
Deidentified Minimum,,87530,CPT4/HCPCS,HSV DNA QUANT,,,96.00
Deidentified Minimum,,87532,CPT4/HCPCS,HHV-6 DNA AMP PROBE,,,96.00
Deidentified Minimum,,87533,CPT4/HCPCS,HHV-6 DNA QUANT,,,96.00
Deidentified Minimum,,87542,CPT4/HCPCS,LEGION PNEUMO DNA QUANT,,,96.00
Deidentified Minimum,,87552,CPT4/HCPCS,MYCOBACTERIA DNA QUANT,,,96.00
Deidentified Minimum,,87555,CPT4/HCPCS,M.TUBERCULO DNA DIR PROBE,,,96.00
Deidentified Minimum,,87591,CPT4/HCPCS,N.GONORRHOEAE DNA AMP PROB,,,96.00
Deidentified Minimum,,87631,CPT4/HCPCS,RESP VIRUS 3-5 TARGETS,,,96.00
Deidentified Minimum,,87640,CPT4/HCPCS,STAPH A DNA AMP PROBE,,,96.00
Deidentified Minimum,,87651,CPT4/HCPCS,STREP A DNA AMP PROBE,,,96.00
Deidentified Minimum,,87803,CPT4/HCPCS,CLOSTRIDIUM TOXIN A W/OPTIC,,,93.32
Deidentified Minimum,,87808,CPT4/HCPCS,TRICHOMONAS ASSAY W/OPTIC,,,93.32
Deidentified Minimum,,87900,CPT4/HCPCS,PHENOTYPE INFECT AGENT DRUG,,,96.00
Deidentified Minimum,,88000,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,96.00
Deidentified Minimum,,88020,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,,96.00
Deidentified Minimum,,88025,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,,96.00
Deidentified Minimum,,88027,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,,96.00
Deidentified Minimum,,88045,CPT4/HCPCS,CORONERS AUTOPSY (NECROPSY),,,96.00
Deidentified Minimum,,88121,CPT4/HCPCS,CYTP URINE 3-5 PROBES CMPTR,,,96.00
Deidentified Minimum,,88142,CPT4/HCPCS,CYTOPATH C/V THIN LAYER,,,96.00
Deidentified Minimum,,88164,CPT4/HCPCS,CYTOPATH TBS C/V MANUAL,,,96.00
Deidentified Minimum,,88167,CPT4/HCPCS,CYTOPATH TBS C/V SELECT,,,96.00
Deidentified Minimum,,88188,CPT4/HCPCS,FLOWCYTOMETRY/READ 9-15,,,96.00
Deidentified Minimum,,88275,CPT4/HCPCS,CYTOGENETICS 100-300,,,96.00
Deidentified Minimum,,88283,CPT4/HCPCS,CHROMOSOME BANDING STUDY,,,86.85
Deidentified Minimum,,88300,CPT4/HCPCS,SURGICAL PATH GROSS,,,96.00
Deidentified Minimum,,88305,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,,96.00
Deidentified Minimum,,88312,CPT4/HCPCS,SPECIAL STAINS GROUP 1,,,96.00
Deidentified Minimum,,88323,CPT4/HCPCS,MICROSLIDE CONSULTATION,,,96.00
Deidentified Minimum,,88358,CPT4/HCPCS,ANALYSIS TUMOR,,,96.00
Deidentified Minimum,,88361,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/COMPUT,,,96.00
Deidentified Minimum,,88362,CPT4/HCPCS,NERVE TEASING PREPARATIONS,,,96.00
Deidentified Minimum,,88366,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,,96.00
Deidentified Minimum,,88373,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,,96.00
Deidentified Minimum,,88377,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,,96.00
Deidentified Minimum,,88720,CPT4/HCPCS,BILIRUBIN TOTAL TRANSCUT,,,50.40
Deidentified Minimum,,89251,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,,96.00
Deidentified Minimum,,89255,CPT4/HCPCS,PREPARE EMBRYO FOR TRANSFER,,,96.00
Deidentified Minimum,,89258,CPT4/HCPCS,CRYOPRESERVATION EMBRYO(S),,,96.00
Deidentified Minimum,,89310,CPT4/HCPCS,SEMEN ANALYSIS W/COUNT,,,86.43
Deidentified Minimum,,89330,CPT4/HCPCS,EVALUATION CERVICAL MUCUS,,,96.00
Deidentified Minimum,,89337,CPT4/HCPCS,CRYOPRESERVATION OOCYTE(S),,,96.00
Deidentified Minimum,,90801,CPT4/HCPCS,PSY DX INTERVIEW,,,312.89
Deidentified Minimum,,90810,CPT4/HCPCS,INTAC PSYTX OFF 20-30 MIN,,,131.62
Deidentified Minimum,,90815,CPT4/HCPCS,INTAC PSYTX 75-80 W/E&M,,,288.06
Deidentified Minimum,,90817,CPT4/HCPCS,PSYTX HOSP 20-30 MIN W/E&M,,,185.31
Deidentified Minimum,,90828,CPT4/HCPCS,INTAC PSYTX HOSP 75-80 MIN,,,317.72
Deidentified Minimum,,90846,CPT4/HCPCS,FAMILY PSYTX W/O PT 50 MIN,,,223.03
Deidentified Minimum,,90865,CPT4/HCPCS,NARCOSYNTHESIS,,,361.17
Deidentified Minimum,,90868,CPT4/HCPCS,TCRANIAL MAGN STIM TX DELI,,,987.78
Deidentified Minimum,,90869,CPT4/HCPCS,TCRAN MAGN STIM REDETEMINE,,,3198.57
Deidentified Minimum,,90885,CPT4/HCPCS,PSY EVALUATION OF RECORDS,,,113.92
Deidentified Minimum,,90945,CPT4/HCPCS,DIALYSIS ONE EVALUATION,,,348.13
Deidentified Minimum,,91013,CPT4/HCPCS,ESOPHGL MOTIL W/STIM/PERFUS,,,186.88
Deidentified Minimum,,91035,CPT4/HCPCS,G-ESOPH REFLX TST W/ELECTROD,,,1145.00
Deidentified Minimum,,91037,CPT4/HCPCS,ESOPH IMPED FUNCTION TEST,,,1145.00
Deidentified Minimum,,91133,CPT4/HCPCS,ELECTROGASTROGRAPHY W/TEST,,,243.06
Deidentified Minimum,,91200,CPT4/HCPCS,LIVER ELASTOGRAPHY,,,287.92
Deidentified Minimum,,91299,CPT4/HCPCS,GASTROENTEROLOGY PROCEDURE,,,1145.00
Deidentified Minimum,,92014,CPT4/HCPCS,EYE EXAM&TX ESTAB PT 1/>VST,,,690.53
Deidentified Minimum,,92020,CPT4/HCPCS,SPECIAL EYE EVALUATION,,,167.63
Deidentified Minimum,,92225,CPT4/HCPCS,SPECIAL EYE EXAM INITIAL,,,109.89
Deidentified Minimum,,92275,CPT4/HCPCS,ELECTRORETINOGRAPHY,,,734.62
Deidentified Minimum,,92314,CPT4/HCPCS,PRESCRIPTION OF CONTACT LENS,,,456.32
Deidentified Minimum,,92316,CPT4/HCPCS,RX CNTACT LENS APHAKIA 2 EYE,,,445.93
Deidentified Minimum,,92325,CPT4/HCPCS,MODIFICATION OF CONTACT LENS,,,196.50
Deidentified Minimum,,92340,CPT4/HCPCS,FIT SPECTACLES MONOFOCAL,,,340.85
Deidentified Minimum,,92341,CPT4/HCPCS,FIT SPECTACLES BIFOCAL,,,360.08
Deidentified Minimum,,92355,CPT4/HCPCS,FIT SPECTACLES COMPOUND LENS,,,2092.28
Deidentified Minimum,,92358,CPT4/HCPCS,APHAKIA PROSTH SERVICE TEMP,,,486.89
Deidentified Minimum,,92512,CPT4/HCPCS,NASAL FUNCTION STUDIES,,,556.59
Deidentified Minimum,,92521,CPT4/HCPCS,EVALUATION OF SPEECH FLUENCY,,,288.00
Deidentified Minimum,,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,,193.00
Deidentified Minimum,,92544,CPT4/HCPCS,OPTOKINETIC NYSTAGMUS TEST,,,354.50
Deidentified Minimum,,92547,CPT4/HCPCS,SUPPLEMENTAL ELECTRICAL TEST,,,577.53
Deidentified Minimum,,92583,CPT4/HCPCS,SELECT PICTURE AUDIOMETRY,,,460.50
Deidentified Minimum,,92596,CPT4/HCPCS,EAR PROTECTOR EVALUATION,,,308.08
Deidentified Minimum,,92601,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM <7,,,1669.01
Deidentified Minimum,,92602,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT <7,,,1163.78
Deidentified Minimum,,92603,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM 7/>,,,1101.23
Deidentified Minimum,,92612,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) VID,,,1339.32
Deidentified Minimum,,92620,CPT4/HCPCS,AUDITORY FUNCTION 60 MIN,,,572.73
Deidentified Minimum,,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,,3544.00
Deidentified Minimum,,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,,41.75
Deidentified Minimum,,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,,1235.00
Deidentified Minimum,,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,,1145.00
Deidentified Minimum,,92980,CPT4/HCPCS,INSERT INTRACORONARY STENT,,,3336.19
Deidentified Minimum,,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,1291.00
Deidentified Minimum,,92996,CPT4/HCPCS,CORONARY ATHERECTOMY ADD-ON,,,651.41
Deidentified Minimum,,93016,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,,89.87
Deidentified Minimum,,93225,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,,277.45
Deidentified Minimum,,93228,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,,203.11
Deidentified Minimum,,93282,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,,195.63
Deidentified Minimum,,93292,CPT4/HCPCS,WCD DEVICE INTERROGATE,,,104.74
Deidentified Minimum,,93298,CPT4/HCPCS,REM INTERROG DEV EVAL SCRMS,,,221.34
Deidentified Minimum,,93317,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,354.64
Deidentified Minimum,,93320,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,,383.45
Deidentified Minimum,,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,,2998.00
Deidentified Minimum,,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,,2998.00
Deidentified Minimum,,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,,987.78
Deidentified Minimum,,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,,2998.00
Deidentified Minimum,,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,,2998.00
Deidentified Minimum,,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,,1145.00
Deidentified Minimum,,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,,4064.90
Deidentified Minimum,,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,,857.53
Deidentified Minimum,,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,,1530.50
Deidentified Minimum,,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,4847.00
Deidentified Minimum,,93631,CPT4/HCPCS,HEART PACING MAPPING,,,1678.00
Deidentified Minimum,,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,3633.80
Deidentified Minimum,,93644,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,1678.88
Deidentified Minimum,,93784,CPT4/HCPCS,AMBL BP MNTR W/SOFTWARE,,,757.90
Deidentified Minimum,,93799,CPT4/HCPCS,CARDIOVASCULAR PROCEDURE,,,1145.00
Deidentified Minimum,,93922,CPT4/HCPCS,UPR/L XTREMITY ART 2 LEVELS,,,874.18
Deidentified Minimum,,93931,CPT4/HCPCS,UPPER EXTREMITY STUDY,,,859.06
Deidentified Minimum,,93990,CPT4/HCPCS,DOPPLER FLOW TESTING,,,857.30
Deidentified Minimum,,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,,193.00
Deidentified Minimum,,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,,182.99
Deidentified Minimum,,94005,CPT4/HCPCS,HOME VENT MGMT SUPERVISION,,,356.20
Deidentified Minimum,,94013,CPT4/HCPCS,MEAS LUNG VOL THRU 2 YRS,,,98.70
Deidentified Minimum,,94016,CPT4/HCPCS,REVIEW PATIENT SPIROMETRY,,,89.87
Deidentified Minimum,,94060,CPT4/HCPCS,EVALUATION OF WHEEZING,,,514.99
Deidentified Minimum,,94070,CPT4/HCPCS,EVALUATION OF WHEEZING,,,1387.59
Deidentified Minimum,,94200,CPT4/HCPCS,LUNG FUNCTION TEST (MBC/MVV),,,205.34
Deidentified Minimum,,94452,CPT4/HCPCS,HAST W/REPORT,,,455.55
Deidentified Minimum,,94621,CPT4/HCPCS,CARDIOPULM EXERCISE TESTING,,,824.63
Deidentified Minimum,,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,,170.11
Deidentified Minimum,,94690,CPT4/HCPCS,EXHALED AIR ANALYSIS,,,954.39
Deidentified Minimum,,94761,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,,57.89
Deidentified Minimum,,94770,CPT4/HCPCS,EXHALED CARBON DIOXIDE TEST,,,812.53
Deidentified Minimum,,95024,CPT4/HCPCS,ICUT ALLERGY TEST DRUG/BUG,,,76.20
Deidentified Minimum,,95028,CPT4/HCPCS,ICUT ALLERGY TEST-DELAYED,,,119.51
Deidentified Minimum,,95149,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,388.95
Deidentified Minimum,,95250,CPT4/HCPCS,CONT GLUC MNTR PHYS/QHP EQP,,,1842.07
Deidentified Minimum,,95801,CPT4/HCPCS,SLP STDY UNATND W/ANAL,,,404.71
Deidentified Minimum,,95807,CPT4/HCPCS,SLEEP STUDY ATTENDED,,,3302.00
Deidentified Minimum,,95827,CPT4/HCPCS,EEG ALL NIGHT RECORDING,,,1163.16
Deidentified Minimum,,95829,CPT4/HCPCS,SURGERY ELECTROCORTICOGRAM,,,13947.35
Deidentified Minimum,,95832,CPT4/HCPCS,HAND MUSCLE TESTING MANUAL,,,166.84
Deidentified Minimum,,95852,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,,129.13
Deidentified Minimum,,95860,CPT4/HCPCS,MUSCLE TEST ONE LIMB,,,503.67
Deidentified Minimum,,95865,CPT4/HCPCS,MUSCLE TEST LARYNX,,,339.29
Deidentified Minimum,,95868,CPT4/HCPCS,MUSCLE TEST CRAN NERVE BILAT,,,356.99
Deidentified Minimum,,95872,CPT4/HCPCS,MUSCLE TEST ONE FIBER,,,308.87
Deidentified Minimum,,95885,CPT4/HCPCS,MUSC TST DONE W/NERV TST LIM,,,538.13
Deidentified Minimum,,95887,CPT4/HCPCS,MUSC TST DONE W/N TST NONEXT,,,576.62
Deidentified Minimum,,95903,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,,465.17
Deidentified Minimum,,95907,CPT4/HCPCS,MOTOR&/SENS 1-2 NRV CNDJ TST,,,0.00
Deidentified Minimum,,95912,CPT4/HCPCS,MOTOR&SEN 11-12 NRV CND TEST,,,0.00
Deidentified Minimum,,95922,CPT4/HCPCS,AUTONOMIC NRV ADRENRG INERVJ,,,186.09
Deidentified Minimum,,95933,CPT4/HCPCS,BLINK REFLEX TEST,,,404.31
Deidentified Minimum,,95934,CPT4/HCPCS,H-REFLEX TEST,,,113.92
Deidentified Minimum,,95938,CPT4/HCPCS,SOMATOSENSORY TESTING,,,3563.07
Deidentified Minimum,,95939,CPT4/HCPCS,C MOTOR EVOKED UPR&LWR LIMBS,,,4919.18
Deidentified Minimum,,95957,CPT4/HCPCS,EEG DIGITAL ANALYSIS,,,871.20
Deidentified Minimum,,95961,CPT4/HCPCS,ELECTRODE STIMULATION BRAIN,,,658.55
Deidentified Minimum,,95965,CPT4/HCPCS,MEG SPONTANEOUS,,,22488.95
Deidentified Minimum,,95966,CPT4/HCPCS,MEG EVOKED SINGLE,,,11263.71
Deidentified Minimum,,95972,CPT4/HCPCS,ALYS CPLX SP/PN NPGT W/PRGRM,,,638.69
Deidentified Minimum,,95973,CPT4/HCPCS,ANALYZE NEUROSTIM COMPLEX,,,326.56
Deidentified Minimum,,95978,CPT4/HCPCS,ANALYZE NEUROSTIM BRAIN/1H,,,1006.07
Deidentified Minimum,,95982,CPT4/HCPCS,IO GA N-STIM SUBSQ W/REPROG,,,106.78
Deidentified Minimum,,96000,CPT4/HCPCS,MOTION ANALYSIS VIDEO/3D,,,299.38
Deidentified Minimum,,96040,CPT4/HCPCS,GENETIC COUNSELING 30 MIN,,,470.75
Deidentified Minimum,,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,,193.00
Deidentified Minimum,,96116,CPT4/HCPCS,NUBHVL XM PHYS/QHP 1ST HR,,,279.51
Deidentified Minimum,,96118,CPT4/HCPCS,NEUROPSYCH TST BY PSYCH/PHYS,,,231.40
Deidentified Minimum,,96120,CPT4/HCPCS,NEUROPSYCH TST ADMIN W/COMP,,,51.36
Deidentified Minimum,,96152,CPT4/HCPCS,INTERVENE HLTH/BEHAVE INDIV,,,42.53
Deidentified Minimum,,96361,CPT4/HCPCS,HYDRATE IV INFUSION ADD-ON,,,165.30
Deidentified Minimum,,96367,CPT4/HCPCS,TX/PROPH/DG ADDL SEQ IV INF,,,343.32
Deidentified Minimum,,96371,CPT4/HCPCS,SC THER INFUSION RESET PUMP,,,985.61
Deidentified Minimum,,96377,CPT4/HCPCS,APPLICATON ON-BODY INJECTOR,,,2002.00
Deidentified Minimum,,96423,CPT4/HCPCS,CHEMO IA INFUSE EACH ADDL HR,,,763.56
Deidentified Minimum,,96425,CPT4/HCPCS,CHEMOTHERAPY INFUSION METHOD,,,1727.96
Deidentified Minimum,,96567,CPT4/HCPCS,PDT DSTR PRMLG LES SKN,,,1145.00
Deidentified Minimum,,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,,33.26
Deidentified Minimum,,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,,60.39
Deidentified Minimum,,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,,52.14
Deidentified Minimum,,97158,CPT4/HCPCS,GRP ADAPT BHV TX BY PHY/QHP,,,206.64
Deidentified Minimum,,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,,193.00
Deidentified Minimum,,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,,193.00
Deidentified Minimum,,97172,CPT4/HCPCS,ATHLETIC TRN RE-EVAL PLAN CR,,,168.25
Deidentified Minimum,,97546,CPT4/HCPCS,WORK HARDENING ADD-ON,,,288.00
Deidentified Minimum,,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,,193.00
Deidentified Minimum,,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,,193.00
Deidentified Minimum,,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,,74.65
Deidentified Minimum,,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,,166.84
Deidentified Minimum,,97762,CPT4/HCPCS,C/O FOR ORTHOTIC/PROSTH USE,,,359.31
Deidentified Minimum,,99172,CPT4/HCPCS,OCULAR FUNCTION SCREEN,,,262.31
Deidentified Minimum,,99183,CPT4/HCPCS,HYPERBARIC OXYGEN THERAPY,,,1628.32
Deidentified Minimum,,A9505,CPT4/HCPCS,TL201 thallium,,,1275.12
Deidentified Minimum,,A9508,CPT4/HCPCS,I131 iodobenguate, dx,,,6183.91
Deidentified Minimum,,A9516,CPT4/HCPCS,Iodine I-123 sod iodide mic,,,1513.09
Deidentified Minimum,,A9521,CPT4/HCPCS,Tc99m exametazime,,,12181.17
Deidentified Minimum,,A9537,CPT4/HCPCS,Tc99m mebrofenin,,,462.84
Deidentified Minimum,,A9540,CPT4/HCPCS,Tc99m MAA,,,250.99
Deidentified Minimum,,A9547,CPT4/HCPCS,In111 oxyquinoline,,,14960.14
Deidentified Minimum,,A9567,CPT4/HCPCS,Technetium TC-99m aerosol,,,28.55
Deidentified Minimum,,A9576,CPT4/HCPCS,Inj prohance multipack,,,11.92
Deidentified Minimum,,A9585,CPT4/HCPCS,Gadobutrol injection,,,3.10
Deidentified Minimum,,C2596,CPT4/HCPCS,Probe, robotic, water-jet,,,5029.00
Deidentified Minimum,,C5275,CPT4/HCPCS,Low cost skin substitute app,,,1145.00
Deidentified Minimum,,C5278,CPT4/HCPCS,Low cost skin substitute app,,,1145.00
Deidentified Minimum,,C8906,CPT4/HCPCS,MRI w/cont, breast, bi,,,4399.00
Deidentified Minimum,,C8910,CPT4/HCPCS,MRA w/o cont, chest,,,4399.00
Deidentified Minimum,,C8913,CPT4/HCPCS,MRA w/o cont, lwr ext,,,4399.00
Deidentified Minimum,,C8918,CPT4/HCPCS,MRA w/cont, pelvis,,,4399.00
Deidentified Minimum,,C9725,CPT4/HCPCS,Place endorectal app,,,1235.00
Deidentified Minimum,,C9738,CPT4/HCPCS,Blue light cysto imag agent,,,1145.00
Deidentified Minimum,,C9753,CPT4/HCPCS,Intraosseous destruct add'l,,,1145.00
Deidentified Minimum,,C9755,CPT4/HCPCS,Rf magnetic-guide av fistula,,,7830.00
Deidentified Minimum,,C9757,CPT4/HCPCS,Spine/lumbar disk surgery,,,5281.00
Deidentified Minimum,,G0106,CPT4/HCPCS,Colon CA screen;barium enema,,,1130.25
Deidentified Minimum,,G0186,CPT4/HCPCS,Dstry eye lesn,fdr vssl tech,,,1235.00
Deidentified Minimum,,G0268,CPT4/HCPCS,Removal of impacted wax md,,,1145.00
Deidentified Minimum,,G0277,CPT4/HCPCS,Hbot, full body chamber, 30m,,,3544.00
Deidentified Minimum,,G0288,CPT4/HCPCS,Recon, CTA for surg plan,,,5201.81
Deidentified Minimum,,G0389,CPT4/HCPCS,Ultrasound exam aaa screen,,,6500.00
Deidentified Minimum,,G0392,CPT4/HCPCS,AV fistula or graft arterial,,,12850.70
Deidentified Minimum,,G6003,CPT4/HCPCS,Radiation treatment delivery,,,1195.46
Deidentified Minimum,,G6009,CPT4/HCPCS,Radiation treatment delivery,,,1417.85
Deidentified Minimum,,G8981,CPT4/HCPCS,Body pos current status,,,0.00
Deidentified Minimum,,G8983,CPT4/HCPCS,Body pos d/c status,,,0.00
Deidentified Minimum,,G8984,CPT4/HCPCS,Carry current status,,,0.00
Deidentified Minimum,,G8985,CPT4/HCPCS,Carry goal status,,,0.00
Deidentified Minimum,,G8990,CPT4/HCPCS,Other pt/ot current status,,,0.00
Deidentified Minimum,,G8998,CPT4/HCPCS,Swallow d/c status,,,6.5e-03
Deidentified Minimum,,G9159,CPT4/HCPCS,Lang comp current status,,,6.5e-03
Deidentified Minimum,,G9162,CPT4/HCPCS,Lang express current status,,,6.5e-03
Deidentified Minimum,,G9171,CPT4/HCPCS,Voice current status,,,6.5e-03
Deidentified Minimum,,G9172,CPT4/HCPCS,Voice goal status,,,6.5e-03
Deidentified Minimum,,G9176,CPT4/HCPCS,Speech lang d/c status,,,6.5e-03
Deidentified Minimum,,J1190,CPT4/HCPCS,Dexrazoxane HCl injection,,,1675.80
Deidentified Minimum,,J2430,CPT4/HCPCS,Pamidronate disodium /30 MG,,,93.82
Deidentified Minimum,,J8530,CPT4/HCPCS,Cyclophosphamide oral 25 MG,,,22.51
Deidentified Minimum,,J8540,CPT4/HCPCS,Oral dexamethasone,,,0.16
Deidentified Minimum,,J8610,CPT4/HCPCS,Methotrexate oral 2.5 mg,,,1.93
Deidentified Minimum,,J9025,CPT4/HCPCS,Azacitidine injection,,,8.65
Deidentified Minimum,,J9185,CPT4/HCPCS,Fludarabine phosphate inj,,,406.30
Deidentified Minimum,,J9208,CPT4/HCPCS,Ifosfamide injection,,,226.46
Deidentified Minimum,,J9212,CPT4/HCPCS,Interferon alfacon-1 inj,,,80.80
Deidentified Minimum,,J9225,CPT4/HCPCS,Vantas implant,,,34952.31
Deidentified Minimum,,J9299,CPT4/HCPCS,Injection, nivolumab,,,238.89
Deidentified Minimum,,J9305,CPT4/HCPCS,Inj. pemetrexed nos 10mg,,,600.60
Deidentified Minimum,,J9320,CPT4/HCPCS,Streptozocin injection,,,2991.91
Deidentified Minimum,,J9370,CPT4/HCPCS,Vincristine sulfate 1 MG inj,,,41.41
Deidentified Minimum,,J9395,CPT4/HCPCS,Injection, Fulvestrant,,,720.80
Deidentified Minimum,,P9022,CPT4/HCPCS,Washed red blood cells unit,,,3628.00
Deidentified Minimum,,P9039,CPT4/HCPCS,RBC deglycerolized,,,3628.00
Deidentified Minimum,,Q0092,CPT4/HCPCS,Set up port xray equipment,,,158.00
Deidentified Minimum,,Q2050,CPT4/HCPCS,Doxorubicin inj 10mg,,,2507.14
Deidentified Minimum,,Q9951,CPT4/HCPCS,LOCM >= 400 mg/ml iodine,1ml,,,10.08
Deidentified Minimum,,Q9967,CPT4/HCPCS,LOCM 300-399mg/ml iodine,1ml,,,1.00
Deidentified Minimum,,Q9982,CPT4/HCPCS,flutemetamol f18 diagnostic,,,27609.12
Deidentified Minimum,,S0156,CPT4/HCPCS,Exemestane, 25 mg,,,72.49
Deidentified Minimum,,S0178,CPT4/HCPCS,Lomustine 10 mg,,,761.03
Deidentified Minimum,,S2351,CPT4/HCPCS,Diskectomy, anterior, with d,,,1678.88
Deidentified Minimum,,S2405,CPT4/HCPCS,Fetal surg sacrococ teratoma,,,8012.00
Deidentified Minimum,,S2409,CPT4/HCPCS,Fetal surg noc,,,8012.00
Deidentified Minimum,,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,,5575.00
Deidentified Minimum,,93660,CPT4/HCPCS,TILT TABLE EVALUATION,,,821.23
Deidentified Minimum,,93662,CPT4/HCPCS,INTRACARDIAC ECG (ICE),,,1145.00
Deidentified Minimum,,93740,CPT4/HCPCS,TEMPERATURE GRADIENT STUDIES,,,81.01
Deidentified Minimum,,93798,CPT4/HCPCS,CARDIAC REHAB/MONITOR,,,225.37
Deidentified Minimum,,93930,CPT4/HCPCS,UPPER EXTREMITY STUDY,,,1364.91
Deidentified Minimum,,94012,CPT4/HCPCS,SPIRMTRY W/BRNCHDIL INF-2 YR,,,484.56
Deidentified Minimum,,94014,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,,377.79
Deidentified Minimum,,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,,171.66
Deidentified Minimum,,94662,CPT4/HCPCS,NEG PRESS VENTILATION CNP,,,122.77
Deidentified Minimum,,94760,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,,27.32
Deidentified Minimum,,95004,CPT4/HCPCS,PERCUT ALLERGY SKIN TESTS,,,52.14
Deidentified Minimum,,95060,CPT4/HCPCS,EYE ALLERGY TESTS,,,176.47
Deidentified Minimum,,95070,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,,1109.93
Deidentified Minimum,,95144,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,95.45
Deidentified Minimum,,95805,CPT4/HCPCS,MULTIPLE SLEEP LATENCY TEST,,,3103.04
Deidentified Minimum,,95812,CPT4/HCPCS,EEG 41-60 MINUTES,,,1709.20
Deidentified Minimum,,95863,CPT4/HCPCS,MUSCLE TEST 3 LIMBS,,,476.50
Deidentified Minimum,,95867,CPT4/HCPCS,MUSCLE TEST CRAN NERV UNILAT,,,295.20
Deidentified Minimum,,95873,CPT4/HCPCS,GUIDE NERV DESTR ELEC STIM,,,104.30
Deidentified Minimum,,95875,CPT4/HCPCS,LIMB EXERCISE TEST,,,505.37
Deidentified Minimum,,95908,CPT4/HCPCS,MOTOR&/SENS 3-4 NRV CNDJ TST,,,0.00
Deidentified Minimum,,95909,CPT4/HCPCS,MOTOR&/SENS 5-6 NRV CNDJ TST,,,0.00
Deidentified Minimum,,95911,CPT4/HCPCS,MOTOR&SEN 9-10 NRV CNDJ TEST,,,0.00
Deidentified Minimum,,95921,CPT4/HCPCS,AUTONOMIC NRV PARASYM INERVJ,,,186.09
Deidentified Minimum,,95923,CPT4/HCPCS,AUTONOMIC NRV SYST FUNJ TEST,,,830.86
Deidentified Minimum,,95936,CPT4/HCPCS,H-REFLEX TEST,,,113.92
Deidentified Minimum,,95937,CPT4/HCPCS,NEUROMUSCULAR JUNCTION TEST,,,171.66
Deidentified Minimum,,95954,CPT4/HCPCS,EEG MONITORING/GIVING DRUGS,,,1583.17
Deidentified Minimum,,95967,CPT4/HCPCS,MEG EVOKED EACH ADDL,,,9507.03
Deidentified Minimum,,95971,CPT4/HCPCS,ALYS SMPL SP/PN NPGT W/PRGRM,,,355.43
Deidentified Minimum,,95975,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,,476.64
Deidentified Minimum,,96004,CPT4/HCPCS,PHYS REVIEW OF MOTION TESTS,,,496.67
Deidentified Minimum,,96103,CPT4/HCPCS,PSYCHO TESTING ADMIN BY COMP,,,51.36
Deidentified Minimum,,96150,CPT4/HCPCS,ASSESS HLTH/BEHAVE INIT,,,47.34
Deidentified Minimum,,96151,CPT4/HCPCS,ASSESS HLTH/BEHAVE SUBSEQ,,,47.34
Deidentified Minimum,,96155,CPT4/HCPCS,INTERV HLTH/BEHAV FAM NO PT,,,56.18
Deidentified Minimum,,96368,CPT4/HCPCS,THER/DIAG CONCURRENT INF,,,179.72
Deidentified Minimum,,96375,CPT4/HCPCS,TX/PRO/DX INJ NEW DRUG ADDON,,,256.72
Deidentified Minimum,,96405,CPT4/HCPCS,CHEMO INTRALESIONAL UP TO 7,,,122.77
Deidentified Minimum,,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,,193.00
Deidentified Minimum,,96522,CPT4/HCPCS,REFILL/MAINT PUMP/RESVR SYST,,,1064.61
Deidentified Minimum,,96900,CPT4/HCPCS,ULTRAVIOLET LIGHT THERAPY,,,277.51
Deidentified Minimum,,96912,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-A,,,1261.56
Deidentified Minimum,,96932,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,,6049.05
Deidentified Minimum,,96933,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,,987.78
Deidentified Minimum,,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,,108.44
Deidentified Minimum,,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,,167.63
Deidentified Minimum,,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,,193.00
Deidentified Minimum,,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,,143.56
Deidentified Minimum,,97537,CPT4/HCPCS,COMMUNITY/WORK REINTEGRATION,,,138.75
Deidentified Minimum,,97755,CPT4/HCPCS,ASSISTIVE TECHNOLOGY ASSESS,,,142.78
Deidentified Minimum,,97804,CPT4/HCPCS,MEDICAL NUTRITION GROUP,,,95.45
Deidentified Minimum,,99184,CPT4/HCPCS,HYPOTHERMIA ILL NEONATE,,,987.78
Deidentified Minimum,,99195,CPT4/HCPCS,PHLEBOTOMY,,,219.78
Deidentified Minimum,,99406,CPT4/HCPCS,BEHAV CHNG SMOKING 3-10 MIN,,,0.00
Deidentified Minimum,,A9500,CPT4/HCPCS,Tc99m sestamibi,,,893.08
Deidentified Minimum,,A9512,CPT4/HCPCS,Tc99m pertechnetate,,,58.80
Deidentified Minimum,,A9538,CPT4/HCPCS,Tc99m pyrophosphate,,,418.31
Deidentified Minimum,,A9552,CPT4/HCPCS,F18 fdg,,,4056.19
Deidentified Minimum,,A9553,CPT4/HCPCS,Cr51 chromate,,,4718.61
Deidentified Minimum,,A9554,CPT4/HCPCS,I125 iothalamate, dx,,,292.82
Deidentified Minimum,,A9558,CPT4/HCPCS,Xe133 xenon 10mci,,,1754.50
Deidentified Minimum,,A9566,CPT4/HCPCS,Tc99m fanolesomab,,,1736.44
Deidentified Minimum,,A9569,CPT4/HCPCS,Technetium TC-99m auto WBC,,,12181.17
Deidentified Minimum,,A9572,CPT4/HCPCS,Indium In-111 pentetreotide,,,47487.72
Deidentified Minimum,,A9599,CPT4/HCPCS,Radioph dx b amyloid pet nos,,,23007.60
Deidentified Minimum,,C5271,CPT4/HCPCS,Low cost skin substitute app,,,1145.00
Deidentified Minimum,,C5274,CPT4/HCPCS,Low cost skin substitute app,,,1145.00
Deidentified Minimum,,C8904,CPT4/HCPCS,Mri w/o cont, breast, uni,,,4399.00
Deidentified Minimum,,C8930,CPT4/HCPCS,Tte w or w/o contr, cont ecg,,,3198.57
Deidentified Minimum,,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,,6876.92
Deidentified Minimum,,C9739,CPT4/HCPCS,Cystoscopy prostatic imp 1-3,,,3965.00
Deidentified Minimum,,C9749,CPT4/HCPCS,Repair nasal stenosis w/imp,,,3544.00
Deidentified Minimum,,C9756,CPT4/HCPCS,Fluorescence lymph map w/icg,,,1145.00
Deidentified Minimum,,G0103,CPT4/HCPCS,PSA screening,,,0.00
Deidentified Minimum,,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,,1235.00
Deidentified Minimum,,G0239,CPT4/HCPCS,Oth resp proc, group,,,172.25
Deidentified Minimum,,G0257,CPT4/HCPCS,Unsched dialysis ESRD pt hos,,,5900.00
Deidentified Minimum,,G0259,CPT4/HCPCS,Inject for sacroiliac joint,,,1145.00
Deidentified Minimum,,G0279,CPT4/HCPCS,Tomosynthesis, mammo,,,4280.43
Deidentified Minimum,,G0341,CPT4/HCPCS,Percutaneous islet celltrans,,,1678.00
Deidentified Minimum,,G0414,CPT4/HCPCS,Pelvic ring fx treat int fix,,,1291.00
Deidentified Minimum,,G0479,CPT4/HCPCS,Drug test presump not opt,,,0.00
Deidentified Minimum,,G0516,CPT4/HCPCS,Insert drug del implant, >=4,,,1145.00
Deidentified Minimum,,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,,150.15
Deidentified Minimum,,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,,193.00
Deidentified Minimum,,G6005,CPT4/HCPCS,Radiation treatment delivery,,,1033.91
Deidentified Minimum,,G6018,CPT4/HCPCS,Ileoscopy w/stent,,,1678.00
Deidentified Minimum,,G6019,CPT4/HCPCS,Colonoscopy lesion removal,,,1678.00
Deidentified Minimum,,G6023,CPT4/HCPCS,Sigmoidoscopy w/stent,,,1678.00
Deidentified Minimum,,G6027,CPT4/HCPCS,Anoscopy hra w/spec collect,,,1678.00
Deidentified Minimum,,G6028,CPT4/HCPCS,Anoscopy hra w/biopsy,,,1678.00
Deidentified Minimum,,G8988,CPT4/HCPCS,Self care goal status,,,0.00
Deidentified Minimum,,G8993,CPT4/HCPCS,Sub pt/ot current status,,,0.00
Deidentified Minimum,,G9163,CPT4/HCPCS,Lang express goal status,,,6.5e-03
Deidentified Minimum,,G9167,CPT4/HCPCS,Atten d/c status,,,6.5e-03
Deidentified Minimum,,G9170,CPT4/HCPCS,Memory d/c status,,,6.5e-03
Deidentified Minimum,,J0881,CPT4/HCPCS,Darbepoetin alfa, non-esrd,,,32.42
Deidentified Minimum,,J0894,CPT4/HCPCS,Decitabine injection,,,36.53
Deidentified Minimum,,J9019,CPT4/HCPCS,Erwinaze injection,,,3519.34
Deidentified Minimum,,J9020,CPT4/HCPCS,Asparaginase, NOS,,,509.54
Deidentified Minimum,,J9039,CPT4/HCPCS,Injection, blinatumomab,,,961.63
Deidentified Minimum,,J9055,CPT4/HCPCS,Cetuximab injection,,,536.25
Deidentified Minimum,,J9165,CPT4/HCPCS,Diethylstilbestrol injection,,,105.75
Deidentified Minimum,,J9178,CPT4/HCPCS,Inj, epirubicin hcl, 2 mg,,,9.49
Deidentified Minimum,,J9206,CPT4/HCPCS,Irinotecan injection,,,21.00
Deidentified Minimum,,J9209,CPT4/HCPCS,Mesna injection,,,18.81
Deidentified Minimum,,J9213,CPT4/HCPCS,Interferon alfa-2a inj,,,355.15
Deidentified Minimum,,J9260,CPT4/HCPCS,Methotrexate sodium inj,,,21.08
Deidentified Minimum,,J9261,CPT4/HCPCS,Nelarabine injection,,,1295.61
Deidentified Minimum,,J9267,CPT4/HCPCS,Paclitaxel injection,,,1.17
Deidentified Minimum,,J9268,CPT4/HCPCS,Pentostatin injection,,,17895.77
Deidentified Minimum,,J9271,CPT4/HCPCS,Inj pembrolizumab,,,426.46
Deidentified Minimum,,J9293,CPT4/HCPCS,Mitoxantrone hydrochl / 5 MG,,,235.87
Deidentified Minimum,,J9301,CPT4/HCPCS,Obinutuzumab inj,,,538.86
Deidentified Minimum,,J9310,CPT4/HCPCS,Rituximab injection,,,7860.38
Deidentified Minimum,,J9355,CPT4/HCPCS,Inj trastuzumab excl biosimi,,,898.04
Deidentified Minimum,,P9010,CPT4/HCPCS,Whole blood for transfusion,,,3628.00
Deidentified Minimum,,Q0035,CPT4/HCPCS,Cardiokymography,,,190.91
Deidentified Minimum,,Q3014,CPT4/HCPCS,Telehealth facility fee,,,6500.00
Deidentified Minimum,,Q9953,CPT4/HCPCS,Inj Fe-based MR contrast,1ml,,,122.22
Deidentified Minimum,,Q9958,CPT4/HCPCS,HOCM <=149 mg/ml iodine, 1ml,,,0.67
Deidentified Minimum,,Q9960,CPT4/HCPCS,HOCM 200-249mg/ml iodine,1ml,,,1.42
Deidentified Minimum,,Q9961,CPT4/HCPCS,HOCM 250-299mg/ml iodine,1ml,,,2.10
Deidentified Minimum,,Q9962,CPT4/HCPCS,HOCM 300-349mg/ml iodine,1ml,,,2.18
Deidentified Minimum,,Q9963,CPT4/HCPCS,HOCM 350-399mg/ml iodine,1ml,,,1.68
Deidentified Minimum,,Q9964,CPT4/HCPCS,HOCM>= 400mg/ml iodine, 1ml,,,2.68
Deidentified Minimum,,Q9983,CPT4/HCPCS,Florbetaben f18 diagnostic,,,23425.92
Deidentified Minimum,,S0117,CPT4/HCPCS,Tretinoin topical 5 g,,,73.58
Deidentified Minimum,,S0145,CPT4/HCPCS,Peg interferon alfa-2A/180,,,8546.24
Deidentified Minimum,,S0175,CPT4/HCPCS,Flutamide 125 mg,,,13.02
Deidentified Minimum,,S0179,CPT4/HCPCS,Megestrol 20 mg,,,3.10
Deidentified Minimum,,S2115,CPT4/HCPCS,Periacetabular osteotomy,,,5783.00
Deidentified Minimum,,S2152,CPT4/HCPCS,Solid organ transpl pkg,,,6588.00
Deidentified Minimum,,S2404,CPT4/HCPCS,Fetal surg myelomeningo,,,8012.00
Deidentified Minimum,,78700,CPT4/HCPCS,KIDNEY IMAGING MORPHOL,,,142.00
Deidentified Minimum,,78801,CPT4/HCPCS,RP LOCLZJ TUM 2+AREA 1+D IMG,,,142.00
Deidentified Minimum,,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,,142.00
Deidentified Minimum,,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,,142.00
Deidentified Minimum,,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,,142.00
Deidentified Minimum,,79440,CPT4/HCPCS,NUCLEAR RX INTRA-ARTICULAR,,,142.00
Deidentified Minimum,,80069,CPT4/HCPCS,RENAL FUNCTION PANEL,,,87.27
Deidentified Minimum,,80074,CPT4/HCPCS,ACUTE HEPATITIS PANEL,,,96.00
Deidentified Minimum,,80076,CPT4/HCPCS,HEPATIC FUNCTION PANEL,,,82.06
Deidentified Minimum,,80157,CPT4/HCPCS,ASSAY CARBAMAZEPINE FREE,,,96.00
Deidentified Minimum,,80169,CPT4/HCPCS,DRUG ASSAY EVEROLIMUS,,,96.00
Deidentified Minimum,,80180,CPT4/HCPCS,DRUG SCRN QUAN MYCOPHENOLATE,,,96.00
Deidentified Minimum,,80184,CPT4/HCPCS,ASSAY OF PHENOBARBITAL,,,96.00
Deidentified Minimum,,80186,CPT4/HCPCS,ASSAY OF PHENYTOIN FREE,,,96.00
Deidentified Minimum,,80188,CPT4/HCPCS,ASSAY OF PRIMIDONE,,,96.00
Deidentified Minimum,,80190,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,,96.00
Deidentified Minimum,,80307,CPT4/HCPCS,DRUG TEST PRSMV CHEM ANLYZR,,,96.00
Deidentified Minimum,,80326,CPT4/HCPCS,AMPHETAMINES 5 OR MORE,,,0.08
Deidentified Minimum,,80328,CPT4/HCPCS,ANABOLIC STEROID 3 OR MORE,,,0.08
Deidentified Minimum,,80338,CPT4/HCPCS,ANTIDEPRESSANT NOT SPECIFIED,,,0.08
Deidentified Minimum,,80342,CPT4/HCPCS,ANTIPSYCHOTICS NOS 1-3,,,0.08
Deidentified Minimum,,80347,CPT4/HCPCS,BENZODIAZEPINES 13 OR MORE,,,0.08
Deidentified Minimum,,80352,CPT4/HCPCS,CANNABINOID SYNTHETIC 7/MORE,,,0.08
Deidentified Minimum,,80353,CPT4/HCPCS,DRUG SCREENING COCAINE,,,0.08
Deidentified Minimum,,80354,CPT4/HCPCS,DRUG SCREENING FENTANYL,,,0.08
Deidentified Minimum,,80357,CPT4/HCPCS,KETAMINE AND NORKETAMINE,,,0.08
Deidentified Minimum,,80366,CPT4/HCPCS,DRUG SCREENING PREGABALIN,,,0.08
Deidentified Minimum,,80368,CPT4/HCPCS,SEDATIVE HYPNOTICS,,,0.08
Deidentified Minimum,,80369,CPT4/HCPCS,SKELETAL MUSCLE RELAXANT 1/2,,,0.08
Deidentified Minimum,,80372,CPT4/HCPCS,DRUG SCREENING TAPENTADOL,,,0.08
Deidentified Minimum,,80402,CPT4/HCPCS,ACTH STIMULATION PANEL,,,96.00
Deidentified Minimum,,80412,CPT4/HCPCS,CRH STIMULATION PANEL,,,96.00
Deidentified Minimum,,80414,CPT4/HCPCS,TESTOSTERONE RESPONSE PANEL,,,96.00
Deidentified Minimum,,80420,CPT4/HCPCS,DEXAMETHASONE PANEL,,,96.00
Deidentified Minimum,,80434,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,,96.00
Deidentified Minimum,,81112,CPT4/HCPCS,HPA-15 GENOTYPING,,,150.00
Deidentified Minimum,,81161,CPT4/HCPCS,DMD DUP/DELET ANALYSIS,,,150.00
Deidentified Minimum,,81175,CPT4/HCPCS,ASXL1 FULL GENE SEQUENCE,,,150.00
Deidentified Minimum,,81181,CPT4/HCPCS,ATXN7 GENE DETC ABNOR ALLELE,,,150.00
Deidentified Minimum,,81183,CPT4/HCPCS,ATXN10 GENE DETC ABNOR ALLEL,,,150.00
Deidentified Minimum,,81212,CPT4/HCPCS,BRCA1&2 185&5385&6174 VRNT,,,150.00
Deidentified Minimum,,81221,CPT4/HCPCS,CFTR GENE KNOWN FAM VARIANTS,,,150.00
Deidentified Minimum,,81223,CPT4/HCPCS,CFTR GENE FULL SEQUENCE,,,150.00
Deidentified Minimum,,81235,CPT4/HCPCS,EGFR GENE COM VARIANTS,,,150.00
Deidentified Minimum,,81239,CPT4/HCPCS,DMPK GENE CHARAC ALLELES,,,150.00
Deidentified Minimum,,81246,CPT4/HCPCS,FLT3 GENE ANALYSIS,,,150.00
Deidentified Minimum,,81248,CPT4/HCPCS,G6PD KNOWN FAMILIAL VARIANT,,,150.00
Deidentified Minimum,,81249,CPT4/HCPCS,G6PD FULL GENE SEQUENCE,,,150.00
Deidentified Minimum,,81257,CPT4/HCPCS,HBA1/HBA2 GENE,,,150.00
Deidentified Minimum,,81258,CPT4/HCPCS,HBA1/HBA2 GENE FAM VRNT,,,150.00
Deidentified Minimum,,81261,CPT4/HCPCS,IGH GENE REARRANGE AMP METH,,,150.00
Deidentified Minimum,,81262,CPT4/HCPCS,IGH GENE REARRANG DIR PROBE,,,150.00
Deidentified Minimum,,81264,CPT4/HCPCS,IGK REARRANGEABN CLONAL POP,,,150.00
Deidentified Minimum,,81266,CPT4/HCPCS,STR MARKERS SPEC ANAL ADDL,,,150.00
Deidentified Minimum,,81267,CPT4/HCPCS,CHIMERISM ANAL NO CELL SELEC,,,150.00
Deidentified Minimum,,81289,CPT4/HCPCS,FXN GENE KNOWN FAMIL VARIANT,,,150.00
Deidentified Minimum,,81291,CPT4/HCPCS,MTHFR GENE,,,150.00
Deidentified Minimum,,81293,CPT4/HCPCS,MLH1 GENE KNOWN VARIANTS,,,150.00
Deidentified Minimum,,81311,CPT4/HCPCS,NRAS GENE VARIANTS EXON 2&3,,,150.00
Deidentified Minimum,,81317,CPT4/HCPCS,PMS2 GENE FULL SEQ ANALYSIS,,,150.00
Deidentified Minimum,,81318,CPT4/HCPCS,PMS2 KNOWN FAMILIAL VARIANTS,,,150.00
Deidentified Minimum,,81321,CPT4/HCPCS,PTEN GENE FULL SEQUENCE,,,150.00
Deidentified Minimum,,81326,CPT4/HCPCS,PMP22 GENE KNOWN FAM VARIANT,,,150.00
Deidentified Minimum,,81332,CPT4/HCPCS,SERPINA1 GENE,,,150.00
Deidentified Minimum,,81336,CPT4/HCPCS,SMN1 GENE FULL GENE SEQUENCE,,,150.00
Deidentified Minimum,,81340,CPT4/HCPCS,TRB@ GENE REARRANGE AMPLIFY,,,150.00
Deidentified Minimum,,81345,CPT4/HCPCS,TERT GENE TARGETED SEQ ALYS,,,150.00
Deidentified Minimum,,81362,CPT4/HCPCS,HBB GENE KNOWN FAM VARIANT,,,150.00
Deidentified Minimum,,81430,CPT4/HCPCS,HEARING LOSS SEQUENCE ANALYS,,,96.00
Deidentified Minimum,,81434,CPT4/HCPCS,HEREDITARY RETINAL DISORDERS,,,96.00
Deidentified Minimum,,81438,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,,96.00
Deidentified Minimum,,81440,CPT4/HCPCS,MITOCHONDRIAL GENE,,,96.00
Deidentified Minimum,,81455,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,,96.00
Deidentified Minimum,,81471,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,,0.08
Deidentified Minimum,,81490,CPT4/HCPCS,AUTOIMMUNE RHEUMATOID ARTHR,,,96.00
Deidentified Minimum,,81506,CPT4/HCPCS,ENDO ASSAY SEVEN ANAL,,,96.00
Deidentified Minimum,,81512,CPT4/HCPCS,FTL CGEN ABNOR FIVE ANAL,,,96.00
Deidentified Minimum,,81518,CPT4/HCPCS,ONC BRST MRNA 11 GENES,,,96.00
Deidentified Minimum,,82024,CPT4/HCPCS,ASSAY OF ACTH,,,96.00
Deidentified Minimum,,82045,CPT4/HCPCS,ALBUMIN ISCHEMIA MODIFIED,,,96.00
Deidentified Minimum,,82088,CPT4/HCPCS,ASSAY OF ALDOSTERONE,,,96.00
Deidentified Minimum,,82103,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN TOTAL,,,96.00
Deidentified Minimum,,82120,CPT4/HCPCS,AMINES VAGINAL FLUID QUAL,,,37.80
Deidentified Minimum,,82128,CPT4/HCPCS,AMINO ACIDS MULT QUAL,,,96.00
Deidentified Minimum,,82136,CPT4/HCPCS,AMINO ACIDS QUANT 2-5,,,96.00
Deidentified Minimum,,82163,CPT4/HCPCS,ASSAY OF ANGIOTENSIN II,,,96.00
Deidentified Minimum,,82239,CPT4/HCPCS,BILE ACIDS TOTAL,,,96.00
Deidentified Minimum,,82240,CPT4/HCPCS,BILE ACIDS CHOLYLGLYCINE,,,96.00
Deidentified Minimum,,82330,CPT4/HCPCS,ASSAY OF CALCIUM,,,96.00
Deidentified Minimum,,82379,CPT4/HCPCS,ASSAY OF CARNITINE,,,96.00
Deidentified Minimum,,82397,CPT4/HCPCS,CHEMILUMINESCENT ASSAY,,,96.00
Deidentified Minimum,,82436,CPT4/HCPCS,ASSAY OF URINE CHLORIDE,,,50.48
Deidentified Minimum,,82525,CPT4/HCPCS,ASSAY OF COPPER,,,96.00
Deidentified Minimum,,82553,CPT4/HCPCS,CREATINE MB FRACTION,,,96.00
Deidentified Minimum,,82554,CPT4/HCPCS,CREATINE ISOFORMS,,,96.00
Deidentified Minimum,,82565,CPT4/HCPCS,ASSAY OF CREATININE,,,51.57
Deidentified Minimum,,82634,CPT4/HCPCS,DEOXYCORTISOL,,,96.00
Deidentified Minimum,,82671,CPT4/HCPCS,ASSAY OF ESTROGENS,,,96.00
Deidentified Minimum,,82679,CPT4/HCPCS,ASSAY OF ESTRONE,,,96.00
Deidentified Minimum,,82725,CPT4/HCPCS,ASSAY OF BLOOD FATTY ACIDS,,,96.00
Deidentified Minimum,,82735,CPT4/HCPCS,ASSAY OF FLUORIDE,,,96.00
Deidentified Minimum,,82747,CPT4/HCPCS,ASSAY OF FOLIC ACID RBC,,,96.00
Deidentified Minimum,,82777,CPT4/HCPCS,GALECTIN-3,,,96.00
Deidentified Minimum,,82803,CPT4/HCPCS,BLOOD GASES ANY COMBINATION,,,96.00
Deidentified Minimum,,82943,CPT4/HCPCS,ASSAY OF GLUCAGON,,,96.00
Deidentified Minimum,,82947,CPT4/HCPCS,ASSAY GLUCOSE BLOOD QUANT,,,39.39
Deidentified Minimum,,82952,CPT4/HCPCS,GTT-ADDED SAMPLES,,,39.31
Deidentified Minimum,,82979,CPT4/HCPCS,ASSAY RBC GLUTATHIONE,,,69.21
Deidentified Minimum,,83001,CPT4/HCPCS,ASSAY OF GONADOTROPIN (FSH),,,96.00
Deidentified Minimum,,83012,CPT4/HCPCS,ASSAY OF HAPTOGLOBINS,,,96.00
Deidentified Minimum,,83013,CPT4/HCPCS,H PYLORI (C-13) BREATH,,,96.00
Deidentified Minimum,,83020,CPT4/HCPCS,HEMOGLOBIN ELECTROPHORESIS,,,96.00
Deidentified Minimum,,83033,CPT4/HCPCS,FETAL HEMOGLOBIN ASSAY QUAL,,,59.89
Deidentified Minimum,,83037,CPT4/HCPCS,GLYCOSYLATED HB HOME DEVICE,,,96.00
Deidentified Minimum,,83051,CPT4/HCPCS,ASSAY OF PLASMA HEMOGLOBIN,,,73.50
Deidentified Minimum,,83060,CPT4/HCPCS,BLOOD SULFHEMOGLOBIN ASSAY,,,83.07
Deidentified Minimum,,83491,CPT4/HCPCS,ASSAY OF CORTICOSTEROIDS 17,,,96.00
Deidentified Minimum,,83527,CPT4/HCPCS,ASSAY OF INSULIN,,,96.00
Deidentified Minimum,,83540,CPT4/HCPCS,ASSAY OF IRON,,,65.10
Deidentified Minimum,,83593,CPT4/HCPCS,FRACTIONATION KETOSTEROIDS,,,96.00
Deidentified Minimum,,83615,CPT4/HCPCS,LACTATE (LD) (LDH) ENZYME,,,60.73
Deidentified Minimum,,83663,CPT4/HCPCS,FLUORO POLARIZE FETAL LUNG,,,96.00
Deidentified Minimum,,83718,CPT4/HCPCS,ASSAY OF LIPOPROTEIN,,,82.23
Deidentified Minimum,,83727,CPT4/HCPCS,ASSAY OF LRH HORMONE,,,96.00
Deidentified Minimum,,83876,CPT4/HCPCS,ASSAY MYELOPEROXIDASE,,,96.00
Deidentified Minimum,,83970,CPT4/HCPCS,ASSAY OF PARATHORMONE,,,96.00
Deidentified Minimum,,84120,CPT4/HCPCS,ASSAY OF URINE PORPHYRINS,,,96.00
Deidentified Minimum,,84135,CPT4/HCPCS,ASSAY OF PREGNANEDIOL,,,96.00
Deidentified Minimum,,84160,CPT4/HCPCS,ASSAY OF PROTEIN ANY SOURCE,,,51.99
Deidentified Minimum,,84252,CPT4/HCPCS,ASSAY OF VITAMIN B-2,,,96.00
Deidentified Minimum,,84375,CPT4/HCPCS,CHROMATOGRAM ASSAY SUGARS,,,96.00
Deidentified Minimum,,84379,CPT4/HCPCS,SUGARS MULTIPLE QUANT,,,96.00
Deidentified Minimum,,84432,CPT4/HCPCS,ASSAY OF THYROGLOBULIN,,,96.00
Deidentified Minimum,,84436,CPT4/HCPCS,ASSAY OF TOTAL THYROXINE,,,69.04
Deidentified Minimum,,84443,CPT4/HCPCS,ASSAY THYROID STIM HORMONE,,,96.00
Deidentified Minimum,,84445,CPT4/HCPCS,ASSAY OF TSI GLOBULIN,,,96.00
Deidentified Minimum,,84484,CPT4/HCPCS,ASSAY OF TROPONIN QUANT,,,96.00
Deidentified Minimum,,84485,CPT4/HCPCS,ASSAY DUODENAL FLUID TRYPSIN,,,75.43
Deidentified Minimum,,84488,CPT4/HCPCS,TEST FECES FOR TRYPSIN,,,73.33
Deidentified Minimum,,84591,CPT4/HCPCS,ASSAY OF NOS VITAMIN,,,96.00
Deidentified Minimum,,84681,CPT4/HCPCS,ASSAY OF C-PEPTIDE,,,96.00
Deidentified Minimum,,85004,CPT4/HCPCS,AUTOMATED DIFF WBC COUNT,,,65.01
Deidentified Minimum,,85014,CPT4/HCPCS,HEMATOCRIT,,,23.77
Deidentified Minimum,,85041,CPT4/HCPCS,AUTOMATED RBC COUNT,,,30.24
Deidentified Minimum,,85055,CPT4/HCPCS,RETICULATED PLATELET ASSAY,,,96.00
Deidentified Minimum,,85060,CPT4/HCPCS,BLOOD SMEAR INTERPRETATION,,,96.00
Deidentified Minimum,,85220,CPT4/HCPCS,BLOOC CLOT FACTOR V TEST,,,96.00
Deidentified Minimum,,85244,CPT4/HCPCS,CLOT FACTOR VIII RELTD ANTGN,,,96.00
Deidentified Minimum,,85301,CPT4/HCPCS,ANTITHROMBIN III ANTIGEN,,,96.00
Deidentified Minimum,,85347,CPT4/HCPCS,COAGULATION TIME ACTIVATED,,,42.75
Deidentified Minimum,,85362,CPT4/HCPCS,FIBRIN DEGRADATION PRODUCTS,,,65.85
Deidentified Minimum,,85390,CPT4/HCPCS,FIBRINOLYSINS SCREEN I&R,,,51.91
Deidentified Minimum,,85421,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,,96.00
Deidentified Minimum,,85475,CPT4/HCPCS,HEMOLYSIN ACID,,,89.12
Deidentified Minimum,,85525,CPT4/HCPCS,HEPARIN NEUTRALIZATION,,,93.32
Deidentified Minimum,,85557,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,,96.00
Deidentified Minimum,,86000,CPT4/HCPCS,AGGLUTININS FEBRILE ANTIGEN,,,57.62
Deidentified Minimum,,86021,CPT4/HCPCS,WBC ANTIBODY IDENTIFICATION,,,96.00
Deidentified Minimum,,86039,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES (ANA),,,96.00
Deidentified Minimum,,86060,CPT4/HCPCS,ANTISTREPTOLYSIN O TITER,,,73.33
Deidentified Minimum,,86077,CPT4/HCPCS,PHYS BLOOD BANK SERV XMATCH,,,96.00
Deidentified Minimum,,86147,CPT4/HCPCS,CARDIOLIPIN ANTIBODY EA IG,,,96.00
Deidentified Minimum,,86318,CPT4/HCPCS,IA INFECTIOUS AGENT ANTIBODY,,,96.00
Deidentified Minimum,,86327,CPT4/HCPCS,IMMUNOELECTROPHORESIS ASSAY,,,96.00
Deidentified Minimum,,86337,CPT4/HCPCS,INSULIN ANTIBODIES,,,96.00
Deidentified Minimum,,86340,CPT4/HCPCS,INTRINSIC FACTOR ANTIBODY,,,96.00
Deidentified Minimum,,86341,CPT4/HCPCS,ISLET CELL ANTIBODY,,,96.00
Deidentified Minimum,,86353,CPT4/HCPCS,LYMPHOCYTE TRANSFORMATION,,,96.00
Deidentified Minimum,,86359,CPT4/HCPCS,T CELLS TOTAL COUNT,,,96.00
Deidentified Minimum,,86384,CPT4/HCPCS,NITROBLUE TETRAZOLIUM DYE,,,96.00
Deidentified Minimum,,86430,CPT4/HCPCS,RHEUMATOID FACTOR TEST QUAL,,,56.95
Deidentified Minimum,,86431,CPT4/HCPCS,RHEUMATOID FACTOR QUANT,,,56.95
Deidentified Minimum,,86480,CPT4/HCPCS,TB TEST CELL IMMUN MEASURE,,,96.00
Deidentified Minimum,,86481,CPT4/HCPCS,TB AG RESPONSE T-CELL SUSP,,,96.00
Deidentified Minimum,,86486,CPT4/HCPCS,SKIN TEST NOS ANTIGEN,,,43.17
Deidentified Minimum,,86490,CPT4/HCPCS,COCCIDIOIDOMYCOSIS SKIN TEST,,,57.96
Deidentified Minimum,,86612,CPT4/HCPCS,BLASTOMYCES ANTIBODY,,,96.00
Deidentified Minimum,,86619,CPT4/HCPCS,BORRELIA ANTIBODY,,,96.00
Deidentified Minimum,,86635,CPT4/HCPCS,COCCIDIOIDES ANTIBODY,,,96.00
Deidentified Minimum,,86641,CPT4/HCPCS,CRYPTOCOCCUS ANTIBODY,,,96.00
Deidentified Minimum,,86652,CPT4/HCPCS,ENCEPHALTIS EAST EQNE ANBDY,,,96.00
Deidentified Minimum,,86666,CPT4/HCPCS,EHRLICHIA ANTIBODY,,,96.00
Deidentified Minimum,,86668,CPT4/HCPCS,FRANCISELLA TULARENSIS,,,96.00
Deidentified Minimum,,86689,CPT4/HCPCS,HTLV/HIV CONFIRMJ ANTIBODY,,,96.00
Deidentified Minimum,,86692,CPT4/HCPCS,HEPATITIS DELTA AGENT ANTBDY,,,96.00
Deidentified Minimum,,86701,CPT4/HCPCS,HIV-1ANTIBODY,,,89.29
Deidentified Minimum,,86703,CPT4/HCPCS,HIV-1/HIV-2 1 RESULT ANTBDY,,,96.00
Deidentified Minimum,,86706,CPT4/HCPCS,HEP B SURFACE ANTIBODY,,,96.00
Deidentified Minimum,,86708,CPT4/HCPCS,HEPATITIS A ANTIBODY,,,96.00
Deidentified Minimum,,86713,CPT4/HCPCS,LEGIONELLA ANTIBODY,,,96.00
Deidentified Minimum,,86720,CPT4/HCPCS,LEPTOSPIRA ANTIBODY,,,96.00
Deidentified Minimum,,86750,CPT4/HCPCS,MALARIA ANTIBODY,,,96.00
Deidentified Minimum,,86753,CPT4/HCPCS,PROTOZOA ANTIBODY NOS,,,96.00
Deidentified Minimum,,86768,CPT4/HCPCS,SALMONELLA ANTIBODY,,,96.00
Deidentified Minimum,,86790,CPT4/HCPCS,VIRUS ANTIBODY NOS,,,96.00
Deidentified Minimum,,86816,CPT4/HCPCS,HLA TYPING DR/DQ,,,96.00
Deidentified Minimum,,86821,CPT4/HCPCS,LYMPHOCYTE CULTURE MIXED,,,96.00
Deidentified Minimum,,86826,CPT4/HCPCS,HLA X-MATCH NONCYTOTOXC ADDL,,,96.00
Deidentified Minimum,,86830,CPT4/HCPCS,HLA CLASS I PHENOTYPE QUAL,,,96.00
Deidentified Minimum,,86831,CPT4/HCPCS,HLA CLASS II PHENOTYPE QUAL,,,96.00
Deidentified Minimum,,86832,CPT4/HCPCS,HLA CLASS I HIGH DEFIN QUAL,,,96.00
Deidentified Minimum,,86901,CPT4/HCPCS,BLOOD TYPING SEROLOGIC RH(D),,,29.98
Deidentified Minimum,,86930,CPT4/HCPCS,FROZEN BLOOD PREP,,,96.00
Deidentified Minimum,,86931,CPT4/HCPCS,FROZEN BLOOD THAW,,,96.00
Deidentified Minimum,,86941,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS,,,96.00
Deidentified Minimum,,86975,CPT4/HCPCS,RBC SERUM PRETX INCUBJ DRUGS,,,96.00
Deidentified Minimum,,87040,CPT4/HCPCS,BLOOD CULTURE FOR BACTERIA,,,96.00
Deidentified Minimum,,87071,CPT4/HCPCS,CULTURE AEROBIC QUANT OTHER,,,94.83
Deidentified Minimum,,87075,CPT4/HCPCS,CULTR BACTERIA EXCEPT BLOOD,,,95.00
Deidentified Minimum,,87077,CPT4/HCPCS,CULTURE AEROBIC IDENTIFY,,,81.14
Deidentified Minimum,,87081,CPT4/HCPCS,CULTURE SCREEN ONLY,,,66.61
Deidentified Minimum,,87088,CPT4/HCPCS,URINE BACTERIA CULTURE,,,65.85
Deidentified Minimum,,87106,CPT4/HCPCS,FUNGI IDENTIFICATION YEAST,,,96.00
Deidentified Minimum,,87107,CPT4/HCPCS,FUNGI IDENTIFICATION MOLD,,,96.00
Deidentified Minimum,,87149,CPT4/HCPCS,DNA/RNA DIRECT PROBE,,,96.00
Deidentified Minimum,,87152,CPT4/HCPCS,CULTURE TYPE PULSE FIELD GEL,,,52.58
Deidentified Minimum,,87153,CPT4/HCPCS,DNA/RNA SEQUENCING,,,96.00
Deidentified Minimum,,87169,CPT4/HCPCS,MACROSCOPIC EXAM PARASITE,,,42.92
Deidentified Minimum,,87181,CPT4/HCPCS,MICROBE SUSCEPTIBLE DIFFUSE,,,16.37
Deidentified Minimum,,87185,CPT4/HCPCS,MICROBE SUSCEPTIBLE ENZYME,,,16.37
Deidentified Minimum,,87210,CPT4/HCPCS,SMEAR WET MOUNT SALINE/INK,,,42.92
Deidentified Minimum,,87220,CPT4/HCPCS,TISSUE EXAM FOR FUNGI,,,42.92
Deidentified Minimum,,87254,CPT4/HCPCS,VIRUS INOCULATION SHELL VIA,,,96.00
Deidentified Minimum,,87279,CPT4/HCPCS,PARAINFLUENZA AG IF,,,93.32
Deidentified Minimum,,87320,CPT4/HCPCS,CHYLMD TRACH AG IA,,,93.32
Deidentified Minimum,,87335,CPT4/HCPCS,E COLI 0157 AG IA,,,93.32
Deidentified Minimum,,87338,CPT4/HCPCS,HPYLORI STOOL IA,,,96.00
Deidentified Minimum,,87341,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,,96.00
Deidentified Minimum,,87427,CPT4/HCPCS,SHIGA-LIKE TOXIN AG IA,,,93.32
Deidentified Minimum,,87451,CPT4/HCPCS,AG DETECT POLYVAL IA MULT,,,34.27
Deidentified Minimum,,87506,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 6-11,,,96.00
Deidentified Minimum,,87511,CPT4/HCPCS,GARDNER VAG DNA AMP PROBE,,,96.00
Deidentified Minimum,,87521,CPT4/HCPCS,HEPATITIS C PROBE&RVRS TRNSC,,,96.00
Deidentified Minimum,,87526,CPT4/HCPCS,HEPATITIS G DNA AMP PROBE,,,96.00
Deidentified Minimum,,87535,CPT4/HCPCS,HIV-1 PROBE&REVERSE TRNSCRPJ,,,96.00
Deidentified Minimum,,87537,CPT4/HCPCS,HIV-2 DNA DIR PROBE,,,96.00
Deidentified Minimum,,87538,CPT4/HCPCS,HIV-2 PROBE&REVRSE TRNSCRIPJ,,,96.00
Deidentified Minimum,,87551,CPT4/HCPCS,MYCOBACTERIA DNA AMP PROBE,,,96.00
Deidentified Minimum,,87557,CPT4/HCPCS,M.TUBERCULO DNA QUANT,,,96.00
Deidentified Minimum,,87560,CPT4/HCPCS,M.AVIUM-INTRA DNA DIR PROB,,,96.00
Deidentified Minimum,,87641,CPT4/HCPCS,MR-STAPH DNA AMP PROBE,,,96.00
Deidentified Minimum,,87662,CPT4/HCPCS,ZIKA VIRUS DNA/RNA AMP PROBE,,,96.00
Deidentified Minimum,,87810,CPT4/HCPCS,CHYLMD TRACH ASSAY W/OPTIC,,,93.32
Deidentified Minimum,,87850,CPT4/HCPCS,N. GONORRHOEAE ASSAY W/OPTIC,,,93.32
Deidentified Minimum,,87905,CPT4/HCPCS,SIALIDASE ENZYME ASSAY,,,96.00
Deidentified Minimum,,87912,CPT4/HCPCS,GENOTYPE DNA HEPATITIS B,,,96.00
Deidentified Minimum,,88005,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,96.00
Deidentified Minimum,,88012,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,96.00
Deidentified Minimum,,88014,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,96.00
Deidentified Minimum,,88040,CPT4/HCPCS,FORENSIC AUTOPSY (NECROPSY),,,96.00
Deidentified Minimum,,88106,CPT4/HCPCS,CYTOPATH FL NONGYN FILTER,,,96.00
Deidentified Minimum,,88125,CPT4/HCPCS,FORENSIC CYTOPATHOLOGY,,,71.40
Deidentified Minimum,,88141,CPT4/HCPCS,CYTOPATH C/V INTERPRET,,,96.00
Deidentified Minimum,,88150,CPT4/HCPCS,CYTOPATH C/V MANUAL,,,96.00
Deidentified Minimum,,88161,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,,96.00
Deidentified Minimum,,88165,CPT4/HCPCS,CYTOPATH TBS C/V REDO,,,96.00
Deidentified Minimum,,88182,CPT4/HCPCS,CELL MARKER STUDY,,,96.00
Deidentified Minimum,,88262,CPT4/HCPCS,CHROMOSOME ANALYSIS 15-20,,,96.00
Deidentified Minimum,,88274,CPT4/HCPCS,CYTOGENETICS 25-99,,,96.00
Deidentified Minimum,,88280,CPT4/HCPCS,CHROMOSOME KARYOTYPE STUDY,,,96.00
Deidentified Minimum,,88302,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,,96.00
Deidentified Minimum,,88304,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,,96.00
Deidentified Minimum,,88314,CPT4/HCPCS,HISTOCHEMICAL STAINS ADD-ON,,,96.00
Deidentified Minimum,,88331,CPT4/HCPCS,PATH CONSULT INTRAOP 1 BLOC,,,96.00
Deidentified Minimum,,88341,CPT4/HCPCS,IMMUNOHISTO ANTB ADDL SLIDE,,,96.00
Deidentified Minimum,,88346,CPT4/HCPCS,IMMUNOFLUOR ANTB 1ST STAIN,,,96.00
Deidentified Minimum,,88355,CPT4/HCPCS,ANALYSIS SKELETAL MUSCLE,,,96.00
Deidentified Minimum,,88363,CPT4/HCPCS,XM ARCHIVE TISSUE MOLEC ANAL,,,60.21
Deidentified Minimum,,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,,96.00
Deidentified Minimum,,89254,CPT4/HCPCS,OOCYTE IDENTIFICATION,,,96.00
Deidentified Minimum,,89257,CPT4/HCPCS,SPERM IDENTIFICATION,,,96.00
Deidentified Minimum,,89260,CPT4/HCPCS,SPERM ISOLATION SIMPLE,,,96.00
Deidentified Minimum,,89264,CPT4/HCPCS,IDENTIFY SPERM TISSUE,,,96.00
Deidentified Minimum,,89281,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,,96.00
Deidentified Minimum,,89290,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,,96.00
Deidentified Minimum,,89321,CPT4/HCPCS,SEMEN ANAL SPERM DETECTION,,,96.00
Deidentified Minimum,,89343,CPT4/HCPCS,STORAGE/YEAR SPERM/SEMEN,,,96.00
Deidentified Minimum,,89352,CPT4/HCPCS,THAWING CRYOPRESRVED EMBRYO,,,96.00
Deidentified Minimum,,89354,CPT4/HCPCS,THAW CRYOPRSVRD REPROD TISS,,,62.24
Deidentified Minimum,,90811,CPT4/HCPCS,INTAC PSYTX 20-30 W/E&M,,,141.24
Deidentified Minimum,,90816,CPT4/HCPCS,PSYTX HOSP 20-30 MIN,,,166.08
Deidentified Minimum,,90819,CPT4/HCPCS,PSYTX HOSP 45-50 MIN W/E&M,,,246.31
Deidentified Minimum,,90821,CPT4/HCPCS,PSYTX HOSP 75-80 MIN,,,312.89
Deidentified Minimum,,90847,CPT4/HCPCS,FAMILY PSYTX W/PT 50 MIN,,,255.94
Deidentified Minimum,,90867,CPT4/HCPCS,TCRANIAL MAGN STIM TX PLAN,,,987.78
Deidentified Minimum,,90912,CPT4/HCPCS,BFB TRAINING 1ST 15 MIN,,,193.00
Deidentified Minimum,,90935,CPT4/HCPCS,HEMODIALYSIS ONE EVALUATION,,,338.51
Deidentified Minimum,,90940,CPT4/HCPCS,HEMODIALYSIS ACCESS STUDY,,,629.69
Deidentified Minimum,,91110,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,,1291.00
Deidentified Minimum,,91132,CPT4/HCPCS,ELECTROGASTROGRAPHY,,,190.91
Deidentified Minimum,,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,,543.08
Deidentified Minimum,,92136,CPT4/HCPCS,OPHTHALMIC BIOMETRY,,,749.98
Deidentified Minimum,,92227,CPT4/HCPCS,IMG RTA DETCJ/MNTR DS STAFF,,,162.81
Deidentified Minimum,,92230,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,,744.25
Deidentified Minimum,,92240,CPT4/HCPCS,ICG ANGIOGRAPHY UNI/BI,,,1678.00
Deidentified Minimum,,92285,CPT4/HCPCS,EYE PHOTOGRAPHY,,,475.56
Deidentified Minimum,,92326,CPT4/HCPCS,REPLACEMENT OF CONTACT LENS,,,808.50
Deidentified Minimum,,92353,CPT4/HCPCS,FIT APHAKIA SPECTCL MULTIFOC,,,359.31
Deidentified Minimum,,92354,CPT4/HCPCS,FIT SPECTACLES SINGLE SYSTEM,,,4317.88
Deidentified Minimum,,92371,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,,306.38
Deidentified Minimum,,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,,1609.55
Deidentified Minimum,,92516,CPT4/HCPCS,FACIAL NERVE FUNCTION TEST,,,581.42
Deidentified Minimum,,92543,CPT4/HCPCS,CALORIC VESTIBULAR TEST,,,234.99
Deidentified Minimum,,92555,CPT4/HCPCS,SPEECH THRESHOLD AUDIOMETRY,,,194.16
Deidentified Minimum,,92561,CPT4/HCPCS,BEKESY AUDIOMETRY DIAGNOSIS,,,370.63
Deidentified Minimum,,92564,CPT4/HCPCS,SISI HEARING TEST,,,246.31
Deidentified Minimum,,92565,CPT4/HCPCS,STENGER TEST PURE TONE,,,203.78
Deidentified Minimum,,92572,CPT4/HCPCS,STAGGERED SPONDAIC WORD TEST,,,47.34
Deidentified Minimum,,92575,CPT4/HCPCS,SENSORINEURAL ACUITY TEST,,,152.41
Deidentified Minimum,,92576,CPT4/HCPCS,SYNTHETIC SENTENCE TEST,,,231.88
Deidentified Minimum,,92579,CPT4/HCPCS,VISUAL AUDIOMETRY (VRA),,,375.44
Deidentified Minimum,,92585,CPT4/HCPCS,AUDITOR EVOKE POTENT COMPRE,,,951.44
Deidentified Minimum,,92586,CPT4/HCPCS,AUDITOR EVOKE POTENT LIMIT,,,951.44
Deidentified Minimum,,92587,CPT4/HCPCS,EVOKED AUDITORY TEST LIMITED,,,674.70
Deidentified Minimum,,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,,193.00
Deidentified Minimum,,92621,CPT4/HCPCS,AUDITORY FUNCTION + 15 MIN,,,144.50
Deidentified Minimum,,92625,CPT4/HCPCS,TINNITUS ASSESSMENT,,,563.11
Deidentified Minimum,,92640,CPT4/HCPCS,AUD BRAINSTEM IMPLT PROGRAMG,,,677.65
Deidentified Minimum,,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,,3544.00
Deidentified Minimum,,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,,5831.00
Deidentified Minimum,,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,,3544.00
Deidentified Minimum,,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,,3544.00
Deidentified Minimum,,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,,1291.00
Deidentified Minimum,,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,,5783.00
Deidentified Minimum,,93224,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,,905.93
Deidentified Minimum,,93264,CPT4/HCPCS,REM MNTR WRLS P-ART PRS SNR,,,285.68
Deidentified Minimum,,93270,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,,135.07
Deidentified Minimum,,93283,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,,225.96
Deidentified Minimum,,93286,CPT4/HCPCS,PERI-PX EVAL PM/LDLS PM IP,,,104.74
Deidentified Minimum,,93287,CPT4/HCPCS,PERI-PX DEVICE EVAL & PRGR,,,113.90
Deidentified Minimum,,93288,CPT4/HCPCS,INTERROG EVL PM/LDLS PM IP,,,153.21
Deidentified Minimum,,93294,CPT4/HCPCS,REM INTERROG EVL PM/LDLS PM,,,274.84
Deidentified Minimum,,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,,608.00
Deidentified Minimum,,93306,CPT4/HCPCS,TTE W/DOPPLER COMPLETE,,,608.00
Deidentified Minimum,,93318,CPT4/HCPCS,ECHO TRANSESOPHAGEAL INTRAOP,,,608.00
Deidentified Minimum,,93350,CPT4/HCPCS,STRESS TTE ONLY,,,608.00
Deidentified Minimum,,93451,CPT4/HCPCS,RIGHT HEART CATH,,,2002.00
Deidentified Minimum,,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,,2998.00
Deidentified Minimum,,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,,2998.00
Deidentified Minimum,,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,,2998.00
Deidentified Minimum,,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,,2998.00
Deidentified Minimum,,93463,CPT4/HCPCS,DRUG ADMIN & HEMODYNMIC MEAS,,,1145.00
Deidentified Minimum,,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,,2002.00
Deidentified Minimum,,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,,2998.00
Deidentified Minimum,,93561,CPT4/HCPCS,CARDIAC OUTPUT MEASUREMENT,,,1145.00
Deidentified Minimum,,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,,1145.00
Deidentified Minimum,,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,,1145.00
Deidentified Minimum,,93572,CPT4/HCPCS,HEART FLOW RESERVE MEASURE,,,1145.00
Deidentified Minimum,,93583,CPT4/HCPCS,PERQ TRANSCATH SEPTAL REDUXN,,,1291.00
Deidentified Minimum,,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,1678.88
Deidentified Minimum,,93701,CPT4/HCPCS,BIOIMPEDANCE CV ANALYSIS,,,461.13
Deidentified Minimum,,93724,CPT4/HCPCS,ANALYZE PACEMAKER SYSTEM,,,2011.84
Deidentified Minimum,,93745,CPT4/HCPCS,SET-UP CARDIOVERT-DEFIBRILL,,,1145.00
Deidentified Minimum,,93770,CPT4/HCPCS,MEASURE VENOUS PRESSURE,,,18.46
Deidentified Minimum,,93797,CPT4/HCPCS,CARDIAC REHAB,,,148.38
Deidentified Minimum,,93880,CPT4/HCPCS,EXTRACRANIAL BILAT STUDY,,,1364.91
Deidentified Minimum,,93892,CPT4/HCPCS,TCD EMBOLI DETECT W/O INJ,,,857.30
Deidentified Minimum,,93925,CPT4/HCPCS,LOWER EXTREMITY STUDY,,,1363.74
Deidentified Minimum,,93926,CPT4/HCPCS,LOWER EXTREMITY STUDY,,,859.06
Deidentified Minimum,,93975,CPT4/HCPCS,VASCULAR STUDY,,,1363.74
Deidentified Minimum,,93981,CPT4/HCPCS,PENILE VASCULAR STUDY,,,877.21
Deidentified Minimum,,93998,CPT4/HCPCS,NONINVAS VASC DX STUDY PROC,,,817.57
Deidentified Minimum,,94250,CPT4/HCPCS,EXPIRED GAS COLLECTION,,,302.36
Deidentified Minimum,,94450,CPT4/HCPCS,HYPOXIA RESPONSE CURVE,,,277.51
Deidentified Minimum,,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,,193.00
Deidentified Minimum,,94762,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,,232.81
Deidentified Minimum,,94775,CPT4/HCPCS,PED HOME APNEA REC HK-UP,,,0.00
Deidentified Minimum,,94780,CPT4/HCPCS,CARS/BD TST INFT-12MO 60 MIN,,,98.70
Deidentified Minimum,,95052,CPT4/HCPCS,PHOTO PATCH TEST,,,129.13
Deidentified Minimum,,95075,CPT4/HCPCS,INGESTION CHALLENGE TEST,,,406.66
Deidentified Minimum,,95115,CPT4/HCPCS,IMMUNOTHERAPY ONE INJECTION,,,190.91
Deidentified Minimum,,95145,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,158.00
Deidentified Minimum,,95148,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,283.11
Deidentified Minimum,,95165,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,95.45
Deidentified Minimum,,95170,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,66.59
Deidentified Minimum,,95782,CPT4/HCPCS,POLYSOM <6 YRS 4/> PARAMTRS,,,7714.30
Deidentified Minimum,,0050T,CPT4/HCPCS,REMOVAL CIRCULATION ASSIST,,,5281.00
Deidentified Minimum,,0078T,CPT4/HCPCS,ENDOVASC AORT REPR W/DEVICE,,,8841.00
Deidentified Minimum,,0080T,CPT4/HCPCS,ENDOVASC AORT REPR RAD S&I,,,8841.00
Deidentified Minimum,,0098T,CPT4/HCPCS,REV ARTIFIC DISC ADDL,,,3544.00
Deidentified Minimum,,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,,7830.00
Deidentified Minimum,,0123T,CPT4/HCPCS,SCLERAL FISTULIZATION,,,5783.00
Deidentified Minimum,,0207T,CPT4/HCPCS,CLEAR EYELID GLAND W/HEAT,,,987.78
Deidentified Minimum,,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,,987.78
Deidentified Minimum,,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,,987.78
Deidentified Minimum,,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,,987.78
Deidentified Minimum,,0246T,CPT4/HCPCS,OPN TX RIB FX 3-4 RIBS,,,3544.00
Deidentified Minimum,,0251T,CPT4/HCPCS,REMOV BRONCHIAL VALVE,,,1678.88
Deidentified Minimum,,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,,3198.57
Deidentified Minimum,,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,,3544.00
Deidentified Minimum,,0273T,CPT4/HCPCS,INTERROGATE CRTD SNS W/PGRMG,,,987.78
Deidentified Minimum,,0296T,CPT4/HCPCS,EXT ECG RECORDING,,,987.78
Deidentified Minimum,,0301T,CPT4/HCPCS,MW THERAPY FOR BREAST TUMOR,,,3544.00
Deidentified Minimum,,0322T,CPT4/HCPCS,RMVL SUBQ DEFIB PLS GEN,,,5029.00
Deidentified Minimum,,0323T,CPT4/HCPCS,RMVL & REPLC SUBQ PLS GEN,,,1678.88
Deidentified Minimum,,0332T,CPT4/HCPCS,HEART SYMP IMAGE PLNR SPECT,,,987.78
Deidentified Minimum,,0355T,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,,1291.00
Deidentified Minimum,,0356T,CPT4/HCPCS,INSRT DRUG DEVICE FOR IOP,,,1145.00
Deidentified Minimum,,0388T,CPT4/HCPCS,LEADLESS PM REMOVE VENTR,,,1678.88
Deidentified Minimum,,0392T,CPT4/HCPCS,LAP ES SPH AUGMENT DEV PLACE,,,5029.00
Deidentified Minimum,,0395T,CPT4/HCPCS,HDR ELCTR NTRST/NTRCV BRCHTX,,,12850.70
Deidentified Minimum,,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,,3198.57
Deidentified Minimum,,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,,1678.88
Deidentified Minimum,,0438T,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,,1678.00
Deidentified Minimum,,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,,987.78
Deidentified Minimum,,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,,987.78
Deidentified Minimum,,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,,987.78
Deidentified Minimum,,0466T,CPT4/HCPCS,INSJ CH WAL RESPIR ELTRD/RA,,,1145.00
Deidentified Minimum,,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,,1145.00
Deidentified Minimum,,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,,1291.00
Deidentified Minimum,,0496T,CPT4/HCPCS,MNTR CDVR DON LNG EA ADDL HR,,,1291.00
Deidentified Minimum,,0539T,CPT4/HCPCS,RECEIPT&PREP CAR-T CLL ADMN,,,1678.00
Deidentified Minimum,,0571T,CPT4/HCPCS,INSJ/RPLCMT ICDS SS ELTRD,,,1291.00
Deidentified Minimum,,0573T,CPT4/HCPCS,REMOVAL SS DFB ELECTRODE,,,1291.00
Deidentified Minimum,,0575T,CPT4/HCPCS,PRGRMG DEV EVAL ICDS SS IP,,,1291.00
Deidentified Minimum,,0584T,CPT4/HCPCS,PERQ ISLET CELL TRANSPLANT,,,1291.00
Deidentified Minimum,,0587T,CPT4/HCPCS,PERQ IMPLTJ/RPLCMT ISDNS PTN,,,1235.00
Deidentified Minimum,,10008,CPT4/HCPCS,FNA BX W/FLUOR GDN EA ADDL,,,1145.00
Deidentified Minimum,,10012,CPT4/HCPCS,FNA BX W/MR GDN EA ADDL,,,1145.00
Deidentified Minimum,,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,,400.00
Deidentified Minimum,,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,,400.00
Deidentified Minimum,,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,,1291.00
Deidentified Minimum,,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,,1145.00
Deidentified Minimum,,11056,CPT4/HCPCS,TRIM SKIN LESIONS 2 TO 4,,,400.00
Deidentified Minimum,,11057,CPT4/HCPCS,TRIM SKIN LESIONS OVER 4,,,400.00
Deidentified Minimum,,11103,CPT4/HCPCS,TANGNTL BX SKIN EA SEP/ADDL,,,1145.00
Deidentified Minimum,,11201,CPT4/HCPCS,REMOVE SKIN TAGS ADD-ON,,,987.78
Deidentified Minimum,,11301,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,,987.78
Deidentified Minimum,,11303,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,,987.78
Deidentified Minimum,,11307,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,,987.78
Deidentified Minimum,,11310,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,,987.78
Deidentified Minimum,,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,,1291.00
Deidentified Minimum,,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,,1291.00
Deidentified Minimum,,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,,1235.00
Deidentified Minimum,,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,,1235.00
Deidentified Minimum,,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,1678.88
Deidentified Minimum,,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,,1678.88
Deidentified Minimum,,11755,CPT4/HCPCS,BIOPSY NAIL UNIT,,,1235.00
Deidentified Minimum,,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,,3544.00
Deidentified Minimum,,11954,CPT4/HCPCS,TX CONTOUR DEFECTS >10.0 CC,,,987.78
Deidentified Minimum,,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,,1678.00
Deidentified Minimum,,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,,987.78
Deidentified Minimum,,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,,400.00
Deidentified Minimum,,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,,400.00
Deidentified Minimum,,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,,1291.00
Deidentified Minimum,,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,,1145.00
Deidentified Minimum,,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,,1145.00
Deidentified Minimum,,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,,1145.00
Deidentified Minimum,,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,,1291.00
Deidentified Minimum,,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,,1291.00
Deidentified Minimum,,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,,3000.00
Deidentified Minimum,,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,,1145.00
Deidentified Minimum,,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,,1145.00
Deidentified Minimum,,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,,1291.00
Deidentified Minimum,,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,,1291.00
Deidentified Minimum,,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,,3544.00
Deidentified Minimum,,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,,987.78
Deidentified Minimum,,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,,3544.00
Deidentified Minimum,,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,,1291.00
Deidentified Minimum,,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,,1291.00
Deidentified Minimum,,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,,1678.88
Deidentified Minimum,,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,,3544.00
Deidentified Minimum,,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,,1291.00
Deidentified Minimum,,15775,CPT4/HCPCS,HAIR TRNSPL 1-15 PUNCH GRFTS,,,1145.00
Deidentified Minimum,,15776,CPT4/HCPCS,HAIR TRNSPL >15 PUNCH GRAFTS,,,1145.00
Deidentified Minimum,,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,,3544.00
Deidentified Minimum,,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,,1678.88
Deidentified Minimum,,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,,3544.00
Deidentified Minimum,,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,,1291.00
Deidentified Minimum,,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,,1678.88
Deidentified Minimum,,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,,1291.00
Deidentified Minimum,,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,1291.00
Deidentified Minimum,,17003,CPT4/HCPCS,DESTRUCT PREMALG LES 2-14,,,987.78
Deidentified Minimum,,17004,CPT4/HCPCS,DESTROY PREMAL LESIONS 15/>,,,987.78
Deidentified Minimum,,17311,CPT4/HCPCS,MOHS 1 STAGE H/N/HF/G,,,1145.00
Deidentified Minimum,,17313,CPT4/HCPCS,MOHS 1 STAGE T/A/L,,,1145.00
Deidentified Minimum,,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,,1678.88
Deidentified Minimum,,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,,1145.00
Deidentified Minimum,,19105,CPT4/HCPCS,CRYOSURG ABLATE FA EACH,,,3198.57
Deidentified Minimum,,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,,1235.00
Deidentified Minimum,,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,,1145.00
Deidentified Minimum,,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,,1678.00
Deidentified Minimum,,19304,CPT4/HCPCS,MAST SUBQ,,,5029.00
Deidentified Minimum,,19305,CPT4/HCPCS,MAST RADICAL,,,1291.00
Deidentified Minimum,,19307,CPT4/HCPCS,MAST MOD RAD,,,5281.00
Deidentified Minimum,,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,,1291.00
Deidentified Minimum,,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,,5029.00
Deidentified Minimum,,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,,1291.00
Deidentified Minimum,,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,,1291.00
Deidentified Minimum,,20501,CPT4/HCPCS,INJECT SINUS TRACT FOR X-RAY,,,1145.00
Deidentified Minimum,,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,,1678.88
Deidentified Minimum,,20526,CPT4/HCPCS,THER INJECTION CARP TUNNEL,,,987.78
Deidentified Minimum,,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,,3000.00
Deidentified Minimum,,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,,400.00
Deidentified Minimum,,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,,1291.00
Deidentified Minimum,,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,,3544.00
Deidentified Minimum,,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,,1235.00
Deidentified Minimum,,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,,1291.00
Deidentified Minimum,,20934,CPT4/HCPCS,INTERCALARY ALGRFT COMPL,,,1145.00
Deidentified Minimum,,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,,1678.00
Deidentified Minimum,,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,,1145.00
Deidentified Minimum,,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,,3000.00
Deidentified Minimum,,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,,3000.00
Deidentified Minimum,,20999,CPT4/HCPCS,MUSCULOSKELETAL SURGERY,,,1145.00
Deidentified Minimum,,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,,400.00
Deidentified Minimum,,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,,1235.00
Deidentified Minimum,,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,,1291.00
Deidentified Minimum,,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,,1678.88
Deidentified Minimum,,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,,1678.88
Deidentified Minimum,,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,,1678.88
Deidentified Minimum,,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,,3656.00
Deidentified Minimum,,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,,1678.88
Deidentified Minimum,,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,,3544.00
Deidentified Minimum,,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1678.88
Deidentified Minimum,,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1145.00
Deidentified Minimum,,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,,1678.88
Deidentified Minimum,,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,,3965.00
Deidentified Minimum,,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,,1291.00
Deidentified Minimum,,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,,1291.00
Deidentified Minimum,,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,,5730.00
Deidentified Minimum,,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,,5730.00
Deidentified Minimum,,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,,1291.00
Deidentified Minimum,,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,,5730.00
Deidentified Minimum,,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,,5000.00
Deidentified Minimum,,21280,CPT4/HCPCS,REVISION OF EYELID,,,5000.00
Deidentified Minimum,,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,,1291.00
Deidentified Minimum,,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,,3965.00
Deidentified Minimum,,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,,4000.00
Deidentified Minimum,,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,,3000.00
Deidentified Minimum,,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,,3544.00
Deidentified Minimum,,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,,3198.57
Deidentified Minimum,,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,,3198.57
Deidentified Minimum,,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,,3198.57
Deidentified Minimum,,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,,3000.00
Deidentified Minimum,,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,,1291.00
Deidentified Minimum,,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,,1291.00
Deidentified Minimum,,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,,4000.00
Deidentified Minimum,,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,3544.00
Deidentified Minimum,,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,4000.00
Deidentified Minimum,,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,,1145.00
Deidentified Minimum,,21497,CPT4/HCPCS,INTERDENTAL WIRING,,,1291.00
Deidentified Minimum,,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,,1678.88
Deidentified Minimum,,21601,CPT4/HCPCS,EXC CHEST WALL TUMOR W/RIBS,,,3000.00
Deidentified Minimum,,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,,1678.88
Deidentified Minimum,,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,,3544.00
Deidentified Minimum,,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,,4000.00
Deidentified Minimum,,21800,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,,1678.00
Deidentified Minimum,,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,,3000.00
Deidentified Minimum,,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,,1291.00
Deidentified Minimum,,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,,1291.00
Deidentified Minimum,,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,,1291.00
Deidentified Minimum,,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,,1145.00
Deidentified Minimum,,22526,CPT4/HCPCS,IDET SINGLE LEVEL,,,4847.00
Deidentified Minimum,,22548,CPT4/HCPCS,NECK SPINE FUSION,,,4891.93
Deidentified Minimum,,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,,1291.00
Deidentified Minimum,,22595,CPT4/HCPCS,NECK SPINAL FUSION,,,1291.00
Deidentified Minimum,,22600,CPT4/HCPCS,NECK SPINE FUSION,,,1291.00
Deidentified Minimum,,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,1145.00
Deidentified Minimum,,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,,1291.00
Deidentified Minimum,,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,,1291.00
Deidentified Minimum,,22857,CPT4/HCPCS,LUMBAR ARTIF DISKECTOMY,,,1291.00
Deidentified Minimum,,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,,987.78
Deidentified Minimum,,22868,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,,1145.00
Deidentified Minimum,,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,,1678.88
Deidentified Minimum,,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,,1678.00
Deidentified Minimum,,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,,4000.00
Deidentified Minimum,,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,,4000.00
Deidentified Minimum,,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,,4000.00
Deidentified Minimum,,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,,5000.00
Deidentified Minimum,,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,5000.00
Deidentified Minimum,,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,,3000.00
Deidentified Minimum,,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,,4891.93
Deidentified Minimum,,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,,4000.00
Deidentified Minimum,,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,4000.00
Deidentified Minimum,,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,,1145.00
Deidentified Minimum,,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,,1678.88
Deidentified Minimum,,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,,3544.00
Deidentified Minimum,,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,,1678.88
Deidentified Minimum,,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,,3544.00
Deidentified Minimum,,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,,3544.00
Deidentified Minimum,,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,,4000.00
Deidentified Minimum,,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,,3544.00
Deidentified Minimum,,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,,3544.00
Deidentified Minimum,,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,,5000.00
Deidentified Minimum,,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3544.00
Deidentified Minimum,,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1145.00
Deidentified Minimum,,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,,3544.00
Deidentified Minimum,,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,,4000.00
Deidentified Minimum,,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,,1145.00
Deidentified Minimum,,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,,1291.00
Deidentified Minimum,,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,1678.88
Deidentified Minimum,,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,,3544.00
Deidentified Minimum,,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,,4847.00
Deidentified Minimum,,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,,3544.00
Deidentified Minimum,,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,,3965.00
Deidentified Minimum,,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,,3544.00
Deidentified Minimum,,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,,3544.00
Deidentified Minimum,,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,4000.00
Deidentified Minimum,,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,,4000.00
Deidentified Minimum,,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,,3544.00
Deidentified Minimum,,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,,3544.00
Deidentified Minimum,,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,,3544.00
Deidentified Minimum,,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,,4000.00
Deidentified Minimum,,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,,4000.00
Deidentified Minimum,,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,,4000.00
Deidentified Minimum,,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,,4000.00
Deidentified Minimum,,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,,5000.00
Deidentified Minimum,,25446,CPT4/HCPCS,WRIST REPLACEMENT,,,3000.00
Deidentified Minimum,,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,,5000.00
Deidentified Minimum,,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,,4000.00
Deidentified Minimum,,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,,1145.00
Deidentified Minimum,,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,,3544.00
Deidentified Minimum,,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,,1678.88
Deidentified Minimum,,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,1145.00
Deidentified Minimum,,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,987.78
Deidentified Minimum,,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,1145.00
Deidentified Minimum,,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,1678.88
Deidentified Minimum,,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,,4000.00
Deidentified Minimum,,25820,CPT4/HCPCS,FUSION OF HAND BONES,,,4000.00
Deidentified Minimum,,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,,3544.00
Deidentified Minimum,,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,,1291.00
Deidentified Minimum,,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,,1291.00
Deidentified Minimum,,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,,3544.00
Deidentified Minimum,,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,,1291.00
Deidentified Minimum,,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,,1291.00
Deidentified Minimum,,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,,1291.00
Deidentified Minimum,,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,,987.78
Deidentified Minimum,,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,,4000.00
Deidentified Minimum,,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,,1291.00
Deidentified Minimum,,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,,1291.00
Deidentified Minimum,,26490,CPT4/HCPCS,REVISE THUMB TENDON,,,3544.00
Deidentified Minimum,,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,,1291.00
Deidentified Minimum,,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,,3544.00
Deidentified Minimum,,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,,1291.00
Deidentified Minimum,,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,,4000.00
Deidentified Minimum,,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,,3544.00
Deidentified Minimum,,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,,3544.00
Deidentified Minimum,,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,,4000.00
Deidentified Minimum,,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,,3544.00
Deidentified Minimum,,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,,1678.88
Deidentified Minimum,,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,,1145.00
Deidentified Minimum,,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,,1678.00
Deidentified Minimum,,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,,3000.00
Deidentified Minimum,,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,,1678.88
Deidentified Minimum,,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,,1291.00
Deidentified Minimum,,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,,1291.00
Deidentified Minimum,,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,,1291.00
Deidentified Minimum,,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,,1291.00
Deidentified Minimum,,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,,1291.00
Deidentified Minimum,,27095,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,,1145.00
Deidentified Minimum,,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,,1291.00
Deidentified Minimum,,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,,4891.93
Deidentified Minimum,,27146,CPT4/HCPCS,INCISION OF HIP BONE,,,1291.00
Deidentified Minimum,,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,,1145.00
Deidentified Minimum,,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,,3000.00
Deidentified Minimum,,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,,1291.00
Deidentified Minimum,,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,,1291.00
Deidentified Minimum,,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,,1291.00
Deidentified Minimum,,27299,CPT4/HCPCS,PELVIS/HIP JOINT SURGERY,,,1145.00
Deidentified Minimum,,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,,1678.00
Deidentified Minimum,,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,,1678.88
Deidentified Minimum,,27347,CPT4/HCPCS,REMOVE KNEE CYST,,,3965.00
Deidentified Minimum,,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,,1145.00
Deidentified Minimum,,27369,CPT4/HCPCS,NJX CNTRST KNE ARTHG/CT/MRI,,,1145.00
Deidentified Minimum,,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,,3544.00
Deidentified Minimum,,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,,5730.00
Deidentified Minimum,,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,,4000.00
Deidentified Minimum,,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,,3544.00
Deidentified Minimum,,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,,5000.00
Deidentified Minimum,,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,,3198.57
Deidentified Minimum,,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,,1291.00
Deidentified Minimum,,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,,5281.00
Deidentified Minimum,,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,,3544.00
Deidentified Minimum,,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,3000.00
Deidentified Minimum,,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,3000.00
Deidentified Minimum,,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,,1145.00
Deidentified Minimum,,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,,1291.00
Deidentified Minimum,,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,,3544.00
Deidentified Minimum,,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,,4000.00
Deidentified Minimum,,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,,1678.88
Deidentified Minimum,,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,,3544.00
Deidentified Minimum,,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,,1678.88
Deidentified Minimum,,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,,1678.88
Deidentified Minimum,,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,,4000.00
Deidentified Minimum,,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,,1291.00
Deidentified Minimum,,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,,1678.88
Deidentified Minimum,,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,,3544.00
Deidentified Minimum,,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,,3544.00
Deidentified Minimum,,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,,1291.00
Deidentified Minimum,,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,,1235.00
Deidentified Minimum,,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,,3544.00
Deidentified Minimum,,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,1291.00
Deidentified Minimum,,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,,1291.00
Deidentified Minimum,,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,,1678.88
Deidentified Minimum,,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,,1678.00
Deidentified Minimum,,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,,1291.00
Deidentified Minimum,,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,,1678.88
Deidentified Minimum,,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,,3544.00
Deidentified Minimum,,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,,3544.00
Deidentified Minimum,,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,,3544.00
Deidentified Minimum,,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,,3544.00
Deidentified Minimum,,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,,3544.00
Deidentified Minimum,,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,,1678.00
Deidentified Minimum,,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,,3000.00
Deidentified Minimum,,28293,CPT4/HCPCS,CORRECTION OF BUNION,,,3544.00
Deidentified Minimum,,28294,CPT4/HCPCS,CORRECTION OF BUNION,,,3544.00
Deidentified Minimum,,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,3544.00
Deidentified Minimum,,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,,1678.88
Deidentified Minimum,,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,,1678.88
Deidentified Minimum,,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,,5029.00
Deidentified Minimum,,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,400.00
Deidentified Minimum,,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,,400.00
Deidentified Minimum,,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,,3544.00
Deidentified Minimum,,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,,1678.88
Deidentified Minimum,,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,400.00
Deidentified Minimum,,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,1678.88
Deidentified Minimum,,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,400.00
Deidentified Minimum,,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,,400.00
Deidentified Minimum,,28820,CPT4/HCPCS,AMPUTATION OF TOE,,,1678.88
Deidentified Minimum,,28899,CPT4/HCPCS,FOOT/TOES SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,,987.78
Deidentified Minimum,,29025,CPT4/HCPCS,APPLICATION OF BODY CAST,,,3544.00
Deidentified Minimum,,29085,CPT4/HCPCS,APPLY HAND/WRIST CAST,,,987.78
Deidentified Minimum,,29126,CPT4/HCPCS,APPLY FOREARM SPLINT,,,987.78
Deidentified Minimum,,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,,193.00
Deidentified Minimum,,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,,400.00
Deidentified Minimum,,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,,193.00
Deidentified Minimum,,29505,CPT4/HCPCS,APPLICATION LONG LEG SPLINT,,,987.78
Deidentified Minimum,,29730,CPT4/HCPCS,WINDOWING OF CAST,,,987.78
Deidentified Minimum,,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,,3544.00
Deidentified Minimum,,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,,3544.00
Deidentified Minimum,,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,,3544.00
Deidentified Minimum,,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,,3000.00
Deidentified Minimum,,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,,3544.00
Deidentified Minimum,,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,,6049.05
Deidentified Minimum,,30020,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,,400.00
Deidentified Minimum,,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,,3544.00
Deidentified Minimum,,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,,1678.88
Deidentified Minimum,,30160,CPT4/HCPCS,REMOVAL OF NOSE,,,4000.00
Deidentified Minimum,,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,,3965.00
Deidentified Minimum,,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,,5000.00
Deidentified Minimum,,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,,4000.00
Deidentified Minimum,,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,,3544.00
Deidentified Minimum,,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,,3544.00
Deidentified Minimum,,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,,6049.05
Deidentified Minimum,,29999,CPT4/HCPCS,ARTHROSCOPY OF JOINT,,,1145.00
Deidentified Minimum,,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,,1678.88
Deidentified Minimum,,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,,3544.00
Deidentified Minimum,,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,,5000.00
Deidentified Minimum,,30462,CPT4/HCPCS,REVISION OF NOSE,,,5281.00
Deidentified Minimum,,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,,3544.00
Deidentified Minimum,,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,,1145.00
Deidentified Minimum,,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,,400.00
Deidentified Minimum,,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,,1678.88
Deidentified Minimum,,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,,4000.00
Deidentified Minimum,,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,,3965.00
Deidentified Minimum,,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,4000.00
Deidentified Minimum,,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,4000.00
Deidentified Minimum,,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,4000.00
Deidentified Minimum,,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,1291.00
Deidentified Minimum,,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,,1678.00
Deidentified Minimum,,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,,3544.00
Deidentified Minimum,,31299,CPT4/HCPCS,SINUS SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,1291.00
Deidentified Minimum,,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,,1291.00
Deidentified Minimum,,31505,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,,1145.00
Deidentified Minimum,,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,,1145.00
Deidentified Minimum,,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,,3965.00
Deidentified Minimum,,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,,3000.00
Deidentified Minimum,,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,,1291.00
Deidentified Minimum,,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,,1145.00
Deidentified Minimum,,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,,5000.00
Deidentified Minimum,,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,,1145.00
Deidentified Minimum,,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,,1678.88
Deidentified Minimum,,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,,1678.00
Deidentified Minimum,,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,,1678.88
Deidentified Minimum,,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,,1291.00
Deidentified Minimum,,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,,1291.00
Deidentified Minimum,,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,,3965.00
Deidentified Minimum,,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,,1291.00
Deidentified Minimum,,32201,CPT4/HCPCS,DRAIN PERCUT LUNG LESION,,,1678.00
Deidentified Minimum,,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,,1291.00
Deidentified Minimum,,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,,3000.00
Deidentified Minimum,,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,,3000.00
Deidentified Minimum,,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,,3198.57
Deidentified Minimum,,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,,1291.00
Deidentified Minimum,,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,,1291.00
Deidentified Minimum,,33010,CPT4/HCPCS,DRAINAGE OF HEART SAC,,,1678.00
Deidentified Minimum,,33020,CPT4/HCPCS,INCISION OF HEART SAC,,,1291.00
Deidentified Minimum,,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,,1291.00
Deidentified Minimum,,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,,3000.00
Deidentified Minimum,,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,,1678.88
Deidentified Minimum,,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,,3000.00
Deidentified Minimum,,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,,3198.57
Deidentified Minimum,,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,,3000.00
Deidentified Minimum,,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,,1678.88
Deidentified Minimum,,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,,1678.88
Deidentified Minimum,,33286,CPT4/HCPCS,RMVL SUBQ CAR RHYTHM MNTR,,,1235.00
Deidentified Minimum,,33332,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,,6588.00
Deidentified Minimum,,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,,1291.00
Deidentified Minimum,,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,,1291.00
Deidentified Minimum,,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,,1291.00
Deidentified Minimum,,33406,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,,1291.00
Deidentified Minimum,,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,,987.78
Deidentified Minimum,,33440,CPT4/HCPCS,RPLCMT A-VALVE TLCJ AUTOL PV,,,1291.00
Deidentified Minimum,,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,1291.00
Deidentified Minimum,,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,,1291.00
Deidentified Minimum,,33507,CPT4/HCPCS,REPAIR ART INTRAMURAL,,,1291.00
Deidentified Minimum,,33508,CPT4/HCPCS,ENDOSCOPIC VEIN HARVEST,,,1145.00
Deidentified Minimum,,33510,CPT4/HCPCS,CABG VEIN SINGLE,,,1291.00
Deidentified Minimum,,33542,CPT4/HCPCS,REMOVAL OF HEART LESION,,,1291.00
Deidentified Minimum,,33615,CPT4/HCPCS,REPAIR MODIFIED FONTAN,,,1291.00
Deidentified Minimum,,33617,CPT4/HCPCS,REPAIR SINGLE VENTRICLE,,,1291.00
Deidentified Minimum,,33647,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECTS,,,1291.00
Deidentified Minimum,,33676,CPT4/HCPCS,CLOSE MULT VSD W/RESECTION,,,1291.00
Deidentified Minimum,,33702,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,1291.00
Deidentified Minimum,,33710,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,1291.00
Deidentified Minimum,,33770,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1291.00
Deidentified Minimum,,33781,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1291.00
Deidentified Minimum,,33788,CPT4/HCPCS,REVISION OF PULMONARY ARTERY,,,1291.00
Deidentified Minimum,,33859,CPT4/HCPCS,AS-AORT GRF F/DS OTH/THN DSJ,,,1291.00
Deidentified Minimum,,33860,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,,8841.00
Deidentified Minimum,,33864,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,,1291.00
Deidentified Minimum,,33875,CPT4/HCPCS,THORACIC AORTIC GRAFT,,,1291.00
Deidentified Minimum,,33877,CPT4/HCPCS,THORACOABDOMINAL GRAFT,,,1291.00
Deidentified Minimum,,33881,CPT4/HCPCS,ENDOVASC TAA REPR W/O SUBCL,,,1291.00
Deidentified Minimum,,33883,CPT4/HCPCS,INSERT ENDOVASC PROSTH TAA,,,1291.00
Deidentified Minimum,,33925,CPT4/HCPCS,RPR PUL ART UNIFOCAL W/O CPB,,,1291.00
Deidentified Minimum,,33926,CPT4/HCPCS,REPR PUL ART UNIFOCAL W/CPB,,,1291.00
Deidentified Minimum,,33930,CPT4/HCPCS,REMOVAL OF DONOR HEART/LUNG,,,1291.00
Deidentified Minimum,,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,,987.78
Deidentified Minimum,,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,987.78
Deidentified Minimum,,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,987.78
Deidentified Minimum,,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,,987.78
Deidentified Minimum,,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,,987.78
Deidentified Minimum,,33971,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,,1291.00
Deidentified Minimum,,33979,CPT4/HCPCS,INSERT INTRACORPOREAL DEVICE,,,1291.00
Deidentified Minimum,,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,,987.78
Deidentified Minimum,,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,,1291.00
Deidentified Minimum,,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,,5029.00
Deidentified Minimum,,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,,3544.00
Deidentified Minimum,,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,,5029.00
Deidentified Minimum,,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,,1291.00
Deidentified Minimum,,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,,1291.00
Deidentified Minimum,,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,,1291.00
Deidentified Minimum,,34812,CPT4/HCPCS,OPN FEM ART EXPOS,,,1291.00
Deidentified Minimum,,34813,CPT4/HCPCS,FEMORAL ENDOVAS GRAFT ADD-ON,,,1291.00
Deidentified Minimum,,34825,CPT4/HCPCS,ENDOVASC EXTEND PROSTH INIT,,,3544.00
Deidentified Minimum,,34832,CPT4/HCPCS,OPEN AORTOFEMOR PROSTH REPR,,,1291.00
Deidentified Minimum,,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,,987.78
Deidentified Minimum,,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,,1291.00
Deidentified Minimum,,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,,1291.00
Deidentified Minimum,,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1235.00
Deidentified Minimum,,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,4847.00
Deidentified Minimum,,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,3000.00
Deidentified Minimum,,35303,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35371,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35472,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,5029.00
Deidentified Minimum,,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,,1291.00
Deidentified Minimum,,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,,1291.00
Deidentified Minimum,,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,,1291.00
Deidentified Minimum,,35539,CPT4/HCPCS,ART BYP GRFT AORTOFEMORAL,,,1291.00
Deidentified Minimum,,35570,CPT4/HCPCS,ART BYP TIBIAL-TIB/PERONEAL,,,1291.00
Deidentified Minimum,,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,,1291.00
Deidentified Minimum,,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,,1291.00
Deidentified Minimum,,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,,1291.00
Deidentified Minimum,,35632,CPT4/HCPCS,ART BYP ILIO-CELIAC,,,1291.00
Deidentified Minimum,,35633,CPT4/HCPCS,ART BYP ILIO-MESENTERIC,,,1291.00
Deidentified Minimum,,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,,1145.00
Deidentified Minimum,,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,,1145.00
Deidentified Minimum,,35702,CPT4/HCPCS,EXPL N/FLWD SURG UXTR ART,,,1291.00
Deidentified Minimum,,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,,1678.88
Deidentified Minimum,,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,,5281.00
Deidentified Minimum,,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,,5029.00
Deidentified Minimum,,35883,CPT4/HCPCS,REVISE GRAFT W/NONAUTO GRAFT,,,5029.00
Deidentified Minimum,,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,,1291.00
Deidentified Minimum,,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,,1235.00
Deidentified Minimum,,36100,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,,1145.00
Deidentified Minimum,,36140,CPT4/HCPCS,INTRO NDL ICATH UPR/LXTR ART,,,1145.00
Deidentified Minimum,,36218,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,1145.00
Deidentified Minimum,,36245,CPT4/HCPCS,INS CATH ABD/L-EXT ART 1ST,,,1145.00
Deidentified Minimum,,36248,CPT4/HCPCS,INS CATH ABD/L-EXT ART ADDL,,,1145.00
Deidentified Minimum,,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,,1678.00
Deidentified Minimum,,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,,1145.00
Deidentified Minimum,,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,,1145.00
Deidentified Minimum,,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,,1291.00
Deidentified Minimum,,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,,3544.00
Deidentified Minimum,,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,,1145.00
Deidentified Minimum,,36500,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,,1145.00
Deidentified Minimum,,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,3544.00
Deidentified Minimum,,36572,CPT4/HCPCS,INSJ PICC RS&I <5 YR,,,1235.00
Deidentified Minimum,,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,,400.00
Deidentified Minimum,,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,,1235.00
Deidentified Minimum,,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,,1235.00
Deidentified Minimum,,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,,1291.00
Deidentified Minimum,,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,,4000.00
Deidentified Minimum,,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,,3544.00
Deidentified Minimum,,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,,4000.00
Deidentified Minimum,,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,,4000.00
Deidentified Minimum,,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,,3000.00
Deidentified Minimum,,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,,1291.00
Deidentified Minimum,,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,,1291.00
Deidentified Minimum,,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,,3544.00
Deidentified Minimum,,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,,3000.00
Deidentified Minimum,,37205,CPT4/HCPCS,TRANSCATH IV STENT PERCUT,,,5029.00
Deidentified Minimum,,37215,CPT4/HCPCS,TRANSCATH STENT CCA W/EPS,,,1291.00
Deidentified Minimum,,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,,987.78
Deidentified Minimum,,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,,3000.00
Deidentified Minimum,,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,,3000.00
Deidentified Minimum,,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,,1678.88
Deidentified Minimum,,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,,987.78
Deidentified Minimum,,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,,3000.00
Deidentified Minimum,,37253,CPT4/HCPCS,INTRVASC US NONCORONARY ADDL,,,1145.00
Deidentified Minimum,,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,,1235.00
Deidentified Minimum,,37700,CPT4/HCPCS,REVISE LEG VEIN,,,3000.00
Deidentified Minimum,,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,,3544.00
Deidentified Minimum,,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,,1235.00
Deidentified Minimum,,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,,1291.00
Deidentified Minimum,,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,,1145.00
Deidentified Minimum,,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,,1145.00
Deidentified Minimum,,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,,987.78
Deidentified Minimum,,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,,1291.00
Deidentified Minimum,,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,,1678.88
Deidentified Minimum,,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,,1678.88
Deidentified Minimum,,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,,1678.88
Deidentified Minimum,,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,,3544.00
Deidentified Minimum,,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,,5029.00
Deidentified Minimum,,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,,1678.88
Deidentified Minimum,,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,,1291.00
Deidentified Minimum,,38790,CPT4/HCPCS,INJECT FOR LYMPHATIC X-RAY,,,1145.00
Deidentified Minimum,,38900,CPT4/HCPCS,IO MAP OF SENT LYMPH NODE,,,1145.00
Deidentified Minimum,,39400,CPT4/HCPCS,MEDIASTINOSCOPY INCL BIOPSY,,,3544.00
Deidentified Minimum,,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,,1291.00
Deidentified Minimum,,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,,1291.00
Deidentified Minimum,,40650,CPT4/HCPCS,REPAIR LIP,,,1145.00
Deidentified Minimum,,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,,5029.00
Deidentified Minimum,,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,,400.00
Deidentified Minimum,,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,,1291.00
Deidentified Minimum,,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1145.00
Deidentified Minimum,,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1291.00
Deidentified Minimum,,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,,1291.00
Deidentified Minimum,,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,,1291.00
Deidentified Minimum,,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,,1291.00
Deidentified Minimum,,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,,1678.88
Deidentified Minimum,,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,,1145.00
Deidentified Minimum,,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,,1678.00
Deidentified Minimum,,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,,1291.00
Deidentified Minimum,,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,,1291.00
Deidentified Minimum,,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,,1145.00
Deidentified Minimum,,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,,3965.00
Deidentified Minimum,,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,,1291.00
Deidentified Minimum,,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,5000.00
Deidentified Minimum,,42235,CPT4/HCPCS,REPAIR PALATE,,,5000.00
Deidentified Minimum,,42299,CPT4/HCPCS,PALATE/UVULA SURGERY,,,1145.00
Deidentified Minimum,,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,,1678.88
Deidentified Minimum,,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,,5730.00
Deidentified Minimum,,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,,1678.00
Deidentified Minimum,,42802,CPT4/HCPCS,BIOPSY OF THROAT,,,1678.00
Deidentified Minimum,,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,,1291.00
Deidentified Minimum,,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,,1678.88
Deidentified Minimum,,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,,3965.00
Deidentified Minimum,,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,,3544.00
Deidentified Minimum,,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,,5281.00
Deidentified Minimum,,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,,3544.00
Deidentified Minimum,,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,,3544.00
Deidentified Minimum,,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,,1291.00
Deidentified Minimum,,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,,1291.00
Deidentified Minimum,,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,,4280.43
Deidentified Minimum,,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,,1291.00
Deidentified Minimum,,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,,1291.00
Deidentified Minimum,,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,,3198.57
Deidentified Minimum,,43219,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY,,,1678.00
Deidentified Minimum,,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,,1291.00
Deidentified Minimum,,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,,1291.00
Deidentified Minimum,,43258,CPT4/HCPCS,OPERATIVE UPPER GI ENDOSCOPY,,,1678.88
Deidentified Minimum,,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Minimum,,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,,1678.88
Deidentified Minimum,,43269,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Minimum,,43271,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Minimum,,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,,1678.88
Deidentified Minimum,,43279,CPT4/HCPCS,LAP MYOTOMY HELLER,,,5783.00
Deidentified Minimum,,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,,1678.88
Deidentified Minimum,,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,,1291.00
Deidentified Minimum,,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,,1291.00
Deidentified Minimum,,43401,CPT4/HCPCS,ESOPHAGUS SURGERY FOR VEINS,,,3198.57
Deidentified Minimum,,43496,CPT4/HCPCS,FREE JEJUNUM FLAP MICROVASC,,,1291.00
Deidentified Minimum,,43499,CPT4/HCPCS,ESOPHAGUS SURGERY PROCEDURE,,,1291.00
Deidentified Minimum,,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,,1291.00
Deidentified Minimum,,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,,1291.00
Deidentified Minimum,,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,,1291.00
Deidentified Minimum,,43645,CPT4/HCPCS,LAP GASTR BYPASS INCL SMLL I,,,5783.00
Deidentified Minimum,,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,,1678.88
Deidentified Minimum,,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,,5029.00
Deidentified Minimum,,43659,CPT4/HCPCS,LAPAROSCOPE PROC STOM,,,3000.00
Deidentified Minimum,,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,,400.00
Deidentified Minimum,,43760,CPT4/HCPCS,CHANGE GASTROSTOMY TUBE,,,1678.00
Deidentified Minimum,,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,,3000.00
Deidentified Minimum,,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,,3198.57
Deidentified Minimum,,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,,1291.00
Deidentified Minimum,,43845,CPT4/HCPCS,GASTROPLASTY DUODENAL SWITCH,,,1291.00
Deidentified Minimum,,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,,1291.00
Deidentified Minimum,,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,,1291.00
Deidentified Minimum,,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,,1291.00
Deidentified Minimum,,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,,1291.00
Deidentified Minimum,,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,,1291.00
Deidentified Minimum,,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,,1291.00
Deidentified Minimum,,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,,1291.00
Deidentified Minimum,,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,,1291.00
Deidentified Minimum,,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,,1291.00
Deidentified Minimum,,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,1291.00
Deidentified Minimum,,44150,CPT4/HCPCS,REMOVAL OF COLON,,,1291.00
Deidentified Minimum,,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,,1291.00
Deidentified Minimum,,44188,CPT4/HCPCS,LAP COLOSTOMY,,,1291.00
Deidentified Minimum,,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,,1291.00
Deidentified Minimum,,44238,CPT4/HCPCS,LAPAROSCOPE PROC INTESTINE,,,5730.00
Deidentified Minimum,,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,,1678.00
Deidentified Minimum,,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,,3000.00
Deidentified Minimum,,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,,1291.00
Deidentified Minimum,,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,,1678.88
Deidentified Minimum,,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,,1678.88
Deidentified Minimum,,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,,1291.00
Deidentified Minimum,,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,,1291.00
Deidentified Minimum,,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,,1291.00
Deidentified Minimum,,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,,1291.00
Deidentified Minimum,,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,,1291.00
Deidentified Minimum,,44720,CPT4/HCPCS,PREP DONOR INTESTINE/VENOUS,,,1291.00
Deidentified Minimum,,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,,1291.00
Deidentified Minimum,,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,,1291.00
Deidentified Minimum,,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,,1291.00
Deidentified Minimum,,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,,1291.00
Deidentified Minimum,,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,,1291.00
Deidentified Minimum,,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,,1291.00
Deidentified Minimum,,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,,1291.00
Deidentified Minimum,,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,,1678.00
Deidentified Minimum,,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,,1291.00
Deidentified Minimum,,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,,1235.00
Deidentified Minimum,,45345,CPT4/HCPCS,SIGMOIDOSCOPY W/STENT,,,1678.00
Deidentified Minimum,,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,,1291.00
Deidentified Minimum,,45399,CPT4/HCPCS,UNLISTED PROCEDURE COLON,,,1291.00
Deidentified Minimum,,45505,CPT4/HCPCS,REPAIR OF RECTUM,,,1678.88
Deidentified Minimum,,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,,1291.00
Deidentified Minimum,,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,,1678.88
Deidentified Minimum,,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,,1291.00
Deidentified Minimum,,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,,1291.00
Deidentified Minimum,,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,,1678.88
Deidentified Minimum,,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,,1145.00
Deidentified Minimum,,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,,1678.88
Deidentified Minimum,,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,,3544.00
Deidentified Minimum,,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,,1291.00
Deidentified Minimum,,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,,1678.00
Deidentified Minimum,,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,,3544.00
Deidentified Minimum,,46710,CPT4/HCPCS,REPR PER/VAG POUCH SNGL PROC,,,1291.00
Deidentified Minimum,,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,,1291.00
Deidentified Minimum,,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,,1291.00
Deidentified Minimum,,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,,1678.88
Deidentified Minimum,,46762,CPT4/HCPCS,IMPLANT ARTIFICIAL SPHINCTER,,,3544.00
Deidentified Minimum,,46948,CPT4/HCPCS,INT HRHC TRANAL DARTLZJ 2+,,,1678.88
Deidentified Minimum,,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,,1291.00
Deidentified Minimum,,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,,1291.00
Deidentified Minimum,,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,,1291.00
Deidentified Minimum,,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,,1291.00
Deidentified Minimum,,47146,CPT4/HCPCS,PREP DONOR LIVER/VENOUS,,,1291.00
Deidentified Minimum,,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,,1291.00
Deidentified Minimum,,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,,1291.00
Deidentified Minimum,,47511,CPT4/HCPCS,INSERT BILE DUCT DRAIN,,,1678.88
Deidentified Minimum,,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,,1678.00
Deidentified Minimum,,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,,1678.00
Deidentified Minimum,,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,,3544.00
Deidentified Minimum,,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,,3544.00
Deidentified Minimum,,47561,CPT4/HCPCS,LAPARO W/CHOLANGIO/BIOPSY,,,3544.00
Deidentified Minimum,,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,,6612.00
Deidentified Minimum,,47630,CPT4/HCPCS,REMOVE BILE DUCT STONE,,,3544.00
Deidentified Minimum,,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,,1291.00
Deidentified Minimum,,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,,1291.00
Deidentified Minimum,,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,,1291.00
Deidentified Minimum,,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,,1291.00
Deidentified Minimum,,48548,CPT4/HCPCS,FUSE PANCREAS AND BOWEL,,,1291.00
Deidentified Minimum,,49014,CPT4/HCPCS,REEXPLORATION PELVIC WOUND,,,1291.00
Deidentified Minimum,,49082,CPT4/HCPCS,ABD PARACENTESIS,,,987.78
Deidentified Minimum,,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,,1291.00
Deidentified Minimum,,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,,1678.00
Deidentified Minimum,,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,,1678.00
Deidentified Minimum,,49411,CPT4/HCPCS,INS MARK ABD/PEL FOR RT PERQ,,,987.78
Deidentified Minimum,,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,,1291.00
Deidentified Minimum,,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,,3000.00
Deidentified Minimum,,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,,4000.00
Deidentified Minimum,,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,,4000.00
Deidentified Minimum,,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,,1145.00
Deidentified Minimum,,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,,1291.00
Deidentified Minimum,,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,,5029.00
Deidentified Minimum,,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,,5029.00
Deidentified Minimum,,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,,3000.00
Deidentified Minimum,,50070,CPT4/HCPCS,INCISION OF KIDNEY,,,1291.00
Deidentified Minimum,,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,,1291.00
Deidentified Minimum,,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,,1291.00
Deidentified Minimum,,50220,CPT4/HCPCS,REMOVE KIDNEY OPEN,,,1291.00
Deidentified Minimum,,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,,1291.00
Deidentified Minimum,,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,,1291.00
Deidentified Minimum,,50323,CPT4/HCPCS,PREP CADAVER RENAL ALLOGRAFT,,,1291.00
Deidentified Minimum,,50327,CPT4/HCPCS,PREP RENAL GRAFT/VENOUS,,,1291.00
Deidentified Minimum,,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,,1291.00
Deidentified Minimum,,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,,1291.00
Deidentified Minimum,,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,,1235.00
Deidentified Minimum,,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,,1291.00
Deidentified Minimum,,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,,1235.00
Deidentified Minimum,,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,,1678.00
Deidentified Minimum,,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,,1235.00
Deidentified Minimum,,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,,1235.00
Deidentified Minimum,,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,,1291.00
Deidentified Minimum,,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,,1291.00
Deidentified Minimum,,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,,1291.00
Deidentified Minimum,,80416,CPT4/HCPCS,RENIN STIMULATION PANEL,,,96.00
Deidentified Minimum,,80417,CPT4/HCPCS,RENIN STIMULATION PANEL,,,96.00
Deidentified Minimum,,80418,CPT4/HCPCS,PITUITARY EVALUATION PANEL,,,96.00
Deidentified Minimum,,80422,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,,96.00
Deidentified Minimum,,80432,CPT4/HCPCS,INSULIN SUPPRESSION PANEL,,,96.00
Deidentified Minimum,,80439,CPT4/HCPCS,TRH STIMULATION PANEL,,,96.00
Deidentified Minimum,,80502,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,,96.00
Deidentified Minimum,,81003,CPT4/HCPCS,URINALYSIS AUTO W/O SCOPE,,,22.59
Deidentified Minimum,,81025,CPT4/HCPCS,URINE PREGNANCY TEST,,,23.60
Deidentified Minimum,,81108,CPT4/HCPCS,HPA-4 GENOTYPING,,,150.00
Deidentified Minimum,,81173,CPT4/HCPCS,AR GENE FULL GENE SEQUENCE,,,150.00
Deidentified Minimum,,81174,CPT4/HCPCS,AR GENE KNOWN FAMIL VARIANT,,,150.00
Deidentified Minimum,,81176,CPT4/HCPCS,ASXL1 GENE TARGET SEQ ALYS,,,150.00
Deidentified Minimum,,81178,CPT4/HCPCS,ATXN1 GENE DETC ABNOR ALLELE,,,150.00
Deidentified Minimum,,81187,CPT4/HCPCS,CNBP GENE DETC ABNOR ALLELE,,,150.00
Deidentified Minimum,,81188,CPT4/HCPCS,CSTB GENE DETC ABNOR ALLELE,,,150.00
Deidentified Minimum,,81189,CPT4/HCPCS,CSTB GENE FULL GENE SEQUENCE,,,150.00
Deidentified Minimum,,81209,CPT4/HCPCS,BLM GENE,,,150.00
Deidentified Minimum,,81218,CPT4/HCPCS,CEBPA GENE FULL SEQUENCE,,,150.00
Deidentified Minimum,,81230,CPT4/HCPCS,CYP3A4 GENE COMMON VARIANTS,,,150.00
Deidentified Minimum,,81237,CPT4/HCPCS,EZH2 GENE COMMON VARIANTS,,,150.00
Deidentified Minimum,,81247,CPT4/HCPCS,G6PD GENE ALYS CMN VARIANT,,,150.00
Deidentified Minimum,,81253,CPT4/HCPCS,GJB2 GENE KNOWN FAM VARIANTS,,,150.00
Deidentified Minimum,,81254,CPT4/HCPCS,GJB6 GENE COM VARIANTS,,,145.48
Deidentified Minimum,,81271,CPT4/HCPCS,HTT GENE DETC ABNOR ALLELES,,,150.00
Deidentified Minimum,,81276,CPT4/HCPCS,KRAS GENE ADDL VARIANTS,,,150.00
Deidentified Minimum,,81283,CPT4/HCPCS,IFNL3 GENE,,,150.00
Deidentified Minimum,,81284,CPT4/HCPCS,FXN GENE DETC ABNOR ALLELES,,,150.00
Deidentified Minimum,,81286,CPT4/HCPCS,FXN GENE FULL GENE SEQUENCE,,,150.00
Deidentified Minimum,,81287,CPT4/HCPCS,MGMT GENE PRMTR MTHYLTN ALYS,,,150.00
Deidentified Minimum,,81290,CPT4/HCPCS,MCOLN1 GENE,,,150.00
Deidentified Minimum,,81303,CPT4/HCPCS,MECP2 GENE KNOWN VARIANT,,,150.00
Deidentified Minimum,,81304,CPT4/HCPCS,MECP2 GENE DUP/DELET VARIANT,,,150.00
Deidentified Minimum,,81312,CPT4/HCPCS,PABPN1 GENE DETC ABNOR ALLEL,,,150.00
Deidentified Minimum,,81316,CPT4/HCPCS,PML/RARALPHA 1 BREAKPOINT,,,150.00
Deidentified Minimum,,81325,CPT4/HCPCS,PMP22 GENE FULL SEQUENCE,,,150.00
Deidentified Minimum,,81328,CPT4/HCPCS,SLCO1B1 GENE COM VARIANTS,,,150.00
Deidentified Minimum,,81333,CPT4/HCPCS,TGFBI GENE COMMON VARIANTS,,,150.00
Deidentified Minimum,,81342,CPT4/HCPCS,TRG GENE REARRANGEMENT ANAL,,,150.00
Deidentified Minimum,,81364,CPT4/HCPCS,HBB FULL GENE SEQUENCE,,,150.00
Deidentified Minimum,,81370,CPT4/HCPCS,HLA I & II TYPING LR,,,150.00
Deidentified Minimum,,81371,CPT4/HCPCS,HLA I & II TYPE VERIFY LR,,,150.00
Deidentified Minimum,,81376,CPT4/HCPCS,HLA II TYPING 1 LOCUS LR,,,150.00
Deidentified Minimum,,81378,CPT4/HCPCS,HLA I & II TYPING HR,,,150.00
Deidentified Minimum,,81379,CPT4/HCPCS,HLA I TYPING COMPLETE HR,,,150.00
Deidentified Minimum,,81381,CPT4/HCPCS,HLA I TYPING 1 ALLELE HR,,,150.00
Deidentified Minimum,,81383,CPT4/HCPCS,HLA II TYPING 1 ALLELE HR,,,150.00
Deidentified Minimum,,81404,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 5,,,150.00
Deidentified Minimum,,81412,CPT4/HCPCS,ASHKENAZI JEWISH ASSOC DIS,,,96.00
Deidentified Minimum,,81417,CPT4/HCPCS,EXOME RE-EVALUATION,,,96.00
Deidentified Minimum,,81431,CPT4/HCPCS,HEARING LOSS DUP/DEL ANALYS,,,96.00
Deidentified Minimum,,81436,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,,96.00
Deidentified Minimum,,81443,CPT4/HCPCS,GENETIC TSTG SEVERE INH COND,,,96.00
Deidentified Minimum,,81445,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,,96.00
Deidentified Minimum,,81450,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,,96.00
Deidentified Minimum,,81465,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,,96.00
Deidentified Minimum,,81520,CPT4/HCPCS,ONC BREAST MRNA 58 GENES,,,96.00
Deidentified Minimum,,81525,CPT4/HCPCS,ONCOLOGY COLON MRNA,,,96.00
Deidentified Minimum,,81536,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,,96.00
Deidentified Minimum,,81539,CPT4/HCPCS,ONCOLOGY PROSTATE PROB SCORE,,,96.00
Deidentified Minimum,,82010,CPT4/HCPCS,ACETONE ASSAY,,,82.15
Deidentified Minimum,,82085,CPT4/HCPCS,ASSAY OF ALDOLASE,,,96.00
Deidentified Minimum,,82107,CPT4/HCPCS,ALPHA-FETOPROTEIN L3,,,96.00
Deidentified Minimum,,82160,CPT4/HCPCS,ASSAY OF ANDROSTERONE,,,96.00
Deidentified Minimum,,82164,CPT4/HCPCS,ANGIOTENSIN I ENZYME TEST,,,96.00
Deidentified Minimum,,82175,CPT4/HCPCS,ASSAY OF ARSENIC,,,96.00
Deidentified Minimum,,82180,CPT4/HCPCS,ASSAY OF ASCORBIC ACID,,,96.00
Deidentified Minimum,,82252,CPT4/HCPCS,FECAL BILIRUBIN TEST,,,45.69
Deidentified Minimum,,82270,CPT4/HCPCS,OCCULT BLOOD FECES,,,32.67
Deidentified Minimum,,82331,CPT4/HCPCS,CALCIUM INFUSION TEST,,,51.99
Deidentified Minimum,,82375,CPT4/HCPCS,ASSAY CARBOXYHB QUANT,,,96.00
Deidentified Minimum,,82480,CPT4/HCPCS,ASSAY SERUM CHOLINESTERASE,,,79.21
Deidentified Minimum,,82552,CPT4/HCPCS,ASSAY OF CPK IN BLOOD,,,96.00
Deidentified Minimum,,82600,CPT4/HCPCS,ASSAY OF CYANIDE,,,96.00
Deidentified Minimum,,82615,CPT4/HCPCS,TEST FOR URINE CYSTINES,,,81.98
Deidentified Minimum,,82626,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,,96.00
Deidentified Minimum,,82638,CPT4/HCPCS,ASSAY OF DIBUCAINE NUMBER,,,96.00
Deidentified Minimum,,82656,CPT4/HCPCS,PANCREATIC ELASTASE FECAL,,,93.32
Deidentified Minimum,,82658,CPT4/HCPCS,ENZYME CELL ACTIVITY RA,,,96.00
Deidentified Minimum,,82670,CPT4/HCPCS,ASSAY OF TOTAL ESTRADIOL,,,96.00
Deidentified Minimum,,82672,CPT4/HCPCS,ASSAY OF ESTROGEN,,,96.00
Deidentified Minimum,,82715,CPT4/HCPCS,ASSAY OF FECAL FAT,,,96.00
Deidentified Minimum,,82784,CPT4/HCPCS,ASSAY IGA/IGD/IGG/IGM EACH,,,65.85
Deidentified Minimum,,82810,CPT4/HCPCS,BLOOD GASES O2 SAT ONLY,,,87.69
Deidentified Minimum,,82948,CPT4/HCPCS,REAGENT STRIP/BLOOD GLUCOSE,,,31.75
Deidentified Minimum,,82955,CPT4/HCPCS,ASSAY OF G6PD ENZYME,,,96.00
Deidentified Minimum,,82985,CPT4/HCPCS,ASSAY OF GLYCATED PROTEIN,,,96.00
Deidentified Minimum,,83015,CPT4/HCPCS,HEAVY METAL QUAL ANY ANAL,,,96.00
Deidentified Minimum,,83026,CPT4/HCPCS,HEMOGLOBIN COPPER SULFATE,,,23.68
Deidentified Minimum,,83030,CPT4/HCPCS,FETAL HEMOGLOBIN CHEMICAL,,,83.07
Deidentified Minimum,,83505,CPT4/HCPCS,ASSAY TOTAL HYDROXYPROLINE,,,96.00
Deidentified Minimum,,83630,CPT4/HCPCS,LACTOFERRIN FECAL (QUAL),,,96.00
Deidentified Minimum,,83662,CPT4/HCPCS,FOAM STABILITY FETAL LUNG,,,96.00
Deidentified Minimum,,83690,CPT4/HCPCS,ASSAY OF LIPASE,,,69.21
Deidentified Minimum,,83825,CPT4/HCPCS,ASSAY OF MERCURY,,,96.00
Deidentified Minimum,,83872,CPT4/HCPCS,ASSAY SYNOVIAL FLUID MUCIN,,,57.62
Deidentified Minimum,,83873,CPT4/HCPCS,ASSAY OF CSF PROTEIN,,,96.00
Deidentified Minimum,,83919,CPT4/HCPCS,ORGANIC ACIDS QUAL EACH,,,96.00
Deidentified Minimum,,83937,CPT4/HCPCS,ASSAY OF OSTEOCALCIN,,,96.00
Deidentified Minimum,,83951,CPT4/HCPCS,ONCOPROTEIN DCP,,,96.00
Deidentified Minimum,,84060,CPT4/HCPCS,ASSAY ACID PHOSPHATASE,,,74.17
Deidentified Minimum,,84080,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASES,,,96.00
Deidentified Minimum,,84132,CPT4/HCPCS,ASSAY OF SERUM POTASSIUM,,,46.20
Deidentified Minimum,,84140,CPT4/HCPCS,ASSAY OF PREGNENOLONE,,,96.00
Deidentified Minimum,,84163,CPT4/HCPCS,PAPPA SERUM,,,96.00
Deidentified Minimum,,84202,CPT4/HCPCS,ASSAY RBC PROTOPORPHYRIN,,,96.00
Deidentified Minimum,,84210,CPT4/HCPCS,ASSAY OF PYRUVATE,,,96.00
Deidentified Minimum,,84255,CPT4/HCPCS,ASSAY OF SELENIUM,,,96.00
Deidentified Minimum,,84302,CPT4/HCPCS,ASSAY OF SWEAT SODIUM,,,48.88
Deidentified Minimum,,84402,CPT4/HCPCS,ASSAY OF FREE TESTOSTERONE,,,96.00
Deidentified Minimum,,84410,CPT4/HCPCS,TESTOSTERONE BIOAVAILABLE,,,96.00
Deidentified Minimum,,84525,CPT4/HCPCS,UREA NITROGEN SEMI-QUANT,,,37.80
Deidentified Minimum,,84580,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,,71.23
Deidentified Minimum,,84588,CPT4/HCPCS,ASSAY OF VASOPRESSIN,,,96.00
Deidentified Minimum,,85002,CPT4/HCPCS,BLEEDING TIME TEST,,,45.19
Deidentified Minimum,,85008,CPT4/HCPCS,BL SMEAR W/O DIFF WBC COUNT,,,34.52
Deidentified Minimum,,85013,CPT4/HCPCS,SPUN MICROHEMATOCRIT,,,23.77
Deidentified Minimum,,85130,CPT4/HCPCS,CHROMOGENIC SUBSTRATE ASSAY,,,96.00
Deidentified Minimum,,85240,CPT4/HCPCS,CLOT FACTOR VIII AHG 1 STAGE,,,96.00
Deidentified Minimum,,85260,CPT4/HCPCS,CLOT FACTOR X STUART-POWER,,,96.00
Deidentified Minimum,,85280,CPT4/HCPCS,CLOT FACTOR XII HAGEMAN,,,96.00
Deidentified Minimum,,85293,CPT4/HCPCS,CLOT FACTOR WGHT KININOGEN,,,96.00
Deidentified Minimum,,85302,CPT4/HCPCS,CLOT INHIBIT PROT C ANTIGEN,,,96.00
Deidentified Minimum,,85305,CPT4/HCPCS,CLOT INHIBIT PROT S TOTAL,,,96.00
Deidentified Minimum,,85366,CPT4/HCPCS,FIBRINOGEN TEST,,,82.15
Deidentified Minimum,,85396,CPT4/HCPCS,CLOTTING ASSAY WHOLE BLOOD,,,93.12
Deidentified Minimum,,85410,CPT4/HCPCS,FIBRINOLYTIC ANTIPLASMIN,,,77.53
Deidentified Minimum,,85651,CPT4/HCPCS,RBC SED RATE NONAUTOMATED,,,35.70
Deidentified Minimum,,85652,CPT4/HCPCS,RBC SED RATE AUTOMATED,,,27.13
Deidentified Minimum,,85675,CPT4/HCPCS,THROMBIN TIME TITER,,,68.79
Deidentified Minimum,,85732,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,,65.01
Deidentified Minimum,,85810,CPT4/HCPCS,BLOOD VISCOSITY EXAMINATION,,,96.00
Deidentified Minimum,,86001,CPT4/HCPCS,ALLERGEN SPECIFIC IGG,,,52.41
Deidentified Minimum,,86063,CPT4/HCPCS,ANTISTREPTOLYSIN O SCREEN,,,58.04
Deidentified Minimum,,86200,CPT4/HCPCS,CCP ANTIBODY,,,96.00
Deidentified Minimum,,86277,CPT4/HCPCS,GROWTH HORMONE ANTIBODY,,,96.00
Deidentified Minimum,,86300,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 15-3,,,96.00
Deidentified Minimum,,86309,CPT4/HCPCS,HETEROPHILE ANTIBODY TITER,,,65.01
Deidentified Minimum,,86310,CPT4/HCPCS,HETEROPHILE ANTIBODY ABSRBJ,,,74.00
Deidentified Minimum,,86352,CPT4/HCPCS,CELL FUNCTION ASSAY W/STIM,,,96.00
Deidentified Minimum,,86356,CPT4/HCPCS,MONONUCLEAR CELL ANTIGEN,,,96.00
Deidentified Minimum,,86376,CPT4/HCPCS,MICROSOMAL ANTIBODY EACH,,,96.00
Deidentified Minimum,,86406,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY TITR,,,96.00
Deidentified Minimum,,86510,CPT4/HCPCS,HISTOPLASMOSIS SKIN TEST,,,55.02
Deidentified Minimum,,86603,CPT4/HCPCS,ADENOVIRUS ANTIBODY,,,96.00
Deidentified Minimum,,86631,CPT4/HCPCS,CHLAMYDIA ANTIBODY,,,96.00
Deidentified Minimum,,86644,CPT4/HCPCS,CMV ANTIBODY,,,96.00
Deidentified Minimum,,86723,CPT4/HCPCS,LISTERIA MONOCYTOGENES,,,96.00
Deidentified Minimum,,86729,CPT4/HCPCS,LYMPHO VENEREUM ANTIBODY,,,0.00
Deidentified Minimum,,86756,CPT4/HCPCS,RESPIRATORY VIRUS ANTIBODY,,,96.00
Deidentified Minimum,,86762,CPT4/HCPCS,RUBELLA ANTIBODY,,,96.00
Deidentified Minimum,,86777,CPT4/HCPCS,TOXOPLASMA ANTIBODY,,,96.00
Deidentified Minimum,,86780,CPT4/HCPCS,TREPONEMA PALLIDUM,,,96.00
Deidentified Minimum,,86794,CPT4/HCPCS,ZIKA VIRUS IGM ANTIBODY,,,96.00
Deidentified Minimum,,86808,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,,96.00
Deidentified Minimum,,86829,CPT4/HCPCS,HLA CLASS I/II ANTIBODY QUAL,,,96.00
Deidentified Minimum,,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,,96.00
Deidentified Minimum,,86885,CPT4/HCPCS,COOMBS TEST INDIRECT QUAL,,,57.53
Deidentified Minimum,,86890,CPT4/HCPCS,AUTOLOGOUS BLOOD PROCESS,,,96.00
Deidentified Minimum,,86910,CPT4/HCPCS,BLOOD TYPING PATERNITY TEST,,,96.00
Deidentified Minimum,,86911,CPT4/HCPCS,BLOOD TYPING ANTIGEN SYSTEM,,,96.00
Deidentified Minimum,,86945,CPT4/HCPCS,BLOOD PRODUCT/IRRADIATION,,,96.00
Deidentified Minimum,,87045,CPT4/HCPCS,FECES CULTURE AEROBIC BACT,,,94.83
Deidentified Minimum,,87070,CPT4/HCPCS,CULTURE OTHR SPECIMN AEROBIC,,,86.52
Deidentified Minimum,,87102,CPT4/HCPCS,FUNGUS ISOLATION CULTURE,,,84.50
Deidentified Minimum,,87110,CPT4/HCPCS,CHLAMYDIA CULTURE,,,96.00
Deidentified Minimum,,87150,CPT4/HCPCS,DNA/RNA AMPLIFIED PROBE,,,96.00
Deidentified Minimum,,87168,CPT4/HCPCS,MACROSCOPIC EXAM ARTHROPOD,,,42.92
Deidentified Minimum,,87172,CPT4/HCPCS,PINWORM EXAM,,,42.92
Deidentified Minimum,,87176,CPT4/HCPCS,TISSUE HOMOGENIZATION CULTR,,,59.13
Deidentified Minimum,,87187,CPT4/HCPCS,MICROBE SUSCEPTIBLE MLC,,,96.00
Deidentified Minimum,,87197,CPT4/HCPCS,BACTERICIDAL LEVEL SERUM,,,96.00
Deidentified Minimum,,87230,CPT4/HCPCS,ASSAY TOXIN OR ANTITOXIN,,,96.00
Deidentified Minimum,,87255,CPT4/HCPCS,GENET VIRUS ISOLATE HSV,,,96.00
Deidentified Minimum,,87269,CPT4/HCPCS,GIARDIA AG IF,,,93.32
Deidentified Minimum,,87270,CPT4/HCPCS,CHLAMYDIA TRACHOMATIS AG IF,,,93.32
Deidentified Minimum,,87272,CPT4/HCPCS,CRYPTOSPORIDIUM AG IF,,,93.32
Deidentified Minimum,,87274,CPT4/HCPCS,HERPES SIMPLEX 1 AG IF,,,93.32
Deidentified Minimum,,87275,CPT4/HCPCS,INFLUENZA B AG IF,,,93.32
Deidentified Minimum,,87300,CPT4/HCPCS,AG DETECTION POLYVAL IF,,,93.32
Deidentified Minimum,,87301,CPT4/HCPCS,ADENOVIRUS AG IA,,,93.32
Deidentified Minimum,,87328,CPT4/HCPCS,CRYPTOSPORIDIUM AG IA,,,93.32
Deidentified Minimum,,87390,CPT4/HCPCS,HIV-1 AG IA,,,96.00
Deidentified Minimum,,87471,CPT4/HCPCS,BARTONELLA DNA AMP PROBE,,,96.00
Deidentified Minimum,,87475,CPT4/HCPCS,LYME DIS DNA DIR PROBE,,,96.00
Deidentified Minimum,,87476,CPT4/HCPCS,LYME DIS DNA AMP PROBE,,,96.00
Deidentified Minimum,,87490,CPT4/HCPCS,CHYLMD TRACH DNA DIR PROBE,,,96.00
Deidentified Minimum,,87500,CPT4/HCPCS,VANOMYCIN DNA AMP PROBE,,,96.00
Deidentified Minimum,,87502,CPT4/HCPCS,INFLUENZA DNA AMP PROBE,,,96.00
Deidentified Minimum,,87510,CPT4/HCPCS,GARDNER VAG DNA DIR PROBE,,,96.00
Deidentified Minimum,,87512,CPT4/HCPCS,GARDNER VAG DNA QUANT,,,96.00
Deidentified Minimum,,87525,CPT4/HCPCS,HEPATITIS G DNA DIR PROBE,,,96.00
Deidentified Minimum,,87536,CPT4/HCPCS,HIV-1 QUANT&REVRSE TRNSCRPJ,,,96.00
Deidentified Minimum,,87540,CPT4/HCPCS,LEGION PNEUMO DNA DIR PROB,,,96.00
Deidentified Minimum,,87541,CPT4/HCPCS,LEGION PNEUMO DNA AMP PROB,,,96.00
Deidentified Minimum,,87561,CPT4/HCPCS,M.AVIUM-INTRA DNA AMP PROB,,,96.00
Deidentified Minimum,,87590,CPT4/HCPCS,N.GONORRHOEAE DNA DIR PROB,,,96.00
Deidentified Minimum,,87625,CPT4/HCPCS,HPV TYPES 16 & 18 ONLY,,,96.00
Deidentified Minimum,,87632,CPT4/HCPCS,RESP VIRUS 6-11 TARGETS,,,96.00
Deidentified Minimum,,87650,CPT4/HCPCS,STREP A DNA DIR PROBE,,,96.00
Deidentified Minimum,,87653,CPT4/HCPCS,STREP B DNA AMP PROBE,,,96.00
Deidentified Minimum,,87799,CPT4/HCPCS,DETECT AGENT NOS DNA QUANT,,,96.00
Deidentified Minimum,,87800,CPT4/HCPCS,DETECT AGNT MULT DNA DIREC,,,96.00
Deidentified Minimum,,87802,CPT4/HCPCS,STREP B ASSAY W/OPTIC,,,93.32
Deidentified Minimum,,87880,CPT4/HCPCS,STREP A ASSAY W/OPTIC,,,93.32
Deidentified Minimum,,87903,CPT4/HCPCS,PHENOTYPE DNA HIV W/CULTURE,,,96.00
Deidentified Minimum,,87904,CPT4/HCPCS,PHENOTYPE DNA HIV W/CLT ADD,,,96.00
Deidentified Minimum,,88016,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,96.00
Deidentified Minimum,,88037,CPT4/HCPCS,LIMITED AUTOPSY,,,96.00
Deidentified Minimum,,88104,CPT4/HCPCS,CYTOPATH FL NONGYN SMEARS,,,96.00
Deidentified Minimum,,88108,CPT4/HCPCS,CYTOPATH CONCENTRATE TECH,,,96.00
Deidentified Minimum,,88148,CPT4/HCPCS,CYTOPATH C/V AUTO RESCREEN,,,96.00
Deidentified Minimum,,88152,CPT4/HCPCS,CYTOPATH C/V AUTO REDO,,,96.00
Deidentified Minimum,,88160,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,,96.00
Deidentified Minimum,,88172,CPT4/HCPCS,CYTP DX EVAL FNA 1ST EA SITE,,,96.00
Deidentified Minimum,,88174,CPT4/HCPCS,CYTOPATH C/V AUTO IN FLUID,,,96.00
Deidentified Minimum,,88177,CPT4/HCPCS,CYTP FNA EVAL EA ADDL,,,55.02
Deidentified Minimum,,88185,CPT4/HCPCS,FLOWCYTOMETRY/TC ADD-ON,,,96.00
Deidentified Minimum,,88230,CPT4/HCPCS,TISSUE CULTURE LYMPHOCYTE,,,96.00
Deidentified Minimum,,88237,CPT4/HCPCS,TISSUE CULTURE BONE MARROW,,,96.00
Deidentified Minimum,,88239,CPT4/HCPCS,TISSUE CULTURE TUMOR,,,96.00
Deidentified Minimum,,88241,CPT4/HCPCS,FROZEN CELL PREPARATION,,,96.00
Deidentified Minimum,,88263,CPT4/HCPCS,CHROMOSOME ANALYSIS 45,,,96.00
Deidentified Minimum,,88267,CPT4/HCPCS,CHROMOSOME ANALYS PLACENTA,,,96.00
Deidentified Minimum,,88272,CPT4/HCPCS,CYTOGENETICS 3-5,,,96.00
Deidentified Minimum,,88273,CPT4/HCPCS,CYTOGENETICS 10-30,,,96.00
Deidentified Minimum,,88285,CPT4/HCPCS,CHROMOSOME COUNT ADDITIONAL,,,96.00
Deidentified Minimum,,88289,CPT4/HCPCS,CHROMOSOME STUDY ADDITIONAL,,,96.00
Deidentified Minimum,,88311,CPT4/HCPCS,DECALCIFY TISSUE,,,47.34
Deidentified Minimum,,88321,CPT4/HCPCS,MICROSLIDE CONSULTATION,,,96.00
Deidentified Minimum,,88356,CPT4/HCPCS,ANALYSIS NERVE,,,96.00
Deidentified Minimum,,88365,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,,96.00
Deidentified Minimum,,88367,CPT4/HCPCS,INSITU HYBRIDIZATION AUTO,,,96.00
Deidentified Minimum,,88368,CPT4/HCPCS,INSITU HYBRIDIZATION MANUAL,,,96.00
Deidentified Minimum,,88372,CPT4/HCPCS,PROTEIN ANALYSIS W/PROBE,,,96.00
Deidentified Minimum,,89050,CPT4/HCPCS,BODY FLUID CELL COUNT,,,47.46
Deidentified Minimum,,89051,CPT4/HCPCS,BODY FLUID CELL COUNT,,,55.35
Deidentified Minimum,,89055,CPT4/HCPCS,LEUKOCYTE ASSESSMENT FECAL,,,42.92
Deidentified Minimum,,89268,CPT4/HCPCS,INSEMINATION OF OOCYTES,,,96.00
Deidentified Minimum,,89344,CPT4/HCPCS,STORAGE/YEAR REPROD TISSUE,,,96.00
Deidentified Minimum,,89346,CPT4/HCPCS,STORAGE/YEAR OOCYTE(S),,,96.00
Deidentified Minimum,,89356,CPT4/HCPCS,THAWING CRYOPRESRVED OOCYTE,,,55.43
Deidentified Minimum,,90802,CPT4/HCPCS,INTAC PSY DX INTERVIEW,,,345.81
Deidentified Minimum,,90806,CPT4/HCPCS,PSYTX OFF 45-50 MIN,,,174.91
Deidentified Minimum,,90807,CPT4/HCPCS,PSYTX OFF 45-50 MIN W/E&M,,,193.38
Deidentified Minimum,,90808,CPT4/HCPCS,PSYTX OFFICE 75-80 MIN,,,259.98
Deidentified Minimum,,90813,CPT4/HCPCS,INTAC PSYTX 45-50 MIN W/E&M,,,203.00
Deidentified Minimum,,90827,CPT4/HCPCS,INTAC PSYTX HSP 45-50 W/E&M,,,255.94
Deidentified Minimum,,90853,CPT4/HCPCS,GROUP PSYCHOTHERAPY,,,100.27
Deidentified Minimum,,90870,CPT4/HCPCS,ELECTROCONVULSIVE THERAPY,,,203.78
Deidentified Minimum,,90911,CPT4/HCPCS,BIOFEEDBACK PERI/URO/RECTAL,,,193.00
Deidentified Minimum,,91030,CPT4/HCPCS,ACID PERFUSION OF ESOPHAGUS,,,1004.08
Deidentified Minimum,,91060,CPT4/HCPCS,GASTRIC SALINE LOAD TEST,,,85.04
Deidentified Minimum,,91065,CPT4/HCPCS,BREATH HYDROGEN/METHANE TEST,,,917.47
Deidentified Minimum,,92002,CPT4/HCPCS,EYE EXAM NEW PATIENT,,,474.80
Deidentified Minimum,,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,,281.55
Deidentified Minimum,,92072,CPT4/HCPCS,FIT CONTAC LENS FOR MANAGMNT,,,395.63
Deidentified Minimum,,92132,CPT4/HCPCS,CMPTR OPHTH DX IMG ANT SEGMT,,,987.78
Deidentified Minimum,,92134,CPT4/HCPCS,CPTR OPHTH DX IMG POST SEGMT,,,987.78
Deidentified Minimum,,92235,CPT4/HCPCS,FLUORESCEIN ANGRPH UNI/BI,,,1255.98
Deidentified Minimum,,92270,CPT4/HCPCS,ELECTRO-OCULOGRAPHY,,,595.09
Deidentified Minimum,,92310,CPT4/HCPCS,CONTACT LENS FITTING,,,555.03
Deidentified Minimum,,92313,CPT4/HCPCS,CONTACT LENS FITTING,,,518.10
Deidentified Minimum,,92545,CPT4/HCPCS,OSCILLATING TRACKING TEST,,,335.25
Deidentified Minimum,,92552,CPT4/HCPCS,PURE TONE AUDIOMETRY AIR,,,227.84
Deidentified Minimum,,92562,CPT4/HCPCS,LOUDNESS BALANCE TEST,,,208.59
Deidentified Minimum,,92570,CPT4/HCPCS,ACOUSTIC IMMITANCE TESTING,,,128.36
Deidentified Minimum,,92577,CPT4/HCPCS,STENGER TEST SPEECH,,,374.68
Deidentified Minimum,,92582,CPT4/HCPCS,CONDITIONING PLAY AUDIOMETRY,,,375.44
Deidentified Minimum,,92584,CPT4/HCPCS,ELECTROCOCHLEOGRAPHY,,,1282.81
Deidentified Minimum,,92597,CPT4/HCPCS,ORAL SPEECH DEVICE EVAL,,,825.26
Deidentified Minimum,,92613,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) I&R,,,212.63
Deidentified Minimum,,92618,CPT4/HCPCS,EX FOR NONSPEECH DEV RX ADD,,,137.21
Deidentified Minimum,,92626,CPT4/HCPCS,EVAL AUD FUNCJ 1ST HOUR,,,1082.76
Deidentified Minimum,,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,,5831.00
Deidentified Minimum,,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,,574.58
Deidentified Minimum,,92990,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,,6612.00
Deidentified Minimum,,93018,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,,56.96
Deidentified Minimum,,93024,CPT4/HCPCS,CARDIAC DRUG STRESS TEST,,,504.67
Deidentified Minimum,,93227,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,,99.48
Deidentified Minimum,,93229,CPT4/HCPCS,REMOTE 30 DAY ECG TECH SUPP,,,6072.44
Deidentified Minimum,,93261,CPT4/HCPCS,INTERROGATE SUBQ DEFIB,,,190.42
Deidentified Minimum,,93272,CPT4/HCPCS,ECG/REVIEW INTERPRET ONLY,,,99.48
Deidentified Minimum,,93281,CPT4/HCPCS,PM DEVICE PROGR EVAL MULTI,,,219.91
Deidentified Minimum,,93293,CPT4/HCPCS,PM PHONE R-STRIP DEVICE EVAL,,,356.24
Deidentified Minimum,,93297,CPT4/HCPCS,REM INTERROG DEV EVAL ICPMS,,,203.11
Deidentified Minimum,,93299,CPT4/HCPCS,INTERROG EVAL ICPMS/SCRMS,,,0.00
Deidentified Minimum,,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,,608.00
Deidentified Minimum,,93314,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,608.00
Deidentified Minimum,,93316,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,135.65
Deidentified Minimum,,93325,CPT4/HCPCS,DOPPLER COLOR FLOW ADD-ON,,,283.50
Deidentified Minimum,,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,,2998.00
Deidentified Minimum,,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,,1235.00
Deidentified Minimum,,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,,694.72
Deidentified Minimum,,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,,162.03
Deidentified Minimum,,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,,162.03
Deidentified Minimum,,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,,1009.96
Deidentified Minimum,,93651,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,3506.44
Deidentified Minimum,,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,,2002.00
Deidentified Minimum,,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,,5575.00
Deidentified Minimum,,93668,CPT4/HCPCS,PERIPHERAL VASCULAR REHAB,,,663.38
Deidentified Minimum,,93890,CPT4/HCPCS,TCD VASOREACTIVITY STUDY,,,857.30
Deidentified Minimum,,93923,CPT4/HCPCS,UPR/LXTR ART STDY 3+ LVLS,,,1319.55
Deidentified Minimum,,93924,CPT4/HCPCS,LWR XTR VASC STDY BILAT,,,1676.97
Deidentified Minimum,,93979,CPT4/HCPCS,VASCULAR STUDY,,,859.06
Deidentified Minimum,,93980,CPT4/HCPCS,PENILE VASCULAR STUDY,,,1007.49
Deidentified Minimum,,94004,CPT4/HCPCS,VENT MGMT NF PER DAY,,,131.62
Deidentified Minimum,,94453,CPT4/HCPCS,HAST W/OXYGEN TITRATE,,,676.88
Deidentified Minimum,,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,,162.03
Deidentified Minimum,,94668,CPT4/HCPCS,CHEST WALL MANIPULATION,,,229.40
Deidentified Minimum,,94680,CPT4/HCPCS,EXHALED AIR ANALYSIS O2,,,895.11
Deidentified Minimum,,94681,CPT4/HCPCS,EXHALED AIR ANALYSIS O2/CO2,,,1275.38
Deidentified Minimum,,94727,CPT4/HCPCS,PULM FUNCTION TEST BY GAS,,,422.64
Deidentified Minimum,,94781,CPT4/HCPCS,CARS/BD TST INFT-12MO +30MIN,,,32.89
Deidentified Minimum,,95010,CPT4/HCPCS,PERCUT ALLERGY TITRATE TEST,,,158.00
Deidentified Minimum,,95015,CPT4/HCPCS,ID ALLERGY TITRATE-DRUG/BUG,,,71.40
Deidentified Minimum,,95027,CPT4/HCPCS,ICUT ALLERGY TITRATE-AIRBORN,,,76.20
Deidentified Minimum,,95071,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,,1417.88
Deidentified Minimum,,95117,CPT4/HCPCS,IMMUNOTHERAPY INJECTIONS,,,248.65
Deidentified Minimum,,95147,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,206.12
Deidentified Minimum,,95180,CPT4/HCPCS,RAPID DESENSITIZATION,,,997.71
Deidentified Minimum,,95251,CPT4/HCPCS,CONT GLUC MNTR ANALYSIS I&R,,,99.48
Deidentified Minimum,,95783,CPT4/HCPCS,POLYSOM <6 YRS CPAP/BILVL,,,8205.28
Deidentified Minimum,,95808,CPT4/HCPCS,POLYSOM ANY AGE 1-3> PARAM,,,3302.00
Deidentified Minimum,,95851,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,,177.25
Deidentified Minimum,,95861,CPT4/HCPCS,MUSCLE TEST 2 LIMBS,,,380.26
Deidentified Minimum,,95886,CPT4/HCPCS,MUSC TEST DONE W/N TEST COMP,,,566.99
Deidentified Minimum,,95920,CPT4/HCPCS,INTRAOP NERVE TEST ADD-ON,,,658.55
Deidentified Minimum,,95927,CPT4/HCPCS,SOMATOSENSORY TESTING,,,462.06
Deidentified Minimum,,95929,CPT4/HCPCS,C MOTOR EVOKED LWR LIMBS,,,1243.88
Deidentified Minimum,,95930,CPT4/HCPCS,VISUAL EP TEST CNS W/I&R,,,619.91
Deidentified Minimum,,95951,CPT4/HCPCS,EEG MONITORING/VIDEORECORD,,,1360.88
Deidentified Minimum,,95955,CPT4/HCPCS,EEG DURING SURGERY,,,1016.47
Deidentified Minimum,,95962,CPT4/HCPCS,ELECTRODE STIM BRAIN ADD-ON,,,658.55
Deidentified Minimum,,95980,CPT4/HCPCS,IO ANAL GAST N-STIM INIT,,,148.53
Deidentified Minimum,,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,,745.95
Deidentified Minimum,,96002,CPT4/HCPCS,DYNAMIC SURFACE EMG,,,80.23
Deidentified Minimum,,96365,CPT4/HCPCS,THER/PROPH/DIAG IV INF INIT,,,193.00
Deidentified Minimum,,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,,193.00
Deidentified Minimum,,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,,193.00
Deidentified Minimum,,96440,CPT4/HCPCS,CHEMOTHERAPY INTRACAVITARY,,,549.75
Deidentified Minimum,,96446,CPT4/HCPCS,CHEMOTX ADMN PRTL CAVITY,,,119.66
Deidentified Minimum,,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,,108.34
Deidentified Minimum,,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,,287.13
Deidentified Minimum,,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,,526.16
Deidentified Minimum,,97003,CPT4/HCPCS,OT EVALUATION,,,399.50
Deidentified Minimum,,97026,CPT4/HCPCS,INFRARED THERAPY,,,33.26
Deidentified Minimum,,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,,109.89
Deidentified Minimum,,97152,CPT4/HCPCS,BHV ID SUPRT ASSMT BY 1 TECH,,,153.21
Deidentified Minimum,,97157,CPT4/HCPCS,MULT FAM ADAPT BHV TX GDN,,,206.64
Deidentified Minimum,,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,,193.00
Deidentified Minimum,,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,,193.00
Deidentified Minimum,,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,,193.00
Deidentified Minimum,,97533,CPT4/HCPCS,SENSORY INTEGRATION,,,133.94
Deidentified Minimum,,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,,193.00
Deidentified Minimum,,97803,CPT4/HCPCS,MED NUTRITION INDIV SUBSEQ,,,230.18
Deidentified Minimum,,A9504,CPT4/HCPCS,Tc99m apcitide,,,3486.00
Deidentified Minimum,,A9509,CPT4/HCPCS,Iodine I-123 sod iodide mil,,,15130.66
Deidentified Minimum,,A9524,CPT4/HCPCS,I131 serum albumin, dx,,,662.34
Deidentified Minimum,,A9531,CPT4/HCPCS,I131 max 100uCi,,,40.99
Deidentified Minimum,,A9546,CPT4/HCPCS,Co57/58,,,205.80
Deidentified Minimum,,A9548,CPT4/HCPCS,In111 pentetate,,,3456.93
Deidentified Minimum,,A9568,CPT4/HCPCS,Technetium tc99m arcitumomab,,,9063.60
Deidentified Minimum,,A9583,CPT4/HCPCS,Gadofosveset trisodium inj,,,146.49
Deidentified Minimum,,A9586,CPT4/HCPCS,Florbetapir F18,,,23906.14
Deidentified Minimum,,C8900,CPT4/HCPCS,MRA w/cont, abd,,,4399.00
Deidentified Minimum,,C8901,CPT4/HCPCS,MRA w/o cont, abd,,,4399.00
Deidentified Minimum,,C8903,CPT4/HCPCS,MRI w/cont, breast, uni,,,4399.00
Deidentified Minimum,,C8908,CPT4/HCPCS,MRI w/o fol w/cont, breast,,,,4399.00
Deidentified Minimum,,C8911,CPT4/HCPCS,MRA w/o fol w/cont, chest,,,4399.00
Deidentified Minimum,,C8934,CPT4/HCPCS,MRA, w/dye, upper extremity,,,4399.00
Deidentified Minimum,,C8936,CPT4/HCPCS,MRA, w/o&w/dye, upper extr,,,4399.00
Deidentified Minimum,,C8957,CPT4/HCPCS,Prolonged IV inf, req pump,,,193.00
Deidentified Minimum,,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,,6876.92
Deidentified Minimum,,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,,6876.92
Deidentified Minimum,,C9748,CPT4/HCPCS,Prostatic rf water vapor tx,,,3544.00
Deidentified Minimum,,0052T,CPT4/HCPCS,REPLACE THRC UNIT HRT SYST,,,8841.00
Deidentified Minimum,,0053T,CPT4/HCPCS,REPLACE IMPLANTABLE HRT SYST,,,8841.00
Deidentified Minimum,,0076T,CPT4/HCPCS,S&I STENT/CHEST VERT ART,,,1291.00
Deidentified Minimum,,0079T,CPT4/HCPCS,ENDOVASC VISC EXTNSN REPR,,,5029.00
Deidentified Minimum,,0126T,CPT4/HCPCS,CHD RISK IMT STUDY,,,1678.00
Deidentified Minimum,,0163T,CPT4/HCPCS,LUMB ARTIF DISKECTOMY ADDL,,,1291.00
Deidentified Minimum,,0190T,CPT4/HCPCS,PLACE INTRAOC RADIATION SRC,,,3198.57
Deidentified Minimum,,0200T,CPT4/HCPCS,PERQ SACRAL AUGMT UNILAT INJ,,,3198.57
Deidentified Minimum,,0205T,CPT4/HCPCS,INIRS EACH VESSEL ADD-ON,,,1678.00
Deidentified Minimum,,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,,987.78
Deidentified Minimum,,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,,987.78
Deidentified Minimum,,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,,987.78
Deidentified Minimum,,0226T,CPT4/HCPCS,ANOSCOPY HRA W/SPEC COLLECT,,,1678.00
Deidentified Minimum,,0232T,CPT4/HCPCS,NJX PLATELET PLASMA,,,1145.00
Deidentified Minimum,,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,,5029.00
Deidentified Minimum,,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,,5029.00
Deidentified Minimum,,0250T,CPT4/HCPCS,INSERT BRONCHIAL VALVE,,,1678.00
Deidentified Minimum,,0252T,CPT4/HCPCS,REMOV BRONCH VALVE ADDL,,,1678.00
Deidentified Minimum,,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,,3544.00
Deidentified Minimum,,0277T,CPT4/HCPCS,BRONCH THERMOPLASTY LOBES,,,1678.88
Deidentified Minimum,,0283T,CPT4/HCPCS,PERIPH FIELD STIMUL PERM,,,1678.88
Deidentified Minimum,,0290T,CPT4/HCPCS,LASER INC FOR PKP/LKP RECIP,,,1145.00
Deidentified Minimum,,0303T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS ELTRD,,,3544.00
Deidentified Minimum,,0304T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS DEVICE,,,3544.00
Deidentified Minimum,,0331T,CPT4/HCPCS,HEART SYMP IMAGE PLNR,,,987.78
Deidentified Minimum,,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,,3198.57
Deidentified Minimum,,0342T,CPT4/HCPCS,THXP APHERESIS W/HDL DELIP,,,5730.00
Deidentified Minimum,,0387T,CPT4/HCPCS,LEADLESS PM INS/RPL VENTR,,,3544.00
Deidentified Minimum,,0397T,CPT4/HCPCS,ERCP W/OPTICAL ENDOMICROSCPY,,,1145.00
Deidentified Minimum,,0406T,CPT4/HCPCS,SIN NDSC PLMT DRG ELUT MPLNT,,,3544.00
Deidentified Minimum,,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,,3198.57
Deidentified Minimum,,0429T,CPT4/HCPCS,RMVL NSTIM APNEA SEN LD,,,1678.00
Deidentified Minimum,,0430T,CPT4/HCPCS,RMVL NSTIM APNEA STIMJ LD,,,1678.00
Deidentified Minimum,,0433T,CPT4/HCPCS,REPOS NSTIM APNEA SENSING LD,,,1678.00
Deidentified Minimum,,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,,1678.00
Deidentified Minimum,,0443T,CPT4/HCPCS,R-T SPCTRL ALYS PRST8 TISS,,,1145.00
Deidentified Minimum,,0448T,CPT4/HCPCS,REMVL INSJ IMPLTBL GLUC SENS,,,1145.00
Deidentified Minimum,,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,,987.78
Deidentified Minimum,,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,,987.78
Deidentified Minimum,,0462T,CPT4/HCPCS,PRGRMG EVAL AORTIC VENTR SYS,,,1145.00
Deidentified Minimum,,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,,1145.00
Deidentified Minimum,,0482T,CPT4/HCPCS,ABSL QUAN MYOCRD BLD FLO PET,,,3198.57
Deidentified Minimum,,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,,1145.00
Deidentified Minimum,,0515T,CPT4/HCPCS,INSJ WCS LV COMPL SYS,,,5281.00
Deidentified Minimum,,0516T,CPT4/HCPCS,INSJ WCS LV ELTRD ONLY,,,5281.00
Deidentified Minimum,,0517T,CPT4/HCPCS,INSJ WCS LV PG COMPNT,,,5281.00
Deidentified Minimum,,0525T,CPT4/HCPCS,INSJ/RPLCMT COMPL IIMS,,,3544.00
Deidentified Minimum,,0532T,CPT4/HCPCS,REMOVAL IIMS IMPLT MNTR ONLY,,,3544.00
Deidentified Minimum,,0538T,CPT4/HCPCS,BLD DRV T LYMPHCYT PREP TRNS,,,1678.00
Deidentified Minimum,,0549T,CPT4/HCPCS,TPRNL BALO CNTNC DEV UNI,,,4847.00
Deidentified Minimum,,0563T,CPT4/HCPCS,EVAC MEIBOMIAN GLND HEAT BI,,,1145.00
Deidentified Minimum,,0576T,CPT4/HCPCS,INTERROG DEV EVAL ICDS SS IP,,,1291.00
Deidentified Minimum,,0578T,CPT4/HCPCS,REM INTERROG DEV ICDS PHYS,,,1291.00
Deidentified Minimum,,0581T,CPT4/HCPCS,ABLTJ MAL BRST TUM PERQ CRTX,,,1291.00
Deidentified Minimum,,0583T,CPT4/HCPCS,TMPST AUTO TUBE DLVR SYS,,,1291.00
Deidentified Minimum,,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,,400.00
Deidentified Minimum,,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,,400.00
Deidentified Minimum,,10080,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,,400.00
Deidentified Minimum,,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,,400.00
Deidentified Minimum,,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,,1235.00
Deidentified Minimum,,11055,CPT4/HCPCS,TRIM SKIN LESION,,,400.00
Deidentified Minimum,,11102,CPT4/HCPCS,TANGNTL BX SKIN SINGLE LES,,,400.00
Deidentified Minimum,,11104,CPT4/HCPCS,PUNCH BX SKIN SINGLE LESION,,,400.00
Deidentified Minimum,,11106,CPT4/HCPCS,INCAL BX SKN SINGLE LES,,,1145.00
Deidentified Minimum,,11311,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,,987.78
Deidentified Minimum,,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,,1678.88
Deidentified Minimum,,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,,1235.00
Deidentified Minimum,,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,,1235.00
Deidentified Minimum,,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,,1145.00
Deidentified Minimum,,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,,1678.88
Deidentified Minimum,,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,,1235.00
Deidentified Minimum,,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,,1291.00
Deidentified Minimum,,11730,CPT4/HCPCS,REMOVAL OF NAIL PLATE,,,987.78
Deidentified Minimum,,11765,CPT4/HCPCS,EXCISION OF NAIL FOLD TOE,,,987.78
Deidentified Minimum,,11900,CPT4/HCPCS,INJECT SKIN LESIONS ,,,1145.00
Deidentified Minimum,,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,,1145.00
Deidentified Minimum,,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,,1145.00
Deidentified Minimum,,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,,1291.00
Deidentified Minimum,,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,,1291.00
Deidentified Minimum,,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,,1145.00
Deidentified Minimum,,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,,1145.00
Deidentified Minimum,,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,,1678.88
Deidentified Minimum,,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,,1145.00
Deidentified Minimum,,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,,1291.00
Deidentified Minimum,,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,,1145.00
Deidentified Minimum,,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,,1291.00
Deidentified Minimum,,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,,3544.00
Deidentified Minimum,,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,,3000.00
Deidentified Minimum,,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,,3000.00
Deidentified Minimum,,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,,1145.00
Deidentified Minimum,,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,,987.78
Deidentified Minimum,,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,,1291.00
Deidentified Minimum,,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,,1291.00
Deidentified Minimum,,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,,1291.00
Deidentified Minimum,,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,,3544.00
Deidentified Minimum,,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,,1291.00
Deidentified Minimum,,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,,1291.00
Deidentified Minimum,,15847,CPT4/HCPCS,EXC SKIN ABD ADD-ON,,,1145.00
Deidentified Minimum,,15860,CPT4/HCPCS,TEST FOR BLOOD FLOW IN GRAFT,,,400.00
Deidentified Minimum,,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,,1678.88
Deidentified Minimum,,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,3544.00
Deidentified Minimum,,15999,CPT4/HCPCS,REMOVAL OF PRESSURE SORE,,,1235.00
Deidentified Minimum,,16020,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN S,,,987.78
Deidentified Minimum,,17250,CPT4/HCPCS,CHEM CAUT OF GRANLTJ TISSUE,,,987.78
Deidentified Minimum,,17264,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,400.00
Deidentified Minimum,,17315,CPT4/HCPCS,MOHS SURG ADDL BLOCK,,,1145.00
Deidentified Minimum,,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,,987.78
Deidentified Minimum,,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,,1291.00
Deidentified Minimum,,19102,CPT4/HCPCS,BX BREAST PERCUT W/IMAGE,,,1678.88
Deidentified Minimum,,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,,1678.88
Deidentified Minimum,,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,,3544.00
Deidentified Minimum,,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,,1145.00
Deidentified Minimum,,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,,1678.00
Deidentified Minimum,,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,,3544.00
Deidentified Minimum,,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,,4000.00
Deidentified Minimum,,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,,1678.88
Deidentified Minimum,,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,,4847.00
Deidentified Minimum,,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,,5000.00
Deidentified Minimum,,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,,1235.00
Deidentified Minimum,,20200,CPT4/HCPCS,MUSCLE BIOPSY,,,1291.00
Deidentified Minimum,,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,,400.00
Deidentified Minimum,,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,,3198.57
Deidentified Minimum,,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,,1291.00
Deidentified Minimum,,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,,3544.00
Deidentified Minimum,,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,,3544.00
Deidentified Minimum,,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,,1145.00
Deidentified Minimum,,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,,1291.00
Deidentified Minimum,,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,,1291.00
Deidentified Minimum,,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,,1678.88
Deidentified Minimum,,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,,3000.00
Deidentified Minimum,,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,,3656.00
Deidentified Minimum,,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1678.88
Deidentified Minimum,,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1678.88
Deidentified Minimum,,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1678.88
Deidentified Minimum,,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,,1678.88
Deidentified Minimum,,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,,1678.88
Deidentified Minimum,,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,,5029.00
Deidentified Minimum,,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,,3000.00
Deidentified Minimum,,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,,1291.00
Deidentified Minimum,,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,,1291.00
Deidentified Minimum,,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,,4891.93
Deidentified Minimum,,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,,1291.00
Deidentified Minimum,,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,,1291.00
Deidentified Minimum,,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,,1291.00
Deidentified Minimum,,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,,1291.00
Deidentified Minimum,,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,,5000.00
Deidentified Minimum,,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,,5730.00
Deidentified Minimum,,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,,5730.00
Deidentified Minimum,,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,,1291.00
Deidentified Minimum,,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,,1145.00
Deidentified Minimum,,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,,3965.00
Deidentified Minimum,,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,,3965.00
Deidentified Minimum,,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,,3965.00
Deidentified Minimum,,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,,1291.00
Deidentified Minimum,,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,,3000.00
Deidentified Minimum,,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,,5730.00
Deidentified Minimum,,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,,3198.57
Deidentified Minimum,,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,1145.00
Deidentified Minimum,,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,5000.00
Deidentified Minimum,,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,,3000.00
Deidentified Minimum,,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,,3544.00
Deidentified Minimum,,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,,1145.00
Deidentified Minimum,,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,,1291.00
Deidentified Minimum,,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,,1678.88
Deidentified Minimum,,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,,1291.00
Deidentified Minimum,,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,,1291.00
Deidentified Minimum,,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,,1145.00
Deidentified Minimum,,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,,3000.00
Deidentified Minimum,,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,,3000.00
Deidentified Minimum,,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,,1291.00
Deidentified Minimum,,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,,1145.00
Deidentified Minimum,,22527,CPT4/HCPCS,IDET 1 OR MORE LEVELS,,,4847.00
Deidentified Minimum,,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,,1291.00
Deidentified Minimum,,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,,6588.00
Deidentified Minimum,,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,,1291.00
Deidentified Minimum,,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,1145.00
Deidentified Minimum,,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,3198.57
Deidentified Minimum,,22856,CPT4/HCPCS,CERV ARTIFIC DISKECTOMY,,,3000.00
Deidentified Minimum,,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,,3000.00
Deidentified Minimum,,22870,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,,1145.00
Deidentified Minimum,,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,,1291.00
Deidentified Minimum,,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,,1678.00
Deidentified Minimum,,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,,1678.88
Deidentified Minimum,,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,,1678.88
Deidentified Minimum,,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,,1291.00
Deidentified Minimum,,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,,1291.00
Deidentified Minimum,,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,,3965.00
Deidentified Minimum,,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,,4000.00
Deidentified Minimum,,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,,4000.00
Deidentified Minimum,,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,,4000.00
Deidentified Minimum,,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,,1291.00
Deidentified Minimum,,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,,1235.00
Deidentified Minimum,,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,,5730.00
Deidentified Minimum,,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,,1291.00
Deidentified Minimum,,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,,3544.00
Deidentified Minimum,,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,1145.00
Deidentified Minimum,,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,1145.00
Deidentified Minimum,,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4000.00
Deidentified Minimum,,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,5000.00
Deidentified Minimum,,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,,6000.00
Deidentified Minimum,,23929,CPT4/HCPCS,SHOULDER SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,,1291.00
Deidentified Minimum,,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,,4000.00
Deidentified Minimum,,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,,3544.00
Deidentified Minimum,,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,,3544.00
Deidentified Minimum,,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,,1678.88
Deidentified Minimum,,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,,1235.00
Deidentified Minimum,,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,,3000.00
Deidentified Minimum,,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,,3000.00
Deidentified Minimum,,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,,1678.88
Deidentified Minimum,,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1678.00
Deidentified Minimum,,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4000.00
Deidentified Minimum,,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1145.00
Deidentified Minimum,,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1678.88
Deidentified Minimum,,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,,1291.00
Deidentified Minimum,,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,,1145.00
Deidentified Minimum,,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,,1678.88
Deidentified Minimum,,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,,1678.88
Deidentified Minimum,,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,,1291.00
Deidentified Minimum,,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,,3544.00
Deidentified Minimum,,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,,1678.00
Deidentified Minimum,,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,,3544.00
Deidentified Minimum,,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,,1678.88
Deidentified Minimum,,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,,1291.00
Deidentified Minimum,,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,,4000.00
Deidentified Minimum,,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,,3544.00
Deidentified Minimum,,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,,3544.00
Deidentified Minimum,,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,,3544.00
Deidentified Minimum,,25332,CPT4/HCPCS,REVISE WRIST JOINT,,,5000.00
Deidentified Minimum,,25355,CPT4/HCPCS,REVISION OF RADIUS,,,3544.00
Deidentified Minimum,,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,,4000.00
Deidentified Minimum,,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,,4000.00
Deidentified Minimum,,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,,3544.00
Deidentified Minimum,,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,,4000.00
Deidentified Minimum,,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,,3000.00
Deidentified Minimum,,25490,CPT4/HCPCS,REINFORCE RADIUS,,,3544.00
Deidentified Minimum,,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,1145.00
Deidentified Minimum,,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,,400.00
Deidentified Minimum,,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,,3544.00
Deidentified Minimum,,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,,3544.00
Deidentified Minimum,,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,,3544.00
Deidentified Minimum,,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,1235.00
Deidentified Minimum,,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,3544.00
Deidentified Minimum,,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,3544.00
Deidentified Minimum,,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,,4000.00
Deidentified Minimum,,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,,1678.88
Deidentified Minimum,,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,,3544.00
Deidentified Minimum,,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,1678.88
Deidentified Minimum,,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,1291.00
Deidentified Minimum,,25999,CPT4/HCPCS,FOREARM OR WRIST SURGERY,,,1145.00
Deidentified Minimum,,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,,1291.00
Deidentified Minimum,,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,,1291.00
Deidentified Minimum,,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,,1291.00
Deidentified Minimum,,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,,4000.00
Deidentified Minimum,,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,,1291.00
Deidentified Minimum,,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,,4000.00
Deidentified Minimum,,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,1678.88
Deidentified Minimum,,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,4000.00
Deidentified Minimum,,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,,3544.00
Deidentified Minimum,,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,,1291.00
Deidentified Minimum,,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,,1291.00
Deidentified Minimum,,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,,1291.00
Deidentified Minimum,,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,,1678.88
Deidentified Minimum,,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,,3544.00
Deidentified Minimum,,26499,CPT4/HCPCS,REVISION OF FINGER,,,3544.00
Deidentified Minimum,,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,,1291.00
Deidentified Minimum,,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,,3544.00
Deidentified Minimum,,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,,5029.00
Deidentified Minimum,,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,,5000.00
Deidentified Minimum,,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,,1291.00
Deidentified Minimum,,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,,1291.00
Deidentified Minimum,,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,,4847.00
Deidentified Minimum,,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,,1291.00
Deidentified Minimum,,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,,987.78
Deidentified Minimum,,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,,1145.00
Deidentified Minimum,,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,,1291.00
Deidentified Minimum,,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,400.00
Deidentified Minimum,,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,3965.00
Deidentified Minimum,,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,987.78
Deidentified Minimum,,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,,1145.00
Deidentified Minimum,,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,,1678.88
Deidentified Minimum,,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,,4847.00
Deidentified Minimum,,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,,3000.00
Deidentified Minimum,,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,,3544.00
Deidentified Minimum,,27075,CPT4/HCPCS,RESECT HIP TUMOR,,,1291.00
Deidentified Minimum,,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,,1678.88
Deidentified Minimum,,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,,1291.00
Deidentified Minimum,,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,,5783.00
Deidentified Minimum,,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,,4891.93
Deidentified Minimum,,27158,CPT4/HCPCS,REVISION OF PELVIS,,,1291.00
Deidentified Minimum,,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,,1291.00
Deidentified Minimum,,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,,1291.00
Deidentified Minimum,,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,,1291.00
Deidentified Minimum,,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,,1291.00
Deidentified Minimum,,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,,1678.88
Deidentified Minimum,,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,,1291.00
Deidentified Minimum,,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,,3965.00
Deidentified Minimum,,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,,1145.00
Deidentified Minimum,,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,,1145.00
Deidentified Minimum,,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,,1291.00
Deidentified Minimum,,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,,1235.00
Deidentified Minimum,,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,,987.78
Deidentified Minimum,,27267,CPT4/HCPCS,CLTX THIGH FX,,,1291.00
Deidentified Minimum,,27269,CPT4/HCPCS,OPTX THIGH FX,,,1291.00
Deidentified Minimum,,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,,1291.00
Deidentified Minimum,,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,,1291.00
Deidentified Minimum,,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,,1291.00
Deidentified Minimum,,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,,1678.88
Deidentified Minimum,,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,,4000.00
Deidentified Minimum,,27370,CPT4/HCPCS,INJECTION FOR KNEE X-RAY,,,1678.00
Deidentified Minimum,,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,,1678.00
Deidentified Minimum,,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,,3544.00
Deidentified Minimum,,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,,1678.00
Deidentified Minimum,,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,,1678.88
Deidentified Minimum,,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,,3544.00
Deidentified Minimum,,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,,3544.00
Deidentified Minimum,,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,,4847.00
Deidentified Minimum,,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,,5000.00
Deidentified Minimum,,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,,1678.88
Deidentified Minimum,,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,,3544.00
Deidentified Minimum,,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,1145.00
Deidentified Minimum,,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,1145.00
Deidentified Minimum,,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,1145.00
Deidentified Minimum,,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,,1145.00
Deidentified Minimum,,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,,1145.00
Deidentified Minimum,,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,,3000.00
Deidentified Minimum,,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,,3198.57
Deidentified Minimum,,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,,1145.00
Deidentified Minimum,,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,,3198.57
Deidentified Minimum,,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,,1145.00
Deidentified Minimum,,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,,1145.00
Deidentified Minimum,,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,,1678.88
Deidentified Minimum,,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,,1291.00
Deidentified Minimum,,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,,1678.88
Deidentified Minimum,,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,,1678.88
Deidentified Minimum,,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,,3000.00
Deidentified Minimum,,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,,4000.00
Deidentified Minimum,,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,,1678.88
Deidentified Minimum,,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,,1678.00
Deidentified Minimum,,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,,3544.00
Deidentified Minimum,,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,,3544.00
Deidentified Minimum,,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,,1678.88
Deidentified Minimum,,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,,1291.00
Deidentified Minimum,,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,,4891.93
Deidentified Minimum,,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,,1291.00
Deidentified Minimum,,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,,1678.88
Deidentified Minimum,,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,,1678.88
Deidentified Minimum,,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,,1678.88
Deidentified Minimum,,27745,CPT4/HCPCS,REINFORCE TIBIA,,,3544.00
Deidentified Minimum,,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,,1291.00
Deidentified Minimum,,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,,4000.00
Deidentified Minimum,,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,,1145.00
Deidentified Minimum,,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,3544.00
Deidentified Minimum,,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,3544.00
Deidentified Minimum,,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,,1145.00
Deidentified Minimum,,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,,1291.00
Deidentified Minimum,,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,,1291.00
Deidentified Minimum,,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,3544.00
Deidentified Minimum,,27899,CPT4/HCPCS,LEG/ANKLE SURGERY PROCEDURE,,,987.78
Deidentified Minimum,,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,,1678.88
Deidentified Minimum,,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,,1291.00
Deidentified Minimum,,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,,1678.00
Deidentified Minimum,,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,,3544.00
Deidentified Minimum,,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,,3544.00
Deidentified Minimum,,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,3544.00
Deidentified Minimum,,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,,1678.88
Deidentified Minimum,,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,,1678.88
Deidentified Minimum,,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,,4000.00
Deidentified Minimum,,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,,3544.00
Deidentified Minimum,,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,,3544.00
Deidentified Minimum,,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,,1678.88
Deidentified Minimum,,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,,400.00
Deidentified Minimum,,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,,1678.88
Deidentified Minimum,,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,,3544.00
Deidentified Minimum,,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,,400.00
Deidentified Minimum,,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,1291.00
Deidentified Minimum,,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,,400.00
Deidentified Minimum,,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,,3544.00
Deidentified Minimum,,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,,4000.00
Deidentified Minimum,,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,,1291.00
Deidentified Minimum,,29345,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,,400.00
Deidentified Minimum,,29358,CPT4/HCPCS,APPLY LONG LEG CAST BRACE,,,987.78
Deidentified Minimum,,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,,987.78
Deidentified Minimum,,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,,137.80
Deidentified Minimum,,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,,619.45
Deidentified Minimum,,29583,CPT4/HCPCS,APPLY MULTLAY COMPRS UPR ARM,,,1678.00
Deidentified Minimum,,29710,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,,987.78
Deidentified Minimum,,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,,987.78
Deidentified Minimum,,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,,3544.00
Deidentified Minimum,,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,,5000.00
Deidentified Minimum,,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,,1678.88
Deidentified Minimum,,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,,4000.00
Deidentified Minimum,,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,,3000.00
Deidentified Minimum,,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,,6049.05
Deidentified Minimum,,30210,CPT4/HCPCS,NASAL SINUS THERAPY,,,1291.00
Deidentified Minimum,,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,,5000.00
Deidentified Minimum,,30435,CPT4/HCPCS,REVISION OF NOSE,,,5000.00
Deidentified Minimum,,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,,3965.00
Deidentified Minimum,,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,,400.00
Deidentified Minimum,,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,,1145.00
Deidentified Minimum,,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,3544.00
Deidentified Minimum,,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,,1291.00
Deidentified Minimum,,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,1678.88
Deidentified Minimum,,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,,3000.00
Deidentified Minimum,,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,,1678.88
Deidentified Minimum,,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,3544.00
Deidentified Minimum,,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,1291.00
Deidentified Minimum,,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,,1291.00
Deidentified Minimum,,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,,1145.00
Deidentified Minimum,,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,,1291.00
Deidentified Minimum,,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,,1678.88
Deidentified Minimum,,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,,3000.00
Deidentified Minimum,,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,,4847.00
Deidentified Minimum,,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,,1291.00
Deidentified Minimum,,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,,1678.88
Deidentified Minimum,,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,,1678.00
Deidentified Minimum,,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,,1291.00
Deidentified Minimum,,31627,CPT4/HCPCS,NAVIGATIONAL BRONCHOSCOPY,,,1145.00
Deidentified Minimum,,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,,1678.88
Deidentified Minimum,,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,,1145.00
Deidentified Minimum,,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,,1678.88
Deidentified Minimum,,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,,1145.00
Deidentified Minimum,,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,,1678.88
Deidentified Minimum,,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,,1291.00
Deidentified Minimum,,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,,1678.88
Deidentified Minimum,,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,,1145.00
Deidentified Minimum,,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,,1291.00
Deidentified Minimum,,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,,1678.88
Deidentified Minimum,,31899,CPT4/HCPCS,AIRWAYS SURGICAL PROCEDURE,,,1145.00
Deidentified Minimum,,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,,1291.00
Deidentified Minimum,,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,,1291.00
Deidentified Minimum,,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,,1291.00
Deidentified Minimum,,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,,1291.00
Deidentified Minimum,,32420,CPT4/HCPCS,PUNCTURE/CLEAR LUNG,,,1678.00
Deidentified Minimum,,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,,1291.00
Deidentified Minimum,,32482,CPT4/HCPCS,BILOBECTOMY,,,1291.00
Deidentified Minimum,,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,,987.78
Deidentified Minimum,,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,,1235.00
Deidentified Minimum,,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,,3000.00
Deidentified Minimum,,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,,3544.00
Deidentified Minimum,,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,,3198.57
Deidentified Minimum,,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,,1291.00
Deidentified Minimum,,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,,1291.00
Deidentified Minimum,,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,,1291.00
Deidentified Minimum,,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,,3000.00
Deidentified Minimum,,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,,1291.00
Deidentified Minimum,,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,,1291.00
Deidentified Minimum,,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,,1291.00
Deidentified Minimum,,32940,CPT4/HCPCS,REVISION OF LUNG,,,1291.00
Deidentified Minimum,,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,,1291.00
Deidentified Minimum,,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,,4280.43
Deidentified Minimum,,33018,CPT4/HCPCS,PRCRD DRG 0-5YR OR W/ANOMLY,,,1291.00
Deidentified Minimum,,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,,1291.00
Deidentified Minimum,,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,,1291.00
Deidentified Minimum,,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,,1291.00
Deidentified Minimum,,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,,3000.00
Deidentified Minimum,,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,,3000.00
Deidentified Minimum,,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,,4000.00
Deidentified Minimum,,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,,4000.00
Deidentified Minimum,,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,,3000.00
Deidentified Minimum,,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,,1678.88
Deidentified Minimum,,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,,1291.00
Deidentified Minimum,,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,,3000.00
Deidentified Minimum,,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,,1678.88
Deidentified Minimum,,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,,1678.88
Deidentified Minimum,,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,,1678.88
Deidentified Minimum,,33254,CPT4/HCPCS,ABLATE ATRIA LMTD,,,1291.00
Deidentified Minimum,,33265,CPT4/HCPCS,ABLATE ATRIA LMTD ENDO,,,1291.00
Deidentified Minimum,,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,,3000.00
Deidentified Minimum,,33282,CPT4/HCPCS,IMPLANT PAT-ACTIVE HT RECORD,,,3544.00
Deidentified Minimum,,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,,1291.00
Deidentified Minimum,,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,,1291.00
Deidentified Minimum,,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,,1291.00
Deidentified Minimum,,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,,1291.00
Deidentified Minimum,,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,,1291.00
Deidentified Minimum,,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,,1291.00
Deidentified Minimum,,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,,1291.00
Deidentified Minimum,,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,,1291.00
Deidentified Minimum,,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,,1291.00
Deidentified Minimum,,33463,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,,1291.00
Deidentified Minimum,,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,,987.78
Deidentified Minimum,,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,,1291.00
Deidentified Minimum,,33505,CPT4/HCPCS,REPAIR ARTERY W/TUNNEL,,,1291.00
Deidentified Minimum,,33548,CPT4/HCPCS,RESTORE/REMODEL VENTRICLE,,,1291.00
Deidentified Minimum,,33602,CPT4/HCPCS,CLOSURE OF VALVE,,,1291.00
Deidentified Minimum,,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,,1291.00
Deidentified Minimum,,33670,CPT4/HCPCS,REPAIR OF HEART CHAMBERS,,,1291.00
Deidentified Minimum,,33688,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,,1291.00
Deidentified Minimum,,33692,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,1291.00
Deidentified Minimum,,33694,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,1291.00
Deidentified Minimum,,33732,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT,,,1291.00
Deidentified Minimum,,33736,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,1291.00
Deidentified Minimum,,33750,CPT4/HCPCS,MAJOR VESSEL SHUNT,,,1291.00
Deidentified Minimum,,33764,CPT4/HCPCS,MAJOR VESSEL SHUNT & GRAFT,,,1291.00
Deidentified Minimum,,33780,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1291.00
Deidentified Minimum,,33802,CPT4/HCPCS,REPAIR VESSEL DEFECT,,,1291.00
Deidentified Minimum,,33814,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,,1291.00
Deidentified Minimum,,33852,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,,1291.00
Deidentified Minimum,,33858,CPT4/HCPCS,AS-AORT GRF F/AORTIC DSJ,,,1291.00
Deidentified Minimum,,33866,CPT4/HCPCS,AORTIC HEMIARCH GRAFT,,,1145.00
Deidentified Minimum,,33910,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,,1291.00
Deidentified Minimum,,33915,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,,1291.00
Deidentified Minimum,,33917,CPT4/HCPCS,REPAIR PULMONARY ARTERY,,,1291.00
Deidentified Minimum,,33924,CPT4/HCPCS,REMOVE PULMONARY SHUNT,,,1291.00
Deidentified Minimum,,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,,1291.00
Deidentified Minimum,,33933,CPT4/HCPCS,PREPARE DONOR HEART/LUNG,,,1291.00
Deidentified Minimum,,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,,987.78
Deidentified Minimum,,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,,987.78
Deidentified Minimum,,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,,987.78
Deidentified Minimum,,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,987.78
Deidentified Minimum,,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,,987.78
Deidentified Minimum,,33975,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,,1291.00
Deidentified Minimum,,33980,CPT4/HCPCS,REMOVE INTRACORPOREAL DEVICE,,,1291.00
Deidentified Minimum,,33982,CPT4/HCPCS,REPLACE VAD INTRA W/O BP,,,1291.00
Deidentified Minimum,,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,,987.78
Deidentified Minimum,,33999,CPT4/HCPCS,CARDIAC SURGERY PROCEDURE,,,1235.00
Deidentified Minimum,,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,,1291.00
Deidentified Minimum,,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,,1145.00
Deidentified Minimum,,34826,CPT4/HCPCS,ENDOVASC EXTEN PROSTH ADDL,,,1678.88
Deidentified Minimum,,34900,CPT4/HCPCS,ENDOVASC ILIAC REPR W/GRAFT,,,5281.00
Deidentified Minimum,,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,,1291.00
Deidentified Minimum,,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,3544.00
Deidentified Minimum,,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,,3198.57
Deidentified Minimum,,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,,1291.00
Deidentified Minimum,,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,3000.00
Deidentified Minimum,,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35306,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5281.00
Deidentified Minimum,,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35390,CPT4/HCPCS,REOPERATION CAROTID ADD-ON,,,1291.00
Deidentified Minimum,,35452,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,5029.00
Deidentified Minimum,,35475,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,5029.00
Deidentified Minimum,,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,,1291.00
Deidentified Minimum,,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,,1291.00
Deidentified Minimum,,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,,1291.00
Deidentified Minimum,,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,,1291.00
Deidentified Minimum,,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,,1291.00
Deidentified Minimum,,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,,1291.00
Deidentified Minimum,,35540,CPT4/HCPCS,ART BYP GRFT AORTBIFEMORAL,,,1291.00
Deidentified Minimum,,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,,1291.00
Deidentified Minimum,,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,,1291.00
Deidentified Minimum,,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,,1291.00
Deidentified Minimum,,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,,1291.00
Deidentified Minimum,,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,,1291.00
Deidentified Minimum,,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,,1291.00
Deidentified Minimum,,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,,1291.00
Deidentified Minimum,,35691,CPT4/HCPCS,ART TRNSPOSJ VERTBRL CAROTID,,,1291.00
Deidentified Minimum,,35693,CPT4/HCPCS,ART TRNSPOSJ SUBCLAVIAN,,,1291.00
Deidentified Minimum,,35694,CPT4/HCPCS,ART TRNSPOSJ SUBCLAV CAROTID,,,1291.00
Deidentified Minimum,,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,,1291.00
Deidentified Minimum,,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,,1291.00
Deidentified Minimum,,35721,CPT4/HCPCS,EXPLORATION FEMORAL ARTERY,,,3198.57
Deidentified Minimum,,35761,CPT4/HCPCS,EXPLORATION OF ARTERY/VEIN,,,3544.00
Deidentified Minimum,,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,,1291.00
Deidentified Minimum,,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,,1291.00
Deidentified Minimum,,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,,1291.00
Deidentified Minimum,,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,,1678.88
Deidentified Minimum,,36005,CPT4/HCPCS,INJECTION EXT VENOGRAPHY,,,1145.00
Deidentified Minimum,,36015,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,1145.00
Deidentified Minimum,,36147,CPT4/HCPCS,ACCESS AV DIAL GRFT FOR EVAL,,,1678.00
Deidentified Minimum,,36200,CPT4/HCPCS,PLACE CATHETER IN AORTA,,,1145.00
Deidentified Minimum,,36215,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,1145.00
Deidentified Minimum,,36217,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,1145.00
Deidentified Minimum,,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,,3000.00
Deidentified Minimum,,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,,1145.00
Deidentified Minimum,,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,,3000.00
Deidentified Minimum,,36415,CPT4/HCPCS,ROUTINE VENIPUNCTURE,,,0.00
Deidentified Minimum,,36416,CPT4/HCPCS,CAPILLARY BLOOD DRAW,,,1678.00
Deidentified Minimum,,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,,1145.00
Deidentified Minimum,,36470,CPT4/HCPCS,NJX SCLRSNT 1 INCMPTNT VEIN,,,1145.00
Deidentified Minimum,,36474,CPT4/HCPCS,ENDOVENOUS MCHNCHEM ADD-ON,,,1145.00
Deidentified Minimum,,36514,CPT4/HCPCS,APHERESIS PLASMA,,,1291.00
Deidentified Minimum,,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,,1235.00
Deidentified Minimum,,36571,CPT4/HCPCS,INSERT PICVAD CATH,,,3198.57
Deidentified Minimum,,36580,CPT4/HCPCS,REPLACE CVAD CATH,,,1235.00
Deidentified Minimum,,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,,1678.00
Deidentified Minimum,,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,,1235.00
Deidentified Minimum,,36591,CPT4/HCPCS,DRAW BLOOD OFF VENOUS DEVICE,,,1145.00
Deidentified Minimum,,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,,3544.00
Deidentified Minimum,,36833,CPT4/HCPCS,AV FISTULA REVISION,,,4000.00
Deidentified Minimum,,36861,CPT4/HCPCS,CANNULA DECLOTTING,,,3544.00
Deidentified Minimum,,36870,CPT4/HCPCS,PERCUT THROMBECT AV FISTULA,,,1678.88
Deidentified Minimum,,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,,1678.88
Deidentified Minimum,,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,,1145.00
Deidentified Minimum,,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,,1145.00
Deidentified Minimum,,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,,1291.00
Deidentified Minimum,,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,,1145.00
Deidentified Minimum,,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,,1678.88
Deidentified Minimum,,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,,1235.00
Deidentified Minimum,,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,,3000.00
Deidentified Minimum,,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,,1678.88
Deidentified Minimum,,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,,1678.88
Deidentified Minimum,,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,,3000.00
Deidentified Minimum,,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,,3000.00
Deidentified Minimum,,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,,3000.00
Deidentified Minimum,,37501,CPT4/HCPCS,VASCULAR ENDOSCOPY PROCEDURE,,,1235.00
Deidentified Minimum,,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,,3544.00
Deidentified Minimum,,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,,1291.00
Deidentified Minimum,,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,,3544.00
Deidentified Minimum,,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,,3544.00
Deidentified Minimum,,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,,3544.00
Deidentified Minimum,,37799,CPT4/HCPCS,VASCULAR SURGERY PROCEDURE,,,1235.00
Deidentified Minimum,,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,,1291.00
Deidentified Minimum,,38200,CPT4/HCPCS,INJECTION FOR SPLEEN X-RAY,,,1145.00
Deidentified Minimum,,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,,1145.00
Deidentified Minimum,,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,,1145.00
Deidentified Minimum,,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,,987.78
Deidentified Minimum,,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,,3000.00
Deidentified Minimum,,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,,1291.00
Deidentified Minimum,,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,,1678.88
Deidentified Minimum,,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,,1291.00
Deidentified Minimum,,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,,1678.88
Deidentified Minimum,,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,,3000.00
Deidentified Minimum,,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,,1291.00
Deidentified Minimum,,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,,3000.00
Deidentified Minimum,,39499,CPT4/HCPCS,CHEST PROCEDURE,,,1291.00
Deidentified Minimum,,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,,1291.00
Deidentified Minimum,,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,,1291.00
Deidentified Minimum,,40490,CPT4/HCPCS,BIOPSY OF LIP,,,1145.00
Deidentified Minimum,,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,,1291.00
Deidentified Minimum,,40652,CPT4/HCPCS,REPAIR LIP,,,1145.00
Deidentified Minimum,,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1145.00
Deidentified Minimum,,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,,1145.00
Deidentified Minimum,,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,,1291.00
Deidentified Minimum,,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,,987.78
Deidentified Minimum,,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1145.00
Deidentified Minimum,,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1678.00
Deidentified Minimum,,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,,1678.00
Deidentified Minimum,,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,,1235.00
Deidentified Minimum,,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,,1291.00
Deidentified Minimum,,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,,5000.00
Deidentified Minimum,,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,,1291.00
Deidentified Minimum,,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,,1291.00
Deidentified Minimum,,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,,1291.00
Deidentified Minimum,,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,,1678.88
Deidentified Minimum,,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,,1678.88
Deidentified Minimum,,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,5730.00
Deidentified Minimum,,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,,3544.00
Deidentified Minimum,,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,,1291.00
Deidentified Minimum,,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,,3544.00
Deidentified Minimum,,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,,4000.00
Deidentified Minimum,,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,,4000.00
Deidentified Minimum,,42699,CPT4/HCPCS,SALIVARY SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,,1145.00
Deidentified Minimum,,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,,1291.00
Deidentified Minimum,,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,,1678.00
Deidentified Minimum,,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,,3544.00
Deidentified Minimum,,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,,1291.00
Deidentified Minimum,,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,,1291.00
Deidentified Minimum,,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,,1291.00
Deidentified Minimum,,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,,1678.00
Deidentified Minimum,,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,,1291.00
Deidentified Minimum,,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,,1291.00
Deidentified Minimum,,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,,1291.00
Deidentified Minimum,,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,,1291.00
Deidentified Minimum,,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,,1291.00
Deidentified Minimum,,43228,CPT4/HCPCS,ESOPH ENDOSCOPY ABLATION,,,1678.88
Deidentified Minimum,,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,,1291.00
Deidentified Minimum,,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,,1291.00
Deidentified Minimum,,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,,1291.00
Deidentified Minimum,,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,,1291.00
Deidentified Minimum,,43256,CPT4/HCPCS,UPPR GI ENDOSCOPY W/STENT,,,1678.00
Deidentified Minimum,,43267,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Minimum,,43270,CPT4/HCPCS,EGD LESION ABLATION,,,1291.00
Deidentified Minimum,,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,,1145.00
Deidentified Minimum,,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,,3000.00
Deidentified Minimum,,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43350,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,,5783.00
Deidentified Minimum,,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,,1291.00
Deidentified Minimum,,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,,1291.00
Deidentified Minimum,,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,,1291.00
Deidentified Minimum,,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,,1291.00
Deidentified Minimum,,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,,1291.00
Deidentified Minimum,,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,,3198.57
Deidentified Minimum,,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,,1291.00
Deidentified Minimum,,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,,1291.00
Deidentified Minimum,,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,,987.78
Deidentified Minimum,,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,,1291.00
Deidentified Minimum,,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,,1291.00
Deidentified Minimum,,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,,1291.00
Deidentified Minimum,,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,,1291.00
Deidentified Minimum,,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,,1291.00
Deidentified Minimum,,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,1291.00
Deidentified Minimum,,44157,CPT4/HCPCS,COLECTOMY W/ILEOANAL ANAST,,,1291.00
Deidentified Minimum,,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,,3198.57
Deidentified Minimum,,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,,1291.00
Deidentified Minimum,,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,,1291.00
Deidentified Minimum,,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,,1291.00
Deidentified Minimum,,44320,CPT4/HCPCS,COLOSTOMY,,,1291.00
Deidentified Minimum,,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,,1291.00
Deidentified Minimum,,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,,1291.00
Deidentified Minimum,,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,,1291.00
Deidentified Minimum,,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,,1291.00
Deidentified Minimum,,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,,1291.00
Deidentified Minimum,,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,,1291.00
Deidentified Minimum,,44701,CPT4/HCPCS,INTRAOP COLON LAVAGE ADD-ON,,,1145.00
Deidentified Minimum,,44901,CPT4/HCPCS,DRAIN APP ABSCESS PERCUT,,,1678.88
Deidentified Minimum,,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,,1291.00
Deidentified Minimum,,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,,1291.00
Deidentified Minimum,,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,,1291.00
Deidentified Minimum,,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,,1291.00
Deidentified Minimum,,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,,1291.00
Deidentified Minimum,,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,,1291.00
Deidentified Minimum,,45355,CPT4/HCPCS,SURGICAL COLONOSCOPY,,,1678.00
Deidentified Minimum,,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,,1291.00
Deidentified Minimum,,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,,1291.00
Deidentified Minimum,,45395,CPT4/HCPCS,LAP REMOVAL OF RECTUM,,,1291.00
Deidentified Minimum,,45397,CPT4/HCPCS,LAP REMOVE RECTUM W/POUCH,,,1291.00
Deidentified Minimum,,45402,CPT4/HCPCS,LAP PROCTOPEXY W/SIG RESECT,,,1291.00
Deidentified Minimum,,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,,987.78
Deidentified Minimum,,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,,1291.00
Deidentified Minimum,,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,,1291.00
Deidentified Minimum,,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,,1291.00
Deidentified Minimum,,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,,1235.00
Deidentified Minimum,,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,,1235.00
Deidentified Minimum,,46606,CPT4/HCPCS,ANOSCOPY AND BIOPSY,,,1291.00
Deidentified Minimum,,46611,CPT4/HCPCS,ANOSCOPY,,,1291.00
Deidentified Minimum,,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,,1678.00
Deidentified Minimum,,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,,1291.00
Deidentified Minimum,,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,,1291.00
Deidentified Minimum,,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,,1678.00
Deidentified Minimum,,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,,1678.00
Deidentified Minimum,,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,,1291.00
Deidentified Minimum,,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,,1291.00
Deidentified Minimum,,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,,1291.00
Deidentified Minimum,,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,,1291.00
Deidentified Minimum,,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,,1291.00
Deidentified Minimum,,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,,1291.00
Deidentified Minimum,,50940,CPT4/HCPCS,RELEASE OF URETER,,,1291.00
Deidentified Minimum,,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,,5000.00
Deidentified Minimum,,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,,1235.00
Deidentified Minimum,,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,,1291.00
Deidentified Minimum,,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,,1678.00
Deidentified Minimum,,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,,3198.57
Deidentified Minimum,,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,,1291.00
Deidentified Minimum,,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,,1291.00
Deidentified Minimum,,51703,CPT4/HCPCS,INSERT BLADDER CATH COMPLEX,,,1145.00
Deidentified Minimum,,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,,1235.00
Deidentified Minimum,,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,,1291.00
Deidentified Minimum,,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,,3000.00
Deidentified Minimum,,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,,3000.00
Deidentified Minimum,,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,,1291.00
Deidentified Minimum,,52000,CPT4/HCPCS,CYSTOSCOPY,,,1235.00
Deidentified Minimum,,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,,1235.00
Deidentified Minimum,,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,,1678.88
Deidentified Minimum,,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,,1678.88
Deidentified Minimum,,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,,3544.00
Deidentified Minimum,,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,,3544.00
Deidentified Minimum,,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,,1678.88
Deidentified Minimum,,52450,CPT4/HCPCS,INCISION OF PROSTATE,,,3544.00
Deidentified Minimum,,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,,1678.88
Deidentified Minimum,,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,,1678.88
Deidentified Minimum,,53010,CPT4/HCPCS,INCISION OF URETHRA,,,1678.00
Deidentified Minimum,,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,,3544.00
Deidentified Minimum,,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,,2002.00
Deidentified Minimum,,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,,1678.00
Deidentified Minimum,,53460,CPT4/HCPCS,REVISION OF URETHRA,,,1678.00
Deidentified Minimum,,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,,1235.00
Deidentified Minimum,,53660,CPT4/HCPCS,DILATION OF URETHRA,,,400.00
Deidentified Minimum,,53854,CPT4/HCPCS,TRURL DSTRJ PRST8 TISS RF WV,,,3544.00
Deidentified Minimum,,54015,CPT4/HCPCS,DRAIN PENIS LESION,,,1291.00
Deidentified Minimum,,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,,987.78
Deidentified Minimum,,54100,CPT4/HCPCS,BIOPSY OF PENIS,,,1291.00
Deidentified Minimum,,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,,1678.00
Deidentified Minimum,,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,,1678.00
Deidentified Minimum,,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,,1678.00
Deidentified Minimum,,54200,CPT4/HCPCS,TREATMENT OF PENIS LESION,,,987.78
Deidentified Minimum,,54250,CPT4/HCPCS,PENIS STUDY,,,400.00
Deidentified Minimum,,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,4000.00
Deidentified Minimum,,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,4000.00
Deidentified Minimum,,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,1678.88
Deidentified Minimum,,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,,3000.00
Deidentified Minimum,,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,,4000.00
Deidentified Minimum,,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,,4000.00
Deidentified Minimum,,54380,CPT4/HCPCS,REPAIR PENIS,,,4000.00
Deidentified Minimum,,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,,4000.00
Deidentified Minimum,,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,,4000.00
Deidentified Minimum,,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,,4000.00
Deidentified Minimum,,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,,1678.00
Deidentified Minimum,,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,,3965.00
Deidentified Minimum,,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,,3544.00
Deidentified Minimum,,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,,3544.00
Deidentified Minimum,,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,,5000.00
Deidentified Minimum,,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,,3544.00
Deidentified Minimum,,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,,3965.00
Deidentified Minimum,,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,,3965.00
Deidentified Minimum,,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,,3965.00
Deidentified Minimum,,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,,3965.00
Deidentified Minimum,,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,,4847.00
Deidentified Minimum,,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,,3965.00
Deidentified Minimum,,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,,4847.00
Deidentified Minimum,,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,,1291.00
Deidentified Minimum,,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,1291.00
Deidentified Minimum,,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,,1291.00
Deidentified Minimum,,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,1291.00
Deidentified Minimum,,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,,1291.00
Deidentified Minimum,,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,,1145.00
Deidentified Minimum,,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,3198.57
Deidentified Minimum,,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,3198.57
Deidentified Minimum,,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,,400.00
Deidentified Minimum,,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,,1678.88
Deidentified Minimum,,57100,CPT4/HCPCS,BIOPSY OF VAGINA,,,987.78
Deidentified Minimum,,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,,1291.00
Deidentified Minimum,,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,,1678.88
Deidentified Minimum,,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,,1145.00
Deidentified Minimum,,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,,4847.00
Deidentified Minimum,,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,,1145.00
Deidentified Minimum,,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,,3000.00
Deidentified Minimum,,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,,1678.00
Deidentified Minimum,,57410,CPT4/HCPCS,PELVIC EXAMINATION,,,1678.00
Deidentified Minimum,,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,,3000.00
Deidentified Minimum,,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,,987.78
Deidentified Minimum,,57720,CPT4/HCPCS,REVISION OF CERVIX,,,3544.00
Deidentified Minimum,,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,,4847.00
Deidentified Minimum,,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,,1291.00
Deidentified Minimum,,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,,3198.57
Deidentified Minimum,,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,,3198.57
Deidentified Minimum,,58290,CPT4/HCPCS,VAG HYST COMPLEX,,,3000.00
Deidentified Minimum,,58301,CPT4/HCPCS,REMOVE INTRAUTERINE DEVICE,,,987.78
Deidentified Minimum,,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,,1678.00
Deidentified Minimum,,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,,1291.00
Deidentified Minimum,,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,,5000.00
Deidentified Minimum,,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,,5000.00
Deidentified Minimum,,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,,1678.88
Deidentified Minimum,,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,,1678.88
Deidentified Minimum,,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,,6612.00
Deidentified Minimum,,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,,6612.00
Deidentified Minimum,,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,,5000.00
Deidentified Minimum,,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,,3000.00
Deidentified Minimum,,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,,3000.00
Deidentified Minimum,,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,,3544.00
Deidentified Minimum,,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,,3000.00
Deidentified Minimum,,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,,3000.00
Deidentified Minimum,,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,,3000.00
Deidentified Minimum,,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,,1291.00
Deidentified Minimum,,58956,CPT4/HCPCS,BSO OMENTECTOMY W/TAH,,,1291.00
Deidentified Minimum,,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,,3000.00
Deidentified Minimum,,58999,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,,1235.00
Deidentified Minimum,,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,,1145.00
Deidentified Minimum,,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,1291.00
Deidentified Minimum,,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,1291.00
Deidentified Minimum,,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,1291.00
Deidentified Minimum,,59320,CPT4/HCPCS,REVISION OF CERVIX,,,2002.00
Deidentified Minimum,,59350,CPT4/HCPCS,REPAIR OF UTERUS,,,4280.43
Deidentified Minimum,,59618,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY,,,4891.93
Deidentified Minimum,,59620,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY ONLY,,,4891.93
Deidentified Minimum,,59840,CPT4/HCPCS,ABORTION,,,3544.00
Deidentified Minimum,,59856,CPT4/HCPCS,ABORTION,,,1291.00
Deidentified Minimum,,59898,CPT4/HCPCS,LAPARO PROC OB CARE/DELIVER,,,3000.00
Deidentified Minimum,,59899,CPT4/HCPCS,MATERNITY CARE PROCEDURE,,,987.78
Deidentified Minimum,,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,,1291.00
Deidentified Minimum,,60200,CPT4/HCPCS,REMOVE THYROID LESION,,,1678.88
Deidentified Minimum,,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,,1291.00
Deidentified Minimum,,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,,3000.00
Deidentified Minimum,,60522,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,,1291.00
Deidentified Minimum,,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,,3000.00
Deidentified Minimum,,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,,1145.00
Deidentified Minimum,,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,,1235.00
Deidentified Minimum,,61105,CPT4/HCPCS,TWIST DRILL HOLE,,,1291.00
Deidentified Minimum,,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,,1291.00
Deidentified Minimum,,61315,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,1291.00
Deidentified Minimum,,61321,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,1291.00
Deidentified Minimum,,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,,1291.00
Deidentified Minimum,,61490,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,,6588.00
Deidentified Minimum,,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,,1291.00
Deidentified Minimum,,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,,1291.00
Deidentified Minimum,,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,1291.00
Deidentified Minimum,,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,1291.00
Deidentified Minimum,,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,1291.00
Deidentified Minimum,,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,1291.00
Deidentified Minimum,,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,1291.00
Deidentified Minimum,,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,,1291.00
Deidentified Minimum,,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,,1291.00
Deidentified Minimum,,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,,1291.00
Deidentified Minimum,,61610,CPT4/HCPCS,TRANSECT ARTERY SINUS,,,4280.43
Deidentified Minimum,,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,,1291.00
Deidentified Minimum,,61619,CPT4/HCPCS,REPAIR DURA,,,1291.00
Deidentified Minimum,,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,,1291.00
Deidentified Minimum,,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,,1291.00
Deidentified Minimum,,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,1291.00
Deidentified Minimum,,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,1291.00
Deidentified Minimum,,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,,1291.00
Deidentified Minimum,,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,,1291.00
Deidentified Minimum,,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,,1145.00
Deidentified Minimum,,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,,935.23
Deidentified Minimum,,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,,1291.00
Deidentified Minimum,,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,,1291.00
Deidentified Minimum,,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,,1291.00
Deidentified Minimum,,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,,1291.00
Deidentified Minimum,,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,,1291.00
Deidentified Minimum,,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,1291.00
Deidentified Minimum,,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,,1235.00
Deidentified Minimum,,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,,3452.00
Deidentified Minimum,,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,,1235.00
Deidentified Minimum,,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,,1235.00
Deidentified Minimum,,62329,CPT4/HCPCS,THER SPI PNXR CSF FLUOR/CT,,,1235.00
Deidentified Minimum,,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,,1678.88
Deidentified Minimum,,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,,1678.88
Deidentified Minimum,,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,,1145.00
Deidentified Minimum,,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,,3000.00
Deidentified Minimum,,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,,3000.00
Deidentified Minimum,,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,,3452.00
Deidentified Minimum,,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,,2002.00
Deidentified Minimum,,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,,1678.88
Deidentified Minimum,,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,,1145.00
Deidentified Minimum,,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,,1145.00
Deidentified Minimum,,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,,1291.00
Deidentified Minimum,,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,1291.00
Deidentified Minimum,,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,,1291.00
Deidentified Minimum,,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,,1291.00
Deidentified Minimum,,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,,1291.00
Deidentified Minimum,,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,,3452.00
Deidentified Minimum,,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,,1291.00
Deidentified Minimum,,63295,CPT4/HCPCS,REPAIR LAMINECTOMY DEFECT,,,1291.00
Deidentified Minimum,,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,,1678.00
Deidentified Minimum,,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,,3452.00
Deidentified Minimum,,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,,1678.88
Deidentified Minimum,,64412,CPT4/HCPCS,N BLOCK INJ SPINAL ACCESSOR,,,1678.00
Deidentified Minimum,,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,,1235.00
Deidentified Minimum,,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,,1235.00
Deidentified Minimum,,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,,987.78
Deidentified Minimum,,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,,400.00
Deidentified Minimum,,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,,1145.00
Deidentified Minimum,,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,,1145.00
Deidentified Minimum,,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,,1145.00
Deidentified Minimum,,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,,1145.00
Deidentified Minimum,,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,,1235.00
Deidentified Minimum,,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,,1145.00
Deidentified Minimum,,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,,1235.00
Deidentified Minimum,,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1678.00
Deidentified Minimum,,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,,2002.00
Deidentified Minimum,,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,,1678.88
Deidentified Minimum,,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,,400.00
Deidentified Minimum,,64613,CPT4/HCPCS,DESTROY NERVE NECK MUSCLE,,,1678.00
Deidentified Minimum,,64625,CPT4/HCPCS,RF ABLTJ NRV NRVTG SI JT,,,1678.88
Deidentified Minimum,,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,,1678.00
Deidentified Minimum,,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,,1145.00
Deidentified Minimum,,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,,1291.00
Deidentified Minimum,,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,,3452.00
Deidentified Minimum,,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,,3452.00
Deidentified Minimum,,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,,3452.00
Deidentified Minimum,,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,,3452.00
Deidentified Minimum,,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,,3452.00
Deidentified Minimum,,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,,3452.00
Deidentified Minimum,,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,,1145.00
Deidentified Minimum,,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,,1678.88
Deidentified Minimum,,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,,1678.88
Deidentified Minimum,,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,,3452.00
Deidentified Minimum,,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,,1291.00
Deidentified Minimum,,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,,1678.88
Deidentified Minimum,,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,,1678.88
Deidentified Minimum,,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,987.78
Deidentified Minimum,,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,3452.00
Deidentified Minimum,,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,,1678.88
Deidentified Minimum,,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,,1291.00
Deidentified Minimum,,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,,3452.00
Deidentified Minimum,,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,,1678.88
Deidentified Minimum,,65805,CPT4/HCPCS,DRAINAGE OF EYE,,,1678.00
Deidentified Minimum,,65815,CPT4/HCPCS,DRAINAGE OF EYE,,,1678.88
Deidentified Minimum,,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,,1235.00
Deidentified Minimum,,65900,CPT4/HCPCS,REMOVE EYE LESION,,,3452.00
Deidentified Minimum,,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,,1291.00
Deidentified Minimum,,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,,1291.00
Deidentified Minimum,,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,,3000.00
Deidentified Minimum,,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,,1678.00
Deidentified Minimum,,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,,1678.00
Deidentified Minimum,,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,,1678.88
Deidentified Minimum,,66762,CPT4/HCPCS,REVISION OF IRIS,,,1235.00
Deidentified Minimum,,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,,1235.00
Deidentified Minimum,,66930,CPT4/HCPCS,EXTRACTION OF LENS,,,3452.00
Deidentified Minimum,,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,,3452.00
Deidentified Minimum,,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,,1145.00
Deidentified Minimum,,66999,CPT4/HCPCS,EYE SURGERY PROCEDURE,,,1291.00
Deidentified Minimum,,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,,3452.00
Deidentified Minimum,,67028,CPT4/HCPCS,INJECTION EYE DRUG,,,1145.00
Deidentified Minimum,,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,,3452.00
Deidentified Minimum,,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,,3452.00
Deidentified Minimum,,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,,1678.88
Deidentified Minimum,,67141,CPT4/HCPCS,TREATMENT OF RETINA,,,1145.00
Deidentified Minimum,,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,,1235.00
Deidentified Minimum,,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,,1145.00
Deidentified Minimum,,67299,CPT4/HCPCS,EYE SURGERY PROCEDURE,,,1291.00
Deidentified Minimum,,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,,1145.00
Deidentified Minimum,,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,,1145.00
Deidentified Minimum,,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,,3452.00
Deidentified Minimum,,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,,1678.00
Deidentified Minimum,,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,,3452.00
Deidentified Minimum,,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,,1678.88
Deidentified Minimum,,67599,CPT4/HCPCS,ORBIT SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,67830,CPT4/HCPCS,REVISE EYELASHES,,,1291.00
Deidentified Minimum,,67835,CPT4/HCPCS,REVISE EYELASHES,,,1678.88
Deidentified Minimum,,67840,CPT4/HCPCS,REMOVE EYELID LESION,,,1291.00
Deidentified Minimum,,67850,CPT4/HCPCS,TREAT EYELID LESION,,,1291.00
Deidentified Minimum,,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,,1291.00
Deidentified Minimum,,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67966,CPT4/HCPCS,REVISION OF EYELID,,,3452.00
Deidentified Minimum,,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,,3452.00
Deidentified Minimum,,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,,1235.00
Deidentified Minimum,,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,,1678.88
Deidentified Minimum,,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,,3452.00
Deidentified Minimum,,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,,3452.00
Deidentified Minimum,,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,,1145.00
Deidentified Minimum,,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,,3452.00
Deidentified Minimum,,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,,3452.00
Deidentified Minimum,,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,,400.00
Deidentified Minimum,,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,,400.00
Deidentified Minimum,,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,,1145.00
Deidentified Minimum,,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,,1145.00
Deidentified Minimum,,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,,1678.88
Deidentified Minimum,,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,,1678.00
Deidentified Minimum,,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,,400.00
Deidentified Minimum,,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,,1291.00
Deidentified Minimum,,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,,987.78
Deidentified Minimum,,69421,CPT4/HCPCS,INCISION OF EARDRUM,,,1291.00
Deidentified Minimum,,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,,1145.00
Deidentified Minimum,,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,,3452.00
Deidentified Minimum,,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,,3452.00
Deidentified Minimum,,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,,1678.00
Deidentified Minimum,,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,,3000.00
Deidentified Minimum,,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,,3452.00
Deidentified Minimum,,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,,3000.00
Deidentified Minimum,,69806,CPT4/HCPCS,EXPLORE INNER EAR,,,3452.00
Deidentified Minimum,,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,,3452.00
Deidentified Minimum,,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,,3452.00
Deidentified Minimum,,69949,CPT4/HCPCS,INNER EAR SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,,3452.00
Deidentified Minimum,,70010,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,,142.00
Deidentified Minimum,,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,,142.00
Deidentified Minimum,,70310,CPT4/HCPCS,X-RAY EXAM OF TEETH,,,142.00
Deidentified Minimum,,70328,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,,142.00
Deidentified Minimum,,70332,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,,142.00
Deidentified Minimum,,70350,CPT4/HCPCS,X-RAY HEAD FOR ORTHODONTIA,,,102.39
Deidentified Minimum,,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,,1147.00
Deidentified Minimum,,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,,1147.00
Deidentified Minimum,,70557,CPT4/HCPCS,MRI BRAIN W/O DYE,,,1147.00
Deidentified Minimum,,71023,CPT4/HCPCS,CHEST X-RAY AND FLUOROSCOPY,,,0.00
Deidentified Minimum,,71047,CPT4/HCPCS,X-RAY EXAM CHEST 3 VIEWS,,,142.00
Deidentified Minimum,,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,,142.00
Deidentified Minimum,,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,,142.00
Deidentified Minimum,,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,,142.00
Deidentified Minimum,,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,,142.00
Deidentified Minimum,,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,,142.00
Deidentified Minimum,,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,,142.00
Deidentified Minimum,,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,,985.00
Deidentified Minimum,,72240,CPT4/HCPCS,MYELOGRAPHY NECK SPINE,,,142.00
Deidentified Minimum,,72255,CPT4/HCPCS,MYELOGRAPHY THORACIC SPINE,,,142.00
Deidentified Minimum,,72265,CPT4/HCPCS,MYELOGRAPHY L-S SPINE,,,142.00
Deidentified Minimum,,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,,142.00
Deidentified Minimum,,73219,CPT4/HCPCS,MRI UPPER EXTREMITY W/DYE,,,1147.00
Deidentified Minimum,,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,,1147.00
Deidentified Minimum,,73503,CPT4/HCPCS,X-RAY EXAM HIP UNI 4/> VIEWS,,,142.00
Deidentified Minimum,,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,,142.00
Deidentified Minimum,,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,,142.00
Deidentified Minimum,,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,,142.00
Deidentified Minimum,,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,,142.00
Deidentified Minimum,,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,,985.00
Deidentified Minimum,,73719,CPT4/HCPCS,MRI LOWER EXTREMITY W/DYE,,,1147.00
Deidentified Minimum,,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,,1147.00
Deidentified Minimum,,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,,1147.00
Deidentified Minimum,,74000,CPT4/HCPCS,X-RAY EXAM OF ABDOMEN,,,0.00
Deidentified Minimum,,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,,985.00
Deidentified Minimum,,74235,CPT4/HCPCS,REMOVE ESOPHAGUS OBSTRUCTION,,,142.00
Deidentified Minimum,,74247,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,,857.53
Deidentified Minimum,,74249,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,,1302.69
Deidentified Minimum,,74251,CPT4/HCPCS,X-RAY XM SM INT 2CNTRST STD,,,142.00
Deidentified Minimum,,74300,CPT4/HCPCS,X-RAY BILE DUCTS/PANCREAS,,,142.00
Deidentified Minimum,,74301,CPT4/HCPCS,X-RAYS AT SURGERY ADD-ON,,,142.00
Deidentified Minimum,,74329,CPT4/HCPCS,X-RAY FOR PANCREAS ENDOSCOPY,,,142.00
Deidentified Minimum,,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,,142.00
Deidentified Minimum,,74445,CPT4/HCPCS,X-RAY EXAM OF PENIS,,,142.00
Deidentified Minimum,,74455,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,,142.00
Deidentified Minimum,,74740,CPT4/HCPCS,X-RAY FEMALE GENITAL TRACT,,,142.00
Deidentified Minimum,,75563,CPT4/HCPCS,CARD MRI W/STRESS IMG & DYE,,,142.00
Deidentified Minimum,,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,,142.00
Deidentified Minimum,,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,,985.00
Deidentified Minimum,,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,,142.00
Deidentified Minimum,,75733,CPT4/HCPCS,ARTERY X-RAYS ADRENALS,,,142.00
Deidentified Minimum,,75791,CPT4/HCPCS,AV DIALYSIS SHUNT IMAGING,,,6500.00
Deidentified Minimum,,75810,CPT4/HCPCS,VEIN X-RAY SPLEEN/LIVER,,,142.00
Deidentified Minimum,,75898,CPT4/HCPCS,FOLLOW-UP ANGIOGRAPHY,,,142.00
Deidentified Minimum,,75953,CPT4/HCPCS,ABDOM ANEURYSM ENDOVAS RPR,,,6500.00
Deidentified Minimum,,75962,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,6500.00
Deidentified Minimum,,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,,142.00
Deidentified Minimum,,76101,CPT4/HCPCS,COMPLEX BODY SECTION X-RAY,,,142.00
Deidentified Minimum,,76120,CPT4/HCPCS,CINE/VIDEO X-RAYS,,,142.00
Deidentified Minimum,,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,,985.00
Deidentified Minimum,,76529,CPT4/HCPCS,ECHO EXAM OF EYE,,,282.48
Deidentified Minimum,,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,,553.00
Deidentified Minimum,,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,,553.00
Deidentified Minimum,,76812,CPT4/HCPCS,OB US DETAILED ADDL FETUS,,,543.39
Deidentified Minimum,,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,,522.64
Deidentified Minimum,,76945,CPT4/HCPCS,ECHO GUIDE VILLUS SAMPLING,,,515.92
Deidentified Minimum,,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,,436.80
Deidentified Minimum,,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,,3544.00
Deidentified Minimum,,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,,1678.00
Deidentified Minimum,,28055,CPT4/HCPCS,NEURECTOMY FOOT,,,3965.00
Deidentified Minimum,,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,,3544.00
Deidentified Minimum,,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,,3544.00
Deidentified Minimum,,28116,CPT4/HCPCS,REVISION OF FOOT,,,3544.00
Deidentified Minimum,,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,,3544.00
Deidentified Minimum,,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,,3544.00
Deidentified Minimum,,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,,1235.00
Deidentified Minimum,,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,,3544.00
Deidentified Minimum,,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,,1678.00
Deidentified Minimum,,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,,1678.00
Deidentified Minimum,,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,,1678.00
Deidentified Minimum,,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,,1678.00
Deidentified Minimum,,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,,3544.00
Deidentified Minimum,,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,,1678.00
Deidentified Minimum,,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,,1678.00
Deidentified Minimum,,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,1678.88
Deidentified Minimum,,28307,CPT4/HCPCS,INCISION OF METATARSAL,,,3965.00
Deidentified Minimum,,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,,1678.88
Deidentified Minimum,,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,1291.00
Deidentified Minimum,,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,,400.00
Deidentified Minimum,,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,,400.00
Deidentified Minimum,,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,,400.00
Deidentified Minimum,,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,1678.00
Deidentified Minimum,,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,1678.88
Deidentified Minimum,,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,,1678.88
Deidentified Minimum,,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,,3544.00
Deidentified Minimum,,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,,4000.00
Deidentified Minimum,,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,,4000.00
Deidentified Minimum,,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,,4000.00
Deidentified Minimum,,28890,CPT4/HCPCS,HI ENRGY ESWT PLANTAR FASCIA,,,3000.00
Deidentified Minimum,,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,,987.78
Deidentified Minimum,,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,,987.78
Deidentified Minimum,,29105,CPT4/HCPCS,APPLY LONG ARM SPLINT,,,987.78
Deidentified Minimum,,29200,CPT4/HCPCS,STRAPPING OF CHEST,,,987.78
Deidentified Minimum,,29365,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,,987.78
Deidentified Minimum,,29435,CPT4/HCPCS,APPLY SHORT LEG CAST,,,987.78
Deidentified Minimum,,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,,193.00
Deidentified Minimum,,29520,CPT4/HCPCS,STRAPPING OF HIP,,,138.45
Deidentified Minimum,,29550,CPT4/HCPCS,STRAPPING OF TOES,,,137.80
Deidentified Minimum,,29582,CPT4/HCPCS,APPLY MULTLAY COMPRS UPR LEG,,,1678.00
Deidentified Minimum,,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,,987.78
Deidentified Minimum,,29740,CPT4/HCPCS,WEDGING OF CAST,,,987.78
Deidentified Minimum,,29750,CPT4/HCPCS,WEDGING OF CLUBFOOT CAST,,,987.78
Deidentified Minimum,,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,,193.00
Deidentified Minimum,,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,,4000.00
Deidentified Minimum,,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,,5000.00
Deidentified Minimum,,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,,1145.00
Deidentified Minimum,,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,,4891.93
Deidentified Minimum,,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,,3544.00
Deidentified Minimum,,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,,1678.88
Deidentified Minimum,,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,,1678.88
Deidentified Minimum,,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,,3544.00
Deidentified Minimum,,30000,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,,400.00
Deidentified Minimum,,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,,1291.00
Deidentified Minimum,,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,,1678.00
Deidentified Minimum,,30300,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,,987.78
Deidentified Minimum,,30450,CPT4/HCPCS,REVISION OF NOSE,,,5281.00
Deidentified Minimum,,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,,1678.00
Deidentified Minimum,,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,,4000.00
Deidentified Minimum,,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,,5730.00
Deidentified Minimum,,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,,1291.00
Deidentified Minimum,,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,,1678.88
Deidentified Minimum,,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,,1678.88
Deidentified Minimum,,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,4000.00
Deidentified Minimum,,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,3544.00
Deidentified Minimum,,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,,1291.00
Deidentified Minimum,,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,,3000.00
Deidentified Minimum,,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,,3000.00
Deidentified Minimum,,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,,1678.88
Deidentified Minimum,,31320,CPT4/HCPCS,DIAGNOSTIC INCISION LARYNX,,,1678.88
Deidentified Minimum,,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,1291.00
Deidentified Minimum,,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,1291.00
Deidentified Minimum,,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,1291.00
Deidentified Minimum,,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,,3000.00
Deidentified Minimum,,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,,987.78
Deidentified Minimum,,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,,1291.00
Deidentified Minimum,,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,,1678.00
Deidentified Minimum,,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,,1678.88
Deidentified Minimum,,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,,1291.00
Deidentified Minimum,,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,,1678.88
Deidentified Minimum,,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,,3544.00
Deidentified Minimum,,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,,3000.00
Deidentified Minimum,,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,,3000.00
Deidentified Minimum,,31595,CPT4/HCPCS,LARYNX NERVE SURGERY,,,1678.88
Deidentified Minimum,,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,,1291.00
Deidentified Minimum,,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,,1678.88
Deidentified Minimum,,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,,1145.00
Deidentified Minimum,,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,,1291.00
Deidentified Minimum,,31651,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,,1145.00
Deidentified Minimum,,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,,1145.00
Deidentified Minimum,,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,,1145.00
Deidentified Minimum,,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,,1291.00
Deidentified Minimum,,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,,5000.00
Deidentified Minimum,,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,,1678.88
Deidentified Minimum,,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,,1291.00
Deidentified Minimum,,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,,1291.00
Deidentified Minimum,,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,,1291.00
Deidentified Minimum,,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,,1291.00
Deidentified Minimum,,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,,1291.00
Deidentified Minimum,,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,,1291.00
Deidentified Minimum,,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,,1291.00
Deidentified Minimum,,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,,1291.00
Deidentified Minimum,,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,,1291.00
Deidentified Minimum,,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,,1291.00
Deidentified Minimum,,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,,1291.00
Deidentified Minimum,,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,,1291.00
Deidentified Minimum,,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,,1235.00
Deidentified Minimum,,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,,987.78
Deidentified Minimum,,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,,3198.57
Deidentified Minimum,,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,,3198.57
Deidentified Minimum,,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,,3198.57
Deidentified Minimum,,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,,1291.00
Deidentified Minimum,,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,,1291.00
Deidentified Minimum,,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,,1291.00
Deidentified Minimum,,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,,1291.00
Deidentified Minimum,,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,,1291.00
Deidentified Minimum,,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,,1291.00
Deidentified Minimum,,32999,CPT4/HCPCS,CHEST SURGERY PROCEDURE,,,1235.00
Deidentified Minimum,,33017,CPT4/HCPCS,PRCRD DRG 6YR+ W/O CGEN CAR,,,1291.00
Deidentified Minimum,,33019,CPT4/HCPCS,PERQ PRCRD DRG INSJ CATH CT,,,1291.00
Deidentified Minimum,,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,,3000.00
Deidentified Minimum,,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,,1678.88
Deidentified Minimum,,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,,1678.88
Deidentified Minimum,,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,,3000.00
Deidentified Minimum,,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,,1678.88
Deidentified Minimum,,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,,1678.88
Deidentified Minimum,,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,,1291.00
Deidentified Minimum,,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,,3000.00
Deidentified Minimum,,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,1291.00
Deidentified Minimum,,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,1291.00
Deidentified Minimum,,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,,1291.00
Deidentified Minimum,,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,1291.00
Deidentified Minimum,,33266,CPT4/HCPCS,ABLATE ATRIA X10SV ENDO,,,1291.00
Deidentified Minimum,,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,,1291.00
Deidentified Minimum,,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,,1291.00
Deidentified Minimum,,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,,1291.00
Deidentified Minimum,,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,,1291.00
Deidentified Minimum,,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,,987.78
Deidentified Minimum,,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,,1291.00
Deidentified Minimum,,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,,1291.00
Deidentified Minimum,,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,,1291.00
Deidentified Minimum,,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,,1291.00
Deidentified Minimum,,33475,CPT4/HCPCS,REPLACEMENT PULMONARY VALVE,,,1291.00
Deidentified Minimum,,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,,1291.00
Deidentified Minimum,,33513,CPT4/HCPCS,CABG VEIN FOUR,,,1291.00
Deidentified Minimum,,33516,CPT4/HCPCS,CABG VEIN SIX OR MORE,,,1291.00
Deidentified Minimum,,33517,CPT4/HCPCS,CABG ARTERY-VEIN SINGLE,,,1291.00
Deidentified Minimum,,33534,CPT4/HCPCS,CABG ARTERIAL TWO,,,1291.00
Deidentified Minimum,,33535,CPT4/HCPCS,CABG ARTERIAL THREE,,,1291.00
Deidentified Minimum,,33608,CPT4/HCPCS,REPAIR ANOMALY W/CONDUIT,,,1291.00
Deidentified Minimum,,33611,CPT4/HCPCS,REPAIR DOUBLE VENTRICLE,,,1291.00
Deidentified Minimum,,33612,CPT4/HCPCS,REPAIR DOUBLE VENTRICLE,,,1291.00
Deidentified Minimum,,33681,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,,1291.00
Deidentified Minimum,,33684,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,,1291.00
Deidentified Minimum,,33690,CPT4/HCPCS,REINFORCE PULMONARY ARTERY,,,1291.00
Deidentified Minimum,,33737,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,1291.00
Deidentified Minimum,,33755,CPT4/HCPCS,MAJOR VESSEL SHUNT,,,1291.00
Deidentified Minimum,,33766,CPT4/HCPCS,MAJOR VESSEL SHUNT,,,1291.00
Deidentified Minimum,,33767,CPT4/HCPCS,MAJOR VESSEL SHUNT,,,1291.00
Deidentified Minimum,,33783,CPT4/HCPCS,NIKAIDOH PROC W/OSTIA IMPLT,,,1291.00
Deidentified Minimum,,33813,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,,1291.00
Deidentified Minimum,,33820,CPT4/HCPCS,REVISE MAJOR VESSEL,,,6588.00
Deidentified Minimum,,33891,CPT4/HCPCS,CAR-CAR BP GRFT/ENDOVAS TAA,,,1291.00
Deidentified Minimum,,33920,CPT4/HCPCS,REPAIR PULMONARY ATRESIA,,,1291.00
Deidentified Minimum,,33922,CPT4/HCPCS,TRANSECT PULMONARY ARTERY,,,1291.00
Deidentified Minimum,,33944,CPT4/HCPCS,PREPARE DONOR HEART,,,1291.00
Deidentified Minimum,,33960,CPT4/HCPCS,EXTERNAL CIRCULATION ASSIST,,,5281.00
Deidentified Minimum,,33978,CPT4/HCPCS,REMOVE VENTRICULAR DEVICE,,,1291.00
Deidentified Minimum,,33983,CPT4/HCPCS,REPLACE VAD INTRA W/BP,,,1291.00
Deidentified Minimum,,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,,987.78
Deidentified Minimum,,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,,987.78
Deidentified Minimum,,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,,987.78
Deidentified Minimum,,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,,3544.00
Deidentified Minimum,,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,,5281.00
Deidentified Minimum,,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,,1291.00
Deidentified Minimum,,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,,1291.00
Deidentified Minimum,,34808,CPT4/HCPCS,ENDOVAS ILIAC A DEVICE ADDON,,,1291.00
Deidentified Minimum,,34831,CPT4/HCPCS,OPEN AORTOILIAC PROSTH REPR,,,1291.00
Deidentified Minimum,,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,,987.78
Deidentified Minimum,,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,,987.78
Deidentified Minimum,,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,,1291.00
Deidentified Minimum,,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,,1291.00
Deidentified Minimum,,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35302,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35304,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35458,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,3544.00
Deidentified Minimum,,35471,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,5029.00
Deidentified Minimum,,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,,1145.00
Deidentified Minimum,,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,,1291.00
Deidentified Minimum,,35537,CPT4/HCPCS,ART BYP GRFT AORTOILIAC,,,1291.00
Deidentified Minimum,,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,,1291.00
Deidentified Minimum,,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,,1291.00
Deidentified Minimum,,35572,CPT4/HCPCS,HARVEST FEMOROPOPLITEAL VEIN,,,1145.00
Deidentified Minimum,,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,,1291.00
Deidentified Minimum,,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,,1291.00
Deidentified Minimum,,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,,1291.00
Deidentified Minimum,,35697,CPT4/HCPCS,REIMPLANT ARTERY EACH,,,1291.00
Deidentified Minimum,,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,,1291.00
Deidentified Minimum,,36010,CPT4/HCPCS,PLACE CATHETER IN VEIN,,,1145.00
Deidentified Minimum,,36011,CPT4/HCPCS,PLACE CATHETER IN VEIN,,,1145.00
Deidentified Minimum,,36013,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,1145.00
Deidentified Minimum,,36120,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,,1678.00
Deidentified Minimum,,36148,CPT4/HCPCS,ACCESS AV DIAL GRFT FOR PROC,,,1678.00
Deidentified Minimum,,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,,3000.00
Deidentified Minimum,,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,,1678.00
Deidentified Minimum,,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,,400.00
Deidentified Minimum,,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,,1145.00
Deidentified Minimum,,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,,400.00
Deidentified Minimum,,36481,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,,1145.00
Deidentified Minimum,,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,,3000.00
Deidentified Minimum,,36510,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,,1145.00
Deidentified Minimum,,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,,1235.00
Deidentified Minimum,,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,1678.88
Deidentified Minimum,,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,1678.88
Deidentified Minimum,,36573,CPT4/HCPCS,INSJ PICC RS&I 5 YR+,,,1291.00
Deidentified Minimum,,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,,1235.00
Deidentified Minimum,,36810,CPT4/HCPCS,INSERTION OF CANNULA,,,3544.00
Deidentified Minimum,,36815,CPT4/HCPCS,INSERTION OF CANNULA,,,3544.00
Deidentified Minimum,,36822,CPT4/HCPCS,INSERTION OF CANNULA(S),,,3544.00
Deidentified Minimum,,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,,3198.57
Deidentified Minimum,,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,,3544.00
Deidentified Minimum,,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,,4000.00
Deidentified Minimum,,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,,3000.00
Deidentified Minimum,,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,,3000.00
Deidentified Minimum,,37203,CPT4/HCPCS,TRANSCATHETER RETRIEVAL,,,3544.00
Deidentified Minimum,,37204,CPT4/HCPCS,TRANSCATHETER OCCLUSION,,,5029.00
Deidentified Minimum,,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,,1678.88
Deidentified Minimum,,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,,3000.00
Deidentified Minimum,,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,,1678.88
Deidentified Minimum,,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,,1678.88
Deidentified Minimum,,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,,987.78
Deidentified Minimum,,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,,987.78
Deidentified Minimum,,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,,1678.88
Deidentified Minimum,,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,,3544.00
Deidentified Minimum,,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,,3544.00
Deidentified Minimum,,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,,1235.00
Deidentified Minimum,,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,,3544.00
Deidentified Minimum,,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,,1291.00
Deidentified Minimum,,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,,1291.00
Deidentified Minimum,,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,,1145.00
Deidentified Minimum,,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,,1145.00
Deidentified Minimum,,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,,1291.00
Deidentified Minimum,,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,,1291.00
Deidentified Minimum,,38531,CPT4/HCPCS,OPEN BX/EXC INGUINOFEM NODES,,,1678.88
Deidentified Minimum,,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,,1291.00
Deidentified Minimum,,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,,1678.88
Deidentified Minimum,,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,,1291.00
Deidentified Minimum,,38792,CPT4/HCPCS,RA TRACER ID OF SENTINL NODE,,,1145.00
Deidentified Minimum,,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,,1291.00
Deidentified Minimum,,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,,1291.00
Deidentified Minimum,,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,,1291.00
Deidentified Minimum,,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,,1291.00
Deidentified Minimum,,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,,1678.88
Deidentified Minimum,,40654,CPT4/HCPCS,REPAIR LIP,,,1291.00
Deidentified Minimum,,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,,3000.00
Deidentified Minimum,,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,,1678.88
Deidentified Minimum,,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,,5000.00
Deidentified Minimum,,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,,5000.00
Deidentified Minimum,,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1291.00
Deidentified Minimum,,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1291.00
Deidentified Minimum,,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,,1145.00
Deidentified Minimum,,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,,1291.00
Deidentified Minimum,,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,,1291.00
Deidentified Minimum,,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,,1291.00
Deidentified Minimum,,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,,1291.00
Deidentified Minimum,,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,,1678.88
Deidentified Minimum,,41872,CPT4/HCPCS,REPAIR GUM,,,1678.88
Deidentified Minimum,,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,,1291.00
Deidentified Minimum,,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,,1291.00
Deidentified Minimum,,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,,1678.88
Deidentified Minimum,,42182,CPT4/HCPCS,REPAIR PALATE,,,1678.88
Deidentified Minimum,,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,5000.00
Deidentified Minimum,,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,,3965.00
Deidentified Minimum,,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,,1291.00
Deidentified Minimum,,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,,1291.00
Deidentified Minimum,,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,,987.78
Deidentified Minimum,,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,,3544.00
Deidentified Minimum,,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,,3544.00
Deidentified Minimum,,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,,5029.00
Deidentified Minimum,,42508,CPT4/HCPCS,PAROTID DUCT DIVERSION,,,5029.00
Deidentified Minimum,,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,,1291.00
Deidentified Minimum,,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,,1145.00
Deidentified Minimum,,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,,400.00
Deidentified Minimum,,42999,CPT4/HCPCS,THROAT SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,,1291.00
Deidentified Minimum,,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,,1291.00
Deidentified Minimum,,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,,1291.00
Deidentified Minimum,,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,,1291.00
Deidentified Minimum,,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,,1291.00
Deidentified Minimum,,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,,1291.00
Deidentified Minimum,,43244,CPT4/HCPCS,EGD VARICES LIGATION,,,1291.00
Deidentified Minimum,,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,,1291.00
Deidentified Minimum,,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,,1291.00
Deidentified Minimum,,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,,1678.88
Deidentified Minimum,,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Minimum,,43268,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Minimum,,43272,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Minimum,,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,,1678.88
Deidentified Minimum,,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,,3000.00
Deidentified Minimum,,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,,1291.00
Deidentified Minimum,,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,,1291.00
Deidentified Minimum,,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,,1291.00
Deidentified Minimum,,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,,1291.00
Deidentified Minimum,,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,,1291.00
Deidentified Minimum,,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,,1291.00
Deidentified Minimum,,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,,3000.00
Deidentified Minimum,,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,,1291.00
Deidentified Minimum,,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,,1291.00
Deidentified Minimum,,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,,1291.00
Deidentified Minimum,,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,,1291.00
Deidentified Minimum,,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,,3544.00
Deidentified Minimum,,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,,5000.00
Deidentified Minimum,,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,,5000.00
Deidentified Minimum,,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,,987.78
Deidentified Minimum,,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,,987.78
Deidentified Minimum,,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,,987.78
Deidentified Minimum,,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,,6588.00
Deidentified Minimum,,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,,1291.00
Deidentified Minimum,,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,,1291.00
Deidentified Minimum,,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,,1291.00
Deidentified Minimum,,43881,CPT4/HCPCS,IMPL/REDO ELECTRD ANTRUM,,,1291.00
Deidentified Minimum,,43882,CPT4/HCPCS,REVISE/REMOVE ELECTRD ANTRUM,,,1291.00
Deidentified Minimum,,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,,1291.00
Deidentified Minimum,,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,,1291.00
Deidentified Minimum,,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,,1291.00
Deidentified Minimum,,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,1291.00
Deidentified Minimum,,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,1291.00
Deidentified Minimum,,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,1291.00
Deidentified Minimum,,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,,1291.00
Deidentified Minimum,,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,,1291.00
Deidentified Minimum,,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,,1291.00
Deidentified Minimum,,44715,CPT4/HCPCS,PREPARE DONOR INTESTINE,,,1291.00
Deidentified Minimum,,44799,CPT4/HCPCS,UNLISTED PX SMALL INTESTINE,,,1291.00
Deidentified Minimum,,44950,CPT4/HCPCS,APPENDECTOMY,,,3000.00
Deidentified Minimum,,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,,3544.00
Deidentified Minimum,,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,,1291.00
Deidentified Minimum,,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,,3198.57
Deidentified Minimum,,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,,1291.00
Deidentified Minimum,,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,,3000.00
Deidentified Minimum,,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,,1291.00
Deidentified Minimum,,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,,1678.00
Deidentified Minimum,,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,,1291.00
Deidentified Minimum,,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,,1291.00
Deidentified Minimum,,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,,1291.00
Deidentified Minimum,,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,,1291.00
Deidentified Minimum,,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,,1291.00
Deidentified Minimum,,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,,1291.00
Deidentified Minimum,,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,,1291.00
Deidentified Minimum,,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,,1291.00
Deidentified Minimum,,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,,1291.00
Deidentified Minimum,,45499,CPT4/HCPCS,LAPAROSCOPE PROC RECTUM,,,3000.00
Deidentified Minimum,,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,,1291.00
Deidentified Minimum,,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,,1291.00
Deidentified Minimum,,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,,3965.00
Deidentified Minimum,,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,,1678.00
Deidentified Minimum,,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,,1291.00
Deidentified Minimum,,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,,1291.00
Deidentified Minimum,,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,,1291.00
Deidentified Minimum,,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,,1291.00
Deidentified Minimum,,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,,1291.00
Deidentified Minimum,,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,,1291.00
Deidentified Minimum,,0042T,CPT4/HCPCS,CT PERFUSION W/CONTRAST CBF,,,4399.00
Deidentified Minimum,,0101T,CPT4/HCPCS,EXTRACORP SHOCKWV TX HI ENRG,,,1678.88
Deidentified Minimum,,0102T,CPT4/HCPCS,EXTRACORP SHOCKWV TX ANESTH,,,3544.00
Deidentified Minimum,,0164T,CPT4/HCPCS,REMOVE LUMB ARTIF DISC ADDL,,,1291.00
Deidentified Minimum,,0201T,CPT4/HCPCS,PERQ SACRAL AUGMT BILAT INJ,,,3198.57
Deidentified Minimum,,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,,987.78
Deidentified Minimum,,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,,987.78
Deidentified Minimum,,0262T,CPT4/HCPCS,IMPLTJ PULM VLV EVASC APPR,,,8012.00
Deidentified Minimum,,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,,1678.88
Deidentified Minimum,,0281T,CPT4/HCPCS,LAA CLOSURE W/IMPLANT,,,5783.00
Deidentified Minimum,,0293T,CPT4/HCPCS,INS LT ATRL PRESS MONITOR,,,6588.00
Deidentified Minimum,,0295T,CPT4/HCPCS,EXT ECG COMPLETE,,,987.78
Deidentified Minimum,,0309T,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L4/L5,,,5783.00
Deidentified Minimum,,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,,1145.00
Deidentified Minimum,,0320T,CPT4/HCPCS,INSERT SUBQ DEFIB ELECTRODE,,,5029.00
Deidentified Minimum,,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,,987.78
Deidentified Minimum,,0393T,CPT4/HCPCS,ES SPH AUGMNT DEVICE REMOVAL,,,1678.88
Deidentified Minimum,,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,,1678.88
Deidentified Minimum,,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,,1235.00
Deidentified Minimum,,0425T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA SEN LD,,,1678.00
Deidentified Minimum,,0437T,CPT4/HCPCS,IMPLTJ SYNTH RNFCMT ABDL WAL,,,1145.00
Deidentified Minimum,,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,,1678.88
Deidentified Minimum,,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,,987.78
Deidentified Minimum,,0467T,CPT4/HCPCS,REVJ/RPLMNT CH RESPIR ELTRD,,,1678.88
Deidentified Minimum,,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,,1291.00
Deidentified Minimum,,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,,1291.00
Deidentified Minimum,,0495T,CPT4/HCPCS,MNTR CDVR DON LNG 1ST 2 HRS,,,1291.00
Deidentified Minimum,,0518T,CPT4/HCPCS,RMVL PG COMPNT WCS,,,1678.88
Deidentified Minimum,,0520T,CPT4/HCPCS,RMVL&RPLCMT PG WCS NEW ELTRD,,,5281.00
Deidentified Minimum,,0565T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS HRVG,,,1145.00
Deidentified Minimum,,0566T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS NJX,,,1145.00
Deidentified Minimum,,0572T,CPT4/HCPCS,INSERTION SS DFB ELECTRODE,,,1291.00
Deidentified Minimum,,0579T,CPT4/HCPCS,REM INTERROG DEV ICDS TECH,,,1291.00
Deidentified Minimum,,0580T,CPT4/HCPCS,RMVL SS IMPL DFB PG ONLY,,,1291.00
Deidentified Minimum,,0582T,CPT4/HCPCS,TRURL ABLTJ MAL PRST8 TISS,,,1291.00
Deidentified Minimum,,10006,CPT4/HCPCS,FNA BX W/US GDN EA ADDL,,,1145.00
Deidentified Minimum,,10010,CPT4/HCPCS,FNA BX W/CT GDN EA ADDL,,,1145.00
Deidentified Minimum,,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,,1235.00
Deidentified Minimum,,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,,1235.00
Deidentified Minimum,,11045,CPT4/HCPCS,DEB SUBQ TISSUE ADD-ON,,,1145.00
Deidentified Minimum,,11047,CPT4/HCPCS,DEB BONE ADD-ON,,,1145.00
Deidentified Minimum,,11200,CPT4/HCPCS,REMOVAL OF SKIN TAGS 2.0 CM,,,987.78
Deidentified Minimum,,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,,1145.00
Deidentified Minimum,,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,,1235.00
Deidentified Minimum,,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,,1235.00
Deidentified Minimum,,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,,1235.00
Deidentified Minimum,,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,,1235.00
Deidentified Minimum,,11740,CPT4/HCPCS,DRAIN BLOOD FROM UNDER NAIL,,,987.78
Deidentified Minimum,,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,,3544.00
Deidentified Minimum,,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,,400.00
Deidentified Minimum,,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,,1145.00
Deidentified Minimum,,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,,400.00
Deidentified Minimum,,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,,1145.00
Deidentified Minimum,,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,,1145.00
Deidentified Minimum,,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,,1145.00
Deidentified Minimum,,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,,1291.00
Deidentified Minimum,,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,,400.00
Deidentified Minimum,,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,,1145.00
Deidentified Minimum,,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,,1145.00
Deidentified Minimum,,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,,1145.00
Deidentified Minimum,,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,,1145.00
Deidentified Minimum,,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,,1291.00
Deidentified Minimum,,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,,1291.00
Deidentified Minimum,,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,,1145.00
Deidentified Minimum,,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,,1291.00
Deidentified Minimum,,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,,1145.00
Deidentified Minimum,,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,,1145.00
Deidentified Minimum,,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,,1291.00
Deidentified Minimum,,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,,1291.00
Deidentified Minimum,,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,,3544.00
Deidentified Minimum,,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,,1291.00
Deidentified Minimum,,15771,CPT4/HCPCS,GRFG AUTOL FAT LIPO 50 CC/<,,,3000.00
Deidentified Minimum,,15774,CPT4/HCPCS,GFRG AUTOL FAT LIPO EA ADDL,,,1145.00
Deidentified Minimum,,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,,1678.00
Deidentified Minimum,,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,,987.78
Deidentified Minimum,,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,,1291.00
Deidentified Minimum,,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,,3544.00
Deidentified Minimum,,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,,1291.00
Deidentified Minimum,,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,,1145.00
Deidentified Minimum,,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,,1291.00
Deidentified Minimum,,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,,1291.00
Deidentified Minimum,,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,1291.00
Deidentified Minimum,,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,,3544.00
Deidentified Minimum,,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,,3544.00
Deidentified Minimum,,16000,CPT4/HCPCS,INITIAL TREATMENT OF BURN(S),,,987.78
Deidentified Minimum,,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,,1145.00
Deidentified Minimum,,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,,1145.00
Deidentified Minimum,,17000,CPT4/HCPCS,DESTRUCT PREMALG LESION,,,400.00
Deidentified Minimum,,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,987.78
Deidentified Minimum,,17260,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17263,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,400.00
Deidentified Minimum,,17266,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17271,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17282,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17284,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17380,CPT4/HCPCS,HAIR REMOVAL BY ELECTROLYSIS,,,987.78
Deidentified Minimum,,17999,CPT4/HCPCS,SKIN TISSUE PROCEDURE,,,987.78
Deidentified Minimum,,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,,1291.00
Deidentified Minimum,,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,,3544.00
Deidentified Minimum,,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,,1145.00
Deidentified Minimum,,19260,CPT4/HCPCS,REMOVAL OF CHEST WALL LESION,,,3198.57
Deidentified Minimum,,19272,CPT4/HCPCS,EXTENSIVE CHEST WALL SURGERY,,,4280.43
Deidentified Minimum,,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,,1235.00
Deidentified Minimum,,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,,1145.00
Deidentified Minimum,,19290,CPT4/HCPCS,PLACE NEEDLE WIRE BREAST,,,1678.00
Deidentified Minimum,,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,,5029.00
Deidentified Minimum,,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,,4000.00
Deidentified Minimum,,19306,CPT4/HCPCS,MAST RAD URBAN TYPE,,,1291.00
Deidentified Minimum,,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,,1678.88
Deidentified Minimum,,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,,1235.00
Deidentified Minimum,,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,,1678.88
Deidentified Minimum,,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,,3544.00
Deidentified Minimum,,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,,1235.00
Deidentified Minimum,,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,,987.78
Deidentified Minimum,,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,,987.78
Deidentified Minimum,,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,,987.78
Deidentified Minimum,,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,,3544.00
Deidentified Minimum,,20664,CPT4/HCPCS,APPLICATION OF HALO,,,1678.88
Deidentified Minimum,,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,,1678.88
Deidentified Minimum,,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,,3544.00
Deidentified Minimum,,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,,1678.00
Deidentified Minimum,,20701,CPT4/HCPCS,RMVL DEEP RX DELIVERY DEVICE,,,1145.00
Deidentified Minimum,,20703,CPT4/HCPCS,RMVL IMED RX DELIVERY DEVICE,,,1145.00
Deidentified Minimum,,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,,1291.00
Deidentified Minimum,,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,,1291.00
Deidentified Minimum,,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,,1291.00
Deidentified Minimum,,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,,1291.00
Deidentified Minimum,,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,,3000.00
Deidentified Minimum,,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,,4000.00
Deidentified Minimum,,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,,4000.00
Deidentified Minimum,,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,,1678.88
Deidentified Minimum,,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1291.00
Deidentified Minimum,,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1678.88
Deidentified Minimum,,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1678.88
Deidentified Minimum,,21089,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1145.00
Deidentified Minimum,,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,,1291.00
Deidentified Minimum,,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,,1678.88
Deidentified Minimum,,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,,1291.00
Deidentified Minimum,,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,,1291.00
Deidentified Minimum,,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,,1291.00
Deidentified Minimum,,21210,CPT4/HCPCS,FACE BONE GRAFT,,,5029.00
Deidentified Minimum,,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,,5730.00
Deidentified Minimum,,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,,5730.00
Deidentified Minimum,,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,,5730.00
Deidentified Minimum,,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,,1291.00
Deidentified Minimum,,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,,5730.00
Deidentified Minimum,,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,,2002.00
Deidentified Minimum,,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,,1291.00
Deidentified Minimum,,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,,3000.00
Deidentified Minimum,,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,,3000.00
Deidentified Minimum,,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,,4000.00
Deidentified Minimum,,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,,1291.00
Deidentified Minimum,,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,3965.00
Deidentified Minimum,,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,4000.00
Deidentified Minimum,,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,,3544.00
Deidentified Minimum,,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,,1291.00
Deidentified Minimum,,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,,3000.00
Deidentified Minimum,,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,,1291.00
Deidentified Minimum,,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,,1235.00
Deidentified Minimum,,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,,1291.00
Deidentified Minimum,,22015,CPT4/HCPCS,I&D ABSCESS P-SPINE L/S/LS,,,1291.00
Deidentified Minimum,,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,,3544.00
Deidentified Minimum,,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,,1291.00
Deidentified Minimum,,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,,1291.00
Deidentified Minimum,,22525,CPT4/HCPCS,PERCUT KYPHOPLASTY ADD-ON,,,1678.00
Deidentified Minimum,,22552,CPT4/HCPCS,ADDL NECK SPINE FUSION,,,2002.00
Deidentified Minimum,,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,,3198.57
Deidentified Minimum,,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,,1291.00
Deidentified Minimum,,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,,1291.00
Deidentified Minimum,,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,,1291.00
Deidentified Minimum,,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,1291.00
Deidentified Minimum,,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,3198.57
Deidentified Minimum,,22853,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,,1145.00
Deidentified Minimum,,22854,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,,1145.00
Deidentified Minimum,,22862,CPT4/HCPCS,REVISE LUMBAR ARTIF DISC,,,1291.00
Deidentified Minimum,,22899,CPT4/HCPCS,SPINE SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,,1678.88
Deidentified Minimum,,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,,1291.00
Deidentified Minimum,,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,,3544.00
Deidentified Minimum,,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,,1235.00
Deidentified Minimum,,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,,1678.88
Deidentified Minimum,,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,,3000.00
Deidentified Minimum,,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,,4847.00
Deidentified Minimum,,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,,4847.00
Deidentified Minimum,,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,,1678.88
Deidentified Minimum,,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,,1678.88
Deidentified Minimum,,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,,4000.00
Deidentified Minimum,,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,,4847.00
Deidentified Minimum,,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,,1678.88
Deidentified Minimum,,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,,1678.88
Deidentified Minimum,,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,5730.00
Deidentified Minimum,,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,,1235.00
Deidentified Minimum,,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,,1145.00
Deidentified Minimum,,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1678.88
Deidentified Minimum,,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1291.00
Deidentified Minimum,,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,,1291.00
Deidentified Minimum,,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,,1291.00
Deidentified Minimum,,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,1291.00
Deidentified Minimum,,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,,1291.00
Deidentified Minimum,,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,,3544.00
Deidentified Minimum,,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,,3544.00
Deidentified Minimum,,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,,3544.00
Deidentified Minimum,,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,,4000.00
Deidentified Minimum,,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,,3544.00
Deidentified Minimum,,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,,1678.88
Deidentified Minimum,,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,,3544.00
Deidentified Minimum,,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4000.00
Deidentified Minimum,,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4000.00
Deidentified Minimum,,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,,4000.00
Deidentified Minimum,,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,,5000.00
Deidentified Minimum,,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,,400.00
Deidentified Minimum,,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,,1145.00
Deidentified Minimum,,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,,1291.00
Deidentified Minimum,,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,,1291.00
Deidentified Minimum,,24999,CPT4/HCPCS,UPPER ARM/ELBOW SURGERY,,,1145.00
Deidentified Minimum,,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,,1678.88
Deidentified Minimum,,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,,1291.00
Deidentified Minimum,,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,,3544.00
Deidentified Minimum,,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,,1678.88
Deidentified Minimum,,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,,4000.00
Deidentified Minimum,,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,,3544.00
Deidentified Minimum,,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,,3544.00
Deidentified Minimum,,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,,3544.00
Deidentified Minimum,,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,,3544.00
Deidentified Minimum,,25360,CPT4/HCPCS,REVISION OF ULNA,,,3544.00
Deidentified Minimum,,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,,3000.00
Deidentified Minimum,,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,,5000.00
Deidentified Minimum,,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,,4000.00
Deidentified Minimum,,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,1235.00
Deidentified Minimum,,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,,4000.00
Deidentified Minimum,,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,,3544.00
Deidentified Minimum,,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,,1235.00
Deidentified Minimum,,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,3544.00
Deidentified Minimum,,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,3544.00
Deidentified Minimum,,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,,1291.00
Deidentified Minimum,,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,1291.00
Deidentified Minimum,,25927,CPT4/HCPCS,AMPUTATION OF HAND,,,1291.00
Deidentified Minimum,,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,,1291.00
Deidentified Minimum,,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,,1291.00
Deidentified Minimum,,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,,1291.00
Deidentified Minimum,,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,,4000.00
Deidentified Minimum,,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,,1145.00
Deidentified Minimum,,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,,1291.00
Deidentified Minimum,,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,,1291.00
Deidentified Minimum,,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,,1291.00
Deidentified Minimum,,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,,1291.00
Deidentified Minimum,,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,,1291.00
Deidentified Minimum,,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,,4000.00
Deidentified Minimum,,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,,4000.00
Deidentified Minimum,,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,3544.00
Deidentified Minimum,,26410,CPT4/HCPCS,REPAIR HAND TENDON,,,1291.00
Deidentified Minimum,,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,,4000.00
Deidentified Minimum,,26476,CPT4/HCPCS,TENDON LENGTHENING,,,1291.00
Deidentified Minimum,,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,,1291.00
Deidentified Minimum,,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,,3544.00
Deidentified Minimum,,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,,3544.00
Deidentified Minimum,,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,,3544.00
Deidentified Minimum,,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,,4000.00
Deidentified Minimum,,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,,1678.88
Deidentified Minimum,,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,,4000.00
Deidentified Minimum,,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,,1291.00
Deidentified Minimum,,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,,1291.00
Deidentified Minimum,,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,,987.78
Deidentified Minimum,,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,,3544.00
Deidentified Minimum,,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,400.00
Deidentified Minimum,,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,,1678.88
Deidentified Minimum,,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,,987.78
Deidentified Minimum,,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,,1678.88
Deidentified Minimum,,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,,4000.00
Deidentified Minimum,,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,,3544.00
Deidentified Minimum,,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,,4000.00
Deidentified Minimum,,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,,4000.00
Deidentified Minimum,,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,,4000.00
Deidentified Minimum,,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,,1678.88
Deidentified Minimum,,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,,3544.00
Deidentified Minimum,,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,,4000.00
Deidentified Minimum,,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,,1235.00
Deidentified Minimum,,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,,1235.00
Deidentified Minimum,,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,,1291.00
Deidentified Minimum,,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,,1291.00
Deidentified Minimum,,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,,3000.00
Deidentified Minimum,,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,,4000.00
Deidentified Minimum,,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,,1291.00
Deidentified Minimum,,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,,3198.57
Deidentified Minimum,,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,,1291.00
Deidentified Minimum,,27193,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,,1678.00
Deidentified Minimum,,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,,1145.00
Deidentified Minimum,,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,,4847.00
Deidentified Minimum,,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,,1291.00
Deidentified Minimum,,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,,1291.00
Deidentified Minimum,,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,,1291.00
Deidentified Minimum,,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,,1145.00
Deidentified Minimum,,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,,1291.00
Deidentified Minimum,,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,,1235.00
Deidentified Minimum,,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,,1291.00
Deidentified Minimum,,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,,4000.00
Deidentified Minimum,,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,,1291.00
Deidentified Minimum,,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,,1291.00
Deidentified Minimum,,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,,4000.00
Deidentified Minimum,,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,,4000.00
Deidentified Minimum,,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,,4847.00
Deidentified Minimum,,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,,4000.00
Deidentified Minimum,,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,,3544.00
Deidentified Minimum,,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,,4000.00
Deidentified Minimum,,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,,4000.00
Deidentified Minimum,,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,,5730.00
Deidentified Minimum,,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,,4280.43
Deidentified Minimum,,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,,4891.93
Deidentified Minimum,,27495,CPT4/HCPCS,REINFORCE THIGH,,,1291.00
Deidentified Minimum,,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,1145.00
Deidentified Minimum,,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,1291.00
Deidentified Minimum,,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,,3544.00
Deidentified Minimum,,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,,1678.88
Deidentified Minimum,,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,,1145.00
Deidentified Minimum,,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,,1291.00
Deidentified Minimum,,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,3965.00
Deidentified Minimum,,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,,1678.88
Deidentified Minimum,,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,,3544.00
Deidentified Minimum,,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,,1678.00
Deidentified Minimum,,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,,4000.00
Deidentified Minimum,,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,,1678.88
Deidentified Minimum,,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,,1291.00
Deidentified Minimum,,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,,1145.00
Deidentified Minimum,,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,,3000.00
Deidentified Minimum,,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,,3000.00
Deidentified Minimum,,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,,1291.00
Deidentified Minimum,,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,,1145.00
Deidentified Minimum,,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,1145.00
Deidentified Minimum,,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,3544.00
Deidentified Minimum,,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,1145.00
Deidentified Minimum,,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,3544.00
Deidentified Minimum,,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,,1291.00
Deidentified Minimum,,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,,3544.00
Deidentified Minimum,,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,,1678.00
Deidentified Minimum,,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,,1678.00
Deidentified Minimum,,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,,1678.88
Deidentified Minimum,,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,,1291.00
Deidentified Minimum,,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,,1678.88
Deidentified Minimum,,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,,3544.00
Deidentified Minimum,,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,,3544.00
Deidentified Minimum,,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,,1678.00
Deidentified Minimum,,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,,3544.00
Deidentified Minimum,,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,,1678.88
Deidentified Minimum,,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,,1678.88
Deidentified Minimum,,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,,3544.00
Deidentified Minimum,,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,,1678.88
Deidentified Minimum,,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,,3544.00
Deidentified Minimum,,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,1678.88
Deidentified Minimum,,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,,3544.00
Deidentified Minimum,,28306,CPT4/HCPCS,INCISION OF METATARSAL,,,3965.00
Deidentified Minimum,,28308,CPT4/HCPCS,INCISION OF METATARSAL,,,3000.00
Deidentified Minimum,,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,,3965.00
Deidentified Minimum,,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,,3544.00
Deidentified Minimum,,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,,3544.00
Deidentified Minimum,,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,,1145.00
Deidentified Minimum,,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,,3544.00
Deidentified Minimum,,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,1678.88
Deidentified Minimum,,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,,3544.00
Deidentified Minimum,,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,,1678.88
Deidentified Minimum,,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,,1678.88
Deidentified Minimum,,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,,400.00
Deidentified Minimum,,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,400.00
Deidentified Minimum,,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,,3544.00
Deidentified Minimum,,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,,1291.00
Deidentified Minimum,,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,,1145.00
Deidentified Minimum,,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,,3000.00
Deidentified Minimum,,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,,1678.88
Deidentified Minimum,,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,,1678.88
Deidentified Minimum,,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,,987.78
Deidentified Minimum,,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,,987.78
Deidentified Minimum,,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,,987.78
Deidentified Minimum,,29065,CPT4/HCPCS,APPLICATION OF LONG ARM CAST,,,987.78
Deidentified Minimum,,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,,193.00
Deidentified Minimum,,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,,400.00
Deidentified Minimum,,29355,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,,987.78
Deidentified Minimum,,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,,1291.00
Deidentified Minimum,,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,,3544.00
Deidentified Minimum,,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,,987.78
Deidentified Minimum,,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,,3544.00
Deidentified Minimum,,47379,CPT4/HCPCS,LAPAROSCOPE PROCEDURE LIVER,,,3000.00
Deidentified Minimum,,47500,CPT4/HCPCS,INJECTION FOR LIVER X-RAYS,,,1678.00
Deidentified Minimum,,47505,CPT4/HCPCS,INJECTION FOR LIVER X-RAYS,,,1678.00
Deidentified Minimum,,47525,CPT4/HCPCS,CHANGE BILE DUCT CATHETER,,,1678.00
Deidentified Minimum,,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,,1678.88
Deidentified Minimum,,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,,3544.00
Deidentified Minimum,,47579,CPT4/HCPCS,LAPAROSCOPE PROC BILIARY,,,3000.00
Deidentified Minimum,,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,,1291.00
Deidentified Minimum,,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,,1291.00
Deidentified Minimum,,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,,1291.00
Deidentified Minimum,,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,,1291.00
Deidentified Minimum,,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,,1291.00
Deidentified Minimum,,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,,1291.00
Deidentified Minimum,,48153,CPT4/HCPCS,PANCREATECTOMY,,,1291.00
Deidentified Minimum,,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,,1291.00
Deidentified Minimum,,48551,CPT4/HCPCS,PREP DONOR PANCREAS,,,3544.00
Deidentified Minimum,,48552,CPT4/HCPCS,PREP DONOR PANCREAS/VENOUS,,,1678.00
Deidentified Minimum,,48556,CPT4/HCPCS,REMOVAL ALLOGRAFT PANCREAS,,,3198.57
Deidentified Minimum,,49021,CPT4/HCPCS,DRAIN ABDOMINAL ABSCESS,,,1678.00
Deidentified Minimum,,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,,1291.00
Deidentified Minimum,,49041,CPT4/HCPCS,DRAIN PERCUT ABDOM ABSCESS,,,1678.00
Deidentified Minimum,,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,,1291.00
Deidentified Minimum,,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,,1291.00
Deidentified Minimum,,49204,CPT4/HCPCS,EXC ABD TUM OVER 5 CM,,,6612.00
Deidentified Minimum,,49329,CPT4/HCPCS,LAPARO PROC ABDM/PER/OMENT,,,2002.00
Deidentified Minimum,,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,,1678.00
Deidentified Minimum,,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,,1291.00
Deidentified Minimum,,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,,1145.00
Deidentified Minimum,,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,,4000.00
Deidentified Minimum,,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,,4847.00
Deidentified Minimum,,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,,4847.00
Deidentified Minimum,,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,,4847.00
Deidentified Minimum,,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,,4847.00
Deidentified Minimum,,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,,4000.00
Deidentified Minimum,,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,,3544.00
Deidentified Minimum,,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,,3544.00
Deidentified Minimum,,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,,1291.00
Deidentified Minimum,,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,,5029.00
Deidentified Minimum,,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,,5029.00
Deidentified Minimum,,49659,CPT4/HCPCS,LAPARO PROC HERNIA REPAIR,,,3000.00
Deidentified Minimum,,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,,1291.00
Deidentified Minimum,,49906,CPT4/HCPCS,FREE OMENTAL FLAP MICROVASC,,,1291.00
Deidentified Minimum,,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,,1291.00
Deidentified Minimum,,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,,1291.00
Deidentified Minimum,,50250,CPT4/HCPCS,CRYOABLATE RENAL MASS OPEN,,,1291.00
Deidentified Minimum,,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,,1291.00
Deidentified Minimum,,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,,1291.00
Deidentified Minimum,,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,,1291.00
Deidentified Minimum,,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,,1291.00
Deidentified Minimum,,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,,1678.88
Deidentified Minimum,,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,,1235.00
Deidentified Minimum,,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,,1291.00
Deidentified Minimum,,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,,3000.00
Deidentified Minimum,,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,,1678.00
Deidentified Minimum,,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,,1678.00
Deidentified Minimum,,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,,1291.00
Deidentified Minimum,,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,,4891.93
Deidentified Minimum,,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,,1291.00
Deidentified Minimum,,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,,1291.00
Deidentified Minimum,,50660,CPT4/HCPCS,REMOVAL OF URETER,,,1291.00
Deidentified Minimum,,50770,CPT4/HCPCS,SPLICING OF URETERS,,,1291.00
Deidentified Minimum,,50783,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,,1291.00
Deidentified Minimum,,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,,1291.00
Deidentified Minimum,,50949,CPT4/HCPCS,LAPAROSCOPE PROC URETER,,,3000.00
Deidentified Minimum,,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,,1678.00
Deidentified Minimum,,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,,3965.00
Deidentified Minimum,,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,,400.00
Deidentified Minimum,,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,,1291.00
Deidentified Minimum,,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,,1145.00
Deidentified Minimum,,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,,400.00
Deidentified Minimum,,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,,1145.00
Deidentified Minimum,,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,,987.78
Deidentified Minimum,,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,,987.78
Deidentified Minimum,,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,,3000.00
Deidentified Minimum,,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1235.00
Deidentified Minimum,,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,,1678.88
Deidentified Minimum,,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,,3544.00
Deidentified Minimum,,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,,3965.00
Deidentified Minimum,,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,,987.78
Deidentified Minimum,,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,,1678.88
Deidentified Minimum,,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,,1678.88
Deidentified Minimum,,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,,1678.88
Deidentified Minimum,,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,,1678.00
Deidentified Minimum,,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,,3965.00
Deidentified Minimum,,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,,3544.00
Deidentified Minimum,,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,,1678.00
Deidentified Minimum,,53450,CPT4/HCPCS,REVISION OF URETHRA,,,1678.00
Deidentified Minimum,,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,,1678.88
Deidentified Minimum,,53661,CPT4/HCPCS,DILATION OF URETHRA,,,987.78
Deidentified Minimum,,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,,400.00
Deidentified Minimum,,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,,987.78
Deidentified Minimum,,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,,987.78
Deidentified Minimum,,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,,1678.00
Deidentified Minimum,,54231,CPT4/HCPCS,DYNAMIC CAVERNOSOMETRY,,,1291.00
Deidentified Minimum,,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,,4000.00
Deidentified Minimum,,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,,4000.00
Deidentified Minimum,,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,,4000.00
Deidentified Minimum,,54430,CPT4/HCPCS,REVISION OF PENIS,,,1291.00
Deidentified Minimum,,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,,3000.00
Deidentified Minimum,,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,,987.78
Deidentified Minimum,,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,,1291.00
Deidentified Minimum,,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,,1678.88
Deidentified Minimum,,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,,3198.57
Deidentified Minimum,,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,,4000.00
Deidentified Minimum,,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,,1678.88
Deidentified Minimum,,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,,1678.00
Deidentified Minimum,,55175,CPT4/HCPCS,REVISION OF SCROTUM,,,1678.00
Deidentified Minimum,,55450,CPT4/HCPCS,LIGATION OF SPERM DUCT,,,1678.00
Deidentified Minimum,,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,,3544.00
Deidentified Minimum,,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,,1235.00
Deidentified Minimum,,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,,1291.00
Deidentified Minimum,,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,,3000.00
Deidentified Minimum,,55899,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,,1291.00
Deidentified Minimum,,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,1291.00
Deidentified Minimum,,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,,3544.00
Deidentified Minimum,,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,,3965.00
Deidentified Minimum,,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,,1678.88
Deidentified Minimum,,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,,1678.88
Deidentified Minimum,,57150,CPT4/HCPCS,TREAT VAGINA INFECTION,,,987.78
Deidentified Minimum,,57170,CPT4/HCPCS,FITTING OF DIAPHRAGM/CAP,,,987.78
Deidentified Minimum,,57220,CPT4/HCPCS,REVISION OF URETHRA,,,3544.00
Deidentified Minimum,,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,,4847.00
Deidentified Minimum,,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,,3000.00
Deidentified Minimum,,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,,1291.00
Deidentified Minimum,,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,,3198.57
Deidentified Minimum,,57335,CPT4/HCPCS,REPAIR VAGINA,,,3000.00
Deidentified Minimum,,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,,987.78
Deidentified Minimum,,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,,1678.00
Deidentified Minimum,,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,,3198.57
Deidentified Minimum,,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,,3000.00
Deidentified Minimum,,58300,CPT4/HCPCS,INSERT INTRAUTERINE DEVICE,,,400.00
Deidentified Minimum,,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,,1678.00
Deidentified Minimum,,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,,4847.00
Deidentified Minimum,,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,,1291.00
Deidentified Minimum,,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,,5000.00
Deidentified Minimum,,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,,1678.00
Deidentified Minimum,,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,,3544.00
Deidentified Minimum,,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,,6612.00
Deidentified Minimum,,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,,3544.00
Deidentified Minimum,,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,,5000.00
Deidentified Minimum,,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,,5000.00
Deidentified Minimum,,58679,CPT4/HCPCS,LAPARO PROC OVIDUCT-OVARY,,,3000.00
Deidentified Minimum,,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,,3000.00
Deidentified Minimum,,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,,3000.00
Deidentified Minimum,,58823,CPT4/HCPCS,DRAIN PELVIC ABSCESS PERCUT,,,1678.00
Deidentified Minimum,,59015,CPT4/HCPCS,CHORION BIOPSY,,,1235.00
Deidentified Minimum,,59030,CPT4/HCPCS,FETAL SCALP BLOOD SAMPLE,,,1145.00
Deidentified Minimum,,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,,987.78
Deidentified Minimum,,59410,CPT4/HCPCS,OBSTETRICAL CARE,,,2002.00
Deidentified Minimum,,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,,987.78
Deidentified Minimum,,59425,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,,987.78
Deidentified Minimum,,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,,3544.00
Deidentified Minimum,,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,,3544.00
Deidentified Minimum,,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,,3544.00
Deidentified Minimum,,59841,CPT4/HCPCS,ABORTION,,,3544.00
Deidentified Minimum,,59851,CPT4/HCPCS,ABORTION,,,1291.00
Deidentified Minimum,,59852,CPT4/HCPCS,ABORTION,,,1291.00
Deidentified Minimum,,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,,3000.00
Deidentified Minimum,,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,,4000.00
Deidentified Minimum,,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,,400.00
Deidentified Minimum,,60521,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,,1291.00
Deidentified Minimum,,60699,CPT4/HCPCS,ENDOCRINE SURGERY PROCEDURE,,,2002.00
Deidentified Minimum,,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,,1235.00
Deidentified Minimum,,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,,1291.00
Deidentified Minimum,,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,,1291.00
Deidentified Minimum,,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,,1291.00
Deidentified Minimum,,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,,3544.00
Deidentified Minimum,,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,,1291.00
Deidentified Minimum,,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,,1291.00
Deidentified Minimum,,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,,3000.00
Deidentified Minimum,,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,,1291.00
Deidentified Minimum,,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,1291.00
Deidentified Minimum,,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,1291.00
Deidentified Minimum,,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,,1291.00
Deidentified Minimum,,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,,1291.00
Deidentified Minimum,,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,,1291.00
Deidentified Minimum,,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,,1291.00
Deidentified Minimum,,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,,1291.00
Deidentified Minimum,,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,,1291.00
Deidentified Minimum,,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,,1291.00
Deidentified Minimum,,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,,1291.00
Deidentified Minimum,,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,1291.00
Deidentified Minimum,,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,,1291.00
Deidentified Minimum,,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,,1291.00
Deidentified Minimum,,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,,1291.00
Deidentified Minimum,,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,1291.00
Deidentified Minimum,,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,1291.00
Deidentified Minimum,,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,,1291.00
Deidentified Minimum,,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,,1291.00
Deidentified Minimum,,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,,1145.00
Deidentified Minimum,,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,,3452.00
Deidentified Minimum,,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,,1291.00
Deidentified Minimum,,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,,764.04
Deidentified Minimum,,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1291.00
Deidentified Minimum,,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,,1291.00
Deidentified Minimum,,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,,1291.00
Deidentified Minimum,,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,,1678.00
Deidentified Minimum,,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,,3198.57
Deidentified Minimum,,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,,1291.00
Deidentified Minimum,,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,,1291.00
Deidentified Minimum,,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,1291.00
Deidentified Minimum,,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,,1235.00
Deidentified Minimum,,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,,1235.00
Deidentified Minimum,,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,,1145.00
Deidentified Minimum,,62310,CPT4/HCPCS,INJECT SPINE CERV/THORACIC,,,1678.00
Deidentified Minimum,,62319,CPT4/HCPCS,INJECT SPINE W/CATH LMB/SCRL,,,1678.00
Deidentified Minimum,,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,,1235.00
Deidentified Minimum,,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,,1678.88
Deidentified Minimum,,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,,3000.00
Deidentified Minimum,,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,,3452.00
Deidentified Minimum,,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,,3452.00
Deidentified Minimum,,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,,1145.00
Deidentified Minimum,,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,,1291.00
Deidentified Minimum,,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,,1291.00
Deidentified Minimum,,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,1291.00
Deidentified Minimum,,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,,1291.00
Deidentified Minimum,,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,,3198.57
Deidentified Minimum,,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,,1291.00
Deidentified Minimum,,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,,1291.00
Deidentified Minimum,,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,,3198.57
Deidentified Minimum,,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,,1291.00
Deidentified Minimum,,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,,1291.00
Deidentified Minimum,,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,,1291.00
Deidentified Minimum,,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,,3452.00
Deidentified Minimum,,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,,1291.00
Deidentified Minimum,,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,,1291.00
Deidentified Minimum,,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,,3452.00
Deidentified Minimum,,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,,3452.00
Deidentified Minimum,,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,,1291.00
Deidentified Minimum,,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,,1291.00
Deidentified Minimum,,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,,1075.83
Deidentified Minimum,,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,,1678.88
Deidentified Minimum,,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,,2002.00
Deidentified Minimum,,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,,1291.00
Deidentified Minimum,,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,,3000.00
Deidentified Minimum,,64410,CPT4/HCPCS,N BLOCK INJ PHRENIC,,,1678.00
Deidentified Minimum,,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,,1235.00
Deidentified Minimum,,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,,1235.00
Deidentified Minimum,,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,,1235.00
Deidentified Minimum,,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,,3452.00
Deidentified Minimum,,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1678.00
Deidentified Minimum,,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1678.00
Deidentified Minimum,,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1678.88
Deidentified Minimum,,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,1678.00
Deidentified Minimum,,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,,400.00
Deidentified Minimum,,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,,400.00
Deidentified Minimum,,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,1235.00
Deidentified Minimum,,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,1235.00
Deidentified Minimum,,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,,1678.00
Deidentified Minimum,,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,,1678.00
Deidentified Minimum,,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,,1678.88
Deidentified Minimum,,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,,1678.00
Deidentified Minimum,,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,,1291.00
Deidentified Minimum,,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,,1678.88
Deidentified Minimum,,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,,1291.00
Deidentified Minimum,,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,,1291.00
Deidentified Minimum,,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,,3452.00
Deidentified Minimum,,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,,1678.88
Deidentified Minimum,,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,,1145.00
Deidentified Minimum,,64787,CPT4/HCPCS,IMPLANT NERVE END,,,1145.00
Deidentified Minimum,,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,,3452.00
Deidentified Minimum,,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,,1678.88
Deidentified Minimum,,64859,CPT4/HCPCS,NERVE SURGERY,,,1145.00
Deidentified Minimum,,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,,3452.00
Deidentified Minimum,,64870,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,,5029.00
Deidentified Minimum,,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,,1145.00
Deidentified Minimum,,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,,3000.00
Deidentified Minimum,,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,,1678.00
Deidentified Minimum,,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,,1678.88
Deidentified Minimum,,64999,CPT4/HCPCS,NERVOUS SYSTEM SURGERY,,,1145.00
Deidentified Minimum,,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,,3452.00
Deidentified Minimum,,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,,3452.00
Deidentified Minimum,,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,,3452.00
Deidentified Minimum,,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,,3452.00
Deidentified Minimum,,65430,CPT4/HCPCS,CORNEAL SMEAR,,,987.78
Deidentified Minimum,,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,,400.00
Deidentified Minimum,,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,,3452.00
Deidentified Minimum,,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,,3452.00
Deidentified Minimum,,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,,3452.00
Deidentified Minimum,,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,,1678.00
Deidentified Minimum,,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,,3452.00
Deidentified Minimum,,65800,CPT4/HCPCS,DRAINAGE OF EYE,,,1145.00
Deidentified Minimum,,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,,3452.00
Deidentified Minimum,,66630,CPT4/HCPCS,REMOVAL OF IRIS,,,1291.00
Deidentified Minimum,,66761,CPT4/HCPCS,REVISION OF IRIS,,,1235.00
Deidentified Minimum,,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,,3452.00
Deidentified Minimum,,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,,3452.00
Deidentified Minimum,,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,,1678.00
Deidentified Minimum,,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,,1235.00
Deidentified Minimum,,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,,1678.88
Deidentified Minimum,,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,,1678.00
Deidentified Minimum,,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,,1235.00
Deidentified Minimum,,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,,400.00
Deidentified Minimum,,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,,3452.00
Deidentified Minimum,,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,,1145.00
Deidentified Minimum,,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,,3452.00
Deidentified Minimum,,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,,987.78
Deidentified Minimum,,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,,987.78
Deidentified Minimum,,67825,CPT4/HCPCS,REVISE EYELASHES,,,1145.00
Deidentified Minimum,,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,,3452.00
Deidentified Minimum,,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,,1678.00
Deidentified Minimum,,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,,1678.00
Deidentified Minimum,,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,,1678.88
Deidentified Minimum,,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,,400.00
Deidentified Minimum,,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,,3452.00
Deidentified Minimum,,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,,1678.00
Deidentified Minimum,,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,,3452.00
Deidentified Minimum,,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,,3452.00
Deidentified Minimum,,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,,1678.88
Deidentified Minimum,,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,,400.00
Deidentified Minimum,,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,,1678.88
Deidentified Minimum,,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,,3452.00
Deidentified Minimum,,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,,3452.00
Deidentified Minimum,,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,,400.00
Deidentified Minimum,,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,,1291.00
Deidentified Minimum,,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,,1678.88
Deidentified Minimum,,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,,1291.00
Deidentified Minimum,,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,,3452.00
Deidentified Minimum,,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,,400.00
Deidentified Minimum,,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,,1145.00
Deidentified Minimum,,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,,3452.00
Deidentified Minimum,,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,,3452.00
Deidentified Minimum,,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,3452.00
Deidentified Minimum,,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,,3452.00
Deidentified Minimum,,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,,1291.00
Deidentified Minimum,,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,,3000.00
Deidentified Minimum,,70134,CPT4/HCPCS,X-RAY EXAM OF MIDDLE EAR,,,142.00
Deidentified Minimum,,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,,142.00
Deidentified Minimum,,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,,142.00
Deidentified Minimum,,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,,142.00
Deidentified Minimum,,70370,CPT4/HCPCS,THROAT X-RAY & FLUOROSCOPY,,,142.00
Deidentified Minimum,,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,,142.00
Deidentified Minimum,,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,,142.00
Deidentified Minimum,,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,,142.00
Deidentified Minimum,,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,,1147.00
Deidentified Minimum,,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,,1147.00
Deidentified Minimum,,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,,1147.00
Deidentified Minimum,,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,,1147.00
Deidentified Minimum,,71020,CPT4/HCPCS,CHEST X-RAY 2VW FRONTAL&LATL,,,0.00
Deidentified Minimum,,71021,CPT4/HCPCS,CHEST X-RAY FRNT LAT LORDOTC,,,0.00
Deidentified Minimum,,71030,CPT4/HCPCS,CHEST X-RAY 4/> VIEWS,,,0.00
Deidentified Minimum,,71035,CPT4/HCPCS,CHEST X-RAY SPECIAL VIEWS,,,0.00
Deidentified Minimum,,71046,CPT4/HCPCS,X-RAY EXAM CHEST 2 VIEWS,,,142.00
Deidentified Minimum,,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,,142.00
Deidentified Minimum,,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,,142.00
Deidentified Minimum,,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,,140.86
Deidentified Minimum,,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,,142.00
Deidentified Minimum,,72072,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 3VWS,,,142.00
Deidentified Minimum,,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,,985.00
Deidentified Minimum,,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,,1147.00
Deidentified Minimum,,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,,1147.00
Deidentified Minimum,,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,,1147.00
Deidentified Minimum,,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,,1147.00
Deidentified Minimum,,72193,CPT4/HCPCS,CT PELVIS W/DYE,,,142.00
Deidentified Minimum,,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,,1147.00
Deidentified Minimum,,72198,CPT4/HCPCS,MR ANGIO PELVIS W/O & W/DYE,,,1147.00
Deidentified Minimum,,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,,142.00
Deidentified Minimum,,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,,142.00
Deidentified Minimum,,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,,142.00
Deidentified Minimum,,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,,142.00
Deidentified Minimum,,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,,142.00
Deidentified Minimum,,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,,1147.00
Deidentified Minimum,,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,,142.00
Deidentified Minimum,,73523,CPT4/HCPCS,X-RAY EXAM HIPS BI 5/> VIEWS,,,142.00
Deidentified Minimum,,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,,142.00
Deidentified Minimum,,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,,142.00
Deidentified Minimum,,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,,142.00
Deidentified Minimum,,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,,142.00
Deidentified Minimum,,74019,CPT4/HCPCS,X-RAY EXAM ABDOMEN 2 VIEWS,,,142.00
Deidentified Minimum,,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,,987.78
Deidentified Minimum,,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,,987.78
Deidentified Minimum,,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,,4000.00
Deidentified Minimum,,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,,4000.00
Deidentified Minimum,,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,,3544.00
Deidentified Minimum,,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,4000.00
Deidentified Minimum,,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,3544.00
Deidentified Minimum,,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,,1678.88
Deidentified Minimum,,30100,CPT4/HCPCS,INTRANASAL BIOPSY,,,1291.00
Deidentified Minimum,,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,,1291.00
Deidentified Minimum,,30200,CPT4/HCPCS,INJECTION TREATMENT OF NOSE,,,1145.00
Deidentified Minimum,,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,,1291.00
Deidentified Minimum,,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,,1291.00
Deidentified Minimum,,30430,CPT4/HCPCS,REVISION OF NOSE,,,3544.00
Deidentified Minimum,,30460,CPT4/HCPCS,REVISION OF NOSE,,,5281.00
Deidentified Minimum,,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,,1145.00
Deidentified Minimum,,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,,3965.00
Deidentified Minimum,,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,,3544.00
Deidentified Minimum,,30999,CPT4/HCPCS,NASAL SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,,1291.00
Deidentified Minimum,,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,,3544.00
Deidentified Minimum,,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,,1678.88
Deidentified Minimum,,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,,4000.00
Deidentified Minimum,,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,,3544.00
Deidentified Minimum,,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,,1291.00
Deidentified Minimum,,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,,400.00
Deidentified Minimum,,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,1291.00
Deidentified Minimum,,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,1678.88
Deidentified Minimum,,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,,3000.00
Deidentified Minimum,,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,,3544.00
Deidentified Minimum,,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,1678.88
Deidentified Minimum,,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,1291.00
Deidentified Minimum,,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,,3000.00
Deidentified Minimum,,31295,CPT4/HCPCS,NSL/SINS NDSC SURG MAX SINS,,,3198.57
Deidentified Minimum,,31297,CPT4/HCPCS,NSL/SINS NDSC SURG SPHN SINS,,,3198.57
Deidentified Minimum,,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,,1291.00
Deidentified Minimum,,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,1291.00
Deidentified Minimum,,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,,1145.00
Deidentified Minimum,,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,,1678.88
Deidentified Minimum,,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,,1291.00
Deidentified Minimum,,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,,4000.00
Deidentified Minimum,,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,,1678.88
Deidentified Minimum,,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,,400.00
Deidentified Minimum,,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,,1291.00
Deidentified Minimum,,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,,1291.00
Deidentified Minimum,,31582,CPT4/HCPCS,REVISION OF LARYNX,,,5281.00
Deidentified Minimum,,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,,3000.00
Deidentified Minimum,,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,,1678.88
Deidentified Minimum,,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,,1145.00
Deidentified Minimum,,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,,3544.00
Deidentified Minimum,,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,,1678.88
Deidentified Minimum,,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,,1678.88
Deidentified Minimum,,31620,CPT4/HCPCS,ENDOBRONCHIAL US ADD-ON,,,1678.00
Deidentified Minimum,,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,,1678.88
Deidentified Minimum,,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,,1291.00
Deidentified Minimum,,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,,1678.88
Deidentified Minimum,,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,,1678.00
Deidentified Minimum,,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,,1291.00
Deidentified Minimum,,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,,1678.00
Deidentified Minimum,,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,,1291.00
Deidentified Minimum,,32215,CPT4/HCPCS,TREAT CHEST LINING,,,1291.00
Deidentified Minimum,,32220,CPT4/HCPCS,RELEASE OF LUNG,,,1291.00
Deidentified Minimum,,32422,CPT4/HCPCS,THORACENTESIS W/TUBE INSERT,,,1678.00
Deidentified Minimum,,32504,CPT4/HCPCS,RESECT APICAL LUNG TUM/CHEST,,,1291.00
Deidentified Minimum,,32506,CPT4/HCPCS,WEDGE RESECT OF LUNG ADD-ON,,,1291.00
Deidentified Minimum,,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,,1291.00
Deidentified Minimum,,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,,1235.00
Deidentified Minimum,,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,,1235.00
Deidentified Minimum,,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,,1291.00
Deidentified Minimum,,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,,1291.00
Deidentified Minimum,,32853,CPT4/HCPCS,LUNG TRANSPLANT DOUBLE,,,1291.00
Deidentified Minimum,,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,,1291.00
Deidentified Minimum,,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,,1235.00
Deidentified Minimum,,33011,CPT4/HCPCS,REPEAT DRAINAGE OF HEART SAC,,,1678.00
Deidentified Minimum,,33015,CPT4/HCPCS,INCISION OF HEART SAC,,,3198.57
Deidentified Minimum,,33016,CPT4/HCPCS,PERICARDIOCENTESIS W/IMAGING,,,1235.00
Deidentified Minimum,,33202,CPT4/HCPCS,INSERT EPICARD ELTRD OPEN,,,1291.00
Deidentified Minimum,,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,,1678.88
Deidentified Minimum,,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,,1678.88
Deidentified Minimum,,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,,1291.00
Deidentified Minimum,,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,,1291.00
Deidentified Minimum,,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,,3000.00
Deidentified Minimum,,33256,CPT4/HCPCS,ABLATE ATRIA W/BYPASS EXTEN,,,1291.00
Deidentified Minimum,,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,,1291.00
Deidentified Minimum,,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,,1678.88
Deidentified Minimum,,33285,CPT4/HCPCS,INSJ SUBQ CAR RHYTHM MNTR,,,2002.00
Deidentified Minimum,,33289,CPT4/HCPCS,TCAT IMPL WRLS P-ART PRS SNR,,,3000.00
Deidentified Minimum,,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,,1291.00
Deidentified Minimum,,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,,1291.00
Deidentified Minimum,,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,,1291.00
Deidentified Minimum,,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,,987.78
Deidentified Minimum,,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,,1291.00
Deidentified Minimum,,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,,1291.00
Deidentified Minimum,,33472,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,,6588.00
Deidentified Minimum,,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,,1291.00
Deidentified Minimum,,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,1291.00
Deidentified Minimum,,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,,1291.00
Deidentified Minimum,,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,,1291.00
Deidentified Minimum,,33506,CPT4/HCPCS,REPAIR ARTERY TRANSLOCATION,,,1291.00
Deidentified Minimum,,33512,CPT4/HCPCS,CABG VEIN THREE,,,1291.00
Deidentified Minimum,,33514,CPT4/HCPCS,CABG VEIN FIVE,,,1291.00
Deidentified Minimum,,33519,CPT4/HCPCS,CABG ARTERY-VEIN THREE,,,1291.00
Deidentified Minimum,,33521,CPT4/HCPCS,CABG ARTERY-VEIN FOUR,,,1291.00
Deidentified Minimum,,33522,CPT4/HCPCS,CABG ARTERY-VEIN FIVE,,,1291.00
Deidentified Minimum,,33533,CPT4/HCPCS,CABG ARTERIAL SINGLE,,,1291.00
Deidentified Minimum,,33545,CPT4/HCPCS,REPAIR OF HEART DAMAGE,,,1291.00
Deidentified Minimum,,33572,CPT4/HCPCS,OPEN CORONARY ENDARTERECTOMY,,,1291.00
Deidentified Minimum,,33675,CPT4/HCPCS,CLOSE MULT VSD,,,1291.00
Deidentified Minimum,,33697,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,1291.00
Deidentified Minimum,,33720,CPT4/HCPCS,REPAIR OF HEART DEFECT,,,1291.00
Deidentified Minimum,,33722,CPT4/HCPCS,REPAIR OF HEART DEFECT,,,1291.00
Deidentified Minimum,,33730,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT(S),,,1291.00
Deidentified Minimum,,33735,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,1291.00
Deidentified Minimum,,33775,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1291.00
Deidentified Minimum,,33776,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1291.00
Deidentified Minimum,,33777,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1291.00
Deidentified Minimum,,33779,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1291.00
Deidentified Minimum,,33800,CPT4/HCPCS,AORTIC SUSPENSION,,,1291.00
Deidentified Minimum,,33851,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,,1291.00
Deidentified Minimum,,33871,CPT4/HCPCS,TRANSVRS A-ARCH GRF HYPTHRM,,,1291.00
Deidentified Minimum,,33880,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,,1291.00
Deidentified Minimum,,33886,CPT4/HCPCS,ENDOVASC PROSTH DELAYED,,,1291.00
Deidentified Minimum,,33940,CPT4/HCPCS,REMOVAL OF DONOR HEART,,,1291.00
Deidentified Minimum,,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,,1291.00
Deidentified Minimum,,34001,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,,1291.00
Deidentified Minimum,,34530,CPT4/HCPCS,LEG VEIN FUSION,,,3544.00
Deidentified Minimum,,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,,1291.00
Deidentified Minimum,,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,,1291.00
Deidentified Minimum,,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,,1291.00
Deidentified Minimum,,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,,1145.00
Deidentified Minimum,,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,,1145.00
Deidentified Minimum,,34803,CPT4/HCPCS,ENDOVAS AAA REPR W/3-P PART,,,5783.00
Deidentified Minimum,,34833,CPT4/HCPCS,OPN ILAC ART EXPOS CNDT CRTJ,,,1291.00
Deidentified Minimum,,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,,987.78
Deidentified Minimum,,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,,1291.00
Deidentified Minimum,,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,1291.00
Deidentified Minimum,,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,,1291.00
Deidentified Minimum,,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,,1291.00
Deidentified Minimum,,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,,1291.00
Deidentified Minimum,,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,5029.00
Deidentified Minimum,,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,3000.00
Deidentified Minimum,,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,3000.00
Deidentified Minimum,,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,1291.00
Deidentified Minimum,,35305,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1291.00
Deidentified Minimum,,35400,CPT4/HCPCS,ANGIOSCOPY,,,1291.00
Deidentified Minimum,,35476,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,,5029.00
Deidentified Minimum,,35510,CPT4/HCPCS,ART BYP GRFT CAROTID-BRCHIAL,,,1291.00
Deidentified Minimum,,35512,CPT4/HCPCS,ART BYP GRFT SUBCLAV-BRCHIAL,,,1291.00
Deidentified Minimum,,35522,CPT4/HCPCS,ART BYP GRFT AXILL-BRACHIAL,,,1291.00
Deidentified Minimum,,35525,CPT4/HCPCS,ART BYP GRFT BRACHIAL-BRCHL,,,1291.00
Deidentified Minimum,,35535,CPT4/HCPCS,ART BYP GRFT HEPATORENAL,,,1291.00
Deidentified Minimum,,35538,CPT4/HCPCS,ART BYP GRFT AORTOBI-ILIAC,,,1291.00
Deidentified Minimum,,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,,1291.00
Deidentified Minimum,,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,,1291.00
Deidentified Minimum,,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,,1291.00
Deidentified Minimum,,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,,1291.00
Deidentified Minimum,,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,,1291.00
Deidentified Minimum,,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,,1291.00
Deidentified Minimum,,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,,1291.00
Deidentified Minimum,,35634,CPT4/HCPCS,ART BYP ILIORENAL,,,1291.00
Deidentified Minimum,,35636,CPT4/HCPCS,ART BYP SPENORENAL,,,1291.00
Deidentified Minimum,,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,,1291.00
Deidentified Minimum,,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,,1291.00
Deidentified Minimum,,35703,CPT4/HCPCS,EXPL N/FLWD SURG LXTR ART,,,1291.00
Deidentified Minimum,,35741,CPT4/HCPCS,EXPLORATION POPLITEAL ARTERY,,,3198.57
Deidentified Minimum,,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,,5281.00
Deidentified Minimum,,36000,CPT4/HCPCS,PLACE NEEDLE IN VEIN,,,1145.00
Deidentified Minimum,,36014,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,1145.00
Deidentified Minimum,,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,,3000.00
Deidentified Minimum,,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,,1145.00
Deidentified Minimum,,36247,CPT4/HCPCS,INS CATH ABD/L-EXT ART 3RD,,,1145.00
Deidentified Minimum,,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,,3000.00
Deidentified Minimum,,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,,1678.00
Deidentified Minimum,,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,,987.78
Deidentified Minimum,,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,,1291.00
Deidentified Minimum,,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,,1145.00
Deidentified Minimum,,36511,CPT4/HCPCS,APHERESIS WBC,,,1291.00
Deidentified Minimum,,36512,CPT4/HCPCS,APHERESIS RBC,,,1291.00
Deidentified Minimum,,36513,CPT4/HCPCS,APHERESIS PLATELETS,,,1145.00
Deidentified Minimum,,36516,CPT4/HCPCS,APHERESIS IMMUNOADS SLCTV,,,3000.00
Deidentified Minimum,,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,3544.00
Deidentified Minimum,,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,,1235.00
Deidentified Minimum,,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,,1678.00
Deidentified Minimum,,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,,1235.00
Deidentified Minimum,,36592,CPT4/HCPCS,COLLECT BLOOD FROM PICC,,,1145.00
Deidentified Minimum,,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,,1678.88
Deidentified Minimum,,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,,987.78
Deidentified Minimum,,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,,1678.00
Deidentified Minimum,,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,,400.00
Deidentified Minimum,,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,,3000.00
Deidentified Minimum,,37186,CPT4/HCPCS,SEC ART THROMBECTOMY ADD-ON,,,1145.00
Deidentified Minimum,,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,,1678.88
Deidentified Minimum,,37201,CPT4/HCPCS,TRANSCATHETER THERAPY INFUSE,,,1678.88
Deidentified Minimum,,37202,CPT4/HCPCS,TRANSCATHETER THERAPY INFUSE,,,1678.88
Deidentified Minimum,,37207,CPT4/HCPCS,TRANSCATH IV STENT OPEN,,,5029.00
Deidentified Minimum,,37210,CPT4/HCPCS,EMBOLIZATION UTERINE FIBROID,,,5029.00
Deidentified Minimum,,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,,1235.00
Deidentified Minimum,,37220,CPT4/HCPCS,ILIAC REVASC,,,3000.00
Deidentified Minimum,,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,,3000.00
Deidentified Minimum,,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,,1678.88
Deidentified Minimum,,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,,3000.00
Deidentified Minimum,,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,,987.78
Deidentified Minimum,,37249,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL VEIN,,,1145.00
Deidentified Minimum,,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,,3544.00
Deidentified Minimum,,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,,3000.00
Deidentified Minimum,,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,,1145.00
Deidentified Minimum,,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,,1291.00
Deidentified Minimum,,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,,1145.00
Deidentified Minimum,,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,,987.78
Deidentified Minimum,,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,,1291.00
Deidentified Minimum,,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,,1678.88
Deidentified Minimum,,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,,1678.88
Deidentified Minimum,,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,,3965.00
Deidentified Minimum,,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,,3000.00
Deidentified Minimum,,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,,4000.00
Deidentified Minimum,,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,,1291.00
Deidentified Minimum,,38794,CPT4/HCPCS,ACCESS THORACIC LYMPH DUCT,,,1145.00
Deidentified Minimum,,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,,1291.00
Deidentified Minimum,,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,,3544.00
Deidentified Minimum,,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,,1145.00
Deidentified Minimum,,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,,400.00
Deidentified Minimum,,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,,1291.00
Deidentified Minimum,,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,,1678.88
Deidentified Minimum,,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,,3965.00
Deidentified Minimum,,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,,1291.00
Deidentified Minimum,,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,,1291.00
Deidentified Minimum,,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,,1145.00
Deidentified Minimum,,41500,CPT4/HCPCS,FIXATION OF TONGUE,,,1678.00
Deidentified Minimum,,41512,CPT4/HCPCS,TONGUE SUSPENSION,,,1678.00
Deidentified Minimum,,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,,1678.88
Deidentified Minimum,,41599,CPT4/HCPCS,TONGUE AND MOUTH SURGERY,,,1145.00
Deidentified Minimum,,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,,1291.00
Deidentified Minimum,,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,5000.00
Deidentified Minimum,,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,5000.00
Deidentified Minimum,,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,,3544.00
Deidentified Minimum,,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,,3544.00
Deidentified Minimum,,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,,400.00
Deidentified Minimum,,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,,1291.00
Deidentified Minimum,,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,,3544.00
Deidentified Minimum,,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,,3544.00
Deidentified Minimum,,42550,CPT4/HCPCS,INJECTION FOR SALIVARY X-RAY,,,1145.00
Deidentified Minimum,,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,,1291.00
Deidentified Minimum,,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,,3544.00
Deidentified Minimum,,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,,3965.00
Deidentified Minimum,,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,,3544.00
Deidentified Minimum,,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,,5029.00
Deidentified Minimum,,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,,1291.00
Deidentified Minimum,,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,,1291.00
Deidentified Minimum,,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,,1291.00
Deidentified Minimum,,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,,1291.00
Deidentified Minimum,,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,,1678.00
Deidentified Minimum,,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,,1291.00
Deidentified Minimum,,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,,1291.00
Deidentified Minimum,,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,,1678.00
Deidentified Minimum,,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,,1291.00
Deidentified Minimum,,43234,CPT4/HCPCS,UPPER GI ENDOSCOPY EXAM,,,1678.00
Deidentified Minimum,,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,,1291.00
Deidentified Minimum,,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,,1291.00
Deidentified Minimum,,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,,1291.00
Deidentified Minimum,,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,,1291.00
Deidentified Minimum,,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,,1291.00
Deidentified Minimum,,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,,1291.00
Deidentified Minimum,,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,,1678.88
Deidentified Minimum,,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,,1678.00
Deidentified Minimum,,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,,1678.88
Deidentified Minimum,,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,,1291.00
Deidentified Minimum,,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,,1291.00
Deidentified Minimum,,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,,1291.00
Deidentified Minimum,,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,,1291.00
Deidentified Minimum,,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,,1291.00
Deidentified Minimum,,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,,1291.00
Deidentified Minimum,,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,,3198.57
Deidentified Minimum,,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,,1291.00
Deidentified Minimum,,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,,1291.00
Deidentified Minimum,,43456,CPT4/HCPCS,DILATE ESOPHAGUS,,,1678.88
Deidentified Minimum,,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,,1291.00
Deidentified Minimum,,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,,1291.00
Deidentified Minimum,,43763,CPT4/HCPCS,RPLC GTUBE REVJ GSTRST TRC,,,1145.00
Deidentified Minimum,,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,,3000.00
Deidentified Minimum,,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,,1291.00
Deidentified Minimum,,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,,3198.57
Deidentified Minimum,,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,,2002.00
Deidentified Minimum,,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,,1291.00
Deidentified Minimum,,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,,1291.00
Deidentified Minimum,,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,,1291.00
Deidentified Minimum,,44137,CPT4/HCPCS,REMOVE INTESTINAL ALLOGRAFT,,,1291.00
Deidentified Minimum,,44160,CPT4/HCPCS,REMOVAL OF COLON,,,1291.00
Deidentified Minimum,,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,,4891.93
Deidentified Minimum,,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,,4891.93
Deidentified Minimum,,44202,CPT4/HCPCS,LAP ENTERECTOMY,,,3000.00
Deidentified Minimum,,44205,CPT4/HCPCS,LAP COLECTOMY PART W/ILEUM,,,1291.00
Deidentified Minimum,,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,,1291.00
Deidentified Minimum,,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,,1291.00
Deidentified Minimum,,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,,1291.00
Deidentified Minimum,,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,,3000.00
Deidentified Minimum,,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,1291.00
Deidentified Minimum,,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,,1291.00
Deidentified Minimum,,44397,CPT4/HCPCS,COLONOSCOPY W/STENT,,,1678.00
Deidentified Minimum,,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,,1291.00
Deidentified Minimum,,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,,1291.00
Deidentified Minimum,,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,,1291.00
Deidentified Minimum,,44979,CPT4/HCPCS,LAPAROSCOPE PROC APP,,,3000.00
Deidentified Minimum,,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,,1291.00
Deidentified Minimum,,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,,1291.00
Deidentified Minimum,,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,,1291.00
Deidentified Minimum,,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,,1291.00
Deidentified Minimum,,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,,1291.00
Deidentified Minimum,,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,,1678.00
Deidentified Minimum,,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,,1235.00
Deidentified Minimum,,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,,1291.00
Deidentified Minimum,,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,,1291.00
Deidentified Minimum,,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,,1291.00
Deidentified Minimum,,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,,1291.00
Deidentified Minimum,,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,,1678.88
Deidentified Minimum,,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,,1291.00
Deidentified Minimum,,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,,1291.00
Deidentified Minimum,,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,,1291.00
Deidentified Minimum,,46020,CPT4/HCPCS,PLACEMENT OF SETON,,,1678.00
Deidentified Minimum,,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,,1291.00
Deidentified Minimum,,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,,1291.00
Deidentified Minimum,,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,,3965.00
Deidentified Minimum,,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,,3965.00
Deidentified Minimum,,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,,3544.00
Deidentified Minimum,,46500,CPT4/HCPCS,INJECTION INTO HEMORRHOID(S),,,1235.00
Deidentified Minimum,,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,,987.78
Deidentified Minimum,,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,,1291.00
Deidentified Minimum,,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,,1291.00
Deidentified Minimum,,46712,CPT4/HCPCS,REPR PER/VAG POUCH DBL PROC,,,1291.00
Deidentified Minimum,,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,,400.00
Deidentified Minimum,,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,,1678.00
Deidentified Minimum,,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,,1235.00
Deidentified Minimum,,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,,1291.00
Deidentified Minimum,,46999,CPT4/HCPCS,ANUS SURGERY PROCEDURE,,,1235.00
Deidentified Minimum,,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,,1291.00
Deidentified Minimum,,47011,CPT4/HCPCS,PERCUT DRAIN LIVER LESION,,,1678.00
Deidentified Minimum,,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,,1291.00
Deidentified Minimum,,47399,CPT4/HCPCS,LIVER SURGERY PROCEDURE,,,1235.00
Deidentified Minimum,,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,,1291.00
Deidentified Minimum,,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,,1678.00
Deidentified Minimum,,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,,1145.00
Deidentified Minimum,,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,,1291.00
Deidentified Minimum,,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,,1291.00
Deidentified Minimum,,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,,1291.00
Deidentified Minimum,,47999,CPT4/HCPCS,BILE TRACT SURGERY PROCEDURE,,,1291.00
Deidentified Minimum,,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,,1291.00
Deidentified Minimum,,48105,CPT4/HCPCS,RESECT/DEBRIDE PANCREAS,,,1291.00
Deidentified Minimum,,48146,CPT4/HCPCS,PANCREATECTOMY,,,1291.00
Deidentified Minimum,,48152,CPT4/HCPCS,PANCREATECTOMY,,,1291.00
Deidentified Minimum,,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,,1291.00
Deidentified Minimum,,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,,1291.00
Deidentified Minimum,,49013,CPT4/HCPCS,PRPERTL PEL PACK HEMRRG TRMA,,,1291.00
Deidentified Minimum,,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,,1291.00
Deidentified Minimum,,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,,1235.00
Deidentified Minimum,,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,,1678.88
Deidentified Minimum,,49327,CPT4/HCPCS,LAP INS DEVICE FOR RT,,,1145.00
Deidentified Minimum,,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,,1678.00
Deidentified Minimum,,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,,1291.00
Deidentified Minimum,,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,,1291.00
Deidentified Minimum,,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,,1678.88
Deidentified Minimum,,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,,1291.00
Deidentified Minimum,,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,,1291.00
Deidentified Minimum,,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,,1291.00
Deidentified Minimum,,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,,1291.00
Deidentified Minimum,,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,,4000.00
Deidentified Minimum,,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,,4847.00
Deidentified Minimum,,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,,985.00
Deidentified Minimum,,74220,CPT4/HCPCS,X-RAY XM ESOPHAGUS 1CNTRST,,,142.00
Deidentified Minimum,,74245,CPT4/HCPCS,X-RAY UPPER GI&SMALL INTEST,,,1202.43
Deidentified Minimum,,74280,CPT4/HCPCS,X-RAY XM COLON 2CNTRST STD,,,142.00
Deidentified Minimum,,74283,CPT4/HCPCS,THER NMA RDCTJ INTUS/OBSTRCJ,,,142.00
Deidentified Minimum,,74415,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BLS W/NF,,,142.00
Deidentified Minimum,,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,,142.00
Deidentified Minimum,,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,,142.00
Deidentified Minimum,,75561,CPT4/HCPCS,CARDIAC MRI FOR MORPH W/DYE,,,142.00
Deidentified Minimum,,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,,692.10
Deidentified Minimum,,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,,985.00
Deidentified Minimum,,75726,CPT4/HCPCS,ARTERY X-RAYS ABDOMEN,,,142.00
Deidentified Minimum,,75801,CPT4/HCPCS,LYMPH VESSEL X-RAY ARM/LEG,,,142.00
Deidentified Minimum,,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,,142.00
Deidentified Minimum,,75870,CPT4/HCPCS,VEIN X-RAY SKULL,,,142.00
Deidentified Minimum,,75893,CPT4/HCPCS,VENOUS SAMPLING BY CATHETER,,,142.00
Deidentified Minimum,,75954,CPT4/HCPCS,ILIAC ANEURYSM ENDOVAS RPR,,,6500.00
Deidentified Minimum,,75956,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,,142.00
Deidentified Minimum,,75978,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,,6500.00
Deidentified Minimum,,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,,142.00
Deidentified Minimum,,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,,96.43
Deidentified Minimum,,76390,CPT4/HCPCS,MR SPECTROSCOPY,,,142.00
Deidentified Minimum,,76391,CPT4/HCPCS,MR ELASTOGRAPHY,,,142.00
Deidentified Minimum,,76512,CPT4/HCPCS,OPH US DX B-SCAN,,,350.95
Deidentified Minimum,,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,,553.00
Deidentified Minimum,,76706,CPT4/HCPCS,US ABDL AORTA SCREEN AAA,,,553.00
Deidentified Minimum,,76811,CPT4/HCPCS,OB US DETAILED SNGL FETUS,,,553.00
Deidentified Minimum,,76813,CPT4/HCPCS,OB US NUCHAL MEAS 1 GEST,,,553.00
Deidentified Minimum,,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,,540.37
Deidentified Minimum,,76818,CPT4/HCPCS,FETAL BIOPHYS PROFILE W/NST,,,553.00
Deidentified Minimum,,76820,CPT4/HCPCS,UMBILICAL ARTERY ECHO,,,194.12
Deidentified Minimum,,76827,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,,333.22
Deidentified Minimum,,76828,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,,185.22
Deidentified Minimum,,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,,553.00
Deidentified Minimum,,76872,CPT4/HCPCS,US TRANSRECTAL,,,553.00
Deidentified Minimum,,76932,CPT4/HCPCS,ECHO GUIDE FOR HEART BIOPSY,,,512.98
Deidentified Minimum,,76936,CPT4/HCPCS,ECHO GUIDE FOR ARTERY REPAIR,,,553.00
Deidentified Minimum,,76941,CPT4/HCPCS,ECHO GUIDE FOR TRANSFUSION,,,501.14
Deidentified Minimum,,76978,CPT4/HCPCS,US TRGT DYN MBUBB 1ST LES,,,553.00
Deidentified Minimum,,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,,142.00
Deidentified Minimum,,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,,985.00
Deidentified Minimum,,77061,CPT4/HCPCS,BREAST TOMOSYNTHESIS UNI,,,348.00
Deidentified Minimum,,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,,142.00
Deidentified Minimum,,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,,281.89
Deidentified Minimum,,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,,1109.35
Deidentified Minimum,,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,,399.29
Deidentified Minimum,,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,,549.48
Deidentified Minimum,,77373,CPT4/HCPCS,SBRT DELIVERY,,,2422.00
Deidentified Minimum,,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,,2422.00
Deidentified Minimum,,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,,438.04
Deidentified Minimum,,77432,CPT4/HCPCS,STEREOTACTIC RADIATION TRMT,,,2166.91
Deidentified Minimum,,77435,CPT4/HCPCS,SBRT MANAGEMENT,,,2422.00
Deidentified Minimum,,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,,762.83
Deidentified Minimum,,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,,990.87
Deidentified Minimum,,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,,2344.44
Deidentified Minimum,,77786,CPT4/HCPCS,HDR BRACHYTX 2-12 CHANNEL,,,1678.88
Deidentified Minimum,,77790,CPT4/HCPCS,RADIATION HANDLING,,,107.85
Deidentified Minimum,,78014,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,,142.00
Deidentified Minimum,,78075,CPT4/HCPCS,ADRENAL CORTEX & MEDULLA IMG,,,142.00
Deidentified Minimum,,78103,CPT4/HCPCS,BONE MARROW IMAGING MULT,,,142.00
Deidentified Minimum,,78111,CPT4/HCPCS,PLASMA VOLUME MULTIPLE,,,142.00
Deidentified Minimum,,78130,CPT4/HCPCS,RED CELL SURVIVAL STUDY,,,142.00
Deidentified Minimum,,78185,CPT4/HCPCS,SPLEEN IMAGING,,,142.00
Deidentified Minimum,,78205,CPT4/HCPCS,LIVER IMAGING (3D),,,2978.36
Deidentified Minimum,,78230,CPT4/HCPCS,SALIVARY GLAND IMAGING,,,142.00
Deidentified Minimum,,78261,CPT4/HCPCS,GASTRIC MUCOSA IMAGING,,,142.00
Deidentified Minimum,,78264,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,,142.00
Deidentified Minimum,,78271,CPT4/HCPCS,VIT B-12 ABSRP EXAM INT FAC,,,834.25
Deidentified Minimum,,78272,CPT4/HCPCS,VIT B-12 ABSORP COMBINED,,,1173.55
Deidentified Minimum,,78290,CPT4/HCPCS,MECKELS DIVERT EXAM,,,142.00
Deidentified Minimum,,78350,CPT4/HCPCS,BONE MINERAL SINGLE PHOTON,,,142.00
Deidentified Minimum,,78456,CPT4/HCPCS,ACUTE VENOUS THROMBUS IMAGE,,,142.00
Deidentified Minimum,,78606,CPT4/HCPCS,BRAIN IMAGE W/FLOW 4 + VIEWS,,,142.00
Deidentified Minimum,,78647,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,,2978.36
Deidentified Minimum,,78707,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/O DRUG,,,142.00
Deidentified Minimum,,78730,CPT4/HCPCS,URINARY BLADDER RETENTION,,,142.00
Deidentified Minimum,,78806,CPT4/HCPCS,ABSCESS IMAGING WHOLE BODY,,,3244.69
Deidentified Minimum,,78811,CPT4/HCPCS,PET IMAGE LTD AREA,,,142.00
Deidentified Minimum,,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,,142.00
Deidentified Minimum,,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,,142.00
Deidentified Minimum,,79403,CPT4/HCPCS,HEMATOPOIETIC NUCLEAR TX,,,142.00
Deidentified Minimum,,80048,CPT4/HCPCS,METABOLIC PANEL TOTAL CA,,,85.00
Deidentified Minimum,,80053,CPT4/HCPCS,COMPREHEN METABOLIC PANEL,,,96.00
Deidentified Minimum,,80055,CPT4/HCPCS,OBSTETRIC PANEL,,,96.00
Deidentified Minimum,,80081,CPT4/HCPCS,OBSTETRIC PANEL,,,96.00
Deidentified Minimum,,80156,CPT4/HCPCS,ASSAY CARBAMAZEPINE TOTAL,,,96.00
Deidentified Minimum,,80162,CPT4/HCPCS,ASSAY OF DIGOXIN TOTAL,,,96.00
Deidentified Minimum,,80165,CPT4/HCPCS,DIPROPYLACETIC ACID FREE,,,96.00
Deidentified Minimum,,80168,CPT4/HCPCS,ASSAY OF ETHOSUXIMIDE,,,96.00
Deidentified Minimum,,80170,CPT4/HCPCS,ASSAY OF GENTAMICIN,,,96.00
Deidentified Minimum,,80173,CPT4/HCPCS,ASSAY OF HALOPERIDOL,,,96.00
Deidentified Minimum,,80183,CPT4/HCPCS,DRUG SCRN QUANT OXCARBAZEPIN,,,96.00
Deidentified Minimum,,80192,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,,96.00
Deidentified Minimum,,80203,CPT4/HCPCS,DRUG SCREEN QUANT ZONISAMIDE,,,96.00
Deidentified Minimum,,80299,CPT4/HCPCS,QUANTITATIVE ASSAY DRUG,,,96.00
Deidentified Minimum,,80305,CPT4/HCPCS,DRUG TEST PRSMV DIR OPT OBS,,,96.00
Deidentified Minimum,,80306,CPT4/HCPCS,DRUG TEST PRSMV INSTRMNT,,,96.00
Deidentified Minimum,,80321,CPT4/HCPCS,ALCOHOLS BIOMARKERS 1OR 2,,,0.08
Deidentified Minimum,,80323,CPT4/HCPCS,ALKALOIDS NOS,,,0.08
Deidentified Minimum,,80346,CPT4/HCPCS,BENZODIAZEPINES1-12,,,0.08
Deidentified Minimum,,80349,CPT4/HCPCS,CANNABINOIDS NATURAL,,,0.08
Deidentified Minimum,,80356,CPT4/HCPCS,HEROIN METABOLITE,,,0.08
Deidentified Minimum,,80359,CPT4/HCPCS,METHYLENEDIOXYAMPHETAMINES,,,0.08
Deidentified Minimum,,80360,CPT4/HCPCS,METHYLPHENIDATE,,,0.08
Deidentified Minimum,,80361,CPT4/HCPCS,OPIATES 1 OR MORE,,,0.08
Deidentified Minimum,,80363,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 3/4,,,0.08
Deidentified Minimum,,80371,CPT4/HCPCS,STIMULANTS SYNTHETIC,,,0.08
Deidentified Minimum,,80373,CPT4/HCPCS,DRUG SCREENING TRAMADOL,,,0.08
Deidentified Minimum,,80406,CPT4/HCPCS,ACTH STIMULATION PANEL,,,96.00
Deidentified Minimum,,80408,CPT4/HCPCS,ALDOSTERONE SUPPRESSION EVAL,,,96.00
Deidentified Minimum,,80410,CPT4/HCPCS,CALCITONIN STIMUL PANEL,,,96.00
Deidentified Minimum,,80435,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,,96.00
Deidentified Minimum,,80436,CPT4/HCPCS,METYRAPONE PANEL,,,96.00
Deidentified Minimum,,81007,CPT4/HCPCS,URINE SCREEN FOR BACTERIA,,,25.78
Deidentified Minimum,,81167,CPT4/HCPCS,BRCA2 GENE FULL DUP/DEL ALYS,,,150.00
Deidentified Minimum,,81170,CPT4/HCPCS,ABL1 GENE,,,150.00
Deidentified Minimum,,81172,CPT4/HCPCS,AFF2 GENE CHARAC ALLELES,,,150.00
Deidentified Minimum,,81177,CPT4/HCPCS,ATN1 GENE DETC ABNOR ALLELES,,,150.00
Deidentified Minimum,,81200,CPT4/HCPCS,ASPA GENE,,,150.00
Deidentified Minimum,,81225,CPT4/HCPCS,CYP2C19 GENE COM VARIANTS,,,150.00
Deidentified Minimum,,81229,CPT4/HCPCS,CYTOGEN M ARRAY COPY NO&SNP,,,150.00
Deidentified Minimum,,81236,CPT4/HCPCS,EZH2 GENE FULL GENE SEQUENCE,,,150.00
Deidentified Minimum,,81240,CPT4/HCPCS,F2 GENE,,,150.00
Deidentified Minimum,,81251,CPT4/HCPCS,GBA GENE,,,150.00
Deidentified Minimum,,81255,CPT4/HCPCS,HEXA GENE,,,150.00
Deidentified Minimum,,81256,CPT4/HCPCS,HFE GENE,,,150.00
Deidentified Minimum,,81270,CPT4/HCPCS,JAK2 GENE,,,150.00
Deidentified Minimum,,81274,CPT4/HCPCS,HTT GENE CHARAC ALLELES,,,150.00
Deidentified Minimum,,81275,CPT4/HCPCS,KRAS GENE VARIANTS EXON 2,,,150.00
Deidentified Minimum,,81288,CPT4/HCPCS,MLH1 GENE,,,150.00
Deidentified Minimum,,81294,CPT4/HCPCS,MLH1 GENE DUP/DELETE VARIANT,,,150.00
Deidentified Minimum,,81310,CPT4/HCPCS,NPM1 GENE,,,150.00
Deidentified Minimum,,81313,CPT4/HCPCS,PCA3/KLK3 ANTIGEN,,,150.00
Deidentified Minimum,,81320,CPT4/HCPCS,PLCG2 GENE COMMON VARIANTS,,,150.00
Deidentified Minimum,,81323,CPT4/HCPCS,PTEN GENE DUP/DELET VARIANT,,,150.00
Deidentified Minimum,,81327,CPT4/HCPCS,SEPT9 GEN PRMTR MTHYLTN ALYS,,,150.00
Deidentified Minimum,,81329,CPT4/HCPCS,SMN1 GENE DOS/DELETION ALYS,,,150.00
Deidentified Minimum,,81331,CPT4/HCPCS,SNRPN/UBE3A GENE,,,150.00
Deidentified Minimum,,81334,CPT4/HCPCS,RUNX1 GENE TARGETED SEQ ALYS,,,150.00
Deidentified Minimum,,81337,CPT4/HCPCS,SMN1 GEN NOWN FAMIL SEQ VRNT,,,150.00
Deidentified Minimum,,81341,CPT4/HCPCS,TRB@ GENE REARRANGE DIRPROBE,,,150.00
Deidentified Minimum,,81346,CPT4/HCPCS,TYMS GENE COM VARIANTS,,,150.00
Deidentified Minimum,,81361,CPT4/HCPCS,HBB GENE COM VARIANTS,,,150.00
Deidentified Minimum,,81373,CPT4/HCPCS,HLA I TYPING 1 LOCUS LR,,,150.00
Deidentified Minimum,,81400,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 1,,,150.00
Deidentified Minimum,,81410,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,,96.00
Deidentified Minimum,,81411,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,,96.00
Deidentified Minimum,,81415,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,,96.00
Deidentified Minimum,,81416,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,,96.00
Deidentified Minimum,,81460,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,,96.00
Deidentified Minimum,,81479,CPT4/HCPCS,UNLISTED MOLECULAR PATHOLOGY,,,96.00
Deidentified Minimum,,81500,CPT4/HCPCS,ONCO (OVAR) TWO PROTEINS,,,96.00
Deidentified Minimum,,81509,CPT4/HCPCS,FTL CGEN ABNOR 3 PROTEINS,,,96.00
Deidentified Minimum,,81541,CPT4/HCPCS,ONC PROSTATE MRNA 46 GENES,,,96.00
Deidentified Minimum,,81551,CPT4/HCPCS,ONC PROSTATE 3 GENES,,,96.00
Deidentified Minimum,,82009,CPT4/HCPCS,TEST FOR ACETONE/KETONES,,,45.44
Deidentified Minimum,,82013,CPT4/HCPCS,ACETYLCHOLINESTERASE ASSAY,,,96.00
Deidentified Minimum,,82016,CPT4/HCPCS,ACYLCARNITINES QUAL,,,96.00
Deidentified Minimum,,82105,CPT4/HCPCS,ALPHA-FETOPROTEIN SERUM,,,96.00
Deidentified Minimum,,82106,CPT4/HCPCS,ALPHA-FETOPROTEIN AMNIOTIC,,,96.00
Deidentified Minimum,,82150,CPT4/HCPCS,ASSAY OF AMYLASE,,,65.10
Deidentified Minimum,,82286,CPT4/HCPCS,ASSAY OF BRADYKININ,,,69.21
Deidentified Minimum,,82300,CPT4/HCPCS,ASSAY OF CADMIUM,,,96.00
Deidentified Minimum,,82340,CPT4/HCPCS,ASSAY OF CALCIUM IN URINE,,,60.64
Deidentified Minimum,,82355,CPT4/HCPCS,CALCULUS ANALYSIS QUAL,,,96.00
Deidentified Minimum,,82365,CPT4/HCPCS,CALCULUS SPECTROSCOPY,,,96.00
Deidentified Minimum,,82370,CPT4/HCPCS,X-RAY ASSAY CALCULUS,,,96.00
Deidentified Minimum,,82376,CPT4/HCPCS,ASSAY CARBOXYHB QUAL,,,60.22
Deidentified Minimum,,82390,CPT4/HCPCS,ASSAY OF CERULOPLASMIN,,,96.00
Deidentified Minimum,,82507,CPT4/HCPCS,ASSAY OF CITRATE,,,96.00
Deidentified Minimum,,82528,CPT4/HCPCS,ASSAY OF CORTICOSTERONE,,,96.00
Deidentified Minimum,,82540,CPT4/HCPCS,ASSAY OF CREATINE,,,46.53
Deidentified Minimum,,82595,CPT4/HCPCS,ASSAY OF CRYOGLOBULIN,,,57.62
Deidentified Minimum,,82696,CPT4/HCPCS,ASSAY OF ETIOCHOLANOLONE,,,96.00
Deidentified Minimum,,82726,CPT4/HCPCS,LONG CHAIN FATTY ACIDS,,,96.00
Deidentified Minimum,,82731,CPT4/HCPCS,ASSAY OF FETAL FIBRONECTIN,,,96.00
Deidentified Minimum,,82757,CPT4/HCPCS,ASSAY OF SEMEN FRUCTOSE,,,96.00
Deidentified Minimum,,82759,CPT4/HCPCS,ASSAY OF RBC GALACTOKINASE,,,96.00
Deidentified Minimum,,82787,CPT4/HCPCS,IGG 1 2 3 OR 4 EACH,,,80.64
Deidentified Minimum,,82820,CPT4/HCPCS,HEMOGLOBIN-OXYGEN AFFINITY,,,96.00
Deidentified Minimum,,82951,CPT4/HCPCS,GLUCOSE TOLERANCE TEST (GTT),,,96.00
Deidentified Minimum,,82960,CPT4/HCPCS,TEST FOR G6PD ENZYME,,,60.81
Deidentified Minimum,,82963,CPT4/HCPCS,ASSAY OF GLUCOSIDASE,,,96.00
Deidentified Minimum,,82977,CPT4/HCPCS,ASSAY OF GGT,,,72.32
Deidentified Minimum,,83498,CPT4/HCPCS,ASSAY OF PROGESTERONE 17-D,,,96.00
Deidentified Minimum,,83518,CPT4/HCPCS,IMMUNOASSAY DIPSTICK,,,34.27
Deidentified Minimum,,83519,CPT4/HCPCS,RIA NONANTIBODY,,,96.00
Deidentified Minimum,,83525,CPT4/HCPCS,ASSAY OF INSULIN,,,96.00
Deidentified Minimum,,83605,CPT4/HCPCS,ASSAY OF LACTIC ACID,,,96.00
Deidentified Minimum,,83631,CPT4/HCPCS,LACTOFERRIN FECAL (QUANT),,,96.00
Deidentified Minimum,,83633,CPT4/HCPCS,TEST URINE FOR LACTOSE,,,55.27
Deidentified Minimum,,83835,CPT4/HCPCS,ASSAY OF METANEPHRINES,,,96.00
Deidentified Minimum,,83857,CPT4/HCPCS,ASSAY OF METHEMALBUMIN,,,96.00
Deidentified Minimum,,83864,CPT4/HCPCS,MUCOPOLYSACCHARIDES,,,96.00
Deidentified Minimum,,83883,CPT4/HCPCS,ASSAY NEPHELOMETRY NOT SPEC,,,96.00
Deidentified Minimum,,83921,CPT4/HCPCS,ORGANIC ACID SINGLE QUANT,,,96.00
Deidentified Minimum,,83945,CPT4/HCPCS,ASSAY OF OXALATE,,,96.00
Deidentified Minimum,,83950,CPT4/HCPCS,ONCOPROTEIN HER-2/NEU,,,96.00
Deidentified Minimum,,83993,CPT4/HCPCS,ASSAY FOR CALPROTECTIN FECAL,,,96.00
Deidentified Minimum,,84119,CPT4/HCPCS,TEST URINE FOR PORPHYRINS,,,86.52
Deidentified Minimum,,84138,CPT4/HCPCS,ASSAY OF PREGNANETRIOL,,,96.00
Deidentified Minimum,,84152,CPT4/HCPCS,ASSAY OF PSA COMPLEXED,,,96.00
Deidentified Minimum,,84203,CPT4/HCPCS,TEST RBC PROTOPORPHYRIN,,,86.43
Deidentified Minimum,,84206,CPT4/HCPCS,ASSAY OF PROINSULIN,,,96.00
Deidentified Minimum,,84207,CPT4/HCPCS,ASSAY OF VITAMIN B-6,,,96.00
Deidentified Minimum,,84220,CPT4/HCPCS,ASSAY OF PYRUVATE KINASE,,,94.83
Deidentified Minimum,,84228,CPT4/HCPCS,ASSAY OF QUININE,,,96.00
Deidentified Minimum,,84238,CPT4/HCPCS,ASSAY NONENDOCRINE RECEPTOR,,,96.00
Deidentified Minimum,,84403,CPT4/HCPCS,ASSAY OF TOTAL TESTOSTERONE,,,96.00
Deidentified Minimum,,84442,CPT4/HCPCS,ASSAY OF THYROID ACTIVITY,,,96.00
Deidentified Minimum,,84460,CPT4/HCPCS,ALANINE AMINO (ALT) (SGPT),,,53.08
Deidentified Minimum,,84540,CPT4/HCPCS,ASSAY OF URINE/UREA-N,,,47.71
Deidentified Minimum,,84583,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,,50.48
Deidentified Minimum,,84586,CPT4/HCPCS,ASSAY OF VIP,,,96.00
Deidentified Minimum,,84630,CPT4/HCPCS,ASSAY OF ZINC,,,96.00
Deidentified Minimum,,84702,CPT4/HCPCS,CHORIONIC GONADOTROPIN TEST,,,96.00
Deidentified Minimum,,84830,CPT4/HCPCS,OVULATION TESTS,,,78.28
Deidentified Minimum,,85007,CPT4/HCPCS,BL SMEAR W/DIFF WBC COUNT,,,34.52
Deidentified Minimum,,85009,CPT4/HCPCS,MANUAL DIFF WBC COUNT B-COAT,,,37.38
Deidentified Minimum,,85018,CPT4/HCPCS,HEMOGLOBIN,,,23.77
Deidentified Minimum,,85027,CPT4/HCPCS,COMPLETE CBC AUTOMATED,,,65.01
Deidentified Minimum,,85032,CPT4/HCPCS,MANUAL CELL COUNT EACH,,,43.17
Deidentified Minimum,,85045,CPT4/HCPCS,AUTOMATED RETICULOCYTE COUNT,,,40.23
Deidentified Minimum,,85097,CPT4/HCPCS,BONE MARROW INTERPRETATION,,,96.00
Deidentified Minimum,,85230,CPT4/HCPCS,CLOT FACTOR VII PROCONVERTIN,,,96.00
Deidentified Minimum,,85335,CPT4/HCPCS,FACTOR INHIBITOR TEST,,,96.00
Deidentified Minimum,,85348,CPT4/HCPCS,COAGULATION TIME OTR METHOD,,,37.38
Deidentified Minimum,,85360,CPT4/HCPCS,EUGLOBULIN LYSIS,,,84.50
Deidentified Minimum,,85384,CPT4/HCPCS,FIBRINOGEN ACTIVITY,,,85.34
Deidentified Minimum,,85385,CPT4/HCPCS,FIBRINOGEN ANTIGEN,,,85.34
Deidentified Minimum,,85397,CPT4/HCPCS,CLOTTING FUNCT ACTIVITY,,,96.00
Deidentified Minimum,,85445,CPT4/HCPCS,HEINZ BODIES INDUCED,,,68.46
Deidentified Minimum,,85530,CPT4/HCPCS,HEPARIN-PROTAMINE TOLERANCE,,,96.00
Deidentified Minimum,,85555,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,,67.20
Deidentified Minimum,,85610,CPT4/HCPCS,PROTHROMBIN TIME,,,39.48
Deidentified Minimum,,85705,CPT4/HCPCS,THROMBOPLASTIN INHIBITION,,,96.00
Deidentified Minimum,,85730,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,,60.31
Deidentified Minimum,,86215,CPT4/HCPCS,DEOXYRIBONUCLEASE ANTIBODY,,,96.00
Deidentified Minimum,,86301,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 19-9,,,96.00
Deidentified Minimum,,86308,CPT4/HCPCS,HETEROPHILE ANTIBODY SCREEN,,,51.99
Deidentified Minimum,,86316,CPT4/HCPCS,IMMUNOASSAY TUMOR OTHER,,,96.00
Deidentified Minimum,,86331,CPT4/HCPCS,IMMUNODIFFUSION OUCHTERLONY,,,96.00
Deidentified Minimum,,86335,CPT4/HCPCS,IMMUNFIX E-PHORSIS/URINE/CSF,,,96.00
Deidentified Minimum,,86367,CPT4/HCPCS,STEM CELLS TOTAL COUNT,,,96.00
Deidentified Minimum,,86590,CPT4/HCPCS,STREPTOKINASE ANTIBODY,,,96.00
Deidentified Minimum,,86622,CPT4/HCPCS,BRUCELLA ANTIBODY,,,89.71
Deidentified Minimum,,86653,CPT4/HCPCS,ENCEPHALTIS ST LOUIS ANTBODY,,,96.00
Deidentified Minimum,,86654,CPT4/HCPCS,ENCEPHALTIS WEST EQNE ANTBDY,,,96.00
Deidentified Minimum,,86674,CPT4/HCPCS,GIARDIA LAMBLIA ANTIBODY,,,96.00
Deidentified Minimum,,86695,CPT4/HCPCS,HERPES SIMPLEX TYPE 1 TEST,,,96.00
Deidentified Minimum,,86698,CPT4/HCPCS,HISTOPLASMA ANTIBODY,,,96.00
Deidentified Minimum,,86705,CPT4/HCPCS,HEP B CORE ANTIBODY IGM,,,96.00
Deidentified Minimum,,86727,CPT4/HCPCS,LYMPH CHORIOMENINGITIS AB,,,96.00
Deidentified Minimum,,86735,CPT4/HCPCS,MUMPS ANTIBODY,,,96.00
Deidentified Minimum,,86759,CPT4/HCPCS,ROTAVIRUS ANTIBODY,,,96.00
Deidentified Minimum,,86765,CPT4/HCPCS,RUBEOLA ANTIBODY,,,96.00
Deidentified Minimum,,86771,CPT4/HCPCS,SHIGELLA ANTIBODY,,,96.00
Deidentified Minimum,,86812,CPT4/HCPCS,HLA TYPING A B OR C,,,96.00
Deidentified Minimum,,86817,CPT4/HCPCS,HLA TYPING DR/DQ,,,96.00
Deidentified Minimum,,86825,CPT4/HCPCS,HLA X-MATH NON-CYTOTOXIC,,,96.00
Deidentified Minimum,,86891,CPT4/HCPCS,AUTOLOGOUS BLOOD OP SALVAGE,,,96.00
Deidentified Minimum,,86906,CPT4/HCPCS,BLD TYPING SEROLOGIC RH PHNT,,,77.86
Deidentified Minimum,,86923,CPT4/HCPCS,COMPATIBILITY TEST ELECTRIC,,,96.00
Deidentified Minimum,,86965,CPT4/HCPCS,POOLING BLOOD PLATELETS,,,96.00
Deidentified Minimum,,86972,CPT4/HCPCS,RBC PRETX INCUBATJ W/DENSITY,,,96.00
Deidentified Minimum,,86977,CPT4/HCPCS,RBC SERUM PRETX INCUBJ/INHIB,,,96.00
Deidentified Minimum,,86978,CPT4/HCPCS,RBC PRETREATMENT SERUM,,,96.00
Deidentified Minimum,,87046,CPT4/HCPCS,STOOL CULTR AEROBIC BACT EA,,,94.83
Deidentified Minimum,,87076,CPT4/HCPCS,CULTURE ANAEROBE IDENT EACH,,,81.14
Deidentified Minimum,,87118,CPT4/HCPCS,MYCOBACTERIC IDENTIFICATION,,,96.00
Deidentified Minimum,,87147,CPT4/HCPCS,CULTURE TYPE IMMUNOLOGIC,,,49.30
Deidentified Minimum,,87166,CPT4/HCPCS,DARK FIELD EXAMINATION,,,96.00
Deidentified Minimum,,87177,CPT4/HCPCS,OVA AND PARASITES SMEARS,,,89.37
Deidentified Minimum,,87190,CPT4/HCPCS,MICROBE SUSCEPT MYCOBACTERI,,,49.30
Deidentified Minimum,,87209,CPT4/HCPCS,SMEAR COMPLEX STAIN,,,96.00
Deidentified Minimum,,87265,CPT4/HCPCS,PERTUSSIS AG IF,,,93.32
Deidentified Minimum,,87271,CPT4/HCPCS,CYTOMEGALOVIRUS DFA,,,93.32
Deidentified Minimum,,87305,CPT4/HCPCS,ASPERGILLUS AG IA,,,93.32
Deidentified Minimum,,87329,CPT4/HCPCS,GIARDIA AG IA,,,93.32
Deidentified Minimum,,87332,CPT4/HCPCS,CYTOMEGALOVIRUS AG IA,,,93.32
Deidentified Minimum,,87492,CPT4/HCPCS,CHYLMD TRACH DNA QUANT,,,96.00
Deidentified Minimum,,87496,CPT4/HCPCS,CYTOMEG DNA AMP PROBE,,,96.00
Deidentified Minimum,,87505,CPT4/HCPCS,NFCT AGENT DETECTION GI,,,96.00
Deidentified Minimum,,87527,CPT4/HCPCS,HEPATITIS G DNA QUANT,,,96.00
Deidentified Minimum,,87528,CPT4/HCPCS,HSV DNA DIR PROBE,,,96.00
Deidentified Minimum,,87531,CPT4/HCPCS,HHV-6 DNA DIR PROBE,,,96.00
Deidentified Minimum,,87562,CPT4/HCPCS,M.AVIUM-INTRA DNA QUANT,,,96.00
Deidentified Minimum,,87652,CPT4/HCPCS,STREP A DNA QUANT,,,96.00
Deidentified Minimum,,87804,CPT4/HCPCS,INFLUENZA ASSAY W/OPTIC,,,93.32
Deidentified Minimum,,87806,CPT4/HCPCS,HIV ANTIGEN W/HIV ANTIBODIES,,,96.00
Deidentified Minimum,,87901,CPT4/HCPCS,GENOTYPE DNA HIV REVERSE T,,,96.00
Deidentified Minimum,,88029,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,,96.00
Deidentified Minimum,,88120,CPT4/HCPCS,CYTP URNE 3-5 PROBES EA SPEC,,,96.00
Deidentified Minimum,,88140,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,,80.30
Deidentified Minimum,,88155,CPT4/HCPCS,CYTOPATH C/V INDEX ADD-ON,,,60.22
Deidentified Minimum,,88173,CPT4/HCPCS,CYTOPATH EVAL FNA REPORT,,,96.00
Deidentified Minimum,,88184,CPT4/HCPCS,FLOWCYTOMETRY/ TC 1 MARKER,,,96.00
Deidentified Minimum,,88187,CPT4/HCPCS,FLOWCYTOMETRY/READ 2-8,,,96.00
Deidentified Minimum,,88235,CPT4/HCPCS,TISSUE CULTURE PLACENTA,,,96.00
Deidentified Minimum,,88240,CPT4/HCPCS,CELL CRYOPRESERVE/STORAGE,,,96.00
Deidentified Minimum,,88249,CPT4/HCPCS,CHROMOSOME ANALYSIS 100,,,96.00
Deidentified Minimum,,88271,CPT4/HCPCS,CYTOGENETICS DNA PROBE,,,96.00
Deidentified Minimum,,88307,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,,96.00
Deidentified Minimum,,88309,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,,96.00
Deidentified Minimum,,88325,CPT4/HCPCS,COMPREHENSIVE REVIEW OF DATA,,,96.00
Deidentified Minimum,,88329,CPT4/HCPCS,PATH CONSULT INTROP,,,96.00
Deidentified Minimum,,88332,CPT4/HCPCS,PATH CONSULT INTRAOP ADDL,,,96.00
Deidentified Minimum,,88333,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 1,,,96.00
Deidentified Minimum,,88334,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 2,,,96.00
Deidentified Minimum,,88350,CPT4/HCPCS,IMMUNOFLUOR ANTB ADDL STAIN,,,96.00
Deidentified Minimum,,88360,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/MANUAL,,,96.00
Deidentified Minimum,,88369,CPT4/HCPCS,M/PHMTRC ALYSISHQUANT/SEMIQ,,,96.00
Deidentified Minimum,,88371,CPT4/HCPCS,PROTEIN WESTERN BLOT TISSUE,,,96.00
Deidentified Minimum,,88375,CPT4/HCPCS,OPTICAL ENDOMICROSCPY INTERP,,,96.00
Deidentified Minimum,,88387,CPT4/HCPCS,TISS EXAM MOLECULAR STUDY,,,75.76
Deidentified Minimum,,89160,CPT4/HCPCS,EXAM FECES FOR MEAT FIBERS,,,37.04
Deidentified Minimum,,89190,CPT4/HCPCS,NASAL SMEAR FOR EOSINOPHILS,,,47.71
Deidentified Minimum,,89250,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,,96.00
Deidentified Minimum,,89259,CPT4/HCPCS,CRYOPRESERVATION SPERM,,,96.00
Deidentified Minimum,,89342,CPT4/HCPCS,STORAGE/YEAR EMBRYO(S),,,96.00
Deidentified Minimum,,90812,CPT4/HCPCS,INTAC PSYTX OFF 45-50 MIN,,,184.53
Deidentified Minimum,,90818,CPT4/HCPCS,PSYTX HOSP 45-50 MIN,,,223.03
Deidentified Minimum,,90823,CPT4/HCPCS,INTAC PSYTX HOSP 20-30 MIN,,,175.69
Deidentified Minimum,,90845,CPT4/HCPCS,PSYCHOANALYSIS,,,170.11
Deidentified Minimum,,90849,CPT4/HCPCS,MULTIPLE FAMILY GROUP PSYTX,,,104.30
Deidentified Minimum,,90857,CPT4/HCPCS,INTAC GROUP PSYTX,,,105.08
Deidentified Minimum,,90887,CPT4/HCPCS,CONSULTATION WITH FAMILY,,,179.72
Deidentified Minimum,,90901,CPT4/HCPCS,BIOFEEDBACK TRAIN ANY METH,,,193.00
Deidentified Minimum,,90937,CPT4/HCPCS,HEMODIALYSIS REPEATED EVAL,,,494.97
Deidentified Minimum,,90947,CPT4/HCPCS,DIALYSIS REPEATED EVAL,,,504.58
Deidentified Minimum,,91010,CPT4/HCPCS,ESOPHAGUS MOTILITY STUDY,,,1121.26
Deidentified Minimum,,91022,CPT4/HCPCS,DUODENAL MOTILITY STUDY,,,1145.00
Deidentified Minimum,,91038,CPT4/HCPCS,ESOPH IMPED FUNCT TEST > 1HR,,,904.73
Deidentified Minimum,,91040,CPT4/HCPCS,ESOPH BALLOON DISTENSION TST,,,1145.00
Deidentified Minimum,,91117,CPT4/HCPCS,COLON MOTILITY 6 HR STUDY,,,1145.00
Deidentified Minimum,,92082,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,,465.94
Deidentified Minimum,,92140,CPT4/HCPCS,GLAUCOMA PROVOCATIVE TESTS,,,480.38
Deidentified Minimum,,92265,CPT4/HCPCS,EYE MUSCLE EVALUATION,,,777.92
Deidentified Minimum,,92284,CPT4/HCPCS,DARK ADAPTATION EYE EXAM,,,1072.22
Deidentified Minimum,,92286,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,,1485.24
Deidentified Minimum,,92287,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,,1158.05
Deidentified Minimum,,92315,CPT4/HCPCS,RX CNTACT LENS APHAKIA 1 EYE,,,413.01
Deidentified Minimum,,92370,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,,272.70
Deidentified Minimum,,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,,193.00
Deidentified Minimum,,92548,CPT4/HCPCS,CDP-SOT 6 COND W/I&R,,,1462.25
Deidentified Minimum,,92571,CPT4/HCPCS,FILTERED SPEECH HEARING TEST,,,198.97
Deidentified Minimum,,92604,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT 7/>,,,735.54
Deidentified Minimum,,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,,5831.00
Deidentified Minimum,,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,,3544.00
Deidentified Minimum,,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,,5831.00
Deidentified Minimum,,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,,1145.00
Deidentified Minimum,,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,,1122.63
Deidentified Minimum,,92971,CPT4/HCPCS,CARDIOASSIST EXTERNAL,,,433.19
Deidentified Minimum,,92974,CPT4/HCPCS,CATH PLACE CARDIO BRACHYTX,,,1145.00
Deidentified Minimum,,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,,1145.00
Deidentified Minimum,,92981,CPT4/HCPCS,INSERT INTRACORONARY STENT,,,901.28
Deidentified Minimum,,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,,5783.00
Deidentified Minimum,,92995,CPT4/HCPCS,CORONARY ATHERECTOMY,,,2730.26
Deidentified Minimum,,93000,CPT4/HCPCS,ELECTROCARDIOGRAM COMPLETE,,,165.56
Deidentified Minimum,,93017,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,,480.39
Deidentified Minimum,,93041,CPT4/HCPCS,RHYTHM ECG TRACING,,,50.23
Deidentified Minimum,,93050,CPT4/HCPCS,ART PRESSURE WAVEFORM ANALYS,,,75.26
Deidentified Minimum,,93268,CPT4/HCPCS,ECG RECORD/REVIEW,,,2208.52
Deidentified Minimum,,93285,CPT4/HCPCS,PRGRMG DEV EVAL SCRMS IP,,,150.19
Deidentified Minimum,,93289,CPT4/HCPCS,INTERROG DEVICE EVAL HEART,,,189.58
Deidentified Minimum,,93290,CPT4/HCPCS,INTERROG DEV EVAL ICPMS IP,,,86.60
Deidentified Minimum,,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,,2998.00
Deidentified Minimum,,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,,1145.00
Deidentified Minimum,,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,,2998.00
Deidentified Minimum,,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,,1145.00
Deidentified Minimum,,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,,1145.00
Deidentified Minimum,,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,,1377.34
Deidentified Minimum,,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,,823.86
Deidentified Minimum,,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,1212.05
Deidentified Minimum,,93623,CPT4/HCPCS,STIMULATION PACING HEART,,,1622.74
Deidentified Minimum,,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,,5575.00
Deidentified Minimum,,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,,4847.00
Deidentified Minimum,,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,,3544.00
Deidentified Minimum,,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,,1291.00
Deidentified Minimum,,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,,1291.00
Deidentified Minimum,,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,,4000.00
Deidentified Minimum,,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,,5029.00
Deidentified Minimum,,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,,1291.00
Deidentified Minimum,,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,,1291.00
Deidentified Minimum,,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,,1678.88
Deidentified Minimum,,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,,1235.00
Deidentified Minimum,,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,,1235.00
Deidentified Minimum,,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,,1678.00
Deidentified Minimum,,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,,1291.00
Deidentified Minimum,,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,,1291.00
Deidentified Minimum,,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,,1291.00
Deidentified Minimum,,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,,6612.00
Deidentified Minimum,,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,,1291.00
Deidentified Minimum,,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,,1291.00
Deidentified Minimum,,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,,1291.00
Deidentified Minimum,,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,,1291.00
Deidentified Minimum,,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,,1678.00
Deidentified Minimum,,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,,3965.00
Deidentified Minimum,,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,,3965.00
Deidentified Minimum,,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,,3198.57
Deidentified Minimum,,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,,3965.00
Deidentified Minimum,,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,,3198.57
Deidentified Minimum,,51600,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,,1145.00
Deidentified Minimum,,51605,CPT4/HCPCS,PREPARATION FOR BLADDER XRAY,,,1145.00
Deidentified Minimum,,51701,CPT4/HCPCS,INSERT BLADDER CATHETER,,,400.00
Deidentified Minimum,,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,,3000.00
Deidentified Minimum,,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,,1291.00
Deidentified Minimum,,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,,3198.57
Deidentified Minimum,,51999,CPT4/HCPCS,LAPAROSCOPE PROC BLA,,,3000.00
Deidentified Minimum,,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,,1291.00
Deidentified Minimum,,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,3544.00
Deidentified Minimum,,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,,1291.00
Deidentified Minimum,,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,,3965.00
Deidentified Minimum,,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,,1678.88
Deidentified Minimum,,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,,3544.00
Deidentified Minimum,,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,,987.78
Deidentified Minimum,,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,,3544.00
Deidentified Minimum,,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,,1678.88
Deidentified Minimum,,53000,CPT4/HCPCS,INCISION OF URETHRA,,,1678.00
Deidentified Minimum,,53025,CPT4/HCPCS,INCISION OF URETHRA,,,1678.00
Deidentified Minimum,,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,,4847.00
Deidentified Minimum,,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,,1678.88
Deidentified Minimum,,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,,1678.00
Deidentified Minimum,,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,1678.88
Deidentified Minimum,,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,1678.88
Deidentified Minimum,,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,,3000.00
Deidentified Minimum,,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,,1678.88
Deidentified Minimum,,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,,1678.88
Deidentified Minimum,,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,,1145.00
Deidentified Minimum,,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,,1291.00
Deidentified Minimum,,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,,1291.00
Deidentified Minimum,,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,,1291.00
Deidentified Minimum,,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,,1291.00
Deidentified Minimum,,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,,3000.00
Deidentified Minimum,,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,,1678.88
Deidentified Minimum,,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,,1291.00
Deidentified Minimum,,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,,1678.00
Deidentified Minimum,,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,,1145.00
Deidentified Minimum,,54230,CPT4/HCPCS,PREPARE PENIS STUDY,,,1145.00
Deidentified Minimum,,54235,CPT4/HCPCS,PENILE INJECTION,,,987.78
Deidentified Minimum,,54240,CPT4/HCPCS,PENIS STUDY,,,400.00
Deidentified Minimum,,54300,CPT4/HCPCS,REVISION OF PENIS,,,3544.00
Deidentified Minimum,,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,,3000.00
Deidentified Minimum,,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,,4000.00
Deidentified Minimum,,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,,1145.00
Deidentified Minimum,,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,,3544.00
Deidentified Minimum,,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,,3544.00
Deidentified Minimum,,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,,3544.00
Deidentified Minimum,,54660,CPT4/HCPCS,REVISION OF TESTIS,,,1678.88
Deidentified Minimum,,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,,1678.00
Deidentified Minimum,,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,,1678.88
Deidentified Minimum,,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,,1235.00
Deidentified Minimum,,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,,1678.00
Deidentified Minimum,,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,,1291.00
Deidentified Minimum,,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,,1678.00
Deidentified Minimum,,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,1291.00
Deidentified Minimum,,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,1291.00
Deidentified Minimum,,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,,2002.00
Deidentified Minimum,,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,,4847.00
Deidentified Minimum,,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,,1145.00
Deidentified Minimum,,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,,3965.00
Deidentified Minimum,,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,4280.43
Deidentified Minimum,,56805,CPT4/HCPCS,REPAIR CLITORIS,,,1678.88
Deidentified Minimum,,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,,987.78
Deidentified Minimum,,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,,1678.00
Deidentified Minimum,,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,,1678.00
Deidentified Minimum,,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,,1678.00
Deidentified Minimum,,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,,3000.00
Deidentified Minimum,,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,,1235.00
Deidentified Minimum,,57200,CPT4/HCPCS,REPAIR OF VAGINA,,,1678.00
Deidentified Minimum,,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,,4847.00
Deidentified Minimum,,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,,5730.00
Deidentified Minimum,,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,,3544.00
Deidentified Minimum,,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,,3965.00
Deidentified Minimum,,57295,CPT4/HCPCS,REVISE VAG GRAFT VIA VAGINA,,,3198.57
Deidentified Minimum,,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,,3000.00
Deidentified Minimum,,57452,CPT4/HCPCS,EXAM OF CERVIX W/SCOPE,,,987.78
Deidentified Minimum,,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,,1678.00
Deidentified Minimum,,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,,3544.00
Deidentified Minimum,,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,,1291.00
Deidentified Minimum,,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,,400.00
Deidentified Minimum,,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,,987.78
Deidentified Minimum,,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,,3198.57
Deidentified Minimum,,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,,3000.00
Deidentified Minimum,,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,,3198.57
Deidentified Minimum,,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,,3000.00
Deidentified Minimum,,58323,CPT4/HCPCS,SPERM WASHING,,,987.78
Deidentified Minimum,,58540,CPT4/HCPCS,REVISION OF UTERUS,,,1291.00
Deidentified Minimum,,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,,5281.00
Deidentified Minimum,,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,,5029.00
Deidentified Minimum,,58548,CPT4/HCPCS,LAP RADICAL HYST,,,5730.00
Deidentified Minimum,,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,,3000.00
Deidentified Minimum,,58579,CPT4/HCPCS,HYSTEROSCOPE PROCEDURE,,,1145.00
Deidentified Minimum,,58750,CPT4/HCPCS,REPAIR OVIDUCT,,,3000.00
Deidentified Minimum,,58760,CPT4/HCPCS,FIMBRIOPLASTY,,,3000.00
Deidentified Minimum,,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,,3198.57
Deidentified Minimum,,58957,CPT4/HCPCS,RESECT RECURRENT GYN MAL,,,1291.00
Deidentified Minimum,,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,,1235.00
Deidentified Minimum,,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,,1145.00
Deidentified Minimum,,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,,1145.00
Deidentified Minimum,,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,,3965.00
Deidentified Minimum,,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,1291.00
Deidentified Minimum,,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,,1678.88
Deidentified Minimum,,59426,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,,3198.57
Deidentified Minimum,,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,,1291.00
Deidentified Minimum,,59855,CPT4/HCPCS,ABORTION,,,1291.00
Deidentified Minimum,,59866,CPT4/HCPCS,ABORTION (MPR),,,1145.00
Deidentified Minimum,,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,,1678.88
Deidentified Minimum,,60270,CPT4/HCPCS,REMOVAL OF THYROID,,,1291.00
Deidentified Minimum,,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,,1291.00
Deidentified Minimum,,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,,1235.00
Deidentified Minimum,,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,,1291.00
Deidentified Minimum,,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,,1291.00
Deidentified Minimum,,61314,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,1291.00
Deidentified Minimum,,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,1291.00
Deidentified Minimum,,61332,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,,1678.88
Deidentified Minimum,,61334,CPT4/HCPCS,EXPLORE ORBIT/REMOVE OBJECT,,,5029.00
Deidentified Minimum,,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,,1291.00
Deidentified Minimum,,61440,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,,6588.00
Deidentified Minimum,,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,,1291.00
Deidentified Minimum,,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,1291.00
Deidentified Minimum,,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,1291.00
Deidentified Minimum,,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,,1291.00
Deidentified Minimum,,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,,1291.00
Deidentified Minimum,,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,,1291.00
Deidentified Minimum,,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,,1291.00
Deidentified Minimum,,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,,1291.00
Deidentified Minimum,,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,,1291.00
Deidentified Minimum,,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,,1291.00
Deidentified Minimum,,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,1291.00
Deidentified Minimum,,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,1291.00
Deidentified Minimum,,61612,CPT4/HCPCS,TRANSECT ARTERY SINUS,,,4280.43
Deidentified Minimum,,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,,1291.00
Deidentified Minimum,,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,1291.00
Deidentified Minimum,,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,,1291.00
Deidentified Minimum,,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,,1291.00
Deidentified Minimum,,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,,3452.00
Deidentified Minimum,,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1291.00
Deidentified Minimum,,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1291.00
Deidentified Minimum,,61875,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,6588.00
Deidentified Minimum,,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,,1291.00
Deidentified Minimum,,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,,1145.00
Deidentified Minimum,,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,,1291.00
Deidentified Minimum,,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,,1235.00
Deidentified Minimum,,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,,1145.00
Deidentified Minimum,,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,,3000.00
Deidentified Minimum,,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,,1235.00
Deidentified Minimum,,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,,1235.00
Deidentified Minimum,,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,,1678.88
Deidentified Minimum,,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,,3452.00
Deidentified Minimum,,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,,3452.00
Deidentified Minimum,,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,,3000.00
Deidentified Minimum,,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,,1291.00
Deidentified Minimum,,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,,1291.00
Deidentified Minimum,,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,1291.00
Deidentified Minimum,,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,,1291.00
Deidentified Minimum,,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,,3198.57
Deidentified Minimum,,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,,3198.57
Deidentified Minimum,,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,,3452.00
Deidentified Minimum,,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,,1291.00
Deidentified Minimum,,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,,3452.00
Deidentified Minimum,,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,,1291.00
Deidentified Minimum,,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,,1291.00
Deidentified Minimum,,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1678.88
Deidentified Minimum,,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,,1291.00
Deidentified Minimum,,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,,1291.00
Deidentified Minimum,,64402,CPT4/HCPCS,N BLOCK INJ FACIAL,,,1678.00
Deidentified Minimum,,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,,987.78
Deidentified Minimum,,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,,1145.00
Deidentified Minimum,,64413,CPT4/HCPCS,N BLOCK INJ CERVICAL PLEXUS,,,1678.00
Deidentified Minimum,,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,,1235.00
Deidentified Minimum,,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,,1235.00
Deidentified Minimum,,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,,1235.00
Deidentified Minimum,,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,,1235.00
Deidentified Minimum,,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,,1145.00
Deidentified Minimum,,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,,1145.00
Deidentified Minimum,,64565,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1678.00
Deidentified Minimum,,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,1678.00
Deidentified Minimum,,64614,CPT4/HCPCS,DESTROY NERVE EXTREM MUSC,,,1678.00
Deidentified Minimum,,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,1235.00
Deidentified Minimum,,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,,400.00
Deidentified Minimum,,64761,CPT4/HCPCS,INCISION OF PELVIS NERVE,,,1678.00
Deidentified Minimum,,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,,1291.00
Deidentified Minimum,,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,,3452.00
Deidentified Minimum,,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,,1291.00
Deidentified Minimum,,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,,3452.00
Deidentified Minimum,,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,,1678.88
Deidentified Minimum,,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,,1678.88
Deidentified Minimum,,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,,3452.00
Deidentified Minimum,,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,,1145.00
Deidentified Minimum,,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,,1678.88
Deidentified Minimum,,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,,3452.00
Deidentified Minimum,,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,,1145.00
Deidentified Minimum,,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,,1678.00
Deidentified Minimum,,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,,1145.00
Deidentified Minimum,,65101,CPT4/HCPCS,REMOVAL OF EYE,,,3452.00
Deidentified Minimum,,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,,3452.00
Deidentified Minimum,,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,,3452.00
Deidentified Minimum,,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,,3452.00
Deidentified Minimum,,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,,1291.00
Deidentified Minimum,,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,,1291.00
Deidentified Minimum,,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,,1291.00
Deidentified Minimum,,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,,400.00
Deidentified Minimum,,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,,3452.00
Deidentified Minimum,,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,,400.00
Deidentified Minimum,,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,,1291.00
Deidentified Minimum,,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,,987.78
Deidentified Minimum,,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,,3452.00
Deidentified Minimum,,65810,CPT4/HCPCS,DRAINAGE OF EYE,,,3452.00
Deidentified Minimum,,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,,1678.00
Deidentified Minimum,,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,,1678.00
Deidentified Minimum,,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,,3452.00
Deidentified Minimum,,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,,3452.00
Deidentified Minimum,,66505,CPT4/HCPCS,INCISION OF IRIS,,,1291.00
Deidentified Minimum,,66625,CPT4/HCPCS,REMOVAL OF IRIS,,,1291.00
Deidentified Minimum,,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,,1291.00
Deidentified Minimum,,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,,3452.00
Deidentified Minimum,,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,,3452.00
Deidentified Minimum,,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,,1235.00
Deidentified Minimum,,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,,3452.00
Deidentified Minimum,,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,,3452.00
Deidentified Minimum,,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,,1678.88
Deidentified Minimum,,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,,3452.00
Deidentified Minimum,,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,,1145.00
Deidentified Minimum,,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,,1145.00
Deidentified Minimum,,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,,3452.00
Deidentified Minimum,,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,,987.78
Deidentified Minimum,,67710,CPT4/HCPCS,INCISION OF EYELID,,,1291.00
Deidentified Minimum,,67800,CPT4/HCPCS,REMOVE EYELID LESION,,,987.78
Deidentified Minimum,,67882,CPT4/HCPCS,REVISION OF EYELID,,,3452.00
Deidentified Minimum,,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,,1678.00
Deidentified Minimum,,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,,3452.00
Deidentified Minimum,,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,,3452.00
Deidentified Minimum,,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,,987.78
Deidentified Minimum,,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,,1678.00
Deidentified Minimum,,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,,987.78
Deidentified Minimum,,68330,CPT4/HCPCS,REVISE EYELID LINING,,,3452.00
Deidentified Minimum,,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,,3452.00
Deidentified Minimum,,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,,1235.00
Deidentified Minimum,,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,,3452.00
Deidentified Minimum,,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,,3452.00
Deidentified Minimum,,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,,1678.00
Deidentified Minimum,,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,,1145.00
Deidentified Minimum,,69090,CPT4/HCPCS,PIERCE EARLOBES,,,987.78
Deidentified Minimum,,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,,987.78
Deidentified Minimum,,69405,CPT4/HCPCS,CATHETERIZE MIDDLE EAR CANAL,,,1678.00
Deidentified Minimum,,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,,1678.00
Deidentified Minimum,,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,,1291.00
Deidentified Minimum,,69554,CPT4/HCPCS,REMOVE EAR LESION,,,1291.00
Deidentified Minimum,,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,,1678.88
Deidentified Minimum,,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,,3452.00
Deidentified Minimum,,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,,3452.00
Deidentified Minimum,,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,,3452.00
Deidentified Minimum,,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,,3452.00
Deidentified Minimum,,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,,3000.00
Deidentified Minimum,,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,,142.00
Deidentified Minimum,,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,,142.00
Deidentified Minimum,,70200,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,,142.00
Deidentified Minimum,,70300,CPT4/HCPCS,X-RAY EXAM OF TEETH,,,75.76
Deidentified Minimum,,70320,CPT4/HCPCS,FULL MOUTH X-RAY OF TEETH,,,142.00
Deidentified Minimum,,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,,142.00
Deidentified Minimum,,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,,985.00
Deidentified Minimum,,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,,985.00
Deidentified Minimum,,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,,985.00
Deidentified Minimum,,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,,1147.00
Deidentified Minimum,,70554,CPT4/HCPCS,FMRI BRAIN BY TECH,,,1147.00
Deidentified Minimum,,70558,CPT4/HCPCS,MRI BRAIN W/DYE,,,1147.00
Deidentified Minimum,,71260,CPT4/HCPCS,CT THORAX DX C+,,,142.00
Deidentified Minimum,,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,,142.00
Deidentified Minimum,,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,,142.00
Deidentified Minimum,,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,,142.00
Deidentified Minimum,,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,,142.00
Deidentified Minimum,,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,,985.00
Deidentified Minimum,,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,,142.00
Deidentified Minimum,,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,,142.00
Deidentified Minimum,,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,,140.86
Deidentified Minimum,,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,,142.00
Deidentified Minimum,,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,,142.00
Deidentified Minimum,,73225,CPT4/HCPCS,MR ANGIO UPR EXTR W/O&W/DYE,,,1147.00
Deidentified Minimum,,73522,CPT4/HCPCS,X-RAY EXAM HIPS BI 3-4 VIEWS,,,142.00
Deidentified Minimum,,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,,142.00
Deidentified Minimum,,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,,142.00
Deidentified Minimum,,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,,142.00
Deidentified Minimum,,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,,142.00
Deidentified Minimum,,73725,CPT4/HCPCS,MR ANG LWR EXT W OR W/O DYE,,,1147.00
Deidentified Minimum,,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,,985.00
Deidentified Minimum,,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,,985.00
Deidentified Minimum,,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,,142.00
Deidentified Minimum,,74260,CPT4/HCPCS,X-RAY EXAM OF SMALL BOWEL,,,749.21
Deidentified Minimum,,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,,985.00
Deidentified Minimum,,74430,CPT4/HCPCS,CONTRAST X-RAY BLADDER,,,142.00
Deidentified Minimum,,74713,CPT4/HCPCS,MRI FETAL EA ADDL GESTATION,,,1147.00
Deidentified Minimum,,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,,142.00
Deidentified Minimum,,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,,142.00
Deidentified Minimum,,75746,CPT4/HCPCS,ARTERY X-RAYS LUNG,,,142.00
Deidentified Minimum,,75803,CPT4/HCPCS,LYMPH VESSEL X-RAY ARMS/LEGS,,,142.00
Deidentified Minimum,,75807,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,,142.00
Deidentified Minimum,,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,,142.00
Deidentified Minimum,,75952,CPT4/HCPCS,ENDOVASC REPAIR ABDOM AORTA,,,6500.00
Deidentified Minimum,,75957,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,,142.00
Deidentified Minimum,,75970,CPT4/HCPCS,VASCULAR BIOPSY,,,142.00
Deidentified Minimum,,76100,CPT4/HCPCS,X-RAY EXAM OF BODY SECTION,,,142.00
Deidentified Minimum,,76102,CPT4/HCPCS,COMPLEX BODY SECTION X-RAYS,,,142.00
Deidentified Minimum,,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,,142.00
Deidentified Minimum,,76499,CPT4/HCPCS,RADIOGRAPHIC PROCEDURE,,,142.00
Deidentified Minimum,,76510,CPT4/HCPCS,OPH US DX B-SCAN&QUAN A-SCAN,,,553.00
Deidentified Minimum,,76511,CPT4/HCPCS,OPH US DX QUAN A-SCAN ONLY,,,360.24
Deidentified Minimum,,76513,CPT4/HCPCS,OPH US DX ANT SGM US UNI/BI,,,425.26
Deidentified Minimum,,76516,CPT4/HCPCS,ECHO EXAM OF EYE,,,259.19
Deidentified Minimum,,76604,CPT4/HCPCS,US EXAM CHEST,,,531.55
Deidentified Minimum,,76810,CPT4/HCPCS,OB US >= 14 WKS ADDL FETUS,,,433.86
Deidentified Minimum,,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,,553.00
Deidentified Minimum,,76937,CPT4/HCPCS,US GUIDE VASCULAR ACCESS,,,170.43
Deidentified Minimum,,76946,CPT4/HCPCS,ECHO GUIDE FOR AMNIOCENTESIS,,,167.49
Deidentified Minimum,,76948,CPT4/HCPCS,ECHO GUIDE OVA ASPIRATION,,,167.49
Deidentified Minimum,,77001,CPT4/HCPCS,FLUOROGUIDE FOR VEIN DEVICE,,,142.00
Deidentified Minimum,,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,,985.00
Deidentified Minimum,,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,,1147.00
Deidentified Minimum,,77046,CPT4/HCPCS,MRI BREAST C- UNILATERAL,,,1147.00
Deidentified Minimum,,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,,348.00
Deidentified Minimum,,77071,CPT4/HCPCS,X-RAY STRESS VIEW,,,142.00
Deidentified Minimum,,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,,142.00
Deidentified Minimum,,77078,CPT4/HCPCS,CT BONE DENSITY AXIAL,,,279.22
Deidentified Minimum,,77263,CPT4/HCPCS,RADIATION THERAPY PLANNING,,,142.00
Deidentified Minimum,,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,,632.25
Deidentified Minimum,,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,,1962.59
Deidentified Minimum,,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,,107.85
Deidentified Minimum,,77431,CPT4/HCPCS,RADIATION THERAPY MANAGEMENT,,,440.99
Deidentified Minimum,,77600,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,,1536.91
Deidentified Minimum,,77615,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,,2051.90
Deidentified Minimum,,77620,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,,1536.91
Deidentified Minimum,,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,,2422.00
Deidentified Minimum,,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,,1101.33
Deidentified Minimum,,78016,CPT4/HCPCS,THYROID MET IMAGING/STUDIES,,,142.00
Deidentified Minimum,,78135,CPT4/HCPCS,RED CELL SURVIVAL KINETICS,,,142.00
Deidentified Minimum,,78140,CPT4/HCPCS,RED CELL SEQUESTRATION,,,142.00
Deidentified Minimum,,78195,CPT4/HCPCS,LYMPH SYSTEM IMAGING,,,142.00
Deidentified Minimum,,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,,142.00
Deidentified Minimum,,78267,CPT4/HCPCS,BREATH TST ATTAIN/ANAL C-14,,,97.69
Deidentified Minimum,,78315,CPT4/HCPCS,BONE IMAGING 3 PHASE,,,142.00
Deidentified Minimum,,78414,CPT4/HCPCS,NON-IMAGING HEART FUNCTION,,,142.00
Deidentified Minimum,,78454,CPT4/HCPCS,HT MUSC IMAGE PLANAR MULT,,,142.00
Deidentified Minimum,,78483,CPT4/HCPCS,HEART FIRST PASS MULTIPLE,,,142.00
Deidentified Minimum,,78491,CPT4/HCPCS,MYOCRD IMG PET 1STD RST/STRS,,,142.00
Deidentified Minimum,,78582,CPT4/HCPCS,LUNG VENTILAT&PERFUS IMAGING,,,142.00
Deidentified Minimum,,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,,142.00
Deidentified Minimum,,78650,CPT4/HCPCS,CSF LEAKAGE IMAGING,,,142.00
Deidentified Minimum,,95806,CPT4/HCPCS,SLEEP STUDY UNATT&RESP EFFT,,,1059.57
Deidentified Minimum,,95810,CPT4/HCPCS,POLYSOM 6/> YRS 4/> PARAM,,,3302.00
Deidentified Minimum,,95813,CPT4/HCPCS,EEG EXTND MNTR 61-119 MIN,,,2079.69
Deidentified Minimum,,95816,CPT4/HCPCS,EEG AWAKE AND DROWSY,,,1329.85
Deidentified Minimum,,95819,CPT4/HCPCS,EEG AWAKE AND ASLEEP,,,1594.50
Deidentified Minimum,,95824,CPT4/HCPCS,EEG CEREBRAL DEATH ONLY,,,802.13
Deidentified Minimum,,95864,CPT4/HCPCS,MUSCLE TEST 4 LIMBS,,,909.69
Deidentified Minimum,,95870,CPT4/HCPCS,MUSCLE TEST NONPARASPINAL,,,113.92
Deidentified Minimum,,95874,CPT4/HCPCS,GUIDE NERV DESTR NEEDLE EMG,,,104.30
Deidentified Minimum,,95900,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,,537.35
Deidentified Minimum,,95974,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,,882.52
Deidentified Minimum,,95979,CPT4/HCPCS,ANALYZ NEUROSTIM BRAIN ADDON,,,450.88
Deidentified Minimum,,95981,CPT4/HCPCS,IO ANAL GAST N-STIM SUBSQ,,,65.81
Deidentified Minimum,,95992,CPT4/HCPCS,CANALITH REPOSITIONING PROC,,,150.80
Deidentified Minimum,,96003,CPT4/HCPCS,DYNAMIC FINE WIRE EMG,,,65.81
Deidentified Minimum,,96110,CPT4/HCPCS,DEVELOPMENTAL SCREEN W/SCORE,,,164.03
Deidentified Minimum,,96360,CPT4/HCPCS,HYDRATION IV INFUSION INIT,,,648.94
Deidentified Minimum,,96376,CPT4/HCPCS,TX/PRO/DX INJ SAME DRUG ADON,,,193.00
Deidentified Minimum,,96406,CPT4/HCPCS,CHEMO INTRALESIONAL OVER 7,,,146.83
Deidentified Minimum,,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,,193.00
Deidentified Minimum,,96420,CPT4/HCPCS,CHEMO IA PUSH TECNIQUE,,,1042.69
Deidentified Minimum,,96422,CPT4/HCPCS,CHEMO IA INFUSION UP TO 1 HR,,,1687.64
Deidentified Minimum,,96573,CPT4/HCPCS,PDT DSTR PRMLG LES PHYS/QHP,,,1145.00
Deidentified Minimum,,96902,CPT4/HCPCS,TRICHOGRAM,,,52.14
Deidentified Minimum,,96931,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,,987.78
Deidentified Minimum,,97001,CPT4/HCPCS,PT EVALUATION,,,342.55
Deidentified Minimum,,97002,CPT4/HCPCS,PT RE-EVALUATION,,,205.34
Deidentified Minimum,,97014,CPT4/HCPCS,ELECTRIC STIMULATION THERAPY,,,90.38
Deidentified Minimum,,97028,CPT4/HCPCS,ULTRAVIOLET THERAPY,,,41.66
Deidentified Minimum,,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,,100.27
Deidentified Minimum,,97034,CPT4/HCPCS,CONTRAST BATH THERAPY,,,100.27
Deidentified Minimum,,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,,193.00
Deidentified Minimum,,97124,CPT4/HCPCS,MASSAGE THERAPY,,,133.94
Deidentified Minimum,,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,,187.84
Deidentified Minimum,,97155,CPT4/HCPCS,ADAPT BEHAVIOR TX PHYS/QHP,,,206.64
Deidentified Minimum,,97169,CPT4/HCPCS,ATHLETIC TRN EVAL LOW CMPLX,,,288.00
Deidentified Minimum,,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,,182.06
Deidentified Minimum,,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,,166.84
Deidentified Minimum,,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,,172.25
Deidentified Minimum,,97802,CPT4/HCPCS,MEDICAL NUTRITION INDIV IN,,,230.18
Deidentified Minimum,,99170,CPT4/HCPCS,ANOGENITAL EXAM CHILD W IMAG,,,883.92
Deidentified Minimum,,99175,CPT4/HCPCS,INDUCTION OF VOMITING,,,713.97
Deidentified Minimum,,99190,CPT4/HCPCS,SPECIAL PUMP SERVICES,,,7464.76
Deidentified Minimum,,A4642,CPT4/HCPCS,In111 satumomab,,,11678.10
Deidentified Minimum,,A9520,CPT4/HCPCS,Tc99 tilmanocept diag 0.5mci,,,3930.52
Deidentified Minimum,,A9529,CPT4/HCPCS,I131 iodide sol, dx,,,7.56
Deidentified Minimum,,A9539,CPT4/HCPCS,Tc99m pentetate,,,262.16
Deidentified Minimum,,A9560,CPT4/HCPCS,Tc99m labeled rbc,,,781.45
Deidentified Minimum,,A9562,CPT4/HCPCS,Tc99m mertiatide,,,6482.11
Deidentified Minimum,,A9570,CPT4/HCPCS,Indium In-111 auto WBC,,,29920.38
Deidentified Minimum,,A9578,CPT4/HCPCS,Inj multihance multipack,,,16.21
Deidentified Minimum,,A9579,CPT4/HCPCS,Gad-base MR contrast NOS,1ml,,,13.10
Deidentified Minimum,,A9580,CPT4/HCPCS,Sodium fluoride F-18,,,1318.80
Deidentified Minimum,,C5276,CPT4/HCPCS,Low cost skin substitute app,,,1145.00
Deidentified Minimum,,C8912,CPT4/HCPCS,MRA w/cont, lwr ext,,,4399.00
Deidentified Minimum,,C8914,CPT4/HCPCS,MRA w/o fol w/cont, lwr ext,,,4399.00
Deidentified Minimum,,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,,6876.92
Deidentified Minimum,,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,,6876.92
Deidentified Minimum,,C9726,CPT4/HCPCS,Rxt breast appl place/remov,,,1145.00
Deidentified Minimum,,C9729,CPT4/HCPCS,Percut lumbar lami,,,3544.00
Deidentified Minimum,,C9734,CPT4/HCPCS,U/S trtmt, not leiomyomata,,,1678.00
Deidentified Minimum,,C9742,CPT4/HCPCS,Laryngoscopy with injection,,,1678.00
Deidentified Minimum,,C9743,CPT4/HCPCS,Bulking/spacer material impl,,,1678.00
Deidentified Minimum,,C9747,CPT4/HCPCS,Ablation, hifu, prostate,,,3656.00
Deidentified Minimum,,C9751,CPT4/HCPCS,Microwave bronch, 3d, ebus,,,7830.00
Deidentified Minimum,,C9752,CPT4/HCPCS,Intraosseous des lumb/sacrum,,,4847.00
Deidentified Minimum,,C9800,CPT4/HCPCS,Dermal filler inj px/suppl,,,1678.00
Deidentified Minimum,,G0127,CPT4/HCPCS,Trim nail(s),,,1145.00
Deidentified Minimum,,G0130,CPT4/HCPCS,Single energy x-ray study,,,409.91
Deidentified Minimum,,G0260,CPT4/HCPCS,Inj for sacroiliac jt anesth,,,1235.00
Deidentified Minimum,,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,,3544.00
Deidentified Minimum,,G0283,CPT4/HCPCS,Elec stim other than wound,,,169.00
Deidentified Minimum,,G0399,CPT4/HCPCS,Home sleep test/type 3 Porta,,,982.80
Deidentified Minimum,,G0400,CPT4/HCPCS,Home sleep test/type 4 Porta,,,819.00
Deidentified Minimum,,G0413,CPT4/HCPCS,Pelvic ring fracture uni/bil,,,3544.00
Deidentified Minimum,,G0480,CPT4/HCPCS,Drug test def 1-7 classes,,,0.00
Deidentified Minimum,,G0515,CPT4/HCPCS,Cognitive skills development,,,193.00
Deidentified Minimum,,G0518,CPT4/HCPCS,Remove w insert drug implant,,,1145.00
Deidentified Minimum,,G6004,CPT4/HCPCS,Radiation treatment delivery,,,925.46
Deidentified Minimum,,G6010,CPT4/HCPCS,Radiation treatment delivery,,,1417.85
Deidentified Minimum,,G6012,CPT4/HCPCS,Radiation treatment delivery,,,1685.30
Deidentified Minimum,,G6013,CPT4/HCPCS,Radiation treatment delivery,,,1897.02
Deidentified Minimum,,G6014,CPT4/HCPCS,Radiation treatment delivery,,,1897.02
Deidentified Minimum,,G6022,CPT4/HCPCS,Sigmoidoscopy w/ablate tumr,,,1678.00
Deidentified Minimum,,G8986,CPT4/HCPCS,Carry d/c status,,,0.00
Deidentified Minimum,,G8987,CPT4/HCPCS,Self care current status,,,0.00
Deidentified Minimum,,G9161,CPT4/HCPCS,Lang comp d/c status,,,6.5e-03
Deidentified Minimum,,G9175,CPT4/HCPCS,Speech lang goal status,,,6.5e-03
Deidentified Minimum,,J8560,CPT4/HCPCS,Etoposide oral 50 MG,,,638.56
Deidentified Minimum,,J9031,CPT4/HCPCS,Bcg live intravesical vac,,,1314.09
Deidentified Minimum,,J9032,CPT4/HCPCS,Injection, belinostat, 10mg,,,346.41
Deidentified Minimum,,J9041,CPT4/HCPCS,Inj., velcade 0.1 mg,,,380.51
Deidentified Minimum,,J9042,CPT4/HCPCS,Brentuximab vedotin inj,,,1436.98
Deidentified Minimum,,J9065,CPT4/HCPCS,Inj cladribine per 1 MG,,,171.19
Deidentified Minimum,,J9130,CPT4/HCPCS,Dacarbazine 100 mg inj,,,34.52
Deidentified Minimum,,J9150,CPT4/HCPCS,Daunorubicin injection,,,410.59
Deidentified Minimum,,J9181,CPT4/HCPCS,Etoposide injection,,,5.29
Deidentified Minimum,,J9200,CPT4/HCPCS,Floxuridine injection,,,724.33
Deidentified Minimum,,J9201,CPT4/HCPCS,In gemcitabine hcl nos 200mg,,,35.28
Deidentified Minimum,,J9211,CPT4/HCPCS,Idarubicin hcl injection,,,308.02
Deidentified Minimum,,J9216,CPT4/HCPCS,Interferon gamma 1-b inj,,,57399.38
Deidentified Minimum,,J9219,CPT4/HCPCS,Leuprolide acetate implant,,,33603.77
Deidentified Minimum,,J9245,CPT4/HCPCS,Inj melpha hydroch nos 50 mg,,,5373.64
Deidentified Minimum,,J9250,CPT4/HCPCS,Methotrexate sodium inj,,,2.10
Deidentified Minimum,,J9266,CPT4/HCPCS,Pegaspargase injection,,,149077.65
Deidentified Minimum,,J9280,CPT4/HCPCS,Mitomycin injection,,,677.79
Deidentified Minimum,,J9306,CPT4/HCPCS,Injection, pertuzumab, 1 mg,,,107.01
Deidentified Minimum,,J9308,CPT4/HCPCS,Injection, ramucirumab,,,506.26
Deidentified Minimum,,J9340,CPT4/HCPCS,Thiotepa injection,,,3495.49
Deidentified Minimum,,J9354,CPT4/HCPCS,Inj, ado-trastuzumab emt 1mg,,,272.41
Deidentified Minimum,,J9390,CPT4/HCPCS,Vinorelbine tartrate inj,,,101.47
Deidentified Minimum,,P9031,CPT4/HCPCS,Platelets leukocytes reduced,,,3628.00
Deidentified Minimum,,P9033,CPT4/HCPCS,Platelets leukoreduced irrad,,,3628.00
Deidentified Minimum,,P9054,CPT4/HCPCS,Blood, l/r, froz/degly/wash,,,3628.00
Deidentified Minimum,,Q9966,CPT4/HCPCS,LOCM 200-299mg/ml iodine,1ml,,,2.77
Deidentified Minimum,,Q9969,CPT4/HCPCS,Non-HEU TC-99M add-on/dose,,,8.40
Deidentified Minimum,,S0148,CPT4/HCPCS,Peg interferon alfa-2b/10,,,1258.57
Deidentified Minimum,,S2095,CPT4/HCPCS,Transcath emboliz microspher,,,5856.00
Deidentified Minimum,,S2225,CPT4/HCPCS,Myringotomy laser-assist,,,5856.00
Deidentified Minimum,,S2402,CPT4/HCPCS,Fetal surg cong cyst malf,,,8012.00
Deidentified Minimum,,S2403,CPT4/HCPCS,Fetal surg pulmon sequest,,,8012.00
Deidentified Minimum,,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,,1291.00
Deidentified Minimum,,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,,1291.00
Deidentified Minimum,,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,,1291.00
Deidentified Minimum,,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,,732.14
Deidentified Minimum,,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,,1145.00
Deidentified Minimum,,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,,400.00
Deidentified Minimum,,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,,987.78
Deidentified Minimum,,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,,3000.00
Deidentified Minimum,,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,,3000.00
Deidentified Minimum,,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,,5000.00
Deidentified Minimum,,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,,5000.00
Deidentified Minimum,,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,,1678.88
Deidentified Minimum,,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1291.00
Deidentified Minimum,,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,,1678.88
Deidentified Minimum,,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1291.00
Deidentified Minimum,,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,1678.88
Deidentified Minimum,,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,,1678.88
Deidentified Minimum,,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,,3544.00
Deidentified Minimum,,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,,1678.88
Deidentified Minimum,,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,,3544.00
Deidentified Minimum,,53020,CPT4/HCPCS,INCISION OF URETHRA,,,1678.00
Deidentified Minimum,,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,,1678.88
Deidentified Minimum,,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,,1678.88
Deidentified Minimum,,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,,1678.00
Deidentified Minimum,,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,,3544.00
Deidentified Minimum,,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,,1678.88
Deidentified Minimum,,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,,2002.00
Deidentified Minimum,,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,,3000.00
Deidentified Minimum,,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,,987.78
Deidentified Minimum,,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,,1291.00
Deidentified Minimum,,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,,1678.00
Deidentified Minimum,,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,,1678.00
Deidentified Minimum,,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,,1678.88
Deidentified Minimum,,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,4000.00
Deidentified Minimum,,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,3544.00
Deidentified Minimum,,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,,4000.00
Deidentified Minimum,,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,,1235.00
Deidentified Minimum,,54440,CPT4/HCPCS,REPAIR OF PENIS,,,4000.00
Deidentified Minimum,,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,,3544.00
Deidentified Minimum,,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,,1678.00
Deidentified Minimum,,55559,CPT4/HCPCS,LAPARO PROC SPERMATIC CORD,,,3000.00
Deidentified Minimum,,55870,CPT4/HCPCS,ELECTROEJACULATION,,,1235.00
Deidentified Minimum,,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,,1678.00
Deidentified Minimum,,55970,CPT4/HCPCS,SEX TRANSFORMATION M TO F,,,3198.57
Deidentified Minimum,,55980,CPT4/HCPCS,SEX TRANSFORMATION F TO M,,,3198.57
Deidentified Minimum,,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,,1145.00
Deidentified Minimum,,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,,1678.00
Deidentified Minimum,,56442,CPT4/HCPCS,HYMENOTOMY,,,1678.00
Deidentified Minimum,,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,,1291.00
Deidentified Minimum,,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,,1235.00
Deidentified Minimum,,56800,CPT4/HCPCS,REPAIR OF VAGINA,,,3544.00
Deidentified Minimum,,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,,1291.00
Deidentified Minimum,,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,,2002.00
Deidentified Minimum,,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,,1678.88
Deidentified Minimum,,57160,CPT4/HCPCS,INSERT PESSARY/OTHER DEVICE,,,987.78
Deidentified Minimum,,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,,3544.00
Deidentified Minimum,,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,,4891.93
Deidentified Minimum,,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,,1678.88
Deidentified Minimum,,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,,4847.00
Deidentified Minimum,,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,,3000.00
Deidentified Minimum,,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,,3544.00
Deidentified Minimum,,57400,CPT4/HCPCS,DILATION OF VAGINA,,,1678.00
Deidentified Minimum,,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,,5029.00
Deidentified Minimum,,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,,1145.00
Deidentified Minimum,,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,,1291.00
Deidentified Minimum,,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,,1291.00
Deidentified Minimum,,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,,3544.00
Deidentified Minimum,,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,,5000.00
Deidentified Minimum,,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,,3965.00
Deidentified Minimum,,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,,1291.00
Deidentified Minimum,,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,,3000.00
Deidentified Minimum,,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,,1291.00
Deidentified Minimum,,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,,3198.57
Deidentified Minimum,,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,,5783.00
Deidentified Minimum,,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,,6612.00
Deidentified Minimum,,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,,3544.00
Deidentified Minimum,,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,,6612.00
Deidentified Minimum,,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,,1291.00
Deidentified Minimum,,58578,CPT4/HCPCS,LAPARO PROC UTERUS,,,3000.00
Deidentified Minimum,,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,,1291.00
Deidentified Minimum,,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,,3000.00
Deidentified Minimum,,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,,5000.00
Deidentified Minimum,,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,,3000.00
Deidentified Minimum,,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,,3000.00
Deidentified Minimum,,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,,3544.00
Deidentified Minimum,,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,,1291.00
Deidentified Minimum,,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,,1291.00
Deidentified Minimum,,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,,1235.00
Deidentified Minimum,,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,,1145.00
Deidentified Minimum,,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,,1145.00
Deidentified Minimum,,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,,1145.00
Deidentified Minimum,,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,,1145.00
Deidentified Minimum,,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,3000.00
Deidentified Minimum,,59400,CPT4/HCPCS,OBSTETRICAL CARE,,,4280.43
Deidentified Minimum,,59409,CPT4/HCPCS,OBSTETRICAL CARE,,,2002.00
Deidentified Minimum,,59510,CPT4/HCPCS,CESAREAN DELIVERY,,,4891.93
Deidentified Minimum,,59610,CPT4/HCPCS,VBAC DELIVERY,,,4280.43
Deidentified Minimum,,59614,CPT4/HCPCS,VBAC CARE AFTER DELIVERY,,,4280.43
Deidentified Minimum,,59622,CPT4/HCPCS,ATTEMPTED VBAC AFTER CARE,,,4891.93
Deidentified Minimum,,59850,CPT4/HCPCS,ABORTION,,,1291.00
Deidentified Minimum,,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,,1678.00
Deidentified Minimum,,59897,CPT4/HCPCS,FETAL INVAS PX W/US,,,1145.00
Deidentified Minimum,,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,,1678.88
Deidentified Minimum,,60252,CPT4/HCPCS,REMOVAL OF THYROID,,,3000.00
Deidentified Minimum,,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,,3000.00
Deidentified Minimum,,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,,1145.00
Deidentified Minimum,,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,,1291.00
Deidentified Minimum,,60659,CPT4/HCPCS,LAPARO PROC ENDOCRINE,,,3000.00
Deidentified Minimum,,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,,1235.00
Deidentified Minimum,,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,,1291.00
Deidentified Minimum,,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,1291.00
Deidentified Minimum,,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,1291.00
Deidentified Minimum,,61343,CPT4/HCPCS,INCISE SKULL (PRESS RELIEF),,,1291.00
Deidentified Minimum,,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,1291.00
Deidentified Minimum,,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,,1291.00
Deidentified Minimum,,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,1291.00
Deidentified Minimum,,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,,1291.00
Deidentified Minimum,,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,,1291.00
Deidentified Minimum,,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,,1291.00
Deidentified Minimum,,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,,1291.00
Deidentified Minimum,,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,,1291.00
Deidentified Minimum,,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,,1291.00
Deidentified Minimum,,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,,1291.00
Deidentified Minimum,,61618,CPT4/HCPCS,REPAIR DURA,,,1291.00
Deidentified Minimum,,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,,1291.00
Deidentified Minimum,,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,,1291.00
Deidentified Minimum,,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,,987.78
Deidentified Minimum,,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,,987.78
Deidentified Minimum,,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,1291.00
Deidentified Minimum,,61783,CPT4/HCPCS,SCAN PROC SPINAL,,,1145.00
Deidentified Minimum,,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,,3452.00
Deidentified Minimum,,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,,3452.00
Deidentified Minimum,,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,,3452.00
Deidentified Minimum,,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,,1678.88
Deidentified Minimum,,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,,3452.00
Deidentified Minimum,,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,,1291.00
Deidentified Minimum,,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,,1291.00
Deidentified Minimum,,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,,1291.00
Deidentified Minimum,,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,,1291.00
Deidentified Minimum,,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,,1291.00
Deidentified Minimum,,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,,1235.00
Deidentified Minimum,,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,,1235.00
Deidentified Minimum,,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,,1235.00
Deidentified Minimum,,62311,CPT4/HCPCS,INJECT SPINE LUMBAR/SACRAL,,,1678.00
Deidentified Minimum,,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,,1235.00
Deidentified Minimum,,62328,CPT4/HCPCS,DX LMBR SPI PNXR W/FLUOR/CT,,,1235.00
Deidentified Minimum,,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,,1678.88
Deidentified Minimum,,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,,3452.00
Deidentified Minimum,,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,,3452.00
Deidentified Minimum,,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,,1145.00
Deidentified Minimum,,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,1291.00
Deidentified Minimum,,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,,1291.00
Deidentified Minimum,,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,,3452.00
Deidentified Minimum,,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,,1291.00
Deidentified Minimum,,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,,3452.00
Deidentified Minimum,,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,,1291.00
Deidentified Minimum,,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,,1291.00
Deidentified Minimum,,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,,1291.00
Deidentified Minimum,,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,,1235.00
Deidentified Minimum,,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,,1235.00
Deidentified Minimum,,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,,1145.00
Deidentified Minimum,,64508,CPT4/HCPCS,N BLOCK CAROTID SINUS S/P,,,1678.00
Deidentified Minimum,,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,,1235.00
Deidentified Minimum,,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,,987.78
Deidentified Minimum,,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,,1678.00
Deidentified Minimum,,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,,1145.00
Deidentified Minimum,,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,1235.00
Deidentified Minimum,,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,,1678.00
Deidentified Minimum,,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,,987.78
Deidentified Minimum,,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,,1678.88
Deidentified Minimum,,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,,1678.88
Deidentified Minimum,,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,,1678.88
Deidentified Minimum,,64752,CPT4/HCPCS,INCISION OF VAGUS NERVE,,,5783.00
Deidentified Minimum,,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,,1291.00
Deidentified Minimum,,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,,3000.00
Deidentified Minimum,,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,,1678.88
Deidentified Minimum,,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,,3452.00
Deidentified Minimum,,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,,3452.00
Deidentified Minimum,,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,,1678.88
Deidentified Minimum,,65091,CPT4/HCPCS,REVISE EYE,,,3452.00
Deidentified Minimum,,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,1145.00
Deidentified Minimum,,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,,1235.00
Deidentified Minimum,,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,,3452.00
Deidentified Minimum,,65600,CPT4/HCPCS,REVISION OF CORNEA,,,1678.00
Deidentified Minimum,,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,,3000.00
Deidentified Minimum,,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,,987.78
Deidentified Minimum,,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,,3452.00
Deidentified Minimum,,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,,3452.00
Deidentified Minimum,,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,,3452.00
Deidentified Minimum,,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,,3452.00
Deidentified Minimum,,66165,CPT4/HCPCS,GLAUCOMA SURGERY,,,5029.00
Deidentified Minimum,,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,,3452.00
Deidentified Minimum,,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,,3000.00
Deidentified Minimum,,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,,3452.00
Deidentified Minimum,,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,,3452.00
Deidentified Minimum,,66635,CPT4/HCPCS,REMOVAL OF IRIS,,,3452.00
Deidentified Minimum,,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,,3452.00
Deidentified Minimum,,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,,1235.00
Deidentified Minimum,,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,,3452.00
Deidentified Minimum,,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,,3452.00
Deidentified Minimum,,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,,3452.00
Deidentified Minimum,,66940,CPT4/HCPCS,EXTRACTION OF LENS,,,1291.00
Deidentified Minimum,,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,,3452.00
Deidentified Minimum,,66988,CPT4/HCPCS,XCAPSL CTRC RMVL W/ECP,,,3000.00
Deidentified Minimum,,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,,1678.00
Deidentified Minimum,,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,,3452.00
Deidentified Minimum,,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,,3000.00
Deidentified Minimum,,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,,1678.88
Deidentified Minimum,,67112,CPT4/HCPCS,REREPAIR DETACHED RETINA,,,6588.00
Deidentified Minimum,,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,,3452.00
Deidentified Minimum,,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,,3452.00
Deidentified Minimum,,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,,3452.00
Deidentified Minimum,,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,,1145.00
Deidentified Minimum,,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,,987.78
Deidentified Minimum,,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,,3452.00
Deidentified Minimum,,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,,1678.00
Deidentified Minimum,,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,,1291.00
Deidentified Minimum,,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,,3452.00
Deidentified Minimum,,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,,1235.00
Deidentified Minimum,,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,,1291.00
Deidentified Minimum,,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,,1291.00
Deidentified Minimum,,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,,400.00
Deidentified Minimum,,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,,1678.88
Deidentified Minimum,,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,,3452.00
Deidentified Minimum,,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,,1291.00
Deidentified Minimum,,69450,CPT4/HCPCS,EARDRUM REVISION,,,1678.00
Deidentified Minimum,,69540,CPT4/HCPCS,REMOVE EAR LESION,,,1291.00
Deidentified Minimum,,69550,CPT4/HCPCS,REMOVE EAR LESION,,,3452.00
Deidentified Minimum,,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,,3452.00
Deidentified Minimum,,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,,3452.00
Deidentified Minimum,,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,,3452.00
Deidentified Minimum,,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,,3452.00
Deidentified Minimum,,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,3452.00
Deidentified Minimum,,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,3452.00
Deidentified Minimum,,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,,3000.00
Deidentified Minimum,,69799,CPT4/HCPCS,MIDDLE EAR SURGERY PROCEDURE,,,1145.00
Deidentified Minimum,,69805,CPT4/HCPCS,EXPLORE INNER EAR,,,3452.00
Deidentified Minimum,,69820,CPT4/HCPCS,ESTABLISH INNER EAR WINDOW,,,5281.00
Deidentified Minimum,,69840,CPT4/HCPCS,REVISE INNER EAR WINDOW,,,5281.00
Deidentified Minimum,,69905,CPT4/HCPCS,REMOVE INNER EAR,,,3452.00
Deidentified Minimum,,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,,3000.00
Deidentified Minimum,,69979,CPT4/HCPCS,TEMPORAL BONE SURGERY,,,1145.00
Deidentified Minimum,,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,,1145.00
Deidentified Minimum,,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,,142.00
Deidentified Minimum,,70371,CPT4/HCPCS,SPEECH EVALUATION COMPLEX,,,142.00
Deidentified Minimum,,70390,CPT4/HCPCS,X-RAY EXAM OF SALIVARY DUCT,,,142.00
Deidentified Minimum,,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,,142.00
Deidentified Minimum,,71010,CPT4/HCPCS,CHEST X-RAY 1 VIEW FRONTAL,,,0.00
Deidentified Minimum,,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,,142.00
Deidentified Minimum,,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,,142.00
Deidentified Minimum,,71551,CPT4/HCPCS,MRI CHEST W/DYE,,,1147.00
Deidentified Minimum,,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,,142.00
Deidentified Minimum,,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,,142.00
Deidentified Minimum,,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,,142.00
Deidentified Minimum,,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,,142.00
Deidentified Minimum,,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,,142.00
Deidentified Minimum,,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,,142.00
Deidentified Minimum,,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,,1147.00
Deidentified Minimum,,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,,1147.00
Deidentified Minimum,,72159,CPT4/HCPCS,MR ANGIO SPINE W/O&W/DYE,,,1147.00
Deidentified Minimum,,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,,1147.00
Deidentified Minimum,,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,,1147.00
Deidentified Minimum,,72200,CPT4/HCPCS,X-RAY EXAM SI JOINTS,,,142.00
Deidentified Minimum,,72270,CPT4/HCPCS,MYELOGPHY 2/> SPINE REGIONS,,,142.00
Deidentified Minimum,,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,,142.00
Deidentified Minimum,,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,,142.00
Deidentified Minimum,,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,,142.00
Deidentified Minimum,,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,,1147.00
Deidentified Minimum,,73551,CPT4/HCPCS,X-RAY EXAM OF FEMUR 1,,,142.00
Deidentified Minimum,,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,,142.00
Deidentified Minimum,,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,,142.00
Deidentified Minimum,,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,,985.00
Deidentified Minimum,,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,,1147.00
Deidentified Minimum,,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,,142.00
Deidentified Minimum,,74021,CPT4/HCPCS,X-RAY EXAM ABDOMEN 3+ VIEWS,,,142.00
Deidentified Minimum,,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,,142.00
Deidentified Minimum,,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,,1147.00
Deidentified Minimum,,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,,1147.00
Deidentified Minimum,,74240,CPT4/HCPCS,X-RAY XM UPR GI TRC 1CNTRST,,,142.00
Deidentified Minimum,,74248,CPT4/HCPCS,X-RAY SM INT F-THRU STD,,,6500.00
Deidentified Minimum,,74400,CPT4/HCPCS,UROGRAPHY IV +-KUB TOMOG,,,142.00
Deidentified Minimum,,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,,142.00
Deidentified Minimum,,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,,142.00
Deidentified Minimum,,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,,985.00
Deidentified Minimum,,75705,CPT4/HCPCS,ARTERY X-RAYS SPINE,,,142.00
Deidentified Minimum,,75805,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,,142.00
Deidentified Minimum,,75809,CPT4/HCPCS,NONVASCULAR SHUNT X-RAY,,,142.00
Deidentified Minimum,,75827,CPT4/HCPCS,VEIN X-RAY CHEST,,,142.00
Deidentified Minimum,,75840,CPT4/HCPCS,VEIN X-RAY ADRENAL GLAND,,,142.00
Deidentified Minimum,,75872,CPT4/HCPCS,VEIN X-RAY SKULL EPIDURAL,,,142.00
Deidentified Minimum,,75880,CPT4/HCPCS,VEIN X-RAY EYE SOCKET,,,142.00
Deidentified Minimum,,75964,CPT4/HCPCS,REPAIR ARTERY BLOCKAGE EACH,,,6500.00
Deidentified Minimum,,75966,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,6500.00
Deidentified Minimum,,75968,CPT4/HCPCS,REPAIR ARTERY BLOCKAGE EACH,,,6500.00
Deidentified Minimum,,75984,CPT4/HCPCS,XRAY CONTROL CATHETER CHANGE,,,142.00
Deidentified Minimum,,76001,CPT4/HCPCS,FLUOROSCOPE EXAM EXTENSIVE,,,1317.13
Deidentified Minimum,,76140,CPT4/HCPCS,X-RAY CONSULTATION,,,142.00
Deidentified Minimum,,76497,CPT4/HCPCS,CT PROCEDURE,,,142.00
Deidentified Minimum,,76519,CPT4/HCPCS,ECHO EXAM OF EYE,,,297.69
Deidentified Minimum,,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,,553.00
Deidentified Minimum,,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,,553.00
Deidentified Minimum,,76802,CPT4/HCPCS,OB US < 14 WKS ADDL FETUS,,,253.34
Deidentified Minimum,,76830,CPT4/HCPCS,TRANSVAGINAL US NON-OB,,,553.00
Deidentified Minimum,,76873,CPT4/HCPCS,ECHOGRAP TRANS R PROS STUDY,,,553.00
Deidentified Minimum,,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,,87.61
Deidentified Minimum,,76886,CPT4/HCPCS,US EXAM INFANT HIPS STATIC,,,364.35
Deidentified Minimum,,76975,CPT4/HCPCS,GI ENDOSCOPIC ULTRASOUND,,,553.00
Deidentified Minimum,,76981,CPT4/HCPCS,USE PARENCHYMA,,,553.00
Deidentified Minimum,,76982,CPT4/HCPCS,USE 1ST TARGET LESION,,,553.00
Deidentified Minimum,,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,,985.00
Deidentified Minimum,,77021,CPT4/HCPCS,MRI GUIDANCE NDL PLMT RS&I,,,1147.00
Deidentified Minimum,,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,,292.25
Deidentified Minimum,,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,,348.00
Deidentified Minimum,,77063,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,,135.44
Deidentified Minimum,,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,,348.00
Deidentified Minimum,,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,,348.00
Deidentified Minimum,,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,,123.06
Deidentified Minimum,,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,,142.00
Deidentified Minimum,,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,,142.00
Deidentified Minimum,,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,,142.00
Deidentified Minimum,,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,,142.00
Deidentified Minimum,,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,,1915.70
Deidentified Minimum,,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,,2422.00
Deidentified Minimum,,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,,193.79
Deidentified Minimum,,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,,327.78
Deidentified Minimum,,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,,423.14
Deidentified Minimum,,77605,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,,2051.90
Deidentified Minimum,,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,,638.84
Deidentified Minimum,,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,,1269.01
Deidentified Minimum,,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,,2422.00
Deidentified Minimum,,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,,2422.00
Deidentified Minimum,,77785,CPT4/HCPCS,HDR BRACHYTX 1 CHANNEL,,,1678.88
Deidentified Minimum,,78018,CPT4/HCPCS,THYROID MET IMAGING BODY,,,142.00
Deidentified Minimum,,78071,CPT4/HCPCS,PARATHYRD PLANAR W/WO SUBTRJ,,,142.00
Deidentified Minimum,,78110,CPT4/HCPCS,PLASMA VOLUME SINGLE,,,142.00
Deidentified Minimum,,78201,CPT4/HCPCS,LIVER IMAGING,,,142.00
Deidentified Minimum,,78215,CPT4/HCPCS,LIVER AND SPLEEN IMAGING,,,142.00
Deidentified Minimum,,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,,142.00
Deidentified Minimum,,78232,CPT4/HCPCS,SALIVARY GLAND FUNCTION EXAM,,,142.00
Deidentified Minimum,,78258,CPT4/HCPCS,ESOPHAGEAL MOTILITY STUDY,,,142.00
Deidentified Minimum,,78262,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX EXAM,,,142.00
Deidentified Minimum,,78266,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,,142.00
Deidentified Minimum,,78268,CPT4/HCPCS,BREATH TEST ANALYSIS C-14,,,142.00
Deidentified Minimum,,78278,CPT4/HCPCS,ACUTE GI BLOOD LOSS IMAGING,,,142.00
Deidentified Minimum,,78282,CPT4/HCPCS,GI PROTEIN LOSS EXAM,,,142.00
Deidentified Minimum,,78306,CPT4/HCPCS,BONE IMAGING WHOLE BODY,,,142.00
Deidentified Minimum,,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,,142.00
Deidentified Minimum,,78457,CPT4/HCPCS,VENOUS THROMBOSIS IMAGING,,,142.00
Deidentified Minimum,,78761,CPT4/HCPCS,TESTICULAR IMAGING W/FLOW,,,142.00
Deidentified Minimum,,78800,CPT4/HCPCS,RP LOCLZJ TUM 1 AREA 1 D IMG,,,142.00
Deidentified Minimum,,78804,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 2+D IMG,,,142.00
Deidentified Minimum,,78805,CPT4/HCPCS,ABSCESS IMAGING LTD AREA,,,1713.38
Deidentified Minimum,,78807,CPT4/HCPCS,NUCLEAR LOCALIZATION/ABSCESS,,,3307.25
Deidentified Minimum,,80050,CPT4/HCPCS,GENERAL HEALTH PANEL,,,96.00
Deidentified Minimum,,80061,CPT4/HCPCS,LIPID PANEL,,,96.00
Deidentified Minimum,,80155,CPT4/HCPCS,DRUG ASSAY CAFFEINE,,,96.00
Deidentified Minimum,,80159,CPT4/HCPCS,DRUG ASSAY CLOZAPINE,,,96.00
Deidentified Minimum,,80175,CPT4/HCPCS,DRUG SCREEN QUAN LAMOTRIGINE,,,96.00
Deidentified Minimum,,80195,CPT4/HCPCS,ASSAY OF SIROLIMUS,,,96.00
Deidentified Minimum,,80324,CPT4/HCPCS,DRUG SCREEN AMPHETAMINES 1/2,,,0.08
Deidentified Minimum,,80325,CPT4/HCPCS,AMPHETAMINES 3OR 4,,,0.08
Deidentified Minimum,,80327,CPT4/HCPCS,ANABOLIC STEROID 1 OR 2,,,0.08
Deidentified Minimum,,80329,CPT4/HCPCS,ANALGESICS NON-OPIOID 1 OR 2,,,0.08
Deidentified Minimum,,80332,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 1 OR 2,,,0.08
Deidentified Minimum,,80333,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 3-5,,,0.08
Deidentified Minimum,,80340,CPT4/HCPCS,ANTIEPILEPTICS NOS 4-6,,,0.08
Deidentified Minimum,,80341,CPT4/HCPCS,ANTIEPILEPTICS NOS 7/MORE,,,0.08
Deidentified Minimum,,80343,CPT4/HCPCS,ANTIPSYCHOTICS NOS 4-6,,,0.08
Deidentified Minimum,,80348,CPT4/HCPCS,DRUG SCREENING BUPRENORPHINE,,,0.08
Deidentified Minimum,,80358,CPT4/HCPCS,DRUG SCREENING METHADONE,,,0.08
Deidentified Minimum,,80362,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 1/2,,,0.08
Deidentified Minimum,,80365,CPT4/HCPCS,DRUG SCREENING OXYCODONE,,,0.08
Deidentified Minimum,,80370,CPT4/HCPCS,SKEL MUSC RELAXANT 3 OR MORE,,,0.08
Deidentified Minimum,,C9750,CPT4/HCPCS,Ins/rem-replace compl iims,,,3544.00
Deidentified Minimum,,G0122,CPT4/HCPCS,Colon ca scrn; barium enema,,,1106.19
Deidentified Minimum,,G0256,CPT4/HCPCS,Prostate brachy w palladium,,,8012.00
Deidentified Minimum,,G0269,CPT4/HCPCS,Occlusive device in vein art,,,1145.00
Deidentified Minimum,,G0290,CPT4/HCPCS,Drug-eluting stents, single,,,8012.00
Deidentified Minimum,,G0339,CPT4/HCPCS,Robot lin-radsurg com, first,,,5730.00
Deidentified Minimum,,G0340,CPT4/HCPCS,Robt lin-radsurg fractx 2-5,,,4847.00
Deidentified Minimum,,G0398,CPT4/HCPCS,Home sleep test/type 2 Porta,,,1310.40
Deidentified Minimum,,G0517,CPT4/HCPCS,Remove drug implant,,,1145.00
Deidentified Minimum,,G6011,CPT4/HCPCS,Radiation treatment delivery,,,2034.57
Deidentified Minimum,,G6016,CPT4/HCPCS,Delivery comp imrt,,,2953.40
Deidentified Minimum,,G8627,CPT4/HCPCS,Surg proc w/in 30 days,,,5029.00
Deidentified Minimum,,G8994,CPT4/HCPCS,Sub pt/ot goal status,,,0.00
Deidentified Minimum,,G9169,CPT4/HCPCS,Memory goal status,,,6.5e-03
Deidentified Minimum,,J0129,CPT4/HCPCS,Abatacept injection,,,465.36
Deidentified Minimum,,J0594,CPT4/HCPCS,Busulfan injection,,,41.49
Deidentified Minimum,,J0885,CPT4/HCPCS,Epoetin alfa, non-esrd,,,89.62
Deidentified Minimum,,J8521,CPT4/HCPCS,Capecitabine, oral, 500 mg,,,23.18
Deidentified Minimum,,J8565,CPT4/HCPCS,Gefitinib oral,,,2172.15
Deidentified Minimum,,J8700,CPT4/HCPCS,Temozolomide,,,7.72
Deidentified Minimum,,J9000,CPT4/HCPCS,Doxorubicin hcl injection,,,24.35
Deidentified Minimum,,J9017,CPT4/HCPCS,Arsenic trioxide injection,,,373.88
Deidentified Minimum,,J9027,CPT4/HCPCS,Clofarabine injection,,,459.98
Deidentified Minimum,,J9060,CPT4/HCPCS,Cisplatin 10 MG injection,,,16.37
Deidentified Minimum,,J9100,CPT4/HCPCS,Cytarabine hcl 100 MG inj,,,6.80
Deidentified Minimum,,J9120,CPT4/HCPCS,Dactinomycin injection,,,9387.16
Deidentified Minimum,,J9175,CPT4/HCPCS,Elliotts b solution per ml,,,75.26
Deidentified Minimum,,J9217,CPT4/HCPCS,Leuprolide acetate suspnsion,,,1951.90
Deidentified Minimum,,J9218,CPT4/HCPCS,Leuprolide acetate injeciton,,,85.93
Deidentified Minimum,,J9264,CPT4/HCPCS,Paclitaxel protein bound,,,106.51
Deidentified Minimum,,J9357,CPT4/HCPCS,Valrubicin injection,,,12101.20
Deidentified Minimum,,J9360,CPT4/HCPCS,Vinblastine sulfate inj,,,32.92
Deidentified Minimum,,P9057,CPT4/HCPCS,RBC, frz/deg/wsh, l/r, irrad,,,3628.00
Deidentified Minimum,,P9615,CPT4/HCPCS,Urine specimen collect mult,,,2002.00
Deidentified Minimum,,Q0084,CPT4/HCPCS,Chemotherapy by infusion,,,298.78
Deidentified Minimum,,Q0114,CPT4/HCPCS,Fern test,,,0.00
Deidentified Minimum,,S0088,CPT4/HCPCS,Imatinib 100 mg,,,36.70
Deidentified Minimum,,S0176,CPT4/HCPCS,Hydroxyurea 500 mg,,,7.13
Deidentified Minimum,,S2054,CPT4/HCPCS,Transplantation of multivisc,,,6588.00
Deidentified Minimum,,S2118,CPT4/HCPCS,Total hip resurfacing,,,5783.00
Deidentified Minimum,,S2350,CPT4/HCPCS,Diskectomy, anterior, with d,,,5281.00
Deidentified Minimum,,S2401,CPT4/HCPCS,Fetal surg urin trac obstr,,,8012.00
Deidentified Minimum,,0055T,CPT4/HCPCS,BONE SRGRY CMPTR CT/MRI IMAG,,,985.00
Deidentified Minimum,,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,,1678.00
Deidentified Minimum,,0081T,CPT4/HCPCS,ENDOVASC VISC EXTNSN S&I,,,5029.00
Deidentified Minimum,,0085T,CPT4/HCPCS,BREATH TEST HEART REJECT,,,10876.15
Deidentified Minimum,,0169T,CPT4/HCPCS,PLACE STEREO CATH BRAIN,,,3544.00
Deidentified Minimum,,0171T,CPT4/HCPCS,LUMBAR SPINE PROCES DISTRACT,,,5281.00
Deidentified Minimum,,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,,987.78
Deidentified Minimum,,0227T,CPT4/HCPCS,ANOSCOPY HRA W/BIOPSY,,,1678.00
Deidentified Minimum,,0229T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,,1145.00
Deidentified Minimum,,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,,5029.00
Deidentified Minimum,,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,,5029.00
Deidentified Minimum,,0247T,CPT4/HCPCS,OPN TX RIB FX 5-6 RIBS,,,3544.00
Deidentified Minimum,,0248T,CPT4/HCPCS,OPEN TX RIB FX 7/> RIBS,,,3544.00
Deidentified Minimum,,0254T,CPT4/HCPCS,EVASC RPR ILIAC ART BIFUR,,,3198.57
Deidentified Minimum,,0256T,CPT4/HCPCS,EVASC AORTIC HRT VALVE,,,6588.00
Deidentified Minimum,,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,,3544.00
Deidentified Minimum,,0289T,CPT4/HCPCS,LASER INC FOR PKP/LKP DONOR,,,6588.00
Deidentified Minimum,,0299T,CPT4/HCPCS,ESW WOUND HEALING INIT WOUND,,,1678.88
Deidentified Minimum,,0300T,CPT4/HCPCS,ESW WOUND HEALING ADDL WOUND,,,1678.88
Deidentified Minimum,,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,,3656.00
Deidentified Minimum,,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,,3198.57
Deidentified Minimum,,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,,3198.57
Deidentified Minimum,,0318T,CPT4/HCPCS,REPLACE AORTIC VALVE TTHORAC,,,6588.00
Deidentified Minimum,,0319T,CPT4/HCPCS,INSERT SUBQ DEFIB W/ELTRD,,,5029.00
Deidentified Minimum,,0325T,CPT4/HCPCS,REPOS SUBQ DEFIB ELTRD &/GEN,,,1678.88
Deidentified Minimum,,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,,3965.00
Deidentified Minimum,,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,,3198.57
Deidentified Minimum,,0340T,CPT4/HCPCS,ABLATE PULM TUMORS EXTNSN,,,5783.00
Deidentified Minimum,,0347T,CPT4/HCPCS,INS BONE DEVICE FOR RSA,,,1145.00
Deidentified Minimum,,0354T,CPT4/HCPCS,OCT BREAST SURG CAVITY I&R,,,56.11
Deidentified Minimum,,0380T,CPT4/HCPCS,COMP ANIMAT RET IMAG SERIES,,,6049.05
Deidentified Minimum,,0396T,CPT4/HCPCS,INTRAOP KINETIC BALNCE SENSR,,,1145.00
Deidentified Minimum,,0407T,CPT4/HCPCS,SIN NDSC PLMT DRG ELUT MPLNT,,,3544.00
Deidentified Minimum,,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,,987.78
Deidentified Minimum,,0427T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA PLS GN,,,1678.88
Deidentified Minimum,,0447T,CPT4/HCPCS,RMVL IMPLTBL GLUCOSE SENSOR,,,1145.00
Deidentified Minimum,,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,,987.78
Deidentified Minimum,,0463T,CPT4/HCPCS,INTERROG AORTIC VENTR SYS,,,1145.00
Deidentified Minimum,,0510T,CPT4/HCPCS,RMVL SINUS TARSI IMPLANT,,,3544.00
Deidentified Minimum,,0511T,CPT4/HCPCS,RMVL&RINSJ SINUS TARSI IMPLT,,,3965.00
Deidentified Minimum,,0512T,CPT4/HCPCS,ESW INTEG WND HLG 1ST WND,,,1145.00
Deidentified Minimum,,0519T,CPT4/HCPCS,RMVL & RPLCMT PG COMPNT WCS,,,4847.00
Deidentified Minimum,,0526T,CPT4/HCPCS,INSJ/RPLCMT IIMS ELTRD ONLY,,,3544.00
Deidentified Minimum,,0545T,CPT4/HCPCS,TCAT TV ANNULUS RCNSTJ,,,1291.00
Deidentified Minimum,,0547T,CPT4/HCPCS,B1 MATRL QUAL TST MCRIND TIB,,,2002.00
Deidentified Minimum,,0548T,CPT4/HCPCS,TPRNL BALO CNTNC DEV BI,,,6401.00
Deidentified Minimum,,0550T,CPT4/HCPCS,TPRNL BALO CNTNC DEV RMVL EA,,,3656.00
Deidentified Minimum,,0551T,CPT4/HCPCS,TPRNL BALO CNTNC DEV ADJMT,,,1145.00
Deidentified Minimum,,0567T,CPT4/HCPCS,PERM FLP TUBE OCCLS W/IMPLT,,,1291.00
Deidentified Minimum,,0570T,CPT4/HCPCS,TTVR PERQ EA ADDL PROSTH,,,1291.00
Deidentified Minimum,,0585T,CPT4/HCPCS,LAPS ISLET CELL TRANSPLANT,,,1291.00
Deidentified Minimum,,10009,CPT4/HCPCS,FNA BX W/CT GDN 1ST LES,,,1235.00
Deidentified Minimum,,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,,1235.00
Deidentified Minimum,,10036,CPT4/HCPCS,PERQ DEV SOFT TISS ADD IMAG,,,1145.00
Deidentified Minimum,,10040,CPT4/HCPCS,ACNE SURGERY,,,987.78
Deidentified Minimum,,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,,400.00
Deidentified Minimum,,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,,1678.88
Deidentified Minimum,,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,,1291.00
Deidentified Minimum,,11100,CPT4/HCPCS,BIOPSY SKIN LESION,,,987.78
Deidentified Minimum,,11101,CPT4/HCPCS,BIOPSY SKIN ADD-ON,,,987.78
Deidentified Minimum,,11300,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,,987.78
Deidentified Minimum,,11302,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,,987.78
Deidentified Minimum,,11305,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,,987.78
Deidentified Minimum,,11306,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,,987.78
Deidentified Minimum,,11312,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,,987.78
Deidentified Minimum,,11313,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,,987.78
Deidentified Minimum,,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,,1235.00
Deidentified Minimum,,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,,1235.00
Deidentified Minimum,,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,,1291.00
Deidentified Minimum,,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,,1235.00
Deidentified Minimum,,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,,1678.88
Deidentified Minimum,,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,1678.88
Deidentified Minimum,,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,,1235.00
Deidentified Minimum,,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,,1291.00
Deidentified Minimum,,11719,CPT4/HCPCS,TRIM NAIL(S) ANY NUMBER,,,987.78
Deidentified Minimum,,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,,987.78
Deidentified Minimum,,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,,987.78
Deidentified Minimum,,11732,CPT4/HCPCS,REMOVE NAIL PLATE ADD-ON,,,1145.00
Deidentified Minimum,,11752,CPT4/HCPCS,REMOVE NAIL BED/TIP,,,1678.00
Deidentified Minimum,,11762,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED,,,400.00
Deidentified Minimum,,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,,3544.00
Deidentified Minimum,,11901,CPT4/HCPCS,INJECT SKIN LESIONS >7,,,400.00
Deidentified Minimum,,11950,CPT4/HCPCS,TX CONTOUR DEFECTS 1 CC/<,,,987.78
Deidentified Minimum,,11976,CPT4/HCPCS,REMOVE CONTRACEPTIVE CAPSULE,,,1235.00
Deidentified Minimum,,11981,CPT4/HCPCS,INSERT DRUG IMPLANT DEVICE,,,987.78
Deidentified Minimum,,11983,CPT4/HCPCS,REMOVE/INSERT DRUG IMPLANT,,,1145.00
Deidentified Minimum,,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,,1145.00
Deidentified Minimum,,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,,1145.00
Deidentified Minimum,,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,,1145.00
Deidentified Minimum,,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,,1145.00
Deidentified Minimum,,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,,1145.00
Deidentified Minimum,,13150,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.0 CM/<,,,3544.00
Deidentified Minimum,,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,,1291.00
Deidentified Minimum,,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,,1145.00
Deidentified Minimum,,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,,1291.00
Deidentified Minimum,,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,,1145.00
Deidentified Minimum,,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,,1678.88
Deidentified Minimum,,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,,1145.00
Deidentified Minimum,,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,,1291.00
Deidentified Minimum,,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,,987.78
Deidentified Minimum,,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,,987.78
Deidentified Minimum,,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,,3544.00
Deidentified Minimum,,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,,1678.88
Deidentified Minimum,,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,,1291.00
Deidentified Minimum,,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,,1678.88
Deidentified Minimum,,15788,CPT4/HCPCS,CHEMICAL PEEL FACE EPIDERM,,,987.78
Deidentified Minimum,,15793,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,,987.78
Deidentified Minimum,,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,,1291.00
Deidentified Minimum,,15830,CPT4/HCPCS,EXC SKIN ABD,,,3544.00
Deidentified Minimum,,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,,3544.00
Deidentified Minimum,,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,,4000.00
Deidentified Minimum,,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,,4000.00
Deidentified Minimum,,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,,400.00
Deidentified Minimum,,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,1678.88
Deidentified Minimum,,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,3544.00
Deidentified Minimum,,17111,CPT4/HCPCS,DESTRUCT LESION 15 OR MORE,,,987.78
Deidentified Minimum,,17270,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17272,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17273,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,400.00
Deidentified Minimum,,17274,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17280,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17281,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,1145.00
Deidentified Minimum,,17360,CPT4/HCPCS,SKIN PEEL THERAPY,,,987.78
Deidentified Minimum,,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,,1145.00
Deidentified Minimum,,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,,1678.88
Deidentified Minimum,,19271,CPT4/HCPCS,REVISION OF CHEST WALL,,,4280.43
Deidentified Minimum,,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,,1235.00
Deidentified Minimum,,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,,1235.00
Deidentified Minimum,,19291,CPT4/HCPCS,PLACE NEEDLE WIRE BREAST,,,1678.00
Deidentified Minimum,,19295,CPT4/HCPCS,PLACE BREAST CLIP PERCUT,,,1678.00
Deidentified Minimum,,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,,3965.00
Deidentified Minimum,,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,,1678.00
Deidentified Minimum,,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,,4000.00
Deidentified Minimum,,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,,3000.00
Deidentified Minimum,,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,,4891.93
Deidentified Minimum,,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,,5281.00
Deidentified Minimum,,19396,CPT4/HCPCS,DESIGN CUSTOM BREAST IMPLANT,,,3000.00
Deidentified Minimum,,19499,CPT4/HCPCS,BREAST SURGERY PROCEDURE,,,2002.00
Deidentified Minimum,,20005,CPT4/HCPCS,I&D ABSCESS SUBFASCIAL,,,1678.88
Deidentified Minimum,,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,,1291.00
Deidentified Minimum,,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,,987.78
Deidentified Minimum,,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,,987.78
Deidentified Minimum,,20560,CPT4/HCPCS,NDL INSJ W/O NJX 1 OR 2 MUSC,,,1291.00
Deidentified Minimum,,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,,400.00
Deidentified Minimum,,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,,4847.00
Deidentified Minimum,,20700,CPT4/HCPCS,MNL PREP&INSJ DP RX DLVR DEV,,,1145.00
Deidentified Minimum,,20702,CPT4/HCPCS,MNL PREP&INSJ IMED RX DEV,,,1145.00
Deidentified Minimum,,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,,4000.00
Deidentified Minimum,,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,,1145.00
Deidentified Minimum,,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,,3544.00
Deidentified Minimum,,20933,CPT4/HCPCS,HEMICRT INTRCLRY ALGRFT PRTL,,,1145.00
Deidentified Minimum,,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,,1678.00
Deidentified Minimum,,20979,CPT4/HCPCS,US BONE STIMULATION,,,987.78
Deidentified Minimum,,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,,1678.88
Deidentified Minimum,,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,,1235.00
Deidentified Minimum,,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,,1678.88
Deidentified Minimum,,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,,1291.00
Deidentified Minimum,,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1678.88
Deidentified Minimum,,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1678.88
Deidentified Minimum,,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1678.88
Deidentified Minimum,,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,1678.88
Deidentified Minimum,,21116,CPT4/HCPCS,INJECTION JAW JOINT X-RAY,,,1145.00
Deidentified Minimum,,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,,1678.88
Deidentified Minimum,,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,,3000.00
Deidentified Minimum,,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,,1291.00
Deidentified Minimum,,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,,1291.00
Deidentified Minimum,,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,,3000.00
Deidentified Minimum,,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,,3000.00
Deidentified Minimum,,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,,4280.43
Deidentified Minimum,,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,,3000.00
Deidentified Minimum,,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,,5000.00
Deidentified Minimum,,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,,4000.00
Deidentified Minimum,,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,,4280.43
Deidentified Minimum,,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,,1291.00
Deidentified Minimum,,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,,3965.00
Deidentified Minimum,,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,,1291.00
Deidentified Minimum,,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,,3965.00
Deidentified Minimum,,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,,1145.00
Deidentified Minimum,,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,,3000.00
Deidentified Minimum,,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,,3198.57
Deidentified Minimum,,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,,1678.88
Deidentified Minimum,,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,,1291.00
Deidentified Minimum,,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,,1291.00
Deidentified Minimum,,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,,3000.00
Deidentified Minimum,,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,,1678.88
Deidentified Minimum,,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,,1235.00
Deidentified Minimum,,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,,1291.00
Deidentified Minimum,,21805,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,,1678.88
Deidentified Minimum,,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,,3544.00
Deidentified Minimum,,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,,1678.88
Deidentified Minimum,,22010,CPT4/HCPCS,I&D P-SPINE C/T/CERV-THOR,,,1291.00
Deidentified Minimum,,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,,3544.00
Deidentified Minimum,,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,,1291.00
Deidentified Minimum,,22206,CPT4/HCPCS,INCIS SPINE 3 COLUMN THORAC,,,1291.00
Deidentified Minimum,,22208,CPT4/HCPCS,INCIS SPINE 3 COLUMN ADL SEG,,,1291.00
Deidentified Minimum,,22305,CPT4/HCPCS,CLOSED TX SPINE PROCESS FX,,,1678.00
Deidentified Minimum,,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,,3000.00
Deidentified Minimum,,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,,3000.00
Deidentified Minimum,,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,,1678.00
Deidentified Minimum,,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,,1678.88
Deidentified Minimum,,22520,CPT4/HCPCS,PERCUT VERTEBROPLASTY THOR,,,1678.00
Deidentified Minimum,,22521,CPT4/HCPCS,PERCUT VERTEBROPLASTY LUMB,,,1678.00
Deidentified Minimum,,22522,CPT4/HCPCS,PERCUT VERTEBROPLASTY ADDL,,,1678.00
Deidentified Minimum,,22534,CPT4/HCPCS,LAT THOR/LUMB ADDL SEG,,,1291.00
Deidentified Minimum,,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,,3000.00
Deidentified Minimum,,22554,CPT4/HCPCS,NECK SPINE FUSION,,,3000.00
Deidentified Minimum,,22556,CPT4/HCPCS,THORAX SPINE FUSION,,,1291.00
Deidentified Minimum,,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,,1291.00
Deidentified Minimum,,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,,1145.00
Deidentified Minimum,,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,,1291.00
Deidentified Minimum,,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,1291.00
Deidentified Minimum,,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,1291.00
Deidentified Minimum,,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,,3000.00
Deidentified Minimum,,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,,1678.88
Deidentified Minimum,,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,,4847.00
Deidentified Minimum,,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,,4847.00
Deidentified Minimum,,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,,1291.00
Deidentified Minimum,,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,,5730.00
Deidentified Minimum,,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,5000.00
Deidentified Minimum,,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,,1145.00
Deidentified Minimum,,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,3544.00
Deidentified Minimum,,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,3965.00
Deidentified Minimum,,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,1145.00
Deidentified Minimum,,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,,1235.00
Deidentified Minimum,,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,,4000.00
Deidentified Minimum,,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,,1291.00
Deidentified Minimum,,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,,1291.00
Deidentified Minimum,,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,,1678.88
Deidentified Minimum,,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,,4000.00
Deidentified Minimum,,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,,1291.00
Deidentified Minimum,,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,,1291.00
Deidentified Minimum,,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,,4000.00
Deidentified Minimum,,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,,3000.00
Deidentified Minimum,,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,,3544.00
Deidentified Minimum,,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,,3544.00
Deidentified Minimum,,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,,3000.00
Deidentified Minimum,,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,,1291.00
Deidentified Minimum,,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,,3544.00
Deidentified Minimum,,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,,3544.00
Deidentified Minimum,,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,,5000.00
Deidentified Minimum,,24410,CPT4/HCPCS,REVISION OF HUMERUS,,,4000.00
Deidentified Minimum,,24420,CPT4/HCPCS,REVISION OF HUMERUS,,,3544.00
Deidentified Minimum,,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,,3544.00
Deidentified Minimum,,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,,4000.00
Deidentified Minimum,,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1145.00
Deidentified Minimum,,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1145.00
Deidentified Minimum,,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,5000.00
Deidentified Minimum,,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1145.00
Deidentified Minimum,,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,1145.00
Deidentified Minimum,,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3544.00
Deidentified Minimum,,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,,1145.00
Deidentified Minimum,,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,,3544.00
Deidentified Minimum,,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,,4000.00
Deidentified Minimum,,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,,1291.00
Deidentified Minimum,,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,,1678.88
Deidentified Minimum,,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,,1678.88
Deidentified Minimum,,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,,4000.00
Deidentified Minimum,,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,,3544.00
Deidentified Minimum,,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,,3544.00
Deidentified Minimum,,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,,4000.00
Deidentified Minimum,,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,,4000.00
Deidentified Minimum,,25246,CPT4/HCPCS,INJECTION FOR WRIST X-RAY,,,1145.00
Deidentified Minimum,,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,4000.00
Deidentified Minimum,,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,,3544.00
Deidentified Minimum,,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,,3544.00
Deidentified Minimum,,25350,CPT4/HCPCS,REVISION OF RADIUS,,,3544.00
Deidentified Minimum,,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,,4000.00
Deidentified Minimum,,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,,4000.00
Deidentified Minimum,,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,,400.00
Deidentified Minimum,,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,,1145.00
Deidentified Minimum,,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,400.00
Deidentified Minimum,,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,,1678.00
Deidentified Minimum,,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,1145.00
Deidentified Minimum,,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,,1145.00
Deidentified Minimum,,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,,1291.00
Deidentified Minimum,,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,3544.00
Deidentified Minimum,,26010,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,,987.78
Deidentified Minimum,,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,,1291.00
Deidentified Minimum,,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,,1291.00
Deidentified Minimum,,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,,1291.00
Deidentified Minimum,,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,,3000.00
Deidentified Minimum,,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,,1291.00
Deidentified Minimum,,26185,CPT4/HCPCS,REMOVE FINGER BONE,,,1291.00
Deidentified Minimum,,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,,3544.00
Deidentified Minimum,,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,,1291.00
Deidentified Minimum,,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,,1291.00
Deidentified Minimum,,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,4000.00
Deidentified Minimum,,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,,4000.00
Deidentified Minimum,,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,3544.00
Deidentified Minimum,,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,,1291.00
Deidentified Minimum,,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,,1291.00
Deidentified Minimum,,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,,1291.00
Deidentified Minimum,,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,,1291.00
Deidentified Minimum,,26477,CPT4/HCPCS,TENDON SHORTENING,,,1291.00
Deidentified Minimum,,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,,1291.00
Deidentified Minimum,,26540,CPT4/HCPCS,REPAIR HAND JOINT,,,1291.00
Deidentified Minimum,,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,,1291.00
Deidentified Minimum,,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,,3000.00
Deidentified Minimum,,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,,4847.00
Deidentified Minimum,,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,,1291.00
Deidentified Minimum,,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,,1678.88
Deidentified Minimum,,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,,987.78
Deidentified Minimum,,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,,1145.00
Deidentified Minimum,,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,,1145.00
Deidentified Minimum,,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,3965.00
Deidentified Minimum,,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,,3544.00
Deidentified Minimum,,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,,1145.00
Deidentified Minimum,,26989,CPT4/HCPCS,HAND/FINGER SURGERY,,,1145.00
Deidentified Minimum,,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,,1291.00
Deidentified Minimum,,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,,3544.00
Deidentified Minimum,,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,,4280.43
Deidentified Minimum,,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,,3544.00
Deidentified Minimum,,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,,1291.00
Deidentified Minimum,,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,,1291.00
Deidentified Minimum,,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,,1145.00
Deidentified Minimum,,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,,3544.00
Deidentified Minimum,,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,,3544.00
Deidentified Minimum,,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,,4000.00
Deidentified Minimum,,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,,4000.00
Deidentified Minimum,,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,,4891.93
Deidentified Minimum,,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,,1291.00
Deidentified Minimum,,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,,3198.57
Deidentified Minimum,,27187,CPT4/HCPCS,REINFORCE HIP BONES,,,1291.00
Deidentified Minimum,,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,,987.78
Deidentified Minimum,,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,,1291.00
Deidentified Minimum,,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,,3198.57
Deidentified Minimum,,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,,1291.00
Deidentified Minimum,,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,,3000.00
Deidentified Minimum,,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,,1291.00
Deidentified Minimum,,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,,1291.00
Deidentified Minimum,,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,,1291.00
Deidentified Minimum,,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,,3544.00
Deidentified Minimum,,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,,4000.00
Deidentified Minimum,,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,,4000.00
Deidentified Minimum,,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,,4000.00
Deidentified Minimum,,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,,4000.00
Deidentified Minimum,,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,,3000.00
Deidentified Minimum,,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,,1291.00
Deidentified Minimum,,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,,3544.00
Deidentified Minimum,,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,,4000.00
Deidentified Minimum,,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,,4000.00
Deidentified Minimum,,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,,5000.00
Deidentified Minimum,,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,,5000.00
Deidentified Minimum,,27450,CPT4/HCPCS,INCISION OF THIGH,,,1291.00
Deidentified Minimum,,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,,1291.00
Deidentified Minimum,,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,,1678.88
Deidentified Minimum,,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,,1291.00
Deidentified Minimum,,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,,1678.88
Deidentified Minimum,,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,1291.00
Deidentified Minimum,,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,3000.00
Deidentified Minimum,,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,,1145.00
Deidentified Minimum,,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,,1678.00
Deidentified Minimum,,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,,1678.00
Deidentified Minimum,,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,,1678.88
Deidentified Minimum,,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,,1678.88
Deidentified Minimum,,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,,1291.00
Deidentified Minimum,,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,,4000.00
Deidentified Minimum,,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,,1678.88
Deidentified Minimum,,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,,1291.00
Deidentified Minimum,,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,,1678.88
Deidentified Minimum,,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,,3544.00
Deidentified Minimum,,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,,1678.88
Deidentified Minimum,,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,,5000.00
Deidentified Minimum,,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,,1678.88
Deidentified Minimum,,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,,1678.88
Deidentified Minimum,,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,,1145.00
Deidentified Minimum,,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,,3544.00
Deidentified Minimum,,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,,1145.00
Deidentified Minimum,,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,1145.00
Deidentified Minimum,,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,1235.00
Deidentified Minimum,,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,,4000.00
Deidentified Minimum,,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,,1678.88
Deidentified Minimum,,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,,1145.00
Deidentified Minimum,,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,,4000.00
Deidentified Minimum,,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,,1291.00
Deidentified Minimum,,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,,4000.00
Deidentified Minimum,,75959,CPT4/HCPCS,XRAY PLACE DIST EXT THOR AO,,,142.00
Deidentified Minimum,,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,,142.00
Deidentified Minimum,,76393,CPT4/HCPCS,MR GUIDANCE FOR NEEDLE PLACE,,,5630.15
Deidentified Minimum,,76496,CPT4/HCPCS,FLUOROSCOPIC PROCEDURE,,,142.00
Deidentified Minimum,,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,,543.39
Deidentified Minimum,,76514,CPT4/HCPCS,ECHO EXAM OF EYE THICKNESS,,,32.89
Deidentified Minimum,,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,,553.00
Deidentified Minimum,,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,,553.00
Deidentified Minimum,,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,,540.37
Deidentified Minimum,,76821,CPT4/HCPCS,MIDDLE CEREBRAL ARTERY ECHO,,,540.37
Deidentified Minimum,,76825,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,,553.00
Deidentified Minimum,,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,,540.37
Deidentified Minimum,,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,,364.35
Deidentified Minimum,,76999,CPT4/HCPCS,ECHO EXAMINATION PROCEDURE,,,364.35
Deidentified Minimum,,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,,566.75
Deidentified Minimum,,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,,1147.00
Deidentified Minimum,,77048,CPT4/HCPCS,MRI BREAST C-+ W/CAD UNI,,,1147.00
Deidentified Minimum,,77049,CPT4/HCPCS,MRI BREAST C-+ W/CAD BI,,,1147.00
Deidentified Minimum,,77059,CPT4/HCPCS,MRI BOTH BREASTS,,,10147.57
Deidentified Minimum,,77062,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,,348.00
Deidentified Minimum,,77262,CPT4/HCPCS,RADIATION THERAPY PLANNING,,,142.00
Deidentified Minimum,,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,,1015.51
Deidentified Minimum,,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,,850.86
Deidentified Minimum,,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,,1637.17
Deidentified Minimum,,77371,CPT4/HCPCS,SRS MULTISOURCE,,,2422.00
Deidentified Minimum,,77372,CPT4/HCPCS,SRS LINEAR BASED,,,2422.00
Deidentified Minimum,,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,,120.98
Deidentified Minimum,,77427,CPT4/HCPCS,RADIATION TX MANAGEMENT X5,,,986.55
Deidentified Minimum,,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,,2028.72
Deidentified Minimum,,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,,953.55
Deidentified Minimum,,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,,673.00
Deidentified Minimum,,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,,1787.52
Deidentified Minimum,,78013,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,,142.00
Deidentified Minimum,,78120,CPT4/HCPCS,RED CELL MASS SINGLE,,,142.00
Deidentified Minimum,,78122,CPT4/HCPCS,BLOOD VOLUME,,,142.00
Deidentified Minimum,,78191,CPT4/HCPCS,PLATELET SURVIVAL,,,142.00
Deidentified Minimum,,78202,CPT4/HCPCS,LIVER IMAGING WITH FLOW,,,142.00
Deidentified Minimum,,78206,CPT4/HCPCS,LIVER IMAGE (3D) WITH FLOW,,,2897.67
Deidentified Minimum,,78216,CPT4/HCPCS,LIVER & SPLEEN IMAGE/FLOW,,,142.00
Deidentified Minimum,,78231,CPT4/HCPCS,SERIAL SALIVARY IMAGING,,,142.00
Deidentified Minimum,,78270,CPT4/HCPCS,VIT B-12 ABSORPTION EXAM,,,786.14
Deidentified Minimum,,78305,CPT4/HCPCS,BONE IMAGING MULTIPLE AREAS,,,142.00
Deidentified Minimum,,78458,CPT4/HCPCS,VEN THROMBOSIS IMAGES BILAT,,,142.00
Deidentified Minimum,,78494,CPT4/HCPCS,HEART IMAGE SPECT,,,142.00
Deidentified Minimum,,78607,CPT4/HCPCS,BRAIN IMAGING (3D),,,3307.25
Deidentified Minimum,,78630,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,,142.00
Deidentified Minimum,,78660,CPT4/HCPCS,NUCLEAR EXAM OF TEAR FLOW,,,142.00
Deidentified Minimum,,78710,CPT4/HCPCS,KIDNEY IMAGING (3D),,,2978.36
Deidentified Minimum,,78740,CPT4/HCPCS,URETERAL REFLUX STUDY,,,142.00
Deidentified Minimum,,78802,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 1 D IMG,,,142.00
Deidentified Minimum,,78803,CPT4/HCPCS,RP LOCLZJ TUM SPECT 1 AREA,,,142.00
Deidentified Minimum,,78812,CPT4/HCPCS,PET IMAGE SKULL-THIGH,,,142.00
Deidentified Minimum,,79200,CPT4/HCPCS,NUCLEAR RX INTRACAV ADMIN,,,142.00
Deidentified Minimum,,80047,CPT4/HCPCS,METABOLIC PANEL IONIZED CA,,,85.00
Deidentified Minimum,,80051,CPT4/HCPCS,ELECTROLYTE PANEL,,,70.47
Deidentified Minimum,,80164,CPT4/HCPCS,ASSAY DIPROPYLACETIC ACD TOT,,,96.00
Deidentified Minimum,,80171,CPT4/HCPCS,DRUG SCREEN QUANT GABAPENTIN,,,96.00
Deidentified Minimum,,80177,CPT4/HCPCS,DRUG SCRN QUAN LEVETIRACETAM,,,96.00
Deidentified Minimum,,80185,CPT4/HCPCS,ASSAY OF PHENYTOIN TOTAL,,,96.00
Deidentified Minimum,,80198,CPT4/HCPCS,ASSAY OF THEOPHYLLINE,,,96.00
Deidentified Minimum,,80201,CPT4/HCPCS,ASSAY OF TOPIRAMATE,,,96.00
Deidentified Minimum,,80202,CPT4/HCPCS,ASSAY OF VANCOMYCIN,,,96.00
Deidentified Minimum,,80339,CPT4/HCPCS,ANTIEPILEPTICS NOS 1-3,,,0.08
Deidentified Minimum,,80350,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 1-3,,,0.08
Deidentified Minimum,,80351,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 4-6,,,0.08
Deidentified Minimum,,80430,CPT4/HCPCS,GROWTH HORMONE PANEL,,,96.00
Deidentified Minimum,,81000,CPT4/HCPCS,URINALYSIS NONAUTO W/SCOPE,,,31.75
Deidentified Minimum,,81106,CPT4/HCPCS,HPA-2 GENOTYPING,,,150.00
Deidentified Minimum,,81107,CPT4/HCPCS,HPA-3 GENOTYPING,,,150.00
Deidentified Minimum,,81109,CPT4/HCPCS,HPA-5 GENOTYPING,,,150.00
Deidentified Minimum,,81163,CPT4/HCPCS,BRCA1&2 GENE FULL SEQ ALYS,,,150.00
Deidentified Minimum,,81165,CPT4/HCPCS,BRCA1 GENE FULL SEQ ALYS,,,150.00
Deidentified Minimum,,81166,CPT4/HCPCS,BRCA1 GENE FULL DUP/DEL ALYS,,,150.00
Deidentified Minimum,,81179,CPT4/HCPCS,ATXN2 GENE DETC ABNOR ALLELE,,,150.00
Deidentified Minimum,,81180,CPT4/HCPCS,ATXN3 GENE DETC ABNOR ALLELE,,,150.00
Deidentified Minimum,,81184,CPT4/HCPCS,CACNA1A GEN DETC ABNOR ALLEL,,,150.00
Deidentified Minimum,,81185,CPT4/HCPCS,CACNA1A GENE FULL GENE SEQ,,,150.00
Deidentified Minimum,,81201,CPT4/HCPCS,APC GENE FULL SEQUENCE,,,150.00
Deidentified Minimum,,81204,CPT4/HCPCS,AR GENE CHARAC ALLELES,,,150.00
Deidentified Minimum,,81205,CPT4/HCPCS,BCKDHB GENE,,,150.00
Deidentified Minimum,,81211,CPT4/HCPCS,BRCA1&2 SEQ & COM DUP/DEL,,,0.00
Deidentified Minimum,,81217,CPT4/HCPCS,BRCA2 GENE KNOWN FAMIL VRNT,,,150.00
Deidentified Minimum,,81219,CPT4/HCPCS,CALR GENE COM VARIANTS,,,150.00
Deidentified Minimum,,81234,CPT4/HCPCS,DMPK GENE DETC ABNOR ALLELE,,,150.00
Deidentified Minimum,,81243,CPT4/HCPCS,FMR1 GENE DETECTION,,,150.00
Deidentified Minimum,,81245,CPT4/HCPCS,FLT3 GENE,,,150.00
Deidentified Minimum,,81259,CPT4/HCPCS,HBA1/HBA2 FULL GENE SEQUENCE,,,150.00
Deidentified Minimum,,81265,CPT4/HCPCS,STR MARKERS SPECIMEN ANAL,,,150.00
Deidentified Minimum,,81272,CPT4/HCPCS,KIT GENE TARGETED SEQ ANALYS,,,150.00
Deidentified Minimum,,81273,CPT4/HCPCS,KIT GENE ANALYS D816 VARIANT,,,150.00
Deidentified Minimum,,81296,CPT4/HCPCS,MSH2 GENE KNOWN VARIANTS,,,150.00
Deidentified Minimum,,81297,CPT4/HCPCS,MSH2 GENE DUP/DELETE VARIANT,,,150.00
Deidentified Minimum,,81298,CPT4/HCPCS,MSH6 GENE FULL SEQ,,,150.00
Deidentified Minimum,,81299,CPT4/HCPCS,MSH6 GENE KNOWN VARIANTS,,,150.00
Deidentified Minimum,,81302,CPT4/HCPCS,MECP2 GENE FULL SEQ,,,150.00
Deidentified Minimum,,81305,CPT4/HCPCS,MYD88 GENE P.LEU265PRO VRNT,,,150.00
Deidentified Minimum,,81324,CPT4/HCPCS,PMP22 GENE DUP/DELET,,,150.00
Deidentified Minimum,,81344,CPT4/HCPCS,TBP GENE DETC ABNOR ALLELES,,,150.00
Deidentified Minimum,,81350,CPT4/HCPCS,UGT1A1 GENE COMMON VARIANTS,,,150.00
Deidentified Minimum,,81355,CPT4/HCPCS,VKORC1 GENE,,,150.00
Deidentified Minimum,,81372,CPT4/HCPCS,HLA I TYPING COMPLETE LR,,,150.00
Deidentified Minimum,,81377,CPT4/HCPCS,HLA II TYPE 1 AG EQUIV LR,,,150.00
Deidentified Minimum,,81407,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 8,,,150.00
Deidentified Minimum,,81432,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,,96.00
Deidentified Minimum,,81433,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,,96.00
Deidentified Minimum,,81439,CPT4/HCPCS,HRDTRY CARDMYPY GENE PANEL,,,96.00
Deidentified Minimum,,81508,CPT4/HCPCS,FTL CGEN ABNOR TWO PROTEINS,,,96.00
Deidentified Minimum,,81521,CPT4/HCPCS,ONC BREAST MRNA 70 GENES,,,96.00
Deidentified Minimum,,81535,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,,96.00
Deidentified Minimum,,82017,CPT4/HCPCS,ACYLCARNITINES QUANT,,,96.00
Deidentified Minimum,,82040,CPT4/HCPCS,ASSAY OF SERUM ALBUMIN,,,49.72
Deidentified Minimum,,82043,CPT4/HCPCS,UR ALBUMIN QUANTITATIVE,,,58.12
Deidentified Minimum,,82044,CPT4/HCPCS,UR ALBUMIN SEMIQUANTITATIVE,,,45.94
Deidentified Minimum,,82135,CPT4/HCPCS,ASSAY AMINOLEVULINIC ACID,,,96.00
Deidentified Minimum,,82140,CPT4/HCPCS,ASSAY OF AMMONIA,,,96.00
Deidentified Minimum,,82247,CPT4/HCPCS,BILIRUBIN TOTAL,,,50.40
Deidentified Minimum,,82248,CPT4/HCPCS,BILIRUBIN DIRECT,,,50.40
Deidentified Minimum,,82308,CPT4/HCPCS,ASSAY OF CALCITONIN,,,96.00
Deidentified Minimum,,82360,CPT4/HCPCS,CALCULUS ASSAY QUANT,,,96.00
Deidentified Minimum,,82378,CPT4/HCPCS,CARCINOEMBRYONIC ANTIGEN,,,96.00
Deidentified Minimum,,82383,CPT4/HCPCS,ASSAY BLOOD CATECHOLAMINES,,,96.00
Deidentified Minimum,,82384,CPT4/HCPCS,ASSAY THREE CATECHOLAMINES,,,96.00
Deidentified Minimum,,82438,CPT4/HCPCS,ASSAY OTHER FLUID CHLORIDES,,,49.14
Deidentified Minimum,,82482,CPT4/HCPCS,ASSAY RBC CHOLINESTERASE,,,77.19
Deidentified Minimum,,82495,CPT4/HCPCS,ASSAY OF CHROMIUM,,,96.00
Deidentified Minimum,,82570,CPT4/HCPCS,ASSAY OF URINE CREATININE,,,51.99
Deidentified Minimum,,82575,CPT4/HCPCS,CREATININE CLEARANCE TEST,,,95.00
Deidentified Minimum,,82607,CPT4/HCPCS,VITAMIN B-12,,,96.00
Deidentified Minimum,,82627,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,,96.00
Deidentified Minimum,,82710,CPT4/HCPCS,FATS/LIPIDS FECES QUANT,,,96.00
Deidentified Minimum,,82746,CPT4/HCPCS,ASSAY OF FOLIC ACID SERUM,,,96.00
Deidentified Minimum,,82760,CPT4/HCPCS,ASSAY OF GALACTOSE,,,96.00
Deidentified Minimum,,82775,CPT4/HCPCS,ASSAY GALACTOSE TRANSFERASE,,,96.00
Deidentified Minimum,,82800,CPT4/HCPCS,BLOOD PH,,,82.15
Deidentified Minimum,,82805,CPT4/HCPCS,BLOOD GASES W/O2 SATURATION,,,96.00
Deidentified Minimum,,82930,CPT4/HCPCS,GASTRIC ANALY W/PH EA SPEC,,,52.50
Deidentified Minimum,,82941,CPT4/HCPCS,ASSAY OF GASTRIN,,,96.00
Deidentified Minimum,,82945,CPT4/HCPCS,GLUCOSE OTHER FLUID,,,39.39
Deidentified Minimum,,82946,CPT4/HCPCS,GLUCAGON TOLERANCE TEST,,,96.00
Deidentified Minimum,,82962,CPT4/HCPCS,GLUCOSE BLOOD TEST,,,23.52
Deidentified Minimum,,83002,CPT4/HCPCS,ASSAY OF GONADOTROPIN (LH),,,96.00
Deidentified Minimum,,83010,CPT4/HCPCS,ASSAY OF HAPTOGLOBIN QUANT,,,96.00
Deidentified Minimum,,83045,CPT4/HCPCS,BLOOD METHEMOGLOBIN TEST,,,49.72
Deidentified Minimum,,83050,CPT4/HCPCS,BLOOD METHEMOGLOBIN ASSAY,,,73.58
Deidentified Minimum,,83068,CPT4/HCPCS,HEMOGLOBIN STABILITY SCREEN,,,85.00
Deidentified Minimum,,83069,CPT4/HCPCS,ASSAY OF URINE HEMOGLOBIN,,,39.73
Deidentified Minimum,,83070,CPT4/HCPCS,ASSAY OF HEMOSIDERIN QUAL,,,47.71
Deidentified Minimum,,83080,CPT4/HCPCS,ASSAY OF B HEXOSAMINIDASE,,,96.00
Deidentified Minimum,,83088,CPT4/HCPCS,ASSAY OF HISTAMINE,,,96.00
Deidentified Minimum,,83150,CPT4/HCPCS,ASSAY OF HOMOVANILLIC ACID,,,96.00
Deidentified Minimum,,83497,CPT4/HCPCS,ASSAY OF 5-HIAA,,,96.00
Deidentified Minimum,,83516,CPT4/HCPCS,IMMUNOASSAY NONANTIBODY,,,93.32
Deidentified Minimum,,83625,CPT4/HCPCS,ASSAY OF LDH ENZYMES,,,96.00
Deidentified Minimum,,83632,CPT4/HCPCS,PLACENTAL LACTOGEN,,,96.00
Deidentified Minimum,,83664,CPT4/HCPCS,LAMELLAR BDY FETAL LUNG,,,96.00
Deidentified Minimum,,83695,CPT4/HCPCS,ASSAY OF LIPOPROTEIN(A),,,96.00
Deidentified Minimum,,83701,CPT4/HCPCS,LIPOPROTEIN BLD HR FRACTION,,,96.00
Deidentified Minimum,,83719,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,,96.00
Deidentified Minimum,,83722,CPT4/HCPCS,LIPOPRTN DIR MEAS SD LDL CHL,,,96.00
Deidentified Minimum,,83785,CPT4/HCPCS,ASSAY OF MANGANESE,,,96.00
Deidentified Minimum,,83915,CPT4/HCPCS,ASSAY OF NUCLEOTIDASE,,,96.00
Deidentified Minimum,,83930,CPT4/HCPCS,ASSAY OF BLOOD OSMOLALITY,,,66.44
Deidentified Minimum,,83986,CPT4/HCPCS,ASSAY PH BODY FLUID NOS,,,35.95
Deidentified Minimum,,84030,CPT4/HCPCS,ASSAY OF BLOOD PKU,,,55.27
Deidentified Minimum,,84035,CPT4/HCPCS,ASSAY OF PHENYLKETONES,,,36.79
Deidentified Minimum,,84066,CPT4/HCPCS,ASSAY PROSTATE PHOSPHATASE,,,96.00
Deidentified Minimum,,84075,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,,51.99
Deidentified Minimum,,84100,CPT4/HCPCS,ASSAY OF PHOSPHORUS,,,47.62
Deidentified Minimum,,84105,CPT4/HCPCS,ASSAY OF URINE PHOSPHORUS,,,51.99
Deidentified Minimum,,84126,CPT4/HCPCS,ASSAY OF FECES PORPHYRINS,,,96.00
Deidentified Minimum,,84134,CPT4/HCPCS,ASSAY OF PREALBUMIN,,,96.00
Deidentified Minimum,,84145,CPT4/HCPCS,PROCALCITONIN (PCT),,,96.00
Deidentified Minimum,,84150,CPT4/HCPCS,ASSAY OF PROSTAGLANDIN,,,96.00
Deidentified Minimum,,84153,CPT4/HCPCS,ASSAY OF PSA TOTAL,,,96.00
Deidentified Minimum,,84166,CPT4/HCPCS,PROTEIN E-PHORESIS/URINE/CSF,,,96.00
Deidentified Minimum,,84181,CPT4/HCPCS,WESTERN BLOT TEST,,,96.00
Deidentified Minimum,,84244,CPT4/HCPCS,ASSAY OF RENIN,,,96.00
Deidentified Minimum,,84260,CPT4/HCPCS,ASSAY OF SEROTONIN,,,96.00
Deidentified Minimum,,84285,CPT4/HCPCS,ASSAY OF SILICA,,,96.00
Deidentified Minimum,,84311,CPT4/HCPCS,SPECTROPHOTOMETRY,,,70.22
Deidentified Minimum,,84377,CPT4/HCPCS,SUGARS MULTIPLE QUAL,,,55.27
Deidentified Minimum,,84378,CPT4/HCPCS,SUGARS SINGLE QUANT,,,96.00
Deidentified Minimum,,84430,CPT4/HCPCS,ASSAY OF THIOCYANATE,,,96.00
Deidentified Minimum,,84490,CPT4/HCPCS,ASSAY OF FECES FOR TRYPSIN,,,76.43
Deidentified Minimum,,84550,CPT4/HCPCS,ASSAY OF BLOOD/URIC ACID,,,45.44
Deidentified Minimum,,84597,CPT4/HCPCS,ASSAY OF VITAMIN K,,,96.00
Deidentified Minimum,,84704,CPT4/HCPCS,HCG FREE BETACHAIN TEST,,,96.00
Deidentified Minimum,,85046,CPT4/HCPCS,RETICYTE/HGB CONCENTRATE,,,56.02
Deidentified Minimum,,85048,CPT4/HCPCS,AUTOMATED LEUKOCYTE COUNT,,,25.45
Deidentified Minimum,,85175,CPT4/HCPCS,BLOOD CLOT LYSIS TIME,,,45.69
Deidentified Minimum,,85210,CPT4/HCPCS,CLOT FACTOR II PROTHROM SPEC,,,96.00
Deidentified Minimum,,85291,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN SCRN,,,89.29
Deidentified Minimum,,85292,CPT4/HCPCS,CLOT FACTOR FLETCHER FACT,,,96.00
Deidentified Minimum,,85300,CPT4/HCPCS,ANTITHROMBIN III ACTIVITY,,,96.00
Deidentified Minimum,,85306,CPT4/HCPCS,CLOT INHIBIT PROT S FREE,,,96.00
Deidentified Minimum,,85337,CPT4/HCPCS,THROMBOMODULIN,,,96.00
Deidentified Minimum,,85345,CPT4/HCPCS,COAGULATION TIME LEE & WHITE,,,43.17
Deidentified Minimum,,85379,CPT4/HCPCS,FIBRIN DEGRADATION QUANT,,,96.00
Deidentified Minimum,,85415,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,,96.00
Deidentified Minimum,,85420,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,,65.68
Deidentified Minimum,,85520,CPT4/HCPCS,HEPARIN ASSAY,,,96.00
Deidentified Minimum,,85547,CPT4/HCPCS,RBC MECHANICAL FRAGILITY,,,86.43
Deidentified Minimum,,85598,CPT4/HCPCS,HEXAGNAL PHOSPH PLTLT NEUTRL,,,96.00
Deidentified Minimum,,85611,CPT4/HCPCS,PROTHROMBIN TEST,,,39.56
Deidentified Minimum,,85612,CPT4/HCPCS,VIPER VENOM PROTHROMBIN TIME,,,96.00
Deidentified Minimum,,85635,CPT4/HCPCS,REPTILASE TEST,,,96.00
Deidentified Minimum,,85670,CPT4/HCPCS,THROMBIN TIME PLASMA,,,58.04
Deidentified Minimum,,86078,CPT4/HCPCS,PHYS BLOOD BANK SERV REACTJ,,,96.00
Deidentified Minimum,,86146,CPT4/HCPCS,BETA-2 GLYCOPROTEIN ANTIBODY,,,96.00
Deidentified Minimum,,86148,CPT4/HCPCS,ANTI-PHOSPHOLIPID ANTIBODY,,,96.00
Deidentified Minimum,,86155,CPT4/HCPCS,CHEMOTAXIS ASSAY,,,96.00
Deidentified Minimum,,86157,CPT4/HCPCS,COLD AGGLUTININ TITER,,,81.06
Deidentified Minimum,,86235,CPT4/HCPCS,NUCLEAR ANTIGEN ANTIBODY,,,96.00
Deidentified Minimum,,86255,CPT4/HCPCS,FLUORESCENT ANTIBODY SCREEN,,,96.00
Deidentified Minimum,,86256,CPT4/HCPCS,FLUORESCENT ANTIBODY TITER,,,96.00
Deidentified Minimum,,86294,CPT4/HCPCS,IMMUNOASSAY TUMOR QUAL,,,96.00
Deidentified Minimum,,86304,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 125,,,96.00
Deidentified Minimum,,86305,CPT4/HCPCS,HUMAN EPIDIDYMIS PROTEIN 4,,,96.00
Deidentified Minimum,,86317,CPT4/HCPCS,IMMUNOASSAY INFECTIOUS AGENT,,,96.00
Deidentified Minimum,,86320,CPT4/HCPCS,SERUM IMMUNOELECTROPHORESIS,,,96.00
Deidentified Minimum,,86325,CPT4/HCPCS,OTHER IMMUNOELECTROPHORESIS,,,96.00
Deidentified Minimum,,86343,CPT4/HCPCS,LEUKOCYTE HISTAMINE RELEASE,,,96.00
Deidentified Minimum,,86357,CPT4/HCPCS,NK CELLS TOTAL COUNT,,,96.00
Deidentified Minimum,,86361,CPT4/HCPCS,T CELL ABSOLUTE COUNT,,,96.00
Deidentified Minimum,,86382,CPT4/HCPCS,NEUTRALIZATION TEST VIRAL,,,96.00
Deidentified Minimum,,86386,CPT4/HCPCS,NUCLEAR MATRIX PROTEIN 22,,,96.00
Deidentified Minimum,,86580,CPT4/HCPCS,TB INTRADERMAL TEST,,,63.92
Deidentified Minimum,,86592,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUAL,,,42.92
Deidentified Minimum,,86593,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUANT,,,44.18
Deidentified Minimum,,86602,CPT4/HCPCS,ANTINOMYCES ANTIBODY,,,96.00
Deidentified Minimum,,86625,CPT4/HCPCS,CAMPYLOBACTER ANTIBODY,,,96.00
Deidentified Minimum,,86665,CPT4/HCPCS,EPSTEIN-BARR CAPSID VCA,,,96.00
Deidentified Minimum,,86694,CPT4/HCPCS,HERPES SIMPLEX NES ANTBDY,,,96.00
Deidentified Minimum,,86707,CPT4/HCPCS,HEPATITIS BE ANTIBODY,,,96.00
Deidentified Minimum,,86710,CPT4/HCPCS,INFLUENZA VIRUS ANTIBODY,,,96.00
Deidentified Minimum,,86717,CPT4/HCPCS,LEISHMANIA ANTIBODY,,,96.00
Deidentified Minimum,,86738,CPT4/HCPCS,MYCOPLASMA ANTIBODY,,,96.00
Deidentified Minimum,,86784,CPT4/HCPCS,TRICHINELLA ANTIBODY,,,96.00
Deidentified Minimum,,86789,CPT4/HCPCS,WEST NILE VIRUS ANTIBODY,,,96.00
Deidentified Minimum,,86793,CPT4/HCPCS,YERSINIA ANTIBODY,,,96.00
Deidentified Minimum,,86807,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,,96.00
Deidentified Minimum,,86813,CPT4/HCPCS,HLA TYPING A B OR C,,,96.00
Deidentified Minimum,,86828,CPT4/HCPCS,HLA CLASS I&II ANTIBODY QUAL,,,96.00
Deidentified Minimum,,86834,CPT4/HCPCS,HLA CLASS I SEMIQUANT PANEL,,,96.00
Deidentified Minimum,,86835,CPT4/HCPCS,HLA CLASS II SEMIQUANT PANEL,,,96.00
Deidentified Minimum,,86870,CPT4/HCPCS,RBC ANTIBODY IDENTIFICATION,,,96.00
Deidentified Minimum,,86904,CPT4/HCPCS,BLOOD TYPING PATIENT SERUM,,,95.50
Deidentified Minimum,,86921,CPT4/HCPCS,COMPATIBILITY TEST INCUBATE,,,96.00
Deidentified Minimum,,86922,CPT4/HCPCS,COMPATIBILITY TEST ANTIGLOB,,,96.00
Deidentified Minimum,,86932,CPT4/HCPCS,FROZEN BLOOD FREEZE/THAW,,,96.00
Deidentified Minimum,,86985,CPT4/HCPCS,SPLIT BLOOD OR PRODUCTS,,,96.00
Deidentified Minimum,,87073,CPT4/HCPCS,CULTURE BACTERIA ANAEROBIC,,,94.83
Deidentified Minimum,,87086,CPT4/HCPCS,URINE CULTURE/COLONY COUNT,,,81.14
Deidentified Minimum,,87103,CPT4/HCPCS,BLOOD FUNGUS CULTURE,,,90.63
Deidentified Minimum,,87109,CPT4/HCPCS,MYCOPLASMA,,,96.00
Deidentified Minimum,,87164,CPT4/HCPCS,DARK FIELD EXAMINATION,,,96.00
Deidentified Minimum,,87186,CPT4/HCPCS,MICROBE SUSCEPTIBLE MIC,,,86.85
Deidentified Minimum,,87205,CPT4/HCPCS,SMEAR GRAM STAIN,,,42.92
Deidentified Minimum,,87207,CPT4/HCPCS,SMEAR SPECIAL STAIN,,,60.22
Deidentified Minimum,,87250,CPT4/HCPCS,VIRUS INOCULATE EGGS/ANIMAL,,,96.00
Deidentified Minimum,,87252,CPT4/HCPCS,VIRUS INOCULATION TISSUE,,,96.00
Deidentified Minimum,,87273,CPT4/HCPCS,HERPES SIMPLEX 2 AG IF,,,93.32
Deidentified Minimum,,87299,CPT4/HCPCS,ANTIBODY DETECTION NOS IF,,,93.32
Deidentified Minimum,,87324,CPT4/HCPCS,CLOSTRIDIUM AG IA,,,93.32
Deidentified Minimum,,87327,CPT4/HCPCS,CRYPTOCOCCUS NEOFORM AG IA,,,93.32
Deidentified Minimum,,87380,CPT4/HCPCS,HEPATITIS DELTA AG IA,,,96.00
Deidentified Minimum,,87430,CPT4/HCPCS,STREP A AG IA,,,93.32
Deidentified Minimum,,87485,CPT4/HCPCS,CHYLMD PNEUM DNA DIR PROBE,,,96.00
Deidentified Minimum,,87486,CPT4/HCPCS,CHYLMD PNEUM DNA AMP PROBE,,,96.00
Deidentified Minimum,,87503,CPT4/HCPCS,INFLUENZA DNA AMP PROB ADDL,,,96.00
Deidentified Minimum,,87516,CPT4/HCPCS,HEPATITIS B DNA AMP PROBE,,,96.00
Deidentified Minimum,,87517,CPT4/HCPCS,HEPATITIS B DNA QUANT,,,96.00
Deidentified Minimum,,87520,CPT4/HCPCS,HEPATITIS C RNA DIR PROBE,,,96.00
Deidentified Minimum,,87522,CPT4/HCPCS,HEPATITIS C REVRS TRNSCRPJ,,,96.00
Deidentified Minimum,,87529,CPT4/HCPCS,HSV DNA AMP PROBE,,,96.00
Deidentified Minimum,,87556,CPT4/HCPCS,M.TUBERCULO DNA AMP PROBE,,,96.00
Deidentified Minimum,,87580,CPT4/HCPCS,M.PNEUMON DNA DIR PROBE,,,96.00
Deidentified Minimum,,87581,CPT4/HCPCS,M.PNEUMON DNA AMP PROBE,,,96.00
Deidentified Minimum,,87582,CPT4/HCPCS,M.PNEUMON DNA QUANT,,,96.00
Deidentified Minimum,,87623,CPT4/HCPCS,HPV LOW-RISK TYPES,,,96.00
Deidentified Minimum,,87624,CPT4/HCPCS,HPV HIGH-RISK TYPES,,,96.00
Deidentified Minimum,,87660,CPT4/HCPCS,TRICHOMONAS VAGIN DIR PROBE,,,96.00
Deidentified Minimum,,87661,CPT4/HCPCS,TRICHOMONAS VAGINALIS AMPLIF,,,96.00
Deidentified Minimum,,87807,CPT4/HCPCS,RSV ASSAY W/OPTIC,,,93.32
Deidentified Minimum,,87809,CPT4/HCPCS,ADENOVIRUS ASSAY W/OPTIC,,,93.32
Deidentified Minimum,,87902,CPT4/HCPCS,GENOTYPE DNA/RNA HEP C,,,96.00
Deidentified Minimum,,88028,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,,96.00
Deidentified Minimum,,88112,CPT4/HCPCS,CYTOPATH CELL ENHANCE TECH,,,96.00
Deidentified Minimum,,88147,CPT4/HCPCS,CYTOPATH C/V AUTOMATED,,,96.00
Deidentified Minimum,,88153,CPT4/HCPCS,CYTOPATH C/V REDO,,,96.00
Deidentified Minimum,,88175,CPT4/HCPCS,CYTOPATH C/V AUTO FLUID REDO,,,96.00
Deidentified Minimum,,88189,CPT4/HCPCS,FLOWCYTOMETRY/READ 16 & >,,,96.00
Deidentified Minimum,,88233,CPT4/HCPCS,TISSUE CULTURE SKIN/BIOPSY,,,96.00
Deidentified Minimum,,88248,CPT4/HCPCS,CHROMOSOME ANALYSIS 50-100,,,96.00
Deidentified Minimum,,88261,CPT4/HCPCS,CHROMOSOME ANALYSIS 5,,,96.00
Deidentified Minimum,,88264,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,,96.00
Deidentified Minimum,,88319,CPT4/HCPCS,ENZYME HISTOCHEMISTRY,,,96.00
Deidentified Minimum,,88342,CPT4/HCPCS,IMMUNOHISTO ANTB 1ST STAIN,,,96.00
Deidentified Minimum,,88364,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,,96.00
Deidentified Minimum,,88374,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,,96.00
Deidentified Minimum,,88380,CPT4/HCPCS,MICRODISSECTION LASER,,,96.00
Deidentified Minimum,,88740,CPT4/HCPCS,TRANSCUTANEOUS CARBOXYHB,,,50.40
Deidentified Minimum,,89049,CPT4/HCPCS,CHCT FOR MAL HYPERTHERMIA,,,96.00
Deidentified Minimum,,89060,CPT4/HCPCS,EXAM SYNOVIAL FLUID CRYSTALS,,,71.82
Deidentified Minimum,,89125,CPT4/HCPCS,SPECIMEN FAT STAIN,,,43.42
Deidentified Minimum,,89230,CPT4/HCPCS,COLLECT SWEAT FOR TEST,,,25.45
Deidentified Minimum,,89280,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,,96.00
Deidentified Minimum,,89291,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,,96.00
Deidentified Minimum,,89325,CPT4/HCPCS,SPERM ANTIBODY TEST,,,96.00
Deidentified Minimum,,89335,CPT4/HCPCS,CRYOPRESERVE TESTICULAR TISS,,,96.00
Deidentified Minimum,,89353,CPT4/HCPCS,THAWING CRYOPRESRVED SPERM,,,62.24
Deidentified Minimum,,90804,CPT4/HCPCS,PSYTX OFFICE 20-30 MIN,,,117.95
Deidentified Minimum,,90824,CPT4/HCPCS,INTAC PSYTX HSP 20-30 W/E&M,,,198.97
Deidentified Minimum,,90826,CPT4/HCPCS,INTAC PSYTX HOSP 45-50 MIN,,,241.50
Deidentified Minimum,,90997,CPT4/HCPCS,HEMOPERFUSION,,,341.76
Deidentified Minimum,,91020,CPT4/HCPCS,GASTRIC MOTILITY STUDIES,,,1145.00
Deidentified Minimum,,91111,CPT4/HCPCS,ESOPHAGEAL CAPSULE ENDOSCOPY,,,1291.00
Deidentified Minimum,,91120,CPT4/HCPCS,RECTAL SENSATION TEST,,,1145.00
Deidentified Minimum,,91122,CPT4/HCPCS,ANAL PRESSURE RECORD,,,1145.00
Deidentified Minimum,,92060,CPT4/HCPCS,SPECIAL EYE EVALUATION,,,210.93
Deidentified Minimum,,92071,CPT4/HCPCS,CONTACT LENS FITTING FOR TX,,,175.69
Deidentified Minimum,,92081,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,,340.85
Deidentified Minimum,,92083,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,,538.13
Deidentified Minimum,,92100,CPT4/HCPCS,SERIAL TONOMETRY EXAM(S),,,657.63
Deidentified Minimum,,92133,CPT4/HCPCS,CMPTR OPHTH IMG OPTIC NERVE,,,987.78
Deidentified Minimum,,92228,CPT4/HCPCS,IMG RTA DETC/MNTR DS PHY/QHP,,,177.25
Deidentified Minimum,,92312,CPT4/HCPCS,CONTACT LENS FITTING,,,531.75
Deidentified Minimum,,92506,CPT4/HCPCS,SPEECH/HEARING EVALUATION,,,1263.13
Deidentified Minimum,,92508,CPT4/HCPCS,SPEECH/HEARING THERAPY,,,212.94
Deidentified Minimum,,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,,193.00
Deidentified Minimum,,92522,CPT4/HCPCS,EVALUATE SPEECH PRODUCTION,,,288.00
Deidentified Minimum,,92537,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,,987.78
Deidentified Minimum,,92538,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,,987.78
Deidentified Minimum,,92540,CPT4/HCPCS,BASIC VESTIBULAR EVALUATION,,,220.56
Deidentified Minimum,,92553,CPT4/HCPCS,AUDIOMETRY AIR & BONE,,,341.76
Deidentified Minimum,,92557,CPT4/HCPCS,COMPREHENSIVE HEARING TEST,,,621.00
Deidentified Minimum,,92563,CPT4/HCPCS,TONE DECAY HEARING TEST,,,194.16
Deidentified Minimum,,92567,CPT4/HCPCS,TYMPANOMETRY,,,274.41
Deidentified Minimum,,92568,CPT4/HCPCS,ACOUSTIC REFL THRESHOLD TST,,,194.16
Deidentified Minimum,,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,,193.00
Deidentified Minimum,,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,,193.00
Deidentified Minimum,,92614,CPT4/HCPCS,LARYNGOSCOPIC SENSORY VID,,,1223.85
Deidentified Minimum,,92616,CPT4/HCPCS,FEES W/LARYNGEAL SENSE TEST,,,1660.16
Deidentified Minimum,,92617,CPT4/HCPCS,FEES W/LARYNGEAL SENSE I&R,,,231.88
Deidentified Minimum,,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,,3544.00
Deidentified Minimum,,92984,CPT4/HCPCS,CORONARY ARTERY DILATION,,,642.87
Deidentified Minimum,,93005,CPT4/HCPCS,ELECTROCARDIOGRAM TRACING,,,95.67
Deidentified Minimum,,93010,CPT4/HCPCS,ELECTROCARDIOGRAM REPORT,,,32.89
Deidentified Minimum,,93015,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,,786.57
Deidentified Minimum,,93025,CPT4/HCPCS,MICROVOLT T-WAVE ASSESS,,,1371.04
Deidentified Minimum,,93040,CPT4/HCPCS,RHYTHM ECG WITH REPORT,,,104.30
Deidentified Minimum,,93042,CPT4/HCPCS,RHYTHM ECG REPORT,,,28.09
Deidentified Minimum,,93226,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,,410.75
Deidentified Minimum,,93280,CPT4/HCPCS,PM DEVICE PROGR EVAL DUAL,,,189.58
Deidentified Minimum,,93284,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,,256.28
Deidentified Minimum,,93296,CPT4/HCPCS,REM INTERROG EVL PM/IDS,,,289.54
Deidentified Minimum,,93352,CPT4/HCPCS,ADMIN ECG CONTRAST AGENT,,,314.32
Deidentified Minimum,,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,,2998.00
Deidentified Minimum,,93582,CPT4/HCPCS,PERQ TRANSCATH CLOSURE PDA,,,5783.00
Deidentified Minimum,,93591,CPT4/HCPCS,PERQ TRANSCATH CLS AORTIC,,,8797.00
Deidentified Minimum,,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,,567.13
Deidentified Minimum,,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,3913.80
Deidentified Minimum,,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,,3633.80
Deidentified Minimum,,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,2430.86
Deidentified Minimum,,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,,2002.00
Deidentified Minimum,,93750,CPT4/HCPCS,INTERROGATION VAD IN PERSON,,,164.52
Deidentified Minimum,,93882,CPT4/HCPCS,EXTRACRANIAL UNI/LTD STUDY,,,1361.89
Deidentified Minimum,,93971,CPT4/HCPCS,EXTREMITY STUDY,,,859.06
Deidentified Minimum,,93978,CPT4/HCPCS,VASCULAR STUDY,,,1364.91
Deidentified Minimum,,94010,CPT4/HCPCS,BREATHING CAPACITY TEST,,,306.38
Deidentified Minimum,,94011,CPT4/HCPCS,SPIROMETRY UP TO 2 YRS OLD,,,318.49
Deidentified Minimum,,94015,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,,292.73
Deidentified Minimum,,94375,CPT4/HCPCS,RESPIRATORY FLOW VOLUME LOOP,,,253.46
Deidentified Minimum,,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,,193.00
Deidentified Minimum,,94726,CPT4/HCPCS,PULM FUNCT TST PLETHYSMOGRAP,,,585.46
Deidentified Minimum,,94728,CPT4/HCPCS,AIRWY RESIST BY OSCILLOMETRY,,,422.64
Deidentified Minimum,,94729,CPT4/HCPCS,CO/MEMBANE DIFFUSE CAPACITY,,,639.16
Deidentified Minimum,,94750,CPT4/HCPCS,PULMONARY COMPLIANCE STUDY,,,632.02
Deidentified Minimum,,95012,CPT4/HCPCS,EXHALED NITRIC OXIDE MEAS,,,234.99
Deidentified Minimum,,95065,CPT4/HCPCS,NOSE ALLERGY TEST,,,105.08
Deidentified Minimum,,95146,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,215.75
Deidentified Minimum,,95800,CPT4/HCPCS,SLP STDY UNATTENDED,,,1313.42
Deidentified Minimum,,95811,CPT4/HCPCS,POLYSOM 6/>YRS CPAP 4/> PARM,,,3302.00
Deidentified Minimum,,95831,CPT4/HCPCS,LIMB MUSCLE TESTING MANUAL,,,225.37
Deidentified Minimum,,95834,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,,315.24
Deidentified Minimum,,95904,CPT4/HCPCS,SENSE NERVE CONDUCTION TEST,,,469.98
Deidentified Minimum,,95905,CPT4/HCPCS,MOTOR &/ SENS NRVE CNDJ TEST,,,975.98
Deidentified Minimum,,95910,CPT4/HCPCS,MOTOR&SENS 7-8 NRV CNDJ TEST,,,0.00
Deidentified Minimum,,95928,CPT4/HCPCS,C MOTOR EVOKED UPPR LIMBS,,,1152.46
Deidentified Minimum,,95953,CPT4/HCPCS,EEG MONITORING/COMPUTER,,,3228.86
Deidentified Minimum,,95956,CPT4/HCPCS,EEG MONITOR TECHNOL ATTENDED,,,6351.60
Deidentified Minimum,,95958,CPT4/HCPCS,EEG MONITORING/FUNCTION TEST,,,894.48
Deidentified Minimum,,95970,CPT4/HCPCS,ALYS NPGT W/O PRGRMG,,,421.08
Deidentified Minimum,,96001,CPT4/HCPCS,MOTION TEST W/FT PRESS MEAS,,,357.91
Deidentified Minimum,,96105,CPT4/HCPCS,ASSESSMENT OF APHASIA,,,924.27
Deidentified Minimum,,96370,CPT4/HCPCS,SC THER INFUSION ADDL HR,,,121.98
Deidentified Minimum,,96374,CPT4/HCPCS,THER/PROPH/DIAG INJ IV PUSH,,,632.02
Deidentified Minimum,,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,,193.00
Deidentified Minimum,,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,,187.02
Deidentified Minimum,,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,,241.65
Deidentified Minimum,,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,,276.74
Deidentified Minimum,,97004,CPT4/HCPCS,OT RE-EVALUATION,,,272.70
Deidentified Minimum,,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,,129.19
Deidentified Minimum,,97024,CPT4/HCPCS,DIATHERMY EG MICROWAVE,,,37.80
Deidentified Minimum,,97036,CPT4/HCPCS,HYDROTHERAPY,,,184.29
Deidentified Minimum,,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,,162.03
Deidentified Minimum,,97151,CPT4/HCPCS,BHV ID ASSMT BY PHYS/QHP,,,206.64
Deidentified Minimum,,97153,CPT4/HCPCS,ADAPTIVE BEHAVIOR TX BY TECH,,,153.21
Deidentified Minimum,,97154,CPT4/HCPCS,GRP ADAPT BHV TX BY TECH,,,153.21
Deidentified Minimum,,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,,193.00
Deidentified Minimum,,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,,193.00
Deidentified Minimum,,97170,CPT4/HCPCS,ATHLETIC TRN EVAL MOD CMPLX,,,288.00
Deidentified Minimum,,97171,CPT4/HCPCS,ATHLETIC TRN EVAL HIGH CMPLX,,,288.00
Deidentified Minimum,,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,,186.88
Deidentified Minimum,,97532,CPT4/HCPCS,COGNITIVE SKILLS DEVELOPMENT,,,109.89
Deidentified Minimum,,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,,143.56
Deidentified Minimum,,97545,CPT4/HCPCS,WORK HARDENING,,,288.00
Deidentified Minimum,,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,,65.81
Deidentified Minimum,,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,,123.50
Deidentified Minimum,,99192,CPT4/HCPCS,SPECIAL PUMP SERVICES,,,3732.38
Deidentified Minimum,,A9501,CPT4/HCPCS,Technetium TC-99m teboroxime,,,1003.12
Deidentified Minimum,,A9502,CPT4/HCPCS,Tc99m tetrofosmin,,,815.38
Deidentified Minimum,,A9510,CPT4/HCPCS,Tc99m disofenin,,,585.64
Deidentified Minimum,,A9526,CPT4/HCPCS,Nitrogen N-13 ammonia,,,5019.84
Deidentified Minimum,,A9532,CPT4/HCPCS,I125 serum albumin, dx,,,183.03
Deidentified Minimum,,A9536,CPT4/HCPCS,Tc99m depreotide,,,9760.80
Deidentified Minimum,,A9541,CPT4/HCPCS,Tc99m sulfur colloid,,,447.38
Deidentified Minimum,,A9542,CPT4/HCPCS,In111 ibritumomab, dx,,,29282.40
Deidentified Minimum,,A9551,CPT4/HCPCS,Tc99m succimer,,,5014.96
Deidentified Minimum,,A9555,CPT4/HCPCS,Rb82 rubidium,,,2987.12
Deidentified Minimum,,A9556,CPT4/HCPCS,Ga67 gallium,,,1005.39
Deidentified Minimum,,A9559,CPT4/HCPCS,Co57 cyano,,,612.94
Deidentified Minimum,,A9561,CPT4/HCPCS,Tc99m oxidronate,,,368.08
Deidentified Minimum,,A9577,CPT4/HCPCS,Inj multihance,,,16.37
Deidentified Minimum,,A9584,CPT4/HCPCS,Iodine I-123 ioflupane,,,20648.29
Deidentified Minimum,,C5272,CPT4/HCPCS,Low cost skin substitute app,,,1145.00
Deidentified Minimum,,C5273,CPT4/HCPCS,Low cost skin substitute app,,,1291.00
Deidentified Minimum,,C5277,CPT4/HCPCS,Low cost skin substitute app,,,1145.00
Deidentified Minimum,,C8902,CPT4/HCPCS,MRA w/o fol w/cont, abd,,,4399.00
Deidentified Minimum,,C8905,CPT4/HCPCS,MRI w/o fol w/cont, brst, un,,,4399.00
Deidentified Minimum,,C8919,CPT4/HCPCS,MRA w/o cont, pelvis,,,4399.00
Deidentified Minimum,,C8929,CPT4/HCPCS,Tte w or wo fol wcon,doppler,,,3198.57
Deidentified Minimum,,C8935,CPT4/HCPCS,MRA, w/o dye, upper extr,,,4399.00
Deidentified Minimum,,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,,6876.92
Deidentified Minimum,,C9727,CPT4/HCPCS,Insert palate implants,,,1291.00
Deidentified Minimum,,C9745,CPT4/HCPCS,Nasal endo eustachian tube,,,3656.00
Deidentified Minimum,,C9754,CPT4/HCPCS,Perc av fistula, direct,,,7830.00
Deidentified Minimum,,C9758,CPT4/HCPCS,Blind interatrial shunt ide,,,8841.00
Deidentified Minimum,,G0120,CPT4/HCPCS,Colon ca scrn; barium enema,,,1130.25
Deidentified Minimum,,G0237,CPT4/HCPCS,Therapeutic procd strg endur,,,172.25
Deidentified Minimum,,G0238,CPT4/HCPCS,Oth resp proc, indiv,,,172.25
Deidentified Minimum,,G0289,CPT4/HCPCS,Arthro, loose body + chondro,,,1145.00
Deidentified Minimum,,G0293,CPT4/HCPCS,Non-cov surg proc,clin trial,,,1678.00
Deidentified Minimum,,G0297,CPT4/HCPCS,Ldct for lung ca screen,,,4280.43
Deidentified Minimum,,G0393,CPT4/HCPCS,AV fistula or graft venous,,,12850.70
Deidentified Minimum,,G0412,CPT4/HCPCS,Open tx iliac spine uni/bil,,,1291.00
Deidentified Minimum,,G0429,CPT4/HCPCS,Dermal filler injection(s),,,1678.00
Deidentified Minimum,,G0448,CPT4/HCPCS,Place perm pacing cardiovert,,,1291.00
Deidentified Minimum,,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,,85.15
Deidentified Minimum,,G6002,CPT4/HCPCS,Stereoscopic x-ray guidance,,,588.34
Deidentified Minimum,,G6006,CPT4/HCPCS,Radiation treatment delivery,,,1028.74
Deidentified Minimum,,G6008,CPT4/HCPCS,Radiation treatment delivery,,,1280.30
Deidentified Minimum,,G6015,CPT4/HCPCS,Radiation tx delivery imrt,,,2957.43
Deidentified Minimum,,G6020,CPT4/HCPCS,Colonoscopy w/stent,,,1678.00
Deidentified Minimum,,G8628,CPT4/HCPCS,No surg proc w/in 30 days,,,5783.00
Deidentified Minimum,,G8978,CPT4/HCPCS,Mobility current status,,,0.00
Deidentified Minimum,,G8999,CPT4/HCPCS,Motor speech current status,,,6.5e-03
Deidentified Minimum,,G9160,CPT4/HCPCS,Lang comp goal status,,,6.5e-03
Deidentified Minimum,,G9164,CPT4/HCPCS,Lang express d/c status,,,6.5e-03
Deidentified Minimum,,G9166,CPT4/HCPCS,Atten goal status,,,6.5e-03
Deidentified Minimum,,G9168,CPT4/HCPCS,Memory current status,,,6.5e-03
Deidentified Minimum,,G9173,CPT4/HCPCS,Voice d/c status,,,6.5e-03
Deidentified Minimum,,G9174,CPT4/HCPCS,Speech lang current status,,,6.5e-03
Deidentified Minimum,,J9035,CPT4/HCPCS,Bevacizumab injection,,,684.18
Deidentified Minimum,,J9040,CPT4/HCPCS,Bleomycin sulfate injection,,,192.27
Deidentified Minimum,,J9045,CPT4/HCPCS,Carboplatin injection,,,22.84
Deidentified Minimum,,J9047,CPT4/HCPCS,Injection, carfilzomib, 1 mg,,,318.52
Deidentified Minimum,,J9050,CPT4/HCPCS,Carmustine injection,,,22216.40
Deidentified Minimum,,J9190,CPT4/HCPCS,Fluorouracil injection,,,12.85
Deidentified Minimum,,J9214,CPT4/HCPCS,Interferon alfa-2b inj,,,290.21
Deidentified Minimum,,J9351,CPT4/HCPCS,Topotecan injection,,,8.31
Deidentified Minimum,,J9600,CPT4/HCPCS,Porfimer sodium injection,,,176029.05
Deidentified Minimum,,Q0083,CPT4/HCPCS,Chemo by other than infusion,,,692.16
Deidentified Minimum,,S0170,CPT4/HCPCS,Anastrozole 1 mg,,,4.03
Deidentified Minimum,,S0172,CPT4/HCPCS,Chlorambucil 2 mg,,,203.53
Deidentified Minimum,,S0182,CPT4/HCPCS,Procarbazine, oral,,,827.40
Deidentified Minimum,,S0187,CPT4/HCPCS,Tamoxifen 10 mg,,,3.19
Deidentified Minimum,,S2083,CPT4/HCPCS,Adjustment gastric band,,,1678.00
Deidentified Maximum,,0071T,CPT4/HCPCS,US LEIOMYOMATA ABLATE <200,,,4204.00
Deidentified Maximum,,0075T,CPT4/HCPCS,PERQ STENT/CHEST VERT ART,,,6588.00
Deidentified Maximum,,0124T,CPT4/HCPCS,CONJUNCTIVAL DRUG PLACEMENT,,,5029.00
Deidentified Maximum,,0202T,CPT4/HCPCS,POST VERT ARTHRPLST 1 LUMBAR,,,1370.00
Deidentified Maximum,,0216T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,,2002.00
Deidentified Maximum,,0249T,CPT4/HCPCS,LIGATION HEMORRHOID W/US,,,4280.43
Deidentified Maximum,,0265T,CPT4/HCPCS,IM B1 MRW CEL THER HRVST ONL,,,6075.00
Deidentified Maximum,,0266T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV TOTAL,,,14317.00
Deidentified Maximum,,0267T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV LEAD,,,9304.06
Deidentified Maximum,,0271T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV GEN,,,9304.06
Deidentified Maximum,,0272T,CPT4/HCPCS,INTERROGATE CRTD SNS DEV,,,987.78
Deidentified Maximum,,0274T,CPT4/HCPCS,PERQ LAMOT/LAM CRV/THRC,,,9548.65
Deidentified Maximum,,0278T,CPT4/HCPCS,TEMPR,,,1214.00
Deidentified Maximum,,0282T,CPT4/HCPCS,PERIPH FIELD STIMUL TRIAL,,,1678.88
Deidentified Maximum,,0294T,CPT4/HCPCS,INS LT ATRL MONT PRES LEAD,,,5281.00
Deidentified Maximum,,0307T,CPT4/HCPCS,RMVL ICAR ISCHM MNTRNG DVCE,,,3544.00
Deidentified Maximum,,0308T,CPT4/HCPCS,INSJ OCULAR TELESCOPE PROSTH,,,14317.00
Deidentified Maximum,,0312T,CPT4/HCPCS,LAPS IMPLTJ NSTIM VAGUS,,,14317.00
Deidentified Maximum,,0343T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,,8841.00
Deidentified Maximum,,0344T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,,8841.00
Deidentified Maximum,,0378T,CPT4/HCPCS,VISUAL FIELD ASSMNT REV/RPRT,,,6049.05
Deidentified Maximum,,0390T,CPT4/HCPCS,PERIPROC EVAL INPER LEDLS PM,,,7966.00
Deidentified Maximum,,0402T,CPT4/HCPCS,COLGN CROSS-LINK CRN MED SEP,,,4204.00
Deidentified Maximum,,0404T,CPT4/HCPCS,TRNSCRV UTERIN FIBROID ABLTJ,,,6876.92
Deidentified Maximum,,0410T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ ATR ELT,,,10119.00
Deidentified Maximum,,0420T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,,3544.00
Deidentified Maximum,,0424T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA COMPL,,,24180.00
Deidentified Maximum,,0426T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA STM LD,,,14317.00
Deidentified Maximum,,0431T,CPT4/HCPCS,RMVL/RPLC NSTIM APNEA PLS GN,,,14317.00
Deidentified Maximum,,0440T,CPT4/HCPCS,ABLTJ PERC UXTR/PERPH NRV,,,6075.00
Deidentified Maximum,,0444T,CPT4/HCPCS,1ST PLMT DRUG ELUT OC INS,,,5856.00
Deidentified Maximum,,0445T,CPT4/HCPCS,SBSQT PLMT DRUG ELUT OC INS,,,5856.00
Deidentified Maximum,,0446T,CPT4/HCPCS,INSJ IMPLTBL GLUCOSE SENSOR,,,3656.00
Deidentified Maximum,,0450T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV EACH,,,3198.57
Deidentified Maximum,,0456T,CPT4/HCPCS,REMVL AORTIC DEV VASC SEAL,,,3544.00
Deidentified Maximum,,0527T,CPT4/HCPCS,INSJ/RPLCMT IIMS IMPLT MNTR,,,10119.00
Deidentified Maximum,,0530T,CPT4/HCPCS,REMOVAL COMPLETE IIMS,,,5856.00
Deidentified Maximum,,0537T,CPT4/HCPCS,BLD DRV T LYMPHCYT CAR-T CLL,,,1678.00
Deidentified Maximum,,0544T,CPT4/HCPCS,TCAT MV ANNULUS RCNSTJ,,,1370.00
Deidentified Maximum,,0569T,CPT4/HCPCS,TTVR PERQ APPR 1ST PROSTH,,,8012.00
Deidentified Maximum,,0588T,CPT4/HCPCS,REVISION/REMOVAL ISDNS PTN,,,2002.00
Deidentified Maximum,,10005,CPT4/HCPCS,FNA BX W/US GDN 1ST LES,,,3000.00
Deidentified Maximum,,10007,CPT4/HCPCS,FNA BX W/FLUOR GDN 1ST LES,,,3000.00
Deidentified Maximum,,10011,CPT4/HCPCS,FNA BX W/MR GDN 1ST LES,,,3000.00
Deidentified Maximum,,10022,CPT4/HCPCS,FNA W/IMAGE,,,3198.57
Deidentified Maximum,,10030,CPT4/HCPCS,GUIDE CATHET FLUID DRAINAGE,,,3656.00
Deidentified Maximum,,10061,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,,3198.57
Deidentified Maximum,,11004,CPT4/HCPCS,DEBRIDE GENITALIA & PERINEUM,,,3198.57
Deidentified Maximum,,11008,CPT4/HCPCS,REMOVE MESH FROM ABD WALL,,,5138.00
Deidentified Maximum,,11042,CPT4/HCPCS,DEB SUBQ TISSUE 20 SQ CM/<,,,4280.43
Deidentified Maximum,,11046,CPT4/HCPCS,DEB MUSC/FASCIA ADD-ON,,,3000.00
Deidentified Maximum,,11105,CPT4/HCPCS,PUNCH BX SKIN EA SEP/ADDL,,,3000.00
Deidentified Maximum,,11107,CPT4/HCPCS,INCAL BX SKN EA SEP/ADDL,,,3000.00
Deidentified Maximum,,11424,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 3.1-4,,,4280.43
Deidentified Maximum,,11441,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.6-1 CM,,,3656.00
Deidentified Maximum,,11451,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,4280.43
Deidentified Maximum,,11470,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,4280.43
Deidentified Maximum,,11471,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,4280.43
Deidentified Maximum,,11620,CPT4/HCPCS,EXC H-F-NK-SP MAL+MARG 0.5/<,,,3198.57
Deidentified Maximum,,11643,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 2.1-3,,,3656.00
Deidentified Maximum,,11760,CPT4/HCPCS,REPAIR OF NAIL BED,,,3198.57
Deidentified Maximum,,11921,CPT4/HCPCS,CORRECT SKN COLOR 6.1-20.0CM,,,2002.00
Deidentified Maximum,,11922,CPT4/HCPCS,CORRECT SKIN COLOR EA 20.0CM,,,3000.00
Deidentified Maximum,,12007,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK >30.0 CM,,,4280.43
Deidentified Maximum,,12011,CPT4/HCPCS,RPR F/E/E/N/L/M 2.5 CM/<,,,1678.88
Deidentified Maximum,,12031,CPT4/HCPCS,INTMD RPR S/A/T/EXT 2.5 CM/<,,,3198.57
Deidentified Maximum,,12046,CPT4/HCPCS,INTMD RPR N-HF/GENIT20.1-30,,,4280.43
Deidentified Maximum,,12053,CPT4/HCPCS,INTMD RPR FACE/MM 5.1-7.5 CM,,,3198.57
Deidentified Maximum,,13100,CPT4/HCPCS,CMPLX RPR TRUNK 1.1-2.5 CM,,,4280.43
Deidentified Maximum,,13120,CPT4/HCPCS,CMPLX RPR S/A/L 1.1-2.5 CM,,,4280.43
Deidentified Maximum,,13121,CPT4/HCPCS,CMPLX RPR S/A/L 2.6-7.5 CM,,,5856.00
Deidentified Maximum,,13133,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,,3198.57
Deidentified Maximum,,14001,CPT4/HCPCS,TIS TRNFR TRUNK 10.1-30SQCM,,,5856.00
Deidentified Maximum,,15116,CPT4/HCPCS,EPIDRM A-GRFT F/N/HF/G ADDL,,,3198.57
Deidentified Maximum,,15120,CPT4/HCPCS,SKN SPLT A-GRFT FAC/NCK/HF/G,,,5138.00
Deidentified Maximum,,15131,CPT4/HCPCS,DERM AUTOGRAFT T/A/L ADD-ON,,,3198.57
Deidentified Maximum,,15135,CPT4/HCPCS,DERM AUTOGRAFT FACE/NCK/HF/G,,,5138.00
Deidentified Maximum,,15157,CPT4/HCPCS,CULT EPIDERM GRFT F/N/HFG +%,,,3198.57
Deidentified Maximum,,15221,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,,4280.43
Deidentified Maximum,,15240,CPT4/HCPCS,SKIN FULL GRFT FACE/GENIT/HF,,,5856.00
Deidentified Maximum,,15261,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,,4280.43
Deidentified Maximum,,15273,CPT4/HCPCS,SKIN SUB GRFT T/ARM/LG CHILD,,,5138.00
Deidentified Maximum,,15278,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CH ADD,,,3000.00
Deidentified Maximum,,15732,CPT4/HCPCS,MUSCLE-SKIN GRAFT HEAD/NECK,,,3544.00
Deidentified Maximum,,15733,CPT4/HCPCS,MUSC MYOQ/FSCQ FLP H&N PEDCL,,,5856.00
Deidentified Maximum,,15740,CPT4/HCPCS,ISLAND PEDICLE FLAP GRAFT,,,4280.43
Deidentified Maximum,,15758,CPT4/HCPCS,FREE FASCIAL FLAP MICROVASC,,,6876.92
Deidentified Maximum,,15769,CPT4/HCPCS,GRFG AUTOL SOFT TISS DIR EXC,,,6401.00
Deidentified Maximum,,15773,CPT4/HCPCS,GRFG AUTOL FAT LIPO 25 CC/<,,,3656.00
Deidentified Maximum,,15782,CPT4/HCPCS,DERMABRASION OTHER THAN FACE,,,3198.57
Deidentified Maximum,,15783,CPT4/HCPCS,DERMABRASION SUPRFL ANY SITE,,,1214.00
Deidentified Maximum,,15792,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,,1214.00
Deidentified Maximum,,15825,CPT4/HCPCS,REMOVAL OF NECK WRINKLES,,,5856.00
Deidentified Maximum,,15920,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,,5856.00
Deidentified Maximum,,15933,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,5856.00
Deidentified Maximum,,15935,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,6401.00
Deidentified Maximum,,15951,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,6401.00
Deidentified Maximum,,15953,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,6401.00
Deidentified Maximum,,16025,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN M,,,4280.43
Deidentified Maximum,,17106,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3000.00
Deidentified Maximum,,17276,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3656.00
Deidentified Maximum,,17314,CPT4/HCPCS,MOHS ADDL STAGE T/A/L,,,3198.57
Deidentified Maximum,,17340,CPT4/HCPCS,CRYOTHERAPY OF SKIN,,,1214.00
Deidentified Maximum,,19000,CPT4/HCPCS,DRAINAGE OF BREAST LESION,,,3000.00
Deidentified Maximum,,19081,CPT4/HCPCS,Bx breast 1st Lesion strtctc,,,4280.43
Deidentified Maximum,,19086,CPT4/HCPCS,BX BREAST ADD LESION MR IMAG,,,3000.00
Deidentified Maximum,,19282,CPT4/HCPCS,PERQ DEVICE BREAST EA IMAG,,,3000.00
Deidentified Maximum,,19318,CPT4/HCPCS,BREAST REDUCTION,,,6401.00
Deidentified Maximum,,19325,CPT4/HCPCS,BREAST AUGMENTATION W/IMPLT,,,12850.70
Deidentified Maximum,,19368,CPT4/HCPCS,BRST RCNSTJ 1PDCL TRAM ANAST,,,6075.00
Deidentified Maximum,,20102,CPT4/HCPCS,EXPLORE WOUND ABDOMEN,,,4280.43
Deidentified Maximum,,20500,CPT4/HCPCS,INJECTION OF SINUS TRACT,,,3000.00
Deidentified Maximum,,20527,CPT4/HCPCS,INJ DUPUYTREN CORD W/ENZYME,,,2002.00
Deidentified Maximum,,20555,CPT4/HCPCS,PLACE NDL MUSC/TIS FOR RT,,,8300.00
Deidentified Maximum,,20605,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,,3000.00
Deidentified Maximum,,20662,CPT4/HCPCS,APPLICATION OF PELVIS BRACE,,,5856.00
Deidentified Maximum,,20694,CPT4/HCPCS,REMOVE BONE FIXATION DEVICE,,,3198.57
Deidentified Maximum,,20805,CPT4/HCPCS,REPLANT FOREARM COMPLETE,,,12850.70
Deidentified Maximum,,20824,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,,12850.70
Deidentified Maximum,,20926,CPT4/HCPCS,REMOVAL OF TISSUE FOR GRAFT,,,6049.05
Deidentified Maximum,,20950,CPT4/HCPCS,FLUID PRESSURE MUSCLE,,,3000.00
Deidentified Maximum,,20974,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,,1214.00
Deidentified Maximum,,20975,CPT4/HCPCS,ELECTRICAL BONE STIMULATION,,,4280.43
Deidentified Maximum,,21010,CPT4/HCPCS,INCISION OF JAW JOINT,,,4280.43
Deidentified Maximum,,21013,CPT4/HCPCS,EXC FACE TUM DEEP < 2 CM,,,4891.93
Deidentified Maximum,,21040,CPT4/HCPCS,EXCISE MANDIBLE LESION,,,4280.43
Deidentified Maximum,,21047,CPT4/HCPCS,EXCISE LWR JAW CYST W/REPAIR,,,6075.00
Deidentified Maximum,,21073,CPT4/HCPCS,MNPJ OF TMJ W/ANESTH,,,3198.57
Deidentified Maximum,,21141,CPT4/HCPCS,LEFORT I-1 PIECE W/O GRAFT,,,6401.00
Deidentified Maximum,,21142,CPT4/HCPCS,LEFORT I-2 PIECE W/O GRAFT,,,6401.00
Deidentified Maximum,,21182,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,,6876.92
Deidentified Maximum,,21194,CPT4/HCPCS,RECONST LWR JAW W/GRAFT,,,5281.00
Deidentified Maximum,,21198,CPT4/HCPCS,RECONSTR LWR JAW SEGMENT,,,9548.65
Deidentified Maximum,,21206,CPT4/HCPCS,RECONSTRUCT UPPER JAW BONE,,,6876.92
Deidentified Maximum,,21230,CPT4/HCPCS,RIB CARTILAGE GRAFT,,,9548.65
Deidentified Maximum,,21261,CPT4/HCPCS,REVISE EYE SOCKETS,,,9548.65
Deidentified Maximum,,21267,CPT4/HCPCS,REVISE EYE SOCKETS,,,9548.65
Deidentified Maximum,,21282,CPT4/HCPCS,REVISION OF EYELID,,,6876.92
Deidentified Maximum,,21299,CPT4/HCPCS,CRANIO/MAXILLOFACIAL SURGERY,,,4280.43
Deidentified Maximum,,21320,CPT4/HCPCS,CLOSED TX NOSE FX W/ STABLJ,,,4280.43
Deidentified Maximum,,21348,CPT4/HCPCS,OPN TX NASOMAX FX W/GRAFT,,,7188.00
Deidentified Maximum,,21356,CPT4/HCPCS,OPN TX DPRSD ZYGOMATIC ARCH,,,5856.00
Deidentified Maximum,,21401,CPT4/HCPCS,CLOSED TX ORBIT W/MANIPULJ,,,5856.00
Deidentified Maximum,,21407,CPT4/HCPCS,OPN TX ORBIT FX W/IMPLANT,,,9548.65
Deidentified Maximum,,21436,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,,5281.00
Deidentified Maximum,,21451,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,6401.00
Deidentified Maximum,,21501,CPT4/HCPCS,DRAIN NECK/CHEST LESION,,,4280.43
Deidentified Maximum,,21502,CPT4/HCPCS,DRAIN CHEST LESION,,,4280.43
Deidentified Maximum,,21550,CPT4/HCPCS,BIOPSY OF NECK/CHEST,,,3198.57
Deidentified Maximum,,21552,CPT4/HCPCS,EXC NECK LES SC 3 CM/>,,,5856.00
Deidentified Maximum,,21556,CPT4/HCPCS,EXC NECK TUM DEEP < 5 CM,,,4280.43
Deidentified Maximum,,21602,CPT4/HCPCS,EXC CH WAL TUM W/O LYMPHADEC,,,5281.00
Deidentified Maximum,,21615,CPT4/HCPCS,REMOVAL OF RIB,,,5281.00
Deidentified Maximum,,21630,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,,5281.00
Deidentified Maximum,,21632,CPT4/HCPCS,EXTENSIVE STERNUM SURGERY,,,5281.00
Deidentified Maximum,,21705,CPT4/HCPCS,REVISION OF NECK MUSCLE/RIB,,,5783.00
Deidentified Maximum,,21740,CPT4/HCPCS,RECONSTRUCTION OF STERNUM,,,6401.00
Deidentified Maximum,,21813,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,,8300.00
Deidentified Maximum,,21825,CPT4/HCPCS,TREAT STERNUM FRACTURE,,,5281.00
Deidentified Maximum,,21933,CPT4/HCPCS,EXC BACK TUM DEEP 5 CM/>,,,5856.00
Deidentified Maximum,,21935,CPT4/HCPCS,RESECT BACK TUM < 5 CM,,,5856.00
Deidentified Maximum,,22207,CPT4/HCPCS,INCIS SPINE 3 COLUMN LUMBAR,,,1370.00
Deidentified Maximum,,22222,CPT4/HCPCS,INCIS W/DISCECTOMY THORACIC,,,5029.00
Deidentified Maximum,,22224,CPT4/HCPCS,INCIS W/DISCECTOMY LUMBAR,,,5029.00
Deidentified Maximum,,22326,CPT4/HCPCS,TREAT NECK SPINE FRACTURE,,,5856.00
Deidentified Maximum,,22513,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,,7007.00
Deidentified Maximum,,22523,CPT4/HCPCS,PERCUT KYPHOPLASTY THOR,,,1678.88
Deidentified Maximum,,22524,CPT4/HCPCS,PERCUT KYPHOPLASTY LUMBAR,,,1678.88
Deidentified Maximum,,22533,CPT4/HCPCS,LAT LUMBAR SPINE FUSION,,,3198.57
Deidentified Maximum,,22612,CPT4/HCPCS,LUMBAR SPINE FUSION,,,9548.65
Deidentified Maximum,,22614,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,,9548.65
Deidentified Maximum,,22812,CPT4/HCPCS,ANT FUSION 8/> VERT SEG,,,8841.00
Deidentified Maximum,,22818,CPT4/HCPCS,KYPHECTOMY 1-2 SEGMENTS,,,6876.92
Deidentified Maximum,,22845,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,7007.00
Deidentified Maximum,,22849,CPT4/HCPCS,REINSERT SPINAL FIXATION,,,4280.43
Deidentified Maximum,,22855,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,,5281.00
Deidentified Maximum,,22864,CPT4/HCPCS,REMOVE CERV ARTIF DISC,,,5029.00
Deidentified Maximum,,22865,CPT4/HCPCS,REMOVE LUMB ARTIF DISC,,,1370.00
Deidentified Maximum,,22900,CPT4/HCPCS,EXC ABDL TUM DEEP < 5 CM,,,6401.00
Deidentified Maximum,,22999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,,4891.93
Deidentified Maximum,,23040,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,,5856.00
Deidentified Maximum,,23077,CPT4/HCPCS,RESECT SHOULDER TUMOR < 5 CM,,,5856.00
Deidentified Maximum,,23100,CPT4/HCPCS,BIOPSY OF SHOULDER JOINT,,,4280.43
Deidentified Maximum,,23101,CPT4/HCPCS,SHOULDER JOINT SURGERY,,,9548.65
Deidentified Maximum,,23106,CPT4/HCPCS,INCISION OF COLLARBONE JOINT,,,6401.00
Deidentified Maximum,,23331,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,,1678.00
Deidentified Maximum,,23332,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,,5029.00
Deidentified Maximum,,23334,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,,9548.65
Deidentified Maximum,,23400,CPT4/HCPCS,FIXATION OF SHOULDER BLADE,,,9548.65
Deidentified Maximum,,23410,CPT4/HCPCS,REPAIR ROTATOR CUFF ACUTE,,,6876.92
Deidentified Maximum,,23420,CPT4/HCPCS,REPAIR OF SHOULDER,,,9548.65
Deidentified Maximum,,23430,CPT4/HCPCS,REPAIR BICEPS TENDON,,,6401.00
Deidentified Maximum,,23455,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,9548.65
Deidentified Maximum,,23460,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,7007.00
Deidentified Maximum,,23466,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,9548.65
Deidentified Maximum,,23485,CPT4/HCPCS,REVISION OF COLLAR BONE,,,9548.65
Deidentified Maximum,,23491,CPT4/HCPCS,REINFORCE SHOULDER BONES,,,7007.00
Deidentified Maximum,,23515,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,,7007.00
Deidentified Maximum,,23550,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,7007.00
Deidentified Maximum,,23615,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,7007.00
Deidentified Maximum,,23620,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3198.57
Deidentified Maximum,,23650,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,,3198.57
Deidentified Maximum,,23675,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,,4280.43
Deidentified Maximum,,23680,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,,7007.00
Deidentified Maximum,,23930,CPT4/HCPCS,DRAINAGE OF ARM LESION,,,4204.00
Deidentified Maximum,,24006,CPT4/HCPCS,RELEASE ELBOW JOINT,,,6401.00
Deidentified Maximum,,24066,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,,4280.43
Deidentified Maximum,,24136,CPT4/HCPCS,REMOVE RADIUS BONE LESION,,,5138.00
Deidentified Maximum,,24147,CPT4/HCPCS,PARTIAL REMOVAL OF ELBOW,,,5138.00
Deidentified Maximum,,24220,CPT4/HCPCS,INJECTION FOR ELBOW X-RAY,,,3000.00
Deidentified Maximum,,24320,CPT4/HCPCS,REPAIR OF ARM TENDON,,,5856.00
Deidentified Maximum,,24331,CPT4/HCPCS,REVISION OF ARM MUSCLES,,,6075.00
Deidentified Maximum,,24343,CPT4/HCPCS,REPR ELBOW LAT LIGMNT W/TISS,,,6401.00
Deidentified Maximum,,24345,CPT4/HCPCS,REPR ELBW MED LIGMNT W/TISSU,,,5138.00
Deidentified Maximum,,24361,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,,10119.00
Deidentified Maximum,,24371,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,,10119.00
Deidentified Maximum,,24400,CPT4/HCPCS,REVISION OF HUMERUS,,,6401.00
Deidentified Maximum,,24470,CPT4/HCPCS,REVISION OF ELBOW JOINT,,,6075.00
Deidentified Maximum,,24582,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4280.43
Deidentified Maximum,,24635,CPT4/HCPCS,TREAT ELBOW FRACTURE,,,7007.00
Deidentified Maximum,,24640,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,,1678.00
Deidentified Maximum,,24930,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,3544.00
Deidentified Maximum,,24935,CPT4/HCPCS,REVISION OF AMPUTATION,,,9548.65
Deidentified Maximum,,25023,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,,5856.00
Deidentified Maximum,,25065,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,,3198.57
Deidentified Maximum,,25110,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,,5856.00
Deidentified Maximum,,25112,CPT4/HCPCS,REREMOVE WRIST TENDON LESION,,,6401.00
Deidentified Maximum,,25116,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,,6401.00
Deidentified Maximum,,25118,CPT4/HCPCS,EXCISE WRIST TENDON SHEATH,,,4280.43
Deidentified Maximum,,25170,CPT4/HCPCS,RESECT RADIUS/ULNAR TUMOR,,,9548.65
Deidentified Maximum,,25251,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,,5138.00
Deidentified Maximum,,25263,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,5138.00
Deidentified Maximum,,25265,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,5856.00
Deidentified Maximum,,25274,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,6401.00
Deidentified Maximum,,25275,CPT4/HCPCS,REPAIR FOREARM TENDON SHEATH,,,6401.00
Deidentified Maximum,,25394,CPT4/HCPCS,REPAIR CARPAL BONE SHORTEN,,,6840.00
Deidentified Maximum,,25425,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,,6075.00
Deidentified Maximum,,25440,CPT4/HCPCS,REPAIR/GRAFT WRIST BONE,,,6401.00
Deidentified Maximum,,25444,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,,7007.00
Deidentified Maximum,,25515,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,7007.00
Deidentified Maximum,,25525,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,7007.00
Deidentified Maximum,,25526,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,7007.00
Deidentified Maximum,,25622,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,1678.00
Deidentified Maximum,,25805,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,,7007.00
Deidentified Maximum,,25830,CPT4/HCPCS,FUSION RADIOULNAR JNT/ULNA,,,6876.92
Deidentified Maximum,,25900,CPT4/HCPCS,AMPUTATION OF FOREARM,,,6588.00
Deidentified Maximum,,25909,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,6588.00
Deidentified Maximum,,26070,CPT4/HCPCS,EXPLORE/TREAT HAND JOINT,,,4280.43
Deidentified Maximum,,26105,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,,3198.57
Deidentified Maximum,,26113,CPT4/HCPCS,EXC HAND TUM DEEP 1.5 CM/>,,,5856.00
Deidentified Maximum,,26200,CPT4/HCPCS,REMOVE HAND BONE LESION,,,4280.43
Deidentified Maximum,,26235,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,,5856.00
Deidentified Maximum,,26262,CPT4/HCPCS,RESECT DISTAL FINGER TUMOR,,,4280.43
Deidentified Maximum,,26340,CPT4/HCPCS,MANIPULATE FINGER W/ANESTH,,,3000.00
Deidentified Maximum,,26352,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,,6401.00
Deidentified Maximum,,26357,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,6401.00
Deidentified Maximum,,26412,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,,5856.00
Deidentified Maximum,,26428,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,,5856.00
Deidentified Maximum,,26433,CPT4/HCPCS,REPAIR FINGER TENDON,,,5856.00
Deidentified Maximum,,26434,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,,5856.00
Deidentified Maximum,,26437,CPT4/HCPCS,REALIGNMENT OF TENDONS,,,5856.00
Deidentified Maximum,,26480,CPT4/HCPCS,TRANSPLANT HAND TENDON,,,5856.00
Deidentified Maximum,,26494,CPT4/HCPCS,HAND TENDON/MUSCLE TRANSFER,,,5856.00
Deidentified Maximum,,26541,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,,9548.65
Deidentified Maximum,,26546,CPT4/HCPCS,REPAIR NONUNION HAND,,,6401.00
Deidentified Maximum,,26551,CPT4/HCPCS,GREAT TOE-HAND TRANSFER,,,9548.65
Deidentified Maximum,,26580,CPT4/HCPCS,REPAIR HAND DEFORMITY,,,6876.92
Deidentified Maximum,,26587,CPT4/HCPCS,RECONSTRUCT EXTRA FINGER,,,6876.92
Deidentified Maximum,,26590,CPT4/HCPCS,REPAIR FINGER DEFORMITY,,,6876.92
Deidentified Maximum,,26605,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,,4280.43
Deidentified Maximum,,26608,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,,6401.00
Deidentified Maximum,,26685,CPT4/HCPCS,TREAT HAND DISLOCATION,,,5856.00
Deidentified Maximum,,26720,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,2002.00
Deidentified Maximum,,26735,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,6401.00
Deidentified Maximum,,26742,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,4280.43
Deidentified Maximum,,26750,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,1678.00
Deidentified Maximum,,26910,CPT4/HCPCS,AMPUTATE METACARPAL BONE,,,5856.00
Deidentified Maximum,,26990,CPT4/HCPCS,DRAINAGE OF PELVIS LESION,,,4204.00
Deidentified Maximum,,26992,CPT4/HCPCS,DRAINAGE OF BONE LESION,,,6049.05
Deidentified Maximum,,27025,CPT4/HCPCS,INCISION OF HIP/THIGH FASCIA,,,3198.57
Deidentified Maximum,,27027,CPT4/HCPCS,BUTTOCK FASCIOTOMY,,,8300.00
Deidentified Maximum,,27050,CPT4/HCPCS,BIOPSY OF SACROILIAC JOINT,,,5856.00
Deidentified Maximum,,27057,CPT4/HCPCS,BUTTOCK FASCIOTOMY W/DBRDMT,,,8300.00
Deidentified Maximum,,27060,CPT4/HCPCS,REMOVAL OF ISCHIAL BURSA,,,6876.92
Deidentified Maximum,,27062,CPT4/HCPCS,REMOVE FEMUR LESION/BURSA,,,6876.92
Deidentified Maximum,,27066,CPT4/HCPCS,REMOVE HIP BONE LES DEEP,,,6876.92
Deidentified Maximum,,27067,CPT4/HCPCS,REMOVE/GRAFT HIP BONE LESION,,,6876.92
Deidentified Maximum,,27076,CPT4/HCPCS,RESECT HIP TUM INCL ACETABUL,,,6049.05
Deidentified Maximum,,27140,CPT4/HCPCS,TRANSPLANT FEMUR RIDGE,,,5029.00
Deidentified Maximum,,27151,CPT4/HCPCS,INCISION OF HIP BONES,,,6049.05
Deidentified Maximum,,27176,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,,7007.00
Deidentified Maximum,,27232,CPT4/HCPCS,TREAT THIGH FRACTURE,,,3198.57
Deidentified Maximum,,27236,CPT4/HCPCS,TREAT THIGH FRACTURE,,,5281.00
Deidentified Maximum,,27244,CPT4/HCPCS,TREAT THIGH FRACTURE,,,5281.00
Deidentified Maximum,,27246,CPT4/HCPCS,TREAT THIGH FRACTURE,,,3198.57
Deidentified Maximum,,27254,CPT4/HCPCS,TREAT HIP DISLOCATION,,,5029.00
Deidentified Maximum,,27265,CPT4/HCPCS,TREAT HIP DISLOCATION,,,3198.57
Deidentified Maximum,,27323,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,,3198.57
Deidentified Maximum,,27326,CPT4/HCPCS,NEURECTOMY POPLITEAL,,,4280.43
Deidentified Maximum,,27331,CPT4/HCPCS,EXPLORE/TREAT KNEE JOINT,,,6401.00
Deidentified Maximum,,27337,CPT4/HCPCS,EXC THIGH/KNEE LES SC 3 CM/>,,,5856.00
Deidentified Maximum,,27355,CPT4/HCPCS,REMOVE FEMUR LESION,,,5856.00
Deidentified Maximum,,27357,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,,6876.92
Deidentified Maximum,,27394,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,,5856.00
Deidentified Maximum,,27412,CPT4/HCPCS,AUTOCHONDROCYTE IMPLANT KNEE,,,12850.70
Deidentified Maximum,,27424,CPT4/HCPCS,REVISION/REMOVAL OF KNEECAP,,,6075.00
Deidentified Maximum,,27428,CPT4/HCPCS,RECONSTRUCTION KNEE,,,8012.00
Deidentified Maximum,,27447,CPT4/HCPCS,TOTAL KNEE ARTHROPLASTY,,,10119.00
Deidentified Maximum,,27470,CPT4/HCPCS,REPAIR OF THIGH,,,5029.00
Deidentified Maximum,,27496,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,,6876.92
Deidentified Maximum,,27506,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,5783.00
Deidentified Maximum,,27532,CPT4/HCPCS,TREAT KNEE FRACTURE,,,3198.57
Deidentified Maximum,,27557,CPT4/HCPCS,TREAT KNEE DISLOCATION,,,6075.00
Deidentified Maximum,,27580,CPT4/HCPCS,FUSION OF KNEE,,,5281.00
Deidentified Maximum,,27590,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,,4280.43
Deidentified Maximum,,27598,CPT4/HCPCS,AMPUTATE LOWER LEG AT KNEE,,,5029.00
Deidentified Maximum,,27618,CPT4/HCPCS,EXC LEG/ANKLE TUM < 3 CM,,,4280.43
Deidentified Maximum,,27619,CPT4/HCPCS,EXC LEG/ANKLE TUM DEEP <5 CM,,,5856.00
Deidentified Maximum,,27648,CPT4/HCPCS,INJECTION FOR ANKLE X-RAY,,,3000.00
Deidentified Maximum,,27650,CPT4/HCPCS,REPAIR ACHILLES TENDON,,,6075.00
Deidentified Maximum,,27654,CPT4/HCPCS,REPAIR OF ACHILLES TENDON,,,6075.00
Deidentified Maximum,,27675,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,,4280.43
Deidentified Maximum,,27681,CPT4/HCPCS,RELEASE OF LOWER LEG TENDONS,,,5138.00
Deidentified Maximum,,27686,CPT4/HCPCS,REVISE LOWER LEG TENDONS,,,5856.00
Deidentified Maximum,,27696,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENTS,,,5138.00
Deidentified Maximum,,27703,CPT4/HCPCS,RECONSTRUCTION ANKLE JOINT,,,5281.00
Deidentified Maximum,,27712,CPT4/HCPCS,REALIGNMENT OF LOWER LEG,,,5029.00
Deidentified Maximum,,27720,CPT4/HCPCS,REPAIR OF TIBIA,,,7007.00
Deidentified Maximum,,27758,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,,7007.00
Deidentified Maximum,,27762,CPT4/HCPCS,CLTX MED ANKLE FX W/MNPJ,,,3198.57
Deidentified Maximum,,27769,CPT4/HCPCS,OPTX POST ANKLE FX,,,8300.00
Deidentified Maximum,,27788,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,3198.57
Deidentified Maximum,,27826,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,,7007.00
Deidentified Maximum,,27881,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,,5281.00
Deidentified Maximum,,27893,CPT4/HCPCS,DECOMPRESSION OF LEG,,,5856.00
Deidentified Maximum,,28072,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,,5856.00
Deidentified Maximum,,28100,CPT4/HCPCS,REMOVAL OF ANKLE/HEEL LESION,,,4280.43
Deidentified Maximum,,28103,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,,7007.00
Deidentified Maximum,,28120,CPT4/HCPCS,PART REMOVAL OF ANKLE/HEEL,,,9548.65
Deidentified Maximum,,28130,CPT4/HCPCS,REMOVAL OF ANKLE BONE,,,5856.00
Deidentified Maximum,,28171,CPT4/HCPCS,RESECT TARSAL TUMOR,,,5856.00
Deidentified Maximum,,28175,CPT4/HCPCS,RESECT PHALANX OF TOE TUMOR,,,5856.00
Deidentified Maximum,,28190,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,,3656.00
Deidentified Maximum,,28202,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,,5856.00
Deidentified Maximum,,28225,CPT4/HCPCS,RELEASE OF FOOT TENDON,,,4204.00
Deidentified Maximum,,28261,CPT4/HCPCS,REVISION OF FOOT TENDON,,,5856.00
Deidentified Maximum,,28280,CPT4/HCPCS,FUSION OF TOES,,,4280.43
Deidentified Maximum,,28286,CPT4/HCPCS,REPAIR OF HAMMERTOE,,,6401.00
Deidentified Maximum,,28290,CPT4/HCPCS,CORRECTION OF BUNION,,,1678.88
Deidentified Maximum,,28299,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,6876.92
Deidentified Maximum,,28446,CPT4/HCPCS,OSTEOCHONDRAL TALUS AUTOGRFT,,,8300.00
Deidentified Maximum,,28450,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,,2002.00
Deidentified Maximum,,28495,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,,2002.00
Deidentified Maximum,,28555,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,,7007.00
Deidentified Maximum,,28636,CPT4/HCPCS,TREAT TOE DISLOCATION,,,5856.00
Deidentified Maximum,,28645,CPT4/HCPCS,REPAIR TOE DISLOCATION,,,5856.00
Deidentified Maximum,,28705,CPT4/HCPCS,FUSION OF FOOT BONES,,,7007.00
Deidentified Maximum,,28715,CPT4/HCPCS,FUSION OF FOOT BONES,,,7007.00
Deidentified Maximum,,28725,CPT4/HCPCS,FUSION OF FOOT BONES,,,7007.00
Deidentified Maximum,,28737,CPT4/HCPCS,REVISION OF FOOT BONES,,,7007.00
Deidentified Maximum,,28750,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,,7007.00
Deidentified Maximum,,29020,CPT4/HCPCS,APPLICATION OF BODY CAST,,,1678.88
Deidentified Maximum,,29049,CPT4/HCPCS,APPLICATION OF FIGURE EIGHT,,,1678.00
Deidentified Maximum,,29130,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,,6766.00
Deidentified Maximum,,29131,CPT4/HCPCS,APPLICATION OF FINGER SPLINT,,,1214.00
Deidentified Maximum,,29240,CPT4/HCPCS,STRAPPING OF SHOULDER,,,6766.00
Deidentified Maximum,,29450,CPT4/HCPCS,APPLICATION OF LEG CAST,,,1214.00
Deidentified Maximum,,29800,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29822,CPT4/HCPCS,SHO ARTHRS SRG LMTD DBRDMT,,,5856.00
Deidentified Maximum,,29850,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,6401.00
Deidentified Maximum,,29860,CPT4/HCPCS,HIP ARTHROSCOPY DX,,,7007.00
Deidentified Maximum,,29868,CPT4/HCPCS,MENISCAL TRNSPL KNEE W/SCPE,,,12850.70
Deidentified Maximum,,29884,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29894,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29895,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29899,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,8012.00
Deidentified Maximum,,78320,CPT4/HCPCS,BONE IMAGING (3D),,,2978.36
Deidentified Maximum,,78351,CPT4/HCPCS,BONE MINERAL DUAL PHOTON,,,150.00
Deidentified Maximum,,78428,CPT4/HCPCS,CARDIAC SHUNT IMAGING,,,1342.99
Deidentified Maximum,,78445,CPT4/HCPCS,VASCULAR FLOW IMAGING,,,1283.77
Deidentified Maximum,,78453,CPT4/HCPCS,HT MUSCLE IMAGE PLANAR SING,,,2130.24
Deidentified Maximum,,78466,CPT4/HCPCS,HEART INFARCT IMAGE,,,1317.13
Deidentified Maximum,,78468,CPT4/HCPCS,HEART INFARCT IMAGE (EF),,,1847.32
Deidentified Maximum,,78469,CPT4/HCPCS,HEART INFARCT IMAGE (3D),,,2634.25
Deidentified Maximum,,78472,CPT4/HCPCS,GATED HEART PLANAR SINGLE,,,2781.86
Deidentified Maximum,,78473,CPT4/HCPCS,GATED HEART MULTIPLE,,,4158.27
Deidentified Maximum,,78481,CPT4/HCPCS,HEART FIRST PASS SINGLE,,,2634.25
Deidentified Maximum,,78492,CPT4/HCPCS,MYOCRD IMG PET MLT RST&STRS,,,12600.00
Deidentified Maximum,,78496,CPT4/HCPCS,HEART FIRST PASS ADD-ON,,,3537.29
Deidentified Maximum,,78579,CPT4/HCPCS,LUNG VENTILATION IMAGING,,,2139.61
Deidentified Maximum,,78597,CPT4/HCPCS,LUNG PERFUSION DIFFERENTIAL,,,2293.59
Deidentified Maximum,,78600,CPT4/HCPCS,BRAIN IMAGE < 4 VIEWS,,,1447.04
Deidentified Maximum,,78601,CPT4/HCPCS,BRAIN IMAGE W/FLOW < 4 VIEWS,,,1713.38
Deidentified Maximum,,78605,CPT4/HCPCS,BRAIN IMAGE 4+ VIEWS,,,1713.38
Deidentified Maximum,,78608,CPT4/HCPCS,BRAIN IMAGING (PET),,,18766.18
Deidentified Maximum,,78609,CPT4/HCPCS,BRAIN IMAGING (PET),,,12600.00
Deidentified Maximum,,78645,CPT4/HCPCS,CSF SHUNT EVALUATION,,,2091.76
Deidentified Maximum,,78701,CPT4/HCPCS,KIDNEY IMAGING WITH FLOW,,,1790.36
Deidentified Maximum,,78709,CPT4/HCPCS,K FLOW/FUNCT IMAGE MULTIPLE,,,2586.02
Deidentified Maximum,,78813,CPT4/HCPCS,PET IMAGE FULL BODY,,,19935.70
Deidentified Maximum,,80150,CPT4/HCPCS,ASSAY OF AMIKACIN,,,151.45
Deidentified Maximum,,80158,CPT4/HCPCS,DRUG ASSAY CYCLOSPORINE,,,181.35
Deidentified Maximum,,80176,CPT4/HCPCS,ASSAY OF LIDOCAINE,,,147.58
Deidentified Maximum,,80197,CPT4/HCPCS,ASSAY OF TACROLIMUS,,,137.92
Deidentified Maximum,,80199,CPT4/HCPCS,DRUG SCREEN QUANT TIAGABINE,,,175.89
Deidentified Maximum,,80200,CPT4/HCPCS,ASSAY OF TOBRAMYCIN,,,161.95
Deidentified Maximum,,80336,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 3-5,,,102.00
Deidentified Maximum,,80344,CPT4/HCPCS,ANTIPSYCHOTICS NOS 7/MORE,,,102.00
Deidentified Maximum,,80345,CPT4/HCPCS,DRUG SCREENING BARBITURATES,,,102.00
Deidentified Maximum,,80355,CPT4/HCPCS,GABAPENTIN NON-BLOOD,,,102.00
Deidentified Maximum,,80374,CPT4/HCPCS,STEREOISOMER ANALYSIS,,,102.00
Deidentified Maximum,,80375,CPT4/HCPCS,DRUG/SUBSTANCE NOS 1-3,,,102.00
Deidentified Maximum,,80377,CPT4/HCPCS,DRUG/SUBSTANCE NOS 7/MORE,,,102.00
Deidentified Maximum,,80424,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,,507.36
Deidentified Maximum,,80428,CPT4/HCPCS,GROWTH HORMONE PANEL,,,670.32
Deidentified Maximum,,81001,CPT4/HCPCS,URINALYSIS AUTO W/SCOPE,,,102.00
Deidentified Maximum,,81002,CPT4/HCPCS,URINALYSIS NONAUTO W/O SCOPE,,,102.00
Deidentified Maximum,,81015,CPT4/HCPCS,MICROSCOPIC EXAM OF URINE,,,102.00
Deidentified Maximum,,81050,CPT4/HCPCS,URINALYSIS VOLUME MEASURE,,,102.00
Deidentified Maximum,,81105,CPT4/HCPCS,HPA-1 GENOTYPING,,,1077.38
Deidentified Maximum,,81120,CPT4/HCPCS,IDH1 COMMON VARIANTS,,,1379.78
Deidentified Maximum,,81121,CPT4/HCPCS,IDH2 COMMON VARIANTS,,,2111.92
Deidentified Maximum,,81162,CPT4/HCPCS,BRCA1&2 GEN FULL SEQ DUP/DEL,,,17749.03
Deidentified Maximum,,81164,CPT4/HCPCS,BRCA1&2 GEN FUL DUP/DEL ALYS,,,4171.44
Deidentified Maximum,,81171,CPT4/HCPCS,AFF2 GENE DETC ABNOR ALLELES,,,978.18
Deidentified Maximum,,81202,CPT4/HCPCS,APC GENE KNOWN FAM VARIANTS,,,355.15
Deidentified Maximum,,81208,CPT4/HCPCS,BCR/ABL1 GENE OTHER BP,,,436.38
Deidentified Maximum,,81210,CPT4/HCPCS,BRAF GENE,,,378.00
Deidentified Maximum,,81215,CPT4/HCPCS,BRCA1 GENE KNOWN FAMIL VRNT,,,399.42
Deidentified Maximum,,81222,CPT4/HCPCS,CFTR GENE DUP/DELET VARIANTS,,,2835.84
Deidentified Maximum,,81226,CPT4/HCPCS,CYP2D6 GENE COM VARIANTS,,,1033.03
Deidentified Maximum,,81228,CPT4/HCPCS,CYTOGEN MICRARRAY COPY NMBR,,,1542.24
Deidentified Maximum,,81232,CPT4/HCPCS,DPYD GENE COMMON VARIANTS,,,1248.15
Deidentified Maximum,,81233,CPT4/HCPCS,BTK GENE COMMON VARIANTS,,,1252.35
Deidentified Maximum,,81238,CPT4/HCPCS,F9 FULL GENE SEQUENCE,,,4284.00
Deidentified Maximum,,81242,CPT4/HCPCS,FANCC GENE,,,419.83
Deidentified Maximum,,81244,CPT4/HCPCS,FMR1 GENE CHARAC ALLELES,,,158.00
Deidentified Maximum,,81263,CPT4/HCPCS,IGH VARI REGIONAL MUTATION,,,428.40
Deidentified Maximum,,81268,CPT4/HCPCS,CHIMERISM ANAL W/CELL SELECT,,,1524.18
Deidentified Maximum,,81292,CPT4/HCPCS,MLH1 GENE FULL SEQ,,,3276.00
Deidentified Maximum,,81300,CPT4/HCPCS,MSH6 GENE DUP/DELETE VARIANT,,,756.00
Deidentified Maximum,,81315,CPT4/HCPCS,PML/RARALPHA COM BREAKPOINTS,,,570.52
Deidentified Maximum,,81319,CPT4/HCPCS,PMS2 GENE DUP/DELET VARIANTS,,,874.43
Deidentified Maximum,,81322,CPT4/HCPCS,PTEN GENE KNOWN FAM VARIANT,,,222.43
Deidentified Maximum,,81330,CPT4/HCPCS,SMPD1 GENE COMMON VARIANTS,,,673.93
Deidentified Maximum,,81343,CPT4/HCPCS,PPP2R2B GEN DETC ABNOR ALLEL,,,978.18
Deidentified Maximum,,81375,CPT4/HCPCS,HLA II TYPING AG EQUIV LR,,,902.16
Deidentified Maximum,,81380,CPT4/HCPCS,HLA I TYPING 1 LOCUS HR,,,718.11
Deidentified Maximum,,81382,CPT4/HCPCS,HLA II TYPING 1 LOC HR,,,483.58
Deidentified Maximum,,81401,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 2,,,327.60
Deidentified Maximum,,81402,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 3,,,504.00
Deidentified Maximum,,81403,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 4,,,504.00
Deidentified Maximum,,81405,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 6,,,882.00
Deidentified Maximum,,81406,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 7,,,502.31
Deidentified Maximum,,81414,CPT4/HCPCS,CAR ION CHNNLPATH INC 2 GNS,,,5728.63
Deidentified Maximum,,81422,CPT4/HCPCS,FETAL CHRMOML MICRODELTJ,,,5728.63
Deidentified Maximum,,81425,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,,102.00
Deidentified Maximum,,81427,CPT4/HCPCS,GENOME RE-EVALUATION,,,102.00
Deidentified Maximum,,81442,CPT4/HCPCS,NOONAN SPECTRUM DISORDERS,,,4350.27
Deidentified Maximum,,81448,CPT4/HCPCS,HRDTRY PERPH NEURPHY PANEL,,,5155.83
Deidentified Maximum,,81493,CPT4/HCPCS,COR ARTERY DISEASE MRNA,,,7442.40
Deidentified Maximum,,81503,CPT4/HCPCS,ONCO (OVAR) FIVE PROTEINS,,,2587.20
Deidentified Maximum,,81507,CPT4/HCPCS,FETAL ANEUPLOIDY TRISOM RISK,,,4851.00
Deidentified Maximum,,81510,CPT4/HCPCS,FTL CGEN ABNOR THREE ANAL,,,793.80
Deidentified Maximum,,81519,CPT4/HCPCS,ONCOLOGY BREAST MRNA,,,23940.00
Deidentified Maximum,,81528,CPT4/HCPCS,ONCOLOGY COLORECTAL SCR,,,3633.33
Deidentified Maximum,,81540,CPT4/HCPCS,ONCOLOGY TUM UNKNOWN ORIGIN,,,20850.98
Deidentified Maximum,,81545,CPT4/HCPCS,ONCOLOGY THYROID,,,23007.93
Deidentified Maximum,,81595,CPT4/HCPCS,CARDIOLOGY HRT TRNSPL MRNA,,,20282.97
Deidentified Maximum,,81596,CPT4/HCPCS,NFCT DS CHRNC HCV 6 ASSAYS,,,515.42
Deidentified Maximum,,82030,CPT4/HCPCS,ASSAY OF ADP & AMP,,,259.22
Deidentified Maximum,,82042,CPT4/HCPCS,OTHER SOURCE ALBUMIN QUAN EA,,,102.00
Deidentified Maximum,,82127,CPT4/HCPCS,AMINO ACID SINGLE QUAL,,,139.27
Deidentified Maximum,,82131,CPT4/HCPCS,AMINO ACIDS SINGLE QUANT,,,169.51
Deidentified Maximum,,82139,CPT4/HCPCS,AMINO ACIDS QUAN 6 OR MORE,,,169.51
Deidentified Maximum,,82154,CPT4/HCPCS,ANDROSTANEDIOL GLUCURONIDE,,,289.63
Deidentified Maximum,,82190,CPT4/HCPCS,ATOMIC ABSORPTION,,,149.77
Deidentified Maximum,,82272,CPT4/HCPCS,OCCULT BLD FECES 1-3 TESTS,,,102.00
Deidentified Maximum,,82274,CPT4/HCPCS,ASSAY TEST FOR BLOOD FECAL,,,159.76
Deidentified Maximum,,82306,CPT4/HCPCS,VITAMIN D 25 HYDROXY,,,297.44
Deidentified Maximum,,82373,CPT4/HCPCS,ASSAY C-D TRANSFER MEASURE,,,181.44
Deidentified Maximum,,82374,CPT4/HCPCS,ASSAY BLOOD CARBON DIOXIDE,,,102.00
Deidentified Maximum,,82380,CPT4/HCPCS,ASSAY OF CAROTENE,,,102.00
Deidentified Maximum,,82387,CPT4/HCPCS,ASSAY OF CATHEPSIN-D,,,209.07
Deidentified Maximum,,82415,CPT4/HCPCS,ASSAY OF CHLORAMPHENICOL,,,127.34
Deidentified Maximum,,82441,CPT4/HCPCS,TEST FOR CHLOROHYDROCARBONS,,,102.00
Deidentified Maximum,,82485,CPT4/HCPCS,ASSAY CHONDROITIN SULFATE,,,207.47
Deidentified Maximum,,82523,CPT4/HCPCS,COLLAGEN CROSSLINKS,,,186.39
Deidentified Maximum,,82530,CPT4/HCPCS,CORTISOL FREE,,,167.91
Deidentified Maximum,,82533,CPT4/HCPCS,TOTAL CORTISOL,,,163.88
Deidentified Maximum,,82608,CPT4/HCPCS,B-12 BINDING CAPACITY,,,143.89
Deidentified Maximum,,82610,CPT4/HCPCS,CYSTATIN C,,,136.58
Deidentified Maximum,,82664,CPT4/HCPCS,ELECTROPHORETIC TEST,,,345.24
Deidentified Maximum,,82668,CPT4/HCPCS,ASSAY OF ERYTHROPOIETIN,,,188.91
Deidentified Maximum,,82693,CPT4/HCPCS,ASSAY OF ETHYLENE GLYCOL,,,149.68
Deidentified Maximum,,82728,CPT4/HCPCS,ASSAY OF FERRITIN,,,136.83
Deidentified Maximum,,83003,CPT4/HCPCS,ASSAY GROWTH HORMONE (HGH),,,167.58
Deidentified Maximum,,83009,CPT4/HCPCS,H PYLORI (C-13) BLOOD,,,676.78
Deidentified Maximum,,83014,CPT4/HCPCS,H PYLORI DRUG ADMIN,,,102.00
Deidentified Maximum,,83065,CPT4/HCPCS,ASSAY OF HEMOGLOBIN HEAT,,,102.00
Deidentified Maximum,,83090,CPT4/HCPCS,ASSAY OF HOMOCYSTINE,,,169.51
Deidentified Maximum,,83520,CPT4/HCPCS,IMMUNOASSAY QUANT NOS NONAB,,,130.11
Deidentified Maximum,,83528,CPT4/HCPCS,ASSAY OF INTRINSIC FACTOR,,,159.76
Deidentified Maximum,,83550,CPT4/HCPCS,IRON BINDING TEST,,,102.00
Deidentified Maximum,,83570,CPT4/HCPCS,ASSAY OF IDH ENZYME,,,102.00
Deidentified Maximum,,83655,CPT4/HCPCS,ASSAY OF LEAD,,,121.63
Deidentified Maximum,,83670,CPT4/HCPCS,ASSAY OF LAP ENZYME,,,102.00
Deidentified Maximum,,83700,CPT4/HCPCS,LIPOPRO BLD ELECTROPHORETIC,,,113.06
Deidentified Maximum,,83721,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,,102.00
Deidentified Maximum,,83735,CPT4/HCPCS,ASSAY OF MAGNESIUM,,,102.00
Deidentified Maximum,,83789,CPT4/HCPCS,MASS SPECTROMETRY QUAL/QUAN,,,181.44
Deidentified Maximum,,83861,CPT4/HCPCS,MICROFLUID ANALY TEARS,,,168.33
Deidentified Maximum,,83874,CPT4/HCPCS,ASSAY OF MYOGLOBIN,,,129.69
Deidentified Maximum,,83880,CPT4/HCPCS,ASSAY OF NATRIURETIC PEPTIDE,,,341.04
Deidentified Maximum,,83918,CPT4/HCPCS,ORGANIC ACIDS TOTAL QUANT,,,165.39
Deidentified Maximum,,83935,CPT4/HCPCS,ASSAY OF URINE OSMOLALITY,,,102.00
Deidentified Maximum,,83987,CPT4/HCPCS,EXHALED BREATH CONDENSATE,,,159.59
Deidentified Maximum,,83992,CPT4/HCPCS,ASSAY FOR PHENCYCLIDINE,,,102.00
Deidentified Maximum,,84085,CPT4/HCPCS,ASSAY OF RBC PG6D ENZYME,,,102.00
Deidentified Maximum,,84087,CPT4/HCPCS,ASSAY PHOSPHOHEXOSE ENZYMES,,,103.73
Deidentified Maximum,,84110,CPT4/HCPCS,ASSAY OF PORPHOBILINOGEN,,,102.00
Deidentified Maximum,,84112,CPT4/HCPCS,EVAL AMNIOTIC FLUID PROTEIN,,,647.13
Deidentified Maximum,,84143,CPT4/HCPCS,ASSAY OF 17-HYDROXYPREGNENO,,,229.32
Deidentified Maximum,,84144,CPT4/HCPCS,ASSAY OF PROGESTERONE,,,209.66
Deidentified Maximum,,84146,CPT4/HCPCS,ASSAY OF PROLACTIN,,,194.71
Deidentified Maximum,,84154,CPT4/HCPCS,ASSAY OF PSA FREE,,,184.88
Deidentified Maximum,,84165,CPT4/HCPCS,PROTEIN E-PHORESIS SERUM,,,107.94
Deidentified Maximum,,84182,CPT4/HCPCS,PROTEIN WESTERN BLOT TEST,,,180.85
Deidentified Maximum,,84233,CPT4/HCPCS,ASSAY OF ESTROGEN,,,647.13
Deidentified Maximum,,84275,CPT4/HCPCS,ASSAY OF SIALIC ACID,,,134.98
Deidentified Maximum,,84295,CPT4/HCPCS,ASSAY OF SERUM SODIUM,,,102.00
Deidentified Maximum,,84305,CPT4/HCPCS,ASSAY OF SOMATOMEDIN,,,213.61
Deidentified Maximum,,84392,CPT4/HCPCS,ASSAY OF URINE SULFATE,,,102.00
Deidentified Maximum,,84425,CPT4/HCPCS,ASSAY OF VITAMIN B-1,,,213.35
Deidentified Maximum,,84437,CPT4/HCPCS,ASSAY OF NEONATAL THYROXINE,,,102.00
Deidentified Maximum,,84439,CPT4/HCPCS,ASSAY OF FREE THYROXINE,,,102.00
Deidentified Maximum,,84449,CPT4/HCPCS,ASSAY OF TRANSCORTIN,,,168.75
Deidentified Maximum,,84478,CPT4/HCPCS,ASSAY OF TRIGLYCERIDES,,,102.00
Deidentified Maximum,,84479,CPT4/HCPCS,ASSAY OF THYROID (T3 OR T4),,,102.00
Deidentified Maximum,,84512,CPT4/HCPCS,ASSAY OF TROPONIN QUAL,,,102.00
Deidentified Maximum,,84577,CPT4/HCPCS,ASSAY OF FECES/UROBILINOGEN,,,125.41
Deidentified Maximum,,84585,CPT4/HCPCS,ASSAY OF URINE VMA,,,155.82
Deidentified Maximum,,84600,CPT4/HCPCS,ASSAY OF VOLATILES,,,161.53
Deidentified Maximum,,84620,CPT4/HCPCS,XYLOSE TOLERANCE TEST,,,119.02
Deidentified Maximum,,84703,CPT4/HCPCS,CHORIONIC GONADOTROPIN ASSAY,,,102.00
Deidentified Maximum,,85025,CPT4/HCPCS,COMPLETE CBC W/AUTO DIFF WBC,,,102.00
Deidentified Maximum,,85044,CPT4/HCPCS,MANUAL RETICULOCYTE COUNT,,,102.00
Deidentified Maximum,,85245,CPT4/HCPCS,CLOT FACTOR VIII VW RISTOCTN,,,230.58
Deidentified Maximum,,85246,CPT4/HCPCS,CLOT FACTOR VIII VW ANTIGEN,,,230.58
Deidentified Maximum,,85247,CPT4/HCPCS,CLOT FACTOR VIII MULTIMETRIC,,,230.58
Deidentified Maximum,,85270,CPT4/HCPCS,CLOT FACTOR XI PTA,,,179.92
Deidentified Maximum,,85303,CPT4/HCPCS,CLOT INHIBIT PROT C ACTIVITY,,,138.93
Deidentified Maximum,,85307,CPT4/HCPCS,ASSAY ACTIVATED PROTEIN C,,,153.97
Deidentified Maximum,,85378,CPT4/HCPCS,FIBRIN DEGRADE SEMIQUANT,,,102.00
Deidentified Maximum,,85380,CPT4/HCPCS,FIBRIN DEGRADJ D-DIMER,,,102.22
Deidentified Maximum,,85400,CPT4/HCPCS,FIBRINOLYTIC PLASMIN,,,102.00
Deidentified Maximum,,85441,CPT4/HCPCS,HEINZ BODIES DIRECT,,,102.00
Deidentified Maximum,,85460,CPT4/HCPCS,HEMOGLOBIN FETAL,,,102.00
Deidentified Maximum,,85461,CPT4/HCPCS,HEMOGLOBIN FETAL,,,102.00
Deidentified Maximum,,85536,CPT4/HCPCS,IRON STAIN PERIPHERAL BLOOD,,,102.00
Deidentified Maximum,,85540,CPT4/HCPCS,WBC ALKALINE PHOSPHATASE,,,102.00
Deidentified Maximum,,85549,CPT4/HCPCS,MURAMIDASE,,,188.49
Deidentified Maximum,,85597,CPT4/HCPCS,PHOSPHOLIPID PLTLT NEUTRALIZ,,,180.68
Deidentified Maximum,,85660,CPT4/HCPCS,RBC SICKLE CELL TEST,,,102.00
Deidentified Maximum,,86003,CPT4/HCPCS,ALLG SPEC IGE CRUDE XTRC EA,,,102.00
Deidentified Maximum,,86008,CPT4/HCPCS,ALLG SPEC IGE RECOMB EA,,,158.08
Deidentified Maximum,,86038,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES,,,121.46
Deidentified Maximum,,86152,CPT4/HCPCS,CELL ENUMERATION & ID,,,5829.26
Deidentified Maximum,,86162,CPT4/HCPCS,COMPLEMENT TOTAL (CH50),,,204.12
Deidentified Maximum,,86171,CPT4/HCPCS,COMPLEMENT FIXATION EACH,,,102.00
Deidentified Maximum,,86225,CPT4/HCPCS,DNA ANTIBODY NATIVE,,,138.01
Deidentified Maximum,,86226,CPT4/HCPCS,DNA ANTIBODY SINGLE STRAND,,,121.63
Deidentified Maximum,,86336,CPT4/HCPCS,INHIBIN A,,,156.57
Deidentified Maximum,,86355,CPT4/HCPCS,B CELLS TOTAL COUNT,,,379.00
Deidentified Maximum,,86403,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY SCRN,,,102.39
Deidentified Maximum,,86485,CPT4/HCPCS,SKIN TEST CANDIDA,,,115.41
Deidentified Maximum,,86606,CPT4/HCPCS,ASPERGILLUS ANTIBODY,,,151.28
Deidentified Maximum,,86615,CPT4/HCPCS,BORDETELLA ANTIBODY,,,132.55
Deidentified Maximum,,86628,CPT4/HCPCS,CANDIDA ANTIBODY,,,120.70
Deidentified Maximum,,86632,CPT4/HCPCS,CHLAMYDIA IGM ANTIBODY,,,127.51
Deidentified Maximum,,86638,CPT4/HCPCS,Q FEVER ANTIBODY,,,121.80
Deidentified Maximum,,86648,CPT4/HCPCS,DIPHTHERIA ANTIBODY,,,152.88
Deidentified Maximum,,86671,CPT4/HCPCS,FUNGUS NES ANTIBODY,,,123.14
Deidentified Maximum,,86677,CPT4/HCPCS,HELICOBACTER PYLORI ANTIBODY,,,145.82
Deidentified Maximum,,86688,CPT4/HCPCS,HTLV-II ANTIBODY,,,140.70
Deidentified Maximum,,86696,CPT4/HCPCS,HERPES SIMPLEX TYPE 2 TEST,,,194.46
Deidentified Maximum,,86702,CPT4/HCPCS,HIV-2 ANTIBODY,,,135.91
Deidentified Maximum,,86704,CPT4/HCPCS,HEP B CORE ANTIBODY TOTAL,,,121.12
Deidentified Maximum,,86732,CPT4/HCPCS,MUCORMYCOSIS ANTIBODY,,,132.55
Deidentified Maximum,,86757,CPT4/HCPCS,RICKETTSIA ANTIBODY,,,194.46
Deidentified Maximum,,86778,CPT4/HCPCS,TOXOPLASMA ANTIBODY IGM,,,144.73
Deidentified Maximum,,86788,CPT4/HCPCS,WEST NILE VIRUS AB IGM,,,169.25
Deidentified Maximum,,86803,CPT4/HCPCS,HEPATITIS C AB TEST,,,143.38
Deidentified Maximum,,86806,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,,217.47
Deidentified Maximum,,86860,CPT4/HCPCS,RBC ANTIBODY ELUTION,,,226.15
Deidentified Maximum,,86880,CPT4/HCPCS,COOMBS TEST DIRECT,,,102.00
Deidentified Maximum,,86900,CPT4/HCPCS,BLOOD TYPING SEROLOGIC ABO,,,102.00
Deidentified Maximum,,86902,CPT4/HCPCS,BLOOD TYPE ANTIGEN DONOR EA,,,102.00
Deidentified Maximum,,86920,CPT4/HCPCS,COMPATIBILITY TEST SPIN,,,250.19
Deidentified Maximum,,86960,CPT4/HCPCS,VOL REDUCTION OF BLOOD/PROD,,,189.42
Deidentified Maximum,,86970,CPT4/HCPCS,RBC PRETX INCUBATJ W/CHEMICL,,,182.84
Deidentified Maximum,,86971,CPT4/HCPCS,RBC PRETX INCUBATJ W/ENZYMES,,,182.84
Deidentified Maximum,,87003,CPT4/HCPCS,SMALL ANIMAL INOCULATION,,,169.17
Deidentified Maximum,,87015,CPT4/HCPCS,SPECIMEN INFECT AGNT CONCNTJ,,,102.00
Deidentified Maximum,,87084,CPT4/HCPCS,CULTURE OF SPECIMEN BY KIT,,,102.00
Deidentified Maximum,,87140,CPT4/HCPCS,CULTURE TYPE IMMUNOFLUORESC,,,102.00
Deidentified Maximum,,87143,CPT4/HCPCS,CULTURE TYPING GLC/HPLC,,,125.91
Deidentified Maximum,,87158,CPT4/HCPCS,CULTURE TYPING ADDED METHOD,,,102.00
Deidentified Maximum,,87184,CPT4/HCPCS,MICROBE SUSCEPTIBLE DISK,,,102.00
Deidentified Maximum,,87206,CPT4/HCPCS,SMEAR FLUORESCENT/ACID STAI,,,102.00
Deidentified Maximum,,87253,CPT4/HCPCS,VIRUS INOCULATE TISSUE ADDL,,,202.94
Deidentified Maximum,,87260,CPT4/HCPCS,ADENOVIRUS AG IF,,,102.00
Deidentified Maximum,,87280,CPT4/HCPCS,RESPIRATORY SYNCYTIAL AG IF,,,102.00
Deidentified Maximum,,87281,CPT4/HCPCS,PNEUMOCYSTIS CARINII AG IF,,,102.00
Deidentified Maximum,,87285,CPT4/HCPCS,TREPONEMA PALLIDUM AG IF,,,102.00
Deidentified Maximum,,87336,CPT4/HCPCS,ENTAMOEB HIST DISPR AG IA,,,102.00
Deidentified Maximum,,87337,CPT4/HCPCS,ENTAMOEB HIST GROUP AG IA,,,102.00
Deidentified Maximum,,87340,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,,103.73
Deidentified Maximum,,87389,CPT4/HCPCS,HIV-1 AG W/HIV-1 & HIV-2 AB,,,243.60
Deidentified Maximum,,87400,CPT4/HCPCS,INFLUENZA A/B AG IA,,,102.00
Deidentified Maximum,,87425,CPT4/HCPCS,ROTAVIRUS AG IA,,,102.00
Deidentified Maximum,,87449,CPT4/HCPCS,AG DETECT NOS IA MULT,,,102.00
Deidentified Maximum,,87450,CPT4/HCPCS,AG DETECT NOS IA SINGLE,,,102.00
Deidentified Maximum,,87481,CPT4/HCPCS,CANDIDA DNA AMP PROBE,,,352.63
Deidentified Maximum,,87482,CPT4/HCPCS,CANDIDA DNA QUANT,,,419.49
Deidentified Maximum,,87487,CPT4/HCPCS,CHYLMD PNEUM DNA QUANT,,,430.41
Deidentified Maximum,,87495,CPT4/HCPCS,CYTOMEG DNA DIR PROBE,,,201.51
Deidentified Maximum,,87501,CPT4/HCPCS,INFLUENZA DNA AMP PROB 1+,,,515.67
Deidentified Maximum,,87534,CPT4/HCPCS,HIV-1 DNA DIR PROBE,,,201.51
Deidentified Maximum,,87539,CPT4/HCPCS,HIV-2 QUANT&REVRSE TRNSCRIPJ,,,430.41
Deidentified Maximum,,87550,CPT4/HCPCS,MYCOBACTERIA DNA DIR PROBE,,,201.51
Deidentified Maximum,,87592,CPT4/HCPCS,N.GONORRHOEAE DNA QUANT,,,430.41
Deidentified Maximum,,87633,CPT4/HCPCS,RESP VIRUS 12-25 TARGETS,,,4090.54
Deidentified Maximum,,87634,CPT4/HCPCS,RSV DNA/RNA AMP PROBE,,,618.74
Deidentified Maximum,,87797,CPT4/HCPCS,DETECT AGENT NOS DNA DIR,,,201.51
Deidentified Maximum,,87798,CPT4/HCPCS,DETECT AGENT NOS DNA AMP,,,352.63
Deidentified Maximum,,87801,CPT4/HCPCS,DETECT AGNT MULT DNA AMPLI,,,705.26
Deidentified Maximum,,87899,CPT4/HCPCS,AGENT NOS ASSAY W/OPTIC,,,102.00
Deidentified Maximum,,87906,CPT4/HCPCS,GENOTYPE DNA/RNA HIV,,,1293.34
Deidentified Maximum,,87910,CPT4/HCPCS,GENOTYPE CYTOMEGALOVIRUS,,,2526.72
Deidentified Maximum,,88007,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,2071.69
Deidentified Maximum,,88036,CPT4/HCPCS,LIMITED AUTOPSY,,,846.46
Deidentified Maximum,,88130,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,,151.20
Deidentified Maximum,,88143,CPT4/HCPCS,CYTOPATH C/V THIN LAYER REDO,,,152.71
Deidentified Maximum,,88162,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,,356.91
Deidentified Maximum,,88166,CPT4/HCPCS,CYTOPATH TBS C/V AUTO REDO,,,106.17
Deidentified Maximum,,88245,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,,1304.85
Deidentified Maximum,,88269,CPT4/HCPCS,CHROMOSOME ANALYS AMNIOTIC,,,1671.09
Deidentified Maximum,,88291,CPT4/HCPCS,CYTO/MOLECULAR REPORT,,,228.06
Deidentified Maximum,,88313,CPT4/HCPCS,SPECIAL STAINS GROUP 2,,,575.90
Deidentified Maximum,,88344,CPT4/HCPCS,IMMUNOHISTO ANTIBODY SLIDE,,,1033.72
Deidentified Maximum,,88348,CPT4/HCPCS,ELECTRON MICROSCOPY,,,5285.11
Deidentified Maximum,,88381,CPT4/HCPCS,MICRODISSECTION MANUAL,,,2004.89
Deidentified Maximum,,88388,CPT4/HCPCS,TISS EX MOLECUL STUDY ADD-ON,,,102.00
Deidentified Maximum,,88738,CPT4/HCPCS,HGB QUANT TRANSCUTANEOUS,,,102.00
Deidentified Maximum,,88741,CPT4/HCPCS,TRANSCUTANEOUS METHB,,,102.00
Deidentified Maximum,,89253,CPT4/HCPCS,EMBRYO HATCHING,,,3047.68
Deidentified Maximum,,89261,CPT4/HCPCS,SPERM ISOLATION COMPLEX,,,684.76
Deidentified Maximum,,89272,CPT4/HCPCS,EXTENDED CULTURE OF OOCYTES,,,3785.62
Deidentified Maximum,,89300,CPT4/HCPCS,SEMEN ANALYSIS W/HUHNER,,,102.00
Deidentified Maximum,,89320,CPT4/HCPCS,SEMEN ANAL VOL/COUNT/MOT,,,121.12
Deidentified Maximum,,89322,CPT4/HCPCS,SEMEN ANAL STRICT CRITERIA,,,155.82
Deidentified Maximum,,89329,CPT4/HCPCS,SPERM EVALUATION TEST,,,210.67
Deidentified Maximum,,89331,CPT4/HCPCS,RETROGRADE EJACULATION ANAL,,,196.81
Deidentified Maximum,,90805,CPT4/HCPCS,PSYTX OFF 20-30 MIN W/E&M,,,127.58
Deidentified Maximum,,90809,CPT4/HCPCS,PSYTX OFF 75-80 W/E&M,,,283.25
Deidentified Maximum,,90814,CPT4/HCPCS,INTAC PSYTX OFF 75-80 MIN,,,274.41
Deidentified Maximum,,90822,CPT4/HCPCS,PSYTX HOSP 75-80 MIN W/E&M,,,340.22
Deidentified Maximum,,90829,CPT4/HCPCS,INTAC PSYTX HSP 75-80 W/E&M,,,345.81
Deidentified Maximum,,90862,CPT4/HCPCS,MEDICATION MANAGEMENT,,,137.97
Deidentified Maximum,,90875,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,,150.86
Deidentified Maximum,,90876,CPT4/HCPCS,PSYCHOPHYSIOLOGICAL THERAPY,,,231.88
Deidentified Maximum,,90880,CPT4/HCPCS,HYPNOTHERAPY,,,207.83
Deidentified Maximum,,90913,CPT4/HCPCS,BFB TRAINING EA ADDL 15 MIN,,,6766.00
Deidentified Maximum,,91034,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX TEST,,,2381.90
Deidentified Maximum,,91112,CPT4/HCPCS,GI WIRELESS CAPSULE MEASURE,,,4280.43
Deidentified Maximum,,92004,CPT4/HCPCS,EYE EXAM NEW PATIENT,,,834.11
Deidentified Maximum,,92012,CPT4/HCPCS,EYE EXAM ESTABLISH PATIENT,,,503.67
Deidentified Maximum,,92015,CPT4/HCPCS,DETERMINE REFRACTIVE STATE,,,720.97
Deidentified Maximum,,92025,CPT4/HCPCS,CORNEAL TOPOGRAPHY,,,158.00
Deidentified Maximum,,92065,CPT4/HCPCS,ORTHOPTIC/PLEOPTIC TRAINING,,,191.69
Deidentified Maximum,,92226,CPT4/HCPCS,SPECIAL EYE EXAM SUBSEQUENT,,,1678.00
Deidentified Maximum,,92250,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,,1678.00
Deidentified Maximum,,92260,CPT4/HCPCS,OPHTHALMOSCOPY/DYNAMOMETRY,,,1678.00
Deidentified Maximum,,92283,CPT4/HCPCS,COLOR VISION EXAMINATION,,,369.72
Deidentified Maximum,,92311,CPT4/HCPCS,CONTACT LENS FITTING,,,536.57
Deidentified Maximum,,92317,CPT4/HCPCS,RX CORNEOSCLERAL CNTACT LENS,,,456.32
Deidentified Maximum,,92342,CPT4/HCPCS,FIT SPECTACLES MULTIFOCAL,,,369.72
Deidentified Maximum,,92352,CPT4/HCPCS,FIT APHAKIA SPECTCL MONOFOCL,,,331.23
Deidentified Maximum,,92502,CPT4/HCPCS,EAR AND THROAT EXAMINATION,,,1678.00
Deidentified Maximum,,92504,CPT4/HCPCS,EAR MICROSCOPY EXAMINATION,,,244.62
Deidentified Maximum,,92507,CPT4/HCPCS,SPEECH/HEARING THERAPY,,,6766.00
Deidentified Maximum,,92524,CPT4/HCPCS,BEHAVRAL QUALIT ANALYS VOICE,,,764.98
Deidentified Maximum,,92541,CPT4/HCPCS,SPONTANEOUS NYSTAGMUS TEST,,,383.38
Deidentified Maximum,,92542,CPT4/HCPCS,POSITIONAL NYSTAGMUS TEST,,,441.12
Deidentified Maximum,,92546,CPT4/HCPCS,SINUSOIDAL ROTATIONAL TEST,,,811.61
Deidentified Maximum,,92550,CPT4/HCPCS,TYMPANOMETRY & REFLEX THRESH,,,105.08
Deidentified Maximum,,92556,CPT4/HCPCS,SPEECH AUDIOMETRY COMPLETE,,,298.47
Deidentified Maximum,,92588,CPT4/HCPCS,EVOKED AUDITORY TST COMPLETE,,,759.75
Deidentified Maximum,,92608,CPT4/HCPCS,EX FOR SPEECH DEVICE RX ADDL,,,342.55
Deidentified Maximum,,92611,CPT4/HCPCS,MOTION FLUOROSCOPY/SWALLOW,,,6766.00
Deidentified Maximum,,92615,CPT4/HCPCS,LARYNGOSCOPIC SENSORY I&R,,,188.58
Deidentified Maximum,,92627,CPT4/HCPCS,EVAL AUD FUNCJ EA ADDL 15,,,272.70
Deidentified Maximum,,92920,CPT4/HCPCS,PRQ CARDIAC ANGIOPLAST 1 ART,,,8970.00
Deidentified Maximum,,92924,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT 1 ART,,,8970.00
Deidentified Maximum,,92943,CPT4/HCPCS,PRQ CARD REVASC CHRONIC 1VSL,,,10119.00
Deidentified Maximum,,92973,CPT4/HCPCS,PRQ CORONARY MECH THROMBECT,,,5281.00
Deidentified Maximum,,92977,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,,4073.36
Deidentified Maximum,,92982,CPT4/HCPCS,CORONARY ARTERY DILATION,,,8841.00
Deidentified Maximum,,92993,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,8841.00
Deidentified Maximum,,92997,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,,9548.65
Deidentified Maximum,,92998,CPT4/HCPCS,PUL ART BALLOON REPR PERCUT,,,9548.65
Deidentified Maximum,,93260,CPT4/HCPCS,PRGRMG DEV EVAL IMPLTBL SYS,,,190.42
Deidentified Maximum,,93271,CPT4/HCPCS,ECG/MONITORING AND ANALYSIS,,,2978.84
Deidentified Maximum,,93278,CPT4/HCPCS,ECG/SIGNAL-AVERAGED,,,597.71
Deidentified Maximum,,93279,CPT4/HCPCS,PRGRMG DEV EVAL PM/LDLS PM,,,162.37
Deidentified Maximum,,93291,CPT4/HCPCS,INTERROG DEV EVAL SCRMS IP,,,138.09
Deidentified Maximum,,93295,CPT4/HCPCS,DEV INTERROG REMOTE 1/2/MLT,,,541.04
Deidentified Maximum,,93303,CPT4/HCPCS,ECHO TRANSTHORACIC,,,1954.89
Deidentified Maximum,,93307,CPT4/HCPCS,TTE W/O DOPPLER COMPLETE,,,1954.89
Deidentified Maximum,,93312,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,1940.59
Deidentified Maximum,,93313,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,643.00
Deidentified Maximum,,93315,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,5012.19
Deidentified Maximum,,93321,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,,643.00
Deidentified Maximum,,93351,CPT4/HCPCS,STRESS TTE COMPLETE,,,1386.75
Deidentified Maximum,,93355,CPT4/HCPCS,ECHO TRANSESOPHAGEAL (TEE),,,7966.00
Deidentified Maximum,,93454,CPT4/HCPCS,CORONARY ARTERY ANGIO S&I,,,9548.65
Deidentified Maximum,,93562,CPT4/HCPCS,CARD OUTPUT MEASURE SUBSQ,,,4613.00
Deidentified Maximum,,93566,CPT4/HCPCS,INJECT R VENTR/ATRIAL ANGIO,,,4613.00
Deidentified Maximum,,93571,CPT4/HCPCS,HEART FLOW RESERVE MEASURE,,,1214.00
Deidentified Maximum,,93581,CPT4/HCPCS,TRANSCATH CLOSURE OF VSD,,,10772.00
Deidentified Maximum,,93590,CPT4/HCPCS,PERQ TRANSCATH CLS MITRAL,,,14317.00
Deidentified Maximum,,93592,CPT4/HCPCS,PERQ TRANSCATH CLOSURE EACH,,,2002.00
Deidentified Maximum,,93600,CPT4/HCPCS,BUNDLE OF HIS RECORDING,,,7830.00
Deidentified Maximum,,93618,CPT4/HCPCS,HEART RHYTHM PACING,,,7830.00
Deidentified Maximum,,93622,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,7830.00
Deidentified Maximum,,93652,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,8841.00
Deidentified Maximum,,93786,CPT4/HCPCS,AMBL BP MNTR W/SW REC ONLY,,,441.88
Deidentified Maximum,,93788,CPT4/HCPCS,AMBL BP MNTR W/SW A/R,,,249.43
Deidentified Maximum,,93790,CPT4/HCPCS,AMBL BP MNTR W/SW I&R,,,66.59
Deidentified Maximum,,93886,CPT4/HCPCS,INTRACRANIAL COMPLETE STUDY,,,2130.11
Deidentified Maximum,,93888,CPT4/HCPCS,INTRACRANIAL LIMITED STUDY,,,1451.36
Deidentified Maximum,,93893,CPT4/HCPCS,TCD EMBOLI DETECT W/INJ,,,2356.25
Deidentified Maximum,,93895,CPT4/HCPCS,CAROTID INTIMA ATHEROMA EVAL,,,627.14
Deidentified Maximum,,93965,CPT4/HCPCS,EXTREMITY STUDY,,,885.63
Deidentified Maximum,,93970,CPT4/HCPCS,EXTREMITY STUDY,,,1960.92
Deidentified Maximum,,93976,CPT4/HCPCS,VASCULAR STUDY,,,1593.39
Deidentified Maximum,,93982,CPT4/HCPCS,ANEURYSM PRESSURE SENS STUDY,,,388.95
Deidentified Maximum,,94150,CPT4/HCPCS,VITAL CAPACITY TEST,,,220.56
Deidentified Maximum,,94400,CPT4/HCPCS,CO2 BREATHING RESPONSE CURVE,,,370.63
Deidentified Maximum,,94610,CPT4/HCPCS,SURFACTANT ADMIN THRU TUBE,,,273.30
Deidentified Maximum,,94620,CPT4/HCPCS,PULMONARY STRESS TEST/SIMPLE,,,1108.52
Deidentified Maximum,,28090,CPT4/HCPCS,REMOVAL OF FOOT LESION,,,5856.00
Deidentified Maximum,,28106,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,,7007.00
Deidentified Maximum,,28250,CPT4/HCPCS,REVISION OF FOOT FASCIA,,,5856.00
Deidentified Maximum,,28262,CPT4/HCPCS,REVISION OF FOOT AND ANKLE,,,6401.00
Deidentified Maximum,,28285,CPT4/HCPCS,REPAIR OF HAMMERTOE,,,5856.00
Deidentified Maximum,,28288,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,,5856.00
Deidentified Maximum,,28309,CPT4/HCPCS,INCISION OF METATARSALS,,,7007.00
Deidentified Maximum,,28310,CPT4/HCPCS,REVISION OF BIG TOE,,,5856.00
Deidentified Maximum,,28312,CPT4/HCPCS,REVISION OF TOE,,,5856.00
Deidentified Maximum,,28405,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,,4280.43
Deidentified Maximum,,28415,CPT4/HCPCS,TREAT HEEL FRACTURE,,,7007.00
Deidentified Maximum,,28445,CPT4/HCPCS,TREAT ANKLE FRACTURE,,,7007.00
Deidentified Maximum,,28505,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,,5856.00
Deidentified Maximum,,28605,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,3198.57
Deidentified Maximum,,28606,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,4280.43
Deidentified Maximum,,28615,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,,7007.00
Deidentified Maximum,,29010,CPT4/HCPCS,APPLICATION OF BODY CAST,,,1678.88
Deidentified Maximum,,29044,CPT4/HCPCS,APPLICATION OF BODY CAST,,,1678.88
Deidentified Maximum,,29058,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,,1678.00
Deidentified Maximum,,29075,CPT4/HCPCS,APPLICATION OF FOREARM CAST,,,1214.00
Deidentified Maximum,,29086,CPT4/HCPCS,APPLY FINGER CAST,,,6766.00
Deidentified Maximum,,29125,CPT4/HCPCS,APPLY FOREARM SPLINT,,,6766.00
Deidentified Maximum,,29425,CPT4/HCPCS,APPLY SHORT LEG CAST,,,1214.00
Deidentified Maximum,,29530,CPT4/HCPCS,STRAPPING OF KNEE,,,6766.00
Deidentified Maximum,,29584,CPT4/HCPCS,APPL MULTLAY COMPRS ARM/HAND,,,7902.34
Deidentified Maximum,,29700,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,,1678.00
Deidentified Maximum,,29804,CPT4/HCPCS,JAW ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29807,CPT4/HCPCS,SHO ARTHRS SRG RPR SLAP LES,,,7007.00
Deidentified Maximum,,29819,CPT4/HCPCS,SHO ARTHRS SRG RMVL LOOSE/FB,,,7007.00
Deidentified Maximum,,29830,CPT4/HCPCS,ELBOW ARTHROSCOPY,,,7007.00
Deidentified Maximum,,29855,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,,7007.00
Deidentified Maximum,,29862,CPT4/HCPCS,HIP ARTHR0 W/DEBRIDEMENT,,,12850.70
Deidentified Maximum,,29870,CPT4/HCPCS,KNEE ARTHROSCOPY DX,,,5856.00
Deidentified Maximum,,29882,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29887,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29898,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29907,CPT4/HCPCS,SUBTALAR ARTHRO W/FUSION,,,8300.00
Deidentified Maximum,,30115,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,,4280.43
Deidentified Maximum,,30117,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,,5856.00
Deidentified Maximum,,30120,CPT4/HCPCS,REVISION OF NOSE,,,4204.00
Deidentified Maximum,,30220,CPT4/HCPCS,INSERT NASAL SEPTAL BUTTON,,,5856.00
Deidentified Maximum,,31075,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,,6401.00
Deidentified Maximum,,31254,CPT4/HCPCS,NSL/SINS NDSC W/PRTL ETHMDCT,,,6401.00
Deidentified Maximum,,31293,CPT4/HCPCS,NSL/SINS NDSC MED&INF DCMPRN,,,5856.00
Deidentified Maximum,,31296,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT SINS,,,8300.00
Deidentified Maximum,,31400,CPT4/HCPCS,REVISION OF LARYNX,,,6075.00
Deidentified Maximum,,31513,CPT4/HCPCS,INJECTION INTO VOCAL CORD,,,4280.43
Deidentified Maximum,,31554,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,,6876.92
Deidentified Maximum,,31577,CPT4/HCPCS,LARGSC W/RMVL FOREIGN BDY(S),,,4280.43
Deidentified Maximum,,31584,CPT4/HCPCS,LARYNGOPLASTY FX RDCTJ FIXJ,,,6401.00
Deidentified Maximum,,31588,CPT4/HCPCS,REVISION OF LARYNX,,,5281.00
Deidentified Maximum,,31590,CPT4/HCPCS,REINNERVATE LARYNX,,,6876.92
Deidentified Maximum,,31646,CPT4/HCPCS,BRNCHSC W/THER ASPIR SBSQ,,,3198.57
Deidentified Maximum,,31648,CPT4/HCPCS,BRONCHIAL VALVE REMOV INIT,,,6000.00
Deidentified Maximum,,31649,CPT4/HCPCS,BRONCHIAL VALVE REMOV ADDL,,,4000.00
Deidentified Maximum,,31656,CPT4/HCPCS,BRONCHOSCOPY INJ FOR X-RAY,,,1678.00
Deidentified Maximum,,31766,CPT4/HCPCS,RECONSTRUCTION OF WINDPIPE,,,6588.00
Deidentified Maximum,,31770,CPT4/HCPCS,REPAIR/GRAFT OF BRONCHUS,,,6588.00
Deidentified Maximum,,31800,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,,3656.00
Deidentified Maximum,,31805,CPT4/HCPCS,REPAIR OF WINDPIPE INJURY,,,6049.05
Deidentified Maximum,,32160,CPT4/HCPCS,OPEN CHEST HEART MASSAGE,,,5281.00
Deidentified Maximum,,32320,CPT4/HCPCS,FREE/REMOVE CHEST LINING,,,6588.00
Deidentified Maximum,,32488,CPT4/HCPCS,COMPLETION PNEUMONECTOMY,,,4280.43
Deidentified Maximum,,32550,CPT4/HCPCS,INSERT PLEURAL CATH,,,8300.00
Deidentified Maximum,,32552,CPT4/HCPCS,REMOVE LUNG CATHETER,,,2002.00
Deidentified Maximum,,32554,CPT4/HCPCS,ASPIRATE PLEURA W/O IMAGING,,,3198.57
Deidentified Maximum,,32607,CPT4/HCPCS,THORACOSCOPY W/BX INFILTRATE,,,8300.00
Deidentified Maximum,,32608,CPT4/HCPCS,THORACOSCOPY W/BX NODULE,,,8300.00
Deidentified Maximum,,32659,CPT4/HCPCS,THORACOSCOPY W/SAC DRAINAGE,,,6588.00
Deidentified Maximum,,32668,CPT4/HCPCS,THORACOSCOPY W/W RESECT DIAG,,,3544.00
Deidentified Maximum,,32674,CPT4/HCPCS,THORACOSCOPY LYMPH NODE EXC,,,3544.00
Deidentified Maximum,,32852,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,,7902.34
Deidentified Maximum,,32856,CPT4/HCPCS,PREPARE DONOR LUNG DOUBLE,,,3544.00
Deidentified Maximum,,32994,CPT4/HCPCS,ABLATE PULM TUMOR PERQ CRYBL,,,7007.00
Deidentified Maximum,,33025,CPT4/HCPCS,INCISION OF HEART SAC,,,6588.00
Deidentified Maximum,,33050,CPT4/HCPCS,RESECT HEART SAC LESION,,,5783.00
Deidentified Maximum,,33203,CPT4/HCPCS,INSERT EPICARD ELTRD ENDO,,,1678.88
Deidentified Maximum,,33207,CPT4/HCPCS,INSERT HEART PM VENTRICULAR,,,12850.70
Deidentified Maximum,,33220,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB DUAL,,,12850.70
Deidentified Maximum,,33259,CPT4/HCPCS,ABLATE ATRIA W/BYPASS ADD-ON,,,5281.00
Deidentified Maximum,,33272,CPT4/HCPCS,RMVL OF SUBQ DEFIBRILLATOR,,,24180.00
Deidentified Maximum,,33274,CPT4/HCPCS,TCAT INSJ/RPL PERM LDLS PM,,,14317.00
Deidentified Maximum,,33310,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,,5783.00
Deidentified Maximum,,33404,CPT4/HCPCS,PREPARE HEART-AORTA CONDUIT,,,5281.00
Deidentified Maximum,,33411,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,,8841.00
Deidentified Maximum,,33412,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,,8841.00
Deidentified Maximum,,33413,CPT4/HCPCS,REPLACEMENT OF AORTIC VALVE,,,6876.92
Deidentified Maximum,,33416,CPT4/HCPCS,REVISE VENTRICLE MUSCLE,,,8841.00
Deidentified Maximum,,33422,CPT4/HCPCS,REVISION OF MITRAL VALVE,,,8012.00
Deidentified Maximum,,33430,CPT4/HCPCS,REPLACEMENT OF MITRAL VALVE,,,8841.00
Deidentified Maximum,,33460,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,,8841.00
Deidentified Maximum,,33465,CPT4/HCPCS,REPLACE TRICUSPID VALVE,,,8841.00
Deidentified Maximum,,33530,CPT4/HCPCS,CORONARY ARTERY BYPASS/REOP,,,1370.00
Deidentified Maximum,,33536,CPT4/HCPCS,CABG ARTERIAL FOUR OR MORE,,,1370.00
Deidentified Maximum,,33606,CPT4/HCPCS,ANASTOMOSIS/ARTERY-AORTA,,,1370.00
Deidentified Maximum,,33619,CPT4/HCPCS,REPAIR SINGLE VENTRICLE,,,1370.00
Deidentified Maximum,,33620,CPT4/HCPCS,APPLY R&L PULM ART BANDS,,,6588.00
Deidentified Maximum,,33622,CPT4/HCPCS,REDO COMPL CARDIAC ANOMALY,,,3198.57
Deidentified Maximum,,33645,CPT4/HCPCS,REVISION OF HEART VEINS,,,5783.00
Deidentified Maximum,,33660,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,8841.00
Deidentified Maximum,,33724,CPT4/HCPCS,REPAIR VENOUS ANOMALY,,,8012.00
Deidentified Maximum,,33771,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1370.00
Deidentified Maximum,,33774,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,8841.00
Deidentified Maximum,,33778,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,8841.00
Deidentified Maximum,,33782,CPT4/HCPCS,NIKAIDOH PROC,,,1370.00
Deidentified Maximum,,33786,CPT4/HCPCS,REPAIR ARTERIAL TRUNK,,,8841.00
Deidentified Maximum,,33803,CPT4/HCPCS,REPAIR VESSEL DEFECT,,,8012.00
Deidentified Maximum,,33822,CPT4/HCPCS,REVISE MAJOR VESSEL,,,10119.00
Deidentified Maximum,,33840,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,,8841.00
Deidentified Maximum,,33845,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,,8841.00
Deidentified Maximum,,33870,CPT4/HCPCS,TRANSVERSE AORTIC ARCH GRAFT,,,8841.00
Deidentified Maximum,,33884,CPT4/HCPCS,ENDOVASC PROSTH TAA ADD-ON,,,3544.00
Deidentified Maximum,,33889,CPT4/HCPCS,ARTERY TRANSPOSE/ENDOVAS TAA,,,1370.00
Deidentified Maximum,,33916,CPT4/HCPCS,SURGERY OF GREAT VESSEL,,,8841.00
Deidentified Maximum,,33951,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,,3544.00
Deidentified Maximum,,33953,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,,3544.00
Deidentified Maximum,,33962,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,8012.00
Deidentified Maximum,,33964,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,8012.00
Deidentified Maximum,,33967,CPT4/HCPCS,INSERT I-AORT PERCUT DEVICE,,,14317.00
Deidentified Maximum,,33968,CPT4/HCPCS,REMOVE AORTIC ASSIST DEVICE,,,14317.00
Deidentified Maximum,,33974,CPT4/HCPCS,REMOVE INTRA-AORTIC BALLOON,,,1370.00
Deidentified Maximum,,33976,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,,8012.00
Deidentified Maximum,,33977,CPT4/HCPCS,REMOVE VENTRICULAR DEVICE,,,1370.00
Deidentified Maximum,,34151,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,,5281.00
Deidentified Maximum,,34502,CPT4/HCPCS,RECONSTRUCT VENA CAVA,,,6588.00
Deidentified Maximum,,34520,CPT4/HCPCS,CROSS-OVER VEIN GRAFT,,,9548.65
Deidentified Maximum,,34702,CPT4/HCPCS,EVASC RPR A-AO NDGFT RPT,,,7188.00
Deidentified Maximum,,34711,CPT4/HCPCS,DLYD PLMT XTN PROSTH EA ADDL,,,3544.00
Deidentified Maximum,,34717,CPT4/HCPCS,EVASC RPR A-ILIAC NDGFT,,,5783.00
Deidentified Maximum,,34718,CPT4/HCPCS,EVASC RPR N/A A-ILIAC NDGFT,,,5281.00
Deidentified Maximum,,34804,CPT4/HCPCS,ENDOVAS AAA REPR W/1-P PART,,,5783.00
Deidentified Maximum,,34806,CPT4/HCPCS,ANEURYSM PRESS SENSOR ADD-ON,,,1678.88
Deidentified Maximum,,34820,CPT4/HCPCS,OPN ILIAC ART EXPOS,,,5029.00
Deidentified Maximum,,34834,CPT4/HCPCS,OPN BRACH ART EXPOS,,,8797.00
Deidentified Maximum,,34847,CPT4/HCPCS,VISC & INFRAREN ABD 3 PROSTH,,,8841.00
Deidentified Maximum,,34848,CPT4/HCPCS,VISC & INFRAREN ABD 4+ PROST,,,8841.00
Deidentified Maximum,,35005,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,5281.00
Deidentified Maximum,,35102,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,8012.00
Deidentified Maximum,,35141,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,5281.00
Deidentified Maximum,,35188,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,7007.00
Deidentified Maximum,,35201,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,7007.00
Deidentified Maximum,,35206,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,6401.00
Deidentified Maximum,,35216,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,8012.00
Deidentified Maximum,,35226,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,6401.00
Deidentified Maximum,,35251,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,6588.00
Deidentified Maximum,,35261,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,7902.34
Deidentified Maximum,,35331,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5783.00
Deidentified Maximum,,35450,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,3544.00
Deidentified Maximum,,35460,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,,3544.00
Deidentified Maximum,,35506,CPT4/HCPCS,ART BYP GRFT SUBCLAV-CAROTID,,,5029.00
Deidentified Maximum,,35508,CPT4/HCPCS,ART BYP GRFT CAROTID-VERTBRL,,,5029.00
Deidentified Maximum,,35585,CPT4/HCPCS,VEIN BYP FEM-TIBIAL PERONEAL,,,5029.00
Deidentified Maximum,,35623,CPT4/HCPCS,ART BYP AXILLARY-POP-TIBIAL,,,3198.57
Deidentified Maximum,,35637,CPT4/HCPCS,ART BYP AORTOILIAC,,,5783.00
Deidentified Maximum,,35638,CPT4/HCPCS,ART BYP AORTOBI-ILIAC,,,1370.00
Deidentified Maximum,,35647,CPT4/HCPCS,ART BYP AORTOFEMORAL,,,5783.00
Deidentified Maximum,,35654,CPT4/HCPCS,ART BYP AXILL-FEM-FEMORAL,,,5281.00
Deidentified Maximum,,35656,CPT4/HCPCS,ART BYP FEMORAL-POPLITEAL,,,5029.00
Deidentified Maximum,,35695,CPT4/HCPCS,ART TRNSPOSJ CAROTID SUBCLAV,,,3198.57
Deidentified Maximum,,35879,CPT4/HCPCS,REVISE GRAFT W/VEIN,,,9548.65
Deidentified Maximum,,35884,CPT4/HCPCS,REVISE GRAFT W/VEIN,,,8300.00
Deidentified Maximum,,35907,CPT4/HCPCS,EXCISION GRAFT ABDOMEN,,,6588.00
Deidentified Maximum,,36012,CPT4/HCPCS,PLACE CATHETER IN VEIN,,,3000.00
Deidentified Maximum,,36216,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,3656.00
Deidentified Maximum,,36222,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,,5138.00
Deidentified Maximum,,36224,CPT4/HCPCS,PLACE CATH CAROTD ART,,,7007.00
Deidentified Maximum,,36225,CPT4/HCPCS,PLACE CATH SUBCLAVIAN ART,,,5138.00
Deidentified Maximum,,36246,CPT4/HCPCS,INS CATH ABD/L-EXT ART 2ND,,,3656.00
Deidentified Maximum,,36252,CPT4/HCPCS,INS CATH REN ART 1ST BILAT,,,5138.00
Deidentified Maximum,,36299,CPT4/HCPCS,VESSEL INJECTION PROCEDURE,,,1214.00
Deidentified Maximum,,36468,CPT4/HCPCS,NJX SCLRSNT SPIDER VEINS,,,3198.57
Deidentified Maximum,,36471,CPT4/HCPCS,NJX SCLRSNT MLT INCMPTNT VN,,,3198.57
Deidentified Maximum,,36476,CPT4/HCPCS,ENDOVENOUS RF VEIN ADD-ON,,,6876.92
Deidentified Maximum,,36555,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,,3198.57
Deidentified Maximum,,36570,CPT4/HCPCS,INSERT PICVAD CATH,,,5856.00
Deidentified Maximum,,36578,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,,5138.00
Deidentified Maximum,,36582,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,,6876.92
Deidentified Maximum,,36590,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,,3198.57
Deidentified Maximum,,36800,CPT4/HCPCS,INSERTION OF CANNULA,,,7007.00
Deidentified Maximum,,36838,CPT4/HCPCS,DIST REVAS LIGATION HEMO,,,9548.65
Deidentified Maximum,,37181,CPT4/HCPCS,SPLICE SPLEEN/KIDNEY VEINS,,,5783.00
Deidentified Maximum,,37182,CPT4/HCPCS,INSERT HEPATIC SHUNT (TIPS),,,5029.00
Deidentified Maximum,,37185,CPT4/HCPCS,PRIM ART M-THRMBC SBSQ VSL,,,4891.93
Deidentified Maximum,,37191,CPT4/HCPCS,INS ENDOVAS VENA CAVA FILTR,,,7007.00
Deidentified Maximum,,37200,CPT4/HCPCS,TRANSCATHETER BIOPSY,,,7007.00
Deidentified Maximum,,37206,CPT4/HCPCS,TRANSCATH IV STENT/PERC ADDL,,,1678.88
Deidentified Maximum,,37209,CPT4/HCPCS,CHANGE IV CATH AT THROMB TX,,,1678.00
Deidentified Maximum,,37217,CPT4/HCPCS,STENT PLACEMT RETRO CAROTID,,,5856.00
Deidentified Maximum,,37226,CPT4/HCPCS,FEM/POPL REVASC W/STENT,,,10119.00
Deidentified Maximum,,37229,CPT4/HCPCS,TIB/PER REVASC W/ATHER,,,10119.00
Deidentified Maximum,,37252,CPT4/HCPCS,INTRVASC US NONCORONARY 1ST,,,3000.00
Deidentified Maximum,,37600,CPT4/HCPCS,LIGATION OF NECK ARTERY,,,6049.05
Deidentified Maximum,,37609,CPT4/HCPCS,TEMPORAL ARTERY PROCEDURE,,,4280.43
Deidentified Maximum,,37615,CPT4/HCPCS,LIGATION OF NECK ARTERY,,,7902.34
Deidentified Maximum,,37618,CPT4/HCPCS,LIGATION OF EXTREMITY ARTERY,,,3544.00
Deidentified Maximum,,37660,CPT4/HCPCS,REVISION OF MAJOR VEIN,,,5029.00
Deidentified Maximum,,37718,CPT4/HCPCS,LIGATE/STRIP SHORT LEG VEIN,,,5856.00
Deidentified Maximum,,38129,CPT4/HCPCS,LAPAROSCOPE PROC SPLEEN,,,7902.34
Deidentified Maximum,,38204,CPT4/HCPCS,BL DONOR SEARCH MANAGEMENT,,,3198.57
Deidentified Maximum,,38242,CPT4/HCPCS,TRANSPLT ALLO LYMPHOCYTES,,,3198.57
Deidentified Maximum,,38505,CPT4/HCPCS,NEEDLE BIOPSY LYMPH NODES,,,3198.57
Deidentified Maximum,,38564,CPT4/HCPCS,REMOVAL ABDOMEN LYMPH NODES,,,5281.00
Deidentified Maximum,,38570,CPT4/HCPCS,LAPAROSCOPY LYMPH NODE BIOP,,,12850.70
Deidentified Maximum,,38724,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,,8012.00
Deidentified Maximum,,38760,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,,4280.43
Deidentified Maximum,,38999,CPT4/HCPCS,BLOOD/LYMPH SYSTEM PROCEDURE,,,3198.57
Deidentified Maximum,,39501,CPT4/HCPCS,REPAIR DIAPHRAGM LACERATION,,,5783.00
Deidentified Maximum,,39599,CPT4/HCPCS,DIAPHRAGM SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,40520,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,,4280.43
Deidentified Maximum,,40525,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,,4280.43
Deidentified Maximum,,40701,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,,9548.65
Deidentified Maximum,,40800,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,1678.00
Deidentified Maximum,,41000,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,4280.43
Deidentified Maximum,,41007,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,3198.57
Deidentified Maximum,,41015,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,3198.57
Deidentified Maximum,,41116,CPT4/HCPCS,EXCISION OF MOUTH LESION,,,4204.00
Deidentified Maximum,,41130,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,,5281.00
Deidentified Maximum,,41150,CPT4/HCPCS,TONGUE MOUTH JAW SURGERY,,,5783.00
Deidentified Maximum,,41800,CPT4/HCPCS,DRAINAGE OF GUM LESION,,,3198.57
Deidentified Maximum,,41870,CPT4/HCPCS,GUM GRAFT,,,6049.05
Deidentified Maximum,,41899,CPT4/HCPCS,DENTAL SURGERY PROCEDURE,,,4280.43
Deidentified Maximum,,42106,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,,4280.43
Deidentified Maximum,,42310,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,,3198.57
Deidentified Maximum,,42420,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,,9548.65
Deidentified Maximum,,42426,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,,5783.00
Deidentified Maximum,,42660,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,,3198.57
Deidentified Maximum,,42800,CPT4/HCPCS,BIOPSY OF THROAT,,,4280.43
Deidentified Maximum,,42815,CPT4/HCPCS,EXCISION OF NECK CYST,,,6876.92
Deidentified Maximum,,42821,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,,6876.92
Deidentified Maximum,,42825,CPT4/HCPCS,REMOVAL OF TONSILS,,,6401.00
Deidentified Maximum,,42826,CPT4/HCPCS,REMOVAL OF TONSILS,,,6401.00
Deidentified Maximum,,42830,CPT4/HCPCS,REMOVAL OF ADENOIDS,,,6401.00
Deidentified Maximum,,42962,CPT4/HCPCS,CONTROL THROAT BLEEDING,,,4280.43
Deidentified Maximum,,42972,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,,5856.00
Deidentified Maximum,,43192,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO INJECT,,,5000.00
Deidentified Maximum,,43195,CPT4/HCPCS,ESOPHAGOSCOPY RIGID BALLOON,,,5000.00
Deidentified Maximum,,43196,CPT4/HCPCS,ESOPHAGOSCP GUIDE WIRE DILAT,,,5000.00
Deidentified Maximum,,43215,CPT4/HCPCS,ESOPHAGOSCOPY FLEX REMOVE FB,,,3198.57
Deidentified Maximum,,43216,CPT4/HCPCS,ESOPHAGOSCOPY LESION REMOVAL,,,4204.00
Deidentified Maximum,,43217,CPT4/HCPCS,ESOPHAGOSCOPY SNARE LES REMV,,,3198.57
Deidentified Maximum,,43236,CPT4/HCPCS,UPPR GI SCOPE W/SUBMUC INJ,,,4280.43
Deidentified Maximum,,43237,CPT4/HCPCS,ENDOSCOPIC US EXAM ESOPH,,,3656.00
Deidentified Maximum,,43238,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,,3656.00
Deidentified Maximum,,43243,CPT4/HCPCS,EGD INJECTION VARICES,,,4280.43
Deidentified Maximum,,43245,CPT4/HCPCS,EGD DILATE STRICTURE,,,4280.43
Deidentified Maximum,,43280,CPT4/HCPCS,LAPAROSCOPY FUNDOPLASTY,,,12850.70
Deidentified Maximum,,43289,CPT4/HCPCS,LAPAROSCOPE PROC ESOPH,,,7902.34
Deidentified Maximum,,43300,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,,5281.00
Deidentified Maximum,,43327,CPT4/HCPCS,ESOPH FUNDOPLASTY LAP,,,5783.00
Deidentified Maximum,,43335,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,,6588.00
Deidentified Maximum,,43336,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,,8012.00
Deidentified Maximum,,43425,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,,6588.00
Deidentified Maximum,,43458,CPT4/HCPCS,DILATE ESOPHAGUS,,,1678.88
Deidentified Maximum,,43460,CPT4/HCPCS,PRESSURE TREATMENT ESOPHAGUS,,,3198.57
Deidentified Maximum,,43631,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,,5783.00
Deidentified Maximum,,43640,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,,5783.00
Deidentified Maximum,,43755,CPT4/HCPCS,DX GASTR INTUB W/ASP SPECS,,,3000.00
Deidentified Maximum,,43762,CPT4/HCPCS,RPLC GTUBE NO REVJ TRC,,,3000.00
Deidentified Maximum,,43820,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,,5783.00
Deidentified Maximum,,43831,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,,3198.57
Deidentified Maximum,,43846,CPT4/HCPCS,GASTRIC BYPASS FOR OBESITY,,,5783.00
Deidentified Maximum,,43870,CPT4/HCPCS,REPAIR STOMACH OPENING,,,4204.00
Deidentified Maximum,,43999,CPT4/HCPCS,STOMACH SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,44015,CPT4/HCPCS,INSERT NEEDLE CATH BOWEL,,,3544.00
Deidentified Maximum,,44020,CPT4/HCPCS,EXPLORE SMALL INTESTINE,,,7188.00
Deidentified Maximum,,44055,CPT4/HCPCS,CORRECT MALROTATION OF BOWEL,,,7830.00
Deidentified Maximum,,44110,CPT4/HCPCS,EXCISE INTESTINE LESION(S),,,5281.00
Deidentified Maximum,,44135,CPT4/HCPCS,INTESTINE TRANSPLNT CADAVER,,,5783.00
Deidentified Maximum,,44140,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,5783.00
Deidentified Maximum,,44207,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,,12850.70
Deidentified Maximum,,44227,CPT4/HCPCS,LAP CLOSE ENTEROSTOMY,,,6876.92
Deidentified Maximum,,44310,CPT4/HCPCS,ILEOSTOMY/JEJUNOSTOMY,,,5281.00
Deidentified Maximum,,44340,CPT4/HCPCS,REVISION OF COLOSTOMY,,,5856.00
Deidentified Maximum,,44366,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4280.43
Deidentified Maximum,,44372,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4280.43
Deidentified Maximum,,44382,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,3198.57
Deidentified Maximum,,44389,CPT4/HCPCS,COLONOSCOPY WITH BIOPSY,,,3198.57
Deidentified Maximum,,44391,CPT4/HCPCS,COLONOSCOPY FOR BLEEDING,,,3198.57
Deidentified Maximum,,44405,CPT4/HCPCS,COLONOSCOPY W/DILATION,,,4000.00
Deidentified Maximum,,44408,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,,4000.00
Deidentified Maximum,,44625,CPT4/HCPCS,REPAIR BOWEL OPENING,,,5783.00
Deidentified Maximum,,44640,CPT4/HCPCS,REPAIR BOWEL-SKIN FISTULA,,,5281.00
Deidentified Maximum,,44650,CPT4/HCPCS,REPAIR BOWEL FISTULA,,,5281.00
Deidentified Maximum,,44705,CPT4/HCPCS,PREPARE FECAL MICROBIOTA,,,3544.00
Deidentified Maximum,,44850,CPT4/HCPCS,REPAIR OF MESENTERY,,,5281.00
Deidentified Maximum,,44900,CPT4/HCPCS,DRAIN APPENDIX ABSCESS OPEN,,,5281.00
Deidentified Maximum,,44960,CPT4/HCPCS,APPENDECTOMY,,,5281.00
Deidentified Maximum,,45000,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,,3198.57
Deidentified Maximum,,45112,CPT4/HCPCS,REMOVAL OF RECTUM,,,6588.00
Deidentified Maximum,,45126,CPT4/HCPCS,PELVIC EXENTERATION,,,6588.00
Deidentified Maximum,,45135,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,,5783.00
Deidentified Maximum,,45160,CPT4/HCPCS,EXCISION OF RECTAL LESION,,,4280.43
Deidentified Maximum,,45171,CPT4/HCPCS,EXC RECT TUM TRANSANAL PART,,,7902.34
Deidentified Maximum,,45308,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,,3198.57
Deidentified Maximum,,45320,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY ABLATE,,,4204.00
Deidentified Maximum,,45335,CPT4/HCPCS,SIGMOIDOSCOPY W/SUBMUC INJ,,,3198.57
Deidentified Maximum,,45347,CPT4/HCPCS,SIGMOIDOSCOPY W/PLCMT STENT,,,4000.00
Deidentified Maximum,,45383,CPT4/HCPCS,LESION REMOVAL COLONOSCOPY,,,1678.00
Deidentified Maximum,,45387,CPT4/HCPCS,COLONOSCOPY W/STENT,,,1678.00
Deidentified Maximum,,45392,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPIC FNB,,,3656.00
Deidentified Maximum,,45400,CPT4/HCPCS,LAPAROSCOPIC PROC,,,5856.00
Deidentified Maximum,,45500,CPT4/HCPCS,REPAIR OF RECTUM,,,4280.43
Deidentified Maximum,,45562,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,,3198.57
Deidentified Maximum,,45999,CPT4/HCPCS,RECTUM SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,46030,CPT4/HCPCS,REMOVAL OF RECTAL MARKER,,,3198.57
Deidentified Maximum,,46220,CPT4/HCPCS,EXCISE ANAL EXT TAG/PAPILLA,,,3198.57
Deidentified Maximum,,46230,CPT4/HCPCS,REMOVAL OF ANAL TAGS,,,4280.43
Deidentified Maximum,,46257,CPT4/HCPCS,REMOVE IN/EX HEM GRP & FISS,,,5856.00
Deidentified Maximum,,46275,CPT4/HCPCS,REMOVE ANAL FIST INTER,,,5856.00
Deidentified Maximum,,46288,CPT4/HCPCS,REPAIR ANAL FISTULA,,,6401.00
Deidentified Maximum,,46505,CPT4/HCPCS,CHEMODENERVATION ANAL MUSC,,,3198.57
Deidentified Maximum,,46604,CPT4/HCPCS,ANOSCOPY AND DILATION,,,3198.57
Deidentified Maximum,,46615,CPT4/HCPCS,ANOSCOPY,,,4280.43
Deidentified Maximum,,46750,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,,5856.00
Deidentified Maximum,,46753,CPT4/HCPCS,RECONSTRUCTION OF ANUS,,,5856.00
Deidentified Maximum,,46945,CPT4/HCPCS,INT HRHC LIG 1 HROID W/O IMG,,,4204.00
Deidentified Maximum,,47000,CPT4/HCPCS,NEEDLE BIOPSY OF LIVER,,,3198.57
Deidentified Maximum,,47001,CPT4/HCPCS,NEEDLE BIOPSY LIVER ADD-ON,,,3000.00
Deidentified Maximum,,47141,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,,6876.92
Deidentified Maximum,,47143,CPT4/HCPCS,PREP DONOR LIVER WHOLE,,,3544.00
Deidentified Maximum,,47145,CPT4/HCPCS,PREP DONOR LIVER LOBE SPLIT,,,3544.00
Deidentified Maximum,,47400,CPT4/HCPCS,INCISION OF LIVER DUCT,,,5281.00
Deidentified Maximum,,47490,CPT4/HCPCS,INCISION OF GALLBLADDER,,,5138.00
Deidentified Maximum,,47510,CPT4/HCPCS,INSERT CATHETER BILE DUCT,,,1678.88
Deidentified Maximum,,47530,CPT4/HCPCS,REVISE/REINSERT BILE TUBE,,,1678.00
Deidentified Maximum,,47535,CPT4/HCPCS,CONVERSION EXT BIL DRG CATH,,,8300.00
Deidentified Maximum,,47536,CPT4/HCPCS,EXCHANGE BILIARY DRG CATH,,,8300.00
Deidentified Maximum,,47541,CPT4/HCPCS,PLMT ACCESS BIL TREE SM BWL,,,8300.00
Deidentified Maximum,,47543,CPT4/HCPCS,ENDOLUMINAL BX BILIARY TREE,,,4891.93
Deidentified Maximum,,47544,CPT4/HCPCS,REMOVAL DUCT GLBLDR CALCULI,,,4891.93
Deidentified Maximum,,47556,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,,12850.70
Deidentified Maximum,,47620,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,,7830.00
Deidentified Maximum,,47712,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,,5783.00
Deidentified Maximum,,47715,CPT4/HCPCS,EXCISION OF BILE DUCT CYST,,,5783.00
Deidentified Maximum,,47760,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,,5783.00
Deidentified Maximum,,47780,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,,5783.00
Deidentified Maximum,,47801,CPT4/HCPCS,PLACEMENT BILE DUCT SUPPORT,,,5029.00
Deidentified Maximum,,47802,CPT4/HCPCS,FUSE LIVER DUCT & INTESTINE,,,5281.00
Deidentified Maximum,,48145,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,,5783.00
Deidentified Maximum,,48150,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,,6588.00
Deidentified Maximum,,48154,CPT4/HCPCS,PANCREATECTOMY,,,6049.05
Deidentified Maximum,,48540,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,,5783.00
Deidentified Maximum,,48545,CPT4/HCPCS,PANCREATORRHAPHY,,,5281.00
Deidentified Maximum,,48554,CPT4/HCPCS,TRANSPL ALLOGRAFT PANCREAS,,,3198.57
Deidentified Maximum,,49084,CPT4/HCPCS,PERITONEAL LAVAGE,,,4891.93
Deidentified Maximum,,49419,CPT4/HCPCS,INSERT TUN IP CATH W/PORT,,,12850.70
Deidentified Maximum,,49446,CPT4/HCPCS,CHANGE G-TUBE TO G-J PERC,,,4280.43
Deidentified Maximum,,49452,CPT4/HCPCS,REPLACE G-J TUBE PERC,,,4280.43
Deidentified Maximum,,49491,CPT4/HCPCS,RPR HERN PREEMIE REDUC,,,6876.92
Deidentified Maximum,,49500,CPT4/HCPCS,RPR ING HERNIA INIT REDUCE,,,6401.00
Deidentified Maximum,,49557,CPT4/HCPCS,REREPAIR FEM HERNIA BLOCKED,,,12850.70
Deidentified Maximum,,49652,CPT4/HCPCS,LAP VENT/ABD HERNIA REPAIR,,,8300.00
Deidentified Maximum,,50020,CPT4/HCPCS,RENAL ABSCESS OPEN DRAIN,,,4280.43
Deidentified Maximum,,50065,CPT4/HCPCS,INCISION OF KIDNEY,,,3198.57
Deidentified Maximum,,50081,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,,9548.65
Deidentified Maximum,,50130,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,,5029.00
Deidentified Maximum,,50205,CPT4/HCPCS,RENAL BIOPSY OPEN,,,5029.00
Deidentified Maximum,,50230,CPT4/HCPCS,REMOVAL KIDNEY OPEN RADICAL,,,5783.00
Deidentified Maximum,,50234,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,,5783.00
Deidentified Maximum,,50236,CPT4/HCPCS,REMOVAL OF KIDNEY & URETER,,,5783.00
Deidentified Maximum,,50329,CPT4/HCPCS,PREP RENAL GRAFT/URETERAL,,,1678.00
Deidentified Maximum,,50385,CPT4/HCPCS,CHANGE STENT VIA TRANSURETH,,,5000.00
Deidentified Maximum,,50398,CPT4/HCPCS,CHANGE KIDNEY TUBE,,,1678.00
Deidentified Maximum,,50431,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,,4000.00
Deidentified Maximum,,50437,CPT4/HCPCS,DILAT XST TRC NEW ACCESS RCS,,,5138.00
Deidentified Maximum,,50525,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,,5783.00
Deidentified Maximum,,50526,CPT4/HCPCS,CLOSE NEPHROVISCERAL FISTULA,,,6588.00
Deidentified Maximum,,50541,CPT4/HCPCS,LAPARO ABLATE RENAL CYST,,,7902.34
Deidentified Maximum,,50544,CPT4/HCPCS,LAPAROSCOPY PYELOPLASTY,,,7902.34
Deidentified Maximum,,50546,CPT4/HCPCS,LAPAROSCOPIC NEPHRECTOMY,,,6840.00
Deidentified Maximum,,50548,CPT4/HCPCS,LAPARO REMOVE W/URETER,,,6840.00
Deidentified Maximum,,50549,CPT4/HCPCS,LAPAROSCOPE PROC RENAL,,,7902.34
Deidentified Maximum,,50694,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,,8300.00
Deidentified Maximum,,50715,CPT4/HCPCS,RELEASE OF URETER,,,5281.00
Deidentified Maximum,,50725,CPT4/HCPCS,RELEASE/REVISE URETER,,,5783.00
Deidentified Maximum,,50728,CPT4/HCPCS,REVISE URETER,,,3544.00
Deidentified Maximum,,30802,CPT4/HCPCS,ABLATE INF TURBINATE SUBMUC,,,3198.57
Deidentified Maximum,,30903,CPT4/HCPCS,CONTROL OF NOSEBLEED,,,3198.57
Deidentified Maximum,,30930,CPT4/HCPCS,THER FX NASAL INF TURBINATE,,,6401.00
Deidentified Maximum,,31090,CPT4/HCPCS,EXPLORATION OF SINUSES,,,6876.92
Deidentified Maximum,,31200,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,,6075.00
Deidentified Maximum,,31233,CPT4/HCPCS,NSL/SINS NDSC DX MAX SINUSC,,,4280.43
Deidentified Maximum,,31235,CPT4/HCPCS,NSL/SINS NDSC DX SPHN SINUSC,,,3656.00
Deidentified Maximum,,31255,CPT4/HCPCS,NSL/SINS NDSC W/TOT ETHMDCT,,,6876.92
Deidentified Maximum,,31300,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,,6876.92
Deidentified Maximum,,31375,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,6049.05
Deidentified Maximum,,31390,CPT4/HCPCS,REMOVAL OF LARYNX & PHARYNX,,,7902.34
Deidentified Maximum,,31500,CPT4/HCPCS,INSERT EMERGENCY AIRWAY,,,3198.57
Deidentified Maximum,,31525,CPT4/HCPCS,DX LARYNGOSCOPY EXCL NB,,,3656.00
Deidentified Maximum,,31529,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,,4280.43
Deidentified Maximum,,31541,CPT4/HCPCS,LARYNSCOP W/TUMR EXC + SCOPE,,,6401.00
Deidentified Maximum,,31561,CPT4/HCPCS,LARYNSCOP REMVE CART + SCOP,,,6876.92
Deidentified Maximum,,31572,CPT4/HCPCS,LARGSC W/LASER DSTRJ LES,,,6000.00
Deidentified Maximum,,31574,CPT4/HCPCS,LARGSC W/NJX AUGMENTATION,,,6000.00
Deidentified Maximum,,31587,CPT4/HCPCS,LARYNGOPLASTY CRICOID SPLIT,,,6401.00
Deidentified Maximum,,31599,CPT4/HCPCS,LARYNX SURGERY PROCEDURE,,,6049.05
Deidentified Maximum,,31603,CPT4/HCPCS,INCISION OF WINDPIPE,,,3544.00
Deidentified Maximum,,31610,CPT4/HCPCS,INCISION OF WINDPIPE,,,6049.05
Deidentified Maximum,,31622,CPT4/HCPCS,DX BRONCHOSCOPE/WASH,,,3656.00
Deidentified Maximum,,31625,CPT4/HCPCS,BRONCHOSCOPY W/BIOPSY(S),,,4280.43
Deidentified Maximum,,31626,CPT4/HCPCS,BRONCHOSCOPY W/MARKERS,,,5856.00
Deidentified Maximum,,31628,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX EACH,,,4280.43
Deidentified Maximum,,31636,CPT4/HCPCS,BRONCHOSCOPY BRONCH STENTS,,,6049.05
Deidentified Maximum,,31641,CPT4/HCPCS,BRONCHOSCOPY TREAT BLOCKAGE,,,5138.00
Deidentified Maximum,,31715,CPT4/HCPCS,INJECTION FOR BRONCHUS X-RAY,,,1678.00
Deidentified Maximum,,31755,CPT4/HCPCS,REPAIR OF WINDPIPE,,,6075.00
Deidentified Maximum,,31780,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,,6588.00
Deidentified Maximum,,31786,CPT4/HCPCS,REMOVE WINDPIPE LESION,,,6049.05
Deidentified Maximum,,32140,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,,6588.00
Deidentified Maximum,,32141,CPT4/HCPCS,REMOVE/TREAT LUNG LESIONS,,,6588.00
Deidentified Maximum,,32150,CPT4/HCPCS,REMOVAL OF LUNG LESION(S),,,6588.00
Deidentified Maximum,,32151,CPT4/HCPCS,REMOVE LUNG FOREIGN BODY,,,6588.00
Deidentified Maximum,,32225,CPT4/HCPCS,PARTIAL RELEASE OF LUNG,,,6588.00
Deidentified Maximum,,32421,CPT4/HCPCS,THORACENTESIS FOR ASPIRATION,,,1678.00
Deidentified Maximum,,32440,CPT4/HCPCS,REMOVE LUNG PNEUMONECTOMY,,,8012.00
Deidentified Maximum,,32484,CPT4/HCPCS,SEGMENTECTOMY,,,8012.00
Deidentified Maximum,,32501,CPT4/HCPCS,REPAIR BRONCHUS ADD-ON,,,3544.00
Deidentified Maximum,,32503,CPT4/HCPCS,RESECT APICAL LUNG TUMOR,,,6588.00
Deidentified Maximum,,32507,CPT4/HCPCS,WEDGE RESECT OF LUNG DIAG,,,6588.00
Deidentified Maximum,,32551,CPT4/HCPCS,INSERTION OF CHEST TUBE,,,3656.00
Deidentified Maximum,,32656,CPT4/HCPCS,THORACOSCOPY W/PLEURECTOMY,,,10119.00
Deidentified Maximum,,32667,CPT4/HCPCS,THORACOSCOPY W/W RESECT ADDL,,,3544.00
Deidentified Maximum,,32670,CPT4/HCPCS,THORACOSCOPY BILOBECTOMY,,,7902.34
Deidentified Maximum,,32671,CPT4/HCPCS,THORACOSCOPY PNEUMONECTOMY,,,7902.34
Deidentified Maximum,,32701,CPT4/HCPCS,THORAX STEREO RAD TARGETW/TX,,,1678.00
Deidentified Maximum,,32851,CPT4/HCPCS,LUNG TRANSPLANT SINGLE,,,8841.00
Deidentified Maximum,,32854,CPT4/HCPCS,LUNG TRANSPLANT WITH BYPASS,,,9548.65
Deidentified Maximum,,32855,CPT4/HCPCS,PREPARE DONOR LUNG SINGLE,,,3544.00
Deidentified Maximum,,32905,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,,5783.00
Deidentified Maximum,,33030,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,,5783.00
Deidentified Maximum,,33031,CPT4/HCPCS,PARTIAL REMOVAL OF HEART SAC,,,6588.00
Deidentified Maximum,,33223,CPT4/HCPCS,RELOCATE POCKET FOR DEFIB,,,4280.43
Deidentified Maximum,,33224,CPT4/HCPCS,INSERT PACING LEAD & CONNECT,,,21405.00
Deidentified Maximum,,33230,CPT4/HCPCS,INSRT PULSE GEN W/DUAL LEADS,,,24180.00
Deidentified Maximum,,33235,CPT4/HCPCS,REMOVAL PACEMAKER ELECTRODE,,,6401.00
Deidentified Maximum,,33255,CPT4/HCPCS,ABLATE ATRIA W/O BYPASS EXT,,,5281.00
Deidentified Maximum,,33262,CPT4/HCPCS,RMVL& REPLC PULSE GEN 1 LEAD,,,24180.00
Deidentified Maximum,,33271,CPT4/HCPCS,INSJ SUBQ IMPLTBL DFB ELCTRD,,,24180.00
Deidentified Maximum,,33273,CPT4/HCPCS,REPOS PREV IMPLTBL SUBQ DFB,,,8300.00
Deidentified Maximum,,33284,CPT4/HCPCS,REMOVE PAT-ACTIVE HT RECORD,,,3198.57
Deidentified Maximum,,33322,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,,6588.00
Deidentified Maximum,,33362,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,,9548.65
Deidentified Maximum,,33363,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,,9548.65
Deidentified Maximum,,33400,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,,8841.00
Deidentified Maximum,,33414,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,,4891.93
Deidentified Maximum,,33464,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,,4891.93
Deidentified Maximum,,33470,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,,6588.00
Deidentified Maximum,,33471,CPT4/HCPCS,VALVOTOMY PULMONARY VALVE,,,5281.00
Deidentified Maximum,,33501,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,,6588.00
Deidentified Maximum,,33511,CPT4/HCPCS,CABG VEIN TWO,,,1370.00
Deidentified Maximum,,33518,CPT4/HCPCS,CABG ARTERY-VEIN TWO,,,1370.00
Deidentified Maximum,,33523,CPT4/HCPCS,CABG ART-VEIN SIX OR MORE,,,1370.00
Deidentified Maximum,,33600,CPT4/HCPCS,CLOSURE OF VALVE,,,1370.00
Deidentified Maximum,,33610,CPT4/HCPCS,REPAIR BY ENLARGEMENT,,,1370.00
Deidentified Maximum,,33641,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,,8841.00
Deidentified Maximum,,33665,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,8841.00
Deidentified Maximum,,33677,CPT4/HCPCS,CL MULT VSD W/REM PUL BAND,,,8841.00
Deidentified Maximum,,33726,CPT4/HCPCS,REPAIR PUL VENOUS STENOSIS,,,8841.00
Deidentified Maximum,,33762,CPT4/HCPCS,MAJOR VESSEL SHUNT,,,8012.00
Deidentified Maximum,,33768,CPT4/HCPCS,CAVOPULMONARY SHUNTING,,,1370.00
Deidentified Maximum,,33824,CPT4/HCPCS,REVISE MAJOR VESSEL,,,10772.00
Deidentified Maximum,,33853,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,,1370.00
Deidentified Maximum,,33863,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,,1370.00
Deidentified Maximum,,33927,CPT4/HCPCS,IMPLTJ TOT RPLCMT HRT SYS,,,8841.00
Deidentified Maximum,,33928,CPT4/HCPCS,RMVL & RPLCMT TOT HRT SYS,,,8841.00
Deidentified Maximum,,33935,CPT4/HCPCS,TRANSPLANTATION HEART/LUNG,,,1370.00
Deidentified Maximum,,33945,CPT4/HCPCS,TRANSPLANTATION OF HEART,,,1370.00
Deidentified Maximum,,33946,CPT4/HCPCS,ECMO/ECLS INITIATION VENOUS,,,5281.00
Deidentified Maximum,,33947,CPT4/HCPCS,ECMO/ECLS INITIATION ARTERY,,,5281.00
Deidentified Maximum,,33949,CPT4/HCPCS,ECMO/ECLS DAILY MGMT ARTERY,,,3544.00
Deidentified Maximum,,33954,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,,3544.00
Deidentified Maximum,,33959,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,8012.00
Deidentified Maximum,,33970,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,,5029.00
Deidentified Maximum,,33973,CPT4/HCPCS,INSERT BALLOON DEVICE,,,1370.00
Deidentified Maximum,,33981,CPT4/HCPCS,REPLACE VAD PUMP EXT,,,1370.00
Deidentified Maximum,,33986,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,,5281.00
Deidentified Maximum,,33991,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTL&VEN,,,9304.06
Deidentified Maximum,,33993,CPT4/HCPCS,REPOSG PERQ R/L HRT VAD,,,9304.06
Deidentified Maximum,,34051,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,,6588.00
Deidentified Maximum,,34101,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,,9548.65
Deidentified Maximum,,34471,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,,9548.65
Deidentified Maximum,,34490,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,,9548.65
Deidentified Maximum,,34510,CPT4/HCPCS,TRANSPOSITION OF VEIN VALVE,,,9548.65
Deidentified Maximum,,34704,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT RPT,,,7188.00
Deidentified Maximum,,34707,CPT4/HCPCS,EVASC RPR ILIO-ILIAC NDGFT,,,8797.00
Deidentified Maximum,,34708,CPT4/HCPCS,EVASC RPR ILIO-ILIAC RPT,,,8797.00
Deidentified Maximum,,34714,CPT4/HCPCS,OPN FEM ART EXPOS CNDT CRTJ,,,5029.00
Deidentified Maximum,,34800,CPT4/HCPCS,ENDOVAS AAA REPR W/SM TUBE,,,5783.00
Deidentified Maximum,,34802,CPT4/HCPCS,ENDOVAS AAA REPR W/2-P PART,,,5783.00
Deidentified Maximum,,34805,CPT4/HCPCS,ENDOVAS AAA REPR W/LONG TUBE,,,5783.00
Deidentified Maximum,,34830,CPT4/HCPCS,OPEN AORTIC TUBE PROSTH REPR,,,8012.00
Deidentified Maximum,,34843,CPT4/HCPCS,ENDOVASC VISC AORTA 3 GRAFT,,,8841.00
Deidentified Maximum,,34845,CPT4/HCPCS,VISC & INFRAREN ABD 1 PROSTH,,,8841.00
Deidentified Maximum,,35142,CPT4/HCPCS,REPAIR ARTERY RUPTURE THIGH,,,5281.00
Deidentified Maximum,,35207,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,6401.00
Deidentified Maximum,,35231,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,7188.00
Deidentified Maximum,,35281,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,5783.00
Deidentified Maximum,,35501,CPT4/HCPCS,ART BYP GRFT IPSILAT CAROTID,,,5281.00
Deidentified Maximum,,35523,CPT4/HCPCS,ART BYP GRFT BRCHL-ULNR-RDL,,,1370.00
Deidentified Maximum,,35645,CPT4/HCPCS,ART BYP SUBCLAV-VERTEBRL,,,5029.00
Deidentified Maximum,,35646,CPT4/HCPCS,ART BYP AORTOBIFEMORAL,,,5783.00
Deidentified Maximum,,35665,CPT4/HCPCS,ART BYP ILIOFEMORAL,,,5029.00
Deidentified Maximum,,35681,CPT4/HCPCS,COMPOSITE BYP GRFT PROS&VEIN,,,5281.00
Deidentified Maximum,,35682,CPT4/HCPCS,COMPOSITE BYP GRFT 2 VEINS,,,3198.57
Deidentified Maximum,,35901,CPT4/HCPCS,EXCISION GRAFT NECK,,,3198.57
Deidentified Maximum,,36160,CPT4/HCPCS,ESTABLISH ACCESS TO AORTA,,,3656.00
Deidentified Maximum,,36251,CPT4/HCPCS,INS CATH REN ART 1ST UNILAT,,,5138.00
Deidentified Maximum,,36420,CPT4/HCPCS,VEIN ACCESS CUTDOWN < 1 YR,,,3198.57
Deidentified Maximum,,36450,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NB,,,3198.57
Deidentified Maximum,,36475,CPT4/HCPCS,ENDOVENOUS RF 1ST VEIN,,,8300.00
Deidentified Maximum,,36522,CPT4/HCPCS,PHOTOPHERESIS,,,9548.65
Deidentified Maximum,,36557,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,7007.00
Deidentified Maximum,,36561,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,6876.92
Deidentified Maximum,,36565,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,6876.92
Deidentified Maximum,,36576,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,,3656.00
Deidentified Maximum,,36585,CPT4/HCPCS,REPLACE PICVAD CATH,,,5856.00
Deidentified Maximum,,36600,CPT4/HCPCS,WITHDRAWAL OF ARTERIAL BLOOD,,,6766.00
Deidentified Maximum,,36620,CPT4/HCPCS,INSERTION CATHETER ARTERY,,,3000.00
Deidentified Maximum,,36625,CPT4/HCPCS,INSERTION CATHETER ARTERY,,,1678.00
Deidentified Maximum,,36680,CPT4/HCPCS,INSERT NEEDLE BONE CAVITY,,,2002.00
Deidentified Maximum,,36831,CPT4/HCPCS,OPEN THROMBECT AV FISTULA,,,12850.70
Deidentified Maximum,,36835,CPT4/HCPCS,ARTERY TO VEIN SHUNT,,,6401.00
Deidentified Maximum,,36860,CPT4/HCPCS,EXTERNAL CANNULA DECLOTTING,,,4280.43
Deidentified Maximum,,36909,CPT4/HCPCS,DIALYSIS CIRCUIT EMBOLJ,,,6049.05
Deidentified Maximum,,37180,CPT4/HCPCS,REVISION OF CIRCULATION,,,5783.00
Deidentified Maximum,,37183,CPT4/HCPCS,REMOVE HEPATIC SHUNT (TIPS),,,10119.00
Deidentified Maximum,,37187,CPT4/HCPCS,VENOUS MECH THROMBECTOMY,,,9770.00
Deidentified Maximum,,37193,CPT4/HCPCS,REM ENDOVAS VENA CAVA FILTER,,,5856.00
Deidentified Maximum,,37197,CPT4/HCPCS,REMOVE INTRVAS FOREIGN BODY,,,8300.00
Deidentified Maximum,,37208,CPT4/HCPCS,TRANSCATH IV STENT/OPEN ADDL,,,1678.88
Deidentified Maximum,,37211,CPT4/HCPCS,THROMBOLYTIC ART THERAPY,,,7007.00
Deidentified Maximum,,37216,CPT4/HCPCS,TRANSCATH STENT CCA W/O EPS,,,5856.00
Deidentified Maximum,,37228,CPT4/HCPCS,TIB/PER REVASC W/TLA,,,7007.00
Deidentified Maximum,,37239,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,,7007.00
Deidentified Maximum,,37247,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL ART,,,5029.00
Deidentified Maximum,,37616,CPT4/HCPCS,LIGATION OF CHEST ARTERY,,,5029.00
Deidentified Maximum,,37650,CPT4/HCPCS,REVISION OF MAJOR VEIN,,,5138.00
Deidentified Maximum,,37722,CPT4/HCPCS,LIGATE/STRIP LONG LEG VEIN,,,5856.00
Deidentified Maximum,,38102,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,,3544.00
Deidentified Maximum,,38120,CPT4/HCPCS,LAPAROSCOPY SPLENECTOMY,,,9548.65
Deidentified Maximum,,38208,CPT4/HCPCS,THAW PRESERVED STEM CELLS,,,3198.57
Deidentified Maximum,,38215,CPT4/HCPCS,HARVEST STEM CELL CONCENTRTE,,,3198.57
Deidentified Maximum,,38232,CPT4/HCPCS,BONE MARROW HARVEST AUTOLOG,,,8300.00
Deidentified Maximum,,38243,CPT4/HCPCS,TRANSPLJ HEMATOPOIETIC BOOST,,,6588.00
Deidentified Maximum,,38500,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,,4280.43
Deidentified Maximum,,38572,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,,12850.70
Deidentified Maximum,,38589,CPT4/HCPCS,LAPAROSCOPE PROC LYMPHATIC,,,7902.34
Deidentified Maximum,,38746,CPT4/HCPCS,REMOVE THORACIC LYMPH NODES,,,6588.00
Deidentified Maximum,,39220,CPT4/HCPCS,RESECT MEDIASTINAL TUMOR,,,5029.00
Deidentified Maximum,,39401,CPT4/HCPCS,MEDIASTINOSCPY W/MEDSTNL BX,,,7902.34
Deidentified Maximum,,40510,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,,4280.43
Deidentified Maximum,,40527,CPT4/HCPCS,RECONSTRUCT LIP WITH FLAP,,,4280.43
Deidentified Maximum,,40761,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,,6075.00
Deidentified Maximum,,40799,CPT4/HCPCS,LIP SURGERY PROCEDURE,,,4280.43
Deidentified Maximum,,40804,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,,1678.00
Deidentified Maximum,,40816,CPT4/HCPCS,EXCISION OF MOUTH LESION,,,4280.43
Deidentified Maximum,,40819,CPT4/HCPCS,EXCISE LIP OR CHEEK FOLD,,,3198.57
Deidentified Maximum,,40831,CPT4/HCPCS,REPAIR MOUTH LACERATION,,,3198.57
Deidentified Maximum,,40840,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,,4280.43
Deidentified Maximum,,40842,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,,5856.00
Deidentified Maximum,,40899,CPT4/HCPCS,MOUTH SURGERY PROCEDURE,,,6840.00
Deidentified Maximum,,41018,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,3198.57
Deidentified Maximum,,41113,CPT4/HCPCS,EXCISION OF TONGUE LESION,,,4280.43
Deidentified Maximum,,41250,CPT4/HCPCS,REPAIR TONGUE LACERATION,,,4280.43
Deidentified Maximum,,41510,CPT4/HCPCS,TONGUE TO LIP SURGERY,,,3198.57
Deidentified Maximum,,41520,CPT4/HCPCS,RECONSTRUCTION TONGUE FOLD,,,6075.00
Deidentified Maximum,,41830,CPT4/HCPCS,REMOVAL OF GUM TISSUE,,,4280.43
Deidentified Maximum,,42104,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,,4280.43
Deidentified Maximum,,42120,CPT4/HCPCS,REMOVE PALATE/LESION,,,6401.00
Deidentified Maximum,,42140,CPT4/HCPCS,EXCISION OF UVULA,,,4280.43
Deidentified Maximum,,42180,CPT4/HCPCS,REPAIR PALATE,,,3198.57
Deidentified Maximum,,42210,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,6876.92
Deidentified Maximum,,42320,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,,3198.57
Deidentified Maximum,,42340,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,,4280.43
Deidentified Maximum,,42409,CPT4/HCPCS,DRAINAGE OF SALIVARY CYST,,,5856.00
Deidentified Maximum,,42450,CPT4/HCPCS,EXCISE SUBLINGUAL GLAND,,,4280.43
Deidentified Maximum,,42505,CPT4/HCPCS,REPAIR SALIVARY DUCT,,,6401.00
Deidentified Maximum,,42650,CPT4/HCPCS,DILATION OF SALIVARY DUCT,,,3198.57
Deidentified Maximum,,42725,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,,6075.00
Deidentified Maximum,,42809,CPT4/HCPCS,REMOVE PHARYNX FOREIGN BODY,,,3000.00
Deidentified Maximum,,42810,CPT4/HCPCS,EXCISION OF NECK CYST,,,5856.00
Deidentified Maximum,,42950,CPT4/HCPCS,RECONSTRUCTION OF THROAT,,,4280.43
Deidentified Maximum,,42955,CPT4/HCPCS,SURGICAL OPENING OF THROAT,,,4280.43
Deidentified Maximum,,43020,CPT4/HCPCS,INCISION OF ESOPHAGUS,,,5029.00
Deidentified Maximum,,43100,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,,5783.00
Deidentified Maximum,,43112,CPT4/HCPCS,ESPHG TOT W/THRCM,,,6588.00
Deidentified Maximum,,43116,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,6049.05
Deidentified Maximum,,43122,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43130,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,,6840.00
Deidentified Maximum,,43204,CPT4/HCPCS,ESOPH SCOPE W/SCLEROSIS INJ,,,3198.57
Deidentified Maximum,,43233,CPT4/HCPCS,EGD BALLOON DIL ESOPH30 MM/>,,,5000.00
Deidentified Maximum,,43240,CPT4/HCPCS,EGD W/TRANSMURAL DRAIN CYST,,,4280.43
Deidentified Maximum,,43250,CPT4/HCPCS,EGD CAUTERY TUMOR POLYP,,,4280.43
Deidentified Maximum,,43253,CPT4/HCPCS,EGD US TRANSMURAL INJXN/MARK,,,5856.00
Deidentified Maximum,,43257,CPT4/HCPCS,EGD W/THRML TXMNT GERD,,,6049.05
Deidentified Maximum,,43263,CPT4/HCPCS,ERCP SPHINCTER PRESSURE MEAS,,,4280.43
Deidentified Maximum,,43274,CPT4/HCPCS,ERCP DUCT STENT PLACEMENT,,,8300.00
Deidentified Maximum,,43275,CPT4/HCPCS,ERCP REMOVE FORGN BODY DUCT,,,8300.00
Deidentified Maximum,,43281,CPT4/HCPCS,LAP PARAESOPHAG HERN REPAIR,,,7902.34
Deidentified Maximum,,43305,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,,5783.00
Deidentified Maximum,,43325,CPT4/HCPCS,REVISE ESOPHAGUS & STOMACH,,,5783.00
Deidentified Maximum,,43328,CPT4/HCPCS,ESOPH FUNDOPLASTY THOR,,,6588.00
Deidentified Maximum,,43332,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,,6588.00
Deidentified Maximum,,43334,CPT4/HCPCS,TRANSTHOR DIAPHRAG HERN RPR,,,6588.00
Deidentified Maximum,,43337,CPT4/HCPCS,THORABD DIAPHR HERN REPAIR,,,8012.00
Deidentified Maximum,,43338,CPT4/HCPCS,ESOPH LENGTHENING,,,5783.00
Deidentified Maximum,,43341,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,,6588.00
Deidentified Maximum,,43410,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,,5281.00
Deidentified Maximum,,43415,CPT4/HCPCS,REPAIR ESOPHAGUS WOUND,,,6588.00
Deidentified Maximum,,43611,CPT4/HCPCS,EXCISION OF STOMACH LESION,,,3198.57
Deidentified Maximum,,43620,CPT4/HCPCS,REMOVAL OF STOMACH,,,6588.00
Deidentified Maximum,,43644,CPT4/HCPCS,LAP GASTRIC BYPASS/ROUX-EN-Y,,,7007.00
Deidentified Maximum,,43754,CPT4/HCPCS,DX GASTR INTUB W/ASP SPEC,,,3000.00
Deidentified Maximum,,43770,CPT4/HCPCS,LAP PLACE GASTR ADJ DEVICE,,,7007.00
Deidentified Maximum,,43771,CPT4/HCPCS,LAP REVISE GASTR ADJ DEVICE,,,6049.05
Deidentified Maximum,,43772,CPT4/HCPCS,LAP RMVL GASTR ADJ DEVICE,,,6049.05
Deidentified Maximum,,43800,CPT4/HCPCS,RECONSTRUCTION OF PYLORUS,,,5783.00
Deidentified Maximum,,43810,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,,5783.00
Deidentified Maximum,,43832,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,,5281.00
Deidentified Maximum,,43840,CPT4/HCPCS,REPAIR OF STOMACH LESION,,,5783.00
Deidentified Maximum,,43888,CPT4/HCPCS,CHANGE GASTRIC PORT OPEN,,,5138.00
Deidentified Maximum,,44121,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,,3198.57
Deidentified Maximum,,44126,CPT4/HCPCS,ENTERECTOMY W/O TAPER CONG,,,5783.00
Deidentified Maximum,,44132,CPT4/HCPCS,ENTERECTOMY CADAVER DONOR,,,3544.00
Deidentified Maximum,,44147,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,5783.00
Deidentified Maximum,,44156,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,,6588.00
Deidentified Maximum,,44158,CPT4/HCPCS,COLECTOMY W/NEO-RECTUM POUCH,,,6588.00
Deidentified Maximum,,44187,CPT4/HCPCS,LAP ILEO/JEJUNO-STOMY,,,5856.00
Deidentified Maximum,,44203,CPT4/HCPCS,LAP RESECT S/INTESTINE ADDL,,,6075.00
Deidentified Maximum,,44208,CPT4/HCPCS,L COLECTOMY/COLOPROCTOSTOMY,,,12850.70
Deidentified Maximum,,44210,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,,7902.34
Deidentified Maximum,,44213,CPT4/HCPCS,LAP MOBIL SPLENIC FL ADD-ON,,,6876.92
Deidentified Maximum,,44365,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4280.43
Deidentified Maximum,,44376,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4280.43
Deidentified Maximum,,44383,CPT4/HCPCS,ILEOSCOPY W/STENT,,,1678.00
Deidentified Maximum,,44388,CPT4/HCPCS,COLONOSCOPY THRU STOMA SPX,,,3198.57
Deidentified Maximum,,44392,CPT4/HCPCS,COLONOSCOPY & POLYPECTOMY,,,3198.57
Deidentified Maximum,,44393,CPT4/HCPCS,COLONOSCOPY LESION REMOVAL,,,1678.00
Deidentified Maximum,,44403,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,,4000.00
Deidentified Maximum,,44404,CPT4/HCPCS,COLONOSCOPY W/INJECTION,,,4000.00
Deidentified Maximum,,44406,CPT4/HCPCS,COLONOSCOPY W/ULTRASOUND,,,4000.00
Deidentified Maximum,,44407,CPT4/HCPCS,COLONOSCOPY W/NDL ASPIR/BX,,,4000.00
Deidentified Maximum,,44602,CPT4/HCPCS,SUTURE SMALL INTESTINE,,,5281.00
Deidentified Maximum,,44605,CPT4/HCPCS,REPAIR OF BOWEL LESION,,,5783.00
Deidentified Maximum,,44626,CPT4/HCPCS,REPAIR BOWEL OPENING,,,5783.00
Deidentified Maximum,,44660,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,,5281.00
Deidentified Maximum,,44721,CPT4/HCPCS,PREP DONOR INTESTINE/ARTERY,,,1678.00
Deidentified Maximum,,44800,CPT4/HCPCS,EXCISION OF BOWEL POUCH,,,3198.57
Deidentified Maximum,,44899,CPT4/HCPCS,BOWEL SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,44955,CPT4/HCPCS,APPENDECTOMY ADD-ON,,,3198.57
Deidentified Maximum,,45005,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,,4280.43
Deidentified Maximum,,45108,CPT4/HCPCS,REMOVAL OF ANORECTAL LESION,,,4280.43
Deidentified Maximum,,45190,CPT4/HCPCS,DESTRUCTION RECTAL TUMOR,,,12850.70
Deidentified Maximum,,45300,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DX,,,3198.57
Deidentified Maximum,,45303,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY DILATE,,,3198.57
Deidentified Maximum,,45330,CPT4/HCPCS,DIAGNOSTIC SIGMOIDOSCOPY,,,3198.57
Deidentified Maximum,,45334,CPT4/HCPCS,SIGMOIDOSCOPY FOR BLEEDING,,,3198.57
Deidentified Maximum,,45339,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATE TUMR,,,1678.00
Deidentified Maximum,,45341,CPT4/HCPCS,SIGMOIDOSCOPY W/ULTRASOUND,,,3198.57
Deidentified Maximum,,45385,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,,4280.43
Deidentified Maximum,,45393,CPT4/HCPCS,COLONOSCOPY W/DECOMPRESSION,,,4000.00
Deidentified Maximum,,45550,CPT4/HCPCS,REPAIR RECTUM/REMOVE SIGMOID,,,5783.00
Deidentified Maximum,,45805,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,,5281.00
Deidentified Maximum,,45900,CPT4/HCPCS,REDUCTION OF RECTAL PROLAPSE,,,3198.57
Deidentified Maximum,,46255,CPT4/HCPCS,REMOVE INT/EXT HEM 1 GROUP,,,5856.00
Deidentified Maximum,,46258,CPT4/HCPCS,REMOVE IN/EX HEM GRP W/FISTU,,,5856.00
Deidentified Maximum,,46260,CPT4/HCPCS,REMOVE IN/EX HEM GROUPS 2+,,,5856.00
Deidentified Maximum,,46600,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY SPX,,,3000.00
Deidentified Maximum,,46607,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY & BIOPSY,,,4000.00
Deidentified Maximum,,46610,CPT4/HCPCS,ANOSCOPY REMOVE LESION,,,4204.00
Deidentified Maximum,,46706,CPT4/HCPCS,REPR OF ANAL FISTULA W/GLUE,,,4204.00
Deidentified Maximum,,46730,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,,3544.00
Deidentified Maximum,,46735,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,,5281.00
Deidentified Maximum,,46942,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,,3198.57
Deidentified Maximum,,46946,CPT4/HCPCS,INT HRHC LIG 2+HROID W/O IMG,,,4204.00
Deidentified Maximum,,47125,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,,6876.92
Deidentified Maximum,,47130,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,,6876.92
Deidentified Maximum,,47144,CPT4/HCPCS,PREP DONOR LIVER 3-SEGMENT,,,3544.00
Deidentified Maximum,,47147,CPT4/HCPCS,PREP DONOR LIVER/ARTERIAL,,,1678.00
Deidentified Maximum,,47371,CPT4/HCPCS,LAPARO ABLATE LIVER CRYOSURG,,,10119.00
Deidentified Maximum,,47380,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR RF,,,6840.00
Deidentified Maximum,,47383,CPT4/HCPCS,PERQ ABLTJ LVR CRYOABLATION,,,9770.00
Deidentified Maximum,,47420,CPT4/HCPCS,INCISION OF BILE DUCT,,,5281.00
Deidentified Maximum,,47480,CPT4/HCPCS,INCISION OF GALLBLADDER,,,3544.00
Deidentified Maximum,,47534,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,,8300.00
Deidentified Maximum,,47537,CPT4/HCPCS,REMOVAL BILIARY DRG CATH,,,3198.57
Deidentified Maximum,,47550,CPT4/HCPCS,BILE DUCT ENDOSCOPY ADD-ON,,,3198.57
Deidentified Maximum,,47552,CPT4/HCPCS,BILIARY ENDO PERQ DX W/SPECI,,,5138.00
Deidentified Maximum,,47560,CPT4/HCPCS,LAPAROSCOPY W/CHOLANGIO,,,3544.00
Deidentified Maximum,,47563,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/GRAPH,,,9548.65
Deidentified Maximum,,47600,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,,6588.00
Deidentified Maximum,,47612,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,,7188.00
Deidentified Maximum,,47701,CPT4/HCPCS,BILE DUCT REVISION,,,5783.00
Deidentified Maximum,,47721,CPT4/HCPCS,FUSE UPPER GI STRUCTURES,,,5783.00
Deidentified Maximum,,48001,CPT4/HCPCS,PLACEMENT OF DRAIN PANCREAS,,,5783.00
Deidentified Maximum,,48020,CPT4/HCPCS,REMOVAL OF PANCREATIC STONE,,,5281.00
Deidentified Maximum,,48120,CPT4/HCPCS,REMOVAL OF PANCREAS LESION,,,5783.00
Deidentified Maximum,,48148,CPT4/HCPCS,REMOVAL OF PANCREATIC DUCT,,,5783.00
Deidentified Maximum,,48155,CPT4/HCPCS,REMOVAL OF PANCREAS,,,6588.00
Deidentified Maximum,,48500,CPT4/HCPCS,SURGERY OF PANCREATIC CYST,,,5281.00
Deidentified Maximum,,48550,CPT4/HCPCS,DONOR PANCREATECTOMY,,,5783.00
Deidentified Maximum,,48999,CPT4/HCPCS,PANCREAS SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,49010,CPT4/HCPCS,EXPLORATION BEHIND ABDOMEN,,,8012.00
Deidentified Maximum,,49020,CPT4/HCPCS,DRAINAGE ABDOM ABSCESS OPEN,,,8012.00
Deidentified Maximum,,49203,CPT4/HCPCS,EXC ABD TUM 5 CM OR LESS,,,5029.00
Deidentified Maximum,,49205,CPT4/HCPCS,EXC ABD TUM OVER 10 CM,,,7007.00
Deidentified Maximum,,49215,CPT4/HCPCS,EXCISE SACRAL SPINE TUMOR,,,5029.00
Deidentified Maximum,,49220,CPT4/HCPCS,MULTIPLE SURGERY ABDOMEN,,,5783.00
Deidentified Maximum,,49250,CPT4/HCPCS,EXCISION OF UMBILICUS,,,6401.00
Deidentified Maximum,,49322,CPT4/HCPCS,LAPAROSCOPY ASPIRATION,,,6588.00
Deidentified Maximum,,49323,CPT4/HCPCS,LAPARO DRAIN LYMPHOCELE,,,7902.34
Deidentified Maximum,,49326,CPT4/HCPCS,LAP W/OMENTOPEXY ADD-ON,,,8300.00
Deidentified Maximum,,49400,CPT4/HCPCS,AIR INJECTION INTO ABDOMEN,,,3000.00
Deidentified Maximum,,49422,CPT4/HCPCS,REMOVE TUNNELED IP CATH,,,5138.00
Deidentified Maximum,,49440,CPT4/HCPCS,PLACE GASTROSTOMY TUBE PERC,,,4280.43
Deidentified Maximum,,49451,CPT4/HCPCS,REPLACE DUOD/JEJ TUBE PERC,,,4280.43
Deidentified Maximum,,49505,CPT4/HCPCS,PRP I/HERN INIT REDUC >5 YR,,,6401.00
Deidentified Maximum,,49525,CPT4/HCPCS,REPAIR ING HERNIA SLIDING,,,6401.00
Deidentified Maximum,,49540,CPT4/HCPCS,REPAIR LUMBAR HERNIA,,,5138.00
Deidentified Maximum,,49561,CPT4/HCPCS,RPR VENTRAL HERN INIT BLOCK,,,12850.70
Deidentified Maximum,,49580,CPT4/HCPCS,RPR UMBIL HERN REDUC < 5 YR,,,6401.00
Deidentified Maximum,,49582,CPT4/HCPCS,RPR UMBIL HERN BLOCK < 5 YR,,,12850.70
Deidentified Maximum,,49585,CPT4/HCPCS,RPR UMBIL HERN REDUC > 5 YR,,,6401.00
Deidentified Maximum,,49587,CPT4/HCPCS,RPR UMBIL HERN BLOCK > 5 YR,,,12850.70
Deidentified Maximum,,49654,CPT4/HCPCS,LAP INC HERNIA REPAIR,,,8300.00
Deidentified Maximum,,49900,CPT4/HCPCS,REPAIR OF ABDOMINAL WALL,,,3544.00
Deidentified Maximum,,49999,CPT4/HCPCS,ABDOMEN SURGERY PROCEDURE,,,4891.93
Deidentified Maximum,,50060,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,,3198.57
Deidentified Maximum,,50080,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,,9548.65
Deidentified Maximum,,50100,CPT4/HCPCS,REVISE KIDNEY BLOOD VESSELS,,,5783.00
Deidentified Maximum,,50120,CPT4/HCPCS,EXPLORATION OF KIDNEY,,,5783.00
Deidentified Maximum,,50225,CPT4/HCPCS,REMOVAL KIDNEY OPEN COMPLEX,,,5783.00
Deidentified Maximum,,50240,CPT4/HCPCS,PARTIAL REMOVAL OF KIDNEY,,,5281.00
Deidentified Maximum,,50400,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,,5783.00
Deidentified Maximum,,50543,CPT4/HCPCS,LAPARO PARTIAL NEPHRECTOMY,,,9548.65
Deidentified Maximum,,50553,CPT4/HCPCS,KIDNEY ENDOSCOPY,,,4204.00
Deidentified Maximum,,50557,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,,4204.00
Deidentified Maximum,,50562,CPT4/HCPCS,RENAL SCOPE W/TUMOR RESECT,,,9548.65
Deidentified Maximum,,50580,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,,3198.57
Deidentified Maximum,,50592,CPT4/HCPCS,PERC RF ABLATE RENAL TUMOR,,,7007.00
Deidentified Maximum,,50600,CPT4/HCPCS,EXPLORATION OF URETER,,,6840.00
Deidentified Maximum,,50650,CPT4/HCPCS,REMOVAL OF URETER,,,7188.00
Deidentified Maximum,,50684,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,,3000.00
Deidentified Maximum,,50706,CPT4/HCPCS,BALLOON DILATE URTRL STRIX,,,3000.00
Deidentified Maximum,,50727,CPT4/HCPCS,REVISE URETER,,,4204.00
Deidentified Maximum,,50782,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,,3198.57
Deidentified Maximum,,50830,CPT4/HCPCS,REVISE URINE FLOW,,,6588.00
Deidentified Maximum,,50920,CPT4/HCPCS,CLOSURE URETER/SKIN FISTULA,,,5783.00
Deidentified Maximum,,50947,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,,12850.70
Deidentified Maximum,,50974,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,,3198.57
Deidentified Maximum,,50980,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,,4204.00
Deidentified Maximum,,51555,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,,3198.57
Deidentified Maximum,,50620,CPT4/HCPCS,REMOVAL OF URETER STONE,,,6840.00
Deidentified Maximum,,50686,CPT4/HCPCS,MEASURE URETER PRESSURE,,,1678.00
Deidentified Maximum,,50690,CPT4/HCPCS,INJECTION FOR URETER X-RAY,,,3000.00
Deidentified Maximum,,50693,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,,8300.00
Deidentified Maximum,,50700,CPT4/HCPCS,REVISION OF URETER,,,5281.00
Deidentified Maximum,,50760,CPT4/HCPCS,FUSION OF URETERS,,,5281.00
Deidentified Maximum,,50800,CPT4/HCPCS,IMPLANT URETER IN BOWEL,,,5281.00
Deidentified Maximum,,50951,CPT4/HCPCS,ENDOSCOPY OF URETER,,,3198.57
Deidentified Maximum,,50957,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,,4204.00
Deidentified Maximum,,50972,CPT4/HCPCS,URETER ENDOSCOPY & CATHETER,,,3198.57
Deidentified Maximum,,51020,CPT4/HCPCS,INCISE & TREAT BLADDER,,,6401.00
Deidentified Maximum,,51100,CPT4/HCPCS,DRAIN BLADDER BY NEEDLE,,,2002.00
Deidentified Maximum,,51500,CPT4/HCPCS,REMOVAL OF BLADDER CYST,,,6401.00
Deidentified Maximum,,51520,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,,6401.00
Deidentified Maximum,,51590,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,,8012.00
Deidentified Maximum,,51610,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,,1678.88
Deidentified Maximum,,51715,CPT4/HCPCS,ENDOSCOPIC INJECTION/IMPLANT,,,5856.00
Deidentified Maximum,,51727,CPT4/HCPCS,CYSTOMETROGRAM W/UP,,,3198.57
Deidentified Maximum,,51784,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,,1678.00
Deidentified Maximum,,51792,CPT4/HCPCS,URINARY REFLEX STUDY,,,1678.00
Deidentified Maximum,,51820,CPT4/HCPCS,REVISION OF URINARY TRACT,,,7830.00
Deidentified Maximum,,51960,CPT4/HCPCS,REVISION OF BLADDER & BOWEL,,,5783.00
Deidentified Maximum,,52007,CPT4/HCPCS,CYSTOSCOPY AND BIOPSY,,,4280.43
Deidentified Maximum,,52234,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52260,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52285,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52287,CPT4/HCPCS,CYSTOSCOPY CHEMODENERVATION,,,5000.00
Deidentified Maximum,,52315,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52351,CPT4/HCPCS,CYSTOURETERO & OR PYELOSCOPE,,,5856.00
Deidentified Maximum,,52402,CPT4/HCPCS,CYSTOURETHRO CUT EJACUL DUCT,,,6049.05
Deidentified Maximum,,53060,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,,4280.43
Deidentified Maximum,,53080,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,,5856.00
Deidentified Maximum,,53220,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,,5138.00
Deidentified Maximum,,53260,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,,4280.43
Deidentified Maximum,,53415,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,6075.00
Deidentified Maximum,,53425,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 2,,,5138.00
Deidentified Maximum,,53444,CPT4/HCPCS,INSERT TANDEM CUFF,,,10119.00
Deidentified Maximum,,53448,CPT4/HCPCS,REMOV/REPLC UR SPHINCTR COMP,,,5783.00
Deidentified Maximum,,53449,CPT4/HCPCS,REPAIR URO SPHINCTER,,,5138.00
Deidentified Maximum,,53605,CPT4/HCPCS,DILATE URETHRA STRICTURE,,,4280.43
Deidentified Maximum,,54000,CPT4/HCPCS,SLITTING OF PREPUCE,,,4280.43
Deidentified Maximum,,54105,CPT4/HCPCS,BIOPSY OF PENIS,,,4204.00
Deidentified Maximum,,54110,CPT4/HCPCS,TREATMENT OF PENIS LESION,,,6075.00
Deidentified Maximum,,54111,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,,6075.00
Deidentified Maximum,,54328,CPT4/HCPCS,REVISE PENIS/URETHRA,,,6075.00
Deidentified Maximum,,54360,CPT4/HCPCS,PENIS PLASTIC SURGERY,,,6075.00
Deidentified Maximum,,54385,CPT4/HCPCS,REPAIR PENIS,,,5856.00
Deidentified Maximum,,54390,CPT4/HCPCS,REPAIR PENIS AND BLADDER,,,6075.00
Deidentified Maximum,,54405,CPT4/HCPCS,INSERT MULTI-COMP PENIS PROS,,,10772.00
Deidentified Maximum,,54411,CPT4/HCPCS,REMOV/REPLC PENIS PROS COMP,,,6840.00
Deidentified Maximum,,54420,CPT4/HCPCS,REVISION OF PENIS,,,6401.00
Deidentified Maximum,,54435,CPT4/HCPCS,REVISION OF PENIS,,,6401.00
Deidentified Maximum,,54512,CPT4/HCPCS,EXCISE LESION TESTIS,,,4280.43
Deidentified Maximum,,54640,CPT4/HCPCS,ORCHIOPEXY INGUN/SCROT APPR,,,6401.00
Deidentified Maximum,,54700,CPT4/HCPCS,DRAINAGE OF SCROTUM,,,4280.43
Deidentified Maximum,,54800,CPT4/HCPCS,BIOPSY OF EPIDIDYMIS,,,3198.57
Deidentified Maximum,,55000,CPT4/HCPCS,DRAINAGE OF HYDROCELE,,,1308.00
Deidentified Maximum,,55060,CPT4/HCPCS,REPAIR OF HYDROCELE,,,6401.00
Deidentified Maximum,,55100,CPT4/HCPCS,DRAINAGE OF SCROTUM ABSCESS,,,3198.57
Deidentified Maximum,,55110,CPT4/HCPCS,EXPLORE SCROTUM,,,4280.43
Deidentified Maximum,,55180,CPT4/HCPCS,REVISION OF SCROTUM,,,4280.43
Deidentified Maximum,,55700,CPT4/HCPCS,BIOPSY OF PROSTATE,,,4280.43
Deidentified Maximum,,55812,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,5783.00
Deidentified Maximum,,55831,CPT4/HCPCS,REMOVAL OF PROSTATE,,,5783.00
Deidentified Maximum,,55862,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,5281.00
Deidentified Maximum,,55873,CPT4/HCPCS,CRYOABLATE PROSTATE,,,12850.70
Deidentified Maximum,,56440,CPT4/HCPCS,SURGERY FOR VULVA LESION,,,4280.43
Deidentified Maximum,,56632,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,10119.00
Deidentified Maximum,,56633,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,10119.00
Deidentified Maximum,,56640,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,5783.00
Deidentified Maximum,,57112,CPT4/HCPCS,VAGINECTOMY W/NODES COMPL,,,5856.00
Deidentified Maximum,,57210,CPT4/HCPCS,REPAIR VAGINA/PERINEUM,,,4280.43
Deidentified Maximum,,57270,CPT4/HCPCS,REPAIR OF BOWEL POUCH,,,5029.00
Deidentified Maximum,,57330,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,,6876.92
Deidentified Maximum,,57420,CPT4/HCPCS,EXAM OF VAGINA W/SCOPE,,,3000.00
Deidentified Maximum,,57425,CPT4/HCPCS,LAPAROSCOPY SURG COLPOPEXY,,,7902.34
Deidentified Maximum,,57461,CPT4/HCPCS,CONZ OF CERVIX W/SCOPE LEEP,,,5856.00
Deidentified Maximum,,57500,CPT4/HCPCS,BIOPSY OF CERVIX,,,3198.57
Deidentified Maximum,,57555,CPT4/HCPCS,REMOVE CERVIX/REPAIR VAGINA,,,6876.92
Deidentified Maximum,,57700,CPT4/HCPCS,REVISION OF CERVIX,,,4204.00
Deidentified Maximum,,58140,CPT4/HCPCS,MYOMECTOMY ABDOM METHOD,,,7830.00
Deidentified Maximum,,58150,CPT4/HCPCS,TOTAL HYSTERECTOMY,,,8012.00
Deidentified Maximum,,58200,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,,8012.00
Deidentified Maximum,,58240,CPT4/HCPCS,REMOVAL OF PELVIS CONTENTS,,,8841.00
Deidentified Maximum,,58322,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,,1678.00
Deidentified Maximum,,58340,CPT4/HCPCS,CATHETER FOR HYSTEROGRAPHY,,,3000.00
Deidentified Maximum,,58356,CPT4/HCPCS,ENDOMETRIAL CRYOABLATION,,,9548.65
Deidentified Maximum,,58544,CPT4/HCPCS,LSH W/T/O UTERUS ABOVE 250 G,,,8300.00
Deidentified Maximum,,58563,CPT4/HCPCS,HYSTEROSCOPY ABLATION,,,8300.00
Deidentified Maximum,,58605,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,,3656.00
Deidentified Maximum,,58670,CPT4/HCPCS,LAPAROSCOPY TUBAL CAUTERY,,,7007.00
Deidentified Maximum,,58671,CPT4/HCPCS,LAPAROSCOPY TUBAL BLOCK,,,7007.00
Deidentified Maximum,,58672,CPT4/HCPCS,LAPAROSCOPY FIMBRIOPLASTY,,,7007.00
Deidentified Maximum,,58822,CPT4/HCPCS,DRAIN OVARY ABSCESS PERCUT,,,5856.00
Deidentified Maximum,,58958,CPT4/HCPCS,RESECT RECUR GYN MAL W/LYM,,,6588.00
Deidentified Maximum,,59020,CPT4/HCPCS,FETAL CONTRACT STRESS TEST,,,1214.00
Deidentified Maximum,,59025,CPT4/HCPCS,FETAL NON-STRESS TEST,,,6500.00
Deidentified Maximum,,59120,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,9548.65
Deidentified Maximum,,59150,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,9548.65
Deidentified Maximum,,59151,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,9548.65
Deidentified Maximum,,59325,CPT4/HCPCS,REVISION OF CERVIX,,,6401.00
Deidentified Maximum,,59414,CPT4/HCPCS,DELIVER PLACENTA,,,4280.43
Deidentified Maximum,,59430,CPT4/HCPCS,CARE AFTER DELIVERY,,,6500.00
Deidentified Maximum,,59514,CPT4/HCPCS,CESAREAN DELIVERY ONLY,,,5783.00
Deidentified Maximum,,59612,CPT4/HCPCS,VBAC DELIVERY ONLY,,,5856.00
Deidentified Maximum,,59857,CPT4/HCPCS,ABORTION,,,5029.00
Deidentified Maximum,,60100,CPT4/HCPCS,BIOPSY OF THYROID,,,3000.00
Deidentified Maximum,,60240,CPT4/HCPCS,REMOVAL OF THYROID,,,9548.65
Deidentified Maximum,,60271,CPT4/HCPCS,REMOVAL OF THYROID,,,8012.00
Deidentified Maximum,,60502,CPT4/HCPCS,RE-EXPLORE PARATHYROIDS,,,8300.00
Deidentified Maximum,,60545,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,,5783.00
Deidentified Maximum,,60605,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,,5281.00
Deidentified Maximum,,61026,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,,3198.57
Deidentified Maximum,,61107,CPT4/HCPCS,DRILL SKULL FOR IMPLANTATION,,,3544.00
Deidentified Maximum,,61108,CPT4/HCPCS,DRILL SKULL FOR DRAINAGE,,,5783.00
Deidentified Maximum,,61253,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,,5281.00
Deidentified Maximum,,61305,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,,4891.93
Deidentified Maximum,,61316,CPT4/HCPCS,IMPLT CRAN BONE FLAP TO ABDO,,,3198.57
Deidentified Maximum,,61322,CPT4/HCPCS,DECOMPRESSIVE CRANIOTOMY,,,6588.00
Deidentified Maximum,,61340,CPT4/HCPCS,SUBTEMPORAL DECOMPRESSION,,,6588.00
Deidentified Maximum,,61450,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,,6588.00
Deidentified Maximum,,61458,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,,6588.00
Deidentified Maximum,,61480,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,,4891.93
Deidentified Maximum,,61514,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,,6588.00
Deidentified Maximum,,61517,CPT4/HCPCS,IMPLT BRAIN CHEMOTX ADD-ON,,,5310.00
Deidentified Maximum,,61521,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,7902.34
Deidentified Maximum,,61540,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,6588.00
Deidentified Maximum,,61550,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,,5783.00
Deidentified Maximum,,61580,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,,6588.00
Deidentified Maximum,,61581,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,,6876.92
Deidentified Maximum,,61597,CPT4/HCPCS,TRANSCONDYLAR APPROACH/SKULL,,,8012.00
Deidentified Maximum,,61605,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,6588.00
Deidentified Maximum,,61626,CPT4/HCPCS,TRANSCATH OCCLUSION NON-CNS,,,10119.00
Deidentified Maximum,,61645,CPT4/HCPCS,PERQ ART M-THROMBECT &/NFS,,,7188.00
Deidentified Maximum,,61697,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,,7902.34
Deidentified Maximum,,61703,CPT4/HCPCS,CLAMP NECK ARTERY,,,6588.00
Deidentified Maximum,,61750,CPT4/HCPCS,INCISE SKULL/BRAIN BIOPSY,,,5310.00
Deidentified Maximum,,61751,CPT4/HCPCS,BRAIN BIOPSY W/CT/MR GUIDE,,,5310.00
Deidentified Maximum,,61867,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,,6588.00
Deidentified Maximum,,62100,CPT4/HCPCS,REPAIR BRAIN FLUID LEAKAGE,,,5783.00
Deidentified Maximum,,62115,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,,5783.00
Deidentified Maximum,,62116,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,,5783.00
Deidentified Maximum,,62145,CPT4/HCPCS,REPAIR OF SKULL & BRAIN,,,6588.00
Deidentified Maximum,,62164,CPT4/HCPCS,REMOVE BRAIN TUMOR W/SCOPE,,,6588.00
Deidentified Maximum,,62192,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,5310.00
Deidentified Maximum,,62268,CPT4/HCPCS,DRAIN SPINAL CORD CYST,,,5310.00
Deidentified Maximum,,62269,CPT4/HCPCS,NEEDLE BIOPSY SPINAL CORD,,,5310.00
Deidentified Maximum,,62281,CPT4/HCPCS,TREAT SPINAL CORD LESION,,,5310.00
Deidentified Maximum,,62304,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,,5310.00
Deidentified Maximum,,62320,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,,5310.00
Deidentified Maximum,,62324,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,,5310.00
Deidentified Maximum,,62325,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,,5310.00
Deidentified Maximum,,62369,CPT4/HCPCS,ANAL SP INF PMP W/REPRG&FILL,,,5310.00
Deidentified Maximum,,63046,CPT4/HCPCS,REMOVE SPINE LAMINA 1 THRC,,,9548.65
Deidentified Maximum,,63051,CPT4/HCPCS,C-LAMINOPLASTY W/GRAFT/PLATE,,,6588.00
Deidentified Maximum,,63055,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,,9548.65
Deidentified Maximum,,63056,CPT4/HCPCS,DECOMPRESS SPINAL CORD LMBR,,,9548.65
Deidentified Maximum,,63101,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,,6588.00
Deidentified Maximum,,63102,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,,5783.00
Deidentified Maximum,,63173,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,,5783.00
Deidentified Maximum,,63252,CPT4/HCPCS,REVISE SPINE CORD VSL THRLMB,,,10119.00
Deidentified Maximum,,63268,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,,7007.00
Deidentified Maximum,,63276,CPT4/HCPCS,BX/EXC XDRL SPINE LESN THRC,,,5310.00
Deidentified Maximum,,63281,CPT4/HCPCS,BX/EXC IDRL SPINE LESN THRC,,,5310.00
Deidentified Maximum,,63300,CPT4/HCPCS,REMOVE VERT XDRL BODY CRVCL,,,5310.00
Deidentified Maximum,,63307,CPT4/HCPCS,REMOV VERT IDRL BDY LMBR/SAC,,,5783.00
Deidentified Maximum,,63600,CPT4/HCPCS,REMOVE SPINAL CORD LESION,,,5310.00
Deidentified Maximum,,63610,CPT4/HCPCS,STIMULATION OF SPINAL CORD,,,5310.00
Deidentified Maximum,,63615,CPT4/HCPCS,REMOVE LESION OF SPINAL CORD,,,5281.00
Deidentified Maximum,,63620,CPT4/HCPCS,SRS SPINAL LESION,,,8841.00
Deidentified Maximum,,63707,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,,5310.00
Deidentified Maximum,,64425,CPT4/HCPCS,NJX AA&/STRD II IH NERVES,,,5310.00
Deidentified Maximum,,64461,CPT4/HCPCS,PVB THORACIC SINGLE INJ SITE,,,5310.00
Deidentified Maximum,,64463,CPT4/HCPCS,PVB THORACIC CONT INFUSION,,,5310.00
Deidentified Maximum,,64486,CPT4/HCPCS,TAP BLOCK UNIL BY INJECTION,,,5310.00
Deidentified Maximum,,64490,CPT4/HCPCS,INJ PARAVERT F JNT C/T 1 LEV,,,5310.00
Deidentified Maximum,,64494,CPT4/HCPCS,INJ PARAVERT F JNT L/S 2 LEV,,,5310.00
Deidentified Maximum,,64530,CPT4/HCPCS,N BLOCK INJ CELIAC PELUS,,,5310.00
Deidentified Maximum,,64561,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,12850.70
Deidentified Maximum,,64600,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,5310.00
Deidentified Maximum,,64624,CPT4/HCPCS,DSTRJ NULYT AGT GNCLR NRV,,,4204.00
Deidentified Maximum,,64632,CPT4/HCPCS,N BLOCK INJ COMMON DIGIT,,,5310.00
Deidentified Maximum,,64636,CPT4/HCPCS,DESTROY L/S FACET JNT ADDL,,,5310.00
Deidentified Maximum,,64645,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> EA,,,5310.00
Deidentified Maximum,,64708,CPT4/HCPCS,REVISE ARM/LEG NERVE,,,5310.00
Deidentified Maximum,,64738,CPT4/HCPCS,INCISION OF JAW NERVE,,,5310.00
Deidentified Maximum,,64742,CPT4/HCPCS,INCISION OF FACIAL NERVE,,,5310.00
Deidentified Maximum,,64772,CPT4/HCPCS,INCISION OF SPINAL NERVE,,,5310.00
Deidentified Maximum,,64778,CPT4/HCPCS,DIGIT NERVE SURGERY ADD-ON,,,5310.00
Deidentified Maximum,,64784,CPT4/HCPCS,REMOVE NERVE LESION,,,5856.00
Deidentified Maximum,,64786,CPT4/HCPCS,REMOVE SCIATIC NERVE LESION,,,6075.00
Deidentified Maximum,,64795,CPT4/HCPCS,BIOPSY OF NERVE,,,5310.00
Deidentified Maximum,,64802,CPT4/HCPCS,SYMPATHECTOMY CERVICAL,,,5310.00
Deidentified Maximum,,64823,CPT4/HCPCS,SYMPATHECTOMY SUPFC PALMAR,,,6049.05
Deidentified Maximum,,64832,CPT4/HCPCS,REPAIR NERVE ADD-ON,,,5310.00
Deidentified Maximum,,64834,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,,6075.00
Deidentified Maximum,,64865,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,,6401.00
Deidentified Maximum,,64874,CPT4/HCPCS,REPAIR & REVISE NERVE ADD-ON,,,5856.00
Deidentified Maximum,,64893,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,,6075.00
Deidentified Maximum,,64897,CPT4/HCPCS,NERVE GRAFT ARM/LEG 4 CM,,,6075.00
Deidentified Maximum,,64911,CPT4/HCPCS,NEURORRAPHY W/VEIN AUTOGRAFT,,,6075.00
Deidentified Maximum,,65103,CPT4/HCPCS,REMOVE EYE/INSERT IMPLANT,,,5856.00
Deidentified Maximum,,65105,CPT4/HCPCS,REMOVE EYE/ATTACH IMPLANT,,,6401.00
Deidentified Maximum,,65110,CPT4/HCPCS,REMOVAL OF EYE,,,6876.92
Deidentified Maximum,,65150,CPT4/HCPCS,REVISE OCULAR IMPLANT,,,5310.00
Deidentified Maximum,,65175,CPT4/HCPCS,REMOVAL OF OCULAR IMPLANT,,,5310.00
Deidentified Maximum,,65205,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,5310.00
Deidentified Maximum,,65235,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,5310.00
Deidentified Maximum,,65272,CPT4/HCPCS,REPAIR OF EYE WOUND,,,5310.00
Deidentified Maximum,,65285,CPT4/HCPCS,REPAIR OF EYE WOUND,,,6401.00
Deidentified Maximum,,65920,CPT4/HCPCS,REMOVE IMPLANT OF EYE,,,9548.65
Deidentified Maximum,,66155,CPT4/HCPCS,GLAUCOMA SURGERY,,,6401.00
Deidentified Maximum,,66172,CPT4/HCPCS,INCISION OF EYE,,,6401.00
Deidentified Maximum,,66179,CPT4/HCPCS,AQUEOUS SHUNT EYE W/O GRAFT,,,8300.00
Deidentified Maximum,,66500,CPT4/HCPCS,INCISION OF IRIS,,,5310.00
Deidentified Maximum,,66710,CPT4/HCPCS,CILIARY TRANSSLERAL THERAPY,,,5310.00
Deidentified Maximum,,66720,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,,5310.00
Deidentified Maximum,,66820,CPT4/HCPCS,INCISION SECONDARY CATARACT,,,5310.00
Deidentified Maximum,,66830,CPT4/HCPCS,REMOVAL OF LENS LESION,,,6401.00
Deidentified Maximum,,66987,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX W/ECP,,,8012.00
Deidentified Maximum,,67025,CPT4/HCPCS,REPLACE EYE FLUID,,,5310.00
Deidentified Maximum,,67042,CPT4/HCPCS,VIT FOR MACULAR HOLE,,,8300.00
Deidentified Maximum,,67145,CPT4/HCPCS,TREATMENT OF RETINA,,,5310.00
Deidentified Maximum,,67220,CPT4/HCPCS,TREATMENT OF CHOROID LESION,,,5310.00
Deidentified Maximum,,67221,CPT4/HCPCS,OCULAR PHOTODYNAMIC THER,,,5310.00
Deidentified Maximum,,67250,CPT4/HCPCS,REINFORCE EYE WALL,,,5856.00
Deidentified Maximum,,67400,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,,5856.00
Deidentified Maximum,,67414,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,,7902.34
Deidentified Maximum,,67420,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,,6876.92
Deidentified Maximum,,67445,CPT4/HCPCS,EXPLR/DECOMPRESS EYE SOCKET,,,7902.34
Deidentified Maximum,,67570,CPT4/HCPCS,DECOMPRESS OPTIC NERVE,,,7902.34
Deidentified Maximum,,67700,CPT4/HCPCS,DRAINAGE OF EYELID ABSCESS,,,5310.00
Deidentified Maximum,,67715,CPT4/HCPCS,INCISION OF EYELID FOLD,,,5310.00
Deidentified Maximum,,67801,CPT4/HCPCS,REMOVE EYELID LESIONS,,,5310.00
Deidentified Maximum,,67880,CPT4/HCPCS,REVISION OF EYELID,,,5856.00
Deidentified Maximum,,67903,CPT4/HCPCS,REPAIR EYELID DEFECT,,,6401.00
Deidentified Maximum,,67909,CPT4/HCPCS,REVISE EYELID DEFECT,,,6401.00
Deidentified Maximum,,67912,CPT4/HCPCS,CORRECTION EYELID W/IMPLANT,,,5856.00
Deidentified Maximum,,67914,CPT4/HCPCS,REPAIR EYELID DEFECT,,,5856.00
Deidentified Maximum,,67917,CPT4/HCPCS,REPAIR EYELID DEFECT,,,6401.00
Deidentified Maximum,,67923,CPT4/HCPCS,REPAIR EYELID DEFECT,,,6401.00
Deidentified Maximum,,67924,CPT4/HCPCS,REPAIR EYELID DEFECT,,,6401.00
Deidentified Maximum,,67961,CPT4/HCPCS,REVISION OF EYELID,,,5856.00
Deidentified Maximum,,68115,CPT4/HCPCS,REMOVE EYELID LINING LESION,,,5310.00
Deidentified Maximum,,68362,CPT4/HCPCS,REVISE EYELID LINING,,,5310.00
Deidentified Maximum,,68400,CPT4/HCPCS,INCISE/DRAIN TEAR GLAND,,,5310.00
Deidentified Maximum,,68811,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,,5310.00
Deidentified Maximum,,68850,CPT4/HCPCS,INJECTION FOR TEAR SAC X-RAY,,,5310.00
Deidentified Maximum,,69000,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,,5310.00
Deidentified Maximum,,69140,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,,5310.00
Deidentified Maximum,,69205,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,,5310.00
Deidentified Maximum,,69320,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,,9548.65
Deidentified Maximum,,69440,CPT4/HCPCS,EXPLORATION OF MIDDLE EAR,,,5856.00
Deidentified Maximum,,69501,CPT4/HCPCS,MASTOIDECTOMY,,,9548.65
Deidentified Maximum,,69601,CPT4/HCPCS,MASTOID SURGERY REVISION,,,9548.65
Deidentified Maximum,,69605,CPT4/HCPCS,MASTOID SURGERY REVISION,,,9548.65
Deidentified Maximum,,69620,CPT4/HCPCS,REPAIR OF EARDRUM,,,5310.00
Deidentified Maximum,,69632,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,,6876.92
Deidentified Maximum,,69635,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,,9548.65
Deidentified Maximum,,69646,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,9548.65
Deidentified Maximum,,69661,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,,6876.92
Deidentified Maximum,,69670,CPT4/HCPCS,REMOVE MASTOID AIR CELLS,,,6075.00
Deidentified Maximum,,69714,CPT4/HCPCS,IMPLANT TEMPLE BONE W/STIMUL,,,12850.70
Deidentified Maximum,,69740,CPT4/HCPCS,REPAIR FACIAL NERVE,,,6876.92
Deidentified Maximum,,70015,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,,4045.45
Deidentified Maximum,,70030,CPT4/HCPCS,X-RAY EYE FOR FOREIGN BODY,,,364.35
Deidentified Maximum,,70110,CPT4/HCPCS,X-RAY EXAM OF JAW 4/> VIEWS,,,657.95
Deidentified Maximum,,70130,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,,657.95
Deidentified Maximum,,70170,CPT4/HCPCS,X-RAY EXAM OF TEAR DUCT,,,2002.47
Deidentified Maximum,,70260,CPT4/HCPCS,X-RAY EXAM OF SKULL,,,657.95
Deidentified Maximum,,70360,CPT4/HCPCS,X-RAY EXAM OF NECK,,,364.35
Deidentified Maximum,,70380,CPT4/HCPCS,X-RAY EXAM OF SALIVARY GLAND,,,364.35
Deidentified Maximum,,70470,CPT4/HCPCS,CT HEAD/BRAIN W/O & W/DYE,,,6766.00
Deidentified Maximum,,70482,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O&W/DYE,,,6766.00
Deidentified Maximum,,70488,CPT4/HCPCS,CT MAXILLOFACIAL W/O & W/DYE,,,6766.00
Deidentified Maximum,,70543,CPT4/HCPCS,MRI ORBT/FAC/NCK W/O &W/DYE,,,12358.33
Deidentified Maximum,,70549,CPT4/HCPCS,MR ANGIOGRAPH NECK W/O&W/DYE,,,11059.37
Deidentified Maximum,,70553,CPT4/HCPCS,MRI BRAIN STEM W/O & W/DYE,,,12547.94
Deidentified Maximum,,70555,CPT4/HCPCS,FMRI BRAIN BY PHYS/PSYCH,,,2427.00
Deidentified Maximum,,71034,CPT4/HCPCS,CHEST X-RAY&FLUORO 4/> VIEWS,,,0.00
Deidentified Maximum,,71045,CPT4/HCPCS,X-RAY EXAM CHEST 1 VIEW,,,364.35
Deidentified Maximum,,71048,CPT4/HCPCS,X-RAY EXAM CHEST 4+ VIEWS,,,657.95
Deidentified Maximum,,71100,CPT4/HCPCS,X-RAY EXAM RIBS UNI 2 VIEWS,,,364.35
Deidentified Maximum,,71550,CPT4/HCPCS,MRI CHEST W/O DYE,,,6766.00
Deidentified Maximum,,71552,CPT4/HCPCS,MRI CHEST W/O & W/DYE,,,12293.78
Deidentified Maximum,,71555,CPT4/HCPCS,MRI ANGIO CHEST W OR W/O DYE,,,5646.30
Deidentified Maximum,,72080,CPT4/HCPCS,X-RAY EXAM THORACOLMB 2/> VW,,,364.35
Deidentified Maximum,,72120,CPT4/HCPCS,X-RAY BEND ONLY L-S SPINE,,,657.95
Deidentified Maximum,,72129,CPT4/HCPCS,CT CHEST SPINE W/DYE,,,6766.00
Deidentified Maximum,,72149,CPT4/HCPCS,MRI LUMBAR SPINE W/DYE,,,6773.29
Deidentified Maximum,,72156,CPT4/HCPCS,MRI NECK SPINE W/O & W/DYE,,,12547.94
Deidentified Maximum,,72192,CPT4/HCPCS,CT PELVIS W/O DYE,,,6766.00
Deidentified Maximum,,72291,CPT4/HCPCS,PERQ VERTE/SACROPLSTY FLUOR,,,0.00
Deidentified Maximum,,73000,CPT4/HCPCS,X-RAY EXAM OF COLLAR BONE,,,364.35
Deidentified Maximum,,73090,CPT4/HCPCS,X-RAY EXAM OF FOREARM,,,364.35
Deidentified Maximum,,73130,CPT4/HCPCS,X-RAY EXAM OF HAND,,,364.35
Deidentified Maximum,,73200,CPT4/HCPCS,CT UPPER EXTREMITY W/O DYE,,,6766.00
Deidentified Maximum,,73201,CPT4/HCPCS,CT UPPER EXTREMITY W/DYE,,,6766.00
Deidentified Maximum,,73220,CPT4/HCPCS,MRI UPPR EXTREMITY W/O&W/DYE,,,12358.33
Deidentified Maximum,,73221,CPT4/HCPCS,MRI JOINT UPR EXTREM W/O DYE,,,6766.00
Deidentified Maximum,,73502,CPT4/HCPCS,X-RAY EXAM HIP UNI 2-3 VIEWS,,,403.39
Deidentified Maximum,,73620,CPT4/HCPCS,X-RAY EXAM OF FOOT,,,364.35
Deidentified Maximum,,73630,CPT4/HCPCS,X-RAY EXAM OF FOOT,,,364.35
Deidentified Maximum,,73660,CPT4/HCPCS,X-RAY EXAM OF TOE(S),,,364.35
Deidentified Maximum,,73722,CPT4/HCPCS,MRI JOINT OF LWR EXTR W/DYE,,,6766.00
Deidentified Maximum,,73723,CPT4/HCPCS,MRI JOINT LWR EXTR W/O&W/DYE,,,12358.33
Deidentified Maximum,,74010,CPT4/HCPCS,X-RAY EXAM OF ABDOMEN,,,0.00
Deidentified Maximum,,74160,CPT4/HCPCS,CT ABDOMEN W/DYE,,,6766.00
Deidentified Maximum,,74170,CPT4/HCPCS,CT ABDOMEN W/O & W/DYE,,,6766.00
Deidentified Maximum,,74174,CPT4/HCPCS,CT ANGIO ABD&PELV W/O&W/DYE,,,6766.00
Deidentified Maximum,,74178,CPT4/HCPCS,CT ABD & PELV 1/> REGNS,,,6766.00
Deidentified Maximum,,74185,CPT4/HCPCS,MRI ANGIO ABDOM W ORW/O DYE,,,6766.00
Deidentified Maximum,,74241,CPT4/HCPCS,X-RAY UPPER GI DELAY W/KUB,,,749.21
Deidentified Maximum,,74290,CPT4/HCPCS,CONTRAST X-RAY GALLBLADDER,,,460.48
Deidentified Maximum,,74328,CPT4/HCPCS,X-RAY BILE DUCT ENDOSCOPY,,,1593.86
Deidentified Maximum,,74330,CPT4/HCPCS,X-RAY BILE/PANC ENDOSCOPY,,,6500.00
Deidentified Maximum,,74355,CPT4/HCPCS,X-RAY GUIDE INTESTINAL TUBE,,,1317.13
Deidentified Maximum,,74360,CPT4/HCPCS,X-RAY GUIDE GI DILATION,,,1593.86
Deidentified Maximum,,74410,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BOLUS,,,987.46
Deidentified Maximum,,74440,CPT4/HCPCS,X-RAY MALE GENITAL TRACT,,,587.74
Deidentified Maximum,,74712,CPT4/HCPCS,MRI FETAL SNGL/1ST GESTATION,,,4444.39
Deidentified Maximum,,74775,CPT4/HCPCS,X-RAY EXAM OF PERINEUM,,,1531.90
Deidentified Maximum,,75557,CPT4/HCPCS,CARDIAC MRI FOR MORPH,,,5321.39
Deidentified Maximum,,75559,CPT4/HCPCS,CARDIAC MRI W/STRESS IMG,,,8044.77
Deidentified Maximum,,75600,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,,6344.13
Deidentified Maximum,,75605,CPT4/HCPCS,CONTRAST EXAM THORACIC AORTA,,,25594.34
Deidentified Maximum,,75731,CPT4/HCPCS,ARTERY X-RAYS ADRENAL GLAND,,,6344.13
Deidentified Maximum,,75741,CPT4/HCPCS,ARTERY X-RAYS LUNG,,,15447.85
Deidentified Maximum,,75743,CPT4/HCPCS,ARTERY X-RAYS LUNGS,,,15447.85
Deidentified Maximum,,75825,CPT4/HCPCS,VEIN X-RAY TRUNK,,,15447.85
Deidentified Maximum,,75831,CPT4/HCPCS,VEIN X-RAY KIDNEY,,,15447.85
Deidentified Maximum,,75833,CPT4/HCPCS,VEIN X-RAY KIDNEYS,,,15447.85
Deidentified Maximum,,75860,CPT4/HCPCS,VEIN X-RAY NECK,,,15447.85
Deidentified Maximum,,75887,CPT4/HCPCS,VEIN X-RAY LIVER W/O HEMODYN,,,6344.13
Deidentified Maximum,,75889,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,,15447.85
Deidentified Maximum,,75894,CPT4/HCPCS,X-RAYS TRANSCATH THERAPY,,,12166.12
Deidentified Maximum,,75901,CPT4/HCPCS,REMOVE CVA DEVICE OBSTRUCT,,,6500.00
Deidentified Maximum,,76000,CPT4/HCPCS,FLUOROSCOPY <1 HR PHYS/QHP,,,1348.35
Deidentified Maximum,,76125,CPT4/HCPCS,CINE/VIDEO X-RAYS ADD-ON,,,400.29
Deidentified Maximum,,76376,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,,6500.00
Deidentified Maximum,,76498,CPT4/HCPCS,MRI PROCEDURE,,,2427.00
Deidentified Maximum,,76641,CPT4/HCPCS,ULTRASOUND BREAST COMPLETE,,,961.54
Deidentified Maximum,,76642,CPT4/HCPCS,ULTRASOUND BREAST LIMITED,,,735.39
Deidentified Maximum,,76775,CPT4/HCPCS,US EXAM ABDO BACK WALL LIM,,,720.97
Deidentified Maximum,,76801,CPT4/HCPCS,OB US < 14 WKS SINGLE FETUS,,,1058.84
Deidentified Maximum,,76814,CPT4/HCPCS,OB US NUCHAL MEAS ADD-ON,,,587.00
Deidentified Maximum,,76819,CPT4/HCPCS,FETAL BIOPHYS PROFIL W/O NST,,,819.83
Deidentified Maximum,,76826,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,,738.69
Deidentified Maximum,,76831,CPT4/HCPCS,ECHO EXAM UTERUS,,,1348.35
Deidentified Maximum,,76870,CPT4/HCPCS,US EXAM SCROTUM,,,803.79
Deidentified Maximum,,76930,CPT4/HCPCS,ECHO GUIDE CARDIOCENTESIS,,,771.71
Deidentified Maximum,,76940,CPT4/HCPCS,US GUIDE TISSUE ABLATION,,,6500.00
Deidentified Maximum,,76942,CPT4/HCPCS,ECHO GUIDE FOR BIOPSY,,,7894.00
Deidentified Maximum,,76970,CPT4/HCPCS,ULTRASOUND EXAM FOLLOW-UP,,,587.00
Deidentified Maximum,,76977,CPT4/HCPCS,US BONE DENSITY MEASURE,,,587.00
Deidentified Maximum,,77057,CPT4/HCPCS,MAMMOGRAM SCREENING,,,0.00
Deidentified Maximum,,77084,CPT4/HCPCS,MAGNETIC IMAGE BONE MARROW,,,6651.93
Deidentified Maximum,,77086,CPT4/HCPCS,FRACTURE ASSESSMENT VIA DXA,,,360.08
Deidentified Maximum,,77290,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,,7894.00
Deidentified Maximum,,77295,CPT4/HCPCS,3-D RADIOTHERAPY PLAN,,,16040.05
Deidentified Maximum,,77306,CPT4/HCPCS,TELETHX ISODOSE PLAN SIMPLE,,,7894.00
Deidentified Maximum,,77321,CPT4/HCPCS,SPECIAL TELETX PORT PLAN,,,7894.00
Deidentified Maximum,,77332,CPT4/HCPCS,RADIATION TREATMENT AID(S),,,7894.00
Deidentified Maximum,,77370,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,,7894.00
Deidentified Maximum,,77401,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,,2567.00
Deidentified Maximum,,77424,CPT4/HCPCS,IO RAD TX DELIVERY BY X-RAY,,,2567.00
Deidentified Maximum,,77425,CPT4/HCPCS,IO RAD TX DELIVER BY ELCTRNS,,,2567.00
Deidentified Maximum,,77469,CPT4/HCPCS,IO RADIATION TX MANAGEMENT,,,2567.00
Deidentified Maximum,,77763,CPT4/HCPCS,APPLY INTRCAV RADIAT COMPL,,,13685.00
Deidentified Maximum,,77767,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,,13685.00
Deidentified Maximum,,77787,CPT4/HCPCS,HDR BRACHYTX OVER 12 CHAN,,,3544.00
Deidentified Maximum,,77789,CPT4/HCPCS,APPLY SURF LDR RADIONUCLIDE,,,13685.00
Deidentified Maximum,,78012,CPT4/HCPCS,THYROID UPTAKE MEASUREMENT,,,1048.16
Deidentified Maximum,,78015,CPT4/HCPCS,THYROID MET IMAGING,,,1585.66
Deidentified Maximum,,78121,CPT4/HCPCS,RED CELL MASS MULTIPLE,,,1461.48
Deidentified Maximum,,78300,CPT4/HCPCS,BONE IMAGING LIMITED AREA,,,1263.10
Deidentified Maximum,,0033T,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,,3198.57
Deidentified Maximum,,0048T,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,,8012.00
Deidentified Maximum,,0051T,CPT4/HCPCS,IMPLANT TOTAL HEART SYSTEM,,,8841.00
Deidentified Maximum,,0054T,CPT4/HCPCS,BONE SRGRY CMPTR FLUOR IMAGE,,,2427.00
Deidentified Maximum,,0092T,CPT4/HCPCS,ARTIFIC DISC ADDL CERVICAL,,,5783.00
Deidentified Maximum,,0095T,CPT4/HCPCS,RMVL ARTIFIC DISC ADDL CRVCL,,,3544.00
Deidentified Maximum,,0099T,CPT4/HCPCS,IMPLANT CORNEAL RING,,,1678.88
Deidentified Maximum,,0165T,CPT4/HCPCS,REVISE LUMB ARTIF DISC ADDL,,,3198.57
Deidentified Maximum,,0172T,CPT4/HCPCS,LUMBAR SPINE PROCESS ADDL,,,5281.00
Deidentified Maximum,,0184T,CPT4/HCPCS,EXC RECTAL TUMOR ENDOSCOPIC,,,5856.00
Deidentified Maximum,,0191T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,,12850.70
Deidentified Maximum,,0219T,CPT4/HCPCS,PLMT POST FACET IMPLT CERV,,,1678.88
Deidentified Maximum,,0230T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,,2002.00
Deidentified Maximum,,0231T,CPT4/HCPCS,NJX TFRML EPRL W/US LUMB/SAC,,,2002.00
Deidentified Maximum,,0235T,CPT4/HCPCS,TRLUML PERIP ATHRC VISCERAL,,,9548.65
Deidentified Maximum,,0245T,CPT4/HCPCS,OPEN TX RIB FX 1-2 RIBS,,,1678.88
Deidentified Maximum,,0263T,CPT4/HCPCS,IM B1 MRW CEL THER CMPL,,,7902.34
Deidentified Maximum,,0268T,CPT4/HCPCS,IMPLT/RPL CRTD SNS DEV GEN,,,14317.00
Deidentified Maximum,,0276T,CPT4/HCPCS,BRONCH THERMOPLASTY 1 LOBE,,,1678.88
Deidentified Maximum,,0284T,CPT4/HCPCS,PERIPH FIELD STIMUL REVISE,,,1678.88
Deidentified Maximum,,0288T,CPT4/HCPCS,ANOSCOPY W/RF DELIVERY,,,1678.00
Deidentified Maximum,,0297T,CPT4/HCPCS,EXT ECG SCAN W/REPORT,,,987.78
Deidentified Maximum,,0298T,CPT4/HCPCS,EXT ECG REVIEW AND INTERP,,,987.78
Deidentified Maximum,,0302T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS COMPL,,,3544.00
Deidentified Maximum,,0314T,CPT4/HCPCS,LAPS RMVL VGL ARRY&PLS GEN,,,6876.92
Deidentified Maximum,,0321T,CPT4/HCPCS,INSERT SUBQ DEFIB PLS GEN,,,6588.00
Deidentified Maximum,,0324T,CPT4/HCPCS,RMVL SUBQ DEFIB ELECTRODE,,,5029.00
Deidentified Maximum,,0336T,CPT4/HCPCS,LAP ABLAT UTERINE FIBROIDS,,,5029.00
Deidentified Maximum,,0375T,CPT4/HCPCS,TOTAL DISC ARTHRP ANT APPR,,,5783.00
Deidentified Maximum,,0376T,CPT4/HCPCS,INSERT ANT SEGMENT DRAIN INT,,,5029.00
Deidentified Maximum,,0377T,CPT4/HCPCS,ANOSCPY INJ AGENT FOR INCONT,,,6049.05
Deidentified Maximum,,0379T,CPT4/HCPCS,VIS FIELD ASSMNT TECH SUPPT,,,6049.05
Deidentified Maximum,,0394T,CPT4/HCPCS,HDR ELCTRNC SKN SURF BRCHYTX,,,12850.70
Deidentified Maximum,,0398T,CPT4/HCPCS,MRGFUS STRTCTC LES ABLTJ,,,10119.00
Deidentified Maximum,,0409T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ PLS GN,,,24180.00
Deidentified Maximum,,0414T,CPT4/HCPCS,RMVL & RPL CAR MODULJ PLS GN,,,24180.00
Deidentified Maximum,,0416T,CPT4/HCPCS,RELOC SKIN POCKET PLS GEN,,,4891.93
Deidentified Maximum,,0419T,CPT4/HCPCS,DSTRJ NEUROFIBROMA XTNSV,,,3544.00
Deidentified Maximum,,0428T,CPT4/HCPCS,RMVL NSTIM APNEA PLS GEN,,,5138.00
Deidentified Maximum,,0432T,CPT4/HCPCS,REPOS NSTIM APNEA STIMJ LD,,,5138.00
Deidentified Maximum,,0442T,CPT4/HCPCS,ABLTJ PERC PLEX/TRNCL NRV,,,6075.00
Deidentified Maximum,,0451T,CPT4/HCPCS,INSJ/RPLCMT AORTIC VENTR SYS,,,5029.00
Deidentified Maximum,,0455T,CPT4/HCPCS,REMVL AORTIC VENTR CMPL SYS,,,3544.00
Deidentified Maximum,,0461T,CPT4/HCPCS,REPOS AORTIC CONTRPULSJ DEV,,,5029.00
Deidentified Maximum,,0465T,CPT4/HCPCS,SUPCHRDL NJX RX W/O SUPPLY,,,3198.57
Deidentified Maximum,,0468T,CPT4/HCPCS,RMVL CH WAL RESPIR ELTRD/RA,,,5138.00
Deidentified Maximum,,0474T,CPT4/HCPCS,INSJ AQUEOUS DRG DEV IO RSVR,,,6075.00
Deidentified Maximum,,0479T,CPT4/HCPCS,FXJL ABL LSR 1ST 100 SQ CM,,,4891.93
Deidentified Maximum,,0483T,CPT4/HCPCS,TMVI PERCUTANEOUS APPROACH,,,8012.00
Deidentified Maximum,,0489T,CPT4/HCPCS,REGN CELL TX SCLDR HANDS,,,6049.05
Deidentified Maximum,,0492T,CPT4/HCPCS,ABL LSR OPN WND ADDL 20 SQCM,,,4891.93
Deidentified Maximum,,0499T,CPT4/HCPCS,CYSTO F/URTL STRIX/STENOSIS,,,5856.00
Deidentified Maximum,,0505T,CPT4/HCPCS,EV FEMPOP ARTL REVSC,,,10119.00
Deidentified Maximum,,0513T,CPT4/HCPCS,ESW INTEG WND HLG EA ADDL,,,1678.88
Deidentified Maximum,,0514T,CPT4/HCPCS,INTRAOP VIS AXIS ID PT FIXJ,,,1678.00
Deidentified Maximum,,0523T,CPT4/HCPCS,NTRAPX C FFR W/3D FUNCJL MAP,,,1214.00
Deidentified Maximum,,0524T,CPT4/HCPCS,EV CATH DIR CHEM ABLTJ W/IMG,,,5856.00
Deidentified Maximum,,0531T,CPT4/HCPCS,REMOVAL IIMS ELECTRODE ONLY,,,5856.00
Deidentified Maximum,,0540T,CPT4/HCPCS,CAR-T CLL ADMN AUTOLOGOUS,,,1678.88
Deidentified Maximum,,0543T,CPT4/HCPCS,TA MV RPR W/ARTIF CHORD TEND,,,1370.00
Deidentified Maximum,,0553T,CPT4/HCPCS,PERQ TCAT ILIAC ANAST IMPLT,,,7188.00
Deidentified Maximum,,0568T,CPT4/HCPCS,INTRO MIX SALINE&AIR F/SSG,,,2002.00
Deidentified Maximum,,0574T,CPT4/HCPCS,REPOS PREV SS IMPL DFB ELTRD,,,5856.00
Deidentified Maximum,,0586T,CPT4/HCPCS,OPEN ISLET CELL TRANSPLANT,,,6588.00
Deidentified Maximum,,10004,CPT4/HCPCS,FNA BX W/O IMG GDN EA ADDL,,,3000.00
Deidentified Maximum,,10121,CPT4/HCPCS,REMOVE FOREIGN BODY,,,4280.43
Deidentified Maximum,,11000,CPT4/HCPCS,DEBRIDE INFECTED SKIN,,,2002.00
Deidentified Maximum,,11001,CPT4/HCPCS,DEBRIDE INFECTED SKIN ADD-ON,,,3000.00
Deidentified Maximum,,11044,CPT4/HCPCS,DEB BONE 20 SQ CM/<,,,4280.43
Deidentified Maximum,,11400,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.5 CM<,,,3198.57
Deidentified Maximum,,11421,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.6-1,,,3656.00
Deidentified Maximum,,11463,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,4280.43
Deidentified Maximum,,11601,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.6-1 CM,,,3198.57
Deidentified Maximum,,11603,CPT4/HCPCS,EXC TR-EXT MAL+MARG 2.1-3 CM,,,3198.57
Deidentified Maximum,,11606,CPT4/HCPCS,EXC TR-EXT MAL+MARG >4 CM,,,4280.43
Deidentified Maximum,,11623,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 2.1-3,,,3198.57
Deidentified Maximum,,11640,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.5CM<,,,3656.00
Deidentified Maximum,,11641,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 0.6-1,,,3656.00
Deidentified Maximum,,11750,CPT4/HCPCS,REMOVAL OF NAIL BED,,,3198.57
Deidentified Maximum,,11960,CPT4/HCPCS,INSERT TISSUE EXPANDER(S),,,5138.00
Deidentified Maximum,,12013,CPT4/HCPCS,RPR F/E/E/N/L/M 2.6-5.0 CM,,,1678.88
Deidentified Maximum,,12036,CPT4/HCPCS,INTMD RPR S/A/T/EXT 20.1-30,,,4280.43
Deidentified Maximum,,12042,CPT4/HCPCS,INTMD RPR N-HF/GENIT2.6-7.5,,,3198.57
Deidentified Maximum,,12051,CPT4/HCPCS,INTMD RPR FACE/MM 2.5 CM/<,,,3198.57
Deidentified Maximum,,13152,CPT4/HCPCS,CMPLX RPR E/N/E/L 2.6-7.5 CM,,,5856.00
Deidentified Maximum,,13160,CPT4/HCPCS,LATE CLOSURE OF WOUND,,,4280.43
Deidentified Maximum,,14041,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,,5856.00
Deidentified Maximum,,14060,CPT4/HCPCS,TIS TRNFR E/N/E/L 10 SQ CM/<,,,5856.00
Deidentified Maximum,,15101,CPT4/HCPCS,SKIN SPLT GRFT T/A/L ADD-ON,,,5856.00
Deidentified Maximum,,15156,CPT4/HCPCS,CULT SKIN GRFT F/N/HFG ADD,,,3198.57
Deidentified Maximum,,15271,CPT4/HCPCS,SKIN SUB GRAFT TRNK/ARM/LEG,,,4280.43
Deidentified Maximum,,15275,CPT4/HCPCS,SKIN SUB GRAFT FACE/NK/HF/G,,,4280.43
Deidentified Maximum,,15576,CPT4/HCPCS,PEDICLE E/N/E/L/NTRORAL,,,5856.00
Deidentified Maximum,,15650,CPT4/HCPCS,TRANSFER SKIN PEDICLE FLAP,,,6876.92
Deidentified Maximum,,15770,CPT4/HCPCS,DERMA-FAT-FASCIA GRAFT,,,5856.00
Deidentified Maximum,,15772,CPT4/HCPCS,GRFG AUTOL FAT LIPO EA ADDL,,,3544.00
Deidentified Maximum,,15781,CPT4/HCPCS,DERMABRASION SEGMENTAL FACE,,,3198.57
Deidentified Maximum,,15789,CPT4/HCPCS,CHEMICAL PEEL FACE DERMAL,,,1214.00
Deidentified Maximum,,15820,CPT4/HCPCS,REVISION OF LOWER EYELID,,,5856.00
Deidentified Maximum,,15826,CPT4/HCPCS,REMOVAL OF BROW WRINKLES,,,5856.00
Deidentified Maximum,,15840,CPT4/HCPCS,NERVE PALSY FASCIAL GRAFT,,,6401.00
Deidentified Maximum,,15842,CPT4/HCPCS,NERVE PALSY MICROSURG GRAFT,,,6401.00
Deidentified Maximum,,15877,CPT4/HCPCS,SUCTION LIPECTOMY TRUNK,,,5856.00
Deidentified Maximum,,15879,CPT4/HCPCS,SUCTION LIPECTOMY LWR EXTREM,,,5856.00
Deidentified Maximum,,15922,CPT4/HCPCS,REMOVAL OF TAIL BONE ULCER,,,6401.00
Deidentified Maximum,,15937,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,6401.00
Deidentified Maximum,,15946,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,,6401.00
Deidentified Maximum,,15952,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,5856.00
Deidentified Maximum,,15958,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,6401.00
Deidentified Maximum,,16036,CPT4/HCPCS,ESCHAROTOMY ADDL INCISION,,,3198.57
Deidentified Maximum,,17108,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3000.00
Deidentified Maximum,,17110,CPT4/HCPCS,DESTRUCT B9 LESION 1-14,,,2002.00
Deidentified Maximum,,17261,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17262,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17283,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17286,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3656.00
Deidentified Maximum,,17312,CPT4/HCPCS,MOHS ADDL STAGE,,,3198.57
Deidentified Maximum,,19030,CPT4/HCPCS,INJECTION FOR BREAST X-RAY,,,3000.00
Deidentified Maximum,,19083,CPT4/HCPCS,Bx breast 1st Lesion US imag,,,4280.43
Deidentified Maximum,,19103,CPT4/HCPCS,BX BREAST PERCUT W/DEVICE,,,1678.00
Deidentified Maximum,,19125,CPT4/HCPCS,EXCISION BREAST LESION,,,5856.00
Deidentified Maximum,,19284,CPT4/HCPCS,PERQ DEV BREAST ADD STRTCTC,,,3000.00
Deidentified Maximum,,19298,CPT4/HCPCS,PLACE BREAST RAD TUBE/CATHS,,,12850.70
Deidentified Maximum,,19324,CPT4/HCPCS,ENLARGE BREAST,,,6401.00
Deidentified Maximum,,19328,CPT4/HCPCS,RMVL INTACT BREAST IMPLANT,,,5138.00
Deidentified Maximum,,19350,CPT4/HCPCS,BREAST RECONSTRUCTION,,,6401.00
Deidentified Maximum,,19355,CPT4/HCPCS,CORRECT INVERTED NIPPLE(S),,,6401.00
Deidentified Maximum,,19357,CPT4/HCPCS,TISS XPNDR PLMT BRST RCNSTJ,,,7007.00
Deidentified Maximum,,19361,CPT4/HCPCS,BRST RCNSTJ LATSMS DRSI FLAP,,,5281.00
Deidentified Maximum,,19371,CPT4/HCPCS,PERI-IMPLT CAPSLC BRST COMPL,,,6401.00
Deidentified Maximum,,20100,CPT4/HCPCS,EXPLORE WOUND NECK,,,3198.57
Deidentified Maximum,,20245,CPT4/HCPCS,BONE BIOPSY OPEN DEEP,,,5856.00
Deidentified Maximum,,20251,CPT4/HCPCS,OPEN BONE BIOPSY,,,5856.00
Deidentified Maximum,,20561,CPT4/HCPCS,NDL INSJ W/O NJX 3+ MUSC,,,3000.00
Deidentified Maximum,,20600,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,,3000.00
Deidentified Maximum,,20606,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,,2002.00
Deidentified Maximum,,20611,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,,3544.00
Deidentified Maximum,,20612,CPT4/HCPCS,ASPIRATE/INJ GANGLION CYST,,,3000.00
Deidentified Maximum,,20660,CPT4/HCPCS,APPLY REM FIXATION DEVICE,,,3656.00
Deidentified Maximum,,20704,CPT4/HCPCS,MNL PREP&INSJ I-ARTIC RX DEV,,,3000.00
Deidentified Maximum,,20705,CPT4/HCPCS,RMVL I-ARTIC RX DELIVERY DEV,,,3000.00
Deidentified Maximum,,20822,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,,12850.70
Deidentified Maximum,,20912,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,,5856.00
Deidentified Maximum,,20931,CPT4/HCPCS,SP BONE ALGRFT STRUCT ADD-ON,,,3198.57
Deidentified Maximum,,20932,CPT4/HCPCS,OSTEOART ALGRFT W/SURF & B1,,,8841.00
Deidentified Maximum,,20937,CPT4/HCPCS,SP BONE AGRFT MORSEL ADD-ON,,,5138.00
Deidentified Maximum,,20970,CPT4/HCPCS,BONE/SKIN GRAFT ILIAC CREST,,,9548.65
Deidentified Maximum,,20985,CPT4/HCPCS,CPTR-ASST DIR MS PX,,,3000.00
Deidentified Maximum,,21026,CPT4/HCPCS,EXCISION OF FACIAL BONE(S),,,4280.43
Deidentified Maximum,,21032,CPT4/HCPCS,REMOVE EXOSTOSIS MAXILLA,,,6049.05
Deidentified Maximum,,21034,CPT4/HCPCS,EXCISE MAX/ZYGOMA MAL TUMOR,,,6075.00
Deidentified Maximum,,21044,CPT4/HCPCS,REMOVAL OF JAW BONE LESION,,,6075.00
Deidentified Maximum,,21050,CPT4/HCPCS,REMOVAL OF JAW JOINT,,,6075.00
Deidentified Maximum,,21139,CPT4/HCPCS,REDUCTION OF FOREHEAD,,,9548.65
Deidentified Maximum,,21151,CPT4/HCPCS,LEFORT II W/BONE GRAFTS,,,6588.00
Deidentified Maximum,,21172,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,,6840.00
Deidentified Maximum,,21181,CPT4/HCPCS,CONTOUR CRANIAL BONE LESION,,,9548.65
Deidentified Maximum,,21193,CPT4/HCPCS,RECONST LWR JAW W/O GRAFT,,,6840.00
Deidentified Maximum,,21235,CPT4/HCPCS,EAR CARTILAGE GRAFT,,,9548.65
Deidentified Maximum,,21242,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,,6876.92
Deidentified Maximum,,21275,CPT4/HCPCS,REVISION ORBITOFACIAL BONES,,,9548.65
Deidentified Maximum,,21344,CPT4/HCPCS,OPEN TX COMPL FRONT SINUS FX,,,7830.00
Deidentified Maximum,,21346,CPT4/HCPCS,OPN TX NASOMAX FX W/FIXJ,,,6401.00
Deidentified Maximum,,21421,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,,6401.00
Deidentified Maximum,,21431,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,,3544.00
Deidentified Maximum,,21440,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,,5856.00
Deidentified Maximum,,21452,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,4280.43
Deidentified Maximum,,21470,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,9548.65
Deidentified Maximum,,21485,CPT4/HCPCS,RESET DISLOCATED JAW,,,4280.43
Deidentified Maximum,,21495,CPT4/HCPCS,TREAT HYOID BONE FRACTURE,,,5029.00
Deidentified Maximum,,21499,CPT4/HCPCS,HEAD SURGERY PROCEDURE,,,4280.43
Deidentified Maximum,,21603,CPT4/HCPCS,EXC CH WAL TUM W/LYMPHADEC,,,6588.00
Deidentified Maximum,,21627,CPT4/HCPCS,STERNAL DEBRIDEMENT,,,4280.43
Deidentified Maximum,,21743,CPT4/HCPCS,REPAIR STERNUM/NUSS W/SCOPE,,,9548.65
Deidentified Maximum,,21810,CPT4/HCPCS,TREATMENT OF RIB FRACTURE(S),,,1678.88
Deidentified Maximum,,21899,CPT4/HCPCS,NECK/CHEST SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,22100,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,,9548.65
Deidentified Maximum,,22103,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,,9548.65
Deidentified Maximum,,22212,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG THORAC,,,4280.43
Deidentified Maximum,,22220,CPT4/HCPCS,INCIS W/DISCECTOMY CERVICAL,,,6588.00
Deidentified Maximum,,22315,CPT4/HCPCS,CLOSED TX VERT FX W/MANJ,,,4280.43
Deidentified Maximum,,22328,CPT4/HCPCS,TREAT EACH ADD SPINE FX,,,5856.00
Deidentified Maximum,,22511,CPT4/HCPCS,PERQ LUMBOSACRAL INJECTION,,,9770.00
Deidentified Maximum,,22532,CPT4/HCPCS,LAT THORAX SPINE FUSION,,,4280.43
Deidentified Maximum,,22558,CPT4/HCPCS,LUMBAR SPINE FUSION,,,4891.93
Deidentified Maximum,,22610,CPT4/HCPCS,THORAX SPINE FUSION,,,5783.00
Deidentified Maximum,,22802,CPT4/HCPCS,POST FUSION 7-12 VERT SEG,,,8012.00
Deidentified Maximum,,22808,CPT4/HCPCS,ANT FUSION 2-3 VERT SEG,,,6588.00
Deidentified Maximum,,22819,CPT4/HCPCS,KYPHECTOMY 3 OR MORE,,,8012.00
Deidentified Maximum,,22850,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,,3544.00
Deidentified Maximum,,22859,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,,3544.00
Deidentified Maximum,,22861,CPT4/HCPCS,REVISE CERV ARTIFIC DISC,,,5783.00
Deidentified Maximum,,22869,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,,7007.00
Deidentified Maximum,,22904,CPT4/HCPCS,RADICAL RESECT ABD TUMOR<5CM,,,4891.93
Deidentified Maximum,,23105,CPT4/HCPCS,REMOVE SHOULDER JOINT LINING,,,6401.00
Deidentified Maximum,,23120,CPT4/HCPCS,PARTIAL REMOVAL COLLAR BONE,,,6876.92
Deidentified Maximum,,23130,CPT4/HCPCS,REMOVE SHOULDER BONE PART,,,6876.92
Deidentified Maximum,,23155,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,,6876.92
Deidentified Maximum,,23174,CPT4/HCPCS,REMOVE HUMERUS LESION,,,5138.00
Deidentified Maximum,,23220,CPT4/HCPCS,RESECT PROX HUMERUS TUMOR,,,5281.00
Deidentified Maximum,,23333,CPT4/HCPCS,REMOVE SHOULDER FB DEEP,,,4280.43
Deidentified Maximum,,23335,CPT4/HCPCS,SHOULDER PROSTHESIS REMOVAL,,,6401.00
Deidentified Maximum,,23350,CPT4/HCPCS,INJECTION FOR SHOULDER X-RAY,,,3000.00
Deidentified Maximum,,23395,CPT4/HCPCS,MUSCLE TRANSFER SHOULDER/ARM,,,6876.92
Deidentified Maximum,,23440,CPT4/HCPCS,REMOVE/TRANSPLANT TENDON,,,6401.00
Deidentified Maximum,,23473,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,,9548.65
Deidentified Maximum,,23520,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,3198.57
Deidentified Maximum,,23585,CPT4/HCPCS,TREAT SCAPULA FRACTURE,,,7007.00
Deidentified Maximum,,23600,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3198.57
Deidentified Maximum,,23660,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,,7007.00
Deidentified Maximum,,23670,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,,7007.00
Deidentified Maximum,,23931,CPT4/HCPCS,DRAINAGE OF ARM BURSA,,,4280.43
Deidentified Maximum,,24073,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP 5 CM/>,,,5856.00
Deidentified Maximum,,24079,CPT4/HCPCS,RESECT ARM/ELBOW TUM 5 CM/>,,,5856.00
Deidentified Maximum,,24100,CPT4/HCPCS,BIOPSY ELBOW JOINT LINING,,,4204.00
Deidentified Maximum,,24116,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,,5856.00
Deidentified Maximum,,24120,CPT4/HCPCS,REMOVE ELBOW LESION,,,5856.00
Deidentified Maximum,,24138,CPT4/HCPCS,REMOVE ELBOW BONE LESION,,,5138.00
Deidentified Maximum,,24145,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,,5856.00
Deidentified Maximum,,24300,CPT4/HCPCS,MANIPULATE ELBOW W/ANESTH,,,4000.00
Deidentified Maximum,,24330,CPT4/HCPCS,REVISION OF ARM MUSCLES,,,7007.00
Deidentified Maximum,,24332,CPT4/HCPCS,TENOLYSIS TRICEPS,,,5138.00
Deidentified Maximum,,24342,CPT4/HCPCS,REPAIR OF RUPTURED TENDON,,,6075.00
Deidentified Maximum,,24344,CPT4/HCPCS,RECONSTRUCT ELBOW LAT LIGMNT,,,9548.65
Deidentified Maximum,,24362,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,,6876.92
Deidentified Maximum,,24370,CPT4/HCPCS,REVISE RECONST ELBOW JOINT,,,10119.00
Deidentified Maximum,,24498,CPT4/HCPCS,REINFORCE HUMERUS,,,7007.00
Deidentified Maximum,,24500,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3198.57
Deidentified Maximum,,24535,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3198.57
Deidentified Maximum,,24605,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,,4280.43
Deidentified Maximum,,24666,CPT4/HCPCS,TREAT RADIUS FRACTURE,,,7007.00
Deidentified Maximum,,24802,CPT4/HCPCS,FUSION/GRAFT OF ELBOW JOINT,,,7007.00
Deidentified Maximum,,25001,CPT4/HCPCS,INCISE FLEXOR CARPI RADIALIS,,,4891.93
Deidentified Maximum,,25020,CPT4/HCPCS,DECOMPRESS FOREARM 1 SPACE,,,5856.00
Deidentified Maximum,,25028,CPT4/HCPCS,DRAINAGE OF FOREARM LESION,,,4204.00
Deidentified Maximum,,25066,CPT4/HCPCS,BIOPSY FOREARM SOFT TISSUES,,,4280.43
Deidentified Maximum,,25071,CPT4/HCPCS,EXC FOREARM LES SC 3 CM/>,,,5856.00
Deidentified Maximum,,25076,CPT4/HCPCS,EXC FOREARM TUM DEEP < 3 CM,,,5856.00
Deidentified Maximum,,25078,CPT4/HCPCS,RESECT FORARM/WRIST TUM 3CM>,,,5856.00
Deidentified Maximum,,25085,CPT4/HCPCS,INCISION OF WRIST CAPSULE,,,5856.00
Deidentified Maximum,,25100,CPT4/HCPCS,BIOPSY OF WRIST JOINT,,,4280.43
Deidentified Maximum,,25101,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,,5856.00
Deidentified Maximum,,25125,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,,5856.00
Deidentified Maximum,,25126,CPT4/HCPCS,REMOVE/GRAFT FOREARM LESION,,,5856.00
Deidentified Maximum,,25145,CPT4/HCPCS,REMOVE FOREARM BONE LESION,,,5138.00
Deidentified Maximum,,25151,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,,5138.00
Deidentified Maximum,,25250,CPT4/HCPCS,REMOVAL OF WRIST PROSTHESIS,,,3198.57
Deidentified Maximum,,25272,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,5856.00
Deidentified Maximum,,25365,CPT4/HCPCS,REVISE RADIUS & ULNA,,,6075.00
Deidentified Maximum,,25430,CPT4/HCPCS,VASC GRAFT INTO CARPAL BONE,,,6075.00
Deidentified Maximum,,25445,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,,6876.92
Deidentified Maximum,,25450,CPT4/HCPCS,REVISION OF WRIST JOINT,,,6075.00
Deidentified Maximum,,25491,CPT4/HCPCS,REINFORCE ULNA,,,6075.00
Deidentified Maximum,,25500,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,2002.00
Deidentified Maximum,,25600,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,,2002.00
Deidentified Maximum,,25690,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,3198.57
Deidentified Maximum,,25810,CPT4/HCPCS,FUSION/GRAFT OF WRIST JOINT,,,7007.00
Deidentified Maximum,,25825,CPT4/HCPCS,FUSE HAND BONES WITH GRAFT,,,7007.00
Deidentified Maximum,,25905,CPT4/HCPCS,AMPUTATION OF FOREARM,,,6588.00
Deidentified Maximum,,26035,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,,6401.00
Deidentified Maximum,,26040,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,,6401.00
Deidentified Maximum,,26055,CPT4/HCPCS,INCISE FINGER TENDON SHEATH,,,4280.43
Deidentified Maximum,,26060,CPT4/HCPCS,INCISION OF FINGER TENDON,,,4280.43
Deidentified Maximum,,26110,CPT4/HCPCS,BIOPSY FINGER JOINT LINING,,,3198.57
Deidentified Maximum,,26111,CPT4/HCPCS,EXC HAND LES SC 1.5 CM/>,,,5856.00
Deidentified Maximum,,26230,CPT4/HCPCS,PARTIAL REMOVAL OF HAND BONE,,,9548.65
Deidentified Maximum,,26260,CPT4/HCPCS,RESECT PROX FINGER TUMOR,,,5856.00
Deidentified Maximum,,26390,CPT4/HCPCS,REVISE HAND/FINGER TENDON,,,6401.00
Deidentified Maximum,,26442,CPT4/HCPCS,RELEASE PALM & FINGER TENDON,,,5856.00
Deidentified Maximum,,26449,CPT4/HCPCS,RELEASE FOREARM/HAND TENDON,,,5856.00
Deidentified Maximum,,26460,CPT4/HCPCS,INCISE HAND/FINGER TENDON,,,5856.00
Deidentified Maximum,,26496,CPT4/HCPCS,REVISE THUMB TENDON,,,5856.00
Deidentified Maximum,,26502,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,,6401.00
Deidentified Maximum,,26517,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,,5856.00
Deidentified Maximum,,26535,CPT4/HCPCS,REVISE FINGER JOINT,,,6876.92
Deidentified Maximum,,26548,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,,6401.00
Deidentified Maximum,,26560,CPT4/HCPCS,REPAIR OF WEB FINGER,,,4280.43
Deidentified Maximum,,26568,CPT4/HCPCS,LENGTHEN METACARPAL/FINGER,,,5856.00
Deidentified Maximum,,26615,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,,7007.00
Deidentified Maximum,,26665,CPT4/HCPCS,TREAT THUMB FRACTURE,,,7007.00
Deidentified Maximum,,26700,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,,1678.00
Deidentified Maximum,,26715,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,,6401.00
Deidentified Maximum,,26765,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,6401.00
Deidentified Maximum,,26841,CPT4/HCPCS,FUSION OF THUMB,,,6401.00
Deidentified Maximum,,26860,CPT4/HCPCS,FUSION OF FINGER JOINT,,,5856.00
Deidentified Maximum,,26951,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,,4280.43
Deidentified Maximum,,26952,CPT4/HCPCS,AMPUTATION OF FINGER/THUMB,,,6401.00
Deidentified Maximum,,27003,CPT4/HCPCS,INCISION OF HIP TENDON,,,5856.00
Deidentified Maximum,,27043,CPT4/HCPCS,EXC HIP PELVIS LES SC 3 CM/>,,,5856.00
Deidentified Maximum,,27065,CPT4/HCPCS,REMOVE HIP BONE LES SUPER,,,6876.92
Deidentified Maximum,,27077,CPT4/HCPCS,RESECT HIP TUM W/INNOM BONE,,,9548.65
Deidentified Maximum,,27087,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,,5856.00
Deidentified Maximum,,27093,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,,3000.00
Deidentified Maximum,,27100,CPT4/HCPCS,TRANSFER OF ABDOMINAL MUSCLE,,,6401.00
Deidentified Maximum,,27134,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,,10119.00
Deidentified Maximum,,27147,CPT4/HCPCS,REVISION OF HIP BONE,,,5783.00
Deidentified Maximum,,27156,CPT4/HCPCS,REVISION OF HIP BONES,,,6588.00
Deidentified Maximum,,27181,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,,5783.00
Deidentified Maximum,,27194,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,,1678.88
Deidentified Maximum,,27215,CPT4/HCPCS,TREAT PELVIC FRACTURE(S),,,5029.00
Deidentified Maximum,,27220,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,,1678.88
Deidentified Maximum,,27228,CPT4/HCPCS,TREAT HIP FRACTURE(S),,,6049.05
Deidentified Maximum,,27290,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,,5281.00
Deidentified Maximum,,27301,CPT4/HCPCS,DRAIN THIGH/KNEE LESION,,,5856.00
Deidentified Maximum,,27305,CPT4/HCPCS,INCISE THIGH TENDON & FASCIA,,,4280.43
Deidentified Maximum,,27329,CPT4/HCPCS,RESECT THIGH/KNEE TUM < 5 CM,,,6401.00
Deidentified Maximum,,27332,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,,6401.00
Deidentified Maximum,,27340,CPT4/HCPCS,REMOVAL OF KNEECAP BURSA,,,5856.00
Deidentified Maximum,,27345,CPT4/HCPCS,REMOVAL OF KNEE CYST,,,6401.00
Deidentified Maximum,,27372,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,,9548.65
Deidentified Maximum,,27381,CPT4/HCPCS,REPAIR/GRAFT KNEECAP TENDON,,,5856.00
Deidentified Maximum,,27391,CPT4/HCPCS,INCISION OF THIGH TENDONS,,,4280.43
Deidentified Maximum,,27392,CPT4/HCPCS,INCISION OF THIGH TENDONS,,,5856.00
Deidentified Maximum,,27409,CPT4/HCPCS,REPAIR OF KNEE LIGAMENTS,,,6401.00
Deidentified Maximum,,27415,CPT4/HCPCS,OSTEOCHONDRAL KNEE ALLOGRAFT,,,12850.70
Deidentified Maximum,,27430,CPT4/HCPCS,REVISION OF THIGH MUSCLES,,,6401.00
Deidentified Maximum,,27435,CPT4/HCPCS,INCISION OF KNEE JOINT,,,6401.00
Deidentified Maximum,,27437,CPT4/HCPCS,REVISE KNEECAP,,,6401.00
Deidentified Maximum,,27442,CPT4/HCPCS,REVISION OF KNEE JOINT,,,6876.92
Deidentified Maximum,,27446,CPT4/HCPCS,REVISION OF KNEE JOINT,,,12850.70
Deidentified Maximum,,27448,CPT4/HCPCS,INCISION OF THIGH,,,5281.00
Deidentified Maximum,,27455,CPT4/HCPCS,REALIGNMENT OF KNEE,,,5281.00
Deidentified Maximum,,27465,CPT4/HCPCS,SHORTENING OF THIGH BONE,,,5281.00
Deidentified Maximum,,27468,CPT4/HCPCS,SHORTEN/LENGTHEN THIGHS,,,5281.00
Deidentified Maximum,,27472,CPT4/HCPCS,REPAIR/GRAFT OF THIGH,,,5281.00
Deidentified Maximum,,27479,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,,6588.00
Deidentified Maximum,,27485,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,,6840.00
Deidentified Maximum,,27501,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,4280.43
Deidentified Maximum,,27509,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,5856.00
Deidentified Maximum,,27519,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,,5281.00
Deidentified Maximum,,27558,CPT4/HCPCS,TREAT KNEE DISLOCATION,,,5138.00
Deidentified Maximum,,27591,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,,5281.00
Deidentified Maximum,,27596,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,4280.43
Deidentified Maximum,,27599,CPT4/HCPCS,LEG SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,27604,CPT4/HCPCS,DRAIN LOWER LEG BURSA,,,4280.43
Deidentified Maximum,,27613,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,,3198.57
Deidentified Maximum,,27620,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,,6401.00
Deidentified Maximum,,27630,CPT4/HCPCS,REMOVAL OF TENDON LESION,,,5856.00
Deidentified Maximum,,27634,CPT4/HCPCS,EXC LEG/ANKLE TUM DEP 5 CM/>,,,5856.00
Deidentified Maximum,,27652,CPT4/HCPCS,REPAIR/GRAFT ACHILLES TENDON,,,6075.00
Deidentified Maximum,,27664,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,,5138.00
Deidentified Maximum,,27680,CPT4/HCPCS,RELEASE OF LOWER LEG TENDON,,,5856.00
Deidentified Maximum,,27691,CPT4/HCPCS,REVISE LOWER LEG TENDON,,,6401.00
Deidentified Maximum,,27705,CPT4/HCPCS,INCISION OF TIBIA,,,6075.00
Deidentified Maximum,,27707,CPT4/HCPCS,INCISION OF FIBULA,,,5138.00
Deidentified Maximum,,27722,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,,7007.00
Deidentified Maximum,,27750,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,,3198.57
Deidentified Maximum,,27781,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,,3198.57
Deidentified Maximum,,27810,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,3198.57
Deidentified Maximum,,27824,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,,3198.57
Deidentified Maximum,,27827,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,,7007.00
Deidentified Maximum,,27829,CPT4/HCPCS,TREAT LOWER LEG JOINT,,,7007.00
Deidentified Maximum,,27846,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,,7007.00
Deidentified Maximum,,27870,CPT4/HCPCS,FUSION OF ANKLE JOINT OPEN,,,7007.00
Deidentified Maximum,,28001,CPT4/HCPCS,DRAINAGE OF BURSA OF FOOT,,,3656.00
Deidentified Maximum,,28003,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,,5856.00
Deidentified Maximum,,28008,CPT4/HCPCS,INCISION OF FOOT FASCIA,,,5856.00
Deidentified Maximum,,28011,CPT4/HCPCS,INCISION OF TOE TENDONS,,,5856.00
Deidentified Maximum,,28020,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,,4280.43
Deidentified Maximum,,28035,CPT4/HCPCS,DECOMPRESSION OF TIBIA NERVE,,,6401.00
Deidentified Maximum,,28047,CPT4/HCPCS,RESECT FOOT/TOE TUMOR 3 CM/>,,,5856.00
Deidentified Maximum,,28050,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,,4280.43
Deidentified Maximum,,28060,CPT4/HCPCS,PARTIAL REMOVAL FOOT FASCIA,,,4280.43
Deidentified Maximum,,28086,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,,4280.43
Deidentified Maximum,,28102,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,,7007.00
Deidentified Maximum,,28104,CPT4/HCPCS,REMOVAL OF FOOT LESION,,,4280.43
Deidentified Maximum,,28108,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,,4891.93
Deidentified Maximum,,28114,CPT4/HCPCS,REMOVAL OF METATARSAL HEADS,,,5856.00
Deidentified Maximum,,28119,CPT4/HCPCS,REMOVAL OF HEEL SPUR,,,6401.00
Deidentified Maximum,,28124,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,,4891.93
Deidentified Maximum,,28150,CPT4/HCPCS,REMOVAL OF TOE,,,5856.00
Deidentified Maximum,,28192,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,,4280.43
Deidentified Maximum,,28200,CPT4/HCPCS,REPAIR OF FOOT TENDON,,,5856.00
Deidentified Maximum,,28230,CPT4/HCPCS,INCISION OF FOOT TENDON(S),,,4891.93
Deidentified Maximum,,28234,CPT4/HCPCS,INCISION OF FOOT TENDON,,,4280.43
Deidentified Maximum,,28297,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,5856.00
Deidentified Maximum,,94644,CPT4/HCPCS,CBT 1ST HOUR,,,450.74
Deidentified Maximum,,94772,CPT4/HCPCS,BREATH RECORDING INFANT,,,0.00
Deidentified Maximum,,95044,CPT4/HCPCS,ALLERGY PATCH TESTS,,,105.08
Deidentified Maximum,,95056,CPT4/HCPCS,PHOTOSENSITIVITY TESTS,,,90.64
Deidentified Maximum,,95822,CPT4/HCPCS,EEG COMA OR SLEEP ONLY,,,1928.98
Deidentified Maximum,,95830,CPT4/HCPCS,INSERT ELECTRODES FOR EEG,,,1678.88
Deidentified Maximum,,95833,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,,287.13
Deidentified Maximum,,95857,CPT4/HCPCS,CHOLINESTERASE CHALLENGE,,,296.76
Deidentified Maximum,,95866,CPT4/HCPCS,MUSCLE TEST HEMIDIAPHRAGM,,,406.02
Deidentified Maximum,,95869,CPT4/HCPCS,MUSCLE TEST THOR PARASPINAL,,,113.92
Deidentified Maximum,,95913,CPT4/HCPCS,MOTOR&SENS 13/> NRV CND TEST,,,0.00
Deidentified Maximum,,95925,CPT4/HCPCS,SOMATOSENSORY TESTING,,,462.06
Deidentified Maximum,,95926,CPT4/HCPCS,SOMATOSENSORY TESTING,,,462.06
Deidentified Maximum,,95950,CPT4/HCPCS,AMBULATORY EEG MONITORING,,,2016.32
Deidentified Maximum,,95991,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,,1678.00
Deidentified Maximum,,96101,CPT4/HCPCS,PSYCHO TESTING BY PSYCH/PHYS,,,178.96
Deidentified Maximum,,96102,CPT4/HCPCS,PSYCHO TESTING BY TECHNICIAN,,,47.34
Deidentified Maximum,,96119,CPT4/HCPCS,NEUROPSYCH TESTING BY TEC,,,120.73
Deidentified Maximum,,96125,CPT4/HCPCS,COGNITIVE TEST BY HC PRO,,,242.58
Deidentified Maximum,,96153,CPT4/HCPCS,INTERVENE HLTH/BEHAVE GROUP,,,13.66
Deidentified Maximum,,96154,CPT4/HCPCS,INTERV HLTH/BEHAV FAM W/PT,,,42.53
Deidentified Maximum,,96366,CPT4/HCPCS,THER/PROPH/DIAG IV INF ADDON,,,194.16
Deidentified Maximum,,96369,CPT4/HCPCS,SC THER INFUSION UP TO 1 HR,,,1881.49
Deidentified Maximum,,96372,CPT4/HCPCS,THER/PROPH/DIAG INJ SC/IM,,,210.93
Deidentified Maximum,,96373,CPT4/HCPCS,THER/PROPH/DIAG INJ IA,,,152.41
Deidentified Maximum,,96401,CPT4/HCPCS,CHEMO ANTI-NEOPL SQ/IM,,,899.00
Deidentified Maximum,,96402,CPT4/HCPCS,CHEMO HORMON ANTINEOPL SQ/IM,,,345.66
Deidentified Maximum,,96411,CPT4/HCPCS,CHEMO IV PUSH ADDL DRUG,,,741.13
Deidentified Maximum,,96416,CPT4/HCPCS,CHEMO PROLONG INFUSE W/PUMP,,,1985.80
Deidentified Maximum,,96521,CPT4/HCPCS,REFILL/MAINT PORTABLE PUMP,,,1530.25
Deidentified Maximum,,96523,CPT4/HCPCS,IRRIG DRUG DELIVERY DEVICE,,,311.98
Deidentified Maximum,,96574,CPT4/HCPCS,DBRDMT PRMLG LES W/PDT,,,2002.00
Deidentified Maximum,,96910,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-B,,,978.46
Deidentified Maximum,,96913,CPT4/HCPCS,PHOTOCHEMOTHERAPY UV-A OR B,,,1796.58
Deidentified Maximum,,97012,CPT4/HCPCS,MECHANICAL TRACTION THERAPY,,,6766.00
Deidentified Maximum,,97033,CPT4/HCPCS,ELECTRIC CURRENT THERAPY,,,6766.00
Deidentified Maximum,,97116,CPT4/HCPCS,GAIT TRAINING THERAPY,,,6766.00
Deidentified Maximum,,97156,CPT4/HCPCS,FAM ADAPT BHV TX GDN PHY/QHP,,,305.00
Deidentified Maximum,,97161,CPT4/HCPCS,PT EVAL LOW COMPLEX 20 MIN,,,6766.00
Deidentified Maximum,,98960,CPT4/HCPCS,SELF-MGMT EDUC & TRAIN 1 PT,,,0.00
Deidentified Maximum,,99191,CPT4/HCPCS,SPECIAL PUMP SERVICES,,,5593.36
Deidentified Maximum,,A9503,CPT4/HCPCS,Tc99m medronate,,,108.78
Deidentified Maximum,,A9507,CPT4/HCPCS,In111 capromab,,,36778.72
Deidentified Maximum,,A9528,CPT4/HCPCS,Iodine I-131 iodide cap, dx,,,454.86
Deidentified Maximum,,A9550,CPT4/HCPCS,Tc99m gluceptate,,,161.36
Deidentified Maximum,,A9557,CPT4/HCPCS,Tc99m bicisate,,,3113.04
Deidentified Maximum,,A9571,CPT4/HCPCS,Indium IN-111 auto platelet,,,29920.38
Deidentified Maximum,,A9575,CPT4/HCPCS,Inj gadoterate meglumi 0.1ml,,,1.51
Deidentified Maximum,,A9581,CPT4/HCPCS,Gadoxetate disodium inj,,,125.07
Deidentified Maximum,,C8909,CPT4/HCPCS,MRA w/cont, chest,,,6766.00
Deidentified Maximum,,C8920,CPT4/HCPCS,MRA w/o fol w/cont, pelvis,,,6766.00
Deidentified Maximum,,C9601,CPT4/HCPCS,Perc drug-el cor stent bran,,,10119.00
Deidentified Maximum,,C9607,CPT4/HCPCS,Perc d-e cor revasc chro sin,,,10119.00
Deidentified Maximum,,C9608,CPT4/HCPCS,Perc d-e cor revasc chro add,,,10119.00
Deidentified Maximum,,C9732,CPT4/HCPCS,Insert ocular telescope pros,,,3544.00
Deidentified Maximum,,C9740,CPT4/HCPCS,Cysto impl 4 or more,,,7007.00
Deidentified Maximum,,G0104,CPT4/HCPCS,CA screen;flexi sigmoidscope,,,3198.57
Deidentified Maximum,,G0121,CPT4/HCPCS,Colon ca scrn not hi rsk ind,,,4280.43
Deidentified Maximum,,G0168,CPT4/HCPCS,Wound closure by adhesive,,,3198.57
Deidentified Maximum,,G0173,CPT4/HCPCS,Linear acc stereo radsur com,,,22311.90
Deidentified Maximum,,G0251,CPT4/HCPCS,Linear acc based stero radio,,,9210.50
Deidentified Maximum,,G0291,CPT4/HCPCS,Drug-eluting stents,each add,,,8012.00
Deidentified Maximum,,G0300,CPT4/HCPCS,Hhs/hospice of lpn ea 15 min,,,21405.00
Deidentified Maximum,,G0415,CPT4/HCPCS,Open tx post pelvic fxcture,,,5281.00
Deidentified Maximum,,G0428,CPT4/HCPCS,Collagen meniscus implant,,,1370.00
Deidentified Maximum,,G0453,CPT4/HCPCS,Cont intraop neuro monitor,,,1214.00
Deidentified Maximum,,G0455,CPT4/HCPCS,Fecal microbiota prep instil,,,3544.00
Deidentified Maximum,,G6001,CPT4/HCPCS,Echo guidance radiotherapy,,,159.34
Deidentified Maximum,,G6007,CPT4/HCPCS,Radiation treatment delivery,,,1902.52
Deidentified Maximum,,G6024,CPT4/HCPCS,Lesion removal colonoscopy,,,1678.00
Deidentified Maximum,,G6025,CPT4/HCPCS,Colonoscopy w/stent,,,1678.00
Deidentified Maximum,,G8979,CPT4/HCPCS,Mobility goal status,,,193.00
Deidentified Maximum,,G8980,CPT4/HCPCS,Mobility d/c status,,,193.00
Deidentified Maximum,,G8982,CPT4/HCPCS,Body pos goal status,,,193.00
Deidentified Maximum,,G8989,CPT4/HCPCS,Self care d/c status,,,193.00
Deidentified Maximum,,G8991,CPT4/HCPCS,Other pt/ot goal status,,,193.00
Deidentified Maximum,,G8992,CPT4/HCPCS,Other pt/ot d/c status,,,193.00
Deidentified Maximum,,G8995,CPT4/HCPCS,Sub pt/ot d/c status,,,193.00
Deidentified Maximum,,G8996,CPT4/HCPCS,Swallow current status,,,193.00
Deidentified Maximum,,G8997,CPT4/HCPCS,Swallow goal status,,,193.00
Deidentified Maximum,,G9158,CPT4/HCPCS,Motor speech d/c status,,,193.00
Deidentified Maximum,,G9165,CPT4/HCPCS,Atten current status,,,193.00
Deidentified Maximum,,G9186,CPT4/HCPCS,Motor speech goal status,,,193.00
Deidentified Maximum,,J1447,CPT4/HCPCS,Inj tbo filgrastim 1 microg,,,4.53
Deidentified Maximum,,J8600,CPT4/HCPCS,Melphalan oral 2 MG,,,76.60
Deidentified Maximum,,J9015,CPT4/HCPCS,Aldesleukin injection,,,39184.90
Deidentified Maximum,,J9070,CPT4/HCPCS,Cyclophosphamide 100 MG inj,,,281.98
Deidentified Maximum,,J9151,CPT4/HCPCS,Daunorubicin citrate inj,,,1924.27
Deidentified Maximum,,J9160,CPT4/HCPCS,Denileukin diftitox inj,,,12993.03
Deidentified Maximum,,J9202,CPT4/HCPCS,Goserelin acetate implant,,,4275.76
Deidentified Maximum,,J9215,CPT4/HCPCS,Interferon alfa-n3 inj,,,252.00
Deidentified Maximum,,J9230,CPT4/HCPCS,Mechlorethamine hcl inj,,,2591.14
Deidentified Maximum,,J9262,CPT4/HCPCS,Inj, omacetaxine mep, 0.01mg,,,24.69
Deidentified Maximum,,J9263,CPT4/HCPCS,Oxaliplatin,,,1.26
Deidentified Maximum,,J9270,CPT4/HCPCS,Plicamycin (mithramycin) inj,,,688.38
Deidentified Maximum,,J9371,CPT4/HCPCS,Inj, vincristine sul lip 1mg,,,26095.35
Deidentified Maximum,,J9400,CPT4/HCPCS,Inj, ziv-aflibercept, 1mg,,,71.23
Deidentified Maximum,,P9612,CPT4/HCPCS,Catheterize for urine spec,,,2002.00
Deidentified Maximum,,Q0085,CPT4/HCPCS,Chemo by both infusion and o,,,1405.15
Deidentified Maximum,,Q2017,CPT4/HCPCS,Teniposide, 50 mg,,,20882.14
Deidentified Maximum,,Q9954,CPT4/HCPCS,Oral MR contrast, 100 ml,,,87.61
Deidentified Maximum,,Q9959,CPT4/HCPCS,HOCM 150-199mg/ml iodine,1ml,,,0.75
Deidentified Maximum,,Q9965,CPT4/HCPCS,LOCM 100-199mg/ml iodine,1ml,,,7.47
Deidentified Maximum,,S0108,CPT4/HCPCS,Mercaptopurine 50 mg,,,25.20
Deidentified Maximum,,S0183,CPT4/HCPCS,Prochlorperazine 5 mg,,,3.02
Deidentified Maximum,,S2400,CPT4/HCPCS,Fetal surg congen hernia,,,8012.00
Deidentified Maximum,,47133,CPT4/HCPCS,REMOVAL OF DONOR LIVER,,,6876.92
Deidentified Maximum,,47135,CPT4/HCPCS,TRANSPLANTATION OF LIVER,,,12850.70
Deidentified Maximum,,47140,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,,6049.05
Deidentified Maximum,,47300,CPT4/HCPCS,SURGERY FOR LIVER LESION,,,5281.00
Deidentified Maximum,,47350,CPT4/HCPCS,REPAIR LIVER WOUND,,,5281.00
Deidentified Maximum,,47360,CPT4/HCPCS,REPAIR LIVER WOUND,,,5783.00
Deidentified Maximum,,47362,CPT4/HCPCS,REPAIR LIVER WOUND,,,5029.00
Deidentified Maximum,,47370,CPT4/HCPCS,LAPARO ABLATE LIVER TUMOR RF,,,10119.00
Deidentified Maximum,,47381,CPT4/HCPCS,OPEN ABLATE LIVER TUMOR CRYO,,,6840.00
Deidentified Maximum,,47382,CPT4/HCPCS,PERCUT ABLATE LIVER RF,,,9548.65
Deidentified Maximum,,47539,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,,8300.00
Deidentified Maximum,,47540,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,,8300.00
Deidentified Maximum,,47562,CPT4/HCPCS,LAPAROSCOPIC CHOLECYSTECTOMY,,,9548.65
Deidentified Maximum,,47711,CPT4/HCPCS,EXCISION OF BILE DUCT TUMOR,,,5783.00
Deidentified Maximum,,47800,CPT4/HCPCS,RECONSTRUCTION OF BILE DUCTS,,,5783.00
Deidentified Maximum,,47900,CPT4/HCPCS,SUTURE BILE DUCT INJURY,,,5281.00
Deidentified Maximum,,48400,CPT4/HCPCS,INJECTION INTRAOP ADD-ON,,,3198.57
Deidentified Maximum,,48511,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,,1678.88
Deidentified Maximum,,49000,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,,6401.00
Deidentified Maximum,,49002,CPT4/HCPCS,REOPENING OF ABDOMEN,,,5029.00
Deidentified Maximum,,49061,CPT4/HCPCS,DRAIN PERCUT RETROPER ABSC,,,1678.00
Deidentified Maximum,,49180,CPT4/HCPCS,BIOPSY ABDOMINAL MASS,,,3198.57
Deidentified Maximum,,49321,CPT4/HCPCS,LAPAROSCOPY BIOPSY,,,6401.00
Deidentified Maximum,,49405,CPT4/HCPCS,IMAGE CATH FLUID COLXN VISC,,,8300.00
Deidentified Maximum,,49406,CPT4/HCPCS,IMAGE CATH FLUID PERI/RETRO,,,8300.00
Deidentified Maximum,,49412,CPT4/HCPCS,INS DEVICE FOR RT GUIDE OPEN,,,5029.00
Deidentified Maximum,,49418,CPT4/HCPCS,INSERT TUN IP CATH PERC,,,8300.00
Deidentified Maximum,,49424,CPT4/HCPCS,ASSESS CYST CONTRAST INJECT,,,3000.00
Deidentified Maximum,,49428,CPT4/HCPCS,LIGATION OF SHUNT,,,3198.57
Deidentified Maximum,,49429,CPT4/HCPCS,REMOVAL OF SHUNT,,,5138.00
Deidentified Maximum,,49460,CPT4/HCPCS,FIX G/COLON TUBE W/DEVICE,,,3198.57
Deidentified Maximum,,49465,CPT4/HCPCS,FLUORO EXAM OF G/COLON TUBE,,,3198.57
Deidentified Maximum,,49501,CPT4/HCPCS,RPR ING HERNIA INIT BLOCKED,,,12850.70
Deidentified Maximum,,49550,CPT4/HCPCS,RPR REM HERNIA INIT REDUCE,,,6876.92
Deidentified Maximum,,49905,CPT4/HCPCS,OMENTAL FLAP INTRA-ABDOM,,,3198.57
Deidentified Maximum,,50021,CPT4/HCPCS,RENAL ABSCESS PERCUT DRAIN,,,1678.00
Deidentified Maximum,,50125,CPT4/HCPCS,EXPLORE AND DRAIN KIDNEY,,,3544.00
Deidentified Maximum,,50290,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,,5281.00
Deidentified Maximum,,50325,CPT4/HCPCS,PREP DONOR RENAL GRAFT,,,3544.00
Deidentified Maximum,,50328,CPT4/HCPCS,PREP RENAL GRAFT/ARTERIAL,,,1678.00
Deidentified Maximum,,50382,CPT4/HCPCS,CHANGE URETER STENT PERCUT,,,4280.43
Deidentified Maximum,,50391,CPT4/HCPCS,INSTLL RX AGNT INTO RNAL TUB,,,3000.00
Deidentified Maximum,,50392,CPT4/HCPCS,INSERT KIDNEY DRAIN,,,1678.00
Deidentified Maximum,,50393,CPT4/HCPCS,INSERT URETERAL TUBE,,,1678.00
Deidentified Maximum,,50394,CPT4/HCPCS,INJECTION FOR KIDNEY X-RAY,,,1678.00
Deidentified Maximum,,50395,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,,3198.57
Deidentified Maximum,,50436,CPT4/HCPCS,DILAT XST TRC NDURLGC PX,,,4204.00
Deidentified Maximum,,50570,CPT4/HCPCS,KIDNEY ENDOSCOPY,,,3198.57
Deidentified Maximum,,50572,CPT4/HCPCS,KIDNEY ENDOSCOPY,,,3198.57
Deidentified Maximum,,50574,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,,3198.57
Deidentified Maximum,,50606,CPT4/HCPCS,ENDOLUMINAL BX URTR RNL PLVS,,,3000.00
Deidentified Maximum,,50688,CPT4/HCPCS,CHANGE OF URETER TUBE/STENT,,,3198.57
Deidentified Maximum,,50695,CPT4/HCPCS,PLMT URETERAL STENT PRQ,,,8300.00
Deidentified Maximum,,50705,CPT4/HCPCS,URETERAL EMBOLIZATION/OCCL,,,3000.00
Deidentified Maximum,,50722,CPT4/HCPCS,RELEASE OF URETER,,,5281.00
Deidentified Maximum,,50785,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,,5281.00
Deidentified Maximum,,50900,CPT4/HCPCS,REPAIR OF URETER,,,5783.00
Deidentified Maximum,,50948,CPT4/HCPCS,LAPARO NEW URETER/BLADDER,,,12850.70
Deidentified Maximum,,50953,CPT4/HCPCS,ENDOSCOPY OF URETER,,,3198.57
Deidentified Maximum,,50970,CPT4/HCPCS,URETER ENDOSCOPY,,,3198.57
Deidentified Maximum,,50976,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,,3198.57
Deidentified Maximum,,51530,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,,5138.00
Deidentified Maximum,,51550,CPT4/HCPCS,PARTIAL REMOVAL OF BLADDER,,,3198.57
Deidentified Maximum,,51570,CPT4/HCPCS,REMOVAL OF BLADDER,,,6588.00
Deidentified Maximum,,51580,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,,6588.00
Deidentified Maximum,,51700,CPT4/HCPCS,IRRIGATION OF BLADDER,,,3000.00
Deidentified Maximum,,51702,CPT4/HCPCS,INSERT TEMP BLADDER CATH,,,2002.00
Deidentified Maximum,,51705,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,,3000.00
Deidentified Maximum,,51741,CPT4/HCPCS,ELECTRO-UROFLOWMETRY FIRST,,,1678.00
Deidentified Maximum,,51845,CPT4/HCPCS,REPAIR BLADDER NECK,,,6840.00
Deidentified Maximum,,51880,CPT4/HCPCS,REPAIR OF BLADDER OPENING,,,4204.00
Deidentified Maximum,,52005,CPT4/HCPCS,CYSTOSCOPY & URETER CATHETER,,,4280.43
Deidentified Maximum,,52250,CPT4/HCPCS,CYSTOSCOPY AND RADIOTRACER,,,6401.00
Deidentified Maximum,,52276,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,5856.00
Deidentified Maximum,,52283,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52301,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,5856.00
Deidentified Maximum,,52342,CPT4/HCPCS,CYSTO W/UP STRICTURE TX,,,5856.00
Deidentified Maximum,,52343,CPT4/HCPCS,CYSTO W/RENAL STRICTURE TX,,,5856.00
Deidentified Maximum,,52352,CPT4/HCPCS,CYSTOURETERO W/STONE REMOVE,,,6401.00
Deidentified Maximum,,52400,CPT4/HCPCS,CYSTOURETERO W/CONGEN REPR,,,5856.00
Deidentified Maximum,,52700,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,,4280.43
Deidentified Maximum,,53040,CPT4/HCPCS,DRAINAGE OF URETHRA ABSCESS,,,4280.43
Deidentified Maximum,,53405,CPT4/HCPCS,REVISE URETHRA STAGE 2,,,5138.00
Deidentified Maximum,,53442,CPT4/HCPCS,REMOVE/REVISE MALE SLING,,,5138.00
Deidentified Maximum,,53510,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,,4280.43
Deidentified Maximum,,53520,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,,5138.00
Deidentified Maximum,,53601,CPT4/HCPCS,DILATE URETHRA STRICTURE,,,3198.57
Deidentified Maximum,,53665,CPT4/HCPCS,DILATION OF URETHRA,,,4204.00
Deidentified Maximum,,53852,CPT4/HCPCS,PROSTATIC RF THERMOTX,,,12850.70
Deidentified Maximum,,53899,CPT4/HCPCS,UROLOGY SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,54115,CPT4/HCPCS,TREATMENT OF PENIS LESION,,,4204.00
Deidentified Maximum,,54125,CPT4/HCPCS,REMOVAL OF PENIS,,,3656.00
Deidentified Maximum,,54135,CPT4/HCPCS,REMOVE PENIS & NODES,,,5783.00
Deidentified Maximum,,54304,CPT4/HCPCS,REVISION OF PENIS,,,6075.00
Deidentified Maximum,,54308,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,6075.00
Deidentified Maximum,,54326,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,5856.00
Deidentified Maximum,,54408,CPT4/HCPCS,REPAIR MULTI-COMP PENIS PROS,,,6075.00
Deidentified Maximum,,54530,CPT4/HCPCS,REMOVAL OF TESTIS,,,6401.00
Deidentified Maximum,,54560,CPT4/HCPCS,EXPLORATION FOR TESTIS,,,6401.00
Deidentified Maximum,,54650,CPT4/HCPCS,ORCHIOPEXY (FOWLER-STEPHENS),,,6401.00
Deidentified Maximum,,54699,CPT4/HCPCS,LAPAROSCOPE PROC TESTIS,,,7902.34
Deidentified Maximum,,54840,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,,6401.00
Deidentified Maximum,,55200,CPT4/HCPCS,INCISION OF SPERM DUCT,,,4280.43
Deidentified Maximum,,55300,CPT4/HCPCS,PREPARE SPERM DUCT X-RAY,,,3656.00
Deidentified Maximum,,55500,CPT4/HCPCS,REMOVAL OF HYDROCELE,,,5856.00
Deidentified Maximum,,55530,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,,6401.00
Deidentified Maximum,,55535,CPT4/HCPCS,REVISE SPERMATIC CORD VEINS,,,6401.00
Deidentified Maximum,,55600,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,,4204.00
Deidentified Maximum,,55725,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,,4280.43
Deidentified Maximum,,55810,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,5281.00
Deidentified Maximum,,55845,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,7830.00
Deidentified Maximum,,55920,CPT4/HCPCS,PLACE NEEDLES PELVIC FOR RT,,,8300.00
Deidentified Maximum,,56625,CPT4/HCPCS,COMPLETE REMOVAL OF VULVA,,,9548.65
Deidentified Maximum,,56700,CPT4/HCPCS,PARTIAL REMOVAL OF HYMEN,,,4204.00
Deidentified Maximum,,57065,CPT4/HCPCS,DESTROY VAG LESIONS COMPLEX,,,4204.00
Deidentified Maximum,,57107,CPT4/HCPCS,REMOVE VAGINA TISSUE PART,,,6876.92
Deidentified Maximum,,57111,CPT4/HCPCS,REMOVE VAGINA TISSUE COMPL,,,5856.00
Deidentified Maximum,,57120,CPT4/HCPCS,CLOSURE OF VAGINA,,,6876.92
Deidentified Maximum,,57156,CPT4/HCPCS,INS VAG BRACHYTX DEVICE,,,7894.00
Deidentified Maximum,,57280,CPT4/HCPCS,SUSPENSION OF VAGINA,,,6840.00
Deidentified Maximum,,57283,CPT4/HCPCS,COLPOPEXY INTRAPERITONEAL,,,6840.00
Deidentified Maximum,,57296,CPT4/HCPCS,REVISE VAG GRAFT OPEN ABD,,,1678.00
Deidentified Maximum,,57300,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,,5856.00
Deidentified Maximum,,57307,CPT4/HCPCS,FISTULA REPAIR & COLOSTOMY,,,5783.00
Deidentified Maximum,,57320,CPT4/HCPCS,REPAIR BLADDER-VAGINA LESION,,,6876.92
Deidentified Maximum,,57415,CPT4/HCPCS,REMOVE VAGINAL FOREIGN BODY,,,4280.43
Deidentified Maximum,,57421,CPT4/HCPCS,EXAM/BIOPSY OF VAG W/SCOPE,,,3000.00
Deidentified Maximum,,57454,CPT4/HCPCS,BX/CURETT OF CERVIX W/SCOPE,,,3656.00
Deidentified Maximum,,57510,CPT4/HCPCS,CAUTERIZATION OF CERVIX,,,4280.43
Deidentified Maximum,,57511,CPT4/HCPCS,CRYOCAUTERY OF CERVIX,,,3198.57
Deidentified Maximum,,57513,CPT4/HCPCS,LASER SURGERY OF CERVIX,,,4280.43
Deidentified Maximum,,57520,CPT4/HCPCS,CONIZATION OF CERVIX,,,4280.43
Deidentified Maximum,,57522,CPT4/HCPCS,CONIZATION OF CERVIX,,,4280.43
Deidentified Maximum,,57800,CPT4/HCPCS,DILATION OF CERVICAL CANAL,,,4280.43
Deidentified Maximum,,58120,CPT4/HCPCS,DILATION AND CURETTAGE,,,4280.43
Deidentified Maximum,,58210,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,,8841.00
Deidentified Maximum,,58291,CPT4/HCPCS,VAG HYST INCL T/O COMPLEX,,,8012.00
Deidentified Maximum,,58321,CPT4/HCPCS,ARTIFICIAL INSEMINATION,,,1678.00
Deidentified Maximum,,58350,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,,5856.00
Deidentified Maximum,,58400,CPT4/HCPCS,SUSPENSION OF UTERUS,,,6840.00
Deidentified Maximum,,58541,CPT4/HCPCS,LSH UTERUS 250 G OR LESS,,,8300.00
Deidentified Maximum,,58545,CPT4/HCPCS,LAPAROSCOPIC MYOMECTOMY,,,12850.70
Deidentified Maximum,,58565,CPT4/HCPCS,HYSTEROSCOPY STERILIZATION,,,9548.65
Deidentified Maximum,,58720,CPT4/HCPCS,REMOVAL OF OVARY/TUBE(S),,,6840.00
Deidentified Maximum,,58800,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,,5856.00
Deidentified Maximum,,58940,CPT4/HCPCS,REMOVAL OF OVARY(S),,,6840.00
Deidentified Maximum,,58950,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,,5783.00
Deidentified Maximum,,58952,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,,6588.00
Deidentified Maximum,,59050,CPT4/HCPCS,FETAL MONITOR W/REPORT,,,1214.00
Deidentified Maximum,,59051,CPT4/HCPCS,FETAL MONITOR/INTERPRET ONLY,,,1370.00
Deidentified Maximum,,59300,CPT4/HCPCS,EPISIOTOMY OR VAGINAL REPAIR,,,4280.43
Deidentified Maximum,,59515,CPT4/HCPCS,CESAREAN DELIVERY,,,6840.00
Deidentified Maximum,,59525,CPT4/HCPCS,REMOVE UTERUS AFTER CESAREAN,,,5029.00
Deidentified Maximum,,59870,CPT4/HCPCS,EVACUATE MOLE OF UTERUS,,,6876.92
Deidentified Maximum,,60212,CPT4/HCPCS,PARTIAL THYROID EXCISION,,,9548.65
Deidentified Maximum,,60225,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,,9548.65
Deidentified Maximum,,60280,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,,7007.00
Deidentified Maximum,,60500,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,,9548.65
Deidentified Maximum,,61050,CPT4/HCPCS,REMOVE BRAIN CANAL FLUID,,,3198.57
Deidentified Maximum,,61151,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,,5281.00
Deidentified Maximum,,61330,CPT4/HCPCS,DECOMPRESS EYE SOCKET,,,9548.65
Deidentified Maximum,,61333,CPT4/HCPCS,EXPLORE ORBIT/REMOVE LESION,,,5029.00
Deidentified Maximum,,61510,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,6588.00
Deidentified Maximum,,61522,CPT4/HCPCS,REMOVAL OF BRAIN ABSCESS,,,6588.00
Deidentified Maximum,,61533,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,,5783.00
Deidentified Maximum,,61534,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,6588.00
Deidentified Maximum,,61536,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,6588.00
Deidentified Maximum,,61557,CPT4/HCPCS,INCISE SKULL/SUTURES,,,5783.00
Deidentified Maximum,,61567,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,,6588.00
Deidentified Maximum,,61570,CPT4/HCPCS,REMOVE FOREIGN BODY BRAIN,,,6588.00
Deidentified Maximum,,61606,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,8012.00
Deidentified Maximum,,61607,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,8012.00
Deidentified Maximum,,61609,CPT4/HCPCS,TRANSECT ARTERY SINUS,,,6588.00
Deidentified Maximum,,61623,CPT4/HCPCS,ENDOVASC TEMPORY VESSEL OCCL,,,10119.00
Deidentified Maximum,,61642,CPT4/HCPCS,DILAT IC VSPSM EA DIFF TER,,,5310.00
Deidentified Maximum,,61700,CPT4/HCPCS,BRAIN ANEURYSM REPR SIMPLE,,,7902.34
Deidentified Maximum,,61710,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,,5310.00
Deidentified Maximum,,61720,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,,6075.00
Deidentified Maximum,,61760,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,,5783.00
Deidentified Maximum,,61791,CPT4/HCPCS,TREAT TRIGEMINAL TRACT,,,5856.00
Deidentified Maximum,,61863,CPT4/HCPCS,IMPLANT NEUROELECTRODE,,,6588.00
Deidentified Maximum,,62141,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,,5783.00
Deidentified Maximum,,62161,CPT4/HCPCS,DISSECT BRAIN W/SCOPE,,,5310.00
Deidentified Maximum,,62162,CPT4/HCPCS,REMOVE COLLOID CYST W/SCOPE,,,5310.00
Deidentified Maximum,,62163,CPT4/HCPCS,ZNEUROENDOSCOPY W/FB REMOVAL,,,5310.00
Deidentified Maximum,,62165,CPT4/HCPCS,REMOVE PITUIT TUMOR W/SCOPE,,,6588.00
Deidentified Maximum,,62180,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,5310.00
Deidentified Maximum,,62194,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,,5310.00
Deidentified Maximum,,62220,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,6588.00
Deidentified Maximum,,62223,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,6588.00
Deidentified Maximum,,62225,CPT4/HCPCS,REPLACE/IRRIGATE CATHETER,,,5310.00
Deidentified Maximum,,62230,CPT4/HCPCS,REPLACE/REVISE BRAIN SHUNT,,,6075.00
Deidentified Maximum,,62252,CPT4/HCPCS,CSF SHUNT REPROGRAM,,,5310.00
Deidentified Maximum,,62264,CPT4/HCPCS,EPIDURAL LYSIS ON SINGLE DAY,,,5310.00
Deidentified Maximum,,62272,CPT4/HCPCS,THER SPI PNXR DRG CSF,,,5310.00
Deidentified Maximum,,62291,CPT4/HCPCS,NJX PX DISCOGRAPHY CRV/THRC,,,5310.00
Deidentified Maximum,,62302,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,,5310.00
Deidentified Maximum,,62318,CPT4/HCPCS,INJECT SPINE W/CATH CRV/THRC,,,1678.00
Deidentified Maximum,,62327,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,,5310.00
Deidentified Maximum,,62350,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,,6075.00
Deidentified Maximum,,62351,CPT4/HCPCS,IMPLANT SPINAL CANAL CATH,,,9548.65
Deidentified Maximum,,62361,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,,14317.00
Deidentified Maximum,,62367,CPT4/HCPCS,ANALYZE SPINE INFUS PUMP,,,5310.00
Deidentified Maximum,,62370,CPT4/HCPCS,ANL SP INF PMP W/MDREPRG&FIL,,,5310.00
Deidentified Maximum,,63011,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 SCRL,,,9548.65
Deidentified Maximum,,63016,CPT4/HCPCS,REMOVE SPINE LAMINA >2 THRC,,,9548.65
Deidentified Maximum,,63017,CPT4/HCPCS,REMOVE SPINE LAMINA >2 LMBR,,,9548.65
Deidentified Maximum,,63035,CPT4/HCPCS,SPINAL DISK SURGERY ADD-ON,,,9548.65
Deidentified Maximum,,63045,CPT4/HCPCS,REMOVE SPINE LAMINA 1 CRVL,,,9548.65
Deidentified Maximum,,63047,CPT4/HCPCS,REMOVE SPINE LAMINA 1 LMBR,,,9548.65
Deidentified Maximum,,63081,CPT4/HCPCS,REMOVE VERT BODY DCMPRN CRVL,,,7007.00
Deidentified Maximum,,63082,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,5310.00
Deidentified Maximum,,63085,CPT4/HCPCS,REMOVE VERT BODY DCMPRN THRC,,,5783.00
Deidentified Maximum,,63172,CPT4/HCPCS,DRAINAGE OF SPINAL CYST,,,5783.00
Deidentified Maximum,,63197,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX THRC,,,5783.00
Deidentified Maximum,,63199,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS THRC,,,5783.00
Deidentified Maximum,,63280,CPT4/HCPCS,BX/EXC IDRL SPINE LESN CRVL,,,5310.00
Deidentified Maximum,,63302,CPT4/HCPCS,REMOVE VERT XDRL BODY THRLMB,,,5783.00
Deidentified Maximum,,63305,CPT4/HCPCS,REMOVE VERT IDRL BODY THRC,,,6049.05
Deidentified Maximum,,63308,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,5310.00
Deidentified Maximum,,63655,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,12850.70
Deidentified Maximum,,63662,CPT4/HCPCS,REMOVE SPINE ELTRD PLATE,,,6000.00
Deidentified Maximum,,63685,CPT4/HCPCS,INSRT/REDO SPINE N GENERATOR,,,14317.00
Deidentified Maximum,,63688,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,,5310.00
Deidentified Maximum,,63700,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,,5310.00
Deidentified Maximum,,63740,CPT4/HCPCS,INSTALL SPINAL SHUNT,,,5783.00
Deidentified Maximum,,64400,CPT4/HCPCS,NJX AA&/STRD TRIGEMINAL NRV,,,5310.00
Deidentified Maximum,,64430,CPT4/HCPCS,NJX AA&/STRD PUDENDAL NERVE,,,5310.00
Deidentified Maximum,,64447,CPT4/HCPCS,NJX AA&/STRD FEMORAL NERVE,,,5310.00
Deidentified Maximum,,64448,CPT4/HCPCS,NJX AA&/STRD FEM NERVE NFS,,,5310.00
Deidentified Maximum,,64451,CPT4/HCPCS,NJX AA&/STRD NRV NRVTG SI JT,,,3000.00
Deidentified Maximum,,64454,CPT4/HCPCS,NJX AA&/STRD GNCLR NRV BRNCH,,,3000.00
Deidentified Maximum,,64479,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T 1,,,5310.00
Deidentified Maximum,,64480,CPT4/HCPCS,NJX AA&/STRD TFRM EPI C/T EA,,,5310.00
Deidentified Maximum,,64492,CPT4/HCPCS,INJ PARAVERT F JNT C/T 3 LEV,,,5310.00
Deidentified Maximum,,64520,CPT4/HCPCS,N BLOCK LUMBAR/THORACIC,,,5310.00
Deidentified Maximum,,64550,CPT4/HCPCS,APPL SURFACE NEUROSTIMULATOR,,,6766.00
Deidentified Maximum,,64555,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,12850.70
Deidentified Maximum,,64568,CPT4/HCPCS,INC FOR VAGUS N ELECT IMPL,,,24180.00
Deidentified Maximum,,64585,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,,5310.00
Deidentified Maximum,,64615,CPT4/HCPCS,CHEMODENERV MUSC MIGRAINE,,,5310.00
Deidentified Maximum,,64617,CPT4/HCPCS,CHEMODENER MUSCLE LARYNX EMG,,,5310.00
Deidentified Maximum,,64630,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,5310.00
Deidentified Maximum,,64634,CPT4/HCPCS,DESTROY C/TH FACET JNT ADDL,,,5310.00
Deidentified Maximum,,64643,CPT4/HCPCS,CHEMODENERV 1 EXTREM 1-4 EA,,,5310.00
Deidentified Maximum,,64644,CPT4/HCPCS,CHEMODENERV 1 EXTREM 5/> MUS,,,5310.00
Deidentified Maximum,,64646,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 1-5,,,5310.00
Deidentified Maximum,,64650,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,,5310.00
Deidentified Maximum,,64712,CPT4/HCPCS,REVISION OF SCIATIC NERVE,,,5310.00
Deidentified Maximum,,64714,CPT4/HCPCS,REVISE LOW BACK NERVE(S),,,5310.00
Deidentified Maximum,,64716,CPT4/HCPCS,REVISION OF CRANIAL NERVE,,,5856.00
Deidentified Maximum,,64722,CPT4/HCPCS,RELIEVE PRESSURE ON NERVE(S),,,5310.00
Deidentified Maximum,,64736,CPT4/HCPCS,INCISION OF CHIN NERVE,,,5310.00
Deidentified Maximum,,64744,CPT4/HCPCS,INCISE NERVE BACK OF HEAD,,,5310.00
Deidentified Maximum,,64760,CPT4/HCPCS,INCISION OF VAGUS NERVE,,,5783.00
Deidentified Maximum,,64774,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,,5310.00
Deidentified Maximum,,64809,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,,5310.00
Deidentified Maximum,,64822,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,,6049.05
Deidentified Maximum,,64866,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,,5310.00
Deidentified Maximum,,64902,CPT4/HCPCS,NERVE GRAFT ADD-ON,,,5310.00
Deidentified Maximum,,65125,CPT4/HCPCS,REVISE OCULAR IMPLANT,,,5310.00
Deidentified Maximum,,65155,CPT4/HCPCS,REINSERT OCULAR IMPLANT,,,5856.00
Deidentified Maximum,,65220,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,5310.00
Deidentified Maximum,,65222,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,5310.00
Deidentified Maximum,,65420,CPT4/HCPCS,REMOVAL OF EYE LESION,,,5310.00
Deidentified Maximum,,65710,CPT4/HCPCS,CORNEAL TRANSPLANT,,,9548.65
Deidentified Maximum,,65757,CPT4/HCPCS,PREP CORNEAL ENDO ALLOGRAFT,,,5310.00
Deidentified Maximum,,65760,CPT4/HCPCS,REVISION OF CORNEA,,,9548.65
Deidentified Maximum,,65765,CPT4/HCPCS,REVISION OF CORNEA,,,9548.65
Deidentified Maximum,,65771,CPT4/HCPCS,RADIAL KERATOTOMY,,,9548.65
Deidentified Maximum,,65820,CPT4/HCPCS,RELIEVE INNER EYE PRESSURE,,,5310.00
Deidentified Maximum,,65850,CPT4/HCPCS,INCISION OF EYE,,,6401.00
Deidentified Maximum,,65855,CPT4/HCPCS,TRABECULOPLASTY LASER SURG,,,5310.00
Deidentified Maximum,,65930,CPT4/HCPCS,REMOVE BLOOD CLOT FROM EYE,,,6876.92
Deidentified Maximum,,66130,CPT4/HCPCS,REMOVE EYE LESION,,,9548.65
Deidentified Maximum,,66150,CPT4/HCPCS,GLAUCOMA SURGERY,,,6401.00
Deidentified Maximum,,66220,CPT4/HCPCS,REPAIR EYE LESION,,,4891.93
Deidentified Maximum,,66250,CPT4/HCPCS,FOLLOW-UP SURGERY OF EYE,,,5310.00
Deidentified Maximum,,66605,CPT4/HCPCS,REMOVAL OF IRIS,,,6075.00
Deidentified Maximum,,66682,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,,5310.00
Deidentified Maximum,,66920,CPT4/HCPCS,EXTRACTION OF LENS,,,6401.00
Deidentified Maximum,,66982,CPT4/HCPCS,XCAPSL CTRC RMVL CPLX WO ECP,,,9304.06
Deidentified Maximum,,66984,CPT4/HCPCS,XCAPSL CTRC RMVL W/O ECP,,,9304.06
Deidentified Maximum,,67040,CPT4/HCPCS,LASER TREATMENT OF RETINA,,,9548.65
Deidentified Maximum,,67107,CPT4/HCPCS,REPAIR DETACHED RETINA,,,6876.92
Deidentified Maximum,,67208,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,,6840.00
Deidentified Maximum,,67311,CPT4/HCPCS,REVISE EYE MUSCLE,,,5856.00
Deidentified Maximum,,67314,CPT4/HCPCS,REVISE EYE MUSCLE,,,6401.00
Deidentified Maximum,,67318,CPT4/HCPCS,REVISE EYE MUSCLE(S),,,6401.00
Deidentified Maximum,,67334,CPT4/HCPCS,REVISE EYE MUSCLE W/SUTURE,,,6401.00
Deidentified Maximum,,67346,CPT4/HCPCS,BIOPSY EYE MUSCLE,,,5310.00
Deidentified Maximum,,67399,CPT4/HCPCS,UNLISTED PX EXTRAOCULAR MUSC,,,6049.05
Deidentified Maximum,,67405,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,,6401.00
Deidentified Maximum,,67412,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,,6876.92
Deidentified Maximum,,67440,CPT4/HCPCS,EXPLORE/DRAIN EYE SOCKET,,,6876.92
Deidentified Maximum,,67450,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,,6876.92
Deidentified Maximum,,67515,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,,5310.00
Deidentified Maximum,,67808,CPT4/HCPCS,REMOVE EYELID LESION(S),,,5310.00
Deidentified Maximum,,67820,CPT4/HCPCS,REVISE EYELASHES,,,5310.00
Deidentified Maximum,,67950,CPT4/HCPCS,REVISION OF EYELID,,,5310.00
Deidentified Maximum,,67999,CPT4/HCPCS,REVISION OF EYELID,,,4280.43
Deidentified Maximum,,68320,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,,6401.00
Deidentified Maximum,,68360,CPT4/HCPCS,REVISE EYELID LINING,,,5310.00
Deidentified Maximum,,68399,CPT4/HCPCS,EYELID LINING SURGERY,,,3198.57
Deidentified Maximum,,68510,CPT4/HCPCS,BIOPSY OF TEAR GLAND,,,5310.00
Deidentified Maximum,,68720,CPT4/HCPCS,CREATE TEAR SAC DRAIN,,,6401.00
Deidentified Maximum,,68899,CPT4/HCPCS,TEAR DUCT SYSTEM SURGERY,,,3198.57
Deidentified Maximum,,69100,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR,,,5310.00
Deidentified Maximum,,69399,CPT4/HCPCS,OUTER EAR SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,69420,CPT4/HCPCS,INCISION OF EARDRUM,,,5856.00
Deidentified Maximum,,69502,CPT4/HCPCS,MASTOIDECTOMY,,,9548.65
Deidentified Maximum,,69530,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,,9548.65
Deidentified Maximum,,69552,CPT4/HCPCS,REMOVE EAR LESION,,,9548.65
Deidentified Maximum,,69637,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,,9548.65
Deidentified Maximum,,69642,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,9548.65
Deidentified Maximum,,69644,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,9548.65
Deidentified Maximum,,69660,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,,6876.92
Deidentified Maximum,,69666,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,,6401.00
Deidentified Maximum,,69667,CPT4/HCPCS,REPAIR MIDDLE EAR STRUCTURES,,,6401.00
Deidentified Maximum,,69745,CPT4/HCPCS,REPAIR FACIAL NERVE,,,6876.92
Deidentified Maximum,,69801,CPT4/HCPCS,INCISE INNER EAR,,,6876.92
Deidentified Maximum,,69950,CPT4/HCPCS,INCISE INNER EAR NERVE,,,9548.65
Deidentified Maximum,,70120,CPT4/HCPCS,X-RAY EXAM OF MASTOIDS,,,657.95
Deidentified Maximum,,70220,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,,400.29
Deidentified Maximum,,70250,CPT4/HCPCS,X-RAY EXAM OF SKULL,,,657.95
Deidentified Maximum,,70336,CPT4/HCPCS,MAGNETIC IMAGE JAW JOINT,,,6766.00
Deidentified Maximum,,70355,CPT4/HCPCS,PANORAMIC X-RAY OF JAWS,,,290.39
Deidentified Maximum,,70450,CPT4/HCPCS,CT HEAD/BRAIN W/O DYE,,,6766.00
Deidentified Maximum,,70486,CPT4/HCPCS,CT MAXILLOFACIAL W/O DYE,,,6766.00
Deidentified Maximum,,70491,CPT4/HCPCS,CT SOFT TISSUE NECK W/DYE,,,6766.00
Deidentified Maximum,,70498,CPT4/HCPCS,CT ANGIOGRAPHY NECK,,,6766.00
Deidentified Maximum,,70546,CPT4/HCPCS,MR ANGIOGRAPH HEAD W/O&W/DYE,,,11059.37
Deidentified Maximum,,70547,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/O DYE,,,6766.00
Deidentified Maximum,,70559,CPT4/HCPCS,MRI BRAIN W/O & W/DYE,,,8400.05
Deidentified Maximum,,71250,CPT4/HCPCS,CT THORAX DX C-,,,6766.00
Deidentified Maximum,,71275,CPT4/HCPCS,CT ANGIOGRAPHY CHEST,,,6766.00
Deidentified Maximum,,72040,CPT4/HCPCS,X-RAY EXAM NECK SPINE 2-3 VW,,,364.35
Deidentified Maximum,,72082,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 2/3 VW,,,657.95
Deidentified Maximum,,72128,CPT4/HCPCS,CT CHEST SPINE W/O DYE,,,6766.00
Deidentified Maximum,,72132,CPT4/HCPCS,CT LUMBAR SPINE W/DYE,,,6766.00
Deidentified Maximum,,72147,CPT4/HCPCS,MRI CHEST SPINE W/DYE,,,6773.29
Deidentified Maximum,,72190,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,,657.95
Deidentified Maximum,,72194,CPT4/HCPCS,CT PELVIS W/O & W/DYE,,,6766.00
Deidentified Maximum,,72202,CPT4/HCPCS,X-RAY EXAM SI JOINTS 3/> VWS,,,657.95
Deidentified Maximum,,72275,CPT4/HCPCS,EPIDUROGRAPHY,,,1099.20
Deidentified Maximum,,73050,CPT4/HCPCS,X-RAY EXAM OF SHOULDERS,,,364.35
Deidentified Maximum,,73060,CPT4/HCPCS,X-RAY EXAM OF HUMERUS,,,364.35
Deidentified Maximum,,73100,CPT4/HCPCS,X-RAY EXAM OF WRIST,,,364.35
Deidentified Maximum,,73120,CPT4/HCPCS,X-RAY EXAM OF HAND,,,657.95
Deidentified Maximum,,73202,CPT4/HCPCS,CT UPPR EXTREMITY W/O&W/DYE,,,6766.00
Deidentified Maximum,,73206,CPT4/HCPCS,CT ANGIO UPR EXTRM W/O&W/DYE,,,6766.00
Deidentified Maximum,,73501,CPT4/HCPCS,X-RAY EXAM HIP UNI 1 VIEW,,,364.35
Deidentified Maximum,,73510,CPT4/HCPCS,X-RAY EXAM OF HIP,,,0.00
Deidentified Maximum,,73562,CPT4/HCPCS,X-RAY EXAM OF KNEE 3,,,364.35
Deidentified Maximum,,74182,CPT4/HCPCS,MRI ABDOMEN W/DYE,,,6700.67
Deidentified Maximum,,74190,CPT4/HCPCS,X-RAY EXAM OF PERITONEUM,,,2909.34
Deidentified Maximum,,74210,CPT4/HCPCS,X-RAY XM PHRNX&/CRV ESOPH C+,,,596.78
Deidentified Maximum,,74230,CPT4/HCPCS,X-RAY XM SWLNG FUNCJ C+,,,658.55
Deidentified Maximum,,74250,CPT4/HCPCS,X-RAY XM SM INT 1CNTRST STD,,,726.85
Deidentified Maximum,,74262,CPT4/HCPCS,CT COLONOGRAPHY DX W/DYE,,,7442.81
Deidentified Maximum,,74263,CPT4/HCPCS,CT COLONOGRAPHY SCREENING,,,7866.22
Deidentified Maximum,,74270,CPT4/HCPCS,X-RAY XM COLON 1CNTRST STD,,,1179.80
Deidentified Maximum,,74363,CPT4/HCPCS,X-RAY BILE DUCT DILATION,,,6500.00
Deidentified Maximum,,74425,CPT4/HCPCS,UROGRAPHY ANTEGRADE RS&I,,,2256.65
Deidentified Maximum,,74485,CPT4/HCPCS,DILATION URTR/URT RS&I,,,10174.25
Deidentified Maximum,,74710,CPT4/HCPCS,X-RAY MEASUREMENT OF PELVIS,,,534.24
Deidentified Maximum,,75565,CPT4/HCPCS,CARD MRI VELOC FLOW MAPPING,,,2427.00
Deidentified Maximum,,75573,CPT4/HCPCS,CT HRT W/3D IMAGE CONGEN,,,2427.00
Deidentified Maximum,,75716,CPT4/HCPCS,ARTERY X-RAYS ARMS/LEGS,,,15447.85
Deidentified Maximum,,75756,CPT4/HCPCS,ARTERY X-RAYS CHEST,,,15447.85
Deidentified Maximum,,75774,CPT4/HCPCS,ARTERY X-RAY EACH VESSEL,,,6500.00
Deidentified Maximum,,75842,CPT4/HCPCS,VEIN X-RAY ADRENAL GLANDS,,,6344.13
Deidentified Maximum,,75885,CPT4/HCPCS,VEIN X-RAY LIVER W/HEMODYNAM,,,15447.85
Deidentified Maximum,,75891,CPT4/HCPCS,VEIN X-RAY LIVER,,,6344.13
Deidentified Maximum,,75902,CPT4/HCPCS,REMOVE CVA LUMEN OBSTRUCT,,,6500.00
Deidentified Maximum,,75958,CPT4/HCPCS,XRAY PLACE PROX EXT THOR AO,,,1572.06
Deidentified Maximum,,76979,CPT4/HCPCS,US TRGT DYN MBUBB EA ADDL,,,1520.40
Deidentified Maximum,,76983,CPT4/HCPCS,USE EA ADDL TARGET LESION,,,6500.00
Deidentified Maximum,,76998,CPT4/HCPCS,US GUIDE INTRAOP,,,6500.00
Deidentified Maximum,,77003,CPT4/HCPCS,FLUOROGUIDE FOR SPINE INJECT,,,6500.00
Deidentified Maximum,,77051,CPT4/HCPCS,COMPUTER DX MAMMOGRAM ADD-ON,,,533.54
Deidentified Maximum,,77055,CPT4/HCPCS,MAMMOGRAM ONE BREAST,,,0.00
Deidentified Maximum,,77058,CPT4/HCPCS,MRI ONE BREAST,,,10066.59
Deidentified Maximum,,77073,CPT4/HCPCS,X-RAYS BONE LENGTH STUDIES,,,657.95
Deidentified Maximum,,77080,CPT4/HCPCS,DXA BONE DENSITY AXIAL,,,739.03
Deidentified Maximum,,77261,CPT4/HCPCS,RADIATION THERAPY PLANNING,,,557.25
Deidentified Maximum,,77301,CPT4/HCPCS,RADIOTHERAPY DOSE PLAN IMRT,,,17206.15
Deidentified Maximum,,77307,CPT4/HCPCS,TELETHX ISODOSE PLAN CPLX,,,7894.00
Deidentified Maximum,,77318,CPT4/HCPCS,BRACHYTX ISODOSE COMPLEX,,,7894.00
Deidentified Maximum,,77423,CPT4/HCPCS,NEUTRON BEAM TX COMPLEX,,,2567.00
Deidentified Maximum,,77522,CPT4/HCPCS,PROTON TRMT SIMPLE W/COMP,,,10557.62
Deidentified Maximum,,78020,CPT4/HCPCS,THYROID MET UPTAKE,,,686.79
Deidentified Maximum,,78070,CPT4/HCPCS,PARATHYROID PLANAR IMAGING,,,1088.47
Deidentified Maximum,,78072,CPT4/HCPCS,PARATHYRD PLANAR W/SPECT&CT,,,2370.73
Deidentified Maximum,,78102,CPT4/HCPCS,BONE MARROW IMAGING LTD,,,1212.79
Deidentified Maximum,,78104,CPT4/HCPCS,BONE MARROW IMAGING BODY,,,2056.71
Deidentified Maximum,,78265,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,,4918.40
Deidentified Maximum,,78291,CPT4/HCPCS,LEVEEN/SHUNT PATENCY EXAM,,,1819.52
Deidentified Maximum,,78451,CPT4/HCPCS,HT MUSCLE IMAGE SPECT SING,,,2393.66
Deidentified Maximum,,78459,CPT4/HCPCS,MYOCRD IMG PET SINGLE STUDY,,,12600.00
Deidentified Maximum,,78580,CPT4/HCPCS,LUNG PERFUSION IMAGING,,,1727.81
Deidentified Maximum,,78610,CPT4/HCPCS,BRAIN FLOW IMAGING ONLY,,,1411.03
Deidentified Maximum,,78635,CPT4/HCPCS,CSF VENTRICULOGRAPHY,,,2529.82
Deidentified Maximum,,78708,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/DRUG,,,2248.40
Deidentified Maximum,,78725,CPT4/HCPCS,KIDNEY FUNCTION STUDY,,,905.65
Deidentified Maximum,,78808,CPT4/HCPCS,IV INJ RA DRUG DX STUDY,,,364.30
Deidentified Maximum,,79300,CPT4/HCPCS,NUCLR RX INTERSTIT COLLOID,,,2085.87
Deidentified Maximum,,79445,CPT4/HCPCS,NUCLEAR RX INTRA-ARTERIAL,,,1325.20
Deidentified Maximum,,80163,CPT4/HCPCS,ASSAY OF DIGOXIN FREE,,,129.02
Deidentified Maximum,,80178,CPT4/HCPCS,ASSAY OF LITHIUM,,,102.00
Deidentified Maximum,,80194,CPT4/HCPCS,ASSAY OF QUINIDINE,,,146.66
Deidentified Maximum,,80320,CPT4/HCPCS,DRUG SCREEN QUANTALCOHOLS,,,102.00
Deidentified Maximum,,80322,CPT4/HCPCS,ALCOHOLS BIOMARKERS 3/MORE,,,102.00
Deidentified Maximum,,80330,CPT4/HCPCS,ANALGESICS NON-OPIOID 3-5,,,102.00
Deidentified Maximum,,80331,CPT4/HCPCS,ANALGESICS NON-OPIOID 6/MORE,,,102.00
Deidentified Maximum,,80334,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 6/MORE,,,102.00
Deidentified Maximum,,80335,CPT4/HCPCS,ANTIDEPRESSANT TRICYCLIC 1/2,,,102.00
Deidentified Maximum,,80337,CPT4/HCPCS,TRICYCLIC & CYCLICALS 6/MORE,,,102.00
Deidentified Maximum,,80364,CPT4/HCPCS,OPIOID &OPIATE ANALOG 5/MORE,,,102.00
Deidentified Maximum,,80367,CPT4/HCPCS,DRUG SCREENING PROPOXYPHENE,,,102.00
Deidentified Maximum,,80376,CPT4/HCPCS,DRUG/SUBSTANCE NOS 4-6,,,102.00
Deidentified Maximum,,80400,CPT4/HCPCS,ACTH STIMULATION PANEL,,,327.76
Deidentified Maximum,,80415,CPT4/HCPCS,TOT ESTRADIOL RESPONSE PANEL,,,561.45
Deidentified Maximum,,80426,CPT4/HCPCS,GONADOTROPIN HORMONE PANEL,,,1491.08
Deidentified Maximum,,80438,CPT4/HCPCS,TRH STIMULATION PANEL,,,506.35
Deidentified Maximum,,80500,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,,139.94
Deidentified Maximum,,81005,CPT4/HCPCS,URINALYSIS,,,102.00
Deidentified Maximum,,81020,CPT4/HCPCS,URINALYSIS GLASS TEST,,,102.00
Deidentified Maximum,,81110,CPT4/HCPCS,HPA-6 GENOTYPING,,,1077.38
Deidentified Maximum,,81111,CPT4/HCPCS,HPA-9 GENOTYPING,,,1077.38
Deidentified Maximum,,81182,CPT4/HCPCS,ATXN8OS GEN DETC ABNOR ALLEL,,,978.18
Deidentified Maximum,,81186,CPT4/HCPCS,CACNA1A GEN KNOWN FAMIL VRNT,,,1322.32
Deidentified Maximum,,81190,CPT4/HCPCS,CSTB GENE KNOWN FAMIL VRNT,,,1322.32
Deidentified Maximum,,81203,CPT4/HCPCS,APC GENE DUP/DELET VARIANTS,,,2158.21
Deidentified Maximum,,81206,CPT4/HCPCS,BCR/ABL1 GENE MAJOR BP,,,490.47
Deidentified Maximum,,81207,CPT4/HCPCS,BCR/ABL1 GENE MINOR BP,,,436.38
Deidentified Maximum,,81216,CPT4/HCPCS,BRCA2 GENE FULL SEQ ALYS,,,5283.09
Deidentified Maximum,,81220,CPT4/HCPCS,CFTR GENE COM VARIANTS,,,4114.99
Deidentified Maximum,,81224,CPT4/HCPCS,CFTR GENE INTRON POLY T,,,294.67
Deidentified Maximum,,81227,CPT4/HCPCS,CYP2C9 GENE COM VARIANTS,,,778.93
Deidentified Maximum,,81231,CPT4/HCPCS,CYP3A5 GENE COMMON VARIANTS,,,1248.15
Deidentified Maximum,,81241,CPT4/HCPCS,F5 GENE,,,228.39
Deidentified Maximum,,81250,CPT4/HCPCS,G6PC GENE,,,524.83
Deidentified Maximum,,81252,CPT4/HCPCS,GJB2 GENE FULL SEQUENCE,,,800.85
Deidentified Maximum,,81260,CPT4/HCPCS,IKBKAP GENE,,,521.80
Deidentified Maximum,,81269,CPT4/HCPCS,HBA1/HBA2 GENE DUP/DEL VRNTS,,,1445.13
Deidentified Maximum,,81285,CPT4/HCPCS,FXN GENE CHARAC ALLELES,,,1962.32
Deidentified Maximum,,81295,CPT4/HCPCS,MSH2 GENE FULL SEQ,,,3024.00
Deidentified Maximum,,81301,CPT4/HCPCS,MICROSATELLITE INSTABILITY,,,1144.75
Deidentified Maximum,,81306,CPT4/HCPCS,NUDT15 GENE COMMON VARIANTS,,,2080.34
Deidentified Maximum,,81314,CPT4/HCPCS,PDGFRA GENE,,,2352.67
Deidentified Maximum,,81335,CPT4/HCPCS,TPMT GENE COM VARIANTS,,,1248.15
Deidentified Maximum,,81363,CPT4/HCPCS,HBB GENE DUP/DEL VARIANTS,,,1445.13
Deidentified Maximum,,81374,CPT4/HCPCS,HLA I TYPING 1 ANTIGEN LR,,,817.40
Deidentified Maximum,,81408,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 9,,,6048.00
Deidentified Maximum,,81413,CPT4/HCPCS,CAR ION CHNNLPATH INC 10 GNS,,,5728.63
Deidentified Maximum,,81420,CPT4/HCPCS,FETAL CHRMOML ANEUPLOIDY,,,4200.00
Deidentified Maximum,,81426,CPT4/HCPCS,GENOME SEQUENCE ANALYSIS,,,102.00
Deidentified Maximum,,81435,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,,4200.00
Deidentified Maximum,,81437,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,,4299.03
Deidentified Maximum,,81470,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,,6040.18
Deidentified Maximum,,81504,CPT4/HCPCS,ONCOLOGY TISSUE OF ORIGIN,,,3712.80
Deidentified Maximum,,81511,CPT4/HCPCS,FTL CGEN ABNOR FOUR ANAL,,,1029.00
Deidentified Maximum,,81538,CPT4/HCPCS,ONCOLOGY LUNG,,,15185.18
Deidentified Maximum,,82075,CPT4/HCPCS,ASSAY OF BREATH ETHANOL,,,102.00
Deidentified Maximum,,82104,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN PHENO,,,145.32
Deidentified Maximum,,82108,CPT4/HCPCS,ASSAY OF ALUMINUM,,,255.94
Deidentified Maximum,,82143,CPT4/HCPCS,AMNIOTIC FLUID SCAN,,,102.00
Deidentified Maximum,,82157,CPT4/HCPCS,ASSAY OF ANDROSTENEDIONE,,,294.16
Deidentified Maximum,,82172,CPT4/HCPCS,ASSAY OF APOLIPOPROTEIN,,,141.62
Deidentified Maximum,,82232,CPT4/HCPCS,ASSAY OF BETA-2 PROTEIN,,,162.54
Deidentified Maximum,,82261,CPT4/HCPCS,ASSAY OF BIOTINIDASE,,,169.51
Deidentified Maximum,,82271,CPT4/HCPCS,OCCULT BLOOD OTHER SOURCES,,,102.00
Deidentified Maximum,,82310,CPT4/HCPCS,ASSAY OF CALCIUM,,,102.00
Deidentified Maximum,,82382,CPT4/HCPCS,ASSAY URINE CATECHOLAMINES,,,172.78
Deidentified Maximum,,82435,CPT4/HCPCS,ASSAY OF BLOOD CHLORIDE,,,102.00
Deidentified Maximum,,82465,CPT4/HCPCS,ASSAY BLD/SERUM CHOLESTEROL,,,102.00
Deidentified Maximum,,82542,CPT4/HCPCS,COL CHROMOTOGRAPHY QUAL/QUAN,,,181.44
Deidentified Maximum,,82550,CPT4/HCPCS,ASSAY OF CK (CPK),,,102.00
Deidentified Maximum,,82585,CPT4/HCPCS,ASSAY OF CRYOFIBRINOGEN,,,102.00
Deidentified Maximum,,82633,CPT4/HCPCS,DESOXYCORTICOSTERONE,,,311.21
Deidentified Maximum,,82652,CPT4/HCPCS,VIT D 1 25-DIHYDROXY,,,386.81
Deidentified Maximum,,82657,CPT4/HCPCS,ENZYME CELL ACTIVITY,,,181.44
Deidentified Maximum,,82677,CPT4/HCPCS,ASSAY OF ESTRIOL,,,243.01
Deidentified Maximum,,82705,CPT4/HCPCS,FATS/LIPIDS FECES QUAL,,,102.00
Deidentified Maximum,,82776,CPT4/HCPCS,GALACTOSE TRANSFERASE TEST,,,102.00
Deidentified Maximum,,82785,CPT4/HCPCS,ASSAY OF IGE,,,165.47
Deidentified Maximum,,82938,CPT4/HCPCS,GASTRIN TEST,,,177.82
Deidentified Maximum,,82950,CPT4/HCPCS,GLUCOSE TEST,,,102.00
Deidentified Maximum,,82965,CPT4/HCPCS,ASSAY OF GDH ENZYME,,,102.00
Deidentified Maximum,,82978,CPT4/HCPCS,ASSAY OF GLUTATHIONE,,,143.22
Deidentified Maximum,,83006,CPT4/HCPCS,GROWTH STIMULATION GENE 2,,,213.69
Deidentified Maximum,,83018,CPT4/HCPCS,HEAVY METAL QUANT EACH NES,,,220.66
Deidentified Maximum,,83021,CPT4/HCPCS,HEMOGLOBIN CHROMOTOGRAPHY,,,181.44
Deidentified Maximum,,83036,CPT4/HCPCS,GLYCOSYLATED HEMOGLOBIN TEST,,,102.00
Deidentified Maximum,,83500,CPT4/HCPCS,ASSAY FREE HYDROXYPROLINE,,,227.55
Deidentified Maximum,,83582,CPT4/HCPCS,ASSAY OF KETOGENIC STEROIDS,,,142.38
Deidentified Maximum,,83586,CPT4/HCPCS,ASSAY 17- KETOSTEROIDS,,,128.68
Deidentified Maximum,,83661,CPT4/HCPCS,L/S RATIO FETAL LUNG,,,220.92
Deidentified Maximum,,83698,CPT4/HCPCS,ASSAY LIPOPROTEIN PLA2,,,341.04
Deidentified Maximum,,83704,CPT4/HCPCS,LIPOPROTEIN BLD QUAN PART,,,317.01
Deidentified Maximum,,83775,CPT4/HCPCS,ASSAY MALATE DEHYDROGENASE,,,102.00
Deidentified Maximum,,83885,CPT4/HCPCS,ASSAY OF NICKEL,,,246.20
Deidentified Maximum,,83916,CPT4/HCPCS,OLIGOCLONAL BANDS,,,202.10
Deidentified Maximum,,84078,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,,102.00
Deidentified Maximum,,84081,CPT4/HCPCS,ASSAY PHOSPHATIDYLGLYCEROL,,,165.98
Deidentified Maximum,,84106,CPT4/HCPCS,TEST FOR PORPHOBILINOGEN,,,102.00
Deidentified Maximum,,84133,CPT4/HCPCS,ASSAY OF URINE POTASSIUM,,,102.00
Deidentified Maximum,,84155,CPT4/HCPCS,ASSAY OF PROTEIN SERUM,,,102.00
Deidentified Maximum,,84156,CPT4/HCPCS,ASSAY OF PROTEIN URINE,,,102.00
Deidentified Maximum,,84157,CPT4/HCPCS,ASSAY OF PROTEIN OTHER,,,102.00
Deidentified Maximum,,84234,CPT4/HCPCS,ASSAY OF PROGESTERONE,,,651.84
Deidentified Maximum,,84235,CPT4/HCPCS,ASSAY OF ENDOCRINE HORMONE,,,525.84
Deidentified Maximum,,84270,CPT4/HCPCS,ASSAY OF SEX HORMONE GLOBUL,,,218.31
Deidentified Maximum,,84300,CPT4/HCPCS,ASSAY OF URINE SODIUM,,,102.00
Deidentified Maximum,,84307,CPT4/HCPCS,ASSAY OF SOMATOSTATIN,,,183.70
Deidentified Maximum,,84315,CPT4/HCPCS,BODY FLUID SPECIFIC GRAVITY,,,102.00
Deidentified Maximum,,84376,CPT4/HCPCS,SUGARS SINGLE QUAL,,,102.00
Deidentified Maximum,,84431,CPT4/HCPCS,THROMBOXANE URINE,,,168.75
Deidentified Maximum,,84446,CPT4/HCPCS,ASSAY OF VITAMIN E,,,142.46
Deidentified Maximum,,84450,CPT4/HCPCS,TRANSFERASE (AST) (SGOT),,,102.00
Deidentified Maximum,,84466,CPT4/HCPCS,ASSAY OF TRANSFERRIN,,,128.26
Deidentified Maximum,,84480,CPT4/HCPCS,ASSAY TRIIODOTHYRONINE (T3),,,142.46
Deidentified Maximum,,84481,CPT4/HCPCS,FREE ASSAY (FT-3),,,170.18
Deidentified Maximum,,84482,CPT4/HCPCS,T3 REVERSE,,,158.34
Deidentified Maximum,,84510,CPT4/HCPCS,ASSAY OF TYROSINE,,,104.49
Deidentified Maximum,,84520,CPT4/HCPCS,ASSAY OF UREA NITROGEN,,,102.00
Deidentified Maximum,,84545,CPT4/HCPCS,UREA-N CLEARANCE TEST,,,102.00
Deidentified Maximum,,84560,CPT4/HCPCS,ASSAY OF URINE/URIC ACID,,,102.00
Deidentified Maximum,,84578,CPT4/HCPCS,TEST URINE UROBILINOGEN,,,102.00
Deidentified Maximum,,84590,CPT4/HCPCS,ASSAY OF VITAMIN A,,,116.50
Deidentified Maximum,,85049,CPT4/HCPCS,AUTOMATED PLATELET COUNT,,,102.00
Deidentified Maximum,,85170,CPT4/HCPCS,BLOOD CLOT RETRACTION,,,102.00
Deidentified Maximum,,85250,CPT4/HCPCS,CLOT FACTOR IX PTC/CHRSTMAS,,,191.35
Deidentified Maximum,,85290,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN STAB,,,164.22
Deidentified Maximum,,85370,CPT4/HCPCS,FIBRINOGEN TEST,,,114.07
Deidentified Maximum,,85576,CPT4/HCPCS,BLOOD PLATELET AGGREGATION,,,215.88
Deidentified Maximum,,85613,CPT4/HCPCS,RUSSELL VIPER VENOM DILUTED,,,102.00
Deidentified Maximum,,86005,CPT4/HCPCS,ALLG SPEC IGE MULTIALLG SCR,,,102.00
Deidentified Maximum,,86022,CPT4/HCPCS,PLATELET ANTIBODIES,,,184.54
Deidentified Maximum,,86023,CPT4/HCPCS,IMMUNOGLOBULIN ASSAY,,,125.16
Deidentified Maximum,,86079,CPT4/HCPCS,PHYS BLOOD BANK SERV AUTHRJ,,,372.95
Deidentified Maximum,,86140,CPT4/HCPCS,C-REACTIVE PROTEIN,,,102.00
Deidentified Maximum,,86141,CPT4/HCPCS,C-REACTIVE PROTEIN HS,,,130.11
Deidentified Maximum,,86153,CPT4/HCPCS,CELL ENUMERATION PHYS INTERP,,,1260.00
Deidentified Maximum,,86156,CPT4/HCPCS,COLD AGGLUTININ SCREEN,,,102.00
Deidentified Maximum,,86160,CPT4/HCPCS,COMPLEMENT ANTIGEN,,,120.62
Deidentified Maximum,,86161,CPT4/HCPCS,COMPLEMENT/FUNCTION ACTIVITY,,,120.62
Deidentified Maximum,,86280,CPT4/HCPCS,HEMAGGLUTINATION INHIBITION,,,102.00
Deidentified Maximum,,86329,CPT4/HCPCS,IMMUNODIFFUSION NES,,,141.12
Deidentified Maximum,,86332,CPT4/HCPCS,IMMUNE COMPLEX ASSAY,,,244.94
Deidentified Maximum,,86334,CPT4/HCPCS,IMMUNOFIX E-PHORESIS SERUM,,,224.44
Deidentified Maximum,,86344,CPT4/HCPCS,LEUKOCYTE PHAGOCYTOSIS,,,102.00
Deidentified Maximum,,86360,CPT4/HCPCS,T CELL ABSOLUTE COUNT/RATIO,,,472.08
Deidentified Maximum,,86609,CPT4/HCPCS,BACTERIUM ANTIBODY,,,129.44
Deidentified Maximum,,86611,CPT4/HCPCS,BARTONELLA ANTIBODY,,,102.22
Deidentified Maximum,,86617,CPT4/HCPCS,LYME DISEASE ANTIBODY,,,155.65
Deidentified Maximum,,86618,CPT4/HCPCS,LYME DISEASE ANTIBODY,,,171.10
Deidentified Maximum,,86645,CPT4/HCPCS,CMV ANTIBODY IGM,,,169.25
Deidentified Maximum,,86651,CPT4/HCPCS,ENCEPHALITIS CALIFORN ANTBDY,,,132.55
Deidentified Maximum,,86658,CPT4/HCPCS,ENTEROVIRUS ANTIBODY,,,130.95
Deidentified Maximum,,86663,CPT4/HCPCS,EPSTEIN-BARR ANTIBODY,,,131.79
Deidentified Maximum,,86664,CPT4/HCPCS,EPSTEIN-BARR NUCLEAR ANTIGEN,,,153.72
Deidentified Maximum,,86682,CPT4/HCPCS,HELMINTH ANTIBODY,,,130.70
Deidentified Maximum,,86684,CPT4/HCPCS,HEMOPHILUS INFLUENZA ANTIBDY,,,159.26
Deidentified Maximum,,86687,CPT4/HCPCS,HTLV-I ANTIBODY,,,102.00
Deidentified Maximum,,86709,CPT4/HCPCS,HEPATITIS A IGM ANTIBODY,,,113.06
Deidentified Maximum,,86711,CPT4/HCPCS,JOHN CUNNINGHAM ANTIBODY,,,141.28
Deidentified Maximum,,86741,CPT4/HCPCS,NEISSERIA MENINGITIDIS,,,132.55
Deidentified Maximum,,86744,CPT4/HCPCS,NOCARDIA ANTIBODY,,,132.55
Deidentified Maximum,,86747,CPT4/HCPCS,PARVOVIRUS ANTIBODY,,,151.11
Deidentified Maximum,,86774,CPT4/HCPCS,TETANUS ANTIBODY,,,148.68
Deidentified Maximum,,86787,CPT4/HCPCS,VARICELLA-ZOSTER ANTIBODY,,,129.44
Deidentified Maximum,,86800,CPT4/HCPCS,THYROGLOBULIN ANTIBODY,,,159.76
Deidentified Maximum,,86804,CPT4/HCPCS,HEP C AB TEST CONFIRM,,,155.65
Deidentified Maximum,,86805,CPT4/HCPCS,LYMPHOCYTOTOXICITY ASSAY,,,434.95
Deidentified Maximum,,86833,CPT4/HCPCS,HLA CLASS II HIGH DEFIN QUAL,,,911.06
Deidentified Maximum,,86886,CPT4/HCPCS,COOMBS TEST INDIRECT TITER,,,102.00
Deidentified Maximum,,86905,CPT4/HCPCS,BLOOD TYPING RBC ANTIGENS,,,102.00
Deidentified Maximum,,86927,CPT4/HCPCS,PLASMA FRESH FROZEN,,,125.09
Deidentified Maximum,,86940,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS AUTO,,,102.00
Deidentified Maximum,,86950,CPT4/HCPCS,LEUKACYTE TRANSFUSION,,,625.50
Deidentified Maximum,,86976,CPT4/HCPCS,RBC SERUM PRETX ID DILUTION,,,204.20
Deidentified Maximum,,87101,CPT4/HCPCS,SKIN FUNGI CULTURE,,,102.00
Deidentified Maximum,,87116,CPT4/HCPCS,MYCOBACTERIA CULTURE,,,102.00
Deidentified Maximum,,87188,CPT4/HCPCS,MICROBE SUSCEPT MACROBROTH,,,102.00
Deidentified Maximum,,87267,CPT4/HCPCS,ENTEROVIRUS ANTIBODY DFA,,,102.00
Deidentified Maximum,,87276,CPT4/HCPCS,INFLUENZA A AG IF,,,102.00
Deidentified Maximum,,87278,CPT4/HCPCS,LEGION PNEUMOPHILIA AG IF,,,102.00
Deidentified Maximum,,87283,CPT4/HCPCS,RUBEOLA AG IF,,,102.00
Deidentified Maximum,,87290,CPT4/HCPCS,VARICELLA ZOSTER AG IF,,,102.00
Deidentified Maximum,,87339,CPT4/HCPCS,H PYLORI AG IA,,,102.00
Deidentified Maximum,,87350,CPT4/HCPCS,HEPATITIS BE AG IA,,,115.83
Deidentified Maximum,,87385,CPT4/HCPCS,HISTOPLASMA CAPSUL AG IA,,,102.00
Deidentified Maximum,,87391,CPT4/HCPCS,HIV-2 AG IA,,,177.32
Deidentified Maximum,,87420,CPT4/HCPCS,RESP SYNCYTIAL AG IA,,,102.00
Deidentified Maximum,,87472,CPT4/HCPCS,BARTONELLA DNA QUANT,,,430.41
Deidentified Maximum,,87480,CPT4/HCPCS,CANDIDA DNA DIR PROBE,,,201.51
Deidentified Maximum,,87483,CPT4/HCPCS,CNS DNA AMP PROBE TYPE 12-25,,,4082.06
Deidentified Maximum,,87491,CPT4/HCPCS,CHYLMD TRACH DNA AMP PROBE,,,352.63
Deidentified Maximum,,87493,CPT4/HCPCS,C DIFF AMPLIFIED PROBE,,,352.63
Deidentified Maximum,,87497,CPT4/HCPCS,CYTOMEG DNA QUANT,,,430.41
Deidentified Maximum,,87498,CPT4/HCPCS,ENTEROVIRUS PROBE&REVRS TRNS,,,352.63
Deidentified Maximum,,87507,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 12-25,,,4049.64
Deidentified Maximum,,87530,CPT4/HCPCS,HSV DNA QUANT,,,430.41
Deidentified Maximum,,87532,CPT4/HCPCS,HHV-6 DNA AMP PROBE,,,352.63
Deidentified Maximum,,87533,CPT4/HCPCS,HHV-6 DNA QUANT,,,419.49
Deidentified Maximum,,87542,CPT4/HCPCS,LEGION PNEUMO DNA QUANT,,,419.49
Deidentified Maximum,,87552,CPT4/HCPCS,MYCOBACTERIA DNA QUANT,,,430.41
Deidentified Maximum,,87555,CPT4/HCPCS,M.TUBERCULO DNA DIR PROBE,,,201.51
Deidentified Maximum,,87591,CPT4/HCPCS,N.GONORRHOEAE DNA AMP PROB,,,352.63
Deidentified Maximum,,87631,CPT4/HCPCS,RESP VIRUS 3-5 TARGETS,,,1259.07
Deidentified Maximum,,87640,CPT4/HCPCS,STAPH A DNA AMP PROBE,,,352.63
Deidentified Maximum,,87651,CPT4/HCPCS,STREP A DNA AMP PROBE,,,352.63
Deidentified Maximum,,87803,CPT4/HCPCS,CLOSTRIDIUM TOXIN A W/OPTIC,,,102.00
Deidentified Maximum,,87808,CPT4/HCPCS,TRICHOMONAS ASSAY W/OPTIC,,,102.00
Deidentified Maximum,,87900,CPT4/HCPCS,PHENOTYPE INFECT AGENT DRUG,,,1309.64
Deidentified Maximum,,88000,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,1692.93
Deidentified Maximum,,88020,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,,2918.15
Deidentified Maximum,,88025,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,,2823.49
Deidentified Maximum,,88027,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,,3012.91
Deidentified Maximum,,88045,CPT4/HCPCS,CORONERS AUTOPSY (NECROPSY),,,470.56
Deidentified Maximum,,88121,CPT4/HCPCS,CYTP URINE 3-5 PROBES CMPTR,,,4796.42
Deidentified Maximum,,88142,CPT4/HCPCS,CYTOPATH C/V THIN LAYER,,,203.53
Deidentified Maximum,,88164,CPT4/HCPCS,CYTOPATH TBS C/V MANUAL,,,106.17
Deidentified Maximum,,88167,CPT4/HCPCS,CYTOPATH TBS C/V SELECT,,,106.17
Deidentified Maximum,,88188,CPT4/HCPCS,FLOWCYTOMETRY/READ 9-15,,,644.70
Deidentified Maximum,,88275,CPT4/HCPCS,CYTOGENETICS 100-300,,,403.45
Deidentified Maximum,,88283,CPT4/HCPCS,CHROMOSOME BANDING STUDY,,,102.00
Deidentified Maximum,,88300,CPT4/HCPCS,SURGICAL PATH GROSS,,,194.12
Deidentified Maximum,,88305,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,,689.76
Deidentified Maximum,,88312,CPT4/HCPCS,SPECIAL STAINS GROUP 1,,,700.22
Deidentified Maximum,,88323,CPT4/HCPCS,MICROSLIDE CONSULTATION,,,510.80
Deidentified Maximum,,88358,CPT4/HCPCS,ANALYSIS TUMOR,,,282.91
Deidentified Maximum,,88361,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/COMPUT,,,1077.18
Deidentified Maximum,,88362,CPT4/HCPCS,NERVE TEASING PREPARATIONS,,,1693.83
Deidentified Maximum,,88366,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,,1158.81
Deidentified Maximum,,88373,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,,523.69
Deidentified Maximum,,88377,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,,2000.85
Deidentified Maximum,,88720,CPT4/HCPCS,BILIRUBIN TOTAL TRANSCUT,,,102.00
Deidentified Maximum,,89251,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,,8887.70
Deidentified Maximum,,89255,CPT4/HCPCS,PREPARE EMBRYO FOR TRANSFER,,,1713.51
Deidentified Maximum,,89258,CPT4/HCPCS,CRYOPRESERVATION EMBRYO(S),,,2610.72
Deidentified Maximum,,89310,CPT4/HCPCS,SEMEN ANALYSIS W/COUNT,,,102.00
Deidentified Maximum,,89330,CPT4/HCPCS,EVALUATION CERVICAL MUCUS,,,102.00
Deidentified Maximum,,89337,CPT4/HCPCS,CRYOPRESERVATION OOCYTE(S),,,3465.00
Deidentified Maximum,,90801,CPT4/HCPCS,PSY DX INTERVIEW,,,312.89
Deidentified Maximum,,90810,CPT4/HCPCS,INTAC PSYTX OFF 20-30 MIN,,,131.62
Deidentified Maximum,,90815,CPT4/HCPCS,INTAC PSYTX 75-80 W/E&M,,,288.06
Deidentified Maximum,,90817,CPT4/HCPCS,PSYTX HOSP 20-30 MIN W/E&M,,,185.31
Deidentified Maximum,,90828,CPT4/HCPCS,INTAC PSYTX HOSP 75-80 MIN,,,317.72
Deidentified Maximum,,90846,CPT4/HCPCS,FAMILY PSYTX W/O PT 50 MIN,,,223.03
Deidentified Maximum,,90865,CPT4/HCPCS,NARCOSYNTHESIS,,,361.17
Deidentified Maximum,,90868,CPT4/HCPCS,TCRANIAL MAGN STIM TX DELI,,,987.78
Deidentified Maximum,,90869,CPT4/HCPCS,TCRAN MAGN STIM REDETEMINE,,,3198.57
Deidentified Maximum,,90885,CPT4/HCPCS,PSY EVALUATION OF RECORDS,,,113.92
Deidentified Maximum,,90945,CPT4/HCPCS,DIALYSIS ONE EVALUATION,,,348.13
Deidentified Maximum,,91013,CPT4/HCPCS,ESOPHGL MOTIL W/STIM/PERFUS,,,1214.00
Deidentified Maximum,,91035,CPT4/HCPCS,G-ESOPH REFLX TST W/ELECTROD,,,4951.31
Deidentified Maximum,,91037,CPT4/HCPCS,ESOPH IMPED FUNCTION TEST,,,1270.42
Deidentified Maximum,,91133,CPT4/HCPCS,ELECTROGASTROGRAPHY W/TEST,,,1214.00
Deidentified Maximum,,91200,CPT4/HCPCS,LIVER ELASTOGRAPHY,,,287.92
Deidentified Maximum,,91299,CPT4/HCPCS,GASTROENTEROLOGY PROCEDURE,,,1214.00
Deidentified Maximum,,92014,CPT4/HCPCS,EYE EXAM&TX ESTAB PT 1/>VST,,,690.53
Deidentified Maximum,,92020,CPT4/HCPCS,SPECIAL EYE EVALUATION,,,167.63
Deidentified Maximum,,92225,CPT4/HCPCS,SPECIAL EYE EXAM INITIAL,,,1678.00
Deidentified Maximum,,92275,CPT4/HCPCS,ELECTRORETINOGRAPHY,,,734.62
Deidentified Maximum,,92314,CPT4/HCPCS,PRESCRIPTION OF CONTACT LENS,,,456.32
Deidentified Maximum,,92316,CPT4/HCPCS,RX CNTACT LENS APHAKIA 2 EYE,,,445.93
Deidentified Maximum,,92325,CPT4/HCPCS,MODIFICATION OF CONTACT LENS,,,196.50
Deidentified Maximum,,92340,CPT4/HCPCS,FIT SPECTACLES MONOFOCAL,,,340.85
Deidentified Maximum,,92341,CPT4/HCPCS,FIT SPECTACLES BIFOCAL,,,360.08
Deidentified Maximum,,92355,CPT4/HCPCS,FIT SPECTACLES COMPOUND LENS,,,2092.28
Deidentified Maximum,,92358,CPT4/HCPCS,APHAKIA PROSTH SERVICE TEMP,,,486.89
Deidentified Maximum,,92512,CPT4/HCPCS,NASAL FUNCTION STUDIES,,,556.59
Deidentified Maximum,,92521,CPT4/HCPCS,EVALUATION OF SPEECH FLUENCY,,,868.05
Deidentified Maximum,,92526,CPT4/HCPCS,ORAL FUNCTION THERAPY,,,6766.00
Deidentified Maximum,,92544,CPT4/HCPCS,OPTOKINETIC NYSTAGMUS TEST,,,354.50
Deidentified Maximum,,92547,CPT4/HCPCS,SUPPLEMENTAL ELECTRICAL TEST,,,577.53
Deidentified Maximum,,92583,CPT4/HCPCS,SELECT PICTURE AUDIOMETRY,,,460.50
Deidentified Maximum,,92596,CPT4/HCPCS,EAR PROTECTOR EVALUATION,,,308.08
Deidentified Maximum,,92601,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM <7,,,1669.01
Deidentified Maximum,,92602,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT <7,,,1163.78
Deidentified Maximum,,92603,CPT4/HCPCS,COCHLEAR IMPLT F/UP EXAM 7/>,,,1101.23
Deidentified Maximum,,92612,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) VID,,,1339.32
Deidentified Maximum,,92620,CPT4/HCPCS,AUDITORY FUNCTION 60 MIN,,,572.73
Deidentified Maximum,,92925,CPT4/HCPCS,PRQ CARD ANGIO/ATHRECT ADDL,,,8970.00
Deidentified Maximum,,92953,CPT4/HCPCS,TEMPORARY EXTERNAL PACING,,,1678.00
Deidentified Maximum,,92960,CPT4/HCPCS,CARDIOVERSION ELECTRIC EXT,,,3074.00
Deidentified Maximum,,92978,CPT4/HCPCS,ENDOLUMINL IVUS OCT C 1ST,,,2300.55
Deidentified Maximum,,92980,CPT4/HCPCS,INSERT INTRACORONARY STENT,,,8012.00
Deidentified Maximum,,92992,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,8841.00
Deidentified Maximum,,92996,CPT4/HCPCS,CORONARY ATHERECTOMY ADD-ON,,,3544.00
Deidentified Maximum,,93016,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,,184.54
Deidentified Maximum,,93225,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,,628.91
Deidentified Maximum,,93228,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,,203.11
Deidentified Maximum,,93282,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,,195.63
Deidentified Maximum,,93292,CPT4/HCPCS,WCD DEVICE INTERROGATE,,,104.74
Deidentified Maximum,,93298,CPT4/HCPCS,REM INTERROG DEV EVAL SCRMS,,,221.34
Deidentified Maximum,,93317,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,827.82
Deidentified Maximum,,93320,CPT4/HCPCS,DOPPLER ECHO EXAM HEART,,,876.00
Deidentified Maximum,,93457,CPT4/HCPCS,R HRT ART/GRFT ANGIO,,,9548.65
Deidentified Maximum,,93461,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,,9548.65
Deidentified Maximum,,93464,CPT4/HCPCS,EXERCISE W/HEMODYNAMIC MEAS,,,4613.00
Deidentified Maximum,,93530,CPT4/HCPCS,RT HEART CATH CONGENITAL,,,9548.65
Deidentified Maximum,,93531,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,,9548.65
Deidentified Maximum,,93567,CPT4/HCPCS,INJECT SUPRVLV AORTOGRAPHY,,,4613.00
Deidentified Maximum,,93580,CPT4/HCPCS,TRANSCATH CLOSURE OF ASD,,,10772.00
Deidentified Maximum,,93603,CPT4/HCPCS,RIGHT VENTRICULAR RECORDING,,,7530.00
Deidentified Maximum,,93613,CPT4/HCPCS,ELECTROPHYS MAP 3D ADD-ON,,,7530.00
Deidentified Maximum,,93620,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,7830.00
Deidentified Maximum,,93631,CPT4/HCPCS,HEART PACING MAPPING,,,7530.00
Deidentified Maximum,,93641,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,7830.00
Deidentified Maximum,,93644,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,5138.00
Deidentified Maximum,,93784,CPT4/HCPCS,AMBL BP MNTR W/SOFTWARE,,,757.90
Deidentified Maximum,,93799,CPT4/HCPCS,CARDIOVASCULAR PROCEDURE,,,7966.00
Deidentified Maximum,,93922,CPT4/HCPCS,UPR/L XTREMITY ART 2 LEVELS,,,937.78
Deidentified Maximum,,93931,CPT4/HCPCS,UPPER EXTREMITY STUDY,,,1400.78
Deidentified Maximum,,93990,CPT4/HCPCS,DOPPLER FLOW TESTING,,,1695.05
Deidentified Maximum,,94002,CPT4/HCPCS,VENT MGMT INPAT INIT DAY,,,10429.25
Deidentified Maximum,,94003,CPT4/HCPCS,VENT MGMT INPAT SUBQ DAY,,,10067.85
Deidentified Maximum,,94005,CPT4/HCPCS,HOME VENT MGMT SUPERVISION,,,356.20
Deidentified Maximum,,94013,CPT4/HCPCS,MEAS LUNG VOL THRU 2 YRS,,,98.70
Deidentified Maximum,,94016,CPT4/HCPCS,REVIEW PATIENT SPIROMETRY,,,89.87
Deidentified Maximum,,94060,CPT4/HCPCS,EVALUATION OF WHEEZING,,,514.99
Deidentified Maximum,,94070,CPT4/HCPCS,EVALUATION OF WHEEZING,,,1387.59
Deidentified Maximum,,94200,CPT4/HCPCS,LUNG FUNCTION TEST (MBC/MVV),,,205.34
Deidentified Maximum,,94452,CPT4/HCPCS,HAST W/REPORT,,,455.55
Deidentified Maximum,,94621,CPT4/HCPCS,CARDIOPULM EXERCISE TESTING,,,824.63
Deidentified Maximum,,94664,CPT4/HCPCS,EVALUATE PT USE OF INHALER,,,6766.00
Deidentified Maximum,,94690,CPT4/HCPCS,EXHALED AIR ANALYSIS,,,954.39
Deidentified Maximum,,94761,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,,57.89
Deidentified Maximum,,94770,CPT4/HCPCS,EXHALED CARBON DIOXIDE TEST,,,812.53
Deidentified Maximum,,95024,CPT4/HCPCS,ICUT ALLERGY TEST DRUG/BUG,,,76.20
Deidentified Maximum,,95028,CPT4/HCPCS,ICUT ALLERGY TEST-DELAYED,,,119.51
Deidentified Maximum,,95149,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,388.95
Deidentified Maximum,,95250,CPT4/HCPCS,CONT GLUC MNTR PHYS/QHP EQP,,,1842.07
Deidentified Maximum,,95801,CPT4/HCPCS,SLP STDY UNATND W/ANAL,,,3498.00
Deidentified Maximum,,95807,CPT4/HCPCS,SLEEP STUDY ATTENDED,,,5529.60
Deidentified Maximum,,95827,CPT4/HCPCS,EEG ALL NIGHT RECORDING,,,1163.16
Deidentified Maximum,,95829,CPT4/HCPCS,SURGERY ELECTROCORTICOGRAM,,,13947.35
Deidentified Maximum,,95832,CPT4/HCPCS,HAND MUSCLE TESTING MANUAL,,,166.84
Deidentified Maximum,,95852,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,,129.13
Deidentified Maximum,,95860,CPT4/HCPCS,MUSCLE TEST ONE LIMB,,,503.67
Deidentified Maximum,,95865,CPT4/HCPCS,MUSCLE TEST LARYNX,,,339.29
Deidentified Maximum,,95868,CPT4/HCPCS,MUSCLE TEST CRAN NERVE BILAT,,,356.99
Deidentified Maximum,,95872,CPT4/HCPCS,MUSCLE TEST ONE FIBER,,,308.87
Deidentified Maximum,,95885,CPT4/HCPCS,MUSC TST DONE W/NERV TST LIM,,,538.13
Deidentified Maximum,,95887,CPT4/HCPCS,MUSC TST DONE W/N TST NONEXT,,,576.62
Deidentified Maximum,,95903,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,,465.17
Deidentified Maximum,,95907,CPT4/HCPCS,MOTOR&/SENS 1-2 NRV CNDJ TST,,,0.00
Deidentified Maximum,,95912,CPT4/HCPCS,MOTOR&SEN 11-12 NRV CND TEST,,,0.00
Deidentified Maximum,,95922,CPT4/HCPCS,AUTONOMIC NRV ADRENRG INERVJ,,,186.09
Deidentified Maximum,,95933,CPT4/HCPCS,BLINK REFLEX TEST,,,404.31
Deidentified Maximum,,95934,CPT4/HCPCS,H-REFLEX TEST,,,113.92
Deidentified Maximum,,95938,CPT4/HCPCS,SOMATOSENSORY TESTING,,,3563.07
Deidentified Maximum,,95939,CPT4/HCPCS,C MOTOR EVOKED UPR&LWR LIMBS,,,4919.18
Deidentified Maximum,,95957,CPT4/HCPCS,EEG DIGITAL ANALYSIS,,,871.20
Deidentified Maximum,,95961,CPT4/HCPCS,ELECTRODE STIMULATION BRAIN,,,658.55
Deidentified Maximum,,95965,CPT4/HCPCS,MEG SPONTANEOUS,,,22488.95
Deidentified Maximum,,95966,CPT4/HCPCS,MEG EVOKED SINGLE,,,11263.71
Deidentified Maximum,,95972,CPT4/HCPCS,ALYS CPLX SP/PN NPGT W/PRGRM,,,638.69
Deidentified Maximum,,95973,CPT4/HCPCS,ANALYZE NEUROSTIM COMPLEX,,,326.56
Deidentified Maximum,,95978,CPT4/HCPCS,ANALYZE NEUROSTIM BRAIN/1H,,,1006.07
Deidentified Maximum,,95982,CPT4/HCPCS,IO GA N-STIM SUBSQ W/REPROG,,,106.78
Deidentified Maximum,,96000,CPT4/HCPCS,MOTION ANALYSIS VIDEO/3D,,,299.38
Deidentified Maximum,,96040,CPT4/HCPCS,GENETIC COUNSELING 30 MIN,,,470.75
Deidentified Maximum,,96111,CPT4/HCPCS,DEVELOPMENTAL TEST EXTEND,,,6766.00
Deidentified Maximum,,96116,CPT4/HCPCS,NUBHVL XM PHYS/QHP 1ST HR,,,279.51
Deidentified Maximum,,96118,CPT4/HCPCS,NEUROPSYCH TST BY PSYCH/PHYS,,,231.40
Deidentified Maximum,,96120,CPT4/HCPCS,NEUROPSYCH TST ADMIN W/COMP,,,51.36
Deidentified Maximum,,96152,CPT4/HCPCS,INTERVENE HLTH/BEHAVE INDIV,,,42.53
Deidentified Maximum,,96361,CPT4/HCPCS,HYDRATE IV INFUSION ADD-ON,,,165.30
Deidentified Maximum,,96367,CPT4/HCPCS,TX/PROPH/DG ADDL SEQ IV INF,,,343.32
Deidentified Maximum,,96371,CPT4/HCPCS,SC THER INFUSION RESET PUMP,,,985.61
Deidentified Maximum,,96377,CPT4/HCPCS,APPLICATON ON-BODY INJECTOR,,,2002.00
Deidentified Maximum,,96423,CPT4/HCPCS,CHEMO IA INFUSE EACH ADDL HR,,,927.09
Deidentified Maximum,,96425,CPT4/HCPCS,CHEMOTHERAPY INFUSION METHOD,,,2207.13
Deidentified Maximum,,96567,CPT4/HCPCS,PDT DSTR PRMLG LES SKN,,,1815.69
Deidentified Maximum,,97010,CPT4/HCPCS,HOT OR COLD PACKS THERAPY,,,6766.00
Deidentified Maximum,,97018,CPT4/HCPCS,PARAFFIN BATH THERAPY,,,6766.00
Deidentified Maximum,,97035,CPT4/HCPCS,ULTRASOUND THERAPY,,,6766.00
Deidentified Maximum,,97158,CPT4/HCPCS,GRP ADAPT BHV TX BY PHY/QHP,,,305.00
Deidentified Maximum,,97166,CPT4/HCPCS,OT EVAL MOD COMPLEX 45 MIN,,,6766.00
Deidentified Maximum,,97168,CPT4/HCPCS,OT RE-EVAL EST PLAN CARE,,,6766.00
Deidentified Maximum,,97172,CPT4/HCPCS,ATHLETIC TRN RE-EVAL PLAN CR,,,305.00
Deidentified Maximum,,97546,CPT4/HCPCS,WORK HARDENING ADD-ON,,,312.98
Deidentified Maximum,,97598,CPT4/HCPCS,RMVL DEVITAL TIS ADDL 20CM/<,,,6766.00
Deidentified Maximum,,97602,CPT4/HCPCS,WOUND(S) CARE NON-SELECTIVE,,,6766.00
Deidentified Maximum,,97606,CPT4/HCPCS,NEG PRESS WOUND TX >50 CM,,,6766.00
Deidentified Maximum,,97761,CPT4/HCPCS,PROSTHETIC TRAING 1ST ENC,,,6766.00
Deidentified Maximum,,97762,CPT4/HCPCS,C/O FOR ORTHOTIC/PROSTH USE,,,359.31
Deidentified Maximum,,99172,CPT4/HCPCS,OCULAR FUNCTION SCREEN,,,262.31
Deidentified Maximum,,99183,CPT4/HCPCS,HYPERBARIC OXYGEN THERAPY,,,1628.32
Deidentified Maximum,,A9505,CPT4/HCPCS,TL201 thallium,,,1275.12
Deidentified Maximum,,A9508,CPT4/HCPCS,I131 iodobenguate, dx,,,6183.91
Deidentified Maximum,,A9516,CPT4/HCPCS,Iodine I-123 sod iodide mic,,,1513.09
Deidentified Maximum,,A9521,CPT4/HCPCS,Tc99m exametazime,,,12181.17
Deidentified Maximum,,A9537,CPT4/HCPCS,Tc99m mebrofenin,,,462.84
Deidentified Maximum,,A9540,CPT4/HCPCS,Tc99m MAA,,,250.99
Deidentified Maximum,,A9547,CPT4/HCPCS,In111 oxyquinoline,,,14960.14
Deidentified Maximum,,A9567,CPT4/HCPCS,Technetium TC-99m aerosol,,,28.55
Deidentified Maximum,,A9576,CPT4/HCPCS,Inj prohance multipack,,,11.92
Deidentified Maximum,,A9585,CPT4/HCPCS,Gadobutrol injection,,,3.10
Deidentified Maximum,,C2596,CPT4/HCPCS,Probe, robotic, water-jet,,,5029.00
Deidentified Maximum,,C5275,CPT4/HCPCS,Low cost skin substitute app,,,3656.00
Deidentified Maximum,,C5278,CPT4/HCPCS,Low cost skin substitute app,,,2002.00
Deidentified Maximum,,C8906,CPT4/HCPCS,MRI w/cont, breast, bi,,,6766.00
Deidentified Maximum,,C8910,CPT4/HCPCS,MRA w/o cont, chest,,,6766.00
Deidentified Maximum,,C8913,CPT4/HCPCS,MRA w/o cont, lwr ext,,,6766.00
Deidentified Maximum,,C8918,CPT4/HCPCS,MRA w/cont, pelvis,,,6766.00
Deidentified Maximum,,C9725,CPT4/HCPCS,Place endorectal app,,,7894.00
Deidentified Maximum,,C9738,CPT4/HCPCS,Blue light cysto imag agent,,,2002.00
Deidentified Maximum,,C9753,CPT4/HCPCS,Intraosseous destruct add'l,,,2002.00
Deidentified Maximum,,C9755,CPT4/HCPCS,Rf magnetic-guide av fistula,,,10119.00
Deidentified Maximum,,C9757,CPT4/HCPCS,Spine/lumbar disk surgery,,,7007.00
Deidentified Maximum,,G0106,CPT4/HCPCS,Colon CA screen;barium enema,,,1130.25
Deidentified Maximum,,G0186,CPT4/HCPCS,Dstry eye lesn,fdr vssl tech,,,2002.00
Deidentified Maximum,,G0268,CPT4/HCPCS,Removal of impacted wax md,,,1214.00
Deidentified Maximum,,G0277,CPT4/HCPCS,Hbot, full body chamber, 30m,,,4280.43
Deidentified Maximum,,G0288,CPT4/HCPCS,Recon, CTA for surg plan,,,5201.81
Deidentified Maximum,,G0389,CPT4/HCPCS,Ultrasound exam aaa screen,,,6500.00
Deidentified Maximum,,G0392,CPT4/HCPCS,AV fistula or graft arterial,,,12850.70
Deidentified Maximum,,G6003,CPT4/HCPCS,Radiation treatment delivery,,,1195.46
Deidentified Maximum,,G6009,CPT4/HCPCS,Radiation treatment delivery,,,1417.85
Deidentified Maximum,,G8981,CPT4/HCPCS,Body pos current status,,,193.00
Deidentified Maximum,,G8983,CPT4/HCPCS,Body pos d/c status,,,193.00
Deidentified Maximum,,G8984,CPT4/HCPCS,Carry current status,,,193.00
Deidentified Maximum,,G8985,CPT4/HCPCS,Carry goal status,,,193.00
Deidentified Maximum,,G8990,CPT4/HCPCS,Other pt/ot current status,,,193.00
Deidentified Maximum,,G8998,CPT4/HCPCS,Swallow d/c status,,,193.00
Deidentified Maximum,,G9159,CPT4/HCPCS,Lang comp current status,,,193.00
Deidentified Maximum,,G9162,CPT4/HCPCS,Lang express current status,,,193.00
Deidentified Maximum,,G9171,CPT4/HCPCS,Voice current status,,,193.00
Deidentified Maximum,,G9172,CPT4/HCPCS,Voice goal status,,,193.00
Deidentified Maximum,,G9176,CPT4/HCPCS,Speech lang d/c status,,,193.00
Deidentified Maximum,,J1190,CPT4/HCPCS,Dexrazoxane HCl injection,,,1675.80
Deidentified Maximum,,J2430,CPT4/HCPCS,Pamidronate disodium /30 MG,,,93.82
Deidentified Maximum,,J8530,CPT4/HCPCS,Cyclophosphamide oral 25 MG,,,22.51
Deidentified Maximum,,J8540,CPT4/HCPCS,Oral dexamethasone,,,0.16
Deidentified Maximum,,J8610,CPT4/HCPCS,Methotrexate oral 2.5 mg,,,1.93
Deidentified Maximum,,J9025,CPT4/HCPCS,Azacitidine injection,,,8.65
Deidentified Maximum,,J9185,CPT4/HCPCS,Fludarabine phosphate inj,,,406.30
Deidentified Maximum,,J9208,CPT4/HCPCS,Ifosfamide injection,,,226.46
Deidentified Maximum,,J9212,CPT4/HCPCS,Interferon alfacon-1 inj,,,80.80
Deidentified Maximum,,J9225,CPT4/HCPCS,Vantas implant,,,34952.31
Deidentified Maximum,,J9299,CPT4/HCPCS,Injection, nivolumab,,,238.89
Deidentified Maximum,,J9305,CPT4/HCPCS,Inj. pemetrexed nos 10mg,,,600.60
Deidentified Maximum,,J9320,CPT4/HCPCS,Streptozocin injection,,,2991.91
Deidentified Maximum,,J9370,CPT4/HCPCS,Vincristine sulfate 1 MG inj,,,41.41
Deidentified Maximum,,J9395,CPT4/HCPCS,Injection, Fulvestrant,,,720.80
Deidentified Maximum,,P9022,CPT4/HCPCS,Washed red blood cells unit,,,3628.00
Deidentified Maximum,,P9039,CPT4/HCPCS,RBC deglycerolized,,,3628.00
Deidentified Maximum,,Q0092,CPT4/HCPCS,Set up port xray equipment,,,158.00
Deidentified Maximum,,Q2050,CPT4/HCPCS,Doxorubicin inj 10mg,,,2507.14
Deidentified Maximum,,Q9951,CPT4/HCPCS,LOCM >= 400 mg/ml iodine,1ml,,,10.08
Deidentified Maximum,,Q9967,CPT4/HCPCS,LOCM 300-399mg/ml iodine,1ml,,,1.00
Deidentified Maximum,,Q9982,CPT4/HCPCS,flutemetamol f18 diagnostic,,,27609.12
Deidentified Maximum,,S0156,CPT4/HCPCS,Exemestane, 25 mg,,,72.49
Deidentified Maximum,,S0178,CPT4/HCPCS,Lomustine 10 mg,,,761.03
Deidentified Maximum,,S2351,CPT4/HCPCS,Diskectomy, anterior, with d,,,1678.88
Deidentified Maximum,,S2405,CPT4/HCPCS,Fetal surg sacrococ teratoma,,,8012.00
Deidentified Maximum,,S2409,CPT4/HCPCS,Fetal surg noc,,,8012.00
Deidentified Maximum,,93654,CPT4/HCPCS,EP & ABLATE VENTRIC TACHY,,,9548.65
Deidentified Maximum,,93660,CPT4/HCPCS,TILT TABLE EVALUATION,,,1214.00
Deidentified Maximum,,93662,CPT4/HCPCS,INTRACARDIAC ECG (ICE),,,1718.19
Deidentified Maximum,,93740,CPT4/HCPCS,TEMPERATURE GRADIENT STUDIES,,,81.01
Deidentified Maximum,,93798,CPT4/HCPCS,CARDIAC REHAB/MONITOR,,,225.37
Deidentified Maximum,,93930,CPT4/HCPCS,UPPER EXTREMITY STUDY,,,1924.76
Deidentified Maximum,,94012,CPT4/HCPCS,SPIRMTRY W/BRNCHDIL INF-2 YR,,,484.56
Deidentified Maximum,,94014,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,,377.79
Deidentified Maximum,,94645,CPT4/HCPCS,CBT EACH ADDL HOUR,,,6766.00
Deidentified Maximum,,94662,CPT4/HCPCS,NEG PRESS VENTILATION CNP,,,122.77
Deidentified Maximum,,94760,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,,27.32
Deidentified Maximum,,95004,CPT4/HCPCS,PERCUT ALLERGY SKIN TESTS,,,52.14
Deidentified Maximum,,95060,CPT4/HCPCS,EYE ALLERGY TESTS,,,176.47
Deidentified Maximum,,95070,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,,1109.93
Deidentified Maximum,,95144,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,95.45
Deidentified Maximum,,95805,CPT4/HCPCS,MULTIPLE SLEEP LATENCY TEST,,,7643.31
Deidentified Maximum,,95812,CPT4/HCPCS,EEG 41-60 MINUTES,,,1709.20
Deidentified Maximum,,95863,CPT4/HCPCS,MUSCLE TEST 3 LIMBS,,,476.50
Deidentified Maximum,,95867,CPT4/HCPCS,MUSCLE TEST CRAN NERV UNILAT,,,295.20
Deidentified Maximum,,95873,CPT4/HCPCS,GUIDE NERV DESTR ELEC STIM,,,104.30
Deidentified Maximum,,95875,CPT4/HCPCS,LIMB EXERCISE TEST,,,505.37
Deidentified Maximum,,95908,CPT4/HCPCS,MOTOR&/SENS 3-4 NRV CNDJ TST,,,0.00
Deidentified Maximum,,95909,CPT4/HCPCS,MOTOR&/SENS 5-6 NRV CNDJ TST,,,0.00
Deidentified Maximum,,95911,CPT4/HCPCS,MOTOR&SEN 9-10 NRV CNDJ TEST,,,0.00
Deidentified Maximum,,95921,CPT4/HCPCS,AUTONOMIC NRV PARASYM INERVJ,,,186.09
Deidentified Maximum,,95923,CPT4/HCPCS,AUTONOMIC NRV SYST FUNJ TEST,,,830.86
Deidentified Maximum,,95936,CPT4/HCPCS,H-REFLEX TEST,,,113.92
Deidentified Maximum,,95937,CPT4/HCPCS,NEUROMUSCULAR JUNCTION TEST,,,171.66
Deidentified Maximum,,95954,CPT4/HCPCS,EEG MONITORING/GIVING DRUGS,,,1583.17
Deidentified Maximum,,95967,CPT4/HCPCS,MEG EVOKED EACH ADDL,,,9507.03
Deidentified Maximum,,95971,CPT4/HCPCS,ALYS SMPL SP/PN NPGT W/PRGRM,,,355.43
Deidentified Maximum,,95975,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,,476.64
Deidentified Maximum,,96004,CPT4/HCPCS,PHYS REVIEW OF MOTION TESTS,,,496.67
Deidentified Maximum,,96103,CPT4/HCPCS,PSYCHO TESTING ADMIN BY COMP,,,51.36
Deidentified Maximum,,96150,CPT4/HCPCS,ASSESS HLTH/BEHAVE INIT,,,47.34
Deidentified Maximum,,96151,CPT4/HCPCS,ASSESS HLTH/BEHAVE SUBSEQ,,,47.34
Deidentified Maximum,,96155,CPT4/HCPCS,INTERV HLTH/BEHAV FAM NO PT,,,56.18
Deidentified Maximum,,96368,CPT4/HCPCS,THER/DIAG CONCURRENT INF,,,179.72
Deidentified Maximum,,96375,CPT4/HCPCS,TX/PRO/DX INJ NEW DRUG ADDON,,,256.72
Deidentified Maximum,,96405,CPT4/HCPCS,CHEMO INTRALESIONAL UP TO 7,,,264.85
Deidentified Maximum,,96450,CPT4/HCPCS,CHEMOTHERAPY INTO CNS,,,1607.45
Deidentified Maximum,,96522,CPT4/HCPCS,REFILL/MAINT PUMP/RESVR SYST,,,1332.97
Deidentified Maximum,,96900,CPT4/HCPCS,ULTRAVIOLET LIGHT THERAPY,,,277.51
Deidentified Maximum,,96912,CPT4/HCPCS,PHOTOCHEMOTHERAPY WITH UV-A,,,1261.56
Deidentified Maximum,,96932,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,,6049.05
Deidentified Maximum,,96933,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,,987.78
Deidentified Maximum,,97016,CPT4/HCPCS,VASOPNEUMATIC DEVICE THERAPY,,,6766.00
Deidentified Maximum,,97112,CPT4/HCPCS,NEUROMUSCULAR REEDUCATION,,,6766.00
Deidentified Maximum,,97129,CPT4/HCPCS,THER IVNTJ 1ST 15 MIN,,,6766.00
Deidentified Maximum,,97140,CPT4/HCPCS,MANUAL THERAPY 1/> REGIONS,,,6766.00
Deidentified Maximum,,97537,CPT4/HCPCS,COMMUNITY/WORK REINTEGRATION,,,305.00
Deidentified Maximum,,97755,CPT4/HCPCS,ASSISTIVE TECHNOLOGY ASSESS,,,142.78
Deidentified Maximum,,97804,CPT4/HCPCS,MEDICAL NUTRITION GROUP,,,95.45
Deidentified Maximum,,99184,CPT4/HCPCS,HYPOTHERMIA ILL NEONATE,,,987.78
Deidentified Maximum,,99195,CPT4/HCPCS,PHLEBOTOMY,,,1678.00
Deidentified Maximum,,99406,CPT4/HCPCS,BEHAV CHNG SMOKING 3-10 MIN,,,0.00
Deidentified Maximum,,A9500,CPT4/HCPCS,Tc99m sestamibi,,,893.08
Deidentified Maximum,,A9512,CPT4/HCPCS,Tc99m pertechnetate,,,58.80
Deidentified Maximum,,A9538,CPT4/HCPCS,Tc99m pyrophosphate,,,418.31
Deidentified Maximum,,A9552,CPT4/HCPCS,F18 fdg,,,4056.19
Deidentified Maximum,,A9553,CPT4/HCPCS,Cr51 chromate,,,4718.61
Deidentified Maximum,,A9554,CPT4/HCPCS,I125 iothalamate, dx,,,292.82
Deidentified Maximum,,A9558,CPT4/HCPCS,Xe133 xenon 10mci,,,1754.50
Deidentified Maximum,,A9566,CPT4/HCPCS,Tc99m fanolesomab,,,1736.44
Deidentified Maximum,,A9569,CPT4/HCPCS,Technetium TC-99m auto WBC,,,12181.17
Deidentified Maximum,,A9572,CPT4/HCPCS,Indium In-111 pentetreotide,,,47487.72
Deidentified Maximum,,A9599,CPT4/HCPCS,Radioph dx b amyloid pet nos,,,23007.60
Deidentified Maximum,,C5271,CPT4/HCPCS,Low cost skin substitute app,,,3656.00
Deidentified Maximum,,C5274,CPT4/HCPCS,Low cost skin substitute app,,,2002.00
Deidentified Maximum,,C8904,CPT4/HCPCS,Mri w/o cont, breast, uni,,,6766.00
Deidentified Maximum,,C8930,CPT4/HCPCS,Tte w or w/o contr, cont ecg,,,3198.57
Deidentified Maximum,,C9603,CPT4/HCPCS,Perc d-e cor stent ather br,,,10119.00
Deidentified Maximum,,C9739,CPT4/HCPCS,Cystoscopy prostatic imp 1-3,,,6401.00
Deidentified Maximum,,C9749,CPT4/HCPCS,Repair nasal stenosis w/imp,,,6401.00
Deidentified Maximum,,C9756,CPT4/HCPCS,Fluorescence lymph map w/icg,,,2002.00
Deidentified Maximum,,G0103,CPT4/HCPCS,PSA screening,,,0.00
Deidentified Maximum,,G0105,CPT4/HCPCS,Colorectal scrn; hi risk ind,,,4280.43
Deidentified Maximum,,G0239,CPT4/HCPCS,Oth resp proc, group,,,6766.00
Deidentified Maximum,,G0257,CPT4/HCPCS,Unsched dialysis ESRD pt hos,,,5900.00
Deidentified Maximum,,G0259,CPT4/HCPCS,Inject for sacroiliac joint,,,2002.00
Deidentified Maximum,,G0279,CPT4/HCPCS,Tomosynthesis, mammo,,,6500.00
Deidentified Maximum,,G0341,CPT4/HCPCS,Percutaneous islet celltrans,,,1678.00
Deidentified Maximum,,G0414,CPT4/HCPCS,Pelvic ring fx treat int fix,,,5281.00
Deidentified Maximum,,G0479,CPT4/HCPCS,Drug test presump not opt,,,0.00
Deidentified Maximum,,G0516,CPT4/HCPCS,Insert drug del implant, >=4,,,2002.00
Deidentified Maximum,,G2062,CPT4/HCPCS,Qual nonmd est pt 11-20m,,,6766.00
Deidentified Maximum,,G2063,CPT4/HCPCS,Qual nonmd est pt 21>min,,,6766.00
Deidentified Maximum,,G6005,CPT4/HCPCS,Radiation treatment delivery,,,1033.91
Deidentified Maximum,,G6018,CPT4/HCPCS,Ileoscopy w/stent,,,1678.00
Deidentified Maximum,,G6019,CPT4/HCPCS,Colonoscopy lesion removal,,,1678.00
Deidentified Maximum,,G6023,CPT4/HCPCS,Sigmoidoscopy w/stent,,,1678.00
Deidentified Maximum,,G6027,CPT4/HCPCS,Anoscopy hra w/spec collect,,,1678.00
Deidentified Maximum,,G6028,CPT4/HCPCS,Anoscopy hra w/biopsy,,,1678.00
Deidentified Maximum,,G8988,CPT4/HCPCS,Self care goal status,,,193.00
Deidentified Maximum,,G8993,CPT4/HCPCS,Sub pt/ot current status,,,193.00
Deidentified Maximum,,G9163,CPT4/HCPCS,Lang express goal status,,,193.00
Deidentified Maximum,,G9167,CPT4/HCPCS,Atten d/c status,,,193.00
Deidentified Maximum,,G9170,CPT4/HCPCS,Memory d/c status,,,193.00
Deidentified Maximum,,J0881,CPT4/HCPCS,Darbepoetin alfa, non-esrd,,,32.42
Deidentified Maximum,,J0894,CPT4/HCPCS,Decitabine injection,,,36.53
Deidentified Maximum,,J9019,CPT4/HCPCS,Erwinaze injection,,,3519.34
Deidentified Maximum,,J9020,CPT4/HCPCS,Asparaginase, NOS,,,509.54
Deidentified Maximum,,J9039,CPT4/HCPCS,Injection, blinatumomab,,,961.63
Deidentified Maximum,,J9055,CPT4/HCPCS,Cetuximab injection,,,536.25
Deidentified Maximum,,J9165,CPT4/HCPCS,Diethylstilbestrol injection,,,105.75
Deidentified Maximum,,J9178,CPT4/HCPCS,Inj, epirubicin hcl, 2 mg,,,9.49
Deidentified Maximum,,J9206,CPT4/HCPCS,Irinotecan injection,,,21.00
Deidentified Maximum,,J9209,CPT4/HCPCS,Mesna injection,,,18.81
Deidentified Maximum,,J9213,CPT4/HCPCS,Interferon alfa-2a inj,,,355.15
Deidentified Maximum,,J9260,CPT4/HCPCS,Methotrexate sodium inj,,,21.08
Deidentified Maximum,,J9261,CPT4/HCPCS,Nelarabine injection,,,1295.61
Deidentified Maximum,,J9267,CPT4/HCPCS,Paclitaxel injection,,,1.17
Deidentified Maximum,,J9268,CPT4/HCPCS,Pentostatin injection,,,17895.77
Deidentified Maximum,,J9271,CPT4/HCPCS,Inj pembrolizumab,,,426.46
Deidentified Maximum,,J9293,CPT4/HCPCS,Mitoxantrone hydrochl / 5 MG,,,235.87
Deidentified Maximum,,J9301,CPT4/HCPCS,Obinutuzumab inj,,,538.86
Deidentified Maximum,,J9310,CPT4/HCPCS,Rituximab injection,,,7860.38
Deidentified Maximum,,J9355,CPT4/HCPCS,Inj trastuzumab excl biosimi,,,898.04
Deidentified Maximum,,P9010,CPT4/HCPCS,Whole blood for transfusion,,,3628.00
Deidentified Maximum,,Q0035,CPT4/HCPCS,Cardiokymography,,,190.91
Deidentified Maximum,,Q3014,CPT4/HCPCS,Telehealth facility fee,,,6500.00
Deidentified Maximum,,Q9953,CPT4/HCPCS,Inj Fe-based MR contrast,1ml,,,122.22
Deidentified Maximum,,Q9958,CPT4/HCPCS,HOCM <=149 mg/ml iodine, 1ml,,,0.67
Deidentified Maximum,,Q9960,CPT4/HCPCS,HOCM 200-249mg/ml iodine,1ml,,,1.42
Deidentified Maximum,,Q9961,CPT4/HCPCS,HOCM 250-299mg/ml iodine,1ml,,,2.10
Deidentified Maximum,,Q9962,CPT4/HCPCS,HOCM 300-349mg/ml iodine,1ml,,,2.18
Deidentified Maximum,,Q9963,CPT4/HCPCS,HOCM 350-399mg/ml iodine,1ml,,,1.68
Deidentified Maximum,,Q9964,CPT4/HCPCS,HOCM>= 400mg/ml iodine, 1ml,,,2.68
Deidentified Maximum,,Q9983,CPT4/HCPCS,Florbetaben f18 diagnostic,,,23425.92
Deidentified Maximum,,S0117,CPT4/HCPCS,Tretinoin topical 5 g,,,73.58
Deidentified Maximum,,S0145,CPT4/HCPCS,Peg interferon alfa-2A/180,,,8546.24
Deidentified Maximum,,S0175,CPT4/HCPCS,Flutamide 125 mg,,,13.02
Deidentified Maximum,,S0179,CPT4/HCPCS,Megestrol 20 mg,,,3.10
Deidentified Maximum,,S2115,CPT4/HCPCS,Periacetabular osteotomy,,,5783.00
Deidentified Maximum,,S2152,CPT4/HCPCS,Solid organ transpl pkg,,,6588.00
Deidentified Maximum,,S2404,CPT4/HCPCS,Fetal surg myelomeningo,,,8012.00
Deidentified Maximum,,78700,CPT4/HCPCS,KIDNEY IMAGING MORPHOL,,,1536.91
Deidentified Maximum,,78801,CPT4/HCPCS,RP LOCLZJ TUM 2+AREA 1+D IMG,,,2128.88
Deidentified Maximum,,78815,CPT4/HCPCS,PET IMAGE W/CT SKULL-THIGH,,,18766.18
Deidentified Maximum,,79005,CPT4/HCPCS,NUCLEAR RX ORAL ADMIN,,,1317.13
Deidentified Maximum,,79101,CPT4/HCPCS,NUCLEAR RX IV ADMIN,,,7894.00
Deidentified Maximum,,79440,CPT4/HCPCS,NUCLEAR RX INTRA-ARTICULAR,,,1317.13
Deidentified Maximum,,80069,CPT4/HCPCS,RENAL FUNCTION PANEL,,,102.00
Deidentified Maximum,,80074,CPT4/HCPCS,ACUTE HEPATITIS PANEL,,,478.46
Deidentified Maximum,,80076,CPT4/HCPCS,HEPATIC FUNCTION PANEL,,,102.00
Deidentified Maximum,,80157,CPT4/HCPCS,ASSAY CARBAMAZEPINE FREE,,,133.22
Deidentified Maximum,,80169,CPT4/HCPCS,DRUG ASSAY EVEROLIMUS,,,133.72
Deidentified Maximum,,80180,CPT4/HCPCS,DRUG SCRN QUAN MYCOPHENOLATE,,,175.89
Deidentified Maximum,,80184,CPT4/HCPCS,ASSAY OF PHENOBARBITAL,,,109.28
Deidentified Maximum,,80186,CPT4/HCPCS,ASSAY OF PHENYTOIN FREE,,,138.26
Deidentified Maximum,,80188,CPT4/HCPCS,ASSAY OF PRIMIDONE,,,146.24
Deidentified Maximum,,80190,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,,168.25
Deidentified Maximum,,80307,CPT4/HCPCS,DRUG TEST PRSMV CHEM ANLYZR,,,569.85
Deidentified Maximum,,80326,CPT4/HCPCS,AMPHETAMINES 5 OR MORE,,,102.00
Deidentified Maximum,,80328,CPT4/HCPCS,ANABOLIC STEROID 3 OR MORE,,,102.00
Deidentified Maximum,,80338,CPT4/HCPCS,ANTIDEPRESSANT NOT SPECIFIED,,,102.00
Deidentified Maximum,,80342,CPT4/HCPCS,ANTIPSYCHOTICS NOS 1-3,,,102.00
Deidentified Maximum,,80347,CPT4/HCPCS,BENZODIAZEPINES 13 OR MORE,,,102.00
Deidentified Maximum,,80352,CPT4/HCPCS,CANNABINOID SYNTHETIC 7/MORE,,,102.00
Deidentified Maximum,,80353,CPT4/HCPCS,DRUG SCREENING COCAINE,,,102.00
Deidentified Maximum,,80354,CPT4/HCPCS,DRUG SCREENING FENTANYL,,,102.00
Deidentified Maximum,,80357,CPT4/HCPCS,KETAMINE AND NORKETAMINE,,,102.00
Deidentified Maximum,,80366,CPT4/HCPCS,DRUG SCREENING PREGABALIN,,,102.00
Deidentified Maximum,,80368,CPT4/HCPCS,SEDATIVE HYPNOTICS,,,102.00
Deidentified Maximum,,80369,CPT4/HCPCS,SKELETAL MUSCLE RELAXANT 1/2,,,102.00
Deidentified Maximum,,80372,CPT4/HCPCS,DRUG SCREENING TAPENTADOL,,,102.00
Deidentified Maximum,,80402,CPT4/HCPCS,ACTH STIMULATION PANEL,,,873.68
Deidentified Maximum,,80412,CPT4/HCPCS,CRH STIMULATION PANEL,,,3311.53
Deidentified Maximum,,80414,CPT4/HCPCS,TESTOSTERONE RESPONSE PANEL,,,518.78
Deidentified Maximum,,80420,CPT4/HCPCS,DEXAMETHASONE PANEL,,,723.82
Deidentified Maximum,,80434,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,,1016.40
Deidentified Maximum,,81112,CPT4/HCPCS,HPA-15 GENOTYPING,,,1077.38
Deidentified Maximum,,81161,CPT4/HCPCS,DMD DUP/DELET ANALYSIS,,,4851.00
Deidentified Maximum,,81175,CPT4/HCPCS,ASXL1 FULL GENE SEQUENCE,,,5048.14
Deidentified Maximum,,81181,CPT4/HCPCS,ATXN7 GENE DETC ABNOR ALLELE,,,978.18
Deidentified Maximum,,81183,CPT4/HCPCS,ATXN10 GENE DETC ABNOR ALLEL,,,978.18
Deidentified Maximum,,81212,CPT4/HCPCS,BRCA1&2 185&5385&6174 VRNT,,,757.00
Deidentified Maximum,,81221,CPT4/HCPCS,CFTR GENE KNOWN FAM VARIANTS,,,419.83
Deidentified Maximum,,81223,CPT4/HCPCS,CFTR GENE FULL SEQUENCE,,,5566.76
Deidentified Maximum,,81235,CPT4/HCPCS,EGFR GENE COM VARIANTS,,,1493.10
Deidentified Maximum,,81239,CPT4/HCPCS,DMPK GENE CHARAC ALLELES,,,1962.32
Deidentified Maximum,,81246,CPT4/HCPCS,FLT3 GENE ANALYSIS,,,905.93
Deidentified Maximum,,81248,CPT4/HCPCS,G6PD KNOWN FAMILIAL VARIANT,,,2679.26
Deidentified Maximum,,81249,CPT4/HCPCS,G6PD FULL GENE SEQUENCE,,,4284.00
Deidentified Maximum,,81257,CPT4/HCPCS,HBA1/HBA2 GENE,,,653.68
Deidentified Maximum,,81258,CPT4/HCPCS,HBA1/HBA2 GENE FAM VRNT,,,2679.26
Deidentified Maximum,,81261,CPT4/HCPCS,IGH GENE REARRANGE AMP METH,,,525.33
Deidentified Maximum,,81262,CPT4/HCPCS,IGH GENE REARRANG DIR PROBE,,,255.10
Deidentified Maximum,,81264,CPT4/HCPCS,IGK REARRANGEABN CLONAL POP,,,872.76
Deidentified Maximum,,81266,CPT4/HCPCS,STR MARKERS SPEC ANAL ADDL,,,522.81
Deidentified Maximum,,81267,CPT4/HCPCS,CHIMERISM ANAL NO CELL SELEC,,,3957.24
Deidentified Maximum,,81289,CPT4/HCPCS,FXN GENE KNOWN FAMIL VARIANT,,,1322.32
Deidentified Maximum,,81291,CPT4/HCPCS,MTHFR GENE,,,390.60
Deidentified Maximum,,81293,CPT4/HCPCS,MLH1 GENE KNOWN VARIANTS,,,335.07
Deidentified Maximum,,81311,CPT4/HCPCS,NRAS GENE VARIANTS EXON 2&3,,,2111.92
Deidentified Maximum,,81317,CPT4/HCPCS,PMS2 GENE FULL SEQ ANALYSIS,,,3369.24
Deidentified Maximum,,81318,CPT4/HCPCS,PMS2 KNOWN FAMILIAL VARIANTS,,,428.40
Deidentified Maximum,,81321,CPT4/HCPCS,PTEN GENE FULL SEQUENCE,,,2287.82
Deidentified Maximum,,81326,CPT4/HCPCS,PMP22 GENE KNOWN FAM VARIANT,,,699.72
Deidentified Maximum,,81332,CPT4/HCPCS,SERPINA1 GENE,,,335.07
Deidentified Maximum,,81336,CPT4/HCPCS,SMN1 GENE FULL GENE SEQUENCE,,,2151.65
Deidentified Maximum,,81340,CPT4/HCPCS,TRB@ GENE REARRANGE AMPLIFY,,,970.20
Deidentified Maximum,,81345,CPT4/HCPCS,TERT GENE TARGETED SEQ ALYS,,,1322.32
Deidentified Maximum,,81362,CPT4/HCPCS,HBB GENE KNOWN FAM VARIANT,,,2679.26
Deidentified Maximum,,81430,CPT4/HCPCS,HEARING LOSS SEQUENCE ANALYS,,,11602.50
Deidentified Maximum,,81434,CPT4/HCPCS,HEREDITARY RETINAL DISORDERS,,,4299.03
Deidentified Maximum,,81438,CPT4/HCPCS,HEREDTRY NURONDCRN TUM DSRDR,,,4299.03
Deidentified Maximum,,81440,CPT4/HCPCS,MITOCHONDRIAL GENE,,,8400.00
Deidentified Maximum,,81455,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,,6040.18
Deidentified Maximum,,81471,CPT4/HCPCS,X-LINKED INTELLECTUAL DBLT,,,102.00
Deidentified Maximum,,81490,CPT4/HCPCS,AUTOIMMUNE RHEUMATOID ARTHR,,,4216.96
Deidentified Maximum,,81506,CPT4/HCPCS,ENDO ASSAY SEVEN ANAL,,,211.68
Deidentified Maximum,,81512,CPT4/HCPCS,FTL CGEN ABNOR FIVE ANAL,,,2058.00
Deidentified Maximum,,81518,CPT4/HCPCS,ONC BRST MRNA 11 GENES,,,27653.22
Deidentified Maximum,,82024,CPT4/HCPCS,ASSAY OF ACTH,,,388.08
Deidentified Maximum,,82045,CPT4/HCPCS,ALBUMIN ISCHEMIA MODIFIED,,,341.04
Deidentified Maximum,,82088,CPT4/HCPCS,ASSAY OF ALDOSTERONE,,,409.50
Deidentified Maximum,,82103,CPT4/HCPCS,ALPHA-1-ANTITRYPSIN TOTAL,,,134.98
Deidentified Maximum,,82120,CPT4/HCPCS,AMINES VAGINAL FLUID QUAL,,,102.00
Deidentified Maximum,,82128,CPT4/HCPCS,AMINO ACIDS MULT QUAL,,,139.27
Deidentified Maximum,,82136,CPT4/HCPCS,AMINO ACIDS QUANT 2-5,,,169.51
Deidentified Maximum,,82163,CPT4/HCPCS,ASSAY OF ANGIOTENSIN II,,,206.22
Deidentified Maximum,,82239,CPT4/HCPCS,BILE ACIDS TOTAL,,,172.11
Deidentified Maximum,,82240,CPT4/HCPCS,BILE ACIDS CHOLYLGLYCINE,,,267.03
Deidentified Maximum,,82330,CPT4/HCPCS,ASSAY OF CALCIUM,,,137.34
Deidentified Maximum,,82379,CPT4/HCPCS,ASSAY OF CARNITINE,,,169.51
Deidentified Maximum,,82397,CPT4/HCPCS,CHEMILUMINESCENT ASSAY,,,141.96
Deidentified Maximum,,82436,CPT4/HCPCS,ASSAY OF URINE CHLORIDE,,,102.00
Deidentified Maximum,,82525,CPT4/HCPCS,ASSAY OF COPPER,,,124.65
Deidentified Maximum,,82553,CPT4/HCPCS,CREATINE MB FRACTION,,,116.00
Deidentified Maximum,,82554,CPT4/HCPCS,CREATINE ISOFORMS,,,119.28
Deidentified Maximum,,82565,CPT4/HCPCS,ASSAY OF CREATININE,,,102.00
Deidentified Maximum,,82634,CPT4/HCPCS,DEOXYCORTISOL,,,294.16
Deidentified Maximum,,82671,CPT4/HCPCS,ASSAY OF ESTROGENS,,,324.49
Deidentified Maximum,,82679,CPT4/HCPCS,ASSAY OF ESTRONE,,,250.74
Deidentified Maximum,,82725,CPT4/HCPCS,ASSAY OF BLOOD FATTY ACIDS,,,133.81
Deidentified Maximum,,82735,CPT4/HCPCS,ASSAY OF FLUORIDE,,,186.31
Deidentified Maximum,,82747,CPT4/HCPCS,ASSAY OF FOLIC ACID RBC,,,174.04
Deidentified Maximum,,82777,CPT4/HCPCS,GALECTIN-3,,,127.09
Deidentified Maximum,,82803,CPT4/HCPCS,BLOOD GASES ANY COMBINATION,,,194.37
Deidentified Maximum,,82943,CPT4/HCPCS,ASSAY OF GLUCAGON,,,143.55
Deidentified Maximum,,82947,CPT4/HCPCS,ASSAY GLUCOSE BLOOD QUANT,,,102.00
Deidentified Maximum,,82952,CPT4/HCPCS,GTT-ADDED SAMPLES,,,102.00
Deidentified Maximum,,82979,CPT4/HCPCS,ASSAY RBC GLUTATHIONE,,,102.00
Deidentified Maximum,,83001,CPT4/HCPCS,ASSAY OF GONADOTROPIN (FSH),,,186.73
Deidentified Maximum,,83012,CPT4/HCPCS,ASSAY OF HAPTOGLOBINS,,,172.78
Deidentified Maximum,,83013,CPT4/HCPCS,H PYLORI (C-13) BREATH,,,676.78
Deidentified Maximum,,83020,CPT4/HCPCS,HEMOGLOBIN ELECTROPHORESIS,,,129.36
Deidentified Maximum,,83033,CPT4/HCPCS,FETAL HEMOGLOBIN ASSAY QUAL,,,102.00
Deidentified Maximum,,83037,CPT4/HCPCS,GLYCOSYLATED HB HOME DEVICE,,,102.00
Deidentified Maximum,,83051,CPT4/HCPCS,ASSAY OF PLASMA HEMOGLOBIN,,,102.00
Deidentified Maximum,,83060,CPT4/HCPCS,BLOOD SULFHEMOGLOBIN ASSAY,,,102.00
Deidentified Maximum,,83491,CPT4/HCPCS,ASSAY OF CORTICOSTEROIDS 17,,,175.97
Deidentified Maximum,,83527,CPT4/HCPCS,ASSAY OF INSULIN,,,130.20
Deidentified Maximum,,83540,CPT4/HCPCS,ASSAY OF IRON,,,102.00
Deidentified Maximum,,83593,CPT4/HCPCS,FRACTIONATION KETOSTEROIDS,,,264.26
Deidentified Maximum,,83615,CPT4/HCPCS,LACTATE (LD) (LDH) ENZYME,,,102.00
Deidentified Maximum,,83663,CPT4/HCPCS,FLUORO POLARIZE FETAL LUNG,,,190.17
Deidentified Maximum,,83718,CPT4/HCPCS,ASSAY OF LIPOPROTEIN,,,102.00
Deidentified Maximum,,83727,CPT4/HCPCS,ASSAY OF LRH HORMONE,,,172.78
Deidentified Maximum,,83876,CPT4/HCPCS,ASSAY MYELOPEROXIDASE,,,341.04
Deidentified Maximum,,83970,CPT4/HCPCS,ASSAY OF PARATHORMONE,,,414.70
Deidentified Maximum,,84120,CPT4/HCPCS,ASSAY OF URINE PORPHYRINS,,,147.84
Deidentified Maximum,,84135,CPT4/HCPCS,ASSAY OF PREGNANEDIOL,,,192.19
Deidentified Maximum,,84160,CPT4/HCPCS,ASSAY OF PROTEIN ANY SOURCE,,,102.00
Deidentified Maximum,,84252,CPT4/HCPCS,ASSAY OF VITAMIN B-2,,,203.36
Deidentified Maximum,,84375,CPT4/HCPCS,CHROMATOGRAM ASSAY SUGARS,,,196.97
Deidentified Maximum,,84379,CPT4/HCPCS,SUGARS MULTIPLE QUANT,,,115.83
Deidentified Maximum,,84432,CPT4/HCPCS,ASSAY OF THYROGLOBULIN,,,161.44
Deidentified Maximum,,84436,CPT4/HCPCS,ASSAY OF TOTAL THYROXINE,,,102.00
Deidentified Maximum,,84443,CPT4/HCPCS,ASSAY THYROID STIM HORMONE,,,168.75
Deidentified Maximum,,84445,CPT4/HCPCS,ASSAY OF TSI GLOBULIN,,,510.97
Deidentified Maximum,,84484,CPT4/HCPCS,ASSAY OF TROPONIN QUANT,,,102.00
Deidentified Maximum,,84485,CPT4/HCPCS,ASSAY DUODENAL FLUID TRYPSIN,,,102.00
Deidentified Maximum,,84488,CPT4/HCPCS,TEST FECES FOR TRYPSIN,,,102.00
Deidentified Maximum,,84591,CPT4/HCPCS,ASSAY OF NOS VITAMIN,,,116.50
Deidentified Maximum,,84681,CPT4/HCPCS,ASSAY OF C-PEPTIDE,,,209.07
Deidentified Maximum,,85004,CPT4/HCPCS,AUTOMATED DIFF WBC COUNT,,,102.00
Deidentified Maximum,,85014,CPT4/HCPCS,HEMATOCRIT,,,102.00
Deidentified Maximum,,85041,CPT4/HCPCS,AUTOMATED RBC COUNT,,,102.00
Deidentified Maximum,,85055,CPT4/HCPCS,RETICULATED PLATELET ASSAY,,,268.96
Deidentified Maximum,,85060,CPT4/HCPCS,BLOOD SMEAR INTERPRETATION,,,177.91
Deidentified Maximum,,85220,CPT4/HCPCS,BLOOC CLOT FACTOR V TEST,,,177.32
Deidentified Maximum,,85244,CPT4/HCPCS,CLOT FACTOR VIII RELTD ANTGN,,,205.12
Deidentified Maximum,,85301,CPT4/HCPCS,ANTITHROMBIN III ANTIGEN,,,108.61
Deidentified Maximum,,85347,CPT4/HCPCS,COAGULATION TIME ACTIVATED,,,102.00
Deidentified Maximum,,85362,CPT4/HCPCS,FIBRIN DEGRADATION PRODUCTS,,,102.00
Deidentified Maximum,,85390,CPT4/HCPCS,FIBRINOLYSINS SCREEN I&R,,,102.00
Deidentified Maximum,,85421,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,,102.31
Deidentified Maximum,,85475,CPT4/HCPCS,HEMOLYSIN ACID,,,102.00
Deidentified Maximum,,85525,CPT4/HCPCS,HEPARIN NEUTRALIZATION,,,102.00
Deidentified Maximum,,85557,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,,134.23
Deidentified Maximum,,86000,CPT4/HCPCS,AGGLUTININS FEBRILE ANTIGEN,,,102.00
Deidentified Maximum,,86021,CPT4/HCPCS,WBC ANTIBODY IDENTIFICATION,,,137.34
Deidentified Maximum,,86039,CPT4/HCPCS,ANTINUCLEAR ANTIBODIES (ANA),,,112.14
Deidentified Maximum,,86060,CPT4/HCPCS,ANTISTREPTOLYSIN O TITER,,,102.00
Deidentified Maximum,,86077,CPT4/HCPCS,PHYS BLOOD BANK SERV XMATCH,,,370.01
Deidentified Maximum,,86147,CPT4/HCPCS,CARDIOLIPIN ANTIBODY EA IG,,,255.61
Deidentified Maximum,,86318,CPT4/HCPCS,IA INFECTIOUS AGENT ANTIBODY,,,130.11
Deidentified Maximum,,86327,CPT4/HCPCS,IMMUNOELECTROPHORESIS ASSAY,,,227.97
Deidentified Maximum,,86337,CPT4/HCPCS,INSULIN ANTIBODIES,,,215.12
Deidentified Maximum,,86340,CPT4/HCPCS,INTRINSIC FACTOR ANTIBODY,,,151.45
Deidentified Maximum,,86341,CPT4/HCPCS,ISLET CELL ANTIBODY,,,166.90
Deidentified Maximum,,86353,CPT4/HCPCS,LYMPHOCYTE TRANSFORMATION,,,492.57
Deidentified Maximum,,86359,CPT4/HCPCS,T CELLS TOTAL COUNT,,,379.00
Deidentified Maximum,,86384,CPT4/HCPCS,NITROBLUE TETRAZOLIUM DYE,,,114.40
Deidentified Maximum,,86430,CPT4/HCPCS,RHEUMATOID FACTOR TEST QUAL,,,102.00
Deidentified Maximum,,86431,CPT4/HCPCS,RHEUMATOID FACTOR QUANT,,,102.00
Deidentified Maximum,,86480,CPT4/HCPCS,TB TEST CELL IMMUN MEASURE,,,622.77
Deidentified Maximum,,86481,CPT4/HCPCS,TB AG RESPONSE T-CELL SUSP,,,622.77
Deidentified Maximum,,86486,CPT4/HCPCS,SKIN TEST NOS ANTIGEN,,,102.00
Deidentified Maximum,,86490,CPT4/HCPCS,COCCIDIOIDOMYCOSIS SKIN TEST,,,147.61
Deidentified Maximum,,86612,CPT4/HCPCS,BLASTOMYCES ANTIBODY,,,129.69
Deidentified Maximum,,86619,CPT4/HCPCS,BORRELIA ANTIBODY,,,134.48
Deidentified Maximum,,86635,CPT4/HCPCS,COCCIDIOIDES ANTIBODY,,,115.33
Deidentified Maximum,,86641,CPT4/HCPCS,CRYPTOCOCCUS ANTIBODY,,,144.81
Deidentified Maximum,,86652,CPT4/HCPCS,ENCEPHALTIS EAST EQNE ANBDY,,,132.55
Deidentified Maximum,,86666,CPT4/HCPCS,EHRLICHIA ANTIBODY,,,102.22
Deidentified Maximum,,86668,CPT4/HCPCS,FRANCISELLA TULARENSIS,,,104.49
Deidentified Maximum,,86689,CPT4/HCPCS,HTLV/HIV CONFIRMJ ANTIBODY,,,194.46
Deidentified Maximum,,86692,CPT4/HCPCS,HEPATITIS DELTA AGENT ANTBDY,,,172.45
Deidentified Maximum,,86701,CPT4/HCPCS,HIV-1ANTIBODY,,,102.00
Deidentified Maximum,,86703,CPT4/HCPCS,HIV-1/HIV-2 1 RESULT ANTBDY,,,137.84
Deidentified Maximum,,86706,CPT4/HCPCS,HEP B SURFACE ANTIBODY,,,107.94
Deidentified Maximum,,86708,CPT4/HCPCS,HEPATITIS A ANTIBODY,,,124.48
Deidentified Maximum,,86713,CPT4/HCPCS,LEGIONELLA ANTIBODY,,,153.72
Deidentified Maximum,,86720,CPT4/HCPCS,LEPTOSPIRA ANTIBODY,,,132.55
Deidentified Maximum,,86750,CPT4/HCPCS,MALARIA ANTIBODY,,,132.55
Deidentified Maximum,,86753,CPT4/HCPCS,PROTOZOA ANTIBODY NOS,,,124.48
Deidentified Maximum,,86768,CPT4/HCPCS,SALMONELLA ANTIBODY,,,132.55
Deidentified Maximum,,86790,CPT4/HCPCS,VIRUS ANTIBODY NOS,,,129.44
Deidentified Maximum,,86816,CPT4/HCPCS,HLA TYPING DR/DQ,,,279.97
Deidentified Maximum,,86821,CPT4/HCPCS,LYMPHOCYTE CULTURE MIXED,,,567.25
Deidentified Maximum,,86826,CPT4/HCPCS,HLA X-MATCH NONCYTOTOXC ADDL,,,268.96
Deidentified Maximum,,86830,CPT4/HCPCS,HLA CLASS I PHENOTYPE QUAL,,,637.72
Deidentified Maximum,,86831,CPT4/HCPCS,HLA CLASS II PHENOTYPE QUAL,,,546.67
Deidentified Maximum,,86832,CPT4/HCPCS,HLA CLASS I HIGH DEFIN QUAL,,,1002.20
Deidentified Maximum,,86901,CPT4/HCPCS,BLOOD TYPING SEROLOGIC RH(D),,,102.00
Deidentified Maximum,,86930,CPT4/HCPCS,FROZEN BLOOD PREP,,,1140.35
Deidentified Maximum,,86931,CPT4/HCPCS,FROZEN BLOOD THAW,,,1255.82
Deidentified Maximum,,86941,CPT4/HCPCS,HEMOLYSINS/AGGLUTININS,,,121.63
Deidentified Maximum,,86975,CPT4/HCPCS,RBC SERUM PRETX INCUBJ DRUGS,,,183.45
Deidentified Maximum,,87040,CPT4/HCPCS,BLOOD CULTURE FOR BACTERIA,,,103.73
Deidentified Maximum,,87071,CPT4/HCPCS,CULTURE AEROBIC QUANT OTHER,,,102.00
Deidentified Maximum,,87075,CPT4/HCPCS,CULTR BACTERIA EXCEPT BLOOD,,,102.00
Deidentified Maximum,,87077,CPT4/HCPCS,CULTURE AEROBIC IDENTIFY,,,102.00
Deidentified Maximum,,87081,CPT4/HCPCS,CULTURE SCREEN ONLY,,,102.00
Deidentified Maximum,,87088,CPT4/HCPCS,URINE BACTERIA CULTURE,,,102.00
Deidentified Maximum,,87106,CPT4/HCPCS,FUNGI IDENTIFICATION YEAST,,,103.73
Deidentified Maximum,,87107,CPT4/HCPCS,FUNGI IDENTIFICATION MOLD,,,103.73
Deidentified Maximum,,87149,CPT4/HCPCS,DNA/RNA DIRECT PROBE,,,201.51
Deidentified Maximum,,87152,CPT4/HCPCS,CULTURE TYPE PULSE FIELD GEL,,,102.00
Deidentified Maximum,,87153,CPT4/HCPCS,DNA/RNA SEQUENCING,,,1159.03
Deidentified Maximum,,87169,CPT4/HCPCS,MACROSCOPIC EXAM PARASITE,,,102.00
Deidentified Maximum,,87181,CPT4/HCPCS,MICROBE SUSCEPTIBLE DIFFUSE,,,102.00
Deidentified Maximum,,87185,CPT4/HCPCS,MICROBE SUSCEPTIBLE ENZYME,,,102.00
Deidentified Maximum,,87210,CPT4/HCPCS,SMEAR WET MOUNT SALINE/INK,,,102.00
Deidentified Maximum,,87220,CPT4/HCPCS,TISSUE EXAM FOR FUNGI,,,102.00
Deidentified Maximum,,87254,CPT4/HCPCS,VIRUS INOCULATION SHELL VIA,,,196.47
Deidentified Maximum,,87279,CPT4/HCPCS,PARAINFLUENZA AG IF,,,102.00
Deidentified Maximum,,87320,CPT4/HCPCS,CHYLMD TRACH AG IA,,,102.00
Deidentified Maximum,,87335,CPT4/HCPCS,E COLI 0157 AG IA,,,102.00
Deidentified Maximum,,87338,CPT4/HCPCS,HPYLORI STOOL IA,,,144.47
Deidentified Maximum,,87341,CPT4/HCPCS,HEPATITIS B SURFACE AG IA,,,103.73
Deidentified Maximum,,87427,CPT4/HCPCS,SHIGA-LIKE TOXIN AG IA,,,102.00
Deidentified Maximum,,87451,CPT4/HCPCS,AG DETECT POLYVAL IA MULT,,,102.00
Deidentified Maximum,,87506,CPT4/HCPCS,IADNA-DNA/RNA PROBE TQ 6-11,,,2073.79
Deidentified Maximum,,87511,CPT4/HCPCS,GARDNER VAG DNA AMP PROBE,,,352.63
Deidentified Maximum,,87521,CPT4/HCPCS,HEPATITIS C PROBE&RVRS TRNSC,,,352.63
Deidentified Maximum,,87526,CPT4/HCPCS,HEPATITIS G DNA AMP PROBE,,,352.63
Deidentified Maximum,,87535,CPT4/HCPCS,HIV-1 PROBE&REVERSE TRNSCRPJ,,,352.63
Deidentified Maximum,,87537,CPT4/HCPCS,HIV-2 DNA DIR PROBE,,,201.51
Deidentified Maximum,,87538,CPT4/HCPCS,HIV-2 PROBE&REVRSE TRNSCRIPJ,,,352.63
Deidentified Maximum,,87551,CPT4/HCPCS,MYCOBACTERIA DNA AMP PROBE,,,352.63
Deidentified Maximum,,87557,CPT4/HCPCS,M.TUBERCULO DNA QUANT,,,430.41
Deidentified Maximum,,87560,CPT4/HCPCS,M.AVIUM-INTRA DNA DIR PROB,,,201.51
Deidentified Maximum,,87641,CPT4/HCPCS,MR-STAPH DNA AMP PROBE,,,352.63
Deidentified Maximum,,87662,CPT4/HCPCS,ZIKA VIRUS DNA/RNA AMP PROBE,,,452.34
Deidentified Maximum,,87810,CPT4/HCPCS,CHYLMD TRACH ASSAY W/OPTIC,,,102.00
Deidentified Maximum,,87850,CPT4/HCPCS,N. GONORRHOEAE ASSAY W/OPTIC,,,102.00
Deidentified Maximum,,87905,CPT4/HCPCS,SIALIDASE ENZYME ASSAY,,,122.80
Deidentified Maximum,,87912,CPT4/HCPCS,GENOTYPE DNA HEPATITIS B,,,2526.72
Deidentified Maximum,,88005,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,1977.02
Deidentified Maximum,,88012,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,1692.93
Deidentified Maximum,,88014,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,1553.83
Deidentified Maximum,,88040,CPT4/HCPCS,FORENSIC AUTOPSY (NECROPSY),,,4705.76
Deidentified Maximum,,88106,CPT4/HCPCS,CYTOPATH FL NONGYN FILTER,,,457.54
Deidentified Maximum,,88125,CPT4/HCPCS,FORENSIC CYTOPATHOLOGY,,,102.00
Deidentified Maximum,,88141,CPT4/HCPCS,CYTOPATH C/V INTERPRET,,,229.48
Deidentified Maximum,,88150,CPT4/HCPCS,CYTOPATH C/V MANUAL,,,106.17
Deidentified Maximum,,88161,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,,325.63
Deidentified Maximum,,88165,CPT4/HCPCS,CYTOPATH TBS C/V REDO,,,106.17
Deidentified Maximum,,88182,CPT4/HCPCS,CELL MARKER STUDY,,,617.59
Deidentified Maximum,,88262,CPT4/HCPCS,CHROMOSOME ANALYSIS 15-20,,,1252.35
Deidentified Maximum,,88274,CPT4/HCPCS,CYTOGENETICS 25-99,,,349.77
Deidentified Maximum,,88280,CPT4/HCPCS,CHROMOSOME KARYOTYPE STUDY,,,252.16
Deidentified Maximum,,88302,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,,407.23
Deidentified Maximum,,88304,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,,448.64
Deidentified Maximum,,88314,CPT4/HCPCS,HISTOCHEMICAL STAINS ADD-ON,,,587.74
Deidentified Maximum,,88331,CPT4/HCPCS,PATH CONSULT INTRAOP 1 BLOC,,,277.03
Deidentified Maximum,,88341,CPT4/HCPCS,IMMUNOHISTO ANTB ADDL SLIDE,,,610.29
Deidentified Maximum,,88346,CPT4/HCPCS,IMMUNOFLUOR ANTB 1ST STAIN,,,528.52
Deidentified Maximum,,88355,CPT4/HCPCS,ANALYSIS SKELETAL MUSCLE,,,1132.32
Deidentified Maximum,,88363,CPT4/HCPCS,XM ARCHIVE TISSUE MOLEC ANAL,,,128.09
Deidentified Maximum,,89220,CPT4/HCPCS,SPUTUM SPECIMEN COLLECTION,,,6766.00
Deidentified Maximum,,89254,CPT4/HCPCS,OOCYTE IDENTIFICATION,,,2430.96
Deidentified Maximum,,89257,CPT4/HCPCS,SPERM IDENTIFICATION,,,2675.40
Deidentified Maximum,,89260,CPT4/HCPCS,SPERM ISOLATION SIMPLE,,,1064.44
Deidentified Maximum,,89264,CPT4/HCPCS,IDENTIFY SPERM TISSUE,,,2790.22
Deidentified Maximum,,89281,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,,6823.23
Deidentified Maximum,,89290,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,,8793.62
Deidentified Maximum,,89321,CPT4/HCPCS,SEMEN ANAL SPERM DETECTION,,,121.12
Deidentified Maximum,,89343,CPT4/HCPCS,STORAGE/YEAR SPERM/SEMEN,,,352.80
Deidentified Maximum,,89352,CPT4/HCPCS,THAWING CRYOPRESRVED EMBRYO,,,168.00
Deidentified Maximum,,89354,CPT4/HCPCS,THAW CRYOPRSVRD REPROD TISS,,,102.00
Deidentified Maximum,,90811,CPT4/HCPCS,INTAC PSYTX 20-30 W/E&M,,,141.24
Deidentified Maximum,,90816,CPT4/HCPCS,PSYTX HOSP 20-30 MIN,,,166.08
Deidentified Maximum,,90819,CPT4/HCPCS,PSYTX HOSP 45-50 MIN W/E&M,,,246.31
Deidentified Maximum,,90821,CPT4/HCPCS,PSYTX HOSP 75-80 MIN,,,312.89
Deidentified Maximum,,90847,CPT4/HCPCS,FAMILY PSYTX W/PT 50 MIN,,,255.94
Deidentified Maximum,,90867,CPT4/HCPCS,TCRANIAL MAGN STIM TX PLAN,,,987.78
Deidentified Maximum,,90912,CPT4/HCPCS,BFB TRAINING 1ST 15 MIN,,,6766.00
Deidentified Maximum,,90935,CPT4/HCPCS,HEMODIALYSIS ONE EVALUATION,,,338.51
Deidentified Maximum,,90940,CPT4/HCPCS,HEMODIALYSIS ACCESS STUDY,,,629.69
Deidentified Maximum,,91110,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,,9569.70
Deidentified Maximum,,91132,CPT4/HCPCS,ELECTROGASTROGRAPHY,,,1214.00
Deidentified Maximum,,92018,CPT4/HCPCS,NEW EYE EXAM & TREATMENT,,,4204.00
Deidentified Maximum,,92136,CPT4/HCPCS,OPHTHALMIC BIOMETRY,,,749.98
Deidentified Maximum,,92227,CPT4/HCPCS,IMG RTA DETCJ/MNTR DS STAFF,,,162.81
Deidentified Maximum,,92230,CPT4/HCPCS,EYE EXAM WITH PHOTOS,,,744.25
Deidentified Maximum,,92240,CPT4/HCPCS,ICG ANGIOGRAPHY UNI/BI,,,3171.01
Deidentified Maximum,,92285,CPT4/HCPCS,EYE PHOTOGRAPHY,,,475.56
Deidentified Maximum,,92326,CPT4/HCPCS,REPLACEMENT OF CONTACT LENS,,,808.50
Deidentified Maximum,,92353,CPT4/HCPCS,FIT APHAKIA SPECTCL MULTIFOC,,,359.31
Deidentified Maximum,,92354,CPT4/HCPCS,FIT SPECTACLES SINGLE SYSTEM,,,4317.88
Deidentified Maximum,,92371,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,,306.38
Deidentified Maximum,,92511,CPT4/HCPCS,NASOPHARYNGOSCOPY,,,2002.00
Deidentified Maximum,,92516,CPT4/HCPCS,FACIAL NERVE FUNCTION TEST,,,581.42
Deidentified Maximum,,92543,CPT4/HCPCS,CALORIC VESTIBULAR TEST,,,234.99
Deidentified Maximum,,92555,CPT4/HCPCS,SPEECH THRESHOLD AUDIOMETRY,,,194.16
Deidentified Maximum,,92561,CPT4/HCPCS,BEKESY AUDIOMETRY DIAGNOSIS,,,370.63
Deidentified Maximum,,92564,CPT4/HCPCS,SISI HEARING TEST,,,246.31
Deidentified Maximum,,92565,CPT4/HCPCS,STENGER TEST PURE TONE,,,203.78
Deidentified Maximum,,92572,CPT4/HCPCS,STAGGERED SPONDAIC WORD TEST,,,47.34
Deidentified Maximum,,92575,CPT4/HCPCS,SENSORINEURAL ACUITY TEST,,,152.41
Deidentified Maximum,,92576,CPT4/HCPCS,SYNTHETIC SENTENCE TEST,,,231.88
Deidentified Maximum,,92579,CPT4/HCPCS,VISUAL AUDIOMETRY (VRA),,,375.44
Deidentified Maximum,,92585,CPT4/HCPCS,AUDITOR EVOKE POTENT COMPRE,,,951.44
Deidentified Maximum,,92586,CPT4/HCPCS,AUDITOR EVOKE POTENT LIMIT,,,951.44
Deidentified Maximum,,92587,CPT4/HCPCS,EVOKED AUDITORY TEST LIMITED,,,674.70
Deidentified Maximum,,92610,CPT4/HCPCS,EVALUATE SWALLOWING FUNCTION,,,6766.00
Deidentified Maximum,,92621,CPT4/HCPCS,AUDITORY FUNCTION + 15 MIN,,,144.50
Deidentified Maximum,,92625,CPT4/HCPCS,TINNITUS ASSESSMENT,,,563.11
Deidentified Maximum,,92640,CPT4/HCPCS,AUD BRAINSTEM IMPLT PROGRAMG,,,677.65
Deidentified Maximum,,92921,CPT4/HCPCS,PRQ CARDIAC ANGIO ADDL ART,,,8970.00
Deidentified Maximum,,92933,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,,10119.00
Deidentified Maximum,,92934,CPT4/HCPCS,PRQ CARD STENT/ATH/ANGIO,,,10119.00
Deidentified Maximum,,92944,CPT4/HCPCS,PRQ CARD REVASC CHRONIC ADDL,,,10119.00
Deidentified Maximum,,92975,CPT4/HCPCS,DISSOLVE CLOT HEART VESSEL,,,1678.00
Deidentified Maximum,,92987,CPT4/HCPCS,REVISION OF MITRAL VALVE,,,12850.70
Deidentified Maximum,,93224,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,,1838.63
Deidentified Maximum,,93264,CPT4/HCPCS,REM MNTR WRLS P-ART PRS SNR,,,285.68
Deidentified Maximum,,93270,CPT4/HCPCS,REMOTE 30 DAY ECG REV/REPORT,,,628.91
Deidentified Maximum,,93283,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,,225.96
Deidentified Maximum,,93286,CPT4/HCPCS,PERI-PX EVAL PM/LDLS PM IP,,,104.74
Deidentified Maximum,,93287,CPT4/HCPCS,PERI-PX DEVICE EVAL & PRGR,,,113.90
Deidentified Maximum,,93288,CPT4/HCPCS,INTERROG EVL PM/LDLS PM IP,,,153.21
Deidentified Maximum,,93294,CPT4/HCPCS,REM INTERROG EVL PM/LDLS PM,,,274.84
Deidentified Maximum,,93304,CPT4/HCPCS,ECHO TRANSTHORACIC,,,990.71
Deidentified Maximum,,93306,CPT4/HCPCS,TTE W/DOPPLER COMPLETE,,,1471.00
Deidentified Maximum,,93318,CPT4/HCPCS,ECHO TRANSESOPHAGEAL INTRAOP,,,5012.19
Deidentified Maximum,,93350,CPT4/HCPCS,STRESS TTE ONLY,,,1195.32
Deidentified Maximum,,93451,CPT4/HCPCS,RIGHT HEART CATH,,,9548.65
Deidentified Maximum,,93453,CPT4/HCPCS,R&L HRT CATH W/VENTRICLGRPHY,,,9548.65
Deidentified Maximum,,93455,CPT4/HCPCS,CORONARY ART/GRFT ANGIO S&I,,,9548.65
Deidentified Maximum,,93459,CPT4/HCPCS,L HRT ART/GRFT ANGIO,,,9548.65
Deidentified Maximum,,93460,CPT4/HCPCS,R&L HRT ART/VENTRICLE ANGIO,,,9548.65
Deidentified Maximum,,93463,CPT4/HCPCS,DRUG ADMIN & HEMODYNMIC MEAS,,,4613.00
Deidentified Maximum,,93505,CPT4/HCPCS,BIOPSY OF HEART LINING,,,5138.00
Deidentified Maximum,,93533,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,,9548.65
Deidentified Maximum,,93561,CPT4/HCPCS,CARDIAC OUTPUT MEASUREMENT,,,4613.00
Deidentified Maximum,,93564,CPT4/HCPCS,INJECT HRT CONGNTL ART/GRFT,,,4613.00
Deidentified Maximum,,93565,CPT4/HCPCS,INJECT L VENTR/ATRIAL ANGIO,,,4613.00
Deidentified Maximum,,93572,CPT4/HCPCS,HEART FLOW RESERVE MEASURE,,,1214.00
Deidentified Maximum,,93583,CPT4/HCPCS,PERQ TRANSCATH SEPTAL REDUXN,,,8797.00
Deidentified Maximum,,93642,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,7830.00
Deidentified Maximum,,93701,CPT4/HCPCS,BIOIMPEDANCE CV ANALYSIS,,,461.13
Deidentified Maximum,,93724,CPT4/HCPCS,ANALYZE PACEMAKER SYSTEM,,,7966.00
Deidentified Maximum,,93745,CPT4/HCPCS,SET-UP CARDIOVERT-DEFIBRILL,,,1214.00
Deidentified Maximum,,93770,CPT4/HCPCS,MEASURE VENOUS PRESSURE,,,18.46
Deidentified Maximum,,93797,CPT4/HCPCS,CARDIAC REHAB,,,148.38
Deidentified Maximum,,93880,CPT4/HCPCS,EXTRACRANIAL BILAT STUDY,,,2051.42
Deidentified Maximum,,93892,CPT4/HCPCS,TCD EMBOLI DETECT W/O INJ,,,2418.80
Deidentified Maximum,,93925,CPT4/HCPCS,LOWER EXTREMITY STUDY,,,2388.23
Deidentified Maximum,,93926,CPT4/HCPCS,LOWER EXTREMITY STUDY,,,1709.50
Deidentified Maximum,,93975,CPT4/HCPCS,VASCULAR STUDY,,,2685.15
Deidentified Maximum,,93981,CPT4/HCPCS,PENILE VASCULAR STUDY,,,2271.05
Deidentified Maximum,,93998,CPT4/HCPCS,NONINVAS VASC DX STUDY PROC,,,817.57
Deidentified Maximum,,94250,CPT4/HCPCS,EXPIRED GAS COLLECTION,,,302.36
Deidentified Maximum,,94450,CPT4/HCPCS,HYPOXIA RESPONSE CURVE,,,277.51
Deidentified Maximum,,94667,CPT4/HCPCS,CHEST WALL MANIPULATION,,,6766.00
Deidentified Maximum,,94762,CPT4/HCPCS,MEASURE BLOOD OXYGEN LEVEL,,,232.81
Deidentified Maximum,,94775,CPT4/HCPCS,PED HOME APNEA REC HK-UP,,,0.00
Deidentified Maximum,,94780,CPT4/HCPCS,CARS/BD TST INFT-12MO 60 MIN,,,98.70
Deidentified Maximum,,95052,CPT4/HCPCS,PHOTO PATCH TEST,,,129.13
Deidentified Maximum,,95075,CPT4/HCPCS,INGESTION CHALLENGE TEST,,,406.66
Deidentified Maximum,,95115,CPT4/HCPCS,IMMUNOTHERAPY ONE INJECTION,,,190.91
Deidentified Maximum,,95145,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,158.00
Deidentified Maximum,,95148,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,283.11
Deidentified Maximum,,95165,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,95.45
Deidentified Maximum,,95170,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,66.59
Deidentified Maximum,,95782,CPT4/HCPCS,POLYSOM <6 YRS 4/> PARAMTRS,,,7714.30
Deidentified Maximum,,0050T,CPT4/HCPCS,REMOVAL CIRCULATION ASSIST,,,5281.00
Deidentified Maximum,,0078T,CPT4/HCPCS,ENDOVASC AORT REPR W/DEVICE,,,8841.00
Deidentified Maximum,,0080T,CPT4/HCPCS,ENDOVASC AORT REPR RAD S&I,,,8841.00
Deidentified Maximum,,0098T,CPT4/HCPCS,REV ARTIFIC DISC ADDL,,,3544.00
Deidentified Maximum,,0100T,CPT4/HCPCS,PROSTH RETINA RECEIVE&GEN,,,24180.00
Deidentified Maximum,,0123T,CPT4/HCPCS,SCLERAL FISTULIZATION,,,5783.00
Deidentified Maximum,,0207T,CPT4/HCPCS,CLEAR EYELID GLAND W/HEAT,,,2002.00
Deidentified Maximum,,0213T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,,1678.00
Deidentified Maximum,,0218T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,,2002.00
Deidentified Maximum,,0228T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,,2002.00
Deidentified Maximum,,0246T,CPT4/HCPCS,OPN TX RIB FX 3-4 RIBS,,,3544.00
Deidentified Maximum,,0251T,CPT4/HCPCS,REMOV BRONCHIAL VALVE,,,1678.88
Deidentified Maximum,,0253T,CPT4/HCPCS,INSERT AQUEOUS DRAIN DEVICE,,,6075.00
Deidentified Maximum,,0264T,CPT4/HCPCS,IM B1 MRW CEL THER XCL HRVST,,,6075.00
Deidentified Maximum,,0273T,CPT4/HCPCS,INTERROGATE CRTD SNS W/PGRMG,,,987.78
Deidentified Maximum,,0296T,CPT4/HCPCS,EXT ECG RECORDING,,,987.78
Deidentified Maximum,,0301T,CPT4/HCPCS,MW THERAPY FOR BREAST TUMOR,,,3544.00
Deidentified Maximum,,0322T,CPT4/HCPCS,RMVL SUBQ DEFIB PLS GEN,,,5029.00
Deidentified Maximum,,0323T,CPT4/HCPCS,RMVL & REPLC SUBQ PLS GEN,,,1678.88
Deidentified Maximum,,0332T,CPT4/HCPCS,HEART SYMP IMAGE PLNR SPECT,,,987.78
Deidentified Maximum,,0355T,CPT4/HCPCS,GI TRACT CAPSULE ENDOSCOPY,,,1370.00
Deidentified Maximum,,0356T,CPT4/HCPCS,INSRT DRUG DEVICE FOR IOP,,,1214.00
Deidentified Maximum,,0388T,CPT4/HCPCS,LEADLESS PM REMOVE VENTR,,,6876.92
Deidentified Maximum,,0392T,CPT4/HCPCS,LAP ES SPH AUGMENT DEV PLACE,,,5029.00
Deidentified Maximum,,0395T,CPT4/HCPCS,HDR ELCTR NTRST/NTRCV BRCHTX,,,12850.70
Deidentified Maximum,,0411T,CPT4/HCPCS,INSJ/RPLC CAR MODULJ VNT ELT,,,10119.00
Deidentified Maximum,,0413T,CPT4/HCPCS,RMVL CAR MODULJ TRANVNS ELT,,,5856.00
Deidentified Maximum,,0438T,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,,1678.00
Deidentified Maximum,,0453T,CPT4/HCPCS,INSJ/RPLCMT MECH-ELEC NTRFCE,,,7007.00
Deidentified Maximum,,0457T,CPT4/HCPCS,REMVL MECH-ELEC SKIN NTRFCE,,,5856.00
Deidentified Maximum,,0459T,CPT4/HCPCS,RELOCAJ RPLCMT AORTIC VENTR,,,3544.00
Deidentified Maximum,,0466T,CPT4/HCPCS,INSJ CH WAL RESPIR ELTRD/RA,,,2002.00
Deidentified Maximum,,0480T,CPT4/HCPCS,FXJL ABL LSR EA ADDL 100SQCM,,,4891.93
Deidentified Maximum,,0494T,CPT4/HCPCS,PREP & CANNULJ CDVR DON LUNG,,,3544.00
Deidentified Maximum,,0496T,CPT4/HCPCS,MNTR CDVR DON LNG EA ADDL HR,,,1370.00
Deidentified Maximum,,0539T,CPT4/HCPCS,RECEIPT&PREP CAR-T CLL ADMN,,,1678.00
Deidentified Maximum,,0571T,CPT4/HCPCS,INSJ/RPLCMT ICDS SS ELTRD,,,7830.00
Deidentified Maximum,,0573T,CPT4/HCPCS,REMOVAL SS DFB ELECTRODE,,,5856.00
Deidentified Maximum,,0575T,CPT4/HCPCS,PRGRMG DEV EVAL ICDS SS IP,,,1370.00
Deidentified Maximum,,0584T,CPT4/HCPCS,PERQ ISLET CELL TRANSPLANT,,,6588.00
Deidentified Maximum,,0587T,CPT4/HCPCS,PERQ IMPLTJ/RPLCMT ISDNS PTN,,,3544.00
Deidentified Maximum,,10008,CPT4/HCPCS,FNA BX W/FLUOR GDN EA ADDL,,,3000.00
Deidentified Maximum,,10012,CPT4/HCPCS,FNA BX W/MR GDN EA ADDL,,,3000.00
Deidentified Maximum,,10120,CPT4/HCPCS,REMOVE FOREIGN BODY,,,2002.00
Deidentified Maximum,,10140,CPT4/HCPCS,DRAINAGE OF HEMATOMA/FLUID,,,3198.57
Deidentified Maximum,,11006,CPT4/HCPCS,DEBRIDE GENIT/PER/ABDOM WALL,,,3198.57
Deidentified Maximum,,11043,CPT4/HCPCS,DEB MUSC/FASCIA 20 SQ CM/<,,,4280.43
Deidentified Maximum,,11056,CPT4/HCPCS,TRIM SKIN LESIONS 2 TO 4,,,2002.00
Deidentified Maximum,,11057,CPT4/HCPCS,TRIM SKIN LESIONS OVER 4,,,2002.00
Deidentified Maximum,,11103,CPT4/HCPCS,TANGNTL BX SKIN EA SEP/ADDL,,,3000.00
Deidentified Maximum,,11201,CPT4/HCPCS,REMOVE SKIN TAGS ADD-ON,,,1214.00
Deidentified Maximum,,11301,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,,1214.00
Deidentified Maximum,,11303,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,,1678.00
Deidentified Maximum,,11307,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,,1214.00
Deidentified Maximum,,11310,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,,1214.00
Deidentified Maximum,,11404,CPT4/HCPCS,EXC TR-EXT B9+MARG 3.1-4 CM,,,3198.57
Deidentified Maximum,,11406,CPT4/HCPCS,EXC TR-EXT B9+MARG >4.0 CM,,,4280.43
Deidentified Maximum,,11422,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 1.1-2,,,3198.57
Deidentified Maximum,,11440,CPT4/HCPCS,EXC FACE-MM B9+MARG 0.5 CM/<,,,3656.00
Deidentified Maximum,,11462,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,4280.43
Deidentified Maximum,,11646,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG >4 CM,,,4280.43
Deidentified Maximum,,11755,CPT4/HCPCS,BIOPSY NAIL UNIT,,,3198.57
Deidentified Maximum,,11772,CPT4/HCPCS,REMOVE PILONIDAL CYST COMPL,,,5856.00
Deidentified Maximum,,11954,CPT4/HCPCS,TX CONTOUR DEFECTS >10.0 CC,,,1214.00
Deidentified Maximum,,11971,CPT4/HCPCS,RMVL TIS XPNDR WO INSJ IMPLT,,,4204.00
Deidentified Maximum,,12002,CPT4/HCPCS,RPR S/N/AX/GEN/TRNK2.6-7.5CM,,,1678.88
Deidentified Maximum,,12004,CPT4/HCPCS,RPR S/N/AX/GEN/TRK7.6-12.5CM,,,2002.00
Deidentified Maximum,,12015,CPT4/HCPCS,RPR F/E/E/N/L/M 7.6-12.5 CM,,,2002.00
Deidentified Maximum,,12037,CPT4/HCPCS,INTMD RPR S/TR/EXT >30.0 CM,,,4280.43
Deidentified Maximum,,12044,CPT4/HCPCS,INTMD RPR N-HF/GENIT7.6-12.5,,,4280.43
Deidentified Maximum,,13101,CPT4/HCPCS,CMPLX RPR TRUNK 2.6-7.5 CM,,,5856.00
Deidentified Maximum,,13102,CPT4/HCPCS,CMPLX RPR TRUNK ADDL 5CM/<,,,3198.57
Deidentified Maximum,,14000,CPT4/HCPCS,TIS TRNFR TRUNK 10 SQ CM/<,,,4280.43
Deidentified Maximum,,14021,CPT4/HCPCS,TIS TRNFR S/A/L 10.1-30 SQCM,,,5856.00
Deidentified Maximum,,14301,CPT4/HCPCS,TIS TRNFR ANY 30.1-60 SQ CM,,,5856.00
Deidentified Maximum,,14302,CPT4/HCPCS,TIS TRNFR ADDL 30 SQ CM,,,3198.57
Deidentified Maximum,,15003,CPT4/HCPCS,WOUND PREP ADDL 100 CM,,,3198.57
Deidentified Maximum,,15100,CPT4/HCPCS,SKIN SPLT GRFT TRNK/ARM/LEG,,,4280.43
Deidentified Maximum,,15110,CPT4/HCPCS,EPIDRM AUTOGRFT TRNK/ARM/LEG,,,4280.43
Deidentified Maximum,,15200,CPT4/HCPCS,SKIN FULL GRAFT TRUNK,,,5856.00
Deidentified Maximum,,15274,CPT4/HCPCS,SKN SUB GRFT T/A/L CHILD ADD,,,3000.00
Deidentified Maximum,,15572,CPT4/HCPCS,SKIN PEDICLE FLAP ARMS/LEGS,,,5856.00
Deidentified Maximum,,15574,CPT4/HCPCS,PEDCLE FH/CH/CH/M/N/AX/G/H/F,,,5856.00
Deidentified Maximum,,15620,CPT4/HCPCS,DELAY FLAP F/C/C/N/AX/G/H/F,,,6401.00
Deidentified Maximum,,15730,CPT4/HCPCS,MDFC FLAP W/PRSRV VASC PEDCL,,,5856.00
Deidentified Maximum,,15734,CPT4/HCPCS,MUSCLE-SKIN GRAFT TRUNK,,,5856.00
Deidentified Maximum,,15760,CPT4/HCPCS,COMPOSITE SKIN GRAFT,,,4280.43
Deidentified Maximum,,15775,CPT4/HCPCS,HAIR TRNSPL 1-15 PUNCH GRFTS,,,5856.00
Deidentified Maximum,,15776,CPT4/HCPCS,HAIR TRNSPL >15 PUNCH GRAFTS,,,5856.00
Deidentified Maximum,,15828,CPT4/HCPCS,REMOVAL OF FACE WRINKLES,,,5856.00
Deidentified Maximum,,15832,CPT4/HCPCS,EXCISE EXCESSIVE SKIN THIGH,,,5856.00
Deidentified Maximum,,15835,CPT4/HCPCS,EXCISE EXCESSIVE SKIN BUTTCK,,,5856.00
Deidentified Maximum,,15838,CPT4/HCPCS,EXCISE EXCESS SKIN FAT PAD,,,3656.00
Deidentified Maximum,,15940,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,,5856.00
Deidentified Maximum,,15945,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,,6401.00
Deidentified Maximum,,15956,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,5856.00
Deidentified Maximum,,17003,CPT4/HCPCS,DESTRUCT PREMALG LES 2-14,,,3000.00
Deidentified Maximum,,17004,CPT4/HCPCS,DESTROY PREMAL LESIONS 15/>,,,3000.00
Deidentified Maximum,,17311,CPT4/HCPCS,MOHS 1 STAGE H/N/HF/G,,,3656.00
Deidentified Maximum,,17313,CPT4/HCPCS,MOHS 1 STAGE T/A/L,,,3656.00
Deidentified Maximum,,19020,CPT4/HCPCS,INCISION OF BREAST LESION,,,4280.43
Deidentified Maximum,,19084,CPT4/HCPCS,BX BREAST ADD LESION US IMAG,,,3000.00
Deidentified Maximum,,19105,CPT4/HCPCS,CRYOSURG ABLATE FA EACH,,,8300.00
Deidentified Maximum,,19287,CPT4/HCPCS,PERQ DEV BREAST 1ST MR GUIDE,,,5856.00
Deidentified Maximum,,19294,CPT4/HCPCS,PREP TUM CAV IORT PRTL MAST,,,12850.70
Deidentified Maximum,,19297,CPT4/HCPCS,PLACE BREAST CATH FOR RAD,,,12850.70
Deidentified Maximum,,19304,CPT4/HCPCS,MAST SUBQ,,,6049.05
Deidentified Maximum,,19305,CPT4/HCPCS,MAST RADICAL,,,5281.00
Deidentified Maximum,,19307,CPT4/HCPCS,MAST MOD RAD,,,8300.00
Deidentified Maximum,,20101,CPT4/HCPCS,EXPLORE WOUND CHEST,,,5029.00
Deidentified Maximum,,20150,CPT4/HCPCS,EXCISE EPIPHYSEAL BAR,,,9548.65
Deidentified Maximum,,20205,CPT4/HCPCS,DEEP MUSCLE BIOPSY,,,5856.00
Deidentified Maximum,,20206,CPT4/HCPCS,NEEDLE BIOPSY MUSCLE,,,3198.57
Deidentified Maximum,,20501,CPT4/HCPCS,INJECT SINUS TRACT FOR X-RAY,,,3000.00
Deidentified Maximum,,20525,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,,5856.00
Deidentified Maximum,,20526,CPT4/HCPCS,THER INJECTION CARP TUNNEL,,,3000.00
Deidentified Maximum,,20661,CPT4/HCPCS,APPLICATION OF HEAD BRACE,,,5856.00
Deidentified Maximum,,20665,CPT4/HCPCS,REMOVAL OF FIXATION DEVICE,,,3198.57
Deidentified Maximum,,20670,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,,3198.57
Deidentified Maximum,,20680,CPT4/HCPCS,REMOVAL OF SUPPORT IMPLANT,,,5856.00
Deidentified Maximum,,20697,CPT4/HCPCS,COMP EXT FIXATE STRUT CHANGE,,,6000.00
Deidentified Maximum,,20920,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,,6401.00
Deidentified Maximum,,20934,CPT4/HCPCS,INTERCALARY ALGRFT COMPL,,,8841.00
Deidentified Maximum,,20938,CPT4/HCPCS,SP BONE AGRFT STRUCT ADD-ON,,,5138.00
Deidentified Maximum,,20939,CPT4/HCPCS,BONE MARROW ASPIR BONE GRFG,,,3198.57
Deidentified Maximum,,20955,CPT4/HCPCS,FIBULA BONE GRAFT MICROVASC,,,9548.65
Deidentified Maximum,,20969,CPT4/HCPCS,BONE/SKIN GRAFT MICROVASC,,,9548.65
Deidentified Maximum,,20999,CPT4/HCPCS,MUSCULOSKELETAL SURGERY,,,4891.93
Deidentified Maximum,,21011,CPT4/HCPCS,EXC FACE LES SC <2 CM,,,4280.43
Deidentified Maximum,,21014,CPT4/HCPCS,EXC FACE TUM DEEP 2 CM/>,,,4891.93
Deidentified Maximum,,21015,CPT4/HCPCS,RESECT FACE/SCALP TUM < 2 CM,,,5856.00
Deidentified Maximum,,21025,CPT4/HCPCS,EXCISION OF BONE LOWER JAW,,,6075.00
Deidentified Maximum,,21029,CPT4/HCPCS,CONTOUR OF FACE BONE LESION,,,4280.43
Deidentified Maximum,,21031,CPT4/HCPCS,REMOVE EXOSTOSIS MANDIBLE,,,6049.05
Deidentified Maximum,,21048,CPT4/HCPCS,REMOVE MAXILLA CYST COMPLEX,,,9548.65
Deidentified Maximum,,21060,CPT4/HCPCS,REMOVE JAW JOINT CARTILAGE,,,6075.00
Deidentified Maximum,,21070,CPT4/HCPCS,REMOVE CORONOID PROCESS,,,6075.00
Deidentified Maximum,,21081,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,9548.65
Deidentified Maximum,,21085,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,4280.43
Deidentified Maximum,,21100,CPT4/HCPCS,MAXILLOFACIAL FIXATION,,,6075.00
Deidentified Maximum,,21123,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,,9548.65
Deidentified Maximum,,21147,CPT4/HCPCS,LEFORT I-3/> PIECE W/ GRAFT,,,5783.00
Deidentified Maximum,,21154,CPT4/HCPCS,LEFORT III W/O LEFORT I,,,6588.00
Deidentified Maximum,,21208,CPT4/HCPCS,AUGMENTATION OF FACIAL BONES,,,9548.65
Deidentified Maximum,,21215,CPT4/HCPCS,LOWER JAW BONE GRAFT,,,9548.65
Deidentified Maximum,,21247,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,,6049.05
Deidentified Maximum,,21260,CPT4/HCPCS,REVISE EYE SOCKETS,,,9548.65
Deidentified Maximum,,21270,CPT4/HCPCS,AUGMENTATION CHEEK BONE,,,6876.92
Deidentified Maximum,,21280,CPT4/HCPCS,REVISION OF EYELID,,,6876.92
Deidentified Maximum,,21295,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,,5029.00
Deidentified Maximum,,21336,CPT4/HCPCS,OPEN TX SEPTAL FX W/WO STABJ,,,6401.00
Deidentified Maximum,,21340,CPT4/HCPCS,PERQ TX NASOETHMOID FX,,,6401.00
Deidentified Maximum,,21343,CPT4/HCPCS,OPEN TX DPRSD FRONT SINUS FX,,,6840.00
Deidentified Maximum,,21355,CPT4/HCPCS,PERQ TX MALAR FRACTURE,,,6075.00
Deidentified Maximum,,21360,CPT4/HCPCS,OPN TX DPRSD MALAR FRACTURE,,,6401.00
Deidentified Maximum,,21365,CPT4/HCPCS,OPN TX COMPLX MALAR FX,,,6840.00
Deidentified Maximum,,21385,CPT4/HCPCS,OPN TX ORBIT FX TRANSANTRAL,,,8300.00
Deidentified Maximum,,21395,CPT4/HCPCS,OPN TX ORBIT PERIORBT W/GRFT,,,7830.00
Deidentified Maximum,,21432,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,,5281.00
Deidentified Maximum,,21433,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,,5281.00
Deidentified Maximum,,21445,CPT4/HCPCS,TREAT DENTAL RIDGE FRACTURE,,,6401.00
Deidentified Maximum,,21453,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,6075.00
Deidentified Maximum,,21465,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,6401.00
Deidentified Maximum,,21480,CPT4/HCPCS,RESET DISLOCATED JAW,,,3198.57
Deidentified Maximum,,21497,CPT4/HCPCS,INTERDENTAL WIRING,,,4280.43
Deidentified Maximum,,21600,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,,5138.00
Deidentified Maximum,,21601,CPT4/HCPCS,EXC CHEST WALL TUMOR W/RIBS,,,6840.00
Deidentified Maximum,,21610,CPT4/HCPCS,PARTIAL REMOVAL OF RIB,,,5138.00
Deidentified Maximum,,21720,CPT4/HCPCS,REVISION OF NECK MUSCLE,,,5856.00
Deidentified Maximum,,21742,CPT4/HCPCS,REPAIR STERN/NUSS W/O SCOPE,,,9548.65
Deidentified Maximum,,21800,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,,1678.00
Deidentified Maximum,,21936,CPT4/HCPCS,RESECT BACK TUM 5 CM/>,,,5856.00
Deidentified Maximum,,22112,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,,3544.00
Deidentified Maximum,,22216,CPT4/HCPCS,INCIS ADDL SPINE SEGMENT,,,3544.00
Deidentified Maximum,,22226,CPT4/HCPCS,REVISE EXTRA SPINE SEGMENT,,,3198.57
Deidentified Maximum,,22512,CPT4/HCPCS,VERTEBROPLASTY ADDL INJECT,,,9548.65
Deidentified Maximum,,22526,CPT4/HCPCS,IDET SINGLE LEVEL,,,8300.00
Deidentified Maximum,,22548,CPT4/HCPCS,NECK SPINE FUSION,,,8841.00
Deidentified Maximum,,22586,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L5-S1,,,8841.00
Deidentified Maximum,,22595,CPT4/HCPCS,NECK SPINAL FUSION,,,8012.00
Deidentified Maximum,,22600,CPT4/HCPCS,NECK SPINE FUSION,,,8012.00
Deidentified Maximum,,22840,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,5029.00
Deidentified Maximum,,22848,CPT4/HCPCS,INSERT PELV FIXATION DEVICE,,,3544.00
Deidentified Maximum,,22852,CPT4/HCPCS,REMOVE SPINE FIXATION DEVICE,,,3544.00
Deidentified Maximum,,22857,CPT4/HCPCS,LUMBAR ARTIF DISKECTOMY,,,1370.00
Deidentified Maximum,,22858,CPT4/HCPCS,SECOND LEVEL CER DISKECTOMY,,,5783.00
Deidentified Maximum,,22868,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,,5281.00
Deidentified Maximum,,22903,CPT4/HCPCS,EXC ABD LES SC 3 CM/>,,,5856.00
Deidentified Maximum,,23030,CPT4/HCPCS,DRAIN SHOULDER LESION,,,4204.00
Deidentified Maximum,,23044,CPT4/HCPCS,EXPLORATORY SHOULDER SURGERY,,,6401.00
Deidentified Maximum,,23107,CPT4/HCPCS,EXPLORE TREAT SHOULDER JOINT,,,6401.00
Deidentified Maximum,,23180,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,,6401.00
Deidentified Maximum,,23415,CPT4/HCPCS,RELEASE OF SHOULDER LIGAMENT,,,6876.92
Deidentified Maximum,,23465,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,6876.92
Deidentified Maximum,,23470,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,,12850.70
Deidentified Maximum,,23472,CPT4/HCPCS,RECONSTRUCT SHOULDER JOINT,,,10119.00
Deidentified Maximum,,23480,CPT4/HCPCS,REVISION OF COLLAR BONE,,,6401.00
Deidentified Maximum,,23552,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,7007.00
Deidentified Maximum,,23575,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,,3198.57
Deidentified Maximum,,24071,CPT4/HCPCS,EXC ARM/ELBOW LES SC 3 CM/>,,,5856.00
Deidentified Maximum,,24125,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,,5856.00
Deidentified Maximum,,24134,CPT4/HCPCS,REMOVAL OF ARM BONE LESION,,,5138.00
Deidentified Maximum,,24152,CPT4/HCPCS,RESECT RADIUS TUMOR,,,9548.65
Deidentified Maximum,,24164,CPT4/HCPCS,REMOVE RADIUS HEAD IMPLANT,,,5856.00
Deidentified Maximum,,24301,CPT4/HCPCS,MUSCLE/TENDON TRANSFER,,,6401.00
Deidentified Maximum,,24340,CPT4/HCPCS,REPAIR OF BICEPS TENDON,,,6075.00
Deidentified Maximum,,24358,CPT4/HCPCS,REPAIR ELBOW W/DEB OPEN,,,8300.00
Deidentified Maximum,,24360,CPT4/HCPCS,RECONSTRUCT ELBOW JOINT,,,6876.92
Deidentified Maximum,,24575,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,7007.00
Deidentified Maximum,,24576,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3198.57
Deidentified Maximum,,24615,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,,7007.00
Deidentified Maximum,,24665,CPT4/HCPCS,TREAT RADIUS FRACTURE,,,7007.00
Deidentified Maximum,,24670,CPT4/HCPCS,TREAT ULNAR FRACTURE,,,3198.57
Deidentified Maximum,,24900,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,,5029.00
Deidentified Maximum,,24925,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,5856.00
Deidentified Maximum,,25000,CPT4/HCPCS,INCISION OF TENDON SHEATH,,,5856.00
Deidentified Maximum,,25040,CPT4/HCPCS,EXPLORE/TREAT WRIST JOINT,,,6876.92
Deidentified Maximum,,25111,CPT4/HCPCS,REMOVE WRIST TENDON LESION,,,5856.00
Deidentified Maximum,,25115,CPT4/HCPCS,REMOVE WRIST/FOREARM LESION,,,6401.00
Deidentified Maximum,,25130,CPT4/HCPCS,REMOVAL OF WRIST LESION,,,5856.00
Deidentified Maximum,,25136,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,,5856.00
Deidentified Maximum,,25260,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,6401.00
Deidentified Maximum,,25280,CPT4/HCPCS,REVISE WRIST/FOREARM TENDON,,,6401.00
Deidentified Maximum,,25335,CPT4/HCPCS,REALIGNMENT OF HAND,,,6075.00
Deidentified Maximum,,25370,CPT4/HCPCS,REVISE RADIUS OR ULNA,,,6075.00
Deidentified Maximum,,25390,CPT4/HCPCS,SHORTEN RADIUS OR ULNA,,,6075.00
Deidentified Maximum,,25392,CPT4/HCPCS,SHORTEN RADIUS & ULNA,,,5856.00
Deidentified Maximum,,25405,CPT4/HCPCS,REPAIR/GRAFT RADIUS OR ULNA,,,7007.00
Deidentified Maximum,,25415,CPT4/HCPCS,REPAIR RADIUS & ULNA,,,7007.00
Deidentified Maximum,,25431,CPT4/HCPCS,REPAIR NONUNION CARPAL BONE,,,6075.00
Deidentified Maximum,,25443,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,,6876.92
Deidentified Maximum,,25446,CPT4/HCPCS,WRIST REPLACEMENT,,,10119.00
Deidentified Maximum,,25447,CPT4/HCPCS,REPAIR WRIST JOINTS,,,6876.92
Deidentified Maximum,,25492,CPT4/HCPCS,REINFORCE RADIUS AND ULNA,,,6075.00
Deidentified Maximum,,25535,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,,3198.57
Deidentified Maximum,,25545,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,,7007.00
Deidentified Maximum,,25606,CPT4/HCPCS,TREAT FX DISTAL RADIAL,,,5856.00
Deidentified Maximum,,25635,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,3198.57
Deidentified Maximum,,25650,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,1678.00
Deidentified Maximum,,25675,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,3198.57
Deidentified Maximum,,25676,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,4280.43
Deidentified Maximum,,25800,CPT4/HCPCS,FUSION OF WRIST JOINT,,,7007.00
Deidentified Maximum,,25820,CPT4/HCPCS,FUSION OF HAND BONES,,,6401.00
Deidentified Maximum,,25922,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,,5856.00
Deidentified Maximum,,26025,CPT4/HCPCS,DRAINAGE OF PALM BURSA,,,3198.57
Deidentified Maximum,,26030,CPT4/HCPCS,DRAINAGE OF PALM BURSAS,,,4280.43
Deidentified Maximum,,26045,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,,5856.00
Deidentified Maximum,,26075,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,,6401.00
Deidentified Maximum,,26160,CPT4/HCPCS,REMOVE TENDON SHEATH LESION,,,5856.00
Deidentified Maximum,,26210,CPT4/HCPCS,REMOVAL OF FINGER LESION,,,4280.43
Deidentified Maximum,,26341,CPT4/HCPCS,MANIPULAT PALM CORD POST INJ,,,3000.00
Deidentified Maximum,,26420,CPT4/HCPCS,REPAIR/GRAFT FINGER TENDON,,,6401.00
Deidentified Maximum,,26445,CPT4/HCPCS,RELEASE HAND/FINGER TENDON,,,5856.00
Deidentified Maximum,,26455,CPT4/HCPCS,INCISION OF FINGER TENDON,,,5856.00
Deidentified Maximum,,26490,CPT4/HCPCS,REVISE THUMB TENDON,,,5856.00
Deidentified Maximum,,26500,CPT4/HCPCS,HAND TENDON RECONSTRUCTION,,,6401.00
Deidentified Maximum,,26510,CPT4/HCPCS,THUMB TENDON TRANSFER,,,5856.00
Deidentified Maximum,,26520,CPT4/HCPCS,RELEASE KNUCKLE CONTRACTURE,,,5856.00
Deidentified Maximum,,26545,CPT4/HCPCS,RECONSTRUCT FINGER JOINT,,,6401.00
Deidentified Maximum,,26555,CPT4/HCPCS,POSITIONAL CHANGE OF FINGER,,,5856.00
Deidentified Maximum,,26561,CPT4/HCPCS,REPAIR OF WEB FINGER,,,5856.00
Deidentified Maximum,,26562,CPT4/HCPCS,REPAIR OF WEB FINGER,,,6401.00
Deidentified Maximum,,26591,CPT4/HCPCS,REPAIR MUSCLES OF HAND,,,5856.00
Deidentified Maximum,,26676,CPT4/HCPCS,PIN HAND DISLOCATION,,,4280.43
Deidentified Maximum,,26861,CPT4/HCPCS,FUSION OF FINGER JNT ADD-ON,,,4280.43
Deidentified Maximum,,26991,CPT4/HCPCS,DRAINAGE OF PELVIS BURSA,,,4204.00
Deidentified Maximum,,27006,CPT4/HCPCS,INCISION OF HIP TENDONS,,,6401.00
Deidentified Maximum,,27045,CPT4/HCPCS,EXC HIP/PELV TUM DEEP 5 CM/>,,,5856.00
Deidentified Maximum,,27047,CPT4/HCPCS,EXC HIP/PELVIS LES SC < 3 CM,,,4280.43
Deidentified Maximum,,27049,CPT4/HCPCS,RESECT HIP/PELV TUM < 5 CM,,,5856.00
Deidentified Maximum,,27070,CPT4/HCPCS,PART REMOVE HIP BONE SUPER,,,4891.93
Deidentified Maximum,,27086,CPT4/HCPCS,REMOVE HIP FOREIGN BODY,,,3198.57
Deidentified Maximum,,27091,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,,5281.00
Deidentified Maximum,,27095,CPT4/HCPCS,INJECTION FOR HIP X-RAY,,,3000.00
Deidentified Maximum,,27122,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,,5281.00
Deidentified Maximum,,27130,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,,10119.00
Deidentified Maximum,,27146,CPT4/HCPCS,INCISION OF HIP BONE,,,5281.00
Deidentified Maximum,,27197,CPT4/HCPCS,CLSD TX PELVIC RING FX,,,3198.57
Deidentified Maximum,,27235,CPT4/HCPCS,TREAT THIGH FRACTURE,,,6401.00
Deidentified Maximum,,27258,CPT4/HCPCS,TREAT HIP DISLOCATION,,,5029.00
Deidentified Maximum,,27259,CPT4/HCPCS,TREAT HIP DISLOCATION,,,5029.00
Deidentified Maximum,,27268,CPT4/HCPCS,CLTX THIGH FX W/MNPJ,,,4280.43
Deidentified Maximum,,27299,CPT4/HCPCS,PELVIS/HIP JOINT SURGERY,,,3198.57
Deidentified Maximum,,27324,CPT4/HCPCS,BIOPSY THIGH SOFT TISSUES,,,4204.00
Deidentified Maximum,,27339,CPT4/HCPCS,EXC THIGH/KNEE TUM DEP 5CM/>,,,5856.00
Deidentified Maximum,,27347,CPT4/HCPCS,REMOVE KNEE CYST,,,6401.00
Deidentified Maximum,,27358,CPT4/HCPCS,REMOVE FEMUR LESION/FIXATION,,,6876.92
Deidentified Maximum,,27369,CPT4/HCPCS,NJX CNTRST KNE ARTHG/CT/MRI,,,3000.00
Deidentified Maximum,,27395,CPT4/HCPCS,LENGTHENING OF THIGH TENDONS,,,6075.00
Deidentified Maximum,,27416,CPT4/HCPCS,OSTEOCHONDRAL KNEE AUTOGRAFT,,,8300.00
Deidentified Maximum,,27420,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,,6075.00
Deidentified Maximum,,27427,CPT4/HCPCS,RECONSTRUCTION KNEE,,,7007.00
Deidentified Maximum,,27440,CPT4/HCPCS,REVISION OF KNEE JOINT,,,7902.34
Deidentified Maximum,,27457,CPT4/HCPCS,REALIGNMENT OF KNEE,,,6075.00
Deidentified Maximum,,27466,CPT4/HCPCS,LENGTHENING OF THIGH BONE,,,5281.00
Deidentified Maximum,,27487,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,,10119.00
Deidentified Maximum,,27498,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,,5856.00
Deidentified Maximum,,27507,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,6401.00
Deidentified Maximum,,27511,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,6401.00
Deidentified Maximum,,27517,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,,3198.57
Deidentified Maximum,,27552,CPT4/HCPCS,TREAT KNEE DISLOCATION,,,3198.57
Deidentified Maximum,,27612,CPT4/HCPCS,EXPLORATION OF ANKLE JOINT,,,5856.00
Deidentified Maximum,,27625,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,,6401.00
Deidentified Maximum,,27632,CPT4/HCPCS,EXC LEG/ANKLE LES SC 3 CM/>,,,5856.00
Deidentified Maximum,,27635,CPT4/HCPCS,REMOVE LOWER LEG BONE LESION,,,5856.00
Deidentified Maximum,,27647,CPT4/HCPCS,RESECT TALUS/CALCANEUS TUM,,,5856.00
Deidentified Maximum,,27659,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,,4280.43
Deidentified Maximum,,27690,CPT4/HCPCS,REVISE LOWER LEG TENDON,,,6401.00
Deidentified Maximum,,27702,CPT4/HCPCS,RECONSTRUCT ANKLE JOINT,,,5281.00
Deidentified Maximum,,27732,CPT4/HCPCS,REPAIR OF FIBULA EPIPHYSIS,,,5138.00
Deidentified Maximum,,27756,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,,5856.00
Deidentified Maximum,,27784,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,,7007.00
Deidentified Maximum,,27825,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,,4280.43
Deidentified Maximum,,27831,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,,3198.57
Deidentified Maximum,,27848,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,,7007.00
Deidentified Maximum,,27886,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,5029.00
Deidentified Maximum,,27888,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,,6588.00
Deidentified Maximum,,27892,CPT4/HCPCS,DECOMPRESSION OF LEG,,,5856.00
Deidentified Maximum,,28039,CPT4/HCPCS,EXC FOOT/TOE TUM SC 1.5 CM/>,,,4280.43
Deidentified Maximum,,28045,CPT4/HCPCS,EXC FOOT/TOE TUM DEEP <1.5CM,,,5856.00
Deidentified Maximum,,28054,CPT4/HCPCS,BIOPSY OF TOE JOINT LINING,,,4280.43
Deidentified Maximum,,28110,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,,5856.00
Deidentified Maximum,,28111,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,,5856.00
Deidentified Maximum,,28112,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,,5856.00
Deidentified Maximum,,28118,CPT4/HCPCS,REMOVAL OF HEEL BONE,,,6401.00
Deidentified Maximum,,28238,CPT4/HCPCS,REVISION OF FOOT TENDON,,,7007.00
Deidentified Maximum,,28264,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,,7007.00
Deidentified Maximum,,28291,CPT4/HCPCS,CORRJ HALUX RIGDUS W/IMPLT,,,7007.00
Deidentified Maximum,,28293,CPT4/HCPCS,CORRECTION OF BUNION,,,3544.00
Deidentified Maximum,,28294,CPT4/HCPCS,CORRECTION OF BUNION,,,3544.00
Deidentified Maximum,,28296,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,5856.00
Deidentified Maximum,,28302,CPT4/HCPCS,INCISION OF ANKLE BONE,,,4280.43
Deidentified Maximum,,28304,CPT4/HCPCS,INCISION OF MIDFOOT BONES,,,7007.00
Deidentified Maximum,,28360,CPT4/HCPCS,RECONSTRUCT CLEFT FOOT,,,7007.00
Deidentified Maximum,,28430,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,2002.00
Deidentified Maximum,,28515,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,,2002.00
Deidentified Maximum,,28525,CPT4/HCPCS,TREAT TOE FRACTURE,,,5856.00
Deidentified Maximum,,28531,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,,5856.00
Deidentified Maximum,,28570,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,2002.00
Deidentified Maximum,,28576,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,5856.00
Deidentified Maximum,,28600,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,2002.00
Deidentified Maximum,,28630,CPT4/HCPCS,TREAT TOE DISLOCATION,,,2002.00
Deidentified Maximum,,28820,CPT4/HCPCS,AMPUTATION OF TOE,,,4280.43
Deidentified Maximum,,28899,CPT4/HCPCS,FOOT/TOES SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,29000,CPT4/HCPCS,APPLICATION OF BODY CAST,,,1678.88
Deidentified Maximum,,29025,CPT4/HCPCS,APPLICATION OF BODY CAST,,,3544.00
Deidentified Maximum,,29085,CPT4/HCPCS,APPLY HAND/WRIST CAST,,,1214.00
Deidentified Maximum,,29126,CPT4/HCPCS,APPLY FOREARM SPLINT,,,1214.00
Deidentified Maximum,,29280,CPT4/HCPCS,STRAPPING OF HAND OR FINGER,,,6766.00
Deidentified Maximum,,29325,CPT4/HCPCS,APPLICATION OF HIP CASTS,,,3656.00
Deidentified Maximum,,29405,CPT4/HCPCS,APPLY SHORT LEG CAST,,,6766.00
Deidentified Maximum,,29505,CPT4/HCPCS,APPLICATION LONG LEG SPLINT,,,1214.00
Deidentified Maximum,,29730,CPT4/HCPCS,WINDOWING OF CAST,,,1678.00
Deidentified Maximum,,29821,CPT4/HCPCS,SHO ARTHRS SRG COMPL SYNVCT,,,7007.00
Deidentified Maximum,,29825,CPT4/HCPCS,SHO ARTHRS SRG LSS&RESCJ ADS,,,7007.00
Deidentified Maximum,,29836,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,,7007.00
Deidentified Maximum,,29837,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29844,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29845,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29851,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,7007.00
Deidentified Maximum,,29861,CPT4/HCPCS,HIP ARTHRO W/FB REMOVAL,,,7007.00
Deidentified Maximum,,29867,CPT4/HCPCS,ALLGRFT IMPLNT KNEE W/SCOPE,,,12850.70
Deidentified Maximum,,29873,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,6876.92
Deidentified Maximum,,29874,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29877,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,6401.00
Deidentified Maximum,,29885,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,7007.00
Deidentified Maximum,,29893,CPT4/HCPCS,SCOPE PLANTAR FASCIOTOMY,,,12850.70
Deidentified Maximum,,29897,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29915,CPT4/HCPCS,HIP ARTHRO ACETABULOPLASTY,,,8300.00
Deidentified Maximum,,30020,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,,3198.57
Deidentified Maximum,,30118,CPT4/HCPCS,REMOVAL OF INTRANASAL LESION,,,5856.00
Deidentified Maximum,,30125,CPT4/HCPCS,REMOVAL OF NOSE LESION,,,6075.00
Deidentified Maximum,,30160,CPT4/HCPCS,REMOVAL OF NOSE,,,6401.00
Deidentified Maximum,,30400,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,,6401.00
Deidentified Maximum,,30540,CPT4/HCPCS,REPAIR NASAL DEFECT,,,6876.92
Deidentified Maximum,,30600,CPT4/HCPCS,REPAIR MOUTH/NOSE FISTULA,,,6401.00
Deidentified Maximum,,29905,CPT4/HCPCS,SUBTALAR ARTHRO W/EXC,,,8300.00
Deidentified Maximum,,29906,CPT4/HCPCS,SUBTALAR ARTHRO W/DEB,,,8300.00
Deidentified Maximum,,29914,CPT4/HCPCS,HIP ARTHRO W/FEMOROPLASTY,,,8300.00
Deidentified Maximum,,29999,CPT4/HCPCS,ARTHROSCOPY OF JOINT,,,6876.92
Deidentified Maximum,,30140,CPT4/HCPCS,RESECT INFERIOR TURBINATE,,,4280.43
Deidentified Maximum,,30150,CPT4/HCPCS,PARTIAL REMOVAL OF NOSE,,,6075.00
Deidentified Maximum,,30410,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,,6876.92
Deidentified Maximum,,30462,CPT4/HCPCS,REVISION OF NOSE,,,12850.70
Deidentified Maximum,,30465,CPT4/HCPCS,REPAIR NASAL STENOSIS,,,12850.70
Deidentified Maximum,,30905,CPT4/HCPCS,CONTROL OF NOSEBLEED,,,3198.57
Deidentified Maximum,,31000,CPT4/HCPCS,IRRIGATION MAXILLARY SINUS,,,3198.57
Deidentified Maximum,,31020,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,,4280.43
Deidentified Maximum,,31032,CPT4/HCPCS,EXPLORE SINUS REMOVE POLYPS,,,6401.00
Deidentified Maximum,,31040,CPT4/HCPCS,EXPLORATION BEHIND UPPER JAW,,,6049.05
Deidentified Maximum,,31080,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,6401.00
Deidentified Maximum,,31081,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,6401.00
Deidentified Maximum,,31084,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,6401.00
Deidentified Maximum,,31237,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,4280.43
Deidentified Maximum,,31241,CPT4/HCPCS,NSL/SINS NDSC W/ARTERY LIG,,,6876.92
Deidentified Maximum,,31267,CPT4/HCPCS,ENDOSCOPY MAXILLARY SINUS,,,5856.00
Deidentified Maximum,,31299,CPT4/HCPCS,SINUS SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,31380,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,6049.05
Deidentified Maximum,,31395,CPT4/HCPCS,RECONSTRUCT LARYNX & PHARYNX,,,9548.65
Deidentified Maximum,,31505,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,,3198.57
Deidentified Maximum,,31511,CPT4/HCPCS,REMOVE FOREIGN BODY LARYNX,,,4280.43
Deidentified Maximum,,31545,CPT4/HCPCS,REMOVE VC LESION W/SCOPE,,,6401.00
Deidentified Maximum,,31553,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,,6876.92
Deidentified Maximum,,31570,CPT4/HCPCS,LARYNGOSCOPE W/VC INJ,,,4280.43
Deidentified Maximum,,31579,CPT4/HCPCS,LARYNGOSCOPY TELESCOPIC,,,3656.00
Deidentified Maximum,,31580,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL WEB,,,6876.92
Deidentified Maximum,,31615,CPT4/HCPCS,VISUALIZATION OF WINDPIPE,,,3198.57
Deidentified Maximum,,31630,CPT4/HCPCS,BRONCHOSCOPY DILATE/FX REPR,,,5138.00
Deidentified Maximum,,31653,CPT4/HCPCS,BRONCH EBUS SAMPLNG 3/> NODE,,,8300.00
Deidentified Maximum,,31661,CPT4/HCPCS,BRONCH THERMOPLSTY 2/> LOBES,,,8300.00
Deidentified Maximum,,31760,CPT4/HCPCS,REPAIR OF WINDPIPE,,,6588.00
Deidentified Maximum,,31775,CPT4/HCPCS,RECONSTRUCT BRONCHUS,,,6588.00
Deidentified Maximum,,31785,CPT4/HCPCS,REMOVE WINDPIPE LESION,,,6401.00
Deidentified Maximum,,32036,CPT4/HCPCS,THORACOSTOMY W/FLAP DRAINAGE,,,5029.00
Deidentified Maximum,,32201,CPT4/HCPCS,DRAIN PERCUT LUNG LESION,,,1678.00
Deidentified Maximum,,32556,CPT4/HCPCS,INSERT CATH PLEURA W/O IMAGE,,,3656.00
Deidentified Maximum,,32604,CPT4/HCPCS,THORACOSCOPY WBX SAC,,,7902.34
Deidentified Maximum,,32606,CPT4/HCPCS,THORACOSCOPY W/BX MED SPACE,,,7902.34
Deidentified Maximum,,32655,CPT4/HCPCS,THORACOSCOPY RESECT BULLAE,,,10119.00
Deidentified Maximum,,32662,CPT4/HCPCS,THORACOSCOPY W/MEDIAST EXC,,,5783.00
Deidentified Maximum,,32820,CPT4/HCPCS,RECONSTRUCT INJURED CHEST,,,5783.00
Deidentified Maximum,,33010,CPT4/HCPCS,DRAINAGE OF HEART SAC,,,4280.43
Deidentified Maximum,,33020,CPT4/HCPCS,INCISION OF HEART SAC,,,5029.00
Deidentified Maximum,,33130,CPT4/HCPCS,REMOVAL OF HEART LESION,,,6588.00
Deidentified Maximum,,33211,CPT4/HCPCS,INSERT CARD ELECTRODES DUAL,,,12850.70
Deidentified Maximum,,33217,CPT4/HCPCS,INSERT 2 ELECTRODE PM-DEFIB,,,21405.00
Deidentified Maximum,,33241,CPT4/HCPCS,REMOVE PULSE GENERATOR,,,6401.00
Deidentified Maximum,,33243,CPT4/HCPCS,REMOVE ELTRD/THORACOTOMY,,,6075.00
Deidentified Maximum,,33244,CPT4/HCPCS,REMOVE ELCTRD TRANSVENOUSLY,,,6401.00
Deidentified Maximum,,33264,CPT4/HCPCS,RMVL & RPLCMT DFB GEN MLT LD,,,24180.00
Deidentified Maximum,,33275,CPT4/HCPCS,TCAT RMVL PERM LDLS PM W/IMG,,,8300.00
Deidentified Maximum,,33286,CPT4/HCPCS,RMVL SUBQ CAR RHYTHM MNTR,,,3000.00
Deidentified Maximum,,33332,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,,6588.00
Deidentified Maximum,,33364,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,,9548.65
Deidentified Maximum,,33368,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,,12850.70
Deidentified Maximum,,33369,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,,12850.70
Deidentified Maximum,,33406,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,,6049.05
Deidentified Maximum,,33418,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,,8841.00
Deidentified Maximum,,33440,CPT4/HCPCS,RPLCMT A-VALVE TLCJ AUTOL PV,,,8841.00
Deidentified Maximum,,33478,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,8841.00
Deidentified Maximum,,33504,CPT4/HCPCS,CORONARY ARTERY GRAFT,,,8841.00
Deidentified Maximum,,33507,CPT4/HCPCS,REPAIR ART INTRAMURAL,,,6588.00
Deidentified Maximum,,33508,CPT4/HCPCS,ENDOSCOPIC VEIN HARVEST,,,3544.00
Deidentified Maximum,,33510,CPT4/HCPCS,CABG VEIN SINGLE,,,1370.00
Deidentified Maximum,,33542,CPT4/HCPCS,REMOVAL OF HEART LESION,,,5783.00
Deidentified Maximum,,33615,CPT4/HCPCS,REPAIR MODIFIED FONTAN,,,1370.00
Deidentified Maximum,,33617,CPT4/HCPCS,REPAIR SINGLE VENTRICLE,,,1370.00
Deidentified Maximum,,33647,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECTS,,,8841.00
Deidentified Maximum,,33676,CPT4/HCPCS,CLOSE MULT VSD W/RESECTION,,,8841.00
Deidentified Maximum,,33702,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,8841.00
Deidentified Maximum,,33710,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,8841.00
Deidentified Maximum,,33770,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,1370.00
Deidentified Maximum,,33781,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,8841.00
Deidentified Maximum,,33788,CPT4/HCPCS,REVISION OF PULMONARY ARTERY,,,8012.00
Deidentified Maximum,,33859,CPT4/HCPCS,AS-AORT GRF F/DS OTH/THN DSJ,,,8841.00
Deidentified Maximum,,33860,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,,8841.00
Deidentified Maximum,,33864,CPT4/HCPCS,ASCENDING AORTIC GRAFT,,,8841.00
Deidentified Maximum,,33875,CPT4/HCPCS,THORACIC AORTIC GRAFT,,,8841.00
Deidentified Maximum,,33877,CPT4/HCPCS,THORACOABDOMINAL GRAFT,,,8841.00
Deidentified Maximum,,33881,CPT4/HCPCS,ENDOVASC TAA REPR W/O SUBCL,,,8012.00
Deidentified Maximum,,33883,CPT4/HCPCS,INSERT ENDOVASC PROSTH TAA,,,3544.00
Deidentified Maximum,,33925,CPT4/HCPCS,RPR PUL ART UNIFOCAL W/O CPB,,,1370.00
Deidentified Maximum,,33926,CPT4/HCPCS,REPR PUL ART UNIFOCAL W/CPB,,,1370.00
Deidentified Maximum,,33930,CPT4/HCPCS,REMOVAL OF DONOR HEART/LUNG,,,1370.00
Deidentified Maximum,,33955,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,,3544.00
Deidentified Maximum,,33957,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,8012.00
Deidentified Maximum,,33958,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,8012.00
Deidentified Maximum,,33966,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,,5281.00
Deidentified Maximum,,33969,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,,5281.00
Deidentified Maximum,,33971,CPT4/HCPCS,AORTIC CIRCULATION ASSIST,,,5281.00
Deidentified Maximum,,33979,CPT4/HCPCS,INSERT INTRACORPOREAL DEVICE,,,8012.00
Deidentified Maximum,,33989,CPT4/HCPCS,REMOVAL OF LEFT HEART VENT,,,5029.00
Deidentified Maximum,,33990,CPT4/HCPCS,INSJ PERQ VAD L HRT ARTERIAL,,,9304.06
Deidentified Maximum,,34203,CPT4/HCPCS,REMOVAL OF LEG ARTERY CLOT,,,9548.65
Deidentified Maximum,,34421,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,,9548.65
Deidentified Maximum,,34501,CPT4/HCPCS,REPAIR VALVE FEMORAL VEIN,,,9548.65
Deidentified Maximum,,34703,CPT4/HCPCS,EVASC RPR A-UNILAC NDGFT,,,7188.00
Deidentified Maximum,,34706,CPT4/HCPCS,EVASC RPR A-BIILIAC RPT,,,7188.00
Deidentified Maximum,,34710,CPT4/HCPCS,DLYD PLMT XTN PROSTH 1ST VSL,,,6401.00
Deidentified Maximum,,34812,CPT4/HCPCS,OPN FEM ART EXPOS,,,5029.00
Deidentified Maximum,,34813,CPT4/HCPCS,FEMORAL ENDOVAS GRAFT ADD-ON,,,5029.00
Deidentified Maximum,,34825,CPT4/HCPCS,ENDOVASC EXTEND PROSTH INIT,,,3544.00
Deidentified Maximum,,34832,CPT4/HCPCS,OPEN AORTOFEMOR PROSTH REPR,,,8012.00
Deidentified Maximum,,34842,CPT4/HCPCS,ENDOVASC VISC AORTA 2 GRAFT,,,8841.00
Deidentified Maximum,,35081,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,8012.00
Deidentified Maximum,,35103,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,,8012.00
Deidentified Maximum,,35112,CPT4/HCPCS,REPAIR ARTERY RUPTURE SPLEEN,,,5783.00
Deidentified Maximum,,35180,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,6049.05
Deidentified Maximum,,35184,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,6049.05
Deidentified Maximum,,35286,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,7902.34
Deidentified Maximum,,35303,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5029.00
Deidentified Maximum,,35311,CPT4/HCPCS,RECHANNELING OF ARTERY,,,6588.00
Deidentified Maximum,,35351,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5281.00
Deidentified Maximum,,35355,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5029.00
Deidentified Maximum,,35371,CPT4/HCPCS,RECHANNELING OF ARTERY,,,3198.57
Deidentified Maximum,,35472,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,5029.00
Deidentified Maximum,,35515,CPT4/HCPCS,ART BYP GRFT SUBCLAV-VERTBRL,,,5029.00
Deidentified Maximum,,35521,CPT4/HCPCS,ART BYP GRFT AXILL-FEMORAL,,,5281.00
Deidentified Maximum,,35536,CPT4/HCPCS,ART BYP GRFT SPLENORENAL,,,5783.00
Deidentified Maximum,,35539,CPT4/HCPCS,ART BYP GRFT AORTOFEMORAL,,,5783.00
Deidentified Maximum,,35570,CPT4/HCPCS,ART BYP TIBIAL-TIB/PERONEAL,,,5029.00
Deidentified Maximum,,35571,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,,5029.00
Deidentified Maximum,,35587,CPT4/HCPCS,VEIN BYP POP-TIBL PERONEAL,,,5029.00
Deidentified Maximum,,35626,CPT4/HCPCS,ART BYP AORSUBCL/CAROT/INNOM,,,5281.00
Deidentified Maximum,,35632,CPT4/HCPCS,ART BYP ILIO-CELIAC,,,5281.00
Deidentified Maximum,,35633,CPT4/HCPCS,ART BYP ILIO-MESENTERIC,,,5281.00
Deidentified Maximum,,35685,CPT4/HCPCS,BYPASS GRAFT PATENCY/PATCH,,,6049.05
Deidentified Maximum,,35686,CPT4/HCPCS,BYPASS GRAFT/AV FIST PATENCY,,,6049.05
Deidentified Maximum,,35702,CPT4/HCPCS,EXPL N/FLWD SURG UXTR ART,,,3656.00
Deidentified Maximum,,35860,CPT4/HCPCS,EXPLORE LIMB VESSELS,,,6049.05
Deidentified Maximum,,35876,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,,12850.70
Deidentified Maximum,,35881,CPT4/HCPCS,REVISE GRAFT W/VEIN,,,9548.65
Deidentified Maximum,,35883,CPT4/HCPCS,REVISE GRAFT W/NONAUTO GRAFT,,,8300.00
Deidentified Maximum,,35905,CPT4/HCPCS,EXCISION GRAFT THORAX,,,5029.00
Deidentified Maximum,,36002,CPT4/HCPCS,PSEUDOANEURYSM INJECTION TRT,,,3198.57
Deidentified Maximum,,36100,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,,3000.00
Deidentified Maximum,,36140,CPT4/HCPCS,INTRO NDL ICATH UPR/LXTR ART,,,3000.00
Deidentified Maximum,,36218,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,3656.00
Deidentified Maximum,,36245,CPT4/HCPCS,INS CATH ABD/L-EXT ART 1ST,,,3656.00
Deidentified Maximum,,36248,CPT4/HCPCS,INS CATH ABD/L-EXT ART ADDL,,,3656.00
Deidentified Maximum,,36260,CPT4/HCPCS,INSERTION OF INFUSION PUMP,,,7007.00
Deidentified Maximum,,36440,CPT4/HCPCS,BL PUSH TRANSFUSE 2 YR/<,,,3198.57
Deidentified Maximum,,36456,CPT4/HCPCS,PRTL EXCHANGE TRANSFUSE NB,,,3198.57
Deidentified Maximum,,36466,CPT4/HCPCS,NJX NONCMPND SCLRSNT MLT VN,,,3656.00
Deidentified Maximum,,36478,CPT4/HCPCS,ENDOVENOUS LASER 1ST VEIN,,,8300.00
Deidentified Maximum,,36479,CPT4/HCPCS,ENDOVENOUS LASER VEIN ADDON,,,6876.92
Deidentified Maximum,,36500,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,,3000.00
Deidentified Maximum,,36566,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,12850.70
Deidentified Maximum,,36572,CPT4/HCPCS,INSJ PICC RS&I <5 YR,,,3000.00
Deidentified Maximum,,36593,CPT4/HCPCS,DECLOT VASCULAR DEVICE,,,2002.00
Deidentified Maximum,,36596,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,,3198.57
Deidentified Maximum,,36597,CPT4/HCPCS,REPOSITION VENOUS CATHETER,,,3198.57
Deidentified Maximum,,36660,CPT4/HCPCS,INSERTION CATHETER ARTERY,,,3198.57
Deidentified Maximum,,36819,CPT4/HCPCS,AV FUSE UPPR ARM BASILIC,,,7007.00
Deidentified Maximum,,36820,CPT4/HCPCS,AV FUSION/FOREARM VEIN,,,7007.00
Deidentified Maximum,,36821,CPT4/HCPCS,AV FUSION DIRECT ANY SITE,,,5856.00
Deidentified Maximum,,36825,CPT4/HCPCS,ARTERY-VEIN AUTOGRAFT,,,7007.00
Deidentified Maximum,,36903,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,,10119.00
Deidentified Maximum,,37140,CPT4/HCPCS,REVISION OF CIRCULATION,,,5783.00
Deidentified Maximum,,37160,CPT4/HCPCS,REVISION OF CIRCULATION,,,5783.00
Deidentified Maximum,,37184,CPT4/HCPCS,PRIM ART M-THRMBC 1ST VSL,,,9770.00
Deidentified Maximum,,37192,CPT4/HCPCS,REDO ENDOVAS VENA CAVA FILTR,,,5856.00
Deidentified Maximum,,37205,CPT4/HCPCS,TRANSCATH IV STENT PERCUT,,,5029.00
Deidentified Maximum,,37215,CPT4/HCPCS,TRANSCATH STENT CCA W/EPS,,,5856.00
Deidentified Maximum,,37218,CPT4/HCPCS,STENT PLACEMT ANTE CAROTID,,,5856.00
Deidentified Maximum,,37230,CPT4/HCPCS,TIB/PER REVASC W/STENT,,,10119.00
Deidentified Maximum,,37231,CPT4/HCPCS,TIB/PER REVASC STENT & ATHER,,,14317.00
Deidentified Maximum,,37237,CPT4/HCPCS,OPEN/PERQ PLACE STENT EA ADD,,,7007.00
Deidentified Maximum,,37242,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ARTERY,,,10119.00
Deidentified Maximum,,37248,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST VEIN,,,7830.00
Deidentified Maximum,,37253,CPT4/HCPCS,INTRVASC US NONCORONARY ADDL,,,3000.00
Deidentified Maximum,,37565,CPT4/HCPCS,LIGATION OF NECK VEIN,,,6049.05
Deidentified Maximum,,37700,CPT4/HCPCS,REVISE LEG VEIN,,,5138.00
Deidentified Maximum,,37760,CPT4/HCPCS,LIGATE LEG VEINS RADICAL,,,5856.00
Deidentified Maximum,,37761,CPT4/HCPCS,LIGATE LEG VEINS OPEN,,,6876.92
Deidentified Maximum,,37788,CPT4/HCPCS,REVASCULARIZATION PENIS,,,5029.00
Deidentified Maximum,,38209,CPT4/HCPCS,WASH HARVEST STEM CELLS,,,3198.57
Deidentified Maximum,,38214,CPT4/HCPCS,VOLUME DEPLETE OF HARVEST,,,3198.57
Deidentified Maximum,,38221,CPT4/HCPCS,DX BONE MARROW BIOPSIES,,,3000.00
Deidentified Maximum,,38380,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,,5783.00
Deidentified Maximum,,38520,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,,4280.43
Deidentified Maximum,,38525,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,,4280.43
Deidentified Maximum,,38542,CPT4/HCPCS,EXPLORE DEEP NODE(S) NECK,,,7007.00
Deidentified Maximum,,38550,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,,5856.00
Deidentified Maximum,,38571,CPT4/HCPCS,LAPAROSCOPY LYMPHADENECTOMY,,,12850.70
Deidentified Maximum,,38700,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,,4891.93
Deidentified Maximum,,38765,CPT4/HCPCS,REMOVE GROIN LYMPH NODES,,,3198.57
Deidentified Maximum,,38790,CPT4/HCPCS,INJECT FOR LYMPHATIC X-RAY,,,3000.00
Deidentified Maximum,,38900,CPT4/HCPCS,IO MAP OF SENT LYMPH NODE,,,3000.00
Deidentified Maximum,,39400,CPT4/HCPCS,MEDIASTINOSCOPY INCL BIOPSY,,,3544.00
Deidentified Maximum,,39503,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,,12850.70
Deidentified Maximum,,39541,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,,5783.00
Deidentified Maximum,,40650,CPT4/HCPCS,REPAIR LIP,,,5856.00
Deidentified Maximum,,40720,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,,9548.65
Deidentified Maximum,,40806,CPT4/HCPCS,INCISION OF LIP FOLD,,,3198.57
Deidentified Maximum,,40810,CPT4/HCPCS,EXCISION OF MOUTH LESION,,,4280.43
Deidentified Maximum,,41005,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,3198.57
Deidentified Maximum,,41006,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,3198.57
Deidentified Maximum,,41010,CPT4/HCPCS,INCISION OF TONGUE FOLD,,,3198.57
Deidentified Maximum,,41110,CPT4/HCPCS,EXCISION OF TONGUE LESION,,,4280.43
Deidentified Maximum,,41112,CPT4/HCPCS,EXCISION OF TONGUE LESION,,,4280.43
Deidentified Maximum,,41114,CPT4/HCPCS,EXCISION OF TONGUE LESION,,,4280.43
Deidentified Maximum,,41252,CPT4/HCPCS,REPAIR TONGUE LACERATION,,,4280.43
Deidentified Maximum,,41820,CPT4/HCPCS,EXCISION GUM EACH QUADRANT,,,4204.00
Deidentified Maximum,,41825,CPT4/HCPCS,EXCISION OF GUM LESION,,,4280.43
Deidentified Maximum,,41850,CPT4/HCPCS,TREATMENT OF GUM LESION,,,4280.43
Deidentified Maximum,,42000,CPT4/HCPCS,DRAINAGE MOUTH ROOF LESION,,,4280.43
Deidentified Maximum,,42145,CPT4/HCPCS,REPAIR PALATE PHARYNX/UVULA,,,6876.92
Deidentified Maximum,,42160,CPT4/HCPCS,TREATMENT MOUTH ROOF LESION,,,4280.43
Deidentified Maximum,,42205,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,6876.92
Deidentified Maximum,,42235,CPT4/HCPCS,REPAIR PALATE,,,6876.92
Deidentified Maximum,,42299,CPT4/HCPCS,PALATE/UVULA SURGERY,,,3198.57
Deidentified Maximum,,42305,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,,4280.43
Deidentified Maximum,,42425,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,,9548.65
Deidentified Maximum,,42665,CPT4/HCPCS,LIGATION OF SALIVARY DUCT,,,7830.00
Deidentified Maximum,,42802,CPT4/HCPCS,BIOPSY OF THROAT,,,1678.00
Deidentified Maximum,,42804,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,,3198.57
Deidentified Maximum,,42808,CPT4/HCPCS,EXCISE PHARYNX LESION,,,4280.43
Deidentified Maximum,,42820,CPT4/HCPCS,REMOVE TONSILS AND ADENOIDS,,,5856.00
Deidentified Maximum,,42835,CPT4/HCPCS,REMOVAL OF ADENOIDS,,,6401.00
Deidentified Maximum,,42844,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,,9548.65
Deidentified Maximum,,42860,CPT4/HCPCS,EXCISION OF TONSIL TAGS,,,5856.00
Deidentified Maximum,,42870,CPT4/HCPCS,EXCISION OF LINGUAL TONSIL,,,5856.00
Deidentified Maximum,,42900,CPT4/HCPCS,REPAIR THROAT WOUND,,,3198.57
Deidentified Maximum,,42953,CPT4/HCPCS,REPAIR THROAT ESOPHAGUS,,,5281.00
Deidentified Maximum,,43030,CPT4/HCPCS,THROAT MUSCLE SURGERY,,,6075.00
Deidentified Maximum,,43107,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43108,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43197,CPT4/HCPCS,ESOPHAGOSCOPY FLEX DX BRUSH,,,4000.00
Deidentified Maximum,,43202,CPT4/HCPCS,ESOPHAGOSCOPY FLEX BIOPSY,,,3198.57
Deidentified Maximum,,43210,CPT4/HCPCS,EGD ESOPHAGOGASTRC FNDOPLSTY,,,8300.00
Deidentified Maximum,,43219,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY,,,1678.00
Deidentified Maximum,,43232,CPT4/HCPCS,ESOPHAGOSCOPY W/US NEEDLE BX,,,4280.43
Deidentified Maximum,,43251,CPT4/HCPCS,EGD REMOVE LESION SNARE,,,4280.43
Deidentified Maximum,,43258,CPT4/HCPCS,OPERATIVE UPPER GI ENDOSCOPY,,,1678.88
Deidentified Maximum,,43262,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,4280.43
Deidentified Maximum,,43265,CPT4/HCPCS,ERCP LITHOTRIPSY CALCULI,,,4280.43
Deidentified Maximum,,43269,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Maximum,,43271,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Maximum,,43278,CPT4/HCPCS,ERCP LESION ABLATE W/DILATE,,,8300.00
Deidentified Maximum,,43279,CPT4/HCPCS,LAP MYOTOMY HELLER,,,7007.00
Deidentified Maximum,,43285,CPT4/HCPCS,RMVL ESOPHGL SPHNCTR DEV,,,7007.00
Deidentified Maximum,,43288,CPT4/HCPCS,ESPHG THRSC MOBLJ,,,6588.00
Deidentified Maximum,,43360,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,,5783.00
Deidentified Maximum,,43401,CPT4/HCPCS,ESOPHAGUS SURGERY FOR VEINS,,,5783.00
Deidentified Maximum,,43496,CPT4/HCPCS,FREE JEJUNUM FLAP MICROVASC,,,3198.57
Deidentified Maximum,,43499,CPT4/HCPCS,ESOPHAGUS SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,43500,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,,5281.00
Deidentified Maximum,,43610,CPT4/HCPCS,EXCISION OF STOMACH LESION,,,3198.57
Deidentified Maximum,,43641,CPT4/HCPCS,VAGOTOMY & PYLORUS REPAIR,,,5783.00
Deidentified Maximum,,43645,CPT4/HCPCS,LAP GASTR BYPASS INCL SMLL I,,,7007.00
Deidentified Maximum,,43648,CPT4/HCPCS,LAP REVISE/REMV ELTRD ANTRUM,,,8300.00
Deidentified Maximum,,43653,CPT4/HCPCS,LAPAROSCOPY GASTROSTOMY,,,12850.70
Deidentified Maximum,,43659,CPT4/HCPCS,LAPAROSCOPE PROC STOM,,,7902.34
Deidentified Maximum,,43752,CPT4/HCPCS,NASAL/OROGASTRIC W/TUBE PLMT,,,3656.00
Deidentified Maximum,,43760,CPT4/HCPCS,CHANGE GASTROSTOMY TUBE,,,3198.57
Deidentified Maximum,,43774,CPT4/HCPCS,LAP RMVL GASTR ADJ ALL PARTS,,,10119.00
Deidentified Maximum,,43830,CPT4/HCPCS,PLACE GASTROSTOMY TUBE,,,4204.00
Deidentified Maximum,,43842,CPT4/HCPCS,V-BAND GASTROPLASTY,,,5783.00
Deidentified Maximum,,43845,CPT4/HCPCS,GASTROPLASTY DUODENAL SWITCH,,,6588.00
Deidentified Maximum,,43847,CPT4/HCPCS,GASTRIC BYPASS INCL SMALL I,,,5783.00
Deidentified Maximum,,43850,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,,5783.00
Deidentified Maximum,,43887,CPT4/HCPCS,REMOVE GASTRIC PORT OPEN,,,3544.00
Deidentified Maximum,,44005,CPT4/HCPCS,FREEING OF BOWEL ADHESION,,,7830.00
Deidentified Maximum,,44010,CPT4/HCPCS,INCISION OF SMALL BOWEL,,,7188.00
Deidentified Maximum,,44100,CPT4/HCPCS,BIOPSY OF BOWEL,,,3198.57
Deidentified Maximum,,44120,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,,5783.00
Deidentified Maximum,,44128,CPT4/HCPCS,ENTERECTOMY CONG ADD-ON,,,5783.00
Deidentified Maximum,,44130,CPT4/HCPCS,BOWEL TO BOWEL FUSION,,,5281.00
Deidentified Maximum,,44144,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,5783.00
Deidentified Maximum,,44150,CPT4/HCPCS,REMOVAL OF COLON,,,6588.00
Deidentified Maximum,,44151,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,,6588.00
Deidentified Maximum,,44188,CPT4/HCPCS,LAP COLOSTOMY,,,5856.00
Deidentified Maximum,,44212,CPT4/HCPCS,LAPARO TOTAL PROCTOCOLECTOMY,,,7902.34
Deidentified Maximum,,44238,CPT4/HCPCS,LAPAROSCOPE PROC INTESTINE,,,7902.34
Deidentified Maximum,,44312,CPT4/HCPCS,REVISION OF ILEOSTOMY,,,5138.00
Deidentified Maximum,,44345,CPT4/HCPCS,REVISION OF COLOSTOMY,,,6401.00
Deidentified Maximum,,44361,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,,4280.43
Deidentified Maximum,,44370,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/STENT,,,12850.70
Deidentified Maximum,,44373,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4280.43
Deidentified Maximum,,44379,CPT4/HCPCS,S BOWEL ENDOSCOPE W/STENT,,,12850.70
Deidentified Maximum,,44380,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,,3198.57
Deidentified Maximum,,44386,CPT4/HCPCS,ENDOSCOPY BOWEL POUCH/BIOP,,,3198.57
Deidentified Maximum,,44394,CPT4/HCPCS,COLONOSCOPY W/SNARE,,,3198.57
Deidentified Maximum,,44401,CPT4/HCPCS,COLONOSCOPY WITH ABLATION,,,4000.00
Deidentified Maximum,,44661,CPT4/HCPCS,REPAIR BOWEL-BLADDER FISTULA,,,5783.00
Deidentified Maximum,,44720,CPT4/HCPCS,PREP DONOR INTESTINE/VENOUS,,,1678.00
Deidentified Maximum,,44820,CPT4/HCPCS,EXCISION OF MESENTERY LESION,,,5281.00
Deidentified Maximum,,45113,CPT4/HCPCS,PARTIAL PROCTECTOMY,,,6588.00
Deidentified Maximum,,45116,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,,5783.00
Deidentified Maximum,,45119,CPT4/HCPCS,REMOVE RECTUM W/RESERVOIR,,,6588.00
Deidentified Maximum,,45120,CPT4/HCPCS,REMOVAL OF RECTUM,,,6588.00
Deidentified Maximum,,45121,CPT4/HCPCS,REMOVAL OF RECTUM AND COLON,,,6588.00
Deidentified Maximum,,45130,CPT4/HCPCS,EXCISION OF RECTAL PROLAPSE,,,5029.00
Deidentified Maximum,,45307,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY FB,,,4204.00
Deidentified Maximum,,45332,CPT4/HCPCS,SIGMOIDOSCOPY W/FB REMOVAL,,,3198.57
Deidentified Maximum,,45333,CPT4/HCPCS,SIGMOIDOSCOPY & POLYPECTOMY,,,3198.57
Deidentified Maximum,,45345,CPT4/HCPCS,SIGMOIDOSCOPY W/STENT,,,1678.00
Deidentified Maximum,,45398,CPT4/HCPCS,COLONOSCOPY W/BAND LIGATION,,,4000.00
Deidentified Maximum,,45399,CPT4/HCPCS,UNLISTED PROCEDURE COLON,,,5000.00
Deidentified Maximum,,45505,CPT4/HCPCS,REPAIR OF RECTUM,,,5138.00
Deidentified Maximum,,45540,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,,5281.00
Deidentified Maximum,,45541,CPT4/HCPCS,CORRECT RECTAL PROLAPSE,,,5138.00
Deidentified Maximum,,45825,CPT4/HCPCS,REPAIR FISTULA W/COLOSTOMY,,,5281.00
Deidentified Maximum,,45990,CPT4/HCPCS,SURG DX EXAM ANORECTAL,,,4280.43
Deidentified Maximum,,46045,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,,4280.43
Deidentified Maximum,,46083,CPT4/HCPCS,INCISE EXTERNAL HEMORRHOID,,,3198.57
Deidentified Maximum,,46200,CPT4/HCPCS,REMOVAL OF ANAL FISSURE,,,4280.43
Deidentified Maximum,,46250,CPT4/HCPCS,REMOVE EXT HEM GROUPS 2+,,,5856.00
Deidentified Maximum,,46608,CPT4/HCPCS,ANOSCOPY REMOVE FOR BODY,,,3198.57
Deidentified Maximum,,46612,CPT4/HCPCS,ANOSCOPY REMOVE LESIONS,,,4204.00
Deidentified Maximum,,46700,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,,5856.00
Deidentified Maximum,,46710,CPT4/HCPCS,REPR PER/VAG POUCH SNGL PROC,,,5856.00
Deidentified Maximum,,46742,CPT4/HCPCS,REPAIR OF IMPERFORATED ANUS,,,6049.05
Deidentified Maximum,,46744,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,,6876.92
Deidentified Maximum,,46760,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,,5138.00
Deidentified Maximum,,46762,CPT4/HCPCS,IMPLANT ARTIFICIAL SPHINCTER,,,9548.65
Deidentified Maximum,,46948,CPT4/HCPCS,INT HRHC TRANAL DARTLZJ 2+,,,4204.00
Deidentified Maximum,,47015,CPT4/HCPCS,INJECT/ASPIRATE LIVER CYST,,,5281.00
Deidentified Maximum,,47100,CPT4/HCPCS,WEDGE BIOPSY OF LIVER,,,5029.00
Deidentified Maximum,,47120,CPT4/HCPCS,PARTIAL REMOVAL OF LIVER,,,5783.00
Deidentified Maximum,,47142,CPT4/HCPCS,PARTIAL REMOVAL DONOR LIVER,,,7902.34
Deidentified Maximum,,47146,CPT4/HCPCS,PREP DONOR LIVER/VENOUS,,,1678.00
Deidentified Maximum,,47361,CPT4/HCPCS,REPAIR LIVER WOUND,,,6049.05
Deidentified Maximum,,47460,CPT4/HCPCS,INCISE BILE DUCT SPHINCTER,,,5029.00
Deidentified Maximum,,47511,CPT4/HCPCS,INSERT BILE DUCT DRAIN,,,1678.88
Deidentified Maximum,,47531,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,,5138.00
Deidentified Maximum,,47532,CPT4/HCPCS,INJECTION FOR CHOLANGIOGRAM,,,8300.00
Deidentified Maximum,,47553,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,,7007.00
Deidentified Maximum,,47554,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,,7007.00
Deidentified Maximum,,47561,CPT4/HCPCS,LAPARO W/CHOLANGIO/BIOPSY,,,3544.00
Deidentified Maximum,,47564,CPT4/HCPCS,LAPARO CHOLECYSTECTOMY/EXPLR,,,9548.65
Deidentified Maximum,,47630,CPT4/HCPCS,REMOVE BILE DUCT STONE,,,3544.00
Deidentified Maximum,,47720,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,,5783.00
Deidentified Maximum,,47740,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,,5783.00
Deidentified Maximum,,48100,CPT4/HCPCS,BIOPSY OF PANCREAS OPEN,,,5783.00
Deidentified Maximum,,48510,CPT4/HCPCS,DRAIN PANCREATIC PSEUDOCYST,,,5281.00
Deidentified Maximum,,48548,CPT4/HCPCS,FUSE PANCREAS AND BOWEL,,,5783.00
Deidentified Maximum,,49014,CPT4/HCPCS,REEXPLORATION PELVIC WOUND,,,1678.88
Deidentified Maximum,,49082,CPT4/HCPCS,ABD PARACENTESIS,,,3656.00
Deidentified Maximum,,49255,CPT4/HCPCS,REMOVAL OF OMENTUM,,,5029.00
Deidentified Maximum,,49324,CPT4/HCPCS,LAP INSERT TUNNEL IP CATH,,,8300.00
Deidentified Maximum,,49325,CPT4/HCPCS,LAP REVISION PERM IP CATH,,,8300.00
Deidentified Maximum,,49411,CPT4/HCPCS,INS MARK ABD/PEL FOR RT PERQ,,,3000.00
Deidentified Maximum,,49442,CPT4/HCPCS,PLACE CECOSTOMY TUBE PERC,,,5000.00
Deidentified Maximum,,49492,CPT4/HCPCS,RPR ING HERN PREMIE BLOCKED,,,6876.92
Deidentified Maximum,,49560,CPT4/HCPCS,RPR VENTRAL HERN INIT REDUC,,,6401.00
Deidentified Maximum,,49565,CPT4/HCPCS,REREPAIR VENTRL HERN REDUCE,,,6401.00
Deidentified Maximum,,49568,CPT4/HCPCS,HERNIA REPAIR W/MESH,,,9548.65
Deidentified Maximum,,49610,CPT4/HCPCS,REPAIR UMBILICAL LESION,,,5281.00
Deidentified Maximum,,49655,CPT4/HCPCS,LAP INC HERN REPAIR COMP,,,8300.00
Deidentified Maximum,,49656,CPT4/HCPCS,LAP INC HERNIA REPAIR RECUR,,,8300.00
Deidentified Maximum,,50040,CPT4/HCPCS,DRAINAGE OF KIDNEY,,,5856.00
Deidentified Maximum,,50070,CPT4/HCPCS,INCISION OF KIDNEY,,,3198.57
Deidentified Maximum,,50135,CPT4/HCPCS,EXPLORATION OF KIDNEY,,,5029.00
Deidentified Maximum,,50200,CPT4/HCPCS,RENAL BIOPSY PERQ,,,3198.57
Deidentified Maximum,,50220,CPT4/HCPCS,REMOVE KIDNEY OPEN,,,3198.57
Deidentified Maximum,,50280,CPT4/HCPCS,REMOVAL OF KIDNEY LESION,,,5783.00
Deidentified Maximum,,50300,CPT4/HCPCS,REMOVE CADAVER DONOR KIDNEY,,,3544.00
Deidentified Maximum,,50323,CPT4/HCPCS,PREP CADAVER RENAL ALLOGRAFT,,,3544.00
Deidentified Maximum,,50327,CPT4/HCPCS,PREP RENAL GRAFT/VENOUS,,,1678.00
Deidentified Maximum,,50340,CPT4/HCPCS,REMOVAL OF KIDNEY,,,5281.00
Deidentified Maximum,,50387,CPT4/HCPCS,CHANGE NEPHROURETERAL CATH,,,4280.43
Deidentified Maximum,,50390,CPT4/HCPCS,DRAINAGE OF KIDNEY LESION,,,3198.57
Deidentified Maximum,,50405,CPT4/HCPCS,REVISION OF KIDNEY/URETER,,,5281.00
Deidentified Maximum,,50430,CPT4/HCPCS,NJX PX NFROSGRM &/URTRGRM,,,4000.00
Deidentified Maximum,,50433,CPT4/HCPCS,PLMT NEPHROURETERAL CATHETER,,,6000.00
Deidentified Maximum,,50434,CPT4/HCPCS,CONVERT NEPHROSTOMY CATHETER,,,4000.00
Deidentified Maximum,,50520,CPT4/HCPCS,CLOSE KIDNEY-SKIN FISTULA,,,3198.57
Deidentified Maximum,,50545,CPT4/HCPCS,LAPARO RADICAL NEPHRECTOMY,,,6588.00
Deidentified Maximum,,50551,CPT4/HCPCS,KIDNEY ENDOSCOPY,,,3198.57
Deidentified Maximum,,50610,CPT4/HCPCS,REMOVAL OF URETER STONE,,,6840.00
Deidentified Maximum,,80416,CPT4/HCPCS,RENIN STIMULATION PANEL,,,1325.94
Deidentified Maximum,,80417,CPT4/HCPCS,RENIN STIMULATION PANEL,,,442.00
Deidentified Maximum,,80418,CPT4/HCPCS,PITUITARY EVALUATION PANEL,,,5823.13
Deidentified Maximum,,80422,CPT4/HCPCS,GLUCAGON TOLERANCE PANEL,,,462.92
Deidentified Maximum,,80432,CPT4/HCPCS,INSULIN SUPPRESSION PANEL,,,1357.27
Deidentified Maximum,,80439,CPT4/HCPCS,TRH STIMULATION PANEL,,,675.19
Deidentified Maximum,,80502,CPT4/HCPCS,LAB PATHOLOGY CONSULTATION,,,474.76
Deidentified Maximum,,81003,CPT4/HCPCS,URINALYSIS AUTO W/O SCOPE,,,102.00
Deidentified Maximum,,81025,CPT4/HCPCS,URINE PREGNANCY TEST,,,102.00
Deidentified Maximum,,81108,CPT4/HCPCS,HPA-4 GENOTYPING,,,1077.38
Deidentified Maximum,,81173,CPT4/HCPCS,AR GENE FULL GENE SEQUENCE,,,2151.65
Deidentified Maximum,,81174,CPT4/HCPCS,AR GENE KNOWN FAMIL VARIANT,,,1322.32
Deidentified Maximum,,81176,CPT4/HCPCS,ASXL1 GENE TARGET SEQ ALYS,,,2132.25
Deidentified Maximum,,81178,CPT4/HCPCS,ATXN1 GENE DETC ABNOR ALLELE,,,978.18
Deidentified Maximum,,81187,CPT4/HCPCS,CNBP GENE DETC ABNOR ALLELE,,,978.18
Deidentified Maximum,,81188,CPT4/HCPCS,CSTB GENE DETC ABNOR ALLELE,,,978.18
Deidentified Maximum,,81189,CPT4/HCPCS,CSTB GENE FULL GENE SEQUENCE,,,1962.32
Deidentified Maximum,,81209,CPT4/HCPCS,BLM GENE,,,335.07
Deidentified Maximum,,81218,CPT4/HCPCS,CEBPA GENE FULL SEQUENCE,,,2352.67
Deidentified Maximum,,81230,CPT4/HCPCS,CYP3A4 GENE COMMON VARIANTS,,,1248.15
Deidentified Maximum,,81237,CPT4/HCPCS,EZH2 GENE COMMON VARIANTS,,,1252.35
Deidentified Maximum,,81247,CPT4/HCPCS,G6PD GENE ALYS CMN VARIANT,,,1248.15
Deidentified Maximum,,81253,CPT4/HCPCS,GJB2 GENE KNOWN FAM VARIANTS,,,308.28
Deidentified Maximum,,81254,CPT4/HCPCS,GJB6 GENE COM VARIANTS,,,158.00
Deidentified Maximum,,81271,CPT4/HCPCS,HTT GENE DETC ABNOR ALLELES,,,978.18
Deidentified Maximum,,81276,CPT4/HCPCS,KRAS GENE ADDL VARIANTS,,,1407.92
Deidentified Maximum,,81283,CPT4/HCPCS,IFNL3 GENE,,,538.60
Deidentified Maximum,,81284,CPT4/HCPCS,FXN GENE DETC ABNOR ALLELES,,,978.18
Deidentified Maximum,,81286,CPT4/HCPCS,FXN GENE FULL GENE SEQUENCE,,,1962.32
Deidentified Maximum,,81287,CPT4/HCPCS,MGMT GENE PRMTR MTHYLTN ALYS,,,2940.00
Deidentified Maximum,,81290,CPT4/HCPCS,MCOLN1 GENE,,,419.83
Deidentified Maximum,,81303,CPT4/HCPCS,MECP2 GENE KNOWN VARIANT,,,604.80
Deidentified Maximum,,81304,CPT4/HCPCS,MECP2 GENE DUP/DELET VARIANT,,,1056.97
Deidentified Maximum,,81312,CPT4/HCPCS,PABPN1 GENE DETC ABNOR ALLEL,,,978.18
Deidentified Maximum,,81316,CPT4/HCPCS,PML/RARALPHA 1 BREAKPOINT,,,1848.08
Deidentified Maximum,,81325,CPT4/HCPCS,PMP22 GENE FULL SEQUENCE,,,1123.58
Deidentified Maximum,,81328,CPT4/HCPCS,SLCO1B1 GENE COM VARIANTS,,,1248.15
Deidentified Maximum,,81333,CPT4/HCPCS,TGFBI GENE COMMON VARIANTS,,,978.18
Deidentified Maximum,,81342,CPT4/HCPCS,TRG GENE REARRANGEMENT ANAL,,,811.43
Deidentified Maximum,,81364,CPT4/HCPCS,HBB FULL GENE SEQUENCE,,,2317.47
Deidentified Maximum,,81370,CPT4/HCPCS,HLA I & II TYPING LR,,,2350.23
Deidentified Maximum,,81371,CPT4/HCPCS,HLA I & II TYPE VERIFY LR,,,1406.74
Deidentified Maximum,,81376,CPT4/HCPCS,HLA II TYPING 1 LOCUS LR,,,477.45
Deidentified Maximum,,81378,CPT4/HCPCS,HLA I & II TYPING HR,,,2019.61
Deidentified Maximum,,81379,CPT4/HCPCS,HLA I TYPING COMPLETE HR,,,1960.05
Deidentified Maximum,,81381,CPT4/HCPCS,HLA I TYPING 1 ALLELE HR,,,817.23
Deidentified Maximum,,81383,CPT4/HCPCS,HLA II TYPING 1 ALLELE HR,,,349.86
Deidentified Maximum,,81404,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 5,,,882.00
Deidentified Maximum,,81412,CPT4/HCPCS,ASHKENAZI JEWISH ASSOC DIS,,,4268.96
Deidentified Maximum,,81417,CPT4/HCPCS,EXOME RE-EVALUATION,,,2284.80
Deidentified Maximum,,81431,CPT4/HCPCS,HEARING LOSS DUP/DEL ANALYS,,,4852.09
Deidentified Maximum,,81436,CPT4/HCPCS,HEREDITARY COLON CA DSORDRS,,,2940.00
Deidentified Maximum,,81443,CPT4/HCPCS,GENETIC TSTG SEVERE INH COND,,,17482.75
Deidentified Maximum,,81445,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,,6040.18
Deidentified Maximum,,81450,CPT4/HCPCS,TARGETED GENOMIC SEQ ANALYS,,,6040.18
Deidentified Maximum,,81465,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,,9660.00
Deidentified Maximum,,81520,CPT4/HCPCS,ONC BREAST MRNA 58 GENES,,,22127.02
Deidentified Maximum,,81525,CPT4/HCPCS,ONCOLOGY COLON MRNA,,,2692.95
Deidentified Maximum,,81536,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,,1267.81
Deidentified Maximum,,81539,CPT4/HCPCS,ONCOLOGY PROSTATE PROB SCORE,,,4299.03
Deidentified Maximum,,82010,CPT4/HCPCS,ACETONE ASSAY,,,102.00
Deidentified Maximum,,82085,CPT4/HCPCS,ASSAY OF ALDOLASE,,,102.00
Deidentified Maximum,,82107,CPT4/HCPCS,ALPHA-FETOPROTEIN L3,,,647.13
Deidentified Maximum,,82160,CPT4/HCPCS,ASSAY OF ANDROSTERONE,,,251.24
Deidentified Maximum,,82164,CPT4/HCPCS,ANGIOTENSIN I ENZYME TEST,,,146.66
Deidentified Maximum,,82175,CPT4/HCPCS,ASSAY OF ARSENIC,,,190.68
Deidentified Maximum,,82180,CPT4/HCPCS,ASSAY OF ASCORBIC ACID,,,102.00
Deidentified Maximum,,82252,CPT4/HCPCS,FECAL BILIRUBIN TEST,,,102.00
Deidentified Maximum,,82270,CPT4/HCPCS,OCCULT BLOOD FECES,,,102.00
Deidentified Maximum,,82331,CPT4/HCPCS,CALCIUM INFUSION TEST,,,102.00
Deidentified Maximum,,82375,CPT4/HCPCS,ASSAY CARBOXYHB QUANT,,,123.90
Deidentified Maximum,,82480,CPT4/HCPCS,ASSAY SERUM CHOLINESTERASE,,,102.00
Deidentified Maximum,,82552,CPT4/HCPCS,ASSAY OF CPK IN BLOOD,,,134.65
Deidentified Maximum,,82600,CPT4/HCPCS,ASSAY OF CYANIDE,,,194.96
Deidentified Maximum,,82615,CPT4/HCPCS,TEST FOR URINE CYSTINES,,,102.00
Deidentified Maximum,,82626,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,,253.93
Deidentified Maximum,,82638,CPT4/HCPCS,ASSAY OF DIBUCAINE NUMBER,,,123.06
Deidentified Maximum,,82656,CPT4/HCPCS,PANCREATIC ELASTASE FECAL,,,102.00
Deidentified Maximum,,82658,CPT4/HCPCS,ENZYME CELL ACTIVITY RA,,,181.44
Deidentified Maximum,,82670,CPT4/HCPCS,ASSAY OF TOTAL ESTRADIOL,,,280.72
Deidentified Maximum,,82672,CPT4/HCPCS,ASSAY OF ESTROGEN,,,217.97
Deidentified Maximum,,82715,CPT4/HCPCS,ASSAY OF FECAL FAT,,,172.95
Deidentified Maximum,,82784,CPT4/HCPCS,ASSAY IGA/IGD/IGG/IGM EACH,,,102.00
Deidentified Maximum,,82810,CPT4/HCPCS,BLOOD GASES O2 SAT ONLY,,,102.00
Deidentified Maximum,,82948,CPT4/HCPCS,REAGENT STRIP/BLOOD GLUCOSE,,,102.00
Deidentified Maximum,,82955,CPT4/HCPCS,ASSAY OF G6PD ENZYME,,,102.00
Deidentified Maximum,,82985,CPT4/HCPCS,ASSAY OF GLYCATED PROTEIN,,,151.45
Deidentified Maximum,,83015,CPT4/HCPCS,HEAVY METAL QUAL ANY ANAL,,,131.62
Deidentified Maximum,,83026,CPT4/HCPCS,HEMOGLOBIN COPPER SULFATE,,,102.00
Deidentified Maximum,,83030,CPT4/HCPCS,FETAL HEMOGLOBIN CHEMICAL,,,102.00
Deidentified Maximum,,83505,CPT4/HCPCS,ASSAY TOTAL HYDROXYPROLINE,,,244.27
Deidentified Maximum,,83630,CPT4/HCPCS,LACTOFERRIN FECAL (QUAL),,,197.23
Deidentified Maximum,,83662,CPT4/HCPCS,FOAM STABILITY FETAL LUNG,,,190.17
Deidentified Maximum,,83690,CPT4/HCPCS,ASSAY OF LIPASE,,,102.00
Deidentified Maximum,,83825,CPT4/HCPCS,ASSAY OF MERCURY,,,163.38
Deidentified Maximum,,83872,CPT4/HCPCS,ASSAY SYNOVIAL FLUID MUCIN,,,102.00
Deidentified Maximum,,83873,CPT4/HCPCS,ASSAY OF CSF PROTEIN,,,172.87
Deidentified Maximum,,83919,CPT4/HCPCS,ORGANIC ACIDS QUAL EACH,,,165.39
Deidentified Maximum,,83937,CPT4/HCPCS,ASSAY OF OSTEOCALCIN,,,286.10
Deidentified Maximum,,83951,CPT4/HCPCS,ONCOPROTEIN DCP,,,647.13
Deidentified Maximum,,84060,CPT4/HCPCS,ASSAY ACID PHOSPHATASE,,,102.00
Deidentified Maximum,,84080,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASES,,,148.68
Deidentified Maximum,,84132,CPT4/HCPCS,ASSAY OF SERUM POTASSIUM,,,102.00
Deidentified Maximum,,84140,CPT4/HCPCS,ASSAY OF PREGNENOLONE,,,207.81
Deidentified Maximum,,84163,CPT4/HCPCS,PAPPA SERUM,,,151.28
Deidentified Maximum,,84202,CPT4/HCPCS,ASSAY RBC PROTOPORPHYRIN,,,144.14
Deidentified Maximum,,84210,CPT4/HCPCS,ASSAY OF PYRUVATE,,,109.03
Deidentified Maximum,,84255,CPT4/HCPCS,ASSAY OF SELENIUM,,,256.53
Deidentified Maximum,,84302,CPT4/HCPCS,ASSAY OF SWEAT SODIUM,,,102.00
Deidentified Maximum,,84402,CPT4/HCPCS,ASSAY OF FREE TESTOSTERONE,,,255.86
Deidentified Maximum,,84410,CPT4/HCPCS,TESTOSTERONE BIOAVAILABLE,,,518.02
Deidentified Maximum,,84525,CPT4/HCPCS,UREA NITROGEN SEMI-QUANT,,,102.00
Deidentified Maximum,,84580,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,,102.00
Deidentified Maximum,,84588,CPT4/HCPCS,ASSAY OF VASOPRESSIN,,,341.04
Deidentified Maximum,,85002,CPT4/HCPCS,BLEEDING TIME TEST,,,102.00
Deidentified Maximum,,85008,CPT4/HCPCS,BL SMEAR W/O DIFF WBC COUNT,,,102.00
Deidentified Maximum,,85013,CPT4/HCPCS,SPUN MICROHEMATOCRIT,,,102.00
Deidentified Maximum,,85130,CPT4/HCPCS,CHROMOGENIC SUBSTRATE ASSAY,,,119.53
Deidentified Maximum,,85240,CPT4/HCPCS,CLOT FACTOR VIII AHG 1 STAGE,,,179.92
Deidentified Maximum,,85260,CPT4/HCPCS,CLOT FACTOR X STUART-POWER,,,179.92
Deidentified Maximum,,85280,CPT4/HCPCS,CLOT FACTOR XII HAGEMAN,,,194.37
Deidentified Maximum,,85293,CPT4/HCPCS,CLOT FACTOR WGHT KININOGEN,,,190.25
Deidentified Maximum,,85302,CPT4/HCPCS,CLOT INHIBIT PROT C ANTIGEN,,,120.79
Deidentified Maximum,,85305,CPT4/HCPCS,CLOT INHIBIT PROT S TOTAL,,,116.50
Deidentified Maximum,,85366,CPT4/HCPCS,FIBRINOGEN TEST,,,102.00
Deidentified Maximum,,85396,CPT4/HCPCS,CLOTTING ASSAY WHOLE BLOOD,,,145.90
Deidentified Maximum,,85410,CPT4/HCPCS,FIBRINOLYTIC ANTIPLASMIN,,,102.00
Deidentified Maximum,,85651,CPT4/HCPCS,RBC SED RATE NONAUTOMATED,,,102.00
Deidentified Maximum,,85652,CPT4/HCPCS,RBC SED RATE AUTOMATED,,,102.00
Deidentified Maximum,,85675,CPT4/HCPCS,THROMBIN TIME TITER,,,102.00
Deidentified Maximum,,85732,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,,102.00
Deidentified Maximum,,85810,CPT4/HCPCS,BLOOD VISCOSITY EXAMINATION,,,117.34
Deidentified Maximum,,86001,CPT4/HCPCS,ALLERGEN SPECIFIC IGG,,,102.00
Deidentified Maximum,,86063,CPT4/HCPCS,ANTISTREPTOLYSIN O SCREEN,,,102.00
Deidentified Maximum,,86200,CPT4/HCPCS,CCP ANTIBODY,,,130.11
Deidentified Maximum,,86277,CPT4/HCPCS,GROWTH HORMONE ANTIBODY,,,158.17
Deidentified Maximum,,86300,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 15-3,,,209.16
Deidentified Maximum,,86309,CPT4/HCPCS,HETEROPHILE ANTIBODY TITER,,,102.00
Deidentified Maximum,,86310,CPT4/HCPCS,HETEROPHILE ANTIBODY ABSRBJ,,,102.00
Deidentified Maximum,,86352,CPT4/HCPCS,CELL FUNCTION ASSAY W/STIM,,,1365.08
Deidentified Maximum,,86356,CPT4/HCPCS,MONONUCLEAR CELL ANTIGEN,,,268.96
Deidentified Maximum,,86376,CPT4/HCPCS,MICROSOMAL ANTIBODY EACH,,,146.24
Deidentified Maximum,,86406,CPT4/HCPCS,PARTICLE AGGLUT ANTBDY TITR,,,106.84
Deidentified Maximum,,86510,CPT4/HCPCS,HISTOPLASMOSIS SKIN TEST,,,162.03
Deidentified Maximum,,86603,CPT4/HCPCS,ADENOVIRUS ANTIBODY,,,129.27
Deidentified Maximum,,86631,CPT4/HCPCS,CHLAMYDIA ANTIBODY,,,118.77
Deidentified Maximum,,86644,CPT4/HCPCS,CMV ANTIBODY,,,144.56
Deidentified Maximum,,86723,CPT4/HCPCS,LISTERIA MONOCYTOGENES,,,132.55
Deidentified Maximum,,86729,CPT4/HCPCS,LYMPHO VENEREUM ANTIBODY,,,0.00
Deidentified Maximum,,86756,CPT4/HCPCS,RESPIRATORY VIRUS ANTIBODY,,,129.52
Deidentified Maximum,,86762,CPT4/HCPCS,RUBELLA ANTIBODY,,,144.56
Deidentified Maximum,,86777,CPT4/HCPCS,TOXOPLASMA ANTIBODY,,,144.56
Deidentified Maximum,,86780,CPT4/HCPCS,TREPONEMA PALLIDUM,,,133.05
Deidentified Maximum,,86794,CPT4/HCPCS,ZIKA VIRUS IGM ANTIBODY,,,148.51
Deidentified Maximum,,86808,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,,217.47
Deidentified Maximum,,86829,CPT4/HCPCS,HLA CLASS I/II ANTIBODY QUAL,,,291.31
Deidentified Maximum,,86850,CPT4/HCPCS,RBC ANTIBODY SCREEN,,,226.15
Deidentified Maximum,,86885,CPT4/HCPCS,COOMBS TEST INDIRECT QUAL,,,102.00
Deidentified Maximum,,86890,CPT4/HCPCS,AUTOLOGOUS BLOOD PROCESS,,,914.21
Deidentified Maximum,,86910,CPT4/HCPCS,BLOOD TYPING PATERNITY TEST,,,250.19
Deidentified Maximum,,86911,CPT4/HCPCS,BLOOD TYPING ANTIGEN SYSTEM,,,192.47
Deidentified Maximum,,86945,CPT4/HCPCS,BLOOD PRODUCT/IRRADIATION,,,341.63
Deidentified Maximum,,87045,CPT4/HCPCS,FECES CULTURE AEROBIC BACT,,,102.00
Deidentified Maximum,,87070,CPT4/HCPCS,CULTURE OTHR SPECIMN AEROBIC,,,102.00
Deidentified Maximum,,87102,CPT4/HCPCS,FUNGUS ISOLATION CULTURE,,,102.00
Deidentified Maximum,,87110,CPT4/HCPCS,CHLAMYDIA CULTURE,,,196.81
Deidentified Maximum,,87150,CPT4/HCPCS,DNA/RNA AMPLIFIED PROBE,,,352.63
Deidentified Maximum,,87168,CPT4/HCPCS,MACROSCOPIC EXAM ARTHROPOD,,,102.00
Deidentified Maximum,,87172,CPT4/HCPCS,PINWORM EXAM,,,102.00
Deidentified Maximum,,87176,CPT4/HCPCS,TISSUE HOMOGENIZATION CULTR,,,102.00
Deidentified Maximum,,87187,CPT4/HCPCS,MICROBE SUSCEPTIBLE MLC,,,104.16
Deidentified Maximum,,87197,CPT4/HCPCS,BACTERICIDAL LEVEL SERUM,,,150.94
Deidentified Maximum,,87230,CPT4/HCPCS,ASSAY TOXIN OR ANTITOXIN,,,198.40
Deidentified Maximum,,87255,CPT4/HCPCS,GENET VIRUS ISOLATE HSV,,,340.28
Deidentified Maximum,,87269,CPT4/HCPCS,GIARDIA AG IF,,,102.00
Deidentified Maximum,,87270,CPT4/HCPCS,CHLAMYDIA TRACHOMATIS AG IF,,,102.00
Deidentified Maximum,,87272,CPT4/HCPCS,CRYPTOSPORIDIUM AG IF,,,102.00
Deidentified Maximum,,87274,CPT4/HCPCS,HERPES SIMPLEX 1 AG IF,,,102.00
Deidentified Maximum,,87275,CPT4/HCPCS,INFLUENZA B AG IF,,,102.00
Deidentified Maximum,,87300,CPT4/HCPCS,AG DETECTION POLYVAL IF,,,102.00
Deidentified Maximum,,87301,CPT4/HCPCS,ADENOVIRUS AG IA,,,102.00
Deidentified Maximum,,87328,CPT4/HCPCS,CRYPTOSPORIDIUM AG IA,,,102.00
Deidentified Maximum,,87390,CPT4/HCPCS,HIV-1 AG IA,,,177.32
Deidentified Maximum,,87471,CPT4/HCPCS,BARTONELLA DNA AMP PROBE,,,352.63
Deidentified Maximum,,87475,CPT4/HCPCS,LYME DIS DNA DIR PROBE,,,201.51
Deidentified Maximum,,87476,CPT4/HCPCS,LYME DIS DNA AMP PROBE,,,352.63
Deidentified Maximum,,87490,CPT4/HCPCS,CHYLMD TRACH DNA DIR PROBE,,,201.51
Deidentified Maximum,,87500,CPT4/HCPCS,VANOMYCIN DNA AMP PROBE,,,352.63
Deidentified Maximum,,87502,CPT4/HCPCS,INFLUENZA DNA AMP PROBE,,,855.03
Deidentified Maximum,,87510,CPT4/HCPCS,GARDNER VAG DNA DIR PROBE,,,201.51
Deidentified Maximum,,87512,CPT4/HCPCS,GARDNER VAG DNA QUANT,,,419.49
Deidentified Maximum,,87525,CPT4/HCPCS,HEPATITIS G DNA DIR PROBE,,,201.51
Deidentified Maximum,,87536,CPT4/HCPCS,HIV-1 QUANT&REVRSE TRNSCRPJ,,,855.03
Deidentified Maximum,,87540,CPT4/HCPCS,LEGION PNEUMO DNA DIR PROB,,,201.51
Deidentified Maximum,,87541,CPT4/HCPCS,LEGION PNEUMO DNA AMP PROB,,,352.63
Deidentified Maximum,,87561,CPT4/HCPCS,M.AVIUM-INTRA DNA AMP PROB,,,352.63
Deidentified Maximum,,87590,CPT4/HCPCS,N.GONORRHOEAE DNA DIR PROB,,,201.51
Deidentified Maximum,,87625,CPT4/HCPCS,HPV TYPES 16 & 18 ONLY,,,341.04
Deidentified Maximum,,87632,CPT4/HCPCS,RESP VIRUS 6-11 TARGETS,,,2094.62
Deidentified Maximum,,87650,CPT4/HCPCS,STREP A DNA DIR PROBE,,,201.51
Deidentified Maximum,,87653,CPT4/HCPCS,STREP B DNA AMP PROBE,,,352.63
Deidentified Maximum,,87799,CPT4/HCPCS,DETECT AGENT NOS DNA QUANT,,,430.41
Deidentified Maximum,,87800,CPT4/HCPCS,DETECT AGNT MULT DNA DIREC,,,402.94
Deidentified Maximum,,87802,CPT4/HCPCS,STREP B ASSAY W/OPTIC,,,102.00
Deidentified Maximum,,87880,CPT4/HCPCS,STREP A ASSAY W/OPTIC,,,102.00
Deidentified Maximum,,87903,CPT4/HCPCS,PHENOTYPE DNA HIV W/CULTURE,,,4909.71
Deidentified Maximum,,87904,CPT4/HCPCS,PHENOTYPE DNA HIV W/CLT ADD,,,261.91
Deidentified Maximum,,88016,CPT4/HCPCS,AUTOPSY (NECROPSY) GROSS,,,2163.50
Deidentified Maximum,,88037,CPT4/HCPCS,LIMITED AUTOPSY,,,751.71
Deidentified Maximum,,88104,CPT4/HCPCS,CYTOPATH FL NONGYN SMEARS,,,327.34
Deidentified Maximum,,88108,CPT4/HCPCS,CYTOPATH CONCENTRATE TECH,,,419.07
Deidentified Maximum,,88148,CPT4/HCPCS,CYTOPATH C/V AUTO RESCREEN,,,152.71
Deidentified Maximum,,88152,CPT4/HCPCS,CYTOPATH C/V AUTO REDO,,,106.17
Deidentified Maximum,,88160,CPT4/HCPCS,CYTOPATH SMEAR OTHER SOURCE,,,344.88
Deidentified Maximum,,88172,CPT4/HCPCS,CYTP DX EVAL FNA 1ST EA SITE,,,195.72
Deidentified Maximum,,88174,CPT4/HCPCS,CYTOPATH C/V AUTO IN FLUID,,,214.62
Deidentified Maximum,,88177,CPT4/HCPCS,CYTP FNA EVAL EA ADDL,,,102.00
Deidentified Maximum,,88185,CPT4/HCPCS,FLOWCYTOMETRY/TC ADD-ON,,,436.80
Deidentified Maximum,,88230,CPT4/HCPCS,TISSUE CULTURE LYMPHOCYTE,,,1170.54
Deidentified Maximum,,88237,CPT4/HCPCS,TISSUE CULTURE BONE MARROW,,,1269.07
Deidentified Maximum,,88239,CPT4/HCPCS,TISSUE CULTURE TUMOR,,,1482.26
Deidentified Maximum,,88241,CPT4/HCPCS,FROZEN CELL PREPARATION,,,102.00
Deidentified Maximum,,88263,CPT4/HCPCS,CHROMOSOME ANALYSIS 45,,,1043.86
Deidentified Maximum,,88267,CPT4/HCPCS,CHROMOSOME ANALYS PLACENTA,,,1806.25
Deidentified Maximum,,88272,CPT4/HCPCS,CYTOGENETICS 3-5,,,268.96
Deidentified Maximum,,88273,CPT4/HCPCS,CYTOGENETICS 10-30,,,322.81
Deidentified Maximum,,88285,CPT4/HCPCS,CHROMOSOME COUNT ADDITIONAL,,,190.93
Deidentified Maximum,,88289,CPT4/HCPCS,CHROMOSOME STUDY ADDITIONAL,,,130.53
Deidentified Maximum,,88311,CPT4/HCPCS,DECALCIFY TISSUE,,,102.00
Deidentified Maximum,,88321,CPT4/HCPCS,MICROSLIDE CONSULTATION,,,623.70
Deidentified Maximum,,88356,CPT4/HCPCS,ANALYSIS NERVE,,,1318.12
Deidentified Maximum,,88365,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,,942.90
Deidentified Maximum,,88367,CPT4/HCPCS,INSITU HYBRIDIZATION AUTO,,,1741.96
Deidentified Maximum,,88368,CPT4/HCPCS,INSITU HYBRIDIZATION MANUAL,,,1419.57
Deidentified Maximum,,88372,CPT4/HCPCS,PROTEIN ANALYSIS W/PROBE,,,228.56
Deidentified Maximum,,89050,CPT4/HCPCS,BODY FLUID CELL COUNT,,,102.00
Deidentified Maximum,,89051,CPT4/HCPCS,BODY FLUID CELL COUNT,,,102.00
Deidentified Maximum,,89055,CPT4/HCPCS,LEUKOCYTE ASSESSMENT FECAL,,,102.00
Deidentified Maximum,,89268,CPT4/HCPCS,INSEMINATION OF OOCYTES,,,2826.09
Deidentified Maximum,,89344,CPT4/HCPCS,STORAGE/YEAR REPROD TISSUE,,,872.50
Deidentified Maximum,,89346,CPT4/HCPCS,STORAGE/YEAR OOCYTE(S),,,1814.40
Deidentified Maximum,,89356,CPT4/HCPCS,THAWING CRYOPRESRVED OOCYTE,,,102.00
Deidentified Maximum,,90802,CPT4/HCPCS,INTAC PSY DX INTERVIEW,,,345.81
Deidentified Maximum,,90806,CPT4/HCPCS,PSYTX OFF 45-50 MIN,,,174.91
Deidentified Maximum,,90807,CPT4/HCPCS,PSYTX OFF 45-50 MIN W/E&M,,,193.38
Deidentified Maximum,,90808,CPT4/HCPCS,PSYTX OFFICE 75-80 MIN,,,259.98
Deidentified Maximum,,90813,CPT4/HCPCS,INTAC PSYTX 45-50 MIN W/E&M,,,203.00
Deidentified Maximum,,90827,CPT4/HCPCS,INTAC PSYTX HSP 45-50 W/E&M,,,255.94
Deidentified Maximum,,90853,CPT4/HCPCS,GROUP PSYCHOTHERAPY,,,100.27
Deidentified Maximum,,90870,CPT4/HCPCS,ELECTROCONVULSIVE THERAPY,,,203.78
Deidentified Maximum,,90911,CPT4/HCPCS,BIOFEEDBACK PERI/URO/RECTAL,,,6766.00
Deidentified Maximum,,91030,CPT4/HCPCS,ACID PERFUSION OF ESOPHAGUS,,,1214.00
Deidentified Maximum,,91060,CPT4/HCPCS,GASTRIC SALINE LOAD TEST,,,85.04
Deidentified Maximum,,91065,CPT4/HCPCS,BREATH HYDROGEN/METHANE TEST,,,1214.00
Deidentified Maximum,,92002,CPT4/HCPCS,EYE EXAM NEW PATIENT,,,474.80
Deidentified Maximum,,92019,CPT4/HCPCS,EYE EXAM & TREATMENT,,,4204.00
Deidentified Maximum,,92072,CPT4/HCPCS,FIT CONTAC LENS FOR MANAGMNT,,,395.63
Deidentified Maximum,,92132,CPT4/HCPCS,CMPTR OPHTH DX IMG ANT SEGMT,,,987.78
Deidentified Maximum,,92134,CPT4/HCPCS,CPTR OPHTH DX IMG POST SEGMT,,,987.78
Deidentified Maximum,,92235,CPT4/HCPCS,FLUORESCEIN ANGRPH UNI/BI,,,1678.00
Deidentified Maximum,,92270,CPT4/HCPCS,ELECTRO-OCULOGRAPHY,,,595.09
Deidentified Maximum,,92310,CPT4/HCPCS,CONTACT LENS FITTING,,,555.03
Deidentified Maximum,,92313,CPT4/HCPCS,CONTACT LENS FITTING,,,518.10
Deidentified Maximum,,92545,CPT4/HCPCS,OSCILLATING TRACKING TEST,,,335.25
Deidentified Maximum,,92552,CPT4/HCPCS,PURE TONE AUDIOMETRY AIR,,,227.84
Deidentified Maximum,,92562,CPT4/HCPCS,LOUDNESS BALANCE TEST,,,208.59
Deidentified Maximum,,92570,CPT4/HCPCS,ACOUSTIC IMMITANCE TESTING,,,128.36
Deidentified Maximum,,92577,CPT4/HCPCS,STENGER TEST SPEECH,,,374.68
Deidentified Maximum,,92582,CPT4/HCPCS,CONDITIONING PLAY AUDIOMETRY,,,375.44
Deidentified Maximum,,92584,CPT4/HCPCS,ELECTROCOCHLEOGRAPHY,,,1282.81
Deidentified Maximum,,92597,CPT4/HCPCS,ORAL SPEECH DEVICE EVAL,,,825.26
Deidentified Maximum,,92613,CPT4/HCPCS,ENDOSCOPY SWALLOW (FEES) I&R,,,212.63
Deidentified Maximum,,92618,CPT4/HCPCS,EX FOR NONSPEECH DEV RX ADD,,,137.21
Deidentified Maximum,,92626,CPT4/HCPCS,EVAL AUD FUNCJ 1ST HOUR,,,1082.76
Deidentified Maximum,,92937,CPT4/HCPCS,PRQ REVASC BYP GRAFT 1 VSL,,,10119.00
Deidentified Maximum,,92970,CPT4/HCPCS,CARDIOASSIST INTERNAL,,,1678.00
Deidentified Maximum,,92990,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,,12850.70
Deidentified Maximum,,93018,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,,121.63
Deidentified Maximum,,93024,CPT4/HCPCS,CARDIAC DRUG STRESS TEST,,,571.17
Deidentified Maximum,,93227,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,,217.72
Deidentified Maximum,,93229,CPT4/HCPCS,REMOTE 30 DAY ECG TECH SUPP,,,6072.44
Deidentified Maximum,,93261,CPT4/HCPCS,INTERROGATE SUBQ DEFIB,,,190.42
Deidentified Maximum,,93272,CPT4/HCPCS,ECG/REVIEW INTERPRET ONLY,,,205.63
Deidentified Maximum,,93281,CPT4/HCPCS,PM DEVICE PROGR EVAL MULTI,,,219.91
Deidentified Maximum,,93293,CPT4/HCPCS,PM PHONE R-STRIP DEVICE EVAL,,,356.24
Deidentified Maximum,,93297,CPT4/HCPCS,REM INTERROG DEV EVAL ICPMS,,,203.11
Deidentified Maximum,,93299,CPT4/HCPCS,INTERROG EVAL ICPMS/SCRMS,,,0.00
Deidentified Maximum,,93308,CPT4/HCPCS,TTE F-UP OR LMTD,,,990.71
Deidentified Maximum,,93314,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,1980.46
Deidentified Maximum,,93316,CPT4/HCPCS,ECHO TRANSESOPHAGEAL,,,643.00
Deidentified Maximum,,93325,CPT4/HCPCS,DOPPLER COLOR FLOW ADD-ON,,,1484.90
Deidentified Maximum,,93452,CPT4/HCPCS,LEFT HRT CATH W/VENTRCLGRPHY,,,9548.65
Deidentified Maximum,,93503,CPT4/HCPCS,INSERT/PLACE HEART CATHETER,,,4613.00
Deidentified Maximum,,93610,CPT4/HCPCS,INTRA-ATRIAL PACING,,,7530.00
Deidentified Maximum,,93615,CPT4/HCPCS,ESOPHAGEAL RECORDING,,,7530.00
Deidentified Maximum,,93616,CPT4/HCPCS,ESOPHAGEAL RECORDING,,,7530.00
Deidentified Maximum,,93624,CPT4/HCPCS,ELECTROPHYSIOLOGIC STUDY,,,7530.00
Deidentified Maximum,,93651,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,8841.00
Deidentified Maximum,,93655,CPT4/HCPCS,ABLATE ARRHYTHMIA ADD ON,,,9548.65
Deidentified Maximum,,93656,CPT4/HCPCS,TX ATRIAL FIB PULM VEIN ISOL,,,9548.65
Deidentified Maximum,,93668,CPT4/HCPCS,PERIPHERAL VASCULAR REHAB,,,663.38
Deidentified Maximum,,93890,CPT4/HCPCS,TCD VASOREACTIVITY STUDY,,,2322.57
Deidentified Maximum,,93923,CPT4/HCPCS,UPR/LXTR ART STDY 3+ LVLS,,,1460.06
Deidentified Maximum,,93924,CPT4/HCPCS,LWR XTR VASC STDY BILAT,,,1828.23
Deidentified Maximum,,93979,CPT4/HCPCS,VASCULAR STUDY,,,1299.73
Deidentified Maximum,,93980,CPT4/HCPCS,PENILE VASCULAR STUDY,,,2239.84
Deidentified Maximum,,94004,CPT4/HCPCS,VENT MGMT NF PER DAY,,,131.62
Deidentified Maximum,,94453,CPT4/HCPCS,HAST W/OXYGEN TITRATE,,,676.88
Deidentified Maximum,,94640,CPT4/HCPCS,AIRWAY INHALATION TREATMENT,,,6766.00
Deidentified Maximum,,94668,CPT4/HCPCS,CHEST WALL MANIPULATION,,,229.40
Deidentified Maximum,,94680,CPT4/HCPCS,EXHALED AIR ANALYSIS O2,,,895.11
Deidentified Maximum,,94681,CPT4/HCPCS,EXHALED AIR ANALYSIS O2/CO2,,,1275.38
Deidentified Maximum,,94727,CPT4/HCPCS,PULM FUNCTION TEST BY GAS,,,422.64
Deidentified Maximum,,94781,CPT4/HCPCS,CARS/BD TST INFT-12MO +30MIN,,,32.89
Deidentified Maximum,,95010,CPT4/HCPCS,PERCUT ALLERGY TITRATE TEST,,,158.00
Deidentified Maximum,,95015,CPT4/HCPCS,ID ALLERGY TITRATE-DRUG/BUG,,,71.40
Deidentified Maximum,,95027,CPT4/HCPCS,ICUT ALLERGY TITRATE-AIRBORN,,,76.20
Deidentified Maximum,,95071,CPT4/HCPCS,BRONCHIAL ALLERGY TESTS,,,1417.88
Deidentified Maximum,,95117,CPT4/HCPCS,IMMUNOTHERAPY INJECTIONS,,,248.65
Deidentified Maximum,,95147,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,206.12
Deidentified Maximum,,95180,CPT4/HCPCS,RAPID DESENSITIZATION,,,997.71
Deidentified Maximum,,95251,CPT4/HCPCS,CONT GLUC MNTR ANALYSIS I&R,,,99.48
Deidentified Maximum,,95783,CPT4/HCPCS,POLYSOM <6 YRS CPAP/BILVL,,,8205.28
Deidentified Maximum,,95808,CPT4/HCPCS,POLYSOM ANY AGE 1-3> PARAM,,,5933.77
Deidentified Maximum,,95851,CPT4/HCPCS,RANGE OF MOTION MEASUREMENTS,,,177.25
Deidentified Maximum,,95861,CPT4/HCPCS,MUSCLE TEST 2 LIMBS,,,380.26
Deidentified Maximum,,95886,CPT4/HCPCS,MUSC TEST DONE W/N TEST COMP,,,566.99
Deidentified Maximum,,95920,CPT4/HCPCS,INTRAOP NERVE TEST ADD-ON,,,658.55
Deidentified Maximum,,95927,CPT4/HCPCS,SOMATOSENSORY TESTING,,,462.06
Deidentified Maximum,,95929,CPT4/HCPCS,C MOTOR EVOKED LWR LIMBS,,,1243.88
Deidentified Maximum,,95930,CPT4/HCPCS,VISUAL EP TEST CNS W/I&R,,,619.91
Deidentified Maximum,,95951,CPT4/HCPCS,EEG MONITORING/VIDEORECORD,,,1360.88
Deidentified Maximum,,95955,CPT4/HCPCS,EEG DURING SURGERY,,,1016.47
Deidentified Maximum,,95962,CPT4/HCPCS,ELECTRODE STIM BRAIN ADD-ON,,,658.55
Deidentified Maximum,,95980,CPT4/HCPCS,IO ANAL GAST N-STIM INIT,,,148.53
Deidentified Maximum,,95990,CPT4/HCPCS,SPIN/BRAIN PUMP REFIL & MAIN,,,1678.00
Deidentified Maximum,,96002,CPT4/HCPCS,DYNAMIC SURFACE EMG,,,80.23
Deidentified Maximum,,96365,CPT4/HCPCS,THER/PROPH/DIAG IV INF INIT,,,788.48
Deidentified Maximum,,96413,CPT4/HCPCS,CHEMO IV INFUSION 1 HR,,,1769.27
Deidentified Maximum,,96415,CPT4/HCPCS,CHEMO IV INFUSION ADDL HR,,,356.85
Deidentified Maximum,,96440,CPT4/HCPCS,CHEMOTHERAPY INTRACAVITARY,,,1252.94
Deidentified Maximum,,96446,CPT4/HCPCS,CHEMOTX ADMN PRTL CAVITY,,,180.76
Deidentified Maximum,,96571,CPT4/HCPCS,PHOTODYNAMIC TX ADDL 15 MIN,,,1678.00
Deidentified Maximum,,96920,CPT4/HCPCS,LASER TX SKIN < 250 SQ CM,,,2002.00
Deidentified Maximum,,96922,CPT4/HCPCS,LASER TX SKIN >500 SQ CM,,,2002.00
Deidentified Maximum,,97003,CPT4/HCPCS,OT EVALUATION,,,399.50
Deidentified Maximum,,97026,CPT4/HCPCS,INFRARED THERAPY,,,305.00
Deidentified Maximum,,97150,CPT4/HCPCS,GROUP THERAPEUTIC PROCEDURES,,,6766.00
Deidentified Maximum,,97152,CPT4/HCPCS,BHV ID SUPRT ASSMT BY 1 TECH,,,305.00
Deidentified Maximum,,97157,CPT4/HCPCS,MULT FAM ADAPT BHV TX GDN,,,305.00
Deidentified Maximum,,97163,CPT4/HCPCS,PT EVAL HIGH COMPLEX 45 MIN,,,6766.00
Deidentified Maximum,,97164,CPT4/HCPCS,PT RE-EVAL EST PLAN CARE,,,6766.00
Deidentified Maximum,,97165,CPT4/HCPCS,OT EVAL LOW COMPLEX 30 MIN,,,6766.00
Deidentified Maximum,,97533,CPT4/HCPCS,SENSORY INTEGRATION,,,6766.00
Deidentified Maximum,,97597,CPT4/HCPCS,RMVL DEVITAL TIS 20 CM/<,,,6766.00
Deidentified Maximum,,97803,CPT4/HCPCS,MED NUTRITION INDIV SUBSEQ,,,230.18
Deidentified Maximum,,A9504,CPT4/HCPCS,Tc99m apcitide,,,3486.00
Deidentified Maximum,,A9509,CPT4/HCPCS,Iodine I-123 sod iodide mil,,,15130.66
Deidentified Maximum,,A9524,CPT4/HCPCS,I131 serum albumin, dx,,,662.34
Deidentified Maximum,,A9531,CPT4/HCPCS,I131 max 100uCi,,,40.99
Deidentified Maximum,,A9546,CPT4/HCPCS,Co57/58,,,205.80
Deidentified Maximum,,A9548,CPT4/HCPCS,In111 pentetate,,,3456.93
Deidentified Maximum,,A9568,CPT4/HCPCS,Technetium tc99m arcitumomab,,,9063.60
Deidentified Maximum,,A9583,CPT4/HCPCS,Gadofosveset trisodium inj,,,146.49
Deidentified Maximum,,A9586,CPT4/HCPCS,Florbetapir F18,,,23906.14
Deidentified Maximum,,C8900,CPT4/HCPCS,MRA w/cont, abd,,,6766.00
Deidentified Maximum,,C8901,CPT4/HCPCS,MRA w/o cont, abd,,,6766.00
Deidentified Maximum,,C8903,CPT4/HCPCS,MRI w/cont, breast, uni,,,6766.00
Deidentified Maximum,,C8908,CPT4/HCPCS,MRI w/o fol w/cont, breast,,,,6766.00
Deidentified Maximum,,C8911,CPT4/HCPCS,MRA w/o fol w/cont, chest,,,6766.00
Deidentified Maximum,,C8934,CPT4/HCPCS,MRA, w/dye, upper extremity,,,6766.00
Deidentified Maximum,,C8936,CPT4/HCPCS,MRA, w/o&w/dye, upper extr,,,6766.00
Deidentified Maximum,,C8957,CPT4/HCPCS,Prolonged IV inf, req pump,,,193.00
Deidentified Maximum,,C9602,CPT4/HCPCS,Perc d-e cor stent ather s,,,10119.00
Deidentified Maximum,,C9606,CPT4/HCPCS,Perc d-e cor revasc w ami s,,,10119.00
Deidentified Maximum,,C9748,CPT4/HCPCS,Prostatic rf water vapor tx,,,12850.70
Deidentified Maximum,,0052T,CPT4/HCPCS,REPLACE THRC UNIT HRT SYST,,,8841.00
Deidentified Maximum,,0053T,CPT4/HCPCS,REPLACE IMPLANTABLE HRT SYST,,,8841.00
Deidentified Maximum,,0076T,CPT4/HCPCS,S&I STENT/CHEST VERT ART,,,6588.00
Deidentified Maximum,,0079T,CPT4/HCPCS,ENDOVASC VISC EXTNSN REPR,,,5029.00
Deidentified Maximum,,0126T,CPT4/HCPCS,CHD RISK IMT STUDY,,,1678.00
Deidentified Maximum,,0163T,CPT4/HCPCS,LUMB ARTIF DISKECTOMY ADDL,,,3198.57
Deidentified Maximum,,0190T,CPT4/HCPCS,PLACE INTRAOC RADIATION SRC,,,3198.57
Deidentified Maximum,,0200T,CPT4/HCPCS,PERQ SACRAL AUGMT UNILAT INJ,,,5138.00
Deidentified Maximum,,0205T,CPT4/HCPCS,INIRS EACH VESSEL ADD-ON,,,1678.00
Deidentified Maximum,,0214T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,,1678.00
Deidentified Maximum,,0217T,CPT4/HCPCS,NJX PARAVERT W/US LUMB/SAC,,,2002.00
Deidentified Maximum,,0222T,CPT4/HCPCS,PLMT POST FACET IMPLT ADDL,,,2002.00
Deidentified Maximum,,0226T,CPT4/HCPCS,ANOSCOPY HRA W/SPEC COLLECT,,,1678.00
Deidentified Maximum,,0232T,CPT4/HCPCS,NJX PLATELET PLASMA,,,2002.00
Deidentified Maximum,,0234T,CPT4/HCPCS,TRLUML PERIP ATHRC RENAL ART,,,10119.00
Deidentified Maximum,,0236T,CPT4/HCPCS,TRLUML PERIP ATHRC ABD AORTA,,,10119.00
Deidentified Maximum,,0250T,CPT4/HCPCS,INSERT BRONCHIAL VALVE,,,1678.00
Deidentified Maximum,,0252T,CPT4/HCPCS,REMOV BRONCH VALVE ADDL,,,1678.00
Deidentified Maximum,,0270T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV LEAD,,,9304.06
Deidentified Maximum,,0277T,CPT4/HCPCS,BRONCH THERMOPLASTY LOBES,,,1678.88
Deidentified Maximum,,0283T,CPT4/HCPCS,PERIPH FIELD STIMUL PERM,,,1678.88
Deidentified Maximum,,0290T,CPT4/HCPCS,LASER INC FOR PKP/LKP RECIP,,,6588.00
Deidentified Maximum,,0303T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS ELTRD,,,3544.00
Deidentified Maximum,,0304T,CPT4/HCPCS,ICAR ISCHM MNTRNG SYS DEVICE,,,3544.00
Deidentified Maximum,,0331T,CPT4/HCPCS,HEART SYMP IMAGE PLNR,,,987.78
Deidentified Maximum,,0338T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV UNL,,,5138.00
Deidentified Maximum,,0342T,CPT4/HCPCS,THXP APHERESIS W/HDL DELIP,,,6075.00
Deidentified Maximum,,0387T,CPT4/HCPCS,LEADLESS PM INS/RPL VENTR,,,6876.92
Deidentified Maximum,,0397T,CPT4/HCPCS,ERCP W/OPTICAL ENDOMICROSCPY,,,2002.00
Deidentified Maximum,,0406T,CPT4/HCPCS,SIN NDSC PLMT DRG ELUT MPLNT,,,3544.00
Deidentified Maximum,,0408T,CPT4/HCPCS,INSJ/RPLC CARDIAC MODULJ SYS,,,24180.00
Deidentified Maximum,,0429T,CPT4/HCPCS,RMVL NSTIM APNEA SEN LD,,,5138.00
Deidentified Maximum,,0430T,CPT4/HCPCS,RMVL NSTIM APNEA STIMJ LD,,,5138.00
Deidentified Maximum,,0433T,CPT4/HCPCS,REPOS NSTIM APNEA SENSING LD,,,5138.00
Deidentified Maximum,,0441T,CPT4/HCPCS,ABLTJ PERC LXTR/PERPH NRV,,,6075.00
Deidentified Maximum,,0443T,CPT4/HCPCS,R-T SPCTRL ALYS PRST8 TISS,,,4280.43
Deidentified Maximum,,0448T,CPT4/HCPCS,REMVL INSJ IMPLTBL GLUC SENS,,,3656.00
Deidentified Maximum,,0452T,CPT4/HCPCS,INSJ/RPLCMT DEV VASC SEAL,,,5029.00
Deidentified Maximum,,0454T,CPT4/HCPCS,INSJ/RPLCMT SUBQ ELECTRODE,,,7007.00
Deidentified Maximum,,0462T,CPT4/HCPCS,PRGRMG EVAL AORTIC VENTR SYS,,,1214.00
Deidentified Maximum,,0481T,CPT4/HCPCS,NJX AUTOL WBC CONCENTRATE,,,6049.05
Deidentified Maximum,,0482T,CPT4/HCPCS,ABSL QUAN MYOCRD BLD FLO PET,,,3198.57
Deidentified Maximum,,0491T,CPT4/HCPCS,ABL LSR OPN WND 1ST 20 SQCM,,,4891.93
Deidentified Maximum,,0515T,CPT4/HCPCS,INSJ WCS LV COMPL SYS,,,24180.00
Deidentified Maximum,,0516T,CPT4/HCPCS,INSJ WCS LV ELTRD ONLY,,,10119.00
Deidentified Maximum,,0517T,CPT4/HCPCS,INSJ WCS LV PG COMPNT,,,10119.00
Deidentified Maximum,,0525T,CPT4/HCPCS,INSJ/RPLCMT COMPL IIMS,,,10119.00
Deidentified Maximum,,0532T,CPT4/HCPCS,REMOVAL IIMS IMPLT MNTR ONLY,,,5856.00
Deidentified Maximum,,0538T,CPT4/HCPCS,BLD DRV T LYMPHCYT PREP TRNS,,,1678.00
Deidentified Maximum,,0549T,CPT4/HCPCS,TPRNL BALO CNTNC DEV UNI,,,5856.00
Deidentified Maximum,,0563T,CPT4/HCPCS,EVAC MEIBOMIAN GLND HEAT BI,,,2002.00
Deidentified Maximum,,0576T,CPT4/HCPCS,INTERROG DEV EVAL ICDS SS IP,,,1370.00
Deidentified Maximum,,0578T,CPT4/HCPCS,REM INTERROG DEV ICDS PHYS,,,1370.00
Deidentified Maximum,,0581T,CPT4/HCPCS,ABLTJ MAL BRST TUM PERQ CRTX,,,6401.00
Deidentified Maximum,,0583T,CPT4/HCPCS,TMPST AUTO TUBE DLVR SYS,,,5856.00
Deidentified Maximum,,10021,CPT4/HCPCS,FNA BX W/O IMG GDN 1ST LES,,,5310.00
Deidentified Maximum,,10060,CPT4/HCPCS,DRAINAGE OF SKIN ABSCESS,,,2002.00
Deidentified Maximum,,10080,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,,2002.00
Deidentified Maximum,,10160,CPT4/HCPCS,PUNCTURE DRAINAGE OF LESION,,,2002.00
Deidentified Maximum,,11011,CPT4/HCPCS,DEBRIDE SKIN MUSC AT FX SITE,,,4280.43
Deidentified Maximum,,11055,CPT4/HCPCS,TRIM SKIN LESION,,,2002.00
Deidentified Maximum,,11102,CPT4/HCPCS,TANGNTL BX SKIN SINGLE LES,,,2002.00
Deidentified Maximum,,11104,CPT4/HCPCS,PUNCH BX SKIN SINGLE LESION,,,2002.00
Deidentified Maximum,,11106,CPT4/HCPCS,INCAL BX SKN SINGLE LES,,,3000.00
Deidentified Maximum,,11311,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,,1214.00
Deidentified Maximum,,11426,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG >4 CM,,,4280.43
Deidentified Maximum,,11443,CPT4/HCPCS,EXC FACE-MM B9+MARG 2.1-3 CM,,,3198.57
Deidentified Maximum,,11444,CPT4/HCPCS,EXC FACE-MM B9+MARG 3.1-4 CM,,,3198.57
Deidentified Maximum,,11602,CPT4/HCPCS,EXC TR-EXT MAL+MARG 1.1-2 CM,,,3198.57
Deidentified Maximum,,11626,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG >4 CM,,,4280.43
Deidentified Maximum,,11642,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 1.1-2,,,3656.00
Deidentified Maximum,,11644,CPT4/HCPCS,EXC F/E/E/N/L MAL+MRG 3.1-4,,,4280.43
Deidentified Maximum,,11730,CPT4/HCPCS,REMOVAL OF NAIL PLATE,,,3000.00
Deidentified Maximum,,11765,CPT4/HCPCS,EXCISION OF NAIL FOLD TOE,,,3000.00
Deidentified Maximum,,11900,CPT4/HCPCS,INJECT SKIN LESIONS ,,,3198.57
Deidentified Maximum,,13131,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,,4280.43
Deidentified Maximum,,13151,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.1-2.5 CM,,,5856.00
Deidentified Maximum,,14040,CPT4/HCPCS,TIS TRNFR F/C/C/M/N/A/G/H/F,,,4280.43
Deidentified Maximum,,14061,CPT4/HCPCS,TIS TRNFR E/N/E/L10.1-30SQCM,,,5856.00
Deidentified Maximum,,15005,CPT4/HCPCS,WND PREP F/N/HF/G ADDL CM,,,3198.57
Deidentified Maximum,,15050,CPT4/HCPCS,SKIN PINCH GRAFT,,,4280.43
Deidentified Maximum,,15130,CPT4/HCPCS,DERM AUTOGRAFT TRNK/ARM/LEG,,,4280.43
Deidentified Maximum,,15136,CPT4/HCPCS,DERM AUTOGRAFT F/N/HF/G ADD,,,3198.57
Deidentified Maximum,,15150,CPT4/HCPCS,CULT SKIN GRFT T/ARM/LEG,,,4280.43
Deidentified Maximum,,15152,CPT4/HCPCS,CULT SKIN GRAFT T/A/L +%,,,3198.57
Deidentified Maximum,,15220,CPT4/HCPCS,SKIN FULL GRAFT SCLP/ARM/LEG,,,4280.43
Deidentified Maximum,,15738,CPT4/HCPCS,MUSCLE-SKIN GRAFT LEG,,,5856.00
Deidentified Maximum,,15756,CPT4/HCPCS,FREE MYO/SKIN FLAP MICROVASC,,,6876.92
Deidentified Maximum,,15757,CPT4/HCPCS,FREE SKIN FLAP MICROVASC,,,6876.92
Deidentified Maximum,,15777,CPT4/HCPCS,ACELLULAR DERM MATRIX IMPLT,,,3000.00
Deidentified Maximum,,15786,CPT4/HCPCS,ABRASION LESION SINGLE,,,1678.00
Deidentified Maximum,,15819,CPT4/HCPCS,PLASTIC SURGERY NECK,,,3656.00
Deidentified Maximum,,15822,CPT4/HCPCS,REVISION OF UPPER EYELID,,,5856.00
Deidentified Maximum,,15823,CPT4/HCPCS,REVISION OF UPPER EYELID,,,6876.92
Deidentified Maximum,,15829,CPT4/HCPCS,REMOVAL OF SKIN WRINKLES,,,6876.92
Deidentified Maximum,,15837,CPT4/HCPCS,EXCISE EXCESS SKIN ARM/HAND,,,3656.00
Deidentified Maximum,,15839,CPT4/HCPCS,EXCISE EXCESS SKIN & TISSUE,,,5856.00
Deidentified Maximum,,15847,CPT4/HCPCS,EXC SKIN ABD ADD-ON,,,5856.00
Deidentified Maximum,,15860,CPT4/HCPCS,TEST FOR BLOOD FLOW IN GRAFT,,,3198.57
Deidentified Maximum,,15876,CPT4/HCPCS,SUCTION LIPECTOMY HEAD&NECK,,,5856.00
Deidentified Maximum,,15934,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,5856.00
Deidentified Maximum,,15999,CPT4/HCPCS,REMOVAL OF PRESSURE SORE,,,4891.93
Deidentified Maximum,,16020,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN S,,,3000.00
Deidentified Maximum,,17250,CPT4/HCPCS,CHEM CAUT OF GRANLTJ TISSUE,,,3000.00
Deidentified Maximum,,17264,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17315,CPT4/HCPCS,MOHS SURG ADDL BLOCK,,,3198.57
Deidentified Maximum,,19001,CPT4/HCPCS,DRAIN BREAST LESION ADD-ON,,,3000.00
Deidentified Maximum,,19100,CPT4/HCPCS,BX BREAST PERCUT W/O IMAGE,,,3198.57
Deidentified Maximum,,19102,CPT4/HCPCS,BX BREAST PERCUT W/IMAGE,,,1678.88
Deidentified Maximum,,19110,CPT4/HCPCS,NIPPLE EXPLORATION,,,4280.43
Deidentified Maximum,,19120,CPT4/HCPCS,REMOVAL OF BREAST LESION,,,5856.00
Deidentified Maximum,,19286,CPT4/HCPCS,PERQ DEV BREAST ADD US IMAG,,,3000.00
Deidentified Maximum,,19296,CPT4/HCPCS,PLACE PO BREAST CATH FOR RAD,,,12850.70
Deidentified Maximum,,19301,CPT4/HCPCS,PARTIAL MASTECTOMY,,,5856.00
Deidentified Maximum,,19316,CPT4/HCPCS,SUSPENSION OF BREAST,,,6401.00
Deidentified Maximum,,19340,CPT4/HCPCS,INSJ BREAST IMPLT SM D MAST,,,6075.00
Deidentified Maximum,,19366,CPT4/HCPCS,BREAST RECONSTRUCTION,,,6876.92
Deidentified Maximum,,19380,CPT4/HCPCS,REVJ RECONSTRUCTED BREAST,,,6876.92
Deidentified Maximum,,20103,CPT4/HCPCS,EXPLORE WOUND EXTREMITY,,,3198.57
Deidentified Maximum,,20200,CPT4/HCPCS,MUSCLE BIOPSY,,,4280.43
Deidentified Maximum,,20604,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/US,,,2002.00
Deidentified Maximum,,20663,CPT4/HCPCS,APPLICATION OF THIGH BRACE,,,5856.00
Deidentified Maximum,,20816,CPT4/HCPCS,REPLANTATION DIGIT COMPLETE,,,12850.70
Deidentified Maximum,,20900,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,,5856.00
Deidentified Maximum,,20922,CPT4/HCPCS,REMOVAL OF FASCIA FOR GRAFT,,,5856.00
Deidentified Maximum,,20930,CPT4/HCPCS,SP BONE ALGRFT MORSEL ADD-ON,,,3198.57
Deidentified Maximum,,20956,CPT4/HCPCS,ILIAC BONE GRAFT MICROVASC,,,7902.34
Deidentified Maximum,,20957,CPT4/HCPCS,MT BONE GRAFT MICROVASC,,,6876.92
Deidentified Maximum,,20983,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,,9548.65
Deidentified Maximum,,21046,CPT4/HCPCS,REMOVE MANDIBLE CYST COMPLEX,,,6075.00
Deidentified Maximum,,21049,CPT4/HCPCS,EXCIS UPPR JAW CYST W/REPAIR,,,9548.65
Deidentified Maximum,,21077,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,9548.65
Deidentified Maximum,,21080,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,9548.65
Deidentified Maximum,,21084,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,9548.65
Deidentified Maximum,,21120,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,,7830.00
Deidentified Maximum,,21122,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,,9548.65
Deidentified Maximum,,21127,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,,12850.70
Deidentified Maximum,,21137,CPT4/HCPCS,REDUCTION OF FOREHEAD,,,6049.05
Deidentified Maximum,,21143,CPT4/HCPCS,LEFORT I-3/> PIECE W/O GRAFT,,,6588.00
Deidentified Maximum,,21146,CPT4/HCPCS,LEFORT I-2 PIECE W/ GRAFT,,,6401.00
Deidentified Maximum,,21150,CPT4/HCPCS,LEFORT II ANTERIOR INTRUSION,,,6588.00
Deidentified Maximum,,21155,CPT4/HCPCS,LEFORT III W/ LEFORT I,,,6876.92
Deidentified Maximum,,21160,CPT4/HCPCS,LEFORT III W/FHD W/ LEFORT I,,,9548.65
Deidentified Maximum,,21183,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,,6876.92
Deidentified Maximum,,21188,CPT4/HCPCS,RECONSTRUCTION OF MIDFACE,,,5281.00
Deidentified Maximum,,21243,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,,6876.92
Deidentified Maximum,,21245,CPT4/HCPCS,RECONSTRUCTION OF JAW,,,9548.65
Deidentified Maximum,,21248,CPT4/HCPCS,RECONSTRUCTION OF JAW,,,9548.65
Deidentified Maximum,,21268,CPT4/HCPCS,REVISE EYE SOCKETS,,,5783.00
Deidentified Maximum,,21310,CPT4/HCPCS,CLOSED TX NOSE FX W/O MANJ,,,4280.43
Deidentified Maximum,,21325,CPT4/HCPCS,OPEN TX NOSE FX UNCOMPLICATD,,,6401.00
Deidentified Maximum,,21335,CPT4/HCPCS,OPEN TX NOSE & SEPTAL FX,,,9548.65
Deidentified Maximum,,21339,CPT4/HCPCS,OPEN NASOETHMOID FX W/ FIXJ,,,6876.92
Deidentified Maximum,,21347,CPT4/HCPCS,OPN TX NASOMAX FX MULTPLE,,,6840.00
Deidentified Maximum,,21366,CPT4/HCPCS,OPN TX COMPLX MALAR W/GRFT,,,7188.00
Deidentified Maximum,,21390,CPT4/HCPCS,OPN TX ORBIT PERIORBTL IMPLT,,,9548.65
Deidentified Maximum,,21408,CPT4/HCPCS,OPN TX ORBIT FX W/BONE GRFT,,,6075.00
Deidentified Maximum,,21450,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,5856.00
Deidentified Maximum,,21462,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,6876.92
Deidentified Maximum,,21510,CPT4/HCPCS,DRAINAGE OF BONE LESION,,,5856.00
Deidentified Maximum,,21811,CPT4/HCPCS,OPTX OF RIB FX W/FIXJ SCOPE,,,8300.00
Deidentified Maximum,,21820,CPT4/HCPCS,TREAT STERNUM FRACTURE,,,3198.57
Deidentified Maximum,,21930,CPT4/HCPCS,EXC BACK LES SC < 3 CM,,,4280.43
Deidentified Maximum,,21931,CPT4/HCPCS,EXC BACK LES SC 3 CM/>,,,5856.00
Deidentified Maximum,,22114,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,,3544.00
Deidentified Maximum,,22214,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG LUMBAR,,,4891.93
Deidentified Maximum,,22310,CPT4/HCPCS,CLOSED TX VERT FX W/O MANJ,,,3198.57
Deidentified Maximum,,22318,CPT4/HCPCS,TREAT ODONTOID FX W/O GRAFT,,,5281.00
Deidentified Maximum,,22319,CPT4/HCPCS,TREAT ODONTOID FX W/GRAFT,,,5783.00
Deidentified Maximum,,22505,CPT4/HCPCS,MANIPULATION OF SPINE,,,4280.43
Deidentified Maximum,,22515,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,,9548.65
Deidentified Maximum,,22527,CPT4/HCPCS,IDET 1 OR MORE LEVELS,,,8300.00
Deidentified Maximum,,22590,CPT4/HCPCS,SPINE & SKULL SPINAL FUSION,,,8012.00
Deidentified Maximum,,22633,CPT4/HCPCS,LUMBAR SPINE FUSION COMBINED,,,10772.00
Deidentified Maximum,,22800,CPT4/HCPCS,POST FUSION 6 VERT SEG,,,8012.00
Deidentified Maximum,,22842,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,5281.00
Deidentified Maximum,,22846,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,7007.00
Deidentified Maximum,,22856,CPT4/HCPCS,CERV ARTIFIC DISKECTOMY,,,7188.00
Deidentified Maximum,,22867,CPT4/HCPCS,INSJ STABLJ DEV W/DCMPRN,,,7007.00
Deidentified Maximum,,22870,CPT4/HCPCS,INSJ STABLJ DEV W/O DCMPRN,,,5029.00
Deidentified Maximum,,22902,CPT4/HCPCS,EXC ABD LES SC < 3 CM,,,4280.43
Deidentified Maximum,,23031,CPT4/HCPCS,DRAIN SHOULDER BURSA,,,5856.00
Deidentified Maximum,,23066,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,,4280.43
Deidentified Maximum,,23071,CPT4/HCPCS,EXC SHOULDER LES SC 3 CM/>,,,5856.00
Deidentified Maximum,,23075,CPT4/HCPCS,EXC SHOULDER LES SC < 3 CM,,,4280.43
Deidentified Maximum,,23076,CPT4/HCPCS,EXC SHOULDER TUM DEEP < 5 CM,,,4280.43
Deidentified Maximum,,23140,CPT4/HCPCS,REMOVAL OF BONE LESION,,,6401.00
Deidentified Maximum,,23150,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,,6401.00
Deidentified Maximum,,23182,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,,6401.00
Deidentified Maximum,,23184,CPT4/HCPCS,REMOVE HUMERUS LESION,,,6401.00
Deidentified Maximum,,23210,CPT4/HCPCS,RESECT SCAPULA TUMOR,,,5029.00
Deidentified Maximum,,23330,CPT4/HCPCS,REMOVE SHOULDER FOREIGN BODY,,,3198.57
Deidentified Maximum,,23397,CPT4/HCPCS,MUSCLE TRANSFERS,,,9548.65
Deidentified Maximum,,23474,CPT4/HCPCS,REVIS RECONST SHOULDER JOINT,,,9548.65
Deidentified Maximum,,23490,CPT4/HCPCS,REINFORCE CLAVICLE,,,7007.00
Deidentified Maximum,,23525,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,3198.57
Deidentified Maximum,,23545,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,3198.57
Deidentified Maximum,,23616,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,7007.00
Deidentified Maximum,,23630,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,7007.00
Deidentified Maximum,,23802,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,,9548.65
Deidentified Maximum,,23929,CPT4/HCPCS,SHOULDER SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,24077,CPT4/HCPCS,RESECT ARM/ELBOW TUM < 5 CM,,,5856.00
Deidentified Maximum,,24102,CPT4/HCPCS,REMOVE ELBOW JOINT LINING,,,6401.00
Deidentified Maximum,,24105,CPT4/HCPCS,REMOVAL OF ELBOW BURSA,,,5856.00
Deidentified Maximum,,24140,CPT4/HCPCS,PARTIAL REMOVAL OF ARM BONE,,,5856.00
Deidentified Maximum,,24160,CPT4/HCPCS,REMOVE ELBOW JOINT IMPLANT,,,5138.00
Deidentified Maximum,,24200,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,,3198.57
Deidentified Maximum,,24363,CPT4/HCPCS,REPLACE ELBOW JOINT,,,10119.00
Deidentified Maximum,,24366,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,,10119.00
Deidentified Maximum,,24495,CPT4/HCPCS,DECOMPRESSION OF FOREARM,,,5138.00
Deidentified Maximum,,24538,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4280.43
Deidentified Maximum,,24545,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,7007.00
Deidentified Maximum,,24565,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4280.43
Deidentified Maximum,,24566,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4280.43
Deidentified Maximum,,24620,CPT4/HCPCS,TREAT ELBOW FRACTURE,,,4280.43
Deidentified Maximum,,24655,CPT4/HCPCS,TREAT RADIUS FRACTURE,,,3198.57
Deidentified Maximum,,25031,CPT4/HCPCS,DRAINAGE OF FOREARM BURSA,,,4280.43
Deidentified Maximum,,25073,CPT4/HCPCS,EXC FOREARM TUM DEEP 3 CM/>,,,5856.00
Deidentified Maximum,,25077,CPT4/HCPCS,RESECT FOREARM/WRIST TUM<3CM,,,5856.00
Deidentified Maximum,,25107,CPT4/HCPCS,REMOVE WRIST JOINT CARTILAGE,,,5856.00
Deidentified Maximum,,25109,CPT4/HCPCS,EXCISE TENDON FOREARM/WRIST,,,6401.00
Deidentified Maximum,,25119,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,,5856.00
Deidentified Maximum,,25248,CPT4/HCPCS,REMOVE FOREARM FOREIGN BODY,,,4280.43
Deidentified Maximum,,25259,CPT4/HCPCS,MANIPULATE WRIST W/ANESTHES,,,4000.00
Deidentified Maximum,,25312,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,,6401.00
Deidentified Maximum,,25315,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,,5856.00
Deidentified Maximum,,25316,CPT4/HCPCS,REVISE PALSY HAND TENDON(S),,,7007.00
Deidentified Maximum,,25320,CPT4/HCPCS,REPAIR/REVISE WRIST JOINT,,,6075.00
Deidentified Maximum,,25332,CPT4/HCPCS,REVISE WRIST JOINT,,,6876.92
Deidentified Maximum,,25355,CPT4/HCPCS,REVISION OF RADIUS,,,6075.00
Deidentified Maximum,,25375,CPT4/HCPCS,REVISE RADIUS & ULNA,,,6401.00
Deidentified Maximum,,25391,CPT4/HCPCS,LENGTHEN RADIUS OR ULNA,,,6401.00
Deidentified Maximum,,25400,CPT4/HCPCS,REPAIR RADIUS OR ULNA,,,6075.00
Deidentified Maximum,,25426,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,,6401.00
Deidentified Maximum,,25442,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,,10119.00
Deidentified Maximum,,25490,CPT4/HCPCS,REINFORCE RADIUS,,,6075.00
Deidentified Maximum,,25520,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,3198.57
Deidentified Maximum,,25560,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,,2002.00
Deidentified Maximum,,25607,CPT4/HCPCS,TREAT FX RAD EXTRA-ARTICUL,,,7007.00
Deidentified Maximum,,25608,CPT4/HCPCS,TREAT FX RAD INTRA-ARTICUL,,,7007.00
Deidentified Maximum,,25609,CPT4/HCPCS,TREAT FX RADIAL 3+ FRAG,,,7007.00
Deidentified Maximum,,25624,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,4280.43
Deidentified Maximum,,25628,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,7007.00
Deidentified Maximum,,25645,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,7007.00
Deidentified Maximum,,25652,CPT4/HCPCS,TREAT FRACTURE ULNAR STYLOID,,,7902.34
Deidentified Maximum,,25671,CPT4/HCPCS,PIN RADIOULNAR DISLOCATION,,,4204.00
Deidentified Maximum,,25685,CPT4/HCPCS,TREAT WRIST FRACTURE,,,5856.00
Deidentified Maximum,,25695,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,4280.43
Deidentified Maximum,,25929,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,5856.00
Deidentified Maximum,,25999,CPT4/HCPCS,FOREARM OR WRIST SURGERY,,,3198.57
Deidentified Maximum,,26011,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,,3198.57
Deidentified Maximum,,26034,CPT4/HCPCS,TREAT HAND BONE LESION,,,4280.43
Deidentified Maximum,,26080,CPT4/HCPCS,EXPLORE/TREAT FINGER JOINT,,,6401.00
Deidentified Maximum,,26123,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,,6401.00
Deidentified Maximum,,26130,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,,5856.00
Deidentified Maximum,,26135,CPT4/HCPCS,REVISE FINGER JOINT EACH,,,6401.00
Deidentified Maximum,,26350,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,5138.00
Deidentified Maximum,,26370,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,6401.00
Deidentified Maximum,,26392,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,,5856.00
Deidentified Maximum,,26418,CPT4/HCPCS,REPAIR FINGER TENDON,,,6401.00
Deidentified Maximum,,26474,CPT4/HCPCS,FUSION OF FINGER TENDONS,,,4280.43
Deidentified Maximum,,26478,CPT4/HCPCS,LENGTHENING OF HAND TENDON,,,3198.57
Deidentified Maximum,,26485,CPT4/HCPCS,TRANSPLANT PALM TENDON,,,5138.00
Deidentified Maximum,,26497,CPT4/HCPCS,FINGER TENDON TRANSFER,,,5856.00
Deidentified Maximum,,26499,CPT4/HCPCS,REVISION OF FINGER,,,5856.00
Deidentified Maximum,,26525,CPT4/HCPCS,RELEASE FINGER CONTRACTURE,,,5856.00
Deidentified Maximum,,26530,CPT4/HCPCS,REVISE KNUCKLE JOINT,,,6075.00
Deidentified Maximum,,26531,CPT4/HCPCS,REVISE KNUCKLE WITH IMPLANT,,,9548.65
Deidentified Maximum,,26536,CPT4/HCPCS,REVISE/IMPLANT FINGER JOINT,,,6876.92
Deidentified Maximum,,26553,CPT4/HCPCS,SINGLE TRANSFER TOE-HAND,,,9548.65
Deidentified Maximum,,26556,CPT4/HCPCS,TOE JOINT TRANSFER,,,9548.65
Deidentified Maximum,,26565,CPT4/HCPCS,CORRECT METACARPAL FLAW,,,6876.92
Deidentified Maximum,,26596,CPT4/HCPCS,EXCISION CONSTRICTING TISSUE,,,4280.43
Deidentified Maximum,,26600,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,,1678.00
Deidentified Maximum,,26645,CPT4/HCPCS,TREAT THUMB FRACTURE,,,3198.57
Deidentified Maximum,,26706,CPT4/HCPCS,PIN KNUCKLE DISLOCATION,,,4280.43
Deidentified Maximum,,26740,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,2002.00
Deidentified Maximum,,26746,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,6876.92
Deidentified Maximum,,26755,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,1678.00
Deidentified Maximum,,26775,CPT4/HCPCS,TREAT FINGER DISLOCATION,,,3198.57
Deidentified Maximum,,26785,CPT4/HCPCS,TREAT FINGER DISLOCATION,,,4280.43
Deidentified Maximum,,26820,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,,6876.92
Deidentified Maximum,,27030,CPT4/HCPCS,DRAINAGE OF HIP JOINT,,,5856.00
Deidentified Maximum,,27052,CPT4/HCPCS,BIOPSY OF HIP JOINT,,,5856.00
Deidentified Maximum,,27075,CPT4/HCPCS,RESECT HIP TUMOR,,,7902.34
Deidentified Maximum,,27080,CPT4/HCPCS,REMOVAL OF TAIL BONE,,,5138.00
Deidentified Maximum,,27125,CPT4/HCPCS,PARTIAL HIP REPLACEMENT,,,5783.00
Deidentified Maximum,,27132,CPT4/HCPCS,TOTAL HIP ARTHROPLASTY,,,10119.00
Deidentified Maximum,,27137,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,,10119.00
Deidentified Maximum,,27158,CPT4/HCPCS,REVISION OF PELVIS,,,5281.00
Deidentified Maximum,,27161,CPT4/HCPCS,INCISION OF NECK OF FEMUR,,,5281.00
Deidentified Maximum,,27165,CPT4/HCPCS,INCISION/FIXATION OF FEMUR,,,4280.43
Deidentified Maximum,,27170,CPT4/HCPCS,REPAIR/GRAFT FEMUR HEAD/NECK,,,5281.00
Deidentified Maximum,,27177,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,,5783.00
Deidentified Maximum,,27202,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,,7007.00
Deidentified Maximum,,27218,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,,5029.00
Deidentified Maximum,,27227,CPT4/HCPCS,TREAT HIP FRACTURE(S),,,5281.00
Deidentified Maximum,,27230,CPT4/HCPCS,TREAT THIGH FRACTURE,,,3198.57
Deidentified Maximum,,27238,CPT4/HCPCS,TREAT THIGH FRACTURE,,,3198.57
Deidentified Maximum,,27245,CPT4/HCPCS,TREAT THIGH FRACTURE,,,5281.00
Deidentified Maximum,,27252,CPT4/HCPCS,TREAT HIP DISLOCATION,,,4280.43
Deidentified Maximum,,27256,CPT4/HCPCS,TREAT HIP DISLOCATION,,,3656.00
Deidentified Maximum,,27267,CPT4/HCPCS,CLTX THIGH FX,,,4280.43
Deidentified Maximum,,27269,CPT4/HCPCS,OPTX THIGH FX,,,6876.92
Deidentified Maximum,,27282,CPT4/HCPCS,FUSION OF PUBIC BONES,,,6588.00
Deidentified Maximum,,27286,CPT4/HCPCS,FUSION OF HIP JOINT,,,6049.05
Deidentified Maximum,,27295,CPT4/HCPCS,AMPUTATION OF LEG AT HIP,,,5029.00
Deidentified Maximum,,27327,CPT4/HCPCS,EXC THIGH/KNEE LES SC < 3 CM,,,4280.43
Deidentified Maximum,,27356,CPT4/HCPCS,REMOVE FEMUR LESION/GRAFT,,,6401.00
Deidentified Maximum,,27370,CPT4/HCPCS,INJECTION FOR KNEE X-RAY,,,1678.00
Deidentified Maximum,,27380,CPT4/HCPCS,REPAIR OF KNEECAP TENDON,,,5138.00
Deidentified Maximum,,27386,CPT4/HCPCS,REPAIR/GRAFT OF THIGH MUSCLE,,,5856.00
Deidentified Maximum,,27390,CPT4/HCPCS,INCISION OF THIGH TENDON,,,4204.00
Deidentified Maximum,,27393,CPT4/HCPCS,LENGTHENING OF THIGH TENDON,,,5138.00
Deidentified Maximum,,27396,CPT4/HCPCS,TRANSPLANT OF THIGH TENDON,,,5856.00
Deidentified Maximum,,27418,CPT4/HCPCS,REPAIR DEGENERATED KNEECAP,,,6075.00
Deidentified Maximum,,27425,CPT4/HCPCS,LAT RETINACULAR RELEASE OPEN,,,9548.65
Deidentified Maximum,,27443,CPT4/HCPCS,REVISION OF KNEE JOINT,,,6876.92
Deidentified Maximum,,27477,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,,6840.00
Deidentified Maximum,,27499,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,,5856.00
Deidentified Maximum,,27500,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,3198.57
Deidentified Maximum,,27503,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,5856.00
Deidentified Maximum,,27508,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,3198.57
Deidentified Maximum,,27516,CPT4/HCPCS,TREAT THIGH FX GROWTH PLATE,,,3198.57
Deidentified Maximum,,27520,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,,3198.57
Deidentified Maximum,,27535,CPT4/HCPCS,TREAT KNEE FRACTURE,,,5856.00
Deidentified Maximum,,27536,CPT4/HCPCS,TREAT KNEE FRACTURE,,,5138.00
Deidentified Maximum,,27538,CPT4/HCPCS,TREAT KNEE FRACTURE(S),,,3198.57
Deidentified Maximum,,27540,CPT4/HCPCS,TREAT KNEE FRACTURE,,,6075.00
Deidentified Maximum,,27550,CPT4/HCPCS,TREAT KNEE DISLOCATION,,,3198.57
Deidentified Maximum,,27560,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,,3198.57
Deidentified Maximum,,27566,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,,7007.00
Deidentified Maximum,,27592,CPT4/HCPCS,AMPUTATE LEG AT THIGH,,,5029.00
Deidentified Maximum,,27601,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,,5856.00
Deidentified Maximum,,27610,CPT4/HCPCS,EXPLORE/TREAT ANKLE JOINT,,,5138.00
Deidentified Maximum,,27616,CPT4/HCPCS,RESECT LEG/ANKLE TUM 5 CM/>,,,5856.00
Deidentified Maximum,,27638,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,,5856.00
Deidentified Maximum,,27656,CPT4/HCPCS,REPAIR LEG FASCIA DEFECT,,,4280.43
Deidentified Maximum,,27658,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,,4204.00
Deidentified Maximum,,27676,CPT4/HCPCS,REPAIR LOWER LEG TENDONS,,,5856.00
Deidentified Maximum,,27687,CPT4/HCPCS,REVISION OF CALF TENDON,,,5856.00
Deidentified Maximum,,27695,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,,5138.00
Deidentified Maximum,,27725,CPT4/HCPCS,REPAIR OF LOWER LEG,,,4891.93
Deidentified Maximum,,27726,CPT4/HCPCS,REPAIR FIBULA NONUNION,,,8300.00
Deidentified Maximum,,27727,CPT4/HCPCS,REPAIR OF LOWER LEG,,,4280.43
Deidentified Maximum,,27730,CPT4/HCPCS,REPAIR OF TIBIA EPIPHYSIS,,,5138.00
Deidentified Maximum,,27734,CPT4/HCPCS,REPAIR LOWER LEG EPIPHYSES,,,5138.00
Deidentified Maximum,,27740,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,,5138.00
Deidentified Maximum,,27745,CPT4/HCPCS,REINFORCE TIBIA,,,7007.00
Deidentified Maximum,,27752,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,,3198.57
Deidentified Maximum,,27759,CPT4/HCPCS,TREATMENT OF TIBIA FRACTURE,,,7007.00
Deidentified Maximum,,27768,CPT4/HCPCS,CLTX POST ANKLE FX W/MNPJ,,,4280.43
Deidentified Maximum,,27792,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,7007.00
Deidentified Maximum,,27823,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,7007.00
Deidentified Maximum,,27830,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,,3198.57
Deidentified Maximum,,27842,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,,3198.57
Deidentified Maximum,,27860,CPT4/HCPCS,FIXATION OF ANKLE JOINT,,,3198.57
Deidentified Maximum,,27884,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,5856.00
Deidentified Maximum,,27899,CPT4/HCPCS,LEG/ANKLE SURGERY PROCEDURE,,,3000.00
Deidentified Maximum,,28002,CPT4/HCPCS,TREATMENT OF FOOT INFECTION,,,5856.00
Deidentified Maximum,,28046,CPT4/HCPCS,RESECT FOOT/TOE TUMOR < 3 CM,,,5856.00
Deidentified Maximum,,28052,CPT4/HCPCS,BIOPSY OF FOOT JOINT LINING,,,4280.43
Deidentified Maximum,,28062,CPT4/HCPCS,REMOVAL OF FOOT FASCIA,,,5856.00
Deidentified Maximum,,28070,CPT4/HCPCS,REMOVAL OF FOOT JOINT LINING,,,5856.00
Deidentified Maximum,,28298,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,5856.00
Deidentified Maximum,,28300,CPT4/HCPCS,INCISION OF HEEL BONE,,,7007.00
Deidentified Maximum,,28313,CPT4/HCPCS,REPAIR DEFORMITY OF TOE,,,4280.43
Deidentified Maximum,,28320,CPT4/HCPCS,REPAIR OF FOOT BONES,,,7007.00
Deidentified Maximum,,28340,CPT4/HCPCS,RESECT ENLARGED TOE TISSUE,,,6401.00
Deidentified Maximum,,28344,CPT4/HCPCS,REPAIR EXTRA TOE(S),,,6401.00
Deidentified Maximum,,28406,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,,4280.43
Deidentified Maximum,,28455,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,,3198.57
Deidentified Maximum,,28456,CPT4/HCPCS,TREAT MIDFOOT FRACTURE,,,4280.43
Deidentified Maximum,,28485,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,,7007.00
Deidentified Maximum,,28530,CPT4/HCPCS,TREAT SESAMOID BONE FRACTURE,,,2002.00
Deidentified Maximum,,28575,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,3198.57
Deidentified Maximum,,28660,CPT4/HCPCS,TREAT TOE DISLOCATION,,,2002.00
Deidentified Maximum,,28755,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,,6401.00
Deidentified Maximum,,28760,CPT4/HCPCS,FUSION OF BIG TOE JOINT,,,7007.00
Deidentified Maximum,,28800,CPT4/HCPCS,AMPUTATION OF MIDFOOT,,,3544.00
Deidentified Maximum,,29345,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,,2002.00
Deidentified Maximum,,29358,CPT4/HCPCS,APPLY LONG LEG CAST BRACE,,,1214.00
Deidentified Maximum,,29440,CPT4/HCPCS,ADDITION OF WALKER TO CAST,,,1678.00
Deidentified Maximum,,29540,CPT4/HCPCS,STRAPPING OF ANKLE AND/OR FT,,,6766.00
Deidentified Maximum,,29580,CPT4/HCPCS,APPLICATION OF PASTE BOOT,,,6766.00
Deidentified Maximum,,29583,CPT4/HCPCS,APPLY MULTLAY COMPRS UPR ARM,,,1678.00
Deidentified Maximum,,29710,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,,1214.00
Deidentified Maximum,,29720,CPT4/HCPCS,REPAIR OF BODY CAST,,,1678.00
Deidentified Maximum,,29820,CPT4/HCPCS,SHO ARTHRS SRG PRTL SYNVCT,,,7007.00
Deidentified Maximum,,29827,CPT4/HCPCS,SHO ARTHRS SRG RT8TR CUF RPR,,,7007.00
Deidentified Maximum,,29834,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29843,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29847,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,,7007.00
Deidentified Maximum,,29848,CPT4/HCPCS,WRIST ENDOSCOPY/SURGERY,,,12850.70
Deidentified Maximum,,29863,CPT4/HCPCS,HIP ARTHR0 W/SYNOVECTOMY,,,7007.00
Deidentified Maximum,,29866,CPT4/HCPCS,AUTGRFT IMPLNT KNEE W/SCOPE,,,12850.70
Deidentified Maximum,,29875,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,6401.00
Deidentified Maximum,,29881,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,6401.00
Deidentified Maximum,,29886,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29888,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,8012.00
Deidentified Maximum,,29916,CPT4/HCPCS,HIP ARTHRO W/LABRAL REPAIR,,,8300.00
Deidentified Maximum,,30210,CPT4/HCPCS,NASAL SINUS THERAPY,,,3198.57
Deidentified Maximum,,30420,CPT4/HCPCS,RECONSTRUCTION OF NOSE,,,6876.92
Deidentified Maximum,,30435,CPT4/HCPCS,REVISION OF NOSE,,,6876.92
Deidentified Maximum,,30520,CPT4/HCPCS,REPAIR OF NASAL SEPTUM,,,6588.00
Deidentified Maximum,,30901,CPT4/HCPCS,CONTROL OF NOSEBLEED,,,2002.00
Deidentified Maximum,,30906,CPT4/HCPCS,REPEAT CONTROL OF NOSEBLEED,,,3198.57
Deidentified Maximum,,31087,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,6401.00
Deidentified Maximum,,31201,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,,6876.92
Deidentified Maximum,,31239,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,6401.00
Deidentified Maximum,,31253,CPT4/HCPCS,NSL/SINS NDSC TOTAL,,,6876.92
Deidentified Maximum,,31256,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,,5856.00
Deidentified Maximum,,31288,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,5856.00
Deidentified Maximum,,31291,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,5856.00
Deidentified Maximum,,31365,CPT4/HCPCS,REMOVAL OF LARYNX,,,6876.92
Deidentified Maximum,,31515,CPT4/HCPCS,LARYNGOSCOPY FOR ASPIRATION,,,3198.57
Deidentified Maximum,,31526,CPT4/HCPCS,DX LARYNGOSCOPY W/OPER SCOPE,,,4280.43
Deidentified Maximum,,31535,CPT4/HCPCS,LARYNGOSCOPY W/BIOPSY,,,4280.43
Deidentified Maximum,,31551,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,,6876.92
Deidentified Maximum,,31560,CPT4/HCPCS,LARYNGOSCOP W/ARYTENOIDECTOM,,,6876.92
Deidentified Maximum,,31573,CPT4/HCPCS,LARGSC W/THER INJECTION,,,6000.00
Deidentified Maximum,,31601,CPT4/HCPCS,INCISION OF WINDPIPE,,,6049.05
Deidentified Maximum,,31612,CPT4/HCPCS,PUNCTURE/CLEAR WINDPIPE,,,4204.00
Deidentified Maximum,,31624,CPT4/HCPCS,DX BRONCHOSCOPE/LAVAGE,,,4280.43
Deidentified Maximum,,31627,CPT4/HCPCS,NAVIGATIONAL BRONCHOSCOPY,,,3000.00
Deidentified Maximum,,31629,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX EACH,,,5138.00
Deidentified Maximum,,31632,CPT4/HCPCS,BRONCHOSCOPY/LUNG BX ADDL,,,3656.00
Deidentified Maximum,,31634,CPT4/HCPCS,BRONCH W/BALLOON OCCLUSION,,,5856.00
Deidentified Maximum,,31637,CPT4/HCPCS,BRONCHOSCOPY STENT ADD-ON,,,3198.57
Deidentified Maximum,,31640,CPT4/HCPCS,BRONCHOSCOPY W/TUMOR EXCISE,,,5138.00
Deidentified Maximum,,31643,CPT4/HCPCS,DIAG BRONCHOSCOPE/CATHETER,,,4280.43
Deidentified Maximum,,31660,CPT4/HCPCS,BRONCH THERMOPLSTY 1 LOBE,,,8300.00
Deidentified Maximum,,31717,CPT4/HCPCS,BRONCHIAL BRUSH BIOPSY,,,3198.57
Deidentified Maximum,,31725,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,,3198.57
Deidentified Maximum,,31830,CPT4/HCPCS,REVISE WINDPIPE SCAR,,,4280.43
Deidentified Maximum,,31899,CPT4/HCPCS,AIRWAYS SURGICAL PROCEDURE,,,3198.57
Deidentified Maximum,,32035,CPT4/HCPCS,THORACOSTOMY W/RIB RESECTION,,,5029.00
Deidentified Maximum,,32098,CPT4/HCPCS,OPEN BIOPSY OF LUNG PLEURA,,,8012.00
Deidentified Maximum,,32110,CPT4/HCPCS,EXPLORE/REPAIR CHEST,,,6588.00
Deidentified Maximum,,32400,CPT4/HCPCS,NEEDLE BIOPSY CHEST LINING,,,3198.57
Deidentified Maximum,,32420,CPT4/HCPCS,PUNCTURE/CLEAR LUNG,,,1678.00
Deidentified Maximum,,32445,CPT4/HCPCS,REMOVAL OF LUNG EXTRAPLEURAL,,,8012.00
Deidentified Maximum,,32482,CPT4/HCPCS,BILOBECTOMY,,,8841.00
Deidentified Maximum,,32553,CPT4/HCPCS,INS MARK THOR FOR RT PERQ,,,3000.00
Deidentified Maximum,,32555,CPT4/HCPCS,ASPIRATE PLEURA W/ IMAGING,,,3198.57
Deidentified Maximum,,32601,CPT4/HCPCS,THORACOSCOPY DIAGNOSTIC,,,7902.34
Deidentified Maximum,,32609,CPT4/HCPCS,THORACOSCOPY W/BX PLEURA,,,8300.00
Deidentified Maximum,,32653,CPT4/HCPCS,THORACOSCOPY REMOV FB/FIBRIN,,,7007.00
Deidentified Maximum,,32658,CPT4/HCPCS,THORACOSCOPY W/SAC FB REMOVE,,,5783.00
Deidentified Maximum,,32661,CPT4/HCPCS,THORACOSCOPY W/PERICARD EXC,,,8012.00
Deidentified Maximum,,32663,CPT4/HCPCS,THORACOSCOPY W/LOBECTOMY,,,8012.00
Deidentified Maximum,,32664,CPT4/HCPCS,THORACOSCOPY W/ TH NRV EXC,,,5783.00
Deidentified Maximum,,32666,CPT4/HCPCS,THORACOSCOPY W/WEDGE RESECT,,,7902.34
Deidentified Maximum,,32669,CPT4/HCPCS,THORACOSCOPY REMOVE SEGMENT,,,7902.34
Deidentified Maximum,,32672,CPT4/HCPCS,THORACOSCOPY FOR LVRS,,,7902.34
Deidentified Maximum,,32940,CPT4/HCPCS,REVISION OF LUNG,,,5029.00
Deidentified Maximum,,32997,CPT4/HCPCS,TOTAL LUNG LAVAGE,,,3198.57
Deidentified Maximum,,32998,CPT4/HCPCS,ABLATE PULM TUMOR PERQ RF,,,8300.00
Deidentified Maximum,,33018,CPT4/HCPCS,PRCRD DRG 0-5YR OR W/ANOMLY,,,3544.00
Deidentified Maximum,,33120,CPT4/HCPCS,REMOVAL OF HEART LESION,,,6588.00
Deidentified Maximum,,33140,CPT4/HCPCS,HEART REVASCULARIZE (TMR),,,5783.00
Deidentified Maximum,,33141,CPT4/HCPCS,HEART TMR W/OTHER PROCEDURE,,,3544.00
Deidentified Maximum,,33206,CPT4/HCPCS,INSERT HEART PM ATRIAL,,,12850.70
Deidentified Maximum,,33210,CPT4/HCPCS,INSERT ELECTRD/PM CATH SNGL,,,12850.70
Deidentified Maximum,,33212,CPT4/HCPCS,INSERT PULSE GEN SNGL LEAD,,,12850.70
Deidentified Maximum,,33213,CPT4/HCPCS,INSERT PULSE GEN DUAL LEADS,,,12850.70
Deidentified Maximum,,33214,CPT4/HCPCS,UPGRADE OF PACEMAKER SYSTEM,,,12850.70
Deidentified Maximum,,33221,CPT4/HCPCS,INSERT PULSE GEN MULT LEADS,,,10772.00
Deidentified Maximum,,33222,CPT4/HCPCS,RELOCATION POCKET PACEMAKER,,,4280.43
Deidentified Maximum,,33226,CPT4/HCPCS,REPOSITION L VENTRIC LEAD,,,5856.00
Deidentified Maximum,,33229,CPT4/HCPCS,REMV&REPLC PM GEN MULT LEADS,,,10772.00
Deidentified Maximum,,33233,CPT4/HCPCS,REMOVAL OF PM GENERATOR,,,5138.00
Deidentified Maximum,,33234,CPT4/HCPCS,REMOVAL OF PACEMAKER SYSTEM,,,6401.00
Deidentified Maximum,,33254,CPT4/HCPCS,ABLATE ATRIA LMTD,,,5029.00
Deidentified Maximum,,33265,CPT4/HCPCS,ABLATE ATRIA LMTD ENDO,,,5029.00
Deidentified Maximum,,33270,CPT4/HCPCS,INS/REP SUBQ DEFIBRILLATOR,,,24180.00
Deidentified Maximum,,33282,CPT4/HCPCS,IMPLANT PAT-ACTIVE HT RECORD,,,12850.70
Deidentified Maximum,,33300,CPT4/HCPCS,REPAIR OF HEART WOUND,,,5783.00
Deidentified Maximum,,33330,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,,6588.00
Deidentified Maximum,,33361,CPT4/HCPCS,REPLACE AORTIC VALVE PERQ,,,7902.34
Deidentified Maximum,,33365,CPT4/HCPCS,REPLACE AORTIC VALVE OPEN,,,9548.65
Deidentified Maximum,,33405,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,,6588.00
Deidentified Maximum,,33410,CPT4/HCPCS,REPLACEMENT AORTIC VALVE OPN,,,8841.00
Deidentified Maximum,,33417,CPT4/HCPCS,REPAIR OF AORTIC VALVE,,,8841.00
Deidentified Maximum,,33420,CPT4/HCPCS,REVISION OF MITRAL VALVE,,,5783.00
Deidentified Maximum,,33427,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,,8841.00
Deidentified Maximum,,33463,CPT4/HCPCS,VALVULOPLASTY TRICUSPID,,,4280.43
Deidentified Maximum,,33477,CPT4/HCPCS,IMPLANT TCAT PULM VLV PERQ,,,8012.00
Deidentified Maximum,,33500,CPT4/HCPCS,REPAIR HEART VESSEL FISTULA,,,8841.00
Deidentified Maximum,,33505,CPT4/HCPCS,REPAIR ARTERY W/TUNNEL,,,6049.05
Deidentified Maximum,,33548,CPT4/HCPCS,RESTORE/REMODEL VENTRICLE,,,5783.00
Deidentified Maximum,,33602,CPT4/HCPCS,CLOSURE OF VALVE,,,1370.00
Deidentified Maximum,,33621,CPT4/HCPCS,TRANSTHOR CATH FOR STENT,,,6588.00
Deidentified Maximum,,33670,CPT4/HCPCS,REPAIR OF HEART CHAMBERS,,,8841.00
Deidentified Maximum,,33688,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,,8841.00
Deidentified Maximum,,33692,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,8841.00
Deidentified Maximum,,33694,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,8841.00
Deidentified Maximum,,33732,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT,,,1370.00
Deidentified Maximum,,33736,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,1370.00
Deidentified Maximum,,33750,CPT4/HCPCS,MAJOR VESSEL SHUNT,,,8012.00
Deidentified Maximum,,33764,CPT4/HCPCS,MAJOR VESSEL SHUNT & GRAFT,,,8012.00
Deidentified Maximum,,33780,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,8841.00
Deidentified Maximum,,33802,CPT4/HCPCS,REPAIR VESSEL DEFECT,,,6588.00
Deidentified Maximum,,33814,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,,8841.00
Deidentified Maximum,,33852,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,,8841.00
Deidentified Maximum,,33858,CPT4/HCPCS,AS-AORT GRF F/AORTIC DSJ,,,8841.00
Deidentified Maximum,,33866,CPT4/HCPCS,AORTIC HEMIARCH GRAFT,,,8841.00
Deidentified Maximum,,33910,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,,8841.00
Deidentified Maximum,,33915,CPT4/HCPCS,REMOVE LUNG ARTERY EMBOLI,,,8012.00
Deidentified Maximum,,33917,CPT4/HCPCS,REPAIR PULMONARY ARTERY,,,1370.00
Deidentified Maximum,,33924,CPT4/HCPCS,REMOVE PULMONARY SHUNT,,,5281.00
Deidentified Maximum,,33929,CPT4/HCPCS,RMVL RPLCMT HRT SYS F/TRNSPL,,,8841.00
Deidentified Maximum,,33933,CPT4/HCPCS,PREPARE DONOR HEART/LUNG,,,3544.00
Deidentified Maximum,,33948,CPT4/HCPCS,ECMO/ECLS DAILY MGMT-VENOUS,,,3544.00
Deidentified Maximum,,33952,CPT4/HCPCS,ECMO/ECLS INSJ PRPH CANNULA,,,3544.00
Deidentified Maximum,,33956,CPT4/HCPCS,ECMO/ECLS INSJ CTR CANNULA,,,3544.00
Deidentified Maximum,,33963,CPT4/HCPCS,ECMO/ECLS REPOS PERPH CNULA,,,8012.00
Deidentified Maximum,,33965,CPT4/HCPCS,ECMO/ECLS RMVL PERPH CANNULA,,,5281.00
Deidentified Maximum,,33975,CPT4/HCPCS,IMPLANT VENTRICULAR DEVICE,,,1370.00
Deidentified Maximum,,33980,CPT4/HCPCS,REMOVE INTRACORPOREAL DEVICE,,,5281.00
Deidentified Maximum,,33982,CPT4/HCPCS,REPLACE VAD INTRA W/O BP,,,1370.00
Deidentified Maximum,,33984,CPT4/HCPCS,ECMO/ECLS RMVL PRPH CANNULA,,,5281.00
Deidentified Maximum,,33999,CPT4/HCPCS,CARDIAC SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,34401,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,,5029.00
Deidentified Maximum,,34715,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS,,,5029.00
Deidentified Maximum,,34826,CPT4/HCPCS,ENDOVASC EXTEN PROSTH ADDL,,,1678.88
Deidentified Maximum,,34900,CPT4/HCPCS,ENDOVASC ILIAC REPR W/GRAFT,,,5281.00
Deidentified Maximum,,35002,CPT4/HCPCS,REPAIR ARTERY RUPTURE NECK,,,5783.00
Deidentified Maximum,,35011,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,7902.34
Deidentified Maximum,,35021,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,6588.00
Deidentified Maximum,,35045,CPT4/HCPCS,REPAIR DEFECT OF ARM ARTERY,,,7007.00
Deidentified Maximum,,35092,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,,8012.00
Deidentified Maximum,,35111,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,5783.00
Deidentified Maximum,,35121,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,5783.00
Deidentified Maximum,,35131,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,5783.00
Deidentified Maximum,,35151,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,5281.00
Deidentified Maximum,,35189,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,5783.00
Deidentified Maximum,,35221,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,5783.00
Deidentified Maximum,,35236,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,7188.00
Deidentified Maximum,,35271,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,8841.00
Deidentified Maximum,,35301,CPT4/HCPCS,RECHANNELING OF ARTERY,,,7902.34
Deidentified Maximum,,35306,CPT4/HCPCS,RECHANNELING OF ARTERY,,,1678.88
Deidentified Maximum,,35321,CPT4/HCPCS,RECHANNELING OF ARTERY,,,7007.00
Deidentified Maximum,,35341,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5783.00
Deidentified Maximum,,35361,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5783.00
Deidentified Maximum,,35390,CPT4/HCPCS,REOPERATION CAROTID ADD-ON,,,3198.57
Deidentified Maximum,,35452,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,5029.00
Deidentified Maximum,,35475,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,5029.00
Deidentified Maximum,,35511,CPT4/HCPCS,ART BYP GRFT SUBCLAV-SUBCLAV,,,5281.00
Deidentified Maximum,,35516,CPT4/HCPCS,ART BYP GRFT SUBCLAV-AXILARY,,,5029.00
Deidentified Maximum,,35518,CPT4/HCPCS,ART BYP GRFT AXILLARY-AXILRY,,,5281.00
Deidentified Maximum,,35526,CPT4/HCPCS,ART BYP GRFT AOR/CAROT/INNOM,,,5281.00
Deidentified Maximum,,35531,CPT4/HCPCS,ART BYP GRFT AORCEL/AORMESEN,,,5783.00
Deidentified Maximum,,35533,CPT4/HCPCS,ART BYP GRFT AXILL/FEM/FEM,,,5281.00
Deidentified Maximum,,35540,CPT4/HCPCS,ART BYP GRFT AORTBIFEMORAL,,,5783.00
Deidentified Maximum,,35556,CPT4/HCPCS,ART BYP GRFT FEM-POPLITEAL,,,5281.00
Deidentified Maximum,,35566,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,,5029.00
Deidentified Maximum,,35621,CPT4/HCPCS,ART BYP AXILLARY-FEMORAL,,,5281.00
Deidentified Maximum,,35642,CPT4/HCPCS,ART BYP CAROTID-VERTEBRAL,,,5029.00
Deidentified Maximum,,35650,CPT4/HCPCS,ART BYP AXILLARY-AXILLARY,,,5281.00
Deidentified Maximum,,35661,CPT4/HCPCS,ART BYP FEMORAL-FEMORAL,,,5029.00
Deidentified Maximum,,35663,CPT4/HCPCS,ART BYP ILIOILIAC,,,5029.00
Deidentified Maximum,,35691,CPT4/HCPCS,ART TRNSPOSJ VERTBRL CAROTID,,,3198.57
Deidentified Maximum,,35693,CPT4/HCPCS,ART TRNSPOSJ SUBCLAVIAN,,,3198.57
Deidentified Maximum,,35694,CPT4/HCPCS,ART TRNSPOSJ SUBCLAV CAROTID,,,3198.57
Deidentified Maximum,,35700,CPT4/HCPCS,REOPERATION BYPASS GRAFT,,,3198.57
Deidentified Maximum,,35701,CPT4/HCPCS,EXPL N/FLWD SURG NECK ART,,,3544.00
Deidentified Maximum,,35721,CPT4/HCPCS,EXPLORATION FEMORAL ARTERY,,,3544.00
Deidentified Maximum,,35761,CPT4/HCPCS,EXPLORATION OF ARTERY/VEIN,,,6876.92
Deidentified Maximum,,35800,CPT4/HCPCS,EXPLORE NECK VESSELS,,,3198.57
Deidentified Maximum,,35840,CPT4/HCPCS,EXPLORE ABDOMINAL VESSELS,,,5029.00
Deidentified Maximum,,35870,CPT4/HCPCS,REPAIR VESSEL GRAFT DEFECT,,,5783.00
Deidentified Maximum,,35903,CPT4/HCPCS,EXCISION GRAFT EXTREMITY,,,6876.92
Deidentified Maximum,,36005,CPT4/HCPCS,INJECTION EXT VENOGRAPHY,,,3000.00
Deidentified Maximum,,36015,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,3000.00
Deidentified Maximum,,36147,CPT4/HCPCS,ACCESS AV DIAL GRFT FOR EVAL,,,1678.00
Deidentified Maximum,,36200,CPT4/HCPCS,PLACE CATHETER IN AORTA,,,3656.00
Deidentified Maximum,,36215,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,3656.00
Deidentified Maximum,,36217,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,3656.00
Deidentified Maximum,,36223,CPT4/HCPCS,PLACE CATH CAROTID/INOM ART,,,7007.00
Deidentified Maximum,,36227,CPT4/HCPCS,PLACE CATH XTRNL CAROTID,,,3544.00
Deidentified Maximum,,36253,CPT4/HCPCS,INS CATH REN ART 2ND+ UNILAT,,,7007.00
Deidentified Maximum,,36415,CPT4/HCPCS,ROUTINE VENIPUNCTURE,,,0.00
Deidentified Maximum,,36416,CPT4/HCPCS,CAPILLARY BLOOD DRAW,,,1678.00
Deidentified Maximum,,36455,CPT4/HCPCS,BL EXCHANGE/TRANSFUSE NON-NB,,,3544.00
Deidentified Maximum,,36470,CPT4/HCPCS,NJX SCLRSNT 1 INCMPTNT VEIN,,,3198.57
Deidentified Maximum,,36474,CPT4/HCPCS,ENDOVENOUS MCHNCHEM ADD-ON,,,3000.00
Deidentified Maximum,,36514,CPT4/HCPCS,APHERESIS PLASMA,,,3656.00
Deidentified Maximum,,36569,CPT4/HCPCS,INSJ PICC 5 YR+ W/O IMAGING,,,3198.57
Deidentified Maximum,,36571,CPT4/HCPCS,INSERT PICVAD CATH,,,5856.00
Deidentified Maximum,,36580,CPT4/HCPCS,REPLACE CVAD CATH,,,3198.57
Deidentified Maximum,,36583,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,,7007.00
Deidentified Maximum,,36589,CPT4/HCPCS,REMOVAL TUNNELED CV CATH,,,3198.57
Deidentified Maximum,,36591,CPT4/HCPCS,DRAW BLOOD OFF VENOUS DEVICE,,,1214.00
Deidentified Maximum,,36818,CPT4/HCPCS,AV FUSE UPPR ARM CEPHALIC,,,9548.65
Deidentified Maximum,,36833,CPT4/HCPCS,AV FISTULA REVISION,,,7007.00
Deidentified Maximum,,36861,CPT4/HCPCS,CANNULA DECLOTTING,,,7007.00
Deidentified Maximum,,36870,CPT4/HCPCS,PERCUT THROMBECT AV FISTULA,,,1678.88
Deidentified Maximum,,36904,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,,12850.70
Deidentified Maximum,,36907,CPT4/HCPCS,BALO ANGIOP CTR DIALYSIS SEG,,,6049.05
Deidentified Maximum,,36908,CPT4/HCPCS,STENT PLMT CTR DIALYSIS SEG,,,6049.05
Deidentified Maximum,,37145,CPT4/HCPCS,REVISION OF CIRCULATION,,,5783.00
Deidentified Maximum,,37195,CPT4/HCPCS,THROMBOLYTIC THERAPY STROKE,,,3198.57
Deidentified Maximum,,37212,CPT4/HCPCS,THROMBOLYTIC VENOUS THERAPY,,,5138.00
Deidentified Maximum,,37214,CPT4/HCPCS,CESSJ THERAPY CATH REMOVAL,,,5856.00
Deidentified Maximum,,37227,CPT4/HCPCS,FEM/POPL REVASC STNT & ATHER,,,14317.00
Deidentified Maximum,,37232,CPT4/HCPCS,TIB/PER REVASC ADD-ON,,,7007.00
Deidentified Maximum,,37235,CPT4/HCPCS,TIB/PER REVASC STNT & ATHER,,,7007.00
Deidentified Maximum,,37236,CPT4/HCPCS,OPEN/PERQ PLACE STENT 1ST,,,10119.00
Deidentified Maximum,,37238,CPT4/HCPCS,OPEN/PERQ PLACE STENT SAME,,,10119.00
Deidentified Maximum,,37246,CPT4/HCPCS,TRLUML BALO ANGIOP 1ST ART,,,7830.00
Deidentified Maximum,,37501,CPT4/HCPCS,VASCULAR ENDOSCOPY PROCEDURE,,,6876.92
Deidentified Maximum,,37607,CPT4/HCPCS,LIGATION OF A-V FISTULA,,,5856.00
Deidentified Maximum,,37617,CPT4/HCPCS,LIGATION OF ABDOMEN ARTERY,,,5029.00
Deidentified Maximum,,37765,CPT4/HCPCS,STAB PHLEB VEINS XTR 10-20,,,7902.34
Deidentified Maximum,,37766,CPT4/HCPCS,PHLEB VEINS - EXTREM 20+,,,7902.34
Deidentified Maximum,,37790,CPT4/HCPCS,PENILE VENOUS OCCLUSION,,,5856.00
Deidentified Maximum,,37799,CPT4/HCPCS,VASCULAR SURGERY PROCEDURE,,,3656.00
Deidentified Maximum,,38115,CPT4/HCPCS,REPAIR OF RUPTURED SPLEEN,,,5783.00
Deidentified Maximum,,38200,CPT4/HCPCS,INJECTION FOR SPLEEN X-RAY,,,3000.00
Deidentified Maximum,,38207,CPT4/HCPCS,CRYOPRESERVE STEM CELLS,,,3198.57
Deidentified Maximum,,38211,CPT4/HCPCS,TUMOR CELL DEPLETE OF HARVST,,,3198.57
Deidentified Maximum,,38220,CPT4/HCPCS,DX BONE MARROW ASPIRATIONS,,,3000.00
Deidentified Maximum,,38240,CPT4/HCPCS,TRANSPLT ALLO HCT/DONOR,,,6840.00
Deidentified Maximum,,38300,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,,3198.57
Deidentified Maximum,,38305,CPT4/HCPCS,DRAINAGE LYMPH NODE LESION,,,4280.43
Deidentified Maximum,,38381,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,,6588.00
Deidentified Maximum,,38510,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,,4280.43
Deidentified Maximum,,38573,CPT4/HCPCS,LAPS PELVIC LYMPHADEC,,,12850.70
Deidentified Maximum,,38770,CPT4/HCPCS,REMOVE PELVIS LYMPH NODES,,,5783.00
Deidentified Maximum,,39402,CPT4/HCPCS,MEDIASTINOSCPY W/LMPH NOD BX,,,7902.34
Deidentified Maximum,,39499,CPT4/HCPCS,CHEST PROCEDURE,,,3198.57
Deidentified Maximum,,39560,CPT4/HCPCS,RESECT DIAPHRAGM SIMPLE,,,5281.00
Deidentified Maximum,,39561,CPT4/HCPCS,RESECT DIAPHRAGM COMPLEX,,,6588.00
Deidentified Maximum,,40490,CPT4/HCPCS,BIOPSY OF LIP,,,3198.57
Deidentified Maximum,,40500,CPT4/HCPCS,PARTIAL EXCISION OF LIP,,,4280.43
Deidentified Maximum,,40652,CPT4/HCPCS,REPAIR LIP,,,5856.00
Deidentified Maximum,,40801,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,4280.43
Deidentified Maximum,,40818,CPT4/HCPCS,EXCISE ORAL MUCOSA FOR GRAFT,,,3198.57
Deidentified Maximum,,40820,CPT4/HCPCS,TREATMENT OF MOUTH LESION,,,4280.43
Deidentified Maximum,,40830,CPT4/HCPCS,REPAIR MOUTH LACERATION,,,1678.00
Deidentified Maximum,,41009,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,3198.57
Deidentified Maximum,,41016,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,4204.00
Deidentified Maximum,,41019,CPT4/HCPCS,PLACE NEEDLES H&N FOR RT,,,6000.00
Deidentified Maximum,,41108,CPT4/HCPCS,BIOPSY OF FLOOR OF MOUTH,,,3198.57
Deidentified Maximum,,41115,CPT4/HCPCS,EXCISION OF TONGUE FOLD,,,3198.57
Deidentified Maximum,,41120,CPT4/HCPCS,PARTIAL REMOVAL OF TONGUE,,,6876.92
Deidentified Maximum,,41805,CPT4/HCPCS,REMOVAL FOREIGN BODY GUM,,,6049.05
Deidentified Maximum,,41821,CPT4/HCPCS,EXCISION OF GUM FLAP,,,3198.57
Deidentified Maximum,,41822,CPT4/HCPCS,EXCISION OF GUM LESION,,,4280.43
Deidentified Maximum,,41823,CPT4/HCPCS,EXCISION OF GUM LESION,,,6049.05
Deidentified Maximum,,41826,CPT4/HCPCS,EXCISION OF GUM LESION,,,4280.43
Deidentified Maximum,,42215,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,9548.65
Deidentified Maximum,,42335,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,,5856.00
Deidentified Maximum,,42405,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,,4280.43
Deidentified Maximum,,42507,CPT4/HCPCS,PAROTID DUCT DIVERSION,,,6075.00
Deidentified Maximum,,42509,CPT4/HCPCS,PAROTID DUCT DIVERSION,,,6401.00
Deidentified Maximum,,42510,CPT4/HCPCS,PAROTID DUCT DIVERSION,,,6401.00
Deidentified Maximum,,42699,CPT4/HCPCS,SALIVARY SURGERY PROCEDURE,,,4280.43
Deidentified Maximum,,42700,CPT4/HCPCS,DRAINAGE OF TONSIL ABSCESS,,,3198.57
Deidentified Maximum,,42720,CPT4/HCPCS,DRAINAGE OF THROAT ABSCESS,,,3198.57
Deidentified Maximum,,42806,CPT4/HCPCS,BIOPSY OF UPPER NOSE/THROAT,,,4280.43
Deidentified Maximum,,42831,CPT4/HCPCS,REMOVAL OF ADENOIDS,,,6401.00
Deidentified Maximum,,42894,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,,5281.00
Deidentified Maximum,,42961,CPT4/HCPCS,CONTROL THROAT BLEEDING,,,3198.57
Deidentified Maximum,,43123,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43135,CPT4/HCPCS,REMOVAL OF ESOPHAGUS POUCH,,,6588.00
Deidentified Maximum,,43180,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO,,,8300.00
Deidentified Maximum,,43191,CPT4/HCPCS,ESOPHAGOSCOPY RIGID TRNSO DX,,,4000.00
Deidentified Maximum,,43194,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO REM FB,,,5000.00
Deidentified Maximum,,43201,CPT4/HCPCS,ESOPH SCOPE W/SUBMUCOUS INJ,,,3198.57
Deidentified Maximum,,43206,CPT4/HCPCS,ESOPH OPTICAL ENDOMICROSCOPY,,,5000.00
Deidentified Maximum,,43220,CPT4/HCPCS,ESOPHAGOSCOPY BALLOON <30MM,,,3656.00
Deidentified Maximum,,43228,CPT4/HCPCS,ESOPH ENDOSCOPY ABLATION,,,1678.88
Deidentified Maximum,,43242,CPT4/HCPCS,EGD US FINE NEEDLE BX/ASPIR,,,4280.43
Deidentified Maximum,,43247,CPT4/HCPCS,EGD REMOVE FOREIGN BODY,,,4280.43
Deidentified Maximum,,43252,CPT4/HCPCS,EGD OPTICAL ENDOMICROSCOPY,,,5000.00
Deidentified Maximum,,43255,CPT4/HCPCS,EGD CONTROL BLEEDING ANY,,,4280.43
Deidentified Maximum,,43256,CPT4/HCPCS,UPPR GI ENDOSCOPY W/STENT,,,1678.00
Deidentified Maximum,,43267,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Maximum,,43270,CPT4/HCPCS,EGD LESION ABLATION,,,5856.00
Deidentified Maximum,,43273,CPT4/HCPCS,ENDOSCOPIC PANCREATOSCOPY,,,8300.00
Deidentified Maximum,,43284,CPT4/HCPCS,LAPS ESOPHGL SPHNCTR AGMNTJ,,,7007.00
Deidentified Maximum,,43310,CPT4/HCPCS,REPAIR OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43350,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,,5783.00
Deidentified Maximum,,43351,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,,6588.00
Deidentified Maximum,,43352,CPT4/HCPCS,SURGICAL OPENING ESOPHAGUS,,,5029.00
Deidentified Maximum,,43450,CPT4/HCPCS,DILATE ESOPHAGUS 1/MULT PASS,,,3198.57
Deidentified Maximum,,43501,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,,5783.00
Deidentified Maximum,,43510,CPT4/HCPCS,SURGICAL OPENING OF STOMACH,,,3198.57
Deidentified Maximum,,43605,CPT4/HCPCS,BIOPSY OF STOMACH,,,5029.00
Deidentified Maximum,,43621,CPT4/HCPCS,REMOVAL OF STOMACH,,,6588.00
Deidentified Maximum,,43633,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,,5783.00
Deidentified Maximum,,43756,CPT4/HCPCS,DX DUOD INTUB W/ASP SPEC,,,3000.00
Deidentified Maximum,,43860,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,,5783.00
Deidentified Maximum,,43880,CPT4/HCPCS,REPAIR STOMACH-BOWEL FISTULA,,,5783.00
Deidentified Maximum,,44025,CPT4/HCPCS,INCISION OF LARGE BOWEL,,,7188.00
Deidentified Maximum,,44125,CPT4/HCPCS,REMOVAL OF SMALL INTESTINE,,,5783.00
Deidentified Maximum,,44127,CPT4/HCPCS,ENTERECTOMY W/TAPER CONG,,,6049.05
Deidentified Maximum,,44145,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,5783.00
Deidentified Maximum,,44157,CPT4/HCPCS,COLECTOMY W/ILEOANAL ANAST,,,6588.00
Deidentified Maximum,,44204,CPT4/HCPCS,LAPARO PARTIAL COLECTOMY,,,6075.00
Deidentified Maximum,,44206,CPT4/HCPCS,LAP PART COLECTOMY W/STOMA,,,12850.70
Deidentified Maximum,,44211,CPT4/HCPCS,LAP COLECTOMY W/PROCTECTOMY,,,7902.34
Deidentified Maximum,,44316,CPT4/HCPCS,DEVISE BOWEL POUCH,,,5783.00
Deidentified Maximum,,44320,CPT4/HCPCS,COLOSTOMY,,,5281.00
Deidentified Maximum,,44363,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4280.43
Deidentified Maximum,,44377,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY/BIOPSY,,,4280.43
Deidentified Maximum,,44381,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY BR/WA,,,4891.93
Deidentified Maximum,,44390,CPT4/HCPCS,COLONOSCOPY FOR FOREIGN BODY,,,3198.57
Deidentified Maximum,,44500,CPT4/HCPCS,INTRO GASTROINTESTINAL TUBE,,,3198.57
Deidentified Maximum,,44603,CPT4/HCPCS,SUTURE SMALL INTESTINE,,,5281.00
Deidentified Maximum,,44615,CPT4/HCPCS,INTESTINAL STRICTUROPLASTY,,,5783.00
Deidentified Maximum,,44701,CPT4/HCPCS,INTRAOP COLON LAVAGE ADD-ON,,,1678.00
Deidentified Maximum,,44901,CPT4/HCPCS,DRAIN APP ABSCESS PERCUT,,,1678.88
Deidentified Maximum,,45020,CPT4/HCPCS,DRAINAGE OF RECTAL ABSCESS,,,4280.43
Deidentified Maximum,,45111,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,,3198.57
Deidentified Maximum,,45309,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,,3198.57
Deidentified Maximum,,45338,CPT4/HCPCS,SIGMOIDOSCOPY W/TUMR REMOVE,,,3198.57
Deidentified Maximum,,45346,CPT4/HCPCS,SIGMOIDOSCOPY W/ABLATION,,,4000.00
Deidentified Maximum,,45349,CPT4/HCPCS,SIGMOIDOSCOPY W/RESECTION,,,4000.00
Deidentified Maximum,,45355,CPT4/HCPCS,SURGICAL COLONOSCOPY,,,1678.00
Deidentified Maximum,,45379,CPT4/HCPCS,COLONOSCOPY W/FB REMOVAL,,,4280.43
Deidentified Maximum,,45381,CPT4/HCPCS,COLONOSCOPY SUBMUCOUS NJX,,,4280.43
Deidentified Maximum,,45395,CPT4/HCPCS,LAP REMOVAL OF RECTUM,,,6588.00
Deidentified Maximum,,45397,CPT4/HCPCS,LAP REMOVE RECTUM W/POUCH,,,5856.00
Deidentified Maximum,,45402,CPT4/HCPCS,LAP PROCTOPEXY W/SIG RESECT,,,5856.00
Deidentified Maximum,,45520,CPT4/HCPCS,TREATMENT OF RECTAL PROLAPSE,,,3000.00
Deidentified Maximum,,45905,CPT4/HCPCS,DILATION OF ANAL SPHINCTER,,,3198.57
Deidentified Maximum,,45910,CPT4/HCPCS,DILATION OF RECTAL NARROWING,,,3198.57
Deidentified Maximum,,46040,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,,5856.00
Deidentified Maximum,,46050,CPT4/HCPCS,INCISION OF ANAL ABSCESS,,,3198.57
Deidentified Maximum,,46221,CPT4/HCPCS,LIGATION OF HEMORRHOID(S),,,3198.57
Deidentified Maximum,,46606,CPT4/HCPCS,ANOSCOPY AND BIOPSY,,,3198.57
Deidentified Maximum,,46611,CPT4/HCPCS,ANOSCOPY,,,3198.57
Deidentified Maximum,,46707,CPT4/HCPCS,REPAIR ANORECTAL FIST W/PLUG,,,7902.34
Deidentified Maximum,,46746,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,,7902.34
Deidentified Maximum,,46910,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,,4280.43
Deidentified Maximum,,46917,CPT4/HCPCS,LASER SURGERY ANAL LESIONS,,,4204.00
Deidentified Maximum,,46924,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,,4204.00
Deidentified Maximum,,50740,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,,5029.00
Deidentified Maximum,,50750,CPT4/HCPCS,FUSION OF URETER & KIDNEY,,,5029.00
Deidentified Maximum,,50810,CPT4/HCPCS,FUSION OF URETER & BOWEL,,,5783.00
Deidentified Maximum,,50815,CPT4/HCPCS,URINE SHUNT TO INTESTINE,,,6588.00
Deidentified Maximum,,50845,CPT4/HCPCS,APPENDICO-VESICOSTOMY,,,5783.00
Deidentified Maximum,,50930,CPT4/HCPCS,CLOSURE URETER/BOWEL FISTULA,,,5783.00
Deidentified Maximum,,50940,CPT4/HCPCS,RELEASE OF URETER,,,5783.00
Deidentified Maximum,,50945,CPT4/HCPCS,LAPAROSCOPY URETEROLITHOTOMY,,,9548.65
Deidentified Maximum,,51045,CPT4/HCPCS,INCISE BLADDER/DRAIN URETER,,,6401.00
Deidentified Maximum,,51080,CPT4/HCPCS,DRAINAGE OF BLADDER ABSCESS,,,3544.00
Deidentified Maximum,,51102,CPT4/HCPCS,DRAIN BL W/CATH INSERTION,,,4204.00
Deidentified Maximum,,51525,CPT4/HCPCS,REMOVAL OF BLADDER LESION,,,5138.00
Deidentified Maximum,,51575,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,,6588.00
Deidentified Maximum,,51585,CPT4/HCPCS,REMOVAL OF BLADDER & NODES,,,6588.00
Deidentified Maximum,,51703,CPT4/HCPCS,INSERT BLADDER CATH COMPLEX,,,3000.00
Deidentified Maximum,,51710,CPT4/HCPCS,CHANGE OF BLADDER TUBE,,,3198.57
Deidentified Maximum,,51800,CPT4/HCPCS,REVISION OF BLADDER/URETHRA,,,7830.00
Deidentified Maximum,,51840,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,,7830.00
Deidentified Maximum,,51841,CPT4/HCPCS,ATTACH BLADDER/URETHRA,,,7830.00
Deidentified Maximum,,51925,CPT4/HCPCS,HYSTERECTOMY/BLADDER REPAIR,,,5783.00
Deidentified Maximum,,52000,CPT4/HCPCS,CYSTOSCOPY,,,3198.57
Deidentified Maximum,,52010,CPT4/HCPCS,CYSTOSCOPY & DUCT CATHETER,,,4280.43
Deidentified Maximum,,52224,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52275,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,,4280.43
Deidentified Maximum,,52277,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52318,CPT4/HCPCS,REMOVE BLADDER STONE,,,4280.43
Deidentified Maximum,,52330,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52332,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52334,CPT4/HCPCS,CREATE PASSAGE TO KIDNEY,,,5856.00
Deidentified Maximum,,52354,CPT4/HCPCS,CYSTOURETERO W/BIOPSY,,,6401.00
Deidentified Maximum,,52356,CPT4/HCPCS,CYSTO/URETERO W/LITHOTRIPSY,,,8300.00
Deidentified Maximum,,52450,CPT4/HCPCS,INCISION OF PROSTATE,,,5856.00
Deidentified Maximum,,52630,CPT4/HCPCS,REMOVE PROSTATE REGROWTH,,,6075.00
Deidentified Maximum,,52649,CPT4/HCPCS,PROSTATE LASER ENUCLEATION,,,8300.00
Deidentified Maximum,,53010,CPT4/HCPCS,INCISION OF URETHRA,,,4204.00
Deidentified Maximum,,53420,CPT4/HCPCS,RECONSTRUCT URETHRA STAGE 1,,,5856.00
Deidentified Maximum,,53446,CPT4/HCPCS,REMOVE URO SPHINCTER,,,7007.00
Deidentified Maximum,,53447,CPT4/HCPCS,REMOVE/REPLACE UR SPHINCTER,,,10772.00
Deidentified Maximum,,53460,CPT4/HCPCS,REVISION OF URETHRA,,,4204.00
Deidentified Maximum,,53620,CPT4/HCPCS,DILATE URETHRA STRICTURE,,,4280.43
Deidentified Maximum,,53660,CPT4/HCPCS,DILATION OF URETHRA,,,2002.00
Deidentified Maximum,,53854,CPT4/HCPCS,TRURL DSTRJ PRST8 TISS RF WV,,,8300.00
Deidentified Maximum,,54015,CPT4/HCPCS,DRAIN PENIS LESION,,,6401.00
Deidentified Maximum,,54050,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,,1678.00
Deidentified Maximum,,54100,CPT4/HCPCS,BIOPSY OF PENIS,,,3198.57
Deidentified Maximum,,54160,CPT4/HCPCS,CIRCUMCISION NEONATE,,,4280.43
Deidentified Maximum,,54162,CPT4/HCPCS,LYSIS PENIL CIRCUMIC LESION,,,4280.43
Deidentified Maximum,,54164,CPT4/HCPCS,FRENULOTOMY OF PENIS,,,4280.43
Deidentified Maximum,,54200,CPT4/HCPCS,TREATMENT OF PENIS LESION,,,1214.00
Deidentified Maximum,,54250,CPT4/HCPCS,PENIS STUDY,,,2002.00
Deidentified Maximum,,54312,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,5856.00
Deidentified Maximum,,54318,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,5856.00
Deidentified Maximum,,54322,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,5856.00
Deidentified Maximum,,54332,CPT4/HCPCS,REVISE PENIS/URETHRA,,,6840.00
Deidentified Maximum,,54348,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,,5856.00
Deidentified Maximum,,54352,CPT4/HCPCS,RECONSTRUCT URETHRA/PENIS,,,6075.00
Deidentified Maximum,,54380,CPT4/HCPCS,REPAIR PENIS,,,5856.00
Deidentified Maximum,,54400,CPT4/HCPCS,INSERT SEMI-RIGID PROSTHESIS,,,10119.00
Deidentified Maximum,,54415,CPT4/HCPCS,REMOVE SELF-CONTD PENIS PROS,,,5856.00
Deidentified Maximum,,54416,CPT4/HCPCS,REMV/REPL PENIS CONTAIN PROS,,,10772.00
Deidentified Maximum,,54505,CPT4/HCPCS,BIOPSY OF TESTIS,,,4204.00
Deidentified Maximum,,54600,CPT4/HCPCS,REDUCE TESTIS TORSION,,,6401.00
Deidentified Maximum,,54670,CPT4/HCPCS,REPAIR TESTIS INJURY,,,5856.00
Deidentified Maximum,,54680,CPT4/HCPCS,RELOCATION OF TESTIS(ES),,,5856.00
Deidentified Maximum,,54692,CPT4/HCPCS,LAPAROSCOPY ORCHIOPEXY,,,12850.70
Deidentified Maximum,,54830,CPT4/HCPCS,REMOVE EPIDIDYMIS LESION,,,5856.00
Deidentified Maximum,,54860,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,,5856.00
Deidentified Maximum,,54861,CPT4/HCPCS,REMOVAL OF EPIDIDYMIS,,,6401.00
Deidentified Maximum,,54900,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,,6401.00
Deidentified Maximum,,54901,CPT4/HCPCS,FUSION OF SPERMATIC DUCTS,,,6401.00
Deidentified Maximum,,55041,CPT4/HCPCS,REMOVAL OF HYDROCELES,,,6876.92
Deidentified Maximum,,55520,CPT4/HCPCS,REMOVAL OF SPERM CORD LESION,,,6401.00
Deidentified Maximum,,55540,CPT4/HCPCS,REVISE HERNIA & SPERM VEINS,,,6876.92
Deidentified Maximum,,55705,CPT4/HCPCS,BIOPSY OF PROSTATE,,,4280.43
Deidentified Maximum,,55815,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,5783.00
Deidentified Maximum,,55821,CPT4/HCPCS,REMOVAL OF PROSTATE,,,5783.00
Deidentified Maximum,,55865,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,5281.00
Deidentified Maximum,,55876,CPT4/HCPCS,PLACE RT DEVICE/MARKER PROS,,,12850.70
Deidentified Maximum,,56405,CPT4/HCPCS,I & D OF VULVA/PERINEUM,,,3656.00
Deidentified Maximum,,56631,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,10119.00
Deidentified Maximum,,56634,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,10119.00
Deidentified Maximum,,56820,CPT4/HCPCS,EXAM OF VULVA W/SCOPE,,,2002.00
Deidentified Maximum,,57020,CPT4/HCPCS,DRAINAGE OF PELVIC FLUID,,,4280.43
Deidentified Maximum,,57100,CPT4/HCPCS,BIOPSY OF VAGINA,,,3000.00
Deidentified Maximum,,57110,CPT4/HCPCS,REMOVE VAGINA WALL COMPLETE,,,5856.00
Deidentified Maximum,,57130,CPT4/HCPCS,REMOVE VAGINA LESION,,,4280.43
Deidentified Maximum,,57180,CPT4/HCPCS,TREAT VAGINAL BLEEDING,,,3198.57
Deidentified Maximum,,57250,CPT4/HCPCS,REPAIR RECTUM & VAGINA,,,6876.92
Deidentified Maximum,,57267,CPT4/HCPCS,INSERT MESH/PELVIC FLR ADDON,,,7830.00
Deidentified Maximum,,57282,CPT4/HCPCS,COLPOPEXY EXTRAPERITONEAL,,,6840.00
Deidentified Maximum,,57287,CPT4/HCPCS,REVISE/REMOVE SLING REPAIR,,,9548.65
Deidentified Maximum,,57410,CPT4/HCPCS,PELVIC EXAMINATION,,,4280.43
Deidentified Maximum,,57426,CPT4/HCPCS,REVISE PROSTH VAG GRAFT LAP,,,6876.92
Deidentified Maximum,,57455,CPT4/HCPCS,BIOPSY OF CERVIX W/SCOPE,,,3000.00
Deidentified Maximum,,57720,CPT4/HCPCS,REVISION OF CERVIX,,,5856.00
Deidentified Maximum,,58146,CPT4/HCPCS,MYOMECTOMY ABDOM COMPLEX,,,6876.92
Deidentified Maximum,,58152,CPT4/HCPCS,TOTAL HYSTERECTOMY,,,8012.00
Deidentified Maximum,,58262,CPT4/HCPCS,VAG HYST INCLUDING T/O,,,8300.00
Deidentified Maximum,,58267,CPT4/HCPCS,VAG HYST W/URINARY REPAIR,,,8012.00
Deidentified Maximum,,58290,CPT4/HCPCS,VAG HYST COMPLEX,,,8012.00
Deidentified Maximum,,58301,CPT4/HCPCS,REMOVE INTRAUTERINE DEVICE,,,3000.00
Deidentified Maximum,,58345,CPT4/HCPCS,REOPEN FALLOPIAN TUBE,,,4891.93
Deidentified Maximum,,58520,CPT4/HCPCS,REPAIR OF RUPTURED UTERUS,,,6840.00
Deidentified Maximum,,58552,CPT4/HCPCS,LAPARO-VAG HYST INCL T/O,,,12850.70
Deidentified Maximum,,58553,CPT4/HCPCS,LAPARO-VAG HYST COMPLEX,,,12850.70
Deidentified Maximum,,58558,CPT4/HCPCS,HYSTEROSCOPY BIOPSY,,,5856.00
Deidentified Maximum,,58562,CPT4/HCPCS,HYSTEROSCOPY REMOVE FB,,,5856.00
Deidentified Maximum,,58572,CPT4/HCPCS,TLH UTERUS OVER 250 G,,,8300.00
Deidentified Maximum,,58573,CPT4/HCPCS,TLH W/T/O UTERUS OVER 250 G,,,8300.00
Deidentified Maximum,,58662,CPT4/HCPCS,LAPAROSCOPY EXCISE LESIONS,,,7007.00
Deidentified Maximum,,58770,CPT4/HCPCS,CREATE NEW TUBAL OPENING,,,6840.00
Deidentified Maximum,,58805,CPT4/HCPCS,DRAINAGE OF OVARIAN CYST(S),,,5856.00
Deidentified Maximum,,58820,CPT4/HCPCS,DRAIN OVARY ABSCESS OPEN,,,5856.00
Deidentified Maximum,,58825,CPT4/HCPCS,TRANSPOSITION OVARY(S),,,5856.00
Deidentified Maximum,,58920,CPT4/HCPCS,PARTIAL REMOVAL OF OVARY(S),,,6876.92
Deidentified Maximum,,58925,CPT4/HCPCS,REMOVAL OF OVARIAN CYST(S),,,6876.92
Deidentified Maximum,,58954,CPT4/HCPCS,TAH RAD DEBULK/LYMPH REMOVE,,,8012.00
Deidentified Maximum,,58956,CPT4/HCPCS,BSO OMENTECTOMY W/TAH,,,5281.00
Deidentified Maximum,,58960,CPT4/HCPCS,EXPLORATION OF ABDOMEN,,,7830.00
Deidentified Maximum,,58999,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,59000,CPT4/HCPCS,AMNIOCENTESIS DIAGNOSTIC,,,3198.57
Deidentified Maximum,,59012,CPT4/HCPCS,FETAL CORD PUNCTURE PRENATAL,,,3198.57
Deidentified Maximum,,59130,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,9548.65
Deidentified Maximum,,59135,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,9548.65
Deidentified Maximum,,59140,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,9548.65
Deidentified Maximum,,59320,CPT4/HCPCS,REVISION OF CERVIX,,,4204.00
Deidentified Maximum,,59350,CPT4/HCPCS,REPAIR OF UTERUS,,,5281.00
Deidentified Maximum,,59618,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY,,,5783.00
Deidentified Maximum,,59620,CPT4/HCPCS,ATTEMPTED VBAC DELIVERY ONLY,,,5783.00
Deidentified Maximum,,59840,CPT4/HCPCS,ABORTION,,,6876.92
Deidentified Maximum,,59856,CPT4/HCPCS,ABORTION,,,4891.93
Deidentified Maximum,,59898,CPT4/HCPCS,LAPARO PROC OB CARE/DELIVER,,,7902.34
Deidentified Maximum,,59899,CPT4/HCPCS,MATERNITY CARE PROCEDURE,,,3656.00
Deidentified Maximum,,60000,CPT4/HCPCS,DRAIN THYROID/TONGUE CYST,,,3198.57
Deidentified Maximum,,60200,CPT4/HCPCS,REMOVE THYROID LESION,,,7007.00
Deidentified Maximum,,60505,CPT4/HCPCS,EXPLORE PARATHYROID GLANDS,,,8012.00
Deidentified Maximum,,60520,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,,6401.00
Deidentified Maximum,,60522,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,,4280.43
Deidentified Maximum,,60650,CPT4/HCPCS,LAPAROSCOPY ADRENALECTOMY,,,6588.00
Deidentified Maximum,,61055,CPT4/HCPCS,INJECTION INTO BRAIN CANAL,,,3198.57
Deidentified Maximum,,61070,CPT4/HCPCS,BRAIN CANAL SHUNT PROCEDURE,,,3198.57
Deidentified Maximum,,61105,CPT4/HCPCS,TWIST DRILL HOLE,,,3198.57
Deidentified Maximum,,61120,CPT4/HCPCS,BURR HOLE FOR PUNCTURE,,,5783.00
Deidentified Maximum,,61315,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,4891.93
Deidentified Maximum,,61321,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,4891.93
Deidentified Maximum,,61460,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,,6588.00
Deidentified Maximum,,61490,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,,6588.00
Deidentified Maximum,,61501,CPT4/HCPCS,REMOVE INFECTED SKULL BONE,,,5783.00
Deidentified Maximum,,61512,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,,6588.00
Deidentified Maximum,,61518,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,6876.92
Deidentified Maximum,,61520,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,9548.65
Deidentified Maximum,,61526,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,9548.65
Deidentified Maximum,,61530,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,8012.00
Deidentified Maximum,,61566,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,6588.00
Deidentified Maximum,,61582,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,,8012.00
Deidentified Maximum,,61586,CPT4/HCPCS,RESECT NASOPHARYNX SKULL,,,6049.05
Deidentified Maximum,,61590,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,,8012.00
Deidentified Maximum,,61610,CPT4/HCPCS,TRANSECT ARTERY SINUS,,,8012.00
Deidentified Maximum,,61611,CPT4/HCPCS,TRANSECT ARTERY SINUS,,,6588.00
Deidentified Maximum,,61619,CPT4/HCPCS,REPAIR DURA,,,5783.00
Deidentified Maximum,,61630,CPT4/HCPCS,INTRACRANIAL ANGIOPLASTY,,,5310.00
Deidentified Maximum,,61640,CPT4/HCPCS,DILATE IC VASOSPASM INIT,,,5310.00
Deidentified Maximum,,61684,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,6876.92
Deidentified Maximum,,61690,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,6588.00
Deidentified Maximum,,61705,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,,8012.00
Deidentified Maximum,,61708,CPT4/HCPCS,REVISE CIRCULATION TO HEAD,,,6588.00
Deidentified Maximum,,61782,CPT4/HCPCS,SCAN PROC CRANIAL EXTRA,,,5310.00
Deidentified Maximum,,61797,CPT4/HCPCS,SRS CRAN LES SIMPLE ADDL,,,5310.00
Deidentified Maximum,,62120,CPT4/HCPCS,REPAIR SKULL CAVITY LESION,,,6588.00
Deidentified Maximum,,62140,CPT4/HCPCS,REPAIR OF SKULL DEFECT,,,5783.00
Deidentified Maximum,,62142,CPT4/HCPCS,REMOVE SKULL PLATE/FLAP,,,5783.00
Deidentified Maximum,,62143,CPT4/HCPCS,REPLACE SKULL PLATE/FLAP,,,6588.00
Deidentified Maximum,,62148,CPT4/HCPCS,RETR BONE FLAP TO FIX SKULL,,,5310.00
Deidentified Maximum,,62190,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,5310.00
Deidentified Maximum,,62270,CPT4/HCPCS,DX LMBR SPI PNXR,,,5310.00
Deidentified Maximum,,62287,CPT4/HCPCS,PERCUTANEOUS DISKECTOMY,,,12850.70
Deidentified Maximum,,62303,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,,5310.00
Deidentified Maximum,,62322,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,,5310.00
Deidentified Maximum,,62329,CPT4/HCPCS,THER SPI PNXR CSF FLUOR/CT,,,3000.00
Deidentified Maximum,,62360,CPT4/HCPCS,INSERT SPINE INFUSION DEVICE,,,6075.00
Deidentified Maximum,,62365,CPT4/HCPCS,REMOVE SPINE INFUSION DEVICE,,,7007.00
Deidentified Maximum,,62368,CPT4/HCPCS,ANALYZE SP INF PUMP W/REPROG,,,5310.00
Deidentified Maximum,,63001,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 CRVL,,,9548.65
Deidentified Maximum,,63003,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 THRC,,,9548.65
Deidentified Maximum,,63042,CPT4/HCPCS,LAMINOTOMY SINGLE LUMBAR,,,9548.65
Deidentified Maximum,,63043,CPT4/HCPCS,LAMINOTOMY ADDL CERVICAL,,,6588.00
Deidentified Maximum,,63044,CPT4/HCPCS,LAMINOTOMY ADDL LUMBAR,,,5310.00
Deidentified Maximum,,63057,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,,9548.65
Deidentified Maximum,,63076,CPT4/HCPCS,NECK SPINE DISK SURGERY,,,6401.00
Deidentified Maximum,,63087,CPT4/HCPCS,REMOV VERTBR DCMPRN THRCLMBR,,,6876.92
Deidentified Maximum,,63088,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,5783.00
Deidentified Maximum,,63170,CPT4/HCPCS,INCISE SPINAL CORD TRACT(S),,,5310.00
Deidentified Maximum,,63194,CPT4/HCPCS,INCISE SPINE & CORD CERVICAL,,,5783.00
Deidentified Maximum,,63198,CPT4/HCPCS,INCISE SPIN&CORD 2 STGS CRVL,,,5783.00
Deidentified Maximum,,63266,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,,7007.00
Deidentified Maximum,,63286,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRC,,,6049.05
Deidentified Maximum,,63295,CPT4/HCPCS,REPAIR LAMINECTOMY DEFECT,,,5310.00
Deidentified Maximum,,63661,CPT4/HCPCS,REMOVE SPINE ELTRD PERQ ARAY,,,6000.00
Deidentified Maximum,,63744,CPT4/HCPCS,REVISION OF SPINAL SHUNT,,,6075.00
Deidentified Maximum,,63746,CPT4/HCPCS,REMOVAL OF SPINAL SHUNT,,,5310.00
Deidentified Maximum,,64412,CPT4/HCPCS,N BLOCK INJ SPINAL ACCESSOR,,,1678.00
Deidentified Maximum,,64421,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV EA,,,5310.00
Deidentified Maximum,,64435,CPT4/HCPCS,NJX AA&/STRD PARACRV NRV,,,5310.00
Deidentified Maximum,,64445,CPT4/HCPCS,NJX AA&/STRD SCIATIC NERVE,,,5310.00
Deidentified Maximum,,64455,CPT4/HCPCS,NJX AA&/STRD PLTR COM DG NRV,,,5310.00
Deidentified Maximum,,64487,CPT4/HCPCS,TAP BLOCK UNI BY INFUSION,,,5310.00
Deidentified Maximum,,64488,CPT4/HCPCS,TAP BLOCK BI INJECTION,,,5310.00
Deidentified Maximum,,64489,CPT4/HCPCS,TAP BLOCK BI BY INFUSION,,,5310.00
Deidentified Maximum,,64491,CPT4/HCPCS,INJ PARAVERT F JNT C/T 2 LEV,,,5310.00
Deidentified Maximum,,64493,CPT4/HCPCS,INJ PARAVERT F JNT L/S 1 LEV,,,5310.00
Deidentified Maximum,,64495,CPT4/HCPCS,INJ PARAVERT F JNT L/S 3 LEV,,,5310.00
Deidentified Maximum,,64510,CPT4/HCPCS,N BLOCK STELLATE GANGLION,,,5310.00
Deidentified Maximum,,64553,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,7007.00
Deidentified Maximum,,64570,CPT4/HCPCS,REMOVE VAGUS N ELTRD,,,8300.00
Deidentified Maximum,,64590,CPT4/HCPCS,INSRT/REDO PN/GASTR STIMUL,,,14317.00
Deidentified Maximum,,64611,CPT4/HCPCS,CHEMODENERV SALIV GLANDS,,,5310.00
Deidentified Maximum,,64613,CPT4/HCPCS,DESTROY NERVE NECK MUSCLE,,,1678.00
Deidentified Maximum,,64625,CPT4/HCPCS,RF ABLTJ NRV NRVTG SI JT,,,6401.00
Deidentified Maximum,,64633,CPT4/HCPCS,DESTROY CERV/THOR FACET JNT,,,5310.00
Deidentified Maximum,,64727,CPT4/HCPCS,INTERNAL NERVE REVISION,,,5310.00
Deidentified Maximum,,64732,CPT4/HCPCS,INCISION OF BROW NERVE,,,5310.00
Deidentified Maximum,,64776,CPT4/HCPCS,REMOVE DIGIT NERVE LESION,,,5856.00
Deidentified Maximum,,64788,CPT4/HCPCS,REMOVE SKIN NERVE LESION,,,5856.00
Deidentified Maximum,,64790,CPT4/HCPCS,REMOVAL OF NERVE LESION,,,5856.00
Deidentified Maximum,,64821,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,,6401.00
Deidentified Maximum,,64835,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,,6075.00
Deidentified Maximum,,64836,CPT4/HCPCS,REPAIR OF HAND OR FOOT NERVE,,,6075.00
Deidentified Maximum,,64837,CPT4/HCPCS,REPAIR NERVE ADD-ON,,,5310.00
Deidentified Maximum,,64840,CPT4/HCPCS,REPAIR OF LEG NERVE,,,6075.00
Deidentified Maximum,,64857,CPT4/HCPCS,REPAIR ARM/LEG NERVE,,,6075.00
Deidentified Maximum,,64862,CPT4/HCPCS,REPAIR OF LOW BACK NERVES,,,6075.00
Deidentified Maximum,,64868,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,,5310.00
Deidentified Maximum,,64890,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,,6075.00
Deidentified Maximum,,65135,CPT4/HCPCS,INSERT OCULAR IMPLANT,,,5310.00
Deidentified Maximum,,65210,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,5310.00
Deidentified Maximum,,65265,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,6401.00
Deidentified Maximum,,65270,CPT4/HCPCS,REPAIR OF EYE WOUND,,,5310.00
Deidentified Maximum,,65273,CPT4/HCPCS,REPAIR OF EYE WOUND,,,5310.00
Deidentified Maximum,,65290,CPT4/HCPCS,REPAIR OF EYE SOCKET WOUND,,,5856.00
Deidentified Maximum,,65785,CPT4/HCPCS,IMPLTJ NTRSTRML CRNL RNG SEG,,,9548.65
Deidentified Maximum,,65805,CPT4/HCPCS,DRAINAGE OF EYE,,,1678.00
Deidentified Maximum,,65815,CPT4/HCPCS,DRAINAGE OF EYE,,,5310.00
Deidentified Maximum,,65860,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,,6401.00
Deidentified Maximum,,65900,CPT4/HCPCS,REMOVE EYE LESION,,,6876.92
Deidentified Maximum,,66020,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,,5310.00
Deidentified Maximum,,66030,CPT4/HCPCS,INJECTION TREATMENT OF EYE,,,5310.00
Deidentified Maximum,,66160,CPT4/HCPCS,GLAUCOMA SURGERY,,,5310.00
Deidentified Maximum,,66174,CPT4/HCPCS,TRANSLUM DIL EYE CANAL,,,6840.00
Deidentified Maximum,,66711,CPT4/HCPCS,ECP CILIARY BODY DESTRUCTION,,,5310.00
Deidentified Maximum,,66740,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,,5310.00
Deidentified Maximum,,66762,CPT4/HCPCS,REVISION OF IRIS,,,5310.00
Deidentified Maximum,,66821,CPT4/HCPCS,AFTER CATARACT LASER SURGERY,,,5310.00
Deidentified Maximum,,66930,CPT4/HCPCS,EXTRACTION OF LENS,,,6876.92
Deidentified Maximum,,66986,CPT4/HCPCS,EXCHANGE LENS PROSTHESIS,,,7902.34
Deidentified Maximum,,66990,CPT4/HCPCS,OPHTHALMIC ENDOSCOPE ADD-ON,,,5310.00
Deidentified Maximum,,66999,CPT4/HCPCS,EYE SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,67027,CPT4/HCPCS,IMPLANT EYE DRUG SYSTEM,,,6401.00
Deidentified Maximum,,67028,CPT4/HCPCS,INJECTION EYE DRUG,,,5310.00
Deidentified Maximum,,67039,CPT4/HCPCS,LASER TREATMENT OF RETINA,,,9548.65
Deidentified Maximum,,67108,CPT4/HCPCS,REPAIR DETACHED RETINA,,,9548.65
Deidentified Maximum,,67121,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,,6075.00
Deidentified Maximum,,67141,CPT4/HCPCS,TREATMENT OF RETINA,,,5310.00
Deidentified Maximum,,67210,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,,6840.00
Deidentified Maximum,,67225,CPT4/HCPCS,EYE PHOTODYNAMIC THER ADD-ON,,,5310.00
Deidentified Maximum,,67299,CPT4/HCPCS,EYE SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,67335,CPT4/HCPCS,EYE SUTURE DURING SURGERY,,,6401.00
Deidentified Maximum,,67345,CPT4/HCPCS,DESTROY NERVE OF EYE MUSCLE,,,5310.00
Deidentified Maximum,,67413,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,,6876.92
Deidentified Maximum,,67415,CPT4/HCPCS,ASPIRATION ORBITAL CONTENTS,,,5310.00
Deidentified Maximum,,67550,CPT4/HCPCS,INSERT EYE SOCKET IMPLANT,,,6401.00
Deidentified Maximum,,67560,CPT4/HCPCS,REVISE EYE SOCKET IMPLANT,,,5310.00
Deidentified Maximum,,67599,CPT4/HCPCS,ORBIT SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,67830,CPT4/HCPCS,REVISE EYELASHES,,,5310.00
Deidentified Maximum,,67835,CPT4/HCPCS,REVISE EYELASHES,,,5310.00
Deidentified Maximum,,67840,CPT4/HCPCS,REMOVE EYELID LESION,,,5310.00
Deidentified Maximum,,67850,CPT4/HCPCS,TREAT EYELID LESION,,,5310.00
Deidentified Maximum,,67875,CPT4/HCPCS,CLOSURE OF EYELID BY SUTURE,,,5310.00
Deidentified Maximum,,67906,CPT4/HCPCS,REPAIR EYELID DEFECT,,,6876.92
Deidentified Maximum,,67966,CPT4/HCPCS,REVISION OF EYELID,,,5856.00
Deidentified Maximum,,67974,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,,5856.00
Deidentified Maximum,,68100,CPT4/HCPCS,BIOPSY OF EYELID LINING,,,5310.00
Deidentified Maximum,,68130,CPT4/HCPCS,REMOVE EYELID LINING LESION,,,5310.00
Deidentified Maximum,,68328,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,,6401.00
Deidentified Maximum,,68340,CPT4/HCPCS,SEPARATE EYELID ADHESIONS,,,6401.00
Deidentified Maximum,,68440,CPT4/HCPCS,INCISE TEAR DUCT OPENING,,,5310.00
Deidentified Maximum,,68505,CPT4/HCPCS,PARTIAL REMOVAL TEAR GLAND,,,5856.00
Deidentified Maximum,,68550,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,,5856.00
Deidentified Maximum,,68760,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,,5310.00
Deidentified Maximum,,68761,CPT4/HCPCS,CLOSE TEAR DUCT OPENING,,,5310.00
Deidentified Maximum,,68801,CPT4/HCPCS,DILATE TEAR DUCT OPENING,,,5310.00
Deidentified Maximum,,68810,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,,5310.00
Deidentified Maximum,,68815,CPT4/HCPCS,PROBE NASOLACRIMAL DUCT,,,5310.00
Deidentified Maximum,,68816,CPT4/HCPCS,PROBE NL DUCT W/BALLOON,,,5310.00
Deidentified Maximum,,69020,CPT4/HCPCS,DRAIN OUTER EAR CANAL LESION,,,5310.00
Deidentified Maximum,,69105,CPT4/HCPCS,BIOPSY OF EXTERNAL EAR CANAL,,,5310.00
Deidentified Maximum,,69220,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,,5310.00
Deidentified Maximum,,69421,CPT4/HCPCS,INCISION OF EARDRUM,,,5856.00
Deidentified Maximum,,69433,CPT4/HCPCS,CREATE EARDRUM OPENING,,,5856.00
Deidentified Maximum,,69505,CPT4/HCPCS,REMOVE MASTOID STRUCTURES,,,9548.65
Deidentified Maximum,,69710,CPT4/HCPCS,IMPLANT/REPLACE HEARING AID,,,6075.00
Deidentified Maximum,,69711,CPT4/HCPCS,REMOVE/REPAIR HEARING AID,,,6075.00
Deidentified Maximum,,69718,CPT4/HCPCS,REVISE TEMPLE BONE IMPLANT,,,12850.70
Deidentified Maximum,,69720,CPT4/HCPCS,RELEASE FACIAL NERVE,,,6876.92
Deidentified Maximum,,69725,CPT4/HCPCS,RELEASE FACIAL NERVE,,,6876.92
Deidentified Maximum,,69806,CPT4/HCPCS,EXPLORE INNER EAR,,,9548.65
Deidentified Maximum,,69910,CPT4/HCPCS,REMOVE INNER EAR & MASTOID,,,9548.65
Deidentified Maximum,,69930,CPT4/HCPCS,IMPLANT COCHLEAR DEVICE,,,24180.00
Deidentified Maximum,,69949,CPT4/HCPCS,INNER EAR SURGERY PROCEDURE,,,4280.43
Deidentified Maximum,,69960,CPT4/HCPCS,RELEASE INNER EAR CANAL,,,9548.65
Deidentified Maximum,,70010,CPT4/HCPCS,CONTRAST X-RAY OF BRAIN,,,2177.00
Deidentified Maximum,,70210,CPT4/HCPCS,X-RAY EXAM OF SINUSES,,,364.35
Deidentified Maximum,,70310,CPT4/HCPCS,X-RAY EXAM OF TEETH,,,250.32
Deidentified Maximum,,70328,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,,243.84
Deidentified Maximum,,70332,CPT4/HCPCS,X-RAY EXAM OF JAW JOINT,,,1058.84
Deidentified Maximum,,70350,CPT4/HCPCS,X-RAY HEAD FOR ORTHODONTIA,,,186.09
Deidentified Maximum,,70545,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/DYE,,,6766.00
Deidentified Maximum,,70551,CPT4/HCPCS,MRI BRAIN STEM W/O DYE,,,6766.00
Deidentified Maximum,,70557,CPT4/HCPCS,MRI BRAIN W/O DYE,,,7560.21
Deidentified Maximum,,71023,CPT4/HCPCS,CHEST X-RAY AND FLUOROSCOPY,,,0.00
Deidentified Maximum,,71047,CPT4/HCPCS,X-RAY EXAM CHEST 3 VIEWS,,,364.35
Deidentified Maximum,,71111,CPT4/HCPCS,X-RAY EXAM RIBS/CHEST4/> VWS,,,657.95
Deidentified Maximum,,72050,CPT4/HCPCS,X-RAY EXAM NECK SPINE 4/5VWS,,,657.95
Deidentified Maximum,,72081,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 1 VW,,,364.35
Deidentified Maximum,,72100,CPT4/HCPCS,X-RAY EXAM L-S SPINE 2/3 VWS,,,657.95
Deidentified Maximum,,72130,CPT4/HCPCS,CT CHEST SPINE W/O & W/DYE,,,6766.00
Deidentified Maximum,,72170,CPT4/HCPCS,X-RAY EXAM OF PELVIS,,,657.95
Deidentified Maximum,,72191,CPT4/HCPCS,CT ANGIOGRAPH PELV W/O&W/DYE,,,6766.00
Deidentified Maximum,,72240,CPT4/HCPCS,MYELOGRAPHY NECK SPINE,,,4045.45
Deidentified Maximum,,72255,CPT4/HCPCS,MYELOGRAPHY THORACIC SPINE,,,4045.45
Deidentified Maximum,,72265,CPT4/HCPCS,MYELOGRAPHY L-S SPINE,,,4045.45
Deidentified Maximum,,73115,CPT4/HCPCS,CONTRAST X-RAY OF WRIST,,,2256.65
Deidentified Maximum,,73219,CPT4/HCPCS,MRI UPPER EXTREMITY W/DYE,,,6680.50
Deidentified Maximum,,73222,CPT4/HCPCS,MRI JOINT UPR EXTREM W/DYE,,,6766.00
Deidentified Maximum,,73503,CPT4/HCPCS,X-RAY EXAM HIP UNI 4/> VIEWS,,,499.63
Deidentified Maximum,,73560,CPT4/HCPCS,X-RAY EXAM OF KNEE 1 OR 2,,,364.35
Deidentified Maximum,,73580,CPT4/HCPCS,CONTRAST X-RAY OF KNEE JOINT,,,2256.65
Deidentified Maximum,,73592,CPT4/HCPCS,X-RAY EXAM OF LEG INFANT,,,364.35
Deidentified Maximum,,73650,CPT4/HCPCS,X-RAY EXAM OF HEEL,,,364.35
Deidentified Maximum,,73700,CPT4/HCPCS,CT LOWER EXTREMITY W/O DYE,,,6766.00
Deidentified Maximum,,73719,CPT4/HCPCS,MRI LOWER EXTREMITY W/DYE,,,6680.50
Deidentified Maximum,,73720,CPT4/HCPCS,MRI LWR EXTREMITY W/O&W/DYE,,,12358.33
Deidentified Maximum,,73721,CPT4/HCPCS,MRI JNT OF LWR EXTRE W/O DYE,,,6766.00
Deidentified Maximum,,74000,CPT4/HCPCS,X-RAY EXAM OF ABDOMEN,,,0.00
Deidentified Maximum,,74177,CPT4/HCPCS,CT ABD & PELV W/CONTRAST,,,6766.00
Deidentified Maximum,,74235,CPT4/HCPCS,REMOVE ESOPHAGUS OBSTRUCTION,,,6500.00
Deidentified Maximum,,74247,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,,857.53
Deidentified Maximum,,74249,CPT4/HCPCS,CONTRST X-RAY UPPR GI TRACT,,,1302.69
Deidentified Maximum,,74251,CPT4/HCPCS,X-RAY XM SM INT 2CNTRST STD,,,1234.12
Deidentified Maximum,,74300,CPT4/HCPCS,X-RAY BILE DUCTS/PANCREAS,,,6500.00
Deidentified Maximum,,74301,CPT4/HCPCS,X-RAYS AT SURGERY ADD-ON,,,257.50
Deidentified Maximum,,74329,CPT4/HCPCS,X-RAY FOR PANCREAS ENDOSCOPY,,,1593.86
Deidentified Maximum,,74340,CPT4/HCPCS,X-RAY GUIDE FOR GI TUBE,,,6500.00
Deidentified Maximum,,74445,CPT4/HCPCS,X-RAY EXAM OF PENIS,,,1531.90
Deidentified Maximum,,74455,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,,1348.35
Deidentified Maximum,,74740,CPT4/HCPCS,X-RAY FEMALE GENITAL TRACT,,,1348.35
Deidentified Maximum,,75563,CPT4/HCPCS,CARD MRI W/STRESS IMG & DYE,,,9456.44
Deidentified Maximum,,75625,CPT4/HCPCS,CONTRAST EXAM ABDOMINL AORTA,,,15447.85
Deidentified Maximum,,75635,CPT4/HCPCS,CT ANGIO ABDOMINAL ARTERIES,,,7841.51
Deidentified Maximum,,75710,CPT4/HCPCS,ARTERY X-RAYS ARM/LEG,,,15447.85
Deidentified Maximum,,75733,CPT4/HCPCS,ARTERY X-RAYS ADRENALS,,,6344.13
Deidentified Maximum,,75791,CPT4/HCPCS,AV DIALYSIS SHUNT IMAGING,,,6500.00
Deidentified Maximum,,75810,CPT4/HCPCS,VEIN X-RAY SPLEEN/LIVER,,,17652.93
Deidentified Maximum,,75898,CPT4/HCPCS,FOLLOW-UP ANGIOGRAPHY,,,6395.65
Deidentified Maximum,,75953,CPT4/HCPCS,ABDOM ANEURYSM ENDOVAS RPR,,,6500.00
Deidentified Maximum,,75962,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,6500.00
Deidentified Maximum,,76010,CPT4/HCPCS,X-RAY NOSE TO RECTUM,,,364.35
Deidentified Maximum,,76101,CPT4/HCPCS,COMPLEX BODY SECTION X-RAY,,,1250.67
Deidentified Maximum,,76120,CPT4/HCPCS,CINE/VIDEO X-RAYS,,,657.95
Deidentified Maximum,,76380,CPT4/HCPCS,CAT SCAN FOLLOW-UP STUDY,,,6766.00
Deidentified Maximum,,76529,CPT4/HCPCS,ECHO EXAM OF EYE,,,587.00
Deidentified Maximum,,76770,CPT4/HCPCS,US EXAM ABDO BACK WALL COMP,,,997.08
Deidentified Maximum,,76805,CPT4/HCPCS,OB US >= 14 WKS SNGL FETUS,,,1058.84
Deidentified Maximum,,76812,CPT4/HCPCS,OB US DETAILED ADDL FETUS,,,675.44
Deidentified Maximum,,76815,CPT4/HCPCS,OB US LIMITED FETUS(S),,,720.34
Deidentified Maximum,,76945,CPT4/HCPCS,ECHO GUIDE VILLUS SAMPLING,,,768.45
Deidentified Maximum,,76965,CPT4/HCPCS,ECHO GUIDANCE RADIOTHERAPY,,,7894.00
Deidentified Maximum,,28005,CPT4/HCPCS,TREAT FOOT BONE LESION,,,5856.00
Deidentified Maximum,,28024,CPT4/HCPCS,EXPLORATION OF TOE JOINT,,,4280.43
Deidentified Maximum,,28055,CPT4/HCPCS,NEURECTOMY FOOT,,,6401.00
Deidentified Maximum,,28080,CPT4/HCPCS,REMOVAL OF FOOT LESION,,,5856.00
Deidentified Maximum,,28092,CPT4/HCPCS,REMOVAL OF TOE LESIONS,,,5856.00
Deidentified Maximum,,28116,CPT4/HCPCS,REVISION OF FOOT,,,5856.00
Deidentified Maximum,,28122,CPT4/HCPCS,PARTIAL REMOVAL OF FOOT BONE,,,5856.00
Deidentified Maximum,,28173,CPT4/HCPCS,RESECT METATARSAL TUMOR,,,5856.00
Deidentified Maximum,,28193,CPT4/HCPCS,REMOVAL OF FOOT FOREIGN BODY,,,6401.00
Deidentified Maximum,,28210,CPT4/HCPCS,REPAIR/GRAFT OF FOOT TENDON,,,7007.00
Deidentified Maximum,,28220,CPT4/HCPCS,RELEASE OF FOOT TENDON,,,4891.93
Deidentified Maximum,,28222,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,,4204.00
Deidentified Maximum,,28226,CPT4/HCPCS,RELEASE OF FOOT TENDONS,,,4204.00
Deidentified Maximum,,28232,CPT4/HCPCS,INCISION OF TOE TENDON,,,4891.93
Deidentified Maximum,,28260,CPT4/HCPCS,RELEASE OF MIDFOOT JOINT,,,5856.00
Deidentified Maximum,,28270,CPT4/HCPCS,RELEASE OF FOOT CONTRACTURE,,,5856.00
Deidentified Maximum,,28272,CPT4/HCPCS,RELEASE OF TOE JOINT EACH,,,4891.93
Deidentified Maximum,,28295,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,5138.00
Deidentified Maximum,,28307,CPT4/HCPCS,INCISION OF METATARSAL,,,6401.00
Deidentified Maximum,,28315,CPT4/HCPCS,REMOVAL OF SESAMOID BONE,,,6401.00
Deidentified Maximum,,28435,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,4280.43
Deidentified Maximum,,28470,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,,2002.00
Deidentified Maximum,,28475,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,,2002.00
Deidentified Maximum,,28490,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,,2002.00
Deidentified Maximum,,28545,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,4204.00
Deidentified Maximum,,28546,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,4280.43
Deidentified Maximum,,28666,CPT4/HCPCS,TREAT TOE DISLOCATION,,,5856.00
Deidentified Maximum,,28675,CPT4/HCPCS,REPAIR OF TOE DISLOCATION,,,5856.00
Deidentified Maximum,,28730,CPT4/HCPCS,FUSION OF FOOT BONES,,,7007.00
Deidentified Maximum,,28735,CPT4/HCPCS,FUSION OF FOOT BONES,,,7007.00
Deidentified Maximum,,28740,CPT4/HCPCS,FUSION OF FOOT BONES,,,7007.00
Deidentified Maximum,,28890,CPT4/HCPCS,HI ENRGY ESWT PLANTAR FASCIA,,,6401.00
Deidentified Maximum,,29035,CPT4/HCPCS,APPLICATION OF BODY CAST,,,1678.88
Deidentified Maximum,,29046,CPT4/HCPCS,APPLICATION OF BODY CAST,,,1678.88
Deidentified Maximum,,29105,CPT4/HCPCS,APPLY LONG ARM SPLINT,,,1214.00
Deidentified Maximum,,29200,CPT4/HCPCS,STRAPPING OF CHEST,,,1678.00
Deidentified Maximum,,29365,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,,1214.00
Deidentified Maximum,,29435,CPT4/HCPCS,APPLY SHORT LEG CAST,,,1214.00
Deidentified Maximum,,29515,CPT4/HCPCS,APPLICATION LOWER LEG SPLINT,,,6766.00
Deidentified Maximum,,29520,CPT4/HCPCS,STRAPPING OF HIP,,,6766.00
Deidentified Maximum,,29550,CPT4/HCPCS,STRAPPING OF TOES,,,6766.00
Deidentified Maximum,,29582,CPT4/HCPCS,APPLY MULTLAY COMPRS UPR LEG,,,1678.00
Deidentified Maximum,,29705,CPT4/HCPCS,REMOVAL/REVISION OF CAST,,,1678.00
Deidentified Maximum,,29740,CPT4/HCPCS,WEDGING OF CAST,,,1214.00
Deidentified Maximum,,29750,CPT4/HCPCS,WEDGING OF CLUBFOOT CAST,,,1214.00
Deidentified Maximum,,29799,CPT4/HCPCS,CASTING/STRAPPING PROCEDURE,,,6766.00
Deidentified Maximum,,29823,CPT4/HCPCS,SHO ARTHRS SRG XTNSV DBRDMT,,,7007.00
Deidentified Maximum,,29824,CPT4/HCPCS,SHO ARTHRS SRG DSTL CLAVICLC,,,7007.00
Deidentified Maximum,,29826,CPT4/HCPCS,SHO ARTHRS SRG DECOMPRESSION,,,5856.00
Deidentified Maximum,,29828,CPT4/HCPCS,SHO ARTHRS SRG BICP TENODSIS,,,8300.00
Deidentified Maximum,,29846,CPT4/HCPCS,WRIST ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29856,CPT4/HCPCS,TIBIAL ARTHROSCOPY/SURGERY,,,7007.00
Deidentified Maximum,,29871,CPT4/HCPCS,KNEE ARTHROSCOPY/DRAINAGE,,,5856.00
Deidentified Maximum,,29876,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,6401.00
Deidentified Maximum,,29879,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29880,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,6401.00
Deidentified Maximum,,29900,CPT4/HCPCS,MCP JOINT ARTHROSCOPY DX,,,5856.00
Deidentified Maximum,,29901,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,,7007.00
Deidentified Maximum,,29904,CPT4/HCPCS,SUBTALAR ARTHRO W/FB RMVL,,,8300.00
Deidentified Maximum,,30000,CPT4/HCPCS,DRAINAGE OF NOSE LESION,,,3198.57
Deidentified Maximum,,30124,CPT4/HCPCS,REMOVAL OF NOSE LESION,,,3198.57
Deidentified Maximum,,30130,CPT4/HCPCS,EXCISE INFERIOR TURBINATE,,,5856.00
Deidentified Maximum,,30300,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,,1214.00
Deidentified Maximum,,30450,CPT4/HCPCS,REVISION OF NOSE,,,9548.65
Deidentified Maximum,,30545,CPT4/HCPCS,REPAIR NASAL DEFECT,,,6876.92
Deidentified Maximum,,30580,CPT4/HCPCS,REPAIR UPPER JAW FISTULA,,,6401.00
Deidentified Maximum,,30620,CPT4/HCPCS,INTRANASAL RECONSTRUCTION,,,9548.65
Deidentified Maximum,,30801,CPT4/HCPCS,ABLATE INF TURBINATE SUPERF,,,3198.57
Deidentified Maximum,,30915,CPT4/HCPCS,LIGATION NASAL SINUS ARTERY,,,5138.00
Deidentified Maximum,,31070,CPT4/HCPCS,EXPLORATION OF FRONTAL SINUS,,,4280.43
Deidentified Maximum,,31085,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,6401.00
Deidentified Maximum,,31086,CPT4/HCPCS,REMOVAL OF FRONTAL SINUS,,,6401.00
Deidentified Maximum,,31225,CPT4/HCPCS,REMOVAL OF UPPER JAW,,,5029.00
Deidentified Maximum,,31257,CPT4/HCPCS,NSL/SINS NDSC TOT W/SPHENDT,,,6876.92
Deidentified Maximum,,31292,CPT4/HCPCS,NSL/SINS NDSC MED/INF DCMPRN,,,5856.00
Deidentified Maximum,,31298,CPT4/HCPCS,NSL/SINS NDSC SURG FRNT&SPHN,,,6401.00
Deidentified Maximum,,31320,CPT4/HCPCS,DIAGNOSTIC INCISION LARYNX,,,1678.88
Deidentified Maximum,,31367,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,6876.92
Deidentified Maximum,,31368,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,7902.34
Deidentified Maximum,,31382,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,8841.00
Deidentified Maximum,,31420,CPT4/HCPCS,REMOVAL OF EPIGLOTTIS,,,6075.00
Deidentified Maximum,,31502,CPT4/HCPCS,CHANGE OF WINDPIPE AIRWAY,,,3000.00
Deidentified Maximum,,31510,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,,4280.43
Deidentified Maximum,,31512,CPT4/HCPCS,REMOVAL OF LARYNX LESION,,,4280.43
Deidentified Maximum,,31528,CPT4/HCPCS,LARYNGOSCOPY AND DILATION,,,4280.43
Deidentified Maximum,,31531,CPT4/HCPCS,LARYNGOSCOPY W/FB & OP SCOPE,,,5856.00
Deidentified Maximum,,31536,CPT4/HCPCS,LARYNGOSCOPY W/BX & OP SCOPE,,,5856.00
Deidentified Maximum,,31540,CPT4/HCPCS,LARYNGOSCOPY W/EXC OF TUMOR,,,5856.00
Deidentified Maximum,,31552,CPT4/HCPCS,LARYNGOPLASTY LARYNGEAL STEN,,,6876.92
Deidentified Maximum,,31591,CPT4/HCPCS,LARYNGOPLASTY MEDIALIZATION,,,6876.92
Deidentified Maximum,,31595,CPT4/HCPCS,LARYNX NERVE SURGERY,,,4280.43
Deidentified Maximum,,31623,CPT4/HCPCS,DX BRONCHOSCOPE/BRUSH,,,4280.43
Deidentified Maximum,,31631,CPT4/HCPCS,BRONCHOSCOPY DILATE W/STENT,,,5138.00
Deidentified Maximum,,31633,CPT4/HCPCS,BRONCHOSCOPY/NEEDLE BX ADDL,,,3656.00
Deidentified Maximum,,31635,CPT4/HCPCS,BRONCHOSCOPY W/FB REMOVAL,,,4280.43
Deidentified Maximum,,31651,CPT4/HCPCS,BRONCHIAL VALVE ADDL INSERT,,,6000.00
Deidentified Maximum,,31654,CPT4/HCPCS,BRONCH EBUS IVNTJ PERPH LES,,,3198.57
Deidentified Maximum,,31720,CPT4/HCPCS,CLEARANCE OF AIRWAYS,,,3198.57
Deidentified Maximum,,31730,CPT4/HCPCS,INTRO WINDPIPE WIRE/TUBE,,,3656.00
Deidentified Maximum,,31750,CPT4/HCPCS,REPAIR OF WINDPIPE,,,6876.92
Deidentified Maximum,,31825,CPT4/HCPCS,REPAIR OF WINDPIPE DEFECT,,,4280.43
Deidentified Maximum,,32097,CPT4/HCPCS,OPEN WEDGE/BX LUNG NODULE,,,8012.00
Deidentified Maximum,,32100,CPT4/HCPCS,EXPLORATION OF CHEST,,,8012.00
Deidentified Maximum,,32120,CPT4/HCPCS,RE-EXPLORATION OF CHEST,,,6588.00
Deidentified Maximum,,32124,CPT4/HCPCS,EXPLORE CHEST FREE ADHESIONS,,,6588.00
Deidentified Maximum,,32200,CPT4/HCPCS,DRAIN OPEN LUNG LESION,,,6588.00
Deidentified Maximum,,32310,CPT4/HCPCS,REMOVAL OF CHEST LINING,,,6588.00
Deidentified Maximum,,32405,CPT4/HCPCS,PERCUT BX LUNG/MEDIASTINUM,,,3198.57
Deidentified Maximum,,32442,CPT4/HCPCS,SLEEVE PNEUMONECTOMY,,,8012.00
Deidentified Maximum,,32480,CPT4/HCPCS,PARTIAL REMOVAL OF LUNG,,,8841.00
Deidentified Maximum,,32486,CPT4/HCPCS,SLEEVE LOBECTOMY,,,8012.00
Deidentified Maximum,,32491,CPT4/HCPCS,LUNG VOLUME REDUCTION,,,8841.00
Deidentified Maximum,,32505,CPT4/HCPCS,WEDGE RESECT OF LUNG INITIAL,,,7902.34
Deidentified Maximum,,32557,CPT4/HCPCS,INSERT CATH PLEURA W/ IMAGE,,,3656.00
Deidentified Maximum,,32562,CPT4/HCPCS,LYSE CHEST FIBRIN SUBQ DAY,,,3000.00
Deidentified Maximum,,32650,CPT4/HCPCS,THORACOSCOPY W/PLEURODESIS,,,10119.00
Deidentified Maximum,,32651,CPT4/HCPCS,THORACOSCOPY REMOVE CORTEX,,,10119.00
Deidentified Maximum,,32652,CPT4/HCPCS,THORACOSCOPY REM TOTL CORTEX,,,10119.00
Deidentified Maximum,,32654,CPT4/HCPCS,THORACOSCOPY CONTRL BLEEDING,,,3544.00
Deidentified Maximum,,32665,CPT4/HCPCS,THORACOSCOP W/ESOPH MUSC EXC,,,5783.00
Deidentified Maximum,,32673,CPT4/HCPCS,THORACOSCOPY W/THYMUS RESECT,,,7902.34
Deidentified Maximum,,32800,CPT4/HCPCS,REPAIR LUNG HERNIA,,,8012.00
Deidentified Maximum,,32810,CPT4/HCPCS,CLOSE CHEST AFTER DRAINAGE,,,6588.00
Deidentified Maximum,,32906,CPT4/HCPCS,REVISE & REPAIR CHEST WALL,,,5783.00
Deidentified Maximum,,32999,CPT4/HCPCS,CHEST SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,33017,CPT4/HCPCS,PRCRD DRG 6YR+ W/O CGEN CAR,,,3544.00
Deidentified Maximum,,33019,CPT4/HCPCS,PERQ PRCRD DRG INSJ CATH CT,,,3544.00
Deidentified Maximum,,33208,CPT4/HCPCS,INSRT HEART PM ATRIAL & VENT,,,12850.70
Deidentified Maximum,,33216,CPT4/HCPCS,INSERT 1 ELECTRODE PM-DEFIB,,,21405.00
Deidentified Maximum,,33218,CPT4/HCPCS,REPAIR LEAD PACE-DEFIB ONE,,,12850.70
Deidentified Maximum,,33225,CPT4/HCPCS,L VENTRIC PACING LEAD ADD-ON,,,21405.00
Deidentified Maximum,,33227,CPT4/HCPCS,REMOVE&REPLACE PM GEN SINGL,,,10772.00
Deidentified Maximum,,33231,CPT4/HCPCS,INSRT PULSE GEN W/MULT LEADS,,,24180.00
Deidentified Maximum,,33237,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,,5029.00
Deidentified Maximum,,33240,CPT4/HCPCS,INSRT PULSE GEN W/SINGL LEAD,,,24180.00
Deidentified Maximum,,33250,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,5281.00
Deidentified Maximum,,33251,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,5281.00
Deidentified Maximum,,33258,CPT4/HCPCS,ABLATE ATRIA X10SV ADD-ON,,,5029.00
Deidentified Maximum,,33261,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,5281.00
Deidentified Maximum,,33266,CPT4/HCPCS,ABLATE ATRIA X10SV ENDO,,,5029.00
Deidentified Maximum,,33305,CPT4/HCPCS,REPAIR OF HEART WOUND,,,6588.00
Deidentified Maximum,,33315,CPT4/HCPCS,EXPLORATORY HEART SURGERY,,,6588.00
Deidentified Maximum,,33321,CPT4/HCPCS,REPAIR MAJOR VESSEL,,,5783.00
Deidentified Maximum,,33340,CPT4/HCPCS,PERQ CLSR TCAT L ATR APNDGE,,,9304.06
Deidentified Maximum,,33366,CPT4/HCPCS,TRCATH REPLACE AORTIC VALVE,,,6588.00
Deidentified Maximum,,33390,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,,8841.00
Deidentified Maximum,,33391,CPT4/HCPCS,VALVULOPLASTY AORTIC VALVE,,,8841.00
Deidentified Maximum,,33415,CPT4/HCPCS,REVISION SUBVALVULAR TISSUE,,,8841.00
Deidentified Maximum,,33426,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,,8841.00
Deidentified Maximum,,33475,CPT4/HCPCS,REPLACEMENT PULMONARY VALVE,,,6049.05
Deidentified Maximum,,33502,CPT4/HCPCS,CORONARY ARTERY CORRECTION,,,5783.00
Deidentified Maximum,,33513,CPT4/HCPCS,CABG VEIN FOUR,,,1370.00
Deidentified Maximum,,33516,CPT4/HCPCS,CABG VEIN SIX OR MORE,,,1370.00
Deidentified Maximum,,33517,CPT4/HCPCS,CABG ARTERY-VEIN SINGLE,,,1370.00
Deidentified Maximum,,33534,CPT4/HCPCS,CABG ARTERIAL TWO,,,1370.00
Deidentified Maximum,,33535,CPT4/HCPCS,CABG ARTERIAL THREE,,,1370.00
Deidentified Maximum,,33608,CPT4/HCPCS,REPAIR ANOMALY W/CONDUIT,,,1370.00
Deidentified Maximum,,33611,CPT4/HCPCS,REPAIR DOUBLE VENTRICLE,,,1370.00
Deidentified Maximum,,33612,CPT4/HCPCS,REPAIR DOUBLE VENTRICLE,,,1370.00
Deidentified Maximum,,33681,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,,8841.00
Deidentified Maximum,,33684,CPT4/HCPCS,REPAIR HEART SEPTUM DEFECT,,,8841.00
Deidentified Maximum,,33690,CPT4/HCPCS,REINFORCE PULMONARY ARTERY,,,6588.00
Deidentified Maximum,,33737,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,8012.00
Deidentified Maximum,,33755,CPT4/HCPCS,MAJOR VESSEL SHUNT,,,8012.00
Deidentified Maximum,,33766,CPT4/HCPCS,MAJOR VESSEL SHUNT,,,8012.00
Deidentified Maximum,,33767,CPT4/HCPCS,MAJOR VESSEL SHUNT,,,1370.00
Deidentified Maximum,,33783,CPT4/HCPCS,NIKAIDOH PROC W/OSTIA IMPLT,,,1370.00
Deidentified Maximum,,33813,CPT4/HCPCS,REPAIR SEPTAL DEFECT,,,8012.00
Deidentified Maximum,,33820,CPT4/HCPCS,REVISE MAJOR VESSEL,,,10772.00
Deidentified Maximum,,33891,CPT4/HCPCS,CAR-CAR BP GRFT/ENDOVAS TAA,,,1370.00
Deidentified Maximum,,33920,CPT4/HCPCS,REPAIR PULMONARY ATRESIA,,,1370.00
Deidentified Maximum,,33922,CPT4/HCPCS,TRANSECT PULMONARY ARTERY,,,1370.00
Deidentified Maximum,,33944,CPT4/HCPCS,PREPARE DONOR HEART,,,3544.00
Deidentified Maximum,,33960,CPT4/HCPCS,EXTERNAL CIRCULATION ASSIST,,,5281.00
Deidentified Maximum,,33978,CPT4/HCPCS,REMOVE VENTRICULAR DEVICE,,,1370.00
Deidentified Maximum,,33983,CPT4/HCPCS,REPLACE VAD INTRA W/BP,,,1370.00
Deidentified Maximum,,33985,CPT4/HCPCS,ECMO/ECLS RMVL CTR CANNULA,,,5281.00
Deidentified Maximum,,33987,CPT4/HCPCS,ARTERY EXPOS/GRAFT ARTERY,,,5029.00
Deidentified Maximum,,33988,CPT4/HCPCS,INSERTION OF LEFT HEART VENT,,,5029.00
Deidentified Maximum,,34111,CPT4/HCPCS,REMOVAL OF ARM ARTERY CLOT,,,9548.65
Deidentified Maximum,,34201,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,,9548.65
Deidentified Maximum,,34451,CPT4/HCPCS,REMOVAL OF VEIN CLOT,,,3544.00
Deidentified Maximum,,34712,CPT4/HCPCS,TCAT DLVR ENHNCD FIXJ DEV,,,5856.00
Deidentified Maximum,,34808,CPT4/HCPCS,ENDOVAS ILIAC A DEVICE ADDON,,,3544.00
Deidentified Maximum,,34831,CPT4/HCPCS,OPEN AORTOILIAC PROSTH REPR,,,8012.00
Deidentified Maximum,,34841,CPT4/HCPCS,ENDOVASC VISC AORTA 1 GRAFT,,,8841.00
Deidentified Maximum,,34846,CPT4/HCPCS,VISC & INFRAREN ABD 2 PROSTH,,,8841.00
Deidentified Maximum,,35013,CPT4/HCPCS,REPAIR ARTERY RUPTURE ARM,,,5281.00
Deidentified Maximum,,35082,CPT4/HCPCS,REPAIR ARTERY RUPTURE AORTA,,,8012.00
Deidentified Maximum,,35182,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,5029.00
Deidentified Maximum,,35241,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,8841.00
Deidentified Maximum,,35246,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,6588.00
Deidentified Maximum,,35302,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5281.00
Deidentified Maximum,,35304,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5029.00
Deidentified Maximum,,35372,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5029.00
Deidentified Maximum,,35458,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,3544.00
Deidentified Maximum,,35471,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,5029.00
Deidentified Maximum,,35500,CPT4/HCPCS,HARVEST VEIN FOR BYPASS,,,9548.65
Deidentified Maximum,,35509,CPT4/HCPCS,ART BYP GRFT CONTRAL CAROTID,,,5281.00
Deidentified Maximum,,35537,CPT4/HCPCS,ART BYP GRFT AORTOILIAC,,,5783.00
Deidentified Maximum,,35560,CPT4/HCPCS,ART BYP GRFT AORTORENAL,,,5783.00
Deidentified Maximum,,35563,CPT4/HCPCS,ART BYP GRFT ILIOILIAC,,,5281.00
Deidentified Maximum,,35572,CPT4/HCPCS,HARVEST FEMOROPOPLITEAL VEIN,,,1678.00
Deidentified Maximum,,35583,CPT4/HCPCS,VEIN BYP GRFT FEM-POPLITEAL,,,5029.00
Deidentified Maximum,,35631,CPT4/HCPCS,ART BYP AOR-CELIAC-MSN-RENAL,,,5281.00
Deidentified Maximum,,35683,CPT4/HCPCS,COMPOSITE BYP GRFT 3/> SEGMT,,,3198.57
Deidentified Maximum,,35697,CPT4/HCPCS,REIMPLANT ARTERY EACH,,,3198.57
Deidentified Maximum,,35820,CPT4/HCPCS,EXPLORE CHEST VESSELS,,,5281.00
Deidentified Maximum,,36010,CPT4/HCPCS,PLACE CATHETER IN VEIN,,,3000.00
Deidentified Maximum,,36011,CPT4/HCPCS,PLACE CATHETER IN VEIN,,,3000.00
Deidentified Maximum,,36013,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,3000.00
Deidentified Maximum,,36120,CPT4/HCPCS,ESTABLISH ACCESS TO ARTERY,,,1678.00
Deidentified Maximum,,36148,CPT4/HCPCS,ACCESS AV DIAL GRFT FOR PROC,,,1678.00
Deidentified Maximum,,36221,CPT4/HCPCS,PLACE CATH THORACIC AORTA,,,5138.00
Deidentified Maximum,,36261,CPT4/HCPCS,REVISION OF INFUSION PUMP,,,5138.00
Deidentified Maximum,,36425,CPT4/HCPCS,VEIN ACCESS CUTDOWN > 1 YR,,,3198.57
Deidentified Maximum,,36460,CPT4/HCPCS,TRANSFUSION SERVICE FETAL,,,3198.57
Deidentified Maximum,,36473,CPT4/HCPCS,ENDOVENOUS MCHNCHEM 1ST VEIN,,,6876.92
Deidentified Maximum,,36481,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,,3000.00
Deidentified Maximum,,36482,CPT4/HCPCS,ENDOVEN THER CHEM ADHES 1ST,,,7007.00
Deidentified Maximum,,36510,CPT4/HCPCS,INSERTION OF CATHETER VEIN,,,1678.00
Deidentified Maximum,,36556,CPT4/HCPCS,INSERT NON-TUNNEL CV CATH,,,3198.57
Deidentified Maximum,,36558,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,5138.00
Deidentified Maximum,,36560,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,6876.92
Deidentified Maximum,,36573,CPT4/HCPCS,INSJ PICC RS&I 5 YR+,,,3000.00
Deidentified Maximum,,36575,CPT4/HCPCS,REPAIR TUNNELED CV CATH,,,3656.00
Deidentified Maximum,,36810,CPT4/HCPCS,INSERTION OF CANNULA,,,5856.00
Deidentified Maximum,,36815,CPT4/HCPCS,INSERTION OF CANNULA,,,7007.00
Deidentified Maximum,,36822,CPT4/HCPCS,INSERTION OF CANNULA(S),,,3544.00
Deidentified Maximum,,36823,CPT4/HCPCS,INSERTION OF CANNULA(S),,,5281.00
Deidentified Maximum,,36830,CPT4/HCPCS,ARTERY-VEIN NONAUTOGRAFT,,,7007.00
Deidentified Maximum,,36832,CPT4/HCPCS,AV FISTULA REVISION OPEN,,,7007.00
Deidentified Maximum,,36902,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,,9548.65
Deidentified Maximum,,36906,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,,14317.00
Deidentified Maximum,,37203,CPT4/HCPCS,TRANSCATHETER RETRIEVAL,,,3544.00
Deidentified Maximum,,37204,CPT4/HCPCS,TRANSCATHETER OCCLUSION,,,5029.00
Deidentified Maximum,,37223,CPT4/HCPCS,ILIAC REVASC W/STENT ADD-ON,,,7007.00
Deidentified Maximum,,37224,CPT4/HCPCS,FEM/POPL REVAS W/TLA,,,7007.00
Deidentified Maximum,,37233,CPT4/HCPCS,TIBPER REVASC W/ATHER ADD-ON,,,10119.00
Deidentified Maximum,,37234,CPT4/HCPCS,REVSC OPN/PRQ TIB/PERO STENT,,,7007.00
Deidentified Maximum,,37243,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE ORGAN,,,10119.00
Deidentified Maximum,,37244,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE BLEED,,,10119.00
Deidentified Maximum,,37500,CPT4/HCPCS,ENDOSCOPY LIGATE PERF VEINS,,,7007.00
Deidentified Maximum,,37606,CPT4/HCPCS,LIGATION OF NECK ARTERY,,,7902.34
Deidentified Maximum,,37735,CPT4/HCPCS,REMOVAL OF LEG VEINS/LESION,,,5856.00
Deidentified Maximum,,37780,CPT4/HCPCS,REVISION OF LEG VEIN,,,5856.00
Deidentified Maximum,,37785,CPT4/HCPCS,LIGATE/DIVIDE/EXCISE VEIN,,,5856.00
Deidentified Maximum,,38100,CPT4/HCPCS,REMOVAL OF SPLEEN TOTAL,,,5783.00
Deidentified Maximum,,38101,CPT4/HCPCS,REMOVAL OF SPLEEN PARTIAL,,,5783.00
Deidentified Maximum,,38212,CPT4/HCPCS,RBC DEPLETION OF HARVEST,,,3198.57
Deidentified Maximum,,38213,CPT4/HCPCS,PLATELET DEPLETE OF HARVEST,,,3198.57
Deidentified Maximum,,38230,CPT4/HCPCS,BONE MARROW HARVEST ALLOGEN,,,6840.00
Deidentified Maximum,,38382,CPT4/HCPCS,THORACIC DUCT PROCEDURE,,,5783.00
Deidentified Maximum,,38531,CPT4/HCPCS,OPEN BX/EXC INGUINOFEM NODES,,,5138.00
Deidentified Maximum,,38562,CPT4/HCPCS,REMOVAL PELVIC LYMPH NODES,,,5281.00
Deidentified Maximum,,38740,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,,7007.00
Deidentified Maximum,,38780,CPT4/HCPCS,REMOVE ABDOMEN LYMPH NODES,,,5783.00
Deidentified Maximum,,38792,CPT4/HCPCS,RA TRACER ID OF SENTINL NODE,,,3000.00
Deidentified Maximum,,39000,CPT4/HCPCS,EXPLORATION OF CHEST,,,5029.00
Deidentified Maximum,,39010,CPT4/HCPCS,EXPLORATION OF CHEST,,,5029.00
Deidentified Maximum,,39200,CPT4/HCPCS,RESECT MEDIASTINAL CYST,,,5029.00
Deidentified Maximum,,39545,CPT4/HCPCS,REVISION OF DIAPHRAGM,,,5783.00
Deidentified Maximum,,40530,CPT4/HCPCS,PARTIAL REMOVAL OF LIP,,,4280.43
Deidentified Maximum,,40654,CPT4/HCPCS,REPAIR LIP,,,5856.00
Deidentified Maximum,,40702,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,,9548.65
Deidentified Maximum,,40814,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,,4280.43
Deidentified Maximum,,40844,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,,6876.92
Deidentified Maximum,,40845,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,,6876.92
Deidentified Maximum,,41008,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,3198.57
Deidentified Maximum,,41017,CPT4/HCPCS,DRAINAGE OF MOUTH LESION,,,3198.57
Deidentified Maximum,,41100,CPT4/HCPCS,BIOPSY OF TONGUE,,,3198.57
Deidentified Maximum,,41105,CPT4/HCPCS,BIOPSY OF TONGUE,,,4280.43
Deidentified Maximum,,41145,CPT4/HCPCS,TONGUE REMOVAL NECK SURGERY,,,6049.05
Deidentified Maximum,,41155,CPT4/HCPCS,TONGUE JAW & NECK SURGERY,,,6588.00
Deidentified Maximum,,41806,CPT4/HCPCS,REMOVAL FOREIGN BODY JAWBONE,,,4280.43
Deidentified Maximum,,41827,CPT4/HCPCS,EXCISION OF GUM LESION,,,6075.00
Deidentified Maximum,,41872,CPT4/HCPCS,REPAIR GUM,,,6075.00
Deidentified Maximum,,41874,CPT4/HCPCS,REPAIR TOOTH SOCKET,,,6049.05
Deidentified Maximum,,42100,CPT4/HCPCS,BIOPSY ROOF OF MOUTH,,,3198.57
Deidentified Maximum,,42107,CPT4/HCPCS,EXCISION LESION MOUTH ROOF,,,4280.43
Deidentified Maximum,,42182,CPT4/HCPCS,REPAIR PALATE,,,4280.43
Deidentified Maximum,,42225,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,9548.65
Deidentified Maximum,,42260,CPT4/HCPCS,REPAIR NOSE TO LIP FISTULA,,,6401.00
Deidentified Maximum,,42281,CPT4/HCPCS,INSERTION PALATE PROSTHESIS,,,5856.00
Deidentified Maximum,,42300,CPT4/HCPCS,DRAINAGE OF SALIVARY GLAND,,,3198.57
Deidentified Maximum,,42400,CPT4/HCPCS,BIOPSY OF SALIVARY GLAND,,,3000.00
Deidentified Maximum,,42408,CPT4/HCPCS,EXCISION OF SALIVARY CYST,,,5856.00
Deidentified Maximum,,42410,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,,6075.00
Deidentified Maximum,,42415,CPT4/HCPCS,EXCISE PAROTID GLAND/LESION,,,9548.65
Deidentified Maximum,,42508,CPT4/HCPCS,PAROTID DUCT DIVERSION,,,5029.00
Deidentified Maximum,,42845,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,,5281.00
Deidentified Maximum,,42960,CPT4/HCPCS,CONTROL THROAT BLEEDING,,,3198.57
Deidentified Maximum,,42970,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,,3198.57
Deidentified Maximum,,42999,CPT4/HCPCS,THROAT SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,43045,CPT4/HCPCS,INCISION OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43101,CPT4/HCPCS,EXCISION OF ESOPHAGUS LESION,,,6588.00
Deidentified Maximum,,43117,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43121,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43198,CPT4/HCPCS,ESOPHAGOSC FLEX TRNSN BIOPSY,,,4000.00
Deidentified Maximum,,43200,CPT4/HCPCS,ESOPHAGOSCOPY FLEXIBLE BRUSH,,,3198.57
Deidentified Maximum,,43205,CPT4/HCPCS,ESOPHAGUS ENDOSCOPY/LIGATION,,,3198.57
Deidentified Maximum,,43214,CPT4/HCPCS,ESOPHAGOSC DILATE BALLOON 30,,,5000.00
Deidentified Maximum,,43227,CPT4/HCPCS,ESOPHAGOSCOPY CONTROL BLEED,,,4280.43
Deidentified Maximum,,43244,CPT4/HCPCS,EGD VARICES LIGATION,,,4280.43
Deidentified Maximum,,43246,CPT4/HCPCS,EGD PLACE GASTROSTOMY TUBE,,,4280.43
Deidentified Maximum,,43259,CPT4/HCPCS,EGD US EXAM DUODENUM/JEJUNUM,,,5856.00
Deidentified Maximum,,43260,CPT4/HCPCS,ERCP W/SPECIMEN COLLECTION,,,4280.43
Deidentified Maximum,,43261,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,4280.43
Deidentified Maximum,,43268,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Maximum,,43272,CPT4/HCPCS,ENDO CHOLANGIOPANCREATOGRAPH,,,1678.88
Deidentified Maximum,,43276,CPT4/HCPCS,ERCP STENT EXCHANGE W/DILATE,,,8300.00
Deidentified Maximum,,43282,CPT4/HCPCS,LAP PARAESOPH HER RPR W/MESH,,,9548.65
Deidentified Maximum,,43283,CPT4/HCPCS,LAP ESOPH LENGTHENING,,,6588.00
Deidentified Maximum,,43286,CPT4/HCPCS,ESPHG TOT W/LAPS MOBLJ,,,6588.00
Deidentified Maximum,,43312,CPT4/HCPCS,REPAIR ESOPHAGUS AND FISTULA,,,6588.00
Deidentified Maximum,,43314,CPT4/HCPCS,TRACHEO-ESOPHAGOPLASTY CONG,,,6876.92
Deidentified Maximum,,43330,CPT4/HCPCS,ESOPHAGOMYOTOMY ABDOMINAL,,,5783.00
Deidentified Maximum,,43331,CPT4/HCPCS,ESOPHAGOMYOTOMY THORACIC,,,6588.00
Deidentified Maximum,,43420,CPT4/HCPCS,REPAIR ESOPHAGUS OPENING,,,5281.00
Deidentified Maximum,,43502,CPT4/HCPCS,SURGICAL REPAIR OF STOMACH,,,5783.00
Deidentified Maximum,,43520,CPT4/HCPCS,INCISION OF PYLORIC MUSCLE,,,5281.00
Deidentified Maximum,,43632,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,,5783.00
Deidentified Maximum,,43634,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,,5783.00
Deidentified Maximum,,43647,CPT4/HCPCS,LAP IMPL ELECTRODE ANTRUM,,,10119.00
Deidentified Maximum,,43651,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,,12850.70
Deidentified Maximum,,43652,CPT4/HCPCS,LAPAROSCOPY VAGUS NERVE,,,12850.70
Deidentified Maximum,,43753,CPT4/HCPCS,TX GASTRO INTUB W/ASP,,,3000.00
Deidentified Maximum,,43757,CPT4/HCPCS,DX DUOD INTUB W/ASP SPECS,,,3000.00
Deidentified Maximum,,43761,CPT4/HCPCS,REPOSITION GASTROSTOMY TUBE,,,3000.00
Deidentified Maximum,,43775,CPT4/HCPCS,LAP SLEEVE GASTRECTOMY,,,9548.65
Deidentified Maximum,,43848,CPT4/HCPCS,REVISION GASTROPLASTY,,,5783.00
Deidentified Maximum,,43855,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,,5783.00
Deidentified Maximum,,43865,CPT4/HCPCS,REVISE STOMACH-BOWEL FUSION,,,5783.00
Deidentified Maximum,,43881,CPT4/HCPCS,IMPL/REDO ELECTRD ANTRUM,,,5281.00
Deidentified Maximum,,43882,CPT4/HCPCS,REVISE/REMOVE ELECTRD ANTRUM,,,5281.00
Deidentified Maximum,,44133,CPT4/HCPCS,ENTERECTOMY LIVE DONOR,,,5783.00
Deidentified Maximum,,44136,CPT4/HCPCS,INTESTINE TRANSPLANT LIVE,,,5281.00
Deidentified Maximum,,44139,CPT4/HCPCS,MOBILIZATION OF COLON,,,3198.57
Deidentified Maximum,,44141,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,5783.00
Deidentified Maximum,,44143,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,5783.00
Deidentified Maximum,,44146,CPT4/HCPCS,PARTIAL REMOVAL OF COLON,,,5783.00
Deidentified Maximum,,44155,CPT4/HCPCS,REMOVAL OF COLON/ILEOSTOMY,,,6588.00
Deidentified Maximum,,44360,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4280.43
Deidentified Maximum,,44378,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4280.43
Deidentified Maximum,,44604,CPT4/HCPCS,SUTURE LARGE INTESTINE,,,5783.00
Deidentified Maximum,,44700,CPT4/HCPCS,SUSPEND BOWEL W/PROSTHESIS,,,3544.00
Deidentified Maximum,,44715,CPT4/HCPCS,PREPARE DONOR INTESTINE,,,3544.00
Deidentified Maximum,,44799,CPT4/HCPCS,UNLISTED PX SMALL INTESTINE,,,3198.57
Deidentified Maximum,,44950,CPT4/HCPCS,APPENDECTOMY,,,6401.00
Deidentified Maximum,,44970,CPT4/HCPCS,LAPAROSCOPY APPENDECTOMY,,,7902.34
Deidentified Maximum,,45110,CPT4/HCPCS,REMOVAL OF RECTUM,,,6588.00
Deidentified Maximum,,45123,CPT4/HCPCS,PARTIAL PROCTECTOMY,,,7007.00
Deidentified Maximum,,45150,CPT4/HCPCS,EXCISION OF RECTAL STRICTURE,,,4280.43
Deidentified Maximum,,45172,CPT4/HCPCS,EXC RECT TUM TRANSANAL FULL,,,7902.34
Deidentified Maximum,,45315,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY REMOVAL,,,3198.57
Deidentified Maximum,,45321,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY VOLVUL,,,4204.00
Deidentified Maximum,,45337,CPT4/HCPCS,SIGMOIDOSCOPY & DECOMPRESS,,,3198.57
Deidentified Maximum,,45342,CPT4/HCPCS,SIGMOIDOSCOPY W/US GUIDE BX,,,3198.57
Deidentified Maximum,,45350,CPT4/HCPCS,SGMDSC W/BAND LIGATION,,,4000.00
Deidentified Maximum,,45378,CPT4/HCPCS,DIAGNOSTIC COLONOSCOPY,,,4280.43
Deidentified Maximum,,45380,CPT4/HCPCS,COLONOSCOPY AND BIOPSY,,,4280.43
Deidentified Maximum,,45386,CPT4/HCPCS,COLONOSCOPY W/BALLOON DILAT,,,4280.43
Deidentified Maximum,,45388,CPT4/HCPCS,COLONOSCOPY W/ABLATION,,,4000.00
Deidentified Maximum,,45389,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,,4000.00
Deidentified Maximum,,45391,CPT4/HCPCS,COLONOSCOPY W/ENDOSCOPE US,,,3656.00
Deidentified Maximum,,45499,CPT4/HCPCS,LAPAROSCOPE PROC RECTUM,,,6075.00
Deidentified Maximum,,45820,CPT4/HCPCS,REPAIR RECTOURETHRAL FISTULA,,,5281.00
Deidentified Maximum,,46080,CPT4/HCPCS,INCISION OF ANAL SPHINCTER,,,5856.00
Deidentified Maximum,,46280,CPT4/HCPCS,REMOVE ANAL FIST COMPLEX,,,6401.00
Deidentified Maximum,,46285,CPT4/HCPCS,REMOVE ANAL FIST 2 STAGE,,,4204.00
Deidentified Maximum,,46320,CPT4/HCPCS,REMOVAL OF HEMORRHOID CLOT,,,3198.57
Deidentified Maximum,,46715,CPT4/HCPCS,REP PERF ANOPER FISTU,,,3544.00
Deidentified Maximum,,46716,CPT4/HCPCS,REP PERF ANOPER/VESTIB FISTU,,,3544.00
Deidentified Maximum,,46740,CPT4/HCPCS,CONSTRUCTION OF ABSENT ANUS,,,5281.00
Deidentified Maximum,,46748,CPT4/HCPCS,REPAIR OF CLOACAL ANOMALY,,,9548.65
Deidentified Maximum,,46751,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,,3544.00
Deidentified Maximum,,0042T,CPT4/HCPCS,CT PERFUSION W/CONTRAST CBF,,,6766.00
Deidentified Maximum,,0101T,CPT4/HCPCS,EXTRACORP SHOCKWV TX HI ENRG,,,5138.00
Deidentified Maximum,,0102T,CPT4/HCPCS,EXTRACORP SHOCKWV TX ANESTH,,,5138.00
Deidentified Maximum,,0164T,CPT4/HCPCS,REMOVE LUMB ARTIF DISC ADDL,,,3198.57
Deidentified Maximum,,0201T,CPT4/HCPCS,PERQ SACRAL AUGMT BILAT INJ,,,5138.00
Deidentified Maximum,,0220T,CPT4/HCPCS,PLMT POST FACET IMPLT THOR,,,1678.88
Deidentified Maximum,,0221T,CPT4/HCPCS,PLMT POST FACET IMPLT LUMB,,,6840.00
Deidentified Maximum,,0262T,CPT4/HCPCS,IMPLTJ PULM VLV EVASC APPR,,,8012.00
Deidentified Maximum,,0275T,CPT4/HCPCS,PERQ LAMOT/LAM LUMBAR,,,9548.65
Deidentified Maximum,,0281T,CPT4/HCPCS,LAA CLOSURE W/IMPLANT,,,5783.00
Deidentified Maximum,,0293T,CPT4/HCPCS,INS LT ATRL PRESS MONITOR,,,6588.00
Deidentified Maximum,,0295T,CPT4/HCPCS,EXT ECG COMPLETE,,,987.78
Deidentified Maximum,,0309T,CPT4/HCPCS,PRESCRL FUSE W/ INSTR L4/L5,,,5783.00
Deidentified Maximum,,0317T,CPT4/HCPCS,ELEC ALYS VAGUS NRV PLS GEN,,,5281.00
Deidentified Maximum,,0320T,CPT4/HCPCS,INSERT SUBQ DEFIB ELECTRODE,,,5029.00
Deidentified Maximum,,0345T,CPT4/HCPCS,TRANSCATH MTRAL VLVE REPAIR,,,8841.00
Deidentified Maximum,,0393T,CPT4/HCPCS,ES SPH AUGMNT DEVICE REMOVAL,,,1678.88
Deidentified Maximum,,0412T,CPT4/HCPCS,RMVL CARDIAC MODULJ PLS GEN,,,5856.00
Deidentified Maximum,,0415T,CPT4/HCPCS,REPOS CAR MODULJ TRANVNS ELT,,,4891.93
Deidentified Maximum,,0425T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA SEN LD,,,7007.00
Deidentified Maximum,,0437T,CPT4/HCPCS,IMPLTJ SYNTH RNFCMT ABDL WAL,,,2002.00
Deidentified Maximum,,0449T,CPT4/HCPCS,INSJ AQUEOUS DRAIN DEV 1ST,,,6075.00
Deidentified Maximum,,0460T,CPT4/HCPCS,REPOS AORTIC VENTR DEV ELTRD,,,5856.00
Deidentified Maximum,,0467T,CPT4/HCPCS,REVJ/RPLMNT CH RESPIR ELTRD,,,5138.00
Deidentified Maximum,,0484T,CPT4/HCPCS,TMVI TRANSTHORACIC EXPOSURE,,,8012.00
Deidentified Maximum,,0490T,CPT4/HCPCS,REGN CELL TX SCLDR H MLT INJ,,,6049.05
Deidentified Maximum,,0495T,CPT4/HCPCS,MNTR CDVR DON LNG 1ST 2 HRS,,,1370.00
Deidentified Maximum,,0518T,CPT4/HCPCS,RMVL PG COMPNT WCS,,,6401.00
Deidentified Maximum,,0520T,CPT4/HCPCS,RMVL&RPLCMT PG WCS NEW ELTRD,,,24180.00
Deidentified Maximum,,0565T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS HRVG,,,5856.00
Deidentified Maximum,,0566T,CPT4/HCPCS,AUTOL CELL IMPLT ADPS NJX,,,3544.00
Deidentified Maximum,,0572T,CPT4/HCPCS,INSERTION SS DFB ELECTRODE,,,5856.00
Deidentified Maximum,,0579T,CPT4/HCPCS,REM INTERROG DEV ICDS TECH,,,1370.00
Deidentified Maximum,,0580T,CPT4/HCPCS,RMVL SS IMPL DFB PG ONLY,,,5856.00
Deidentified Maximum,,0582T,CPT4/HCPCS,TRURL ABLTJ MAL PRST8 TISS,,,5029.00
Deidentified Maximum,,10006,CPT4/HCPCS,FNA BX W/US GDN EA ADDL,,,3000.00
Deidentified Maximum,,10010,CPT4/HCPCS,FNA BX W/CT GDN EA ADDL,,,3000.00
Deidentified Maximum,,11010,CPT4/HCPCS,DEBRIDE SKIN AT FX SITE,,,4280.43
Deidentified Maximum,,11012,CPT4/HCPCS,DEB SKIN BONE AT FX SITE,,,4280.43
Deidentified Maximum,,11045,CPT4/HCPCS,DEB SUBQ TISSUE ADD-ON,,,3000.00
Deidentified Maximum,,11047,CPT4/HCPCS,DEB BONE ADD-ON,,,3000.00
Deidentified Maximum,,11200,CPT4/HCPCS,REMOVAL OF SKIN TAGS 2.0 CM,,,1214.00
Deidentified Maximum,,11401,CPT4/HCPCS,EXC TR-EXT B9+MARG 0.6-1 CM,,,3198.57
Deidentified Maximum,,11420,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 0.5/<,,,3656.00
Deidentified Maximum,,11600,CPT4/HCPCS,EXC TR-EXT MAL+MARG 0.5 CM/<,,,3198.57
Deidentified Maximum,,11604,CPT4/HCPCS,EXC TR-EXT MAL+MARG 3.1-4 CM,,,4280.43
Deidentified Maximum,,11621,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 0.6-1,,,3198.57
Deidentified Maximum,,11740,CPT4/HCPCS,DRAIN BLOOD FROM UNDER NAIL,,,3000.00
Deidentified Maximum,,11770,CPT4/HCPCS,REMOVE PILONIDAL CYST SIMPLE,,,5856.00
Deidentified Maximum,,11980,CPT4/HCPCS,IMPLANT HORMONE PELLET(S),,,2002.00
Deidentified Maximum,,12005,CPT4/HCPCS,RPR S/N/A/GEN/TRK12.6-20.0CM,,,4280.43
Deidentified Maximum,,12014,CPT4/HCPCS,RPR F/E/E/N/L/M 5.1-7.5 CM,,,2002.00
Deidentified Maximum,,12020,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,,3198.57
Deidentified Maximum,,12035,CPT4/HCPCS,INTMD RPR S/A/T/EXT 12.6-20,,,4280.43
Deidentified Maximum,,12045,CPT4/HCPCS,INTMD RPR N-HF/GENIT12.6-20,,,4280.43
Deidentified Maximum,,12047,CPT4/HCPCS,INTMD RPR N-HF/GENIT >30.0CM,,,4280.43
Deidentified Maximum,,12052,CPT4/HCPCS,INTMD RPR FACE/MM 2.6-5.0 CM,,,3198.57
Deidentified Maximum,,12054,CPT4/HCPCS,INTMD RPR FACE/MM 7.6-12.5CM,,,4280.43
Deidentified Maximum,,12055,CPT4/HCPCS,INTMD RPR FACE/MM 12.6-20 CM,,,4280.43
Deidentified Maximum,,12057,CPT4/HCPCS,INTMD RPR FACE/MM >30.0 CM,,,4280.43
Deidentified Maximum,,13153,CPT4/HCPCS,CMPLX RPR E/N/E/L ADDL 5CM/<,,,5856.00
Deidentified Maximum,,14020,CPT4/HCPCS,TIS TRNFR S/A/L 10 SQ CM/<,,,5856.00
Deidentified Maximum,,14350,CPT4/HCPCS,FILLETED FINGER/TOE FLAP,,,5856.00
Deidentified Maximum,,15111,CPT4/HCPCS,EPIDRM AUTOGRFT T/A/L ADD-ON,,,3198.57
Deidentified Maximum,,15115,CPT4/HCPCS,EPIDRM A-GRFT FACE/NCK/HF/G,,,4280.43
Deidentified Maximum,,15151,CPT4/HCPCS,CULT SKIN GRFT T/A/L ADDL,,,3198.57
Deidentified Maximum,,15241,CPT4/HCPCS,SKIN FULL GRAFT ADD-ON,,,5856.00
Deidentified Maximum,,15277,CPT4/HCPCS,SKN SUB GRFT F/N/HF/G CHILD,,,4280.43
Deidentified Maximum,,15570,CPT4/HCPCS,SKIN PEDICLE FLAP TRUNK,,,5856.00
Deidentified Maximum,,15610,CPT4/HCPCS,DELAY FLAP ARMS/LEGS,,,5856.00
Deidentified Maximum,,15630,CPT4/HCPCS,DELAY FLAP EYE/NOS/EAR/LIP,,,5856.00
Deidentified Maximum,,15771,CPT4/HCPCS,GRFG AUTOL FAT LIPO 50 CC/<,,,6401.00
Deidentified Maximum,,15774,CPT4/HCPCS,GFRG AUTOL FAT LIPO EA ADDL,,,3544.00
Deidentified Maximum,,15780,CPT4/HCPCS,DERMABRASION TOTAL FACE,,,4891.93
Deidentified Maximum,,15787,CPT4/HCPCS,ABRASION LESIONS ADD-ON,,,1678.00
Deidentified Maximum,,15824,CPT4/HCPCS,REMOVAL OF FOREHEAD WRINKLES,,,5856.00
Deidentified Maximum,,15834,CPT4/HCPCS,EXCISE EXCESSIVE SKIN HIP,,,5856.00
Deidentified Maximum,,15836,CPT4/HCPCS,EXCISE EXCESSIVE SKIN ARM,,,5856.00
Deidentified Maximum,,15850,CPT4/HCPCS,REMOVE SUTURES SAME SURGEON,,,3198.57
Deidentified Maximum,,15851,CPT4/HCPCS,REMOVE SUTURES DIFF SURGEON,,,3198.57
Deidentified Maximum,,15878,CPT4/HCPCS,SUCTION LIPECTOMY UPR EXTREM,,,5856.00
Deidentified Maximum,,15936,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,6401.00
Deidentified Maximum,,15941,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,,5856.00
Deidentified Maximum,,15944,CPT4/HCPCS,REMOVE HIP PRESSURE SORE,,,5856.00
Deidentified Maximum,,16000,CPT4/HCPCS,INITIAL TREATMENT OF BURN(S),,,1214.00
Deidentified Maximum,,16030,CPT4/HCPCS,DRESS/DEBRID P-THICK BURN L,,,4280.43
Deidentified Maximum,,16035,CPT4/HCPCS,INCISION OF BURN SCAB INITI,,,3656.00
Deidentified Maximum,,17000,CPT4/HCPCS,DESTRUCT PREMALG LESION,,,2002.00
Deidentified Maximum,,17107,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3000.00
Deidentified Maximum,,17260,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17263,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17266,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3656.00
Deidentified Maximum,,17271,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17282,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17284,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17380,CPT4/HCPCS,HAIR REMOVAL BY ELECTROLYSIS,,,1214.00
Deidentified Maximum,,17999,CPT4/HCPCS,SKIN TISSUE PROCEDURE,,,3000.00
Deidentified Maximum,,19085,CPT4/HCPCS,BX BREAST 1ST LESION MR IMAG,,,5856.00
Deidentified Maximum,,19112,CPT4/HCPCS,EXCISE BREAST DUCT FISTULA,,,5856.00
Deidentified Maximum,,19126,CPT4/HCPCS,EXCISION ADDL BREAST LESION,,,5856.00
Deidentified Maximum,,19260,CPT4/HCPCS,REMOVAL OF CHEST WALL LESION,,,5281.00
Deidentified Maximum,,19272,CPT4/HCPCS,EXTENSIVE CHEST WALL SURGERY,,,6588.00
Deidentified Maximum,,19285,CPT4/HCPCS,PERQ DEV BREAST 1ST US IMAG,,,3656.00
Deidentified Maximum,,19288,CPT4/HCPCS,PERQ DEV BREAST ADD MR GUIDE,,,3000.00
Deidentified Maximum,,19290,CPT4/HCPCS,PLACE NEEDLE WIRE BREAST,,,1678.00
Deidentified Maximum,,19302,CPT4/HCPCS,P-MASTECTOMY W/LN REMOVAL,,,9548.65
Deidentified Maximum,,19303,CPT4/HCPCS,MAST SIMPLE COMPLETE,,,6401.00
Deidentified Maximum,,19306,CPT4/HCPCS,MAST RAD URBAN TYPE,,,5281.00
Deidentified Maximum,,19370,CPT4/HCPCS,REVJ PERI-IMPLT CAPSULE BRST,,,6401.00
Deidentified Maximum,,20220,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,,3198.57
Deidentified Maximum,,20240,CPT4/HCPCS,BONE BIOPSY OPEN SUPERFICIAL,,,4280.43
Deidentified Maximum,,20250,CPT4/HCPCS,OPEN BONE BIOPSY,,,5856.00
Deidentified Maximum,,20520,CPT4/HCPCS,REMOVAL OF FOREIGN BODY,,,3656.00
Deidentified Maximum,,20550,CPT4/HCPCS,INJ TENDON SHEATH/LIGAMENT,,,3000.00
Deidentified Maximum,,20553,CPT4/HCPCS,INJECT TRIGGER POINTS 3/>,,,3000.00
Deidentified Maximum,,20610,CPT4/HCPCS,DRAIN/INJ JOINT/BURSA W/O US,,,3544.00
Deidentified Maximum,,20650,CPT4/HCPCS,INSERT AND REMOVE BONE PIN,,,5856.00
Deidentified Maximum,,20664,CPT4/HCPCS,APPLICATION OF HALO,,,4204.00
Deidentified Maximum,,20690,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,,5138.00
Deidentified Maximum,,20692,CPT4/HCPCS,APPLY BONE FIXATION DEVICE,,,5856.00
Deidentified Maximum,,20693,CPT4/HCPCS,ADJUST BONE FIXATION DEVICE,,,5856.00
Deidentified Maximum,,20701,CPT4/HCPCS,RMVL DEEP RX DELIVERY DEVICE,,,3000.00
Deidentified Maximum,,20703,CPT4/HCPCS,RMVL IMED RX DELIVERY DEVICE,,,3000.00
Deidentified Maximum,,20802,CPT4/HCPCS,REPLANTATION ARM COMPLETE,,,8012.00
Deidentified Maximum,,20808,CPT4/HCPCS,REPLANTATION HAND COMPLETE,,,12850.70
Deidentified Maximum,,20827,CPT4/HCPCS,REPLANTATION THUMB COMPLETE,,,12850.70
Deidentified Maximum,,20838,CPT4/HCPCS,REPLANTATION FOOT COMPLETE,,,8012.00
Deidentified Maximum,,20962,CPT4/HCPCS,OTHER BONE GRAFT MICROVASC,,,7902.34
Deidentified Maximum,,20972,CPT4/HCPCS,BONE/SKIN GRAFT METATARSAL,,,7007.00
Deidentified Maximum,,20973,CPT4/HCPCS,BONE/SKIN GRAFT GREAT TOE,,,9548.65
Deidentified Maximum,,21016,CPT4/HCPCS,RESECT FACE/SCALP TUM 2 CM/>,,,4891.93
Deidentified Maximum,,21076,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,6049.05
Deidentified Maximum,,21082,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,9548.65
Deidentified Maximum,,21086,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,9548.65
Deidentified Maximum,,21089,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,4280.43
Deidentified Maximum,,21110,CPT4/HCPCS,INTERDENTAL FIXATION,,,3198.57
Deidentified Maximum,,21121,CPT4/HCPCS,RECONSTRUCTION OF CHIN,,,9548.65
Deidentified Maximum,,21179,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,,6049.05
Deidentified Maximum,,21180,CPT4/HCPCS,RECONSTRUCT ENTIRE FOREHEAD,,,6049.05
Deidentified Maximum,,21184,CPT4/HCPCS,RECONSTRUCT CRANIAL BONE,,,6049.05
Deidentified Maximum,,21210,CPT4/HCPCS,FACE BONE GRAFT,,,9548.65
Deidentified Maximum,,21244,CPT4/HCPCS,RECONSTRUCTION OF LOWER JAW,,,9548.65
Deidentified Maximum,,21246,CPT4/HCPCS,RECONSTRUCTION OF JAW,,,9548.65
Deidentified Maximum,,21249,CPT4/HCPCS,RECONSTRUCTION OF JAW,,,9548.65
Deidentified Maximum,,21255,CPT4/HCPCS,RECONSTRUCT LOWER JAW BONE,,,5281.00
Deidentified Maximum,,21263,CPT4/HCPCS,REVISE EYE SOCKETS,,,9548.65
Deidentified Maximum,,21296,CPT4/HCPCS,REVISION OF JAW MUSCLE/BONE,,,5029.00
Deidentified Maximum,,21345,CPT4/HCPCS,CLOSED TX NOSE/JAW FX,,,9548.65
Deidentified Maximum,,21386,CPT4/HCPCS,OPN TX ORBIT FX PERIORBITAL,,,6840.00
Deidentified Maximum,,21387,CPT4/HCPCS,OPN TX ORBIT FX COMBINED,,,6840.00
Deidentified Maximum,,21406,CPT4/HCPCS,OPN TX ORBIT FX W/O IMPLANT,,,9548.65
Deidentified Maximum,,21435,CPT4/HCPCS,TREAT CRANIOFACIAL FRACTURE,,,5281.00
Deidentified Maximum,,21454,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,6876.92
Deidentified Maximum,,21461,CPT4/HCPCS,TREAT LOWER JAW FRACTURE,,,6401.00
Deidentified Maximum,,21490,CPT4/HCPCS,REPAIR DISLOCATED JAW,,,6075.00
Deidentified Maximum,,21557,CPT4/HCPCS,RESECT NECK THORAX TUMOR<5CM,,,5029.00
Deidentified Maximum,,21558,CPT4/HCPCS,RESECT NECK TUMOR 5 CM/>,,,5856.00
Deidentified Maximum,,21620,CPT4/HCPCS,PARTIAL REMOVAL OF STERNUM,,,3656.00
Deidentified Maximum,,21920,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,,3198.57
Deidentified Maximum,,21932,CPT4/HCPCS,EXC BACK TUM DEEP < 5 CM,,,4891.93
Deidentified Maximum,,22015,CPT4/HCPCS,I&D ABSCESS P-SPINE L/S/LS,,,1678.88
Deidentified Maximum,,22102,CPT4/HCPCS,REMOVE PART LUMBAR VERTEBRA,,,9548.65
Deidentified Maximum,,22116,CPT4/HCPCS,REMOVE EXTRA SPINE SEGMENT,,,3544.00
Deidentified Maximum,,22210,CPT4/HCPCS,INCIS 1 VERTEBRAL SEG CERV,,,4891.93
Deidentified Maximum,,22525,CPT4/HCPCS,PERCUT KYPHOPLASTY ADD-ON,,,1678.00
Deidentified Maximum,,22552,CPT4/HCPCS,ADDL NECK SPINE FUSION,,,6075.00
Deidentified Maximum,,22585,CPT4/HCPCS,ADDITIONAL SPINAL FUSION,,,7007.00
Deidentified Maximum,,22632,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,,3544.00
Deidentified Maximum,,22810,CPT4/HCPCS,ANT FUSION 4-7 VERT SEG,,,8012.00
Deidentified Maximum,,22830,CPT4/HCPCS,EXPLORATION OF SPINAL FUSION,,,5281.00
Deidentified Maximum,,22843,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,5783.00
Deidentified Maximum,,22847,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,7007.00
Deidentified Maximum,,22853,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,,3544.00
Deidentified Maximum,,22854,CPT4/HCPCS,INSJ BIOMECHANICAL DEVICE,,,3544.00
Deidentified Maximum,,22862,CPT4/HCPCS,REVISE LUMBAR ARTIF DISC,,,1370.00
Deidentified Maximum,,22899,CPT4/HCPCS,SPINE SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,22901,CPT4/HCPCS,EXC ABDL TUM DEEP 5 CM/>,,,5856.00
Deidentified Maximum,,23000,CPT4/HCPCS,REMOVAL OF CALCIUM DEPOSITS,,,4280.43
Deidentified Maximum,,23035,CPT4/HCPCS,DRAIN SHOULDER BONE LESION,,,5856.00
Deidentified Maximum,,23065,CPT4/HCPCS,BIOPSY SHOULDER TISSUES,,,3198.57
Deidentified Maximum,,23073,CPT4/HCPCS,EXC SHOULDER TUM DEEP 5 CM/>,,,5856.00
Deidentified Maximum,,23078,CPT4/HCPCS,RESECT SHOULDER TUMOR 5 CM/>,,,5856.00
Deidentified Maximum,,23146,CPT4/HCPCS,REMOVAL OF BONE LESION,,,6876.92
Deidentified Maximum,,23156,CPT4/HCPCS,REMOVAL OF HUMERUS LESION,,,6876.92
Deidentified Maximum,,23170,CPT4/HCPCS,REMOVE COLLAR BONE LESION,,,5138.00
Deidentified Maximum,,23172,CPT4/HCPCS,REMOVE SHOULDER BLADE LESION,,,5138.00
Deidentified Maximum,,23190,CPT4/HCPCS,PARTIAL REMOVAL OF SCAPULA,,,6401.00
Deidentified Maximum,,23195,CPT4/HCPCS,REMOVAL OF HEAD OF HUMERUS,,,6876.92
Deidentified Maximum,,23405,CPT4/HCPCS,INCISION OF TENDON & MUSCLE,,,5138.00
Deidentified Maximum,,23406,CPT4/HCPCS,INCISE TENDON(S) & MUSCLE(S),,,5138.00
Deidentified Maximum,,23462,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,9548.65
Deidentified Maximum,,23505,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,,3198.57
Deidentified Maximum,,23570,CPT4/HCPCS,TREAT SHOULDER BLADE FX,,,3198.57
Deidentified Maximum,,23605,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4280.43
Deidentified Maximum,,23625,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,4280.43
Deidentified Maximum,,23655,CPT4/HCPCS,TREAT SHOULDER DISLOCATION,,,3198.57
Deidentified Maximum,,23700,CPT4/HCPCS,FIXATION OF SHOULDER,,,3198.57
Deidentified Maximum,,23921,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,5856.00
Deidentified Maximum,,24076,CPT4/HCPCS,EX ARM/ELBOW TUM DEEP < 5 CM,,,4280.43
Deidentified Maximum,,24126,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,,5856.00
Deidentified Maximum,,24150,CPT4/HCPCS,RESECT DISTAL HUMERUS TUMOR,,,9548.65
Deidentified Maximum,,24155,CPT4/HCPCS,REMOVAL OF ELBOW JOINT,,,5856.00
Deidentified Maximum,,24305,CPT4/HCPCS,ARM TENDON LENGTHENING,,,6401.00
Deidentified Maximum,,24310,CPT4/HCPCS,REVISION OF ARM TENDON,,,5856.00
Deidentified Maximum,,24341,CPT4/HCPCS,REPAIR ARM TENDON/MUSCLE,,,6075.00
Deidentified Maximum,,24346,CPT4/HCPCS,RECONSTRUCT ELBOW MED LIGMNT,,,9548.65
Deidentified Maximum,,24515,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,7007.00
Deidentified Maximum,,24516,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,7007.00
Deidentified Maximum,,24586,CPT4/HCPCS,TREAT ELBOW FRACTURE,,,7007.00
Deidentified Maximum,,24587,CPT4/HCPCS,TREAT ELBOW FRACTURE,,,7007.00
Deidentified Maximum,,24650,CPT4/HCPCS,TREAT RADIUS FRACTURE,,,2002.00
Deidentified Maximum,,24675,CPT4/HCPCS,TREAT ULNAR FRACTURE,,,3198.57
Deidentified Maximum,,24920,CPT4/HCPCS,AMPUTATION OF UPPER ARM,,,5029.00
Deidentified Maximum,,24940,CPT4/HCPCS,REVISION OF UPPER ARM,,,9548.65
Deidentified Maximum,,24999,CPT4/HCPCS,UPPER ARM/ELBOW SURGERY,,,3198.57
Deidentified Maximum,,25035,CPT4/HCPCS,TREAT FOREARM BONE LESION,,,4280.43
Deidentified Maximum,,25075,CPT4/HCPCS,EXC FOREARM LES SC < 3 CM,,,4280.43
Deidentified Maximum,,25135,CPT4/HCPCS,REMOVE & GRAFT WRIST LESION,,,5856.00
Deidentified Maximum,,25150,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,,5138.00
Deidentified Maximum,,25230,CPT4/HCPCS,PARTIAL REMOVAL OF RADIUS,,,6401.00
Deidentified Maximum,,25290,CPT4/HCPCS,INCISE WRIST/FOREARM TENDON,,,5856.00
Deidentified Maximum,,25301,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,,5856.00
Deidentified Maximum,,25310,CPT4/HCPCS,TRANSPLANT FOREARM TENDON,,,5856.00
Deidentified Maximum,,25337,CPT4/HCPCS,RECONSTRUCT ULNA/RADIOULNAR,,,6876.92
Deidentified Maximum,,25360,CPT4/HCPCS,REVISION OF ULNA,,,6075.00
Deidentified Maximum,,25441,CPT4/HCPCS,RECONSTRUCT WRIST JOINT,,,10119.00
Deidentified Maximum,,25449,CPT4/HCPCS,REMOVE WRIST JOINT IMPLANT,,,6876.92
Deidentified Maximum,,25455,CPT4/HCPCS,REVISION OF WRIST JOINT,,,6075.00
Deidentified Maximum,,25505,CPT4/HCPCS,TREAT FRACTURE OF RADIUS,,,3198.57
Deidentified Maximum,,25574,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,,7007.00
Deidentified Maximum,,25575,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,,7007.00
Deidentified Maximum,,25605,CPT4/HCPCS,TREAT FRACTURE RADIUS/ULNA,,,5856.00
Deidentified Maximum,,25670,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,5856.00
Deidentified Maximum,,25907,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,5856.00
Deidentified Maximum,,25920,CPT4/HCPCS,AMPUTATE HAND AT WRIST,,,5281.00
Deidentified Maximum,,25924,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,5281.00
Deidentified Maximum,,25927,CPT4/HCPCS,AMPUTATION OF HAND,,,4280.43
Deidentified Maximum,,26100,CPT4/HCPCS,BIOPSY HAND JOINT LINING,,,4280.43
Deidentified Maximum,,26115,CPT4/HCPCS,EXC HAND LES SC < 1.5 CM,,,4280.43
Deidentified Maximum,,26117,CPT4/HCPCS,RAD RESECT HAND TUMOR < 3 CM,,,5856.00
Deidentified Maximum,,26121,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,,6401.00
Deidentified Maximum,,26125,CPT4/HCPCS,RELEASE PALM CONTRACTURE,,,6401.00
Deidentified Maximum,,26140,CPT4/HCPCS,REVISE FINGER JOINT EACH,,,4280.43
Deidentified Maximum,,26170,CPT4/HCPCS,REMOVAL OF PALM TENDON EACH,,,5856.00
Deidentified Maximum,,26180,CPT4/HCPCS,REMOVAL OF FINGER TENDON,,,5856.00
Deidentified Maximum,,26236,CPT4/HCPCS,PARTIAL REMOVAL FINGER BONE,,,5856.00
Deidentified Maximum,,26250,CPT4/HCPCS,EXTENSIVE HAND SURGERY,,,5856.00
Deidentified Maximum,,26358,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,,6401.00
Deidentified Maximum,,26372,CPT4/HCPCS,REPAIR/GRAFT HAND TENDON,,,6401.00
Deidentified Maximum,,26373,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,5856.00
Deidentified Maximum,,26410,CPT4/HCPCS,REPAIR HAND TENDON,,,5856.00
Deidentified Maximum,,26416,CPT4/HCPCS,GRAFT HAND OR FINGER TENDON,,,5856.00
Deidentified Maximum,,26476,CPT4/HCPCS,TENDON LENGTHENING,,,3198.57
Deidentified Maximum,,26479,CPT4/HCPCS,SHORTENING OF HAND TENDON,,,3198.57
Deidentified Maximum,,26483,CPT4/HCPCS,TRANSPLANT/GRAFT HAND TENDON,,,5856.00
Deidentified Maximum,,26489,CPT4/HCPCS,TRANSPLANT/GRAFT PALM TENDON,,,5856.00
Deidentified Maximum,,26492,CPT4/HCPCS,TENDON TRANSFER WITH GRAFT,,,5856.00
Deidentified Maximum,,26498,CPT4/HCPCS,FINGER TENDON TRANSFER,,,6401.00
Deidentified Maximum,,26516,CPT4/HCPCS,FUSION OF KNUCKLE JOINT,,,5138.00
Deidentified Maximum,,26518,CPT4/HCPCS,FUSION OF KNUCKLE JOINTS,,,5856.00
Deidentified Maximum,,26554,CPT4/HCPCS,DOUBLE TRANSFER TOE-HAND,,,9548.65
Deidentified Maximum,,26593,CPT4/HCPCS,RELEASE MUSCLES OF HAND,,,5856.00
Deidentified Maximum,,26641,CPT4/HCPCS,TREAT THUMB DISLOCATION,,,1678.00
Deidentified Maximum,,26686,CPT4/HCPCS,TREAT HAND DISLOCATION,,,7007.00
Deidentified Maximum,,26725,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,3656.00
Deidentified Maximum,,26756,CPT4/HCPCS,PIN FINGER FRACTURE EACH,,,4280.43
Deidentified Maximum,,26770,CPT4/HCPCS,TREAT FINGER DISLOCATION,,,1678.00
Deidentified Maximum,,26776,CPT4/HCPCS,PIN FINGER DISLOCATION,,,4280.43
Deidentified Maximum,,26842,CPT4/HCPCS,THUMB FUSION WITH GRAFT,,,6401.00
Deidentified Maximum,,26843,CPT4/HCPCS,FUSION OF HAND JOINT,,,5856.00
Deidentified Maximum,,26850,CPT4/HCPCS,FUSION OF KNUCKLE,,,6401.00
Deidentified Maximum,,26852,CPT4/HCPCS,FUSION OF KNUCKLE WITH GRAFT,,,6401.00
Deidentified Maximum,,26862,CPT4/HCPCS,FUSION/GRAFT OF FINGER JOINT,,,6401.00
Deidentified Maximum,,27000,CPT4/HCPCS,INCISION OF HIP TENDON,,,4280.43
Deidentified Maximum,,27001,CPT4/HCPCS,INCISION OF HIP TENDON,,,5856.00
Deidentified Maximum,,27035,CPT4/HCPCS,DENERVATION OF HIP JOINT,,,6401.00
Deidentified Maximum,,27040,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,,3198.57
Deidentified Maximum,,27041,CPT4/HCPCS,BIOPSY OF SOFT TISSUES,,,4280.43
Deidentified Maximum,,27048,CPT4/HCPCS,EXC HIP/PELV TUM DEEP < 5 CM,,,5856.00
Deidentified Maximum,,27054,CPT4/HCPCS,REMOVAL OF HIP JOINT LINING,,,3544.00
Deidentified Maximum,,27059,CPT4/HCPCS,RESECT HIP/PELV TUM 5 CM/>,,,5856.00
Deidentified Maximum,,27110,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,,6401.00
Deidentified Maximum,,27120,CPT4/HCPCS,RECONSTRUCTION OF HIP SOCKET,,,5783.00
Deidentified Maximum,,27178,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,,7007.00
Deidentified Maximum,,27185,CPT4/HCPCS,REVISION OF FEMUR EPIPHYSIS,,,5281.00
Deidentified Maximum,,27193,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,,1678.00
Deidentified Maximum,,27198,CPT4/HCPCS,CLSD TX PELVIC RING FX,,,4280.43
Deidentified Maximum,,27216,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,,6049.05
Deidentified Maximum,,27217,CPT4/HCPCS,TREAT PELVIC RING FRACTURE,,,5029.00
Deidentified Maximum,,27240,CPT4/HCPCS,TREAT THIGH FRACTURE,,,3198.57
Deidentified Maximum,,27248,CPT4/HCPCS,TREAT THIGH FRACTURE,,,5281.00
Deidentified Maximum,,27250,CPT4/HCPCS,TREAT HIP DISLOCATION,,,3198.57
Deidentified Maximum,,27253,CPT4/HCPCS,TREAT HIP DISLOCATION,,,3544.00
Deidentified Maximum,,27257,CPT4/HCPCS,TREAT HIP DISLOCATION,,,5856.00
Deidentified Maximum,,27275,CPT4/HCPCS,MANIPULATION OF HIP JOINT,,,4280.43
Deidentified Maximum,,27307,CPT4/HCPCS,INCISION OF THIGH TENDONS,,,5856.00
Deidentified Maximum,,27325,CPT4/HCPCS,NEURECTOMY HAMSTRING,,,4280.43
Deidentified Maximum,,27328,CPT4/HCPCS,EXC THIGH/KNEE TUM DEEP <5CM,,,5856.00
Deidentified Maximum,,27333,CPT4/HCPCS,REMOVAL OF KNEE CARTILAGE,,,6401.00
Deidentified Maximum,,27350,CPT4/HCPCS,REMOVAL OF KNEECAP,,,6401.00
Deidentified Maximum,,27360,CPT4/HCPCS,PARTIAL REMOVAL LEG BONE(S),,,6876.92
Deidentified Maximum,,27397,CPT4/HCPCS,TRANSPLANTS OF THIGH TENDONS,,,6075.00
Deidentified Maximum,,27400,CPT4/HCPCS,REVISE THIGH MUSCLES/TENDONS,,,6075.00
Deidentified Maximum,,27403,CPT4/HCPCS,REPAIR OF KNEE CARTILAGE,,,6401.00
Deidentified Maximum,,27407,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,,7007.00
Deidentified Maximum,,27422,CPT4/HCPCS,REVISION OF UNSTABLE KNEECAP,,,9548.65
Deidentified Maximum,,27445,CPT4/HCPCS,REVISION OF KNEE JOINT,,,7007.00
Deidentified Maximum,,27486,CPT4/HCPCS,REVISE/REPLACE KNEE JOINT,,,10119.00
Deidentified Maximum,,27495,CPT4/HCPCS,REINFORCE THIGH,,,5029.00
Deidentified Maximum,,27510,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,3198.57
Deidentified Maximum,,27514,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,5281.00
Deidentified Maximum,,27524,CPT4/HCPCS,TREAT KNEECAP FRACTURE,,,7902.34
Deidentified Maximum,,27556,CPT4/HCPCS,TREAT KNEE DISLOCATION,,,5138.00
Deidentified Maximum,,27562,CPT4/HCPCS,TREAT KNEECAP DISLOCATION,,,3198.57
Deidentified Maximum,,27570,CPT4/HCPCS,FIXATION OF KNEE JOINT,,,3198.57
Deidentified Maximum,,27594,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,5856.00
Deidentified Maximum,,27600,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,,5856.00
Deidentified Maximum,,27602,CPT4/HCPCS,DECOMPRESSION OF LOWER LEG,,,5856.00
Deidentified Maximum,,27603,CPT4/HCPCS,DRAIN LOWER LEG LESION,,,4280.43
Deidentified Maximum,,27626,CPT4/HCPCS,REMOVE ANKLE JOINT LINING,,,6401.00
Deidentified Maximum,,27641,CPT4/HCPCS,PARTIAL REMOVAL OF FIBULA,,,5138.00
Deidentified Maximum,,27645,CPT4/HCPCS,RESECT TIBIA TUMOR,,,6049.05
Deidentified Maximum,,27692,CPT4/HCPCS,REVISE ADDITIONAL LEG TENDON,,,5856.00
Deidentified Maximum,,27709,CPT4/HCPCS,INCISION OF TIBIA & FIBULA,,,5138.00
Deidentified Maximum,,27715,CPT4/HCPCS,REVISION OF LOWER LEG,,,6401.00
Deidentified Maximum,,27724,CPT4/HCPCS,REPAIR/GRAFT OF TIBIA,,,5281.00
Deidentified Maximum,,27767,CPT4/HCPCS,CLTX POST ANKLE FX,,,4280.43
Deidentified Maximum,,27808,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,3198.57
Deidentified Maximum,,27814,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,7007.00
Deidentified Maximum,,27816,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,3198.57
Deidentified Maximum,,27822,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,7007.00
Deidentified Maximum,,27882,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,,5281.00
Deidentified Maximum,,27894,CPT4/HCPCS,DECOMPRESSION OF LEG,,,5856.00
Deidentified Maximum,,28010,CPT4/HCPCS,INCISION OF TOE TENDON,,,4891.93
Deidentified Maximum,,28022,CPT4/HCPCS,EXPLORATION OF FOOT JOINT,,,4280.43
Deidentified Maximum,,28041,CPT4/HCPCS,EXC FOOT/TOE TUM DEP 1.5CM/>,,,5856.00
Deidentified Maximum,,28043,CPT4/HCPCS,EXC FOOT/TOE TUM SC < 1.5 CM,,,4280.43
Deidentified Maximum,,28088,CPT4/HCPCS,EXCISE FOOT TENDON SHEATH,,,4280.43
Deidentified Maximum,,28107,CPT4/HCPCS,REMOVE/GRAFT FOOT LESION,,,7007.00
Deidentified Maximum,,28113,CPT4/HCPCS,PART REMOVAL OF METATARSAL,,,5856.00
Deidentified Maximum,,28126,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,,5856.00
Deidentified Maximum,,28140,CPT4/HCPCS,REMOVAL OF METATARSAL,,,5856.00
Deidentified Maximum,,28153,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,,5856.00
Deidentified Maximum,,28160,CPT4/HCPCS,PARTIAL REMOVAL OF TOE,,,5856.00
Deidentified Maximum,,28208,CPT4/HCPCS,REPAIR OF FOOT TENDON,,,5856.00
Deidentified Maximum,,28240,CPT4/HCPCS,RELEASE OF BIG TOE,,,4280.43
Deidentified Maximum,,28289,CPT4/HCPCS,CORRJ HALUX RIGDUS W/O IMPLT,,,5856.00
Deidentified Maximum,,28292,CPT4/HCPCS,CORRECTION HALLUX VALGUS,,,5138.00
Deidentified Maximum,,28305,CPT4/HCPCS,INCISE/GRAFT MIDFOOT BONES,,,7007.00
Deidentified Maximum,,28306,CPT4/HCPCS,INCISION OF METATARSAL,,,6401.00
Deidentified Maximum,,28308,CPT4/HCPCS,INCISION OF METATARSAL,,,4280.43
Deidentified Maximum,,28322,CPT4/HCPCS,REPAIR OF METATARSALS,,,6401.00
Deidentified Maximum,,28341,CPT4/HCPCS,RESECT ENLARGED TOE,,,6401.00
Deidentified Maximum,,28345,CPT4/HCPCS,REPAIR WEBBED TOE(S),,,6401.00
Deidentified Maximum,,28400,CPT4/HCPCS,TREATMENT OF HEEL FRACTURE,,,3198.57
Deidentified Maximum,,28420,CPT4/HCPCS,TREAT/GRAFT HEEL FRACTURE,,,7007.00
Deidentified Maximum,,28436,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,4280.43
Deidentified Maximum,,28465,CPT4/HCPCS,TREAT MIDFOOT FRACTURE EACH,,,7007.00
Deidentified Maximum,,28476,CPT4/HCPCS,TREAT METATARSAL FRACTURE,,,4280.43
Deidentified Maximum,,28496,CPT4/HCPCS,TREAT BIG TOE FRACTURE,,,4280.43
Deidentified Maximum,,28510,CPT4/HCPCS,TREATMENT OF TOE FRACTURE,,,2002.00
Deidentified Maximum,,28540,CPT4/HCPCS,TREAT FOOT DISLOCATION,,,2002.00
Deidentified Maximum,,28585,CPT4/HCPCS,REPAIR FOOT DISLOCATION,,,5856.00
Deidentified Maximum,,28635,CPT4/HCPCS,TREAT TOE DISLOCATION,,,3198.57
Deidentified Maximum,,28665,CPT4/HCPCS,TREAT TOE DISLOCATION,,,3198.57
Deidentified Maximum,,28805,CPT4/HCPCS,AMPUTATION THRU METATARSAL,,,5856.00
Deidentified Maximum,,28810,CPT4/HCPCS,AMPUTATION TOE & METATARSAL,,,4280.43
Deidentified Maximum,,28825,CPT4/HCPCS,PARTIAL AMPUTATION OF TOE,,,4280.43
Deidentified Maximum,,29015,CPT4/HCPCS,APPLICATION OF BODY CAST,,,1678.88
Deidentified Maximum,,29040,CPT4/HCPCS,APPLICATION OF BODY CAST,,,1678.88
Deidentified Maximum,,29055,CPT4/HCPCS,APPLICATION OF SHOULDER CAST,,,1678.00
Deidentified Maximum,,29065,CPT4/HCPCS,APPLICATION OF LONG ARM CAST,,,1214.00
Deidentified Maximum,,29260,CPT4/HCPCS,STRAPPING OF ELBOW OR WRIST,,,6766.00
Deidentified Maximum,,29305,CPT4/HCPCS,APPLICATION OF HIP CAST,,,2002.00
Deidentified Maximum,,29355,CPT4/HCPCS,APPLICATION OF LONG LEG CAST,,,1214.00
Deidentified Maximum,,46754,CPT4/HCPCS,REMOVAL OF SUTURE FROM ANUS,,,4280.43
Deidentified Maximum,,46761,CPT4/HCPCS,REPAIR OF ANAL SPHINCTER,,,5856.00
Deidentified Maximum,,46900,CPT4/HCPCS,DESTRUCTION ANAL LESION(S),,,3000.00
Deidentified Maximum,,46947,CPT4/HCPCS,HEMORRHOIDOPEXY BY STAPLING,,,7830.00
Deidentified Maximum,,47379,CPT4/HCPCS,LAPAROSCOPE PROCEDURE LIVER,,,7902.34
Deidentified Maximum,,47500,CPT4/HCPCS,INJECTION FOR LIVER X-RAYS,,,1678.00
Deidentified Maximum,,47505,CPT4/HCPCS,INJECTION FOR LIVER X-RAYS,,,1678.00
Deidentified Maximum,,47525,CPT4/HCPCS,CHANGE BILE DUCT CATHETER,,,1678.00
Deidentified Maximum,,47533,CPT4/HCPCS,PLMT BILIARY DRAINAGE CATH,,,8300.00
Deidentified Maximum,,47555,CPT4/HCPCS,BILIARY ENDOSCOPY THRU SKIN,,,5856.00
Deidentified Maximum,,47579,CPT4/HCPCS,LAPAROSCOPE PROC BILIARY,,,7902.34
Deidentified Maximum,,47605,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,,6840.00
Deidentified Maximum,,47700,CPT4/HCPCS,EXPLORATION OF BILE DUCTS,,,5281.00
Deidentified Maximum,,47765,CPT4/HCPCS,FUSE LIVER DUCTS & BOWEL,,,5783.00
Deidentified Maximum,,47785,CPT4/HCPCS,FUSE BILE DUCTS AND BOWEL,,,5783.00
Deidentified Maximum,,48102,CPT4/HCPCS,NEEDLE BIOPSY PANCREAS,,,3198.57
Deidentified Maximum,,48140,CPT4/HCPCS,PARTIAL REMOVAL OF PANCREAS,,,5783.00
Deidentified Maximum,,48153,CPT4/HCPCS,PANCREATECTOMY,,,6876.92
Deidentified Maximum,,48520,CPT4/HCPCS,FUSE PANCREAS CYST AND BOWEL,,,5783.00
Deidentified Maximum,,48551,CPT4/HCPCS,PREP DONOR PANCREAS,,,3544.00
Deidentified Maximum,,48552,CPT4/HCPCS,PREP DONOR PANCREAS/VENOUS,,,1678.00
Deidentified Maximum,,48556,CPT4/HCPCS,REMOVAL ALLOGRAFT PANCREAS,,,5783.00
Deidentified Maximum,,49021,CPT4/HCPCS,DRAIN ABDOMINAL ABSCESS,,,1678.00
Deidentified Maximum,,49040,CPT4/HCPCS,DRAIN OPEN ABDOM ABSCESS,,,8012.00
Deidentified Maximum,,49041,CPT4/HCPCS,DRAIN PERCUT ABDOM ABSCESS,,,1678.00
Deidentified Maximum,,49060,CPT4/HCPCS,DRAIN OPEN RETROPERI ABSCESS,,,8012.00
Deidentified Maximum,,49083,CPT4/HCPCS,ABD PARACENTESIS W/IMAGING,,,3656.00
Deidentified Maximum,,49204,CPT4/HCPCS,EXC ABD TUM OVER 5 CM,,,7007.00
Deidentified Maximum,,49329,CPT4/HCPCS,LAPARO PROC ABDM/PER/OMENT,,,7902.34
Deidentified Maximum,,49421,CPT4/HCPCS,INS TUN IP CATH FOR DIAL OPN,,,5138.00
Deidentified Maximum,,49425,CPT4/HCPCS,INSERT ABDOMEN-VENOUS DRAIN,,,3656.00
Deidentified Maximum,,49427,CPT4/HCPCS,INJECTION ABDOMINAL SHUNT,,,3000.00
Deidentified Maximum,,49495,CPT4/HCPCS,RPR ING HERNIA BABY REDUC,,,6401.00
Deidentified Maximum,,49507,CPT4/HCPCS,PRP I/HERN INIT BLOCK >5 YR,,,12850.70
Deidentified Maximum,,49520,CPT4/HCPCS,REREPAIR ING HERNIA REDUCE,,,9548.65
Deidentified Maximum,,49553,CPT4/HCPCS,RPR FEM HERNIA INIT BLOCKED,,,12850.70
Deidentified Maximum,,49566,CPT4/HCPCS,REREPAIR VENTRL HERN BLOCK,,,12850.70
Deidentified Maximum,,49570,CPT4/HCPCS,RPR EPIGASTRIC HERN REDUCE,,,6401.00
Deidentified Maximum,,49590,CPT4/HCPCS,REPAIR SPIGELIAN HERNIA,,,5856.00
Deidentified Maximum,,49600,CPT4/HCPCS,REPAIR UMBILICAL LESION,,,6401.00
Deidentified Maximum,,49606,CPT4/HCPCS,REPAIR UMBILICAL LESION,,,5281.00
Deidentified Maximum,,49651,CPT4/HCPCS,LAP ING HERNIA REPAIR RECUR,,,9548.65
Deidentified Maximum,,49657,CPT4/HCPCS,LAP INC HERN RECUR COMP,,,8300.00
Deidentified Maximum,,49659,CPT4/HCPCS,LAPARO PROC HERNIA REPAIR,,,9548.65
Deidentified Maximum,,49904,CPT4/HCPCS,OMENTAL FLAP EXTRA-ABDOM,,,4280.43
Deidentified Maximum,,49906,CPT4/HCPCS,FREE OMENTAL FLAP MICROVASC,,,3198.57
Deidentified Maximum,,50010,CPT4/HCPCS,EXPLORATION OF KIDNEY,,,5783.00
Deidentified Maximum,,50075,CPT4/HCPCS,REMOVAL OF KIDNEY STONE,,,5783.00
Deidentified Maximum,,50250,CPT4/HCPCS,CRYOABLATE RENAL MASS OPEN,,,7830.00
Deidentified Maximum,,50360,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,,6588.00
Deidentified Maximum,,50365,CPT4/HCPCS,TRANSPLANTATION OF KIDNEY,,,6588.00
Deidentified Maximum,,50370,CPT4/HCPCS,REMOVE TRANSPLANTED KIDNEY,,,5281.00
Deidentified Maximum,,50380,CPT4/HCPCS,REIMPLANTATION OF KIDNEY,,,6588.00
Deidentified Maximum,,50386,CPT4/HCPCS,REMOVE STENT VIA TRANSURETH,,,4280.43
Deidentified Maximum,,50435,CPT4/HCPCS,EXCHANGE NEPHROSTOMY CATH,,,4000.00
Deidentified Maximum,,50540,CPT4/HCPCS,REVISION OF HORSESHOE KIDNEY,,,5783.00
Deidentified Maximum,,50542,CPT4/HCPCS,LAPARO ABLATE RENAL MASS,,,10119.00
Deidentified Maximum,,50561,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,,4204.00
Deidentified Maximum,,50575,CPT4/HCPCS,KIDNEY ENDOSCOPY,,,6075.00
Deidentified Maximum,,50576,CPT4/HCPCS,KIDNEY ENDOSCOPY & TREATMENT,,,3198.57
Deidentified Maximum,,50593,CPT4/HCPCS,PERC CRYO ABLATE RENAL TUM,,,9770.00
Deidentified Maximum,,50605,CPT4/HCPCS,INSERT URETERAL SUPPORT,,,6840.00
Deidentified Maximum,,50630,CPT4/HCPCS,REMOVAL OF URETER STONE,,,6840.00
Deidentified Maximum,,50660,CPT4/HCPCS,REMOVAL OF URETER,,,7188.00
Deidentified Maximum,,50770,CPT4/HCPCS,SPLICING OF URETERS,,,5281.00
Deidentified Maximum,,50783,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,,3198.57
Deidentified Maximum,,50820,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,,8012.00
Deidentified Maximum,,50949,CPT4/HCPCS,LAPAROSCOPE PROC URETER,,,7902.34
Deidentified Maximum,,50961,CPT4/HCPCS,URETER ENDOSCOPY & TREATMENT,,,4204.00
Deidentified Maximum,,51050,CPT4/HCPCS,REMOVAL OF BLADDER STONE,,,6401.00
Deidentified Maximum,,51101,CPT4/HCPCS,DRAIN BLADDER BY TROCAR/CATH,,,3198.57
Deidentified Maximum,,51597,CPT4/HCPCS,REMOVAL OF PELVIC STRUCTURES,,,8841.00
Deidentified Maximum,,51726,CPT4/HCPCS,COMPLEX CYSTOMETROGRAM,,,3198.57
Deidentified Maximum,,51728,CPT4/HCPCS,CYSTOMETROGRAM W/VP,,,3198.57
Deidentified Maximum,,51785,CPT4/HCPCS,ANAL/URINARY MUSCLE STUDY,,,3198.57
Deidentified Maximum,,51797,CPT4/HCPCS,INTRAABDOMINAL PRESSURE TEST,,,3000.00
Deidentified Maximum,,51798,CPT4/HCPCS,US URINE CAPACITY MEASURE,,,1678.00
Deidentified Maximum,,51920,CPT4/HCPCS,CLOSE BLADDER-UTERUS FISTULA,,,5856.00
Deidentified Maximum,,52265,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,3656.00
Deidentified Maximum,,52317,CPT4/HCPCS,REMOVE BLADDER STONE,,,4204.00
Deidentified Maximum,,52346,CPT4/HCPCS,CYSTOURETERO W/RENAL STRICT,,,5856.00
Deidentified Maximum,,52355,CPT4/HCPCS,CYSTOURETERO W/EXCISE TUMOR,,,6401.00
Deidentified Maximum,,52441,CPT4/HCPCS,CYSTOURETHRO W/IMPLANT,,,5856.00
Deidentified Maximum,,52640,CPT4/HCPCS,RELIEVE BLADDER CONTRACTURE,,,4280.43
Deidentified Maximum,,52647,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,,12850.70
Deidentified Maximum,,53085,CPT4/HCPCS,DRAINAGE OF URINARY LEAKAGE,,,4204.00
Deidentified Maximum,,53200,CPT4/HCPCS,BIOPSY OF URETHRA,,,4204.00
Deidentified Maximum,,53215,CPT4/HCPCS,REMOVAL OF URETHRA,,,6876.92
Deidentified Maximum,,53235,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,,5856.00
Deidentified Maximum,,53275,CPT4/HCPCS,REPAIR OF URETHRA DEFECT,,,4280.43
Deidentified Maximum,,53450,CPT4/HCPCS,REVISION OF URETHRA,,,5138.00
Deidentified Maximum,,53502,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,,4280.43
Deidentified Maximum,,53661,CPT4/HCPCS,DILATION OF URETHRA,,,1214.00
Deidentified Maximum,,53855,CPT4/HCPCS,INSERT PROST URETHRAL STENT,,,3198.57
Deidentified Maximum,,53860,CPT4/HCPCS,TRANSURETHRAL RF TREATMENT,,,6000.00
Deidentified Maximum,,54056,CPT4/HCPCS,CRYOSURGERY PENIS LESION(S),,,1678.00
Deidentified Maximum,,54150,CPT4/HCPCS,CIRCUMCISION W/REGIONL BLOCK,,,4204.00
Deidentified Maximum,,54231,CPT4/HCPCS,DYNAMIC CAVERNOSOMETRY,,,4280.43
Deidentified Maximum,,54340,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,,5856.00
Deidentified Maximum,,54344,CPT4/HCPCS,SECONDARY URETHRAL SURGERY,,,5856.00
Deidentified Maximum,,54401,CPT4/HCPCS,INSERT SELF-CONTD PROSTHESIS,,,10772.00
Deidentified Maximum,,54430,CPT4/HCPCS,REVISION OF PENIS,,,3198.57
Deidentified Maximum,,54437,CPT4/HCPCS,REPAIR CORPOREAL TEAR,,,6049.05
Deidentified Maximum,,54438,CPT4/HCPCS,REPLANTATION OF PENIS,,,5281.00
Deidentified Maximum,,54500,CPT4/HCPCS,BIOPSY OF TESTIS,,,3198.57
Deidentified Maximum,,54522,CPT4/HCPCS,ORCHIECTOMY PARTIAL,,,5856.00
Deidentified Maximum,,54535,CPT4/HCPCS,EXTENSIVE TESTIS SURGERY,,,5281.00
Deidentified Maximum,,55040,CPT4/HCPCS,REMOVAL OF HYDROCELE,,,5856.00
Deidentified Maximum,,55120,CPT4/HCPCS,REMOVAL OF SCROTUM LESION,,,4280.43
Deidentified Maximum,,55150,CPT4/HCPCS,REMOVAL OF SCROTUM,,,4204.00
Deidentified Maximum,,55175,CPT4/HCPCS,REVISION OF SCROTUM,,,6075.00
Deidentified Maximum,,55450,CPT4/HCPCS,LIGATION OF SPERM DUCT,,,1678.00
Deidentified Maximum,,55550,CPT4/HCPCS,LAPARO LIGATE SPERMATIC VEIN,,,12850.70
Deidentified Maximum,,55650,CPT4/HCPCS,REMOVE SPERM DUCT POUCH,,,3198.57
Deidentified Maximum,,55801,CPT4/HCPCS,REMOVAL OF PROSTATE,,,5281.00
Deidentified Maximum,,55866,CPT4/HCPCS,LAPARO RADICAL PROSTATECTOMY,,,10119.00
Deidentified Maximum,,55899,CPT4/HCPCS,GENITAL SURGERY PROCEDURE,,,3656.00
Deidentified Maximum,,56501,CPT4/HCPCS,DESTROY VULVA LESIONS SIM,,,4280.43
Deidentified Maximum,,56630,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,5281.00
Deidentified Maximum,,56740,CPT4/HCPCS,REMOVE VAGINA GLAND LESION,,,5856.00
Deidentified Maximum,,56810,CPT4/HCPCS,REPAIR OF PERINEUM,,,6876.92
Deidentified Maximum,,57010,CPT4/HCPCS,DRAINAGE OF PELVIC ABSCESS,,,4280.43
Deidentified Maximum,,57105,CPT4/HCPCS,BIOPSY OF VAGINA,,,4280.43
Deidentified Maximum,,57150,CPT4/HCPCS,TREAT VAGINA INFECTION,,,1214.00
Deidentified Maximum,,57170,CPT4/HCPCS,FITTING OF DIAPHRAGM/CAP,,,1214.00
Deidentified Maximum,,57220,CPT4/HCPCS,REVISION OF URETHRA,,,6075.00
Deidentified Maximum,,57260,CPT4/HCPCS,CMBN ANT PST COLPRHY,,,6876.92
Deidentified Maximum,,57284,CPT4/HCPCS,REPAIR PARAVAG DEFECT OPEN,,,6876.92
Deidentified Maximum,,57305,CPT4/HCPCS,REPAIR RECTUM-VAGINA FISTULA,,,6840.00
Deidentified Maximum,,57308,CPT4/HCPCS,FISTULA REPAIR TRANSPERINE,,,5281.00
Deidentified Maximum,,57335,CPT4/HCPCS,REPAIR VAGINA,,,5856.00
Deidentified Maximum,,57505,CPT4/HCPCS,ENDOCERVICAL CURETTAGE,,,3000.00
Deidentified Maximum,,57558,CPT4/HCPCS,D&C OF CERVICAL STUMP,,,5856.00
Deidentified Maximum,,58280,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,,8012.00
Deidentified Maximum,,58292,CPT4/HCPCS,VAG HYST T/O & REPAIR COMPL,,,8012.00
Deidentified Maximum,,58300,CPT4/HCPCS,INSERT INTRAUTERINE DEVICE,,,2002.00
Deidentified Maximum,,58346,CPT4/HCPCS,INSERT HEYMAN UTERI CAPSULE,,,4280.43
Deidentified Maximum,,58353,CPT4/HCPCS,ENDOMETR ABLATE THERMAL,,,7830.00
Deidentified Maximum,,58410,CPT4/HCPCS,SUSPENSION OF UTERUS,,,3544.00
Deidentified Maximum,,58554,CPT4/HCPCS,LAPARO-VAG HYST W/T/O COMPL,,,12850.70
Deidentified Maximum,,58555,CPT4/HCPCS,HYSTEROSCOPY DX SEP PROC,,,4204.00
Deidentified Maximum,,58560,CPT4/HCPCS,HYSTEROSCOPY RESECT SEPTUM,,,5856.00
Deidentified Maximum,,58571,CPT4/HCPCS,TLH W/T/O 250 G OR LESS,,,8300.00
Deidentified Maximum,,58600,CPT4/HCPCS,DIVISION OF FALLOPIAN TUBE,,,6876.92
Deidentified Maximum,,58660,CPT4/HCPCS,LAPAROSCOPY LYSIS,,,7007.00
Deidentified Maximum,,58661,CPT4/HCPCS,LAPAROSCOPY REMOVE ADNEXA,,,7007.00
Deidentified Maximum,,58679,CPT4/HCPCS,LAPARO PROC OVIDUCT-OVARY,,,7902.34
Deidentified Maximum,,58700,CPT4/HCPCS,REMOVAL OF FALLOPIAN TUBE,,,6840.00
Deidentified Maximum,,58752,CPT4/HCPCS,REVISE OVARIAN TUBE(S),,,6840.00
Deidentified Maximum,,58823,CPT4/HCPCS,DRAIN PELVIC ABSCESS PERCUT,,,1678.00
Deidentified Maximum,,59015,CPT4/HCPCS,CHORION BIOPSY,,,3198.57
Deidentified Maximum,,59030,CPT4/HCPCS,FETAL SCALP BLOOD SAMPLE,,,3198.57
Deidentified Maximum,,59200,CPT4/HCPCS,INSERT CERVICAL DILATOR,,,3000.00
Deidentified Maximum,,59410,CPT4/HCPCS,OBSTETRICAL CARE,,,4280.43
Deidentified Maximum,,59412,CPT4/HCPCS,ANTEPARTUM MANIPULATION,,,4204.00
Deidentified Maximum,,59425,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,,987.78
Deidentified Maximum,,59812,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,,6876.92
Deidentified Maximum,,59820,CPT4/HCPCS,CARE OF MISCARRIAGE,,,6876.92
Deidentified Maximum,,59821,CPT4/HCPCS,TREATMENT OF MISCARRIAGE,,,6876.92
Deidentified Maximum,,59841,CPT4/HCPCS,ABORTION,,,6876.92
Deidentified Maximum,,59851,CPT4/HCPCS,ABORTION,,,4891.93
Deidentified Maximum,,59852,CPT4/HCPCS,ABORTION,,,4891.93
Deidentified Maximum,,60254,CPT4/HCPCS,EXTENSIVE THYROID SURGERY,,,7830.00
Deidentified Maximum,,60281,CPT4/HCPCS,REMOVE THYROID DUCT LESION,,,7007.00
Deidentified Maximum,,60300,CPT4/HCPCS,ASPIR/INJ THYROID CYST,,,2002.00
Deidentified Maximum,,60521,CPT4/HCPCS,REMOVAL OF THYMUS GLAND,,,3198.57
Deidentified Maximum,,60699,CPT4/HCPCS,ENDOCRINE SURGERY PROCEDURE,,,9548.65
Deidentified Maximum,,61000,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,,3198.57
Deidentified Maximum,,61140,CPT4/HCPCS,PIERCE SKULL FOR BIOPSY,,,5783.00
Deidentified Maximum,,61156,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,,5281.00
Deidentified Maximum,,61210,CPT4/HCPCS,PIERCE SKULL IMPLANT DEVICE,,,5281.00
Deidentified Maximum,,61215,CPT4/HCPCS,INSERT BRAIN-FLUID DEVICE,,,6075.00
Deidentified Maximum,,61304,CPT4/HCPCS,OPEN SKULL FOR EXPLORATION,,,6588.00
Deidentified Maximum,,61323,CPT4/HCPCS,DECOMPRESSIVE LOBECTOMY,,,6588.00
Deidentified Maximum,,61500,CPT4/HCPCS,REMOVAL OF SKULL LESION,,,8797.00
Deidentified Maximum,,61535,CPT4/HCPCS,REMOVE BRAIN ELECTRODES,,,5783.00
Deidentified Maximum,,61537,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,6588.00
Deidentified Maximum,,61538,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,8012.00
Deidentified Maximum,,61544,CPT4/HCPCS,REMOVE & TREAT BRAIN LESION,,,8012.00
Deidentified Maximum,,61548,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,,6588.00
Deidentified Maximum,,61556,CPT4/HCPCS,INCISE SKULL/SUTURES,,,5783.00
Deidentified Maximum,,61558,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,,6588.00
Deidentified Maximum,,61571,CPT4/HCPCS,INCISE SKULL FOR BRAIN WOUND,,,6588.00
Deidentified Maximum,,61575,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,,8012.00
Deidentified Maximum,,61585,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,,6876.92
Deidentified Maximum,,61598,CPT4/HCPCS,TRANSPETROSAL APPROACH/SKULL,,,8012.00
Deidentified Maximum,,61600,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,6588.00
Deidentified Maximum,,61613,CPT4/HCPCS,REMOVE ANEURYSM SINUS,,,8012.00
Deidentified Maximum,,61616,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,,8841.00
Deidentified Maximum,,61635,CPT4/HCPCS,INTRACRAN ANGIOPLSTY W/STENT,,,5310.00
Deidentified Maximum,,61682,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,9548.65
Deidentified Maximum,,61686,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,9548.65
Deidentified Maximum,,61698,CPT4/HCPCS,BRAIN ANEURYSM REPR COMPLX,,,7902.34
Deidentified Maximum,,61702,CPT4/HCPCS,INNER SKULL VESSEL SURGERY,,,8012.00
Deidentified Maximum,,61781,CPT4/HCPCS,SCAN PROC CRANIAL INTRA,,,5310.00
Deidentified Maximum,,61790,CPT4/HCPCS,TREAT TRIGEMINAL NERVE,,,5856.00
Deidentified Maximum,,61799,CPT4/HCPCS,SRS CRAN LES COMPLEX ADDL,,,5310.00
Deidentified Maximum,,61800,CPT4/HCPCS,APPLY SRS HEADFRAME ADD-ON,,,5310.00
Deidentified Maximum,,61860,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,5783.00
Deidentified Maximum,,61864,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,,5310.00
Deidentified Maximum,,61868,CPT4/HCPCS,IMPLANT NEUROELECTRDE ADDL,,,5310.00
Deidentified Maximum,,61888,CPT4/HCPCS,REVISE/REMOVE NEURORECEIVER,,,5310.00
Deidentified Maximum,,62000,CPT4/HCPCS,TREAT SKULL FRACTURE,,,6075.00
Deidentified Maximum,,62010,CPT4/HCPCS,TREATMENT OF HEAD INJURY,,,5783.00
Deidentified Maximum,,62146,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,,6588.00
Deidentified Maximum,,62200,CPT4/HCPCS,ESTABLISH BRAIN CAVITY SHUNT,,,5783.00
Deidentified Maximum,,62263,CPT4/HCPCS,EPIDURAL LYSIS MULT SESSIONS,,,5310.00
Deidentified Maximum,,62273,CPT4/HCPCS,INJECT EPIDURAL PATCH,,,5310.00
Deidentified Maximum,,62284,CPT4/HCPCS,INJECTION FOR MYELOGRAM,,,5310.00
Deidentified Maximum,,62310,CPT4/HCPCS,INJECT SPINE CERV/THORACIC,,,1678.00
Deidentified Maximum,,62319,CPT4/HCPCS,INJECT SPINE W/CATH LMB/SCRL,,,1678.00
Deidentified Maximum,,62323,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,,5310.00
Deidentified Maximum,,62380,CPT4/HCPCS,NDSC DCMPRN 1 NTRSPC LUMBAR,,,9548.65
Deidentified Maximum,,63015,CPT4/HCPCS,REMOVE SPINE LAMINA >2 CRVCL,,,9548.65
Deidentified Maximum,,63030,CPT4/HCPCS,LOW BACK DISK SURGERY,,,9548.65
Deidentified Maximum,,63040,CPT4/HCPCS,LAMINOTOMY SINGLE CERVICAL,,,9548.65
Deidentified Maximum,,63048,CPT4/HCPCS,REMOVE SPINAL LAMINA ADD-ON,,,9548.65
Deidentified Maximum,,63050,CPT4/HCPCS,CERVICAL LAMINOPLSTY 2/> SEG,,,5310.00
Deidentified Maximum,,63077,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,,5310.00
Deidentified Maximum,,63086,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,5310.00
Deidentified Maximum,,63182,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,,6588.00
Deidentified Maximum,,63185,CPT4/HCPCS,INCISE SPINE NRV HALF SEGMNT,,,10119.00
Deidentified Maximum,,63195,CPT4/HCPCS,INCISE SPINE & CORD THORACIC,,,5783.00
Deidentified Maximum,,63196,CPT4/HCPCS,INCISE SPINE&CORD 2 TRX CRVL,,,5783.00
Deidentified Maximum,,63267,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,,5310.00
Deidentified Maximum,,63270,CPT4/HCPCS,EXCISE INTRSPINL LESION CRVL,,,5783.00
Deidentified Maximum,,63273,CPT4/HCPCS,EXCISE INTRSPINL LESION SCRL,,,5310.00
Deidentified Maximum,,63275,CPT4/HCPCS,BX/EXC XDRL SPINE LESN CRVL,,,5310.00
Deidentified Maximum,,63282,CPT4/HCPCS,BX/EXC IDRL SPINE LESN LMBR,,,10119.00
Deidentified Maximum,,63283,CPT4/HCPCS,BX/EXC IDRL SPINE LESN SCRL,,,5310.00
Deidentified Maximum,,63285,CPT4/HCPCS,BX/EXC IDRL IMED LESN CERVL,,,6049.05
Deidentified Maximum,,63287,CPT4/HCPCS,BX/EXC IDRL IMED LESN THRLMB,,,10119.00
Deidentified Maximum,,63290,CPT4/HCPCS,BX/EXC XDRL/IDRL LSN ANY LVL,,,10119.00
Deidentified Maximum,,63303,CPT4/HCPCS,REMOV VERT XDRL BDY LMBR/SAC,,,5783.00
Deidentified Maximum,,63306,CPT4/HCPCS,REMOV VERT IDRL BDY THRCLMBR,,,6049.05
Deidentified Maximum,,63621,CPT4/HCPCS,SRS SPINAL LESION ADDL,,,5310.00
Deidentified Maximum,,63663,CPT4/HCPCS,REVISE SPINE ELTRD PERQ ARAY,,,7007.00
Deidentified Maximum,,63664,CPT4/HCPCS,REVISE SPINE ELTRD PLATE,,,7007.00
Deidentified Maximum,,63706,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,,5310.00
Deidentified Maximum,,63741,CPT4/HCPCS,INSTALL SPINAL SHUNT,,,12850.70
Deidentified Maximum,,64410,CPT4/HCPCS,N BLOCK INJ PHRENIC,,,3198.57
Deidentified Maximum,,64418,CPT4/HCPCS,NJX AA&/STRD SPRSCAP NRV,,,5310.00
Deidentified Maximum,,64446,CPT4/HCPCS,NJX AA&/STRD SCIATIC NRV NFS,,,5310.00
Deidentified Maximum,,64483,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S 1,,,5310.00
Deidentified Maximum,,64569,CPT4/HCPCS,REVISE/REPL VAGUS N ELTRD,,,7007.00
Deidentified Maximum,,64575,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,10119.00
Deidentified Maximum,,64580,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,10119.00
Deidentified Maximum,,64581,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,12850.70
Deidentified Maximum,,64610,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,5310.00
Deidentified Maximum,,64616,CPT4/HCPCS,CHEMODENERV MUSC NECK DYSTON,,,5310.00
Deidentified Maximum,,64647,CPT4/HCPCS,CHEMODENERV TRUNK MUSC 6/>,,,5310.00
Deidentified Maximum,,64680,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,5310.00
Deidentified Maximum,,64681,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,5310.00
Deidentified Maximum,,64702,CPT4/HCPCS,REVISE FINGER/TOE NERVE,,,5310.00
Deidentified Maximum,,64704,CPT4/HCPCS,REVISE HAND/FOOT NERVE,,,5310.00
Deidentified Maximum,,64718,CPT4/HCPCS,REVISE ULNAR NERVE AT ELBOW,,,5310.00
Deidentified Maximum,,64726,CPT4/HCPCS,RELEASE FOOT/TOE NERVE,,,5310.00
Deidentified Maximum,,64734,CPT4/HCPCS,INCISION OF CHEEK NERVE,,,5310.00
Deidentified Maximum,,64740,CPT4/HCPCS,INCISION OF TONGUE NERVE,,,5310.00
Deidentified Maximum,,64746,CPT4/HCPCS,INCISE DIAPHRAGM NERVE,,,5310.00
Deidentified Maximum,,64755,CPT4/HCPCS,INCISION OF STOMACH NERVES,,,5310.00
Deidentified Maximum,,64766,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,,5310.00
Deidentified Maximum,,64771,CPT4/HCPCS,SEVER CRANIAL NERVE,,,5310.00
Deidentified Maximum,,64783,CPT4/HCPCS,LIMB NERVE SURGERY ADD-ON,,,5310.00
Deidentified Maximum,,64787,CPT4/HCPCS,IMPLANT NERVE END,,,5310.00
Deidentified Maximum,,64792,CPT4/HCPCS,REMOVAL OF NERVE LESION,,,6075.00
Deidentified Maximum,,64820,CPT4/HCPCS,SYMPATHECTOMY DIGITAL ARTERY,,,5310.00
Deidentified Maximum,,64859,CPT4/HCPCS,NERVE SURGERY,,,5310.00
Deidentified Maximum,,64864,CPT4/HCPCS,REPAIR OF FACIAL NERVE,,,6075.00
Deidentified Maximum,,64870,CPT4/HCPCS,FUSION OF FACIAL/OTHER NERVE,,,5029.00
Deidentified Maximum,,64876,CPT4/HCPCS,REPAIR NERVE/SHORTEN BONE,,,5856.00
Deidentified Maximum,,64885,CPT4/HCPCS,NERVE GRAFT HEAD/NECK 4 CM,,,6075.00
Deidentified Maximum,,64907,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,,6075.00
Deidentified Maximum,,64912,CPT4/HCPCS,NRV RPR W/NRV ALGRFT 1ST,,,6075.00
Deidentified Maximum,,64999,CPT4/HCPCS,NERVOUS SYSTEM SURGERY,,,3198.57
Deidentified Maximum,,65093,CPT4/HCPCS,REVISE EYE WITH IMPLANT,,,5856.00
Deidentified Maximum,,65140,CPT4/HCPCS,ATTACH OCULAR IMPLANT,,,5856.00
Deidentified Maximum,,65275,CPT4/HCPCS,REPAIR OF EYE WOUND,,,6401.00
Deidentified Maximum,,65280,CPT4/HCPCS,REPAIR OF EYE WOUND,,,6401.00
Deidentified Maximum,,65430,CPT4/HCPCS,CORNEAL SMEAR,,,5310.00
Deidentified Maximum,,65436,CPT4/HCPCS,CURETTE/TREAT CORNEA,,,5310.00
Deidentified Maximum,,65730,CPT4/HCPCS,CORNEAL TRANSPLANT,,,9548.65
Deidentified Maximum,,65750,CPT4/HCPCS,CORNEAL TRANSPLANT,,,9548.65
Deidentified Maximum,,65755,CPT4/HCPCS,CORNEAL TRANSPLANT,,,9548.65
Deidentified Maximum,,65775,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,,6401.00
Deidentified Maximum,,65780,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,,9548.65
Deidentified Maximum,,65800,CPT4/HCPCS,DRAINAGE OF EYE,,,5310.00
Deidentified Maximum,,66170,CPT4/HCPCS,GLAUCOMA SURGERY,,,6401.00
Deidentified Maximum,,66630,CPT4/HCPCS,REMOVAL OF IRIS,,,5856.00
Deidentified Maximum,,66761,CPT4/HCPCS,REVISION OF IRIS,,,5310.00
Deidentified Maximum,,66852,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,,6401.00
Deidentified Maximum,,67005,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,,6401.00
Deidentified Maximum,,67030,CPT4/HCPCS,INCISE INNER EYE STRANDS,,,5310.00
Deidentified Maximum,,67105,CPT4/HCPCS,REPAIR DETACHED RETINA PC,,,6840.00
Deidentified Maximum,,67115,CPT4/HCPCS,RELEASE ENCIRCLING MATERIAL,,,5310.00
Deidentified Maximum,,67227,CPT4/HCPCS,DSTRJ EXTENSIVE RETINOPATHY,,,5310.00
Deidentified Maximum,,67228,CPT4/HCPCS,TREATMENT X10SV RETINOPATHY,,,5310.00
Deidentified Maximum,,67229,CPT4/HCPCS,TR RETINAL LES PRETERM INF,,,7902.34
Deidentified Maximum,,67312,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,,6401.00
Deidentified Maximum,,67320,CPT4/HCPCS,REVISE EYE MUSCLE(S) ADD-ON,,,6401.00
Deidentified Maximum,,67343,CPT4/HCPCS,RELEASE EYE TISSUE,,,7830.00
Deidentified Maximum,,67505,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,,5310.00
Deidentified Maximum,,67805,CPT4/HCPCS,REMOVE EYELID LESIONS,,,5310.00
Deidentified Maximum,,67825,CPT4/HCPCS,REVISE EYELASHES,,,5310.00
Deidentified Maximum,,67902,CPT4/HCPCS,REPAIR EYELID DEFECT,,,6876.92
Deidentified Maximum,,67908,CPT4/HCPCS,REPAIR EYELID DEFECT,,,6401.00
Deidentified Maximum,,67911,CPT4/HCPCS,REVISE EYELID DEFECT,,,5856.00
Deidentified Maximum,,67915,CPT4/HCPCS,REPAIR EYELID DEFECT,,,5856.00
Deidentified Maximum,,67922,CPT4/HCPCS,REPAIR EYELID DEFECT,,,5856.00
Deidentified Maximum,,67935,CPT4/HCPCS,REPAIR EYELID WOUND,,,5310.00
Deidentified Maximum,,67938,CPT4/HCPCS,REMOVE EYELID FOREIGN BODY,,,5310.00
Deidentified Maximum,,67975,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,,5856.00
Deidentified Maximum,,68135,CPT4/HCPCS,REMOVE EYELID LINING LESION,,,5310.00
Deidentified Maximum,,68325,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,,6401.00
Deidentified Maximum,,68326,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,,6401.00
Deidentified Maximum,,68371,CPT4/HCPCS,HARVEST EYE TISSUE ALOGRAFT,,,5310.00
Deidentified Maximum,,68530,CPT4/HCPCS,CLEARANCE OF TEAR DUCT,,,5310.00
Deidentified Maximum,,68700,CPT4/HCPCS,REPAIR TEAR DUCTS,,,5310.00
Deidentified Maximum,,68745,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,,6401.00
Deidentified Maximum,,68750,CPT4/HCPCS,CREATE TEAR DUCT DRAIN,,,6401.00
Deidentified Maximum,,68840,CPT4/HCPCS,EXPLORE/IRRIGATE TEAR DUCTS,,,5310.00
Deidentified Maximum,,69110,CPT4/HCPCS,REMOVE EXTERNAL EAR PARTIAL,,,5310.00
Deidentified Maximum,,69120,CPT4/HCPCS,REMOVAL OF EXTERNAL EAR,,,5310.00
Deidentified Maximum,,69145,CPT4/HCPCS,REMOVE EAR CANAL LESION(S),,,5310.00
Deidentified Maximum,,69150,CPT4/HCPCS,EXTENSIVE EAR CANAL SURGERY,,,5856.00
Deidentified Maximum,,69209,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,,5310.00
Deidentified Maximum,,69222,CPT4/HCPCS,CLEAN OUT MASTOID CAVITY,,,5310.00
Deidentified Maximum,,69511,CPT4/HCPCS,EXTENSIVE MASTOID SURGERY,,,9548.65
Deidentified Maximum,,69603,CPT4/HCPCS,MASTOID SURGERY REVISION,,,9548.65
Deidentified Maximum,,69641,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,9548.65
Deidentified Maximum,,69662,CPT4/HCPCS,REVISE MIDDLE EAR BONE,,,6876.92
Deidentified Maximum,,69700,CPT4/HCPCS,CLOSE MASTOID FISTULA,,,5856.00
Deidentified Maximum,,69717,CPT4/HCPCS,TEMPLE BONE IMPLANT REVISION,,,12850.70
Deidentified Maximum,,70134,CPT4/HCPCS,X-RAY EXAM OF MIDDLE EAR,,,376.23
Deidentified Maximum,,70160,CPT4/HCPCS,X-RAY EXAM OF NASAL BONES,,,364.35
Deidentified Maximum,,70190,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,,364.35
Deidentified Maximum,,70240,CPT4/HCPCS,X-RAY EXAM PITUITARY SADDLE,,,364.35
Deidentified Maximum,,70370,CPT4/HCPCS,THROAT X-RAY & FLUOROSCOPY,,,658.55
Deidentified Maximum,,70460,CPT4/HCPCS,CT HEAD/BRAIN W/DYE,,,6766.00
Deidentified Maximum,,70481,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/DYE,,,6766.00
Deidentified Maximum,,70492,CPT4/HCPCS,CT SFT TSUE NCK W/O & W/DYE,,,6766.00
Deidentified Maximum,,70540,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/O DYE,,,6766.00
Deidentified Maximum,,70544,CPT4/HCPCS,MR ANGIOGRAPHY HEAD W/O DYE,,,6766.00
Deidentified Maximum,,70548,CPT4/HCPCS,MR ANGIOGRAPHY NECK W/DYE,,,6766.00
Deidentified Maximum,,70552,CPT4/HCPCS,MRI BRAIN STEM W/DYE,,,6773.29
Deidentified Maximum,,71020,CPT4/HCPCS,CHEST X-RAY 2VW FRONTAL&LATL,,,0.00
Deidentified Maximum,,71021,CPT4/HCPCS,CHEST X-RAY FRNT LAT LORDOTC,,,0.00
Deidentified Maximum,,71030,CPT4/HCPCS,CHEST X-RAY 4/> VIEWS,,,0.00
Deidentified Maximum,,71035,CPT4/HCPCS,CHEST X-RAY SPECIAL VIEWS,,,0.00
Deidentified Maximum,,71046,CPT4/HCPCS,X-RAY EXAM CHEST 2 VIEWS,,,364.35
Deidentified Maximum,,71101,CPT4/HCPCS,X-RAY EXAM UNILAT RIBS/CHEST,,,657.95
Deidentified Maximum,,71110,CPT4/HCPCS,X-RAY EXAM RIBS BIL 3 VIEWS,,,657.95
Deidentified Maximum,,72020,CPT4/HCPCS,X-RAY EXAM OF SPINE 1 VIEW,,,364.35
Deidentified Maximum,,72052,CPT4/HCPCS,X-RAY EXAM NECK SPINE 6/>VWS,,,657.95
Deidentified Maximum,,72072,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 3VWS,,,376.23
Deidentified Maximum,,72125,CPT4/HCPCS,CT NECK SPINE W/O DYE,,,6766.00
Deidentified Maximum,,72141,CPT4/HCPCS,MRI NECK SPINE W/O DYE,,,6766.00
Deidentified Maximum,,72146,CPT4/HCPCS,MRI CHEST SPINE W/O DYE,,,6766.00
Deidentified Maximum,,72148,CPT4/HCPCS,MRI LUMBAR SPINE W/O DYE,,,6766.00
Deidentified Maximum,,72158,CPT4/HCPCS,MRI LUMBAR SPINE W/O & W/DYE,,,12547.94
Deidentified Maximum,,72193,CPT4/HCPCS,CT PELVIS W/DYE,,,6766.00
Deidentified Maximum,,72196,CPT4/HCPCS,MRI PELVIS W/DYE,,,6766.00
Deidentified Maximum,,72198,CPT4/HCPCS,MR ANGIO PELVIS W/O & W/DYE,,,5646.30
Deidentified Maximum,,72285,CPT4/HCPCS,DISCOGRAPHY CERV/THOR SPINE,,,9541.04
Deidentified Maximum,,73030,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,,364.35
Deidentified Maximum,,73040,CPT4/HCPCS,CONTRAST X-RAY OF SHOULDER,,,2256.65
Deidentified Maximum,,73092,CPT4/HCPCS,X-RAY EXAM OF ARM INFANT,,,657.95
Deidentified Maximum,,73110,CPT4/HCPCS,X-RAY EXAM OF WRIST,,,364.35
Deidentified Maximum,,73223,CPT4/HCPCS,MRI JOINT UPR EXTR W/O&W/DYE,,,12358.33
Deidentified Maximum,,73521,CPT4/HCPCS,X-RAY EXAM HIPS BI 2 VIEWS,,,657.95
Deidentified Maximum,,73523,CPT4/HCPCS,X-RAY EXAM HIPS BI 5/> VIEWS,,,542.94
Deidentified Maximum,,73525,CPT4/HCPCS,CONTRAST X-RAY OF HIP,,,2256.65
Deidentified Maximum,,73565,CPT4/HCPCS,X-RAY EXAM OF KNEES,,,364.35
Deidentified Maximum,,73590,CPT4/HCPCS,X-RAY EXAM OF LOWER LEG,,,364.35
Deidentified Maximum,,73702,CPT4/HCPCS,CT LWR EXTREMITY W/O&W/DYE,,,6766.00
Deidentified Maximum,,74019,CPT4/HCPCS,X-RAY EXAM ABDOMEN 2 VIEWS,,,657.95
Deidentified Maximum,,29445,CPT4/HCPCS,APPLY RIGID LEG CAST,,,6766.00
Deidentified Maximum,,29581,CPT4/HCPCS,APPLY MULTLAY COMPRS LWR LEG,,,1678.00
Deidentified Maximum,,29805,CPT4/HCPCS,SHO ARTHRS DX +- SYNOVIAL BX,,,5856.00
Deidentified Maximum,,29806,CPT4/HCPCS,SHO ARTHRS SRG CAPSULORRAPHY,,,7007.00
Deidentified Maximum,,29835,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,,7007.00
Deidentified Maximum,,29838,CPT4/HCPCS,ELBOW ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29840,CPT4/HCPCS,WRIST ARTHROSCOPY,,,5856.00
Deidentified Maximum,,29883,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,5856.00
Deidentified Maximum,,29889,CPT4/HCPCS,KNEE ARTHROSCOPY/SURGERY,,,8012.00
Deidentified Maximum,,29891,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,7007.00
Deidentified Maximum,,29892,CPT4/HCPCS,ANKLE ARTHROSCOPY/SURGERY,,,6075.00
Deidentified Maximum,,29902,CPT4/HCPCS,MCP JOINT ARTHROSCOPY SURG,,,5856.00
Deidentified Maximum,,30100,CPT4/HCPCS,INTRANASAL BIOPSY,,,3198.57
Deidentified Maximum,,30110,CPT4/HCPCS,REMOVAL OF NOSE POLYP(S),,,4280.43
Deidentified Maximum,,30200,CPT4/HCPCS,INJECTION TREATMENT OF NOSE,,,4280.43
Deidentified Maximum,,30310,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,,3198.57
Deidentified Maximum,,30320,CPT4/HCPCS,REMOVE NASAL FOREIGN BODY,,,4280.43
Deidentified Maximum,,30430,CPT4/HCPCS,REVISION OF NOSE,,,5856.00
Deidentified Maximum,,30460,CPT4/HCPCS,REVISION OF NOSE,,,9548.65
Deidentified Maximum,,30560,CPT4/HCPCS,RELEASE OF NASAL ADHESIONS,,,4280.43
Deidentified Maximum,,30630,CPT4/HCPCS,REPAIR NASAL SEPTUM DEFECT,,,9548.65
Deidentified Maximum,,30920,CPT4/HCPCS,LIGATION UPPER JAW ARTERY,,,5856.00
Deidentified Maximum,,30999,CPT4/HCPCS,NASAL SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,31002,CPT4/HCPCS,IRRIGATION SPHENOID SINUS,,,3198.57
Deidentified Maximum,,31030,CPT4/HCPCS,EXPLORATION MAXILLARY SINUS,,,6075.00
Deidentified Maximum,,31050,CPT4/HCPCS,EXPLORATION SPHENOID SINUS,,,6075.00
Deidentified Maximum,,31051,CPT4/HCPCS,SPHENOID SINUS SURGERY,,,6401.00
Deidentified Maximum,,31205,CPT4/HCPCS,REMOVAL OF ETHMOID SINUS,,,5856.00
Deidentified Maximum,,31230,CPT4/HCPCS,REMOVAL OF UPPER JAW,,,4891.93
Deidentified Maximum,,31231,CPT4/HCPCS,NASAL ENDOSCOPY DX,,,3656.00
Deidentified Maximum,,31238,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,3656.00
Deidentified Maximum,,31240,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,4280.43
Deidentified Maximum,,31259,CPT4/HCPCS,NSL/SINS NDSC SPHN TISS RMVL,,,6876.92
Deidentified Maximum,,31276,CPT4/HCPCS,NSL/SINS NDSC FRNT TISS RMVL,,,5856.00
Deidentified Maximum,,31287,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,5856.00
Deidentified Maximum,,31290,CPT4/HCPCS,NASAL/SINUS ENDOSCOPY SURG,,,5856.00
Deidentified Maximum,,31294,CPT4/HCPCS,NSL/SINS NDSC SURG ON DCMPRN,,,5856.00
Deidentified Maximum,,31295,CPT4/HCPCS,NSL/SINS NDSC SURG MAX SINS,,,8300.00
Deidentified Maximum,,31297,CPT4/HCPCS,NSL/SINS NDSC SURG SPHN SINS,,,8300.00
Deidentified Maximum,,31360,CPT4/HCPCS,REMOVAL OF LARYNX,,,6588.00
Deidentified Maximum,,31370,CPT4/HCPCS,PARTIAL REMOVAL OF LARYNX,,,6876.92
Deidentified Maximum,,31520,CPT4/HCPCS,DX LARYNGOSCOPY NEWBORN,,,3198.57
Deidentified Maximum,,31527,CPT4/HCPCS,LARYNGOSCOPY FOR TREATMENT,,,4204.00
Deidentified Maximum,,31530,CPT4/HCPCS,LARYNGOSCOPY W/FB REMOVAL,,,4280.43
Deidentified Maximum,,31546,CPT4/HCPCS,REMOVE VC LESION SCOPE/GRAFT,,,6401.00
Deidentified Maximum,,31571,CPT4/HCPCS,LARYNGOSCOP W/VC INJ + SCOPE,,,4280.43
Deidentified Maximum,,31575,CPT4/HCPCS,DIAGNOSTIC LARYNGOSCOPY,,,3656.00
Deidentified Maximum,,31576,CPT4/HCPCS,LARYNGOSCOPY WITH BIOPSY,,,4280.43
Deidentified Maximum,,31578,CPT4/HCPCS,LARGSC W/REMOVAL LESION,,,4280.43
Deidentified Maximum,,31582,CPT4/HCPCS,REVISION OF LARYNX,,,5281.00
Deidentified Maximum,,31592,CPT4/HCPCS,CRICOTRACHEAL RESECTION,,,6876.92
Deidentified Maximum,,31600,CPT4/HCPCS,INCISION OF WINDPIPE,,,6049.05
Deidentified Maximum,,31605,CPT4/HCPCS,INCISION OF WINDPIPE,,,4280.43
Deidentified Maximum,,31611,CPT4/HCPCS,SURGERY/SPEECH PROSTHESIS,,,5856.00
Deidentified Maximum,,31613,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,,4280.43
Deidentified Maximum,,31614,CPT4/HCPCS,REPAIR WINDPIPE OPENING,,,6075.00
Deidentified Maximum,,31620,CPT4/HCPCS,ENDOBRONCHIAL US ADD-ON,,,1678.00
Deidentified Maximum,,31638,CPT4/HCPCS,BRONCHOSCOPY REVISE STENT,,,6049.05
Deidentified Maximum,,31645,CPT4/HCPCS,BRNCHSC W/THER ASPIR 1ST,,,3656.00
Deidentified Maximum,,31647,CPT4/HCPCS,BRONCHIAL VALVE INIT INSERT,,,6000.00
Deidentified Maximum,,31652,CPT4/HCPCS,BRONCH EBUS SAMPLNG 1/2 NODE,,,8300.00
Deidentified Maximum,,31781,CPT4/HCPCS,RECONSTRUCT WINDPIPE,,,6588.00
Deidentified Maximum,,31820,CPT4/HCPCS,CLOSURE OF WINDPIPE LESION,,,4204.00
Deidentified Maximum,,32096,CPT4/HCPCS,OPEN WEDGE/BX LUNG INFILTR,,,8012.00
Deidentified Maximum,,32215,CPT4/HCPCS,TREAT CHEST LINING,,,3544.00
Deidentified Maximum,,32220,CPT4/HCPCS,RELEASE OF LUNG,,,8012.00
Deidentified Maximum,,32422,CPT4/HCPCS,THORACENTESIS W/TUBE INSERT,,,1678.00
Deidentified Maximum,,32504,CPT4/HCPCS,RESECT APICAL LUNG TUM/CHEST,,,6588.00
Deidentified Maximum,,32506,CPT4/HCPCS,WEDGE RESECT OF LUNG ADD-ON,,,6588.00
Deidentified Maximum,,32540,CPT4/HCPCS,REMOVAL OF LUNG LESION,,,6588.00
Deidentified Maximum,,32560,CPT4/HCPCS,TREAT PLEURODESIS W/AGENT,,,3656.00
Deidentified Maximum,,32561,CPT4/HCPCS,LYSE CHEST FIBRIN INIT DAY,,,3198.57
Deidentified Maximum,,32815,CPT4/HCPCS,CLOSE BRONCHIAL FISTULA,,,6588.00
Deidentified Maximum,,32850,CPT4/HCPCS,DONOR PNEUMONECTOMY,,,5281.00
Deidentified Maximum,,32853,CPT4/HCPCS,LUNG TRANSPLANT DOUBLE,,,7902.34
Deidentified Maximum,,32900,CPT4/HCPCS,REMOVAL OF RIB(S),,,5783.00
Deidentified Maximum,,32960,CPT4/HCPCS,THERAPEUTIC PNEUMOTHORAX,,,3198.57
Deidentified Maximum,,33011,CPT4/HCPCS,REPEAT DRAINAGE OF HEART SAC,,,4280.43
Deidentified Maximum,,33015,CPT4/HCPCS,INCISION OF HEART SAC,,,3544.00
Deidentified Maximum,,33016,CPT4/HCPCS,PERICARDIOCENTESIS W/IMAGING,,,3656.00
Deidentified Maximum,,33202,CPT4/HCPCS,INSERT EPICARD ELTRD OPEN,,,5029.00
Deidentified Maximum,,33215,CPT4/HCPCS,REPOSITION PACING-DEFIB LEAD,,,12850.70
Deidentified Maximum,,33228,CPT4/HCPCS,REMV&REPLC PM GEN DUAL LEAD,,,10772.00
Deidentified Maximum,,33236,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,,5029.00
Deidentified Maximum,,33238,CPT4/HCPCS,REMOVE ELECTRODE/THORACOTOMY,,,5029.00
Deidentified Maximum,,33249,CPT4/HCPCS,INSJ/RPLCMT DEFIB W/LEAD(S),,,24180.00
Deidentified Maximum,,33256,CPT4/HCPCS,ABLATE ATRIA W/BYPASS EXTEN,,,5783.00
Deidentified Maximum,,33257,CPT4/HCPCS,ABLATE ATRIA LMTD ADD-ON,,,5029.00
Deidentified Maximum,,33263,CPT4/HCPCS,RMVL & RPLCMT DFB GEN 2 LEAD,,,24180.00
Deidentified Maximum,,33285,CPT4/HCPCS,INSJ SUBQ CAR RHYTHM MNTR,,,10119.00
Deidentified Maximum,,33289,CPT4/HCPCS,TCAT IMPL WRLS P-ART PRS SNR,,,24180.00
Deidentified Maximum,,33320,CPT4/HCPCS,REPAIR MAJOR BLOOD VESSEL(S),,,5783.00
Deidentified Maximum,,33335,CPT4/HCPCS,INSERT MAJOR VESSEL GRAFT,,,8012.00
Deidentified Maximum,,33367,CPT4/HCPCS,REPLACE AORTIC VALVE W/BYP,,,12850.70
Deidentified Maximum,,33419,CPT4/HCPCS,REPAIR TCAT MITRAL VALVE,,,8841.00
Deidentified Maximum,,33425,CPT4/HCPCS,REPAIR OF MITRAL VALVE,,,8841.00
Deidentified Maximum,,33468,CPT4/HCPCS,REVISION OF TRICUSPID VALVE,,,8841.00
Deidentified Maximum,,33472,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,,6588.00
Deidentified Maximum,,33474,CPT4/HCPCS,REVISION OF PULMONARY VALVE,,,8841.00
Deidentified Maximum,,33476,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,8012.00
Deidentified Maximum,,33496,CPT4/HCPCS,REPAIR PROSTH VALVE CLOT,,,8841.00
Deidentified Maximum,,33503,CPT4/HCPCS,CORONARY ARTERY GRAFT,,,6588.00
Deidentified Maximum,,33506,CPT4/HCPCS,REPAIR ARTERY TRANSLOCATION,,,6049.05
Deidentified Maximum,,33512,CPT4/HCPCS,CABG VEIN THREE,,,1370.00
Deidentified Maximum,,33514,CPT4/HCPCS,CABG VEIN FIVE,,,1370.00
Deidentified Maximum,,33519,CPT4/HCPCS,CABG ARTERY-VEIN THREE,,,1370.00
Deidentified Maximum,,33521,CPT4/HCPCS,CABG ARTERY-VEIN FOUR,,,1370.00
Deidentified Maximum,,33522,CPT4/HCPCS,CABG ARTERY-VEIN FIVE,,,1370.00
Deidentified Maximum,,33533,CPT4/HCPCS,CABG ARTERIAL SINGLE,,,1370.00
Deidentified Maximum,,33545,CPT4/HCPCS,REPAIR OF HEART DAMAGE,,,5783.00
Deidentified Maximum,,33572,CPT4/HCPCS,OPEN CORONARY ENDARTERECTOMY,,,5783.00
Deidentified Maximum,,33675,CPT4/HCPCS,CLOSE MULT VSD,,,8841.00
Deidentified Maximum,,33697,CPT4/HCPCS,REPAIR OF HEART DEFECTS,,,1370.00
Deidentified Maximum,,33720,CPT4/HCPCS,REPAIR OF HEART DEFECT,,,8841.00
Deidentified Maximum,,33722,CPT4/HCPCS,REPAIR OF HEART DEFECT,,,1370.00
Deidentified Maximum,,33730,CPT4/HCPCS,REPAIR HEART-VEIN DEFECT(S),,,8841.00
Deidentified Maximum,,33735,CPT4/HCPCS,REVISION OF HEART CHAMBER,,,6588.00
Deidentified Maximum,,33775,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,8841.00
Deidentified Maximum,,33776,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,8841.00
Deidentified Maximum,,33777,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,8841.00
Deidentified Maximum,,33779,CPT4/HCPCS,REPAIR GREAT VESSELS DEFECT,,,8841.00
Deidentified Maximum,,33800,CPT4/HCPCS,AORTIC SUSPENSION,,,8012.00
Deidentified Maximum,,33851,CPT4/HCPCS,REMOVE AORTA CONSTRICTION,,,8841.00
Deidentified Maximum,,33871,CPT4/HCPCS,TRANSVRS A-ARCH GRF HYPTHRM,,,8841.00
Deidentified Maximum,,33880,CPT4/HCPCS,ENDOVASC TAA REPR INCL SUBCL,,,8012.00
Deidentified Maximum,,33886,CPT4/HCPCS,ENDOVASC PROSTH DELAYED,,,5029.00
Deidentified Maximum,,33940,CPT4/HCPCS,REMOVAL OF DONOR HEART,,,1370.00
Deidentified Maximum,,33992,CPT4/HCPCS,RMVL PERQ LEFT HEART VAD,,,9304.06
Deidentified Maximum,,34001,CPT4/HCPCS,REMOVAL OF ARTERY CLOT,,,3544.00
Deidentified Maximum,,34530,CPT4/HCPCS,LEG VEIN FUSION,,,9548.65
Deidentified Maximum,,34701,CPT4/HCPCS,EVASC RPR A-AO NDGFT,,,7188.00
Deidentified Maximum,,34705,CPT4/HCPCS,EVAC RPR A-BIILIAC NDGFT,,,7188.00
Deidentified Maximum,,34709,CPT4/HCPCS,PLMT XTN PROSTH EVASC RPR,,,3544.00
Deidentified Maximum,,34713,CPT4/HCPCS,PERQ ACCESS & CLSR FEM ART,,,5029.00
Deidentified Maximum,,34716,CPT4/HCPCS,OPN AX/SUBCLA ART EXPOS CNDT,,,5029.00
Deidentified Maximum,,34803,CPT4/HCPCS,ENDOVAS AAA REPR W/3-P PART,,,5783.00
Deidentified Maximum,,34833,CPT4/HCPCS,OPN ILAC ART EXPOS CNDT CRTJ,,,8797.00
Deidentified Maximum,,34844,CPT4/HCPCS,ENDOVASC VISC AORTA 4 GRAFT,,,8841.00
Deidentified Maximum,,35001,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,5281.00
Deidentified Maximum,,35022,CPT4/HCPCS,REPAIR ARTERY RUPTURE CHEST,,,6588.00
Deidentified Maximum,,35091,CPT4/HCPCS,REPAIR DEFECT OF ARTERY,,,8012.00
Deidentified Maximum,,35122,CPT4/HCPCS,REPAIR ARTERY RUPTURE BELLY,,,6588.00
Deidentified Maximum,,35132,CPT4/HCPCS,REPAIR ARTERY RUPTURE GROIN,,,5783.00
Deidentified Maximum,,35152,CPT4/HCPCS,REPAIR RUPTD POPLITEAL ART,,,5281.00
Deidentified Maximum,,35190,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,7007.00
Deidentified Maximum,,35211,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,8841.00
Deidentified Maximum,,35256,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,7188.00
Deidentified Maximum,,35266,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,7902.34
Deidentified Maximum,,35276,CPT4/HCPCS,REPAIR BLOOD VESSEL LESION,,,6588.00
Deidentified Maximum,,35305,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5029.00
Deidentified Maximum,,35363,CPT4/HCPCS,RECHANNELING OF ARTERY,,,5783.00
Deidentified Maximum,,35400,CPT4/HCPCS,ANGIOSCOPY,,,3198.57
Deidentified Maximum,,35476,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,,5029.00
Deidentified Maximum,,35510,CPT4/HCPCS,ART BYP GRFT CAROTID-BRCHIAL,,,3198.57
Deidentified Maximum,,35512,CPT4/HCPCS,ART BYP GRFT SUBCLAV-BRCHIAL,,,3198.57
Deidentified Maximum,,35522,CPT4/HCPCS,ART BYP GRFT AXILL-BRACHIAL,,,3198.57
Deidentified Maximum,,35525,CPT4/HCPCS,ART BYP GRFT BRACHIAL-BRCHL,,,3198.57
Deidentified Maximum,,35535,CPT4/HCPCS,ART BYP GRFT HEPATORENAL,,,5783.00
Deidentified Maximum,,35538,CPT4/HCPCS,ART BYP GRFT AORTOBI-ILIAC,,,5783.00
Deidentified Maximum,,35558,CPT4/HCPCS,ART BYP GRFT FEM-FEMORAL,,,5281.00
Deidentified Maximum,,35565,CPT4/HCPCS,ART BYP GRFT ILIOFEMORAL,,,5029.00
Deidentified Maximum,,35600,CPT4/HCPCS,HARVEST ART FOR CABG ADD-ON,,,3198.57
Deidentified Maximum,,35601,CPT4/HCPCS,ART BYP COMMON IPSI CAROTID,,,5281.00
Deidentified Maximum,,35606,CPT4/HCPCS,ART BYP CAROTID-SUBCLAVIAN,,,5029.00
Deidentified Maximum,,35612,CPT4/HCPCS,ART BYP SUBCLAV-SUBCLAVIAN,,,5281.00
Deidentified Maximum,,35616,CPT4/HCPCS,ART BYP SUBCLAV-AXILLARY,,,5029.00
Deidentified Maximum,,35634,CPT4/HCPCS,ART BYP ILIORENAL,,,5281.00
Deidentified Maximum,,35636,CPT4/HCPCS,ART BYP SPENORENAL,,,5281.00
Deidentified Maximum,,35666,CPT4/HCPCS,ART BYP FEM-ANT-POST TIB/PRL,,,5029.00
Deidentified Maximum,,35671,CPT4/HCPCS,ART BYP POP-TIBL-PRL-OTHER,,,5029.00
Deidentified Maximum,,35703,CPT4/HCPCS,EXPL N/FLWD SURG LXTR ART,,,3656.00
Deidentified Maximum,,35741,CPT4/HCPCS,EXPLORATION POPLITEAL ARTERY,,,3544.00
Deidentified Maximum,,35875,CPT4/HCPCS,REMOVAL OF CLOT IN GRAFT,,,12850.70
Deidentified Maximum,,36000,CPT4/HCPCS,PLACE NEEDLE IN VEIN,,,1678.00
Deidentified Maximum,,36014,CPT4/HCPCS,PLACE CATHETER IN ARTERY,,,3000.00
Deidentified Maximum,,36226,CPT4/HCPCS,PLACE CATH VERTEBRAL ART,,,7007.00
Deidentified Maximum,,36228,CPT4/HCPCS,PLACE CATH INTRACRANIAL ART,,,3544.00
Deidentified Maximum,,36247,CPT4/HCPCS,INS CATH ABD/L-EXT ART 3RD,,,3656.00
Deidentified Maximum,,36254,CPT4/HCPCS,INS CATH REN ART 2ND+ BILAT,,,5138.00
Deidentified Maximum,,36262,CPT4/HCPCS,REMOVAL OF INFUSION PUMP,,,5138.00
Deidentified Maximum,,36430,CPT4/HCPCS,BLOOD TRANSFUSION SERVICE,,,3000.00
Deidentified Maximum,,36465,CPT4/HCPCS,NJX NONCMPND SCLRSNT 1 VEIN,,,3656.00
Deidentified Maximum,,36483,CPT4/HCPCS,ENDOVEN THER CHEM ADHES SBSQ,,,6876.92
Deidentified Maximum,,36511,CPT4/HCPCS,APHERESIS WBC,,,3656.00
Deidentified Maximum,,36512,CPT4/HCPCS,APHERESIS RBC,,,3656.00
Deidentified Maximum,,36513,CPT4/HCPCS,APHERESIS PLATELETS,,,3656.00
Deidentified Maximum,,36516,CPT4/HCPCS,APHERESIS IMMUNOADS SLCTV,,,9548.65
Deidentified Maximum,,36563,CPT4/HCPCS,INSERT TUNNELED CV CATH,,,7007.00
Deidentified Maximum,,36568,CPT4/HCPCS,INSJ PICC <5 YR W/O IMAGING,,,3198.57
Deidentified Maximum,,36581,CPT4/HCPCS,REPLACE TUNNELED CV CATH,,,5138.00
Deidentified Maximum,,36584,CPT4/HCPCS,COMPL RPLCMT PICC RS&I,,,3198.57
Deidentified Maximum,,36592,CPT4/HCPCS,COLLECT BLOOD FROM PICC,,,1214.00
Deidentified Maximum,,36595,CPT4/HCPCS,MECH REMOV TUNNELED CV CATH,,,6401.00
Deidentified Maximum,,36598,CPT4/HCPCS,INJ W/FLUOR EVAL CV DEVICE,,,3656.00
Deidentified Maximum,,36640,CPT4/HCPCS,INSERTION CATHETER ARTERY,,,5138.00
Deidentified Maximum,,36901,CPT4/HCPCS,INTRO CATH DIALYSIS CIRCUIT,,,9548.65
Deidentified Maximum,,36905,CPT4/HCPCS,THRMBC/NFS DIALYSIS CIRCUIT,,,12850.70
Deidentified Maximum,,37186,CPT4/HCPCS,SEC ART THROMBECTOMY ADD-ON,,,4891.93
Deidentified Maximum,,37188,CPT4/HCPCS,VEN MECHNL THRMBC REPEAT TX,,,9770.00
Deidentified Maximum,,37201,CPT4/HCPCS,TRANSCATHETER THERAPY INFUSE,,,1678.88
Deidentified Maximum,,37202,CPT4/HCPCS,TRANSCATHETER THERAPY INFUSE,,,1678.88
Deidentified Maximum,,37207,CPT4/HCPCS,TRANSCATH IV STENT OPEN,,,5029.00
Deidentified Maximum,,37210,CPT4/HCPCS,EMBOLIZATION UTERINE FIBROID,,,5029.00
Deidentified Maximum,,37213,CPT4/HCPCS,THROMBLYTIC ART/VEN THERAPY,,,5856.00
Deidentified Maximum,,37220,CPT4/HCPCS,ILIAC REVASC,,,7007.00
Deidentified Maximum,,37221,CPT4/HCPCS,ILIAC REVASC W/STENT,,,10119.00
Deidentified Maximum,,37222,CPT4/HCPCS,ILIAC REVASC ADD-ON,,,7007.00
Deidentified Maximum,,37225,CPT4/HCPCS,FEM/POPL REVAS W/ATHER,,,10119.00
Deidentified Maximum,,37241,CPT4/HCPCS,VASC EMBOLIZE/OCCLUDE VENOUS,,,10119.00
Deidentified Maximum,,37249,CPT4/HCPCS,TRLUML BALO ANGIOP ADDL VEIN,,,5029.00
Deidentified Maximum,,37605,CPT4/HCPCS,LIGATION OF NECK ARTERY,,,7902.34
Deidentified Maximum,,37619,CPT4/HCPCS,LIGATION OF INF VENA CAVA,,,7902.34
Deidentified Maximum,,38205,CPT4/HCPCS,HARVEST ALLOGENEIC STEM CELL,,,3198.57
Deidentified Maximum,,38206,CPT4/HCPCS,HARVEST AUTO STEM CELLS,,,3198.57
Deidentified Maximum,,38210,CPT4/HCPCS,T-CELL DEPLETION OF HARVEST,,,3198.57
Deidentified Maximum,,38222,CPT4/HCPCS,DX BONE MARROW BX & ASPIR,,,3000.00
Deidentified Maximum,,38241,CPT4/HCPCS,TRANSPLT AUTOL HCT/DONOR,,,6840.00
Deidentified Maximum,,38308,CPT4/HCPCS,INCISION OF LYMPH CHANNELS,,,4280.43
Deidentified Maximum,,38530,CPT4/HCPCS,BIOPSY/REMOVAL LYMPH NODES,,,4280.43
Deidentified Maximum,,38555,CPT4/HCPCS,REMOVAL NECK/ARMPIT LESION,,,6401.00
Deidentified Maximum,,38720,CPT4/HCPCS,REMOVAL OF LYMPH NODES NECK,,,6401.00
Deidentified Maximum,,38745,CPT4/HCPCS,REMOVE ARMPIT LYMPH NODES,,,7007.00
Deidentified Maximum,,38747,CPT4/HCPCS,REMOVE ABDOMINAL LYMPH NODES,,,6588.00
Deidentified Maximum,,38794,CPT4/HCPCS,ACCESS THORACIC LYMPH DUCT,,,1678.88
Deidentified Maximum,,39540,CPT4/HCPCS,REPAIR OF DIAPHRAGM HERNIA,,,5783.00
Deidentified Maximum,,40700,CPT4/HCPCS,REPAIR CLEFT LIP/NASAL,,,9548.65
Deidentified Maximum,,40805,CPT4/HCPCS,REMOVAL FOREIGN BODY MOUTH,,,3656.00
Deidentified Maximum,,40808,CPT4/HCPCS,BIOPSY OF MOUTH LESION,,,3198.57
Deidentified Maximum,,40812,CPT4/HCPCS,EXCISE/REPAIR MOUTH LESION,,,4280.43
Deidentified Maximum,,40843,CPT4/HCPCS,RECONSTRUCTION OF MOUTH,,,5856.00
Deidentified Maximum,,41135,CPT4/HCPCS,TONGUE AND NECK SURGERY,,,5281.00
Deidentified Maximum,,41140,CPT4/HCPCS,REMOVAL OF TONGUE,,,5783.00
Deidentified Maximum,,41153,CPT4/HCPCS,TONGUE MOUTH NECK SURGERY,,,5783.00
Deidentified Maximum,,41251,CPT4/HCPCS,REPAIR TONGUE LACERATION,,,4280.43
Deidentified Maximum,,41500,CPT4/HCPCS,FIXATION OF TONGUE,,,3198.57
Deidentified Maximum,,41512,CPT4/HCPCS,TONGUE SUSPENSION,,,6075.00
Deidentified Maximum,,41530,CPT4/HCPCS,TONGUE BASE VOL REDUCTION,,,6000.00
Deidentified Maximum,,41599,CPT4/HCPCS,TONGUE AND MOUTH SURGERY,,,3198.57
Deidentified Maximum,,41828,CPT4/HCPCS,EXCISION OF GUM LESION,,,4280.43
Deidentified Maximum,,42200,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,6876.92
Deidentified Maximum,,42220,CPT4/HCPCS,RECONSTRUCT CLEFT PALATE,,,6876.92
Deidentified Maximum,,42226,CPT4/HCPCS,LENGTHENING OF PALATE,,,6876.92
Deidentified Maximum,,42227,CPT4/HCPCS,LENGTHENING OF PALATE,,,9548.65
Deidentified Maximum,,42280,CPT4/HCPCS,PREPARATION PALATE MOLD,,,2002.00
Deidentified Maximum,,42330,CPT4/HCPCS,REMOVAL OF SALIVARY STONE,,,4280.43
Deidentified Maximum,,42440,CPT4/HCPCS,EXCISE SUBMAXILLARY GLAND,,,6075.00
Deidentified Maximum,,42500,CPT4/HCPCS,REPAIR SALIVARY DUCT,,,5856.00
Deidentified Maximum,,42550,CPT4/HCPCS,INJECTION FOR SALIVARY X-RAY,,,3000.00
Deidentified Maximum,,42600,CPT4/HCPCS,CLOSURE OF SALIVARY FISTULA,,,3198.57
Deidentified Maximum,,42836,CPT4/HCPCS,REMOVAL OF ADENOIDS,,,6401.00
Deidentified Maximum,,42842,CPT4/HCPCS,EXTENSIVE SURGERY OF THROAT,,,6049.05
Deidentified Maximum,,42890,CPT4/HCPCS,PARTIAL REMOVAL OF PHARYNX,,,9548.65
Deidentified Maximum,,42892,CPT4/HCPCS,REVISION OF PHARYNGEAL WALLS,,,9548.65
Deidentified Maximum,,42971,CPT4/HCPCS,CONTROL NOSE/THROAT BLEEDING,,,3198.57
Deidentified Maximum,,43113,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43118,CPT4/HCPCS,PARTIAL REMOVAL OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43124,CPT4/HCPCS,REMOVAL OF ESOPHAGUS,,,6588.00
Deidentified Maximum,,43193,CPT4/HCPCS,ESOPHAGOSCP RIG TRNSO BIOPSY,,,5000.00
Deidentified Maximum,,43211,CPT4/HCPCS,ESOPHAGOSCOP MUCOSAL RESECT,,,4000.00
Deidentified Maximum,,43212,CPT4/HCPCS,ESOPHAGOSCOP STENT PLACEMENT,,,8300.00
Deidentified Maximum,,43213,CPT4/HCPCS,ESOPHAGOSCOPY RETRO BALLOON,,,5000.00
Deidentified Maximum,,43226,CPT4/HCPCS,ESOPH ENDOSCOPY DILATION,,,3198.57
Deidentified Maximum,,43229,CPT4/HCPCS,ESOPHAGOSCOPY LESION ABLATE,,,8300.00
Deidentified Maximum,,43231,CPT4/HCPCS,ESOPHAGOSCOP ULTRASOUND EXAM,,,4280.43
Deidentified Maximum,,43234,CPT4/HCPCS,UPPER GI ENDOSCOPY EXAM,,,1678.00
Deidentified Maximum,,43235,CPT4/HCPCS,EGD DIAGNOSTIC BRUSH WASH,,,3198.57
Deidentified Maximum,,43239,CPT4/HCPCS,EGD BIOPSY SINGLE/MULTIPLE,,,4280.43
Deidentified Maximum,,43241,CPT4/HCPCS,EGD TUBE/CATH INSERTION,,,4280.43
Deidentified Maximum,,43248,CPT4/HCPCS,EGD GUIDE WIRE INSERTION,,,4280.43
Deidentified Maximum,,43249,CPT4/HCPCS,ESOPH EGD DILATION <30 MM,,,4280.43
Deidentified Maximum,,43254,CPT4/HCPCS,EGD ENDO MUCOSAL RESECTION,,,5856.00
Deidentified Maximum,,43264,CPT4/HCPCS,ERCP REMOVE DUCT CALCULI,,,4280.43
Deidentified Maximum,,43266,CPT4/HCPCS,EGD ENDOSCOPIC STENT PLACE,,,8300.00
Deidentified Maximum,,43277,CPT4/HCPCS,ERCP EA DUCT/AMPULLA DILATE,,,8300.00
Deidentified Maximum,,43287,CPT4/HCPCS,ESPHG DSTL 2/3 W/LAPS MOBLJ,,,6588.00
Deidentified Maximum,,43313,CPT4/HCPCS,ESOPHAGOPLASTY CONGENITAL,,,6876.92
Deidentified Maximum,,43320,CPT4/HCPCS,FUSE ESOPHAGUS & STOMACH,,,6588.00
Deidentified Maximum,,43333,CPT4/HCPCS,TRANSAB ESOPH HIAT HERN RPR,,,6588.00
Deidentified Maximum,,43340,CPT4/HCPCS,FUSE ESOPHAGUS & INTESTINE,,,5783.00
Deidentified Maximum,,43361,CPT4/HCPCS,GASTROINTESTINAL REPAIR,,,5783.00
Deidentified Maximum,,43400,CPT4/HCPCS,LIGATE ESOPHAGUS VEINS,,,7007.00
Deidentified Maximum,,43405,CPT4/HCPCS,LIGATE/STAPLE ESOPHAGUS,,,5783.00
Deidentified Maximum,,43453,CPT4/HCPCS,DILATE ESOPHAGUS,,,3198.57
Deidentified Maximum,,43456,CPT4/HCPCS,DILATE ESOPHAGUS,,,1678.88
Deidentified Maximum,,43622,CPT4/HCPCS,REMOVAL OF STOMACH,,,5783.00
Deidentified Maximum,,43635,CPT4/HCPCS,REMOVAL OF STOMACH PARTIAL,,,3544.00
Deidentified Maximum,,43763,CPT4/HCPCS,RPLC GTUBE REVJ GSTRST TRC,,,3000.00
Deidentified Maximum,,43773,CPT4/HCPCS,LAP REPLACE GASTR ADJ DEVICE,,,6075.00
Deidentified Maximum,,43825,CPT4/HCPCS,FUSION OF STOMACH AND BOWEL,,,5783.00
Deidentified Maximum,,43843,CPT4/HCPCS,GASTROPLASTY W/O V-BAND,,,6075.00
Deidentified Maximum,,43886,CPT4/HCPCS,REVISE GASTRIC PORT OPEN,,,5138.00
Deidentified Maximum,,44021,CPT4/HCPCS,DECOMPRESS SMALL BOWEL,,,5281.00
Deidentified Maximum,,44050,CPT4/HCPCS,REDUCE BOWEL OBSTRUCTION,,,7188.00
Deidentified Maximum,,44111,CPT4/HCPCS,EXCISION OF BOWEL LESION(S),,,5281.00
Deidentified Maximum,,44137,CPT4/HCPCS,REMOVE INTESTINAL ALLOGRAFT,,,5281.00
Deidentified Maximum,,44160,CPT4/HCPCS,REMOVAL OF COLON,,,5783.00
Deidentified Maximum,,44180,CPT4/HCPCS,LAP ENTEROLYSIS,,,7007.00
Deidentified Maximum,,44186,CPT4/HCPCS,LAP JEJUNOSTOMY,,,7007.00
Deidentified Maximum,,44202,CPT4/HCPCS,LAP ENTERECTOMY,,,6840.00
Deidentified Maximum,,44205,CPT4/HCPCS,LAP COLECTOMY PART W/ILEUM,,,3198.57
Deidentified Maximum,,44300,CPT4/HCPCS,OPEN BOWEL TO SKIN,,,5281.00
Deidentified Maximum,,44314,CPT4/HCPCS,REVISION OF ILEOSTOMY,,,5281.00
Deidentified Maximum,,44322,CPT4/HCPCS,COLOSTOMY WITH BIOPSIES,,,5783.00
Deidentified Maximum,,44346,CPT4/HCPCS,REVISION OF COLOSTOMY,,,6401.00
Deidentified Maximum,,44364,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4280.43
Deidentified Maximum,,44369,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4280.43
Deidentified Maximum,,44384,CPT4/HCPCS,SMALL BOWEL ENDOSCOPY,,,4000.00
Deidentified Maximum,,44385,CPT4/HCPCS,ENDOSCOPY OF BOWEL POUCH,,,3198.57
Deidentified Maximum,,44397,CPT4/HCPCS,COLONOSCOPY W/STENT,,,1678.00
Deidentified Maximum,,44402,CPT4/HCPCS,COLONOSCOPY W/STENT PLCMT,,,4000.00
Deidentified Maximum,,44620,CPT4/HCPCS,REPAIR BOWEL OPENING,,,5281.00
Deidentified Maximum,,44680,CPT4/HCPCS,SURGICAL REVISION INTESTINE,,,5281.00
Deidentified Maximum,,44979,CPT4/HCPCS,LAPAROSCOPE PROC APP,,,7902.34
Deidentified Maximum,,45100,CPT4/HCPCS,BIOPSY OF RECTUM,,,3198.57
Deidentified Maximum,,45114,CPT4/HCPCS,PARTIAL REMOVAL OF RECTUM,,,6588.00
Deidentified Maximum,,45136,CPT4/HCPCS,EXCISE ILEOANAL RESERVIOR,,,5783.00
Deidentified Maximum,,45305,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/BX,,,3198.57
Deidentified Maximum,,45317,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY BLEED,,,3198.57
Deidentified Maximum,,45327,CPT4/HCPCS,PROCTOSIGMOIDOSCOPY W/STENT,,,9548.65
Deidentified Maximum,,45331,CPT4/HCPCS,SIGMOIDOSCOPY AND BIOPSY,,,3198.57
Deidentified Maximum,,45340,CPT4/HCPCS,SIG W/TNDSC BALLOON DILATION,,,3198.57
Deidentified Maximum,,45382,CPT4/HCPCS,COLONOSCOPY W/CONTROL BLEED,,,4280.43
Deidentified Maximum,,45384,CPT4/HCPCS,COLONOSCOPY W/LESION REMOVAL,,,4280.43
Deidentified Maximum,,45390,CPT4/HCPCS,COLONOSCOPY W/RESECTION,,,4000.00
Deidentified Maximum,,45560,CPT4/HCPCS,REPAIR OF RECTOCELE,,,5138.00
Deidentified Maximum,,45563,CPT4/HCPCS,EXPLORATION/REPAIR OF RECTUM,,,5281.00
Deidentified Maximum,,45800,CPT4/HCPCS,REPAIR RECT/BLADDER FISTULA,,,5281.00
Deidentified Maximum,,45915,CPT4/HCPCS,REMOVE RECTAL OBSTRUCTION,,,3198.57
Deidentified Maximum,,46020,CPT4/HCPCS,PLACEMENT OF SETON,,,5856.00
Deidentified Maximum,,46060,CPT4/HCPCS,INCISION OF RECTAL ABSCESS,,,4280.43
Deidentified Maximum,,46070,CPT4/HCPCS,INCISION OF ANAL SEPTUM,,,3198.57
Deidentified Maximum,,46261,CPT4/HCPCS,REMOVE IN/EX HEM GRPS & FISS,,,6401.00
Deidentified Maximum,,46262,CPT4/HCPCS,REMOVE IN/EX HEM GRPS W/FIST,,,6401.00
Deidentified Maximum,,46270,CPT4/HCPCS,REMOVE ANAL FIST SUBQ,,,5856.00
Deidentified Maximum,,46500,CPT4/HCPCS,INJECTION INTO HEMORRHOID(S),,,3198.57
Deidentified Maximum,,46601,CPT4/HCPCS,DIAGNOSTIC ANOSCOPY,,,3000.00
Deidentified Maximum,,46614,CPT4/HCPCS,ANOSCOPY CONTROL BLEEDING,,,3198.57
Deidentified Maximum,,46705,CPT4/HCPCS,REPAIR OF ANAL STRICTURE,,,3544.00
Deidentified Maximum,,46712,CPT4/HCPCS,REPR PER/VAG POUCH DBL PROC,,,5856.00
Deidentified Maximum,,46916,CPT4/HCPCS,CRYOSURGERY ANAL LESION(S),,,3656.00
Deidentified Maximum,,46922,CPT4/HCPCS,EXCISION OF ANAL LESION(S),,,4204.00
Deidentified Maximum,,46930,CPT4/HCPCS,DESTROY INTERNAL HEMORRHOIDS,,,5000.00
Deidentified Maximum,,46940,CPT4/HCPCS,TREATMENT OF ANAL FISSURE,,,4280.43
Deidentified Maximum,,46999,CPT4/HCPCS,ANUS SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,47010,CPT4/HCPCS,OPEN DRAINAGE LIVER LESION,,,5783.00
Deidentified Maximum,,47011,CPT4/HCPCS,PERCUT DRAIN LIVER LESION,,,1678.00
Deidentified Maximum,,47122,CPT4/HCPCS,EXTENSIVE REMOVAL OF LIVER,,,6876.92
Deidentified Maximum,,47399,CPT4/HCPCS,LIVER SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,47425,CPT4/HCPCS,INCISION OF BILE DUCT,,,5783.00
Deidentified Maximum,,47538,CPT4/HCPCS,PERQ PLMT BILE DUCT STENT,,,8300.00
Deidentified Maximum,,47542,CPT4/HCPCS,DILATE BILIARY DUCT/AMPULLA,,,4891.93
Deidentified Maximum,,47570,CPT4/HCPCS,LAPARO CHOLECYSTOENTEROSTOMY,,,8841.00
Deidentified Maximum,,47610,CPT4/HCPCS,REMOVAL OF GALLBLADDER,,,8012.00
Deidentified Maximum,,47741,CPT4/HCPCS,FUSE GALLBLADDER & BOWEL,,,5783.00
Deidentified Maximum,,47999,CPT4/HCPCS,BILE TRACT SURGERY PROCEDURE,,,3198.57
Deidentified Maximum,,48000,CPT4/HCPCS,DRAINAGE OF ABDOMEN,,,5281.00
Deidentified Maximum,,48105,CPT4/HCPCS,RESECT/DEBRIDE PANCREAS,,,1370.00
Deidentified Maximum,,48146,CPT4/HCPCS,PANCREATECTOMY,,,4280.43
Deidentified Maximum,,48152,CPT4/HCPCS,PANCREATECTOMY,,,6049.05
Deidentified Maximum,,48160,CPT4/HCPCS,PANCREAS REMOVAL/TRANSPLANT,,,6588.00
Deidentified Maximum,,48547,CPT4/HCPCS,DUODENAL EXCLUSION,,,5783.00
Deidentified Maximum,,49013,CPT4/HCPCS,PRPERTL PEL PACK HEMRRG TRMA,,,1678.88
Deidentified Maximum,,49062,CPT4/HCPCS,DRAIN TO PERITONEAL CAVITY,,,5029.00
Deidentified Maximum,,49185,CPT4/HCPCS,SCLEROTX FLUID COLLECTION,,,6000.00
Deidentified Maximum,,49320,CPT4/HCPCS,DIAG LAPARO SEPARATE PROC,,,6075.00
Deidentified Maximum,,49327,CPT4/HCPCS,LAP INS DEVICE FOR RT,,,8300.00
Deidentified Maximum,,49402,CPT4/HCPCS,REMOVE FOREIGN BODY ADBOMEN,,,5138.00
Deidentified Maximum,,49407,CPT4/HCPCS,IMAGE CATH FLUID TRNS/VGNL,,,5856.00
Deidentified Maximum,,49423,CPT4/HCPCS,EXCHANGE DRAINAGE CATHETER,,,3198.57
Deidentified Maximum,,49426,CPT4/HCPCS,REVISE ABDOMEN-VENOUS SHUNT,,,5138.00
Deidentified Maximum,,49435,CPT4/HCPCS,INSERT SUBQ EXTEN TO IP CATH,,,3198.57
Deidentified Maximum,,49436,CPT4/HCPCS,EMBEDDED IP CATH EXIT-SITE,,,4280.43
Deidentified Maximum,,49441,CPT4/HCPCS,PLACE DUOD/JEJ TUBE PERC,,,4280.43
Deidentified Maximum,,49450,CPT4/HCPCS,REPLACE G/C TUBE PERC,,,4280.43
Deidentified Maximum,,49496,CPT4/HCPCS,RPR ING HERNIA BABY BLOCKED,,,6401.00
Deidentified Maximum,,49521,CPT4/HCPCS,REREPAIR ING HERNIA BLOCKED,,,12850.70
Deidentified Maximum,,74176,CPT4/HCPCS,CT ABD & PELVIS W/O CONTRAST,,,6766.00
Deidentified Maximum,,74220,CPT4/HCPCS,X-RAY XM ESOPHAGUS 1CNTRST,,,1179.80
Deidentified Maximum,,74245,CPT4/HCPCS,X-RAY UPPER GI&SMALL INTEST,,,1202.43
Deidentified Maximum,,74280,CPT4/HCPCS,X-RAY XM COLON 2CNTRST STD,,,1235.89
Deidentified Maximum,,74283,CPT4/HCPCS,THER NMA RDCTJ INTUS/OBSTRCJ,,,1297.88
Deidentified Maximum,,74415,CPT4/HCPCS,UROGRAPHY NFS DRIP&/BLS W/NF,,,1179.80
Deidentified Maximum,,74470,CPT4/HCPCS,X-RAY EXAM OF KIDNEY LESION,,,2909.34
Deidentified Maximum,,74742,CPT4/HCPCS,X-RAY FALLOPIAN TUBE,,,6500.00
Deidentified Maximum,,75561,CPT4/HCPCS,CARDIAC MRI FOR MORPH W/DYE,,,7575.86
Deidentified Maximum,,75572,CPT4/HCPCS,CT HRT W/3D IMAGE,,,6766.00
Deidentified Maximum,,75574,CPT4/HCPCS,CT ANGIO HRT W/3D IMAGE,,,6766.00
Deidentified Maximum,,75726,CPT4/HCPCS,ARTERY X-RAYS ABDOMEN,,,25594.34
Deidentified Maximum,,75801,CPT4/HCPCS,LYMPH VESSEL X-RAY ARM/LEG,,,3544.38
Deidentified Maximum,,75820,CPT4/HCPCS,VEIN X-RAY ARM/LEG,,,3625.90
Deidentified Maximum,,75870,CPT4/HCPCS,VEIN X-RAY SKULL,,,6344.13
Deidentified Maximum,,75893,CPT4/HCPCS,VENOUS SAMPLING BY CATHETER,,,25594.34
Deidentified Maximum,,75954,CPT4/HCPCS,ILIAC ANEURYSM ENDOVAS RPR,,,6500.00
Deidentified Maximum,,75956,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,,2768.30
Deidentified Maximum,,75978,CPT4/HCPCS,REPAIR VENOUS BLOCKAGE,,,6500.00
Deidentified Maximum,,75989,CPT4/HCPCS,ABSCESS DRAINAGE UNDER X-RAY,,,6500.00
Deidentified Maximum,,76098,CPT4/HCPCS,X-RAY EXAM SURGICAL SPECIMEN,,,2909.34
Deidentified Maximum,,76390,CPT4/HCPCS,MR SPECTROSCOPY,,,6766.00
Deidentified Maximum,,76391,CPT4/HCPCS,MR ELASTOGRAPHY,,,1537.28
Deidentified Maximum,,76512,CPT4/HCPCS,OPH US DX B-SCAN,,,587.00
Deidentified Maximum,,76536,CPT4/HCPCS,US EXAM OF HEAD AND NECK,,,791.95
Deidentified Maximum,,76706,CPT4/HCPCS,US ABDL AORTA SCREEN AAA,,,899.00
Deidentified Maximum,,76811,CPT4/HCPCS,OB US DETAILED SNGL FETUS,,,1876.79
Deidentified Maximum,,76813,CPT4/HCPCS,OB US NUCHAL MEAS 1 GEST,,,888.88
Deidentified Maximum,,76816,CPT4/HCPCS,OB US FOLLOW-UP PER FETUS,,,657.95
Deidentified Maximum,,76818,CPT4/HCPCS,FETAL BIOPHYS PROFILE W/NST,,,819.83
Deidentified Maximum,,76820,CPT4/HCPCS,UMBILICAL ARTERY ECHO,,,823.08
Deidentified Maximum,,76827,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,,880.82
Deidentified Maximum,,76828,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,,587.00
Deidentified Maximum,,76856,CPT4/HCPCS,US EXAM PELVIC COMPLETE,,,791.95
Deidentified Maximum,,76872,CPT4/HCPCS,US TRANSRECTAL,,,935.30
Deidentified Maximum,,76932,CPT4/HCPCS,ECHO GUIDE FOR HEART BIOPSY,,,771.71
Deidentified Maximum,,76936,CPT4/HCPCS,ECHO GUIDE FOR ARTERY REPAIR,,,3178.11
Deidentified Maximum,,76941,CPT4/HCPCS,ECHO GUIDE FOR TRANSFUSION,,,768.45
Deidentified Maximum,,76978,CPT4/HCPCS,US TRGT DYN MBUBB 1ST LES,,,2082.44
Deidentified Maximum,,77002,CPT4/HCPCS,NEEDLE LOCALIZATION BY XRAY,,,6500.00
Deidentified Maximum,,77013,CPT4/HCPCS,CT GUIDE FOR TISSUE ABLATION,,,6766.00
Deidentified Maximum,,77061,CPT4/HCPCS,BREAST TOMOSYNTHESIS UNI,,,992.29
Deidentified Maximum,,77074,CPT4/HCPCS,X-RAYS BONE SURVEY LIMITED,,,657.95
Deidentified Maximum,,77300,CPT4/HCPCS,RADIATION THERAPY DOSE PLAN,,,7894.00
Deidentified Maximum,,77317,CPT4/HCPCS,BRACHYTX ISODOSE INTERMED,,,7894.00
Deidentified Maximum,,77333,CPT4/HCPCS,RADIATION TREATMENT AID(S),,,7894.00
Deidentified Maximum,,77336,CPT4/HCPCS,RADIATION PHYSICS CONSULT,,,7894.00
Deidentified Maximum,,77373,CPT4/HCPCS,SBRT DELIVERY,,,20679.88
Deidentified Maximum,,77385,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR SMPL,,,11173.50
Deidentified Maximum,,77412,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,,7894.00
Deidentified Maximum,,77432,CPT4/HCPCS,STEREOTACTIC RADIATION TRMT,,,3134.12
Deidentified Maximum,,77435,CPT4/HCPCS,SBRT MANAGEMENT,,,5203.12
Deidentified Maximum,,77520,CPT4/HCPCS,PROTON TRMT SIMPLE W/O COMP,,,9231.76
Deidentified Maximum,,77525,CPT4/HCPCS,PROTON TREATMENT COMPLEX,,,15603.75
Deidentified Maximum,,77768,CPT4/HCPCS,HDR RDNCL SKN SURF BRACHYTX,,,13685.00
Deidentified Maximum,,77786,CPT4/HCPCS,HDR BRACHYTX 2-12 CHANNEL,,,1678.88
Deidentified Maximum,,77790,CPT4/HCPCS,RADIATION HANDLING,,,13685.00
Deidentified Maximum,,78014,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,,3110.79
Deidentified Maximum,,78075,CPT4/HCPCS,ADRENAL CORTEX & MEDULLA IMG,,,3392.84
Deidentified Maximum,,78103,CPT4/HCPCS,BONE MARROW IMAGING MULT,,,1598.68
Deidentified Maximum,,78111,CPT4/HCPCS,PLASMA VOLUME MULTIPLE,,,1302.69
Deidentified Maximum,,78130,CPT4/HCPCS,RED CELL SURVIVAL STUDY,,,1432.60
Deidentified Maximum,,78185,CPT4/HCPCS,SPLEEN IMAGING,,,1576.84
Deidentified Maximum,,78205,CPT4/HCPCS,LIVER IMAGING (3D),,,2978.36
Deidentified Maximum,,78230,CPT4/HCPCS,SALIVARY GLAND IMAGING,,,1248.32
Deidentified Maximum,,78261,CPT4/HCPCS,GASTRIC MUCOSA IMAGING,,,2066.32
Deidentified Maximum,,78264,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,,2080.77
Deidentified Maximum,,78271,CPT4/HCPCS,VIT B-12 ABSRP EXAM INT FAC,,,834.25
Deidentified Maximum,,78272,CPT4/HCPCS,VIT B-12 ABSORP COMBINED,,,1173.55
Deidentified Maximum,,78290,CPT4/HCPCS,MECKELS DIVERT EXAM,,,2082.86
Deidentified Maximum,,78350,CPT4/HCPCS,BONE MINERAL SINGLE PHOTON,,,385.86
Deidentified Maximum,,78456,CPT4/HCPCS,ACUTE VENOUS THROMBUS IMAGE,,,2041.65
Deidentified Maximum,,78606,CPT4/HCPCS,BRAIN IMAGE W/FLOW 4 + VIEWS,,,2547.55
Deidentified Maximum,,78647,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,,2978.36
Deidentified Maximum,,78707,CPT4/HCPCS,K FLOW/FUNCT IMAGE W/O DRUG,,,2248.40
Deidentified Maximum,,78730,CPT4/HCPCS,URINARY BLADDER RETENTION,,,734.76
Deidentified Maximum,,78806,CPT4/HCPCS,ABSCESS IMAGING WHOLE BODY,,,3244.69
Deidentified Maximum,,78811,CPT4/HCPCS,PET IMAGE LTD AREA,,,17587.83
Deidentified Maximum,,78814,CPT4/HCPCS,PET IMAGE W/CT LMTD,,,17587.83
Deidentified Maximum,,78816,CPT4/HCPCS,PET IMAGE W/CT FULL BODY,,,19935.70
Deidentified Maximum,,79403,CPT4/HCPCS,HEMATOPOIETIC NUCLEAR TX,,,2120.67
Deidentified Maximum,,80048,CPT4/HCPCS,METABOLIC PANEL TOTAL CA,,,102.00
Deidentified Maximum,,80053,CPT4/HCPCS,COMPREHEN METABOLIC PANEL,,,106.17
Deidentified Maximum,,80055,CPT4/HCPCS,OBSTETRIC PANEL,,,654.38
Deidentified Maximum,,80081,CPT4/HCPCS,OBSTETRIC PANEL,,,728.02
Deidentified Maximum,,80156,CPT4/HCPCS,ASSAY CARBAMAZEPINE TOTAL,,,146.32
Deidentified Maximum,,80162,CPT4/HCPCS,ASSAY OF DIGOXIN TOTAL,,,133.47
Deidentified Maximum,,80165,CPT4/HCPCS,DIPROPYLACETIC ACID FREE,,,131.62
Deidentified Maximum,,80168,CPT4/HCPCS,ASSAY OF ETHOSUXIMIDE,,,164.22
Deidentified Maximum,,80170,CPT4/HCPCS,ASSAY OF GENTAMICIN,,,164.72
Deidentified Maximum,,80173,CPT4/HCPCS,ASSAY OF HALOPERIDOL,,,146.32
Deidentified Maximum,,80183,CPT4/HCPCS,DRUG SCRN QUANT OXCARBAZEPIN,,,129.19
Deidentified Maximum,,80192,CPT4/HCPCS,ASSAY OF PROCAINAMIDE,,,168.25
Deidentified Maximum,,80203,CPT4/HCPCS,DRUG SCREEN QUANT ZONISAMIDE,,,129.19
Deidentified Maximum,,80299,CPT4/HCPCS,QUANTITATIVE ASSAY DRUG,,,133.05
Deidentified Maximum,,80305,CPT4/HCPCS,DRUG TEST PRSMV DIR OPT OBS,,,106.84
Deidentified Maximum,,80306,CPT4/HCPCS,DRUG TEST PRSMV INSTRMNT,,,142.46
Deidentified Maximum,,80321,CPT4/HCPCS,ALCOHOLS BIOMARKERS 1OR 2,,,102.00
Deidentified Maximum,,80323,CPT4/HCPCS,ALKALOIDS NOS,,,102.00
Deidentified Maximum,,80346,CPT4/HCPCS,BENZODIAZEPINES1-12,,,102.00
Deidentified Maximum,,80349,CPT4/HCPCS,CANNABINOIDS NATURAL,,,102.00
Deidentified Maximum,,80356,CPT4/HCPCS,HEROIN METABOLITE,,,102.00
Deidentified Maximum,,80359,CPT4/HCPCS,METHYLENEDIOXYAMPHETAMINES,,,102.00
Deidentified Maximum,,80360,CPT4/HCPCS,METHYLPHENIDATE,,,102.00
Deidentified Maximum,,80361,CPT4/HCPCS,OPIATES 1 OR MORE,,,102.00
Deidentified Maximum,,80363,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 3/4,,,102.00
Deidentified Maximum,,80371,CPT4/HCPCS,STIMULANTS SYNTHETIC,,,102.00
Deidentified Maximum,,80373,CPT4/HCPCS,DRUG SCREENING TRAMADOL,,,102.00
Deidentified Maximum,,80406,CPT4/HCPCS,ACTH STIMULATION PANEL,,,786.40
Deidentified Maximum,,80408,CPT4/HCPCS,ALDOSTERONE SUPPRESSION EVAL,,,1260.92
Deidentified Maximum,,80410,CPT4/HCPCS,CALCITONIN STIMUL PANEL,,,807.32
Deidentified Maximum,,80435,CPT4/HCPCS,INSULIN TOLERANCE PANEL,,,1034.96
Deidentified Maximum,,80436,CPT4/HCPCS,METYRAPONE PANEL,,,916.10
Deidentified Maximum,,81007,CPT4/HCPCS,URINE SCREEN FOR BACTERIA,,,102.00
Deidentified Maximum,,81167,CPT4/HCPCS,BRCA2 GENE FULL DUP/DEL ALYS,,,2019.78
Deidentified Maximum,,81170,CPT4/HCPCS,ABL1 GENE,,,2352.67
Deidentified Maximum,,81172,CPT4/HCPCS,AFF2 GENE CHARAC ALLELES,,,1962.32
Deidentified Maximum,,81177,CPT4/HCPCS,ATN1 GENE DETC ABNOR ALLELES,,,978.18
Deidentified Maximum,,81200,CPT4/HCPCS,ASPA GENE,,,758.60
Deidentified Maximum,,81225,CPT4/HCPCS,CYP2C19 GENE COM VARIANTS,,,673.93
Deidentified Maximum,,81229,CPT4/HCPCS,CYTOGEN M ARRAY COPY NO&SNP,,,1542.24
Deidentified Maximum,,81236,CPT4/HCPCS,EZH2 GENE FULL GENE SEQUENCE,,,2019.78
Deidentified Maximum,,81240,CPT4/HCPCS,F2 GENE,,,254.94
Deidentified Maximum,,81251,CPT4/HCPCS,GBA GENE,,,1012.78
Deidentified Maximum,,81255,CPT4/HCPCS,HEXA GENE,,,1097.54
Deidentified Maximum,,81256,CPT4/HCPCS,HFE GENE,,,335.07
Deidentified Maximum,,81270,CPT4/HCPCS,JAK2 GENE,,,290.05
Deidentified Maximum,,81274,CPT4/HCPCS,HTT GENE CHARAC ALLELES,,,1962.32
Deidentified Maximum,,81275,CPT4/HCPCS,KRAS GENE VARIANTS EXON 2,,,758.60
Deidentified Maximum,,81288,CPT4/HCPCS,MLH1 GENE,,,2714.20
Deidentified Maximum,,81294,CPT4/HCPCS,MLH1 GENE DUP/DELETE VARIANT,,,1951.90
Deidentified Maximum,,81310,CPT4/HCPCS,NPM1 GENE,,,209.91
Deidentified Maximum,,81313,CPT4/HCPCS,PCA3/KLK3 ANTIGEN,,,1680.00
Deidentified Maximum,,81320,CPT4/HCPCS,PLCG2 GENE COMMON VARIANTS,,,2080.34
Deidentified Maximum,,81323,CPT4/HCPCS,PTEN GENE DUP/DELET VARIANT,,,333.64
Deidentified Maximum,,81327,CPT4/HCPCS,SEPT9 GEN PRMTR MTHYLTN ALYS,,,597.40
Deidentified Maximum,,81329,CPT4/HCPCS,SMN1 GENE DOS/DELETION ALYS,,,978.18
Deidentified Maximum,,81331,CPT4/HCPCS,SNRPN/UBE3A GENE,,,294.67
Deidentified Maximum,,81334,CPT4/HCPCS,RUNX1 GENE TARGETED SEQ ALYS,,,2352.67
Deidentified Maximum,,81337,CPT4/HCPCS,SMN1 GEN NOWN FAMIL SEQ VRNT,,,1322.32
Deidentified Maximum,,81341,CPT4/HCPCS,TRB@ GENE REARRANGE DIRPROBE,,,289.80
Deidentified Maximum,,81346,CPT4/HCPCS,TYMS GENE COM VARIANTS,,,1248.15
Deidentified Maximum,,81361,CPT4/HCPCS,HBB GENE COM VARIANTS,,,1248.15
Deidentified Maximum,,81373,CPT4/HCPCS,HLA I TYPING 1 LOCUS LR,,,817.40
Deidentified Maximum,,81400,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 1,,,345.32
Deidentified Maximum,,81410,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,,3598.55
Deidentified Maximum,,81411,CPT4/HCPCS,AORTIC DYSFUNCTION/DILATION,,,6115.19
Deidentified Maximum,,81415,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,,8400.00
Deidentified Maximum,,81416,CPT4/HCPCS,EXOME SEQUENCE ANALYSIS,,,8400.00
Deidentified Maximum,,81460,CPT4/HCPCS,WHOLE MITOCHONDRIAL GENOME,,,13272.00
Deidentified Maximum,,81479,CPT4/HCPCS,UNLISTED MOLECULAR PATHOLOGY,,,378.00
Deidentified Maximum,,81500,CPT4/HCPCS,ONCO (OVAR) TWO PROTEINS,,,1860.01
Deidentified Maximum,,81509,CPT4/HCPCS,FTL CGEN ABNOR 3 PROTEINS,,,487.20
Deidentified Maximum,,81541,CPT4/HCPCS,ONC PROSTATE MRNA 46 GENES,,,27653.22
Deidentified Maximum,,81551,CPT4/HCPCS,ONC PROSTATE 3 GENES,,,11094.71
Deidentified Maximum,,82009,CPT4/HCPCS,TEST FOR ACETONE/KETONES,,,102.00
Deidentified Maximum,,82013,CPT4/HCPCS,ACETYLCHOLINESTERASE ASSAY,,,112.22
Deidentified Maximum,,82016,CPT4/HCPCS,ACYLCARNITINES QUAL,,,139.27
Deidentified Maximum,,82105,CPT4/HCPCS,ALPHA-FETOPROTEIN SERUM,,,168.58
Deidentified Maximum,,82106,CPT4/HCPCS,ALPHA-FETOPROTEIN AMNIOTIC,,,168.58
Deidentified Maximum,,82150,CPT4/HCPCS,ASSAY OF AMYLASE,,,102.00
Deidentified Maximum,,82286,CPT4/HCPCS,ASSAY OF BRADYKININ,,,102.00
Deidentified Maximum,,82300,CPT4/HCPCS,ASSAY OF CADMIUM,,,232.51
Deidentified Maximum,,82340,CPT4/HCPCS,ASSAY OF CALCIUM IN URINE,,,102.00
Deidentified Maximum,,82355,CPT4/HCPCS,CALCULUS ANALYSIS QUAL,,,116.34
Deidentified Maximum,,82365,CPT4/HCPCS,CALCULUS SPECTROSCOPY,,,129.52
Deidentified Maximum,,82370,CPT4/HCPCS,X-RAY ASSAY CALCULUS,,,125.91
Deidentified Maximum,,82376,CPT4/HCPCS,ASSAY CARBOXYHB QUAL,,,102.00
Deidentified Maximum,,82390,CPT4/HCPCS,ASSAY OF CERULOPLASMIN,,,107.94
Deidentified Maximum,,82507,CPT4/HCPCS,ASSAY OF CITRATE,,,279.38
Deidentified Maximum,,82528,CPT4/HCPCS,ASSAY OF CORTICOSTERONE,,,226.21
Deidentified Maximum,,82540,CPT4/HCPCS,ASSAY OF CREATINE,,,102.00
Deidentified Maximum,,82595,CPT4/HCPCS,ASSAY OF CRYOGLOBULIN,,,102.00
Deidentified Maximum,,82696,CPT4/HCPCS,ASSAY OF ETIOCHOLANOLONE,,,236.96
Deidentified Maximum,,82726,CPT4/HCPCS,LONG CHAIN FATTY ACIDS,,,181.44
Deidentified Maximum,,82731,CPT4/HCPCS,ASSAY OF FETAL FIBRONECTIN,,,647.13
Deidentified Maximum,,82757,CPT4/HCPCS,ASSAY OF SEMEN FRUCTOSE,,,174.30
Deidentified Maximum,,82759,CPT4/HCPCS,ASSAY OF RBC GALACTOKINASE,,,215.88
Deidentified Maximum,,82787,CPT4/HCPCS,IGG 1 2 3 OR 4 EACH,,,102.00
Deidentified Maximum,,82820,CPT4/HCPCS,HEMOGLOBIN-OXYGEN AFFINITY,,,102.00
Deidentified Maximum,,82951,CPT4/HCPCS,GLUCOSE TOLERANCE TEST (GTT),,,129.36
Deidentified Maximum,,82960,CPT4/HCPCS,TEST FOR G6PD ENZYME,,,102.00
Deidentified Maximum,,82963,CPT4/HCPCS,ASSAY OF GLUCOSIDASE,,,215.88
Deidentified Maximum,,82977,CPT4/HCPCS,ASSAY OF GGT,,,102.00
Deidentified Maximum,,83498,CPT4/HCPCS,ASSAY OF PROGESTERONE 17-D,,,273.00
Deidentified Maximum,,83518,CPT4/HCPCS,IMMUNOASSAY DIPSTICK,,,102.00
Deidentified Maximum,,83519,CPT4/HCPCS,RIA NONANTIBODY,,,135.74
Deidentified Maximum,,83525,CPT4/HCPCS,ASSAY OF INSULIN,,,114.91
Deidentified Maximum,,83605,CPT4/HCPCS,ASSAY OF LACTIC ACID,,,107.35
Deidentified Maximum,,83631,CPT4/HCPCS,LACTOFERRIN FECAL (QUANT),,,197.23
Deidentified Maximum,,83633,CPT4/HCPCS,TEST URINE FOR LACTOSE,,,102.00
Deidentified Maximum,,83835,CPT4/HCPCS,ASSAY OF METANEPHRINES,,,170.18
Deidentified Maximum,,83857,CPT4/HCPCS,ASSAY OF METHEMALBUMIN,,,107.94
Deidentified Maximum,,83864,CPT4/HCPCS,MUCOPOLYSACCHARIDES,,,200.08
Deidentified Maximum,,83883,CPT4/HCPCS,ASSAY NEPHELOMETRY NOT SPEC,,,136.58
Deidentified Maximum,,83921,CPT4/HCPCS,ORGANIC ACID SINGLE QUANT,,,165.39
Deidentified Maximum,,83945,CPT4/HCPCS,ASSAY OF OXALATE,,,129.36
Deidentified Maximum,,83950,CPT4/HCPCS,ONCOPROTEIN HER-2/NEU,,,647.13
Deidentified Maximum,,83993,CPT4/HCPCS,ASSAY FOR CALPROTECTIN FECAL,,,197.23
Deidentified Maximum,,84119,CPT4/HCPCS,TEST URINE FOR PORPHYRINS,,,102.00
Deidentified Maximum,,84138,CPT4/HCPCS,ASSAY OF PREGNANETRIOL,,,190.25
Deidentified Maximum,,84152,CPT4/HCPCS,ASSAY OF PSA COMPLEXED,,,184.88
Deidentified Maximum,,84203,CPT4/HCPCS,TEST RBC PROTOPORPHYRIN,,,102.00
Deidentified Maximum,,84206,CPT4/HCPCS,ASSAY OF PROINSULIN,,,179.00
Deidentified Maximum,,84207,CPT4/HCPCS,ASSAY OF VITAMIN B-6,,,282.32
Deidentified Maximum,,84220,CPT4/HCPCS,ASSAY OF PYRUVATE KINASE,,,102.00
Deidentified Maximum,,84228,CPT4/HCPCS,ASSAY OF QUININE,,,116.92
Deidentified Maximum,,84238,CPT4/HCPCS,ASSAY NONENDOCRINE RECEPTOR,,,367.41
Deidentified Maximum,,84403,CPT4/HCPCS,ASSAY OF TOTAL TESTOSTERONE,,,259.39
Deidentified Maximum,,84442,CPT4/HCPCS,ASSAY OF THYROID ACTIVITY,,,148.68
Deidentified Maximum,,84460,CPT4/HCPCS,ALANINE AMINO (ALT) (SGPT),,,102.00
Deidentified Maximum,,84540,CPT4/HCPCS,ASSAY OF URINE/UREA-N,,,102.00
Deidentified Maximum,,84583,CPT4/HCPCS,ASSAY OF URINE UROBILINOGEN,,,102.00
Deidentified Maximum,,84586,CPT4/HCPCS,ASSAY OF VIP,,,354.98
Deidentified Maximum,,84630,CPT4/HCPCS,ASSAY OF ZINC,,,114.40
Deidentified Maximum,,84702,CPT4/HCPCS,CHORIONIC GONADOTROPIN TEST,,,151.28
Deidentified Maximum,,84830,CPT4/HCPCS,OVULATION TESTS,,,102.00
Deidentified Maximum,,85007,CPT4/HCPCS,BL SMEAR W/DIFF WBC COUNT,,,102.00
Deidentified Maximum,,85009,CPT4/HCPCS,MANUAL DIFF WBC COUNT B-COAT,,,102.00
Deidentified Maximum,,85018,CPT4/HCPCS,HEMOGLOBIN,,,102.00
Deidentified Maximum,,85027,CPT4/HCPCS,COMPLETE CBC AUTOMATED,,,102.00
Deidentified Maximum,,85032,CPT4/HCPCS,MANUAL CELL COUNT EACH,,,102.00
Deidentified Maximum,,85045,CPT4/HCPCS,AUTOMATED RETICULOCYTE COUNT,,,102.00
Deidentified Maximum,,85097,CPT4/HCPCS,BONE MARROW INTERPRETATION,,,361.11
Deidentified Maximum,,85230,CPT4/HCPCS,CLOT FACTOR VII PROCONVERTIN,,,179.92
Deidentified Maximum,,85335,CPT4/HCPCS,FACTOR INHIBITOR TEST,,,129.36
Deidentified Maximum,,85348,CPT4/HCPCS,COAGULATION TIME OTR METHOD,,,102.00
Deidentified Maximum,,85360,CPT4/HCPCS,EUGLOBULIN LYSIS,,,102.00
Deidentified Maximum,,85384,CPT4/HCPCS,FIBRINOGEN ACTIVITY,,,102.00
Deidentified Maximum,,85385,CPT4/HCPCS,FIBRINOGEN ANTIGEN,,,102.00
Deidentified Maximum,,85397,CPT4/HCPCS,CLOTTING FUNCT ACTIVITY,,,230.58
Deidentified Maximum,,85445,CPT4/HCPCS,HEINZ BODIES INDUCED,,,102.00
Deidentified Maximum,,85530,CPT4/HCPCS,HEPARIN-PROTAMINE TOLERANCE,,,142.46
Deidentified Maximum,,85555,CPT4/HCPCS,RBC OSMOTIC FRAGILITY,,,102.00
Deidentified Maximum,,85610,CPT4/HCPCS,PROTHROMBIN TIME,,,102.00
Deidentified Maximum,,85705,CPT4/HCPCS,THROMBOPLASTIN INHIBITION,,,102.00
Deidentified Maximum,,85730,CPT4/HCPCS,THROMBOPLASTIN TIME PARTIAL,,,102.00
Deidentified Maximum,,86215,CPT4/HCPCS,DEOXYRIBONUCLEASE ANTIBODY,,,133.14
Deidentified Maximum,,86301,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 19-9,,,209.16
Deidentified Maximum,,86308,CPT4/HCPCS,HETEROPHILE ANTIBODY SCREEN,,,102.00
Deidentified Maximum,,86316,CPT4/HCPCS,IMMUNOASSAY TUMOR OTHER,,,209.16
Deidentified Maximum,,86331,CPT4/HCPCS,IMMUNODIFFUSION OUCHTERLONY,,,120.37
Deidentified Maximum,,86335,CPT4/HCPCS,IMMUNFIX E-PHORSIS/URINE/CSF,,,294.92
Deidentified Maximum,,86367,CPT4/HCPCS,STEM CELLS TOTAL COUNT,,,379.00
Deidentified Maximum,,86590,CPT4/HCPCS,STREPTOKINASE ANTIBODY,,,110.88
Deidentified Maximum,,86622,CPT4/HCPCS,BRUCELLA ANTIBODY,,,102.00
Deidentified Maximum,,86653,CPT4/HCPCS,ENCEPHALTIS ST LOUIS ANTBODY,,,132.55
Deidentified Maximum,,86654,CPT4/HCPCS,ENCEPHALTIS WEST EQNE ANTBDY,,,132.55
Deidentified Maximum,,86674,CPT4/HCPCS,GIARDIA LAMBLIA ANTIBODY,,,147.92
Deidentified Maximum,,86695,CPT4/HCPCS,HERPES SIMPLEX TYPE 1 TEST,,,132.55
Deidentified Maximum,,86698,CPT4/HCPCS,HISTOPLASMA ANTIBODY,,,125.58
Deidentified Maximum,,86705,CPT4/HCPCS,HEP B CORE ANTIBODY IGM,,,118.27
Deidentified Maximum,,86727,CPT4/HCPCS,LYMPH CHORIOMENINGITIS AB,,,129.27
Deidentified Maximum,,86735,CPT4/HCPCS,MUMPS ANTIBODY,,,131.12
Deidentified Maximum,,86759,CPT4/HCPCS,ROTAVIRUS ANTIBODY,,,132.55
Deidentified Maximum,,86765,CPT4/HCPCS,RUBEOLA ANTIBODY,,,129.44
Deidentified Maximum,,86771,CPT4/HCPCS,SHIGELLA ANTIBODY,,,132.55
Deidentified Maximum,,86812,CPT4/HCPCS,HLA TYPING A B OR C,,,259.30
Deidentified Maximum,,86817,CPT4/HCPCS,HLA TYPING DR/DQ,,,646.96
Deidentified Maximum,,86825,CPT4/HCPCS,HLA X-MATH NON-CYTOTOXIC,,,807.07
Deidentified Maximum,,86891,CPT4/HCPCS,AUTOLOGOUS BLOOD OP SALVAGE,,,1424.24
Deidentified Maximum,,86906,CPT4/HCPCS,BLD TYPING SEROLOGIC RH PHNT,,,102.00
Deidentified Maximum,,86923,CPT4/HCPCS,COMPATIBILITY TEST ELECTRIC,,,162.79
Deidentified Maximum,,86965,CPT4/HCPCS,POOLING BLOOD PLATELETS,,,189.42
Deidentified Maximum,,86972,CPT4/HCPCS,RBC PRETX INCUBATJ W/DENSITY,,,239.73
Deidentified Maximum,,86977,CPT4/HCPCS,RBC SERUM PRETX INCUBJ/INHIB,,,204.20
Deidentified Maximum,,86978,CPT4/HCPCS,RBC PRETREATMENT SERUM,,,250.19
Deidentified Maximum,,87046,CPT4/HCPCS,STOOL CULTR AEROBIC BACT EA,,,102.00
Deidentified Maximum,,87076,CPT4/HCPCS,CULTURE ANAEROBE IDENT EACH,,,102.00
Deidentified Maximum,,87118,CPT4/HCPCS,MYCOBACTERIC IDENTIFICATION,,,109.95
Deidentified Maximum,,87147,CPT4/HCPCS,CULTURE TYPE IMMUNOLOGIC,,,102.00
Deidentified Maximum,,87166,CPT4/HCPCS,DARK FIELD EXAMINATION,,,113.56
Deidentified Maximum,,87177,CPT4/HCPCS,OVA AND PARASITES SMEARS,,,102.00
Deidentified Maximum,,87190,CPT4/HCPCS,MICROBE SUSCEPT MYCOBACTERI,,,102.00
Deidentified Maximum,,87209,CPT4/HCPCS,SMEAR COMPLEX STAIN,,,180.59
Deidentified Maximum,,87265,CPT4/HCPCS,PERTUSSIS AG IF,,,102.00
Deidentified Maximum,,87271,CPT4/HCPCS,CYTOMEGALOVIRUS DFA,,,102.00
Deidentified Maximum,,87305,CPT4/HCPCS,ASPERGILLUS AG IA,,,102.00
Deidentified Maximum,,87329,CPT4/HCPCS,GIARDIA AG IA,,,102.00
Deidentified Maximum,,87332,CPT4/HCPCS,CYTOMEGALOVIRUS AG IA,,,102.00
Deidentified Maximum,,87492,CPT4/HCPCS,CHYLMD TRACH DNA QUANT,,,351.28
Deidentified Maximum,,87496,CPT4/HCPCS,CYTOMEG DNA AMP PROBE,,,352.63
Deidentified Maximum,,87505,CPT4/HCPCS,NFCT AGENT DETECTION GI,,,1246.47
Deidentified Maximum,,87527,CPT4/HCPCS,HEPATITIS G DNA QUANT,,,419.49
Deidentified Maximum,,87528,CPT4/HCPCS,HSV DNA DIR PROBE,,,201.51
Deidentified Maximum,,87531,CPT4/HCPCS,HHV-6 DNA DIR PROBE,,,201.51
Deidentified Maximum,,87562,CPT4/HCPCS,M.AVIUM-INTRA DNA QUANT,,,430.41
Deidentified Maximum,,87652,CPT4/HCPCS,STREP A DNA QUANT,,,419.49
Deidentified Maximum,,87804,CPT4/HCPCS,INFLUENZA ASSAY W/OPTIC,,,102.00
Deidentified Maximum,,87806,CPT4/HCPCS,HIV ANTIGEN W/HIV ANTIBODIES,,,233.94
Deidentified Maximum,,87901,CPT4/HCPCS,GENOTYPE DNA HIV REVERSE T,,,2586.69
Deidentified Maximum,,88029,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,,1692.93
Deidentified Maximum,,88120,CPT4/HCPCS,CYTP URNE 3-5 PROBES EA SPEC,,,5718.68
Deidentified Maximum,,88140,CPT4/HCPCS,SEX CHROMATIN IDENTIFICATION,,,102.00
Deidentified Maximum,,88155,CPT4/HCPCS,CYTOPATH C/V INDEX ADD-ON,,,102.00
Deidentified Maximum,,88173,CPT4/HCPCS,CYTOPATH EVAL FNA REPORT,,,602.53
Deidentified Maximum,,88184,CPT4/HCPCS,FLOWCYTOMETRY/ TC 1 MARKER,,,729.79
Deidentified Maximum,,88187,CPT4/HCPCS,FLOWCYTOMETRY/READ 2-8,,,519.62
Deidentified Maximum,,88235,CPT4/HCPCS,TISSUE CULTURE PLACENTA,,,1479.57
Deidentified Maximum,,88240,CPT4/HCPCS,CELL CRYOPRESERVE/STORAGE,,,102.00
Deidentified Maximum,,88249,CPT4/HCPCS,CHROMOSOME ANALYSIS 100,,,1740.06
Deidentified Maximum,,88271,CPT4/HCPCS,CYTOGENETICS DNA PROBE,,,215.20
Deidentified Maximum,,88307,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,,1277.38
Deidentified Maximum,,88309,CPT4/HCPCS,TISSUE EXAM BY PATHOLOGIST,,,1772.14
Deidentified Maximum,,88325,CPT4/HCPCS,COMPREHENSIVE REVIEW OF DATA,,,988.51
Deidentified Maximum,,88329,CPT4/HCPCS,PATH CONSULT INTROP,,,264.68
Deidentified Maximum,,88332,CPT4/HCPCS,PATH CONSULT INTRAOP ADDL,,,123.55
Deidentified Maximum,,88333,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 1,,,303.66
Deidentified Maximum,,88334,CPT4/HCPCS,INTRAOP CYTO PATH CONSULT 2,,,191.18
Deidentified Maximum,,88350,CPT4/HCPCS,IMMUNOFLUOR ANTB ADDL STAIN,,,591.04
Deidentified Maximum,,88360,CPT4/HCPCS,TUMOR IMMUNOHISTOCHEM/MANUAL,,,617.31
Deidentified Maximum,,88369,CPT4/HCPCS,M/PHMTRC ALYSISHQUANT/SEMIQ,,,653.60
Deidentified Maximum,,88371,CPT4/HCPCS,PROTEIN WESTERN BLOT TISSUE,,,223.27
Deidentified Maximum,,88375,CPT4/HCPCS,OPTICAL ENDOMICROSCPY INTERP,,,338.68
Deidentified Maximum,,88387,CPT4/HCPCS,TISS EXAM MOLECULAR STUDY,,,105.08
Deidentified Maximum,,89160,CPT4/HCPCS,EXAM FECES FOR MEAT FIBERS,,,102.00
Deidentified Maximum,,89190,CPT4/HCPCS,NASAL SMEAR FOR EOSINOPHILS,,,102.00
Deidentified Maximum,,89250,CPT4/HCPCS,CULTR OOCYTE/EMBRYO <4 DAYS,,,12919.21
Deidentified Maximum,,89259,CPT4/HCPCS,CRYOPRESERVATION SPERM,,,942.48
Deidentified Maximum,,89342,CPT4/HCPCS,STORAGE/YEAR EMBRYO(S),,,699.72
Deidentified Maximum,,90812,CPT4/HCPCS,INTAC PSYTX OFF 45-50 MIN,,,184.53
Deidentified Maximum,,90818,CPT4/HCPCS,PSYTX HOSP 45-50 MIN,,,223.03
Deidentified Maximum,,90823,CPT4/HCPCS,INTAC PSYTX HOSP 20-30 MIN,,,175.69
Deidentified Maximum,,90845,CPT4/HCPCS,PSYCHOANALYSIS,,,170.11
Deidentified Maximum,,90849,CPT4/HCPCS,MULTIPLE FAMILY GROUP PSYTX,,,104.30
Deidentified Maximum,,90857,CPT4/HCPCS,INTAC GROUP PSYTX,,,105.08
Deidentified Maximum,,90887,CPT4/HCPCS,CONSULTATION WITH FAMILY,,,179.72
Deidentified Maximum,,90901,CPT4/HCPCS,BIOFEEDBACK TRAIN ANY METH,,,6766.00
Deidentified Maximum,,90937,CPT4/HCPCS,HEMODIALYSIS REPEATED EVAL,,,494.97
Deidentified Maximum,,90947,CPT4/HCPCS,DIALYSIS REPEATED EVAL,,,504.58
Deidentified Maximum,,91010,CPT4/HCPCS,ESOPHAGUS MOTILITY STUDY,,,2002.00
Deidentified Maximum,,91022,CPT4/HCPCS,DUODENAL MOTILITY STUDY,,,2002.00
Deidentified Maximum,,91038,CPT4/HCPCS,ESOPH IMPED FUNCT TEST > 1HR,,,1214.00
Deidentified Maximum,,91040,CPT4/HCPCS,ESOPH BALLOON DISTENSION TST,,,5215.94
Deidentified Maximum,,91117,CPT4/HCPCS,COLON MOTILITY 6 HR STUDY,,,1214.00
Deidentified Maximum,,92082,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,,465.94
Deidentified Maximum,,92140,CPT4/HCPCS,GLAUCOMA PROVOCATIVE TESTS,,,480.38
Deidentified Maximum,,92265,CPT4/HCPCS,EYE MUSCLE EVALUATION,,,777.92
Deidentified Maximum,,92284,CPT4/HCPCS,DARK ADAPTATION EYE EXAM,,,1072.22
Deidentified Maximum,,92286,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,,1485.24
Deidentified Maximum,,92287,CPT4/HCPCS,INTERNAL EYE PHOTOGRAPHY,,,1158.05
Deidentified Maximum,,92315,CPT4/HCPCS,RX CNTACT LENS APHAKIA 1 EYE,,,413.01
Deidentified Maximum,,92370,CPT4/HCPCS,REPAIR & ADJUST SPECTACLES,,,272.70
Deidentified Maximum,,92523,CPT4/HCPCS,SPEECH SOUND LANG COMPREHEN,,,6766.00
Deidentified Maximum,,92548,CPT4/HCPCS,CDP-SOT 6 COND W/I&R,,,1462.25
Deidentified Maximum,,92571,CPT4/HCPCS,FILTERED SPEECH HEARING TEST,,,198.97
Deidentified Maximum,,92604,CPT4/HCPCS,REPROGRAM COCHLEAR IMPLT 7/>,,,735.54
Deidentified Maximum,,92928,CPT4/HCPCS,PRQ CARD STENT W/ANGIO 1 VSL,,,10119.00
Deidentified Maximum,,92929,CPT4/HCPCS,PRQ CARD STENT W/ANGIO ADDL,,,10119.00
Deidentified Maximum,,92941,CPT4/HCPCS,PRQ CARD REVASC MI 1 VSL,,,8970.00
Deidentified Maximum,,92950,CPT4/HCPCS,HEART/LUNG RESUSCITATION CPR,,,2138.65
Deidentified Maximum,,92961,CPT4/HCPCS,CARDIOVERSION ELECTRIC INT,,,1678.00
Deidentified Maximum,,92971,CPT4/HCPCS,CARDIOASSIST EXTERNAL,,,1370.00
Deidentified Maximum,,92974,CPT4/HCPCS,CATH PLACE CARDIO BRACHYTX,,,1214.00
Deidentified Maximum,,92979,CPT4/HCPCS,ENDOLUMINL IVUS OCT C EA,,,1678.00
Deidentified Maximum,,92981,CPT4/HCPCS,INSERT INTRACORONARY STENT,,,8012.00
Deidentified Maximum,,92986,CPT4/HCPCS,REVISION OF AORTIC VALVE,,,12850.70
Deidentified Maximum,,92995,CPT4/HCPCS,CORONARY ATHERECTOMY,,,8841.00
Deidentified Maximum,,93000,CPT4/HCPCS,ELECTROCARDIOGRAM COMPLETE,,,257.50
Deidentified Maximum,,93017,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,,857.53
Deidentified Maximum,,93041,CPT4/HCPCS,RHYTHM ECG TRACING,,,76.20
Deidentified Maximum,,93050,CPT4/HCPCS,ART PRESSURE WAVEFORM ANALYS,,,987.78
Deidentified Maximum,,93268,CPT4/HCPCS,ECG RECORD/REVIEW,,,3702.44
Deidentified Maximum,,93285,CPT4/HCPCS,PRGRMG DEV EVAL SCRMS IP,,,150.19
Deidentified Maximum,,93289,CPT4/HCPCS,INTERROG DEVICE EVAL HEART,,,189.58
Deidentified Maximum,,93290,CPT4/HCPCS,INTERROG DEV EVAL ICPMS IP,,,86.60
Deidentified Maximum,,93458,CPT4/HCPCS,L HRT ARTERY/VENTRICLE ANGIO,,,9548.65
Deidentified Maximum,,93462,CPT4/HCPCS,L HRT CATH TRNSPTL PUNCTURE,,,8841.00
Deidentified Maximum,,93532,CPT4/HCPCS,R & L HEART CATH CONGENITAL,,,9548.65
Deidentified Maximum,,93563,CPT4/HCPCS,INJECT CONGENITAL CARD CATH,,,4613.00
Deidentified Maximum,,93568,CPT4/HCPCS,INJECT PULM ART HRT CATH,,,4613.00
Deidentified Maximum,,93609,CPT4/HCPCS,MAP TACHYCARDIA ADD-ON,,,7830.00
Deidentified Maximum,,93612,CPT4/HCPCS,INTRAVENTRICULAR PACING,,,7530.00
Deidentified Maximum,,93621,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,7830.00
Deidentified Maximum,,93623,CPT4/HCPCS,STIMULATION PACING HEART,,,7530.00
Deidentified Maximum,,93653,CPT4/HCPCS,EP & ABLATE SUPRAVENT ARRHYT,,,9548.65
Deidentified Maximum,,49555,CPT4/HCPCS,REREPAIR FEM HERNIA REDUCE,,,6876.92
Deidentified Maximum,,49572,CPT4/HCPCS,RPR EPIGASTRIC HERN BLOCKED,,,12850.70
Deidentified Maximum,,49605,CPT4/HCPCS,REPAIR UMBILICAL LESION,,,9548.65
Deidentified Maximum,,49611,CPT4/HCPCS,REPAIR UMBILICAL LESION,,,6049.05
Deidentified Maximum,,49650,CPT4/HCPCS,LAP ING HERNIA REPAIR INIT,,,7007.00
Deidentified Maximum,,49653,CPT4/HCPCS,LAP VENT/ABD HERN PROC COMP,,,8300.00
Deidentified Maximum,,50045,CPT4/HCPCS,EXPLORATION OF KIDNEY,,,9548.65
Deidentified Maximum,,50320,CPT4/HCPCS,REMOVE KIDNEY LIVING DONOR,,,5281.00
Deidentified Maximum,,50384,CPT4/HCPCS,REMOVE URETER STENT PERCUT,,,4280.43
Deidentified Maximum,,50389,CPT4/HCPCS,REMOVE RENAL TUBE W/FLUORO,,,4280.43
Deidentified Maximum,,50396,CPT4/HCPCS,MEASURE KIDNEY PRESSURE,,,3198.57
Deidentified Maximum,,50432,CPT4/HCPCS,PLMT NEPHROSTOMY CATHETER,,,6000.00
Deidentified Maximum,,50500,CPT4/HCPCS,REPAIR OF KIDNEY WOUND,,,5281.00
Deidentified Maximum,,50547,CPT4/HCPCS,LAPARO REMOVAL DONOR KIDNEY,,,6840.00
Deidentified Maximum,,50555,CPT4/HCPCS,KIDNEY ENDOSCOPY & BIOPSY,,,3198.57
Deidentified Maximum,,50590,CPT4/HCPCS,FRAGMENTING OF KIDNEY STONE,,,12850.70
Deidentified Maximum,,50780,CPT4/HCPCS,REIMPLANT URETER IN BLADDER,,,5783.00
Deidentified Maximum,,50825,CPT4/HCPCS,CONSTRUCT BOWEL BLADDER,,,8012.00
Deidentified Maximum,,50840,CPT4/HCPCS,REPLACE URETER BY BOWEL,,,6588.00
Deidentified Maximum,,50860,CPT4/HCPCS,TRANSPLANT URETER TO SKIN,,,5029.00
Deidentified Maximum,,50955,CPT4/HCPCS,URETER ENDOSCOPY & BIOPSY,,,4204.00
Deidentified Maximum,,51030,CPT4/HCPCS,INCISE & TREAT BLADDER,,,6401.00
Deidentified Maximum,,51040,CPT4/HCPCS,INCISE & DRAIN BLADDER,,,6401.00
Deidentified Maximum,,51060,CPT4/HCPCS,REMOVAL OF URETER STONE,,,6075.00
Deidentified Maximum,,51065,CPT4/HCPCS,REMOVE URETER CALCULUS,,,6401.00
Deidentified Maximum,,51535,CPT4/HCPCS,REPAIR OF URETER LESION,,,5029.00
Deidentified Maximum,,51600,CPT4/HCPCS,INJECTION FOR BLADDER X-RAY,,,1678.88
Deidentified Maximum,,51605,CPT4/HCPCS,PREPARATION FOR BLADDER XRAY,,,1678.00
Deidentified Maximum,,51701,CPT4/HCPCS,INSERT BLADDER CATHETER,,,2002.00
Deidentified Maximum,,51900,CPT4/HCPCS,REPAIR BLADDER/VAGINA LESION,,,6401.00
Deidentified Maximum,,51940,CPT4/HCPCS,CORRECTION OF BLADDER DEFECT,,,5281.00
Deidentified Maximum,,51980,CPT4/HCPCS,CONSTRUCT BLADDER OPENING,,,5029.00
Deidentified Maximum,,51999,CPT4/HCPCS,LAPAROSCOPE PROC BLA,,,6075.00
Deidentified Maximum,,52001,CPT4/HCPCS,CYSTOSCOPY REMOVAL OF CLOTS,,,4280.43
Deidentified Maximum,,52214,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52240,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,5856.00
Deidentified Maximum,,52270,CPT4/HCPCS,CYSTOSCOPY & REVISE URETHRA,,,4280.43
Deidentified Maximum,,52305,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52325,CPT4/HCPCS,CYSTOSCOPY STONE REMOVAL,,,6401.00
Deidentified Maximum,,52341,CPT4/HCPCS,CYSTO W/URETER STRICTURE TX,,,5856.00
Deidentified Maximum,,52345,CPT4/HCPCS,CYSTO/URETERO W/UP STRICTURE,,,5856.00
Deidentified Maximum,,52442,CPT4/HCPCS,CYSTOURETHRO W/ADDL IMPLANT,,,3000.00
Deidentified Maximum,,52601,CPT4/HCPCS,PROSTATECTOMY (TURP),,,6401.00
Deidentified Maximum,,52648,CPT4/HCPCS,LASER SURGERY OF PROSTATE,,,12850.70
Deidentified Maximum,,53000,CPT4/HCPCS,INCISION OF URETHRA,,,4204.00
Deidentified Maximum,,53025,CPT4/HCPCS,INCISION OF URETHRA,,,4280.43
Deidentified Maximum,,53210,CPT4/HCPCS,REMOVAL OF URETHRA,,,6876.92
Deidentified Maximum,,53250,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,,4280.43
Deidentified Maximum,,53270,CPT4/HCPCS,REMOVAL OF URETHRA GLAND,,,4280.43
Deidentified Maximum,,53410,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,5138.00
Deidentified Maximum,,53430,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,5138.00
Deidentified Maximum,,53431,CPT4/HCPCS,RECONSTRUCT URETHRA/BLADDER,,,5138.00
Deidentified Maximum,,53505,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,,5138.00
Deidentified Maximum,,53515,CPT4/HCPCS,REPAIR OF URETHRA INJURY,,,5138.00
Deidentified Maximum,,53600,CPT4/HCPCS,DILATE URETHRA STRICTURE,,,3198.57
Deidentified Maximum,,54055,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,,4280.43
Deidentified Maximum,,54057,CPT4/HCPCS,LASER SURG PENIS LESION(S),,,3198.57
Deidentified Maximum,,54060,CPT4/HCPCS,EXCISION OF PENIS LESION(S),,,3198.57
Deidentified Maximum,,54065,CPT4/HCPCS,DESTRUCTION PENIS LESION(S),,,3198.57
Deidentified Maximum,,54112,CPT4/HCPCS,TREAT PENIS LESION GRAFT,,,6075.00
Deidentified Maximum,,54120,CPT4/HCPCS,PARTIAL REMOVAL OF PENIS,,,5138.00
Deidentified Maximum,,54130,CPT4/HCPCS,REMOVE PENIS & NODES,,,5281.00
Deidentified Maximum,,54163,CPT4/HCPCS,REPAIR OF CIRCUMCISION,,,4280.43
Deidentified Maximum,,54220,CPT4/HCPCS,TREATMENT OF PENIS LESION,,,3198.57
Deidentified Maximum,,54230,CPT4/HCPCS,PREPARE PENIS STUDY,,,3000.00
Deidentified Maximum,,54235,CPT4/HCPCS,PENILE INJECTION,,,1214.00
Deidentified Maximum,,54240,CPT4/HCPCS,PENIS STUDY,,,2002.00
Deidentified Maximum,,54300,CPT4/HCPCS,REVISION OF PENIS,,,6075.00
Deidentified Maximum,,54336,CPT4/HCPCS,REVISE PENIS/URETHRA,,,7830.00
Deidentified Maximum,,54410,CPT4/HCPCS,REMOVE/REPLACE PENIS PROSTH,,,10772.00
Deidentified Maximum,,54450,CPT4/HCPCS,PREPUTIAL STRETCHING,,,3198.57
Deidentified Maximum,,54520,CPT4/HCPCS,REMOVAL OF TESTIS,,,5856.00
Deidentified Maximum,,54550,CPT4/HCPCS,EXPLORATION FOR TESTIS,,,6401.00
Deidentified Maximum,,54620,CPT4/HCPCS,SUSPENSION OF TESTIS,,,5856.00
Deidentified Maximum,,54660,CPT4/HCPCS,REVISION OF TESTIS,,,4280.43
Deidentified Maximum,,54865,CPT4/HCPCS,EXPLORE EPIDIDYMIS,,,4204.00
Deidentified Maximum,,55250,CPT4/HCPCS,REMOVAL OF SPERM DUCT(S),,,4280.43
Deidentified Maximum,,55605,CPT4/HCPCS,INCISE SPERM DUCT POUCH,,,3198.57
Deidentified Maximum,,55680,CPT4/HCPCS,REMOVE SPERM POUCH LESION,,,4204.00
Deidentified Maximum,,55706,CPT4/HCPCS,PROSTATE SATURATION SAMPLING,,,4280.43
Deidentified Maximum,,55720,CPT4/HCPCS,DRAINAGE OF PROSTATE ABSCESS,,,4204.00
Deidentified Maximum,,55840,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,5783.00
Deidentified Maximum,,55842,CPT4/HCPCS,EXTENSIVE PROSTATE SURGERY,,,5783.00
Deidentified Maximum,,55860,CPT4/HCPCS,SURGICAL EXPOSURE PROSTATE,,,4280.43
Deidentified Maximum,,55875,CPT4/HCPCS,TRANSPERI NEEDLE PLACE PROS,,,12850.70
Deidentified Maximum,,56606,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,,3198.57
Deidentified Maximum,,56620,CPT4/HCPCS,PARTIAL REMOVAL OF VULVA,,,6876.92
Deidentified Maximum,,56637,CPT4/HCPCS,EXTENSIVE VULVA SURGERY,,,10119.00
Deidentified Maximum,,56805,CPT4/HCPCS,REPAIR CLITORIS,,,4891.93
Deidentified Maximum,,56821,CPT4/HCPCS,EXAM/BIOPSY OF VULVA W/SCOPE,,,3000.00
Deidentified Maximum,,57000,CPT4/HCPCS,EXPLORATION OF VAGINA,,,4204.00
Deidentified Maximum,,57023,CPT4/HCPCS,I & D VAG HEMATOMA NON-OB,,,4204.00
Deidentified Maximum,,57061,CPT4/HCPCS,DESTROY VAG LESIONS SIMPLE,,,4891.93
Deidentified Maximum,,57106,CPT4/HCPCS,REMOVE VAGINA WALL PARTIAL,,,5856.00
Deidentified Maximum,,57155,CPT4/HCPCS,INSERT UTERI TANDEM/OVOIDS,,,7894.00
Deidentified Maximum,,57200,CPT4/HCPCS,REPAIR OF VAGINA,,,4204.00
Deidentified Maximum,,57240,CPT4/HCPCS,ANTERIOR COLPORRHAPHY,,,6876.92
Deidentified Maximum,,57265,CPT4/HCPCS,CMBN AP COLPRHY W/NTRCL RPR,,,9548.65
Deidentified Maximum,,57268,CPT4/HCPCS,REPAIR OF BOWEL BULGE,,,5856.00
Deidentified Maximum,,57291,CPT4/HCPCS,CONSTRUCTION OF VAGINA,,,6876.92
Deidentified Maximum,,57295,CPT4/HCPCS,REVISE VAG GRAFT VIA VAGINA,,,5856.00
Deidentified Maximum,,57311,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,,6401.00
Deidentified Maximum,,57452,CPT4/HCPCS,EXAM OF CERVIX W/SCOPE,,,3656.00
Deidentified Maximum,,57460,CPT4/HCPCS,BX OF CERVIX W/SCOPE LEEP,,,4280.43
Deidentified Maximum,,57530,CPT4/HCPCS,REMOVAL OF CERVIX,,,5856.00
Deidentified Maximum,,57540,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,,5783.00
Deidentified Maximum,,58100,CPT4/HCPCS,BIOPSY OF UTERUS LINING,,,2002.00
Deidentified Maximum,,58110,CPT4/HCPCS,BX DONE W/COLPOSCOPY ADD-ON,,,3000.00
Deidentified Maximum,,58260,CPT4/HCPCS,VAGINAL HYSTERECTOMY,,,8300.00
Deidentified Maximum,,58263,CPT4/HCPCS,VAG HYST W/T/O & VAG REPAIR,,,8012.00
Deidentified Maximum,,58275,CPT4/HCPCS,HYSTERECTOMY/REVISE VAGINA,,,8012.00
Deidentified Maximum,,58294,CPT4/HCPCS,VAG HYST W/ENTEROCELE COMPL,,,8012.00
Deidentified Maximum,,58323,CPT4/HCPCS,SPERM WASHING,,,1214.00
Deidentified Maximum,,58540,CPT4/HCPCS,REVISION OF UTERUS,,,7830.00
Deidentified Maximum,,58542,CPT4/HCPCS,LSH W/T/O UT 250 G OR LESS,,,8300.00
Deidentified Maximum,,58543,CPT4/HCPCS,LSH UTERUS ABOVE 250 G,,,8300.00
Deidentified Maximum,,58548,CPT4/HCPCS,LAP RADICAL HYST,,,6075.00
Deidentified Maximum,,58559,CPT4/HCPCS,HYSTEROSCOPY LYSIS,,,4280.43
Deidentified Maximum,,58579,CPT4/HCPCS,HYSTEROSCOPE PROCEDURE,,,5856.00
Deidentified Maximum,,58750,CPT4/HCPCS,REPAIR OVIDUCT,,,6840.00
Deidentified Maximum,,58760,CPT4/HCPCS,FIMBRIOPLASTY,,,6840.00
Deidentified Maximum,,58943,CPT4/HCPCS,REMOVAL OF OVARY(S),,,5783.00
Deidentified Maximum,,58957,CPT4/HCPCS,RESECT RECURRENT GYN MAL,,,5783.00
Deidentified Maximum,,58974,CPT4/HCPCS,TRANSFER OF EMBRYO,,,3198.57
Deidentified Maximum,,59072,CPT4/HCPCS,UMBILICAL CORD OCCLUD W/US,,,3544.00
Deidentified Maximum,,59076,CPT4/HCPCS,FETAL SHUNT PLACEMENT W/US,,,3198.57
Deidentified Maximum,,59100,CPT4/HCPCS,REMOVE UTERUS LESION,,,9548.65
Deidentified Maximum,,59136,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,9548.65
Deidentified Maximum,,59160,CPT4/HCPCS,D & C AFTER DELIVERY,,,5856.00
Deidentified Maximum,,59426,CPT4/HCPCS,ANTEPARTUM CARE ONLY,,,3198.57
Deidentified Maximum,,59830,CPT4/HCPCS,TREAT UTERUS INFECTION,,,4280.43
Deidentified Maximum,,59855,CPT4/HCPCS,ABORTION,,,4891.93
Deidentified Maximum,,59866,CPT4/HCPCS,ABORTION (MPR),,,3198.57
Deidentified Maximum,,60220,CPT4/HCPCS,PARTIAL REMOVAL OF THYROID,,,9548.65
Deidentified Maximum,,60270,CPT4/HCPCS,REMOVAL OF THYROID,,,8012.00
Deidentified Maximum,,60600,CPT4/HCPCS,REMOVE CAROTID BODY LESION,,,5281.00
Deidentified Maximum,,61020,CPT4/HCPCS,REMOVE BRAIN CAVITY FLUID,,,3198.57
Deidentified Maximum,,61150,CPT4/HCPCS,PIERCE SKULL FOR DRAINAGE,,,5281.00
Deidentified Maximum,,61250,CPT4/HCPCS,PIERCE SKULL & EXPLORE,,,5281.00
Deidentified Maximum,,61314,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,4280.43
Deidentified Maximum,,61320,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,6588.00
Deidentified Maximum,,61332,CPT4/HCPCS,EXPLORE/BIOPSY EYE SOCKET,,,6049.05
Deidentified Maximum,,61334,CPT4/HCPCS,EXPLORE ORBIT/REMOVE OBJECT,,,5029.00
Deidentified Maximum,,61345,CPT4/HCPCS,RELIEVE CRANIAL PRESSURE,,,6588.00
Deidentified Maximum,,61440,CPT4/HCPCS,INCISE SKULL FOR SURGERY,,,6588.00
Deidentified Maximum,,61519,CPT4/HCPCS,REMOVE BRAIN LINING LESION,,,6876.92
Deidentified Maximum,,61524,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,6588.00
Deidentified Maximum,,61539,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,8012.00
Deidentified Maximum,,61541,CPT4/HCPCS,INCISION OF BRAIN TISSUE,,,6588.00
Deidentified Maximum,,61545,CPT4/HCPCS,EXCISION OF BRAIN TUMOR,,,8012.00
Deidentified Maximum,,61552,CPT4/HCPCS,RELEASE OF SKULL SEAMS,,,6588.00
Deidentified Maximum,,61576,CPT4/HCPCS,SKULL BASE/BRAINSTEM SURGERY,,,8012.00
Deidentified Maximum,,61583,CPT4/HCPCS,CRANIOFACIAL APPROACH SKULL,,,6876.92
Deidentified Maximum,,61584,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,,6876.92
Deidentified Maximum,,61591,CPT4/HCPCS,INFRATEMPORAL APPROACH/SKULL,,,8012.00
Deidentified Maximum,,61601,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,8012.00
Deidentified Maximum,,61608,CPT4/HCPCS,RESECT/EXCISE CRANIAL LESION,,,7902.34
Deidentified Maximum,,61612,CPT4/HCPCS,TRANSECT ARTERY SINUS,,,8012.00
Deidentified Maximum,,61615,CPT4/HCPCS,RESECT/EXCISE LESION SKULL,,,8841.00
Deidentified Maximum,,61680,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,6588.00
Deidentified Maximum,,61711,CPT4/HCPCS,FUSION OF SKULL ARTERIES,,,6049.05
Deidentified Maximum,,61735,CPT4/HCPCS,INCISE SKULL/BRAIN SURGERY,,,5310.00
Deidentified Maximum,,61770,CPT4/HCPCS,INCISE SKULL FOR TREATMENT,,,6075.00
Deidentified Maximum,,61850,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,5783.00
Deidentified Maximum,,61870,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,6588.00
Deidentified Maximum,,61875,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,6588.00
Deidentified Maximum,,62005,CPT4/HCPCS,TREAT SKULL FRACTURE,,,5783.00
Deidentified Maximum,,62160,CPT4/HCPCS,NEUROENDOSCOPY ADD-ON,,,5310.00
Deidentified Maximum,,62258,CPT4/HCPCS,REPLACE BRAIN CAVITY SHUNT,,,5783.00
Deidentified Maximum,,62282,CPT4/HCPCS,TREAT SPINAL CANAL LESION,,,5310.00
Deidentified Maximum,,62290,CPT4/HCPCS,NJX PX DISCOGRAPHY LUMBAR,,,5310.00
Deidentified Maximum,,62292,CPT4/HCPCS,NJX CHEMONUCLEOLYSIS LMBR,,,5310.00
Deidentified Maximum,,62305,CPT4/HCPCS,MYELOGRAPHY LUMBAR INJECTION,,,5310.00
Deidentified Maximum,,62321,CPT4/HCPCS,NJX INTERLAMINAR CRV/THRC,,,5310.00
Deidentified Maximum,,62355,CPT4/HCPCS,REMOVE SPINAL CANAL CATHETER,,,5310.00
Deidentified Maximum,,63012,CPT4/HCPCS,REMOVE LAMINA/FACETS LUMBAR,,,9548.65
Deidentified Maximum,,63020,CPT4/HCPCS,NECK SPINE DISK SURGERY,,,9548.65
Deidentified Maximum,,63075,CPT4/HCPCS,NECK SPINE DISK SURGERY,,,7007.00
Deidentified Maximum,,63078,CPT4/HCPCS,SPINE DISK SURGERY THORAX,,,5310.00
Deidentified Maximum,,63090,CPT4/HCPCS,REMOVE VERT BODY DCMPRN LMBR,,,5783.00
Deidentified Maximum,,63103,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,5310.00
Deidentified Maximum,,63180,CPT4/HCPCS,REVISE SPINAL CORD LIGAMENTS,,,5783.00
Deidentified Maximum,,63190,CPT4/HCPCS,INCISE SPINE NRV >2 SEGMNTS,,,10119.00
Deidentified Maximum,,63191,CPT4/HCPCS,INCISE SPINE ACCESSORY NERVE,,,10119.00
Deidentified Maximum,,63200,CPT4/HCPCS,RELEASE SPINAL CORD LUMBAR,,,10119.00
Deidentified Maximum,,63251,CPT4/HCPCS,REVISE SPINAL CORD VSLS THRC,,,6876.92
Deidentified Maximum,,63277,CPT4/HCPCS,BX/EXC XDRL SPINE LESN LMBR,,,10119.00
Deidentified Maximum,,63278,CPT4/HCPCS,BX/EXC XDRL SPINE LESN SCRL,,,5310.00
Deidentified Maximum,,63301,CPT4/HCPCS,REMOVE VERT XDRL BODY THRC,,,5783.00
Deidentified Maximum,,63650,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,8300.00
Deidentified Maximum,,63704,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,,5310.00
Deidentified Maximum,,63709,CPT4/HCPCS,REPAIR SPINAL FLUID LEAKAGE,,,5310.00
Deidentified Maximum,,64402,CPT4/HCPCS,N BLOCK INJ FACIAL,,,3198.57
Deidentified Maximum,,64405,CPT4/HCPCS,NJX AA&/STRD GR OCPL NRV,,,5310.00
Deidentified Maximum,,64408,CPT4/HCPCS,NJX AA&/STRD VAGUS NRV,,,5310.00
Deidentified Maximum,,64413,CPT4/HCPCS,N BLOCK INJ CERVICAL PLEXUS,,,3198.57
Deidentified Maximum,,64415,CPT4/HCPCS,NJX AA&/STRD BRACH PLEXUS,,,5310.00
Deidentified Maximum,,64416,CPT4/HCPCS,NJX AA&/STRD BRACH PLEX NFS,,,5310.00
Deidentified Maximum,,64417,CPT4/HCPCS,NJX AA&/STRD AXILLARY NRV,,,5310.00
Deidentified Maximum,,64420,CPT4/HCPCS,NJX AA&/STRD NTRCOST NRV 1,,,5310.00
Deidentified Maximum,,64484,CPT4/HCPCS,NJX AA&/STRD TFRM EPI L/S EA,,,5310.00
Deidentified Maximum,,64505,CPT4/HCPCS,N BLOCK SPENOPALATINE GANGL,,,5310.00
Deidentified Maximum,,64565,CPT4/HCPCS,IMPLANT NEUROELECTRODES,,,1678.00
Deidentified Maximum,,64605,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,5310.00
Deidentified Maximum,,64614,CPT4/HCPCS,DESTROY NERVE EXTREM MUSC,,,1678.00
Deidentified Maximum,,64640,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,5310.00
Deidentified Maximum,,64642,CPT4/HCPCS,CHEMODENERV 1 EXTREMITY 1-4,,,5310.00
Deidentified Maximum,,64761,CPT4/HCPCS,INCISION OF PELVIS NERVE,,,1678.00
Deidentified Maximum,,64763,CPT4/HCPCS,INCISE HIP/THIGH NERVE,,,5310.00
Deidentified Maximum,,64782,CPT4/HCPCS,REMOVE LIMB NERVE LESION,,,5856.00
Deidentified Maximum,,64804,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,,5310.00
Deidentified Maximum,,64831,CPT4/HCPCS,REPAIR OF DIGIT NERVE,,,6401.00
Deidentified Maximum,,64856,CPT4/HCPCS,REPAIR/TRANSPOSE NERVE,,,6075.00
Deidentified Maximum,,64858,CPT4/HCPCS,REPAIR SCIATIC NERVE,,,5310.00
Deidentified Maximum,,64861,CPT4/HCPCS,REPAIR OF ARM NERVES,,,5856.00
Deidentified Maximum,,64872,CPT4/HCPCS,SUBSEQUENT REPAIR OF NERVE,,,5310.00
Deidentified Maximum,,64891,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,,6075.00
Deidentified Maximum,,64895,CPT4/HCPCS,NERVE GRAFT HAND/FOOT 4 CM,,,6075.00
Deidentified Maximum,,64901,CPT4/HCPCS,NERVE GRAFT ADD-ON,,,5310.00
Deidentified Maximum,,64910,CPT4/HCPCS,NERVE REPAIR W/ALLOGRAFT,,,6075.00
Deidentified Maximum,,64913,CPT4/HCPCS,NRV RPR W/NRV ALGRFT EA ADDL,,,6049.05
Deidentified Maximum,,65101,CPT4/HCPCS,REMOVAL OF EYE,,,5856.00
Deidentified Maximum,,65112,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,,9548.65
Deidentified Maximum,,65114,CPT4/HCPCS,REMOVE EYE/REVISE SOCKET,,,9548.65
Deidentified Maximum,,65130,CPT4/HCPCS,INSERT OCULAR IMPLANT,,,5856.00
Deidentified Maximum,,65286,CPT4/HCPCS,REPAIR OF EYE WOUND,,,5310.00
Deidentified Maximum,,65400,CPT4/HCPCS,REMOVAL OF EYE LESION,,,5310.00
Deidentified Maximum,,65435,CPT4/HCPCS,CURETTE/TREAT CORNEA,,,5310.00
Deidentified Maximum,,65450,CPT4/HCPCS,TREATMENT OF CORNEAL LESION,,,5310.00
Deidentified Maximum,,65756,CPT4/HCPCS,CORNEAL TRNSPL ENDOTHELIAL,,,8300.00
Deidentified Maximum,,65767,CPT4/HCPCS,CORNEAL TISSUE TRANSPLANT,,,9548.65
Deidentified Maximum,,65772,CPT4/HCPCS,CORRECTION OF ASTIGMATISM,,,6401.00
Deidentified Maximum,,65778,CPT4/HCPCS,COVER EYE W/MEMBRANE,,,5310.00
Deidentified Maximum,,65781,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,,9548.65
Deidentified Maximum,,65810,CPT4/HCPCS,DRAINAGE OF EYE,,,5856.00
Deidentified Maximum,,65865,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,,5310.00
Deidentified Maximum,,66175,CPT4/HCPCS,TRNSLUM DIL EYE CANAL W/STNT,,,6840.00
Deidentified Maximum,,66183,CPT4/HCPCS,INSERT ANT DRAINAGE DEVICE,,,8300.00
Deidentified Maximum,,66184,CPT4/HCPCS,REVISION OF AQUEOUS SHUNT,,,8300.00
Deidentified Maximum,,66505,CPT4/HCPCS,INCISION OF IRIS,,,5310.00
Deidentified Maximum,,66625,CPT4/HCPCS,REMOVAL OF IRIS,,,5856.00
Deidentified Maximum,,66700,CPT4/HCPCS,DESTRUCTION CILIARY BODY,,,5310.00
Deidentified Maximum,,66985,CPT4/HCPCS,INSERT LENS PROSTHESIS,,,7902.34
Deidentified Maximum,,67010,CPT4/HCPCS,PARTIAL REMOVAL OF EYE FLUID,,,6401.00
Deidentified Maximum,,67031,CPT4/HCPCS,LASER SURGERY EYE STRANDS,,,5310.00
Deidentified Maximum,,67041,CPT4/HCPCS,VIT FOR MACULAR PUCKER,,,8300.00
Deidentified Maximum,,67043,CPT4/HCPCS,VIT FOR MEMBRANE DISSECT,,,8300.00
Deidentified Maximum,,67120,CPT4/HCPCS,REMOVE EYE IMPLANT MATERIAL,,,5310.00
Deidentified Maximum,,67255,CPT4/HCPCS,REINFORCE/GRAFT EYE WALL,,,5856.00
Deidentified Maximum,,67331,CPT4/HCPCS,EYE SURGERY FOLLOW-UP ADD-ON,,,6401.00
Deidentified Maximum,,67340,CPT4/HCPCS,REVISE EYE MUSCLE ADD-ON,,,6401.00
Deidentified Maximum,,67430,CPT4/HCPCS,EXPLORE/TREAT EYE SOCKET,,,6876.92
Deidentified Maximum,,67500,CPT4/HCPCS,INJECT/TREAT EYE SOCKET,,,5310.00
Deidentified Maximum,,67710,CPT4/HCPCS,INCISION OF EYELID,,,5310.00
Deidentified Maximum,,67800,CPT4/HCPCS,REMOVE EYELID LESION,,,5310.00
Deidentified Maximum,,67882,CPT4/HCPCS,REVISION OF EYELID,,,5856.00
Deidentified Maximum,,67900,CPT4/HCPCS,REPAIR BROW DEFECT,,,6401.00
Deidentified Maximum,,67904,CPT4/HCPCS,REPAIR EYELID DEFECT,,,6401.00
Deidentified Maximum,,67916,CPT4/HCPCS,REPAIR EYELID DEFECT,,,6401.00
Deidentified Maximum,,67921,CPT4/HCPCS,REPAIR EYELID DEFECT,,,5856.00
Deidentified Maximum,,67971,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,,5856.00
Deidentified Maximum,,67973,CPT4/HCPCS,RECONSTRUCTION OF EYELID,,,5856.00
Deidentified Maximum,,68040,CPT4/HCPCS,TREATMENT OF EYELID LESIONS,,,5310.00
Deidentified Maximum,,68110,CPT4/HCPCS,REMOVE EYELID LINING LESION,,,5310.00
Deidentified Maximum,,68200,CPT4/HCPCS,TREAT EYELID BY INJECTION,,,5310.00
Deidentified Maximum,,68330,CPT4/HCPCS,REVISE EYELID LINING,,,6401.00
Deidentified Maximum,,68335,CPT4/HCPCS,REVISE/GRAFT EYELID LINING,,,6401.00
Deidentified Maximum,,68420,CPT4/HCPCS,INCISE/DRAIN TEAR SAC,,,5310.00
Deidentified Maximum,,68500,CPT4/HCPCS,REMOVAL OF TEAR GLAND,,,5856.00
Deidentified Maximum,,68520,CPT4/HCPCS,REMOVAL OF TEAR SAC,,,5856.00
Deidentified Maximum,,68525,CPT4/HCPCS,BIOPSY OF TEAR SAC,,,5310.00
Deidentified Maximum,,68705,CPT4/HCPCS,REVISE TEAR DUCT OPENING,,,5310.00
Deidentified Maximum,,69090,CPT4/HCPCS,PIERCE EARLOBES,,,5310.00
Deidentified Maximum,,69200,CPT4/HCPCS,CLEAR OUTER EAR CANAL,,,5310.00
Deidentified Maximum,,69405,CPT4/HCPCS,CATHETERIZE MIDDLE EAR CANAL,,,1678.00
Deidentified Maximum,,69424,CPT4/HCPCS,REMOVE VENTILATING TUBE,,,5310.00
Deidentified Maximum,,69535,CPT4/HCPCS,REMOVE PART OF TEMPORAL BONE,,,7902.34
Deidentified Maximum,,69554,CPT4/HCPCS,REMOVE EAR LESION,,,6876.92
Deidentified Maximum,,69610,CPT4/HCPCS,REPAIR OF EARDRUM,,,6049.05
Deidentified Maximum,,69633,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,,6876.92
Deidentified Maximum,,69650,CPT4/HCPCS,RELEASE MIDDLE EAR BONE,,,9548.65
Deidentified Maximum,,69676,CPT4/HCPCS,REMOVE MIDDLE EAR NERVE,,,5856.00
Deidentified Maximum,,69915,CPT4/HCPCS,INCISE INNER EAR NERVE,,,9548.65
Deidentified Maximum,,69970,CPT4/HCPCS,REMOVE INNER EAR LESION,,,9548.65
Deidentified Maximum,,70100,CPT4/HCPCS,X-RAY EXAM OF JAW <4VIEWS,,,364.35
Deidentified Maximum,,70150,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,,657.95
Deidentified Maximum,,70200,CPT4/HCPCS,X-RAY EXAM OF EYE SOCKETS,,,400.29
Deidentified Maximum,,70300,CPT4/HCPCS,X-RAY EXAM OF TEETH,,,150.00
Deidentified Maximum,,70320,CPT4/HCPCS,FULL MOUTH X-RAY OF TEETH,,,400.29
Deidentified Maximum,,70330,CPT4/HCPCS,X-RAY EXAM OF JAW JOINTS,,,429.16
Deidentified Maximum,,70480,CPT4/HCPCS,CT ORBIT/EAR/FOSSA W/O DYE,,,6766.00
Deidentified Maximum,,70490,CPT4/HCPCS,CT SOFT TISSUE NECK W/O DYE,,,6766.00
Deidentified Maximum,,70496,CPT4/HCPCS,CT ANGIOGRAPHY HEAD,,,6766.00
Deidentified Maximum,,70542,CPT4/HCPCS,MRI ORBIT/FACE/NECK W/DYE,,,6766.00
Deidentified Maximum,,70554,CPT4/HCPCS,FMRI BRAIN BY TECH,,,6533.00
Deidentified Maximum,,70558,CPT4/HCPCS,MRI BRAIN W/DYE,,,8361.56
Deidentified Maximum,,71260,CPT4/HCPCS,CT THORAX DX C+,,,6766.00
Deidentified Maximum,,71270,CPT4/HCPCS,CT THORAX DX C-/C+,,,6766.00
Deidentified Maximum,,72083,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 4/5 VW,,,672.85
Deidentified Maximum,,72114,CPT4/HCPCS,X-RAY EXAM L-S SPINE BENDING,,,657.95
Deidentified Maximum,,72127,CPT4/HCPCS,CT NECK SPINE W/O & W/DYE,,,6766.00
Deidentified Maximum,,72131,CPT4/HCPCS,CT LUMBAR SPINE W/O DYE,,,6766.00
Deidentified Maximum,,72220,CPT4/HCPCS,X-RAY EXAM SACRUM TAILBONE,,,364.35
Deidentified Maximum,,73010,CPT4/HCPCS,X-RAY EXAM OF SHOULDER BLADE,,,657.95
Deidentified Maximum,,73020,CPT4/HCPCS,X-RAY EXAM OF SHOULDER,,,364.35
Deidentified Maximum,,73070,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,,364.35
Deidentified Maximum,,73085,CPT4/HCPCS,CONTRAST X-RAY OF ELBOW,,,2256.65
Deidentified Maximum,,73225,CPT4/HCPCS,MR ANGIO UPR EXTR W/O&W/DYE,,,5535.63
Deidentified Maximum,,73522,CPT4/HCPCS,X-RAY EXAM HIPS BI 3-4 VIEWS,,,451.51
Deidentified Maximum,,73564,CPT4/HCPCS,X-RAY EXAM KNEE 4 OR MORE,,,657.95
Deidentified Maximum,,73600,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,,364.35
Deidentified Maximum,,73610,CPT4/HCPCS,X-RAY EXAM OF ANKLE,,,364.35
Deidentified Maximum,,73615,CPT4/HCPCS,CONTRAST X-RAY OF ANKLE,,,2256.65
Deidentified Maximum,,73725,CPT4/HCPCS,MR ANG LWR EXT W OR W/O DYE,,,5646.30
Deidentified Maximum,,74150,CPT4/HCPCS,CT ABDOMEN W/O DYE,,,6766.00
Deidentified Maximum,,74175,CPT4/HCPCS,CT ANGIO ABDOM W/O & W/DYE,,,6766.00
Deidentified Maximum,,74246,CPT4/HCPCS,X-RAY XM UPR GI TRC 2CNTRST,,,1179.80
Deidentified Maximum,,74260,CPT4/HCPCS,X-RAY EXAM OF SMALL BOWEL,,,749.21
Deidentified Maximum,,74261,CPT4/HCPCS,CT COLONOGRAPHY DX,,,6766.00
Deidentified Maximum,,74430,CPT4/HCPCS,CONTRAST X-RAY BLADDER,,,2256.65
Deidentified Maximum,,74713,CPT4/HCPCS,MRI FETAL EA ADDL GESTATION,,,2427.00
Deidentified Maximum,,75630,CPT4/HCPCS,X-RAY AORTA LEG ARTERIES,,,15447.85
Deidentified Maximum,,75736,CPT4/HCPCS,ARTERY X-RAYS PELVIS,,,25594.34
Deidentified Maximum,,75746,CPT4/HCPCS,ARTERY X-RAYS LUNG,,,6395.65
Deidentified Maximum,,75803,CPT4/HCPCS,LYMPH VESSEL X-RAY ARMS/LEGS,,,3544.38
Deidentified Maximum,,75807,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,,3544.38
Deidentified Maximum,,75822,CPT4/HCPCS,VEIN X-RAY ARMS/LEGS,,,6395.65
Deidentified Maximum,,75952,CPT4/HCPCS,ENDOVASC REPAIR ABDOM AORTA,,,6500.00
Deidentified Maximum,,75957,CPT4/HCPCS,XRAY ENDOVASC THOR AO REPR,,,2369.47
Deidentified Maximum,,75970,CPT4/HCPCS,VASCULAR BIOPSY,,,5818.73
Deidentified Maximum,,76100,CPT4/HCPCS,X-RAY EXAM OF BODY SECTION,,,658.81
Deidentified Maximum,,76102,CPT4/HCPCS,COMPLEX BODY SECTION X-RAYS,,,1774.58
Deidentified Maximum,,76377,CPT4/HCPCS,3D RENDER W/INTRP POSTPROCES,,,6500.00
Deidentified Maximum,,76499,CPT4/HCPCS,RADIOGRAPHIC PROCEDURE,,,392.44
Deidentified Maximum,,76510,CPT4/HCPCS,OPH US DX B-SCAN&QUAN A-SCAN,,,1077.18
Deidentified Maximum,,76511,CPT4/HCPCS,OPH US DX QUAN A-SCAN ONLY,,,587.00
Deidentified Maximum,,76513,CPT4/HCPCS,OPH US DX ANT SGM US UNI/BI,,,587.00
Deidentified Maximum,,76516,CPT4/HCPCS,ECHO EXAM OF EYE,,,587.00
Deidentified Maximum,,76604,CPT4/HCPCS,US EXAM CHEST,,,658.55
Deidentified Maximum,,76810,CPT4/HCPCS,OB US >= 14 WKS ADDL FETUS,,,6500.00
Deidentified Maximum,,76881,CPT4/HCPCS,US COMPL JOINT R-T W/IMG,,,1221.38
Deidentified Maximum,,76937,CPT4/HCPCS,US GUIDE VASCULAR ACCESS,,,6500.00
Deidentified Maximum,,76946,CPT4/HCPCS,ECHO GUIDE FOR AMNIOCENTESIS,,,771.71
Deidentified Maximum,,76948,CPT4/HCPCS,ECHO GUIDE OVA ASPIRATION,,,771.71
Deidentified Maximum,,77001,CPT4/HCPCS,FLUOROGUIDE FOR VEIN DEVICE,,,6500.00
Deidentified Maximum,,77011,CPT4/HCPCS,CT SCAN FOR LOCALIZATION,,,9388.52
Deidentified Maximum,,77022,CPT4/HCPCS,MRI GDN PARNCHYMA TISS ABLTJ,,,6766.00
Deidentified Maximum,,77046,CPT4/HCPCS,MRI BREAST C- UNILATERAL,,,2427.00
Deidentified Maximum,,77065,CPT4/HCPCS,DX MAMMO INCL CAD UNI,,,996.14
Deidentified Maximum,,77071,CPT4/HCPCS,X-RAY STRESS VIEW,,,389.88
Deidentified Maximum,,77077,CPT4/HCPCS,JOINT SURVEY SINGLE VIEW,,,657.95
Deidentified Maximum,,77078,CPT4/HCPCS,CT BONE DENSITY AXIAL,,,2427.00
Deidentified Maximum,,77263,CPT4/HCPCS,RADIATION THERAPY PLANNING,,,1239.50
Deidentified Maximum,,77280,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,,7894.00
Deidentified Maximum,,77293,CPT4/HCPCS,RESPIRATOR MOTION MGMT SIMUL,,,7894.00
Deidentified Maximum,,77331,CPT4/HCPCS,SPECIAL RADIATION DOSIMETRY,,,7894.00
Deidentified Maximum,,77431,CPT4/HCPCS,RADIATION THERAPY MANAGEMENT,,,2567.00
Deidentified Maximum,,77600,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,,2867.17
Deidentified Maximum,,77615,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,,7553.36
Deidentified Maximum,,77620,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,,3528.92
Deidentified Maximum,,77772,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,,13685.00
Deidentified Maximum,,77778,CPT4/HCPCS,APPLY INTERSTIT RADIAT COMPL,,,13685.00
Deidentified Maximum,,78016,CPT4/HCPCS,THYROID MET IMAGING/STUDIES,,,2322.59
Deidentified Maximum,,78135,CPT4/HCPCS,RED CELL SURVIVAL KINETICS,,,2707.40
Deidentified Maximum,,78140,CPT4/HCPCS,RED CELL SEQUESTRATION,,,1985.30
Deidentified Maximum,,78195,CPT4/HCPCS,LYMPH SYSTEM IMAGING,,,2236.83
Deidentified Maximum,,78226,CPT4/HCPCS,HEPATOBILIARY SYSTEM IMAGING,,,4145.29
Deidentified Maximum,,78267,CPT4/HCPCS,BREATH TST ATTAIN/ANAL C-14,,,150.00
Deidentified Maximum,,78315,CPT4/HCPCS,BONE IMAGING 3 PHASE,,,2410.44
Deidentified Maximum,,78414,CPT4/HCPCS,NON-IMAGING HEART FUNCTION,,,701.87
Deidentified Maximum,,78454,CPT4/HCPCS,HT MUSC IMAGE PLANAR MULT,,,3123.45
Deidentified Maximum,,78483,CPT4/HCPCS,HEART FIRST PASS MULTIPLE,,,3961.78
Deidentified Maximum,,78491,CPT4/HCPCS,MYOCRD IMG PET 1STD RST/STRS,,,12600.00
Deidentified Maximum,,78582,CPT4/HCPCS,LUNG VENTILAT&PERFUS IMAGING,,,3837.34
Deidentified Maximum,,78598,CPT4/HCPCS,LUNG PERF&VENTILAT DIFERENTL,,,3717.05
Deidentified Maximum,,78650,CPT4/HCPCS,CSF LEAKAGE IMAGING,,,2603.83
Deidentified Maximum,,95806,CPT4/HCPCS,SLEEP STUDY UNATT&RESP EFFT,,,3498.00
Deidentified Maximum,,95810,CPT4/HCPCS,POLYSOM 6/> YRS 4/> PARAM,,,7791.06
Deidentified Maximum,,95813,CPT4/HCPCS,EEG EXTND MNTR 61-119 MIN,,,2079.69
Deidentified Maximum,,95816,CPT4/HCPCS,EEG AWAKE AND DROWSY,,,1329.85
Deidentified Maximum,,95819,CPT4/HCPCS,EEG AWAKE AND ASLEEP,,,1594.50
Deidentified Maximum,,95824,CPT4/HCPCS,EEG CEREBRAL DEATH ONLY,,,802.13
Deidentified Maximum,,95864,CPT4/HCPCS,MUSCLE TEST 4 LIMBS,,,909.69
Deidentified Maximum,,95870,CPT4/HCPCS,MUSCLE TEST NONPARASPINAL,,,113.92
Deidentified Maximum,,95874,CPT4/HCPCS,GUIDE NERV DESTR NEEDLE EMG,,,104.30
Deidentified Maximum,,95900,CPT4/HCPCS,MOTOR NERVE CONDUCTION TEST,,,537.35
Deidentified Maximum,,95974,CPT4/HCPCS,CRANIAL NEUROSTIM COMPLEX,,,882.52
Deidentified Maximum,,95979,CPT4/HCPCS,ANALYZ NEUROSTIM BRAIN ADDON,,,450.88
Deidentified Maximum,,95981,CPT4/HCPCS,IO ANAL GAST N-STIM SUBSQ,,,65.81
Deidentified Maximum,,95992,CPT4/HCPCS,CANALITH REPOSITIONING PROC,,,6766.00
Deidentified Maximum,,96003,CPT4/HCPCS,DYNAMIC FINE WIRE EMG,,,65.81
Deidentified Maximum,,96110,CPT4/HCPCS,DEVELOPMENTAL SCREEN W/SCORE,,,164.03
Deidentified Maximum,,96360,CPT4/HCPCS,HYDRATION IV INFUSION INIT,,,648.94
Deidentified Maximum,,96376,CPT4/HCPCS,TX/PRO/DX INJ SAME DRUG ADON,,,193.00
Deidentified Maximum,,96406,CPT4/HCPCS,CHEMO INTRALESIONAL OVER 7,,,382.03
Deidentified Maximum,,96417,CPT4/HCPCS,CHEMO IV INFUS EACH ADDL SEQ,,,855.84
Deidentified Maximum,,96420,CPT4/HCPCS,CHEMO IA PUSH TECNIQUE,,,1326.59
Deidentified Maximum,,96422,CPT4/HCPCS,CHEMO IA INFUSION UP TO 1 HR,,,1860.69
Deidentified Maximum,,96573,CPT4/HCPCS,PDT DSTR PRMLG LES PHYS/QHP,,,1214.00
Deidentified Maximum,,96902,CPT4/HCPCS,TRICHOGRAM,,,52.14
Deidentified Maximum,,96931,CPT4/HCPCS,RCM CELULR SUBCELULR IMG SKN,,,987.78
Deidentified Maximum,,97001,CPT4/HCPCS,PT EVALUATION,,,342.55
Deidentified Maximum,,97002,CPT4/HCPCS,PT RE-EVALUATION,,,205.34
Deidentified Maximum,,97014,CPT4/HCPCS,ELECTRIC STIMULATION THERAPY,,,305.00
Deidentified Maximum,,97028,CPT4/HCPCS,ULTRAVIOLET THERAPY,,,305.00
Deidentified Maximum,,97032,CPT4/HCPCS,ELECTRICAL STIMULATION,,,6766.00
Deidentified Maximum,,97034,CPT4/HCPCS,CONTRAST BATH THERAPY,,,305.00
Deidentified Maximum,,97113,CPT4/HCPCS,AQUATIC THERAPY/EXERCISES,,,6766.00
Deidentified Maximum,,97124,CPT4/HCPCS,MASSAGE THERAPY,,,305.00
Deidentified Maximum,,97130,CPT4/HCPCS,THER IVNTJ EA ADDL 15 MIN,,,6766.00
Deidentified Maximum,,97155,CPT4/HCPCS,ADAPT BEHAVIOR TX PHYS/QHP,,,305.00
Deidentified Maximum,,97169,CPT4/HCPCS,ATHLETIC TRN EVAL LOW CMPLX,,,336.75
Deidentified Maximum,,97535,CPT4/HCPCS,SELF CARE MNGMENT TRAINING,,,6766.00
Deidentified Maximum,,97750,CPT4/HCPCS,PHYSICAL PERFORMANCE TEST,,,6766.00
Deidentified Maximum,,97760,CPT4/HCPCS,ORTHOTIC MGMT&TRAING 1ST ENC,,,6766.00
Deidentified Maximum,,97802,CPT4/HCPCS,MEDICAL NUTRITION INDIV IN,,,230.18
Deidentified Maximum,,99170,CPT4/HCPCS,ANOGENITAL EXAM CHILD W IMAG,,,1678.00
Deidentified Maximum,,99175,CPT4/HCPCS,INDUCTION OF VOMITING,,,713.97
Deidentified Maximum,,99190,CPT4/HCPCS,SPECIAL PUMP SERVICES,,,7464.76
Deidentified Maximum,,A4642,CPT4/HCPCS,In111 satumomab,,,11678.10
Deidentified Maximum,,A9520,CPT4/HCPCS,Tc99 tilmanocept diag 0.5mci,,,3930.52
Deidentified Maximum,,A9529,CPT4/HCPCS,I131 iodide sol, dx,,,7.56
Deidentified Maximum,,A9539,CPT4/HCPCS,Tc99m pentetate,,,262.16
Deidentified Maximum,,A9560,CPT4/HCPCS,Tc99m labeled rbc,,,781.45
Deidentified Maximum,,A9562,CPT4/HCPCS,Tc99m mertiatide,,,6482.11
Deidentified Maximum,,A9570,CPT4/HCPCS,Indium In-111 auto WBC,,,29920.38
Deidentified Maximum,,A9578,CPT4/HCPCS,Inj multihance multipack,,,16.21
Deidentified Maximum,,A9579,CPT4/HCPCS,Gad-base MR contrast NOS,1ml,,,13.10
Deidentified Maximum,,A9580,CPT4/HCPCS,Sodium fluoride F-18,,,1318.80
Deidentified Maximum,,C5276,CPT4/HCPCS,Low cost skin substitute app,,,2002.00
Deidentified Maximum,,C8912,CPT4/HCPCS,MRA w/cont, lwr ext,,,6766.00
Deidentified Maximum,,C8914,CPT4/HCPCS,MRA w/o fol w/cont, lwr ext,,,6766.00
Deidentified Maximum,,C9600,CPT4/HCPCS,Perc drug-el cor stent sing,,,10119.00
Deidentified Maximum,,C9604,CPT4/HCPCS,Perc d-e cor revasc t cabg s,,,10119.00
Deidentified Maximum,,C9726,CPT4/HCPCS,Rxt breast appl place/remov,,,1214.00
Deidentified Maximum,,C9729,CPT4/HCPCS,Percut lumbar lami,,,3544.00
Deidentified Maximum,,C9734,CPT4/HCPCS,U/S trtmt, not leiomyomata,,,4204.00
Deidentified Maximum,,C9742,CPT4/HCPCS,Laryngoscopy with injection,,,4280.43
Deidentified Maximum,,C9743,CPT4/HCPCS,Bulking/spacer material impl,,,1678.00
Deidentified Maximum,,C9747,CPT4/HCPCS,Ablation, hifu, prostate,,,6075.00
Deidentified Maximum,,C9751,CPT4/HCPCS,Microwave bronch, 3d, ebus,,,10119.00
Deidentified Maximum,,C9752,CPT4/HCPCS,Intraosseous des lumb/sacrum,,,6840.00
Deidentified Maximum,,C9800,CPT4/HCPCS,Dermal filler inj px/suppl,,,1678.00
Deidentified Maximum,,G0127,CPT4/HCPCS,Trim nail(s),,,1214.00
Deidentified Maximum,,G0130,CPT4/HCPCS,Single energy x-ray study,,,409.91
Deidentified Maximum,,G0260,CPT4/HCPCS,Inj for sacroiliac jt anesth,,,2002.00
Deidentified Maximum,,G0276,CPT4/HCPCS,Pild/placebo control clin tr,,,7007.00
Deidentified Maximum,,G0283,CPT4/HCPCS,Elec stim other than wound,,,6766.00
Deidentified Maximum,,G0399,CPT4/HCPCS,Home sleep test/type 3 Porta,,,3498.00
Deidentified Maximum,,G0400,CPT4/HCPCS,Home sleep test/type 4 Porta,,,3498.00
Deidentified Maximum,,G0413,CPT4/HCPCS,Pelvic ring fracture uni/bil,,,6840.00
Deidentified Maximum,,G0480,CPT4/HCPCS,Drug test def 1-7 classes,,,0.00
Deidentified Maximum,,G0515,CPT4/HCPCS,Cognitive skills development,,,6766.00
Deidentified Maximum,,G0518,CPT4/HCPCS,Remove w insert drug implant,,,2002.00
Deidentified Maximum,,G6004,CPT4/HCPCS,Radiation treatment delivery,,,925.46
Deidentified Maximum,,G6010,CPT4/HCPCS,Radiation treatment delivery,,,1417.85
Deidentified Maximum,,G6012,CPT4/HCPCS,Radiation treatment delivery,,,1685.30
Deidentified Maximum,,G6013,CPT4/HCPCS,Radiation treatment delivery,,,1897.02
Deidentified Maximum,,G6014,CPT4/HCPCS,Radiation treatment delivery,,,1897.02
Deidentified Maximum,,G6022,CPT4/HCPCS,Sigmoidoscopy w/ablate tumr,,,1678.00
Deidentified Maximum,,G8986,CPT4/HCPCS,Carry d/c status,,,193.00
Deidentified Maximum,,G8987,CPT4/HCPCS,Self care current status,,,193.00
Deidentified Maximum,,G9161,CPT4/HCPCS,Lang comp d/c status,,,193.00
Deidentified Maximum,,G9175,CPT4/HCPCS,Speech lang goal status,,,193.00
Deidentified Maximum,,J8560,CPT4/HCPCS,Etoposide oral 50 MG,,,638.56
Deidentified Maximum,,J9031,CPT4/HCPCS,Bcg live intravesical vac,,,1314.09
Deidentified Maximum,,J9032,CPT4/HCPCS,Injection, belinostat, 10mg,,,346.41
Deidentified Maximum,,J9041,CPT4/HCPCS,Inj., velcade 0.1 mg,,,380.51
Deidentified Maximum,,J9042,CPT4/HCPCS,Brentuximab vedotin inj,,,1436.98
Deidentified Maximum,,J9065,CPT4/HCPCS,Inj cladribine per 1 MG,,,171.19
Deidentified Maximum,,J9130,CPT4/HCPCS,Dacarbazine 100 mg inj,,,34.52
Deidentified Maximum,,J9150,CPT4/HCPCS,Daunorubicin injection,,,410.59
Deidentified Maximum,,J9181,CPT4/HCPCS,Etoposide injection,,,5.29
Deidentified Maximum,,J9200,CPT4/HCPCS,Floxuridine injection,,,724.33
Deidentified Maximum,,J9201,CPT4/HCPCS,In gemcitabine hcl nos 200mg,,,35.28
Deidentified Maximum,,J9211,CPT4/HCPCS,Idarubicin hcl injection,,,308.02
Deidentified Maximum,,J9216,CPT4/HCPCS,Interferon gamma 1-b inj,,,57399.38
Deidentified Maximum,,J9219,CPT4/HCPCS,Leuprolide acetate implant,,,33603.77
Deidentified Maximum,,J9245,CPT4/HCPCS,Inj melpha hydroch nos 50 mg,,,5373.64
Deidentified Maximum,,J9250,CPT4/HCPCS,Methotrexate sodium inj,,,2.10
Deidentified Maximum,,J9266,CPT4/HCPCS,Pegaspargase injection,,,149077.65
Deidentified Maximum,,J9280,CPT4/HCPCS,Mitomycin injection,,,677.79
Deidentified Maximum,,J9306,CPT4/HCPCS,Injection, pertuzumab, 1 mg,,,107.01
Deidentified Maximum,,J9308,CPT4/HCPCS,Injection, ramucirumab,,,506.26
Deidentified Maximum,,J9340,CPT4/HCPCS,Thiotepa injection,,,3495.49
Deidentified Maximum,,J9354,CPT4/HCPCS,Inj, ado-trastuzumab emt 1mg,,,272.41
Deidentified Maximum,,J9390,CPT4/HCPCS,Vinorelbine tartrate inj,,,101.47
Deidentified Maximum,,P9031,CPT4/HCPCS,Platelets leukocytes reduced,,,3628.00
Deidentified Maximum,,P9033,CPT4/HCPCS,Platelets leukoreduced irrad,,,3628.00
Deidentified Maximum,,P9054,CPT4/HCPCS,Blood, l/r, froz/degly/wash,,,3628.00
Deidentified Maximum,,Q9966,CPT4/HCPCS,LOCM 200-299mg/ml iodine,1ml,,,2.77
Deidentified Maximum,,Q9969,CPT4/HCPCS,Non-HEU TC-99M add-on/dose,,,8.40
Deidentified Maximum,,S0148,CPT4/HCPCS,Peg interferon alfa-2b/10,,,1258.57
Deidentified Maximum,,S2095,CPT4/HCPCS,Transcath emboliz microspher,,,5856.00
Deidentified Maximum,,S2225,CPT4/HCPCS,Myringotomy laser-assist,,,5856.00
Deidentified Maximum,,S2402,CPT4/HCPCS,Fetal surg cong cyst malf,,,8012.00
Deidentified Maximum,,S2403,CPT4/HCPCS,Fetal surg pulmon sequest,,,8012.00
Deidentified Maximum,,51565,CPT4/HCPCS,REVISE BLADDER & URETER(S),,,6588.00
Deidentified Maximum,,51595,CPT4/HCPCS,REMOVE BLADDER/REVISE TRACT,,,8012.00
Deidentified Maximum,,51596,CPT4/HCPCS,REMOVE BLADDER/CREATE POUCH,,,8012.00
Deidentified Maximum,,51720,CPT4/HCPCS,TREATMENT OF BLADDER LESION,,,1678.00
Deidentified Maximum,,51725,CPT4/HCPCS,SIMPLE CYSTOMETROGRAM,,,3198.57
Deidentified Maximum,,51729,CPT4/HCPCS,CYSTOMETROGRAM W/VP&UP,,,3198.57
Deidentified Maximum,,51736,CPT4/HCPCS,URINE FLOW MEASUREMENT,,,1678.00
Deidentified Maximum,,51860,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,,5029.00
Deidentified Maximum,,51865,CPT4/HCPCS,REPAIR OF BLADDER WOUND,,,6401.00
Deidentified Maximum,,51990,CPT4/HCPCS,LAPARO URETHRAL SUSPENSION,,,9548.65
Deidentified Maximum,,51992,CPT4/HCPCS,LAPARO SLING OPERATION,,,12850.70
Deidentified Maximum,,52204,CPT4/HCPCS,CYSTOSCOPY W/BIOPSY(S),,,4280.43
Deidentified Maximum,,52235,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,5856.00
Deidentified Maximum,,52281,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52282,CPT4/HCPCS,CYSTOSCOPY IMPLANT STENT,,,12850.70
Deidentified Maximum,,52290,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52300,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52310,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,4280.43
Deidentified Maximum,,52320,CPT4/HCPCS,CYSTOSCOPY AND TREATMENT,,,6876.92
Deidentified Maximum,,52327,CPT4/HCPCS,CYSTOSCOPY INJECT MATERIAL,,,6075.00
Deidentified Maximum,,52344,CPT4/HCPCS,CYSTO/URETERO STRICTURE TX,,,5856.00
Deidentified Maximum,,52353,CPT4/HCPCS,CYSTOURETERO W/LITHOTRIPSY,,,8792.00
Deidentified Maximum,,52500,CPT4/HCPCS,REVISION OF BLADDER NECK,,,5856.00
Deidentified Maximum,,53020,CPT4/HCPCS,INCISION OF URETHRA,,,4204.00
Deidentified Maximum,,53230,CPT4/HCPCS,REMOVAL OF URETHRA LESION,,,5138.00
Deidentified Maximum,,53240,CPT4/HCPCS,SURGERY FOR URETHRA POUCH,,,5138.00
Deidentified Maximum,,53265,CPT4/HCPCS,TREATMENT OF URETHRA LESION,,,4280.43
Deidentified Maximum,,53400,CPT4/HCPCS,REVISE URETHRA STAGE 1,,,5856.00
Deidentified Maximum,,53440,CPT4/HCPCS,MALE SLING PROCEDURE,,,10119.00
Deidentified Maximum,,53445,CPT4/HCPCS,INSERT URO/VES NCK SPHINCTER,,,10772.00
Deidentified Maximum,,53500,CPT4/HCPCS,URETHRLYS TRANSVAG W/ SCOPE,,,7902.34
Deidentified Maximum,,53621,CPT4/HCPCS,DILATE URETHRA STRICTURE,,,3000.00
Deidentified Maximum,,53850,CPT4/HCPCS,PROSTATIC MICROWAVE THERMOTX,,,12850.70
Deidentified Maximum,,54001,CPT4/HCPCS,SLITTING OF PREPUCE,,,4280.43
Deidentified Maximum,,54161,CPT4/HCPCS,CIRCUM 28 DAYS OR OLDER,,,4280.43
Deidentified Maximum,,54205,CPT4/HCPCS,TREATMENT OF PENIS LESION,,,6401.00
Deidentified Maximum,,54316,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,5856.00
Deidentified Maximum,,54324,CPT4/HCPCS,RECONSTRUCTION OF URETHRA,,,6075.00
Deidentified Maximum,,54406,CPT4/HCPCS,REMOVE MUTI-COMP PENIS PROS,,,5856.00
Deidentified Maximum,,54417,CPT4/HCPCS,REMV/REPLC PENIS PROS COMPL,,,6401.00
Deidentified Maximum,,54440,CPT4/HCPCS,REPAIR OF PENIS,,,6401.00
Deidentified Maximum,,54690,CPT4/HCPCS,LAPAROSCOPY ORCHIECTOMY,,,12850.70
Deidentified Maximum,,55400,CPT4/HCPCS,REPAIR OF SPERM DUCT,,,4204.00
Deidentified Maximum,,55559,CPT4/HCPCS,LAPARO PROC SPERMATIC CORD,,,7902.34
Deidentified Maximum,,55870,CPT4/HCPCS,ELECTROEJACULATION,,,3198.57
Deidentified Maximum,,55874,CPT4/HCPCS,TPRNL PLMT BIODEGRDABL MATRL,,,12850.70
Deidentified Maximum,,55970,CPT4/HCPCS,SEX TRANSFORMATION M TO F,,,5783.00
Deidentified Maximum,,55980,CPT4/HCPCS,SEX TRANSFORMATION F TO M,,,5783.00
Deidentified Maximum,,56420,CPT4/HCPCS,DRAINAGE OF GLAND ABSCESS,,,3198.57
Deidentified Maximum,,56441,CPT4/HCPCS,LYSIS OF LABIAL LESION(S),,,4204.00
Deidentified Maximum,,56442,CPT4/HCPCS,HYMENOTOMY,,,4204.00
Deidentified Maximum,,56515,CPT4/HCPCS,DESTROY VULVA LESION/S COMPL,,,5856.00
Deidentified Maximum,,56605,CPT4/HCPCS,BIOPSY OF VULVA/PERINEUM,,,3198.57
Deidentified Maximum,,56800,CPT4/HCPCS,REPAIR OF VAGINA,,,5856.00
Deidentified Maximum,,57022,CPT4/HCPCS,I & D VAGINAL HEMATOMA PP,,,3656.00
Deidentified Maximum,,57109,CPT4/HCPCS,VAGINECTOMY PARTIAL W/NODES,,,6876.92
Deidentified Maximum,,57135,CPT4/HCPCS,REMOVE VAGINA LESION,,,4280.43
Deidentified Maximum,,57160,CPT4/HCPCS,INSERT PESSARY/OTHER DEVICE,,,1214.00
Deidentified Maximum,,57230,CPT4/HCPCS,REPAIR OF URETHRAL LESION,,,5856.00
Deidentified Maximum,,57285,CPT4/HCPCS,REPAIR PARAVAG DEFECT VAG,,,8300.00
Deidentified Maximum,,57288,CPT4/HCPCS,REPAIR BLADDER DEFECT,,,9548.65
Deidentified Maximum,,57289,CPT4/HCPCS,REPAIR BLADDER & VAGINA,,,6876.92
Deidentified Maximum,,57292,CPT4/HCPCS,CONSTRUCT VAGINA WITH GRAFT,,,6401.00
Deidentified Maximum,,57310,CPT4/HCPCS,REPAIR URETHROVAGINAL LESION,,,6876.92
Deidentified Maximum,,57400,CPT4/HCPCS,DILATION OF VAGINA,,,4280.43
Deidentified Maximum,,57423,CPT4/HCPCS,REPAIR PARAVAG DEFECT LAP,,,8300.00
Deidentified Maximum,,57456,CPT4/HCPCS,ENDOCERV CURETTAGE W/SCOPE,,,3198.57
Deidentified Maximum,,57531,CPT4/HCPCS,REMOVAL OF CERVIX RADICAL,,,5783.00
Deidentified Maximum,,57545,CPT4/HCPCS,REMOVE CERVIX/REPAIR PELVIS,,,5783.00
Deidentified Maximum,,57550,CPT4/HCPCS,REMOVAL OF RESIDUAL CERVIX,,,5856.00
Deidentified Maximum,,57556,CPT4/HCPCS,REMOVE CERVIX REPAIR BOWEL,,,6876.92
Deidentified Maximum,,58145,CPT4/HCPCS,MYOMECTOMY VAG METHOD,,,6876.92
Deidentified Maximum,,58180,CPT4/HCPCS,PARTIAL HYSTERECTOMY,,,7830.00
Deidentified Maximum,,58270,CPT4/HCPCS,VAG HYST W/ENTEROCELE REPAIR,,,8012.00
Deidentified Maximum,,58285,CPT4/HCPCS,EXTENSIVE HYSTERECTOMY,,,8012.00
Deidentified Maximum,,58293,CPT4/HCPCS,VAG HYST W/URO REPAIR COMPL,,,8012.00
Deidentified Maximum,,58546,CPT4/HCPCS,LAPARO-MYOMECTOMY COMPLEX,,,12850.70
Deidentified Maximum,,58550,CPT4/HCPCS,LAPARO-ASST VAG HYSTERECTOMY,,,12850.70
Deidentified Maximum,,58561,CPT4/HCPCS,HYSTEROSCOPY REMOVE MYOMA,,,5856.00
Deidentified Maximum,,58570,CPT4/HCPCS,TLH UTERUS 250 G OR LESS,,,8300.00
Deidentified Maximum,,58575,CPT4/HCPCS,LAPS TOT HYST RESJ MAL,,,8012.00
Deidentified Maximum,,58578,CPT4/HCPCS,LAPARO PROC UTERUS,,,7902.34
Deidentified Maximum,,58611,CPT4/HCPCS,LIGATE OVIDUCT(S) ADD-ON,,,3544.00
Deidentified Maximum,,58615,CPT4/HCPCS,OCCLUDE FALLOPIAN TUBE(S),,,5856.00
Deidentified Maximum,,58673,CPT4/HCPCS,LAPAROSCOPY SALPINGOSTOMY,,,7007.00
Deidentified Maximum,,58674,CPT4/HCPCS,LAPS ABLTJ UTERINE FIBROIDS,,,7007.00
Deidentified Maximum,,58740,CPT4/HCPCS,ADHESIOLYSIS TUBE OVARY,,,6840.00
Deidentified Maximum,,58900,CPT4/HCPCS,BIOPSY OF OVARY(S),,,5856.00
Deidentified Maximum,,58951,CPT4/HCPCS,RESECT OVARIAN MALIGNANCY,,,5783.00
Deidentified Maximum,,58953,CPT4/HCPCS,TAH RAD DISSECT FOR DEBULK,,,8012.00
Deidentified Maximum,,58970,CPT4/HCPCS,RETRIEVAL OF OOCYTE,,,4891.93
Deidentified Maximum,,58976,CPT4/HCPCS,TRANSFER OF EMBRYO,,,3198.57
Deidentified Maximum,,59001,CPT4/HCPCS,AMNIOCENTESIS THERAPEUTIC,,,3198.57
Deidentified Maximum,,59070,CPT4/HCPCS,TRANSABDOM AMNIOINFUS W/US,,,3544.00
Deidentified Maximum,,59074,CPT4/HCPCS,FETAL FLUID DRAINAGE W/US,,,3198.57
Deidentified Maximum,,59121,CPT4/HCPCS,TREAT ECTOPIC PREGNANCY,,,9548.65
Deidentified Maximum,,59400,CPT4/HCPCS,OBSTETRICAL CARE,,,4280.43
Deidentified Maximum,,59409,CPT4/HCPCS,OBSTETRICAL CARE,,,5783.00
Deidentified Maximum,,59510,CPT4/HCPCS,CESAREAN DELIVERY,,,4891.93
Deidentified Maximum,,59610,CPT4/HCPCS,VBAC DELIVERY,,,5281.00
Deidentified Maximum,,59614,CPT4/HCPCS,VBAC CARE AFTER DELIVERY,,,5281.00
Deidentified Maximum,,59622,CPT4/HCPCS,ATTEMPTED VBAC AFTER CARE,,,5783.00
Deidentified Maximum,,59850,CPT4/HCPCS,ABORTION,,,4891.93
Deidentified Maximum,,59871,CPT4/HCPCS,REMOVE CERCLAGE SUTURE,,,6876.92
Deidentified Maximum,,59897,CPT4/HCPCS,FETAL INVAS PX W/US,,,3198.57
Deidentified Maximum,,60210,CPT4/HCPCS,PARTIAL THYROID EXCISION,,,9548.65
Deidentified Maximum,,60252,CPT4/HCPCS,REMOVAL OF THYROID,,,9548.65
Deidentified Maximum,,60260,CPT4/HCPCS,REPEAT THYROID SURGERY,,,9548.65
Deidentified Maximum,,60512,CPT4/HCPCS,AUTOTRANSPLANT PARATHYROID,,,5856.00
Deidentified Maximum,,60540,CPT4/HCPCS,EXPLORE ADRENAL GLAND,,,7830.00
Deidentified Maximum,,60659,CPT4/HCPCS,LAPARO PROC ENDOCRINE,,,7902.34
Deidentified Maximum,,61001,CPT4/HCPCS,REMOVE CRANIAL CAVITY FLUID,,,3198.57
Deidentified Maximum,,61154,CPT4/HCPCS,PIERCE SKULL & REMOVE CLOT,,,5281.00
Deidentified Maximum,,61312,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,6588.00
Deidentified Maximum,,61313,CPT4/HCPCS,OPEN SKULL FOR DRAINAGE,,,6588.00
Deidentified Maximum,,61343,CPT4/HCPCS,INCISE SKULL (PRESS RELIEF),,,4891.93
Deidentified Maximum,,61516,CPT4/HCPCS,REMOVAL OF BRAIN LESION,,,6588.00
Deidentified Maximum,,61531,CPT4/HCPCS,IMPLANT BRAIN ELECTRODES,,,5310.00
Deidentified Maximum,,61543,CPT4/HCPCS,REMOVAL OF BRAIN TISSUE,,,5310.00
Deidentified Maximum,,61546,CPT4/HCPCS,REMOVAL OF PITUITARY GLAND,,,6049.05
Deidentified Maximum,,61559,CPT4/HCPCS,EXCISION OF SKULL/SUTURES,,,6588.00
Deidentified Maximum,,61563,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,,5310.00
Deidentified Maximum,,61564,CPT4/HCPCS,EXCISION OF SKULL TUMOR,,,6049.05
Deidentified Maximum,,61592,CPT4/HCPCS,ORBITOCRANIAL APPROACH/SKULL,,,7902.34
Deidentified Maximum,,61595,CPT4/HCPCS,TRANSTEMPORAL APPROACH/SKULL,,,8012.00
Deidentified Maximum,,61596,CPT4/HCPCS,TRANSCOCHLEAR APPROACH/SKULL,,,6876.92
Deidentified Maximum,,61618,CPT4/HCPCS,REPAIR DURA,,,6588.00
Deidentified Maximum,,61624,CPT4/HCPCS,TRANSCATH OCCLUSION CNS,,,5310.00
Deidentified Maximum,,61641,CPT4/HCPCS,DILAT IC VSPSM EA VSL SM TER,,,5310.00
Deidentified Maximum,,61650,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT 1ST,,,5310.00
Deidentified Maximum,,61651,CPT4/HCPCS,EVASC PRLNG ADMN RX AGNT ADD,,,5310.00
Deidentified Maximum,,61692,CPT4/HCPCS,INTRACRANIAL VESSEL SURGERY,,,9548.65
Deidentified Maximum,,61783,CPT4/HCPCS,SCAN PROC SPINAL,,,5310.00
Deidentified Maximum,,61796,CPT4/HCPCS,SRS CRANIAL LESION SIMPLE,,,8841.00
Deidentified Maximum,,61798,CPT4/HCPCS,SRS CRANIAL LESION COMPLEX,,,8841.00
Deidentified Maximum,,61880,CPT4/HCPCS,REVISE/REMOVE NEUROELECTRODE,,,5310.00
Deidentified Maximum,,61885,CPT4/HCPCS,INSRT/REDO NEUROSTIM 1 ARRAY,,,14317.00
Deidentified Maximum,,61886,CPT4/HCPCS,IMPLANT NEUROSTIM ARRAYS,,,24180.00
Deidentified Maximum,,62117,CPT4/HCPCS,REDUCTION OF SKULL DEFECT,,,6588.00
Deidentified Maximum,,62121,CPT4/HCPCS,INCISE SKULL REPAIR,,,8012.00
Deidentified Maximum,,62147,CPT4/HCPCS,REPAIR OF SKULL WITH GRAFT,,,6588.00
Deidentified Maximum,,62201,CPT4/HCPCS,BRAIN CAVITY SHUNT W/SCOPE,,,5783.00
Deidentified Maximum,,62256,CPT4/HCPCS,REMOVE BRAIN CAVITY SHUNT,,,5310.00
Deidentified Maximum,,62267,CPT4/HCPCS,INTERDISCAL PERQ ASPIR DX,,,5310.00
Deidentified Maximum,,62280,CPT4/HCPCS,TREAT SPINAL CORD LESION,,,5310.00
Deidentified Maximum,,62294,CPT4/HCPCS,INJECTION INTO SPINAL ARTERY,,,5856.00
Deidentified Maximum,,62311,CPT4/HCPCS,INJECT SPINE LUMBAR/SACRAL,,,1678.00
Deidentified Maximum,,62326,CPT4/HCPCS,NJX INTERLAMINAR LMBR/SAC,,,5310.00
Deidentified Maximum,,62328,CPT4/HCPCS,DX LMBR SPI PNXR W/FLUOR/CT,,,3000.00
Deidentified Maximum,,62362,CPT4/HCPCS,IMPLANT SPINE INFUSION PUMP,,,14317.00
Deidentified Maximum,,63005,CPT4/HCPCS,REMOVE SPINE LAMINA 1/2 LMBR,,,9548.65
Deidentified Maximum,,63064,CPT4/HCPCS,DECOMPRESS SPINAL CORD THRC,,,9548.65
Deidentified Maximum,,63066,CPT4/HCPCS,DECOMPRESS SPINE CORD ADD-ON,,,9548.65
Deidentified Maximum,,63091,CPT4/HCPCS,REMOVE VERTEBRAL BODY ADD-ON,,,5310.00
Deidentified Maximum,,63250,CPT4/HCPCS,REVISE SPINAL CORD VSLS CRVL,,,6876.92
Deidentified Maximum,,63265,CPT4/HCPCS,EXCISE INTRASPINL LESION CRV,,,8300.00
Deidentified Maximum,,63271,CPT4/HCPCS,EXCISE INTRSPINL LESION THRC,,,5783.00
Deidentified Maximum,,63272,CPT4/HCPCS,EXCISE INTRSPINL LESION LMBR,,,10119.00
Deidentified Maximum,,63304,CPT4/HCPCS,REMOVE VERT IDRL BODY CRVCL,,,5783.00
Deidentified Maximum,,63702,CPT4/HCPCS,REPAIR OF SPINAL HERNIATION,,,5310.00
Deidentified Maximum,,63710,CPT4/HCPCS,GRAFT REPAIR OF SPINE DEFECT,,,5310.00
Deidentified Maximum,,64449,CPT4/HCPCS,NJX AA&/STRD LMBR PLEX NFS,,,5310.00
Deidentified Maximum,,64450,CPT4/HCPCS,NJX AA&/STRD OTHER PN/BRANCH,,,5310.00
Deidentified Maximum,,64462,CPT4/HCPCS,PVB THORACIC 2ND+ INJ SITE,,,5310.00
Deidentified Maximum,,64508,CPT4/HCPCS,N BLOCK CAROTID SINUS S/P,,,3198.57
Deidentified Maximum,,64517,CPT4/HCPCS,N BLOCK INJ HYPOGAS PLXS,,,5310.00
Deidentified Maximum,,64566,CPT4/HCPCS,NEUROELTRD STIM POST TIBIAL,,,5310.00
Deidentified Maximum,,64595,CPT4/HCPCS,REVISE/RMV PN/GASTR STIMUL,,,5310.00
Deidentified Maximum,,64612,CPT4/HCPCS,DESTROY NERVE FACE MUSCLE,,,5310.00
Deidentified Maximum,,64620,CPT4/HCPCS,INJECTION TREATMENT OF NERVE,,,5310.00
Deidentified Maximum,,64635,CPT4/HCPCS,DESTROY LUMB/SAC FACET JNT,,,5310.00
Deidentified Maximum,,64653,CPT4/HCPCS,CHEMODENERV ECCRINE GLANDS,,,5310.00
Deidentified Maximum,,64713,CPT4/HCPCS,REVISION OF ARM NERVE(S),,,5310.00
Deidentified Maximum,,64719,CPT4/HCPCS,REVISE ULNAR NERVE AT WRIST,,,5310.00
Deidentified Maximum,,64721,CPT4/HCPCS,CARPAL TUNNEL SURGERY,,,5310.00
Deidentified Maximum,,64752,CPT4/HCPCS,INCISION OF VAGUS NERVE,,,5783.00
Deidentified Maximum,,64818,CPT4/HCPCS,REMOVE SYMPATHETIC NERVES,,,5310.00
Deidentified Maximum,,64886,CPT4/HCPCS,NERVE GRAFT HEAD/NECK >4 CM,,,6075.00
Deidentified Maximum,,64892,CPT4/HCPCS,NERVE GRAFT ARM/LEG <4 CM,,,6075.00
Deidentified Maximum,,64896,CPT4/HCPCS,NERVE GRAFT HAND/FOOT >4 CM,,,6075.00
Deidentified Maximum,,64898,CPT4/HCPCS,NERVE GRAFT ARM/LEG >4 CM,,,6075.00
Deidentified Maximum,,64905,CPT4/HCPCS,NERVE PEDICLE TRANSFER,,,6075.00
Deidentified Maximum,,65091,CPT4/HCPCS,REVISE EYE,,,5856.00
Deidentified Maximum,,65260,CPT4/HCPCS,REMOVE FOREIGN BODY FROM EYE,,,5856.00
Deidentified Maximum,,65410,CPT4/HCPCS,BIOPSY OF CORNEA,,,5310.00
Deidentified Maximum,,65426,CPT4/HCPCS,REMOVAL OF EYE LESION,,,6876.92
Deidentified Maximum,,65600,CPT4/HCPCS,REVISION OF CORNEA,,,5310.00
Deidentified Maximum,,65770,CPT4/HCPCS,REVISE CORNEA WITH IMPLANT,,,9548.65
Deidentified Maximum,,65779,CPT4/HCPCS,COVER EYE W/MEMBRANE SUTURE,,,5310.00
Deidentified Maximum,,65782,CPT4/HCPCS,OCULAR RECONST TRANSPLANT,,,9548.65
Deidentified Maximum,,65870,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,,6401.00
Deidentified Maximum,,65875,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,,6401.00
Deidentified Maximum,,65880,CPT4/HCPCS,INCISE INNER EYE ADHESIONS,,,6401.00
Deidentified Maximum,,66165,CPT4/HCPCS,GLAUCOMA SURGERY,,,5029.00
Deidentified Maximum,,66180,CPT4/HCPCS,AQUEOUS SHUNT EYE W/GRAFT,,,6876.92
Deidentified Maximum,,66185,CPT4/HCPCS,REVISE AQUEOUS SHUNT EYE,,,5310.00
Deidentified Maximum,,66225,CPT4/HCPCS,REPAIR/GRAFT EYE LESION,,,6401.00
Deidentified Maximum,,66600,CPT4/HCPCS,REMOVE IRIS AND LESION,,,5856.00
Deidentified Maximum,,66635,CPT4/HCPCS,REMOVAL OF IRIS,,,5856.00
Deidentified Maximum,,66680,CPT4/HCPCS,REPAIR IRIS & CILIARY BODY,,,5856.00
Deidentified Maximum,,66770,CPT4/HCPCS,REMOVAL OF INNER EYE LESION,,,5310.00
Deidentified Maximum,,66825,CPT4/HCPCS,REPOSITION INTRAOCULAR LENS,,,6401.00
Deidentified Maximum,,66840,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,,6401.00
Deidentified Maximum,,66850,CPT4/HCPCS,REMOVAL OF LENS MATERIAL,,,9548.65
Deidentified Maximum,,66940,CPT4/HCPCS,EXTRACTION OF LENS,,,6876.92
Deidentified Maximum,,66983,CPT4/HCPCS,CATARACT SURG W/IOL 1 STAGE,,,9304.06
Deidentified Maximum,,66988,CPT4/HCPCS,XCAPSL CTRC RMVL W/ECP,,,8012.00
Deidentified Maximum,,67015,CPT4/HCPCS,RELEASE OF EYE FLUID,,,5310.00
Deidentified Maximum,,67036,CPT4/HCPCS,REMOVAL OF INNER EYE FLUID,,,6401.00
Deidentified Maximum,,67101,CPT4/HCPCS,REPAIR DETACHED RETINA CRTX,,,6401.00
Deidentified Maximum,,67110,CPT4/HCPCS,REPAIR DETACHED RETINA,,,5310.00
Deidentified Maximum,,67112,CPT4/HCPCS,REREPAIR DETACHED RETINA,,,6588.00
Deidentified Maximum,,67113,CPT4/HCPCS,REPAIR RETINAL DETACH CPLX,,,9548.65
Deidentified Maximum,,67218,CPT4/HCPCS,TREATMENT OF RETINAL LESION,,,6876.92
Deidentified Maximum,,67316,CPT4/HCPCS,REVISE TWO EYE MUSCLES,,,6401.00
Deidentified Maximum,,67332,CPT4/HCPCS,REREVISE EYE MUSCLES ADD-ON,,,6401.00
Deidentified Maximum,,67810,CPT4/HCPCS,BIOPSY EYELID & LID MARGIN,,,5310.00
Deidentified Maximum,,67901,CPT4/HCPCS,REPAIR EYELID DEFECT,,,6876.92
Deidentified Maximum,,67930,CPT4/HCPCS,REPAIR EYELID WOUND,,,5310.00
Deidentified Maximum,,68020,CPT4/HCPCS,INCISE/DRAIN EYELID LINING,,,5310.00
Deidentified Maximum,,68540,CPT4/HCPCS,REMOVE TEAR GLAND LESION,,,5856.00
Deidentified Maximum,,68770,CPT4/HCPCS,CLOSE TEAR SYSTEM FISTULA,,,6401.00
Deidentified Maximum,,69005,CPT4/HCPCS,DRAIN EXTERNAL EAR LESION,,,5310.00
Deidentified Maximum,,69155,CPT4/HCPCS,EXTENSIVE EAR/NECK SURGERY,,,5310.00
Deidentified Maximum,,69210,CPT4/HCPCS,REMOVE IMPACTED EAR WAX UNI,,,5310.00
Deidentified Maximum,,69300,CPT4/HCPCS,REVISE EXTERNAL EAR,,,5856.00
Deidentified Maximum,,69310,CPT4/HCPCS,REBUILD OUTER EAR CANAL,,,6075.00
Deidentified Maximum,,69436,CPT4/HCPCS,CREATE EARDRUM OPENING,,,5856.00
Deidentified Maximum,,69450,CPT4/HCPCS,EARDRUM REVISION,,,6075.00
Deidentified Maximum,,69540,CPT4/HCPCS,REMOVE EAR LESION,,,5310.00
Deidentified Maximum,,69550,CPT4/HCPCS,REMOVE EAR LESION,,,6876.92
Deidentified Maximum,,69602,CPT4/HCPCS,MASTOID SURGERY REVISION,,,9548.65
Deidentified Maximum,,69604,CPT4/HCPCS,MASTOID SURGERY REVISION,,,9548.65
Deidentified Maximum,,69631,CPT4/HCPCS,REPAIR EARDRUM STRUCTURES,,,6876.92
Deidentified Maximum,,69636,CPT4/HCPCS,REBUILD EARDRUM STRUCTURES,,,9548.65
Deidentified Maximum,,69643,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,9548.65
Deidentified Maximum,,69645,CPT4/HCPCS,REVISE MIDDLE EAR & MASTOID,,,9548.65
Deidentified Maximum,,69715,CPT4/HCPCS,TEMPLE BNE IMPLNT W/STIMULAT,,,12850.70
Deidentified Maximum,,69799,CPT4/HCPCS,MIDDLE EAR SURGERY PROCEDURE,,,4280.43
Deidentified Maximum,,69805,CPT4/HCPCS,EXPLORE INNER EAR,,,9548.65
Deidentified Maximum,,69820,CPT4/HCPCS,ESTABLISH INNER EAR WINDOW,,,5281.00
Deidentified Maximum,,69840,CPT4/HCPCS,REVISE INNER EAR WINDOW,,,5281.00
Deidentified Maximum,,69905,CPT4/HCPCS,REMOVE INNER EAR,,,9548.65
Deidentified Maximum,,69955,CPT4/HCPCS,RELEASE FACIAL NERVE,,,9548.65
Deidentified Maximum,,69979,CPT4/HCPCS,TEMPORAL BONE SURGERY,,,3198.57
Deidentified Maximum,,69990,CPT4/HCPCS,MICROSURGERY ADD-ON,,,5310.00
Deidentified Maximum,,70140,CPT4/HCPCS,X-RAY EXAM OF FACIAL BONES,,,364.35
Deidentified Maximum,,70371,CPT4/HCPCS,SPEECH EVALUATION COMPLEX,,,1058.84
Deidentified Maximum,,70390,CPT4/HCPCS,X-RAY EXAM OF SALIVARY DUCT,,,905.65
Deidentified Maximum,,70487,CPT4/HCPCS,CT MAXILLOFACIAL W/DYE,,,6766.00
Deidentified Maximum,,71010,CPT4/HCPCS,CHEST X-RAY 1 VIEW FRONTAL,,,0.00
Deidentified Maximum,,71120,CPT4/HCPCS,X-RAY EXAM BREASTBONE 2/>VWS,,,364.35
Deidentified Maximum,,71130,CPT4/HCPCS,X-RAY STRENOCLAVIC JT 3/>VWS,,,364.35
Deidentified Maximum,,71551,CPT4/HCPCS,MRI CHEST W/DYE,,,6700.67
Deidentified Maximum,,72070,CPT4/HCPCS,X-RAY EXAM THORAC SPINE 2VWS,,,657.95
Deidentified Maximum,,72074,CPT4/HCPCS,X-RAY EXAM THORAC SPINE4/>VW,,,657.95
Deidentified Maximum,,72084,CPT4/HCPCS,X-RAY EXAM ENTIRE SPI 6/> VW,,,807.58
Deidentified Maximum,,72110,CPT4/HCPCS,X-RAY EXAM L-2 SPINE 4/>VWS,,,657.95
Deidentified Maximum,,72126,CPT4/HCPCS,CT NECK SPINE W/DYE,,,6766.00
Deidentified Maximum,,72133,CPT4/HCPCS,CT LUMBAR SPINE W/O & W/DYE,,,6766.00
Deidentified Maximum,,72142,CPT4/HCPCS,MRI NECK SPINE W/DYE,,,6773.29
Deidentified Maximum,,72157,CPT4/HCPCS,MRI CHEST SPINE W/O & W/DYE,,,12547.94
Deidentified Maximum,,72159,CPT4/HCPCS,MR ANGIO SPINE W/O&W/DYE,,,6142.81
Deidentified Maximum,,72195,CPT4/HCPCS,MRI PELVIS W/O DYE,,,6766.00
Deidentified Maximum,,72197,CPT4/HCPCS,MRI PELVIS W/O & W/DYE,,,12390.60
Deidentified Maximum,,72200,CPT4/HCPCS,X-RAY EXAM SI JOINTS,,,258.26
Deidentified Maximum,,72270,CPT4/HCPCS,MYELOGPHY 2/> SPINE REGIONS,,,4045.45
Deidentified Maximum,,72295,CPT4/HCPCS,X-RAY OF LOWER SPINE DISK,,,9541.04
Deidentified Maximum,,73080,CPT4/HCPCS,X-RAY EXAM OF ELBOW,,,364.35
Deidentified Maximum,,73140,CPT4/HCPCS,X-RAY EXAM OF FINGER(S),,,364.35
Deidentified Maximum,,73218,CPT4/HCPCS,MRI UPPER EXTREMITY W/O DYE,,,6766.00
Deidentified Maximum,,73551,CPT4/HCPCS,X-RAY EXAM OF FEMUR 1,,,259.05
Deidentified Maximum,,73552,CPT4/HCPCS,X-RAY EXAM OF FEMUR 2/>,,,364.35
Deidentified Maximum,,73701,CPT4/HCPCS,CT LOWER EXTREMITY W/DYE,,,6766.00
Deidentified Maximum,,73706,CPT4/HCPCS,CT ANGIO LWR EXTR W/O&W/DYE,,,6766.00
Deidentified Maximum,,73718,CPT4/HCPCS,MRI LOWER EXTREMITY W/O DYE,,,6766.00
Deidentified Maximum,,74018,CPT4/HCPCS,X-RAY EXAM ABDOMEN 1 VIEW,,,364.35
Deidentified Maximum,,74021,CPT4/HCPCS,X-RAY EXAM ABDOMEN 3+ VIEWS,,,340.85
Deidentified Maximum,,74022,CPT4/HCPCS,X-RAY EXAM COMPLETE ABDOMEN,,,657.95
Deidentified Maximum,,74181,CPT4/HCPCS,MRI ABDOMEN W/O DYE,,,6766.00
Deidentified Maximum,,74183,CPT4/HCPCS,MRI ABDOMEN W/O & W/DYE,,,12390.60
Deidentified Maximum,,74240,CPT4/HCPCS,X-RAY XM UPR GI TRC 1CNTRST,,,1179.80
Deidentified Maximum,,74248,CPT4/HCPCS,X-RAY SM INT F-THRU STD,,,6500.00
Deidentified Maximum,,74400,CPT4/HCPCS,UROGRAPHY IV +-KUB TOMOG,,,1179.80
Deidentified Maximum,,74420,CPT4/HCPCS,UROGRAPHY RTRGR +-KUB,,,2256.65
Deidentified Maximum,,74450,CPT4/HCPCS,X-RAY URETHRA/BLADDER,,,1531.90
Deidentified Maximum,,75571,CPT4/HCPCS,CT HRT W/O DYE W/CA TEST,,,6766.00
Deidentified Maximum,,75705,CPT4/HCPCS,ARTERY X-RAYS SPINE,,,25594.34
Deidentified Maximum,,75805,CPT4/HCPCS,LYMPH VESSEL X-RAY TRUNK,,,3544.38
Deidentified Maximum,,75809,CPT4/HCPCS,NONVASCULAR SHUNT X-RAY,,,657.95
Deidentified Maximum,,75827,CPT4/HCPCS,VEIN X-RAY CHEST,,,6344.13
Deidentified Maximum,,75840,CPT4/HCPCS,VEIN X-RAY ADRENAL GLAND,,,6344.13
Deidentified Maximum,,75872,CPT4/HCPCS,VEIN X-RAY SKULL EPIDURAL,,,6344.13
Deidentified Maximum,,75880,CPT4/HCPCS,VEIN X-RAY EYE SOCKET,,,1185.57
Deidentified Maximum,,75964,CPT4/HCPCS,REPAIR ARTERY BLOCKAGE EACH,,,6500.00
Deidentified Maximum,,75966,CPT4/HCPCS,REPAIR ARTERIAL BLOCKAGE,,,6500.00
Deidentified Maximum,,75968,CPT4/HCPCS,REPAIR ARTERY BLOCKAGE EACH,,,6500.00
Deidentified Maximum,,75984,CPT4/HCPCS,XRAY CONTROL CATHETER CHANGE,,,6500.00
Deidentified Maximum,,76001,CPT4/HCPCS,FLUOROSCOPE EXAM EXTENSIVE,,,1317.13
Deidentified Maximum,,76140,CPT4/HCPCS,X-RAY CONSULTATION,,,304.08
Deidentified Maximum,,76497,CPT4/HCPCS,CT PROCEDURE,,,6766.00
Deidentified Maximum,,76519,CPT4/HCPCS,ECHO EXAM OF EYE,,,587.00
Deidentified Maximum,,76700,CPT4/HCPCS,US EXAM ABDOM COMPLETE,,,997.08
Deidentified Maximum,,76705,CPT4/HCPCS,ECHO EXAM OF ABDOMEN,,,720.34
Deidentified Maximum,,76802,CPT4/HCPCS,OB US < 14 WKS ADDL FETUS,,,6500.00
Deidentified Maximum,,76830,CPT4/HCPCS,TRANSVAGINAL US NON-OB,,,794.89
Deidentified Maximum,,76873,CPT4/HCPCS,ECHOGRAP TRANS R PROS STUDY,,,1074.99
Deidentified Maximum,,76882,CPT4/HCPCS,US LMTD JT/NONVASC XTR STRUX,,,657.95
Deidentified Maximum,,76886,CPT4/HCPCS,US EXAM INFANT HIPS STATIC,,,720.34
Deidentified Maximum,,76975,CPT4/HCPCS,GI ENDOSCOPIC ULTRASOUND,,,1330.64
Deidentified Maximum,,76981,CPT4/HCPCS,USE PARENCHYMA,,,662.00
Deidentified Maximum,,76982,CPT4/HCPCS,USE 1ST TARGET LESION,,,657.95
Deidentified Maximum,,77012,CPT4/HCPCS,CT SCAN FOR NEEDLE BIOPSY,,,6766.00
Deidentified Maximum,,77021,CPT4/HCPCS,MRI GUIDANCE NDL PLMT RS&I,,,4436.86
Deidentified Maximum,,77053,CPT4/HCPCS,X-RAY OF MAMMARY DUCT,,,1348.34
Deidentified Maximum,,77054,CPT4/HCPCS,X-RAY OF MAMMARY DUCTS,,,1348.34
Deidentified Maximum,,77063,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,,366.00
Deidentified Maximum,,77066,CPT4/HCPCS,DX MAMMO INCL CAD BI,,,1494.93
Deidentified Maximum,,77067,CPT4/HCPCS,SCR MAMMO BI INCL CAD,,,1514.18
Deidentified Maximum,,77072,CPT4/HCPCS,X-RAYS FOR BONE AGE,,,657.95
Deidentified Maximum,,77075,CPT4/HCPCS,X-RAYS BONE SURVEY COMPLETE,,,984.98
Deidentified Maximum,,77076,CPT4/HCPCS,X-RAYS BONE SURVEY INFANT,,,852.58
Deidentified Maximum,,77081,CPT4/HCPCS,DXA BONE DENSITY/PERIPHERAL,,,364.35
Deidentified Maximum,,77085,CPT4/HCPCS,DXA BONE DENSITY STUDY,,,657.95
Deidentified Maximum,,77338,CPT4/HCPCS,DESIGN MLC DEVICE FOR IMRT,,,12726.35
Deidentified Maximum,,77386,CPT4/HCPCS,NTSTY MODUL RAD TX DLVR CPLX,,,13037.05
Deidentified Maximum,,77387,CPT4/HCPCS,GUIDANCE FOR RADJ TX DLVR,,,7894.00
Deidentified Maximum,,77402,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,,7894.00
Deidentified Maximum,,77407,CPT4/HCPCS,RADIATION TREATMENT DELIVERY,,,7894.00
Deidentified Maximum,,77605,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,,7137.90
Deidentified Maximum,,77610,CPT4/HCPCS,HYPERTHERMIA TREATMENT,,,6717.64
Deidentified Maximum,,77761,CPT4/HCPCS,APPLY INTRCAV RADIAT SIMPLE,,,13685.00
Deidentified Maximum,,77770,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,,13685.00
Deidentified Maximum,,77771,CPT4/HCPCS,HDR RDNCL NTRSTL/ICAV BRCHTX,,,13685.00
Deidentified Maximum,,77785,CPT4/HCPCS,HDR BRACHYTX 1 CHANNEL,,,1678.88
Deidentified Maximum,,78018,CPT4/HCPCS,THYROID MET IMAGING BODY,,,2739.32
Deidentified Maximum,,78071,CPT4/HCPCS,PARATHYRD PLANAR W/WO SUBTRJ,,,4337.76
Deidentified Maximum,,78110,CPT4/HCPCS,PLASMA VOLUME SINGLE,,,635.62
Deidentified Maximum,,78201,CPT4/HCPCS,LIVER IMAGING,,,1425.90
Deidentified Maximum,,78215,CPT4/HCPCS,LIVER AND SPLEEN IMAGING,,,1475.91
Deidentified Maximum,,78227,CPT4/HCPCS,HEPATOBIL SYST IMAGE W/DRUG,,,5756.40
Deidentified Maximum,,78232,CPT4/HCPCS,SALIVARY GLAND FUNCTION EXAM,,,1780.75
Deidentified Maximum,,78258,CPT4/HCPCS,ESOPHAGEAL MOTILITY STUDY,,,1665.63
Deidentified Maximum,,78262,CPT4/HCPCS,GASTROESOPHAGEAL REFLUX EXAM,,,2143.32
Deidentified Maximum,,78266,CPT4/HCPCS,GASTRIC EMPTYING IMAG STUDY,,,5885.55
Deidentified Maximum,,78268,CPT4/HCPCS,BREATH TEST ANALYSIS C-14,,,825.72
Deidentified Maximum,,78278,CPT4/HCPCS,ACUTE GI BLOOD LOSS IMAGING,,,2453.73
Deidentified Maximum,,78282,CPT4/HCPCS,GI PROTEIN LOSS EXAM,,,2082.36
Deidentified Maximum,,78306,CPT4/HCPCS,BONE IMAGING WHOLE BODY,,,2152.94
Deidentified Maximum,,78452,CPT4/HCPCS,HT MUSCLE IMAGE SPECT MULT,,,4007.30
Deidentified Maximum,,78457,CPT4/HCPCS,VENOUS THROMBOSIS IMAGING,,,1366.68
Deidentified Maximum,,78761,CPT4/HCPCS,TESTICULAR IMAGING W/FLOW,,,1613.11
Deidentified Maximum,,78800,CPT4/HCPCS,RP LOCLZJ TUM 1 AREA 1 D IMG,,,1713.38
Deidentified Maximum,,78804,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 2+D IMG,,,4596.14
Deidentified Maximum,,78805,CPT4/HCPCS,ABSCESS IMAGING LTD AREA,,,1713.38
Deidentified Maximum,,78807,CPT4/HCPCS,NUCLEAR LOCALIZATION/ABSCESS,,,3307.25
Deidentified Maximum,,80050,CPT4/HCPCS,GENERAL HEALTH PANEL,,,572.58
Deidentified Maximum,,80061,CPT4/HCPCS,LIPID PANEL,,,134.56
Deidentified Maximum,,80155,CPT4/HCPCS,DRUG ASSAY CAFFEINE,,,137.84
Deidentified Maximum,,80159,CPT4/HCPCS,DRUG ASSAY CLOZAPINE,,,180.18
Deidentified Maximum,,80175,CPT4/HCPCS,DRUG SCREEN QUAN LAMOTRIGINE,,,129.19
Deidentified Maximum,,80195,CPT4/HCPCS,ASSAY OF SIROLIMUS,,,137.92
Deidentified Maximum,,80324,CPT4/HCPCS,DRUG SCREEN AMPHETAMINES 1/2,,,102.00
Deidentified Maximum,,80325,CPT4/HCPCS,AMPHETAMINES 3OR 4,,,102.00
Deidentified Maximum,,80327,CPT4/HCPCS,ANABOLIC STEROID 1 OR 2,,,102.00
Deidentified Maximum,,80329,CPT4/HCPCS,ANALGESICS NON-OPIOID 1 OR 2,,,102.00
Deidentified Maximum,,80332,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 1 OR 2,,,102.00
Deidentified Maximum,,80333,CPT4/HCPCS,ANTIDEPRESSANTS CLASS 3-5,,,102.00
Deidentified Maximum,,80340,CPT4/HCPCS,ANTIEPILEPTICS NOS 4-6,,,102.00
Deidentified Maximum,,80341,CPT4/HCPCS,ANTIEPILEPTICS NOS 7/MORE,,,102.00
Deidentified Maximum,,80343,CPT4/HCPCS,ANTIPSYCHOTICS NOS 4-6,,,102.00
Deidentified Maximum,,80348,CPT4/HCPCS,DRUG SCREENING BUPRENORPHINE,,,102.00
Deidentified Maximum,,80358,CPT4/HCPCS,DRUG SCREENING METHADONE,,,102.00
Deidentified Maximum,,80362,CPT4/HCPCS,OPIOIDS & OPIATE ANALOGS 1/2,,,102.00
Deidentified Maximum,,80365,CPT4/HCPCS,DRUG SCREENING OXYCODONE,,,102.00
Deidentified Maximum,,80370,CPT4/HCPCS,SKEL MUSC RELAXANT 3 OR MORE,,,102.00
Deidentified Maximum,,C9750,CPT4/HCPCS,Ins/rem-replace compl iims,,,3544.00
Deidentified Maximum,,G0122,CPT4/HCPCS,Colon ca scrn; barium enema,,,1106.19
Deidentified Maximum,,G0256,CPT4/HCPCS,Prostate brachy w palladium,,,8012.00
Deidentified Maximum,,G0269,CPT4/HCPCS,Occlusive device in vein art,,,1678.00
Deidentified Maximum,,G0290,CPT4/HCPCS,Drug-eluting stents, single,,,8012.00
Deidentified Maximum,,G0339,CPT4/HCPCS,Robot lin-radsurg com, first,,,8841.00
Deidentified Maximum,,G0340,CPT4/HCPCS,Robt lin-radsurg fractx 2-5,,,8841.00
Deidentified Maximum,,G0398,CPT4/HCPCS,Home sleep test/type 2 Porta,,,3498.00
Deidentified Maximum,,G0517,CPT4/HCPCS,Remove drug implant,,,2002.00
Deidentified Maximum,,G6011,CPT4/HCPCS,Radiation treatment delivery,,,2034.57
Deidentified Maximum,,G6016,CPT4/HCPCS,Delivery comp imrt,,,2953.40
Deidentified Maximum,,G8627,CPT4/HCPCS,Surg proc w/in 30 days,,,5029.00
Deidentified Maximum,,G8994,CPT4/HCPCS,Sub pt/ot goal status,,,193.00
Deidentified Maximum,,G9169,CPT4/HCPCS,Memory goal status,,,193.00
Deidentified Maximum,,J0129,CPT4/HCPCS,Abatacept injection,,,465.36
Deidentified Maximum,,J0594,CPT4/HCPCS,Busulfan injection,,,41.49
Deidentified Maximum,,J0885,CPT4/HCPCS,Epoetin alfa, non-esrd,,,89.62
Deidentified Maximum,,J8521,CPT4/HCPCS,Capecitabine, oral, 500 mg,,,23.18
Deidentified Maximum,,J8565,CPT4/HCPCS,Gefitinib oral,,,2172.15
Deidentified Maximum,,J8700,CPT4/HCPCS,Temozolomide,,,7.72
Deidentified Maximum,,J9000,CPT4/HCPCS,Doxorubicin hcl injection,,,24.35
Deidentified Maximum,,J9017,CPT4/HCPCS,Arsenic trioxide injection,,,373.88
Deidentified Maximum,,J9027,CPT4/HCPCS,Clofarabine injection,,,459.98
Deidentified Maximum,,J9060,CPT4/HCPCS,Cisplatin 10 MG injection,,,16.37
Deidentified Maximum,,J9100,CPT4/HCPCS,Cytarabine hcl 100 MG inj,,,6.80
Deidentified Maximum,,J9120,CPT4/HCPCS,Dactinomycin injection,,,9387.16
Deidentified Maximum,,J9175,CPT4/HCPCS,Elliotts b solution per ml,,,75.26
Deidentified Maximum,,J9217,CPT4/HCPCS,Leuprolide acetate suspnsion,,,1951.90
Deidentified Maximum,,J9218,CPT4/HCPCS,Leuprolide acetate injeciton,,,85.93
Deidentified Maximum,,J9264,CPT4/HCPCS,Paclitaxel protein bound,,,106.51
Deidentified Maximum,,J9357,CPT4/HCPCS,Valrubicin injection,,,12101.20
Deidentified Maximum,,J9360,CPT4/HCPCS,Vinblastine sulfate inj,,,32.92
Deidentified Maximum,,P9057,CPT4/HCPCS,RBC, frz/deg/wsh, l/r, irrad,,,3628.00
Deidentified Maximum,,P9615,CPT4/HCPCS,Urine specimen collect mult,,,2002.00
Deidentified Maximum,,Q0084,CPT4/HCPCS,Chemotherapy by infusion,,,298.78
Deidentified Maximum,,Q0114,CPT4/HCPCS,Fern test,,,0.00
Deidentified Maximum,,S0088,CPT4/HCPCS,Imatinib 100 mg,,,36.70
Deidentified Maximum,,S0176,CPT4/HCPCS,Hydroxyurea 500 mg,,,7.13
Deidentified Maximum,,S2054,CPT4/HCPCS,Transplantation of multivisc,,,6588.00
Deidentified Maximum,,S2118,CPT4/HCPCS,Total hip resurfacing,,,5783.00
Deidentified Maximum,,S2350,CPT4/HCPCS,Diskectomy, anterior, with d,,,5281.00
Deidentified Maximum,,S2401,CPT4/HCPCS,Fetal surg urin trac obstr,,,8012.00
Deidentified Maximum,,0055T,CPT4/HCPCS,BONE SRGRY CMPTR CT/MRI IMAG,,,2427.00
Deidentified Maximum,,0072T,CPT4/HCPCS,US LEIOMYOMATA ABLATE >200,,,4204.00
Deidentified Maximum,,0081T,CPT4/HCPCS,ENDOVASC VISC EXTNSN S&I,,,5029.00
Deidentified Maximum,,0085T,CPT4/HCPCS,BREATH TEST HEART REJECT,,,10876.15
Deidentified Maximum,,0169T,CPT4/HCPCS,PLACE STEREO CATH BRAIN,,,3544.00
Deidentified Maximum,,0171T,CPT4/HCPCS,LUMBAR SPINE PROCES DISTRACT,,,5281.00
Deidentified Maximum,,0215T,CPT4/HCPCS,NJX PARAVERT W/US CER/THOR,,,1678.00
Deidentified Maximum,,0227T,CPT4/HCPCS,ANOSCOPY HRA W/BIOPSY,,,1678.00
Deidentified Maximum,,0229T,CPT4/HCPCS,NJX TFRML EPRL W/US CER/THOR,,,2002.00
Deidentified Maximum,,0237T,CPT4/HCPCS,TRLUML PERIP ATHRC BRCHIOCPH,,,10119.00
Deidentified Maximum,,0238T,CPT4/HCPCS,TRLUML PERIP ATHRC ILIAC ART,,,10119.00
Deidentified Maximum,,0247T,CPT4/HCPCS,OPN TX RIB FX 5-6 RIBS,,,3544.00
Deidentified Maximum,,0248T,CPT4/HCPCS,OPEN TX RIB FX 7/> RIBS,,,3544.00
Deidentified Maximum,,0254T,CPT4/HCPCS,EVASC RPR ILIAC ART BIFUR,,,5281.00
Deidentified Maximum,,0256T,CPT4/HCPCS,EVASC AORTIC HRT VALVE,,,6588.00
Deidentified Maximum,,0269T,CPT4/HCPCS,REV/REMVL CRTD SNS DEV TOTAL,,,9304.06
Deidentified Maximum,,0289T,CPT4/HCPCS,LASER INC FOR PKP/LKP DONOR,,,6588.00
Deidentified Maximum,,0299T,CPT4/HCPCS,ESW WOUND HEALING INIT WOUND,,,1678.88
Deidentified Maximum,,0300T,CPT4/HCPCS,ESW WOUND HEALING ADDL WOUND,,,1678.88
Deidentified Maximum,,0313T,CPT4/HCPCS,LAPS RMVL NSTIM ARRAY VAGUS,,,6876.92
Deidentified Maximum,,0315T,CPT4/HCPCS,RMVL VAGUS NERVE PLS GEN,,,5856.00
Deidentified Maximum,,0316T,CPT4/HCPCS,REPLC VAGUS NERVE PLS GEN,,,14317.00
Deidentified Maximum,,0318T,CPT4/HCPCS,REPLACE AORTIC VALVE TTHORAC,,,6588.00
Deidentified Maximum,,0319T,CPT4/HCPCS,INSERT SUBQ DEFIB W/ELTRD,,,5029.00
Deidentified Maximum,,0325T,CPT4/HCPCS,REPOS SUBQ DEFIB ELTRD &/GEN,,,1678.88
Deidentified Maximum,,0335T,CPT4/HCPCS,INSJ SINUS TARSI IMPLANT,,,6876.92
Deidentified Maximum,,0339T,CPT4/HCPCS,TRNSCTH RENAL SYMP DENRV BIL,,,5138.00
Deidentified Maximum,,0340T,CPT4/HCPCS,ABLATE PULM TUMORS EXTNSN,,,5783.00
Deidentified Maximum,,0347T,CPT4/HCPCS,INS BONE DEVICE FOR RSA,,,3656.00
Deidentified Maximum,,0354T,CPT4/HCPCS,OCT BREAST SURG CAVITY I&R,,,56.11
Deidentified Maximum,,0380T,CPT4/HCPCS,COMP ANIMAT RET IMAG SERIES,,,6049.05
Deidentified Maximum,,0396T,CPT4/HCPCS,INTRAOP KINETIC BALNCE SENSR,,,2002.00
Deidentified Maximum,,0407T,CPT4/HCPCS,SIN NDSC PLMT DRG ELUT MPLNT,,,3544.00
Deidentified Maximum,,0421T,CPT4/HCPCS,WATERJET PROSTATE ABLTJ CMPL,,,6075.00
Deidentified Maximum,,0427T,CPT4/HCPCS,INSJ/RPLC NSTIM APNEA PLS GN,,,14317.00
Deidentified Maximum,,0447T,CPT4/HCPCS,RMVL IMPLTBL GLUCOSE SENSOR,,,2002.00
Deidentified Maximum,,0458T,CPT4/HCPCS,REMVL SUBQ ELECTRODE,,,5856.00
Deidentified Maximum,,0463T,CPT4/HCPCS,INTERROG AORTIC VENTR SYS,,,1214.00
Deidentified Maximum,,0510T,CPT4/HCPCS,RMVL SINUS TARSI IMPLANT,,,5856.00
Deidentified Maximum,,0511T,CPT4/HCPCS,RMVL&RINSJ SINUS TARSI IMPLT,,,5856.00
Deidentified Maximum,,0512T,CPT4/HCPCS,ESW INTEG WND HLG 1ST WND,,,1678.88
Deidentified Maximum,,0519T,CPT4/HCPCS,RMVL & RPLCMT PG COMPNT WCS,,,6401.00
Deidentified Maximum,,0526T,CPT4/HCPCS,INSJ/RPLCMT IIMS ELTRD ONLY,,,10119.00
Deidentified Maximum,,0545T,CPT4/HCPCS,TCAT TV ANNULUS RCNSTJ,,,1370.00
Deidentified Maximum,,0547T,CPT4/HCPCS,B1 MATRL QUAL TST MCRIND TIB,,,2002.00
Deidentified Maximum,,0548T,CPT4/HCPCS,TPRNL BALO CNTNC DEV BI,,,10772.00
Deidentified Maximum,,0550T,CPT4/HCPCS,TPRNL BALO CNTNC DEV RMVL EA,,,4204.00
Deidentified Maximum,,0551T,CPT4/HCPCS,TPRNL BALO CNTNC DEV ADJMT,,,2002.00
Deidentified Maximum,,0567T,CPT4/HCPCS,PERM FLP TUBE OCCLS W/IMPLT,,,5856.00
Deidentified Maximum,,0570T,CPT4/HCPCS,TTVR PERQ EA ADDL PROSTH,,,8012.00
Deidentified Maximum,,0585T,CPT4/HCPCS,LAPS ISLET CELL TRANSPLANT,,,6588.00
Deidentified Maximum,,10009,CPT4/HCPCS,FNA BX W/CT GDN 1ST LES,,,3000.00
Deidentified Maximum,,10035,CPT4/HCPCS,PERQ DEV SOFT TISS 1ST IMAG,,,3656.00
Deidentified Maximum,,10036,CPT4/HCPCS,PERQ DEV SOFT TISS ADD IMAG,,,3000.00
Deidentified Maximum,,10040,CPT4/HCPCS,ACNE SURGERY,,,1214.00
Deidentified Maximum,,10081,CPT4/HCPCS,DRAINAGE OF PILONIDAL CYST,,,3198.57
Deidentified Maximum,,10180,CPT4/HCPCS,COMPLEX DRAINAGE WOUND,,,4280.43
Deidentified Maximum,,11005,CPT4/HCPCS,DEBRIDE ABDOM WALL,,,3198.57
Deidentified Maximum,,11100,CPT4/HCPCS,BIOPSY SKIN LESION,,,987.78
Deidentified Maximum,,11101,CPT4/HCPCS,BIOPSY SKIN ADD-ON,,,987.78
Deidentified Maximum,,11300,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,,1214.00
Deidentified Maximum,,11302,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,,1214.00
Deidentified Maximum,,11305,CPT4/HCPCS,SHAVE SKIN LESION 0.5 CM/<,,,1214.00
Deidentified Maximum,,11306,CPT4/HCPCS,SHAVE SKIN LESION 0.6-1.0 CM,,,1214.00
Deidentified Maximum,,11312,CPT4/HCPCS,SHAVE SKIN LESION 1.1-2.0 CM,,,1214.00
Deidentified Maximum,,11313,CPT4/HCPCS,SHAVE SKIN LESION >2.0 CM,,,1214.00
Deidentified Maximum,,11402,CPT4/HCPCS,EXC TR-EXT B9+MARG 1.1-2 CM,,,3198.57
Deidentified Maximum,,11403,CPT4/HCPCS,EXC TR-EXT B9+MARG 2.1-3CM,,,3198.57
Deidentified Maximum,,11423,CPT4/HCPCS,EXC H-F-NK-SP B9+MARG 2.1-3,,,3198.57
Deidentified Maximum,,11442,CPT4/HCPCS,EXC FACE-MM B9+MARG 1.1-2 CM,,,3198.57
Deidentified Maximum,,11446,CPT4/HCPCS,EXC FACE-MM B9+MARG >4 CM,,,4280.43
Deidentified Maximum,,11450,CPT4/HCPCS,REMOVAL SWEAT GLAND LESION,,,4280.43
Deidentified Maximum,,11622,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 1.1-2,,,3198.57
Deidentified Maximum,,11624,CPT4/HCPCS,EXC S/N/H/F/G MAL+MRG 3.1-4,,,4280.43
Deidentified Maximum,,11719,CPT4/HCPCS,TRIM NAIL(S) ANY NUMBER,,,1214.00
Deidentified Maximum,,11720,CPT4/HCPCS,DEBRIDE NAIL 1-5,,,3000.00
Deidentified Maximum,,11721,CPT4/HCPCS,DEBRIDE NAIL 6 OR MORE,,,3000.00
Deidentified Maximum,,11732,CPT4/HCPCS,REMOVE NAIL PLATE ADD-ON,,,3198.57
Deidentified Maximum,,11752,CPT4/HCPCS,REMOVE NAIL BED/TIP,,,1678.00
Deidentified Maximum,,11762,CPT4/HCPCS,RECONSTRUCTION OF NAIL BED,,,3656.00
Deidentified Maximum,,11771,CPT4/HCPCS,REMOVE PILONIDAL CYST EXTEN,,,5856.00
Deidentified Maximum,,11901,CPT4/HCPCS,INJECT SKIN LESIONS >7,,,2002.00
Deidentified Maximum,,11950,CPT4/HCPCS,TX CONTOUR DEFECTS 1 CC/<,,,1214.00
Deidentified Maximum,,11976,CPT4/HCPCS,REMOVE CONTRACEPTIVE CAPSULE,,,3198.57
Deidentified Maximum,,11981,CPT4/HCPCS,INSERT DRUG IMPLANT DEVICE,,,3000.00
Deidentified Maximum,,11983,CPT4/HCPCS,REMOVE/INSERT DRUG IMPLANT,,,3198.57
Deidentified Maximum,,12016,CPT4/HCPCS,RPR FE/E/EN/L/M 12.6-20.0 CM,,,4280.43
Deidentified Maximum,,12018,CPT4/HCPCS,RPR F/E/E/N/L/M >30.0 CM,,,4280.43
Deidentified Maximum,,12021,CPT4/HCPCS,CLOSURE OF SPLIT WOUND,,,3198.57
Deidentified Maximum,,12034,CPT4/HCPCS,INTMD RPR S/TR/EXT 7.6-12.5,,,4280.43
Deidentified Maximum,,13132,CPT4/HCPCS,CMPLX RPR F/C/C/M/N/AX/G/H/F,,,5856.00
Deidentified Maximum,,13150,CPT4/HCPCS,CMPLX RPR E/N/E/L 1.0 CM/<,,,3544.00
Deidentified Maximum,,15002,CPT4/HCPCS,WOUND PREP TRK/ARM/LEG,,,4280.43
Deidentified Maximum,,15004,CPT4/HCPCS,WOUND PREP F/N/HF/G,,,4280.43
Deidentified Maximum,,15040,CPT4/HCPCS,HARVEST CULTURED SKIN GRAFT,,,4280.43
Deidentified Maximum,,15121,CPT4/HCPCS,SKN SPLT A-GRFT F/N/HF/G ADD,,,5856.00
Deidentified Maximum,,15155,CPT4/HCPCS,CULT SKIN GRAFT F/N/HF/G,,,5138.00
Deidentified Maximum,,15201,CPT4/HCPCS,SKIN FULL GRAFT TRUNK ADD-ON,,,4280.43
Deidentified Maximum,,15260,CPT4/HCPCS,SKIN FULL GRAFT EEN & LIPS,,,4280.43
Deidentified Maximum,,15272,CPT4/HCPCS,SKIN SUB GRAFT T/A/L ADD-ON,,,3000.00
Deidentified Maximum,,15276,CPT4/HCPCS,SKIN SUB GRAFT F/N/HF/G ADDL,,,3000.00
Deidentified Maximum,,15600,CPT4/HCPCS,DELAY FLAP TRUNK,,,5856.00
Deidentified Maximum,,15731,CPT4/HCPCS,FOREHEAD FLAP W/VASC PEDICLE,,,5856.00
Deidentified Maximum,,15736,CPT4/HCPCS,MUSCLE-SKIN GRAFT ARM,,,5856.00
Deidentified Maximum,,15750,CPT4/HCPCS,NEUROVASCULAR PEDICLE FLAP,,,5138.00
Deidentified Maximum,,15788,CPT4/HCPCS,CHEMICAL PEEL FACE EPIDERM,,,1214.00
Deidentified Maximum,,15793,CPT4/HCPCS,CHEMICAL PEEL NONFACIAL,,,1214.00
Deidentified Maximum,,15821,CPT4/HCPCS,REVISION OF LOWER EYELID,,,5856.00
Deidentified Maximum,,15830,CPT4/HCPCS,EXC SKIN ABD,,,6075.00
Deidentified Maximum,,15833,CPT4/HCPCS,EXCISE EXCESSIVE SKIN LEG,,,5856.00
Deidentified Maximum,,15841,CPT4/HCPCS,NERVE PALSY MUSCLE GRAFT,,,6401.00
Deidentified Maximum,,15845,CPT4/HCPCS,SKIN AND MUSCLE REPAIR FACE,,,6401.00
Deidentified Maximum,,15852,CPT4/HCPCS,DRESSING CHANGE NOT FOR BURN,,,3198.57
Deidentified Maximum,,15931,CPT4/HCPCS,REMOVE SACRUM PRESSURE SORE,,,5856.00
Deidentified Maximum,,15950,CPT4/HCPCS,REMOVE THIGH PRESSURE SORE,,,5856.00
Deidentified Maximum,,17111,CPT4/HCPCS,DESTRUCT LESION 15 OR MORE,,,3000.00
Deidentified Maximum,,17270,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17272,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17273,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17274,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17280,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17281,CPT4/HCPCS,DESTRUCTION OF SKIN LESIONS,,,3198.57
Deidentified Maximum,,17360,CPT4/HCPCS,SKIN PEEL THERAPY,,,1214.00
Deidentified Maximum,,19082,CPT4/HCPCS,BX BREAST ADD LESION STRTCTC,,,3000.00
Deidentified Maximum,,19101,CPT4/HCPCS,BIOPSY OF BREAST OPEN,,,4280.43
Deidentified Maximum,,19271,CPT4/HCPCS,REVISION OF CHEST WALL,,,5281.00
Deidentified Maximum,,19281,CPT4/HCPCS,PERQ DEVICE BREAST 1ST IMAG,,,3656.00
Deidentified Maximum,,19283,CPT4/HCPCS,PERQ DEV BREAST 1ST STRTCTC,,,3656.00
Deidentified Maximum,,19291,CPT4/HCPCS,PLACE NEEDLE WIRE BREAST,,,1678.00
Deidentified Maximum,,19295,CPT4/HCPCS,PLACE BREAST CLIP PERCUT,,,1678.00
Deidentified Maximum,,19300,CPT4/HCPCS,REMOVAL OF BREAST TISSUE,,,6401.00
Deidentified Maximum,,19330,CPT4/HCPCS,RMVL RUPTURED BREAST IMPLANT,,,5138.00
Deidentified Maximum,,19342,CPT4/HCPCS,INSJ/RPLCMT BRST IMPLT SEP D,,,7007.00
Deidentified Maximum,,19364,CPT4/HCPCS,BRST RCNSTJ FREE FLAP,,,7902.34
Deidentified Maximum,,19367,CPT4/HCPCS,BRST RCNSTJ 1 PDCL TRAM FLAP,,,6075.00
Deidentified Maximum,,19369,CPT4/HCPCS,BRST RCNSTJ 2 PDCL TRAM FLAP,,,6075.00
Deidentified Maximum,,19396,CPT4/HCPCS,DESIGN CUSTOM BREAST IMPLANT,,,7902.34
Deidentified Maximum,,19499,CPT4/HCPCS,BREAST SURGERY PROCEDURE,,,4280.43
Deidentified Maximum,,20005,CPT4/HCPCS,I&D ABSCESS SUBFASCIAL,,,4280.43
Deidentified Maximum,,20225,CPT4/HCPCS,BONE BIOPSY TROCAR/NEEDLE,,,4280.43
Deidentified Maximum,,20551,CPT4/HCPCS,INJ TENDON ORIGIN/INSERTION,,,3000.00
Deidentified Maximum,,20552,CPT4/HCPCS,INJ TRIGGER POINT 1/2 MUSCL,,,3000.00
Deidentified Maximum,,20560,CPT4/HCPCS,NDL INSJ W/O NJX 1 OR 2 MUSC,,,3000.00
Deidentified Maximum,,20615,CPT4/HCPCS,TREATMENT OF BONE CYST,,,2002.00
Deidentified Maximum,,20696,CPT4/HCPCS,COMP MULTIPLANE EXT FIXATION,,,8300.00
Deidentified Maximum,,20700,CPT4/HCPCS,MNL PREP&INSJ DP RX DLVR DEV,,,3000.00
Deidentified Maximum,,20702,CPT4/HCPCS,MNL PREP&INSJ IMED RX DEV,,,3000.00
Deidentified Maximum,,20902,CPT4/HCPCS,REMOVAL OF BONE FOR GRAFT,,,6401.00
Deidentified Maximum,,20910,CPT4/HCPCS,REMOVE CARTILAGE FOR GRAFT,,,5856.00
Deidentified Maximum,,20924,CPT4/HCPCS,REMOVAL OF TENDON FOR GRAFT,,,6401.00
Deidentified Maximum,,20933,CPT4/HCPCS,HEMICRT INTRCLRY ALGRFT PRTL,,,8841.00
Deidentified Maximum,,20936,CPT4/HCPCS,SP BONE AGRFT LOCAL ADD-ON,,,5138.00
Deidentified Maximum,,20979,CPT4/HCPCS,US BONE STIMULATION,,,1214.00
Deidentified Maximum,,20982,CPT4/HCPCS,ABLATE BONE TUMOR(S) PERQ,,,9548.65
Deidentified Maximum,,21012,CPT4/HCPCS,EXC FACE LES SBQ 2 CM/>,,,4280.43
Deidentified Maximum,,21030,CPT4/HCPCS,EXCISE MAX/ZYGOMA B9 TUMOR,,,6049.05
Deidentified Maximum,,21045,CPT4/HCPCS,EXTENSIVE JAW SURGERY,,,5029.00
Deidentified Maximum,,21079,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,9548.65
Deidentified Maximum,,21083,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,9548.65
Deidentified Maximum,,21087,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,9548.65
Deidentified Maximum,,21088,CPT4/HCPCS,PREPARE FACE/ORAL PROSTHESIS,,,9548.65
Deidentified Maximum,,21116,CPT4/HCPCS,INJECTION JAW JOINT X-RAY,,,3000.00
Deidentified Maximum,,21125,CPT4/HCPCS,AUGMENTATION LOWER JAW BONE,,,7830.00
Deidentified Maximum,,21138,CPT4/HCPCS,REDUCTION OF FOREHEAD,,,9548.65
Deidentified Maximum,,21145,CPT4/HCPCS,LEFORT I-1 PIECE W/ GRAFT,,,5783.00
Deidentified Maximum,,21159,CPT4/HCPCS,LEFORT III W/FHDW/O LEFORT I,,,6876.92
Deidentified Maximum,,21175,CPT4/HCPCS,RECONSTRUCT ORBIT/FOREHEAD,,,6840.00
Deidentified Maximum,,21195,CPT4/HCPCS,RECONST LWR JAW W/O FIXATION,,,6840.00
Deidentified Maximum,,21196,CPT4/HCPCS,RECONST LWR JAW W/FIXATION,,,6075.00
Deidentified Maximum,,21199,CPT4/HCPCS,RECONSTR LWR JAW W/ADVANCE,,,9548.65
Deidentified Maximum,,21209,CPT4/HCPCS,REDUCTION OF FACIAL BONES,,,6876.92
Deidentified Maximum,,21240,CPT4/HCPCS,RECONSTRUCTION OF JAW JOINT,,,6401.00
Deidentified Maximum,,21256,CPT4/HCPCS,RECONSTRUCTION OF ORBIT,,,6075.00
Deidentified Maximum,,21315,CPT4/HCPCS,CLOSED TX NOSE FX W/O STABLJ,,,4280.43
Deidentified Maximum,,21330,CPT4/HCPCS,OPEN TX NOSE FX W/SKELE FIXJ,,,6876.92
Deidentified Maximum,,21337,CPT4/HCPCS,CLOSED TX SEPTAL&NOSE FX,,,4280.43
Deidentified Maximum,,21338,CPT4/HCPCS,OPEN NASOETHMOID FX W/O FIXJ,,,6401.00
Deidentified Maximum,,21400,CPT4/HCPCS,CLOSED TX ORBIT W/O MANIPULJ,,,4280.43
Deidentified Maximum,,21422,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,,6840.00
Deidentified Maximum,,21423,CPT4/HCPCS,TREAT MOUTH ROOF FRACTURE,,,6075.00
Deidentified Maximum,,21554,CPT4/HCPCS,EXC NECK TUM DEEP 5 CM/>,,,5856.00
Deidentified Maximum,,21555,CPT4/HCPCS,EXC NECK LES SC < 3 CM,,,4280.43
Deidentified Maximum,,21616,CPT4/HCPCS,REMOVAL OF RIB AND NERVES,,,5783.00
Deidentified Maximum,,21685,CPT4/HCPCS,HYOID MYOTOMY & SUSPENSION,,,5281.00
Deidentified Maximum,,21700,CPT4/HCPCS,REVISION OF NECK MUSCLE,,,4280.43
Deidentified Maximum,,21725,CPT4/HCPCS,REVISION OF NECK MUSCLE,,,5856.00
Deidentified Maximum,,21750,CPT4/HCPCS,REPAIR OF STERNUM SEPARATION,,,5029.00
Deidentified Maximum,,21805,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,,1678.88
Deidentified Maximum,,21812,CPT4/HCPCS,TREATMENT OF RIB FRACTURE,,,8300.00
Deidentified Maximum,,21925,CPT4/HCPCS,BIOPSY SOFT TISSUE OF BACK,,,4280.43
Deidentified Maximum,,22010,CPT4/HCPCS,I&D P-SPINE C/T/CERV-THOR,,,1678.88
Deidentified Maximum,,22101,CPT4/HCPCS,REMOVE PART THORAX VERTEBRA,,,9548.65
Deidentified Maximum,,22110,CPT4/HCPCS,REMOVE PART OF NECK VERTEBRA,,,3544.00
Deidentified Maximum,,22206,CPT4/HCPCS,INCIS SPINE 3 COLUMN THORAC,,,1370.00
Deidentified Maximum,,22208,CPT4/HCPCS,INCIS SPINE 3 COLUMN ADL SEG,,,1370.00
Deidentified Maximum,,22305,CPT4/HCPCS,CLOSED TX SPINE PROCESS FX,,,1678.00
Deidentified Maximum,,22325,CPT4/HCPCS,TREAT SPINE FRACTURE,,,5856.00
Deidentified Maximum,,22327,CPT4/HCPCS,TREAT THORAX SPINE FRACTURE,,,5856.00
Deidentified Maximum,,22510,CPT4/HCPCS,PERQ CERVICOTHORACIC INJECT,,,9770.00
Deidentified Maximum,,22514,CPT4/HCPCS,PERQ VERTEBRAL AUGMENTATION,,,7007.00
Deidentified Maximum,,22520,CPT4/HCPCS,PERCUT VERTEBROPLASTY THOR,,,1678.00
Deidentified Maximum,,22521,CPT4/HCPCS,PERCUT VERTEBROPLASTY LUMB,,,1678.00
Deidentified Maximum,,22522,CPT4/HCPCS,PERCUT VERTEBROPLASTY ADDL,,,1678.00
Deidentified Maximum,,22534,CPT4/HCPCS,LAT THOR/LUMB ADDL SEG,,,3198.57
Deidentified Maximum,,22551,CPT4/HCPCS,NECK SPINE FUSE&REMOV BEL C2,,,8841.00
Deidentified Maximum,,22554,CPT4/HCPCS,NECK SPINE FUSION,,,8841.00
Deidentified Maximum,,22556,CPT4/HCPCS,THORAX SPINE FUSION,,,8841.00
Deidentified Maximum,,22630,CPT4/HCPCS,LUMBAR SPINE FUSION,,,6588.00
Deidentified Maximum,,22634,CPT4/HCPCS,SPINE FUSION EXTRA SEGMENT,,,6588.00
Deidentified Maximum,,22804,CPT4/HCPCS,POST FUSION 13/> VERT SEG,,,8841.00
Deidentified Maximum,,22841,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,3544.00
Deidentified Maximum,,22844,CPT4/HCPCS,INSERT SPINE FIXATION DEVICE,,,6588.00
Deidentified Maximum,,22905,CPT4/HCPCS,RAD RESECT ABD TUMOR 5 CM/>,,,5856.00
Deidentified Maximum,,23020,CPT4/HCPCS,RELEASE SHOULDER JOINT,,,5138.00
Deidentified Maximum,,23125,CPT4/HCPCS,REMOVAL OF COLLAR BONE,,,6876.92
Deidentified Maximum,,23145,CPT4/HCPCS,REMOVAL OF BONE LESION,,,6876.92
Deidentified Maximum,,23200,CPT4/HCPCS,RESECT CLAVICLE TUMOR,,,5029.00
Deidentified Maximum,,23412,CPT4/HCPCS,REPAIR ROTATOR CUFF CHRONIC,,,9548.65
Deidentified Maximum,,23450,CPT4/HCPCS,REPAIR SHOULDER CAPSULE,,,7007.00
Deidentified Maximum,,23500,CPT4/HCPCS,TREAT CLAVICLE FRACTURE,,,3198.57
Deidentified Maximum,,23530,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,7007.00
Deidentified Maximum,,23532,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,6401.00
Deidentified Maximum,,23540,CPT4/HCPCS,TREAT CLAVICLE DISLOCATION,,,3198.57
Deidentified Maximum,,23665,CPT4/HCPCS,TREAT DISLOCATION/FRACTURE,,,4280.43
Deidentified Maximum,,23800,CPT4/HCPCS,FUSION OF SHOULDER JOINT,,,7007.00
Deidentified Maximum,,23900,CPT4/HCPCS,AMPUTATION OF ARM & GIRDLE,,,5281.00
Deidentified Maximum,,23920,CPT4/HCPCS,AMPUTATION AT SHOULDER JOINT,,,5029.00
Deidentified Maximum,,23935,CPT4/HCPCS,DRAIN ARM/ELBOW BONE LESION,,,4280.43
Deidentified Maximum,,24000,CPT4/HCPCS,EXPLORATORY ELBOW SURGERY,,,6401.00
Deidentified Maximum,,24065,CPT4/HCPCS,BIOPSY ARM/ELBOW SOFT TISSUE,,,3198.57
Deidentified Maximum,,24075,CPT4/HCPCS,EXC ARM/ELBOW LES SC < 3 CM,,,4280.43
Deidentified Maximum,,24101,CPT4/HCPCS,EXPLORE/TREAT ELBOW JOINT,,,6401.00
Deidentified Maximum,,24110,CPT4/HCPCS,REMOVE HUMERUS LESION,,,4280.43
Deidentified Maximum,,24115,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,,5856.00
Deidentified Maximum,,24130,CPT4/HCPCS,REMOVAL OF HEAD OF RADIUS,,,5856.00
Deidentified Maximum,,24149,CPT4/HCPCS,RADICAL RESECTION OF ELBOW,,,6401.00
Deidentified Maximum,,24201,CPT4/HCPCS,REMOVAL OF ARM FOREIGN BODY,,,4280.43
Deidentified Maximum,,24357,CPT4/HCPCS,REPAIR ELBOW PERC,,,8300.00
Deidentified Maximum,,24359,CPT4/HCPCS,REPAIR ELBOW DEB/ATTCH OPEN,,,8300.00
Deidentified Maximum,,24365,CPT4/HCPCS,RECONSTRUCT HEAD OF RADIUS,,,6876.92
Deidentified Maximum,,24410,CPT4/HCPCS,REVISION OF HUMERUS,,,6401.00
Deidentified Maximum,,24420,CPT4/HCPCS,REVISION OF HUMERUS,,,6075.00
Deidentified Maximum,,24430,CPT4/HCPCS,REPAIR OF HUMERUS,,,7007.00
Deidentified Maximum,,24435,CPT4/HCPCS,REPAIR HUMERUS WITH GRAFT,,,7007.00
Deidentified Maximum,,24505,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3198.57
Deidentified Maximum,,24530,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3198.57
Deidentified Maximum,,24546,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,7007.00
Deidentified Maximum,,24560,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3198.57
Deidentified Maximum,,24577,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,3198.57
Deidentified Maximum,,24579,CPT4/HCPCS,TREAT HUMERUS FRACTURE,,,7007.00
Deidentified Maximum,,24600,CPT4/HCPCS,TREAT ELBOW DISLOCATION,,,3198.57
Deidentified Maximum,,24685,CPT4/HCPCS,TREAT ULNAR FRACTURE,,,7007.00
Deidentified Maximum,,24800,CPT4/HCPCS,FUSION OF ELBOW JOINT,,,6401.00
Deidentified Maximum,,24931,CPT4/HCPCS,AMPUTATE UPPER ARM & IMPLANT,,,5029.00
Deidentified Maximum,,25024,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,,5856.00
Deidentified Maximum,,25025,CPT4/HCPCS,DECOMPRESS FOREARM 2 SPACES,,,5856.00
Deidentified Maximum,,25105,CPT4/HCPCS,REMOVE WRIST JOINT LINING,,,6401.00
Deidentified Maximum,,25120,CPT4/HCPCS,REMOVAL OF FOREARM LESION,,,5856.00
Deidentified Maximum,,25210,CPT4/HCPCS,REMOVAL OF WRIST BONE,,,5856.00
Deidentified Maximum,,25215,CPT4/HCPCS,REMOVAL OF WRIST BONES,,,6401.00
Deidentified Maximum,,25240,CPT4/HCPCS,PARTIAL REMOVAL OF ULNA,,,6401.00
Deidentified Maximum,,25246,CPT4/HCPCS,INJECTION FOR WRIST X-RAY,,,3000.00
Deidentified Maximum,,25270,CPT4/HCPCS,REPAIR FOREARM TENDON/MUSCLE,,,6401.00
Deidentified Maximum,,25295,CPT4/HCPCS,RELEASE WRIST/FOREARM TENDON,,,5856.00
Deidentified Maximum,,25300,CPT4/HCPCS,FUSION OF TENDONS AT WRIST,,,5856.00
Deidentified Maximum,,25350,CPT4/HCPCS,REVISION OF RADIUS,,,6075.00
Deidentified Maximum,,25393,CPT4/HCPCS,LENGTHEN RADIUS & ULNA,,,6401.00
Deidentified Maximum,,25420,CPT4/HCPCS,REPAIR/GRAFT RADIUS & ULNA,,,7007.00
Deidentified Maximum,,25530,CPT4/HCPCS,TREAT FRACTURE OF ULNA,,,2002.00
Deidentified Maximum,,25565,CPT4/HCPCS,TREAT FRACTURE RADIUS & ULNA,,,4280.43
Deidentified Maximum,,25630,CPT4/HCPCS,TREAT WRIST BONE FRACTURE,,,2002.00
Deidentified Maximum,,25651,CPT4/HCPCS,PIN ULNAR STYLOID FRACTURE,,,7902.34
Deidentified Maximum,,25660,CPT4/HCPCS,TREAT WRIST DISLOCATION,,,3198.57
Deidentified Maximum,,25680,CPT4/HCPCS,TREAT WRIST FRACTURE,,,4280.43
Deidentified Maximum,,25915,CPT4/HCPCS,AMPUTATION OF FOREARM,,,5029.00
Deidentified Maximum,,25931,CPT4/HCPCS,AMPUTATION FOLLOW-UP SURGERY,,,4891.93
Deidentified Maximum,,26010,CPT4/HCPCS,DRAINAGE OF FINGER ABSCESS,,,1214.00
Deidentified Maximum,,26020,CPT4/HCPCS,DRAIN HAND TENDON SHEATH,,,4280.43
Deidentified Maximum,,26037,CPT4/HCPCS,DECOMPRESS FINGERS/HAND,,,6401.00
Deidentified Maximum,,26116,CPT4/HCPCS,EXC HAND TUM DEEP < 1.5 CM,,,4280.43
Deidentified Maximum,,26118,CPT4/HCPCS,RAD RESECT HAND TUMOR 3 CM/>,,,5856.00
Deidentified Maximum,,26145,CPT4/HCPCS,TENDON EXCISION PALM/FINGER,,,5856.00
Deidentified Maximum,,26185,CPT4/HCPCS,REMOVE FINGER BONE,,,6401.00
Deidentified Maximum,,26205,CPT4/HCPCS,REMOVE/GRAFT BONE LESION,,,5856.00
Deidentified Maximum,,26215,CPT4/HCPCS,REMOVE/GRAFT FINGER LESION,,,5856.00
Deidentified Maximum,,26320,CPT4/HCPCS,REMOVAL OF IMPLANT FROM HAND,,,4280.43
Deidentified Maximum,,26356,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,6401.00
Deidentified Maximum,,26415,CPT4/HCPCS,EXCISION HAND/FINGER TENDON,,,6401.00
Deidentified Maximum,,26426,CPT4/HCPCS,REPAIR FINGER/HAND TENDON,,,5856.00
Deidentified Maximum,,26432,CPT4/HCPCS,REPAIR FINGER TENDON,,,5856.00
Deidentified Maximum,,26440,CPT4/HCPCS,RELEASE PALM/FINGER TENDON,,,5856.00
Deidentified Maximum,,26450,CPT4/HCPCS,INCISION OF PALM TENDON,,,5856.00
Deidentified Maximum,,26471,CPT4/HCPCS,FUSION OF FINGER TENDONS,,,4280.43
Deidentified Maximum,,26477,CPT4/HCPCS,TENDON SHORTENING,,,3198.57
Deidentified Maximum,,26508,CPT4/HCPCS,RELEASE THUMB CONTRACTURE,,,5856.00
Deidentified Maximum,,26540,CPT4/HCPCS,REPAIR HAND JOINT,,,6401.00
Deidentified Maximum,,26542,CPT4/HCPCS,REPAIR HAND JOINT WITH GRAFT,,,6401.00
Deidentified Maximum,,26550,CPT4/HCPCS,CONSTRUCT THUMB REPLACEMENT,,,5281.00
Deidentified Maximum,,26567,CPT4/HCPCS,CORRECT FINGER DEFORMITY,,,6876.92
Deidentified Maximum,,26607,CPT4/HCPCS,TREAT METACARPAL FRACTURE,,,4280.43
Deidentified Maximum,,26650,CPT4/HCPCS,TREAT THUMB FRACTURE,,,4280.43
Deidentified Maximum,,26670,CPT4/HCPCS,TREAT HAND DISLOCATION,,,1678.00
Deidentified Maximum,,26675,CPT4/HCPCS,TREAT HAND DISLOCATION,,,4280.43
Deidentified Maximum,,26705,CPT4/HCPCS,TREAT KNUCKLE DISLOCATION,,,4280.43
Deidentified Maximum,,26727,CPT4/HCPCS,TREAT FINGER FRACTURE EACH,,,9548.65
Deidentified Maximum,,26844,CPT4/HCPCS,FUSION/GRAFT OF HAND JOINT,,,5856.00
Deidentified Maximum,,26863,CPT4/HCPCS,FUSE/GRAFT ADDED JOINT,,,5856.00
Deidentified Maximum,,26989,CPT4/HCPCS,HAND/FINGER SURGERY,,,3198.57
Deidentified Maximum,,27005,CPT4/HCPCS,INCISION OF HIP TENDON,,,3544.00
Deidentified Maximum,,27033,CPT4/HCPCS,EXPLORATION OF HIP JOINT,,,6075.00
Deidentified Maximum,,27036,CPT4/HCPCS,EXCISION OF HIP JOINT/MUSCLE,,,5138.00
Deidentified Maximum,,27071,CPT4/HCPCS,PART REMOVAL HIP BONE DEEP,,,7007.00
Deidentified Maximum,,27078,CPT4/HCPCS,RSECT HIP TUM INCL FEMUR,,,4891.93
Deidentified Maximum,,27090,CPT4/HCPCS,REMOVAL OF HIP PROSTHESIS,,,5281.00
Deidentified Maximum,,27096,CPT4/HCPCS,INJECT SACROILIAC JOINT,,,3198.57
Deidentified Maximum,,27097,CPT4/HCPCS,REVISION OF HIP TENDON,,,5856.00
Deidentified Maximum,,27098,CPT4/HCPCS,TRANSFER TENDON TO PELVIS,,,5856.00
Deidentified Maximum,,27105,CPT4/HCPCS,TRANSFER OF SPINAL MUSCLE,,,6401.00
Deidentified Maximum,,27111,CPT4/HCPCS,TRANSFER OF ILIOPSOAS MUSCLE,,,6401.00
Deidentified Maximum,,27138,CPT4/HCPCS,REVISE HIP JOINT REPLACEMENT,,,10119.00
Deidentified Maximum,,27175,CPT4/HCPCS,TREAT SLIPPED EPIPHYSIS,,,3198.57
Deidentified Maximum,,27179,CPT4/HCPCS,REVISE HEAD/NECK OF FEMUR,,,7007.00
Deidentified Maximum,,27187,CPT4/HCPCS,REINFORCE HIP BONES,,,5783.00
Deidentified Maximum,,27200,CPT4/HCPCS,TREAT TAIL BONE FRACTURE,,,3000.00
Deidentified Maximum,,27222,CPT4/HCPCS,TREAT HIP SOCKET FRACTURE,,,3198.57
Deidentified Maximum,,27226,CPT4/HCPCS,TREAT HIP WALL FRACTURE,,,5029.00
Deidentified Maximum,,27266,CPT4/HCPCS,TREAT HIP DISLOCATION,,,4280.43
Deidentified Maximum,,27279,CPT4/HCPCS,ARTHRODESIS SACROILIAC JOINT,,,10119.00
Deidentified Maximum,,27280,CPT4/HCPCS,FUSION OF SACROILIAC JOINT,,,5029.00
Deidentified Maximum,,27284,CPT4/HCPCS,FUSION OF HIP JOINT,,,6049.05
Deidentified Maximum,,27303,CPT4/HCPCS,DRAINAGE OF BONE LESION,,,4280.43
Deidentified Maximum,,27306,CPT4/HCPCS,INCISION OF THIGH TENDON,,,5856.00
Deidentified Maximum,,27310,CPT4/HCPCS,EXPLORATION OF KNEE JOINT,,,6401.00
Deidentified Maximum,,27330,CPT4/HCPCS,BIOPSY KNEE JOINT LINING,,,6401.00
Deidentified Maximum,,27334,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,,6401.00
Deidentified Maximum,,27335,CPT4/HCPCS,REMOVE KNEE JOINT LINING,,,6401.00
Deidentified Maximum,,27364,CPT4/HCPCS,RESECT THIGH/KNEE TUM 5 CM/>,,,5856.00
Deidentified Maximum,,27365,CPT4/HCPCS,RESECT FEMUR/KNEE TUMOR,,,5783.00
Deidentified Maximum,,27385,CPT4/HCPCS,REPAIR OF THIGH MUSCLE,,,5856.00
Deidentified Maximum,,27405,CPT4/HCPCS,REPAIR OF KNEE LIGAMENT,,,6401.00
Deidentified Maximum,,27429,CPT4/HCPCS,RECONSTRUCTION KNEE,,,7007.00
Deidentified Maximum,,27438,CPT4/HCPCS,REVISE KNEECAP WITH IMPLANT,,,7007.00
Deidentified Maximum,,27441,CPT4/HCPCS,REVISION OF KNEE JOINT,,,6876.92
Deidentified Maximum,,27450,CPT4/HCPCS,INCISION OF THIGH,,,6588.00
Deidentified Maximum,,27454,CPT4/HCPCS,REALIGNMENT OF THIGH BONE,,,5281.00
Deidentified Maximum,,27475,CPT4/HCPCS,SURGERY TO STOP LEG GROWTH,,,6401.00
Deidentified Maximum,,27488,CPT4/HCPCS,REMOVAL OF KNEE PROSTHESIS,,,5029.00
Deidentified Maximum,,27497,CPT4/HCPCS,DECOMPRESSION OF THIGH/KNEE,,,5856.00
Deidentified Maximum,,27502,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,4280.43
Deidentified Maximum,,27513,CPT4/HCPCS,TREATMENT OF THIGH FRACTURE,,,6840.00
Deidentified Maximum,,27530,CPT4/HCPCS,TREAT KNEE FRACTURE,,,3198.57
Deidentified Maximum,,27605,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,,4204.00
Deidentified Maximum,,27606,CPT4/HCPCS,INCISION OF ACHILLES TENDON,,,4204.00
Deidentified Maximum,,27607,CPT4/HCPCS,TREAT LOWER LEG BONE LESION,,,4280.43
Deidentified Maximum,,27614,CPT4/HCPCS,BIOPSY LOWER LEG SOFT TISSUE,,,4280.43
Deidentified Maximum,,27615,CPT4/HCPCS,RESECT LEG/ANKLE TUM < 5 CM,,,5856.00
Deidentified Maximum,,27637,CPT4/HCPCS,REMOVE/GRAFT LEG BONE LESION,,,5856.00
Deidentified Maximum,,27640,CPT4/HCPCS,PARTIAL REMOVAL OF TIBIA,,,5138.00
Deidentified Maximum,,27646,CPT4/HCPCS,RESECT FIBULA TUMOR,,,6049.05
Deidentified Maximum,,27665,CPT4/HCPCS,REPAIR OF LEG TENDON EACH,,,5138.00
Deidentified Maximum,,27685,CPT4/HCPCS,REVISION OF LOWER LEG TENDON,,,5856.00
Deidentified Maximum,,27698,CPT4/HCPCS,REPAIR OF ANKLE LIGAMENT,,,5138.00
Deidentified Maximum,,27700,CPT4/HCPCS,REVISION OF ANKLE JOINT,,,6876.92
Deidentified Maximum,,27704,CPT4/HCPCS,REMOVAL OF ANKLE IMPLANT,,,5138.00
Deidentified Maximum,,27742,CPT4/HCPCS,REPAIR OF LEG EPIPHYSES,,,6075.00
Deidentified Maximum,,27760,CPT4/HCPCS,CLTX MEDIAL ANKLE FX,,,3198.57
Deidentified Maximum,,27766,CPT4/HCPCS,OPTX MEDIAL ANKLE FX,,,7007.00
Deidentified Maximum,,27780,CPT4/HCPCS,TREATMENT OF FIBULA FRACTURE,,,3198.57
Deidentified Maximum,,27786,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,3198.57
Deidentified Maximum,,27818,CPT4/HCPCS,TREATMENT OF ANKLE FRACTURE,,,3198.57
Deidentified Maximum,,27828,CPT4/HCPCS,TREAT LOWER LEG FRACTURE,,,7007.00
Deidentified Maximum,,27832,CPT4/HCPCS,TREAT LOWER LEG DISLOCATION,,,7007.00
Deidentified Maximum,,27840,CPT4/HCPCS,TREAT ANKLE DISLOCATION,,,3198.57
Deidentified Maximum,,27871,CPT4/HCPCS,FUSION OF TIBIOFIBULAR JOINT,,,7007.00
Deidentified Maximum,,27880,CPT4/HCPCS,AMPUTATION OF LOWER LEG,,,5783.00
Deidentified Maximum,,27889,CPT4/HCPCS,AMPUTATION OF FOOT AT ANKLE,,,6588.00
Deidentified Maximum,,75959,CPT4/HCPCS,XRAY PLACE DIST EXT THOR AO,,,1379.78
Deidentified Maximum,,76080,CPT4/HCPCS,X-RAY EXAM OF FISTULA,,,2909.34
Deidentified Maximum,,76393,CPT4/HCPCS,MR GUIDANCE FOR NEEDLE PLACE,,,5630.15
Deidentified Maximum,,76496,CPT4/HCPCS,FLUOROSCOPIC PROCEDURE,,,726.85
Deidentified Maximum,,76506,CPT4/HCPCS,ECHO EXAM OF HEAD,,,720.34
Deidentified Maximum,,76514,CPT4/HCPCS,ECHO EXAM OF EYE THICKNESS,,,587.00
Deidentified Maximum,,76776,CPT4/HCPCS,US EXAM K TRANSPL W/DOPPLER,,,1478.24
Deidentified Maximum,,76800,CPT4/HCPCS,US EXAM SPINAL CANAL,,,720.34
Deidentified Maximum,,76817,CPT4/HCPCS,TRANSVAGINAL US OBSTETRIC,,,755.57
Deidentified Maximum,,76821,CPT4/HCPCS,MIDDLE CEREBRAL ARTERY ECHO,,,823.08
Deidentified Maximum,,76825,CPT4/HCPCS,ECHO EXAM OF FETAL HEART,,,1185.57
Deidentified Maximum,,76857,CPT4/HCPCS,US EXAM PELVIC LIMITED,,,779.63
Deidentified Maximum,,76885,CPT4/HCPCS,US EXAM INFANT HIPS DYNAMIC,,,771.71
Deidentified Maximum,,76999,CPT4/HCPCS,ECHO EXAMINATION PROCEDURE,,,364.35
Deidentified Maximum,,77014,CPT4/HCPCS,CT SCAN FOR THERAPY GUIDE,,,6766.00
Deidentified Maximum,,77047,CPT4/HCPCS,MRI BREAST C- BILATERAL,,,6766.00
Deidentified Maximum,,77048,CPT4/HCPCS,MRI BREAST C-+ W/CAD UNI,,,2427.00
Deidentified Maximum,,77049,CPT4/HCPCS,MRI BREAST C-+ W/CAD BI,,,2427.00
Deidentified Maximum,,77059,CPT4/HCPCS,MRI BOTH BREASTS,,,10147.57
Deidentified Maximum,,77062,CPT4/HCPCS,BREAST TOMOSYNTHESIS BI,,,778.84
Deidentified Maximum,,77262,CPT4/HCPCS,RADIATION THERAPY PLANNING,,,835.63
Deidentified Maximum,,77285,CPT4/HCPCS,SET RADIATION THERAPY FIELD,,,7894.00
Deidentified Maximum,,77316,CPT4/HCPCS,BRACHYTX ISODOSE PLAN SIMPLE,,,7894.00
Deidentified Maximum,,77334,CPT4/HCPCS,RADIATION TREATMENT AID(S),,,7894.00
Deidentified Maximum,,77371,CPT4/HCPCS,SRS MULTISOURCE,,,14607.62
Deidentified Maximum,,77372,CPT4/HCPCS,SRS LINEAR BASED,,,27390.35
Deidentified Maximum,,77417,CPT4/HCPCS,RADIOLOGY PORT IMAGES(S),,,7894.00
Deidentified Maximum,,77427,CPT4/HCPCS,RADIATION TX MANAGEMENT X5,,,2567.00
Deidentified Maximum,,77470,CPT4/HCPCS,SPECIAL RADIATION TREATMENT,,,7894.00
Deidentified Maximum,,77523,CPT4/HCPCS,PROTON TRMT INTERMEDIATE,,,15981.50
Deidentified Maximum,,77750,CPT4/HCPCS,INFUSE RADIOACTIVE MATERIALS,,,13685.00
Deidentified Maximum,,77762,CPT4/HCPCS,APPLY INTRCAV RADIAT INTERM,,,13685.00
Deidentified Maximum,,78013,CPT4/HCPCS,THYROID IMAGING W/BLOOD FLOW,,,2725.86
Deidentified Maximum,,78120,CPT4/HCPCS,RED CELL MASS SINGLE,,,881.60
Deidentified Maximum,,78122,CPT4/HCPCS,BLOOD VOLUME,,,2319.80
Deidentified Maximum,,78191,CPT4/HCPCS,PLATELET SURVIVAL,,,3690.63
Deidentified Maximum,,78202,CPT4/HCPCS,LIVER IMAGING WITH FLOW,,,1553.16
Deidentified Maximum,,78206,CPT4/HCPCS,LIVER IMAGE (3D) WITH FLOW,,,2897.67
Deidentified Maximum,,78216,CPT4/HCPCS,LIVER & SPLEEN IMAGE/FLOW,,,1751.88
Deidentified Maximum,,78231,CPT4/HCPCS,SERIAL SALIVARY IMAGING,,,1598.68
Deidentified Maximum,,78270,CPT4/HCPCS,VIT B-12 ABSORPTION EXAM,,,786.14
Deidentified Maximum,,78305,CPT4/HCPCS,BONE IMAGING MULTIPLE AREAS,,,1847.32
Deidentified Maximum,,78458,CPT4/HCPCS,VEN THROMBOSIS IMAGES BILAT,,,2028.61
Deidentified Maximum,,78494,CPT4/HCPCS,HEART IMAGE SPECT,,,3537.29
Deidentified Maximum,,78607,CPT4/HCPCS,BRAIN IMAGING (3D),,,3307.25
Deidentified Maximum,,78630,CPT4/HCPCS,CEREBROSPINAL FLUID SCAN,,,2633.40
Deidentified Maximum,,78660,CPT4/HCPCS,NUCLEAR EXAM OF TEAR FLOW,,,1304.52
Deidentified Maximum,,78710,CPT4/HCPCS,KIDNEY IMAGING (3D),,,2978.36
Deidentified Maximum,,78740,CPT4/HCPCS,URETERAL REFLUX STUDY,,,1674.45
Deidentified Maximum,,78802,CPT4/HCPCS,RP LOCLZJ TUM WHBDY 1 D IMG,,,2791.48
Deidentified Maximum,,78803,CPT4/HCPCS,RP LOCLZJ TUM SPECT 1 AREA,,,3307.25
Deidentified Maximum,,78812,CPT4/HCPCS,PET IMAGE SKULL-THIGH,,,18766.18
Deidentified Maximum,,79200,CPT4/HCPCS,NUCLEAR RX INTRACAV ADMIN,,,1317.13
Deidentified Maximum,,80047,CPT4/HCPCS,METABOLIC PANEL IONIZED CA,,,102.00
Deidentified Maximum,,80051,CPT4/HCPCS,ELECTROLYTE PANEL,,,102.00
Deidentified Maximum,,80164,CPT4/HCPCS,ASSAY DIPROPYLACETIC ACD TOT,,,136.08
Deidentified Maximum,,80171,CPT4/HCPCS,DRUG SCREEN QUANT GABAPENTIN,,,129.19
Deidentified Maximum,,80177,CPT4/HCPCS,DRUG SCRN QUAN LEVETIRACETAM,,,129.19
Deidentified Maximum,,80185,CPT4/HCPCS,ASSAY OF PHENYTOIN TOTAL,,,133.22
Deidentified Maximum,,80198,CPT4/HCPCS,ASSAY OF THEOPHYLLINE,,,142.12
Deidentified Maximum,,80201,CPT4/HCPCS,ASSAY OF TOPIRAMATE,,,119.78
Deidentified Maximum,,80202,CPT4/HCPCS,ASSAY OF VANCOMYCIN,,,136.08
Deidentified Maximum,,80339,CPT4/HCPCS,ANTIEPILEPTICS NOS 1-3,,,102.00
Deidentified Maximum,,80350,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 1-3,,,102.00
Deidentified Maximum,,80351,CPT4/HCPCS,CANNABINOIDS SYNTHETIC 4-6,,,102.00
Deidentified Maximum,,80430,CPT4/HCPCS,GROWTH HORMONE PANEL,,,788.50
Deidentified Maximum,,81000,CPT4/HCPCS,URINALYSIS NONAUTO W/SCOPE,,,102.00
Deidentified Maximum,,81106,CPT4/HCPCS,HPA-2 GENOTYPING,,,1077.38
Deidentified Maximum,,81107,CPT4/HCPCS,HPA-3 GENOTYPING,,,1077.38
Deidentified Maximum,,81109,CPT4/HCPCS,HPA-5 GENOTYPING,,,1077.38
Deidentified Maximum,,81163,CPT4/HCPCS,BRCA1&2 GENE FULL SEQ ALYS,,,3341.52
Deidentified Maximum,,81165,CPT4/HCPCS,BRCA1 GENE FULL SEQ ALYS,,,2019.78
Deidentified Maximum,,81166,CPT4/HCPCS,BRCA1 GENE FULL DUP/DEL ALYS,,,2151.65
Deidentified Maximum,,81179,CPT4/HCPCS,ATXN2 GENE DETC ABNOR ALLELE,,,978.18
Deidentified Maximum,,81180,CPT4/HCPCS,ATXN3 GENE DETC ABNOR ALLELE,,,978.18
Deidentified Maximum,,81184,CPT4/HCPCS,CACNA1A GEN DETC ABNOR ALLEL,,,978.18
Deidentified Maximum,,81185,CPT4/HCPCS,CACNA1A GENE FULL GENE SEQ,,,6042.37
Deidentified Maximum,,81201,CPT4/HCPCS,APC GENE FULL SEQUENCE,,,4817.90
Deidentified Maximum,,81204,CPT4/HCPCS,AR GENE CHARAC ALLELES,,,978.18
Deidentified Maximum,,81205,CPT4/HCPCS,BCKDHB GENE,,,694.17
Deidentified Maximum,,81211,CPT4/HCPCS,BRCA1&2 SEQ & COM DUP/DEL,,,0.00
Deidentified Maximum,,81217,CPT4/HCPCS,BRCA2 GENE KNOWN FAMIL VRNT,,,399.42
Deidentified Maximum,,81219,CPT4/HCPCS,CALR GENE COM VARIANTS,,,1182.97
Deidentified Maximum,,81234,CPT4/HCPCS,DMPK GENE DETC ABNOR ALLELE,,,978.18
Deidentified Maximum,,81243,CPT4/HCPCS,FMR1 GENE DETECTION,,,443.94
Deidentified Maximum,,81245,CPT4/HCPCS,FLT3 GENE,,,399.58
Deidentified Maximum,,81259,CPT4/HCPCS,HBA1/HBA2 FULL GENE SEQUENCE,,,4284.00
Deidentified Maximum,,81265,CPT4/HCPCS,STR MARKERS SPECIMEN ANAL,,,2268.00
Deidentified Maximum,,81272,CPT4/HCPCS,KIT GENE TARGETED SEQ ANALYS,,,2352.67
Deidentified Maximum,,81273,CPT4/HCPCS,KIT GENE ANALYS D816 VARIANT,,,891.57
Deidentified Maximum,,81296,CPT4/HCPCS,MSH2 GENE KNOWN VARIANTS,,,335.07
Deidentified Maximum,,81297,CPT4/HCPCS,MSH2 GENE DUP/DELETE VARIANT,,,1730.98
Deidentified Maximum,,81298,CPT4/HCPCS,MSH6 GENE FULL SEQ,,,4284.00
Deidentified Maximum,,81299,CPT4/HCPCS,MSH6 GENE KNOWN VARIANTS,,,335.07
Deidentified Maximum,,81302,CPT4/HCPCS,MECP2 GENE FULL SEQ,,,1625.98
Deidentified Maximum,,81305,CPT4/HCPCS,MYD88 GENE P.LEU265PRO VRNT,,,1252.35
Deidentified Maximum,,81324,CPT4/HCPCS,PMP22 GENE DUP/DELET,,,4284.00
Deidentified Maximum,,81344,CPT4/HCPCS,TBP GENE DETC ABNOR ALLELES,,,978.18
Deidentified Maximum,,81350,CPT4/HCPCS,UGT1A1 GENE COMMON VARIANTS,,,417.98
Deidentified Maximum,,81355,CPT4/HCPCS,VKORC1 GENE,,,250.40
Deidentified Maximum,,81372,CPT4/HCPCS,HLA I TYPING COMPLETE LR,,,2411.80
Deidentified Maximum,,81377,CPT4/HCPCS,HLA II TYPE 1 AG EQUIV LR,,,388.41
Deidentified Maximum,,81407,CPT4/HCPCS,MOPATH PROCEDURE LEVEL 8,,,6048.00
Deidentified Maximum,,81432,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,,6650.78
Deidentified Maximum,,81433,CPT4/HCPCS,HRDTRY BRST CA-RLATD DSORDRS,,,4299.03
Deidentified Maximum,,81439,CPT4/HCPCS,HRDTRY CARDMYPY GENE PANEL,,,5728.63
Deidentified Maximum,,81508,CPT4/HCPCS,FTL CGEN ABNOR TWO PROTEINS,,,735.00
Deidentified Maximum,,81521,CPT4/HCPCS,ONC BREAST MRNA 70 GENES,,,27653.22
Deidentified Maximum,,81535,CPT4/HCPCS,ONCOLOGY GYNECOLOGIC,,,4137.33
Deidentified Maximum,,82017,CPT4/HCPCS,ACYLCARNITINES QUANT,,,169.51
Deidentified Maximum,,82040,CPT4/HCPCS,ASSAY OF SERUM ALBUMIN,,,102.00
Deidentified Maximum,,82043,CPT4/HCPCS,UR ALBUMIN QUANTITATIVE,,,102.00
Deidentified Maximum,,82044,CPT4/HCPCS,UR ALBUMIN SEMIQUANTITATIVE,,,102.00
Deidentified Maximum,,82135,CPT4/HCPCS,ASSAY AMINOLEVULINIC ACID,,,165.39
Deidentified Maximum,,82140,CPT4/HCPCS,ASSAY OF AMMONIA,,,146.41
Deidentified Maximum,,82247,CPT4/HCPCS,BILIRUBIN TOTAL,,,102.00
Deidentified Maximum,,82248,CPT4/HCPCS,BILIRUBIN DIRECT,,,102.00
Deidentified Maximum,,82308,CPT4/HCPCS,ASSAY OF CALCITONIN,,,269.13
Deidentified Maximum,,82360,CPT4/HCPCS,CALCULUS ASSAY QUANT,,,129.36
Deidentified Maximum,,82378,CPT4/HCPCS,CARCINOEMBRYONIC ANTIGEN,,,190.68
Deidentified Maximum,,82383,CPT4/HCPCS,ASSAY BLOOD CATECHOLAMINES,,,251.74
Deidentified Maximum,,82384,CPT4/HCPCS,ASSAY THREE CATECHOLAMINES,,,253.68
Deidentified Maximum,,82438,CPT4/HCPCS,ASSAY OTHER FLUID CHLORIDES,,,102.00
Deidentified Maximum,,82482,CPT4/HCPCS,ASSAY RBC CHOLINESTERASE,,,102.00
Deidentified Maximum,,82495,CPT4/HCPCS,ASSAY OF CHROMIUM,,,203.78
Deidentified Maximum,,82570,CPT4/HCPCS,ASSAY OF URINE CREATININE,,,102.00
Deidentified Maximum,,82575,CPT4/HCPCS,CREATININE CLEARANCE TEST,,,102.00
Deidentified Maximum,,82607,CPT4/HCPCS,VITAMIN B-12,,,151.45
Deidentified Maximum,,82627,CPT4/HCPCS,DEHYDROEPIANDROSTERONE,,,223.44
Deidentified Maximum,,82710,CPT4/HCPCS,FATS/LIPIDS FECES QUANT,,,168.75
Deidentified Maximum,,82746,CPT4/HCPCS,ASSAY OF FOLIC ACID SERUM,,,147.75
Deidentified Maximum,,82760,CPT4/HCPCS,ASSAY OF GALACTOSE,,,112.47
Deidentified Maximum,,82775,CPT4/HCPCS,ASSAY GALACTOSE TRANSFERASE,,,211.59
Deidentified Maximum,,82800,CPT4/HCPCS,BLOOD PH,,,102.00
Deidentified Maximum,,82805,CPT4/HCPCS,BLOOD GASES W/O2 SATURATION,,,285.18
Deidentified Maximum,,82930,CPT4/HCPCS,GASTRIC ANALY W/PH EA SPEC,,,102.00
Deidentified Maximum,,82941,CPT4/HCPCS,ASSAY OF GASTRIN,,,177.24
Deidentified Maximum,,82945,CPT4/HCPCS,GLUCOSE OTHER FLUID,,,102.00
Deidentified Maximum,,82946,CPT4/HCPCS,GLUCAGON TOLERANCE TEST,,,151.45
Deidentified Maximum,,82962,CPT4/HCPCS,GLUCOSE BLOOD TEST,,,102.00
Deidentified Maximum,,83002,CPT4/HCPCS,ASSAY OF GONADOTROPIN (LH),,,186.06
Deidentified Maximum,,83010,CPT4/HCPCS,ASSAY OF HAPTOGLOBIN QUANT,,,126.42
Deidentified Maximum,,83045,CPT4/HCPCS,BLOOD METHEMOGLOBIN TEST,,,102.00
Deidentified Maximum,,83050,CPT4/HCPCS,BLOOD METHEMOGLOBIN ASSAY,,,102.00
Deidentified Maximum,,83068,CPT4/HCPCS,HEMOGLOBIN STABILITY SCREEN,,,102.00
Deidentified Maximum,,83069,CPT4/HCPCS,ASSAY OF URINE HEMOGLOBIN,,,102.00
Deidentified Maximum,,83070,CPT4/HCPCS,ASSAY OF HEMOSIDERIN QUAL,,,102.00
Deidentified Maximum,,83080,CPT4/HCPCS,ASSAY OF B HEXOSAMINIDASE,,,169.51
Deidentified Maximum,,83088,CPT4/HCPCS,ASSAY OF HISTAMINE,,,296.77
Deidentified Maximum,,83150,CPT4/HCPCS,ASSAY OF HOMOVANILLIC ACID,,,194.37
Deidentified Maximum,,83497,CPT4/HCPCS,ASSAY OF 5-HIAA,,,129.52
Deidentified Maximum,,83516,CPT4/HCPCS,IMMUNOASSAY NONANTIBODY,,,102.00
Deidentified Maximum,,83625,CPT4/HCPCS,ASSAY OF LDH ENZYMES,,,128.60
Deidentified Maximum,,83632,CPT4/HCPCS,PLACENTAL LACTOGEN,,,203.11
Deidentified Maximum,,83664,CPT4/HCPCS,LAMELLAR BDY FETAL LUNG,,,190.17
Deidentified Maximum,,83695,CPT4/HCPCS,ASSAY OF LIPOPROTEIN(A),,,130.11
Deidentified Maximum,,83701,CPT4/HCPCS,LIPOPROTEIN BLD HR FRACTION,,,249.39
Deidentified Maximum,,83719,CPT4/HCPCS,ASSAY OF BLOOD LIPOPROTEIN,,,116.92
Deidentified Maximum,,83722,CPT4/HCPCS,LIPOPRTN DIR MEAS SD LDL CHL,,,250.32
Deidentified Maximum,,83785,CPT4/HCPCS,ASSAY OF MANGANESE,,,247.12
Deidentified Maximum,,83915,CPT4/HCPCS,ASSAY OF NUCLEOTIDASE,,,112.14
Deidentified Maximum,,83930,CPT4/HCPCS,ASSAY OF BLOOD OSMOLALITY,,,102.00
Deidentified Maximum,,83986,CPT4/HCPCS,ASSAY PH BODY FLUID NOS,,,102.00
Deidentified Maximum,,84030,CPT4/HCPCS,ASSAY OF BLOOD PKU,,,102.00
Deidentified Maximum,,84035,CPT4/HCPCS,ASSAY OF PHENYLKETONES,,,102.00
Deidentified Maximum,,84066,CPT4/HCPCS,ASSAY PROSTATE PHOSPHATASE,,,102.00
Deidentified Maximum,,84075,CPT4/HCPCS,ASSAY ALKALINE PHOSPHATASE,,,102.00
Deidentified Maximum,,84100,CPT4/HCPCS,ASSAY OF PHOSPHORUS,,,102.00
Deidentified Maximum,,84105,CPT4/HCPCS,ASSAY OF URINE PHOSPHORUS,,,102.00
Deidentified Maximum,,84126,CPT4/HCPCS,ASSAY OF FECES PORPHYRINS,,,255.94
Deidentified Maximum,,84134,CPT4/HCPCS,ASSAY OF PREALBUMIN,,,146.49
Deidentified Maximum,,84145,CPT4/HCPCS,PROCALCITONIN (PCT),,,269.13
Deidentified Maximum,,84150,CPT4/HCPCS,ASSAY OF PROSTAGLANDIN,,,250.74
Deidentified Maximum,,84153,CPT4/HCPCS,ASSAY OF PSA TOTAL,,,184.88
Deidentified Maximum,,84166,CPT4/HCPCS,PROTEIN E-PHORESIS/URINE/CSF,,,179.17
Deidentified Maximum,,84181,CPT4/HCPCS,WESTERN BLOT TEST,,,171.10
Deidentified Maximum,,84244,CPT4/HCPCS,ASSAY OF RENIN,,,221.00
Deidentified Maximum,,84260,CPT4/HCPCS,ASSAY OF SEROTONIN,,,311.21
Deidentified Maximum,,84285,CPT4/HCPCS,ASSAY OF SILICA,,,236.62
Deidentified Maximum,,84311,CPT4/HCPCS,SPECTROPHOTOMETRY,,,102.00
Deidentified Maximum,,84377,CPT4/HCPCS,SUGARS MULTIPLE QUAL,,,102.00
Deidentified Maximum,,84378,CPT4/HCPCS,SUGARS SINGLE QUANT,,,115.83
Deidentified Maximum,,84430,CPT4/HCPCS,ASSAY OF THIOCYANATE,,,116.92
Deidentified Maximum,,84490,CPT4/HCPCS,ASSAY OF FECES FOR TRYPSIN,,,102.00
Deidentified Maximum,,84550,CPT4/HCPCS,ASSAY OF BLOOD/URIC ACID,,,102.00
Deidentified Maximum,,84597,CPT4/HCPCS,ASSAY OF VITAMIN K,,,137.75
Deidentified Maximum,,84704,CPT4/HCPCS,HCG FREE BETACHAIN TEST,,,151.28
Deidentified Maximum,,85046,CPT4/HCPCS,RETICYTE/HGB CONCENTRATE,,,102.00
Deidentified Maximum,,85048,CPT4/HCPCS,AUTOMATED LEUKOCYTE COUNT,,,102.00
Deidentified Maximum,,85175,CPT4/HCPCS,BLOOD CLOT LYSIS TIME,,,102.00
Deidentified Maximum,,85210,CPT4/HCPCS,CLOT FACTOR II PROTHROM SPEC,,,130.45
Deidentified Maximum,,85291,CPT4/HCPCS,CLOT FACTOR XIII FIBRIN SCRN,,,102.00
Deidentified Maximum,,85292,CPT4/HCPCS,CLOT FACTOR FLETCHER FACT,,,190.25
Deidentified Maximum,,85300,CPT4/HCPCS,ANTITHROMBIN III ACTIVITY,,,119.11
Deidentified Maximum,,85306,CPT4/HCPCS,CLOT INHIBIT PROT S FREE,,,153.97
Deidentified Maximum,,85337,CPT4/HCPCS,THROMBOMODULIN,,,104.74
Deidentified Maximum,,85345,CPT4/HCPCS,COAGULATION TIME LEE & WHITE,,,102.00
Deidentified Maximum,,85379,CPT4/HCPCS,FIBRIN DEGRADATION QUANT,,,102.22
Deidentified Maximum,,85415,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,,172.78
Deidentified Maximum,,85420,CPT4/HCPCS,FIBRINOLYTIC PLASMINOGEN,,,102.00
Deidentified Maximum,,85520,CPT4/HCPCS,HEPARIN ASSAY,,,131.62
Deidentified Maximum,,85547,CPT4/HCPCS,RBC MECHANICAL FRAGILITY,,,102.00
Deidentified Maximum,,85598,CPT4/HCPCS,HEXAGNAL PHOSPH PLTLT NEUTRL,,,180.68
Deidentified Maximum,,85611,CPT4/HCPCS,PROTHROMBIN TEST,,,102.00
Deidentified Maximum,,85612,CPT4/HCPCS,VIPER VENOM PROTHROMBIN TIME,,,102.00
Deidentified Maximum,,85635,CPT4/HCPCS,REPTILASE TEST,,,102.00
Deidentified Maximum,,85670,CPT4/HCPCS,THROMBIN TIME PLASMA,,,102.00
Deidentified Maximum,,86078,CPT4/HCPCS,PHYS BLOOD BANK SERV REACTJ,,,372.95
Deidentified Maximum,,86146,CPT4/HCPCS,BETA-2 GLYCOPROTEIN ANTIBODY,,,255.61
Deidentified Maximum,,86148,CPT4/HCPCS,ANTI-PHOSPHOLIPID ANTIBODY,,,161.44
Deidentified Maximum,,86155,CPT4/HCPCS,CHEMOTAXIS ASSAY,,,160.60
Deidentified Maximum,,86157,CPT4/HCPCS,COLD AGGLUTININ TITER,,,102.00
Deidentified Maximum,,86235,CPT4/HCPCS,NUCLEAR ANTIGEN ANTIBODY,,,164.47
Deidentified Maximum,,86255,CPT4/HCPCS,FLUORESCENT ANTIBODY SCREEN,,,121.12
Deidentified Maximum,,86256,CPT4/HCPCS,FLUORESCENT ANTIBODY TITER,,,121.12
Deidentified Maximum,,86294,CPT4/HCPCS,IMMUNOASSAY TUMOR QUAL,,,197.14
Deidentified Maximum,,86304,CPT4/HCPCS,IMMUNOASSAY TUMOR CA 125,,,209.16
Deidentified Maximum,,86305,CPT4/HCPCS,HUMAN EPIDIDYMIS PROTEIN 4,,,209.16
Deidentified Maximum,,86317,CPT4/HCPCS,IMMUNOASSAY INFECTIOUS AGENT,,,150.69
Deidentified Maximum,,86320,CPT4/HCPCS,SERUM IMMUNOELECTROPHORESIS,,,225.20
Deidentified Maximum,,86325,CPT4/HCPCS,OTHER IMMUNOELECTROPHORESIS,,,224.61
Deidentified Maximum,,86343,CPT4/HCPCS,LEUKOCYTE HISTAMINE RELEASE,,,125.24
Deidentified Maximum,,86357,CPT4/HCPCS,NK CELLS TOTAL COUNT,,,379.00
Deidentified Maximum,,86361,CPT4/HCPCS,T CELL ABSOLUTE COUNT,,,268.96
Deidentified Maximum,,86382,CPT4/HCPCS,NEUTRALIZATION TEST VIRAL,,,169.93
Deidentified Maximum,,86386,CPT4/HCPCS,NUCLEAR MATRIX PROTEIN 22,,,161.44
Deidentified Maximum,,86580,CPT4/HCPCS,TB INTRADERMAL TEST,,,133.16
Deidentified Maximum,,86592,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUAL,,,102.00
Deidentified Maximum,,86593,CPT4/HCPCS,SYPHILIS TEST NON-TREP QUANT,,,102.00
Deidentified Maximum,,86602,CPT4/HCPCS,ANTINOMYCES ANTIBODY,,,102.22
Deidentified Maximum,,86625,CPT4/HCPCS,CAMPYLOBACTER ANTIBODY,,,131.79
Deidentified Maximum,,86665,CPT4/HCPCS,EPSTEIN-BARR CAPSID VCA,,,182.28
Deidentified Maximum,,86694,CPT4/HCPCS,HERPES SIMPLEX NES ANTBDY,,,144.56
Deidentified Maximum,,86707,CPT4/HCPCS,HEPATITIS BE ANTIBODY,,,116.25
Deidentified Maximum,,86710,CPT4/HCPCS,INFLUENZA VIRUS ANTIBODY,,,136.24
Deidentified Maximum,,86717,CPT4/HCPCS,LEISHMANIA ANTIBODY,,,123.06
Deidentified Maximum,,86738,CPT4/HCPCS,MYCOPLASMA ANTIBODY,,,133.05
Deidentified Maximum,,86784,CPT4/HCPCS,TRICHINELLA ANTIBODY,,,126.25
Deidentified Maximum,,86789,CPT4/HCPCS,WEST NILE VIRUS ANTIBODY,,,144.56
Deidentified Maximum,,86793,CPT4/HCPCS,YERSINIA ANTIBODY,,,132.55
Deidentified Maximum,,86807,CPT4/HCPCS,CYTOTOXIC ANTIBODY SCREENING,,,397.65
Deidentified Maximum,,86813,CPT4/HCPCS,HLA TYPING A B OR C,,,411.34
Deidentified Maximum,,86828,CPT4/HCPCS,HLA CLASS I&II ANTIBODY QUAL,,,388.41
Deidentified Maximum,,86834,CPT4/HCPCS,HLA CLASS I SEMIQUANT PANEL,,,2824.33
Deidentified Maximum,,86835,CPT4/HCPCS,HLA CLASS II SEMIQUANT PANEL,,,2550.99
Deidentified Maximum,,86870,CPT4/HCPCS,RBC ANTIBODY IDENTIFICATION,,,399.37
Deidentified Maximum,,86904,CPT4/HCPCS,BLOOD TYPING PATIENT SERUM,,,102.00
Deidentified Maximum,,86921,CPT4/HCPCS,COMPATIBILITY TEST INCUBATE,,,226.15
Deidentified Maximum,,86922,CPT4/HCPCS,COMPATIBILITY TEST ANTIGLOB,,,218.98
Deidentified Maximum,,86932,CPT4/HCPCS,FROZEN BLOOD FREEZE/THAW,,,1366.50
Deidentified Maximum,,86985,CPT4/HCPCS,SPLIT BLOOD OR PRODUCTS,,,240.58
Deidentified Maximum,,87073,CPT4/HCPCS,CULTURE BACTERIA ANAEROBIC,,,102.00
Deidentified Maximum,,87086,CPT4/HCPCS,URINE CULTURE/COLONY COUNT,,,102.00
Deidentified Maximum,,87103,CPT4/HCPCS,BLOOD FUNGUS CULTURE,,,102.00
Deidentified Maximum,,87109,CPT4/HCPCS,MYCOPLASMA,,,154.56
Deidentified Maximum,,87164,CPT4/HCPCS,DARK FIELD EXAMINATION,,,107.94
Deidentified Maximum,,87186,CPT4/HCPCS,MICROBE SUSCEPTIBLE MIC,,,102.00
Deidentified Maximum,,87205,CPT4/HCPCS,SMEAR GRAM STAIN,,,102.00
Deidentified Maximum,,87207,CPT4/HCPCS,SMEAR SPECIAL STAIN,,,102.00
Deidentified Maximum,,87250,CPT4/HCPCS,VIRUS INOCULATE EGGS/ANIMAL,,,196.47
Deidentified Maximum,,87252,CPT4/HCPCS,VIRUS INOCULATION TISSUE,,,261.91
Deidentified Maximum,,87273,CPT4/HCPCS,HERPES SIMPLEX 2 AG IF,,,102.00
Deidentified Maximum,,87299,CPT4/HCPCS,ANTIBODY DETECTION NOS IF,,,102.00
Deidentified Maximum,,87324,CPT4/HCPCS,CLOSTRIDIUM AG IA,,,102.00
Deidentified Maximum,,87327,CPT4/HCPCS,CRYPTOCOCCUS NEOFORM AG IA,,,102.00
Deidentified Maximum,,87380,CPT4/HCPCS,HEPATITIS DELTA AG IA,,,164.97
Deidentified Maximum,,87430,CPT4/HCPCS,STREP A AG IA,,,102.00
Deidentified Maximum,,87485,CPT4/HCPCS,CHYLMD PNEUM DNA DIR PROBE,,,201.51
Deidentified Maximum,,87486,CPT4/HCPCS,CHYLMD PNEUM DNA AMP PROBE,,,352.63
Deidentified Maximum,,87503,CPT4/HCPCS,INFLUENZA DNA AMP PROB ADDL,,,208.65
Deidentified Maximum,,87516,CPT4/HCPCS,HEPATITIS B DNA AMP PROBE,,,352.63
Deidentified Maximum,,87517,CPT4/HCPCS,HEPATITIS B DNA QUANT,,,430.41
Deidentified Maximum,,87520,CPT4/HCPCS,HEPATITIS C RNA DIR PROBE,,,201.51
Deidentified Maximum,,87522,CPT4/HCPCS,HEPATITIS C REVRS TRNSCRPJ,,,430.41
Deidentified Maximum,,87529,CPT4/HCPCS,HSV DNA AMP PROBE,,,352.63
Deidentified Maximum,,87556,CPT4/HCPCS,M.TUBERCULO DNA AMP PROBE,,,352.63
Deidentified Maximum,,87580,CPT4/HCPCS,M.PNEUMON DNA DIR PROBE,,,201.51
Deidentified Maximum,,87581,CPT4/HCPCS,M.PNEUMON DNA AMP PROBE,,,352.63
Deidentified Maximum,,87582,CPT4/HCPCS,M.PNEUMON DNA QUANT,,,419.49
Deidentified Maximum,,87623,CPT4/HCPCS,HPV LOW-RISK TYPES,,,341.04
Deidentified Maximum,,87624,CPT4/HCPCS,HPV HIGH-RISK TYPES,,,341.04
Deidentified Maximum,,87660,CPT4/HCPCS,TRICHOMONAS VAGIN DIR PROBE,,,201.51
Deidentified Maximum,,87661,CPT4/HCPCS,TRICHOMONAS VAGINALIS AMPLIF,,,341.79
Deidentified Maximum,,87807,CPT4/HCPCS,RSV ASSAY W/OPTIC,,,102.00
Deidentified Maximum,,87809,CPT4/HCPCS,ADENOVIRUS ASSAY W/OPTIC,,,102.00
Deidentified Maximum,,87902,CPT4/HCPCS,GENOTYPE DNA/RNA HEP C,,,2586.69
Deidentified Maximum,,88028,CPT4/HCPCS,AUTOPSY (NECROPSY) COMPLETE,,,1692.93
Deidentified Maximum,,88112,CPT4/HCPCS,CYTOPATH CELL ENHANCE TECH,,,715.38
Deidentified Maximum,,88147,CPT4/HCPCS,CYTOPATH C/V AUTOMATED,,,114.40
Deidentified Maximum,,88153,CPT4/HCPCS,CYTOPATH C/V REDO,,,106.17
Deidentified Maximum,,88175,CPT4/HCPCS,CYTOPATH C/V AUTO FLUID REDO,,,266.19
Deidentified Maximum,,88189,CPT4/HCPCS,FLOWCYTOMETRY/READ 16 & >,,,787.33
Deidentified Maximum,,88233,CPT4/HCPCS,TISSUE CULTURE SKIN/BIOPSY,,,1413.97
Deidentified Maximum,,88248,CPT4/HCPCS,CHROMOSOME ANALYSIS 50-100,,,1740.06
Deidentified Maximum,,88261,CPT4/HCPCS,CHROMOSOME ANALYSIS 5,,,1775.76
Deidentified Maximum,,88264,CPT4/HCPCS,CHROMOSOME ANALYSIS 20-25,,,1252.35
Deidentified Maximum,,88319,CPT4/HCPCS,ENZYME HISTOCHEMISTRY,,,1043.53
Deidentified Maximum,,88342,CPT4/HCPCS,IMMUNOHISTO ANTB 1ST STAIN,,,546.33
Deidentified Maximum,,88364,CPT4/HCPCS,INSITU HYBRIDIZATION (FISH),,,942.29
Deidentified Maximum,,88374,CPT4/HCPCS,M/PHMTRC ALYS ISHQUANT/SEMIQ,,,2150.02
Deidentified Maximum,,88380,CPT4/HCPCS,MICRODISSECTION LASER,,,892.58
Deidentified Maximum,,88740,CPT4/HCPCS,TRANSCUTANEOUS CARBOXYHB,,,102.00
Deidentified Maximum,,89049,CPT4/HCPCS,CHCT FOR MAL HYPERTHERMIA,,,1737.15
Deidentified Maximum,,89060,CPT4/HCPCS,EXAM SYNOVIAL FLUID CRYSTALS,,,102.00
Deidentified Maximum,,89125,CPT4/HCPCS,SPECIMEN FAT STAIN,,,102.00
Deidentified Maximum,,89230,CPT4/HCPCS,COLLECT SWEAT FOR TEST,,,769.86
Deidentified Maximum,,89280,CPT4/HCPCS,ASSIST OOCYTE FERTILIZATION,,,5329.96
Deidentified Maximum,,89291,CPT4/HCPCS,BIOPSY OOCYTE POLAR BODY,,,7560.00
Deidentified Maximum,,89325,CPT4/HCPCS,SPERM ANTIBODY TEST,,,107.26
Deidentified Maximum,,89335,CPT4/HCPCS,CRYOPRESERVE TESTICULAR TISS,,,1362.73
Deidentified Maximum,,89353,CPT4/HCPCS,THAWING CRYOPRESRVED SPERM,,,102.00
Deidentified Maximum,,90804,CPT4/HCPCS,PSYTX OFFICE 20-30 MIN,,,117.95
Deidentified Maximum,,90824,CPT4/HCPCS,INTAC PSYTX HSP 20-30 W/E&M,,,198.97
Deidentified Maximum,,90826,CPT4/HCPCS,INTAC PSYTX HOSP 45-50 MIN,,,241.50
Deidentified Maximum,,90997,CPT4/HCPCS,HEMOPERFUSION,,,341.76
Deidentified Maximum,,91020,CPT4/HCPCS,GASTRIC MOTILITY STUDIES,,,2002.00
Deidentified Maximum,,91111,CPT4/HCPCS,ESOPHAGEAL CAPSULE ENDOSCOPY,,,8760.42
Deidentified Maximum,,91120,CPT4/HCPCS,RECTAL SENSATION TEST,,,5135.71
Deidentified Maximum,,91122,CPT4/HCPCS,ANAL PRESSURE RECORD,,,2659.42
Deidentified Maximum,,92060,CPT4/HCPCS,SPECIAL EYE EVALUATION,,,210.93
Deidentified Maximum,,92071,CPT4/HCPCS,CONTACT LENS FITTING FOR TX,,,175.69
Deidentified Maximum,,92081,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,,340.85
Deidentified Maximum,,92083,CPT4/HCPCS,VISUAL FIELD EXAMINATION(S),,,538.13
Deidentified Maximum,,92100,CPT4/HCPCS,SERIAL TONOMETRY EXAM(S),,,657.63
Deidentified Maximum,,92133,CPT4/HCPCS,CMPTR OPHTH IMG OPTIC NERVE,,,987.78
Deidentified Maximum,,92228,CPT4/HCPCS,IMG RTA DETC/MNTR DS PHY/QHP,,,177.25
Deidentified Maximum,,92312,CPT4/HCPCS,CONTACT LENS FITTING,,,531.75
Deidentified Maximum,,92506,CPT4/HCPCS,SPEECH/HEARING EVALUATION,,,1263.13
Deidentified Maximum,,92508,CPT4/HCPCS,SPEECH/HEARING THERAPY,,,305.00
Deidentified Maximum,,92520,CPT4/HCPCS,LARYNGEAL FUNCTION STUDIES,,,6766.00
Deidentified Maximum,,92522,CPT4/HCPCS,EVALUATE SPEECH PRODUCTION,,,702.74
Deidentified Maximum,,92537,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,,987.78
Deidentified Maximum,,92538,CPT4/HCPCS,CALORIC VSTBLR TEST W/REC,,,987.78
Deidentified Maximum,,92540,CPT4/HCPCS,BASIC VESTIBULAR EVALUATION,,,220.56
Deidentified Maximum,,92553,CPT4/HCPCS,AUDIOMETRY AIR & BONE,,,341.76
Deidentified Maximum,,92557,CPT4/HCPCS,COMPREHENSIVE HEARING TEST,,,621.00
Deidentified Maximum,,92563,CPT4/HCPCS,TONE DECAY HEARING TEST,,,194.16
Deidentified Maximum,,92567,CPT4/HCPCS,TYMPANOMETRY,,,274.41
Deidentified Maximum,,92568,CPT4/HCPCS,ACOUSTIC REFL THRESHOLD TST,,,194.16
Deidentified Maximum,,92607,CPT4/HCPCS,EX FOR SPEECH DEVICE RX 1HR,,,6766.00
Deidentified Maximum,,92609,CPT4/HCPCS,USE OF SPEECH DEVICE SERVICE,,,6766.00
Deidentified Maximum,,92614,CPT4/HCPCS,LARYNGOSCOPIC SENSORY VID,,,1223.85
Deidentified Maximum,,92616,CPT4/HCPCS,FEES W/LARYNGEAL SENSE TEST,,,1660.16
Deidentified Maximum,,92617,CPT4/HCPCS,FEES W/LARYNGEAL SENSE I&R,,,231.88
Deidentified Maximum,,92938,CPT4/HCPCS,PRQ REVASC BYP GRAFT ADDL,,,10119.00
Deidentified Maximum,,92984,CPT4/HCPCS,CORONARY ARTERY DILATION,,,3544.00
Deidentified Maximum,,93005,CPT4/HCPCS,ELECTROCARDIOGRAM TRACING,,,224.59
Deidentified Maximum,,93010,CPT4/HCPCS,ELECTROCARDIOGRAM REPORT,,,69.88
Deidentified Maximum,,93015,CPT4/HCPCS,CARDIOVASCULAR STRESS TEST,,,999.55
Deidentified Maximum,,93025,CPT4/HCPCS,MICROVOLT T-WAVE ASSESS,,,3840.75
Deidentified Maximum,,93040,CPT4/HCPCS,RHYTHM ECG WITH REPORT,,,108.94
Deidentified Maximum,,93042,CPT4/HCPCS,RHYTHM ECG REPORT,,,58.63
Deidentified Maximum,,93226,CPT4/HCPCS,ECG MONIT/REPRT UP TO 48 HRS,,,1110.23
Deidentified Maximum,,93280,CPT4/HCPCS,PM DEVICE PROGR EVAL DUAL,,,189.58
Deidentified Maximum,,93284,CPT4/HCPCS,PRGRMG EVAL IMPLANTABLE DFB,,,256.28
Deidentified Maximum,,93296,CPT4/HCPCS,REM INTERROG EVL PM/IDS,,,289.54
Deidentified Maximum,,93352,CPT4/HCPCS,ADMIN ECG CONTRAST AGENT,,,643.00
Deidentified Maximum,,93456,CPT4/HCPCS,R HRT CORONARY ARTERY ANGIO,,,9548.65
Deidentified Maximum,,93582,CPT4/HCPCS,PERQ TRANSCATH CLOSURE PDA,,,10772.00
Deidentified Maximum,,93591,CPT4/HCPCS,PERQ TRANSCATH CLS AORTIC,,,14317.00
Deidentified Maximum,,93602,CPT4/HCPCS,INTRA-ATRIAL RECORDING,,,7530.00
Deidentified Maximum,,93619,CPT4/HCPCS,ELECTROPHYSIOLOGY EVALUATION,,,7830.00
Deidentified Maximum,,93640,CPT4/HCPCS,EVALUATION HEART DEVICE,,,7830.00
Deidentified Maximum,,93650,CPT4/HCPCS,ABLATE HEART DYSRHYTHM FOCUS,,,8885.00
Deidentified Maximum,,93657,CPT4/HCPCS,TX L/R ATRIAL FIB ADDL,,,9548.65
Deidentified Maximum,,93750,CPT4/HCPCS,INTERROGATION VAD IN PERSON,,,1214.00
Deidentified Maximum,,93882,CPT4/HCPCS,EXTRACRANIAL UNI/LTD STUDY,,,1469.69
Deidentified Maximum,,93971,CPT4/HCPCS,EXTREMITY STUDY,,,1412.88
Deidentified Maximum,,93978,CPT4/HCPCS,VASCULAR STUDY,,,1765.98
Deidentified Maximum,,94010,CPT4/HCPCS,BREATHING CAPACITY TEST,,,306.38
Deidentified Maximum,,94011,CPT4/HCPCS,SPIROMETRY UP TO 2 YRS OLD,,,318.49
Deidentified Maximum,,94015,CPT4/HCPCS,PATIENT RECORDED SPIROMETRY,,,292.73
Deidentified Maximum,,94375,CPT4/HCPCS,RESPIRATORY FLOW VOLUME LOOP,,,253.46
Deidentified Maximum,,94660,CPT4/HCPCS,POS AIRWAY PRESSURE CPAP,,,6766.00
Deidentified Maximum,,94726,CPT4/HCPCS,PULM FUNCT TST PLETHYSMOGRAP,,,585.46
Deidentified Maximum,,94728,CPT4/HCPCS,AIRWY RESIST BY OSCILLOMETRY,,,422.64
Deidentified Maximum,,94729,CPT4/HCPCS,CO/MEMBANE DIFFUSE CAPACITY,,,639.16
Deidentified Maximum,,94750,CPT4/HCPCS,PULMONARY COMPLIANCE STUDY,,,632.02
Deidentified Maximum,,95012,CPT4/HCPCS,EXHALED NITRIC OXIDE MEAS,,,234.99
Deidentified Maximum,,95065,CPT4/HCPCS,NOSE ALLERGY TEST,,,105.08
Deidentified Maximum,,95146,CPT4/HCPCS,ANTIGEN THERAPY SERVICES,,,215.75
Deidentified Maximum,,95800,CPT4/HCPCS,SLP STDY UNATTENDED,,,3498.00
Deidentified Maximum,,95811,CPT4/HCPCS,POLYSOM 6/>YRS CPAP 4/> PARM,,,8439.85
Deidentified Maximum,,95831,CPT4/HCPCS,LIMB MUSCLE TESTING MANUAL,,,225.37
Deidentified Maximum,,95834,CPT4/HCPCS,BODY MUSCLE TESTING MANUAL,,,315.24
Deidentified Maximum,,95904,CPT4/HCPCS,SENSE NERVE CONDUCTION TEST,,,469.98
Deidentified Maximum,,95905,CPT4/HCPCS,MOTOR &/ SENS NRVE CNDJ TEST,,,975.98
Deidentified Maximum,,95910,CPT4/HCPCS,MOTOR&SENS 7-8 NRV CNDJ TEST,,,0.00
Deidentified Maximum,,95928,CPT4/HCPCS,C MOTOR EVOKED UPPR LIMBS,,,1152.46
Deidentified Maximum,,95953,CPT4/HCPCS,EEG MONITORING/COMPUTER,,,3228.86
Deidentified Maximum,,95956,CPT4/HCPCS,EEG MONITOR TECHNOL ATTENDED,,,6351.60
Deidentified Maximum,,95958,CPT4/HCPCS,EEG MONITORING/FUNCTION TEST,,,894.48
Deidentified Maximum,,95970,CPT4/HCPCS,ALYS NPGT W/O PRGRMG,,,421.08
Deidentified Maximum,,96001,CPT4/HCPCS,MOTION TEST W/FT PRESS MEAS,,,357.91
Deidentified Maximum,,96105,CPT4/HCPCS,ASSESSMENT OF APHASIA,,,924.27
Deidentified Maximum,,96370,CPT4/HCPCS,SC THER INFUSION ADDL HR,,,121.98
Deidentified Maximum,,96374,CPT4/HCPCS,THER/PROPH/DIAG INJ IV PUSH,,,632.02
Deidentified Maximum,,96409,CPT4/HCPCS,CHEMO IV PUSH SNGL DRUG,,,1357.03
Deidentified Maximum,,96542,CPT4/HCPCS,CHEMOTHERAPY INJECTION,,,403.00
Deidentified Maximum,,96570,CPT4/HCPCS,PHOTODYNMC TX 30 MIN ADD-ON,,,1678.00
Deidentified Maximum,,96921,CPT4/HCPCS,LASER TX SKIN 250-500 SQ CM,,,2002.00
Deidentified Maximum,,97004,CPT4/HCPCS,OT RE-EVALUATION,,,272.70
Deidentified Maximum,,97022,CPT4/HCPCS,WHIRLPOOL THERAPY,,,6766.00
Deidentified Maximum,,97024,CPT4/HCPCS,DIATHERMY EG MICROWAVE,,,305.00
Deidentified Maximum,,97036,CPT4/HCPCS,HYDROTHERAPY,,,305.00
Deidentified Maximum,,97110,CPT4/HCPCS,THERAPEUTIC EXERCISES,,,6766.00
Deidentified Maximum,,97151,CPT4/HCPCS,BHV ID ASSMT BY PHYS/QHP,,,305.00
Deidentified Maximum,,97153,CPT4/HCPCS,ADAPTIVE BEHAVIOR TX BY TECH,,,305.00
Deidentified Maximum,,97154,CPT4/HCPCS,GRP ADAPT BHV TX BY TECH,,,305.00
Deidentified Maximum,,97162,CPT4/HCPCS,PT EVAL MOD COMPLEX 30 MIN,,,6766.00
Deidentified Maximum,,97167,CPT4/HCPCS,OT EVAL HIGH COMPLEX 60 MIN,,,6766.00
Deidentified Maximum,,97170,CPT4/HCPCS,ATHLETIC TRN EVAL MOD CMPLX,,,336.75
Deidentified Maximum,,97171,CPT4/HCPCS,ATHLETIC TRN EVAL HIGH CMPLX,,,336.75
Deidentified Maximum,,97530,CPT4/HCPCS,THERAPEUTIC ACTIVITIES,,,6766.00
Deidentified Maximum,,97532,CPT4/HCPCS,COGNITIVE SKILLS DEVELOPMENT,,,109.89
Deidentified Maximum,,97542,CPT4/HCPCS,WHEELCHAIR MNGMENT TRAINING,,,6766.00
Deidentified Maximum,,97545,CPT4/HCPCS,WORK HARDENING,,,784.56
Deidentified Maximum,,97605,CPT4/HCPCS,NEG PRESS WOUND TX <=50 CM,,,6766.00
Deidentified Maximum,,97763,CPT4/HCPCS,ORTHC/PROSTC MGMT SBSQ ENC,,,6766.00
Deidentified Maximum,,99192,CPT4/HCPCS,SPECIAL PUMP SERVICES,,,3732.38
Deidentified Maximum,,A9501,CPT4/HCPCS,Technetium TC-99m teboroxime,,,1003.12
Deidentified Maximum,,A9502,CPT4/HCPCS,Tc99m tetrofosmin,,,815.38
Deidentified Maximum,,A9510,CPT4/HCPCS,Tc99m disofenin,,,585.64
Deidentified Maximum,,A9526,CPT4/HCPCS,Nitrogen N-13 ammonia,,,5019.84
Deidentified Maximum,,A9532,CPT4/HCPCS,I125 serum albumin, dx,,,183.03
Deidentified Maximum,,A9536,CPT4/HCPCS,Tc99m depreotide,,,9760.80
Deidentified Maximum,,A9541,CPT4/HCPCS,Tc99m sulfur colloid,,,447.38
Deidentified Maximum,,A9542,CPT4/HCPCS,In111 ibritumomab, dx,,,29282.40
Deidentified Maximum,,A9551,CPT4/HCPCS,Tc99m succimer,,,5014.96
Deidentified Maximum,,A9555,CPT4/HCPCS,Rb82 rubidium,,,2987.12
Deidentified Maximum,,A9556,CPT4/HCPCS,Ga67 gallium,,,1005.39
Deidentified Maximum,,A9559,CPT4/HCPCS,Co57 cyano,,,612.94
Deidentified Maximum,,A9561,CPT4/HCPCS,Tc99m oxidronate,,,368.08
Deidentified Maximum,,A9577,CPT4/HCPCS,Inj multihance,,,16.37
Deidentified Maximum,,A9584,CPT4/HCPCS,Iodine I-123 ioflupane,,,20648.29
Deidentified Maximum,,C5272,CPT4/HCPCS,Low cost skin substitute app,,,2002.00
Deidentified Maximum,,C5273,CPT4/HCPCS,Low cost skin substitute app,,,3656.00
Deidentified Maximum,,C5277,CPT4/HCPCS,Low cost skin substitute app,,,3656.00
Deidentified Maximum,,C8902,CPT4/HCPCS,MRA w/o fol w/cont, abd,,,6766.00
Deidentified Maximum,,C8905,CPT4/HCPCS,MRI w/o fol w/cont, brst, un,,,6766.00
Deidentified Maximum,,C8919,CPT4/HCPCS,MRA w/o cont, pelvis,,,6766.00
Deidentified Maximum,,C8929,CPT4/HCPCS,Tte w or wo fol wcon,doppler,,,3198.57
Deidentified Maximum,,C8935,CPT4/HCPCS,MRA, w/o dye, upper extr,,,6766.00
Deidentified Maximum,,C9605,CPT4/HCPCS,Perc d-e cor revasc t cabg b,,,10119.00
Deidentified Maximum,,C9727,CPT4/HCPCS,Insert palate implants,,,1370.00
Deidentified Maximum,,C9745,CPT4/HCPCS,Nasal endo eustachian tube,,,6075.00
Deidentified Maximum,,C9754,CPT4/HCPCS,Perc av fistula, direct,,,10119.00
Deidentified Maximum,,C9758,CPT4/HCPCS,Blind interatrial shunt ide,,,10772.00
Deidentified Maximum,,G0120,CPT4/HCPCS,Colon ca scrn; barium enema,,,6500.00
Deidentified Maximum,,G0237,CPT4/HCPCS,Therapeutic procd strg endur,,,6766.00
Deidentified Maximum,,G0238,CPT4/HCPCS,Oth resp proc, indiv,,,6766.00
Deidentified Maximum,,G0289,CPT4/HCPCS,Arthro, loose body + chondro,,,5029.00
Deidentified Maximum,,G0293,CPT4/HCPCS,Non-cov surg proc,clin trial,,,1678.00
Deidentified Maximum,,G0297,CPT4/HCPCS,Ldct for lung ca screen,,,21405.00
Deidentified Maximum,,G0393,CPT4/HCPCS,AV fistula or graft venous,,,12850.70
Deidentified Maximum,,G0412,CPT4/HCPCS,Open tx iliac spine uni/bil,,,5029.00
Deidentified Maximum,,G0429,CPT4/HCPCS,Dermal filler injection(s),,,1678.00
Deidentified Maximum,,G0448,CPT4/HCPCS,Place perm pacing cardiovert,,,5856.00
Deidentified Maximum,,G2061,CPT4/HCPCS,Qual nonmd est pt 5-10m,,,6766.00
Deidentified Maximum,,G6002,CPT4/HCPCS,Stereoscopic x-ray guidance,,,588.34
Deidentified Maximum,,G6006,CPT4/HCPCS,Radiation treatment delivery,,,1028.74
Deidentified Maximum,,G6008,CPT4/HCPCS,Radiation treatment delivery,,,1280.30
Deidentified Maximum,,G6015,CPT4/HCPCS,Radiation tx delivery imrt,,,2957.43
Deidentified Maximum,,G6020,CPT4/HCPCS,Colonoscopy w/stent,,,1678.00
Deidentified Maximum,,G8628,CPT4/HCPCS,No surg proc w/in 30 days,,,5783.00
Deidentified Maximum,,G8978,CPT4/HCPCS,Mobility current status,,,193.00
Deidentified Maximum,,G8999,CPT4/HCPCS,Motor speech current status,,,193.00
Deidentified Maximum,,G9160,CPT4/HCPCS,Lang comp goal status,,,193.00
Deidentified Maximum,,G9164,CPT4/HCPCS,Lang express d/c status,,,193.00
Deidentified Maximum,,G9166,CPT4/HCPCS,Atten goal status,,,193.00
Deidentified Maximum,,G9168,CPT4/HCPCS,Memory current status,,,193.00
Deidentified Maximum,,G9173,CPT4/HCPCS,Voice d/c status,,,193.00
Deidentified Maximum,,G9174,CPT4/HCPCS,Speech lang current status,,,193.00
Deidentified Maximum,,J9035,CPT4/HCPCS,Bevacizumab injection,,,684.18
Deidentified Maximum,,J9040,CPT4/HCPCS,Bleomycin sulfate injection,,,192.27
Deidentified Maximum,,J9045,CPT4/HCPCS,Carboplatin injection,,,22.84
Deidentified Maximum,,J9047,CPT4/HCPCS,Injection, carfilzomib, 1 mg,,,318.52
Deidentified Maximum,,J9050,CPT4/HCPCS,Carmustine injection,,,22216.40
Deidentified Maximum,,J9190,CPT4/HCPCS,Fluorouracil injection,,,12.85
Deidentified Maximum,,J9214,CPT4/HCPCS,Interferon alfa-2b inj,,,290.21
Deidentified Maximum,,J9351,CPT4/HCPCS,Topotecan injection,,,8.31
Deidentified Maximum,,J9600,CPT4/HCPCS,Porfimer sodium injection,,,176029.05
Deidentified Maximum,,Q0083,CPT4/HCPCS,Chemo by other than infusion,,,692.16
Deidentified Maximum,,S0170,CPT4/HCPCS,Anastrozole 1 mg,,,4.03
Deidentified Maximum,,S0172,CPT4/HCPCS,Chlorambucil 2 mg,,,203.53
Deidentified Maximum,,S0182,CPT4/HCPCS,Procarbazine, oral,,,827.40
Deidentified Maximum,,S0187,CPT4/HCPCS,Tamoxifen 10 mg,,,3.19
Deidentified Maximum,,S2083,CPT4/HCPCS,Adjustment gastric band,,,2002.00
Deidentified Minimum,,0410090,ICD10-PCS,BYPASS ABD AORTA ABD AORTA AUTO VENOUS TISS OPN,,,8271.00
Deidentified Minimum,,041009D,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Minimum,,041009K,ICD10-PCS,BYPS ABD AO B FEM ART AUTO VEN TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100A8,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO ART TISS OPN APPR,,,8271.00
Deidentified Minimum,,04100AJ,ICD10-PCS,BP ABD AO LT FEM ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100J6,ICD10-PCS,BP ABD AO RT COMMON ILIAC ART SYN SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100JF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART SYN SUB OPN APPROACH,,,8271.00
Deidentified Minimum,,04100K9,ICD10-PCS,BP ABD AO RT IIA NONAUTO SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100KB,ICD10-PCS,BP ABD AO LT IIA NONAUTO SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100Z0,ICD10-PCS,BYPASS ABD AORTA ABDOMINAL AORTA OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100Z9,ICD10-PCS,BYPASS ABD AO RT INTRL ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100ZJ,ICD10-PCS,BYPASS ABD AORTA LT FEMORAL ARTERY OPEN APPROACH,,,8271.00
Deidentified Minimum,,0410492,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,0410495,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,0410497,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041049C,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041049J,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,04104A5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104A7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104AB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104J7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104JK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104K1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104K6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104KF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104KJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104KR,ICD10-PCS,Bypass Abd Aorta to Low Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104Z5,ICD10-PCS,Bypass Abdominal Aorta to B Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04140J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,04140K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,04140Z3,ICD10-PCS,Bypass Splenic Artery to Right Renal Artery, Open Approach,,,8271.00
Deidentified Minimum,,04144J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04144Z3,ICD10-PCS,Bypass Splenic Artery to R Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C095,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C09D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C0J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Open Approach,,,8271.00
Deidentified Minimum,,041C492,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C497,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C498,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C49B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C49C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C49D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C49J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C4A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4Z0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4Z3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D09C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D09H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D0A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0Z7,ICD10-PCS,Bypass Left Common Iliac Artery to L Com Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041D0Z8,ICD10-PCS,Bypass Left Common Iliac Artery to B Com Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041D0Z9,ICD10-PCS,Bypass Left Common Iliac Artery to R Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041D0ZF,ICD10-PCS,Bypass Left Common Iliac Artery to L Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041D492,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D495,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D49G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D49H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D49K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D49Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D4A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4ZF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4ZH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E09C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E09P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E09Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E0AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E0KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E0ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041E0ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Open Approach,,,8271.00
Deidentified Minimum,,041E0ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Open Approach,,,8271.00
Deidentified Minimum,,041E49B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E49F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E4AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041E4AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041E4AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041E4JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E4ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041F099,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F09F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F09K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F0AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041F0ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041F0ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041F49C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F49F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F49G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F49P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F4AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041F4ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H09H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H0AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H0ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041H0ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041H0ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041H0ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041H4AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H4ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J09J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J09P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J0J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J0KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J0KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J0ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041J0ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041J0ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041J0ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041J49Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J4JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4ZP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J4ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04504ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04523ZZ,ICD10-PCS,Destruction of Gastric Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04564ZZ,ICD10-PCS,Destruction of Right Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,045B3ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Perc Approach,,,8271.00
Deidentified Minimum,,045C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,045F4ZZ,ICD10-PCS,Destruction of L Int Iliac Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04B20ZZ,ICD10-PCS,Excision of Gastric Artery, Open Approach,,,8271.00
Deidentified Minimum,,04B33ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04BE0ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04BF4ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04BH4ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04BJ0ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04R04JZ,ICD10-PCS,Replacement of Abd Aorta with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R04KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R20JZ,ICD10-PCS,Replacement of Gastric Artery with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R247Z,ICD10-PCS,Replace of Gastric Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R30JZ,ICD10-PCS,Replacement of Hepatic Artery with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R30KZ,ICD10-PCS,Replacement of Hepatic Artery with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R34KZ,ICD10-PCS,Replace of Hepatic Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R507Z,ICD10-PCS,Replacement of Sup Mesent Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R50JZ,ICD10-PCS,Replacement of Sup Mesent Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R64KZ,ICD10-PCS,Replace of R Colic Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R70KZ,ICD10-PCS,Replacement of L Colic Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R74JZ,ICD10-PCS,Replace of L Colic Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R847Z,ICD10-PCS,Replace of Mid Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R84KZ,ICD10-PCS,Replace of Mid Colic Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04RA4KZ,ICD10-PCS,Replace of L Renal Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04RB07Z,ICD10-PCS,Replacement of Inf Mesent Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RC0JZ,ICD10-PCS,Replacement of R Com Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RC4JZ,ICD10-PCS,Replace R Com Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RC4KZ,ICD10-PCS,Replace R Com Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RD0KZ,ICD10-PCS,Replace of L Com Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RD47Z,ICD10-PCS,Replace L Com Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RH0JZ,ICD10-PCS,Replacement of R Ext Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RH47Z,ICD10-PCS,Replace R Ext Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RH4KZ,ICD10-PCS,Replace R Ext Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RJ4JZ,ICD10-PCS,Replace L Ext Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RJ4KZ,ICD10-PCS,Replace L Ext Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04S84ZZ,ICD10-PCS,Reposition Middle Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SB3ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SJ3ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SL3ZZ,ICD10-PCS,Reposition Left Femoral Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SL4ZZ,ICD10-PCS,Reposition Left Femoral Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SM4ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SS3ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04SY0ZZ,ICD10-PCS,Reposition Lower Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SY3ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04U037Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04U137Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04U147Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U447Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U547Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U947Z,ICD10-PCS,Supplement R Renal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UB47Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UD07Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UD37Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UH07Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UJ07Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04US07Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04US37Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04US47Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UT07Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,051007Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,051049Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,05104AY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,051109Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Open,,,8271.00
Deidentified Minimum,,051147Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,051149Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,05134KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,051409Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,051447Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05150AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Open,,,8271.00
Deidentified Minimum,,05150ZY,ICD10-PCS,Bypass Right Subclavian Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Minimum,,051547Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05154ZY,ICD10-PCS,Bypass Right Subclavian Vein to Up Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,051607Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Open,,,8271.00
Deidentified Minimum,,051649Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,05500ZZ,ICD10-PCS,Destruction of Azygos Vein, Open Approach,,,8271.00
Deidentified Minimum,,05B13ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05B44ZZ,ICD10-PCS,Excision of Left Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05B50ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Open Approach,,,8271.00
Deidentified Minimum,,05R04KZ,ICD10-PCS,Replace of Azygos Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R30KZ,ICD10-PCS,Replacement of R Innom Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R34KZ,ICD10-PCS,Replace of R Innom Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R607Z,ICD10-PCS,Replacement of L Subclav Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R64JZ,ICD10-PCS,Replace of L Subclav Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R64KZ,ICD10-PCS,Replace L Subclav Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05S00ZZ,ICD10-PCS,Reposition Azygos Vein, Open Approach,,,8271.00
Deidentified Minimum,,05S14ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,05S54ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05S80ZZ,ICD10-PCS,Reposition Left Axillary Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SA0ZZ,ICD10-PCS,Reposition Left Brachial Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SB4ZZ,ICD10-PCS,Reposition Right Basilic Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SC3ZZ,ICD10-PCS,Reposition Left Basilic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SL0ZZ,ICD10-PCS,Reposition Intracranial Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SM0ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SM4ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SR4ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SS0ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SS4ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SY0ZZ,ICD10-PCS,Reposition Upper Vein, Open Approach,,,8271.00
Deidentified Minimum,,05U337Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05U347Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05U637Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05U947Z,ICD10-PCS,Supplement R Brach Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05UA47Z,ICD10-PCS,Supplement L Brach Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05UB37Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UF47Z,ICD10-PCS,Supplement L Cephalic Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05UG07Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UG37Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UH37Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UQ37Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05US47Z,ICD10-PCS,Supplement L Verteb Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06503ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06564ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06570ZZ,ICD10-PCS,Destruction of Colic Vein, Open Approach,,,8271.00
Deidentified Minimum,,065F3ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Approach,,,8271.00
Deidentified Minimum,,065G3ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Approach,,,8271.00
Deidentified Minimum,,065H3ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,065H4ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06B04ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06B73ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06BF3ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06BJ3ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06R047Z,ICD10-PCS,Replace of Inf Vena Cava with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R04JZ,ICD10-PCS,Replace of Inf Vena Cava with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R107Z,ICD10-PCS,Replacement of Splenic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R10KZ,ICD10-PCS,Replacement of Splenic Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R147Z,ICD10-PCS,Replace of Splenic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R14KZ,ICD10-PCS,Replace of Splenic Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R20KZ,ICD10-PCS,Replacement of Gastric Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R24KZ,ICD10-PCS,Replace of Gastric Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R44JZ,ICD10-PCS,Replace of Hepatic Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R50JZ,ICD10-PCS,Replacement of Sup Mesent Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R607Z,ICD10-PCS,Replacement of Inf Mesent Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R647Z,ICD10-PCS,Replace Inf Mesent Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06R90JZ,ICD10-PCS,Replacement of R Renal Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R90KZ,ICD10-PCS,Replacement of R Renal Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RC4KZ,ICD10-PCS,Replace R Com Iliac Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RD0JZ,ICD10-PCS,Replace of L Com Iliac Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RF0KZ,ICD10-PCS,Replace of R Ext Iliac Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RF4JZ,ICD10-PCS,Replace R Ext Iliac Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RH0JZ,ICD10-PCS,Replacement of R Hypogast Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RH47Z,ICD10-PCS,Replace R Hypogast Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06S13ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06S80ZZ,ICD10-PCS,Reposition Portal Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SF3ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SG3ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SG4ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SH3ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SN3ZZ,ICD10-PCS,Reposition Left Femoral Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SP3ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SP4ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SQ0ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SS0ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SY0ZZ,ICD10-PCS,Reposition Lower Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SY3ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06U007Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06U237Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06U247Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06U637Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06U647Z,ICD10-PCS,Supplement Inf Mesent Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06U747Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06U837Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UJ47Z,ICD10-PCS,Supplement L Hypogast Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06UM07Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UN07Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UR47Z,ICD10-PCS,Supplement R Less Saphenous w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06UV47Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0PS44ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0PS4XZZ,ICD10-PCS,Reposition Thoracic Vertebra, External Approach,,,8271.00
Deidentified Minimum,,0QS0XZZ,ICD10-PCS,Reposition Lumbar Vertebra, External Approach,,,8271.00
Deidentified Minimum,,0QS13ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0QSS04Z,ICD10-PCS,Reposition Coccyx with Int Fix, Open Approach,,,8271.00
Deidentified Minimum,,0R550ZZ,ICD10-PCS,Destruction of Cervicothoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RB04ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RB10ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Open Approach,,,8271.00
Deidentified Minimum,,0RB43ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Perc Approach,,,8271.00
Deidentified Minimum,,0RB44ZZ,ICD10-PCS,Excision of C-thor Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RB60ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Open Approach,,,8271.00
Deidentified Minimum,,0RBA0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Open Approach,,,8271.00
Deidentified Minimum,,0RG0070,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,06SR4ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SS4ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SV0ZZ,ICD10-PCS,Reposition Left Foot Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SV4ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06SY4ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06U437Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06U447Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06U547Z,ICD10-PCS,Supplement Sup Mesent Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06U707Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06U737Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06U807Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UH47Z,ICD10-PCS,Supplement R Hypogast Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06UJ07Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UN47Z,ICD10-PCS,Supplement L Femor Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0JH638Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Perc Approach,,,8271.00
Deidentified Minimum,,0JH808Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Open Approach,,,8271.00
Deidentified Minimum,,0Q834ZZ,ICD10-PCS,Division of Left Pelvic Bone, Perc Endo Approach,,,4303.00
Deidentified Minimum,,0QS034Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Approach,,,8271.00
Deidentified Minimum,,0QS044Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0QS04ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,0QS134Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Approach,,,8271.00
Deidentified Minimum,,0QSS3ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0R530ZZ,ICD10-PCS,Destruction of Cervical Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RB00ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Open Approach,,,8271.00
Deidentified Minimum,,0RB13ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0RB30ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RB34ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RB40ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Open Approach,,,8271.00
Deidentified Minimum,,0RB54ZZ,ICD10-PCS,Excision of C-thor Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RBA4ZZ,ICD10-PCS,Excision of T-lum Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG00A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG00K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG00KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG037J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG1070,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG10A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG10K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG13J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG13K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG13KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG147J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG207J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG20A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG20A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG20Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG2370,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG2371,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG237J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG23J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG2471,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG24J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG24J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG24Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG24Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG40A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG40J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG40K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG40K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG40Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG43AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG43K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG43KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG44J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG44J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG60J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG60K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG63KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG63Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG7070,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG70KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG737J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG73J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG73Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG73ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG74A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG80A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG80A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG80J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG80K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG83KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG83Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG847J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG84A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG84J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA0J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RGA0J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RGA0K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RGA0Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0RGA3KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RGA4K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RH14DZ,ICD10-PCS,Insert of Facet Stabl Dev into Cerv Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RH40DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RH60CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RHA0CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RT30ZZ,ICD10-PCS,Resection of Cervical Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RT90ZZ,ICD10-PCS,Resection of Thoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RU50JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RU54JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RU60JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RU64JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RW54JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RW90JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RW93JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Perc Approach,,,8271.00
Deidentified Minimum,,0SB00ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Open Approach,,,8271.00
Deidentified Minimum,,0SB33ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SB34ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SB80ZZ,ICD10-PCS,EXCISION LEFT SACROILIAC JOINT OPEN,,,8271.00
Deidentified Minimum,,0SB83ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SG00A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG00A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG00K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG0370,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG03K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG0470,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG04J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG04ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG13A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG13Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0SG14Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG33A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG33KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG33Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0SG34A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG34JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG34K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG53ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SG604Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Open Approach,,,8271.00
Deidentified Minimum,,0SG634Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Approach,,,8271.00
Deidentified Minimum,,0SG64KZ,ICD10-PCS,Fusion of Coccygeal Jt with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG707Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG737Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SG74ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG807Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG83KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SG847Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG84KZ,ICD10-PCS,Fusion L Sacroiliac Jt w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,0SH00BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Open Approach,,,8271.00
Deidentified Minimum,,0SH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Open Approach,,,8271.00
Deidentified Minimum,,0SH34DZ,ICD10-PCS,Insert of Facet Stabl Dev into Lumsac Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SR40JZ,ICD10-PCS,Replacement of Lumsac Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SR9019,ICD10-PCS,Replacement of R Hip Jt with Metal, Cement, Open Approach,,,8271.00
Deidentified Minimum,,0SR90KZ,ICD10-PCS,Replacement of R Hip Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRA07Z,ICD10-PCS,Replace of R Hip Jt, Acetab with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRA0KZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRB02Z,ICD10-PCS,Replacement of L Hip Jt with Metal on Poly, Open Approach,,,8271.00
Deidentified Minimum,,0SRB03Z,ICD10-PCS,Replacement of Left Hip Joint with Ceramic, Open Approach,,,8271.00
Deidentified Minimum,,0SRB049,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Cement, Open,,,8271.00
Deidentified Minimum,,0SRB0KZ,ICD10-PCS,Replacement of Left Hip Joint with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRC0KZ,ICD10-PCS,Replacement of R Knee Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRD0J9,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Cement, Open Approach,,,8271.00
Deidentified Minimum,,0SRD0JA,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Uncement, Open Approach,,,8271.00
Deidentified Minimum,,0SRE01A,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRE0KZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRR019,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Cement, Open,,,8271.00
Deidentified Minimum,,0SRR039,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Cement, Open,,,8271.00
Deidentified Minimum,,0SRR03A,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRR0JZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRS07Z,ICD10-PCS,Replace of L Hip Jt, Femoral with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRS0JA,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRT07Z,ICD10-PCS,Replace of R Knee Jt, Femoral with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRU07Z,ICD10-PCS,Replace of L Knee Jt, Femoral with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRV0J9,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Cement, Open,,,8271.00
Deidentified Minimum,,0ST20ZZ,ICD10-PCS,Resection of Lumbar Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0SU33JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SU34JZ,ICD10-PCS,Supplement Lumsac Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SW44JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0TQD7ZZ,ICD10-PCS,Repair Urethra, Via Natural or Artificial Opening,,,4303.00
Deidentified Minimum,,10908ZC,ICD10-PCS,Drainage of Amniotic Fluid, Therapeutic from POC, Endo,,,4303.00
Deidentified Minimum,,4A023N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Perc,,,8271.00
Deidentified Minimum,,5A02110,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Intermittent,,,8271.00
Deidentified Minimum,,B201YZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using Oth Contrast,,,8271.00
Deidentified Minimum,,B2020ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using H Osm Contrast,,,8271.00
Deidentified Minimum,,B202YZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using Oth Contrast,,,8271.00
Deidentified Minimum,,B2031ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using L Osm Contrast,,,8271.00
Deidentified Minimum,,B2080ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2111ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using L Osm Contrast,,,8271.00
Deidentified Minimum,,B211YZZ,ICD10-PCS,Fluoroscopy of Multiple Coronary Arteries using Oth Contrast,,,8271.00
Deidentified Minimum,,B212YZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using Oth Contrast,,,8271.00
Deidentified Minimum,,B2130ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2131ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using L Osm Contrast,,,8271.00
Deidentified Minimum,,B2181ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using L Osm Contrast,,,8271.00
Deidentified Minimum,,B218YZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using Oth Contrast,,,8271.00
Deidentified Minimum,,B21F1ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Low Osmolar Contrast,,,8271.00
Deidentified Minimum,,X2RF032,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Open, New Tech 2,,,8271.00
Deidentified Minimum,,0RG0071,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG03AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG03J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG0470,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG04A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG04A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG10AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG10J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG13J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG13K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG1470,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG14A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG2071,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG20J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG20JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG20ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG23JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG23ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG24K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG24K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG4071,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG40ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG43Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG44A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG44AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG44JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG44Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG44Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG44ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG6071,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG60Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG60Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG63K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG63ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG6470,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG64A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG64KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG64ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG707J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG70A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG70AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG70ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG74KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG80Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG8370,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG837J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG83AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG83Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG83ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG84AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG84KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA0A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RGA0KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RGA371,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RGA3JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RGA3K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RGA3Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RGA4A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA4J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RH03BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc,,,8271.00
Deidentified Minimum,,0RH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RH10CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RH44CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into C-thor Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RH44DZ,ICD10-PCS,Insert of Facet Stabl Dev into C-thor Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RH63BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RH63CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RH63DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RH64DZ,ICD10-PCS,Insert of Facet Stabl Dev into Thor Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RHA3DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RHA4BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc Endo,,,8271.00
Deidentified Minimum,,0RHA4DZ,ICD10-PCS,Insert of Facet Stabl Dev into T-lum Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RU40JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RU44JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RUA0JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RUA4JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0S540ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0S544ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SB23ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SB50ZZ,ICD10-PCS,EXCISION SACROCOCCYGEAL JOINT OPEN,,,8271.00
Deidentified Minimum,,0SB70ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Open Approach,,,8271.00
Deidentified Minimum,,0SG00AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG00J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG00Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0SG03K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG03ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0SG04K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG04K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG1071,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG10J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG10K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG1370,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG13AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG13ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0SG14AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG14ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG30J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG30JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG30K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG337J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG33K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG50ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Open Approach,,,8271.00
Deidentified Minimum,,0SG53JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SG544Z,ICD10-PCS,Fusion of Sacrococcygeal Jt with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG54KZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,0SG54ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG63KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SG70ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Open Approach,,,8271.00
Deidentified Minimum,,0SG734Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Perc Approach,,,8271.00
Deidentified Minimum,,0SG744Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG74KZ,ICD10-PCS,Fusion R Sacroiliac Jt w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,0SG80JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG83ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SG84JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SH03BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0SH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0SH04DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SH30BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Open,,,8271.00
Deidentified Minimum,,0SR20JZ,ICD10-PCS,Replacement of Lum Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SR902Z,ICD10-PCS,Replacement of R Hip Jt with Metal on Poly, Open Approach,,,8271.00
Deidentified Minimum,,0SR9039,ICD10-PCS,Replacement of R Hip Jt with Ceramic, Cement, Open Approach,,,8271.00
Deidentified Minimum,,0SR904Z,ICD10-PCS,Replacement of R Hip Jt with Ceramic on Poly, Open Approach,,,8271.00
Deidentified Minimum,,0SR90J9,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Cement, Open Approach,,,8271.00
Deidentified Minimum,,0SRA00A,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRA00Z,ICD10-PCS,REPLACEMENT RT HIP JOINT ACETAB SURF POLYETHYLENE SYNTH SUBS,,,8271.00
Deidentified Minimum,,0SRA019,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Cement, Open,,,8271.00
Deidentified Minimum,,0SRA039,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Cement, Open,,,8271.00
Deidentified Minimum,,0SRA03Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Ceramic, Open Approach,,,8271.00
Deidentified Minimum,,0SRA0JA,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRB04A,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRB0J9,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Cement, Open Approach,,,8271.00
Deidentified Minimum,,0SRD07Z,ICD10-PCS,Replacement of Left Knee Joint with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRD0JZ,ICD10-PCS,Replacement of Left Knee Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRE019,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Cement, Open,,,8271.00
Deidentified Minimum,,0SRE01Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Metal, Open Approach,,,8271.00
Deidentified Minimum,,0SRE03Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Ceramic, Open Approach,,,8271.00
Deidentified Minimum,,0SRE0JA,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRE0JZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRR01A,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRR07Z,ICD10-PCS,Replace of R Hip Jt, Femoral with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRR0KZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRT0JZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRV07Z,ICD10-PCS,Replace of R Knee Jt, Tibial with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRV0JZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRV0KZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRW07Z,ICD10-PCS,Replace of L Knee Jt, Tibial with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SU00JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SUB0BZ,ICD10-PCS,Supplement Left Hip Joint with Resurf Dev, Open Approach,,,8271.00
Deidentified Minimum,,0SUR0BZ,ICD10-PCS,Supplement R Hip Jt, Femoral with Resurf Dev, Open Approach,,,8271.00
Deidentified Minimum,,0SW94JZ,ICD10-PCS,Revision of Synth Sub in R Hip Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SWB0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Open Approach,,,8271.00
Deidentified Minimum,,0SWC0JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Open Approach,,,8271.00
Deidentified Minimum,,0UQC0ZZ,ICD10-PCS,Repair Cervix, Open Approach,,,4303.00
Deidentified Minimum,,0UQG8ZZ,ICD10-PCS,Repair Vagina, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Minimum,,0WFD3ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0WFD4ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Perc Endo Approach,,,8271.00
Deidentified Minimum,,10900ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Open Approach,,,4303.00
Deidentified Minimum,,10904ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Perc Endo Approach,,,4303.00
Deidentified Minimum,,10908ZA,ICD10-PCS,Drainage of Fetal Cerebrospinal Fluid from POC, Endo,,,4303.00
Deidentified Minimum,,5A02116,ICD10-PCS,Assist with Cardiac Output using Other Pump, Intermittent,,,8271.00
Deidentified Minimum,,5A02216,ICD10-PCS,Assistance with Cardiac Output using Other Pump, Continuous,,,8271.00
Deidentified Minimum,,B2000ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2030ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using H Osm Contrast,,,8271.00
Deidentified Minimum,,B213YZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using Oth Contrast,,,8271.00
Deidentified Minimum,,B214YZZ,ICD10-PCS,Fluoroscopy of Right Heart using Other Contrast,,,8271.00
Deidentified Minimum,,B2161ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using L Osm Contrast,,,8271.00
Deidentified Minimum,,B21F0ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using H Osm Contrast,,,8271.00
Deidentified Minimum,,X2RF432,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Perc Endo, New Tech 2,,,8271.00
Deidentified Minimum,,001U074,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Open,,,8271.00
Deidentified Minimum,,001U0J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Open,,,8271.00
Deidentified Minimum,,001U3J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Perc,,,8271.00
Deidentified Minimum,,001U3J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Perc,,,8271.00
Deidentified Minimum,,001U3J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Perc,,,8271.00
Deidentified Minimum,,001U3K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Perc,,,8271.00
Deidentified Minimum,,001U3K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Perc,,,8271.00
Deidentified Minimum,,005X3ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,005Y3ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,009T30Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Perc Approach,,,8271.00
Deidentified Minimum,,009X00Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Open Approach,,,8271.00
Deidentified Minimum,,009X0ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Minimum,,009X30Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Perc Approach,,,8271.00
Deidentified Minimum,,009X40Z,ICD10-PCS,Drain of Thor Spinal Cord with Drain Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,009Y30Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Perc Approach,,,8271.00
Deidentified Minimum,,009Y40Z,ICD10-PCS,Drain of Lum Spinal Cord with Drain Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00BT4ZX,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach, Diagn,,,8271.00
Deidentified Minimum,,00BX4ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00BY0ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Minimum,,00CT3ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Perc Approach,,,8271.00
Deidentified Minimum,,00DT3ZZ,ICD10-PCS,Extraction of Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00FU0ZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL OPEN APPROACH,,,8271.00
Deidentified Minimum,,00HU02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00HU32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00HU42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00HV0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00HV32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00HV3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00JU0ZZ,ICD10-PCS,INSPECTION OF SPINAL CANAL OPEN,,,8271.00
Deidentified Minimum,,00NW0ZZ,ICD10-PCS,Release Cervical Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00NX0ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00PU02Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00PU40Z,ICD10-PCS,Removal of Drain Dev from Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00PU4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00PV00Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00PV33Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00PV40Z,ICD10-PCS,Removal of Drain Dev from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00SY3ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00UT3JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,00WU00Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00WU42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00WV02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00WV0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00WV33Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00WV3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00WV3KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00WV3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,015B4ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,015R0ZZ,ICD10-PCS,DESTRUCTION OF SACRAL NERVE OPEN APPROACH,,,8271.00
Deidentified Minimum,,015R4ZZ,ICD10-PCS,Destruction of Sacral Nerve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,018R3ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE PERQ APPR,,,8271.00
Deidentified Minimum,,021008C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,0210098,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Minimum,,02100A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,0210483,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02104A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02104AW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02104K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02104KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02104ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02104ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0211089,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021108C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,0211099,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Minimum,,02110AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02110JW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02110Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Open Approach,,,8271.00
Deidentified Minimum,,02110ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Open Approach,,,8271.00
Deidentified Minimum,,0211489,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021148W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0211498,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021149C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021149F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02114AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02114AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,0212099,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021209C,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02120JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02120Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,02124A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02124AW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02124J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02124JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02124K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02124KW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02124Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021308W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,021309C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02130A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Open,,,8271.00
Deidentified Minimum,,02130K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02130KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,021348F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0213499,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021349C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02134AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02134JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02134JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02134K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02134Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02134ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021609P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02160AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02160ZR,ICD10-PCS,Bypass Right Atrium to Left Pulmonary Artery, Open Approach,,,8271.00
Deidentified Minimum,,021648Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02164JR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02164KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02164KR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02164Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02164ZR,ICD10-PCS,Bypass Right Atrium to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021709Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02170AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02170AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02170ZR,ICD10-PCS,Bypass Left Atrium to Left Pulmonary Artery, Open Approach,,,8271.00
Deidentified Minimum,,021748R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02174ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02174ZR,ICD10-PCS,Bypass Left Atrium to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021K08R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021K0AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,021K4KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021K4ZP,ICD10-PCS,Bypass Right Ventricle to Pulm Trunk, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021L08R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021L0AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,021L0ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Minimum,,021L0ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,021L48P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021L4AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021L4AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021L4Z5,ICD10-PCS,Bypass Left Ventricle to Cor Circ, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021L4ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021V08P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021V0AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,021V0JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021V0JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021V0ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,021V4AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021V4ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulm Trunk, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021W09D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021W09R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021W0AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Open,,,8271.00
Deidentified Minimum,,021W0JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021W0JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021W0ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,021W48R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021W4AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021W4KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W4KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W4ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021W4ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021X08D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021X0JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021X0ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Open Approach,,,8271.00
Deidentified Minimum,,021X0ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,021X48B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021X4JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,024G0J2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Synth Sub, Open,,,8271.00
Deidentified Minimum,,024J072,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Autol Sub, Open,,,8271.00
Deidentified Minimum,,024J0K2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02550ZZ,ICD10-PCS,Destruction of Atrial Septum, Open Approach,,,8271.00
Deidentified Minimum,,02580ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Open Approach,,,8271.00
Deidentified Minimum,,02583ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02593ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025F3ZZ,ICD10-PCS,Destruction of Aortic Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025J0ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Open Approach,,,8271.00
Deidentified Minimum,,025J3ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025K0ZZ,ICD10-PCS,Destruction of Right Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,025M0ZZ,ICD10-PCS,Destruction of Ventricular Septum, Open Approach,,,8271.00
Deidentified Minimum,,025Q0ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Open Approach,,,8271.00
Deidentified Minimum,,025S4ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,025X0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Open Approach,,,8271.00
Deidentified Minimum,,025X3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Perc Approach,,,8271.00
Deidentified Minimum,,0270046,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Open,,,8271.00
Deidentified Minimum,,027004Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Open Approach,,,8271.00
Deidentified Minimum,,027005Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,027006Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02700EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02700FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,027035Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,0270376,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,027037Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,027047Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02704F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02704TZ,ICD10-PCS,Dilate 1 Cor Art w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,0271056,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,027105Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,0271066,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02710FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02710TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Open Approach,,,8271.00
Deidentified Minimum,,0271346,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc,,,8271.00
Deidentified Minimum,,0271356,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02713Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Minimum,,0271456,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,027146Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02714T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,02714Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027206Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02720E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02720GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,0272346,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc,,,8271.00
Deidentified Minimum,,027234Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Perc Approach,,,8271.00
Deidentified Minimum,,027235Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,027247Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0273066,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Open,,,8271.00
Deidentified Minimum,,0273076,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Open,,,8271.00
Deidentified Minimum,,02730D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02730EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02730G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02734E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02734TZ,ICD10-PCS,Dilate 4+ Cor Art w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,02734ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027G34Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc,,,8271.00
Deidentified Minimum,,027G3ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,027G4DZ,ICD10-PCS,Dilate of Mitral Valve with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027G4ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,027H3ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,027H4DZ,ICD10-PCS,Dilation of Pulm Valve with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027K0DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,027K44Z,ICD10-PCS,Dilate R Ventricle w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,027R0DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,027R4DT,ICD10-PCS,Dilate Ductus Arterio w Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02894ZZ,ICD10-PCS,Division of Chordae Tendineae, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02B54ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02B64ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02B70ZZ,ICD10-PCS,Excision of Left Atrium, Open Approach,,,8271.00
Deidentified Minimum,,02BD0ZZ,ICD10-PCS,Excision of Papillary Muscle, Open Approach,,,8271.00
Deidentified Minimum,,02BK3ZZ,ICD10-PCS,Excision of Right Ventricle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BM3ZZ,ICD10-PCS,Excision of Ventricular Septum, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BP3ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BR4ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02BX3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Perc Approach,,,8271.00
Deidentified Minimum,,02C00ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Open Approach,,,8271.00
Deidentified Minimum,,02C04Z6,ICD10-PCS,Extirpate matter from 1 Cor Art, Bifurc, Perc Endo,,,8271.00
Deidentified Minimum,,02C30ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Open Approach,,,8271.00
Deidentified Minimum,,02C33ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Approach,,,8271.00
Deidentified Minimum,,02CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Perc Approach,,,8271.00
Deidentified Minimum,,02H40KZ,ICD10-PCS,Insertion of Defibrillator Lead into Cor Vein, Open Approach,,,8271.00
Deidentified Minimum,,02H433Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Perc Approach,,,8271.00
Deidentified Minimum,,02H443Z,ICD10-PCS,Insertion of Infusion Dev into Cor Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02H44NZ,ICD10-PCS,Insert of Intracard Pacer into Cor Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HA3RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Approach,,,8271.00
Deidentified Minimum,,02HK0KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,02HL4KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HN3KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Approach,,,8271.00
Deidentified Minimum,,02HN4KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HQ0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,02HR3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Perc Approach,,,8271.00
Deidentified Minimum,,02HR4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HS4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HT3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Perc Approach,,,8271.00
Deidentified Minimum,,02HT4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HW4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Desc, Perc Endo,,,8271.00
Deidentified Minimum,,02HX32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Perc Approach,,,8271.00
Deidentified Minimum,,02LH0CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02LH3CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02LH3ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02LH4ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02N40ZZ,ICD10-PCS,Release Coronary Vein, Open Approach,,,8271.00
Deidentified Minimum,,02N80ZZ,ICD10-PCS,Release Conduction Mechanism, Open Approach,,,8271.00
Deidentified Minimum,,02N90ZZ,ICD10-PCS,Release Chordae Tendineae, Open Approach,,,8271.00
Deidentified Minimum,,02N93ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02NK3ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02NL3ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02NL4ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02PY38Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02PY4DZ,ICD10-PCS,Remove of Intralum Dev from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02PY4KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02Q20ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Open Approach,,,8271.00
Deidentified Minimum,,02Q43ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02Q64ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02Q74ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QD3ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02QG0ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Open Approach,,,8271.00
Deidentified Minimum,,02QM0ZZ,ICD10-PCS,Repair Ventricular Septum, Open Approach,,,8271.00
Deidentified Minimum,,02QM4ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QN4ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02R50KZ,ICD10-PCS,Replacement of Atrial Septum with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R608Z,ICD10-PCS,Replacement of Right Atrium with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02R60KZ,ICD10-PCS,Replacement of Right Atrium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R64JZ,ICD10-PCS,Replacement of R Atrium with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R747Z,ICD10-PCS,Replacement of L Atrium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R908Z,ICD10-PCS,Replace of Chordae Tendineae with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02R90KZ,ICD10-PCS,Replace of Chordae Tendineae with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R947Z,ICD10-PCS,Replace Chordae Tendineae w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02RD08Z,ICD10-PCS,Replace of Papillary Muscle with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RD0JZ,ICD10-PCS,Replace of Papillary Muscle with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RF07Z,ICD10-PCS,Replacement of Aortic Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RF0JZ,ICD10-PCS,Replacement of Aortic Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RF4KZ,ICD10-PCS,Replace of Aortic Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RG07Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RG4JZ,ICD10-PCS,Replace of Mitral Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RH0JZ,ICD10-PCS,Replacement of Pulmonary Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RH47Z,ICD10-PCS,Replacement of Pulm Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RJ08Z,ICD10-PCS,Replacement of Tricusp Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RK0JZ,ICD10-PCS,Replacement of Right Ventricle with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RK0KZ,ICD10-PCS,Replacement of R Ventricle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RL0KZ,ICD10-PCS,Replacement of Left Ventricle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RL47Z,ICD10-PCS,Replace of L Ventricle with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RL4JZ,ICD10-PCS,Replace of L Ventricle with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RM07Z,ICD10-PCS,Replace of Ventricular Sept with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RM08Z,ICD10-PCS,Replace of Ventricular Sept with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RM0JZ,ICD10-PCS,Replace of Ventricular Sept with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RM0KZ,ICD10-PCS,Replace of Ventricular Sept with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RM47Z,ICD10-PCS,Replace Ventricular Sept w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02RN0JZ,ICD10-PCS,Replacement of Pericardium with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RN0KZ,ICD10-PCS,Replacement of Pericardium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RQ08Z,ICD10-PCS,Replacement of R Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RR0JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RS0KZ,ICD10-PCS,Replacement of R Pulm Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RS48Z,ICD10-PCS,Replace of R Pulm Vein with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RS4KZ,ICD10-PCS,Replace of R Pulm Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RW07Z,ICD10-PCS,Replacement of Thor Aorta Desc with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RW0JZ,ICD10-PCS,Replacement of Thor Aorta Desc with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RW0KZ,ICD10-PCS,Replace of Thor Aorta Desc with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RW48Z,ICD10-PCS,Replace Thor Aorta Desc w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02RX08Z,ICD10-PCS,Replacement of Thor Aorta Asc with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02S10ZZ,ICD10-PCS,Reposition Coronary Artery, Two Arteries, Open Approach,,,8271.00
Deidentified Minimum,,02U50JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U50KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U54JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U607Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U60KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U647Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U707Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U74KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U93JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02U94KZ,ICD10-PCS,Supplement Chordae Tendineae w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UA0JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Open Approach,,,8271.00
Deidentified Minimum,,02UA3JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Perc Approach,,,8271.00
Deidentified Minimum,,02UD08Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UD37Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UD4JZ,ICD10-PCS,Supplement Papillary Muscle w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UF37Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UF4JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UF4KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UG38Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UG3JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc,,,8271.00
Deidentified Minimum,,02UG3JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UH37Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UH3JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UJ08G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Open,,,8271.00
Deidentified Minimum,,02UJ38G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc,,,8271.00
Deidentified Minimum,,02UJ47G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UJ4JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UJ4KZ,ICD10-PCS,Supplement Tricusp Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UK4JZ,ICD10-PCS,Supplement R Ventricle with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UL37Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UL3KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UL4KZ,ICD10-PCS,Supplement L Ventricle with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UM07Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UM08Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UM3JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UM4KZ,ICD10-PCS,Supplement Ventricular Sept w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UN0JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UN0KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UN38Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Perc Approach,,,8271.00
Deidentified Minimum,,02UN3JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UP37Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UR0KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UR38Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UR3KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UR4KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02US0KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02US47Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UT3KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UT48Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UX3KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UX47Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02VA0CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Open Approach,,,8271.00
Deidentified Minimum,,02VA0ZZ,ICD10-PCS,Restriction of Heart, Open Approach,,,8271.00
Deidentified Minimum,,03SY3ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SY4ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,03U337Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03U407Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03U537Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03U737Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UB47Z,ICD10-PCS,Supplement R Radial Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UC07Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UL37Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UM07Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UM37Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UM47Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UU37Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UY37Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0410092,ICD10-PCS,Bypass Abd Aorta to Mesent Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,041009B,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Minimum,,041009J,ICD10-PCS,BP ABD AO LT FEM ART AUTO VEN TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100A5,ICD10-PCS,BP ABD AO B RENL ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100AB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Minimum,,04100AC,ICD10-PCS,BP ABDOMINAL AO BIL INTRL ILIAC ART AUTO ART OPN,,,8271.00
Deidentified Minimum,,04100AF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Minimum,,04100AK,ICD10-PCS,BYPS ABD AO B FEM ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100J1,ICD10-PCS,BYPS ABD AO CELIAC ART SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100J8,ICD10-PCS,BP ABD AO B COMMON ILIAC ART SYN SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100JJ,ICD10-PCS,BYPS ABD AO LT FEM ART SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100JR,ICD10-PCS,BYPASS ABD AO LOW ART SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100K4,ICD10-PCS,BP ABD AO LT RENL ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100K8,ICD10-PCS,BP ABD AO B CMN ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100KG,ICD10-PCS,BP ABD AO B EXT ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100KH,ICD10-PCS,BP ABD AO RT FEM ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100Z6,ICD10-PCS,BYPASS ABD AO RT COMMON ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100Z8,ICD10-PCS,BYPASS ABD AO BIL COMMON ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100ZC,ICD10-PCS,BYPASS ABD AO BIL INTRL ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Minimum,,0410491,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,0410493,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041049H,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,04104A3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104AF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104AJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104JG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104JJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104JQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104K0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104K7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104K8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104K9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104KC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104KD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104KG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104KQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104Z3,ICD10-PCS,Bypass Abdominal Aorta to R Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104Z4,ICD10-PCS,Bypass Abdominal Aorta to L Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104Z6,ICD10-PCS,Bypass Abdominal Aorta to R Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104ZB,ICD10-PCS,Bypass Abdominal Aorta to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104ZC,ICD10-PCS,Bypass Abdominal Aorta to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104ZF,ICD10-PCS,Bypass Abdominal Aorta to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0414093,ICD10-PCS,Bypass Splenic Art to R Renal A with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,04140A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Open,,,8271.00
Deidentified Minimum,,04140K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,04140Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Open Approach,,,8271.00
Deidentified Minimum,,04144A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C091,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C0A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041C0Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041C0ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041C0ZJ,ICD10-PCS,Bypass Right Common Iliac Artery to L Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041C0ZK,ICD10-PCS,Bypass Right Common Iliac Artery to B Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041C0ZR,ICD10-PCS,Bypass Right Common Iliac Artery to Low Art, Open Approach,,,8271.00
Deidentified Minimum,,041C49K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C4A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4Z5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4ZH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D091,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D099,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D09R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D0A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0Z5,ICD10-PCS,Bypass Left Common Iliac Artery to B Renal A, Open Approach,,,8271.00
Deidentified Minimum,,041D0ZG,ICD10-PCS,Bypass Left Common Iliac Artery to B Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041D0ZK,ICD10-PCS,Bypass Left Common Iliac Artery to B Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041D0ZQ,ICD10-PCS,Bypass Left Common Iliac Artery to Low Ex Art, Open Approach,,,8271.00
Deidentified Minimum,,041D490,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D499,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D49J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D4AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4Z1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4Z6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4Z9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4ZR,ICD10-PCS,Bypass L Com Iliac Art to Low Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E099,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E0AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E0ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041E0ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041E0ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041E49C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E49G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E49Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E4AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F09H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F09J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F09P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F09Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F0AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041F49B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F4AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041F4ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H099,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H09B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H09F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H09K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H0JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H0KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H0ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Open Approach,,,8271.00
Deidentified Minimum,,041H499,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H49F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H4AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J09F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J09G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J09K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J0AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J0ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041J0ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041J499,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J49C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J49P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J4AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J4ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J4ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J4ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J4ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04524ZZ,ICD10-PCS,Destruction of Gastric Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04534ZZ,ICD10-PCS,Destruction of Hepatic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04540ZZ,ICD10-PCS,Destruction of Splenic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04554ZZ,ICD10-PCS,Destruction of Sup Mesent Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04563ZZ,ICD10-PCS,Destruction of Right Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,045A3ZZ,ICD10-PCS,Destruction of Left Renal Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,045B4ZZ,ICD10-PCS,Destruction of Inf Mesent Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,045C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,045C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,045D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,045F0ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,045H3ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,045H4ZZ,ICD10-PCS,Destruction of R Ext Iliac Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04B13ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04B64ZZ,ICD10-PCS,Excision of Right Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04B73ZZ,ICD10-PCS,Excision of Left Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04BA4ZZ,ICD10-PCS,Excision of Left Renal Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04BB3ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04BE4ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R207Z,ICD10-PCS,Replacement of Gastric Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R24JZ,ICD10-PCS,Replace of Gastric Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R34JZ,ICD10-PCS,Replace of Hepatic Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R40JZ,ICD10-PCS,Replacement of Splenic Artery with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R447Z,ICD10-PCS,Replace of Splenic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R60KZ,ICD10-PCS,Replacement of R Colic Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R70JZ,ICD10-PCS,Replacement of L Colic Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R747Z,ICD10-PCS,Replace of L Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R74KZ,ICD10-PCS,Replace of L Colic Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R80JZ,ICD10-PCS,Replacement of Mid Colic Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R907Z,ICD10-PCS,Replacement of R Renal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R94JZ,ICD10-PCS,Replace of R Renal Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04RA0JZ,ICD10-PCS,Replacement of L Renal Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RA47Z,ICD10-PCS,Replace of L Renal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04RC47Z,ICD10-PCS,Replace R Com Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RE47Z,ICD10-PCS,Replace R Int Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RE4KZ,ICD10-PCS,Replace R Int Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04S20ZZ,ICD10-PCS,Reposition Gastric Artery, Open Approach,,,8271.00
Deidentified Minimum,,04S33ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04S40ZZ,ICD10-PCS,Reposition Splenic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04S73ZZ,ICD10-PCS,Reposition Left Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04S83ZZ,ICD10-PCS,Reposition Middle Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SE0ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SM0ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SN4ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SR0ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SR3ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04SU3ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SW3ZZ,ICD10-PCS,Reposition Left Foot Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04U047Z,ICD10-PCS,Supplement Abd Aorta with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U107Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04U207Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UE07Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UJ37Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UP37Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UR47Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UU47Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UY07Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05104JY,ICD10-PCS,BYPASS AZYGOS VEIN UP VEIN SYNTH SUB PERC ENDO,,,8271.00
Deidentified Minimum,,05130AY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,05140AY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,05140JY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,05140KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,05144JY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05144ZY,ICD10-PCS,Bypass Left Innominate Vein to Up Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,051507Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Open,,,8271.00
Deidentified Minimum,,051549Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,05154KY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,051609Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Open,,,8271.00
Deidentified Minimum,,05160JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Open,,,8271.00
Deidentified Minimum,,05164JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05530ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Open Approach,,,8271.00
Deidentified Minimum,,05564ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05B53ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05R007Z,ICD10-PCS,Replacement of Azygos Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R047Z,ICD10-PCS,Replace of Azygos Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R10KZ,ICD10-PCS,Replace of Hemiazygos Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R30JZ,ICD10-PCS,Replacement of R Innom Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R44KZ,ICD10-PCS,Replace of L Innom Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05S83ZZ,ICD10-PCS,Reposition Left Axillary Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SF0ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SN3ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SQ4ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05ST0ZZ,ICD10-PCS,Reposition Right Face Vein, Open Approach,,,8271.00
Deidentified Minimum,,05ST4ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,05SV0ZZ,ICD10-PCS,Reposition Left Face Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SY3ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05UA37Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UB07Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UC47Z,ICD10-PCS,Supplement L Basilic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05UD37Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UD47Z,ICD10-PCS,Supplement R Cephalic Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05UF07Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UG47Z,ICD10-PCS,Supplement R Hand Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05UH47Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05UL37Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UL47Z,ICD10-PCS,Supplement Intracran Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05UM07Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UN07Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UP47Z,ICD10-PCS,Supplement R Ext Jugular Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05UR37Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UR47Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05UT07Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UT37Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UV47Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05UY07Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UY47Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06504ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06513ZZ,ICD10-PCS,Destruction of Splenic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06523ZZ,ICD10-PCS,Destruction of Gastric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06544ZZ,ICD10-PCS,Destruction of Hepatic Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06563ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Approach,,,8271.00
Deidentified Minimum,,065C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,065C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Approach,,,8271.00
Deidentified Minimum,,065D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,065F4ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,065J0ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B03ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06B24ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06B40ZZ,ICD10-PCS,Excision of Hepatic Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B43ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06B60ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B64ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06BB0ZZ,ICD10-PCS,Excision of Left Renal Vein, Open Approach,,,8271.00
Deidentified Minimum,,06BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06BF4ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R007Z,ICD10-PCS,Replacement of Inf Vena Cava with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R207Z,ICD10-PCS,Replacement of Gastric Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R50KZ,ICD10-PCS,Replace of Sup Mesent Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R70KZ,ICD10-PCS,Replacement of Colic Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RC0JZ,ICD10-PCS,Replace of R Com Iliac Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RC47Z,ICD10-PCS,Replace R Com Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RF4KZ,ICD10-PCS,Replace R Ext Iliac Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RG0KZ,ICD10-PCS,Replace of L Ext Iliac Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RG4JZ,ICD10-PCS,Replace L Ext Iliac Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RH0KZ,ICD10-PCS,Replace of R Hypogast Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06S00ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Open Approach,,,8271.00
Deidentified Minimum,,06S03ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06S04ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06S10ZZ,ICD10-PCS,Reposition Splenic Vein, Open Approach,,,8271.00
Deidentified Minimum,,06S34ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06S40ZZ,ICD10-PCS,Reposition Hepatic Vein, Open Approach,,,8271.00
Deidentified Minimum,,06S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06S63ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06S64ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06S84ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06SF4ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SN4ZZ,ICD10-PCS,Reposition Left Femoral Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SQ3ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SR3ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Approach,,,8271.00
Deidentified Minimum,,06ST3ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06U037Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06U107Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06U347Z,ICD10-PCS,Supplement Esophageal Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06U507Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06U907Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UB07Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UV07Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UY37Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06500ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Open Approach,,,8271.00
Deidentified Minimum,,06514ZZ,ICD10-PCS,Destruction of Splenic Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06560ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06573ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06594ZZ,ICD10-PCS,Destruction of Right Renal Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,065C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,065D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,065J4ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06B14ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06B23ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06B63ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06B70ZZ,ICD10-PCS,Excision of Colic Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B80ZZ,ICD10-PCS,Excision of Portal Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B93ZZ,ICD10-PCS,Excision of Right Renal Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06BG0ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,06R00KZ,ICD10-PCS,Replacement of Inf Vena Cava with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R04KZ,ICD10-PCS,Replace of Inf Vena Cava with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R40KZ,ICD10-PCS,Replacement of Hepatic Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R44KZ,ICD10-PCS,Replace of Hepatic Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R547Z,ICD10-PCS,Replace Sup Mesent Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06R807Z,ICD10-PCS,Replacement of Portal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R80KZ,ICD10-PCS,Replacement of Portal Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R84KZ,ICD10-PCS,Replace of Portal Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R94JZ,ICD10-PCS,Replace of R Renal Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R94KZ,ICD10-PCS,Replace of R Renal Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06RB47Z,ICD10-PCS,Replace of L Renal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06RB4JZ,ICD10-PCS,Replace of L Renal Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06RC0KZ,ICD10-PCS,Replace of R Com Iliac Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RC4JZ,ICD10-PCS,Replace R Com Iliac Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RD4KZ,ICD10-PCS,Replace L Com Iliac Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RF47Z,ICD10-PCS,Replace R Ext Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RJ07Z,ICD10-PCS,Replacement of L Hypogast Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RJ47Z,ICD10-PCS,Replace L Hypogast Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RJ4JZ,ICD10-PCS,Replace L Hypogast Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06S23ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06S30ZZ,ICD10-PCS,Reposition Esophageal Vein, Open Approach,,,8271.00
Deidentified Minimum,,06S33ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06S43ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06S44ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06S83ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SM3ZZ,ICD10-PCS,Reposition Right Femoral Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SP0ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SR0ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Open Approach,,,8271.00
Deidentified Minimum,,06ST0ZZ,ICD10-PCS,Reposition Right Foot Vein, Open Approach,,,8271.00
Deidentified Minimum,,06U047Z,ICD10-PCS,Supplement Inf Vena Cava with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06U137Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06U307Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06U407Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UD47Z,ICD10-PCS,Supplement L Com Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06UF07Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UG07Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UG47Z,ICD10-PCS,Supplement L Ext Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06UH37Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UM37Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UP37Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UQ07Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UT47Z,ICD10-PCS,Supplement R Foot Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0DQP0ZZ,ICD10-PCS,Repair Rectum, Open Approach,,,4303.00
Deidentified Minimum,,0DQP8ZZ,ICD10-PCS,Repair Rectum, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Minimum,,0PS33ZZ,ICD10-PCS,Reposition Cervical Vertebra, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0PS3XZZ,ICD10-PCS,Reposition Cervical Vertebra, External Approach,,,8271.00
Deidentified Minimum,,0QS004Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Open Approach,,,8271.00
Deidentified Minimum,,0QS10ZZ,ICD10-PCS,Reposition Sacrum, Open Approach,,,8271.00
Deidentified Minimum,,0QSS0ZZ,ICD10-PCS,Reposition Coccyx, Open Approach,,,8271.00
Deidentified Minimum,,0RB33ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0RBB4ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG00JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG00Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG00Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG00ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG03KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG03Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG04J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG04J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG04JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG04KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG107J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG1371,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG137J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG14A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG14J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG14Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG23K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG23K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG23KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG24AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG24JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG24KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG24ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG4070,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG4371,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG437J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG43A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG43K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG43ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG4470,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG4471,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG44A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG44KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG6070,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG60A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG6370,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG6371,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG63AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG63J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG63K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG64A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG64K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG70A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG7370,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG73A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG73K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG7470,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG74AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG74K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG83J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG8470,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG8471,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG84JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG84K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG84Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG84Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RGA071,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RGA0ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RGA370,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RGA3J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RGA470,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA471,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA4A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA4JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA4Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RH10BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RH13BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RH13CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RH13DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RH14BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Cerv Jt, Perc Endo,,,8271.00
Deidentified Minimum,,0RH43CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RH64CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Thor Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RHA3BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc,,,8271.00
Deidentified Minimum,,0RU03JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0RU10JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RU53JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0RW50JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RWB4JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SB44ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG007J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG00J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG00ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0SG0371,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG03A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG03KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG04KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG10J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG10JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG10K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG1371,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG137J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG13A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG13J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG13K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG14K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG307J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG30AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG33JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG34J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG34J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG34Z0,ICD10-PCS,Fusion of Lumsac Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG34Z1,ICD10-PCS,Fusion of Lumsac Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG504Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Open Approach,,,8271.00
Deidentified Minimum,,0SG50JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG50KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG537Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SG547Z,ICD10-PCS,Fusion Sacrococcygeal Jt w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,0SG607Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG63ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SG644Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG844Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Open Approach,,,8271.00
Deidentified Minimum,,0SH33DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0SR901A,ICD10-PCS,Replacement of R Hip Jt with Metal, Uncement, Open Approach,,,8271.00
Deidentified Minimum,,0SR9029,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Cement, Open,,,8271.00
Deidentified Minimum,,0SR903Z,ICD10-PCS,REPLACE RT HIP JOINT CERAMIC SYNTH SUBST OPEN,,,8271.00
Deidentified Minimum,,0SR9049,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Cement, Open,,,8271.00
Deidentified Minimum,,0SRA01A,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRB01Z,ICD10-PCS,Replacement of Left Hip Joint with Metal, Open Approach,,,8271.00
Deidentified Minimum,,0SRB029,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Cement, Open,,,8271.00
Deidentified Minimum,,0SRB039,ICD10-PCS,Replacement of L Hip Jt with Ceramic, Cement, Open Approach,,,8271.00
Deidentified Minimum,,0SRB03A,ICD10-PCS,Replace of L Hip Jt with Ceramic, Uncement, Open Approach,,,8271.00
Deidentified Minimum,,0SRB0JA,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Uncement, Open Approach,,,8271.00
Deidentified Minimum,,0SRC0JA,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Uncement, Open Approach,,,8271.00
Deidentified Minimum,,0SRD0KZ,ICD10-PCS,Replacement of L Knee Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRE009,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Cement, Open,,,8271.00
Deidentified Minimum,,0SRE00A,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRE07Z,ICD10-PCS,Replace of L Hip Jt, Acetab with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRR03Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Ceramic, Open Approach,,,8271.00
Deidentified Minimum,,0SRS019,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Cement, Open,,,8271.00
Deidentified Minimum,,0SRS03A,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRS0JZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRS0KZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRU0JZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRW0KZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SU50JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SU63JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SU64JZ,ICD10-PCS,Supplement Coccygeal Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SUA0BZ,ICD10-PCS,Supplement R Hip Jt, Acetab with Resurf Dev, Open Approach,,,8271.00
Deidentified Minimum,,0SUE0BZ,ICD10-PCS,Supplement L Hip Jt, Acetab with Resurf Dev, Open Approach,,,8271.00
Deidentified Minimum,,0SW23JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Perc Approach,,,8271.00
Deidentified Minimum,,0SW93JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0TQD8ZZ,ICD10-PCS,Repair Urethra, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Minimum,,0TQDXZZ,ICD10-PCS,Repair Urethra, External Approach,,,4303.00
Deidentified Minimum,,0UQ98ZZ,ICD10-PCS,Repair Uterus, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Minimum,,0UQGXZZ,ICD10-PCS,Repair Vagina, External Approach,,,4303.00
Deidentified Minimum,,0WFD0ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Open Approach,,,8271.00
Deidentified Minimum,,0WFDXZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, External Approach,,,8271.00
Deidentified Minimum,,10E0XZZ,ICD10-PCS,Delivery of Products of Conception, External Approach,,,4303.00
Deidentified Minimum,,4A020N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Open,,,8271.00
Deidentified Minimum,,5A02210,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Continuous,,,8271.00
Deidentified Minimum,,5A0221D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Continuous,,,8271.00
Deidentified Minimum,,B2010ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2021ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using L Osm Contrast,,,8271.00
Deidentified Minimum,,B2051ZZ,ICD10-PCS,Plain Radiography of Left Heart using Low Osmolar Contrast,,,8271.00
Deidentified Minimum,,B205YZZ,ICD10-PCS,Plain Radiography of Left Heart using Other Contrast,,,8271.00
Deidentified Minimum,,B2060ZZ,ICD10-PCS,Plain Radiography of R & L Heart using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2061ZZ,ICD10-PCS,Plain Radiography of R & L Heart using L Osm Contrast,,,8271.00
Deidentified Minimum,,B208YZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using Oth Contrast,,,8271.00
Deidentified Minimum,,B20F0ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2121ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using L Osm Contrast,,,8271.00
Deidentified Minimum,,B2151ZZ,ICD10-PCS,Fluoroscopy of Left Heart using Low Osmolar Contrast,,,8271.00
Deidentified Minimum,,B216YZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using Other Contrast,,,8271.00
Deidentified Minimum,,03UB07Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UB37Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UD07Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UH37Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UK07Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UK37Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UK47Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UL47Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03US37Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UV07Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UY47Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0410096,ICD10-PCS,Bypass Abd Aorta to R Com Ilia with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,041009Q,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO VEN TISS OPN APPR,,,8271.00
Deidentified Minimum,,041009R,ICD10-PCS,BYPS ABD AO LOW ART AUTO VEN TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100A0,ICD10-PCS,BYPS ABD AO ABD AO AUTO ART TISSUE OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100A7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Minimum,,04100A9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Minimum,,04100AD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Minimum,,04100AG,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO ART TISS OPN APPR,,,8271.00
Deidentified Minimum,,04100AR,ICD10-PCS,BYPS ABD AO LOW ART AUTO ART TISSUE OPN APPROACH,,,8271.00
Deidentified Minimum,,04100J0,ICD10-PCS,BYPASS ABD AO ABD AO SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100J3,ICD10-PCS,BYPS ABD AO RT RENL ART SYNTH SUBST OPN APPROACH,,,8271.00
Deidentified Minimum,,04100J4,ICD10-PCS,BYPS ABD AO LT RENL ART SYNTH SUBST OPN APPROACH,,,8271.00
Deidentified Minimum,,04100K2,ICD10-PCS,BP ABD AO MES ART NONAUTO TISS SUB OPN APPROACH,,,8271.00
Deidentified Minimum,,04100KC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100KQ,ICD10-PCS,BP ABD AO LOW EXT ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100Z5,ICD10-PCS,BYPASS ABDDOMINAL AORTA BILATERAL RENAL ART OPEN,,,8271.00
Deidentified Minimum,,04100ZG,ICD10-PCS,BYPASS ABD AO BIL EXT ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Open Approach,,,8271.00
Deidentified Minimum,,0410496,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,0410499,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041049K,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041049R,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,04104A0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104A1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104A6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104A9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104AG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104AK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104J0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104J1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104J3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104J9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104JC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104JF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104K3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104K5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104KK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104Z1,ICD10-PCS,Bypass Abdominal Aorta to Celiac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104ZD,ICD10-PCS,Bypass Abdominal Aorta to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104ZG,ICD10-PCS,Bypass Abdominal Aorta to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104ZJ,ICD10-PCS,Bypass Abdominal Aorta to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04140A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Open,,,8271.00
Deidentified Minimum,,04140J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,04140K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,0414493,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,04144J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04144K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04144Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C090,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C093,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C097,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C09B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C09J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C09Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C09R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C0A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Open Approach,,,8271.00
Deidentified Minimum,,041C0Z4,ICD10-PCS,Bypass Right Common Iliac Artery to L Renal A, Open Approach,,,8271.00
Deidentified Minimum,,041C0Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041C0ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041C491,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C494,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C499,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C49R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C4A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4Z4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D090,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D093,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D094,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D097,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D09J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D0A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0Z2,ICD10-PCS,Bypass Left Common Iliac Artery to Mesent Art, Open Approach,,,8271.00
Deidentified Minimum,,041D0Z6,ICD10-PCS,Bypass Left Common Iliac Artery to R Com Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041D0ZC,ICD10-PCS,Bypass Left Common Iliac Artery to B Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041D491,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D493,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D49B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D49F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D49R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D4A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4ZB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E09B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E09D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E09J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E0AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041E49K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E4J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E4ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041F0AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Open Approach,,,8271.00
Deidentified Minimum,,041F499,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F49K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F4KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H09D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H09J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H0AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H49B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H49C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H49G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H49P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H4JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H4ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J09C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J09D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J09H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J0A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J0KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J0ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Open Approach,,,8271.00
Deidentified Minimum,,041J49B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J49D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J49F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J49J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J4AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04503ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04514ZZ,ICD10-PCS,Destruction of Celiac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04573ZZ,ICD10-PCS,Destruction of Left Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04574ZZ,ICD10-PCS,Destruction of Left Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04580ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04590ZZ,ICD10-PCS,Destruction of Right Renal Artery, Open Approach,,,8271.00
Deidentified Minimum,,045D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04B00ZZ,ICD10-PCS,Excision of Abdominal Aorta, Open Approach,,,8271.00
Deidentified Minimum,,04B40ZZ,ICD10-PCS,Excision of Splenic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04B44ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,04B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Minimum,,04B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04B70ZZ,ICD10-PCS,Excision of Left Colic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04BA0ZZ,ICD10-PCS,Excision of Left Renal Artery, Open Approach,,,8271.00
Deidentified Minimum,,04BA3ZZ,ICD10-PCS,Excision of Left Renal Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04BB0ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Minimum,,04BJ4ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R00JZ,ICD10-PCS,Replacement of Abdominal Aorta with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R107Z,ICD10-PCS,Replacement of Celiac Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R10JZ,ICD10-PCS,Replacement of Celiac Artery with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R307Z,ICD10-PCS,Replacement of Hepatic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R44JZ,ICD10-PCS,Replace of Splenic Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R50KZ,ICD10-PCS,Replacement of Sup Mesent Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R547Z,ICD10-PCS,Replace of Sup Mesent Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R54KZ,ICD10-PCS,Replace Sup Mesent Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04R707Z,ICD10-PCS,Replacement of L Colic Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R90KZ,ICD10-PCS,Replacement of R Renal Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RA0KZ,ICD10-PCS,Replacement of L Renal Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RC0KZ,ICD10-PCS,Replace of R Com Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RD4KZ,ICD10-PCS,Replace L Com Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RE0JZ,ICD10-PCS,Replacement of R Int Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RE0KZ,ICD10-PCS,Replace of R Int Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RF4KZ,ICD10-PCS,Replace L Int Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RH07Z,ICD10-PCS,Replacement of R Ext Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04S00ZZ,ICD10-PCS,Reposition Abdominal Aorta, Open Approach,,,8271.00
Deidentified Minimum,,04S03ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04S04ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,04S13ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SE3ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04SF3ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SF4ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SH4ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SK3ZZ,ICD10-PCS,Reposition Right Femoral Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SP0ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SP3ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04SS0ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SS4ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SW0ZZ,ICD10-PCS,Reposition Left Foot Artery, Open Approach,,,8271.00
Deidentified Minimum,,04U637Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04U747Z,ICD10-PCS,Supplement L Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U847Z,ICD10-PCS,Supplement Mid Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U907Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04U937Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UF07Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UK07Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UK47Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UN47Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UP47Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UQ07Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UR37Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UU07Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05100KY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,05100ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Minimum,,05104ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05110KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,051309Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,051349Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,05134AY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,05134ZY,ICD10-PCS,Bypass Right Innominate Vein to Up Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05144AY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,05154AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,05160AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Open,,,8271.00
Deidentified Minimum,,05160ZY,ICD10-PCS,Bypass Left Subclavian Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Minimum,,05164KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05514ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05533ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05560ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Open Approach,,,8271.00
Deidentified Minimum,,05B63ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05R04JZ,ICD10-PCS,Replace of Azygos Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R107Z,ICD10-PCS,Replacement of Hemiazygos Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R147Z,ICD10-PCS,Replace Hemiazygos Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05R14KZ,ICD10-PCS,Replace Hemiazygos Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05R40JZ,ICD10-PCS,Replacement of L Innom Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R447Z,ICD10-PCS,Replace of L Innom Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05S10ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Open Approach,,,8271.00
Deidentified Minimum,,05S40ZZ,ICD10-PCS,Reposition Left Innominate Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SC4ZZ,ICD10-PCS,Reposition Left Basilic Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SH0ZZ,ICD10-PCS,Reposition Left Hand Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SH4ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,05SP0ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SP3ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Approach,,,8271.00
Deidentified Minimum,,05SQ3ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SR3ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05ST3ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05U437Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05U607Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05U707Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05U907Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UA07Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UD07Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UN37Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UN47Z,ICD10-PCS,Supplement L Int Jugular Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05UV37Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06540ZZ,ICD10-PCS,Destruction of Hepatic Vein, Open Approach,,,8271.00
Deidentified Minimum,,06583ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06593ZZ,ICD10-PCS,Destruction of Right Renal Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,065G4ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,065J3ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06B00ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Open Approach,,,8271.00
Deidentified Minimum,,06B20ZZ,ICD10-PCS,Excision of Gastric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B74ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06B83ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06B84ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06BB3ZZ,ICD10-PCS,Excision of Left Renal Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,06BG3ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06BH3ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06BH4ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06BJ0ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06BJ4ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R20JZ,ICD10-PCS,Replacement of Gastric Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R24JZ,ICD10-PCS,Replace of Gastric Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R40JZ,ICD10-PCS,Replacement of Hepatic Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R507Z,ICD10-PCS,Replacement of Sup Mesent Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R80JZ,ICD10-PCS,Replacement of Portal Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RB4KZ,ICD10-PCS,Replace of L Renal Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06RD4JZ,ICD10-PCS,Replace L Com Iliac Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RG47Z,ICD10-PCS,Replace L Ext Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RG4KZ,ICD10-PCS,Replace L Ext Iliac Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RH07Z,ICD10-PCS,Replacement of R Hypogast Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RJ0JZ,ICD10-PCS,Replacement of L Hypogast Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RJ0KZ,ICD10-PCS,Replace of L Hypogast Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06S14ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06S70ZZ,ICD10-PCS,Reposition Colic Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SG0ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SH0ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SM4ZZ,ICD10-PCS,Reposition Right Femoral Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SQ4ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SS3ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06ST4ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06U337Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06U537Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06U847Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06UB37Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UC37Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UC47Z,ICD10-PCS,Supplement R Com Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06UD07Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UF37Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UJ37Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UV07Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0DQR4ZZ,ICD10-PCS,Repair Anal Sphincter, Percutaneous Endoscopic Approach,,,4303.00
Deidentified Minimum,,0JH608Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Open Approach,,,8271.00
Deidentified Minimum,,0JH838Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Perc Approach,,,8271.00
Deidentified Minimum,,0PS404Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Open Approach,,,8271.00
Deidentified Minimum,,0PS40ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Open Approach,,,8271.00
Deidentified Minimum,,0PS43ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0QS03ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0QS144Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0QS1XZZ,ICD10-PCS,Reposition Sacrum, External Approach,,,8271.00
Deidentified Minimum,,0R590ZZ,ICD10-PCS,Destruction of Thoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RB14ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RB50ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RB63ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0RB90ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RBB3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Approach,,,8271.00
Deidentified Minimum,,001U079,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Open,,,8271.00
Deidentified Minimum,,001U0J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Open,,,8271.00
Deidentified Minimum,,001U374,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Perc,,,8271.00
Deidentified Minimum,,001U376,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Perc,,,8271.00
Deidentified Minimum,,001U379,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Perc,,,8271.00
Deidentified Minimum,,005Y0ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,009T4ZX,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach, Diagn,,,8271.00
Deidentified Minimum,,009T4ZZ,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach,,,8271.00
Deidentified Minimum,,009W30Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Perc Approach,,,8271.00
Deidentified Minimum,,009W4ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Minimum,,009W4ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,009X4ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Minimum,,00BT0ZZ,ICD10-PCS,EXCISION OF SPINAL MENINGES OPEN APPROACH,,,8271.00
Deidentified Minimum,,00BT3ZX,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach, Diagn,,,8271.00
Deidentified Minimum,,00BW3ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00BX3ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Approach, Diagn,,,8271.00
Deidentified Minimum,,00BX3ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00BY0ZZ,ICD10-PCS,EXCISION OF LUMBAR SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Minimum,,00C33ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Perc Approach,,,8271.00
Deidentified Minimum,,00CT0ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Open Approach,,,8271.00
Deidentified Minimum,,00CW3ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00CY3ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00HU0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00HU3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00NY0ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00PU0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00PV03Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00PV0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00PV32Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00PV4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00QX4ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00QY0ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00SW4ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00SX0ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00SX4ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00SY0ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00SY4ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00UT0JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,00WU0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00WU43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00WV0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00WV30Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00WV40Z,ICD10-PCS,Revision of Drain Dev in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,01813ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,01883ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0210083,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,0210088,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021008F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,021009C,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02100A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Open,,,8271.00
Deidentified Minimum,,02100JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02100K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02100KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02100Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Open Approach,,,8271.00
Deidentified Minimum,,02100Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,0210498,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,0210499,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021049F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02104A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02104AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02104J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02104KW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02104Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02110A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Open,,,8271.00
Deidentified Minimum,,02110AW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02110KW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02110Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,021148C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0211499,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021149W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02114A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02114K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0212083,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,021208F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02120J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02120JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02120KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02120KW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02120ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Open Approach,,,8271.00
Deidentified Minimum,,0212488,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0212489,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021249C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02124AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02124J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02124JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02124K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02124KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02124KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,0213093,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02130A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02130ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Open Approach,,,8271.00
Deidentified Minimum,,021349W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02134AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02134AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02134JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02134KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02134Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021608Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,021609R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02160JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02160KR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02164AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02164AR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02164ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02170KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02170ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Minimum,,021749R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02174AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02174JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021K09P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021K0AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,021K0Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,021K0ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,021K48Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021L09P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021L09Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021L0JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021L0KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021L48Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021L48R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021L4JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021L4KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021V08Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021V48P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021V4AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021V4JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W08R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021W0AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,021W0KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021W4JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021X08P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021X09B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021X0AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Open,,,8271.00
Deidentified Minimum,,021X0AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,021X0AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,021X0JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021X0KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021X0KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021X4AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021X4AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021X4ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Perc Endo Approach,,,8271.00
Deidentified Minimum,,024F0JJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02573ZZ,ICD10-PCS,Destruction of Left Atrium, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025F0ZZ,ICD10-PCS,Destruction of Aortic Valve, Open Approach,,,8271.00
Deidentified Minimum,,025G3ZZ,ICD10-PCS,Destruction of Mitral Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025R0ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Open Approach,,,8271.00
Deidentified Minimum,,025R3ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025S3ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025T4ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,025V0ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Open Approach,,,8271.00
Deidentified Minimum,,025V3ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025V4ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027007Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02700F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Open,,,8271.00
Deidentified Minimum,,027034Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Perc Approach,,,8271.00
Deidentified Minimum,,02703DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02703ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Approach,,,8271.00
Deidentified Minimum,,0270446,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,,8271.00
Deidentified Minimum,,02704D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02704FZ,ICD10-PCS,Dilate of 1 Cor Art with 3 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02704GZ,ICD10-PCS,Dilate of 1 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02710GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02710Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Minimum,,027134Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Perc Approach,,,8271.00
Deidentified Minimum,,027137Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02713D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02713FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02713GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02713TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Perc Approach,,,8271.00
Deidentified Minimum,,02713ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Perc Approach,,,8271.00
Deidentified Minimum,,02714E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02714FZ,ICD10-PCS,Dilate of 2 Cor Art with 3 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02714TZ,ICD10-PCS,Dilate 2 Cor Art w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,02714ZZ,ICD10-PCS,Dilation of 2 Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027204Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Open Approach,,,8271.00
Deidentified Minimum,,0272056,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02723E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02723EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02723F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02723T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc,,,8271.00
Deidentified Minimum,,02723TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Perc Approach,,,8271.00
Deidentified Minimum,,0272446,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,,8271.00
Deidentified Minimum,,02724F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02724TZ,ICD10-PCS,Dilate 3 Cor Art w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,02724ZZ,ICD10-PCS,Dilation of 3 Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02730FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02730TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Open Approach,,,8271.00
Deidentified Minimum,,02730Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Minimum,,0273346,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc,,,8271.00
Deidentified Minimum,,0273356,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc,,,8271.00
Deidentified Minimum,,027335Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,0273366,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc,,,8271.00
Deidentified Minimum,,027337Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02733DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02733TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Perc Approach,,,8271.00
Deidentified Minimum,,0273466,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,02734EZ,ICD10-PCS,Dilate of 4+ Cor Art with 2 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02734T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,027F04Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Open,,,8271.00
Deidentified Minimum,,027G04Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Open,,,8271.00
Deidentified Minimum,,027G0DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,027H3DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,027H44Z,ICD10-PCS,Dilate Pulm Valve w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,027H4ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027K3ZZ,ICD10-PCS,Dilation of Right Ventricle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02890ZZ,ICD10-PCS,Division of Chordae Tendineae, Open Approach,,,8271.00
Deidentified Minimum,,02B40ZZ,ICD10-PCS,Excision of Coronary Vein, Open Approach,,,8271.00
Deidentified Minimum,,02B44ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02B60ZZ,ICD10-PCS,Excision of Right Atrium, Open Approach,,,8271.00
Deidentified Minimum,,02B73ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BF3ZZ,ICD10-PCS,Excision of Aortic Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BG0ZZ,ICD10-PCS,Excision of Mitral Valve, Open Approach,,,8271.00
Deidentified Minimum,,02BK0ZZ,ICD10-PCS,Excision of Right Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,02BL3ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BL4ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02BR0ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Open Approach,,,8271.00
Deidentified Minimum,,02BR3ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BS4ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02BT0ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Open Approach,,,8271.00
Deidentified Minimum,,02BT3ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BV0ZZ,ICD10-PCS,Excision of Superior Vena Cava, Open Approach,,,8271.00
Deidentified Minimum,,02BW4ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02C00Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Minimum,,02C23Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Minimum,,02C24ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02C30Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Minimum,,02C40ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Open Approach,,,8271.00
Deidentified Minimum,,02H40DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Open Approach,,,8271.00
Deidentified Minimum,,02H43NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Perc Approach,,,8271.00
Deidentified Minimum,,02H60KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Open Approach,,,8271.00
Deidentified Minimum,,02HA0RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Open Approach,,,8271.00
Deidentified Minimum,,02HP0DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Open Approach,,,8271.00
Deidentified Minimum,,02HQ4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HW0DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Open Approach,,,8271.00
Deidentified Minimum,,02HW42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Desc, Perc Endo,,,8271.00
Deidentified Minimum,,02K80ZZ,ICD10-PCS,Map Conduction Mechanism, Open Approach,,,8271.00
Deidentified Minimum,,02LH0ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Open Approach,,,8271.00
Deidentified Minimum,,02LH3DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02N83ZZ,ICD10-PCS,Release Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02N84ZZ,ICD10-PCS,Release Conduction Mechanism, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02NK4ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02NL0ZZ,ICD10-PCS,Release Left Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,02PY47Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02PY4CZ,ICD10-PCS,Remove of Extralum Dev from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02Q03ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02Q04ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02Q10ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Open Approach,,,8271.00
Deidentified Minimum,,02Q33ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Perc Approach,,,8271.00
Deidentified Minimum,,02Q50ZZ,ICD10-PCS,Repair Atrial Septum, Open Approach,,,8271.00
Deidentified Minimum,,02Q54ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02Q83ZZ,ICD10-PCS,Repair Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02Q94ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QA3ZZ,ICD10-PCS,Repair Heart, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02QB0ZZ,ICD10-PCS,Repair Right Heart, Open Approach,,,8271.00
Deidentified Minimum,,02QB4ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QC0ZZ,ICD10-PCS,Repair Left Heart, Open Approach,,,8271.00
Deidentified Minimum,,02QF3ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02QG4ZE,ICD10-PCS,Repair Mitral Valve fr L AV Vlv, Perc Endo,,,8271.00
Deidentified Minimum,,02QH3ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02QK4ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QL4ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QN0ZZ,ICD10-PCS,Repair Pericardium, Open Approach,,,8271.00
Deidentified Minimum,,02QN3ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02R507Z,ICD10-PCS,Replacement of Atrial Septum with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R70KZ,ICD10-PCS,Replacement of Left Atrium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R948Z,ICD10-PCS,Replace Chordae Tendineae w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02RG3KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02RK4KZ,ICD10-PCS,Replace of R Ventricle with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RL08Z,ICD10-PCS,Replacement of Left Ventricle with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RN48Z,ICD10-PCS,Replace of Pericardium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RN4KZ,ICD10-PCS,Replace of Pericardium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RP0KZ,ICD10-PCS,Replacement of Pulm Trunk with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RR07Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RR48Z,ICD10-PCS,Replace of L Pulm Art with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RS07Z,ICD10-PCS,Replacement of R Pulm Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RS0JZ,ICD10-PCS,Replacement of R Pulm Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RT08Z,ICD10-PCS,Replacement of L Pulm Vein with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RT0KZ,ICD10-PCS,Replacement of L Pulm Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RW4JZ,ICD10-PCS,Replace Thor Aorta Desc w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02RX0KZ,ICD10-PCS,Replacement of Thor Aorta Asc with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RX48Z,ICD10-PCS,Replace Thor Aorta Asc w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02SQ0ZZ,ICD10-PCS,Reposition Right Pulmonary Artery, Open Approach,,,8271.00
Deidentified Minimum,,02ST0ZZ,ICD10-PCS,Reposition Left Pulmonary Vein, Open Approach,,,8271.00
Deidentified Minimum,,02SW0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Descending, Open Approach,,,8271.00
Deidentified Minimum,,02TD3ZZ,ICD10-PCS,Resection of Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02U53JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02U548Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U60JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U90KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U93KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02U948Z,ICD10-PCS,Supplement Chordae Tendineae w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02UA47Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UD3JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UD3KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UF07J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Open,,,8271.00
Deidentified Minimum,,02UF0JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UF0KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UF3KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UF47J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UF48J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02UG0KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UG3KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc,,,8271.00
Deidentified Minimum,,02UG47E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UG48Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UH08Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UK37Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UK3KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UK47Z,ICD10-PCS,Supplement R Ventricle with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UL07Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UM37Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UM38Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UM3KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UM4JZ,ICD10-PCS,Supplement Ventricular Sept w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UN08Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Open Approach,,,8271.00
Deidentified Minimum,,02UP07Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UP0KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UP3KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UP47Z,ICD10-PCS,Supplement Pulm Trunk with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UQ0KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UQ37Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UQ47Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UV0KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UV3KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UW47Z,ICD10-PCS,Supplement Thor Aorta Desc w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UX0KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UX37Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UX38Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02VA3ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02VA4ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02VW0EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Open,,,8271.00
Deidentified Minimum,,02VW3EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc,,,8271.00
Deidentified Minimum,,02VX3DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02VX4DZ,ICD10-PCS,Restrict Thor Aorta Asc w Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02WF08Z,ICD10-PCS,Revision of Zooplastic Tissue in Aortic Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WG0JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WG4KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WY0CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02WY4CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,031309N,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,03130ZM,ICD10-PCS,Bypass Right Subclavian Artery to R Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,03500ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Minimum,,03543ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03B03ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03B30ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Open Approach,,,8271.00
Deidentified Minimum,,03B40ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Open Approach,,,8271.00
Deidentified Minimum,,03R14KZ,ICD10-PCS,Replace L Int Mamm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,03R30KZ,ICD10-PCS,Replacement of R Subclav Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R40KZ,ICD10-PCS,Replacement of L Subclav Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,03S03ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03S14ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S50ZZ,ICD10-PCS,Reposition Right Axillary Artery, Open Approach,,,8271.00
Deidentified Minimum,,03S53ZZ,ICD10-PCS,Reposition Right Axillary Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03S54ZZ,ICD10-PCS,Reposition Right Axillary Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S60ZZ,ICD10-PCS,Reposition Left Axillary Artery, Open Approach,,,8271.00
Deidentified Minimum,,03S64ZZ,ICD10-PCS,Reposition Left Axillary Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S83ZZ,ICD10-PCS,Reposition Left Brachial Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03S94ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SD3ZZ,ICD10-PCS,Reposition Right Hand Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SG3ZZ,ICD10-PCS,Reposition Intracranial Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SK0ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SL4ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SN4ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03ST3ZZ,ICD10-PCS,Reposition Left Temporal Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03ST4ZZ,ICD10-PCS,Reposition Left Temporal Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SU3ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03U047Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,001U0J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Open,,,8271.00
Deidentified Minimum,,001U3K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Perc,,,8271.00
Deidentified Minimum,,005Y4ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,008Y4ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,009T3ZX,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach, Diagn,,,8271.00
Deidentified Minimum,,009U0ZZ,ICD10-PCS,DRAINAGE OF SPINAL CANAL OPEN APPROACH,,,8271.00
Deidentified Minimum,,009W3ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,009X3ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Approach, Diagn,,,8271.00
Deidentified Minimum,,009X3ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,009Y00Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Open Approach,,,8271.00
Deidentified Minimum,,009Y0ZZ,ICD10-PCS,DRAINAGE OF LUMBAR SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Minimum,,00BT4ZZ,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00BW0ZZ,ICD10-PCS,EXCISION OF CERVICAL SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Minimum,,00BX0ZZ,ICD10-PCS,EXCISION OF THORACIC SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Minimum,,00C30ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Open Approach,,,8271.00
Deidentified Minimum,,00CY4ZZ,ICD10-PCS,Extirpate of Matter from Lum Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00FU3ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00HU4MZ,ICD10-PCS,Insert of Neuro Lead into Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00JV0ZZ,ICD10-PCS,INSPECTION OF SPINAL CORD OPEN APPR,,,8271.00
Deidentified Minimum,,00JV3ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00JV4ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,00PU0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00PU3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00PV02Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00PV30Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00PV37Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00PV3KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00PV3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00PV47Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00QW0ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00QX0ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00QY4ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,00SW0ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00UT47Z,ICD10-PCS,Supplement Spinal Meninges w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,00UT4JZ,ICD10-PCS,Supplement Spinal Meninges w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,00WU02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00WU32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00WU33Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00WU4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00WV00Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00WV03Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00WV07Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00WV0KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00WV43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00WV4KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,01810ZZ,ICD10-PCS,DIVISION OF CERVICAL NERVE OPEN APPROACH,,,8271.00
Deidentified Minimum,,01814ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,018B3ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE PERCUTANEOUS APPROACH,,,8271.00
Deidentified Minimum,,0210089,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021009F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,021009W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02100AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02100J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02100KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02100KW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02100ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Open Approach,,,8271.00
Deidentified Minimum,,0210488,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021048F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021048W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021049W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02104JW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,0211083,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,0211088,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021108F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,021108W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02110A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02110AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02110J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02110KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02110KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02110ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Open Approach,,,8271.00
Deidentified Minimum,,021148F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0211493,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02114A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02114AW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02114J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0212088,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Minimum,,0212089,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Minimum,,02120AW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02120KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,0212483,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0212498,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02124JW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02124ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0213098,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021309F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,021309W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02130A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Open,,,8271.00
Deidentified Minimum,,02130AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02130J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02130JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02130JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02130KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02130Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Open Approach,,,8271.00
Deidentified Minimum,,0213483,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0213489,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02134K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02134ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021608P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,021608R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02160AR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02160JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,021649Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02170AR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02170JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02170JR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02170KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02170ZQ,ICD10-PCS,Bypass Left Atrium to Right Pulmonary Artery, Open Approach,,,8271.00
Deidentified Minimum,,02174JR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02174KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021K08Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021K09Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021K0AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Open,,,8271.00
Deidentified Minimum,,021K49Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021K4KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021L08P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021L08Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021L09R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021L0ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Open Approach,,,8271.00
Deidentified Minimum,,021L0ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,021L49R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021L4JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021V08R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021V0ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Minimum,,021V49P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021V4JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021V4KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W08B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021W09P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021W0AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Open,,,8271.00
Deidentified Minimum,,021W0JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021W0KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021W0ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,021W48D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021W49Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021W4AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021W4AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021W4JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W4KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W4ZD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021X08B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021X08Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021X09Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021X0ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Open Approach,,,8271.00
Deidentified Minimum,,021X0ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,021X48Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021X4KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021X4KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021X4ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Perc Endo Approach,,,8271.00
Deidentified Minimum,,024F0KJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,024G082,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Zooplastic, Open,,,8271.00
Deidentified Minimum,,024G0K2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02544ZZ,ICD10-PCS,Destruction of Coronary Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02553ZZ,ICD10-PCS,Destruction of Atrial Septum, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025D4ZZ,ICD10-PCS,Destruction of Papillary Muscle, Perc Endo Approach,,,8271.00
Deidentified Minimum,,025K3ZZ,ICD10-PCS,Destruction of Right Ventricle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025P4ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Perc Endo Approach,,,8271.00
Deidentified Minimum,,025R4ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,025W3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Perc Approach,,,8271.00
Deidentified Minimum,,02700DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02700TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Open Approach,,,8271.00
Deidentified Minimum,,02703D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02703G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02703GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02703TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Perc Approach,,,8271.00
Deidentified Minimum,,027044Z,ICD10-PCS,Dilate of 1 Cor Art with Drug-elut Intra, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02704E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02704T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,02704ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027104Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Open Approach,,,8271.00
Deidentified Minimum,,02710DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02710EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02710F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02713F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,027144Z,ICD10-PCS,Dilate of 2 Cor Art with Drug-elut Intra, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02714D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,027205Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,0272076,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02720EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02723Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Minimum,,02723ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Perc Approach,,,8271.00
Deidentified Minimum,,0272476,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,02724D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,0273046,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Open,,,8271.00
Deidentified Minimum,,027304Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Open Approach,,,8271.00
Deidentified Minimum,,02730T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Open,,,8271.00
Deidentified Minimum,,027336Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02733E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02733T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc,,,8271.00
Deidentified Minimum,,027344Z,ICD10-PCS,Dilate 4+ Cor Art w Drug-elut Intra, Perc Endo,,,8271.00
Deidentified Minimum,,027346Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02734DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02734GZ,ICD10-PCS,Dilate 4+ Cor Art w 4+ Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,027F34Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc,,,8271.00
Deidentified Minimum,,027F3ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,027G44Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,027H0DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,027J4ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027R44T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,02B74ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02B80ZZ,ICD10-PCS,Excision of Conduction Mechanism, Open Approach,,,8271.00
Deidentified Minimum,,02B83ZZ,ICD10-PCS,Excision of Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BH0ZZ,ICD10-PCS,Excision of Pulmonary Valve, Open Approach,,,8271.00
Deidentified Minimum,,02BL0ZZ,ICD10-PCS,Excision of Left Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,02BM0ZZ,ICD10-PCS,Excision of Ventricular Septum, Open Approach,,,8271.00
Deidentified Minimum,,02BP0ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Minimum,,02BQ0ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Open Approach,,,8271.00
Deidentified Minimum,,02BQ3ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02C13Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Minimum,,02C34Z6,ICD10-PCS,Extirpate matter from 4+ Cor Art, Bifurc, Perc Endo,,,8271.00
Deidentified Minimum,,02CD0ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Open Approach,,,8271.00
Deidentified Minimum,,02CD3ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Perc Approach,,,8271.00
Deidentified Minimum,,02CD4ZZ,ICD10-PCS,Extirpate matter from Papillary Muscle, Perc Endo,,,8271.00
Deidentified Minimum,,02CW3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Perc Approach,,,8271.00
Deidentified Minimum,,02CW4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Desc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02CX4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Asc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02H40NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Open Approach,,,8271.00
Deidentified Minimum,,02H44DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02H63KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Perc Approach,,,8271.00
Deidentified Minimum,,02H70KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Open Approach,,,8271.00
Deidentified Minimum,,02H74KZ,ICD10-PCS,Insertion of Defib Lead into L Atrium, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HR0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,02HS32Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Perc Approach,,,8271.00
Deidentified Minimum,,02HS42Z,ICD10-PCS,Insert of Monitor Dev into R Pulm Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HW32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Perc Approach,,,8271.00
Deidentified Minimum,,02HX0DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Open Approach,,,8271.00
Deidentified Minimum,,02K84ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02LH0DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02LH4CZ,ICD10-PCS,Occlusion Pulm Valve w Extralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02N44ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02PY0JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02PY37Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02PY3DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02Q13ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02Q70ZZ,ICD10-PCS,Repair Left Atrium, Open Approach,,,8271.00
Deidentified Minimum,,02Q93ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02QC3ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02QD0ZZ,ICD10-PCS,Repair Papillary Muscle, Open Approach,,,8271.00
Deidentified Minimum,,02QF3ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Perc Approach,,,8271.00
Deidentified Minimum,,02QG0ZZ,ICD10-PCS,Repair Mitral Valve, Open Approach,,,8271.00
Deidentified Minimum,,02QG3ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02QJ3ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Perc Approach,,,8271.00
Deidentified Minimum,,02QL0ZZ,ICD10-PCS,Repair Left Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,02R50JZ,ICD10-PCS,Replacement of Atrial Septum with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R54KZ,ICD10-PCS,Replace of Atrial Sept with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R607Z,ICD10-PCS,Replacement of Right Atrium with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R60JZ,ICD10-PCS,Replacement of Right Atrium with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R907Z,ICD10-PCS,Replace of Chordae Tendineae with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R94JZ,ICD10-PCS,Replace Chordae Tendineae w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02R94KZ,ICD10-PCS,Replace Chordae Tendineae w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02RD48Z,ICD10-PCS,Replace Papillary Muscle w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02RD4JZ,ICD10-PCS,Replace Papillary Muscle w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02RG08Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RG37Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02RH4KZ,ICD10-PCS,Replace of Pulm Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RJ48Z,ICD10-PCS,Replace of Tricusp Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RJ4KZ,ICD10-PCS,Replace of Tricusp Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RK47Z,ICD10-PCS,Replace of R Ventricle with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RP08Z,ICD10-PCS,Replacement of Pulm Trunk with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RQ48Z,ICD10-PCS,Replace of R Pulm Art with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RQ4KZ,ICD10-PCS,Replace of R Pulm Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RR47Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RT07Z,ICD10-PCS,Replacement of L Pulm Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RV47Z,ICD10-PCS,Replace of Sup Vena Cava with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RW08Z,ICD10-PCS,Replace of Thor Aorta Desc with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RX0JZ,ICD10-PCS,Replacement of Thor Aorta Asc with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RX47Z,ICD10-PCS,Replace of Thor Aorta Asc with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02T80ZZ,ICD10-PCS,Resection of Conduction Mechanism, Open Approach,,,8271.00
Deidentified Minimum,,02TD0ZZ,ICD10-PCS,Resection of Papillary Muscle, Open Approach,,,8271.00
Deidentified Minimum,,02TD4ZZ,ICD10-PCS,Resection of Papillary Muscle, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U537Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02U54KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U608Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02U648Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U737Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02U94JZ,ICD10-PCS,Supplement Chordae Tendineae w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UA07Z,ICD10-PCS,Supplement Heart with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UA08Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Open Approach,,,8271.00
Deidentified Minimum,,02UA37Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UA48Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UD07Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UD4KZ,ICD10-PCS,Supplement Papillary Muscle w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UF08J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Open,,,8271.00
Deidentified Minimum,,02UF0KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02UF47Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UF48Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UG0JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02UG38E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc,,,8271.00
Deidentified Minimum,,02UG47Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UH07Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UH0JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UJ0JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02UJ0KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UJ48Z,ICD10-PCS,Supplement Tricusp Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UJ4JZ,ICD10-PCS,Supplement Tricusp Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UL3JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UL47Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UL48Z,ICD10-PCS,Supplement L Ventricle with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UM47Z,ICD10-PCS,Supplement Ventricular Sept w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UN3KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UN48Z,ICD10-PCS,Supplement Pericardium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UN4KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02US08Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02US48Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UT07Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UT37Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UV08Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UV4KZ,ICD10-PCS,Supplement Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UW07Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UW08Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UW38Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UW4KZ,ICD10-PCS,Supplement Thor Aorta Desc w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02VA4CZ,ICD10-PCS,Restriction of Heart with Extralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02VX4FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc Endo,,,8271.00
Deidentified Minimum,,02W54JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WG47Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WH08Z,ICD10-PCS,Revision of Zooplastic Tissue in Pulm Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WH0JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WJ07Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WJ0KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WY0JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02WY48Z,ICD10-PCS,Revision of Zooplastic in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WY4JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,031309M,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,03130JM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,03140AN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,03140JN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,03140KN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,03503ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03514ZZ,ICD10-PCS,Destruction of L Int Mamm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R00JZ,ICD10-PCS,Replacement of R Int Mamm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R047Z,ICD10-PCS,Replace of R Int Mamm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R10JZ,ICD10-PCS,Replacement of L Int Mamm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R20JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R347Z,ICD10-PCS,Replace of R Subclav Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R34KZ,ICD10-PCS,Replace of R Subclav Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S43ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03S44ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S73ZZ,ICD10-PCS,Reposition Right Brachial Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03S90ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SJ0ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SK4ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SL3ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03SP0ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SP4ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SR0ZZ,ICD10-PCS,Reposition Face Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SV0ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SV3ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SV4ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03U147Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03U307Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03U847Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03U907Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03U947Z,ICD10-PCS,Supplement R Ulnar Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UA07Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UG47Z,ICD10-PCS,Supplement Intracran Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UH07Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UJ47Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UN37Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UN47Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UP47Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UQ07Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UR47Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UT47Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UU07Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UU47Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02VA3CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Perc Approach,,,8271.00
Deidentified Minimum,,02VW3DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02WF07Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WF0JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WG08Z,ICD10-PCS,Revision of Zooplastic Tissue in Mitral Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WJ48Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WJ4JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WY07Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02WY37Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02WY3JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02WY47Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03130AM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,031409N,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,03140ZN,ICD10-PCS,Bypass Left Subclavian Artery to L Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,03533ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03534ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03540ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Open Approach,,,8271.00
Deidentified Minimum,,03B04ZZ,ICD10-PCS,Excision of R Int Mamm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03B14ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03B20ZZ,ICD10-PCS,Excision of Innominate Artery, Open Approach,,,8271.00
Deidentified Minimum,,03B24ZZ,ICD10-PCS,Excision of Innominate Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03B34ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R00KZ,ICD10-PCS,Replacement of R Int Mamm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R247Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R24JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R307Z,ICD10-PCS,Replacement of R Subclav Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R34JZ,ICD10-PCS,Replace of R Subclav Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S04ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S23ZZ,ICD10-PCS,Reposition Innominate Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03S24ZZ,ICD10-PCS,Reposition Innominate Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S40ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Open Approach,,,8271.00
Deidentified Minimum,,03S63ZZ,ICD10-PCS,Reposition Left Axillary Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03S70ZZ,ICD10-PCS,Reposition Right Brachial Artery, Open Approach,,,8271.00
Deidentified Minimum,,03S74ZZ,ICD10-PCS,Reposition Right Brachial Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S84ZZ,ICD10-PCS,Reposition Left Brachial Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SB0ZZ,ICD10-PCS,Reposition Right Radial Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SD0ZZ,ICD10-PCS,Reposition Right Hand Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SF0ZZ,ICD10-PCS,Reposition Left Hand Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SG4ZZ,ICD10-PCS,Reposition Intracranial Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SH0ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SM3ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03SM4ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SP3ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SQ0ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SQ4ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03ST0ZZ,ICD10-PCS,Reposition Left Temporal Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SU4ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03U447Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03U547Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03U807Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03U937Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UA37Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UD47Z,ICD10-PCS,Supplement R Hand Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UG07Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UJ07Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UL07Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UP07Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UP37Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UQ37Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UR07Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UV47Z,ICD10-PCS,Supplement L Thyroid Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0410094,ICD10-PCS,BP ABD AORTA LT RENAL ARTERY AUTO VEN TISS OPN,,,8271.00
Deidentified Minimum,,0410098,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO VEN TISS OPN APPR,,,8271.00
Deidentified Minimum,,04100A1,ICD10-PCS,BP ABD AO CELIAC ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100A3,ICD10-PCS,BP ABD AO RT RENL ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100J7,ICD10-PCS,BP ABD AO LT COMMON ILIAC ART SYN SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100J9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART SYN SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100JB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART SYN SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100K5,ICD10-PCS,BP ABD AO B RENL ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100K6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100Z2,ICD10-PCS,BYPASS ABD AORTA MESENTERIC ARTERY OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100Z4,ICD10-PCS,BYPASS ABD AORTA LT RENAL ARTERY OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100ZH,ICD10-PCS,BYPASS ABD AORTA RT FEMORAL ARTERY OPEN APPROACH,,,8271.00
Deidentified Minimum,,0410490,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,04104AC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104AD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104AH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104AQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104J6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104JD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104JH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104KH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104Z9,ICD10-PCS,Bypass Abdominal Aorta to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0414094,ICD10-PCS,Bypass Splenic Art to L Renal A with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,04140Z4,ICD10-PCS,Bypass Splenic Artery to Left Renal Artery, Open Approach,,,8271.00
Deidentified Minimum,,04144A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C099,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C0AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0Z0,ICD10-PCS,Bypass Right Common Iliac Artery to Abd Aorta, Open Approach,,,8271.00
Deidentified Minimum,,041C0Z3,ICD10-PCS,Bypass Right Common Iliac Artery to R Renal A, Open Approach,,,8271.00
Deidentified Minimum,,041C0ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041C0ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041C493,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C496,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C4J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4ZJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4ZK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D098,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D09B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D09Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D0A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0Z1,ICD10-PCS,Bypass Left Common Iliac Artery to Celiac Art, Open Approach,,,8271.00
Deidentified Minimum,,041D0ZD,ICD10-PCS,Bypass Left Common Iliac Artery to R Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041D0ZH,ICD10-PCS,Bypass Left Common Iliac Artery to R Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041D496,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D4A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4Z0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4Z3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E09F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E09G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E09K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E0A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E0KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E0KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E0Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041E0ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041E0ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041E0ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041E49H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E49P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E4A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041E4JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041F0AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041F0ZP,ICD10-PCS,Bypass Left Internal Iliac Artery to Foot Art, Open Approach,,,8271.00
Deidentified Minimum,,041F4A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H0AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H0KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H0KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H0KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H0ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041H0ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Open Approach,,,8271.00
Deidentified Minimum,,041H49D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H49J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H49Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H4JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H4ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J0JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0ZP,ICD10-PCS,Bypass Left External Iliac Artery to Foot Art, Open Approach,,,8271.00
Deidentified Minimum,,041J49G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J4AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04510ZZ,ICD10-PCS,Destruction of Celiac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04560ZZ,ICD10-PCS,Destruction of Right Colic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04583ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04593ZZ,ICD10-PCS,Destruction of Right Renal Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04594ZZ,ICD10-PCS,Destruction of Right Renal Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,045B0ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Minimum,,045E3ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04B10ZZ,ICD10-PCS,Excision of Celiac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04B34ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,04B43ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04B60ZZ,ICD10-PCS,Excision of Right Colic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04B74ZZ,ICD10-PCS,Excision of Left Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04B84ZZ,ICD10-PCS,Excision of Middle Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04BF0ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04BF3ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04C00ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Open Approach,,,8271.00
Deidentified Minimum,,04C03ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Perc Approach,,,8271.00
Deidentified Minimum,,04C04ZZ,ICD10-PCS,Extirpation of Matter from Abd Aorta, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R00KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R20KZ,ICD10-PCS,Replacement of Gastric Artery with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R24KZ,ICD10-PCS,Replace of Gastric Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R407Z,ICD10-PCS,Replacement of Splenic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R40KZ,ICD10-PCS,Replacement of Splenic Artery with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R647Z,ICD10-PCS,Replace of R Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R807Z,ICD10-PCS,Replacement of Mid Colic Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R90JZ,ICD10-PCS,Replacement of R Renal Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R947Z,ICD10-PCS,Replace of R Renal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04RA4JZ,ICD10-PCS,Replace of L Renal Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04RB0JZ,ICD10-PCS,Replacement of Inf Mesent Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RB0KZ,ICD10-PCS,Replacement of Inf Mesent Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RD0JZ,ICD10-PCS,Replacement of L Com Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RE4JZ,ICD10-PCS,Replace R Int Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RF0JZ,ICD10-PCS,Replacement of L Int Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RF47Z,ICD10-PCS,Replace L Int Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RH4JZ,ICD10-PCS,Replace R Ext Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RJ0JZ,ICD10-PCS,Replacement of L Ext Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RJ47Z,ICD10-PCS,Replace L Ext Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04S23ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04S24ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,04S30ZZ,ICD10-PCS,Reposition Hepatic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04S34ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,04S43ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04S63ZZ,ICD10-PCS,Reposition Right Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04S70ZZ,ICD10-PCS,Reposition Left Colic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SB4ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SN0ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SQ4ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04ST3ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SW4ZZ,ICD10-PCS,Reposition Left Foot Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U407Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04U437Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04U707Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UA47Z,ICD10-PCS,Supplement L Renal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UB07Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UB37Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UK37Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UM37Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UM47Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UQ37Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UQ47Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UR07Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UV47Z,ICD10-PCS,Supplement R Foot Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UY47Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,051009Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,051047Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05104KY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,051107Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Open,,,8271.00
Deidentified Minimum,,05110AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Open,,,8271.00
Deidentified Minimum,,05114KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05114ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05130JY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,05144KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05150JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Open,,,8271.00
Deidentified Minimum,,05160KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,051647Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05503ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05540ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Open Approach,,,8271.00
Deidentified Minimum,,05543ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05554ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05B00ZZ,ICD10-PCS,Excision of Azygos Vein, Open Approach,,,8271.00
Deidentified Minimum,,05B04ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,05B10ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Open Approach,,,8271.00
Deidentified Minimum,,05B34ZZ,ICD10-PCS,Excision of Right Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05B43ZZ,ICD10-PCS,Excision of Left Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05B54ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05B60ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Open Approach,,,8271.00
Deidentified Minimum,,05B64ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R00KZ,ICD10-PCS,Replacement of Azygos Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R507Z,ICD10-PCS,Replacement of R Subclav Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R647Z,ICD10-PCS,Replace of L Subclav Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05S04ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,05S33ZZ,ICD10-PCS,Reposition Right Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05S63ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05S73ZZ,ICD10-PCS,REPOSITION RIGHT AXILLARY VEIN PERQ,,,8271.00
Deidentified Minimum,,05S84ZZ,ICD10-PCS,Reposition Left Axillary Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SA4ZZ,ICD10-PCS,Reposition Left Brachial Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SB0ZZ,ICD10-PCS,Reposition Right Basilic Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SB3ZZ,ICD10-PCS,Reposition Right Basilic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SD0ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SD3ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SD4ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SG0ZZ,ICD10-PCS,Reposition Right Hand Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SN0ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SP4ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SR0ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SS3ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SV4ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,05U307Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05U407Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05U507Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05U807Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05U937Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UC07Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UL07Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UQ47Z,ICD10-PCS,Supplement L Ext Jugular Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05US07Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05US37Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06520ZZ,ICD10-PCS,Destruction of Gastric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Approach,,,8271.00
Deidentified Minimum,,06584ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,065B0ZZ,ICD10-PCS,Destruction of Left Renal Vein, Open Approach,,,8271.00
Deidentified Minimum,,065B4ZZ,ICD10-PCS,Destruction of Left Renal Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,065D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,065F0ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,065H0ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06B90ZZ,ICD10-PCS,Excision of Right Renal Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B94ZZ,ICD10-PCS,Excision of Right Renal Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06BB4ZZ,ICD10-PCS,Excision of Left Renal Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,06BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R00JZ,ICD10-PCS,Replacement of Inf Vena Cava with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R14JZ,ICD10-PCS,Replace of Splenic Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R407Z,ICD10-PCS,Replacement of Hepatic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R447Z,ICD10-PCS,Replace of Hepatic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R54KZ,ICD10-PCS,Replace Sup Mesent Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06R60KZ,ICD10-PCS,Replace of Inf Mesent Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R64JZ,ICD10-PCS,Replace Inf Mesent Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06R64KZ,ICD10-PCS,Replace Inf Mesent Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06R947Z,ICD10-PCS,Replace of R Renal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06RB0JZ,ICD10-PCS,Replacement of Left Renal Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RB0KZ,ICD10-PCS,Replacement of L Renal Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RD07Z,ICD10-PCS,Replace of L Com Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RD47Z,ICD10-PCS,Replace L Com Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RF0JZ,ICD10-PCS,Replace of R Ext Iliac Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RG07Z,ICD10-PCS,Replace of L Ext Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06S73ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SF0ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SH4ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SJ3ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SJ4ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SN0ZZ,ICD10-PCS,Reposition Left Femoral Vein, Open Approach,,,8271.00
Deidentified Minimum,,06UB47Z,ICD10-PCS,Supplement L Renal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06UC07Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UD37Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UF47Z,ICD10-PCS,Supplement R Ext Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06UG37Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UH07Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UM47Z,ICD10-PCS,Supplement R Femor Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06UP47Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06UT07Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0PS334Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Perc Approach,,,8271.00
Deidentified Minimum,,0PS344Z,ICD10-PCS,Reposition Cervcal Vertebra with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0PS434Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Perc Approach,,,8271.00
Deidentified Minimum,,0QS104Z,ICD10-PCS,Reposition Sacrum with Int Fix, Open Approach,,,8271.00
Deidentified Minimum,,0QS14ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,0QSSXZZ,ICD10-PCS,Reposition Coccyx, External Approach,,,8271.00
Deidentified Minimum,,0RB03ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0RB64ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RB94ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RBA3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Perc Approach,,,8271.00
Deidentified Minimum,,0RG00AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG00K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG0370,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG0371,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG047J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG04K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG1071,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG10A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG10J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG10JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG10ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG13A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG13AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG13Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG14AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG14J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG20AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG20K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG23Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG2470,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG24A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG40JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG40Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG4370,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG44K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG60AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG60JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG63J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG63Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG647J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG64JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG64Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG7071,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG70J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG70K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG70Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG73A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG73K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG73Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG74JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG74Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG80J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG80K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG83K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG84J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG84ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RGA37J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RGA3K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RGA3Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RGA4J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA4KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc Endo,,,8271.00
Deidentified Minimum,,0RH04CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Occip Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RH04DZ,ICD10-PCS,Insert of Facet Stabl Dev into Occip Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RH10DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RH14CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Cerv Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RH43DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RH60BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RH64BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Thor Jt, Perc Endo,,,8271.00
Deidentified Minimum,,0RHA0DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RHA3CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RR30JZ,ICD10-PCS,Replacement of Cerv Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RU00JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RU13JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0RU43JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0RUA3JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0RWB3JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Approach,,,8271.00
Deidentified Minimum,,0S543ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SB40ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL DISC OPEN,,,8271.00
Deidentified Minimum,,0SB84ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG0071,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG00KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG03A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG03J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG047J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG04A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG04Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG04Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG10ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0SG147J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG14A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG14JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG3071,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG30Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0SG33J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG33K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG3470,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG34K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG34ZJ,ICD10-PCS,Fusion of Lumsac Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG507Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG60ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Open Approach,,,8271.00
Deidentified Minimum,,0SG637Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SG64JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG73JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SG804Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Open Approach,,,8271.00
Deidentified Minimum,,0SG80KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG84ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SH04CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SH30CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Open Approach,,,8271.00
Deidentified Minimum,,0SH34CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Lumsac Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SR902A,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Uncement, Open,,,8271.00
Deidentified Minimum,,0SR903A,ICD10-PCS,Replace of R Hip Jt with Ceramic, Uncement, Open Approach,,,8271.00
Deidentified Minimum,,0SR904A,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Uncement, Open,,,8271.00
Deidentified Minimum,,0SR907Z,ICD10-PCS,Replacement of Right Hip Joint with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SR90JZ,ICD10-PCS,Replacement of Right Hip Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRC0JZ,ICD10-PCS,Replacement of R Knee Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRE039,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Cement, Open,,,8271.00
Deidentified Minimum,,0SRE03A,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRE0J9,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Cement, Open,,,8271.00
Deidentified Minimum,,0SRR01Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Metal, Open Approach,,,8271.00
Deidentified Minimum,,0SRS0J9,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Cement, Open,,,8271.00
Deidentified Minimum,,0SRT0JA,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRU0J9,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Cement, Open,,,8271.00
Deidentified Minimum,,0SRU0JA,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRU0KZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRV0JA,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRW0JA,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Uncement, Open,,,8271.00
Deidentified Minimum,,0SU04JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SU30JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SU53JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SU60JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SW40JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Open Approach,,,8271.00
Deidentified Minimum,,0SWB3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0SWB4JZ,ICD10-PCS,Revision of Synth Sub in L Hip Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SWC3JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0SWD3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0TQB8ZZ,ICD10-PCS,Repair Bladder, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Minimum,,0W8NXZZ,ICD10-PCS,Division of Female Perineum, External Approach,,,4303.00
Deidentified Minimum,,10903ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Perc Approach,,,4303.00
Deidentified Minimum,,10907ZA,ICD10-PCS,Drainage of Fetal Cerebrospinal Fluid from POC, Via Opening,,,4303.00
Deidentified Minimum,,10D07Z3,ICD10-PCS,Extraction of POC, Low Forceps, Via Opening,,,4303.00
Deidentified Minimum,,4A020N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Open Approach,,,8271.00
Deidentified Minimum,,4A023FZ,ICD10-PCS,Measurement of Cardiac Rhythm, Percutaneous Approach,,,8271.00
Deidentified Minimum,,4A023N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Perc Approach,,,8271.00
Deidentified Minimum,,4A023N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Perc Approach,,,8271.00
Deidentified Minimum,,B2040ZZ,ICD10-PCS,Plain Radiography of Right Heart using High Osmolar Contrast,,,8271.00
Deidentified Minimum,,B2050ZZ,ICD10-PCS,Plain Radiography of Left Heart using High Osmolar Contrast,,,8271.00
Deidentified Minimum,,B20F1ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using L Osm Contrast,,,8271.00
Deidentified Minimum,,B2100ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2141ZZ,ICD10-PCS,Fluoroscopy of Right Heart using Low Osmolar Contrast,,,8271.00
Deidentified Minimum,,B2160ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2170ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using H Osm Contrast,,,8271.00
Deidentified Minimum,,X2A5312,ICD10-PCS,Cereb Filtr, Brach L Carotid Art, Perc, New Tech 2,,,8271.00
Deidentified Minimum,,001U077,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Open,,,8271.00
Deidentified Minimum,,001U0K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,001U0K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,001U3J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Perc,,,8271.00
Deidentified Minimum,,005T3ZZ,ICD10-PCS,Destruction of Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Minimum,,005T4ZZ,ICD10-PCS,Destruction of Spinal Meninges, Perc Endo Approach,,,8271.00
Deidentified Minimum,,008W3ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,008Y0ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,009T00Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Open Approach,,,8271.00
Deidentified Minimum,,009T0ZX,ICD10-PCS,Drainage of Spinal Meninges, Open Approach, Diagnostic,,,8271.00
Deidentified Minimum,,009T0ZZ,ICD10-PCS,DRAINAGE OF SPINAL MENINGES OPEN APPROACH,,,8271.00
Deidentified Minimum,,009U0ZX,ICD10-PCS,Drainage of Spinal Canal, Open Approach, Diagnostic,,,8271.00
Deidentified Minimum,,009W00Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Open Approach,,,8271.00
Deidentified Minimum,,009W0ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Minimum,,009X0ZZ,ICD10-PCS,DRAINAGE OF THORACIC SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Minimum,,009X4ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,009Y4ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Minimum,,009Y4ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00BT3ZZ,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00BX4ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Minimum,,00BY3ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00CW4ZZ,ICD10-PCS,Extirpate matter from Cerv Spinal Cord, Perc Endo,,,8271.00
Deidentified Minimum,,00DT0ZZ,ICD10-PCS,EXTRACTION OF SPINAL MENINGES OPEN APPROACH,,,8271.00
Deidentified Minimum,,00DT4ZZ,ICD10-PCS,Extraction of Spinal Meninges, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00HV42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00JU3ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00JU4ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,00NT0ZZ,ICD10-PCS,Release Spinal Meninges, Open Approach,,,8271.00
Deidentified Minimum,,00NT3ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00NT4ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,00NW3ZZ,ICD10-PCS,Release Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00NW4ZZ,ICD10-PCS,Release Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00PU30Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00PU42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00PU43Z,ICD10-PCS,Remove of Infusion Dev from Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00PU4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00PV0KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00PV3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00PV43Z,ICD10-PCS,Removal of Infusion Dev from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00QY3ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00SW3ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00UT07Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,00UT0KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,00UT3KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,00WU03Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00WU3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00WV37Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,00WV4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00WV4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,01510ZZ,ICD10-PCS,Destruction of Cervical Nerve, Open Approach,,,8271.00
Deidentified Minimum,,01580ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Open Approach,,,8271.00
Deidentified Minimum,,01584ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,01880ZZ,ICD10-PCS,DIVISION OF THORACIC NERVE OPEN APPROACH,,,8271.00
Deidentified Minimum,,018B0ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE OPEN APPR,,,8271.00
Deidentified Minimum,,021008W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,0210093,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,0210099,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Minimum,,02100ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Open Approach,,,8271.00
Deidentified Minimum,,0210489,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02104A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02104AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02104K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,0211098,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Minimum,,02110K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02110K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02114JW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021208W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,0212098,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021209W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02120AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02120AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02120J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02120JW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,021248W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021249F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02124A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02124A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02124AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02124K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02130AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,02130AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02130JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02130KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02130Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,021348W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0213498,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021349F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02134A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02134J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02134Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021649P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021649R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02164AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02164ZQ,ICD10-PCS,Bypass Right Atrium to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021708R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,021709R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02170JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02170KR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,021748P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021748Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02174JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02174KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021K08P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021K0JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021K0JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021K0ZP,ICD10-PCS,Bypass Right Ventricle to Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Minimum,,021K48R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021K49P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021K4AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021K4AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021K4JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021K4JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021K4KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021K4Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021K4ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021K4ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021L0JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021L0Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,021L0ZF,ICD10-PCS,Bypass Left Ventricle to Abdominal Artery, Open Approach,,,8271.00
Deidentified Minimum,,021L0ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Open Approach,,,8271.00
Deidentified Minimum,,021L4JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021L4KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021L4ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021L4ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021V09R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021V0AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,021V0KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021V0ZQ,ICD10-PCS,Bypass Superior Vena Cava to R Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,021V48Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021V49Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021V4KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W09Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021W0JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021W0ZB,ICD10-PCS,Bypass Thoracic Aorta, Descending to Subclav, Open Approach,,,8271.00
Deidentified Minimum,,021W48P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021W48Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021W49P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021W49R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021W4KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W4ZB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021X08R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021X09R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021X0AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Open,,,8271.00
Deidentified Minimum,,021X0JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021X48R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021X49B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021X49R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021X4JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021X4KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021X4ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021X4ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,024J0J2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02540ZZ,ICD10-PCS,Destruction of Coronary Vein, Open Approach,,,8271.00
Deidentified Minimum,,02543ZZ,ICD10-PCS,Destruction of Coronary Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025H0ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Open Approach,,,8271.00
Deidentified Minimum,,025M3ZZ,ICD10-PCS,Destruction of Ventricular Septum, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025P0ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Minimum,,025P3ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025Q4ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,025S0ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Open Approach,,,8271.00
Deidentified Minimum,,025W4ZZ,ICD10-PCS,Destruction of Thor Aorta Desc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,025X4ZZ,ICD10-PCS,Destruction of Thor Aorta Asc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0270076,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02700E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02700GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02700Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Minimum,,0270346,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc,,,8271.00
Deidentified Minimum,,0270356,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02703E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02703F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02703FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02703T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc,,,8271.00
Deidentified Minimum,,02703Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Minimum,,0270456,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,027045Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0270466,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,027046Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0271046,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Open,,,8271.00
Deidentified Minimum,,02710T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Open,,,8271.00
Deidentified Minimum,,02713G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02713T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc,,,8271.00
Deidentified Minimum,,0271466,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,02714GZ,ICD10-PCS,Dilate of 2 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0272046,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Open,,,8271.00
Deidentified Minimum,,027207Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02720D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02720F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02720G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02720T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Open,,,8271.00
Deidentified Minimum,,02720ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Open Approach,,,8271.00
Deidentified Minimum,,027237Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02723GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,027246Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02724GZ,ICD10-PCS,Dilate of 3 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02730DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02730GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02730ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Open Approach,,,8271.00
Deidentified Minimum,,027334Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Perc Approach,,,8271.00
Deidentified Minimum,,0273376,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc,,,8271.00
Deidentified Minimum,,02733D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02733EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02733F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02733FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02733ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Approach,,,8271.00
Deidentified Minimum,,0273446,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,,8271.00
Deidentified Minimum,,02734FZ,ICD10-PCS,Dilate of 4+ Cor Art with 3 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02734G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02734Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027F4ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,027H0ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Open Approach,,,8271.00
Deidentified Minimum,,027H34Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Perc Approach,,,8271.00
Deidentified Minimum,,027J04Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Open,,,8271.00
Deidentified Minimum,,027J3DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,027J3ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,027J44Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,027J4DZ,ICD10-PCS,Dilate Tricusp Valve w Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,027K4ZZ,ICD10-PCS,Dilation of Right Ventricle, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027R04T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Open,,,8271.00
Deidentified Minimum,,027R0ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Open Approach,,,8271.00
Deidentified Minimum,,027R34T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc,,,8271.00
Deidentified Minimum,,027R3ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Percutaneous Approach,,,8271.00
Deidentified Minimum,,027R4ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Perc Endo Approach,,,8271.00
Deidentified Minimum,,028D0ZZ,ICD10-PCS,Division of Papillary Muscle, Open Approach,,,8271.00
Deidentified Minimum,,028D3ZZ,ICD10-PCS,Division of Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02B50ZZ,ICD10-PCS,Excision of Atrial Septum, Open Approach,,,8271.00
Deidentified Minimum,,02B53ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02B90ZZ,ICD10-PCS,Excision of Chordae Tendineae, Open Approach,,,8271.00
Deidentified Minimum,,02B93ZZ,ICD10-PCS,Excision of Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BD3ZZ,ICD10-PCS,Excision of Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BD4ZZ,ICD10-PCS,Excision of Papillary Muscle, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02BF0ZZ,ICD10-PCS,Excision of Aortic Valve, Open Approach,,,8271.00
Deidentified Minimum,,02BH3ZZ,ICD10-PCS,Excision of Pulmonary Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BT4ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02BW3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Approach,,,8271.00
Deidentified Minimum,,02BX0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Open Approach,,,8271.00
Deidentified Minimum,,02BX4ZZ,ICD10-PCS,Excision of Thor Aorta Asc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02C03ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Approach,,,8271.00
Deidentified Minimum,,02C04ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02C10Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Minimum,,02C14Z6,ICD10-PCS,Extirpate matter from 2 Cor Art, Bifurc, Perc Endo,,,8271.00
Deidentified Minimum,,02C43ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Approach,,,8271.00
Deidentified Minimum,,02CW0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Open Approach,,,8271.00
Deidentified Minimum,,02FN4ZZ,ICD10-PCS,Fragmentation in Pericardium, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HA4RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HK3KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Approach,,,8271.00
Deidentified Minimum,,02HL0KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,02HL3KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Approach,,,8271.00
Deidentified Minimum,,02HL3NZ,ICD10-PCS,Insertion of Intracard Pacer into L Ventricle, Perc Approach,,,8271.00
Deidentified Minimum,,02HP4DZ,ICD10-PCS,Insert of Intralum Dev into Pulm Trunk, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HS0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Open Approach,,,8271.00
Deidentified Minimum,,02HW3DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Perc Approach,,,8271.00
Deidentified Minimum,,02HX02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Open Approach,,,8271.00
Deidentified Minimum,,02LH4DZ,ICD10-PCS,Occlusion Pulm Valve w Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02N94ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02ND4ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02NF0ZZ,ICD10-PCS,Release Aortic Valve, Open Approach,,,8271.00
Deidentified Minimum,,02PY02Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02PY03Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02PY0CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02PY0KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02PY42Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02PY48Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02Q00ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Open Approach,,,8271.00
Deidentified Minimum,,02Q23ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Approach,,,8271.00
Deidentified Minimum,,02Q30ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Open Approach,,,8271.00
Deidentified Minimum,,02Q63ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02Q73ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02Q84ZZ,ICD10-PCS,Repair Conduction Mechanism, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02QB3ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02QD4ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QH4ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QJ3ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02QJ4ZG,ICD10-PCS,Repair Tricusp Valve fr R AV Vlv, Perc Endo,,,8271.00
Deidentified Minimum,,02QJ4ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QL3ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02QM3ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02R508Z,ICD10-PCS,Replacement of Atrial Septum with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02R547Z,ICD10-PCS,Replace of Atrial Sept with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R548Z,ICD10-PCS,Replace of Atrial Sept with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R748Z,ICD10-PCS,Replacement of L Atrium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R74JZ,ICD10-PCS,Replacement of L Atrium with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R74KZ,ICD10-PCS,Replacement of L Atrium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RF08Z,ICD10-PCS,Replacement of Aortic Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RF47Z,ICD10-PCS,Replace of Aortic Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RF48Z,ICD10-PCS,Replace of Aortic Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RF4JZ,ICD10-PCS,Replace of Aortic Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RG38Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02RG4KZ,ICD10-PCS,Replace of Mitral Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RH07Z,ICD10-PCS,Replacement of Pulmonary Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RH0KZ,ICD10-PCS,Replacement of Pulm Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RJ07Z,ICD10-PCS,Replacement of Tricuspid Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RJ0JZ,ICD10-PCS,Replacement of Tricuspid Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RK07Z,ICD10-PCS,Replacement of Right Ventricle with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RL07Z,ICD10-PCS,Replacement of Left Ventricle with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RL48Z,ICD10-PCS,Replace of L Ventricle with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RP0JZ,ICD10-PCS,Replacement of Pulmonary Trunk with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RP4JZ,ICD10-PCS,Replacement of Pulm Trunk with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RR4JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RS08Z,ICD10-PCS,Replacement of R Pulm Vein with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RT47Z,ICD10-PCS,Replace of L Pulm Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RT4JZ,ICD10-PCS,Replace of L Pulm Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RV07Z,ICD10-PCS,Replacement of Sup Vena Cava with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RV0KZ,ICD10-PCS,Replacement of Sup Vena Cava with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RW47Z,ICD10-PCS,Replace Thor Aorta Desc w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02RW4KZ,ICD10-PCS,Replace Thor Aorta Desc w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02RX4KZ,ICD10-PCS,Replace Thor Aorta Asc w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02SX0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Ascending/Arch, Open Approach,,,8271.00
Deidentified Minimum,,02T94ZZ,ICD10-PCS,Resection of Chordae Tendineae, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U507Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U538Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02U63JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02U70KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U747Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U908Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02U90JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U937Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UA0KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UF4KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UG07E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Open,,,8271.00
Deidentified Minimum,,02UG07Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UG0JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UG37Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UG48E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02UG4KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UG4KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UH47Z,ICD10-PCS,Supplement Pulm Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UJ07G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Open,,,8271.00
Deidentified Minimum,,02UJ07Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UJ47Z,ICD10-PCS,Supplement Tricusp Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UJ4KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UK07Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UK08Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UK0JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UK0KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UK38Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UK3JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UL08Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UL0JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UM48Z,ICD10-PCS,Supplement Ventricular Sept w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02UN37Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UN47Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UN4JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UP48Z,ICD10-PCS,Supplement Pulm Trunk with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UQ08Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UQ38Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UQ48Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UR07Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UR08Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UR47Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02US07Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02US3KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UT08Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UV37Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UW3KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UX07Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UX08Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UX3JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UX4JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02VW3FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc,,,8271.00
Deidentified Minimum,,02VW4DZ,ICD10-PCS,Restrict Thor Aorta Desc w Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02VX0EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Open,,,8271.00
Deidentified Minimum,,02VX3FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc,,,8271.00
Deidentified Minimum,,02WF4JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WG07Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WG0KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Open Approach,,,8271.00
Deidentified Minimum,,001U076,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Open,,,8271.00
Deidentified Minimum,,001U0K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,001U377,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Perc,,,8271.00
Deidentified Minimum,,001U3K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Perc,,,8271.00
Deidentified Minimum,,005T0ZZ,ICD10-PCS,Destruction of Spinal Meninges, Open Approach,,,8271.00
Deidentified Minimum,,005W4ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,005X4ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,008W0ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,008W4ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,008X3ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,008X4ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,009T40Z,ICD10-PCS,Drain of Spinal Meninges with Drain Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,009W0ZZ,ICD10-PCS,DRAINAGE OF CERVICAL SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Minimum,,009Y0ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Minimum,,009Y3ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,,8271.00
Deidentified Minimum,,009Y3ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00BW0ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Minimum,,00BW4ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Minimum,,00BX0ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Minimum,,00BY3ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,,8271.00
Deidentified Minimum,,00BY4ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Minimum,,00CW0ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00CX4ZZ,ICD10-PCS,Extirpate matter from Thor Spinal Cord, Perc Endo,,,8271.00
Deidentified Minimum,,00CY0ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00FU4ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00HV02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00NX3ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00NY3ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00NY4ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,00PU32Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00PU33Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00PU3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00PV4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00QT3ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00QT4ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,00QW3ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00QX3ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00WU30Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00WU40Z,ICD10-PCS,Revision of Drain Dev in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00WV42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00WV47Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,01514ZZ,ICD10-PCS,Destruction of Cervical Nerve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,018R0ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE OPEN APPR,,,8271.00
Deidentified Minimum,,018R4ZZ,ICD10-PCS,Division of Sacral Nerve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02100AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02100AW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02100J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02100J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02100K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02100K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02100Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,021048C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0210493,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02104J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02104JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02104KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02104Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021109C,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,021109F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,021109W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02110J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02110JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02110K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,0211488,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02114A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02114J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,0212093,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,021209F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02120A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Open,,,8271.00
Deidentified Minimum,,02120A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Open,,,8271.00
Deidentified Minimum,,02120J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02120K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02120Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Open Approach,,,8271.00
Deidentified Minimum,,02120Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,02120ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Open Approach,,,8271.00
Deidentified Minimum,,021248C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021248F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0212493,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,0213083,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,0213099,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Minimum,,02130J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02130J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02130ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Open Approach,,,8271.00
Deidentified Minimum,,0213488,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02134K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02134KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021609Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02160Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Open Approach,,,8271.00
Deidentified Minimum,,021648R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02164JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02164JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02164KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021708P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,021749P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02174AR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02174ZQ,ICD10-PCS,Bypass Left Atrium to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021K0KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021K0KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021K0ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,021K4ZC,ICD10-PCS,Bypass Right Ventricle to Thor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021L0KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021L4Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021L4Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021L4ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021L4ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021V09P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021V0AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Open,,,8271.00
Deidentified Minimum,,021V0KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021V0KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021V48R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021V4JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021V4KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021V4ZQ,ICD10-PCS,BYPASS SUPERIOR VENA CAVA TO RT PULM ART PC ENDO,,,8271.00
Deidentified Minimum,,021W08Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021W09B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021W0JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021W0KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021W0KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021W0ZD,ICD10-PCS,Bypass Thoracic Aorta, Descending to Carotid, Open Approach,,,8271.00
Deidentified Minimum,,021W4AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021W4JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W4JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021X09D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021X0JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021X0KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021X0KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021X0ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Open Approach,,,8271.00
Deidentified Minimum,,021X49P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021X4AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021X4AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021X4AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021X4JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021X4JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021X4KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021X4KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,024F07J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Autol Sub, Open,,,8271.00
Deidentified Minimum,,024G072,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Autol Sub, Open,,,8271.00
Deidentified Minimum,,024J082,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Zooplastic, Open,,,8271.00
Deidentified Minimum,,02570ZZ,ICD10-PCS,Destruction of Left Atrium, Open Approach,,,8271.00
Deidentified Minimum,,025D0ZZ,ICD10-PCS,Destruction of Papillary Muscle, Open Approach,,,8271.00
Deidentified Minimum,,025D3ZZ,ICD10-PCS,Destruction of Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025G0ZZ,ICD10-PCS,Destruction of Mitral Valve, Open Approach,,,8271.00
Deidentified Minimum,,025H3ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025T0ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Open Approach,,,8271.00
Deidentified Minimum,,025T3ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025W0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Open Approach,,,8271.00
Deidentified Minimum,,0270056,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,027036Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02703EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02704DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02704EZ,ICD10-PCS,Dilate of 1 Cor Art with 2 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027106Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,027107Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02710G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02710ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Open Approach,,,8271.00
Deidentified Minimum,,027135Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,0271376,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02713DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,0271446,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,,8271.00
Deidentified Minimum,,027145Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027147Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02714DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02714EZ,ICD10-PCS,Dilate of 2 Cor Art with 2 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0272066,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02720FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02720TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Open Approach,,,8271.00
Deidentified Minimum,,0272376,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02723D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02723G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,027244Z,ICD10-PCS,Dilate of 3 Cor Art with Drug-elut Intra, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027245Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0272466,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,02724EZ,ICD10-PCS,Dilate of 3 Cor Art with 2 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02724T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,027306Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02730E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02730F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Open,,,8271.00
Deidentified Minimum,,0273476,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,02734D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02734F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,027F0DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,027F0ZZ,ICD10-PCS,Dilation of Aortic Valve, Open Approach,,,8271.00
Deidentified Minimum,,027F44Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Minimum,,027G3DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,027H04Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Open Approach,,,8271.00
Deidentified Minimum,,027J0DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,027J34Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc,,,8271.00
Deidentified Minimum,,027K04Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Open Approach,,,8271.00
Deidentified Minimum,,027K34Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Perc Approach,,,8271.00
Deidentified Minimum,,027K3DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,028D4ZZ,ICD10-PCS,Division of Papillary Muscle, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02B63ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BG3ZZ,ICD10-PCS,Excision of Mitral Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BJ0ZZ,ICD10-PCS,Excision of Tricuspid Valve, Open Approach,,,8271.00
Deidentified Minimum,,02BJ3ZZ,ICD10-PCS,Excision of Tricuspid Valve, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BK4ZZ,ICD10-PCS,Excision of Right Ventricle, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02BP4ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02BS0ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Open Approach,,,8271.00
Deidentified Minimum,,02BS3ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BV3ZZ,ICD10-PCS,Excision of Superior Vena Cava, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BV4ZZ,ICD10-PCS,Excision of Superior Vena Cava, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02BW0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Open Approach,,,8271.00
Deidentified Minimum,,02C14ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02C20Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Minimum,,02C23ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Approach,,,8271.00
Deidentified Minimum,,02C24Z6,ICD10-PCS,Extirpate matter from 3 Cor Art, Bifurc, Perc Endo,,,8271.00
Deidentified Minimum,,02C34ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Open Approach,,,8271.00
Deidentified Minimum,,02FN3ZZ,ICD10-PCS,Fragmentation in Pericardium, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02H402Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Open Approach,,,8271.00
Deidentified Minimum,,02H403Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Open Approach,,,8271.00
Deidentified Minimum,,02H43DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Approach,,,8271.00
Deidentified Minimum,,02H442Z,ICD10-PCS,Insertion of Monitor Dev into Cor Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02H44KZ,ICD10-PCS,Insertion of Defib Lead into Cor Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02H64KZ,ICD10-PCS,Insertion of Defib Lead into R Atrium, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HL3DZ,ICD10-PCS,Insertion of Intralum Dev into L Ventricle, Perc Approach,,,8271.00
Deidentified Minimum,,02HN0KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Open Approach,,,8271.00
Deidentified Minimum,,02HT32Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Perc Approach,,,8271.00
Deidentified Minimum,,02HT42Z,ICD10-PCS,Insert of Monitor Dev into L Pulm Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HW02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Open Approach,,,8271.00
Deidentified Minimum,,02HX3DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Perc Approach,,,8271.00
Deidentified Minimum,,02HX4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Asc, Perc Endo,,,8271.00
Deidentified Minimum,,02N43ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02ND0ZZ,ICD10-PCS,Release Papillary Muscle, Open Approach,,,8271.00
Deidentified Minimum,,02NK0ZZ,ICD10-PCS,Release Right Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,02PY33Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02PY3CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02PY3JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02PY3KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02PY4JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02Q14ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02Q34ZZ,ICD10-PCS,Repair 4+ Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02Q40ZZ,ICD10-PCS,Repair Coronary Vein, Open Approach,,,8271.00
Deidentified Minimum,,02Q44ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02Q53ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02Q60ZZ,ICD10-PCS,Repair Right Atrium, Open Approach,,,8271.00
Deidentified Minimum,,02QA0ZZ,ICD10-PCS,Repair Heart, Open Approach,,,8271.00
Deidentified Minimum,,02QA4ZZ,ICD10-PCS,Repair Heart, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QC4ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QF0ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Open Approach,,,8271.00
Deidentified Minimum,,02QF0ZZ,ICD10-PCS,Repair Aortic Valve, Open Approach,,,8271.00
Deidentified Minimum,,02QF4ZJ,ICD10-PCS,Repair Aort Valve created from Trunc Vlv, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02QF4ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QG3ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Perc Approach,,,8271.00
Deidentified Minimum,,02QG4ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02QJ0ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Open Approach,,,8271.00
Deidentified Minimum,,02QJ0ZZ,ICD10-PCS,Repair Tricuspid Valve, Open Approach,,,8271.00
Deidentified Minimum,,02R648Z,ICD10-PCS,Replacement of R Atrium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R64KZ,ICD10-PCS,Replacement of R Atrium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R707Z,ICD10-PCS,Replacement of Left Atrium with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R708Z,ICD10-PCS,Replacement of Left Atrium with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RD0KZ,ICD10-PCS,Replace of Papillary Muscle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RD47Z,ICD10-PCS,Replace Papillary Muscle w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02RG0KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RG47Z,ICD10-PCS,Replace of Mitral Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RG48Z,ICD10-PCS,Replace of Mitral Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RH08Z,ICD10-PCS,Replacement of Pulm Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RH48Z,ICD10-PCS,Replace of Pulm Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RJ0KZ,ICD10-PCS,Replacement of Tricusp Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RL4KZ,ICD10-PCS,Replace of L Ventricle with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RN07Z,ICD10-PCS,Replacement of Pericardium with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RN08Z,ICD10-PCS,Replacement of Pericardium with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RP48Z,ICD10-PCS,Replace of Pulm Trunk with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RQ0JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RQ0KZ,ICD10-PCS,Replacement of R Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RQ47Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RQ4JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RR0KZ,ICD10-PCS,Replacement of L Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RS47Z,ICD10-PCS,Replace of R Pulm Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RS4JZ,ICD10-PCS,Replace of R Pulm Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RT0JZ,ICD10-PCS,Replacement of L Pulm Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RT48Z,ICD10-PCS,Replace of L Pulm Vein with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RV08Z,ICD10-PCS,Replacement of Sup Vena Cava with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RV48Z,ICD10-PCS,Replace of Sup Vena Cava with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RX4JZ,ICD10-PCS,Replace of Thor Aorta Asc with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02S00ZZ,ICD10-PCS,Reposition Coronary Artery, One Artery, Open Approach,,,8271.00
Deidentified Minimum,,02SP0ZZ,ICD10-PCS,Reposition Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Minimum,,02T83ZZ,ICD10-PCS,Resection of Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02T93ZZ,ICD10-PCS,Resection of Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02U53KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02U547Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U64KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U70JZ,ICD10-PCS,Supplement Left Atrium with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U738Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Perc Approach,,,8271.00
Deidentified Minimum,,02U748Z,ICD10-PCS,Supplement Left Atrium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UA38Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Approach,,,8271.00
Deidentified Minimum,,02UA4JZ,ICD10-PCS,Supplement Heart with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UA4KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UD38Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UF08Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UF0JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02UF3JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc,,,8271.00
Deidentified Minimum,,02UF3JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UF3KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc,,,8271.00
Deidentified Minimum,,02UG08Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UG4JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UH0KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UH38Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UH3KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UH4KZ,ICD10-PCS,Supplement Pulm Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UJ08Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UJ0JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UJ37G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc,,,8271.00
Deidentified Minimum,,02UJ38Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UJ3JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc,,,8271.00
Deidentified Minimum,,02UJ3JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UJ3KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UJ48G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02UK48Z,ICD10-PCS,Supplement R Ventricle with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UL38Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UL4JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UP4KZ,ICD10-PCS,Supplement Pulm Trunk with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UQ4KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UR37Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UR48Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02US37Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02US38Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02US4KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UT38Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UV07Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UV48Z,ICD10-PCS,Supplement Sup Vena Cava with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UX4KZ,ICD10-PCS,Supplement Thor Aorta Asc w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02VW0DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02VX0DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02VX3EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc,,,8271.00
Deidentified Minimum,,02VX4EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc Endo,,,8271.00
Deidentified Minimum,,02WF4KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WJ08Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WM4JZ,ICD10-PCS,Revise of Synth Sub in Ventricular Sept, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WY02Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02WY0DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02WY32Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02WY43Z,ICD10-PCS,Revision of Infusion Dev in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03130AN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,031409M,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,03504ZZ,ICD10-PCS,Destruction of R Int Mamm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03510ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Minimum,,03530ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Open Approach,,,8271.00
Deidentified Minimum,,03R107Z,ICD10-PCS,Replacement of L Int Mamm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R207Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R24KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R447Z,ICD10-PCS,Replace of L Subclav Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R44KZ,ICD10-PCS,Replace of L Subclav Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S20ZZ,ICD10-PCS,Reposition Innominate Artery, Open Approach,,,8271.00
Deidentified Minimum,,03S30ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Open Approach,,,8271.00
Deidentified Minimum,,03S80ZZ,ICD10-PCS,Reposition Left Brachial Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SA3ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SA4ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SC0ZZ,ICD10-PCS,Reposition Left Radial Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SC3ZZ,ICD10-PCS,Reposition Left Radial Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SC4ZZ,ICD10-PCS,Reposition Left Radial Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SF4ZZ,ICD10-PCS,Reposition Left Hand Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SG0ZZ,ICD10-PCS,Reposition Intracranial Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SH3ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03SJ3ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SJ4ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SN0ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SR3ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SR4ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,03SS0ZZ,ICD10-PCS,Reposition Right Temporal Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SS3ZZ,ICD10-PCS,Reposition Right Temporal Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03U237Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03U247Z,ICD10-PCS,Supplement Innom Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03U347Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03U607Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UA47Z,ICD10-PCS,Supplement L Ulnar Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03U637Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03U647Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03U707Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03U747Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UF47Z,ICD10-PCS,Supplement L Hand Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UJ37Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UN07Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03US07Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UT07Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UY07Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0410091,ICD10-PCS,Bypass Abd Aorta to Celiac Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,0410093,ICD10-PCS,BP ABDOMINAL AORTA RT RENL ART AUTO VEN TISS OPN,,,8271.00
Deidentified Minimum,,0410095,ICD10-PCS,Bypass Abd Aorta to B Renal A with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,0410099,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Minimum,,041009C,ICD10-PCS,BP ABD AO B INTRL ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Minimum,,041009F,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Minimum,,04100A2,ICD10-PCS,BYPS ABD AO MES ART AUTO ART TISSUE OPN APPROACH,,,8271.00
Deidentified Minimum,,04100A4,ICD10-PCS,BP ABD AO LT RENL ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100AH,ICD10-PCS,BP ABD AO RT FEM ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100AQ,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO ART TISS OPN APPR,,,8271.00
Deidentified Minimum,,04100J5,ICD10-PCS,BYPS ABD AO BIL RENL ART SYN SUBST OPN APPROACH,,,8271.00
Deidentified Minimum,,04100JD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART SYN SUB OPN APPROACH,,,8271.00
Deidentified Minimum,,04100JG,ICD10-PCS,BP ABD AO B EXT ILIAC ART SYN SUBST OPN APPROACH,,,8271.00
Deidentified Minimum,,04100JK,ICD10-PCS,BYPS ABD AO BIL FEM ART SYNTH SUBST OPN APPROACH,,,8271.00
Deidentified Minimum,,04100JQ,ICD10-PCS,BP ABD AO LOW EXTREM ART SYN SUBST OPN APPROACH,,,8271.00
Deidentified Minimum,,04100K1,ICD10-PCS,BP ABD AO CELIAC ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100K7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100KJ,ICD10-PCS,BP ABD AO LT FEM ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100KR,ICD10-PCS,BP ABD AO LOW ART NONAUTO TISS SUB OPN APPROACH,,,8271.00
Deidentified Minimum,,04100Z3,ICD10-PCS,BYPASS ABD AORTA RT RENAL ARTERY OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100ZF,ICD10-PCS,BYPASS ABD AORTA LT EXT ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100ZK,ICD10-PCS,BYPASS ABD AO BIL FEMORAL ART OPEN APPROACH,,,8271.00
Deidentified Minimum,,041049D,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041049G,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041049Q,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,04104A4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104A8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104J5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104JR,ICD10-PCS,Bypass Abd Aorta to Low Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104K2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104K4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104Z7,ICD10-PCS,Bypass Abdominal Aorta to L Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104ZK,ICD10-PCS,Bypass Abdominal Aorta to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0414095,ICD10-PCS,Bypass Splenic Art to B Renal A with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,0414494,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,0414495,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,04144A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C094,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C09F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C09G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C09H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C0A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041C0ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041C0ZH,ICD10-PCS,Bypass Right Common Iliac Artery to R Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041C490,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C495,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C4AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C4ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D095,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D096,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D09D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D09K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D0A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0Z0,ICD10-PCS,Bypass Left Common Iliac Artery to Abd Aorta, Open Approach,,,8271.00
Deidentified Minimum,,041D0Z3,ICD10-PCS,Bypass Left Common Iliac Artery to R Renal A, Open Approach,,,8271.00
Deidentified Minimum,,041D49C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D4A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4Z5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4Z7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4ZD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4ZG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4ZJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4ZK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4ZQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E09H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041E0AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E0KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E0KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E49D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E49J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E4AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041E4AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041E4AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041E4AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041E4AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041E4JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E4ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E4ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E4ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E4ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E4ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041F09D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F09G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F0AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041F0KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041F49D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F4AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041F4ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H09C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H09G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H09P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H09Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041H0A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041H0ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041H0ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041H49K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H4AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H4ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J0AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J0KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J0KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J0KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J0Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041J0ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041J0ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041J4AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J4ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04513ZZ,ICD10-PCS,Destruction of Celiac Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04584ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,045E4ZZ,ICD10-PCS,Destruction of R Int Iliac Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,045J0ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,045J3ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04B04ZZ,ICD10-PCS,Excision of Abdominal Aorta, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04B23ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04B30ZZ,ICD10-PCS,Excision of Hepatic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04B80ZZ,ICD10-PCS,Excision of Middle Colic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04B94ZZ,ICD10-PCS,Excision of Right Renal Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04BJ3ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04R147Z,ICD10-PCS,Replacement of Celiac Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R347Z,ICD10-PCS,Replace of Hepatic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R60JZ,ICD10-PCS,Replacement of R Colic Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R64JZ,ICD10-PCS,Replace of R Colic Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R80KZ,ICD10-PCS,Replacement of Mid Colic Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R84JZ,ICD10-PCS,Replace of Mid Colic Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04RB47Z,ICD10-PCS,Replace of Inf Mesent Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04RD07Z,ICD10-PCS,Replacement of L Com Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RD4JZ,ICD10-PCS,Replace L Com Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RF07Z,ICD10-PCS,Replacement of L Int Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RH0KZ,ICD10-PCS,Replace of R Ext Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04S10ZZ,ICD10-PCS,Reposition Celiac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04S60ZZ,ICD10-PCS,Reposition Right Colic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04S64ZZ,ICD10-PCS,Reposition Right Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04S74ZZ,ICD10-PCS,Reposition Left Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SB0ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SE4ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SF0ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SH3ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04SK0ZZ,ICD10-PCS,Reposition Right Femoral Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SL0ZZ,ICD10-PCS,Reposition Left Femoral Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SM3ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SN3ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04ST0ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Open Approach,,,8271.00
Deidentified Minimum,,04ST4ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SU4ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SV0ZZ,ICD10-PCS,Reposition Right Foot Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SV3ZZ,ICD10-PCS,Reposition Right Foot Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04SV4ZZ,ICD10-PCS,Reposition Right Foot Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U007Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04U247Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U307Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04U347Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U607Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04U737Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04U807Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UA07Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UA37Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UC07Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UE47Z,ICD10-PCS,Supplement R Int Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04UH37Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UH47Z,ICD10-PCS,Supplement R Ext Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04UL37Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UT37Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UU37Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UV37Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UW07Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UW37Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05100JY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,05110JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Open,,,8271.00
Deidentified Minimum,,05110ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Minimum,,05130KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,05130ZY,ICD10-PCS,Bypass Right Innominate Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Minimum,,051347Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05134JY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05164AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,05510ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Open Approach,,,8271.00
Deidentified Minimum,,05513ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05534ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05553ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05563ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05B03ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05B30ZZ,ICD10-PCS,Excision of Right Innominate Vein, Open Approach,,,8271.00
Deidentified Minimum,,05R10JZ,ICD10-PCS,Replacement of Hemiazygos Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R347Z,ICD10-PCS,Replace of R Innom Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R44JZ,ICD10-PCS,Replace of L Innom Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R50JZ,ICD10-PCS,Replacement of R Subclav Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R50KZ,ICD10-PCS,Replacement of R Subclav Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R547Z,ICD10-PCS,Replace of R Subclav Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R60JZ,ICD10-PCS,Replacement of L Subclav Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,05S34ZZ,ICD10-PCS,Reposition Right Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05S43ZZ,ICD10-PCS,Reposition Left Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05S44ZZ,ICD10-PCS,Reposition Left Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05S53ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05S70ZZ,ICD10-PCS,Reposition Right Axillary Vein, Open Approach,,,8271.00
Deidentified Minimum,,05S74ZZ,ICD10-PCS,Reposition Right Axillary Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05S90ZZ,ICD10-PCS,Reposition Right Brachial Vein, Open Approach,,,8271.00
Deidentified Minimum,,05S93ZZ,ICD10-PCS,Reposition Right Brachial Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05S94ZZ,ICD10-PCS,Reposition Right Brachial Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SA3ZZ,ICD10-PCS,Reposition Left Brachial Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SC0ZZ,ICD10-PCS,Reposition Left Basilic Vein, Open Approach,,,8271.00
Deidentified Minimum,,05SF3ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SG4ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,05SM3ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Approach,,,8271.00
Deidentified Minimum,,05SN4ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SQ0ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Open Approach,,,8271.00
Deidentified Minimum,,05U447Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05U537Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05U547Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05U737Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05U747Z,ICD10-PCS,Supplement R Axilla Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05U847Z,ICD10-PCS,Supplement L Axilla Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05UB47Z,ICD10-PCS,Supplement R Basilic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05UF37Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UM37Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UM47Z,ICD10-PCS,Supplement R Int Jugular Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05UP07Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UT47Z,ICD10-PCS,Supplement R Face Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06510ZZ,ICD10-PCS,Destruction of Splenic Vein, Open Approach,,,8271.00
Deidentified Minimum,,06524ZZ,ICD10-PCS,Destruction of Gastric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06543ZZ,ICD10-PCS,Destruction of Hepatic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06554ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06574ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06580ZZ,ICD10-PCS,Destruction of Portal Vein, Open Approach,,,8271.00
Deidentified Minimum,,06590ZZ,ICD10-PCS,Destruction of Right Renal Vein, Open Approach,,,8271.00
Deidentified Minimum,,065B3ZZ,ICD10-PCS,Destruction of Left Renal Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,065G0ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B10ZZ,ICD10-PCS,Excision of Splenic Vein, Open Approach,,,8271.00
Deidentified Minimum,,06B13ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06B44ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06BF0ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,06BG4ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06BH0ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06R10JZ,ICD10-PCS,Replacement of Splenic Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R247Z,ICD10-PCS,Replace of Gastric Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R54JZ,ICD10-PCS,Replace Sup Mesent Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06R60JZ,ICD10-PCS,Replacement of Inf Mesent Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R707Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R70JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06R747Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R74JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R74KZ,ICD10-PCS,Replace of Colic Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R847Z,ICD10-PCS,Replace of Portal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R84JZ,ICD10-PCS,Replace of Portal Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06R907Z,ICD10-PCS,Replacement of R Renal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RB07Z,ICD10-PCS,Replacement of Left Renal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RC07Z,ICD10-PCS,Replace of R Com Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RD0KZ,ICD10-PCS,Replace of L Com Iliac Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RF07Z,ICD10-PCS,Replace of R Ext Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RG0JZ,ICD10-PCS,Replace of L Ext Iliac Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,06RH4JZ,ICD10-PCS,Replace R Hypogast Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RH4KZ,ICD10-PCS,Replace R Hypogast Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06RJ4KZ,ICD10-PCS,Replace L Hypogast Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06S20ZZ,ICD10-PCS,Reposition Gastric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06S24ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06S60ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06S74ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,06SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06SJ0ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SM0ZZ,ICD10-PCS,Reposition Right Femoral Vein, Open Approach,,,8271.00
Deidentified Minimum,,06SV3ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,06U147Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06U207Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06U607Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06U937Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06U947Z,ICD10-PCS,Supplement R Renal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06UN37Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UP07Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UQ37Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UQ47Z,ICD10-PCS,Supplement L Saphenous with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,06UR07Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UR37Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06US07Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06US37Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06US47Z,ICD10-PCS,Supplement L Less Saphenous w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,06UT37Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UV37Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,06UY07Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,06UY37Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,001U0J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Open,,,8271.00
Deidentified Minimum,,001U0K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,005W0ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,005W3ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,005X0ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,008X0ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,008Y3ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,009T3ZZ,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Minimum,,009U00Z,ICD10-PCS,Drainage of Spinal Canal with Drainage Device, Open Approach,,,8271.00
Deidentified Minimum,,009W3ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Approach, Diagn,,,8271.00
Deidentified Minimum,,009W40Z,ICD10-PCS,Drain of Cerv Spinal Cord with Drain Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00BT0ZX,ICD10-PCS,Excision of Spinal Meninges, Open Approach, Diagnostic,,,8271.00
Deidentified Minimum,,00BW3ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Approach, Diagn,,,8271.00
Deidentified Minimum,,00BW4ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00BY4ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00C34ZZ,ICD10-PCS,Extirpate of Matter from Cran Epidur Spc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00CT4ZZ,ICD10-PCS,Extirpate of Matter from Spinal Meninges, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00FUXZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL EXTERNAL APPROACH,,,8271.00
Deidentified Minimum,,00HV4MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00NX4ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00PU00Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00PU03Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00PV07Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00PV0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Open Approach,,,8271.00
Deidentified Minimum,,00PV42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00PV4KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00QT0ZZ,ICD10-PCS,Repair Spinal Meninges, Open Approach,,,8271.00
Deidentified Minimum,,00QW4ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00SX3ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Minimum,,00UT37Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,00UT4KZ,ICD10-PCS,Supplement Spinal Meninges w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,00WU0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Open Approach,,,8271.00
Deidentified Minimum,,00WU3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Approach,,,8271.00
Deidentified Minimum,,00WU4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Minimum,,00WV32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Perc Approach,,,8271.00
Deidentified Minimum,,015B0ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Open Approach,,,8271.00
Deidentified Minimum,,01884ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,018B4ZZ,ICD10-PCS,Division of Lumbar Nerve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,02100A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Open,,,8271.00
Deidentified Minimum,,02100JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02100JW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,021049C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02104J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02104JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02104K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02104Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0211093,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,02110A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Open,,,8271.00
Deidentified Minimum,,02110J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Minimum,,02110JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02110Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,0211483,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02114J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114KW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02114Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02114ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021208C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,02120A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02120K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02120K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,0212499,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021249W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02124J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02124Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02124Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02124ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0213088,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Minimum,,0213089,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021308C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021308F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Open,,,8271.00
Deidentified Minimum,,02130K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02130K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02130Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,021348C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,0213493,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02134A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02134A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02134J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02134J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02134KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02160AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,02160JR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02160KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02160KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02160ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Minimum,,02160ZQ,ICD10-PCS,Bypass Right Atrium to Right Pulmonary Artery, Open Approach,,,8271.00
Deidentified Minimum,,021648P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021708Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,021709P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Vn, Open Approach,,,8271.00
Deidentified Minimum,,021749Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,02174AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,02174KR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021K09R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021K0JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021K0KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021K0Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,021K0ZC,ICD10-PCS,Bypass Right Ventricle to Thoracic Artery, Open Approach,,,8271.00
Deidentified Minimum,,021K0ZF,ICD10-PCS,Bypass Right Ventricle to Abdominal Artery, Open Approach,,,8271.00
Deidentified Minimum,,021K0ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Open Approach,,,8271.00
Deidentified Minimum,,021K48P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021K49R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021K4AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021K4JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021K4Z5,ICD10-PCS,Bypass Right Ventricle to Cor Circ, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021K4Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021K4ZF,ICD10-PCS,Bypass Right Ventricle to Abd Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021K4ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021L0AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Open,,,8271.00
Deidentified Minimum,,021L0AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,021L0JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021L0KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021L0Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Open Approach,,,8271.00
Deidentified Minimum,,021L49P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021L49Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021L4AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021L4KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021L4ZF,ICD10-PCS,Bypass Left Ventricle to Abd Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021V09Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021V0JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021V49R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021V4AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021V4ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021W08D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021W08P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Open,,,8271.00
Deidentified Minimum,,021W0AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Open,,,8271.00
Deidentified Minimum,,021W0AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,021W0KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021W0ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Open Approach,,,8271.00
Deidentified Minimum,,021W48B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021W49B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021W49D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021W4AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,021W4JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W4KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021W4ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,021X09P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Open,,,8271.00
Deidentified Minimum,,021X0AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Open,,,8271.00
Deidentified Minimum,,021X0JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,021X0KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,021X48D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021X48P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,021X49D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021X49Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,021X4JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,021X4ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,024F08J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Zooplastic, Open,,,8271.00
Deidentified Minimum,,02560ZZ,ICD10-PCS,Destruction of Right Atrium, Open Approach,,,8271.00
Deidentified Minimum,,02563ZZ,ICD10-PCS,Destruction of Right Atrium, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02590ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Open Approach,,,8271.00
Deidentified Minimum,,025L0ZZ,ICD10-PCS,Destruction of Left Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,025L3ZZ,ICD10-PCS,Destruction of Left Ventricle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,025Q3ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0270066,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02700D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02700G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02700T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Open,,,8271.00
Deidentified Minimum,,02700ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Open Approach,,,8271.00
Deidentified Minimum,,0270366,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,0270476,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,02704G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02704Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0271076,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02710D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Open,,,8271.00
Deidentified Minimum,,02710E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Open,,,8271.00
Deidentified Minimum,,0271366,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,027136Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02713E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02713EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,0271476,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,02714F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02714G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02720DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Open Approach,,,8271.00
Deidentified Minimum,,02720Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Minimum,,0272356,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,0272366,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,027236Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Minimum,,02723DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02723FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,0272456,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,02724DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02724E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02724FZ,ICD10-PCS,Dilate of 3 Cor Art with 3 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02724G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,,8271.00
Deidentified Minimum,,02724Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0273056,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Open,,,8271.00
Deidentified Minimum,,027305Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,027307Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Minimum,,02733G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,,8271.00
Deidentified Minimum,,02733GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02733Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Minimum,,0273456,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,,8271.00
Deidentified Minimum,,027345Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027347Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027F3DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,027F4DZ,ICD10-PCS,Dilate of Aortic Valve with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027G0ZZ,ICD10-PCS,Dilation of Mitral Valve, Open Approach,,,8271.00
Deidentified Minimum,,027J0ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Open Approach,,,8271.00
Deidentified Minimum,,027K0ZZ,ICD10-PCS,Dilation of Right Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,027K4DZ,ICD10-PCS,Dilate of R Ventricle with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Minimum,,027R3DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Perc Approach,,,8271.00
Deidentified Minimum,,02893ZZ,ICD10-PCS,Division of Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02B43ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02BQ4ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02C03Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Minimum,,02C10ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Open Approach,,,8271.00
Deidentified Minimum,,02C13ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Approach,,,8271.00
Deidentified Minimum,,02C20ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Open Approach,,,8271.00
Deidentified Minimum,,02C33Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Minimum,,02C44ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02FN0ZZ,ICD10-PCS,Fragmentation in Pericardium, Open Approach,,,8271.00
Deidentified Minimum,,02H432Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Perc Approach,,,8271.00
Deidentified Minimum,,02H73KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Perc Approach,,,8271.00
Deidentified Minimum,,02HK4KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02HP3DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Perc Approach,,,8271.00
Deidentified Minimum,,02HQ3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Perc Approach,,,8271.00
Deidentified Minimum,,02HS02Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Open Approach,,,8271.00
Deidentified Minimum,,02HS3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Perc Approach,,,8271.00
Deidentified Minimum,,02HT02Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Open Approach,,,8271.00
Deidentified Minimum,,02HT0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Open Approach,,,8271.00
Deidentified Minimum,,02HX42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Asc, Perc Endo,,,8271.00
Deidentified Minimum,,02K83ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02ND3ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02NG0ZZ,ICD10-PCS,Release Mitral Valve, Open Approach,,,8271.00
Deidentified Minimum,,02NH0ZZ,ICD10-PCS,Release Pulmonary Valve, Open Approach,,,8271.00
Deidentified Minimum,,02NJ0ZZ,ICD10-PCS,Release Tricuspid Valve, Open Approach,,,8271.00
Deidentified Minimum,,02PY07Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02PY08Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02PY0DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02PY32Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02PY43Z,ICD10-PCS,Remove of Infusion Dev from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02Q24ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02Q80ZZ,ICD10-PCS,Repair Conduction Mechanism, Open Approach,,,8271.00
Deidentified Minimum,,02Q90ZZ,ICD10-PCS,Repair Chordae Tendineae, Open Approach,,,8271.00
Deidentified Minimum,,02QH0ZZ,ICD10-PCS,Repair Pulmonary Valve, Open Approach,,,8271.00
Deidentified Minimum,,02QK0ZZ,ICD10-PCS,Repair Right Ventricle, Open Approach,,,8271.00
Deidentified Minimum,,02QK3ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Approach,,,8271.00
Deidentified Minimum,,02R54JZ,ICD10-PCS,Replace of Atrial Sept with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R647Z,ICD10-PCS,Replacement of R Atrium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02R70JZ,ICD10-PCS,Replacement of Left Atrium with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02R90JZ,ICD10-PCS,Replace of Chordae Tendineae with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RD07Z,ICD10-PCS,Replace of Papillary Muscle with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RD4KZ,ICD10-PCS,Replace Papillary Muscle w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02RF0KZ,ICD10-PCS,Replacement of Aortic Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RG0JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RG3JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02RH4JZ,ICD10-PCS,Replacement of Pulm Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RJ47Z,ICD10-PCS,Replace of Tricusp Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RJ4JZ,ICD10-PCS,Replace of Tricusp Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RK08Z,ICD10-PCS,Replacement of R Ventricle with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RK48Z,ICD10-PCS,Replace of R Ventricle with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RK4JZ,ICD10-PCS,Replace of R Ventricle with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RL0JZ,ICD10-PCS,Replacement of Left Ventricle with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RM48Z,ICD10-PCS,Replace Ventricular Sept w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02RM4KZ,ICD10-PCS,Replace Ventricular Sept w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02RN47Z,ICD10-PCS,Replace of Pericardium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RN4JZ,ICD10-PCS,Replace of Pericardium with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RP07Z,ICD10-PCS,Replacement of Pulmonary Trunk with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RP47Z,ICD10-PCS,Replacement of Pulm Trunk with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RP4KZ,ICD10-PCS,Replace of Pulm Trunk with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RQ07Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RR08Z,ICD10-PCS,Replacement of L Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02RR4KZ,ICD10-PCS,Replace of L Pulm Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RT4KZ,ICD10-PCS,Replace of L Pulm Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RV0JZ,ICD10-PCS,Replacement of Sup Vena Cava with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02RV4JZ,ICD10-PCS,Replace of Sup Vena Cava with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RV4KZ,ICD10-PCS,Replace of Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02RX07Z,ICD10-PCS,Replacement of Thor Aorta Asc with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02SR0ZZ,ICD10-PCS,Reposition Left Pulmonary Artery, Open Approach,,,8271.00
Deidentified Minimum,,02SS0ZZ,ICD10-PCS,Reposition Right Pulmonary Vein, Open Approach,,,8271.00
Deidentified Minimum,,02SV0ZZ,ICD10-PCS,Reposition Superior Vena Cava, Open Approach,,,8271.00
Deidentified Minimum,,02T90ZZ,ICD10-PCS,Resection of Chordae Tendineae, Open Approach,,,8271.00
Deidentified Minimum,,02U508Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02U637Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02U638Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02U63KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02U64JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02U708Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Open Approach,,,8271.00
Deidentified Minimum,,02U73KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02U907Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02U938Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02U947Z,ICD10-PCS,Supplement Chordae Tendineae w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UA3KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UD0JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UD0KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UD47Z,ICD10-PCS,Supplement Papillary Muscle w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UD48Z,ICD10-PCS,Supplement Papillary Muscle w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02UF07Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UF37J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc,,,8271.00
Deidentified Minimum,,02UF38J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc,,,8271.00
Deidentified Minimum,,02UF38Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UF4JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UG08E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Open,,,8271.00
Deidentified Minimum,,02UG0KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02UG37E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc,,,8271.00
Deidentified Minimum,,02UG3KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UG4JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UH48Z,ICD10-PCS,Supplement Pulm Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UH4JZ,ICD10-PCS,Supplement Pulm Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UJ0KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,02UJ37Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UJ3KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc,,,8271.00
Deidentified Minimum,,02UK4KZ,ICD10-PCS,Supplement R Ventricle with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UL0KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UM0JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UM0KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UN07Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UP08Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Open Approach,,,8271.00
Deidentified Minimum,,02UP38Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UQ07Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UQ3KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UT0KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UT47Z,ICD10-PCS,Supplement L Pulm Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UT4KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UV38Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Perc Approach,,,8271.00
Deidentified Minimum,,02UV47Z,ICD10-PCS,Supplement Sup Vena Cava with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02UW0KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,02UW37Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UW3JZ,ICD10-PCS,Supplement Thor Aorta Desc with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,02UW48Z,ICD10-PCS,Supplement Thor Aorta Desc w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02UW4JZ,ICD10-PCS,Supplement Thor Aorta Desc w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,02UX48Z,ICD10-PCS,Supplement Thor Aorta Asc w Zooplastic, Perc Endo,,,8271.00
Deidentified Minimum,,02VW0FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Open,,,8271.00
Deidentified Minimum,,02VW4EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc Endo,,,8271.00
Deidentified Minimum,,02VW4FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc Endo,,,8271.00
Deidentified Minimum,,02VX0FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Open,,,8271.00
Deidentified Minimum,,02W50JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Open Approach,,,8271.00
Deidentified Minimum,,02WF0KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WF47Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WF48Z,ICD10-PCS,Revision of Zooplastic in Aortic Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WH0KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WH47Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WH4KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WJ4KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WY08Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02WY0KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02WY33Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02WY3DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02WY3KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02WY4DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03130JN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,03130KM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,03130KN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,03140ZM,ICD10-PCS,Bypass Left Subclavian Artery to R Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,03544ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03B00ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Minimum,,03B10ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Minimum,,03B13ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03B23ZZ,ICD10-PCS,Excision of Innominate Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03B33ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03B43ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03R007Z,ICD10-PCS,Replacement of R Int Mamm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R10KZ,ICD10-PCS,Replacement of L Int Mamm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R14JZ,ICD10-PCS,Replace of L Int Mamm Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R407Z,ICD10-PCS,Replacement of L Subclav Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03S00ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Minimum,,03S10ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Minimum,,03S13ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03S33ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SA0ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SB3ZZ,ICD10-PCS,Reposition Right Radial Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SH4ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SK3ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03SL0ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SN3ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03SQ3ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SS4ZZ,ICD10-PCS,Reposition Right Temporal Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WG48Z,ICD10-PCS,Revision of Zooplastic in Mitral Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WG4JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WH07Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WH48Z,ICD10-PCS,Revision of Zooplastic in Pulm Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WH4JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WJ0JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Open Approach,,,8271.00
Deidentified Minimum,,02WJ47Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WM0JZ,ICD10-PCS,Revision of Synth Sub in Ventricular Sept, Open Approach,,,8271.00
Deidentified Minimum,,02WY03Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Open Approach,,,8271.00
Deidentified Minimum,,02WY38Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02WY3CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Approach,,,8271.00
Deidentified Minimum,,02WY42Z,ICD10-PCS,Revision of Monitor Dev in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,02WY4KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03130ZN,ICD10-PCS,Bypass Right Subclavian Artery to L Pulm Art, Open Approach,,,8271.00
Deidentified Minimum,,03140AM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,03140JM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,03140KM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,03513ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Minimum,,03520ZZ,ICD10-PCS,Destruction of Innominate Artery, Open Approach,,,8271.00
Deidentified Minimum,,03523ZZ,ICD10-PCS,Destruction of Innominate Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03524ZZ,ICD10-PCS,Destruction of Innominate Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03B44ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R04JZ,ICD10-PCS,Replace of R Int Mamm Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R04KZ,ICD10-PCS,Replace R Int Mamm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,03R147Z,ICD10-PCS,Replace of L Int Mamm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03R20KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R30JZ,ICD10-PCS,Replacement of R Subclav Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R40JZ,ICD10-PCS,Replacement of L Subclav Art with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,03R44JZ,ICD10-PCS,Replace of L Subclav Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S34ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03S93ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SB4ZZ,ICD10-PCS,Reposition Right Radial Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SD4ZZ,ICD10-PCS,Reposition Right Hand Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03SF3ZZ,ICD10-PCS,Reposition Left Hand Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,03SM0ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SU0ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Open Approach,,,8271.00
Deidentified Minimum,,03SY0ZZ,ICD10-PCS,Reposition Upper Artery, Open Approach,,,8271.00
Deidentified Minimum,,03U007Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03U037Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03U107Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03U137Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03U207Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03U437Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03U507Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03U837Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UC37Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UC47Z,ICD10-PCS,Supplement L Radial Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UD37Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UF07Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,03UF37Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UG37Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UH47Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UQ47Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UR37Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03US47Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,03UT37Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,03UV37Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0410097,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Minimum,,041009G,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO VEN TISS OPN APPR,,,8271.00
Deidentified Minimum,,041009H,ICD10-PCS,BP ABD AO RT FEM ART AUTO VEN TISS OPN APPROACH,,,8271.00
Deidentified Minimum,,04100A6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Minimum,,04100J2,ICD10-PCS,BYPASS ABD AO MES ART SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100JC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART SYN SUB OPN APPROACH,,,8271.00
Deidentified Minimum,,04100JH,ICD10-PCS,BYPS ABD AO RT FEM ART SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100K0,ICD10-PCS,BP ABD AO ABD AO NONAUTO TISS SUBST OPN APPROACH,,,8271.00
Deidentified Minimum,,04100K3,ICD10-PCS,BP ABD AO RT RENL ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100KD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100KF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100KK,ICD10-PCS,BP ABD AO B FEM ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Minimum,,04100Z1,ICD10-PCS,BYPASS ABD AORTA CELIAC ARTERY OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100Z7,ICD10-PCS,BYPASS ABD AO LT COMMON ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100ZB,ICD10-PCS,BYPASS ABD AO LT INTRL ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100ZD,ICD10-PCS,BYPASS ABD AORTA RT EXT ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Minimum,,04100ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Open Approach,,,8271.00
Deidentified Minimum,,0410494,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,0410498,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041049B,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041049F,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,04104A2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104AR,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,04104J2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104J4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104J8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104JB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104KB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04104Z0,ICD10-PCS,Bypass Abdominal Aorta to Abd Aorta, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104Z2,ICD10-PCS,Bypass Abdominal Aorta to Mesent Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104Z8,ICD10-PCS,Bypass Abdominal Aorta to B Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104ZH,ICD10-PCS,Bypass Abdominal Aorta to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04104ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04140A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Open,,,8271.00
Deidentified Minimum,,04140J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,04144J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04144K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04144K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04144Z4,ICD10-PCS,Bypass Splenic Artery to L Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041C092,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C096,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C098,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C09C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C09K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041C0A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041C0JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041C0K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041C0Z5,ICD10-PCS,Bypass Right Common Iliac Artery to B Renal A, Open Approach,,,8271.00
Deidentified Minimum,,041C0ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Open Approach,,,8271.00
Deidentified Minimum,,041C49F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C49G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C49H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C49Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041C4A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041C4J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041C4ZR,ICD10-PCS,Bypass R Com Iliac Art to Low Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D092,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D09F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D09G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041D0AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041D0J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041D0K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041D0Z4,ICD10-PCS,Bypass Left Common Iliac Artery to L Renal A, Open Approach,,,8271.00
Deidentified Minimum,,041D0ZB,ICD10-PCS,Bypass Left Common Iliac Artery to L Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041D0ZJ,ICD10-PCS,Bypass Left Common Iliac Artery to L Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041D0ZR,ICD10-PCS,Bypass Left Common Iliac Artery to Low Art, Open Approach,,,8271.00
Deidentified Minimum,,041D494,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D497,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D498,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D49D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041D4A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041D4J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041D4Z2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4Z4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4Z8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041D4ZC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041E0AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041E0JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041E0K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E0KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041E499,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041E4AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041E4JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041E4KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F09B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F09C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041F0A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041F0KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041F0ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041F0ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041F0ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Open Approach,,,8271.00
Deidentified Minimum,,041F49H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F49J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F49Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041F4AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041F4JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041F4ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041F4ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041F4ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041F4ZP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H0AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Minimum,,041H0JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041H0KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H0KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H0KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041H0ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Open Approach,,,8271.00
Deidentified Minimum,,041H49H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041H4A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041H4JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041H4ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H4ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041H4ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,041J099,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J09B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J09Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Minimum,,041J0AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Minimum,,041J0JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Minimum,,041J0KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Minimum,,041J49H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J49K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,041J4A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,041J4JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,041J4ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04500ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Open Approach,,,8271.00
Deidentified Minimum,,04520ZZ,ICD10-PCS,Destruction of Gastric Artery, Open Approach,,,8271.00
Deidentified Minimum,,04530ZZ,ICD10-PCS,Destruction of Hepatic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04533ZZ,ICD10-PCS,Destruction of Hepatic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04543ZZ,ICD10-PCS,Destruction of Splenic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04544ZZ,ICD10-PCS,Destruction of Splenic Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Minimum,,04553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04570ZZ,ICD10-PCS,Destruction of Left Colic Artery, Open Approach,,,8271.00
Deidentified Minimum,,045A0ZZ,ICD10-PCS,Destruction of Left Renal Artery, Open Approach,,,8271.00
Deidentified Minimum,,045A4ZZ,ICD10-PCS,Destruction of Left Renal Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,045D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,045E0ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,045F3ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,045H0ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,045J4ZZ,ICD10-PCS,Destruction of L Ext Iliac Art, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04B03ZZ,ICD10-PCS,Excision of Abdominal Aorta, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04B14ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,04B24ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,04B63ZZ,ICD10-PCS,Excision of Right Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04B83ZZ,ICD10-PCS,Excision of Middle Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04B90ZZ,ICD10-PCS,Excision of Right Renal Artery, Open Approach,,,8271.00
Deidentified Minimum,,04B93ZZ,ICD10-PCS,Excision of Right Renal Artery, Percutaneous Approach,,,8271.00
Deidentified Minimum,,04BB4ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04BE3ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04BH0ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04BH3ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04R007Z,ICD10-PCS,Replacement of Abdominal Aorta with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R047Z,ICD10-PCS,Replacement of Abd Aorta with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R10KZ,ICD10-PCS,Replacement of Celiac Artery with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R14JZ,ICD10-PCS,Replacement of Celiac Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R14KZ,ICD10-PCS,Replace of Celiac Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R44KZ,ICD10-PCS,Replace of Splenic Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R54JZ,ICD10-PCS,Replace of Sup Mesent Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04R607Z,ICD10-PCS,Replacement of R Colic Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04R94KZ,ICD10-PCS,Replace of R Renal Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04RA07Z,ICD10-PCS,Replacement of L Renal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RB4JZ,ICD10-PCS,Replace of Inf Mesent Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04RB4KZ,ICD10-PCS,Replace Inf Mesent Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RC07Z,ICD10-PCS,Replacement of R Com Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RE07Z,ICD10-PCS,Replacement of R Int Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RF0KZ,ICD10-PCS,Replace of L Int Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RF4JZ,ICD10-PCS,Replace L Int Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04RJ07Z,ICD10-PCS,Replacement of L Ext Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04RJ0KZ,ICD10-PCS,Replace of L Ext Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,04S14ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,04S44ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,04S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Minimum,,04S80ZZ,ICD10-PCS,Reposition Middle Colic Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SH0ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SJ0ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SJ4ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SK4ZZ,ICD10-PCS,Reposition Right Femoral Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SP4ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SQ0ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SQ3ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Approach,,,8271.00
Deidentified Minimum,,04SR4ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04SU0ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Open Approach,,,8271.00
Deidentified Minimum,,04SY4ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,04U237Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04U337Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04U507Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04U537Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04U647Z,ICD10-PCS,Supplement R Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04U837Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UC37Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UC47Z,ICD10-PCS,Supplement R Com Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04UD47Z,ICD10-PCS,Supplement L Com Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04UE37Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UF37Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UF47Z,ICD10-PCS,Supplement L Int Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04UJ47Z,ICD10-PCS,Supplement L Ext Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,04UL07Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UL47Z,ICD10-PCS,Supplement L Femor Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UM07Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UN07Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UN37Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,04UP07Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UT47Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UV07Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,04UW47Z,ICD10-PCS,Supplement L Foot Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,04UY37Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05100AY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Art, Open Approach,,,8271.00
Deidentified Minimum,,05114AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Minimum,,05114JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,051307Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,051407Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05140ZY,ICD10-PCS,Bypass Left Innominate Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Minimum,,051449Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Minimum,,051509Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Open,,,8271.00
Deidentified Minimum,,05150KY,ICD10-PCS,BYPS RT SV UP VEIN NONAUT SUB OPEN,,,8271.00
Deidentified Minimum,,05154JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05164ZY,ICD10-PCS,Bypass Left Subclavian Vein to Up Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05504ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,05544ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05550ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Open Approach,,,8271.00
Deidentified Minimum,,05B14ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05B33ZZ,ICD10-PCS,Excision of Right Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05B40ZZ,ICD10-PCS,Excision of Left Innominate Vein, Open Approach,,,8271.00
Deidentified Minimum,,05R00JZ,ICD10-PCS,Replacement of Azygos Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R14JZ,ICD10-PCS,Replace Hemiazygos Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05R307Z,ICD10-PCS,Replacement of R Innom Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R34JZ,ICD10-PCS,Replace of R Innom Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R407Z,ICD10-PCS,Replacement of L Innom Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R40KZ,ICD10-PCS,Replacement of L Innom Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,05R54JZ,ICD10-PCS,Replace of R Subclav Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05R54KZ,ICD10-PCS,Replace R Subclav Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05R60KZ,ICD10-PCS,Replacement of L Subclav Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,05S03ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05S13ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05S30ZZ,ICD10-PCS,Reposition Right Innominate Vein, Open Approach,,,8271.00
Deidentified Minimum,,05S50ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Open Approach,,,8271.00
Deidentified Minimum,,05S60ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Open Approach,,,8271.00
Deidentified Minimum,,05S64ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SF4ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SG3ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SH3ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SL3ZZ,ICD10-PCS,Reposition Intracranial Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SL4ZZ,ICD10-PCS,Reposition Intracranial Vein, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05SV3ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Approach,,,8271.00
Deidentified Minimum,,05SY4ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,05U007Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05U037Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05U047Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05U107Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05U137Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05U147Z,ICD10-PCS,Supplement Hemiazygos Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Minimum,,05U647Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,05U837Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UC37Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UH07Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UP37Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,05UQ07Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,05UR07Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RG007J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG00A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG00J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG03J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG03JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG03K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG03Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG04AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG04K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG04Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG04Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG04ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG10K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG10KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG10Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG10Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG14K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG14K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG14KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG14ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG20K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG20KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG23A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG23J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG24A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG407J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG40A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG40AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG40J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG40KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG43A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG43JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG43Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG447J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG607J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG60J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG60K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG63JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG64AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG64J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG64Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG70J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG70JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG70K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG70Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG7371,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG73KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG747J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG74A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG74Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG807J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG80AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG80JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG80ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG83J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG84A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA0AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RGA0K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RGA0Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RGA3A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RGA3AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RGA3J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RGA4K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RH40BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Open,,,8271.00
Deidentified Minimum,,0RH43BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc,,,8271.00
Deidentified Minimum,,0RH44BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc Endo,,,8271.00
Deidentified Minimum,,0RHA0BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Open,,,8271.00
Deidentified Minimum,,0RHA4CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into T-lum Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RR50JZ,ICD10-PCS,Replacement of C-thor Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RRB0JZ,ICD10-PCS,Replacement of T-lum Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RT40ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Joint, Open Approach,,,8271.00
Deidentified Minimum,,0RT50ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RTB0ZZ,ICD10-PCS,Resection of Thoracolumbar Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RW30JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RW34JZ,ICD10-PCS,Revision of Synth Sub in Cerv Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RW53JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Approach,,,8271.00
Deidentified Minimum,,0S523ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SB20ZZ,ICD10-PCS,EXCISION LUMBAR VERTEBRAL DISC OPEN,,,8271.00
Deidentified Minimum,,0SB43ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SB53ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SB54ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SB60ZZ,ICD10-PCS,EXCISION OF COCCYGEAL JOINT OPEN,,,8271.00
Deidentified Minimum,,0SB63ZZ,ICD10-PCS,Excision of Coccygeal Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SB73ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SB74ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG0070,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG00K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG03AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG0471,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG04A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG04J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG04JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG1070,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG107J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG10Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0SG10Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0SG13J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG1470,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG14KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG14Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG30KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG30Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0SG30ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0SG3370,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG33A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG33AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG33Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0SG33ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0SG3471,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG34A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG34KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG53KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SG54JZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,0SG60JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG64ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,0SG704Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Open Approach,,,8271.00
Deidentified Minimum,,0SG70KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG73ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SG83JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0SH30DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Open Approach,,,8271.00
Deidentified Minimum,,0SH33BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc,,,8271.00
Deidentified Minimum,,0SH33CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0SH34BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc Endo,,,8271.00
Deidentified Minimum,,0SR901Z,ICD10-PCS,Replacement of Right Hip Joint with Metal, Open Approach,,,8271.00
Deidentified Minimum,,0SRA009,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Cement, Open,,,8271.00
Deidentified Minimum,,0SRA01Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Metal, Open Approach,,,8271.00
Deidentified Minimum,,0SRA03A,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRA0JZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRB019,ICD10-PCS,Replacement of L Hip Jt with Metal, Cement, Open Approach,,,8271.00
Deidentified Minimum,,0SRB01A,ICD10-PCS,Replacement of L Hip Jt with Metal, Uncement, Open Approach,,,8271.00
Deidentified Minimum,,0SRB04Z,ICD10-PCS,Replacement of L Hip Jt with Ceramic on Poly, Open Approach,,,8271.00
Deidentified Minimum,,0SRB07Z,ICD10-PCS,Replacement of Left Hip Joint with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRB0JZ,ICD10-PCS,Replacement of Left Hip Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRC07Z,ICD10-PCS,Replacement of R Knee Jt with Autol Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRE00Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Polyeth, Open Approach,,,8271.00
Deidentified Minimum,,0SRS01A,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRS039,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Cement, Open,,,8271.00
Deidentified Minimum,,0SRS03Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Ceramic, Open Approach,,,8271.00
Deidentified Minimum,,0SRT0J9,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Cement, Open,,,8271.00
Deidentified Minimum,,0SRT0KZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SRW0JZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SUS0BZ,ICD10-PCS,Supplement L Hip Jt, Femoral with Resurf Dev, Open Approach,,,8271.00
Deidentified Minimum,,0SW24JZ,ICD10-PCS,Revision of Synth Sub in Lum Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SW90JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Open Approach,,,8271.00
Deidentified Minimum,,0SWC4JZ,ICD10-PCS,Revision of Synth Sub in R Knee Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SWD0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Open Approach,,,8271.00
Deidentified Minimum,,0TQB0ZZ,ICD10-PCS,Repair Bladder, Open Approach,,,4303.00
Deidentified Minimum,,0WQNXZZ,ICD10-PCS,Repair Female Perineum, External Approach,,,4303.00
Deidentified Minimum,,10D00Z0,ICD10-PCS,Extraction of Products of Conception, High, Open Approach,,,4303.00
Deidentified Minimum,,10D00Z2,ICD10-PCS,Extraction of POC, Extraperitoneal, Open Approach,,,4303.00
Deidentified Minimum,,10D07Z8,ICD10-PCS,Extraction of Products of Conception, Other, Via Opening,,,4303.00
Deidentified Minimum,,10S0XZZ,ICD10-PCS,Reposition Products of Conception, External Approach,,,4303.00
Deidentified Minimum,,5A0211D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Intermittent,,,8271.00
Deidentified Minimum,,B200YZZ,ICD10-PCS,Plain Radiography of Single Cor Art using Oth Contrast,,,8271.00
Deidentified Minimum,,B203YZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using Oth Contrast,,,8271.00
Deidentified Minimum,,B2041ZZ,ICD10-PCS,Plain Radiography of Right Heart using Low Osmolar Contrast,,,8271.00
Deidentified Minimum,,B207YZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using Oth Contrast,,,8271.00
Deidentified Minimum,,B2110ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2150ZZ,ICD10-PCS,Fluoroscopy of Left Heart using High Osmolar Contrast,,,8271.00
Deidentified Minimum,,B215YZZ,ICD10-PCS,Fluoroscopy of Left Heart using Other Contrast,,,8271.00
Deidentified Minimum,,B217YZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using Oth Contrast,,,8271.00
Deidentified Minimum,,B2180ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using H Osm Contrast,,,8271.00
Deidentified Minimum,,06UY47Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0DQR0ZZ,ICD10-PCS,Repair Anal Sphincter, Open Approach,,,4303.00
Deidentified Minimum,,0PS304Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Open Approach,,,8271.00
Deidentified Minimum,,0PS30ZZ,ICD10-PCS,Reposition Cervical Vertebra, Open Approach,,,8271.00
Deidentified Minimum,,0PS34ZZ,ICD10-PCS,Reposition Cervical Vertebra, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0PS444Z,ICD10-PCS,Reposition Thor Vertebra with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0Q820ZZ,ICD10-PCS,Division of Right Pelvic Bone, Open Approach,,,4303.00
Deidentified Minimum,,0QS00ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Open Approach,,,8271.00
Deidentified Minimum,,0QSS34Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Approach,,,8271.00
Deidentified Minimum,,0QSS44Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0QSS4ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Minimum,,0R5B0ZZ,ICD10-PCS,Destruction of Thoracolumbar Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RB53ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Perc Approach,,,8271.00
Deidentified Minimum,,0RB93ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0RBB0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0RG00J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG03A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG03A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG03K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG03ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG0471,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG1370,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG13A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG13JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG13Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG13ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG1471,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG14JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG14Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG2070,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG20J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG20Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG23A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG23AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG23Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RG247J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG43J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG43J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG44K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG60A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG60KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG60ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG637J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG63A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG63A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG6471,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG64J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG64K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG73AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG73J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG73JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG7471,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG74J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG74J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG74K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RG74ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RG8070,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG8071,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RG80KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RG80Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Minimum,,0RG8371,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG83A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG83A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG83JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RG83K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0RG84K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA070,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RGA07J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RGA0A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0RGA0JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0RGA3A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0RGA3ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0RGA47J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA4AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0RGA4Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RGA4ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RH00BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Open,,,8271.00
Deidentified Minimum,,0RH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Perc Approach,,,8271.00
Deidentified Minimum,,0RH40CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RH60DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Open Approach,,,8271.00
Deidentified Minimum,,0RR90JZ,ICD10-PCS,Replacement of Thor Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0RU04JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RU14JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RU63JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0RW33JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Perc Approach,,,8271.00
Deidentified Minimum,,0RW94JZ,ICD10-PCS,Revision of Synth Sub in Thor Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0RWB0JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Open Approach,,,8271.00
Deidentified Minimum,,0S520ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0S524ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SB03ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Percutaneous Approach,,,8271.00
Deidentified Minimum,,0SB04ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SB24ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SB30ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL JOINT OPEN,,,8271.00
Deidentified Minimum,,0SB64ZZ,ICD10-PCS,Excision of Coccygeal Joint, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG00JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG00Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Minimum,,0SG037J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG03J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG03JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG03Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0SG03Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Minimum,,0SG04AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG10A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG10A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG10AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG10KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG13JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG13K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG13KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG13Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Minimum,,0SG1471,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG14A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG14J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG14J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG14K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG3070,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG30A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Minimum,,0SG30A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG30J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG30K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Minimum,,0SG3371,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Minimum,,0SG33J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Minimum,,0SG347J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG34AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Minimum,,0SG534Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Perc Approach,,,8271.00
Deidentified Minimum,,0SG60KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG63JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SG647Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG70JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Minimum,,0SG73KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SG747Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG74JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0SG80ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Open Approach,,,8271.00
Deidentified Minimum,,0SG834Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Perc Approach,,,8271.00
Deidentified Minimum,,0SG837Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lum Jt, Perc Endo,,,8271.00
Deidentified Minimum,,0SR90JA,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Uncement, Open Approach,,,8271.00
Deidentified Minimum,,0SRA0J9,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Cement, Open,,,8271.00
Deidentified Minimum,,0SRB02A,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRC0J9,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Cement, Open Approach,,,8271.00
Deidentified Minimum,,0SRR0J9,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Cement, Open,,,8271.00
Deidentified Minimum,,0SRR0JA,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Uncement, Open,,,8271.00
Deidentified Minimum,,0SRS01Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Metal, Open Approach,,,8271.00
Deidentified Minimum,,0SRW0J9,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Cement, Open,,,8271.00
Deidentified Minimum,,0ST40ZZ,ICD10-PCS,Resection of Lumbosacral Disc, Open Approach,,,8271.00
Deidentified Minimum,,0SU03JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Minimum,,0SU54JZ,ICD10-PCS,Supplement Sacrococcygeal Jt w Synth Sub, Perc Endo,,,8271.00
Deidentified Minimum,,0SU90BZ,ICD10-PCS,Supplement Right Hip Joint with Resurf Dev, Open Approach,,,8271.00
Deidentified Minimum,,0SW20JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Open Approach,,,8271.00
Deidentified Minimum,,0SW43JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Approach,,,8271.00
Deidentified Minimum,,0SWD4JZ,ICD10-PCS,Revision of Synth Sub in L Knee Jt, Perc Endo Approach,,,8271.00
Deidentified Minimum,,0UQC8ZZ,ICD10-PCS,Repair Cervix, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Minimum,,0UQMXZZ,ICD10-PCS,Repair Vulva, External Approach,,,4303.00
Deidentified Minimum,,10907ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Via Opening,,,4303.00
Deidentified Minimum,,4A020N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Open Approach,,,8271.00
Deidentified Minimum,,B2001ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using L Osm Contrast,,,8271.00
Deidentified Minimum,,B2011ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using L Osm Contrast,,,8271.00
Deidentified Minimum,,B204YZZ,ICD10-PCS,Plain Radiography of Right Heart using Other Contrast,,,8271.00
Deidentified Minimum,,B206YZZ,ICD10-PCS,Plain Radiography of Right and Left Heart using Oth Contrast,,,8271.00
Deidentified Minimum,,B2070ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2071ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using L Osm Contrast,,,8271.00
Deidentified Minimum,,B2081ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using L Osm Contrast,,,8271.00
Deidentified Minimum,,B20FYZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using Other Contrast,,,8271.00
Deidentified Minimum,,B2101ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using L Osm Contrast,,,8271.00
Deidentified Minimum,,B210YZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using Other Contrast,,,8271.00
Deidentified Minimum,,B2120ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using H Osm Contrast,,,8271.00
Deidentified Minimum,,B2140ZZ,ICD10-PCS,Fluoroscopy of Right Heart using High Osmolar Contrast,,,8271.00
Deidentified Minimum,,B2171ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using L Osm Contrast,,,8271.00
Deidentified Minimum,,B21FYZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Other Contrast,,,8271.00
Deidentified Maximum,,0410090,ICD10-PCS,BYPASS ABD AORTA ABD AORTA AUTO VENOUS TISS OPN,,,8271.00
Deidentified Maximum,,041009D,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Maximum,,041009K,ICD10-PCS,BYPS ABD AO B FEM ART AUTO VEN TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100A8,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO ART TISS OPN APPR,,,8271.00
Deidentified Maximum,,04100AJ,ICD10-PCS,BP ABD AO LT FEM ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100J6,ICD10-PCS,BP ABD AO RT COMMON ILIAC ART SYN SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100JF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART SYN SUB OPN APPROACH,,,8271.00
Deidentified Maximum,,04100K9,ICD10-PCS,BP ABD AO RT IIA NONAUTO SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100KB,ICD10-PCS,BP ABD AO LT IIA NONAUTO SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100Z0,ICD10-PCS,BYPASS ABD AORTA ABDOMINAL AORTA OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100Z9,ICD10-PCS,BYPASS ABD AO RT INTRL ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100ZJ,ICD10-PCS,BYPASS ABD AORTA LT FEMORAL ARTERY OPEN APPROACH,,,8271.00
Deidentified Maximum,,0410492,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,0410495,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,0410497,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041049C,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041049J,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,04104A5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104A7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104AB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104J7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104JK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104K1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104K6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104KF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104KJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104KR,ICD10-PCS,Bypass Abd Aorta to Low Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104Z5,ICD10-PCS,Bypass Abdominal Aorta to B Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04140J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,04140K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,04140Z3,ICD10-PCS,Bypass Splenic Artery to Right Renal Artery, Open Approach,,,8271.00
Deidentified Maximum,,04144J3,ICD10-PCS,Bypass Splenic Art to R Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04144Z3,ICD10-PCS,Bypass Splenic Artery to R Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C095,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C09D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C0J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Open Approach,,,8271.00
Deidentified Maximum,,041C492,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C497,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C498,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C49B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C49C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C49D,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C49J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C4A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4Z0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4Z3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D09C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D09H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D0A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0Z7,ICD10-PCS,Bypass Left Common Iliac Artery to L Com Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041D0Z8,ICD10-PCS,Bypass Left Common Iliac Artery to B Com Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041D0Z9,ICD10-PCS,Bypass Left Common Iliac Artery to R Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041D0ZF,ICD10-PCS,Bypass Left Common Iliac Artery to L Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041D492,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D495,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D49G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D49H,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D49K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D49Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D4A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4ZF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4ZH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E09C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E09P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E09Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E0AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E0KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E0ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041E0ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Open Approach,,,8271.00
Deidentified Maximum,,041E0ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Open Approach,,,8271.00
Deidentified Maximum,,041E49B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E49F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E4AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041E4AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041E4AQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041E4JF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E4ZP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041F099,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F09F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F09K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F0AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041F0ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041F0ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041F49C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F49F,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F49G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F49P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F4AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4AF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4ZC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041F4ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H09H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H0AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H0ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041H0ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041H0ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041H0ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041H4AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H4ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J09J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J09P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J0J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J0KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J0KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J0ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041J0ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041J0ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041J0ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041J49Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J4JC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4ZP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J4ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04504ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04523ZZ,ICD10-PCS,Destruction of Gastric Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04564ZZ,ICD10-PCS,Destruction of Right Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,045B3ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Perc Approach,,,8271.00
Deidentified Maximum,,045C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,045F4ZZ,ICD10-PCS,Destruction of L Int Iliac Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04B20ZZ,ICD10-PCS,Excision of Gastric Artery, Open Approach,,,8271.00
Deidentified Maximum,,04B33ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04BE0ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04BF4ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04BH4ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04BJ0ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04R04JZ,ICD10-PCS,Replacement of Abd Aorta with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R04KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R20JZ,ICD10-PCS,Replacement of Gastric Artery with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R247Z,ICD10-PCS,Replace of Gastric Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R30JZ,ICD10-PCS,Replacement of Hepatic Artery with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R30KZ,ICD10-PCS,Replacement of Hepatic Artery with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R34KZ,ICD10-PCS,Replace of Hepatic Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R507Z,ICD10-PCS,Replacement of Sup Mesent Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R50JZ,ICD10-PCS,Replacement of Sup Mesent Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R64KZ,ICD10-PCS,Replace of R Colic Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R70KZ,ICD10-PCS,Replacement of L Colic Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R74JZ,ICD10-PCS,Replace of L Colic Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R847Z,ICD10-PCS,Replace of Mid Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R84KZ,ICD10-PCS,Replace of Mid Colic Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04RA4KZ,ICD10-PCS,Replace of L Renal Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04RB07Z,ICD10-PCS,Replacement of Inf Mesent Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RC0JZ,ICD10-PCS,Replacement of R Com Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RC4JZ,ICD10-PCS,Replace R Com Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RC4KZ,ICD10-PCS,Replace R Com Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RD0KZ,ICD10-PCS,Replace of L Com Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RD47Z,ICD10-PCS,Replace L Com Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RH0JZ,ICD10-PCS,Replacement of R Ext Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RH47Z,ICD10-PCS,Replace R Ext Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RH4KZ,ICD10-PCS,Replace R Ext Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RJ4JZ,ICD10-PCS,Replace L Ext Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RJ4KZ,ICD10-PCS,Replace L Ext Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04S84ZZ,ICD10-PCS,Reposition Middle Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SB3ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SJ3ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SL3ZZ,ICD10-PCS,Reposition Left Femoral Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SL4ZZ,ICD10-PCS,Reposition Left Femoral Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SM4ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SS3ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04SY0ZZ,ICD10-PCS,Reposition Lower Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SY3ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04U037Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04U137Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04U147Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U447Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U547Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U947Z,ICD10-PCS,Supplement R Renal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UB47Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UD07Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UD37Z,ICD10-PCS,Supplement L Com Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UH07Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UJ07Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04US07Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04US37Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04US47Z,ICD10-PCS,Supplement L Post Tib Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UT07Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,051007Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,051049Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,05104AY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,051109Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Open,,,8271.00
Deidentified Maximum,,051147Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,051149Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,05134KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,051409Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,051447Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05150AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Open,,,8271.00
Deidentified Maximum,,05150ZY,ICD10-PCS,Bypass Right Subclavian Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Maximum,,051547Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05154ZY,ICD10-PCS,Bypass Right Subclavian Vein to Up Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,051607Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Open,,,8271.00
Deidentified Maximum,,051649Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,05500ZZ,ICD10-PCS,Destruction of Azygos Vein, Open Approach,,,8271.00
Deidentified Maximum,,05B13ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05B44ZZ,ICD10-PCS,Excision of Left Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05B50ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Open Approach,,,8271.00
Deidentified Maximum,,05R04KZ,ICD10-PCS,Replace of Azygos Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R30KZ,ICD10-PCS,Replacement of R Innom Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R34KZ,ICD10-PCS,Replace of R Innom Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R607Z,ICD10-PCS,Replacement of L Subclav Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R64JZ,ICD10-PCS,Replace of L Subclav Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R64KZ,ICD10-PCS,Replace L Subclav Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05S00ZZ,ICD10-PCS,Reposition Azygos Vein, Open Approach,,,8271.00
Deidentified Maximum,,05S14ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,05S54ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05S80ZZ,ICD10-PCS,Reposition Left Axillary Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SA0ZZ,ICD10-PCS,Reposition Left Brachial Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SB4ZZ,ICD10-PCS,Reposition Right Basilic Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SC3ZZ,ICD10-PCS,Reposition Left Basilic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SL0ZZ,ICD10-PCS,Reposition Intracranial Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SM0ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SM4ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SR4ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SS0ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SS4ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SY0ZZ,ICD10-PCS,Reposition Upper Vein, Open Approach,,,8271.00
Deidentified Maximum,,05U337Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05U347Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05U637Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05U947Z,ICD10-PCS,Supplement R Brach Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05UA47Z,ICD10-PCS,Supplement L Brach Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05UB37Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UF47Z,ICD10-PCS,Supplement L Cephalic Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05UG07Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UG37Z,ICD10-PCS,Supplement Right Hand Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UH37Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UQ37Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05US47Z,ICD10-PCS,Supplement L Verteb Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06503ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06564ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06570ZZ,ICD10-PCS,Destruction of Colic Vein, Open Approach,,,8271.00
Deidentified Maximum,,065F3ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Approach,,,8271.00
Deidentified Maximum,,065G3ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Approach,,,8271.00
Deidentified Maximum,,065H3ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,065H4ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06B04ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06B73ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06BF3ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06BJ3ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06R047Z,ICD10-PCS,Replace of Inf Vena Cava with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R04JZ,ICD10-PCS,Replace of Inf Vena Cava with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R107Z,ICD10-PCS,Replacement of Splenic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R10KZ,ICD10-PCS,Replacement of Splenic Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R147Z,ICD10-PCS,Replace of Splenic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R14KZ,ICD10-PCS,Replace of Splenic Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R20KZ,ICD10-PCS,Replacement of Gastric Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R24KZ,ICD10-PCS,Replace of Gastric Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R44JZ,ICD10-PCS,Replace of Hepatic Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R50JZ,ICD10-PCS,Replacement of Sup Mesent Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R607Z,ICD10-PCS,Replacement of Inf Mesent Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R647Z,ICD10-PCS,Replace Inf Mesent Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06R90JZ,ICD10-PCS,Replacement of R Renal Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R90KZ,ICD10-PCS,Replacement of R Renal Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RC4KZ,ICD10-PCS,Replace R Com Iliac Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RD0JZ,ICD10-PCS,Replace of L Com Iliac Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RF0KZ,ICD10-PCS,Replace of R Ext Iliac Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RF4JZ,ICD10-PCS,Replace R Ext Iliac Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RH0JZ,ICD10-PCS,Replacement of R Hypogast Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RH47Z,ICD10-PCS,Replace R Hypogast Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06S13ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06S80ZZ,ICD10-PCS,Reposition Portal Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SF3ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SG3ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SG4ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SH3ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SN3ZZ,ICD10-PCS,Reposition Left Femoral Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SP3ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SP4ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SQ0ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SS0ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SY0ZZ,ICD10-PCS,Reposition Lower Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SY3ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06U007Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06U237Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06U247Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06U637Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06U647Z,ICD10-PCS,Supplement Inf Mesent Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06U747Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06U837Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UJ47Z,ICD10-PCS,Supplement L Hypogast Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06UM07Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UN07Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UR47Z,ICD10-PCS,Supplement R Less Saphenous w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06UV47Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0PS44ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0PS4XZZ,ICD10-PCS,Reposition Thoracic Vertebra, External Approach,,,8271.00
Deidentified Maximum,,0QS0XZZ,ICD10-PCS,Reposition Lumbar Vertebra, External Approach,,,8271.00
Deidentified Maximum,,0QS13ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0QSS04Z,ICD10-PCS,Reposition Coccyx with Int Fix, Open Approach,,,8271.00
Deidentified Maximum,,0R550ZZ,ICD10-PCS,Destruction of Cervicothoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RB04ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RB10ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Open Approach,,,8271.00
Deidentified Maximum,,0RB43ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Perc Approach,,,8271.00
Deidentified Maximum,,0RB44ZZ,ICD10-PCS,Excision of C-thor Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RB60ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Open Approach,,,8271.00
Deidentified Maximum,,0RBA0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Open Approach,,,8271.00
Deidentified Maximum,,0RG0070,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,06SR4ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SS4ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SV0ZZ,ICD10-PCS,Reposition Left Foot Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SV4ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06SY4ZZ,ICD10-PCS,Reposition Lower Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06U437Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06U447Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06U547Z,ICD10-PCS,Supplement Sup Mesent Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06U707Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06U737Z,ICD10-PCS,Supplement Colic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06U807Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UH47Z,ICD10-PCS,Supplement R Hypogast Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06UJ07Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UN47Z,ICD10-PCS,Supplement L Femor Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0JH638Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Perc Approach,,,8271.00
Deidentified Maximum,,0JH808Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Open Approach,,,8271.00
Deidentified Maximum,,0Q834ZZ,ICD10-PCS,Division of Left Pelvic Bone, Perc Endo Approach,,,4303.00
Deidentified Maximum,,0QS034Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Approach,,,8271.00
Deidentified Maximum,,0QS044Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0QS04ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,0QS134Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Approach,,,8271.00
Deidentified Maximum,,0QSS3ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0R530ZZ,ICD10-PCS,Destruction of Cervical Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RB00ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Open Approach,,,8271.00
Deidentified Maximum,,0RB13ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0RB30ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RB34ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RB40ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Joint, Open Approach,,,8271.00
Deidentified Maximum,,0RB54ZZ,ICD10-PCS,Excision of C-thor Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RBA4ZZ,ICD10-PCS,Excision of T-lum Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG00A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG00K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG00KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG037J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG1070,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG10A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG10K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG13J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG13K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG13KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG147J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG207J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG20A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG20A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG20Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG2370,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG2371,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG237J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG23J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG2471,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG24J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG24J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG24Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG24Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG40A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG40J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG40K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG40K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG40Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG43AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG43K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG43KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG44J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG44J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG60J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG60K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG63KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG63Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG7070,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG70KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG737J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG73J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG73Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG73ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG74A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG80A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG80A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG80J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG80K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG83KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG83Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG847J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG84A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG84J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA0J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RGA0J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RGA0K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RGA0Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0RGA3KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RGA4K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RH14DZ,ICD10-PCS,Insert of Facet Stabl Dev into Cerv Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RH40DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RH60CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RHA0CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RT30ZZ,ICD10-PCS,Resection of Cervical Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RT90ZZ,ICD10-PCS,Resection of Thoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RU50JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RU54JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RU60JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RU64JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RW54JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RW90JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RW93JZ,ICD10-PCS,Revision of Synthetic Substitute in Thor Disc, Perc Approach,,,8271.00
Deidentified Maximum,,0SB00ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Open Approach,,,8271.00
Deidentified Maximum,,0SB33ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SB34ZZ,ICD10-PCS,Excision of Lumbosacral Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SB80ZZ,ICD10-PCS,EXCISION LEFT SACROILIAC JOINT OPEN,,,8271.00
Deidentified Maximum,,0SB83ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SG00A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG00A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG00K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG0370,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG03K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG0470,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG04J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG04ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG13A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG13Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0SG14Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG33A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG33KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG33Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0SG34A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG34JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG34K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG53ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SG604Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Open Approach,,,8271.00
Deidentified Maximum,,0SG634Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Approach,,,8271.00
Deidentified Maximum,,0SG64KZ,ICD10-PCS,Fusion of Coccygeal Jt with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG707Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG737Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SG74ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG807Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG83KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SG847Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG84KZ,ICD10-PCS,Fusion L Sacroiliac Jt w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,0SH00BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Open Approach,,,8271.00
Deidentified Maximum,,0SH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Open Approach,,,8271.00
Deidentified Maximum,,0SH34DZ,ICD10-PCS,Insert of Facet Stabl Dev into Lumsac Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SR40JZ,ICD10-PCS,Replacement of Lumsac Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SR9019,ICD10-PCS,Replacement of R Hip Jt with Metal, Cement, Open Approach,,,8271.00
Deidentified Maximum,,0SR90KZ,ICD10-PCS,Replacement of R Hip Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRA07Z,ICD10-PCS,Replace of R Hip Jt, Acetab with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRA0KZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRB02Z,ICD10-PCS,Replacement of L Hip Jt with Metal on Poly, Open Approach,,,8271.00
Deidentified Maximum,,0SRB03Z,ICD10-PCS,Replacement of Left Hip Joint with Ceramic, Open Approach,,,8271.00
Deidentified Maximum,,0SRB049,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Cement, Open,,,8271.00
Deidentified Maximum,,0SRB0KZ,ICD10-PCS,Replacement of Left Hip Joint with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRC0KZ,ICD10-PCS,Replacement of R Knee Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRD0J9,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Cement, Open Approach,,,8271.00
Deidentified Maximum,,0SRD0JA,ICD10-PCS,Replace of L Knee Jt with Synth Sub, Uncement, Open Approach,,,8271.00
Deidentified Maximum,,0SRE01A,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRE0KZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRR019,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Cement, Open,,,8271.00
Deidentified Maximum,,0SRR039,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Cement, Open,,,8271.00
Deidentified Maximum,,0SRR03A,ICD10-PCS,Replace R Hip Jt, Femoral w Ceramic, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRR0JZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRS07Z,ICD10-PCS,Replace of L Hip Jt, Femoral with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRS0JA,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRT07Z,ICD10-PCS,Replace of R Knee Jt, Femoral with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRU07Z,ICD10-PCS,Replace of L Knee Jt, Femoral with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRV0J9,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Cement, Open,,,8271.00
Deidentified Maximum,,0ST20ZZ,ICD10-PCS,Resection of Lumbar Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0SU33JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SU34JZ,ICD10-PCS,Supplement Lumsac Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SW44JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0TQD7ZZ,ICD10-PCS,Repair Urethra, Via Natural or Artificial Opening,,,4303.00
Deidentified Maximum,,10908ZC,ICD10-PCS,Drainage of Amniotic Fluid, Therapeutic from POC, Endo,,,4303.00
Deidentified Maximum,,4A023N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Perc,,,8271.00
Deidentified Maximum,,5A02110,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Intermittent,,,8271.00
Deidentified Maximum,,B201YZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using Oth Contrast,,,8271.00
Deidentified Maximum,,B2020ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using H Osm Contrast,,,8271.00
Deidentified Maximum,,B202YZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using Oth Contrast,,,8271.00
Deidentified Maximum,,B2031ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using L Osm Contrast,,,8271.00
Deidentified Maximum,,B2080ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2111ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using L Osm Contrast,,,8271.00
Deidentified Maximum,,B211YZZ,ICD10-PCS,Fluoroscopy of Multiple Coronary Arteries using Oth Contrast,,,8271.00
Deidentified Maximum,,B212YZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using Oth Contrast,,,8271.00
Deidentified Maximum,,B2130ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2131ZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using L Osm Contrast,,,8271.00
Deidentified Maximum,,B2181ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using L Osm Contrast,,,8271.00
Deidentified Maximum,,B218YZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using Oth Contrast,,,8271.00
Deidentified Maximum,,B21F1ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Low Osmolar Contrast,,,8271.00
Deidentified Maximum,,X2RF032,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Open, New Tech 2,,,8271.00
Deidentified Maximum,,0RG0071,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG03AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG03J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG0470,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG04A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG04A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG10AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG10J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG13J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG13K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG1470,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG14A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG2071,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG20J1,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG20JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG20ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG23JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG23ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG24K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG24K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG4071,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG40ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG43Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG44A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG44AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG44JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG44Z0,ICD10-PCS,Fusion of C-thor Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG44Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG44ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG6071,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG60Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG60Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG63K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG63ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG6470,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG64A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG64KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG64ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG707J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG70A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG70AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG70ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG74KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG80Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG8370,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG837J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG83AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG83Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG83ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG84AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG84KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA0A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RGA0KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RGA371,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RGA3JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RGA3K0,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RGA3Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RGA4A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA4J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RH03BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc,,,8271.00
Deidentified Maximum,,0RH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RH10CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RH44CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into C-thor Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RH44DZ,ICD10-PCS,Insert of Facet Stabl Dev into C-thor Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RH63BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RH63CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Thor Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RH63DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RH64DZ,ICD10-PCS,Insert of Facet Stabl Dev into Thor Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RHA3DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RHA4BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc Endo,,,8271.00
Deidentified Maximum,,0RHA4DZ,ICD10-PCS,Insert of Facet Stabl Dev into T-lum Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RU40JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RU44JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RUA0JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RUA4JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0S540ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0S544ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SB23ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SB50ZZ,ICD10-PCS,EXCISION SACROCOCCYGEAL JOINT OPEN,,,8271.00
Deidentified Maximum,,0SB70ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Open Approach,,,8271.00
Deidentified Maximum,,0SG00AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG00J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG00Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0SG03K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG03ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0SG04K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG04K1,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG1071,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG10J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG10K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG1370,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG13AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG13ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0SG14AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG14ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG30J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG30JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG30K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG337J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG33K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG50ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Open Approach,,,8271.00
Deidentified Maximum,,0SG53JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SG544Z,ICD10-PCS,Fusion of Sacrococcygeal Jt with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG54KZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,0SG54ZZ,ICD10-PCS,Fusion of Sacrococcygeal Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG63KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SG70ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Open Approach,,,8271.00
Deidentified Maximum,,0SG734Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Perc Approach,,,8271.00
Deidentified Maximum,,0SG744Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG74KZ,ICD10-PCS,Fusion R Sacroiliac Jt w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,0SG80JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG83ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SG84JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SH03BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Lum Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0SH03DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0SH04DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SH30BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Open,,,8271.00
Deidentified Maximum,,0SR20JZ,ICD10-PCS,Replacement of Lum Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SR902Z,ICD10-PCS,Replacement of R Hip Jt with Metal on Poly, Open Approach,,,8271.00
Deidentified Maximum,,0SR9039,ICD10-PCS,Replacement of R Hip Jt with Ceramic, Cement, Open Approach,,,8271.00
Deidentified Maximum,,0SR904Z,ICD10-PCS,Replacement of R Hip Jt with Ceramic on Poly, Open Approach,,,8271.00
Deidentified Maximum,,0SR90J9,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Cement, Open Approach,,,8271.00
Deidentified Maximum,,0SRA00A,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRA00Z,ICD10-PCS,REPLACEMENT RT HIP JOINT ACETAB SURF POLYETHYLENE SYNTH SUBS,,,8271.00
Deidentified Maximum,,0SRA019,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Cement, Open,,,8271.00
Deidentified Maximum,,0SRA039,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Cement, Open,,,8271.00
Deidentified Maximum,,0SRA03Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Ceramic, Open Approach,,,8271.00
Deidentified Maximum,,0SRA0JA,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRB04A,ICD10-PCS,Replace L Hip Jt w Ceramic on Poly, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRB0J9,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Cement, Open Approach,,,8271.00
Deidentified Maximum,,0SRD07Z,ICD10-PCS,Replacement of Left Knee Joint with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRD0JZ,ICD10-PCS,Replacement of Left Knee Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRE019,ICD10-PCS,Replace L Hip Jt, Acetab w Metal, Cement, Open,,,8271.00
Deidentified Maximum,,0SRE01Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Metal, Open Approach,,,8271.00
Deidentified Maximum,,0SRE03Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Ceramic, Open Approach,,,8271.00
Deidentified Maximum,,0SRE0JA,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRE0JZ,ICD10-PCS,Replace of L Hip Jt, Acetab with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRR01A,ICD10-PCS,Replace R Hip Jt, Femoral w Metal, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRR07Z,ICD10-PCS,Replace of R Hip Jt, Femoral with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRR0KZ,ICD10-PCS,Replace of R Hip Jt, Femoral with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRT0JZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRV07Z,ICD10-PCS,Replace of R Knee Jt, Tibial with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRV0JZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRV0KZ,ICD10-PCS,Replace of R Knee Jt, Tibial with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRW07Z,ICD10-PCS,Replace of L Knee Jt, Tibial with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SU00JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SUB0BZ,ICD10-PCS,Supplement Left Hip Joint with Resurf Dev, Open Approach,,,8271.00
Deidentified Maximum,,0SUR0BZ,ICD10-PCS,Supplement R Hip Jt, Femoral with Resurf Dev, Open Approach,,,8271.00
Deidentified Maximum,,0SW94JZ,ICD10-PCS,Revision of Synth Sub in R Hip Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SWB0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Open Approach,,,8271.00
Deidentified Maximum,,0SWC0JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Open Approach,,,8271.00
Deidentified Maximum,,0UQC0ZZ,ICD10-PCS,Repair Cervix, Open Approach,,,4303.00
Deidentified Maximum,,0UQG8ZZ,ICD10-PCS,Repair Vagina, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Maximum,,0WFD3ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0WFD4ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Perc Endo Approach,,,8271.00
Deidentified Maximum,,10900ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Open Approach,,,4303.00
Deidentified Maximum,,10904ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Perc Endo Approach,,,4303.00
Deidentified Maximum,,10908ZA,ICD10-PCS,Drainage of Fetal Cerebrospinal Fluid from POC, Endo,,,4303.00
Deidentified Maximum,,5A02116,ICD10-PCS,Assist with Cardiac Output using Other Pump, Intermittent,,,8271.00
Deidentified Maximum,,5A02216,ICD10-PCS,Assistance with Cardiac Output using Other Pump, Continuous,,,8271.00
Deidentified Maximum,,B2000ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2030ZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using H Osm Contrast,,,8271.00
Deidentified Maximum,,B213YZZ,ICD10-PCS,Fluoroscopy of Mult Cor A Graft using Oth Contrast,,,8271.00
Deidentified Maximum,,B214YZZ,ICD10-PCS,Fluoroscopy of Right Heart using Other Contrast,,,8271.00
Deidentified Maximum,,B2161ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using L Osm Contrast,,,8271.00
Deidentified Maximum,,B21F0ZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using H Osm Contrast,,,8271.00
Deidentified Maximum,,X2RF432,ICD10-PCS,Replace Aort Valve w Zoopl Rapid Depl, Perc Endo, New Tech 2,,,8271.00
Deidentified Maximum,,001U074,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Open,,,8271.00
Deidentified Maximum,,001U0J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Open,,,8271.00
Deidentified Maximum,,001U3J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Perc,,,8271.00
Deidentified Maximum,,001U3J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Perc,,,8271.00
Deidentified Maximum,,001U3J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Perc,,,8271.00
Deidentified Maximum,,001U3K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Perc,,,8271.00
Deidentified Maximum,,001U3K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Perc,,,8271.00
Deidentified Maximum,,005X3ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,005Y3ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,009T30Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Perc Approach,,,8271.00
Deidentified Maximum,,009X00Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Open Approach,,,8271.00
Deidentified Maximum,,009X0ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Maximum,,009X30Z,ICD10-PCS,Drainage of Thor Spinal Cord with Drain Dev, Perc Approach,,,8271.00
Deidentified Maximum,,009X40Z,ICD10-PCS,Drain of Thor Spinal Cord with Drain Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,009Y30Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Perc Approach,,,8271.00
Deidentified Maximum,,009Y40Z,ICD10-PCS,Drain of Lum Spinal Cord with Drain Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00BT4ZX,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach, Diagn,,,8271.00
Deidentified Maximum,,00BX4ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00BY0ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Maximum,,00CT3ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Perc Approach,,,8271.00
Deidentified Maximum,,00DT3ZZ,ICD10-PCS,Extraction of Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00FU0ZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL OPEN APPROACH,,,8271.00
Deidentified Maximum,,00HU02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00HU32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00HU42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00HV0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00HV32Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00HV3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00JU0ZZ,ICD10-PCS,INSPECTION OF SPINAL CANAL OPEN,,,8271.00
Deidentified Maximum,,00NW0ZZ,ICD10-PCS,Release Cervical Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00NX0ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00PU02Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00PU40Z,ICD10-PCS,Removal of Drain Dev from Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00PU4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00PV00Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00PV33Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00PV40Z,ICD10-PCS,Removal of Drain Dev from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00SY3ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00UT3JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,00WU00Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00WU42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00WV02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00WV0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00WV33Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00WV3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00WV3KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00WV3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,015B4ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,015R0ZZ,ICD10-PCS,DESTRUCTION OF SACRAL NERVE OPEN APPROACH,,,8271.00
Deidentified Maximum,,015R4ZZ,ICD10-PCS,Destruction of Sacral Nerve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,018R3ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE PERQ APPR,,,8271.00
Deidentified Maximum,,021008C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,0210098,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Maximum,,02100A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,0210483,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02104A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02104AW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02104K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02104KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02104ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02104ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0211089,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021108C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,0211099,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Maximum,,02110AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02110JW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02110Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Open Approach,,,8271.00
Deidentified Maximum,,02110ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Open Approach,,,8271.00
Deidentified Maximum,,0211489,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021148W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0211498,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021149C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021149F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02114AC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02114AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,0212099,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021209C,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02120JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02120Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,02124A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02124AW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02124J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02124JC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02124K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02124KW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02124Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021308W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,021309C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02130A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Open,,,8271.00
Deidentified Maximum,,02130K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02130KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,021348F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0213499,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021349C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02134AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02134JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02134JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02134K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02134Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02134ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021609P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02160AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02160ZR,ICD10-PCS,Bypass Right Atrium to Left Pulmonary Artery, Open Approach,,,8271.00
Deidentified Maximum,,021648Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02164JR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02164KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02164KR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02164Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02164ZR,ICD10-PCS,Bypass Right Atrium to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021709Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02170AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02170AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02170ZR,ICD10-PCS,Bypass Left Atrium to Left Pulmonary Artery, Open Approach,,,8271.00
Deidentified Maximum,,021748R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02174ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02174ZR,ICD10-PCS,Bypass Left Atrium to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021K08R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021K0AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,021K4KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021K4ZP,ICD10-PCS,Bypass Right Ventricle to Pulm Trunk, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021L08R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021L0AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,021L0ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Maximum,,021L0ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,021L48P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021L4AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021L4AR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021L4Z5,ICD10-PCS,Bypass Left Ventricle to Cor Circ, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021L4ZQ,ICD10-PCS,Bypass Left Ventricle to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021V08P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021V0AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,021V0JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021V0JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021V0ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,021V4AQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021V4ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulm Trunk, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021W09D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021W09R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021W0AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Open,,,8271.00
Deidentified Maximum,,021W0JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021W0JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021W0ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,021W48R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021W4AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021W4KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W4KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W4ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021W4ZQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021X08D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021X0JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021X0ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Open Approach,,,8271.00
Deidentified Maximum,,021X0ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,021X48B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021X4JD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,024G0J2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Synth Sub, Open,,,8271.00
Deidentified Maximum,,024J072,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Autol Sub, Open,,,8271.00
Deidentified Maximum,,024J0K2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02550ZZ,ICD10-PCS,Destruction of Atrial Septum, Open Approach,,,8271.00
Deidentified Maximum,,02580ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Open Approach,,,8271.00
Deidentified Maximum,,02583ZZ,ICD10-PCS,Destruction of Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02593ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025F3ZZ,ICD10-PCS,Destruction of Aortic Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025J0ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Open Approach,,,8271.00
Deidentified Maximum,,025J3ZZ,ICD10-PCS,Destruction of Tricuspid Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025K0ZZ,ICD10-PCS,Destruction of Right Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,025M0ZZ,ICD10-PCS,Destruction of Ventricular Septum, Open Approach,,,8271.00
Deidentified Maximum,,025Q0ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Open Approach,,,8271.00
Deidentified Maximum,,025S4ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,025X0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Open Approach,,,8271.00
Deidentified Maximum,,025X3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Ascending/Arch, Perc Approach,,,8271.00
Deidentified Maximum,,0270046,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Open,,,8271.00
Deidentified Maximum,,027004Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Open Approach,,,8271.00
Deidentified Maximum,,027005Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,027006Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02700EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02700FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,027035Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,0270376,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,027037Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,027047Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02704F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02704TZ,ICD10-PCS,Dilate 1 Cor Art w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,0271056,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,027105Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,0271066,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02710FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02710TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Open Approach,,,8271.00
Deidentified Maximum,,0271346,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc,,,8271.00
Deidentified Maximum,,0271356,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02713Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Maximum,,0271456,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,027146Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02714T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,02714Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027206Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02720E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02720GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,0272346,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc,,,8271.00
Deidentified Maximum,,027234Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Perc Approach,,,8271.00
Deidentified Maximum,,027235Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,027247Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0273066,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Open,,,8271.00
Deidentified Maximum,,0273076,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Open,,,8271.00
Deidentified Maximum,,02730D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02730EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02730G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02734E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02734TZ,ICD10-PCS,Dilate 4+ Cor Art w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,02734ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027G34Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc,,,8271.00
Deidentified Maximum,,027G3ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,027G4DZ,ICD10-PCS,Dilate of Mitral Valve with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027G4ZZ,ICD10-PCS,Dilation of Mitral Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,027H3ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,027H4DZ,ICD10-PCS,Dilation of Pulm Valve with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027K0DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,027K44Z,ICD10-PCS,Dilate R Ventricle w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,027R0DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,027R4DT,ICD10-PCS,Dilate Ductus Arterio w Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02894ZZ,ICD10-PCS,Division of Chordae Tendineae, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02B54ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02B64ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02B70ZZ,ICD10-PCS,Excision of Left Atrium, Open Approach,,,8271.00
Deidentified Maximum,,02BD0ZZ,ICD10-PCS,Excision of Papillary Muscle, Open Approach,,,8271.00
Deidentified Maximum,,02BK3ZZ,ICD10-PCS,Excision of Right Ventricle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BM3ZZ,ICD10-PCS,Excision of Ventricular Septum, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BP3ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BR4ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02BX3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Perc Approach,,,8271.00
Deidentified Maximum,,02C00ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Open Approach,,,8271.00
Deidentified Maximum,,02C04Z6,ICD10-PCS,Extirpate matter from 1 Cor Art, Bifurc, Perc Endo,,,8271.00
Deidentified Maximum,,02C30ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Open Approach,,,8271.00
Deidentified Maximum,,02C33ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Approach,,,8271.00
Deidentified Maximum,,02CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Perc Approach,,,8271.00
Deidentified Maximum,,02H40KZ,ICD10-PCS,Insertion of Defibrillator Lead into Cor Vein, Open Approach,,,8271.00
Deidentified Maximum,,02H433Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Perc Approach,,,8271.00
Deidentified Maximum,,02H443Z,ICD10-PCS,Insertion of Infusion Dev into Cor Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02H44NZ,ICD10-PCS,Insert of Intracard Pacer into Cor Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HA3RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Approach,,,8271.00
Deidentified Maximum,,02HK0KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,02HL4KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HN3KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Approach,,,8271.00
Deidentified Maximum,,02HN4KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HQ0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,02HR3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Perc Approach,,,8271.00
Deidentified Maximum,,02HR4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HS4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HT3DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Perc Approach,,,8271.00
Deidentified Maximum,,02HT4DZ,ICD10-PCS,Insert of Intralum Dev into L Pulm Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HW4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Desc, Perc Endo,,,8271.00
Deidentified Maximum,,02HX32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Perc Approach,,,8271.00
Deidentified Maximum,,02LH0CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02LH3CZ,ICD10-PCS,Occlusion of Pulm Valve with Extralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02LH3ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02LH4ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02N40ZZ,ICD10-PCS,Release Coronary Vein, Open Approach,,,8271.00
Deidentified Maximum,,02N80ZZ,ICD10-PCS,Release Conduction Mechanism, Open Approach,,,8271.00
Deidentified Maximum,,02N90ZZ,ICD10-PCS,Release Chordae Tendineae, Open Approach,,,8271.00
Deidentified Maximum,,02N93ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02NK3ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02NL3ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02NL4ZZ,ICD10-PCS,Release Left Ventricle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02PY38Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02PY4DZ,ICD10-PCS,Remove of Intralum Dev from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02PY4KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02Q20ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Open Approach,,,8271.00
Deidentified Maximum,,02Q43ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02Q64ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02Q74ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QD3ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02QG0ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Open Approach,,,8271.00
Deidentified Maximum,,02QM0ZZ,ICD10-PCS,Repair Ventricular Septum, Open Approach,,,8271.00
Deidentified Maximum,,02QM4ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QN4ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02R50KZ,ICD10-PCS,Replacement of Atrial Septum with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R608Z,ICD10-PCS,Replacement of Right Atrium with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02R60KZ,ICD10-PCS,Replacement of Right Atrium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R64JZ,ICD10-PCS,Replacement of R Atrium with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R747Z,ICD10-PCS,Replacement of L Atrium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R908Z,ICD10-PCS,Replace of Chordae Tendineae with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02R90KZ,ICD10-PCS,Replace of Chordae Tendineae with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R947Z,ICD10-PCS,Replace Chordae Tendineae w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02RD08Z,ICD10-PCS,Replace of Papillary Muscle with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RD0JZ,ICD10-PCS,Replace of Papillary Muscle with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RF07Z,ICD10-PCS,Replacement of Aortic Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RF0JZ,ICD10-PCS,Replacement of Aortic Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RF4KZ,ICD10-PCS,Replace of Aortic Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RG07Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RG4JZ,ICD10-PCS,Replace of Mitral Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RH0JZ,ICD10-PCS,Replacement of Pulmonary Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RH47Z,ICD10-PCS,Replacement of Pulm Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RJ08Z,ICD10-PCS,Replacement of Tricusp Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RK0JZ,ICD10-PCS,Replacement of Right Ventricle with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RK0KZ,ICD10-PCS,Replacement of R Ventricle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RL0KZ,ICD10-PCS,Replacement of Left Ventricle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RL47Z,ICD10-PCS,Replace of L Ventricle with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RL4JZ,ICD10-PCS,Replace of L Ventricle with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RM07Z,ICD10-PCS,Replace of Ventricular Sept with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RM08Z,ICD10-PCS,Replace of Ventricular Sept with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RM0JZ,ICD10-PCS,Replace of Ventricular Sept with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RM0KZ,ICD10-PCS,Replace of Ventricular Sept with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RM47Z,ICD10-PCS,Replace Ventricular Sept w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02RN0JZ,ICD10-PCS,Replacement of Pericardium with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RN0KZ,ICD10-PCS,Replacement of Pericardium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RQ08Z,ICD10-PCS,Replacement of R Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RR0JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RS0KZ,ICD10-PCS,Replacement of R Pulm Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RS48Z,ICD10-PCS,Replace of R Pulm Vein with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RS4KZ,ICD10-PCS,Replace of R Pulm Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RW07Z,ICD10-PCS,Replacement of Thor Aorta Desc with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RW0JZ,ICD10-PCS,Replacement of Thor Aorta Desc with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RW0KZ,ICD10-PCS,Replace of Thor Aorta Desc with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RW48Z,ICD10-PCS,Replace Thor Aorta Desc w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02RX08Z,ICD10-PCS,Replacement of Thor Aorta Asc with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02S10ZZ,ICD10-PCS,Reposition Coronary Artery, Two Arteries, Open Approach,,,8271.00
Deidentified Maximum,,02U50JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U50KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U54JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U607Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U60KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U647Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U707Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U74KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U93JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02U94KZ,ICD10-PCS,Supplement Chordae Tendineae w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UA0JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Open Approach,,,8271.00
Deidentified Maximum,,02UA3JZ,ICD10-PCS,Supplement Heart with Synthetic Substitute, Perc Approach,,,8271.00
Deidentified Maximum,,02UD08Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UD37Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UD4JZ,ICD10-PCS,Supplement Papillary Muscle w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UF37Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UF4JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UF4KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UG38Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UG3JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc,,,8271.00
Deidentified Maximum,,02UG3JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UH37Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UH3JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UJ08G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Open,,,8271.00
Deidentified Maximum,,02UJ38G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc,,,8271.00
Deidentified Maximum,,02UJ47G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UJ4JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UJ4KZ,ICD10-PCS,Supplement Tricusp Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UK4JZ,ICD10-PCS,Supplement R Ventricle with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UL37Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UL3KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UL4KZ,ICD10-PCS,Supplement L Ventricle with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UM07Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UM08Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UM3JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UM4KZ,ICD10-PCS,Supplement Ventricular Sept w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UN0JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UN0KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UN38Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Perc Approach,,,8271.00
Deidentified Maximum,,02UN3JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UP37Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UR0KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UR38Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UR3KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UR4KZ,ICD10-PCS,Supplement L Pulm Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02US0KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02US47Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UT3KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UT48Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UX3KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UX47Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02VA0CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Open Approach,,,8271.00
Deidentified Maximum,,02VA0ZZ,ICD10-PCS,Restriction of Heart, Open Approach,,,8271.00
Deidentified Maximum,,03SY3ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SY4ZZ,ICD10-PCS,Reposition Upper Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,03U337Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03U407Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03U537Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03U737Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UB47Z,ICD10-PCS,Supplement R Radial Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UC07Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UL37Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UM07Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UM37Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UM47Z,ICD10-PCS,Supplement R Ext Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UU37Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UY37Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0410092,ICD10-PCS,Bypass Abd Aorta to Mesent Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,041009B,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Maximum,,041009J,ICD10-PCS,BP ABD AO LT FEM ART AUTO VEN TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100A5,ICD10-PCS,BP ABD AO B RENL ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100AB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Maximum,,04100AC,ICD10-PCS,BP ABDOMINAL AO BIL INTRL ILIAC ART AUTO ART OPN,,,8271.00
Deidentified Maximum,,04100AF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Maximum,,04100AK,ICD10-PCS,BYPS ABD AO B FEM ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100J1,ICD10-PCS,BYPS ABD AO CELIAC ART SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100J8,ICD10-PCS,BP ABD AO B COMMON ILIAC ART SYN SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100JJ,ICD10-PCS,BYPS ABD AO LT FEM ART SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100JR,ICD10-PCS,BYPASS ABD AO LOW ART SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100K4,ICD10-PCS,BP ABD AO LT RENL ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100K8,ICD10-PCS,BP ABD AO B CMN ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100KG,ICD10-PCS,BP ABD AO B EXT ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100KH,ICD10-PCS,BP ABD AO RT FEM ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100Z6,ICD10-PCS,BYPASS ABD AO RT COMMON ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100Z8,ICD10-PCS,BYPASS ABD AO BIL COMMON ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100ZC,ICD10-PCS,BYPASS ABD AO BIL INTRL ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Maximum,,0410491,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,0410493,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041049H,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,04104A3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104AF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104AJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104JG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104JJ,ICD10-PCS,Bypass Abd Aorta to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104JQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104K0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104K7,ICD10-PCS,Bypass Abd Aorta to L Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104K8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104K9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104KC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104KD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104KG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104KQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104Z3,ICD10-PCS,Bypass Abdominal Aorta to R Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104Z4,ICD10-PCS,Bypass Abdominal Aorta to L Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104Z6,ICD10-PCS,Bypass Abdominal Aorta to R Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104ZB,ICD10-PCS,Bypass Abdominal Aorta to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104ZC,ICD10-PCS,Bypass Abdominal Aorta to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104ZF,ICD10-PCS,Bypass Abdominal Aorta to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0414093,ICD10-PCS,Bypass Splenic Art to R Renal A with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,04140A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Open,,,8271.00
Deidentified Maximum,,04140K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,04140Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Open Approach,,,8271.00
Deidentified Maximum,,04144A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C091,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C0A1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0K0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0KB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041C0Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041C0ZB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041C0ZJ,ICD10-PCS,Bypass Right Common Iliac Artery to L Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041C0ZK,ICD10-PCS,Bypass Right Common Iliac Artery to B Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041C0ZR,ICD10-PCS,Bypass Right Common Iliac Artery to Low Art, Open Approach,,,8271.00
Deidentified Maximum,,041C49K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C4A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4A7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4AK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4JH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4K1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4Z2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4Z5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4Z8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4ZH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D091,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D099,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D09R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D0A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0AF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0Z5,ICD10-PCS,Bypass Left Common Iliac Artery to B Renal A, Open Approach,,,8271.00
Deidentified Maximum,,041D0ZG,ICD10-PCS,Bypass Left Common Iliac Artery to B Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041D0ZK,ICD10-PCS,Bypass Left Common Iliac Artery to B Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041D0ZQ,ICD10-PCS,Bypass Left Common Iliac Artery to Low Ex Art, Open Approach,,,8271.00
Deidentified Maximum,,041D490,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D499,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D49J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D4AD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4JJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4K2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4KF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4KH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4KJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4KQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4Z1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4Z6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4Z9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4ZR,ICD10-PCS,Bypass L Com Iliac Art to Low Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E099,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E0AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E0ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041E0ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041E0ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041E49C,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E49G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E49Q,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E4AB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F09H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F09J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F09P,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F09Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F0AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041F49B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F4AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4K9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4KB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4KC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4KD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4Z9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041F4ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H099,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H09B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H09F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H09K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H0JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H0KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H0ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Open Approach,,,8271.00
Deidentified Maximum,,041H499,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H49F,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H4AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J09F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J09G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J09K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J0AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J0ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041J0ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041J499,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J49C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J49P,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J4AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4JF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4K9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4KJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J4ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J4ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J4ZF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J4ZG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04524ZZ,ICD10-PCS,Destruction of Gastric Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04534ZZ,ICD10-PCS,Destruction of Hepatic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04540ZZ,ICD10-PCS,Destruction of Splenic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04554ZZ,ICD10-PCS,Destruction of Sup Mesent Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04563ZZ,ICD10-PCS,Destruction of Right Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,045A3ZZ,ICD10-PCS,Destruction of Left Renal Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,045B4ZZ,ICD10-PCS,Destruction of Inf Mesent Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,045C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,045C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,045D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,045F0ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,045H3ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,045H4ZZ,ICD10-PCS,Destruction of R Ext Iliac Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04B13ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04B64ZZ,ICD10-PCS,Excision of Right Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04B73ZZ,ICD10-PCS,Excision of Left Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04BA4ZZ,ICD10-PCS,Excision of Left Renal Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04BB3ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04BD3ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04BE4ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R207Z,ICD10-PCS,Replacement of Gastric Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R24JZ,ICD10-PCS,Replace of Gastric Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R34JZ,ICD10-PCS,Replace of Hepatic Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R40JZ,ICD10-PCS,Replacement of Splenic Artery with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R447Z,ICD10-PCS,Replace of Splenic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R60KZ,ICD10-PCS,Replacement of R Colic Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R70JZ,ICD10-PCS,Replacement of L Colic Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R747Z,ICD10-PCS,Replace of L Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R74KZ,ICD10-PCS,Replace of L Colic Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R80JZ,ICD10-PCS,Replacement of Mid Colic Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R907Z,ICD10-PCS,Replacement of R Renal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R94JZ,ICD10-PCS,Replace of R Renal Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04RA0JZ,ICD10-PCS,Replacement of L Renal Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RA47Z,ICD10-PCS,Replace of L Renal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04RC47Z,ICD10-PCS,Replace R Com Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RE47Z,ICD10-PCS,Replace R Int Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RE4KZ,ICD10-PCS,Replace R Int Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04S20ZZ,ICD10-PCS,Reposition Gastric Artery, Open Approach,,,8271.00
Deidentified Maximum,,04S33ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04S40ZZ,ICD10-PCS,Reposition Splenic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04S73ZZ,ICD10-PCS,Reposition Left Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04S83ZZ,ICD10-PCS,Reposition Middle Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SE0ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SM0ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SN4ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SR0ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SR3ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04SU3ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SW3ZZ,ICD10-PCS,Reposition Left Foot Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04U047Z,ICD10-PCS,Supplement Abd Aorta with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U107Z,ICD10-PCS,Supplement Celiac Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04U207Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UE07Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UJ37Z,ICD10-PCS,Supplement L Ext Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UP37Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UR47Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UU47Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UY07Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05104JY,ICD10-PCS,BYPASS AZYGOS VEIN UP VEIN SYNTH SUB PERC ENDO,,,8271.00
Deidentified Maximum,,05130AY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,05140AY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,05140JY,ICD10-PCS,Bypass L Innom Vein to Up Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,05140KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,05144JY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05144ZY,ICD10-PCS,Bypass Left Innominate Vein to Up Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,051507Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Sub, Open,,,8271.00
Deidentified Maximum,,051549Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,05154KY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,051609Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Vn, Open,,,8271.00
Deidentified Maximum,,05160JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Open,,,8271.00
Deidentified Maximum,,05164JY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05530ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Open Approach,,,8271.00
Deidentified Maximum,,05564ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05B53ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05R007Z,ICD10-PCS,Replacement of Azygos Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R047Z,ICD10-PCS,Replace of Azygos Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R10KZ,ICD10-PCS,Replace of Hemiazygos Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R30JZ,ICD10-PCS,Replacement of R Innom Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R44KZ,ICD10-PCS,Replace of L Innom Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05S83ZZ,ICD10-PCS,Reposition Left Axillary Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SF0ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SN3ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SQ4ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05ST0ZZ,ICD10-PCS,Reposition Right Face Vein, Open Approach,,,8271.00
Deidentified Maximum,,05ST4ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,05SV0ZZ,ICD10-PCS,Reposition Left Face Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SY3ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05UA37Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UB07Z,ICD10-PCS,Supplement Right Basilic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UC47Z,ICD10-PCS,Supplement L Basilic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05UD37Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UD47Z,ICD10-PCS,Supplement R Cephalic Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05UF07Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UG47Z,ICD10-PCS,Supplement R Hand Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05UH47Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05UL37Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UL47Z,ICD10-PCS,Supplement Intracran Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05UM07Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UN07Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UP47Z,ICD10-PCS,Supplement R Ext Jugular Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05UR37Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UR47Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05UT07Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UT37Z,ICD10-PCS,Supplement Right Face Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UV47Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05UY07Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UY47Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06504ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06513ZZ,ICD10-PCS,Destruction of Splenic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06523ZZ,ICD10-PCS,Destruction of Gastric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06544ZZ,ICD10-PCS,Destruction of Hepatic Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06563ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Perc Approach,,,8271.00
Deidentified Maximum,,065C0ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,065C3ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Approach,,,8271.00
Deidentified Maximum,,065D3ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,065F4ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,065J0ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B03ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06B24ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06B40ZZ,ICD10-PCS,Excision of Hepatic Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B43ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06B60ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B64ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06BB0ZZ,ICD10-PCS,Excision of Left Renal Vein, Open Approach,,,8271.00
Deidentified Maximum,,06BC3ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06BF4ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R007Z,ICD10-PCS,Replacement of Inf Vena Cava with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R207Z,ICD10-PCS,Replacement of Gastric Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R50KZ,ICD10-PCS,Replace of Sup Mesent Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R70KZ,ICD10-PCS,Replacement of Colic Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RC0JZ,ICD10-PCS,Replace of R Com Iliac Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RC47Z,ICD10-PCS,Replace R Com Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RF4KZ,ICD10-PCS,Replace R Ext Iliac Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RG0KZ,ICD10-PCS,Replace of L Ext Iliac Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RG4JZ,ICD10-PCS,Replace L Ext Iliac Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RH0KZ,ICD10-PCS,Replace of R Hypogast Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06S00ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Open Approach,,,8271.00
Deidentified Maximum,,06S03ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06S04ZZ,ICD10-PCS,Reposition Inferior Vena Cava, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06S10ZZ,ICD10-PCS,Reposition Splenic Vein, Open Approach,,,8271.00
Deidentified Maximum,,06S34ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06S40ZZ,ICD10-PCS,Reposition Hepatic Vein, Open Approach,,,8271.00
Deidentified Maximum,,06S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06S63ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06S64ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06S84ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06SF4ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SN4ZZ,ICD10-PCS,Reposition Left Femoral Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SQ3ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SR3ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Perc Approach,,,8271.00
Deidentified Maximum,,06ST3ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06U037Z,ICD10-PCS,Supplement Inferior Vena Cava with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06U107Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06U347Z,ICD10-PCS,Supplement Esophageal Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06U507Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06U907Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UB07Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UV07Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UY37Z,ICD10-PCS,Supplement Upper Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06500ZZ,ICD10-PCS,Destruction of Inferior Vena Cava, Open Approach,,,8271.00
Deidentified Maximum,,06514ZZ,ICD10-PCS,Destruction of Splenic Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06560ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06573ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06594ZZ,ICD10-PCS,Destruction of Right Renal Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,065C4ZZ,ICD10-PCS,Destruction of Right Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,065D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,065J4ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06B14ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06B23ZZ,ICD10-PCS,Excision of Gastric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06B63ZZ,ICD10-PCS,Excision of Inferior Mesenteric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06B70ZZ,ICD10-PCS,Excision of Colic Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B80ZZ,ICD10-PCS,Excision of Portal Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B93ZZ,ICD10-PCS,Excision of Right Renal Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06BG0ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,06R00KZ,ICD10-PCS,Replacement of Inf Vena Cava with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R04KZ,ICD10-PCS,Replace of Inf Vena Cava with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R40KZ,ICD10-PCS,Replacement of Hepatic Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R44KZ,ICD10-PCS,Replace of Hepatic Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R547Z,ICD10-PCS,Replace Sup Mesent Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06R807Z,ICD10-PCS,Replacement of Portal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R80KZ,ICD10-PCS,Replacement of Portal Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R84KZ,ICD10-PCS,Replace of Portal Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R94JZ,ICD10-PCS,Replace of R Renal Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R94KZ,ICD10-PCS,Replace of R Renal Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06RB47Z,ICD10-PCS,Replace of L Renal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06RB4JZ,ICD10-PCS,Replace of L Renal Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06RC0KZ,ICD10-PCS,Replace of R Com Iliac Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RC4JZ,ICD10-PCS,Replace R Com Iliac Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RD4KZ,ICD10-PCS,Replace L Com Iliac Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RF47Z,ICD10-PCS,Replace R Ext Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RJ07Z,ICD10-PCS,Replacement of L Hypogast Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RJ47Z,ICD10-PCS,Replace L Hypogast Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RJ4JZ,ICD10-PCS,Replace L Hypogast Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06S23ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06S30ZZ,ICD10-PCS,Reposition Esophageal Vein, Open Approach,,,8271.00
Deidentified Maximum,,06S33ZZ,ICD10-PCS,Reposition Esophageal Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06S43ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06S44ZZ,ICD10-PCS,Reposition Hepatic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06S83ZZ,ICD10-PCS,Reposition Portal Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SM3ZZ,ICD10-PCS,Reposition Right Femoral Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SP0ZZ,ICD10-PCS,Reposition Right Saphenous Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SR0ZZ,ICD10-PCS,Reposition Right Lesser Saphenous Vein, Open Approach,,,8271.00
Deidentified Maximum,,06ST0ZZ,ICD10-PCS,Reposition Right Foot Vein, Open Approach,,,8271.00
Deidentified Maximum,,06U047Z,ICD10-PCS,Supplement Inf Vena Cava with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06U137Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06U307Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06U407Z,ICD10-PCS,Supplement Hepatic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UD47Z,ICD10-PCS,Supplement L Com Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06UF07Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UG07Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UG47Z,ICD10-PCS,Supplement L Ext Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06UH37Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UM37Z,ICD10-PCS,Supplement Right Femoral Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UP37Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UQ07Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UT47Z,ICD10-PCS,Supplement R Foot Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0DQP0ZZ,ICD10-PCS,Repair Rectum, Open Approach,,,4303.00
Deidentified Maximum,,0DQP8ZZ,ICD10-PCS,Repair Rectum, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Maximum,,0PS33ZZ,ICD10-PCS,Reposition Cervical Vertebra, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0PS3XZZ,ICD10-PCS,Reposition Cervical Vertebra, External Approach,,,8271.00
Deidentified Maximum,,0QS004Z,ICD10-PCS,Reposition Lumbar Vertebra with Int Fix, Open Approach,,,8271.00
Deidentified Maximum,,0QS10ZZ,ICD10-PCS,Reposition Sacrum, Open Approach,,,8271.00
Deidentified Maximum,,0QSS0ZZ,ICD10-PCS,Reposition Coccyx, Open Approach,,,8271.00
Deidentified Maximum,,0RB33ZZ,ICD10-PCS,Excision of Cervical Vertebral Disc, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0RBB4ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG00JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG00Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG00Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG00ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG03KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG03Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG04J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG04J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG04JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG04KJ,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG107J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG1371,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG137J,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG14A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG14J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG14Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG23K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG23K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG23KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG24AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG24JJ,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG24KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG24ZJ,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG4070,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG4371,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG437J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG43A1,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG43K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG43ZJ,ICD10-PCS,Fusion of C-thor Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG4470,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG4471,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG44A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG44KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG6070,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG60A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG6370,ICD10-PCS,Fusion Thor Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG6371,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG63AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG63J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG63K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG64A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG64K0,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG70A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG7370,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG73A0,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG73K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG7470,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG74AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG74K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG83J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG8470,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG8471,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG84JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG84K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG84Z0,ICD10-PCS,Fusion of >7 T Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG84Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RGA071,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RGA0ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RGA370,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RGA3J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RGA470,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA471,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA4A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA4JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA4Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Occip Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RH10BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RH13BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Cerv Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RH13CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Cerv Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RH13DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RH14BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Cerv Jt, Perc Endo,,,8271.00
Deidentified Maximum,,0RH43CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RH64CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Thor Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RHA3BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Perc,,,8271.00
Deidentified Maximum,,0RU03JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0RU10JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RU53JZ,ICD10-PCS,Supplement C-thor Disc with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0RW50JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RWB4JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SB44ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG007J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG00J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG00ZJ,ICD10-PCS,Fusion of Lum Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0SG0371,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG03A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG03KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG04KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG10J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG10JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG10K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG1371,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG137J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG13A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG13J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG13K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG14K1,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG307J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG30AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG33JJ,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG34J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG34J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG34Z0,ICD10-PCS,Fusion of Lumsac Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG34Z1,ICD10-PCS,Fusion of Lumsac Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG504Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Open Approach,,,8271.00
Deidentified Maximum,,0SG50JZ,ICD10-PCS,Fusion of Sacrococcygeal Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG50KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG537Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SG547Z,ICD10-PCS,Fusion Sacrococcygeal Jt w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,0SG607Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG63ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SG644Z,ICD10-PCS,Fusion of Coccygeal Joint with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG844Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SH00DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lum Jt, Open Approach,,,8271.00
Deidentified Maximum,,0SH33DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0SR901A,ICD10-PCS,Replacement of R Hip Jt with Metal, Uncement, Open Approach,,,8271.00
Deidentified Maximum,,0SR9029,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Cement, Open,,,8271.00
Deidentified Maximum,,0SR903Z,ICD10-PCS,REPLACE RT HIP JOINT CERAMIC SYNTH SUBST OPEN,,,8271.00
Deidentified Maximum,,0SR9049,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Cement, Open,,,8271.00
Deidentified Maximum,,0SRA01A,ICD10-PCS,Replace R Hip Jt, Acetab w Metal, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRB01Z,ICD10-PCS,Replacement of Left Hip Joint with Metal, Open Approach,,,8271.00
Deidentified Maximum,,0SRB029,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Cement, Open,,,8271.00
Deidentified Maximum,,0SRB039,ICD10-PCS,Replacement of L Hip Jt with Ceramic, Cement, Open Approach,,,8271.00
Deidentified Maximum,,0SRB03A,ICD10-PCS,Replace of L Hip Jt with Ceramic, Uncement, Open Approach,,,8271.00
Deidentified Maximum,,0SRB0JA,ICD10-PCS,Replace of L Hip Jt with Synth Sub, Uncement, Open Approach,,,8271.00
Deidentified Maximum,,0SRC0JA,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Uncement, Open Approach,,,8271.00
Deidentified Maximum,,0SRD0KZ,ICD10-PCS,Replacement of L Knee Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRE009,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Cement, Open,,,8271.00
Deidentified Maximum,,0SRE00A,ICD10-PCS,Replace L Hip Jt, Acetab w Polyeth, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRE07Z,ICD10-PCS,Replace of L Hip Jt, Acetab with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRR03Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Ceramic, Open Approach,,,8271.00
Deidentified Maximum,,0SRS019,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Cement, Open,,,8271.00
Deidentified Maximum,,0SRS03A,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRS0JZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRS0KZ,ICD10-PCS,Replace of L Hip Jt, Femoral with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRU0JZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRW0KZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SU50JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SU63JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SU64JZ,ICD10-PCS,Supplement Coccygeal Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SUA0BZ,ICD10-PCS,Supplement R Hip Jt, Acetab with Resurf Dev, Open Approach,,,8271.00
Deidentified Maximum,,0SUE0BZ,ICD10-PCS,Supplement L Hip Jt, Acetab with Resurf Dev, Open Approach,,,8271.00
Deidentified Maximum,,0SW23JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Perc Approach,,,8271.00
Deidentified Maximum,,0SW93JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0TQD8ZZ,ICD10-PCS,Repair Urethra, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Maximum,,0TQDXZZ,ICD10-PCS,Repair Urethra, External Approach,,,4303.00
Deidentified Maximum,,0UQ98ZZ,ICD10-PCS,Repair Uterus, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Maximum,,0UQGXZZ,ICD10-PCS,Repair Vagina, External Approach,,,4303.00
Deidentified Maximum,,0WFD0ZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, Open Approach,,,8271.00
Deidentified Maximum,,0WFDXZZ,ICD10-PCS,Fragmentation in Pericardial Cavity, External Approach,,,8271.00
Deidentified Maximum,,10E0XZZ,ICD10-PCS,Delivery of Products of Conception, External Approach,,,4303.00
Deidentified Maximum,,4A020N8,ICD10-PCS,Measure Cardiac Sampl & Pressure, Bilateral, Open,,,8271.00
Deidentified Maximum,,5A02210,ICD10-PCS,Assist with Cardiac Output using Balloon Pump, Continuous,,,8271.00
Deidentified Maximum,,5A0221D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Continuous,,,8271.00
Deidentified Maximum,,B2010ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2021ZZ,ICD10-PCS,Plain Radiography of Sing Cor A Graft using L Osm Contrast,,,8271.00
Deidentified Maximum,,B2051ZZ,ICD10-PCS,Plain Radiography of Left Heart using Low Osmolar Contrast,,,8271.00
Deidentified Maximum,,B205YZZ,ICD10-PCS,Plain Radiography of Left Heart using Other Contrast,,,8271.00
Deidentified Maximum,,B2060ZZ,ICD10-PCS,Plain Radiography of R & L Heart using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2061ZZ,ICD10-PCS,Plain Radiography of R & L Heart using L Osm Contrast,,,8271.00
Deidentified Maximum,,B208YZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using Oth Contrast,,,8271.00
Deidentified Maximum,,B20F0ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2121ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using L Osm Contrast,,,8271.00
Deidentified Maximum,,B2151ZZ,ICD10-PCS,Fluoroscopy of Left Heart using Low Osmolar Contrast,,,8271.00
Deidentified Maximum,,B216YZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using Other Contrast,,,8271.00
Deidentified Maximum,,03UB07Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UB37Z,ICD10-PCS,Supplement Right Radial Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UD07Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UH37Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UK07Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UK37Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UK47Z,ICD10-PCS,Supplement R Int Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UL47Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03US37Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UV07Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UY47Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0410096,ICD10-PCS,Bypass Abd Aorta to R Com Ilia with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,041009Q,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO VEN TISS OPN APPR,,,8271.00
Deidentified Maximum,,041009R,ICD10-PCS,BYPS ABD AO LOW ART AUTO VEN TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100A0,ICD10-PCS,BYPS ABD AO ABD AO AUTO ART TISSUE OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100A7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Maximum,,04100A9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Maximum,,04100AD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Maximum,,04100AG,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO ART TISS OPN APPR,,,8271.00
Deidentified Maximum,,04100AR,ICD10-PCS,BYPS ABD AO LOW ART AUTO ART TISSUE OPN APPROACH,,,8271.00
Deidentified Maximum,,04100J0,ICD10-PCS,BYPASS ABD AO ABD AO SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100J3,ICD10-PCS,BYPS ABD AO RT RENL ART SYNTH SUBST OPN APPROACH,,,8271.00
Deidentified Maximum,,04100J4,ICD10-PCS,BYPS ABD AO LT RENL ART SYNTH SUBST OPN APPROACH,,,8271.00
Deidentified Maximum,,04100K2,ICD10-PCS,BP ABD AO MES ART NONAUTO TISS SUB OPN APPROACH,,,8271.00
Deidentified Maximum,,04100KC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100KQ,ICD10-PCS,BP ABD AO LOW EXT ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100Z5,ICD10-PCS,BYPASS ABDDOMINAL AORTA BILATERAL RENAL ART OPEN,,,8271.00
Deidentified Maximum,,04100ZG,ICD10-PCS,BYPASS ABD AO BIL EXT ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Open Approach,,,8271.00
Deidentified Maximum,,0410496,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,0410499,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041049K,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041049R,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,04104A0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104A1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104A6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104A9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104AG,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104AK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104J0,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104J1,ICD10-PCS,Bypass Abd Aorta to Celiac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104J3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104J9,ICD10-PCS,Bypass Abd Aorta to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104JC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104JF,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104K3,ICD10-PCS,Bypass Abd Aorta to R Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104K5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104KK,ICD10-PCS,Bypass Abd Aorta to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104Z1,ICD10-PCS,Bypass Abdominal Aorta to Celiac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104ZD,ICD10-PCS,Bypass Abdominal Aorta to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104ZG,ICD10-PCS,Bypass Abdominal Aorta to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104ZJ,ICD10-PCS,Bypass Abdominal Aorta to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04140A5,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Art, Open,,,8271.00
Deidentified Maximum,,04140J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,04140K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,0414493,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,04144J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04144K4,ICD10-PCS,Bypass Splenic Art to L Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04144Z5,ICD10-PCS,Bypass Splenic Artery to B Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C090,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C093,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C097,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C09B,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C09J,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C09Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C09R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C0A0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0AC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0J4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0KK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0Z1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art, Open Approach,,,8271.00
Deidentified Maximum,,041C0Z4,ICD10-PCS,Bypass Right Common Iliac Artery to L Renal A, Open Approach,,,8271.00
Deidentified Maximum,,041C0Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041C0ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041C491,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C494,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C499,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C49R,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C4A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4AD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4J5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4J8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4JJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4JQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4K8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4Z4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D090,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D093,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D094,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D097,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D09J,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D0A0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0J2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0Z2,ICD10-PCS,Bypass Left Common Iliac Artery to Mesent Art, Open Approach,,,8271.00
Deidentified Maximum,,041D0Z6,ICD10-PCS,Bypass Left Common Iliac Artery to R Com Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041D0ZC,ICD10-PCS,Bypass Left Common Iliac Artery to B Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041D491,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D493,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D49B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D49F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D49R,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D4A4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4A5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4A8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4J8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4J9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4K7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4ZB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E09B,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E09D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E09J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E0AG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041E49K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E4J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4KH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E4ZK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041F0AP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0JC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Open Approach,,,8271.00
Deidentified Maximum,,041F499,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F49K,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F4KG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H09D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H09J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H0AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0AJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0AP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H49B,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H49C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H49G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H49P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H4JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4JQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4KJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4ZK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H4ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J09C,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J09D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J09H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J0A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0AK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J0KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J0ZQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art, Open Approach,,,8271.00
Deidentified Maximum,,041J49B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J49D,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J49F,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J49J,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J4AD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4JB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4KG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4ZJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04503ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04514ZZ,ICD10-PCS,Destruction of Celiac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04573ZZ,ICD10-PCS,Destruction of Left Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04574ZZ,ICD10-PCS,Destruction of Left Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04580ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04590ZZ,ICD10-PCS,Destruction of Right Renal Artery, Open Approach,,,8271.00
Deidentified Maximum,,045D0ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04B00ZZ,ICD10-PCS,Excision of Abdominal Aorta, Open Approach,,,8271.00
Deidentified Maximum,,04B40ZZ,ICD10-PCS,Excision of Splenic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04B44ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,04B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Maximum,,04B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04B70ZZ,ICD10-PCS,Excision of Left Colic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04BA0ZZ,ICD10-PCS,Excision of Left Renal Artery, Open Approach,,,8271.00
Deidentified Maximum,,04BA3ZZ,ICD10-PCS,Excision of Left Renal Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04BB0ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Maximum,,04BJ4ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R00JZ,ICD10-PCS,Replacement of Abdominal Aorta with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R107Z,ICD10-PCS,Replacement of Celiac Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R10JZ,ICD10-PCS,Replacement of Celiac Artery with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R307Z,ICD10-PCS,Replacement of Hepatic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R44JZ,ICD10-PCS,Replace of Splenic Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R50KZ,ICD10-PCS,Replacement of Sup Mesent Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R547Z,ICD10-PCS,Replace of Sup Mesent Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R54KZ,ICD10-PCS,Replace Sup Mesent Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04R707Z,ICD10-PCS,Replacement of L Colic Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R90KZ,ICD10-PCS,Replacement of R Renal Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RA0KZ,ICD10-PCS,Replacement of L Renal Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RC0KZ,ICD10-PCS,Replace of R Com Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RD4KZ,ICD10-PCS,Replace L Com Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RE0JZ,ICD10-PCS,Replacement of R Int Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RE0KZ,ICD10-PCS,Replace of R Int Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RF4KZ,ICD10-PCS,Replace L Int Iliac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RH07Z,ICD10-PCS,Replacement of R Ext Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04S00ZZ,ICD10-PCS,Reposition Abdominal Aorta, Open Approach,,,8271.00
Deidentified Maximum,,04S03ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04S04ZZ,ICD10-PCS,Reposition Abdominal Aorta, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,04S13ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SE3ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04SF3ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SF4ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SH4ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SK3ZZ,ICD10-PCS,Reposition Right Femoral Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SP0ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SP3ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04SS0ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SS4ZZ,ICD10-PCS,Reposition Left Posterior Tibial Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SW0ZZ,ICD10-PCS,Reposition Left Foot Artery, Open Approach,,,8271.00
Deidentified Maximum,,04U637Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04U747Z,ICD10-PCS,Supplement L Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U847Z,ICD10-PCS,Supplement Mid Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U907Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04U937Z,ICD10-PCS,Supplement Right Renal Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UF07Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UK07Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UK47Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UN47Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UP47Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UQ07Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UR37Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UU07Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05100KY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,05100ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Maximum,,05104ZY,ICD10-PCS,Bypass Azygos Vein to Upper Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05110KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,051309Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,051349Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,05134AY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,05134ZY,ICD10-PCS,Bypass Right Innominate Vein to Up Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05144AY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,05154AY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,05160AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Open,,,8271.00
Deidentified Maximum,,05160ZY,ICD10-PCS,Bypass Left Subclavian Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Maximum,,05164KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05514ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05533ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05560ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Open Approach,,,8271.00
Deidentified Maximum,,05B63ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05R04JZ,ICD10-PCS,Replace of Azygos Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R107Z,ICD10-PCS,Replacement of Hemiazygos Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R147Z,ICD10-PCS,Replace Hemiazygos Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05R14KZ,ICD10-PCS,Replace Hemiazygos Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05R40JZ,ICD10-PCS,Replacement of L Innom Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R447Z,ICD10-PCS,Replace of L Innom Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05S10ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Open Approach,,,8271.00
Deidentified Maximum,,05S40ZZ,ICD10-PCS,Reposition Left Innominate Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SC4ZZ,ICD10-PCS,Reposition Left Basilic Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SH0ZZ,ICD10-PCS,Reposition Left Hand Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SH4ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,05SP0ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SP3ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Approach,,,8271.00
Deidentified Maximum,,05SQ3ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SR3ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05ST3ZZ,ICD10-PCS,Reposition Right Face Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05U437Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05U607Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05U707Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05U907Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UA07Z,ICD10-PCS,Supplement Left Brachial Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UD07Z,ICD10-PCS,Supplement Right Cephalic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UN37Z,ICD10-PCS,Supplement L Int Jugular Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UN47Z,ICD10-PCS,Supplement L Int Jugular Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05UV37Z,ICD10-PCS,Supplement Left Face Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06540ZZ,ICD10-PCS,Destruction of Hepatic Vein, Open Approach,,,8271.00
Deidentified Maximum,,06583ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06593ZZ,ICD10-PCS,Destruction of Right Renal Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,065G4ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,065J3ZZ,ICD10-PCS,Destruction of Left Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06B00ZZ,ICD10-PCS,Excision of Inferior Vena Cava, Open Approach,,,8271.00
Deidentified Maximum,,06B20ZZ,ICD10-PCS,Excision of Gastric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B74ZZ,ICD10-PCS,Excision of Colic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06B83ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06B84ZZ,ICD10-PCS,Excision of Portal Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06BB3ZZ,ICD10-PCS,Excision of Left Renal Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,06BG3ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06BH3ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06BH4ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06BJ0ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06BJ4ZZ,ICD10-PCS,Excision of Left Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R20JZ,ICD10-PCS,Replacement of Gastric Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R24JZ,ICD10-PCS,Replace of Gastric Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R40JZ,ICD10-PCS,Replacement of Hepatic Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R507Z,ICD10-PCS,Replacement of Sup Mesent Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R80JZ,ICD10-PCS,Replacement of Portal Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RB4KZ,ICD10-PCS,Replace of L Renal Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06RD4JZ,ICD10-PCS,Replace L Com Iliac Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RG47Z,ICD10-PCS,Replace L Ext Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RG4KZ,ICD10-PCS,Replace L Ext Iliac Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RH07Z,ICD10-PCS,Replacement of R Hypogast Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RJ0JZ,ICD10-PCS,Replacement of L Hypogast Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RJ0KZ,ICD10-PCS,Replace of L Hypogast Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06S14ZZ,ICD10-PCS,Reposition Splenic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06S70ZZ,ICD10-PCS,Reposition Colic Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SG0ZZ,ICD10-PCS,Reposition Left External Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SH0ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SM4ZZ,ICD10-PCS,Reposition Right Femoral Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SQ4ZZ,ICD10-PCS,Reposition Left Saphenous Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SS3ZZ,ICD10-PCS,Reposition Left Lesser Saphenous Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06ST4ZZ,ICD10-PCS,Reposition Right Foot Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06U337Z,ICD10-PCS,Supplement Esophageal Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06U537Z,ICD10-PCS,Supplement Sup Mesent Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06U847Z,ICD10-PCS,Supplement Portal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06UB37Z,ICD10-PCS,Supplement Left Renal Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UC37Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UC47Z,ICD10-PCS,Supplement R Com Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06UD07Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UF37Z,ICD10-PCS,Supplement R Ext Iliac Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UJ37Z,ICD10-PCS,Supplement L Hypogast Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UV07Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0DQR4ZZ,ICD10-PCS,Repair Anal Sphincter, Percutaneous Endoscopic Approach,,,4303.00
Deidentified Maximum,,0JH608Z,ICD10-PCS,Insert of Defib Gen into Chest Subcu/Fascia, Open Approach,,,8271.00
Deidentified Maximum,,0JH838Z,ICD10-PCS,Insertion of Defib Gen into Abd Subcu/Fascia, Perc Approach,,,8271.00
Deidentified Maximum,,0PS404Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Open Approach,,,8271.00
Deidentified Maximum,,0PS40ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Open Approach,,,8271.00
Deidentified Maximum,,0PS43ZZ,ICD10-PCS,Reposition Thoracic Vertebra, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0QS03ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0QS144Z,ICD10-PCS,Reposition Sacrum with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0QS1XZZ,ICD10-PCS,Reposition Sacrum, External Approach,,,8271.00
Deidentified Maximum,,0R590ZZ,ICD10-PCS,Destruction of Thoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RB14ZZ,ICD10-PCS,Excision of Cervical Vertebral Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RB50ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RB63ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0RB90ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RBB3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Perc Approach,,,8271.00
Deidentified Maximum,,001U079,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Open,,,8271.00
Deidentified Maximum,,001U0J6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Synth Sub, Open,,,8271.00
Deidentified Maximum,,001U374,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Autol Sub, Perc,,,8271.00
Deidentified Maximum,,001U376,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Perc,,,8271.00
Deidentified Maximum,,001U379,ICD10-PCS,Bypass Spinal Canal to Fallopian w Autol Sub, Perc,,,8271.00
Deidentified Maximum,,005Y0ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,009T4ZX,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach, Diagn,,,8271.00
Deidentified Maximum,,009T4ZZ,ICD10-PCS,Drainage of Spinal Meninges, Perc Endo Approach,,,8271.00
Deidentified Maximum,,009W30Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Perc Approach,,,8271.00
Deidentified Maximum,,009W4ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Maximum,,009W4ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,009X4ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Maximum,,00BT0ZZ,ICD10-PCS,EXCISION OF SPINAL MENINGES OPEN APPROACH,,,8271.00
Deidentified Maximum,,00BT3ZX,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach, Diagn,,,8271.00
Deidentified Maximum,,00BW3ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00BX3ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Approach, Diagn,,,8271.00
Deidentified Maximum,,00BX3ZZ,ICD10-PCS,Excision of Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00BY0ZZ,ICD10-PCS,EXCISION OF LUMBAR SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Maximum,,00C33ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Perc Approach,,,8271.00
Deidentified Maximum,,00CT0ZZ,ICD10-PCS,Extirpation of Matter from Spinal Meninges, Open Approach,,,8271.00
Deidentified Maximum,,00CW3ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00CX3ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00CY3ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00HU0MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00HU3MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00NY0ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00PU0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00PV03Z,ICD10-PCS,Removal of Infusion Device from Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00PV0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00PV32Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00PV4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00QX4ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00QY0ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00SW4ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00SX0ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00SX4ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00SY0ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00SY4ZZ,ICD10-PCS,Reposition Lumbar Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00UT0JZ,ICD10-PCS,Supplement Spinal Meninges with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,00WU0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00WU43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00WV0MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00WV30Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00WV40Z,ICD10-PCS,Revision of Drain Dev in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,01813ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,01883ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0210083,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,0210088,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021008F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,021009C,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02100A8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Art, Open,,,8271.00
Deidentified Maximum,,02100JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02100K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02100KC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02100Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Open Approach,,,8271.00
Deidentified Maximum,,02100Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,0210498,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,0210499,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021049F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02104A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02104AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02104J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02104KW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02104Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02110A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Open,,,8271.00
Deidentified Maximum,,02110AW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02110KW,ICD10-PCS,Bypass 2 Cor Art from Aorta with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02110Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,021148C,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0211499,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021149W,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02114A9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02114K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0212083,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,021208F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02120J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02120JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02120KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02120KW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02120ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Open Approach,,,8271.00
Deidentified Maximum,,0212488,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0212489,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021249C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02124AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02124J3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02124JF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02124K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02124KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02124KF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,0213093,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02130A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02130ZF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art, Open Approach,,,8271.00
Deidentified Maximum,,021349W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02134AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02134AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02134JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02134KW,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02134Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021608Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,021609R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02160JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02160KR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02164AP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02164AR,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02164ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02170KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02170ZP,ICD10-PCS,Bypass Left Atrium to Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Maximum,,021749R,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02174AP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02174JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021K09P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021K0AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,021K0Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,021K0ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,021K48Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021L09P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021L09Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021L0JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021L0KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021L48Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021L48R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021L4JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021L4KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021V08Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021V48P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021V4AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021V4JP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W08R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021W0AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,021W0KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021W4JR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021X08P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021X09B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021X0AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Open,,,8271.00
Deidentified Maximum,,021X0AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,021X0AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,021X0JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021X0KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021X0KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021X4AB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021X4AR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021X4ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Perc Endo Approach,,,8271.00
Deidentified Maximum,,024F0JJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02573ZZ,ICD10-PCS,Destruction of Left Atrium, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025F0ZZ,ICD10-PCS,Destruction of Aortic Valve, Open Approach,,,8271.00
Deidentified Maximum,,025G3ZZ,ICD10-PCS,Destruction of Mitral Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025R0ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Open Approach,,,8271.00
Deidentified Maximum,,025R3ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025S3ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025T4ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,025V0ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Open Approach,,,8271.00
Deidentified Maximum,,025V3ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025V4ZZ,ICD10-PCS,Destruction of Superior Vena Cava, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027007Z,ICD10-PCS,Dilation of 1 Cor Art with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02700F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Open,,,8271.00
Deidentified Maximum,,027034Z,ICD10-PCS,Dilation of 1 Cor Art with Drug-elut Intra, Perc Approach,,,8271.00
Deidentified Maximum,,02703DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02703ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Approach,,,8271.00
Deidentified Maximum,,0270446,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,,8271.00
Deidentified Maximum,,02704D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02704FZ,ICD10-PCS,Dilate of 1 Cor Art with 3 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02704GZ,ICD10-PCS,Dilate of 1 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02710GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02710Z6,ICD10-PCS,Dilation of 2 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Maximum,,027134Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Perc Approach,,,8271.00
Deidentified Maximum,,027137Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02713D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02713FZ,ICD10-PCS,Dilation of 2 Cor Art with 3 Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02713GZ,ICD10-PCS,Dilation of 2 Cor Art with 4+ Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02713TZ,ICD10-PCS,Dilation of 2 Cor Art with Radioact Intralum, Perc Approach,,,8271.00
Deidentified Maximum,,02713ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Perc Approach,,,8271.00
Deidentified Maximum,,02714E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02714FZ,ICD10-PCS,Dilate of 2 Cor Art with 3 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02714TZ,ICD10-PCS,Dilate 2 Cor Art w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,02714ZZ,ICD10-PCS,Dilation of 2 Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027204Z,ICD10-PCS,Dilation of 3 Cor Art with Drug-elut Intra, Open Approach,,,8271.00
Deidentified Maximum,,0272056,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02723E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02723EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02723F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02723T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc,,,8271.00
Deidentified Maximum,,02723TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Perc Approach,,,8271.00
Deidentified Maximum,,0272446,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,,8271.00
Deidentified Maximum,,02724F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02724TZ,ICD10-PCS,Dilate 3 Cor Art w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,02724ZZ,ICD10-PCS,Dilation of 3 Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02730FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02730TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Open Approach,,,8271.00
Deidentified Maximum,,02730Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Maximum,,0273346,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc,,,8271.00
Deidentified Maximum,,0273356,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc,,,8271.00
Deidentified Maximum,,027335Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,0273366,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc,,,8271.00
Deidentified Maximum,,027337Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02733DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02733TZ,ICD10-PCS,Dilation of 4+ Cor Art with Radioact Intralum, Perc Approach,,,8271.00
Deidentified Maximum,,0273466,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,02734EZ,ICD10-PCS,Dilate of 4+ Cor Art with 2 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02734T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,027F04Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Open,,,8271.00
Deidentified Maximum,,027G04Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Open,,,8271.00
Deidentified Maximum,,027G0DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,027H3DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,027H44Z,ICD10-PCS,Dilate Pulm Valve w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,027H4ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027K3ZZ,ICD10-PCS,Dilation of Right Ventricle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02890ZZ,ICD10-PCS,Division of Chordae Tendineae, Open Approach,,,8271.00
Deidentified Maximum,,02B40ZZ,ICD10-PCS,Excision of Coronary Vein, Open Approach,,,8271.00
Deidentified Maximum,,02B44ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02B60ZZ,ICD10-PCS,Excision of Right Atrium, Open Approach,,,8271.00
Deidentified Maximum,,02B73ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BF3ZZ,ICD10-PCS,Excision of Aortic Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BG0ZZ,ICD10-PCS,Excision of Mitral Valve, Open Approach,,,8271.00
Deidentified Maximum,,02BK0ZZ,ICD10-PCS,Excision of Right Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,02BL3ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BL4ZZ,ICD10-PCS,Excision of Left Ventricle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02BR0ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Open Approach,,,8271.00
Deidentified Maximum,,02BR3ZZ,ICD10-PCS,Excision of Left Pulmonary Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BS4ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02BT0ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Open Approach,,,8271.00
Deidentified Maximum,,02BT3ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BV0ZZ,ICD10-PCS,Excision of Superior Vena Cava, Open Approach,,,8271.00
Deidentified Maximum,,02BW4ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02C00Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Maximum,,02C23Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Maximum,,02C24ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02C30Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Maximum,,02C40ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Open Approach,,,8271.00
Deidentified Maximum,,02H40DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Open Approach,,,8271.00
Deidentified Maximum,,02H43NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Perc Approach,,,8271.00
Deidentified Maximum,,02H60KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Open Approach,,,8271.00
Deidentified Maximum,,02HA0RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Open Approach,,,8271.00
Deidentified Maximum,,02HP0DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Open Approach,,,8271.00
Deidentified Maximum,,02HQ4DZ,ICD10-PCS,Insert of Intralum Dev into R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HW0DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Open Approach,,,8271.00
Deidentified Maximum,,02HW42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Desc, Perc Endo,,,8271.00
Deidentified Maximum,,02K80ZZ,ICD10-PCS,Map Conduction Mechanism, Open Approach,,,8271.00
Deidentified Maximum,,02LH0ZZ,ICD10-PCS,Occlusion of Pulmonary Valve, Open Approach,,,8271.00
Deidentified Maximum,,02LH3DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02N83ZZ,ICD10-PCS,Release Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02N84ZZ,ICD10-PCS,Release Conduction Mechanism, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02NK4ZZ,ICD10-PCS,Release Right Ventricle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02NL0ZZ,ICD10-PCS,Release Left Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,02PY47Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02PY4CZ,ICD10-PCS,Remove of Extralum Dev from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02Q03ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02Q04ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02Q10ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Open Approach,,,8271.00
Deidentified Maximum,,02Q33ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Perc Approach,,,8271.00
Deidentified Maximum,,02Q50ZZ,ICD10-PCS,Repair Atrial Septum, Open Approach,,,8271.00
Deidentified Maximum,,02Q54ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02Q83ZZ,ICD10-PCS,Repair Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02Q94ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QA3ZZ,ICD10-PCS,Repair Heart, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02QB0ZZ,ICD10-PCS,Repair Right Heart, Open Approach,,,8271.00
Deidentified Maximum,,02QB4ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QC0ZZ,ICD10-PCS,Repair Left Heart, Open Approach,,,8271.00
Deidentified Maximum,,02QF3ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02QG4ZE,ICD10-PCS,Repair Mitral Valve fr L AV Vlv, Perc Endo,,,8271.00
Deidentified Maximum,,02QH3ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02QK4ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QL4ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QN0ZZ,ICD10-PCS,Repair Pericardium, Open Approach,,,8271.00
Deidentified Maximum,,02QN3ZZ,ICD10-PCS,Repair Pericardium, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02R507Z,ICD10-PCS,Replacement of Atrial Septum with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R70KZ,ICD10-PCS,Replacement of Left Atrium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R948Z,ICD10-PCS,Replace Chordae Tendineae w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02RG3KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02RK4KZ,ICD10-PCS,Replace of R Ventricle with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RL08Z,ICD10-PCS,Replacement of Left Ventricle with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RN48Z,ICD10-PCS,Replace of Pericardium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RN4KZ,ICD10-PCS,Replace of Pericardium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RP0KZ,ICD10-PCS,Replacement of Pulm Trunk with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RR07Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RR48Z,ICD10-PCS,Replace of L Pulm Art with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RS07Z,ICD10-PCS,Replacement of R Pulm Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RS0JZ,ICD10-PCS,Replacement of R Pulm Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RT08Z,ICD10-PCS,Replacement of L Pulm Vein with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RT0KZ,ICD10-PCS,Replacement of L Pulm Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RW4JZ,ICD10-PCS,Replace Thor Aorta Desc w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02RX0KZ,ICD10-PCS,Replacement of Thor Aorta Asc with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RX48Z,ICD10-PCS,Replace Thor Aorta Asc w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02SQ0ZZ,ICD10-PCS,Reposition Right Pulmonary Artery, Open Approach,,,8271.00
Deidentified Maximum,,02ST0ZZ,ICD10-PCS,Reposition Left Pulmonary Vein, Open Approach,,,8271.00
Deidentified Maximum,,02SW0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Descending, Open Approach,,,8271.00
Deidentified Maximum,,02TD3ZZ,ICD10-PCS,Resection of Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02U53JZ,ICD10-PCS,Supplement Atrial Septum with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02U548Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U60JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U90KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U93KZ,ICD10-PCS,Supplement Chordae Tendineae with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02U948Z,ICD10-PCS,Supplement Chordae Tendineae w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02UA47Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UD3JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UD3KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UF07J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Open,,,8271.00
Deidentified Maximum,,02UF0JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UF0KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UF3KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UF47J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UF48J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02UG0KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UG3KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc,,,8271.00
Deidentified Maximum,,02UG47E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UG48Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UH08Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UK37Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UK3KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UK47Z,ICD10-PCS,Supplement R Ventricle with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UL07Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UM37Z,ICD10-PCS,Supplement Ventricular Septum with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UM38Z,ICD10-PCS,Supplement Ventricular Septum with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UM3KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UM4JZ,ICD10-PCS,Supplement Ventricular Sept w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UN08Z,ICD10-PCS,Supplement Pericardium with Zooplastic Tissue, Open Approach,,,8271.00
Deidentified Maximum,,02UP07Z,ICD10-PCS,Supplement Pulmonary Trunk with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UP0KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UP3KZ,ICD10-PCS,Supplement Pulmonary Trunk with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UP47Z,ICD10-PCS,Supplement Pulm Trunk with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UQ0KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UQ37Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UQ47Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UV0KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UV3KZ,ICD10-PCS,Supplement Superior Vena Cava with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UW47Z,ICD10-PCS,Supplement Thor Aorta Desc w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UX0KZ,ICD10-PCS,Supplement Thor Aorta Asc with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UX37Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UX38Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02VA3ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02VA4ZZ,ICD10-PCS,Restriction of Heart, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02VW0EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Open,,,8271.00
Deidentified Maximum,,02VW3EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc,,,8271.00
Deidentified Maximum,,02VX3DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02VX4DZ,ICD10-PCS,Restrict Thor Aorta Asc w Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02WF08Z,ICD10-PCS,Revision of Zooplastic Tissue in Aortic Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WG0JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WG4KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WY0CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02WY4CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,031309N,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,03130ZM,ICD10-PCS,Bypass Right Subclavian Artery to R Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,03500ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Maximum,,03543ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03B03ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03B30ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Open Approach,,,8271.00
Deidentified Maximum,,03B40ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Open Approach,,,8271.00
Deidentified Maximum,,03R14KZ,ICD10-PCS,Replace L Int Mamm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,03R30KZ,ICD10-PCS,Replacement of R Subclav Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R40KZ,ICD10-PCS,Replacement of L Subclav Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,03S03ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03S14ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S50ZZ,ICD10-PCS,Reposition Right Axillary Artery, Open Approach,,,8271.00
Deidentified Maximum,,03S53ZZ,ICD10-PCS,Reposition Right Axillary Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03S54ZZ,ICD10-PCS,Reposition Right Axillary Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S60ZZ,ICD10-PCS,Reposition Left Axillary Artery, Open Approach,,,8271.00
Deidentified Maximum,,03S64ZZ,ICD10-PCS,Reposition Left Axillary Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S83ZZ,ICD10-PCS,Reposition Left Brachial Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03S94ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SD3ZZ,ICD10-PCS,Reposition Right Hand Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SG3ZZ,ICD10-PCS,Reposition Intracranial Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SK0ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SL4ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SN4ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03ST3ZZ,ICD10-PCS,Reposition Left Temporal Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03ST4ZZ,ICD10-PCS,Reposition Left Temporal Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SU3ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03U047Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,001U0J4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Synth Sub, Open,,,8271.00
Deidentified Maximum,,001U3K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Perc,,,8271.00
Deidentified Maximum,,005Y4ZZ,ICD10-PCS,Destruction of Lumbar Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,008Y4ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,009T3ZX,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach, Diagn,,,8271.00
Deidentified Maximum,,009U0ZZ,ICD10-PCS,DRAINAGE OF SPINAL CANAL OPEN APPROACH,,,8271.00
Deidentified Maximum,,009W3ZZ,ICD10-PCS,Drainage of Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,009X3ZX,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Approach, Diagn,,,8271.00
Deidentified Maximum,,009X3ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,009Y00Z,ICD10-PCS,Drainage of Lumbar Spinal Cord with Drain Dev, Open Approach,,,8271.00
Deidentified Maximum,,009Y0ZZ,ICD10-PCS,DRAINAGE OF LUMBAR SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Maximum,,00BT4ZZ,ICD10-PCS,Excision of Spinal Meninges, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00BW0ZZ,ICD10-PCS,EXCISION OF CERVICAL SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Maximum,,00BX0ZZ,ICD10-PCS,EXCISION OF THORACIC SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Maximum,,00C30ZZ,ICD10-PCS,Extirpation of Matter from Cran Epidur Spc, Open Approach,,,8271.00
Deidentified Maximum,,00CY4ZZ,ICD10-PCS,Extirpate of Matter from Lum Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00FU3ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00HU4MZ,ICD10-PCS,Insert of Neuro Lead into Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00JV0ZZ,ICD10-PCS,INSPECTION OF SPINAL CORD OPEN APPR,,,8271.00
Deidentified Maximum,,00JV3ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00JV4ZZ,ICD10-PCS,Inspection of Spinal Cord, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,00PU0MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00PU3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00PV02Z,ICD10-PCS,Removal of Monitoring Device from Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00PV30Z,ICD10-PCS,Removal of Drainage Device from Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00PV37Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00PV3KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00PV3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00PV47Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00QW0ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00QX0ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00QY4ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,00SW0ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00UT47Z,ICD10-PCS,Supplement Spinal Meninges w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,00UT4JZ,ICD10-PCS,Supplement Spinal Meninges w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,00WU02Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00WU32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00WU33Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00WU4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00WV00Z,ICD10-PCS,Revision of Drainage Device in Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00WV03Z,ICD10-PCS,Revision of Infusion Device in Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00WV07Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00WV0KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00WV43Z,ICD10-PCS,Revision of Infusion Dev in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00WV4KZ,ICD10-PCS,Revision of Nonaut Sub in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,01810ZZ,ICD10-PCS,DIVISION OF CERVICAL NERVE OPEN APPROACH,,,8271.00
Deidentified Maximum,,01814ZZ,ICD10-PCS,Division of Cervical Nerve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,018B3ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE PERCUTANEOUS APPROACH,,,8271.00
Deidentified Maximum,,0210089,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021009F,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,021009W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02100AC,ICD10-PCS,Bypass 1 Cor Art from Thor Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02100J8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02100KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02100KW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02100ZF,ICD10-PCS,Bypass 1 Cor Art from Abd Art, Open Approach,,,8271.00
Deidentified Maximum,,0210488,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021048F,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021048W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021049W,ICD10-PCS,Bypass 1 Cor Art from Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02104JW,ICD10-PCS,Bypass 1 Cor Art from Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,0211083,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,0211088,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021108F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,021108W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02110A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02110AF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02110J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02110KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02110KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02110ZC,ICD10-PCS,Bypass 2 Cor Art from Thor Art, Open Approach,,,8271.00
Deidentified Maximum,,021148F,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0211493,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02114A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02114AW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02114J8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114KF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0212088,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Maximum,,0212089,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Maximum,,02120AW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02120KC,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,0212483,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0212498,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02124JW,ICD10-PCS,Bypass 3 Cor Art from Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02124ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0213098,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021309F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,021309W,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02130A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Open,,,8271.00
Deidentified Maximum,,02130AW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02130J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02130JC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02130JF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02130KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02130Z3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art, Open Approach,,,8271.00
Deidentified Maximum,,0213483,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0213489,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02134K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02134ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021608P,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,021608R,ICD10-PCS,Bypass R Atrium to L Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02160AR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02160JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,021649Q,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02170AR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02170JQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02170JR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02170KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02170ZQ,ICD10-PCS,Bypass Left Atrium to Right Pulmonary Artery, Open Approach,,,8271.00
Deidentified Maximum,,02174JR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02174KQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021K08Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021K09Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021K0AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Open,,,8271.00
Deidentified Maximum,,021K49Q,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021K4KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021L08P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021L08Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021L09R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021L0ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Open Approach,,,8271.00
Deidentified Maximum,,021L0ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,021L49R,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021L4JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021V08R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021V0ZP,ICD10-PCS,Bypass Superior Vena Cava to Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Maximum,,021V49P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021V4JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021V4KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W08B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021W09P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021W0AP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Art, Open,,,8271.00
Deidentified Maximum,,021W0JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021W0KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021W0ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,021W48D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021W49Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021W4AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021W4AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021W4JB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W4KB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W4ZD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021X08B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021X08Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021X09Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021X0ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Open Approach,,,8271.00
Deidentified Maximum,,021X0ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,021X48Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021X4KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021X4KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021X4ZD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid, Perc Endo Approach,,,8271.00
Deidentified Maximum,,024F0KJ,ICD10-PCS,Create Aort Valve from Trunc Vlv w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,024G082,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Zooplastic, Open,,,8271.00
Deidentified Maximum,,024G0K2,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02544ZZ,ICD10-PCS,Destruction of Coronary Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02553ZZ,ICD10-PCS,Destruction of Atrial Septum, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025D4ZZ,ICD10-PCS,Destruction of Papillary Muscle, Perc Endo Approach,,,8271.00
Deidentified Maximum,,025K3ZZ,ICD10-PCS,Destruction of Right Ventricle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025P4ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Perc Endo Approach,,,8271.00
Deidentified Maximum,,025R4ZZ,ICD10-PCS,Destruction of Left Pulmonary Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,025W3ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Perc Approach,,,8271.00
Deidentified Maximum,,02700DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02700TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Open Approach,,,8271.00
Deidentified Maximum,,02703D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02703G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02703GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02703TZ,ICD10-PCS,Dilation of 1 Cor Art with Radioact Intralum, Perc Approach,,,8271.00
Deidentified Maximum,,027044Z,ICD10-PCS,Dilate of 1 Cor Art with Drug-elut Intra, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02704E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02704T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,02704ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027104Z,ICD10-PCS,Dilation of 2 Cor Art with Drug-elut Intra, Open Approach,,,8271.00
Deidentified Maximum,,02710DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02710EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02710F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02713F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,027144Z,ICD10-PCS,Dilate of 2 Cor Art with Drug-elut Intra, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02714D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,027205Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,0272076,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02720EZ,ICD10-PCS,Dilation of 3 Cor Art with 2 Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02723Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Maximum,,02723ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Perc Approach,,,8271.00
Deidentified Maximum,,0272476,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,02724D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,0273046,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Open,,,8271.00
Deidentified Maximum,,027304Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Open Approach,,,8271.00
Deidentified Maximum,,02730T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Open,,,8271.00
Deidentified Maximum,,027336Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02733E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02733T6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Radioact Intralum, Perc,,,8271.00
Deidentified Maximum,,027344Z,ICD10-PCS,Dilate 4+ Cor Art w Drug-elut Intra, Perc Endo,,,8271.00
Deidentified Maximum,,027346Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02734DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02734GZ,ICD10-PCS,Dilate 4+ Cor Art w 4+ Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,027F34Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc,,,8271.00
Deidentified Maximum,,027F3ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,027G44Z,ICD10-PCS,Dilate Mitral Valve w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,027H0DZ,ICD10-PCS,Dilation of Pulmonary Valve with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,027J4ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027R44T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,02B74ZZ,ICD10-PCS,Excision of Left Atrium, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02B80ZZ,ICD10-PCS,Excision of Conduction Mechanism, Open Approach,,,8271.00
Deidentified Maximum,,02B83ZZ,ICD10-PCS,Excision of Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BH0ZZ,ICD10-PCS,Excision of Pulmonary Valve, Open Approach,,,8271.00
Deidentified Maximum,,02BL0ZZ,ICD10-PCS,Excision of Left Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,02BM0ZZ,ICD10-PCS,Excision of Ventricular Septum, Open Approach,,,8271.00
Deidentified Maximum,,02BP0ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Maximum,,02BQ0ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Open Approach,,,8271.00
Deidentified Maximum,,02BQ3ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02C13Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Maximum,,02C34Z6,ICD10-PCS,Extirpate matter from 4+ Cor Art, Bifurc, Perc Endo,,,8271.00
Deidentified Maximum,,02CD0ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Open Approach,,,8271.00
Deidentified Maximum,,02CD3ZZ,ICD10-PCS,Extirpation of Matter from Papillary Muscle, Perc Approach,,,8271.00
Deidentified Maximum,,02CD4ZZ,ICD10-PCS,Extirpate matter from Papillary Muscle, Perc Endo,,,8271.00
Deidentified Maximum,,02CW3ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Perc Approach,,,8271.00
Deidentified Maximum,,02CW4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Desc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02CX4ZZ,ICD10-PCS,Extirpate of Matter from Thor Aorta Asc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02H40NZ,ICD10-PCS,Insertion of Intracard Pacer into Cor Vein, Open Approach,,,8271.00
Deidentified Maximum,,02H44DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02H63KZ,ICD10-PCS,Insertion of Defibrillator Lead into R Atrium, Perc Approach,,,8271.00
Deidentified Maximum,,02H70KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Open Approach,,,8271.00
Deidentified Maximum,,02H74KZ,ICD10-PCS,Insertion of Defib Lead into L Atrium, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HR0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,02HS32Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Perc Approach,,,8271.00
Deidentified Maximum,,02HS42Z,ICD10-PCS,Insert of Monitor Dev into R Pulm Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HW32Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Perc Approach,,,8271.00
Deidentified Maximum,,02HX0DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Open Approach,,,8271.00
Deidentified Maximum,,02K84ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02LH0DZ,ICD10-PCS,Occlusion of Pulm Valve with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02LH4CZ,ICD10-PCS,Occlusion Pulm Valve w Extralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02N44ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02PY0JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02PY37Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02PY3DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02Q13ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02Q70ZZ,ICD10-PCS,Repair Left Atrium, Open Approach,,,8271.00
Deidentified Maximum,,02Q93ZZ,ICD10-PCS,Repair Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02QC3ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02QD0ZZ,ICD10-PCS,Repair Papillary Muscle, Open Approach,,,8271.00
Deidentified Maximum,,02QF3ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Perc Approach,,,8271.00
Deidentified Maximum,,02QG0ZZ,ICD10-PCS,Repair Mitral Valve, Open Approach,,,8271.00
Deidentified Maximum,,02QG3ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02QJ3ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Perc Approach,,,8271.00
Deidentified Maximum,,02QL0ZZ,ICD10-PCS,Repair Left Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,02R50JZ,ICD10-PCS,Replacement of Atrial Septum with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R54KZ,ICD10-PCS,Replace of Atrial Sept with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R607Z,ICD10-PCS,Replacement of Right Atrium with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R60JZ,ICD10-PCS,Replacement of Right Atrium with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R907Z,ICD10-PCS,Replace of Chordae Tendineae with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R94JZ,ICD10-PCS,Replace Chordae Tendineae w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02R94KZ,ICD10-PCS,Replace Chordae Tendineae w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02RD48Z,ICD10-PCS,Replace Papillary Muscle w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02RD4JZ,ICD10-PCS,Replace Papillary Muscle w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02RG08Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RG37Z,ICD10-PCS,Replacement of Mitral Valve with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02RH4KZ,ICD10-PCS,Replace of Pulm Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RJ48Z,ICD10-PCS,Replace of Tricusp Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RJ4KZ,ICD10-PCS,Replace of Tricusp Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RK47Z,ICD10-PCS,Replace of R Ventricle with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RP08Z,ICD10-PCS,Replacement of Pulm Trunk with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RQ48Z,ICD10-PCS,Replace of R Pulm Art with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RQ4KZ,ICD10-PCS,Replace of R Pulm Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RR47Z,ICD10-PCS,Replacement of L Pulm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RT07Z,ICD10-PCS,Replacement of L Pulm Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RV47Z,ICD10-PCS,Replace of Sup Vena Cava with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RW08Z,ICD10-PCS,Replace of Thor Aorta Desc with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RX0JZ,ICD10-PCS,Replacement of Thor Aorta Asc with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RX47Z,ICD10-PCS,Replace of Thor Aorta Asc with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02T80ZZ,ICD10-PCS,Resection of Conduction Mechanism, Open Approach,,,8271.00
Deidentified Maximum,,02TD0ZZ,ICD10-PCS,Resection of Papillary Muscle, Open Approach,,,8271.00
Deidentified Maximum,,02TD4ZZ,ICD10-PCS,Resection of Papillary Muscle, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U537Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02U54KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U608Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02U648Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U737Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02U94JZ,ICD10-PCS,Supplement Chordae Tendineae w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UA07Z,ICD10-PCS,Supplement Heart with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UA08Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Open Approach,,,8271.00
Deidentified Maximum,,02UA37Z,ICD10-PCS,Supplement Heart with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UA48Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UD07Z,ICD10-PCS,Supplement Papillary Muscle with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UD4KZ,ICD10-PCS,Supplement Papillary Muscle w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UF08J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Open,,,8271.00
Deidentified Maximum,,02UF0KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02UF47Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UF48Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UG0JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02UG38E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc,,,8271.00
Deidentified Maximum,,02UG47Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UH07Z,ICD10-PCS,Supplement Pulmonary Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UH0JZ,ICD10-PCS,Supplement Pulmonary Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UJ0JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02UJ0KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UJ48Z,ICD10-PCS,Supplement Tricusp Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UJ4JZ,ICD10-PCS,Supplement Tricusp Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UL3JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UL47Z,ICD10-PCS,Supplement Left Ventricle with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UL48Z,ICD10-PCS,Supplement L Ventricle with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UM47Z,ICD10-PCS,Supplement Ventricular Sept w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UN3KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UN48Z,ICD10-PCS,Supplement Pericardium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UN4KZ,ICD10-PCS,Supplement Pericardium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02US08Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02US48Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UT07Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UT37Z,ICD10-PCS,Supplement Left Pulmonary Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UV08Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UV4KZ,ICD10-PCS,Supplement Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UW07Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UW08Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UW38Z,ICD10-PCS,Supplement Thor Aorta Desc with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UW4KZ,ICD10-PCS,Supplement Thor Aorta Desc w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02VA4CZ,ICD10-PCS,Restriction of Heart with Extralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02VX4FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc Endo,,,8271.00
Deidentified Maximum,,02W54JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WG47Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WH08Z,ICD10-PCS,Revision of Zooplastic Tissue in Pulm Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WH0JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WJ07Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WJ0KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WY0JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02WY48Z,ICD10-PCS,Revision of Zooplastic in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WY4JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,031309M,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,03130JM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,03140AN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,03140JN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,03140KN,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,03503ZZ,ICD10-PCS,Destruction of Right Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03514ZZ,ICD10-PCS,Destruction of L Int Mamm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R00JZ,ICD10-PCS,Replacement of R Int Mamm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R047Z,ICD10-PCS,Replace of R Int Mamm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R10JZ,ICD10-PCS,Replacement of L Int Mamm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R20JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R347Z,ICD10-PCS,Replace of R Subclav Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R34KZ,ICD10-PCS,Replace of R Subclav Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S43ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03S44ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S73ZZ,ICD10-PCS,Reposition Right Brachial Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03S90ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SJ0ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SK4ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SL3ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03SP0ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SP4ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SR0ZZ,ICD10-PCS,Reposition Face Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SV0ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SV3ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SV4ZZ,ICD10-PCS,Reposition Left Thyroid Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03U147Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03U307Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03U847Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03U907Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03U947Z,ICD10-PCS,Supplement R Ulnar Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UA07Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UG47Z,ICD10-PCS,Supplement Intracran Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UH07Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UJ47Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UN37Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UN47Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UP47Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UQ07Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UR47Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UT47Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UU07Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UU47Z,ICD10-PCS,Supplement R Thyroid Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02VA3CZ,ICD10-PCS,Restriction of Heart with Extraluminal Device, Perc Approach,,,8271.00
Deidentified Maximum,,02VW3DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02WF07Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WF0JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WG08Z,ICD10-PCS,Revision of Zooplastic Tissue in Mitral Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WJ48Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WJ4JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WY07Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02WY37Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02WY3JZ,ICD10-PCS,Revision of Synth Sub in Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02WY47Z,ICD10-PCS,Revision of Autol Sub in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03130AM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,031409N,ICD10-PCS,Bypass L Subclav Art to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,03140ZN,ICD10-PCS,Bypass Left Subclavian Artery to L Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,03533ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03534ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03540ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Open Approach,,,8271.00
Deidentified Maximum,,03B04ZZ,ICD10-PCS,Excision of R Int Mamm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03B14ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03B20ZZ,ICD10-PCS,Excision of Innominate Artery, Open Approach,,,8271.00
Deidentified Maximum,,03B24ZZ,ICD10-PCS,Excision of Innominate Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03B34ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R00KZ,ICD10-PCS,Replacement of R Int Mamm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R247Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R24JZ,ICD10-PCS,Replacement of Innom Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R307Z,ICD10-PCS,Replacement of R Subclav Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R34JZ,ICD10-PCS,Replace of R Subclav Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S04ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S23ZZ,ICD10-PCS,Reposition Innominate Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03S24ZZ,ICD10-PCS,Reposition Innominate Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S40ZZ,ICD10-PCS,Reposition Left Subclavian Artery, Open Approach,,,8271.00
Deidentified Maximum,,03S63ZZ,ICD10-PCS,Reposition Left Axillary Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03S70ZZ,ICD10-PCS,Reposition Right Brachial Artery, Open Approach,,,8271.00
Deidentified Maximum,,03S74ZZ,ICD10-PCS,Reposition Right Brachial Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S84ZZ,ICD10-PCS,Reposition Left Brachial Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SB0ZZ,ICD10-PCS,Reposition Right Radial Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SD0ZZ,ICD10-PCS,Reposition Right Hand Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SF0ZZ,ICD10-PCS,Reposition Left Hand Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SG4ZZ,ICD10-PCS,Reposition Intracranial Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SH0ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SM3ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03SM4ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SP3ZZ,ICD10-PCS,Reposition Right Vertebral Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SQ0ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SQ4ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03ST0ZZ,ICD10-PCS,Reposition Left Temporal Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SU4ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03U447Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03U547Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03U807Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03U937Z,ICD10-PCS,Supplement Right Ulnar Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UA37Z,ICD10-PCS,Supplement Left Ulnar Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UD47Z,ICD10-PCS,Supplement R Hand Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UG07Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UJ07Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UL07Z,ICD10-PCS,Supplement L Int Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UP07Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UP37Z,ICD10-PCS,Supplement R Verteb Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UQ37Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UR07Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UV47Z,ICD10-PCS,Supplement L Thyroid Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0410094,ICD10-PCS,BP ABD AORTA LT RENAL ARTERY AUTO VEN TISS OPN,,,8271.00
Deidentified Maximum,,0410098,ICD10-PCS,BP ABD AO B CMN ILIAC ART AUTO VEN TISS OPN APPR,,,8271.00
Deidentified Maximum,,04100A1,ICD10-PCS,BP ABD AO CELIAC ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100A3,ICD10-PCS,BP ABD AO RT RENL ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100J7,ICD10-PCS,BP ABD AO LT COMMON ILIAC ART SYN SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100J9,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART SYN SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100JB,ICD10-PCS,BP ABD AO LT INTRL ILIAC ART SYN SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100K5,ICD10-PCS,BP ABD AO B RENL ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100K6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100Z2,ICD10-PCS,BYPASS ABD AORTA MESENTERIC ARTERY OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100Z4,ICD10-PCS,BYPASS ABD AORTA LT RENAL ARTERY OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100ZH,ICD10-PCS,BYPASS ABD AORTA RT FEMORAL ARTERY OPEN APPROACH,,,8271.00
Deidentified Maximum,,0410490,ICD10-PCS,Bypass Abd Aorta to Abd Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,04104AC,ICD10-PCS,Bypass Abd Aorta to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104AD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104AH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104AQ,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104J6,ICD10-PCS,Bypass Abd Aorta to R Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104JD,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104JH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104KH,ICD10-PCS,Bypass Abd Aorta to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104Z9,ICD10-PCS,Bypass Abdominal Aorta to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0414094,ICD10-PCS,Bypass Splenic Art to L Renal A with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,04140Z4,ICD10-PCS,Bypass Splenic Artery to Left Renal Artery, Open Approach,,,8271.00
Deidentified Maximum,,04144A3,ICD10-PCS,Bypass Splenic Art to R Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C099,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C0AG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0J2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0KD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0KG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0KR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0Z0,ICD10-PCS,Bypass Right Common Iliac Artery to Abd Aorta, Open Approach,,,8271.00
Deidentified Maximum,,041C0Z3,ICD10-PCS,Bypass Right Common Iliac Artery to R Renal A, Open Approach,,,8271.00
Deidentified Maximum,,041C0ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041C0ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041C493,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C496,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C4J7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4JD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4JF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4K2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4K7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4KC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4Z7,ICD10-PCS,Bypass R Com Iliac Art to L Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4ZD,ICD10-PCS,Bypass R Com Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4ZG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4ZJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4ZK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D098,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D09B,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D09Q,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D0A3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0AB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0K4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0K8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0Z1,ICD10-PCS,Bypass Left Common Iliac Artery to Celiac Art, Open Approach,,,8271.00
Deidentified Maximum,,041D0ZD,ICD10-PCS,Bypass Left Common Iliac Artery to R Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041D0ZH,ICD10-PCS,Bypass Left Common Iliac Artery to R Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041D496,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D4A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4A7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4AC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4AG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4AJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4AK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4J0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4J7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4JB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4JG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4KK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4Z0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4Z3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E09F,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E09G,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E09K,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E0A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0AH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0KJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E0KP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E0KQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E0Z9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041E0ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041E0ZD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041E0ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041E49H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E49P,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E4A9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041E4JB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4ZB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041F0AB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0AQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0JH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0JQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0KF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0KJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0ZJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041F0ZP,ICD10-PCS,Bypass Left Internal Iliac Artery to Foot Art, Open Approach,,,8271.00
Deidentified Maximum,,041F4A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4JK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4ZB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H0AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0JJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0K9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H0KB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H0KF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H0KG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H0ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041H0ZP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art, Open Approach,,,8271.00
Deidentified Maximum,,041H49D,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H49J,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H49Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H4JD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4JP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4KD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4ZH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H4ZQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J0JJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0ZP,ICD10-PCS,Bypass Left External Iliac Artery to Foot Art, Open Approach,,,8271.00
Deidentified Maximum,,041J49G,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J4AC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4AG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4AH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4J9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4KB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04510ZZ,ICD10-PCS,Destruction of Celiac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04560ZZ,ICD10-PCS,Destruction of Right Colic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04583ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04593ZZ,ICD10-PCS,Destruction of Right Renal Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04594ZZ,ICD10-PCS,Destruction of Right Renal Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,045B0ZZ,ICD10-PCS,Destruction of Inferior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Maximum,,045E3ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04B10ZZ,ICD10-PCS,Excision of Celiac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04B34ZZ,ICD10-PCS,Excision of Hepatic Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,04B43ZZ,ICD10-PCS,Excision of Splenic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04B60ZZ,ICD10-PCS,Excision of Right Colic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04B74ZZ,ICD10-PCS,Excision of Left Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04B84ZZ,ICD10-PCS,Excision of Middle Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04BF0ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04BF3ZZ,ICD10-PCS,Excision of Left Internal Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04C00ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Open Approach,,,8271.00
Deidentified Maximum,,04C03ZZ,ICD10-PCS,Extirpation of Matter from Abdominal Aorta, Perc Approach,,,8271.00
Deidentified Maximum,,04C04ZZ,ICD10-PCS,Extirpation of Matter from Abd Aorta, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R00KZ,ICD10-PCS,Replacement of Abd Aorta with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R20KZ,ICD10-PCS,Replacement of Gastric Artery with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R24KZ,ICD10-PCS,Replace of Gastric Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R407Z,ICD10-PCS,Replacement of Splenic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R40KZ,ICD10-PCS,Replacement of Splenic Artery with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R647Z,ICD10-PCS,Replace of R Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R807Z,ICD10-PCS,Replacement of Mid Colic Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R90JZ,ICD10-PCS,Replacement of R Renal Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R947Z,ICD10-PCS,Replace of R Renal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04RA4JZ,ICD10-PCS,Replace of L Renal Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04RB0JZ,ICD10-PCS,Replacement of Inf Mesent Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RB0KZ,ICD10-PCS,Replacement of Inf Mesent Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RD0JZ,ICD10-PCS,Replacement of L Com Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RE4JZ,ICD10-PCS,Replace R Int Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RF0JZ,ICD10-PCS,Replacement of L Int Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RF47Z,ICD10-PCS,Replace L Int Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RH4JZ,ICD10-PCS,Replace R Ext Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RJ0JZ,ICD10-PCS,Replacement of L Ext Iliac Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RJ47Z,ICD10-PCS,Replace L Ext Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04S23ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04S24ZZ,ICD10-PCS,Reposition Gastric Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,04S30ZZ,ICD10-PCS,Reposition Hepatic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04S34ZZ,ICD10-PCS,Reposition Hepatic Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,04S43ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04S63ZZ,ICD10-PCS,Reposition Right Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04S70ZZ,ICD10-PCS,Reposition Left Colic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SB4ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SC3ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SN0ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SQ4ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04ST3ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SW4ZZ,ICD10-PCS,Reposition Left Foot Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U407Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04U437Z,ICD10-PCS,Supplement Splenic Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04U707Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UA47Z,ICD10-PCS,Supplement L Renal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UB07Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UB37Z,ICD10-PCS,Supplement Inf Mesent Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UK37Z,ICD10-PCS,Supplement R Femor Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UM37Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UM47Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UQ37Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UQ47Z,ICD10-PCS,Supplement L Ant Tib Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UR07Z,ICD10-PCS,Supplement R Post Tib Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UV47Z,ICD10-PCS,Supplement R Foot Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UY47Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,051009Y,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,051047Y,ICD10-PCS,Bypass Azygos Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05104KY,ICD10-PCS,Bypass Azygos Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,051107Y,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Sub, Open,,,8271.00
Deidentified Maximum,,05110AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Open,,,8271.00
Deidentified Maximum,,05114KY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05114ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05130JY,ICD10-PCS,Bypass R Innom Vein to Up Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,05144KY,ICD10-PCS,Bypass L Innom Vein to Up Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05150JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Open,,,8271.00
Deidentified Maximum,,05160KY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,051647Y,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05503ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05540ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Open Approach,,,8271.00
Deidentified Maximum,,05543ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05554ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05B00ZZ,ICD10-PCS,Excision of Azygos Vein, Open Approach,,,8271.00
Deidentified Maximum,,05B04ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,05B10ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Open Approach,,,8271.00
Deidentified Maximum,,05B34ZZ,ICD10-PCS,Excision of Right Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05B43ZZ,ICD10-PCS,Excision of Left Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05B54ZZ,ICD10-PCS,Excision of Right Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05B60ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Open Approach,,,8271.00
Deidentified Maximum,,05B64ZZ,ICD10-PCS,Excision of Left Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R00KZ,ICD10-PCS,Replacement of Azygos Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R507Z,ICD10-PCS,Replacement of R Subclav Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R647Z,ICD10-PCS,Replace of L Subclav Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05S04ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,05S33ZZ,ICD10-PCS,Reposition Right Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05S63ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05S73ZZ,ICD10-PCS,REPOSITION RIGHT AXILLARY VEIN PERQ,,,8271.00
Deidentified Maximum,,05S84ZZ,ICD10-PCS,Reposition Left Axillary Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SA4ZZ,ICD10-PCS,Reposition Left Brachial Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SB0ZZ,ICD10-PCS,Reposition Right Basilic Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SB3ZZ,ICD10-PCS,Reposition Right Basilic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SD0ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SD3ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SD4ZZ,ICD10-PCS,Reposition Right Cephalic Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SG0ZZ,ICD10-PCS,Reposition Right Hand Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SN0ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SP4ZZ,ICD10-PCS,Reposition Right External Jugular Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SR0ZZ,ICD10-PCS,Reposition Right Vertebral Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SS3ZZ,ICD10-PCS,Reposition Left Vertebral Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SV4ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,05U307Z,ICD10-PCS,Supplement R Innom Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05U407Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05U507Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05U807Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05U937Z,ICD10-PCS,Supplement Right Brachial Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UC07Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UL07Z,ICD10-PCS,Supplement Intracranial Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UQ47Z,ICD10-PCS,Supplement L Ext Jugular Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05US07Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05US37Z,ICD10-PCS,Supplement Left Vertebral Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06520ZZ,ICD10-PCS,Destruction of Gastric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Approach,,,8271.00
Deidentified Maximum,,06584ZZ,ICD10-PCS,Destruction of Portal Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,065B0ZZ,ICD10-PCS,Destruction of Left Renal Vein, Open Approach,,,8271.00
Deidentified Maximum,,065B4ZZ,ICD10-PCS,Destruction of Left Renal Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,065D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,065F0ZZ,ICD10-PCS,Destruction of Right External Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,065H0ZZ,ICD10-PCS,Destruction of Right Hypogastric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B50ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B54ZZ,ICD10-PCS,Excision of Superior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06B90ZZ,ICD10-PCS,Excision of Right Renal Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B94ZZ,ICD10-PCS,Excision of Right Renal Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06BB4ZZ,ICD10-PCS,Excision of Left Renal Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,06BD4ZZ,ICD10-PCS,Excision of Left Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R00JZ,ICD10-PCS,Replacement of Inf Vena Cava with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R14JZ,ICD10-PCS,Replace of Splenic Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R407Z,ICD10-PCS,Replacement of Hepatic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R447Z,ICD10-PCS,Replace of Hepatic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R54KZ,ICD10-PCS,Replace Sup Mesent Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06R60KZ,ICD10-PCS,Replace of Inf Mesent Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R64JZ,ICD10-PCS,Replace Inf Mesent Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06R64KZ,ICD10-PCS,Replace Inf Mesent Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06R947Z,ICD10-PCS,Replace of R Renal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06RB0JZ,ICD10-PCS,Replacement of Left Renal Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RB0KZ,ICD10-PCS,Replacement of L Renal Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RD07Z,ICD10-PCS,Replace of L Com Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RD47Z,ICD10-PCS,Replace L Com Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RF0JZ,ICD10-PCS,Replace of R Ext Iliac Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RG07Z,ICD10-PCS,Replace of L Ext Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06S73ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SF0ZZ,ICD10-PCS,Reposition Right External Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SH4ZZ,ICD10-PCS,Reposition Right Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SJ3ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SJ4ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SN0ZZ,ICD10-PCS,Reposition Left Femoral Vein, Open Approach,,,8271.00
Deidentified Maximum,,06UB47Z,ICD10-PCS,Supplement L Renal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06UC07Z,ICD10-PCS,Supplement R Com Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UD37Z,ICD10-PCS,Supplement L Com Iliac Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UF47Z,ICD10-PCS,Supplement R Ext Iliac Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06UG37Z,ICD10-PCS,Supplement L Ext Iliac Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UH07Z,ICD10-PCS,Supplement R Hypogast Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UM47Z,ICD10-PCS,Supplement R Femor Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06UP47Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06UT07Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0PS334Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Perc Approach,,,8271.00
Deidentified Maximum,,0PS344Z,ICD10-PCS,Reposition Cervcal Vertebra with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0PS434Z,ICD10-PCS,Reposition Thoracic Vertebra with Int Fix, Perc Approach,,,8271.00
Deidentified Maximum,,0QS104Z,ICD10-PCS,Reposition Sacrum with Int Fix, Open Approach,,,8271.00
Deidentified Maximum,,0QS14ZZ,ICD10-PCS,Reposition Sacrum, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,0QSSXZZ,ICD10-PCS,Reposition Coccyx, External Approach,,,8271.00
Deidentified Maximum,,0RB03ZZ,ICD10-PCS,Excision of Occipital-cervical Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0RB64ZZ,ICD10-PCS,Excision of Thoracic Vertebral Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RB94ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RBA3ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Joint, Perc Approach,,,8271.00
Deidentified Maximum,,0RG00AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG00K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG0370,ICD10-PCS,Fusion Occip Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG0371,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG047J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG04K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG1071,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG10A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG10J0,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG10JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG10ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG13A0,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG13AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG13Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG14AJ,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG14J1,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG20AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG20K1,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG23Z1,ICD10-PCS,Fusion of 2-6 C Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG2470,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG24A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG40JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG40Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG4370,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG44K1,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG60AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG60JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG63J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG63Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG647J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG64JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG64Z0,ICD10-PCS,Fusion of Thor Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG7071,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG70J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG70K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG70Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG73A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG73K0,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG73Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG74JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG74Z0,ICD10-PCS,Fusion of 2-7 T Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG80J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG80K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG83K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG84J0,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG84ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RGA37J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RGA3K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RGA3Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RGA4J1,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA4KJ,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Perc Endo,,,8271.00
Deidentified Maximum,,0RH04CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Occip Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RH04DZ,ICD10-PCS,Insert of Facet Stabl Dev into Occip Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RH10DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Cerv Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RH14CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Cerv Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RH43DZ,ICD10-PCS,Insertion of Facet Stabl Dev into C-thor Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RH60BZ,ICD10-PCS,Insert of Intspin Prcs Stabl Dev into Thor Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RH64BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Thor Jt, Perc Endo,,,8271.00
Deidentified Maximum,,0RHA0DZ,ICD10-PCS,Insertion of Facet Stabl Dev into T-lum Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RHA3CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into T-lum Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RR30JZ,ICD10-PCS,Replacement of Cerv Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RU00JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RU13JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0RU43JZ,ICD10-PCS,Supplement C-thor Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0RUA3JZ,ICD10-PCS,Supplement T-lum Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0RWB3JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Perc Approach,,,8271.00
Deidentified Maximum,,0S543ZZ,ICD10-PCS,Destruction of Lumbosacral Disc, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SB40ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL DISC OPEN,,,8271.00
Deidentified Maximum,,0SB84ZZ,ICD10-PCS,Excision of Left Sacroiliac Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG0071,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG00KJ,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG03A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG03J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG047J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG04A0,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG04Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG04Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG10ZJ,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0SG147J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG14A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG14JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG3071,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG30Z1,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0SG33J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG33K0,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG3470,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG34K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG34ZJ,ICD10-PCS,Fusion of Lumsac Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG507Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG60ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Open Approach,,,8271.00
Deidentified Maximum,,0SG637Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SG64JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG73JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SG804Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Open Approach,,,8271.00
Deidentified Maximum,,0SG80KZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG84ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SH04CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SH30CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Open Approach,,,8271.00
Deidentified Maximum,,0SH34CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into Lumsac Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SR902A,ICD10-PCS,Replace R Hip Jt w Metal on Poly, Uncement, Open,,,8271.00
Deidentified Maximum,,0SR903A,ICD10-PCS,Replace of R Hip Jt with Ceramic, Uncement, Open Approach,,,8271.00
Deidentified Maximum,,0SR904A,ICD10-PCS,Replace R Hip Jt w Ceramic on Poly, Uncement, Open,,,8271.00
Deidentified Maximum,,0SR907Z,ICD10-PCS,Replacement of Right Hip Joint with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SR90JZ,ICD10-PCS,Replacement of Right Hip Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRC0JZ,ICD10-PCS,Replacement of R Knee Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRE039,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Cement, Open,,,8271.00
Deidentified Maximum,,0SRE03A,ICD10-PCS,Replace L Hip Jt, Acetab w Ceramic, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRE0J9,ICD10-PCS,Replace L Hip Jt, Acetab w Synth Sub, Cement, Open,,,8271.00
Deidentified Maximum,,0SRR01Z,ICD10-PCS,Replacement of R Hip Jt, Femoral with Metal, Open Approach,,,8271.00
Deidentified Maximum,,0SRS0J9,ICD10-PCS,Replace L Hip Jt, Femoral w Synth Sub, Cement, Open,,,8271.00
Deidentified Maximum,,0SRT0JA,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRU0J9,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Cement, Open,,,8271.00
Deidentified Maximum,,0SRU0JA,ICD10-PCS,Replace L Knee Jt, Femoral w Synth Sub, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRU0KZ,ICD10-PCS,Replace of L Knee Jt, Femoral with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRV0JA,ICD10-PCS,Replace R Knee Jt, Tibial w Synth Sub, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRW0JA,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Uncement, Open,,,8271.00
Deidentified Maximum,,0SU04JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SU30JZ,ICD10-PCS,Supplement Lumbosacral Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SU53JZ,ICD10-PCS,Supplement Sacrococcygeal Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SU60JZ,ICD10-PCS,Supplement Coccygeal Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SW40JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Open Approach,,,8271.00
Deidentified Maximum,,0SWB3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Hip Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0SWB4JZ,ICD10-PCS,Revision of Synth Sub in L Hip Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SWC3JZ,ICD10-PCS,Revision of Synthetic Substitute in R Knee Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0SWD3JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0TQB8ZZ,ICD10-PCS,Repair Bladder, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Maximum,,0W8NXZZ,ICD10-PCS,Division of Female Perineum, External Approach,,,4303.00
Deidentified Maximum,,10903ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Perc Approach,,,4303.00
Deidentified Maximum,,10907ZA,ICD10-PCS,Drainage of Fetal Cerebrospinal Fluid from POC, Via Opening,,,4303.00
Deidentified Maximum,,10D07Z3,ICD10-PCS,Extraction of POC, Low Forceps, Via Opening,,,4303.00
Deidentified Maximum,,4A020N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Open Approach,,,8271.00
Deidentified Maximum,,4A023FZ,ICD10-PCS,Measurement of Cardiac Rhythm, Percutaneous Approach,,,8271.00
Deidentified Maximum,,4A023N6,ICD10-PCS,Measure of Cardiac Sampl & Pressure, R Heart, Perc Approach,,,8271.00
Deidentified Maximum,,4A023N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Perc Approach,,,8271.00
Deidentified Maximum,,B2040ZZ,ICD10-PCS,Plain Radiography of Right Heart using High Osmolar Contrast,,,8271.00
Deidentified Maximum,,B2050ZZ,ICD10-PCS,Plain Radiography of Left Heart using High Osmolar Contrast,,,8271.00
Deidentified Maximum,,B20F1ZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using L Osm Contrast,,,8271.00
Deidentified Maximum,,B2100ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2141ZZ,ICD10-PCS,Fluoroscopy of Right Heart using Low Osmolar Contrast,,,8271.00
Deidentified Maximum,,B2160ZZ,ICD10-PCS,Fluoroscopy of Right and Left Heart using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2170ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using H Osm Contrast,,,8271.00
Deidentified Maximum,,X2A5312,ICD10-PCS,Cereb Filtr, Brach L Carotid Art, Perc, New Tech 2,,,8271.00
Deidentified Maximum,,001U077,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Open,,,8271.00
Deidentified Maximum,,001U0K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,001U0K9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,001U3J7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Synth Sub, Perc,,,8271.00
Deidentified Maximum,,005T3ZZ,ICD10-PCS,Destruction of Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Maximum,,005T4ZZ,ICD10-PCS,Destruction of Spinal Meninges, Perc Endo Approach,,,8271.00
Deidentified Maximum,,008W3ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,008Y0ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,009T00Z,ICD10-PCS,Drainage of Spinal Meninges with Drain Dev, Open Approach,,,8271.00
Deidentified Maximum,,009T0ZX,ICD10-PCS,Drainage of Spinal Meninges, Open Approach, Diagnostic,,,8271.00
Deidentified Maximum,,009T0ZZ,ICD10-PCS,DRAINAGE OF SPINAL MENINGES OPEN APPROACH,,,8271.00
Deidentified Maximum,,009U0ZX,ICD10-PCS,Drainage of Spinal Canal, Open Approach, Diagnostic,,,8271.00
Deidentified Maximum,,009W00Z,ICD10-PCS,Drainage of Cerv Spinal Cord with Drain Dev, Open Approach,,,8271.00
Deidentified Maximum,,009W0ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Maximum,,009X0ZZ,ICD10-PCS,DRAINAGE OF THORACIC SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Maximum,,009X4ZZ,ICD10-PCS,Drainage of Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,009Y4ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Maximum,,009Y4ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00BT3ZZ,ICD10-PCS,Excision of Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00BX4ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Maximum,,00BY3ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00CW4ZZ,ICD10-PCS,Extirpate matter from Cerv Spinal Cord, Perc Endo,,,8271.00
Deidentified Maximum,,00DT0ZZ,ICD10-PCS,EXTRACTION OF SPINAL MENINGES OPEN APPROACH,,,8271.00
Deidentified Maximum,,00DT4ZZ,ICD10-PCS,Extraction of Spinal Meninges, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00HV42Z,ICD10-PCS,Insert of Monitor Dev into Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00JU3ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00JU4ZZ,ICD10-PCS,Inspection of Spinal Canal, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,00NT0ZZ,ICD10-PCS,Release Spinal Meninges, Open Approach,,,8271.00
Deidentified Maximum,,00NT3ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00NT4ZZ,ICD10-PCS,Release Spinal Meninges, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,00NW3ZZ,ICD10-PCS,Release Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00NW4ZZ,ICD10-PCS,Release Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00PU30Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00PU42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00PU43Z,ICD10-PCS,Remove of Infusion Dev from Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00PU4MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00PV0KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00PV3JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00PV43Z,ICD10-PCS,Removal of Infusion Dev from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00QY3ZZ,ICD10-PCS,Repair Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00SW3ZZ,ICD10-PCS,Reposition Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00UT07Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,00UT0KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,00UT3KZ,ICD10-PCS,Supplement Spinal Meninges with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,00WU03Z,ICD10-PCS,Revision of Infusion Device in Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00WU3JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00WV37Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,00WV4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00WV4MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,01510ZZ,ICD10-PCS,Destruction of Cervical Nerve, Open Approach,,,8271.00
Deidentified Maximum,,01580ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Open Approach,,,8271.00
Deidentified Maximum,,01584ZZ,ICD10-PCS,Destruction of Thoracic Nerve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,01880ZZ,ICD10-PCS,DIVISION OF THORACIC NERVE OPEN APPROACH,,,8271.00
Deidentified Maximum,,018B0ZZ,ICD10-PCS,DIVISION OF LUMBAR NERVE OPEN APPR,,,8271.00
Deidentified Maximum,,021008W,ICD10-PCS,Bypass 1 Cor Art from Aorta with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,0210093,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,0210099,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Maximum,,02100ZC,ICD10-PCS,Bypass 1 Cor Art from Thor Art, Open Approach,,,8271.00
Deidentified Maximum,,0210489,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02104A3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02104AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02104K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,0211098,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Maximum,,02110K3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02110K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02114JW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114K9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114KC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114Z8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021208W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,0212098,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021209W,ICD10-PCS,Bypass 3 Cor Art from Aorta with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02120AC,ICD10-PCS,Bypass 3 Cor Art from Thor Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02120AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02120J9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02120JW,ICD10-PCS,Bypass 3 Cor Art from Aorta with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,021248W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021249F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02124A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02124A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02124AF,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02124K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02130AC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,02130AF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02130JW,ICD10-PCS,Bypass 4+ Cor Art from Aorta with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02130KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02130Z9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,021348W,ICD10-PCS,Bypass 4+ Cor Art from Aorta w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0213498,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021349F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02134A3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02134J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02134Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021649P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021649R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02164AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02164ZQ,ICD10-PCS,Bypass Right Atrium to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021708R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,021709R,ICD10-PCS,Bypass L Atrium to L Pulm Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02170JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02170KR,ICD10-PCS,Bypass L Atrium to L Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,021748P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021748Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02174JP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02174KP,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021K08P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021K0JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021K0JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021K0ZP,ICD10-PCS,Bypass Right Ventricle to Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Maximum,,021K48R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021K49P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021K4AP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021K4AQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021K4JP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021K4JQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021K4KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021K4Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021K4ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021K4ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021L0JP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021L0Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,021L0ZF,ICD10-PCS,Bypass Left Ventricle to Abdominal Artery, Open Approach,,,8271.00
Deidentified Maximum,,021L0ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Open Approach,,,8271.00
Deidentified Maximum,,021L4JQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021L4KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021L4ZR,ICD10-PCS,Bypass Left Ventricle to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021L4ZW,ICD10-PCS,Bypass Left Ventricle to Aorta, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021V09R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021V0AR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,021V0KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021V0ZQ,ICD10-PCS,Bypass Superior Vena Cava to R Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,021V48Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021V49Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021V4KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W09Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021W0JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021W0ZB,ICD10-PCS,Bypass Thoracic Aorta, Descending to Subclav, Open Approach,,,8271.00
Deidentified Maximum,,021W48P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021W48Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021W49P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021W49R,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021W4KR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W4ZB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021X08R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021X09R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021X0AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Open,,,8271.00
Deidentified Maximum,,021X0JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021X48R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021X49B,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021X49R,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021X4JR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021X4KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021X4ZP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021X4ZQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,024J0J2,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02540ZZ,ICD10-PCS,Destruction of Coronary Vein, Open Approach,,,8271.00
Deidentified Maximum,,02543ZZ,ICD10-PCS,Destruction of Coronary Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025H0ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Open Approach,,,8271.00
Deidentified Maximum,,025M3ZZ,ICD10-PCS,Destruction of Ventricular Septum, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025P0ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Maximum,,025P3ZZ,ICD10-PCS,Destruction of Pulmonary Trunk, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025Q4ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,025S0ZZ,ICD10-PCS,Destruction of Right Pulmonary Vein, Open Approach,,,8271.00
Deidentified Maximum,,025W4ZZ,ICD10-PCS,Destruction of Thor Aorta Desc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,025X4ZZ,ICD10-PCS,Destruction of Thor Aorta Asc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0270076,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02700E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02700GZ,ICD10-PCS,Dilation of 1 Cor Art with 4+ Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02700Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Maximum,,0270346,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Drug-elut Intra, Perc,,,8271.00
Deidentified Maximum,,0270356,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02703E6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02703F6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02703FZ,ICD10-PCS,Dilation of 1 Cor Art with 3 Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02703T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Perc,,,8271.00
Deidentified Maximum,,02703Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Maximum,,0270456,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,027045Z,ICD10-PCS,Dilation of 1 Cor Art with 2 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0270466,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,027046Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0271046,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Open,,,8271.00
Deidentified Maximum,,02710T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Open,,,8271.00
Deidentified Maximum,,02713G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02713T6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Radioact Intralum, Perc,,,8271.00
Deidentified Maximum,,0271466,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,02714GZ,ICD10-PCS,Dilate of 2 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0272046,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Drug-elut Intra, Open,,,8271.00
Deidentified Maximum,,027207Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02720D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02720F6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02720G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02720T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Open,,,8271.00
Deidentified Maximum,,02720ZZ,ICD10-PCS,Dilation of Coronary Artery, Three Arteries, Open Approach,,,8271.00
Deidentified Maximum,,027237Z,ICD10-PCS,Dilation of 3 Cor Art with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02723GZ,ICD10-PCS,Dilation of 3 Cor Art with 4+ Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,027246Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02724GZ,ICD10-PCS,Dilate of 3 Cor Art with 4+ Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02730DZ,ICD10-PCS,Dilation of 4+ Cor Art with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02730GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02730ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Open Approach,,,8271.00
Deidentified Maximum,,027334Z,ICD10-PCS,Dilation of 4+ Cor Art with Drug-elut Intra, Perc Approach,,,8271.00
Deidentified Maximum,,0273376,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc,,,8271.00
Deidentified Maximum,,02733D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02733EZ,ICD10-PCS,Dilation of 4+ Cor Art with 2 Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02733F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02733FZ,ICD10-PCS,Dilation of 4+ Cor Art with 3 Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02733ZZ,ICD10-PCS,Dilation of 4+ Cor Art, Perc Approach,,,8271.00
Deidentified Maximum,,0273446,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,,8271.00
Deidentified Maximum,,02734FZ,ICD10-PCS,Dilate of 4+ Cor Art with 3 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02734G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02734Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027F4ZZ,ICD10-PCS,Dilation of Aortic Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,027H0ZZ,ICD10-PCS,Dilation of Pulmonary Valve, Open Approach,,,8271.00
Deidentified Maximum,,027H34Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Perc Approach,,,8271.00
Deidentified Maximum,,027J04Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Open,,,8271.00
Deidentified Maximum,,027J3DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,027J3ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,027J44Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,027J4DZ,ICD10-PCS,Dilate Tricusp Valve w Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,027K4ZZ,ICD10-PCS,Dilation of Right Ventricle, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027R04T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Open,,,8271.00
Deidentified Maximum,,027R0ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Open Approach,,,8271.00
Deidentified Maximum,,027R34T,ICD10-PCS,Dilate Ductus Arterio w Drug-elut Intralum, Perc,,,8271.00
Deidentified Maximum,,027R3ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Percutaneous Approach,,,8271.00
Deidentified Maximum,,027R4ZT,ICD10-PCS,Dilation of Ductus Arteriosus, Perc Endo Approach,,,8271.00
Deidentified Maximum,,028D0ZZ,ICD10-PCS,Division of Papillary Muscle, Open Approach,,,8271.00
Deidentified Maximum,,028D3ZZ,ICD10-PCS,Division of Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02B50ZZ,ICD10-PCS,Excision of Atrial Septum, Open Approach,,,8271.00
Deidentified Maximum,,02B53ZZ,ICD10-PCS,Excision of Atrial Septum, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02B90ZZ,ICD10-PCS,Excision of Chordae Tendineae, Open Approach,,,8271.00
Deidentified Maximum,,02B93ZZ,ICD10-PCS,Excision of Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BD3ZZ,ICD10-PCS,Excision of Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BD4ZZ,ICD10-PCS,Excision of Papillary Muscle, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02BF0ZZ,ICD10-PCS,Excision of Aortic Valve, Open Approach,,,8271.00
Deidentified Maximum,,02BH3ZZ,ICD10-PCS,Excision of Pulmonary Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BT4ZZ,ICD10-PCS,Excision of Left Pulmonary Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02BW3ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Perc Approach,,,8271.00
Deidentified Maximum,,02BX0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Ascending/Arch, Open Approach,,,8271.00
Deidentified Maximum,,02BX4ZZ,ICD10-PCS,Excision of Thor Aorta Asc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02C03ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Approach,,,8271.00
Deidentified Maximum,,02C04ZZ,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02C10Z6,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Maximum,,02C14Z6,ICD10-PCS,Extirpate matter from 2 Cor Art, Bifurc, Perc Endo,,,8271.00
Deidentified Maximum,,02C43ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Approach,,,8271.00
Deidentified Maximum,,02CW0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Desc, Open Approach,,,8271.00
Deidentified Maximum,,02FN4ZZ,ICD10-PCS,Fragmentation in Pericardium, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HA4RZ,ICD10-PCS,Insertion of Ext Heart Assist into Heart, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HK3KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Approach,,,8271.00
Deidentified Maximum,,02HL0KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,02HL3KZ,ICD10-PCS,Insertion of Defib Lead into L Ventricle, Perc Approach,,,8271.00
Deidentified Maximum,,02HL3NZ,ICD10-PCS,Insertion of Intracard Pacer into L Ventricle, Perc Approach,,,8271.00
Deidentified Maximum,,02HP4DZ,ICD10-PCS,Insert of Intralum Dev into Pulm Trunk, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HS0DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Open Approach,,,8271.00
Deidentified Maximum,,02HW3DZ,ICD10-PCS,Insert of Intralum Dev into Thor Aorta Desc, Perc Approach,,,8271.00
Deidentified Maximum,,02HX02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Asc, Open Approach,,,8271.00
Deidentified Maximum,,02LH4DZ,ICD10-PCS,Occlusion Pulm Valve w Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02N94ZZ,ICD10-PCS,Release Chordae Tendineae, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02ND4ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02NF0ZZ,ICD10-PCS,Release Aortic Valve, Open Approach,,,8271.00
Deidentified Maximum,,02PY02Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02PY03Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02PY0CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02PY0KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02PY42Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02PY48Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02Q00ZZ,ICD10-PCS,Repair Coronary Artery, One Artery, Open Approach,,,8271.00
Deidentified Maximum,,02Q23ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Approach,,,8271.00
Deidentified Maximum,,02Q30ZZ,ICD10-PCS,Repair Coronary Artery, Four or More Arteries, Open Approach,,,8271.00
Deidentified Maximum,,02Q63ZZ,ICD10-PCS,Repair Right Atrium, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02Q73ZZ,ICD10-PCS,Repair Left Atrium, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02Q84ZZ,ICD10-PCS,Repair Conduction Mechanism, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02QB3ZZ,ICD10-PCS,Repair Right Heart, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02QD4ZZ,ICD10-PCS,Repair Papillary Muscle, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QH4ZZ,ICD10-PCS,Repair Pulmonary Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QJ3ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02QJ4ZG,ICD10-PCS,Repair Tricusp Valve fr R AV Vlv, Perc Endo,,,8271.00
Deidentified Maximum,,02QJ4ZZ,ICD10-PCS,Repair Tricuspid Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QL3ZZ,ICD10-PCS,Repair Left Ventricle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02QM3ZZ,ICD10-PCS,Repair Ventricular Septum, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02R508Z,ICD10-PCS,Replacement of Atrial Septum with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02R547Z,ICD10-PCS,Replace of Atrial Sept with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R548Z,ICD10-PCS,Replace of Atrial Sept with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R748Z,ICD10-PCS,Replacement of L Atrium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R74JZ,ICD10-PCS,Replacement of L Atrium with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R74KZ,ICD10-PCS,Replacement of L Atrium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RF08Z,ICD10-PCS,Replacement of Aortic Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RF47Z,ICD10-PCS,Replace of Aortic Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RF48Z,ICD10-PCS,Replace of Aortic Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RF4JZ,ICD10-PCS,Replace of Aortic Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RG38Z,ICD10-PCS,Replacement of Mitral Valve with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02RG4KZ,ICD10-PCS,Replace of Mitral Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RH07Z,ICD10-PCS,Replacement of Pulmonary Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RH0KZ,ICD10-PCS,Replacement of Pulm Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RJ07Z,ICD10-PCS,Replacement of Tricuspid Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RJ0JZ,ICD10-PCS,Replacement of Tricuspid Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RK07Z,ICD10-PCS,Replacement of Right Ventricle with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RL07Z,ICD10-PCS,Replacement of Left Ventricle with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RL48Z,ICD10-PCS,Replace of L Ventricle with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RP0JZ,ICD10-PCS,Replacement of Pulmonary Trunk with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RP4JZ,ICD10-PCS,Replacement of Pulm Trunk with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RR4JZ,ICD10-PCS,Replacement of L Pulm Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RS08Z,ICD10-PCS,Replacement of R Pulm Vein with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RT47Z,ICD10-PCS,Replace of L Pulm Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RT4JZ,ICD10-PCS,Replace of L Pulm Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RV07Z,ICD10-PCS,Replacement of Sup Vena Cava with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RV0KZ,ICD10-PCS,Replacement of Sup Vena Cava with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RW47Z,ICD10-PCS,Replace Thor Aorta Desc w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02RW4KZ,ICD10-PCS,Replace Thor Aorta Desc w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02RX4KZ,ICD10-PCS,Replace Thor Aorta Asc w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02SX0ZZ,ICD10-PCS,Reposition Thoracic Aorta, Ascending/Arch, Open Approach,,,8271.00
Deidentified Maximum,,02T94ZZ,ICD10-PCS,Resection of Chordae Tendineae, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U507Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U538Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02U63JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02U70KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U747Z,ICD10-PCS,Supplement Left Atrium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U908Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02U90JZ,ICD10-PCS,Supplement Chordae Tendineae with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U937Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UA0KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UF4KZ,ICD10-PCS,Supplement Aortic Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UG07E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Open,,,8271.00
Deidentified Maximum,,02UG07Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UG0JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UG37Z,ICD10-PCS,Supplement Mitral Valve with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UG48E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02UG4KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UG4KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UH47Z,ICD10-PCS,Supplement Pulm Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UJ07G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Open,,,8271.00
Deidentified Maximum,,02UJ07Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UJ47Z,ICD10-PCS,Supplement Tricusp Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UJ4KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UK07Z,ICD10-PCS,Supplement Right Ventricle with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UK08Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UK0JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UK0KZ,ICD10-PCS,Supplement Right Ventricle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UK38Z,ICD10-PCS,Supplement Right Ventricle with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UK3JZ,ICD10-PCS,Supplement Right Ventricle with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UL08Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UL0JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UM48Z,ICD10-PCS,Supplement Ventricular Sept w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02UN37Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UN47Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UN4JZ,ICD10-PCS,Supplement Pericardium with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UP48Z,ICD10-PCS,Supplement Pulm Trunk with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UQ08Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UQ38Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UQ48Z,ICD10-PCS,Supplement R Pulm Art with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UR07Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UR08Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UR47Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02US07Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02US3KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UT08Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UV37Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UW3KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UX07Z,ICD10-PCS,Supplement Thor Aorta Asc with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UX08Z,ICD10-PCS,Supplement Thor Aorta Asc with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UX3JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UX4JZ,ICD10-PCS,Supplement Thor Aorta Asc with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02VW3FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc,,,8271.00
Deidentified Maximum,,02VW4DZ,ICD10-PCS,Restrict Thor Aorta Desc w Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02VX0EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Open,,,8271.00
Deidentified Maximum,,02VX3FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Perc,,,8271.00
Deidentified Maximum,,02WF4JZ,ICD10-PCS,Revision of Synth Sub in Aortic Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WG07Z,ICD10-PCS,Revision of Autol Sub in Mitral Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WG0KZ,ICD10-PCS,Revision of Nonaut Sub in Mitral Valve, Open Approach,,,8271.00
Deidentified Maximum,,001U076,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Autol Sub, Open,,,8271.00
Deidentified Maximum,,001U0K4,ICD10-PCS,Bypass Spinal Canal to Pleural Cav w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,001U377,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Autol Sub, Perc,,,8271.00
Deidentified Maximum,,001U3K7,ICD10-PCS,Bypass Spinal Canal to Urinary Tract w Nonaut Sub, Perc,,,8271.00
Deidentified Maximum,,005T0ZZ,ICD10-PCS,Destruction of Spinal Meninges, Open Approach,,,8271.00
Deidentified Maximum,,005W4ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,005X4ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,008W0ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,008W4ZZ,ICD10-PCS,Division of Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,008X3ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,008X4ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,009T40Z,ICD10-PCS,Drain of Spinal Meninges with Drain Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,009W0ZZ,ICD10-PCS,DRAINAGE OF CERVICAL SPINAL CORD OPEN APPROACH,,,8271.00
Deidentified Maximum,,009Y0ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Maximum,,009Y3ZX,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,,8271.00
Deidentified Maximum,,009Y3ZZ,ICD10-PCS,Drainage of Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00BW0ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Maximum,,00BW4ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Maximum,,00BX0ZX,ICD10-PCS,Excision of Thoracic Spinal Cord, Open Approach, Diagnostic,,,8271.00
Deidentified Maximum,,00BY3ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Percutaneous Approach, Diagn,,,8271.00
Deidentified Maximum,,00BY4ZX,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach, Diagn,,,8271.00
Deidentified Maximum,,00CW0ZZ,ICD10-PCS,Extirpation of Matter from Cerv Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00CX4ZZ,ICD10-PCS,Extirpate matter from Thor Spinal Cord, Perc Endo,,,8271.00
Deidentified Maximum,,00CY0ZZ,ICD10-PCS,Extirpation of Matter from Lumbar Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00FU4ZZ,ICD10-PCS,Fragmentation in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00HV02Z,ICD10-PCS,Insertion of Monitor Dev into Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00NX3ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00NY3ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00NY4ZZ,ICD10-PCS,Release Lumbar Spinal Cord, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,00PU32Z,ICD10-PCS,Removal of Monitor Dev from Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00PU33Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00PU3MZ,ICD10-PCS,Removal of Neuro Lead from Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00PV4JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00QT3ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00QT4ZZ,ICD10-PCS,Repair Spinal Meninges, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,00QW3ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00QX3ZZ,ICD10-PCS,Repair Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00WU30Z,ICD10-PCS,Revision of Drainage Device in Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00WU40Z,ICD10-PCS,Revision of Drain Dev in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00WV42Z,ICD10-PCS,Revision of Monitor Dev in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00WV47Z,ICD10-PCS,Revision of Autol Sub in Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,01514ZZ,ICD10-PCS,Destruction of Cervical Nerve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,018R0ZZ,ICD10-PCS,DIVISION OF SACRAL NERVE OPEN APPR,,,8271.00
Deidentified Maximum,,018R4ZZ,ICD10-PCS,Division of Sacral Nerve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02100AF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02100AW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02100J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02100J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02100K3,ICD10-PCS,Bypass 1 Cor Art from Cor Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02100K8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02100Z8,ICD10-PCS,Bypass 1 Cor Art from R Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,021048C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0210493,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02104J3,ICD10-PCS,Bypass 1 Cor Art from Cor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02104JC,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02104KF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02104Z9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021109C,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,021109F,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,021109W,ICD10-PCS,Bypass 2 Cor Art from Aorta with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02110J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02110JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02110K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,0211488,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02114A3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02114J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,0212093,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,021209F,ICD10-PCS,Bypass 3 Cor Art from Abd Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02120A8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Autol Art, Open,,,8271.00
Deidentified Maximum,,02120A9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Art, Open,,,8271.00
Deidentified Maximum,,02120J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02120K3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02120Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Open Approach,,,8271.00
Deidentified Maximum,,02120Z8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,02120ZF,ICD10-PCS,Bypass 3 Cor Art from Abd Art, Open Approach,,,8271.00
Deidentified Maximum,,021248C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021248F,ICD10-PCS,Bypass 3 Cor Art from Abd Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0212493,ICD10-PCS,Bypass 3 Cor Art from Cor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,0213083,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,0213099,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Vn, Open,,,8271.00
Deidentified Maximum,,02130J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02130J8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02130ZC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art, Open Approach,,,8271.00
Deidentified Maximum,,0213488,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02134K3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02134KF,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021609Q,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02160Z7,ICD10-PCS,Bypass Right Atrium to Left Atrium, Open Approach,,,8271.00
Deidentified Maximum,,021648R,ICD10-PCS,Bypass R Atrium to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02164JP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02164JQ,ICD10-PCS,Bypass R Atrium to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02164KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021708P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,021749P,ICD10-PCS,Bypass L Atrium to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02174AR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02174ZQ,ICD10-PCS,Bypass Left Atrium to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021K0KP,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021K0KR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021K0ZR,ICD10-PCS,Bypass Right Ventricle to L Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,021K4ZC,ICD10-PCS,Bypass Right Ventricle to Thor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021L0KP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021L4Z8,ICD10-PCS,Bypass Left Ventricle to R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021L4Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021L4ZC,ICD10-PCS,Bypass Left Ventricle to Thoracic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021L4ZP,ICD10-PCS,Bypass Left Ventricle to Pulmonary Trunk, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021V09P,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021V0AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Open,,,8271.00
Deidentified Maximum,,021V0KP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021V0KQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021V48R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021V4JR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021V4KR,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021V4ZQ,ICD10-PCS,BYPASS SUPERIOR VENA CAVA TO RT PULM ART PC ENDO,,,8271.00
Deidentified Maximum,,021W08Q,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021W09B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021W0JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021W0KD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021W0KP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021W0ZD,ICD10-PCS,Bypass Thoracic Aorta, Descending to Carotid, Open Approach,,,8271.00
Deidentified Maximum,,021W4AQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021W4JP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W4JQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021X09D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021X0JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021X0KD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021X0KQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021X0ZB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav, Open Approach,,,8271.00
Deidentified Maximum,,021X49P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021X4AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021X4AP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021X4AQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021X4JP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021X4JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021X4KB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021X4KR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,024F07J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Autol Sub, Open,,,8271.00
Deidentified Maximum,,024G072,ICD10-PCS,Create Mitral Valve from Comn AV Valve w Autol Sub, Open,,,8271.00
Deidentified Maximum,,024J082,ICD10-PCS,Create Tricusp Valve from Comn AV Valve w Zooplastic, Open,,,8271.00
Deidentified Maximum,,02570ZZ,ICD10-PCS,Destruction of Left Atrium, Open Approach,,,8271.00
Deidentified Maximum,,025D0ZZ,ICD10-PCS,Destruction of Papillary Muscle, Open Approach,,,8271.00
Deidentified Maximum,,025D3ZZ,ICD10-PCS,Destruction of Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025G0ZZ,ICD10-PCS,Destruction of Mitral Valve, Open Approach,,,8271.00
Deidentified Maximum,,025H3ZZ,ICD10-PCS,Destruction of Pulmonary Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025T0ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Open Approach,,,8271.00
Deidentified Maximum,,025T3ZZ,ICD10-PCS,Destruction of Left Pulmonary Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025W0ZZ,ICD10-PCS,Destruction of Thoracic Aorta, Descending, Open Approach,,,8271.00
Deidentified Maximum,,0270056,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,027036Z,ICD10-PCS,Dilation of 1 Cor Art with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02703EZ,ICD10-PCS,Dilation of 1 Cor Art with 2 Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02704DZ,ICD10-PCS,Dilation of 1 Cor Art with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02704EZ,ICD10-PCS,Dilate of 1 Cor Art with 2 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027106Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,027107Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02710G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02710ZZ,ICD10-PCS,Dilation of Coronary Artery, Two Arteries, Open Approach,,,8271.00
Deidentified Maximum,,027135Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,0271376,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02713DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,0271446,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Drug-elut Intra, Perc Endo,,,8271.00
Deidentified Maximum,,027145Z,ICD10-PCS,Dilation of 2 Cor Art with 2 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027147Z,ICD10-PCS,Dilation of 2 Cor Art with 4 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02714DZ,ICD10-PCS,Dilation of 2 Cor Art with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02714EZ,ICD10-PCS,Dilate of 2 Cor Art with 2 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0272066,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02720FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02720TZ,ICD10-PCS,Dilation of 3 Cor Art with Radioact Intralum, Open Approach,,,8271.00
Deidentified Maximum,,0272376,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 4 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02723D6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02723G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,027244Z,ICD10-PCS,Dilate of 3 Cor Art with Drug-elut Intra, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027245Z,ICD10-PCS,Dilation of 3 Cor Art with 2 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0272466,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 3 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,02724EZ,ICD10-PCS,Dilate of 3 Cor Art with 2 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02724T6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w Radioact Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,027306Z,ICD10-PCS,Dilation of 4+ Cor Art with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02730E6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02730F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Open,,,8271.00
Deidentified Maximum,,0273476,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,02734D6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02734F6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,027F0DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,027F0ZZ,ICD10-PCS,Dilation of Aortic Valve, Open Approach,,,8271.00
Deidentified Maximum,,027F44Z,ICD10-PCS,Dilate Aortic Valve w Drug-elut Intralum, Perc Endo,,,8271.00
Deidentified Maximum,,027G3DZ,ICD10-PCS,Dilation of Mitral Valve with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,027H04Z,ICD10-PCS,Dilate of Pulm Valve with Drug-elut Intralum, Open Approach,,,8271.00
Deidentified Maximum,,027J0DZ,ICD10-PCS,Dilation of Tricuspid Valve with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,027J34Z,ICD10-PCS,Dilate Tricusp Valve w Drug-elut Intralum, Perc,,,8271.00
Deidentified Maximum,,027K04Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Open Approach,,,8271.00
Deidentified Maximum,,027K34Z,ICD10-PCS,Dilate of R Ventricle with Drug-elut Intralum, Perc Approach,,,8271.00
Deidentified Maximum,,027K3DZ,ICD10-PCS,Dilation of Right Ventricle with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,028D4ZZ,ICD10-PCS,Division of Papillary Muscle, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02B63ZZ,ICD10-PCS,Excision of Right Atrium, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BG3ZZ,ICD10-PCS,Excision of Mitral Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BJ0ZZ,ICD10-PCS,Excision of Tricuspid Valve, Open Approach,,,8271.00
Deidentified Maximum,,02BJ3ZZ,ICD10-PCS,Excision of Tricuspid Valve, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BK4ZZ,ICD10-PCS,Excision of Right Ventricle, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02BP4ZZ,ICD10-PCS,Excision of Pulmonary Trunk, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02BS0ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Open Approach,,,8271.00
Deidentified Maximum,,02BS3ZZ,ICD10-PCS,Excision of Right Pulmonary Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BV3ZZ,ICD10-PCS,Excision of Superior Vena Cava, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BV4ZZ,ICD10-PCS,Excision of Superior Vena Cava, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02BW0ZZ,ICD10-PCS,Excision of Thoracic Aorta, Descending, Open Approach,,,8271.00
Deidentified Maximum,,02C14ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02C20Z6,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Maximum,,02C23ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Perc Approach,,,8271.00
Deidentified Maximum,,02C24Z6,ICD10-PCS,Extirpate matter from 3 Cor Art, Bifurc, Perc Endo,,,8271.00
Deidentified Maximum,,02C34ZZ,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02CX0ZZ,ICD10-PCS,Extirpation of Matter from Thor Aorta Asc, Open Approach,,,8271.00
Deidentified Maximum,,02FN3ZZ,ICD10-PCS,Fragmentation in Pericardium, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02H402Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Open Approach,,,8271.00
Deidentified Maximum,,02H403Z,ICD10-PCS,Insertion of Infusion Device into Cor Vein, Open Approach,,,8271.00
Deidentified Maximum,,02H43DZ,ICD10-PCS,Insertion of Intralum Dev into Cor Vein, Perc Approach,,,8271.00
Deidentified Maximum,,02H442Z,ICD10-PCS,Insertion of Monitor Dev into Cor Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02H44KZ,ICD10-PCS,Insertion of Defib Lead into Cor Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02H64KZ,ICD10-PCS,Insertion of Defib Lead into R Atrium, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HL3DZ,ICD10-PCS,Insertion of Intralum Dev into L Ventricle, Perc Approach,,,8271.00
Deidentified Maximum,,02HN0KZ,ICD10-PCS,Insertion of Defib Lead into Pericardium, Open Approach,,,8271.00
Deidentified Maximum,,02HT32Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Perc Approach,,,8271.00
Deidentified Maximum,,02HT42Z,ICD10-PCS,Insert of Monitor Dev into L Pulm Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HW02Z,ICD10-PCS,Insertion of Monitor Dev into Thor Aorta Desc, Open Approach,,,8271.00
Deidentified Maximum,,02HX3DZ,ICD10-PCS,Insertion of Intralum Dev into Thor Aorta Asc, Perc Approach,,,8271.00
Deidentified Maximum,,02HX4DZ,ICD10-PCS,Insert Intralum Dev in Thor Aorta Asc, Perc Endo,,,8271.00
Deidentified Maximum,,02N43ZZ,ICD10-PCS,Release Coronary Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02ND0ZZ,ICD10-PCS,Release Papillary Muscle, Open Approach,,,8271.00
Deidentified Maximum,,02NK0ZZ,ICD10-PCS,Release Right Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,02PY33Z,ICD10-PCS,Removal of Infusion Device from Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02PY3CZ,ICD10-PCS,Removal of Extralum Dev from Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02PY3JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02PY3KZ,ICD10-PCS,Removal of Nonaut Sub from Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02PY4JZ,ICD10-PCS,Removal of Synth Sub from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02Q14ZZ,ICD10-PCS,Repair Coronary Artery, Two Arteries, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02Q34ZZ,ICD10-PCS,Repair 4+ Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02Q40ZZ,ICD10-PCS,Repair Coronary Vein, Open Approach,,,8271.00
Deidentified Maximum,,02Q44ZZ,ICD10-PCS,Repair Coronary Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02Q53ZZ,ICD10-PCS,Repair Atrial Septum, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02Q60ZZ,ICD10-PCS,Repair Right Atrium, Open Approach,,,8271.00
Deidentified Maximum,,02QA0ZZ,ICD10-PCS,Repair Heart, Open Approach,,,8271.00
Deidentified Maximum,,02QA4ZZ,ICD10-PCS,Repair Heart, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QC4ZZ,ICD10-PCS,Repair Left Heart, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QF0ZJ,ICD10-PCS,Repair Aortic Valve created from Trunc Vlv, Open Approach,,,8271.00
Deidentified Maximum,,02QF0ZZ,ICD10-PCS,Repair Aortic Valve, Open Approach,,,8271.00
Deidentified Maximum,,02QF4ZJ,ICD10-PCS,Repair Aort Valve created from Trunc Vlv, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02QF4ZZ,ICD10-PCS,Repair Aortic Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QG3ZE,ICD10-PCS,Repair Mitral Valve created from L AV Vlv, Perc Approach,,,8271.00
Deidentified Maximum,,02QG4ZZ,ICD10-PCS,Repair Mitral Valve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02QJ0ZG,ICD10-PCS,Repair Tricuspid Valve created from R AV Vlv, Open Approach,,,8271.00
Deidentified Maximum,,02QJ0ZZ,ICD10-PCS,Repair Tricuspid Valve, Open Approach,,,8271.00
Deidentified Maximum,,02R648Z,ICD10-PCS,Replacement of R Atrium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R64KZ,ICD10-PCS,Replacement of R Atrium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R707Z,ICD10-PCS,Replacement of Left Atrium with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R708Z,ICD10-PCS,Replacement of Left Atrium with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RD0KZ,ICD10-PCS,Replace of Papillary Muscle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RD47Z,ICD10-PCS,Replace Papillary Muscle w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02RG0KZ,ICD10-PCS,Replacement of Mitral Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RG47Z,ICD10-PCS,Replace of Mitral Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RG48Z,ICD10-PCS,Replace of Mitral Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RH08Z,ICD10-PCS,Replacement of Pulm Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RH48Z,ICD10-PCS,Replace of Pulm Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RJ0KZ,ICD10-PCS,Replacement of Tricusp Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RL4KZ,ICD10-PCS,Replace of L Ventricle with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RN07Z,ICD10-PCS,Replacement of Pericardium with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RN08Z,ICD10-PCS,Replacement of Pericardium with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RP48Z,ICD10-PCS,Replace of Pulm Trunk with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RQ0JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RQ0KZ,ICD10-PCS,Replacement of R Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RQ47Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RQ4JZ,ICD10-PCS,Replacement of R Pulm Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RR0KZ,ICD10-PCS,Replacement of L Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RS47Z,ICD10-PCS,Replace of R Pulm Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RS4JZ,ICD10-PCS,Replace of R Pulm Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RT0JZ,ICD10-PCS,Replacement of L Pulm Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RT48Z,ICD10-PCS,Replace of L Pulm Vein with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RV08Z,ICD10-PCS,Replacement of Sup Vena Cava with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RV48Z,ICD10-PCS,Replace of Sup Vena Cava with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RX4JZ,ICD10-PCS,Replace of Thor Aorta Asc with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02S00ZZ,ICD10-PCS,Reposition Coronary Artery, One Artery, Open Approach,,,8271.00
Deidentified Maximum,,02SP0ZZ,ICD10-PCS,Reposition Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Maximum,,02T83ZZ,ICD10-PCS,Resection of Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02T93ZZ,ICD10-PCS,Resection of Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02U53KZ,ICD10-PCS,Supplement Atrial Septum with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02U547Z,ICD10-PCS,Supplement Atrial Septum with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U64KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U70JZ,ICD10-PCS,Supplement Left Atrium with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U738Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Perc Approach,,,8271.00
Deidentified Maximum,,02U748Z,ICD10-PCS,Supplement Left Atrium with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UA38Z,ICD10-PCS,Supplement Heart with Zooplastic Tissue, Perc Approach,,,8271.00
Deidentified Maximum,,02UA4JZ,ICD10-PCS,Supplement Heart with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UA4KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UD38Z,ICD10-PCS,Supplement Papillary Muscle with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UF08Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UF0JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02UF3JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc,,,8271.00
Deidentified Maximum,,02UF3JZ,ICD10-PCS,Supplement Aortic Valve with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UF3KJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Nonaut Sub, Perc,,,8271.00
Deidentified Maximum,,02UG08Z,ICD10-PCS,Supplement Mitral Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UG4JE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UH0KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UH38Z,ICD10-PCS,Supplement Pulmonary Valve with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UH3KZ,ICD10-PCS,Supplement Pulmonary Valve with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UH4KZ,ICD10-PCS,Supplement Pulm Valve with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UJ08Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UJ0JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UJ37G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Autol Sub, Perc,,,8271.00
Deidentified Maximum,,02UJ38Z,ICD10-PCS,Supplement Tricuspid Valve with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UJ3JG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Synth Sub, Perc,,,8271.00
Deidentified Maximum,,02UJ3JZ,ICD10-PCS,Supplement Tricuspid Valve with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UJ3KZ,ICD10-PCS,Supplement Tricuspid Valve with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UJ48G,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02UK48Z,ICD10-PCS,Supplement R Ventricle with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UL38Z,ICD10-PCS,Supplement Left Ventricle with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UL4JZ,ICD10-PCS,Supplement Left Ventricle with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UP4KZ,ICD10-PCS,Supplement Pulm Trunk with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UQ4KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UR37Z,ICD10-PCS,Supplement L Pulm Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UR48Z,ICD10-PCS,Supplement L Pulm Art with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02US37Z,ICD10-PCS,Supplement R Pulm Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02US38Z,ICD10-PCS,Supplement R Pulm Vein with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02US4KZ,ICD10-PCS,Supplement R Pulm Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UT38Z,ICD10-PCS,Supplement L Pulm Vein with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UV07Z,ICD10-PCS,Supplement Superior Vena Cava with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UV48Z,ICD10-PCS,Supplement Sup Vena Cava with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UX4KZ,ICD10-PCS,Supplement Thor Aorta Asc w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02VW0DZ,ICD10-PCS,Restrict of Thor Aorta Desc with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02VX0DZ,ICD10-PCS,Restrict of Thor Aorta Asc with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02VX3EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc,,,8271.00
Deidentified Maximum,,02VX4EZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 1 or 2, Perc Endo,,,8271.00
Deidentified Maximum,,02WF4KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WJ08Z,ICD10-PCS,Revision of Zooplastic in Tricusp Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WM4JZ,ICD10-PCS,Revise of Synth Sub in Ventricular Sept, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WY02Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02WY0DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02WY32Z,ICD10-PCS,Revision of Monitoring Device in Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02WY43Z,ICD10-PCS,Revision of Infusion Dev in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03130AN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,031409M,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,03504ZZ,ICD10-PCS,Destruction of R Int Mamm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03510ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Maximum,,03530ZZ,ICD10-PCS,Destruction of Right Subclavian Artery, Open Approach,,,8271.00
Deidentified Maximum,,03R107Z,ICD10-PCS,Replacement of L Int Mamm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R207Z,ICD10-PCS,Replacement of Innom Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R24KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R447Z,ICD10-PCS,Replace of L Subclav Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R44KZ,ICD10-PCS,Replace of L Subclav Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S20ZZ,ICD10-PCS,Reposition Innominate Artery, Open Approach,,,8271.00
Deidentified Maximum,,03S30ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Open Approach,,,8271.00
Deidentified Maximum,,03S80ZZ,ICD10-PCS,Reposition Left Brachial Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SA3ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SA4ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SC0ZZ,ICD10-PCS,Reposition Left Radial Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SC3ZZ,ICD10-PCS,Reposition Left Radial Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SC4ZZ,ICD10-PCS,Reposition Left Radial Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SF4ZZ,ICD10-PCS,Reposition Left Hand Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SG0ZZ,ICD10-PCS,Reposition Intracranial Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SH3ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03SJ3ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SJ4ZZ,ICD10-PCS,Reposition Left Common Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SN0ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SR3ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SR4ZZ,ICD10-PCS,Reposition Face Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,03SS0ZZ,ICD10-PCS,Reposition Right Temporal Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SS3ZZ,ICD10-PCS,Reposition Right Temporal Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03U237Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03U247Z,ICD10-PCS,Supplement Innom Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03U347Z,ICD10-PCS,Supplement R Subclav Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03U607Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UA47Z,ICD10-PCS,Supplement L Ulnar Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03U637Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03U647Z,ICD10-PCS,Supplement L Axilla Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03U707Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03U747Z,ICD10-PCS,Supplement R Brach Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UF47Z,ICD10-PCS,Supplement L Hand Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UJ37Z,ICD10-PCS,Supplement L Com Carotid with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UN07Z,ICD10-PCS,Supplement L Ext Carotid with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03US07Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UT07Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UY07Z,ICD10-PCS,Supplement Upper Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0410091,ICD10-PCS,Bypass Abd Aorta to Celiac Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,0410093,ICD10-PCS,BP ABDOMINAL AORTA RT RENL ART AUTO VEN TISS OPN,,,8271.00
Deidentified Maximum,,0410095,ICD10-PCS,Bypass Abd Aorta to B Renal A with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,0410099,ICD10-PCS,BP ABD AO RT INTRL ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Maximum,,041009C,ICD10-PCS,BP ABD AO B INTRL ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Maximum,,041009F,ICD10-PCS,BP ABD AO LT EXT ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Maximum,,04100A2,ICD10-PCS,BYPS ABD AO MES ART AUTO ART TISSUE OPN APPROACH,,,8271.00
Deidentified Maximum,,04100A4,ICD10-PCS,BP ABD AO LT RENL ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100AH,ICD10-PCS,BP ABD AO RT FEM ART AUTO ART TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100AQ,ICD10-PCS,BP ABD AO LOW EXTREM ART AUTO ART TISS OPN APPR,,,8271.00
Deidentified Maximum,,04100J5,ICD10-PCS,BYPS ABD AO BIL RENL ART SYN SUBST OPN APPROACH,,,8271.00
Deidentified Maximum,,04100JD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART SYN SUB OPN APPROACH,,,8271.00
Deidentified Maximum,,04100JG,ICD10-PCS,BP ABD AO B EXT ILIAC ART SYN SUBST OPN APPROACH,,,8271.00
Deidentified Maximum,,04100JK,ICD10-PCS,BYPS ABD AO BIL FEM ART SYNTH SUBST OPN APPROACH,,,8271.00
Deidentified Maximum,,04100JQ,ICD10-PCS,BP ABD AO LOW EXTREM ART SYN SUBST OPN APPROACH,,,8271.00
Deidentified Maximum,,04100K1,ICD10-PCS,BP ABD AO CELIAC ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100K7,ICD10-PCS,BP ABD AO LT CMN ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100KJ,ICD10-PCS,BP ABD AO LT FEM ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100KR,ICD10-PCS,BP ABD AO LOW ART NONAUTO TISS SUB OPN APPROACH,,,8271.00
Deidentified Maximum,,04100Z3,ICD10-PCS,BYPASS ABD AORTA RT RENAL ARTERY OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100ZF,ICD10-PCS,BYPASS ABD AORTA LT EXT ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100ZK,ICD10-PCS,BYPASS ABD AO BIL FEMORAL ART OPEN APPROACH,,,8271.00
Deidentified Maximum,,041049D,ICD10-PCS,Bypass Abd Aorta to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041049G,ICD10-PCS,Bypass Abd Aorta to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041049Q,ICD10-PCS,Bypass Abd Aorta to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,04104A4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104A8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104J5,ICD10-PCS,Bypass Abd Aorta to B Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104JR,ICD10-PCS,Bypass Abd Aorta to Low Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104K2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104K4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104Z7,ICD10-PCS,Bypass Abdominal Aorta to L Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104ZK,ICD10-PCS,Bypass Abdominal Aorta to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0414095,ICD10-PCS,Bypass Splenic Art to B Renal A with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,0414494,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,0414495,ICD10-PCS,Bypass Splenic Art to B Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,04144A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C094,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C09F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C09G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C09H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C0A5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0A6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0AQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0J0,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0JG,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0K6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0KQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0Z6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041C0ZC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041C0ZH,ICD10-PCS,Bypass Right Common Iliac Artery to R Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041C490,ICD10-PCS,Bypass R Com Iliac Art to Abd Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C495,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C4AJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4AR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4J3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4J9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4JB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4K5,ICD10-PCS,Bypass R Com Iliac Art to B Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4K9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4KF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4Z9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C4ZF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D095,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D096,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D09D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D09K,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D0A2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0AH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0J3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0J5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0JC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0JD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0JF,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0KC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0Z0,ICD10-PCS,Bypass Left Common Iliac Artery to Abd Aorta, Open Approach,,,8271.00
Deidentified Maximum,,041D0Z3,ICD10-PCS,Bypass Left Common Iliac Artery to R Renal A, Open Approach,,,8271.00
Deidentified Maximum,,041D49C,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D4A1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4J4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4J6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4K6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4K9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4KB,ICD10-PCS,Bypass L Com Iliac Art to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4Z5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4Z7,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4ZD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4ZG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4ZJ,ICD10-PCS,Bypass L Com Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4ZK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4ZQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E09H,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041E0AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0J9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0JH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0KB,ICD10-PCS,Bypass R Int Iliac Art to L Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E0KG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E0KK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E49D,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E49J,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E4AC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041E4AD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041E4AF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041E4AK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041E4AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041E4JD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4JQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4KD,ICD10-PCS,Bypass R Int Iliac Art to R Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4ZC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E4ZF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E4ZG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E4ZH,ICD10-PCS,Bypass R Int Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E4ZJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E4ZQ,ICD10-PCS,Bypass R Int Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041F09D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F09G,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F0AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0AH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0AK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0JJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041F0KP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041F49D,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F4AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4AJ,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4J9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4JD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4JP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041F4ZQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H09C,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H09G,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H09P,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H09Q,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041H0A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0AC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0J9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0JG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0JH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0Z9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041H0ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041H0ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041H49K,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H4AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4AH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4AQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4KH,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4KK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4ZB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H4ZF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J0AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0AP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J0KD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J0KF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J0KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J0Z9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041J0ZB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041J0ZD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041J4AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4JD,ICD10-PCS,Bypass L Ext Iliac Art to R Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4JQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4KH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4ZC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J4ZH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04513ZZ,ICD10-PCS,Destruction of Celiac Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04584ZZ,ICD10-PCS,Destruction of Middle Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,045E4ZZ,ICD10-PCS,Destruction of R Int Iliac Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,045J0ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,045J3ZZ,ICD10-PCS,Destruction of Left External Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04B04ZZ,ICD10-PCS,Excision of Abdominal Aorta, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04B23ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04B30ZZ,ICD10-PCS,Excision of Hepatic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04B53ZZ,ICD10-PCS,Excision of Superior Mesenteric Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04B80ZZ,ICD10-PCS,Excision of Middle Colic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04B94ZZ,ICD10-PCS,Excision of Right Renal Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04BC4ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04BD0ZZ,ICD10-PCS,Excision of Left Common Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04BJ3ZZ,ICD10-PCS,Excision of Left External Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04R147Z,ICD10-PCS,Replacement of Celiac Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R347Z,ICD10-PCS,Replace of Hepatic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R60JZ,ICD10-PCS,Replacement of R Colic Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R64JZ,ICD10-PCS,Replace of R Colic Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R80KZ,ICD10-PCS,Replacement of Mid Colic Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R84JZ,ICD10-PCS,Replace of Mid Colic Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04RB47Z,ICD10-PCS,Replace of Inf Mesent Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04RD07Z,ICD10-PCS,Replacement of L Com Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RD4JZ,ICD10-PCS,Replace L Com Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RF07Z,ICD10-PCS,Replacement of L Int Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RH0KZ,ICD10-PCS,Replace of R Ext Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04S10ZZ,ICD10-PCS,Reposition Celiac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04S53ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04S54ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04S60ZZ,ICD10-PCS,Reposition Right Colic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04S64ZZ,ICD10-PCS,Reposition Right Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04S74ZZ,ICD10-PCS,Reposition Left Colic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SB0ZZ,ICD10-PCS,Reposition Inferior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SE4ZZ,ICD10-PCS,Reposition Right Internal Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SF0ZZ,ICD10-PCS,Reposition Left Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SH3ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04SK0ZZ,ICD10-PCS,Reposition Right Femoral Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SL0ZZ,ICD10-PCS,Reposition Left Femoral Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SM3ZZ,ICD10-PCS,Reposition Right Popliteal Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SN3ZZ,ICD10-PCS,Reposition Left Popliteal Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04ST0ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Open Approach,,,8271.00
Deidentified Maximum,,04ST4ZZ,ICD10-PCS,Reposition Right Peroneal Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SU4ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SV0ZZ,ICD10-PCS,Reposition Right Foot Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SV3ZZ,ICD10-PCS,Reposition Right Foot Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04SV4ZZ,ICD10-PCS,Reposition Right Foot Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U007Z,ICD10-PCS,Supplement Abdominal Aorta with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04U247Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U307Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04U347Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U607Z,ICD10-PCS,Supplement Right Colic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04U737Z,ICD10-PCS,Supplement Left Colic Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04U807Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UA07Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UA37Z,ICD10-PCS,Supplement Left Renal Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UC07Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UE47Z,ICD10-PCS,Supplement R Int Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04UH37Z,ICD10-PCS,Supplement R Ext Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UH47Z,ICD10-PCS,Supplement R Ext Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04UL37Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UT37Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UU37Z,ICD10-PCS,Supplement L Peroneal Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UV37Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UW07Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UW37Z,ICD10-PCS,Supplement Left Foot Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05100JY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,05110JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Open,,,8271.00
Deidentified Maximum,,05110ZY,ICD10-PCS,Bypass Hemiazygos Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Maximum,,05130KY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,05130ZY,ICD10-PCS,Bypass Right Innominate Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Maximum,,051347Y,ICD10-PCS,Bypass R Innom Vein to Up Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05134JY,ICD10-PCS,Bypass R Innom Vein to Up Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05164AY,ICD10-PCS,Bypass L Subclav Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,05510ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Open Approach,,,8271.00
Deidentified Maximum,,05513ZZ,ICD10-PCS,Destruction of Hemiazygos Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05534ZZ,ICD10-PCS,Destruction of Right Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05553ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05563ZZ,ICD10-PCS,Destruction of Left Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05B03ZZ,ICD10-PCS,Excision of Azygos Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05B30ZZ,ICD10-PCS,Excision of Right Innominate Vein, Open Approach,,,8271.00
Deidentified Maximum,,05R10JZ,ICD10-PCS,Replacement of Hemiazygos Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R347Z,ICD10-PCS,Replace of R Innom Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R44JZ,ICD10-PCS,Replace of L Innom Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R50JZ,ICD10-PCS,Replacement of R Subclav Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R50KZ,ICD10-PCS,Replacement of R Subclav Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R547Z,ICD10-PCS,Replace of R Subclav Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R60JZ,ICD10-PCS,Replacement of L Subclav Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,05S34ZZ,ICD10-PCS,Reposition Right Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05S43ZZ,ICD10-PCS,Reposition Left Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05S44ZZ,ICD10-PCS,Reposition Left Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05S53ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05S70ZZ,ICD10-PCS,Reposition Right Axillary Vein, Open Approach,,,8271.00
Deidentified Maximum,,05S74ZZ,ICD10-PCS,Reposition Right Axillary Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05S90ZZ,ICD10-PCS,Reposition Right Brachial Vein, Open Approach,,,8271.00
Deidentified Maximum,,05S93ZZ,ICD10-PCS,Reposition Right Brachial Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05S94ZZ,ICD10-PCS,Reposition Right Brachial Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SA3ZZ,ICD10-PCS,Reposition Left Brachial Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SC0ZZ,ICD10-PCS,Reposition Left Basilic Vein, Open Approach,,,8271.00
Deidentified Maximum,,05SF3ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SG4ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,05SM3ZZ,ICD10-PCS,Reposition Right Internal Jugular Vein, Perc Approach,,,8271.00
Deidentified Maximum,,05SN4ZZ,ICD10-PCS,Reposition Left Internal Jugular Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SQ0ZZ,ICD10-PCS,Reposition Left External Jugular Vein, Open Approach,,,8271.00
Deidentified Maximum,,05U447Z,ICD10-PCS,Supplement L Innom Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05U537Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05U547Z,ICD10-PCS,Supplement R Subclav Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05U737Z,ICD10-PCS,Supplement Right Axillary Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05U747Z,ICD10-PCS,Supplement R Axilla Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05U847Z,ICD10-PCS,Supplement L Axilla Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05UB47Z,ICD10-PCS,Supplement R Basilic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05UF37Z,ICD10-PCS,Supplement Left Cephalic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UM37Z,ICD10-PCS,Supplement R Int Jugular Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UM47Z,ICD10-PCS,Supplement R Int Jugular Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05UP07Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UT47Z,ICD10-PCS,Supplement R Face Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06510ZZ,ICD10-PCS,Destruction of Splenic Vein, Open Approach,,,8271.00
Deidentified Maximum,,06524ZZ,ICD10-PCS,Destruction of Gastric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06543ZZ,ICD10-PCS,Destruction of Hepatic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06554ZZ,ICD10-PCS,Destruction of Superior Mesenteric Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06574ZZ,ICD10-PCS,Destruction of Colic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06580ZZ,ICD10-PCS,Destruction of Portal Vein, Open Approach,,,8271.00
Deidentified Maximum,,06590ZZ,ICD10-PCS,Destruction of Right Renal Vein, Open Approach,,,8271.00
Deidentified Maximum,,065B3ZZ,ICD10-PCS,Destruction of Left Renal Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,065G0ZZ,ICD10-PCS,Destruction of Left External Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B10ZZ,ICD10-PCS,Excision of Splenic Vein, Open Approach,,,8271.00
Deidentified Maximum,,06B13ZZ,ICD10-PCS,Excision of Splenic Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06B44ZZ,ICD10-PCS,Excision of Hepatic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06BF0ZZ,ICD10-PCS,Excision of Right External Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,06BG4ZZ,ICD10-PCS,Excision of Left External Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06BH0ZZ,ICD10-PCS,Excision of Right Hypogastric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06R10JZ,ICD10-PCS,Replacement of Splenic Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R247Z,ICD10-PCS,Replace of Gastric Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R54JZ,ICD10-PCS,Replace Sup Mesent Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06R60JZ,ICD10-PCS,Replacement of Inf Mesent Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R707Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R70JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06R747Z,ICD10-PCS,Replacement of Colic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R74JZ,ICD10-PCS,Replacement of Colic Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R74KZ,ICD10-PCS,Replace of Colic Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R847Z,ICD10-PCS,Replace of Portal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R84JZ,ICD10-PCS,Replace of Portal Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06R907Z,ICD10-PCS,Replacement of R Renal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RB07Z,ICD10-PCS,Replacement of Left Renal Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RC07Z,ICD10-PCS,Replace of R Com Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RD0KZ,ICD10-PCS,Replace of L Com Iliac Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RF07Z,ICD10-PCS,Replace of R Ext Iliac Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RG0JZ,ICD10-PCS,Replace of L Ext Iliac Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,06RH4JZ,ICD10-PCS,Replace R Hypogast Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RH4KZ,ICD10-PCS,Replace R Hypogast Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06RJ4KZ,ICD10-PCS,Replace L Hypogast Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06S20ZZ,ICD10-PCS,Reposition Gastric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06S24ZZ,ICD10-PCS,Reposition Gastric Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06S60ZZ,ICD10-PCS,Reposition Inferior Mesenteric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06S74ZZ,ICD10-PCS,Reposition Colic Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,06SC0ZZ,ICD10-PCS,Reposition Right Common Iliac Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SD3ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06SD4ZZ,ICD10-PCS,Reposition Left Common Iliac Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06SJ0ZZ,ICD10-PCS,Reposition Left Hypogastric Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SM0ZZ,ICD10-PCS,Reposition Right Femoral Vein, Open Approach,,,8271.00
Deidentified Maximum,,06SV3ZZ,ICD10-PCS,Reposition Left Foot Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,06U147Z,ICD10-PCS,Supplement Splenic Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06U207Z,ICD10-PCS,Supplement Gastric Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06U607Z,ICD10-PCS,Supplement Inf Mesent Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06U937Z,ICD10-PCS,Supplement Right Renal Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06U947Z,ICD10-PCS,Supplement R Renal Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06UN37Z,ICD10-PCS,Supplement Left Femoral Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UP07Z,ICD10-PCS,Supplement R Saphenous with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UQ37Z,ICD10-PCS,Supplement Left Saphenous Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UQ47Z,ICD10-PCS,Supplement L Saphenous with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,06UR07Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UR37Z,ICD10-PCS,Supplement R Less Saphenous with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06US07Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06US37Z,ICD10-PCS,Supplement L Less Saphenous with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06US47Z,ICD10-PCS,Supplement L Less Saphenous w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,06UT37Z,ICD10-PCS,Supplement Right Foot Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UV37Z,ICD10-PCS,Supplement Left Foot Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,06UY07Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,06UY37Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,001U0J9,ICD10-PCS,Bypass Spinal Canal to Fallopian w Synth Sub, Open,,,8271.00
Deidentified Maximum,,001U0K6,ICD10-PCS,Bypass Spinal Canal to Periton Cav w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,005W0ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,005W3ZZ,ICD10-PCS,Destruction of Cervical Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,005X0ZZ,ICD10-PCS,Destruction of Thoracic Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,008X0ZZ,ICD10-PCS,Division of Thoracic Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,008Y3ZZ,ICD10-PCS,Division of Lumbar Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,009T3ZZ,ICD10-PCS,Drainage of Spinal Meninges, Percutaneous Approach,,,8271.00
Deidentified Maximum,,009U00Z,ICD10-PCS,Drainage of Spinal Canal with Drainage Device, Open Approach,,,8271.00
Deidentified Maximum,,009W3ZX,ICD10-PCS,Drainage of Cervical Spinal Cord, Perc Approach, Diagn,,,8271.00
Deidentified Maximum,,009W40Z,ICD10-PCS,Drain of Cerv Spinal Cord with Drain Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00BT0ZX,ICD10-PCS,Excision of Spinal Meninges, Open Approach, Diagnostic,,,8271.00
Deidentified Maximum,,00BW3ZX,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Approach, Diagn,,,8271.00
Deidentified Maximum,,00BW4ZZ,ICD10-PCS,Excision of Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00BY4ZZ,ICD10-PCS,Excision of Lumbar Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00C34ZZ,ICD10-PCS,Extirpate of Matter from Cran Epidur Spc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00CT4ZZ,ICD10-PCS,Extirpate of Matter from Spinal Meninges, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00FUXZZ,ICD10-PCS,FRAGMENTATION IN SPINAL CANAL EXTERNAL APPROACH,,,8271.00
Deidentified Maximum,,00HV4MZ,ICD10-PCS,Insertion of Neuro Lead into Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00NX4ZZ,ICD10-PCS,Release Thoracic Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00PU00Z,ICD10-PCS,Removal of Drainage Device from Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00PU03Z,ICD10-PCS,Removal of Infusion Device from Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00PV07Z,ICD10-PCS,Removal of Autol Sub from Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00PV0JZ,ICD10-PCS,Removal of Synth Sub from Spinal Cord, Open Approach,,,8271.00
Deidentified Maximum,,00PV42Z,ICD10-PCS,Removal of Monitor Dev from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00PV4KZ,ICD10-PCS,Removal of Nonaut Sub from Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00QT0ZZ,ICD10-PCS,Repair Spinal Meninges, Open Approach,,,8271.00
Deidentified Maximum,,00QW4ZZ,ICD10-PCS,Repair Cervical Spinal Cord, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00SX3ZZ,ICD10-PCS,Reposition Thoracic Spinal Cord, Percutaneous Approach,,,8271.00
Deidentified Maximum,,00UT37Z,ICD10-PCS,Supplement Spinal Meninges with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,00UT4KZ,ICD10-PCS,Supplement Spinal Meninges w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,00WU0JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Open Approach,,,8271.00
Deidentified Maximum,,00WU3MZ,ICD10-PCS,Revision of Neuro Lead in Spinal Canal, Perc Approach,,,8271.00
Deidentified Maximum,,00WU4JZ,ICD10-PCS,Revision of Synth Sub in Spinal Canal, Perc Endo Approach,,,8271.00
Deidentified Maximum,,00WV32Z,ICD10-PCS,Revision of Monitoring Device in Spinal Cord, Perc Approach,,,8271.00
Deidentified Maximum,,015B0ZZ,ICD10-PCS,Destruction of Lumbar Nerve, Open Approach,,,8271.00
Deidentified Maximum,,01884ZZ,ICD10-PCS,Division of Thoracic Nerve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,018B4ZZ,ICD10-PCS,Division of Lumbar Nerve, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,02100A9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Autol Art, Open,,,8271.00
Deidentified Maximum,,02100JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02100JW,ICD10-PCS,Bypass 1 Cor Art from Aorta with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,021049C,ICD10-PCS,Bypass 1 Cor Art from Thor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02104J9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02104JF,ICD10-PCS,Bypass 1 Cor Art from Abd Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02104K9,ICD10-PCS,Bypass 1 Cor Art from L Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02104Z3,ICD10-PCS,Bypass 1 Cor Art from Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0211093,ICD10-PCS,Bypass 2 Cor Art from Cor Art with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,02110A8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Autol Art, Open,,,8271.00
Deidentified Maximum,,02110J9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary w Synth Sub, Open,,,8271.00
Deidentified Maximum,,02110JF,ICD10-PCS,Bypass 2 Cor Art from Abd Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02110Z9,ICD10-PCS,Bypass 2 Cor Art from L Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,0211483,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02114J3,ICD10-PCS,Bypass 2 Cor Art from Cor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114JC,ICD10-PCS,Bypass 2 Cor Art from Thor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114K8,ICD10-PCS,Bypass 2 Cor Art from R Int Mammary w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114KW,ICD10-PCS,Bypass 2 Cor Art from Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02114Z3,ICD10-PCS,Bypass 2 Cor Art from Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02114ZF,ICD10-PCS,Bypass 2 Cor Art from Abd Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021208C,ICD10-PCS,Bypass 3 Cor Art from Thor Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,02120A3,ICD10-PCS,Bypass 3 Cor Art from Cor Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02120K8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02120K9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,0212499,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021249W,ICD10-PCS,Bypass 3 Cor Art from Aorta w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02124J8,ICD10-PCS,Bypass 3 Cor Art from R Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02124Z3,ICD10-PCS,Bypass 3 Cor Art from Cor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02124Z9,ICD10-PCS,Bypass 3 Cor Art from L Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02124ZC,ICD10-PCS,Bypass 3 Cor Art from Thor Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0213088,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Maximum,,0213089,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021308C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021308F,ICD10-PCS,Bypass 4+ Cor Art from Abd Art w Zooplastic, Open,,,8271.00
Deidentified Maximum,,02130K8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02130K9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02130Z8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,021348C,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,0213493,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02134A8,ICD10-PCS,Bypass 4+ Cor Art from R Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02134A9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02134J3,ICD10-PCS,Bypass 4+ Cor Art from Cor Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02134J9,ICD10-PCS,Bypass 4+ Cor Art from L Int Mammary w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02134KC,ICD10-PCS,Bypass 4+ Cor Art from Thor Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02160AQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,02160JR,ICD10-PCS,Bypass R Atrium to L Pulm Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02160KP,ICD10-PCS,Bypass R Atrium to Pulm Trunk with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02160KQ,ICD10-PCS,Bypass R Atrium to R Pulm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02160ZP,ICD10-PCS,Bypass Right Atrium to Pulmonary Trunk, Open Approach,,,8271.00
Deidentified Maximum,,02160ZQ,ICD10-PCS,Bypass Right Atrium to Right Pulmonary Artery, Open Approach,,,8271.00
Deidentified Maximum,,021648P,ICD10-PCS,Bypass R Atrium to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021708Q,ICD10-PCS,Bypass L Atrium to R Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,021709P,ICD10-PCS,Bypass L Atrium to Pulm Trunk with Autol Vn, Open Approach,,,8271.00
Deidentified Maximum,,021749Q,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,02174AQ,ICD10-PCS,Bypass L Atrium to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,02174KR,ICD10-PCS,Bypass L Atrium to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021K09R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021K0JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021K0KQ,ICD10-PCS,Bypass R Ventricle to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021K0Z9,ICD10-PCS,Bypass Right Ventricle to L Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,021K0ZC,ICD10-PCS,Bypass Right Ventricle to Thoracic Artery, Open Approach,,,8271.00
Deidentified Maximum,,021K0ZF,ICD10-PCS,Bypass Right Ventricle to Abdominal Artery, Open Approach,,,8271.00
Deidentified Maximum,,021K0ZW,ICD10-PCS,Bypass Right Ventricle to Aorta, Open Approach,,,8271.00
Deidentified Maximum,,021K48P,ICD10-PCS,Bypass R Ventricle to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021K49R,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021K4AR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021K4JR,ICD10-PCS,Bypass R Ventricle to L Pulm Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021K4Z5,ICD10-PCS,Bypass Right Ventricle to Cor Circ, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021K4Z8,ICD10-PCS,Bypass Right Ventricle to R Int Mammary, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021K4ZF,ICD10-PCS,Bypass Right Ventricle to Abd Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021K4ZQ,ICD10-PCS,Bypass Right Ventricle to R Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021L0AP,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Art, Open,,,8271.00
Deidentified Maximum,,021L0AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,021L0JR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021L0KQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021L0Z9,ICD10-PCS,Bypass Left Ventricle to L Int Mammary, Open Approach,,,8271.00
Deidentified Maximum,,021L49P,ICD10-PCS,Bypass L Ventricle to Pulm Trunk w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021L49Q,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021L4AQ,ICD10-PCS,Bypass L Ventricle to R Pulm Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021L4KR,ICD10-PCS,Bypass L Ventricle to L Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021L4ZF,ICD10-PCS,Bypass Left Ventricle to Abd Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021V09Q,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021V0JQ,ICD10-PCS,Bypass Sup Vena Cava to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021V49R,ICD10-PCS,Bypass Sup Vena Cava to L Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021V4AP,ICD10-PCS,Bypass Sup Vena Cava to Pulm Trunk w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021V4ZR,ICD10-PCS,Bypass Superior Vena Cava to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021W08D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021W08P,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk w Zooplastic, Open,,,8271.00
Deidentified Maximum,,021W0AB,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Art, Open,,,8271.00
Deidentified Maximum,,021W0AR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,021W0KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021W0ZP,ICD10-PCS,Bypass Thor Aorta Desc to Pulm Trunk, Open Approach,,,8271.00
Deidentified Maximum,,021W48B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021W49B,ICD10-PCS,Bypass Thor Aorta Desc to Subclav w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021W49D,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021W4AD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,021W4JD,ICD10-PCS,Bypass Thor Aorta Desc to Carotid w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W4KQ,ICD10-PCS,Bypass Thor Aorta Desc to R Pulm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021W4ZR,ICD10-PCS,Bypass Thor Aorta Desc to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,021X09P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Autol Vn, Open,,,8271.00
Deidentified Maximum,,021X0AD,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Art, Open,,,8271.00
Deidentified Maximum,,021X0JQ,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,021X0KP,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,021X48D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021X48P,ICD10-PCS,Bypass Thor Aorta Asc to Pulm Trunk w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,021X49D,ICD10-PCS,Bypass Thor Aorta Asc to Carotid w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021X49Q,ICD10-PCS,Bypass Thor Aorta Asc to R Pulm Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,021X4JB,ICD10-PCS,Bypass Thor Aorta Asc to Subclav w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,021X4ZR,ICD10-PCS,Bypass Thor Aorta Asc to L Pulm Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,024F08J,ICD10-PCS,Create Aort Valve from Trunc Vlv w Zooplastic, Open,,,8271.00
Deidentified Maximum,,02560ZZ,ICD10-PCS,Destruction of Right Atrium, Open Approach,,,8271.00
Deidentified Maximum,,02563ZZ,ICD10-PCS,Destruction of Right Atrium, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02590ZZ,ICD10-PCS,Destruction of Chordae Tendineae, Open Approach,,,8271.00
Deidentified Maximum,,025L0ZZ,ICD10-PCS,Destruction of Left Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,025L3ZZ,ICD10-PCS,Destruction of Left Ventricle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,025Q3ZZ,ICD10-PCS,Destruction of Right Pulmonary Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0270066,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02700D6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02700G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02700T6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w Radioact Intralum, Open,,,8271.00
Deidentified Maximum,,02700ZZ,ICD10-PCS,Dilation of Coronary Artery, One Artery, Open Approach,,,8271.00
Deidentified Maximum,,0270366,ICD10-PCS,Dilate of 1 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,0270476,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,02704G6,ICD10-PCS,Dilate 1 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02704Z6,ICD10-PCS,Dilation of 1 Cor Art, Bifurc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0271076,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02710D6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w Intralum Dev, Open,,,8271.00
Deidentified Maximum,,02710E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Open,,,8271.00
Deidentified Maximum,,0271366,ICD10-PCS,Dilate of 2 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,027136Z,ICD10-PCS,Dilation of 2 Cor Art with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02713E6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 2 Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02713EZ,ICD10-PCS,Dilation of 2 Cor Art with 2 Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,0271476,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,02714F6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 3 Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02714G6,ICD10-PCS,Dilate 2 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02720DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Open Approach,,,8271.00
Deidentified Maximum,,02720Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Open Approach,,,8271.00
Deidentified Maximum,,0272356,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 2 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,0272366,ICD10-PCS,Dilate of 3 Cor Art, Bifurc, with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,027236Z,ICD10-PCS,Dilation of 3 Cor Art with 3 Drug-elut, Perc Approach,,,8271.00
Deidentified Maximum,,02723DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02723FZ,ICD10-PCS,Dilation of 3 Cor Art with 3 Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,0272456,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,02724DZ,ICD10-PCS,Dilation of 3 Cor Art with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02724E6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 2 Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02724FZ,ICD10-PCS,Dilate of 3 Cor Art with 3 Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02724G6,ICD10-PCS,Dilate 3 Cor Art, Bifurc, w 4+ Intralum Dev, Perc Endo,,,8271.00
Deidentified Maximum,,02724Z6,ICD10-PCS,Dilation of 3 Cor Art, Bifurc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0273056,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Open,,,8271.00
Deidentified Maximum,,027305Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,027307Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Open Approach,,,8271.00
Deidentified Maximum,,02733G6,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 4+ Intralum Dev, Perc,,,8271.00
Deidentified Maximum,,02733GZ,ICD10-PCS,Dilation of 4+ Cor Art with 4+ Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02733Z6,ICD10-PCS,Dilation of 4+ Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Maximum,,0273456,ICD10-PCS,Dilate 4+ Cor Art, Bifurc, w 2 Drug-elut, Perc Endo,,,8271.00
Deidentified Maximum,,027345Z,ICD10-PCS,Dilation of 4+ Cor Art with 2 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027347Z,ICD10-PCS,Dilation of 4+ Cor Art with 4 Drug-elut, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027F3DZ,ICD10-PCS,Dilation of Aortic Valve with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,027F4DZ,ICD10-PCS,Dilate of Aortic Valve with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027G0ZZ,ICD10-PCS,Dilation of Mitral Valve, Open Approach,,,8271.00
Deidentified Maximum,,027J0ZZ,ICD10-PCS,Dilation of Tricuspid Valve, Open Approach,,,8271.00
Deidentified Maximum,,027K0ZZ,ICD10-PCS,Dilation of Right Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,027K4DZ,ICD10-PCS,Dilate of R Ventricle with Intralum Dev, Perc Endo Approach,,,8271.00
Deidentified Maximum,,027R3DT,ICD10-PCS,Dilation of Ductus Arterio with Intralum Dev, Perc Approach,,,8271.00
Deidentified Maximum,,02893ZZ,ICD10-PCS,Division of Chordae Tendineae, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02B43ZZ,ICD10-PCS,Excision of Coronary Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02BQ4ZZ,ICD10-PCS,Excision of Right Pulmonary Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02C03Z6,ICD10-PCS,Extirpation of Matter from 1 Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Maximum,,02C10ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Open Approach,,,8271.00
Deidentified Maximum,,02C13ZZ,ICD10-PCS,Extirpation of Matter from 2 Cor Art, Perc Approach,,,8271.00
Deidentified Maximum,,02C20ZZ,ICD10-PCS,Extirpation of Matter from 3 Cor Art, Open Approach,,,8271.00
Deidentified Maximum,,02C33Z6,ICD10-PCS,Extirpation of Matter from 4+ Cor Art, Bifurc, Perc Approach,,,8271.00
Deidentified Maximum,,02C44ZZ,ICD10-PCS,Extirpation of Matter from Coronary Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02FN0ZZ,ICD10-PCS,Fragmentation in Pericardium, Open Approach,,,8271.00
Deidentified Maximum,,02H432Z,ICD10-PCS,Insertion of Monitoring Device into Cor Vein, Perc Approach,,,8271.00
Deidentified Maximum,,02H73KZ,ICD10-PCS,Insertion of Defibrillator Lead into L Atrium, Perc Approach,,,8271.00
Deidentified Maximum,,02HK4KZ,ICD10-PCS,Insertion of Defib Lead into R Ventricle, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02HP3DZ,ICD10-PCS,Insertion of Intralum Dev into Pulm Trunk, Perc Approach,,,8271.00
Deidentified Maximum,,02HQ3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Art, Perc Approach,,,8271.00
Deidentified Maximum,,02HS02Z,ICD10-PCS,Insertion of Monitor Dev into R Pulm Vein, Open Approach,,,8271.00
Deidentified Maximum,,02HS3DZ,ICD10-PCS,Insertion of Intralum Dev into R Pulm Vein, Perc Approach,,,8271.00
Deidentified Maximum,,02HT02Z,ICD10-PCS,Insertion of Monitor Dev into L Pulm Vein, Open Approach,,,8271.00
Deidentified Maximum,,02HT0DZ,ICD10-PCS,Insertion of Intralum Dev into L Pulm Vein, Open Approach,,,8271.00
Deidentified Maximum,,02HX42Z,ICD10-PCS,Insert Monitor Dev in Thor Aorta Asc, Perc Endo,,,8271.00
Deidentified Maximum,,02K83ZZ,ICD10-PCS,Map Conduction Mechanism, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02ND3ZZ,ICD10-PCS,Release Papillary Muscle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02NG0ZZ,ICD10-PCS,Release Mitral Valve, Open Approach,,,8271.00
Deidentified Maximum,,02NH0ZZ,ICD10-PCS,Release Pulmonary Valve, Open Approach,,,8271.00
Deidentified Maximum,,02NJ0ZZ,ICD10-PCS,Release Tricuspid Valve, Open Approach,,,8271.00
Deidentified Maximum,,02PY07Z,ICD10-PCS,Removal of Autol Sub from Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02PY08Z,ICD10-PCS,Removal of Zooplastic from Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02PY0DZ,ICD10-PCS,Removal of Intralum Dev from Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02PY32Z,ICD10-PCS,Removal of Monitor Dev from Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02PY43Z,ICD10-PCS,Remove of Infusion Dev from Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02Q24ZZ,ICD10-PCS,Repair Coronary Artery, Three Arteries, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02Q80ZZ,ICD10-PCS,Repair Conduction Mechanism, Open Approach,,,8271.00
Deidentified Maximum,,02Q90ZZ,ICD10-PCS,Repair Chordae Tendineae, Open Approach,,,8271.00
Deidentified Maximum,,02QH0ZZ,ICD10-PCS,Repair Pulmonary Valve, Open Approach,,,8271.00
Deidentified Maximum,,02QK0ZZ,ICD10-PCS,Repair Right Ventricle, Open Approach,,,8271.00
Deidentified Maximum,,02QK3ZZ,ICD10-PCS,Repair Right Ventricle, Percutaneous Approach,,,8271.00
Deidentified Maximum,,02R54JZ,ICD10-PCS,Replace of Atrial Sept with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R647Z,ICD10-PCS,Replacement of R Atrium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02R70JZ,ICD10-PCS,Replacement of Left Atrium with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02R90JZ,ICD10-PCS,Replace of Chordae Tendineae with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RD07Z,ICD10-PCS,Replace of Papillary Muscle with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RD4KZ,ICD10-PCS,Replace Papillary Muscle w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02RF0KZ,ICD10-PCS,Replacement of Aortic Valve with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RG0JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RG3JZ,ICD10-PCS,Replacement of Mitral Valve with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02RH4JZ,ICD10-PCS,Replacement of Pulm Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RJ47Z,ICD10-PCS,Replace of Tricusp Valve with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RJ4JZ,ICD10-PCS,Replace of Tricusp Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RK08Z,ICD10-PCS,Replacement of R Ventricle with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RK48Z,ICD10-PCS,Replace of R Ventricle with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RK4JZ,ICD10-PCS,Replace of R Ventricle with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RL0JZ,ICD10-PCS,Replacement of Left Ventricle with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RM48Z,ICD10-PCS,Replace Ventricular Sept w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02RM4KZ,ICD10-PCS,Replace Ventricular Sept w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02RN47Z,ICD10-PCS,Replace of Pericardium with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RN4JZ,ICD10-PCS,Replace of Pericardium with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RP07Z,ICD10-PCS,Replacement of Pulmonary Trunk with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RP47Z,ICD10-PCS,Replacement of Pulm Trunk with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RP4KZ,ICD10-PCS,Replace of Pulm Trunk with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RQ07Z,ICD10-PCS,Replacement of R Pulm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RR08Z,ICD10-PCS,Replacement of L Pulm Art with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02RR4KZ,ICD10-PCS,Replace of L Pulm Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RT4KZ,ICD10-PCS,Replace of L Pulm Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RV0JZ,ICD10-PCS,Replacement of Sup Vena Cava with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02RV4JZ,ICD10-PCS,Replace of Sup Vena Cava with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RV4KZ,ICD10-PCS,Replace of Sup Vena Cava with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02RX07Z,ICD10-PCS,Replacement of Thor Aorta Asc with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02SR0ZZ,ICD10-PCS,Reposition Left Pulmonary Artery, Open Approach,,,8271.00
Deidentified Maximum,,02SS0ZZ,ICD10-PCS,Reposition Right Pulmonary Vein, Open Approach,,,8271.00
Deidentified Maximum,,02SV0ZZ,ICD10-PCS,Reposition Superior Vena Cava, Open Approach,,,8271.00
Deidentified Maximum,,02T90ZZ,ICD10-PCS,Resection of Chordae Tendineae, Open Approach,,,8271.00
Deidentified Maximum,,02U508Z,ICD10-PCS,Supplement Atrial Septum with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02U637Z,ICD10-PCS,Supplement Right Atrium with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02U638Z,ICD10-PCS,Supplement Right Atrium with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02U63KZ,ICD10-PCS,Supplement Right Atrium with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02U64JZ,ICD10-PCS,Supplement Right Atrium with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02U708Z,ICD10-PCS,Supplement Left Atrium with Zooplastic Tissue, Open Approach,,,8271.00
Deidentified Maximum,,02U73KZ,ICD10-PCS,Supplement Left Atrium with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02U907Z,ICD10-PCS,Supplement Chordae Tendineae with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02U938Z,ICD10-PCS,Supplement Chordae Tendineae with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02U947Z,ICD10-PCS,Supplement Chordae Tendineae w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UA3KZ,ICD10-PCS,Supplement Heart with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UD0JZ,ICD10-PCS,Supplement Papillary Muscle with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UD0KZ,ICD10-PCS,Supplement Papillary Muscle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UD47Z,ICD10-PCS,Supplement Papillary Muscle w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UD48Z,ICD10-PCS,Supplement Papillary Muscle w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02UF07Z,ICD10-PCS,Supplement Aortic Valve with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UF37J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Autol Sub, Perc,,,8271.00
Deidentified Maximum,,02UF38J,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Zooplastic, Perc,,,8271.00
Deidentified Maximum,,02UF38Z,ICD10-PCS,Supplement Aortic Valve with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UF4JJ,ICD10-PCS,Supplement Aort Valve fr Trunc Vlv w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UG08E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Zooplastic, Open,,,8271.00
Deidentified Maximum,,02UG0KE,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02UG37E,ICD10-PCS,Supplement Mitral Valve fr L AV Vlv w Autol Sub, Perc,,,8271.00
Deidentified Maximum,,02UG3KZ,ICD10-PCS,Supplement Mitral Valve with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UG4JZ,ICD10-PCS,Supplement Mitral Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UH48Z,ICD10-PCS,Supplement Pulm Valve with Zooplastic, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UH4JZ,ICD10-PCS,Supplement Pulm Valve with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UJ0KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,02UJ37Z,ICD10-PCS,Supplement Tricuspid Valve with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UJ3KG,ICD10-PCS,Supplement Tricusp Valve fr R AV Vlv w Nonaut Sub, Perc,,,8271.00
Deidentified Maximum,,02UK4KZ,ICD10-PCS,Supplement R Ventricle with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UL0KZ,ICD10-PCS,Supplement Left Ventricle with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UM0JZ,ICD10-PCS,Supplement Ventricular Septum with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UM0KZ,ICD10-PCS,Supplement Ventricular Septum with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UN07Z,ICD10-PCS,Supplement Pericardium with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UP08Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Open Approach,,,8271.00
Deidentified Maximum,,02UP38Z,ICD10-PCS,Supplement Pulmonary Trunk with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UQ07Z,ICD10-PCS,Supplement R Pulm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UQ3KZ,ICD10-PCS,Supplement R Pulm Art with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UT0KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UT47Z,ICD10-PCS,Supplement L Pulm Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UT4KZ,ICD10-PCS,Supplement L Pulm Vein with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UV38Z,ICD10-PCS,Supplement Superior Vena Cava with Zooplastic, Perc Approach,,,8271.00
Deidentified Maximum,,02UV47Z,ICD10-PCS,Supplement Sup Vena Cava with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02UW0KZ,ICD10-PCS,Supplement Thor Aorta Desc with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,02UW37Z,ICD10-PCS,Supplement Thor Aorta Desc with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UW3JZ,ICD10-PCS,Supplement Thor Aorta Desc with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,02UW48Z,ICD10-PCS,Supplement Thor Aorta Desc w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02UW4JZ,ICD10-PCS,Supplement Thor Aorta Desc w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,02UX48Z,ICD10-PCS,Supplement Thor Aorta Asc w Zooplastic, Perc Endo,,,8271.00
Deidentified Maximum,,02VW0FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Open,,,8271.00
Deidentified Maximum,,02VW4EZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 1 or 2, Perc Endo,,,8271.00
Deidentified Maximum,,02VW4FZ,ICD10-PCS,Restrict Thor Aorta Desc w Fenestr Dev 3+, Perc Endo,,,8271.00
Deidentified Maximum,,02VX0FZ,ICD10-PCS,Restrict Thor Aorta Asc w Fenestr Dev 3+, Open,,,8271.00
Deidentified Maximum,,02W50JZ,ICD10-PCS,Revision of Synth Sub in Atrial Sept, Open Approach,,,8271.00
Deidentified Maximum,,02WF0KZ,ICD10-PCS,Revision of Nonaut Sub in Aortic Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WF47Z,ICD10-PCS,Revision of Autol Sub in Aortic Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WF48Z,ICD10-PCS,Revision of Zooplastic in Aortic Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WH0KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WH47Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WH4KZ,ICD10-PCS,Revision of Nonaut Sub in Pulm Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WJ4KZ,ICD10-PCS,Revision of Nonaut Sub in Tricusp Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WY08Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02WY0KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02WY33Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02WY3DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02WY3KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02WY4DZ,ICD10-PCS,Revision of Intralum Dev in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03130JN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,03130KM,ICD10-PCS,Bypass R Subclav Art to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,03130KN,ICD10-PCS,Bypass R Subclav Art to L Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,03140ZM,ICD10-PCS,Bypass Left Subclavian Artery to R Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,03544ZZ,ICD10-PCS,Destruction of Left Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03B00ZZ,ICD10-PCS,Excision of Right Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Maximum,,03B10ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Maximum,,03B13ZZ,ICD10-PCS,Excision of Left Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03B23ZZ,ICD10-PCS,Excision of Innominate Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03B33ZZ,ICD10-PCS,Excision of Right Subclavian Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03B43ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03R007Z,ICD10-PCS,Replacement of R Int Mamm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R10KZ,ICD10-PCS,Replacement of L Int Mamm Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R14JZ,ICD10-PCS,Replace of L Int Mamm Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R407Z,ICD10-PCS,Replacement of L Subclav Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03S00ZZ,ICD10-PCS,Reposition Right Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Maximum,,03S10ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Open Approach,,,8271.00
Deidentified Maximum,,03S13ZZ,ICD10-PCS,Reposition Left Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03S33ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SA0ZZ,ICD10-PCS,Reposition Left Ulnar Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SB3ZZ,ICD10-PCS,Reposition Right Radial Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SH4ZZ,ICD10-PCS,Reposition Right Common Carotid Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SK3ZZ,ICD10-PCS,Reposition Right Internal Carotid Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03SL0ZZ,ICD10-PCS,Reposition Left Internal Carotid Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SN3ZZ,ICD10-PCS,Reposition Left External Carotid Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03SQ3ZZ,ICD10-PCS,Reposition Left Vertebral Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SS4ZZ,ICD10-PCS,Reposition Right Temporal Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WG48Z,ICD10-PCS,Revision of Zooplastic in Mitral Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WG4JZ,ICD10-PCS,Revision of Synth Sub in Mitral Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WH07Z,ICD10-PCS,Revision of Autol Sub in Pulm Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WH48Z,ICD10-PCS,Revision of Zooplastic in Pulm Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WH4JZ,ICD10-PCS,Revision of Synth Sub in Pulm Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WJ0JZ,ICD10-PCS,Revision of Synth Sub in Tricusp Valve, Open Approach,,,8271.00
Deidentified Maximum,,02WJ47Z,ICD10-PCS,Revision of Autol Sub in Tricusp Valve, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WM0JZ,ICD10-PCS,Revision of Synth Sub in Ventricular Sept, Open Approach,,,8271.00
Deidentified Maximum,,02WY03Z,ICD10-PCS,Revision of Infusion Device in Great Vessel, Open Approach,,,8271.00
Deidentified Maximum,,02WY38Z,ICD10-PCS,Revision of Zooplastic Tissue in Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02WY3CZ,ICD10-PCS,Revision of Extralum Dev in Great Vessel, Perc Approach,,,8271.00
Deidentified Maximum,,02WY42Z,ICD10-PCS,Revision of Monitor Dev in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,02WY4KZ,ICD10-PCS,Revision of Nonaut Sub in Great Vessel, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03130ZN,ICD10-PCS,Bypass Right Subclavian Artery to L Pulm Art, Open Approach,,,8271.00
Deidentified Maximum,,03140AM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,03140JM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,03140KM,ICD10-PCS,Bypass L Subclav Art to R Pulm Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,03513ZZ,ICD10-PCS,Destruction of Left Internal Mammary Artery, Perc Approach,,,8271.00
Deidentified Maximum,,03520ZZ,ICD10-PCS,Destruction of Innominate Artery, Open Approach,,,8271.00
Deidentified Maximum,,03523ZZ,ICD10-PCS,Destruction of Innominate Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03524ZZ,ICD10-PCS,Destruction of Innominate Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03B44ZZ,ICD10-PCS,Excision of Left Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R04JZ,ICD10-PCS,Replace of R Int Mamm Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R04KZ,ICD10-PCS,Replace R Int Mamm Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,03R147Z,ICD10-PCS,Replace of L Int Mamm Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03R20KZ,ICD10-PCS,Replacement of Innom Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R30JZ,ICD10-PCS,Replacement of R Subclav Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R40JZ,ICD10-PCS,Replacement of L Subclav Art with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,03R44JZ,ICD10-PCS,Replace of L Subclav Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S34ZZ,ICD10-PCS,Reposition Right Subclavian Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03S93ZZ,ICD10-PCS,Reposition Right Ulnar Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SB4ZZ,ICD10-PCS,Reposition Right Radial Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SD4ZZ,ICD10-PCS,Reposition Right Hand Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03SF3ZZ,ICD10-PCS,Reposition Left Hand Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,03SM0ZZ,ICD10-PCS,Reposition Right External Carotid Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SU0ZZ,ICD10-PCS,Reposition Right Thyroid Artery, Open Approach,,,8271.00
Deidentified Maximum,,03SY0ZZ,ICD10-PCS,Reposition Upper Artery, Open Approach,,,8271.00
Deidentified Maximum,,03U007Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03U037Z,ICD10-PCS,Supplement R Int Mamm Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03U107Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03U137Z,ICD10-PCS,Supplement L Int Mamm Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03U207Z,ICD10-PCS,Supplement Innominate Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03U437Z,ICD10-PCS,Supplement L Subclav Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03U507Z,ICD10-PCS,Supplement R Axilla Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03U837Z,ICD10-PCS,Supplement L Brach Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UC37Z,ICD10-PCS,Supplement Left Radial Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UC47Z,ICD10-PCS,Supplement L Radial Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UD37Z,ICD10-PCS,Supplement Right Hand Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UF07Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,03UF37Z,ICD10-PCS,Supplement Left Hand Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UG37Z,ICD10-PCS,Supplement Intracranial Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UH47Z,ICD10-PCS,Supplement R Com Carotid with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UQ47Z,ICD10-PCS,Supplement L Verteb Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UR37Z,ICD10-PCS,Supplement Face Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03US47Z,ICD10-PCS,Supplement R Temporal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,03UT37Z,ICD10-PCS,Supplement L Temporal Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,03UV37Z,ICD10-PCS,Supplement Left Thyroid Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0410097,ICD10-PCS,BP ABD AO LT CMN ILIAC ART AUTO VEN OPN APPR,,,8271.00
Deidentified Maximum,,041009G,ICD10-PCS,BP ABD AO B EXT ILIAC ART AUTO VEN TISS OPN APPR,,,8271.00
Deidentified Maximum,,041009H,ICD10-PCS,BP ABD AO RT FEM ART AUTO VEN TISS OPN APPROACH,,,8271.00
Deidentified Maximum,,04100A6,ICD10-PCS,BP ABD AO RT CMN ILIAC ART AUTO ART OPN APPR,,,8271.00
Deidentified Maximum,,04100J2,ICD10-PCS,BYPASS ABD AO MES ART SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100JC,ICD10-PCS,BP ABD AO B INTRL ILIAC ART SYN SUB OPN APPROACH,,,8271.00
Deidentified Maximum,,04100JH,ICD10-PCS,BYPS ABD AO RT FEM ART SYNTH SUBST OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100K0,ICD10-PCS,BP ABD AO ABD AO NONAUTO TISS SUBST OPN APPROACH,,,8271.00
Deidentified Maximum,,04100K3,ICD10-PCS,BP ABD AO RT RENL ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100KD,ICD10-PCS,BP ABD AO RT EXT ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100KF,ICD10-PCS,BP ABD AO LT EXT ILIAC ART NONAUTO SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100KK,ICD10-PCS,BP ABD AO B FEM ART NONAUTO TISS SUB OPN APPR,,,8271.00
Deidentified Maximum,,04100Z1,ICD10-PCS,BYPASS ABD AORTA CELIAC ARTERY OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100Z7,ICD10-PCS,BYPASS ABD AO LT COMMON ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100ZB,ICD10-PCS,BYPASS ABD AO LT INTRL ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100ZD,ICD10-PCS,BYPASS ABD AORTA RT EXT ILIAC ART OPEN APPROACH,,,8271.00
Deidentified Maximum,,04100ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Open Approach,,,8271.00
Deidentified Maximum,,0410494,ICD10-PCS,Bypass Abd Aorta to L Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,0410498,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041049B,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041049F,ICD10-PCS,Bypass Abd Aorta to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,04104A2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104AR,ICD10-PCS,Bypass Abd Aorta to Low Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,04104J2,ICD10-PCS,Bypass Abd Aorta to Mesent Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104J4,ICD10-PCS,Bypass Abd Aorta to L Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104J8,ICD10-PCS,Bypass Abd Aorta to B Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104JB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104KB,ICD10-PCS,Bypass Abd Aorta to L Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04104Z0,ICD10-PCS,Bypass Abdominal Aorta to Abd Aorta, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104Z2,ICD10-PCS,Bypass Abdominal Aorta to Mesent Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104Z8,ICD10-PCS,Bypass Abdominal Aorta to B Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104ZH,ICD10-PCS,Bypass Abdominal Aorta to R Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104ZQ,ICD10-PCS,Bypass Abdominal Aorta to Low Ex Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04104ZR,ICD10-PCS,Bypass Abdominal Aorta to Lower Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04140A4,ICD10-PCS,Bypass Splenic Art to L Renal A w Autol Art, Open,,,8271.00
Deidentified Maximum,,04140J5,ICD10-PCS,Bypass Splenic Art to B Renal A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,04144J4,ICD10-PCS,Bypass Splenic Art to L Renal A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04144K3,ICD10-PCS,Bypass Splenic Art to R Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04144K5,ICD10-PCS,Bypass Splenic Art to B Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04144Z4,ICD10-PCS,Bypass Splenic Artery to L Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041C092,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C096,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C098,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C09C,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C09K,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041C0A2,ICD10-PCS,Bypass R Com Iliac Art to Mesent Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0A4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0A8,ICD10-PCS,Bypass R Com Iliac Art to B Com Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0AH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041C0JC,ICD10-PCS,Bypass R Com Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0JK,ICD10-PCS,Bypass R Com Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0JR,ICD10-PCS,Bypass R Com Iliac Art to Low Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041C0K4,ICD10-PCS,Bypass R Com Iliac Art to L Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0KH,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041C0Z5,ICD10-PCS,Bypass Right Common Iliac Artery to B Renal A, Open Approach,,,8271.00
Deidentified Maximum,,041C0ZQ,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art, Open Approach,,,8271.00
Deidentified Maximum,,041C49F,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C49G,ICD10-PCS,Bypass R Com Iliac Art to B Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C49H,ICD10-PCS,Bypass R Com Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C49Q,ICD10-PCS,Bypass R Com Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041C4A3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4A9,ICD10-PCS,Bypass R Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4AB,ICD10-PCS,Bypass R Com Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4AF,ICD10-PCS,Bypass R Com Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041C4J1,ICD10-PCS,Bypass R Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4J6,ICD10-PCS,Bypass R Com Iliac Art to R Com Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4K3,ICD10-PCS,Bypass R Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4KJ,ICD10-PCS,Bypass R Com Iliac Art to L Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041C4ZR,ICD10-PCS,Bypass R Com Iliac Art to Low Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D092,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D09F,ICD10-PCS,Bypass L Com Iliac Art to L Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D09G,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041D0AQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041D0J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0JR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041D0K5,ICD10-PCS,Bypass L Com Iliac Art to B Renal A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0KD,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0KG,ICD10-PCS,Bypass L Com Iliac Art to B Ext Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041D0Z4,ICD10-PCS,Bypass Left Common Iliac Artery to L Renal A, Open Approach,,,8271.00
Deidentified Maximum,,041D0ZB,ICD10-PCS,Bypass Left Common Iliac Artery to L Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041D0ZJ,ICD10-PCS,Bypass Left Common Iliac Artery to L Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041D0ZR,ICD10-PCS,Bypass Left Common Iliac Artery to Low Art, Open Approach,,,8271.00
Deidentified Maximum,,041D494,ICD10-PCS,Bypass L Com Iliac Art to L Renal A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D497,ICD10-PCS,Bypass L Com Iliac Art to L Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D498,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D49D,ICD10-PCS,Bypass L Com Iliac Art to R Ext Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041D4A6,ICD10-PCS,Bypass L Com Iliac Art to R Com Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4A9,ICD10-PCS,Bypass L Com Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4AR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041D4J1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4JH,ICD10-PCS,Bypass L Com Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4JK,ICD10-PCS,Bypass L Com Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4JQ,ICD10-PCS,Bypass L Com Iliac Art to Low Ex Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4K0,ICD10-PCS,Bypass L Com Iliac Art to Abd Aorta w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4K1,ICD10-PCS,Bypass L Com Iliac Art to Celiac Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4K3,ICD10-PCS,Bypass L Com Iliac Art to R Renal A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4KR,ICD10-PCS,Bypass L Com Iliac Art to Low Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041D4Z2,ICD10-PCS,Bypass L Com Iliac Art to Mesent Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4Z4,ICD10-PCS,Bypass L Com Iliac Art to L Renal A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4Z8,ICD10-PCS,Bypass L Com Iliac Art to B Com Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041D4ZC,ICD10-PCS,Bypass L Com Iliac Art to B Int Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041E0AP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041E0JG,ICD10-PCS,Bypass R Int Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041E0K9,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E0KC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041E499,ICD10-PCS,Bypass R Int Iliac Art to R Int Ilia w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041E4AJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041E4JC,ICD10-PCS,Bypass R Int Iliac Art to B Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4JJ,ICD10-PCS,Bypass R Int Iliac Art to L Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4JK,ICD10-PCS,Bypass R Int Iliac Art to B Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4JP,ICD10-PCS,Bypass R Int Iliac Art to Foot Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041E4KF,ICD10-PCS,Bypass R Int Iliac Art to L Ext Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F09B,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F09C,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041F0A9,ICD10-PCS,Bypass L Int Iliac Art to R Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0AC,ICD10-PCS,Bypass L Int Iliac Art to B Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0AD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041F0KH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0KQ,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041F0ZF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041F0ZH,ICD10-PCS,Bypass L Int Iliac Art to R Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041F0ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Open Approach,,,8271.00
Deidentified Maximum,,041F49H,ICD10-PCS,Bypass L Int Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F49J,ICD10-PCS,Bypass L Int Iliac Art to L Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F49Q,ICD10-PCS,Bypass L Int Iliac Art to Low Ex Art w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041F4AG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041F4JB,ICD10-PCS,Bypass L Int Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4JF,ICD10-PCS,Bypass L Int Iliac Art to L Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4JG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4KK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041F4ZD,ICD10-PCS,Bypass L Int Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041F4ZG,ICD10-PCS,Bypass L Int Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041F4ZK,ICD10-PCS,Bypass L Int Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041F4ZP,ICD10-PCS,Bypass L Int Iliac Art to Foot Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H0AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0AF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0AG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0AK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Autol Art, Open,,,8271.00
Deidentified Maximum,,041H0JC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0JF,ICD10-PCS,Bypass R Ext Iliac Art to L Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0JK,ICD10-PCS,Bypass R Ext Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041H0KC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H0KP,ICD10-PCS,Bypass R Ext Iliac Art to Foot Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H0KQ,ICD10-PCS,Bypass R Ext Iliac Art to Low Ex Art w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041H0ZC,ICD10-PCS,Bypass R Ext Iliac Art to B Int Ilia, Open Approach,,,8271.00
Deidentified Maximum,,041H49H,ICD10-PCS,Bypass R Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041H4A9,ICD10-PCS,Bypass R Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4AB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4AD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041H4JB,ICD10-PCS,Bypass R Ext Iliac Art to L Int Ilia w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041H4ZD,ICD10-PCS,Bypass R Ext Iliac Art to R Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H4ZG,ICD10-PCS,Bypass R Ext Iliac Art to B Ext Ilia, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041H4ZJ,ICD10-PCS,Bypass R Ext Iliac Art to L Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,041J099,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J09B,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J09Q,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Vn, Open,,,8271.00
Deidentified Maximum,,041J0AB,ICD10-PCS,Bypass L Ext Iliac Art to L Int Ilia w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0AQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Autol Art, Open,,,8271.00
Deidentified Maximum,,041J0JG,ICD10-PCS,Bypass L Ext Iliac Art to B Ext Ilia w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0JK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Synth Sub, Open,,,8271.00
Deidentified Maximum,,041J0KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Open,,,8271.00
Deidentified Maximum,,041J49H,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J49K,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,041J4A9,ICD10-PCS,Bypass L Ext Iliac Art to R Int Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4AF,ICD10-PCS,Bypass L Ext Iliac Art to L Ext Ilia w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4AJ,ICD10-PCS,Bypass L Ext Iliac Art to L Femor A w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,041J4JH,ICD10-PCS,Bypass L Ext Iliac Art to R Femor A w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4JP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4KC,ICD10-PCS,Bypass L Ext Iliac Art to B Int Ilia w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4KK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4KP,ICD10-PCS,Bypass L Ext Iliac Art to Foot Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4KQ,ICD10-PCS,Bypass L Ext Iliac Art to Low Ex Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,041J4ZK,ICD10-PCS,Bypass L Ext Iliac Art to B Femor A, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04500ZZ,ICD10-PCS,Destruction of Abdominal Aorta, Open Approach,,,8271.00
Deidentified Maximum,,04520ZZ,ICD10-PCS,Destruction of Gastric Artery, Open Approach,,,8271.00
Deidentified Maximum,,04530ZZ,ICD10-PCS,Destruction of Hepatic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04533ZZ,ICD10-PCS,Destruction of Hepatic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04543ZZ,ICD10-PCS,Destruction of Splenic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04544ZZ,ICD10-PCS,Destruction of Splenic Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04550ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Maximum,,04553ZZ,ICD10-PCS,Destruction of Superior Mesenteric Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04570ZZ,ICD10-PCS,Destruction of Left Colic Artery, Open Approach,,,8271.00
Deidentified Maximum,,045A0ZZ,ICD10-PCS,Destruction of Left Renal Artery, Open Approach,,,8271.00
Deidentified Maximum,,045A4ZZ,ICD10-PCS,Destruction of Left Renal Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,045D4ZZ,ICD10-PCS,Destruction of Left Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,045E0ZZ,ICD10-PCS,Destruction of Right Internal Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,045F3ZZ,ICD10-PCS,Destruction of Left Internal Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,045H0ZZ,ICD10-PCS,Destruction of Right External Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,045J4ZZ,ICD10-PCS,Destruction of L Ext Iliac Art, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04B03ZZ,ICD10-PCS,Excision of Abdominal Aorta, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04B14ZZ,ICD10-PCS,Excision of Celiac Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,04B24ZZ,ICD10-PCS,Excision of Gastric Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,04B63ZZ,ICD10-PCS,Excision of Right Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04B83ZZ,ICD10-PCS,Excision of Middle Colic Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04B90ZZ,ICD10-PCS,Excision of Right Renal Artery, Open Approach,,,8271.00
Deidentified Maximum,,04B93ZZ,ICD10-PCS,Excision of Right Renal Artery, Percutaneous Approach,,,8271.00
Deidentified Maximum,,04BB4ZZ,ICD10-PCS,Excision of Inferior Mesenteric Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04BC0ZZ,ICD10-PCS,Excision of Right Common Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04BE3ZZ,ICD10-PCS,Excision of Right Internal Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04BH0ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04BH3ZZ,ICD10-PCS,Excision of Right External Iliac Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04R007Z,ICD10-PCS,Replacement of Abdominal Aorta with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R047Z,ICD10-PCS,Replacement of Abd Aorta with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R10KZ,ICD10-PCS,Replacement of Celiac Artery with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R14JZ,ICD10-PCS,Replacement of Celiac Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R14KZ,ICD10-PCS,Replace of Celiac Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R44KZ,ICD10-PCS,Replace of Splenic Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R54JZ,ICD10-PCS,Replace of Sup Mesent Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04R607Z,ICD10-PCS,Replacement of R Colic Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04R94KZ,ICD10-PCS,Replace of R Renal Art with Nonaut Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04RA07Z,ICD10-PCS,Replacement of L Renal Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RB4JZ,ICD10-PCS,Replace of Inf Mesent Art with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04RB4KZ,ICD10-PCS,Replace Inf Mesent Art w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RC07Z,ICD10-PCS,Replacement of R Com Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RE07Z,ICD10-PCS,Replacement of R Int Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RF0KZ,ICD10-PCS,Replace of L Int Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RF4JZ,ICD10-PCS,Replace L Int Iliac Art w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04RJ07Z,ICD10-PCS,Replacement of L Ext Iliac Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04RJ0KZ,ICD10-PCS,Replace of L Ext Iliac Art with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,04S14ZZ,ICD10-PCS,Reposition Celiac Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,04S44ZZ,ICD10-PCS,Reposition Splenic Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,04S50ZZ,ICD10-PCS,Reposition Superior Mesenteric Artery, Open Approach,,,8271.00
Deidentified Maximum,,04S80ZZ,ICD10-PCS,Reposition Middle Colic Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SC4ZZ,ICD10-PCS,Reposition Right Common Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SD0ZZ,ICD10-PCS,Reposition Left Common Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SH0ZZ,ICD10-PCS,Reposition Right External Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SJ0ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SJ4ZZ,ICD10-PCS,Reposition Left External Iliac Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SK4ZZ,ICD10-PCS,Reposition Right Femoral Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SP4ZZ,ICD10-PCS,Reposition Right Anterior Tibial Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SQ0ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SQ3ZZ,ICD10-PCS,Reposition Left Anterior Tibial Artery, Perc Approach,,,8271.00
Deidentified Maximum,,04SR4ZZ,ICD10-PCS,Reposition Right Posterior Tibial Artery, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04SU0ZZ,ICD10-PCS,Reposition Left Peroneal Artery, Open Approach,,,8271.00
Deidentified Maximum,,04SY4ZZ,ICD10-PCS,Reposition Lower Artery, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,04U237Z,ICD10-PCS,Supplement Gastric Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04U337Z,ICD10-PCS,Supplement Hepatic Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04U507Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04U537Z,ICD10-PCS,Supplement Sup Mesent Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04U647Z,ICD10-PCS,Supplement R Colic Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04U837Z,ICD10-PCS,Supplement Middle Colic Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UC37Z,ICD10-PCS,Supplement R Com Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UC47Z,ICD10-PCS,Supplement R Com Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04UD47Z,ICD10-PCS,Supplement L Com Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04UE37Z,ICD10-PCS,Supplement R Int Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UF37Z,ICD10-PCS,Supplement L Int Iliac Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UF47Z,ICD10-PCS,Supplement L Int Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04UJ47Z,ICD10-PCS,Supplement L Ext Iliac Art w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,04UL07Z,ICD10-PCS,Supplement Left Femoral Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UL47Z,ICD10-PCS,Supplement L Femor Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UM07Z,ICD10-PCS,Supplement R Poplit Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UN07Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UN37Z,ICD10-PCS,Supplement L Poplit Art with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,04UP07Z,ICD10-PCS,Supplement R Ant Tib Art with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UT47Z,ICD10-PCS,Supplement R Peroneal Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UV07Z,ICD10-PCS,Supplement Right Foot Artery with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,04UW47Z,ICD10-PCS,Supplement L Foot Art with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,04UY37Z,ICD10-PCS,Supplement Lower Artery with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05100AY,ICD10-PCS,Bypass Azygos Vein to Up Vein with Autol Art, Open Approach,,,8271.00
Deidentified Maximum,,05114AY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Autol Art, Perc Endo,,,8271.00
Deidentified Maximum,,05114JY,ICD10-PCS,Bypass Hemiazygos Vein to Up Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,051307Y,ICD10-PCS,Bypass R Innom Vein to Up Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,051407Y,ICD10-PCS,Bypass L Innom Vein to Up Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05140ZY,ICD10-PCS,Bypass Left Innominate Vein to Upper Vein, Open Approach,,,8271.00
Deidentified Maximum,,051449Y,ICD10-PCS,Bypass L Innom Vein to Up Vein w Autol Vn, Perc Endo,,,8271.00
Deidentified Maximum,,051509Y,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Autol Vn, Open,,,8271.00
Deidentified Maximum,,05150KY,ICD10-PCS,BYPS RT SV UP VEIN NONAUT SUB OPEN,,,8271.00
Deidentified Maximum,,05154JY,ICD10-PCS,Bypass R Subclav Vein to Up Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05164ZY,ICD10-PCS,Bypass Left Subclavian Vein to Up Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05504ZZ,ICD10-PCS,Destruction of Azygos Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,05544ZZ,ICD10-PCS,Destruction of Left Innominate Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05550ZZ,ICD10-PCS,Destruction of Right Subclavian Vein, Open Approach,,,8271.00
Deidentified Maximum,,05B14ZZ,ICD10-PCS,Excision of Hemiazygos Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05B33ZZ,ICD10-PCS,Excision of Right Innominate Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05B40ZZ,ICD10-PCS,Excision of Left Innominate Vein, Open Approach,,,8271.00
Deidentified Maximum,,05R00JZ,ICD10-PCS,Replacement of Azygos Vein with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R14JZ,ICD10-PCS,Replace Hemiazygos Vein w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05R307Z,ICD10-PCS,Replacement of R Innom Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R34JZ,ICD10-PCS,Replace of R Innom Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R407Z,ICD10-PCS,Replacement of L Innom Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R40KZ,ICD10-PCS,Replacement of L Innom Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,05R54JZ,ICD10-PCS,Replace of R Subclav Vein with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05R54KZ,ICD10-PCS,Replace R Subclav Vein w Nonaut Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05R60KZ,ICD10-PCS,Replacement of L Subclav Vein with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,05S03ZZ,ICD10-PCS,Reposition Azygos Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05S13ZZ,ICD10-PCS,Reposition Hemiazygos Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05S30ZZ,ICD10-PCS,Reposition Right Innominate Vein, Open Approach,,,8271.00
Deidentified Maximum,,05S50ZZ,ICD10-PCS,Reposition Right Subclavian Vein, Open Approach,,,8271.00
Deidentified Maximum,,05S60ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Open Approach,,,8271.00
Deidentified Maximum,,05S64ZZ,ICD10-PCS,Reposition Left Subclavian Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SF4ZZ,ICD10-PCS,Reposition Left Cephalic Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SG3ZZ,ICD10-PCS,Reposition Right Hand Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SH3ZZ,ICD10-PCS,Reposition Left Hand Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SL3ZZ,ICD10-PCS,Reposition Intracranial Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SL4ZZ,ICD10-PCS,Reposition Intracranial Vein, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05SV3ZZ,ICD10-PCS,Reposition Left Face Vein, Percutaneous Approach,,,8271.00
Deidentified Maximum,,05SY4ZZ,ICD10-PCS,Reposition Upper Vein, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,05U007Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05U037Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05U047Z,ICD10-PCS,Supplement Azygos Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05U107Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05U137Z,ICD10-PCS,Supplement Hemiazygos Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05U147Z,ICD10-PCS,Supplement Hemiazygos Vein w Autol Sub, Perc Endo,,,8271.00
Deidentified Maximum,,05U647Z,ICD10-PCS,Supplement L Subclav Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,05U837Z,ICD10-PCS,Supplement Left Axillary Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UC37Z,ICD10-PCS,Supplement Left Basilic Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UH07Z,ICD10-PCS,Supplement Left Hand Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UP37Z,ICD10-PCS,Supplement R Ext Jugular Vein with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,05UQ07Z,ICD10-PCS,Supplement L Ext Jugular Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,05UR07Z,ICD10-PCS,Supplement R Verteb Vein with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RG007J,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG00A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG00J1,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG03J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG03JJ,ICD10-PCS,Fusion Occip Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG03K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG03Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG04AJ,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG04K1,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG04Z0,ICD10-PCS,Fusion of Occip Jt, Ant Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG04Z1,ICD10-PCS,Fusion of Occip Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG04ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG10K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG10KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG10Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG10Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG14K0,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG14K1,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG14KJ,ICD10-PCS,Fusion Cerv Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG14ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG20K0,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG20KJ,ICD10-PCS,Fusion 2-6 C Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG23A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG23J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG24A1,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG407J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG40A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG40AJ,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG40J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG40KJ,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG43A0,ICD10-PCS,Fusion C-thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG43JJ,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG43Z1,ICD10-PCS,Fusion of C-thor Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG447J,ICD10-PCS,Fusion C-thor Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG607J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG60J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG60K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG63JJ,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG64AJ,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG64J0,ICD10-PCS,Fusion Thor Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG64Z1,ICD10-PCS,Fusion of Thor Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG70J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG70JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG70K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG70Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG7371,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG73KJ,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG747J,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG74A1,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG74Z1,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG807J,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG80AJ,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG80JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG80ZJ,ICD10-PCS,Fusion of >7 T Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG83J1,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG84A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA0AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RGA0K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RGA0Z0,ICD10-PCS,Fusion of T-lum Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RGA3A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RGA3AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RGA3J0,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RGA4K1,ICD10-PCS,Fusion T-lum Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RH40BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Open,,,8271.00
Deidentified Maximum,,0RH43BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc,,,8271.00
Deidentified Maximum,,0RH44BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in C-thor Jt, Perc Endo,,,8271.00
Deidentified Maximum,,0RHA0BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in T-lum Jt, Open,,,8271.00
Deidentified Maximum,,0RHA4CZ,ICD10-PCS,Insert of Pedcl Stabl Dev into T-lum Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RR50JZ,ICD10-PCS,Replacement of C-thor Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RRB0JZ,ICD10-PCS,Replacement of T-lum Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RT40ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Joint, Open Approach,,,8271.00
Deidentified Maximum,,0RT50ZZ,ICD10-PCS,Resection of Cervicothoracic Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RTB0ZZ,ICD10-PCS,Resection of Thoracolumbar Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RW30JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RW34JZ,ICD10-PCS,Revision of Synth Sub in Cerv Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RW53JZ,ICD10-PCS,Revision of Synth Sub in C-thor Disc, Perc Approach,,,8271.00
Deidentified Maximum,,0S523ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SB20ZZ,ICD10-PCS,EXCISION LUMBAR VERTEBRAL DISC OPEN,,,8271.00
Deidentified Maximum,,0SB43ZZ,ICD10-PCS,Excision of Lumbosacral Disc, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SB53ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SB54ZZ,ICD10-PCS,Excision of Sacrococcygeal Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SB60ZZ,ICD10-PCS,EXCISION OF COCCYGEAL JOINT OPEN,,,8271.00
Deidentified Maximum,,0SB63ZZ,ICD10-PCS,Excision of Coccygeal Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SB73ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SB74ZZ,ICD10-PCS,Excision of Right Sacroiliac Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG0070,ICD10-PCS,Fusion Lum Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG00K0,ICD10-PCS,Fusion Lum Jt w Nonaut Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG03AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG0471,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG04A1,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG04J1,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG04JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG1070,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG107J,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG10Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0SG10Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0SG13J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG1470,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG14KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG14Z1,ICD10-PCS,Fusion of 2-4 L Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG30KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG30Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0SG30ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0SG3370,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG33A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG33AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG33Z0,ICD10-PCS,Fusion of Lumbosacral Joint, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0SG33ZJ,ICD10-PCS,Fusion of Lumbosacral Joint, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0SG3471,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG34A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG34KJ,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG53KZ,ICD10-PCS,Fusion of Sacrococcygeal Jt with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SG54JZ,ICD10-PCS,Fusion Sacrococcygeal Jt w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,0SG60JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG64ZZ,ICD10-PCS,Fusion of Coccygeal Joint, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,0SG704Z,ICD10-PCS,Fusion of Right Sacroiliac Joint with Int Fix, Open Approach,,,8271.00
Deidentified Maximum,,0SG70KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG73ZZ,ICD10-PCS,Fusion of Right Sacroiliac Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SG83JZ,ICD10-PCS,Fusion of L Sacroiliac Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lum Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0SH30DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Lumsac Jt, Open Approach,,,8271.00
Deidentified Maximum,,0SH33BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc,,,8271.00
Deidentified Maximum,,0SH33CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Lumsac Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0SH34BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lumsac Jt, Perc Endo,,,8271.00
Deidentified Maximum,,0SR901Z,ICD10-PCS,Replacement of Right Hip Joint with Metal, Open Approach,,,8271.00
Deidentified Maximum,,0SRA009,ICD10-PCS,Replace R Hip Jt, Acetab w Polyeth, Cement, Open,,,8271.00
Deidentified Maximum,,0SRA01Z,ICD10-PCS,Replacement of R Hip Jt, Acetab with Metal, Open Approach,,,8271.00
Deidentified Maximum,,0SRA03A,ICD10-PCS,Replace R Hip Jt, Acetab w Ceramic, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRA0JZ,ICD10-PCS,Replace of R Hip Jt, Acetab with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRB019,ICD10-PCS,Replacement of L Hip Jt with Metal, Cement, Open Approach,,,8271.00
Deidentified Maximum,,0SRB01A,ICD10-PCS,Replacement of L Hip Jt with Metal, Uncement, Open Approach,,,8271.00
Deidentified Maximum,,0SRB04Z,ICD10-PCS,Replacement of L Hip Jt with Ceramic on Poly, Open Approach,,,8271.00
Deidentified Maximum,,0SRB07Z,ICD10-PCS,Replacement of Left Hip Joint with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRB0JZ,ICD10-PCS,Replacement of Left Hip Joint with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRC07Z,ICD10-PCS,Replacement of R Knee Jt with Autol Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRE00Z,ICD10-PCS,Replacement of L Hip Jt, Acetab with Polyeth, Open Approach,,,8271.00
Deidentified Maximum,,0SRS01A,ICD10-PCS,Replace L Hip Jt, Femoral w Metal, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRS039,ICD10-PCS,Replace L Hip Jt, Femoral w Ceramic, Cement, Open,,,8271.00
Deidentified Maximum,,0SRS03Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Ceramic, Open Approach,,,8271.00
Deidentified Maximum,,0SRT0J9,ICD10-PCS,Replace R Knee Jt, Femoral w Synth Sub, Cement, Open,,,8271.00
Deidentified Maximum,,0SRT0KZ,ICD10-PCS,Replace of R Knee Jt, Femoral with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SRW0JZ,ICD10-PCS,Replace of L Knee Jt, Tibial with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SUS0BZ,ICD10-PCS,Supplement L Hip Jt, Femoral with Resurf Dev, Open Approach,,,8271.00
Deidentified Maximum,,0SW24JZ,ICD10-PCS,Revision of Synth Sub in Lum Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SW90JZ,ICD10-PCS,Revision of Synthetic Substitute in R Hip Jt, Open Approach,,,8271.00
Deidentified Maximum,,0SWC4JZ,ICD10-PCS,Revision of Synth Sub in R Knee Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SWD0JZ,ICD10-PCS,Revision of Synthetic Substitute in L Knee Jt, Open Approach,,,8271.00
Deidentified Maximum,,0TQB0ZZ,ICD10-PCS,Repair Bladder, Open Approach,,,4303.00
Deidentified Maximum,,0WQNXZZ,ICD10-PCS,Repair Female Perineum, External Approach,,,4303.00
Deidentified Maximum,,10D00Z0,ICD10-PCS,Extraction of Products of Conception, High, Open Approach,,,4303.00
Deidentified Maximum,,10D00Z2,ICD10-PCS,Extraction of POC, Extraperitoneal, Open Approach,,,4303.00
Deidentified Maximum,,10D07Z8,ICD10-PCS,Extraction of Products of Conception, Other, Via Opening,,,4303.00
Deidentified Maximum,,10S0XZZ,ICD10-PCS,Reposition Products of Conception, External Approach,,,4303.00
Deidentified Maximum,,5A0211D,ICD10-PCS,Assist with Cardiac Output using Impeller Pump, Intermittent,,,8271.00
Deidentified Maximum,,B200YZZ,ICD10-PCS,Plain Radiography of Single Cor Art using Oth Contrast,,,8271.00
Deidentified Maximum,,B203YZZ,ICD10-PCS,Plain Radiography of Mult Cor A Graft using Oth Contrast,,,8271.00
Deidentified Maximum,,B2041ZZ,ICD10-PCS,Plain Radiography of Right Heart using Low Osmolar Contrast,,,8271.00
Deidentified Maximum,,B207YZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using Oth Contrast,,,8271.00
Deidentified Maximum,,B2110ZZ,ICD10-PCS,Fluoroscopy of Mult Cor Art using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2150ZZ,ICD10-PCS,Fluoroscopy of Left Heart using High Osmolar Contrast,,,8271.00
Deidentified Maximum,,B215YZZ,ICD10-PCS,Fluoroscopy of Left Heart using Other Contrast,,,8271.00
Deidentified Maximum,,B217YZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using Oth Contrast,,,8271.00
Deidentified Maximum,,B2180ZZ,ICD10-PCS,Fluoroscopy of L Int Mamm Graft using H Osm Contrast,,,8271.00
Deidentified Maximum,,06UY47Z,ICD10-PCS,Supplement Lower Vein with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0DQR0ZZ,ICD10-PCS,Repair Anal Sphincter, Open Approach,,,4303.00
Deidentified Maximum,,0PS304Z,ICD10-PCS,Reposition Cervical Vertebra with Int Fix, Open Approach,,,8271.00
Deidentified Maximum,,0PS30ZZ,ICD10-PCS,Reposition Cervical Vertebra, Open Approach,,,8271.00
Deidentified Maximum,,0PS34ZZ,ICD10-PCS,Reposition Cervical Vertebra, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0PS444Z,ICD10-PCS,Reposition Thor Vertebra with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0Q820ZZ,ICD10-PCS,Division of Right Pelvic Bone, Open Approach,,,4303.00
Deidentified Maximum,,0QS00ZZ,ICD10-PCS,Reposition Lumbar Vertebra, Open Approach,,,8271.00
Deidentified Maximum,,0QSS34Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Approach,,,8271.00
Deidentified Maximum,,0QSS44Z,ICD10-PCS,Reposition Coccyx with Int Fix, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0QSS4ZZ,ICD10-PCS,Reposition Coccyx, Percutaneous Endoscopic Approach,,,8271.00
Deidentified Maximum,,0R5B0ZZ,ICD10-PCS,Destruction of Thoracolumbar Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RB53ZZ,ICD10-PCS,Excision of Cervicothoracic Vertebral Disc, Perc Approach,,,8271.00
Deidentified Maximum,,0RB93ZZ,ICD10-PCS,Excision of Thoracic Vertebral Disc, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0RBB0ZZ,ICD10-PCS,Excision of Thoracolumbar Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0RG00J0,ICD10-PCS,Fusion Occip Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG03A0,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG03A1,ICD10-PCS,Fusion Occip Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG03K0,ICD10-PCS,Fusion Occip Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG03ZJ,ICD10-PCS,Fusion of Occip Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG0471,ICD10-PCS,Fusion Occip Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG1370,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG13A1,ICD10-PCS,Fusion Cerv Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG13JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG13Z0,ICD10-PCS,Fusion of Cerv Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG13ZJ,ICD10-PCS,Fusion of Cerv Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG1471,ICD10-PCS,Fusion Cerv Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG14JJ,ICD10-PCS,Fusion Cerv Jt w Synth Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG14Z1,ICD10-PCS,Fusion of Cerv Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG2070,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG20J0,ICD10-PCS,Fusion 2-6 C Jt w Synth Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG20Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG23A0,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG23AJ,ICD10-PCS,Fusion 2-6 C Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG23Z0,ICD10-PCS,Fusion of 2-6 C Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RG247J,ICD10-PCS,Fusion 2-6 C Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG43J0,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG43J1,ICD10-PCS,Fusion C-thor Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG44K0,ICD10-PCS,Fusion C-thor Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG60A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG60KJ,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG60ZJ,ICD10-PCS,Fusion of Thor Jt, Post Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG637J,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG63A0,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG63A1,ICD10-PCS,Fusion Thor Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG6471,ICD10-PCS,Fusion Thor Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG64J1,ICD10-PCS,Fusion Thor Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG64K1,ICD10-PCS,Fusion Thor Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG73AJ,ICD10-PCS,Fusion 2-7 T Jt w Intbd Fus Dev, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG73J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG73JJ,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG7471,ICD10-PCS,Fusion 2-7 T Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG74J0,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG74J1,ICD10-PCS,Fusion 2-7 T Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG74K1,ICD10-PCS,Fusion 2-7 T Jt w Nonaut Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RG74ZJ,ICD10-PCS,Fusion of 2-7 T Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RG8070,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG8071,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RG80KJ,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RG80Z1,ICD10-PCS,Fusion of >7 T Jt, Post Appr P Col, Open Approach,,,8271.00
Deidentified Maximum,,0RG8371,ICD10-PCS,Fusion >7 T Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG83A0,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG83A1,ICD10-PCS,Fusion >7 T Jt w Intbd Fus Dev, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG83JJ,ICD10-PCS,Fusion >7 T Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RG83K1,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0RG84K0,ICD10-PCS,Fusion >7 T Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA070,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RGA07J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RGA0A1,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0RGA0JJ,ICD10-PCS,Fusion T-lum Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0RGA3A0,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0RGA3ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0RGA47J,ICD10-PCS,Fusion T-lum Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA4AJ,ICD10-PCS,Fusion T-lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0RGA4Z1,ICD10-PCS,Fusion of T-lum Jt, Post Appr P Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RGA4ZJ,ICD10-PCS,Fusion of T-lum Jt, Post Appr A Col, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RH00BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Occip Jt, Open,,,8271.00
Deidentified Maximum,,0RH00CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RH03CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into Occip Jt, Perc Approach,,,8271.00
Deidentified Maximum,,0RH40CZ,ICD10-PCS,Insertion of Pedcl Stabl Dev into C-thor Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RH60DZ,ICD10-PCS,Insertion of Facet Stabl Dev into Thor Jt, Open Approach,,,8271.00
Deidentified Maximum,,0RR90JZ,ICD10-PCS,Replacement of Thor Disc with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0RU04JZ,ICD10-PCS,Supplement Occip Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RU14JZ,ICD10-PCS,Supplement Cerv Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RU63JZ,ICD10-PCS,Supplement Thor Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0RW33JZ,ICD10-PCS,Revision of Synthetic Substitute in Cerv Disc, Perc Approach,,,8271.00
Deidentified Maximum,,0RW94JZ,ICD10-PCS,Revision of Synth Sub in Thor Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0RWB0JZ,ICD10-PCS,Revision of Synth Sub in T-lum Disc, Open Approach,,,8271.00
Deidentified Maximum,,0S520ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0S524ZZ,ICD10-PCS,Destruction of Lumbar Vertebral Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SB03ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Percutaneous Approach,,,8271.00
Deidentified Maximum,,0SB04ZZ,ICD10-PCS,Excision of Lumbar Vertebral Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SB24ZZ,ICD10-PCS,Excision of Lumbar Vertebral Disc, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SB30ZZ,ICD10-PCS,EXCISION OF LUMBOSACRAL JOINT OPEN,,,8271.00
Deidentified Maximum,,0SB64ZZ,ICD10-PCS,Excision of Coccygeal Joint, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG00JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG00Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Open Approach,,,8271.00
Deidentified Maximum,,0SG037J,ICD10-PCS,Fusion Lum Jt w Autol Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG03J0,ICD10-PCS,Fusion Lum Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG03JJ,ICD10-PCS,Fusion Lum Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG03Z0,ICD10-PCS,Fusion of Lum Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0SG03Z1,ICD10-PCS,Fusion of Lum Jt, Post Appr P Col, Perc Approach,,,8271.00
Deidentified Maximum,,0SG04AJ,ICD10-PCS,Fusion Lum Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG10A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG10A1,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG10AJ,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG10KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG13JJ,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG13K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG13KJ,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Post Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG13Z0,ICD10-PCS,Fusion of 2-4 L Jt, Ant Appr A Col, Perc Approach,,,8271.00
Deidentified Maximum,,0SG1471,ICD10-PCS,Fusion 2-4 L Jt w Autol Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG14A0,ICD10-PCS,Fusion 2-4 L Jt w Intbd Fus Dev, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG14J0,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG14J1,ICD10-PCS,Fusion 2-4 L Jt w Synth Sub, Post Appr P Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG14K0,ICD10-PCS,Fusion 2-4 L Jt w Nonaut Sub, Ant Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG3070,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG30A0,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Ant Appr A Col, Open,,,8271.00
Deidentified Maximum,,0SG30A1,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG30J1,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG30K1,ICD10-PCS,Fusion Lumsac Jt w Nonaut Sub, Post Appr P Col, Open,,,8271.00
Deidentified Maximum,,0SG3371,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr P Col, Perc,,,8271.00
Deidentified Maximum,,0SG33J0,ICD10-PCS,Fusion Lumsac Jt w Synth Sub, Ant Appr A Col, Perc,,,8271.00
Deidentified Maximum,,0SG347J,ICD10-PCS,Fusion Lumsac Jt w Autol Sub, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG34AJ,ICD10-PCS,Fusion Lumsac Jt w Intbd Fus Dev, Post Appr A Col, Perc Endo,,,8271.00
Deidentified Maximum,,0SG534Z,ICD10-PCS,Fusion of Sacrococcygeal Joint with Int Fix, Perc Approach,,,8271.00
Deidentified Maximum,,0SG60KZ,ICD10-PCS,Fusion of Coccygeal Joint with Nonaut Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG63JZ,ICD10-PCS,Fusion of Coccygeal Joint with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SG647Z,ICD10-PCS,Fusion of Coccygeal Joint with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG70JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Open Approach,,,8271.00
Deidentified Maximum,,0SG73KZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Nonaut Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SG747Z,ICD10-PCS,Fusion of R Sacroiliac Jt with Autol Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG74JZ,ICD10-PCS,Fusion of R Sacroiliac Jt with Synth Sub, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0SG80ZZ,ICD10-PCS,Fusion of Left Sacroiliac Joint, Open Approach,,,8271.00
Deidentified Maximum,,0SG834Z,ICD10-PCS,Fusion of Left Sacroiliac Joint with Int Fix, Perc Approach,,,8271.00
Deidentified Maximum,,0SG837Z,ICD10-PCS,Fusion of L Sacroiliac Jt with Autol Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SH04BZ,ICD10-PCS,Insert Intspin Prcs Stabl Dev in Lum Jt, Perc Endo,,,8271.00
Deidentified Maximum,,0SR90JA,ICD10-PCS,Replace of R Hip Jt with Synth Sub, Uncement, Open Approach,,,8271.00
Deidentified Maximum,,0SRA0J9,ICD10-PCS,Replace R Hip Jt, Acetab w Synth Sub, Cement, Open,,,8271.00
Deidentified Maximum,,0SRB02A,ICD10-PCS,Replace L Hip Jt w Metal on Poly, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRC0J9,ICD10-PCS,Replace of R Knee Jt with Synth Sub, Cement, Open Approach,,,8271.00
Deidentified Maximum,,0SRR0J9,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Cement, Open,,,8271.00
Deidentified Maximum,,0SRR0JA,ICD10-PCS,Replace R Hip Jt, Femoral w Synth Sub, Uncement, Open,,,8271.00
Deidentified Maximum,,0SRS01Z,ICD10-PCS,Replacement of L Hip Jt, Femoral with Metal, Open Approach,,,8271.00
Deidentified Maximum,,0SRW0J9,ICD10-PCS,Replace L Knee Jt, Tibial w Synth Sub, Cement, Open,,,8271.00
Deidentified Maximum,,0ST40ZZ,ICD10-PCS,Resection of Lumbosacral Disc, Open Approach,,,8271.00
Deidentified Maximum,,0SU03JZ,ICD10-PCS,Supplement Lum Jt with Synth Sub, Perc Approach,,,8271.00
Deidentified Maximum,,0SU54JZ,ICD10-PCS,Supplement Sacrococcygeal Jt w Synth Sub, Perc Endo,,,8271.00
Deidentified Maximum,,0SU90BZ,ICD10-PCS,Supplement Right Hip Joint with Resurf Dev, Open Approach,,,8271.00
Deidentified Maximum,,0SW20JZ,ICD10-PCS,Revision of Synthetic Substitute in Lum Disc, Open Approach,,,8271.00
Deidentified Maximum,,0SW43JZ,ICD10-PCS,Revision of Synth Sub in Lumsac Disc, Perc Approach,,,8271.00
Deidentified Maximum,,0SWD4JZ,ICD10-PCS,Revision of Synth Sub in L Knee Jt, Perc Endo Approach,,,8271.00
Deidentified Maximum,,0UQC8ZZ,ICD10-PCS,Repair Cervix, Via Natural or Artificial Opening Endoscopic,,,4303.00
Deidentified Maximum,,0UQMXZZ,ICD10-PCS,Repair Vulva, External Approach,,,4303.00
Deidentified Maximum,,10907ZC,ICD10-PCS,Drainage of Amniotic Fl, Therap from POC, Via Opening,,,4303.00
Deidentified Maximum,,4A020N7,ICD10-PCS,Measure of Cardiac Sampl & Pressure, L Heart, Open Approach,,,8271.00
Deidentified Maximum,,B2001ZZ,ICD10-PCS,Plain Radiography of Single Cor Art using L Osm Contrast,,,8271.00
Deidentified Maximum,,B2011ZZ,ICD10-PCS,Plain Radiography of Mult Cor Art using L Osm Contrast,,,8271.00
Deidentified Maximum,,B204YZZ,ICD10-PCS,Plain Radiography of Right Heart using Other Contrast,,,8271.00
Deidentified Maximum,,B206YZZ,ICD10-PCS,Plain Radiography of Right and Left Heart using Oth Contrast,,,8271.00
Deidentified Maximum,,B2070ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2071ZZ,ICD10-PCS,Plain Radiography of R Int Mamm Graft using L Osm Contrast,,,8271.00
Deidentified Maximum,,B2081ZZ,ICD10-PCS,Plain Radiography of L Int Mamm Graft using L Osm Contrast,,,8271.00
Deidentified Maximum,,B20FYZZ,ICD10-PCS,Plain Radiography of Other Bypass Graft using Other Contrast,,,8271.00
Deidentified Maximum,,B2101ZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using L Osm Contrast,,,8271.00
Deidentified Maximum,,B210YZZ,ICD10-PCS,Fluoroscopy of Single Coronary Artery using Other Contrast,,,8271.00
Deidentified Maximum,,B2120ZZ,ICD10-PCS,Fluoroscopy of Sing Cor A Graft using H Osm Contrast,,,8271.00
Deidentified Maximum,,B2140ZZ,ICD10-PCS,Fluoroscopy of Right Heart using High Osmolar Contrast,,,8271.00
Deidentified Maximum,,B2171ZZ,ICD10-PCS,Fluoroscopy of R Int Mamm Graft using L Osm Contrast,,,8271.00
Deidentified Maximum,,B21FYZZ,ICD10-PCS,Fluoroscopy of Other Bypass Graft using Other Contrast,,,8271.00